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When pathogenic factors transmit inward, they must first enter from the chest, then pass through the hypochondrium, sequentially entering the epigastrium and abdomen, and finally reaching the stomach. Therefore, fullness in the chest is often accompanied by exterior syndrome, while fullness in the hypochondrium is often accompanied by half-exterior half-interior syndrome. For instance, if pulse is rapid (Cu) and there is chest fullness after sweating or purging, Guizhi Qu Shaoyao Tang (Cinnamon Twig Decoction without Paeonia) should be used. Similarly, in the combined disease of Taiyang and Yangming with wheezing and chest fullness, purging is contraindicated, and Mahuang Tang (Ephedra Decoction) is appropriate. Both cases belong to exterior syndromes and require diaphoresis because the chest is close to the exterior. Regarding the hypochondrium, diaphoresis is no longer mentioned; instead, harmonization is employed. The Classic states: If there is chest fullness and hypochondriac pain, or persistent fullness in the chest and hypochondrium, or if a primary Taiyang disease does not resolve but transmits to Shaoyang presenting with hardness and fullness below the hypochondrium, dry retching, alternating chills and fever, and a deep-tight pulse, Xiaochaihu Tang (Minor Bupleurum Decoction) is suitable for harmonization. Generally, when pathogenic factors first enter the interior and have not yet stagnated to form excess, causing only distension due to depression and accumulation, harmonization suffices. However, if pathogens remain in the chest and condense into excess, neither vomiting nor purging alone may suffice. For example, after sweating or purging, if irritability, heat, and a sensation of obstruction in the chest occur, Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) is indicated. If there is palpitation and hardness in the chest with qi rushing up to the throat causing difficulty in breathing, this indicates cold-phlegm in the chest, and Gengti San (Seed of Melon Citron Powder) is used. Both are emetics; it should be known that Zhizi Chi Tang expels deficiency-heat and guest-heat, while Gengti San expels phlegm-excess and retained cold.

If ten days have passed since the onset of Taiyang disease, and the pulse is floating and fine with a desire to sleep, the exterior has resolved. If there is still chest fullness and hypochondriac pain, administer Xiaochaihu Tang (Minor Bupleurum Decoction); if the pulse is floating, administer Mahuang Tang (Ephedra Decoction). In Shanghan (Cold Damage) of four or five days, with body heat, aversion to wind, stiffness of the head and neck, fullness below the hypochondrium, warm hands and feet, and thirst, Xiaochaihu Tang modified by removing Banxia (Pinellia Rhizome) and adding Gualougen (Trichosanthes Root) is the primary treatment. In Shanghan of five or six days with Fengzhong (Wind Strike), presenting with alternating chills and fever, bitter fullness in the chest and hypochondrium, loss of appetite, vexation, and frequent retching, or vexation in the chest without retching, thirst, abdominal fullness, hardness below the hypochondrium, palpitations, difficult urination, absence of thirst with slight body heat, or cough, Xiaochaihu Tang (Minor Bupleurum Decoction) is the primary treatment.

After thirteen days of unresolved Shanghan, with chest and hypochondriac fullness and vomiting, tidal fever occurring at dusk, followed by mild diarrhea, this was originally a Chaihu (Bupleurum) pattern. Improper purging failed to stop the diarrhea; now the diarrhea persists, indicating the physician incorrectly used pill-based purgatives. Tidal fever indicates excess. First, use Xiaochaihu Tang (Minor Bupleurum Decoction) to resolve the exterior, then treat with Chaihu Jia Mangxiao Tang (Bupleurum Decoction plus Gypsum).

Six or seven days after contracting disease, with a slow, floating, and weak pulse, aversion to wind and cold, and warm hands and feet, if the physician repeatedly purged, leading to inability to eat, hypochondriac fullness and pain, yellowing of the face, eyes, and body, neck stiffness, and difficult urination, administering Chaihu Tang will inevitably cause a sensation of heaviness in the anus. For heat pathogens transmitting meridians causing hypochondriac fullness and dry retching, Dachaihu Tang (Major Bupleurum Decoction) is used. In Taiyang Fengzhong (Wind Strike) with diarrhea and vomiting, once the exterior is resolved, internal attack is permissible. If the patient sweats intermittently, has headache, epigastric palpitation and hardness radiating to the hypochondrium, dry retching, shortness of breath, sweating without aversion to cold, this indicates the exterior is resolved but the interior is disharmonious; Shizao Tang (Ten Jujube Decoction) is indicated.

