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。短气躁烦。心中懊 。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。
辨脉篇云。阴阳相搏。名曰动。阳动则汗出。阴动则发热。又云。数脉见于关上。上下无头尾如豆大。厥厥动
摇者。名曰动也。此所谓动数者。数而躁动也。痛。即下文头痛也。虚。谓营阴弱也。盗汗。睡卧中之汗也。
阳以外卫乎皮毛。阴以滋荣其血络。目闭则卫阳内入。无以外卫。营虚不守。故阴液盗出。此因风邪伤卫。则卫强
营弱。毛孔不闭。故微盗汗出也。发热盗汗。即数则为虚之义。言卫强则阳盛发热而脉数。营弱则阴虚恶寒而汗出也。
浮则为风以下四句。即所以释脉浮而动数也。头痛发热微盗汗出而恶寒。即风热痛虚之见证也。言浮则风邪在卫。数则
邪郁发热。躁动则风邪不得发越。故头痛。脉数则阳邪胜而营阴虚弱。故微盗汗出而恶寒。即前太阳中风。阳浮而
阴弱。阳浮热自发。阴弱。汗自出。啬啬恶寒之变文也。此为表邪未解。乃桂枝汤证也。粗工不察而反下之。则胃脘之
阳
气大伤。遂至动数之脉。变而为迟矣。迟者。虚寒之脉也。中气既馁。则表间阳邪。乘胃气之虚寒。陷入胸膈。邪盛正
虚。正邪相拒。故作痛也。曰胃中空虚。非水谷尽出而空虚也。乃胃中真阳。因误下之损而空虚也。真气空虚。则陷入
之客气。扰动胸膈。而膻中呼吸之气。有所隔碍。故短促不伸也。膈间气不得舒。邪结于里。所以躁扰烦闷。而心中
若有所懊 者然。此皆阳邪内陷。故心下因之而硬。遂为热入之结胸矣。以动数之脉。变而为迟。虽为中气已虚。然邪
热结硬于胸中。则为实邪在里。当以大陷胸汤主之。若阳邪虽陷而不结于胸中。但头汗出者。以诸阳脉皆上至头。头为
诸阳之会。阳
邪独盛于上。故但头汗出也。诸阴脉皆至颈。从胸中而还。然阴液为阳气所蒸。乃得为汗。阴阳之脉络。
虽交互于周身。因阳邪在上。无以蒸腾。故余皆无汗。但剂颈而还也。热邪内陷。既不得汗泄。而小便不利。
则又不得随水液而下走。湿热郁蒸。故身必发黄也。发黄不立治法者。以有例在后也。此条虽动数变迟。
终属阳邪内陷。故以大陷胸汤攻之。热邪内陷。尚且动数变迟。岂阴痞反有热入同推之理乎。故曰纲领中难于
并言。至条目中。始能悉言之也。喻氏谓动数变迟三十六字。形容结胸之状殆尽。叹其为化工之笔。宜哉。
大陷胸汤方
大黄（六两） 芒硝（半升，升法见小柴胡汤下） 甘遂（一钱）
汉之六两。即宋之一两六钱二分。李时珍云。古之一升。今之二合半。约即今之一瓯也。每服一瓯。约大黄
五钱外。结胸恶症。理亦宜然。未为太过。况快利止后服乎。
上三味。以水六升。先煮大黄取三升。去滓。内芒硝煮一两沸。内甘遂末。温服一升。得快利。止后服。
陷胸者。谓能治热邪陷入胸中而名之也。邪陷胸膈。犹大敌入寇。绝我津梁。据我要害。饷道不通。
樵苏不爨。坚壁固垒。非勇敢之将。锋锐之兵。不能破也。故用苦寒涌泄之将为君。咸寒软坚之副为佐。然邪结胸中。
胃气不行。津液不流。水饮并结。故又以逐水利痰之奇兵为使。鼎足之形已定。犄角之势已成。然后建大将旗鼓。
水陆并进。而成冲锋陷阵之功。岂不伟哉。然苟非热入胃实之证。如阴痞之属。则当以德化绥徕。威镇摄服而已。
未可穷兵黩武。涂炭生民也。其有表证而脉浮者。尤所禁忌。用者审之。
辨误 仲景为伤寒立法之祖。虽后贤继起。鲜有不读其书而师其训者矣。故凡读之者。各有议论。
虽或未能尽其典要。而亦各鸣其所得。或者或否。皆不敢逾越其轨度。然未有如丹溪朱氏之不善读书者也。
如此条之痛斥仲景曰。按太阳病。在表未曾解。在表而攻里。可谓虚矣。而况所得之脉。皆浮而动数乎。
今得误下。动数变迟矣。而又曰胃中空虚。又曰短气躁烦。虚之甚矣。借曰阳气内陷。心下因硬。而可迅
攻之乎。岂大陷胸之力。缓于承气。况已下者不可再下。宁不畏其虚乎。上文曰结胸脉浮大者不可下。
下者死。又曰结胸证悉具。烦躁者死。今曰脉浮。又曰烦躁。大陷胸果可用乎。彼阳病实。下后若胃中空虚。
客气动膈。心中懊 者。栀子豉汤吐胸中之邪。况太阳失下后。明有虚证乎。如此议论。岂非痛贬仲景叙
证之差。用药之误乎。岂知仲景原因脉浮而动数。头痛发热。盗汗恶寒之表症未解。为不可攻下。故曰反下。
至误下之后。胃中真阳已虚。所以动数之脉。已变而为迟矣。变迟之后。阳邪已陷。岂尚有浮脉耶。仲景
所谓浮而动数者。盖未下之前。邪气在表之脉也。丹溪不晓此义。此不善读之一也。又以动数变迟为
虚。不知正气既虚。热邪已陷。正虚邪实而膈内拒痛矣。丹溪又不知此义。其不善读者二也。又以胃中空
虚为虚。不知仲景之曰空虚。盖以胃中真阳虚损为言。非水谷邪气尽空也。所以下文即有客气动膈四字。因
胃气虚。故客气得以入膈而变动。此亦正虚邪实也。岂可竟作虚论耶。丹溪又不知此。其不善读者三也。又以
短气躁烦为虚甚。不知邪结胸膈。气道阻塞。且热邪内郁。故短气躁烦而心中懊 也。丹溪又昧其旨。此不
善读之四也。又云借曰阳气内陷。心下因硬。而可迅攻之乎。岂大陷胸之力。缓于承气。况已下者不可再下。
宁不畏其虚乎。王肯堂论大陷胸汤云。伤寒错恶。结胸为甚。此非不能通利。须其迅速。方能分解结邪。丹溪识见。
又不至此。其不善读者五也。又云上文
曰结胸脉浮大者不可下。下者死。仲景于未结胸之脉浮动数者。已云不可下。恐误下成结胸也。至若既
成结胸而尚往来寒热者。已不用大陷胸。而用大柴胡汤表里两解之法矣。况已结胸而脉尚浮大。则在表之邪。
不可限量。故曰不可下。且此条动数变迟之后。并无浮脉再见。岂可引此以责仲景乎。此不善读之六也。
又曰结胸证悉具。烦躁者死。今脉浮。又曰烦躁。大陷胸果可用乎。不知仲景之所谓悉具者。言结胸所犯之
脉证。无所不备也。此一节非真有此证。乃仲景设言以训后世之文。故铺叙自表入里。所以致成结胸之故。
及描写邪气陷入而成结胸之状。历历如绘。直至结胸已成。然后云以大陷胸汤主之。若如此以渐而入者。
即谓结胸症悉具。则下文结胸热实。脉沉而紧心下痛。按之石硬者。当如何耶。况尚有舌上燥而渴。日晡
潮热。从心下至少腹。硬满而痛不可近者。又如何耶。且所谓短气躁烦。心中懊 。胸犹未结也。至阳气内陷。
心下因硬。则为结胸矣。所谓躁烦者。热邪初入。不得发越而躁烦。非已成硬结。胃气将绝之烦躁可比。烦
