张兼善曰。凡耳叶红润者生。或黄或白或黑或青而枯燥者死。薄而白。薄而黑。皆为肾败。凡
耳聋耳中疼。皆属少阳之热而为可治。若耳聋舌卷唇青。此属厥阴。为难治也。凡目睛明。能识见
者可治。睛昏不识人。或反目上视。或瞪
目直视。或目睛正圆。或戴眼反折。或眼胞陷下。皆不治也。凡开目而欲见人者。阳症也。凡闭目
而不欲见人者。阴症也。凡目中不了了。睛不和。热甚于内也。凡目疼痛者。属阳明之热。目赤者。
亦热甚也。目瞑者。必将衄血。白睛黄者。将发身黄也。凡病欲愈。目 黄。鼻准明。山根亮也。
【纲】仲景曰。太阳与少阳并病。脉弦。头项强痛。或眩冒。时如结胸。心下痞硬者。当刺大
椎第一间。肺俞肝俞。慎不可发汗。发汗则谵语。或谵语不止。当刺期门。
【目】朱肱曰。夫结胸与痞。盖以病发于阳。下之早。即为结胸。病发于阴。下之早。即为痞。
然结胸与痞相似。但以痛不痛为异耳。心下满而硬痛者。为结胸。但按之满。不痛者。为痞。医
家不审。一有差误。立致危殆。结胸属陷胸症。痞属泻心症。其详各于逐门备论之。
心下紧满。按之石硬而痛。此名结胸也。伤寒本无结胸。应身热。下之早。热气乘虚而入。痞
结不散。便成结胸。
若已误转了。初未成结胸者。急与理中汤服。自然解了。更不作结胸。盖理中治中焦故也。此
古人亦说不到。后人因消息之。若大段转损有厥症者。兼与四逆汤。便安。胃中虽和。伤寒未退者
即候日数足。可沉紧。名曰结胸也。治结胸大率当下。然脉浮与大。皆不可下。下之则死。尚宜发
汗也。仲景云。结胸脉浮者。不可下。只可用小陷胸汤。大抵脉浮是尚有表症。兼以小柴胡等先发
表。表症罢。方用下结胸药。便安。
西晋催行功云。伤寒结胸欲绝。心膈高起。手不得近。用大陷胸汤不瘥者。此是下后虚逆。气
已不理。而毒复上攻。气毒相薄。结于胸中。当用枳实理中丸与之服之。先理其气。次疗诸疾。古
今用之如神。应手而愈。
【纲】仲景曰。太阳少阳并病。而反下之。成结胸。心下硬。下利不止。水浆不下。其人心烦。
【目】朱肱曰。结胸有三种。有大结胸。不按而痛。胸连脐腹坚硬。大陷胸丸主之。有小结胸。
按之心下痛。小陷胸主之。有水结胸。在胸胁间。头微汗出。但结胸无大热。小半夏加茯苓汤、
小柴胡去枣加牡蛎主之也。又有寒热二症。有实热结胸。胸中烦躁。心内懊 。舌上燥渴。脉沉滑
者。皆热症也。大陷胸汤主之。有寒实结胸。其无热症者是也。三物白散、枳实理中丸主之。近世
治结胸。多行金针丸。用硫黄阳起石者。若寒实结胸行之。或有瘥者。或热实结胸行之。必死也。脏
结无阳症。不往来寒热。其人反静。舌上苔滑者。不可攻也。病患胸下旧有痞。连在脐旁。痛引少
腹。入阴筋者。亦名脏结。死不治。
魏荔彤曰。此条之上条曰。太阳少阳并病。心下硬。颈项强而眩者。当刺大椎肺俞肝俞。慎勿
下之。因病并于太阳。治亦应并于太阳。当仍用剌法以泄太阳之邪。切戒以慎勿可下也。医者若用
刺而不用下。则得矣。倘反下之。前之风因。时如结胸者。必真成结胸。前之寒因。心下痞硬者。
必更坚且硬。前之风寒两因。而时如结胸。心下痞硬兼有者。必如结胸者成结胸。心下痞硬者愈坚
硬。皆不明并治于太阳经表而用刺法。反误下之为害也。下之而下利旋止。禀气素盛。犹可为也。
倘素禀虚亏。下利不止。上则结胸中心痞。下则利不止。或专见。或兼见。皆水浆必不能下之道也。
阳陷于阴分而不能升。阴陷于阳分而不能降。上下隔绝。津液不通。中焦枯竭。心烦则必作躁。
其去结胸症下利躁死者不远矣。
【纲】仲景曰。伤寒五六日。呕而发热者。柴胡汤症具。而以他药下之。若心下满而硬痛者。
此为结胸也。大陷胸汤主之。但满而不痛者。为痞。柴胡不中与之。宜半夏泻心汤。
【目】张介宾曰。凡心腹胀满硬痛而手不可近者。方是结胸。若但满而不痛。此为痞满。凡痞
满症。乃表邪传至胸中。
未入于腑。此其将入未入。犹兼乎表。是即半表半里之症。只宜以小柴胡之属加枳壳之类治之。
或以本方对小陷胸汤亦妙。至结胸。仲景皆以大陷胸主之。然以余之见。惟伤寒本病。不因误下而
实邪传里。心下硬满。痛连小腹不可近。或燥渴谵妄。大便硬。脉沉实有力者。此皆大陷胸所宜。其
太阳少阳表邪未解。因下早而致结胸者。此其表邪犹在。若再用大陷胸。是既误下而复下之。此则
余所未敢。不若于痞满门诸法。酌其轻重。而从乎双解以缓治之。或外用罨法。以解散胸中实邪。
此余之屡用奏效。而最稳最捷者也。
