（论见前胁满痛条内兼胁病者已前见）
太阳 太阳与阳明合病喘而胸满者不可下宜麻黄汤（阳受气于胸中喘而胸满者阳气不宣发壅而逆也心下满腹满皆为
实当下之此以为胸满非里实故不可下虽有阳明然与太阳合病为属表是与麻黄汤发汗）发汗若下之而烦热胸中窒者栀子豉
汤（阳受气于胸中发汗若下使阳气不足邪热客于胸中结而不散故烦热而胸中窒塞与栀子豉汤以吐胸中之邪）病如桂枝证
头不痛项不强寸脉微浮胸中痞硬气上冲咽喉不得息者此为胸有寒也当吐之宜瓜蒂散（病如桂枝证为发热汗出恶风言邪在
表也头痛项强为桂枝证具若头项不痛强则邪不在表而传里也浮为在表沉为在里今寸脉微浮则邪不在表亦不在里而在胸
中胸中与表相应故知邪在胸中者犹如桂枝证而寸脉微浮也以胸中痞硬上冲咽喉不得息知寒邪客于胸中而不在表也千金
曰气浮上部填塞胸心胸中满者吐之则愈与瓜蒂散以吐胸中之邪若气不上冲则不可用也）太阳病下之脉促胸满者桂枝去芍
药汤（方论见恶寒）若脉促不结者欲解也 下后胸满小便不利若兼烦惊谵语身重不可转侧者柴胡加龙骨牡蛎汤（方论见
惊门） 若兼哕而舌苔者为湿痹
阳明 潮热大便溏小便可胸胁满属阳明（见胁满痛）
少阳 中风两耳无所闻目赤胸中满而烦者若吐下之则悸而惊救逆小柴胡去黄芩加茯苓汤（少阳之脉起于目 走于耳
中其支者下胸中贯膈风伤气风则为热少阳中风气壅而热故耳聋目赤胸满而烦邪在少阳为半表半里以吐除烦吐则伤气气
虚者悸以下除满下则亡血血虚者惊）
太阴 太阴之为病腹满而吐食不下自利益甚时腹自痛若下之必胸下结硬（太阴为病阳邪传里也太阴之脉布胃中邪气
壅而为腹满上不得降者呕吐而食不下下不得升者自利益甚时腹自痛阴寒在内而为腹痛者则为常痛此阳邪干里虽痛而亦
不常痛但时时腹自痛也若下之则阴邪留于胸下为结硬经曰病发于阴而反下之因作痞 泻心汤理中汤元不渴四逆汤 赵
活人第十八问中云太阴者脾之经主胸膈 胀愚尝观成氏明理论云胸中至表犹近所以仲景云喘而胸满者麻黄汤是属表而
可汗者也又云胸胁满者小柴胡汤属半表半里而可和解者也至于太阴止云腹满而吐食不下时腹自痛或腹满而咽干由此观
之可见太阴不主胸上者明矣）
少阴 病下利咽痛胸满心烦者猪肤汤（少阴之脉从肾上贯肝膈入肺中而循喉咙其支别者从肺出络心注胸中邪自阳经
传于少阴阴虚客热下利咽痛胸满心烦也与猪肤汤调阴散热咽痛五方大能解）
厥阴 病患手足厥冷脉乍紧者邪结在胸中心中满而烦饥不能食者病在胸中当须吐之宜瓜蒂散（手足厥冷者邪气内陷
也脉紧牢者为实邪气入腑则脉沉今脉乍紧知邪结在胸中为实故心下满而烦胃中无邪则喜饥以病在胸中虽饥而不能食与
瓜蒂散以吐胸中之邪 手足厥冷非脉紧胸痛别之）热少厥微胸胁烦满一证已前见
吴 胸满多用吐法实者宜瓜蒂散虚者宜人参芦或以香苏散饮下一瓯以手探喉中吐之亦可凡伤寒三四日已传少阳
经
脉弦口苦发热而胸满宜小柴胡汤若胸中满闷者加枳壳桔梗各二钱以利之若胸胁满而烦者加栝蒌实三钱黄连一钱半活人
