〔仲景（见血门）〕
（仲景）
治伤寒下之早，表邪入里，心下满而硬痛，或重汗而复下之，不大便五六日，舌上燥渴，
日晡潮热，从心至小腹硬满，痛不可近；或无大热，但头微汗出，脉沉，为水结胸。（按之
硬痛
又次
重汗
饮结
久不
结胸
阳误下
发于阳
曰∶发
嘉言曰
发阴，
言以寒
是阴证
于内者
经而下
下或边
寒药，
胁肋胀
胁满多
巴豆
苦辛
大黄（二两） 芒硝（一升） 甘遂（一钱。）为末。先煮大黄，去渣；内芒硝，煮一
二沸，
此足太阳药也。表邪入里，结于高位，以致三焦俱实，手不可近，证为危急，非常药
所能平。故
至峻，而有起死之功（《准绳》曰∶邪结胸中，处至高之分，宜若可吐；然邪气与胸中阳气
相结，不能分解，壅于心下，为硬为痛，非虚烦膈实者所可同，故须攻下之。低者举之，高
者陷之，以平为正，故曰陷胸也。经又曰∶太阳病脉浮而动数，浮则为风，数则为热，动则
为痛，数则为虚。头痛、发热微、盗汗出而反恶寒者，表未解也，医反下之，动数变迟，膈
内拒痛，胃中空虚，客气动膈，短气躁烦，心中懊 ，阳气内陷，心下因硬，则为结胸，大
陷胸汤主之。朱丹溪曰∶太阳病在表而攻里，可谓虚矣。原文曰∶太阳病脉浮而动数，今得
误下，动数变迟矣。又曰∶胃中空虚。又曰短气躁烦，虚之甚矣，借曰阳气内陷，心下因硬，
而可迅攻之乎。岂陷胸之力，反缓于承气，一下再下，宁不畏其虚乎。前文曰∶结胸脉浮大
者，下之死，又曰∶结胸证悉具，烦躁者死，今曰脉浮，又曰烦躁，大陷胸果可用乎。若胃
中空虚，客气动膈，心中懊 者，当以栀子豉汤吐去胸中之邪。陶节庵曰∶结胸乃下早而成，
未曾经下者，非结胸也，乃表邪传入胸中，证虽满闷，尚为在表，正属少阳部分，半表半里
之间，只须小柴胡加枳桔以治，未效则以小柴胡对小陷胸一服豁然。若因下早而成者，方用
陷胸汤，以分浅深，从缓治之，不宜太峻。上焦乃清道至高之分，过下则伤元气也。崔行功
曰∶伤寒结胸欲绝，心膈高起，手不可近，用大陷胸汤。不瘥者，此下后虚逆，气已不理，
毒复上攻，当用枳实理中丸，先理其气，次调诸疾，用之如神。《活人》云∶误下未成结胸
者，急频与理中汤，自然解了，盖理中治中焦故也。胃中虽和，伤寒未退者，宜侯日数足，
却以承气再下之，盖前药之下未是也。其水结胸者，用小半夏加茯苓汤、小柴胡去枣加牡蛎
主之；又有血结胸证，手不可近，漱水不欲咽，善妄如狂，大便黑，小便利，宜犀角地黄汤。
刘心山曰∶结胸痞满，多由痰饮凝结心胸，故陷胸、泻心用甘遂、半夏、栝蒌、枳实、旋复
之类，皆为
【张仲景（参见“见血门”章节）】
治疗伤寒因过早使用泻下法，导致表邪内陷进入里部，出现心下部胀满且坚硬疼痛；或者经过再次发汗后又误用泻下法，导致五六日不大便，舌面干燥口渴，下午申时左右出现潮热，从心窝直到小腹部硬满，疼痛剧烈到不能触碰；或者没有明显的大热，仅头部微微出汗，脉象沉，这是水饮结聚形成的结胸证。（按之则硬痛，又其次为重度发汗后饮水停结，久治不愈形成结胸。阳经病误用下法，发于阳经者……嘉言曰：发阴经者，是以寒药……这是阴证在内部……经病而下……下或边……寒药，胁肋胀……胁满多……巴豆……苦辛……大黄（二两）芒硝（一升）甘遂（一钱）。研为末。先煮大黄，去渣；加入芒硝，煮一二沸。）
这是足太阳膀胱经的药物。表邪入里，结聚于高位，导致三焦俱实，手不可触碰，证候危急，非常规药物所能平复。因此（此方作用）至为峻猛，却有起死回生的功效。（《准绳》说：邪气结聚于胸中，处于最高之位，似乎应当用吐法；然而邪气与胸中阳气相结，不能分解，壅塞于心下，导致硬痛，这不是虚烦膈实者可以等同视之的，所以必须用攻下法。低位的病证用提升法，高位的病证用陷下法，以平正为原则，所以称为“陷胸”。经文又说：太阳病脉象浮而动数，浮则为风邪，数则为热邪，动则为痛，数则为虚。头痛、发热、微盗汗出而反而恶寒的，说明表证未解，医生反而用下法，导致动数之脉变为迟脉，膈内拒痛，胃中空虚，客气扰动膈膜，短气躁烦，心中懊恼，阳气内陷，心下因此变硬，这就形成了结胸，用大陷胸汤主治。朱丹溪说：太阳病在表却攻里，可以说是虚了。原文说：太阳病脉浮而动数，现在误用下法，动数变为迟脉。又说：胃中空虚。又说短气躁烦，这是极度的虚证，假如说是阳气内陷，心下因此变硬，难道可以迅速攻下吗？难道陷胸汤的力量，反而比承气汤缓慢吗？一下再下，难道不怕损伤正气吗？