而可也。钱氏则称朱氏不善读书者。因历举七条。以辨其误。可谓至当矣。文繁。今省之。
大陷胸汤方
大黄（六两去皮○千金。及翼。无去皮二字。） 芒硝（一升） 甘遂（一钱匕○千金。及翼。外台。一上。
有末字。成本。脱匕字。）
上三味。以水六升。先煮大黄。取二升。去滓。纳芒硝。煮一两沸。纳甘遂末。温服一升。得快利止后服。
〔成〕大黄谓之将军。以苦荡涤。芒硝一名硝石。以其咸能软硬。夫间有遂。以通水也。甘遂。若夫间之遂。
其气可以直达透结。陷胸三物为允。（〔汪〕案甘遂。若夫间之遂。考周礼。凡治野。夫间有遂。注云。自一夫
至千夫之田。为遂。沟洫浍所以通水于川。遂者。通水之道也。广深各三尺曰遂。则是甘遂。乃通水之要药。
陷胸汤中。以之为君。乃知结胸证。非但实热。此系水邪结于心下故也。○案周礼。遂人。上地夫一廛。夫间有
遂。遂上有径。十夫有沟。郑玄注云。遂沟。皆所以通水于川也。遂深二尺。沟倍之。）〔钱〕大黄六两。汉之
六两。即宋之一两六钱二分。李时珍云。古之一升。今之二合半。约即今之一瓯也。每服一瓯。约大黄五钱外。
结胸恶症。理亦宜然。未为太过。况快利止后服乎。
明理论曰。胸为高邪。陷下以平之。故治结胸。曰陷胸汤。利药中此为 剂。伤寒错恶。结胸为甚。非此
汤则不能通利。大而数少。取其迅疾。分解结邪也。
柯琴方论曰。以上二方。比大承气更峻。治水肿痢疾之初起者甚捷。然必视其人之壮实者施之。如平素
虚弱。或病后不任攻伐者。当念虚虚之祸。
玉函。又大陷胸汤方。桂枝四两。甘遂四两。大枣十二枚。栝蒌实一枚。去皮。人参四两。上五味。以
水七升。煮取三升。去滓。温服一升。胸中无坚。勿服之。古方选注曰。栝蒌。陷胸中之痰。甘遂。陷经隧之
水。以桂枝回护经气。以人参奠安里气。仍以大枣泄营。徐徐纵热下行。得成陷下清化之功。○案此方。大陷胸
汤证。而兼里虚者。宜用也。故附载于此。又案亦见活人书。分两少异。
千金翼陷胸汤。主胸中心下结坚。食饮不消方。甘遂。大黄。各一两。栝蒌。甘草。各一两。黄连六两。
上以水五升。煮取二升五合。分三服。千金。无甘遂。
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。（脉沉而紧。玉函。作其脉浮
紧。石硬者。玉函。脉经。千金翼。作如石坚。）
〔程〕结胸一证。虽曰阳邪陷入。然阴阳二字。从虚实寒热上区别。非从中风伤寒上区别。表热盛实。转
入胃腑。则为阳明证。表热盛实。不转入胃腑。而陷入膈。则为结胸证。故不必误下始成。伤寒六七日。有竟
成结胸者。以热已成实。而填塞在胸也。脉沉紧心下痛。按之石硬。知邪热聚于此一处矣。不因下而成结胸者。
必其人胸有燥邪。以失汗而表邪合之。遂成里实。此处之紧脉。从痛得之。不作寒断。〔魏〕六七日之久。表
寒不解。而内热大盛。于是寒邪能变热于里。在胃则为传阳明。在胸则为结胸矣。入胃则为胃实。入胸则为胸
实。实者邪热已盛而实也。〔兼〕下早结胸。事之常。热实结胸。事之变。所入之因不同其证治则一理而已。
伤寒十余日。热结在里。复往来寒热者。与大柴胡汤。但结胸无大热者。此为水结在胸胁也。但头微汗
出者。大陷胸汤主之。（玉函。无也但二字。）
〔喻〕治结胸之证。取用陷胸之法者。以外邪挟内饮。抟结胸间。未全入于里也。若十余日热结在里则
是无形之邪热蕴结。必不定在胸上。加以往来寒热。仍兼半表。当用大柴胡汤。以两解表里之热邪。于陷胸之
义无取矣。无大热。与上文热实互意。内陷之邪。但结胸间。表里之热。反不炽盛。是为水饮结在胸胁。其人
头有微汗。乃邪结在高。而阳气不能下达之明征。此则主用大陷胸汤。允为的对也。后人反谓结胸之外。复有
水结胸一证。（案活人书。另用小半夏加茯苓汤。）可笑极矣。〔程〕热尽入里。表无大热矣。无大热。更无往
来之寒可知。〔钱〕若是水饮必不与热邪并结。则大陷胸方中。何必有逐水利痰之甘遂乎。可谓一言破惑。
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。（【原注】一云。日晡所发
心胸大烦。）从心下至少腹硬满。而痛不可近者。大陷胸汤主之。（所。玉函。无。千金翼。作如。千金。作
日晡有小潮热。心胸大烦。从心下云云。盖原于短剧文。内台方议。所下。补发字。总病。所。作则。）
〔喻〕不大便。燥渴。日晡潮热。少腹硬满。证与阳明颇同。但小有潮热。则不似阳明大热。从心上至少
腹手不可近。则阳明又不似此大痛。因是辨其为太阳结胸。兼阳明内实也。缘误汗复误下。重伤津液。不大便
而燥渴潮热。虽太阳阳明。亦属下证。但痰饮内结。必用陷胸汤。由胸胁以及胃肠。荡涤始无余。若但下肠胃
结热。反遗胸上痰饮。则非法矣。〔钱〕日晡。未申之时也。所者。即书云多历年所之所也。邪从太阳误入阳
明。故从心上至少腹。无少空隙。皆硬满而痛。至
手不可近也。
案证治准绳。朱震亨云。汗下之后。表里俱虚矣。不大便五六日。可见津液之耗。今虽有硬痛。而可以
