汗下之后，不大便五、六日，舌干而渴，日晡小有潮热，从心至少腹硬满而痛，不可近，
脉尚沉、紧、滑、数，或但关脉沉紧者，通宜大陷胸汤或凡下之。或脉浮者，表未罢也，不可下
之（下之死），宜小陷胸汤及小柴胡之类和解，罢者，方可下之。或结胸，虽脉浮而里热势恶，须
可下者，宜三一承气汤，一服分作三次，约三时许服讫，得利甚良，虽未利，稍减，脉必渐沉。病
微者，只用三一承气汤半服，按而下之。里热甚者，以大陷胸汤大半服而下之。
谓有前药之力也。然虽二方中甘遂反甘草，或势恶者故意以甘草击甘遂，使开发峻疾而
为效速矣。故《世方》及《活人书》双圆子，亦直用甘草、甘遂也。
或但结胸，别无大段热证，但头微汗出，脉沉潜者，水结胸也，通宜大陷胸
汤。小结胸者，心下按之而痛，脉浮而滑，别无大段热证也。
此亦下之早而热结心胸也。但以热微于大架构，而甚于痞，但热之微，甚也。俗未明之，
又以妄谓，但结胸无大热，证为寒实结胸。殊不知《素问》明言热病而实非寒也。及夫脏结、阴
结、阳结者，经以热结于腑，而腑为阳，是名阳结；热结于脏，而脏为阴，是名阴结，一名脏结
也。然热结于腑则微而浅，故病厥微而易治；热结于脏则深，而当病甚，故厥深而难治矣。
或脏结蓄热极深，而至身冷、脉微而欲绝者，表之热证反不见也。俗未知本热极而致，反言阴寒脏结，
本亦病热极，俗又妄加热药，反绝残阴而暴死，十无一生，因以世传脏结便为死病也。若以《素问》六
气脉证标本验之，则明可见其热证也。留饮不散而成头汗，而脉沉潜反附于骨者，积饮以成水结胸。
及水结胸者，通宜小陷胸汤也。
发汗或攻下之后，过了五、六天仍然不大便，舌面干燥且口渴，傍晚时分有轻微的潮热，从心窝部一直到小腹部位坚硬胀满且疼痛，甚至不能让人靠近触摸。
如果脉象呈现沉、紧、滑、数，或者仅仅是关脉沉紧的，通常适宜使用大陷胸汤（Daxiexiong Tang, Great Trap the Chest Decoction）进行攻下治疗。如果脉象浮，说明表证尚未解除，不可攻下（若误用攻下疗法会导致死亡），适宜使用小陷胸汤（Xiao Xiexiong Tang, Minor Trap the Chest Decoction）及小柴胡汤（Xiaochaihu Tang, Minor Bupleurum Decoction）等方剂进行和解治疗，待表证解除后，方可考虑攻下。
如果是结胸病（Jie Xiong, Chest Binding Syndrome），虽然脉象浮但里热势头凶险，必须攻下的情况，适宜使用三一承气汤（Sanyi Chengqi Tang, Three-One Chengqi Decoction）。将一服药分三次服用，大约在三小时内服完，大便通畅则疗效很好；即使尚未通便，症状也会稍减，脉象必然逐渐转为沉脉。病情较轻者，只服用三一承气汤的一半剂量，按压腹部以助药力下行攻下。里热极盛者，以大陷胸汤的大半剂量进行攻下。
这是考虑到前一种药物的药力作用。然而，虽然在大陷胸汤和小陷胸汤这两首方剂中，甘遂（Gansui, Kansui Root）与甘草（Gancao, Licorice Root）属于十八反禁忌配伍，但在病情凶险时，故意利用甘草来激发甘遂的药性，使其发挥峻猛迅速的功效。因此，《世方》及《活人书》中的双圆子（Shuangyuanzi, Double Pill），也直接使用了甘草和甘遂。
如果只是单纯的结胸，没有其他严重的热证表现，仅头部微微出汗，脉象沉潜的，这是水结胸（Shui Jie Xiong, Water Chest Binding Syndrome），通常适宜使用大陷胸汤。小结胸病患者，心下部按压时感到疼痛，脉象浮而滑，也没有其他严重的热证表现。
这也是因为攻下过早导致热邪结聚在心胸部位。只是热邪程度比大结胸轻，但比痞证（Pi Zheng, Stagnation Syndrome）重。所谓“热微”是指热势轻微，“甚”是指病情较重。世俗之人不明此理，又妄加揣测，认为只有结胸没有大热证，就将其诊断为寒实结胸（Han Shi Jie Xiong, Cold-Excess Chest Binding Syndrome）。殊不知《素问》明确说明这是热病，而非寒证。至于脏结（Zang Jie, Zang Binding）、阴结（Yin Jie, Yin Binding）、阳结（Yang Jie, Yang Binding），经典记载热邪结聚于腑，腑属阳，称为阳结；热邪结聚于脏，脏属阴，称为阴结，也叫脏结。然而，热邪结聚于腑则病位浅且轻微，所以四肢厥冷轻微且容易治疗；热邪结聚于脏则病位深，所以病情严重，因此四肢厥冷深重且难以治疗。
如果是脏结蓄热极深，导致身体冰冷、脉象微弱几乎要断绝的情况，体表的发热症状反而看不见了。世俗之人不知道这是本体内热极盛所致，反而说是阴寒性质的脏结，本来也是热极之病，世俗之人又错误地施用热性药物，反而耗竭残存的阴气导致暴死，十个人中没有能救活一个的，因此世人便流传脏结是死症。如果用《素问》中六气（Six Qi）的脉证标本理论来验证，就能清楚地看到其热证的本质。留饮（Liu Yin, Retained Fluids）不散导致头部出汗，且脉象沉潜仿佛附着在骨头上，这是积饮形成了水结胸。对于水结胸患者，通常适宜使用小陷胸汤。
After sweating or purging therapies, if there has been no bowel movement for five or six days, accompanied by a dry tongue and thirst, slight afternoon tidal fever (ri bu xiao you chao re), hardness, fullness, and pain extending from the epigastrium to the lower abdomen that cannot be tolerated to touch,
and the pulse is still deep (chen), tight (jin), slippery (hua), or rapid (shu), or only the Guan position pulse is deep and tight, it is generally appropriate to use Daxiexiong Tang (Great Trap the Chest Decoction) for purging. If the pulse is floating (fu), the exterior syndrome has not yet resolved, and purging must not be used (purging in this case leads to death); instead, Xiao Xiexiong Tang (Minor Trap the Chest Decoction) and formulas like Xiaochaihu Tang (Minor Bupleurum Decoction) should be used for harmonizing. Only after the exterior syndrome resolves can purging be considered.
