一条 师曰。夫脉。当取太过不及。阳微阴弦。即胸痹而痛。所以然者。责其极虚也。今阳虚。知在上焦。所
以胸痹心痛者。以其阴弦故也。
脉有伦类。盛则俱盛。衰则俱衰。此大较也。故凡诊脉者。当取其既有太过处。又有不及处。则不及者自为病。
而有余者将乘之。而尤为不及者之病矣。即如其脉。关以前之阳部得微。关以后之阴部得弦。夫关前之阳
脉微。则自胃脘上至胸中。其真阳卑弱而不能奋鼓。故病名曰痹。关后之阴脉弦。则自胃腑下至肝脏。其浊
邪弦急而从上弹射。故症则见痛。所以然者。责在胸中阳位之极虚。故招下焦之上凌耳。二句。就主一边说。
即后文栝蒌薤白及人参诸汤。填阳之案也。关前应胸分。关前之脉微。故知胸分之阳虚而病痹也。二句是
自注。所以知其为胸痹之故。弦脉。于脏为肝。于气为阴。于邪为寒。于症为痛。病胸痹而心痛者。正弦脉以肝
脏阴寒之邪。上乘阳虚之所致也。二句就客一边说。即后文栝蒌薤白加半夏。及薏苡附子等汤。并乌头赤
石脂丸。兼责中下二焦逆阴之案也。此与腹满寒疝第一条。寸口脉微弦。文虽同而大有分别。彼处之微
弦。在寸口一部上见。盖浮之得微。而沉之得弦也。此处之微弦。是寸口与关上。或下与尺中两部分见。故三
条曰寸口脉云云。关上脉云云。九条乌头赤石脂丸一症。虽未尝言脉。然就其症与方意细审之。又确为尺
弦之候故也。又彼处心肺间。其无形之宗气虚馁。与此处同。而胸痹一症。多在当心之膈膜。其有形血肉中
之气虚。故痹着而痛。且从孙络而痛彻于背也。大概无形之宗气。虚于大惊大吐。或忧戚所致。其病顿。略久
而上不能御下者。则成惊悸。或便难而见吐衄等血。其不能提下者。又成半产漏淋。亡血失精诸候。并传变
为本门之胸痹者亦有之。当心之膈膜。其有形血肉中之气。又虚于形寒饮冷。及伤心诸事者居多。其病渐
而在心后之脉络。故其曰心痛者。谓当心而痛。非心脏中之自痛也。
二条 平人无寒热。短气不足以息者。实也。
短气者。宗气上虚。而逆阴凑之。则吸气艰于深入。入浅则出亦浅。故殊觉短而不足以息也。寒则肺卷。热则
气闭。俱能短气。今外则似无病之平人。既无寒热之症。则其所以短气者。岂非上虚而邪凑之。以致气机不
能深入之故乎。夫邪之所凑。其气必虚。留而不去。其病乃实。即第五条所谓留气结在胸中者是也。故曰实
也。上照前条之极虚。故使客邪逗留而反实。下伏后方之攻实。故用橘枳浓朴以散痞也。
三条 胸痹之病。喘息咳唾。胸背痛。短气。寸口脉沉而迟。关上小紧数。栝蒌薤白白酒汤主之。
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。
此言胸痹之全症也。喘息及短气者。胸中之本气虚。而胃邪实之。以致呼吸之气不能深入远出之义。肺气
逆。故咳。肺液与气俱逆。故咳而且唾也。胸背痛者。胸中阴维阴跷之脉。其孙络与督脉。及阳维阳跷之在背
者相贯。其痛从胸透背。故胸背阴沁而切痛也。寸口二句。又即首条阳微阴弦而深细言之。盖寸口为胸之
应。沉为阳不能上鼓。迟为气不能连续。是沉迟为微脉之根蒂。寸口外微而内沉迟。故知胸中之阳气极虚
而病痹也。关上为胃之应。紧即首条之弦脉。与伤寒之紧脉不同。伤寒之紧脉。因寒气凝敛。脉从两头中缩
而紧。其体常短。故曰形如转索。转索者。以中缩而紧也。弦脉之紧。因阴弛阳急。脉从两头扯拔而紧。其体较
长。故曰状如弓弦。弓弦者。以绷急而紧也。胸膈上虚下吸有力。以致中焦之气奔之。吸张乘两就之势。故其
脉数也。小紧数。犹言略略紧数之谓。盖终不比有余者之上射也。关上小紧数。故知胸病虚痹。胃以阴弛阳
急之气赴之。而致痛矣。夫胸膈象天。常喜轻清。薤白气味俱薄。而性辛温。薄则应在天之气而走胸分。辛温
则能迎导其阳气而发越之。佐以蔓生甘润。而善于通窍之栝蒌。蔓生则走经络。甘润而通窍。则又能入络
脉。而行其阴中之气矣。然后以浮缓之酒托之。取气味俱薄之白酒者。一则以轻清应天。再则以少火生气。
将阳回春满。从胸温络。而痹自愈矣。薤独取白者。以白具上行之性故也。且南方种之以供蔬。尝留白而就
地刈之。不数天而苗长如故。则尤见其上行之最速者矣。此胸痹之正病正方。单责胸分之阳虚。而未责
中下者也。
四条 胸痹不得卧。心痛彻背者。栝蒌薤白半夏汤主之。
栝蒌薤白半夏汤方 栝蒌实（一枚） 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。（以四升日三服计之。当缺夜一服三字。）
胸痹二字。包上条之脉症在内。后仿此。前条之症。因胸中自虚。下吸胃气。胃家本无上犯之意。犹胸中之谩
藏冶容。诲其淫盗耳。故以填阳通气之外。略无余议下及者。此也。本条之症。胸中之虚未甚。却以胃家之浊
邪方实。以盛凌衰而贯注之。浊气上浮而不下伏。故不得卧。且胸分虚而客气上乘。犹之盗贼所经。于墙垣
门径之低小残缺者。则一往趋之。心后之络。外通于背。阳虚而痹。墙垣之低小。门径之残缺是也。浊气从胸
之心后而贯痹。故痛如在心。又从痹之络脉而贯背。故痛彻背矣。于前汤中。减辛温填气之薤白过半。故知
