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Pathogenic factors entering the interior must first pass through the chest, then the hypochondrium, sequentially entering the heart and abdomen, and finally reaching the stomach. Therefore, chest fullness (chest distension) often accompanies exterior syndrome, while hypochondriac fullness often accompanies half-exterior half-interior syndrome. For instance, after purgation or sweating, if pulse is rapid (Cu Mai) and there is chest fullness, Guizhi Qu Shaoyao Tang (Cinnamon Twig Decoction without Paeonia) should be used. In cases of concurrent Taiyang and Yangming diseases with wheezing and chest fullness, purgation is contraindicated, and Mahuang Tang (Ephedra Decoction) is appropriate. Both conditions belong to the exterior and require diaphoresis, as the chest is relatively close to the body surface. When the pathogen reaches the hypochondrium, diaphoresis is no longer mentioned; instead, harmonization is employed. The classic text states: for chest fullness and hypochondriac pain, or persistent chest and hypochondriac fullness, and for initial Taiyang disease that has not resolved and transmitted to Shaoyang, presenting with hardness and fullness below the hypochondrium, dry retching, alternating chills and fever, and a deep-tight pulse, Xiaochaihu Tang (Minor Bupleurum Decoction) is suitable for harmonization. Generally, when pathogenic factors first enter the interior but have not yet stagnated to form excess, causing only depression and accumulation leading to fullness, harmonization suffices. If the pathogen remains in the chest and aggregates into an excess pattern, neither emesis nor purgation alone may suffice depending on the nature. For example, after sweating or purgation, if irritability, heat, and a sensation of obstruction in the chest occur, Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) is indicated. If there is epigastric stiffness and hardness with qi rushing up to the throat causing difficulty breathing, this indicates cold-phlegm in the chest, treated with Gengti San (Thladiantha Powder). Both are emetic agents; it should be noted that Zhizi Chi Tang expels empty irritability and guest-heat, while Gengti San expels phlegm-excess and retained cold.

If ten days have passed since Taiyang disease, and the pulse is floating and fine with a desire to sleep, the exterior has resolved. If chest fullness and hypochondriac pain persist, administer Xiaochaihu Tang; if the pulse is floating, administer Mahuang Tang. In Shanghan (Cold Damage) lasting four to five days, with body heat, aversion to wind, stiffness of the head and neck, fullness below the hypochondrium, warm hands and feet, and thirst, Xiaochaihu Tang modified by removing Banxia (Pinellia) and adding Renshen (Ginseng) and Gualougen (Trichosanthes Root) is the primary treatment. In Shanghan or Zhongfeng (Wind Strike) lasting five to six days, presenting with alternating chills and fever, bitter fullness in the chest and hypochondrium, poor appetite, vexation, and frequent vomiting, or alternatively, chest vexation without vomiting, thirst, abdominal fullness, hypochondriac palpable hardness, palpitations, difficult urination, absence of thirst with slight body heat, or cough, Xiaochaihu Tang is the primary treatment. In Shanghan unresolved for thirteen days, with chest and hypochondriac fullness and vomiting, tidal fever occurring in the late afternoon, followed by mild diarrhea: this was originally a Chaihu syndrome, but improper purgation failed to stop the diarrhea, which now persists. This indicates the physician incorrectly used pill-based purgatives. Tidal fever indicates excess; first use Xiaochaihu Tang to resolve the exterior, then treat with Chaihu Jia Mangxiao Tang (Bupleurum Decoction with Mirabilite).

After contracting disease for six to seven days, with a slow, floating, and weak pulse, aversion to wind and cold, and warm hands and feet, repeated incorrect purgation by the physician leads to inability to eat, hypochondriac fullness and pain, yellowing of the face, eyes, and body, neck stiffness, and difficult urination. Administering Chaihu Tang in this scenario will inevitably cause a feeling of heaviness in the rectum. For heat pathogens transmitting meridians causing hypochondriac fullness and dry retching, Daxiehu Tang (Greater Bupleurum Decoction) is used. In Taiyang Zhongfeng with diarrhea and vomiting, once the exterior is resolved, internal attack is permissible. If the patient sweats intermittently, has headache, epigastric stiffness and fullness radiating to the hypochondrium, dry retching, shortness of breath, sweating without aversion to cold, this indicates the exterior is resolved but the interior is disharmonious; Shizao Tang (Ten Jujube Decoction) is appropriate.

