有饮食尚在胃口。未当下而早下之。成结胸者。倘脉虚质弱。不可更下。（故知未经下者。
症虽满闷。尚为在表。非结胸也。）结胸欲绝。心膈高起。手不得近。用大陷胸汤。不瘥者。此
是下后虚逆。气已不理。而毒复上攻。气毒相搏结于胸者。用枳实理中丸。自安。胸中虽和。伤
寒未退。必有正便。候日数足。以法去之。戴院使曰。有寒实结胸。虽痛而无烦躁等症。此因下
后虚逆。寒气独结。宜理中汤。加枳实半钱。茯苓一钱。
大陷胸汤
大黄（君） 芒硝（臣） 甘遂（佐）
枳实理中丸
枳实（臣） 茯苓（佐） 白术（臣） 人参（君） 甘草（佐） 干姜（使）
上为末。炼蜜为丸。如鸡子黄大。每服一丸。热汤化下。连进二三服。胸中豁然。渴者加天
花粉一两。自汗
者加牡蛎 过二两。下利亦加。
有下早成结胸症。见微热神昏。口干微渴。舌兼燥或殷紫色。大便溏泄时至。此谓傍流。乃
热结于中。逼注大肠非关脾也。养阴滋血药中。须加黄芩知母。又必合白虎用石膏。傍流方止。
止后数日。方得正便而愈矣。（中者胃也。故宜用石膏。已经误下。必伤胃阴。故宜用滋阴。）
兼有小便秘者。热解自通。切勿用木通车前等利水药。利水阴阳易竭。为不可救也。（自利症云
发汗则内外皆虚。此症则云利水则阴阳易竭。皆是不刊之论。）有伤寒热甚。失于汗下。唇焦舌
燥。能饮水。大便秘硬。小便赤涩。时有稀粪水利出者。此内有燥矢结骤。乃旁漏之物。非冷利
也。再审有矢气极臭者是也。其脉虽沉。切之必滑有力。或时躁热。不欲衣被。或扬手掷足。或
语有力。此阳气亢极。轻者人参白虎汤。或小柴胡合解毒汤主之。内实者须下之。有潮热者大
柴胡加芒硝。
Food and drink remain in the stomach region, having not yet descended to the intestines where they should be evacuated. If purgation is employed prematurely before descent occurs, it results in Jie Xiong (Chest Binding Syndrome). If the pulse is deficient and the constitution is weak, further purgation must not be used. (Thus, it is known that if purgation has not been performed, although symptoms of fullness and oppression are present, the pathogen remains at the exterior level, and this is not Jie Xiong.)
If Jie Xiong reaches a critical state, with the epigastrium and diaphragm protruding high, and the area cannot be touched by hand, Da Xian Xiong Tang (Major Trapping the Chest Decoction) should be used. If the condition does not improve after administration, this indicates that post-purgative deficiency and rebellious Qi have occurred; the Qi mechanism is disordered, and toxic pathogens attack upward again. The Qi and toxins struggle and bind together in the chest; in this case, Zhi Shi Li Zhong Wan (Aurantium Pill to Regulate the Middle) should be used to restore stability. Although the chest harmonizes, the Shang Han (Cold Damage) pathogen has not yet cleared, and normal bowel movements will inevitably occur. One must wait for the appropriate duration and then eliminate the remaining pathogens according to the method. Dai Yuan Shi stated: There is Cold-Excess Jie Xiong, characterized by pain but without irritability or other heat signs. This arises from post-purgative deficiency and rebellious Qi, causing cold pathogens to bind exclusively. It is suitable to use Li Zhong Tang (Regulate the Middle Decoction), adding Ban Qian (half a qian) of Zhi Shi (Fructus Aurantii Immaturus) and Yi Qian (one qian) of Fu Ling (Poria).
Da Xian Xiong Tang (Major Trapping the Chest Decoction)
Da Huang (Rhei Radix et Rhizoma, Sovereign Herb) Mang Xiao (Natrii Sulfas, Minister Herb) Gan Sui (Radix Euphorbiae Kansui, Assistant Herb)
Zhi Shi Li Zhong Wan (Aurantium Pill to Regulate the Middle)
Zhi Shi (Fructus Aurantii Immaturus, Minister Herb) Fu Ling (Poria, Assistant Herb) Bai Zhu (Atractylodis Macrocephalae Rhizoma, Minister Herb) Ren Shen (Ginseng Radix, Sovereign Herb) Gan Cao (Glycyrrhizae Radix et Rhizoma, Assistant Herb) Gan Jiang (Zingiberis Rhizoma, Envoy Herb)
Grind the above herbs into fine powder, mix with refined honey to form pills the size of a chicken egg yolk. Take one pill per dose, dissolved in hot water. After continuous intake of two or three doses, the chest will feel clear and open. If thirst is present, add Hua Tian Fen (Trichosanthis Radix) one liang. If spontaneous sweating occurs, add Mu Li (Ostreae Concha) more than two liang; also add this if there is diarrhea.
In cases where premature purgation leads to Jie Xiong syndrome, presenting with slight fever, mental confusion, dry mouth with slight thirst, a dry tongue coating or deep purple color, and loose stools occurring intermittently, this is termed "Re-Jie Pang Liu" (Heat-Binding Paradoxical Diarrhea). This is caused by heat binding in the middle jiao, forcing fluids into the large intestine, unrelated to the spleen. In nourishing Yin and moistening blood prescriptions, Huang Qin (Scutellariae Radix) and Zhi Mu (Anemarrhenae Rhizoma) must be added, and it is essential to combine with Bai Hu Tang (White Tiger Decoction) using Shi Gao (Gypsum Fibrosum) to stop the paradoxical diarrhea. Several days after cessation, normal bowel movements will resume, leading to recovery. (The "middle" refers to the Stomach, hence Shi Gao is suitable. Since erroneous purgation has already damaged Stomach Yin, Yin-nourishing herbs are suitable.)
If accompanied by difficulty in urination, once the heat resolves, urination will naturally flow freely. Do not use diuretic herbs such as Mu Tong (Akebiae Caulis) or Che Qian Zi (Plantaginis Semen). Diuretics can cause exhaustion of Yin and Yang, leading to incurable conditions. (Regarding spontaneous diarrhea, it is said that sweating causes both interior and exterior deficiency; regarding this condition, it is said that diuresis causes rapid exhaustion of Yin and Yang. Both are unalterable principles.)
In cases of severe Shang Han heat, neglected by sweating or purging, presenting with cracked lips, dry tongue, ability to drink water, constipation with hard stools, red and scanty urine, and occasional passage of watery stool, this indicates internal accumulation of dry feces, which is leakage material, not cold-type diarrhea. Further examination revealing extremely foul-smelling flatus confirms this. Although the pulse may appear deep, palpation reveals it to be slippery and forceful. Symptoms may include intermittent restlessness and heat, aversion to clothing/bedding, throwing hands and feet about, or forceful delirious speech. These indicate extreme hyperactivity of Yang Qi. For mild cases, Ren Shen Bai Hu Tang (Ginseng White Tiger Decoction) or Xiao Chai Hu Tang (Minor Bupleurum Decoction) combined with Jie Du Tang (Detoxification Decoction) should be used. For internal excess, purgation is required. For tidal fever, Da Chai Hu Tang (Major Bupleurum Decoction) with added Mang Xiao (Natrii Sulfas) is indicated.