躁躁烦。义自不同。丹溪又不能辨。此不善读之七也。又言彼阳病实。下后若胃中空虚。客气动膈。心中懊 。
以栀子豉汤吐胸中之邪。况太阳失下后。明有虚证乎。此段乃仲景论中阳明条下。脉浮而紧。咽燥口苦。
腹满而喘。不恶寒反恶热之证也。非脉浮而动数。发热汗出。反恶寒。太阳表证未解之可比也。且阳明条下。
原云若下之。则胃中空虚。客气动膈。心中懊 。舌上有苔而犹未结胸也。故以栀子豉汤涌其未结之邪耳。
此条乃太阳脉浮动数之表邪。因误下而动数变迟。遂致膈内拒痛。胃中空虚。客气动膈。短气躁烦。心中懊 。
然必阳气内陷。心下固硬而为结胸。方用大陷胸汤攻之。若热邪未陷。心下不硬。则犹未成结胸。不过胃中
空虚。客气动膈。心中懊 。初入胸中之邪而已。岂有不用栀子豉汤以吐其未结之邪乎。若犹未信。但观阳明篇中有云。
阳
明病下之。其外有热。手足温。不结胸。心中懊 。饥不能食。但头汗出者。栀子豉汤主之。非若心中懊 而犹
未结胸者之明证耶。今阳气已陷。心下已硬。结胸已成。岂可亦以栀子豉汤吐之。丹溪读其书而不达其意。
昧其义而妄毁之。是诚何心哉。呜呼。斯道之晦。斯民之厄也。能无辨乎。所以张介宾类经求正录云。刘朱之言不息。
则轩岐之泽不彰。信乎斯言之不谬也夫。
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。从心下至少腹。硬满而痛不
可近者。大陷胸汤主之。
此太阳入阳明之结胸也。病本太阳中风。当以桂枝汤汗解。使 微似汗可也。乃重发其汗。使如水流漓。则病必
不除。而复早下之。邪热遂乘虚而陷入阳明矣。因汗下两竭其津液。邪入胃中而燥热。故五六日不大便。而舌上燥
渴也。日晡。未申之时也。所者。即书云多历年所之所也。不大便。舌上燥渴。日晡潮热。皆阳明证也。潮热而曰小有。
则
未离太阳而已入阳明矣。故不似全入阳明之甚也。邪在太阳而陷入。则结于胸。邪入阳明而归里。则实于胃。此本
太阳病。因汗下之误。邪从太阳误入阳明。故从心上至少腹。无少空隙。皆硬满而痛。至于手不可近也。前条但结胸
而硬痛者。尚以大陷胸汤主之。况兼阳明胃实者乎。故亦以大陷胸汤主之。
结胸者项亦强。如柔 状。下之则和。宜大陷胸丸。
结胸本太阳陷入而成。然犹在上焦阳位而未深入阳明也。项强。亦太阳表症也。 。即痉也。仲景之论 病。其总
证
曰。病身热足寒。颈项强急。恶寒。时头热面赤。目脉赤。独头动摇。卒口噤。背反张者。 病也。其分条曰。太阳病。
发热无
汗。反恶寒者。名曰刚 。又曰。太阳病。发热汗出而不恶寒者。名曰柔 。其不言项强者。总证中已叙之矣。不必重
复
也。大约无论 病之刚柔。皆身热项强。但以恶寒无汗者。乃寒伤营之 。以寒主劲急故也。汗出而不恶寒者。乃风
伤卫之 。以阳邪性缓故也。此以结胸证而云项亦强者。所以证其邪未离乎太阳之表。未可攻也。曰如柔 状。所
以状结胸之汗出不恶寒者也。以结胸而状如柔 之汗出不恶寒。其无表证而宜下可知。故曰下之则和。既无表
证。又不言热实硬痛。则势非甚剧也。故不须以大陷胸汤之 剂攻之。而更立大陷胸丸治之足矣。
辨误 方注取成氏邪结胸中。心下紧实。能仰而不能俯之说。谓邪结硬于胸。俯则碍而不利。势必常昂。有反张之
疑似。病已至剧。喻氏复兼取两说云。结胸而至项强。症愈笃矣。胸间邪结紧实。项势常昂。有似柔 之状。借此以验
胸邪十分紧迫耳。皆失仲景本意。岂知以柔 之汗出不恶寒。以证表邪既解。为结胸之较轻者哉。若犹未以为然。
试观大陷胸汤之大黄六两。芒硝半升。不过二次温服。而大陷胸丸虽大黄半斤。葶苈芒硝杏仁各半升。而究竟所
用者。止服如弹丸之一枚而已。其大小之制。为何如哉。
大陷胸丸
大黄（半斤） 葶苈 芒硝 杏仁（各半升熬黑）
上四味。捣筛二味。内杏仁芒硝。合研如脂。和散取如弹丸一枚。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。
大黄芒硝甘遂。即前大陷胸汤之意。白蜜二合。亦即十枣汤中之大枣十枚也。增入葶苈杏仁者。盖以胸为肺之所
处。膻中为气之海。上通于肺而为呼吸。邪结胸膈。硬满而痛。气道阻塞。则有少气躁烦。水结胸胁之害。故用葶苈甘
遂以逐水泻肺。杏仁以利肺下气也。所用不过一弹丸。剂虽大而用实小也。和之以白蜜。药虽峻而佐则缓也。大陷
胸汤之制。六师并出也。大陷胸丸之法。分锐攻略也。陷胸汤。一人独用之剂也。陷胸丸。众病分用之药也。其大小分
合之迥异。步伐止齐之不同。奈何方注以为白蜜甘润。导滞最良。名虽曰丸。犹之散耳。较之于汤。力有加焉。虽喻氏
谓白蜜留恋润导。下行其缓。斯得一宿乃下之旨矣。岂如承气陷胸汤之人行十里二十里之迅速哉。
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。
历来注家。皆以中风误下而成者为结胸。伤寒误下而成者为痞。此千载未悟之惑也。仲景原云发于阳发于阴而
反下之。并未言中风伤寒而反下之也。前条皆中风之结胸。此条以伤寒而亦成结胸。则知非独中风误下而成也。
说见首章注中。然此条并未误下而亦结胸者。盖以邪在太阳。稽久失治而致变者也。脉沉紧者。关脉沉紧也。或曰。
此但以伤寒二字冠之。何以知其邪在太阳乎。曰。以热实二字推之。即可知也。又以大陷胸汤之咸寒苦泄而知之
也。何以知其为失治乎。曰。以六七日言之。乃行其经尽之期也。又不言及汗下。是以知其为失治也。何以知沉紧为
关脉乎。曰。脏结条云。按之痛。寸脉浮。关脉沉。名曰结胸也。曰。沉则然矣。紧脉何以言之。曰。浮紧则为寒邪在
太阳病。脉象浮而动数。浮脉主风邪，数脉主热邪，动脉主痛证，数脉亦主正气虚弱（营阴不足）。出现头痛、发热，睡眠中微微盗汗，反而恶寒的，说明表邪尚未解除。医生反而使用攻下法，导致原本动数的脉象变为迟脉，膈间拒按疼痛，胃中空虚，客气扰动胸膈，呼吸短促，烦躁不安，心中懊恼不舒。阳气内陷，心下因此变硬，这就形成了结胸证，应当用大陷胸汤治疗。如果不形成结胸，仅见头部出汗，身体其他部位无汗，汗水只到颈部为止，小便不利，身体必然发黄。
