问曰∶病有结胸，有脏结，其状何如？答曰∶按之痛，寸脉浮，关脉沉，名曰结胸也。何谓脏结？答曰∶
如结胸状，饮食如故，时时下利，寸脉浮，关脉细小沉紧，名曰脏结。舌上白胎滑者，难治。（王朝奉云∶
可刺关元穴。）脏结无阳症，不往来寒热，其人反静，舌上滑胎者，不可攻也。（王朝奉云∶可刺关元穴，
服小柴胡汤。）病胸中素有痞，连在脐旁，引入小腹入阴筋者，此名脏结，死。
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。
伤寒五六日，呕而发热者，柴胡汤症具，而以他药下之，柴胡症仍在者，复与柴胡汤，此虽已下之，不为逆，
必蒸蒸而振，却发热汗出而解。若心满而硬痛者，此为结胸也，大陷胸汤主之。但满而不痛者，此为痞，柴胡
不中与之，与半夏泻心汤。
太阳病，重发汗而复下之，不大便五六日，舌上燥而渴，日晡所有潮热，从心下至少腹，而痛不可近者，
大陷胸汤主之。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。（丹溪云∶此症曰胃中空，曰短气躁烦，曰脉浮，大陷胸汤不可轻用。）
伤寒六七日，结胸热实，脉沉而紧，心下痛，按之实硬者，大陷胸汤主之。（云岐云∶三症陷胸，皆日
西潮热。）
大陷胸汤
大黄（一两半，去皮，为末，锦纹者佳） 芒硝（一两八钱） 甘遂（一字，赤连珠者，为细末）
上水二盏，煮大黄至八分，去渣，下硝一沸，下甘遂末，温服，得快利，止后服。小结胸病，正在心下，
按之则痛，脉浮滑者，宜小陷胸汤。
半夏（汤洗，二两） 黄连（一两） 栝蒌（一枚，用四分之一）
上 咀，水二盏，先煎栝蒌至一盏半，后用半夏、黄连煎取八分，去渣温服。未和再服，微解下黄涎便安
也。
〔孙〕工部郎中郑忠浓，因患伤寒，胸腹满，面黄如金色，诸翰林医官商议略不定，推让曰∶胸满可下，
恐脉浮虚。召孙至，曰∶诸公虽疑不用下药，郑之福也，下之必死，某有一二服药，服之必瘥。遂下小陷胸汤
寻利，其病遂良愈。明日面色改白，京城人称服。
伤寒十余日，热结在里，复往来寒热者，与大柴胡汤。
但结胸无大热者，此为水结在胸胁也。但头微汗出者，大陷胸汤主之。（《活人》云∶水结胸，小半夏
加茯苓汤，小柴胡去
牡蛎汤亦主之。）
病在阳，应以汗解之，反以冷水 之，若灌之，其热被却不得去，弥更益烦，肉上粟起，意欲饮水，
反不渴者，服文蛤散。若不瘥者，与五苓散。寒实结胸，无热证者，与三物小陷胸汤，白散亦可。
桔梗（三分） 巴豆（一分，去皮尖，熬黑研如脂） 贝母（三分）
上三味为末，纳巴豆，更于臼中杵之，以白饮和服。强人半钱匕，羸者减之。病在膈上必吐，在膈下必利，
不利进热粥一碗，利过不止，进冷粥一碗。汗出已，腹中痛，与芍药一两。
上热实结胸，及寒实结胸。《活人》不拘寒热，但用陷胸汤。不瘥，用枳实理中丸，应手而愈。
结胸，项亦强，如柔 状，下之则和，宜大陷胸丸。
大黄（二两） 葶苈 芒硝 杏仁（去皮，炒，各三分）
上捣罗二味，纳杏仁、芒硝合研如脂，相和为丸，如弹大。后用甘遂末一字，白蜜少许，水二盏半，煎至
一盏，顿服。一宿乃下，如不下，再服。王海藏云∶大陷胸汤，太阳入本药也；大陷胸丸，阳明药也；小陷
