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Zhang Jianshan stated: If the auricle is red and lustrous, the prognosis is good. If the auricle is yellow, white, black, or blue and dry withered, the prognosis is poor. Thinness with a white color, or thinness with a black color, both indicate failure of the Kidney (Shen). Deafness or pain in the ears generally belongs to heat in the Shaoyang (Lesser Yang) channel and is treatable. However, deafness accompanied by tongue retraction and cyanosis of the lips belongs to the Jueyin (Terminal Yin) stage and is difficult to treat. If the eyes are bright and capable of recognition, it is treatable. If the gaze is dim and unable to recognize people, or if the eyes roll upward, stare fixedly, remain round and fixed, look upward with opisthotonos, or if the eyelids are sunken, these are all untreatable. Those who keep their eyes open and wish to see people have a Yang syndrome (Yang Zheng). Those who keep their eyes closed and do not wish to see people have a Yin syndrome (Yin Zheng). A vague vision and discordant gaze indicate excessive internal heat. Eye pain belongs to heat in the Yangming (Bright Yang) channel. Red eyes also indicate excessive heat. Photophobia and eye closure will inevitably lead to epistaxis (nosebleed). Yellow sclera indicates impending icterus (jaundice). When a disease is about to resolve, signs include slight yellowing of the eyes, brightness of the nasal tip, and luminosity of the shangen (root of the nose).

[Gang] Zhang Zhongjing said: When Taiyang (Greater Yang) and Shaoyang syndromes occur simultaneously, with a wiry pulse, stiffness and pain in the head and neck, occasional dizziness or vertigo, symptoms that occasionally resemble chest binding (Jie Xiong), and fullness and hardness below the heart, one should needle the first interspace of the Dazhui (GV14) point, as well as Feishu (BL13) and Ganshu (BL18). One must be cautious against inducing sweating; if sweating is induced, it leads to delirium. If delirium persists, one should needle the Qimen (LR14) point.

[Mu] Zhu Gong said: Chest binding (Jie Xiong) and fullness obstruction (Pi) arise because when a disease originates in the Yang aspect, premature purgation results in chest binding; when a disease originates in the Yin aspect, premature purgation results in fullness obstruction. Although chest binding and fullness obstruction are similar, they differ in whether there is pain. Fullness and hardness with pain below the heart is called chest binding; fullness upon palpation without pain is called fullness obstruction. If physicians fail to examine carefully, any error can immediately lead to critical danger. Chest binding belongs to the category of Xianxiong (Depressing the Chest) formulas, while fullness obstruction belongs to the category of Xiexin (Draining the Heart) formulas. Details are discussed in their respective sections. Tightness and fullness below the heart, which feels hard as stone and painful upon pressure, is named chest binding. Shanyin originally does not have chest binding; rather, when body heat is present and purgation is used prematurely, heat enters through the deficiency, stagnates, and forms chest binding.

If the condition has already been altered by error, and chest binding has not yet fully formed, administer Lizhong Tang (Regulate the Middle Decoction) urgently to resolve it naturally and prevent the formation of chest binding, as Lizhong Tang treats the Middle Jiao. This was not mentioned by ancients but understood by later generations through reflection. If the condition deteriorates severely with signs of jue (cold limbs), combine with Sini Tang (Frigid Extremities Decoction) for stabilization. Even if the stomach qi harmonizes, if shanghan pathogens remain, wait until the appropriate days pass and the pulse becomes deep and tight; this is named chest binding. Generally, chest binding should be treated with purgation. However, if the pulse is floating or large, purgation is contraindicated; purging will cause death. Sweating may still be appropriate. Zhang Zhongjing stated: If the pulse in chest binding is floating, do not purge; use Xiaoxiantong Tang (Minor Inhibiting the Binding Decoction) only. Generally, a floating pulse indicates residual exterior syndrome. Use Xiao Chaihu Tang (Minor Bupleurum Decoction) etc. to release the exterior first. Once the exterior syndrome resolves, then use purgative medicines for chest binding for safety.

Cui Xinggong of the Western Jin dynasty stated: In critical cases of shanghan chest binding where the epigastrium and diaphragm are elevated and tender to touch, if Da Xiantong Tang (Major Inhibiting the Binding Decoction) fails, this is due to post-purgative deficiency and rebellious qi, where toxins attack upward again, causing qi and toxin to clash and bind in the chest. Administer Zhishi Lizhong Wan (Immature Bitter Orange Regulate the Middle Pill) to regulate the qi first, then treat other diseases. It works miraculously in ancient and modern times, bringing recovery promptly.

