（仲景） 治伤寒下早，表邪内陷，膈内拒痛，心下因硬成结胸证。或重汗而复下之，
不大便五六日，舌上燥渴，日晡所，小有潮热。从心上至小腹，硬满而痛不可近者。（按之
硬痛者为结胸，硬而不痛者为痞。下之太早，邪热乘虚入结于心胸之间，故硬而痛。又有硬
痛而无热证者，为寒实结胸，白散主之。结胸固当下，然脉浮大者，下之则死。以其犹带表
邪，下之重虚，结而又结，故死。嘉言曰∶太阳误下之脉，主病皆在阳，在表即有沉紧沉滑
之殊，皆不得以里阴名之。六书云∶胸膈满者，胸间气塞满闷也，非心下满。胁满者，胁肋
胀满也，非腹中满。盖表邪传里，必先胸，以至心腹入胃。是以胸满多带表证，宜微汗。胁
满多带半表半里，宜和解。胸中痰实者，宜涌之。如结实燥渴便秘，宜以此汤下之。附白散，
巴豆一分，去心皮炒黑研，贝母桔梗各三分，治寒实结胸。巴豆辛热，以散寒结。贝母苦辛，
以散痰热。结在胸，故以桔梗浮而上之，利膈清表。故病在膈上必吐，病在膈下必利
大黄（二两） 芒硝（一升） 甘遂（一钱为末） 先煮大黄去渣，内芒硝，煮一二沸，
内甘遂末
表邪入里，结于高位，以致三焦俱实，手不可近，证为危急，非常药所能平。故以甘遂
苦寒
功。
于心
故曰
头痛
客
曰
矣
乎
又
动膈，心中懊 ，当以栀子豉汤，吐去胸中之邪。陶节庵曰∶结胸乃下早而成，未曾经下者，
柴
分浅深从缓治之，不宜太峻。上焦乃清道至高之分，过下则伤元气也。崔行功曰∶伤寒结胸
欲
枳
自然解了，盖理中治中焦故也。胃中虽和，伤寒未退，宜候日数足，欲以承气再下之，盖前
来之下未是也。其水结胸者，用小半夏加茯苓汤小柴胡去枣加牡蛎主之，又有血结胸证，手
不可近，漱水不欲咽，喜忘如狂，大便黑，小便利，宜犀角地黄汤。）
（张仲景）治疗伤寒因过早使用下法，导致表邪内陷，膈部抗拒疼痛，心下部因此变硬，形成结胸证。或者经过重度发汗后又再次使用下法，导致五六天不大便，舌面干燥且口渴，在傍晚时分（日晡所），出现轻微的潮热。从心部一直到小腹部，坚硬胀满且疼痛剧烈，甚至不能让人靠近触碰。（用手按压时感到坚硬且疼痛的称为结胸；坚硬但不疼痛的称为痞证。因为下法使用太早，邪热乘虚侵入并结聚在心胸之间，所以表现为坚硬且疼痛。又有虽然坚硬疼痛但没有热象表现的，属于寒实结胸，用白散主治。结胸证固然应当使用下法，但如果脉象浮大，则不可使用下法，否则会导致死亡。因为此时病邪仍带有表邪，若强行攻下会严重损伤正气，导致邪气结聚更深，所以致死。嘉言说：太阳病误用下法后的脉象，主病都在阳分，如果在表，即使有沉紧或沉滑的不同，都不能将其命名为里阴证。六书说：胸膈满闷，是指胸间气机阻塞、满闷的感觉，并非指心下部满闷。胁肋满闷，是指胁肋部位胀满，并非指腹中满闷。大概表邪传入体内，必定先影响胸部，进而波及心腹进入胃部。因此胸满多伴有表证，适宜轻微发汗。胁满多伴有半表半里的证候，适宜和解。胸中有痰实阻滞的，适宜涌吐。如果结实、燥渴、便秘，适宜用此汤剂攻下。）
附注白散方：巴豆一分，去除心皮后炒黑研碎，贝母、桔梗各三分，用于治疗寒实结胸。巴豆辛热，用以消散寒结。贝母苦辛，用以消散痰热。结聚在胸部，故用桔梗性浮而上行，通利膈膜，清解表邪。因此病位在膈上者必然呕吐，病位在膈下者必然腹泻。
大黄（二两） 芒硝（一升） 甘遂（一钱，研末） 先煮大黄，去渣，加入芒硝，煮沸一两次，再加入甘遂末。
表邪入里，结聚于高位，导致三焦全部实证，疼痛剧烈到手不可触碰，病情危急，非常规药物所能平复。所以用甘遂的苦寒之性……（原文此处有缺漏或错乱，结合语境意为利用其峻下逐水之功）。
头痛……客……曰……矣……乎……又……动膈，心中懊憹，应当用栀子豉汤，涌吐去除胸中之邪。陶节庵说：结胸是因过早下法而成，未曾经过下法的，应分浅深从缓治之，不宜过于峻猛。上焦是清道，位置至高，过度攻下会损伤元气。崔行功说：伤寒结胸欲……枳……自然解了，大概是理中汤治疗中焦的缘故。胃中虽然调和，但伤寒未退，宜等待时日充足，打算再用承气汤攻下，大概之前的下法并不恰当。如果是水结胸证，用小半夏加茯苓汤或小柴胡汤去大枣加牡蛎主治。又有血结胸证，手不可触碰，漱水不欲咽，健忘如狂，大便色黑，小便通利，适宜用犀角地黄汤。）
(Zhang Zhongjing) Treats Taiyang disease (Taiyang disease, a syndrome caused by pathogenic factors invading the Taiyang channel) where premature purgation causes exterior pathogens to sink inward. This results in resistance and pain in the diaphragm, hardness in the epigastrium, forming the Jie Xiong syndrome (Chest Binding syndrome). If heavy sweating is followed by further purgation, leading to constipation for five or six days, dryness and thirst on the tongue, and slight tidal fever in the late afternoon (Ri Bu), from the heart region down to the lower abdomen, there is hardness, fullness, and severe pain that makes the area intolerable to touch. (Pressing reveals hardness and pain: this is Jie Xiong; hardness without pain is Pi [Stagnation]. Premature purgation allows pathogenic heat to enter vacuity and bind between the heart and chest, causing hardness and pain. There are cases of hardness and pain without heat signs, known as Cold-Shi Jie Xiong [Cold-Excess Chest Binding], treated with Bai San [White Powder]. Although Jie Xiong generally requires purgation, if the pulse is floating and large, purgation must be avoided as it leads to death. This is because exterior pathogens remain; purging severely depletes healthy Qi, causing deeper binding of pathogens, hence fatal. Jiayan states: In Taiyang disease mismanaged by purgation, the pathology remains in Yang. Even if pulses