大黄（去皮）六两 芒硝一升 甘遂（另碾）一钱
右三味，以水六升，先煮大黄，取二升，去滓，内芒硝，煮一两沸，内甘遂末，温服
一升，得快利，止后服。
【集解】
方有执曰：上焦有高邪，必陷下以平之，故曰陷胸汤。平邪荡寇，将军之职也，以大
黄为君；咸能软坚，以芒硝为臣；彻上彻下，破结逐水，以甘遂为佐；惟大实者，乃
为合法。如挟虚或脉浮，不可轻试。
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，从心下至
少腹□满而痛，不可近者，大陷胸汤主之。
【注】
此承上条互发其义，以详其证治也。太阳病，重发汗而复下之，津液伤矣。不大便五
六日，胃府燥矣。舌上燥渴，胃中干也。日晡潮热，胃热盛也。从心下至少腹，□满
而痛不可近者，谓胸腹之中上、下俱□满结实大痛，手不可近，故以大陷胸汤主之无
疑也。
【集注】
『内台方议』曰：「日晡所」作「日晡所发」。
方有执曰：此明结胸有阳明内实疑似之辨。晡，日加申时也。小有，微觉有也。盖不
大便，燥渴，日晡潮热，从心下至少腹□满而痛，皆似阳明内热。惟小有潮热，不似
阳明大热之甚。所以阳明必以胃家实为主，而凡有一毫太阳证在，皆不得入阳明例者
，亦以此也。
程知曰：太阳结胸兼阳明内实，故用大陷胸汤，由胸□以及肠胃，皆可荡涤无余。若
但下肠胃结热，而遗胸上痰饮，则非法矣。
吴人驹曰：一腹之中，上、下邪气皆盛，证之全实者，其脉常沉伏，不可生疑畏，惟
下之，而脉自渐出也。
小结胸，病正在心下，按之则痛，脉浮滑者，小陷胸汤主之。
【注】
大结胸，邪重热深，病从心下至少腹，□满痛不可近，脉沉实，故宜大陷胸汤，以攻
其结，泻其热也。小结胸，邪浅热轻，病正在心下□满，按之则痛，不按不痛，脉浮
滑，故用小陷胸汤以开其结，涤其热也。
【集注】
程应旄曰：按陷胸条曰：心下痛按之石□。又曰：心下满而□痛。此曰：病正在心下
。则知结胸不拘在心下与胸上，只在痛不痛上分别，故痞证亦有心下□者，但不痛耳
。
张锡驹曰：汤有大小之别，证有轻重之殊。今人多以小陷胸汤治大结胸证，皆致不救
，遂诿结胸为不可治之证。不知结胸之不可治。只一二节，余皆可治者，苟不体认经
旨，必致临时推诿，误人性命也。
魏荔彤曰：小结胸无实热之邪，但微热而挟痰饮为患。故虽结胸而不能高踞胸巅，但
正在心下而已；不能实力作痛，惟按之痛而已；诊之不沉而深，惟浮而轻浅而已；不
能作石□，惟虚而结阻而已，所以大陷胸汤不应用，而另设小陷胸汤，高下、坚软、
轻重、沉浮之间，病机治法昭然已。又云：痞阴邪，结胸阳邪，然于阳邪中又有大小
之分，学者审之，于凡寒热杂合之证，无大实大热。俱宜斟酌下法，勿孟浪也。
Da Huang (Rheum Palmatum Rhizome, peeled) 6 liang, Mang Xiao (Natrii Sulfas, Mirabilite) 1 sheng, Gan Sui (Kansui Radix, crushed separately) 1 qian.
The above three ingredients: Use 6 sheng of water, first decoct Da Huang, reduce to 2 sheng, remove the dregs, add Mang Xiao, boil for one or two rolls, then add the powder of Gan Sui. Take 1 sheng warm. If rapid purgation occurs, stop taking the remaining medicine.
[Ji Jie - Collected Explanations]
Fang Youzhi stated: When there is high-pathogenic factors in the Upper Jiao (Upper Burner), they must be flattened by descending methods; hence it is named Xian Xiong Tang (Chest-Subduing Decoction). To pacify pathogens and sweep away bandits is the duty of a General; therefore, Da Huang is used as the Sovereign herb. Salty flavor can soften hardness, so Mang Xiao is used as the Minister herb. Penetrating from top to bottom, breaking accumulations and driving out water retention, Gan Sui is used as the Assistant herb. This formula is only appropriate for cases of great excess. If deficiency is involved or the pulse is floating, it should not be tried lightly.
In Taiyang disease (Disease of the Taiyang Channel), after severe sweating followed by mistaken purgation, if there is no bowel movement for five or six days, with a dry tongue and thirst, slight tidal fever in the late afternoon, and distension and pain from the epigastrium down to the lower abdomen that cannot be touched, Da Xian Xiong Tang (Major Chest-Subduing Decoction) is indicated.
