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(Relevant discussions are found in the preceding section on "Hypochondriac Fullness and Pain" involving hypochondriac diseases, which have been mentioned previously.)

Taiyang Disease: In combined Taiyang and Yangming disease, presenting with panting and chest fullness, purgation is contraindicated; Mahuang Tang (Ephedra Decoction) is appropriate. (Qi receives its influence in the chest; panting with chest fullness indicates that Yang Qi fails to diffuse, leading to stagnation and rebellion. Fullness below the heart or in the abdomen belongs to excess patterns and should be treated with purgation; however, chest fullness here is not interior excess, hence purgation is contraindicated. Although Yangming is involved, the combination with Taiyang indicates a exterior pattern, thus Mahuang Tang is used to induce sweating.) If, after sweating or purgation, restlessness, fever, and a sensation of obstruction in the chest occur, Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) is appropriate. (Yang Qi receives its influence in the chest; sweating or purgation depletes Yang Qi, allowing pathogenic heat to lodge in the chest, condensing without dispersing, resulting in restlessness, fever, and chest obstruction. Zhizi Chi Tang is given to vomit out the pathogen from the chest.) The condition resembles Guizhi Tang syndrome, but without headache or neck stiffness, with a slightly floating pulse at the cun position, chest痞 (pi, stuffiness/hardness), qi rushing up to the throat causing dyspnea; this is cold pathogen (phlegm-fluids) in the chest, requiring emesis; Gouti San (Melon Seed Powder) is appropriate. (Resembling Guizhi Tang syndrome implies fever, sweating, and aversion to wind, indicating the pathogen is in the exterior; headache and neck stiffness are characteristic of Guizhi Tang syndrome. Absence thereof suggests the pathogen has entered the interior. A floating pulse indicates exterior location, a deep pulse indicates interior location; a slightly floating pulse at the cun position indicates the pathogen is neither in the exterior nor the interior, but in the chest. The chest corresponds to the exterior, so the condition resembles Guizhi Tang syndrome but with a slightly floating cun pulse. Chest stuffiness, qi rushing to the throat, and dyspnea indicate cold pathogen lodging in the chest rather than the exterior. *Qianjin Fang* states: When qi floats to the upper part, filling the chest, causing fullness, vomiting cures it. Gouti San is given to vomit out the pathogen from the chest. If qi does not rush upward, this method is contraindicated.) After purgation in Taiyang disease, if a rapid, intermittent pulse (cu mai) and chest fullness occur, Guizhi Qu Shaoyao Tang (Cinnamon Twig Decoction without Paeonia) is appropriate. (Formula discussion see "Aversion to Cold"). If the pulse is rapid, intermittent, but not knotted, the disease is resolving.

After purgation, if chest fullness and dysuria occur, accompanied by restlessness, palpitations, delirium, heaviness of the body, and inability to turn over, Chaihu Jia Longgu Muli Tang (Bupleurum Decoction plus Dragon Bone and Oyster Shell) is appropriate. (Formula discussion see "Palpitations/Panic"). If accompanied by hiccups and a slippery tongue coating, it is damp-bi.

Yangming Disease: Tidal fever, loose stools, normal urination, and chest and hypochondriac fullness belong to Yangming disease. (See "Hypochondriac Fullness and Pain")

Shaoyang Disease: Wind-strike, with deafness, red eyes, chest fullness, and irritability; if emesis or purgation is used, palpitations and fright ensue; to rescue from adverse effects, Xiaochaihu Tang (Minor Bupleurum Decoction) without Huangqin plus Fuling is appropriate. (The Shaoyang meridian originates at the eye, travels through the ear, and its branch descends into the chest, piercing the diaphragm. Wind damages qi; wind generates heat. Shaoyang pathogen causes qi stagnation and heat, leading to deafness, red eyes, chest fullness, and irritability. The pathogen is in Shaoyang, a half-exterior, half-interior stage. Emesis removes irritability but damages qi, leading to palpitations due to qi deficiency; purgation removes fullness but depletes blood, leading to fright due to blood deficiency.)

