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The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: The south wind arises in summer, diseases occur in the Heart, and the Shu points are located in the chest and hypochondrium. It also states: In midsummer, diseases of the chest and hypochondrium are common; this indicates that pain in the chest and hypochondrium belongs to the Heart, thus it is classified under the Heart section.

When the Liver is deficient, there is pain in the chest radiating to the back and hypochondrium; when the Liver is excess, there is pain in the chest with an inability to turn or lie on one side, and a preference for sighing; in Gan Zhuo (Liver Fixation), the patient often desires someone to tread upon or press their chest. The *Neijing* states: The spring pulse resembles a string; if the Qi is not solid but slightly weak, this is called "not reaching" (Bu Ji), causing pain in the chest radiating to the back, and fullness and distension in the lower two hypochondria. This is how the pulse and symptoms of Liver deficiency appear in spring.

[Zhang Zhongjing] Those with Cold in the Liver cannot raise both arms, have a dry root of the tongue, prefer sighing, experience pain in the chest, an inability to turn or lie on one side, and vomiting with sweating after eating. For Gan Zhuo (Liver Fixation), where the patient constantly desires to tread on their chest, and before suffering desires only hot drinks, Xuan Fu Hua Tang (Inula Flower Decoction) is the primary treatment. (Formula not verified. There is a Xuan Fu Hua Tang formula in the Women's Diseases section of *Jin Gui Yao Lue*; some say this is that formula.)

[*Suwen*] What the Yangming channel describes as pain in the chest and shortness of breath is due to Water Qi residing in the Zang-Fu organs. Water is Yin Qi; since Yin Qi is in the interior, it causes pain in the chest and scanty Qi.

[Zhang Zhongjing] In Xiong Bi (Chest Bi Syndrome), symptoms include wheezing, coughing and spitting, pain in the chest and back, and shortness of breath. The Cun Kou pulse is deep and slow, while the Guan position pulse is small, tight, and rapid. Gualou Xiebai Baijiu Tang (Trichosanthes Fruit, Allium Macrostemon, and White Wine Decoction) is appropriate.
Gualou Shi (Trichosanthis Fructus, one fruit, crushed) Xiebai (Allii Macrostemonis Bulbus, half sheng) Baijiu (White Wine, seven sheng)
Boil these three ingredients together until two sheng remain, divide into two doses, and take warm.

Gualou Xiebai Banxia Tang (Trichosanthes Fruit, Allium Macrostemon, and Pinellia Decoction) treats Xiong Bi where the patient cannot lie down, and heart pain radiates to the back. (Formula seen in Heart Pain section.)

For Xiong Bi with epigastric stuffiness, Qi stagnation remaining in the chest, chest fullness, and rebellious Qi from the hypochondrium rushing up to the Heart, Zhishi Xiebai Guizhi Tang (Immature Bitter Orange, Allium Macrostemon, and Cinnamon Twig Decoction) is the primary treatment; Renshen Tang (Ginseng Decoction) can also be used.

Zhishi Xiebai Guizhi Tang
Zhishi (Immature Bitter Orange, four pieces) Nongpo (Magnolia Bark, four liang) Xiebai (Allium Macrostemon, half sheng) Guizhi (Cinnamon Twig, one liang) Gualou Shi (Trichosanthis Fructus, one fruit, crushed)
Take the above five ingredients, add five sheng of water, first boil Nongpo and Zhishi until two sheng remain, remove the dregs, add the other herbs, boil for a few boils, divide into three warm doses.

Renshen Tang
Baizhu (Atractylodes Rhizome) Renshen (Ginseng Root) Gancao (Licorice Root) Ganjiang (Dried Ginger) (each two liang)
Take the above four ingredients, add eight sheng of water, boil until three sheng remain, take one sheng warm, three times a day.

The mother of Sun Zhuzhu Ji Shu suffered from epigastric stuffiness and urgency, inability to breathe, and pain upon pressure. Her pulse was rapid and choppy. She was diagnosed with Xiong Bi. She was given Zhang Zhongjing's Sanwu Xiaoxianxiong Tang (Three-Ingredient Small Trap Chest Decoction). One dose showed improvement, and two doses cured her. (Formula seen in Cold Damage section.)