治胸满气痞不宽只用枳壳桔梗各二钱生姜五片名曰枳壳汤 凡心之上胸之分宜枳壳心之下胃之分宜枳实盖枳壳能泄至
高之气枳实能泄至低之气其栝蒌仁能泻肺洗涤胸中痰垢之要药也故胸满而烦必加之一法治气痞胸满用小麦麸一二升以
生枳壳切半同炒令热去枳壳以帛包热麸熨胸中顿易热之则气易散而愈矣
（相关论述见前文“胁满痛”条中兼有胁部病症的部分，此前已提及）
太阳病：太阳与阳明合病，出现喘息且胸部胀满者，不可使用攻下法，适宜用麻黄汤。（阳气在胸中受气，若出现喘息且胸部胀满，是阳气不能宣发，郁滞而上逆所致。心下部胀满、腹部胀满都属于实证，应当使用攻下法；此处认为是胸部胀满而非里实，所以不可攻下。虽然涉及阳明，但因与太阳合病，属于表证，因此适宜用麻黄汤发汗。）如果经过发汗或攻下治疗后，出现烦躁发热、胸部窒塞感者，适宜用栀子豉汤。（阳气在胸中受气，发汗或攻下导致阳气不足，邪热客居于胸中，凝结而不消散，所以出现烦躁发热和胸部窒塞感。给予栀子豉汤以涌吐胸中的邪气。）病情类似桂枝汤证，但头部不痛、项部不强直，寸脉微浮，胸部痞塞坚硬，气上冲咽喉导致呼吸不畅者，这是胸中有寒邪（痰饮），应当使用涌吐法，适宜用瓜蒂散。（病情类似桂枝汤证是指发热、出汗、恶风，说明邪气在表；头痛、项强是桂枝汤证的典型表现，如果头项不痛、不强直，则说明邪气不在表而传入里了。脉浮表示邪在表，脉沉表示邪在里，现在寸脉微浮，说明邪气既不在表也不在里，而在胸中。胸中与体表相应，所以知道邪气在胸中就像桂枝汤证一样，但寸脉微浮。根据胸部痞塞坚硬、气上冲咽喉、呼吸不畅，可知寒邪客居在胸中而不在表。《千金方》说：气浮于上部，填塞心胸，胸部胀满的，通过涌吐可以痊愈。给予瓜蒂散以涌吐胸中的邪气。如果气不上冲，则不可使用此法。）太阳病经过攻下后，出现脉促、胸部胀满者，适宜用桂枝去芍药汤。（方剂论述见“恶寒”条）。如果脉促但不结滞的，表示病欲解。
攻下后出现胸部胀满、小便不利，如果兼有烦躁、惊悸、谵语、身体沉重不可转侧者，适宜用柴胡加龙骨牡蛎汤。（方剂论述见“惊门”条）。如果兼有呃逆且舌苔滑腻者为湿痹。
阳明病：潮热，大便溏薄，小便正常，胸部和胁部胀满，属于阳明病。（见“胁满痛”条）
少阳病：中风，两耳听不见，目赤，胸部胀满且烦躁者，如果使用涌吐或攻下法，则会出现心悸和惊悸，应救逆，适宜用去黄芩加茯苓的小柴胡汤。（少阳经脉起于眼部，行于耳中，其分支下行至胸中，贯穿膈肌。风邪伤及气分，风即为热，少阳经受邪，气机壅滞而生热，所以耳聋、目赤、胸满且烦躁。邪气在少阳，属于半表半里证。如果用涌吐法除烦，会损伤正气，气虚则心悸；如果用攻下法除满，会耗伤血液，血虚则惊悸。）
