《伤寒论》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，此千
古疑句也。观仲景以大小陷胸汤重方治结胸，以诸泻心汤轻方治痞满，则知发于阳、发于
阴，乃言病之轻重。旧注以发热恶寒，发于阳；无热恶寒，发于阴。不知无热恶寒者，阴症
也，反下之，即死矣，焉能成痞满？仲景岂用黄连泻心寒药，治误下后之阴症乎！又云∶太
阳病风伤于卫，当用桂枝汤，误用承气汤下之，因作结胸。太阳病，寒伤于营，当用麻黄
汤，误用承气汤下之，因成痞满。余细玩之，亦不拘太阳一经以致病。下文云∶伤寒五六
日，呕而发热，柴胡症具，而以他药下之。若心下满而硬痛者，此为结胸也，大陷胸汤主
之。若但满不痛者，此为痞，柴胡不中与也，宜泻心汤。可见少阳经误下，亦有结胸痞满之
症。又以心下硬痛者，为结胸，以心下但满而不痛者，为痞满，可见结胸痞满但以痛不痛分
别病之轻重命名。总之，三阳表邪未解而重，下早而变心下硬痛，名曰结胸；三阳表邪未解
而轻，下早变心下但满不痛，名曰痞满。仲景未曾尽拘太阳一经，亦未必以风寒伤卫伤营分
别。观其用方主治，则以大陷胸汤丸，治心下直至小腹硬痛大结胸症；用小陷胸汤丸，但治
心下痛小结胸症；以诸泻心汤，但治心下满不痛之痞气。细玩寒伤营发于阴，无汗之表邪
症，重于风伤卫有汗之表邪，何故误下反不成结胸反成不痛之痞满，反用泻心汤轻方，按此
明明以症之轻重，命名立方。其以陷胸泻心立名者，以其病在心胸博位耳。若热邪内陷阳明
大肠下部，则不得谓之结胸而为阳明腹痛下症，不用陷胸而用承气汤下之矣。又如表症未
解，而误下之，表邪内陷，系在太阴脾家阴经，而见下症者不用承气，而用桂枝大黄汤。以
大黄下秽腐，以桂枝散内陷之表邪，且制大黄不伤太阴脏气，不比结胸在上之阳经症，可用
陷胸汤者；不比热结在下之阳明症，可用承气汤者。外另有水结胸症，用生姜半夏汤者；有
痰火结胸而用川连半夏汤者。今余又推展邪气食气，互相胶结，用平胃保和散者，凡此皆后
世类结胸症也。
太阳篇云∶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
者以下之太早故也。
此条申明表热未解，失汗误下，成结胸痞满之由。言病发于阳，表热之重者，下早表热内
陷而成结胸；发于阴，表热之轻者，若下早成痞满。旧注风伤卫为阳，寒伤营为阴。不知
寒伤营无汗身痛，发热之表邪，重于风伤卫有汗之表邪。岂误下反变痞满之轻病？必是以
表热之轻重而分阴阳也。
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，短气燥烦，
心下懊 ，阳气内陷，心下因硬，则为结胸。大陷胸汤主之。若不结胸，但头汗出，余无汗
剂颈而还，小便不利，身必发黄也。
浮而动数，表脉也。头痛发热，盗汗恶寒，表症也。医反下之，动数变迟，结胸脉也。膈
内拒痛，懊 ，心下因硬，结胸症也，故用大陷汤。设若不结胸，头有汗遍身无汗，小便
不利，则淤热无从发泄，身发黄矣。
太阳病，重发汗而复下之，不大便五六日，舌上燥而渴，日晡小有潮热，从心下至小腹硬满
而痛不可近者大，陷胸汤主之。
表症失汗，惧下有成结胸痞满。今重发汗，复下之，亦成结胸。不大便，舌上燥而渴，日
晡小有潮热，心下至小腹硬满而痛，故用大陷胸汤。
结胸者项亦强，如柔痉状，下之则和，宜大陷胸汤。
结胸而至颈项亦强，胸邪十分紧实，用大陷胸汤，恐过而不留；陷胸丸，恐滞而愈结。今
煮汁服之，则婉转逐邪。
病有结胸，有脏结，其状何如？答曰∶按之痛，寸脉浮，关脉沉，名曰结胸也。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。
此条辨结胸脏结之症，惟在饮食如故，时时下利上以别症。寸脉浮，关脉沉，舌上有苔，
不可用辛温。白苔而滑，不可用寒凉，故曰难治。
病患胁下，素有痞气，连在脐旁，痛引小腹入阴筋者，此名脏结，死脏结无阳症，不往来寒
热，其人反静，舌上苔滑者，不可攻也。
此申素有痞气之人，今痛引入小腹，下连阴筋者，名脏结之死症。又申脏结非阳经症，故
无往来寒热，其人反静，舌上有苔而滑者，故不可攻。
伤寒六七日，结胸热实，脉沉紧，心下痛，按之石硬者，大陷胸汤主之。
此条重申胸前实热，脉沉而紧，心下痛，按之石硬者，宜用大陷胸汤。
小结胸症，正在心下，按之则痛，脉浮滑者，小陷胸汤主之。
此重申不按不痛，脉浮滑，不沉实，宜用小陷胸汤。
伤寒十余日，热结在里，复往来寒热者，与大柴胡汤主之。但结胸无大热者，此为水结在胸
胁也，但头汗出者，大陷胸汤主之。
上段言伤寒十余日，热结在里，已可下。然见往来寒热，少阳表症，只可大柴胡双解表
里。下段言但结胸，外无大热者，乃是水结胸，阻绝阴阳，故但头汗，余处无汗，必以大
陷胸逐水饮，通闭塞。此申明但头有汗之症，当治胸前凝结。
伤寒六七日，发热微恶寒，骨节烦疼，微呕，心下支结，外症未去者，柴胡桂枝汤主之。
此章邪结胁下，不成结胸，又见太阳少阳表症，当用柴胡桂枝汤先散表邪。结胸病，其脉
浮大者，不可下，下则死。
结胸病，脉浮大，即为表邪，故曰下之则死。
伤寒五六日，呕而发热者，柴胡症具，而以他药下之，柴胡症仍在者，复与柴胡汤。此虽已
下之，不为逆，必蒸蒸而振，却发热汗出而解。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，柴胡汤不中与之，宜半夏泻心汤。