Shizao Tang Formula: Yuanhua (Genkwa Flower, stir-fried until black), Suxi (Kansui Root), Daji (Euphorbia Lathyris Root), each in equal parts. Grind into fine powder, mix well, and pound in a mortar two to three hundred times. Boil ten large jujubes in one sheng of water until reduced to five or six he, strain, and add the powder. Strong individuals take one qian, weak individuals take half a qian, taken alone with the jujube decoction at dawn. If defecation is insufficient and the disease persists, repeat the dose the next day, increasing by half a qian. Nourish with millet porridge after defecation. Failure to purge when indicated leads to abdominal distension and generalized edema. Du Ren once asked Sun Zhao: What disease does Shizao Tang treat? Sun replied: It treats Taiyang Zhongfeng where the exterior is resolved but the interior is disharmonious. Du asked how one knows the interior is disharmonious. Sun said: Headache, epigastric fullness, hypochondriac pain, dry retching, and sweating indicate interior disharmony. Du remarked that you described the symptoms but not the root cause of the disharmony. Sun admitted his uncertainty and asked for explanation. Du explained: Interior disharmony arises from phlegm and dry qi obstructing the middle jiao, causing headache, dry retching, shortness of breath, and sweating; this is Phlegm Obstruction (Tan Ge), requiring Shizao Tang. However, this formula should not be used lightly as it can rapidly damage the body; practitioners must exercise caution.

In Yangming disease, with tidal fever, loose stools, normal urination, but persistent chest and hypochondriac fullness, Xiaochaihu Tang is primary. In Yangming disease, with hardness and fullness below the hypochondrium, constipation, vomiting, and a white coating on the tongue, Xiaochaihu Tang is used. In Yangming Zhongfeng, with string-like, floating, and large pulse, shortness of breath, general abdominal fullness, hypochondriac and heart pain, obstruction of qi upon prolonged pressing, dry nose, inability to sweat, lethargy, jaundice of the whole body and eyes, difficult urination, tidal fever, and occasional hiccups, Xiaochaihu Tang is indicated. If the pulse is merely floating without other symptoms, Mahuang Tang is used. If initially thirsty, drinking water leads to vomiting, Chaihu Tang is contraindicated; if eating leads to hiccups (note: lack of desire to drink with vomiting indicates Chaihu syndrome; vomiting due to water retention indicates water stagnation in the heart/epigastrium).

For Shaoyang disease, hypochondriac fullness, dry retching, and alternating chills and fever belong to Shaoyang (see "Alternating Chills and Fever" for formula discussion).

In Jueyin disease, Shanghan with minimal heat and slight cold extremities (cold fingertips), silence, anorexia, and irritability for several days, with clear urine indicating heat elimination, desires food indicating recovery. If cold extremities accompany vomiting and chest/hypochondriac vexation, hematochezia will likely occur (treat with Huangqin Shaoyao Tang, Xiaochaihu Tang, or Didang Tang).

Wu Shou treated hypochondriac pain by adding Zhiqiao (Aurantii Fructus), Qingpi (Citrus Reticulata Pericarpium), Jiegeng (Platycodon Root), and Shaoyao (Paeonia Root) to the formula. For hypochondriac hardness, add Moli (Ostrea Shell). If chills, rigidity, alternating chills and fever, and chest/hypochondriac fullness increase, add Guizhi (Cinnamon Twig) and Baishao (White Peony Root); these modifications are applied within Xiaochaihu Tang.

In women with fever and aversion to cold during menstruation, if fever subsides, pulse becomes slow, body cools, hypochondriac fullness resembles Jie Xiong (Chest Binding) syndrome, and delirium occurs, puncture Qimen (LR14) (see "Delirium" for discussion).

After vomiting, purgation, or sweating, if pulse is faint, epigastric fullness, hypochondriac pain, qi rushing to the throat, dizziness, palpitations, and tremors occur, Wei Syndrome (flaccidity syndrome) develops (see "Fullness" for discussion). After purgation, if the pulse is string-like, bilateral hypochondriac rigidity will occur. A pre-existing mass below the hypochondrium connected to the umbilicus, with pain radiating to the lower abdomen and genitals, is named Zang Jie (Organ Knotting) and is fatal. (The left and right sides are the pathways of Yin and Yang; the hypochondrium is part of this region. A pre-existing mass here blocks the pathways of Yin and Yang, preventing pathogenic transmission via meridians and allowing direct invasion of the Zang organs, hence death.)