师曰。病有奔豚。有吐脓。（师曰奔豚病以下。脉经为别条。宜从。）
按欲死二字。形容苦恼之状而言。与少阴篇吴茱萸汤条同语例。
奔豚汤方
按此方证。挟有热邪。故不取桂枝之温。而用黄芩生葛之凉。且既有半夏。故不再用茯苓芎归芍药三味。以和
其腹痛也。
伤寒总病论。动气在上。不可发汗。发汗则气上冲。正在心端。李根汤主之。
于本方。去芎 。生葛。加桂枝。人参。茯苓。
桂枝加桂汤方
伤寒论。本方后曰。本云桂枝汤。今加桂满五两。所以加桂者。以能泄奔豚气也。
发汗后。脐下悸者。（茯苓下。辑义。桂枝二字偶脱。）
〔余述〕奔豚一证。多因水寒上冲。故治法不出降逆散寒。而注家概解以肾邪。殆不免牵凑。要坐不检难经仲
景之有异耳。
师曰。夫脉当取太过不及。
按责。读如平脉法。肥人责浮。瘦人责沉之责。即求责之义。
胸痹之病。喘息咳唾。
〔徐〕此段。实注胸痹之证脉。后凡言胸痹。皆当以此概之。但微有参差不同。故特首揭以为胸痹之主证主脉
主方耳。〔周〕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。为咳为痛。为短气
也。阴寒凝泣。阳气不复自舒。故沉迟见于寸口。理自然也。乃小紧数。复显于关上者。何耶。邪之所聚。自见小
紧。而阴寒所积。正足以遏抑阳气。故反形数。然阳遏则从而通之。栝蒌实。最足开结豁痰。得薤白白酒佐之。既
辛散而复下达。则所痹之阳自通矣。
按周说为当。但解数脉。未免牵强。姑存之。
栝蒌薤白白酒汤方
按先兄曰。说文曰。 。酢浆也。从酉 声。郑玄注周礼四饮曰。浆。今之 浆也。陈藏器曰。醋。破结气。
心中酸水痰饮。
胸痹。心中痞气（本草枳实条。图经引。与外台相同。类聚。与赵本同。）
枳实薤白桂枝汤方（图经引。无枝字。）
人参汤方（人参条。图经引。作治中汤。白术之白字。无。末附加减法。一与伤寒论同。仍不录。）
圣济总录曰。胸痹之病。其脉阳微而阴弦。阳虚则知在上焦。阴弦故令胸痹心痛。古方用理中汤。取缓其中气。
阴证略例。理中汤方后曰。若胸痹胁下妨闷者。加枳实半两。茯苓半两。
御药院方。枳实理中丸。治证与本条同。
于理中丸中。加枳实。茯苓。附子。
按外台。崔氏。疗时行四五日。大下后。或不下。皆患心中结满。两胁痞塞。胸中气急。厥逆欲绝。心胸高起。
手不得近。思与增损理中丸。（于本方中。加栝蒌根。枳实。茯苓。牡蛎。）正师胸痹人参汤之意。其效甚着。而王
好古许国祯。则移崔氏之方。以治本证。亦善于变通者矣。
茯苓杏仁甘草汤方
医心方。医门方。治胸中痞塞。短气 者。或腹急痛方。
于本方。加半夏。生姜。若气不下。加大黄。槟榔。取利为瘥。
橘皮枳实生姜汤方
圣济。治风寒客于肝经。膈脘痞塞。胁下拘痛。常欲蹈其胸上。名肝着。蹈胸汤方。
于本方。加桔梗。甘草。薤白。胸痹缓急者。（本草。图经引。缓上。有偏字。原本。诸本。并无人字。）
〔周〕胸痹缓急者。痹之急证也。寒饮上聚心膈。使阳气不达。危急为何如乎。故取薏苡逐水为君。附子之辛
热为佐。驱除寒结。席卷而下。又乌不胜任而愉快耶。
按周说似是。苡仁之用。能托郁结。况附子之雄烈。相合为散。比之前款诸方。其力最峻。足以奏功于燃眉之
际焉。盖此缓急。主在急字。非或缓或急之谓。史记仓公传。缓急无可使者。袁盎传。一旦有缓急。宁足恃乎。游
侠传。且缓急人之所时有也。俱是系于一时切迫之谓。此足以证焉。
焦循雕菰集。罗浩医经余论序曰。其论本草。以神农经为主。而证以南阳之方。以薏苡主筋急拘挛。故金匮胸
痹缓急者主之。用以健脾利湿。则失其义。
