问曰、病有结胸。有脏结。其状如何。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。关脉小细沉紧。名曰脏结。舌上白苔滑者。
难治。
此设为问答。以辨结胸、脏结之异。结胸者。邪结胸中。按之则痛。脏结者。邪结脏间。按之
亦痛。如结胸者。谓如结胸之按而痛也。然胸高而脏下。胸阳而脏阴。病状虽同。而所处之位则
不同。是以结胸不能食。脏结则饮食如故。结胸不必下利。脏结则时时下利。结胸关脉沉。脏结则
更小细紧。而其病之从表入里。与表犹未尽之故。则又无不同。故结胸、脏结。其寸脉俱浮也。
舌上白苔滑者。在里之阳不振。入结之邪已深。结邪非攻不去。而脏虚又不可攻。故曰难治。
脏结无阳证。不往来寒热。其人反静。舌上苔滑者。不可攻也。
邪结在脏。必阳气内动。或邪气外达。而后可施攻取之法。若无阳证。不往来寒热。则内动
外达之机俱
泯。是以其人反静。其舌苔反滑。邪气伏而不发。正气弱而不振。虽欲攻之。无可攻已。盖即上文
难治之端。而引其说如此。
病胁下素有痞。连在脐旁。痛引少腹入阴筋者。此名脏结。死。
脏结之证。不特伤寒。即杂病亦有之。曰胁下素有痞。则其病久而非暴矣。曰连在脐旁。痛引
少腹入阴筋。则其邪深而非浅矣。既深且久。攻之不去。补之无益。虽不卒死。亦无愈期矣。故曰
死。
问：疾病中有结胸和脏结两种情况，它们的症状表现是怎样的？
答：按压时感到疼痛，寸脉浮，关脉沉，这叫做结胸。
什么是脏结呢？
答：症状表现像结胸一样，但饮食如常，经常腹泻。寸脉浮，关脉小、细、沉、紧，这叫做脏结。如果舌面上有白色滑腻苔的，属于难治之症。
这里采用设问的方式，来辨析结胸与脏结的不同。所谓结胸，是邪气结聚在胸中，按压就会疼痛；所谓脏结，是邪气结聚在脏腑之间，按压也会疼痛。“如结胸状”，是指像结胸那样按压而痛。然而，胸部位置高且属阳，腹部（脏）位置低且属阴。虽然病状相似，但所处的部位不同。因此，结胸患者不能进食，而脏结患者饮食如常；结胸不一定出现腹泻，而脏结患者经常腹泻；结胸的关脉沉，而脏结的关脉则更加小、细、紧。至于病情由表入里，或者表证尚未完全解除的缘故，两者又没有不同。所以，结胸和脏结的寸脉都是浮的。
舌面上有白色滑腻苔，说明体内的阳气不振，侵入并结聚的邪气已经深入。结聚的邪气非攻逐不能去除，但脏腑已虚又不可攻逐，所以说难治。
脏结没有阳证表现，不出现往来寒热，病人反而安静，舌苔滑润的，不可使用攻下法。
邪气结聚在脏，必须依靠阳气在内鼓动，或邪气向外透达，之后才可以施用攻逐的方法。如果没有阳证，不出现往来寒热，那么内动外达的机制都消失了，因此病人反而安静，舌苔反而滑润。这是邪气潜伏而不发作，正气虚弱而不能振奋，即使想要攻逐，也没有可攻逐的条件了。这大概是上文所说的“难治”的开端，于是引出这样的论述。
如果病人胁下向来有痞块，连接到脐旁，疼痛牵引至少腹并进入阴筋，这叫做脏结，预后不良（死）。
脏结这种病症，不仅见于伤寒，即使是杂病也有这种情况。说“胁下向来有痞块”，说明病程长久而非突然发生；说“连接到脐旁，疼痛牵引至少腹并进入阴筋”，说明邪气深重而非浅表。既然病位深且病程久，攻逐则邪不去，补益则无益处，虽然不会立即死亡，但也看不到痊愈的日期了。所以说预后不良（死）。
Question: In diseases, there are conditions known as Jie Xiong (Chest Binding) and Zang Jie (Organ Binding). What are their clinical manifestations?