胸汤，少阳药也。大陷胸治热实，大陷胸丸兼喘，小陷胸治痞。
心下满痛，如结胸状，若头下强痛眩冒者，刺大椎、肝 。若汗下后头项强痛，发热，小便不利者，桂枝
去桂加茯苓白术汤。（方论并见项强。）
若妇人经水来，热除谵语者，刺期门。（论见谵语。）
太阳病，二三日不能卧，但欲起，心下必结，脉微弱者，此本有寒也，反下之，若利止，必作结胸。未止
者，四日复下之，此作协热利也。（“四日复下之”五字衍文也。）太阳病，下之脉浮者，必结胸也。
（论见大法。）太阳少阳并病，而反下之，成结胸，心下硬，下利不止，水浆不下，其人心烦。结胸症悉具，
烦躁者亦死。
问：疾病中有结胸和脏结，它们的症状表现是怎样的？
答：按压时疼痛，寸脉浮，关脉沉，这叫做结胸。
什么是脏结？
答：症状像结胸一样，但饮食如常，经常腹泻，寸脉浮，关脉脉象细小、沉而紧，这叫做脏结。舌苔白且滑润的，难以治愈。（王朝奉说：可以针刺关元穴。）
脏结没有阳证表现，不出现往来寒热，病人反而安静，舌苔滑润的，不可使用攻下法。（王朝奉说：可以针刺关元穴，服用小柴胡汤。）
如果病人胸中素有痞气，牵连到脐旁，并延伸入小腹及阴筋部位，这叫做脏结，属死证。
疾病发于阳经，却错误地使用了攻下法，导致热邪内陷从而形成结胸；疾病发于阴经，却错误地使用了攻下法，从而形成痞证。之所以形成结胸，是因为攻下太早的缘故。
伤寒病五六天，出现呕吐且发热的，这是小柴胡汤证具备的表现，但如果被其他医生误用攻下药治疗，若小柴胡汤证依然存在，再次给予小柴胡汤，虽然已经经过攻下，但不算逆证，病人一定会出现蒸蒸战栗，随后发热出汗而痊愈。
如果心下部胀满且硬痛，这就是结胸，由大陷胸汤主治。如果只是胀满而不疼痛，这就是痞证，小柴胡汤不适用，应给予半夏泻心汤。
太阳病，重发汗后又误用攻下法，导致五六天不大便，舌面干燥且口渴，下午申酉时分有潮热，从心下直到小腹，疼痛剧烈到不能触碰的，由大陷胸汤主治。
太阳病，脉象浮而动数，浮主风邪，数主热，动主痛，数主虚，头痛发热，微微盗汗，反而恶寒的，说明表证未解。医生反而误用攻下法，使动数之脉变为迟脉，膈内拒抗疼痛，胃中空虚，外邪扰动膈部，出现短气、烦躁，心中懊恼，阳气内陷，心下部因此变硬，这就形成结胸，由大陷胸汤主治。如果不形成结胸，仅头部出汗，身体其余部位无汗，汗止于颈部，小便不利，身体必然发黄。（朱丹溪说：此症称为胃中空虚，短气烦躁，脉浮，大陷胸汤不可轻易使用。）
伤寒六七天，出现结胸热实证，脉沉而紧，心下疼痛，按之坚实坚硬的，由大陷胸汤主治。（云岐子说：这三种情况下的结胸，都伴有日西时的潮热。）
大陷胸汤方：
大黄（一两半，去皮，研为末，以锦纹者为佳） 芒硝（一两八钱） 甘遂（一字量，赤色连珠者，研为细末）
以上药物用水二盏，先煮大黄至八分，去渣，加入芒硝煮沸一次，再加入甘遂末，温服，若得快利，停后服。
小结胸病，病位正在心下，按之则痛，脉浮滑的，适宜用小陷胸汤。
半夏（汤洗，二两） 黄连（一两） 栝蒌（一枚，取四分之一）
以上药物切碎，用水二盏，先煎栝蒌至一盏半，然后加入半夏、黄连煎取八分，去渣温服。若未愈可再服，轻微排出黄涎后即可安宁。
