（金匮 治胸痹，喘息咳唾，胸背痛，短气，寸口脉沉而迟，关上小紧数。）
栝蒌（一枚） 薤白（三两） 白酒（四升）
此上焦膻中药也。（膻中，两乳中间。经曰∶膻中者，臣使之官，喜乐出焉。）喻嘉言曰∶
胸中阳气，如离照当空，旷然无外。设地气一上，则窒塞有加。故知胸痹者，阴气上逆之候
也，仲景微则用薤白白酒以益其阳，（薤叶光滑，露亦难伫，故曰薤露。其性滑泄，能通气
滞，故胸痹下重并用之。）甚则用附子干姜以消其阴。世医不知胸痹为何病，习用豆蔻、木
香、诃子、三棱、神曲、麦芽等药，坐耗其胸中之阳，亦相悬矣。
加半夏，名栝蒌薤白半夏汤。（金匮）治胸痹不得卧，心痛彻背。〔徐忠可曰∶胸痹而加
以不得卧，此支饮之兼证。又心痛彻背，支饮原不痛，饮由胸痹而痛应背，故即前方加半夏
以去饮下逆（此条若无心痛彻背，竟是支饮矣。）〕除白酒，加枳实浓朴桂枝，名枳实薤白桂
枝汤。（金匮）治胸痹心中痞，留气结在胸，胸满，胁下逆，抢心。（徐忠可曰∶胸痹而加以
心中痞胸满，似痞与结胸之象。乃上焦阳微，而客气动膈也。注云，留气结在胸，即客气也。
更胁下逆抢心，是不独上焦虚，而中焦亦虚，阴邪得以据之，为逆为抢。故于薤白栝蒌，又
加枳朴以开其结，桂枝行阳以疏其肝。又曰人参汤亦主之者，病由中虚，去其太甚，即可补
正以化邪也。胸痹之虚，本阳气微，非营气虚也。阳无取乎补，宣而通之。即阳气畅，畅则
阳盛矣。故薤白方以行阳为主，不取补也。此曰人参汤亦主之，因胁下逆由中气虚，故兼补
中尔。人参汤即理中汤等分，而用干姜者尔。）
（出自《金匮要略》，治疗胸痹，症状包括喘息、咳嗽吐痰、胸背疼痛、呼吸短促，脉象表现为寸口脉沉而迟，关上脉小紧且数。）
这是上焦膻中穴区域的药物。（膻中，位于两乳之间。医经记载：膻中是臣使之官，主管喜乐之情。）喻嘉言说：
胸中的阳气，就像太阳高悬空中，广阔无垠。如果地气（阴邪）一旦上升，就会加重窒塞感。因此可知胸痹是阴气上逆的证候。张仲景在病情轻微时用薤白和白酒来补益阳气，（薤叶表面光滑，露水难以停留，所以称为“薤露”。其性质滑利通泄，能够疏通气机阻滞，所以治疗胸痹伴有下重感时并用此药。）病情严重时则用附子和干姜来消除阴寒。世间的医生不知道胸痹是什么病，习惯性地使用豆蔻、木香、诃子、三棱、神曲、麦芽等药物，白白耗损胸中的阳气，这相差太远了。
加入半夏，命名为栝蒌薤白半夏汤。（出自《金匮要略》）治疗胸痹导致无法平卧，心痛放射至背部。〔徐忠可说：胸痹加上无法平卧，这是支饮兼夹的症状。另外心痛放射至背部，支饮本身通常不痛，是因为饮邪由胸痹引发而疼痛牵连背部，所以在前方基础上加半夏以去除饮邪并降逆（如果没有心痛放射至背部这一条，这简直就是支饮了。）〕去掉白酒，加入枳实、厚朴、桂枝，命名为枳实薤白桂枝汤。（出自《金匮要略》）治疗胸痹心中痞塞，气结留在胸中，胸部胀满，胁下有气逆冲，冲击心脏。〔徐忠可说：胸痹加上心中痞塞和胸部胀满，类似痞证与结胸的表现。这是由于上焦阳气微弱，客气扰动膈膜。注释说，留气结在胸，就是客气。再加上胁下有气逆冲心脏，说明不仅上焦虚，中焦也虚，阴邪得以占据，形成逆气和抢心。所以在薤白和栝蒌的基础上，又加入枳实和厚朴来开散结滞，加入桂枝运行阳气以疏肝。又说人参汤也可以主治，是因为病由中焦虚弱引起，去除过于严重的邪气后，就可以通过补益正气来化解邪气。胸痹的虚，本质是阳气微弱，并非营气虚弱。阳气不需要补益，而是要宣通。只要阳气通畅，畅达则阳气旺盛。所以薤白方剂以行阳为主，不取补益之法。这里说人参汤也可主治，是因为胁下气逆源于中气虚弱，所以兼以补中。人参汤即理中汤等量配比，只是将人参换为干姜罢了。〕
(From *Jin Gui Yao Lue*, treating Chest Bi (Chest Obstruction), with symptoms of panting, coughing and expectoration, chest and back pain, shortness of breath; the pulse at Cun Kou is deep and slow, while the pulse at Guan Shang is slightly tight and rapid.)