前文说：结胸脉浮大的，下之则死，又说：结胸证全部具备，烦躁者死，现在说脉浮，又说烦躁，大陷胸汤果真可以用吗？如果胃中空虚，客气动膈，心中懊恼的，应当用栀子豉汤吐去胸中之邪。陶节庵说：结胸是因过早下法而成，未曾经过下法的，不是结胸，而是表邪传入胸中，证候虽然满闷，尚且在表，正属于少阳部分，在半表半里之间，只需用小柴胡汤加枳壳、桔梗来治疗，无效则以小柴胡汤合小陷胸汤一服即豁然开朗。如果是因过早下法而成的，才用陷胸汤，以区分深浅，从缓治疗，不宜过于峻猛。上焦是清道，处于最高之位，过度攻下则会损伤元气。崔行功说：伤寒结胸欲绝，心膈高起，手不可触碰，用大陷胸汤。如果不痊愈，这是下法后虚逆，气机已乱，毒邪再次上攻，应当用枳实理中丸，先调理气机，其次调治诸疾，效果如神。《活人书》说：误下但未形成结胸的，急频给予理中汤，自然解除，因为理中汤治疗中焦的缘故。胃中虽调和，但伤寒未退的，宜等待日数充足，再用承气汤攻下，因为前面的下药力度不够。那些水结胸的，用小半夏加茯苓汤、小柴胡汤去大枣加牡蛎主治；又有血结胸证，手不可触碰，漱水不欲咽，善妄如狂，大便黑，小便通利，宜用犀角地黄汤。刘心山说：结胸痞满，多由痰饮凝结心胸，所以陷胸、泻心汤用甘遂、半夏、栝蒌、枳实、旋覆花之类，都是……
[Zhang Zhongjing (see "Section on Bleeding") ]
Treats conditions where early purgation in Cold Damage (Shanghan) causes exterior pathogens to penetrate inward, resulting in fullness and hardness with pain in the epigastrium; or after repeated sweating followed by misapplied purgation, leading to constipation for five to six days, dry tongue with thirst, tidal fever around the Shen hour (3-5 PM), hardness and fullness from the heart to the lower abdomen with pain so severe it cannot be touched; or without significant heat, only slight sweating on the head, and a deep pulse, indicating Water-Binding Chest Syndrome (Jie Xiong). (Pressing causes hardness and pain; next is heavy sweating leading to fluid retention binding; long-standing cases lead to Jie Xiong. Yang channel diseases misused with purgation... Jiayan said: Fa Yin [emerging from Yin]... speaking of cold medicines... this is a Yin syndrome internally... meridian disease treated with purgation... purgation or sides... cold medicines, hypochondriac distension... hypochondriac fullness mostly... Croton seed (Badou)... bitter and pungent... Rhubarb (Dahuang) (2 liang), Mirabilite (Mangxiao) (1 sheng), Kansui (Gansui) (1 qian). Pulverized. First decoct Dahuang, remove dregs; add Mangxiao, boil one or two boils.)
