囊缩为足厥阴肝经受病，因热极筋枯，而燥缩也。再看其大小便结，发热引饮者，急用大承
气下之。若无下症而脉浮者，宜汗，缓者宜和。六七日，脉微浮微缓，是有胃气，胃不受邪，将作
寒热，则大汗解矣。阴症而囊缩者，不在此例。
吴又可《瘟疫论》中，止有胸胁腹满一症，而抑知结胸痞气，瘟疫中皆有之，且不因误下而成
者更多也。论曰∶太阳病表未解，医反下之，膈内拒痛，心下因 ，则为结胸。又曰∶从心下至少
腹满而痛不可近为结胸，皆大陷胸汤主之。夫曰膈内拒痛，是胸胁间事；曰心下 ，则兼胃之
上脘而言也。曰从心下至少腹，则又兼满腹而言矣。盖表邪传里，必先胸以至心腹耳。第大结胸最
重，小结胸次之，痞气则又其次也。经又曰∶病发于阳而反下之，热入因作结胸，病发于阴而反下
之，因作痞。而成氏释曰∶发热恶寒，发于阳，无热恶寒，发于阴。夫无热恶寒，似指寒邪直中阴
经之症。随来陶张二氏之驳，驳之诚是也，而阴阳二字，总未得真解，故有谓伤风属阳，而伤寒属
阴者。有谓在表属阳，在里属阴者，纷纷聚讼，随成千古之疑团。愚意以为，何必尽推敲阴阳二字
于闲处错意。不论大小结胸，以
及痞气支结，皆属于郁，郁而未有不结者，总以开郁为主，而痞结自散矣。又当审其兼症，诊其
脉理。气郁者，顺之调之；血郁者，行之破之；痰郁者，化之吐之；表郁者，散之和之；里郁者，
攻之下之；热郁者，清之；寒郁者，温之；（瘟疫无寒，或过服寒凉药，或汗下后。）食郁者，消之；
水郁者，利之。而治痞结之能事尽矣。至于仲景用大陷胸汤，治误下之结胸，想古人所秉者浓，故误
下而复用陷胸不至为害，至陶氏则心知其未稳，故有上焦乃清道至高之分，过下则伤元气之论。
然尚未敢深驳。惟张景岳则云∶伤寒本病有不因误下，而实邪传里，心下 满，痛连少腹而不可近
者，此大陷胸汤所宜也。至于太阳、少阳表邪未解，因下早而成结胸者，若再用大陷胸，是既因
误下而复下之，可乎？不若以痞满门诸法，酌轻重而从双解，或用葱熨法，以解散胸中实邪。此余
屡用而屡效等语，虽大翻仲景之案，然明白洞达，有至理存焉，真长沙之功臣，结胸之宝筏，最稳
最捷者也。且外熨法不特治结胸为然，遇瘟疫用药弗效，俟六七日，应汗不汗之期，觉心腹稍有痞
闷疼痛，用葱熨法（见前 熨）。往往大汗而解。至于陷胸等汤，一概不录。
囊缩是足厥阴肝经受病，因热极导致筋脉干枯，从而出现干燥收缩的症状。再看如果伴有大小便不通、发热且想喝水的情况，应立即使用大承气汤攻下。如果没有可下的症状而脉象浮的，适宜用发汗法；病情缓和的适宜用和解法。病程六七天，脉象微浮微缓，说明还有胃气，胃不受邪气侵犯，将要出现寒热交替的症状，这时通过大汗即可解除。属于阴证而出现囊缩的，不在此列讨论。
吴又可《瘟疫论》中，只有胸胁腹部胀满这一症状的描述，哪里知道结胸和痞气在瘟疫病中也都存在，而且并非因为误用下法才形成的情况更多。经文说：太阳病表证未解，医生反而使用下法，膈内抗拒疼痛，心下硬满，就形成结胸。又说：从心下直到小腹部胀满且疼痛剧烈到不能触碰的，属于结胸，都用大陷胸汤主治。所谓“膈内拒痛”，是指胸胁间的事情；所谓“心下硬满”，则兼指胃的上脘部位而言。所谓“从心下至少腹”，则是兼指整个腹部胀满而言。大概表邪传入里部，必定先从胸部传到心腹。只是大结胸最严重，小结胸次之，痞气又再次之。经文又说：病发于阳而反用下法，热邪内入因而形成结胸；病发于阴而反用下法，因而形成痞证。成无己解释为：发热恶寒，是发于阳；无热恶寒，是发于阴。那无热恶寒，似乎指的是寒邪直接中伤阴经的症状。