〔孙思邈〕工部郎中郑忠浓，因患伤寒，胸腹满闷，面色黄如金色，各位翰林医官商议不定，互相推让说：“胸满可用下法，但恐怕脉浮虚。”召请孙思邈诊治，孙思邈说：“各位虽然怀疑不敢用下药，这是郑某的福气，若用下法必死，我有一两种药，服用后必能痊愈。”于是给予小陷胸汤，不久即通利，病情随即良愈。第二天面色转为白色，京城人称佩服。
伤寒十余天，热邪结聚在里，又出现往来寒热的，给予大柴胡汤。
只有结胸而无大热表现的，这是水饮结聚在胸胁。只有头部微微出汗的，由大陷胸汤主治。（《活人书》说：水结胸，小半夏加茯苓汤，以及小柴胡汤去牡蛎也可主治。）
病在阳经，本应以汗法解表，却反用冷水喷洒或浇灌，导致热邪被遏制无法散去，更加烦闷，皮肤起粟粒状鸡皮疙瘩，想喝水，反而不觉得渴的，服用文蛤散。若不愈的，给予五苓散。
寒实结胸，无热证的，给予三物小陷胸汤，白散也可以。
桔梗（三分） 巴豆（一分，去皮尖，炒黑研如脂状） 贝母（三分）
以上三味研为末，纳入巴豆，再在臼中杵匀，用白米汤送服。体质强者服半钱匕，体弱者减量。病在膈上必然呕吐，病在膈下必然腹泻，若不利，进热粥一碗助药力；若利过不止，进冷粥一碗止利。若汗出后腹中痛，给予芍药一两。
上述为上热实结胸及寒实结胸的治疗。《活人书》不拘寒热，只用陷胸汤。若不愈，用枳实理中丸，应手而愈。
结胸，项部也强直，像柔痉的样子，攻下后则和解，宜用大陷胸丸。
大黄（二两） 葶苈子 芒硝 杏仁（去皮，炒，各三分）
以上将前二味捣罗成粉，纳入杏仁、芒硝合研如脂状，混合制成丸药，如弹子大小。后用甘遂末一字量，少许白蜜，水二盏半，煎至一盏，顿服。一宿后大便下行，若不下，再服。王海藏说：大陷胸汤是太阳经的本药；大陷胸丸是阳明经的药；小陷胸汤是少阳经的药。大陷胸汤治热实结胸，大陷胸丸兼治喘，小陷胸汤治痞。
心下部胀满疼痛，像结胸的样子，若伴有头项强痛、眩晕冒昧的，针刺大椎、肝俞穴。若在汗下之后出现头项强痛、发热、小便不利的，给予桂枝去桂加茯苓白术汤。（方论并见项强条。）
若妇女月经来潮，热退后出现谵语的，针刺期门穴。（论见谵语条。）
太阳病，二三天不能卧，只想起身，心下部必定有结滞，脉微弱的，这原本是有寒，却反用攻下法，若腹泻停止，必然形成结胸。若腹泻未止，第四日又攻下，这形成协热利。（“四日复下之”五字为衍文。）
太阳病，攻下后脉浮的，必然形成结胸。（论见大法条。）
太阳少阳并病，却反用攻下法，形成结胸，心下部硬，腹泻不止，水浆不入，病人心中烦躁。结胸症状全部具备，且烦躁的，亦属死证。
Question: In disease, there are Jie Xiong (Chest Binding) and Zang Jie (Organ Binding). What are their manifestations?
Answer: When pressed, there is pain; the Cun (Inch) pulse is floating, and the Guan (Carpal) pulse is sunken. This is called Jie Xiong (Chest Binding).
What is Zang Jie (Organ Binding)?
