师曰。失脉当取太过不及。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。（过不间。脉经。有与字。）
〔鉴〕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。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〕阳主开阴主闭。阳虚而阴干之。即胸痹而痛。痹者闭也。
案灵本藏篇云。肺大则多饮。善病胸痹喉痹逆气。巢源云。胸痹之候。胸中 如满。噎塞不利。习习
如痒。喉里涩唾燥。甚者心里强否急痛。肌肉苦痹。绞急如刺。不得俯仰。胸前皮皆痛。手不能犯。胸满
短气。咳唾引痛。烦闷白汗出。或彻背膂。其脉浮而微者是也。不治数日杀人。三因。作胸痞。
平人无寒热。短气不足以息者。实也。（平。赵本。作凡。）
〔尤〕平人。素无疾之人也。无寒热。无新邪也。而仍短气不足以息。当是里气暴实。或痰或食或饮。
碍其升降之气而然。盖短气有从素虚宿疾而来者。有从新邪暴遏而得者。二端并否。其为里实无疑。此审
因察病之法也。
〔鉴〕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。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。
明理论云。短气者。呼吸虽数。而不能相续。似喘不摇
肩。似呻吟。而无痛者是也。
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。
〔程〕内经曰。肺痹者。烦满喘而呕。心痹者。脉不通。烦则心下鼓。暴上气而喘。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。寸脉沉迟。关脉小紧。皆寒客上焦之脉。数字误。
案沈云。迟字下。当有一若字。盖此论当以寸口脉沉而迟。为虚寒之证。关上小紧数。栝蒌薤白白酒汤。
为寒实之证。另作一节解。否则岂有迟数二脉同见之理哉。此说似有理。然不如程之为误文之义长矣。
张氏医通云。寸口脉沉迟者。阳气衰微也。关上小紧者。胃以上有阴寒结聚。所以胸中喘息咳唾。胸背
痛而短气。栝蒌性润。专以涤垢腻之痰。薤白臭秽。用以通秽浊之气。同
气相求也。白酒熟谷之液。色白上通于胸中。使佐药力。上行极而下耳。案张不注及数脉。其意盖与程同。
栝蒌薤白白酒汤方
栝蒌实（一枚捣） 薤白（半斤） 白酒（七升）
上三味。同煮取二升。分温再服。
案薤白。本草。辛苦温。别录云。温中散结气。杜甫薤诗云。衰年关膈冷。味暖并无忧。可见其以辛温。
而散胸膈中之结气也。白酒。注家无解。似指为酒之白者。然灵经筋篇。以白酒和桂云云。且饮美酒。由此
观之。白酒非常酒。千金方。用白 浆一斗。外台亦引仲景伤寒论载本条云。栝蒌薤白白酒汤主之。而方中。
则用白 酒。程敬通云。 音再。酢浆也。知白酒。即是酢浆。今用米醋极验。
千金栝蒌汤 主疗与本文同。
栝蒌实（一枚） 半夏（半升） 薤白（一斤） 枳实（二两） 生姜（四两）
上五味 咀。以白 浆一斗。煮取四升。服一升。日二。仲景肘后。不用生姜枳实半夏。（外台。引千金同。）
胸痹不得卧。心痛彻背者。栝蒌薤白半夏汤主之。（外台。引仲景伤寒论。半夏下。有白 浆三字。）
〔尤〕胸痹不得卧。是肺气上而不下也。心痛彻背。是心气塞而不和也。其痹为尤甚矣。所以然者。有痰
饮以为之援也。故于胸痹药中。加半夏。以逐痰饮。
张氏医通云。心痛彻背者。胸中痰垢积满。循脉而溢于
背。背者胸之府。故于前药。但加半夏。以祛痰积之痹逆也。
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○外台作白 浆云古今录验范汪同）
上四味同煮。取四升。温服一升。日三服。
圣惠方 治胸痹不得卧。心痛彻背方。
栝蒌（一枚） 桂心（三分） 半夏（一两汤洗七遍去滑）
上件药捣筛为散。每服三钱。以浆水一中盏。入薤白七
茎。生姜半分。煎至六分。去滓。稍热频服。
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。（赵本。作心
中痞留气结在胸。徐沈同。外台作心中痞坚留气结于胸。逆下。有气字。）
〔魏〕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。又治胸痹从本治之一法也。
张氏医通云。二汤。一以治胸中实痰外溢。用薤白桂枝
以解散之。一以治胸中虚痰内结。即用人参理中以清理之。一病二治。因人素禀而施。两不移易之法也。
案千金治中汤。胸痹方。别标为一条。外台亦引仲景伤寒论。疗胸痹理中汤。即并人参汤。方后注云。张
仲景曰。胸痹心中痞坚。留气结于胸。胸满。胁下逆气抢心。理中汤亦主之。而引范汪。出枳实薤白桂
枝汤方。名枳实汤。方后云。此本仲景伤寒论方。
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（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。（千金。用浓朴三两。薤白一斤。）
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。
〔程〕此即理中汤也。中气强则痞气能散。胸满能消。胁
气能下。人参白术所以益脾。甘草干姜所以温胃。脾胃得其和。则上焦之气开发。而胸痹亦愈。
胸痹。胸中气塞。短气。茯苓杏仁甘草汤主之。橘枳姜汤亦主之。（千金。外台。无橘枳姜汤亦主之七字。）
〔鉴〕胸痹。胸中急痛。胸痹之重者也。胸中气塞。胸痹之轻者也。
〔程〕膻中为气之海。痹在胸中。
则气塞短气也。神农经曰。茯苓主胸胁逆气。杏仁主下气。甘草主寒热邪气。为治胸痹之轻剂。
茯苓杏仁甘草汤方（千金。名茯苓汤。外台。引千金。方后云。仲景伤寒论同。）
茯苓（三两） 杏仁（五十枚） 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。
外台。古今录验。疗气忽发满胸急方。
于本方中。去甘草。加橘皮。
橘皮枳实生姜汤方（千金。无方名。外台。作橘皮枳实汤。）
橘皮（一斤○外台作半斤） 枳实（三两○外台作四枚） 生姜（半斤）
上三味。以水五斤。煮取二斤。分温再服。（〔原注〕肘后。千
金云。治胸痹。胸中 如满噎塞。习习如痒。喉中涩燥唾沫○外台。引仲景伤寒论。主
