问曰∶病有结胸，有脏结，其状何如？答曰∶按之痛，寸脉浮，关脉沉，名曰结胸也。何谓脏结？答
曰∶如结胸状，饮食如故，时时下利，寸脉浮，关脉小细沉紧，名曰脏结。舌上白苔滑者，难治。
结胸者，邪结在胸；脏结者，邪结在脏。二者皆下后，邪气乘虚入里所致。下后邪气入里，与阳相结者为
结胸，以阳受气于胸中故尔；与阴相结者，为脏结，以阴受之，则入五脏故尔。气与宜通而塞，故痛。邪结阳
分，则阴气不得上通；邪结阴分，则阳气不得下通。是二者，皆心下硬痛。寸脉浮，关脉沉，知
邪结在阳也；寸脉浮，关脉小细沉紧，知邪结在阴也。阴结而阳不结，虽心下结痛，饮食亦自如，故阴气乘肠
虚而下，故时时自下利。阴得阳则解，脏结得热证多，则易治。舌上白苔滑者，邪气结胸中亦寒，故云难治。
脏结无阳证，不往来寒热，（赵本注∶“一云，寒而不热”）其人反静，舌上苔滑者，不可攻也。
脏结于法当下，无阳证，为表无热；不往来寒热，为半表半里无热；其人反静，为里无热。经曰∶舌上
如苔者，以丹田有热，胸中有寒，（医统本有“邪气”二字）以表里皆寒，故不可攻。
病发于阳而反下之，热入，因作结胸；病发于阴而反下之，（赵本注∶“一作汗出”）因作痞。（赵本有“
也”字）所以成结胸者，以下之太早故也。
发热恶寒者，发于阳也，而反下之，则表中阳邪入里，结于胸中为结胸；无热恶寒者，发于阴也，而
反下之，（医统本有“则”字）表中之阴入里，结于心下为痞。
结胸者，项亦强，如柔 状。下之则和，宜大陷胸丸方。
结胸病项强者，为邪结胸中，胸膈结满，心下紧实，但能仰而不能俯，是项强，亦如柔 之状也。与
大陷胸丸，下结泄满。
大陷胸丸方∶
大黄（半斤。味苦寒） 葶苈（赵本有“子”字。半升，熬。味苦寒） 芒硝（半升。味咸寒） 杏
人（赵本作“仁”，半升，去皮尖，熬黑。味苦，甘温）
大黄、芒硝之苦咸，所以下热；葶苈、杏人之苦甘，所以泄满；甘遂取其直达，白蜜取其润利，皆以
下泄满实物也。
上四味，捣筛二味，内杏人、（赵本作“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。
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，（赵本注∶“一云∶头痛即眩”）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，余处无汗，
剂颈而还，小便不利，身必发黄也。（赵本无“也”字）
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（医统本作“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。
大陷胸汤方∶
大黄（六两，去皮。苦寒） 芒硝（一升。咸寒） 甘遂（一钱，赵本医统本并有“匕”字。苦寒）
大黄谓之将军，以苦荡涤；芒硝一名硝石，以其咸能软硬，夫间有甘遂以通水也。甘遂若夫间之，遂
其气，可以直达透结，陷胸三物为允。
上三味，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。
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。
病在表而下之，热入因作结胸。此不云下后，而云伤寒六七日，则是传里之实热也。沉为在里，紧为
里实，以心下痛，按之实硬，是以为结胸，与大陷胸汤，以下结热。
伤寒十余日，热结在里，复往来寒热者，与大柴胡汤。（赵本有“大柴胡汤方”详见本书卷三）但结胸无
大热者，此为水结在胸胁也，但头微汗出者，大陷胸汤主之。
伤寒十余日，热结在里，是可下之证，复往来寒热，为正邪分争，未全敛结，与大柴胡汤下之。但结胸无
大热者，非热结也，是水饮结于胸胁，谓之水结胸。周身汗出者，是水饮外散，
则愈；若但头微汗出，余处无汗，是水饮不得外泄，停蓄而不行也，与大陷胸汤以逐其水。
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，（赵本注∶“一云∶日晡
所发心胸大烦”）从心下至少腹，硬满而痛，不可近者，大陷胸汤主之。
重发汗而复下之，则内外重亡津液，而邪热内结，致不大便五六日，舌上燥而渴也。日晡潮热者属胃，此
日晡小有潮热，非但在胃。从心下至少腹，硬满而痛不可近者，是一腹之
中，上下邪气俱甚也，与大陷胸汤以下其邪。
小结胸病，正在心下，按之则痛，脉浮滑者，小陷胸汤主之。
心下硬痛，手不可近者，结胸也。正在心下，按之则痛，是热气犹浅，谓之小结胸。结胸脉沉紧，或寸浮
关沉，今脉浮滑，知热未深结，与小陷胸汤，以除胸膈上结热也。
小陷胸汤方∶
黄连（一两。苦寒） 半夏（半升，洗。辛温） 栝蒌实（大者
一个，赵本作枚。味苦寒）
苦以泄之，辛以散之；黄连栝蒌实（医统本有“之”字）苦寒以泄热，半夏之辛以散结。
上三味，以水六升，先煮栝蒌取三升，去滓，内诸药，煮取二升，去滓，分温三服。
太阳病二三日，不能卧，但欲起，心下必结，脉微弱者，此本有寒分也。反下之，若利止，必作结胸；未
止者，四日复下之，此作协热利也。
太阳病，二三日，邪在表也。不能卧、但欲起、心下必结者，以心下结满，卧则气壅而愈甚，故不能卧而
但欲起也。心下结满，有水分，有寒分，有气分，今脉微弱，知本有寒分。医见心下结，而反下之，则太阳
表邪乘虚入里，利止则邪气留结为结胸，利不止，至次日复如前下利不止者，是邪热下攻肠胃，为挟热利也。
太阳病下之，其脉促，（赵本注∶“一作纵”）不结胸者，此为欲解也。脉浮者，必结胸也；（赵本无“也
”字）脉紧者，必咽痛；脉弦者，必两胁拘急；脉细数者，头痛未止；脉沉
紧者，必欲呕；脉沉滑者，协热利；脉浮滑者，必下血。
此太阳病下之后，邪气传变。其脉促者，为阳盛，下后脉促，为阳胜阴也，故不作结胸，为欲解；下后脉
浮，为上焦阳邪结，而为结胸也，经曰∶结胸者，寸脉浮，关脉沉。下后脉紧，则太阳之邪，传于少阴，经曰∶
