仲景曰∶病有结胸，其状何如？答曰。按之痛，寸脉浮，关脉沉，名曰结胸也。曰∶病发于阳
而反下之，热入因作结胸。病发于阴而反下之，因作痞。所以成结胸者，以下之太早故也。曰∶结
胸，脉浮大者不可下，下之即死。曰∶结胸证悉具，烦躁者亦死。
《论》曰∶太阳病，脉浮而动数，头痛发热，微盗汗出，而反恶寒者，表未解也，医反下之，
胃中空虚，阳气内陷，心下因硬，而为结胸，大陷胸汤主之。曰∶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，从心下至少腹硬满而痛不可近者，大陷胸汤主之。按此
二条，皆言太阳表证未解，因误下之而成结胸也。
《论》曰∶伤寒五六日，呕而发热者，此柴胡汤证具，而以他药下之，其柴胡证仍在者，当复
与柴胡汤，必蒸蒸而振，却发热汗出而解。若心下满而硬痛者，此为结胸也，大陷胸汤主之。但满
而不痛者，此为痞，柴胡不中与之，宜半夏泻心汤。按此一条以少阳表证未解，因误下之而为结胸
也。
《论》曰∶太阳少阳并病，而反下之，成结胸，心下硬，下痢不止，水浆不入，其人烦心。按
此一条，以太阳少阳并病，二经表邪未解，亦因误下而成结胸也。
《论》曰∶阳明病，心下硬满者，不可攻之，攻之利遂不止者死，利止者愈。按此一条，谓阳
明邪气入腑者，必腹满便结，今惟心下硬，以邪气尚浅，未全入腑，故不可攻。此虽非结胸，而实
亦结胸之类，盖不由误下，而因阳明之邪渐深也。
《论》曰∶伤寒六七日，结胸热实，脉沉而紧，心下痛，按之石硬者，大陷胸汤主之。按此一
条，不云下早，而云热实，其于六七日，脉沉紧而心下硬痛者，此伤寒传里之实邪，有不因误下而
成结胸者，乃伤寒之本病也。
愚按∶结胸一证，观《伤寒论》所载，如前数条，凡太阳表邪未解而误下者，成结胸，少阳证
亦然，太阳少阳并病者亦然，此不当下而误下之，以致脏气空虚，外邪乘虚内陷，结于胸膈之间，
是皆因下而结者也。又曰∶伤寒六七日，结胸热实，脉沉而紧，心下痛，按之石硬者，此不因下而
邪实渐深，结聚于胸者也。然则结胸一证，有因误下而成者，有不因下而由于本病者。观近代伤寒
诸书，云未经下者，非结胸也，岂不谬哉。
一、结胸证，观仲景所言，惟太阳、少阳二经误下者有之，而阳明一经独无言及者，何也？盖凡
病入阳明，胃腑已实，故可下之而无害也。然又曰∶阳明病，心下硬满者，不可攻之，攻之痢不止
者死。此岂非阳明在经表证，邪未入腑者，亦为不可下乎？不惟三阳为然，即三阴之证，其有发热
恶寒，表邪未解者，切不可下，最当慎也。
一、结胸证治之辨，凡心腹胀满硬痛，而手不可近者，方是结胸，若但满不痛者，此为痞满，非
结胸也。凡痞满之证，乃表邪传至胸中，未入于腑，此其将入未入，犹兼乎表。是即半表半里之证
，只宜小柴胡之属，加入枳壳之类治之，或以本方对小陷胸汤亦妙。今余新方制有柴陈煎，及一柴
胡饮之类，皆可择而用之也。至于结胸之治，则仲景俱用大陷胸汤主之。然余之见，则惟伤寒本病
，其有不因误下，而实邪传里，心下硬满，痛连小腹而不可近，或燥渴谵妄，大便硬，脉来沉实有
力者，此皆大陷胸汤所正宜也。其于太阳少阳表邪未解，因下早而致结胸者，此其表邪犹在，若再
用大陷胸汤，是既因误下而复下之，此则余所未敢。不若以痞满门诸法，酌其轻重，而从乎双解，
以缓治之；或外用罨法，以解散胸中实邪，此余之屡用获效，而最稳最捷者也。罨法见新方因类第
三十。
张仲景说：病有结胸这一类，它的症状是怎样的？回答说：按压时疼痛，寸脉浮，关脉沉，这就叫做结胸。又说：病发于阳证（指表热证），反而用攻下法治疗，热邪内陷因而形成结胸。病发于阴证（指表寒证或里虚证），反而用攻下法治疗，因而形成痞证。之所以形成结胸，是因为攻下太早的缘故。又说：结胸病，如果脉象浮大的，不可用攻下法，用了就会死亡。又说：结胸证的症状全部具备，如果出现烦躁不安的，也是死证。
《伤寒论》说：太阳病，脉象浮而动数，头痛发热，微微盗汗，反而恶寒的，这是表证未解，医生反而用攻下法，导致胃中空虚，阳气内陷，心下部因而变硬，形成结胸，用大陷胸汤主治。又说：太阳病，重发汗后又攻下，五六天不大便，舌上干燥而口渴，傍晚时分有轻微潮热，从心下直到小腹坚硬胀满且疼痛剧烈，手不能靠近的，用大陷胸汤主治。按这两条，都是说太阳表证未解，因为误用攻下法而成为结胸。
《伤寒论》说：伤寒五六天，呕吐且发热的，这是柴胡汤证具全，如果用其他药攻下，那些柴胡证仍在的，应当再给予柴胡汤，必定会感到体内蒸蒸发热并战栗，随后发热出汗而病解。如果心下部胀满而且硬痛的，这就是结胸，用大陷胸汤主治。只是胀满而不痛的，这就是痞证，柴胡汤不适合使用，适宜用半夏泻心汤。按这一条，是说少阳表证未解，因为误用攻下法而成为结胸。
《伤寒论》说：太阳少阳并病，反而用攻下法，形成结胸，心下部硬，下痢不止，水浆无法入口，其人心中烦乱。按这一条，是说太阳少阳并病，两经表邪未解，也是因为误用攻下而成结胸。
《伤寒论》说：阳明病，心下部硬满的，不可攻下，攻下后利下不止的会死亡，利止的则痊愈。按这一条，是说阳明邪气入腑的，必然腹部胀满、大便干结，现在只有心下部硬，是因为邪气尚浅，没有完全入腑，所以不可攻下。这虽然不是结胸，但实际上也属于结胸之类，只不过不是由误下引起，而是由于阳明邪气逐渐深入所致。
《伤寒论》说：伤寒六七天，结胸热实证，脉象沉而紧，心下部疼痛，按压像石头一样硬的，用大陷胸汤主治。按这一条，没说攻下太早，而说是热实，在六七天时，脉沉紧且心下部硬痛，这是伤寒传里的实邪，有不因误下而形成结胸的，乃是伤寒的本病。
