伤寒下之太早，则成痞硬。中风下之太早，则成结胸，均为表邪乘之，入里硬满，按之而痛，为结胸实
邪也，硬满按之不痛，为痞硬虚邪也。大结胸从心下至少腹硬满而痛，手不可近者，宜大陷胸汤攻之。小结
胸微结心下，按之方痛，不按不痛者，宜小陷胸汤开之。身有微热，头自汗出，兼有是证者，为水结胸，宜
大陷胸丸攻之。嗽水不欲咽，兼有是证者，为血结胸，血瘀不成衄解，或衄未尽，或妇人经来适断，皆能成
之，宜抵当丸，或桃仁承气汤攻之。凡结胸内实证，实可攻也，沉大脉，实可攻也。审其的当，则用抵当、桃
仁承气、大陷胸汤、丸以攻之。审其不内实，脉浮滑，或脉浮大，是未的也，乃小陷胸汤证，不可攻也。误
攻之，定主凶。再脏结，证状如结胸，舌苔白滑，脉浮而细，通腹两胁皆硬满痛，此证加之烦躁，凶死可知
矣。
伤寒下早、则成痞硬。中风下早，则成结胸，此其常也。然论中，中风下早，未尝无痞硬，伤寒下早，亦
有结胸。大抵从虚化者，多为痞硬，从实化者，多为结胸也。阳证心下痞硬者为热痞，宜大黄黄连泻心汤。阳
证汗出恶寒者，为寒热痞。宜附子泻心汤。误下少阳，发热而呕，心下痞满者，为呕逆痞，宜半夏泻心汤。
阳证误下，心下痞硬，下利，心烦干呕，腹中雷鸣，胁下有水气，致小便不利者，为虚热水气之痞，宜生姜泻
心汤。若有是证，胁下无水气，其痞急益甚者，为虚热咳气上逆之痞，
宜甘草泻心汤。凡有痞者，有无汗恶寒之表证，宜用桂枝汤。表解已，乃可以大黄黄连泻心汤攻痞也。若
有痞者，与泻心汤。痞不解，其人烦渴，小便不利者，先以五苓散，大便利后，乃可与诸泻心汤治痞也。
If the purgative method is used too early in Taiyang disease (Taiyang disease, a syndrome caused by pathogenic factors invading the Taiyang meridian), Piying syndrome (a condition characterized by fullness and hardness in the epigastrium due to deficiency) will form. If the purgative method is used too early in Fengzhong disease (Wind-stroke disease, often referring to exterior syndromes with sweating), Jiexiong syndrome (Chest binding syndrome, characterized by pain and hardness in the chest/epigastrium due to excess pathogens) will form. In both cases, this is because the exterior pathogen takes advantage of the deficiency to enter the interior, causing hardness and fullness. If pressing on the area causes pain, it is Jiexiong excess pathogen; if pressing causes no pain, it is Piying deficiency pathogen. Da Jiexiong (Major Chest Binding) presents with hardness, fullness, and pain from the epigastrium down to the lower abdomen, such that the hands cannot approach it; Da Xianxiong Tang (Major Trapdoor Decoction) should be used to attack it. Xiao Jiexiong (Minor Chest Binding) presents with slight binding in the epigastrium, painful only upon pressure and not when untouched; Xiao Xianxiong Tang (Minor Trapdoor Decoction) should be used to open and resolve it. If there is slight fever in the body and spontaneous sweating of the head, accompanied by these symptoms, it is Shui Jiexiong (Water Chest Binding); Da Xianxiong Wan (Major Trapdoor Pill) should be used to attack it. If one wants to rinse the mouth but does not wish to swallow, accompanied by these symptoms, it is Xue Jiexiong (Blood Chest Binding). This occurs when blood stasis fails to resolve through nosebleed (Xue), or the nosebleed is incomplete, or in women when menstruation has just stopped; Dangdang Wan (Dangdang Pill) or Taoren Chengqi Tang (Peach Kernel and Cathartic Decoction) should be used to attack it. For all Jiexiong syndromes that are internal excess patterns, where excess allows for attack, and the pulse is deep and large, indicating excess allowing for attack: after careful confirmation, use Dangdang Wan, Taoren Chengqi Tang, Da Xianxiong Tang, or Da Xianxiong Wan to attack. If examination reveals no internal excess, and the pulse is floating and slippery, or floating and large, it is not confirmed excess; it is a Xiao Xianxiong Tang pattern, and attack/purgation is contraindicated. Mistaken attack will surely lead to ominous outcomes. Furthermore, Zangjie (Zang Knotting) presents similarly to Jiexiong, with a white and slippery tongue coating, a floating and fine pulse, and hardness, fullness, and pain throughout the abdomen and hypochondrium. If this pattern is accompanied by irritability, death is evident.
Early purgation in Taiyang disease leads to Piying. Early purgation in Fengzhong disease leads to Jiexiong; this is the general rule. However, in the Treatise, Fengzhong with early purgation does not preclude Piying, nor does Taiyang with early purgation preclude Jiexiong. Generally, transformations from deficiency tend to become Piying, while transformations from excess tend to become Jiexiong. Yang syndrome with epigastric Piying is Re Pi (Heat Epigastric Fullness); Dahuang Huanglian Xiexin Tang (Rhubarb and Coptis Heart-Draining Decoction) is indicated. Yang syndrome with sweating and aversion to cold is Hanre Pi (Cold-Heat Epigastric Fullness); Fuzi Xiexin Tang (Aconite Heart-Draining Decoction) is indicated. Mistaken purgation damaging Shaoyang, resulting in fever, vomiting, and epigastric fullness, is Ni Pi (Rebellious Qi Epigastric Fullness); Banxia Xiexin Tang (Pinellia Heart-Draining Decoction) is indicated. Yang syndrome mistaken purgation leading to epigastric Piying, diarrhea, irritability, dry retching, borborygmus, fluid retention under the hypochondrium causing difficult urination, is Xu Re Shuiqi Pi (Deficiency-Heat Fluid-Retention Epigastric Fullness); Shengjiang Xiexin Tang (Fresh Ginger Heart-Draining Decoction) is indicated. If these symptoms exist but there is no fluid retention under the hypochondrium, and the Pi is severely aggravated, it is Xu Re Kouqi Shangni Pi (Deficiency-Heat Rebellious Qi Epigastric Fullness); Gancao Xiexin Tang (Licorice Heart-Draining Decoction) is indicated. For any Pi syndrome accompanied by exterior signs of anhidrosis and aversion to cold, Guizhi Tang (Cinnamon Twig Decoction) should be used first. Only after the exterior is resolved can Dahuang Huanglian Xiexin Tang be used to treat the Pi. If Pi is present and treated with Xiexin Tangs without resolution, and the patient develops irritability, thirst, and difficult urination, Wuling San (Five-Ingredient Powder with Poria) should be administered first; only after urination becomes free can the various Xiexin Tangs be used to treat the Pi.