雍曰。结胸。痞气。阳毒。阴毒。狐惑。百合六证。虽有见于前证
中者。而庞氏皆以其异证。故别列于后。今根据庞氏之法。益以斑黄血
衄证。为十证。
仲景曰。问病有结胸。有脏结。其状何如。曰。按之痛。寸脉浮。
关脉沉。名曰结胸。庞氏曰。寸口脉浮。关上尺中皆沉。或沉紧。
又曰。何为脏结。答曰。如结胸状。饮食如故。时时下利。寸脉
浮。关脉小细沉紧。名曰脏结。舌上白苔滑者。难治。常氏云。可刺关
元。在脐下。
又曰。脏结无阳证。不往来寒热。（一云寒而不热）其人反静。舌
上苔滑者。不可攻也。常氏云。可刺关元穴。
又曰。病患胁下素有痞。连在脐旁。痛引小腹。入阴筋者。此名
脏结。死。常氏云。可刺大赫。在腹部第二行。
又曰。发病于阳。而反下之。热入因作结胸。病发于阴。而反下
之。因作痞也。所以成结胸者。此下之太早故也。朱氏曰。伤寒本无
结胸。以其热下之早。热气乘虚而入。痞结不散。变成结胸。王仲弓
曰。杜壬云。伤寒在表误下者。宜急频与理中汤丸。更加人参。多得
解。不作结胸。若大腹转损发厥者。愚与四逆汤便安。若胃中虽和。
而病不退。候再有里证再下之。朱氏云。以前来下汤未是故也。
又曰。若心下满而硬痛者。此为结胸也。大陷胸汤主之。但满而
不痛者。此为痞。宜半夏泻心汤。
又曰。结胸证。其脉浮大者。不可下。下之则死。朱氏云。尚宜发
汗也。脉浮是表证。兼以小柴胡汤等先发表。表证罢。后以结胸药下
之。常氏云。用巴豆黄连饼子。封脐中灸之。即诸方中所谓圣饼子灸
法也。
又曰。结胸证悉具。烦躁者亦死。
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。短气烦躁。心中懊 。阳气
内陷。心下因硬。则为结胸。大陷胸汤主之。雍曰。此即病发于阳而
反下之之证也。若不结胸。但头汗出。余处无汗。剂颈而还。小便不
利。身必发黄者。可茵陈蒿汤。雍曰。若单服茵陈浓汁。调五苓散。亦
可。
又曰。伤寒六七日。结胸热实。脉沉而紧。心下痛。按之石硬者。
大陷胸汤主之。
又曰。伤寒十余日。热结在里。往来寒热者。与大柴胡汤。但结
胸。无大热者。此为水结在胸膈也。但头微汗出者。大陷胸汤主之。
雍曰。可下证中。自但结胸下。分别为二证。故用二药不同。
又曰。太阳病。重发汗。而复下之。不大便五六日。舌上燥而渴。
日晡所小有潮热。（一云日晡所发心胸大烦）从心下至少腹。硬满而
痛者。大陷胸汤。或以大陷胸丸下之。
又曰。小结胸证。正在心下。按之则痛。脉浮滑者。小陷胸汤主
之。
又曰。太阳病二三日。不得卧。但欲起。心下必结。脉微弱者。此
本有寒分。反下之。若利止。必作结胸。未止者。四日复下之。此作协
热利也。常氏云。脉微弱有寒者。可增损理中丸。作结胸者。大小陷
胸汤。协热利者。白头翁汤。
又曰。太阳病。下之后。其脉数促。（一作纵）不结胸者。此为欲
解也。脉浮者。必结胸。（常氏云可增损理中丸）脉紧者。必咽痛。（常
氏云可桔梗甘草汤）脉弦者。必两胁拘急。（常氏云可小柴胡汤）脉
细数者。头痛未止。（常氏云可葱须汤）脉沉紧者。必欲呕。（常氏云
可七物黄连汤）脉沉滑者。协热利。（常氏云可白头翁汤）脉浮滑者。
必下血。（常氏云可柏皮汤）
又曰。病在阳。应以汗解之。反以冷水灌之 之。其热被却不得
去。弥更益烦。肉上粟起。意欲饮水。反不渴者。服文蛤散。若不瘥
者。与五苓散。寒实结胸。无热证者。与三物小陷胸汤。白散亦可服。
庞氏云。无热证者。与三物白散。（小陷胸汤非也）愚以为热者。小陷
胸汤。寒者。三物白散。
又曰。结胸者。项亦强。如柔 状。下之则和。庞氏云。宜服大陷
胸汤。
又曰。太阳少阳并病。而反下之。成结胸。心下硬。下利不止。水
浆不下。其人心烦。常氏云。可半夏生姜二泻心汤。
活人书云。西晋崔行功云。伤寒。结胸欲绝。心膈高起。手不得
近。大小陷胸皆不瘥者。此是下后虚逆。气已不理。而毒复上攻。气
毒相搏。结于胸中。当用枳实理中丸先理其气。次疗诸疾。古今用之