胸中之虚未甚。君平胃降气之半夏而用至半升。故知以盛凌衰。为胃中之邪过实也。是此汤即第一条太
过不及而两责之者。盖以栝蒌薤白本汤。责胸分之阳虚者十之三。加半夏为君。而责胃中之气实者十之
七也。岐黄论卧与不卧。明明说是气伏于阴分。则神明收藏。故得卧。气出于阳分。则灵醒发越。故不得卧。
半夏粳米汤治之。覆杯即卧者。以半夏乘春发生。入夏将半。即归根复命而苗便枯。故名。是圣人取半夏之
性降。能伏其气以入于阴分故也。佐粳米者。滋胃中之阴液以覆庇阳神。犹之衣被之用而已。李氏旧注。引
甲乙本灵枢之意。而以半夏治不眠。谓半夏入少阳经。已乖仲景用在阳明之旨。至其谓为转运阴阳之药。
阴阳得通。其卧立至。则平人之白日不欲卧者。其阴阳俱不通者耶。冤哉。
五条 胸痹。心中痞。留气结在胸。胸满。胁下逆抢心。枳实薤白桂枝汤主之。人参汤亦主之。
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。内诸药。煮数沸。分温三服。
人参汤方 人参 白术 甘草 干姜（各三两）
上四味。以水八升。煮取三升。温服一升。日三服。
胸分之阳虚。而下阴上凑。故心中痞。但痞之为病。常随阳气之起伏以为消长。故腹满时减者。痞之候也。今
其气逗留而结在胸。以致胸满不减者。此留气也。譬之天地。寒云断脚。冷雾横拖。逗留于太虚。而不收不散
之象。是从胃脘中路上浮。而已据胸中矣。加之胁下以肝胆之逆。从旁抢心。而争趋空处。此虽胸中阳虚之
所招致。填膈之品。固宜首重。以降逆阴。然其留气结胸。犹之贼据城郭。扫除之法。不得不与抚绥兼施矣。故
以散气之枳实。开痞之浓朴为主。而先煮之者。其意以微风荡云雾而去留气也。然后以薤白、桂枝之辛温
而甘者。填胸阳以引其气。以栝蒌实之甘寒而润者。走络脉以入其痹。犹之人尿、猪胆及柏叶等之反佐也。
于是留气散而胸阳上复。则不治逆而逆将自靖矣。至于枳实、浓朴。欲并用其苦味以泄土邪。故久煮之以
取其重浊。薤桂二味。欲单用其温阳以通天气。故略煮之以取其轻清耳。人参汤亦主之者。盖人参补气。白
术填胸。干姜散结开痞。甘草浮缓上托。使一团太和之气。氤氲胸中。上则旁导阳气而治痹。下则照临阴氛
而消逆。其于留气之结胸者。舞干羽而有苗格化矣。或曰。前汤是治全症之方。后汤是单治胁下逆抢之
方。又曰。服前汤而留气已散。痞结已开。后汤所以愈痹。而为善后之剂也。二说虽与仲景一条。而主两汤之
文例不合。然皆近理。故俱存之。以俟有识者之鉴定焉。
六条 胸痹。胸中气塞。短气。茯苓杏仁甘草汤主之。橘枳生姜汤亦主之。
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。（以煮五升。服一升按之。则日三服之下。当缺
夜二服一语。盖不瘥更服。是更作一服之谓。若谓即服此二升。金匮前后诸汤。并无一剂分作数服。今日
服一半。至明日服完。为更服之例也。）
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。
胸痹上虚而中下之逆邪有二。湿与寒是也。肺性恶湿复恶寒。湿则肺滞。寒则肺敛。俱能使膈膜之痹处作
痛外。而又能令其气塞且短也。湿气上逆者。以茯苓之温胸燥湿者为主。佐杏仁以利肺窍。而以浮缓之甘
草。托之上行而留恋之。则湿去滞通。而气之塞且短者可愈矣。故主之。寒气上逆者。以辛温之橘皮为君。温
则暖膈。辛则散结也。生姜祛寒止逆。而性复宣通。与犀利之橘皮相济。则成和风爽气之象。然后佐以破留
气之枳实。则寒去而肺畅。气之塞且短者亦愈。故曰亦主之。然二汤皆微弦两责之方也。
七条 胸痹。缓急者。薏苡附子散主之。
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。
此即前条茯苓杏仁。及橘枳汤之合症合方也。缓急统胸痹之全症而言。凡喘息咳唾。背痛短气。及不得卧
等候。有时而缓。有时而急者。以其人之脾胃。素有客湿客寒之邪。上冲下伏之所致也。夫阴阳五行。生扶囚
谢之化。人身之脏腑。与天地准。故火土之气衰。而水木为妖者。得丙丁戊己而持。得壬癸甲乙而甚。持则病
缓。而甚则病急者。一也。且湿气浸淫。寒气劲迫。是湿邪为害尚缓。而寒邪为害则急者。又一也。故其谓病痹
之人。其诸痹症。或缓或急。此湿寒之气在中焦。以上窥胸阳之往复。而为更迭入寇之象。故主祛湿利水之
薏苡者。即上条茯苓甘草杏仁汤之义。配温中行阳之附子者。即上条橘枳生姜汤之义。而进之者也。至杵
为散而连服其渣质。则留连胃中。使寒湿既去。而其干温之化。还浮于太虚。则填胸贯络。而痹自愈。此虽似
乎单责阴弦之脉。注意在讨贼一边。不知荡平之后。阳微大振。而贺太平者。却正在朝廷也。噫、神矣哉。
八条 心中痞。诸逆。心悬痛。桂枝生姜枳实汤主之。
桂枝生姜枳实汤方 桂枝 生姜（各三两） 枳实（五枚）
上三味。以水六升。煮取三升。分温三服。
痞及诸逆之由于胸阳虚馁者。详已见。心之所以如有根据辅者。真气为之旁薄故也。真气上虚。则心无凭借。
