Discussion on Jie Xiong Syndrome, July 23, 1977

Discussion on Jie Xiong Syndrome, July 23, 1977

Jie Xiong syndrome is a well-known condition in Traditional Chinese Medicine, and although many physicians throughout history have attempted to explain it, few have provided a fully satisfactory explanation. Article 128 of the “Shang Han Lun” states: “If pressing causes pain, the cun pulse is floating, and the guan pulse is sinking, then it is called Jie Xiong.” However, the phrase “pressing causes pain” leaves some ambiguity—where exactly is the pain located? Article 137 further clarifies: “For solar diseases, if repeated sweating leads to constipation lasting five or six days, with a dry tongue and thirst, slight afternoon heat, and hard, painful fullness from the heart to the lower abdomen that cannot be approached, Da Xian Xiong Tang is the primary treatment.” This passage explicitly states that the pain in Jie Xiong syndrome is located “from the heart to the lower abdomen,” and Article 138 adds: “For minor Jie Xiong, the pain is only in the heart, and pressing causes pain.” Thus, the pain in Jie Xiong syndrome is localized in the heart. Based on these passages, Jie Xiong syndrome can be divided into two categories: ① Major Jie Xiong; ② Minor Jie Xiong. The former involves pain from the heart to the lower abdomen, with abdominal fullness and unbearable pain; the latter involves pain only in the heart. Clearly, the former covers a wider range and is more severe, while the latter covers a smaller range and is milder. However, both share the common characteristic of pain upon pressing, with a floating cun pulse and a sinking guan pulse. Major Jie Xiong uses Da Xian Xiong Tang, while Minor Jie Xiong uses Xiao Xian Xiong Tang. Why is it called “Xian Xiong”? Because in solar diseases, improper downward treatment allows pathogenic factors to penetrate into the chest and ribs, where they combine with dampness (water and heat combine), resulting in Jie Xiong. Hence the name “Xian Xiong.” Additionally, there is another situation where water and heat do not combine, only cold and heat do; since cold tends to disperse dampness, no pain forms, only a feeling of fullness in the heart—this is referred to as “pi” (fullness in the heart without pain). Article 131 of the “Shang Han Lun” states: “If a disease originates from yang but is treated incorrectly, heat enters and results in Jie Xiong.” This shows that Jie Xiong belongs to yang and heat, so treatment should focus on cooling and descending. The compositions of Da Xian Xiong Tang and Xiao Xian Xiong Tang are precisely aligned with this principle. There is also a category called “Zang Jie,” which refers to cold-related conditions. Article 129 of the “Shang Han Lun” states: “If the condition is similar to Jie Xiong, with unchanged diet, frequent diarrhea, floating cun pulse, and thin, weak guan pulse, then it is called Zang Jie.” This clearly illustrates the point. From a modern medical perspective, Jie Xiong syndrome can be considered a type of exudative pleurisy. Recently, people have used Da Xian Xiong Tang to treat pleural effusion and Xiao Xian Xiong Tang to treat dry pleurisy, achieving remarkable results—this confirms the validity of this theory. However, judging from the characteristics of Da Xian Xiong Tang—such as “hard, painful fullness from the heart to the lower abdomen that cannot be approached”—this condition should also include intestinal obstruction and acute peritonitis. If it falls into these categories, traditional Chinese medicine alone may not be sufficient, so the “Shang Han Lun” states: “All cases of Jie Xiong syndrome are fatal if the patient is agitated.” Article 132 further specifies: “For Jie Xiong syndrome, if the pulse is floating and large, do not descend; descending will result in death.” Thus, Traditional Chinese Medicine has long understood the prognosis of this disease.