如神。应手而愈。今常氏谓增损理中丸。即是也。庞氏曰。近世治结
胸。多用针头丸。用硫黄阳起石者。若病热毒甚者。必死。惟治冷结
寒实耳。
活人书云。结胸三种。有大结胸。不按而痛。胸连腹坚硬。大陷
胸汤主之。有小结胸。接之心下痛。小陷胸汤主之。有水结胸。在膈
间。亦名结胸。小半夏加茯苓汤、小柴胡去枣加牡蛎汤主之。又有寒
热二证。有热实结胸者。胸中烦躁。心内懊 。舌上燥渴。脉沉滑者。
皆热证也。大陷胸汤主之。有寒实结胸。无热证者。三物白散。枳实
理中丸主之。
王仲弓曰。治结胸。当用小陷胸汤。甚佳。大陷胸汤太峻。如不
得已。则用大陷胸汤丸。脉浮者。不得用大陷胸丸。宜用小陷胸、枳
实理中丸。结胸。用黄连巴豆灸法。得解。心下痞硬。宜旋覆代赭汤。
若外尚未解。胸满胁痛者。宜小柴胡汤。雍曰。凡用仲景药。皆当准
此为式。盖今古不同。病患血气不能胜药力。医工不能精于诊视。非
古人比。故用药可不及。不可太过。如脉浮者。尤宜从朱氏用发表
药。表证罢。以结胸药治之。
郭雍说：结胸、痞气、阳毒、阴毒、狐惑、百合这六种病证，虽然在前面的病证中有所提及，但庞安时都将其作为不同的病证单独列出。现在依据庞氏的方法，加上斑疹、发黄、鼻衄这三种证候，共列为十种证候。
张仲景说：问：有病名为结胸的，有病名为脏结的，它们的症状是怎样的？回答说：按压时疼痛，寸脉浮，关脉沉，这就叫作结胸。庞安时说：寸口脉浮，关上和尺中的脉象都沉，或者沉而紧。又说：什么是脏结？回答说：症状像结胸一样，饮食如常，经常腹泻，寸脉浮，关脉小细而沉紧，这就叫作脏结。如果舌上苔白滑，属于难治之症。常器之说：可以针刺关元穴，位于脐下。
又说：脏结没有阳证表现，不出现往来寒热（一说为只恶寒不发热的情况），病人反而安静，舌上苔滑的，不可用攻下法治疗。常器之说：可以针刺关元穴。
又说：病人胁下素来有痞块，连在脐旁，疼痛牵引小腹，甚至进入阴筋部位，这就叫作脏结，预后不良，主死。常器之说：可以针刺大赫穴，位于腹部第二行。
又说：发病于阳分（表证），却反而使用下法，热邪内陷因而形成结胸；发病于阴分（里证），却反而使用下法，因而形成痞证。之所以形成结胸，是因为下法用得过早的缘故。朱肱说：伤寒本来没有结胸，因为热证误用下法过早，热气乘虚而入，痞结不散，变成了结胸。王仲弓引用杜壬的话说：伤寒在表时误用下法，应当频繁给予理中汤丸，并多加人参，多出汗即可痊愈，不会形成结胸。如果大腹受损发生厥逆的，我主张用四逆汤就能安定。如果胃中虽然调和，但病邪不退，等待出现里证后再用下法。朱肱说：这是因为之前用的泻下药不对的缘故。
又说：如果心下（胃脘部）胀满而且硬痛，这就是结胸，用大陷胸汤主治。只是胀满而不痛的，这是痞证，宜用半夏泻心汤。
又说：结胸证，如果脉象浮大的，不可用下法，用了就会死亡。朱肱说：还应当发汗。脉浮是表证，兼用小柴胡汤等先解表，表证解除后，再用治疗结胸的药攻下。常器之说：用巴豆黄连饼封在脐中灸治，就是各方书中所谓的圣饼子灸法。
又说：太阳病，脉象浮而动数，浮表示有风邪，数表示有热，动表示有痛，数表示正气虚。头痛发热，微微盗汗，反而恶寒的，说明表证未解。医生反而用下法，动数脉变为迟脉，膈内拒按而痛，胃中空虚，客气扰动膈间，短气烦躁，心中懊恼，阳气内陷，心下因此变硬，这就形成结胸，用大陷胸汤主治。郭雍说：这就是“病发于阳而反下之”的证候。如果不形成结胸，只是头部出汗，身体其他部位无汗，汗止于颈部，小便不利，身体一定会发黄，可用茵陈蒿汤。郭雍说：如果单服茵陈浓汁，调服五苓散，也可以。
又说：伤寒六七天，结胸热实证，脉沉而紧，心下痛，按上去像石头一样硬的，用大陷胸汤主治。
又说：伤寒十多天，热邪结聚在里，出现往来寒热的，用大柴胡汤。如果只是结胸，没有大热的，这是水饮结聚在胸膈，只有头部微微出汗的，用大陷胸汤主治。郭雍说：在下法的证候中，从单纯的结胸开始分别列为两种证候，所以用药不同。