有如空悬之状。故曰心悬。胸为阳位。阴邪留之。则阴阳不相宜。而阴沁作痛。故曰心悬痛也。以辛温之桂枝
生姜填真气者。所以治其心之虚悬。以苦温开痞之枳实破留气者。所以除其痛耳。大概即五条枳实薤白
之汤意而变易之者也。此及下文二条。又就胸痹之症而推展言之。盖谓胸痹者。见种种等候。固宜主此。
然不必执定胸痹。凡上虚而下气上犯。以致留而不散者。俱主之。故于条端。既不冠胸痹字。而且曰诸逆云尔。
九条 心痛彻背。背痛彻心。乌头赤石脂丸主之。
乌头赤石脂丸方
乌头（一分炮） 赤石脂（一两） 附子（半两炮） 干姜（一两） 蜀椒（一两）
上五味。末之。蜜丸如梧子大。先食服一丸。三服不知。稍加服。（梧子大者服一丸。恐有误。）
细按症治。其脉亦当阳微阴弦。但微脉固在寸口。而阴弦之脉。当在关以下之尺中耳。人身心胸中之真阳。
外为周身卫气之根。内为中下二焦之主。真阳上虚。而脾胃之邪。就近犯之。则为四、五、六、七等条之症。若夫
肾为牡脏。肝居至阴之下。其虚寒之邪。比之吴楚诸夷。周室既衰。而泽国蛮荆。亦来远窥王室矣。然肝肾之
阴邪上犯。较之中土之逆为尤甚。故心痛彻背。与四条之症既同。而胸阳内亏。卫气衰薄。寒从背入。且与下
阴之逆。起而贯痹者。同类而两相感召。故背痛而又内彻于心也。夫三焦之化。阳从底生。盖以命门之温热。
蒸熟水谷。而化悍气。然后上熏如雾。而贮为胸阳者也。况本症又属下焦之寒逆乎。是非温下以温上不可
也。故以乌头之老阳。壮先天之元气。以附子之生阳。发后天之化气。取蜀椒之辛敛者。所以补其阳而封之
固之也。取干姜之辛散者。又所以种其根而升之举之也。总交于气重色赤之石中脂髓。以为使者。气重、易
致下行。色赤、偏宜阴脏。石中之脂髓。岂非欲其入精血中。而温资始之化源乎。丸非汤散之仅行上中者可
Article 1 The Master said: "When taking the pulse, one should assess both excess (Tai Guo) and deficiency (Bu Ji). If the Yang portion (Cun/Guan) is micro (Wei) and the Yin portion (Chi) is wiry (Xian), this indicates Chest Bi with pain. The reason for this is attributed to extreme deficiency. Now, knowing that Yang Qi is deficient in the Upper Jiao, the cause of Chest Bi and heart pain lies in the Wiry Yin pulse."
Pulses have their categories; when excessive, both are excessive; when deficient, both are deficient. This is the general rule. Therefore, whenever diagnosing the pulse, one should identify areas of both excess and deficiency. The deficient part naturally becomes diseased, and the excess part will exploit it, causing even greater disease to the deficient part. Consider this pulse: the Yang portion before the Guan (Cun) presents as Micro, and the Yin portion after the Guan (Chi) presents as Wiry. A Micro Yang pulse before the Guan indicates that from the epigastrium up to the chest, the True Yang is weak and unable to stir and propel. Thus, the disease is named Bi (Obstruction). A Wiry Yin pulse after the Guan indicates that from the stomach fu down to the Liver, turbid pathogens are wiry and urgent, shooting upwards from above. Thus, the symptom is pain. The reason is that