伤寒结胸者,今人不分曾下与未下,便呼为结胸,便与枳桔汤,反成真结胸者有之。殊不知乃
因下早而成,未经下者,非结胸也,乃表邪传至胸中,未入于腑者,
虽满闷,尚为在表,正属少阳部分,只消小柴胡加枳、桔以治其闷。如未效,则以本方对小陷胸汤,
一服豁然,其妙如神。秘之,莫与俗人言之耳。若因下早而成者,方可用陷胸汤,分浅深从缓而治
之,不宜太峻,此乃清道至高之分,若过下之,则伤元气也。太阳证,发热恶寒,头疼无汗,此寒
伤荣血,当服麻黄汤发散。医者不达而误下之,荣血重伤而成痞满。太阳证,头疼恶寒,发热自汗,
此风伤卫气,当服桂枝汤散邪实表。医者不达而误下之,卫气重伤而成结胸。盖言荣卫,阴阳也。
若言寒热阴阳证者,则误之甚矣。治法又录于后条。
夫病身不热,头不疼,初起怕寒,四肢厥冷,腹痛呕吐,泄泻,蜷卧,沉默不渴,脉来沉迟无
力,人皆共知为阴证必矣。至于发热面赤,烦躁,揭去衣被,脉大,人皆不识,认作阳证,误投寒
药,死者多矣。殊不知阴证不分热与不热,须凭脉下药,至为切当。不问脉之浮沉大小,但指下无
力,重按全无,便是伏阴,不可与凉药,服之必死,急与五积散一服,通解表里之寒,随手而愈。
若内有沉寒,必须姜、
附以温之,切忌发泄。脉虽洪大,按之无力,重按全无者,阴脉也。若将伏阴之证而误作热证,用
凉药治之,则渴愈盛而燥愈急,岂得生乎?此取脉不取证也。
In cases of *Jie Xiong* (Chest Binding) due to Cold Damage, people nowadays do not distinguish whether purgatives have been used or not, and immediately call it *Jie Xiong*, administering Zhiju Tang (Bitter Orange and Fructus Trichosanthis Decoction), which sometimes results in a true *Jie Xiong*. They fail to realize that *Jie Xiong* is caused by premature purgation; if no purgative has been used, it is not *Jie Xiong*, but rather pathogenic factors from the exterior transmitted to the chest, not yet entering the fu organs. Although there is fullness and oppression, it remains at the exterior level and belongs to the Shaoyang pattern. It can be treated with Xiaochaihu Tang (Minor Bupleurum Decoction) added with Zhishi (Immature Bitter Orange) and Jiegeng (Platycodon Root) to relieve the oppression. If ineffective, combine this formula with Xiaoxianxiong Tang (Minor Intra-thoracic Knot Decoction); one dose brings immediate relief, miraculous as if by divine power. This method should be kept secret and not told to ordinary people. Only when *Jie Xiong* is formed due to premature purgation can Xiantong Tang (Knot-Loosening Decoctions) be used, treating it gradually according to depth, avoiding overly harsh methods, for this is the highest part of the clear pathways; excessive purgation will damage Yuan Qi (Primal Qi). In Taiyang disease patterns, with fever, aversion to cold, headache, and anhidrosis, this indicates Cold damaging Ying Blood (Nutritive Blood), and Mahuang Tang (Ephedra Decoction) should be taken to disperse. Doctors who do not understand may mistakenly use purgatives, severely injuring Ying Blood and resulting in Pi Man (Fullness Syndrome). In Taiyang disease patterns, with headache, aversion to cold, fever, and spontaneous sweating, this indicates Wind damaging Wei Qi (Defensive Qi), and Guizhi Tang (Cinnamon Twig Decoction) should be taken to dispel pathogens and secure the exterior. Doctors who do not understand may mistakenly use purgatives, severely injuring Wei Qi and resulting in *Jie Xiong*. Ying and Wei correspond to Yin and Yang. Confusing these with Cold/Heat or Yin/Yang patterns leads to grave errors. Treatment methods are recorded in subsequent sections.
Regarding diseases where the body is not hot, the head does not hurt, initially there is aversion to cold, cold limbs, abdominal pain, vomiting, diarrhea, curling up while lying, silence, no thirst, and a deep, slow, and weak pulse, everyone knows this must be a Yin Pattern. However, regarding fever, red face, restlessness, removing clothes and blankets, and a large pulse, people often fail to recognize them, mistaking them for Yang Patterns, erroneously administering Cold-Cooling Medicines, leading to many deaths. One must not know that for Yin Patterns, regardless of heat or no heat, medication must be based on the pulse, which is most appropriate. Regardless of whether the pulse is floating, sunken, large, or small, if it feels weak under the fingers and completely vanishes upon heavy pressure, it is Fu Yin (Hidden Yin), and cooling medicines must not be given, as administration will lead to death. Immediately administer Wuji San (Five Accumulations Powder) to resolve exterior and interior cold simultaneously, resulting in quick recovery. If there is deep-seated cold within, Shengjiang (Dried Ginger) and Fuzi (Prepared Aconite Root) must be used to warm, and absolutely avoid dispersing/sweating methods. Even if the pulse is surging and large, if it is weak upon pressing and completely vanishes upon heavy pressure, it is a Yin Pulse. Mistaking Fu Yin patterns for Heat patterns and treating them with cooling medicines will cause thirst to increase and dryness to intensify, making survival impossible. This emphasizes relying on pulse diagnosis rather than symptoms alone.