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Zhang Zhongjing stated: There is a condition known as Jie Xiong (Chest Binding), what are its manifestations? The answer is: Pain upon palpation, floating pulse at the Cun position, and sunken pulse at the Guan position; this is named Jie Xiong. It is further stated: When a disease originates from Yang patterns (exterior heat syndromes) and is incorrectly treated with purgation, heat pathogens enter inward, resulting in Jie Xiong. When a disease originates from Yin patterns (exterior cold or interior deficiency syndromes) and is incorrectly treated with purgation, it results in Pi (Glomus/Fullness). The reason for forming Jie Xiong is that purgation was applied too early. It is also stated: In Jie Xiong, if the pulse is floating and large, purgation must not be used; doing so leads to death. Furthermore: If all symptoms of Jie Xiong are present and restlessness (Fan Zao) occurs, the prognosis is fatal.

The Treatise states: In Tai Yang disease, if the pulse is floating, active, and rapid, accompanied by headache, fever, slight night sweating, and aversion to cold, the exterior syndrome has not yet resolved. If the physician incorrectly applies purgation, the stomach becomes empty, Yang Qi sinks inward, causing hardness below the heart, resulting in Jie Xiong, which is primarily treated with Da Xian Xiong Tang (Major Decoction to Drain the Chest). It is also stated: In Tai Yang disease, after excessive sweating followed by purgation, if there is no bowel movement for five to six days, dryness and thirst on the tongue, and slight tidal fever in the late afternoon, with hardness, fullness, and severe pain from below the heart down to the lower abdomen that cannot be touched, Da Xian Xiong Tang should be administered. These two clauses indicate that Tai Yang exterior syndromes remained unresolved and were complicated into Jie Xiong due to erroneous purgation.

The Treatise states: After five or six days of Shang Han (Cold Damage), if vomiting and fever occur, Chai Hu Tang (Bupleurum Decoction) indications are fully present. If other drugs are used for purgation and the Chai Hu symptoms persist, Chai Hu Tang should be re-administered. The patient will likely experience internal steaming heat and shivering, followed by fever and sweating, leading to resolution. However, if there is fullness and hardness with pain below the heart, this is Jie Xiong, treated with Da Xian Xiong Tang. If there is only fullness without pain, this is Pi (Glomus), and Chai Hu Tang is contraindicated; Ban Xia Xie Xin Tang (Pinellia Decoction to Drain the Epigastrium) is appropriate. This clause indicates that Shaoyang exterior syndromes remained unresolved and were complicated into Jie Xiong due to erroneous purgation.

The Treatise states: In concurrent Tai Yang and Shaoyang diseases, incorrect purgation leads to Jie Xiong, characterized by hardness below the heart, incessant diarrhea, inability to take fluids, and mental restlessness. This clause indicates that concurrent Tai Yang and Shaoyang diseases involve unresolved exterior pathogens in both meridians, and Jie Xiong forms due to erroneous purgation.

The Treatise states: In Yang Ming disease, if there is hardness and fullness below the heart, purgation is contraindicated. If purgation is applied and diarrhea becomes incessant, death ensues; if diarrhea stops, recovery occurs. This clause explains that when Yang Ming pathogens enter the Fu organs, abdominal fullness and constipation are expected. Since only hardness below the heart is present, the pathogen is still shallow and has not fully entered the Fu organs, hence purgation is contraindicated. Although this is not strictly Jie Xiong, it belongs to the category of Jie Xiong, arising not from erroneous purgation but from the gradual deepening of Yang Ming pathogens.

The Treatise states: After six or seven days of Shang Han, in cases of Re Shi (Heat Excess) type Jie Xiong, with a sunken and tight pulse, pain below the heart, and hardness like stone upon palpation, Da Xian Xiong Tang is indicated. This clause does not mention premature purgation but emphasizes Heat Excess. In cases occurring around day six or seven with sunken-tight pulses and hardness/pain below the heart, these are excess pathogens transmitted inward from Shang Han. Thus, Jie Xiong can form without erroneous purgation, representing the primary pathology of Shang Han.

My Commentary: Regarding the syndrome of Jie Xiong, as recorded in the Shang Han Lun, such as the previous clauses, whenever Tai Yang exterior pathogens remain unresolved and are incorrectly purged, Jie Xiong forms. The same applies to Shaoyang syndromes and concurrent Tai Yang-Shaoyang syndromes. These cases involve purging when one should not, leading to emptiness of the Zang Qi, allowing external pathogens to sink inward due to deficiency, and binding between the chest and diaphragm. All these result from erroneous purgation. Additionally, the case of Shang Han on day six or seven with Re Shi Jie Xiong, sunken-tight pulse, pain below the heart, and stone-like hardness, arises not from purgation but from the gradual deepening of excess pathogens binding in the chest. Therefore, Jie Xiong can result from either erroneous purgation or the natural progression of the primary disease. Contemporary Shang Han texts claim that Jie Xiong does not exist without prior purgation, which is absurd.

First, regarding the differentiation of Jie Xiong: Zhang Zhongjing mentions only erroneous purgation in Tai Yang and Shaoyang meridians, omitting Yang Ming. Why? Generally, once disease enters Yang Ming, the Stomach Fu organ is already excess, making purgation safe. Yet, it is stated: In Yang Ming disease, hardness and fullness below the heart contraindicate purgation; if purged and dysentery becomes incessant, death ensues. Does this not imply that Yang Ming Jing (Meridian/Exterior) syndromes, where pathogens have not entered the Fu organs, also contraindicate purgation? This principle applies not only to the Three Yang meridians but also to the Three Yin meridians. If fever and aversion to cold indicate unresolved exterior pathogens, purgation must absolutely be avoided with utmost caution.

Second, regarding the treatment differentiation of Jie Xiong: Only cases with abdominal distension, fullness, hardness, and pain that cannot be tolerated by touch constitute Jie Xiong. Cases with fullness but no pain are classified as Pi Man (Glomus Fullness), not Jie Xiong. Pi Man syndromes arise when exterior pathogens transmit to the chest but have not entered the Fu organs; they are on the verge of entering, retaining exterior characteristics. This represents a Half-Exterior Half-Interior syndrome, best treated with formulas like Xiao Chai Hu Tang (Minor Bupleurum Decoction) augmented with Zhi Qiao (Aurantii Fructus), or combined with Xiao Xian Xiong Tang (Minor Decoction to Drain the Chest). My new formula, Chai Chen Jian (Bupleurum and Citrus Decoction), and Yi Chai Hu Yin (Single Bupleurum Infusion), are suitable options. For the treatment of true Jie Xiong, Zhang Zhongjing primarily uses Da Xian Xiong Tang. However, my view is that Da Xian Xiong Tang is strictly indicated only for primary Shang Han cases where excess pathogens transmit inward without erroneous purgation, presenting with hardness/fullness below the heart, pain radiating to the lower abdomen intolerable to touch, dryness/thirst, delirium, hard stool, and a strong, sunken, solid pulse. For cases where Tai Yang or Shaoyang exterior pathogens remain unresolved and Jie Xiong results from premature purgation, the exterior pathogen is still present. Using Da Xian Xiong Tang again would constitute double purgation, which I dare not recommend. Instead, one should refer to methods for Pi Man, assess severity, and employ dual-release strategies for gentle treatment, or use external compress therapies (Ya Fa) to dissipate excess pathogens in the chest. This approach has proven effective, stable, and swift in my practice. See Ya Fa in New Formulas, Category 30.