雍曰。结胸。痞气。阳毒。阴毒。狐惑。百合六证。虽有见于前证
中者。而庞氏皆以其异证。故别列于后。今根据庞氏之法。益以斑黄血
衄证。为十证。
仲景曰。问病有结胸。有脏结。其状何如。曰。按之痛。寸脉浮。
关脉沉。名曰结胸。庞氏曰。寸口脉浮。关上尺中皆沉。或沉紧。
又曰。何为脏结。答曰。如结胸状。饮食如故。时时下利。寸脉
浮。关脉小细沉紧。名曰脏结。舌上白苔滑者。难治。常氏云。可刺关
元。在脐下。
又曰。脏结无阳证。不往来寒热。（一云寒而不热）其人反静。舌
上苔滑者。不可攻也。常氏云。可刺关元穴。
又曰。病患胁下素有痞。连在脐旁。痛引小腹。入阴筋者。此名
脏结。死。常氏云。可刺大赫。在腹部第二行。
又曰。发病于阳。而反下之。热入因作结胸。病发于阴。而反下
之。因作痞也。所以成结胸者。此下之太早故也。朱氏曰。伤寒本无
结胸。以其热下之早。热气乘虚而入。痞结不散。变成结胸。王仲弓
曰。杜壬云。伤寒在表误下者。宜急频与理中汤丸。更加人参。多得
解。不作结胸。若大腹转损发厥者。愚与四逆汤便安。若胃中虽和。
而病不退。候再有里证再下之。朱氏云。以前来下汤未是故也。
又曰。若心下满而硬痛者。此为结胸也。大陷胸汤主之。但满而
不痛者。此为痞。宜半夏泻心汤。
又曰。结胸证。其脉浮大者。不可下。下之则死。朱氏云。尚宜发
汗也。脉浮是表证。兼以小柴胡汤等先发表。表证罢。后以结胸药下
之。常氏云。用巴豆黄连饼子。封脐中灸之。即诸方中所谓圣饼子灸
法也。
又曰。结胸证悉具。烦躁者亦死。
又曰。太阳病。脉浮而动数。浮则为风。数则为热。动则为痛。数
则为虚。头痛发热。微盗汗出。而反恶寒者。表未解也。医反下之。动
数变迟。膈内拒痛。胃中空虚。客气动膈。短气烦躁。心中懊 。阳气
内陷。心下因硬。则为结胸。大陷胸汤主之。雍曰。此即病发于阳而
反下之之证也。若不结胸。但头汗出。余处无汗。剂颈而还。小便不
利。身必发黄者。可茵陈蒿汤。雍曰。若单服茵陈浓汁。调五苓散。亦
可。
又曰。伤寒六七日。结胸热实。脉沉而紧。心下痛。按之石硬者。
大陷胸汤主之。
又曰。伤寒十余日。热结在里。往来寒热者。与大柴胡汤。但结
胸。无大热者。此为水结在胸膈也。但头微汗出者。大陷胸汤主之。
雍曰。可下证中。自但结胸下。分别为二证。故用二药不同。
又曰。太阳病。重发汗。而复下之。不大便五六日。舌上燥而渴。
日晡所小有潮热。（一云日晡所发心胸大烦）从心下至少腹。硬满而
痛者。大陷胸汤。或以大陷胸丸下之。
又曰。小结胸证。正在心下。按之则痛。脉浮滑者。小陷胸汤主
之。
又曰。太阳病二三日。不得卧。但欲起。心下必结。脉微弱者。此
本有寒分。反下之。若利止。必作结胸。未止者。四日复下之。此作协
热利也。常氏云。脉微弱有寒者。可增损理中丸。作结胸者。大小陷
胸汤。协热利者。白头翁汤。
又曰。太阳病。下之后。其脉数促。（一作纵）不结胸者。此为欲
解也。脉浮者。必结胸。（常氏云可增损理中丸）脉紧者。必咽痛。（常
氏云可桔梗甘草汤）脉弦者。必两胁拘急。（常氏云可小柴胡汤）脉
细数者。头痛未止。（常氏云可葱须汤）脉沉紧者。必欲呕。（常氏云
可七物黄连汤）脉沉滑者。协热利。（常氏云可白头翁汤）脉浮滑者。
必下血。（常氏云可柏皮汤）
又曰。病在阳。应以汗解之。反以冷水灌之 之。其热被却不得
去。弥更益烦。肉上粟起。意欲饮水。反不渴者。服文蛤散。若不瘥
者。与五苓散。寒实结胸。无热证者。与三物小陷胸汤。白散亦可服。
庞氏云。无热证者。与三物白散。（小陷胸汤非也）愚以为热者。小陷
胸汤。寒者。三物白散。
又曰。结胸者。项亦强。如柔 状。下之则和。庞氏云。宜服大陷
胸汤。
又曰。太阳少阳并病。而反下之。成结胸。心下硬。下利不止。水
浆不下。其人心烦。常氏云。可半夏生姜二泻心汤。
活人书云。西晋崔行功云。伤寒。结胸欲绝。心膈高起。手不得
近。大小陷胸皆不瘥者。此是下后虚逆。气已不理。而毒复上攻。气
毒相搏。结于胸中。当用枳实理中丸先理其气。次疗诸疾。古今用之
如神。应手而愈。今常氏谓增损理中丸。即是也。庞氏曰。近世治结
胸。多用针头丸。用硫黄阳起石者。若病热毒甚者。必死。惟治冷结
寒实耳。
活人书云。结胸三种。有大结胸。不按而痛。胸连腹坚硬。大陷
胸汤主之。有小结胸。接之心下痛。小陷胸汤主之。有水结胸。在膈
间。亦名结胸。小半夏加茯苓汤、小柴胡去枣加牡蛎汤主之。又有寒
热二证。有热实结胸者。胸中烦躁。心内懊 。舌上燥渴。脉沉滑者。
皆热证也。大陷胸汤主之。有寒实结胸。无热证者。三物白散。枳实
理中丸主之。
王仲弓曰。治结胸。当用小陷胸汤。甚佳。大陷胸汤太峻。如不
得已。则用大陷胸汤丸。脉浮者。不得用大陷胸丸。宜用小陷胸、枳
实理中丸。结胸。用黄连巴豆灸法。得解。心下痞硬。宜旋覆代赭汤。
若外尚未解。胸满胁痛者。宜小柴胡汤。雍曰。凡用仲景药。皆当准
此为式。盖今古不同。病患血气不能胜药力。医工不能精于诊视。非
