病发于阳，而反下之，热入因作结胸。病发于阴，而反下之，因作痞。所以成结胸者，以下之太早故也。
按卫气为阳，风伤卫者，病发于阳也。卫伤则遏逼营血，而生里热，血化于脏，脏阴衰者，多传于阳
明之腑。营血为阴，寒伤营者，病发于阴也。营伤则束闭卫气，而生表寒，气化于腑，腑阳弱者，多传于太
阴之脏。病发于阳者，俟其热邪传里，已入胃腑，非不可下，方其在经，法应汗解，而反下之，表阳内陷，
而成结胸。病发于阴者，内寒郁动，易入脾脏，始终忌下。方其在经，亦应汗解，而反下之，里阴上逆，
则成痞证。太阳之病不解于太阳之经，而内传脏腑，生死攸关，是皆太阳之坏病也。然入腑则用承气，入脏
则用四逆，犹有救坏之法。至于未入胃腑，下早而为结胸，未入脾脏，误下而成痞证，则坏而又坏矣。
仲景变承气而为陷胸，变四逆而为泻心，所以救坏中之坏也。
按结胸证重者，以大陷胸汤，大陷胸丸主之。轻者以小陷胸汤主之。痞证表未解而里虚，以桂枝
人参汤主之。表已解而里实，上有热，以大黄黄连泻心汤主之。表已解而里实，下有寒，以附子泻心汤
主之。表解而里有水，以十枣汤主之。表解而里有寒、有热，以生姜泻心汤，甘草泻心汤主之。里湿而便滑
，以赤石脂禹余粮汤主之。里湿而水停，以五苓散主之。表解而里郁，以旋复花代赭石汤主之。里寒而可
吐，以瓜蒂散主之。
疾病初起于阳证，如果误用攻下法，热邪内陷就会形成结胸。疾病初起于阴证，如果误用攻下法，就会形成痞证。之所以形成结胸，是因为攻下法使用过早的缘故。
按：卫气属于阳，风邪损伤卫气，就是病发于阳。卫气受伤则遏制逼迫营血，从而产生里热；营血在脏中化生，若脏阴虚弱，多传入阳明之腑。营血属于阴，寒邪损伤营血，就是病发于阴。营血受伤则束缚闭阻卫气，从而产生表寒；卫气在腑中气化，若腑阳虚弱，多传入太阴之脏。
病发于阳证的，等到热邪传变入里，已经进入胃腑时，并非不可使用攻下法；但在邪气尚在经络时，依法应当通过发汗解除，却反而误用攻下，导致表阳内陷，从而形成结胸。病发于阴证的，内寒郁而发动，容易传入脾脏，治疗应始终禁忌攻下。邪气尚在经络时，也应当通过发汗解除，却反而误用攻下，导致里阴之气上逆，从而形成痞证。
太阳病如果在太阳经未能解除，反而内传脏腑，关乎生死，这些都属于太阳病的坏病（因误治而变坏的病证）。然而，邪气传入腑则使用承气汤类方剂，传入脏则使用四逆汤类方剂，还有挽救坏病的方法。至于邪气未入胃腑，因攻下过早而形成结胸；或邪气未入脾脏，因误用攻下而形成痞证，这就属于坏病中的坏病了。张仲景将承气汤变化为陷胸汤，将四逆汤变化为泻心汤，正是为了挽救这种坏中之坏。
按：结胸证严重的，以大陷胸汤、大陷胸丸为主治方剂。轻症的，以小陷胸汤为主治方剂。痞证若表证未解且里虚，以桂枝人参汤为主治方剂。表证已解且里实，上部有热，以大黄黄连泻心汤为主治方剂。表证已解且里实，下部有寒，以附子泻心汤为主治方剂。表证已解但里有水饮，以十枣汤为主治方剂。表证已解但里有寒热错杂，以生姜泻心汤、甘草泻心汤为主治方剂。里有湿邪且大便滑泄，以赤石脂禹余粮汤为主治方剂。里有湿邪且水液停聚，以五苓散为主治方剂。表证已解但里有气机郁滞，以旋复花代赭石汤为主治方剂。里有寒邪且适合催吐，以瓜蒂散为主治方剂。
The disease originates in the Yang pattern, but if purgation is incorrectly applied, heat enters and results in Jie Xiong (Chest Binding). The disease originates in the Yin pattern, but if purgation is incorrectly applied, Pi Syndrome (Stagnant Lump) ensues. The reason for the formation of Jie Xiong is that purgation was administered too early.
