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The chest and stomach are both located in the middle. The hypochondrium (lateral aspect of the body) is on the sides of the body. Therefore, for symptoms in the hypochondriac region, in the category of miscellaneous diseases, they are governed by the Liver, Gallbladder, and Lung meridians; in the category of external contraction diseases, they belong exclusively to the Shaoyang (Lesser Yang) meridian. This is because when exterior pathogens transmit inward, they must pass from the chest to the hypochondrium. Thus, chest fullness is mostly an exterior syndrome, abdominal fullness is a interior syndrome, while hypochondriac fullness with pain is a half-exterior, half-interior syndrome. However, in Shanghan (Cold Damage) fever accompanied by hypochondriac fullness and pain, there are cases also involving exterior pathogens of the Taiyang (Greater Yang) and Yangming (Bright Yang) meridians. Therefore, for patients with no sweating, floating pulse, aversion to cold, and hypochondriac pain, first use Qianghuo Chaihu Fangfeng Tang (Notopterygium, Bupleurum, and Saposhnikovia Decoction) to disperse exterior pathogens, then treat with Xiao Chaihu Tang (Minor Bupleurum Decoction) combined with Xiao Xianxiong Tang (Minor Phlegm-Heat Congestion Decoction), adding Zhike (Aurantii Fructus), Jiegeng (Platycodonis Radix), Shanzhi (Gardeniae Fructus), and Qingpi (Tangerine Peel) to treat it. If there is internal accumulation of phlegm-fluids, add herbs that resolve phlegm. Another type arises directly from the Shaoyang meridian with alternating chills and fever, or stabbing pain in one or both hypochondria, which can even lead to death from extreme pain. This is caused by contracting epidemic dry-heat pathogens that lie dormant inside, combined with external constriction by wind-cold, leading to stagnation in the Shaoyang meridian. It is named Rib-Stabbing Cold Damage (Leici Shanghan), also known as Sand Distension (Shazhang). If there is no sweating, aversion to cold, and a tight floating pulse, first use Qianghuo Baidu San (Notopterygium and Rescue the Ailing Powder) to disperse exterior pathogens, followed by Xiao Chaihu Tang added with Shanzhi, Qingpi, Sugen (Perilla Stem), and Mutong (Akebia Caulis) to disperse Shaoyang pathogens. If it is due to dry-heat, add Zhimu (Anemarrhenae Rhizoma) and Shigao (Gypsum Fibrosum), so that sweating occurs and pathogens dissipate. If the condition does not improve, puncture Weizhong (BL40) and Zusanli (ST36), and prick the ten fingers to bleed; this is called "Fangsha" method (bloodletting to release sand/heat). There is another case of hypochondriac pain with chills and fever, accompanied by cough and rebellious qi; this is the Lung affected by exterior pathogens, named Metal Pathogen Entering Wood (Jin Xie Ru Mu - Lung metal pathogen invading Liver wood). There is also Fire in the Gallbladder meridian punishing and overcoming Lung Metal, named Wood-Fire Punishing Metal (Mu Huo Xing Jin). These two syndromes are the most severe. In the initial stage with fever, floating pulse, and no sweating, use Fangfeng Xiebai San (Saposhnikovia and White Peony Root Powder); if there is no sweating, aversion to cold, body ache, and exterior signs, add Qianghuo and Chaihu to first disperse exterior pathogens; if there is sweating and a deep, rapid pulse, use Huangqin Xiebai San (Scutellaria and White Peony Root Powder) combined with Zhilian Zhijie Tang (Gardenia, Coptis, Aurantium, and Platycodon Decoction); if it is a year of prevalent dry-heat, heavily add Zhimu and Shigao. Even if Shaoyang chest-hypochondriac pain appears, it is still Metal Pathogen Entering Wood, with Lung pathogen being primary; one should clear Lung dryness and strictly avoid acrid-warm herbs; if there are no Lung meridian wheezing and coughing symptoms, then treat the Shaoyang meridian alone. Regarding external contraction hypochondriac pain, Rib-Stabbing Cold Damage is the most severe, as epidemic virulent pathogens harm people fastest; one should carefully examine which Qi governs the annual cycle. Therefore, I separately detail Shaoyang hypochondriac pain and Lung Pathogen hypochondriac pain. The key to recognizing symptoms is: no cough indicates Shaoyang disease, cough indicates Lung Pathogen disease; left-sided hypochondriac pain indicates Shaoyang disease, right-sided hypochondriac pain indicates Lung Pathogen disease. The key to recognizing pulses is: pathology in the left hand pulse indicates Shaoyang disease, pathology in the right hand pulse indicates Lung Pathogen disease. Regarding treatment methods: floating pulse, body heat, and no sweating indicate dispersing the exterior first; deep pulse, interior heat, and frequent sweating indicate clearing interior heat. If after taking diaphoretic medicines, profuse sweating occurs but pathogens do not resolve, heavily add Huangqin, Shanzhi, Zhike, and Qingpi to the exterior-dispersing formula to clear Shaoyang, and heavily add Zhimu, Shigao, Zhike, and Sangbaipi to clear Lung pathogens. Some use half the formula to disperse the exterior and half to clear the interior, heavily using Mutong and Sugen to unblock collaterals, achieving harmonization and recovery. I once used Mutong and Sugen, each 5 qian, added to a harmonizing formula to treat no-sweating hypochondriac and body pain; sweating would occur and pain would decrease. Because Mutong opens orifices and Sugen disperses. I once decocted Mutong and Sugen, each 5 qian, to treat fever and hypochondriac pain, often resulting in recovery after "Sha" (sand/heat toxin) was released. Note that these two herbs do not primarily treat pain; now, by using them to unblock collaterals, pain ceases. Note that these two herbs do not primarily induce "Sha" release; now, by using them to unblock collaterals, pathogens dissipate and exit.

