〔《活》〕若误下了，初未成结胸者，急频与理中汤，自然解了，更不作结胸，盖理中汤治中焦故也。此
古人亦说不到，后因人消息得之。若大段转损，有厥症者，兼与四逆汤便安。胃中虽和，伤寒未退者，宜候日
数足可下，却以承气再下之，盖前来下之未是故也。
西晋崔行功云∶伤寒结胸欲绝，心膈高起，手不得近，用大陷胸汤皆不瘥者，此是下后虚逆，气已不理，
而毒复上攻，气毒相抟结于胸者，当用枳实理中丸先理其气，次疗其疾，古今用之如神，应手而愈。
枳实理中丸 治伤寒结胸欲绝，心膈高起，手不得近。
枳实（十六片，麸炒） 茯苓 人参 白术 干姜（炮） 甘草（炮，以上各二两）
上为末，炼蜜丸，如鸡子黄大。每服一丸，热汤化下，连进二三服，胸中豁然。渴者，加栝蒌根一两。自
汗者，加牡蛎二两， 过，下利亦加。
〔海〕增损理中丸 王朝奉云∶大小陷胸汤丸不愈者，宜与之。
人参 白术 栝蒌 牡蛎 甘草（炙。各二两） 干姜（炒白，半两） 枳实（炒，二十四个） 黄芩（去
枯，一两）
上为细末，炼蜜为丸，如弹子大，汤一盏，煎服。不效，复与之，不过五六丸，胸中豁然矣，用药神速，
未尝见也。渴者，加栝蒌根。有汗，加牡蛎。
〔《活》〕水结在胸胁间，亦名结胸，其证头微汗出，但结胸无热者，小半夏加茯苓汤、小柴胡去枣加牡
蛎主之。
〔孙〕按俞伯道忽患微热，心下满，头有汗，不能解。众医以为温病，用表药，有谓食在膈者，治之皆不
愈。召孙至。曰∶用半夏茯苓汤遂瘥。众问其故，曰∶头有汗，心下满，非湿症，乃水结胸胁也。水既去，其
病乃愈。且如湿气心下满，自当遍身汗，若有食，心满，头岂得有汗？若言是表，身又不疼，不恶寒，表证何
在？故凡水结胸胁，头必有汗耳。
小半夏加茯苓汤。（方见呕门）
穿结散 大实大满，心胸高起，气塞不通者，为结也。
蟾酥 麝香 轻粉 巴豆（另研，少许）
上再研过至细，以乳汁为丸，如黍米大。每服二丸，用姜汤下，不时服。
〔《本》〕妇人伤寒，血结胸膈，揉而痛，不可抚近，宜海蛤散。
海蛤 滑石 甘草（炙。各一两） 芒硝（半两）
上末，每服二钱，鸡子清调下。
小肠通利则胸膈血散，膻中血聚则小肠壅，小肠壅，膻中血不流行，宜此方。若小便血散数行，
更宜桂枝红花汤发其汗则愈。《活人书》云∶此方疑非仲景，然其言有理，姑存之。
治结胸灸法。
巴豆（十四个） 黄连（七寸，去皮用）
上捣细，津唾和成膏，填入脐中，以艾灸其上，腹中有声，其病去矣。不拘壮数，病去为度。才灸了，便
以温汤浸手帕拭之，恐生疮也。
〔《摘》〕伤寒结胸。先使人心蔽骨下正痛处左畔揉之，以毫针刺左畔支沟穴。（正坐侧臂，取之，二分。）
次刺左间使，名曰双关刺，次左行间。（卧取之，针入六分。此支沟行间穴下针至分数内，捻针令病患五吸，
次外捻针三呼，又次内捻针五吸讫，长呼一口气，出针，即左畔一壁结胸立效。右畔根据上刺之，慢慢呼吸停
针用针，获时而愈，无有不效。）
〔云〕伤寒结胸痞气。
胸中结痞∶涌泉 太溪 中冲 大陵
心中结痞∶隐白 太白 少冲 神门
胃中结痞∶少商 太渊 大敦 太冲 并上下中脘泻之。
〔通玄〕结胸身黄∶涌泉
〔《摘》〕血结胸，面赤，大燥口干，消渴，胸中疼痛不可忍∶期门 大陵 关元（妊娠不得刺关元，
胎死不出，子母俱亡，慎之。）
〔《集》〕伤寒胸膈痛∶期门 大陵
〔《活》〕近世治结胸多用金针，并用硫黄、阳起石者，若寒实结胸，或有瘥者，若热实结胸，必死也。
〔《活人书》〕如果误用下法，起初尚未形成结胸证的，应立即频繁给予理中汤，自然就会痊愈，不会再转为结胸证，这是因为理中汤主治中焦的缘故。这一点古人也没有说到，后来是有人通过观察病情变化而领悟到的。如果病情严重恶化，出现四肢厥冷的症状，应同时配合使用四逆汤，身体就能安定。虽然胃气已调和，但伤寒表邪未退的，应当等待时日充足、里实已成时，再用承气汤类方剂攻下，这是因为之前的攻下方法不当的缘故。
西晋崔行功说：伤寒导致结胸证危重欲绝，心窝和膈部高高隆起，手不能触碰，使用大陷胸汤均无效者，这是攻下后导致正气虚弱、气机逆乱，气机已经紊乱，而毒邪再次向上攻冲，气与毒相互搏结于胸部的，应当先用枳实理中丸来调理气机，然后再治疗疾病，古今使用此法如神，手到病除。
枳实理中丸 治疗伤寒结胸证危重欲绝，心窝和膈部高高隆起，手不能触碰。
枳实（十六片，麸皮炒） 茯苓 人参 白术 干姜（炮制） 甘草（炮制，以上各二两）
将上述药物研为细末，用炼蜜制成丸药，大小如鸡蛋黄。每次服用一丸，用热开水化开服下，连续服用二三服，胸中豁然开朗。口渴的，加栝蒌根一两。自汗出的，加牡蛎二两，腹泻的也加入。
〔海藏〕增损理中丸 王朝奉说：大小陷胸汤丸无效者，适宜使用此方。
人参 白术 栝蒌 牡蛎 甘草（炙。各二两） 干姜（炒至变白，半两） 枳实（炒，二十四个） 黄芩（去掉枯朽部分，一两）
将上述药物研为细末，用炼蜜制成丸药，大小如弹子，用一盏水煎服。如果无效，再服用它，不过五六丸，胸中就会豁然开朗，用药神速，前所未见。口渴的，加栝蒌根。有汗出的，加牡蛎。
