茯苓半筋 桂枝四两 甘草（炙）二两 大枣十五枚
右四味，以甘澜水一斗，先煮茯苓，减二升，内诸药，煮取三升，去滓，温服一升，
日三服作甘澜水法：取水三升置大盆内，以杓扬之数千遍，水上有珠子五、六千颗相
逐，取用之。
【集解】
程林曰：汗后脐下悸者，阳气虚而肾邪上逆也。脐下为肾气发源之地，茯苓泄水以伐
肾邪，桂枝行阳以散逆气，甘草、大枣甘温助脾土以制肾水。煎用甘澜水者，扬之无
力，全无水性，取其不助肾邪也。
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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。
【注】
脉太过则病，不及亦病，故脉当取太过不及而候病也。阳微，寸口脉微也，阳得阴脉
为阳不及，上焦阳虚也。阴弦，尺中脉弦也，阴得阴脉为阴太过，下焦阴实也。凡阴
实之邪，皆得以上乘阳虚之胸，所以病胸痹心痛。胸痹之病轻者即今之胸满，重者即
今之胸痛也。
【集注】
李□曰：『内经』云：胃脉平者不可见，太过不及则病见矣。寸脉为阳，以候上焦，
正应胸中部分，若阳脉不及而微，则为阳虚，主病上焦，故受病胸痹。尺脉太过而弦
，则为阴盛，知在下焦，故上逆而为痛也。
尤怡曰：上焦为阳之位，而微脉为虚之甚，故曰责其极虚。
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平人无寒热，短气不足以息者，实也。
【注】
平人，无病之人也。无寒热，无表邪也。平人无故而有短气不足以息之证，不可责其
虚也，此必邪在胸中，痹而不通，阻碍呼吸，当责其实也。
【集注】
李□曰：上节云责其极虚，此又云实何也？经云：邪之所□，其气必虚，留而不去，
其病为实是也。然短气与少气有辨，少气者，气少不足于言，『内经』云：言而微，
终日乃复言者，此夺气是也。短气者，气短不能相续，似喘非喘，若有气上□，故似
喘而不摇肩，似呻吟而无痛是也。
尤怡曰：平人，素无疾之人也。无寒热，无新邪也。而乃短气不足以息，当是里气因
邪而实，或痰、或食、或饮，碍其升降之气而然也。
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胸痹之病，喘息欬唾，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。
【注】
寸口脉沉而迟，沉则为里气滞，迟则为藏内寒，主上焦藏寒气滞也。关上小紧而疾，
小为阳虚，紧疾寒痛，是主中焦气急寒痛也。胸背者，心肺之宫城也，阳气一虚，诸
寒阴邪，得以乘之，则胸背之气，痹而不通，轻者病满，重者病痛，理之必然也，喘
息、欬唾、短气证之必有也。主之以栝蒌薤白白酒汤者，用辛以开胸痹，用温以行阳
气也。
【集注】
赵良曰：凡寒浊之邪，滞于上焦，则阻其上下往来之气，塞其前后阴阳之位，遂令为
喘息，为欬唾、为痛、为短气也。
程林曰：胸中者，心肺之分，故作喘息欬唾也。诸阳受气于胸，而转行于背，气痹不
行，则胸背为痛，而气为短也。
茯苓半筋，桂枝四两，甘草（炙）二两，大枣十五枚。
以上四味药，用甘澜水一斗，先煮茯苓，水量减少二升后，加入其余药物，煎煮至取药液三升，滤去药渣，每次温服一升，每日服用三次。
制作甘澜水的方法：取三升水放入大盆中，用勺子反复扬动数千遍，直到水面上出现五、六千颗相互追逐的小水泡，即可取用。
【集解】
程林说：发汗之后出现脐下悸动，是因为阳气虚弱，导致肾邪上逆。脐下是肾气发源的地方，茯苓能泄水以祛除肾邪，桂枝能通行阳气以消散逆气，甘草和大枣味甘性温，能补益脾土以制约肾水。煎药时使用甘澜水，是因为经过扬动后水体无力，完全失去了水的本性，取其不助长肾邪的作用。
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老师说：脉象应当区分太过和不及，阳微阴弦，就会出现胸痹并伴有疼痛。之所以如此，责任在于上焦阳气极度虚弱。现在知道阳气虚损位于上焦，所以出现胸痹心痛，是因为下焦阴寒之邪盛实（表现为阴弦脉）的缘故。
【注】
脉象太过则生病，不及也会生病，所以诊脉时应当通过观察脉象的太过与不及来候察疾病。阳微，指的是寸口脉微弱，阳脉出现阴脉的特征属于阳不及，表示上焦阳气虚弱。阴弦，指的是尺中脉呈弦象，阴脉出现阴脉的特征属于阴太过，表示下焦阴寒实邪盛实。凡是阴寒实邪，都会乘袭上焦阳虚之处，从而导致胸痹心痛。胸痹病轻者相当于现在的胸闷，重者相当于现在的胸痛。
【集注】
李□说：《内经》记载：胃脉平和时不可见异常，如果太过或不及，病症就会显现。寸脉属阳，用以候察上焦，正对应胸中部位，如果阳脉不及而微弱，就是阳虚，主病在上焦，因此受病为胸痹。尺脉太过而呈弦象，就是阴盛，可知病在下焦，因此上逆而导致疼痛。
尤怡说：上焦是阳气所在的位置，而微脉代表极度的虚损，所以说责任在于极度的虚弱。
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平素健康的人没有恶寒发热等表证，却出现短气、呼吸不足的症状，这是实证。
【注】
平人，指没有疾病的人。无寒热，指没有表邪。平素健康的人无故出现短气、呼吸不足的证候，不能归咎于虚证，这一定是邪气停留在胸中，导致气机痹阻不通，阻碍了呼吸，应当归咎于实证。
【集注】
李□说：上一节说责任在于极度的虚弱，这一节又说属于实证，为什么呢？《经》云：邪气所停留的地方，正气必然虚弱；但如果邪气停留不去，病情就会转化为实证。然而短气与少气是有区别的，少气是指气少不足以说话，《内经》说：说话声音微弱，整天才能再说几句话，这是夺气的表现。短气是指气短不能接续，像喘但不是真正的喘，好像有气上冲，所以像喘但不摇动肩膀，像呻吟但没有疼痛。