心中痞。诸逆心。悬痛。（辑义。肘后。痛下。有五字。当作肘后。作三字。）
按诸逆。程氏以病证言。尤氏以病因言。二说俱通。魏氏曰。诸逆。兼有形无形之邪为言。与尤意同。伊芳泽信
恬曰。悬牵。音义相同。悬痛。谓牵急而痛。肘后可证。又巢源。有心悬急懊痛候。千金养胎篇。有腹满悬急。心
下悬急之文。亦并悬牵通用之征也。斯说为核。（三国志管辂传。有心中悬痛文。）
九痛丸方（原本。诸本。附子三两下。有炮字。）
〔余述〕本篇。题云胸痹心痛。而首条。则二证并论。其他诸条。皆为胸痹立方。（栝蒌薤白半夏汤。心痛彻
背。不过言心胸痛甚。桂枝生姜。枳实汤。心中痞。前注犹以为胸痹。）心痛。则仅乌头赤石脂丸一方已。故二证
之辨。难就而可考。以臆测之。胸痹其痛颇泛。
心痛其痛殊紧。胸痹则病浅。心痛则病深。盖二证中。更自有轻重之别。而其实似无大异同。故胸痹之方。足
以治心痛。至真心痛。则固属不治。仲景略而不言。殆以此也。短气一证。病属上焦。故亦连类并及者欤。
老师说：疾病中有奔豚病，有吐脓血的症状。（按：关于“奔豚病”以下的条文，《脉经》将其列为单独条目，应当遵循此说。）
“欲死”二字，是用来形容痛苦不堪的状态。这与《伤寒论·少阴篇》吴茱萸汤条中的用法相同。
奔豚汤方
按：此方证候夹杂热邪，所以不选用桂枝的温性，而使用黄芩、生葛根的凉性。且既然已有半夏，就不再使用茯苓、川芎、当归、芍药这三味药，以此来调和腹痛。
《伤寒总病论》记载：动气在上焦，不可发汗。若发汗则气上冲，直抵心窝部，用李根白皮汤主治。
在本方（奔豚汤）基础上，去掉川芎、生葛根，加入桂枝、人参、茯苓。
《伤寒论》在本方后注说：原本说是桂枝汤，现在增加桂枝至五两。之所以加桂枝，是因为它能泄除奔豚之气。
发汗之后，脐下跳动不安的。（按：此处原文可能有脱漏，辑义认为“桂枝”二字偶有脱落，应补入。）
〔余述〕奔豚这一证候，多因水寒之气上冲所致，所以治法不离降逆散寒。而注释家大多解释为肾邪作祟，恐怕不免牵强附会。这大概是因为未能仔细区分《难经》与张仲景论述的不同之处罢了。
按：“责”字，读音如同《平脉法》中“肥人责浮，瘦人责沉”的“责”，即寻求、推究的意思。
〔徐〕这一段，实际上是注解胸痹的病证和脉象。后世凡是提到胸痹，都应当以此作为概括。只是略有参差不同，所以特别首先揭示它作为胸痹的主要证候、主要脉象和主要方剂。〔周〕寒浊之邪，停滞于上焦，阻碍了上下往来的气机，堵塞了前后阴阳的位置，于是导致喘息、咳嗽、疼痛、短气等症状。阴寒凝滞，阳气不能自行舒展，所以在寸口出现沉迟脉，这是理所当然的。然而在小紧数脉显见于关部的情况下，为什么呢？邪气聚集之处，自然显现小紧脉；而阴寒积聚，足以遏制阳气，所以反而呈现数脉。然而阳气被遏则需要通导，栝蒌实最能开结豁痰，配合薤白、白酒辅助，既辛散又下达，那么被痹阻的阳气自然通畅了。
按：周氏的说法较为妥当，但解释数脉未免有些牵强，暂且保留其说。
按：先兄说，《说文解字》记载：酢浆也。从酉声。郑玄注释《周礼》四饮时说：浆，就是现在的浆水。陈藏器说：醋能破结气，治疗心中酸水痰饮。
胸痹，心中痞塞感。（《本草》枳实条，《图经》引用，与《外台秘要》相同，《类聚方广义》与赵本相同。）
人参汤方（《本草》人参条，《图经》引用时称为治中汤，“白术”的“白”字缺失，末尾附加减法，一种与《伤寒论》相同，仍不录入。）
《圣济总录》说：胸痹病，其脉象阳微而阴弦。阳虚可知病位在上焦，阴弦故导致胸痹心痛。古方使用理中汤，旨在缓和其中焦之气。
《阴证略例》在理中汤方后注说：若胸痹胁下妨闷者，加枳实半两，茯苓半两。