《辨脉篇》说：阴阳相互搏击，称为“动”。阳动则汗出，阴动则发热。又说：数脉出现在关部，上下没有头尾，像豆子一样大小，厥厥动摇不定，称为“动”脉。这里所说的“动数”，是指脉数且躁动不安。“痛”，即下文提到的头痛。“虚”，指营阴虚弱。“盗汗”，指睡卧中的汗液。卫阳在外护卫皮毛，营阴在内滋养血络。眼睛闭合时，卫阳内入，无法在外护卫，营阴虚弱不能固守，所以阴液在睡梦中盗出。这是因为风邪伤及卫气，导致卫强营弱，毛孔开泄不闭，所以出现微盗汗出。发热和盗汗，就是“数则为虚”的含义，意思是卫气强盛则阳气盛而发热、脉数；营气虚弱则阴虚而恶寒、汗出。
“浮则为风”以下四句，是用来解释脉象浮而动数的原因。头痛、发热、微盗汗出而恶寒，是风、热、痛、虚这些病理变化的见证表现。意思是浮脉表示风邪在卫分，数脉表示邪气郁滞发热，躁动表示风邪不得发散，所以头痛；脉数表示阳邪胜而营阴虚弱，所以微盗汗出而恶寒。这是前文太阳中风证“阳浮而阴弱，阳浮者热自发，阴弱者汗自出，啬啬恶寒”的另一种表述。这属于表邪未解，是桂枝汤的适应证。粗疏的医生不加审察反而使用攻下法，就会损伤胃脘的阳气，致使动数的脉象变为迟脉。迟脉是虚寒的脉象。中气既然衰弱，表间的阳邪就乘胃气虚寒之机，陷入胸膈。邪气盛而正气虚，正邪相争抗拒，所以产生疼痛。所谓“胃中空虚”，并非指水谷食物全部排空而空虚，而是指胃中的真阳之气，因为误用攻下而受损变得空虚。真气空虚，那么陷入的客气就会扰动胸膈，导致膻中呼吸之气有所隔碍，所以呼吸短促不能舒展。膈间气机不得舒展，邪气结聚于里，所以躁扰烦闷，心中好像有懊恼不适的感觉。这都是阳邪内陷，所以心下因此变硬，遂成为热邪内入的结胸证。虽然因为动数之脉变为迟脉，表明中气已经虚弱，但邪热结硬在胸中，属于实邪在里，应当用大陷胸汤主治。如果阳邪虽然内陷但没有结聚在胸中，仅见头部出汗，是因为所有阳经都上行至头部，头为诸阳之会，阳邪独盛于上部，所以只有头部出汗。所有阴经都上行至颈部，从胸中返回。然而阴液被阳气蒸腾才能化为汗液，阴阳经络虽然交互遍布全身，但因为阳邪在上，无法蒸腾下部，所以身体其余部分无汗，汗水只到颈部为止。热邪内陷，既不能通过汗液发泄，又因小便不利，不能随水液下行，湿热郁蒸，所以身体必然发黄。关于发黄不单独列出治法的原因，是因为后面有先例可循。这一条虽然动数脉变为迟脉，最终仍属于阳邪内陷，所以用大陷胸汤攻逐。热邪内陷，尚且使动数脉变为迟脉，难道阴痞证反而会有热邪内入并推演此理吗？所以说纲领中难以一并说明，直到具体条目中，才能详尽阐述。喻嘉言认为“动数变迟”三十六字，将结胸的状态形容得淋漓尽致，赞叹其为化工之笔，确实是应该的。
大陷胸汤方
大黄（六两） 芒硝（半升，升的用法见小柴胡汤下方） 甘遂（一钱）
汉代的六两，相当于宋代的一两六钱二分。李时珍说，古代的一升，相当于现在的二合半，大约就是一瓯（一种容器）。每次服用一瓯，除了大黄约五钱外，对于结胸这种恶症，药量也是适宜的，并不算太过，况且服药后得快利就要停服后面的药物。
以上三味药，用水六升，先煮大黄取三升，去渣，加入芒硝煮一两沸，再加入甘遂末，温服一升。得到快利后，停止服用后面的药物。
所谓“陷胸”，是指能治疗热邪陷入胸中的病证而得名。邪气陷入胸膈，犹如大敌入侵，切断我的津液通道，占据要害之地，粮道不通，柴火断绝，坚守壁垒，如果不是勇敢的将领、锋利的兵器，是不能攻破的。所以用苦寒涌泄的药物作为君药，咸寒软坚的药物作为辅佐。然而邪气结聚胸中，胃气不行，津液不流，水饮并结，所以又用逐水利痰的药物作为奇兵。鼎足之势已定，犄角之势已成，然后树立大将旗鼓，水陆并进，成就冲锋陷阵的功效，岂不伟大吗？然而如果不是热入胃实的证候，如阴痞之类的，就应当以德化安抚，威镇摄服而已，不可穷兵黩武，使百姓受苦。如果有表证而脉浮的，尤其禁忌使用，用药者务必审慎。
【辨误】
张仲景是制定伤寒治疗法则的始祖，虽然后世贤才继起，很少有没读过他的书、不效法他教诲的人。所以凡是读他的人，各有议论，虽然或许未能完全掌握其精髓，但也各自表达了自己的见解，有的赞同，有的反对，都不敢逾越规矩法度。然而没有像丹溪朱氏那样不善于读书的了。像这一条，朱丹溪严厉斥责张仲景说：“考察太阳病，在表邪尚未解除的情况下，在表而攻里，可以说是虚妄了。何况所得的脉象，都是浮而动数呢？现在误用攻下，动数脉变为迟脉了，又说‘胃中空虚’，又说‘短气躁烦’，虚损已经很严重了。假如说是阳气内陷，心下因此变硬，就可以迅速攻下吗？难道大陷胸汤的力量比承气汤还缓吗？况且已经攻下过的不能再攻下，难道不怕它虚损吗？上文说‘结胸脉浮大的不可下，下的会死’，又说‘结胸证悉具，烦躁者死’。现在又说脉浮，又说烦躁，大陷胸汤真的可以用吗？如果是阳病实证，下后若胃中空虚，客气动膈，心中懊恼的，应用栀子豉汤吐除胸中之邪。何况太阳病失于攻下后，明明有虚证呢？”这样的议论，岂不是痛贬张仲景叙述证候有误、用药错误吗？哪里知道张仲景正是因为脉浮而动数，头痛发热，盗汗恶寒等表证未解，认为不可攻下，所以说“反下”。到了误下之后，胃中真阳已虚，所以动数的脉象，已经变为迟脉了。变为迟脉之后，阳邪已经内陷，哪里还有浮脉呢？张仲景所说的“浮而动数”，是未攻下之前，邪气在表的脉象。丹溪不懂这个意义，这是他不善于读书的第一点。他又把“动数变迟”当作虚证，不知道正气既已虚弱，热邪已经内陷，正虚邪实而膈内拒痛。丹溪又不懂这个意义，这是他不善于读书的第二点。他又把“胃中空虚”当作虚证，不知道张仲景说的“空虚”，是指胃中真阳虚损，并非水谷邪气全部清空。所以下文紧接着就有“客气动膈”四个字。因为胃气虚，所以客气得以进入膈中变动。这也是正虚邪实啊。怎么可以竟作纯虚论呢？丹溪又不懂这个，这是他不善于读书的第三点。他又把“短气躁烦”当作虚损严重，不知道邪气结聚胸膈，气道阻塞，且热邪内郁，所以短气躁烦而心中懊恼。丹溪又昧于其中旨意，这是他不善于读书的第四点。他又说：“假如说是阳气内陷，心下因此变硬，就可以迅速攻下吗？难道大陷胸汤的力量比承气汤还缓？况且已经攻下过的不能再攻下，难道不怕它虚损吗？”王肯堂论述大陷胸汤说：“伤寒错杂恶症，结胸最为严重。这不是不能通利，必须迅速，才能分解结邪。”丹溪的见识，还没到这个程度，这是他不善于读书的第五点。他又说：“上文说‘结胸脉浮大的不可下，下的会死’。”张仲景在未形成结胸、脉浮动数时，已经说不可以下，是怕误下形成结胸。至于已经形成结胸而尚有往来寒热的，已经不用大陷胸汤，而用大柴胡汤表里双解的方法了。