蜀椒一两（一法二分） 乌头（炮）一分 附子（炮）半两（一法一分） 赤石脂一
两（一法二分） 干姜一两（一法一分）
右五味，末之，蜜丸如桐子大。先食服一丸，日三服，不知稍加服。
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胸痹，缓急者，薏苡附子散主之。
【注】
缓急者，谓胸痹痛而时缓时急也，当审其缓急而施治。若缓而不急者，以栝蒌薤白白
酒汤主之。今时缓时急，故以薏苡附子散，急通痹气，以迅扫阴邪也。
薏苡仁十五两 大附子（炮）十枚
右二味，杵为散，服方寸匕，日三服。
【集解】
李□曰：缓急者，或缓而痛暂止，或急而痛。复作也。薏苡仁入肺利气，附子温中行
阳，为散服，则其效更速矣。
魏荔彤曰：薏苡下气宽胸，附子温中散邪，为邪盛甚而阳微亦甚者立法也。
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胸痹，胸中气塞、短气，茯苓杏仁甘草汤主之，橘枳姜汤亦主之。
【注】
胸痹胸中急痛，胸痹之重者也；胸中气塞，胸痹之轻者也。胸为气海，一有其隙，若
阳邪干之则化火，火性气开不大病痹也。若阴邪干之则化水，水性气阖，故令胸中气
塞短气，不足以息，而为胸痹也。水盛气者，则息促，主以茯苓杏仁甘草汤，以利其
水，水利则气顺矣。气盛水者，则痞塞，主以橘枳实生姜汤，以开其气，气开则痹通
矣。
【集注】
沈明宗曰：邪气阻塞胸膈，肺气不得往来流利，则胸中气塞短气，方用杏仁使肺气下
通，以茯苓导引湿下行，甘草和中，俾邪去则痹开而气不短矣，然胸痹乃胸中气塞，
土湿寒浊阴气以挟外邪上逆所致，故橘、枳、生姜善于散邪下浊，所以亦主之。
魏荔彤曰：此证乃邪实而正不甚虚，阳微而阴不甚盛。盖痹则气必塞，气塞则必短气
，前言之矣。今开降其气，而诸证自除矣。
蜀椒一两（另一种用法为二分） 乌头（炮制）一分 附子（炮制）半两（另一种用法为一分） 赤石脂一两（另一种用法为二分） 干姜一两（另一种用法为一分）
以上五味药，研成细末，用蜂蜜制成如梧桐子大小的丸剂。饭前服用一丸，每日三次，若无效则稍微增加剂量。
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胸痹病，疼痛发作有时缓解有时加剧的，用薏苡附子散主治。
【注】
所谓“缓急”，是指胸痹疼痛时而缓解、时而加剧，应当根据病情的缓急来施治。如果病情缓和而不剧烈，用栝蒌薤白白酒汤主治。如今病情时缓时急，所以用薏苡附子散，迅速通利痹阻之气，以迅疾扫除阴邪。
薏苡仁十五两 大附子（炮制）十枚
以上两味药，捣碎成散剂，每次服用一方寸匕，每日三次。
【集解】
李□说：所谓“缓急”，是有的情况疼痛暂时停止而表现为缓，有的情况疼痛剧烈而反复发作。薏苡仁入肺经以利气，附子温中行阳，制成散剂服用，疗效会更迅速。
魏荔彤说：薏苡仁下气宽胸，附子温中散邪，这是针对邪气极盛且阳气极度微弱的情况所立的法则。
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胸痹病，出现胸中气塞、短气的症状，用茯苓杏仁甘草汤主治，橘枳姜汤也主治。
【注】
胸痹伴有胸中急痛，是胸痹的重症；胸中气塞，是胸痹的轻症。胸为气海，一旦有间隙，若阳邪侵犯它则化为火，火的性质使气开散，不会造成大病痹阻。若阴邪侵犯它则化为水，水的性质使气闭合，因此导致胸中气塞、短气，呼吸不足，从而形成胸痹。若是水盛而气受阻，则呼吸急促，主治用茯苓杏仁甘草汤，以利水为主，水得利则气顺。若是气盛而水湿停聚，则痞塞不通，主治用橘枳实生姜汤，以开气为主，气开则痹阻通。
【集注】
沈明宗说：邪气阻塞胸膈，肺气不能往来流利，就会出现胸中气塞、短气，方中使用杏仁使肺气下通，用茯苓引导湿气下行，甘草调和脾胃，使得邪气去除则痹阻开通而气不短促。然而胸痹乃是胸中气塞，由脾土湿寒浊阴气挟带外邪上逆所致，所以橘皮、枳实、生姜善于散邪降浊，因此也主治此证。
魏荔彤说：此证属于邪气实而正气不甚虚，阳气微而阴气不甚盛。大概痹阻则气必塞，气塞则必短气，前面已经论述过。现在通过开降其气，各种症状自然消除。
Sichuan Pepper (Zanthoxyli Pericarpium) one liang (another method: two fen); Aconitum carmichaelii radix preparata (Chuanwu, prepared) one fen; Aconitum carmichaelii radix lateralis preparata (Fuzi, prepared) half a liang (another method: one fen); Halloysit Rubra (Chishizhi) one liang (another method: two fen); Zingiberis Rhizoma Recens (Ganjiang) one liang (another method: one fen).