脉紧者属少阴。《内经》曰∶邪客于少阴之络，令人咽（医统本作“嗌”）痛，不可内食，所以脉紧者，
必咽痛。脉弦则太阳之邪传于少阳，经曰∶尺寸俱弦者，少阳受病也。其脉循胁，络于耳，所以脉弦者，必
两胁拘急。下后邪气传里，则头痛未止，脉细数为邪未传里而伤气也，细为气
少，数为在表，故头痛未止。脉沉紧，则太阳之邪传于阳明，为里实也，沉为在里，紧为里实，阳明里实，
故必欲呕。脉滑则太阳之邪传于肠胃，以滑为阴气有余，知邪气入里，干于下焦也，沉为血胜气虚，是为协
热利、浮为气胜血虚，是知必下血。经曰∶不宜下而便攻之，诸变不可胜数，此之谓也。
病在阳，应以汗解之，反以冷水 之，若灌之，其热被却（赵本医统本并作“劫”）不得去，弥更益
烦，肉上粟起，意欲饮水，反不渴者，服文蛤散。若不瘥者，与五苓散。
寒实结胸，无热证者，与三物小陷胸汤，白散亦可服。
病在阳，为邪在表也，法当汗出而解，反以冷水 之，灌洗，热被寒水，外不得出，则反攻其里。弥更益
烦，肉上粟起者，水寒之气客于皮肤也；意欲饮水者，里有热也；反不渴者，寒在表也。与文蛤散以散表中水
寒之气。若不瘥，是水热相搏，欲传于里，与五苓散发汗以和之。始热在表，因水寒制之，不得外泄，内攻于
里，结于胸膈，心下硬痛，本是（医统本作“以”）水寒伏热为实，故谓之寒实结胸。无热证者，外无热，而
热悉收敛于里也，与小陷胸汤以下逐之。白散下热，故亦可攻。
文蛤散方∶
文蛤（五两。味咸寒）
咸走肾邪，（医统本作“则”）可以胜水气。
上一味，为散，以沸汤和一钱（赵本作“方寸”）匕服，汤用五合。（赵本有“五苓散方”详见本书卷三）
白散方∶
桔梗（三分。味辛苦，微温） 芭（赵本作“巴”）豆（一分，去皮心，熬黑，研如脂。平。医统本作“
辛”温） 贝母（三分。味辛苦平）
辛散而苦泄。桔梗、贝母之苦辛，用以下气；芭豆之辛，用
以散实。
上件（赵本无“件”字）三味为末，（赵本医统本并作“散”）内芭（赵本作“巴”）豆，更于臼
中杵之，以白饮和服。强人半钱，（赵本医统本并有“匕”字）羸者减之。病在膈上必吐，在膈下
必利，不利进热粥一杯，利过不止，进冷粥一杯。身热，皮粟不解，欲引衣自覆者，（赵本无“者”字）若水
以（赵本作“以水”） 之、洗之，益令热却（赵本作“劫”）不得出，当汗而不
汗，则烦。假令汗出已，腹中痛，与芍药三两如上法。
太阳与少阳并病，头项强痛，或眩冒，时如结胸，心下痞硬者，当刺大椎第一间，肺俞、肝俞，慎不可发
汗，发汗则谵语。脉弦，五六（赵本无“六”字）日，谵语不止，当刺期门。
太阳之脉，络头下项。头项强痛者，太阳表病也。少阳之脉，循胸络胁，如结胸心下痞硬者，少阳里病也。
太阳少阳相并为病，不纯在表，故头项不但强痛而或眩冒，亦未全入里，故时如结胸，心下痞硬，此邪在半
表半里之间也。刺大椎第一间，肺俞，以泻太阳之邪；刺肝俞，以泻少阳之邪。邪在表，则
可发汗；邪在半表半里，则不可发汗。发汗则亡津液，损动胃气。少阳之邪，因干于胃，土为木刑，必发谵语。脉
弦，至五六日传经尽，邪热去而谵语当止；若复不止，为少阳邪热甚也，刺期门，以泻肝胆之气。
妇人中风，发热恶寒，经水适来，得之七八日，热除而脉迟身凉，胸胁下满，如结胸状，谵语者，此为热
入血室也，当刺期门，随其实而泻（赵本作“取”）之。
中风，发热恶寒，表病也。若经水不来，表邪传里，则入腑而不入血室也；因经水适来，血室空虚，至
七八日邪气传里之
时，更不入腑，乘虚而入于血室。热除脉迟身凉者，邪气内陷而表证罢也。胸胁下满，如结胸状，谵语者，
热入血室而里实。期门者，肝之募，肝主血，刺期门者，泻血室之热。审看何经气实，更随其实而泻之。
妇人中风，七八日，续得寒热，发作有时，经水适断者，此为热入血室，其血必结，故使如疟状，发作有
时，小柴胡汤主之。（赵本有“小柴胡汤方”详见本书卷三）
中风七八日，邪气传里之时，本无寒热，而续得寒热，经水适断者，此为表邪。乘血室虚，入于血室，
与血相搏而血结不行，经水所以断也。血气与邪分争，致寒热如疟而发作有时，与小柴胡汤，以解传经之邪。
妇人伤寒发热，经水适来，昼日明了，暮则谵语，如见鬼状者，此为热入血室。无犯胃气及上二焦，必自愈。
伤寒发热者，寒已成热也。经水适来，则血室虚空，（医统本作“空虚”）邪热乘虚入于血室。若昼日谵
语，为邪客于腑，与阳争也；此昼日明了，暮则谵语，如见鬼状，是邪不入腑，入于血室，与阴争也。阳盛谵
语，则宜下；此热入血室，不可与下药，犯其胃气。热入血室，血结实（医统本作“寒”）热者，与小柴胡
汤，散邪发汗；此虽热入血室，而不留结，不可与发汗药，犯其上焦。热入血室，胸胁满如结胸状者，可
刺期门；此虽热入血室而无满结，不可刺期门，犯其中焦。必自愈者，以经行则热随血去，血下
也已，则邪热悉除而愈矣。所为发汗为犯上焦者，发汗则动卫气，卫气出上焦故也。刺期门为犯中焦者，刺
问：疾病中有结胸证，有脏结证，它们的症状表现是怎样的？
答：按压胸部感到疼痛，寸脉浮，关脉沉，这叫做结胸证。什么是脏结证？
答：症状像结胸证一样，但饮食正常，经常腹泻，寸脉浮，关脉脉象小、细、沉、紧，这叫做脏结证。如果舌苔白且滑润，属于难治之症。
结胸证，是邪气结聚在胸膈；脏结证，是邪气结聚在脏腑。这两种病都是因为误用泻下法后，邪气乘虚侵入体内所致。泻下后邪气入里，与阳热相结的，称为结胸，因为阳气受气于胸中；与阴寒相结的，称为脏结，因为阴气受邪，则进入五脏。气机应当通畅而受阻塞，所以产生疼痛。邪气结聚在阳分，阴气就不能向上通达；邪气结聚在阴分，阳气就不能向下通达。这两种情况，都会导致心下（胃脘部）硬满疼痛。寸脉浮，关脉沉，可知邪气结聚在阳分；寸脉浮，关脉小细沉紧，可知邪气结聚在阴分。阴气结聚而阳气未结，虽然心下结痛，但饮食如常，这是因为阴气乘肠道空虚而下注，所以经常自发性腹泻。阴证得到阳热就能解除，脏结证如果出现热证较多，就容易治疗。舌上白苔滑润，说明邪气结聚在胸中也伴有寒邪，所以说难治。
脏结证没有阳证表现，不出现往来寒热，病人反而安静，舌苔滑润，不可使用攻下法。