太阴病：太阴病的症状是腹部胀满且呕吐，饮食不下，自发性腹泻日益加重，时常腹部自行疼痛。如果误用攻下法，必然导致胸下结硬。（太阴病是阳邪传入里。太阴经脉布散于胃中，邪气壅滞导致腹部胀满；向上不能下降则呕吐且饮食不下；向下不能上升则自发性腹泻日益加重，时常腹部自行疼痛。阴寒在内导致的腹痛通常是持续性的疼痛；这里是阳邪干扰里部，虽然疼痛但也非持续性，只是时常腹部自行疼痛。如果误用攻下法，阴邪留滞于胸下形成结硬。经书说：病发于阴证却反而使用攻下法，因此造成痞证。泻心汤、理中汤、四逆汤均不适用。赵献可《活人书》第十八问中说：太阴是脾的经脉，主管胸膈胀满。我曾观察成无己《明理论》说：胸中到体表距离较近，所以张仲景说喘息且胸部胀满的用麻黄汤，这属于表证，可以使用发汗法；又说胸部和胁部胀满的用小柴胡汤，属于半表半里证，可以使用和解法。至于太阴只提到腹部胀满、呕吐、饮食不下、时常腹部自行疼痛，或者腹部胀满且咽干。由此看来，太阴不主管胸部以上部位是很明显的。）
少阴病：病证表现为腹泻、咽喉疼痛、胸部胀满、心烦者，适宜用猪肤汤。（少阴经脉从肾脏上行，贯穿肝脏和膈肌，进入肺中，并循行喉咙；其分支从肺出，联络心脏，注入胸中。邪气从阳经传入少阴，阴虚而有客热，导致腹泻、咽喉疼痛、胸部胀满、心烦。给予猪肤汤调理阴液、散热。治疗咽喉疼痛的五首方剂中，猪肤汤最能解毒。）
厥阴病：病患手足厥冷，脉搏突然紧涩者，邪气结聚在胸中，心中胀满且烦躁，饥饿但不能进食者，病位在胸中，应当使用涌吐法，适宜用瓜蒂散。（手足厥冷是因为邪气内陷。脉搏紧而牢靠表示实证，邪气入腑则脉沉，现在脉搏突然紧涩，知道邪气结聚在胸中为实证，所以心下部胀满且烦躁。胃中没有邪气则喜欢饥饿，但因为病在胸中，虽然饥饿却不能进食。给予瓜蒂散以涌吐胸中的邪气。手足厥冷需通过脉搏是否紧涩、是否有胸痛来区别。）“热少厥微，胸部和胁部烦躁胀满”这一证候此前已提及。
吴氏医案/经验：胸部胀满多用涌吐法。实证适宜用瓜蒂散，虚证适宜用人参芦，或者用香苏散饮用一杯，用手探喉催吐也可以。凡是伤寒三四日已传入少阳经，脉弦、口苦、发热且胸部胀满者，适宜用小柴胡汤。如果胸部胀满闷塞的，加枳壳、桔梗各二钱以利气。如果胸部和胁部胀满且烦躁的，加栝蒌实三钱、黄连一钱半。《活人书》治疗胸满、气痞不通畅，只用枳壳、桔梗各二钱、生姜五片，名叫枳壳汤。凡是心脏上方、胸部区域，适宜用枳壳；心脏下方、胃部区域，适宜用枳实。盖因枳壳能泄至高之气，枳实能泄至低之气。而栝蒌仁是泻肺、洗涤胸中痰垢的重要药物，所以胸部胀满且烦躁必须加上它。另一种方法治疗气痞、胸部胀满：用小麦麸一二升，与切开的生枳壳同炒至热，去掉枳壳，用布包裹热的麦麸熨烫胸部，顿时容易变热，热气散发则病愈。
(Relevant discussions are found in the preceding section on "Hypochondriac Fullness and Pain" involving hypochondriac diseases, which have been mentioned previously.)
