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Chapter 15 of 29
伤寒杂病论
This chapter is the second part of the section on Taiyang disease (initial-stage externally contracted illness with the pathogenic factor located at the body surface), focusing on several important secondary syndromes arising after improper treatment of Taiyang disease—especially erroneous use of purging. These include: organ accumulation (zangjie) , chest binding (jiexiong) , and gastric stuffiness (pizheng) , extending further to heat entering the blood chamber, combined/overlapping diseases, and Yangming heat syndromes.
The original text opens with questions and answers. Someone asks: "There are diseases known as organ accumulation and chest binding—what do they look like?" The teacher answers: "Cun pulse floating, guan pulse small, thin, deep, and tense indicates organ accumulation; pain upon palpation, with cun pulse floating and guan pulse deep, indicates chest binding."
Further explanation: Organ accumulation can occur in any of the five viscera and requires differentiation between cold and heat. The disease location lies at the blood level (the layer of blood stasis in the vessels); although qi stagnation is visible superficially, the root cause originates from blood-level pathology.
The original text particularly emphasizes: If organ accumulation presents without yang-heat manifestations, without alternating chills and fever, with the patient relatively quiet and the tongue coating slippery, purging must not be used; if appetite remains normal but there is frequent diarrhea with white, slippery tongue coating, this is difficult to treat.
Cause of chest binding: Disease originating from yang with erroneous purging brings heat pathogen into the interior, forming chest binding; disease originating from yin with premature purging forms gastric stuffiness. Chest binding results from erroneous purging. When chest binding presents with stiffness of the head and neck resembling flaccid rigidity (neck and back stiff without opisthotonos), Daxianxiong Pill can be used. When the pulse is floating and large in chest binding, purging must not be used—purging may be fatal; when chest binding signs are fully present with accompanying restlessness, the prognosis is also ominous.
In Taiyang disease with floating and rapid pulse (exterior heat with pain pattern), after erroneous purging, there appears pain and resistance in the diaphragm area, emptiness in the stomach region, shortness of breath, restlessness, vexation, and hardness below the heart — this is chest binding, treated with Daxianxiong Decoction. If chest binding does not develop, but only sweating on the head with anhidrosis elsewhere, scanty urine, and yellowing of the body, use Wuling Powder. In cold damage of six to seven days, with chest binding from heat and excess, pain below the heart with stone-hardness upon pressure, use Daxianxiong Decoction. In cold damage of over ten days, with heat bound in the interior accompanied by alternating chills and fever, use Dachaihu Decoction; if there is chest binding without marked heat, indicating water-fluid accumulating in the chest and hypochondria, with only slight sweating on the head, use Daxianxiong Decoction. In Taiyang disease with repeated diaphoresis followed by purging, no bowel movement for five to six days, dry tongue with thirst, tidal fever in the evening, and hard, distended, painful abdomen from below the heart to the lower abdomen where touching is unbearable, use Daxianxiong Decoction. Minor chest binding is located right below the heart, painful upon pressure, with floating and slippery pulse; use Xiaoxianxiong Decoction.
Outcomes after erroneous purging: In Taiyang disease of two to three days with inability to lie down but desire to sit up, there must be binding below the heart; if the pulse is weak and thin, indicating pre-existing cold-fluid, and purging is erroneously applied—if diarrhea ceases, chest binding may form; if diarrhea continues unabated, this becomes heat-purging diarrhea. After purging in Taiyang disease, the outcome can be judged by the pulse: rapid pulse without chest binding indicates impending resolution; floating pulse may develop into chest binding; tight pulse may cause throat pain; wiry pulse indicates bilateral hypochondriac tightness; thin and rapid pulse indicates unresolved headache; deep and tight pulse indicates nausea; deep and slippery pulse indicates heat diarrhea; floating and slippery pulse may indicate blood per rectum.