从治法上讲，脏结证应当用下法，但没有阳证，说明表无热邪；没有往来寒热，说明半表半里无热邪；病人反而安静，说明里没有热邪。经书说：“舌上像有苔（实为白滑苔），是因为丹田有热，胸中有寒。”由于表里皆寒，所以不可攻下。
疾病发于阳证却误用泻下法，热邪内陷，因而形成结胸证；疾病发于阴证却误用泻下法，因而形成痞证。之所以形成结胸证，是因为泻下太早的缘故。
发热恶寒的，是发于阳证，如果误用泻下法，则表中的阳邪内陷，结聚在胸中成为结胸证；无热恶寒的，是发于阴证，如果误用泻下法，则表中的阴邪内陷，结聚在心下成为痞证。
结胸证的病人，颈部也强直，像柔痉证（以汗出、项背强直为特征的痉病）的样子。服用泻下剂后病情缓解，适宜用大陷胸丸方。
结胸病出现颈部强直的，是因为邪气结聚在胸中，胸膈间结聚胀满，心下紧实，只能仰面而不能俯身，这就是颈部强直，也像柔痉证的样子。给予大陷胸丸，以泻下结聚、消除胀满。
大陷胸丸方：
大黄（半斤，味苦寒） 葶苈子（赵本有“子”字。半升，炒制。味苦寒） 芒硝（半升，味咸寒） 杏仁（赵本作“仁”，半升，去皮尖，炒至黑色。味苦，甘温）
大黄、芒硝的苦咸之性，用来泻下热邪；葶苈子、杏仁的苦甘之性，用来消除胀满；甘遂取其药力直达病所，白蜜取其润滑通利，都是用来泻下结聚的实物邪气。
以上四味药，将大黄、芒硝捣筛成粉末，加入杏仁、芒硝，一起研磨如脂状，混合均匀，取如弹丸大小的一枚；另将甘遂末捣碎，取一钱匕，加白蜜二合，水二升，煮取一升，温服，一次顿服。过一夜才排便，如果不排便再服，以下便为有效，禁忌事项同一般服药法。
结胸证，如果脉象浮大的，不可用泻下法，用了就会死亡。
结胸证是邪气结聚在胸中，属于上焦部位，出现寸脉浮、关脉沉的，说明病在里，可以用泻下法。如果脉象浮大，虽然心下结聚，但表证仍多，尚未完全结聚，此时泻下会严重损伤正气，邪气再次结聚，就难以控制了，所以说：“误用泻下法就会死亡。”
结胸证的症状全部具备，又出现烦躁不安的，也是死证。
结胸证的症状全部具备，说明邪气结聚已经很深。烦躁不安，说明正气散乱。邪气胜过正气，病人必定死亡。
太阳病，脉象浮而动数，浮脉主风，数脉主热，动脉主痛，数脉也主虚，头痛发热，微微盗汗却反而恶寒的，说明表证未解。医生反而用泻下法，动数脉变为迟脉，膈内拒按疼痛，（赵本注：“一说头痛即眩”）胃中空虚，外邪扰动膈膜，短气烦躁，心中烦闷不舒，阳气内陷，心下因此硬满，这就成了结胸证，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，身体一定会发黄。（赵本无“也”字）
动脉和数脉都是阳脉，应当责求邪气在表。睡着时出汗的，叫做盗汗。如果邪气在半表半里，就不会恶寒，现在头痛发热，微微盗汗却反而恶寒，说明表证未解，应当发汗。医生反而用泻下法，使胃气虚弱，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，动数脉所以变为迟脉，而浮脉唯独不变的，是因为邪气结聚在胸中，上焦阳热结聚，脉象不能下沉。客气（指外邪）乘胃中空虚入里，结聚在胸膈，膈中拒按疼痛，这是客气扰动膈膜。《金匮要略》说：“呼吸短促不足以息的，是实证。”短气烦躁，心中懊恼，都是邪热壅盛为实。阳气内陷，气机不得通达于膈，壅滞于心下，形成硬满而痛，成为结胸证。给予大陷胸汤，以泻下结聚的热邪。如果胃中空虚，阳气内陷，不结聚在胸膈，而是下行进入胃中，全身出汗，这叫热邪外越，不会发黄；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，必定发黄。
大陷胸汤方：
大黄（六两，去皮。苦寒） 芒硝（一升。咸寒） 甘遂（一钱，赵本医统本并有“匕”字。苦寒）
大黄被称为将军，以其苦味荡涤邪热；芒硝又名硝石，以其咸味能软化坚积，中间有甘遂来通利水道。甘遂如同疏通沟渠的人，顺其气机，可以直达病所穿透结聚，大陷胸汤三味药配合最为妥当。
以上三味药，用水六升，先煮大黄，取二升，去渣，加入芒硝，煮一两沸，再加入甘遂末，温服一升，得快利（剧烈腹泻），停止后服。
伤寒六七日，出现结胸热实证，脉象沉而紧，心下疼痛，按之像石头一样硬的，用大陷胸汤主治。
病在表而误用泻下法，热邪内陷因而形成结胸证。这里不说“下后”，而说“伤寒六七日”，则是邪气传入里的实热证。沉脉主在里，紧脉主里实，以心下疼痛，按之实硬，所以诊断为结胸，给予大陷胸汤，以泻下结聚的热邪。
伤寒十余日，热邪结聚在里，又出现往来寒热的，用大柴胡汤。（赵本有“大柴胡汤方”详见本书卷三）如果是结胸证而没有大热的，这是水饮结聚在胸胁，只有头部微微出汗的，用大陷胸汤主治。
伤寒十余日，热邪结聚在里，是可以泻下的证候，又出现往来寒热，是正气与邪气分争，尚未完全结聚，用大柴胡汤泻下。如果是结胸证而没有大热的，不是热邪结聚，而是水饮结聚在胸胁，称为水结胸。周身出汗的，是水饮向外发散，病就会好；如果只有头部微微出汗，身体其他部位无汗，是水饮不能向外宣泄，停蓄而不运行，给予大陷胸汤以逐除水饮。
太阳病，重发汗，又误用泻下法，五六天不大便，舌上干燥而口渴，傍晚时分有轻微潮热，（赵本注：“一说傍晚发作心胸大烦”）从心下直到小腹，硬满而疼痛，不能触碰的，用大陷胸汤主治。
重发汗又误用泻下法，导致内外津液严重耗伤，邪热内结，导致五六天不大便，舌上干燥而口渴。傍晚潮热通常属胃病，这里傍晚仅有轻微潮热，说明不仅仅在胃。从心下直到小腹，硬满而疼痛不能触碰，是一腹之中，上下邪气都很严重，给予大陷胸汤以泻下邪气。
小结胸病，病位正在心下，按之才疼痛，脉象浮滑的，用小陷胸汤主治。
心下硬痛，手不可触碰的，是结胸证。病位正在心下，按之才疼痛，说明热邪尚浅，称为小结胸。结胸证脉象沉紧，或寸浮关沉，现在脉象浮滑，可知热邪未深结，给予小陷胸汤，以清除胸膈上的结聚热邪。
小陷胸汤方：
黄连（一两。苦寒） 半夏（半升，洗。辛温） 瓜蒌实（大者一个，赵本作枚。味苦寒）