迅攻之乎。调胃承气。缓取之乎。此乃与前用栀子豉汤之见同矣。皆坐不熟经旨而已。
案舌上燥干而渴。与脏结之舌上滑白。大分别处。
小结胸病。正在心下。按之则痛。脉浮滑者。小陷胸汤主之。（玉函。病。作者。滑下。无者字。）
〔成〕心下硬痛。手不可近者。结胸也。正在心下。按之则痛。是热气犹浅。谓之小结胸。结胸脉沉紧。
或寸浮关沉。今脉浮滑。知热未深结。与小陷胸汤。以除胸膈上结热也。
〔王〕上文云硬满而痛不可近者。是不待按而亦痛也。此云按之则痛。是手按之。然后作痛尔。上文云至
少腹。是通一腹而言之。此云正在心下。则少腹不硬痛可知矣。热微于前。故云小结胸也。〔喻〕其人外邪陷
入原微。但痰饮素盛。挟热邪而内结。所以脉见浮滑也。
小陷胸汤方
黄连（一两○玉函作二两） 半夏（半升洗） 栝蒌实（大者一枚○成本。作一个。）
上三味。以水六升。先煮栝蒌。取三升。去滓。纳诸药。煮取二升。去滓分温三服。（三服下。总病论。
有微解下黄涎即愈七字。活人书。准绳。并同。）
〔钱〕夫邪结虽小。同是热结。故以黄连之苦寒。以解热开结。非比大黄之苦寒荡涤也。邪结胸中。则
胃气不行。痰饮留聚。故以半夏之辛温滑利。化痰蠲饮。而散其滞结也。栝蒌实之甘寒。能降上焦之火。使痰
气下降也。此方之制。病小则制方亦小。即内经所云。有毒无毒。所治为主。适大小为制也。
内台方议曰。又治心下结痛。气喘而闷者。
汪昂医方集解。刘心山曰。结胸。多挟痰饮。凝结心胸。故陷胸泻心。用甘遂半夏栝蒌枳实旋复之类。皆
为痰饮而设也。
汪氏云。大抵此汤。病患痰热内结者。正宜用之。锡驹云。案汤有大小之别。症有轻重之殊。今人多以小
陷胸汤。治大结胸症。皆致不救。遂诿结胸。为不可治之证。不知结胸之不可治者。止一二节。余皆可治者也。
苟不体认经旨。以致临时推诿。误人性命。深可叹也。
伤寒直格曰。栝蒌实。惟锉其壳。子则不锉。或但用其中子者。非也。
医学纲目曰。工部郎中郑忠浓因患伤寒。胸腹满。面黄如金色。诸翰林医官商议。略不定。推让曰。胸满
可下。恐脉浮虚。召孙兆至。曰。诸公虽疑。不用下药。郑之福也。下之必死。某有一二服药。服之必瘥。遂
下小陷胸汤。寻利。其病遂良愈。明日面色改白。京城人称服。
又曰。孙主簿述之母。患胸中痞急。不得喘息。按之则痛。脉数且涩。此胸痹也。因与仲景三物小陷胸汤。
一剂而和。二剂而愈。
医垒元戎。小陷胸汤。去半夏。加大黄。
赤水玄珠。徐文学三泉先生令郎。每下午发热。直至天明。夜发更甚。右胁胀痛。咳嗽吊疼。坐卧俱疼。
医以疟治。罔效。逆予诊之。左弦大。右滑大搏指。予曰。内经云。左右者。阴阳之道路。据脉。肝胆之火。
为痰所凝。必勉强作文。过思不决。郁而为疼。夜甚者。肝邪实也。乃以仲景小陷胸汤为主。栝蒌一两。黄连
三钱。半夏二钱。前胡青皮各一钱。水煎饮之。夜服当归龙荟丸。微下之。夜半痛止热退。
两帖全安。
医林集要。加味陷胸汤。治壅热痞满。胸膈痛。或两胁痛。
于本方。加桔梗。黄芩。黄连。麦门冬。姜水煎。饥时服。利下黄涎。即安。凡疟痢病后余热。留滞胸膈。
及有饮酒过度。胸结痛。亦宜服此。神效。一法。只用小陷胸汤。加桔梗。枳壳。甚效。
医学入门小调中汤。治一切痰火。及百般怪病。善调脾胃神效。
于本方。加甘草。生姜。
证治大还。加味小陷胸汤。（秘方）治火动其痰嘈杂。
于本方。加枳实。栀子。
张氏医通。凡咳嗽面赤。胸腹胁常热。惟手足有凉时。其脉洪者。热痰在膈上也。小陷胸汤。（即本方）
太阳病二三日。不能卧。但欲起。心下必结。脉微弱者。此本有寒分也。反下之若利止。必作结胸。未止
者。四日复下之。此作协热利也。（玉函。脉经。千金翼。起下。有者字。作此本寒也。反上。有而字。四下。
有五字。复下。有重字。协。作挟。脉经。不上。有终字。外台。寒分。作久寒。神巧万全方。分。作故。王
本。删分字。金鉴云。复下之之字。当是利字。上文利未止。岂有复下之理乎。细玩自知。是必传写之误。方
云。末句此下。疑有脱误。是不必矣。）
〔钱〕二三日。表邪未解。将入里而未入里之时也。不能卧。但欲起者。邪势搅扰。坐卧不宁之状也。若
此则知邪已在胸次之阳位矣。以尚未入胃。故知心下必结。必者。决词也。本文虽不言治法。以理推之。即栀
子豉汤之类症也。若此症而脉见微弱者。其中气本属虚寒。尤为不可下之证。而反下之。若利随下止。则陷入
之邪。不得乘势下走。必硬结
于胸中矣。若三日下之。而利未止者。第四日复下之。则已误再误。有不至中气不守。胃气下陷。以虚协热。
而下利者乎。此所以重以为戒也。桂枝人参汤症。误下而利下不止。故因虚寒而成痞硬。此条误下利止。亦因
虚寒而成结胸。均属太阳未解之证。一痞一结。似有虚实之殊。然脉微弱而本有寒分者。其可竟以实热待之耶。
协热二字。当与桂枝人参汤条。不甚相远也。
案寒分。汪氏云。痰饮也。以痰饮本寒。故曰寒分。然分字不成义。当从外台而作久寒。或根据玉函等。
