（一十二法）
病源结胸者，谓热毒瓦斯结聚于心胸也，此由病发于阳而早下之，热气乘虚而痞结不散也
，按之痛，其脉寸口浮关上反自沉是也，脉大不可下，下之则死，脉浮而大，下之为逆，若
阳脉浮关上细小沉紧，而饮食如故，时小便利者，名为脏结，脏结病舌上白苔滑者为难疗，
不往来寒热，其人反静，舌上不苔者，不可攻之。（出第七卷中）
张仲景伤寒论问曰∶病有结胸，有脏结，其状如何。答曰∶按之痛，寸脉浮，关脉沉，
名结胸也。问曰∶何谓脏结？答曰∶如结胸状，饮食如故，时时下利，寸口脉浮，关上小细
而沉紧，名脏结，舌上白苔滑者，为难治，脏结无阳证，不往来寒热其人反静，舌上苔滑者，
不可攻也，病发于阳而反下之，热入因作结胸，病发于阴而反下之，（一作汗之）因作痞也
，所以成结胸者以下之太早故也。
结胸证悉具，烦躁者亦死。
结胸证其脉浮大者，不可下也，下之则死。
夫结胸病项亦强如柔 状，下之则和，宜大陷胸丸方。
蜀大黄（半斤） 葶苈子（半升熬） 杏仁（半升去皮尖熬令赤黑色） 芒硝（半升）
上四味捣筛二味，杏仁合芒硝研如泥和散合和，丸如弹子大，每服一丸用甘遂末一钱匕
，白蜜一两，水二升同煮取一升温顿服之，一宿乃自下，如不下，更服取下为效。（千金翼
同）
又太阳病脉浮动数浮则为风，数则为热动则为痛，数则为虚，头痛发热微盗汗出而反恶
寒表未解也医反下之，动数变迟膈内拒痛，（一云头痛即眩）胃中空虚客热动膈，短气烦躁，
心内懊 阳气内陷心下因坚，则为结胸，大陷胸汤主之。
若不结胸，但头汗出，余处无汗，剂颈而还小便不利身必发黄，大陷胸汤方。
蜀大黄（六两） 甘遂末（一钱匕） 芒硝（一升）
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。（千金翼同）
又伤寒六七日结胸热实脉沉紧心下痛，按之石坚，大陷胸汤主之方依前法。
但结胸无大热者，此水结在胸胁也，但头微汗出者大陷胸汤主之方依前法。
又伤寒十余日，热结在里复往来寒热者与大柴胡汤。
大柴胡汤方。
柴胡（半斤） 枳实（四枚炙） 生姜（五两） 黄芩（三两） 芍药（三两） 半夏
（半升洗） 大枣（十二枚擘）
上七味切，以水一斗二升，煮取六升，去滓，更煎取三升温服一升，日三服，一方加大
黄二两，若不加大黄，恐不名为大柴胡汤。忌羊肉饧。（千金翼古今录验同）
又太阳病二三日不能卧但欲起，心下必结脉微弱者本有久寒也，而反下之，若利止者必
作结胸，未止者四日复下之此作KT 热利也。
又太阳病下之其脉促不结胸者，此为欲解也，若心下满硬痛者，此为结胸也，大陷胸汤
主之，但满而不痛者，此为痞柴胡不中与之也宜半夏泻心汤主之方。
半夏（半升洗） 干姜（三两） 人参（三两） 甘草（三两炙） 黄连（一两） 大
枣（十二枚
擘） 黄芩（三两）
上七味切，以水一斗，煮取六升，去滓，温服一升日三。若须大陷胸汤，服者如前法。
忌羊肉饧海藻菘菜猪肉冷水等。（千金翼同一方半夏五两）
又小结胸病正在心下，按之则痛，脉浮滑者，小陷胸汤主之方。
黄连（一两上好者） 栝蒌实（一枚大者破） 半夏（半升洗）
上三味切，以水六升，煮栝蒌实取三升，去滓，纳诸药，煮取二升，去滓，温分三服。
忌羊肉饧猪肉。（千金翼同）
又病在太阳，应以汗解之，反以冷水 之，若灌之其热却不得去，弥更益烦，皮上粟起
，意欲饮水，而反不渴者，服文蛤散，若不瘥者，与五苓散，用前篇方。（士弱氏曰热得冷
水之气约退而后却也）
又寒实结胸无热证者，与三物小陷胸汤，方如前法白散亦可服。
文蛤散方。（士弱氏曰庞安常云无热证者与三物白散小陷胸汤治热白散治寒旨哉言乎）
文蛤（五两）
上一味捣筛为散，以沸汤和一方寸匕服之，汤用五合。（千金翼同）
又白散方
桔梗（三分） 贝母（三分） 巴豆（一分去心及皮熬令黑赤别研如脂）
上三味捣筛更于臼内捣之，以白饮和服强人半钱匕，羸人减之，病在膈上则吐，在膈下
则利，利不止，饮冷粥一杯止。忌猪肉芦笋等。（并出第四卷中千金翼同）
(Twelve Methods)
The etiology of Jie Xiong (Chest Binding Syndrome) refers to the accumulation and stagnation of heat-toxic qi in the chest and epigastrium. This occurs when a disease originating from Yang syndromes is treated with purgatives too early, allowing heat qi to enter due to deficiency and become stuck without dispersing. Pressing on the affected area causes pain, and the pulse presents as floating at the Cun (inch) position and sunken at the Guan (bar) position; this is characteristic of Jie Xiong. If the pulse is large, purgation must not be used, as it may lead to death; if the pulse is floating and large, using purgation is contraindicated. If the Yang pulse (Cun) is floating, while the Guan pulse is fine, small, and sunken-tight, yet appetite remains normal and urination is occasionally clear, this is called Zang Jie (Zang Binding). If Zang Jie presents with a slippery white coating on the tongue, it is difficult to treat. If there are no alternating chills and fever, the patient appears quiet, and there is no coating on the tongue, attack methods should not be used. (From Volume VII)
Zhang Zhongjing asked in the *Shanghan Lun* (Treatise on Cold Damage): There are cases of Jie Xiong and Zang Jie; what are their manifestations? The answer is: Pain upon pressing, floating pulse at Cun, and sunken pulse at Guan is named Jie Xiong. Another question: What is Zang Jie? The answer is: It resembles Jie Xiong in appearance, but digestion is normal, and there is frequent diarrhea. The pulse at Cun is floating, while at Guan it is fine, small, and sunken-tight; this is named Zang Jie. If the tongue has a slippery white coating, it is difficult to treat. Zang Jie lacks Yang syndrome signs, has no alternating chills and fever, the patient is quiet, and the tongue has a slippery coating; it cannot be attacked. When a disease originates from Yang and is incorrectly purged, heat enters and forms Jie Xiong; when a disease originates from Yin and is incorrectly purged (or sweated), Pi (Stagnation/Blockage) forms. The reason Jie Xiong occurs is due to premature purgation.