苦味以泄降，辛味以散结；黄连、瓜蒌实的苦寒之性以泄热，半夏的辛味以散结。
以上三味药，用水六升，先煮瓜蒌取三升，去渣，加入其余药物，煮取二升，去渣，分三次温服。
太阳病二三日，不能卧倒，只想起来，心下必然结聚，脉象微弱的，这是原本就有寒饮停滞。误用泻下法，如果腹泻停止，必定形成结胸证；如果腹泻不止，第四天又误用泻下法，这会形成协热利（兼夹热邪的腹泻）。
太阳病，二三日，邪气在表。不能卧倒、只想起来、心下必然结聚的，是因为心下结满，卧倒时气机壅滞加重，所以不能卧倒而只想起来。心下结满，有水饮停聚，有寒饮停聚，有气机阻滞，现在脉象微弱，可知原本有寒饮。医生见到心下结聚，反而用泻下法，则太阳表邪乘虚入里，腹泻停止则邪气留结成为结胸证，腹泻不止，到第二天又如前所述腹泻不止的，是邪热下攻肠胃，形成挟热利。
太阳病误用泻下法，脉象急促的，（赵本注：“一作纵”）不形成结胸证的，这是病欲解除的表现。脉象浮的，必定形成结胸证；（赵本无“也”字）脉象紧的，必定咽痛；脉象弦的，必定两胁拘急；脉象细数的，头痛不会停止；脉象沉紧的，必定想呕吐；脉象沉滑的，形成协热利；脉象浮滑的，必定便血。
这是太阳病误用泻下后，邪气传变的结果。脉象急促的，为阳气盛，下后脉促，是阳胜阴，所以不形成结胸，是病欲解除；下后脉浮，为上焦阳邪结聚，而形成结胸证，经书说：“结胸证，寸脉浮，关脉沉。”下后脉紧，则太阳之邪传于少阴，经书说：“脉紧者属少阴。”《内经》说：“邪气客于少阴之络，令人咽痛，不能进食，所以脉紧的，必定咽痛。”脉弦则太阳之邪传于少阳，经书说：“尺寸俱弦者，少阳受病。”其脉循行胁肋，联络耳朵，所以脉弦的，必定两胁拘急。下后邪气传里，则头痛未止，脉细数是邪气未传里而伤及气分，细为气少，数为在表，所以头痛未止。脉沉紧，则太阳之邪传于阳明，为里实证，沉为在里，紧为里实，阳明里实，所以必定想呕吐。脉滑则太阳之邪传于肠胃，以滑为阴气有余，可知邪气入里，干扰下焦，沉为血胜气虚，这是协热利；浮为气胜血虚，可知必定便血。经书说：“不宜泻下而强行攻下，变证不可胜数，说的就是这种情况。”
病在阳证，应当用发汗法解除，反而用冷水喷洒或灌洗，热邪被遏制不能散去，更加烦躁，皮肤起粟粒，想要喝水，反而不觉得渴的，服用文蛤散。如果不好转，给予五苓散。
寒实结胸证，没有热证表现的，给予三物小陷胸汤，白散也可以服用。
病在阳证，为邪气在表，依法应当出汗而解，反而用冷水喷洒、灌洗，热邪被寒水遏制，外不得出，则反过来攻里。更加烦躁，皮肤起粟粒的，是水寒之气客于皮肤；想要喝水的，里有热邪；反而不渴的，寒在表。给予文蛤散以疏散表中的水寒之气。如果不好转，是水热相搏，欲传入里，给予五苓散发汗以调和。起初热在表，因水寒制约，不能外泄，内攻于里，结聚在胸膈，心下硬痛，本是由水寒伏热而成实证，所以称为寒实结胸。没有热证，说明外无热，而热邪全部收敛于里，给予小陷胸汤以泻下逐邪。白散能下热，所以也可以攻下。
文蛤散方：
文蛤（五两。味咸寒）
咸味走肾邪，（医统本作“则”）可以胜水气。
以上一味药，研为散，用沸水调和一钱（赵本作“方寸”）匕服用，用水五合。（赵本有“五苓散方”详见本书卷三）
白散方：
桔梗（三分。味辛苦，微温） 巴豆（一分，去皮心，炒黑，研如脂。平。医统本作“辛”温） 贝母（三分。味辛苦平）
辛味发散，苦味泄降。桔梗、贝母的辛苦之性，用来降气；巴豆的辛味，用来消散实邪。
以上三味药研为末，（赵本医统本并作“散”）加入巴豆，再在臼中杵匀，用白饮（米汤）送服。体质强壮的人服半钱，（赵本医统本并有“匕”字）体弱者减量。病在膈上必定呕吐，在膈下必定腹泻，如果不腹泻，进热粥一杯；如果腹泻不止，进冷粥一杯。身体发热，皮肤粟粒不解，想要拉衣服盖住自己，（赵本无“者”字）如果用冷水喷洒、清洗，更使热邪被遏制不能外出，应当出汗而不出汗，就会烦躁。假如已经出汗，腹部疼痛，给予芍药三两，如上法服用。
太阳病与少阳病并病，头项强痛，有时眩晕昏冒，时常像结胸证，心下痞硬的，应当针刺大椎第一间，肺俞、肝俞，千万不要发汗，发汗则会出现谵语。脉象弦，经过五六天，谵语不止，应当针刺期门。
太阳经脉，络头下项。头项强痛的，是太阳表病。少阳经脉，循胸络胁，像结胸心下痞硬的，是少阳里病。太阳少阳相并为病，不纯在表，所以头项不但强痛而且有时眩晕昏冒，也未全入里，所以时常像结胸，心下痞硬，这是邪气在半表半里之间。针刺大椎第一间、肺俞，以泻太阳之邪；针刺肝俞，以泻少阳之邪。邪气在表，则可以发汗；邪气在半表半里，则不可发汗。发汗则亡失津液，损伤胃气。少阳之邪，因而干扰胃，土被木刑，必定发生谵语。脉象弦，至五六日传经尽，邪热去而谵语应当停止；如果仍不停止，为少阳邪热甚，针刺期门，以泻肝胆之气。
妇人中风，发热恶寒，月经适来，得病七八日，热退而脉迟身凉，胸胁下满，像结胸证的样子，谵语的，这是热入血室证，应当针刺期门，根据其实证所在而泻之（赵本作“取”）。
中风，发热恶寒，是表病。如果月经不来，表邪传里，则入腑而不入血室；因为月经适来，血室空虚，到了七八日邪气传里的时间，更不入腑，乘虚而入于血室。热退脉迟身凉的，是邪气内陷而表证罢除。胸胁下满，像结胸证的样子，谵语的，是热入血室而里实。期门穴是肝之募穴，肝主血，刺期门穴，是泻血室之热。审看哪条经气实，更随其实而泻之。
妇人中风，七八日，续发寒热，发作有时，月经适断的，这是热入血室，其血必结，所以使寒热像疟疾一样，发作有时，用小柴胡汤主治。（赵本有“小柴胡汤方”详见本书卷三）
中风七八日，邪气传里的时间，本来无寒热，而续发寒热，月经适断的，这是表邪乘血室虚，入于血室，与血相搏而血结不行，月经所以中断。血气与邪气分争，导致寒热像疟疾而发作有时，给予小柴胡汤，以解除传经之邪。
妇人伤寒发热，月经适来，白天神志清楚，晚上则谵语，像看见鬼怪一样的，这是热入血室。不要侵犯胃气及上二焦，必定自愈。