删之亦得。○协热之协。成本作协并挟同。成注作挟热利。程氏云。里寒夹表热而下利。是曰协热。是也。况玉
函等。作挟。可为确证矣。方氏云。协。互相和同之谓。后世注家。多宗其说。不可从矣。
案此条结胸证。乃属虚寒。常器之云。可增损理中丸。方出外台天行病。即理中丸。加栝蒌根。枳实。茯
苓。牡蛎。云治下后虚逆。而气已不理。而毒复上攻。结于胸中。乃于此条症。为切当矣。协热利。成氏而降。
皆云邪热下攻肠胃。为热利。常氏主以白头翁汤。而此条曰脉微弱。曰有寒分。岂是热利耶。钱氏注。似于经
旨不相戾也。
太阳病下之。其脉促。（【原注】一作纵）不结胸者。此为欲解也。脉浮者。必结胸。脉紧者。必咽痛。
脉弦者。必两胁拘急。脉细数者。头痛未止。脉沉紧者。必欲呕。脉沉滑者。协热利。脉浮滑者必下血。（玉
函。脉经。脉上。并有其字。协。作挟。）
〔钱〕此条详言误下之脉证。以尽其变。误下之后脉促。即不能盛于上而为喘汗。亦不至陷于内而为结胸。
脉虽促而阳分之邪。已自不能为患。是邪势将衰。故为欲解。此误下之侥幸者也。若脉仍浮者。可见表邪甚盛。
不为下衰。将必
乘误下之里虚。陷入上焦清阳之分。而为结胸矣。若脉见紧者。则下后下焦之虚阳。为少阴之阴寒所逼。循经
上冲。必作咽痛也。脉弦者。邪传少阳。经云。尺寸俱弦者。少阳受病。少阳之脉循胁。故云必两胁拘急也。
脉细数者。细则为虚。数则为热。下后虚阳上奔。故头痛未止。若脉见沉紧。则为下后阳虚。致下焦阴邪上逆
而呕也。沉为在里。沉主下焦。滑为阳动。滑主里实。误下之后沉滑。热在里而仍挟表。水谷下趋。随其误下
之势。必为胁热下利也。若脉浮滑。阳邪止在阳分。而邪热下走。扰动其血。故必下血也。〔鉴〕咽痛。少阴寒
热俱有之证也。咽干肿痛者为热。不干不肿而痛者为寒。故少阴论中。有甘橘汤通脉四逆汤二治法也。〔锡〕
不曰必头痛。而曰头痛未止者。以见太阳原有之头痛。因脉细数而未止也。〔程〕据脉见证。各着一必字。见
势所必然。考其源头。总在太阳病。下之而来。故虽有已成坏病。未成坏病之分。但宜以活法治之。不得据脉
This is acceptable. Qian Shi criticized Zhu Shi as someone who was not good at reading books, and thus listed seven points one by one to clarify the errors therein, which can be considered most appropriate. Due to the lengthy text, it is omitted here.
Da Xianxiong Decoction Formula
Dahuang (Cortex Rhei Radix et Rhizoma, 6 liang; peeled in original text ○ *Qianjin* and *Yi* do not have "peeled"). Mangxiao (Natrii Sulfas, 1 sheng). Gansui (Radix Kansui, 1 qian bi ○ *Qianjin*, *Yi*, *Waitai* read "yi shang"; some versions include "mo" (powder); *Chengben* omits "bi").
Take the above three herbs. Boil in 6 sheng of water. First decoct Dahuang until 2 sheng remains. Remove the dregs. Add Mangxiao. Boil for two or three boils. Add Gansui powder. Take 1 sheng warm. Stop taking after obtaining rapid purgation.
[Cheng Wuji] Dahuang is called the General, using its bitter property to purge and cleanse. Mangxiao, also known as Xiaoshi, uses its salty property to soften hardness. "Sui" between fields serves to drain water. Gansui, like the drainage ditch between fields, its qi can reach directly through and penetrate accumulations. The three ingredients of Da Xianxiong