此申明误下，变三症三条治法。言结胸痞满，不独太阳下早而成，即少阳表症，误下亦成
者。故曰伤寒五六日，呕而发热，柴胡汤症，反用他药下之，若发热表症仍在，不成结胸
者，当复与柴胡汤，必蒸蒸发热汗出而解。若下后身不热而见心下硬痛，则成结胸矣，宜
用大陷胸汤。若满而不痛，则为痞气，宜用半夏泻心汤。
大陷胸汤
芫花 甘遂 大戟
热邪传里，内结小腹，用大承气汤。若失汗误下，热邪内陷，作痛胸腹，用大陷胸汤丸。
小陷胸汤
川连 半夏 栝蒌实
此方详注胸满，以半夏辛散豁痰，栝蒌荡涤邪秽，川连去积热，则热散痰消。
承气汤 见便结。
结胸上部病，本不用承气汤。若满而不痛，腹中痛多，又见大便闭结，故变用承气汤下
行，则上亦宽。
桂枝大黄汤 见腹痛。
误下，表邪内陷，阳明胃家作痛，脉沉而紧，用大陷胸汤。内陷大肠作痛，脉数而实，用
承气汤。内陷太阴作痛，脉细而数，用桂枝大黄汤。
生姜半夏泻心汤
生姜 半夏 枳壳 浓朴 人参 川连 甘草
此方通治失汗下早痞满之方。多加甘草，名甘草泻心汤，治胃中虚，客气上逆；多加生姜，
名生姜泻心汤，治胁下水气，腹中雷鸣。
平胃保和散 即平胃散保和丸同研。
挟食外感，胸中凝结作痛，手不可近，似结胸，实痰饮食积症，故用此方。
柴胡桂枝汤 详注痞满。
《伤寒论》中说：疾病发于阳证，如果误用攻下法，热邪内陷就会形成结胸；疾病发于阴证，如果误用攻下法，就会形成痞满。这是千古以来令人疑惑的语句。观察张仲景使用大陷胸汤和小陷胸汤这两个重剂来治疗结胸，使用各种泻心汤这些轻剂来治疗痞满，就可以知道“发于阳”、“发于阴”是在谈论病情的轻重。旧有的注释认为发热恶寒是发于阳，无热恶寒是发于阴。却不知道无热恶寒属于阴证，如果误用攻下法，病人就会死亡，怎么可能形成痞满呢？张仲景怎么会用黄连泻心汤这样的寒凉药物，去治疗误下后产生的阴证呢！又说：太阳病中风伤及卫分，应当使用桂枝汤，如果误用承气汤攻下，就会形成结胸。太阳病伤寒伤及营分，应当使用麻黄汤，如果误用承气汤攻下，就会形成痞满。我仔细研读，发现这并不局限于太阳一经导致疾病。下文说：伤寒五六天，呕吐且发热，少阳病（柴胡证）具备，却用其他药物攻下。如果心下部胀满而且硬痛，这就是结胸，用大陷胸汤主治。如果只是胀满而不痛，这就是痞满，不适合用柴胡汤，适宜用泻心汤。可见少阳经误用攻下法，也会出现结胸和痞满的症状。又以心下部硬痛作为结胸，以心下部只是胀满而不痛作为痞满，可见结胸和痞满仅仅通过疼痛与否来区分病情轻重并命名。总之，三阳表邪未解而病情较重，过早攻下导致变证为心下部硬痛，名叫结胸；三阳表邪未解而病情较轻，过早攻下导致变证为心下部只是胀满而不痛，名叫痞满。张仲景并没有完全拘泥于太阳一经，也未必是以风寒伤卫、伤营来分别。看他的用药主治，就是用大陷胸汤丸，治疗从心下直到小腹硬痛的大结胸症；用小陷胸汤丸，只治疗心下痛的结胸症；用各种泻心汤，只治疗心下部胀满不痛的痞气。仔细推敲寒伤营发于阴，无汗的表邪症，比风伤卫有汗的表邪症严重，为什么误用攻下反而不成结胸反而成不痛的痞满，反而用泻心汤这种轻剂，按照这样看来，明明是依据症状的轻重来命名和立方。之所以以“陷胸”、“泻心”立名，是因为病变部位在心胸广阔之处罢了。如果热邪内陷到阳明大肠下部，就不能称为结胸而成为阳明腹痛下症，不用陷胸汤而用承气汤攻下。又如表症未解，而误用攻下，表邪内陷，系连在太阴脾家阴经，而出现下利症状的，不用承气汤，而用桂枝大黄汤。用大黄排泄秽浊腐败之物，用桂枝疏散内陷的表邪，并且制约大黄不损伤太阴脏气，不像结胸在上部的阳经症，可以用陷胸汤的；不像热结在下部的阳明症，可以用承气汤的。另外有水结胸症，用生姜半夏汤治疗的；有痰火结胸用川连半夏汤治疗的。现在我进一步推演，邪气与食气互相胶结，用平胃保和散治疗的，这些都是后世类似结胸的病症。
太阳篇说：疾病发于阳而误用攻下，热邪内陷因此形成结胸；疾病发于阴而误用攻下，因此形成痞满。之所以形成结胸，是因为攻下得太早的缘故。
这一条阐明表热未解，失于发汗而误用攻下，形成结胸和痞满的原因。说疾病发于阳，表热较重的，过早攻下导致表热内陷而形成结胸；发于阴，表热较轻的，如果过早攻下形成痞满。旧注认为风伤卫为阳，寒伤营为阴。却不知道寒伤营无汗身痛、发热的表邪，比风伤卫有汗的表邪严重。难道误用攻下反而变成痞满这种轻病吗？必定是以表热的轻重来区分阴阳。
太阳病，脉象浮而动数，浮表示有风，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，说明表邪未解。医生反而攻下，动数之脉变为迟脉，膈内抗拒疼痛，胃中空虚，客气扰动膈部，短气烦躁，心中懊恼，阳气内陷，心下部因此变硬，这就形成结胸。用大陷胸汤主治。如果不形成结胸，只有头部出汗，其余身体无汗至颈部而止，小便不利，身体一定会发黄。
浮而动数，是表脉。头痛发热，盗汗恶寒，是表症。医生反而攻下，动数变迟，是结胸脉。膈内拒痛，心中懊恼，心下部变硬，是结胸症，所以用大陷胸汤。假设如果不结胸，头部有汗遍身无汗，小便不利，那么瘀热无从发泄，身体就会发黄。
太阳病，重发汗又复攻下，不大便五六天，舌上干燥而渴，傍晚时分有轻微潮热，从心下直到小腹硬满而且疼痛不可触碰的，用大陷胸汤主治。
表症失于发汗，担心攻下会形成结胸痞满。现在重发汗，又攻下，也形成结胸。不大便，舌上干燥而渴，傍晚轻微潮热，心下到小腹硬满而痛，所以用大陷胸汤。