伤寒发热，寒已化热。月经适来，则血室虚空，邪热乘虚入于血室。如果白天谵语，为邪客于腑，与阳争；这里白天神志清楚，晚上则谵语，像看见鬼怪，是邪不入腑，入于血室，与阴争。阳盛谵语，则宜用下法；此热入血室，不可给下药，以免犯其胃气。热入血室，血结实热者，与小柴胡汤，散邪发汗；此虽热入血室，而不留结，不可给发汗药，以免犯其上焦。热入血室，胸胁满像结胸状的，可刺期门；此虽热入血室而无满结，不可刺期门，以免犯其中焦。必定自愈的，是因为行经则热随血去，血下行已，则邪热悉除而愈了。所谓发汗为犯上焦的，发汗则动卫气，卫气出于上焦故也。刺期门为犯中焦的，刺
Question: In diseases, there are Jie Xiong (Chest Binding Syndrome) and Zang Jie (Organ Binding Syndrome). What are their clinical manifestations?
Answer: When pressure on the chest causes pain, with a floating pulse at the Cun (inch) position and a sinking pulse at the Guan (middle) position, it is called Jie Xiong. What is Zang Jie?
Answer: The symptoms resemble Jie Xiong, but the patient's diet remains normal, and there is frequent diarrhea. With a floating pulse at the Cun position and a small, thin, sinking, and tight pulse at the Guan position, it is called Zang Jie. If the tongue coating is white and slippery, it is difficult to treat.
In Jie Xiong, pathogenic factors bind in the chest; in Zang Jie, pathogenic factors bind in the Zang organs. Both conditions result from pathogenic factors entering the interior due to deficiency after improper purgation. After purgation, if pathogenic factors enter the interior and bind with Yang heat, it is called Jie Xiong, because Qi receives its influence from the chest center; if they bind with Yin cold, it is called Zang Jie, because Yin receives the pathogen and enters the Five Zang organs. Qi should flow freely but is obstructed, causing pain. When pathogenic factors bind in the Yang aspect, Yin Qi cannot ascend; when they bind in the Yin aspect, Yang Qi cannot descend. Both conditions result in hardness and pain in the Xin Xia (epigastrium). A floating pulse at the Cun and a sinking pulse at the Guan indicate binding in the Yang aspect; a floating pulse at the Cun and a small, thin, sinking, and tight pulse at the Guan indicate binding in the Yin aspect. Since only Yin binds while Yang does not, although there is binding and pain in the Xin Xia, diet remains normal. This is because Yin Qi descends into the intestines due to emptiness, causing spontaneous frequent diarrhea. Yin conditions resolve with Yang heat; if Zang Jie presents with more heat signs, it is easier to treat. A white, slippery tongue coating indicates that pathogenic factors binding in the chest also involve cold, hence it is said to be difficult to treat.
Zang Jie lacks Yang signs, such as alternating chills and fever. The patient appears unusually quiet, and with a slippery tongue coating, purgation must not be used.
