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There are cases of fullness in the epigastrium not caused by sweating or purging. The *Classic* states: "When pathogenic factors are knotted in the chest, there is fullness and irritability in the heart/chest, hunger but no desire to eat; emesis should be used." It also states: "If the pulse is floating and large, and the epigastrium is conversely hard with internal heat, if the disease belongs to the Zang organs (pathogens deeply entrenched in the viscera), purgation should be used." Wu Shi explains: "What is meant by 'belongs to the Zang' is that old stool is retained in the intestines; in this case, diaphoresis (sweating) should not be induced." These two situations—one using emesis and one using purgation—are treatments based on the high or low location of the pathogen.

There are also situations where purgation must not be used. For example, in Yangming disease, if there is hardness and fullness in the epigastrium, it cannot be purged. If purgation leads to unceasing diarrhea, the prognosis is fatal; if the diarrhea stops, the patient recovers. This is because the pathogen is between the exterior and interior, lingering in the epigastrium and not yet fully entering the Fu organs; thus, it is warned against being purged.

There are also cases of epigastric fullness with slight pain after sweating or purging, and cases of rebellious Qi causing fullness in the epigastrium after vomiting or purging, which are suitable for Guizhi Baizhu Fuling Tang (Cinnamon Twig, Atractodes Macrocephala, and Poria Decoction). There are also cases where purgation leads to hardness and fullness in the epigastrium, forming Jie Xiong (Chest Binding) or Pi (Glomus) syndromes; these require careful examination and cross-referencing.

Taiyang disease (treated with harmonizing methods): After taking Guizhi Tang (Cinnamon Twig Decoction) or undergoing purgation, if there is still stiffness and pain in the head and neck, fever resembling a feather's touch (Xi Xi Fa Re), absence of sweat, epigastric fullness, slight pain, and difficulty in urination, Guizhi Qu Gui Jia Fuling Baizhu Tang (Cinnamon Twig Decoction without Cinnamon Twig plus Poria and Atractodes Macrocephala) is indicated.

After Tai Shang (Cold Damage) is treated with vomiting or purging, if there is rebellious Qi causing fullness in the epigastrium, Qi rushing up to the chest, dizziness upon rising, and a sinking, tight pulse; if further sweating disturbs the meridians causing the body to tremble and shake, Fuling Guizhi Baizhu Gancao Tang (Poria, Cinnamon Twig, Atractodes Macrocephala, and Licorice Decoction) is indicated.

In Tai Shang for six or seven days, with fever, slight aversion to cold, vexing pain in the joints, slight vomiting, and "Zhi Jie" (supporting knot/fullness) in the epigastrium, while exterior symptoms persist, Chaihu Jia Guizhi Tang (Bupleurum plus Cinnamon Twig Decoction) is the primary treatment. (*Huo Ren Shu* states: Fullness without hardness, with vexation in the epigastrium, is called "Zhi Jie"; also, excessive water intake causing water retention is treated with Xiao Banxia Fuling Tang (Minor Pinellia and Poria Decoction)).

After Tai Shang (treated with vomiting) for five or six days, if body heat persists after bowel movement and there is knotted pain in the heart/mind, Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) is indicated.

In Tai Shang with fever, if sweating does not resolve the heat, and there is epigastric glomus/hardness, vomiting, and diarrhea, Da Chaihu Tang (Major Bupleurum Decoction) is indicated.

Simultaneous Taiyang and Shaoyang disease (treated with acupuncture): If there is epigastric hardness, neck stiffness, and dizziness, Da Zhui (GV14) and Fei Shu (BL13) should be needled; do not use purgation.

Moxibustion/Ironing Method: If there is knotted pathogenic factors in the chest, heart, and hypochondrium causing fullness, stuffiness, hardness, and pain, take one slice of fresh ginger, mash it, squeeze out the juice, stir-fry the residue until slightly dry but still moist, wrap it in silk, and gently iron/press it on the affected area. When slightly relieved, mix the residue with the previous juice, stir-fry until dry, and iron again for a long time until suddenly feeling relaxed and comfortable. This is an excellent method.

In Tai Shang for five or six days, with only head sweating, slight aversion to cold, cold hands and feet, epigastric fullness, no desire to eat, hard stools, and a fine pulse, this is "Yang Wei Jie" (Slight Yang Knotting), having both exterior and interior aspects. A sinking pulse also indicates interior involvement. If it were pure Yin knotting, there would be no exterior symptoms. Although the pulse is sinking and tight, it cannot be diagnosed as Shaoyin disease because of the head sweating; thus, it is known not to be Shaoyin. Xiao Chaihu Tang (Minor Bupleurum Decoction) is appropriate. If the patient remains uncomfortable, resolution will occur after passing stool.

Yangming disease: If there is hardness and fullness in the epigastrium, it cannot be purged. If purging leads to unceasing diarrhea, death ensues; if the diarrhea stops, recovery occurs. (Alternatively, use Xi Xin Tang (Heart-Draining Decoctions). Abdominal fullness in Yangming disease indicates pathogens have entered the Fu organs and can be purged; however, epigastric hardness indicates the pathogen is still shallow and has not fully entered the Fu organs, so immediate purging is contraindicated. If diarrhea stops after purging, the pathogen is gone and Zheng Qi (Upright Qi) is secure, leading to recovery; if purging causes unceasing diarrhea, Zheng Qi collapses, leading to death.)

For illness lasting two to three days, with a weak pulse, no Taiyang or Shaoyang symptoms, irritability, and epigastric hardness; progressing to four or five days, even if the patient can eat, give Xiao Chengqi Tang (Minor Order the Qi Decoction) in small amounts to slightly harmonize the stomach. (See details on Stomach Excess).

Jueyin disease: If the patient has cold extremities and a pulse that suddenly becomes tight, the pathogen is knotted in the chest. With fullness and irritability in the heart, hunger but no desire to eat, and the disease located in the chest, emesis is required. Geng Ti San (Melon Seed Powder) is indicated.

Wu Shi's Commentary: Whenever there is fullness in the epigastrium, it is located below the heart and above the stomach. This is spontaneous fullness, not caused by purging. If premature purging causes epigastric fullness, this is called "Pi Qi" (Glomus Qi), which has separate treatment guidelines. For any epigastric fullness that dissipates and softens upon pressing and rubbing, this is deficiency Qi. If there is no fever, Muxiang Hezhong Tang (Costus Harmonizing the Middle Decoction) is used. If there is fever, Xiao Chaihu Tang (Minor Bupleurum Decoction) is used with added Zhishi (Immature Bitter Orange, 1 qian), Huangqin (Scutellaria Root) removed, Jiang Chao Huanglian (Ginger-processed Coptis Rhizome, 1 qian) added, and Renshen (Ginseng Root) reduced by half. If pressing produces a sound of fluid, there is retained water. If pressing yields hardness and pain, there is retained food. If there is pain without pressing, and the patient suffers from forgetfulness, there is accumulated blood. Each has its own specific clause and requires careful examination and treatment. For any Shaoyang disease presenting with a wiry pulse, bitter taste in the mouth, fever, and epigastric fullness, Xiao Chaihu Tang (Minor Bupleurum Decoction) is used with added Zhishi (Immature Bitter Orange) and Huanglian (Coptis Rhizome), each 1 qian.