又说：太阳病，重发汗之后，又用下法，五六天不大便，舌上干燥而渴，傍晚时分有轻微潮热（一说傍晚发作心胸大烦），从心下直到小腹，硬满且疼痛的，用大陷胸汤，或者用大陷胸丸攻下。
又说：小结胸证，病位正在心下，按压才痛，脉象浮滑的，用小陷胸汤主治。
又说：太阳病二三天，不能卧倒，只想起来，心下必然有结滞，脉象微弱的，这原本体内有寒湿停聚，反而用下法，如果腹泻停止，必定形成结胸；如果腹泻不止，第四日再用下法，这就形成协热利。常器之说：脉微弱且有寒的，可用增损理中丸。形成结胸的，用大小陷胸汤。协热利的，用白头翁汤。
又说：太阳病，用下法之后，脉象数而促（一作纵），不形成结胸的，这是病欲解的表现。脉浮的，必定形成结胸。（常器之说可增损理中丸）脉紧的，必定咽痛。（常器之说可用桔梗甘草汤）脉弦的，必定两胁拘急。（常器之说可用小柴胡汤）脉细数的，头痛未止。（常器之说可用葱须汤）脉沉紧的，必定想呕吐。（常器之说可用七物黄连汤）脉沉滑的，形成协热利。（常器之说可用白头翁汤）脉浮滑的，必定下血。（常器之说可用柏皮汤）
又说：病在阳分，应当用汗法解表，反而用冷水浇灌，热邪被遏制而不能去除，更加烦躁，皮肤起粟粒，想喝水，反而不觉得渴的，服用文蛤散。如果不好转，给五苓散。寒实结胸，没有热证的，给三物小陷胸汤（即三物白散）。庞安时说：没有热证的，给三物白散（注：此处指小陷胸汤非此证所用）。我认为热证用小陷胸汤，寒证用三物白散。
又说：结胸证，项背也强直，像柔痉的样子，用下法治疗后就会和解。庞安时说：宜服用大陷胸汤。
又说：太阳少阳并病，反而用下法，形成结胸，心下硬，腹泻不止，水浆不能入口，其人烦躁。常器之说：可用半夏生姜二泻心汤。
《活人书》引西晋崔行功的话说：伤寒，结胸严重到极点，心膈部高起，手不能靠近，大小陷胸汤都不见效的，这是下法后导致虚逆，气机已乱，而毒邪再次上攻，气毒相互搏结，结于胸中，应当先用枳实理中丸调理气机，再治疗各种疾病。古今使用如神，应手而愈。现在的常器之说增损理中丸，就是这个方子。庞安时说：近代治疗结胸，多用针头丸，其中含有硫黄、阳起石的。如果病属热毒严重的，必死无疑，只能治疗冷结和寒实证。
《活人书》说：结胸有三种，有大结胸，不按就痛，胸部连带腹部坚硬，用大陷胸汤主治。有小结胸，按压心下才痛，用小陷胸汤主治。有水结胸，在膈间，也叫结胸，用小半夏加茯苓汤、小柴胡去枣加牡蛎汤主治。又有寒热两种证候，有热实结胸的，胸中烦躁，心中懊恼，舌上干燥口渴，脉沉滑的，都是热证，用大陷胸汤主治。有寒实结胸，没有热证的，用三物白散、枳实理中丸主治。
王仲弓说：治疗结胸，用小陷胸汤很好。大陷胸汤药力太峻猛，如果不得已，才用大陷胸汤或丸。脉浮的，不能用大陷胸丸，宜用小陷胸汤、枳实理中丸。结胸，用黄连巴豆灸法，可以得解。心下痞硬，宜用旋覆代赭汤。如果外证尚未解除，胸满胁痛的，宜用小柴胡汤。郭雍说：凡是使用张仲景的药物，都应当以此为准则。因为古今不同，病人的气血不能承受药力，医生的诊视也不如古人精妙，所以用药宁可不足，不可太过。比如脉浮的，尤其应该遵循朱肱的意见，先用发表药，表证解除后，再用治疗结胸的药。
Guo Yong stated: The six conditions—Jie Xiong (Chest Binding), Pi Qi (Stagnant Qi), Yang Du (Yang Toxin), Yin Du (Yin Toxin), Hu Huo (Fox Infection), and Bai He (Lily Disease)—although mentioned in previous discussions, were listed separately by Pang Anshi as distinct conditions. Following Pang's method, I add three conditions: Ban Zhen (Macules and Rashes), Huang Dan (Jaundice), and Bi Nu (Nosebleed), totaling ten conditions.
