结胸之证，尝见俗医不问曾下与未下，但见心胸满闷，便与枳桔汤，便呼为结胸，盖本朱奉议
之说也。有频频与之，反成真结胸者。殊不知结胸乃下早而成，未曾下者，非结胸也。乃表邪传至
胸中，未入于腑，证虽满闷，尚为在表，正属少阳部分，为半表半里之间，只消小柴胡加枳壳以治。
如未效，则以本方对小陷胸汤，一服豁然，其妙如神。秘之，不与俗人言之耳。若因下早而成者，
方用陷胸汤丸，分浅深
从缓而治之，不宜太峻，上焦乃清道至高之分，若过下则伤元气也，慎之。尝读仲景《伤寒论》结
胸条云∶病发于阳而反下之，热入因作结胸。病发于阴而反下之，因作痞满。所以成结胸者，以下
太早故也。及成氏注释曰∶发热恶寒者，发于阳也。无热恶寒者，发于阴也。再三熟玩，不能不致
疑于其间。盖无热恶寒者，寒邪直中阴经之真寒证也，非阳经传至阴经之病也。若误下之，不死则
危矣，岂可以泻心汤寒热相参之药治之而愈乎？岂反轻如结胸者乎？详此恐言荣卫阴阳也。风属阳，
阳邪伤卫，头疼发热，微盗汗出，反恶风者，当服桂枝汤止汗散邪。医者不达而下之，卫气重伤，
胸中结硬。经又云∶结胸证，脉浮大者，不可下，下之即死。结胸证悉具而烦躁者，亦死。盖卫出
上焦，清道受伤，不为不重也，故用陷胸汤峻利之药以下之。寒为阴，阴邪伤荣，当以麻黄汤发表。
误下之而成痞满，宜泻心汤以理痞。盖荣出中焦，黄连能泻心下之痞。邪下于膈，不犯清道，则元
气不伤，故轻于结胸耳。若阴经自中之寒，以泻心汤理之而愈者，则吾不信也。夫以药验证，愚见
如此，然未敢以为必当，候明哲证之。
结胸这一病证，我曾见到世俗医生不问患者是否已经使用过泻下法，只要看到心胸部位胀满憋闷，就给予枳桔汤治疗，并称之为结胸，这大概是沿袭了朱奉议的说法。有人频繁使用这种方法，反而导致患者真正变成了结胸证。殊不知结胸是由于过早使用泻下法而形成的，未曾使用泻下法的，不属于结胸。这是表邪传入胸中，但尚未进入腑脏，虽然症状表现为胀满憋闷，但病邪仍在体表，正属于少阳病的范畴，处于半表半里之间，只需用小柴胡汤加枳壳来治疗。如果效果不明显，则用本方（小柴胡汤）合用小陷胸汤，服用一次后豁然开朗，其疗效神奇如神。我将其视为秘方，不告诉世俗之人。如果是因过早使用泻下法而形成的结胸，才使用陷胸汤或陷胸丸，根据病位的深浅，从缓进行治疗，不宜用药过于峻猛，因为上焦是清道所在，位置最高，如果过度泻下则会损伤元气，务必谨慎。
我曾经阅读张仲景《伤寒论》中关于结胸的条文说：“病发于阳而反被误下，热邪内陷因而形成结胸。病发于阴而反被误下，因而形成痞满。之所以形成结胸，是因为泻下太早的缘故。”等到成无己对此进行注释时说：“发热恶寒的，是发于阳经。无热恶寒的，是发于阴经。”我反复研读玩味，不能不对其中的说法产生怀疑。我认为“无热恶寒”是寒邪直接侵入阴经的真寒证，而不是阳经病传变至阴经的病证。如果对此误用泻下法，不是死亡就是极其危险，怎么能用寒热药配伍的泻心汤治愈呢？怎么会比结胸证还轻呢？详细分析此处，恐怕说的是营卫阴阳的关系。风邪属阳，阳邪伤害卫气，出现头痛、发热、微微盗汗、反而怕风的症状，应当服用桂枝汤来止汗散邪。医生不懂此理而误用泻下法，导致卫气严重受损，胸中结聚坚硬。《伤寒论》又说：“结胸证，脉象浮大的，不可用泻下法，误下即死。结胸证症状全部具备且出现烦躁的，也是死证。”这是因为卫气出于上焦，清道受伤，伤势并不轻，所以要用陷胸汤这样峻猛的药剂来泻下。寒邪属阴，阴邪伤害营血，应当用麻黄汤发表。误用泻下法而形成痞满，适宜用泻心汤来调理痞证。因为营血出于中焦，黄连能泻除心下的痞满。邪气下行至膈部，未侵犯清道，则元气不受损伤，所以病情比结胸轻。如果是阴经自受的寒邪，用泻心汤调理而痊愈的，那我是不相信的。通过药物验证病症，我的见解如此，但不敢认为一定正确，等待明智之士来考证。
The syndrome of Jie Xiong (Chest Binding) is often seen where common physicians, without inquiring whether purgatives have been used or not, merely observe fullness and oppression in the chest and epigastrium, prescribe Zhijie Tang (Bitter Orange and Prickly Ash Decoction), and label it as Jie Xiong. This likely stems from the theory of Zhu Fengyi. Frequent application of this method may even transform a non-Jie Xiong case into a true Jie Xiong. It is unknown to them that Jie Xiong is caused by premature purgation; cases that have not undergone purgation are not Jie Xiong. In such instances, pathogenic factors from the exterior have transmitted to the chest but have not yet entered the Fu organs. Although symptoms include fullness and oppression, the pathogen remains at the exterior level, specifically belonging to the Shaoyang (Lesser Yang) aspect, situated between the exterior and interior. Treatment requires only Xiaochaihu Tang (Minor Bupleurum Decoction) with added Zhike (Aurantii Fructus). If there is no improvement, combine the original formula with Xiaoxianxiong Tang (Minor Golden Pill Decoction); one dose brings immediate relief, miraculous as if by divine power. I keep this secret and do not share it with ordinary practitioners. However, if Jie Xiong is indeed formed due to premature purgation, then Xiantong Tang (Pectoral Binding Decoction) or its pill form should be used, treating according to the depth of the pathology gradually, avoiding overly harsh methods. The Upper Jiao (Upper Burner) is the highest part of the Clear Pathways; excessive purgation damages Yuan Qi (Original Qi), so caution is essential.
