浦 中阳困顿浊阴凝冱。胃痛彻背。午后为甚。即不嗜饮食。亦是阳伤。温通阳气。在所必施。
（胸脘清阳不运）
薤白（三钱） 半夏（三钱） 茯苓（五钱） 干姜（一钱） 桂枝（五分）
华（四六） 因劳。胸痹。阳伤。清气不运。仲景每以辛滑微通其阳。
薤白 栝蒌皮 茯苓 桂枝 生姜
王 胸前附骨板痛。甚至呼吸不通。必捶背稍缓。病来迅速。莫晓其因。议从仲景胸痹症。乃清
阳失展。主以辛滑。
薤白 川桂枝尖 半夏 生姜 加白酒一杯同煎。
谢 冲气至脘则痛。散漫高突。气聚如瘕。由乎过劳伤阳。
薤白 桂枝 茯苓 甘草 临服冲入白酒一小杯。
某（六五） 脉弦。胸脘痹痛欲呕。便结。此清阳失旷。气机不降。久延怕成噎格。
薤白（三钱） 杏仁（三钱） 半夏（三钱） 姜汁（七分） 浓朴（一钱） 枳实（五分）
徐（六一） 胸痹因怒而致。痰气凝结。
土栝蒌 半夏 薤白 桂枝 茯苓 生姜
王（五七） 气逆自左升。胸脘阻痹。仅饮米汤。形质不得下咽。此属胸痹。宗仲景法。栝蒌薤白汤。
又 脉沉如伏。痞胀格拒。在脘膈上部。病患述气壅。自左觉热。凡木郁达之。火郁发之。患在上
宜吐之。
巴豆霜（一分制） 川贝母（三分） 桔梗（二分）
为细末服。吐后。服凉水即止之。
某（二六） 肺卫窒痹。胸膈痹痛。咳呛痰粘。苦辛开郁为主。当戒腥 。
栝蒌皮 炒桃仁 冬瓜子 苦桔梗 紫菀 川贝母
华 阳气微弱。胸痹。苓桂术甘汤。
某（二十） 脉弦。色鲜明。吞酸胸痹。大便不爽。此痰饮凝冱。清阳失旷。气机不利。法当温通阳气为主。
薤白 杏仁 茯苓 半夏 浓朴 姜汁
某（三八） 气阻胸痛。
鲜枇杷叶 半夏 杏仁 桔梗 橘红 姜汁
某 脉沉。短气咳甚。呕吐饮食。便溏泻。乃寒湿郁痹。胸痹如 。无非清阳少旋。（寒湿郁痹）小半夏
汤加姜汁。
王（三三） 始于胸痹。六七年来。发必呕吐甜水黄浊。七八日后渐安。自述病发秋月。意谓新凉天降。
郁折生阳。甘味色黄。都因中焦脾胃主病。仿内经辛以胜甘论。（脾胃阳虚）
半夏 淡干姜 杏仁 茯苓 浓朴 草蔻 姜汁法丸。
某 痛久入血络。胸痹引痛。（血络痹痛）
炒桃仁 延胡 川楝子 木防己 川桂枝 青葱管
胸痹与胸痞不同。胸痞有暴寒郁结于胸者。有火郁于中者。有寒热互郁者。有气实填胸
而痞者。有气衰而成虚痞者。亦有肺胃津液枯涩。因燥而痞者。亦有上焦湿浊弥漫而痞
者。若夫胸痹。则但因胸中阳虚不运。久而成痹。内经未曾详言。惟金匮立方。俱用辛滑温
通。所云寸口脉沉而迟。阳微阴弦。是知但有寒症。而无热症矣。先生宗之加减而治。亦惟
流运上焦清阳为主。莫与胸痞结胸噎膈痰食等症混治。斯得之矣。（华玉堂）
徐评 此即俗名心头痛也。病有数种。偶然卒得者。不外仲景栝蒌薤白汤。其余诸种。各有治
法。非一煎剂所能必愈也。案中俱不能见及。
浦某：中焦阳气困顿衰微，阴寒浊邪凝结阻滞。胃痛放射至背部。午后症状加重。即使没有食欲，也是阳气受损的表现。温补并通阳的方法，是必须施用的。
（胸脘部清阳之气运行不畅）
薤白（三钱） 半夏（三钱） 茯苓（五钱） 干姜（一钱） 桂枝（五分）
华某：因劳累所致。胸痹（胸部闷痛、窒塞感）。阳气受损。清气不能正常运化。张仲景常用辛味滑利之品微微通达阳气。
薤白 栝蒌皮 茯苓 桂枝 生姜
王某：胸前贴近肋骨处感到板硬疼痛。甚至呼吸受阻。必须捶打背部才能稍缓解。发病迅速，不知其原因。建议参照张仲景的胸痹证治疗。这是清阳之气失于舒展。主治以辛滑之法。
薤白 川桂枝尖 半夏 生姜 加白酒一杯同煎。
