桔梗（三分） 巴豆（去皮心，熬黑，研如脂）一分 贝母三分
右件二味为末，内巴豆，更于臼中杵之，以白饮和服，强人半钱匕，羸者减之。病在
膈上必吐，在膈下必利。不利，进热粥一杯；利过不止，进冷粥一杯。
【方解】
是方也，治寒实水结胸证，极峻之药也。君以巴豆，极辛极烈，攻寒逐水，斩关夺门
，所到之处，无不破也；佐以贝母，开胸之结；使以桔梗，为之舟楫，载巴豆搜逐胸
邪，悉尽无余。膈上者必吐，膈下者必利。然惟知任毒以攻邪，不量强羸，鲜能善其
后也。故羸者减之，不利进热粥，利过进冷粥；盖巴豆性热，得热则行，得冷则止。
不用水而用粥者，藉谷气以保胃也。
伤寒十余日，热结在里，复往来寒热者，与大柴胡汤。但结胸无大热者，此为水结在
胸□也，但头微汗出者，大陷胸汤主之。
【注】
伤寒十余日，热结在里，若胸□满□者，此结胸也。今不满□，复往来寒热者，乃少
阳表里病，非结胸也，当与大柴胡汤两解之。但结胸证，亦有水结者，水结胸不但表
无大热，里亦无大热也。有结胸状，头微汗出者，此水停于胸，为热气上蒸使然也。
故曰水结在胸□也。亦以大陷胸汤主之，饮热并攻也。
【集注】
方有执曰：水即饮也，以不实□，故曰水结。胸□亦里也，以热结不高，故曰在里。
程知曰：此言热结于里兼少阳者，则不宜陷胸；水结于胸者，虽无大热，犹宜大陷胸
也。
程应旄曰：大柴胡与大陷胸，皆能破结。大柴胡之破结，使表分无留邪；大陷胸之破
结，使里分无留邪。
林澜曰：此言水结胸之与热结在里不同也。十余日，邪深入府之时，然热结在里，而
犹有半表半里之邪，作往来寒热者，必以大柴胡两解之。若但胸□结满，初无大热，
收敛入内者，此亦不得为大柴胡证，必水结胸□也。何以知之？水结胸者，头汗出，
今但头微汗，为水结胸明矣。与大陷胸汤。
结胸者，项亦强，如柔痉状，下之则和，宜大陷胸丸。
【注】
结胸从心上至少腹，□满痛不可近，则其势甚于下者，治下宜急攻之，以大陷胸汤。
结胸从胸上，满□项强，如柔痉状，则其热甚于上者，治上宜缓攻之，以大陷胸丸直
攻胸肺之邪。煮服倍蜜，峻治缓行，下而和之，以其病势缓急之形既殊，汤丸之制亦
异也。故知此项强乃结胸之项强，下之则和，非柔痉之项强也。
【集注】
成为己曰：项强者、为邪结胸中，胸膈结满，但能仰而不能俯，是项强也。
程知曰：项强如柔痉者，胸中邪气紧实，项势常昂，有似柔痉之状；然痉病身手俱张
，此但项强原非痉也，借此以验胸邪十分紧逼耳。
汪琥曰：下之则和者，言邪实去，胸中和而项自舒之意。若不云如柔痉，恐医人认以
为太阳经风寒之邪未解，反疑其当用发汗之药。殊不知项虽强，表证已解，里证甚急
，治法宜下也。
桔梗（三分） 巴豆（去皮心，炒至黑色，研成脂状）一分 贝母三分
以上三味药，将前二味研为细末，加入巴豆，再在臼中捣匀，用米汤调和服用。体质强壮者服半钱匕量，体弱者减量。病邪在膈上者必然呕吐，在膈下者必然腹泻。若服药后未腹泻，可喝一碗热粥；若腹泻不止，可喝一碗冷粥。
【方解】
此方用于治疗寒实水结胸证，是极为峻烈的药物。以巴豆为君药，其性极辛极烈，能攻逐寒邪、驱逐水饮，势如破竹，所到之处无坚不摧；以贝母为佐药，开通胸中的郁结；以桔梗为使药，作为舟楫，载着巴豆搜逐胸中的邪气，使其清除殆尽。病在膈上者必然呕吐，在膈下者必然腹泻。然而，如果只知道依靠毒性药物来攻伐邪气，而不衡量患者体质的强弱，很少能有好的结局。因此，体弱者应减量，未腹泻者进热粥，腹泻过度者进冷粥；这是因为巴豆性热，遇热则药效运行，遇冷则药效停止。不用水而用粥的原因，是借助谷气来保护胃气。
伤寒十余日，热邪结聚在体内，又出现往来寒热症状的，给予大柴胡汤治疗。只有结胸证且体表没有大热的，这是水饮结聚在胸中，仅头部微微出汗的，以大陷胸汤主治。
【注】
伤寒十余日，热邪结聚在体内，如果胸部胀满疼痛的，这是结胸证。如今胸部不胀满，又出现往来寒热的，这是少阳经表里同病，不是结胸证，应当用大柴胡汤表里双解。但是结胸证中，也有水饮结聚的情况，水结胸不仅体表没有大热，体内也没有大热。有类似结胸的症状，头部微微出汗的，这是水停于胸中，被热气上蒸所致。所以说这是水结聚在胸中。也使用大陷胸汤主治，因为它是饮水与热邪并攻的病证。
【集注】
方有执说：水即饮邪，因其实质不实，所以称为水结。胸中也属于里，因热结位置不高，所以称为在里。
程知说：这里说的是热结在里兼有少阳病证的，就不宜用陷胸法；水结在胸中的，虽然体表没有大热，仍然适宜用大陷胸汤。
程应旄说：大柴胡汤与大陷胸汤，都能破除结滞。大柴胡汤破除结滞，使表分没有留存的邪气；大陷胸汤破除结滞，使里分没有留存的邪气。
林澜说：这里说的是水结胸与热结在里的不同。病程十余日，是邪气深入脏腑的时候，然而热结在里， yet仍有半表半里的邪气，表现为往来寒热的，必须用大柴胡汤表里双解。如果只是胸部结满，初起没有大热，邪气收敛入内的，这也不能诊断为大柴胡汤证，一定是水结胸中。怎么知道的呢？水结胸的患者，头部出汗，现在只是头部微微出汗，这明确是水结胸。给予大陷胸汤。
结胸证，颈部也僵硬，像柔痉病的状态，泻下后就会调和，适宜用大陷胸丸。
【注】
