胸满在心之上，故多表症。盖表邪传里。必先胸至胁，然后入里者也。胸满症必内有痰涎，
外邪传里，互相交结致是。故胸满胸痹之症，多用栝蒌等豁痰，或用瓜蒂散吐法。伤寒胸满
心烦发热者，柴胡陷胸汤。胸满连胁，加青皮、枳桔。若尚带太阳表症，加散表药。寒热胸
满而呕苦，通用小柴胡汤加枳、桔。未效，合小陷胸汤。故胸满症，栝蒌、枳、桔为必用之
药。惟呕多者用半夏，不用栝蒌。若夹食胸满，见嗳气饱闷，用保和平胃散消导法。有表邪
者，兼散表；有里热者，兼清热；有痰饮，导痰汤等。另有不发热，口不渴，唇不焦，二便
清利，六脉沉迟，此阴寒胸满，另用温散。
太阳病，下之，脉促，胸满，微恶寒，桂枝去芍药汤主之。
太阳表症误下，则变脉促胸满，因尚有微恶寒表症，故用桂枝。去芍药者，因胸满症，忌
血药凝滞耳。
太阳阳明合病，喘而胸满，不可下，宜麻黄汤。
三阳合病而喘，表邪未伸，故不可下，而用麻黄汤。
若发汗，若下之，烦热胸中窒者，栀子豆豉汤。
汗后烦热，不可再汗，下后烦热；不可再下。汗下后烦热胸中窒者，即烦闷懊 ，故用栀
子豆豉汤。未汗下者，表症胸满，吐法不中用也。
病如桂枝症，但头不痛，项不强，寸脉微浮，胸中痞硬，气冲咽喉不得息，此胸中有寒也，当吐之。
如桂枝症，但头不痛，项不强，寸脉微浮，非桂枝症。胸中痞硬，气冲咽喉不得息，此胸
中有寒饮，故吐之，非言里气虚寒用此法。
少阳中风，耳无闻，目赤，胸中满而烦，若吐下之，则悸而惊。救逆，小柴胡去黄芩，加茯苓。
少阳中风，言有汗发热少阳症。少阳之脉，起目锐 ，入耳中；其支者，贯胸膈。故少阳
症则目赤耳聋，胸中满而烦，若以吐下除烦，则悸而惊，故以小柴胡去黄芩，加茯苓定悸安神。
阳明潮热，大便溏，小便可，胸胁满，属阳明。
阳明潮热，大便硬，小便不利，乃是里症。今大便溏，小便又利，且胸胁满，属阳明表症。
太阴病，腹满而吐食，不下，自利益甚，时腹自痛。若下之，必胸中结硬。
太阴之脉，络胃统腹，故腹满吐食自利，时腹自痛。本非下症，若误下之必胸中结硬。
少阴病，下利咽痛，胸满心烦者，猪肤汤主之。
此热邪传入少阴，故以猪肤润燥滋阴。
厥阴病，手足厥冷，脉乍紧，邪结胸中，满而烦，饥不能食，病在胸中，当吐，瓜蒂散。
厥阴病，手足厥冷，脉本沉迟。今乍紧急，此阳邪传入厥阴之病，病在胸中，故用瓜蒂散吐之。
瓜蒂散
苦瓜蒂一两，为细末吹鼻。
黄水蓄于中焦，此方吹鼻得嚏，则目出泪，鼻出水矣。然内有黄水者可用。
柴胡陷胸汤
柴胡 栝蒌 半夏 黄连 甘草 青皮 枳壳
此即小陷胸汤，加柴胡、青皮、枳壳。大凡治凝结之症，必开豁气道。
小柴胡加枳桔汤
柴胡 黄芩 广皮 甘草 枳壳 桔梗
前方因热痰凝结，故以小柴胡合小陷胸汤。此条但是热邪结聚，故不合陷胸汤，但加枳壳、桔梗。
小陷胸汤
栝蒌 熟半夏 川连 甘草
按小柴胡汤加枳、桔，治少阳表里有邪者；柴胡陷胸汤，治少阳表里热邪，兼有痰结者；
小陷胸汤，治内有热痰，外无表症者。加枳、桔则力专；加甘草则力缓。
保和散
楂肉 麦芽 莱菔子 半夏 连翘 香附 枳壳
痰食胸满者，宜用此方。尚有表邪，仍兼散表。
平胃散
熟苍术 浓朴 广皮 甘草
外感发热，不用燥药。但湿邪满闷，非此不能治。
二陈汤 见似疟。
胃中有痰饮，则呕恶饱满，豁痰和胃，对症之药。
导痰汤 见似疟。
痰结上焦，用二陈汤。若痰结中焦，用此方上消下行。
栀子豆豉汤 见懊 。
小柴胡去黄芩加茯苓汤 即柴胡二陈汤。
小柴胡汤，不去黄芩加茯苓，名柴苓汤；去黄芩加茯苓。名柴胡二陈汤。总之，热痰凝
结，以半夏黄芩同用；水饮凝结，则去黄芩而以半夏茯苓同用。
The chest is located above the heart, thus it is often associated with exterior syndromes (Biao Zheng). This is because when pathogenic factors from the exterior transmit inward, they must first move from the chest to the hypochondrium before entering the interior organs. The symptom of chest fullness (Xiong Man) necessarily involves internal retention of phlegm-fluids (Tan Xian). When external pathogens transmit inward, they interlock with the phlegm-fluids, resulting in this condition. Therefore, for treating chest fullness and chest bi (Xiong Bi) syndromes, herbs that resolve phlegm such as Trichosanthis Fructus (Gualou) are mostly used, or the emetic method using Melon Stalk Powder (Gua Di San) is applied. In Shaoyang disease presenting with chest fullness, irritability, and fever, Chaihu Xiantong Tang is used. If the chest fullness extends to the hypochondrium, add Qingpi, Zhike, and Jiegeng. If there are still Taiyang exterior symptoms, add exterior-releasing herbs. For alternating chills and fever, chest fullness, and bitter vomiting, Xiaochaihu Tang combined with Zhike and Jiegeng is generally used. If ineffective, combine with Xiaoxiantong Tang. Thus, for chest fullness syndromes, Gualou, Zhike, and Jiegeng are essential herbs. Only when vomiting is severe is Banxia used instead of Gualou. If chest fullness is caused by