结胸痞气。二者皆曰下早而成。但有轻重之分。实无阴阳之别。仲景以大
小陷胸及泻心汤主之。余不能不致疑其间也。夫既曰下之早。则邪或在
表。或在上皆未可遽下者也。未可下而下之。则邪气反结于胸中。有痛有
不痛。或痞满而不快也。试思所下之药。必大黄芒硝峻厉等味。苟失其宜。
则外邪内陷而不复出。中气下陷而不复运。故为结为痞。岂有误下乃结。
因结复下之理乎。然则仲景大小陷胸等汤。何为而设也。仲景云。大结胸。
手不可按。用大黄芒硝入甘遂末。名大陷胸汤。乃荡涤之剂。恐为失下者
立。小结胸。用黄连半夏加栝蒌实。名小陷胸汤。乃痰热为患。又岂曰下早
所致乎。水结胸。半夏茯苓汤入姜汁。乃水停心下也。心下痞。腹鸣下利。半
夏泻心汤。人参半夏干姜甘草大枣。因中气伤也。同黄连黄芩。或热犹未
解乎。若然则结胸何法以治之。曰邪气尚实仍与内消。中气伤残。只应温
补。理中汤加枳实主之。或藿香半夏甘草人参加炒枳实。随症施之可耳。
断无复下陷胸之法也。
大陷胸汤
大黄（四钱） 芒硝（三钱） 甘遂末（二分）
水煎入甘遂末调服。
小陷胸汤
黄连（一钱五分） 半夏（三钱） 栝蒌实（二钱）
水煎服。
半夏茯苓汤
半夏（四钱） 白茯苓（二钱五分）
水煎。入姜汁服。
半夏泻心汤
人参 半夏 干姜 甘草 黄芩（各一钱） 黄连（五分）
加姜五片。枣五枚。水煎服。
枳实理中汤
枳实（麸炒） 干姜 人参 白术 茯苓 甘草（各等分）
水煎服。或为末。蜜丸弹子大。热汤化下。连进二三服。
浓朴半夏甘草人参汤
浓朴 半夏（各一钱） 甘草 人参（各五分）
姜五片水煎。
结胸证与痞气证，这两种病证都是因为过早使用泻下法而形成的。它们之间只有病情轻重的区别，并没有阴证与阳证的本质差异。张仲景主张用大陷胸汤、小陷胸汤以及泻心汤来治疗这些病症，但我对此不能不表示怀疑。
既然说是因为“下之早”（过早攻下），那么邪气或许还在体表，或者停留在上部，这些都是不可以立即使用泻下法的。在不可泻下的情况下误用了泻下法，邪气反而结聚在胸中，表现为有的疼痛，有的不疼痛，或者是心下痞塞满闷而不舒畅。
试想一下，所使用的泻下药，必定是大黄、芒硝等峻猛激烈的药物。如果用药不当，就会导致外邪内陷而不能复出，中气下陷而不能恢复运化功能，从而形成结胸或痞证。难道会有因为误下导致邪气结聚，然后又针对这种结聚再次使用泻下法的道理吗？
既然如此，那么张仲景设立的大、小陷胸汤等方剂，是为什么呢？张仲景说：大结胸证，手不能触碰按压，使用大黄、芒硝配合甘遂末，名为大陷胸汤，这是荡涤实邪的方剂，恐怕是为那些该用泻下法却未用（失下）的患者设立的。小结胸证，使用黄连、半夏加上栝蒌实，名为小陷胸汤，这是痰热为患的病症，又哪里是因为过早攻下所导致的呢？
水结胸证，使用半夏茯苓汤加入姜汁，这是水饮停聚在心下的缘故。心下痞证，伴有肠鸣和下利，使用半夏泻心汤，由人参、半夏、干姜、甘草、大枣组成，这是因为中气受损的缘故。如果再同用黄连、黄芩，难道是热邪还没有解除吗？
如果是这样的话，那么结胸证究竟用什么方法治疗呢？回答说：如果邪气仍然强盛，仍应给予内部消散的方法；如果中气已经伤残，只应当使用温补法。理中汤加枳实主治。或者使用藿香、半夏、甘草、人参，加入炒枳实，根据症状灵活施治即可。绝对没有再次使用泻下法来治疗结胸的道理。
大陷胸汤
大黄（四钱） 芒硝（三钱） 甘遂末（二分）
用水煎煮，调入甘遂末服用。
小陷胸汤
黄连（一钱五分） 半夏（三钱） 栝蒌实（二钱）
用水煎煮后服用。
半夏茯苓汤
半夏（四钱） 白茯苓（二钱五分）
用水煎煮，加入姜汁服用。
半夏泻心汤
人参 半夏 干姜 甘草 黄芩（各一钱） 黄连（五分）
加入生姜五片，大枣五枚，用水煎煮后服用。
枳实理中汤
枳实（麸炒） 干姜 人参 白术 茯苓 甘草（各等分）
用水煎煮后服用。或者制成粉末，炼蜜为丸，如弹子大小，用热水化开服用，连续服用二三服。
Jie Xiong (Chest Binding Syndrome) and Pi Qi (Stagnant Qi Syndrome) are both conditions resulting from premature purgation. There is a distinction in severity, but no fundamental difference between Yin and Yang syndromes. Zhang Zhongjing advocated the use of Da Xian Xiong Tang (Major Chest-Binding Decoction), Xiao Xian Xiong Tang (Minor Chest-Binding Decoction), and Xie Xin Tang (Drain the Epigastrium Decoction) to treat these conditions; however, I cannot help but harbor doubts regarding this approach.
