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Furthermore, there are cases where phlegm and qi (vital energy) congeal not in the epigastrium but in the chest. This congealed phlegm and qi fill the chest and diaphragm to such an extent that they obstruct respiration in the lungs, nearly bringing it to a halt. This constitutes a critical and dangerous syndrome of Jie Xiong (chest binding), which originally cannot be treated by ordinary medications.

The original text of *Shanghan Lun* (Treatise on Cold Pathogenic Diseases) states: In Taiyang disease (disease of the Taiyang channel), the pulse is floating and rapid-numerous. Floating indicates wind; rapid-numerous indicates heat. Agitated indicates pain; rapid-numerous also indicates deficiency. The patient presents with headache, fever, slight night sweating, and conversely, aversion to cold, indicating that the exterior syndrome has not yet resolved. If the physician erroneously applies purgation, the agitated-rapid pulse changes to a slow one. There is resistance and pain within the diaphragm, the stomach is empty and deficient, pathogenic qi disturbs the diaphragm, leading to shortness of breath, irritability, and inner restlessness. Yang qi sinks inward, causing the epigastrium to become hard, thus forming Jie Xiong (chest binding). Da Xian Xiong Tang (Major Decoction for Draining the Chest) should be administered.

When the pulse is floating and heat remains at the exterior, one should originally use acrid-cool herbs to induce sweating and resolve the exterior. However, mistakenly believing the heat has entered the interior, the physician uses purgatives. This causes the Great Qi (Zong Qi) in the chest to become deficient due to downward draining. Consequently, external wind-heat enters through this deficiency and congeals with existing phlegm-fluids in the upper jiao between the chest and shoulders, filling the hollow organs and resulting in Jie Xiong. The patient feels extreme fullness and oppression in the chest, and even respiration in the lungs feels significantly obstructed. The guideline mentions both "rapid-numerous indicates heat" and "rapid-numerous indicates deficiency." This is because if a person's yin aspect is not deficient, even with external heat, the pulse may not necessarily be rapid-numerous. Now, since the heat is still at the exterior but the pulse rate is already rapid, the rapidity is interpreted as a sign of underlying deficiency. Regarding the pulse becoming slow due to Jie Xiong, it is not because the heat turns cold after purgation. Rather, when there is substantial stasis or accumulation in the viscera and bowels blocking the flow of qi transformation, the pulse often appears slow. Thus, in the syndrome of Da Cheng Qi Tang (Major Order the Qi Decoction), the pulse is also slow. "Resistance and pain within the diaphragm" refers to the mutual distension and pain caused by the Great Qi in the chest clashing with the congealed qi of phlegm-fluids; pressing exacerbates the pain, hence the rejection of pressure. "Empty stomach and pathogenic qi disturbing the diaphragm" occurs because purgation damages stomach qi, preventing qi transformation from descending continuously (stomach qi transmits food and drink, so continuous downward movement is favorable). The Chong Mai (Penetrating Vessel), whose upper source connects with the stomach, allows its qi to easily ascend and harass the diaphragm. It then drums against the diaphragm and compresses respiratory qi, preventing it from ascending, thereby causing shortness of breath. Irritability arises because exterior heat sinks into the chest, disturbing the fire of the Heart Mind. Restlessness (Ao Nao) occurs because the harassing qi attempts to penetrate the diaphragm and escape outward but fails, causing internal frustration.

[Da Xian Xiong Tang Formula]
Da Huang (Rhubarb Root and Rhizome) 6 liang (peeled), Mang Xiao (Mirabilite) 1 sheng, Gan Sui (Kansui Root) 1 qian bi (powdered).

Take these three ingredients. Add 6 sheng of water, first decoct Da Huang until 2 sheng remain, remove the dregs, add Mang Xiao, boil for one or two boils, then add the Gan Sui powder. Take 1 sheng warm. If loose stools occur rapidly, stop taking the remaining medicine. "1 qian bi" refers to accumulating powder on a flat, dagger-shaped scoop, weighing approximately 1 qian.

In Jie Xiong syndrome, although the chest is filled with extreme fullness and oppression, it is purely due to external wind-heat sinking inward and combining with pre-existing fluid retention in the chest. Even if pathogenic qi harasses upward affecting the diaphragm, it remains blocked at the diaphragm and does not reach higher levels. Therefore, qi-regulating herbs like Zhi Shi (Immature Bitter Orange) and Hou Po (Magnolia Bark) are unnecessary. One should heavily use Da Huang and Mang Xiao to resolve phlegm and clear heat. Anticipating that although Da Huang and Mang Xiao are potent, they might not act instantly, a small amount of Gan Sui is added as an assistant. Gan Sui acts by breaking down accumulations and is extremely rapid. Combined with Da Huang and Mang Xiao, it immediately clears the hollow organs without obstruction. The creator of this formula employed thunderbolt-like measures.

