天津张姓叟，年近五旬，于季夏得温热结胸证。
病因 心有忿怒，继复饱食，夜眠又当窗受风，晨起遂觉头疼发热，心下痞闷，服药数次病益进。
证候 初但心下痞闷，继则胸膈之间亦甚痞塞，且甚烦热，其脉左部沉弦，右部沉牢。
诊断 寒温下早成结胸，若表有外感，里有瘀积，不知表散药与消积药并用，而专事开破以
消其积，则外感乘虚而入亦可成结胸。审证察脉，其病属结胸无疑，然其结之非剧，本陷胸
汤之义而通变治之可也。
处方 病者旬余辍工，家几断炊，愚怜其贫，为拟简便之方，与以自制通彻丸（即牵牛轧取头次末，
水泛为小丸）五钱及自制离中丹两半，俾先服通彻丸三钱，迟一点半钟，若不觉药力猛烈，再服下所余
二钱，候须臾再服离中丹三钱，服后多饮开水，俾出汗。若痞塞开后，仍有余热者，将所余离中
丹分数次徐徐服之，每服后皆宜多饮开水取微汗。
效果 如法将两种药服下，痞塞与烦热皆愈。
天津赵××，年四十二岁，得温病结胸证。
病因 季春下旬，因饭后有汗出受风，翌日头疼，身热无汗，心中发闷，医者外散其表热，内
攻其发闷，服药后表未汗解而热与发闷转加剧。医者见服药无效，再疏方时益将攻破之药
加重，下大便一次，遂至成结胸证。
证候 胸中满闷异常，似觉有物填塞，压其气息不能上达，且发
热嗜饮水，小便不利，大便日溏泻两三次。其脉左部弦长，
右部中分似洪而重按不实，一息五至强。
诊断 此证因下早而成结胸，又因小便不利而致溏泻，即其证脉合参，此乃上实下虚外感之热
兼挟有阴虚之热也。治之者宜上开其结，下止其泻，兼清其内伤外感之热庶可奏效。
处方 生怀山药（一两五钱） 生莱菔子（一两捣碎） 滑石（一两） 生杭芍（六钱）
甘草（三钱）
共煎汤一大盅，温服。
复诊 服药后上焦之结已愈强半，气息颇形顺适，灼热亦减，已不感渴，大便仍溏，服药后下
一次，脉象较前平和仍微数，遂再即原方略加减之。
处方 生怀山药（一两五钱） 生莱菔子（八钱捣碎） 滑石（八钱） 生杭芍（五钱） 甘草（三钱）
先用白茅根（鲜者更好）、青竹茹各二两，同煎数沸，取汤以之代水煎药。
效果 将药煎服后，诸病皆愈，惟大便仍不实，俾每日用生怀山药细末两许，水调煮作茶汤，
以之送服西药百布圣五分，充作点心以善其后。
A surnamed Zhang, an elderly man from Tianjin, nearly fifty years old, contracted a Jie Xiong (Chest Binding Syndrome) caused by warm-heat pathogen at the end of summer.
Etiology He harbored anger in his heart, followed by overeating. At night, while sleeping, he was exposed to wind through an open window. Upon rising in the morning, he felt headache and fever, along with fullness and oppression in the epigastrium. After taking several doses of medicine, the condition worsened.
Symptoms Initially, there was only fullness and oppression in the epigastrium; subsequently, the chest and diaphragm became severely obstructed, accompanied by intense irritability and heat. The pulse was deep and wiry on the left position, and deep and firm on the right position.
Diagnosis If purgatives are used too early in cold or warm diseases, Jie Xiong (Chest Binding Syndrome) may result. If there is an external contraction on the surface and internal accumulation within, failing to combine exterior-releasing herbs with accumulation-dispersing herbs, but instead solely employing opening and breaking agents to eliminate accumulation, allows the external pathogen to enter due to deficiency, also resulting in Jie Xiong (Chest Binding Syndrome). Examining the signs and palpating the pulse, this disease undoubtedly belongs to Jie Xiong (Chest Binding Syndrome). However, the binding is not severe; treatment can be effective by adapting the principle of Tianxiong Tang (Pectoral Disimpacting Decoction).
