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[Outline] Zhang Zhongjing stated: In Taiyang disease (a syndrome caused by pathogenic factors affecting the Taiyang meridian), if ten days have passed and the pulse is floating and fine, and the patient desires to lie still, it indicates that the exterior pathogens have been resolved. If chest fullness and hypochondriac pain occur, Xiao Chai Hu Tang (Minor Bupleurum Decoction) should be administered. If the pulse is merely floating, Ma Huang Tang (Ephedra Decoction) should be given.

[Commentary] Huang Zhongli stated: This section describes a combined disease of Taiyang and Shaoyang (Lesser Yang). Therefore, chest fullness, hypochondriac pain, and somnolence occur because the Qi of Shaoyang cannot ascend. Thus, Chai Hu Tang (Bupleurum Decoction) is used to harmonize. If the pulse is merely floating, it still belongs to the pulse pattern of Taiyang; therefore, Ma Huang Tang is used to disperse the pathogen.

Han Zhihe stated: Chest fullness refers to a sensation of Qi stagnation and oppression in the chest and diaphragm, not fullness in the epigastrium (Xin Xia). Hypochondriac fullness refers to a sensation of Qi filling and distension below the ribs, not fullness in the abdomen. Generally, when pathogens transmit from the exterior to the interior, they must first pass through the chest and hypochondrium before entering the heart, abdomen, and stomach. Therefore, chest fullness often carries exterior symptoms and is suitable for sweating therapy. Only hypochondriac fullness or pain often carries half-exterior, half-interior characteristics. It can be harmonized with Xiao Chai Hu Tang added with Zhi Shi (Aurantii Fructus). For phlegm-fluid retention causing excess patterns in the chest, emesis should be induced. If pathogenic factors condense in the chest forming an excess pattern, accompanied by dry thirst and constipation, Da Xian Xiong Tang (Major Draining the Chest Decoction) is the primary treatment.

[Outline] Zhang Zhongjing stated: After purgation, if the pulse is hurried and there is chest fullness, Gui Zhi Qu Shao Yao Tang (Cinnamon Twig Decoction without Paeonia) is the primary treatment. In a combined disease of Taiyang and Yangming, if wheezing and chest fullness occur, purgation is contraindicated; Ma Huang Tang is suitable.

[Commentary] Cheng Wuji stated: These two clauses describe cases where chest fullness belongs to the exterior and requires sweating therapy. The chest is relatively close to the exterior. When the condition reaches the hypochondrium, sweating is no longer mentioned, but only harmonization is performed. Generally, chest and hypochondriac fullness occurs because pathogens have just entered the interior without settling, causing dampness to stagnate and fail to circulate, leading to fullness. Harmonization is sufficient. If pathogens remain in the chest and condense into an excess pattern, only emesis can cure it. Thus, Hua Tuo said, "On the fourth day, when the pathogen is in the chest, emesis leads to recovery." This applies when pathogens have condensed and are no longer diffuse, allowing for emesis.

Han Zhihe stated: Wheezing with chest pain still carries exterior symptoms and purgation is contraindicated; administer Ma Huang Tang, or Ma Huang Xing Zi Gan Cao Shi Gao Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction). For hurried pulse and chest fullness treated with Gui Zhi Qu Shao Yao Tang, the disease is located in the Stomach. Since Shao Yao (Paeoniae Radix Alba) enters the Ying (Nutritive) level, it is removed.

Shen Jin'ao's Note: Chest fullness originally belongs to Yang syndromes. However, if fullness occurs after purgation without wheezing, it indicates cold pathogens binding internally, potentially developing into Jie Xiong (Chest Binding). Thus, chest fullness occurs not only in cases of Yang excess but also in cases of Yang deficiency.

[Outline] Zhang Zhongjing stated: In Shang Han (Cold Damage), if vomiting or purgation is used, resulting in rebellious fullness in the epigastrium, Qi rushing up to the chest, dizziness upon rising, and a deep, tight pulse, further sweating will disturb the meridians, causing tremors and shaking of the body. Fu Ling Gui Zhi Bai Zhu Gan Cao Tang (Poria, Cinnamon Twig, Atractylodes Macrocephala, and Licorice Decoction) is the primary treatment.

