房侄 舌下地丁左畔略肿，诵读劳倦则发渴颊红，脘闷痰稠，呼吸不利，脉沉少力，或进寒凉药，腹痛
食减。此素廪阴气不足，神劳则五志火动，脾气困倦，故痰气壅而成痹也。经言一阴一阳结谓之喉痹，一
阴少阴君火也，一阳少阳相火也，二经之脉，夹咽循喉，火动痰升，结而不散，其源总由肾阴素虚，水不制火
使然。用六味丸。熟地（砂仁末拌蒸）、丹皮（酒炒）、加参、麦、贝、膝、藕粉蜜丸。服而平。
尹氏 久患梅核，气塞如梗，妨咽不利，非火非痰，乃气郁为患。用郁金、木香、贝母、桔梗、陈皮、
栝蒌皮、甘草，数服效。
胸痹，胸中阳微不运，久则阴乘阳位而为痹结也。其症胸满喘息，短气不利，痛引心背，由胸中阳气不舒，
浊阴得以上逆，
而阻其升降，甚则气结咳唾，胸痛彻背。夫诸阳受气于胸中，必胸次空旷，而后清气转运，布息展舒。胸
痹之脉，阳微阴弦，阳微知在上焦，阴弦则为心痛，此《金匮》、《千金》均以通阳主治也。《金匮》云∶
胸痹喘息，咳唾，胸背痛，短气，寸口脉沉迟，关上小紧数，栝蒌薤白白酒汤。胸痹不得卧，心痛彻背，栝蒌
薤白半夏汤。胸痹气急胸满，胁下逆抢心，枳实薤白桂枝汤。胸痹气塞短气，茯苓杏甘汤、橘枳生姜汤。
胸痹缓急者，薏苡附子散。心中痞，诸逆，心悬痛，桂枝姜枳汤。心痛彻背，背痛彻心，乌头赤石脂丸。《千金》
治胸痹达背痛，细辛散。胸中逆气，心痛彻背，少气不食，前胡汤。胸中满，噎塞，喉燥唾沫，橘枳生姜汤。
不应，治中汤。胸背闭满，上气喘急，下气汤。胸背疼痛，熨背散。大约阳微者用甘温，苓桂术甘汤。阴凝者
用温通，理中汤。饮逆者用辛泄，吴茱萸汤。痞阻者用辛滑，栝蒌薤白半夏汤。喘逆者用苦降，桂枝加朴杏汤。
痹久者兼通络，旋复花汤。只在旋转上焦清阳，疏利膈间痰气，不与胸痞结胸等症混治，则得之矣。
喻嘉言曰∶胸中阳气，如离照当空，旷然无外，设地气一上，则窒塞有加。故知胸痹者，阳气不用，阴气
上逆之候也。然有微甚不同，微者但通其不足之阳于上焦；甚者必驱其厥逆之阴于下焦。仲景通胸中之阳，
以薤白、白酒，或栝蒌、半夏、桂枝、枳实、浓朴、干姜、白术、人参、甘草、茯苓、杏仁、橘皮。选用对症，
三四味即成一方，不但苦寒尽屏，即清凉不入，盖以阳通阳，阴药不得预也。甚者用附子、乌头、川椒。
大辛热以驱下焦之阴，而复上焦之阳，补天浴日，独出手眼。世医不知胸痹为何病，习用豆蔻、木香、诃子、
三棱、神曲、麦芽等药，坐耗其胸中之阳，其识见亦相悬哉。
房姓侄子舌下左侧略见肿胀，因诵读导致劳倦时便出现口渴、面颊发红，胃脘部闷胀、痰液黏稠，呼吸不畅，脉象沉而无力。若服用寒凉药物，则会出现腹痛、食欲减退。此人身素来禀赋阴气不足，神思劳损则五志之火妄动，脾气困倦，因此痰气壅滞而成胸痹。《内经》说：“一阴一阳结，谓之喉痹。”一阴指少阴君火，一阳指少阳相火，这两条经脉的循行路线夹着咽喉、沿着喉咙。火热妄动，痰随火升，凝结不散，其根源总由肾阴素虚，水不能制约火所致。使用六味地黄丸治疗。处方：熟地黄（用砂仁末拌和后蒸制）、牡丹皮（酒炒）、加人参、麦冬、贝母、牛膝，制成藕粉蜜丸。服用后病情平息。
尹氏长期患有梅核气，感觉气塞如异物梗阻，妨碍吞咽不利。这不是火邪也不是痰浊，而是气机郁结为患。使用郁金、木香、贝母、桔梗、陈皮、瓜蒌皮、甘草，服用几剂后见效。
胸痹，是由于胸中阳气微弱不能运化，日久则阴邪乘袭阳位而形成痹结。其症状表现为胸部满闷、喘息、短气不利，疼痛牵引心背。这是由于胸中阳气不舒展，浊阴之气得以向上逆行，阻碍了气机的升降，严重时出现气结、咳嗽吐涎沫，胸痛彻背。凡是诸阳之气受气于胸中，必须胸次空旷，然后清气才能转运，呼吸舒展。胸痹的脉象，寸脉微、尺脉弦，寸脉微说明病在上焦，尺脉弦则主心痛，《金匮要略》和《千金方》都以通阳作为主治原则。《金匮要略》记载：胸痹伴有喘息、咳嗽吐涎沫、胸背痛、短气，寸口脉沉迟，关上脉小紧数，用栝蒌薤白白酒汤治疗。胸痹不能平卧，心痛彻背，用栝蒌薤白半夏汤治疗。胸痹气急、胸部满闷，胁下有气逆上抢心，用枳实薤白桂枝汤治疗。胸痹气塞、短气，用茯苓杏仁甘草汤、橘皮枳实生姜汤治疗。胸痹发作有时缓解有时紧急的，用薏苡附子散治疗。心中痞塞，各种逆气上冲，心脏悬痛，用桂枝生姜枳实汤治疗。心痛彻背，背痛彻心，用乌头赤石脂丸治疗。《千金方》治疗胸痹牵连背部疼痛，用细辛散。胸中逆气，心痛彻背，少气不想进食，用前胡汤治疗。胸中满闷，噎塞，喉咙干燥唾沫多，用橘皮枳实生姜汤治疗。无效者，用治中汤治疗。胸背闭满，上气喘急，用下气汤治疗。胸背疼痛，用熨背散外敷。大抵阳气微弱的用甘温法，如苓桂术甘汤。阴凝严重的用温通法，如理中汤。饮邪上逆的用辛泄法，如吴茱萸汤。痞阻严重的用辛滑法，如栝蒌薤白半夏汤。喘逆严重的用苦降法，如桂枝加厚朴杏子汤。痹症日久兼有络脉不通的，用旋覆花汤治疗。关键在于旋转上焦清阳，疏利膈间痰气，不与胸痞、结胸等病症混淆治疗，就能掌握要领了。
喻嘉言说：“胸中阳气，如同太阳当空照耀，旷然无外，如果地气一旦上升，就会更加窒塞。所以知道胸痹是阳气不用、阴气上逆的证候。然而有轻重不同，轻的只需通补上焦不足的阳气；重的必须驱除下焦厥逆的阴气。张仲景通胸中之阳，选用薤白、白酒，或栝蒌、半夏、桂枝、枳实、厚朴、干姜、白术、人参、甘草、茯苓、杏仁、橘皮。对症选用，三四味药即成一方，不但摒弃苦寒之品，连清凉药也不用，因为是以阳通阳，阴药不得参与。重的用附子、乌头、川椒等大辛热之品以驱除下焦之阴，恢复上焦之阳，犹如补天浴日，独具匠心。世俗医生不知道胸痹是什么病，习惯使用豆蔻、木香、诃子、三棱、神曲、麦芽等药物，白白耗损胸中的阳气，他们的见识相差太远了。”