随后陶华、张介宾两位先生对此进行驳斥，驳斥得确实正确，但是对“阴阳”二字，始终没有获得真正的理解，所以有人说是伤风属阳，而伤寒属阴；有人说是病在表属阳，病在里属阴，纷纷争论，遂成为千古疑团。我认为，何必非要推敲“阴阳”二字在无关紧要处产生误解。不论是大结胸、小结胸，以及痞气、支结，都属于郁滞，郁滞而没有不结聚的，总以开郁为主，那么痞结自然消散了。还应当审查其兼夹症状，诊察其脉理。气机郁滞的，顺其势调理它；血瘀郁滞的，行血破瘀；痰湿郁滞的，化痰涌吐；表郁的，发散和解；里郁的，攻下；热郁的，清热；寒郁的，温散（瘟疫本无寒证，或是过服寒凉药，或汗下之后）；食积郁滞的，消导；水饮郁滞的，利水。这样治疗痞结的能事就完备了。至于张仲景使用大陷胸汤，治疗误下导致的结胸，猜想古人禀赋浓厚，所以误下后复用陷胸汤不至于造成危害。到了陶华氏则心里知道这并不稳妥，所以有上焦是清道至高之分，过度攻下会损伤元气的论述。然而尚不敢深入驳斥。只有张景岳说：伤寒本病中有不因误下，而是实邪传入里部，心下硬满，疼痛牵连少腹且不能触碰的，这是大陷胸汤适宜的适应症。至于太阳、少阳表邪未解，因为过早使用下法而成结胸的，如果再使用大陷胸汤，是因为误下而又再次攻下，可以吗？不如以痞满门的各种方法，斟酌轻重采用双解法，或者用葱熨法，来解散胸中的实邪。这是我屡用而屡效的话，虽然大大推翻张仲景的案例，但明白透彻，有至理存在，真是长沙太守（张仲景）的功臣，治疗结胸的宝筏，是最稳妥最快捷的方法。而且外熨法不仅治疗结胸是这样，遇到瘟疫用药无效，等到六七天，应当发汗而不发汗的时期，感觉心腹稍有痞闷疼痛，使用葱熨法（见前文熨法），往往大汗而解。至于陷胸等汤剂，一概不收录。
Scrotal retraction is a disease of the Foot-Jueyin Liver Meridian, caused by extreme heat leading to withering of the sinews and subsequent dry contraction. If accompanied by constipation of both stool and urine, fever, and thirst, Da Cheng Qi Tang (Great Order the Qi Decoction) should be urgently administered to purge. If there are no signs for purging but the pulse is floating, sweating is appropriate; if the condition is mild, harmonizing is appropriate. After six or seven days, if the pulse is slightly floating and slightly slow, it indicates the presence of Stomach Qi, meaning the Stomach is not invaded by pathogenic factors, and chills and fever will likely occur, which can be resolved through profuse sweating. Cases of scrotal retraction due to Yin patterns are not included in this discussion.
