浦 中阳困顿浊阴凝冱。胃痛彻背。午后为甚。即不嗜饮食。亦是阳伤。温通阳气。在所必施。
（胸脘清阳不运）
薤白（三钱） 半夏（三钱） 茯苓（五钱） 干姜（一钱） 桂枝（五分）
华（四六） 因劳。胸痹。阳伤。清气不运。仲景每以辛滑微通其阳。
薤白 栝蒌皮 茯苓 桂枝 生姜
王 胸前附骨板痛。甚至呼吸不通。必捶背稍缓。病来迅速。莫晓其因。议从仲景胸痹症。乃清
阳失展。主以辛滑。
薤白 川桂枝尖 半夏 生姜 加白酒一杯同煎。
谢 冲气至脘则痛。散漫高突。气聚如瘕。由乎过劳伤阳。
薤白 桂枝 茯苓 甘草 临服冲入白酒一小杯。
某（六五） 脉弦。胸脘痹痛欲呕。便结。此清阳失旷。气机不降。久延怕成噎格。
薤白（三钱） 杏仁（三钱） 半夏（三钱） 姜汁（七分） 浓朴（一钱） 枳实（五分）
徐（六一） 胸痹因怒而致。痰气凝结。
土栝蒌 半夏 薤白 桂枝 茯苓 生姜
王（五七） 气逆自左升。胸脘阻痹。仅饮米汤。形质不得下咽。此属胸痹。宗仲景法。栝蒌薤白汤。
又 脉沉如伏。痞胀格拒。在脘膈上部。病患述气壅。自左觉热。凡木郁达之。火郁发之。患在上
宜吐之。
巴豆霜（一分制） 川贝母（三分） 桔梗（二分）
为细末服。吐后。服凉水即止之。
某（二六） 肺卫窒痹。胸膈痹痛。咳呛痰粘。苦辛开郁为主。当戒腥 。
栝蒌皮 炒桃仁 冬瓜子 苦桔梗 紫菀 川贝母
华 阳气微弱。胸痹。苓桂术甘汤。
某（二十） 脉弦。色鲜明。吞酸胸痹。大便不爽。此痰饮凝冱。清阳失旷。气机不利。法当温通阳气为主。
薤白 杏仁 茯苓 半夏 浓朴 姜汁
某（三八） 气阻胸痛。
鲜枇杷叶 半夏 杏仁 桔梗 橘红 姜汁
某 脉沉。短气咳甚。呕吐饮食。便溏泻。乃寒湿郁痹。胸痹如 。无非清阳少旋。（寒湿郁痹）小半夏
汤加姜汁。
王（三三） 始于胸痹。六七年来。发必呕吐甜水黄浊。七八日后渐安。自述病发秋月。意谓新凉天降。
郁折生阳。甘味色黄。都因中焦脾胃主病。仿内经辛以胜甘论。（脾胃阳虚）
半夏 淡干姜 杏仁 茯苓 浓朴 草蔻 姜汁法丸。
某 痛久入血络。胸痹引痛。（血络痹痛）
炒桃仁 延胡 川楝子 木防己 川桂枝 青葱管
胸痹与胸痞不同。胸痞有暴寒郁结于胸者。有火郁于中者。有寒热互郁者。有气实填胸
而痞者。有气衰而成虚痞者。亦有肺胃津液枯涩。因燥而痞者。亦有上焦湿浊弥漫而痞
者。若夫胸痹。则但因胸中阳虚不运。久而成痹。内经未曾详言。惟金匮立方。俱用辛滑温
通。所云寸口脉沉而迟。阳微阴弦。是知但有寒症。而无热症矣。先生宗之加减而治。亦惟
流运上焦清阳为主。莫与胸痞结胸噎膈痰食等症混治。斯得之矣。（华玉堂）
徐评 此即俗名心头痛也。病有数种。偶然卒得者。不外仲景栝蒌薤白汤。其余诸种。各有治
法。非一煎剂所能必愈也。案中俱不能见及。
Pu: The middle yang is trapped and depleted, while turbid yin-cold condenses and freezes. Stomach pain radiates to the back. Symptoms worsen in the afternoon. Even if there is a lack of appetite, it indicates damage to yang. Warming and unblocking the yang qi is absolutely necessary.
