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37. Abdominal distension and hardness without pain upon palpation indicate Pi Syndrome (Pihardness, a syndrome of fullness and hardness due to qi stagnation). Hardness with distension and pain indicates Jie Xiong Syndrome (Chest Binding Syndrome, a syndrome characterized by binding pain in the chest/epigastrium). The Da Jie Xiong (Major Chest Binding) syndrome extends from the epigastrium to the lower abdomen. The Xiao Jie Xiong (Minor Chest Binding) syndrome is located at the epigastrium and causes pain only upon pressure. Mild heat with sweating only on the head indicates Water-Jie Xiong (Water Binding in the Chest). Desire to rinse the mouth but unwillingness to swallow indicates Blood-Jie Xiong (Blood Binding in the Chest). If nasal bleeding (Bi Xu) has not fully resolved, or if a woman's menstruation has suddenly ceased, these conditions can also lead to such syndromes. When internal excess is confirmed and the pulse is deep and forceful, purgative methods should be employed; formulas such as Didang Tang (Ephedra and Ground Beetle Decoction), Taoren Chengqi Tang (Peach Kernel and Rhubarb Decoction), Daxiexiong Tang (Major Chest Binding Decoction), or Xiaoxiexiong Tang (Minor Chest Binding Decoction) may be used. Misapplying purgatives to patients with floating and large pulses (indicating deficiency or exterior pathogen) can lead to death. If the pulse is floating and slippery and the condition is mild, it is an indication for Xiaoxiexiong Tang. If Zang Jie (Visceral Binding) presents with restlessness and irritability, the prognosis is ominous.

[Annotation] If Han Bing (Cold Damage) is treated too early with purgatives, Pi Syndrome (Pihardness) results; if Feng Zhong (Wind Strike) is treated too early with purgatives, Jie Xiong Syndrome results. Both occur because exterior pathogens enter the interior due to deficiency. Hardness and fullness with pain upon palpation indicate the excess pathogen of Jie Xiong Syndrome. Hardness and fullness without pain upon palpation indicate the deficient pathogen of Pi Syndrome. "Da Jie" refers to Major Chest Binding Syndrome, where hardness, fullness, and severe pain extend from the epigastrium to the lower abdomen, making the area intolerable to touch; Daxiexiong Tang should be used to purge it. "Xiao Jie" refers to Minor Chest Binding Syndrome, where slight binding occurs at the epigastrium, causing pain only upon pressure, not otherwise; Xiaoxiexiong Tang should be used to open and scatter it. Slight body heat with spontaneous sweating on the head, accompanied by these signs, indicates Water-Jie Xiong; Daxiexiong Wan (Major Chest Binding Pill) should be used to purge it. Desire to rinse the mouth but unwillingness to swallow, accompanied by these signs, indicates Blood-Jie Xiong. If blood stasis does not resolve through nasal bleeding, or if nasal bleeding is incomplete, or if a woman's menstruation has just stopped, these can all form this syndrome; Didang Wan (Ground Beetle Pill) or Taoren Chengqi Tang should be used to purge it. Internal excess and solid symptoms are indications for purging; a deep and large pulse is also an indication for purging. After careful verification, Didang Tang, Taoren Chengqi Tang, Daxiexiong Tang, or Wan may be used for purging. If internal excess is absent and the pulse is floating and slippery or floating and large, it is not a definite excess pattern but rather a Xiaoxiexiong pattern; purging is contraindicated. Misapplication of purgatives will certainly lead to fatal consequences. "Zang Jie" refers to a condition resembling Jie Xiong, but with a white and slippery tongue coating and a floating, thin pulse. "Xi Ju" means that the Jie Xiong symptoms involve the entire abdomen, with hardness, fullness, and pain in both hypochondriac regions. If this condition is accompanied by irritability and restlessness, death is inevitable.