千金论曰∶夫脉当取太过与不及。阳微阴弦。即胸痹而痛。所以然者。责其极虚故也。
今阳虚知在上焦。所以胸痹心痛者。以其脉阴弦故也。平人无寒热。短气不足以息者实也。
仲景伤寒论同。胸痹之病。喘息咳唾。胸背痛。短气。其脉沉而迟。关上小紧数者。栝蒌汤
主之方。
栝蒌（一枚） 薤白（一斤） 半夏（半升洗） 生姜（四两） 枳实（二两炙）
上五味切。以白 浆一斗煮。取四升。服一升。日三。肘后。仲景伤寒论。无生姜枳实
半夏等三味同。短剧云∶用水一斗。忌羊肉饧。
又胸中气塞短气。茯苓汤主之方。
茯苓（三两） 甘草（一两炙） 杏仁（五十枚）
上三味 咀。以水一斗。煮取五升。温服一升。日三服。不瘥更合。仲景伤寒论同。（
并出第十三卷中）
深师疗胸痹连背痛。短气。细辛散方。
细辛 干地黄 甘草（各二两炙） 桂心 茯苓（各五两） 枳实（炙） 白术 生姜 栝
蒌
实（各三两）
上九味捣筛。酒服方寸匕。日三。（古今录验千金同出第十三卷中）
千金论胸痹之病。令人心中坚痞急痛。肌中苦痹。绞急如刺。不得俯仰。其胸前皮皆痛
。手不得犯。胸中 如满。咽塞习习痒。喉中干燥。时欲呕吐。胸满短气。咳唾引痛。烦
闷自汗出。或彻引背腹痛。不即疗之。数日杀人。（出第十三卷中）
范汪疗胸痹。心中痞坚。留气结于胸中。胸满胁下。逆气抢心。枳实汤方。
陈枳实（四枚炙） 浓朴（四两炙） 薤白（八两） 桂心（一两） 栝蒌实（一枚）
上五味。先以水五升煮枳实浓朴。取二升半。去滓。纳余药又煎三两沸。去滓。分温三
服。除心气良。（古今录验千金同此本仲景伤寒论方）
古今录验疗胸中隐然而痛。脊膂肩痛方。
桂心（一分） 干姜（一分） 人参（三分） 细辛（三分） 乌头（一分炮） 山茱
萸（三分）
贝母（三分）
上七味捣下筛。和以蜜丸如小豆大。酒若粥汁吞二丸。稍稍益。以胸中痛止温温为度。
忌生葱生菜猪肉冷水。又疗胸痹偏缓急。薏苡仁散方。
薏苡仁（五百枚） 附子（十枚大者炮） 甘草（三两炙）
上三味捣下筛。服方寸匕。日三。忌海藻菘菜猪肉冷水。又疗胸痹偏缓急。薏苡仁散方
薏苡仁（一千五百枚） 附子（大者十枚炮）
上二味捣下筛。服方寸匕。日三。不知稍增之。忌猪肉冷水。（此方出僧深范汪同仲景
方用薏苡仁十五两并出第八卷中）
The *Qianjin Fang* discusses: The pulse should be assessed for excess and deficiency. When Yang is deficient (weak) and Yin is wiry (tense), it results in chest bi syndrome with pain. This occurs because of extreme deficiency (in the upper jiao).
Now, knowing that Yang deficiency resides in the upper jiao, the reason for chest bi and heart pain is due to the wiry Yin pulse. A healthy person without chills or fever who experiences shortness of breath and insufficient respiration has an excess condition.
This is consistent with Zhang Zhongjing's *Shanghan Lun*. The disease of chest bi presents with panting, coughing, and spitting phlegm, chest and back pain, and shortness of breath. The pulse is deep and slow; if the Guan position shows a small, tight, and rapid pulse, it is treated with Gualou Tang (Trichosanthes Decoction).
Gualou (one fruit) Xiebai (one jin) Banxia (half sheng, washed) Shengjiang (four liang) Zhishi (two liang, stir-fried)
Cut the above five herbs. Boil in one dou of Baijiang (white rice water) to obtain four sheng. Take one sheng per dose, three times daily. The *Zhouhou Beiji Fang* and Zhang Zhongjing's *Shanghan Lun* do not include Shengjiang, Zhishi, and Banxia. The *Duanju Fang* states: Boil in one dou of water; avoid mutton and malt sugar.
