【纲】仲景曰。伤寒热少厥微。指头寒。默默不欲食。烦躁。数日。小便利。色白者。此热除
也。欲得食。其病为愈。若厥而呕。胸胁烦满者。其后必便血。
【目】吴绶曰。治胁下痛。加枳壳、青皮、枯梗、芍药。胁下硬。加牡蛎粉。若憎寒拘急。往
来寒热。而胸胁满者。加桂枝、白芍。俱小柴胡汤内加之。
李时珍曰。此宜小柴胡汤、抵当汤、黄芩芍药汤。
魏荔彤曰。此就邪热之微。阳气之出。易于升举而得愈者。明之也。若小便色不白。即热少厥
微。然有烦躁病在。日久郁内。无所宣泄。遂致上冲下注。且下肝脏之血。示人不可轻忽其微热也。
此条总是一串成文。
【纲】仲景曰。妇人发热恶寒。经水适来。热除。脉迟。身凉。胸满如结胸状。谵语者。刺期门。
吐下后。脉微。心下痞。胁痛。气
上冲咽。眩冒。脉动惕者。必成痿。下后。脉弦者。必两胁拘急。胁下素有痞。连在脐旁。痛引少
腹。入阴筋者。名脏结。死。
【目】王肯堂曰。左右者。阴阳之道路。胁之部也。宿痞在胁。则阴阳之道路不通。故邪不得
传经而直入于脏。是以死。
【纲】仲景曰。病患手足厥冷。脉乍紧者。邪结在胸中。心中满而烦。饥不能食者。病在胸中。
当须吐之。宜瓜蒂散。
【目】吴绶曰。胸满多用吐法。实者瓜蒂散。虚者人参芦。或以香苏散送下。以手探喉中吐之。
亦可。伤寒三四日。已传少阳经。脉弦口苦。发热而胸满。小柴胡汤。胸中满闷者。加桔梗、枳壳
各二钱以利之。胸胁满而烦者。加栝蒌实三钱。黄连一钱半。活人治胸满。气痞不宽。只用桔梗、
枳壳各二钱。生姜五片。名曰枳壳汤。凡心之上。胸之分。宜枳壳。心之下。胃之分。宜枳实。盖
枳壳能泄至高之气。枳实泄至低之气。栝蒌仁能泄肺。涤胸中痰垢之要药也。故胸满而烦必加之。
一法。治痞气胸满。用小麦麸一二升。以生枳壳切半同炒令热。去枳壳。以帛包麸熨胸中。冷则易。
则气易散而愈。
[Outline] Zhang Zhongjing stated: In Shaoyang disease, if the heat is slight and the cold extremities are mild, with only the fingertips being cold, accompanied by a silent demeanor, anorexia, and irritability. After several days, if urination is free and the urine is clear in color, this indicates that the pathogenic heat has been eliminated. If the patient desires food, it signifies that the disease is about to heal. However, if there are cold extremities accompanied by vomiting, and vexation and fullness in the chest and hypochondrium, hematochezia (blood in stool) will inevitably follow later.
[Commentary] Wu Shou said: To treat pain under the hypochondrium, add Zhiqiao (Bitter Orange Peel), Qingpi (Green Tangerine Peel), Jiegeng (Platycodon Root), and Shaoyao (Peony Root). If hardness is felt under the hypochondrium, add Muli Powder (Oyster Shell Powder). If there is aversion to cold, limb stiffness, alternating chills and fever, and chest-hypochondriac fullness, add Guizhi (Cinnamon Twig) and Baishao (White Peony Root). These herbs should all be added to Xiaochaihu Tang (Minor Bupleurum Decoction).
Li Shizhen said: This condition is suitable for treatment with Xiaochaihu Tang (Minor Bupleurum Decoction), Didang Tang (Eradicate the Stasis Decoction), or Huangqin Shaoyao Tang (Scutellaria and Peony Decoction).
Wei Litong said: This passage elucidates cases where pathogenic heat is slight and yang qi exits, making it easy to rise and recover. If the urine is not clear in color, although the heat is slight and cold extremities are mild, the symptom of irritability persists. Over time, stagnation accumulates internally without release, leading to rebellious qi rushing upward or sinking downward, damaging the blood of the Liver. This serves as a warning not to disregard slight heat. This clause forms a coherent whole.
[Outline] Zhang Zhongjing stated: When a woman presents with fever and aversion to cold during her menstrual flow, and after the fever subsides, the pulse becomes slow, the body cools down, and she exhibits chest fullness resembling Jiechesth (Chest Binding Syndrome) along with delirium (chan yu), one should puncture Qimen (LR14). After emesis or purgation therapy, if the pulse is faint, there is epigastric stuffiness (pi), hypochondriac pain, qi rushing up to the throat, dizziness, and palpitations/tremors in the pulse, Pi syndrome (flaccidity syndrome) will inevitably develop. After purgation, if the pulse is wiry, bilateral hypochondriac stiffness and spasm will occur. If there is a pre-existing mass (pi) under the hypochondrium connected to the side of the umbilicus, with pain radiating to the lower abdomen and entering the genital tendons, this condition is named Zangjie (Organ Knotting), which is fatal.
[Commentary] Wang Kentang said: The left and right sides are the pathways of yin and yang qi. The hypochondrium belongs to this region. A chronic mass located in the hypochondrium obstructs these pathways, preventing pathogenic factors from transmitting through the meridians and causing them to directly enter the zang organs, hence resulting in death.
[Outline] Zhang Zhongjing stated: When patients present with cold extremities and a pulse that suddenly becomes tight, this indicates pathogenic accumulation in the chest. They experience chest fullness and irritability, feel hungry but cannot eat. The pathology lies in the chest, and emetic therapy should be employed. Gouti San (Melon Seed Powder) is appropriate.
[Commentary] Wu Shou said: Emetic therapy is commonly used to treat chest fullness. For excess patterns, use Gouti San; for deficiency patterns, use Ren Shen Lu (Deer Antler Velvet Base) or administer via Xiangsu San (Fragrant Perilla Powder), inducing vomiting by stimulating the throat with fingers. This method is also acceptable. In Shaoyang disease occurring on the third or fourth day, where the pulse is wiry, the mouth tastes bitter, there is fever and chest fullness, use Xiaochaihu Tang (Minor Bupleurum Decoction). For chest stuffiness, add Jiegeng (Platycodon Root) and Zhiqiao (Bitter Orange Peel), each 2 qian, to promote circulation. For chest-hypochondriac fullness with irritability, add Gualou Shi (Trichosanthes Fruit) 3 qian and Huanglian (Coptis Rhizome) 1.5 qian. *Huoren Shu* treats chest fullness with qi stuffiness and lack of expansion using only Jiegeng (Platycodon Root) and Zhiqiao (Bitter Orange Peel), each 2 qian, and Shengjiang (Fresh Ginger) 5 slices, named Zhike Tang (Citrus Aurantium Decoction). Generally, above the heart and in the chest region, Zhike (Zhiqiao) is preferred; below the heart and in the stomach region, Zhishi (Immature Bitter Orange) is preferred. Zhike drains qi from the highest regions, while Zhishi drains qi from the lowest regions. Gualou Ren (Trichosanthes Seed) clears the Lungs and is a key herb for cleansing phlegm turbidity from the chest; thus, it must be added when there is chest fullness with irritability. Another method: To treat pi masses causing chest fullness, use 1-2 sheng of wheat bran. Stir-fry it with fresh Zhike cut in half until hot, remove the Zhike, wrap the bran in cloth, and apply warm compresses to the chest. Replace when cool. This allows qi to dissipate easily, leading to recovery.