结胸由邪在胸中。处身之高分。邪结于是。宜若可汗。然所谓结者。若绑定之结。不
能分解者也。诸阳受提于胸中。邪气与阳气相结。不能分解。气不通。壅于心下。为
硬为痛。是邪正因结于胸中。非虚烦膈实之所同。是须攻下之物可理。低者举之。
高者陷之。以平为正。结胸为高邪。陷下以平之。故治结胸。曰陷胸汤。甘遂味苦寒。
苦性泄。寒胜热。虽曰泄热。而甘遂又若夫间之。遂直达之气。陷胸破结。非直达者
不能透。是以甘遂为君。芒硝味咸寒。内经曰。咸味下泄为阴。又曰。咸以软之。气坚
者。以咸软之。热胜者。以寒消之。是以芒硝为臣。大黄味苦寒。将军也。荡涤邪寇。除
去不平。将军之功也。陷胸涤热。是以大黄为使。利药之中。此为峻剂。伤寒错恶。结
胸为甚。非此汤则不能通利之。剂大而数少。取其迅疾。分解结邪。此奇方之制也。
黄帝针经曰。结虽大。犹可解也。在伤寒之结。又不能久。非陷胸汤。孰可解之矣。
甘遂（君一钱七） 芒硝（臣一升） 大黄（使六两去皮）
上三味。以水六升。先煮大黄。取二升。去渣。内芒硝。煮一两沸。内甘遂未。温服一
升。得快利。止后服。
凡陷胸汤攻结也。泻心汤攻痞也。气结而不散。壅而不通为结胸。陷胸汤为直达
之剂。塞而不通。否而不分为痞。泻心汤为分解之剂。所以谓之泻心者。谓泻心下
之邪也。痞与结胸。有高下焉。结胸者。邪结在胸中。故治结胸曰陷胸汤。痞者。邪留
在心下。故治痞曰泻心汤。黄连味苦寒。黄芩味苦寒。内经曰。苦先入心。以苦泄之。
泻心者。必以苦为主。是以黄连为君。黄芩为臣。以降阳而升阴也。半夏味辛温。干
姜味辛热。内经曰。辛走气。辛以散之。散痞者必以辛为助。故以半夏干姜为佐。以
分阴而行阳也。甘草味甘平。大枣味甘温。人参味甘温。阴阳不交曰痞。上下不通
为满。欲通上下。交阴阳。必和其中。所谓中者。脾胃是也。脾不足者。以甘补之。故用
人参甘草大枣为使。以补脾而和中。中气得和。上下得通。阴阳得位。水升火降。则
痞消热已。而大汗解矣。
黄连（君四两） 黄芩（臣三两） 半夏（佐半升洗） 干姜（佐三两） 人参（使三两） 甘草（使三两炙）
大枣（使十二枚擘）
上七味。以水一斗。煮取六升。去渣再煎。取三升。温服一升。日三服。
结胸证是由于邪气停留在胸中。胸位于人体的高位，邪气结聚于此，看似应当使用发汗法治疗。然而所谓的“结”，就像被绑紧的绳结一样，无法自行解开。诸阳经之气汇聚于胸中，邪气与阳气相互搏结，不能分离，导致气机不通，壅滞于心下，表现为坚硬和疼痛。这说明邪气确实结聚在胸中，这与虚烦、膈实的情况不同，必须使用攻下法才能治愈。根据“低者举之，高者陷之”的原则，以平复为正常标准。结胸属于高位之邪，需用陷下之法来平复它，所以治疗结胸的方剂称为陷胸汤。
甘遂味苦性寒，苦能泄降，寒能胜热。虽然说是泄热，但甘遂的作用如同穿透缝隙一般，能够直达病所之气，攻破胸中结聚。如果不是这种直达之药，就不能透达病所，因此用甘遂作为君药。芒硝味咸性寒，《内经》说：“咸味向下泄降，属于阴。”又说：“咸能软坚。”对于气机坚结的病证，用咸味来软化它；对于热盛的情况，用寒性来消除它。因此用芒硝作为臣药。大黄味苦性寒，被称为“将军”，能荡涤邪气，去除不平，这是将军的功效。陷胸汤需要涤除热邪，因此用大黄作为使药。在利水通便的药物中，这属于峻猛之剂。伤寒病情错杂恶劣，其中结胸最为严重，不用此汤就不能通利。方剂剂量大且药味少，是为了取其迅速快捷，分解结聚的邪气，这是奇方的制法。《黄帝针经》说：“结聚即使很大，仍然可以解开。”但在伤寒病的结聚中，又不能拖延太久，除了陷胸汤，还有什么能解开它呢？
甘遂（君药一钱七） 芒硝（臣药一升） 大黄（使药六两，去皮）
以上三味药，用水六升，先煮大黄，取汁二升，去渣，加入芒硝，煮沸一两滚，再加入甘遂末，温服一升。若得快速通利，则停服后药。