Prescription Since the patient had been off work for over ten days and the family was nearly out of food, pitying his poverty, I prescribed a simple formula: Wutongche Wan (Unobstructed Pill, self-made), which consists of the finest powder of first-ground Qian Niu Zi (Morning Glory Seed, *Ipomoeae Semen*), formed into small pills with water, five qian, and Lizhong Dan (Inner Center Elixir, self-made), one and a half liang. He was instructed to take three qian of Wutongche Wan first. After an hour and a half, if the medicinal force did not feel too strong, he should take the remaining two qian. After a short while, he should take three qian of Lizhong Dan. After taking the medicine, drink plenty of boiled water to induce sweating. If after the obstruction opens, residual heat remains, take the remaining Lizhong Dan in divided doses slowly. After each dose, drink plenty of boiled water to induce slight sweating.
Outcome Following the method, both medicines were taken, and the obstruction and irritability/heat were completely cured.
Zhao XX from Tianjin, forty-two years old, contracted Jie Xiong (Chest Binding Syndrome) due to warm disease.
Etiology In the late part of the third lunar month, after eating, he sweated and was exposed to wind. The next day, he developed headache, body fever without sweat, and mental stuffiness. The physician treated the exterior heat with dispersing herbs and the internal stuffiness with attacking/purgative herbs. After taking the medicine, the exterior was not resolved through sweating, and the fever and stuffiness intensified. Seeing that the medicine was ineffective, the physician further increased the dosage of attacking and breaking herbs when prescribing again. After one bowel movement, Jie Xiong (Chest Binding Syndrome) was formed.
Symptoms There was extreme fullness and oppression in the chest, as if something were filling it, compressing the breath so it could not rise upwards. He had fever, thirst for drinking water, difficult urination, and loose stools two to three times daily. The pulse was string-long on the left position; on the right position, the middle portion seemed surging but was empty upon heavy pressure, beating more than five times per respiration.
Diagnosis This syndrome resulted in Jie Xiong (Chest Binding Syndrome) due to premature purgation, and the loose stools were caused by difficult urination. Combining symptoms and pulse, this is a case of upper excess and lower deficiency, where external-contracted heat is combined with yin-deficiency heat. Treatment should open the upper binding, stop the lower diarrhea, and simultaneously clear the internal heat from both injury and external contraction, which may achieve efficacy.
Prescription Raw Huai Shan Yao (Chinese Yam Rhizome, *Dioscoreae Hypoglaucae Rhizoma*) 1.5 liang, Raw Lai Fu Zi (Radish Seed, *Raphani Fructus*) 1 liang (crushed), Hua Shi (Talcum, *Talcum*) 1 liang, Raw Hang Shao (White Peony Root, *Paeoniae Radix Alba*) 6 qian, Gan Cao (Licorice Root, *Glycyrrhizae Radix et Rhizoma*) 3 qian.
Decoct together in a large cup of water, take warm.
Follow-up Visit After taking the medicine, the binding in the upper jiao was relieved by more than half, breathing became quite smooth, burning heat decreased, and thirst ceased. Stools remained loose, with one bowel movement after taking the medicine. The pulse was relatively peaceful compared to before, still slightly rapid. Therefore, the original prescription was slightly modified.
Prescription Raw Huai Shan Yao (Chinese Yam Rhizome, *Dioscoreae Hypoglaucae Rhizoma*) 1.5 liang, Raw Lai Fu Zi (Radish Seed, *Raphani Fructus*) 8 qian (crushed), Hua Shi (Talcum, *Talcum*) 8 qian, Raw Hang Shao (White Peony Root, *Paeoniae Radix Alba*) 5 qian, Gan Cao (Licorice Root, *Glycyrrhizae Radix et Rhizoma*) 3 qian.
First, decoct Bai Mao Gen (Imperata Rhizome, *Imperatae Rhizoma*, fresh is better) and Qing Zhu Ru (Bamboo Shavings, *Bambusae Caulis in Taenia*) each 2 liang, boil briefly, and use the decoction to replace water for decocting the main herbs.
Outcome After decocting and taking the medicine, all illnesses were cured, except that stools remained unformed. He was instructed to take about one liang of fine powder of Raw Huai Shan Yao (Chinese Yam Rhizome, *Dioscoreae Hypoglaucae Rhizoma*) daily, mixed with water and cooked into a tea-like consistency, to take with 5 fen of Western medicine Bromelain (Papain enzyme preparation) as a snack for convalescence.