尤怡说：平人，指平素没有疾病的人。无寒热，指没有新感的外邪。而出现短气、呼吸不足，应当是里气因为邪气而变得实滞，或者是痰、食积、水饮，阻碍了升降之气所致。
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胸痹病的症状包括喘息、咳嗽吐涎沫、胸背疼痛、短气，寸口脉沉而迟，关上脉小紧数，用栝蒌薤白白酒汤主治。
【注】
寸口脉沉而迟，沉表示里气滞涩，迟表示脏腑内有寒，主要指上焦脏寒气滞。关上脉小紧而疾，小表示阳气虚，紧疾表示寒痛，主要指中焦气急寒痛。胸背部是心肺所在的宫城，一旦阳气虚弱，各种寒湿阴邪就能乘虚侵袭，导致胸背之气痹阻不通，轻者表现为胀满，重者表现为疼痛，这是必然的道理，喘息、咳嗽吐涎沫、短气都是该病必然伴随的症状。使用栝蒌薤白白酒汤主治，是利用辛味药来开通胸痹，利用温性药来运行阳气。
【集注】
赵良说：凡是寒浊邪气，停滞在上焦，就会阻碍上下往来的气机，堵塞前后阴阳的位置，于是导致喘息、咳嗽吐涎沫、疼痛、短气等症状。
程林说：胸中是心肺的分野，所以会出现喘息、咳嗽吐涎沫。诸阳之气受气于胸中，而转行于背部，气机痹阻不行，就会导致胸背疼痛，气息短促。
Fuling (Poria) Ban Jin, Guizhi (Cinnamon Twig) 4 Liang, Gancao (Licorice Root, roasted) 2 Liang, Dazao (Jujube Fruit) 15 pieces.
The above four ingredients are decocted with one dou of Ganlan Shui (Ganlan Water). First, boil Fuling until the liquid reduces by two sheng, then add the remaining herbs. Decoct to obtain three sheng of liquid, strain out the dregs, and take one sheng warm per dose, three times a day.
Method for preparing Ganlan Shui: Take three sheng of water and place it in a large basin. Use a ladle to splash and stir the water thousands of times until five or six thousand small bubbles appear on the surface chasing each other. This water is then used.
[Ji Jie]
Cheng Lin stated: Palpitations below the umbilicus after sweating indicate deficiency of Yang Qi and counterflow of Kidney pathogenic factors. The area below the umbilicus is the source of Kidney Qi. Fuling drains dampness to attack the Kidney pathogen; Guizhi promotes Yang circulation to dissipate counterflowing Qi; Gancao and Dazao, being sweet and warm, strengthen Spleen Earth to control Kidney Water. Using Ganlan Shui for decoction works because the splashing renders the water powerless and devoid of its natural fluid nature, thus preventing it from assisting the Kidney pathogen.
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The Master said: Pulse diagnosis should assess excess (Tai Guo) and deficiency (Bu Ji). Yang Wei (deficient Yang pulse) and Yin Xian (wiry Yin pulse) indicate Xiong Bi (Chest Bi syndrome) accompanied by pain. This occurs because of extreme deficiency [of Upper Jiao Yang]. Now that we know Yang deficiency is located in the Upper Jiao, the reason for Xiong Bi and heart pain lies in the presence of Yin Xian [indicating Lower Jiao excess cold].