凡是陷胸汤攻逐的是结聚，泻心汤攻逐的是痞证。气机结聚而不散，壅塞而不通，形成结胸，陷胸汤是直达病所的药剂；堵塞而不通，阴阳否隔而不能分开，形成痞证，泻心汤是分解病邪的药剂。之所以叫泻心汤，是因为要泻除心下的邪气。痞证与结胸有高低之分。结胸，是邪气结聚在胸中，所以治疗结胸叫陷胸汤；痞证，是邪气留滞在心下，所以治疗痞证叫泻心汤。
黄连味苦性寒，黄芩味苦性寒。《内经》说：“苦味先入心，用苦味来泄降。”治疗痞证，必须以苦味为主，因此用黄连作为君药，黄芩作为臣药，用以降阳而升阴。半夏味辛性温，干姜味辛性热。《内经》说：“辛味走气，用辛味来发散。”消散痞证必须以辛味为辅助，因此用半夏、干姜作为佐药，用以分阴而行阳。甘草味甘性平，大枣味甘性温，人参味甘性温。阴阳不交叫做痞，上下不通叫做满。想要打通上下，使阴阳相交，必须调和其中焦。所谓中焦，就是脾胃。脾不足时，用甘味来补益，因此用人参、甘草、大枣作为使药，用以补脾而和中。中气得调和，上下得以通畅，阴阳各归其位，水升火降，那么痞证消除，热邪已退，大汗出而病解。
黄连（君药四两） 黄芩（臣药三两） 半夏（佐药半升，洗） 干姜（佐药三两） 人参（使药三两） 甘草（使药三两，炙） 大枣（使药十二枚，掰开）
以上七味药，用水一斗，煮取六升，去渣，再次煎煮，取汁三升，温服一升，每日三次。
Jie Xiong (Chest Binding Syndrome) arises from pathogenic factors lingering in the chest. The chest is located at a high position in the body, and when pathogens accumulate there, it might seem appropriate to use diaphoresis (sweating method). However, what is meant by "binding" is like a tightly knotted rope that cannot be untied on its own. The Qi of all Yang meridians converges in the chest; when pathogenic factors bind with Yang Qi, they cannot separate, leading to obstruction of Qi flow. This stagnation accumulates in the epigastrium, causing hardness and pain. This indicates that the pathogen is indeed bound in the chest, which differs from deficiency-heat vexation or fullness in the diaphragm. Therefore, purgatives must be used to resolve it. According to the principle "raise what is low, depress what is high," the goal is to restore balance. Jie Xiong involves high-level pathogens, so a depressing method is needed to level it. Hence, the formula for treating Jie Xiong is called Xian Xiong Tang (Major Inward-Draining Chest Decoction).
