典藏书目

Question: In diseases, there are "Jie Xiong" (Chest Binding) and "Zang Jie" (Organ Binding). What are their clinical manifestations?
Answer: Tenderness upon palpation, with a floating pulse at the Cun position and a deep pulse at the Guan position is called Jie Xiong (Chest Binding).
What is Zang Jie (Organ Binding)?
Answer: The symptoms resemble those of Jie Xiong (Chest Binding), but appetite remains normal, and there is frequent diarrhea. A floating pulse at the Cun position and a fine, small, deep, and tight pulse at the Guan position is called Zang Jie (Organ Binding). If the tongue has a white and slippery coating, it is difficult to treat.

(Cheng Wuji's commentary: In Jie Xiong (Chest Binding), pathogenic factors bind in the chest; in Zang Jie (Organ Binding), pathogenic factors bind in the Zang organs. Both conditions result from pathogenic factors entering the interior due to deficiency after improper use of purgative methods. After purgation, if pathogenic factors enter the interior and bind with Yang Qi, it is called Jie Xiong (Chest Binding), because Yang Qi resides in the chest; if they bind with Yin Qi, it is called Zang Jie (Organ Binding), because Yin Qi receives the pathogen and enters the Five Zang Organs. Qi should flow freely; obstruction causes pain. When pathogens bind in the Yang aspect, Yin Qi cannot ascend; when pathogens bind in the Yin aspect, Yang Qi cannot descend. Both conditions result in hardness and fullness below the heart. A floating pulse at the Cun and a deep pulse at the Guan indicate pathogenic binding in the Yang aspect; a floating, fine, small, deep, and tight pulse at the Cun and Guan indicates pathogenic binding in the Yin aspect. With Yin binding and Yang unbound, although there is pain and constriction below the heart, diet remains normal. Yin Qi sinks due to Yang deficiency, causing spontaneous frequent diarrhea. Yin conditions resolve with Yang; if Zang Jie (Organ Binding) presents with many heat signs, it is easier to treat. A white and slippery tongue coating indicates pathogenic binding in the chest accompanied by cold, hence described as difficult to treat.)

According to the text stating "resembling Jie Xiong (Chest Binding)," there must be a distinction from Jie Xiong (Chest Binding). The commentary stating "both involve hardness and pain below the heart" is inaccurate. "Resembling Jie Xiong (Chest Binding) with normal diet" implies that there is no pain upon palpation. Since the binding is in the Zang organs, and the white tongue coating is an external sign of chest cold, with pathology affecting both upper and lower regions, it is difficult to treat. Wang Chaofeng suggested acupuncture at the Guanyuan (CV-4) acupoint.

Zang Jie (Organ Binding) lacks Yang syndrome signs, such as alternating chills and fever. The patient appears unusually quiet, and the tongue has a slippery coating; aggressive treatment (attacking/purgation) is contraindicated.

(Cheng Wuji's commentary: Zang Jie (Organ Binding) typically requires purgation, but the absence of Yang signs indicates no exterior heat; the absence of alternating chills and fever indicates no half-exterior/half-interior heat; the patient's quietness indicates no interior heat. The Classic states, "A tongue coating resembling a fur," indicating heat in the Dantian and cold in the chest. Since both exterior and interior are cold, aggressive treatment is contraindicated. Wang Chaofeng suggested acupuncture at the Guanyuan (CV-4) acupoint and administration of Xiaochaihu Tang (Minor Bupleurum Decoction).)

If a patient has chronic Pi (Glomus/Blockage) in the chest, extending to the side of the umbilicus, radiating to the lower abdomen and into the genital tendons, this is called Zang Jie (Organ Binding), which is a fatal condition.

When a disease originates in the Yang aspect and is incorrectly treated with purgatives, heat enters internally, resulting in Jie Xiong (Chest Binding). When a disease originates in the Yin aspect and is incorrectly treated with purgatives, it results in Pi (Glomus/Blockage). The reason Jie Xiong (Chest Binding) occurs is due to premature purgation.