疗与肘后千金同。方后云。肘后短剧。文仲。深师。范汪。古今录验。经心录。千金同。）
〔程〕气塞气短。非辛温之药。不足以行之。橘皮枳实生
姜辛温。同为下气药也。内经曰。病有缓急。方有大小。此胸痹之缓者。故用君一臣二之小方也。
胸痹缓急者。薏苡仁附子散主之。（外台。引古今录验痹下。有偏字。）
〔程〕寒邪客于上焦则痛急。痛急则神归之。神归之则气聚。气聚则寒邪散。寒邪散则痛缓。此胸痹
之所以有缓急者。亦心痛去来之义也。薏苡仁以除痹下气。大附子以温中散寒。
〔鉴〕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。
案缓急之缓。或谓绞字之讹。此说似是而却非。外台。
载胸痹心下坚痞缓急方四首。圣惠亦同。故知程李之解是也。
薏苡仁附子散方
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。
案外台。引古今录验。载薏苡仁散二方。初一方。用薏
苡仁五百枚。甘草三两。后一方。与本方同。唯用薏苡仁一
千五百枚。云此方出僧深。范汪同。仲景方。用薏苡仁十五两。
圣惠方 薏苡仁散。治胸痹心下坚痞缓急。
薏苡仁（二两） 附子（二两炮） 甘草（一两炙）
上捣筛为散。每服三钱。以水一中盏。入生姜半分。煎至六分。去滓稍热频服之。
心中痞。诸逆心悬痛。桂枝生姜枳实汤主之。（肘后痛下。有心下牵急懊痛六字。）
〔程〕心中痞。即胸痹也。诸逆。如胁下逆抢心之类。邪气独留于上。则心悬痛。枳实以泄痞。桂枝
以下逆。生姜以散气。
〔尤〕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。
〔鉴〕心悬而空痛。如空中悬物。动摇而痛也。用桂枝生姜枳实汤。通阳气破逆气。痛止痞开矣。
潘氏续焰云。悬者悬阁之义。不在胃。而悬留于腹胁间也。
桂枝生姜枳实汤方（外台。载仲景伤寒论。心下悬痛。诸逆大虚者桂心生姜枳实汤。方同。）
桂枝 生姜（各三两） 枳实（五枚○徐沈尤枚作两外台有炙字）
上三味。以水六升。煮取三升。分温三服。
千金桂心三物汤 治心下痞诸逆悬痛。
桂心（二两） 胶饴（半斤） 生姜（二两）
上药切。以水四升。煮二味。取三升。去滓。内饴。分三服。
心痛彻背。背痛彻心。乌头赤石脂丸主之。
〔鉴〕心痛彻背。尚有休止之时。故以栝蒌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。
故以乌头赤石脂丸主之。方中乌附椒姜一派。大辛大热。别无他顾。峻逐阴邪而已。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（外台。引仲景伤寒论云。千金。必效。文仲。范汪。经心录等同。）
蜀椒（一两一法二分○外台作二分） 乌头（一分炮） 附子（半两炮一法一分○外
台作一分） 干姜（一两一法一分○外台作二分） 赤石脂（一两一法二分○外台作二分）
上五味。末之。蜜丸。如梧子大。先食服一丸。日三服。
不知。稍加服。（千金。名乌头丸 用乌头六铢。附子蜀椒各半两。注云。范汪。
不用附子。崔氏。用桂半两为六味。）
外台云。此方丹阳有隐士。出山云。得华佗法。若久心
痛。每旦服三丸。稍加至十丸。尽一剂。遂终身不发。
九痛丸 治九种心痛。（外台。引千金。名附子丸。○徐本。标附方二字。
沈同。程云。非仲景方。并是。）
附子（三两○千金用二两） 生野狼牙（一两炙香○千金用生野狼毒四两外台同） 人
参干姜 巴豆（一两去皮心熬研如脂） 吴茱萸（各一两○千金用干姜二两）
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。○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。落马坠车血疾等。
皆主之。忌口如常法。（冲。赵本。作肿非。）
〔程〕九痛者。一虫心痛。二注心痛。三风心痛。四悸心痛。五食心痛。六饮心痛。七冷心痛。八热心
痛。九去来心痛。（案以上。见千金本方主疗。）虽分九种。不外积聚痰饮结血虫注寒冷而成。附子巴豆。
散寒冷而破坚积。野狼牙茱萸。杀虫注而除痰饮。干姜人参。理中气而和胃脘。相将治九种之心痛
巴豆除邪杀鬼。故治中恶腹胀痛。口不能言。连年积冷。流
注心胸痛。冷气上冲。皆宜于辛热。辛热能行血破血。落马坠车。血凝血积者。故并宜之。
老师（医师）说：诊脉时应当观察脉象的太过与不及。如果寸口脉微而尺中脉弦，这就是胸痹并伴有疼痛的症状。之所以这样，是因为上焦阳气极度虚弱。现在知道阳虚位于上焦，导致胸痹心痛的原因，就是因为下焦阴寒之气过盛（表现为尺脉弦）。
〔尤在泾按〕：脉象太过则致病，不及也会致病，所以诊脉时要观察太过与不及来候察疾病。阳微，是指寸口脉微弱。阳脉出现阴脉的特征，说明阳气不及，即上焦阳虚。阴弦，是指尺中脉弦。阴脉出现阴脉的特征，说明阴气太过，即下焦阴实。凡是阴实之邪，都能上乘于阳虚的胸部，从而引发胸痹心痛。胸痹病，轻者就是现在的胸闷，重者就是现在的胸痛。李氏说：《内经》记载，胃脉平和时，不会出现太过或不及的现象，一旦出现太过或不及，就是病了。寸脉属阳，用来候察上焦，正对应胸中的部位。如果阳脉不及而微弱，就是阳虚，主病在上焦，所以受病为胸痹。尺脉太过而弦，就是阴盛，知病在下焦，所以上逆而导致疼痛。
〔尤在泾按〕：阳主开泄，阴主闭藏。阳虚而被阴邪侵犯，就会发生胸痹并疼痛。痹，就是闭塞的意思。查考《灵枢·本脏篇》说：肺大的人容易多饮，容易患胸痹、喉痹和气逆的病。巢元方《诸病源候论》说：胸痹的症状是胸中像堵塞满闷，噎塞不通利，皮肤感觉像瘙痒一样，喉咙里干燥涩滞有痰涎，严重的感到心里强急疼痛，肌肉苦于痹阻，绞痛如针刺，不能俯仰，胸前皮肤都痛，手不能触碰，胸闷短气，咳嗽吐唾引致疼痛，烦闷出冷汗，或者疼痛放射至背部脊柱。其脉象浮而微弱的就是这种病。如果不治疗，几天内就会致死。《三因极一病证方论》将其称为胸痞。
没有外感寒热症状的普通人，如果出现短气、呼吸不足以接续的情况，属于实证。（“平人”在赵开美本中作“凡人”。）
〔尤在泾按〕：平人，指平时没有疾病的人。没有寒热，说明没有新近的外邪侵袭。但仍然短气不足以息，这应该是体内正气突然变得壅实，或者是痰、食积、水饮等阻碍了升降之气所致。一般来说，短气有的源于素体虚弱和宿疾，有的源于新邪突然遏制。如果这两种情况都不符合，那么肯定是里实证无疑。这是审察病因、诊察疾病的方法。