Zhang Zhongjing asked: There are conditions named Jie Xiong (Chest Binding) and Zang Jie (Organ Binding). What are their manifestations? The answer is: Pain upon palpation, with a floating pulse at the Cun position and a sunken pulse at the Guan position; this is called Jie Xiong (Chest Binding). Pang Anshi added: The pulse at the Cun Kou (Inkwell) is floating, while both the Guan and Chi positions are sunken, or sunken and tight. He further asked: What is Zang Jie (Organ Binding)? The answer is: It resembles Jie Xiong (Chest Binding) in appearance, but digestion remains normal, and there is frequent diarrhea. The Cun pulse is floating, and the Guan pulse is small, fine, sunken, and tight; this is called Zang Jie (Organ Binding). If the tongue has a white and slippery coating, it is difficult to treat. Chang Qizhi suggested: Acupuncture at Guan Yuan (CV-4), located below the umbilicus.
He also stated: Zang Jie (Organ Binding) presents without Yang syndrome signs, such as alternating chills and fever (some texts say only chills without fever). The patient appears quiet. If the tongue coating is slippery, purgative methods should not be used. Chang Qizhi suggested: Acupuncture at Guan Yuan (CV-4).
He also stated: If a patient has had a Pi Kuai (Subcutaneous Mass) under the hypochondrium since before, extending to the side of the umbilicus, with pain radiating to the lower abdomen and into the genitalia, this is called Zang Jie (Organ Binding), which is fatal. Chang Qizhi suggested: Acupuncture at Da He (KI-12), located in the second row of the abdomen.