are suitable. ([Wang Ang] Note: Regarding "Gansui, like the Sui between fields," consulting *Zhou Li*: "When managing fields, there is a Sui between each 'fu' (unit of land)." The annotation states: From one fu to a thousand fus of fields, it is called Sui. Sui, gou, xu, and kuai are channels to drain water into rivers. Sui refers to the water-draining path. A Sui with width and depth of three chi is called Sui. Thus, Gansui is a key herb for draining water. Used as the sovereign herb in Da Xianxiong Tang, we know that Jie Xiong syndrome is not merely excess heat, but water pathogen accumulating in the epigastrium. ○ Note: *Zhou Li · Sui Ren* records: For superior land, each household has one chan, with a Sui between them, and a Jing on top of the Sui. Every ten households have a Gou. Zheng Xuan annotates: Sui and Gou are both used to drain water into rivers. Sui is two chi deep, Gou is double that.) [Qian Huang] Six liang of Dahuang in Han dynasty equals 1 liang 6 qian 2 fen in Song dynasty. Li Shizhen stated: Ancient 1 sheng equals modern 2 he 5 shao, approximately one bowl. Each dose is about one bowl. Apart from 5 qian of Dahuang, for such severe Jie Xiong cases, this dosage is reasonable and not excessive, especially given the instruction to stop after rapid purgation.
*Ming Li Lun* states: The chest is high; to level it, use sinking methods. Hence, treating Jie Xiong is called Xianxiong Tang. Among purgative formulas, this is the strongest. Among complex and severe cold damage syndromes, Jie Xiong is the most severe; without this decoction, unblocking is impossible. Large dosage with few administrations aims for swiftness to resolve accumulated pathogens.
Ke Qin's Formula Commentary states: These two formulas are more drastic than Da Chengqi Tang. They act swiftly on early-stage edema and dysentery. However, they must only be used on robust patients. If the patient is constitutionally weak or cannot withstand attack post-illness, one must consider the danger of exacerbating deficiency.
