结胸之证，有内伤外感之殊。内伤结胸，大抵系寒饮凝于贲门之间，遏抑胃气不能上达，阻隔饮食不
能下降。当用干姜八钱，赭石两半，川朴、甘草各三钱开之。其在幼童，脾胃阳虚，寒饮填胸，呕吐饮食成
慢惊，此亦皆寒饮结胸证。可治以庄在田《福幼编》逐寒荡惊汤。若用其方寒痰仍不开，呕吐仍不能止者，可
将方中胡椒倍用二钱。若非寒饮结胸，或为顽痰结胸，或为热痰
结胸者，阻塞胸中之气化不能升降，甚或有碍呼吸，危在目前，欲救其急，可用硼砂四钱开水融化服之，
将其痰吐出。其为顽痰者，可再用栝蒌仁二两，苦葶苈三钱（袋装）煎汤饮之，以涤荡其痰。其为热痰者，
可于方中加芒硝四钱。有胸中大气下陷，兼寒饮结胸者，其证尤为难治。（曾治一赵姓媪，案详回阳升陷
汤后，可参阅）。
至于外感结胸，伤寒与温病皆有。伤寒降早可成结胸，温病即非降早亦可成结胸，皆外感之邪内陷与
胸中痰饮互相胶漆也。无论伤寒、温病，其治法皆可从同。若《伤寒论》大陷胸汤及大陷胸丸，俱为治
外感结胸良方，宜斟酌病之轻重浅深，分别用之。至拙拟之荡胸汤，亦可斟酌加减，以代诸陷胸汤、丸。
有内伤结胸与外感结胸相并而成一至险之结胸证者。在奉天时曾治郝××，年四十余，心下痞闷杜塞，
饮食不能下行，延医治不效。继入东人医院，治一星期，仍然无效。浸至不能起床，吐痰腥臭，精神昏愦。
再延医诊视，以为肺病已成，又兼胃病，不能治疗。其家人惶恐无措，迎愚延医。其脉左右皆弦，右部则
弦而有力，其舌苔白浓微黄，抚其肌肤发热，问其心中亦觉热，思食凉物，大便不行者已四五日，自言心中满
闷异常，食物已数日不进，吐痰不惟腥臭，且又觉凉。愚筹思再四，知系温病结胸。然其脉不为洪而有力，而
为弦而有力，且所吐之痰臭而且凉者何也？盖因其人素有寒饮，其平素之脉必弦，其平素吐痰亦必
凉（平素忽不自觉，今因病温咽喉发热觉痰凉耳），因有温病之热与之混合，所以脉虽弦而
仍然有力，其痰虽凉，而为温病之热熏蒸，遂至腥臭也。为疏方用蒌仁、生赭石细末各一两，玄参、知母
各八钱，苏子、半夏、党参、生姜各四钱，煎汤冲服西药留苦四钱。一剂胸次豁然，可进饮食，右脉较前柔
和，舌苔变白，心中犹觉发热，吐痰不臭，仍然觉凉。遂将原方前四味皆减半，加当归三钱，服后大便通
下，心中益觉通豁。惟有时觉有凉痰自下发动，逆行上冲，周身
即出汗。遂改用赭石、党参、干姜各四钱，半夏、白芍各三钱。川朴、五味、甘草各二钱，细辛一钱，连服
数剂，寒痰亦消矣。此证原寒饮结胸与温病结胸相并而成，而初次方中但注重温病结胸，惟生姜一味为治寒
饮结胸之药。因此二病之因，一凉一热，原难并治。若将方中之生姜改为干姜，则温病之热必不退。至若
生姜之性虽热，而与凉药并用实又能散热。迨至温病热退，然后重用干姜以开其寒饮。此权其病势之缓急先
后分治，而仍用意周匝，不至顾此失彼，是以能循序奏效也。
结胸这一病证，有内伤和外感的不同。内伤引起的结胸，大抵是由于寒饮凝结在贲门之间，遏制胃气不能向上通达，阻隔饮食不能向下通行。应当使用干姜八钱、代赭石一两半、厚朴和三钱甘草各三钱来开散结滞。对于幼童，如果是脾胃阳气虚弱，寒饮充满胸部，呕吐饮食导致慢惊风，这也都属于寒饮结胸的证候。可以用庄在田《福幼编》中的逐寒荡惊汤治疗。如果使用这个方剂后寒痰仍然不消散，呕吐仍然不能停止，可以将方中的胡椒加倍用到二钱。如果不是寒饮结胸，而是顽痰结胸或热痰结胸，阻塞了胸中的气化功能，使其不能升降，甚至影响呼吸，情况危急，想要急救，可以使用硼砂四钱开水化开后服用，将痰吐出。如果是顽痰，可以再使用瓜蒌仁二两、苦葶苈三钱（袋装）煎汤饮用，以涤荡清除痰浊。如果是热痰，可以在方中加入芒硝四钱。如果有胸中大气下陷，兼有寒饮结胸的情况，这种证候尤其难治。（曾经治疗过一位赵姓老妇人，医案详细记载在回阳升陷汤之后，可以参考）。
至于外感引起的结胸，伤寒和温病都会出现。伤寒如果过早使用攻下法可以形成结胸，温病即使没有过早攻下也可以形成结胸，这都是因为外感的邪气内陷，与胸中的痰饮互相胶结所致。无论是伤寒还是温病，其治疗方法都可以相同。像《伤寒论》中的大陷胸汤和大陷胸丸，都是治疗外感结胸的良好方剂，应当斟酌病情的轻重深浅，分别使用。至于我拟定的荡胸汤，也可以斟酌加减，用来替代各种陷胸汤、丸。
还有内伤结胸与外感结胸同时存在，从而形成一种极其危险的结胸证候。在奉天时期，我曾经治疗过郝某某，四十多岁，心下部痞闷堵塞，饮食不能下行，请医生治疗无效。后来进入日本人开的医院，治疗了一星期，仍然无效。逐渐发展到不能起床，吐出的痰腥臭，精神昏沉糊涂。再次请医生诊视，认为肺病已成，又兼胃病，无法治疗。家属惶恐无措，迎接我去诊治。他的脉象左右都弦，右部则弦而有力，舌苔白厚微黄，触摸肌肤发热，询问他心中也觉得热，想吃凉的东西，大便已经四五日未行，自述心中满闷异常，食物已经几天没吃，吐出的痰不仅腥臭，而且感觉发凉。我反复思考，知道这是温病结胸。但是他的脉象不是洪大而有力，而是弦而有力，且吐出的痰既臭又凉，这是为什么呢？大概是因为这个人素来有寒饮，他平时的脉象必定是弦的，平时吐的痰也必定是凉的（平时自己没察觉，现在因为患温病咽喉发热，反而觉得痰凉），因为有温病的火热之邪与之混合，所以脉象虽然弦但仍然有力，痰虽然凉，但因为被温病的火热熏蒸，所以变得腥臭。于是开具处方：用瓜蒌仁、生代赭石细末各一两，玄参、知母各八钱，苏子、半夏、党参、生姜各四钱，煎汤冲服西药鲁米那四钱。