张兼善说：凡是耳廓红润的，预后良好。如果耳廓颜色发黄、发白、发黑或发青且干枯的，预后不良。耳廓薄而色白，或薄而色黑，都属于肾气败绝的表现。凡是耳聋或耳中疼痛，都属于少阳经有热所致，是可以治疗的。如果耳聋伴有舌头卷缩、嘴唇发青，这属于厥阴病，是难以治疗的。凡是眼睛明亮，能够辨认人的，可以治疗。如果眼神昏花，不能辨认人，或者眼球向上翻，或者瞪眼直视，或者眼球固定不动呈圆形，或者两眼上视伴身体反折，或者眼睑凹陷，这些都是无法治疗的。凡是睁着眼睛想要看人的，属于阳证。凡是闭着眼睛不想看人的，属于阴证。凡是眼中感觉模糊不清，眼神不和顺，这是体内热邪极盛的表现。凡是眼睛疼痛的，属于阳明经有热。眼睛发红的，也是热邪极盛的表现。眼睛畏光闭合的，必将发生鼻出血。眼白部分发黄的，将要出现全身发黄的症状。凡是疾病快要痊愈时，会出现眼睛微黄、鼻尖明亮、山根（鼻梁根部）光亮这些征象。
【纲】张仲景说：太阳病与少阳病同时发病，脉象弦，头项强痛，有时感到头晕目眩，症状时而像结胸，心下痞塞硬满的，应当针刺大椎穴第一间隙、肺俞穴和肝俞穴。千万不要发汗，如果发汗就会导致谵语（神志不清，胡言乱语）。如果谵语不止，应当针刺期门穴。
【目】朱肱说：结胸证和痞证，大概是因为病发于阳分，过早使用泻下法，就会形成结胸；病发于阴分，过早使用泻下法，就会形成痞证。然而结胸和痞证相似，只是以疼痛与否作为区别。心下部位胀满而且坚硬疼痛的，称为结胸；只是按上去感觉胀满，但不疼痛的，称为痞证。医生如果不仔细审察，一旦有误，立刻会导致危重局面。结胸属于陷胸汤证范畴，痞证属于泻心汤证范畴，详细内容在各门类中分别论述。心下部位紧绷胀满，按上去像石头一样坚硬且疼痛，这叫做结胸。伤寒原本没有结胸这一病名，应该是身体发热时，过早使用泻下法，热气乘虚而入，痞结不散，便形成了结胸。
如果已经误治转变了病情，起初尚未形成结胸的，急忙给予理中汤服用，自然就能解除，不再形成结胸。这是因为理中汤治疗中焦的缘故。这也是古人未曾说到的，后人经过思考才明白的。如果病情严重转损并出现四肢厥冷的症状，兼用四逆汤，病人就能安定。虽然胃气调和，但伤寒表邪未退的，就等待时日充足，脉象变得沉紧，这就叫做结胸。治疗结胸大体上应当使用攻下法。然而脉象浮大，都不可攻下，攻下就会导致死亡，此时尚宜使用发汗法。张仲景说：结胸证脉象浮的，不可攻下，只可用小陷胸汤。大致来说，脉浮说明还有表证，兼用小柴胡汤等先解表，表证解除后，再用攻下结胸的药物，病人就能安定。
西晋崔行功说：伤寒结胸证危急欲绝，心膈部高高隆起，手不能触碰。使用大陷胸汤无效的，这是泻下后导致正气虚弱逆乱，气机已经紊乱，而毒邪再次上攻，气毒相互搏结，郁结在胸中，应当用枳实理中丸给它服用。先调理其气机，再治疗其他疾病。古今使用此方如神，应手而愈。
【纲】张仲景说：太阳病和少阳病同时发病，反而使用泻下法，形成了结胸，心下硬满，腹泻不止，水浆不能入口，病人心中烦乱。
【目】朱肱说：结胸有三种类型。有大结胸，不按就痛，胸部连及脐腹坚硬，用大陷胸丸主治。有小结胸，按之心下疼痛，用小陷胸汤主治。有水结胸，位于胸胁之间，头部微微出汗，只有结胸而没有大热症状，用小半夏加茯苓汤、或小柴胡汤去掉大枣加入牡蛎主治。又有寒热两种证型。有实热结胸，表现为胸中烦躁，心中懊恼，舌上干燥口渴，脉象沉滑的，都是热证，用大陷胸汤主治。有寒实结胸，就是没有热证的，用三物白散、枳实理中丸主治。近代治疗结胸，多使用金针丸，含有硫黄、阳起石的。如果是寒实结胸使用它，或许有痊愈的；如果是热实结胸使用它，必定致死。脏结证没有阳证表现，不往来寒热，病人反而安静，舌苔滑润的，不可攻下。病人胸下旧有痞块，连及脐旁，疼痛牵引少腹，进入阴筋的，也叫做脏结，死证，无法治疗。
魏荔彤说：这条上面的条文说：太阳少阳并病，心下硬满，颈项强直且眩晕的，应当针刺大椎、肺俞、肝俞，千万不要泻下。因为病邪并在于太阳经，治疗也应并治太阳经，应当仍然使用刺法来泄除太阳经的邪气，切记禁止使用泻下法。医生如果使用刺法而不使用泻下法，那就对了。如果反而使用泻下法，之前那种“时而像结胸”的风邪因素，必然真正形成结胸；之前那种“心下痞硬”的寒邪因素，必然更加坚硬；之前那种风寒两因并存，时而像结胸、心下痞硬兼有的情况，必然像结胸的形成结胸，心下痞硬的更加坚硬。这都是因为没有明白并病应治于太阳经表而使用刺法，反而误用泻下法造成的危害。如果泻下后腹泻随即停止，禀赋素来强盛的，还可以救治。如果素来禀赋虚弱亏损，腹泻不止，上面结胸中心痞塞，下面腹泻不止，或者单独出现，或者同时出现，都是水浆不能下咽的情况。阳气陷入阴分而不能上升，阴气陷入阳分而不能下降，上下隔绝，津液不通，中焦枯竭，心烦则必然产生躁动，离结胸证腹泻躁动而死就不远了。
