病发于阳而反下之，热入内作结胸。其病心下坚满，按之如石，硬而痛，项强如柔 状，其脉
寸口浮，关上尺中皆沉，或沉紧，名曰结胸也。下之则和，宜大陷胸汤。（今作煮散煎之。）
大黄（一两半） 芒硝（一两八钱半） 甘遂（末，一字）
异末，先以水一升半，煎大黄半升，绞去大黄滓，下硝末，更煮一二沸，内甘遂末，和匀，温
分二服。一服快利，止后服。如作煮散，即先以水一盏，煎大黄末四钱匕，至八分，下硝末二钱匕，
候化匀，下甘遂末半钱匕，沸匀，温服之。移时未利，再煎一服，快利为度。
脏结如结胸状，饮食如故，时时下利，寸口脉浮，关上脉小细沉紧，名曰脏结，舌上白苔生者，
难治。脏结无阳证，不往来寒热，其人反静，舌上苔滑，不可攻也。
结胸证，其脉尺寸浮大者，不可下，下之则死。（复宜发汗也。）
结胸证悉具，烦躁甚者死。
太阳病，脉浮而动数，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，胃中空虚，宿热动膈，短气烦躁，心下懊 ，
阳气内陷，心下固硬，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，身必发黄也。
结胸无大热者，此为水结在胸胁也，但头微汗出者，宜大陷胸汤。
太阳病，重发汗而复下之，不大便五六日，舌燥而渴，日晡则少有潮热，从心下至小腹满而痛
不可近者，宜大陷胸汤。
虚弱家不耐大陷胸汤，即以大陷胸丸下之。
结胸者，项亦强，如柔 状，下之则和，宜大陷胸丸。
大黄（四两） 葶苈子（一两半） 朴硝（一两八钱） 杏仁（二合）
杵二味，内杏仁、朴硝，合研如脂，丸如弹子大，抄甘遂末一钱，白蜜二合，水二升，煮取一
升，温顿服之。一宿乃下，不下更服。
小结胸，正在心下，按之则痛，脉浮滑者，宜小陷胸汤。
半夏（六钱半） 黄连（一分） 栝蒌（一枚，用四钱）
咀，水三升，煮栝蒌至二升，下诸药，煮取一升，去滓。温温服一盏，食顷再服，一日尽剂，
微解下黄涎即愈。
太阳病下之，脉促者不结胸，此为欲解也；脉浮者必结胸；脉紧者必咽痛；脉弦者必两胁拘急；
脉细数者头痛未止；脉沉紧者必欲呕；脉沉滑者协热而利；脉浮滑者必下血。
寒实结胸，无热证者，与三物白散方。（小陷胸者非也。）
桔梗（三分） 巴豆（一分） 贝母（三分）
细末，内巴豆研匀，白饮调下一钱，羸人减之。病在膈上必吐，在膈下必利。未利啜热粥投之；
利过不止，饮冷粥止之。
庞曰∶近世治结胸，多行针头丸，用硫黄，阳起石者，若病热毒甚者，必死，
唯治冷结寒实耳。
病邪在阳分（体表），反而误用攻下法，导致热邪内陷，形成结胸证。其病症表现为心窝部坚硬胀满，按压时像石头一样硬且疼痛，颈部僵硬如同柔痉（一种以项背强直、角弓反张为特征的病证）的样子，脉象寸口部浮，关部和尺部皆沉，或者沉而紧，这叫做结胸证。通过攻下治疗可以使病情缓解，适宜使用大陷胸汤。（现在的做法是将其制成煮散来煎服。）
将前两种药捣碎成不同粗细的粉末，先用水一升半，煎煮大黄至半升，滤去大黄渣，加入芒硝末，再煮沸一两次，然后加入甘遂末，搅拌均匀，温服，分两次服用。如果服药后大便通畅顺利，就停止服用后面的药。如果是做成煮散，先用一盏水，煎煮大黄末四钱匕，煎至八分满，加入芒硝末二钱匕，等待融化均匀，再加入甘遂末半钱匕，煮沸搅拌均匀，温服。过了一段时间如果没有通便，再煎服一次，以大便通畅顺利为标准。
脏结证的临床表现与结胸相似，但饮食如常，时常腹泻，脉象寸口浮，关部脉小细沉紧，这叫做脏结。舌上生有白苔的，难以治愈。脏结没有阳证表现，没有往来寒热的症状，病人反而安静，舌苔滑润，不可使用攻下法。
结胸证，如果脉象尺寸部都浮大的，不可使用攻下法，攻下会导致死亡。（此时适宜采用发汗法。）
太阳病，脉象浮而动数，浮代表风邪，数代表热邪，动代表痛症，数也代表正气虚，头痛发热，微微盗汗，反而恶寒，说明表证未解。医生反而误用攻下法，脉象由动数变为迟，膈内抗拒疼痛，胃中空虚，宿留的热邪扰动膈膜，气短烦躁，心下部懊恼不适，阳气内陷，心下部必然坚硬，这就形成了结胸证，应当用大陷胸汤主治。如果不形成结胸，只是头部出汗，身体其他部位无汗，汗水仅到颈部为止，小便不利，身体一定会发黄。
结胸证没有明显高热表现的，这是水饮结聚在胸胁所致，只有头部微微出汗的，适宜使用大陷胸汤。
太阳病，过度发汗后又误用攻下法，导致五六天不大便，舌干燥口渴，傍晚时分略有潮热，从心窝部一直到小腹部位胀满疼痛，甚至不能靠近触碰的，适宜使用大陷胸汤。
结胸证，颈部也僵硬，如同柔痉的样子，通过攻下治疗可使病情缓解，适宜使用大陷胸丸。
大黄（四两） 葶苈子（一两半） 朴硝（一两八钱） 杏仁（二合）
将大黄和葶苈子捣碎，加入杏仁、朴硝，一起研磨如脂状，制成如弹子大小的丸剂，每次取甘遂末一钱，白蜜二合，水二升，煮取一升，温服，一次性服完。过夜后大便下行，若不行则再服。
小结胸证，病位正在心下部，按压时才疼痛，脉象浮滑的，适宜使用小陷胸汤。
切碎，用水三升，先煮栝蒌至二升，再加入其他药物，煮取一升，滤去药渣。温服一盏，大约一顿饭的时间后再服，一天内服完一剂，轻微排出黄色涎沫即痊愈。
太阳病误用攻下法后，脉象急促的，不形成结胸，这是病情将要解除的表现；脉象浮的，必定形成结胸；脉象紧的，必定咽喉痛；脉象弦的，必定两胁拘急；脉象细数的，头痛不会停止；脉象沉紧的，必定想呕吐；脉象沉滑的，伴有热邪而下利；脉象浮滑的，必定便血。
寒实结胸，没有热证表现的，给予三物白散方。（小陷胸汤不适合。）
研成细末，加入巴豆研匀，用米汤调服一钱，体弱者减量。病位在膈上的必定呕吐，在膈下的必定腹泻。如果尚未腹泻，喝热粥以促进药效；如果腹泻不止，喝冷粥以止泻。