food stagnation, accompanied by belching and distension, Baohe San and Pingwei San are used for digestion-promoting methods. If there are exterior pathogens, combine with exterior-releasing herbs; if there is interior heat, combine with heat-clearing herbs; if there are phlegm-fluids, use Daotan Tang, etc. Additionally, cases without fever, thirst, or dry lips, with clear urination and defecation, and deep-slow pulses indicate cold-yin chest fullness, which requires a separate warming and dispersing method.
In Taiyang disease, after mistaken purgation, if the pulse is rapid (Cu), there is chest fullness, and slight aversion to cold, Guizhi Qushaoyao Tang is the primary treatment.
Mistaken purgation of Taiyang exterior syndrome leads to a rapid pulse and chest fullness. Because slight aversion to cold (an exterior symptom) remains, Guizhi Tang is used. Shaoyao is removed because blood-invigorating or astringent herbs are contraindicated in chest fullness to avoid causing stagnation.
When Taiyang and Yangming meridians are affected simultaneously, with wheezing and chest fullness, purgation is forbidden; Mahuang Tang is appropriate.
When all three yang meridians are affected with wheezing, it indicates that exterior pathogens have not yet been resolved; therefore, purgation is forbidden, and Mahuang Tang should be used.
If, after sweating or purgation, irritability, heat, and a sensation of obstruction in the chest occur, Zhizi Chidui Tang is used.
After sweating, if irritability and heat occur, sweating should not be repeated; after purgation, if irritability and heat occur, purgation should not be repeated. Irritability, heat, and chest obstruction after both sweating and purgation constitute "agony" (Ao Nao); thus, Zhizi Chidui Tang is used. For those who have not undergone sweating or purgation, if chest fullness is due to exterior syndrome, the emetic method is ineffective.
The condition resembles Guizhi Tang syndrome, but the head does not hurt, the neck is not stiff, the cun pulse is slightly floating, the chest feels痞 (Pi - stuffy/hard), Qi rushes to the throat causing difficulty in breathing. This indicates cold-fluids in the chest, and emesis should be induced.
Although resembling Guizhi Tang syndrome, the absence of headache and neck stiffness, along with a slightly floating cun pulse, distinguishes it. The stuffiness and hardness in the chest, with Qi rushing to the throat causing respiratory distress, indicates cold-fluids in the chest; hence, emesis is induced. This does not refer to deficiency-cold of the interior qi requiring this method.
In Shaoyang wind-stroke, hearing loss, red eyes, chest fullness, and irritability occur. If emesis or purgation is mistakenly used, palpitations and fright will result. Rescue requires Xiaochaihu Tang with Huangqin removed and Fuling added.