〔徐彬按〕：平人，指无病之人。没有寒热，说明没有表邪。平人无故而出现短气不足以息的证候，不能责怪其虚。这一定是邪气在胸中，痹阻而不通，阻碍了呼吸，应当责之于实。李氏说：上一节说责其极虚，这一节又说实，为什么呢？《内经》说：邪气聚集的地方，正气必然虚弱；邪气停留不去，病势就会转为实。《明理论》说：短气，是指呼吸虽然急促，但不能连续，好像喘但不摇肩，好像呻吟但没有疼痛。
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，关上脉小紧数，用栝蒌薤白白酒汤主治。
〔程林按〕：《内经》说：肺痹，烦闷、喘促而呕吐；心痹，脉不通，心烦则心下悸动，突然气逆而上喘。胸中是心肺的分野，所以出现喘息、咳嗽、吐唾沫。诸阳之气受气于胸中，而转行于背部。气痹阻不行，则胸背疼痛，气短。寸脉沉迟，关脉小紧，都是寒邪客居上焦的脉象。“数”字可能是误文。
查考沈明宗注：在“迟”字下，应当有一个“若”字。大概这一论述应当以“寸口脉沉而迟”作为虚寒证，“关上小紧数”以及使用栝蒌薤白白酒汤，作为寒实证。另作一节来解释。否则，怎么会有迟脉和数脉同时出现的道理呢？这种说法似乎有理，但不如程林认为是误文的解释更合理。《张氏医通》说：寸口脉沉迟，是阳气衰微。关上脉小紧，是胃以上有阴寒结聚。所以胸中喘息、咳嗽、吐唾沫，胸背痛且短气。栝蒌性质滋润，专门涤除黏腻之痰；薤白气味臭秽，用以通散秽浊之气，这是同气相求。白酒是熟谷的液体，色白上行通达于胸中，借助药力，上行至极点然后下行。查考张氏未注释及数脉，他的意思大概与程林相同。
栝蒌薤白白酒汤方
栝蒌实（一枚，捣碎） 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。
查考：薤白，《本草》记载辛苦温。《名医别录》说：温中散结气。杜甫《薤诗》说：“衰年关膈冷，味暖并无忧。”可见它是用辛温之性，来疏散胸膈中的结气。白酒，注家没有解释，似乎指白色的酒。然而《灵枢·经筋篇》提到“以白酒和桂”，并且说“饮美酒”。由此看来，白酒不是普通的酒。《千金方》用白浆一斗，《外台秘要》也引用仲景《伤寒论》记载本条云：“栝蒌薤白白酒汤主之”，但方中用的是“白醯酒”。程敬通说：“醯音再，酢浆也。”可知白酒就是醋浆。现在用米醋非常有效。
《千金方》栝蒌汤，主治与本文相同。
栝蒌实（一枚） 半夏（半升） 薤白（一斤） 枳实（二两） 生姜（四两）
以上五味药切碎，用白浆一斗，煮取四升，每次服一升，每日两次。仲景《肘后备急方》不用生姜、枳实、半夏。（《外台秘要》引用《千金方》相同。）
胸痹病，不能平卧，心痛放射至背部，用栝蒌薤白半夏汤主治。（《外台秘要》引用仲景《伤寒论》，在“半夏”下有“白酒”二字。）
〔尤在泾按〕：胸痹不能平卧，是肺气上逆而不能下降。心痛放射至背部，是心气闭塞而不调和。这种痹阻比一般的更为严重。之所以这样，是因为有痰饮作为依托。所以在治疗胸痹的药中加入半夏，以驱逐痰饮。
《张氏医通》说：心痛放射至背部，是胸中痰垢积满，顺着经脉溢于背部。背是胸的府库，所以在前面的药物中，只加半夏，以祛除痰积引起的痹逆。
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○《外台》作白浆，云《古今录验》、《范汪方》相同）
以上四味药一起煮，取四升药液，温服一升，每日三次。
《太平圣惠方》治疗胸痹不能平卧，心痛放射至背部的方子：
栝蒌（一枚） 桂心（三分） 半夏（一两，汤洗七遍去滑）
以上药物捣筛为散。每次服三钱，用浆水一中盏，加入薤白七茎，生姜半分，煎至六分，去渣，稍热频频服用。
胸痹病，心中痞塞胀气，气结在胸，胸满，胁下之气上逆抢心，用枳实薤白桂枝汤主治。人参汤也主治。（赵开美本作“心中痞留气结在胸”，徐忠可、沈明宗相同。《外台》作“心中痞坚留气结于胸”，“逆”下多一个“气”字。）
〔魏荔彤按〕：胸痹本来就是阳微阴盛。心中痞气，气结在胸，正是胸痹的病状。再加上胁下的气，全部上逆抢心，那么痰饮水气，都乘着阴寒之邪，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，使缓缓荡除结聚的邪气。或者如果虚寒已经很严重，不敢肆意使用开破药物的，所以人参汤也主治，以温补其阳，使正气旺盛，邪气自然消除。这也是治疗胸痹从本治的一种方法。
《张氏医通》说：这两个方子，一个用于治疗胸中实痰外溢，用薤白、桂枝以解散之；一个用于治疗胸中虚痰内结，即用人参理中汤以清理之。同一疾病两种治法，根据病人平时的体质而施治，是两不相移易的方法。
查考《千金方》治中汤，胸痹方，另外标为一条。《外台秘要》也引用仲景《伤寒论》，治疗胸痹理中汤，即并为人参汤。方后注云：张仲景说：胸痹心中痞坚，留气结于胸，胸满，胁下逆气抢心，理中汤也主治。并引用《范汪方》，列出枳实薤白桂枝汤方，名为枳实汤。方后云：这本是仲景《伤寒论》方。
枳实薤白桂枝汤方
枳实（四枚） 厚朴（四两） 薤白（半斤） 桂枝（一两） 栝蒌实（一枚，捣碎）
以上五味药，用水五升，先煮枳实、厚朴，取二升药液，去渣，加入其他药物，煮几沸，分三次温服。（《千金方》用厚朴三两，薤白一斤。）
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。
〔程林按〕：这就是理中汤。中气强则痞气能散，胸满能消，胁气能下。人参、白术所以益脾，甘草、干姜所以温胃。脾胃得其和，则上焦之气开发，而胸痹也痊愈。
胸痹，胸中气塞，短气，用茯苓杏仁甘草汤主治。橘枳姜汤也主治。（《千金方》、《外台秘要》无“橘枳姜汤亦主之”七字。）
〔徐彬按〕：胸痹，胸中急痛，是胸痹的重症。胸中气塞，是胸痹的轻症。
〔程林按〕：膻中是气之海，痹在胸中，则气塞短气。《神农本草经》说：茯苓主胸胁逆气，杏仁主下气，甘草主寒热邪气，这是治疗胸痹的轻剂。
茯苓杏仁甘草汤方（《千金方》名茯苓汤，《外台秘要》引用《千金方》，方后云：仲景《伤寒论》相同。）
茯苓（三两） 杏仁（五十枚） 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。不好转再服。
《外台秘要》、《古今录验》，治疗气忽然发作满胸急痛的方子：
在本方中，去掉甘草，加橘皮。
橘皮枳实生姜汤方（《千金方》无方名，《外台秘要》作橘皮枳实汤。）
橘皮（一斤○《外台》作半斤） 枳实（三两○《外台》作四枚） 生姜（半斤）
