脉阳微阴弦，即胸痹痛。（《金匮》寸口脉沉迟，关上小紧数，阳衰，胃以上阴寒结聚。
〔阳微〕栝蒌薤白白酒汤 栝蒌 薤白 白酒
〔不卧〕栝蒌薤白半夏汤 蒌 薤 酒 半夏
〔饮邪〕枳实薤白桂枝汤 枳 薤 桂 蒌 朴
〔虚寒〕人参汤 参 术 姜 草
〔利肺〕茯苓杏甘汤 苓 杏 草
〔疏胃〕橘枳生姜汤 橘 枳 姜
〔复阳〕薏苡附子散 薏仁 附子
〔痞逆〕桂枝姜枳汤 桂 姜 枳
〔温填〕乌头赤石脂丸 赤石脂 乌头 附子 干姜 川椒
〔温散〕细辛散 细辛 甘草（各六钱） 枳 姜 蒌 地 术（各一两） 桂心 茯苓（各两半）
酒服。
〔下气〕前胡汤 前胡 夏 芍 草（各二钱） 参 归 芩（各一钱） 姜（三片） 枣（三枚）
竹叶（一握）
〔理气〕治中汤 见三卷饮食。
〔下气〕下气汤 杏仁 槟榔 童便煎。
〔外治〕熨背散 乌头 桂 附 羌 辛 芎 椒 为末，绵裹，烘令暖。
〔阳虚〕苓桂白术甘草汤 苓 桂 术 草
〔阴凝〕理中汤 见一卷中风。
〔饮逆〕吴茱萸汤 见三卷呕吐。
〔喘逆〕桂枝加朴杏汤 桂 芍 草 朴 杏 姜 枣
〔络瘀〕旋复花汤 旋复 葱管 新绛
赵 有年，胸痹食阻，由举重伤气所致。脉小弱是阳结欲闭之候，述数月前膈痛，饮糜粥辄阻，自
谓膈噎已成。今作胸痹治，通其脘中欲闭之阳。参《金匮》法，栝蒌、薤白、桔梗、杏仁、橘白、丁香，用辛
滑温通，胸脘俱爽，食入不拒，竟进粥饭，然病初愈，恣意粉团干饭，非高年祝噎所宜。
马 病后脉弦胸痛，金不制木，当节劳戒怒。栝蒌、橘白、白芍、茯神、杏仁、炙草、煨姜，二服愈。
糜氏 中年脘痞，食减不饥，吐沫，渐成胸痹。乃上焦气阻，腑失通降。治者以为噎膈，专用术、附、
蔻、朴，燥脾破气劫津，渐致阴伤液涸，大便不通，下焦壅则上焦益加胀满，恐延关格重症矣。宜辛通苦降法。
蒌仁、杏仁、郁李仁、贝母、枳壳、苏梗、郁金汁、薤白汁，五七服胸膈舒，大便润而食进。
金氏 诸阳受气于胸中，喻氏谓胸中阳气所经，如离照当空，旷然无外，设地气一上，则晦塞有加。
今脘闭食胀，清阳不旋，浊气失降，午后足肿，阳益下陷矣。用升清降浊。桔梗、半夏、橘白、升麻、砂仁壳、
枳壳、茯苓，加姜枣煎。服愈。
赵 脉缓胸痹，阳气不舒。用苓桂术甘汤加砂仁壳，数服效。
蒋 胸右偏痛，呼号欲绝，日夕不能卧。医初疑胃气，疏香燥破气方，不应，改用乳香、当归、延胡、灵
脂，由气分兼入血分，乃益痛，更谓心痛彻背。予问曾呕吐否，曰未也。予谓痛不在心胃，乃胸痹耳。症由胸
中阳微，浊阴上干。仲景治胸痹喘息短气，用栝蒌薤白白酒汤通阳豁痰，复加半夏，正合斯症，仍加橘红，
一啜遂定。
脉象寸口部（阳）微弱，尺中部位（阴）弦紧，这是胸痹疼痛的征象。（出自《金匮要略》：寸口脉沉迟，关上脉小紧数，提示阳气衰微，胃脘以上有阴寒邪气结聚。）
【对应方剂与症状】
〔阳气微弱〕适用栝蒌薤白白酒汤。组成：栝蒌、薤白、白酒。
〔不能平卧〕适用栝蒌薤白半夏汤。组成：栝蒌、薤白、酒、半夏。
〔饮邪内停〕适用枳实薤白桂枝汤。组成：枳实、薤白、桂枝、栝蒌、厚朴。
〔虚寒证〕适用人参汤。组成：人参、白术、干姜、甘草。
〔宣利肺气〕适用茯苓杏甘汤。组成：茯苓、杏仁、甘草。
〔疏理胃气〕适用橘枳生姜汤。组成：橘皮、枳实、生姜。
〔恢复阳气〕适用薏苡附子散。组成：薏苡仁、附子。
〔痞满气逆〕适用桂枝姜枳汤。组成：桂枝、生姜、枳实。
〔温补填精〕适用乌头赤石脂丸。组成：赤石脂、乌头、附子、干姜、川椒。
〔温散寒邪〕适用细辛散。组成：细辛、甘草（各六钱），枳实、生姜、栝蒌、地黄、白术（各一两），桂心、茯苓（各一两半）。用酒送服。
〔降气〕适用前胡汤。组成：前胡、半夏、白芍、甘草（各二钱），人参、当归、黄芩（各一钱），生姜（三片），大枣（三枚），竹叶（一把）。
〔调理气机〕适用治中汤。（详见第三卷饮食病篇）
〔降气〕适用下气汤。组成：杏仁、槟榔，用童便煎服。
〔外治法〕适用熨背散。组成：乌头、桂枝、附子、羌活、细辛、川芎、花椒，研为末，用绵布包裹，加热后熨烫背部。
