（论一首脉证六条方九首）
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。
〔补注〕痹者痞 而不通也。经云。通则不痛。故惟痛为痹。而所以为痹者。邪入之。
其所以为邪入者。正先虚也。故曰。脉取太过不及。不及为阳微。太过即阴弦。阳
虚故邪痹于胸。阴盛故心痛。仲景已自申说甚明。乃知此证。总因阳虚。故阴得
以乘之。设或不弦。则阳虽虚而阴不上干可知也。然胸痹有微甚之不同。则为
治因亦异。微者但通上焦不足之阳。甚者且驱其下焦厥逆之阴。通阳者。以薤
白、白酒、半夏、桂枝、人参、杏仁之属。不但苦寒不入。即清凉尽屏。盖以阳通阳。阴
分之药不得预也。甚者用附子、乌头、蜀椒大辛热。以驱下焦之阴。惟阴退而阳可以渐复耳。可不留意乎。
平人无寒热。短气不足以息者。实也。
〔补注〕阳不足。则阴上入而为寒。阴不足。则阳下陷而为热。阴阳未尝偏胜。故无
寒热如平人。然短气不足以息者。是邪痹于中。而滞其升降之气。不可信其中
虚而辄补之。以蹈实实之戒也。
胸痹之病。喘息咳唾。胸背痛。短气。寸口脉沉而迟。关上小紧数。栝蒌薤白白酒汤主之。
栝蒌薤白白酒汤方
栝蒌实（一枚捣） 薤白（半升） 白酒（七升）
上三味。同煮取二升。分温再服。
〔补注〕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。阴寒凝泣。阳气不复自舒。故沉迟见于寸口。理自
然也。乃小紧数复显于关上者何耶。邪之所聚。自见小紧。而阴寒所积。正足以
遏抑阳气。故反形数。然阳遏则从而通之。栝蒌实最足开结豁痰。得薤白、白酒
佐之。既辛散而复下达。则所痹之阳自通矣。
胸痹不得卧。心痛彻背者。栝蒌薤白半夏汤主之。
栝蒌薤白半夏汤方
栝蒌实（一枚捣） 薤白（三两） 半夏（半升） 白酒（一斗）
上四味。同煮。取四升。温服一升。日一服。
〔补注〕胸痹痹在气。气在上焦。故即不言脉。而与上条无异。即证亦不甚相异也。
所异者。止不得卧耳。经云。昼行于阳则寤。夜行于阴则寐。然则不得卧。以气之
行于阳而不行于阴故也。经以小半夏汤覆杯即卧。非半夏为得寐药也。特以
草生于夏。夏半为一阴初生。由阳入阴。使气归于肝。而血亦入焉。故于本汤增
此一味。而能事毕矣。可不谓神乎。
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。
枳实薤白桂枝汤方
枳实（四枚） 浓朴（四两） 薤白（半升） 桂枝（一两） 栝蒌（一枚捣）
上五味。以水五升。先煮枳实、浓朴。取二升。去滓。内诸药。煮数沸。分温三服。
人参汤方
人参 白术 甘草 干姜（各三两）
上四味。以水八升。煮取三升。温服一升。日三服。
〔补注〕同一病也。一用通痞去满之药。一用辛散补中之味。全不相谋。谓治一证。
岂仲景自为矛盾耶。不知证有久暂。病有虚实也。假如气果有滞。上焦痞满。下
气亦上逆。不得不于通痹药中加降气消满。调和荣卫之药也。若夫病久而中
气大虚。宗气不利。时时满。或从胁下抢心。不用甘温。必不足以益中州之气。不
用辛散。且不足以破凝滞之阴。气足而清者自升。浊者自降。将结去而抢消矣。又何痹之有焉。
胸痹。胸中气塞短气。茯苓杏仁甘草汤主之。橘枳姜汤亦主之。
茯苓杏仁甘草汤方
茯苓（三两） 杏仁（五十粒） 甘草（一两）
上三味。以水一斗。煮取五升。温服一升。日三服。不瘥再服。
橘枳姜汤方
橘皮（一斤） 枳实（三两） 生姜（半斤）
上三味。以水五升。煮取二升。分温再服。
〔补注〕胸痹既有虚实。又有轻重。故痹之重者。必彻背彻心者也。轻者不然。然而
何以亦言痹。以其气塞而不舒。短而弗畅也。然一属手太阴肺。肺有饮。则气每