[Note]
An excessive pulse indicates disease, and a deficient pulse also indicates disease; therefore, pulse diagnosis must evaluate both excess and deficiency to ascertain the pathology. Yang Wei refers to a faint pulse at the Cun Kou (inch position), where the Yang position presents a Yin pulse character, indicating insufficient Yang and deficiency of Upper Jiao Yang. Yin Xian refers to a wiry pulse at the Chi position, where the Yin position presents a Yin pulse character, indicating excessive Yin and excess cold in the Lower Jiao. Any Yin excess pathogen will ascend to invade the Yang-deficient chest, resulting in Xiong Bi and heart pain. Mild cases of Xiong Bi correspond to modern chest fullness, while severe cases correspond to modern chest pain.
[Ji Zhu]
Li [Name obscured] stated: The "Nei Jing" (Inner Canon) says: A healthy Stomach pulse shows no abnormalities; only when there is excess or deficiency do pathological signs appear. The Cun pulse belongs to Yang and observes the Upper Jiao, corresponding to the chest region. If the Yang pulse is deficient and faint, it indicates Yang deficiency and disease in the Upper Jiao, hence suffering from Xiong Bi. The Chi pulse is excessive and wiry, indicating Yin excess known to be in the Lower Jiao, which then ascends to cause pain.
You Yi stated: The Upper Jiao is the domain of Yang, and the faint pulse represents extreme deficiency; thus, it is attributed to extreme deficiency.
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A healthy person without chills or fever who suffers from shortness of breath and inability to breathe fully has an Excess pattern.
[Note]
Ping Ren refers to a person free of disease. Wu Han Re means absence of exterior pathogens. When a healthy person inexplicably presents with shortness of breath and respiratory insufficiency, it should not be attributed to deficiency. Rather, this is caused by pathogenic factors lodged in the chest, causing Bi obstruction and impeding respiration; thus, it must be attributed to Excess.
[Ji Zhu]
Li [Name obscured] stated: The previous section attributed the condition to extreme deficiency, while this section attributes it to Excess. Why? The Classics state: Where pathogenic factors reside, Zheng Qi (Upright Qi) must be deficient; if the pathogen remains and does not depart, the condition becomes Excess. However, Duan Qi (shortness of breath) differs from Shao Qi (insufficient Qi). Shao Qi refers to having too little Qi to speak; the "Nei Jing" states: Speaking weakly and only speaking again after a whole day indicates loss of Qi. Duan Qi refers to Qi being too short to continue, resembling panting but not true panting, as if Qi is rushing upward; thus, it resembles panting without shoulder movement, and resembles groaning without pain.
You Yi stated: Ping Ren refers to someone usually free of illness. Wu Han Re means no new external pathogens. Shortness of breath and inability to breathe fully suggest that Interior Qi has become Excess due to pathogens, or that Phlegm, Food stagnation, or Fluid retention is obstructing the ascending and descending movements of Qi.
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Xiong Bi syndrome manifests with wheezing, coughing and spitting saliva, chest and back pain, and shortness of breath. The Cun Kou pulse is Chen (deep) and Chi (slow), and the Guan position pulse is Xiao Jin Shu (small, wiry, and rapid). It is treated with Gualou Xiebai Baijiu Tang (Trichosanthes Radix, Macrostemon Rhizome, and White Wine Decoction).
[Note]
A deep and slow pulse at the Cun Kou indicates stagnation of Interior Qi and Cold within the Zang organs, primarily reflecting Cold Qi stagnation in the Upper Jiao. A small, wiry, and rapid pulse at the Guan position indicates Yang deficiency (small) and Cold pain (wiry/rapid), primarily reflecting acute Qi stagnation and Cold pain in the Middle Jiao. The chest and back are the palaces of the Heart and Lungs. Once Yang Qi is deficient, various Cold and Yin pathogens can invade, causing Bi obstruction of Qi in the chest and back. Mild cases present as fullness, severe cases as pain; this is inevitable. Wheezing, coughing with sputum, and shortness of breath are necessary accompanying symptoms. Gualou Xiebai Baijiu Tang is used because its acrid nature opens Xiong Bi, and its warm nature promotes Yang Qi circulation.
[Ji Zhu]
Zhao Liang stated: When Cold-Turbid pathogens stagnate in the Upper Jiao, they obstruct the ascending and descending Qi flow and block the positions of Front-Back and Yin-Yang, leading to wheezing, coughing with sputum, pain, and shortness of breath.
Cheng Lin stated: The chest is the domain of the Heart and Lungs, hence wheezing and coughing occur. All Yang Qi receives energy in the chest and circulates through the back. When Qi is Bi-obstructed and fails to move, it causes chest and back pain and shortness of breath.