血结胸中不可按。如狂嗽水不欲咽。大便黑色小便通。犀角地黄汤最善。
按伤寒经病。热极而蓄血积于胸中。硬痛而不可按者。为血结胸也。宜犀角地黄汤、
及桃
仁承气汤主之。活人云。大抵结胸症固当下。须看气之虚实。脉之盛衰。若脉来浮大者。犹
带表邪不可下。下之则死。下后而复反结者亦死。结胸症悉具。而烦躁者亦死。下后而舌反
黑裂者亦死。下后而谵言 语者亦死也。
满而不痛名为痞。枳桔频投是妙方。更有泻心汤可服。大黄附子半甘姜。
按伤寒心下痞硬而痛者。为结胸。为实。硬满而不痛者。为痞气。为虚。凡伤寒痞
气。
轻者通用枳桔汤。其行气下膈也。若心下痞。按之濡。关上浮者。大黄黄连泻心汤主之。若
心下痞。而复恶寒汗出者。附子泻心汤主之。若寒多热少。胸满而不痛。脉濡者半夏泻心汤
主之。若干呕有水气者。生姜泻心汤主之。若干呕下利腹鸣者。此非结热。但以胃虚客气上
逆。故使硬也。甘草泻心汤主之。大抵伤寒之痞。与杂症不同。伤寒之痞。从外之内。故宜
苦泻。杂症之痞。从内之外。故宜辛散。
附子泻心用三黄。寒加热药以维扬。痞乃热邪寒药治。恶寒加附始相当。半夏泻心黄连
芩。
干姜甘草与人参。大枣和之治虚痞。法在降阳并和阴。（去人参即甘草泻心汤加姜即生姜泻
心汤）
血结胸证，胸部不可按压。患者出现如狂状的神志症状，想喝水但不愿咽下。大便颜色发黑，小便通畅。犀角地黄汤是最佳选择。
按照伤寒经病的理论，热邪极盛导致蓄血积聚在胸中，胸部硬痛且不可按压的，称为血结胸。适宜使用犀角地黄汤、以及桃仁承气汤来主治。《活人书》说：大抵结胸证固然应当用下法，但必须看气的虚实、脉象的盛衰。如果脉象浮大，说明还带有表邪，不可用下法，误下会导致死亡。下法之后又反复出现结胸症状的，也是死证。结胸证的症状全部具备，但出现烦躁不安的，也是死证。下法之后舌面反而变黑并出现裂纹的，也是死证。下法之后出现胡言乱语的，也是死证。
胀满但不疼痛的称为痞证。频繁投用枳桔汤是妙方。还有泻心汤可以服用，方中包含大黄、附子、半量甘草和干姜。
按照伤寒理论，心下部痞硬且疼痛的，为结胸证，属于实证；坚硬胀满但不疼痛的，为痞气证，属于虚证。凡是伤寒引起的痞气证，轻症通用枳桔汤，因为它能行气并降膈。如果心下部痞闷，按压时柔软，关脉浮的，主治用大黄黄连泻心汤。如果心下部痞闷，并且伴有恶寒、出汗的，主治用附子泻心汤。如果寒多热少，胸部胀满但不疼痛，脉象濡软的，主治用半夏泻心汤。如果有干呕且伴有水气的，主治用生姜泻心汤。如果有干呕、腹泻、肠鸣的，这不是结热，而是因为胃气虚弱，客气上逆，所以导致痞硬，主治用甘草泻心汤。大抵伤寒引起的痞证，与杂病不同。伤寒的痞证，病邪从外入内，所以适宜用苦寒药泻热；杂病的痞证，病机从内达外，所以适宜用辛温药发散。
附子泻心汤使用三黄（大黄、黄连、黄芩），在寒性药中加入温热药以维持平衡。痞证本是热邪所致，用寒药治疗，若伴有恶寒则加入附子才相当。半夏泻心汤包含黄连、黄芩、干姜、甘草和人参，再用大枣调和以治疗虚痞。其治法在于降阳气并调和阴气。（去掉人参即为甘草泻心汤，加上生姜即为生姜泻心汤）
Blood-binding chest syndrome (Xue Jie Xiong) cannot be pressed. The patient exhibits a manic-like state, desiring to drink water but unwilling to swallow it. The stool is black, and urination is unobstructed. Xi Jiao Di Huang Tang (Rhinoceros Horn and Rehmannia Decoction) is the most effective formula.