壅而不利。故以茯苓逐水。杏仁散结。用之当矣。又何取于甘草。盖以短气则中
土不足也。土为金之母也。一属足阳明胃。胃中实。故君橘皮以理气。枳实以消
满。且使积滞去而机窍通。更加生姜之辛。无处不宣。靡有遏抑。庶邪去而正自
快。此同一实证中。而又有脏腑之别也。
胸痹缓急者。薏苡附子散主之。
薏苡仁（十五两） 大附子（十枚炮）
上二味。杵为散。服方寸匕。日三服。
〔补注〕胸痹缓急者。痹之急证也。寒饮上聚心膈。使阳气不达。危急为何如乎。故
取薏苡逐水为君。附子之辛热为佐。驱除寒结。席卷而下。又乌能不胜任而愉快耶。
心中痞。诸逆心悬痛。桂枝生姜枳实汤主之。
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。
〔补注〕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。或肾气上冲。正未可知。桂伐肾邪。正其能事。不但调和荣卫。为去痞臣也。
心痛彻背。背痛彻心。乌头赤石脂丸主之。
乌头赤石脂丸方
乌头（一分炮） 赤石脂（一两） 蜀椒（一两） 附子（半两炮） 干姜（一两）
上五味末之。蜜丸如梧子大。先食服一丸。日三服。不知。稍加服。
〔补注〕心痛彻背。背痛彻心。乃阴寒之气厥逆而上干者。横格于胸背经脉之间。
牵连痛楚。乱其气血。紊其疆界。此而用气分诸药。则转益其痛。势必危殆。仲景
用蜀椒乌头。一派辛辣。以温散其阴邪。然恐胸背既乱之气难安。而即于温药
队中。取用干姜之泥。赤石脂之涩。以填塞厥气所横冲之新队。俾胸之气自行
于胸。背之气自行于背。各不相犯。其患乃除。此炼石补天之精义也。今人知有
温气、补气、行气、散气诸法矣。亦知有堵塞邪气攻冲之窦。令胸背阴阳二气并行不悖者哉。
九痛丸 治九种心痛。（非仲景方）
附子（二两炮） 生野狼牙（一两炙香） 巴豆（一两去皮心熬研如脂）
人参 干姜 吴茱萸（各一两）
上六味末之。炼蜜丸如梧子大。酒下。强人初服三丸。日三服。弱者二丸。
〔补注〕丸以九名。能治九种心痛。吾不知其治何者为九也。且兼治卒中恶腹胀
痛。口不能言。又治连年积冷。流注心胸痛。并冷冲上气。落马堕车血疾等。皆主
之。由此言之。则知热以去冷。辛以开郁。降以治逆。香以散结。甘以补正。毒以攻
毒。萃群力于一方。合诸毒而罔顾。用力少而成功多者。正以君主之地。无使窃
发。故无礼于侧。鹰 逐之。况于胞络受害。不啻震惊辇毂者乎。此宁速无宁缓
者也。然则火痛亦可治欤。曰可。何也。此从治之法也。观落马堕车以及血疾。则
皆因伤而滞。或素有瘀。所痛即不关于心者。无不可治也明矣。
（一篇论述，六条脉证，九个方剂）
老师说：诊脉应当辨别脉象的太过与不及。阳气微弱而阴气弦急，就会出现胸痹并伴有疼痛。之所以如此，是因为正气极度虚弱。如今知道阳气虚损位于上焦，所以出现胸痹心痛，正是因为阴脉弦急的缘故。
〔补注〕痹，就是痞塞而不通畅的意思。医经说：“通则不痛。”所以只有疼痛才称为痹。而导致痹的原因，是邪气侵入；导致邪气侵入的原因，是正气先已虚弱。所以说，脉象取太过与不及，不及表现为阳微，太过表现为阴弦。因为阳虚，所以邪气痹阻于胸部；因为阴盛，所以发生心痛。张仲景已经自我解释得很明白了。由此可知，这个病症总归是因为阳虚，所以阴寒得以乘虚而入。假使脉不弦，那么虽然阳虚，但阴寒不会上犯，这是显而易见的。然而胸痹有轻微和严重的不同，因此治疗方法也各异。轻微的只需通补上焦不足的阳气；严重的则要驱逐下焦厥逆的阴寒之气。通阳的方法，使用薤白、白酒、半夏、桂枝、人参、杏仁这一类药物，不仅不用苦寒药，就连清凉药也全部摒弃。这是因为要用阳药来通达阳气，阴分的药物不得参与。严重的则用附子、乌头、蜀椒等大辛大热之品，以驱逐下焦的阴寒。只有阴寒退去，阳气才能逐渐恢复。能不留意吗？
