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There are cases of fullness in the epigastrium not caused by sweating or purging. The classic text states: "When pathogenic factors are knotted in the chest, causing epigastric fullness and irritability, with hunger but no desire to eat, emesis should be used." It also states: "If the pulse is floating and large, and the epigastrium is conversely hard with internal heat, if the disease belongs to the Zang organs (referring to accumulated feces in the intestines), purgation should be used." Wu Shi said: "What is meant here by 'belongs to the Zang organs' is that old stool is retained in the bowels; sweating should not be induced." These two methods—emesis and purgation—are applied according to the high or low location of the pathogen. There are also cases where purgation is contraindicated, such as in Yangming disease. If there is hardness and fullness in the epigastrium, it must not be purged; if purged and diarrhea persists unceasingly, death ensues; if diarrhea stops, recovery occurs. This is because the pathogen is between the exterior and interior, lingering in the epigastrium and not yet fully entering the Fu organs, hence the warning against purgation.

There are cases where epigastric fullness and slight pain occur after sweating or purging, and cases of rebellious fullness in the epigastrium after vomiting and purging, for which Guizhi Baizhu Fuling Tang (Cinnamon Twig, Atractodes Macrocephala, and Poria Decoction) is appropriate. There are also cases where purging leads to hardness and fullness in the epigastrium, forming Jie Xiong (Chest Binding) or Pi (Glomus) syndromes; these require careful examination and cross-referencing.

Taiyang Disease (treated with harmonizing method): After taking Guizhi Tang or undergoing purging, if there remains stiffness and pain in the head and neck, a mild fever, absence of sweat, epigastric fullness with slight pain, and difficulty urinating, Gui Zhi Qu Gui Jia Fuling Baizhu Tang (Cinnamon Twig Decoction minus Cinnamon Twig plus Poria and Atractodes Macrocephala Decoction) is indicated. In Shanghan (Cold Damage) after vomiting and purging, if there is rebellious fullness in the epigastrium, Qi rushing upward to the chest, dizziness upon rising, a deep and tight pulse, and further sweating would disturb the meridians causing body tremors and shaking, Fuling Guizhi Baizhu Gancao Tang (Poria, Cinnamon Twig, Atractodes Macrocephala, and Licorice Decoction) is indicated. In Shanghan for six or seven days, with fever, slight aversion to cold, vexing pain in the joints, slight vomiting, and epigastric support-like fullness (Zhi Jie), while exterior symptoms persist, Chai Hu Jia Guizhi Tang (Bupleurum plus Cinnamon Twig Decoction) is the primary treatment. (*Huo Ren Shu* states: Fullness without hardness, with epigastric vexation, is called Zhi Jie. Also, excessive water intake causing water accumulation is treated with Xiao Banxia Fuling Tang).

Shanghan (after emesis): On the fifth or sixth day, if body heat persists after bowel movement and there is knotting pain in the heart/mind, Zhizi Chi Tang (Gardenia and Soybean Fermented Decoction) is indicated. In Shanghan with fever, sweating, unresolved illness, epigastric glomus hardness, vomiting, and diarrhea, Da Chai Hu Tang (Major Bupleurum Decoction) is indicated.

Taiyang-Shaoyang Concurrent Disease (treated with acupuncture): If there is epigastric hardness, neck stiffness, and dizziness, one should needle Dazhui (GV14) and Feishu (BL13); never use purgation.

Moxibustion/Warming Method: If there is pathogenic accumulation in the chest, heart, and hypochondrium causing fullness, oppression, hardness, and pain, take one slice of fresh ginger, mash it, squeeze out the juice, and stir-fry the residue until slightly dry but still moist. Wrap it in silk cloth and gently warm the affected area. When slightly relieved, mix the residue with the previously squeezed juice, dry it again, and continue warming for a long time until sudden relief is felt. This is an excellent method.

In Shanghan on the fifth or sixth day, with only sweat on the head, slight aversion to cold, cold hands and feet, epigastric fullness, lack of desire to eat, hard stools, and a fine pulse, this is Yang Wei Jie (Yang Micro-Constraint), having both exterior and interior aspects. A deep pulse also indicates interior involvement. If it were Pure Yin Constraint, there would be no exterior symptoms. Although the pulse is deep and tight, it cannot be diagnosed as Shaoyin disease because of the head sweat; thus, it is known not to be Shaoyin. Xiao Chai Hu Tang (Minor Bupleurum Decoction) is appropriate. If the condition remains unsatisfactory, passage of stool will resolve it.

Yangming Disease: Epigastric hardness and fullness must not be purged. If purged and diarrhea persists unceasingly, death ensues; if diarrhea stops, recovery occurs. (Alternatively, Xi Xin Tang may be used. Abdominal fullness in Yangming disease indicates pathogen entering the Fu organs, suitable for purgation; epigastric hardness and fullness indicate the pathogen is shallow and not fully in the Fu organs, so immediate purgation is contraindicated. If diarrhea stops, the pathogen is gone and righteous Qi is restored, leading to recovery; if purgation causes unceasing diarrhea, righteous Qi collapses, leading to death.) For diseases resolving with downward movement, if on the second or third day the pulse is weak, without Taiyang or Chai Hu symptoms, with irritability and epigastric hardness, and by the fourth or fifth day the patient can eat, give Xiao Cheng Qi Tang (Minor Order the Qi Decoction) in small amounts to mildly harmonize the stomach. (See detailed discussion on Stomach Excess).

Jueyin Disease: If patients have cold extremities and a pulse that is suddenly tight, the pathogen is knotted in the chest. With central fullness, irritability, hunger but no desire to eat, the disease is in the chest and requires emesis; Geng Ti San (Melon Seed Powder) is indicated.

Wu Shi's Commentary: Whenever there is epigastric fullness, it is located below the heart and above the stomach. This is spontaneous fullness, not caused by purging. If early purging causes epigastric fullness, this is Pi Qi (Glomus Qi), which has separate treatment guidelines. For any epigastric fullness, if pressing and rubbing causes it to dissipate and become soft, it is deficient Qi. If there is no fever, Mu Xiang He Zhong Tang (Costus Harmonizing the Middle Decoction) is used; if there is fever, Xiao Chai Hu Tang (Minor Bupleurum Decoction) plus 1 qian of Zhi Shi (Immature Bitter Orange), removing Huang Qin (Scutellaria Root), adding 1 qian of Jiang Chao Huang Lian (Ginger-fried Coptis Rhizome), and reducing the dosage of Ren Shen (Ginseng Root) by half. If pressing produces sound, there is retained water; if pressing causes hardness and pain, there is retained food; if there is pain without pressing and the patient suffers from forgetfulness, there is stored blood. Each has its own section and requires careful examination and treatment. For any case with Shaoyao pulse (wiry), bitter taste, fever, and epigastric fullness, Xiao Chai Hu Tang (Minor Bupleurum Decoction) plus 1 qian each of Zhi Shi (Immature Bitter Orange) and Huang Lian (Coptis Rhizome) is used.