Gan Sui is stated to be toxic in *Shennong Bencao Jing*. I recall when I first studied medicine, I tasted various herbs to understand their practical effects. One morning, I chewed and swallowed 1 qian of raw Gan Sui. After an hour, without experiencing dizzying reactions, I suddenly had watery diarrhea nearly ten times. By Si hour (9–11 AM), I ate normally. After the meal, I had several more episodes of diarrhea, expelling all the food eaten. From this, I realized that among herbs that drain phlegm-fluids, Gan Sui is supreme. Later, using it to treat madness caused by phlegm confusing the heart orifices, it consistently succeeded. Its maximum dose can exceed 1 qian, but I dare not administer it lightly unless the pulse indicates substantial excess, due to its extreme potency. In Da Xian Xiong Tang, the dosage of Gan Sui is折算 (converted) to modern units: only 1.5 fen per dose. Yet, it guides Da Huang and Mang Xiao directly to the core of the Jie Xiong pathology, allowing them to exert their power instantly. It serves as a guide; a small amount suffices, and large doses are unnecessary.

Gan Sui is originally suitable for pills or powders. If added to a decoction, it often induces vomiting upon swallowing. Therefore, in Da Xian Xiong Tang, other herbs are decocted first, and Gan Sui powder is added subsequently. Initially, Gan Sui may not cause vomiting, but with consecutive days of use, vomiting becomes likely. If a second dose is needed because the first did not fully resolve the illness, adding 2 qian of fine powder of Sheng Zhe Shi (Hematite) to be taken with the decoction will prevent vomiting.

Using Da Xian Xiong Tang to treat Jie Xiong originally yields swift results, yet later physicians who dared to use this formula accounted for less than two out of a hundred. Some feared the toxicity of Gan Sui; others doubted the pulse discussion in the guidelines, specifically the statement "rapid-numerous indicates deficiency," fearing the body could not withstand such a fierce preparation. While I cannot force those who fear the formula to use it, the formula itself allows for modification. Before Da Xian Xiong Tang in *Shanghan Lun*, there exists Da Xian Xiong Wan (Major Pill for Draining the Chest), composed of Da Huang 8 liang, Ting Li Zi (Periploca Seed) 0.5 sheng (roasted), Xing Ren (Apricot Seed) 0.5 sheng (skin and tip removed, roasted until black), and Mang Xiao 0.5 sheng.

Take these four ingredients. Pound and sieve two of them, then add Xing Ren and Mang Xiao, grind into a paste-like consistency, mix well. Take one pill-sized portion. Separately, pound Gan Sui powder 1 qian bi and Bai Mi (White Honey) 2 he. Add 2 sheng of water, decoct to obtain 1 sheng, take warm in one dose.

This formula treats the same syndrome as Da Xian Xiong Tang. Because it is accompanied by neck stiffness resembling Rou Ji (soft tetanus), Ting Li Zi and Xing Ren are added to Da Xian Xiong Tang, mixed with white honey, and decocted with dregs. This is because the pathology extends upward to the neck, requiring the medicinal power to descend slowly. To substitute for Gan Sui in Da Xian Xiong Tang, one can add several qian each of Ting Li Zi from Da Xian Xiong Wan and Zhe Shi from the previous formula for persistent belching to Da Xian Xiong Tang. This achieves efficacy without Gan Sui. As previously discussed, Zhe Shi possesses heavy-sinking properties. Ting Li Zi is bitter and excellent at descending, similar in nature to Gan Sui but non-toxic, and far less potent. Its bitter-descending nature can expel phlegm-fluids overflowing into the lungs, driving them down rapidly. Thus, it can share the role with Zhe Shi to replace Gan Sui.

If one still fears the potency of such modified Da Xian Xiong Tang, I have another self-formulated replacement: Dang Xiong Tang (Chest-Sweeping Decoction) found in the Medical Formulas section. This Dang Xiong Tang contains neither Gan Sui nor Da Huang. Used to replace Da Xian Xiong Tang, it invariably produces immediate results. Therefore, I dare to record it in this book for the medical community.