平素没有寒热症状的人，如果出现短气、呼吸急促不足以喘息的情况，属于实证。
〔补注〕阳气不足，阴气就会上入而产生寒象；阴气不足，阳气就会下陷而产生热象。阴阳如果没有偏胜，就像正常人一样没有寒热。但是出现短气、呼吸急促不足以喘息，是因为邪气痹阻在中焦，阻滞了升降之气。不可轻信其中焦虚而随意进补，以免犯“实实”（使实证更实）的错误。
胸痹病，表现为喘息、咳嗽吐痰、胸背疼痛、短气。寸口脉沉而迟，关上脉小紧数。用栝蒌薤白白酒汤主治。
栝蒌薤白白酒汤方
栝蒌实（一枚，捣碎） 薤白（半升） 白酒（七升）
以上三味药，一起煎煮，取药液二升，分两次温服。
〔补注〕寒浊之邪，停滞在上焦，就会阻碍上下往来的气机，堵塞前后阴阳的位置，从而导致喘息、咳嗽吐痰、疼痛、短气等症状。阴寒凝滞，阳气不能自行舒展，所以在寸口脉出现沉迟，这是理所当然的。那么为什么在关上脉又显现出小紧数呢？邪气聚集的地方，自然会出现小紧脉；而阴寒积聚，足以遏制阳气，所以反而表现出数脉。既然阳气被遏制，就要加以通达。栝蒌实最能开结豁痰，得到薤白、白酒的辅助，既辛散又能下达，那么被痹阻的阳气自然就能通畅了。
胸痹严重到不能平卧，心痛放射至背部者，用栝蒌薤白半夏汤主治。
栝蒌薤白半夏汤方
栝蒌实（一枚，捣碎） 薤白（三两） 半夏（半升） 白酒（一斗）
以上四味药，一起煎煮，取药液四升，每次温服一升，每日一次。
〔补注〕胸痹的病机在于气痹，气位于上焦，所以这里不提脉象，与上一条无异，症状也不甚相异。不同的地方仅在于不能平卧罢了。医经说：“白天行于阳则醒，夜晚行于阴则睡。”那么不能平卧，是因为气行于阳而不能行于阴的缘故。医经用小半夏汤，喝下去就能入睡，并不是因为半夏是安眠药。而是因为草生于夏季，夏至是一阴初生之时，由阳入阴，使气归于肝，血也随之进入。所以在本方中增加这一味药，就能完成任务了。难道不神奇吗？
胸痹，心中感觉痞闷，气结聚在胸部，胸部胀满，胁下有气逆冲心胸者，用枳实薤白桂枝汤主治。人参汤也可以主治。
枳实薤白桂枝汤方
枳实（四枚） 浓朴（四两） 薤白（半升） 桂枝（一两） 栝蒌（一枚，捣碎）
以上五味药，用水五升，先煎煮枳实、浓朴，取药液二升，去渣，加入其他药物，煮沸几沸，分三次温服。
以上四味药，用水八升，煎煮取药液三升，每次温服一升，每日三次。
〔补注〕同样是这个病，一个用通痞除满的药物，一个用辛散补中的药物，完全不相谋合。难道治疗同一个证候，张仲景自相矛盾吗？不知道病情有久暂之分，病性有虚实之别。假如气确实有阻滞，上焦痞满，下气也上逆，不得不在通痹药中加入降气消满、调和营卫的药物。如果是病程长久且中气大虚，宗气运行不利，时时感到胀满，或者从胁下气逆冲心，不用甘温的药，就不足以补益中州之气；不用辛散的药，就不足以破除凝滞的阴寒。气足而清阳自然上升，浊阴自然下降，结聚去除，逆气消除，还有什么痹症呢？
胸痹，胸中气塞、短气者，用茯苓杏仁甘草汤主治。橘枳姜汤也可以主治。
以上三味药，用水一斗，煎煮取药液五升，每次温服一升，每日三次。如果未愈，再服用。
以上三味药，用水五升，煎煮取药液二升，分两次温服。
〔补注〕胸痹既有虚实，又有轻重。所以痹症严重的，一定是心痛彻背、背痛彻心的。轻症则不是这样。然而为什么也称为痹呢？因为气机闭塞而不舒畅，短促而不通畅。然而一种情况属于手太阴肺经，肺中有水饮，则气每多壅滞而不利，所以用茯苓逐水，杏仁散结，使用得当。又为什么要用甘草呢？因为短气说明中土不足。土是金之母。另一种情况属于足阳明胃经，胃中有实邪，所以用橘皮为主药来理气，枳实来消满，并且使积滞去除而气机通畅，再加上生姜的辛散，无处不宣发，没有遏抑，这样邪气去除而正气自然畅快。这是在同一个实证中，又有脏腑的区别。