(Zhang Yin'an's commentary: Some cite Cheng Wuji's annotation: "Absence of heat with aversion to cold indicates origin in the Yin." If there is no heat and only aversion to cold, it is a Yin syndrome; where would the indication for purgation lie? Moreover, would it not result in more than just Pi (Glomus/Blockage)? Zhongjing's reference to Yin and Yang refers to Exterior and Interior, not this specific context. When disease is in the Exterior, sweating should be induced; incorrect purgation leads to Jie Xiong (Chest Binding). When disease is in the Interior but has not yet entered the Fu organs, premature purgation leads to Pi (Glomus/Blockage). Thus, Jie Xiong (Chest Binding) results from premature purgation; Pi (Glomus/Blockage) also results from premature purgation. The Classic states: "Pulse floating and tight; floating indicates Wind, tight indicates Cold." Wind injures Wei (Defensive) Qi, Cold injures Ying (Nutritive) Qi. It further states: "Pulse floating and tight, if purged again, the tightness enters the interior forming Pi (Glomus/Blockage)." From this, we deduce that Wind pathogens entering the interior form Jie Xiong (Chest Binding), while Cold pathogens entering the interior form Pi (Glomus/Blockage). However, these are all consequences of Taiyang Disease (Sunshine Disease), not Yin syndromes. It is also stated: "Disease in Yang should be resolved by sweating." Here, Yang refers to the Exterior syndrome, which is clear. Furthermore, among various descriptions of Pi (Glomus/Blockage), none arise from purging patients with no heat and aversion to cold. This is an error by Mr. Cheng.)

In Shanghan (Cold Damage) after five or six days, if there is vomiting and fever, and the Chaihu Syndrome (Bupleurum Syndrome) is present, but other drugs were used to purge, and the Chaihu Syndrome (Bupleurum Syndrome) persists, administering Xiaochaihu Tang (Minor Bupleurum Decoction) again is appropriate. Although purgation has been performed, this is not a counter-indication (Ni Zheng). The patient will likely experience intense internal heat followed by shivering, then fever and sweating, leading to resolution. If there is fullness and hardness with pain below the heart, this is Jie Xiong (Chest Binding), primarily treated with Daxiexin Tang (Major Draining the Chest Decoction). If there is fullness without pain, this is Pi (Glomus/Blockage); Xiaochaihu Tang (Minor Bupleurum Decoction) is not indicated. Banxia Xiexin Tang (Pinellia Decoction to Drain the Epigastrium) should be used.

(The *Ren Shu* states: Knowing it is Pi (Glomus/Blockage), using Jiegeng Tang (Platycodon Decoction) first is excellent; this formula moves Qi and descends through the diaphragm, proving effective. If righteous Qi is unimpaired and the interior does not accept pathogens, the patient experiences intense heat, shivering, fever, and sweating before recovery. If post-purgation pathogens transmit deeply to the interior, causing Pi (Glomus/Blockage) with hardness and pain, this is Jie Xiong (Chest Binding), requiring Daxiexin Tang (Major Draining the Chest Decoction) to purge interior pathogens. For mild Pi (Glomus/Blockage) characterized only by fullness without pain, Xiaochaihu Tang (Minor Bupleurum Decoction) is contraindicated; Banxia Xiexin Tang (Pinellia Decoction to Drain the Epigastrium) is indicated. Cheng Wuji stated: Post-purgation, Yang pathogens transmitting to the interior bind in the chest, as the chest is the domain of Yang. Zhongjing diagnoses Jie Xiong (Chest Binding) based on hardness and pain below the heart; is this located below the heart? Cheng Wuji's clever but distorted interpretation—that Yang Qi resides in the chest and Yang pathogens binding there constitute Jie Xiong (Chest Binding)—is erroneous.)