师曰∶夫脉当取太过不及，阳微阴弦，即胸痹而痛，所以然者，责其极虚也，今阳虚
知在上焦，所以胸痹心痛者，以其阴弦故也。
【注】脉太过则病，不及亦病，故脉当取太过不及而候病也。阳微，寸口脉微也，阳
得阴脉为阳不及，上焦阳虚也；阴弦，尺中脉弦也，阴得阴脉为阴太过，下焦阴实也。凡
阴实之邪，皆得以上乘阳虚之胸，所以病胸痹心痛。胸痹之病轻者即今之胸满，重者即今之胸
痛也。
【集注】李 曰∶《内经》云∶胃脉平者。不可见，太过不及则病见矣。寸脉为阳，以
候上焦，正应胸中部分，若阳脉不及而微，则为阳虚，主病上焦，故受病胸痹。尺脉太过而弦，则为
阴盛，知在下焦，故上逆而为痛也。
尤怡曰∶上焦为阳之位，而微脉为虚之甚，故曰责其极虚。
平人无寒热，短气不足以息者，实也。
【注】平人，无病之人也。无寒热，无表邪也。平人无故而有短气不足以息之证，不
可责其虚也，此必邪在胸中，痹而不通，阻碍呼吸，当责其实也。
【集注】李 曰∶上节云责其极虚，此又云实何也？经云∶邪之所凑，其气必虚。留
而不去，其病为实是也。然短气与少气有辨，少气者，气少不足于言，《内经》云∶言而微，
终日乃复言者，此夺气是也。短气者，气短不能相续，似喘非喘，若有气上冲，故似喘
而不摇肩，似呻吟而无痛是也。
尤怡曰∶平人，素无疾之人也。无寒热，无新邪也。而乃短气不足以息，当是里气因
邪而实，或痰、或食、或饮碍其升降之气而然也。
胸痹之病，喘息咳唾，胸背痛，短气，寸口脉沉而迟，关上小紧数，栝萎薤白白酒汤
主之。
【注】寸口脉沉而迟，沉则为里气滞，迟则为脏内寒，主上焦脏寒气滞也。关上小紧
而疾，小为阳虚，紧疾寒痛，是主中焦气急寒痛也。胸背者，心肺之宫城也。阳气一虚，
诸寒阴邪得以乘之，则胸背之气痹而不通，轻者病满，重者病痛，理之必然也，喘息、咳
唾、短气证之必有也。主之以栝萎薤白白酒汤者，用辛以开胸痹，用温以行阳气也。
【集注】赵良曰∶凡寒浊之邪，滞于上焦，则阻其上下往来之气，塞其前后阴阳之
位，遂令为喘息、为咳唾。为痛、为短气也。
程林曰∶胸中者，心肺之分，故作喘息咳唾也。诸阳受气于胸，而转行于背，气痹
不行，则胸背为痛，而气为短也。
栝篓薤白白酒汤方
栝蒌实（捣，一枚） 薤白（半斤） 白酒（七升）
上三味，同煮取二升，分温再服。
胸痹不得卧，心痛彻背者，栝萎薤白半夏汤主之。
【注】上条胸痹胸背痛，尚能卧，以痛微而气不逆也。此条心痛彻背不
得卧，是痛甚而气上逆也，故仍用前方，大加半夏以降逆也。
【集注】尤怡曰∶胸痹不得卧，是胸中痛甚，肺气上而不下也；心痛彻背，是气闭塞
而前后不通故也，其痹为尤甚矣。所以然者，有痰饮以为之援也。
栝萎薤白半夏汤方
栝萎实（捣，一枚） 薤白（三两） 半夏（半升） 白酒（一斗）
上四味，同煮取四升，温服一升，日三服。
【集解】魏荔彤曰∶用半夏之苦，以开郁行气。痛甚则结甚，故减薤白之湿，用半夏
之燥，更能使胶腻之物，随汤而荡涤也。日三服，亦从上治者，应徐取频服也。
心痛彻背，背痛彻心，乌头赤石脂丸主之。
【注】上条心痛彻背，尚有休止之时，故以栝萎薤白白酒加半夏汤平剂治之；此条心
痛彻背，背痛彻心，是连连痛而不休，则为阴寒邪甚，浸浸乎阳光欲熄，非薤白白酒之
所能治也，故以乌头赤石脂九主之。方中乌、附、椒、姜，一派大辛大热，别无他顾，峻
逐阴邪而已。
【集注】李 曰∶心痛在内而彻背，则内而达于外矣；背痛在外而彻心，则外而入于
内矣。故既有附子之温，而复用乌头之迅，佐干姜行阳。大散其寒，佐蜀椒下气，大开其
郁，恐过于大散大开，故复佐赤石脂入心，以固涩而收阳气也。
赤石脂丸方
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）
上五味，末之，蜜丸如桐子大。先食服
一丸，日三服，不知稍加服。
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。
薏苡附子散方
薏苡仁（十五两） 大附子（炮，十枚）
上二味，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。