以上两味药，捣碎成散剂，每次服一方寸匕，每日三次。
〔补注〕胸痹缓急者，是胸痹的急证。寒饮上聚于心膈，使阳气不能通达，危急到了什么程度呢？所以取薏苡仁为君药以逐水，附子的辛热为佐药，驱除寒结，席卷而下，这怎么能不胜任而感到愉快呢？
以上三味药，用水六升，煎煮取药液三升，分三次温服。
〔补注〕枳实、生姜，原本是用来治疗气塞的，何况是痞闷呢？所以比前一条稍微减轻分量，使痞闷者能下行其气以开通它。悬痛属于饮邪的，得到生姜来发散，已经足够建功了。去掉橘皮而用桂枝的原因，是因为所逆之气不止一种，或者是肾气上冲，还不确定。桂枝能伐肾邪，正是它的专长。不仅仅是调和营卫，作为去除痞气的臣药。
乌头赤石脂丸方
乌头（一分，炮制） 赤石脂（一两） 蜀椒（一两） 附子（半两，炮制） 干姜（一两）
以上五味药研末，炼蜜制成梧桐子大小的丸药。饭前服一丸，每日三次。如果无效，稍加剂量服用。
〔补注〕心痛彻背，背痛彻心，这是阴寒之气厥逆而上犯，横格于胸背经脉之间，牵连痛楚，扰乱气血，混淆界限。这种情况下如果使用理气分的药物，只会加重疼痛，势必危险。张仲景使用蜀椒、乌头，一派辛辣之品，以温散阴邪。然而担心胸背紊乱的气机难以安定，就在温药队伍中，选用干姜的守中、赤石脂的收敛，来填塞厥气横冲的新通道，使得胸的气自行于胸，背的气自行于背，互不侵犯，病患才能消除。这是炼石补天的精义啊。现在的人只知道有温气、补气、行气、散气等方法，也知道有堵塞邪气攻冲的窦道，让胸背阴阳二气并行不悖的吗？
九痛丸，治疗九种心痛。（非张仲景原方）
附子（二两，炮制） 生野狼牙（一两，炙香） 巴豆（一两，去皮心，熬研如脂）
人参 干姜 吴茱萸（各一两）
以上六味药研末，炼蜜制成梧桐子大小的丸药，酒送服。体质强者初次服三丸，每日三次。体质弱者服二丸。
〔补注〕丸药名叫“九”，能治九种心痛，我不知道它具体治哪九种。而且兼治卒中恶腹胀痛、口不能言，又治连年积冷、流注心胸痛，以及冷冲上气、落马堕车引起的血疾等，都主治。由此说来，就知道是用热来祛冷，用辛来开郁，用降来治逆，用香来散结，用甘来补正，用毒来攻毒，汇聚群力于一方，结合诸毒而不顾惜。用力少而成功多，正是因为君主之地，不让邪气窃发，所以对侧畔无礼之邪，像鹰隼追逐一样将其驱逐。何况胞络受害，不啻于震惊都城，这难道是求慢不求快的吗？那么火痛也可以治吗？回答说可以。为什么呢？这是从治的方法。看落马堕车以及血疾，都是因为受伤而停滞，或者素有瘀血，所痛即使不关乎心脏，也没有不可以治疗的，这很明白了。
(One treatise, six pulse-symptom entries, nine formulas)
The Master said: In taking the pulse, one should assess excess (Tai Guo) and deficiency (Bu Ji). When Yang is micro (Wei) and Yin is string-like (Xian), chest bi (Chest Obstruction Syndrome) with pain occurs. The reason for this is attributed to extreme deficiency. Now, knowing that Yang deficiency resides in the Upper Jiao (Upper Burner), the reason for chest bi and heart pain is precisely due to the string-like Yin pulse.
