师曰。（病有最虚之处。即为容邪之处。当辨之于脉。）夫（欲知）脉当（先）取
（其）太过（之与）不及。（如关前之）阳（脉）微（是阳气虚也。关后之）阴（脉）
（弦。是阴邪实也。阴邪乘于阳位。）即胸痹而（心）痛。所以然者。责其（
上焦阳气）极虚也。（极虚则无以为胜邪之本矣。然单虚不为痛。）今阳（脉微则
为）虚。知（其病）在上焦。（究其）所以胸痹心痛者。以其阴（中之）弦（乃阴中之
寒邪。乘上焦之虚。而为痹为痛。是虚为致邪之因。而弦则露其袭虚之本象）故也。
此言胸痹心痛之病。皆由虚处容邪。从其脉象而探其病源。
（其间亦有不从虚得者。当分别观之。姑另备一审因察病之法。如无病之。）平人
（又）无（新邪而发）寒热。（乃忽然）短气不足以息者。（当是痰饮食积。碍其升降
之气而然。此不责其虚。当责其）实也。
此另出实证。与上节对勘而愈明也。
（人之胸中。如天阳气用事。阳气一虚。诸阴寒得而乘之。则为）胸痹之病。（盖
诸阳受气于胸。而转行于背。气痹不行。则阻其上下往来之路。而为）喘息咳唾。（塞
其前后阴阳之位。则为）胸背痛。（且不特喘息咳
唾。而呼吸之间。不相续而）短气。（更审其脉）寸口（之阳）脉沉而迟。（即上所
言阳微之意也。）关上（之阴脉）小紧数。（即上所言阴弦之意。由尺而上溢于关也。
阳气失权。诸阴反得而 之。法当通其胸中之阳。以）栝蒌薤白白酒汤主之。
此详胸痹之证脉。凡言胸痹。皆当以此概之。但微有参差不同。故首揭以为胸痹之
主证主方耳。其云寸口脉沉而迟。即首节阳微之互辞。关上小紧数。即首节阴弦之互辞。
但关居阴阳之界。缘阴邪盛于真阴之本位。由尺而上溢于关。故于关上见之。亦即首
节太过不及。于阴阳分其上下之意。而不必拘拘于字句间也。
栝蒌薤白白酒汤方
栝蒌实（一枚） 薤白（半斤） 白酒（七升）
上三味。同煮取二升。分温再服。
胸痹（证。上已详言。不复再赘。今又加气上）不得卧。（是有痰饮以为之援也。
此证与支饮证相类。而唯）心痛彻背者。（为胸痹证所独。以）栝蒌薤白半夏汤主之。
此承上而言不得卧及心痛彻背。为痹甚于前。而前方亦宜加减也。
栝蒌薤白半夏汤方
栝蒌实（一枚捣） 薤白（三两） 半夏（半升） 白酒（一斗）
上四味。同煎取四升。温服一升。日三服。
（更有病势之最急者。）胸痹（病。更加）心中痞。（为羁）留（不去之客）气结
（聚）在胸。（胸痹之外。又见）胸满胁下（之气又）逆。（而）抢心。（是胸既痹而且
满。而又及于
心中。牵及胁下。为留为结。为逆为抢。可谓阴邪之横行无忌矣。此际急兴问罪之师。
以）枳实薤白桂枝汤主之。（抑或务为本源之计。）人参汤亦主之。
此言胸痹已甚之证。出二方以听人之临时择用也。或先后相间用之。惟在临时之活
泼。
尤在泾云、心中痞气。气痹而成痞也。胁下逆抢心。气逆不降。将为中之害也。是
宜急通其痞结之气。否则速复其不振之阳。盖去邪之实。即以安正。养阳之虚。即以逐
阴。是在审其病之久暂。与气之虚实而决之。
枳实薤白桂枝汤方
枳实（四枚） 薤白（半斤） 桂枝（一两） 浓朴（四两） 栝蒌实（一枚捣）
上五味。以水五升。先煮枳实浓朴。取二升。去滓。内诸药。煮数沸。分温三服。
人参汤方
人参 干姜 白术（各三两） 桂枝 甘草（各四两）
上四味。以水九升。煮取五升。内桂枝更煮。取三升。温服一升。日三服。
（更有病势之稍缓者。）胸痹。（病）胸中（时觉）气（之阻）塞。（息之出入。
亦觉不流利。而）短气。（此水气滞而为病。若水盛于气者。则短气。以）茯苓杏仁甘
草汤主之。（水利则气顺矣。若气盛于水者。则胸中气塞。）橘枳生姜汤亦主之。（气
开则痹通矣。）
尤在泾云、此亦气闭气逆之证。视前条为稍缓矣。二方皆下气散结之剂。而有甘淡
苦辛之异。亦在酌其强弱而用之。
茯苓杏仁甘草汤方
茯苓（三两） 杏仁（五十个） 甘草（一两）
上三味。以水一斗。煮取五升。温服一升。日三服。不瘥。更服。
橘枳生姜汤方
橘皮（一斤） 枳实（三两） 生姜（半斤）
上三味。以水五升。煮取二升。分温再服。
（又有本脏病。而殃及他脏者。不可不知。）胸痹（为手少阴之君火衰微。以致
足少阴之阴气上弥。势盛而及于肝。肝主通身之筋。今筋时见）缓急者。（乙癸同病
也。以）薏苡附子散主之。
此言胸痹之兼证也。
薏苡附子散方
薏苡仁（十五两） 大附子（十枚炮）
上二味。杵为散。服方寸匕。日三服。
（若胸痹之外。病有同类者。不可不知。）心中（闷）痞。（或痰饮客气）诸逆心
悬（而空。如空中悬物。动摇而）痛。（以）桂枝生姜枳实汤主之。