以上三味药，用水五斤，煮取二斤，分两次温服。（〔原注〕《肘后备急方》、《千金方》说：治疗胸痹，胸中像满闷噎塞，皮肤像瘙痒，喉咙中涩燥唾沫○《外台秘要》引用仲景《伤寒论》，主治与《肘后》、《千金》相同。方后云：《肘后》、《短剧》、《文仲》、《深师》、《范汪》、《古今录验》、《经心录》、《千金方》相同。）
〔程林按〕：气塞气短，不用辛温的药物，不足以行之。橘皮、枳实、生姜辛温，同为下气药。《内经》说：病有缓急，方有大小。这是胸痹的缓症，所以用君一臣二的小方。
胸痹病势忽缓忽急的，用薏苡仁附子散主治。（《外台秘要》引用《古今录验》，在“痹”下多一个“偏”字。）
〔程林按〕：寒邪客居上焦则痛急，痛急则神归之，神归之则气聚，气聚则寒邪散，寒邪散则痛缓。这就是胸痹之所以有缓急的原因，也是心痛去来的意义。薏苡仁以除痹下气，大附子以温中散寒。
〔徐彬按〕：李氏说：缓急，指有时缓和而痛暂时停止，有时紧急而痛又发作。薏苡仁入肺利气，附子温中行阳，制成散剂服用，则疗效更快。
查考：缓急的“缓”，有人说是“绞”字的讹误。这种说法似是而非。《外台秘要》载有胸痹心下坚痞缓急方四首，《圣惠方》也相同。所以知道程林、李氏的解释是正确的。
薏苡仁附子散方
薏苡仁（十五两） 大附子（十枚，炮制）
以上两味药，杵为散。每次服方寸匕，每日三次。
查考：《外台秘要》引用《古今录验》，载有薏苡仁散二方。初一方，用薏苡仁五百枚，甘草三两。后一方，与本方相同，只用薏苡仁一千五百枚，云此方出自僧深，《范汪方》相同。仲景方用薏苡仁十五两。
《太平圣惠方》薏苡仁散，治疗胸痹心下坚痞缓急：
薏苡仁（二两） 附子（二两，炮制） 甘草（一两，炙）
以上捣筛为散。每次服三钱，用水一中盏，加入生姜半分，煎至六分，去渣稍热频频服用。
心中痞塞，各种气逆导致的心悬痛，用桂枝生姜枳实汤主治。（《肘后备急方》在“痛”下，有“心下牵急懊痛”六字。）
〔程林按〕：心中痞，就是胸痹。诸逆，如胁下逆抢心之类。邪气独留于上，则心悬痛。枳实以泄痞，桂枝以下逆，生姜以散气。
〔尤在泾按〕：诸逆，包括痰饮客气而言。心悬痛，谓如悬挂之物动摇而痛，是逆气造成的。
〔徐彬按〕：心悬而空痛，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，痛止痞开矣。
潘氏《续焰》说：悬，是悬阁的意思。不在胃，而是悬留于腹胁间。
桂枝生姜枳实汤方（《外台秘要》载仲景《伤寒论》，心下悬痛，诸逆大虚者桂心生姜枳实汤，方相同。）
桂枝 生姜（各三两） 枳实（五枚○徐、沈、尤将“枚”作“两”，《外台》有“炙”字）
以上三味药，用水六升，煮取三升，分三次温服。
《千金方》桂心三物汤，治疗心下痞诸逆悬痛：
桂心（二两） 胶饴（半斤） 生姜（二两）
以上药物切碎，用水四升，煮前二味，取三升，去渣，加入饴糖，分三次服用。
〔徐彬按〕：心痛放射至背部，还有休止的时候，所以用栝蒌薤白白酒加半夏汤这种平剂治疗。这一条心痛放射至背部，背痛放射至心部，是连连痛而不休，则为阴寒邪气甚盛，渐渐阳光欲熄，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，别无他顾，只是峻逐阴邪而已。李氏说：心痛在内而彻背，则内而达于外；背痛在外而彻心，则外而入于内。所以既有附子的温，又复用乌头的迅烈，佐干姜行阳，大散其寒；佐蜀椒下气，大开其郁。恐怕过于大散大开，所以复佐赤石脂入心以固涩，收敛阳气。
赤石脂丸方（《外台秘要》引用仲景《伤寒论》云：《千金方》、《必效方》、《文仲》、《范汪方》、《经心录》相同。）
蜀椒（一两，一法二分○《外台》作二分） 乌头（一分，炮制） 附子（半两，炮制，一法一分○《外台》作一分） 干姜（一两，一法一分○《外台》作二分） 赤石脂（一两，一法二分○《外台》作二分）
以上五味药，研末，蜜丸，如梧桐子大。饭前服一丸，每日三次。无效，稍微增加剂量。（《千金方》名乌头丸，用乌头六铢，附子、蜀椒各半两。注云：《范汪方》不用附子，崔氏用桂半两为六味。）
《外台秘要》云：此方丹阳有隐士，出山时说：得华佗之法。如果久心痛，每天早晨服三丸，稍微加至十丸，服完一剂，终身不再发作。
九痛丸，治疗九种心痛。（《外台秘要》引用《千金方》，名附子丸。○徐本，标附方二字。沈明宗相同。程林说：非仲景方，都是。）
附子（三两○《千金方》用二两） 生野狼牙（一两，炙香○《千金方》用生野狼毒四两，《外台》相同） 人参 干姜 巴豆（一两，去皮心熬研如脂） 吴茱萸（各一两○《千金方》用干姜二两）
以上六味药，研末，炼蜜丸，如梧桐子大，酒送下。强壮的人初服三丸，每日三次。体弱者二丸。○兼治卒中恶气，腹胀痛，口不能言。又治连年积冷，流注心胸痛，并冷冲上气，落马坠车血疾等，都主治。忌口如常法。（“冲”字，赵开美本作“肿”，非。）
〔程林按〕：九痛，指：一虫心痛，二注心痛，三风心痛，四悸心痛，五食心痛，六饮心痛，七冷心痛，八热心痛，九去来心痛。（案以上见《千金方》本方主疗。）虽然分为九种，不外乎积聚、痰饮、结血、虫注、寒冷而成。附子、巴豆，散寒冷而破坚积；野狼牙、茱萸，杀虫注而除痰饮；干姜、人参，理中气而和胃脘。相互配合治疗九种心痛。巴豆除邪杀鬼，故治中恶腹胀痛，口不能言，连年积冷，流注心胸痛，冷气上冲，皆宜于辛热。辛热能行血破血，落马坠车，血凝血积者，故一并适宜。
The Master said: When taking the pulse, one should observe whether it is excessive (Tai Guo) or deficient (Bu Ji). If the Cun (inch) position is faint (Wei) and the Chi (cubit) position is wiry (Xian), this indicates Chest Bi syndrome with pain. The reason for this is attributed to extreme deficiency. Now, knowing that Yang deficiency is located in the Upper Jiao, the cause of Chest Bi and heart pain lies in the excess of Yin (manifested as a wiry Chi pulse).