[Supplementary Note] Bi refers to obstruction and lack of free flow. The Classics state: "When there is free flow, there is no pain." Therefore, only when there is pain is it termed Bi. The cause of Bi is the invasion of pathogenic factors; the reason for pathogenic invasion is the prior deficiency of Zheng Qi (Upright Qi). Thus, it is said that assessing the pulse involves excess and deficiency: deficiency manifests as Yang Wei (micro Yang), and excess manifests as Yin Xian (string-like Yin). Due to Yang deficiency, pathogens obstruct the chest; due to Yin excess, heart pain occurs. Zhang Zhongjing has explained this clearly himself. From this, we know that this syndrome is fundamentally caused by Yang deficiency, allowing Yin to take advantage of the situation. If the pulse were not string-like, it would be evident that although Yang is deficient, Yin does not invade upward. However, chest bi varies in severity, so treatments differ accordingly. For mild cases, one merely needs to unblock and tonify the insufficient Yang of the Upper Jiao. For severe cases, one must drive out the rebellious Yin from the Lower Jiao. To unblock Yang, herbs such as Xi Bai (Allii Macrostemonis Bulbus), Bai Jiu (White Wine), Ban Xia (Pinelliae Rhizoma), Gui Zhi (Cinnamomi Ramulus), Ren Shen (Ginseng Radix et Rhizoma), and Xing Ren (Armeniacae Semen Amarum) are used. Bitter-cold herbs are not only excluded, but even cooling herbs are entirely discarded. This is because Yang is used to unblock Yang, and herbs belonging to the Yin aspect are not permitted to participate. For severe cases, Da Xin Re (Great Acrid-Heat) herbs like Fu Zi (Aconiti Lateralis Radix Praeparata), Wu Tou (Aconiti Radix), and Shu Jiao (Zanthoxyli Pericarpium) are used to drive out Yin from the Lower Jiao. Only when Yin retreats can Yang gradually recover. One must pay attention to this.
In a person without chills or fever, shortness of breath and inability to breathe deeply constitute an Excess pattern.
[Supplementary Note] When Yang is insufficient, Yin enters upward causing cold; when Yin is insufficient, Yang sinks downward causing heat. When Yin and Yang do not prevail excessively, the person appears normal without chills or fever. However, shortness of breath and inability to breathe deeply indicate that pathogens are obstructing the Middle Jiao, stagnating the ascending and descending Qi. One must not mistakenly believe this is Middle Jiao deficiency and administer tonics, thereby committing the error of "tonifying excess" (Shi Shi).
In chest bi disease, symptoms include wheezing, coughing and expectoration, chest and back pain, and shortness of breath. The pulse at Cun Kou (Radial Artery at the wrist crease) is deep and slow, while the pulse at Guan (Middle position) is slightly tight and rapid. Gua Lou Xie Bai Bai Jiu Tang (Trichosanthes Fruit, Allii Macrostemonis Bulbus, and White Wine Decoction) is the primary formula.
Formula: Gua Lou Xie Bai Bai Jiu Tang
Gua Lou Shi (Trichosanthis Fructus) - 1 fruit, crushed
Xie Bai (Allii Macrostemonis Bulbus) - 0.5 sheng
Bai Jiu (White Wine) - 7 sheng
Boil these three ingredients together until two sheng remain. Divide into two doses and take warm.