《御药院方》的枳实理中丸，治疗的证候与本条相同。
按：《外台秘要》记载，崔氏治疗时行病四五日，大下之后，或者未下，皆患心中结满，两胁痞塞，胸中气急，厥逆欲绝，心胸高起，手不得近。建议用增损理中丸。（在本方中加入栝蒌根、枳实、茯苓、牡蛎。）这正是师承张仲景胸痹人参汤的本意，疗效显著。而王好古、许国祯则将崔氏的方子移用来治疗本证，也是善于变通的例子。
《医心方》、《医门方》治疗胸中痞塞、短气的，或者是腹急痛的方子。
在本方基础上，加入半夏、生姜。如果气不下行，加大黄、槟榔，取利便为痊愈。
《圣济总录》治疗风寒客于肝经，膈脘痞塞，胁下拘痛，常想让人踩踏胸部上方，名为肝着，用蹈胸汤方。
胸痹缓急者。（《本草》，《图经》引用时作“缓上”，有“偏”字。原本及诸本均无“人”字。）
〔周〕胸痹缓急者，是胸痹的急重证候。寒饮上聚于心膈，使阳气不达，危急到了什么程度呢？所以取薏苡仁驱逐水湿为君药，附子的辛热为佐药，驱除寒结，席卷而下，又有谁不胜任而感到愉快呢？
按：周氏的说法似是而非。薏苡仁的作用，在于托出郁结，何况附子雄烈，两者相合为散，比之前几款方剂，药力最为峻猛，足以在燃眉之急时奏效。这里的“缓急”，重在“急”字，并非指或缓或急的意思。《史记·仓公传》说：缓急无可使者。《袁盎传》说：一旦有缓急，宁足恃乎？《游侠传》说：且缓急人之所时有也。都是指一时切迫的情况。这足以证明这一点。
焦循《雕菰集》罗浩《医经余论序》说：其论本草，以《神农经》为主，而以南阳（张仲景）的方剂来验证。因为认为薏苡仁主治筋急拘挛，所以《金匮》胸痹缓急者用它，用以健脾利湿，这就失去了本义。
心中痞塞，各种逆气上冲，心悬痛。（辑义：《肘后备急方》中，“痛”字下有“五”字，当作《肘后》作三字。）
按：对于“诸逆”，程氏以病证言，尤氏以病因言，两种说法都通顺。魏氏说：诸逆，兼有形无形之邪而言，与尤氏意思相同。伊芳泽信恬说：悬、牵，音义相同。悬痛，谓牵急而痛。《肘后方》可证。另外，《诸病源候论》有心悬急懊痛候，《千金要方·养胎篇》有腹满悬急、心下悬急的文字，也都是悬、牵通用的征象。这种说法更为确切。（《三国志·管辂传》中有心中悬痛的文字。）
〔余述〕本篇题目为胸痹心痛，但首条则是两个证候并论，其他各条，都是为了胸痹设立方剂。（栝蒉薤白半夏汤治疗心痛彻背，不过是说心胸痛得很厉害；桂枝生姜枳实汤治疗心中痞，前注还认为是胸痹。）至于心痛，则仅有乌头赤石脂丸一方而已。所以这两个证候的区别，难以考证。凭推测来看，胸痹的疼痛比较泛泛，心痛的疼痛特别紧缩。胸痹病位较浅，心痛病位较深。可以说在这两个证候中，更有轻重之别，但其实似乎没有太大的异同。所以胸痹的方剂，足以治疗心痛。至于真心痛，则确实属于不治之症，仲景简略而不提及，大概就是因为这个原因吧。短气一证，病属上焦，所以也连带一并讨论吧。
The Master said: There are diseases of Ben Tun (Rushing Pig, a condition characterized by a sensation of Qi rushing up from the lower abdomen) and vomiting of pus. [Note: Regarding the text following "Ben Tun disease," *Mai Jing* lists it as a separate section; one should follow this arrangement.]