Answer: The condition resembles Jie Xiong (Chest Binding), but food intake remains normal, with frequent diarrhea. The Cun (Inch) pulse is floating, while the Guan (Carpal) pulse is fine, small, sunken, and tight. This is called Zang Jie (Organ Binding). If the tongue coating is white and slippery, it is difficult to treat. (Wang Chaofeng stated: One may needle the Guanyuan [CV-4] acupoint.)
Zang Jie (Organ Binding) lacks Yang syndrome manifestations, does not present with alternating chills and fever, and the patient appears unusually quiet. If the tongue coating is slippery, attack methods (purging) must not be used. (Wang Chaofeng stated: One may needle the Guanyuan [CV-4] acupoint and administer Xiao Chai Hu Tang [Minor Bupleurum Decoction].)
If a patient has chronic Pi (Glomus/Fullness) in the chest, extending to the side of the umbilicus, and drawing into the lower abdomen and Yin sinews, this is named Zang Jie (Organ Binding), which is a fatal condition.
When a disease originates from the Yang level, but is incorrectly treated with purging, heat enters internally and forms Jie Xiong (Chest Binding); when a disease originates from the Yin level, but is incorrectly treated with purging, it forms Pi (Glomus/Fullness). The reason Jie Xiong (Chest Binding) forms is due to premature purging.
In Shang Han (Cold Damage) for five or six days, if vomiting and fever occur, the symptoms of Chai Hu Tang (Bupleurum Decoction) are present. If other medications were used to purge, and the Chai Hu Tang (Bupleurum Decoction) symptoms remain, administering Chai Hu Tang (Bupleurum Decoction) again is appropriate. Although purging has been performed, this is not a counter-indication (Ni Zheng). The patient will inevitably experience shivering and trembling, followed by fever and sweating, leading to resolution.
If there is fullness and hard pain in the heart region, this is Jie Xiong (Chest Binding), primarily treated with Da Xian Xiong Tang [Major Sinking Chest Decoction]. If there is only fullness without pain, this is Pi (Glomus/Fullness); Chai Hu Tang (Bupleurum Decoction) is not indicated. Instead, Ban Xia Xie Xin Tang [Pinellia Decoction to Drain the Epigastrium] should be given.
In Tai Yang (Greater Yang) syndrome, after excessive sweating and subsequent incorrect purging, if there is no bowel movement for five or six days, dryness and thirst on the tongue, tidal fever in the late afternoon (Shen and You hours), and pain from the epigastrium down to the lower abdomen that is intolerable to touch, Da Xian Xiong Tang [Major Sinking Chest Decoction] is indicated.
In Tai Yang (Greater Yang) syndrome, if the pulse is floating, moving, and rapid: floating indicates wind, rapid indicates heat, moving indicates pain, and rapid indicates deficiency. With headache, fever, slight night sweats, and contrary aversion to cold, the exterior is unresolved. If the physician incorrectly purges, the moving/rapid pulse changes to slow. There is resistance and pain within the diaphragm, emptiness in the stomach, disturbance of pathogenic factors affecting the diaphragm, shortness of breath, irritability, and mental restlessness (Ao Nan). Yang Qi sinks internally, causing hardness in the epigastrium, resulting in Jie Xiong (Chest Binding), primarily treated with Da Xian Xiong Tang [Major Sinking Chest Decoction]. If Jie Xiong (Chest Binding) does not form, but there is sweating only on the head, with no sweat elsewhere up to the neck, and dysuria, jaundice will likely develop. (Zhu Danxi stated: This condition is described as empty stomach, shortness of breath, irritability, and floating pulse; Da Xian Xiong Tang [Major Sinking Chest Decoction] should not be used lightly.)
In Shang Han (Cold Damage) for six or seven days, if there is Jie Xiong (Chest Binding) with heat and excess, a sunken and tight pulse, pain in the epigastrium, and hardness upon pressure, Da Xian Xiong Tang [Major Sinking Chest Decoction] is indicated. (Yun Qizi stated: These three types of Jie Xiong (Chest Binding) all involve tidal fever in the evening.)