(The clear yang of the chest and epigastrium fails to circulate)
Xiebai (Allii Macrostemonis Bulbus, 3 qian) Banxia (Pinelliae Rhizoma, 3 qian) Fuling (Poria, 5 qian) Ganjiang (Zingiberis Rhizoma Recens, 1 qian) Guizhi (Cinnamomi Ramulus, 5 fen)
Hua: Caused by labor/overwork. Xiongbi (Chest Bi syndrome). Yang is damaged. Clear qi fails to transport. Zhang Zhongjing often uses acrid and slippery substances to slightly unblock the yang.
Xiebai Gualoupi (Trichosanthis Pericarpium) Fuling Guizhi Shengjiang (Zingiberis Rhizoma Recens)
Wang: The area in front of the chest adjacent to the ribs feels rigid and painful. Breathing is even obstructed. Beating the back provides slight relief. The onset is rapid, and the cause is unknown. It is proposed to treat according to Zhang Zhongjing’s Xiongbi syndrome. This is due to the failure of clear yang to expand. The main treatment principle is acrid and slippery methods.
Xiebai Chuan Guizhi Jian (Tip of Cinnamomi Ramulus) Banxia Shengjiang Decoct together with one cup of Baijiu (White Liquor).
Xie: When Chong Qi (Penetrating Vessel Qi) rises to the epigastrium, pain occurs. The qi scatters and protrudes high. Qi gathers forming a mass like Jia (abdominal mass). This results from overwork damaging yang.
Xiebai Guizhi Fuling Gancao (Glycyrrhizae Radix et Rhizoma) Add one small cup of Baijiu when taking the medicine.
Certain Patient (65 years old): Pulse is Xian (Wiry). Chest and epigastrium Bi pain with urge to vomit. Constipation. This is due to clear yang failing to be expansive. Qi mechanism does not descend. If prolonged, it may develop into Yege (Dysphagia/Oesophageal Obstruction).
Xiebai (3 qian) Xingren (Armeniacae Semen Amarum, 3 qian) Banxia (3 qian) Jiangzhi (Zingiberis Juice, 7 fen) Houpo (Magnoliae Officinalis Cortex, 1 qian) Zhishi (Aurantii Fructus Immaturus, 5 fen)
Xu (61 years old): Xiongbi caused by anger. Phlegm and qi condense.
Tu Gualou (Trichosanthis Fructus) Banxia Xiebai Guizhi Fuling Shengjiang
Wang (57 years old): Qi rebels and rises from the left. Chest and epigastrium obstruction and Bi pain. Can only drink rice soup. Solid food cannot be swallowed. This belongs to Xiongbi. Following Zhang Zhongjing’s method. Use Gualou Xiebai Tang (Trichosanthis and Allii Macrostemoni Decoction).
Another case: Pulse is Chen (Deep) and Fu (Hidden). Fullness and distension with rejection. Located in the upper epigastrium and diaphragm. The patient describes Qi stagnation. Feels heat originating from the left. For Wood stagnation, use dispersing; for Fire stagnation, use venting. Since the disease is in the Upper Jiao, vomiting therapy is appropriate.
Baiduoshuang (Crotonis Fructus Frost, 1 fen prepared) Chuan Beimu (Fritillariae Cirrhosae Bulbus, 3 fen) Jiegeng (Platycodonis Radix, 2 fen)
Grind into fine powder and take. After vomiting, drink cool water to stop the emetic effect.
Certain Patient (26 years old): Lung and Wei (Defensive) Qi are obstructed and Bi. Chest and diaphragm Bi pain. Coughing and wheezing with sticky phlegm. Main treatment is bitter and acrid to open stagnation. Must avoid seafood/fishy foods.