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，主以橘皮枳实生姜汤，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。
茯苓杏仁甘草汤方
茯苓（三两） 杏仁（五十个） 甘草（一两）
上三味，以水一斗，煮取五升，温服一升，日三服，不瘥更服。
橘皮枳实生姜汤方
橘皮（一斤） 枳实（三两） 生姜（半斤）
上三味，以水五升，煎取二升，分温再服。
胸痹，心中痞气，气结在胸，胸满，胁下逆抢心，枳实薤白桂枝汤主之，人参
汤亦主之。
【注】心中，即心下也。胸痹病，心下痞气，闷而不通者虚也。若不在心下而气结在
胸，胸满连胁下，气逆撞心者实也。实者用枳实薤白桂枝汤主之，倍用枳、朴者，是以
破气降逆为主也。虚者用人参汤主之，即理中汤，是以温中补气为主也。由此可知痛有
补法，塞因塞用之义也。
【集注】魏荔彤曰∶胸痹自是阳微阴盛矣。心中痞气，气结在胸，正胸痹之病状也。再
连胁下之气，俱逆而抢心，则痰饮水气，俱乘阴寒之邪，动而上逆，胸胃之阳气全难支
拒矣。故用枳实薤白桂枝汤，行阳开郁，温中降气。犹必先后煮治，以融和其气味，俾
缓缓荡除其结聚之邪也。再或虚寒已甚，无敢恣为开破者，故人参汤亦主之，以温补其
阳，使正气旺而邪气自消也。
尤怡曰∶心中痞气，气痹而成痞也。胁下逆抢心，气逆不降，将为中之害也。用此
二方者，一以去邪之实，即以安正；一以养阳之虚，即以逐阴。是在审其病之新久，与
气之虚实而决之。
枳实薤白桂枝汤方
枳实（四枚） 浓朴（四两） 薤白（半斤） 桂枝（一两） 栝蒌实（捣，一枚）
上五味，以水五升，先煮枳实、浓朴，取三升，去滓，内诸药，煮数沸，分温三服。
人参汤方
人参 甘草 干姜 白术（各三两）
上四味，以水八升，煮取三升，温服一升，日三服。
心中痞，诸逆，心悬痛，桂枝生姜枳实汤主之。
【注】心中痞，即上条心中痞气也。诸逆，诸气上逆也。上条之逆，不过撞心而不痛；此
条之逆，则心悬而空痛，如空中悬物动摇而痛也。用桂枝生姜积实汤，通阳气破逆气，痛
止痞开矣。
【集注】程林曰∶诸逆如胁下逆抢心之类，邪气独留于上，则心悬痛。
尤怡曰∶诸逆，该痰饮客气而言。心悬痛，谓如悬物动摇而痛，逆气使然也。
桂枝生姜枳实汤方
桂枝（三两） 生姜（三两） 枳实（五枚）
上三味，以水六升，煮取三升，分温三服。
【集解】赵良曰∶枳实。生姜，原以治气塞、况于痞乎？故较前条稍减轻分两，使痞
者下其气以开之。悬痛属饮者，得生姜以散之，既足建功矣。乃去橘皮而用桂枝者，以
所逆非一，或通阳气，或破结气，或散寒气，皆能去痹也。
老师说：脉诊应当辨别太过与不及。寸口脉微（阳气虚弱）而尺中脉弦（阴气盛实），这就是胸痹心痛的原因。之所以如此，是因为上焦阳气极度虚弱。如今知道是上焦阳虚导致胸痹心痛，正是因为下焦阴寒太盛所致。
【注】脉象太过则致病，不及也会致病，所以诊脉应当通过观察太过与不及来候察疾病。阳微，指寸口脉微弱，阳分出现阴脉属于阳不及，即上焦阳虚；阴弦，指尺中脉弦紧，阴分出现阴脉属于阴太过，即下焦阴实。凡是阴实之邪，都能上乘侵袭阳虚的胸部，从而导致胸痹心痛。胸痹病轻者就是现在的胸闷，重者就是现在的胸痛。
【集注】李氏说：《内经》讲：胃脉平和时是不可见的，一旦出现太过或不及，病症就显现了。寸脉属阳，用来候察上焦，正对应胸中部位，如果阳脉不及而微弱，就是阳虚，主病在上焦，所以受病形成胸痹。尺脉太过而弦，就是阴盛，可知病在下焦，所以上逆而导致疼痛。
尤怡说：上焦是阳气所在的位置，而微脉表示极度的虚弱，所以说责任在于极度的虚弱。
健康人没有恶寒发热的表证，却感到短气、呼吸急促不足以息，这是实证。
【注】平人，指无病的人。无寒热，指没有表邪。平人无故出现短气、呼吸不足的证候，不能归咎于虚证，这必定是邪气在胸中，痹阻不通，阻碍呼吸，应当归咎于实证。
【集注】李氏说：上一节说责任在于极度的虚弱，这一节又说实证，为什么呢？经文说：邪气聚集的地方，正气必然虚弱。邪气停留不去，其病就转为实证。然而短气与少气是有区别的，少气是指气少不足以说话，《内经》说：说话声音微弱，整天才能再说一句，这是夺气（元气大伤）。短气是指气短不能连续，像喘但不是喘，好像有气上冲，所以像喘但不摇肩，像呻吟但没有疼痛。