According to treatment principles, Zang Jie should be treated with purgation, but the absence of Yang signs indicates no heat in the exterior; the absence of alternating chills and fever indicates no heat in the half-exterior/half-interior; the patient's quietness indicates no heat in the interior. The Classics state: "A tongue coating resembling moss indicates heat in the Dan Tian (lower abdomen) and cold in the chest." Since both exterior and interior are cold, purgation is contraindicated.
If a disease originating in Yang is incorrectly purged, heat enters, resulting in Jie Xiong; if a disease originating in Yin is incorrectly purged, Pi (Glomus/Blockage) results. Jie Xiong occurs because purgation was administered too early.
Fever with chills indicates origin in Yang; incorrect purgation causes exterior Yang pathogens to enter the interior and bind in the chest, forming Jie Xiong. Absence of fever with chills indicates origin in Yin; incorrect purgation causes exterior Yin pathogens to enter the interior and bind in the Xin Xia, forming Pi.
In Jie Xiong, the neck may also be stiff, resembling Rou Ji (Soft Spasm). Administration of a purgative formula brings relief; Da Xian Xiong Wan (Major Decoction to Drain the Chest Pill) is indicated.
Neck stiffness in Jie Xiong disease is due to pathogenic binding in the chest, fullness and binding in the chest and diaphragm, and tightness/hardness in the Xin Xia. The patient can only lie supine and cannot flex forward, constituting neck stiffness, similar to Rou Ji. Da Xian Xiong Wan is given to purge binding and relieve fullness.
Da Xian Xiong Wan Formula:
Da Huang (Rhei Radix et Rhizoma, 8 liang, bitter, cold) Ting Li (Semen Lepidii seu Descureniae, 0.5 sheng, fried, bitter, cold) Mang Xiao (Natrii Sulfas, 0.5 sheng, salty, cold) Xing Ren (Semen Armeniacae Amarum, 0.5 sheng, skin and tips removed, fried until black, bitter, sweet, warm)
The bitter and salty properties of Da Huang and Mang Xiao purge heat; the bitter and sweet properties of Ting Li and Xing Ren relieve fullness; Gan Sui (Radix Kansui) reaches the target directly, and Bai Mi (Honey) provides lubrication; all act to purge solid pathogenic matter.
Pulverize two ingredients (Da Huang and Mang Xiao), add Xing Ren and Mang Xiao, grind together until paste-like, mix with powder. Take one pill the size of a bullet. Separately, prepare Gan Sui powder (one Qian Bi), Bai Mi (2 he), and water (2 sheng). Boil to obtain 1 sheng, take warm in one dose. Stooling occurs after one night; if not, administer again. Effective when stooling occurs. Observe standard dietary restrictions.
If the pulse is floating and large in Jie Xiong syndrome, purgation is contraindicated; using it leads to death.
Jie Xiong involves pathogenic binding in the chest, belonging to the Upper Jiao. Floating Cun and sinking Guan pulses indicate interior location, permitting purgation. However, if the pulse is floating and large, although there is Xin Xia binding, exterior patterns predominate, and binding is incomplete. Purgation severely depletes healthy Qi, allowing pathogenic re-binding, which becomes uncontrollable. Hence, "purgation leads to death."
If all Jie Xiong symptoms are present and the patient is irritable/restless, it is a fatal sign.
Complete Jie Xiong symptoms indicate deep pathogenic binding. Irritability indicates dispersion of healthy Qi. Pathogen overcomes healthy Qi; the patient will die.
In Tai Yang disease, if 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, yet paradoxical aversion to cold, indicate the exterior pattern is unresolved. If the physician incorrectly uses purgation, the moving/rapid pulse changes to slow. Rejection/pain in the Diaphragm interior occurs. The Stomach is empty; external pathogens disturb the Diaphragm. There is shortness of breath, irritability, and internal restlessness (Ao Nao). Yang Qi sinks inward, causing hardness in the Xin Xia, resulting in Jie Xiong. Da Xian Xiong Tang (Major Decoction to Drain the Chest Decoction) is the primary treatment. If Jie Xiong does not form, but there is sweating only on the head, no sweat elsewhere, stopping at the neck, and urination is difficult, jaundice will certainly develop.
Moving and rapid pulses are Yang pulses, indicating pathogen in the exterior. Sweating during sleep is called Dao Han (Night Sweat). If pathogen were in the half-exterior/half-interior, there would be no aversion to cold. Here, headache, fever, slight nocturnal sweating, and paradoxical aversion to cold indicate unresolved exterior; sweating should be induced. Incorrect purgation weakens Stomach Qi, allowing exterior pathogen to sink inward.
Exterior pathogen presents with Yang pulses; interior pathogen presents with Yin pulses. Sinking inward changes the moving/rapid pulse to slow. The floating pulse remains unchanged because pathogen binds in the chest, causing Upper Jiao Yang binding, preventing the pulse from sinking. "Ke Qi" (Guest Qi/External Pathogen) enters the interior due to empty Stomach Qi, binding in the chest/diaphragm. Diaphragmatic rejection pain indicates Guest Qi disturbing the Diaphragm. The Jingui Yaolue states: "Shortness of breath with inability to breathe fully is Excess." Shortness of breath, irritability, and Ao Nao are all Excess of pathogenic heat. Yang sinking inward blocks Qi transmission through the Diaphragm, congesting the Xin Xia, causing hardness, fullness, and pain, forming Jie Xiong. Da Xian Xiong Tang is given to purge binding heat. If Stomach Qi is empty and Yang sinks inward without binding in the chest/diaphragm, but descends into the Stomach, general sweating occurs ("Re Yue"/Heat Venting), preventing jaundice. If only head sweating occurs, body has no sweat, stopping at the neck, and urination is difficult, heat cannot vent, leading inevitably to jaundice.
Da Xian Xiong Tang Formula:
Da Huang (Rhei Radix et Rhizoma, 6 liang, peeled, bitter, cold) Mang Xiao (Natrii Sulfas, 1 sheng, salty, cold) Gan Sui (Radix Kansui, 1 Qian Bi, bitter, cold)
Da Huang is called the General, using bitterness to cleanse; Mang Xiao (also known as Xiao Shi/Niter) uses salinity to soften hardness; Gan Sui facilitates water passage. Gan Sui acts like clearing a channel, following Qi flow, penetrating binding directly. The three ingredients of Da Xian Xiong Tang are well-matched.