【纲】张仲景说：伤寒五六天，呕吐且发热的，具备柴胡汤证，却用其他药物泻下。如果心下胀满而且坚硬疼痛的，这是结胸，用大陷胸汤主治。只是胀满而不疼痛的，是痞证，柴胡汤不适合给病人服用，适宜用半夏泻心汤。
【目】张介宾说：凡是心腹胀满坚硬疼痛且手不能触碰的，才是结胸。如果只是胀满而不疼痛，这叫痞满。凡痞满证，是表邪传至胸中，尚未进入腑脏，这是即将进入 yet 尚未进入的状态，仍然兼有表证，这就是半表半里的证候，只适宜用小柴胡汤之类加上枳壳之类的药物治疗。或者用本方配合小陷胸汤也很好。至于结胸，张仲景都用大陷胸汤主治。然而依我之见，只有在伤寒本病，不因误用泻下法而导致实邪传入里部，心下硬满，疼痛连及小腹不可触碰，或者燥渴谵妄，大便干硬，脉象沉实有力的，这些才适合用大陷胸汤。如果是太阳少阳表邪未解，因过早泻下而导致结胸的，这说明表邪仍在，如果再用大陷胸汤，就是既误用泻下又再次泻下，这是我所不敢采用的。不如在痞满门的诸种方法中，斟酌病情的轻重，采用双解法来缓和治疗。或者外用热敷法，以解散胸中的实邪，这是我屡用奏效，而且最稳妥最快捷的方法。
Zhang Jianshan stated: If the auricle is red and lustrous, the prognosis is good. If the auricle is yellow, white, black, or blue and dry withered, the prognosis is poor. Thinness with a white color, or thinness with a black color, both indicate failure of the Kidney (Shen). Deafness or pain in the ears generally belongs to heat in the Shaoyang (Lesser Yang) channel and is treatable. However, deafness accompanied by tongue retraction and cyanosis of the lips belongs to the Jueyin (Terminal Yin) stage and is difficult to treat. If the eyes are bright and capable of recognition, it is treatable. If the gaze is dim and unable to recognize people, or if the eyes roll upward, stare fixedly, remain round and fixed, look upward with opisthotonos, or if the eyelids are sunken, these are all untreatable. Those who keep their eyes open and wish to see people have a Yang syndrome (Yang Zheng). Those who keep their eyes closed and do not wish to see people have a Yin syndrome (Yin Zheng). A vague vision and discordant gaze indicate excessive internal heat. Eye pain belongs to heat in the Yangming (Bright Yang) channel. Red eyes also indicate excessive heat. Photophobia and eye closure will inevitably lead to epistaxis (nosebleed). Yellow sclera indicates impending icterus (jaundice). When a disease is about to resolve, signs include slight yellowing of the eyes, brightness of the nasal tip, and luminosity of the shangen (root of the nose).