庞安石说：近代治疗结胸证，多使用针头丸，其中含有硫黄、阳起石等药，如果病人热毒严重，必定致死，这些药只适用于治疗冷结和寒实证。
When a disease originates in the Yang (exterior), but purgation is wrongly applied, heat enters the interior and forms Jie Xiong (Chest Binding Syndrome). The pathology presents as hardness and fullness below the heart, feeling like a stone upon palpation, hard and painful. There is stiffness of the neck resembling Rou Ji (Soft Spasm), and the pulse at Cun Kou (Radial Artery) is floating, while Guan (Middle) and Chi (Distal) positions are both sunken, or sunken and tight; this is named Jie Xiong (Chest Binding Syndrome). Purging will harmonize the condition; Da Xian Xiong Tang (Major Downward-Draining Chest Decoction) is indicated. (Currently, it is prepared as a decoction powder.)
Da Huang (Rhubarb Root and Rhizome, 1.5 liang) Mang Xiao (Mirabilite, 1.8 qian ban) Gan Sui (Kansui Root, powdered, 1 zi amount)
Pulverize the first two herbs to different consistencies. First, boil Da Huang in 1.5 sheng of water until reduced to 0.5 sheng, strain out the Da Huang dregs, add Mang Xiao powder, boil for one or two more boils, then add Gan Sui powder, mix evenly, and take warm, divided into two doses. If rapid bowel movement occurs after one dose, stop taking the remaining medicine. If prepared as a decoction powder, first boil 4 qian bi of Da Huang powder in 1 lamp of water until reduced to 0.8 parts, add 2 qian bi of Mang Xiao powder, wait until dissolved evenly, add 0.5 qian bi of Gan Sui powder, boil until mixed, and take warm. If there is no bowel movement after some time, decoct and take another dose; the goal is rapid and smooth bowel movement.
Zang Jie (Organ Binding) resembles Jie Xiong in presentation, but appetite remains normal, with frequent diarrhea. The pulse at Cun Kou is floating, while Guan is small, fine, sunken, and tight; this is named Zang Jie (Organ Binding). If white coating appears on the tongue, it is difficult to treat. Zang Jie has no Yang syndrome manifestations, no alternating chills and fever, the patient is instead quiet, and the tongue coating is slippery; attacking methods should not be used.
In Jie Xiong syndrome, if the pulse at Cun and Chi positions are both large and floating, do not use purgation; purging will lead to death. (Sweating-inducing methods are appropriate instead.)
