伤寒下之太早，则成痞硬。中风下之太早，则成结胸，均为表邪乘之，入里硬满，按之而痛，为结胸实
邪也，硬满按之不痛，为痞硬虚邪也。大结胸从心下至少腹硬满而痛，手不可近者，宜大陷胸汤攻之。小结
胸微结心下，按之方痛，不按不痛者，宜小陷胸汤开之。身有微热，头自汗出，兼有是证者，为水结胸，宜
大陷胸丸攻之。嗽水不欲咽，兼有是证者，为血结胸，血瘀不成衄解，或衄未尽，或妇人经来适断，皆能成
之，宜抵当丸，或桃仁承气汤攻之。凡结胸内实证，实可攻也，沉大脉，实可攻也。审其的当，则用抵当、桃
仁承气、大陷胸汤、丸以攻之。审其不内实，脉浮滑，或脉浮大，是未的也，乃小陷胸汤证，不可攻也。误
攻之，定主凶。再脏结，证状如结胸，舌苔白滑，脉浮而细，通腹两胁皆硬满痛，此证加之烦躁，凶死可知
矣。
伤寒下早、则成痞硬。中风下早，则成结胸，此其常也。然论中，中风下早，未尝无痞硬，伤寒下早，亦
有结胸。大抵从虚化者，多为痞硬，从实化者，多为结胸也。阳证心下痞硬者为热痞，宜大黄黄连泻心汤。阳
证汗出恶寒者，为寒热痞。宜附子泻心汤。误下少阳，发热而呕，心下痞满者，为呕逆痞，宜半夏泻心汤。
阳证误下，心下痞硬，下利，心烦干呕，腹中雷鸣，胁下有水气，致小便不利者，为虚热水气之痞，宜生姜泻
心汤。若有是证，胁下无水气，其痞急益甚者，为虚热咳气上逆之痞，
宜甘草泻心汤。凡有痞者，有无汗恶寒之表证，宜用桂枝汤。表解已，乃可以大黄黄连泻心汤攻痞也。若
有痞者，与泻心汤。痞不解，其人烦渴，小便不利者，先以五苓散，大便利后，乃可与诸泻心汤治痞也。
伤寒病如果过早使用泻下法，就会形成痞硬证。中风病如果过早使用泻下法，就会形成结胸证。这两种情况都是因为表邪趁虚内陷，进入体内导致心下部位坚硬胀满，按压时疼痛的，属于结胸实证；坚硬胀满但按压时不痛的，属于痞硬虚证。大结胸证表现为从心窝部一直到小腹部都坚硬胀满且疼痛，手不能触碰的，适宜用大陷胸汤来攻逐邪气。小结胸证表现为邪气轻微结聚于心下，只有按压时才痛，不按就不痛的，适宜用小陷胸汤来开通散结。身体有轻微发热，头部自然出汗，并兼有上述症状的，属于水结胸证，适宜用大陷胸丸来攻逐。想漱口但不想咽下，并兼有上述症状的，属于血结胸证，这是因瘀血未能通过鼻衄（流鼻血）而解，或者鼻衄后余血未尽，或者是妇女月经刚断绝等原因造成的，适宜用抵当丸或桃仁承气汤来攻逐。凡是结胸证属于内部实证的，说明正气尚足可以攻伐，脉象沉大，也说明是实证可以攻伐。仔细审察确凿无疑后，才使用抵当丸、桃仁承气汤、大陷胸汤或大陷胸丸来攻逐邪气。如果审察发现内部并无实邪，脉象浮滑，或者脉象浮大，这就不是确凿的实证，而是小陷胸汤证，不可使用攻下法。误用攻下法，必然导致凶险后果。另外，脏结证的症状表现像结胸，舌苔白滑，脉象浮而细弱，全腹及两侧胁肋部都坚硬胀满疼痛，此证如果再伴有烦躁不安，可知预后不良，会导致死亡。
伤寒病下法过早，会形成痞硬证。中风病下法过早，会形成结胸证，这是一般规律。然而在《伤寒论》中论述里，中风病下法过早，并非没有形成痞硬证的情况；伤寒病下法过早，也有形成结胸证的情况。大致来说，从虚证转化的，多形成痞硬证；从实证转化的，多形成结胸证。阳证出现心下痞硬的，属于热痞证，适宜用大黄黄连泻心汤。阳证出现汗出且恶寒的，属于寒热错杂痞证，适宜用附子泻心汤。误用下法损伤少阳，出现发热且呕吐，心下痞满的，属于呕逆痞证，适宜用半夏泻心汤。阳证误用下法，出现心下痞硬、腹泻、心烦、干呕、肠鸣、胁下有停饮导致小便不利的，属于虚热水气痞证，适宜用生姜泻心汤。如果有上述症状，但胁下没有停饮，且痞满症状急剧加重的，属于虚热气逆痞证，适宜用甘草泻心汤。凡是有痞证的患者，如果伴有无汗恶寒的表证，适宜先用桂枝汤解表。表证解除后，才可以再用大黄黄连泻心汤来治疗痞证。如果有痞证，给予泻心汤治疗后，痞证未解，患者出现烦渴、小便不利的，应先使用五苓散利水，待小便通利后，再给予各类泻心汤来治疗痞证。
If the purgative method is used too early in Taiyang disease (Taiyang disease, a syndrome caused by pathogenic factors invading the Taiyang meridian), Piying syndrome (a condition characterized by fullness and hardness in the epigastrium due to deficiency) will form. If the purgative method is used too early in Fengzhong disease (Wind-stroke disease, often referring to exterior syndromes with sweating), Jiexiong syndrome (Chest binding syndrome, characterized by pain and hardness in the chest/epigastrium due to excess pathogens) will form. In both cases, this is because the exterior pathogen takes advantage of the deficiency to enter the interior, causing hardness and fullness. If pressing on the area causes pain, it is Jiexiong excess pathogen; if pressing causes no pain, it is Piying deficiency pathogen. Da Jiexiong (Major Chest Binding) presents with hardness, fullness, and pain from the epigastrium down to the lower abdomen, such that the hands cannot approach it; Da Xianxiong Tang (Major Trapdoor Decoction) should be used to attack it. Xiao Jiexiong (Minor Chest Binding) presents with slight binding in the epigastrium, painful only upon pressure and not when untouched; Xiao Xianxiong Tang (Minor Trapdoor Decoction) should be used to open and resolve it. If there is slight fever in the body and spontaneous sweating of the head, accompanied by these symptoms, it is Shui Jiexiong (Water Chest Binding); Da Xianxiong Wan (Major Trapdoor Pill) should be used to attack it. If one wants to rinse the mouth but does not wish to swallow, accompanied by these