问曰病有结胸有□□□□□之痛□□□□浮关脉沉名曰结胸□□□□□□曰如结胸□□□□食如故。时时下利□□
细沉紧。□□□□□舌上白胎滑者难□□
结胸者阳邪结胸也。脏结者。阴邪结□□□胸位高脏位其中脉之寸浮。关沉两俱无问□□□□结之关脉更小细而紧者以
关脉居上下□□□□之界。外邪由下。结积气由此。上于实。往来之□□□冲。所以病。在而脉反困。于中也。若见舌
白胎滑□□□则外邪固结于里。其劳最重以表里两解之法□□□□不可用。故为难治。其不出方者。正欲入深究其气□
□□□而施治非不可治也。治之务在分解表里错杂之邪□□使阴气渐下而内消。客邪渐上而外散庶可图功于万一也。
脏结无阳证不往来寒热其人反静。舌上胎滑者不可攻也。
脏结之所以不可攻者。从来置之不讲以为仲景未尝明言后人无从知之。不知仲景言之甚明。人第不参讨耳。夫所谓
不可攻者。乃垂戒之辞。正欲人详审其攻之之次第也。试思脏已结矣匪攻。而结何由开耶。所谓其外不解者尚未可攻。
又谓下利呕逆不可攻。又谓表解乃可攻痞。言之已悉。于此特出一诀谓脏结无阳证不往来寒热其人反静。则证不在六经
之表里而在上焦下焦之两途欲知其候。但观舌上有无苔滑。有之则外感之阳热挟痞气而反。在下。素痞之阴寒。挟热势
而反。在上此与里证已具表证未除者。相去不远。但其阴阳悖逆格拒不入证转凶危耳岂结胸腹内拒痛而脏结腹内不拒痛
耶。此而攻之是速其痛引阴筋而死不攻则病不除。所以以攻为戒。是则调其阴阳使之相入。而滑苔既退然后攻之则邪热
外散。阳气内消。此持危扶颠之真手眼也。
病胁下素有痞。连在脐旁痛引少腹。入阴筋者。此名脏结死。
按病患素有动气。在当脐上下左右。则不可发汗素有痞气在胁下连脐旁则不可攻下。医不细询病家不明告。因而贻
祸者多矣。
以上脏结例。
病发于阳。而反下之热入。因作结胸病发于阴而反下之。因作痞。所以成结胸者。以下之太早故也。
病发于阳者。太阳表证误下邪结于胸也。病发于阴者。皆是内挟痰饮。外感风寒。中气先伤。所以汗下不解。而心
下痞也。凡结胸正在胸中。此正太阳全盛之邪因误下乘虚而入。故曰热入。因作结胸是处方名为陷胸。若痞则多偏胸胁
而无正中结痛之候故但言因作痞。而不用热入二字。其邪之盛衰可知。是处方名为泻心。观其主治。则虚实迥然不侔。
则知表邪为阳里邪为阴也明矣。或言中风为阳邪。伤寒为阴邪。安有风伤卫气。气受伤而反变为结胸寒伤营血。血受伤
而反成痞之理。复有误认直中阴寒之阴。下早变成痞者。则阴寒本无实热。何得有下早之变。设阴结阴躁而误下之立变
危逆。恐不至于成痞停曰待变而死也。
太阳病脉浮而动。数浮则为风。数则为热。动则为痛。数则为虚。头痛发热。微盗汗出而反恶寒者。表未解也。医
反下之动数变迟膈内拒痛胃中空虚。客气动膈。短气躁烦。心中懊 。阳气内陷。心下因硬则为结胸大陷胸汤主之。若
不结胸。但头汗出余处无汗。剂颈而还。小便不利。身必发黄也。
脉浮而动数。虽主风热亦主正虚。虚故邪持日久头痛发热恶寒。表终不解。医不知其邪持太阳未传他经。反误下之
于是动数之脉变迟而在表之证变结胸矣。动数变迟三十六字。形容结胸之状殆尽。盖动数为欲传之。脉变迟则力绵势缓
而不能传。曰有结而难开之象。膈中之气与外实之邪两相格斗。故为拒痛。胃中水谷所生之精悍。因误下而致空虚。则
不能藉之以冲开外邪。反为外邪冲动其膈。于是正气往返邪逼之界。觉短气不足以息更烦燥有加。遂至神明不安。无端
而生懊 。凡此皆阳邪内陷所致也。
结胸者。项亦强如柔痉状下之则和。宜大陷胸丸。
结胸而至颈项亦强证愈笃矣。盖胸间邪结紧实项势常昂。有似柔痉之状。然痉病身首俱张。此但项强。原非痉也借
此以验胸即六分紧逼。以大陷胸汤下之。恐过而不留即以大陷胸丸下之。又恐滞而不行。故煮而连滓服之。然后与邪相
当。观方中用大黄芒硝甘遂可谓峻矣。而更加葶苈杏仁以射肺邪而上行。其急煮时。又倍加白蜜以留恋润导之而下行。
其缓必识此意。始得用法之妙。
结胸证其脉浮大者不可下。下之则死。
胸既结矣。本当下以开其结。然脉浮大则表邪未尽下之。是令结而又结也。所以致死。此见一误不堪再误也。
结胸证悉具烦躁者亦死。