The phrase "desiring death" describes the state of extreme suffering. This usage is identical to that in the Wuzhuyu Tang section of the Shaoyin Chapter in *Shanghan Lun*.
**Ben Tun Tang Formula**
[Analysis]: This syndrome involves heat pathogens. Therefore, the warming property of Guizhi (Cinnamon Twig) is not adopted; instead, the cooling properties of Huangqin (Scutellaria Root) and Sheng Gegen (Pueraria Root) are used. Since Banxia (Pinellia Tuber) is already present, Fuling (Poria), Xiong (Ligusticum Rhizome), Danggui (Angelica Sinensis Root), and Shaoyao (Peony Root) are omitted to harmonize abdominal pain.
*Shanghan Zongbing Lun* states: When Dong Qi (Moving Qi) is located in the upper jiao, sweating therapy is contraindicated. If sweating is induced, Qi rushes upward, stopping precisely at the heart region. Li Gen Tang (Li Gen Decoction) is the primary treatment.
Modification of the above formula (Ben Tun Tang): Remove Xiong and Sheng Gegen; add Guizhi (Cinnamon Twig), Renshen (Ginseng Root), and Fuling (Poria).
**Guizhi Jia Gui Tang Formula (Cinnamon Twig Plus Cinnamon Twig Decoction)**
*Shanghan Lun* notes after this formula: Originally stated as Guizhi Tang, now Guizhi is increased to five liang. The reason for adding Guizhi is its ability to drain Ben Tun Qi.
After inducing sweating, if there is palpitations below the umbilicus. [Note: Textual criticism suggests the characters "Guizhi" may have been accidentally omitted.]
[Commentary]: The syndrome of Ben Tun is mostly caused by Water-Cold rushing upward. Thus, the treatment method focuses on descending rebellious Qi and dispersing Cold. Commentators generally interpret this as Kidney Evil, which is likely forced interpretation. This likely stems from failing to distinguish between the descriptions in *Nan Jing* and those of Zhang Zhongjing.
The Master said: Pulse diagnosis should seek excess or deficiency.
[Analysis]: The character "Ze" (to demand/inquire) is read as in Ping Mai Fa (Method of Assessing Pulses), e.g., "For a fat person, inquire about floating pulse; for a thin person, inquire about deep pulse." Here, "Ze" means to seek or investigate.
The disease of Xiong Bi (Chest Bi/Obsstruction) presents with wheezing, coughing, and spitting saliva.
[Xu]: This paragraph actually annotates the symptoms and pulses of Xiong Bi. Whenever Xiong Bi is mentioned subsequently, it should be generalized by this passage. However, there are slight variations, so it is specifically highlighted here as the main symptom, main pulse, and main formula for Xiong Bi. [Zhou]: Cold-Turbid pathogens stagnating in the Upper Jiao obstruct the ascending and descending Qi flow, blocking the positions of anterior-posterior Yin and Yang. This leads to wheezing, coughing, pain, and shortness of breath. Yin-Cold coagulation prevents Yang Qi from naturally relaxing, hence Chen Chi (Deep and Slow) pulses appear at Cun Kou (Radial Artery). This is natural logic. However, why do Xiao Jin Shuo (Slight Tightness and Rapid) pulses appear at Guan? Where pathogens gather, Xiao Jin naturally appears. Yin-Cold accumulation suppresses Yang Qi, thus presenting as Shuo (Rapid). When Yang is suppressed, it must be unblocked. Gua Lou Shi (Trichosanthes Fruit) best opens congestion and resolves phlegm. Assisted by Xie Bai (Allium Macrostemon Bulb) and Bai Jiu (White Wine), it is both acrid-dispersing and descending, thereby unblocking the obstructed Yang.