Shizao Tang Formula: Yuanhua (Genkwa Flower, stir-fried until black), Gansui (Kansui Root), Daji (Euphorbia Lathyris Root) in equal parts. Grind into fine powder, mix, and pound in a mortar two or three hundred times. Boil ten large jujubes in one sheng of water until reduced to five or six he, strain, and add the powder. Strong individuals take one qian; weak individuals take half a qian. Take alone with jujube decoction in the morning on an empty stomach. If defecation is insufficient and disease remains, take again the next day, increasing by half a qian. Regulate with millet porridge after purging. Failure to purge when indicated leads to abdominal distension and generalized edema. Du Ren once asked Sun Zhao: "What disease does Shizao Tang ultimately treat?" Sun Zhao replied: "It treats Taiyang Fengzhong where the exterior is resolved but the interior is disharmonious." Du Ren asked: "How do you know the interior is disharmonious?" Sun Zhao said: "Headache, epigastric fullness and hardness, hypochondriac pain, dry retching, and sweating indicate interior disharmony." Du Ren said: "You described the symptoms, but not the root cause of the interior disharmony." Sun Zhao said: "I had doubts about this and wish to hear your explanation." Du Ren said: "The cause of interior disharmony is phlegm and dry qi obstructing the middle jiao, causing headache, dry retching, shortness of breath, and sweating; this is Phlegm Diaphragm syndrome, which requires Shizao Tang. However, this decoction should not be used lightly as it may damage the body suddenly; physicians must be cautious."

In Yangming disease, with tidal fever, loose stools, normal urination, but persistent hypochondriac fullness, Xiaochaihu Tang (Minor Bupleurum Decoction) is the primary treatment. In Yangming disease, with hardness below the hypochondrium, constipation, vomiting, and a white coating on the tongue, Xiaochaihu Tang (Minor Bupleurum Decoction) is used. In Yangming Fengzhong, with string-like, floating, and large pulse, shortness of breath, general abdominal fullness, pain in the hypochondrium and heart region, obstruction of qi upon prolonged pressing, dry nose, inability to sweat, lethargy, jaundice of the whole body and eyes, difficult urination, tidal fever, and occasional hiccups, Xiaochaihu Tang (Minor Bupleurum Decoction) is used. If the pulse is merely floating without other symptoms, Mahuang Tang (Ephedra Decoction) is used. If there is original thirst, drinking water leads to vomiting; Chaihu Tang is contraindicated (Thirst without desire to drink and vomiting is a Chaihu pattern; vomiting due to water intake indicates water retention in the epigastrium).

In Shaoyang disease, hypochondriac fullness, dry retching, and alternating chills and fever belong to Shaoyang (See formula discussion under 'Alternating Chills and Fever').

In Jueyin disease, Shanghan with little heat and slight cold extremities, cold fingertips, silence, lack of desire to eat, and vexation for several days, with clear urine, indicates heat elimination. Desire to eat indicates recovery. If cold extremities, vomiting, and vexation/fullness in the chest and hypochondrium occur, hematochezia will likely result (use Huangqin Shaoyao Tang, Xiaochaihu Tang, or Didang Tang).

Wu Shou treated hypochondriac pain by adding Zhike (Aurantii Fructus), Qingpi (Citrus Reticulata Pericarpium), Jiegeng (Platycodon Root), and Shaoyao (Paeonia Root) to the formula. For hardness below the hypochondrium, add Muli (Ostrea Shell). If chills, spasm, alternating chills and fever, and chest/hypochondriac fullness increase, add Guizhi (Cinnamon Twig) and Baishao (White Peony Root), all added to Xiaochaihu Tang (Minor Bupleurum Decoction).

In women with fever and aversion to cold during menstruation, if fever subsides, pulse becomes slow, body cools, hypochondriac fullness resembles Jiechesthag (Phlegm-Rheum binding in chest), and delirium occurs, puncture Qimen (LR14). (See discussion under 'Delirium').

After vomiting, purging, or sweating, if pulse is faint, epigastric palpitation, hypochondriac pain, qi rushing to the throat, dizziness, palpitations, and tremors occur, Wei Syndrome (flaccidity syndrome) develops. (See discussion under 'Palpitation'). After purging, if the pulse is string-like, bilateral hypochondriac tension is inevitable. If there is a pre-existing mass below the hypochondrium connected to the umbilicus, with pain radiating to the lower abdomen and genitals, named Zangjie (Organ Knot), the prognosis is fatal. (Left and right are the pathways of Yin and Yang; the hypochondrium is this region. A pre-existing mass here blocks the pathways of Yin and Yang, preventing pathogenic transmission via meridians and allowing direct entry into the Zang organs, hence death.)