结胸证从心下至少腹，胀满疼痛不可触碰，那么病势重于下方的，治疗下方应当急攻，用大陷胸汤。结胸证从胸部向上，导致颈部僵硬，像柔痉病的状态，那么病势重于上方的，治疗上方应当缓攻，用大陷胸丸直接攻逐胸肺的邪气。煮服时加倍蜂蜜，峻猛的药力缓和地发挥，通过泻下使病情调和，因为病势的缓急形态既然不同，汤剂和丸剂的制法也就不同。所以知道这种颈部僵硬是结胸引起的颈部僵硬，泻下后就会调和，而不是柔痉病的颈部僵硬。
【集注】
成为己说：颈部僵硬，是因为邪气结聚在胸中，胸膈胀满，只能仰头而不能低头，这就是颈部僵硬。
程知说：颈部僵硬像柔痉病的，是因为胸中邪气紧实，颈部姿势常昂起，有类似柔痉的状态；然而痉病是手和身都张开的，这里只是颈部僵硬，原本就不是痉病，借此来验证胸中邪气十分紧逼罢了。
汪琥说：“下之则和”的意思是，邪实去除，胸中调和，颈部自然舒展的意思。如果不说“像柔痉”，恐怕医生会误认为是太阳经风寒邪气未解，反而怀疑应当使用发汗的药物。殊不知颈部虽然僵硬，但表证已解，里证非常紧急，治疗方法应当用泻下法。
Radix Platycodi (Jiegeng, 桔梗) 3 fen; Semen Crotonis (Badou, 巴豆), peeled and cored, fried until black, ground into a paste 1 fen; Fructus Amomi Rotundus (Beimu, 贝母) 3 fen.
Grind the first two herbs into powder, mix in the Semen Crotonis, and pound further in a mortar. Mix with rice water for administration. For robust individuals, administer half a qianbi dose; for frail individuals, reduce the dose. If the pathogen is above the diaphragm, vomiting will occur; if below the diaphragm, diarrhea will occur. If there is no diarrhea, drink one cup of hot congee; if diarrhea is excessive and unceasing, drink one cup of cold congee.
[Formula Analysis]
This formula treats Cold-Excess Water-Binding Chest Syndrome (Han-Shi Shui-Jie Xiong Zheng), utilizing extremely potent drugs. Semen Crotonis serves as the Sovereign herb; its nature is extremely pungent and fierce, attacking cold and expelling water, breaking through barriers, leaving nothing intact where it reaches. Fructus Amomi Rotundus acts as the Minister herb, opening chest stagnation. Radix Platycodi serves as the Guide herb, acting as a vessel to carry Semen Crotonis to search out and eliminate chest pathogens completely. Pathogens above the diaphragm cause vomiting; those below cause diarrhea. However, relying solely on toxic herbs to attack pathogens without assessing patient constitution rarely yields good outcomes. Therefore, doses are reduced for frail patients; hot congee is given if there is no diarrhea, and cold congee if diarrhea is excessive. This is because Semen Crotonis is hot in nature; its action accelerates with heat and stops with cold. Rice water is used instead of plain water to leverage the grain qi to protect Stomach Qi.