In Taiyang Disease, after more than ten days, the exterior has resolved. If chest and hypochondriac pain occur, Xiao Chaihu Tang is indicated. If the pulse is floating, Ma Huang Tang is still given. In Shanghan, after four or five days, with body heat, aversion to wind, fullness under the hypochondrium, warm hands and feet, and thirst, Xiao Chaihu Tang without Banxia, plus Tianhuafen, is indicated.

After ten days of Taiyang Disease, chest and hypochondriac pain indicate pathogen transmission to Shaoyang, requiring Xiao Chaihu Tang. If the pulse is floating, it remains a Taiyang exterior pulse, and dispersing the exterior is still appropriate. If after four or five days there is body heat, hypochondriac fullness, warm extremities, and thirst, heat pathogens have transmitted inward; Xiao Chaihu Tang should be used, removing the acrid-warm Banxia and replacing it with Tianhuafen to moisten thirst.

Shanghan unresolved for thirteen days, with chest-hypochondriac fullness and vomiting, tidal fever at dusk, followed by mild diarrhea. This was originally a Chaihu syndrome where diarrhea should not occur. The current diarrhea indicates erroneous purgation with pill medicines. First use Xiao Chaihu Tang to resolve the exterior, then treat with Mangxiao Tang (Mirabilite Decoction).

Thirteen days of chest-hypochondriac fullness, vomiting, dusk tidal fever, and mild diarrhea. This is originally a Chaihu syndrome; diarrhea should not have occurred, implying erroneous purgation. Thus, resolve the exterior first, then use Mangxiao to treat tidal fever.

Transmitted heat pathogens causing hypochondriac fullness and dry retching are treated with Da Chaihu Tang.

Transmitted heat pathogens require purging the interior. However, due to hypochondriac fullness and dry retching, it is not yet a Chengqi Tang syndrome, so Da Chaihu Tang is used.

In Taiyang Wind Strike, with diarrhea and rebellious vomiting, after the exterior resolves, one may attack the interior. If the patient sweats intermittently, has headaches, epigastric stiffness and fullness radiating to the hypochondrium, dry retching, shortness of breath, sweating without aversion to cold, Shizao Tang (Ten Date Decoction) is indicated.

