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Whenever there is fever and aversion to cold with a floating pulse, it indicates an injury by Yang pathogenic factors. If purgation is employed too early, the pathogenic factors will fully enter the interior, resulting in Jie Xiong (Chest Binding). If there is no fever but only aversion to cold, with a deep and tight pulse, it indicates an injury by Yin pathogenic factors. If purgation is employed too early, the pathogenic factors will gather and knot at the epigastrium, forming Pi Syndrome (Epigastric Fullness and Obstruction). The *Classic* states: "When turbid Qi remains in the upper part, distension occurs." It also states: "When a disease originates from the Yin level, and purgation is wrongly applied, Pi Syndrome results." This refers to the aforementioned situation. However, Pi Syndrome must knot at the epigastrium, as this is where the Yin levels receive Qi. Jie Xiong presents with fullness and pain, indicating an Excess condition; Pi Syndrome presents with fullness without pain, indicating a Deficiency condition. Pi Syndrome accompanied by diarrhea indicates Deficiency, while constipation indicates Excess. If urination is difficult, and the presentation resembles Pi Syndrome but does not resolve with attacking methods, this is due to internal accumulation of Water-Fluids, leading to impaired fluid metabolism; treatment should focus on dispersing Water-Fluids for recovery. If there is epigastric fullness accompanied by aversion to cold, it indicates that both exterior and interior syndromes remain unresolved. One should first release the exterior, and subsequently treat the Pi Syndrome. Generally, various Pi Syndromes are heat-related, so treatment often employs cold-natured agents. Therefore, various Xi Xin Tang (Drain the Epigastrium Decoctions) are used to treat Pi and fullness caused by Shang Han (Cold Damage), because the fullness is located in the chest and heart region, not in the Stomach. Alternatively, Pi and fullness arising from miscellaneous diseases may differ in Cold, Heat, Deficiency, and Excess. *Bao Ming Ji* (Collection for Preserving Life) states: "If the Spleen cannot transport Qi to the four Zang organs, and Qi knots without dispersing, Pi Syndrome forms." For Pi Syndrome caused by Shang Han, which proceeds from the exterior to the interior, bitter-draining methods are appropriate. For Pi Syndrome caused by miscellaneous diseases, which proceeds from the interior to the exterior, acrid-dispersing methods are appropriate. Furthermore, if a patient has pre-existing accumulations and then contracts Shang Han, cold pathogenic factors entering the interior combine with these accumulations to form Pi Syndrome. This causes Zang Qi to knot and become obstructed, also known as Zang Jie (Zang Knotting). It necessarily involves pain radiating to the lower abdomen and penetrating into the genitalia, leading to death.

Wen Re Bing (Warm-Heat Diseases) arise from external contraction or internal injury, which stirs up latent Fire accumulating within, causing it to erupt from the interior to the exterior. In the initial stage, both the exterior and interior present with heat, so acrid-cool agents should be used to clear heat from both levels. After a prolonged period, exterior heat becomes mild while interior heat becomes severe; at this point, Cheng Qi Tang (Order the Qi Decoction) and other bitter-cold agents should be used to purge the interior. Once the heat recedes and the body cools, the disease resolves. If one is unfamiliar with Fu Wen Re (Latent Warm-Heat) syndromes, and mistakes the simultaneous exterior and interior heat for Ji Bing Shang Han (Immediate Cold Damage upon contraction), using Ma Huang Tang (Ephedra Decoction), an acrid-warm agent for releasing the exterior, will cause internal heat to intensify, leading to symptoms such as macules, jaundice, mania, and confusion. Or, if one fails to use acrid-cool agents to release the exterior and instead immediately uses Cheng Qi Tang, a bitter-cold agent to attack the interior, the exterior heat will not have dissipated, yet symptoms of Jie Xiong or Xu Pi (Deficient Epigastric Fullness) will appear.