〔阳虚证〕适用苓桂白术甘草汤。组成：茯苓、桂枝、白术、甘草。
〔阴凝证〕适用理中汤。（详见第一卷中风病篇）
〔饮邪上逆〕适用吴茱萸汤。（详见第三卷呕吐病篇）
〔喘促气逆〕适用桂枝加朴杏汤。组成：桂枝、白芍、甘草、厚朴、杏仁、生姜、大枣。
〔络脉瘀阻〕适用旋复花汤。组成：旋覆花、葱管、新绛。
赵姓患者，患有胸痹且伴有食物阻滞感，这是由于举重导致损伤元气所致。脉象小弱，是阳气郁结欲闭的征候。自述几个月前膈间疼痛，喝稀粥米汤就发生阻滞，自己认为已经形成了噎膈病。现在按胸痹治疗，疏通胃脘中欲闭的阳气。参考《金匮要略》的方法，使用栝蒌、薤白、桔梗、杏仁、橘白、丁香，采用辛滑温通的治法，胸部和胃脘都感到舒畅，进食不再抗拒，最终能够正常进食粥饭。然而病初愈时，肆意食用粉团和干饭，这对于高龄之人预防噎膈是不适宜的。
马姓患者，病后脉象弦，胸痛，肺金不能制约肝木，应当节制劳累，戒除愤怒。使用栝蒌、橘白、白芍、茯神、杏仁、炙甘草、煨生姜，服用两剂后痊愈。
糜姓患者，中年时期胃脘痞闷，食欲减退且不觉得饿，吐口水沫，逐渐发展成胸痹。这是上焦气机阻滞，六腑失去通降功能。治疗者误认为是噎膈，专门使用白术、附子、豆蔻、厚朴等药物，燥湿健脾、破气劫伤津液，逐渐导致阴伤液涸，大便不通。下焦壅塞则上焦更加胀满，恐怕会延宕成关格重症。适宜采用辛通苦降的治法。使用栝蒌仁、杏仁、郁李仁、贝母、枳壳、苏梗、郁金汁、薤白汁，服用五到七剂后胸膈舒展，大便润通，食欲增进。
金姓患者，诸阳之气汇聚于胸中，喻嘉言先生认为胸中阳气所经行之处，如同太阳当空照耀，广阔无碍，如果地气（阴浊之气）上泛，则晦暗闭塞会更加严重。如今胃脘闭塞，食物胀滞，清阳之气不能旋转上升，浊气不能下降，午后足部浮肿，说明阳气进一步下陷。采用升清降浊的治法。使用桔梗、半夏、橘白、升麻、砂仁壳、枳壳、茯苓，加入生姜、大枣煎服。服药后痊愈。
赵姓患者，脉缓，患胸痹，阳气不得舒展。使用苓桂术甘汤加上砂仁壳，服用几剂后见效。
蒋姓患者，右侧胸部偏痛，呼号欲绝，日夜不能入睡。医生起初怀疑是胃气问题，开具香燥破气的方剂，无效；改用乳香、当归、延胡索、五灵脂，由气分兼入血分，反而疼痛加剧，甚至说心痛放射至背部。我询问是否曾呕吐，回答说没有。我说疼痛不在心和胃，而是胸痹。病症原因是胸中阳气微弱，浊阴之气上犯。张仲景治疗胸痹喘息短气，使用栝蒌薤白白酒汤通阳豁痰，再加半夏，正符合此症，仍然加入橘红，一次饮用后疼痛随即平息。
Pulse at the cun position (Yang) is faint, while the chi position (Yin) is wiry and tight; this indicates chest bi pain with obstruction. (From *Jingui Yaolue*: If the pulse at the cun position is deep and slow, and the pulse at the guan position is small, tight, and rapid, it indicates Yang deficiency and the accumulation of Yin-cold pathogenic factors above the stomach.)
[Corresponding Formulas and Symptoms]
[Yang Deficiency/Faintness]: Apply Gualou Xiebai Baijiu Tang (Trichosanthes Fruit, Rhizoma Allii Macrostemonis, and White Wine Decoction). Ingredients: Gualou (Fructus Trichosanthis), Xiebai (Rhizoma Allii Macrostemonis), Baijiu (White Wine).