古人比。故用药可不及。不可太过。如脉浮者。尤宜从朱氏用发表
药。表证罢。以结胸药治之。
Guo Yong stated: The six conditions—Jie Xiong (Chest Binding), Pi Qi (Stagnant Qi), Yang Du (Yang Toxin), Yin Du (Yin Toxin), Hu Huo (Fox Infection), and Bai He (Lily Disease)—although mentioned in previous discussions, were listed separately by Pang Anshi as distinct conditions. Following Pang's method, I add three conditions: Ban Zhen (Macules and Rashes), Huang Dan (Jaundice), and Bi Nu (Nosebleed), totaling ten conditions.
Zhang Zhongjing asked: There are conditions named Jie Xiong (Chest Binding) and Zang Jie (Organ Binding). What are their manifestations? The answer is: Pain upon palpation, with a floating pulse at the Cun position and a sunken pulse at the Guan position; this is called Jie Xiong (Chest Binding). Pang Anshi added: The pulse at the Cun Kou (Inkwell) is floating, while both the Guan and Chi positions are sunken, or sunken and tight. He further asked: What is Zang Jie (Organ Binding)? The answer is: It resembles Jie Xiong (Chest Binding) in appearance, but digestion remains normal, and there is frequent diarrhea. The Cun pulse is floating, and the Guan pulse is small, fine, sunken, and tight; this is called Zang Jie (Organ Binding). If the tongue has a white and slippery coating, it is difficult to treat. Chang Qizhi suggested: Acupuncture at Guan Yuan (CV-4), located below the umbilicus.
He also stated: Zang Jie (Organ Binding) presents without Yang syndrome signs, such as alternating chills and fever (some texts say only chills without fever). The patient appears quiet. If the tongue coating is slippery, purgative methods should not be used. Chang Qizhi suggested: Acupuncture at Guan Yuan (CV-4).
He also stated: If a patient has had a Pi Kuai (Subcutaneous Mass) under the hypochondrium since before, extending to the side of the umbilicus, with pain radiating to the lower abdomen and into the genitalia, this is called Zang Jie (Organ Binding), which is fatal. Chang Qizhi suggested: Acupuncture at Da He (KI-12), located in the second row of the abdomen.