亦字承上见结胸证全具更加烦躁即不下亦主死也。烦躁曷为主死耶。盖邪结于胸。虽籍药力以开之。而所以载药力
上行者胃气也。胃气充溢于津液之内。汗之津液一伤下之津液再伤至热邪抟饮结于当胸。而津液又急奔以应上。正有不
尽不已之势胃气垂绝能无败乎。此结胸诸法见几于早竞竞以涤饮为先。务饮涤则津液自安矣。
伤寒六七日结胸热实脉沉而紧。心下痛按之石硬者大陷胸汤主之。
热实二字形容结胸之状其明见邪热填实于膈间也。前条言寸脉浮。关脉沉。此言脉沉紧更明盖紧脉有浮沉之别浮紧
主伤寒无汗沉紧主伤寒结胸。则知结胸非中风下早而成也。
伤寒十余日热结在里复往来寒热者。与大柴胡汤。但结胸无寒热者。此为水结在胸胁也。但头微汗出者。大
陷胸汤主之。
治结胸证所用陷胸之法者。以外邪挟内饮抟结胸间。未全入于里也。若十余日热结在里则是无形之邪。热蕴结。必
不定在胸上。而非结胸明矣。加以往来寒热。仍兼半表当用大柴胡汤两解表里之热。庶其陷胸之义无取也。无大热与上
文热实互意。内陷之邪。但结胸间。而表里之热。反不炽盛是为水饮结在胸胁。其人头有微汗。乃邪在高而阳气不得下
达之。明征。此则主用大陷胸汤允为的对也。
太阳病重发汗而复下之。不大便五六日。舌上燥而渴。日晡所小有潮热从心下至少腹硬满而痛不可近者大陷胸汤主
之。
不大便燥渴。日晡潮热少腹硬满证与阳明颇同。但小有潮热则不似阳明之大热。从心下至少腹手不可近则阳明又不
似此大痛因是辨其为太阳结胸脉。阳明内实也。缘误汗误下。重伤津液不大便而燥渴潮热更加痰饮内结。必用陷胸汤由
胸胁以及胃肠始得荡涤无余。若但下肠胃结热反遗膈上痰饮。则非法矣。
太阳少阳并病。而反下之成结胸。心下硬下利不止。水浆不下。其人心烦。
此条虽系并病。以其反下之而成结胸当随见所变之证而归重于结胸也。误下之变乃致结胸下利。上下交征而阳明之
居中者。水浆不入。心烦待毙伤寒顾可易言哉。
小结胸病正在心下。按之则痛脉浮滑者。小陷胸汤主之。
小结胸病。正在心下。则不似大结胸之高在心上也。按之则痛。比手不可近。则较轻也。而脉之浮又浅于沉滑。又
缓于紧可见其人外邪陷入。原微但痰饮素盛挟热邪而内结。所以脉见浮滑也。黄连半夏栝蒌实药味虽平而泄热散结。亦
是突围而入。所以名为小陷胸也。
寒实结胸。无热证者。与三物小陷胸汤。白散亦可服。
寒实结胸。乃寒饮结聚。而无大热也。意开小陷胸。半夏栝蒌实足以去其痰饮。又虑黄连难祛寒实。故又主白散。
取巴豆之辛热破结。贝母之苦寒开郁。桔梗载之上涌为的当耳。
以上结胸例。
伤寒汗出解之后胃中不和。心下痞硬。干噫食臭。胁下有水气。腹中雷鸣下利者。生姜泻心汤主之。
汗后外邪虽解。是必胃气安和。始得脱然无恙以胃主津液故也。若有因邪入而内结。因发汗而外亡。两相告匮。其
人心下必痞硬。以伏饮搏聚。胃气不足以开之也。胃病故干噫食臭食入而嗳馊酸也。胃病故水入而旁渗胁肋也。胃中水
谷不行。腹中必雷鸣。而搏击有声。下利而清浊不分也。虽不由误下。而且成痞。设误下之其痞结又当何似耶。
伤寒中风医反下之。其人下利日数十行。谷不化腹中雷鸣。心下痞硬而满。干呕心烦不得安。医见心下痞谓病不尽。
复下之其痞益甚。此非结热但以胃中虚。客气上逆。故使硬也。甘草泻心汤主之。
此条痞证。伤寒与中风互言大意具见。可见病发于阴下之。而成痞者。非指伤寒为阴也。下利完谷腹鸣呕烦皆误下。
而胃中空虚之互辞也。设不知此义。以为结热。而复下之。其痞必益甚。故重以胃中虚。客气上逆昭揭病因方用甘草泻
心汤者。即生姜泻心汤除去生姜人参。而倍甘草干姜也。客邪乘虚结于心下。本当用人参。以误而再误。其痞已极。人
参仁柔无刚决之方。故不宜用。生姜辛温最宜用者。然以气并主散恐其领津液上升。客邪从之犯上。故倍用萸姜代之以
开痞。而用甘草为君。坐镇中州庶心下兴。腹中渐至宁泰耳。今人但知以生姜代干姜之僭。孰知以干姜代生姜之散哉。
但知甘草能增满。孰知甘草能去满哉。
伤寒五六日。呕而发热者。柴胡汤证具。而以他药下之。柴胡证仍在者。复与柴胡汤。此虽已下之不为逆必蒸蒸而
振。却发热汗出而解。若心下满而硬痛者。此为结胸也。大陷胸汤主之。但满而不痛者。此为痞柴胡汤不中与之。宜半
夏泻心汤。