Da Xian Xiong Tang [Major Sinking Chest Decoction]:
Da Huang (Rhubarb Root and Rhizome, 1.5 liang, peeled, powdered; Jin Wen variety is best) Mang Xiao (Mirabilite, 1.8 qian) Gan Sui (Kansui Root, one character dose, red beaded variety, finely powdered)
Take two zhan of water, boil Da Huang (Rhubarb Root and Rhizome) until reduced to 0.8 zhan, remove dregs, add Mang Xiao (Mirabilite) and boil once, then add Gan Sui (Kansui Root) powder. Take warm. If loose stools occur rapidly, stop taking the remaining medicine.
For Xiao Jie Xiong Bing (Minor Chest Binding Disease), located precisely at the epigastrium, painful upon pressure, with a floating and slippery pulse, Xiao Xian Xiong Tang [Minor Sinking Chest Decoction] is suitable.
Ban Xia (Pinellia Tuber, washed in hot water, 2 liang) Huang Lian (Coptis Rhizome, 1 liang) Gua Lou (Trichosanthes Fruit, one fruit, using one-quarter)
Chop the ingredients. Take two zhan of water, first decoct Gua Lou (Trichosanthes Fruit) until reduced to 1.5 zhan, then add Ban Xia (Pinellia Tuber) and Huang Lian (Coptis Rhizome) to decoct until 0.8 zhan remains. Remove dregs and take warm. If not resolved, take again. Mild discharge of yellow phlegm/fluid indicates relief.
[Sun Simiao] Zheng Zhongnong, Official of the Ministry of Works, suffered from Shang Han (Cold Damage) with chest and abdominal fullness, and a face yellow like gold color. Various Hanlin physicians could not agree, deferring to each other, saying: "Chest fullness can be purged, but fear the pulse is floating and deficient." Sun Simiao was summoned and said: "Although you doubt and do not use purgatives, this is Zheng's fortune; purging would certainly cause death. I have one or two prescriptions; taking them will surely cure him." He administered Xiao Xian Xiong Tang [Minor Sinking Chest Decoction]. Soon there was purgation, and the illness greatly improved. The next day, his complexion turned white, and the people of the capital praised him.
In Shang Han (Cold Damage) for ten-plus days, if heat is bound internally, accompanied by alternating chills and fever, Da Chai Hu Tang [Major Bupleurum Decoction] is given.
If there is Jie Xiong (Chest Binding) without significant heat, this is water binding in the chest and hypochondrium. If there is only slight sweating on the head, Da Xian Xiong Tang [Major Sinking Chest Decoction] is indicated. (The *Huo Ren* book states: For water binding in the chest, Xiao Ban Xia Jia Fu Ling Tang [Minor Pinellia Decoction plus Poria] and Xiao Chai Hu Tang [Minor Bupleurum Decoction] minus Mu Li (Oyster Shell) are also indicated.)
When the disease is at the Yang level, it should be resolved by sweating. If incorrectly sprayed or poured with cold water, the heat is suppressed and cannot escape, increasing irritability, causing gooseflesh on the skin, desire to drink water but without actual thirst. Wen Ge San [Arca Shell Powder] is administered. If not cured, Wu Ling San [Five Ingredient Powder with Poria] is given.
For Han Shi Jie Xiong (Cold-Excess Chest Binding) without heat signs, San Wu Xiao Xian Xiong Tang [Three-Ingredient Minor Sinking Chest Decoction] or Bai San [White Powder] may be used.
Jie Geng (Platycodon Root, 3 fen) Ba Dou (Croton Seed, 1 fen, peeled and de-seeded, stir-fried black and ground to paste) Bei Mu (Fritillaria Bulb, 3 fen)
Grind the three ingredients to powder, mix in Ba Dou (Croton Seed), and pound further in a mortar. Mix with white rice water and administer. Strong individuals take half a qian bi; weak individuals reduce the dose. Disease above the diaphragm causes vomiting; disease below the diaphragm causes diarrhea. If no diarrhea occurs, consume one bowl of hot porridge to assist; if diarrhea persists excessively, consume one bowl of cold porridge to stop it. If sweating occurs followed by abdominal pain, give Shao Yao (Peony Root), 1 liang.
