栝蒌实（捣）一枚 薤白半筋 白酒七升
右三味，同煮取二升，分温再服。
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胸痹，不得卧，心痛彻背者，栝蒌薤白半夏汤主之。
【注】
上条胸痹胸背痛，尚能卧，以痛微而气不逆也；此条心痛彻背不得卧，是痛甚而气上
逆也；故仍用前方，大加半夏以降逆也。
【集注】
尤怡曰：胸痹不得卧，是胸中痛甚，肺气上而不下也；心痛彻背，是气闭塞而前后不
通故也，其痹为尤甚矣。所以然者，有痰饮以为之援也。
栝蒌实（捣）一枚 薤白三两 半夏半升 白酒一斗
右四味，同煮取四升，温服一升，日三服。
【集解】
魏荔彤曰：同半夏之苦，以开郁行气，痛甚则结甚，故减薤白之湿，用半夏之躁，更
能使胶腻之物，随汤而荡涤也。日三服，亦从上治者，应徐取频服也。
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心痛彻背，背痛彻心，乌头赤石脂圆主之。
【注】
上条心痛彻背，尚有休止之时，故以栝蒌薤白白酒加半夏汤平剂治之。此条心痛彻背
，背痛彻心，是连连痛而不休，则为阴寒邪甚，浸浸乎阳光欲熄，非薤白白酒之所能
治也，故以乌头赤石脂圆主之。方中乌、附、椒、姜，一派大辛大热，别无他顾，峻
逐阴邪而已。
【集注】
李□曰：心痛在内而彻背，则内而达于外矣；背痛在外而彻心，则外而入于内矣。故
既有附子之温，而复用乌头之迅，佐干姜行阳，大散其寒，佐蜀椒下气，大开其郁恐
过于大散大开，故复佐赤石脂入心，以固涩而收阳气也。
栝蒌实（捣碎）一枚，薤白半筋，白酒七升。
以上三味药，一同煎煮，取药液二升，分两次温服。
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胸痹（胸部闷痛），不能平卧，心痛放射至背部者，用栝蒌薤白半夏汤主治。
【注】
上一条所述胸痹表现为胸背痛，尚能平卧，是因为疼痛轻微且气机未上逆；这一条所述心痛放射至背部且不能平卧，是因为疼痛剧烈且气机上逆；因此仍使用前方（栝蒌薤白白酒汤），大量加入半夏以降逆气。
【集注】
尤怡说：胸痹不能平卧，是胸中疼痛剧烈，肺气上逆而不能下行；心痛放射至背部，是气机闭塞导致前后不通，其痹阻程度尤为严重。之所以如此，是因为有痰饮作为辅助（致病因素）。
栝蒌实（捣碎）一枚，薤白三两，半夏半升，白酒一斗。
以上四味药，一同煎煮，取药液四升，每次温服一升，每日服用三次。
【集解】
魏荔彤说：配合半夏的苦味，以开通郁结、运行气机，疼痛剧烈则邪气结聚严重，所以减少薤白的湿性，使用半夏的燥性，更能使胶腻的痰浊之物，随汤剂而荡涤清除。每日服用三次，也是从上焦治疗的思路，应当缓慢取效、频繁服药。
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心痛放射至背部，背痛放射至心前区，用乌头赤石脂丸主治。
【注】
上一条所述心痛放射至背部，尚有间歇停止的时候，所以用栝蒌薤白白酒汤加半夏汤这种平和的方剂治疗。这一条所述心痛放射至背部，背痛放射至心前区，是连续疼痛不止，属于阴寒邪气极盛，阳气即将熄灭，不是薤白白酒所能治疗的，所以用乌头赤石脂丸主治。方中的乌头、附子、花椒、干姜，一派大辛大热之性，没有其他顾虑，旨在峻猛驱逐阴寒邪气。
【集注】
李□说：心痛在内而放射至背部，则是从内达于外；背痛在外而放射至心前区，则是从外入于内。因此既有附子的温性，又复用乌头的迅疾，佐以干姜通行阳气，大散寒邪，佐以蜀椒降气，大开郁结。恐怕过于大散大开，所以再佐以赤石脂入心经，以固涩收敛阳气。
Gualou Fruit (crushed) one piece, Xiebai (Allii Macrostemonis Bulbus) half jin, Baijiu (white wine) seven sheng.
The above three ingredients are boiled together to obtain two sheng of liquid, taken in two divided doses at a warm temperature.
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In Chest Bi (chest stuffiness and pain) where the patient cannot lie down, and heart pain radiates to the back, Gualou Xiebai Banxia Tang (Trichosanthes, Allium Macrostemon, and Pinellia Decoction) is the primary treatment.
[Annotation]
In the previous clause regarding Chest Bi with chest and back pain, the patient could still lie down because the pain was mild and qi did not rebel upward. In this clause, heart pain radiating to the back accompanied by an inability to lie down indicates severe pain and rebellious qi upward. Therefore, the previous formula (Gualou Xiebai Baijiu Tang) is still used, but with a significant increase in Banxia (Pinelliae Rhizoma) to direct rebellious qi downward.
[Collected Annotations]
You Yi stated: In Chest Bi where the patient cannot lie down, it is due to severe pain in the chest causing Lung Qi to rebel upward and fail to descend. Heart pain radiating to the back indicates that qi is blocked, preventing circulation between the front and back, making the Bi obstruction particularly severe. The reason for this is the presence of Phlegm-Fluids acting as support for the pathogen.
Gualou Fruit (crushed) one piece, Xiebai (Allii Macrostemonis Bulbus) three liang, Banxia (Pinelliae Rhizoma) half sheng, Baijiu (white wine) one dou.
The above four ingredients are boiled together to obtain four sheng of liquid. Take one sheng warm per dose, administered three times daily.
[Collected Explanations]
Wei Litong stated: Combined with the bitter nature of Banxia to open stagnation and promote qi movement. When pain is severe, the knotting of pathogens is also severe; thus, the dampening property of Xiebai is reduced, and the drying property of Banxia is utilized to further wash away and clear sticky, viscous phlegm via the decoction. Administering the medicine three times daily aligns with treating from the Upper Jiao, requiring slow efficacy through frequent dosing.
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When heart pain radiates to the back, and back pain radiates to the heart region, Wutou Chishizhi Wan (Aconite and Red Kaolin Pill) is the primary treatment.
[Annotation]
In the previous clause, heart pain radiating to the back had intervals of cessation, so it was treated with the moderate formula of Gualou Xiebai Baijiu Tang plus Banxia. In this clause, heart pain radiating to the back and back pain radiating to the heart indicates continuous, unceasing pain, representing extreme Yin-Cold pathogenic factors. The Yang energy is on the verge of extinction, and it cannot be treated by Xiebai and Baijiu alone. Therefore, Wutou Chishizhi Wan is used. The Aconitum (Wutou), Prepared Aconite Root (Fuzi), Sichuan Pepper (Huajiao), and Dried Ginger (Ganjiang) in the formula are all intensely acrid and hot, with no other considerations, aiming solely to vigorously expel Yin-Cold pathogens.
[Collected Annotations]
Li [Name Missing] stated: Heart pain originating internally and radiating to the back indicates transmission from interior to exterior; back pain originating externally and radiating to the heart indicates transmission from exterior to interior. Therefore, besides the warming property of Fuzi, the rapid action of Wutou is employed again. Ganjiang assists in circulating Yang to greatly disperse Cold, and Huajiao assists in descending Qi to greatly open Stagnation. Fearing that this great dispersing and opening might be too excessive, Chishizhi (Kaolinite) is added to enter the Heart channel to astringe and consolidate Yang Qi.