[Inability to Lie Flat]: Apply Gualou Xiebai Banxia Tang (Trichosanthes Fruit, Rhizoma Allii Macrostemonis, and Pinellia Decoction). Ingredients: Gualou (Fructus Trichosanthis), Xiebai (Rhizoma Allii Macrostemonis), Jiu (Wine), Banxia (Rhizoma Pinelliae).
[Fluid Retention/Pathogenic Fluids]: Apply Zhishi Xiebai Guizhi Tang (Immature Bitter Orange, Rhizoma Allii Macrostemonis, and Cinnamon Twig Decoction). Ingredients: Zhishi (Fructus Aurantii Immaturus), Xiebai (Rhizoma Allii Macrostemonis), Guizhi (Ramulus Cinnamomi), Gualou (Fructus Trichosanthis), Poxiao (Cortex Magnoliae Officinalis).
[Deficient Cold]: Apply Renshen Tang (Ginseng Decoction). Ingredients: Renshen (Radix Ginseng), Baizhu (Rhizoma Atractylodis Macrocephalae), Ganjiang (Radix Zingiberis Recens), Gancao (Radix Glycyrrhizae).
[Benefiting Lung Qi]: Apply Fuling Xinggan Tang (Poria, Apricot Kernel, and Licorice Decoction). Ingredients: Fuling (Sclerotium Poriae), Xingren (Semen Armeniacae Amarum), Gancao (Radix Glycyrrhizae).
[Dredging Stomach Qi]: Apply Juqi Shengjiang Tang (Tangerine Peel, Immature Bitter Orange, and Fresh Ginger Decoction). Ingredients: Jupi (Pericarpium Citri Reticulatae), Zhishi (Fructus Aurantii Immaturus), Shengjiang (Rhizoma Zingiberis Recens).
[Restoring Yang]: Apply Yiyi Fuzi San (Coix Seed and Aconite Powder). Ingredients: Yiren (Semen Coicis), Fuzi (Radix Aconiti Lateralis Preparata).
[Fullness and Rebellious Qi]: Apply Guizhi Jiangzhi Tang (Cinnamon Twig, Ginger, and Immature Bitter Orange Decoction). Ingredients: Guizhi (Ramulus Cinnamomi), Jiang (Ginger), Zhishi (Fructus Aurantii Immaturus).