何况已经结胸而脉尚浮大，那么在表的邪气，不可限量，所以说不可下。而且这一条在动数变为迟脉之后，并没有再次见到浮脉，怎么能引用这条来责备张仲景呢？这是他不善于读书的第六点。他又说：“又说‘结胸证悉具，烦躁者死’。现在脉浮，又说烦躁，大陷胸汤真的可以用吗？”不知道张仲景所说的“悉具”，是说结胸所涉及的脉证，无所不备。这一段并非真有此证，而是张仲景设言以教导后世的文字。所以铺叙从表入里，以致形成结胸的缘故，以及描写邪气陷入而成结胸的状态，历历如画，直到结胸已成，然后说用大陷胸汤主治。如果像这样逐渐而入的，就说结胸症悉具，那么下文“结胸热实，脉沉而紧，心下痛，按之石硬者”，应当如何呢？况且还有舌上燥而渴，日晡潮热，从心下至少腹，硬满而痛不可近者，又如何呢？而且所谓的短气躁烦，心中懊恼，胸犹未结也。直到阳气内陷，心下因硬，才成为结胸。所谓的躁烦，是热邪初入，不得发越而躁烦，并非已成硬结、胃气将绝的烦躁可比。烦躁与躁烦，含义自然不同。丹溪又不能辨别，这是他不善于读书的第七点。他又说：“如果是阳病实证，下后若胃中空虚，客气动膈，心中懊恼，以栀子豉汤吐胸中之邪。何况太阳病失于攻下后，明明有虚证呢？”这段乃是张仲景论述阳明条下，脉浮而紧，咽燥口苦，腹满而喘，不恶寒反恶热的证候。不是脉浮而动数，发热汗出，反恶寒，太阳表证未解的可比的。而且阳明条下，原文明确说“若下之，则胃中空虚，客气动膈，心中懊恼，舌上有苔而犹未结胸也”。所以用栀子豉汤涌吐未结之邪罢了。这一条乃是太阳脉浮动数之表邪，因误下而动数变迟，遂致膈内拒痛，胃中空虚，客气动膈，短气躁烦，心中懊恼。然而必须阳气内陷，心下固硬而为结胸，方才用大陷胸汤攻之。如果热邪未陷，心下不硬，则犹未成结胸，不过是胃中空虚，客气动膈，心中懊恼，初入胸中之邪而已。难道有不用栀子豉汤以吐其未结之邪的吗？如果还不相信，只看阳明篇中有云：“阳明病下之，其外有热，手足温，不结胸，心中懊恼，饥不能食，但头汗出者，栀子豉汤主之。”这不是心中懊恼而犹未结胸的明证吗？如今阳气已陷，心下已硬，结胸已成，难道也可以用栀子豉汤吐之吗？丹溪读他的书而不通达其意，昧于其义而妄加毁谤，这究竟是什么用心呢？唉！医道晦暗，百姓遭殃，能不辨析吗？所以张介宾在《类经求正录》中说：“刘朱之言不息，则轩岐之泽不彰。”确实这话不假啊。
太阳病，重发汗而又攻下，不大便五六天，舌上干燥而渴，日晡时分略有潮热，从心下至少腹，硬满而疼痛不可触碰的，大陷胸汤主治。
这是太阳病转入阳明的结胸证。病本属太阳中风，应当用桂枝汤发汗解表，使微微似有汗出即可。却重发其汗，使汗出如水流漓，则病必定不愈，而又过早地攻下，邪热就乘虚陷入阳明。因为汗下两法耗竭津液，邪入胃中而燥热，所以五六天不大便，而舌上干燥口渴。日晡，是未时和申时（下午3-7点）。“所”字，即古书中“多历年所”的“所”字。不大便，舌上燥渴，日晡潮热，都是阳明证。潮热而说“小有”，说明还未完全脱离太阳而已进入阳明。所以不像完全入阳明的严重。邪在太阳而陷入，则结于胸；邪入阳明而归里，则实于胃。这本来是太阳病，因汗下误治，邪从太阳误入阳明，所以从心上至少腹，没有一丝空隙，皆硬满而疼痛，以至于手不可接近。前一条只是结胸而硬痛的，尚且用大陷胸汤主治，何况兼有阳明胃实的呢？所以也用大陷胸汤主治。
结胸证，项部也强直，像柔痉的样子，用攻下法就能调和，宜用大陷胸丸。
结胸本是太阳邪气陷入而成，然而还在上焦阳位而未深入阳明。项强，也是太阳表证。“痉”，即痉病。张仲景论述痉病的总证说：“病身热足寒，颈项强急，恶寒，时头热面赤，目脉赤，独头动摇，卒口噤，背反张者，痉病也。”其分条说：“太阳病，发热无汗，反恶寒者，名叫刚痉。”又说：“太阳病，发热汗出而不恶寒者，名叫柔痉。”之所以不言项强，是因为总证中已经叙述过了，不必重复。大概无论痉病是刚是柔，都是身热项强，但以恶寒无汗的，是寒伤营的痉病，因为寒性劲急故也；汗出而不恶寒的，是风伤卫的痉病，因为阳邪性缓故也。这里说结胸证而项也强，是为了证明邪气未离开太阳之表，不可攻下。说“如柔痉状”，是为了描述结胸证汗出不恶寒的情况。因为结胸而像柔痉那样的汗出不恶寒，可知无表证而宜用下法。所以说“下之则和”。既然无表证，又不言热实硬痛，则病情不是很剧烈。所以不需要用大陷胸汤的峻剂攻之，而另外设立大陷胸丸治疗就足够了。
【辨误】
方注引用成无己的说法，认为邪结胸中，心下紧实，能仰而不能俯，说邪结硬于胸，俯则碍而不利，势必常昂，有反张的疑似。病已到严重程度。喻嘉言又兼取两种说法，说：“结胸而至项强，症状更重了。胸间邪结紧实，项势常昂，有类似柔痉的样子。借此以验证胸邪十分紧迫罢了。”都失去了张仲景的本意。哪里知道是用柔痉的汗出不恶寒，来证明表邪已解，为结胸中较轻的一种呢？如果还不以为然，试看大陷胸汤的大黄六两，芒硝半升，不过分两次温服。而大陷胸丸虽然大黄半斤，葶苈、芒硝、杏仁各半升，但最终所用的，只服用像弹丸大小的一枚而已。其剂量的大小，是怎样的悬殊呢？
以上四味药，捣筛两味（大黄、葶苈），加入杏仁、芒硝，合研如脂状，和散取像弹丸大小的一枚。另捣甘遂末一钱匕，白蜜二合，水二升，煮取一升，温顿服之。一夜之后大便通下，如果不下再服。取下为有效。禁忌同前药法。
大黄、芒硝、甘遂，就是前面大陷胸汤的意思。白蜜二合，也就是十枣汤中的大枣十枚。增加葶苈、杏仁，是因为胸为肺之所处，膻中为气之海，上通于肺而为呼吸。邪结胸膈，硬满而痛，气道阻塞，则有少气躁烦，水结胸胁的危害。所以用葶苈、甘遂以逐水泻肺，杏仁以利肺下气。所用不过一枚弹丸，剂量虽大而实际用量小。配合白蜜，药性虽峻烈而辅助则缓和。大陷胸汤的制剂，是六师并出；大陷胸丸的法度，是分锐攻略。陷胸汤，是一个人独用的药剂；陷胸丸，是众病分用的药物。其大小分合的差异迥然不同，步伐止齐也不一样。为什么方注认为白蜜甘润，导滞最好，名义上是丸，其实如同散剂，比起汤剂，力量还要大呢？虽然喻嘉言认为白蜜留恋润导，下行缓慢，这才符合“一宿乃下”的宗旨，但哪能像承气汤、陷胸汤那样人行十里二十里的迅速呢？
伤寒六七天，结胸热实，脉沉紧，心下痛，按之石硬者，大陷胸汤主治。
