结胸证其脉浮大者不可下下之则死
结胸之脉寸浮关沉寸浮则上热关沉则中寒上热甚而中寒不甚则浮多而沉少是以可下若其脉浮大绝无沉意是非无中寒
也乃中寒之极阳气全格于上是以但见浮大而不见其沉下之中气败竭必死无疑也结胸可以下愈者下焦之阳未至绝根故推陷
其上郁之阳使之通达于下以接下焦之根是以愈也其脉浮大则阳已绝根于下是中虚外寒之诊下之所以速其死也
结胸证悉具烦躁者亦死
迁延日久结胸证无一不具若见烦躁则热极矣上热极者下寒必极如是者虽不下而亦死非死于上热非死于下寒乃死于中
气之败也
小结胸病正在心下按之则痛脉浮滑者小陷胸汤主之
小结胸病正在心下位与大结胸同但按之则痛未如大结胸之不按亦痛也脉则浮滑亦不如大结胸之寸浮关沉白虎汤证脉
浮滑者此里有热表有寒也此虽不如大结胸之热实而亦有里热较之大结胸证同而病轻小陷胸汤黄连泄热半夏降逆而涤饮栝
蒌清金而去垢是即大陷胸之制变而从轻者也
黄连（一两） 半夏（半升洗） 栝蒌实（大者一枚）
上三味以水六升先煮栝蒌内诸药煮出三升去滓分温三服
问曰病有结胸有脏结其状何如答曰按之痛寸脉浮关脉沉名曰结胸也何谓脏结答曰如结胸状饮食如故时时下利寸脉浮
关脉细小沉紧名曰脏结舌上白苔滑者难治
结胸证不按亦痛前章膈内拒痛从心下至小腹硬满而痛心下不按亦痛也此曰按之痛者按之则痛剧耳寸脉浮者膈上有热
也关脉沉者腹中寒也脏结如结胸状病因阴邪逆冲即太阴之心下结硬而上无热者也其脉寸浮关沉亦与结胸无异加以脉小细
紧则阴邪独结而无阳也关主中焦人之卫气出于下焦升清阳于浊阴者中焦也宗气出于上焦降浊阴于清阳者中焦也今关脉细
小沉紧则积寒内结有阴无阳是谓死阴故名脏结心窍于舌白苔滑者心火败而肺津凝也金性收敛得火以温之则雾气飘洒而不
凝所谓相克而实相成也火衰则肺气不布而津液郁浊胶塞心宫故舌上苔生滑者气滞而津凝也土燥则津枯而黄涩金湿则液凝
而白滑寒热之分也舌苔白滑火败金郁是以难治
结胸证如果脉象浮大，不可使用攻下法；若误用攻下法，患者就会死亡。
结胸病的脉象，寸部浮、关部沉。寸部浮说明上焦有热，关部沉说明中焦有寒。如果上热严重而中寒不重，则脉象中浮多而沉少，这种情况下可以使用攻下法。如果脉象浮大，完全没有沉象，这并不是没有中寒，而是中寒极盛，阳气完全格拒于上部，因此只见浮大而不见沉下的脉象。此时中气败竭，必然死亡，毫无疑问。结胸证可以通过攻下治愈的，是因为下焦的阳气尚未断绝根底，所以通过攻下推陷上焦郁滞的阳气，使其通达于下，以接续下焦的阳气根底，因此得以痊愈。如果脉象浮大，说明阳气已在下面断绝根底，这是中虚外寒的诊断，攻下会加速其死亡。
病程迁延日久，结胸证的症状无一不备，如果见到烦躁，说明热势已至极点。上焦热极，下焦寒必极。像这样的情况，即使不使用攻下法也会死亡。这不是死于上热，也不是死于下寒，而是死于中气的败绝。
小结胸病，病位正在心下（胃脘部），按压才会疼痛，脉象浮滑的，用小陷胸汤主治。
小结胸病的病位与大结胸相同，都在心下，但只有按压时才痛，不像大结胸那样不按压也痛。脉象是浮滑，也不像大结胸那样寸浮关沉。白虎汤证的脉象也是浮滑，那是里有热、表有寒的情况。此证虽然不如大结胸的热实严重，但也有里热，比之大结胸证，病机相同但病情较轻。小陷胸汤中，黄连清泄热邪，半夏降逆气并涤除痰饮，栝蒌清肺金之热并去除垢腻。这就是大陷胸汤的变法，取轻缓之意而制方。
以上三味药，用水六升，先煮栝蒌，再加入其他药物，煮至剩余三升，去渣，分三次温服。
问：疾病中有结胸和脏结，它们的症状表现是怎样的？答：按压疼痛，寸脉浮，关脉沉，叫做结胸。什么是脏结？答：症状表现像结胸一样，但饮食如常，经常腹泻，寸脉浮，关脉细小且沉紧，叫做脏结。舌上有白色滑苔的，难以治疗。
结胸证是不按压也痛，前章提到膈内抗拒疼痛，从心下直到小腹硬满而心痛，心下不按压也痛。这里说“按之痛”，是指按压时疼痛加剧。寸脉浮，说明膈上有热；关脉沉，说明腹中有寒。脏结像结胸的症状，病因是阴邪逆冲，即太阴经导致的心下结硬，而上部没有热邪。其脉象寸浮关沉，也与结胸无异，再加上脉象小、细、紧，则是阴邪独自结聚而没有阳气。关脉主中焦，人的卫气出于下焦，将清阳上升于浊阴之中，依靠的是中焦；宗气出于上焦，将浊阴下降于清阳之中，依靠的也是中焦。现在关脉细小沉紧，说明积寒内结，有阴无阳，这叫做死阴，所以名为脏结。心窍通于舌，舌上白苔滑，说明心火败坏而肺津凝滞。金的性质收敛，得到火的温煦则雾气飘洒而不凝滞，所谓相克而实则相生。火衰则肺气不能布散，津液郁滞浑浊胶塞于心宫，所以舌上生苔。滑，是因为气滞而津液凝结。土燥则津枯而苔黄涩，金湿则液凝而苔白滑，这是寒热的区别。舌苔白滑，是因为火败金郁，所以难以治疗。