[You Zaijing's Commentary]: An excessive pulse causes disease, and a deficient pulse also causes disease; therefore, when examining the pulse, one must observe both excess and deficiency to diagnose the illness. "Yang faint" refers to a faint pulse at the Cun position. When a Yang position presents a Yin pulse characteristic, it indicates Yang deficiency, specifically deficiency of Yang in the Upper Jiao. "Yin wiry" refers to a wiry pulse at the Chi position. When a Yin position presents a Yin pulse characteristic, it indicates Yin excess, specifically excess of Yin in the Lower Jiao. Any pathogenic factor of Yin excess can ascend to attack the Yang-deficient chest, thereby causing Chest Bi and heart pain. In mild cases, Chest Bi manifests as current-day chest fullness; in severe cases, it manifests as current-day chest pain. Li Shi stated: The *Nei Jing* records that when the Stomach pulse is peaceful, neither excess nor deficiency is seen. Once excess or deficiency appears, disease arises. The Cun pulse belongs to Yang and is used to examine the Upper Jiao, corresponding precisely to the chest area. If the Yang pulse is deficient and faint, it indicates Yang deficiency, primarily affecting the Upper Jiao, thus resulting in Chest Bi. The Chi pulse being excessive and wiry indicates Yin excess, locating the pathology in the Lower Jiao, which then ascends to cause pain.
[You Zaijing's Commentary]: Yang governs opening and releasing, while Yin governs closing and storing. When Yang is deficient and invaded by Yin, Chest Bi and pain occur. "Bi" means obstruction. According to the *Ling Shu: Ben Cang Pian*, individuals with large lungs tend to drink excessively and are prone to Chest Bi, Hou Bi (throat obstruction), and Qi rebellion. Chao Yuanfang in *Zhu Bing Yuan Hou Lun* states that symptoms of Chest Bi include a sensation of fullness and blockage in the chest, difficulty swallowing, a prickling itching sensation, dryness and astringency in the throat with sticky saliva, and in severe cases, strong urgency and pain in the heart region, muscle bi-obstruction, cramping pain like stabbing, inability to bend or extend, pain on the anterior chest skin that cannot be touched, chest fullness, shortness of breath, coughing and expectoration inducing pain, irritability, spontaneous sweating, or pain radiating to the back and spine. The pulse is floating and faint. If untreated, death may occur within days. The *San Yin Fang* refers to this as Chest Pi (stagnation).
In a healthy person without chills or fever, if there is shortness of breath and insufficient respiration, it is an Excess pattern. ("Ping Ren" [healthy person] is written as "Fan Ren" [ordinary person] in Zhao Kaimei's edition.)
[You Zaijing's Commentary]: A "Ping Ren" refers to someone who is usually free of disease. The absence of chills or fever indicates no recent external pathogenic invasion. However, persistent shortness of breath and insufficient respiration suggest a sudden internal excess, possibly due to phlegm, food stagnation, or fluid retention obstructing the ascending and descending Qi mechanisms. Generally, shortness of breath may stem from constitutional deficiency and chronic illness, or from acute obstruction by new pathogens. If neither applies, it is undoubtedly an Interior Excess pattern. This illustrates the method of investigating etiology and diagnosing disease.
[Xu Bin's Commentary]: A "Ping Ren" is a person without disease. No chills or fever means no Exterior pathogen. If a healthy person suddenly experiences shortness of breath and insufficient respiration, it should not be attributed to deficiency. It is likely due to pathogenic factors in the chest causing obstruction and impeding respiration, indicating an Excess pattern. Li Shi asked: The previous section attributes the condition to extreme deficiency, while this section attributes it to excess. Why? The *Nei Jing* states: "Where pathogenic factors gather, Qi is necessarily deficient; if they remain and do not depart, the disease becomes Excess." The *Ming Li Lun* defines shortness of breath as rapid breathing that cannot continue, resembling panting but without shoulder movement, and resembling groaning but without pain.
In Chest Bi syndrome, characterized by wheezing, coughing, and expectoration, chest and back pain, and shortness of breath, where the Cun pulse is deep and slow, and the Guan pulse is slightly tight and rapid, Gua Lou Xie Bai Bai Jiu Tang (Trichosanthes Fruit, Macrostemon Rhizome, and White Wine Decoction) is the primary formula.
[Cheng Lin's Commentary]: The *Nei Jing* states: Lung Bi presents with irritability, fullness, wheezing, and vomiting; Heart Bi presents with blocked pulses, irritability, palpitations under the heart, sudden upward Qi rebellion, and wheezing. The chest is the domain of the Heart and Lungs, hence wheezing, coughing, and expectoration occur. All Yang Qi receives energy in the chest and circulates to the back. When Qi is obstructed, chest and back pain and shortness of breath result. A deep and slow Cun pulse and a slightly tight Guan pulse are signs of Cold pathogens lodging in the Upper Jiao. The character "Shu" (rapid) is likely a textual error.
