结胸有五∶一为邪气结胸，一为痰气结胸，一为滞气结胸，一为水气结胸，其一则误下之结胸也。
虽同一中脘痞懑，而受病不同，施治各异，倘一混投，为祸最烈，学人当明辨之。
邪气结胸，不外因寒因热。寒气遏抑，则胃阳不通，故中脘痞满，四肢倦怠，祛寒平胃散主
之。风热内郁，则胸脘烦闷，心神焦燥，栀子解郁汤主之。
祛寒平胃散（自制）
炮姜（五分） 广皮（一钱） 茅术（一钱） 浓朴（一钱） 佩兰（一钱）
归身（一钱五分） 茯苓（二钱） 木香（五分） 砂仁（一钱） 郁金（二钱） 佛手柑（五分）
栀子解郁汤（自制）
黑山栀（二钱） 栝蒌实（一个切） 连翘（二钱） 薄荷（一钱） 葛根（二钱）
苏梗（一钱五分） 豆豉（三钱） 郁金（二钱） 淡竹叶（二十张） 白茅根（五钱）
痰气结胸，当分燥湿。痰随火升，壅于中脘，竹沥涤痰汤主之。湿痰上泛，窒滞中都，香苏二
陈汤主之。
竹沥涤痰汤（自制）
川贝（二钱） 天竺黄（六分） 羚羊角（一钱五分） 桑皮（二钱） 栝蒌仁（四钱）
石决明（八钱） 杏仁（三钱） 旋复花（一钱绢包） 淡竹沥（半杯冲服） 姜汁（二滴冲服）
香苏二陈汤（自制）
沉香（六分） 苏子（二钱） 橘红（ 一钱） 半夏（一钱五分） 茯苓（二钱）
枳壳（一钱） 浓朴（一钱） 杏仁（三钱） 郁金（二钱） 苡仁（四钱炒） 姜汁（二
小匙冲服）
滞气结胸，症有缓急，治分轻重，古人成法具在，按症用药，尤宜谨慎。
壮热，神昏谵语，胸满拒按，舌焦黑起刺，脉实有力，此为大结胸，大承气汤主之。
大承气汤
大黄（五钱酒洗） 芒硝（五钱） 枳实（一钱五分） 浓朴（一钱五分） 先将枳实、浓
朴煎好，后入大黄，再后入芒硝，煎数沸。
发热，谵语，便硬，胸痞拒按，舌焦黄，脉实有力，此为小结胸，小承气汤主之。
小承气汤
大黄（五钱酒洗） 浓朴（一钱五分） 枳实（一钱五分） 先将浓朴、枳实煎好，后入
大黄，约百沸。
结胸痞满，按之则痛，脉来浮滑者，小陷胸汤主之。
小陷胸汤
黄连（五分） 蒌仁（五钱） 半夏（一钱五分） 水煎服。
结胸失下，以致胸中大实，元气大亏，不下则胀满而死，下之则元气随脱，所谓下亦死、不下
亦死也。然于死中求活，须一面攻下，一面保真如黄龙汤一法，人参、大黄并用，用意虽佳，然究
竟互相牵制，补者不补，而攻者不攻；不若先服攻下之剂，俟药力已达病所，随后即服保纳元气
之剂以收摄之。因自制承气保真汤，十中可救三四。
承气汤
即大黄、芒硝、枳实、浓朴四味。先煎服，俟滞气将动，随服保真汤。
保真汤（自制）
人参（三钱） 附子（二钱） 干河车（四钱） 当归（三钱） 五味（一钱五分）
菟丝子（八钱） 大枣（三枚） 姜（三片）
水结胸，心下至少腹硬满，痛不可近，或潮热，或无大热，但头微汗出，脉沉，名水结胸，
大陷胸汤主之。
大陷胸汤
大黄五钱，先煎，去渣，入芒硝五钱，煎数沸，再入甘遂末一钱，温服。
按此药过于峻猛，万不可轻投，予自制决壅顺流汤，颇能于平稳中取效。
决壅顺流汤（自制）
大黄（三钱） 木通（三钱） 栝蒌实（一个） 浓朴（一钱） 青皮（一钱） 枳实（
一钱） 瞿麦（二钱） 车前子（二钱） 水煎服。
误下之结胸，因邪未入阳明，下之太早，徒伤元气，邪反乘虚而入，居于心胸之间，内既不能
从肠胃而下，外又不能从肌表而出，逗留蕴结，胸脘痞满，按之不痛；盖无形之邪，非有形之滞，
邪在心胸而不在胃也。
诸泻心汤主之。其药味分两，当随症随时谨慎加减。
误下之结胸，心下痞，而复恶寒汗出者，附子泻心汤主之。
附子泻心汤
附子 大黄 黄连 黄芩
误下结胸，痞满不痛，身寒而呕，饮食不下者，半夏泻心汤主之。
半夏泻心汤
半夏 黄连 黄芩 甘草 人参 干姜 大枣
误下结胸，下利完谷不化，腹中雷鸣，心下痞满，干呕心烦者，甘草泻心汤主之。
甘草泻心汤
甘草（倍用） 半夏 黄连 干姜 大枣
结胸病有五种类型：一是邪气结胸，二是痰气结胸，三是滞气结胸，四是水气结胸，五是误用下法导致的结胸。
虽然都表现为中脘部痞塞胀闷，但致病原因不同，治疗方法也各异。如果混淆乱投药物，危害极大，学习者应当仔细辨别。
邪气结胸，不外乎由寒邪或热邪引起。寒气遏制阳气，导致胃阳不通畅，所以出现中脘痞满、四肢倦怠的症状，使用祛寒平胃散主治。风热内郁于体内，则导致胸脘烦闷、心神焦躁不安，使用栀子解郁汤主治。
祛寒平胃散（自制方）
炮姜（五分） 广皮（一钱） 茅术（一钱） 浓朴（一钱） 佩兰（一钱）
