按之满硬不痛痞，硬而满痛为结胸，大结从心至少腹，小结心下按方疼。热微头汗
为水结，漱水不咽血结名，瘀衄未尽经适断，内实沉大审的攻，抵当桃仁大小陷，误攻浮
大命多倾，不实浮滑小陷证，脏结悉具躁烦凶。
【注】伤寒下之太早则成痞硬，中风下之太早则成结胸，均为表邪乘虚入里。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，谓大结胸，从心下至少
腹，硬满而痛，手不可近者，宜大陷胸汤攻之。小结，谓小结胸，微结心下，按之方痛，
不按不疼也，宜小陷胸汤开之。身有微热，头自汗出，兼有是证者，为水结胸也，宜大陷
胸丸攻之。漱水不欲咽，兼有是证者，为血结胸也，血瘀不成衄解，或衄末尽，或妇人
经来适断，皆能成之，宜抵当丸，或桃仁承气汤攻之。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。审若不内实，脉浮滑或脉浮
大是未的也，乃小陷胸证，不可攻也，误攻之，定然凶也。脏结，谓状如结胸，舌苔白
滑，脉浮而细也。悉具，谓结胸通腹，两胁皆硬满痛也，此证加之烦躁，凶死可知。
阳证痞硬为热痞，大黄黄连泻心宁，汗出恶寒寒热痞，附子泻心两收功。误下少阳
发热呕，痞满半夏泻心能。虚热水气痞下利。心烦干呕腹雷鸣，虚热水气生姜泻，痞急气
逆甘草灵。桂枝表解乃攻痞，五苓烦渴利尿通。
【注】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，从实化者多结胸也。阳证心下痞硬为
热痞，宜大黄黄连泻心汤。若阳证汗出恶寒，为寒热痞，宜附子泻心汤。误下少阳发热而
呕，心下痞满，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，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，为虚热客气上逆之痞，宜甘草泻心汤。凡有痞者，有无汗恶寒之表，宜
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，先以五苓散，小便利后，乃可与诸泻心汤治痞也。
用手按压时感觉胀满坚硬但不疼痛的是痞证，如果坚硬且胀满疼痛则是结胸。大结胸的范围从心窝一直延伸到小腹部，小结胸仅在胃脘部，只有按压时才疼痛。热邪轻微而仅有头部出汗，这是水饮内结；想漱口但不愿吞咽，这是血瘀内结。如果是瘀血未完全排出、鼻衄未尽，或者妇女月经突然中断，都可能导致这种情况。此时若体内实邪确凿，脉象沉大有力，应当仔细审查后使用攻下法。可选用抵当汤、桃仁承气汤或大陷胸汤/丸。如果误用于脉象浮大的虚证，患者生命多会倾覆危殆。若脉象不实而呈浮滑之象，则属于小结胸证，不宜攻下；若出现脏结的全部症状且伴有烦躁不安，预后凶险。
【注】伤寒病过早使用泻下法会导致痞硬，中风病过早使用泻下法会导致结胸，这都是因为表邪趁正气虚弱侵入体内所致。按之坚硬胀满且疼痛的是结胸，属于实证。按之坚硬胀满但不疼痛的是痞硬，属于虚证。所谓“大结”，指大结胸证，病变范围从心下延伸至小腹，坚硬胀满且疼痛，手不能触碰，适宜用大陷胸汤攻逐邪气。所谓“小结”，指小结胸证，病位轻微局限于心下，只有按压时才痛，不按不痛，适宜用小陷胸汤开泄痰热。身体有微热，头部自然出汗，兼有此证候的，是水结胸证，适宜用大陷胸丸攻逐。想漱口但不欲咽下，兼有此证候的，是血结胸证。若血瘀未能通过鼻衄解除，或衄血未止，或妇女经期刚断，都能形成此证，适宜用抵当丸或桃仁承气汤攻逐。体内实邪确凿可以攻下，脉象沉大有力也可以攻下，仔细审察确当无误后，才使用抵当汤、桃仁承气汤、大陷胸汤或丸来攻逐。若审察发现并非内实，脉象浮滑或浮大，说明病机未确切对应攻下法，乃是小陷胸证，不可攻下，若误用攻下法，必然导致凶险后果。脏结证，表现为症状类似结胸，但舌苔白滑，脉象浮而细弱。所谓“悉具”，是指结胸证全腹及两胁都坚硬胀满疼痛，此证若再加上烦躁不安，可知其预后凶死。
阳证引起的痞硬属于热痞，可用大黄黄连泻心汤治疗使其安宁。若伴有汗出、恶寒等寒热错杂症状的痞证，附子泻心汤能兼顾疗效。误治导致少阳病见发热呕吐，出现痞满，半夏泻心汤能够治愈。若为虚热与水气互结导致的痞证，伴以下利、心烦、干呕、腹中雷鸣，生姜泻心汤可治。若痞证急迫且气逆上冲，甘草泻心汤有效。必须待桂枝汤证所代表的表证解除后，才能攻治痞证。若五苓散证见烦渴，需通利小便。
Palpation reveals fullness and hardness without pain indicates Pi syndrome (Pi Syndrome, a sensation of obstruction in the epigastrium). Hardness with fullness and pain indicates Jie Xiong syndrome (Jie Xiong Syndrome, chest binding, characterized by pain and hardness in the chest and abdomen). Da Jie Xiong (Major Chest Binding) extends from the heart region to the lower abdomen. Xiao Jie Xiong (Minor Chest Binding) is painful only upon palpation at the epigastrium. Mild heat with sweating only on the head indicates Water Jie Xiong (Water Binding). Desire to rinse the mouth but no desire to swallow indicates Blood Jie Xiong (Blood Binding). If blood stasis has not fully resolved, nasal bleeding (Bi Yu) has not ceased, or menstruation has suddenly stopped in women, these conditions can lead to such presentations. When internal excess is confirmed and the pulse is deep and large, careful examination should guide the use of purgative methods. Options include Didang Tang (Ephedra and Asari Decoction), Taoren Chengqi Tang (Peach Kernel and Rhubarb Decoction), or Daxiexiong Tang/Wan (Major Chest Binding Decoction/Pill). Misapplication in cases with floating and large pulses may endanger life. If the pulse is floating and slippery without excess signs, it points to Xiao Jie Xiong syndrome, which should not be purged. If all symptoms of Zang Jie (Zang Binding) are present accompanied by restlessness, the prognosis is ominous.