Since it is stated that these conditions arise from "premature purgation," the pathogenic factor may still be at the exterior or located in the upper jiao. In such cases, purgation should not be applied hastily. If purgation is used when it is contraindicated, the pathogenic factor instead becomes bound in the chest region, manifesting as pain in some cases and non-pain in others, or as epigastric fullness and stuffiness with discomfort.
Consider that the purgative herbs used must be harsh and potent substances such as Dahuang (Rhei Radix et Rhizoma) and Mangxiao (Natrii Sulfas). If their application is inappropriate, external pathogens will sink inward and fail to emerge again, while the Middle Qi will collapse downward and fail to restore its transformative functions. Consequently, Jie Xiong or Pi syndromes are formed. How could there be a rationale where erroneous purgation leads to binding, followed by further purgation to address that binding?
Then, for what purpose were Zhang Zhongjing's Da Xian Xiong Tang and Xiao Xian Xiong Tang established? Zhang Zhongjing stated: For Da Jie Xiong (Major Chest Binding), where the area is so tender that it cannot be touched or pressed, one uses Dahuang, Mangxiao, and Gansui powder, named Da Xian Xiong Tang. This is a drastic cleansing formula, likely established for patients who required purgation but did not receive it (missed opportunity for purgation). For Xiao Jie Xiong (Minor Chest Binding), one uses Huanglian (Coptidis Rhizoma), Banxia (Pinelliae Tuber), plus Gualou Shi (Trichosanthis Fructus), named Xiao Xian Xiong Tang. This addresses pathology caused by Phlegm-Heat; how could this be attributed to premature purgation?
For Shui Jie Xiong (Water Binding in the Chest), one uses Banxia Fuling Tang (Pinellia and Poria Decoction) with Jiangzhi (Ginger Juice); this results from water retention under the heart. For Xià Xīn Pǐ (Epigastric Stagnation), accompanied by abdominal borborygmus and diarrhea, one uses Banxia Xiexin Tang, composed of Renshen (Ginseng Radix), Banxia, Ganjiang (Zingiberis Rhizoma), Gancao (Glycyrrhizae Radix), and Dazao (Jujubae Fructus), because the Middle Qi has been injured. If Huanglian and Huangqin (Scutellariae Radix) are added, does this imply that Heat pathogens have not yet resolved?
If so, then what method should be used to treat Jie Xiong? The answer is: If the pathogenic factor remains substantial, internal resolution methods should still be employed; if the Middle Qi is damaged, only warming and tonifying methods should be used. Lizhong Tang (Regulate the Middle Decoction) with Zhishi (Aurantii Fructus Immaturus) is indicated. Alternatively, Huoxiang (Agastachis Herba), Banxia, Gancao, and Renshen, combined with Chao Zhishi (Fried Aurantii Fructus Immaturus), can be administered according to specific symptoms. There is absolutely no method involving repeated purgation to treat chest binding.
Da Xian Xiong Tang (Major Chest-Binding Decoction)
Dahuang (4 qian) Mangxiao (3 qian) Gansui mo (2 fen)
Decoct in water, mix in Gansui powder, and take orally.
Xiao Xian Xiong Tang (Minor Chest-Binding Decoction)
Huanglian (1.5 qian) Banxia (3 qian) Gualou Shi (2 qian)
Decoct in water and take orally.
Banxia Fuling Tang (Pinellia and Poria Decoction)
Banxia (4 qian) Bai Fuling (2.5 qian)
Decoct in water, add Ginger Juice, and take orally.
Banxia Xiexin Tang (Pinellia Drain-the-Epigastrium Decoction)
Renshen, Banxia, Ganjiang, Gancao, Huangqin (each 1 qian) Huanglian (0.5 qian)
Add five slices of fresh ginger and five dates. Decoct in water and take orally.
Zhishi Lizhong Tang (Immature Bitter Orange Regulate-the-Middle Decoction)
Zhishi (bran-fried), Ganjiang, Renshen, Baizhu, Fuling, Gancao (equal parts)
Decoct in water and take orally. Alternatively, grind into powder, make pills with honey the size of quail eggs, dissolve in hot water, and take. Administer two or three doses consecutively.
Noupo Banxia Gancao Renshen Tang (Magnolia Bark, Pinellia, Licorice, and Ginseng Decoction)
Noupo, Banxia (each 1 qian) Gancao, Renshen (each 0.5 qian)
Add five slices of fresh ginger. Decoct in water and take orally.