治伤寒发热，不发汗而反下之，表热乘虚入于胸中，与不得为汗之水气结而不散，令心
下至少腹石硬而痛不可近者，名大结胸证。其人身无大热，但头汗出，或潮热燥渴，脉沉而
紧。
大黄（六两酒洗） 芒硝（一升） 甘遂（一钱匕） 水六升，先煮大黄取二升，去滓，
纳芒硝，
治结胸项强，如柔痉状者；并治阳明热喘，及水肿初起形实者。
大黄（半斤） 葶苈子（熬） 芒硝 杏仁（各半升去皮尖熬黑） 先捣葶苈、大黄为
末，纳杏仁、芒硝合研如脂，和散，取如弹丸一枚；别捣甘遂末一钱匕，白蜜二合，水二升，
煮一升，温
大陷胸（汤）治大结胸，大黄（涤热荡实）芒硝（软坚破结）甘遂（逐水消饮）从。心
腹石硬（结胸之的证）痛拒按，（心下至少腹石硬而痛不可近，较承气证为尤甚。）便秘焦烦
燥渴供。（与承气证同）但头汗出脉沉紧，（结胸因下早，致热与水结，热不外泄，而但上蒸，
故头有汗而身无汗。脉沉紧者，水遏热伏，阳病（反见阴脉。）水结胸中治亦同。（结胸本无
他物，热与水气结也。）项若强如柔痉状，更加葶杏蜜丸攻。（名大陷胸丸 结胸项强，邪据
太阳之高位矣，故于前方加葶苈、杏仁，从高陷下其邪。蜜丸者，欲其缓攻于下也。）此泄
水邪并热实，（此陷胸汤丸之总诀）太阴寒实勿相蒙。（寒实结胸，治宜温下，误服寒药则死。）
后人通变斯方治，热喘水肿有殊功。（按∶大陷胸丸，王海藏以之治阳明热喘，柯韵伯以之
治水肿初起形实者，均收奇效。可知古方贵于活用，触类旁通，医之能事毕矣。）
治疗伤寒发热，本应发汗却反而使用下法，导致表热乘虚进入胸中，与体内无法化为汗液的水气相互搏结而消散不去，致使从心下（胃脘部）直到小腹坚硬如石且疼痛剧烈、拒按不可触碰的病症，称为大结胸证。患者身上没有明显的大热，仅头部出汗，或者出现定时发热、烦躁口渴，脉象沉而紧。
大黄（六两，用酒清洗） 芒硝（一升） 甘遂（一钱匕） 用水六升，先煮大黄取二升药液，滤去药渣，加入芒硝，
治疗结胸证伴有项部强直，类似柔痉症状者；同时也治疗阳明经热盛引起的喘息，以及水肿初起体质壮实者。
大黄（半斤） 葶苈子（炒制） 芒硝 杏仁（各半升，去皮尖，炒至黑色） 先将葶苈子、大黄捣成粉末，加入杏仁、芒硝共同研磨成膏状，混合均匀制成散剂，取如弹丸大小的一枚；另将甘遂捣成细末一钱匕，白蜜二合，水二升，煎煮至一升，温服。
大陷胸汤治疗大结胸证：大黄具有涤荡热邪、攻逐实邪的作用；芒硝具有软化坚积、破除结聚的作用；甘遂具有驱逐水饮、消除痰饮的作用。这是针对心腹部位坚硬如石（大结胸证的典型症状）、疼痛拒按（从心下至少腹坚硬如石且疼痛剧烈不可触碰，比承气汤证更为严重）、便秘、焦躁烦渴（与大承气汤证相同）的症状。若仅见头部出汗、脉象沉紧（结胸因过早攻下，导致热邪与水气互结，热邪不能向外发散，只能向上蒸腾，所以只有头部出汗而身体无汗。脉象沉紧，是因为水气遏制热邪潜伏，阳病反见阴脉）。水气结于胸中的治法也与此相同。如果项部强直如同柔痉的样子，则需加用葶苈子、杏仁和白蜜制成的丸剂来攻逐（名为大陷胸丸。结胸证出现项强，说明邪气占据太阳经的高位，所以在前方基础上加入葶苈子、杏仁，从高处分消并向下引邪外出。制成蜜丸，是为了使其作用缓和，缓缓攻下）。这是泄除水邪兼清热实的总诀。太阴寒实证不可混淆（寒实结胸，治疗宜用温下法，误服寒凉药物会导致死亡）。后人通变此方进行治疗，对热喘和水肿有特殊的功效。（按语：大陷胸丸，王海藏用它治疗阳明热喘，柯韵伯用它治疗水肿初起体质壮实者，都收到了奇效。可知古方贵在灵活运用，触类旁通，医者的本事也就到此为止了。）
Treating Taiyang disease (Taiyang disease) with fever, if sweating is not induced but purgation is used instead, the exterior heat enters the chest cavity due to deficiency, where it knots and fails to dissipate with the fluid metabolism that cannot transform into sweat. This results in a condition called Da Jie Xiong Syndrome (Major Chest Binding Syndrome), characterized by hardness like stone from the epigastrium (Xin Xia) down to the lower abdomen, accompanied by severe pain that cannot be touched or pressed. The patient may present with no significant body heat, only sweating on the head, or tidal fever (Chao Re) with dryness and thirst, and a deep (Chen) and tight (Jin) pulse.
