Library

The *Huoren Shu* (Book of Living People) discusses the treatment methods for Shanghan (Cold Damage) in both children and adults; generally, they are the same, except that the dosages are slightly smaller and the medicinal properties are cooler. Question: What is it when there is tightness and fullness below the heart, hardness upon palpation like a stone, and pain?
This is named Jie Xiong (Chest Binding). Shanghan originally does not involve Jie Xiong; it occurs because purgatives were used too early while fever was present, allowing heat qi to enter through deficiency, leading to stagnation and binding that does not dissipate, thus forming Jie Xiong. (If the condition has already been wrongly transformed by purgation but Jie Xiong has not yet formed, one should frequently administer Lizhong Tang [Regulate the Middle Decoction], and it will naturally resolve without becoming Jie Xiong, because Lizhong Tang treats the Middle Jiao. This point was not fully elaborated by ancients, but later generations understood it through reflection. If the condition deteriorates severely with signs of Jue [extremity cold], administering Sini Tang [Reverse the Inversion Decoction] concurrently will stabilize the patient. Although the Stomach Qi is harmonized, if the Shanghan pathogen remains, wait until the appropriate number of days have passed for purgation, then use Chengqi Tang [Purgative Decoction] again to purge, because the previous purgation was inappropriate.) The symptoms include tightness and fullness below the heart, hardness upon palpation like a stone, and pain, along with neck stiffness resembling Rou Jing (Soft Spasm, characterized by fever, sweating, and aversion to cold absent). The pulse at Cun Kou is floating, while Guan and Chi positions are sunken or sunken-tight; this is named Jie Xiong. Treatment for Jie Xiong generally requires purgation. (Zhang Zhongjing stated: Purging leads to harmony.) However, if the pulse is floating or large, purgation is contraindicated; purging will cause death, and sweating methods should be preferred instead. (Zhang Zhongjing stated: For Jie Xiong with a floating pulse, do not purge; only Xiaoxianxiong Tang [Minor Chest-Expelling Decoction] can be used. Generally, a floating pulse indicates exterior syndrome persists; combine with Xiao Chaihu Tang [Minor Bupleurum Decoction] etc. to release the exterior first; once the exterior syndrome resolves, then use drugs to purge Jie Xiong for stabilization.) Cui Xinggong of Western Jin said: For severe Shanghan Jie Xiong nearing death, with high elevation of the chest and diaphragm where touch is intolerable, if Daxiexiong Tang [Major Chest-Expelling Decoction] fails to cure, this is due to deficiency after purgation, rebellious Qi being disordered, and toxin attacking upwards again, with Qi and toxin battling and binding in the chest. One should use Zhishi Lizhong Wan [Immature Bitter Orange Regulate Middle Pill] to regulate Qi first, then treat other ailments. Used since ancient times, it works miraculously, bringing recovery instantly. However, there are three types of Jie Xiong: There is Da Jie Xiong (Major Chest Binding), where pain exists without pressing, and the chest connects to the umbilicus and abdomen with hardness, treated primarily with Daxiexiong Wan [Major Chest-Expelling Pill]. There is Xiao Jie Xiong (Minor Chest Binding), where pressing does not cause pain, treated adequately with Xiaoxianxiong Tang [Minor Chest-Expelling Decoction]. There is Water Binding in the chest and hypochondrium, also named Shui Jie Xiong (Water Chest Binding), characterized by slight sweating on the head, only Jie Xiong without significant heat; this water-binding syndrome in the chest and hypochondrium is treated with Xiaobanxia Jiashengfu Tang [Minor Pinellia plus Ginger and Poria Decoction] or Xiaochaihu Tang minus Zao plus Muli [Minor Bupleurum Decoction minus Date plus Oyster Shell]. There are also Cold and Heat syndromes: Re Shi Jie Xiong (Heat Excess Chest Binding), characterized by restlessness in the chest, internal vexation, dry tongue with thirst, and sunken-slippery pulse, all indicating Heat syndrome, treated with Daxiexiong Tang [Major Chest-Expelling Decoction]; and Han Shi Jie Xiong (Cold Excess Chest Binding), where there are no Heat signs, treated with Sanwu Bai San [Three-Material White Powder] or Zhishi Lizhong Wan [Immature Bitter Orange Regulate Middle Pill]. Recent times often treat Jie Xiong using Jinzhen Wan [Golden Needle Pill] containing Sulfur and Yangqish [Stalactite]. If it is Han Shi Jie Xiong, using it may cure; if it is Re Shi Jie Xiong, using it will certainly cause death. Another question: What is the difference between Daxiexiong Tang and Daxiexiong Wan? Daxiexiong Tang uses Kansui [Kansui Root], which is too harsh and should not be used lightly; one must assess deficiency/excess and severity. If unavoidable, Daxiexiong Wan is safest. Another question: How about applying Shengbingzi moxa to the navel? It should definitely not be used. Another question: What is Zang Jie (Organ Binding)? Zang Jie is a fatal condition; Zhang Zhongjing provided no treatment method. Generally, Zang Jie presents similarly to Jie Xiong, with normal diet intake, frequent diarrhea, floating Yang pulse, and small, fine, sunken-tight Guan pulse, named Zang Jie. A white, slippery coating on the tongue indicates difficult treatment.

