大黄（半斤） 葶苈（半升熬） 芒硝（半升） 杏仁（半升去皮尖熬黑）
上四味。捣筛二味。内杏人芒硝。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。
成注云。大黄芒硝之苦咸。所以下。热。葶苈杏人之苦甘。所以泄满。甘遂取其直达。白蜜取其润利。皆以下泄
实满之物也。
琥按大陷胸汤。止硝黄甘遂三物。兹方中更加葶苈杏人白蜜。是名虽为丸。比汤倍有力焉。大抵结胸证。水逆于肺。
喘胀胸满者。宜用之。陷胸名义详下汤方中。
结胸证。其脉浮大者不可下。下之则死。（结胸证。寸脉虽浮。关脉必沉。为邪热结里。里实。所以可下。今者其脉
浮大。浮为在表。大为虚。是在表之邪犹未尽。胸中之结犹未实。下之是重虚其里。表邪尽入。所以主死。医人不可不
以此为戒也。按此条证。仲景既云不可下。则是当用何药。补亡论常器之云。可与增损理中丸。如未效。用黄连巴豆捣
如泥。封脐上。灼艾灸热渐效。愚以上证。虽未全结。终是里实之证。理中丸太补。不可用也。又灼艾法。亦未妥。）
结胸证悉具。烦躁者亦死（成注云。结胸证悉具。邪结已深也。烦躁者。正气散乱也。邪气胜。正气虚。即不下。
亦主死也。或云烦躁者。里证急也。下之。庶有可生之理。尚论篇云。烦躁为津液已竭。胃气垂绝之征。医人于此。宁
莫投药。可免病家之咎。）
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。余处无汗。剂颈而还。小便不利。身必发黄也。（太阳中风之脉本浮。其兼动数者。
动为痛。数为热为虚也。风热外盛。则头痛发热。卫气虚。肤腠空疏。故睡则盗汗微出也。脉动数而汗出。似乎表解。
邪欲传里。故以恶寒为反也。医人不知表未解。反误下之。动数之脉变迟。脉迟。则表邪乘虚入里。已结于胸膈间矣。
膈内拒痛者。膈中之气。与邪气相拒而作痛也。胃中空虚者。胃家之真气。因误下而致虚也。客气者。邪气也。短气者。
真气短促也。阳气者。即客气之别名也。胃家真气既虚而短。则客邪之气方盛。内动于膈。因发躁烦而热。必中懊 不
宁。此为阳邪内陷。热蒸成湿。湿热相结而坚实。以故心下硬。成结胸也。治法。宜大陷胸汤以下结热。夫曰膈内。曰
心中。曰心下。皆胸之分也。名曰结胸。其邪实陷于胃。胃中真气虚。斯阳邪从而陷入于胸。作结硬之形也。其有邪虽
入胃。而胸不至结者。胃中邪热不能外泄。此为热不得越。但上升于头而汗出。余处无汗。剂颈而还。剂者。分也。言
至颈。则汗分而还。于身则无汗也。小便不利者。胃中邪热。气蒸湿积而成水。思欲下泄而不得也。胃属土。其色黄。
湿热不得下泄。郁于内。必见于外。故至发黄也。补亡论常器之云。发黄者。与茵陈蒿汤。煎茵陈浓汁。调五苓散。亦
可。）
大黄（半斤） 葶苈子（半升，炒） 芒硝（半升） 杏仁（半升，去皮尖，炒至黑色）
以上四味药。将其中两味捣碎过筛。加入杏仁和芒硝，共同研磨成脂状。混合药散。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。温服，一次顿服。一夜后大便通下。如果未通下，再服用。以下便为有效。禁忌同一般服药法。
成无己注解说：大黄、芒硝的苦咸之性，用来泻热。葶苈子、杏仁的苦甘之性，用来泄满。甘遂取其药力直达病所。白蜜取其润利之性。都是用来泻下实满之邪的。
琥按：大陷胸汤，只有硝石、大黄、甘遂三味药。此方中再加葶苈子、杏仁、白蜜。虽然名为丸剂，但比汤剂效力加倍。大概结胸证，水气逆于肺，出现喘促、胀满、胸满者，适宜使用此方。陷胸的名义详见下方汤方条文中。
结胸证，如果脉象浮大的，不可用攻下法。攻下则致死。（结胸证，寸脉虽浮，关脉必沉，这是邪热结于里，里实，所以可以攻下。现在脉象浮大，浮表示在表，大表示虚，这是在表的邪气尚未完全解除，胸中的结聚还未坚实。攻下是使里气更虚，表邪全部内陷，所以主死。医生不可以不以此为戒。）按此条证候，仲景既然说不可攻下，那么应当用什么药？《补亡论》常器之说：可与增损理中丸。如果无效，用黄连、巴豆捣如泥，封在脐上，灼艾艾灸，热力渐入，逐渐见效。我认为上述证候，虽然未完全结聚，终归是里实证。理中丸太补，不可用。又灼艾法，也不妥当。）
结胸证症状全部具备，出现烦躁的，也主死（成无己注解说：结胸证症状全部具备，说明邪气结聚已深。烦躁，是正气散乱的表现。邪气胜，正气虚，即使不攻下，也主死。有人说烦躁是里证急迫。攻下，或许有生还的道理。《尚论篇》说：烦躁是津液已竭，胃气垂绝的征象。医生在此时，宁可不用药，可免除病人的责怪。）