This is a formula for the Foot-Taiyang Bladder Meridian. Exterior pathogens enter the interior and bind at a high position, causing all three Jiaos to be excess, making the area untouchable; the syndrome is critical and cannot be resolved by ordinary medicines. Therefore, its action is extremely峻猛 (harsh/potent), yet it has the power to revive the dead. (*Zhunsheng* states: Pathogens binding in the chest are at the highest point, seemingly suitable for emesis; however, pathogenic qi binds with the Yang qi of the chest and cannot separate, obstructing the epigastrium, causing hardness and pain. This is not comparable to deficiency vexation or diaphragmatic excess, so purgation is required. Low syndromes are lifted, high syndromes are陷 (sunken/descended); equilibrium is the standard, hence named "Xian Xiong" [Cave/Descend Chest]. The Classic further states: In Taiyang disease, if the pulse is floating, moving, and rapid, floating indicates Wind, rapid indicates Heat, moving indicates Pain, and rapid indicates Deficiency. Headache, fever, slight night sweats, yet aversion to cold indicates the exterior is unresolved. If the physician erroneously uses purgation, the moving/rapid pulse becomes slow, there is resistance and pain in the diaphragm, the Stomach is empty and deficient, hostile Qi disturbs the diaphragm, causing shortness of breath, irritability, and inner restlessness (Ao Nao). Yang Qi sinks inward, the epigastrium becomes hard, forming Jie Xiong, treated with Da Xian Xiong Tang. Zhu Danxi said: Treating an exterior Taiyang syndrome by attacking the interior is indeed deficient. The original text says: Taiyang pulse is floating, moving, and rapid; now after erroneous purgation, it becomes slow. It also says: The Stomach is empty and deficient. It also says: Shortness of breath and irritability indicate extreme deficiency. If we say Yang Qi has sunk inward and the epigastrium is hard, can we swiftly purge? Is the power of Xian Xiong Tang actually slower than Cheng Qi Tang? Purging once then again, are we not afraid of causing deficiency? The previous text states: If the pulse in Jie Xiong is floating and large, purgation leads to death. It also states: If all Jie Xiong symptoms are present and there is irritability, death ensues. Now it mentions a floating pulse and irritability; can Da Xian Xiong Tang truly be used? If the Stomach is empty, hostile Qi disturbs the diaphragm, and there is inner restlessness, Zhi Zi Chi Tang should be used to vomit out the pathogens from the chest. Tao Jian'an said: Jie Xiong is formed by early purgation. Those who have not been purged do not have Jie Xiong; rather, exterior pathogens have transmitted to the chest. Although there is fullness and oppression, it remains in the exterior, belonging to the Shaoyang aspect, between the exterior and interior. Only Xiao Chai Hu Tang plus Zhi Ke and Jie Geng is needed. If ineffective, one dose of Xiao Chai Hu Tang combined with Xiao Xian Xiong Tang brings sudden relief. If formed due to early purgation, then Xian Xiong Tang is used to distinguish depth and treat gradually, avoiding excessive harshness. The Upper Jiao is the clear pathway at the highest position; excessive purgation damages Yuan Qi. Cui Xinggong said: For severe Cold Damage Jie Xiong with high elevation of the heart and diaphragm, untouchable to the hand, use Da Xian Xiong Tang. If not cured, this is post-purgation deficiency and rebellion, Qi is disordered, and toxins attack upward again. Use Zhi Shi Li Zhong Wan to first regulate Qi, then treat other ailments; the effect is miraculous. *Huo Ren* states: If erroneous purgation has not yet formed Jie Xiong, urgently and frequently give Li Zhong Tang, and it will naturally resolve, as Li Zhong Tang treats the Middle Jiao. If the Stomach is harmonious but Cold Damage persists, wait for sufficient days, then use Cheng Qi Tang to purge again, as the previous purgative was insufficient. For Water-Binding Chest, use Xiao Ban Xia Jia Fu Ling Tang or Xiao Chai Hu Tang removing Da Zao and adding Mu Li. There is also Blood-Binding Chest syndrome, untouchable, rinsing water but not swallowing, delirium like madness, black stool, free urination; use Xi Jiao Di Huang Tang. Liu Xinshan said: Jie Xiong and Pi Man are mostly caused by Phlegm-Fluid congealing in the heart and chest, therefore Xian Xiong and Xie Xin formulas use Gansui, Ban Xia, Gua Lou, Zhi Shi, Xuan Fu Hua, etc., which are all...)