我按语：结胸这一证候，看《伤寒论》所载，如前面几条，凡是太阳表邪未解而误用攻下的，形成结胸；少阳证也是这样；太阳少阳并病的也是这样，这些是不当下而误下，导致脏气空虚，外邪乘虚内陷，结聚在胸膈之间，这都是因为误下而结成的。又说：伤寒六七天，结胸热实证，脉沉而紧，心下部痛，按压像石头一样硬的，这是不因误下而邪实逐渐深入，结聚在胸中的。既然这样，结胸这一证候，有因误下而成的，也有不因误下而由于本病形成的。看近代的伤寒诸书，说未经攻下的，就不是结胸，这难道不荒谬吗？
一、结胸证，看仲景所言，只有太阳、少阳二经误下的才有，而阳明一经唯独没有提及，为什么呢？大概凡是病入阳明，胃腑已经实热，所以可以攻下而无害。但又说：阳明病，心下部硬满的，不可攻下，攻下后痢疾不止的会死亡。这岂不是说明阳明在经表证，邪气未入腑的，也不可以攻下吗？不仅三阳经是这样，就是三阴经的证候，如果有发热恶寒，表邪未解的，切不可攻下，最为慎重。
一、结胸证治疗的辨别，凡是心腹胀满硬痛，而且手不能靠近的，才是结胸，如果只是胀满而不痛的，这叫痞满，不是结胸。凡是痞满之证，是表邪传至胸中，未入于腑，这是将入未入，还兼有表证。这就是半表半里的证候，只宜用小柴胡汤之类的方剂，加入枳壳等药治疗，或者用本方配合小陷胸汤也很好。现在我新方制剂中有柴陈煎，以及一柴胡饮之类，都可以选择使用。至于结胸的治疗，仲景都用大陷胸汤主治。然而我的见解，则是只有伤寒本病，那些不因误下，而实邪传里，心下部硬满，疼痛牵连小腹且手不能靠近，或者燥渴谵妄，大便硬，脉象沉实有力的，这才是大陷胸汤正宜使用的。对于太阳少阳表邪未解，因为攻下太早而导致结胸的，此时表邪还在，如果再使用大陷胸汤，这是既因误下又再次攻下，这是我所不敢做的。不如参照痞满门的诸种方法，斟酌其轻重，采用双解法，以缓治之；或者外用罨法（热敷法），以解散胸中实邪，这是我屡用获效，而且最稳妥最快捷的方法。罨法见新方因类第三十条。
Zhang Zhongjing stated: There is a condition known as Jie Xiong (Chest Binding), what are its manifestations? The answer is: Pain upon palpation, floating pulse at the Cun position, and sunken pulse at the Guan position; this is named Jie Xiong. It is further stated: When a disease originates from Yang patterns (exterior heat syndromes) and is incorrectly treated with purgation, heat pathogens enter inward, resulting in Jie Xiong. When a disease originates from Yin patterns (exterior cold or interior deficiency syndromes) and is incorrectly treated with purgation, it results in Pi (Glomus/Fullness). The reason for forming Jie Xiong is that purgation was applied too early. It is also stated: In Jie Xiong, if the pulse is floating and large, purgation must not be used; doing so leads to death. Furthermore: If all symptoms of Jie Xiong are present and restlessness (Fan Zao) occurs, the prognosis is fatal.
The Treatise states: In Tai Yang disease, if the pulse is floating, active, and rapid, accompanied by headache, fever, slight night sweating, and aversion to cold, the exterior syndrome has not yet resolved. If the physician incorrectly applies purgation, the stomach becomes empty, Yang Qi sinks inward, causing hardness below the heart, resulting in Jie Xiong, which is primarily treated with Da Xian Xiong Tang (Major Decoction to Drain the Chest). It is also stated: In Tai Yang disease, after excessive sweating followed by purgation, if there is no bowel movement for five to six