太阳病，脉象浮而动数。浮则为风邪，数为热邪，动则为痛，数为虚。头痛发热，微微盗汗出，反而恶寒的，是表证未解。医生反而用攻下法。动数脉变为迟脉。膈内拒痛，胃中空虚，客气（邪气）动膈，短气躁烦，心中懊憹。阳气内陷，心下因硬，则为结胸。大陷胸汤主治。如果不结胸，仅头部出汗，其余部位无汗，齐颈而还，小便不利，身体必然发黄。（太阳中风之脉本浮。其兼见动数的，动为痛，数为热为虚。风热外盛，则头痛发热。卫气虚，肤腠空疏，所以睡则微盗汗出。脉动数而汗出，似乎表解，邪欲传里，故以恶寒为反常。医生不知表未解，反而误用攻下。动数之脉变迟。脉迟，则表邪乘虚入里，已结于胸膈间。膈内拒痛，是膈中之气与邪气相拒而作痛。胃中空虚，是胃家真气因误下而致虚。客气，即邪气。短气，是真气短促。阳气，即客气的别名。胃家真气既虚而短，则客邪之气方盛，内动于膈，因发躁烦而热，必心中懊憹不宁。此为阳邪内陷，热蒸成湿，湿热相结而坚实，所以心下硬，成为结胸。治法，宜用大陷胸汤以下结热。所谓膈内、心中、心下，皆属胸之分野。名曰结胸，其邪实陷于胃，胃中真气虚，斯阳邪从而陷入于胸，作结硬之形。其有邪虽入胃，而胸不至结者，胃中邪热不能外泄，此为热不得越，仅上升于头而汗出，其余部位无汗，齐颈而还。剂者，分也。言至颈，则汗分而还，于身则无汗。小便不利，是胃中邪热气蒸湿积而成水，思欲下泄而不得。胃属土，其色黄。湿热不得下泄，郁于内，必见于外，所以至发黄。《补亡论》常器之说：发黄者，与茵陈蒿汤。煎茵陈浓汁，调五苓散，也可。）
Rhubarb (Ban Zhi, half jin) Tingli Zi (Semen Lepidii, Ban Sheng, stir-fried) Mangxiao (Natrii Sulfas, Ban Sheng) Xingren (Semen Armeniacae Amarum, Ban Sheng, skin and tip removed, stir-fried until black)
The above four herbs. Crush and sieve two of them. Add Xingren and Mangxiao, grind together into a paste-like consistency. Mix with the powder. Take one pill-sized piece (size of a bullet). Separately crush Gansui powder (Qian Bi, one qian bi), Bai Mi (Honey, Er He), and water (Er Sheng). Boil to obtain Yi Sheng (one sheng). Take warm in one dose. Bowel movement occurs after one night. If no bowel movement, administer again. Passage of stool indicates efficacy. Dietary restrictions follow general medication rules.
Cheng Wuji's commentary states: The bitter and salty nature of Dahuang and Mangxiao is used to purge heat. The bitter and sweet nature of Tingli Zi and Xingren is used to drain fullness. Gansui is chosen for its ability to reach the disease site directly. Bai Mi is chosen for its moistening and lubricating properties. All are used to purge excess accumulation and fullness.
Hu notes: Da Xianxiong Tang contains only three herbs: Xiaoshi, Dahuang, and Gansui. This formula adds Tingli Zi, Xingren, and Bai Mi. Although named as a pill, it is twice as potent as the decoction. Generally, for Jie Xiong syndrome (Chest Binding Syndrome) where water qi rebels against the Lung, causing panting, distension, and chest fullness, this formula is suitable. The meaning of "Xian Xiong" (sinking the binding) is detailed in the following Tang formula section.