此下不言胸痹。是不必有胸痹的证矣。
桂枝生姜枳实汤方
桂枝 生姜（各三两） 枳实（五两）
上三味。以水六升。煮取三升。分温三服。
（上言心痛彻背。尚有休止之时。故以栝蒌薤白白酒加半夏汤。平平之剂可治。今
则）心痛彻痛。背痛彻心。（连连痛而不休。则为阴寒邪甚。浸浸乎阳光欲熄。非薤白
之类所能治也。以）乌头赤石脂丸主之。
此言心痛牵引前后。阴邪僭于阳位。必用大剂以急救也。
乌头赤石脂丸方
乌头（一分炮） 蜀椒 干姜（各一两） 附子（半两） 赤石脂（一两）
上五味。末之。蜜丸如桐子大。先食服一丸。日三服。不知。稍加服。
附方
九痛丸 治九种心疼。
附子（三两炮） 生野狼牙 巴豆（去皮熬研如膏） 干姜 吴茱萸 人参（各一两）
上六味。末之。炼蜜丸如梧子大。酒下。强人初服三丸。日三服。弱者二丸。 兼治
卒中恶。腹胀。口不能言。又治连年积冷流注。心胸痛。并冷冲二气。落马坠车血疾等。
皆主之。忌口如常法。（按痛虽有九。而心痛不离于寒。故以姜附为主。而降浊去风逐
滞补虚次之。）
The Master said: "Disease often resides in the body's most deficient areas, becoming a place where pathogenic factors lodge. Therefore, differentiation must be made through pulse diagnosis."
To understand the pulse, one must first distinguish between excess (Tai Guo) and deficiency (Bu Ji). For instance, a faint Yang pulse at the position anterior to the Guan indicates deficiency of Yang Qi; a wiry Yin pulse at the position posterior to the Guan indicates excess of Yin pathogens. When Yin pathogens invade Yang positions, it results in Chest Bi (Chest Obstruction) and Heart Pain. The reason for this is the extreme deficiency of Upper Jiao Yang Qi. (When Yang Qi is extremely deficient, it lacks the foundation to overcome pathogens. However, pure deficiency does not necessarily cause pain.) Now, a faint Yang pulse indicates deficiency, confirming the disease location is in the Upper Jiao. (Investigating the cause of Chest Bi and Heart Pain, the wiry quality within the Yin pulse represents cold Yin pathogens attacking the deficiency of the Upper Jiao, thereby forming obstruction and pain. This shows that deficiency is the cause inviting pathogens, while the wiry pulse reveals the nature of pathogens invading deficiency.) This is the reason. This passage explains that diseases such as Chest Bi and Heart Pain all arise from pathogens lodging in deficient areas, exploring the disease source through pulse manifestations.