The patient, a nephew of the Fang family, presented with slight swelling on the left side under the tongue. Fatigue from reading and reciting triggered thirst and facial flushing, epigastric fullness, thick phlegm, and dyspnea. The pulse was deep and weak. Administration of cold-natured herbs resulted in abdominal pain and reduced appetite. This condition stems from a constitutional deficiency of Yin Qi (Vital Energy). Mental exertion stirs up the Fire of the Five Emotions (Wu Zhi), leading to Spleen Qi fatigue; thus, Phlegm and Qi stagnate to form Bi Syndrome (Obstruction). The Classics state: "When one Yin and one Yang knot together, it is called Hou Bi (Throat Obstruction)." One Yin refers to Shao Yin Jun Huo (Ministerial Fire of the Heart/Kidney system), and one Yang refers to Shao Yang Xiang Huo (Ministerial Fire of the San Jiao/Gallbladder system). The meridians of these two channels run alongside the throat. When Fire moves and Phlegm rises, they knot and do not disperse. The root cause lies in the inherent deficiency of Kidney Yin, where Water fails to control Fire. Treatment utilized Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill). The prescription included Shu Di Huang (Prepared Rehmannia Root, steamed with Amomum powder), Mu Dan Pi (Moutan Bark, stir-fried with wine), Ren Shen (Ginseng), Mai Dong (Ophiopogon Tuber), Bei Mu (Fritillaria Bulb), Niu Xi (Achyranthes Root), formulated into pills with Lotus Root Powder and Honey. The condition subsided after administration.
Ms. Yin suffered for a long time from Mei He Qi (Plum-pit Qi), feeling as if Qi were blocked like a foreign object obstructing the throat, causing difficulty in swallowing. This was neither due to Fire nor Phlegm, but caused by Qi Stagnation (Qi Yu). Treatment employed Yu Jin (Curcuma Aromatica Rhizome), Mu Xiang (Aucklandiae Radix), Bei Mu (Fritillaria Bulb), Jie Geng (Platycodon Root), Chen Pi (Citrus Reticulata Peel), Gua Lou Pi (Trichosanthes Peel), and Gan Cao (Licorice Root). Several doses yielded effective results.
Xiong Bi (Chest Bi) occurs when Yang Qi in the chest is weak and fails to circulate; over time, Yin pathogens invade the Yang position, forming obstruction. Symptoms include chest fullness, wheezing, shortness of breath, and pain radiating to the heart and back. This arises because Yang Qi in the chest is not free-flowing, allowing Turbid Yin to reverse upward, obstructing the ascending and descending mechanisms. In severe cases, Qi knots with