Gansui (Kansui Root) has a bitter and cold nature. Bitterness drains downward, and cold overcomes heat. Although it clears heat, Gansui acts like penetrating through gaps, reaching the Qi directly to break the chest binding. Only such direct-penetrating herbs can reach the pathology, so Gansui serves as the Sovereign herb. Mangxiao (Natrii Sulfas) has a salty and cold nature. The *Neijing* states: "Salty flavor descends and drains, belonging to Yin." It also says: "Salty softens hardness." For conditions of solidified Qi, salty flavors are used to soften them; for excessive heat, cold properties are used to eliminate it. Thus, Mangxiao serves as the Minister herb. Dahuang (Rhei Radix et Rhizoma), with a bitter and cold nature, is known as the "General." It sweeps away pathogenic invaders and removes imbalance, fulfilling the role of a general. To drain heat in Xian Xiong Tang, Dahuang serves as the Envoy herb. Among purgative drugs, this is a harsh/decocting formula. Typhoid disorders are complex and severe, with Jie Xiong being the most serious. Without this decoction, unblocking is impossible. The dosage is large but the number of ingredients is small, aiming for speed to decompose the bound pathogens. This is the formulation of an extraordinary prescription. The *Huangdi Zhenjing* (Yellow Emperor's Classic of Acupuncture) states: "Even if the binding is large, it can still be resolved." In typhoid bindings, one cannot wait long; apart from Xian Xiong Tang, what else could resolve it?
Gansui (Sovereign, 1 qian 7 fen) Mangxiao (Minister, 1 sheng) Dahuang (Envoy, 6 liang, peeled)
Take the above three ingredients. Add 6 sheng of water. First boil Dahuang until reduced to 2 sheng. Remove dregs. Add Mangxiao. Boil for one or two boils. Add Gansui powder. Take 1 sheng warm. If rapid purgation occurs, stop taking the remaining medicine.
Xian Xiong Tang attacks binding, while Xi Xin Tang (Minor Inward-Draining Heart Decoction) attacks Pi (fullness/stuffiness). When Qi binds and does not disperse, accumulating and obstructing, it forms Jie Xiong; Xian Xiong Tang is a direct-penetrating agent. When blockage prevents passage, and Yin-Yang fail to interact, forming Pi; Xi Xin Tang is a decomposing agent. It is called "Xi Xin" because it drains pathogens from the heart region. There is a distinction in location between Pi and Jie Xiong. Jie Xiong involves pathogens bound in the chest, hence treated with Xian Xiong Tang. Pi involves pathogens lingering in the epigastrium (heart region), hence treated with Xi Xin Tang.
Huanglian (Coptidis Rhizoma) is bitter and cold. Huangqin (Scutellariae Radix) is bitter and cold. The *Neijing* states: "Bitter flavor enters the Heart first; use bitter to drain." Treating Pi requires bitterness as the main component. Thus, Huanglian serves as the Sovereign herb, and Huangqin as the Minister, to descend Yang and ascend Yin. Banxia (Pinelliae Rhizoma) is acrid and warm. Ganjiang (Zingiberis Rhizoma) is acrid and hot. The *Neijing* states: "Acrid flavor moves Qi; use acrid to disperse." Dispersing Pi requires acrid assistance. Thus, Banxia and Ganjiang serve as Assistant herbs, to differentiate Yin and move Yang. Gancao (Glycyrrhizae Radix et Rhizoma) is sweet and neutral. Dazao (Jujubae Fructus) is sweet and warm. Renshen (Ginseng Radix) is sweet and warm. When Yin and Yang do not intersect, it is called Pi; when upper and lower do not communicate, it is called Man (fullness). To connect upper and lower, and allow Yin-Yang interaction, the Middle Jiao must be harmonized. The Middle Jiao refers to the Spleen and Stomach. When Spleen Qi is deficient, it is tonified with sweet flavors. Thus, Renshen, Gancao, and Dazao serve as Envoy herbs to tonify the Spleen and harmonize the Middle. When Middle Qi is harmonized, upper and lower flow freely, Yin and Yang return to their proper positions, Water ascends and Fire descends. Then Pi resolves, heat subsides, and the disease is solved through profuse sweating.
Huanglian (Sovereign, 4 liang) Huangqin (Minister, 3 liang) Banxia (Assistant, 0.5 sheng, washed) Ganjiang (Assistant, 3 liang) Renshen (Envoy, 3 liang) Gancao (Envoy, 3 liang, honey-fried) Dazao (Envoy, 12 pieces, split)
Take the above seven ingredients. Add 1 dou of water. Boil to obtain 6 sheng. Remove dregs. Decoct again to obtain 3 sheng. Take 1 sheng warm, three times daily.