[Analysis]: Zhou's explanation is appropriate, but his interpretation of the Shuo pulse is somewhat forced. It is retained tentatively.
**Gua Lou Xie Bai Bai Jiu Tang Formula (Trichosanthes Fruit, Allium Macrostemon Bulb, and White Wine Decoction)**
[Analysis]: My elder brother stated: *Shuo Wen Jie Zi* defines "Su" as vinegar juice. Zheng Xuan annotated the Four Drinks in *Zhou Li*: "Jiang" refers to what is now Jiang water (fermented grain drink). Chen Cangqi stated: Vinegar breaks Qi stagnation and treats sour fluid/phlegm-fluid in the heart.
Xiong Bi, with a feeling of fullness/stagnation in the heart/chest. (*Ben Cao*, Zhi Shi entry, cited from *Tu Jing*, consistent with *Wai Tai Mi Yao*; *Lei Ju Fang* consistent with Zhao edition.)
**Zhi Shi Xie Bai Gui Zhi Tang Formula (Immature Bitter Orange, Allium Macrostemon Bulb, and Cinnamon Twig Decoction)** (*Tu Jing* citation omits the character "Zhi" in Gui Zhi.)
**Ren Shen Tang Formula (Ginseng Decoction)** (*Ben Cao*, Ren Shen entry, *Tu Jing* cites it as Zhi Zhong Tang; the character "Bai" in Bai Zhu is missing. The final addition/subtraction rules are identical to *Shanghan Lun* and are not recorded here.)
*Sheng Ji Zong Lu* states: In Xiong Bi disease, the pulse is Yang Wei (Superficially Weak) and Yin Xian (Taut like a Bowstring). Yang deficiency indicates pathology in the Upper Jiao; Yin Xian causes Chest Bi and Heart Pain. Ancient formulas use Li Zhong Tang (Regulate the Middle Decoction) to moderate the Middle Jiao Qi.
*Yin Zheng Lue Li* postscript for Li Zhong Tang: If there is chest obstruction and hypochondriac fullness/distress, add Zhi Shi (0.5 liang) and Fuling (0.5 liang).
*Yu Yao Yuan Fang*'s Zhi Shi Li Zhong Wan (Immature Bitter Orange Regulate the Middle Pill) treats syndromes identical to this section.
Modification of Li Zhong Wan: Add Zhi Shi, Fuling, and Fuzi (Prepared Aconite Root).
[Analysis]: *Wai Tai Mi Yao* records Cui Shi treating epidemic diseases lasting four to five days. After severe purgation, or if purgation was ineffective, patients suffer from central knotting/fullness, hypochondriac blockage, chest Qi urgency, cold limbs approaching death, elevated chest/heart area, and tenderness to touch. The recommendation is Zeng Sun Li Zhong Wan (Modified Regulate the Middle Decoction) [Add Gua Lou Gen (Trichosanthes Root), Zhi Shi, Fuling, Mu Li (Oyster Shell)]. This aligns with the intent of Zhongjing's Ren Shen Tang for Xiong Bi, showing significant efficacy. Wang Haogu and Xu Guozhen adapted Cui Shi's formula to treat this syndrome, demonstrating flexibility.
**Fu Ling Xing Ren Gan Cao Tang Formula (Poria, Apricot Seed, and Licorice Decoction)**
*Yi Xin Fang* and *Yi Men Fang* treat chest fullness/stagnation and shortness of breath, or abdominal urgency/pain.
Modification: Add Banxia and Sheng Jiang (Fresh Ginger). If Qi does not descend, add Da Huang (Rhubarb Root) and Bing Lang (Areca Seed); cure is achieved through bowel movement.
**Ju Pi Zhi Shi Sheng Jiang Tang Formula (Tangerine Peel, Immature Bitter Orange, and Fresh Ginger Decoction)**
*Sheng Ji* treats Wind-Cold invading the Liver Meridian, causing diaphragmatic/epigastric fullness, hypochondriac tension/pain, and a desire to have the chest stepped upon. Named Gan Zhuo (Liver Fixation), treated with Dao Xiong Tang (Step-on-Chest Decoction).