Taiyang Disease: In combined Taiyang and Yangming disease, presenting with panting and chest fullness, purgation is contraindicated; Mahuang Tang (Ephedra Decoction) is appropriate. (Qi receives its influence in the chest; panting with chest fullness indicates that Yang Qi fails to diffuse, leading to stagnation and rebellion. Fullness below the heart or in the abdomen belongs to excess patterns and should be treated with purgation; however, chest fullness here is not interior excess, hence purgation is contraindicated. Although Yangming is involved, the combination with Taiyang indicates a exterior pattern, thus Mahuang Tang is used to induce sweating.) If, after sweating or purgation, restlessness, fever, and a sensation of obstruction in the chest occur, Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) is appropriate. (Yang Qi receives its influence in the chest; sweating or purgation depletes Yang Qi, allowing pathogenic heat to lodge in the chest, condensing without dispersing, resulting in restlessness, fever, and chest obstruction. Zhizi Chi Tang is given to vomit out the pathogen from the chest.) The condition resembles Guizhi Tang syndrome, but without headache or neck stiffness, with a slightly floating pulse at the cun position, chest痞 (pi, stuffiness/hardness), qi rushing up to the throat causing dyspnea; this is cold pathogen (phlegm-fluids) in the chest, requiring emesis; Gouti San (Melon Seed Powder) is appropriate. (Resembling Guizhi Tang syndrome implies fever, sweating, and aversion to wind, indicating the pathogen is in the exterior; headache and neck stiffness are characteristic of Guizhi Tang syndrome. Absence thereof suggests the pathogen has entered the interior. A floating pulse indicates exterior location, a deep pulse indicates interior location; a slightly floating pulse at the cun position indicates the pathogen is neither in the exterior nor the interior, but in the chest. The chest corresponds to the exterior, so the condition resembles Guizhi Tang syndrome but with a slightly floating cun pulse. Chest stuffiness, qi rushing to the throat, and dyspnea indicate cold pathogen lodging in the chest rather than the exterior. *Qianjin Fang* states: When qi floats to the upper part, filling the chest, causing fullness, vomiting cures it. Gouti San is given to vomit out the pathogen from the chest. If qi does not rush upward, this method is contraindicated.) After purgation in Taiyang disease, if a rapid, intermittent pulse (cu mai) and chest fullness occur, Guizhi Qu Shaoyao Tang (Cinnamon Twig Decoction without Paeonia) is appropriate. (Formula discussion see "Aversion to Cold"). If the pulse is rapid, intermittent, but not knotted, the disease is resolving.
After purgation, if chest fullness and dysuria occur, accompanied by restlessness, palpitations, delirium, heaviness of the body, and inability to turn over, Chaihu Jia Longgu Muli Tang (Bupleurum Decoction plus Dragon Bone and Oyster Shell) is appropriate. (Formula discussion see "Palpitations/Panic"). If accompanied by hiccups and a slippery tongue coating, it is damp-bi.
Yangming Disease: Tidal fever, loose stools, normal urination, and chest and hypochondriac fullness belong to Yangming disease. (See "Hypochondriac Fullness and Pain")
Shaoyang Disease: Wind-strike, with deafness, red eyes, chest fullness, and irritability; if emesis or purgation is used, palpitations and fright ensue; to rescue from adverse effects, Xiaochaihu Tang (Minor Bupleurum Decoction) without Huangqin plus Fuling is appropriate. (The Shaoyang meridian originates at the eye, travels through the ear, and its branch descends into the chest, piercing the diaphragm. Wind damages qi; wind generates heat. Shaoyang pathogen causes qi stagnation and heat, leading to deafness, red eyes, chest fullness, and irritability. The pathogen is in Shaoyang, a half-exterior, half-interior stage. Emesis removes irritability but damages qi, leading to palpitations due to qi deficiency; purgation removes fullness but depletes blood, leading to fright due to blood deficiency.)