谢某：冲脉之气上逆至胃脘则疼痛。气散漫高突。气聚集成如瘕聚般的包块。这是由于过度劳累损伤阳气所致。
薤白 桂枝 茯苓 甘草 临服用时冲入白酒一小杯。
某人（65岁）：脉象弦。胸脘部痹痛欲呕吐。大便干结。这是清阳之气失于旷达。气机不降。拖延日久恐怕会发展成噎膈（吞咽困难）。
薤白（三钱） 杏仁（三钱） 半夏（三钱） 姜汁（七分） 厚朴（一钱） 枳实（五分）
徐某（61岁）：胸痹因愤怒而引发。痰气凝结。
土栝蒌 半夏 薤白 桂枝 茯苓 生姜
王某（57岁）：气逆自左侧上升。胸脘部阻塞痹痛。仅能饮用米汤。有形质的食物无法下咽。这属于胸痹。遵循张仲景的方法。使用栝蒌薤白汤。
又案：脉象沉伏。痞满胀气格拒。病位在胃脘膈膜上部。患者叙述气壅滞。自觉从左侧发热。凡是木郁应当疏达，火郁应当发散。病位在上焦适宜用吐法。
巴豆霜（一分制） 川贝母（三分） 桔梗（二分）
研为细末服用。吐完后，服用凉水即可停止催吐反应。
某人（26岁）：肺卫之气窒塞痹阻。胸膈痹痛。咳嗽气喘痰液粘稠。以苦辛开郁为主。应当戒除腥荤食物。
栝蒌皮 炒桃仁 冬瓜子 苦桔梗 紫菀 川贝母
某人（20岁）：脉象弦。面色鲜明。吞酸且胸痹。大便不爽利。这是痰饮凝结阻滞。清阳之气失于旷达。气机不利。治法当以温通阳气为主。
薤白 杏仁 茯苓 半夏 厚朴 姜汁
某人（38岁）：气机阻滞导致胸痛。
鲜枇杷叶 半夏 杏仁 桔梗 橘红 姜汁
某人：脉象沉。短气咳嗽严重。呕吐饮食。大便溏泻。这是寒湿郁闭痹阻。胸痹如同……无非是清阳之气很少回旋。（寒湿郁痹）小半夏汤加姜汁。
王某（33岁）：始于胸痹。六七年来，发作时必须呕吐甜水黄浊之物。七八日后逐渐安宁。自述病发于秋季。意谓新凉天气下降。
郁折生阳。甘味色黄，都因中焦脾胃主病。仿效《内经》“辛以胜甘”的理论。（脾胃阳虚）
半夏 淡干姜 杏仁 茯苓 厚朴 草蔻 姜汁法制丸。
某人：疼痛日久深入血络。胸痹牵引作痛。（血络痹痛）
炒桃仁 延胡索 川楝子 木防己 川桂枝 青葱管
胸痹与胸痞不同。胸痞有暴寒郁结于胸部的；有火郁于中的；有寒热互郁的；有气实填塞胸部而成痞的；有气衰而成虚痞的；也有肺胃津液枯涩，因燥而痞的；也有上焦湿浊弥漫而痞的。至于胸痹，则只是因为胸中阳气虚弱不能运化，久而成痹。《内经》未曾详细论述。只有《金匮要略》设立方剂，都用辛滑温通之法。所谓寸口脉沉而迟，阳微阴弦，可知只有寒症，而无热症了。先生遵循此理加减治疗，也只是以流通上焦清阳为主。不要与胸痞、结胸、噎膈、痰食等症混淆治疗。这样才能得当。（华玉堂）
徐评：这就是俗名心头痛的疾病。病有好几种，偶然突然得病的，不外乎张仲景的栝蒌薤白汤。其余各种类型，各有治疗方法，不是一副药就能保证痊愈的。医案中都不能涵盖所有情况。
Pu: The middle yang is trapped and depleted, while turbid yin-cold condenses and freezes. Stomach pain radiates to the back. Symptoms worsen in the afternoon. Even if there is a lack of appetite, it indicates damage to yang. Warming and unblocking the yang qi is absolutely necessary.
