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Question: In diseases, there are "Jie Xiong" (Chest Binding) and "Zang Jie" (Organ Binding). What are their clinical manifestations?
Answer: Pain upon palpation, with a floating pulse at the Cun position and a deep pulse at the Guan position. This is called Jie Xiong (Chest Binding).
What is meant by Zang Jie (Organ Binding)?
Answer: The presentation resembles that of Jie Xiong (Chest Binding), yet appetite remains normal, and there is frequent diarrhea. The pulse at the Cun position is floating, while the pulse at the Guan position is small, fine, deep, and tight. This is called Zang Jie (Organ Binding). If the tongue coating is white and slippery, it is difficult to treat.

This passage employs a question-and-answer format to clarify the distinction between Jie Xiong (Chest Binding) and Zang Jie (Organ Binding). However, the writings of Zhang Zhongjing are profound, and his therapeutic principles are subtle, making them indeed difficult to speculate upon.
The term "Cun pulse" refers to the Qi Kou pulse (radial artery pulse at the wrist).
The term "Guan pulse" here refers to the Right Guan pulse.
A floating pulse belongs to Yang and indicates a exterior syndrome; a deep pulse belongs to Yin and indicates an interior syndrome.
A pulse that is small, fine, deep, and tight indicates that cold pathogenic factors have penetrated deeply into the interior.
How do we know this corresponds to the Right Cun and Right Guan positions?
The *Ling Shu: Mai Yao Jing Wei Lun* (Treatise on the Essentials of Pulse Diagnosis) states: "At the upper level, the right side externally corresponds to the Lung and internally corresponds to the Chest Middle." Hence this explanation, as detailed in the preceding text.
Pathogenic factors from the exterior of the Taiyang channel sink into the Yang aspect of the Upper Jiao, resulting in a floating pulse at the Cun position.
When pathogens enter the chest and diaphragm, the Stomach Qi fails to circulate, causing obstruction in the Middle Jiao, resulting in a deep pulse at the Guan position.
If heat pathogens sink into the heart and chest region, causing hardness and pain upon palpation, accompanied by a floating Cun pulse and a deep Guan pulse, it is termed Jie Xiong (Chest Binding).
"Resembling Jie Xiong" implies that the presentation is similar to Jie Xiong (Chest Binding), but not necessarily characterized by the hardness and pain upon palpation seen in true Jie Xiong.
If it were hard and painful like Jie Xiong, the pathogenic factors would be firmly bound, obstructing the stomach and epigastrium, thereby preventing normal eating.
Wang Kentang stated: "To call it 'resembling Jie Xiong' implies a distinction from actual Jie Xiong."
Cheng Wuji's commentary states: "Both involve hardness and pain below the heart; this interpretation is insufficiently accurate."
"Resembling Jie Xiong, yet eating normally" indicates that there is no pain upon palpation. This understanding truly captures the intent of Zhang Zhongjing.
It is called Zang Jie (Organ Binding) because the pathogenic factors bind within the Zang organs rather than the Fu organs.
The Fu organ referred to is the Stomach; the Zang organ referred to is the Spleen.
Since the pathogenic factors bind in the Spleen without invading the Stomach, appetite remains normal.
However, the binding occurs only in the Taiyin Spleen Earth, not in all five Zang organs.
Then why do pathogenic factors bind in the Zang organs?
Because Zang Jie resembles Jie Xiong, differing primarily in the ability to eat versus the presence of diarrhea, despite the yin-yang distinction.
Due to the sinking of external pathogens, instead of binding in the chest, they enter the large collateral of the Spleen, known as the Da Bao point.
This collateral emerges from under the axilla, three cun below the Yuan Ye point of the Foot-Shaoyang Gallbladder Channel.
Its vessels spread across the chest and hypochondrium like a net. When pathogens invade, they bind in the Spleen.
Why is there frequent diarrhea?
Generally, the Stomach governs reception and is the sea of water and grain; thus, the *Nei Jing* regards the intestines and stomach as the foundation of the granary.
The Spleen, however, governs the dispersion of essence and transports fluids for the Stomach.
Human defecation is regulated, as if constrained by something, due to the Spleen Qi's restraining function.
The *Su Wen: Wu Yun Yun Da Lun* (Great Treatise on the Five Movements and Six Qi) states: "The earth floats in the great void, upheld by the great qi."
Qibo used the earth to metaphorically represent the Spleen Earth in the human body.
Therefore, if Stomach Yang is excessive, the Spleen's constraint becomes too strong, leading to difficult defecation, as described in the Yangming chapter: "A floating Douyang pulse indicates strong Stomach Qi, leading to difficult stools, a condition where the Spleen is constrained."
If cold pathogens bind in the Zang organs, the Spleen cannot retain, and water and grain cannot be stored.
As stated in the *Wu Zang Bie Lun*: "The anal opening serves the five Zang organs; water and grain cannot be stored long."
The *Mai Yao Jing Lun* states: "The five Zang organs are the guardians within. If the granary cannot store, the gates are not secured. Those who retain security live; those who lose it die."
Currently, the Cun pulse is floating, and pathogens do not bind in the Stomach, hence appetite is normal; the Guan pulse is small, fine, deep, and tight, indicating cold pathogens binding in the Spleen, causing frequent diarrhea.
This is because the Qi Kou pulse primarily reflects the Stomach, while the Guan pulse corresponds to the Spleen.
With such pulse and symptom patterns, it is named Zang Jie (Organ Binding).
A white and slippery tongue coating indicates cold in the Stomach.
Whenever there is heat and excess in the Stomach, the tongue coating becomes yellow or black and dry.
Here, the Spleen has been bound by yin pathogens. It would be easier to treat if yang symptoms were present.
For instance, in Shaoyin or Taiyin syndromes, if the hands and feet are warm, or if heat predominates over cold limbs, treatment is feasible.
Now, since the tongue coating is white and slippery, it indicates a lack of yang in the Stomach-Fu, hence it is said to be difficult to treat.

