Pain indicates Jie Xiong (Chest Binding), while absence of pain indicates Pi Syndrome (Epigastric Fullness and Obstruction). ("Pi" is pronounced pǐ.) The Guan pulse at both wrists is deep, indicating they share a similar pathogenesis. (*Jade Box Classic* states: When disease originates from the Yin aspect and purgatives are incorrectly applied, Pi Syndrome results. *Treatise on Cold Damage* states: When disease originates from the Yang aspect and purgatives are incorrectly applied, heat enters internally, resulting in Jie Xiong; when disease originates from the Yin aspect and diaphoretics are incorrectly applied, Pi Syndrome also results. Generally, pain signifies Jie Xiong, and lack of pain signifies Pi Syndrome. In both Jie Xiong and Pi Syndrome, the Cun pulse is floating, and the Guan pulses are deep.)

If the Guan pulse is floating accompanied by epigastric fullness, Xiexin Decoction should be used. (Zhang Zhongjing stated: For epigastric fullness that is soft upon palpation, with a floating Guan pulse, Dahuang Huanglian Xiexin Tang [Rhubarb and Coptis Decoction to Drain the Epigastrium] is the primary formula.) If thirst and irritability occur, Wuling San (Five-Ingredient Powder with Poria) is indicated. (Zhang Zhongjing stated: For epigastric fullness treated with Xiexin Decoction, if the patient remains thirsty, irritable, and has difficulty urinating, Wuling Tang [Five-Ingredient Decoction] is the primary formula.) Jiegeng Zhishi Tang (Platycodon and Aurantium Decoction) is optimal; administer it first to promote Qi movement. (Physicians of the Jin Dynasty often treated Pi Qi (Qi Stagnation in the Epigastrium) with Jiegeng Zhishi Tang, frequently achieving recovery because it descends Qi.) If diarrhea sounds like thunder and there is hardness in the epigastrium, Gancao Xiexin Tang (Licorice Decoction to Drain the Epigastrium) can treat it. (In Zhang Zhongjing's discussions, there are five variations of Xiexin Decoctions, all designed for Pi Syndrome. However, for fullness without pain, Banxia Xiexin Tang [Pinellia Decoction to Drain the Epigastrium] is suitable; for yellow complexion and warm hands and feet, Huanglian Xiexin Tang [Coptis Decoction to Drain the Epigastrium]; for aversion to cold and sweating, Fuzi Xiexin Tang [Aconite Decoction to Drain the Epigastrium]; for dry heaving, food odor, and fluid retention under the ribs, Shengjiang Xiexin Tang [Fresh Ginger Decoction to Drain the Epigastrium]; for rumbling bowels, epigastric hardness, and vexation preventing rest, Gancao Xiexin Tang [Licorice Decoction to Drain the Epigastrium].)

Cold-dampness trapped inside cannot dissipate, and heat accumulates in the Spleen causing this affliction. Damp-heat struggles with retained food, stagnating and failing to resolve, leading to the emergence of jaundice. (Chao Yuanfang stated: Cold-dampness inside causes heat to accumulate in the Spleen and Stomach. With pores closed, stasis-heat struggles with retained food. Vexation and stagnation prevent digestion, leading to obstruction of urination and defecation, thus the body and face turn yellow.) Sweat appears only on the head and face, stopping at the neck; thirst drives drinking fluids without relief. (Zhang Zhongjing stated: If sweat occurs only on the head and nowhere else, stopping at the neck, and urination is difficult, jaundice will inevitably develop.) When the pulse is floating, slippery, tight, or rapid, Yinchenshao Tang (Artemisiae Scopariae Decoction) or Wuling San may be selected. (Yinchenshao Tang and Wuling San are both selectable options.) Blood stasis syndromes are also similar, but black stool is the distinguishing feature. During blood syndromes, mania often occurs; careful differentiation is required to avoid error. (Jaundice and blood stasis have similar symptoms, both caused by stasis-heat trapped inside. However, in jaundice, urination is usually difficult; in blood stasis, urination is free, the lower abdomen is hard and full, and stool is black. Zhang Zhongjing stated: In Taiyang disease lasting six or seven days, if exterior signs persist, the pulse is faint and deep, there is no Jie Xiong, and the patient becomes manic, it is because heat is in the Lower Jiao. The lower abdomen should be hard and full; if urination is spontaneous, bleeding resolves the condition. This is because Taiyang follows the meridians into the interior, causing stasis-heat inside. He also stated: If urination is spontaneous and the patient is like manic, it is a definitive sign of a blood syndrome.) Baihu Tang syndrome also presents with fever, making similarities and differences hard to distinguish. Baihu Tang does not lead to jaundice because it involves profuse sweating over the whole body. (Baihu Tang syndrome resembles jaundice, but Baihu Tang involves sweating over the entire body, so jaundice does not occur; in jaundice, there is no sweat elsewhere, stopping at the neck.) There are also dampness and wind-stroke syndromes where jaundice generally appears similarly. Dampness causes smoky-yellow discoloration and whole-body pain; wind-stroke with jaundice involves blocked Qi mechanism. (Zhang Zhongjing stated: Patients with chronic dampness suffer from whole-body pain, fever, and a smoky-yellow skin color. There is also wind-stroke jaundice, characterized by yellow eyes and obstructed Qi flow.)