病发于阳下之早。热气乘虚心 。（仲景云。病发于阳。而反下之。热入因作结胸。所以成结胸者。下之早。故也。）
按之石 头项强。此是结胸证分晓。（仲景云。结胸者。头项亦强。如柔 状。下之则和。又云。其脉浮紧。心下痛。按
之如石坚。）脉浮与大未可下。先汗后下无颠倒。（仲景云。其脉浮大。不可下。下之则死。）热毒上攻结在胸。枳实理中
应恰好。（大抵结胸未辨虚实。先与理中加枳实佳。）大抵结胸有三说。大结小结并水结。（有大结胸。有小结胸。有水结
胸。仲景云。但结胸无大热者。此为水结在胸胁也。但头汗出者。大陷胸汤治。）更有寒热二证存。热实寒实宜区别。（仲
景云。太阳病。从心下至小腹满。痛不可近者。大陷胸汤主之。此大结胸也。又云。小结胸。病正在心下按之痛。脉浮
滑者。小陷胸汤主之。此小结胸也。又云。伤寒结胸。热实脉沉紧。心下痛。大陷胸汤主之。此热实者也。又云。寒实
结胸。无热证者。三物小陷胸汤。白散亦可服。此寒实者也。）此外有证名脏结。脉浮关小沉细绝。（仲景云。饮食如故。
时时下利。寸脉浮关小细沉紧。名曰脏结。舌上白苔。滑者。难治也。）舌上滑苔不可医。痛引阴筋当死别。（仲景云。
病者胁下素有痞。而在脐旁。痛引小腹。入阴筋者。此名脏结。死也。）结胸之状如 病。从心至脐不可近。（仲景云。
结胸者项亦强。如柔 状。又云。从心以下至脐。不可近。大陷胸汤主之。）心中懊 并躁烦。阳气内陷非虚靳。（靳、
居切。固也。仲景云。膈内拒痛。胃中空虚。客气动膈。短气烦躁。心中懊 。心下因硬。则为结胸也。）
疾病发于阳证阶段，若过早使用攻下法，热气便会乘虚而入。（张仲景说：疾病发于阳证，却反而使用攻下法，热邪内陷因而形成结胸。之所以形成结胸，是因为攻下太早的缘故。）
用手按压腹部，感觉像石头一样坚硬，且伴有头项强直，这就是结胸证的明确表现。（张仲景说：结胸病患者，头项也会强直，症状类似柔痉（汗出恶风的痉病），经过正确治疗后病情会缓解。又说：如果脉象浮紧，心下部疼痛，按压时感觉像石头一样坚硬。）
脉象浮大者不可轻易使用攻下法，应先解表发汗，后攻里泻下，顺序不可颠倒。（张仲景说：脉象浮大的，不可攻下，误用攻下法会导致死亡。）
热毒向上攻冲，结聚在胸部，使用枳实理中汤治疗正为合适。（大抵而言，结胸证尚未分辨虚实之前，先给予理中汤加枳实较为妥当。）
大体上结胸有三种说法：大结胸、小结胸和水结胸。（有大结胸，有小结胸，有水结胸。张仲景说：只是结胸而没有明显大热的，这是水饮结聚在胸胁所致。仅头部出汗的，用大陷胸汤治疗。）
此外还有寒实和热实两种证型存在，需要加以区别。（张仲景说：太阳病，从心下直到小腹胀满，疼痛剧烈不能触碰的，主治方为大陷胸汤，这是大结胸。又说：小结胸病，病灶正在心下部，按压才痛，脉象浮滑的，主治方为小陷胸汤，这是小结胸。又说：伤寒导致结胸，热实证见脉沉紧，心下部疼痛，主治方为大陷胸汤，这是热实证。又说：寒实结胸，没有热象的，可用三物小陷胸汤，白散也可以服用，这是寒实证。）
除此之外还有一种证候名为脏结，脉象表现为寸部浮、关部小、尺部沉细甚至绝止。（张仲景说：饮食如常，时常腹泻，寸脉浮、关脉小细沉紧，称为脏结。舌苔白滑的，难以治愈。）
舌苔白滑者不可医治，疼痛牵引至阴筋者当判为死证。（张仲景说：患者胁下素有痞块，位于脐旁，疼痛牵引小腹，并进入阴筋的，这名叫脏结，属死证。）
结胸的症状类似于柔痉病，从心窝到肚脐部位拒按不可触碰。（张仲景说：结胸病患者头项也强直，像柔痉的样子。又说：从心窝以下直到肚脐，疼痛拒按，主治方为大陷胸汤。）
心中烦闷不安且躁动烦躁，这是因为阳气内陷而非单纯的虚弱固涩。（靳，音居，意为固涩。张仲景说：膈内抗拒疼痛，胃中空虚，客气扰动膈部，短气烦躁，心中懊恼，心下部因此变硬，这就形成了结胸。）
The disease originates in a Yang syndrome stage; if purgation is applied prematurely, heat pathogens enter the deficiency. (Zhang Zhongjing stated: When the disease arises from Yang, and purgation is wrongly employed, heat enters and causes Jie Xiong (Chest Binding). The reason for forming Jie Xiong is premature purgation.)