He also stated: When a disease originates in the Yang (Exterior) and is incorrectly treated with purgatives, heat enters internally, resulting in Jie Xiong (Chest Binding). When a disease originates in the Yin (Interior) and is incorrectly treated with purgatives, it results in Pi Zheng (Stagnation Syndrome). The reason Jie Xiong (Chest Binding) forms is that purgatives were administered too early. Zhu Gong stated: Shang Han (Cold Damage) does not naturally involve Jie Xiong (Chest Binding); it occurs because heat was purged too early, allowing heat qi to enter through deficiency, causing stagnation that transforms into Jie Xiong (Chest Binding). Wang Zhonggong cited Du Ren: If Shang Han (Cold Damage) at the exterior is mistakenly purged, one should frequently administer Li Zhong Tang (Regulate the Middle Decoction) pills, adding extra Ren Shen (Ginseng Root). Abundant sweating will lead to recovery, preventing Jie Xiong (Chest Binding). If the great abdomen is damaged leading to Jue Ni (Reversal Cold), I recommend Si Ni Tang (Frigid Extremities Decoction) to stabilize the condition. If the Stomach is harmonious but the pathogen persists, wait for interior signs before purging again. Zhu Gong stated: This is because the previous purgative formula was incorrect.
He also stated: If there is fullness and hardness with pain in the Xin Xia (Epigastrium), this is Jie Xiong (Chest Binding), treated with Da Xian Xiong Tang (Major Sinking Chest Decoction). If there is fullness without pain, this is Pi Zheng (Stagnation Syndrome), treated with Ban Xia Xie Xin Tang (Pinellia Drain the Epigastrium Decoction).
He also stated: In Jie Xiong (Chest Binding), if the pulse is floating and large, purgatives must not be used; using them leads to death. Zhu Gong stated: Sweating methods should still be employed. A floating pulse indicates an Exterior Syndrome. Use Xiao Chai Hu Tang (Minor Bupleurum Decoction) etc. to release the exterior first. Once the exterior syndrome resolves, then use formulas for Jie Xiong (Chest Binding) to purge. Chang Qizhi suggested: Apply a cake of Ba Dou (Croton Seed) and Huang Lian (Coptis Rhizome) to the umbilicus and moxibustion; this is the "Sheng Bing Zi" (Holy Cake) moxibustion method found in various texts.
He also stated: If all symptoms of Jie Xiong (Chest Binding) are present and the patient becomes restive (Fan Zao), it is fatal.
He also stated: In Tai Yang Bing (Tai Yang 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, indicate the Exterior has not resolved. If the physician incorrectly uses purgatives, the moving/rapid pulse changes to slow. Rejection pain occurs inside the Diaphragm. The Stomach is empty, and hostile Qi disturbs the Diaphragm, causing shortness of breath, restiveness, and internal discomfort (Ao Nan). Yang Qi sinks inward, causing hardness in the Xin Xia (Epigastrium), forming Jie Xiong (Chest Binding), treated with Da Xian Xiong Tang (Major Sinking Chest Decoction). Guo Yong stated: This is the condition described as "disease originating in Yang and incorrectly purged." If Jie Xiong (Chest Binding) does not form, but there is sweating only on the head, no sweat elsewhere up to the neck, urinary difficulty, and jaundice, use Yin Chen Hao Tang (Artemisia Capillaris Decoction). Guo Yong added: Taking concentrated Yin Chen (Artemisiae Scopariae Herba) juice mixed with Wu Ling San (Five-Ingredient Powder with Poria) is also effective.
He also stated: In Shang Han (Cold Damage) after six or seven days, if there is Jie Xiong (Chest Binding) with Heat Excess, a sunken and tight pulse, pain in the Xin Xia (Epigastrium), and hardness like stone upon palpation, treat with Da Xian Xiong Tang (Major Sinking Chest Decoction).
He also stated: In Shang Han (Cold Damage) after more than ten days, if heat is bound internally with alternating chills and fever, use Da Chai Hu Tang (Major Bupleurum Decoction). If it is merely Jie Xiong (Chest Binding) without significant heat, this is Water Binding in the Chest and Diaphragm. If there is only slight sweating on the head, treat with Da Xian Xiong Tang (Major Sinking Chest Decoction). Guo Yong stated: Among purgative indications, simple Jie Xiong (Chest Binding) is distinguished into two conditions, hence different medications are used.