结胸症项部也强直，像柔痉的样子，攻下后就会缓和，适宜用大陷胸汤。
结胸发展到颈项也强直，胸中邪气十分紧实，用大陷胸汤，恐怕药力过猛而不留驻病所；用陷胸丸，恐怕药力滞缓而使结聚更甚。现在煮汁服用，则能婉转地驱逐邪气。
有病叫结胸，有病叫脏结，它们的症状怎么样？回答说：按压疼痛，寸脉浮，关脉沉，名叫结胸。像结胸的样子，饮食如常，经常腹泻，寸脉浮，关脉小细沉紧，名叫脏结。舌上有白苔滑腻的，难治。
这一条辨别结胸和脏结的症状，只在饮食如常和经常腹泻上区别症状。寸脉浮，关脉沉，舌上有苔，不可用辛温药。白苔而滑，不可用寒凉药，所以说难治。
病患胁下，向来有痞气，连在脐旁，疼痛牵引小腹进入阴筋的，这叫脏结，死脏结没有阳症，没有往来寒热，其人反而安静，舌上有苔滑的，不可攻下。
这一条申述向来有痞气的人，现在疼痛引入小腹，下连阴筋的，名叫脏结的死症。又申述脏结不是阳经症，所以没有往来寒热，其人反而安静，舌上有苔而滑的，所以不可攻下。
伤寒六七天，结胸热实证，脉沉紧，心下痛，按之像石头一样硬的，用大陷胸汤主治。
这一条重申胸前实热，脉沉而紧，心下痛，按之像石头一样硬的，适宜用大陷胸汤。
伤寒十多天，热结在里，又出现往来寒热的，用大柴胡汤主治。只有结胸而没有大热的，这是水结在胸胁，只有头部出汗的，用大陷胸汤主治。
上段说伤寒十多天，热结在里，已经可以攻下。然而见往来寒热，这是少阳表症，只能大柴胡汤双解表里。下段说只有结胸，外无大热的，乃是水结胸，阻绝阴阳，所以只有头汗，其余地方无汗，必须用大陷胸汤逐水饮，通闭塞。这一条申明只有头部有汗的症状，应当治疗胸前的凝结。
伤寒六七天，发热微恶寒，骨节烦疼，微呕，心下部支撑感结聚，外症未去的，用柴胡桂枝汤主治。
这一段邪气结聚胁下，不成结胸，又见太阳少阳表症，应当用柴胡桂枝汤先散表邪。结胸病，其脉浮大的，不可攻下，攻下就会死亡。
伤寒五六天，呕吐且发热，具备柴胡症，却用其他药物攻下，柴胡症仍在的，再给柴胡汤。这虽然已经攻下，不算逆证，一定蒸蒸而振栗，随后发热汗出而解。如果心下部胀满而且硬痛，这就是结胸，用大陷胸汤主治。只是胀满而不痛的，这就是痞满，柴胡汤不适合给它，适宜用半夏泻心汤。
这一条申明误用攻下，变化出三种症状三条治法。说结胸痞满，不只是太阳过早攻下而成，即使是少阳表症，误用攻下也会形成。所以说伤寒五六天，呕吐且发热，具备柴胡汤症，反而用其他药物攻下，如果发热表症仍在，不成结胸的，应当再给柴胡汤，一定蒸蒸发热汗出而解。如果攻下后身不热而见心下部硬痛，就形成结胸了，适宜用大陷胸汤。如果胀满而不痛，就是痞气，适宜用半夏泻心汤。
大陷胸汤
芫花 甘遂 大戟
热邪传入里，内结小腹，用大承气汤。如果失于发汗误用攻下，热邪内陷，造成胸腹疼痛，用大陷胸汤丸。
小陷胸汤
川连 半夏 栝蒌实
此方详细注解胸满，用半夏辛散豁痰，栝蒌荡涤邪秽，川连去除积热，则热散痰消。
承气汤 见便结。
结胸上部病，本来不用承气汤。如果胀满而不痛，腹中痛多，又见大便闭结，所以变用承气汤下行，则上部也宽舒。
桂枝大黄汤 见腹痛。
误用攻下，表邪内陷，阳明胃家作痛，脉沉而紧，用大陷胸汤。内陷大肠作痛，脉数而实，用承气汤。内陷太阴作痛，脉细而数，用桂枝大黄汤。
生姜半夏泻心汤
生姜 半夏 枳壳 浓朴 人参 川连 甘草
此方通治失于发汗过早攻下导致的痞满。多加甘草，名叫甘草泻心汤，治疗胃中虚，客气上逆；多加生姜，名叫生姜泻心汤，治疗胁下水气，腹中雷鸣。
The *Shanghan Lun* (Treatise on Cold Damage) states: "When a disease originates from Yang, and purgation is wrongly applied, heat enters and causes Jie Xiong (Chest Binding); when a disease originates from Yin, and purgation is wrongly applied, Pi Man (Stagnant Fullness) results." This has been a perplexing sentence for millennia. Observing that Zhang Zhongjing uses heavy formulas such as Da Xianxiong Tang (Major Chest-Trap Decoction) and Xiao Xianxiong Tang (Minor Chest-Trap Decoction) to treat Jie Xiong, and light formulas such as the various Xiexin Tangs (Heart-Draining Decoctions) to treat Pi Man, we can understand that "originating from Yang" and "originating from Yin" refer to the severity of the disease. Old annotations claim that fever with aversion to cold indicates originating from