历来注家，都以中风误下而成者为结胸，伤寒误下而成者为痞，这是千年来未悟的困惑。张仲景原文说“发于阳发于阴而反下之”，并未说中风伤寒而反下之。前几条都是中风的结胸，这一条以伤寒也形成结胸，就知道并非只有中风误下才能形成。说法见首章注中。然而这一条并未误下也形成结胸的，是因为邪在太阳，稽留日久失治而导致变证。脉沉紧，指的是关脉沉紧。有人问：这里仅以“伤寒”二字冠首，怎么知道邪在太阳呢？回答说：从“热实”二字推断，就可以知道了。又从大陷胸汤的咸寒苦泄性质而知晓。怎么知道是失治呢？回答说：从“六七日”而言，是经行尽的时期。又不提及汗下，所以知道是失治。怎么知道沉紧是关脉呢？回答说：脏结条说：“按之痛，寸脉浮，关脉沉，名叫结胸。”曰：沉自然是沉了，紧脉怎么说呢？回答说：浮紧则为寒邪在表……
Taiyang disease. The pulse is floating, moving, and rapid. Floating indicates wind; rapid indicates heat; moving indicates pain; rapid also indicates deficiency (deficiency of Ying-Yin). Headache, fever, slight night sweating, yet aversion to cold, indicate that the exterior pathogen has not yet resolved. If a physician inappropriately applies purgation, the moving-rapid pulse changes to a slow one. There is resistance and pain within the diaphragm, the stomach is empty and deficient, hostile Qi agitates the diaphragm, shortness of breath occurs, irritability and vexation arise, and there is a feeling of stifled discomfort in the chest. Yang Qi sinks inward, causing the epigastrium to become hard, resulting in Chest Binding (Jie Xiong, a syndrome characterized by accumulation of phlegm-fluid and heat in the chest). Da Xian Xiong Tang (Major Decoction to Sinking into the Chest) should be administered. If Chest Binding does not form, but only head sweating occurs with no sweat elsewhere on the body, stopping at the neck, accompanied by difficult urination, the body will inevitably develop jaundice.
The *Bian Mai Pian* (Chapter on Distinguishing Pulses) states: "When Yin and Yang beat against each other, it is called 'Moving'. Yang moving causes sweating; Yin moving causes fever." It further states: "When a rapid pulse appears at the Guan position, without head or tail above or below, resembling a bean in size, quivering and shaking, it is called 'Moving'." Here, "moving-rapid" refers to a rapid pulse that is restless and agitated. "Pain" refers to the headache mentioned later. "Deficiency" refers to the weakness of Ying-Yin. "Night sweating" refers to sweating during sleep. Wei-Yang guards the exterior of the skin and hair, while Ying-Yin nourishes the blood vessels internally. When the eyes are closed, Wei-Yang enters inward and cannot guard the exterior; due to Ying deficiency failing to hold, Yin fluids leak out during sleep. This is because wind pathogen injures Wei, leading to strong Wei and weak Ying, causing the pores to fail to close, hence slight night sweating. Fever and night sweating embody the meaning of "rapid indicates deficiency": strong Wei means Yang is abundant, causing fever and rapid pulse; weak Ying means Yin is deficient, causing aversion to cold and sweating.
