痛为结胸否为痞。（音被。）关脉皆沉本同类。（仲景玉函云。发于阴而反下之。因作痞。仲景伤寒论云。病发于阳。
而反下之。热入。因作结胸。病发于阴而反汗之。因作痞。盖痛则为结胸。不痛则为痞。结胸与痞。寸脉浮。关脉皆沉。）
关上若浮且泻心。（仲景云。心下痞。按之濡。其脉关上浮者。大黄黄连泻心汤主之。）发渴烦躁五苓对。（仲景云。心下
痞。与泻心汤。其人渴而口烦躁。小便不利者。用五苓汤主之。）桔梗枳实汤最佳。先与服之使行气。（晋人治痞气。多
作桔梗枳实汤。往往便瘥。以其下气故尔。）下利雷鸣心下硬。甘草泻心汤可治。（仲景论中。泻心汤加减有五证。皆为
痞气而设也。但满而不痛者。宜半夏泻心汤。色黄手足温者。黄连泻心汤。恶寒汗出者。附子泻心汤。干呕食臭胁下有
水气者。生姜泻心汤。雷鸣心下硬。心烦不得安者。甘草泻心汤也。）
寒湿在里不能散。热蓄脾中成此患。湿热宿谷更相搏。郁塞不消黄色绽。（巢氏云。寒湿在里则热蓄于脾胃。腠理不
开。瘀热与宿谷相搏。烦郁不得消则大小不通。故身体面目皆变黄色。）头面有汗齐颈止。渴饮水浆曾莫间。（仲景云。
但头汗出余处无汗。齐颈而还。小便不利。身必发黄也。）浮滑紧数脉来时。茵陈五苓皆可选。（茵陈蒿汤。五苓散。皆
可选用之。）瘀血之证亦相类。大便必黑此其异。血证其间多发狂。要须辨别无乖戾。（发黄与瘀血。其证相似。皆因瘀
热在里故也。但发黄者。小便多不利。瘀血则小便利。小腹硬满。大便黑色。仲景云。太阳病六七日。表证仍在。脉微
而沉。及不结胸。其人发狂者。以热在下焦。少腹当硬满。小便自利者。下血乃愈。所以然者。以太阳随经。瘀热在里
故也。又云。小便自利。其人如狂者。血证谛也。）白虎之证亦身热。大率异同难辨别。白虎不能遂发黄。盖为周身汗发
越。（白虎与发黄证亦相似。但白虎周身发汗。故不能黄。发黄证则余处无汗。齐颈而还）更有中湿并中风。发黄大抵亦
皆同。湿则薰黄身尽痛。目黄风中气难通。（仲景云。湿家之为病。一身尽痛。发热。身色如薰黄。又有中风黄者。但目
黄。气难通也。）
Pain indicates Jie Xiong (Chest Binding), while absence of pain indicates Pi Syndrome (Epigastric Fullness and Obstruction). ("Pi" is pronounced pǐ.) The Guan pulse at both wrists is deep, indicating they share a similar pathogenesis. (*Jade Box Classic* states: When disease originates from the Yin aspect and purgatives are incorrectly applied, Pi Syndrome results. *Treatise on Cold Damage* states: When disease originates from the Yang aspect and purgatives are incorrectly applied, heat enters internally, resulting in Jie Xiong; when disease originates from the Yin aspect and diaphoretics are incorrectly applied, Pi Syndrome also results. Generally, pain signifies Jie Xiong, and lack of pain signifies Pi Syndrome. In both Jie Xiong and Pi Syndrome, the Cun pulse is floating, and the Guan pulses are deep.)