[Commentary] Ke Qin stated: At the onset of Shang Han, releasing the exterior is appropriate; vomiting and purgation are illegal treatments. However, after these methods, if the disease does not transfer to Taiyin but instead presents with rebellious epigastric fullness and Qi rushing to the chest, this indicates internal disturbance of Yang Qi.

[Outline] Zhang Zhongjing stated: After sweating or purgation, if irritability and heat appear in the chest with a sensation of obstruction, Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) is the primary treatment.

If symptoms resemble Gui Zhi Tang syndrome, but there is no headache or neck stiffness, and the Cun (Inch) pulse is slightly floating, with chest痞 (Pi, stuffiness/hardness) and hardness, and Qi rushing up to the throat causing breathing difficulty, this is due to cold-fluid in the chest. Emesis should be induced using Gua Di San (Thistle Powder).

[Commentary] Cheng Wuji stated: Both involve emesis. Zhi Zi Chi Tang expels empty irritability and guest-heat from the chest; Gua Di San expels phlegm-fluid excess and old-cold from the chest.

Shen Jin'ao's Note: These two clauses originally belong to Yangming syndromes, attached here to clarify that chest fullness may require emesis.

[Outline] Zhang Zhongjing stated: In Taiyang Wind Strike syndrome, with diarrhea and retching/vomiting, once the exterior is resolved, one may attack the interior. If the patient sweats, with episodes occurring at specific times, epigastric Pi (stuffiness), hardness, fullness pulling into the hypochondrium, dry retching, shortness of breath, sweating without aversion to cold, this indicates the exterior is resolved but the interior is not harmonized. Shi Zao Tang (Ten Jujubes Decoction) is the primary treatment.

[Commentary] Shen Jin'ao's Note: In this clause, epigastric hardness/fullness pulling into hypochondriac fullness is caused by water-Qi overflowing and failing to harmonize in the heart/epigastrium.

[Outline] Zhang Zhongjing stated: After taking Gui Zhi Tang, or after purgation, if head and neck stiffness/pain persist, fever feels like covering (Xi Xi Fa Re - mild fever), there is no sweat, epigastric fullness with slight pain, and urination is difficult, Gui Zhi Qu Gui Jia Fu Ling Bai Zhu Tang (Cinnamon Twig Decoction without Cinnamon Twig plus Poria and Atractylodes Macrocephala) is the primary treatment. Recovery occurs when urination becomes free.

[Commentary] Shen Jin'ao's Note: This is water-dampness knotting in the Middle Jiao (Middle Burner); it can only be drained, not dispersed. Because sweating was incomplete and purgation was hastily applied, water-Qi knotted in the epigastrium. Although the root is in the epigastrium, the pathology remains in the Bladder. Now, with difficult urination, this is essentially a Taiyang disease, not merely unresolved Gui Zhi syndrome. Thus, this formula is used to disperse pathogens and promote urination.

[Outline] Zhang Zhongjing stated: After sweating, if abdominal fullness occurs, Hou Po Sheng Jiang Gan Cao Ban Xia Ren Shen Tang (Magnolia Bark, Fresh Ginger, Licorice, Pinellia, and Ginseng Decoction) is the primary treatment.

[Commentary] Han Zhihe stated: Abdominal fullness indicates pathogens entering the Taiyin Spleen Earth. Constant pain indicates Interior Excess, requiring purgation such as Cheng Qi Tang (Order the Qi Decoction). Intermittent reduction indicates Interior Deficiency, requiring warming such as Li Zhong Tang (Regulate the Middle Decoction). If the exterior is resolved but internal accumulation persists, unless it is a major fullness, chills and fever may still occur, indicating pathogens have not fully entered the interior, so purgation is not yet appropriate. If there is major fullness and excess, accompanied by dry feces, pathogens have entered the Fu organs; even if four or five days have passed, purgation can be used. Generally, Yang pathogens causing heat lead to abdominal fullness and dry throat; Yin pathogens causing cold lead to abdominal fullness, vomiting/diarrhea, and inability to eat. If abdominal fullness occurs after vomiting or purgation, treatment methods differ, which must be known.