coughing and spitting saliva, and chest pain penetrates to the back. All Yang Qi receives its energy in the chest; only when the chest cavity is spacious can Clear Qi circulate freely, allowing for smooth respiration. The pulse of Xiong Bi is characterized by a superficially weak (Yang micro) and deeply wiry (Yin string) quality. A weak superficial pulse indicates pathology in the Upper Jiao (Upper Burner); a wiry deep pulse indicates Heart Pain. Both *Jin Gui Yao Lue* (Essential Prescriptions from the Golden Cabinet) and *Qian Jin Fang* (Prescriptions Worth a Thousand Gold) advocate treating this primarily by unblocking Yang. *Jin Gui Yao Lue* states: For Xiong Bi with wheezing, coughing/spitting saliva, chest/back pain, and shortness of breath, where the cun pulse is deep/slow and the guan pulse is small/tight/rapid, use Gua Lou Xie Bai Bai Jiu Tang (Trichosanthes, Macrostemon, and White Wine Decoction). For Xiong Bi where the patient cannot lie flat, with heart pain penetrating to the back, use Gua Lou Xie Bai Ban Xia Tang (Trichosanthes, Macrostemon, and Pinellia Decoction). For Xiong Bi with急促 breathing and chest fullness, with Qi reversing from the hypochondrium to seize the heart, use Zhi Shi Xie Bai Gui Zhi Tang (Immature Bitter Orange, Macrostemon, and Cinnamon Twig Decoction). For Xiong Bi with Qi blockage and shortness of breath, use Fu Ling Xing Ren Gan Cao Tang (Poria, Apricot Seed, and Licorice Decoction) or Ju Pi Zhi Shi Sheng Jiang Tang (Tangerine Peel, Immature Bitter Orange, and Fresh Ginger Decoction). For Xiong Bi that alternates between relief and urgency, use Yi Yi Fu Zi San (Coix Seed and Aconite Powder). For central palpitations, various rebellious Qi, and hanging heart pain, use Gui Zhi Sheng Jiang Zhi Shi Tang (Cinnamon Twig, Fresh Ginger, and Immature Bitter Orange Decoction). For heart pain penetrating to the back and back pain penetrating to the heart, use Wu Tou Chi Shi Zhi Wan (Aconite and Red Stone Powder Pill). *Qian Jin Fang* treats Xiong Bi radiating to the back pain using Xi Xin San (Asarum Powder). For rebellious Qi in the chest, heart pain penetrating to the back, shortness of breath, and anorexia, use Qian Hu Tang (Peucedani Radix Decoction). For chest fullness, choking sensation, dry throat, and excessive saliva, use Ju Pi Zhi Shi Sheng Jiang Tang. If ineffective, treat with Zhi Zhong Tang (Regulate the Middle Decoction). For