(There are also cases not derived from deficiency, which should be observed separately. Here, another method for examining etiology and diagnosing disease is prepared. If a healthy person,) without new-onset chills or fever, suddenly experiences shortness of breath and inability to take a full breath, this is likely due to Phlegm-Fluids or Food Stagnation obstructing the ascending and descending Qi dynamics. In such cases, blame is placed not on deficiency but on excess.
This section separately lists excess patterns; comparing it with the previous section makes the distinction clearer.
The chest is like the sky where Yang Qi governs. Once Yang Qi is deficient, various Yin-Cold pathogens can invade, resulting in Chest Bi disease. (Since all Yang meridians receive Qi in the chest and circulate it to the back, if Qi becomes obstructed, it blocks the pathways of up-and-down movement, leading to wheezing, coughing, and expectoration. (If pathogens block the anterior and posterior Yin-Yang positions, it leads to) chest and back pain. (Moreover, besides wheezing, coughing, and expectoration, there is) shortness of breath, where respiration is discontinuous. (Carefully examining the pulse,) the Cun position pulse is deep and slow, (which corresponds to the aforementioned faint Yang pulse.) the Guan position pulse is small, tight, and rapid, (which corresponds to the aforementioned wiry Yin pulse, overflowing from the Chi position to the Guan position. When Yang Qi loses its authority, Yin pathogens invade instead. The treatment principle is to unblock the Yang Qi in the chest, primarily using Gualou Xiebai Baijiu Tang (Trichosanthes Fruit, Macrostemon Tuber, and White Wine Decoction).
This section details the symptoms and pulses of Chest Bi. Whenever Chest Bi is mentioned, it should be generalized by this description, though there may be slight variations. Thus, it is presented first as the primary syndrome and formula for Chest Bi. The statement "Cun position pulse is deep and slow" is an alternative expression for the faint Yang pulse in the first section; "Guan position pulse is small, tight, and rapid" is an alternative expression for the wiry Yin pulse. However, the Guan position lies at the boundary of Yin and Yang. Because Yin pathogens are abundant in their original root position (Chi) and overflow upwards to the Guan, they manifest there. This also aligns with the concept in the first section regarding excess and deficiency, distinguishing upper and lower Yin and Yang, rather than being confined strictly to literal wording.
**Gualou Xiebai Baijiu Tang Formula**
* Gualou Shi (Trichosanthis Fructus) - 1 piece
* Xiebai (Allii Macrostemonis Bulbus) - 0.5 jin
* Baijiu (White Wine) - 7 sheng
Boil the above three ingredients together until two sheng remain. Divide into two doses and take warm.
Regarding Chest Bi symptoms, previously detailed, no further repetition is needed. Now, adding the symptom of inability to lie flat due to Qi rebellion, (indicating Phlegm-Fluids acting as supporting pathogens. This pattern resembles Zhi Yin (Branching Fluids), but only) heart pain radiating to the back (is unique to Chest Bi syndrome, treated primarily with Gualou Xiebai Banxia Tang (Trichosanthes Fruit, Macrostemon Tuber, Pinellia Tuber, and White Wine Decoction).
This follows the previous discussion: inability to lie flat and heart pain radiating to the back indicate severe obstruction compared to before, so modifications to the previous formula are appropriate.
**Gualou Xiebai Banxia Tang Formula**
* Gualou Shi (Trichosanthis Fructus) - 1 piece (crushed)
* Xiebai (Allii Macrostemonis Bulbus) - 3 liang
* Banxia (Pinelliae Rhizoma Preparatum) - 0.5 sheng
* Baijiu (White Wine) - 1 dou
Decoct the above four ingredients together until four sheng remain. Take one sheng warm, three times daily.