Yang, while absence of fever with aversion to cold indicates originating from Yin. However, one fails to realize that absence of fever with aversion to cold belongs to Yin syndromes; if purgation is wrongly applied in such cases, death ensues, so how could Pi Man result? Would Zhang Zhongjing use cold herbs like Huanglian Xiexin Tang (Coptis Heart-Draining Decoction) to treat Yin syndromes resulting from erroneous purgation! It is also stated: "In Taiyang disease, wind damages the Wei (Defensive) level, and Guizhi Tang (Cinnamon Twig Decoction) should be used; if Chengqi Tang (Gut-Preserving Decoction) is wrongly used for purgation, Jie Xiong results. In Taiyang disease, cold damages the Ying (Nutritive) level, and Mahuang Tang (Ephedra Decoction) should be used; if Chengqi Tang is wrongly used for purgation, Pi Man results." Upon careful study, I find this is not limited to Taiyang channel pathology. The text later states: "After six or seven days of cold damage, with vomiting and fever, Chaihu syndrome (Bupleurum Syndrome) is present, yet other drugs are used for purgation. If there is fullness and hardness with pain in the epigastrium, this is Jie Xiong, treated with Da Xianxiong Tang. If there is only fullness without pain, this is Pi, and Chaihu Tang is inappropriate; Xiexin Tang is suitable." Thus, erroneous purgation of the Shaoyang channel can also lead to Jie Xiong and Pi Man. Furthermore, hardness and pain in the epigastrium define Jie Xiong, while mere fullness without pain defines Pi Man. This shows that Jie Xiong and Pi Man are named based on the presence or absence of pain to distinguish disease severity. In summary, when exterior pathogens of the Three Yang channels remain unresolved and the condition is severe, premature purgation leads to hard, painful epigastrium, named Jie Xiong; when the condition is mild, premature purgation leads to mere fullness without pain in the epigastrium, named Pi Man. Zhang Zhongjing did not strictly adhere to the Taiyang channel alone, nor did he necessarily differentiate based on wind damaging Wei versus cold damaging Ying. Looking at his formula indications, Da Xianxiong Tang and Wan are used for Da Jie Xiong (Major Chest Binding) characterized by hardness and