归身（一钱五分） 茯苓（二钱） 木香（五分） 砂仁（一钱） 郁金（二钱） 佛手柑（五分）
栀子解郁汤（自制方）
黑山栀（二钱） 栝蒌实（一个，切开） 连翘（二钱） 薄荷（一钱） 葛根（二钱）
苏梗（一钱五分） 豆豉（三钱） 郁金（二钱） 淡竹叶（二十张） 白茅根（五钱）
痰气结胸，应当区分燥痰和湿痰。痰随火势上升，壅塞在中脘部位，使用竹沥涤痰汤主治。湿痰上泛，阻滞在脏腑之中，使用香苏二陈汤主治。
竹沥涤痰汤（自制方）
川贝（二钱） 天竺黄（六分） 羚羊角（一钱五分） 桑皮（二钱） 栝蒌仁（四钱）
石决明（八钱） 杏仁（三钱） 旋复花（一钱，用绢布包裹） 淡竹沥（半杯，冲服） 姜汁（两滴，冲服）
香苏二陈汤（自制方）
沉香（六分） 苏子（二钱） 橘红（一钱） 半夏（一钱五分） 茯苓（二钱）
枳壳（一钱） 浓朴（一钱） 杏仁（三钱） 郁金（二钱） 苡仁（四钱，炒制） 姜汁（两小匙，冲服）
滞气结胸，症状有缓急之分，治疗有轻重之别，古人的成法都在那里，按照症状用药，尤其需要谨慎。
壮热，神志昏迷说胡话，胸部胀满拒按，舌苔焦黑起刺，脉象实而有力，这属于大结胸，使用大承气汤主治。
大承气汤
大黄（五钱，酒洗） 芒硝（五钱） 枳实（一钱五分） 浓朴（一钱五分） 先将枳实、浓朴煎好，后放入大黄，再后放入芒硝，煎煮数沸即可。
发热，说胡话，大便干硬，胸部痞塞拒按，舌苔焦黄，脉象实而有力，这属于小结胸，使用小承气汤主治。
小承气汤
大黄（五钱，酒洗） 浓朴（一钱五分） 枳实（一钱五分） 先将浓朴、枳实煎好，后放入大黄，约煎一百沸。
小陷胸汤
黄连（五分） 蒌仁（五钱） 半夏（一钱五分） 用水煎服。
结胸病若未及时攻下，导致胸中大实，元气大亏，不攻下则会因胀满而死，攻下则元气随之脱失，这就是所谓的“不下亦死，下亦死”。然而在绝境中求生机，必须一面攻下，一面保护真气，如黄龙汤这一方法，人参和大黄并用，用意虽好，但终究互相牵制，补益的不补，攻下的不攻；不如先服用攻下的药剂，等到药力已经到达病所，随后立即服用保养收纳元气的药剂来收敛固摄。因此我自制了承气保真汤，十人中可救活三四。
承气汤
即大黄、芒硝、枳实、浓朴四味药。先煎服，等到滞气将动之时，随即服用保真汤。
保真汤（自制方）
人参（三钱） 附子（二钱） 干河车（四钱） 当归（三钱） 五味子（一钱五分）
菟丝子（八钱） 大枣（三枚） 姜（三片）
水结胸，从心下至少腹部硬满，疼痛剧烈不可触碰，或者伴有潮热，或者没有大热，只有头部微微出汗，脉象沉，称为水结胸，使用大陷胸汤主治。
大陷胸汤
大黄五钱，先煎，去渣，加入芒硝五钱，煎煮数沸，再加入甘遂末一钱，温服。
按语：此药过于峻猛，万万不可轻易投用，我自制了决壅顺流汤，颇能在平稳中取得疗效。
决壅顺流汤（自制方）
大黄（三钱） 木通（三钱） 栝蒌实（一个） 浓朴（一钱） 青皮（一钱） 枳实（一钱） 瞿麦（二钱） 车前子（二钱） 用水煎服。
误用下法导致的结胸，是因为邪气尚未传入阳明经，过早使用下法，徒然损伤元气，邪气反而乘虚而入，停留于心胸之间，内部既不能从肠胃排出，外部又不能从肌表发散，逗留蕴结，导致胸脘痞满，按压时不痛；这是因为无形之邪，而非有形之积滞，邪气在心胸而不在胃。
这种情况使用诸泻心汤主治。药物的剂量，应当根据症状和时机谨慎加减。
误用下法导致的结胸，心下痞塞，又伴有恶寒汗出的，使用附子泻心汤主治。
误用下法导致的结胸，痞满但不痛，身体发冷且呕吐，饮食难下的，使用半夏泻心汤主治。
There are five types of Jie Xiong (Chest Binding Syndrome): one is caused by pathogenic Qi binding, another by Phlegm-Qi binding, another by Stagnant Qi binding, another by Water-Qi binding, and the last is due to improper use of purgatives.