For chest oppression and shortness of breath, treat with Fuling Tang (Poria Decoction).
Fuling (three liang) Gancao (one liang, stir-fried) Xingren (fifty seeds)
Crush the above three herbs. Boil in one dou of water to obtain five sheng. Take one sheng warm, three times daily. If not cured, prepare another batch. This is consistent with Zhang Zhongjing's *Shanghan Lun*. (All from Volume 13)
The *Shenshi Fang* treats chest bi radiating to back pain and shortness of breath using Xixin San (Asarum Powder).
Xixin Radix Asari (quantity unspecified) Dihuang (quantity unspecified) Gancao (two liang each, stir-fried) Guixin Cinnamon Twig (five liang each) Fuling Poria (five liang each) Zhishi Immature Bitter Orange (stir-fried) Baizhu Atractylodes Rhizome (quantity unspecified) Shengjiang Fresh Ginger (quantity unspecified) Gualou Fructus Trichosanthis (three liang each)
Pound and sieve the above nine herbs. Take one cunbi (square-inch measure) with wine, three times daily. (*Gu Jin Lu Yan* and *Qian Jin Fang* also from Volume 13)
The *Qianjin Fang* describes chest bi as causing hardness, fullness, and urgent pain in the heart region, bitter obstruction in the muscles, cramping pain like stabbing, inability to bend forward or backward. The skin of the chest is painful to touch. The chest feels full and blocked, the throat is obstructed with itching sensations, the throat is dry, there is frequent desire to vomit. Chest fullness and shortness of breath, coughing and spitting induce pain, restlessness, spontaneous sweating, or pain radiating to the back and abdomen. If not treated immediately, death may occur within days. (From Volume 13)
Fan Wang treats chest bi with heart fullness and hardness, where stagnant Qi knots in the chest, causing chest fullness, hypochondriac distension, and rebellious Qi rushing to the heart. Use Zhishi Tang (Immature Bitter Orange Decoction).
Zhishi Immature Bitter Orange (four pieces, stir-fried) Houpo Magnolia Bark (four liang, stir-fried) Xiebai Allii Macrostemonis Bulbus (eight liang) Guixin Cinnamon Twig (one liang) Gualou Fructus Trichosanthis (one fruit)
Take the above five herbs. First boil Zhishi and Houpo in five sheng of water to obtain two and a half sheng. Remove dregs, add remaining herbs, and boil for two or three boils. Remove dregs. Divide into three warm doses. Effectively removes heart Qi stagnation. (*Gu Jin Lu Yan* and *Qian Jin Fang* are identical to this source, based on Zhang Zhongjing's *Shanghan Lun* formula)
*Gu Jin Lu Yan* treats dull pain in the chest and pain in the spine and shoulders.
Guixin Cinnamon Twig (one fen) Jianggan Dried Ginger (one fen) Renshen Ginseng Radix (three fen) Xixin Radix Asari (three fen) Wutou Aconite Lateral Root (one fen, processed) Shanzhuyu Cornus Fruit (three fen) Beimu Fritillaria Bulb (three fen)
Pound and sieve the above seven herbs. Mix with honey to make pills the size of small beans. Swallow two pills with wine or gruel juice. Gradually increase the dose until chest pain stops and the body feels warm. Avoid raw green onions, raw vegetables, pork, and cold water. Also treats chest bi with偏缓急 (partial stiffness and spasms) using Yiyiren San (Coix Seed Powder).
Yiyimen Coix Seed (five hundred seeds) Fuzi Aconite Lateral Root (ten large ones, processed) Gancao Licorice Root (three liang, stir-fried)
Pound and sieve the above three herbs. Take one cunbi, three times daily. Avoid seaweed, Chinese cabbage, pork, and cold water. Another prescription for chest bi with partial stiffness and spasms uses Yiyiren San (Coix Seed Powder).
Yiyimen Coix Seed (one thousand five hundred seeds) Fuzi Aconite Lateral Root (ten large ones, processed)
Pound and sieve the above two herbs. Take one cunbi, three times daily. Increase slightly if ineffective. Avoid pork and cold water. (This formula comes from Monk Shen and Fan Wang, same as Zhang Zhongjing's formula using fifteen liang of Coix Seed, all from Volume 8)