五六日呕而发热为太阳之本证。盖呕多属阳明然有太阳邪气未罢。欲传阳明之候有少阳邪气在里逆攻。阳明之候。
所以阳明致戒云。呕多虽有阳明证不可攻之。恐伤太阳少阳也。此本柴胡证误用。下药则邪热乘虚入胃。而胆却受寒。
故于生姜泻心汤中去生姜之走表。君半夏以温胆。兼芩连以除胃中邪热也。泻心诸方原为泻心下痞塞之痰饮水气而设此
证。起于呕故推半夏为君耳。
伤寒大下后复发汗。心下痞恶寒者表未解也。不可攻痞当先解表。表解乃可攻痞。解表宜桂枝汤。攻痞宜大黄黄连
泻心汤。
大下之后。复发汗。先里后表颠倒差误究竟已陷之邪痞结心下证兼恶寒。表邪不为汗衰即不可更攻其痞当先行解肌
之法以治外。外解已后。乃用大黄黄连。攻其湿热凝聚之痞。方为合法耳。
脉浮而紧而复下之紧反入里则作痞。按之自濡但气痞耳。心下痞按之濡其脉关上。浮者大黄黄连泻心汤主之。心下
痞而复恶寒汗出者。附子泻心汤主之。
伤寒脉浮而紧即不可下。误下而紧反入里则寒邪转入转深矣。外邪与饮搏结故心下满硬。若按之自濡而不满硬。乃
是浊气。挟湿热痞聚于心下。则与小邪无预也。浊气上逆。惟苦寒可泻之上条大黄黄连泻心之法即为定药若恶寒汗出虽
有湿热痞聚于心下而挟阳虚阴盛之证。故于大黄黄连泻心汤内。另煎附子汁和服。以各行其事。共成倾痞之功。即一泻
心汤方中。法度森森若此。
伤寒胸中有热胃中有邪气腹中痛欲呕吐者。黄连汤主之。
伤寒邪气传里而为下寒上热也。胃中有邪气。使阴阳不交。阴不得升。而独滞于下。为下寒腹中痛。阳不得降。而
独菀于上。为胸中热欲呕吐。故于半夏泻心汤中。除去黄芩而加桂枝。去黄芩者。为其有下寒腹痛也。加桂枝者。用以
散胸中之热邪。而治呕吐也。经曰上热者。泻之以苦下寒者。散之以辛故用黄连以泻上热干姜桂枝半夏以散下寒人参甘
草大枣以益胃而缓其中。此分理阴阳。和解上下之正法也。常因此而推及脏结之舌上苔滑。湿家之舌上如苔者。皆不出
是方也。
太阳中风下利呕逆。表解者乃可攻之。其人 汗出发作有时。头痛心下痞硬满引胁下痛。干呕短气汗出不恶寒者。
此表解里未和也。十枣汤主之。
此证与结胸颇同。但结胸者邪结于胸其位高。此在心下及胸。其位卑。然必表解。乃可攻之。亦与攻结胸之戒不殊
也。其人 汗出发作有时。而非昼夜俱笃。即此便是表解之征。虽有头痛。心下痞硬满引胁下痛。干呕短气诸证。乃
热邪搏饮之本证不得以表证名之。见汗出不恶寒。便是表解可攻之候。设外邪不解。何缘而得汗乎。攻药取十枣汤者。
正与陷胸相仿。伤寒种种下法。咸为胃实而设。今证在胸胁而不在胃。则荡涤肠胃之药无所取矣。故取芫花之辛以逐饮。
甘遂大戟之苦以泄水。并赖大枣之甘以运脾助诸药祛水饮于胸胁之间。乃下剂中之变法也。
伤寒发汗若吐若下解后。心下痞硬噫气不除者。旋覆代赭石汤主之。
汗吐下法。备而后表解。则中气必虚虚则浊气不降而痰饮上逆。故作痞硬。逆气上冲。而正气不续故噫气不除所以
用代赭领人参下行以镇安其逆气。微加解邪涤饮。而开其痞。则噫气自除耳。
伤寒服汤药下利不止。心下痞硬服泻心汤已复以他药下之利不止。医以理中与之。利益甚。理中者理中焦。此利在
下焦赤石脂禹余粮汤主之。复利不止者。当利其小便。
误下而下利不止。心下痞硬服泻心汤为合法矣。乃服以他药下之。他药则皆荡涤下焦之药与心下之痞全不相涉纵痞
硬微除。而关闸尽撒利无休止。反取危困。用理中以开痞止利原不为过。其利益甚者明是以邻国为壑。徒重其奔迫也。
故用赤石脂禹余粮固下焦之脱。而重修其关闸倘更不止复通支河水道以杀急奔之热。庶水谷分而下利自止耳。
Question: In disease, there are cases of Jie Xiong (Chest Binding) and Zang Jie (Organ Binding) pain. If the pulse is floating at the Cun (inch) position and sunken at the Guan (middle) position, it is called Jie Xiong. If it resembles Jie Xiong but food intake remains normal, with frequent diarrhea, and the pulse is fine, sunken, and tight, it indicates a different condition. If the tongue has a white and slippery coating, it is difficult to treat.
Jie Xiong syndrome involves Yang pathogenic factors binding in the chest and diaphragm. Zang Jie syndrome involves Yin pathogenic factors binding. The chest is located superiorly, while the Zang organs are situated within. A floating pulse at the Cun position and a sunken pulse at the Guan position, with both positions appearing weak or absent, suggest this pattern. In Zang Jie, the Guan pulse is even smaller, finer, and tighter. This is because the Guan position lies between the upper and lower sections; external pathogens enter from below, and accumulated Qi rises from here to strike the solid areas. Thus, the pathology is internal, yet the pulse appears constrained in the middle Jiao. If a white and slippery tongue coating is observed, it indicates that external pathogens are firmly bound internally. The condition is severe because methods addressing both exterior and interior simultaneously are contraindicated, making it difficult to treat. No formula is provided here to encourage deep investigation into the Qi dynamics for appropriate treatment; it is not untreatable. Treatment must focus on resolving the complex intermingling of exterior and interior pathogens, allowing Yin Qi to gradually descend and dissipate internally, while guest pathogens gradually ascend and disperse externally, offering a slim chance of success.
Zang Jie presents without Yang signs, without alternating chills and fever, and the patient appears quiet. If the tongue coating is slippery, purgation is contraindicated.
