问曰、病有结胸。有脏结。其状如何。答曰、按之痛。寸脉浮。关脉沉。名曰结胸也。何谓脏
结。答曰、如结胸状。饮食如故。时时下利。寸脉浮。关脉小细沉紧。名曰脏结。舌上白苔滑者。
难治。
此设为问答。以辨结胸、脏结之异。结胸者。邪结胸中。按之则痛。脏结者。邪结脏间。按之
亦痛。如结胸者。谓如结胸之按而痛也。然胸高而脏下。胸阳而脏阴。病状虽同。而所处之位则
不同。是以结胸不能食。脏结则饮食如故。结胸不必下利。脏结则时时下利。结胸关脉沉。脏结则
更小细紧。而其病之从表入里。与表犹未尽之故。则又无不同。故结胸、脏结。其寸脉俱浮也。
舌上白苔滑者。在里之阳不振。入结之邪已深。结邪非攻不去。而脏虚又不可攻。故曰难治。
脏结无阳证。不往来寒热。其人反静。舌上苔滑者。不可攻也。
邪结在脏。必阳气内动。或邪气外达。而后可施攻取之法。若无阳证。不往来寒热。则内动
外达之机俱
泯。是以其人反静。其舌苔反滑。邪气伏而不发。正气弱而不振。虽欲攻之。无可攻已。盖即上文
难治之端。而引其说如此。
病胁下素有痞。连在脐旁。痛引少腹入阴筋者。此名脏结。死。
脏结之证。不特伤寒。即杂病亦有之。曰胁下素有痞。则其病久而非暴矣。曰连在脐旁。痛引
少腹入阴筋。则其邪深而非浅矣。既深且久。攻之不去。补之无益。虽不卒死。亦无愈期矣。故曰
死。
Question: In diseases, there are conditions known as Jie Xiong (Chest Binding) and Zang Jie (Organ Binding). What are their clinical manifestations?
Answer: When pressed, there is pain; the Cun pulse (Inch pulse) is floating, and the Guan pulse (Carpal pulse) is deep. This is called Jie Xiong (Chest Binding).
What is meant by Zang Jie (Organ Binding)?
Answer: The condition resembles Jie Xiong (Chest Binding), but food intake remains normal, and there is frequent diarrhea. The Cun pulse (Inch pulse) is floating, while the Guan pulse (Carpal pulse) is small, fine, deep, and tight. This is called Zang Jie (Organ Binding). If there is a white and slippery coating on the tongue, it is difficult to treat.
This passage employs a question-and-answer format to distinguish between Jie Xiong (Chest Binding) and Zang Jie (Organ Binding). Jie Xiong (Chest Binding) refers to pathogenic factors binding in the chest region, causing pain upon pressure. Zang Jie (Organ Binding) refers to pathogenic factors binding within the organs, also causing pain upon pressure. "Resembling Jie Xiong" means resembling the tenderness upon pressure seen in Jie Xiong (Chest Binding). However, the chest is superior and belongs to Yang, whereas the organs (abdomen) are inferior and belong to Yin. Although the symptoms appear similar, their locations differ. Therefore, patients with Jie Xiong (Chest Binding) cannot eat, whereas those with Zang Jie (Organ Binding) maintain normal appetite; Jie Xiong (Chest Binding) does not necessarily involve diarrhea, whereas Zang Jie (Organ Binding) involves frequent diarrhea; the Guan pulse (Carpal pulse) in Jie Xiong (Chest Binding) is deep, whereas in Zang Jie (Organ Binding) it is even smaller, finer, and tighter. Regarding the progression of disease from exterior to interior, or the persistence of exterior patterns, there is no difference between the two. Thus, the Cun pulses (Inch pulses) for both Jie Xiong (Chest Binding) and Zang Jie (Organ Binding) are floating.
A white and slippery coating on the tongue indicates that the Yang Qi (Vital Energy) inside is not vigorous, and the invading pathogenic factors have penetrated deeply. The bound pathogens cannot be expelled without purgation, but since the Zang organs are deficient, purgation is contraindicated. Hence, it is said to be difficult to treat.
Zang Jie (Organ Binding) lacks Yang syndrome manifestations, such as alternating chills and fever (Wang Lai Han Re). The patient appears unusually quiet, and if the tongue coating is slippery, purgative methods must not be used.
When pathogens bind in the Zang organs, treatment with purgatives can only be applied after there is internal movement of Yang Qi or external expression of pathogens. If there are no Yang signs and no alternating chills and fever, the mechanisms of internal movement and external expression are absent. Consequently, the patient appears quiet, and the tongue coating becomes slippery. This indicates that pathogens are latent and unexpressed, while Zheng Qi (Upright Qi) is weak and unvigorous. Even if one wishes to purge, there is no basis for doing so. This elaborates on the previously mentioned difficulty in treatment.
If a patient has had a Pi Mass (Focal Distension) in the hypochondrium for a long time, extending to beside the umbilicus, with pain radiating to the Shaoyang abdomen and into the Yin sinews (genitals), this is called Zang Jie (Organ Binding), and the prognosis is fatal.
The condition of Zang Jie (Organ Binding) is not exclusive to Shang Han (Cold Damage); it also occurs in miscellaneous diseases. The phrase "having had a Pi Mass in the hypochondrium for a long time" implies a chronic rather than acute onset. The description "extending to beside the umbilicus, with pain radiating to the Shaoyang abdomen and into the Yin sinews" indicates deep-seated rather than superficial pathogens. Given the depth and chronicity, purgation fails to remove the pathogens, and tonification yields no benefit. Although death may not occur immediately, recovery is unlikely. Hence, it is described as fatal.