Palpation reveals hardness like stone, accompanied by stiffness of the head and neck; this clearly indicates the syndrome of Jie Xiong (Chest Binding). (Zhang Zhongjing stated: In cases of Jie Xiong (Chest Binding), the head and neck are also stiff, resembling Rou Ji (Soft Spasm with sweating). After proper treatment, harmony is restored. He further stated: If the pulse is floating and tight, with pain in the epigastrium and hardness like stone upon palpation.)
A floating or large pulse contraindicates immediate purgation; one must first induce sweating to release the exterior, then purge the interior, without reversing the order. (Zhang Zhongjing stated: With a floating and large pulse, purgation is forbidden; applying it leads to death.)
Heat toxins attack upwards and bind in the chest; Zhi Shi Li Zhong Tang (Bitter Orange and Middle-Regulating Decoction) is appropriately suited. (Generally, before distinguishing between excess and deficiency in Jie Xiong (Chest Binding), administering Li Zhong Tang (Middle-Regulating Decoction) with Zhi Shi (Immature Bitter Orange) is advisable.)
Broadly speaking, there are three types of Jie Xiong (Chest Binding): Da Jie Xiong (Major Chest Binding), Xiao Jie Xiong (Minor Chest Binding), and Shui Jie Xiong (Water Chest Binding). (There is Da Jie Xiong (Major Chest Binding), Xiao Jie Xiong (Minor Chest Binding), and Shui Jie Xiong (Water Chest Binding). Zhang Zhongjing stated: When there is binding in the chest without significant heat, this is water binding in the chest and hypochondrium. If only the head sweats, Da Xian Xiong Tang (Major Draining the Chest Decoction) treats it.)
Furthermore, there exist Cold Excess and Heat Excess syndromes that require distinction. (Zhang Zhongjing stated: In Tai Yang disease (Tai Yang Syndrome), fullness and severe pain extending from the epigastrium to the lower abdomen, which cannot be touched, are treated with Da Xian Xiong Tang (Major Draining the Chest Decoction); this is Da Jie Xiong (Major Chest Binding). He further stated: In Xiao Jie Xiong (Minor Chest Binding), the pathology is located precisely at the epigastrium, painful upon pressure, with a floating and slippery pulse; Xiao Xian Xiong Tang (Minor Draining the Chest Decoction) treats it; this is Xiao Jie Xiong (Minor Chest Binding). He further stated: In Shang Han (Cold Damage) leading to Jie Xiong (Chest Binding), if it is a Heat Excess pattern with a deep and tight pulse and epigastric pain, Da Xian Xiong Tang (Major Draining the Chest Decoction) treats it; this is the Heat Excess type. He further stated: In Cold Excess Jie Xiong (Chest Binding), where there are no heat signs, San Wu Xiao Xian Xiong Tang (Three-Ingredient Minor Draining the Chest Decoction) may be used, or Bai San (White Powder) may also be taken; this is the Cold Excess type.)
Additionally, there is a syndrome named Zang Jie (Zang Binding). The pulse is floating at the Cun (Inch position), small at the Guan (Bar position), and deep, fine, or absent at the Chi (Cubit position). (Zhang Zhongjing stated: With normal appetite but frequent diarrhea, and a pulse that is floating at the Cun (Inch position), small, fine, deep, and tight at the Guan (Bar position), it is named Zang Jie (Zang Binding). If the tongue has a white, slippery coating, it is difficult to treat.)
A slippery white coating on the tongue indicates untreatability; pain radiating to the Yin sinews signifies death. (Zhang Zhongjing stated: If the patient has had a Pi Mass (Mass/Node) under the hypochondrium since old times, located beside the umbilicus, with pain radiating to the lower abdomen and entering the Yin sinews, this is named Zang Jie (Zang Binding), and it is fatal.)
The manifestation of Jie Xiong (Chest Binding) resembles Rou Ji (Soft Spasm); from the heart region down to the umbilicus, the area is tender and cannot be touched. (Zhang Zhongjing stated: In Jie Xiong (Chest Binding), the neck is also stiff, resembling Rou Ji (Soft Spasm). He further stated: From below the heart down to the umbilicus, it is tender and cannot be touched; Da Xian Xiong Tang (Major Draining the Chest Decoction) treats it.)
The mind feels restless and agitated due to internal entrapment of Yang Qi, rather than simple deficiency or stagnation. (Jin means firm/stagnant. Zhang Zhongjing stated: Rejection and pain within the diaphragm, emptiness in the stomach, pathogenic qi disturbing the diaphragm, shortness of breath, irritability, mental restlessness (Ao Nao), and hardness in the epigastrium constitute Jie Xiong (Chest Binding).)