He also stated: In Tai Yang Bing (Tai Yang Disease), after excessive sweating and subsequent purging, if there is constipation for five to six days, dryness and thirst on the tongue, and slight tidal fever in the late afternoon (or severe mental vexation in the chest and heart), with hardness, fullness, and pain from the Xin Xia (Epigastrium) to the lower abdomen, use Da Xian Xiong Tang (Major Sinking Chest Decoction) or Da Xian Xiong Wan (Major Sinking Chest Pill) to purge.
He also stated: In Xiao Jie Xiong (Minor Chest Binding), the location is precisely in the Xin Xia (Epigastrium), painful only upon pressure, with a floating and slippery pulse; treat with Xiao Xian Xiong Tang (Minor Sinking Chest Decoction).
He also stated: In Tai Yang Bing (Tai Yang Disease) after two or three days, if the patient cannot lie down but wants to rise, there must be binding in the Xin Xia (Epigastrium). If the pulse is weak, this originally indicates Cold Fluid retention. Incorrect purging may lead to Jie Xiong (Chest Binding) if diarrhea stops, or Xie Re Li (Collateral Heat Diarrhea) if purging is repeated on the fourth day while diarrhea continues. Chang Qizhi suggested: For weak pulses with Cold, use Zeng Sun Li Zhong Wan (Modified Regulate the Middle Pill). For Jie Xiong (Chest Binding), use Da/Xiao Xian Xiong Tang (Major/Minor Sinking Chest Decoctions). For Xie Re Li (Collateral Heat Diarrhea), use Bai Tou Weng Tang (Pulsatilla Decoction).
He also stated: After purging in Tai Yang Bing (Tai Yang Disease), if the pulse is rapid and intermittent (or slackening) without Jie Xiong (Chest Binding), the disease is resolving. If the pulse is floating, Jie Xiong (Chest Binding) will definitely form (Chang Qizhi: use modified Li Zhong Wan). If the pulse is tight, throat pain will definitely occur (Chang Qizhi: use Jie Geng Gan Cao Tang [Licorice and Platycodon Decoction]). If the pulse is wiry, bilateral hypochondriac stiffness will occur (Chang Qizhi: use Xiao Chai Hu Tang [Minor Bupleurum Decoction]). If the pulse is fine and rapid, headache will persist (Chang Qizhi: use Cong Xu Tang [Scallion Root Decoction]). If the pulse is sunken and tight, vomiting will definitely occur (Chang Qizhi: use Qi Wu Huang Lian Tang [Seven-Ingredient Coptis Decoction]). If the pulse is sunken and slippery, Xie Re Li (Collateral Heat Diarrhea) will occur (Chang Qizhi: use Bai Tou Weng Tang [Pulsatilla Decoction]). If the pulse is floating and slippery, blood in the stool will definitely occur (Chang Qizhi: use Bo Pi Tang [Phellodendron Bark Decoction]).
He also stated: When the disease is in the Yang (Exterior), it should be resolved by sweating. If incorrectly irrigated with cold water, the heat is suppressed and cannot escape, increasing irritability, causing gooseflesh on the skin, desire to drink water but no actual thirst; treat with Wen Ge San (Clam Shell Powder). If ineffective, use Wu Ling San (Five-Ingredient Powder with Poria). For Han Shi Jie Xiong (Cold-Excess Chest Binding) without Heat signs, use San Wu Xiao Xian Xiong Tang (Three-Ingredient Minor Sinking Chest Decoction, i.e., San Wu Bai San). Pang Anshi stated: For cases without Heat signs, use San Wu Bai San (Three-Ingredient White Powder) (not Xiao Xian Xiong Tang). I believe: Heat conditions use Xiao Xian Xiong Tang (Minor Sinking Chest Decoction); Cold conditions use San Wu Bai San (Three-Ingredient White Powder).
He also stated: In Jie Xiong (Chest Binding), the neck may also be stiff, resembling Rou Jing (Soft Spasm). Purging will bring harmony. Pang Anshi stated: Use Da Xian Xiong Tang (Major Sinking Chest Decoction).