In Shaoyang disease (Shanghan) after ten-plus days, if heat binds internally and alternating chills and fever occur, Da Chaihu Tang (Major Bupleurum Decoction) is administered. If there is only Chest Binding (Jie Xiong) without significant external heat, indicating water binding in the chest with slight sweating only on the head, Da Xiexin Tang (Major Downward Draining Decoction) is the primary treatment.
[Annotation]
After ten-plus days of Shaoyang disease, if heat binds internally and causes chest fullness and pain, this is Chest Binding. Since the chest is not currently full, but alternating chills and fever occur, it is a Taiyang-Shaoyang complex syndrome involving both exterior and interior, not Chest Binding; Da Chaihu Tang should be used to resolve both exterior and interior. However, among Chest Binding syndromes, there are cases of water binding. In water-binding chest syndrome, there is neither significant external heat nor internal heat. Cases presenting with symptoms resembling Chest Binding and slight head sweating indicate water retention in the chest steamed by internal heat. Thus, it is termed water binding in the chest. Da Xiexin Tang is also used here to address both fluid and heat accumulation.
[Collections of Annotations]
Fang Youzhi states: "Water" refers to fluid retention; it is called water binding because it lacks solid excrement. The chest is considered the interior; since the heat binding is not high up, it is described as being in the interior.
Cheng Zhi states: This passage discusses heat binding in the interior accompanied by Shaoyang syndrome, which is unsuitable for draining methods targeting the chest. For water binding in the chest, even without significant external heat, Da Xiexin Tang is still appropriate.
Cheng Yingmao states: Both Da Chaihu Tang and Da Xiexin Tang can break down bindings. Da Chaihu Tang breaks bindings to ensure no lingering pathogens remain in the exterior; Da Xiexin Tang breaks bindings to ensure no lingering pathogens remain in the interior.
Lin Lan states: This distinguishes water-binding chest from heat-binding in the interior. After ten-plus days, pathogens have deeply entered the fu organs. If heat binds internally but semi-exterior/semi-interior pathogens remain, causing alternating chills and fever, Da Chaihu Tang must be used to resolve both. If there is merely chest fullness and binding without initial significant heat, with pathogens retreating inward, this is not a Da Chaihu Tang syndrome but rather water-binding chest. How do we know? Patients with water-binding chest sweat on the head; current slight head sweating clearly indicates water-binding chest. Administer Da Xiexin Tang.
In Chest Binding syndrome, the neck may also be stiff, resembling Rou Ji (Soft Spasm). Purging harmonizes the condition; Da Xiexin Wan (Major Downward Draining Pill) is indicated.
[Annotation]
If Chest Binding extends from the epigastrium to the lower abdomen, causing fullness and pain that cannot be touched, the pathology is severe in the lower aspect; urgent purging is required using Da Xiexin Tang. If Chest Binding originates from the chest upwards, causing neck stiffness resembling Rou Ji, the pathology is severe in the upper aspect; slow purging is required using Da Xiexin Wan to directly attack pathogens in the chest and lungs. Boiling with double the amount of honey allows potent medicine to act gently, purging to achieve harmony. Because the urgency of the pathology differs, the forms (decoction vs. pill) differ accordingly. Thus, this neck stiffness is due to Chest Binding, not Rou Ji; purging harmonizes it.
[Collections of Annotations]
Cheng Weiji states: Neck stiffness occurs because pathogens bind in the chest, causing chest and diaphragm fullness; the patient can look up but not bow down, which constitutes neck stiffness.
Cheng Zhi states: Neck stiffness resembling Rou Ji happens because chest pathogens are tight and solid, forcing the neck upward, mimicking Rou Ji. However, true spasm involves extension of hands and body; here, only the neck is stiff, so it is not true spasm. This comparison verifies the tight compression of chest pathogens.
Wang Hu states: "Purging harmonizes" means that once excess pathogens are removed, the chest becomes harmonious and the neck relaxes naturally. Without specifying "resembling Rou Ji," physicians might mistake it for unresolved Taiyang wind-cold and incorrectly prescribe diaphoretic herbs. It is unknown that although the neck is stiff, the exterior syndrome has resolved, and the interior syndrome is critical; thus, purging is the correct treatment.