*Yingtong Baojian* [Precious Mirror for Infants and Children] contains a song regarding pediatric Jie Xiong caused by premature purgation before pathogen enters the interior:
When the disease has not entered, premature purgation is taken; entering the abdomen through deficiency, treatment is hard to heal. Obstruction fills the throat adding panting, Jie Xiong disease should not delay.

*Huoren Shu* records Zhang Zhongjing's Lizhong Tang [Regulate the Middle Decoction]:
Renshen [Ginseng Radix], Ganjiang [Zingiberis Rhizoma] (processed), Gancao [Licorice Radix et Rhizoma] (roasted), Baizhu [Atractylodis Macrocephalae Rhizoma] (each 3 liang).
For abdominal pain, add Renshen 1.5 liang; for cold, add Ganjiang 1.5 liang; for thirst desiring water, add Baizhu 1.5 liang; for pulsation above the umbilicus (indicating Kidney Qi movement), remove Baizhu and add Guizhi [Cinnamon Twig] 4 liang; for excessive vomiting, remove Baizhu and add Shengjiang [Zingiberis Rhizoma Recens] 3 liang; for excessive diarrhea, continue using Baizhu; for palpitations, add Fuling [Poria] 2 liang. If there is tetany of the four limbs, abdominal fullness with diarrhea or muscle cramps, remove Baizhu and add Fuzi [Aconiti Lateralis Radix Praeparata] 1 piece, raw.
Crush the herbs to the size of hemp seeds. Each dose takes 5 qianbi, boiled in 1.5 sheng of water until reduced to 0.8 sheng, strain, and take warm. Three doses daily.

*Huoren Shu* records Zhang Zhongjing's Sini Tang [Reverse the Inversion Decoction]; see the section on Shanghan spontaneous sweating.

*Huoren Shu* records Zhang Zhongjing's Chengqi Tang [Purgative Decoction]; see the section on Shanghan wheezing.

*Huoren Shu* records Zhang Zhongjing's Xiaoxianxiong Tang [Minor Chest-Expelling Decoction]:
Banxia [Pinelliae Rhizoma] (washed in hot water, weighed, 2.5 liang), Huanglian [Coptidis Rhizoma] (1 liang).
Crush to the size of hemp seeds. Each dose takes 5 qian, add half a Gualou [Trichosanthis Fructus], boil in 2 sheng of water until reduced to 0.9 sheng, strain, and take warm. If unknown effect, take again; slight discharge of yellow phlegm brings relief.

*Huoren Shu* records Zhang Zhongjing's Xiao Chaihu Tang [Minor Bupleurum Decoction]; see the section on Shanghan head sweating.