He also stated: In Tai Yang Shao Yang Bing (Combined Tai Yang and Shaoyang Disease), incorrect purging leads to Jie Xiong (Chest Binding), hardness in the Xin Xia (Epigastrium), incessant diarrhea, inability to take fluids, and mental vexation. Chang Qizhi suggested: Use Ban Xia Sheng Jiang Er Xie Xin Tang (Pinellia and Fresh Ginger Double Epigastrium-Draining Decoction).
The *Huoren Shu* (Book Saving Lives) cites Cui Xinggong of the Western Jin: In Shang Han (Cold Damage), if Jie Xiong (Chest Binding) is critical, with high elevation of the chest and diaphragm, untouchable by hand, and neither Da nor Xiao Xian Xiong Tang (Major/Minor Sinking Chest Decoctions) work, this is deficiency and reversal after purging, with chaotic Qi and toxin attacking upward. Qi and toxin struggle, binding in the chest. First use Zhi Shi Li Zhong Wan (Immature Bitter Orange and Regulate the Middle Pill) to regulate Qi, then treat other diseases. It works miraculously. Chang Qizhi’s Zeng Sun Li Zhong Wan (Modified Regulate the Middle Pill) is this formula. Pang Anshi stated: Recent treatments for Jie Xiong (Chest Binding) often use Zhen Tou Wan (Needle-Head Pill) containing Liu Huang (Sulfur) and Yang Qi Shi (Quicksilver Ore). If the disease involves severe Heat Toxin, death is certain; this is only for Cold Binding and Cold-Excess.
The *Huoren Shu* (Book Saving Lives) states: There are three types of Jie Xiong (Chest Binding):
1. Da Jie Xiong (Major Chest Binding): Pain without pressure, chest connected to abdomen is hard; treated with Da Xian Xiong Tang (Major Sinking Chest Decoction).
2. Xiao Jie Xiong (Minor Chest Binding): Pain in Xin Xia (Epigastrium) upon pressure; treated with Xiao Xian Xiong Tang (Minor Sinking Chest Decoction).
3. Shui Jie Xiong (Water Chest Binding): Located between the diaphragm, also called Jie Xiong (Chest Binding); treated with Xiao Ban Xia Jia Fu Ling Tang (Minor Pinellia plus Poria Decoction) or Xiao Chai Hu Qu Zao Jia Mu Li Tang (Minor Bupleurum minus Jujube plus Oyster Shell Decoction).
There are also Heat and Cold syndromes:
- Re Shi Jie Xiong (Heat-Excess Chest Binding): Irritability in the chest, internal discomfort, dry tongue/thirst, sunken slippery pulse; treated with Da Xian Xiong Tang (Major Sinking Chest Decoction).
- Han Shi Jie Xiong (Cold-Excess Chest Binding): No Heat signs; treated with San Wu Bai San (Three-Ingredient White Powder) or Zhi Shi Li Zhong Wan (Immature Bitter Orange and Regulate the Middle Pill).
Wang Zhonggong stated: Treat Jie Xiong (Chest Binding) with Xiao Xian Xiong Tang (Minor Sinking Chest Decoction) for best results. Da Xian Xiong Tang (Major Sinking Chest Decoction) is too harsh; use Da Xian Xiong Wan (Major Sinking Chest Pill) only if necessary. If the pulse is floating, do not use Da Xian Xiong Wan; use Xiao Xian Xiong Tang (Minor Sinking Chest Decoction) and Zhi Shi Li Zhong Wan (Immature Bitter Orange and Regulate the Middle Pill). For Jie Xiong (Chest Binding), Huang Lian Ba Dou Moxibustion can resolve it. For Pi Ying (Stagnant Hardness in Epigastrium), use Xuan Fu Dai Zhe Tang (Inula and Hematite Decoction). If the Exterior has not resolved, with chest fullness and hypochondriac pain, use Xiao Chai Hu Tang (Minor Bupleurum Decoction). Guo Yong stated: When using Zhang Zhongjing’s formulas, one must follow this principle. Ancient and modern times differ; patients' Qi and Blood cannot withstand strong medicines, and physicians' diagnostics are not as precise as ancients. Therefore, medication should be insufficient rather than excessive. For floating pulses, especially follow Zhu Gong’s advice to use Exterior-Releasing formulas first. Once the Exterior resolves, treat Jie Xiong (Chest Binding).