〔《活人书》〕水饮结聚在胸胁之间，也称为结胸，其症状表现为头部微微出汗，如果是没有发热的结胸证，用小半夏加茯苓汤或小柴胡汤去大枣加牡蛎为主治方。
〔孙思邈〕按：俞伯道忽然患轻微发热，心下部胀满，头部出汗，无法缓解。众医生认为是温病，使用解表药；有人说是有食积在膈部，治疗均无效。请孙思邈诊治。孙思邈说：使用半夏茯苓汤随即痊愈。众人询问原因，他说：头部出汗，心下部胀满，这不是湿症，而是水饮结聚在胸胁。水饮去除，病就好了。况且如果是湿气导致的心下部胀满，自然会全身出汗；如果有食积，心下部胀满，头部怎么会有汗？如果说是有表证，身体又不疼痛，也不恶寒，表证在哪里？所以凡是水饮结聚胸胁，头部必然有汗。
小半夏加茯苓汤。（方剂见呕吐门）
穿结散 大实大满，心胸高高隆起，气机堵塞不通的，称为结。
蟾酥 麝香 轻粉 巴豆（另研，少许）
将上述药物再次研磨至极细，用乳汁制成丸药，大小如黍米。每次服用二丸，用姜汤送下，随时服用。
〔《本草》〕妇人患伤寒，血结于胸膈，按压则疼痛，不可靠近，宜用海蛤散。
海蛤 滑石 甘草（炙。各一两） 芒硝（半两）
将上述药物研为末，每次服用二钱，用鸡蛋清调服。
小肠通利则胸膈之血消散，膻中血聚则小肠壅滞，小肠壅滞，膻中之血不流通，宜用此方。如果小便出血且血散数行，更宜用桂枝红花汤发汗则痊愈。《活人书》说：此方怀疑不是张仲景所作，但其言论有理，姑且保留。
治疗结胸的灸法。
巴豆（十四个） 黄连（七寸，去皮取肉）
将上述药物捣碎研细，用唾液调和成膏状，填入肚脐中，在其上施灸，腹中有响声，病就好了。不拘泥于灸的壮数，以病愈为度。刚灸完，立即用温水浸湿的手帕擦拭，恐怕生疮。
〔《针灸资生经》〕伤寒结胸。先在人心骨下正痛处的左侧揉按，用毫针刺左侧支沟穴。（正坐侧臂取穴，进针二分。）接着刺左侧间使穴，名叫双关刺，再刺左侧行间穴。（卧位取穴，进针六分。在支沟、行间穴下针至规定深度内，捻针令患者吸气五次，接着向外捻针呼气三次，再向内捻针吸气五次完毕，长呼一口气，出针，即刻左侧结胸立效。右侧依上法针刺，慢慢呼吸停针用针，适时而愈，无不有效。）
〔云岐子〕伤寒结胸痞气。
胸中结痞：涌泉 太溪 中冲 大陵
心中结痞：隐白 太白 少冲 神门
胃中结痞：少商 太渊 大敦 太冲 并上下中脘泻之。
〔《针灸资生经》〕血结胸，面色红赤，极度干燥口干，消渴，胸中疼痛不可忍受：期门 大陵 关元（妊娠期间不得刺关元，否则胎死不出，母子俱亡，务必谨慎。）
[From *Huoren Shu* (Book of Living Persons)] If purgation is mistakenly applied and the Jie Xiong syndrome (Chest Binding Syndrome) has not yet formed, Lizhong Tang (Regulate the Middle Decoction) should be administered frequently and urgently. The condition will resolve naturally without progressing to Jie Xiong, because Lizhong Tang treats disorders of the Middle Jiao (Middle Burner). This point was not mentioned by ancient physicians; it was later discovered through clinical observation. If the condition deteriorates significantly and presents with Jue symptoms (limb coldness), Sini Tang (Reverse the Extremities Decoction) should be combined to stabilize the patient. Although the Stomach Qi has harmonized, if the Shanghan (Cold Damage) pathogen remains unresolved, one should wait until the appropriate days have passed for the interior excess to mature, then use Chengqi Tang (Bowel-Draining Decoction) again to purge. This is because the previous purgation was inappropriate.
