秦子曰∶胸与膈,肺之分野,膈痛胸痛两症也。但胸痛止在中间,膈痛则连两腋,故歧
骨之上作痛,乃为胸痛;若痛在胸之下,即名胃痛;若胸中满塞而不痛,又名胸痞;若胸中
满塞,水谷全不能下,又名胸痹,皆非胸痛也。或痛久不散,每夜寒热,按之愈痛,视之有
形,此又是内痈之症,而非胸痛矣。
【外感胸痛之症】初起表邪未散,下早闷痛,此伤寒门结胸症也。胸痛胀满,咳嗽气
逆,不能仰卧,此六淫之邪,伤于肺经,方书所谓肺胀胸痛也。若胸痛寒热,咳吐腥秽,又是肺
【外感胸痛之因】伤寒表邪未散,下之太早,内陷胸中,盖胸主半表半里,外邪内陷
,与
【外感胸痛之脉】沉紧而劲,下后作痛,结胸之症。脉来浮大,胸痛身热,支结之别
。寸口浮大,风热肺逆。寸口脉实,脉痈之疾。
【外感胸痛之治】伤寒误下已成结胸者,宜大、小陷胸汤出入加减;若未成结胸者,
壳汤治之;若肺痈风热者,加味泻白散;肺气壅寒,枳桔二母汤;肺痈作痛,桔梗汤、栝蒌
大陷胸汤
大黄 芒硝 甘遂
小陷胸汤
黄连 半夏 栝蒌
加味泻白散 治风热伤肺。
桑白皮 地骨皮 甘草 防风 荆芥
热甚,加石膏、知母。
枳桔二母汤 清理肺气,兼消痰水。
枳壳 知母 川贝母 栝蒌仁 苏子 桔梗
桔梗汤 治肺痈肺 。
川贝母 薏苡仁 桑白皮 地骨皮 葶苈子 枳壳 桔梗 杏仁 甘草
栝蒌汤 通治肺胃之痈。
栝蒌仁一个,去皮,炒黑,研,甘草同煎服。
秦氏说:胸部和膈部,是肺经所主的区域,膈痛和胸痛是两种不同的病症。但是胸痛仅位于身体正中间,膈痛则牵连到两侧腋下,所以在歧骨(胸剑联合)之上疼痛,才称为胸痛;如果疼痛在胸部下方,就命名为胃痛;如果胸中胀满堵塞但不疼痛,又叫做胸痞;如果胸中胀满堵塞,水谷完全不能吞咽下行,又叫做胸痹,这些都不是胸痛。或者疼痛日久不消散,每晚出现寒热往来,按压时疼痛加剧,外观可见肿胀有形,这又是内痈的病症,而不是胸痛了。
【外感胸痛的症候】初起时表邪尚未解散,因过早使用攻下法导致闷痛,这是伤寒门中的结胸症。胸痛且胀满,咳嗽气逆,不能仰卧,这是六淫之邪损伤肺经,方书中所谓的肺胀胸痛。若胸痛伴有寒热,咳吐腥臭秽浊之物,这又是肺痈的症状。
【外感胸痛的病因】伤寒表邪未散,攻下太早,邪气内陷于胸中。因为胸主半表半里,外邪内陷……
【外感胸痛的脉象】脉象沉紧而有力,攻下后出现疼痛,是结胸症的脉象。脉来浮大,胸痛伴身热,是支结证的别类。寸口脉浮大,为风热肺逆。寸口脉实,是脉痈的疾病。
【外感胸痛的治法】伤寒误用攻下已成结胸者,宜在大、小陷胸汤基础上出入加减;若未成结胸者,用栝蒌汤治疗;若是肺痈风热者,用加味泻白散;肺气壅滞兼寒者,用枳桔二母汤;肺痈作痛者,用桔梗汤、栝蒌汤。
大陷胸汤:大黄、芒硝、甘遂。
小陷胸汤:黄连、半夏、栝蒌。
加味泻白散:治疗风热伤肺。桑白皮、地骨皮、甘草、防风、荆芥。热甚,加石膏、知母。
枳桔二母汤:清理肺气,兼消痰水。枳壳、知母、川贝母、栝蒌仁、苏子、桔梗。
桔梗汤:治疗肺痈肺脓。川贝母、薏苡仁、桑白皮、地骨皮、葶苈子、枳壳、桔梗、杏仁、甘草。
栝蒌汤:通治肺胃之痈。栝蒌仁一个,去皮,炒黑,研碎,与甘草同煎服。
Mr. Qin said: The chest and diaphragm are the domains governed by the Lung meridian; Diaphragm pain (pain in the diaphragm region) and Chest pain (pain in the chest region) are two distinct syndromes. However, chest pain is located only in the center, whereas diaphragm pain radiates to both axillae. Therefore, pain above the xiphoid process (the junction of the sternum and xiphoid cartilage) is termed chest pain; if the pain is below the chest, it is named stomach pain; if there is fullness and obstruction in the chest without pain, it is called chest stuffiness (chest痞); if there is fullness and obstruction in the chest such that food and drink cannot pass down at all, it is called chest bi (impediment syndrome). None of these are chest pain. Alternatively, if pain persists for a long time, accompanied by nightly alternating chills and fever, worsened by pressure, and visible swelling or deformity, this is a symptom of internal abscess (internal carbuncle), not chest pain.
