论曰虚极之人。为寒邪所客，气上奔迫。痹而不通。故为胸痹。其证坚满痞急。或胸中
如噎塞，或胸背皆痛。或胸满短气。咳唾引痛。烦闷白汗出。或心痛彻背。或肌痹皮痛
。是皆闭塞而不通也。夫脉当取太过与不及，阳微阴弦。则胸痹而痛。又曰胸痹之病。喘息
咳唾背痛短气。寸口脉沉而迟。关上小紧数是也。
论曰胸痹之病。其脉阳微而阴弦。阳虚则知在上焦。阴弦故令胸痹心痛。古方用理中汤。
取缓其中气则可也。然背者胸之府。或筑或悸或渴或腹痛或寒或腹满。其候不一。治当随宜
加损也。
治胸痹。理中汤方
人参 甘草（炙） 白术 干姜（炮各一两半）
上四味。粗捣筛。每服五钱匕。水二盏。煎至一盏，去滓温服。空心日午临卧各一，若
筑者。此为肾气动也，去术加桂二两。脐上筑吐多者，去术加生姜一两半。下多者。复用术。
悸者、加茯苓一两，渴者、加术二两一分。腹中痛者、加人参二两一分。寒者，加干姜二两
一分。腹满者去术加附子一枚，服汤后。食久以稀粥投之，衣复取微汗。
治胸痹。栝蒌汤方
栝蒌实（一枚并瓤用） 枳实（去瓤麸炒五枚） 半夏（汤洗去滑、四两）
上三味，锉如麻豆。每服五钱匕。白KT 浆二盏。薤白一握切。生姜一分拍破。同煎
至一
治胸痹。枳实汤方
枳实（去瓤麸炒半两） 栝蒌实（一枚并瓤用） 浓朴（去粗皮生姜汁炙三两）
上三味，锉如麻豆。每服五钱匕。水二盏。煎至一盏。去滓温服。空心日晚各一。
治胸痹。枳实汤方
枳实（去瓤麸炒四枚） 浓朴（去粗皮生姜汁炙三两）
上二味，粗捣筛。每服五钱匕。水二盏。入薤白一握切。煎至一盏。去滓温服。空心日
晚各一。
治胸痹。麝香散方
麝香（研一两） 牛黄（研半两） 犀角（镑一分）
上三味，捣研为散。每服二钱匕。温酒调下。空心日午临卧各一。
治胸痹。心下坚痞。急痛彻背。短气烦闷。白汗出。半夏汤方
半夏（汤洗七遍切焙二两半） 栝蒌实（一枚） 薤白（切二合）
上三味，锉如麻豆。每服五钱匕。水二盏。入生姜一分切碎。煎至一盏。去滓温服、日
三。
又方
枳壳（去瓤麸炒三十枚）
上一味。捣罗为散。食前米饮调下。方寸匕。日三夜一。
又方加桂等分。
治胸痹切痛。栀子汤方
栀子仁（二两） 附子（炮裂去皮脐一两）
上二味。 咀。每服三钱匕。水一盏。薤白三寸。同煎至五分。去滓温服。
论述说：极度虚弱的人，被寒邪侵袭，气机上冲逼迫，导致痹阻而不通畅，所以形成胸痹。其症状表现为胸部坚硬胀满、痞塞急迫，或者感觉胸中像有噎塞感，或者胸背都疼痛，或者胸闷短气，咳嗽吐痰时牵引作痛，心烦闷乱并出冷汗，或者心痛放射至背部，或者肌肉痹痛、皮肤疼痛。这些都是闭塞不通的表现。诊脉时应当取太过与不及的脉象，如果寸部脉微（阳微）而尺部脉弦（阴弦），就会出现胸痹且疼痛。又说，胸痹病的表现是喘息、咳嗽吐痰、背痛、短气，其脉象为寸口脉沉而迟，关部脉小紧数。
论述说：胸痹病的脉象是阳部脉微而阴部脉弦。阳虚可知病位在上焦，阴弦故导致胸痹和心痛。古方使用理中汤，旨在缓和其中焦之气即可。然而背部是胸部的府库，症状或筑动感、或悸动、或口渴、或腹痛、或畏寒、或腹部胀满，候证不一，治疗应当根据具体情况加减药物。
治疗胸痹，理中汤方
人参 甘草（炙） 白术 干姜（炮制，各一两半）
以上四味药，粗捣筛过。每次服用五钱匕，用水二盏，煎煮至一盏，去渣温服。空腹、中午、临睡前各服一次。如果有筑动感，这是肾气动扰所致，去掉白术，加入桂枝二两。脐上筑动感且呕吐多者，去掉白术，加入生姜一两半。腹泻多者，重新使用白术。心悸者，加入茯苓一两；口渴者，加入白术二两一分。腹中痛者，加入人参二两一分。畏寒者，加入干姜二两一分。腹部胀满者，去掉白术，加入附子一枚。服药后，隔一段时间后喝稀粥调养，穿衣保暖以取得微微出汗。
治疗胸痹，栝蒌汤方
栝蒌实（一枚，连同瓤一起用） 枳实（去瓤，麸炒，五枚） 半夏（热水洗去滑腻，四两）
以上三味药，锉碎如麻豆大小。每次服用五钱匕，用米浆二盏，薤白一握切碎，生姜一分拍破，同煎至一盏。
治疗胸痹，枳实汤方
枳实（去瓤，麸炒，半两） 栝蒌实（一枚，连同瓤一起用） 厚朴（去粗皮，生姜汁炙，三两）
以上三味药，锉碎如麻豆大小。每次服用五钱匕，用水二盏，煎煮至一盏，去渣温服。空腹、晚上各服一次。
治疗胸痹，枳实汤方
枳实（去瓤，麸炒，四枚） 厚朴（去粗皮，生姜汁炙，三两）
以上两味药，粗捣筛过。每次服用五钱匕，用水二盏，加入薤白一握切碎，煎煮至一盏，去渣温服。空腹、晚上各服一次。
治疗胸痹，麝香散方
麝香（研细，一两） 牛黄（研细，半两） 犀角（镑片，一分）
以上三味药，捣研成散剂。每次服用二钱匕，用温酒调服。空腹、中午、临睡前各服一次。
治疗胸痹，心下坚硬痞塞，急痛放射至背部，短气烦闷，出冷汗，半夏汤方
半夏（热水洗七遍，切碎焙干，二两半） 栝蒌实（一枚） 薤白（切碎，二合）
以上三味药，锉碎如麻豆大小。每次服用五钱匕，用水二盏，加入生姜一分切碎，煎煮至一盏，去渣温服，每日三次。
又一方
枳壳（去瓤，麸炒，三十枚）
