心下满，属阳明胃家。故曰邪结心下，满而烦，饥不欲食，心胸嘈杂，或见冲逆作呕，此胃
家有火之痰饮食积也。宜栀连平胃散、二陈汤调服。心下满而不饥不食，不见嘈杂者，此无
火之痰饮食积也。若初起恶心胀痛，宜先吐之，随用消食化痰，不用苦寒抑遏。若热邪聚
胃，心下痞满，方可用枳壳川连汤、栀连保和散，清热积，栀连二陈汤化热痰。家秘用保和
散加白豆蔻、砂仁消食滞饱闷。若里有热，煎凉药以汤调服，忌燥者冲竹沥、莱菔汁最妙。
总之，胸前饱闷，宜消不宜补，宜散不宜收。若有停滞，切忌寒凉生冷。若胸前真有凝结，
即见烦躁谵语等症，宜察食气痰凝，慎勿误认里热谵妄，误投凉剂攻下。大凡胸痛胃满，皆
是上部之病，非下部肠病，故禁下法也。惟心下硬痛，大便不通者，方用攻下。
脉浮而大，心下反硬，有热属脏者，攻之。
脉浮而大，不当攻。今心下反硬，有热属脏，形容热已深入，而结藏于里，故可攻之。
阳明病，心下硬满不可攻，攻之利遂不止。
前条浮大表脉，尚曰可攻。此条同一硬满，何曰不可攻？前条有有热属脏，内已包藏，便
硬消水，口燥唇焦，种种里热之症，故曰攻之。此条无有热属脏，恐食滞痰饮硬满。言此
条不可攻，则上条可攻，愈有下手。
伤寒五六日，大下之后，身热不可去，心下结痛者，未欲解也，栀子豉汤。
伤寒大下后，若身热去，心下结痛，此为结胸，当用陷胸汤。今身热不去，心下结痛，当
用柴胡汤。不用柴胡而用此汤者，以汗下后，身热里烦，心下结痛耳。
太阳病，重发汗，复下之，不大便六七日，舌上燥而渴，日晡小有潮热，从心下至小腹硬满
而痛，大陷胸汤主之。
此分别同是下后，上条身热不去，心下结痛，与此条日晡潮热，小腹硬痛，治分上下。夫
大便不通六七日，舌上燥而渴，日晡小有潮热，且心下至小腹硬满而痛，则成结胸症，故用陷胸汤。
栀连平胃散 即平胃散加栀连。
胃有湿热，故加栀，连湿郁成痰，加半夏、石菖蒲；若顽痰胶结，加海石、香附。
二陈汤
熟半夏 白茯苓 广皮 甘草 加石菖蒲
治痰用二陈，不易之论。然顽痰胶结，非南星、石菖蒲不能开郁痰成积，非海石、香附不
能解痰食相凝，须以保和丸合用。夫二陈汤，治痰病之缓者；导痰汤、指迷丸、化痰丸，
则稍重；控涎丹、滚痰丸则重矣。要知应用控涎、滚痰症，不惟二陈不及，即用指迷、化
痰亦不及。应用二陈症，不惟控涎、滚痰太过，即指迷、化痰亦太过也。
枳壳川连汤 二味。
此方加木香，能治湿热下利；加当归、大黄，能治燥热下血，腹痛频并。今以心下满闷亦
用此方，以枳壳与川连同用，能消心下热结之痞。若痰涎凝结，加半夏、栝蒌实，则合小
陷胸汤。加广皮、浓朴、竹茹，能清胃热而止呕吐；加大黄、甘草，又合调胃承气汤。
栀子豆豉汤 二味。
仲景治心胸满闷，以表症尚在者仍用发表。表邪已解，里有热结者，用诸泻心汤。心腹硬
痛，有下症者，用陷胸汤。若汗下后，心烦痞塞，立栀子豉汤，和解其热，栀子浓朴汤，
宽解其气，此无穷法门也。
大陷胸汤 见结胸。
按大陷胸汤，治心下硬痛，大实大满。小陷胸汤，治热痰凝结中焦。枳壳川连汤、栀子浓
朴汤，治热邪凝结气分。栀子豆豉汤，治汗下后烦热痞塞。诸泻心汤，治寒药误下，抑遏
痰热于胸前，此丝丝入扣法门也。
Epigastric fullness belongs to the Yangming Stomach system. Therefore, it is said that pathogenic factors are knotted in the epigastrium, causing fullness and irritability; the patient feels hungry but has no desire to eat, experiences a sensation of discomfort (Zaocha) in the chest and heart, or may present with rebellious Qi leading to vomiting. This indicates Phlegm and Food retention due to Fire in the Stomach. It is appropriate to administer Zhilian Pingwei San (Gardenia and Coptis Pingwei Powder) and Erchen Tang (Two-Cured Decoction) harmoniously. If there is epigastric fullness without hunger or desire to eat, and without Zaocha, this indicates Phlegm and Food retention without Fire. If initially there is nausea, distension, and pain, emesis should be induced first, followed by methods to digest food and resolve phlegm; bitter-cold drugs should not be used to suppress the pathogen. If Heat pathogens gather in the Stomach, causing epigastric stuffiness and fullness, Zhike Chuanlian Tang (Immature Bitter Orange and Coptis Decoction) or Zhilian Baohe San (Gardenia and Coptis Harmonize the Middle Powder) can be used to clear Heat accumulation, and Zhilian Erchen Tang (Gardenia, Coptis, and Two-Cured Decoction) to resolve Phlegm-Heat. A secret prescription uses Baohe San (Harmonize the Middle Powder) added with Bai Doukou (White Cardamom) and Sharen (Amomum Fruit) to eliminate Food stagnation causing fullness and oppression. If there is Heat inside, decoct cold medicines and take them mixed with liquid; dry substances are contraindicated. Mixing with Zhuli (Bamboo Sap) and Laifu Zhi (Radish Juice) is excellent. In summary, for fullness and oppression in the chest, resolution is preferred over tonification, and dispersion