[Gang] Zhang Zhongjing said: When Taiyang (Greater Yang) and Shaoyang syndromes occur simultaneously, with a wiry pulse, stiffness and pain in the head and neck, occasional dizziness or vertigo, symptoms that occasionally resemble chest binding (Jie Xiong), and fullness and hardness below the heart, one should needle the first interspace of the Dazhui (GV14) point, as well as Feishu (BL13) and Ganshu (BL18). One must be cautious against inducing sweating; if sweating is induced, it leads to delirium. If delirium persists, one should needle the Qimen (LR14) point.
[Mu] Zhu Gong said: Chest binding (Jie Xiong) and fullness obstruction (Pi) arise because when a disease originates in the Yang aspect, premature purgation results in chest binding; when a disease originates in the Yin aspect, premature purgation results in fullness obstruction. Although chest binding and fullness obstruction are similar, they differ in whether there is pain. Fullness and hardness with pain below the heart is called chest binding; fullness upon palpation without pain is called fullness obstruction. If physicians fail to examine carefully, any error can immediately lead to critical danger. Chest binding belongs to the category of Xianxiong (Depressing the Chest) formulas, while fullness obstruction belongs to the category of Xiexin (Draining the Heart) formulas. Details are discussed in their respective sections. Tightness and fullness below the heart, which feels hard as stone and painful upon pressure, is named chest binding. Shanyin originally does not have chest binding; rather, when body heat is present and purgation is used prematurely, heat enters through the deficiency, stagnates, and forms chest binding.
If the condition has already been altered by error, and chest binding has not yet fully formed, administer Lizhong Tang (Regulate the Middle Decoction) urgently to resolve it naturally and prevent the formation of chest binding, as Lizhong Tang treats the Middle Jiao. This was not mentioned by ancients but understood by later generations through reflection. If the condition deteriorates severely with signs of jue (cold limbs), combine with Sini Tang (Frigid Extremities Decoction) for stabilization. Even if the stomach qi harmonizes, if shanghan pathogens remain, wait until the appropriate days pass and the pulse becomes deep and tight; this is named chest binding. Generally, chest binding should be treated with purgation. However, if the pulse is floating or large, purgation is contraindicated; purging will cause death. Sweating may still be appropriate. Zhang Zhongjing stated: If the pulse in chest binding is floating, do not purge; use Xiaoxiantong Tang (Minor Inhibiting the Binding Decoction) only. Generally, a floating pulse indicates residual exterior syndrome. Use Xiao Chaihu Tang (Minor Bupleurum Decoction) etc. to release the exterior first. Once the exterior syndrome resolves, then use purgative medicines for chest binding for safety.
Cui Xinggong of the Western Jin dynasty stated: In critical cases of shanghan chest binding where the epigastrium and diaphragm are elevated and tender to touch, if Da Xiantong Tang (Major Inhibiting the Binding Decoction) fails, this is due to post-purgative deficiency and rebellious qi, where toxins attack upward again, causing qi and toxin to clash and bind in the chest. Administer Zhishi Lizhong Wan (Immature Bitter Orange Regulate the Middle Pill) to regulate the qi first, then treat other diseases. It works miraculously in ancient and modern times, bringing recovery promptly.