The four sentences from "Floating indicates wind" serve to explain the floating-moving-rapid pulse. Headache, fever, slight night sweating, and aversion to cold are the manifestations of wind, heat, pain, and deficiency. Floating indicates wind pathogen in the Wei level; rapid indicates pathogen stagnation causing fever; restlessness indicates wind pathogen cannot be dispersed, causing headache; rapid pulse indicates Yang pathogen prevails while Ying-Yin is weak, causing slight night sweating and aversion to cold. This is a variation of the earlier Taiyang Wind Strike syndrome: "Yang floating and Yin weak, Yang floating leads to spontaneous fever, Yin weak leads to spontaneous sweating, and chilly aversion to cold." This belongs to unresolved exterior pathogen and is an indication for Guizhi Tang (Cinnamon Twig Decoction). Incompetent physicians, failing to examine carefully, inappropriately apply purgation, severely damaging the Yang Qi of the stomach. Consequently, the moving-rapid pulse changes to a slow one. Slow pulse indicates deficiency-cold. With Middle Qi weakened, the exterior Yang pathogen takes advantage of the stomach's deficiency-cold to sink into the chest and diaphragm. Pathogen is excess, Zheng Qi is deficient, and they resist each other, causing pain. "Stomach empty and deficient" does not mean food and drink are completely emptied, but rather that the True Yang of the stomach is damaged and depleted by inappropriate purgation. With True Qi depleted, the sinking hostile Qi agitates the chest and diaphragm, obstructing the breathing Qi of the Danzhong, causing shortness of breath. Qi in the diaphragm cannot relax, pathogen knots internally, causing restlessness, vexation, and a feeling of stifled discomfort in the chest. These are all due to Yang pathogen sinking inward, causing the epigastrium to become hard, thus forming Heat Entering Chest Binding. Although the change from moving-rapid to slow pulse indicates Middle Qi deficiency, the knotting and hardening of pathogenic heat in the chest constitutes Excess Pathogen in the interior. Therefore, Da Xian Xiong Tang should be used. If Yang pathogen sinks but does not knot in the chest, and only head sweating occurs, it is because all Yang meridians ascend to the head, which is the meeting place of all Yang. Yang pathogen is exclusively abundant in the upper part, so only the head sweats. All Yin meridians ascend to the neck and return from the chest. However, Yin fluids require steaming by Yang Qi to transform into sweat. Although Yin and Yang meridians interweave throughout the body, because Yang pathogen is in the upper part, it cannot steam the lower parts, so there is no sweat elsewhere, only up to the neck. Heat pathogen sinks inward, unable to vent through sweat, and with difficult urination, cannot descend with fluids. Damp-heat stagnates and steams, so the body inevitably develops jaundice. Jaundice does not have a separate treatment method listed here because precedents exist later. Although this case involves the pulse changing from moving-rapid to slow, it ultimately belongs to Yang pathogen sinking inward, so Da Xian Xiong Tang is used to attack it. Heat pathogen sinking inward can cause the moving-rapid pulse to change to slow; how could Yin Obstruction possibly involve heat entering and deducing such principles? Thus, it is said that the general principles are difficult to state together, and only in specific entries can they be fully explained. Yu Jia Yan stated that the thirty-six characters "moving-rapid changes to slow" describe the state of Chest Binding exhaustively, praising it as a stroke of divine craftsmanship, which is fitting.
Da Xian Xiong Tang Formula
Dahuang (Rhei Radix et Rhizoma) - 6 liang
Mangxiao (Natrii Sulfas) - 0.5 sheng (See usage in Xiaochaihu Tang below)
Gansui (Kansui Radix) - 1 qian
Six liang in Han dynasty equals 1.62 qian in Song dynasty. Li Shizhen stated that ancient 1 sheng equals modern 2.5 he, approximately one ou (a vessel). Each dose is one ou. Apart from Dahuang being about 5 qian, for the severe condition of Chest Binding, the dosage is appropriate and not excessive. Moreover, stop taking subsequent doses after obtaining loose stools.
Take the three ingredients, add 6 sheng of water, first decoct Dahuang to obtain 3 sheng, remove dregs, add Mangxiao, boil for one or two boils, then add Gansui powder. Take 1 sheng warm. Stop subsequent doses after obtaining loose stools.
"Sinking into Chest" refers to treating heat pathogen sinking into the chest. Pathogen sinking into chest and diaphragm is like a great enemy invading, cutting off fluid channels, occupying key positions, blocking supply lines, and halting cooking. Strongholds are firm; only brave generals and sharp troops can break them. Therefore, bitter-cold purging-draining herbs are used as Sovereign, salty-cold softening-hardening herbs as Deputy. However, pathogen knots in the chest, Stomach Qi fails to move, Jin-Ye does not flow, and water-fluids accumulate. Thus, water-draining and phlegm-dispelling herbs are used as Envoy. The tripod formation is set, the pincer movement is formed. Then, raising the general's banner, advancing by land and water, achieving the merit of charging into battle, is truly magnificent. However, if it is not a Heat-Entering Stomach-Excess syndrome, such as Yin Obstruction, one should use virtue to pacify and authority to suppress, not engage in endless war and devastate the people. If exterior symptoms exist with a floating pulse, its use is strictly contraindicated; practitioners must exercise caution.