If the pulse in chest binding syndrome (Jie Xiong) is floating and large, purgation must not be used; if purgation is mistakenly applied, death will ensue.
In chest binding syndrome, the pulse is floating at the Cun position (distal radial artery position) and sinking at the Guan position (middle radial artery position). Floating at Cun indicates heat in the upper jiao (upper burner), while sinking at Guan indicates cold in the middle jiao. If upper heat is severe but middle cold is mild, the pulse will show more floating than sinking, and purgation may be employed. If the pulse is floating and large without any sinking quality, it does not mean there is no middle cold; rather, it signifies extreme middle cold with yang qi completely repelled to the upper body. Thus, only floating and large qualities are seen, without sinking qualities below. At this stage, the middle qi is exhausted, and death is inevitable. Chest binding syndrome can be cured by purgation because the root of yang qi in the lower jiao has not yet severed. Purgation pushes down the stagnant yang qi in the upper jiao, allowing it to connect with the root of yang qi in the lower jiao, leading to recovery. However, a floating and large pulse indicates that the root of yang qi has already severed in the lower jiao; this is a sign of deficiency of middle qi and exterior cold. Purgation would accelerate death.
If all symptoms of chest binding syndrome are present and restlessness (Fan Zao) appears, it is also a fatal condition.
After prolonged illness, when all symptoms of chest binding syndrome are fully manifested, the appearance of restlessness indicates extreme heat. Extreme heat in the upper jiao implies extreme cold in the lower jiao. In such cases, even without purgation, death will occur. This is not due to death from upper heat or lower cold, but due to the collapse of middle qi.