In cases of Jie Xiong (Chest Binding Syndrome), although the pulse is floating, if the interior heat is severe and purging is necessary, Sanyi Chengqi Tang (Three-One Chengqi Decoction) is appropriate. Divide one dose into three servings, taken over approximately three hours. If loose stools occur, the effect is excellent; even if not yet loose, symptoms will slightly decrease, and the pulse will gradually become deep. For mild conditions, only half a dose of Sanyi Chengqi Tang is used, with abdominal pressing to assist downward movement. For severe interior heat, a large portion of Daxiexiong Tang is used for purging.
This refers to the efficacy of the aforementioned medicines. Although Gansui (Kansui Root) and Gancao (Licorice Root) are contraindicated in both Daxiexiong Tang and Xiao Xiexiong Tang according to the Eighteen Incompatibilities, in severe cases, Gancao is intentionally used to stimulate Gansui, making its action swift and potent. Therefore, Shuangyuanzi (Double Pill) in *Shifang* and *Huo Ren Shu* also directly uses Gancao and Gansui.
If there is simple Jie Xiong without significant heat signs, but only slight sweating on the head and a deep, hidden pulse, this is Shui Jie Xiong (Water Chest Binding Syndrome), and Daxiexiong Tang is generally appropriate. For minor Jie Xiong, there is pain upon pressing the epigastrium, a floating and slippery pulse, and no significant heat signs.
This results from premature purging causing heat to bind in the chest and heart region. The heat is milder than in major Jie Xiong but more severe than Pi Zheng (Stagnation Syndrome). "Mild heat" refers to slight heat intensity, while "severe" refers to serious condition. Laypeople often misunderstand this, wrongly diagnosing Jie Xiong without major heat as Han Shi Jie Xiong (Cold-Excess Chest Binding Syndrome). However, *Su Wen* clearly states this is a heat disease, not cold. Regarding Zang Jie (Zang Binding), Yin Jie (Yin Binding), and Yang Jie (Yang Binding): classics state that heat binding in the Fu organs (which are Yang) is called Yang Jie; heat binding in the Zang organs (which are Yin) is called Yin Jie, also known as Zang Jie. Heat binding in the Fu is shallow and mild, so limb coldness is slight and easy to treat; heat binding in the Zang is deep, leading to severe illness, so limb coldness is profound and difficult to treat.
If Zang Jie involves extreme internal heat accumulation leading to cold body and faint, nearly imperceptible pulse, exterior heat signs may disappear. Laypeople, unaware that this stems from extreme internal heat, mistakenly diagnose it as Yin-cold Zang Jie. Since it is actually extreme heat, applying hot-natured drugs depletes residual Yin fluid, causing sudden death. Few survive, leading to the belief that Zang Jie is invariably fatal. Verifying against the Six Qi (Liu Qi) pulse and syndrome markers in *Su Wen* reveals the true heat nature. Retained fluids (Liu Yin) failing to dissipate cause head sweating, and a deep, hidden pulse seeming attached to the bone indicates accumulated fluids forming Shui Jie Xiong. For Shui Jie Xiong, Xiao Xiexiong Tang is generally appropriate.