days, dryness and thirst on the tongue, and slight tidal fever in the late afternoon, with hardness, fullness, and severe pain from below the heart down to the lower abdomen that cannot be touched, Da Xian Xiong Tang should be administered. These two clauses indicate that Tai Yang exterior syndromes remained unresolved and were complicated into Jie Xiong due to erroneous purgation.
The Treatise states: After five or six days of Shang Han (Cold Damage), if vomiting and fever occur, Chai Hu Tang (Bupleurum Decoction) indications are fully present. If other drugs are used for purgation and the Chai Hu symptoms persist, Chai Hu Tang should be re-administered. The patient will likely experience internal steaming heat and shivering, followed by fever and sweating, leading to resolution. However, if there is fullness and hardness with pain below the heart, this is Jie Xiong, treated with Da Xian Xiong Tang. If there is only fullness without pain, this is Pi (Glomus), and Chai Hu Tang is contraindicated; Ban Xia Xie Xin Tang (Pinellia Decoction to Drain the Epigastrium) is appropriate. This clause indicates that Shaoyang exterior syndromes remained unresolved and were complicated into Jie Xiong due to erroneous purgation.
The Treatise states: In concurrent Tai Yang and Shaoyang diseases, incorrect purgation leads to Jie Xiong, characterized by hardness below the heart, incessant diarrhea, inability to take fluids, and mental restlessness. This clause indicates that concurrent Tai Yang and Shaoyang diseases involve unresolved exterior pathogens in both meridians, and Jie Xiong forms due to erroneous purgation.
The Treatise states: In Yang Ming disease, if there is hardness and fullness below the heart, purgation is contraindicated. If purgation is applied and diarrhea becomes incessant, death ensues; if diarrhea stops, recovery occurs. This clause explains that when Yang Ming pathogens enter the Fu organs, abdominal fullness and constipation are expected. Since only hardness below the heart is present, the pathogen is still shallow and has not fully entered the Fu organs, hence purgation is contraindicated. Although this is not strictly Jie Xiong, it belongs to the category of Jie Xiong, arising not from erroneous purgation but from the gradual deepening of Yang Ming pathogens.
