（缺盆下曰胸。当与痹满门胸痹条参看。）
五脏及胆、心包络七经，筋脉俱至胸，是诸经之邪，皆得为胸痛。而胸者，肺之部分，则
其痛尤多属肺可知。乃医书多以肝病为言，此举隅之论耳，勿泥。须知胸为清阳之分，其病
也，气滞为多。（实亦滞，虚亦滞。）气滞则痰饮亦停，宜行气除饮，此治在肺分。肺主气，宜下降，
不宜上壅者也。（至气有余为火而属心，痰本于湿而属脾，其义可兼举矣。）若乃肝气实而
上冲，因载血以上，
或肝虚而清阳不升，浊阴不降，此则病在肝胆，痛必连胁矣。（至肝火之上炎。由肾水之竭，
肝气之虚寒，
由肾火之衰，亦可推。）治法于上下编参之。经云∶春脉如弦，其气不实而微，此谓不及，令人胸
痛引背，两胁胀满，此肝虚也，补肝汤。（见胁痛。）《金匮》肝中寒者，（此下有两臂不举，
舌本燥
七字，《医宗金鉴》谓是衍文，删之。）善太息，胸中痛，不得转侧，（则胁亦痛可知。）
食则吐，（肝性条
达，为寒所郁不得伸，故太息以舒之。食则吐者，气上逆也。）而汗出也。又云肝着，（气着
滞不行也。）常
欲蹈其胸，（蹈者，按摩之意。）先未苦时，但欲饮热，（寒则凝滞，热则流通，故喜饮热。）
旋复花汤主之。（方用旋复花三两，葱十四茎，新绛少许，水三升，煮一升，顿服。
《金鉴》谓与证不合，疑误。
愚谓此乃停饮，而阳气不宣，故用此逐饮通阳，加绛以和血也。）此肝实也。《素问》
曰∶阳明所谓
胸痛短气者，水气在脏腑也。轻者五苓散（见伤湿），重者用张子和法取之。木香、郁金
二味，气郁痛者倍木香，血郁痛者倍郁金，为末，每服二钱，老酒下，虚者加人参。
痰饮痛，轻者小陷胸汤，重者大陷胸丸治之。若痰唾稠粘者，则用控涎丹
（见痰饮。）
缺盆骨下方称为胸。（此处应与《痹满门》中关于“胸痹”的条目参考阅读。）
五脏以及胆、心包络这七条经脉，其筋脉都到达胸部，因此各经的病邪，都能导致胸痛。而胸是肺所主的部位，所以胸痛大多属于肺系疾病，这是显而易见的。然而医书中多以肝病来论述，这只是举隅（举例）的说法罢了，不要拘泥于此。须知胸是清阳分布的部位，其病变多因气机阻滞所致。（无论是实证还是虚证，本质都是气机滞涩。）气机阻滞则痰饮也会停聚，适宜采用行气除饮的方法治疗，这是针对肺分的治疗。肺主气，宜于肃降，不宜上逆壅塞。（至于气有余化为火而归属于心，痰源于湿而归属于脾，这些道理可以兼及考虑。）如果是肝气实盛而上冲，挟带血液上行；或者肝气虚弱导致清阳不升、浊阴不降，那么病就在肝胆，疼痛必定牵连胁部。（至于肝火上炎，是由于肾水枯竭所致；肝气的虚寒，是由于肾火衰微所致，这些也可以推演得知。）治疗方法可参考本书上下编的内容。《内经》说：春季的脉象如弦，如果脉气不实而微弱，这叫做“不及”，会导致人胸痛牵引背部，两胁胀满，这是肝虚的表现，应用补肝汤治疗。（见“胁痛”篇。）《金匮要略》中提到肝中寒证，（原文下有“两臂不举，舌本燥”七个字，《医宗金鉴》认为是衍文，将其删除。）患者喜欢长叹气，胸中疼痛，身体不能转动侧身，（由此可知胁部也疼痛。）进食后呕吐，（肝性喜条达舒畅，被寒邪郁遏而不能伸展，所以通过长叹气来舒缓它。进食后呕吐，是因为气机上逆。）并且出汗。又说肝着病，（指气机郁滞不行。）患者常希望别人踩踏或按摩他的胸部，（“蹈”的意思是按摩。）在尚未感到痛苦之前，只想喝热饮，（寒邪则凝滞，热邪则流通，所以喜欢喝热饮。）用旋复花汤主治。（方剂组成：旋复花三两，葱十四茎，新绛少许，水三升，煮取一升，一次性服用。《医宗金鉴》认为此方与证候不合，怀疑有误。我认为这是停饮而阳气不宣通，所以用此方逐饮通阳，加入绛色药以调和血液。）这是肝实证。《素问》说：阳明经所说的胸痛短气，是水气停留在脏腑之中。轻症用五苓散治疗（见“伤湿”篇），重症用张子和的方法攻下。木香、郁金两味药，气郁疼痛者加倍使用木香，血郁疼痛者加倍使用郁金，研为细末，每次服用二钱，老酒送服，体虚者加人参。痰饮疼痛，轻症用小陷胸汤，重症用大陷胸丸治疗。如果痰唾稠厚粘腻的，则用控涎丹治疗（见“痰饮”篇）。
The area below the supraclavicular fossa is called the chest. (This should be read in conjunction with the section on "Chest Bi" [Xiong Bi] in the chapter on Bi and Fullness.)