[Warming and Tonifying]: Apply Wutou Chishizhi Wan (Aconite and Red Kaolin Pill). Ingredients: Chishizhi (Kaolin), Wutou (Radix Aconiti), Fuzi (Radix Aconiti Lateralis Preparata), Ganjiang (Radix Zingiberis Recens), Chuanjiao (Pericarpium Zanthoxyli).
[Warming and Dispersing]: Apply Xixin San (Asarum Powder). Ingredients: Xixin (Herba Asari), Gancao (Radix Glycyrrhizae) [each 3g]; Zhishi (Fructus Aurantii Immaturus), Jiang (Ginger), Gualou (Fructus Trichosanthis), Dihuang (Radix Rehmanniae), Baizhu (Rhizoma Atractylodis Macrocephalae) [each 6g]; Guixin (Cortex Cinnamomi), Fuling (Sclerotium Poriae) [each 7.5g]. Take with wine.
[Descending Qi]: Apply Qianhu Tang (Peucedanum Decoction). Ingredients: Qianhu (Radix Peucedani), Xia (Pinellia), Shaoyao (Radix Paeoniae Alba), Gancao (Radix Glycyrrhizae) [each 1.2g]; Renshen (Radix Ginseng), Danggui (Radix Angelicae Sinensis), Huangqin (Radix Scutellariae) [each 0.6g]; Jiang (Ginger) [3 slices], Zao (Fructus Jujubae) [3 pieces], Zhuye (Folium Bambusae) [a handful].
[Regulating Qi]: Apply Zhizhong Tang (Middle-Regulating Decoction). (See Volume 3, Dietary Diseases section.)
[Descending Qi]: Apply Xiaqi Tang (Qi-Descending Decoction). Ingredients: Xingren (Semen Armeniacae Amarum), Binglang (Areca Seed). Decoct in Tongbian (Child's Urine).
[External Treatment]: Apply Yi Bei San (Back-Irrigating Powder). Ingredients: Wutou (Radix Aconiti), Gui (Cinnamon), Fu (Aconite), Qianghuo (Rhizoma Notopterygii), Xixin (Herba Asari), Xiong (Rhizoma Chuanxiong), Jiao (Zanthoxylum). Grind into powder, wrap in silk, warm, and apply as a hot compress to the back.
[Yang Deficiency]: Apply Linggui Zhugan Tang (Poria, Cinnamon Twig, Atractylodes, and Licorice Decoction). Ingredients: Fuling (Sclerotium Poriae), Guizhi (Ramulus Cinnamomi), Baizhu (Rhizoma Atractylodis Macrocephalae), Gancao (Radix Glycyrrhizae).
[Yin Congestion]: Apply Lizhong Tang (Middle-Warming Decoction). (See Volume 1, Wind-Stroke section.)
[Rebellious Fluids]: Apply Wuzhuyu Tang (Evodia Decoction). (See Volume 3, Vomiting section.)
[Asthma and Rebellious Qi]: Apply Guizhi Ji Poxiao Xingren Tang (Cinnamon Twig Decoction Augmented with Magnolia Bark and Apricot Kernel). Ingredients: Guizhi (Ramulus Cinnamomi), Shaoyao (Radix Paeoniae Alba), Gancao (Radix Glycyrrhizae), Poxiao (Cortex Magnoliae Officinalis), Xingren (Semen Armeniacae Amarum), Jiang (Ginger), Zao (Fructus Jujubae).
[Collateral Stasis]: Apply Xuanfuhua Tang (Inula Flower Decoction). Ingredients: Xuanfu (Flos Inulae), Congguan (Tube of Allium fistulosum), Xinjiang (New Crimson Dye/Safflower).