In Zang Jie (Organ Binding), there are no yang symptoms, no alternating chills and fever, the patient appears calm, and the tongue coating is slippery; purgative methods must not be used.

This follows the previous text to reiterate the difficulty of treating cases with a white, slippery tongue coating.
It means that regardless of whether wind-cold or cold-damp pathogens enter the yang channels becoming yang syndromes, or enter the yin channels becoming yin syndromes, the Zang organs inherently belong to yin. Once pathogens sink in, they form a yin binding.
If yang symptoms are present, there may still be heat pathogens amenable to purgation.
However, since pathogens have bound in the yin, Taiyang and Yangming syndromes will certainly be absent.
Approximating the third layer of the three yang channels, which lies inside the shell of the body, is the Shaoyang channel.
Shaoyang is closest to the internal zang-fu organs.
Perhaps some pathogens remain un-sunk in the Shaoyang, which would manifest as alternating chills and fever.
But since there is no alternating chills and fever, it indicates pathogens are entirely outside the yang channels, hence no yang symptoms.
Furthermore, although pathogens binding in the interior might cause restlessness, the patient is actually calm; calmness also belongs to yin.
The tongue coating observed is slippery and not dry.
Generally, in the six channels, when heat from the three yang channels converges in the Stomach, a tongue coating forms.
It develops from white to yellow, then to black, eventually showing prickles, dryness, and cracks.
These variations allow one to verify cold, heat, deficiency, and excess, guiding warm, cool, tonifying, or draining treatments with high accuracy.
If examined precisely and understood intuitively, success is nearly guaranteed.
Thus, tongue diagnosis rarely misleads, unlike pulse and symptom differentiation, where yin-yang transformations and true/false patterns are hard to discern.
In shaoyin or taiyin syndromes, tongue coatings are scarce; if present, they are gray-white and wet/slippery.
A slippery tongue coating here indicates cold Stomach Qi and purely yin pathogens, requiring warming of the channels and restoration of yang.
Purgation would fail; therefore, it must not be used.
Hence, it is stated that purgation is contraindicated.
Cheng Wuji cited Zhang Zhongjing’s text on dampness, "Heat in the Dantian, Cold in the Chest," leading later scholars to argue that "Dantian is yin but has heat; Chest is yang but has cold."
Later adherents maintained: "Dantian is yin, yet has heat; Chest is yang, yet has cold."
This suggests the pathology is neither exterior-interior nor simply vertical, but that upper and lower pathogens contradict each other without merging.
Such discussions leave later practitioners confused about how to interpret them.
Alas, I fear the principles are so profound that even commentators may not understand them.

If a patient has had a mass (Pi) in the hypochondrium since before, extending to beside the umbilicus, with pain radiating to the lower abdomen and into the yin sinews, this is called Zang Jie (Organ Binding), and the prognosis is fatal.

Pi (mass) refers to accumulation caused by yin-cold.
The center of the umbilicus is the Shenque point, an acupoint of the Ren Mai (Conception Vessel).
Half a cun lateral to the umbilicus on both sides are the Huangshu points of the Kidney Channel.
The lower abdomen is the domain of extreme yin.
Points such as Huiyin, Qugu, Zhongji, Guanyuan, and Qihai are where the Ren Mai originates.
From the inner thigh entering the pubic hair, following the genitalia to the lower abdomen runs the Foot-Jueyin Liver Channel.
Points such as Henggu, Dahe, Siman, and Zhongzhu are acupoints of the Foot-Shaoyin Kidney Channel, running alongside the Ren Mai in the lower abdomen.
Yin sinews refer to the collaterals of the Foot-Jueyin Liver Channel, which connect the testicles to the penis.
This describes a patient who has chronically had a yin-cold mass in the hypochondrium, extending to the yin aspect of the abdominal rows beside the umbilicus.
Complicated by the syndrome of Shanghan Zang Jie (Organ Binding), the pain radiates downward to the lower abdomen, enters the Jueyin channel, and draws the testicular yin sinews.
In such cases of Zang Jie, yin qi is extremely excessive, and yang qi is exhausted; hence, the prognosis is fatal.