With Taiyang exterior resolved, intermittent sweating, and described interior signs amenable to attack: epigastric stiffness, hypochondriac pain, sweating without aversion to cold, indicate excess syndrome without chills/fever or shortness of breath. Even the headache is due to suspended fluid attacking upward; thus, Shizao Tang is used. Xiaolonggu Tang treats winter Taiyang exterior syndrome with dry retching and hypochondriac pain; Xiao Chaihu Tang treats Shaoyang alternating chills/fever, dry retching, and hypochondriac pain; Shizao Tang treats exterior pathogens resolved, internal phlegm-fluid accumulation, dry retching, and hypochondriac pain.

Yangming Disease with tidal fever, loose stools, normal urination, and chest-hypochondriac fullness is treated with Xiao Chaihu Tang.

Tidal fever is a Yangming interior sign, normally requiring clearing and purging. However, with loose stools and normal urination, there is no interior heat binding, and chest-hypochondriac fullness is present. It remains a Chaihu Tang syndrome.

Yangming Disease with hardness/fullness under the hypochondrium, constipation, vomiting, and white coating on the tongue is treated with Xiao Chaihu Tang.

Hardness/fullness under the hypochondrium and constipation normally warrant purgation. However, with vomiting and a white tongue coating, it remains a Xiao Chaihu Tang syndrome.

Hypochondriac fullness, dry retching, and alternating chills and fever belong to Shaoyang.

Hypochondriac fullness is Shaoyang; dry retching is Shaoyang; alternating chills and fever is Shaoyang. Belonging to Shaoyang implies Xiao Chaihu Tang.

Qianghuo Chaihu Tang
Qianghuo, Chaihu, Fangfeng, Zhike, Qingpi, Gancao
For hypochondriac pain with no sweating, floating pulse, aversion to cold, and body heat, indicating simultaneous Taiyang and Shaoyang involvement, this decoction is used. My family secret uses Sugen and Mutong, based on the principle that unblocking leads to absence of pain.

Xiao Chaihu Tang See "Alternating Chills and Fever".
This formula treats Shaoyang hypochondriac pain. If Taiyang exterior pathogens are seen, add Qianghuo; if Yangming exterior pathogens are seen, add Gegen. Pain relief with sweating involves fire; add more Shanzhi, Qingpi, Mutong, Sugen. For sticky heat-phlegm, combine with Xiao Xianxiong Tang.

Xiao Xianxiong Tang See "Phlegm-Heat Congestion".

Baidu San See "Fever".

Fangfeng Xiebai San
Fangfeng, Sangbaipi, Digupi, Gancao
This formula originally treats Lung wind-phlegm wheezing. Thus, for hypochondriac pain with cough and rebellious qi, use this formula.

Huangqin Xiebai San
Huangqin, Sangbaipi, Digupi, Gancao
The previous Xiebai San adds Fangfeng to indicate hypochondriac pain from Lung exposure to wind pathogens; this formula removes Fangfeng and adds Huangqin to indicate hypochondriac pain from latent fire in the Lung.

Zhilian Zhijie Tang
Shanzhi, Huanglian, Jiegeng, Gancao, Qingpi, Mutong, Sugen
For chest-hypochondriac pain with qi pathway obstruction, Zhilian is often used; adding it to qi-regulating herbs eliminates fire-pain. However, this formula treats pain from interior heat; if exterior pathogens exist externally, add exterior-dispersing herbs.

Mangxiao Tang
Mangxiao, Zhike, Houpo
Hypochondriac pain is a upper-jiao disease, lacking downward-draining methods. Now, following erroneous purgation with recurrent diarrhea, it is used reluctantly.

Da Chaihu Tang See "Tidal Fever".
The previous formula used Chaihu and Mangxiao separately, representing a method of resolving exterior then attacking interior. This formula combines Chaihu and Dahuang, representing a method of simultaneously resolving exterior and interior. The previous formula used Mangxiao, focusing on clearing filth and decay; this formula uses Dahuang, focusing on clearing interior heat.

Shizao Tang See "Epigastric Fullness".
When exterior pathogens of the Three Yang meridians are fully resolved, but hardness and pain remain under the hypochondrium, this indicates suspension of fluids accumulating; thus, Shizao Tang is used to purge phlegm-fluid accumulation.