According to the pathology of meridians in Shanghan (Cold Damage) diseases, when heat reaches its extreme and blood stasis accumulates in the chest, resulting in hardness and pain that cannot be pressed, it is termed Blood-binding chest syndrome. It is appropriate to treat with Xi Jiao Di Huang Tang (Rhinoceros Horn and Rehmannia Decoction) or Tao Ren Cheng Qi Tang (Peach Kernel and Rhubarb Decoction). Huo Ren Shu (The Book That Saves Lives) states: Generally, chest binding syndromes should be treated with purgatives; however, one must assess the deficiency or excess of Qi and the strength or weakness of the pulse. If the pulse is floating and large, it indicates that exterior pathogenic factors remain, and purgation is contraindicated; improper purgation leads to death. If chest binding recurs after purgation, it is also fatal. If all symptoms of chest binding are present but accompanied by restlessness and irritability, it is fatal. If the tongue turns black and cracks after purgation, it is fatal. If delirious speech occurs after purgation, it is fatal.
Fullness without pain is termed Pi syndrome (Plugging Syndrome). Frequent administration of Zhi Ju Tang (Citrus Aurantium and Platycodon Decoction) is an excellent method. Additionally, Xie Xin Tang (Drain the Epigastrium Decoctions) can be used, containing Da Huang (Rhubarb), Fu Zi (Aconite), Gan Cao (Licorice), and Gan Jiang (Dried Ginger).
According to Shanghan theory, if the epigastrium is stiff and painful, it is Jie Xiong (Chest Binding), which is an Excess pattern; if it is hard and full but not painful, it is Pi Qi (Pi Pathogen), which is a Deficiency pattern. For mild cases of Pi syndrome caused by Shanghan, Zhi Ju Tang (Citrus Aurantium and Platycodon Decoction) is generally used because it promotes Qi movement and descends from the diaphragm. If there is epigastric fullness, softness upon palpation, and a floating Guan pulse, Da Huang Huang Lian Xie Xin Tang (Rhubarb, Coptis, and Goldthread Drain the Epigastrium Decoction) is indicated. If epigastric fullness is accompanied by aversion to cold and sweating, Fu Zi Xie Xin Tang (Aconite Drain the Epigastrium Decoction) is indicated. If cold predominates over heat, with chest fullness but no pain and a soggy pulse, Ban Xia Xie Xin Tang (Pinellia Drain the Epigastrium Decoction) is indicated. If there is dry heaving with fluid retention, Sheng Jiang Xie Xin Tang (Fresh Ginger Drain the Epigastrium Decoction) is indicated. If there is dry heaving, diarrhea, and borborygmus, this is not due to internal heat binding, but rather due to stomach Qi deficiency and rebellious pathogenic Qi ascending, causing stiffness and fullness; Gan Cao Xie Xin Tang (Licorice Drain the Epigastrium Decoction) is indicated. Generally, Pi syndrome in Shanghan differs from miscellaneous diseases. Pi syndrome in Shanghan arises from external pathogens entering inward, so bitter-cold herbs for draining are suitable. Pi syndrome in miscellaneous diseases arises from internal dysfunction manifesting outward, so acrid-warm herbs for dispersing are suitable.
Fu Zi Xie Xin Tang (Aconite Drain the Epigastrium Decoction) uses San Huang (Three Yellows: Da Huang, Huang Lian, Huang Qin); adding warm-toning herbs to cold-clearing herbs maintains balance. Pi syndrome is caused by heat pathogens and treated with cold-clearing herbs; if aversion to cold is present, adding Fu Zi (Aconite) makes it appropriate. Ban Xia Xie Xin Tang (Pinellia Drain the Epigastrium Decoction) contains Huang Lian (Coptis), Huang Qin (Scutellaria), Gan Jiang (Dried Ginger), Gan Cao (Licorice), and Ren Shen (Ginseng), harmonized with Da Zao (Jujube) to treat deficiency-type Pi. The therapeutic principle involves descending Yang Qi and harmonizing Yin Qi. (Removing Ren Shen yields Gan Cao Xie Xin Tang; adding Sheng Jiang yields Sheng Jiang Xie Xin Tang.)