Note: Wei Qi (Defensive Qi) belongs to Yang; Wind pathogen injuring Wei Qi constitutes a disease originating in Yang. When Wei Qi is injured, it obstructs and forces Ying Blood (Nutritive Blood), generating interior heat. As blood transforms within the Zang organs, if Zang Yin is deficient, the condition often transmits to the Fu organs of the Yangming channel. Ying Blood belongs to Yin; Cold pathogen injuring Ying Blood constitutes a disease originating in Yin. When Ying Blood is injured, it binds and closes off Wei Qi, generating exterior cold. As Qi transforms within the Fu organs, if Fu Yang is weak, the condition often transmits to the Zang organs of the Taiyin channel.
For diseases originating in Yang, once the heat pathogen has transmitted to the interior and entered the Stomach Fu organ, purgation may not be contraindicated. However, while the pathogen is still in the meridians, the appropriate method should be diaphoresis (sweating); incorrectly applying purgation causes Exterior Yang to sink inward, resulting in Jie Xiong. For diseases originating in Yin, interior cold stagnates and moves, easily transmitting to the Spleen Zang organ; purgation should always be avoided. While the pathogen is still in the meridians, diaphoresis should also be employed; incorrectly applying purgation causes Interior Yin to rebel upward, resulting in Pi Syndrome.
Taiyang disease that fails to resolve at the Taiyang meridian level and instead transmits internally to the Zang and Fu organs involves life-and-death stakes; these are all considered Huai Bing (Ruined Diseases due to mistreatment) of Taiyang. Nevertheless, if the pathogen enters the Fu organs, Chengqi Decoctions are used; if it enters the Zang organs, Sini Decoctions are used, providing methods to rescue ruined diseases. However, if purgation is applied too early before the pathogen enters the Stomach Fu organ, resulting in Jie Xiong; or if purgation is mistakenly applied before the pathogen enters the Spleen Zang organ, resulting in Pi Syndrome, this constitutes a "ruin within ruin." Zhang Zhongjing transformed Chengqi Decoction into Xianxiong Decoction, and transformed Sini Decoction into Xiexin Decoction, precisely to rescue such conditions.
Note: For severe cases of Jie Xiong syndrome, Da Xianxiong Tang (Major Chest-Binding Decoction) and Da Xianxiong Wan (Major Chest-Binding Pill) are indicated. For mild cases, Xiao Xianxiong Tang (Minor Chest-Binding Decoction) is indicated. For Pi Syndrome where the exterior pattern remains unresolved and the interior is deficient, Guizhi Renshen Tang (Cinnamon Twig and Ginseng Decoction) is indicated. If the exterior pattern has resolved and the interior is excess with heat above, Dahuang Huanglian Xiexin Tang (Rhubarb and Coptis Heart-Draining Decoction) is indicated. If the exterior pattern has resolved and the interior is excess with cold below, Fuzi Xiexin Tang (Aconite Heart-Draining Decoction) is indicated. If the exterior pattern has resolved but water retention exists in the interior, Shizao Tang (Ten Jujube Decoction) is indicated. If the exterior pattern has resolved but there is a mixture of cold and heat in the interior, Shengjiang Xiexin Tang (Fresh Ginger Heart-Draining Decoction) and Gancao Xiexin Tang (Licorice Heart-Draining Decoction) are indicated. If there is dampness in the interior accompanied by loose stools, Chishizhi Yuyuliang Tang (Red Halloysite and Hematite Decoction) is indicated. If there is dampness in the interior with fluid retention, Wuling San (Five-Ingredient Powder with Poria) is indicated. If the exterior pattern has resolved but there is interior Qi depression, Xuanfuhua Dahezeshi Tang (Inula Flower and Magnetite Decoction) is indicated. If there is interior cold suitable for emesis, Gouti San (Melon Sprout Powder) is indicated.