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The patient, a nephew of the Fang family, presented with slight swelling on the left side under the tongue. Fatigue from reading and reciting triggered thirst and facial flushing, epigastric fullness, thick phlegm, and dyspnea. The pulse was deep and weak. Administration of cold-natured herbs resulted in abdominal pain and reduced appetite. This condition stems from a constitutional deficiency of Yin Qi (Vital Energy). Mental exertion stirs up the Fire of the Five Emotions (Wu Zhi), leading to Spleen Qi fatigue; thus, Phlegm and Qi stagnate to form Bi Syndrome (Obstruction). The Classics state: "When one Yin and one Yang knot together, it is called Hou Bi (Throat Obstruction)." One Yin refers to Shao Yin Jun Huo (Ministerial Fire of the Heart/Kidney system), and one Yang refers to Shao Yang Xiang Huo (Ministerial Fire of the San Jiao/Gallbladder system). The meridians of these two channels run alongside the throat. When Fire moves and Phlegm rises, they knot and do not disperse. The root cause lies in the inherent deficiency of Kidney Yin, where Water fails to control Fire. Treatment utilized Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill). The prescription included Shu Di Huang (Prepared Rehmannia Root, steamed with Amomum powder), Mu Dan Pi (Moutan Bark, stir-fried with wine), Ren Shen (Ginseng), Mai Dong (Ophiopogon Tuber), Bei Mu (Fritillaria Bulb), Niu Xi (Achyranthes Root), formulated into pills with Lotus Root Powder and Honey. The condition subsided after administration.

Ms. Yin suffered for a long time from Mei He Qi (Plum-pit Qi), feeling as if Qi were blocked like a foreign object obstructing the throat, causing difficulty in swallowing. This was neither due to Fire nor Phlegm, but caused by Qi Stagnation (Qi Yu). Treatment employed Yu Jin (Curcuma Aromatica Rhizome), Mu Xiang (Aucklandiae Radix), Bei Mu (Fritillaria Bulb), Jie Geng (Platycodon Root), Chen Pi (Citrus Reticulata Peel), Gua Lou Pi (Trichosanthes Peel), and Gan Cao (Licorice Root). Several doses yielded effective results.

