茯苓三两 杏仁五十个 甘草一两
右三味，以水一斗，煮取五升，温服一升，日三服，不差更服。
橘皮一筋 枳实三两 生姜半筋
右三味，以水五升，煎取二升，分温再服。
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胸痹，心中痞气，气结在胸，胸满，□下逆抢心，枳实薤白桂枝汤主之，人参汤亦主
之。
【注】
心中，即心下也。胸痹病，心下痞气，闷而不通者虚也。若不在心下，而气结在胸，
胸满连□下，气逆撞心者实也。实者用枳实薤白桂枝汤主之，倍用枳朴者，是以破气
降逆为主也。虚者用人参汤主之（即理中汤），是以温中补气为主也。由此可知痛有
补法，塞因塞用之义也。
【集注】
魏荔彤曰：胸痹自是阳微阴盛矣，心中痞气，气结在胸，正胸痹之病状也。再连□下
之气，俱逆而抢心，则痰饮水气。俱乘阴寒之邪，动而上逆，胸胃之阳气全难支拒矣
。故用枳实薤白桂枝汤，行阳开郁，温中降气。犹必先后煮治，以融和其气味，俾缓
缓荡除其结聚之邪也。再或虚寒已甚，无敢恣为开破者，故人参汤亦主之，以温补其
阳，使正气旺而邪气自消也。
尤怡曰：心中痞气，气痹而成痞也。□下逆抢心，气逆不降，将为中之害也。用此二
方者，一以去邪之实，即以安正；一以养阳之虚，即以逐阴，是在审其病之新久，与
气之虚实而决之。
Fuling (Poria) 3 liang, Xingren (Apricot Seed) 50 pieces, Gancao (Licorice Root) 1 liang.
The above three herbs are boiled in 1 dou of water until reduced to 5 sheng. Take 1 sheng warm each time, three times a day. If the condition does not improve, continue taking it.
Jupi (Tangerine Peel) 1 jin, Zhishi (Immature Bitter Orange) 3 liang, Shengjiang (Fresh Ginger) 0.5 jin.
The above three herbs are boiled in 5 sheng of water until reduced to 2 sheng. Divide into two doses and take warm.
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Xiongbi (Chest Bi Syndrome), with a sensation of fullness and obstruction in the heart region, Qi stagnation in the chest, chest distension, and Qi reversing from below the epigastrium rushing up to strike the heart. Zhishi Zheyang Guizhi Tang (Aucklandiae and Macleaya Decoction with Cinnamon Twig) is the primary formula; Renshen Tang (Ginseng Decoction) is also indicated.
[Annotation]
"Zhongxin" (Heart center) refers to "Xinxia" (below the heart/epigastrium). In Xiongbi syndrome, if there is a sensation of fullness and obstruction below the heart with stifling and lack of free flow, it indicates a Deficiency pattern. If the location is not below the heart but rather Qi is knotted in the chest, with chest distension extending to below the epigastrium and Qi reversing to strike the heart, it indicates an Excess pattern. For Excess patterns, Zhishi Zheyang Guizhi Tang is used as the main treatment; the increased use of Zhishi (Immature Bitter Orange) and Houpo (Magnolia Bark) focuses on breaking Qi stagnation and directing rebellious Qi downward. For Deficiency patterns, Renshen Tang (which is Lizhong Tang, Gastrointestinal Warming Decoction) is used, focusing on warming the middle and tonifying Qi. From this, we can understand that pain can also be treated with tonification, illustrating the principle of "treating obstruction with obstruction" (using tonification to treat false excess).
[Collected Annotations]
Wei Litong stated: Xiongbi is inherently characterized by weak Yang and flourishing Yin. The sensation of fullness in the heart region and Qi knotting in the chest are typical manifestations of Xiongbi. Furthermore, when Qi from below the epigastrium reverses and rushes up to strike the heart, it indicates that phlegm-fluids and water-Qi move upward due to cold-Yin pathogens, making it difficult for the Yang Qi of the chest and stomach to resist. Therefore, Zhishi Zheyang Guizhi Tang is used to circulate Yang, open depression, warm the middle, and direct Qi downward. Special decoction methods are employed to harmonize the flavors and slowly dissipate the accumulated pathogens. Alternatively, if deficiency-cold is severe and harsh dispersing agents cannot be used freely, Renshen Tang is also indicated to warm and tonify Yang, allowing righteous Qi to flourish so that pathogenic factors eliminate themselves.
You Yi stated: The sensation of fullness in the heart region is caused by Qi obstruction leading to Pi (fullness). Qi reversing from below the epigastrium to strike the heart indicates rebellious Qi failing to descend, which will harm the Middle Jiao. These two formulas are used: one to remove the Excess of pathogens thereby anchoring Righteous Qi; the other to nourish deficient Yang thereby expelling Yin. The choice depends on assessing whether the disease is new or chronic and whether the Qi is Excess or Deficient.