chest/back closure and fullness with upper asthma and急促 breathing, use Xia Qi Tang (Descend Qi Decoction). For chest/back pain, apply Yi Bei San (Back-Warming Powder externally). Generally, for weak Yang, use Sweet-Warm methods like Ling Gui Zhu Gan Tang (Poria, Cinnamon Twig, Atractylodes, and Licorice Decoction). For Yin condensation, use Warm-Unblocking methods like Li Zhong Tang (Regulate the Middle Decoction). For rebellious fluid retention, use Pungent-Draining methods like Wu Zhu Yu Tang (Evodia Decoction). For palpitation obstruction, use Pungent-Slippery methods like Gua Lou Xie Bai Ban Xia Tang. For rebellious wheezing, use Bitter-Descending methods like Gui Zhi Jia Hou Po Xing Zi Tang (Cinnamon Twig Decoction augmented with Magnolia Bark and Apricot Seed). For chronic Bi involving collateral obstruction, use Xuan Fu Hua Tang (Inula Flower Decoction). The key lies in rotating the Clear Yang of the Upper Jiao and venting Phlegm-Qi in the diaphragm, without confusing it with treatments for Chest Palpitation or Chest Binding syndromes.
Yu Jiayan stated: "Yang Qi in the chest is like the sun shining in the sky, vast and boundless. If Earthly Qi (Yin/Dampness) rises, obstruction increases. Thus, Xiong Bi is a syndrome of unused Yang Qi and rebellious Yin Qi." However, severity varies. Mild cases require only unblocking the deficient Yang in the Upper Jiao; severe cases require driving out the rebellious Yin from the Lower Jiao. Zhang Zhongjing unblocks Yang in the chest using Macrostemon and White Wine, or Trichosanthes, Pinellia, Cinnamon Twig, Immature Bitter Orange, Magnolia Bark, Dried Ginger, Atractylodes, Ginseng, Licorice, Poria, Apricot Seed, and Tangerine Peel. Selected according to symptoms, three or four ingredients form a prescription. Bitter-Cold herbs are entirely excluded, and even Cooling herbs are avoided, because Yang is used to unblock Yang, preventing Yin herbs from interfering. Severe cases utilize Aconite, Aconite Root (Chuan Wu/Cao Wu), and Sichuan Pepper—greatly pungent and hot—to drive out Lower Jiao Yin and restore Upper Jiao Yang, akin to 'repairing heaven and bathing the sun,' demonstrating unique expertise. Modern physicians, unaware of Xiong Bi, habitually use Cardamom, Aucklandia, Chebula, Bupleurum-like rhizomes (San Leng), Divine Leaven, and Malt, thereby wasting the Yang Qi in the chest. Their insight is vastly inferior.