尤怡说：平人，指平时没有疾病的人。无寒热，指没有新感的外邪。但却短气不足以息，应当是里气因为邪气而变得实滞，或者是痰、食、饮阻碍了升降之气所致。
胸痹病，表现为喘息、咳嗽吐唾沫、胸背疼痛、短气，寸口脉沉而迟，关上脉小紧且数，用栝楼薤白白酒汤主治。
【注】寸口脉沉而迟，沉表示里气滞涩，迟表示内脏有寒，主上焦脏寒气滞。关上脉小紧而疾，小表示阳虚，紧和疾表示寒痛，主中焦气急寒痛。胸背是心肺的宫城。阳气一旦虚弱，各种寒邪阴邪就能乘虚而入，导致胸背之气痹阻不通，轻者病满闷，重者病疼痛，这是必然的道理。喘息、咳嗽吐唾、短气是这些证候中必然存在的。使用栝楼薤白白酒汤为主治方剂，是用辛味药来开泄胸痹，用温性药来运行阳气。
【集注】赵良说：凡是寒浊之邪，停滞在上焦，就会阻滞上下往来的气，堵塞前后阴阳的位置，于是导致喘息、咳嗽吐唾、疼痛、短气。
程林说：胸中是心肺的分野，所以出现喘息咳嗽吐唾。诸阳之气受气于胸中，并转行于背部，气痹阻不行，就会导致胸背疼痛，气机短促。
栝楼薤白白酒汤方
栝楼实（捣碎，一枚） 薤白（半斤） 白酒（七升）
以上三味药，一起煮取二升药液，分两次温服。
【注】上一条所述胸痹胸背痛，尚能平卧，是因为疼痛轻微且气不逆乱。这一条心痛放射至背部且不能平卧，说明疼痛剧烈且气机上逆，所以仍用前方，大量加入半夏以降逆气。
【集注】尤怡说：胸痹不能平卧，是胸中疼痛剧烈，肺气上逆而不能下行；心痛放射至背部，是气机闭塞，前后不通，其痹阻更为严重。之所以这样，是因为有痰饮作为依托。
栝楼薤白半夏汤方
栝楼实（捣碎，一枚） 薤白（三两） 半夏（半升） 白酒（一斗）
以上四味药，一起煮取四升药液，每次温服一升，每日三次。
【集解】魏荔彤说：使用半夏的苦味，以开郁结、行气机。疼痛剧烈则结聚严重，所以减少薤白的湿性，使用半夏的燥性，更能使胶腻之物随汤剂荡涤清除。每日三次服用，也是从上焦治疗的思路，应该缓慢取效、频繁服药。
【注】上一条心痛放射至背部，尚有休止的时候，所以用栝楼薤白白酒汤加半夏汤这种平和的方剂治疗；这一条心痛放射至背部，背痛放射至心前区，是连连疼痛不止，说明阴寒邪气极盛，阳光即将熄灭，不是薤白白酒所能治疗的，所以用乌头赤石脂丸主治。方中乌头、附子、花椒、干姜，一派大辛大热，没有其他顾虑，只是峻烈地驱逐阴邪。
【集注】李氏说：心痛在内而放射至背，则是内达于外；背痛在外而放射至心，则是外入于内。所以既有附子的温性，又复用乌头的迅捷，佐以干姜通行阳气，大散其寒；佐以蜀椒降气，大开其郁结。担心过于大散大开，所以又佐以赤石脂入心，以固涩收敛阳气。
赤石脂丸方
蜀椒（一两一分，另一法二分） 乌头（炮制，一分） 附子（炮制，半两一分，另一法一分） 赤石脂（一两一分，另一法二分） 干姜（一两一分，另一法一分）
以上五味药，研成末，蜜炼为丸，如梧桐子大小。饭前服一丸，每日三次，无效可稍增加剂量。
【注】缓急，指胸痹疼痛时而缓解时而紧急。应当审察其缓急而施治。如果缓和而不紧急，用栝楼薤白白酒汤主治。如今时缓时急，所以用薏苡附子散，迅速通利痹气，以迅扫阴邪。
薏苡附子散方
薏苡仁（十五两） 大附子（炮制，十枚）
以上两味药，捣杵为散，每次服一方寸匕，每日三次。
【集解】李氏说：缓急，有时缓和而疼痛暂时停止，有时紧急而疼痛复发。薏苡仁入肺利气，附子温中行阳，制成散剂服用，疗效更快。
魏荔彤说：薏苡仁下气宽胸，附子温中散邪，这是为邪气极盛而阳气也极度微弱的情况立法的。
胸痹，胸中气塞、短气，用茯苓杏仁甘草汤主治，橘皮枳实生姜汤也可主治。
【注】胸痹胸中急痛，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，若阳邪侵犯则化火，火性炎上开泄，不会导致痹证。若阴邪侵犯则化水，水性闭阖，所以导致胸中气塞短气，呼吸不足，而形成胸痹。水盛气滞者，则呼吸急促，主治用茯苓杏仁甘草汤，以利水为主，水去则气顺。气盛水停者，则痞塞，主治用橘皮枳实生姜汤，以开气为主，气开则痹通。
