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The syndrome of Jie Xiong (Chest Binding) differs in etiology between internal injury and external contraction. Internal Jie Xiong is generally caused by cold-fluid retention coagulating between the cardia, obstructing the Stomach Qi from ascending and preventing food and drink from descending. Treatment should employ Gan Jiang (Dried Ginger, 8 qian), Zhe Shi (Hematite, 1.5 liang), Hou Po (Magnolia Bark, 3 qian), and Gan Cao (Licorice Root, 3 qian) to open the obstruction. In children, if Spleen and Stomach Yang deficiency leads to cold-fluid filling the chest, causing vomiting of food and drink resulting in Man Jing Feng (Slow Convulsion), this also belongs to the category of cold-fluid Jie Xiong. It can be treated with Zhu Han Dang Jing Tang (Cold-Expelling Shock-Shaking Decoction) from Zhu Zaitian's *Fu You Bian*. If cold-phlegm remains unresolved and vomiting persists after using this formula, the amount of Hu Jiao (Black Pepper) in the formula can be doubled to 2 qian. If it is not cold-fluid Jie Xiong, but rather stubborn phlegm or heat-phlegm Jie Xiong, blocking the Qi transformation in the chest so that it cannot ascend or descend, potentially affecting respiration and posing an immediate danger, emergency rescue can be achieved by taking Peng Sha (Borax, 4 qian) dissolved in boiling water to induce expectoration. For stubborn phlegm, Gua Lou Ren (Trichosanthes Seed, 2 liang) and Ku Ting Li (Descurainia Seed, 3 qian, bagged) can be decocted and drunk to purge the phlegm. For heat-phlegm, Mang Xiao (Mirabilite, 4 qian) can be added to the formula. Cases involving sinking of the Great Qi in the chest combined with cold-fluid Jie Xiong are particularly difficult to treat. (A case of an elderly surnamed Zhao was treated; see the section on Hui Yang Sheng Xian Tang for details).

Regarding external Jie Xiong, it occurs in both Shang Han (Cold Damage) and Wen Bing (Warm Diseases). In Shang Han, premature use of purgatives can lead to Jie Xiong; in Wen Bing, Jie Xiong can occur even without premature purging. Both result from external pathogenic factors sinking inward and adhering with phlegm-fluid in the chest. Regardless of whether it is Shang Han or Wen Bing, the treatment principles can be similar. Da Xian Xiong Tang (Major Inward-Draining Chest Decoction) and Da Xian Xiong Wan (Major Inward-Draining Chest Pill) from *Shang Han Lun* are excellent formulas for treating external Jie Xiong; they should be selected based on the severity and depth of the disease. My own proposed Dang Xiong Tang (Chest-Purging Decoction) can also be modified to substitute for various Xian Xiong formulas and pills.

There are cases where internal and external Jie Xiong combine to form a highly dangerous syndrome. In Fengtian, I once treated Mr. Hao, aged over forty, who suffered from epigastric fullness and blockage, inability to swallow food, and failed treatments by other physicians. After one week of treatment at a Japanese hospital, there was still no improvement. He eventually became bedridden, expectorating foul-smelling sputum, and experienced mental confusion. Subsequent physicians diagnosed advanced lung disease complicated by stomach disease, deeming it untreatable. His family, in panic, invited me. His pulse was wiry on both sides, stronger on the right. The tongue coating was thick white with slight yellow. His skin felt hot to touch, and he reported feeling heat in the heart/chest area, craving cool foods, and having had no bowel movement for four to five days. He described extreme chest fullness and had not eaten for several days. Although his sputum was foul-smelling, he perceived it as cold. After careful consideration, I determined this was Wen Bing Jie Xiong. However, why was the pulse wiry yet forceful rather than surging, and why was the sputum both foul and cold? This was due to his pre-existing cold-fluid retention; his baseline pulse is typically wiry, and his usual sputum is cold (he did not notice this previously, but now perceives the sputum as cold because the throat feels hot from the warm disease). The heat of the Wen Bing mixed with his cold-fluid condition. Thus, although the pulse was wiry, it remained forceful due to the heat; although the sputum was cold, it became foul-smelling due to steaming by the Wen Bing heat. I prescribed: Gua Lou Ren (Trichosanthes Seed) and raw Zhe Shi (Hematite powder), each 1 liang; Xuan Shen (Scrophularia Root) and Zhi Mu (Anemarrhena Rhizome), each 8 qian; Su Zi (Perilla Fruit), Ban Xia (Pinellia Tuber), Dang Shen (Codonopsis Root), and Sheng Jiang (Fresh Ginger), each 4 qian. These were decocted, and the liquid was used to take Lu Mi Na (Phenobarbital, 4 qian). After one dose, the chest felt clear, allowing him to eat. The right pulse became softer, the tongue coating turned white, but he still felt heat in the chest, though the sputum was no longer foul and still felt cold. I then halved the first four herbs of the original formula and added Dang Gui (Angelica Sinensis Root, 3 qian). After ingestion, his bowels moved, and he felt even more relieved internally. Occasionally, he felt cold phlegm rising from below, counter-flowing upward, accompanied by sweating all over the body. I then changed the prescription to Zhe Shi (Hematite), Dang Shen (Codonopsis Root), and Gan Jiang (Dried Ginger), each 4 qian; Ban Xia (Pinellia Tuber) and Bai Shao (White Peony Root), each 3 qian; Hou Po (Magnolia Bark), Wu Wei Zi (Schisandra Berry), and Gan Cao (Licorice Root), each 2 qian; and Xi Xin (Asarum Root), 1 qian. After several doses, the cold phlegm dissipated. This case originally involved a combination of cold-fluid Jie Xiong and Wen Bing Jie Xiong. The initial prescription focused mainly on the Wen Bing Jie Xiong, with only Sheng Jiang (Fresh Ginger) addressing the cold-fluid Jie Xiong. Since the etiologies were one cold and one heat, simultaneous treatment was difficult. If Sheng Jiang had been replaced with Gan Jiang (Dried Ginger), the heat of the Wen Bing would not have subsided. Although Sheng Jiang is hot-natured, when used with cooling herbs, it actually helps dissipate heat. Once the Wen Bing heat receded, heavy use of Gan Jiang could then be employed to resolve the cold-fluid. This approach weighed the urgency and sequence of the pathological trends, treating them sequentially while maintaining comprehensive intent, avoiding neglecting either aspect, thus achieving gradual efficacy.