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If the pulse in chest binding syndrome (Jie Xiong) is floating and large, purgation must not be used; if purgation is mistakenly applied, death will ensue.

In chest binding syndrome, the pulse is floating at the Cun position (distal radial artery position) and sinking at the Guan position (middle radial artery position). Floating at Cun indicates heat in the upper jiao (upper burner), while sinking at Guan indicates cold in the middle jiao. If upper heat is severe but middle cold is mild, the pulse will show more floating than sinking, and purgation may be employed. If the pulse is floating and large without any sinking quality, it does not mean there is no middle cold; rather, it signifies extreme middle cold with yang qi completely repelled to the upper body. Thus, only floating and large qualities are seen, without sinking qualities below. At this stage, the middle qi is exhausted, and death is inevitable. Chest binding syndrome can be cured by purgation because the root of yang qi in the lower jiao has not yet severed. Purgation pushes down the stagnant yang qi in the upper jiao, allowing it to connect with the root of yang qi in the lower jiao, leading to recovery. However, a floating and large pulse indicates that the root of yang qi has already severed in the lower jiao; this is a sign of deficiency of middle qi and exterior cold. Purgation would accelerate death.

If all symptoms of chest binding syndrome are present and restlessness (Fan Zao) appears, it is also a fatal condition.

After prolonged illness, when all symptoms of chest binding syndrome are fully manifested, the appearance of restlessness indicates extreme heat. Extreme heat in the upper jiao implies extreme cold in the lower jiao. In such cases, even without purgation, death will occur. This is not due to death from upper heat or lower cold, but due to the collapse of middle qi.

In minor chest binding syndrome, the pathology is located precisely at the epigastrium (Xin Xia), and pain occurs only upon pressure. If the pulse is floating and slippery, Xiao Xian Xiong Tang (Minor Intra-thoracic Decoction) is the primary treatment.

The location of minor chest binding syndrome is the same as major chest binding syndrome, i.e., the epigastrium. However, pain occurs only upon pressure, unlike major chest binding syndrome where pain exists even without pressure. The pulse is floating and slippery, differing from major chest binding syndrome which presents with floating at Cun and sinking at Guan. Bai Hu Tang (White Tiger Decoction) indications also feature a floating and slippery pulse, representing interior heat and exterior cold. Although this condition is less severe than the heat-excess of major chest binding syndrome, it still involves interior heat. Compared to major chest binding syndrome, the pathogenesis is similar but the disease is milder. In Xiao Xian Xiong Tang, Huang Lian (Coptidis Rhizoma) clears heat, Ban Xia (Pinelliae Tuber) directs rebellious qi downward and eliminates phlegm-fluids, and Gua Lou Shi (Trichosanthis Fructus) clears lung metal heat and removes turbidity. This is a modified version of Da Xian Xiong Tang (Major Intra-thoracic Decoction), adapted for a milder approach.

Huang Lian (Coptidis Rhizoma) (1 liang), Ban Xia (Pinelliae Tuber) (0.5 sheng, washed), Gua Lou Shi (Trichosanthis Fructus) (one large fruit).

Take these three ingredients, add six sheng of water, first decoct Gua Lou Shi, then add the other herbs. Boil until three sheng remain, strain, and divide into three warm doses.

Q: There are conditions called chest binding (Jie Xiong) and zang binding (Zang Jie). What are their respective presentations? A: Pain upon pressure, with a floating pulse at Cun and a sinking pulse at Guan, is called chest binding. What is zang binding? A: It resembles chest binding in presentation, but digestion remains normal, and there is frequent diarrhea. The pulse is floating at Cun and fine, small, and tight-sinking at Guan; this is called zang binding. If there is a white, slippery coating on the tongue, it is difficult to treat.

Chest binding syndrome involves pain even without pressure, as described in the previous chapter regarding rejection pain in the diaphragm, hardness and fullness extending from the epigastrium to the lower abdomen, and heart pain that persists without pressure. Here, "pain upon pressure" means pain intensifies when pressed. A floating pulse at Cun indicates heat above the diaphragm; a sinking pulse at Guan indicates cold in the abdomen. Zang binding resembles chest binding in symptoms, but its etiology is counter-flowing yin pathogens, causing hardness and binding in the epigastrium due to Taiyin involvement, without heat in the upper part. Its pulse, floating at Cun and sinking at Guan, is indistinguishable from chest binding. However, the addition of fine, small, and tight qualities indicates that yin pathogens are bound exclusively without yang. The Guan position governs the middle jiao. Wei Qi (Defensive Qi) originates from the lower jiao and ascends clear yang through turbid yin via the middle jiao; Zong Qi (Gathering Qi) originates from the upper jiao and descends turbid yin through clear yang via the middle jiao. Now, with fine, small, and tight-sinking pulses at Guan, accumulated cold binds internally, presenting yin without yang. This is termed "dead yin," hence the name zang binding. The heart opens into the tongue; a white, slippery coating on the tongue indicates failure of heart fire and condensation of lung fluids. Metal naturally contracts; warmed by fire, mist evaporates without condensing, illustrating that mutual restriction actually promotes generation. When fire declines, lung qi fails to distribute, causing fluid stagnation, turbidity, and obstruction in the heart palace, resulting in tongue coating. Slipperiness indicates qi stagnation and fluid condensation. Dry earth leads to withered fluids and yellow, rough coating; wet metal leads to condensed fluids and white, slippery coating, distinguishing cold from heat. White, slippery tongue coating results from failed fire and depressed metal, making it difficult to treat.