When disease is in the yang aspect, it should be resolved by diaphoresis; if cold water is instead sprayed or doused onto the patient, the heat is depressed and cannot disperse externally, increasing fever and restlessness, with goosebumps on the skin, desire to drink but without actual thirst—use Wenjia Powder; if not resolved, use Wuling Powder. Cold-excess chest binding without heat signs may be treated with Sanwu Xiaoxianxiong Decoction (referring to the Baidan-type powder in the original text). After taking the white powder, if the pathogen is above the diaphragm, vomiting occurs; if below the diaphragm, diarrhea occurs; if no diarrhea, warm congee may be given; if diarrhea is excessive, cold congee may be given.
In combined Taiyang-Shaoyang disease, with head and neck stiffness and pain or dizziness, sometimes resembling chest binding, with stuffiness and hardness below the heart, acupuncture should be applied to Dazhui, Feishu, and Ganshu; diaphoresis must not be used. If diaphoresis is used, delirium results, with wiry and large pulse; if delirium persists, acupuncture at Qimen point.
Stuffiness from erroneous purging: When the pulse is floating and tight, and after erroneous purging the tightness enters the interior, stuffiness develops, soft upon pressure, belonging to qi-stuffiness; the classical prescription is Xiaoqinglong Decoction. For stuffiness below the heart that is soft upon pressure, with guan pulse floating and large, use Dahuang Huanglian Huangqin Xiexin Decoction. For stuffiness below the heart accompanied by chills and aversion to cold, use Fuzi Xiexin Decoction. If stuffiness does not resolve, with thirst, restlessness, and difficult urination, use Wuling Powder. After cold damage resolves with sweating, with disharmony in the stomach region, stuffiness and hardness below the heart, putrid belching with food odor, water-qi in the hypochondriac region, borborygmus in the abdomen, and diarrhea, use Shengjiang Xiexin Decoction. In cold damage or wind stroke after erroneous purging, with diarrhea dozens of times daily, undigested food in the stool, borborygmus, stuffiness and hardness with fullness below the heart, dry heaving and vexation—if purging is again applied and stuffiness worsens—this indicates vacuity in the stomach with rebellious guest-qi ascending; use Gancao Xiexin Decoction. For incessant diarrhea with stuffiness and hardness below the heart where Xiexin Decoctions are ineffective, the disease lies in the lower burner; use Chishizhi Yuyuliang Decoction; if diarrhea persists, promote urination. After cold damage with vomiting and purging followed by diaphoresis, with vacuity vexation and thin pulse, after eight to nine days, stuffiness and hardness below the heart, hypochondriac pain, qi rushing up to the throat, dizziness, twitching of sinews and vessels—prolonged cases develop atrophy. After cold damage resolves following diaphoresis, emesis, and purging, with stuffiness and hardness below the heart and unremitting belching, use Xuanfu Daizhe Decoction. In Taiyang disease where exterior signs have not resolved and purging is repeatedly used, with heat-purging diarrhea that does not cease, stuffiness and hardness below the heart, and unresolved exterior and interior, use Guizhi Renshen Decoction. After severe purging followed by renewed diaphoresis in cold damage, with stuffiness below the heart and chills, the exterior is not yet resolved; the exterior should be treated first, then the stuffiness. In cold damage with fever and sweating that does not resolve the condition, stuffiness and hardness below the heart, vomiting and diarrhea, use Dachaihu Decoction. When the illness resembles a Guizhi pattern but without headache or neck stiffness, with the cun pulse slightly floating, stuffiness and hardness in the chest, and qi rushing up to the throat making breathing difficult, this indicates cold-excess in the chest that should be expelled by vomiting—use Guadi Powder; those with blood loss or weak constitution must not use it. If there is a pre-existing lump below the hypochondrium extending to the umbilicus, with pain radiating to the lower abdomen and involving the external genitalia, this is called organ accumulation with poor prognosis.