The above covers Shang Re Shi Jie Xiong (Upper Heat-Excess Chest Binding) and Han Shi Jie Xiong (Cold-Excess Chest Binding). The *Huo Ren* book does not distinguish between cold and heat, using only Xian Xiong Tang (Sinking Chest Decoctions). If not cured, use Zhi Shi Li Zhong Wan [Immature Bitter Orange Pill to Regulate the Middle]. It works immediately.
In Jie Xiong (Chest Binding), the neck is also stiff, resembling Rou Jing (Soft Spasm). Purging brings harmony; Da Xian Xiong Wan [Major Sinking Chest Pill] is suitable.
Da Huang (Rhubarb Root and Rhizome, 2 liang) Ting Li Zi (Descurainia Seed) Mang Xiao (Mirabilite) Xing Ren (Apricot Seed, peeled, stir-fried, 3 fen each)
Pound the first two ingredients into powder, mix in Xing Ren (Apricot Seed) and Mang Xiao (Mirabilite), grinding until pasty. Form into pills the size of a bullet. Use one character dose of Gan Sui (Kansui Root) powder, a little white honey, and 2.5 zhan of water. Decoct until 1 zhan remains. Take in one dose. Bowel movement occurs overnight. If not, take again. Wang Haizang stated: Da Xian Xiong Tang [Major Sinking Chest Decoction] is the primary formula for Tai Yang (Greater Yang); Da Xian Xiong Wan [Major Sinking Chest Pill] is for Yang Ming (Bright Yang); Xiao Xian Xiong Tang [Minor Sinking Chest Decoction] is for Shao Yang (Lesser Yang). Da Xian Xiong Tang [Major Sinking Chest Decoction] treats Heat-Excess Jie Xiong (Chest Binding); Da Xian Xiong Wan [Major Sinking Chest Pill] also treats wheezing; Xiao Xian Xiong Tang [Minor Sinking Chest Decoction] treats Pi (Glomus/Fullness).
Epigastric fullness and pain resembling Jie Xiong (Chest Binding), accompanied by stiff neck, headache, and vertigo: needle Da Zhui (GV-14) and Gan Shu (BL-18). After sweating and purging, if there is stiff neck/headache, fever, and dysuria: Gui Zhi Qu Gui Jia Fu Ling Bai Zhu Tang [Cinnamon Twig Decoction minus Cinnamon Twig plus Poria and Atractylodes Macrocephala Decoction] is indicated. (Formula discussion see Stiff Neck section.)
If a woman’s menstruation begins, heat subsides, and delirium occurs: needle Qi Men (LR-14). (Discussion see Delirium section.)
In Tai Yang (Greater Yang) syndrome, for two or three days, inability to lie down, desire only to rise, with epigastric binding and a faint pulse: this originally indicates internal cold. Incorrect purging, if diarrhea stops, will likely result in Jie Xiong (Chest Binding). If diarrhea does not stop, and purging is repeated on the fourth day, this results in Xie Re Li (Colluding Heat Diarrhea). ("Repeat purging on the fourth day" is a textual interpolation.)
In Tai Yang (Greater Yang) syndrome, if the pulse remains floating after purging, Jie Xiong (Chest Binding) will definitely form. (Discussion see General Principles section.)
In Tai Yang (Greater Yang) and Shao Yang (Lesser Yang) combined disease, incorrect purging leads to Jie Xiong (Chest Binding), with epigastric hardness, incessant diarrhea, inability to swallow fluids, and mental irritability. If all Jie Xiong (Chest Binding) symptoms are present and there is irritability, it is a fatal condition.