大黄（去皮）六两 芒硝一升 甘遂（另碾）一钱
右三味，以水六升，先煮大黄，取二升，去滓，内芒硝，煮一两沸，内甘遂末，温服
一升，得快利，止后服。
【集解】
方有执曰：上焦有高邪，必陷下以平之，故曰陷胸汤。平邪荡寇，将军之职也，以大
黄为君；咸能软坚，以芒硝为臣；彻上彻下，破结逐水，以甘遂为佐；惟大实者，乃
为合法。如挟虚或脉浮，不可轻试。
太阳病，重发汗而复下之，不大便五六日，舌上燥而渴，日晡所小有潮热，从心下至
少腹□满而痛，不可近者，大陷胸汤主之。
【注】
此承上条互发其义，以详其证治也。太阳病，重发汗而复下之，津液伤矣。不大便五
六日，胃府燥矣。舌上燥渴，胃中干也。日晡潮热，胃热盛也。从心下至少腹，□满
而痛不可近者，谓胸腹之中上、下俱□满结实大痛，手不可近，故以大陷胸汤主之无
疑也。
【集注】
『内台方议』曰：「日晡所」作「日晡所发」。
方有执曰：此明结胸有阳明内实疑似之辨。晡，日加申时也。小有，微觉有也。盖不
大便，燥渴，日晡潮热，从心下至少腹□满而痛，皆似阳明内热。惟小有潮热，不似
阳明大热之甚。所以阳明必以胃家实为主，而凡有一毫太阳证在，皆不得入阳明例者
，亦以此也。
程知曰：太阳结胸兼阳明内实，故用大陷胸汤，由胸□以及肠胃，皆可荡涤无余。若
但下肠胃结热，而遗胸上痰饮，则非法矣。
吴人驹曰：一腹之中，上、下邪气皆盛，证之全实者，其脉常沉伏，不可生疑畏，惟
下之，而脉自渐出也。
小结胸，病正在心下，按之则痛，脉浮滑者，小陷胸汤主之。
【注】
大结胸，邪重热深，病从心下至少腹，□满痛不可近，脉沉实，故宜大陷胸汤，以攻
其结，泻其热也。小结胸，邪浅热轻，病正在心下□满，按之则痛，不按不痛，脉浮
滑，故用小陷胸汤以开其结，涤其热也。
【集注】
程应旄曰：按陷胸条曰：心下痛按之石□。又曰：心下满而□痛。此曰：病正在心下
。则知结胸不拘在心下与胸上，只在痛不痛上分别，故痞证亦有心下□者，但不痛耳
。
张锡驹曰：汤有大小之别，证有轻重之殊。今人多以小陷胸汤治大结胸证，皆致不救
，遂诿结胸为不可治之证。不知结胸之不可治。只一二节，余皆可治者，苟不体认经
旨，必致临时推诿，误人性命也。
魏荔彤曰：小结胸无实热之邪，但微热而挟痰饮为患。故虽结胸而不能高踞胸巅，但
正在心下而已；不能实力作痛，惟按之痛而已；诊之不沉而深，惟浮而轻浅而已；不
能作石□，惟虚而结阻而已，所以大陷胸汤不应用，而另设小陷胸汤，高下、坚软、
轻重、沉浮之间，病机治法昭然已。又云：痞阴邪，结胸阳邪，然于阳邪中又有大小
之分，学者审之，于凡寒热杂合之证，无大实大热。俱宜斟酌下法，勿孟浪也。
大黄（去皮）六两，芒硝一升，甘遂（单独研碎）一钱。
以上三味药，用水六升，先煮大黄，取药液二升，滤去药渣，加入芒硝，煮沸一两滚，再加入甘遂末，温服一升，若得迅速通利，则停止后续服用。
【集解】
方有执说：上焦有高位的邪气，必须用下法来平抑它，所以叫作陷胸汤。平定邪气、扫荡寇贼，是将军的职责，所以以大黄为君药；咸味能软化坚硬，所以以芒硝为臣药；贯通上下，破除结聚、驱逐水饮，以甘遂为佐药；只有大实证的病人，才适合使用此方。如果夹杂虚证或者脉象浮，不可轻易尝试。
太阳病，经过重度发汗后又误用攻下法，导致五六天不大便，舌面干燥且口渴，傍晚时分略有潮热，从心窝部直到小腹部胀满疼痛，甚至不能触碰，以大陷胸汤主治。
【注】
这是承接上一条条文进一步阐发其含义，详细论述其证候与治疗。太阳病，经过重度发汗后又误用攻下法，津液已经受损。五六天不大便，说明胃腑燥结。舌面干燥口渴，说明胃中津液干枯。傍晚出现潮热，说明胃热炽盛。从心窝部直到小腹部，胀满疼痛且不能触碰，是指胸腹之中上下都胀满结实且剧烈疼痛，手不能靠近，所以毫无疑问应使用大陷胸汤主治。
【集注】
《内台方议》说：“日晡所”写作“日晡所发”。
方有执说：这是阐明结胸证与阳明内实证疑似情况的鉴别。晡时，是申时之后。小有，是微微觉得有。大概不大便、燥渴、傍晚潮热、从心窝部直到小腹部胀满疼痛，这些都类似阳明内热。只是潮热轻微，不像阳明大热那么严重。所以阳明病必须以胃家实为主，而凡是有一丝太阳表证存在的，都不能归入阳明病的范畴，也是因为这个原因。
程知说：太阳结胸兼有阳明内实，所以使用大陷胸汤，由胸部一直到肠胃，都可以荡涤干净。如果只是攻下肠胃的结热，而遗漏了胸上的痰饮，那就不是合法的治疗了。
吴人驹说：在一副腹中，上下的邪气都很盛，如果是全实证的病人，其脉象常常沉伏，不要产生怀疑和畏惧，只要攻下它，脉象自然会逐渐显现出来。
小结胸病，病位正在心窝部，按压时才疼痛，脉象浮滑的，用小陷胸汤主治。
【注】
大结胸，邪气重、热势深，病位从心窝部直到小腹部，胀满疼痛不能触碰，脉象沉实，所以适宜用大陷胸汤，以攻破结聚，泻除热邪。小结胸，邪气浅、热势轻，病位正在心窝部胀满，按压才痛，不按不痛，脉象浮滑，所以使用小陷胸汤以开通结聚，涤除热邪。
