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[Zhang Zhongjing (see "Section on Bleeding") ]

Treats conditions where early purgation in Cold Damage (Shanghan) causes exterior pathogens to penetrate inward, resulting in fullness and hardness with pain in the epigastrium; or after repeated sweating followed by misapplied purgation, leading to constipation for five to six days, dry tongue with thirst, tidal fever around the Shen hour (3-5 PM), hardness and fullness from the heart to the lower abdomen with pain so severe it cannot be touched; or without significant heat, only slight sweating on the head, and a deep pulse, indicating Water-Binding Chest Syndrome (Jie Xiong). (Pressing causes hardness and pain; next is heavy sweating leading to fluid retention binding; long-standing cases lead to Jie Xiong. Yang channel diseases misused with purgation... Jiayan said: Fa Yin [emerging from Yin]... speaking of cold medicines... this is a Yin syndrome internally... meridian disease treated with purgation... purgation or sides... cold medicines, hypochondriac distension... hypochondriac fullness mostly... Croton seed (Badou)... bitter and pungent... Rhubarb (Dahuang) (2 liang), Mirabilite (Mangxiao) (1 sheng), Kansui (Gansui) (1 qian). Pulverized. First decoct Dahuang, remove dregs; add Mangxiao, boil one or two boils.)

This is a formula for the Foot-Taiyang Bladder Meridian. Exterior pathogens enter the interior and bind at a high position, causing all three Jiaos to be excess, making the area untouchable; the syndrome is critical and cannot be resolved by ordinary medicines. Therefore, its action is extremely峻猛 (harsh/potent), yet it has the power to revive the dead. (*Zhunsheng* states: Pathogens binding in the chest are at the highest point, seemingly suitable for emesis; however, pathogenic qi binds with the Yang qi of the chest and cannot separate, obstructing the epigastrium, causing hardness and pain. This is not comparable to deficiency vexation or diaphragmatic excess, so purgation is required. Low syndromes are lifted, high syndromes are陷 (sunken/descended); equilibrium is the standard, hence named "Xian Xiong" [Cave/Descend Chest]. The Classic further states: In Taiyang disease, if the pulse is floating, moving, and rapid, floating indicates Wind, rapid indicates Heat, moving indicates Pain, and rapid indicates Deficiency. Headache, fever, slight night sweats, yet aversion to cold indicates the exterior is unresolved. If the physician erroneously uses purgation, the moving/rapid pulse becomes slow, there is resistance and pain in the diaphragm, the Stomach is empty and deficient, hostile Qi disturbs the diaphragm, causing shortness of breath, irritability, and inner restlessness (Ao Nao). Yang Qi sinks inward, the epigastrium becomes hard, forming Jie Xiong, treated with Da Xian Xiong Tang. Zhu Danxi said: Treating an exterior Taiyang syndrome by attacking the interior is indeed deficient. The original text says: Taiyang pulse is floating, moving, and rapid; now after erroneous purgation, it becomes slow. It also says: The Stomach is empty and deficient. It also says: Shortness of breath and irritability indicate extreme deficiency. If we say Yang Qi has sunk inward and the epigastrium is hard, can we swiftly purge? Is the power of Xian Xiong Tang actually slower than Cheng Qi Tang? Purging once then again, are we not afraid of causing deficiency? The previous text states: If the pulse in Jie Xiong is floating and large, purgation leads to death. It also states: If all Jie Xiong symptoms are present and there is irritability, death ensues. Now it mentions a floating pulse and irritability; can Da Xian Xiong Tang truly be used? If the Stomach is empty, hostile Qi disturbs the diaphragm, and there is inner restlessness, Zhi Zi Chi Tang should be used to vomit out the pathogens from the chest. Tao Jian'an said: Jie Xiong is formed by early purgation. Those who have not been purged do not have Jie Xiong; rather, exterior pathogens have transmitted to the chest. Although there is fullness and oppression, it remains in the exterior, belonging to the Shaoyang aspect, between the exterior and interior. Only Xiao Chai Hu Tang plus Zhi Ke and Jie Geng is needed. If ineffective, one dose of Xiao Chai Hu Tang combined with Xiao Xian Xiong Tang brings sudden relief. If formed due to early purgation, then Xian Xiong Tang is used to distinguish depth and treat gradually, avoiding excessive harshness. The Upper Jiao is the clear pathway at the highest position; excessive purgation damages Yuan Qi. Cui Xinggong said: For severe Cold Damage Jie Xiong with high elevation of the heart and diaphragm, untouchable to the hand, use Da Xian Xiong Tang. If not cured, this is post-purgation deficiency and rebellion, Qi is disordered, and toxins attack upward again. Use Zhi Shi Li Zhong Wan to first regulate Qi, then treat other ailments; the effect is miraculous. *Huo Ren* states: If erroneous purgation has not yet formed Jie Xiong, urgently and frequently give Li Zhong Tang, and it will naturally resolve, as Li Zhong Tang treats the Middle Jiao. If the Stomach is harmonious but Cold Damage persists, wait for sufficient days, then use Cheng Qi Tang to purge again, as the previous purgative was insufficient. For Water-Binding Chest, use Xiao Ban Xia Jia Fu Ling Tang or Xiao Chai Hu Tang removing Da Zao and adding Mu Li. There is also Blood-Binding Chest syndrome, untouchable, rinsing water but not swallowing, delirium like madness, black stool, free urination; use Xi Jiao Di Huang Tang. Liu Xinshan said: Jie Xiong and Pi Man are mostly caused by Phlegm-Fluid congealing in the heart and chest, therefore Xian Xiong and Xie Xin formulas use Gansui, Ban Xia, Gua Lou, Zhi Shi, Xuan Fu Hua, etc., which are all...)