Shen Mingzong notes: There should be a "Ruo" (if) character after "Chi". This passage should be interpreted such that "Cun pulse deep and slow" indicates a Deficient-Cold pattern, while "Guan pulse slightly tight and rapid" treated with Gua Lou Xie Bai Bai Jiu Tang indicates a Cold-Excess pattern, treating them as separate sections. Otherwise, how could Slow and Rapid pulses appear simultaneously? While reasonable, Cheng Lin's view that it is a textual error is more plausible. *Zhang Shi Yi Tong* states: A deep and slow Cun pulse indicates declining Yang Qi. A slightly tight Guan pulse indicates Yin-Cold accumulation above the Stomach. Thus, chest wheezing, coughing, expectoration, chest/back pain, and shortness of breath occur. Gua Lou is moistening and clears sticky phlegm; Xie Bai has a pungent odor and disperses turbid Qi, following the principle of similar Qi attracting. Bai Jiu (white wine) is a liquid of cooked grains, white in color, ascending to the chest, aiding medicinal power to rise and then descend. Zhang did not comment on the Rapid pulse, aligning with Cheng Lin.
**Gua Lou Xie Bai Bai Jiu Tang Formula**
Gua Lou Shi (Trichosanthes Fruit) - 1 piece, crushed
Xie Bai (Macrostemon Rhizome) - 8 liang
Bai Jiu (White Wine) - 7 sheng
Boil the three ingredients together to obtain 2 sheng of decoction. Divide into two warm doses.
Note: Xie Bai is Pungent, Bitter, and Warm according to *Ben Cao*. *Bie Lu* states it warms the Middle and dissipates nodulated Qi. Du Fu's poem mentions its ability to warm the chest and diaphragm. Bai Jiu is often misunderstood as white-colored wine, but *Ling Shu: Jing Jin Pian* mentions mixing Bai Jiu with Gui Zhi, implying fine wine. *Qian Jin Fang* uses Bai Jiang (sour rice water), and *Wai Tai Mi Yao* cites Zhang Zhongjing's *Shang Han Lun* using "Bai Xi Jiu" (vinegar juice). Cheng Jing tong explains "Xi" sounds like "Zai" meaning vinegar sauce. Thus, Bai Jiu here refers to vinegar or sour rice water. Using rice vinegar today is effective.
*Qian Jin Fang* Gua Lou Tang treats the same indications:
Gua Lou Shi - 1 piece
Ban Xia (Pinellia Tuber) - 0.5 sheng
Xie Bai - 1 jin
Zhi Shi (Immature Bitter Orange) - 2 liang
Sheng Jiang (Fresh Ginger) - 4 liang
Cut the five ingredients, boil in 1 dou of Bai Jiang to obtain 4 sheng. Take 1 sheng twice daily. Zhang Zhongjing's *Zhou Hou Bei Ji Fang* omits Sheng Jiang, Zhi Shi, and Ban Xia.
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, Macrostemon Rhizome, and Pinellia Decoction) is indicated. (*Wai Tai Mi Yao* adds "Bai Jiu" after Ban Xia in the citation of *Shang Han Lun*.)
[You Zaijing's Commentary]: Inability to lie flat in Chest Bi indicates Lung Qi rebelling upward instead of descending. Heart pain radiating to the back indicates Heart Qi blocked and disharmonious. This obstruction is more severe because Phlegm-Fluid acts as a support. Therefore, Ban Xia is added to the Chest Bi formula to expel Phlegm-Fluid.
*Zhang Shi Yi Tong* states: Heart pain radiating to the back occurs when phlegm and dirt accumulate in the chest and overflow along meridians to the back. Since the back is the mansion of the chest, adding only Ban Xia to the previous formula dispels the Phlegm-Obstruction.
**Gua Lou Xie Bai Ban Xia Tang Formula**
Gua Lou Shi - 1 piece, crushed
Xie Bai - 3 liang
Ban Xia - 0.5 sheng
Bai Jiu - 1 dou (Note: *Wai Tai* says Bai Jiang, citing *Gu Jin Lu Yan* and *Fan Wang*)
Boil the four ingredients together to obtain 4 sheng. Take 1 sheng warm, three times daily.
*Tai Ping Sheng Hui Fang* formula for Chest Bi with inability to lie flat and heart pain radiating to the back:
Gua Lou - 1 piece
Gui Xin (Cinnamon Heart) - 3 fen
Ban Xia - 1 liang, washed seven times in hot water to remove slipperiness
Pulverize the ingredients. Take 3 qian per dose, decocted with 1 zhong of Jiang Shui (sour water), 7 stalks of Xie Bai, and 0.5 fen of Sheng Jiang, reduced to 0.6 zheng. Strain and take warm frequently.
In Chest Bi, if there is epigastric stagnation/Qi blockage, Qi knotting in the chest, chest fullness, and rebellious Qi seizing the heart from the hypochondrium, Zhi Shi Xie Bai Gui Zhi Tang (Immature Bitter Orange, Macrostemon Rhizome, and Cinnamon Twig Decoction) is indicated. Ren Shen Tang (Ginseng Decoction) is also indicated. (Zhao Kaimei: "Epigastric stagnation, Qi knotting in chest"; Xu/Xu/Shen: same; *Wai Tai*: "Epigastric hardness, Qi knotting in chest", adds "Qi" after "Ni".)
[Wei Litong's Commentary]: Chest Bi is inherently Yang deficiency and Yin excess. Epigastric stagnation and Qi knotting in the chest are typical Chest Bi manifestations. When combined with rebellious Qi from the hypochondrium seizing the heart, Phlegm, Fluid, Water, and Qi all ascend driven by Yin-Cold. The Yang Qi of the Chest and Stomach cannot resist. Thus, Zhi Shi Xie Bai Gui Zhi Tang is used to promote Yang, open depression, warm the Middle, and direct Qi downward. Sequential decoction harmonizes flavors to slowly resolve stagnation. If Deficient-Cold is severe and harsh resolving agents are contraindicated, Ren Shen Tang is used to warm and tonify Yang, strengthening Righteous Qi to eliminate Pathogens. This is a root-treatment method for Chest Bi.
*Zhang Shi Yi Tong* states: One formula treats Excess Phlegm overflowing from the chest (using Xie Bai and Gui Zhi to disperse); the other treats Deficient Phlegm knotting internally (using Ren Shen and Li Zhong to clear). Two treatments for one disease, based on constitution, are immutable methods.
*Qian Jin Fang* Zhi Zhong Tang for Chest Bi is listed separately. *Wai Tai* cites Zhang Zhongjing's *Shang Han Lun* treating Chest Bi with Li Zhong Tang, equating it to Ren Shen Tang. Note: Zhang Zhongjing states that for Chest Bi with epigastric hardness, Qi knotting, chest fullness, and rebellious Qi seizing the heart, Li Zhong Tang is also indicated. It cites *Fan Wang* listing Zhi Shi Xie Bai Gui Zhi Tang, named Zhi Shi Tang.
