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(For relevant discussions, see the section on "Hypochondriac Fullness and Pain" involving hypochondriac diseases mentioned previously.)

Taiyang Disease: In a combined disease of Taiyang and Yangming, presenting with panting and chest fullness, purgation is contraindicated; Mahuang Tang (Ephedra Decoction) is appropriate. (Qi receives its nourishment in the chest. Panting with chest fullness indicates that Yang Qi fails to diffuse, leading to stagnation and rebellion. Fullness below the heart or in the abdomen belongs to excess patterns and should be treated with purgation. Here, the chest fullness is not due to interior excess, hence purgation is contraindicated. Although Yangming is involved, the combination with Taiyang indicates a exterior pattern, thus Mahuang Tang is suitable for inducing sweating.) If, after sweating or purgation, restlessness, fever, and a sensation of obstruction in the chest occur, Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) is appropriate. (Yang Qi receives its nourishment in the chest. Sweating or purgation may deplete Yang Qi, allowing pathogenic heat to lodge in the chest, knotting and failing to disperse, resulting in restlessness, fever, and chest obstruction. Zhizi Chi Tang is given to vomit out the pathogen from the chest.) If the condition resembles Guizhi Tang syndrome, but without headache or stiff neck, with a slightly floating pulse at the Cun position, chest痞 (pi, stuffiness/hardness), qi rushing up to the throat causing dyspnea, this is due to cold-fluid retention in the chest. Vomiting is indicated; Gouti San (Melon Seed Powder) is appropriate. (Resembling Guizhi Tang syndrome implies fever, sweating, and aversion to wind, indicating the pathogen is in the exterior. Headache and stiff neck are characteristic of Guizhi Tang syndrome; their absence suggests the pathogen has entered the interior. Floating pulse indicates exterior, sinking pulse indicates interior. A slightly floating pulse at the Cun position suggests the pathogen is neither in the exterior nor the interior, but in the chest. The chest corresponds to the exterior, so the condition resembles Guizhi Tang syndrome, yet the pulse differs. Chest pi, qi rushing to the throat, and dyspnea indicate cold pathogen lodging in the chest rather than the exterior. *Qianjin Fang* states: When qi floats to the upper part, filling the chest and heart, vomiting cures chest fullness. Gouti San is used to vomit pathogens from the chest. It is contraindicated if qi does not rush upward.) In Taiyang disease, after purgation, if a rapid, intermittent pulse (Cu Mai) and chest fullness occur, Guizhi Qu Shaoyao Tang (Cinnamon Twig Decoction without Paeonia) is appropriate. (Formula discussion see "Aversion to Cold"). If the pulse is Cu but not knotted (Jie), the disease is resolving. After purgation, if chest fullness and difficulty in urination occur, accompanied by restlessness, palpitations, delirium, heaviness of the body, and inability to turn over, Chaihu Jia Longgu Muli Tang (Bupleurum Decoction plus Dragon Bone and Oyster Shell) is appropriate. (Formula discussion see "Palpitations" category). If accompanied by hiccups and a thick tongue coating, it is Damp-Bi (Dampness Obstruction).

Yangming Disease: Tidal fever, loose stools, normal urination, and fullness in the chest and hypochondrium belong to Yangming disease. (See "Hypochondriac Fullness and Pain")

Shaoyang Disease: In Wind Strike, with deafness, red eyes, chest fullness, and irritability, if vomiting or purgation is used, it will lead to palpitations and fright. The remedy is Xiaochaihu Tang (Minor Bupleurum Decoction) minus Huangqin (Scutellaria Root), plus Fuling (Poria). (The Shaoyang meridian originates at the outer canthus, enters the ear, and its branch descends through the chest, piercing the diaphragm. Wind injury affects Qi; wind generates heat. Shaoyang pathogen causes Qi stagnation and heat, leading to deafness, red eyes, chest fullness, and irritability. The pathogen is in Shaoyang, a half-exterior, half-interior stage. Vomiting removes irritability but damages Qi, leading to palpitations due to Qi deficiency. Purging removes fullness but consumes Blood, leading to fright due to Blood deficiency.)