(In cases of even more acute severity,) Chest Bi accompanied by a sensation of痞 (Plugged/Fullness) in the heart region, (where lingering guest Qi stagnates) in the chest. (Beyond Chest Bi, there is also) chest fullness and Qi rebelling upward from the hypochondrium to seize the heart. (This means the chest is both obstructed and full, affecting the heart region and extending to the hypochondrium, characterized by lingering, stagnating, rebellious, and seizing sensations, indicating Yin pathogens running rampant without restraint. At this juncture, urgent intervention is required, primarily using Zhishi Xiebai Guizhi Tang (Immature Bitter Orange, Macrostemon Tuber, Cinnamon Twig, and Magnolia Bark Decoction). Alternatively, focusing on treating the root, Renshen Tang (Ginseng Decoction) may also be used.
This describes severe Chest Bi, offering two formulas for flexible clinical application. They may be used sequentially or alternately, depending on the practitioner's adaptability.
You Zaijing stated: "Heart region plugged sensation arises from Qi obstruction forming Pluggedness. Hypochondriac Qi rebelling to seize the heart indicates rebellious Qi failing to descend, threatening the Middle Jiao. One must urgently unblock the stagnant Qi, or rapidly restore the depressed Yang. Removing pathogenic excess protects righteous Qi; nourishing Yang deficiency expels Yin. This decision depends on assessing the duration of the disease and the excess or deficiency of Qi."
**Zhishi Xiebai Guizhi Tang Formula**
* Zhishi (Aurantii Fructus Immaturus) - 4 pieces
* Xiebai (Allii Macrostemonis Bulbus) - 0.5 jin
* Guizhi (Cinnamomi Ramulus) - 1 liang
* Houpo (Magnoliae Officinalis Cortex) - 4 liang
* Gualou Shi (Trichosanthis Fructus) - 1 piece (crushed)
Add five sheng of water to the above five ingredients. First decoct Zhishi and Houpo until two sheng remain, discard the dregs, add the remaining herbs, boil briefly, divide into three warm doses.
**Renshen Tang Formula**
* Renshen (Ginseng Radix et Rhizoma)
* Ganjiang (Zingiberis Rhizoma)
* Baizhu (Atractylodis Macrocephalae Rhizoma) - each 3 liang
* Guizhi (Cinnamomi Ramulus)
* Gancao (Glycyrrhizae Radix et Rhizoma) - each 4 liang
Add nine sheng of water to the above four ingredients. Decoct until five sheng remain, add Guizhi, decoct again until three sheng remain. Take one sheng warm, three times daily.
(In cases of slightly milder severity,) Chest Bi with intermittent sensation of Qi obstruction in the chest, (making breathing feel unsmooth, accompanied by) shortness of breath. (This is caused by stagnant Water-Qi. If Water exceeds Qi, causing shortness of breath, treat primarily with Fuling Xingren Gancao Tang (Poria, Apricot Seed, and Licorice Decoction). (When Water flows smoothly, Qi becomes smooth. If Qi exceeds Water, causing chest Qi obstruction,) Juqi Shengjiang Tang (Tangerine Peel, Immature Bitter Orange, and Fresh Ginger Decoction) may also be used. (When Qi opens, obstruction resolves.)
You Zaijing stated: "This is also a pattern of Qi closure and rebellion, slightly milder than the previous clause. Both formulas are agents that direct Qi downward and dissipate stagnation, differing in sweet/bland vs. bitter/acrid properties. Usage depends on judging their strength."
**Fuling Xingren Gancao Tang Formula**
* Fuling (Poria) - 3 liang
* Xingren (Armeniacae Semen Amarum) - 50 seeds
* Gancao (Glycyrrhizae Radix et Rhizoma) - 1 liang
Add one dou of water to the above three ingredients. Decoct until five sheng remain. Take one sheng warm, three times daily. If not cured, continue administration.
**Juqi Shengjiang Tang Formula**
* Ju Pi (Citri Reticulatae Pericarpium) - 1 jin
* Zhishi (Aurantii Fructus Immaturus) - 3 liang
* Shengjiang (Zingiberis Rhizoma Recens) - 0.5 jin
Add five sheng of water to the above three ingredients. Decoct until two sheng remain. Divide into two warm doses.