Although all present with fullness and oppression in the epigastrium, the etiology differs, and thus the treatment varies. If mixed indiscriminately, the consequences can be severe; practitioners must distinguish them clearly.
Jie Xiong due to pathogenic Qi is generally caused by either Cold or Heat. When Cold Qi obstructs, causing Stomach Yang to be blocked, symptoms include epigastric fullness and limb fatigue; this is treated with Qu Han Ping Wei San (Cold-Dispersing Stomach-Pacifying Powder). When Wind-Heat is internally constrained, leading to chest and epigastric irritability and mental restlessness, this is treated with Zhi Zi Jie Yu Tang (Gardenia Decoction for Resolving Depression).
Qu Han Ping Wei San (Self-made Formula)
Pao Jiang (Prepared Ginger Rhizome, 0.5 qian) Guang Pi (Tangerine Peel, 1 qian) Mao Zhu (Atractylodes Rhizome, 1 qian) Nong Po (Magnolia Bark, 1 qian) Pei Lan (Eupatorium Herb, 1 qian)
Gui Shen (Angelica Sinensis Root, 1.5 qian) Fu Ling (Poria, 2 qian) Mu Xiang (Costus Root, 0.5 qian) Sha Ren (Amomum Fruit, 1 qian) Yu Jin (Curcuma Tuber, 2 qian) Fo Shou Gan (Finger Citron, 0.5 qian)
Zhi Zi Jie Yu Tang (Self-made Formula)
Hei Shan Zhi (Black Gardenia Fruit, 2 qian) Gua Lou Shi (Trichosanthes Fruit, 1 whole, cut) Lian Qiao (Forsythia Fruit, 2 qian) Bo He (Mint Herb, 1 qian) Ge Gen (Kudzu Root, 2 qian)
Su Geng (Perilla Stem, 1.5 qian) Dou Chi (Fermented Soybean, 3 qian) Yu Jin (Curcuma Tuber, 2 qian) Dan Zhu Ye (Lophatherum Leaf, 20 leaves) Bai Mao Gen (Imperata Rhizome, 5 qian)
Jie Xiong due to Phlegm-Qi should be differentiated into Dry Phlegm and Damp Phlegm. When Phlegm rises with Fire and obstructs the epigastrium, it is treated with Zhu Li Di Tan Tang (Bamboo Juice Decoction for Washing Away Phlegm). When Damp-Phlegm floats upward and obstructs the middle jiao, it is treated with Xiang Su Er Chen Tang (Agarwood and Perilla Decoction Combined with Two-Chen Decoction).