If all symptoms of Jie Xiong are present and irritability arises, the prognosis is fatal.
If the pulse in Jie Xiong is floating and large, purgation is contraindicated; doing so leads to death.
In cases of Jie Xiong where the neck is stiff, resembling Rou Ji (Soft Spasm), purgation can harmonize the condition. Da Xian Xiong Wan (Major Downward Draining Chest Pill) is indicated.
Da Huang (Rhei Radix et Rhizoma, 8 liang), Ting Li Zi (Descurainiae Semen, half sheng, roasted), Xing Ren (Armeniacae Semen Amarum, half sheng, skin and tip removed, roasted until dark red-black), Mang Xiao (Natrii Sulfas, half sheng).
Crush and sieve two of the herbs. Grind Xing Ren and Mang Xiao into a paste, mix evenly, and form pills the size of a bullet. Take one pill per dose, along with one Qianbi of Gan Sui powder, 1 liang of white honey, and 2 sheng of water. Boil together until 1 sheng remains, take warm once. Bowel movement will naturally occur overnight. If not, administer again; efficacy is achieved when bowels move. (Same as *Qianjin Yi Fang*)
Furthermore, in Taiyang disease, if the pulse is floating, rapid, and active: floating indicates wind, rapid indicates heat, active indicates pain, and rapid also indicates deficiency. Headache, fever, slight night sweating, yet paradoxical aversion to cold indicate that the exterior pattern is unresolved. If the physician incorrectly uses purgation, the active/rapid pulse changes to slow, causing resistance and pain in the diaphragm (or headache with dizziness). With an empty stomach, pathogenic heat disturbs the diaphragm, leading to shortness of breath and irritability. As Yang qi sinks inward, the epigastrium becomes hard, forming Jie Xiong. Da Xian Xiong Tang (Major Downward Draining Chest Decoction) is the primary treatment.
If Jie Xiong does not form, but only the head sweats while the rest of the body remains dry, with sweat stopping at the neck, and urination is obstructed, jaundice will likely develop. Da Xian Xiong Tang is indicated.
Da Huang (Rhei Radix et Rhizoma, 6 liang), Gan Sui powder (one Qianbi), Mang Xiao (Natrii Sulfas, 1 sheng).
Boil these three herbs in 6 sheng of water. First, decoct Da Huang to obtain 2 sheng, remove dregs, add Mang Xiao, boil for one or two boils, then add Gan Sui powder. Take 1 sheng warm. Stop subsequent doses once effective purgation (loose stool) occurs. (Same as *Qianjin Yi Fang*)
Furthermore, after six or seven days of Shanghan, if Jie Xiong Heat-Excess presents with a sunken-tight pulse, pain in the epigastrium, and hardness like stone upon pressure, Da Xian Xiong Tang is indicated, following the previous method.
If Jie Xiong presents without significant heat, this indicates water retention in the chest and hypochondrium. If only the head sweats slightly, Da Xian Xiong Tang is indicated, following the previous method.
Furthermore, if after ten-plus days of Shanghan, heat is bound internally and there are alternating chills and fever, Da Chai Hu Tang (Major Bupleurum Decoction) is indicated.