[Gang] Zhang Zhongjing said: When Taiyang and Shaoyang syndromes occur simultaneously, and purgation is wrongly applied, resulting in chest binding with hardness below the heart, incessant diarrhea, inability to take fluids, and mental restlessness.
[Mu] Zhu Gong said: There are three types of chest binding. Major chest binding involves pain without pressure, hardness extending from the chest to the umbilicus and abdomen, treated with Da Xiantong Wan. Minor chest binding involves pain below the heart upon pressure, treated with Xiaoxiantong Tang. Water chest binding occurs between the chest and hypochondrium, with slight sweating on the head and no high fever, treated with Xiao Banxia Jiashengfu Tang (Minor Pinellia plus Alisma and Poria Decoction) or Xiaochaihu Tang minus Zao plus Muli (Minor Bupleurum Decoction minus Jujube plus Oyster Shell). There are also cold and heat patterns. Excess-heat chest binding presents with chest irritability, mental vexation, dry tongue, thirst, and a deep slippery pulse, treated with Da Xiantong Tang. Cold-excess chest binding lacks heat signs, treated with Sanwu Baisan (Three-Ingredient White Powder) or Zhishi Lizhong Wan. Recent treatments often use Jinzhen Wan containing Sulfur and Qiyangshi (Quicksilver Ore); this may cure cold-excess chest binding but will kill patients with excess-heat chest binding. Zangjie (Visceral Binding) lacks yang signs, has no alternating chills and fever, the patient is quiet, and the tongue coating is slippery; it cannot be attacked. If a patient has old pi below the chest extending to the side of the umbilicus, with pain radiating to the lower abdomen and genitalia, it is also named Zangjie, a fatal untreatable condition.
Wei Litong said: The preceding clause states: In Taiyang-Shaoyang simultaneous syndrome with hardness below the heart, stiff neck, and dizziness, needle Dazhui, Feishu, and Ganshu, and strictly avoid purgation. Since the pathogen combines in Taiyang, treatment should target Taiyang, using needling to drain the pathogen. Strictly forbid purgation. If needling is used instead of purgation, it is correct. If purgation is wrongly used, the previous wind factor resembling chest binding will become true chest binding; the previous cold factor causing pi hardness will become harder; the combined wind-cold factors will result in true chest binding and increased pi hardness. This harm arises from failing to treat the simultaneous syndrome via the Taiyang exterior with needling and instead mistakenly using purgation. If purgation stops diarrhea immediately, those with strong constitution may survive. However, those with weak constitutions suffer incessant diarrhea, upper chest binding/pi, and lower diarrhea, preventing fluid intake. Yang sinks into Yin and cannot rise; Yin sinks into Yang and cannot descend. Upper and lower are separated, fluids do not flow, the Middle Jiao dries up, and mental restlessness leads to agitation. Death from chest binding with diarrhea and agitation is imminent.
[Gang] Zhang Zhongjing said: In shanghan after five or six days, vomiting and fever indicate Chaihu Tang syndrome. If purged with other medicines, and there is fullness and hardness with pain below the heart, this is chest binding, treated with Da Xiantong Tang. If there is fullness without pain, it is pi, and Chaihu Tang is inappropriate; Banxia Xiexin Tang (Pinellia Draining the Heart Decoction) is suitable.
[Mu] Zhang Jianbin said: Only when abdominal distension, fullness, hardness, and pain are intolerable to touch is it chest binding. If there is fullness without pain, it is pi-fullness. Pi-fullness arises when exterior pathogens transmit to the chest but have not entered the fu organs. This state is on the verge of entering, retaining exterior characteristics, representing a half-exterior, half-interior syndrome. It should be treated with Xiao Chaihu Tang plus Zhike (Aurantii Fructus) or combined with Xiaoxiantong Tang. For chest binding, Zhang Zhongjing uses Da Xiantong Tang. However, in my view, Da Xiantong Tang is suitable only for shanghan proper where real pathogens transmit inward without erroneous purgation, presenting with hardness/fullness below the heart, pain radiating to the lower abdomen, dryness/thirst, delirium, hard stool, and a deep, solid, forceful pulse. If Taiyang-Shaoyang exterior pathogens remain unresolved and chest binding results from premature purgation, the exterior pathogen is still present. Using Da Xiantong Tang would constitute double purgation, which I dare not do. Instead, one should select methods from the pi-fullness section, assess severity, and use dual-resolution methods for gentle treatment, or apply external compresses to dissipate interior excess. This is my method that consistently succeeds and is the safest and quickest.