治胸中痞硬痰饮, 一切实邪, 及气冲咽不得息者, 用此
吐之.
瓜蒂 ( 熬黄 ) 一分 赤小豆一分,, 右二味, 各别捣筛, 为散已,
合治之. 取一钱匕, 以香豉一合, 热汤七合, 煮作稀糜, 去滓, 取汁
和散, 温, 顿服之. 不吐者, 稍稍加服, 得快吐乃止.
【注】胸中者, 清阳之腑, 诸邪入胸, 皆阻阳气不得宣达, 以致: 胸
满痞硬, 热气上冲, 燥渴心烦, 嗢嗢欲吐, 脉数促者, 热郁结也. 胸
满痞硬, 气上冲咽喉不得息, 手足寒冷, 欲吐不能吐, 脉迟紧者, 寒
郁结也. 凡胸中寒热, 与气, 与饮郁结为病, 谅非汗下之法所能治,
必得酸苦涌泻之品, 因而越之, 上焦得通, 阳气得复, 痞硬可消, 胸
中可和也. 瓜蒂极苦, 赤豆味酸, 相须相益, 能除胸胃中实邪, 为吐
剂中第一品也. 而佐香豉粥汁合服者, 藉谷气以保胃气也. 服之不吐
,稍稍加服, 得快吐而即止者, 恐伤胃中元气也. 此方奏功之捷, 胜
于汗下, 所以三法鼎立, 今人不知岐伯, 仲景之精义, 置之不用, 可
胜惜哉!
治心下痞, 按之则痛, 脉浮滑者.
黄连一两 半夏半升 栝蒌实 ( 大者 ) 一个,, 右三味, 以水六升,
先煮栝蒌实, 取三升, 去滓; 纳诸药, 煮取二升, 分温三服.
【集注】程知曰: 此热结未深者, 在心下, 不似大结胸之高在心上.
按之痛, 比手不可近为轻. 脉之浮滑又缓于沉紧, 但痰饮素盛, 挟热
邪而内结, 所以脉见浮滑也. 以半夏之辛散之, 黄连之苦泻之, 栝蒌
之苦润涤之, 皆所以除热散结于胸中也. 先煮栝蒌, 分温三服, 皆以
缓治上之法. 程应旄曰: 黄连涤热, 半夏导饮, 栝蒌润燥, 合之以开
结气, 亦名曰陷胸者, 攻虽不峻, 而一皆直泻, 其胸里之实邪, 亦从
此夺矣.
治疗胸中痞塞坚硬、痰饮积聚，以及一切实邪阻滞，还有气逆上冲至咽喉导致呼吸不畅的症状，使用此方通过催吐来治疗。
瓜蒂（炒至黄色）一分，赤小豆一分。将以上两味药分别捣碎并筛成细粉，混合均匀。取一钱匕的药粉，用香豉一合，热汤七合，煮成稀粥状，滤去渣滓，取药汁与药粉混合，温热后一次性服下。如果未引起呕吐，可逐渐增加剂量，直到迅速吐出为止。
【注】胸中是清阳之气汇聚的脏腑部位，各种邪气侵入胸中，都会阻碍阳气不能宣通发散，从而导致：胸部胀满痞塞坚硬，热气上冲，口干烦躁，恶心欲吐，脉象数而急促，这是热邪郁结的表现。若见胸部胀满痞塞坚硬，气逆上冲至咽喉导致呼吸困难，手足寒冷，想吐却吐不出来，脉象迟而紧，这是寒邪郁结的表现。凡是胸中的寒热之邪，与气滞、痰饮相互郁结形成的病证，大概不是发汗或攻下的方法所能治疗的，必须使用酸苦涌泄的药物，因势利导向上涌吐，使上焦通畅，阳气恢复，痞塞坚硬即可消除，胸中得以调和。瓜蒂极苦，赤小豆味酸，两者相辅相成，能清除胸胃中的实邪，是催吐剂中的首选药物。配合香豉粥汁一起服用，是借助谷气来保护胃气。服药后若不吐，逐渐加量，一旦迅速吐出就立即停止，是担心损伤胃中的元气。此方见效迅速，胜过发汗和攻下法，所以汗、吐、下三法并列。如今的人不了解岐伯、张仲景的精深义理，将此方搁置不用，实在令人惋惜！
治疗心下部痞塞，按压时感到疼痛，脉象浮滑的症状。
黄连一两，半夏半升，栝蒌实（大的一个）。将以上三味药，用水六升，先煮栝蒌实，取三升药液，滤去渣滓；加入其他药物，再煮取二升药液，分三次温服。
【集注】程知说：这是热邪结聚尚不深的情况，病位在心下，不像大结胸证那样位置高在心上。按压才痛，比手不可触碰的程度要轻。脉象浮滑也比沉紧脉来得缓和，只是患者素来痰饮盛多，挟带热邪内结，所以脉象表现为浮滑。用半夏的辛散作用来疏散它，用黄连的苦寒作用来泻除它，用栝蒌的苦润作用来涤荡它，都是为了清除胸中的热邪并消散结聚。先煮栝蒌，分三次温服，都是采用缓治上焦的方法。程应旄说：黄连涤除热邪，半夏引导痰饮下行，栝蒌滋润燥结，合用可以开通结滞之气。之所以也称为“陷胸”，是因为虽然攻伐之力不猛烈，但都能直泻胸里的实邪，胸中的实邪也就由此被夺去了。
Treats chest oppression and hardness due to phlegm-fluid retention, all kinds of excess pathogenic factors, as well as rebellious Qi rushing to the throat causing dyspnea; use this formula to induce vomiting.