Shaoyang wind-stroke presents with sweating, fever, and Shaoyang symptoms. The Shaoyang meridian starts at the outer canthus, enters the ear; its branch passes through the chest and diaphragm. Thus, Shaoyang syndrome causes red eyes, deafness, chest fullness, and irritability. Using emesis or purgation to relieve irritability leads to palpitations and fright; therefore, Xiaochaihu Tang with Huangqin removed and Fuling added is used to calm palpitations and soothe the spirit.
Yangming tidal fever, loose stools, normal urination, and hypochondriac fullness belong to Yangming.
Yangming tidal fever with hard stools and difficult urination indicates an interior excess syndrome. Now, with loose stools and free urination, plus hypochondriac fullness, it belongs to Yangming exterior syndrome.
In Taiyin disease, abdominal fullness, vomiting of food, inability to eat, worsening spontaneous diarrhea, and occasional spontaneous abdominal pain occur. If purgation is used, it will certainly cause knotting and hardness in the chest.
The Taiyin meridian connects to the stomach and governs the abdomen, leading to abdominal fullness, vomiting, spontaneous diarrhea, and occasional abdominal pain. This is not a purgation indication; mistaken purgation will certainly cause knotting and hardness in the chest.
In Shaoyin disease, with diarrhea, sore throat, chest fullness, and irritability, Zhufu Tang is the primary treatment.
This is heat pathogen transmitting into the Shaoyin meridian; thus, Zhufu (Pig Skin) is used to moisten dryness and nourish yin.
In Jueyin disease, cold extremities, sudden tight pulse, pathogen knotting in the chest, chest fullness, irritability, hunger but inability to eat, with the disease located in the chest, emesis should be induced using Gua Di San.
In Jueyin disease, cold extremities usually present with a deep-slow pulse. A sudden tight pulse indicates yang pathogen transmitting into Jueyin. Since the disease is in the chest, Gua Di San is used for emesis.
Gua Di San
One liang of Melon Stalk (Kugua Di), ground into fine powder, blown into the nose.
Yellow fluid retained in the middle jiao can be treated by blowing this powder into the nose to induce sneezing, causing tears and nasal discharge. It is usable only when yellow fluid is retained internally.
Chaihu Xiantong Tang
Chaihu, Gualou, Banxia, Huanglian, Gancao, Qingpi, Zhike
This is Xiaoxiantong Tang plus Chaihu, Qingpi, and Zhike. Generally, to treat condensation syndromes, one must open and resolve the qi pathway.
Xiaochaihu Jia Zhiji Tang
Chaihu, Huangqin, Guangpi (Chenpi), Gancao, Zhike, Jiegeng
The previous formula was used because of heat-phlegm condensation, combining Xiaochaihu Tang with Xiaoxiantong Tang. This case involves only heat-pathogen aggregation, so Xiaoxiantong Tang is not combined; only Zhike and Jiegeng are added.
Xiaoxiantong Tang
Gualou, Shu Banxia, Chuanlian (Huanglian), Gancao
Note: Xiaochaihu Tang plus Zhike and Jiegeng treats Shaoyang syndrome with pathogens in both interior and exterior; Chaihu Xiantong Tang treats Shaoyang syndrome with interior-exterior heat pathogens combined with phlegm condensation; Xiaoxiantong Tang treats internal heat-phlegm without exterior syndrome. Adding Zhike and Jiegeng makes the action more specific; adding Gancao makes the action milder.
Baohe San
Shanzha Rou, Maiya, Laifuzi, Banxia, Lianqiao, Xiangfu, Zhike
For chest fullness due to phlegm and food stagnation, this formula is suitable. If exterior pathogens remain, combine with exterior-releasing herbs.
Pingwei San
Shu Cangzhu, Houpo, Guangpi (Chenpi), Gancao
For external contraction with fever, drying herbs are not used. However, for fullness and oppression due to damp-pathogen, this formula is necessary for treatment.
Erchen Tang See Simie (Similar to Malaria).
Phlegm-fluids in the stomach cause nausea, vomiting, and fullness. This herb resolves phlegm and harmonizes the stomach, being对症 (symptom-specific).
Daotan Tang See Simie (Similar to Malaria).
For phlegm knotting in the upper jiao, use Erchen Tang. For phlegm knotting in the middle jiao, use this formula to eliminate upper phlegm and guide it downward.
Zhizi Chidui Tang See Ao Nao.
Xiaochaihu Qu Huangqin Jia Fuling Tang Also known as Chaihu Erchen Tang.
Xiaochaihu Tang without removing Huangqin but adding Fuling is named Chailing Tang; removing Huangqin and adding Fuling is named Chaihu Erchen Tang. In summary, for heat-phlegm condensation, Banxia and Huangqin are used together; for water-fluid condensation, Huangqin is removed, and Banxia is used with Fuling.