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。
茯苓三两 杏仁五十个 甘草一两
以上三味药，用水一斗，煎煮至五升，每次温服一升，每日服用三次，若病未愈可继续服用。
橘皮一筋 枳实三两 生姜半筋
以上三味药，用水五升，煎煮至二升，分两次温服。
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胸痹（胸部闷痛窒塞的病证），心中痞塞不通感，气结聚于胸部，胸部胀满，□下（指心窝部或胃脘部）之气上逆冲撞心胸，应以枳实薤白桂枝汤为主治方剂，人参汤也可主治。
【注】
“心中”，即指心下（胃脘部）。胸痹病出现心下痞塞不通、胸闷而不通畅的症状属于虚证。如果病位不在心下，而是气结聚在胸部，胸部胀满连及□下，气逆冲撞心脏的属于实证。实证用枳实薤白桂枝汤主治，重用枳实、厚朴，是以破气降逆为主要作用。虚证用人参汤主治（即理中汤），是以温中补气为主要作用。由此可知疼痛也有补法，体现了“塞因塞用”（以补开塞）的治疗原则。
【集注】
魏荔彤说：胸痹本身就是阳气微弱、阴寒盛行的病证，心中痞塞不通，气结聚在胸部，正是胸痹的典型症状。再加上□下的气全部上逆冲撞心脏，这是痰饮和水气乘阴寒之邪而动，向上逆行，导致胸胃的阳气完全难以抵御。所以使用枳实薤白桂枝汤，通行阳气、开通郁结、温中降气。还必须采用先煎后下的炮制方法，以融合药物的气味，使药力缓缓荡除结聚的邪气。或者如果虚寒非常严重，不敢肆意使用攻破药物时，所以人参汤也主治，用以温补阳气，使正气旺盛而邪气自然消除。
尤怡说：心中痞塞不通，是气机痹阻而成痞。□下之气上逆冲撞心脏，气逆不降，将成为伤害中焦的因素。使用这两个方剂，一个是为了祛除邪气的实滞，从而安定正气；一个是为了养护阳气的虚弱，从而驱逐阴寒，这取决于审察疾病的久新以及气机的虚实来决定选用哪个方子。
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.