Gualou (one fruit) Xiebai (three liang) Baijiu (four sheng)
This acts on the upper jiao Shanzhong area. (Shanzhong is located between the two breasts. The Classics state: "Shanzhong is the official of the minister and envoy, from which joy and happiness emerge.") Yu Jiayan stated:
The yang qi in the chest is like the sun shining in the sky, vast and boundless. If earth qi (yin pathogenic factors) rises even slightly, it will exacerbate the obstruction. Thus, we know that Chest Bi is a condition characterized by the counterflow of yin qi. When the condition is mild, Zhang Zhongjing uses Xiebai and Baijiu to benefit yang qi. (Xie leaves are smooth, making it difficult for dew to remain, hence the term "Xielu" [dew on xie]. Its nature is slippery and purgative, capable of unblocking qi stagnation; therefore, it is used together in cases of Chest Bi accompanied by a sensation of heaviness below.) When the condition is severe, Fuzi and Ganjiang are used to dissipate yin cold. Physicians of later generations do not understand what Chest Bi is, habitually using herbs such as Doukou, Muxiang, Hezi, Sanleng, Shenqu, and Maiya, thereby wastefully consuming the yang qi in the chest. This approach differs vastly from the correct treatment.
Adding Banxia, it is named Gualou Xiebai Banxia Tang. (From *Jin Gui Yao Lue*) It treats Chest Bi where the patient cannot lie down, and heart pain radiates to the back. [Xu Zhongke said: Chest Bi combined with the inability to lie down indicates a concurrent syndrome of Zhi Yin (fluid retention). Furthermore, heart pain radiating to the back suggests that while Zhi Yin itself typically does not cause pain, the fluid pathogen causes pain radiating to the back due to the underlying Chest Bi. Therefore, Banxia is added to the previous formula to eliminate fluid retention and direct rebellious qi downward. (Without the symptom of heart pain radiating to the back, this would essentially be a case of Zhi Yin.))] Removing Baijiu and adding Zhishi, Houpo, and Guizhi, it is named Zhishi Xiebai Guizhi Tang. (From *Jin Gui Yao Lue*) It treats Chest Bi with a feeling of fullness and blockage in the heart region, qi stagnation retained in the chest, chest distension, rebellious qi rising from the hypochondrium striking the heart. [Xu Zhongke said: Chest Bi accompanied by epigastric fullness and chest distension resembles the presentation of Pi Syndrome (glomus) or Jie Xiong (chest binding). This is due to deficient yang in the upper jiao, causing external pathogenic qi to disturb the diaphragm. The commentary states that "qi retained and knotted in the chest" refers to this external pathogenic qi. Additionally, rebellious qi from the hypochondrium striking the heart indicates that not only is the upper jiao deficient, but the middle jiao is also deficient, allowing yin pathogens to occupy the space and create rebellious and striking sensations. Therefore, Zhishi and Houpo are added to Xiebai and Gualou to open the knot, and Guizhi is used to circulate yang qi and soothe the liver. It is also stated that Renshen Tang can also be used to treat this, because the disease originates from middle jiao deficiency; after removing the excessive pathogen, one can tonify healthy qi to transform the pathogen. The deficiency in Chest Bi is fundamentally a deficiency of yang qi, not a deficiency of Ying qi (nutritive qi). Yang qi does not require tonification but rather promotion and unblocking. Once yang qi flows freely, it becomes abundant. Thus, the Xiebai formulas focus on promoting yang rather than tonifying. The mention here that Renshen Tang can also be used is because the rebellious qi from the hypochondrium stems from middle qi deficiency, so it simultaneously tonifies the middle. Renshen Tang is essentially Lizhong Tang in equal proportions, except that Ganjiang is used instead of Renshen.]