The reason Zang Jie cannot be treated with purgation has been largely ignored, with some believing Zhang Zhongjing did not clarify it, leaving later generations unaware. However, Zhang Zhongjing was very clear; people simply failed to investigate. The statement "cannot be purged" is a warning to carefully consider the sequence of treatment. One might ask: if the Zang organs are bound, how can the binding be opened without purging? Zhang Zhongjing stated: "If the exterior is unresolved, purgation is not yet appropriate." He also said: "With diarrhea and vomiting/retching, purgation is contraindicated," and "Only after the exterior is resolved can one attack the Pi (fullness)." These instructions are comprehensive. Here, a specific guideline is given: Zang Jie lacks Yang signs, has no alternating chills and fever, and the patient is quiet. This indicates the pathology is not in the Taiyang/Yangming exterior-interior levels but involves the Upper and Lower Jiao. To determine the prognosis, observe the tongue for a slippery coating. A slippery coating suggests external Yang-heat combined with Pi-Qi sinking downward, while inherent Yin-cold of the Pi rises upward mixed with heat. This is similar to conditions where interior signs are present but exterior signs remain, except that here, Yin-Yang reversal and rejection lead to a critical state. Unlike Jie Xiong which involves abdominal tenderness upon pressure, Zang Jie does not typically involve such tenderness. Purging here would accelerate pain and draw Yin meridians inward, leading to death; not purging leaves the disease unchecked. Hence, purgation is warned against. The correct approach is to regulate Yin and Yang to allow mutual interaction; only after the slippery coating recedes should purgation be considered. This allows pathogenic heat to disperse outward and Yang Qi to dissipate inward, representing true expertise in rescuing critical conditions.
If a patient has a chronic Pi mass under the hypochondrium extending to the side of the umbilicus, with pain radiating to the lower abdomen and genitals, this is named Zang Jie and is fatal.
Note: If a patient has chronic "moving Qi" around the umbilicus (upper, lower, left, right), sweating methods are contraindicated. If there is a chronic Pi mass under the hypochondrium extending to the umbilicus, purgation is contraindicated. Many disasters occur because physicians fail to inquire carefully and patients fail to disclose their history.
The above are examples of Zang Jie.
When a disease begins with Yang characteristics and is incorrectly treated with purgation, heat enters and forms Jie Xiong. When a disease begins with Yin characteristics and is incorrectly treated with purgation, it forms Pi. Jie Xiong results from purgation being too early.
"Disease beginning with Yang" refers to Taiyang exterior syndrome incorrectly treated with purgation, causing pathogens to bind in the chest. "Disease beginning with Yin" refers to internal retention of phlegm-fluids combined with external wind-cold, damaging Middle Jiao Qi first, leading to Pi in the epigastrium unresponsive to sweating or purging. Jie Xiong occurs centrally in the chest due to excess Taiyang pathogens entering via deficiency caused by incorrect purgation, hence termed "Heat Entering," forming Jie Xiong, treated with Xian Xiong Tang (Inferior Chest Decoction). Pi tends to affect the chest and hypochondrium without central binding pain, so it is described as "forming Pi" without using "Heat Entering." The severity of pathogens differs, hence Pi is treated with Xie Xin Tang (Drain the Epigastrium Decoctions). Comparing treatments reveals distinct deficiency-excess patterns, confirming that exterior pathogens are Yang and interior pathogens are Yin. Some argue Wind-stroke is Yang pathogen and Cold-injury is Yin pathogen, questioning how Wind injuring Wei Qi leads to Jie Xiong or Cold injuring Ying Blood leads to Pi. Others mistake direct invasion of Yin-Cold for Pi caused by early purgation; however, Yin-Cold lacks excess heat, so early purgation wouldn't cause Pi. If Yin-Jie or Yin-Mania were purged incorrectly, it would immediately become critical, unlikely to stagnate as Pi.
Taiyang disease with a floating, active, and rapid pulse. Floating indicates Wind, Rapid indicates Heat, Active indicates Pain, Rapid also indicates Deficiency. Headache, fever, slight night sweats, yet aversion to cold indicates the exterior is unresolved. Incorrect purgation changes the active-rapid pulse to slow. Pain resisting pressure in the diaphragm, emptiness in the Stomach, guest pathogens disturbing the diaphragm, shortness of breath, irritability, and inner restlessness (Ao Nao) occur. Yang pathogens sink inward, hardening the epigastrium, forming Jie Xiong, treated with Da Xian Xiong Tang (Major Inferior Chest Decoction). If Jie Xiong does not form, but only head sweating occurs (no sweat elsewhere, stopping at the neck), with urinary difficulty, jaundice will develop.
A floating, active, and rapid pulse indicates Wind-Heat but also Righteous Qi Deficiency. Due to deficiency, pathogens linger long-term. Headache, fever, aversion to cold persist. The physician fails to recognize pathogens lingering in Taiyang without transmitting, and incorrectly purges. The active-rapid pulse becomes slow, and exterior signs transform into Jie Xiong. "Active-rapid becomes slow" describes Jie Xiong thoroughly. Active-rapid suggests impending transmission; slowing indicates weakened force and inability to transmit, showing binding that is hard to open. Qi in the diaphragm fights external excess pathogens, causing resistance pain. Nutritive essence from food/drink in the Stomach is depleted by purgation, unable to flush out pathogens, instead being disturbed by them. Righteous Qi struggles at the boundary of pathogenic pressure, causing shortness of breath and increased irritability, leading to mental unrest and Ao Nao. All result from Yang pathogens sinking inward.
