Question: In diseases, there are "Jie Xiong" (Chest Binding) and "Zang Jie" (Organ Binding). What are their clinical manifestations?
Answer: If tenderness is elicited upon palpation, with a floating pulse at the Cun position and a sinking pulse at the Guan position, it is called "Jie Xiong" (Chest Binding).
What is meant by "Zang Jie" (Organ Binding)?
Answer: The symptoms resemble those of "Jie Xiong" (Chest Binding), but appetite remains normal, and there is frequent diarrhea. With a floating pulse at the Cun position and a fine, small, sinking, and tight pulse at the Guan position, it 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 purgative therapy. When pathogenic factors enter the interior after purgation and bind with Yang Qi, it is termed "Jie Xiong" (Chest Binding), because Yang Qi is received in the chest. When they bind with Yin Qi, it is termed "Zang Jie" (Organ Binding), because Yin Qi enters the Five Zang Organs. Qi should flow freely; obstruction causes pain. Pathogens binding in the Yang aspect prevent Yin Qi from ascending; pathogens binding in the Yin aspect prevent Yang Qi from descending. Both conditions present with hardness and fullness below the heart. A floating pulse at the Cun and a sinking pulse at the Guan indicate pathogen binding in the Yang; a floating, fine, small, sinking, and tight pulse at the Cun and Guan indicates pathogen binding in the Yin. With Yin binding and Yang unbound, although there is binding pain below the heart, diet remains normal. Yin Qi descends due to Yang deficiency, causing spontaneous diarrhea. Yin resolves when aided by Yang; if "Zang Jie" presents with more heat signs, it is easier to treat. A white and slippery tongue coating indicates pathogenic cold binding in the chest, hence it is considered difficult to treat. According to the text, "resembling Jie Xiong" implies a distinction from true "Jie Xiong". The commentary stating "both have hardness and pain below the heart" is inaccurate. "Resembling Jie Xiong, yet diet is normal" simply means there is no pain upon palpation. Since it binds in the Zang organs and the white slippery tongue coating is an external sign of chest cold, with pathology above and below, it is difficult to treat. Wang Chaofeng suggested acupuncture at Guanyuan CV-4.)

"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. Purging methods must not be used.

(Cheng Wuji's Commentary: By protocol, "Zang Jie" might require purging, but the absence of Yang syndrome indicates no exterior heat. The absence of alternating chills and fever indicates no Shaoyang heat. The patient's unusual quietness indicates no interior heat. The Classic states, "A tongue coating resembling a fur indicates heat in the Dantian and cold in the chest." Since both exterior and interior are cold, purging is contraindicated. Wang Chaofeng suggested acupuncture at Guanyuan CV-4 and administration of Xiaochaihu Tang (Minor Bupleurum Decoction).)

If a patient has chronic Pi (Glomus/Stagnation) in the chest that extends to the side of the umbilicus, radiating to the lower abdomen and involving the Yin sinews (genitals), this is called "Zang Jie" (Organ Binding) and is a fatal condition.

When a disease originating in the Yang aspect is incorrectly treated with purgatives, heat enters internally and forms "Jie Xiong" (Chest Binding). When a disease originating in the Yin aspect is incorrectly treated with purgatives, it forms Pi (Glomus/Stagnation). The reason for forming "Jie Xiong" (Chest Binding) is that the purgative was administered too early.

(Zhang Yin'an's Commentary: Some cite Cheng Wuji’s annotation: "Absence of heat with aversion to cold indicates origin in Yin." If there is no heat and only aversion to cold, it is a Yin syndrome; where is the rationale for purging? And would it merely result in Pi? Zhang Zhongjing’s reference to Yin and Yang here refers to Exterior and Interior, not this interpretation. When disease is in the Exterior, sweating is indicated; incorrect purging leads to "Jie Xiong". When disease is in the Interior but has not entered the Fu organs, premature purging leads to Pi. Thus, "Jie Xiong" results from purging too early. Pi also results from purging too early. 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 moves inward, forming Pi." From this, we infer: Wind pathogen entering the interior forms "Jie Xiong"; Cold pathogen entering the interior forms Pi. However, these are all caused by Taiyang 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. Moreover, among all descriptions of Pi syndromes, none arise from purging cases characterized by absence of heat and aversion to cold. This is an error by Mr. Cheng.)

In Taiyang Cold Damage (Cold Damage Syndrome) after five or six days, if there is vomiting and fever, and the Chaihu Syndrome (Bupleurum Syndrome) is fully present, but other drugs were used to purge the bowels: if the Chaihu Syndrome persists, administer Chaihu Tang (Bupleurum Decoction) again. Although purging has been performed, this is not a counter-indication (Ni). The patient will likely experience shivering and trembling (Zhengzhen), followed by fever and sweating, leading to resolution. If there is fullness and hardness with pain in the epigastrium (Xin Xia), this is "Jie Xiong" (Chest Binding), treated with Da Xiexin Tang (Major Draining the Chest Decoction). If there is fullness without pain, this is Pi (Glomus/Stagnation); Chaihu Tang is not suitable. Instead, Banxia Xiexin Tang (Pinellia Decoction to Drain the Epigastrium) is indicated.

(The *Ren Shu* states: Knowing it is Pi, using Jiegeng Tang (Platycodon Decoction) first is excellent. This formula regulates Qi and descends blockage in the diaphragm, proving effective. Because healthy Qi is unimpaired and the interior does not accept pathogenic factors, the patient experiences shivering, then fever and sweating, leading to recovery. If post-purgation pathogenic transmission to the interior is severe, causing epigastric fullness, hardness, and pain, it is "Jie Xiong", treated with Da Xiexin Tang to drain interior pathogens. For mild Pi, presenting only as fullness without pain, Chaihu Tang is contraindicated; Banxia Xiexin Tang is appropriate. Cheng Wuji stated: After purging, if Yang pathogenic factors transmit to the interior, they bind in the chest, as the chest is the seat of Yang. Zhang Zhongjing attributes epigastric fullness, hardness, and pain to "Jie Xiong" located below the heart. Cheng Wuji’s clever but distorted analogy—that Yang receives Qi in the chest and Yang pathogens binding in the interior constitute "Jie Xiong"—is erroneous.)