【集注】沈明宗说：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，以茯苓引导湿气下行，甘草调和脾胃，使邪去则痹开而气不短。然而胸痹乃是胸中气塞，因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，因此也能主治。
魏荔彤说：此证乃邪实而正气不甚虚，阳微而阴不甚盛。既然痹阻则气必塞，气塞则必短气，前面已经说过了。现在开降其气，各种症状自然消除。
茯苓杏仁甘草汤方
茯苓（三两） 杏仁（五十个） 甘草（一两）
以上三味药，用水一斗，煮取五升，温服一升，每日三次，不好再服。
橘皮枳实生姜汤方
橘皮（一斤） 枳实（三两） 生姜（半斤）
以上三味药，用水五升，煎取二升，分两次温服。
胸痹，心中痞气，气结在胸，胸满，胁下气逆上抢心，用枳实薤白桂枝汤主治，人参汤也可主治。
【注】心中，即心下。胸痹病，心下痞气，闷而不通的是虚证。如果不在心下而是气结在胸，胸满连及胁下，气逆撞心的是实证。实证用枳实薤白桂枝汤主治，倍用枳实、厚朴，是以破气降逆为主。虚证用人参汤主治，即理中汤，是以温中补气为主。由此可知疼痛也有补法，体现了“塞因塞用”的意义。
【集注】魏荔彤说：胸痹自然是阳微阴盛。心中痞气，气结在胸，正是胸痹的病状。再加上胁下的气，都逆而上抢心，则痰饮水气，都乘阴寒之邪，动而上逆，胸胃的阳气完全难以抵御。所以用枳实薤白桂枝汤，行阳开郁，温中降气。还必须先后煎煮，以融和其气味，使缓缓荡除其结聚之邪。或者如果虚寒已甚，不敢肆意攻破，所以人参汤也可主治，以温补其阳，使正气旺盛而邪气自消。
尤怡说：心中痞气，气痹而成痞。胁下气逆上抢心，气逆不降，将成为内部的危害。使用这两个方剂，一个是以去除邪实来安正，一个是以养护阳虚来驱逐阴邪。这取决于审察疾病的久暂，以及气的虚实来决定。
枳实薤白桂枝汤方
枳实（四枚） 浓朴（四两） 薤白（半斤） 桂枝（一两） 栝楼实（捣碎，一枚）
以上五味药，用水五升，先煮枳实、浓朴，取三升，去渣，加入其他药物，煮几沸，分三次温服。
人参汤方
人参 甘草 干姜 白术（各三两）
以上四味药，用水八升，煮取三升，温服一升，每日三次。
【注】心中痞，即上一条所说的心中痞气。诸逆，指各种气机上逆。上一条的气逆，不过是撞心而不痛；这一条的气逆，则是心悬空而痛，像空中悬挂之物动摇而痛。用桂枝生姜枳实汤，通阳气破逆气，疼痛停止痞气消散。
【集注】程林说：各种气逆如胁下气逆上抢心之类，邪气独留于上，则心悬痛。
尤怡说：诸逆，包括痰饮客气而言。心悬痛，谓如悬挂之物动摇而痛，是逆气所致。
桂枝生姜枳实汤方
桂枝（三两） 生姜（三两） 枳实（五枚）
以上三味药，用水六升，煮取三升，分三次温服。
【集解】赵良说：枳实、生姜，原本是用来治疗气塞的，何况是痞证呢？所以比上一条稍微减轻分量，使痞证者下其气以开之。悬痛属于饮邪的，得生姜以散之，足以建功。去掉橘皮而用桂枝的原因，是因为所逆之气不一，有的通阳气，有的破结气，有的散寒气，都能去除痹阻。
The Master said: Pulse diagnosis should distinguish between excess (Tai Guo) and deficiency (Bu Ji). A faint pulse at the cun position (Yang Wei) and a string-taut pulse at the chi position (Yin Xian) indicate chest bi syndrome with pain. The reason for this is attributed to extreme deficiency. Now, knowing that Yang Qi is deficient in the upper jiao, the cause of chest bi and heart pain lies precisely in the string-taut Yin pulse.