In Jie Xiong, stiffness of the neck resembling Rou Ji (Soft Spasm) may occur. Purging harmonizes the condition; Da Xian Xiong Wan (Major Inferior Chest Pill) is indicated.
Neck stiffness in Jie Xiong indicates severe binding. Tight binding in the chest causes the neck to extend, resembling Rou Ji. However, unlike full-body spasm, only the neck is stiff. This confirms significant chest binding. Using Da Xian Xiong Tang might be too harsh; Da Xian Xiong Wan might be too sluggish. Therefore, decocting with dregs and taking it together balances the action. The formula contains Da Huang (Rhubarb Root), Mang Xiao (Mirabilite), and Gan Sui (Kansui Root), which are potent. Ting Li Zi (Periploca Seed) and Xing Ren (Apricot Seed) target Lung pathogens ascending. Boiling briefly with extra Bai Mi (White Honey) retains moisture and guides downward. Understanding this balance is key to its efficacy.
In Jie Xiong, if the pulse is floating and large, do not purge; purging leads to death.
Although binding requires purging, a floating-large pulse indicates residual exterior pathogens. Purging now causes double binding, leading to death. This warns against repeated errors.
If all Jie Xiong symptoms are present along with irritability, it is fatal.
"Irritability" implies fatality even without purgation when all symptoms are present. Why? Pathogens bind in the chest; medication relies on Stomach Qi to carry it upward. Stomach Qi depends on fluids. Sweating damages fluids once; purging damages them again. Heat binds with fluids in the chest, forcing remaining fluids upward desperately. Stomach Qi is exhausted and fails. Early intervention focusing on draining fluids preserves fluids and saves the patient.
After six or seven days of Shang Han, Jie Xiong with Heat-Excess presents with a sunken, tight pulse, epigastric pain, and hardness like stone upon pressure. Da Xian Xiong Tang is indicated.
"Heat-Excess" clearly shows heat filling the diaphragm. Previous texts mentioned floating Cun and sunken Guan; here, sunken-tight is more explicit. Tight pulses vary: floating-tight indicates Cold-Injury without sweat; sunken-tight indicates Cold-Injury with Jie Xiong. Thus, Jie Xiong is not caused by Wind-Stroke and early purgation.
After ten-plus days of Shang Han, if heat binds internally with alternating chills and fever, Da Chai Hu Tang (Major Bupleurum Decoction) is used. If only Jie Xiong exists without chills/fever, it is Water-Binding in the chest/thorax. With slight head sweating, Da Xian Xiong Tang is indicated.
Xian Xiong methods address external pathogens combining with internal fluids binding in the chest, not fully interior. Ten-plus days of internal heat binding suggests无形 (formless) heat, not necessarily in the chest, ruling out Jie Xiong. Alternating chills/fever indicate half-exterior/half-interior status, requiring Da Chai Hu Tang to resolve both. "No great heat" contrasts with "Heat-Excess." Internal pathogens bind only in the chest, with less intense exterior-interior heat, indicating Water-Fluid binding. Slight head sweating confirms pathogens high up blocking Yang descent. Da Xian Xiong Tang is appropriate.
In Taiyang disease, excessive sweating followed by purgation leads to five-six days of constipation, dry thirsty tongue, slight afternoon tidal fever, hardness/fullness/pain from epigastrium to lower abdomen intolerable to touch. Da Xian Xiong Tang is indicated.
Constipation, thirst, afternoon fever, and lower abdominal hardness resemble Yangming. However, slight fever differs from Yangming's high fever; pain from epigastrium to lower abdomen is more severe than typical Yangming. Differentiating Taiyang Jie Xiong from Yangming Excess is crucial. Incorrect sweating/purgation damages fluids, causing constipation, thirst, fever, and phlegm-fluid binding. Da Xian Xiong Tang clears from chest/thorax to intestines/stomach. Purging only intestinal heat leaves thoracic phlegm-fluid, which is incorrect.
In concurrent Taiyang-Shaoyang disease, incorrect purgation forms Jie Xiong with epigastric hardness, incessant diarrhea, inability to swallow fluids, and irritability.
Though concurrent disease, incorrect purgation causing Jie Xiong shifts focus to Jie Xiong complications. Diarrhea and inability to eat create upper-lower conflict. Irritability signals danger.