[Note] Premature purgation in Taiyang disease (Taiyang Disease, exterior syndrome caused by cold pathogen) leads to Pi Ying (Pi Hardness), while premature purgation in Wind Strike (Zhong Feng, wind-stroke/exterior deficiency syndrome) leads to Jie Xiong. Both occur because exterior pathogens enter the interior due to deficiency. Hardness, fullness, and pain upon palpation indicate Jie Xiong, an excess condition. Hardness, fullness, but no pain upon palpation indicate Pi Ying, a deficient condition. "Da Jie" refers to Major Chest Binding, extending from the epigastrium to the lower abdomen, with hardness, fullness, and severe pain where the hands cannot bear contact; Da Xiexiong Tang (Major Chest Binding Decoction) is indicated for purging. "Xiao Jie" refers to Minor Chest Binding, slightly bound at the epigastrium, painful only upon pressure; Xiaoxiexiong Tang (Minor Chest Binding Decoction) is indicated for opening phlegm-heat. Slight fever with spontaneous head sweating accompanying these signs indicates Water Jie Xiong; Daxiexiong Wan (Major Chest Binding Pill) is indicated. Desire to rinse but not swallow accompanying these signs indicates Blood Jie Xiong. If blood stasis does not resolve via nasal bleeding, or bleeding persists, or menstruation abruptly stops, this condition forms; Didang Wan (Didang Pill) or Taoren Chengqi Tang (Peach Kernel and Rhubarb Decoction) are indicated. Internal excess confirms the indication for purging; deep and large pulse confirms the indication. After careful verification, use Didang Tang, Taoren Chengqi Tang, or Daxiexiong Tang/Wan. If not internally excess, and the pulse is floating and slippery or floating and large, the indication for purging is not accurate; this is Xiao Jie Xiong syndrome, do not purge. Mis-purging will surely lead to disaster. Zang Jie presents like Jie Xiong but with white and slippery tongue coating and a floating, thin pulse. "Xi Ju" means the entire abdomen and both hypochondriac regions are hard, full, and painful. If this condition is added with irritability, death is foreseeable.
Pi Ying in Yang syndromes is Re Pi (Heat Pi); Dahuang Huanglian Xiexin Tang (Rhubarb and Coptis Heart-Draining Decoction) calms it. Pi with sweating and aversion to cold involves cold-heat complexity; Fuzi Xiexin Tang (Aconite Heart-Draining Decoction) addresses both. Mis-purging leading to Shaoyang syndrome (Shaoyang Syndrome, half-exterior half-interior syndrome) with fever, vomiting, and epigastric fullness is Ni Ni Pi (Rebellious Qi Pi); Banxia Xiexin Tang (Pinellia Heart-Draining Decoction) cures it. Deficient heat with water qi causing Pi with diarrhea, irritability, dry retching, and borborygmus is Xu Re Shui Qi Pi (Deficient Heat and Water Qi Pi); Shengjiang Xiexin Tang (Fresh Ginger Heart-Draining Decoction) treats it. If the Pi is urgent with rebellious qi, Gancao Xiexin Tang (Licorice Heart-Draining Decoction) is effective. Only after the exterior syndrome represented by Guizhi Tang (Cinnamon Twig Decoction) is resolved can Pi be treated. If Wuling San (Polyporus Powder) is indicated for irritability and thirst, diuresis must be promoted first.