[Gang] Zhang Zhongjing said: When Taiyang and Shaoyang syndromes occur simultaneously, and purgation is wrongly applied, resulting in chest binding with hardness below the heart, incessant diarrhea, inability to take fluids, and mental restlessness.

[Mu] Zhu Gong said: There are three types of chest binding. Major chest binding involves pain without pressure, hardness extending from the chest to the umbilicus and abdomen, treated with Da Xiantong Wan. Minor chest binding involves pain below the heart upon pressure, treated with Xiaoxiantong Tang. Water chest binding occurs between the chest and hypochondrium, with slight sweating on the head and no high fever, treated with Xiao Banxia Jiashengfu Tang (Minor Pinellia plus Alisma and Poria Decoction) or Xiaochaihu Tang minus Zao plus Muli (Minor Bupleurum Decoction minus Jujube plus Oyster Shell). There are also cold and heat patterns. Excess-heat chest binding presents with chest irritability, mental vexation, dry tongue, thirst, and a deep slippery pulse, treated with Da Xiantong Tang. Cold-excess chest binding lacks heat signs, treated with Sanwu Baisan (Three-Ingredient White Powder) or Zhishi Lizhong Wan. Recent treatments often use Jinzhen Wan containing Sulfur and Qiyangshi (Quicksilver Ore); this may cure cold-excess chest binding but will kill patients with excess-heat chest binding. Zangjie (Visceral Binding) lacks yang signs, has no alternating chills and fever, the patient is quiet, and the tongue coating is slippery; it cannot be attacked. If a patient has old pi below the chest extending to the side of the umbilicus, with pain radiating to the lower abdomen and genitalia, it is also named Zangjie, a fatal untreatable condition.

Wei Litong said: The preceding clause states: In Taiyang-Shaoyang simultaneous syndrome with hardness below the heart, stiff neck, and dizziness, needle Dazhui, Feishu, and Ganshu, and strictly avoid purgation. Since the pathogen combines in Taiyang, treatment should target Taiyang, using needling to drain the pathogen. Strictly forbid purgation. If needling is used instead of purgation, it is correct. If purgation is wrongly used, the previous wind factor resembling chest binding will become true chest binding; the previous cold factor causing pi hardness will become harder; the combined wind-cold factors will result in true chest binding and increased pi hardness. This harm arises from failing to treat the simultaneous syndrome via the Taiyang exterior with needling and instead mistakenly using purgation. If purgation stops diarrhea immediately, those with strong constitution may survive. However, those with weak constitutions suffer incessant diarrhea, upper chest binding/pi, and lower diarrhea, preventing fluid intake. Yang sinks into Yin and cannot rise; Yin sinks into Yang and cannot descend. Upper and lower are separated, fluids do not flow, the Middle Jiao dries up, and mental restlessness leads to agitation. Death from chest binding with diarrhea and agitation is imminent.

[Gang] Zhang Zhongjing said: In shanghan after five or six days, vomiting and fever indicate Chaihu Tang syndrome. If purged with other medicines, and there is fullness and hardness with pain below the heart, this is chest binding, treated with Da Xiantong Tang. If there is fullness without pain, it is pi, and Chaihu Tang is inappropriate; Banxia Xiexin Tang (Pinellia Draining the Heart Decoction) is suitable.

[Mu] Zhang Jianbin said: Only when abdominal distension, fullness, hardness, and pain are intolerable to touch is it chest binding. If there is fullness without pain, it is pi-fullness. Pi-fullness arises when exterior pathogens transmit to the chest but have not entered the fu organs. This state is on the verge of entering, retaining exterior characteristics, representing a half-exterior, half-interior syndrome. It should be treated with Xiao Chaihu Tang plus Zhike (Aurantii Fructus) or combined with Xiaoxiantong Tang. For chest binding, Zhang Zhongjing uses Da Xiantong Tang. However, in my view, Da Xiantong Tang is suitable only for shanghan proper where real pathogens transmit inward without erroneous purgation, presenting with hardness/fullness below the heart, pain radiating to the lower abdomen, dryness/thirst, delirium, hard stool, and a deep, solid, forceful pulse. If Taiyang-Shaoyang exterior pathogens remain unresolved and chest binding results from premature purgation, the exterior pathogen is still present. Using Da Xiantong Tang would constitute double purgation, which I dare not do. Instead, one should select methods from the pi-fullness section, assess severity, and use dual-resolution methods for gentle treatment, or apply external compresses to dissipate interior excess. This is my method that consistently succeeds and is the safest and quickest.