are deep-tight or deep-slippery, they should not be classified as Interior Yin syndromes. The Six Books state: Fullness in the chest and diaphragm refers to qi obstruction and stuffiness in the chest, not fullness in the epigastrium. Fullness in the hypochondrium refers to distension in the rib area, not abdominal fullness. Generally, when exterior pathogens transmit inward, they first affect the chest, then move to the heart/abdomen and stomach. Thus, chest fullness often accompanies exterior syndromes and is suitable for mild sweating. Hypochondriac fullness often accompanies Half-Exterior/Half-Interior syndromes and is suitable for harmonizing. Phlegm-excess in the chest requires emesis. If there is excess accumulation, dryness, thirst, and constipation, this decoction is suitable for purgation.)
Appendix: Bai San formula. Ba Dou (Crotonis Fructus, 1 fen), peeled, heart removed, stir-fried until black, and ground; Bei Mu (Fritillariae Bulbus, 3 fen); Jie Geng (Platycodonis Radix, 3 fen). Used for Cold-Shi Jie Xiong. Ba Dou is acrid and hot, dispersing cold binding. Bei Mu is bitter and acrid, dispersing phlegm-heat. Since the binding is in the chest, Jie Geng's floating nature directs it upward, benefiting the diaphragm and clearing the exterior. Therefore, if the disease is above the diaphragm, vomiting occurs; if below, diarrhea occurs.
Da Huang (Rhei Radix et Rhizoma, 2 liang); Mang Xiao (Natrii Sulfas, 1 sheng); Gan Sui (Kansui Radix, 1 qian, ground). First, boil Da Huang, remove dregs, add Mang Xiao, boil for one or two boils, then add Gan Sui powder.
When exterior pathogens enter the interior and bind at a high position, resulting in excess conditions in the Triple Burner (San Jiao), with pain so severe the area cannot be touched, the condition is critical and cannot be resolved by ordinary medicines. Therefore, the bitter-cold property of Gan Sui... [Text fragment] ...causes agitation in the chest (Ao Nao), requiring Zhi Zi Chi Tang (Gardenia and Soybean Decoction) to induce vomiting and expel pathogens from the chest. Tao Jian'an states: Jie Xiong is formed by premature purgation. For those who have not yet been purged, treatment should be gradual based on depth, avoiding excessive harshness. The Upper Burner is the pathway of clear Qi and the highest region; excessive purgation damages Yuan Qi (Primal Qi). Cui Xinggong states: In Taiyang Jie Xiong... [Text fragment] ...natural resolution occurs, likely because Li Zhong Tang (Regulate the Middle Decoction) treats the Middle Burner. Although the Stomach is harmonized, if Taiyang pathogens persist, wait for sufficient time before using Cheng Qi Tang (Order the Qi Decoction) again, as previous purgation was inappropriate. For Water-Jie Xiong, use Xiao Ban Xia Jia Fu Ling Tang (Minor Pinellia Formula with Added Poria) or Xiao Chai Hu Tang (Minor Bupleurum Decoction) minus Jujube, plus Mu Li (Oyster Shell). For Blood-Jie Xiong, where the area is untouchable, rinsing water but not swallowing, forgetfulness resembling mania, black stool, and free urination, Xi Jiao Di Huang Tang (Rhino Horn and Rehmannia Decoction) is indicated.)