*Yu Han Jing* additionally records Da Xianxiong Tang Formula: Guizhi (Ramulus Cinnamomi, 4 liang), Gansui (Radix Kansui, 4 liang), Dazao (Fructus Jujubae, 12 pieces), Gualou Shi (Fructus Trichosanthis, 1 large piece; peeled), Renshen (Radix Ginseng, 4 liang). Take the above five herbs. Boil in 7 sheng of water until 3 sheng remains. Remove dregs. Take 1 sheng warm. Do not take if there is no firm accumulation in the chest. *Gu Fang Xuan Zhu* states: Gualou sinks phlegm in the chest; Gansui sinks water in meridians and collaterals. Guizhi protects meridian qi; Renshen stabilizes interior qi. Dazao drains Ying qi, slowly guiding heat downward, achieving the effect of sinking and clearing transformation. ○ Note: This formula is suitable for Da Xianxiong Tang syndrome accompanied by interior deficiency, hence appended here. Also found in *Huo Ren Shu*, with slight dosage differences.
*Qianjin Yi Fang* Xianxiong Tang: Mainly treats firm accumulation in the chest and epigastrium, indigestion. Gansui and Dahuang, 1 liang each; Gualou and Gancao, 1 liang each; Huanglian (Rhizoma Coptidis, 6 liang). Boil in 5 sheng of water until 2.5 sheng remains. Divide into three doses. *Qianjin Fang* lacks Gansui.
Cold damage for six or seven days, presenting as Jie Xiong Re Shi (Excess Heat) syndrome, pulse sun and jin (deep and tight), pain in the epigastrium, hard upon pressure like stone, is treated with Da Xianxiong Tang. (*Pulse sun and jin*, *Yu Han* reads "pulse fu and jin"; *Stone hard*, *Yu Han*, *Mai Jing*, *Qianjin Yi* read "hard like stone".)
[Cheng Yingmao] Jie Xiong syndrome, although described as Yang pathogen sinking, the terms Yin and Yang are distinguished by deficiency/excess and cold/heat, not by wind-strike or cold-damage. Excess heat on the exterior transferring to the stomach becomes Yangming syndrome. Excess heat on the exterior not transferring to the stomach but sinking into the diaphragm becomes Jie Xiong syndrome. Thus, it does not necessarily result from erroneous purgation. Cold damage for six or seven days may directly form Jie Xiong because heat has become excess and fills the chest. Pulse sun/jin, epigastric pain, hardness like stone indicate pathogenic heat gathering in one location. Jie Xiong not caused by purgation implies pre-existing dry pathogen in the chest; failure to sweat allows exterior pathogen to combine, forming interior excess. The jin pulse here arises from pain, not cold. [Wei Litong] After six or seven days, if exterior cold is unresolved and interior heat is intense, cold transforms into heat inside. In the stomach, it transmits to Yangming; in the chest, it forms Jie Xiong. Entering the stomach is Stomach Excess; entering the chest is Chest Excess. Excess means pathogenic heat is abundant and solidified. [Yu Jiayuan] Erroneous early purgation causing Jie Xiong is common; Re Shi Jie Xiong is a variation. Causes differ, but treatment principles are consistent.
Cold damage for over ten days, heat accumulated in the interior, recurring alternating chills and fever, is treated with Da Chaihu Tang. If Jie Xiong presents without significant heat, this is water accumulation in the chest and hypochondrium. Only slight sweating on the head indicates Da Xianxiong Tang is indicated. (*Yu Han* omits "ye dan").
[Yu Jiayuan] Treating Jie Xiong with sinking methods addresses exterior pathogen carrying internal fluid retention, knotting in the chest, not fully entering the interior. If heat accumulates in the interior after ten days, it is formless heat knotting, not fixed in the chest. With alternating chills and fever, it involves half-exterior/half-interior; Da Chaihu Tang resolves both. "No significant heat" contrasts with previous "heat excess." Internal sinking pathogen knots in the chest, while exterior-interior heat is not intense. This is water-fluid knotting in chest/hypochondrium. Head sweating indicates pathogen knotting high, preventing Yang qi from descending. Da Xianxiong Tang is indeed appropriate. Later authors erroneously posit "Water Jie Xiong" separate from standard Jie Xiong. (Note: *Huo Ren Shu* uses Xiao Banxia plus Fuling Tang). Ridiculous. [Cheng Yingmao] Heat fully enters interior, so no exterior heat. No heat implies no alternating chills. [Qian Huang] If it were purely fluid, it would not knot with heat; why include Gansui (draining water/phlegm) in Da Xianxiong? This clarifies confusion.