以上一味药，捣罗成散剂。饭前用米饮调服一方寸匕，每日三次，夜间一次。
又一方，加桂枝等分。
治疗胸痹剧烈疼痛，栀子汤方
栀子仁（二两） 附子（炮裂，去皮脐，一两）
以上两味药，咀碎。每次服用三钱匕，用水一盏，薤白三寸，同煎至五分，去渣温服。
Discourse states: In individuals who are extremely deficient, when invaded by cold pathogenic factors, qi rushes upward and presses, causing obstruction and lack of free flow, thus forming Chest Bi (Thoracic Obstruction). The manifestations include hardness and fullness in the chest, stuffiness and urgency, or a sensation of blockage in the chest, or pain throughout the chest and back, or chest fullness with shortness of breath, coughing and expectoration inducing pain, irritability and restlessness with cold sweat, or heart pain radiating to the back, or muscle Bi (obstruction) and skin pain. These are all signs of blockage and lack of free flow. When taking the pulse, one should look for excess and deficiency patterns; if the Yang position is faint (Yang Wei) and the Yin position is wiry (Yin Xian), Chest Bi with pain will occur. It is also stated that the disease of Chest Bi presents with wheezing, coughing and expectoration, back pain, and shortness of breath; the pulse at the Cun Kou position is deep and slow, while the Guan position is small, tight, and rapid.
Discourse states: The pulse of Chest Bi is characterized by a faint Yang position and a wiry Yin position. Deficiency of Yang indicates the pathology is in the Upper Jiao (Upper Burner); the wiry Yin causes Chest Bi and heart pain. Ancient formulas use Lizhong Tang (Regulate the Middle Decoction) to gently harmonize the Qi of the Middle Jiao. However, the back is the mansion of the chest; symptoms may include a pounding sensation, palpitations, thirst, abdominal pain, aversion to cold, or abdominal fullness. Since the presentations vary, treatment should be adjusted according to specific indications.
To treat Chest Bi, Lizhong Tang Formula:
Ren Shen (Ginseng Radix et Rhizoma), Zhi Gan Cao (Prepared Licorice Root), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Pao Gan Jiang (Prepared Dried Ginger) [each 1 liang 5 qian].