[Correction of Misunderstandings]
Zhang Zhongjing is the ancestor of Taohuyang legislation. Although later sages arose, few did not read his book or follow his teachings. Thus, readers have various discussions. Although some may not grasp the essence, they express their insights, agreeing or disagreeing, without transgressing boundaries. However, none were as poor at reading as Zhu Danxi. Regarding this clause, Zhu Danxi severely criticized Zhang Zhongjing: "Examining Taiyang disease, the exterior is unresolved. Attacking the interior while the exterior is affected is indeed deficient. Moreover, the obtained pulse is floating, moving, and rapid. Now, after mistaken purgation, the moving-rapid pulse changes to slow. It says 'stomach empty and deficient,' and 'shortness of breath, irritability.' Deficiency is extreme. Even if Yang Qi sinks inward and the epigastrium becomes hard, can we rapidly attack? Is Da Xian Xiong Tang weaker than Chengqi Tang? Moreover, what has been purged cannot be purged again; are you not afraid of deficiency? Earlier it said 'Chest Binding with floating-large pulse cannot be purged; purging leads to death.' It also said 'Chest Binding symptoms complete, irritability leads to death.' Now it mentions floating pulse and irritability. Can Da Xian Xiong Tang really be used? For Yang disease excess, after purgation, if stomach is empty and deficient, hostile Qi agitates diaphragm, causing stifled discomfort, Zhi Zi Chi Tang should be used to vomit pathogen from chest. Especially since Taiyang missed purgation clearly shows deficiency signs?" Such arguments seem to severely denounce Zhang Zhongjing's errors in describing syndromes and prescribing medications. Does he not know that Zhang Zhongjing stated "mistakenly purged" precisely because the floating-moving-rapid pulse, headache, fever, night sweating, and aversion to cold indicated unresolved exterior symptoms, making purgation inadvisable? After mistaken purgation, Stomach True Yang is already deficient, so the moving-rapid pulse changes to slow. After changing to slow, Yang pathogen has sunk; where is the floating pulse? Zhang Zhongjing's "floating-moving-rapid" refers to the pulse before purgation, when pathogen was at the exterior. Danxi did not understand this meaning; this is his first failure to read properly. He regarded "moving-rapid changing to slow" as deficiency, not knowing that although Zheng Qi is deficient and heat pathogen has sunk, the deficiency of Zheng and excess of pathogen cause resistance and pain in the diaphragm. Danxi did not understand this; this is his second failure. He regarded "stomach empty and deficient" as deficiency, not knowing that Zhang Zhongjing meant deficiency of Stomach True Yang, not emptiness of food and drink. Hence the following phrase "hostile Qi agitates diaphragm." Because Stomach Qi is deficient, hostile Qi enters and agitates the diaphragm. This is also Zheng deficiency and pathogen excess. How can it be treated purely as deficiency? Danxi did not understand this; this is his third failure. He regarded "shortness of breath and irritability" as extreme deficiency, not knowing that pathogen knots in chest and diaphragm, blocking airways, and heat pathogen stagnates internally, causing shortness of breath, irritability, and stifled discomfort. Danxi was ignorant of this purport; this is his fourth failure. He asked, "If Yang Qi sinks inward and epigastrium becomes hard, can we rapidly attack? Is Da Xian Xiong Tang weaker than Chengqi Tang? Moreover, purged cases cannot be purged again; are you not afraid of deficiency?" Wang Kentang discussed Da Xian Xiong Tang: "Among complex and severe Shaoyang disorders, Chest Binding is the most severe. It is not that unblocking is impossible, but speed is required to resolve the knotted pathogen." Danxi's insight did not reach this level; this is his fifth failure. He cited, "Earlier it said 'Chest Binding with floating-large pulse cannot be purged; purging leads to death.'" Zhang Zhongjing, when the pulse was floating-moving-rapid before Chest Binding formed, already stated it could not be purged, fearing mistaken purgation would cause Chest Binding. If Chest Binding has formed but chills and fever alternate, Da Xian Xiong Tang is not used; instead, Dachaihu Tang is used for simultaneous exterior-interior resolution. Moreover, if Chest Binding has formed and the pulse is still floating-large, the exterior pathogen is immeasurable, hence "cannot be purged." Furthermore, after this case's pulse changed from moving-rapid to slow, no floating pulse reappeared. How can this be cited to blame Zhang Zhongjing? This is his sixth failure. He also cited, "Chest Binding symptoms complete, irritability leads to death. Now pulse is floating, and irritability is mentioned. Can Da Xian Xiong Tang really be used?" Zhang Zhongjing's "symptoms complete" means all pulses and symptoms related to Chest Binding are present. This section is not describing a real existing syndrome but is a hypothetical teaching text. It narrates how pathogen moves from exterior to interior to form Chest Binding, and depicts the state of pathogen sinking and forming Chest Binding vividly. Only after Chest Binding is formed does it say "use Da Xian Xiong Tang." If progressing gradually like this, and saying Chest Binding symptoms are complete, then what about the later text: "Chest Binding Heat-Excess, pulse deep-tight, epigastric pain, stone-hard upon pressure"? And what about dry tongue with thirst, afternoon tidal fever, hardness-fullness and pain from epigastrium to lower abdomen intolerable to touch? Also, "shortness of breath, irritability, stifled discomfort" implies the chest is not yet knotted. Only when Yang Qi sinks inward and epigastrium becomes hard does it become Chest Binding. The "irritability" mentioned here is heat pathogen just entering, unable to vent, causing restlessness and vexation, not comparable to the irritability of exhausted Stomach Qi after hard knotting is formed. "Irritability" (Fanzao) and "restlessness-vexation" (Zaofan) have different meanings. Danxi failed to distinguish this; this is his seventh failure. He also said, "For Yang disease excess, after purgation, if stomach is empty and deficient, hostile Qi agitates diaphragm, causing stifled discomfort, use Zhi Zi Chi Tang to vomit pathogen. Especially since Taiyang missed purgation clearly shows deficiency." This passage discusses Yangming chapter: pulse floating-tight, dry throat, bitter taste, abdominal fullness, panting, no aversion to cold but aversion to heat. This is not comparable to pulse floating-moving-rapid, fever, sweating, aversion to cold, indicating unresolved Taiyang exterior. Moreover, the Yangming chapter originally states: "If purged, then stomach is empty and deficient, hostile Qi agitates diaphragm, stifled discomfort, coating on tongue, yet not yet Chest Binding." Thus, Zhi Zi Chi Tang is used to涌 (vomit/vent) unknotted pathogen. This case involves Taiyang floating-moving-rapid exterior pathogen, which changes to slow after mistaken purgation, leading to resistance-pain in diaphragm, empty-stomach, hostile Qi agitating diaphragm, shortness of breath, irritability, stifled discomfort. However, only when Yang Qi sinks inward and epigastrium becomes hard, forming Chest Binding, is Da Xian Xiong Tang used to attack. If heat pathogen has not sunk and epigastrium is not hard, Chest Binding has not formed; it is merely empty-stomach, hostile Qi agitating diaphragm, stifled discomfort, pathogen newly entering chest. Would one not use Zhi Zi Chi Tang to vent unknotted pathogen? If still unconvinced, observe Yangming chapter: "Yangming disease purged, external heat, warm hands and feet, no Chest Binding, stifled discomfort, hunger but inability to eat, only head sweating, use Zhi Zi Chi Tang." Is this not clear proof for stifled discomfort without Chest Binding? Now Yang Qi has sunk, epigastrium is hard, Chest Binding is formed. How can Zhi Zi Chi Tang be used to vomit? Danxi read the book but did not comprehend its intent, ignored its meaning, and slandered it blindly. What was his intention? Alas! The obscurity of this Way, the calamity of the people, how can we not clarify it? Thus, Zhang Jiabin in *Leijing Qiuzheng Lu* said: "As long as Liu and Zhu's words persist, the grace of Xuanyuan and Qibo will not shine." Indeed, this statement is not false.
Taiyang disease, heavily sweating followed by purgation, constipation for five to six days, dry tongue with thirst, slight afternoon tidal fever, hardness-fullness and pain from epigastrium to lower abdomen intolerable to touch, are treated with Da Xian Xiong Tang.