The Treatise states: After six or seven days of Shang Han, in cases of Re Shi (Heat Excess) type Jie Xiong, with a sunken and tight pulse, pain below the heart, and hardness like stone upon palpation, Da Xian Xiong Tang is indicated. This clause does not mention premature purgation but emphasizes Heat Excess. In cases occurring around day six or seven with sunken-tight pulses and hardness/pain below the heart, these are excess pathogens transmitted inward from Shang Han. Thus, Jie Xiong can form without erroneous purgation, representing the primary pathology of Shang Han.
My Commentary: Regarding the syndrome of Jie Xiong, as recorded in the Shang Han Lun, such as the previous clauses, whenever Tai Yang exterior pathogens remain unresolved and are incorrectly purged, Jie Xiong forms. The same applies to Shaoyang syndromes and concurrent Tai Yang-Shaoyang syndromes. These cases involve purging when one should not, leading to emptiness of the Zang Qi, allowing external pathogens to sink inward due to deficiency, and binding between the chest and diaphragm. All these result from erroneous purgation. Additionally, the case of Shang Han on day six or seven with Re Shi Jie Xiong, sunken-tight pulse, pain below the heart, and stone-like hardness, arises not from purgation but from the gradual deepening of excess pathogens binding in the chest. Therefore, Jie Xiong can result from either erroneous purgation or the natural progression of the primary disease. Contemporary Shang Han texts claim that Jie Xiong does not exist without prior purgation, which is absurd.
First, regarding the differentiation of Jie Xiong: Zhang Zhongjing mentions only erroneous purgation in Tai Yang and Shaoyang meridians, omitting Yang Ming. Why? Generally, once disease enters Yang Ming, the Stomach Fu organ is already excess, making purgation safe. Yet, it is stated: In Yang Ming disease, hardness and fullness below the heart contraindicate purgation; if purged and dysentery becomes incessant, death ensues. Does this not imply that Yang Ming Jing (Meridian/Exterior) syndromes, where pathogens have not entered the Fu organs, also contraindicate purgation? This principle applies not only to the Three Yang meridians but also to the Three Yin meridians. If fever and aversion to cold indicate unresolved exterior pathogens, purgation must absolutely be avoided with utmost caution.
Second, regarding the treatment differentiation of Jie Xiong: Only cases with abdominal distension, fullness, hardness, and pain that cannot be tolerated by touch constitute Jie Xiong. Cases with fullness but no pain are classified as Pi Man (Glomus Fullness), not Jie Xiong. Pi Man syndromes arise when exterior pathogens transmit to the chest but have not entered the Fu organs; they are on the verge of entering, retaining exterior characteristics. This represents a Half-Exterior Half-Interior syndrome, best treated with formulas like Xiao Chai Hu Tang (Minor Bupleurum Decoction) augmented with Zhi Qiao (Aurantii Fructus), or combined with Xiao Xian Xiong Tang (Minor Decoction to Drain the Chest). My new formula, Chai Chen Jian (Bupleurum and Citrus Decoction), and Yi Chai Hu Yin (Single Bupleurum Infusion), are suitable options. For the treatment of true Jie Xiong, Zhang Zhongjing primarily uses Da Xian Xiong Tang. However, my view is that Da Xian Xiong Tang is strictly indicated only for primary Shang Han cases where excess pathogens transmit inward without erroneous purgation, presenting with hardness/fullness below the heart, pain radiating to the lower abdomen intolerable to touch, dryness/thirst, delirium, hard stool, and a strong, sunken, solid pulse. For cases where Tai Yang or Shaoyang exterior pathogens remain unresolved and Jie Xiong results from premature purgation, the exterior pathogen is still present. Using Da Xian Xiong Tang again would constitute double purgation, which I dare not recommend. Instead, one should refer to methods for Pi Man, assess severity, and employ dual-release strategies for gentle treatment, or use external compress therapies (Ya Fa) to dissipate excess pathogens in the chest. This approach has proven effective, stable, and swift in my practice. See Ya Fa in New Formulas, Category 30.