Boil the three ingredients in 6 sheng of water. First boil Da Huang to obtain 2 sheng, remove dregs, add Mang Xiao, boil for one or two boils, add Gan Sui powder. Take 1 sheng warm. Stop subsequent doses upon obtaining brisk diarrhea.
After six or seven days of Shang Han, if Jie Xiong Heat-Excess presents with sinking, tight pulse, Xin Xia pain, and hardness upon palpation like stone, Da Xian Xiong Tang is indicated.
Disease in the exterior treated with purgation causes heat entry, forming Jie Xiong. Not stating "after purgation" but "six or seven days" implies transmitted interior Heat-Excess. Sinking indicates interior; tight indicates interior excess. With Xin Xia pain and stone-hard palpation, it is Jie Xiong. Da Xian Xiong Tang purges binding heat.
After ten-plus days of Shang Han, if heat binds in the interior with alternating chills and fever, Da Chai Hu Tang is used. If Jie Xiong presents without significant heat, this is Water Binding in the chest/hypochondrium. With only slight head sweating, Da Xian Xiong Tang is indicated.
Ten-plus days of Shang Han with interior heat binding allows purgation. Alternating chills and fever indicate Zheng (Healthy Qi) vs. Xie (Pathogen) struggle, not fully bound. Da Chai Hu Tang purges. Jie Xiong without major heat is not heat binding but Water Binding (Shui Jie Xiong). General sweating indicates water dispersing outward, leading to recovery. Only slight head sweating with no body sweat indicates water cannot vent externally, stagnating. Da Xian Xiong Tang drives out water.
In Tai Yang disease, excessive sweating followed by purgation leads to five-six days of constipation, dry thirsty tongue, slight evening tidal fever, hardness/fullness/pain from Xin Xia to lower abdomen unyielding to touch. Da Xian Xiong Tang is indicated.
Excessive sweating and purgation cause severe loss of fluids internally and externally, with pathogenic heat binding inward, causing constipation, dry tongue, and thirst. Evening tidal fever usually belongs to the Stomach; slight evening fever here indicates involvement beyond the Stomach. Hardness/pain from Xin Xia to lower abdomen unyielding to touch indicates severe pathogen throughout the abdomen. Da Xian Xiong Tang purges the pathogen.
Xiao Jie Xiong (Minor Chest Binding) disease is located exactly at the Xin Xia, painful only upon pressure, with floating, slippery pulse. Xiao Jie Xiong Tang is indicated.
Hard, painful Xin Xia unyielding to touch is Jie Xiong. Pain only upon pressure at Xin Xia indicates shallow heat, termed Xiao Jie Xiong. Jie Xiong pulse is sinking/tight or floating Cun/sinking Guan; floating/slippery pulse indicates heat not deeply bound. Xiao Jie Xiong Tang clears binding heat in chest/diaphragm.
Xiao Jie Xiong Tang Formula:
Huang Lian (Coptidis Rhizoma, 1 liang, bitter, cold) Ban Xia (Pinelliae Tuber, 0.5 sheng, washed, acrid, warm) Gua Lou Shi (Fructus Trichosanthis, one large fruit, bitter, cold)
Bitter drains; Acrid disperses. Huang Lian and Gua Lou Shi use bitter-cold to drain heat; Ban Xia uses acridity to disperse binding.
Boil the three ingredients in 6 sheng of water. First boil Gua Lou to obtain 3 sheng, remove dregs, add other herbs, boil to obtain 2 sheng, remove dregs. Divide into three warm doses.
In Tai Yang disease, two-three days in, inability to lie down, desire to rise,必然 Xin Xia binding, with weak pulse, indicates pre-existing Cold Fluid. Incorrect purgation: if diarrhea stops, Jie Xiong forms; if diarrhea continues and purgation is repeated on the fourth day, Xie Re Li (Collateral Heat Diarrhea) forms.
Tai Yang disease, two-three days, pathogen in exterior. Inability to lie down, desire to rise, Xin Xia binding: fullness in Xin Xia causes Qi congestion when lying down, worsening symptoms. Xin Xia fullness involves Water, Cold, or Qi. Weak pulse indicates pre-existing Cold. Physician sees binding, purges incorrectly; Tai Yang exterior pathogen enters interior due to deficiency. If diarrhea stops, pathogen stays bound, forming Jie Xiong. If diarrhea continues, pathogenic heat attacks intestines/stomach, forming Xie Re Li.
After Tai Yang purgation, if pulse is Cu (Rapid/Irregular) and no Jie Xiong forms, the condition resolves. If pulse is floating, Jie Xiong forms; if tight, throat pain occurs; if wiry, hypochondriac tension occurs; if fine/rapid, headache persists; if sinking/tight, vomiting occurs; if sinking/slipping, Xie Re Li occurs; if floating/slipping, hematochezia occurs.
This describes post-purgation pathogen transmission. Cu pulse indicates Yang excess; post-purgation Cu pulse means Yang overcomes Yin, so no Jie Xiong, indicating resolution. Floating pulse indicates Upper Jiao Yang binding, forming Jie Xiong (Classic: Floating Cun, Sinking Guan). Tight pulse indicates transmission to Shao Yin (Classic: Tight pulse belongs to Shao Yin). Neijing states: "Pathogen in Shao Yin collateral causes throat pain, inability to eat." Thus, tight pulse causes throat pain. Wiry pulse indicates transmission to Shao Yang (Classic: Wiry Chi/Cun indicates Shao Yang disease). Meridian passes through hypochondrium; thus, wiry pulse causes hypochondriac tension. Post-purgation interior transmission with persistent headache and fine/rapid pulse indicates pathogen hasn't fully entered interior but damages Qi; fine indicates Qi deficiency, rapid indicates exterior, so headache persists. Sinking/tight pulse indicates transmission to Yang Ming, interior excess; sinking is interior, tight is excess, Yang Ming interior excess causes vomiting. Slipping pulse indicates transmission to intestines/stomach; slipping indicates Yin excess, pathogen enters interior affecting Lower Jiao. Sinking indicates Blood excess/Qi deficiency (Xie Re Li); Floating indicates Qi excess/Blood deficiency (hematochezia). Classic: "Purging when inappropriate causes countless variations."