Cui Xinggong of the Western Jin Dynasty stated: In cases of severe Shanghan leading to critical Jie Xiong, where the heart and diaphragm are elevated and tender to touch, and Dachuanxiong Tang (Major Chest-Penetrating Decoction) fails to cure, this indicates deficiency and rebellious Qi after purgation. The Qi mechanism is disordered, and toxic pathogens attack upward again, binding with Qi in the chest. One should first use Zhishi Lizhong Wan (Immature Bitter Orange Regulate-the-Middle Pill) to regulate Qi, and then treat the disease. It works miraculously in both ancient and modern times, bringing immediate recovery.
Zhishi Lizhong Wan (Immature Bitter Orange Regulate-the-Middle Pill): Treats critical Shanghan Jie Xiong with elevated heart and diaphragm, tender to touch.
Zhishi (Immature Bitter Orange) (16 slices, bran-fried) Poria (Fuling, 茯苓) Ginseng (Renshen, 人参) Atractylodes Macrocephala (Baizhu, 白术) Dried Ginger (Ganjiang, 干姜) (processed) Licorice Root (Gancao, 甘草) (processed, each 2 liang above).
Grind into powder, mix with refined honey to make pills the size of a chicken egg yolk. Take one pill per dose, dissolve in hot water, and administer continuously for 2-3 doses until the chest feels open and clear. For thirst, add Trichosanthes Root (Gualou Gen, 栝蒌根) 1 liang. For spontaneous sweating, add Oyster Shell (Muli, 牡蛎) 2 liang; also add for diarrhea.
[Hai Zang] Zengsun Lizhong Wan (Modified Regulate-the-Middle Pill): Wang Chaofeng said: For cases unresponsive to Dachuanxiong or Xiaochuanxiong Tang/Wan, this formula is suitable.
Ginseng (Renshen, 人参) Atractylodes Macrocephala (Baizhu, 白术) Trichosanthes Fruit (Gualou, 栝蒌) Oyster Shell (Muli, 牡蛎) Licorice Root (Gancao, 甘草) (roasted, each 2 liang) Dried Ginger (Ganjiang, 干姜) (fried until white, 0.5 liang) Immature Bitter Orange (Zhishi, 枳实) (fried, 24 pieces) Scutellaria Root (Huangqin, 黄芩) (remove woody parts, 1 liang).
Grind into fine powder, mix with refined honey to make pills the size of a bullet. Decoct in one cup of water and take orally. If ineffective, repeat. Within 5-6 pills, the chest will feel open. The medication acts swiftly and miraculously, unprecedented. For thirst, add Trichosanthes Root. For sweating, add Oyster Shell.
[From *Huoren Shu*] When water retention binds in the chest and hypochondrium, it is also called Jie Xiong. Symptoms include slight sweating on the head. For Jie Xiong without heat, Banxia Shengjiang San (Pinellia and Ginger Powder) modified with Fuling (Xiaobanxia Jia Fuling Tang, Minor Pinellia and Poria Decoction) or Chaihu Guizhi Gancao Tang (Minor Bupleurum Decoction) minus Jujube plus Muli (Oyster Shell) should be used as the main treatment.
[Sun Simiao] Note: Yu Bodao suddenly suffered from mild fever, fullness below the heart, and sweating on the head, which could not be resolved. Physicians considered it a Wenbing (Warm Disease) and used exterior-releasing drugs; others suspected food stagnation in the diaphragm, but treatments failed. Sun Simiao was summoned and said: Use Banxia Fuling Tang (Pinellia and Poria Decoction), and the patient recovered. When asked why, he said: Sweating on the head and fullness below the heart indicate not dampness, but water binding in the chest and hypochondrium. Once the water is removed, the disease heals. If it were dampness causing fullness below the heart, there would be whole-body sweating. If it were food stagnation, how could there be only head sweating? If it were an exterior syndrome, the body would not be painless, nor free of aversion to cold. Where is the exterior syndrome? Therefore, in water binding in the chest and hypochondrium, head sweating is inevitable.