If all symptoms of Jie Xiong are present and irritability is severe, the prognosis is fatal.
In Tai Yang disease, the pulse is floating, moving, and rapid. Floating indicates Wind, rapid indicates Heat, moving indicates Pain, and rapid also indicates Deficiency. Symptoms include headache, fever, slight night sweating, and aversion to cold, indicating the exterior is not resolved. If the physician wrongly applies purgation, the moving/rapid pulse changes to slow. There is resistance and pain in the diaphragm interior, the Stomach becomes empty and deficient, old heat disturbs the diaphragm, causing shortness of breath and irritability, mental restlessness below the heart, and internal sinking of Yang Qi. The area below the heart becomes firmly hard, forming Jie Xiong; Da Xian Xiong Tang (Major Downward-Draining Chest Decoction) is the primary treatment. If Jie Xiong does not form, but there is only sweating on the head, no sweat elsewhere, stopping at the neck, with difficulty urinating, jaundice will inevitably develop.
Jie Xiong without significant heat indicates water binding in the chest and hypochondrium. If there is only slight sweating on the head, Da Xian Xiong Tang (Major Downward-Draining Chest Decoction) is indicated.
In Tai Yang disease, after excessive sweating and subsequent wrongful purgation, leading to constipation for five to six days, dry tongue with thirst, and slight tidal fever in the late afternoon, with fullness and pain from the epigastrium down to the lower abdomen that cannot be touched, Da Xian Xiong Tang (Major Downward-Draining Chest Decoction) is indicated.
Patients with weak constitutions who cannot tolerate Da Xian Xiong Tang should be treated with Da Xian Xiong Wan (Major Downward-Draining Chest Pill).
For Jie Xiong with neck stiffness resembling Rou Ji (Soft Spasm), purging will harmonize the condition; Da Xian Xiong Wan (Major Downward-Draining Chest Pill) is indicated.
Da Huang (Rhubarb Root and Rhizome, 4 liang) Ting Li Zi (Lepidium Seed, 1.5 liang) Pu Xiao (Mirabilite, 1.8 liang) Xing Ren (Apricot Seed, 2 he)
Pound two ingredients, add Xing Ren and Pu Xiao, grind together until paste-like. Form pills the size of a bullet. Take 1 qian of Gan Sui powder, 2 he of white honey, and 2 sheng of water. Boil to obtain 1 sheng, take warm in one dose. Bowel movement occurs overnight; if not, take another dose.
Xiao Jie Xiong (Minor Chest Binding) is located precisely below the heart, painful only upon pressure, with a floating and slippery pulse; Xiao Jie Xiong Tang (Minor Downward-Draining Chest Decoction) is indicated.
Ban Xia (Pinellia Tuber, 6.5 qian) Huang Lian (Coptis Rhizome, 1 fen) Gua Lou (Trichosanthes Fruit, 1 piece, using 4 qian)
Coarsely crush. Boil Gua Lou in 3 sheng of water until reduced to 2 sheng, then add other herbs. Boil to obtain 1 sheng, strain. Take 1 lamp warm, repeat after about an hour's meal time. Finish one dose within a day. Mild discharge of yellow phlegm indicates recovery.
After Tai Yang disease is wrongly purged: if the pulse is Cuo (hurried), Jie Xiong does not form; this indicates impending resolution. If the pulse is Fu (floating), Jie Xiong will definitely form. If the pulse is Jin (tight), throat pain will definitely occur. If the pulse is Xian (wiry), bilateral hypochondriac tension will definitely occur. If the pulse is Xi Shu (fine and rapid), headache will persist. If the pulse is Chen Jin (deep and tight), vomiting will likely occur. If the pulse is Chen Hua (deep and slippery), diarrhea with heat will occur. If the pulse is Fu Hua (floating and slippery), hematochezia will definitely occur.
Han Shi Jie Xiong (Cold-Excess Chest Binding) with no heat signs is treated with San Wu Bai San (Three-Ingredient White Powder). (Xiao Jie Xiong Tang is incorrect here.)
Jie Geng (Platycodon Root, 3 fen) Ba Dou (Croton Seed, 1 fen) Bei Mu (Fritillaria Bulb, 3 fen)
Grind to fine powder, mix evenly with ground Ba Dou. Administer 1 qian mixed with rice drink. Reduce dose for emaciated patients. Pathology above the diaphragm causes vomiting; below the diaphragm causes diarrhea. If no diarrhea, drink hot porridge to promote effect. If diarrhea persists excessively, drink cold porridge to stop it.
Pang Anshi states: In recent times, treating Jie Xiong often involves Zhen Tou Wan (Needle-Head Pill) containing Liu Huang (Sulfur) and Yang Qi Shi (Leucoglossite). If the patient suffers from severe heat toxicity, death is inevitable; these are only suitable for treating Cold Binding and Cold-Excess conditions.