Disease in Yang (exterior) should be resolved by sweating. Incorrectly spraying/washing with cold water traps heat, increasing irritability, causing gooseflesh. Desire to drink but no thirst indicates Cold-Damp in exterior with interior heat. Wen Ge San (Clam Shell Powder) disperses exterior Cold-Water. If ineffective, Wu Ling San (Five-Ingredient Powder with Poria) harmonizes via sweating.
Han Shi Jie Xiong (Cold-Excess Chest Binding) without heat signs is treated with San Wu Xiao Jie Xiong Tang or Bai San (White Powder).
Disease in Yang (exterior) requires sweating. Cold water washing traps heat, attacking interior. Increased irritability and gooseflesh indicate Cold-Water pathogen in skin. Desire to drink indicates interior heat; lack of thirst indicates exterior cold. Wen Ge San disperses exterior Cold-Water. Ineffectiveness indicates Water-Heat interaction transmitting interior. Wu Ling San harmonizes via sweating. Initial exterior heat trapped by cold water enters interior, binding in chest/diaphragm, causing Xin Xia hardness/pain. This is Cold-Water trapping Heat, forming Cold-Excess Jie Xiong. No exterior heat means heat converges interior. Xiao Jie Xiong Tang purges. Bai San also purges heat.
Wen Ge San Formula:
Wen Ge (Concha Meretricis, 5 liang, salty, cold)
Salty enters Kidney/counteracts pathogen, overcoming Water Qi.
Powder one ingredient, mix with boiling water, take one Qian Bi, using 5 He of water.
Bai San Formula:
Jie Geng (Platycodonis Radix, 3 fen, acrid/bitter, slightly warm) Ba Dou (Semini Crotonis, 1 fen, peeled/cored, fried black, ground to paste, neutral/acrid-warm) Bei Mu (Fritillariae Bulbus, 3 fen, acrid/bitter, neutral)
Acrid disperses, bitter drains. Jie Geng and Bei Mu use acrid-bitter to descend Qi; Ba Dou uses acridity to scatter excess.
Grind three ingredients to powder, add Ba Dou, pound in mortar. Mix with Bai Yin (rice water). Strong adults take half Qian Bi; weak patients reduce dose. Pathogen above Diaphragm causes vomiting; below causes diarrhea. If no diarrhea, drink hot porridge; if diarrhea persists, drink cold porridge. Fever/gooseflesh persisting, desire to cover with clothes, caused by cold water trapping heat, preventing sweating, causing irritability. If sweating occurs and abdominal pain follows, give 3 liang of Shao Yao (Paeoniae Radix Alba) as above.
Tai Yang and Shao Yang Bing (Combined Disease): Head/neck stiffness, dizziness, occasional Jie Xiong-like sensation, Xin Xia pi-fullness. Acupuncture Da Zhui (First Intervertebral), Fei Shu, Gan Shu. Do NOT sweat; sweating causes Chan Yu (Delirium). If wiry pulse persists for five-six days with continuous delirium, acupuncture Qi Men.
Tai Yang meridian connects head/neck. Stiffness is Tai Yang exterior disease. Shao Yang meridian passes chest/hypochondrium. Jie Xiong-like Pi-fullness is Shao Yang interior disease. Combined disease is neither purely exterior nor interior. Head/neck stiffness with dizziness indicates not fully exterior; Jie Xiong-like symptoms indicate not fully interior. Pathogen is in half-exterior/half-interior. Acupuncture Da Zhui/Fei Shu drains Tai Yang; Gan Shu drains Shao Yang. Exterior allows sweating; half-exterior/half-interior forbids it. Sweating loses fluids, damages Stomach Qi. Shao Yang pathogen disturbs Stomach; Wood insults Earth, causing delirium. Wiry pulse, five-six days, delirium stops if pathogen leaves; if not, Shao Yang heat is severe. Acupuncture Qi Men drains Liver/Gallbladder.
Woman with Feng Zhong (Wind Strike), fever/chills, menstruation begins. Seven-eight days later, fever ceases, pulse slows, body cools. Hypochondriac fullness, Jie Xiong-like appearance, delirium. This is Re Ru Xue Shi (Heat Entering Blood Chamber). Acupuncture Qi Men, draining based on excess.
Feng Zhong with fever/chills is exterior. If menstruation absent, pathogen transmits to Fu organs, not Blood Chamber. With menstruation, Blood Chamber is empty. At seven-eight days (transmission time), pathogen enters Blood Chamber due to deficiency. Fever cessation/slow pulse/cooled body indicates interior sinking and exterior resolution. Hypochondriac fullness/Jie Xiong-like/delirium indicates Heat Entering Blood Chamber with interior excess. Qi Men is Liver Mu point; Liver governs Blood. Acupuncture drains Blood Chamber heat. Identify excess meridian and drain accordingly.
Woman with Feng Zhong, seven-eight days, recurring chills/fever at intervals, menstruation ends. This is Heat Entering Blood Chamber, blood binding, causing malaria-like intermittent chills/fever. Xiao Chai Hu Tang is indicated.
Seven-eight days is transmission time. Recurring chills/fever with ended menstruation indicates exterior pathogen entering empty Blood Chamber, binding with blood, stopping menses. Blood/Qi struggling with pathogen causes malaria-like chills/fever. Xiao Chai Hu Tang resolves transmitted pathogen.
Woman with Shang Han fever, menstruation begins. Clear mind by day, delirium seeing ghosts by night. This is Heat Entering Blood Chamber. Do not violate Stomach Qi or Upper Two Jiaos; will self-resolve.
Shang Han fever indicates Cold transforming to Heat. Menstruation means empty Blood Chamber; pathogenic heat enters. Daytime delirium indicates pathogen in Fu organs fighting Yang. Here, clear by day, delirious by night, indicates pathogen in Blood Chamber fighting Yin. Yang-excess delirium requires purgation; Heat Entering Blood Chamber contraindicates purgation (violates Stomach Qi). If Heat Entering Blood Chamber involves blood binding/heat, Xiao Chai Hu Tang disperses/pathogen vents. Here, no binding, so no sweating agents (violates Upper Jiao). If hypochondriac fullness like Jie Xiong, acupuncture Qi Men. Here, no fullness/binding, so avoid Qi Men (violates Middle Jiao). Self-resolution occurs because menstruation carries heat away with blood; once blood flows, pathogenic heat is eliminated. Sweating violates Upper Jiao because it moves Wei Qi, which originates in Upper Jiao. Acupuncture Qi Men violates Middle Jiao...