the responsibility lies in the extreme deficiency of the Yang position in the chest, which attracts the upward encroachment of the Lower Jiao's Yin. These two sentences focus on the primary aspect (root deficiency), corresponding to later formulas like Gualou Xiebai Baijiu Tang and Ren Shen Tang, which fill Yang. The area before the Guan corresponds to the chest; a Micro pulse there indicates Yang deficiency in the chest leading to Bi. These two sentences are self-annotations explaining why it is known as Chest Bi. The Wiry pulse corresponds to the Liver among Zang organs, to Yin among Qi, to Cold among pathogens, and to Pain among symptoms. Chest Bi with heart pain is caused by the Liver's Yin-Cold pathogen, represented by the Wiry pulse, encroaching upon the Yang-deficient state. These two sentences focus on the secondary aspect (branch/excess), corresponding to later formulas like Gualou Xiebai Banxia Tang, Yiyi Fuzi San, and Wutou Chishizhi Wan, which address both Middle and Lower Jiao rebellious Yin. This differs significantly from Article 1 of the Abdominal Fullness, Cold Cramps, and Parasitic Disease chapter, which also mentions "Cunkou pulse Micro and Wiry." There, the Micro-Wiry appears in the Cunkou section alone (Micro on superficial pressure, Wiry on deep pressure). Here, the Micro-Wiry appears in two parts: Cunkou/Guan or Lower/Chi. Hence, Article 3 says "Cunkou pulse..." and "Guan pulse...". Although Article 9 (Wutou Chishizhi Wan) does not explicitly mention the pulse, careful examination of its symptoms and formula intent confirms it fits the Chi-Wiry pattern. Furthermore, while both conditions involve deficiency of formless Zong Qi between the Heart and Lungs, Chest Bi often occurs in the diaphragm at the center of the heart, involving deficiency of Qi within the form-flesh-blood tissues, leading to obstruction and pain that radiates through collateral vessels to the back. Generally, formless Zong Qi becomes deficient due to great fright, severe vomiting, or sorrow, resulting in acute onset. If prolonged and