大黄(六两) 芒硝(一升) 甘遂(一钱匕)
上二味以水六升先煎大黄取二升去滓内芒硝煮一二沸内甘遂末温服一升得快利止后服
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
伤寒六七日后结胸而膈热内实心下满痛按之如石之硬者是真大陷胸证也结胸之脉寸浮而关沉后章寸脉浮关脉沉名曰
结胸是也脉沉而紧指关上言抵当汤证脉微而沉反不结胸盖结胸之脉关上必沉也后章小结胸病正在心下脉浮滑者太阳病下
之脉浮者必结胸也皆指寸脉言
太阳病重发汗而复下之不大便五六日舌上燥而渴日晡时小有潮热从心下至少腹硬满而痛不可近者大陷胸汤主之
结胸证攻下后下寒逼热在上病但在胸不至少腹此从心上至于少腹硬满而痛是结胸而兼阳明腑证也合之舌上燥渴日晡
潮热全是胃腑燥热但小有潮热腑邪尚轻故用陷胸而不用承气也
结胸者项亦强如柔痉状下之则和宜大陷胸丸
胸膈痞塞湿热薰冲俯则痛甚故项常反折状如柔痉大陷胸丸硝黄荡其结热杏仁破其滞气葶苈泄其水饮变汤为丸病连项
颈恐汤之速下也
大黄(半斤) 芒硝(半升) 葶苈(半升熬) 杏仁(半升去皮熬)
上四味捣筛二味内杏仁芒硝合研如脂合散取如弹丸一枚别捣甘遂末一钱匕白蜜二合水二升煮取一升温顿服之一宿乃
下如不下更服取下为效禁如药法
大黄(六两) 芒硝(一升) 甘遂(一钱匕)
以上三味药,用水六升,先煎煮大黄,取汁二升,去渣,加入芒硝,再煮一二沸,加入甘遂末,温服一升。若得快利(迅速通便),则停服后面的药。
伤寒病经过六七日,出现结胸热实证,脉象沉而紧,心下(胃脘部)疼痛,按压时像石头一样硬的,用大陷胸汤主治。
伤寒病六七日后,出现结胸且膈间热邪内盛,心下胀满疼痛,按压如石头般坚硬,这是真正的大陷胸证。结胸病的脉象通常是寸脉浮而关脉沉,后文提到“寸脉浮、关脉沉”名为结胸,就是这个意思。脉沉而紧是指关脉而言。抵当汤证的脉象微而沉,反而不形成结胸,大概是因为结胸病的脉象在关部必定是沉的。后文提到小结胸病,病位正在心下,脉象浮滑的,以及太阳病误下后脉象浮者必成结胸等,都是指寸脉而言。
太阳病,重发汗后又误用攻下法,导致不大便五六日,舌上干燥且口渴,傍晚时分有轻微的潮热,从心下直到少腹硬满且疼痛,不可触碰的,用大陷胸汤主治。
结胸证经攻下治疗后,因下寒逼迫热邪在上,病位仅在胸,不到少腹。此处从心上至于少腹硬满而痛,是结胸兼有阳明腑实证。结合舌上燥渴、傍晚潮热的症状,全是胃腑燥热所致。但因仅有轻微的潮热,腑邪尚轻,所以用大陷胸汤而不是承气汤。
结胸病患者颈部也强直,如同柔痉(一种以项背强急、汗出为特征的病症)的症状。用攻下法可使病情调和,宜用大陷胸丸。
胸膈痞塞,湿热熏蒸冲逆,俯身时疼痛加剧,所以颈部常呈反折状,类似柔痉。大陷胸丸中,硝黄(芒硝、大黄)荡涤结聚的热邪,杏仁破滞气,葶苈子泄水饮。将汤剂改为丸剂,是因为病连及颈项,担心汤剂泻下过快。
大黄(半斤) 芒硝(半升) 葶苈子(半升,熬制) 杏仁(半升,去皮,熬制)
以上四味药,捣筛两种粉末,将杏仁和芒硝合在一起研磨如脂状,混合散剂,取如弹丸大小的一枚,另捣甘遂末一钱匕,白蜜二合,水二升,煮取一升,温顿服。过一夜才大便通下。如果未通下,再服用,以下通为有效。禁忌同前药法。
Rhubarb (Liu liang) Mangxiao (Yi sheng) Kansui (Yi qian bi)
Take the above three herbs, add six sheng of water, first decoct Rhubarb until two sheng remain, remove the dregs, add Mangxiao, boil for one or two boils, add powdered Kansui, take one sheng warm. If rapid purgation occurs, stop taking the remaining medicine.
