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The patient has a chronic mass (痞块, localized swelling or hardness) under the hypochondrium, with pain radiating to the side of the umbilicus, extending into the lower abdomen and entering the Yin sinews (阴筋, referring to the genitalia). This is named Zang Jie (脏结, Organ Knotting), which is a fatal condition.

The Liver meridian runs through both hypochondria. The presence of a chronic mass indicates stagnation and knotting of Liver Qi. The umbilicus is at the junction of the Spleen and Stomach, where the Middle Qi resides. The mass under the hypochondrium connecting to the side of the umbilicus indicates the failure of Earth (Spleen/Stomach) and stagnation of Wood (Liver), leading to Liver pathogenic factors attacking the Spleen. The Liver governs the sinews, and the external genitalia are the gathering point of the Zong Jin (宗筋, major sinews). When Liver Qi stagnates, pain radiates from the lower abdomen into the Yin sinews. Due to the oppression between Wood and Earth, blockage fails to open, hence this is called Zang Jie (脏结, Organ Knotting). Over time, Wood rots Earth, leading to the collapse of Earth, which inevitably results in death.

Zang Jie (脏结, Organ Knotting) presents without Yang syndromes, without alternating chills and fever, and the person appears unusually calm. If the tongue coating is slippery, it cannot be treated with purgation.

In Zang Jie (脏结, Organ Knotting), if Yin prevails, there is cold; if Yang recovers, there is heat. Cold is an omen of death, while heat is an omen of life. When Yin and Yang contend, irritability is common. If Yang recovery is excessive, pathogenic heat may burn fiercely, potentially presenting indications for purgation. However, if there are absolutely no Yang syndromes, no alternating chills and fever, the person remains calm, and the tongue coating is slippery, this indicates absolute Yin deficiency/failure, and purgation is strictly contraindicated. The Liver and Gallbladder share the same Qi. Alternating chills and fever with irritability indicate the recovery of Gallbladder Yang. The absence of alternating chills and fever with a state of calmness indicates the predominance of Liver Yin.

After a Sun Taiyang disease (太阳病, Taiyang Disease) is incorrectly treated with purgation, if the pulse is rapid (促, Cu) but does not form Jie Xiong (结胸, Chest Binding/Knotting), this indicates the condition is about to resolve. If the pulse is floating (浮, Fu), Jie Xiong (结胸, Chest Binding/Knotting) will definitely occur. If the pulse is tight (紧, Jin), throat pain will definitely occur. If the pulse is wiry (弦, Xian), bilateral hypochondriac stiffness and spasm will definitely occur. If the pulse is fine and rapid (细数, Xi Shu), headache will not cease. If the pulse is deep and tight (沉紧, Chen Jin), vomiting will definitely occur. If the pulse is deep and slippery (沉滑, Chen Hua), diarrhea with heat (协热利, Xie Re Li) will definitely occur. If the pulse is floating and slippery (浮滑, Fu Hua), hematochezia (下血, Xia Xue) will definitely occur.

After Sun Taiyang disease (太阳病, Taiyang Disease) is incorrectly treated with purgation, the interior pathogens have departed, so the heat in the meridians cannot transmit inward, while the exterior pathogens remain unresolved, preventing the meridian heat from reaching the exterior. The exterior and interior constrain each other, resulting in a rapid (促, Cu) pulse. If Jie Xiong (结胸, Chest Binding/Knotting) does not form, it means the Exterior Yang has not sunk into the interior, and the meridian Qi is stagnant and vigorous, likely to be released via sweating, indicating the condition is about to resolve. If the Cun position pulse is floating, it indicates Yin pathogens counter-attacking and heat in the diaphragm being constrained, leading to Jie Xiong (结胸, Chest Binding/Knotting). If the pulse is tight, it indicates exterior heat being constrained and pathogenic fire flaring upward, causing severe throat pain. The Liver and Gallbladder meridians run alongside the hypochondrium; their pulse image is wiry (弦, Xian). A wiry pulse indicates unsmooth Wood Qi, leading to bilateral hypochondriac stiffness and spasm. A fine and rapid (细数, Xi Shu) pulse indicates Yang deficiency failing to secure the lower jiao, allowing turbid Yin to rush upward and rise rootlessly, causing persistent headache. A deep and tight (沉紧, Chen Jin) pulse indicates Stomach Qi stagnation and oppression, with loss of its function of containment, leading to vomiting. A deep and slippery (沉滑, Chen Hua) pulse indicates Spleen Yang sinking due to stagnation and Liver Wood losing its draining function, leading to diarrhea with heat. A floating and slippery (浮滑, Fu Hua) pulse indicates Yi Wood (Liver Wood) failing to ascend smoothly, causing stagnant Sheng Qi, generating wind due to stagnation, and losing control over drainage, leading to hematochezia.