unable to control the lower, it leads to palpitations; if it cannot lift the lower, it leads to spontaneous abortion, dripping leukorrhea, blood loss, and essence loss, which may transform into Chest Bi. Deficiency of Qi in the form-flesh-blood tissues at the central diaphragm is mostly caused by external cold, cold drinks, and emotional injury to the Heart. The disease progresses slowly in the meridians behind the heart. Thus, "heart pain" refers to pain at the center of the heart, not pain originating within the Heart organ itself.
Article 2 A healthy person without chills or fever who experiences shortness of breath and insufficient respiration has an Excess condition.
Shortness of breath occurs when Zong Qi is deficient in the upper part and rebellious Yin gathers, making deep inhalation difficult. Shallow inhalation leads to shallow exhalation, feeling particularly short and insufficient. Cold causes lung contraction; heat causes Qi closure; both lead to shortness of breath. Now, externally appearing as a healthy person without chills or fever, the cause of shortness of breath must be upper deficiency allowing pathogens to gather, preventing Qi from penetrating deeply. Where pathogens gather, Qi is necessarily deficient; if they remain and do not depart, the condition becomes Excess. This is what Article 5 calls "stagnant Qi knotting in the chest." Hence, it is called Excess. This echoes the previous article's "extreme deficiency," causing guest pathogens to linger and appear as Excess; it also foreshadows the subsequent treatment attacking Excess, using Ju Pi, Zhi Shi, and Hou Po to dissipate stagnation.
Article 3 In Chest Bi disease, symptoms include panting, coughing, spitting, chest and back pain, and shortness of breath. The Cunkou pulse is Deep and Slow; the Guan pulse is slightly Tight and Rapid. Treat with Gualou Xiebai Baijiu Tang.
Formula: Gualou Fruit (one piece), Allii Macrostemonis Bulbus (half jin), White Wine (seven sheng).
Boil the three ingredients together, obtain two sheng, divide into two warm doses.