The above five herbs are powdered and made into pills the size of paulownia seeds using honey. Take one pill before meals, three times a day. If there is no effect, slightly increase the dosage.
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In cases of Xiongbi (Chest Bi Syndrome) where pain alternates between remission and exacerbation, Yiyi Fuzi San (Coix Seed and Prepared Aconite Powder) is the primary treatment.
[Annotation]
"Huanji" (alternating remission and exacerbation) refers to chest bi pain that fluctuates in intensity. Treatment should be adjusted according to this fluctuation. If the condition is mild and not acute, Gualou Xiebai Baijiu Tang (Trichosanthes Fruit, Macrostemon Rhizome, and White Wine Decoction) is used. Since the current condition fluctuates, Yiyi Fuzi San is employed to rapidly unblock the obstructed qi and swiftly sweep away yin pathogens.
Coix Seed (Yiyiren) fifteen liang; Large Prepared Aconitum carmichaelii radix lateralis (Da Fuzi, prepared) ten pieces.
The above two herbs are pounded into a powder. Take one fangcunbi (a square-inch measure) per dose, three times a day.
[Collected Explanations]
Li [Name Redacted] stated: "Huanji" means sometimes the pain temporarily ceases (huan), and sometimes it is severe and recurs (ji). Coix Seed enters the Lung to benefit qi, while Prepared Aconite warms the middle and supports yang. Administered as a powder, its efficacy is even more rapid.
Wei Litong stated: Coix Seed directs qi downward and broadens the chest, while Prepared Aconite warms the middle and disperses pathogens. This formula is established for conditions where pathogenic factors are extremely abundant and yang qi is extremely deficient.
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In cases of Xiongbi (Chest Bi Syndrome) presenting with a sensation of qi obstruction in the chest and shortness of breath, Linggan Fuling Gancao Tang (Poria, Almond, and Licorice Decoction) is the primary treatment; Juqi Jiangtang (Tangerine Peel, Aurantium, and Ginger Decoction) is also indicated.
[Annotation]
Xiongbi accompanied by urgent pain in the chest represents a severe form of the syndrome; a sensation of qi obstruction in the chest represents a mild form. The chest is the Sea of Qi. Once there is a gap or deficiency, if yang pathogens invade, they transform into fire. Fire has the nature of expansion, so it does not typically cause severe bi obstruction. However, if yin pathogens invade, they transform into water. Water has the nature of closure, leading to qi obstruction in the chest, shortness of breath, insufficient respiration, and thus forming Xiongbi. If water abundance obstructs qi, breathing becomes rapid; the primary treatment is Linggan Fuling Gancao Tang to promote diuresis. When water is drained, qi flows smoothly. If qi abundance leads to water-dampness stagnation, palpitation and obstruction occur; the primary treatment is Juqi Jiangtang to open the qi. When qi opens, the bi obstruction resolves.
[Collected Annotations]
Shen Mingzong stated: Pathogens blocking the chest and diaphragm prevent the smooth flow of Lung qi, resulting in chest qi obstruction and shortness of breath. The formula uses Almond to direct Lung qi downward, Poria to guide dampness downward, and Licorice to harmonize the middle jiao. This ensures that once pathogens are expelled, the bi obstruction opens and shortness of breath ceases. However, Xiongbi involving chest qi obstruction is caused by spleen-earth damp-cold and turbid yin qi ascending along with external pathogens. Therefore, Tangerine Peel, Aurantium, and Ginger are effective in dispersing pathogens and descending turbidity, making them suitable for this condition as well.
Wei Litong stated: This syndrome involves excess pathogens but not significant deficiency of healthy qi, slight deficiency of yang but not excessive abundance of yin. Generally, bi obstruction leads to qi stagnation, and qi stagnation leads to shortness of breath, as previously discussed. By opening and descending the qi, all symptoms will naturally resolve.