大黄 芒硝 甘遂
结胸热实。脉沉而紧。心下痛。按之石硬。 但结胸。无大热。为水结胸也。邪在上者
。宜若可吐。然谓之结者。固结于胸中。非虚烦膈实者比也。上焦为高邪。必陷下以平之。故曰
陷胸。荡平邪寇。将军之职也。所以大黄为君。咸能软坚。所以芒硝为臣。彻上彻下。破结
逐水。惟甘遂有焉。所以为佐。此惟大实者。乃为合剂。如挟虚。或短气。或脉浮。不敢轻
投也。
半夏 黄连 栝蒌实
小结胸者。按之则痛。脉浮滑。此汤主之。 大结胸者。不按亦痛。小结胸者。必手按
而后觉痛也。邪轻于前。故曰小陷胸。夫苦以泄之。辛以散之。黄连栝蒌之苦寒以泄热。半夏之
辛温以散结。邪自解矣。
文蛤
病在阳。应以汗解。反以冷水 之。灌之。热被却。不得去。弥更益烦。肉上粟起。意欲
饮水。反不渴。服文蛤散。若不瘥。服五苓散。 热为寒闭。火郁于肺。而不得泄越。故弥烦也。
此不可以凉药解除。宜以文蛤之酸平。敛而降之。
桔梗 贝母 巴豆
寒实结胸。无热症者。可与白散。 此方为寒结胸而设。惟病甚者。不得已而用之。若
轻者。活人但以枳实理中丸与之。应手取效。
半夏 黄芩 干姜 人参 甘草 黄连 大枣
呕而发热。柴胡症具。而以他药下之。心下满而不痛。以此汤主之。 若加甘草去参。即
甘草泻心汤。治痞硬吐利。若加生姜。即生姜泻心汤。治痞硬噫气。辛入肺而散气。半夏干姜之
辛。以散结气。苦入心而泄热。黄芩黄连之苦。以泻痞热。脾欲缓。急食甘以缓之。人参甘
草大枣之甘以缓脾。
Rhei Radix et Rhizoma (Dahuang), Natrii Sulfas (Mangxiao), Kansui Radix (Gansui)
Jie Xiong (Chest Binding Syndrome) of the heat-excess type. The pulse is deep and tight. There is pain in the epigastrium, and palpation reveals hardness like a stone. This is typical Jie Xiong, with no significant fever on the exterior, indicating water retention binding in the chest. When pathogenic factors are located in the upper jiao (Upper Burner), one might initially consider emesis; however, since it is termed "binding," the pathogens are firmly bound in the chest, differing from deficiency-heat vexation or fullness in the diaphragm. The upper jiao is high; thus, pathogens there must be descended to be pacified. Hence, the formula is named Xia Xiong Tang (Inferior Chest Decoction), aiming to sweep away pathogens, akin to the duty of a general. Therefore, Rhei Radix et Rhizoma (Dahuang) serves as the sovereign herb. Natrii Sulfas (Mangxiao), being salty, softens hardness, serving as the minister herb. Kansui Radix (Gansui) penetrates from top to bottom, breaking bindings and driving out water, serving as the assistant herb. This combined formula is suitable only for cases of great excess. If there is accompanying deficiency, shortness of breath, or a floating pulse, this formula should not be administered lightly.
Pinelliae Rhizoma Preparatum (Banxia), Coptidis Rhizoma (Huanglian), Trichosanthis Fructus (Gualou Shi)
Minor Jie Xiong (Minor Chest Binding) presents with pain only upon palpation, and the pulse is floating and slippery. This decoction treats it. Major Jie Xiong (Major Chest Binding) presents with pain even without palpation. Minor Jie Xiong requires manual pressure to elicit pain. The pathogenic factor is milder than in major Jie Xiong, hence it is called Xiao Xiong Tang (Minor Inferior Chest Decoction). Bitter substances drain downward, and acrid substances disperse. Coptidis Rhizoma (Huanglian) and Trichosanthis Fructus (Gualou Shi), being bitter and cold, drain heat. Pinelliae Rhizoma Preparatum (Banxia), being acrid and warm, disperses bindings. The pathogen is thereby resolved.
Veneris Testium Glans (Wenli)
When the disease is in the yang level, it should be resolved through sweating. However, if cold water is erroneously splashed or poured over the body, the heat is suppressed and cannot escape, leading to increased irritability. Gooseflesh appears on the skin. The patient feels thirsty but does not actually desire water. In such cases, Wenli San (Clam Shell Powder) should be administered. If symptoms do not resolve, Wuling San (Five-Ingredient Powder with Poria) should be given. This occurs because heat is closed by cold, and fire is depressed in the lung, unable to vent. Thus, there is increased irritability. Cool herbs are inappropriate here; instead, the sour and neutral properties of Veneris Testium Glans (Wenli) should be used to astringe and descend qi.
Platycodonis Radix (Jiegeng), Fritillariae Bulbus (Beimu), Crotonis Fructus (Badou)
Cold-excess Jie Xiong (Cold Chest Binding) without heat symptoms can be treated with Baisan (White Powder). This formula is designed for cold binding in the chest and is used only when necessary for severe cases. For mild cases, *Ren Shu* (The Book that Saves the World) suggests using Zhishi Lizhong Wan (Atractylodes Macrocephala and Magnolia Bark Pill to Regulate the Middle), which yields prompt results.
Pinelliae Rhizoma Preparatum (Banxia), Scutellariae Radix (Huangqin), Zingiberis Rhizoma (Ganjiang), Ginseng Radix et Rhizoma (Renshen), Glycyrrhizae Radix et Rhizoma (Gancao), Coptidis Rhizoma (Huanglian), Jujubae Fructus (Dazao)
Vomiting accompanied by fever, presenting with Shaoyang Chai Hu (Bupleurum) syndrome characteristics, but erroneously treated with purgatives, results in epigastric fullness without pain. Banxia Xiexin Tang (Pinellia Decoction to Drain the Epigastrium) is indicated. If Gancao (Licorice) is added and Renshen (Ginseng) removed, it becomes Gancao Xiexin Tang (Licorice Decoction to Drain the Epigastrium), treating fullness and hardness with vomiting and diarrhea. If Shengjiang (Fresh Ginger) is added, it becomes Shengjiang Xiexin Tang (Fresh Ginger Decoction to Drain the Epigastrium), treating fullness and hardness with belching carrying the odor of food. Acrid flavors enter the lung and disperse qi; the acrid nature of Pinelliae Rhizoma Preparatum (Banxia) and Zingiberis Rhizoma (Ganjiang) disperses stagnant qi. Bitter flavors enter the heart and drain heat; the bitter nature of Scutellariae Radix (Huangqin) and Coptidis Rhizoma (Huanglian) drains epigastric heat. The spleen desires relaxation; urgent relief is provided by sweet flavors. The sweet nature of Ginseng Radix et Rhizoma (Renshen), Glycyrrhizae Radix et Rhizoma (Gancao), and Jujubae Fructus (Dazao) soothes the spleen.