Ke Qin stated: This clause is not due to erroneous sweating, but pre-existing deficiency. Post-sweating excess symptoms indicate pathogen excess becoming solid; thus, Sheng Jiang (Fresh Ginger), Hou Po (Magnolia Bark), and Ban Xia (Pinellia) are used to disperse pathogens and remove fullness. Righteous Qi is deficient, so Ren Shen (Ginseng) and Gan Cao (Licorice) are used to tonify the Middle and boost Qi.

[Outline] Zhang Zhongjing stated: Originally a Taiyang disease, if the physician erroneously uses purgation, resulting in abdominal fullness and intermittent pain, it belongs to Taiyin. Gui Zhi Jia Shao Yao Tang (Cinnamon Twig Decoction increased with Paeonia) is the primary treatment. For severe excess pain, Gui Zhi Jia Da Huang Tang (Cinnamon Twig Decoction increased with Rhubarb) is the primary treatment.

[Commentary] Tao Hua stated: Yangming fever, abdominal fullness, slight wheezing, bitter taste, dry throat, or constipation with delirium: use Xiao Chai Hu Tang. Hiccups with difficult urination: add Fu Ling (Poria). Combined disease of Three Yangs, abdominal fullness, heaviness, difficulty turning, delirium, insensitivity in the mouth: use Xiao Chai Hu Tang. With sweating: use Bai Hu Tang (White Tiger Decoction). Taiyin abdominal fullness, vomiting food, inability to eat: use Ji Ju Li Zhong Wan (Aurantium and Isatis Pill regulating the Middle). Shaoying disease for six to seven days, abdominal fullness, constipation: urgent purgation with Da Cheng Qi Tang (Major Order the Qi Decoction). Abdominal fullness and pain due to Spleen failing to control water, water and Qi fighting between skin and flesh, rumbling sounds in abdomen: use Xiao Ban Xia Fu Ling Tang plus Gui Zhi (Cinnamon Twig). Diarrhea with abdominal fullness and body pain: first warm the interior with Si Ni Tang (Frigid Extremities Decoction), then attack the exterior with Gui Zhi Tang. Abdominal fullness after sweating: should be warmed with Hou Po Ban Xia Sheng Jiang Ren Shen Tang. Fullness after vomiting: should be purged with small doses of Tiao Wei Cheng Qi Tang (Regulate the Stomach Order the Qi Decoction). Fullness after purgation: use Zhi Zi Hou Po Tang (Gardenia and Magnolia Bark Decoction).

Abdominal fullness is due to disharmony of Yin and Yang; use Jie Geng Ban Xia Tang (Platycodon and Pinellia Decoction).

Ke Qin stated: Abdominal fullness with intermittent pain results from erroneous purgation, where Yang pathogens transfer to Taiyin, not a primary Taiyin disease. Since exterior symptoms persist, Gui Zhi Tang is still used to release the exterior. Since abdominal pain appears, Shao Yao (Paeonia) is doubled to harmonize the interior. This disease originates from Yang, so Yin herbs are used to harmonize Yang. If erroneous purgation leads to severe excess pain, Taiyang has transferred to Yangming with Stomach excess, yet has not left Taiyang; this is called having both exterior and interior symptoms. Gui Zhi Jia Da Huang Tang is still used to remove excess pain; this is a method of simultaneously resolving exterior and interior. Erroneous purgation inevitably damages Stomach Qi. If Stomach Qi is deficient, Yang pathogens invade Yin, transferring to Taiyin; if Stomach Qi is solid, two Yangs contend, transferring to Yangming. Taiyin presents with fullness and pain but not solidity, because the Yin pathway is deficient. Yangming presents with severe excess and pain, because the Yang pathway is solid. Fullness with intermittent pain is a sign of impending diarrhea; severe excess and pain is a sign of dry feces. Gui Zhi Jia Shao Yao Tang is a variation of Jian Zhong (Establish the Middle) formulas; Gui Zhi Jia Da Huang Tang is a variation of Tiao Wei Cheng Qi Tang.