Taiyang disease, heavily sweated and then purged, leading to constipation for five to six days, dry tongue with thirst, slight afternoon tidal fever. (Original note: Or, severe mental restlessness in heart/chest at dusk.) Hardness and fullness from epigastrium to lower abdomen, painful and untouchable, is treated with Da Xianxiong Tang. ("Suo", *Yu Han* omits; *Qianjin Yi* reads "ru"; *Qianjin* reads "slight afternoon tidal fever, severe heart/chest restlessness...").
[Yu Jiayuan] Constipation, dry thirst, afternoon tidal fever, lower abdominal hardness/fullness resemble Yangming. But slight tidal fever differs from Yangming's high fever. Pain from heart to lower abdomen, untouchable, is more severe than Yangming. Thus, it is Taiyang Jie Xiong combined with Yangming interior excess. Erroneous sweating and purging severely damaged fluids. Although Taiyang/Yangming, it falls under purgative indication. However, with internal phlegm-fluid knotting, Xianxiong Tang is required to sweep from chest/hypochondrium to intestines/stomach. Purging only intestinal heat leaves chest phlegm, which is incorrect. [Qian Huang] Riben is Wei/Shen hours. "Suo" refers to duration. Pathogen entered Yangming from Taiyang erroneously, causing hardness/pain from heart to lower abdomen, untouchable.
Note: *Zheng Zhi Zhun Sheng* Zhu Zhenheng says: After sweating/purging, exterior/interior are deficient. Five-six days constipation shows fluid depletion. Despite hardness/pain, should we use rapid attack? Or Tiaowei Chengqi Tang for slow resolution? Same error as using Zhizi Chi Tang previously due to unfamiliarity with classics.
Note: Dry/thirsty tongue differs significantly from Zang Jie's slippery white tongue.
Xiao Jie Xiong Bing (Minor Chest Knotting Disease), located exactly at the epigastrium, painful only upon pressure, pulse fu hua (floating and slippery), is treated with Xiao Xianxiong Tang. (*Yu Han*: "Bing" reads "Zhe"; no "Zhe" after "Hua".)
[Cheng Wuji] Epigastric hardness/pain, untouchable, is Jie Xiong. Located exactly at epigastrium, painful only on pressure, indicates shallow heat, called Minor Jie Xiong. Jie Xiong pulse is sun/jin, or cun fu/guan chen. Current fu/hua pulse indicates heat not deeply knotted. Xiao Xianxiong Tang clears chest/diaphragm heat.
[Wang Kentang] Previous text: Hard/full, untouchable pain (spontaneous). Here: Pain only on pressure. Previous: Extends to lower abdomen (whole abdomen). Here: Exactly at epigastrium (lower abdomen not painful). Heat is milder, hence "Minor Jie Xiong". [Yu Jiayuan] Exterior pathogen sinking was mild; pre-existing abundant phlegm-fluid combines with heat, resulting in fu/hua pulse.
Xiao Xianxiong Tang Formula
Huanglian (Rhizoma Coptidis, 1 liang ○ *Yu Han* 2 liang). Banxia (Rhizoma Pinelliae Preparatum, half sheng, washed). Gualou Shi (Fructus Trichosanthis, 1 large piece ○ *Chengben* 1 piece).
Take the above three herbs. Boil in 6 sheng of water. First decoct Gualou until 3 sheng remains. Remove dregs. Add other herbs. Boil until 2 sheng remains. Remove dregs. Divide into three warm doses. (*Zong Bing Lun* adds: "Slight yellow turbid discharge indicates cure." *Huo Ren Shu*, *Zhun Sheng* agree.)
[Qian Huang] Though pathogen knotting is minor, it is still heat knotting. Huanglian's bitter-cold clears heat and opens knots, unlike Dahuang's harsh purgation. Pathogen knots in chest, Stomach Qi stagnates, phlegm-fluid accumulates. Banxia's acrid-warm/slippery resolves phlegm/fluid and disperses stagnation. Gualou Shi's sweet-cold descends Upper Jiao fire and phlegm qi. Formula size matches disease size, per *Nei Jing*: "Toxic/non-toxic, treat the main disease, adjust size accordingly."
*Nei Tai Fang Yi* states: Also treats epigastric knotting/pain, asthma, and oppression.
Wang Ang's *Yi Fang Ji Jie* Liu Xinshan says: Jie Xiong often carries phlegm-fluid knotting in heart/chest. Thus, Xianxiong/Xiexin formulas use Gansui, Banxia, Gualou, Zhishi, Xuanshu, etc., all for phlegm-fluid.