[Annotation] An excessive pulse indicates disease, and an insufficient pulse also indicates disease; therefore, pulse diagnosis should assess disease by observing excess and insufficiency. "Yang Wei" refers to a faint pulse at the cun position; when Yang receives a Yin pulse, it signifies Yang insufficiency, i.e., deficiency of Yang Qi in the upper jiao. "Yin Xian" refers to a string-taut pulse at the chi position; when Yin receives a Yin pulse, it signifies Yin excess, i.e., excess of Yin in the lower jiao. Any pathogenic factor of Yin excess can ascend to invade the Yang-deficient chest, thereby causing chest bi and heart pain. Mild cases of chest bi correspond to modern chest fullness, while severe cases correspond to modern chest pain.
[Collected Annotations] Li said: The *Nei Jing* states: A healthy stomach pulse is imperceptible; only when there is excess or insufficiency do pathological signs appear. The cun pulse belongs to Yang and is used to inspect the upper jiao, corresponding exactly to the chest region. If the Yang pulse is insufficient and faint, it indicates Yang deficiency, primarily affecting the upper jiao, thus leading to chest bi. The chi pulse being excessive and taut indicates Yin abundance, suggesting pathology in the lower jiao, which then ascends to cause pain.
You Yi stated: The upper jiao is the domain of Yang, and the faint pulse represents extreme deficiency; hence, it is said that the responsibility lies in extreme deficiency.
A healthy person without chills or fever who experiences shortness of breath and insufficient respiration has an excess condition.
[Annotation] "Ping Ren" refers to a person without disease. "No chills or fever" means no exterior pathogenic factors. When a healthy person suddenly presents with shortness of breath and insufficient respiration, it should not be attributed to deficiency. This must be due to pathogens in the chest causing bi obstruction and blockage, hindering respiration; thus, it should be attributed to excess.
[Collected Annotations] Li said: The previous section attributed the condition to extreme deficiency, while this section describes excess. Why? The classic states: Where pathogens gather, Qi must be deficient. If they remain and do not depart, the disease becomes excess. However, there is a distinction between shortness of breath (Duan Qi) and lack of Qi (Shao Qi). Lack of Qi refers to insufficient breath to speak; as the *Nei Jing* says: Speaking with a faint voice, able to speak only once a day, indicates depletion of Qi. Shortness of breath refers to breath that cannot continue, resembling panting but not true panting, as if Qi is rushing upward; thus, it resembles panting but without shoulder movement, and resembles groaning but without pain.
You Yi stated: "Ping Ren" refers to someone who is usually free of illness. "No chills or fever" means no new external pathogens. Yet, experiencing shortness of breath and insufficient respiration suggests that interior Qi has become excess due to pathogens, or that phlegm, food retention, or fluid retention is obstructing the ascending and descending Qi.
In chest bi syndrome, characterized by wheezing, coughing and spitting, chest and back pain, and shortness of breath, with a deep and slow pulse at the cun position and a slightly tight and rapid pulse at the guan position, Gua Lou Xie Bai Bai Jiu Tang (Trichosanthes Fruit, Macrostemon Bulb, and White Wine Decoction) is the primary treatment.
[Annotation] A deep and slow pulse at the cun position indicates stagnation of interior Qi (deep) and cold within the zang organs (slow), signifying cold qi stagnation in the upper jiao. A slightly tight and rapid pulse at the guan position indicates Yang deficiency (slight) and cold pain (tight/rapid), signifying urgent Qi and cold pain in the middle jiao. The chest and back are the palaces of the Heart and Lungs. Once Yang Qi is deficient, various cold and Yin pathogens can invade, causing the Qi in the chest and back to become bi-obstructed and blocked. Mild cases result in fullness, and severe cases result in pain, which is inevitable. Wheezing, coughing/spitting, and shortness of breath are inevitable symptoms. Gua Lou Xie Bai Bai Jiu Tang is used because its acrid nature opens chest bi, and its warming nature promotes Yang Qi circulation.
[Collected Annotations] Zhao Liang said: When cold-turbid pathogens stagnate in the upper jiao, they obstruct the ascending and descending Qi and block the anterior and posterior Yin-Yang positions, leading to wheezing, coughing/spitting, pain, and shortness of breath.