After six to seven days of Taiyang disease (disease of the Taiyang channel), if there is a Jie Xiong (chest binding) with heat and excess syndrome, the pulse is deep and tight, pain in the Xin Xia (epigastrium), and hardness upon palpation like stone, Da Xian Xiong Tang (Major Sinking Chest Decoction) is the primary treatment.
Six to seven days after Taiyang disease, if Jie Xiong occurs with internal heat in the diaphragm, fullness and pain in the Xin Xia, and hardness upon palpation like stone, this is a true Da Xian Xiong syndrome. The pulse of Jie Xiong is typically floating at the Cun position and deep at the Guan position; later chapters mention "floating Cun pulse and deep Guan pulse" as named Jie Xiong, which refers to this. The deep and tight pulse refers specifically to the Guan position. In Dangdang Tang syndrome, the pulse is faint and deep, but it does not form Jie Xiong, likely because the pulse at the Guan position in Jie Xiong must be deep. Later chapters mention Xiao Jie Xiong Bing (minor chest binding disease) located exactly at the Xin Xia with a floating and slippery pulse, and that Taiyang disease treated with downward methods where the pulse remains floating must result in Jie Xiong; all these refer to the Cun pulse.
In Taiyang disease, after heavy sweating followed by erroneous purgation, leading to constipation for five to six days, dryness and thirst on the tongue, slight tidal fever in the late afternoon, hardness, fullness, and pain from the Xin Xia down to the Shao Fu (lower abdomen) that cannot be touched, Da Xian Xiong Tang is the primary treatment.
After purgation for Jie Xiong syndrome, lower cold forces heat upward, so the pathology is only in the chest, not reaching the Shao Fu. Here, hardness, fullness, and pain extend from the heart down to the Shao Fu, indicating Jie Xiong combined with Yangming Fu organ syndrome. Combined with dryness and thirst on the tongue and tidal fever in the late afternoon, this is entirely due to dryness-heat in the stomach fu. However, since the tidal fever is slight, the fu pathogen is still light, so Da Xian Xiong Tang is used instead of Cheng Qi Tang.
In Jie Xiong, the neck is also stiff, resembling Rou Ji (a condition characterized by stiffness of the neck and back with sweating). Downward treatment harmonizes the condition; Da Xian Xiong Wan (Major Sinking Chest Pill) is appropriate.
Chest and diaphragm obstruction with damp-heat steaming and rushing upward causes severe pain when bending forward, resulting in the neck often being hyperextended, resembling Rou Ji. In Da Xian Xiong Wan, Mangxiao and Dahuang purge accumulated heat, Xingren breaks qi stagnation, and Tinglizi drains fluid retention. Changing the decoction to a pill is because the pathology involves the neck, fearing that the decoction would act too quickly.
Dahuang (Ban jin) Mangxiao (Ban sheng) Tinglizi (Ban sheng, roasted) Xingren (Ban sheng, peeled, roasted)
Pound and sieve four herbs. Mix two powders, combine Xingren and Mangxiao, grind into a paste-like consistency, mix with the powder. Take one pill-sized piece (size of a bullet). Independently pound powdered Kansui (Yi qian bi), Bai Mi (two he), and water (two sheng). Decoct to obtain one sheng, take warm in one dose. Bowel movement occurs after one night. If no bowel movement, administer again. Effective when purged. Contraindications follow standard herbal regulations.