pain from the epigastrium down to the lower abdomen; Xiao Xianxiong Tang and Wan are used only for chest binding with pain in the epigastrium; and the various Xiexin Tangs are used only for Pi Qi (Stagnant Qi) characterized by epigastric fullness without pain. Carefully considering that cold damaging Ying (originating from Yin) presents with anhidrosis and is more severe than wind damaging Wei (originating from Yin) with diaphoresis, why does erroneous purgation fail to produce Jie Xiong but instead produces painless Pi Man, treated with the light Xiexin Tang? Clearly, the naming and formulation are based on symptom severity. The names "Xianxiong" (Chest-Trap) and "Xiexin" (Heart-Drain) are used because the pathological location is in the broad area of the heart and chest. If heat pathogen sinks into the lower part of the Yangming Large Intestine, it cannot be called Jie Xiong but becomes Yangming abdominal pain and downward syndrome, treated with Chengqi Tang for purgation rather than Xianxiong Tang. Similarly, if exterior symptoms are unresolved and purgation is wrongly applied, causing exterior pathogens to sink into the Taiyin Spleen Yin channel, presenting with diarrhea, Chengqi Tang is not used, but Guizhi Dahuang Tang (Cinnamon Twig and Rhubarb Decoction) is used. Dahuang (Rhubarb Root and Rhizome) eliminates filth and decay, while Guizhi (Cinnamon Twig) disperses the sunken exterior pathogen, and simultaneously restrains Dahuang from damaging Taiyin organ qi. This differs from Jie Xiong in the upper Yang channels, which can use Xianxiong Tang; and differs from heat accumulation in the lower Yangming channels, which can use Chengqi Tang. Additionally, there is Shui Jie Xiong (Water Chest Binding) treated with Shengjiang Banxia Tang (Fresh Ginger and Pinellia Decoction); and Tan Huo Jie Xiong (Phlegm-Fire Chest Binding) treated with Chuanlian Banxia Tang (Coptis and Pinellia Decoction). I further deduce that when pathogenic factors and food stagnation bind together, Pingwei Baohe San (Stomach-Calming and Harmony-Preserving Powder) is used. All these are later generations' similar-to-Jie Xiong syndromes.