This describes the full syndrome of Chest Bi. Panting and shortness of breath result from deficiency of original Qi in the chest and excess of Stomach pathogens, preventing respiratory Qi from penetrating deeply and extending far. Lung Qi rebels, causing cough; lung fluids rebel with Qi, causing cough and spitting. Chest and back pain occur because the Yin Wei and Yin Qiao meridians in the chest connect via collateral vessels to the Du Mai and the Yang Wei and Yang Qiao meridians in the back. Pain penetrates from chest to back, causing cold and cutting pain in both regions. The Deep-Slow Cunkou pulse elaborates on the "Yang Micro, Yin Wiry" from Article 1. Cunkou corresponds to the chest; Deep indicates Yang cannot ascend and stir; Slow indicates Qi cannot connect continuously. Thus, Deep-Slow is the root of the Micro pulse. External Micro with internal Deep-Slow indicates extreme Yang deficiency in the chest leading to Bi. Guan corresponds to the Stomach; Tight here refers to the Wiry pulse mentioned in Article 1, but differs from the Tight pulse in Cold Damage. The Cold Damage Tight pulse arises from cold condensation, contracting from both ends inward, usually short, described as "like a turning rope." The Wiry pulse's tightness arises from Yin relaxation and Yang urgency, stretching from both ends, usually longer, described as "like a bowstring." Upper chest deficiency with strong lower suction causes Middle Jiao Qi to surge upward, creating a Rapid pulse. "Slightly Tight-Rapid" means mildly tight and rapid, not as forceful as excess pathogens shooting upward. Guan Slightly Tight-Rapid indicates Chest Bi due to deficiency, with Stomach Qi of Yin-relaxation/Yang-urgency rushing in, causing pain. The chest/diaphragm resembles Heaven, preferring lightness and clarity. Xiebai is thin in aroma and flavor, acrid and warm; thinness acts on Heavenly Qi moving to the chest; acrid-warm guides and disperses Yang Qi. Combined with Gua Lou, which grows vines, is sweet-moist, and opens orifices, it enters collaterals to move Yin-Qi. Then, floating-slow wine supports it. Using thin-aroma white wine responds to Heaven with lightness and generates Qi with mild fire, restoring Yang like spring, warming collaterals from the chest, curing Bi. Xiebai is chosen for its white color because white has ascending nature. Southern cultivation for vegetables shows rapid regrowth after cutting, demonstrating its swift ascending property. This is the standard formula for Chest Bi, addressing only Upper Jiao Yang deficiency, not Middle/Lower Jiao.
Article 4 In Chest Bi, inability to lie flat, and heart pain radiating to the back, treat with Gualou Xiebai Banxia Tang.
Formula: Gualou Fruit (one piece), Allii Macrostemonis Bulbus (three liang), Pinelliae Rhizoma Preparatum (half sheng), White Wine (one dou).
Decoct the four ingredients, obtain four sheng, take one sheng warm, three times daily. (Calculation suggests missing "night dose").
"Chest Bi" encompasses the pulse and symptoms of the previous article. In the previous article, symptoms arose from internal chest deficiency sucking in Stomach Qi; the Stomach had no intention to rebel, akin to inviting theft by improper conduct. Thus, besides filling Yang and unblocking Qi, no other measures were needed. In this article, chest deficiency is less severe, but Stomach turbid pathogens are strong, overwhelming weakness and penetrating. Turbid Qi floats up instead of descending, causing inability to lie flat. Chest deficiency allows guest Qi to attack, like thieves entering through low walls or broken gates. Collaterals behind the heart connect externally to the back; Yang deficiency and Bi are like low walls and broken gates. Turbid Qi penetrates from chest-heart through Bi to back, causing pain felt in the heart and radiating to the back. Reducing Xiebai by more than half indicates less severe chest deficiency. Making Banxia the chief herb at half sheng indicates Stomach excess overwhelming weakness. This formula addresses both Excess and Deficiency from Article 1. Gualou Xiebai Tang addresses chest Yang deficiency (30%); adding Banxia as chief addresses Stomach Qi excess (70%). Huangdi Neijing states Qi resting in Yin allows spirit storage and sleep; Qi emerging in Yang causes alertness and wakefulness. Banxia-Ji Mi Tang cures insomnia quickly because Banxia, rooting in summer, descends Qi into Yin. Ji Mi nourishes Stomach Yin to cover Yang Spirit. Li's commentary citing Jia Yi Ben Ling Shu claims Banxia treats insomnia by entering Shaoyang, contradicting Zhong Jing's use in Yangming. Claiming it transports Yin-Yang so sleep comes instantly implies those awake during day have blocked Yin-Yang, which is unjust.
Article 5 In Chest Bi, epigastric stuffiness, stagnant Qi knotting in chest, chest fullness, and rebellious Qi seizing the heart from hypochondrium, treat with Zhishi Xiebai Guizhi Tang. Renshen Tang is also effective.
Formula: Zhishi (four pieces), Allii Macrostemonis Bulbus (half jin), Guizhi (one liang), Houpo (four liang), Gualou Fruit (one piece, crushed).
Boil Zhishi and Houpo in five sheng water to two sheng, add others, boil briefly, divide into three warm doses.
Renshen Tang Formula: Renshen, Baizhu, Gancao, Ganjiang (each three liang).