Taiyin Disease: Taiyin disease manifests as abdominal fullness and vomiting, inability to eat, worsening spontaneous diarrhea, and occasional spontaneous abdominal pain. If purged, it inevitably leads to hardness and knotting below the chest. (Taiyin disease involves yang pathogen transmitting to the interior. The Taiyin meridian spreads in the stomach; pathogen stagnation causes abdominal fullness. Failure to descend leads to vomiting and anorexia; failure to ascend leads to worsening spontaneous diarrhea and occasional abdominal pain. Abdominal pain caused by interior yin-cold is typically constant; here, yang pathogen interfering with the interior causes pain that is not constant, only occasional. Purging leaves yin pathogen in the lower chest, forming knots. Classics state: If a yin-pattern disease is wrongly purged, pi (stuffiness) results. Xiexin Tang, Lizhong Tang, and Sini Tang are not applicable. Zhao Xikan's *Huoren Shu*, Question 18, states: Taiyin is the spleen meridian, governing chest and diaphragm distension. I observed Cheng Wuji's *Mingli Lun* stating: The chest is close to the exterior, hence Zhang Zhongjing said panting with chest fullness uses Mahuang Tang for exterior sweating. Also, chest and hypochondriac fullness uses Xiaochaihu Tang for harmonizing half-exterior, half-interior. Taiyin only mentions abdominal fullness, vomiting, anorexia, occasional abdominal pain, or abdominal fullness with dry throat. Thus, it is clear Taiyin does not govern the upper chest.)

Shaoyin Disease: Disease presenting with diarrhea, sore throat, chest fullness, and irritability; Zhufu Tang (Pig Skin Decoction) is appropriate. (The Shaoyin meridian ascends from the kidney, passes through the liver and diaphragm, enters the lung, and follows the throat; its branch exits the lung, connects to the heart, and enters the chest. Pathogen transmits from yang meridians to Shaoyin; yin deficiency with exogenous heat causes diarrhea, sore throat, chest fullness, and irritability. Zhufu Tang nourishes yin and clears heat. Among the five formulas for sore throat, Zhufu Tang best resolves toxicity.)

Jueyin Disease: Patient with cold extremities, sudden tight pulse, pathogen knotting in the chest, epigastric fullness and irritability, hunger but inability to eat; the disease is in the chest, requiring emesis; Gouti San (Melon Seed Powder) is appropriate. (Cold extremities indicate pathogen sinking inward. A tight, firm pulse indicates excess; pathogen in fu organs yields a deep pulse. Sudden tightness indicates pathogen knotting in the chest as excess, causing epigastric fullness and irritability. No pathogen in the stomach allows hunger, but disease in the chest prevents eating. Gouti San is given to vomit out the pathogen from the chest. Cold extremities must be distinguished by pulse tightness and chest pain.) The syndrome of "slight heat, slight cold extremities, chest and hypochondriac irritability and fullness" has been mentioned previously.

Wu's Clinical Experience: Chest fullness is often treated with emesis. Excess patterns suit Gouti San; deficiency patterns suit Ren Shen Lu (Deer Antler Velvet) or drinking Xiangsu San (Fragrant Su Decoction) followed by finger-induced vomiting. For typhoid fever transmitting to Shaoyang after three to four days, with wiry pulse, bitter taste, fever, and chest fullness, Xiaochaihu Tang is appropriate. For chest stuffiness, add Zhi Qiao (Bitter Orange Peel) and Jie Geng (Platycodon Root) two qian each to promote qi movement. For chest and hypochondriac fullness with irritability, add Gua Lou Shi (Trichosanthes Fruit) three qian and Huang Lian (Coptis Rhizome) one and a half qian. *Huoren Shu* treats chest fullness and qi pi (stuffiness) with only Zhi Qiao and Jie Geng two qian each, plus five slices of Sheng Jiang (Fresh Ginger), named Zhi Qiao Tang. Above the heart, in the chest region, Zhi Qiao is appropriate; below the heart, in the stomach region, Zhi Shi (Immature Bitter Orange) is appropriate. Zhi Qiao drains qi from the highest level; Zhi Shi drains qi from the lowest level. Gua Lou Ren (Trichosanthes Seed) is a key herb for draining the lungs and washing away phlegm turbidity in the chest; thus, it must be added for chest fullness with irritability. Another method for qi pi and chest fullness: stir-fry one to two sheng of wheat bran with sliced raw Zhi Qiao until hot, remove Zhi Qiao, wrap the hot bran in cloth, and apply as a compress to the chest. Heat dissipates qi quickly, leading to recovery.