Cheng Lin said: The chest is the domain of the Heart and Lungs, hence wheezing and coughing/spitting occur. All Yang Qi receives energy in the chest and circulates to the back. When Qi is bi-obstructed and fails to move, chest and back pain and shortness of breath result.
Gua Lou Xie Bai Bai Jiu Tang Formula
Gua Lou Shi (Trichosanthis Fructus, crushed, one fruit)
Xie Bai (Allii Macrostemonis Bulbus, half jin)
Bai Jiu (White wine, seven sheng)
Boil these three ingredients together to obtain two sheng of liquid. Divide into two warm doses.
In chest bi where the patient cannot lie down, and heart pain radiates to the back, Gua Lou Xie Bai Ban Xia Tang (Trichosanthes Fruit, Macrostemon Bulb, and Pinellia Tuber Decoction) is the primary treatment.
[Annotation] In the previous case of chest bi with chest and back pain, the patient could still lie down because the pain was mild and Qi did not rebel. In this case, heart pain radiating to the back and inability to lie down indicate severe pain and rebellious Qi. Therefore, the previous formula is used again, with a significant addition of Ban Xia (Pinelliae Rhizoma) to direct rebellious Qi downward.
[Collected Annotations] You Yi said: Inability to lie down in chest bi indicates severe chest pain and rebellious Lung Qi failing to descend. Heart pain radiating to the back indicates complete blockage of Qi in the anterior and posterior pathways, making the bi obstruction even more severe. This occurs because Phlegm-Fluid serves as support for the pathology.
Gua Lou Xie Bai Ban Xia Tang Formula
Gua Lou Shi (Trichosanthis Fructus, crushed, one fruit)
Xie Bai (Allii Macrostemonis Bulbus, three liang)
Ban Xia (Pinelliae Rhizoma, half sheng)
Bai Jiu (White wine, one dou)
Boil these four ingredients together to obtain four sheng of liquid. Take one sheng warm per dose, three times daily.
[Collected Annotations] Wei Litong said: The bitter property of Ban Xia is used to open depression and promote Qi movement. Severe pain implies severe knotting; thus, the dampening nature of Xie Bai is reduced, and the drying nature of Ban Xia is employed to further cleanse viscous substances along with the decoction. Taking it three times daily aligns with treating from the upper jiao, requiring frequent dosing for gradual effect.
When heart pain radiates to the back, and back pain radiates to the heart region, Wu Tou Chi Shi Zhi Wan (Aconite Root and Halloysit Rubra Pill) is the primary treatment.
[Annotation] In the previous case, heart pain radiating to the back had periods of remission, so the mild formula Gua Lou Xie Bai Bai Jiu Tang plus Ban Xia was used. In this case, heart pain radiating to the back and back pain radiating to the heart indicate continuous, unremitting pain, signifying extreme Yin-cold pathogens extinguishing the Sun-Yang. This cannot be treated with Xie Bai and White Wine alone; thus, Wu Tou Chi Shi Zhi Wan is used. The formula contains Wu Tou (Aconiti Radix), Fu Zi (Aconiti Lateralis Radix Praeparata), Hua Jiao (Zanthoxyli Pericarpium), and Gan Jiang (Zingiberis Rhizoma), all highly acrid and hot, solely aiming to fiercely expel Yin pathogens.
[Collected Annotations] Li said: Heart pain internally radiating to the back moves from inside to outside; back pain externally radiating to the heart moves from outside to inside. Therefore, alongside the warming Fu Zi, the swift Wu Tou is used, assisted by Gan Jiang to circulate Yang and disperse cold greatly. Shu Jiao (Zanthoxyli Pericarpium) assists in descending Qi and opening depression. To prevent excessive dispersion and opening, Chi Shi Zhi (Halloysit Rubra) is added to enter the Heart, astringe, and consolidate Yang Qi.
Chi Shi Zhi Wan Formula
Shu Jiao (Zanthoxyli Pericarpium, one liang one fen, another method two fen)
Wu Tou (Aconiti Radix, processed, one fen)
Fu Zi (Aconiti Lateralis Radix Praeparata, processed, half liang one fen, another method one fen)
Chi Shi Zhi (Halloysit Rubra, one liang one fen, another method two fen)
Gan Jiang (Zingiberis Rhizoma, one liang one fen, another method one fen)
Grind these five ingredients into powder, mix with honey to form pills the size of paulownia seeds. Take one pill before meals, three times daily. Increase dosage slightly if ineffective.
In chest bi where symptoms alternate between relaxation and urgency, Yi Yi Fu Zi San (Coix Seed and Prepared Aconite Powder) is the primary treatment.
