结胸痞气。二者皆曰下早而成。但有轻重之分。实无阴阳之别。仲景以大
小陷胸及泻心汤主之。余不能不致疑其间也。夫既曰下之早。则邪或在
表。或在上皆未可遽下者也。未可下而下之。则邪气反结于胸中。有痛有
不痛。或痞满而不快也。试思所下之药。必大黄芒硝峻厉等味。苟失其宜。
则外邪内陷而不复出。中气下陷而不复运。故为结为痞。岂有误下乃结。
因结复下之理乎。然则仲景大小陷胸等汤。何为而设也。仲景云。大结胸。
手不可按。用大黄芒硝入甘遂末。名大陷胸汤。乃荡涤之剂。恐为失下者
立。小结胸。用黄连半夏加栝蒌实。名小陷胸汤。乃痰热为患。又岂曰下早
所致乎。水结胸。半夏茯苓汤入姜汁。乃水停心下也。心下痞。腹鸣下利。半
夏泻心汤。人参半夏干姜甘草大枣。因中气伤也。同黄连黄芩。或热犹未
解乎。若然则结胸何法以治之。曰邪气尚实仍与内消。中气伤残。只应温
补。理中汤加枳实主之。或藿香半夏甘草人参加炒枳实。随症施之可耳。
断无复下陷胸之法也。
大陷胸汤
大黄（四钱） 芒硝（三钱） 甘遂末（二分）
水煎入甘遂末调服。
小陷胸汤
黄连（一钱五分） 半夏（三钱） 栝蒌实（二钱）
水煎服。
半夏茯苓汤
半夏（四钱） 白茯苓（二钱五分）
水煎。入姜汁服。
半夏泻心汤
人参 半夏 干姜 甘草 黄芩（各一钱） 黄连（五分）
加姜五片。枣五枚。水煎服。
枳实理中汤
枳实（麸炒） 干姜 人参 白术 茯苓 甘草（各等分）
水煎服。或为末。蜜丸弹子大。热汤化下。连进二三服。
浓朴半夏甘草人参汤
浓朴 半夏（各一钱） 甘草 人参（各五分）
姜五片水煎。
Jie Xiong (Chest Binding Syndrome) and Pi Qi (Stagnant Qi Syndrome) are both conditions resulting from premature purgation. There is a distinction in severity, but no fundamental difference between Yin and Yang syndromes. Zhang Zhongjing advocated the use of Da Xian Xiong Tang (Major Chest-Binding Decoction), Xiao Xian Xiong Tang (Minor Chest-Binding Decoction), and Xie Xin Tang (Drain the Epigastrium Decoction) to treat these conditions; however, I cannot help but harbor doubts regarding this approach.
Since it is stated that these conditions arise from "premature purgation," the pathogenic factor may still be at the exterior or located in the upper jiao. In such cases, purgation should not be applied hastily. If purgation is used when it is contraindicated, the pathogenic factor instead becomes bound in the chest region, manifesting as pain in some cases and non-pain in others, or as epigastric fullness and stuffiness with discomfort.
Consider that the purgative herbs used must be harsh and potent substances such as Dahuang (Rhei Radix et Rhizoma) and Mangxiao (Natrii Sulfas). If their application is inappropriate, external pathogens will sink inward and fail to emerge again, while the Middle Qi will collapse downward and fail to restore its transformative functions. Consequently, Jie Xiong or Pi syndromes are formed. How could there be a rationale where erroneous purgation leads to binding, followed by further purgation to address that binding?
Then, for what purpose were Zhang Zhongjing's Da Xian Xiong Tang and Xiao Xian Xiong Tang established? Zhang Zhongjing stated: For Da Jie Xiong (Major Chest Binding), where the area is so tender that it cannot be touched or pressed, one uses Dahuang, Mangxiao, and Gansui powder, named Da Xian Xiong Tang. This is a drastic cleansing formula, likely established for patients who required purgation but did not receive it (missed opportunity for purgation). For Xiao Jie Xiong (Minor Chest Binding), one uses Huanglian (Coptidis Rhizoma), Banxia (Pinelliae Tuber), plus Gualou Shi (Trichosanthis Fructus), named Xiao Xian Xiong Tang. This addresses pathology caused by Phlegm-Heat; how could this be attributed to premature purgation?
For Shui Jie Xiong (Water Binding in the Chest), one uses Banxia Fuling Tang (Pinellia and Poria Decoction) with Jiangzhi (Ginger Juice); this results from water retention under the heart. For Xià Xīn Pǐ (Epigastric Stagnation), accompanied by abdominal borborygmus and diarrhea, one uses Banxia Xiexin Tang, composed of Renshen (Ginseng Radix), Banxia, Ganjiang (Zingiberis Rhizoma), Gancao (Glycyrrhizae Radix), and Dazao (Jujubae Fructus), because the Middle Qi has been injured. If Huanglian and Huangqin (Scutellariae Radix) are added, does this imply that Heat pathogens have not yet resolved?
If so, then what method should be used to treat Jie Xiong? The answer is: If the pathogenic factor remains substantial, internal resolution methods should still be employed; if the Middle Qi is damaged, only warming and tonifying methods should be used. Lizhong Tang (Regulate the Middle Decoction) with Zhishi (Aurantii Fructus Immaturus) is indicated. Alternatively, Huoxiang (Agastachis Herba), Banxia, Gancao, and Renshen, combined with Chao Zhishi (Fried Aurantii Fructus Immaturus), can be administered according to specific symptoms. There is absolutely no method involving repeated purgation to treat chest binding.
Da Xian Xiong Tang (Major Chest-Binding Decoction)
Dahuang (4 qian) Mangxiao (3 qian) Gansui mo (2 fen)
Decoct in water, mix in Gansui powder, and take orally.
Xiao Xian Xiong Tang (Minor Chest-Binding Decoction)
Huanglian (1.5 qian) Banxia (3 qian) Gualou Shi (2 qian)
Decoct in water and take orally.
Banxia Fuling Tang (Pinellia and Poria Decoction)
Banxia (4 qian) Bai Fuling (2.5 qian)
Decoct in water, add Ginger Juice, and take orally.
Banxia Xiexin Tang (Pinellia Drain-the-Epigastrium Decoction)
Renshen, Banxia, Ganjiang, Gancao, Huangqin (each 1 qian) Huanglian (0.5 qian)
Add five slices of fresh ginger and five dates. Decoct in water and take orally.
Zhishi Lizhong Tang (Immature Bitter Orange Regulate-the-Middle Decoction)
Zhishi (bran-fried), Ganjiang, Renshen, Baizhu, Fuling, Gancao (equal parts)
Decoct in water and take orally. Alternatively, grind into powder, make pills with honey the size of quail eggs, dissolve in hot water, and take. Administer two or three doses consecutively.
Noupo Banxia Gancao Renshen Tang (Magnolia Bark, Pinellia, Licorice, and Ginseng Decoction)
Noupo, Banxia (each 1 qian) Gancao, Renshen (each 0.5 qian)
Add five slices of fresh ginger. Decoct in water and take orally.