Taiyin Disease: The hallmark of Taiyin disease is abdominal fullness and vomiting, inability to eat, worsening spontaneous diarrhea, and occasional spontaneous abdominal pain. If purged, it will inevitably result in hardness and binding below the chest. (Taiyin disease involves the transmission of Yang pathogen into the interior. The Taiyin meridian spreads in the stomach; pathogen stagnation causes abdominal fullness. Upward failure to descend leads to vomiting and anorexia; downward failure to ascend leads to worsening spontaneous diarrhea. Occasional spontaneous abdominal pain occurs. Abdominal pain due to interior Yin-cold is typically constant; here, Yang pathogen interfering with the interior causes pain that is not constant, but occasional. Purging causes Yin pathogen to remain below the chest, forming hardness/binding. The Classics state: If a disease originating in Yin is wrongly purged, Pi (fullness/stuffiness) results. Xiexin Tang, Lizhong Tang, and Sini Tang are not indicated for non-thirsty patients. Zhao Huoren's Question 18 states: Taiyin is the meridian of the Spleen, governing chest and diaphragmatic distension. I have observed Cheng Wuji's *Mingli Lun* stating: The chest is close to the exterior, hence Zhang Zhongjing said panting with chest fullness is treated with Mahuang Tang as an exterior pattern treatable by sweating. He also stated chest and hypochondriac fullness is treated with Xiaochaihu Tang as a half-exterior, half-interior pattern treatable by harmonizing. As for Taiyin, it only mentions abdominal fullness, vomiting, anorexia, occasional abdominal pain, or abdominal fullness with dry throat. Thus, it is clear that Taiyin does not primarily govern the upper chest.)

Shaoyin Disease: Disease presenting with diarrhea, sore throat, chest fullness, and irritability is treated with Zhufu Tang (Pig Skin Decoction). (The Shaoyin meridian ascends from the Kidney, passes through the Liver and Diaphragm, enters the Lung, and follows the throat; its branch emerges from the Lung, connects with the Heart, and pours into the chest. Pathogen transmits from Yang meridians to Shaoyin. Yin deficiency with exogenous heat causes diarrhea, sore throat, chest fullness, and irritability. Zhufu Tang nourishes Yin and dissipates heat; among the five formulas for sore throat, it effectively resolves toxicity.)

Jueyin Disease: Patients with cold extremities and a suddenly tight pulse, where pathogen knots in the chest, causing epigastric fullness and irritability, hunger but inability to eat, the pathology is in the chest. Vomiting is indicated; Gouti San (Melon Seed Powder) is appropriate. (Cold extremities indicate pathogen sinking inward. Tight, firm pulse indicates excess. Pathogen entering Fu organs presents with sinking pulse; sudden tightness indicates pathogen knotting in the chest as excess, causing epigastric fullness and irritability. Absence of pathogen in the Stomach leads to hunger, but pathology in the chest prevents eating despite hunger. Gouti San is used to vomit pathogen from the chest. Cold extremities must be distinguished by tight pulse and chest pain.) The syndrome of "slight heat, slight cold extremities, chest and hypochondriac irritability and fullness" was mentioned previously.

Wu's Clinical Experience: For chest fullness, vomiting methods are often used. Excess patterns suit Gouti San; deficiency patterns suit Ren Shen Lu (Deer Antler Velvet) or drinking Xiangsu San (Fragrant Su Decoction) and inducing vomiting by probing the throat. Generally, after three to four days of Shanghan (Cold Damage), when the pathogen transmits to the Shaoyang meridian, presenting with wiry pulse, bitter taste, fever, and chest fullness, Xiaochaihu Tang is appropriate. If there is chest stuffiness, add Zhiqiao (Aurantii Fructus) and Jiegeng (Platycodon Root) each 2 qian to promote Qi movement. If there is chest and hypochondriac fullness with irritability, add Gualou Shi (Trichosanthes Fruit) 3 qian and Huanglian (Coptis Rhizome) 1.5 qian. *Huoren Shu* treats chest fullness and Qi Pi (Qi Stuffiness) without relief using only Zhiqiao and Jiegeng each 2 qian and Shengjiang (Fresh Ginger) 5 slices, named Zhiqiao Tang. Generally, above the Heart and in the chest region, Zhiqiao is suitable; below the Heart and in the Stomach region, Zhishi (Immature Aurantium) is suitable. Zhiqiao drains Qi from the highest level, while Zhishi drains Qi from the lowest level. Gualou Ren (Trichosanthes Seed) is a key herb for draining the Lungs and washing away phlegm turbidity in the chest; thus, it must be added for chest fullness with irritability. Another method for treating Qi Pi and chest fullness: use 1-2 sheng of wheat bran, stir-fry with sliced raw Zhiqiao until hot, remove Zhiqiao, wrap the hot bran in cloth, and apply as a compress to the chest. Heat disperses easily, promoting Qi dispersion and cure.