I once read in Zhang Zhongjing's *Shanghan Lun* (Treatise on Cold Damage) regarding Jie Xiong: "When disease originates in Yang and is mistakenly purged, heat enters and causes Jie Xiong. When disease originates in Yin and is mistakenly purged, Pi Man (Fullness Obstruction) results. The reason for forming Jie Xiong is premature purgation." Later, Cheng Wuji's commentary stated: "Fever with aversion to cold indicates origin in Yang. Absence of fever with aversion to cold indicates origin in Yin." After repeated study, I cannot help but doubt these statements. I believe "absence of fever with aversion to cold" refers to a True Cold syndrome where Cold pathogens directly invade the Yin meridians, not a disease transmitting from Yang to Yin meridians. If such a condition were mistakenly purged, death or severe danger would ensue; how could it be cured by Xiexin Tang (Gallbladder-Draining Decoction), which contains both cold and hot herbs? How could it be lighter than Jie Xiong? Upon detailed examination, this passage likely discusses Ying and Wei (Nutritive and Defensive) Qi and Yin-Yang. Wind belongs to Yang; Yang pathogens injure Wei Qi, causing headache, fever, slight night sweating, and aversion to wind. One should take Guizhi Tang (Cinnamon Twig Decoction) to stop sweating and disperse pathogens. If physicians fail to understand this and mistakenly purge, Wei Qi is severely injured, leading to binding and hardness in the chest. The classic text also states: "In Jie Xiong syndrome, if the pulse is floating and large, purgation is contraindicated; purging leads to death. If all signs of Jie Xiong are present and restlessness occurs, death is inevitable." This is because Wei Qi emerges from the Upper Jiao, and injury to the Clear Pathways is serious; thus, harsh drugs like those in Xiantong Tang are required to purge. Cold belongs to Yin; Yin pathogens injure Ying Qi, requiring Mahuang Tang (Ephedra Decoction) to release the exterior. Mistaken purgation leads to Pi Man, which should be treated with Xiexin Tang to regulate the obstruction. Since Ying Qi emerges from the Middle Jiao, Huanglian (Coptis Rhizome) can drain the pi in the heart region. The pathogen descends to the diaphragm without invading the Clear Pathways, sparing Yuan Qi, hence the condition is lighter than Jie Xiong. I do not believe that a direct invasion of Cold into the Yin meridians could be cured by Xiexin Tang. Based on verifying diseases with medicines, this is my view, though I dare not claim it is absolute, awaiting verification by wise scholars.