Boil in eight sheng water to three sheng, take one sheng warm, three times daily.
Chest Yang deficiency attracting Lower Yin causes epigastric stuffiness. Stuffiness varies with Yang Qi fluctuations; abdominal fullness that decreases intermittently is a sign of stuffiness. Here, Qi lingers and knots in chest, causing constant fullness—this is stagnant Qi. Like cold clouds and fog lingering in the void, rising from epigastrium to occupy chest. Plus rebellious Qi from Liver/Gallbladder in hypochondrium seizing heart towards empty space. Although caused by chest Yang deficiency, filling agents are primary to subdue rebellious Yin. However, since Qi knots in chest like thieves occupying a city, sweeping methods must combine with pacification. Use Zhishi to disperse Qi and Houpo to open stuffiness as main herbs, boiled first to act like wind clearing fog. Then use acrid-warm Gancao-Guizhi to fill chest Yang and guide Qi, and sweet-cool Gualou to enter collaterals and resolve Bi, acting like counter-agents such as human urine or pig bile. Thus, stagnant Qi disperses, chest Yang restores, and rebellion calms without direct treatment. Long boiling of Zhishi/Houpo extracts heavy-turbid bitter flavors to drain Earth pathogens; brief boiling of Xiebai/Guizhi extracts light-clear warm Yang to connect with Heaven. Renshen Tang works because Renshen tonifies Qi, Baizhu fills chest, Ganjiang scatters knots and opens stuffiness, Gancao floats-slowly lifts, creating harmonious Qi in chest. Upward, it guides Yang to treat Bi; downward, it illuminates Yin to eliminate rebellion. It transforms stagnant Qi knotting like dancing with shield and feather. Some say former formula treats full syndrome, latter treats hypochondriac seizure; or latter is follow-up care. Both interpretations fit logic, so both are preserved for expert judgment.
Article 6 In Chest Bi, chest Qi obstruction and shortness of breath, treat with Fuling Xingren Gancao Tang. Ju Pi Zhishi Shengjiang Tang is also effective.
Formula: Fuling (three liang), Xingren (fifty kernels), Gancao (one liang).
Boil in ten sheng water to five sheng, take one sheng warm, three times daily. If not cured, continue. (Implies night doses missing).
Ju Pi Zhishi Shengjiang Tang Formula: Ju Pi (one jin), Zhishi (three liang), Shengjiang (half jin).
Boil in five sheng water to two sheng, divide into two warm doses.
Upper deficiency in Chest Bi with Middle/Lower rebellious pathogens involves Dampness and Cold. Lung dislikes Dampness and Cold; Dampness stagnates Lung, Cold contracts Lung, both causing pain in diaphragmatic Bi and Qi obstruction/shortness. For upward-rebellious Dampness, use warm-drying Fuling as chief, assist with Xingren to benefit Lung orifices, and floating-slow Gancao to lift and retain, resolving Dampness and stagnation to cure obstruction/shortness. Hence, it is chief. For upward-rebellious Cold, use acrid-warm Ju Pi as chief; warmth warms diaphragm, acridity scatters knots. Shengjiang dispels cold, stops rebellion, and is diffusing; combined with sharp Ju Pi, creates gentle breeze and fresh air. Assist with Zhishi to break stagnant Qi, resolving Cold and unblocking Lung to cure obstruction/shortness. Hence, "also effective." Both formulas address slight Wiry (Excess/Deficiency balance).
Article 7 In Chest Bi, alternating severity, treat with Yiyi Fuzi San.
Formula: Yiyiren (fifteen liang), Da Fuzi (ten pieces, processed).
Pound into powder, take one fangcun bi, three times daily.