Answer: When pressed, there is pain; the Cun pulse (Inch pulse) is floating, and the Guan pulse (Carpal pulse) is deep. This is called Jie Xiong (Chest Binding).
What is meant by Zang Jie (Organ Binding)?
Answer: The condition resembles Jie Xiong (Chest Binding), but food intake remains normal, and there is frequent diarrhea. The Cun pulse (Inch pulse) is floating, while the Guan pulse (Carpal pulse) is small, fine, deep, and tight. This is called Zang Jie (Organ Binding). If there is a white and slippery coating on the tongue, it is difficult to treat.
This passage employs a question-and-answer format to distinguish between Jie Xiong (Chest Binding) and Zang Jie (Organ Binding). Jie Xiong (Chest Binding) refers to pathogenic factors binding in the chest region, causing pain upon pressure. Zang Jie (Organ Binding) refers to pathogenic factors binding within the organs, also causing pain upon pressure. "Resembling Jie Xiong" means resembling the tenderness upon pressure seen in Jie Xiong (Chest Binding). However, the chest is superior and belongs to Yang, whereas the organs (abdomen) are inferior and belong to Yin. Although the symptoms appear similar, their locations differ. Therefore, patients with Jie Xiong (Chest Binding) cannot eat, whereas those with Zang Jie (Organ Binding) maintain normal appetite; Jie Xiong (Chest Binding) does not necessarily involve diarrhea, whereas Zang Jie (Organ Binding) involves frequent diarrhea; the Guan pulse (Carpal pulse) in Jie Xiong (Chest Binding) is deep, whereas in Zang Jie (Organ Binding) it is even smaller, finer, and tighter. Regarding the progression of disease from exterior to interior, or the persistence of exterior patterns, there is no difference between the two. Thus, the Cun pulses (Inch pulses) for both Jie Xiong (Chest Binding) and Zang Jie (Organ Binding) are floating.
A white and slippery coating on the tongue indicates that the Yang Qi (Vital Energy) inside is not vigorous, and the invading pathogenic factors have penetrated deeply. The bound pathogens cannot be expelled without purgation, but since the Zang organs are deficient, purgation is contraindicated. Hence, it is said to be difficult to treat.
Zang Jie (Organ Binding) lacks Yang syndrome manifestations, such as alternating chills and fever (Wang Lai Han Re). The patient appears unusually quiet, and if the tongue coating is slippery, purgative methods must not be used.
When pathogens bind in the Zang organs, treatment with purgatives can only be applied after there is internal movement of Yang Qi or external expression of pathogens. If there are no Yang signs and no alternating chills and fever, the mechanisms of internal movement and external expression are absent. Consequently, the patient appears quiet, and the tongue coating becomes slippery. This indicates that pathogens are latent and unexpressed, while Zheng Qi (Upright Qi) is weak and unvigorous. Even if one wishes to purge, there is no basis for doing so. This elaborates on the previously mentioned difficulty in treatment.
If a patient has had a Pi Mass (Focal Distension) in the hypochondrium for a long time, extending to beside the umbilicus, with pain radiating to the Shaoyang abdomen and into the Yin sinews (genitals), this is called Zang Jie (Organ Binding), and the prognosis is fatal.
The condition of Zang Jie (Organ Binding) is not exclusive to Shang Han (Cold Damage); it also occurs in miscellaneous diseases. The phrase "having had a Pi Mass in the hypochondrium for a long time" implies a chronic rather than acute onset. The description "extending to beside the umbilicus, with pain radiating to the Shaoyang abdomen and into the Yin sinews" indicates deep-seated rather than superficial pathogens. Given the depth and chronicity, purgation fails to remove the pathogens, and tonification yields no benefit. Although death may not occur immediately, recovery is unlikely. Hence, it is described as fatal.