服用一剂后，胸中豁然开朗，可以进食，右脉比以前柔和，舌苔变白，心中仍然觉得发热，吐出的痰不再臭，仍然感觉凉。于是将原方前四味药各减半，加入当归三钱，服用后大便通畅，心中更加觉得通畅开阔。只是偶尔觉得有凉痰从下面发动，逆行上冲，周身随即出汗。于是改用代赭石、党参、干姜各四钱，半夏、白芍各三钱，厚朴、五味子、甘草各二钱，细辛一钱，连续服用数剂，寒痰也就消除了。这个证候原本是寒饮结胸与温病结胸相结合而成，初次处方只注重治疗温病结胸，只有生姜一味药是治疗寒饮结胸的。因为这两种病的病因，一凉一热，原本很难同时治疗。如果把方中的生姜改为干姜，那么温病的火热必然不退。至于生姜的性质虽然热，但与凉药并用实际上又能帮助散热。等到温病的火热退去之后，再重用干姜来开散寒饮。这是权衡病势的缓急先后进行分步治疗，并且用意周全，不至于顾此失彼，所以能够循序渐进地取得疗效。
The syndrome of Jie Xiong (Chest Binding) differs in etiology between internal injury and external contraction. Internal Jie Xiong is generally caused by cold-fluid retention coagulating between the cardia, obstructing the Stomach Qi from ascending and preventing food and drink from descending. Treatment should employ Gan Jiang (Dried Ginger, 8 qian), Zhe Shi (Hematite, 1.5 liang), Hou Po (Magnolia Bark, 3 qian), and Gan Cao (Licorice Root, 3 qian) to open the obstruction. In children, if Spleen and Stomach Yang deficiency leads to cold-fluid filling the chest, causing vomiting of food and drink resulting in Man Jing Feng (Slow Convulsion), this also belongs to the category of cold-fluid Jie Xiong. It can be treated with Zhu Han Dang Jing Tang (Cold-Expelling Shock-Shaking Decoction) from Zhu Zaitian's *Fu You Bian*. If cold-phlegm remains unresolved and vomiting persists after using this formula, the amount of Hu Jiao (Black Pepper) in the formula can be doubled to 2 qian. If it is not cold-fluid Jie Xiong, but rather stubborn phlegm or heat-phlegm Jie Xiong, blocking the Qi transformation in the chest so that it cannot ascend or descend, potentially affecting respiration and posing an immediate danger, emergency rescue can be achieved by taking Peng Sha (Borax, 4 qian) dissolved in boiling water to induce expectoration. For stubborn phlegm, Gua Lou Ren (Trichosanthes Seed, 2 liang) and Ku Ting Li (Descurainia Seed, 3 qian, bagged) can be decocted and drunk to purge the phlegm. For heat-phlegm, Mang Xiao (Mirabilite, 4 qian) can be added to the formula. Cases involving sinking of the Great Qi in the chest combined with cold-fluid Jie Xiong are particularly difficult to treat. (A case of an elderly surnamed Zhao was treated; see the section on Hui Yang Sheng Xian Tang for details).