**Zhi Shi Xie Bai Gui Zhi Tang Formula**
Zhi Shi - 4 pieces
Hou Po (Magnolia Bark) - 4 liang
Xie Bai - 8 liang
Gui Zhi (Cinnamon Twig) - 1 liang
Gua Lou Shi - 1 piece, crushed
Decoct the first two (Zhi Shi, Hou Po) in 5 sheng of water to obtain 2 sheng. Remove dregs, add remaining herbs, boil briefly. Divide into three warm doses. (*Qian Jin*: Hou Po 3 liang, Xie Bai 1 jin).
**Ren Shen Tang Formula**
Ren Shen (Ginseng Root)
Gan Cao (Licorice Root)
Gan Jiang (Dried Ginger)
Bai Zhu (Atractylodes Macrocephala Rhizome)
Each 3 liang.
Decoct in 8 sheng of water to obtain 3 sheng. Take 1 sheng warm, three times daily.
[Cheng Lin's Commentary]: This is Li Zhong Tang. Strengthening Middle Qi disperses stagnation, resolves chest fullness, and directs rebellious Qi downward. Ren Shen and Bai Zhu benefit the Spleen; Gan Cao and Gan Jiang warm the Stomach. Harmonizing Spleen and Stomach allows Upper Jiao Qi to develop, curing Chest Bi.
In Chest Bi, if there is Qi blockage in the chest and shortness of breath, Fu Ling Xing Ren Gan Cao Tang (Poria, Apricot Seed, and Licorice Decoction) is indicated. Ju Zi Jiang Tang (Tangerine Peel, Immature Bitter Orange, and Ginger Decoction) is also indicated. (*Qian Jin*, *Wai Tai* omit "Ju Zi Jiang Tang ye zhu zhi").
[Xu Bin's Commentary]: Severe Chest Bi involves urgent chest pain; mild Chest Bi involves Qi blockage in the chest.
[Cheng Lin's Commentary]: Dan Zhong is the Sea of Qi. Obstruction in the chest causes Qi blockage and shortness of breath. *Shen Nong Ben Cao Jing* states: Poria governs rebellious Qi in chest/hypochondrium; Apricot Seed directs Qi downward; Licorice treats Cold/Heat pathogens. This is a mild formula for Chest Bi.
**Fu Ling Xing Ren Gan Cao Tang Formula** (*Qian Jin* names it Fu Ling Tang; *Wai Tai* cites *Shang Han Lun*):
Fu Ling (Poria) - 3 liang
Xing Ren (Apricot Seed) - 50 pieces
Gan Cao - 1 liang
Decoct in 1 dou of water to obtain 5 sheng. Take 1 sheng warm, three times daily. Repeat if ineffective.
*Wai Tai*, *Gu Jin Lu Yan* formula for sudden chest fullness and urgency:
Remove Gan Cao from the above formula, add Ju Pi (Tangerine Peel).
**Ju Pi Zhi Shi Sheng Jiang Tang Formula** (*Qian Jin* no name; *Wai Tai* names it Ju Pi Zhi Shi Tang):
Ju Pi - 1 jin (*Wai Tai*: 0.5 jin)
Zhi Shi - 3 liang (*Wai Tai*: 4 pieces)
Sheng Jiang - 0.5 jin
Decoct in 5 jin of water to obtain 2 jin. Divide into two warm doses. (*Original Note*: *Zhou Hou*, *Qian Jin* treat Chest Bi with chest fullness/blockage, itching, throat dryness/astringency. *Wai Tai* cites *Shang Han Lun*, matching *Zhou Hou* and *Qian Jin*. Notes: *Zhou Hou*, *Duan Ju*, *Wen Zhong*, *Shen Shi*, *Fan Wang*, *Gu Jin Lu Yan*, *Jing Xin Lu*, *Qian Jin* agree.)
[Cheng Lin's Commentary]: Qi blockage and shortness of breath require Pungent-Warm herbs to move Qi. Ju Pi, Zhi Shi, and Sheng Jiang are Pungent-Warm and direct Qi downward. The *Nei Jing* states diseases vary in severity, formulas in size. This is a mild Chest Bi case, hence a small formula (one sovereign, two minister herbs).
For Chest Bi with alternating relief and exacerbation, Yi Yi Ren Fu Zi San (Coix Seed and Aconite Powder) is indicated. (*Wai Tai* cites *Gu Jin Lu Yan*, adding "Pian" [partial] after Bi).
[Cheng Lin's Commentary]: Cold pathogens in the Upper Jiao cause urgent pain. Urgent pain gathers Shen (Spirit), gathering Shen gathers Qi, dispersing Cold, relieving pain. This explains the alternation of relief and exacerbation in Chest Bi, similar to the coming and going of Heart Pain. Yi Yi Ren removes Bi and directs Qi downward; Da Fu Zi warms the Middle and disperses Cold.
[Xu Bin's Commentary]: Li Shi states: "Huan Ji" means sometimes relaxed with temporary pain cessation, sometimes urgent with pain recurrence. Yi Yi Ren enters the Lung to benefit Qi; Fu Zi warms the Middle and promotes Yang. Taking as powder accelerates efficacy.
Note: Some interpret "Huan" as a typo for "Jiao" (twisting/cramping). This is plausible but incorrect. *Wai Tai* lists four formulas for Chest Bi with epigastric hardness and Huan Ji; *Sheng Hui Fang* agrees. Thus, Cheng and Li's interpretations are correct.
**Yi Yi Ren Fu Zi San Formula**
Yi Yi Ren (Coix Seed) - 15 liang
Da Fu Zi (Large Aconite Mother Root) - 10 pieces, processed
Pulverize into powder. Take 1 fang cun bi per dose, three times daily.
*Wai Tai* cites *Gu Jin Lu Yan* with two Yi Yi Ren formulas: one with 500 seeds and 3 liang Gan Cao; another identical to this formula but using 1500 seeds, attributed to Monk Shen and *Fan Wang*. Zhang Zhongjing uses 15 liang.
*Sheng Hui Fang* Yi Yi Ren San for Chest Bi with epigastric hardness and Huan Ji:
Yi Yi Ren - 2 liang
Fu Zi - 2 liang, processed
Gan Cao - 1 liang, honey-fried
Pulverize. Take 3 qian per dose, decocted with 1 zhong of water and 0.5 fen of Sheng Jiang, reduced to 0.6 zheng. Strain and take warm frequently.
For epigastric stagnation and various rebellious Qi causing "hanging pain" in the heart, Gui Zhi Sheng Jiang Zhi Shi Tang (Cinnamon Twig, Ginger, and Immature Bitter Orange Decoction) is indicated. (*Zhou Hou* adds "Xia Jian Ji Ao Tong" [lower pulling urgency and distress/pain] after "Tong").
[Cheng Lin's Commentary]: Epigastric stagnation is Chest Bi. "Various rebellions" include rebellious Qi from hypochondrium seizing the heart. Pathogenic factors lingering in the Upper Jiao cause hanging pain. Zhi Shi drains stagnation; Gui Zhi directs rebellious Qi downward; Sheng Jiang disperses Qi.