[Zhu - Annotation]
This follows the previous clause to further expound its meaning, detailing the syndrome and treatment. In Taiyang disease, severe sweating followed by purgation injures the body fluids. No bowel movement for five or six days indicates dryness in the Stomach Fu (Stomach Organ). Dry tongue and thirst indicate dryness in the Stomach. Tidal fever in the late afternoon indicates abundant Stomach heat. Distension and pain from the epigastrium to the lower abdomen that cannot be touched means that both upper and lower parts of the chest and abdomen are distended, firm, and severely painful, such that the hand cannot approach. Therefore, there is no doubt that Da Xian Xiong Tang should be used.
[Ji Zhu - Collected Notes]
Nei Tai Fang Yi states: "Ri Bu Suo" is written as "Ri Bu Suo Fa".
Fang Youzhi stated: This clarifies the differentiation between Jie Xiong (Knotted Chest) and suspected Yangming Internal Excess. "Bu" refers to the time after Shen hour (3-5 PM). "Xiao you" means slightly feeling the presence of. Generally, constipation, dryness and thirst, tidal fever in the late afternoon, and distension and pain from the epigastrium to the lower abdomen all resemble Yangming internal heat. However, the tidal fever is slight, unlike the severe heat of Yangming. Therefore, Yangming disease must be centered on "Wei Jia Shi" (Stomach Family Excess); any case retaining even a trace of Taiyang syndrome cannot be categorized as Yangming, which is precisely why this distinction is made.
Cheng Zhi stated: Taiyang Jie Xiong combined with Yangming internal excess necessitates the use of Da Xian Xiong Tang, which can cleanse everything from the chest down to the intestines and stomach. If one only purges intestinal heat but leaves phlegm-fluids in the upper chest, it is not the correct method.
Wu Renju stated: Within the abdomen, pathogenic factors are abundant in both upper and lower regions. In cases of complete excess, the pulse is often deep and hidden. One should not hesitate or fear; simply purge, and the pulse will gradually emerge.
Xiao Jie Xiong (Minor Knotted Chest) syndrome occurs precisely at the epigastrium; it hurts only upon pressure, and the pulse is floating and slippery. Xiao Xian Xiong Tang (Minor Chest-Subduing Decoction) is indicated.
[Zhu - Annotation]
Da Jie Xiong (Major Knotted Chest) involves heavy pathogens and deep heat, with symptoms extending from the epigastrium to the lower abdomen, characterized by distension and pain that cannot be touched, and a deep, solid pulse. Therefore, Da Xian Xiong Tang is suitable to attack the accumulation and drain the heat. Xiao Jie Xiong involves shallow pathogens and mild heat, with symptoms located precisely at the epigastrium causing distension, hurting only upon pressure and not otherwise, and a floating, slippery pulse. Therefore, Xiao Xian Xiong Tang is used to open the accumulation and wash away the heat.
[Ji Zhu - Collected Notes]
Cheng Yingmao stated: In the clauses regarding Xian Xiong, it says: "Pain in the epigastrium, hard like stone upon pressure." It also says: "Distension in the epigastrium and pain." Here it says: "The disease is precisely at the epigastrium." From this, we know that Jie Xiong is not restricted to the epigastrium or the upper chest; the distinction lies solely in the presence of pain. Thus, Pi Zheng (Pi Syndrome/Fullness) also has epigastric distension, but without pain.
Zhang Xiju stated: Decoctions have distinctions of large and small; syndromes have differences in severity. Nowadays, many people use Xiao Xian Xiong Tang to treat Da Jie Xiong syndromes, leading to untreatable conditions, and thus dismissing Jie Xiong as incurable. They do not realize that only one or two stages of Jie Xiong are incurable; the rest are treatable. If one does not comprehend the essence of the classics, it will inevitably lead to shifting blame at the critical moment, costing lives.
Wei Litong stated: Xiao Jie Xiong lacks substantial heat pathogens; it is merely mild heat complicated by phlegm-fluids. Therefore, although it is Jie Xiong, it cannot occupy the peak of the chest, but is located precisely at the epigastrium; it cannot cause severe pain, but only hurts upon pressure; the pulse upon diagnosis is not deep but floating and superficial; it cannot feel hard like stone, but is soft and obstructed. Hence, Da Xian Xiong Tang is not applicable, and Xiao Xian Xiong Tang is separately established. Between high and low, hard and soft, light and heavy, deep and superficial, the pathology and treatment methods are clear. Furthermore, Pi syndrome is caused by Yin pathogens, while Jie Xiong is caused by Yang pathogens. However, among Yang pathogens, there are still distinctions of large and small. Scholars must examine this carefully. For all syndromes mixed with cold and heat, lacking major excess and major heat, the purgative method should be considered cautiously, avoiding rash actions.