[Supplementary Note] Cold-turbid pathogens stagnating in the Upper Jiao obstruct the Qi moving up and down, blocking the positions of anterior-posterior Yin and Yang, leading to wheezing, coughing, pain, and shortness of breath. Yin-cold coagulation prevents Yang from naturally relaxing, hence the deep and slow pulse at Cun Kou is natural. Why then does the Guan position show slightly tight and rapid? Where pathogens gather, a slightly tight pulse naturally appears. The accumulation of Yin-cold suppresses Yang, causing the pulse to appear rapid. Since Yang is suppressed, it must be unblocked. Gua Lou Shi is excellent for resolving nodules and clearing phlegm. Assisted by Xie Bai and Bai Jiu, which are acrid-dispersing and directing downward, the obstructed Yang will naturally become free.
In chest bi, if the patient cannot lie flat and heart pain radiates to the back, Gua Lou Xie Bai Ban Xia Tang (Trichosanthes Fruit, Allii Macrostemonis Bulbus, and Pinellia Decoction) is the primary formula.
Formula: Gua Lou Xie Bai Ban Xia Tang
Gua Lou Shi (Trichosanthis Fructus) - 1 fruit, crushed
Xie Bai (Allii Macrostemonis Bulbus) - 3 liang
Ban Xia (Pinelliae Rhizoma) - 0.5 sheng
Bai Jiu (White Wine) - 1 dou
Boil these four ingredients together until four sheng remain. Take one sheng warm once daily.
[Supplementary Note] Chest bi involves Qi obstruction in the Upper Jiao, so pulses are not mentioned here, differing little from the previous entry, nor do symptoms differ significantly. The difference lies only in the inability to lie flat. The Classics state: "During the day, Qi moves in Yang, so one is awake; at night, Qi moves in Yin, so one sleeps." Therefore, inability to lie flat is due to Qi moving in Yang but not entering Yin. The Classics mention Xiao Ban Xia Tang inducing sleep quickly after drinking; this is not because Ban Xia is a sedative. Rather, herbs born in summer, where the midpoint of summer marks the initial birth of Yin (transition from Yang to Yin), allow Qi to return to the Liver and Blood to enter. Adding this single herb completes the function. Is this not miraculous?
In chest bi, if there is a feeling of fullness/stuffiness in the heart, Qi knotting in the chest, chest distension, and rebellious Qi rushing from the hypochondrium to the heart, Zhi Shi Xie Bai Gui Zhi Tang (Immature Bitter Orange, Allii Macrostemonis Bulbus, and Cinnamon Twig Decoction) is the primary formula. Ren Shen Tang (Ginseng Decoction) may also be used.
Formula: Zhi Shi Xie Bai Gui Zhi Tang
Zhi Shi (Aurantii Fructus Immaturus) - 4 pieces
Nong Po (Magnoliae Officinalis Cortex) - 4 liang
Xie Bai (Allii Macrostemonis Bulbus) - 0.5 sheng
Gui Zhi (Cinnamomi Ramulus) - 1 liang
Gua Lou (Trichosanthis Fructus) - 1 fruit, crushed
Add five sheng of water to the five ingredients. First boil Zhi Shi and Nong Po until two sheng remain, discard the dregs, add the remaining herbs, boil for a few boils, divide into three doses, and take warm.
Formula: Ren Shen Tang
Ren Shen (Ginseng Radix et Rhizoma)
Bai Zhu (Atractylodis Macrocephalae Rhizoma)
Gan Cao (Glycyrrhizae Radix et Rhizoma)
Gan Jiang (Zingiberis Rhizoma) - each 3 liang
Add eight sheng of water to the four ingredients. Boil until three sheng remain. Take one sheng warm, three times daily.
[Supplementary Note] It is the same disease, yet one uses herbs to unblock obstruction and reduce distension, while the other uses acrid-warm herbs to tonify the center. They seem unrelated. Does Zhang Zhongjing contradict himself in treating one syndrome? No. One must understand that conditions vary in duration and nature (Excess vs. Deficiency). If Qi is truly stagnant, causing Upper Jiao fullness and rebellious lower Qi, it is necessary to add herbs that descend Qi, reduce fullness, and harmonize Ying and Wei within the bi-unblocking formula. However, if the disease is chronic with significant Middle Qi deficiency and ineffective Zong Qi (Pectoral Qi), causing frequent fullness or Qi rushing from the hypochondrium to the heart, sweet-warm herbs are required to tonify the Middle Jiao Qi. Without acrid-dispersing herbs, congealed Yin cannot be broken. When Qi is sufficient, clear Yang rises naturally, turbid Yin descends naturally, knots dissipate, and rebellious Qi vanishes. What bi remains?