Zhu Li Di Tan Tang (Self-made Formula)
Chuan Bei (Sichuan Fritillary Bulb, 2 qian) Tian Zhu Huang (Calamus Tuber, 0.6 fen) Ling Yang Jiao (Antelope Horn, 1.5 qian) Sang Pi (Mulberry Root Bark, 2 qian) Gua Lou Ren (Trichosanthes Seed, 4 qian)
Shi Jue Ming (Abalone Shell, 8 qian) Xing Ren (Apricot Seed, 3 qian) Xuan Fu Hua (Inula Flower, 1 qian, wrapped in silk) Dan Zhu Li (Light Bamboo Juice, half cup, taken with decoction) Jiang Zhi (Ginger Juice, two drops, taken with decoction)
Xiang Su Er Chen Tang (Self-made Formula)
Chen Xiang (Aquilaria Wood, 0.6 fen) Su Zi (Perilla Fruit, 2 qian) Ju Hong (Aged Tangerine Peel, 1 qian) Ban Xia (Pinellia Tuber, 1.5 qian) Fu Ling (Poria, 2 qian)
Zhi Ke (Bitter Orange Fruit, 1 qian) Nong Po (Magnolia Bark, 1 qian) Xing Ren (Apricot Seed, 3 qian) Yu Jin (Curcuma Tuber, 2 qian) Yi Ren (Coix Seed, 4 qian, stir-fried) Jiang Zhi (Ginger Juice, two small spoons, taken with decoction)
Jie Xiong due to Stagnant Qi presents with varying severity and urgency; treatments vary accordingly. Ancient methods are available, but medication must be selected cautiously according to symptoms.
With high fever, delirium, chest fullness with tenderness on pressure, a black and prickly tongue coating, and a forceful pulse, this is Da Jie Xiong (Major Chest Binding); it is treated with Da Cheng Qi Tang (Major Order the Qi Decoction).
Da Cheng Qi Tang
Da Huang (Rhubarb Root, 5 qian, washed with wine) Mang Xiao (Mirabilite, 5 qian) Zhi Shi (Immature Bitter Orange Fruit, 1.5 qian) Nong Po (Magnolia Bark, 1.5 qian). First decoct Zhi Shi and Nong Po, then add Da Huang, and finally add Mang Xiao. Bo a few times before serving.
With fever, delirium, hard stools, epigastric fullness with tenderness on pressure, a yellow and scorched tongue coating, and a forceful pulse, this is Xiao Jie Xiong (Minor Chest Binding); it is treated with Xiao Cheng Qi Tang (Minor Order the Qi Decoction).
Xiao Cheng Qi Tang
Da Huang (Rhubarb Root, 5 qian, washed with wine) Nong Po (Magnolia Bark, 1.5 qian) Zhi Shi (Immature Bitter Orange Fruit, 1.5 qian). First decoct Nong Po and Zhi Shi, then add Da Huang. Bo about one hundred times.
When Jie Xiong presents with fullness and pain upon pressure, and a floating-slippery pulse, it is treated with Xiao Xian Xiong Tang (Minor Infiltrating the Chest Decoction).
Xiao Xian Xiong Tang
Huang Lian (Coptis Rhizome, 0.5 fen) Lou Ren (Trichosanthes Seed, 5 qian) Ban Xia (Pinellia Tuber, 1.5 qian). Decoct in water and take orally.
If Jie Xiong is not purged in time, leading to extreme excess in the chest and severe deficiency of Yuan Qi (Primal Qi), failure to purge leads to death from distension, while purging may lead to collapse of Yuan Qi. This is described as "death if not purged, death if purged." However, seeking life amidst death requires simultaneous purging and preservation of True Qi. For example, Huang Long Tang (Yellow Dragon Decoction) uses both Ren Shen (Ginseng) and Da Huang (Rhubarb). Although well-intentioned, these ingredients may counteract each other, resulting in neither tonification nor purgation being effective. It is better to first administer a purgative until its action reaches the disease site, then immediately follow with a tonic to preserve and consolidate Yuan Qi. Therefore, I self-made Cheng Qi Bao Zhen Tang (Order the Qi and Preserve True Qi Decoction), which can save three or four out of ten patients.
