血结胸中不可按。如狂嗽水不欲咽。大便黑色小便通。犀角地黄汤最善。
按伤寒经病。热极而蓄血积于胸中。硬痛而不可按者。为血结胸也。宜犀角地黄汤、
及桃
仁承气汤主之。活人云。大抵结胸症固当下。须看气之虚实。脉之盛衰。若脉来浮大者。犹
带表邪不可下。下之则死。下后而复反结者亦死。结胸症悉具。而烦躁者亦死。下后而舌反
黑裂者亦死。下后而谵言 语者亦死也。
满而不痛名为痞。枳桔频投是妙方。更有泻心汤可服。大黄附子半甘姜。
按伤寒心下痞硬而痛者。为结胸。为实。硬满而不痛者。为痞气。为虚。凡伤寒痞
气。
轻者通用枳桔汤。其行气下膈也。若心下痞。按之濡。关上浮者。大黄黄连泻心汤主之。若
心下痞。而复恶寒汗出者。附子泻心汤主之。若寒多热少。胸满而不痛。脉濡者半夏泻心汤
主之。若干呕有水气者。生姜泻心汤主之。若干呕下利腹鸣者。此非结热。但以胃虚客气上
逆。故使硬也。甘草泻心汤主之。大抵伤寒之痞。与杂症不同。伤寒之痞。从外之内。故宜
苦泻。杂症之痞。从内之外。故宜辛散。
附子泻心用三黄。寒加热药以维扬。痞乃热邪寒药治。恶寒加附始相当。半夏泻心黄连
芩。
干姜甘草与人参。大枣和之治虚痞。法在降阳并和阴。（去人参即甘草泻心汤加姜即生姜泻
心汤）
Blood-binding chest syndrome (Xue Jie Xiong) cannot be pressed. The patient exhibits a manic-like state, desiring to drink water but unwilling to swallow it. The stool is black, and urination is unobstructed. Xi Jiao Di Huang Tang (Rhinoceros Horn and Rehmannia Decoction) is the most effective formula.
According to the pathology of meridians in Shanghan (Cold Damage) diseases, when heat reaches its extreme and blood stasis accumulates in the chest, resulting in hardness and pain that cannot be pressed, it is termed Blood-binding chest syndrome. It is appropriate to treat with Xi Jiao Di Huang Tang (Rhinoceros Horn and Rehmannia Decoction) or Tao Ren Cheng Qi Tang (Peach Kernel and Rhubarb Decoction). Huo Ren Shu (The Book That Saves Lives) states: Generally, chest binding syndromes should be treated with purgatives; however, one must assess the deficiency or excess of Qi and the strength or weakness of the pulse. If the pulse is floating and large, it indicates that exterior pathogenic factors remain, and purgation is contraindicated; improper purgation leads to death. If chest binding recurs after purgation, it is also fatal. If all symptoms of chest binding are present but accompanied by restlessness and irritability, it is fatal. If the tongue turns black and cracks after purgation, it is fatal. If delirious speech occurs after purgation, it is fatal.
Fullness without pain is termed Pi syndrome (Plugging Syndrome). Frequent administration of Zhi Ju Tang (Citrus Aurantium and Platycodon Decoction) is an excellent method. Additionally, Xie Xin Tang (Drain the Epigastrium Decoctions) can be used, containing Da Huang (Rhubarb), Fu Zi (Aconite), Gan Cao (Licorice), and Gan Jiang (Dried Ginger).
According to Shanghan theory, if the epigastrium is stiff and painful, it is Jie Xiong (Chest Binding), which is an Excess pattern; if it is hard and full but not painful, it is Pi Qi (Pi Pathogen), which is a Deficiency pattern. For mild cases of Pi syndrome caused by Shanghan, Zhi Ju Tang (Citrus Aurantium and Platycodon Decoction) is generally used because it promotes Qi movement and descends from the diaphragm. If there is epigastric fullness, softness upon palpation, and a floating Guan pulse, Da Huang Huang Lian Xie Xin Tang (Rhubarb, Coptis, and Goldthread Drain the Epigastrium Decoction) is indicated. If epigastric fullness is accompanied by aversion to cold and sweating, Fu Zi Xie Xin Tang (Aconite Drain the Epigastrium Decoction) is indicated. If cold predominates over heat, with chest fullness but no pain and a soggy pulse, Ban Xia Xie Xin Tang (Pinellia Drain the Epigastrium Decoction) is indicated. If there is dry heaving with fluid retention, Sheng Jiang Xie Xin Tang (Fresh Ginger Drain the Epigastrium Decoction) is indicated. If there is dry heaving, diarrhea, and borborygmus, this is not due to internal heat binding, but rather due to stomach Qi deficiency and rebellious pathogenic Qi ascending, causing stiffness and fullness; Gan Cao Xie Xin Tang (Licorice Drain the Epigastrium Decoction) is indicated. Generally, Pi syndrome in Shanghan differs from miscellaneous diseases. Pi syndrome in Shanghan arises from external pathogens entering inward, so bitter-cold herbs for draining are suitable. Pi syndrome in miscellaneous diseases arises from internal dysfunction manifesting outward, so acrid-warm herbs for dispersing are suitable.
Fu Zi Xie Xin Tang (Aconite Drain the Epigastrium Decoction) uses San Huang (Three Yellows: Da Huang, Huang Lian, Huang Qin); adding warm-toning herbs to cold-clearing herbs maintains balance. Pi syndrome is caused by heat pathogens and treated with cold-clearing herbs; if aversion to cold is present, adding Fu Zi (Aconite) makes it appropriate. Ban Xia Xie Xin Tang (Pinellia Drain the Epigastrium Decoction) contains Huang Lian (Coptis), Huang Qin (Scutellaria), Gan Jiang (Dried Ginger), Gan Cao (Licorice), and Ren Shen (Ginseng), harmonized with Da Zao (Jujube) to treat deficiency-type Pi. The therapeutic principle involves descending Yang Qi and harmonizing Yin Qi. (Removing Ren Shen yields Gan Cao Xie Xin Tang; adding Sheng Jiang yields Sheng Jiang Xie Xin Tang.)