is preferred over consolidation. If there is stagnation, cold and raw foods must be strictly avoided. If there is true condensation in the chest, even if symptoms such as irritability and delirium appear, one must carefully distinguish whether it is caused by Food Qi or Phlegm condensation. Do not mistakenly diagnose it as delirium due to Interior Heat and erroneously administer cold purgatives. Generally, chest pain and stomach fullness are diseases of the Upper Jiao, not diseases of the Lower Jiao intestines; therefore, purgative methods are contraindicated. Only when the epigastrium is hard and painful, accompanied by constipation, should purgative methods be used.
A pulse that is floating and large, with the epigastrium conversely becoming hard, and Heat belonging to the Zang organs, indicates that purgation is indicated.
A pulse that is floating and large should not normally be treated with purgation. Now that the epigastrium is conversely hard, and Heat belongs to the Zang organs, this describes Heat that has penetrated deeply and is knotted in the Interior; thus, purgation is permissible.
Yangming disease, with hardness and fullness in the epigastrium, must not be treated with purgation. If purged, diarrhea will ceaselessly continue.
The previous clause mentioned a floating-large exterior pulse and stated that purgation could be used. This clause presents the same hardness and fullness but states purgation is contraindicated. The previous clause had "Heat belonging to the Zang," implying internal storage, leading to hard stool, water-drinking behavior, dry mouth, and scorched lips—various Interior Heat symptoms—hence "purge." This clause lacks "Heat belonging to the Zang" and likely involves Food stagnation or Phlegm-fluid causing hardness and fullness. Stating this clause is contraindicated for purgation clarifies that the previous clause was amenable to treatment, providing clearer guidance.
After five or six days of Cold Damage, following severe purgation, if body heat persists and there is knotting and pain in the epigastrium, the disease has not yet resolved; use Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction).
After severe purgation in Cold Damage, if body heat subsides but knotting and pain remain in the epigastrium, this is Jie Xiong (Chest Binding), and Xianxiong Tang (Trap-the-Chest Decoction) should be used. Now, since body heat persists and there is knotting and pain in the epigastrium, Chaihu Tang (Bupleurum Decoction) should be used. The reason for using Zhizi Chi Tang instead of Chaihu Tang is that after sweating and purging, there is body heat, interior irritability, and knotting/pain in the epigastrium.
Taiyang disease, after excessive sweating and subsequent purgation, if there is no bowel movement for six or seven days, the tongue is dry and thirsty, there is slight tidal fever in the late afternoon, and from the epigastrium down to the lower abdomen there is hardness, fullness, and pain, Da Xianxiong Tang (Major Trap-the-Chest Decoction) is the primary formula.
