大黄（半斤味苦寒） 葶苈（半升熬味苦寒） 芒硝（半升味咸寒） 杏仁（半升
去皮尖熬黑味苦甘温）
上四味。捣筛二味。内杏仁芒硝。合研如脂。和散。取如弹丸一枚。别捣甘遂末一
钱
匕。白蜜二合。水二升。煮取一升。温顿服之。一宿乃下。如不下。更服。取下为效。禁
如药法。
大黄芒硝之苦咸。所以下热。葶苈杏仁之苦甘。所以泄满。甘遂取其直达。白蜜取
其润利。皆以下泄满实物也。
结胸证。其脉浮大者。不可下。下之则死。
结胸为邪结胸中。属上焦之分。得寸脉浮。关脉沉者。为在里则可下。若脉浮大。
心下虽结。是在表者犹多。未全结也。下之。重虚邪气复结。则难可制。故云下之则死。
结胸证悉具。烦躁者亦死。
结胸证悉具。邪结已深也。烦躁者。正气散乱也。邪气胜正。病者必死。
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。余无汗。剂颈而还。小便不利。身必发黄也。
动数。皆阳脉也。当责邪在表。睡而汗出者。谓之盗汗。为邪气在半表半里。则不恶
寒。此头痛发热。微盗汗出反恶寒者。表未解也。当发其汗。医反下之。虚其胃气。表邪
乘虚则陷。邪在表。则见阳脉。邪在里。则见阴脉。邪气内陷。动数之脉所以变迟。而
浮脉独不变者以邪结胸中。上焦阳结。脉不得而沉也。客气者。外邪乘胃中空虚入里。结
于胸膈。膈中拒痛者。客气动膈也。金匮要略曰。短气不足以息者实也。短气躁烦心中
懊。皆邪热为实。阳气内陷。气不得通于膈。壅于心下。为硬满而痛。成结胸也。与
大陷胸汤。以下结热。若胃中空虚阳气内陷。不结于胸膈。下入于胃中者。遍身汗出。则
为热越不能发黄。若但头汗出身无汗。剂颈而还小便不利者。热不得越。必发黄也。
大黄（半斤，味苦寒） 葶苈子（半升，炒制，味苦寒） 芒硝（半升，味咸寒） 杏仁（半升，去皮尖，炒至黑色，味苦甘温）
以上四味药。将大黄和葶苈子捣碎过筛。加入杏仁和芒硝，共同研磨成脂状。混合药散。取如弹丸大小的一枚药团。另捣甘遂末一钱匕。加入白蜜二合，水二升。煮取一升药液。温热时一次性服下。一夜之后大便通下。如果未通下，再服用一次。以下出实邪为见效。禁忌事项同服药法。
大黄、芒硝的苦咸之性，用来泻热。葶苈子、杏仁的苦甘之性，用来泄除痞满。甘遂取其药力直达病所。白蜜取其润利之性。都是用来泻下痞满实邪的。
结胸证（邪热与水饮互结于胸膈的病证），如果脉象浮大的，不可用攻下法。攻下会导致死亡。
结胸是邪气结聚在胸中，属于上焦部位。出现寸脉浮、关脉沉的，说明病位在里，可以用攻下法。如果脉象浮大，虽然心下痞结，但表邪仍然较多，尚未完全内结。此时攻下，会重伤正气，邪气再次结聚，就难以控制了。所以说攻下会导致死亡。
结胸证的症状全部具备，说明邪气结聚已经很深。烦躁，说明正气散乱。邪气胜过正气，病人必定死亡。
太阳病（外感风寒初期病证），脉象浮而动数。浮脉主风邪，数脉主热，动脉主痛，数脉也主虚。头痛发热，微微盗汗（睡眠中出汗），反而恶寒的，说明表证未解。医生反而使用攻下法。动数脉变为迟脉，膈内拒按疼痛，胃中空虚，客气（外邪）扰动膈部，短气躁烦，心中懊憹（烦闷不适）。阳气内陷，心下因此变硬，这就形成了结胸。用大陷胸汤主治。如果不形成结胸，只是头部出汗，身体其他部位无汗，汗止于颈部，小便不利，身体必然发黄。
动脉、数脉，都是阳脉。应当责求邪气在表。睡着时出汗的，叫做盗汗。这是邪气在半表半里的表现，通常不恶寒。这里头痛发热，微微盗汗反而恶寒，说明表证未解。应当发汗解表。医生反而攻下，损伤了胃气，表邪乘虚内陷。邪气在表，则见阳脉；邪气在里，则见阴脉。邪气内陷，所以动数脉变为迟脉。而浮脉唯独不变的原因，是因为邪气结聚在胸中，上焦阳气被结，脉象不能沉下去。客气，是指外邪乘胃中空虚而入里，结聚于胸膈。膈中拒按疼痛，是客气扰动膈部的表现。《金匮要略》说：短气呼吸困难的，属于实证。短气、躁烦、心中懊憹，都是邪热壅实所致。阳气内陷，气机不能通达于膈，壅塞于心下，导致硬满而痛，形成结胸。给予大陷胸汤，以泻下结聚的热邪。如果胃中空虚，阳气内陷，不结聚于胸膈，而是下入胃中，则遍身出汗，这叫热邪外越，不能发黄。如果只有头部出汗，身体无汗，汗止于颈部，小便不利的，热邪不能外越，必然发黄。
Rhubarb (Banxia, half jin, bitter and cold) [Da Huang]
Sedum Seeds (Tingli, half sheng, roasted, bitter and cold) [Tinglizi]
Mirabilite (Mangxiao, half sheng, salty and cold) [Mangxiao]
Apricot Kernels (Xingren, half sheng, peeled from skin and tips, roasted until black, bitter, sweet and warm) [Xingren]
The above four herbs. Crush and sieve two of them (Rhubarb and Sedum Seeds). Add Apricot Kernels and Mirabilite, grind together until they resemble fat. Mix with the powder. Take one pill-sized portion. Separately crush Kansui Root (Gansui) into fine powder, one qianbi. Add White Honey (Baimi), two he, and water, two sheng. Boil to obtain one sheng of liquid. Take warm in one dose. Bowel movement occurs after one night. If no bowel movement, administer again. Discharge of solid pathogens is considered effective. Observe dietary restrictions as per medication rules.