Patient Zhao suffered from chest bi with food obstruction, caused by injury from lifting heavy objects leading to qi damage. The pulse was small and weak, indicating a sign of Yang stagnation about to close. He reported diaphragmatic pain several months prior, where drinking congee or millet soup caused immediate obstruction, and he believed he had developed dysphagia (ge ye). Treating him now for chest bi, we unblocked the Yang in the epigastrium that was about to close. Referencing the method from *Jingui Yaolue*, we used Fructus Trichosanthis, Rhizoma Allii Macrostemonis, Radix Platycodi, Semen Armeniacae Amarum, Pericarpium Citri Reticulatae, and Flos Caryophylli, employing acrid, slippery, warm, and unblocking methods. Both the chest and epigastrium felt comfortable, food intake was no longer rejected, and he eventually resumed eating rice and porridge. However, immediately after recovery, he indulged in dough balls and dry rice, which is not suitable for an elderly person to prevent dysphagia.
Patient Ma suffered from wiry pulse and chest pain after illness. Metal (Lung) fails to control Wood (Liver); labor should be moderated, and anger avoided. We prescribed Fructus Trichosanthis, Pericarpium Citri Reticulatae, Radix Paeoniae Alba, Poria with Hostwood, Semen Armeniacae Amarum, Prepared Licorice, and Warm Ginger. Two doses resulted in cure.
Patient Mi, in middle age, experienced epigastric fullness, reduced appetite without hunger, and spitting of saliva, gradually developing into chest bi. This was due to Qi obstruction in the Upper Jiao and failure of the Fu organs to descend and circulate. The treating physician mistook it for dysphagia and exclusively used Atractylodes, Aconite, Cardamom, and Magnolia Bark, which dried the Spleen, broke Qi, and depleted fluids, gradually causing Yin injury and fluid exhaustion. Constipation ensued; Lower Jiao congestion exacerbated Upper Jiao distension, risking progression to severe Guan Ge (obstruction and reversal) syndrome. The appropriate method is Acrid Unblocking and Bitter Descending. We used Fructus Trichosanthis seed, Semen Armeniacae Amarum, Semen Pruni, Fructus Stemonaes, Fructus Aurantii, Caulis Elsholtziae, Juice of Curcuma aromatica, and Juice of Rhizoma Allii Macrostemonis. After five to seven doses, the chest and diaphragm relaxed, bowels became moist, and appetite improved.
Patient Jin: All Yang Qi receives its energy in the chest. Mr. Yu Jia Yan stated that the pathway of Yang Qi in the chest is like the sun shining in the sky, vast and unobstructed; if Earth Qi (Yin turbidity) rises, darkness and blockage increase. Currently, there is epigastric closure and food distension, Clear Yang fails to rotate upward, and Turbid Qi fails to descend. Swelling of the feet in the afternoon indicates further sinking of Yang. We employed the method of Ascending Clear and Descending Turbid. We prescribed Radix Platycodi, Rhizoma Pinelliae, Pericarpium Citri Reticulatae, Rhizoma Cimicifugae, Shell of Amomum villosum, Fructus Aurantii, and Poria, decocted with Ginger and Jujube. The patient recovered after taking it.
Patient Zhao: Pulse is slow, suffering from chest bi, Yang Qi is not free. We applied Linggui Zhugan Tang (Poria, Cinnamon Twig, Atractylodes, and Licorice Decoction) augmented with Shell of Amomum villosum. Several doses yielded efficacy.
Patient Jiang: Pain on the right side of the chest, crying out in despair, unable to lie down day or night. The doctor initially suspected Stomach Qi and prescribed aromatic, drying, Qi-breaking formulas, which failed. Then changed to Resina Olibani, Radix Angelicae Sinensis, Rhizoma Cyperi Rotundi, and Placenta Hominis (Wulingzhi), moving from Qi level to Blood level, yet pain increased, described as heart pain penetrating to the back. I asked if he had vomited; he said no. I stated the pain was not in the Heart or Stomach, but in Chest Bi. The pathology was due to faint Yang in the chest and invasion of Turbid Yin. Zhang Zhongjing treats chest bi with asthma and shortness of breath using Gualou Xiebai Baijiu Tang to unblock Yang and resolve phlegm, adding Banxia, which perfectly fits this case. Adding Hongju (Pericarpium Citri Reticulatae Rubrum), one sip settled the condition.