Gua Di (Caulis Momordicae Fructus, processed until yellow) 1 fen, Chi Xiao Dou (Vigna angularis Seed) 1 fen. The above two ingredients are each separately pounded and sifted into powder, then mixed together. Take one qian bi (a measure equivalent to approximately 1-2 grams) of the powder, with Xiang Chi (Fermented Soybean) 1 he, and hot water 7 he, boil into a thin porridge, strain to remove dregs, take the decoction, mix with the powder, warm it, and take in one dose. If vomiting does not occur, gradually increase the dosage, stopping once rapid vomiting is achieved.
[Annotation] The chest is the residence of clear Yang Qi. When various pathogens enter the chest, they obstruct the diffusion and distribution of Yang Qi, leading to: chest fullness, oppression, and hardness, rising heat sensation, dry mouth, irritability, nausea with urge to vomit, and a rapid, intermittent pulse, indicating Heat stagnation and accumulation. If there is chest fullness and oppression with hardness, Qi rebelling upward to the throat causing breathing difficulty, cold hands and feet, desire to vomit but inability to do so, and a slow, tight pulse, this indicates Cold stagnation and accumulation. Generally, diseases caused by the stagnation and accumulation of Cold or Heat in the chest, combined with Qi stagnation or fluid retention, cannot be treated by sweating or purging methods alone. One must employ sour and bitter agents that induce emesis, guiding the pathogen upward via its natural tendency. This allows the Upper Jiao to become unobstructed, Yang Qi to recover, chest oppression and hardness to dissipate, and the chest to harmonize. Gua Di is extremely bitter, and Chi Xiao Dou is sour; they complement each other effectively to eliminate excess pathogens in the chest and stomach, making them the premier agent among emetic formulas. The addition of Xiang Chi porridge juice serves to leverage the grain Qi to protect Stomach Qi. If vomiting does not occur after administration, the dosage is gradually increased, and stopped immediately upon achieving rapid vomiting, out of concern for damaging the Yuan Qi of the Stomach. This formula acts swiftly, surpassing the efficacy of sweating and purging methods, thus establishing the triad of sweating, vomiting, and purging. Today's practitioners, unaware of the profound principles of Qibo and Zhang Zhongjing, discard this formula without use, which is truly lamentable!
Treats epigastric oppression where pain is elicited upon palpation, accompanied by a floating and slippery pulse.
Huang Lian (Coptidis Rhizoma) 1 liang, Ban Xia (Pinelliae Tuber) 0.5 sheng, Gua Lou Shi (Trichosanthis Fructus, large size) 1 piece. The above three ingredients are boiled in 6 sheng of water. First, boil Gua Lou Shi until reduced to 3 sheng, then strain to remove dregs. Add the remaining herbs, boil until reduced to 2 sheng, and divide into three warm doses.
[Collected Annotations] Cheng Zhi states: This condition involves Heat accumulation that has not penetrated deeply, located in the epigastrium, unlike Da Jie Xiong (Major Chest Binding) which is located higher in the chest. Pain only upon pressing is milder than tenderness where the hand cannot approach. A floating and slippery pulse is more relaxed compared to a deep and tight pulse. It occurs because the patient inherently has abundant Phlegm-Fluid, which combines with Heat pathogens to accumulate internally, resulting in a floating and slippery pulse. The acridity of Ban Xia disperses the pathogen, the bitterness of Huang Lian drains the Heat, and the bitterness and moistening nature of Gua Lou Shi cleanses the accumulation; all serve to clear Heat and dissipate binding in the chest. Boiling Gua Lou Shi first and dividing the dose into three warm administrations both reflect the method of treating the Upper Jiao gently. Cheng Yingmao states: Huang Lian clears Heat, Ban Xia guides Fluid downward, and Gua Lou Shi moistens dryness. Together, they open stagnant Qi. It is also named "Xian Xiong" (Sinking the Chest) because although the attacking force is not severe, it directly drains the excess pathogens within the chest, thereby removing them.