[Annotation] "Huan Ji" refers to chest bi pain that alternates between relief and exacerbation. Treatment should be adjusted based on this alternation. If symptoms are relaxed and not urgent, Gua Lou Xie Bai Bai Jiu Tang is used. Since symptoms here alternate, Yi Yi Fu Zi San is used to rapidly unblock bi Qi and swiftly sweep away Yin pathogens.
Yi Yi Fu Zi San Formula
Yi Yi Ren (Coicis Semen, fifteen liang)
Da Fu Zi (Prepared Aconiti Lateralis Radix, ten pieces)
Pound these two ingredients into a powder. Take one fang cun bi (square-inch spoonful) per dose, three times daily.
[Collected Annotations] Li said: "Huan Ji" means sometimes relaxed with temporary pain cessation, or urgent with pain recurrence. Yi Yi Ren enters the Lung to benefit Qi, and Fu Zi warms the middle and promotes Yang. Taking it as a powder accelerates efficacy.
Wei Litong said: Yi Yi Ren descends Qi and broadens the chest, while Fu Zi warms the middle and disperses pathogens. This formula is prescribed for conditions where pathogens are extremely abundant and Yang Qi is extremely deficient.
In chest bi with sensation of Qi obstruction in the chest and shortness of breath, Fu Ling Xing Ren Gan Cao Tang (Poria, Apricot Seed, and Licorice Decoction) is the primary treatment; Ju Pi Zhi Shi Sheng Jiang Tang (Tangerine Peel, Immature Bitter Orange, and Fresh Ginger Decoction) may also be used.
[Annotation] Chest bi with urgent chest pain is a severe form; chest bi with Qi obstruction in the chest is a mild form. The chest is the Sea of Qi. If Yang pathogens invade, they transform into Fire, which is expansive and does not cause bi. If Yin pathogens invade, they transform into Water, which is constrictive, causing Qi obstruction and shortness of breath in the chest, leading to chest bi. When Water abundance causes Qi stagnation, breathing becomes急促 (rapid); treat with Fu Ling Xing Ren Gan Cao Tang to drain Water, so that as Water drains, Qi flows smoothly. When Qi abundance causes Water retention,痞塞 (fullness/blockage) occurs; treat with Ju Pi Zhi Shi Sheng Jiang Tang to open Qi, so that as Qi opens, bi resolves.
[Collected Annotations] Shen Mingzong said: Pathogens blocking the chest and diaphragm prevent smooth Lung Qi movement, causing Qi obstruction and shortness of breath. The formula uses Xing Ren (Armeniacae Semen Amarum) to direct Lung Qi downward, Fu Ling (Poria) to guide Dampness downward, and Gan Cao (Glycyrrhizae Radix et Rhizoma) to harmonize the middle, ensuring that once pathogens leave, bi opens and Qi suffices. However, chest bi involves Qi obstruction in the chest caused by Earth-dampness, cold-turbid Yin Qi, and external pathogens reversing upward. Thus, Ju Pi (Citri Reticulatae Pericarpium), Zhi Shi (Aurantii Fructus Immaturus), and Sheng Jiang (Zingiberis Rhizoma Recens) are good at dispersing pathogens and descending turbidity, hence they are also indicated.
Wei Litong said: This condition involves excess pathogens but not severe Zheng deficiency, and Yang deficiency but not severe Yin abundance. Bi implies Qi obstruction, and Qi obstruction implies shortness of breath, as previously stated. By opening and descending Qi, all symptoms will resolve.
Fu Ling Xing Ren Gan Cao Tang Formula
Fu Ling (Poria, three liang)
Xing Ren (Armeniacae Semen Amarum, fifty seeds)
Gan Cao (Glycyrrhizae Radix et Rhizoma, one liang)
Boil these three ingredients in ten dou of water to obtain five sheng. Take one sheng warm per dose, three times daily. Repeat if not cured.
Ju Pi Zhi Shi Sheng Jiang Tang Formula
Ju Pi (Citri Reticulatae Pericarpium, one jin)
Zhi Shi (Aurantii Fructus Immaturus, three liang)
Sheng Jiang (Zingiberis Rhizoma Recens, half jin)
Boil these three ingredients in five sheng of water to obtain two sheng. Divide into two warm doses.
In chest bi with stifling sensation in the heart region, Qi knotting in the chest, chest fullness, and rebellious Qi from the hypochondrium rushing toward the heart, Zhi Shi Xie Bai Gui Zhi Tang (Immature Bitter Orange, Macrostemon Bulb, and Cinnamon Twig Decoction) is the primary treatment; Ren Shen Tang (Ginseng Decoction) may also be used.
