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After sweating or purging therapies, if there has been no bowel movement for five or six days, accompanied by a dry tongue and thirst, slight afternoon tidal fever (ri bu xiao you chao re), hardness, fullness, and pain extending from the epigastrium to the lower abdomen that cannot be tolerated to touch,

and the pulse is still deep (chen), tight (jin), slippery (hua), or rapid (shu), or only the Guan position pulse is deep and tight, it is generally appropriate to use Daxiexiong Tang (Great Trap the Chest Decoction) for purging. If the pulse is floating (fu), the exterior syndrome has not yet resolved, and purging must not be used (purging in this case leads to death); instead, Xiao Xiexiong Tang (Minor Trap the Chest Decoction) and formulas like Xiaochaihu Tang (Minor Bupleurum Decoction) should be used for harmonizing. Only after the exterior syndrome resolves can purging be considered.

In cases of Jie Xiong (Chest Binding Syndrome), although the pulse is floating, if the interior heat is severe and purging is necessary, Sanyi Chengqi Tang (Three-One Chengqi Decoction) is appropriate. Divide one dose into three servings, taken over approximately three hours. If loose stools occur, the effect is excellent; even if not yet loose, symptoms will slightly decrease, and the pulse will gradually become deep. For mild conditions, only half a dose of Sanyi Chengqi Tang is used, with abdominal pressing to assist downward movement. For severe interior heat, a large portion of Daxiexiong Tang is used for purging.

This refers to the efficacy of the aforementioned medicines. Although Gansui (Kansui Root) and Gancao (Licorice Root) are contraindicated in both Daxiexiong Tang and Xiao Xiexiong Tang according to the Eighteen Incompatibilities, in severe cases, Gancao is intentionally used to stimulate Gansui, making its action swift and potent. Therefore, Shuangyuanzi (Double Pill) in *Shifang* and *Huo Ren Shu* also directly uses Gancao and Gansui.

If there is simple Jie Xiong without significant heat signs, but only slight sweating on the head and a deep, hidden pulse, this is Shui Jie Xiong (Water Chest Binding Syndrome), and Daxiexiong Tang is generally appropriate. For minor Jie Xiong, there is pain upon pressing the epigastrium, a floating and slippery pulse, and no significant heat signs.

This results from premature purging causing heat to bind in the chest and heart region. The heat is milder than in major Jie Xiong but more severe than Pi Zheng (Stagnation Syndrome). "Mild heat" refers to slight heat intensity, while "severe" refers to serious condition. Laypeople often misunderstand this, wrongly diagnosing Jie Xiong without major heat as Han Shi Jie Xiong (Cold-Excess Chest Binding Syndrome). However, *Su Wen* clearly states this is a heat disease, not cold. Regarding Zang Jie (Zang Binding), Yin Jie (Yin Binding), and Yang Jie (Yang Binding): classics state that heat binding in the Fu organs (which are Yang) is called Yang Jie; heat binding in the Zang organs (which are Yin) is called Yin Jie, also known as Zang Jie. Heat binding in the Fu is shallow and mild, so limb coldness is slight and easy to treat; heat binding in the Zang is deep, leading to severe illness, so limb coldness is profound and difficult to treat.

If Zang Jie involves extreme internal heat accumulation leading to cold body and faint, nearly imperceptible pulse, exterior heat signs may disappear. Laypeople, unaware that this stems from extreme internal heat, mistakenly diagnose it as Yin-cold Zang Jie. Since it is actually extreme heat, applying hot-natured drugs depletes residual Yin fluid, causing sudden death. Few survive, leading to the belief that Zang Jie is invariably fatal. Verifying against the Six Qi (Liu Qi) pulse and syndrome markers in *Su Wen* reveals the true heat nature. Retained fluids (Liu Yin) failing to dissipate cause head sweating, and a deep, hidden pulse seeming attached to the bone indicates accumulated fluids forming Shui Jie Xiong. For Shui Jie Xiong, Xiao Xiexiong Tang is generally appropriate.