The above four ingredients are coarsely crushed and sieved. Each dose consists of 5 Qian Bi, decocted in 2 Zhan of water until reduced to 1 Zhan. Strain and take warm. Administer on an empty stomach, at noon, and before bed. If there is a pounding sensation, this indicates disturbance of Kidney Qi; remove Bai Zhu and add Gui Zhi (Cinnamon Twig) 2 liang. If there is a pounding sensation above the umbilicus with excessive vomiting, remove Bai Zhu and add Sheng Jiang (Fresh Ginger) 1 liang 5 qian. If there is excessive diarrhea, reuse Bai Zhu. For palpitations, add Fu Ling (Poria) 1 liang; for thirst, add Bai Zhu 2 liang 1 fen. For abdominal pain, add Ren Shen 2 liang 1 fen. For aversion to cold, add Gan Jiang (Dried Ginger) 2 liang 1 fen. For abdominal fullness, remove Bai Zhu and add Fu Zi (Aconite Lateralis Radix Praeparata) 1 piece. After taking the decoction, consume thin porridge after some time, and keep warm with clothing to induce slight sweating.
To treat Chest Bi, Gualou Tang Formula:
Gua Lou Shi (Trichosanthis Fructus, including pulp) [1 fruit], Zhi Shi (Immature Bitter Orange Fruit, pulp removed, bran-fried) [5 fruits], Ban Xia (Pinellia Tuber, washed in hot water to remove slipperiness) [4 liang].
The above three ingredients are cut into pieces the size of hemp seeds. Each dose consists of 5 Qian Bi, decocted in 2 Zhan of rice liquid (Mi Jiang), with 1 handful of Xie Bai (Allium Macrostemon Bulb) cut, and 1 Fen of Sheng Jiang (Fresh Ginger) crushed. Decoct together until reduced to 1 Zhan.
To treat Chest Bi, Zhishi Tang Formula:
Zhi Shi (Immature Bitter Orange Fruit, pulp removed, bran-fried) [0.5 liang], Gua Lou Shi (Trichosanthis Fructus, including pulp) [1 fruit], Hou Po (Magnolia Bark, coarse skin removed, ginger juice fried) [3 liang].
The above three ingredients are cut into pieces the size of hemp seeds. Each dose consists of 5 Qian Bi, decocted in 2 Zhan of water until reduced to 1 Zhan. Strain and take warm. Administer on an empty stomach and in the evening.
To treat Chest Bi, Zhishi Tang Formula:
Zhi Shi (Immature Bitter Orange Fruit, pulp removed, bran-fried) [4 fruits], Hou Po (Magnolia Bark, coarse skin removed, ginger juice fried) [3 liang].
The above two ingredients are coarsely crushed and sieved. Each dose consists of 5 Qian Bi, decocted in 2 Zhan of water with 1 handful of Xie Bai (Allium Macrostemon Bulb) cut. Decoct until reduced to 1 Zhan. Strain and take warm. Administer on an empty stomach and in the evening.
To treat Chest Bi, Shexiang San Formula:
She Xiang (Musk) [ground, 1 liang], Niu Huang (Calculus Bovis) [ground, 0.5 liang], Xi Jiao (Rhinoceros Horn) [sliced, 1 fen].
The above three ingredients are pounded and ground into a powder. Each dose consists of 2 Qian Bi, taken with warm wine. Administer on an empty stomach, at noon, and before bed.
To treat Chest Bi, with hardness and stuffiness below the heart, urgent pain radiating to the back, shortness of breath, irritability, and cold sweat, Banxia Tang Formula:
Ban Xia (Pinellia Tuber, washed seven times in hot water, cut and dried) [2.5 liang], Gua Lou Shi (Trichosanthis Fructus) [1 fruit], Xie Bai (Allium Macrostemon Bulb, cut) [2 He].
The above three ingredients are cut into pieces the size of hemp seeds. Each dose consists of 5 Qian Bi, decocted in 2 Zhan of water with 1 Fen of Sheng Jiang (Fresh Ginger) cut. Decoct until reduced to 1 Zhan. Strain and take warm. Take three times daily.
Another formula:
Zhi Ke (Aurantii Fructus Immaturus, pulp removed, bran-fried) [30 fruits].
The above single ingredient is pounded and sifted into a powder. Take 1 Fang Cun Bi with Mi Yin (rice drink) before meals. Take three times daily and once at night.
Another formula: Add Gui Zhi (Cinnamon Twig) in equal proportions.
To treat severe pain in Chest Bi, Zhizi Tang Formula:
Zhi Zi Ren (Gardeniae Fructus Seed) [2 liang], Fu Zi (Aconite Lateralis Radix Praeparata, cracked, skin and navel removed) [1 liang].
The above two ingredients are chewed/crushed. Each dose consists of 3 Qian Bi, decocted in 1 Zhan of water with 3 Cun of Xie Bai (Allium Macrostemon Bulb). Decoct until reduced to 0.5 parts. Strain and take warm.