Gualoupi (Trichosanthis Pericarpium) Chao Taoren (Persicae Semen, stir-fried) Dongguazi (Benincasae Semen) Ku Jiegeng (Platycodonis Radix, bitter) Ziwan (Astagti Radix) Chuan Beimu (Fritillariae Cirrhosae Bulbus)
Hua: Yang qi is weak. Xiongbi. Use Linggui Zhugan Tang (Poria, Cinnamon Twig, Atractylodes Macrocephala and Licorice Decoction).
Certain Patient (20 years old): Pulse is Xian (Wiry). Complexion is bright and lustrous. Acid regurgitation and Xiongbi. Bowel movements are unsatisfactory. This is due to Phlegm-fluids condensing and freezing. Clear yang fails to be expansive. Qi mechanism is unfavorable. The method should primarily warm and unblock yang qi.
Xiebai Xingren Fuling Banxia Houpo Jiangzhi
Certain Patient (38 years old): Qi obstruction causing chest pain.
Xian Pipaye (Eriobotryae Folium, fresh) Banxia Xingren Jiegeng Juhong (Citri Reticulatae Pericarpium Rubrum) Jiangzhi
Certain Patient: Pulse is Chen (Deep). Shortness of breath and severe cough. Vomiting of ingested food. Loose stools/diarrhea. This is Cold-Dampness stagnating and obstructing. Xiongbi is like... merely that clear yang rarely rotates. (Cold-Dampness stagnating and obstructing) Xiao Banxia Tang (Minor Pinellia Decoction) plus Jiangzhi.
Wang (33 years old): Started as Xiongbi. For six or seven years, upon attack, must vomit sweet, yellow, turbid fluid. Gradually recovers after seven or eight days. Self-reports onset in autumn. Implies new cool weather descends.
Stagnation breaks and generates yang. Sweet taste corresponds to yellow color. All due to diseases of the Middle Jiao Spleen and Stomach. Imitate the Neijing theory "Acrid overcomes Sweet". (Spleen-Stomach Yang Deficiency)
Banxia Dan Ganjiang (Mild Dried Ginger) Xingren Fuling Houpo Cao Kou (Amomi Fructus Rotundus) Jiangzhi processed into pills using ginger juice method.
Certain Patient: Pain has entered the blood collaterals over time. Xiongbi draws pain. (Blood collateral Bi pain)
Chao Taoren Yanhu (Corydalis Rhizoma) Chuan Lianzi (Meliae Fructus) Mu Fangji (Stephaniae Tetrandrae Radix) Chuan Guizhi Qingcongguan (Allii Tuberosi Caulis)
Xiongbi differs from Xiongpi (Chest Fullness). Xiongpi can be caused by sudden cold stagnating in the chest; fire stagnating internally; cold and heat mutually stagnating; excess qi filling the chest causing fullness; deficiency qi leading to deficient fullness; dryness due to withered fluids of Lung and Stomach causing fullness; or turbid dampness pervading the Upper Jiao causing fullness. As for Xiongbi, it is solely due to deficiency and failure of transportation of Yang in the chest, which becomes Bi over time. The Neijing did not discuss this in detail. Only the Jin Gui Yao Lue established formulas, all using acrid, slippery, warming, and unblocking methods. It states: "The pulse at Cun Kou is deep and slow, Yang is micro, Yin is Xian." Thus, we know there are only Cold syndromes, no Heat syndromes. The Master followed this, adding and subtracting for treatment, focusing mainly on circulating the clear Yang of the Upper Jiao. Do not confuse it with treatments for Xiongpi, Jie Xiong (Chest Binding), Ye Ge, Tan Shi (Phlegm-Food) etc. This is correct. (Hua Yutang)
Xu’s Commentary: This is commonly known as Heart-Headache. There are several types of this disease. Those acquired suddenly do not go beyond Zhang Zhongjing’s Gualou Xiebai Tang. The other types each have their own treatment methods. They cannot necessarily be cured with a single decoction. The medical cases presented here cannot cover all possibilities.