Library

Jie Xiong (Chest Binding) is a complication of Yangming disease resulting from premature purgation. When the stomach fu organ has dry-heat and excessive sweating leads to the loss of yin fluids, Yangming disease forms; when damp-heat in the chest and diaphragm sinks downward causing yang qi to collapse inward, Jie Xiong forms. If one delays for several days, the dampness is consumed by dryness, the exterior cold is resolved, and the fu heat is solidified, purgation at this time would cure it, so why let it reach this state? Therefore, when Taiyang disease presents with signs of Yangming, it is better to delay and use Cheng Qi Tang (Gut-Preserving Decoction) rather than hastily use Xian Xiong Tang (Depress Chest Decoction). This is because Jie Xiong is a *huai bing* (complication from mis-treatment) of Yangming. The pathology of Yangming disease lies in the abdomen, while the pathology of Jie Xiong lies in the chest. Cheng Qi Tang purges dry-heat from the lower jiao, whereas Xian Xiong Tang purges damp-heat from the upper jiao; their locations differ (high vs. low), and their pathological natures differ (dry vs. damp).

In Taiyang disease, the pulse is floating, moving, and rapid. Floating indicates wind pathogen, rapid indicates heat, moving indicates pain, and rapid here also suggests deficiency of righteous qi. The patient experiences headache, fever, slight nocturnal sweating, yet paradoxically feels aversion to cold, indicating that the exterior syndrome is not yet resolved. If the physician erroneously applies purgation, the moving and rapid pulse changes to a slow one. There is resistance and pain in the diaphragm, the stomach cavity becomes empty, and "ke qi" (adverse qi) disturbs the diaphragm, leading to shortness of breath, irritability, and *ao nao* (deep restlessness). Yang qi collapses inward, causing the area below the heart (epigastrium) to become hard; this is Jie Xiong, treated primarily with Da Xian Xiong Tang (Major Depress Chest Decoction). If Jie Xiong does not form, but there is sweating only on the head and no sweat elsewhere, stopping at the neck, accompanied by difficulty in urination, the body will inevitably develop jaundice.

In Taiyang disease, the pulse is floating and combined with moving and rapid qualities. Floating indicates wind attacking the exterior, rapid indicates stagnation of the Ying (nutritive) level causing fever, moving indicates the inability of Jing (channel) qi to vent, leading to pain due to stagnation and pressure. Since the rapid quality appears alongside floating, it indicates that interior excess has not yet formed, hence it is termed "deficiency." The symptoms are headache, fever, slight nocturnal sweating, and paradoxical aversion to cold, which signifies that exterior pathogens remain unresolved. When the physician fails to resolve the exterior and instead purges, the moving and rapid pulse becomes slow, indicating the failure of Stomach qi. Yang qi fails, Stomach qi rebels upward, obstructing the descent of Gallbladder Wood; the rebellious qi rushes into the chest and diaphragm, causing mutual rejection between Gallbladder and Stomach, resulting in pain within the diaphragm. Jia Wood (Gallbladder) normally descends to transform into Ministerial Fire and return to Gui Water (Kidney); Ministerial Fire in water is the ruling qi of the Lower Jiao. Now, with Yang failure and Stomach deficiency, Jia Wood rebels, occupying the Upper Diaphragm as an intruder with the identity of Lower Jiao ruling qi, causing continuous agitation; this is the origin of the resistance pain. Lung and Heart qi should descend smoothly; obstruction by rebellious Stomach and Gallbladder prevents this descent. Ministerial Fire flares upward, assisting Sovereign Fire to attack Xin Metal (Lung), causing irritability, *ao nao*, shortness of breath, chest fullness, and diaphragmatic heat stagnation. With pores closed, Yang qi in the channels collapses inward. Heat in the channels and fu organs blocks each other, condensing firmly in the heart region, forming Jie Xiong. Lung Metal is suppressed, misty dampness steams, turbid fluids transform into phlegm-saliva. Da Xian Xiong Tang uses Mang Xiao (Mirabilite) and Da Huang (Rhubarb) to clear stagnant heat, and Gan Sui (Euphorbia kansui) to drain phlegm-fluids, sweeping away all evil heat from the chest. If Jie Xiong does not form, but there is sweating only on the head, stopping at the neck, and urinary difficulty, this is due to bitter-cold medicines damaging Spleen Yang, causing dampness to stagnate internally without a descending pathway, leading inevitably to jaundice. Exterior heat transmitting to the Stomach forms Yangming syndrome; Yangming has Yang but lacks Yin, so the pathology is dry-heat. Exterior heat entering the diaphragm forms Jie Xiong syndrome; Jie Xiong is Yang above and Yin below, so the pathology is damp-heat. When Zang qi is free, fluids flow freely; when Zang qi is blocked, phlegm-saliva coagulates; there is no difference in principle.

Note: In Da Xian Xiong syndrome, exterior Yang has collapsed inward, yet channel pathogens remain unresolved. Ideally, one should clear interior heat in the chest/diaphragm internally and release exterior pathogens from the skin/hair externally, allowing upper-stagnant interior heat to dissipate from within and collapsed exterior Yang to exit via the surface. Zhang Zhongjing used Da Xian Xiong Tang to purge upper jiao damp-heat without using exterior-releasing herbs; this is a method for emergency rescue, though theoretically adaptable here. My opinion is to use Shi Gao (Gypsum), Gan Sui, Zhi Shi (Immature Bitter Orange), and Ma Huang (Ephedra) to simultaneously resolve both exterior and interior, capturing the meaning beyond Zhang Zhongjing's explicit methods. Mr. Cheng stated: For Jie Xiong syndrome, using Zhi Shi Li Zhong Wan (Immature Bitter Orange and Gastrodia Pill) is very effective. To break the binding and soften hardness, Huang Qin (Scutellaria), Gua Lou (Trichosanthes fruit), and Mu Li (Oyster shell) are excellent choices.