[Zhang Zhongjing] For Zhi Yin (Branching Fluid Retention) causing chest fullness, Zhipo Dahuang Tang (Magnolia Bark, Rhubarb, and Immature Bitter Orange Decoction) is the primary treatment.
Nongpo (Magnolia Bark, one liang) Dahuang (Rhubarb Root and Rhizome, six liang) Zhishi (Immature Bitter Orange, four pieces)
Take the above three ingredients, add five sheng of water, boil until two sheng remain, divide into two warm doses.

[*Maiching*] If the Cun Kou pulse is deep, and there is pain in the chest radiating to the hypochondrium, indicating Water Qi in the chest, Zeqi Tang (Phytolacca Decoction) is appropriate, along with needling Jueque to drain. (Zeqi Tang is a formula by Zhang Zhongjing, seen in the Cough section.)

[Du Ren] Treats pain in the chest and hypochondrium radiating to the back, epigastric and abdominal stuffiness, blocked Qi, and phlegm-cough. Use large Gualou, remove the pulp, take only the seeds, stir-fry thoroughly, grind with the skin, mix with flour paste to make pills the size of paulownia seeds. Take fifty pills with rice drink.

[*Doumen Fang*] Treats chest and abdominal stagnation, removes phlegm, and opens the stomach. Wash Banxia (Pinellia Tuber), bake until dry, grind and sieve into powder. Mix with fresh ginger juice to form cakes. Wrap in wet paper, roast slowly over low heat until fragrant and cooked. Take one cup of water, add one cake the size of a bullet, add half a qian of salt, decoct until one cup remains, take warm. It effectively removes chest diaphragm obstruction, suppresses severe phlegm toxicity, and treats damage from alcohol and food. Its efficacy is great.

[Zhu Danxi] Zheng Zhongyou, aged twenty-three, had a point of pulling pain in the diaphragm, with a sensation of tightness in the skin upon inhalation.
Huashi (Talcum) (one liang) Taoren (Peach Seed, half liang) Zhike (Bitter Orange Peel, one liang, stir-fried) Huanglian (Coptis Rhizome, half liang, stir-fried) Gancao (Licorice Root, honey-fried, two qian)
Grind into fine powder. Take one and a half qian per dose, grind with natural juice of radish roots, decoct until cooked, and drink. Take five to six times a day.
That same year, at age twenty-seven, because he took hot tonic medicines and erroneously practiced self-taught Tu Na (breathing exercises), his Qi became chaotic and Blood became hot, leading to hemoptysis and emaciation. He was then treated with Dao Cang Fa (Stomach Purging Method).
Now that the hemoptysis and emaciation have been eliminated, because he ate fried beans and rice, there is a point of Qi blockage and pain in the diaphragm, as if a thread hangs down to the waist, and the lower abdomen also hurts, mostly biased to the left. This indicates that evil Blood in the Liver region has not yet fully cleared.
Huashi (Talcum) (one liang) Huangdan (Lead Oxide, three qian, stir-fried) Zhike (Bitter Orange Peel, one liang, stir-fried) Huanglian (Coptis Rhizome, five qian) Sheng Gancao (Raw Licorice Root, two qian) Honghua (Carthamus Flower, one qian) Chaihu (Bupleurum Root, five qian) Taoren (Peach Seed, two liang)
Grind into fine powder. Take one and a half qian per dose, decoct with natural radish juice until boiling, and take.

[Li Dongyuan] Shangqing San (Upper Clearing Powder) clears and benefits the head and eyes, relaxes the chest, and resolves obstruction by releasing through the exterior.
Huangqi (Astragalus Root, three qian) Gancao (Licorice Root, two qian) Renshen (Ginseng Root, three qian) Gegen (Pueraria Root, one and a half qian) Fangfenggen (Saposhnikovia Root, one qian) Manjingzi (Vijaya Fruit, half qian)
Chop the ingredients, divide into two doses. For each dose, add one and a half cups of water, decoct until one cup remains, remove dregs, and take warm before sleep. Cover the face and head with a jacket and remain silent. Sweating after a moment indicates effectiveness. Do not speak the day before taking the medicine, and do not speak for one day after finishing the medicine.