He also stated: When a disease originates in the Yang (Exterior) and is incorrectly treated with purgatives, heat enters internally, resulting in Jie Xiong (Chest Binding). When a disease originates in the Yin (Interior) and is incorrectly treated with purgatives, it results in Pi Zheng (Stagnation Syndrome). The reason Jie Xiong (Chest Binding) forms is that purgatives were administered too early. Zhu Gong stated: Shang Han (Cold Damage) does not naturally involve Jie Xiong (Chest Binding); it occurs because heat was purged too early, allowing heat qi to enter through deficiency, causing stagnation that transforms into Jie Xiong (Chest Binding). Wang Zhonggong cited Du Ren: If Shang Han (Cold Damage) at the exterior is mistakenly purged, one should frequently administer Li Zhong Tang (Regulate the Middle Decoction) pills, adding extra Ren Shen (Ginseng Root). Abundant sweating will lead to recovery, preventing Jie Xiong (Chest Binding). If the great abdomen is damaged leading to Jue Ni (Reversal Cold), I recommend Si Ni Tang (Frigid Extremities Decoction) to stabilize the condition. If the Stomach is harmonious but the pathogen persists, wait for interior signs before purging again. Zhu Gong stated: This is because the previous purgative formula was incorrect.
He also stated: If there is fullness and hardness with pain in the Xin Xia (Epigastrium), this is Jie Xiong (Chest Binding), treated with Da Xian Xiong Tang (Major Sinking Chest Decoction). If there is fullness without pain, this is Pi Zheng (Stagnation Syndrome), treated with Ban Xia Xie Xin Tang (Pinellia Drain the Epigastrium Decoction).
He also stated: In Jie Xiong (Chest Binding), if the pulse is floating and large, purgatives must not be used; using them leads to death. Zhu Gong stated: Sweating methods should still be employed. A floating pulse indicates an Exterior Syndrome. Use Xiao Chai Hu Tang (Minor Bupleurum Decoction) etc. to release the exterior first. Once the exterior syndrome resolves, then use formulas for Jie Xiong (Chest Binding) to purge. Chang Qizhi suggested: Apply a cake of Ba Dou (Croton Seed) and Huang Lian (Coptis Rhizome) to the umbilicus and moxibustion; this is the "Sheng Bing Zi" (Holy Cake) moxibustion method found in various texts.
He also stated: If all symptoms of Jie Xiong (Chest Binding) are present and the patient becomes restive (Fan Zao), it is fatal.
He also stated: In Tai Yang Bing (Tai Yang Disease), if the pulse is floating, moving, and rapid: floating indicates Wind, rapid indicates Heat, moving indicates Pain, and rapid indicates Deficiency. Headache, fever, slight night sweats, yet aversion to cold, indicate the Exterior has not resolved. If the physician incorrectly uses purgatives, the moving/rapid pulse changes to slow. Rejection pain occurs inside the Diaphragm. The Stomach is empty, and hostile Qi disturbs the Diaphragm, causing shortness of breath, restiveness, and internal discomfort (Ao Nan). Yang Qi sinks inward, causing hardness in the Xin Xia (Epigastrium), forming Jie Xiong (Chest Binding), treated with Da Xian Xiong Tang (Major Sinking Chest Decoction). Guo Yong stated: This is the condition described as "disease originating in Yang and incorrectly purged." If Jie Xiong (Chest Binding) does not form, but there is sweating only on the head, no sweat elsewhere up to the neck, urinary difficulty, and jaundice, use Yin Chen Hao Tang (Artemisia Capillaris Decoction). Guo Yong added: Taking concentrated Yin Chen (Artemisiae Scopariae Herba) juice mixed with Wu Ling San (Five-Ingredient Powder with Poria) is also effective.
He also stated: In Shang Han (Cold Damage) after six or seven days, if there is Jie Xiong (Chest Binding) with Heat Excess, a sunken and tight pulse, pain in the Xin Xia (Epigastrium), and hardness like stone upon palpation, treat with Da Xian Xiong Tang (Major Sinking Chest Decoction).