The meridians of the five Zang organs, along with the Gallbladder and Pericardium, totaling seven meridians, all have their sinews and vessels reaching the chest. Therefore, pathogenic factors from any of these meridians can cause chest pain. Since the chest is the domain governed by the Lung, it is evident that most chest pain belongs to Lung-related conditions. However, medical texts often discuss this in terms of Liver disease; this is merely an illustrative example, so do not adhere rigidly to it. It must be understood that the chest is the region where Clear Yang distributes. Its pathology is mostly due to Qi stagnation. (Whether excess or deficiency, the underlying mechanism is stagnation.) When Qi stagnates, Phlegm and Fluid retention also accumulate. The appropriate treatment is to move Qi and eliminate fluids, which addresses the Lung aspect. The Lung governs Qi and prefers descending; it should not allow upward congestion. (Regarding Qi excess transforming into Fire belonging to the Heart, and Phlegm originating from Dampness belonging to the Spleen, these principles can be considered comprehensively.) If Liver Qi is excessive and rushes upward, carrying Blood with it, or if Liver Qi is deficient leading to failure of Clear Yang to ascend and Turbid Yin to descend, then the disease lies in the Liver and Gallbladder, and the pain will necessarily radiate to the hypochondrium. (Regarding Liver Fire flaming upward, caused by exhaustion of Kidney Water; or Liver Qi deficiency and cold, caused by decline of Kidney Fire, these can also be deduced.) Treatment methods can be referred to in the upper and lower volumes of this book. The Classics state: "In spring, the pulse resembles a string. If the Qi is not solid but faint, this is called 'insufficiency,' causing chest pain radiating to the back and fullness in both hypochondria; this is Liver deficiency, treated with Bu Gan Tang [Liver Tonifying Decoction]." (See "Hypochondriac Pain.") *Jin Gui Yao Lue* states that for Liver Cold, (the original text has seven characters below: "arms cannot be raised, tongue base is dry"; *Yi Zong Jin Jian* considers these interpolations and deletes them.) patients sigh frequently, experience chest pain and inability to turn or side-bend, (from which it can be known that the hypochondrium also hurts,) vomit after eating, (the Liver nature prefers free flow; constrained by Cold and unable to extend, it sighs to relieve itself. Vomiting after eating is due to rebellious Qi rising,) and sweat occurs. It is also stated regarding Liver Stasis (Qi stagnation and failure to circulate), patients often desire someone to tread upon or massage their chest. ("Tread" here means massage.) Before suffering significantly, they only desire to drink hot liquids. (Cold causes stagnation, Heat promotes circulation, hence the preference for hot drinks.) This is primarily treated with Xuan Fu Hua Tang [Inula Flower Decoction]. (Formula composition: Xuan Huahua 3 liang, Scallion stems 14, Xin Jiang [Safflower/Red Dye] a small amount, water 3 sheng, boiled down to 1 sheng, taken at once. *Yi Zong Jin Jian* argues this formula does not match the syndrome and suspects error. I believe this is Fluid retention with obstruction of Yang Qi, thus using this formula to expel fluid and unblock Yang, adding red dye to harmonize Blood.) This represents Liver Excess. *Su Wen* states: "What Yangming refers to as chest pain and shortness of breath is Water Qi residing in the Zang-Fu." For mild cases, Wu Ling San [Five-Ingredient Poria Pill] is used (see "Damage by Dampness"); for severe cases, the method of Zhang Zihe is employed to purge. For Mu Xiang [Aucklandiae Radix] and Yu Jin [Curcumae Longae Rhizoma], if the pain is due to Qi stagnation, double the Mu Xiang; if due to Blood stagnation, double the Yu Jin. Grind into powder, take 2 qian per dose, washed down with aged wine; add Ren Shen [Ginseng Radix] for deficiency. For Phlegm-Fluid pain, mild cases are treated with Xiao Xian Xiong Tang [Minor Inhibiting Chest Decoction], and severe cases with Da Xian Xiong Wan [Major Inhibiting Chest Pill]. If the phlegm-saliva is thick and sticky, Kong Yan Dan [Controlling Saliva Pill] is used (see "Phlegm-Fluid").