The Taiyang chapter states: "Disease originating from Yang, wrongly purged, heat enters and forms Jie Xiong; disease originating from Yin, wrongly purged, forms Pi Man." The reason Jie Xiong forms is due to purgation being too early.
This clause clarifies the cause of Jie Xiong and Pi Man resulting from failure to sweat and erroneous purgation while exterior heat remains unresolved. It says that disease originating from Yang involves heavier exterior heat; premature purgation causes heat to sink inward, forming Jie Xiong. Originating from Yin involves lighter exterior heat; premature purgation forms Pi Man. Old annotations claim wind damaging Wei is Yang, and cold damaging Ying is Yin. However, one fails to realize that cold damaging Ying, presenting with anhidrosis, body ache, and fever, represents a more severe exterior pathogen than wind damaging Wei, which presents with diaphoresis. Could erroneous purgation transform it into the milder Pi Man? It must be that Yin and Yang are distinguished by the severity of exterior heat.
In Taiyang disease, the pulse is floating, moving, and rapid. Floating indicates Wind, Rapid indicates Heat, Moving indicates Pain, and Rapid indicates Deficiency. Headache, fever, slight nocturnal sweating, and contrary aversion to cold indicate the exterior is unresolved. The physician wrongly applies purgation. The moving and rapid pulse changes to slow. Rejection pain occurs inside the diaphragm. The stomach becomes empty and deficient. Hostile Qi agitates the diaphragm, causing shortness of breath, irritability, and mental restlessness (Ao Nao). Yang Qi sinks inward, causing hardness in the epigastrium, thus forming Jie Xiong. Da Xianxiong Tang is indicated. If Jie Xiong does not form, but only head sweating occurs, with no sweat elsewhere up to the neck, and urination is difficult, the body will surely become jaundiced.
Floating and moving/rapid is an exterior pulse. Headache, fever, nocturnal sweating, and aversion to cold are exterior symptoms. Wrong purgation changing the pulse to slow is the Jie Xiong pulse. Diaphragmatic rejection pain, mental restlessness, and epigastric hardness are Jie Xiong symptoms, hence Da Xianxiong Tang is used. If Jie Xiong does not form, with head sweat but no body sweat, and difficulty urinating, stasis-heat has no outlet to vent, leading to jaundice.