Wang says: This decoction suits patients with internal phlegm-heat knotting. Xi Ju notes: Formulas vary in size; symptoms vary in severity. Many misuse Xiao Xianxiong for Major Jie Xiong, leading to death, claiming Jie Xiong is incurable. Only 1-2 cases are incurable; others are treatable. Ignoring classics leads to fatal errors.
*Shanghan Zhige* states: Gualou Shi should only have shell sliced, seeds whole. Using only seeds is incorrect.
*Yi Xue Gang Mu* records: Official Zheng Zhongnong had cold damage, chest/abdominal fullness, golden-yellow face. Physicians debated. Said: Fullness suggests purgation, but floating/deficient pulse warns against it. Sun Zhao arrived: "Not using purgatives is your fortune. Purgation will kill. I have medicine to cure." Prescribed Xiao Xianxiong Tang. Patient defecated, cured. Face turned white next day, praised in capital.
Also: Supervisor Sun's mother had chest oppression, inability to breathe, pain on pressure, rapid/choppy pulse. Diagnosed as Xiong Bi. Given Zhongjing's Sanwu Xiao Xianxiong Tang. One dose harmonized, two doses cured.
*Yi Lei Yuan Rong*: Xiao Xianxiong Tang, remove Banxia, add Dahuang.
*Chishui Xuanzhu*: Mr. Xu Wenxue's son had afternoon fever till dawn, worse at night, right hypochondriac distension/pain, cough radiating pain, restless. Treated as malaria, ineffective. Pulse: Left xuan da, Right hua da pounding finger. "Left/Right are paths of Yin/Yang." Liver/Gallbladder fire congealed by phlegm, likely from overthinking/writing. Night worsening indicates Liver excess. Used Zhongjing's Xiao Xianxiong Tang as base: Gualou 1 liang, Huanglian 3 qian, Banxia 2 qian, Qianhu/Qingpi 1 qian each. Decocted. Night: Danggui Longhui Wan (mild purgation). Pain/fever stopped by midnight. Two doses cured completely.
*Yi Lin Ji Yao*: Modified Xianxiong Tang treats obstructive heat/oppression, chest/diaphragm pain, or hypochondriac pain.
Add Jiegeng, Huangqin, Huanglian, Maimendong to base. Decoct with ginger. Take when hungry. Yellow turbid discharge brings relief. Effective for residual heat from malaria/dysentery lingering in chest/diaphragm, or alcohol-induced chest knotting/pain. Alternative: Base + Jiegeng, Zhike.
*Yi Xue Ru Men* Xiao Tiaozhong Tang treats all phlegm-fire and strange diseases, regulating spleen/stomach effectively.
Add Gancao, Shengjiang to base.
*Zheng Zhi Da Huan*: Modified Xiao Xianxiong Tang (Secret Recipe) treats fire-agitating phlegm, discomfort.
Add Zhishi, Zhizi to base.
*Zhang Shi Yi Tong*: Cough, red face, frequent heat in chest/abdomen/hypochondrium, cool extremities, hong pulse indicates Phlegm-Heat in Upper Jiao. Use Xiao Xianxiong Tang (Base formula).
Taiyang disease for 2-3 days, unable to lie down, wanting to rise, epigastric knotting, weak/micro pulse, indicates pre-existing cold-fluid. Erroneous purgation: If diarrhea stops, Jie Xiong will form; if diarrhea continues, purging again on day four causes Xie Re Li (Colluding Heat Diarrhea). (*Yu Han*, *Mai Jing*, *Qianjin Yi*: "Qi" has "Zhe"; "Zuo" reads "Ci Ben Han Ye"; "Fan" has "Er"; "Si Xia" has "Wu"; "Fu Xia" has "Chong"; "Xie" reads "Jia"; *Mai Jing* "Bu Shang" has "Zhong"; *Waitai* "Han Fen" reads "Jiu Han"; *Shen Qiao Wan Quan Fang* "Fen" reads "Gu"; *Wang Ben* deletes "Fen"; *Jin Jian* says "Zhi" in "Fu Xia Zhi" should be "Li". Previous text says diarrhea hasn't stopped, how can one purge again? Copying error. Suspected omission at end.)
