治胸中大气下陷，又兼气分郁结，经络湮淤者。
生黄 （六钱） 知母（三钱） 当归身（三钱） 桂枝尖（钱半） 柴胡（钱半） 乳香（三钱，不
去油） 没药（三钱，不去油）
胁下撑胀，或兼疼者，加龙骨、牡蛎（皆不用 ）各五钱；少腹下坠者，加升麻一钱。
一妇人，年三十许。胸中满闷，时或作疼，鼻息发热，常常作渴。自言得之产后数日，劳力过度。其脉
迟而无力，筹思再三，莫得病之端绪。姑以生山药一两，滋其津液，鸡内金二钱、陈皮一钱，理其疼闷，服后
忽发寒热。再诊其脉，无力更甚，知其气分郁结，又下陷也。遂为制此汤，一剂诸病皆觉轻，又服四剂全愈。
一少女，年十五。脐下左边起一 瘕，沉沉下坠作疼，上连腰际，亦下坠作疼楚，时发呻吟。剧时，常
觉小便不通，而非不通也。诊其脉，细小而沉。询其得病之由，言因小便不利，便时
努力过甚，其初腰际坠疼，后遂结此 瘕。其方结时，揉之犹软，今已五阅月，其患处愈坚结。每日晚四点钟，
疼即增重，至早四点钟，又渐觉轻。愚闻此病因，再以脉象参之，知其小便时努力过甚。上焦之气，陷至下焦
而郁结也。遂治以理郁升陷汤，方中乳香、没药皆改用四钱，又加丹参三钱、升麻钱半，二剂而坠与疼皆愈。
遂去升麻，用药汁送服朱血竭末钱许，连服数剂， 瘕亦消。
或问∶龙骨、牡蛎为收涩之品，兼胁下胀疼者，何以加此二药？答曰∶胁为肝之部位，胁下胀疼者，肝
气之横恣也，原当用泻肝之药，又恐与大气下陷者不宜。用龙骨、牡蛎，以敛戢肝火，肝气自不至横恣，此敛
之即以泻之，古人治肝之妙术也。且黄 有膨胀之力，胀疼者原不宜用，有龙骨、牡蛎之收敛，以缩其膨胀之
力，可放胆用之无碍，此又从体验而知道也。尝治一少妇，经水两月不见，寒热往来，胁下作疼，脉甚微弱而
数至六至。询之常常短气，投以理郁升陷汤，加龙骨、牡蛎各五钱，为脉数，又加玄参、生地、白芍各数钱，
连服四剂。觉胁下开通，瘀血下行，色紫黑，自此经水调顺，诸病皆愈。盖龙骨、牡蛎性虽收涩，而实有开通
之力，《神农本草经》谓龙骨消 瘕，而又有牡蛎之咸能软坚者以辅之，所以有此捷效也。
生黄芪（六钱） 知母（三钱） 当归身（三钱） 桂枝尖（一钱半） 柴胡（一钱半） 乳香（三钱，不去油） 没药（三钱，不去油）
若伴有胁肋下方撑胀，或兼有疼痛者，加龙骨、牡蛎（均煅用）各五钱；若伴有少腹下坠感者，加升麻一钱。
有一位三十岁左右的妇女。感到胸部满闷，有时疼痛，鼻息发热，经常口渴。自述发病于产后数日，因过度劳累所致。诊其脉象迟而无力，反复思考，未能找到病因的头绪。暂且给予生山药一两，以滋养津液，鸡内金二钱、陈皮一钱，以调理疼痛和满闷，服药后突然发作寒热症状。再次诊察脉象，无力更加明显，判断其为气分郁结，且大气下陷。于是为她配制此汤剂，服用一剂后各种病症都感觉减轻，又服用四剂后完全痊愈。
有一位十五岁的少女。脐下左侧长出一块瘕积，沉重下坠并疼痛，向上牵连腰部，也出现下坠疼痛楚感，时常发出呻吟。病情剧烈时，常觉得小便不通，但实际上并非真的不通。诊其脉象细小而沉。询问得病原因，说是因为小便不利，排尿时用力过猛，起初只是腰部下坠疼痛，后来便结成了这块瘕积。在刚结成时，揉搓它还较软，如今已过了五个月，患处变得坚硬结实。每天下午四点，疼痛加重，到凌晨四点，又逐渐减轻。我听闻此病的病因，再结合脉象参详，知道是因为排尿时用力过猛，导致上焦之气陷入下焦而郁结。于是用理郁升陷汤治疗，方中的乳香、没药均改为四钱，又加入丹参三钱、升麻一钱半，服用两剂后，下坠感和疼痛都痊愈了。随后去掉升麻，用药汁送服朱砂血竭末约一钱，连续服用数剂，瘕积也随之消散。
有人问：龙骨、牡蛎是收敛固涩的药物，对于兼有胁下胀痛的情况，为什么还要加这两味药？回答说：胁部是肝脏的部位，胁下胀痛，是肝气横逆肆虐的表现，原本应当使用泻肝的药物，但又担心这与大气下陷的病机不相宜。使用龙骨、牡蛎，可以收敛抑制肝火，肝气自然就不会横逆肆虐，这种通过收敛来达到泻实的效果，是古人治疗肝脏的巧妙医术。况且黄芪具有膨胀之力，对于胀痛者原本不宜使用，但有龙骨、牡蛎的收敛作用，可以收缩其膨胀之力，可以放心大胆地使用而无妨碍，这也是从临床体验中领悟到的道理。曾治疗一位年轻妇女，月经两个月未来潮，寒热往来，胁下疼痛，脉象非常微弱且数，一息六至。询问得知她常常短气，投以理郁升陷汤，加龙骨、牡蛎各五钱，因为脉数，又加入玄参、生地、白芍各数钱，连续服用四剂。感觉胁下通畅，瘀血下行，颜色紫黑，从此月经调顺，各种病症都痊愈了。大概龙骨、牡蛎性质虽然收涩，但实际上具有开通的力量，《神农本草经》记载龙骨能消除瘕积，再加上牡蛎咸味能软坚散结来辅助它，所以能有如此迅速的疗效。
Treats conditions where the Great Qi (Da Qi) in the chest sinks, accompanied by stagnation of Qi in the Qi division and stasis in the collaterals.