In Taiyang disease, after excessive sweating followed by purgation, constipation persists for five or six days, the tongue is dry and thirsty, there is slight tidal fever in the late afternoon, and hardness and fullness with unbearable pain from the epigastrium to the lower abdomen occur. Da Xianxiong Tang is indicated.
Failure to sweat the exterior creates fear of Jie Xiong or Pi Man from purgation. Now, excessive sweating followed by purgation also forms Jie Xiong. Constipation, dry tongue with thirst, slight afternoon tidal fever, and hardness/fullness/pain from epigastrium to lower abdomen necessitate Da Xianxiong Tang.
In Jie Xiong, the neck is also stiff, resembling Rou Ji (Soft Spasm). Purging brings relief; Da Xianxiong Tang is suitable.
When Jie Xiong extends to neck stiffness, the chest pathogen is extremely tight and solid. Using Da Xianxiong Tang risks passing through without retaining effect; using Xianxiong Wan risks stagnation worsening the binding. Boiling the decoction allows gentle expulsion of the pathogen.
There are syndromes of Jie Xiong and Zang Jie (Organ Binding). What are their manifestations? Answer: Pressing causes pain, Cun pulse is floating, Guan pulse is sunken, named Jie Xiong. Similar to Jie Xiong, but eating/drinking is normal, with frequent diarrhea, Cun pulse floating, Guan pulse small, fine, sunken, and tight, named Zang Jie. A white slippery coating on the tongue indicates a difficult case to treat.
This clause differentiates Jie Xiong and Zang Jiao symptoms, distinguishing them by normal appetite versus frequent diarrhea. With floating Cun pulse, sunken Guan pulse, and tongue coating, acrid-warm herbs are contraindicated. With white slippery coating, cold-cool herbs are contraindicated, hence "difficult to treat."
If a patient has had Pi Qi (Stagnant Fullness) under the hypochondrium since long ago, connected to the side of the umbilicus, with pain radiating to the lower abdomen and genitals, this is named Zang Jie, a fatal Zang Jie. Zang Jie lacks Yang symptoms, no alternating chills and fever, the person is quiet, and with a slippery tongue coating, it cannot be attacked with purgatives.
This elaborates that in persons with pre-existing Pi Qi, pain now radiating to the lower abdomen and genitals is named fatal Zang Jie. It further states Zang Jie is not a Yang channel syndrome, hence no alternating chills and fever, the person is quiet, and with slippery tongue coating, it cannot be purged.
After six or seven days of cold damage, presenting with Jie Xiong Heat Excess syndrome, sunken and tight pulse, epigastric pain, and hardness upon palpation like stone, Da Xianxiong Tang is indicated.
This reiterates anterior chest excess-heat, sunken-tight pulse, epigastric pain, and stone-hard palpation, indicating Da Xianxiong Tang.
Minor Jie Xiong syndrome is located precisely in the epigastrium, painful only upon pressure, with floating-slippery pulse. Xiao Xianxiong Tang is indicated.
This reiterates non-pain upon non-pressure, floating-slippery pulse, not sunken-excess, indicating Xiao Xianxiong Tang.
After ten-plus days of cold damage, heat accumulates in the interior, accompanied by alternating chills and fever. Da Chaihu Tang (Major Bupleurum Decoction) is indicated. In pure Jie Xiong without significant external heat, this is Water Binding in the chest and hypochondrium. With only head sweating, Da Xianxiong Tang is indicated.
The first part discusses cold damage for ten-plus days with heat binding in the interior, ready for purgation. However, with alternating chills and fever, this is Shaoyang exterior syndrome; only Da Chaihu Tang can resolve both exterior and interior. The second part discusses pure Jie Xiong without significant external heat, which is Water Binding in the chest, blocking Yin and Yang, causing only head sweat and no body sweat. Da Xianxiong Tang must be used to expel water-fluids and open blockages. This clarifies that head-only sweating requires treating chest condensation.
After six or seven days of cold damage, with fever, slight aversion to cold, bone joint vexation/pain, slight vomiting, and epigastric support-binding sensation, with exterior symptoms unresolved, Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction) is indicated.