In women with wind strike, fever, and aversion to wind, if menstruation happens to arrive, and after seven to eight days the fever subsides with slow pulse and cool body, yet there is fullness below the chest and hypochondria resembling chest binding, with delirium—this is heat entering the blood chamber (heat pathogen invading the uterus/chong-ren channels); acupuncture at Qimen is appropriate. In women with wind strike of seven to eight days, with alternating chills and fever at regular intervals and menstruation that has just ceased, this is heat entering the blood chamber with blood binding manifesting like malaria; use Xiaochaihu Decoction. In women with cold damage and fever where menstruation happens to arrive, clear by day but delirious at night speaking as if seeing ghosts—this is heat entering the blood chamber; the stomach qi and the upper and middle burners must not be disturbed, and it will resolve spontaneously.
In cold damage of six to seven days with fever, mild aversion to cold, painful joints, slight nausea, and a sensation of binding below the heart with exterior signs still present, use Chaihu Guizhi Decoction. In cold damage of five to six days, after diaphoresis and purging, with fullness and slight binding in the chest and hypochondria, difficult urination, thirst without nausea, sweating only on the head, alternating chills and fever, and vexation, use Chaihu Guizhi Ganjiang Decoction. In cold damage of five to six days with sweating on the head, mild aversion to cold, cold hands and feet, fullness below the heart, no desire for food, hard stools, and thin pulse—this is yang-slight binding, half in the interior and half in the exterior; Xiaochaihu Decoction may be given; if not fully clear, it resolves once the bowels move. In cold damage of five to six days with vomiting and fever, where Chaihu syndrome signs are present, if after erroneous purging the Chaihu signs persist, Chaihu Decoction may again be given; if there is fullness with hardness and pain below the heart, this is chest binding—use Daxianxiong Decoction; if there is only fullness without pain, this is stuffiness—use Banxia Xiexin Decoction.
In cold damage after vomiting and purging, unresolved after seven to eight days, with heat bound in the interior, heat present in both exterior and interior, occasional aversion to wind, intense thirst, dry tongue, vexation, and desire to drink large quantities of water, use Baihu plus Renshen Decoction. In cold damage without pronounced fever, but with dry mouth, thirst, vexation, and slight aversion to cold on the back, also use Baihu plus Renshen Decoction. When the exterior is unresolved, Baihu Decoction must not be used; when thirst with desire to drink is present without exterior signs, it may be used. In combined Taiyang-Shaoyang disease, with hardness below the heart, neck stiffness, and dizziness, acupuncture should be applied to Dazhui, Feishu, and Ganshu; purging must not be used. In combined Taiyang-Shaoyang disease with spontaneous diarrhea, use Huangqin Decoction; if vomiting is present, use Huangqin plus Banxia Shengjiang Decoction. In cold damage with heat in the chest and pathogenic qi in the stomach, with abdominal pain and desire to vomit, use Huanglian Decoction. In cold damage with floating and slippery pulse, indicating heat in the interior without cold in the exterior, use Baihu Decoction. In cold damage with knotted or skipping pulse and palpitations, use Zhigancao Decoction.
The above formulas are all recorded in the original text and are provided solely for theoretical study; they do not constitute medication guidance.
The heart of this chapter lies in the differential diagnosis and treatment of secondary syndromes after erroneous purging in Taiyang disease. In Taiyang disease, the pathogen resides at the exterior and should be resolved through diaphoresis. If purging is applied prematurely or repeatedly, the pathogen is easily drawn into the interior. Depending on the patient's constitution and the nature of the pathogen, chest binding, gastric stuffiness, organ accumulation, and other conditions may develop.
These provisions record acute chest-abdominal emergencies and gastrointestinal dysfunctions that arose from erroneous treatment of acute febrile diseases in antiquity. Some of these concepts can be correlated with modern medicine, though historical limitations exist.
Compiled by Bua Gua: This content is based on classical Chinese medicine texts and is provided solely for the study of traditional culture. It does not constitute any medical diagnosis, medication, or treatment advice. Please seek medical attention promptly if you are unwell.