If the Guan pulse is floating accompanied by epigastric fullness, Xiexin Decoction should be used. (Zhang Zhongjing stated: For epigastric fullness that is soft upon palpation, with a floating Guan pulse, Dahuang Huanglian Xiexin Tang [Rhubarb and Coptis Decoction to Drain the Epigastrium] is the primary formula.) If thirst and irritability occur, Wuling San (Five-Ingredient Powder with Poria) is indicated. (Zhang Zhongjing stated: For epigastric fullness treated with Xiexin Decoction, if the patient remains thirsty, irritable, and has difficulty urinating, Wuling Tang [Five-Ingredient Decoction] is the primary formula.) Jiegeng Zhishi Tang (Platycodon and Aurantium Decoction) is optimal; administer it first to promote Qi movement. (Physicians of the Jin Dynasty often treated Pi Qi (Qi Stagnation in the Epigastrium) with Jiegeng Zhishi Tang, frequently achieving recovery because it descends Qi.) If diarrhea sounds like thunder and there is hardness in the epigastrium, Gancao Xiexin Tang (Licorice Decoction to Drain the Epigastrium) can treat it. (In Zhang Zhongjing's discussions, there are five variations of Xiexin Decoctions, all designed for Pi Syndrome. However, for fullness without pain, Banxia Xiexin Tang [Pinellia Decoction to Drain the Epigastrium] is suitable; for yellow complexion and warm hands and feet, Huanglian Xiexin Tang [Coptis Decoction to Drain the Epigastrium]; for aversion to cold and sweating, Fuzi Xiexin Tang [Aconite Decoction to Drain the Epigastrium]; for dry heaving, food odor, and fluid retention under the ribs, Shengjiang Xiexin Tang [Fresh Ginger Decoction to Drain the Epigastrium]; for rumbling bowels, epigastric hardness, and vexation preventing rest, Gancao Xiexin Tang [Licorice Decoction to Drain the Epigastrium].)
Cold-dampness trapped inside cannot dissipate, and heat accumulates in the Spleen causing this affliction. Damp-heat struggles with retained food, stagnating and failing to resolve, leading to the emergence of jaundice. (Chao Yuanfang stated: Cold-dampness inside causes heat to accumulate in the Spleen and Stomach. With pores closed, stasis-heat struggles with retained food. Vexation and stagnation prevent digestion, leading to obstruction of urination and defecation, thus the body and face turn yellow.) Sweat appears only on the head and face, stopping at the neck; thirst drives drinking fluids without relief. (Zhang Zhongjing stated: If sweat occurs only on the head and nowhere else, stopping at the neck, and urination is difficult, jaundice will inevitably develop.) When the pulse is floating, slippery, tight, or rapid, Yinchenshao Tang (Artemisiae Scopariae Decoction) or Wuling San may be selected. (Yinchenshao Tang and Wuling San are both selectable options.) Blood stasis syndromes are also similar, but black stool is the distinguishing feature. During blood syndromes, mania often occurs; careful differentiation is required to avoid error. (Jaundice and blood stasis have similar symptoms, both caused by stasis-heat trapped inside. However, in jaundice, urination is usually difficult; in blood stasis, urination is free, the lower abdomen is hard and full, and stool is black. Zhang Zhongjing stated: In Taiyang disease lasting six or seven days, if exterior signs persist, the pulse is faint and deep, there is no Jie Xiong, and the patient becomes manic, it is because heat is in the Lower Jiao. The lower abdomen should be hard and full; if urination is spontaneous, bleeding resolves the condition. This is because Taiyang follows the meridians into the interior, causing stasis-heat inside. He also stated: If urination is spontaneous and the patient is like manic, it is a definitive sign of a blood syndrome.) Baihu Tang syndrome also presents with fever, making similarities and differences hard to distinguish. Baihu Tang does not lead to jaundice because it involves profuse sweating over the whole body. (Baihu Tang syndrome resembles jaundice, but Baihu Tang involves sweating over the entire body, so jaundice does not occur; in jaundice, there is no sweat elsewhere, stopping at the neck.) There are also dampness and wind-stroke syndromes where jaundice generally appears similarly. Dampness causes smoky-yellow discoloration and whole-body pain; wind-stroke with jaundice involves blocked Qi mechanism. (Zhang Zhongjing stated: Patients with chronic dampness suffer from whole-body pain, fever, and a smoky-yellow skin color. There is also wind-stroke jaundice, characterized by yellow eyes and obstructed Qi flow.)