Da Chai Hu Tang Formula:
Chai Hu (Bupleuri Radix, 8 liang), Zhi Shi (Aurantii Fructus Immaturus, 4 pieces, processed with fire), Sheng Jiang (Zingiberis Rhizoma Recens, 5 liang), Huang Qin (Scutellariae Radix, 3 liang), Shao Yao (Paeoniae Radix Alba, 3 liang), Ban Xia (Pinelliae Rhizoma, half sheng, washed), Da Zao (Jujubae Fructus, 12 pieces, split).
Cut the seven herbs, decoct in 12 dou of water to obtain 6 sheng, remove dregs, and further decoct to obtain 3 sheng. Take 1 sheng warm, three times daily. Another version adds 2 liang of Da Huang; without it, it may not be properly called Da Chai Hu Tang. Avoid mutton and malt sugar. (Same as *Qianjin Yi Fang* and *Gu Jin Lu Yan*)
Furthermore, in Taiyang disease lasting two to three days, if the patient cannot lie down but wishes to sit up, the epigastrium is likely blocked. If the pulse is weak, it indicates pre-existing chronic cold. If purgation is incorrectly used, and diarrhea stops, Jie Xiong will likely form; if diarrhea continues and purgation is repeated on the fourth day, it results in Re Li (Heat Diarrhea).
Furthermore, after purgation in Taiyang disease, if the pulse is hurried but Jie Xiong has not formed, this indicates the condition is resolving. If the epigastrium is full, hard, and painful, it is Jie Xiong, treated with Da Xian Xiong Tang. If it is merely full without pain, it is Pi (Stagnation); Chai Hu formulas are not appropriate. Ban Xia Xie Xin Tang (Pinellia Decoction to Drain the Epigastrium) is indicated.
Ban Xia (Pinelliae Rhizoma, half sheng, washed), Gan Jiang (Zingiberis Rhizoma, 3 liang), Ren Shen (Ginseng Radix, 3 liang), Gan Cao (Glycyrrhizae Radix et Rhizoma, 3 liang, processed with fire), Huang Lian (Coptidis Rhizoma, 1 liang), Da Zao (Jujubae Fructus, 12 pieces, split), Huang Qin (Scutellariae Radix, 3 liang).
Cut the seven herbs, decoct in 1 dou of water to obtain 6 sheng, remove dregs, and take 1 sheng warm, three times daily. If Da Xian Xiong Tang is needed, follow the previous method. Avoid mutton, malt sugar, seaweed, Chinese cabbage, pork, and cold water. (Same as *Qianjin Yi Fang*, another version uses 5 liang of Ban Xia)
Furthermore, in minor Jie Xiong, the pathology is located precisely in the epigastrium, causing pain only upon pressure, with a floating-slippery pulse. Xiao Xian Xiong Tang (Minor Downward Draining Chest Decoction) is indicated.
Huang Lian (Coptidis Rhizoma, 1 liang, high quality), Gua Lou Shi (Trichosanthis Fructus, one large piece, broken), Ban Xia (Pinelliae Rhizoma, half sheng, washed).
Cut the three herbs, decoct in 6 sheng of water. First decoct Gua Lou Shi to obtain 3 sheng, remove dregs, add other herbs, decoct to obtain 2 sheng, remove dregs, and divide into three warm doses. Avoid mutton, malt sugar, and pork. (Same as *Qianjin Yi Fang*)
Furthermore, when the disease is in the Taiyang stage, it should be resolved through sweating. If incorrectly treated by spraying or pouring cold water, the heat is suppressed and cannot escape, causing increased irritability, goosebumps on the skin, a desire to drink water yet paradoxically no thirst. Wen Ge San (Clam Shell Powder) should be administered. If ineffective, Wu Ling San (Five-Ingredient Powder with Poria) should be given, using the formula from the previous chapter. (Shi Ruoshi notes: Heat retreats when constrained by the cold energy of cold water.)
Furthermore, for Han Shi Jie Xiong (Cold-Excess Chest Binding) without heat signs, San Wu Xiao Xian Xiong Tang (Three-Ingredient Minor Downward Draining Chest Decoction) is given, following the previous method. Bai San (White Powder) is also applicable.
Wen Ge San Formula:
Wen Ge (Meretrix Shell, 5 liang).
Grind and sieve this single herb into powder. Mix one Fang Cun Bi (square-inch spoonful) with boiling water and take. Use 5 he of water. (Same as *Qianjin Yi Fang*)
Furthermore, Bai San Formula:
Jie Geng (Platycodonis Radix, 3 fen), Bei Mu (Fritillariae Bulbus, 3 fen), Ba Dou (Crotonis Fructus, 1 fen, heart and skin removed, roasted until black-red, ground separately into a grease-like consistency).
Grind and sieve the three herbs, then pound them in a mortar. Mix with Bai Yin (rice water) and administer. For strong individuals, take half a Qianbi; for frail individuals, reduce the dose. If the pathology is above the diaphragm, vomiting occurs; if below, diarrhea occurs. If diarrhea persists, drink a cup of cold porridge to stop it. Avoid pork and reeds. (All from Volume IV, same as *Qianjin Yi Fang*)