Sheng Huangqi (Raw Radix Astragali, 6 qian) Zhi Mu (Rhizoma Anemarrhenae, 3 qian) Danggui Shen (Radix Angelicae Sinensis, Root Body, 3 qian) Guizhi Jian (Ramulus Cinnamomi, Tip, 1.5 qian) Chai Hu (Radix Bupleuri, 1.5 qian) Ruxiang (Resina Olibani, 3 qian, not removing oil) Moyao (Resina Myrrhae, 3 qian, not removing oil)
If accompanied by distending fullness under the hypochondrium, or pain, add Longgu (Fossilia Ossis Mastodi, calcined) and Muli (Concha Ostreae, calcined), each 5 qian; if accompanied by a sensation of sinking in the lower abdomen, add Shengma (Rhizoma Cimicifugae, 1 qian).
A woman, approximately thirty years old, experienced fullness and oppression in the chest, occasional pain, feverish sensation in nasal respiration, and frequent thirst. She stated that the condition began several days after childbirth due to excessive physical labor. Her pulse was slow and deficient. After careful consideration, I could not discern the origin of the disease. Initially, I prescribed Sheng Shanyao (Rhizoma Dioscoreae, 1 liang) to nourish body fluids, Jineijin (Endothelium Corneum Gigeriae Galli, 2 qian), and Chenpi (Pericarpium Citri Reticulatae, 1 qian) to regulate pain and fullness. After taking the medicine, she suddenly developed alternating chills and fever. Upon re-examination, her pulse was even more deficient. I determined that there was stagnation of Qi in the Qi division combined with sinking of the Great Qi. Consequently, I prepared this decoction. After one dose, all symptoms alleviated; after four additional doses, she was completely cured.
A fifteen-year-old girl had a mass (Jia) forming on the left side below the umbilicus, causing a heavy, sinking pain radiating to the waist, also presenting with a sinking painful sensation, accompanied by occasional groaning. During severe episodes, she often felt urinary retention, although urination was not actually obstructed. Her pulse was fine, small, and deep. Inquiry revealed that the condition originated from difficulty in urination, where excessive straining occurred during voiding. Initially, there was only a sinking pain in the waist, which later consolidated into this mass. When it first formed, it was soft upon palpation; however, five months later, the affected area became hard and firm. The pain intensified daily at 4:00 PM and gradually lightened by 4:00 AM. Based on the history and pulse diagnosis, I concluded that excessive straining during urination caused Qi from the Upper Jiao to sink into the Lower Jiao and become stagnant. I treated her with Li Yu Sheng Xian Tang (Regulate Stagnation and Raise Sinking Decoction). In the formula, Ruxiang and Moyao were increased to 4 qian each, and Danshen (Radix Salviae Miltiorrhizae, 3 qian) and Shengma (1.5 qian) were added. After two doses, the sinking sensation and pain resolved. Shengma was then removed, and she took Zhuxuejie (Sanguis Draconis processed with Cinnabar, approx. 1 qian) powder delivered with the decoction juice for several consecutive doses, resulting in the dissipation of the mass.
Someone asked: "Longgu and Muli are astringent agents. Why are they added for cases with hypochondriac distension and pain?" I replied: "The hypochondrium is the territory of the Liver. Hypochondriac distension and pain indicate rampant Liver Qi. Originally, purgative herbs for the Liver should be used, but these are unsuitable for patients with sinking Great Qi. Using Longgu and Muli to restrain Liver Fire prevents Liver Qi from rampaging. This method of using astringency to achieve purgation is a subtle technique of ancient physicians in treating the Liver. Furthermore, Huangqi has an expanding effect, which is generally contraindicated for distension and pain. However, the astringent properties of Longgu and Muli can counteract this expanding force, allowing its safe use. This understanding comes from clinical experience."
I once treated a young woman who had amenorrhea for two months, alternating chills and fever, hypochondriac pain, and a very weak yet rapid pulse (six beats per breath). She reported frequent shortness of breath. I administered Li Yu Sheng Xian Tang with Longgu and Muli (5 qian each). Due to the rapid pulse, I added Xuanshen (Radix Scrophulariae, several qian), Shengdi (Radix Rehmanniae Preparata, several qian), and Baishao (Radix Paeoniae Alba, several qian). After four doses, she felt relief in the hypochondrium, and dark purple blood clots passed. Her menstruation subsequently normalized, and all symptoms resolved. Although Longgu and Muli are astringent, they possess opening properties. The *Shennong Bencao Jing* states that Longgu eliminates masses, and when assisted by Muli, whose salty nature softens hardness, such rapid efficacy is achieved.