(The clear yang of the chest and epigastrium fails to circulate)
Xiebai (Allii Macrostemonis Bulbus, 3 qian) Banxia (Pinelliae Rhizoma, 3 qian) Fuling (Poria, 5 qian) Ganjiang (Zingiberis Rhizoma Recens, 1 qian) Guizhi (Cinnamomi Ramulus, 5 fen)
Hua: Caused by labor/overwork. Xiongbi (Chest Bi syndrome). Yang is damaged. Clear qi fails to transport. Zhang Zhongjing often uses acrid and slippery substances to slightly unblock the yang.
Xiebai Gualoupi (Trichosanthis Pericarpium) Fuling Guizhi Shengjiang (Zingiberis Rhizoma Recens)
Wang: The area in front of the chest adjacent to the ribs feels rigid and painful. Breathing is even obstructed. Beating the back provides slight relief. The onset is rapid, and the cause is unknown. It is proposed to treat according to Zhang Zhongjing’s Xiongbi syndrome. This is due to the failure of clear yang to expand. The main treatment principle is acrid and slippery methods.
Xiebai Chuan Guizhi Jian (Tip of Cinnamomi Ramulus) Banxia Shengjiang Decoct together with one cup of Baijiu (White Liquor).
Xie: When Chong Qi (Penetrating Vessel Qi) rises to the epigastrium, pain occurs. The qi scatters and protrudes high. Qi gathers forming a mass like Jia (abdominal mass). This results from overwork damaging yang.
Xiebai Guizhi Fuling Gancao (Glycyrrhizae Radix et Rhizoma) Add one small cup of Baijiu when taking the medicine.
Certain Patient (65 years old): Pulse is Xian (Wiry). Chest and epigastrium Bi pain with urge to vomit. Constipation. This is due to clear yang failing to be expansive. Qi mechanism does not descend. If prolonged, it may develop into Yege (Dysphagia/Oesophageal Obstruction).
Xiebai (3 qian) Xingren (Armeniacae Semen Amarum, 3 qian) Banxia (3 qian) Jiangzhi (Zingiberis Juice, 7 fen) Houpo (Magnoliae Officinalis Cortex, 1 qian) Zhishi (Aurantii Fructus Immaturus, 5 fen)
Xu (61 years old): Xiongbi caused by anger. Phlegm and qi condense.
Tu Gualou (Trichosanthis Fructus) Banxia Xiebai Guizhi Fuling Shengjiang
Wang (57 years old): Qi rebels and rises from the left. Chest and epigastrium obstruction and Bi pain. Can only drink rice soup. Solid food cannot be swallowed. This belongs to Xiongbi. Following Zhang Zhongjing’s method. Use Gualou Xiebai Tang (Trichosanthis and Allii Macrostemoni Decoction).
Another case: Pulse is Chen (Deep) and Fu (Hidden). Fullness and distension with rejection. Located in the upper epigastrium and diaphragm. The patient describes Qi stagnation. Feels heat originating from the left. For Wood stagnation, use dispersing; for Fire stagnation, use venting. Since the disease is in the Upper Jiao, vomiting therapy is appropriate.
Baiduoshuang (Crotonis Fructus Frost, 1 fen prepared) Chuan Beimu (Fritillariae Cirrhosae Bulbus, 3 fen) Jiegeng (Platycodonis Radix, 2 fen)
Grind into fine powder and take. After vomiting, drink cool water to stop the emetic effect.