(Sometimes the primary organ falls ill, affecting other organs, which must be known.) Chest Bi arises from the decline of Minister Fire in the Hand-Shaoyin Heart Meridian, allowing Yin Qi from the Foot-Shaoyin Kidney Meridian to ascend excessively. When the momentum is strong, it affects the Liver. The Liver governs the tendons of the whole body; now the tendons occasionally appear relaxed or spasmodic. (This indicates simultaneous disease of Liver and Kidney, treated primarily with Yiyi Fuzi San (Coix Seed and Aconite Powder).
This discusses concurrent syndromes of Chest Bi.
**Yiyi Fuzi San Formula**
* Yiyiren (Coicis Semen) - 15 liang
* Dafuzi (Aconiti Lateralis Radix Praeparata) - 10 pieces (prepared)
Grind the above two ingredients into powder. Take one fangcun bi (square-inch measure) per dose, three times daily.
(Beyond Chest Bi, similar conditions exist, which must be known.) Heart region stuffed/plugged, (due to Phlegm-Fluids or guest Qi) causing various rebellions, leading to a hanging, empty pain in the heart, (like an object suspended in air, shaking and causing) pain, treated primarily with Guizhi Shengjiang Zhishi Tang (Cinnamon Twig, Fresh Ginger, and Immature Bitter Orange Decoction).
The following section does not mention Chest Bi, implying that specific Chest Bi criteria are not mandatory.
**Guizhi Shengjiang Zhishi Tang Formula**
* Guizhi (Cinnamomi Ramulus)
* Shengjiang (Zingiberis Rhizoma Recens) - each 3 liang
* Zhishi (Aurantii Fructus Immaturus) - 5 liang
Add six sheng of water to the above three ingredients. Decoct until three sheng remain. Divide into three warm doses.
(Above, it was stated that heart pain radiating to the back has intervals of relief, so the mild Gualou Xiebai Baijiu Tang plus Banxia can treat it. Now, however,) heart pain radiating to the chest and back pain radiating to the heart (continuous pain without cessation indicates extreme Yin-Cold pathogenic excess, gradually extinguishing the Sun-Yang. Herbs like Xiebai are insufficient; treat primarily with Wutou Chishizhi Wan (Aconite and Halloysit Rubra Pill).
This describes heart pain radiating front and back, where Yin pathogens usurp Yang positions, requiring large-dose emergency treatment.
**Wutou Chishizhi Wan Formula**
* Wutou (Aconiti Radix) - 1 fen (prepared)
* Shujiao (Zanthoxyli Pericarpium)
* Ganjiang (Zingiberis Rhizoma) - each 1 liang
* Fuzi (Aconiti Lateralis Radix Praeparata) - 0.5 liang
* Chishizhi (Halloysit Rubra) - 1 liang
Grind the above five ingredients into powder. Make pills with honey the size of tung tree seeds. Take one pill before meals, three times daily. If ineffective, slightly increase the dosage.
**Attached Formulas**
**Jiu Tong Wan (Nine-Pain Pill)** Treats nine types of heart pain.
* Fuzi (Aconiti Lateralis Radix Praeparata) - 3 liang (prepared)
* Sheng Ye Langya (Uncertain Herb, possibly referring to a specific root)
* Badou (Crotonis Fructus) - skin removed, roasted, ground into paste
* Ganjiang (Zingiberis Rhizoma)
* Wuzhuyu (Evodiae Fructus)
* Renshen (Ginseng Radix et Rhizoma) - each 1 liang
Grind the above six ingredients into powder. Refine honey to make pills the size of wu zi (wu berry). Administer with wine. Strong individuals start with three pills, three times daily. Weak individuals take two pills. Also treats sudden stroke from evil qi, abdominal distension, inability to speak. Also treats chronic accumulated cold flowing through channels, chest/heart pain, cold rushing Qi, and blood disorders from falling from horses or vehicles. Follow standard dietary restrictions. (Note: Although there are nine pains, heart pain is inseparable from Cold, so Ginger and Aconite are primary, followed by descending turbidity, dispelling wind, removing stagnation, and tonifying deficiency.)