*Huoren Shu* records Zhang Zhongjing's Daxiexiong Tang [Major Chest-Expelling Decoction]:
Dahuang [Rhei Radix et Rhizoma] (1.5 liang, peeled, those with brocade patterns, powdered), Mangxiao [Natri Sulfas] (1 liang), Gansui [Kansui Radix] (one character, red and nodular, finely sifted powder).
Use 3 sheng of water, first boil Dahuang until reduced to 1 sheng, strain, add Mangxiao, boil once, add Gansui powder, take warm. Stop subsequent doses after obtaining rapid purgation.
Another prescription:
Guizhi [Cinnamon Twig], Renshen [Ginseng Radix] (each 1 liang), Gansui [Kansui Radix] (0.5 liang), Dazao [Jujubae Fructus] (3 pieces), Gualoushi [Trichosanthis Fructus] (1 piece, peeled, use only one-quarter).
Crush. Each dose takes 5 qianbi, boil in 2 sheng of water until reduced to 0.8 sheng, strain, and take warm. Do not take if there is no solid accumulation in the chest.

*Huoren Shu* records Zhang Zhongjing's Zhishi Lizhong Wan [Immature Bitter Orange Regulate Middle Pill]:
Zhishi [Aurantii Fructus Immaturus] (16 slices, bran-fried), Fuling [Poria], Renshen [Ginseng Radix], Baizhu [Atractylodis Macrocephalae Rhizoma], Ganjiang [Zingiberis Rhizoma] (processed), Gancao [Licorice Radix et Rhizoma] (roasted. Each 2 liang).
Pound and sieve into fine powder, mix with refined honey to make pills the size of chicken egg yolks. Take one pill per dose, dissolve in hot water, advance 2-3 doses consecutively, resulting in sudden relief in the chest. For thirst, add Gualou [Trichosanthis Fructus] 2 liang; for diarrhea, add Muli [Concha Ostreae] 2 liang, calcined.

*Huoren Shu* records Zhang Zhongjing's Daxiexiong Wan [Major Chest-Expelling Pill]; see the section on Shanghan thirst.

*Huoren Shu* records Zhang Zhongjing's Xiaochaihu Qu Zao Jia Muli Tang [Minor Bupleurum Decoction minus Date plus Oyster Shell]; see the section on Shanghan head sweating.

*Huoren Shu* records Zhang Zhongjing's Sanwu Bai San [Three-Material White Powder]:
Jiegeng [Platycodonis Radix] (remove rhizome), Beimu [Fritillariae Bulbus] (each 3 fen), Badou [Crotonis Fructus] (remove shell and heart, roasted black, ground to fat-like consistency, 1 fen).
Grind into powder, mix evenly with Badou, take with white rice drink. Strong persons take half qianbi, weak persons reduce dosage. Disease above the diaphragm causes vomiting; below the diaphragm causes diarrhea. If no diarrhea, consume one cup of hot porridge. If body heat and skin gooseflesh persist, desire to cover oneself with clothes. If washed with water, it further prevents heat from escaping, causing vexation when sweat should occur but does not. If sweating occurs and abdominal pain follows, give Shaoyao [Paeoniae Radix Alba] 3 liang, as above.

Ancient formula Jinzhen Wan [Golden Needle Pill] for treating adult and pediatric Shanghan Jie Xiong:
Yangqishi [Stalactite] (good quality), Buhui Mu [Lignitum], Huang [Sulfur] (each 0.5 liang), Badou [Crotonis Fructus] (3-7 grains, shelled), Xingren [Armeniacae Semen Amarum] (3-7 pieces, soaked in hot water, peeled).
First pound the first three ingredients into fine powder, then finely grind Badou and Xingren, mix with decoction ingredients into powder, form pills with glutinous rice porridge, size of cherries. Pierce each pill with a needle, dry in sun. If the patient applies it, burn the paper wick completely, grind finely, stir-fry, and take one pill mixed with ginger juice. For severe cases, alternate with 3-2 pills, delivered with Jinzhen Wan, without harm, further assessing deficiency/excess. (Mentioned in *Huoren Shu*, so this formula is preserved for awareness; must be used cautiously.)