This distinguishes cases following purgation: the previous case had persistent body heat and epigastric knotting/pain, while this case has late-afternoon tidal fever and lower abdominal hardness/pain, indicating treatment directed at the upper versus lower regions. With constipation for six or seven days, dry tongue with thirst, slight late-afternoon tidal fever, and hardness/fullness/pain from the epigastrium to the lower abdomen, this constitutes a Jie Xiong syndrome; thus, Xianxiong Tang is used.
Zhilian Pingwei San is Pingwei San added with Zhizi (Gardenia) and Lian (Coptis).
For Damp-Heat in the Stomach, add Zhizi and Lian; for Dampness stagnating into Phlegm, add Banxia (Pinellia) and Shichangpu (Acorus); for stubborn Phlegm adhesion, add Haishi (Pumice) and Xiangfu (Cyperus).
Erchen Tang
Prepared Banxia (Pinellia) Baifuling (Poria) Guangpi (Tangerine Peel) Gancao (Licorice) Add Shichangpu (Acorus)
Using Erchen Tang for Phlegm diseases is an unchanging principle. However, for stubborn Phlegm adhesion, only Nanxing (Arisaema) and Shichangpu can open depressed Phlegm to resolve masses; only Haishi and Xiangfu can resolve the conglomeration of Phlegm and Food; they must be combined with Baohe Wan (Harmonize the Middle Pill). Erchen Tang treats mild Phlegm diseases; Daotan Tang (Guide-out Phlegm Decoction), Zhimi Wan (Point-to-Mystery Pill), and Huatan Wan (Resolve-Phlegm Pill) are slightly heavier; Kongxian Dan (Drain-Fluid Pellet) and Guntan Wan (Roll-Phlegm Pill) are heavy. One must know that for conditions requiring Kongxian Dan or Guntan Wan, not only is Erchen Tang insufficient, but Zhimi Wan and Huatan Wan are also insufficient. Conversely, for conditions requiring Erchen Tang, not only are Kongxian Dan and Guntan Wan too strong, but Zhimi Wan and Huatan Wan are also too strong.
Zhike Chuanlian Tang consists of two ingredients.
Adding Muxiang (Aucklandia) to this formula treats Damp-Heat dysentery; adding Danggui (Angelica) and Dahuang (Rhubarb) treats Dry-Heat hematochezia with frequent abdominal pain. Currently, it is used for epigastric fullness and oppression because Zhike and Chuanlian together can resolve epigastric Heat-knot stuffiness. If Phlegm-saliva is condensed, add Banxia and Gualou Shi (Trichosanthes Seed) to form Xiao Xianxiong Tang (Minor Trap-the-Chest Decoction). Adding Guangpi, Houpo (Magnolia Bark), and Zhuru (Bamboo Shavings) clears Stomach Heat and stops vomiting; adding Dahuang and Gancao forms Tiaowei Chengqi Tang (Regulate-the-Stomach and Restore-Qi Decoction).
Zhizi Chidui Tang consists of two ingredients.
Zhongjing treated chest and heart fullness by still using exterior-releasing methods if exterior symptoms persisted. If exterior pathogens were resolved but Interior Heat knots remained, various Xiexin Tangs (Drain-the-Epigastrium Decoctions) were used. For hardness and pain in the heart and abdomen with purgative indications, Xianxiong Tang was used. If after sweating and purging, there was irritability and stuffiness, Zhizi Chi Tang was immediately prescribed to harmonize Heat; Zhizi Houpo Tang (Gardenia and Magnolia Decoction) was used to broaden and relieve Qi. These are endless methods.
Da Xianxiong Tang See Jie Xiong (Chest Binding).
Note: Da Xianxiong Tang treats epigastric hardness and pain, representing major excess and fullness. Xiao Xianxiong Tang treats Heat-Phlegm condensation in the Middle Jiao. Zhike Chuanlian Tang and Zhizi Houpo Tang treat Heat-pathogen condensation in the Qi level. Zhizi Chidui Tang treats irritability, heat, and stuffiness after sweating and purging. Various Xiexin Tangs treat cases where erroneous use of cold medicines for purgation suppressed Phlegm-Heat in the chest. These methods are meticulously applied.