Regarding Yunqi (Six Qi Movement) theory, there are two types of chest pain:
First, Fire Evil assists the Heart. The *Neijing* states: When Year Fire is excessive, severe cases involve pain in the chest, fullness and support in the hypochondrium, hypochondriac pain, and pain in the anterior chest, back, shoulder blades, and inner aspects of both arms.
Second, Metal Evil injures the Liver. The *Neijing* states: When Year Metal is excessive, people suffer from pain in the chest radiating to the back, fullness and pain in the two hypochondria radiating to the lower abdomen. It also states: When Year Earth is insufficient, Wind prevails greatly, people suffer from heavy body and abdominal pain; when Metal returns to compensate, there is sudden severe pain in the chest and hypochondrium radiating to the lower abdomen.

The *Neijing* describes four acupuncture and moxibustion methods for treating chest pain:
First, select the Heart channel. The *Neijing* states: Heart pain manifests as pain in the chest, fullness and support in the hypochondrium, pain below the hypochondrium, pain between the anterior chest, arm, and shoulder blade, and pain in the inner aspects of both shoulders and arms. In excess cases, the chest and abdomen are distended, and pain is mutually radiating between the hypochondrium, waist, and kidneys. Select the Shaoyin and Taiyang channels and bleed the blood under the tongue. For transformed diseases, bleed from Xi Zhong.
Second, select the Kidney channel. The *Neijing* states: When Kidney is deficient, there is pain in the chest, pain in the large and small abdomen. Select the blood vessels of the Shaoyin and Taiyang channels. The needling method does not distinguish between tonification and sedation, only stating to take blood. Wang Bing's commentary says to first remove the blood vessels, then regulate deficiency and excess.
Third, select the Gallbladder channel. The *Neijing* states: Diseases generated by the Foot Shaoyang Gallbladder channel include pain in the chest, hypochondrium, ribs, lateral malleolus, and lateral knee. Detailed selection depends on excess/deficiency, heat/cold, and sinking.
Fourth, select the Sinew. The *Neijing* states: The sinews of the Hand Jueyin Pericardium should be treated by selecting affected areas. Also, for pre-spasm and chest pain with Xifen (Lung Accumulation), treatment involves burning needle and urgent puncture, using the number of times until effect is felt, and using the painful point as the Shu point. Similarly, for the sinews of the Foot Taiyang and Foot Shaoyang, pain radiating to the chest is treated with burning needle and urgent puncture, using the number of times until effect is felt, and using the painful point as the Shu point.

There are three methods for acupuncture and moxibustion to treat chest fullness:
First, select Qihai (Sea of Qi). The *Neijing* states: Danzhong is the Sea of Qi. Its Shu points are above and below the hand pillar bone, and anteriorly at Renying. When Qihai is in excess, there is Qi fullness, shortness of breath in the chest, and red face. Carefully observe its Shu points and regulate deficiency and excess without causing harm. (Hand pillar bone refers to the intersection at the upper edge of the scapula, according to Hua Borren.)
Second, select the Liver channel. The *Neijing* states: Diseases generated by the Foot Jueyin Liver channel include chest fullness, vomiting and rebellion, undigested food diarrhea, fox hernia, enuresis, and strangury. Detailed selection depends on excess/deficiency, heat/cold, and sinking.
Third, select the Stomach channel. The *Neijing* states: For Jueni (Rebellious Qi) with abdominal fullness, facial swelling, dripping lips, difficulty speaking suddenly, or inability to speak when severe, select the Foot Yangming channel.

[*Zhenjiu Jicheng*] For unbearable pain in the chest and hypochondrium: Qimen (4 fen), Zhangmen (6 fen, moxa 7 to 49 cones), Xingjian, Qiuxu, Yongquan.