He also stated: In Shang Han (Cold Damage) after more than ten days, if heat is bound internally with alternating chills and fever, use Da Chai Hu Tang (Major Bupleurum Decoction). If it is merely Jie Xiong (Chest Binding) without significant heat, this is Water Binding in the Chest and Diaphragm. If there is only slight sweating on the head, treat with Da Xian Xiong Tang (Major Sinking Chest Decoction). Guo Yong stated: Among purgative indications, simple Jie Xiong (Chest Binding) is distinguished into two conditions, hence different medications are used.
He also stated: In Tai Yang Bing (Tai Yang Disease), after excessive sweating and subsequent purging, if there is constipation for five to six days, dryness and thirst on the tongue, and slight tidal fever in the late afternoon (or severe mental vexation in the chest and heart), with hardness, fullness, and pain from the Xin Xia (Epigastrium) to the lower abdomen, use Da Xian Xiong Tang (Major Sinking Chest Decoction) or Da Xian Xiong Wan (Major Sinking Chest Pill) to purge.
He also stated: In Xiao Jie Xiong (Minor Chest Binding), the location is precisely in the Xin Xia (Epigastrium), painful only upon pressure, with a floating and slippery pulse; treat with Xiao Xian Xiong Tang (Minor Sinking Chest Decoction).
He also stated: In Tai Yang Bing (Tai Yang Disease) after two or three days, if the patient cannot lie down but wants to rise, there must be binding in the Xin Xia (Epigastrium). If the pulse is weak, this originally indicates Cold Fluid retention. Incorrect purging may lead to Jie Xiong (Chest Binding) if diarrhea stops, or Xie Re Li (Collateral Heat Diarrhea) if purging is repeated on the fourth day while diarrhea continues. Chang Qizhi suggested: For weak pulses with Cold, use Zeng Sun Li Zhong Wan (Modified Regulate the Middle Pill). For Jie Xiong (Chest Binding), use Da/Xiao Xian Xiong Tang (Major/Minor Sinking Chest Decoctions). For Xie Re Li (Collateral Heat Diarrhea), use Bai Tou Weng Tang (Pulsatilla Decoction).
He also stated: After purging in Tai Yang Bing (Tai Yang Disease), if the pulse is rapid and intermittent (or slackening) without Jie Xiong (Chest Binding), the disease is resolving. If the pulse is floating, Jie Xiong (Chest Binding) will definitely form (Chang Qizhi: use modified Li Zhong Wan). If the pulse is tight, throat pain will definitely occur (Chang Qizhi: use Jie Geng Gan Cao Tang [Licorice and Platycodon Decoction]). If the pulse is wiry, bilateral hypochondriac stiffness will occur (Chang Qizhi: use Xiao Chai Hu Tang [Minor Bupleurum Decoction]). If the pulse is fine and rapid, headache will persist (Chang Qizhi: use Cong Xu Tang [Scallion Root Decoction]). If the pulse is sunken and tight, vomiting will definitely occur (Chang Qizhi: use Qi Wu Huang Lian Tang [Seven-Ingredient Coptis Decoction]). If the pulse is sunken and slippery, Xie Re Li (Collateral Heat Diarrhea) will occur (Chang Qizhi: use Bai Tou Weng Tang [Pulsatilla Decoction]). If the pulse is floating and slippery, blood in the stool will definitely occur (Chang Qizhi: use Bo Pi Tang [Phellodendron Bark Decoction]).
He also stated: When the disease is in the Yang (Exterior), it should be resolved by sweating. If incorrectly irrigated with cold water, the heat is suppressed and cannot escape, increasing irritability, causing gooseflesh on the skin, desire to drink water but no actual thirst; treat with Wen Ge San (Clam Shell Powder). If ineffective, use Wu Ling San (Five-Ingredient Powder with Poria). For Han Shi Jie Xiong (Cold-Excess Chest Binding) without Heat signs, use San Wu Xiao Xian Xiong Tang (Three-Ingredient Minor Sinking Chest Decoction, i.e., San Wu Bai San). Pang Anshi stated: For cases without Heat signs, use San Wu Bai San (Three-Ingredient White Powder) (not Xiao Xian Xiong Tang). I believe: Heat conditions use Xiao Xian Xiong Tang (Minor Sinking Chest Decoction); Cold conditions use San Wu Bai San (Three-Ingredient White Powder).
He also stated: In Jie Xiong (Chest Binding), the neck may also be stiff, resembling Rou Jing (Soft Spasm). Purging will bring harmony. Pang Anshi stated: Use Da Xian Xiong Tang (Major Sinking Chest Decoction).