In chest bi, if there is Qi sensation of blockage and shortness of breath in the chest, Fu Ling Xing Ren Gan Cao Tang (Poria, Apricot Seed, and Licorice Decoction) is the primary formula. Ju Pi Zhi Jiang Tang (Tangerine Peel, Immature Bitter Orange, and Ginger Decoction) may also be used.
Formula: Fu Ling Xing Ren Gan Cao Tang
Fu Ling (Poria) - 3 liang
Xing Ren (Armeniacae Semen Amarum) - 50 grains
Gan Cao (Glycyrrhizae Radix et Rhizoma) - 1 liang
Add one dou of water to the three ingredients. Boil until five sheng remain. Take one sheng warm, three times daily. If not cured, continue administration.
Formula: Ju Pi Zhi Jiang Tang
Ju Pi (Citri Reticulatae Pericarpium) - 1 jin
Zhi Shi (Aurantii Fructus Immaturus) - 3 liang
Sheng Jiang (Zingiberis Rhizoma Recens) - 0.5 jin
Add five sheng of water to the three ingredients. Boil until two sheng remain. Divide into two doses and take warm.
[Supplementary Note] Chest bi has both excess/deficiency and light/severe distinctions. Severe bi involves pain radiating through to the back and heart. Light bi is different. Yet why is it still called bi? Because Qi is blocked and uncomfortable, short and unsmooth. One case belongs to the Hand-Taiyin Lung Meridian; fluid retention in the Lung causes Qi to be congested and unfavorable. Thus, Fu Ling is used to drain water, and Xing Ren to resolve nodules. Why use Gan Cao? Because shortness of breath indicates insufficiency of the Middle Earth (Spleen/Stomach). Earth is the mother of Metal. Another case belongs to the Foot-Yangming Stomach Meridian; excess in the Stomach requires Ju Pi as the sovereign herb to regulate Qi, and Zhi Shi to reduce fullness, ensuring stagnation is removed and mechanisms open. Added with the acridity of Sheng Jiang, dispersion occurs everywhere without suppression. Thus, pathogens leave and Zheng Qi feels comfortable. Even within the same excess pattern, there are differences between Zang and Fu organs.
In chest bi, where symptoms alternate between relaxation and urgency/spasm, Yi Yi Fu Zi San (Coix Seed and Aconite Powder) is the primary formula.
Yi Yi Ren (Coicis Semen) - 15 liang
Da Fu Zi (Aconiti Lateralis Radix Praeparata) - 10 pieces, prepared
Grind these two ingredients into a powder. Take one fang cun bi (square-inch spoonful) per dose, three times daily.
[Supplementary Note] "Bi alternating between relaxation and urgency" refers to an acute presentation of chest bi. Cold-fluid accumulating above the heart and diaphragm prevents Yang Qi from reaching, creating a critical situation. Therefore, Yi Yi Ren is used as the sovereign herb to drain water, and the acrid-heat of Fu Zi as the assistant to expel cold congealation, sweeping it downward. How could this fail to be effective and satisfying?
If there is stuffiness in the heart, various rebellious Qi causing a hanging pain in the heart, Gui Zhi Sheng Jiang Zhi Shi Tang (Cinnamon Twig, Ginger, and Immature Bitter Orange Decoction) is the primary formula.
Formula: Gui Zhi Sheng Jiang Zhi Shi Tang
Gui Zhi (Cinnamomi Ramulus) - 3 liang
Sheng Jiang (Zingiberis Rhizoma Recens) - 3 liang
Zhi Shi (Aurantii Fructus Immaturus) - 5 pieces
Add six sheng of water to the three ingredients. Boil until three sheng remain. Divide into three doses and take warm.