Cheng Qi Tang
Consists of Da Huang (Rhubarb Root), Mang Xiao (Mirabilite), Zhi Shi (Immature Bitter Orange Fruit), and Nong Po (Magnolia Bark). Take this first. When stagnant Qi begins to move, subsequently take Bao Zhen Tang.
Bao Zhen Tang (Self-made Formula)
Ren Shen (Ginseng Root, 3 qian) Fu Zi (Prepared Aconite Root, 2 qian) Gan He Che (Dried Placenta, 4 qian) Dang Gui (Angelica Sinensis Root, 3 qian) Wu Wei (Schisandra Berry, 1.5 qian)
Tu Si Zi (Dodder Seed, 8 qian) Da Zao (Jujube Fruit, 3 pieces) Jiang (Fresh Ginger, 3 slices)
Water Jie Xiong presents with hardness and fullness from the epigastrium down to the lower abdomen, with pain so severe that touch is intolerable, possibly accompanied by tidal fever or absence of significant fever, only slight sweating on the head, and a deep pulse. This is named Water Jie Xiong and is treated with Da Xian Xiong Tang (Major Infiltrating the Chest Decoction).
Da Xian Xiong Tang
Da Huang (Rhubarb Root, 5 qian), decoct first, remove dregs, add Mang Xiao (Mirabilite, 5 qian), boil a few times, then add Gan Sui (Kansui Root powder, 1 qian). Take warm.
Note: This medicine is too harsh and must never be used lightly. I self-made Jue Yong Shun Liu Tang (Unblocking Obstruction and Smoothing Flow Decoction), which achieves efficacy steadily.
Jue Yong Shun Liu Tang (Self-made Formula)
Da Huang (Rhubarb Root, 3 qian) Mu Tong (Akebia Stem, 3 qian) Gua Lou Shi (Trichosanthes Fruit, 1 whole) Nong Po (Magnolia Bark, 1 qian) Qing Pi (Green Tangerine Peel, 1 qian) Zhi Shi (Immature Bitter Orange Fruit, 1 qian) Qu Mai (Dianthus Herb, 2 qian) Che Qian Zi (Plantago Seed, 2 qian). Decoct in water and take orally.
Jie Xiong due to improper purgation occurs when pathogens have not yet entered the Yangming stage, but purgatives were used too early, merely damaging Yuan Qi. The pathogens then enter vacuously and lodge between the heart and chest. Unable to exit via the intestines and stomach internally, nor via the muscle surface externally, they linger and bind, causing chest and epigastric fullness without pain upon pressure. This is because it is formless pathogenic Qi, not formed stagnation; the pathogen is in the heart and chest, not the Stomach.
This is treated with various Xi Xin Tang (Drain the Heart Decoctions). Dosages should be adjusted cautiously according to symptoms and timing.
For Jie Xiong due to improper purgation, presenting with epigastric fullness, aversion to cold, and sweating, Fu Zi Xi Xin Tang (Aconite Drain the Heart Decoction) is indicated.
Fu Zi Xi Xin Tang
Fu Zi (Prepared Aconite Root) Da Huang (Rhubarb Root) Huang Lian (Coptis Rhizome) Huang Qin (Scutellaria Root)
For Jie Xiong due to improper purgation, presenting with fullness without pain, body coldness, vomiting, and inability to eat, Ban Xia Xi Xin Tang (Pinellia Drain the Heart Decoction) is indicated.
Ban Xia Xi Xin Tang
Ban Xia (Pinellia Tuber) Huang Lian (Coptis Rhizome) Huang Qin (Scutellaria Root) Gan Cao (Licorice Root) Ren Shen (Ginseng Root) Gan Jiang (Dried Ginger) Da Zao (Jujube Fruit)
For Jie Xiong due to improper purgation, presenting with diarrhea of undigested food, borborygmus, epigastric fullness, dry retching, and irritability, Gan Cao Xi Xin Tang (Licorice Drain the Heart Decoction) is indicated.
Gan Cao Xi Xin Tang
Gan Cao (Licorice Root, doubled dose) Ban Xia (Pinellia Tuber) Huang Lian (Coptis Rhizome) Gan Jiang (Dried Ginger) Da Zao (Jujube Fruit)