Xiaobanxia Jia Fuling Tang (Minor Pinellia and Poria Decoction). (Formula see Vomiting Section)
Chuanjie San (Penetrating Binding Powder): For severe excess and fullness, with elevated chest and heart, and blocked Qi flow, termed "Jie" (Binding).
Toad Venom (Chansu, 蟾酥) Musk (Shexiang, 麝香) Calomelas (Qingfen, 轻粉) Croton Seed (Badou, 巴豆) (separately ground, a small amount).
Grind again to extreme fineness, form pills with milk juice, size of millet seeds. Take two pills per dose, wash down with ginger soup, administer at any time.
[From *Bencao*] In women with Shanghan, blood binds in the chest and diaphragm, causing pain upon pressure, intolerable to touch. Hai Ge San (Clam Shell Powder) is indicated.
Clam Shell (Haige, 海蛤) Talcum (Huashi, 滑石) Licorice Root (Gancao, 甘草) (roasted, each 1 liang) Mirabilite (Mangxiao, 芒硝) (0.5 liang).
Grind into powder. Take 2 qian per dose, mixed with egg white.
When the Small Intestine is unobstructed, blood in the chest and diaphragm dissipates. When blood gathers in Danzhong (Conception Vessel), the Small Intestine becomes obstructed. When the Small Intestine is obstructed, blood in Danzhong does not circulate freely. This formula is indicated. If urine contains blood and bleeding occurs multiple times, Gui Zhi Hong Hua Tang (Cinnamon Twig and Safflower Decoction) should be used to induce sweating for recovery. *Huoren Shu* states: This formula is suspected not to be by Zhang Zhongjing, but its reasoning is sound, so it is retained here.
Moxibustion Method for Treating Jie Xiong.
Croton Seed (Badou, 巴豆) (14 seeds) Coptis Rhizome (Huanglian, 黄连) (7 cun, peel off skin).
Pound and grind finely, mix with saliva to form a paste, fill into the umbilicus, and apply moxibustion on top. When sounds are heard in the abdomen, the disease is gone. Do not limit the number of moxa cones; stop when the disease resolves. Immediately after moxibustion, wipe with a warm, wet towel to prevent sores.
[From *Zisheng Jing*] Shanghan Jie Xiong. First, massage the left side of the exact painful point below the xiphoid process. Pierce the left Zhigou (SJ6) acupoint with a filiform needle. (Sit upright, arm to side, insert 2 fen.) Then pierce the left Jianshi (PC5) acupoint, named "Double Guan Piercing." Then pierce the left Xingjian (LR2) acupoint. (Lie down, insert 6 fen. While needles are inserted to the specified depth in Zhigou and Xingjian, rotate the needle while the patient inhales five times, then rotate outward while exhaling three times, then rotate inward while inhaling five times. Finally, exhale long and remove the needle. Left-sided Jie Xiong will immediately respond. For the right side, follow the same method. Breathe slowly, hold the needle appropriately, and recover in due time. No failure.)
[Yun Qizi] Shanghan Jie Xiong Pi Qi (Stagnant Qi).
Chest Jie Pi (Binding Stagnation): Yongquan (KI1) Taixi (KI3) Zhongchong (PC9) Daling (PC7)
Heart Jie Pi: Yinbai (SP1) Taibai (SP3) Shaochong (HT9) Shenmen (HT7)
Stomach Jie Pi: Shaoshang (LU11) Taiyuan (LU9) Dadun (LR1) Taichong (LR3) and reduce upper and lower Zhongwan (CV12).
[Tongxuan Zhiyao Fu] Jie Xiong with yellow complexion: Yongquan (KI1)
[From *Zisheng Jing*] Blood Jie Xiong, red face, extreme dryness and thirst, Xiao Ke (Wasting-Thirst), unbearable chest pain: Qimen (LR14) Daling (PC7) Guanyuan (CV4) (Do not puncture Guanyuan during pregnancy; otherwise, fetal death may occur, harming both mother and child. Be cautious.)
[From *Juying*] Shanghan chest and diaphragm pain: Qimen (LR14) Daling (PC7)
[From *Huoren Shu*] In recent times, treating Jie Xiong often uses gold needles and substances like Realgar (Liu Huang, 硫黄) and Yangqishi (Yangqi Stone, 阳起石). If it is Cold-Excess Jie Xiong, there may be recovery; if it is Heat-Excess Jie Xiong, death is certain.