Wu Keyi's *Treatise on Plague* only mentions abdominal distension in the chest, hypochondrium, and abdomen. How could one know that Jie Xiong (Chest Binding) and Pi Qi (Stagnant Qi) also occur in plague, and that many cases do not result from improper purgation? The classic states: "In Taiyang disease, when the exterior is unresolved, if the physician erroneously uses purgation, pain with resistance in the epigastrium and hardness below the heart constitute Jie Xiong (Chest Binding)." It further states: "Fullness and pain extending from below the heart to the lower abdomen, so severe that it cannot be touched, constitutes Jie Xiong (Chest Binding), treated primarily with Da Xian Xiong Tang (Great Sinking into the Chest Decoction)." "Resistance in the epigastrium" refers to issues in the chest and hypochondrium; "hardness below the heart" refers to the upper epigastrium of the Stomach. "From below the heart to the lower abdomen" refers to fullness of the entire abdomen. Generally, when exterior pathogens transmit inward, they must pass through the chest to reach the heart and abdomen. However, Da Jie Xiong (Major Chest Binding) is the most severe, Xiao Jie Xiong (Minor Chest Binding) is next, and Pi Qi (Stagnant Qi) is the least severe. The classic also states: "Disease originating from Yang, if erroneously purged, heat enters and forms Jie Xiong (Chest Binding); disease originating from Yin, if erroneously purged, forms Pi (Stagnation)." Cheng Wuji explained: "Fever with aversion to cold originates from Yang; absence of fever with aversion to cold originates from Yin." The absence of fever with aversion to cold seems to refer to cold pathogens directly striking the Yin meridians. Tao Hua and Zhang Jingyue refuted this, correctly so, yet neither achieved a true understanding of "Yin and Yang." Consequently, some argued Wind-Strike belongs to Yang while Cold Damage belongs to Yin; others argued Exterior belongs to Yang while Interior belongs to Yin. These disputes created an eternal puzzle. I believe there is no need to over-analyze the terms "Yin and Yang" in irrelevant contexts. Regardless of Major Jie Xiong, Minor Jie Xiong, Pi Qi, or Zhi Jie (Branches of Binding), all belong to Yu (Stagnation). Stagnation inevitably leads to binding; thus, the primary treatment is to open stagnation, after which the Pi binding will naturally dissipate. One must examine accompanying symptoms and diagnose the pulse. For Qi stagnation, regulate it smoothly; for Blood stagnation, invigorate and break it; for Phlegm stagnation, resolve and induce vomiting; for Exterior stagnation, disperse and harmonize; for Interior stagnation, attack and purge; for Heat stagnation, clear it; for Cold stagnation, warm it (Plague inherently lacks Cold, or results from excessive use of cold-cooling herbs, or post-sweating/purging); for Food stagnation, digest it; for Water stagnation, promote diuresis. This completes the treatment of Pi binding. Regarding Zhang Zhongjing's use of Da Xian Xiong Tang for Jie Xiong caused by erroneous purgation, it is presumed that ancient patients had robust constitution, so using Xian Xiong Tang after erroneous purgation did not cause harm. Tao Hua recognized this was unstable, arguing that the Upper Jiao is the highest part of the Clear Path, and excessive purgation damages Yuan Qi (Primal Qi). However, he dared not deeply refute it. Only Zhang Jingyue stated: "In Cold Damage, there are cases not caused by erroneous purgation, where solid pathogens transmit to the interior, causing hardness below the heart, pain radiating to the lower abdomen untouchable, which is suitable for Da Xian Xiong Tang." He continued: "For Taiyang and Shaoyang exterior pathogens unresolved, if Jie Xiong results from premature purgation, using Da Xian Xiong Tang again would mean purging after erroneous purgation, is this acceptable?" He suggested using methods from the Pi Fullness chapter, adjusting for severity with dual-release methods, or using Cong Xi Fa (Green Onion Moxibustion/Fomentation) to disperse solid pathogens in the chest. This is my experience of frequent efficacy. Although this overturns Zhang Zhongjing's cases, it is clear and profound, containing sound principles. He is truly a meritorious servant of Changsha (Zhang Zhongjing) and a precious raft for treating Jie Xiong, being the most stable and rapid method. Moreover, external fomentation is not only for Jie Xiong; in plague cases where medication fails, waiting until the sixth or seventh day—the time for sweating but without it—if slight epigastric/abdominal stuffiness and pain are felt, applying Green Onion Fomentation often resolves the condition with profuse sweating. Therefore, formulas like Xian Xiong Tang are not recorded.