Da Huang (Cortex Rhei Radix et Rhizoma, 6 liang, washed with wine), Mang Xiao (Natrii Sulfas, 1 sheng), Gan Sui (Radix Euphorbiae Kansui, 1 qian bi). Use 6 sheng of water, first decoct Da Huang until 2 sheng remains, remove the dregs, then add Mang Xiao.
It treats Jie Xiong (Chest Binding) with stiffness of the neck, resembling Rou Ji (Soft Spasm); it also treats Yangming Heat-induced panting (Re Chuan) and early-stage edema (Shui Zhong) in patients with excess constitution.
Da Huang (8 liang), Ting Li Zi (Semen Lepidii seu Descurainiae, stir-fried), Mang Xiao, Xing Ren (Semen Armeniacae Amarum, each 0.5 sheng, skin and apricot kernels removed, stir-fried until black). First, pound Ting Li Zi and Da Huang into powder, add Xing Ren and Mang Xiao, and grind together into a paste-like consistency. Mix well to form a powder. Take one pill-sized portion (like an elastic bullet); separately, pound Gan Sui into fine powder (1 qian bi), mix with Bai Mi (White Honey, 2 he) and 2 sheng of water, decoct until 1 sheng remains, and take warm.
Da Xian Xiong Tang (Major Chest-Invigorating Decoction) treats Da Jie Xiong: Da Huang clears heat and eliminates excess; Mang Xiao softens hardness and breaks accumulation; Gan Sui drives out water and resolves retained fluid. These address the cardinal signs of heart and abdominal stone-hardness (the specific manifestation of Jie Xiong), pain with refusal to press (hardness from epigastrium to lower abdomen with unbearable pain, more severe than Cheng Qi syndrome), constipation, agitation, irritability, dryness, and thirst (same as Cheng Qi syndrome). If there is only head sweating and a deep-tight pulse (Jie Xiong caused by premature purgation leads to heat knotting with water; heat cannot vent outward but steams upward, hence only head sweats while body is dry. Deep-tight pulse indicates water restraining hidden heat, a yin pulse appearing in a yang disease). The treatment for water knotting in the chest is similar. If the neck is stiff resembling Rou Ji, add Ting Li Zi, Xing Ren, and honey pills to attack (named Da Xian Xiong Wan [Major Chest-Invigorating Pill]. Neck stiffness in Jie Xiong means evil occupies the high position of the Taiyang channel; thus, Ting Li Zi and Xing Ren are added to the previous formula to descend the evil from above. Making it a honey pill aims for a slow, gradual purge). This is the general principle for draining water evil and clearing heat-excess (the summary of Tang and Wan formulas). Do not confuse it with Taiyin Cold-Excess (Han Shi Jie Xiong should be treated with warming purgation; misusing cold medicines will cause death). Later generations modified this formula to treat heat-panting and edema with special efficacy. (Note: Wang Haicang used Da Xian Xiong Wan to treat Yangming heat-panting, and Ke Yunbo used it for early-stage excess-type edema, both achieving remarkable results. This shows that ancient formulas are valuable for flexible application; mastering analogy and extension completes the physician's art.)