In this section, pathogen binds in the hypochondrium without forming Jie Xiong, yet Taiyang and Shaoyang exterior symptoms are present. Chaihu Guizhi Tang should be used to first disperse exterior pathogens. In Jie Xiong disease, if the pulse is floating and large, purgation is contraindicated; purging leads to death.
In Jie Xiong disease, a floating-large pulse indicates exterior pathogen, hence purging leads to death.
After five or six days of cold damage, with vomiting and fever, Chaihu syndrome is complete. If other drugs are used for purgation, and Chaihu syndrome persists, Chaihu Tang should be administered again. Although purgation has occurred, this is not a counter-indication. There will be shivering and shaking, followed by fever and sweating, leading to resolution. If epigastric fullness with hardness and pain occurs, this is Jie Xiong, treated with Da Xianxiong Tang. If merely full without pain, this is Pi, Chaihu Tang is inappropriate, and Banxia Xiexin Tang (Pinellia Heart-Draining Decoction) is suitable.
This clarifies that erroneous purgation transforms into three syndromes with three treatments. Jie Xiong and Pi Man are not solely caused by premature purgation in Taiyang; even Shaoyang exterior syndrome, if wrongly purged, can result in these conditions. Thus, after five or six days of cold damage with vomiting and fever, if Chaihu Tang syndrome is present but other drugs are wrongly used for purgation, if fever/exterior symptoms persist and Jie Xiong does not form, Chaihu Tang should be given again, leading to resolution via sweating. If post-purgation body heat ceases but epigastric hardness/pain appears, Jie Xiong forms, requiring Da Xianxiong Tang. If full without pain, it is Pi Qi, requiring Banxia Xiexin Tang.
Da Xianxiong Tang
Yuanhua (Kerria Flower), Gansui (Radix Kansui), Daji (Radix Euphorbiae Pekinensis)
When heat pathogen transmits to the interior and binds in the lower abdomen, Dachengqi Tang (Major Gut-Preserving Decoction) is used. If failure to sweat leads to erroneous purgation, causing heat to sink inward and creating chest/abdominal pain, Da Xianxiong Tang/Wan is used.
Xiao Xianxiong Tang
Chuanlian (Rhizoma Coptidis), Banxia (Rhizoma Pinelliae), Gualou Shi (Fructus Trichosanthis)
This formula addresses chest fullness. Banxia disperses phlegm acridly, Gualou clears evil turbidity, and Chuanlian removes accumulated heat, thereby dissipating heat and resolving phlegm.
Chengqi Tang See Bianjie (Constipation).
Upper Jie Xiong does not originally require Chengqi Tang. If full without pain, with abdominal pain and constipation, Chengqi Tang is variedly used to descend, thereby relieving the upper region.
Guizhi Dahuang Tang See Fentong (Abdominal Pain).
Erroneous purgation causes exterior pathogen to sink. Yangming Stomach pain with sunken-tight pulse uses Da Xianxiong Tang. Sink into Large Intestine causing pain with rapid-excess pulse uses Chengqi Tang. Sink into Taiyin causing pain with fine-rapid pulse uses Guizhi Dahuang Tang.
Shengjiang Banxia Xiexin Tang
Shengjiang (Fresh Ginger), Banxia (Pinellia Tuber), Zhike (Aurantii Fructus), Houpo (Magnolia Bark), Renshen (Ginseng Radix), Chuanlian (Coptis Rhizome), Gancao (Licorice Root)
This formula generally treats Pi Man resulting from failed sweating or premature purgation. Adding more Gancao makes Gancao Xiexin Tang, treating Stomach deficiency and hostile Qi rebelling upward. Adding more Shengjiang makes Shengjiang Xiexin Tang, treating subcostal water-fluids and borborygmus.
Pingwei Baohe San Is Pingwei San (Stomach-Calming Powder) and Baohe Wan (Harmony-Preserving Pill) ground together.
For exogenous pathogens complicated by food stagnation, causing chest condensation and pain intolerable to touch, resembling Jie Xiong but actually Phlegm-Food Stagnation, this formula is used.
Chaihu Guizhi Tang See detailed notes on Pi Man.