Modification: Add Jie Geng (Platycodon Root), Gan Cao (Licorice Root), and Xie Bai.
In cases of Xiong Bi with alternating severity (Huan Ji). (*Ben Cao*, *Tu Jing* citation reads "Huan Shang" with character "Pian". Original and other editions lack the character "Ren".)
[Zhou]: "Xiong Bi Huan Ji" refers to the acute/severe stage of Xiong Bi. Cold-Fluid accumulating above the heart/diaphragm blocks Yang Qi, creating a critical situation. Therefore, Yi Yi Ren (Coix Seed) is used as the sovereign herb to expel water; Fuzi's acrid-hot nature serves as the assistant to drive out Cold knots, sweeping them downward. Who could fail to胜任 (be competent) and feel pleased?
[Analysis]: Zhou's view is plausible. Yi Yi Ren's function is to push out stagnation. Combined with the potent Fuzi, this powder is more峻猛 (potent/aggressive) than previous formulas, effective for emergencies. "Huan Ji" emphasizes "Ji" (Urgency/Emergency), not alternating mild and severe conditions. *Shiji - Cang Gong Zhuan*: "In emergencies, no one can be relied upon." *Yuan Ang Zhuan*: "If an emergency arises, can one rely on it?" *Youxia Zhuan*: "Emergencies happen to people occasionally." All refer to sudden urgency. This proves the point.
Jiao Xiong's *Diao Gu Ji*, preface to Luo Hao's *Yi Jing Yu Lun*: Discussing Materia Medica based on *Shen Nong Ben Cao Jing* and verifying with Zhang Zhongjing's formulas. Believing Yi Yi Ren treats muscle spasms/tightness, thus using it for Xiong Bi Huan Ji to strengthen Spleen and promote dampness loses the original meaning.
Central chest fullness/stagnation, various rebellious Qi rising, hanging pain in the heart. [Textual note: *Zhou Hou Bei Ji Fang* has five characters after "Tong"; should be read as three characters.]
[Analysis]: Regarding "Zhu Ni" (Various Rebellions), Cheng interprets it as disease manifestation; You interprets it as etiology. Both are valid. Wei states: "Zhu Ni" includes both tangible and intangible pathogens, agreeing with You. Yi Fang Ze Xin Tian states: "Xuan" (Hang) and "Qian" (Pull) share sound and meaning. "Xuan Tong" means pulling/tightening pain. Supported by *Zhou Hou*. Additionally, *Bing Yuan Hou Ke* mentions "Heart Hanging Urgency and Agonizing Pain"; *Qian Jin Fang - Yang Tai Pian* mentions "Abdominal Fullness Hanging Urgency" and "Epigastric Hanging Urgency." These are evidence of interchangeable usage. This explanation is rigorous. (*Sanguo Zhi - Guan Lu Zhuan* contains "Heart Hanging Pain".)
**Jiu Tong Wan Formula (Nine Sorrows Pill)** (Original and other editions include "Pao" (Processed) after "Fuzi 3 liang".)
[Commentary]: This chapter is titled "Chest Bi and Heart Pain," but the first article discusses both syndromes together. Other articles provide formulas for Chest Bi. [Gua Lou Xie Bai Ban Xia Tang treats Heart Pain Piercing the Back, merely indicating severe chest/heart pain; Gui Zhi Sheng Jiang Zhi Shi Tang treats Central Fullness, previously noted as Chest Bi.] For Heart Pain, only Wu Tou Chi Shi Zhi Wan (Aconite and Red Stone Lipid Pill) exists. Thus, distinguishing these two syndromes is difficult to verify. Speculatively, Chest Bi pain is diffuse/generalized, while Heart Pain is tight/constricted. Chest Bi is superficial; Heart Pain is deep. Within these two, there are degrees of severity, but essentially they are similar. Hence, Chest Bi formulas can treat Heart Pain. True Heart Pain (Zhen Xin Tong) is incurable; Zhongjing omits it, likely for this reason. Shortness of Breath belongs to the Upper Jiao, so it is discussed alongside for relevance.