This combines symptoms and formulas of previous articles. "Alternating severity" covers all Chest Bi symptoms: panting, coughing, spitting, back pain, shortness of breath, inability to lie flat, varying in intensity. This is due to Guest Dampness/Cold in Spleen/Stomach surging up and sinking down. Yin-Yang Five Elements undergo growth, support, imprisonment, and decline transformations. Human organs mirror heaven and earth. When Fire/Earth Qi declines, Water/Wood become demons; supported by Bing/Ding/Wu/Ji (Fire/Earth), they hold; strengthened by Ren/Gui/Jia/Yi (Water/Wood), they intensify. Holding brings缓 (slowness/mildness); intensifying brings ji (urgency/severity). Also, Dampness infiltrates slowly; Cold forces urgently. Damp harm is slower; Cold harm is faster. Thus, Bi symptoms vary in severity due to Damp-Cold in Middle Jiao peeking at Chest Yang cycles, invading alternately. Use Yiyi for damp-draining (meaning of Fuling Xingren Gancao Tang) and Fuzi for warming-middle-moving-Yang (meaning of Ju Pi Zhishi Shengjiang Tang), enhancing them. Powdering and consuming dregs retains them in Stomach; after Damp-Cold leaves, dry-warm transformation floats to Tai Xu, filling chest and penetrating collaterals to cure Bi. Though seemingly focusing only on Yin-Wiry pulse (attacking bandits), after pacification, Yang Qi revives greatly, celebrating peace through court (tonifying Zheng). Ah, how divine!
Article 8 Epigastric stuffiness, various rebellions, hanging heart pain, treat with Guizhi Shengjiang Zhishi Tang.
Formula: Guizhi, Shengjiang (each three liang), Zhishi (five pieces).
Boil in six sheng water to three sheng, divide into three warm doses.
Stuffiness and rebellions due to chest Yang deficiency are detailed earlier. Heart feels supported because True Qi permeates it. Upper True Qi deficiency leaves Heart unsupported, feeling suspended—hence "hanging heart." Chest is Yang position; Yin pathogen lodging makes Yin-Yin incompatible, causing Yin infiltration pain—hence "hanging heart pain." Use acrid-warm Guizhi/Shengjiang to fill True Qi treating heart suspension; use bitter-warm Zhishi to open stuffiness breaking stagnant Qi treating pain. Generally, this modifies the intent of Article 5's Zhishi Xiebai Tang. This and next two articles expand on Chest Bi symptoms. While Chest Bi warrants this formula, do not rigidly stick to Chest Bi; any case of upper deficiency with lower Qi rebelling and lingering warrants it. Hence, no "Chest Bi" prefix, just "various rebellions."
Article 9 Heart pain radiating to back, back pain radiating to heart, treat with Wutou Chishizhi Wan.
Formula: Wutou (one fen, processed), Chishizhi (one liang), Fuzi (half liang, processed), Ganjiang (one liang), Shujiao (one liang).
Powder the five ingredients, honey-pill like wu zi size. Take one pill before meals. If no effect after three doses, slightly increase dosage. (One pill may be error).
Carefully analyzing symptoms/treatment, pulse should be Yang Micro Yin Wiry. Micro is in Cunkou; Wiry should be in Chi below Guan. True Yang in chest-heart is root of exterior Wei Qi and master of Middle/Lower Jiao. Upper True Yang deficiency allows Stomach/Spleen pathogens to invade nearby, causing Articles 4-7 symptoms. Kidney is Yang-Zang; Liver is under Extreme Yin. Their deficiency-cold is like barbarians from Wu-Chu invading declining Zhou royal house. However, Liver-Kidney Yin pathogen encroachment is worse than Central Plains rebellion. Thus, heart pain radiating to back matches Article 4, but with internal chest Yang deficit, thin Wei Qi, cold entering from back, and Lower Yin rebellion penetrating Bi, similar types resonate, causing back pain radiating inward to heart. San Jiao transformation generates Yang from bottom via Mingmen heat steaming grain/water into fierce Qi, misting up to store as Chest Yang. Since this syndrome belongs to Lower Jiao cold rebellion, warming Lower to warm Upper is essential. Use Wutou's old-Yang to strengthen Pre-heaven Yuan Qi; Fuzi's born-Yang to emit Post-heaven transformation Qi; Shujiao's acrid-astringent to supplement and seal Yang; Ganjiang's acrid-dispersive to plant root and lift. Combine with heavy-aroma red-colored Chishizhi marrow as messenger. Heavy-aroma descends easily; red favors Yin-Zang. Marrow enters essence-blood to warm origin of creation. Pills differ from decoctions/powders limited to Upper/Middle Jiao...