Xiao Jie Xiong (Minor Chest Binding) is located exactly at the epigastrium, painful upon pressure, with a floating-slippery pulse. Xiao Xian Xiong Tang (Minor Inferior Chest Decoction) is indicated.
Xiao Jie Xiong is lower than Da Jie Xiong. Pain on pressure is milder than intolerance to touch. Floating pulse is shallower than sunken; slippery is gentler than tight. This indicates mild external pathogens invading, combined with abundant phlegm-fluids and heat. Huang Lian (Coptis Rhizome), Ban Xia (Pinellia Tuber), Gua Lou Shi (Trichosanthes Fruit) are mild but clear heat and resolve binding, hence "Minor."
Cold-Excess Jie Xiong without heat signs is treated with San Wu Xiao Xian Xiong Tang or Bai San (White Powder).
Cold-Excess Jie Xiong involves cold-fluid binding without major heat. While Ban Xia and Gua Lou Shi resolve phlegm, Huang Lian may not suffice for cold-excess. Bai San uses Ba Dou (Croton Seed) for pungent-warm binding-breaking, Bei Mu (Fritillaria Bulb) for bitter-cold depression-opening, and Jie Geng (Platycodon Root) to guide upward.
The above are examples of Jie Xiong.
After Shang Han resolves with sweating, if the Stomach is disharmonious with epigastric hardness/fullness, belching with food odor, fluid-gas under hypochondrium, borborygmus, and diarrhea, Sheng Jiang Xie Xin Tang (Fresh Ginger Drain the Epigastrium Decoction) is indicated.
Post-sweat resolution requires harmonious Stomach Qi. If pathogens bind internally and sweating depletes externally, deficiency arises. Fluids accumulate, overwhelming Stomach Qi, causing epigastric hardness. Stomach dysfunction causes belching with sour/rotten odors. Water permeates hypochondrium. Food stagnation causes borborygmus and diarrhea. Even without incorrect purgation, Pi can form; incorrect purgation would worsen it.
In Shang Han or Wind-Strike, incorrect purgation causes frequent diarrhea with undigested food, borborygmus, epigastric hardness/fullness, dry retching, and irritability. The physician sees Pi, assumes incomplete disease, and purges again, worsening Pi. This is not Heat-Binding but Stomach Deficiency with Guest Qi reversing upward. Gan Cao Xie Xin Tang (Licorice Drain the Epigastrium Decoction) is indicated.
This Pi case discusses Shang Han and Wind-Strike interchangeably. Pi from Yin-disease purgation doesn't mean Shang Han is Yin. Diarrhea, borborygmus, vomiting, irritability result from purgation-induced Stomach emptiness. Mistaking this for Heat-Binding and purging again worsens Pi. Gan Cao Xie Xin Tang modifies Sheng Jiang Xie Xin Tang by removing Sheng Jiang and Ren Shen, doubling Gan Cao and Gan Jiang. Guest Qi binds due to deficiency; Ren Shen is usually used, but repeated errors make Pi extreme. Ren Shen is too soft; Sheng Jiang is too dispersing. Gan Jiang opens Pi without dispersing Qi upward. Gan Cao anchors the Middle Jiao. Modern practitioners misunderstand substituting Sheng Jiang for Gan Jiang or Gan Cao's role in reducing fullness.
After five-six days of Shang Han, vomiting and fever indicate Chai Hu Tang syndrome. Incorrect purgation leaves Chai Hu signs intact; giving Chai Hu Tang again causes shaking chills then fever/sweat resolution. If epigastric fullness/hardness/pain occurs, it is Jie Xiong, treated with Da Xian Xiong Tang. If fullness without pain, it is Pi; Chai Hu Tang is inappropriate; Ban Xia Xie Xin Tang (Pinellia Drain the Epigastrium Decoction) is indicated.
Vomiting/fever at day five-six is Taiyang origin. Vomiting often relates to Yangming but can indicate Taiyang residual or Shaoyang attacking Yangming. Yangming warns against purging with vomiting to protect Taiyang/Shaoyang. Here, Chai Hu syndrome was purged incorrectly, sending heat to Stomach and chilling Gallbladder. Ban Xia Warms Gallbladder; Huang Qin/Lian Clear Stomach Heat. Ban Xia is chief due to vomiting origin.
After major purgation and sweating in Shang Han, if epigastric Pi persists with aversion to cold, the exterior is unresolved. Do not attack Pi; resolve exterior first. Gui Zhi Tang (Cinnamon Twig Decoction) resolves exterior; Da Huang Huang Lian Xie Xin Tang (Rhubarb and Coptis Drain the Epigastrium Decoction) attacks Pi.