[Symptoms of Exogenous Chest Pain] At the onset, when exterior pathogens have not yet dispersed, premature use of purgatives leads to stifling pain; this belongs to the Jie Xiong (Chest Binding) syndrome in the Treatise on Cold Damage. Chest pain with distension and fullness, coughing with rebellious Qi, and inability to lie supine, indicates injury to the Lung meridian by the six exogenous pathogenic factors (Six Evils), known in medical texts as Lung distension with chest pain. If chest pain is accompanied by chills and fever, and expectoration of foul-smelling, turbid sputum, this is another symptom of Lung abscess (Fei Yong).
[Etiology of Exogenous Chest Pain] When exterior pathogens of cold damage have not dispersed, and purgation is used too early, the pathogen sinks inward into the chest. Since the chest governs the half-exterior and half-interior, the exogenous pathogen sinking inward...
[Pulse of Exogenous Chest Pain] A deep, tight, and forceful pulse, with pain appearing after purgation, indicates the Jie Xiong (Chest Binding) syndrome. A floating and large pulse, with chest pain and body heat, indicates the Zhi Jie (Supporting Knot) pattern. A floating and large pulse at the Cun Kou (radial artery) indicates Wind-Heat with Lung rebellion. A solid pulse at the Cun Kou indicates Mai Yong (Pulse Abscess).
[Treatment of Exogenous Chest Pain] For cases where cold damage has been mistakenly treated with purgatives resulting in Jie Xiong (Chest Binding), Da Xian Xiong Tang (Major Yellow Decoction to Drain the Chest) or Xiao Xian Xiong Tang (Minor Yellow Decoction to Drain the Chest) should be used with modifications; if Jie Xiong has not yet formed, Gua Lou Tang (Trichosanthes Decoction) should be used; for Lung abscess due to Wind-Heat, Jia Wei Xie Bai San (Modified White-Draining Powder) is indicated; for Lung Qi stagnation with cold, Zhi Jiao Er Mu Tang (Aurantium and Two Mother Decoction) is used; for pain caused by Lung abscess, Jie Geng Tang (Platycodon Decoction) or Gua Lou Tang (Trichosanthes Decoction) are prescribed.
Da Xian Xiong Tang (Major Yellow Decoction to Drain the Chest): Da Huang (Rhei Radix et Rhizoma), Mang Xiao (Natrii Sulfas), Gan Sui (Kansui Radix).
Xiao Xian Xiong Tang (Minor Yellow Decoction to Drain the Chest): Huang Lian (Coptidis Rhizoma), Ban Xia (Pinelliae Tuber), Gua Lou (Trichosanthis Fructus).
Jia Wei Xie Bai San (Modified White-Draining Powder): Treats Wind-Heat injuring the Lung. Sang Bai Pi (Mori Cortex), Di Gu Pi (Lycii Cortex), Gan Cao (Glycyrrhizae Radix et Rhizoma), Fang Feng (Saposhnikoviae Radix), Jing Jie (Schizonepetae Spica). If heat is severe, add Shi Gao (Gypsum Fibrosum) and Zhi Mu (Anemarrhenae Rhizoma).
Zhi Jiao Er Mu Tang (Aurantium and Two Mother Decoction): Clears Lung Qi and resolves phlegm-fluids. Zhi Qiao (Aurantii Fructus), Zhi Mu (Anemarrhenae Rhizoma), Chuan Bei Mu (Fritillariae Cirrhosae Bulbus), Gua Lou Ren (Trichosanthis Semen), Su Zi (Perillae Fructus), Jie Geng (Platycodonis Radix).
Jie Geng Tang (Platycodon Decoction): Treats Lung abscess and pulmonary suppuration. Chuan Bei Mu (Fritillariae Cirrhosae Bulbus), Yi Yi Ren (Coicis Semen), Sang Bai Pi (Mori Cortex), Di Gu Pi (Lycii Cortex), Ting Li Zi (Lepidii Semen), Zhi Qiao (Aurantii Fructus), Jie Geng (Platycodonis Radix), Xing Ren (Armeniacae Semen Amarum), Gan Cao (Glycyrrhizae Radix et Rhizoma).
Gua Lou Tang (Trichosanthes Decoction): Universally treats Lung and Stomach abscesses. One Gua Lou Ren (Trichosanthis Semen), peeled, stir-fried until black, ground, and decocted together with Gan Cao (Glycyrrhizae Radix et Rhizoma) for oral administration.