In Jie Xiong syndrome, if the pulse is floating and large, purgation is contraindicated. Purging leads to death. (In Jie Xiong syndrome, although the Cun position pulse may be floating, the Guan position pulse must be sunken, indicating pathogenic heat bound internally and internal excess, thus purgation is indicated. Now, the pulse is floating and large; floating indicates exterior location, large indicates deficiency. This means exterior pathogens have not fully resolved, and the binding in the chest is not yet solid. Purging causes further deficiency of the interior, allowing all exterior pathogens to sink inward, hence leading to death. Physicians must take this as a warning.) Regarding this condition, since Zhang Zhongjing stated purgation is contraindicated, what medicine should be used? Chang Qizhi in *Bu Wang Lun* suggests Zeng Sun Lizhong Wan. If ineffective, use Huanglian and Badou crushed into mud, applied to the navel, with moxibustion heat gradually entering for effect. I believe that although the above condition is not fully bound, it is ultimately an internal excess syndrome. Lizhong Wan is too tonifying and should not be used. Also, the moxibustion method is not appropriate.)
If all symptoms of Jie Xiong syndrome are present and restlessness (Fan Zao) occurs, death is also likely. (Cheng Wuji's commentary states: All symptoms of Jie Xiong syndrome being present indicates deep binding of pathogens. Restlessness indicates scattering of healthy Qi. Pathogens prevail, healthy Qi is deficient; even without purging, death is likely. Some say restlessness indicates urgent interior syndrome. Purging might offer a chance of survival. *Shang Lun Pian* states: Restlessness is a sign of exhausted body fluids and impending failure of Stomach Qi. Physicians here would do better to withhold medication to avoid blame from the patient's family.)
Taiyang disease, with a floating, moving, and rapid pulse. Floating indicates Wind, Rapid indicates Heat, Moving indicates Pain, Rapid indicates Deficiency. Headache, fever, slight nocturnal sweating, yet contrary aversion to cold, indicates the exterior is not resolved. The physician erroneously uses purgation. The moving and rapid pulse changes to a slow pulse. Rejection pain within the diaphragm, emptiness in the Stomach, Guest Qi (pathogenic factor) disturbing the diaphragm, shortness of breath, irritability, and mental restlessness (Ao Nao). Yang Qi sinks inward, hardness below the heart results, constituting Jie Xiong. Da Xianxiong Tang is the primary treatment. If Jie Xiong does not form, but there is only sweating on the head, no sweat elsewhere, stopping at the neck, and urination is difficult, the body will certainly become jaundiced. (The pulse of Taiyang Wind Strike is originally floating. When accompanied by moving and rapid qualities, moving indicates pain, rapid indicates heat and deficiency. Exuberant Wind-Heat externally causes headache and fever. Deficiency of Wei Qi and loose skin pores cause slight nocturnal sweating during sleep. A moving and rapid pulse with sweating seems like resolution of the exterior, suggesting pathogens are about to transmit inward, hence aversion to cold is considered contrary. The physician, unaware the exterior is unresolved, erroneously purges. The moving and rapid pulse becomes slow. A slow pulse indicates exterior pathogens enter the interior due to deficiency and bind in the chest and diaphragm. Rejection pain within the diaphragm is the Qi of the diaphragm resisting the pathogens causing pain. Emptiness in the Stomach is the true Qi of the Stomach becoming deficient due to erroneous purging. Guest Qi refers to pathogenic Qi. Shortness of breath refers to shortness of true Qi. Yang Qi is another name for Guest Qi. Since the true Qi of the Stomach is deficient and short, the pathogenic Qi is vigorous, moving inward to the diaphragm, causing irritability and heat, inevitably leading to mental restlessness. This is Yang pathogens sinking inward, heat steaming into dampness, damp-heat binding firmly, resulting in hardness below the heart, forming Jie Xiong. Treatment method: Use Da Xianxiong Tang to purge the bound heat. Terms like "within the diaphragm," "in the heart," and "below the heart" all belong to the chest region. Named Jie Xiong, the pathogens are truly bound in the Stomach, Stomach true Qi is deficient, so Yang pathogens sink into the chest, forming a hard binding. In cases where pathogens enter the Stomach but the chest does not bind, Stomach pathogenic heat cannot vent outward. This is heat unable to escape, rising only to the head causing sweating, while other areas remain dry, stopping at the neck. "Ji" means dividing point. It means sweat stops at the neck and returns, leaving the body dry. Difficulty in urination is due to Stomach pathogenic heat steaming and accumulating dampness into water, desiring to drain downward but unable to do so. The Stomach belongs to Earth, its color is yellow. Damp-heat unable to drain downward stagnates internally and manifests externally, hence jaundice develops. Chang Qizhi in *Bu Wang Lun* states: For jaundice, use Yinchen Hao Tang. Decoct Yinchen into thick juice, mix with Wuling San, which is also effective.)