Incorrect sequencing of purgation then sweating traps pathogens in the epigastrium. Aversion to cold indicates unresolved exterior. Resolve exterior with muscle-relaxing method first. Then use Da Huang/Huang Lian to clear damp-heat Pi.
Floating-tight pulse followed by purgation makes the tightness enter inward, forming Pi. Soft upon pressure indicates Qi-Pi. Epigastric Pi with soft pressure and floating Guan pulse is treated with Da Huang Huang Lian Xie Xin Tang. If Pi accompanies aversion to cold and sweating, Fu Zi Xie Xin Tang (Aconite Drain the Epigastrium Decoction) is indicated.
Floating-tight pulse contraindicates purgation. Incorrect purgation drives cold deeper. External pathogens bind with fluids causing fullness. If soft upon pressure, it is turbid Qi with damp-heat Pi, unrelated to external pathogens. Bitter-cold clears turbid Qi. For Pi with Yang Deficiency (aversion to cold/sweating), add Fu Zi decoction separately to the Da Huang/Huang Lian mix to address both aspects.
Shang Han with heat in the chest and pathogenic Qi in the Stomach, causing abdominal pain and urge to vomit, is treated with Huang Lian Tang (Coptis Decoction).
Pathogens transmitted inward cause Lower Cold and Upper Heat. Pathogenic Qi in Stomach blocks Yin-Yang communication. Yin stays down (Lower Cold, abdominal pain); Yang stays up (Upper Heat, chest heat, vomiting). Huang Lian Tang modifies Ban Xia Xie Xin Tang by removing Huang Qin (for Lower Cold) and adding Gui Zhi (to scatter Upper Heat/vomit). Bitter clears Upper Heat; Pungent scatters Lower Cold. Huang Lian clears heat; Gan Jiang/Gui Zhi/Ban Xia scatter cold; Ren Shen/Gan Cao/Dazao tonify Stomach. This harmonizes Yin-Yang and Upper-Lower. This principle applies to Zang Jie slippery coating and Damp-Home tongue coating.
Taiyang Wind-Strike with diarrhea/retching requires resolving exterior before attacking interior. Copious intermittent sweating, headache, epigastric hardness/fullness radiating to hypochondrium, dry retching, shortness of breath, sweating without aversion to cold indicate resolved exterior/unharmonized interior. Shi Zao Tang (Ten Jujube Decoction) is indicated.
This resembles Jie Xiong but is lower (epigastrium/chest vs. chest). Exterior must be resolved first. Intermittent sweating indicates exterior resolution. Headache, epigastric hardness, etc., are due to heat-fluid binding, not exterior signs. Sweating without aversion confirms exterior resolution. Shi Zao Tang targets fluid-binding in chest/thorax, using Yuan Hua (Genkwa Flower), Gan Sui (Kansui), Da Ji (Euphorbia) to drain water, supported by Da Zao (Jujube) to protect Spleen. This is a variation of purgative formulas.
After Shang Han resolved by sweating/vomiting/purgation, if epigastric hardness and persistent belching remain, Xuan Fu Dai Zhe Shi Tang (Inula, Hematite, and Oyster Shell Decoction) is indicated.
Post-treatment exterior resolution leaves Middle Jiao Deficiency. Turbid Qi fails to descend, phlegm-fluids reverse upward, causing hardness/belching. Dai Zhe Shi guides Ren Shen downward to calm rebellion; minor herbs clear pathogens/fluids to resolve Pi and stop belching.
Shang Han treated with medicine causes incessant diarrhea and epigastric hardness. After Xie Xin Tang, further purgation worsens diarrhea. Li Zhong Tang increases diarrhea because it treats Middle Jiao, but the issue is Lower Jiao. Chi Shi Zhi Yu Liang Tang (Red Halloysite and Levigated Hematite Decoction) is indicated. If diarrhea persists, promote urination.
Incorrect purgation causes diarrhea/hardness. Xie Xin Tang is correct initially. Further purgation drains Lower Jiao, irrelevant to epigastric Pi. Although Pi improves, the "gate" opens, causing endless diarrhea. Li Zhong Tang treats Middle Jiao but worsens Lower Jiao leakage ("pouring neighbor's water into one's own ditch"). Chi Shi Zhi/Yu Liang consolidate Lower Jiao and close the gate. If still uncontrolled, promote urination to separate water/grain and stop diarrhea.