Certain Patient (26 years old): Lung and Wei (Defensive) Qi are obstructed and Bi. Chest and diaphragm Bi pain. Coughing and wheezing with sticky phlegm. Main treatment is bitter and acrid to open stagnation. Must avoid seafood/fishy foods.
Gualoupi (Trichosanthis Pericarpium) Chao Taoren (Persicae Semen, stir-fried) Dongguazi (Benincasae Semen) Ku Jiegeng (Platycodonis Radix, bitter) Ziwan (Astagti Radix) Chuan Beimu (Fritillariae Cirrhosae Bulbus)
Hua: Yang qi is weak. Xiongbi. Use Linggui Zhugan Tang (Poria, Cinnamon Twig, Atractylodes Macrocephala and Licorice Decoction).
Certain Patient (20 years old): Pulse is Xian (Wiry). Complexion is bright and lustrous. Acid regurgitation and Xiongbi. Bowel movements are unsatisfactory. This is due to Phlegm-fluids condensing and freezing. Clear yang fails to be expansive. Qi mechanism is unfavorable. The method should primarily warm and unblock yang qi.
Xiebai Xingren Fuling Banxia Houpo Jiangzhi
Certain Patient (38 years old): Qi obstruction causing chest pain.
Xian Pipaye (Eriobotryae Folium, fresh) Banxia Xingren Jiegeng Juhong (Citri Reticulatae Pericarpium Rubrum) Jiangzhi
Certain Patient: Pulse is Chen (Deep). Shortness of breath and severe cough. Vomiting of ingested food. Loose stools/diarrhea. This is Cold-Dampness stagnating and obstructing. Xiongbi is like... merely that clear yang rarely rotates. (Cold-Dampness stagnating and obstructing) Xiao Banxia Tang (Minor Pinellia Decoction) plus Jiangzhi.
Wang (33 years old): Started as Xiongbi. For six or seven years, upon attack, must vomit sweet, yellow, turbid fluid. Gradually recovers after seven or eight days. Self-reports onset in autumn. Implies new cool weather descends.
Stagnation breaks and generates yang. Sweet taste corresponds to yellow color. All due to diseases of the Middle Jiao Spleen and Stomach. Imitate the Neijing theory "Acrid overcomes Sweet". (Spleen-Stomach Yang Deficiency)
Banxia Dan Ganjiang (Mild Dried Ginger) Xingren Fuling Houpo Cao Kou (Amomi Fructus Rotundus) Jiangzhi processed into pills using ginger juice method.
Certain Patient: Pain has entered the blood collaterals over time. Xiongbi draws pain. (Blood collateral Bi pain)
Chao Taoren Yanhu (Corydalis Rhizoma) Chuan Lianzi (Meliae Fructus) Mu Fangji (Stephaniae Tetrandrae Radix) Chuan Guizhi Qingcongguan (Allii Tuberosi Caulis)
Xiongbi differs from Xiongpi (Chest Fullness). Xiongpi can be caused by sudden cold stagnating in the chest; fire stagnating internally; cold and heat mutually stagnating; excess qi filling the chest causing fullness; deficiency qi leading to deficient fullness; dryness due to withered fluids of Lung and Stomach causing fullness; or turbid dampness pervading the Upper Jiao causing fullness. As for Xiongbi, it is solely due to deficiency and failure of transportation of Yang in the chest, which becomes Bi over time. The Neijing did not discuss this in detail. Only the Jin Gui Yao Lue established formulas, all using acrid, slippery, warming, and unblocking methods. It states: "The pulse at Cun Kou is deep and slow, Yang is micro, Yin is Xian." Thus, we know there are only Cold syndromes, no Heat syndromes. The Master followed this, adding and subtracting for treatment, focusing mainly on circulating the clear Yang of the Upper Jiao. Do not confuse it with treatments for Xiongpi, Jie Xiong (Chest Binding), Ye Ge, Tan Shi (Phlegm-Food) etc. This is correct. (Hua Yutang)
Xu’s Commentary: This is commonly known as Heart-Headache. There are several types of this disease. Those acquired suddenly do not go beyond Zhang Zhongjing’s Gualou Xiebai Tang. The other types each have their own treatment methods. They cannot necessarily be cured with a single decoction. The medical cases presented here cannot cover all possibilities.