Xu You, nearly sixty years old, has always had a robust constitution. Initially, he suffered from a severe cold, and after medical treatment, the fever and chills subsided, but the internal pathogens were not completely cleared. He hastily resumed eating, often overindulging, which led to chest and epigastric pain extending to the abdomen. Above, there was qi counterflow and fullness; below, constipation. He could only lean against the bed rail, unable to lie flat. Upon palpation, his chest, abdomen, and both flanks were hard and painful. He was restless and irritable, with a greasy and yellow tongue coating, a deep and tight pulse, no fever, and slightly cold hands and feet. He had not had a bowel movement for several days. This was a severe case of thoracic accumulation. Observing that both his pulse and symptoms were substantial, he was prescribed Major Chest Bind Decoction with Immature Orange Fruit:
Rhubarb Rhizoma 16g (washed with wine), Natrii Sulfas 16g (divided and infused), prepared Gansui Root 8g (powdered), and fried Immature Orange Fruit 16g.
The first two ingredients were decocted first. Once the decoction was ready, half of the Natrii Sulfas was added and warmed until dissolved, then half of the Gansui Root powder was added and mixed well before consumption. Six hours later, the second decoction was taken in the same manner.
Second consultation: After taking the above prescription, the patient had several significant bowel movements, and the fullness and pain in the chest, flanks, and abdomen gradually lessened. By the third bowel movement, the patient could gradually lie flat. After taking the second decoction, there were two more bowel movements, and it seemed that seventy percent of the illness had been resolved. His pulse, which had been deep, began to rise; his tongue coating at the tip had receded, and the greasy yellow coating at the root was gradually dissolving, with the center becoming clear and floating. Concerned that residual pathogens might remain and cause a relapse, and considering his advanced age and constitution, another dose of the chest-binding formula Burong (ST19) was prescribed. Following Fu Qing-zhu's method, Trichosanthis Fruit was used as the main ingredient, combined with Minor Chest Bind Decoction and Pepperweed Seed to purge the lungs. After two more doses, he fully recovered. He then took a tonic to complete the treatment.