[You Zaijing's Commentary]: "Various rebellions" refer to Phlegm-Fluid and hostile Qi. "Hanging pain" feels like a suspended object shaking and hurting, caused by rebellious Qi.
[Xu Bin's Commentary]: Hanging empty pain in the heart feels like a suspended object shaking. Gui Zhi Sheng Jiang Zhi Shi Tang unblocks Yang Qi and breaks rebellious Qi, stopping pain and opening stagnation.
Pan Shi's *Xu Yan* states: "Xuan" means suspended. It is not in the Stomach but suspended between abdomen and hypochondrium.
**Gui Zhi Sheng Jiang Zhi Shi Tang Formula** (*Wai Tai* cites *Shang Han Lun*: For lower hanging pain and various rebellions in great deficiency, Gui Xin Sheng Jiang Zhi Shi Tang, same formula):
Gui Zhi (Cinnamon Twig) - 3 liang
Sheng Jiang (Fresh Ginger) - 3 liang
Zhi Shi (Immature Bitter Orange) - 5 pieces (Xu/Shen/You read as 2 liang; *Wai Tai* adds "Zhi" [honey-fried])
Decoct in 6 sheng of water to obtain 3 sheng. Divide into three warm doses.
*Qian Jin Fang* Gui Xin San Wu Tang for epigastric stagnation, various rebellions, and hanging pain:
Gui Xin (Cinnamon Heart) - 2 liang
Jiao Yi (Maltose) - 0.5 jin
Sheng Jiang - 2 liang
Cut herbs, decoct first two in 4 sheng of water to obtain 3 sheng. Remove dregs, add maltose. Divide into three doses.
When heart pain radiates to the back, and back pain radiates to the heart, Wu Tou Chi Shi Zhi Wan (Aconite and Halloysite Pill) is indicated.
[Xu Bin's Commentary]: Heart pain radiating to the back has intervals of relief, treated with the moderate Gua Lou Xie Bai Bai Jiu Tang plus Ban Xia. Here, pain radiating to back and back to heart is continuous without rest, indicating severe Yin-Cold, extinguishing Yang light. Xie Bai and Bai Jiu are insufficient. Wu Tou Chi Shi Zhi Wan is used. The formula contains Wu Tou, Fu Zi, Hua Jiao, Gan Jiang—all Great Pungent-Hot—to aggressively expel Yin-Cold. Li Shi states: Heart pain inside radiating out; back pain outside radiating in. Thus, Fu Zi warms, Wu Tou acts swiftly, Gan Jiang promotes Yang to scatter Cold, Hua Jiao directs Qi downward to open depression. To prevent excessive scattering/opening, Chi Shi Zhi enters the Heart to secure and astringe, recovering Yang Qi.
**Chi Shi Zhi Wan Formula** (*Wai Tai* cites *Shang Han Lun*; matches *Qian Jin*, *Bi Xiao*, *Wen Zhong*, *Fan Wang*, *Jing Xin Lu*):
Shu Jiao (Sichuan Pepper) - 1 liang (One method: 2 fen; *Wai Tai*: 2 fen)
Wu Tou (Aconite Child Root) - 1 fen, processed
Fu Zi (Aconite Lateral Root) - 0.5 liang, processed (One method: 1 fen; *Wai Tai*: 1 fen)
Gan Jiang (Dried Ginger) - 1 liang (One method: 1 fen; *Wai Tai*: 2 fen)
Chi Shi Zhi (Halloysite Red Earth) - 1 liang (One method: 2 fen; *Wai Tai*: 2 fen)
Pulverize the five ingredients, mix with honey, form pills the size of wu zi (mulberry seeds). Take one pill before meals, three times daily. Increase dosage slightly if ineffective. (*Qian Jin* names it Wu Tou Wan: Wu Tou 6 zhu, Fu Zi/Shu Jiao 0.5 liang each. Note: *Fan Wang* omits Fu Zi; Cui Shi adds Gui 0.5 liang for six ingredients.)
*Wai Tai* reports a hermit in Danyang claimed Huatuo's method: For chronic heart pain, take three pills every morning, gradually increasing to ten pills. Finish one course, and the condition will not recur for life.
**Jiu Tong Wan (Nine Pain Pill)** treats Nine Types of Heart Pain. (*Wai Tai* cites *Qian Jin* naming it Fu Zi Wan. Xu edition marks as Appendix. Shen agrees. Cheng Lin states: Not Zhang Zhongjing's formula, later additions.*)
Fu Zi (Aconite Lateral Root) - 3 liang (*Qian Jin*: 2 liang)
Sheng Ye Lang Ya (Raw Wild Wolf's Tooth/Root) - 1 liang, honey-fried until fragrant (*Qian Jin*: Raw Ye Lang Du 4 liang; *Wai Tai* same)
Ren Shen (Ginseng Root)
Gan Jiang (Dried Ginger)
Ba Dou (Croton Seed) - 1 liang, husked, core removed, roasted and ground to paste
Wu Zhu Yu (Evodia Fruit) - 1 liang each (*Qian Jin*: Gan Jiang 2 liang)
Pulverize six ingredients, mix with refined honey, form pills size of wu zi. Take with wine. Strong adults start with 3 pills, three times daily. Weak persons take 2 pills. ○ Also treats sudden evil strike, abdominal distension/pain, inability to speak. Treats chronic accumulated cold flowing into chest/heart pain, cold Qi rushing upward, trauma blood stasis from falls/car accidents. Contraindications as usual. ("Chong" in Zhao edition reads "Zhong" [swelling], incorrect.)
[Cheng Lin's Commentary]: The Nine Pains are: 1. Worm Heart Pain, 2. Transmission Heart Pain, 3. Wind Heart Pain, 4. Palpitation Heart Pain, 5. Food Heart Pain, 6. Drink Heart Pain, 7. Cold Heart Pain, 8. Heat Heart Pain, 9. Migratory Heart Pain. (See *Qian Jin* main indications). Though nine types, they stem from accumulation, phlegm-fluid, blood stasis, worms/transmission, and cold. Fu Zi and Ba Dou scatter cold and break hard accumulations; Lang Ya and Zhu Yu kill worms/transmission and remove phlegm-fluid; Gan Jiang and Ren Shen regulate Middle Qi and harmonize Stomach. They work together to treat the nine pains. Ba Dou eliminates evil and kills ghosts, treating sudden evil strike, abdominal distension/pain, inability to speak, chronic cold, flowing chest pain, cold Qi rushing up—all suitable for Pungent-Hot. Pungent-Hot moves and breaks blood, suitable for trauma-induced blood stasis.