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The area below the supraclavicular fossa is called the chest. (This should be read in conjunction with the section on "Chest Bi" [Xiong Bi] in the chapter on Bi and Fullness.)

The meridians of the five Zang organs, along with the Gallbladder and Pericardium, totaling seven meridians, all have their sinews and vessels reaching the chest. Therefore, pathogenic factors from any of these meridians can cause chest pain. Since the chest is the domain governed by the Lung, it is evident that most chest pain belongs to Lung-related conditions. However, medical texts often discuss this in terms of Liver disease; this is merely an illustrative example, so do not adhere rigidly to it. It must be understood that the chest is the region where Clear Yang distributes. Its pathology is mostly due to Qi stagnation. (Whether excess or deficiency, the underlying mechanism is stagnation.) When Qi stagnates, Phlegm and Fluid retention also accumulate. The appropriate treatment is to move Qi and eliminate fluids, which addresses the Lung aspect. The Lung governs Qi and prefers descending; it should not allow upward congestion. (Regarding Qi excess transforming into Fire belonging to the Heart, and Phlegm originating from Dampness belonging to the Spleen, these principles can be considered comprehensively.) If Liver Qi is excessive and rushes upward, carrying Blood with it, or if Liver Qi is deficient leading to failure of Clear Yang to ascend and Turbid Yin to descend, then the disease lies in the Liver and Gallbladder, and the pain will necessarily radiate to the hypochondrium. (Regarding Liver Fire flaming upward, caused by exhaustion of Kidney Water; or Liver Qi deficiency and cold, caused by decline of Kidney Fire, these can also be deduced.) Treatment methods can be referred to in the upper and lower volumes of this book. The Classics state: "In spring, the pulse resembles a string. If the Qi is not solid but faint, this is called 'insufficiency,' causing chest pain radiating to the back and fullness in both hypochondria; this is Liver deficiency, treated with Bu Gan Tang [Liver Tonifying Decoction]." (See "Hypochondriac Pain.") *Jin Gui Yao Lue* states that for Liver Cold, (the original text has seven characters below: "arms cannot be raised, tongue base is dry"; *Yi Zong Jin Jian* considers these interpolations and deletes them.) patients sigh frequently, experience chest pain and inability to turn or side-bend, (from which it can be known that the hypochondrium also hurts,) vomit after eating, (the Liver nature prefers free flow; constrained by Cold and unable to extend, it sighs to relieve itself. Vomiting after eating is due to rebellious Qi rising,) and sweat occurs. It is also stated regarding Liver Stasis (Qi stagnation and failure to circulate), patients often desire someone to tread upon or massage their chest. ("Tread" here means massage.) Before suffering significantly, they only desire to drink hot liquids. (Cold causes stagnation, Heat promotes circulation, hence the preference for hot drinks.) This is primarily treated with Xuan Fu Hua Tang [Inula Flower Decoction]. (Formula composition: Xuan Huahua 3 liang, Scallion stems 14, Xin Jiang [Safflower/Red Dye] a small amount, water 3 sheng, boiled down to 1 sheng, taken at once. *Yi Zong Jin Jian* argues this formula does not match the syndrome and suspects error. I believe this is Fluid retention with obstruction of Yang Qi, thus using this formula to expel fluid and unblock Yang, adding red dye to harmonize Blood.) This represents Liver Excess. *Su Wen* states: "What Yangming refers to as chest pain and shortness of breath is Water Qi residing in the Zang-Fu." For mild cases, Wu Ling San [Five-Ingredient Poria Pill] is used (see "Damage by Dampness"); for severe cases, the method of Zhang Zihe is employed to purge. For Mu Xiang [Aucklandiae Radix] and Yu Jin [Curcumae Longae Rhizoma], if the pain is due to Qi stagnation, double the Mu Xiang; if due to Blood stagnation, double the Yu Jin. Grind into powder, take 2 qian per dose, washed down with aged wine; add Ren Shen [Ginseng Radix] for deficiency. For Phlegm-Fluid pain, mild cases are treated with Xiao Xian Xiong Tang [Minor Inhibiting Chest Decoction], and severe cases with Da Xian Xiong Wan [Major Inhibiting Chest Pill]. If the phlegm-saliva is thick and sticky, Kong Yan Dan [Controlling Saliva Pill] is used (see "Phlegm-Fluid").