In minor chest binding syndrome, the pathology is located precisely at the epigastrium (Xin Xia), and pain occurs only upon pressure. If the pulse is floating and slippery, Xiao Xian Xiong Tang (Minor Intra-thoracic Decoction) is the primary treatment.
The location of minor chest binding syndrome is the same as major chest binding syndrome, i.e., the epigastrium. However, pain occurs only upon pressure, unlike major chest binding syndrome where pain exists even without pressure. The pulse is floating and slippery, differing from major chest binding syndrome which presents with floating at Cun and sinking at Guan. Bai Hu Tang (White Tiger Decoction) indications also feature a floating and slippery pulse, representing interior heat and exterior cold. Although this condition is less severe than the heat-excess of major chest binding syndrome, it still involves interior heat. Compared to major chest binding syndrome, the pathogenesis is similar but the disease is milder. In Xiao Xian Xiong Tang, Huang Lian (Coptidis Rhizoma) clears heat, Ban Xia (Pinelliae Tuber) directs rebellious qi downward and eliminates phlegm-fluids, and Gua Lou Shi (Trichosanthis Fructus) clears lung metal heat and removes turbidity. This is a modified version of Da Xian Xiong Tang (Major Intra-thoracic Decoction), adapted for a milder approach.
Huang Lian (Coptidis Rhizoma) (1 liang), Ban Xia (Pinelliae Tuber) (0.5 sheng, washed), Gua Lou Shi (Trichosanthis Fructus) (one large fruit).
Take these three ingredients, add six sheng of water, first decoct Gua Lou Shi, then add the other herbs. Boil until three sheng remain, strain, and divide into three warm doses.
Q: There are conditions called chest binding (Jie Xiong) and zang binding (Zang Jie). What are their respective presentations? A: Pain upon pressure, with a floating pulse at Cun and a sinking pulse at Guan, is called chest binding. What is zang binding? A: It resembles chest binding in presentation, but digestion remains normal, and there is frequent diarrhea. The pulse is floating at Cun and fine, small, and tight-sinking at Guan; this is called zang binding. If there is a white, slippery coating on the tongue, it is difficult to treat.
Chest binding syndrome involves pain even without pressure, as described in the previous chapter regarding rejection pain in the diaphragm, hardness and fullness extending from the epigastrium to the lower abdomen, and heart pain that persists without pressure. Here, "pain upon pressure" means pain intensifies when pressed. A floating pulse at Cun indicates heat above the diaphragm; a sinking pulse at Guan indicates cold in the abdomen. Zang binding resembles chest binding in symptoms, but its etiology is counter-flowing yin pathogens, causing hardness and binding in the epigastrium due to Taiyin involvement, without heat in the upper part. Its pulse, floating at Cun and sinking at Guan, is indistinguishable from chest binding. However, the addition of fine, small, and tight qualities indicates that yin pathogens are bound exclusively without yang. The Guan position governs the middle jiao. Wei Qi (Defensive Qi) originates from the lower jiao and ascends clear yang through turbid yin via the middle jiao; Zong Qi (Gathering Qi) originates from the upper jiao and descends turbid yin through clear yang via the middle jiao. Now, with fine, small, and tight-sinking pulses at Guan, accumulated cold binds internally, presenting yin without yang. This is termed "dead yin," hence the name zang binding. The heart opens into the tongue; a white, slippery coating on the tongue indicates failure of heart fire and condensation of lung fluids. Metal naturally contracts; warmed by fire, mist evaporates without condensing, illustrating that mutual restriction actually promotes generation. When fire declines, lung qi fails to distribute, causing fluid stagnation, turbidity, and obstruction in the heart palace, resulting in tongue coating. Slipperiness indicates qi stagnation and fluid condensation. Dry earth leads to withered fluids and yellow, rough coating; wet metal leads to condensed fluids and white, slippery coating, distinguishing cold from heat. White, slippery tongue coating results from failed fire and depressed metal, making it difficult to treat.