The bitter and salty nature of Rhubarb and Mirabilite serves to purge heat. The bitter and sweet nature of Sedum Seeds and Apricot Kernels serves to drain fullness. Kansui Root is used for its ability to reach the target directly. White Honey is used for its moistening and lubricating properties. All are used to purge downward the fullness and solid pathogens.
In Chest Binding Syndrome (Jie Xiong Zheng, a syndrome where pathogenic factors bind in the chest), if the pulse is floating and large, purgation is contraindicated. Purgation will lead to death.
Chest Binding refers to pathogens binding in the chest, belonging to the Upper Jiao. If the Cun pulse is floating and the Guan pulse is sinking, it indicates the disease is in the interior, and purgation can be used. If the pulse is floating and large, although there is epigastric binding, there are still many exterior pathogens, and the binding is not complete. Purgation will severely weaken healthy Qi, causing pathogens to re-bind, making it difficult to control. Hence, it is said that purgation leads to death.
If all symptoms of Chest Binding Syndrome are present, and irritability (Fanzao) occurs, it is also a fatal condition.
All symptoms of Chest Binding Syndrome being present indicates deep binding of pathogens. Irrability indicates scattering and disorder of Healthy Qi. When pathogens overcome Healthy Qi, the patient will die.
In Taiyang Disease (Taiyang Bing, early stage exogenous cold damage), the pulse is floating, moving, and rapid. Floating indicates Wind, Rapid indicates Heat, Moving indicates Pain, and Rapid also indicates Deficiency. Headache, fever, slight nocturnal sweating (Dao Han), yet contrary aversion to cold, indicates the exterior is not resolved. The physician incorrectly uses purgation. The moving and rapid pulse changes to slow. Rejection pain occurs inside the diaphragm. The Stomach becomes empty and deficient. External pathogens (Ke Qi) disturb the diaphragm. Shortness of breath, irritability, and mental restlessness (Ao Nao) occur. Yang Qi sinks inward, causing the epigastrium to become hard, forming Chest Binding. Da Xian Xiong Tang (Major Decoction to Drain the Chest) is the primary treatment. If Chest Binding does not form, but only head sweating occurs, with no sweat on the rest of the body, stopping at the neck, and urination is difficult, jaundice will inevitably develop.
Moving and Rapid pulses are both Yang pulses. One should attribute the pathology to the exterior. Sweating during sleep is called nocturnal sweating. This indicates pathogens are in the Half-Exterior Half-Interior, typically without aversion to cold. Here, headache, fever, slight nocturnal sweating, and contrary aversion to cold indicate the exterior is unresolved. Sweating to release the exterior should be employed. The physician incorrectly purges, damaging Stomach Qi. Exterior pathogens sink inward due to deficiency. When pathogens are in the exterior, Yang pulses appear; when in the interior, Yin pulses appear. Pathogen sinking inward causes the moving and rapid pulse to change to slow. The Floating pulse remains unchanged because pathogens are bound in the chest, and Yang Qi in the Upper Jiao is bound, preventing the pulse from sinking. "Ke Qi" refers to external pathogens entering the interior due to Stomach emptiness, binding in the chest and diaphragm. Rejection pain in the diaphragm is caused by Ke Qi disturbing the diaphragm. *Jin Gui Yao Lue* states: Shortness of breath with insufficient respiration indicates Excess. Shortness of breath, irritability, and mental restlessness are all due to excess pathogenic heat. Yang Qi sinking inward prevents Qi from circulating through the diaphragm, obstructing the epigastrium, causing hardness, fullness, and pain, forming Chest Binding. Administer Da Xian Xiong Tang to purge downward the bound heat. If the Stomach is empty and Yang Qi sinks inward, but does not bind in the chest and diaphragm, instead descending into the Stomach, whole-body sweating occurs. This is called heat venting outward, preventing jaundice. If only head sweating occurs, body has no sweat, stopping at the neck, and urination is difficult, heat cannot vent outward, and jaundice will inevitably develop.