[Supplementary Note] Zhi Shi and Sheng Jiang are originally used to treat Qi blockage, let alone stuffiness. Therefore, the dosage is slightly reduced compared to the previous entry to help those with stuffiness descend their Qi to open it. Hanging pain due to fluid retention is dispersed by Sheng Jiang, which is sufficient for efficacy. Why remove Ju Pi and use Gui Zhi? Because the rebellious Qi is not singular; it might be Kidney Qi rushing upward. Gui Zhi can attack Kidney pathogens, fulfilling its role. It not only harmonizes Ying and Wei but serves as the minister herb to remove stuffiness.
If heart pain radiates to the back, and back pain radiates to the heart, Wu Tou Chi Shi Zhi Wan (Aconite, Red Kaolin Pill) is the primary formula.
Formula: Wu Tou Chi Shi Zhi Wan
Wu Tou (Aconiti Radix) - 1 fen, prepared
Chi Shi Zhi (Kaolinite) - 1 liang
Shu Jiao (Zanthoxyli Pericarpium) - 1 liang
Fu Zi (Aconiti Lateralis Radix Praeparata) - 0.5 liang, prepared
Gan Jiang (Zingiberis Rhizoma) - 1 liang
Grind these five ingredients into powder. Mix with honey to form pills the size of wu zi (mulberry seeds). Take one pill before meals, three times daily. If ineffective, increase the dose slightly.
[Supplementary Note] Heart pain radiating to the back and back pain radiating to the heart is caused by Yin-cold Qi rebelling upward and interfering, lodging horizontally between the meridians of the chest and back, causing牵连 (interconnected) pain, disrupting Qi and Blood, and confusing boundaries. Using Qi-regulating herbs here would only worsen the pain and lead to danger. Zhang Zhongjing uses Shu Jiao and Wu Tou, a batch of acrid-hot herbs, to warm and disperse Yin pathogens. However, fearing the chaotic Qi in the chest and back cannot be stabilized, he adds Gan Jiang's stabilizing nature and Chi Shi Zhi's astringency within the warming formula team to fill the new channels breached by the rebellious Qi. This allows Qi in the chest to stay in the chest, and Qi in the back to stay in the back, preventing mutual interference, thus removing the affliction. This is the essence of "smelting stones to repair heaven." Today, people know methods of warming, tonifying, moving, and dispersing Qi. Do they also know how to block the pathways of pathogenic aggression, allowing Yin and Yang Qi of the chest and back to coexist without conflict?
Jiu Tong Wan (Nine Pain Pill) treats nine types of heart pain. (Not a formula from Zhang Zhongjing)
Fu Zi (Aconiti Lateralis Radix Praeparata) - 2 liang, prepared
Sheng Ye Lang Ya (Spiraeae Flavae Herba, raw) - 1 liang, roasted until fragrant
Ba Dou (Crotonis Fructus) - 1 liang, skin and heart removed, roasted and ground into paste
Ren Shen (Ginseng Radix et Rhizoma)
Gan Jiang (Zingiberis Rhizoma)
Wu Zhu Yu (Evodiae Fructus) - each 1 liang
Grind these six ingredients into powder. Refine honey to form pills the size of mulberry seeds. Take with wine. Strong individuals take three pills initially, three times daily. Weak individuals take two pills.
[Supplementary Note] The pill is named "Nine" and treats nine types of heart pain, though I do not know exactly which nine are treated. It also treats sudden onset of evil with abdominal distension and pain, inability to speak, chronic accumulated cold flowing into the chest and heart pain, cold rushing upward Qi, blood disorders from falling off horses or cars, etc. From this, we see that heat is used to remove cold, acridity to open depression, descending to treat rebellion, fragrance to scatter nodules, sweetness to tonify Zheng, and toxicity to attack toxicity. Gathering many forces into one formula, combining various toxic substances without hesitation, achieving much with little effort, is because the sovereign territory must not allow pathogens to emerge secretly. Thus, disrespectful pathogens on the side are chased away like eagles. How much more so when the Bao Luo (Pericardium) is harmed, akin to shocking the capital? This approach seeks speed rather than slowness. Can fire-pain also be treated? Yes. Why? This is the method of "following treatment" (Cong Zhi). Looking at injuries from falls and blood disorders, all involve stagnation due to trauma or pre-existing blood stasis. Even if the pain does not concern the Heart itself, it can certainly be treated. This is clear.