[Annotation] "Xin Zhong" refers to the area below the heart. In chest bi, a stifling sensation below the heart with stuffiness and blockage indicates deficiency. If the Qi knots in the chest rather than below the heart, with chest fullness extending to the hypochondrium and rebellious Qi striking the heart, this indicates excess. For excess, use Zhi Shi Xie Bai Gui Zhi Tang, doubling Zhi Shi and Hou Po (Magnoliae Officinalis Cortex) to primarily break Qi and direct rebellion downward. For deficiency, use Ren Shen Tang (which is Li Zhong Tang), primarily warming the middle and tonifying Qi. This demonstrates that pain can be treated with tonification, illustrating the principle of "treating obstruction with obstruction."
[Collected Annotations] Wei Litong said: Chest bi naturally involves Yang deficiency and Yin abundance. Stifling sensation in the heart region and Qi knotting in the chest are typical manifestations of chest bi. When Qi from the hypochondrium rebels and rushes toward the heart, Phlegm-Fluid and Water-Qi follow the Yin-cold pathogens, reversing upward, overwhelming the Yang Qi of the chest and stomach. Thus, Zhi Shi Xie Bai Gui Zhi Tang is used to promote Yang, open depression, warm the middle, and direct Qi downward. Separate decoction methods are used to blend flavors and gently eliminate accumulated pathogens. If deficiency-cold is severe and aggressive dispersal is contraindicated, Ren Shen Tang is also used to warm and tonify Yang, allowing righteous Qi to flourish and pathogens to dissipate.
You Yi said: Stifling sensation in the heart region results from Qi bi forming a knot. Rebellious Qi from the hypochondrium rushing toward the heart indicates failure of Qi to descend, posing internal harm. These two formulas are chosen: one removes pathogenic excess to stabilize righteousness; the other nourishes Yang deficiency to expel Yin. The choice depends on assessing the duration of the disease and the excess/deficiency status of Qi.
Zhi Shi Xie Bai Gui Zhi Tang Formula
Zhi Shi (Aurantii Fructus Immaturus, four pieces)
Nong Po (Magnoliae Officinalis Cortex, four liang)
Xie Bai (Allii Macrostemonis Bulbus, half jin)
Gui Zhi (Cinnamomi Ramulus, one liang)
Gua Lou Shi (Trichosanthis Fructus, crushed, one fruit)
Boil these five ingredients in five sheng of water. First boil Zhi Shi and Nong Po to obtain three sheng, remove dregs, add remaining herbs, boil briefly, and divide into three warm doses.
Ren Shen Tang Formula
Ren Shen (Panacis Quinquefolii Radix)
Gan Cao (Glycyrrhizae Radix et Rhizoma)
Gan Jiang (Zingiberis Rhizoma)
Bai Zhu (Atractylodis Macrocephalae Rhizoma) (each three liang)
Boil these four ingredients in eight sheng of water to obtain three sheng. Take one sheng warm per dose, three times daily.
When there is stifling sensation in the heart region, various rebellious Qi movements, and hanging pain in the heart, Gui Zhi Sheng Jiang Zhi Shi Tang (Cinnamon Twig, Fresh Ginger, and Immature Bitter Orange Decoction) is the primary treatment.
[Annotation] "Stifling sensation in the heart region" refers to the stifling Qi mentioned in the previous section. "Various rebellious Qi" refers to various forms of Qi rebellion. In the previous case, rebellion merely struck the heart without pain. In this case, rebellion causes a hollow, hanging pain in the heart, as if a suspended object is shaking and causing pain. Gui Zhi Sheng Jiang Zhi Shi Tang is used to circulate Yang Qi and break rebellious Qi, stopping pain and resolving stifling.
[Collected Annotations] Cheng Lin said: Various rebellious Qi, such as Qi from the hypochondrium rushing toward the heart, indicates pathogens lingering exclusively in the upper jiao, causing hanging pain.
You Yi said: "Various rebellious Qi" includes Phlegm-Fluid and hostile Qi. "Hanging pain" refers to pain caused by Qi rebellion, feeling like a suspended object shaking.
Gui Zhi Sheng Jiang Zhi Shi Tang Formula
Gui Zhi (Cinnamomi Ramulus, three liang)
Sheng Jiang (Zingiberis Rhizoma Recens, three liang)
Zhi Shi (Aurantii Fructus Immaturus, five pieces)
Boil these three ingredients in six sheng of water to obtain three sheng. Divide into three warm doses.
[Collected Annotations] Zhao Liang said: Zhi Shi and Sheng Jiang are originally used to treat Qi obstruction, let alone stifling sensation. Therefore, the dosages are slightly reduced compared to the previous section to help resolve stifling by directing Qi downward. Hanging pain caused by Fluid is dispersed by Sheng Jiang, which is sufficient for efficacy. Orange peel is removed and Cinnamon Twig is added because the rebellious Qi varies; whether circulating Yang Qi, breaking knotted Qi, or dispersing cold Qi, all can remove bi obstruction.