Taiyin Disease: Taiyin disease manifests as abdominal fullness and vomiting, inability to eat, worsening spontaneous diarrhea, and occasional spontaneous abdominal pain. If purged, it inevitably leads to hardness and knotting below the chest. (Taiyin disease involves yang pathogen transmitting to the interior. The Taiyin meridian spreads in the stomach; pathogen stagnation causes abdominal fullness. Failure to descend leads to vomiting and anorexia; failure to ascend leads to worsening spontaneous diarrhea and occasional abdominal pain. Abdominal pain caused by interior yin-cold is typically constant; here, yang pathogen interfering with the interior causes pain that is not constant, only occasional. Purging leaves yin pathogen in the lower chest, forming knots. Classics state: If a yin-pattern disease is wrongly purged, pi (stuffiness) results. Xiexin Tang, Lizhong Tang, and Sini Tang are not applicable. Zhao Xikan's *Huoren Shu*, Question 18, states: Taiyin is the spleen meridian, governing chest and diaphragm distension. I observed Cheng Wuji's *Mingli Lun* stating: The chest is close to the exterior, hence Zhang Zhongjing said panting with chest fullness uses Mahuang Tang for exterior sweating. Also, chest and hypochondriac fullness uses Xiaochaihu Tang for harmonizing half-exterior, half-interior. Taiyin only mentions abdominal fullness, vomiting, anorexia, occasional abdominal pain, or abdominal fullness with dry throat. Thus, it is clear Taiyin does not govern the upper chest.)
Shaoyin Disease: Disease presenting with diarrhea, sore throat, chest fullness, and irritability; Zhufu Tang (Pig Skin Decoction) is appropriate. (The Shaoyin meridian ascends from the kidney, passes through the liver and diaphragm, enters the lung, and follows the throat; its branch exits the lung, connects to the heart, and enters the chest. Pathogen transmits from yang meridians to Shaoyin; yin deficiency with exogenous heat causes diarrhea, sore throat, chest fullness, and irritability. Zhufu Tang nourishes yin and clears heat. Among the five formulas for sore throat, Zhufu Tang best resolves toxicity.)
Jueyin Disease: Patient with cold extremities, sudden tight pulse, pathogen knotting in the chest, epigastric fullness and irritability, hunger but inability to eat; the disease is in the chest, requiring emesis; Gouti San (Melon Seed Powder) is appropriate. (Cold extremities indicate pathogen sinking inward. A tight, firm pulse indicates excess; pathogen in fu organs yields a deep pulse. Sudden tightness indicates pathogen knotting in the chest as excess, causing epigastric fullness and irritability. No pathogen in the stomach allows hunger, but disease in the chest prevents eating. Gouti San is given to vomit out the pathogen from the chest. Cold extremities must be distinguished by pulse tightness and chest pain.) The syndrome of "slight heat, slight cold extremities, chest and hypochondriac irritability and fullness" has been mentioned previously.
Wu's Clinical Experience: Chest fullness is often treated with emesis. Excess patterns suit Gouti San; deficiency patterns suit Ren Shen Lu (Deer Antler Velvet) or drinking Xiangsu San (Fragrant Su Decoction) followed by finger-induced vomiting. For typhoid fever transmitting to Shaoyang after three to four days, with wiry pulse, bitter taste, fever, and chest fullness, Xiaochaihu Tang is appropriate. For chest stuffiness, add Zhi Qiao (Bitter Orange Peel) and Jie Geng (Platycodon Root) two qian each to promote qi movement. For chest and hypochondriac fullness with irritability, add Gua Lou Shi (Trichosanthes Fruit) three qian and Huang Lian (Coptis Rhizome) one and a half qian. *Huoren Shu* treats chest fullness and qi pi (stuffiness) with only Zhi Qiao and Jie Geng two qian each, plus five slices of Sheng Jiang (Fresh Ginger), named Zhi Qiao Tang. Above the heart, in the chest region, Zhi Qiao is appropriate; below the heart, in the stomach region, Zhi Shi (Immature Bitter Orange) is appropriate. Zhi Qiao drains qi from the highest level; Zhi Shi drains qi from the lowest level. Gua Lou Ren (Trichosanthes Seed) is a key herb for draining the lungs and washing away phlegm turbidity in the chest; thus, it must be added for chest fullness with irritability. Another method for qi pi and chest fullness: stir-fry one to two sheng of wheat bran with sliced raw Zhi Qiao until hot, remove Zhi Qiao, wrap the hot bran in cloth, and apply as a compress to the chest. Heat dissipates qi quickly, leading to recovery.