He also stated: In Tai Yang Shao Yang Bing (Combined Tai Yang and Shaoyang Disease), incorrect purging leads to Jie Xiong (Chest Binding), hardness in the Xin Xia (Epigastrium), incessant diarrhea, inability to take fluids, and mental vexation. Chang Qizhi suggested: Use Ban Xia Sheng Jiang Er Xie Xin Tang (Pinellia and Fresh Ginger Double Epigastrium-Draining Decoction).
The *Huoren Shu* (Book Saving Lives) cites Cui Xinggong of the Western Jin: In Shang Han (Cold Damage), if Jie Xiong (Chest Binding) is critical, with high elevation of the chest and diaphragm, untouchable by hand, and neither Da nor Xiao Xian Xiong Tang (Major/Minor Sinking Chest Decoctions) work, this is deficiency and reversal after purging, with chaotic Qi and toxin attacking upward. Qi and toxin struggle, binding in the chest. First use Zhi Shi Li Zhong Wan (Immature Bitter Orange and Regulate the Middle Pill) to regulate Qi, then treat other diseases. It works miraculously. Chang Qizhi’s Zeng Sun Li Zhong Wan (Modified Regulate the Middle Pill) is this formula. Pang Anshi stated: Recent treatments for Jie Xiong (Chest Binding) often use Zhen Tou Wan (Needle-Head Pill) containing Liu Huang (Sulfur) and Yang Qi Shi (Quicksilver Ore). If the disease involves severe Heat Toxin, death is certain; this is only for Cold Binding and Cold-Excess.
The *Huoren Shu* (Book Saving Lives) states: There are three types of Jie Xiong (Chest Binding):
1. Da Jie Xiong (Major Chest Binding): Pain without pressure, chest connected to abdomen is hard; treated with Da Xian Xiong Tang (Major Sinking Chest Decoction).
2. Xiao Jie Xiong (Minor Chest Binding): Pain in Xin Xia (Epigastrium) upon pressure; treated with Xiao Xian Xiong Tang (Minor Sinking Chest Decoction).
3. Shui Jie Xiong (Water Chest Binding): Located between the diaphragm, also called Jie Xiong (Chest Binding); treated with Xiao Ban Xia Jia Fu Ling Tang (Minor Pinellia plus Poria Decoction) or Xiao Chai Hu Qu Zao Jia Mu Li Tang (Minor Bupleurum minus Jujube plus Oyster Shell Decoction).
There are also Heat and Cold syndromes:
- Re Shi Jie Xiong (Heat-Excess Chest Binding): Irritability in the chest, internal discomfort, dry tongue/thirst, sunken slippery pulse; treated with Da Xian Xiong Tang (Major Sinking Chest Decoction).
- Han Shi Jie Xiong (Cold-Excess Chest Binding): No Heat signs; treated with San Wu Bai San (Three-Ingredient White Powder) or Zhi Shi Li Zhong Wan (Immature Bitter Orange and Regulate the Middle Pill).
Wang Zhonggong stated: Treat Jie Xiong (Chest Binding) with Xiao Xian Xiong Tang (Minor Sinking Chest Decoction) for best results. Da Xian Xiong Tang (Major Sinking Chest Decoction) is too harsh; use Da Xian Xiong Wan (Major Sinking Chest Pill) only if necessary. If the pulse is floating, do not use Da Xian Xiong Wan; use Xiao Xian Xiong Tang (Minor Sinking Chest Decoction) and Zhi Shi Li Zhong Wan (Immature Bitter Orange and Regulate the Middle Pill). For Jie Xiong (Chest Binding), Huang Lian Ba Dou Moxibustion can resolve it. For Pi Ying (Stagnant Hardness in Epigastrium), use Xuan Fu Dai Zhe Tang (Inula and Hematite Decoction). If the Exterior has not resolved, with chest fullness and hypochondriac pain, use Xiao Chai Hu Tang (Minor Bupleurum Decoction). Guo Yong stated: When using Zhang Zhongjing’s formulas, one must follow this principle. Ancient and modern times differ; patients' Qi and Blood cannot withstand strong medicines, and physicians' diagnostics are not as precise as ancients. Therefore, medication should be insufficient rather than excessive. For floating pulses, especially follow Zhu Gong’s advice to use Exterior-Releasing formulas first. Once the Exterior resolves, treat Jie Xiong (Chest Binding).