Xiong Bi (Chest Bi) occurs when Yang Qi in the chest is weak and fails to circulate; over time, Yin pathogens invade the Yang position, forming obstruction. Symptoms include chest fullness, wheezing, shortness of breath, and pain radiating to the heart and back. This arises because Yang Qi in the chest is not free-flowing, allowing Turbid Yin to reverse upward, obstructing the ascending and descending mechanisms. In severe cases, Qi knots with coughing and spitting saliva, and chest pain penetrates to the back. All Yang Qi receives its energy in the chest; only when the chest cavity is spacious can Clear Qi circulate freely, allowing for smooth respiration. The pulse of Xiong Bi is characterized by a superficially weak (Yang micro) and deeply wiry (Yin string) quality. A weak superficial pulse indicates pathology in the Upper Jiao (Upper Burner); a wiry deep pulse indicates Heart Pain. Both *Jin Gui Yao Lue* (Essential Prescriptions from the Golden Cabinet) and *Qian Jin Fang* (Prescriptions Worth a Thousand Gold) advocate treating this primarily by unblocking Yang. *Jin Gui Yao Lue* states: For Xiong Bi with wheezing, coughing/spitting saliva, chest/back pain, and shortness of breath, where the cun pulse is deep/slow and the guan pulse is small/tight/rapid, use Gua Lou Xie Bai Bai Jiu Tang (Trichosanthes, Macrostemon, and White Wine Decoction). For Xiong Bi where the patient cannot lie flat, with heart pain penetrating to the back, use Gua Lou Xie Bai Ban Xia Tang (Trichosanthes, Macrostemon, and Pinellia Decoction). For Xiong Bi with急促 breathing and chest fullness, with Qi reversing from the hypochondrium to seize the heart, use Zhi Shi Xie Bai Gui Zhi Tang (Immature Bitter Orange, Macrostemon, and Cinnamon Twig Decoction). For Xiong Bi with Qi blockage and shortness of breath, use Fu Ling Xing Ren Gan Cao Tang (Poria, Apricot Seed, and Licorice Decoction) or Ju Pi Zhi Shi Sheng Jiang Tang (Tangerine Peel, Immature Bitter Orange, and Fresh Ginger Decoction). For Xiong Bi that alternates between relief and urgency, use Yi Yi Fu Zi San (Coix Seed and Aconite Powder). For central palpitations, various rebellious Qi, and hanging heart pain, use Gui Zhi Sheng Jiang Zhi Shi Tang (Cinnamon Twig, Fresh Ginger, and Immature Bitter Orange Decoction). For heart pain penetrating to the back and back pain penetrating to the heart, use Wu Tou Chi Shi Zhi Wan (Aconite and Red Stone Powder Pill). *Qian Jin Fang* treats Xiong Bi radiating to the back pain using Xi Xin San (Asarum Powder). For rebellious Qi in the chest, heart pain penetrating to the back, shortness of breath, and anorexia, use Qian Hu Tang (Peucedani Radix Decoction). For chest fullness, choking sensation, dry throat, and excessive saliva, use Ju Pi Zhi Shi Sheng Jiang Tang. If ineffective, treat with Zhi Zhong Tang (Regulate the Middle Decoction). For chest/back closure and fullness with upper asthma and急促 breathing, use Xia Qi Tang (Descend Qi Decoction). For chest/back pain, apply Yi Bei San (Back-Warming Powder externally). Generally, for weak Yang, use Sweet-Warm methods like Ling Gui Zhu Gan Tang (Poria, Cinnamon Twig, Atractylodes, and Licorice Decoction). For Yin condensation, use Warm-Unblocking methods like Li Zhong Tang (Regulate the Middle Decoction). For rebellious fluid retention, use Pungent-Draining methods like Wu Zhu Yu Tang (Evodia Decoction). For palpitation obstruction, use Pungent-Slippery methods like Gua Lou Xie Bai Ban Xia Tang. For rebellious wheezing, use Bitter-Descending methods like Gui Zhi Jia Hou Po Xing Zi Tang (Cinnamon Twig Decoction augmented with Magnolia Bark and Apricot Seed). For chronic Bi involving collateral obstruction, use Xuan Fu Hua Tang (Inula Flower Decoction). The key lies in rotating the Clear Yang of the Upper Jiao and venting Phlegm-Qi in the diaphragm, without confusing it with treatments for Chest Palpitation or Chest Binding syndromes.

Yu Jiayan stated: "Yang Qi in the chest is like the sun shining in the sky, vast and boundless. If Earthly Qi (Yin/Dampness) rises, obstruction increases. Thus, Xiong Bi is a syndrome of unused Yang Qi and rebellious Yin Qi." However, severity varies. Mild cases require only unblocking the deficient Yang in the Upper Jiao; severe cases require driving out the rebellious Yin from the Lower Jiao. Zhang Zhongjing unblocks Yang in the chest using Macrostemon and White Wine, or Trichosanthes, Pinellia, Cinnamon Twig, Immature Bitter Orange, Magnolia Bark, Dried Ginger, Atractylodes, Ginseng, Licorice, Poria, Apricot Seed, and Tangerine Peel. Selected according to symptoms, three or four ingredients form a prescription. Bitter-Cold herbs are entirely excluded, and even Cooling herbs are avoided, because Yang is used to unblock Yang, preventing Yin herbs from interfering. Severe cases utilize Aconite, Aconite Root (Chuan Wu/Cao Wu), and Sichuan Pepper—greatly pungent and hot—to drive out Lower Jiao Yin and restore Upper Jiao Yang, akin to 'repairing heaven and bathing the sun,' demonstrating unique expertise. Modern physicians, unaware of Xiong Bi, habitually use Cardamom, Aucklandia, Chebula, Bupleurum-like rhizomes (San Leng), Divine Leaven, and Malt, thereby wasting the Yang Qi in the chest. Their insight is vastly inferior.