This is Chest Binding transitioning from Taiyang to Yangming. The disease originated as Taiyang Wind Strike, requiring Guizhi Tang to induce slight sweating. Instead, heavy sweating caused profuse perspiration, failing to resolve the disease, followed by premature purgation. Heat pathogen took advantage of deficiency to sink into Yangming. Sweating and purgation both depleted Jin-Ye; pathogen entered Stomach causing dryness-heat, leading to constipation for five to six days and dry tongue/thirst. "Ribuxia" refers to Wei and Shen hours (3 PM - 7 PM). "Suo" refers to duration in ancient texts. Constipation, dry tongue/thirst, and afternoon tidal fever are Yangming symptoms. Tidal fever described as "slight" indicates transition from Taiyang to Yangming, not as severe as full Yangming involvement. Pathogen in Taiyang sinking knots in chest; pathogen entering Yangming returning to interior solidifies in Stomach. Originally Taiyang disease, due to sweating/purgation errors, pathogen mistakenly entered Yangming from Taiyang. Thus, from epigastrium to lower abdomen, without gap, all are hard, full, painful, and intolerable to touch. Previous clause mentioned only Chest Binding hardness-pain, treated with Da Xian Xiong Tang; how much more so with concurrent Yangming Stomach Excess? Thus, Da Xian Xiong Tang is also used.
Chest Binding with stiff neck, resembling Rou Jing (Soft Spasm), resolves with purgation; Da Xian Xiong Wan (Major Pill to Sinking into the Chest) is suitable.
Chest Binding originates from Taiyang sinking but remains in upper Jiao Yang position, not deeply entering Yangming. Stiff neck is also a Taiyang exterior symptom. "Jing" refers to Spasm disease. Zhang Zhongjing's general description of Spasm: "Body fever, cold feet, stiff neck, aversion to cold, occasional head heat, red face, red eye veins, only head shaking, sudden jaw clenching, opisthotonos." Sub-categories: "Taiyang disease, fever, no sweat, aversion to cold, named Gang Jing (Hard Spasm)." "Taiyang disease, fever, sweating, no aversion to cold, named Rou Jing (Soft Spasm)." Stiff neck is omitted in sub-categories because it is covered in the general description. Generally, regardless of Hard or Soft Spasm, there is body fever and stiff neck. Aversion to cold and no sweat indicate Cold injuring Ying (Cold is rigid); sweating and no aversion to cold indicate Wind injuring Wei (Yang pathogen is lax). Here, Chest Binding with stiff neck proves pathogen has not left Taiyang exterior and cannot be attacked. "Resembling Rou Jing" describes Chest Binding sweating without aversion to cold. Since Chest Binding resembles Rou Jing's sweating/no aversion to cold, it indicates no exterior symptoms and suitability for purgation. Hence, "purging harmonizes." With no exterior symptoms and no mention of heat-excess-hard-pain, the condition is not severe. Thus, harsh Da Xian Xiong Tang is unnecessary; Da Xian Xiong Wan suffices.
[Correction of Misunderstandings]
Commentaries cite Cheng Wuji: "Pathogen knots in chest, epigastrium tight and solid, can extend but not flex." They claim pathogen knots hard in chest, flexion is obstructed, so head is always raised, resembling opisthotonos. Disease is severe. Yu Jia Yan combined these views: "Chest Binding with stiff neck is more serious. Tight knot in chest makes neck rise, resembling Rou Jing. This verifies extreme urgency of chest pathogen." Both miss Zhang Zhongjing's original intent. Did he not use Rou Jing's sweating/no aversion to cold to prove exterior pathogen resolved, indicating milder Chest Binding? Consider Da Xian Xiong Tang: Dahuang 6 liang, Mangxiao 0.5 sheng, taken twice warm. Da Xian Xiong Wan: Dahuang 0.5 jin, Tingli, Mangxiao, Xingren 0.5 sheng each, but final dose is only one pill-sized ball. The difference in dosage magnitude is significant.
Da Xian Xiong Wan Formula
Dahuang (Rhei Radix et Rhizoma) - 0.5 jin
Tingli (Descurainiae Semen Lepidii Semens)
Mangxiao (Natrii Sulfas)
Xingren (Armeniacae Semen Amarum) - 0.5 sheng each, roasted black
Sieve the first two ingredients (Dahuang, Tingli), add Xingren and Mangxiao, grind together until paste-like. Mix with powder, take one pill-sized ball. Separately sieve Gansui powder 1 qian-bi, Bai Mi (White Honey) 2 he, water 2 sheng. Decoct to obtain 1 sheng. Take warm in one dose. Bowel movement occurs after one night; if not, take again. Effectiveness is achieved upon evacuation. Follow standard herbal precautions.
Dahuang, Mangxiao, Gansui share the principle of previous Da Xian Xiong Tang. Bai Mi 2 he corresponds to ten dates in Shizao Tang. Adding Tingli and Xingren is because chest is the residence of Lung, Danzhong is Sea of Qi, connecting to Lung for respiration. Pathogen knots chest-diaphragm, causing hardness-fullness-pain, blocking airway, leading to shortness of breath, irritability, and water-knotting in chest-hypochondrium. Thus, Tingli and Gansui drain water and purge Lung; Xingren benefits Lung and directs Qi downward. Dosage is small despite large formula weight. Bai Mi moderates the harsh nature. Da Xian Xiong Tang is like six armies attacking together; Da Xian Xiong Wan is like dividing forces to capture objectives. Tang is for single-target use; Wan is for multi-target distribution. Their differences in size, division, and combination are distinct. Why do commentaries claim Bai Mi is best for guiding stagnation, naming it Wan but acting like San (Powder), stronger than Tang? Although Yu Jia Yan argued Bai Mi lingers and moistens, slowing descent to fit "one night to evacuate," it cannot match the rapidity of Chengqi or Xianxiong Tangs (walking ten or twenty li).
Shaoyang disease for six or seven days, Chest Binding Heat-Excess, pulse deep-tight, epigastric pain, stone-hard upon pressure, are treated with Da Xian Xiong Tang.
Historical commentators believed Wind Strike mistaken purgation forms Chest Binding, while Cold Damage mistaken purgation forms Pi (Obstruction). This is a millennium-long confusion. Zhang Zhongjing originally said "Fa Yang Fa Yin er fan xia zhi" (Initiated in Yang/In Yin, then mistakenly purged), never specifying Wind Strike or Cold Damage mistaken purgation. Previous clauses were Wind Strike Chest Binding; this clause shows Cold Damage also forms Chest Binding, proving it is not exclusive to Wind Strike error. See Chapter 1 notes. However, this clause forms Chest Binding without mistaken purgation because pathogen remained in Taiyang too long without treatment, leading to transformation. Pulse deep-tight refers to Guan pulse deep-tight. Question: How do we know pathogen is in Taiyang just from "Shaoyang"? Answer: Inferring from "Heat-Excess" and the salty-cold bitter-draining nature of Da Xian Xiong Tang. How do we know it is untreated? From "six or seven days," the period of meridian cycle completion, and absence of sweating/purgation history. How do we know deep-tight is Guan pulse? From Zjie Jie clause: "Pressing causes pain, Cun pulse floating, Guan pulse deep, named Chest Binding." Deep is clear. Why tight? Floating-tight indicates Cold pathogen in...