symptoms, it is Xue Jiexiong (Blood Chest Binding). This occurs when blood stasis fails to resolve through nosebleed (Xue), or the nosebleed is incomplete, or in women when menstruation has just stopped; Dangdang Wan (Dangdang Pill) or Taoren Chengqi Tang (Peach Kernel and Cathartic Decoction) should be used to attack it. For all Jiexiong syndromes that are internal excess patterns, where excess allows for attack, and the pulse is deep and large, indicating excess allowing for attack: after careful confirmation, use Dangdang Wan, Taoren Chengqi Tang, Da Xianxiong Tang, or Da Xianxiong Wan to attack. If examination reveals no internal excess, and the pulse is floating and slippery, or floating and large, it is not confirmed excess; it is a Xiao Xianxiong Tang pattern, and attack/purgation is contraindicated. Mistaken attack will surely lead to ominous outcomes. Furthermore, Zangjie (Zang Knotting) presents similarly to Jiexiong, with a white and slippery tongue coating, a floating and fine pulse, and hardness, fullness, and pain throughout the abdomen and hypochondrium. If this pattern is accompanied by irritability, death is evident.
Early purgation in Taiyang disease leads to Piying. Early purgation in Fengzhong disease leads to Jiexiong; this is the general rule. However, in the Treatise, Fengzhong with early purgation does not preclude Piying, nor does Taiyang with early purgation preclude Jiexiong. Generally, transformations from deficiency tend to become Piying, while transformations from excess tend to become Jiexiong. Yang syndrome with epigastric Piying is Re Pi (Heat Epigastric Fullness); Dahuang Huanglian Xiexin Tang (Rhubarb and Coptis Heart-Draining Decoction) is indicated. Yang syndrome with sweating and aversion to cold is Hanre Pi (Cold-Heat Epigastric Fullness); Fuzi Xiexin Tang (Aconite Heart-Draining Decoction) is indicated. Mistaken purgation damaging Shaoyang, resulting in fever, vomiting, and epigastric fullness, is Ni Pi (Rebellious Qi Epigastric Fullness); Banxia Xiexin Tang (Pinellia Heart-Draining Decoction) is indicated. Yang syndrome mistaken purgation leading to epigastric Piying, diarrhea, irritability, dry retching, borborygmus, fluid retention under the hypochondrium causing difficult urination, is Xu Re Shuiqi Pi (Deficiency-Heat Fluid-Retention Epigastric Fullness); Shengjiang Xiexin Tang (Fresh Ginger Heart-Draining Decoction) is indicated. If these symptoms exist but there is no fluid retention under the hypochondrium, and the Pi is severely aggravated, it is Xu Re Kouqi Shangni Pi (Deficiency-Heat Rebellious Qi Epigastric Fullness); Gancao Xiexin Tang (Licorice Heart-Draining Decoction) is indicated. For any Pi syndrome accompanied by exterior signs of anhidrosis and aversion to cold, Guizhi Tang (Cinnamon Twig Decoction) should be used first. Only after the exterior is resolved can Dahuang Huanglian Xiexin Tang be used to treat the Pi. If Pi is present and treated with Xiexin Tangs without resolution, and the patient develops irritability, thirst, and difficult urination, Wuling San (Five-Ingredient Powder with Poria) should be administered first; only after urination becomes free can the various Xiexin Tangs be used to treat the Pi.