[Yang Jizhou] Another method: Qimen (2 cun along the skin), Zhigou, Danshu (1.5 cun along the skin).

[*Jiaying Jing*] For chest fullness and pain, Xuanji is indicated. For chest and hypochondrium fullness with pain radiating to the chest, Huagai is indicated. For chest and hypochondrium fullness, Bi pain and bone pain, inability to eat, vomiting and rebellious Qi, irritability, Zigong is indicated. For chest fullness, inability to breathe, hypochondriac pain and bone pain, wheezing and rebellious Qi, vomiting, irritability, Yutang is indicated. For mutual radiating pain in the chest, hypochondrium, and back, epigastric and chest area, vomiting, hypersomnia, inability to eat, Youmen is indicated. For chest and hypochondrium fullness with pain radiating to the anterior chest, inability to breathe, confusion, irritability, fullness, inability to eat, Lingxu is indicated. For chest and hypochondrium fullness with pulling pain to the back, inability to turn in bed, Xiangxiang is indicated. When Da Qi cannot breathe, breathing causes pain in the chest and hypochondrium; in excess, the whole body feels cold; in deficiency, all joints become lax, Dabao is indicated. For chest fullness with frequent sighing and a distending sensation in the chest, Qiuxu is indicated. (*Qianjin Fang* says: chest and back tension). For pain in the chest, Tianrong is indicated. For chest and hypochondrium fullness, Laogong is indicated. For Xiong Bi radiating to the back with intermittent chills, Jianshi is indicated. For chest fullness with inability to breathe, neck and jaw swelling, Yanggu is indicated. (*Qianjin Fang* says Yangxi). For chest and hypochondrium fullness, diaphragmatic obstruction, inability to eat, vomiting with food regurgitation, Zhongting is indicated. For chest and hypochondrium fullness, convulsions, pulling pain to the umbilicus and lower abdomen, shortness of breath, irritability, Juque is indicated. For chest and hypochondrium fullness, inability to breathe, coughing and rebellion, breast abscess, aversion to cold with shivering, Shenfeng is indicated. For chest and hypochondrium fullness, diaphragmatic rebellion and blockage, shortness of breath, inability to lift arms due to wheezing, Bulang is indicated. For chest and hypochondrium fullness, aversion to human voices and wood sounds, Jubshanglian is indicated. For fullness and pain below the chest, anterior chest swelling, Rugen is indicated. For chest and hypochondrium fullness, wheezing and rebellious Qi, panting, loss of taste, Qihu is indicated. For chest and hypochondrium distension, borborygmus and cutting pain, Taibai is indicated.

[*Zhenjiu Cuoyao*] For chest fullness and blood distension: Qimen (1 fen, 1.5 cun outward along the skin, sedation method).

[*Jiaying Jing*] For food retention, fullness below the hypochondrium, inability to turn or lie on one side, blue-green eyes, and vomiting, Qimen is indicated. For sudden distension with chest and hypochondrium fullness, cold feet, difficult defecation, white face and lips, occasional hematemesis, Taichong is indicated. For sudden chest fullness and insomnia, Zhejin is indicated. For chest and hypochondrium fullness with a sensation of cold like wind blowing, Xiaxi is indicated. For chest and hypochondrium fullness, headache, and alternating cold and heat in the neck, Waiqiu is indicated. For hypersomnia and frequent spitting, chest fullness, and borborygmus, Sanjian is indicated.

[Zhang Zhongjing] Pulse diagnosis should assess excess and deficiency. Yang Wei (superficial weakness) and Yin Xian (deep tension) indicate Xiong Bi with pain. The reason is extreme deficiency. Now, knowing Yang deficiency is in the Upper Jiao, the cause of Xiong Bi and heart pain is the Yin Xian.

People with coarse white lung texture have large lungs; large lungs lead to excessive drinking and susceptibility to Xiong Bi. (Full text seen in Diagnosis section, same below.)

People with sparse costal margins have tilted lungs; tilted lungs lead to unilateral chest pain.