【集注】
程应旄说：在论述陷胸的条文中说：“心下痛，按之像石头一样硬。”又说：“心下胀满且疼痛。”这里说：“病位正在心窝部。”由此可知，结胸不拘泥于在心下还是胸上，只在是否疼痛上加以区分，所以痞证也有心下胀满的，只是不疼痛罢了。
张锡驹说：汤剂有大小之分，证候有轻重之别。现在的人常用小陷胸汤治疗大结胸证，都导致无法挽救，于是推诿结胸为不可治之证。不知道结胸不可治的只有一两个阶段，其余都是可以治疗的，如果不体认经典旨意，必然导致临时推卸责任，误人性命。
魏荔彤说：小结胸没有实热邪气，只是微热并夹杂痰饮为患。所以虽然是结胸，但不能高踞于胸巅，只是正在心窝部而已；不能实力作痛，只是按压才痛而已；诊察时脉象不沉而深，只是浮而轻浅而已；不能像石头一样硬，只是虚而结阻而已，所以不应该用大陷胸汤，而另外设立小陷胸汤，高下、坚软、轻重、沉浮之间，病机和治疗法则已经非常清楚了。又有人说：痞证属阴邪，结胸属阳邪，然而在阳邪中又有大小之分，学者们要仔细审察，对于凡是寒热混杂的证候，如果没有大实大热，都应当斟酌使用下法，切勿鲁莽从事。
Da Huang (Rheum Palmatum Rhizome, peeled) 6 liang, Mang Xiao (Natrii Sulfas, Mirabilite) 1 sheng, Gan Sui (Kansui Radix, crushed separately) 1 qian.
The above three ingredients: Use 6 sheng of water, first decoct Da Huang, reduce to 2 sheng, remove the dregs, add Mang Xiao, boil for one or two rolls, then add the powder of Gan Sui. Take 1 sheng warm. If rapid purgation occurs, stop taking the remaining medicine.
[Ji Jie - Collected Explanations]
Fang Youzhi stated: When there is high-pathogenic factors in the Upper Jiao (Upper Burner), they must be flattened by descending methods; hence it is named Xian Xiong Tang (Chest-Subduing Decoction). To pacify pathogens and sweep away bandits is the duty of a General; therefore, Da Huang is used as the Sovereign herb. Salty flavor can soften hardness, so Mang Xiao is used as the Minister herb. Penetrating from top to bottom, breaking accumulations and driving out water retention, Gan Sui is used as the Assistant herb. This formula is only appropriate for cases of great excess. If deficiency is involved or the pulse is floating, it should not be tried lightly.
In Taiyang disease (Disease of the Taiyang Channel), after severe sweating followed by mistaken purgation, if there is no bowel movement for five or six days, with a dry tongue and thirst, slight tidal fever in the late afternoon, and distension and pain from the epigastrium down to the lower abdomen that cannot be touched, Da Xian Xiong Tang (Major Chest-Subduing Decoction) is indicated.