[Qian Huang] 2-3 days: Exterior pathogen unresolved, transitioning to interior. Unable to lie, wanting to rise: Pathogen disturbing, restlessness. Pathogen in upper Yang position (chest). Not yet in stomach, so epigastric knotting. "Bi" (must) is decisive. Treatment implied: Zhizi Chi Tang type. If pulse is micro/weak, Middle Qi is deficient/cold; purgation is contraindicated. Erroneous purgation: If diarrhea stops, sinking pathogen cannot exit downward, knots in chest. If purged on day 3, diarrhea continues, purging again on day 4 is double error, leading to Middle Qi collapse, Stomach Qi sinking, deficiency with colluding heat diarrhea. Warning against this. Guizhi Renshen Tang: Erroneous purgation causes persistent diarrhea, leading to Pi Ying (Glomeration/Hardness) via deficiency/cold. This case: Erroneous purgation stops diarrhea, leading to Jie Xiong via deficiency/cold. Both Taiyang unresolved. One Pi, one Jie, seemingly deficiency/excess. But micro/weak pulse with pre-existing cold-fluid cannot be treated as excess heat. "Xie Re" aligns with Guizhi Renshen Tang context.
Note: Han Fen (Cold Fluid): Wang says Phlegm-Fluid (originally cold). "Fen" is awkward; *Waitai* "Jiu Han" (Old Cold) or delete per *Yu Han*. Xie Re (Colluding Heat): *Chengben* equates Xie/Jia. Cheng annotates Jia Re Li. Cheng says Interior Cold + Exterior Heat = Xie Re. Correct. *Yu Han* uses Jia, confirming. Fang says Xie means mutual harmony; later scholars follow, incorrectly.
Note: This Jie Xiong case is deficiency/cold. Chang Qizhi says: Modify Lizhong Wan. Formula from *Waitai* Tianxing Bing: Lizhong Wan + Gualou Gen, Zhishi, Fuling, Muli. Treats post-purgation deficiency/reversal, Qi disorder, toxin attacking up, knotting in chest. Fits this case well. Xie Re Li: Cheng/Jiang say Heat attacking intestines/stomach causes Heat Diarrhea. Chang uses Baitouweng Tang. But this case has micro pulse, cold-fluid; is it Heat Diarrhea? Qian's annotation aligns with classics.
Taiyang disease purged, pulse cu (rapid/interrupted). (Original note: Or Zong). If no Jie Xiong, syndrome is resolving. Pulse fu (floating) indicates Jie Xiong. Pulse jin (tight) indicates sore throat. Pulse xuan (string-like) indicates bilateral hypochondriac tension. Pulse xi shuo (fine/rapid) indicates headache persists. Pulse chen jin (deep/tight) indicates desire to vomit. Pulse chen hua (deep/slippery) indicates Xie Re Li. Pulse fu hua (floating/slippery) indicates bloody stool. (*Yu Han*, *Mai Jing*: "Mai" has "Qi"; "Xie" reads "Jia".)
[Qian Huang] Details erroneous purgation pulses/symptoms. Post-purgation cu pulse: Cannot ascend to cause panting/sweating, nor sink to cause Jie Xiong. Yang pathogen weakened, syndrome resolving. Lucky outcome. If pulse remains fu, exterior pathogen strong, not subdued by purgation, sinks into Upper Jiao clear Yang due to interior deficiency, causing Jie Xiong. If jin pulse, Lower Jiao deficient Yang forced by Shaoyin Cold, ascending along channel, causing sore throat. If xuan pulse, pathogen transmits to Shaoyang. *Nei Jing*: "Cun/Guan both xuan" = Shaoyang disease. Shaoyang channel follows hypochondrium, causing tension. If xi/shuo pulse, fine=deficiency, rapid=heat. Post-purgation deficient Yang rushes up, headache persists. If chen/jin pulse, post-purgation Yang deficiency, Lower Jiao Yin evil rebels, causing vomiting. Chen=Interior/Lower Jiao. Hua=Yang movement/Interior excess. Post-purgation chen/hua: Heat in interior carrying exterior, water/grain rushing down, causing Xie Re Diarrhea. If fu/hua pulse, Yang pathogen stays in Yang division, heat moves downward, disturbs blood, causing bloody stool. [Zhao Sizhen] Sore throat occurs in both Shaoyang Cold/Heat. Dry/swollen=painful=Heat. Non-dry/non-swollen=painful=Cold. Shaoyang chapter offers Ganju Tang/Tongmai Sini Tang. [Xi Ju] "Headache not stopping" vs "Must headache": Shows original Taiyang headache persists due to xi/shuo pulse. [Cheng Yingmao] "Bi" (must) indicates inevitable progression based on pulse/symptoms. Origin is Taiyang disease + purgation. Whether formed/broken disease, use flexible methods, do not rely solely on pulse...