Regarding external Jie Xiong, it occurs in both Shang Han (Cold Damage) and Wen Bing (Warm Diseases). In Shang Han, premature use of purgatives can lead to Jie Xiong; in Wen Bing, Jie Xiong can occur even without premature purging. Both result from external pathogenic factors sinking inward and adhering with phlegm-fluid in the chest. Regardless of whether it is Shang Han or Wen Bing, the treatment principles can be similar. Da Xian Xiong Tang (Major Inward-Draining Chest Decoction) and Da Xian Xiong Wan (Major Inward-Draining Chest Pill) from *Shang Han Lun* are excellent formulas for treating external Jie Xiong; they should be selected based on the severity and depth of the disease. My own proposed Dang Xiong Tang (Chest-Purging Decoction) can also be modified to substitute for various Xian Xiong formulas and pills.
There are cases where internal and external Jie Xiong combine to form a highly dangerous syndrome. In Fengtian, I once treated Mr. Hao, aged over forty, who suffered from epigastric fullness and blockage, inability to swallow food, and failed treatments by other physicians. After one week of treatment at a Japanese hospital, there was still no improvement. He eventually became bedridden, expectorating foul-smelling sputum, and experienced mental confusion. Subsequent physicians diagnosed advanced lung disease complicated by stomach disease, deeming it untreatable. His family, in panic, invited me. His pulse was wiry on both sides, stronger on the right. The tongue coating was thick white with slight yellow. His skin felt hot to touch, and he reported feeling heat in the heart/chest area, craving cool foods, and having had no bowel movement for four to five days. He described extreme chest fullness and had not eaten for several days. Although his sputum was foul-smelling, he perceived it as cold. After careful consideration, I determined this was Wen Bing Jie Xiong. However, why was the pulse wiry yet forceful rather than surging, and why was the sputum both foul and cold? This was due to his pre-existing cold-fluid retention; his baseline pulse is typically wiry, and his usual sputum is cold (he did not notice this previously, but now perceives the sputum as cold because the throat feels hot from the warm disease). The heat of the Wen Bing mixed with his cold-fluid condition. Thus, although the pulse was wiry, it remained forceful due to the heat; although the sputum was cold, it became foul-smelling due to steaming by the Wen Bing heat. I prescribed: Gua Lou Ren (Trichosanthes Seed) and raw Zhe Shi (Hematite powder), each 1 liang; Xuan Shen (Scrophularia Root) and Zhi Mu (Anemarrhena Rhizome), each 8 qian; Su Zi (Perilla Fruit), Ban Xia (Pinellia Tuber), Dang Shen (Codonopsis Root), and Sheng Jiang (Fresh Ginger), each 4 qian. These were decocted, and the liquid was used to take Lu Mi Na (Phenobarbital, 4 qian). After one dose, the chest felt clear, allowing him to eat. The right pulse became softer, the tongue coating turned white, but he still felt heat in the chest, though the sputum was no longer foul and still felt cold. I then halved the first four herbs of the original formula and added Dang Gui (Angelica Sinensis Root, 3 qian). After ingestion, his bowels moved, and he felt even more relieved internally. Occasionally, he felt cold phlegm rising from below, counter-flowing upward, accompanied by sweating all over the body. I then changed the prescription to Zhe Shi (Hematite), Dang Shen (Codonopsis Root), and Gan Jiang (Dried Ginger), each 4 qian; Ban Xia (Pinellia Tuber) and Bai Shao (White Peony Root), each 3 qian; Hou Po (Magnolia Bark), Wu Wei Zi (Schisandra Berry), and Gan Cao (Licorice Root), each 2 qian; and Xi Xin (Asarum Root), 1 qian. After several doses, the cold phlegm dissipated. This case originally involved a combination of cold-fluid Jie Xiong and Wen Bing Jie Xiong. The initial prescription focused mainly on the Wen Bing Jie Xiong, with only Sheng Jiang (Fresh Ginger) addressing the cold-fluid Jie Xiong. Since the etiologies were one cold and one heat, simultaneous treatment was difficult. If Sheng Jiang had been replaced with Gan Jiang (Dried Ginger), the heat of the Wen Bing would not have subsided. Although Sheng Jiang is hot-natured, when used with cooling herbs, it actually helps dissipate heat. Once the Wen Bing heat receded, heavy use of Gan Jiang could then be employed to resolve the cold-fluid. This approach weighed the urgency and sequence of the pathological trends, treating them sequentially while maintaining comprehensive intent, avoiding neglecting either aspect, thus achieving gradual efficacy.