[Zhu - Annotation]
This follows the previous clause to further expound its meaning, detailing the syndrome and treatment. In Taiyang disease, severe sweating followed by purgation injures the body fluids. No bowel movement for five or six days indicates dryness in the Stomach Fu (Stomach Organ). Dry tongue and thirst indicate dryness in the Stomach. Tidal fever in the late afternoon indicates abundant Stomach heat. Distension and pain from the epigastrium to the lower abdomen that cannot be touched means that both upper and lower parts of the chest and abdomen are distended, firm, and severely painful, such that the hand cannot approach. Therefore, there is no doubt that Da Xian Xiong Tang should be used.
[Ji Zhu - Collected Notes]
Nei Tai Fang Yi states: "Ri Bu Suo" is written as "Ri Bu Suo Fa".
Fang Youzhi stated: This clarifies the differentiation between Jie Xiong (Knotted Chest) and suspected Yangming Internal Excess. "Bu" refers to the time after Shen hour (3-5 PM). "Xiao you" means slightly feeling the presence of. Generally, constipation, dryness and thirst, tidal fever in the late afternoon, and distension and pain from the epigastrium to the lower abdomen all resemble Yangming internal heat. However, the tidal fever is slight, unlike the severe heat of Yangming. Therefore, Yangming disease must be centered on "Wei Jia Shi" (Stomach Family Excess); any case retaining even a trace of Taiyang syndrome cannot be categorized as Yangming, which is precisely why this distinction is made.
Cheng Zhi stated: Taiyang Jie Xiong combined with Yangming internal excess necessitates the use of Da Xian Xiong Tang, which can cleanse everything from the chest down to the intestines and stomach. If one only purges intestinal heat but leaves phlegm-fluids in the upper chest, it is not the correct method.
Wu Renju stated: Within the abdomen, pathogenic factors are abundant in both upper and lower regions. In cases of complete excess, the pulse is often deep and hidden. One should not hesitate or fear; simply purge, and the pulse will gradually emerge.
Xiao Jie Xiong (Minor Knotted Chest) syndrome occurs precisely at the epigastrium; it hurts only upon pressure, and the pulse is floating and slippery. Xiao Xian Xiong Tang (Minor Chest-Subduing Decoction) is indicated.
[Zhu - Annotation]
Da Jie Xiong (Major Knotted Chest) involves heavy pathogens and deep heat, with symptoms extending from the epigastrium to the lower abdomen, characterized by distension and pain that cannot be touched, and a deep, solid pulse. Therefore, Da Xian Xiong Tang is suitable to attack the accumulation and drain the heat. Xiao Jie Xiong involves shallow pathogens and mild heat, with symptoms located precisely at the epigastrium causing distension, hurting only upon pressure and not otherwise, and a floating, slippery pulse. Therefore, Xiao Xian Xiong Tang is used to open the accumulation and wash away the heat.
[Ji Zhu - Collected Notes]
Cheng Yingmao stated: In the clauses regarding Xian Xiong, it says: "Pain in the epigastrium, hard like stone upon pressure." It also says: "Distension in the epigastrium and pain." Here it says: "The disease is precisely at the epigastrium." From this, we know that Jie Xiong is not restricted to the epigastrium or the upper chest; the distinction lies solely in the presence of pain. Thus, Pi Zheng (Pi Syndrome/Fullness) also has epigastric distension, but without pain.
Zhang Xiju stated: Decoctions have distinctions of large and small; syndromes have differences in severity. Nowadays, many people use Xiao Xian Xiong Tang to treat Da Jie Xiong syndromes, leading to untreatable conditions, and thus dismissing Jie Xiong as incurable. They do not realize that only one or two stages of Jie Xiong are incurable; the rest are treatable. If one does not comprehend the essence of the classics, it will inevitably lead to shifting blame at the critical moment, costing lives.
Wei Litong stated: Xiao Jie Xiong lacks substantial heat pathogens; it is merely mild heat complicated by phlegm-fluids. Therefore, although it is Jie Xiong, it cannot occupy the peak of the chest, but is located precisely at the epigastrium; it cannot cause severe pain, but only hurts upon pressure; the pulse upon diagnosis is not deep but floating and superficial; it cannot feel hard like stone, but is soft and obstructed. Hence, Da Xian Xiong Tang is not applicable, and Xiao Xian Xiong Tang is separately established. Between high and low, hard and soft, light and heavy, deep and superficial, the pathology and treatment methods are clear. Furthermore, Pi syndrome is caused by Yin pathogens, while Jie Xiong is caused by Yang pathogens. However, among Yang pathogens, there are still distinctions of large and small. Scholars must examine this carefully. For all syndromes mixed with cold and heat, lacking major excess and major heat, the purgative method should be considered cautiously, avoiding rash actions.