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Chapter 11 of 27
金匮要略
This chapter specifically discusses the pulse manifestations, patterns, and treatment methods for chest bi (a category of conditions where yang qi in the chest is obstructed and blocked, primarily manifesting as chest oppression and pain), heart pain, and shortness of breath.
Zhang Zhongjing first addresses pulse principles: when examining the pulse, one must distinguish between "excess" and "insufficiency." If there is yang faint and yin wiry — that is, the cun (inch) position pulse is faint, indicating insufficiency of yang qi in the upper burner; and the chi (foot) position pulse is wiry, indicating dominance of yin cold in the lower burner — chest bi with pain will occur. Why is this so? The root cause lies in extreme deficiency of upright qi. Knowing now that yang deficiency is in the upper burner, chest bi and heart pain develop; and because yin cold qi is excessive, pain manifests.
For those who ordinarily show no obvious deficiency pattern, without exterior manifestations such as aversion to cold or fever, yet experience shortness of breath with difficulty in continuous respiration, this belongs to excess pattern (mostly due to obstruction by phlegm-rheum, qi stagnation, and other pathogenic factors).
The typical presentation of chest bi is: wheezing, coughing, spitting saliva, pain in the chest and back, and shortness of breath. The cun-kou pulse is deep and slow, while the guan (bar) pulse is small, tight, and rapid. Gualou Xiebai Baijiu Tang is the main formula for treatment.
Gualou Xiebai Baijiu Tang formula: One piece of Trichosanthes fruit (Gualou Shi), crushed; half a jin of Chinese chive (Xiebai); seven sheng of white wine. Boil all three ingredients together, reducing to two sheng. Take warm in two divided doses.
If chest bi is severe enough to prevent lying flat, with heart pain radiating to the back, Gualou Xiebai Banxia Tang is the main formula.
Gualou Xiebai Banxia Tang formula: One piece of Trichosanthes fruit, three liang of Chinese chive, half a jin of Pinellia (Banxia), one dou of white wine. Boil all four ingredients together, reducing to four sheng. Take one sheng warm, three times daily.
For chest bi with epigastric stuffiness, qi stagnating and binding in the chest, fullness in the chest, and qi from the hypochondria rebelling upward toward the chest and heart, Zhishi Xiebai Guizhi Tang is the main formula; Renshen Tang can also be used as the main formula. (The original text "Ren Tang" should be "Renshen Tang.")
Zhishi Xiebai Guizhi Tang formula: Four pieces of immature bitter orange (Zhishi), four liang of magnolia bark (Houpo), half a jin of Chinese chive, one liang of cinnamon twig (Guizhi), one piece of Trichosanthes fruit, crushed. Use five sheng of water for all five ingredients; first boil the Zhishi and Houpo until two sheng remain, remove the dregs, add the remaining ingredients, and boil for a few more rounds. Take warm in three divided doses.
Renshen Tang formula: Three liang each of ginseng (Renshen), licorice (Gancao), dried ginger (Ganjiang), and atractylodes (Baizhu). Use eight sheng of water for all four ingredients, boil down to three sheng. Take one sheng warm, three times daily.
For chest bi with qi stuffing and shortness of breath in the chest, Fuling Xingren Gancao Tang is the main formula; Ju Zhi Jiang Tang can also be used as the main formula.
Fuling Xingren Gancao Tang formula: Three liang of Poria (Fuling), fifty pieces of apricot kernel (Xingren), one liang of licorice. Use one dou of water for all three ingredients, boil down to five sheng. Take one sheng warm, three times daily. If not recovered, may take again.
Ju Zhi Jiang Tang formula: One jin of tangerine peel (Jupi), three liang of immature bitter orange, half a jin of fresh ginger. Use five sheng of water for all three ingredients, boil down to two sheng. Take warm in two divided doses. (The Handbook of Emergency Remedies and Important Formulas Worth a Thousand Gold Pieces state this formula treats chest bi with stuffiness and fullness in the chest, a sensation of something obstructing the throat with slight itching, dry throat, and expectoration of dry phlegm-saliva.)
For chest bi with pain that alternates between mild and severe, with varying urgency, Yiyi Fuzi San is the main formula.
Yiyi Fuzi San formula: Fifteen liang of Job's tears (Yiyiren), ten large processed aconite roots (Fuzi). Grind both ingredients into powder. Take one square-cun spoonful each time, three times daily.
For stuffiness in the heart region with various types of qi rebelling upward, and a suspended, pulling pain beneath the heart (epigastrium), Guizhi Shengjiang Zhishi Tang is the main formula.
Guizhi Shengjiang Zhishi Tang formula: Three liang of cinnamon twig, three liang of fresh ginger, five pieces of immature bitter orange. Use six sheng of water for all three ingredients, boil down to three sheng. Take warm in three divided doses.
For heart pain that penetrates through to the back, and back pain that penetrates through to the heart region, Wutou Chishizhi Wan is the main formula.
Wutou Chishizhi Wan formula: One liang of Sichuan pepper (Shujiao) (some say two fen), one fen of processed aconite root (Wutou) (some say one fen), half a liang of processed aconite (Fuzi) (some say one fen), one liang of dried ginger (some say one fen), one liang of red halloysite (Chishizhi) (some say two fen). Grind all five ingredients into powder, mix with honey to form pills the size of parasol tree seeds. Take one pill before meals, three times daily. If pain does not resolve, may slightly increase the dose.
Jiutong Wan: Treats the nine types of heart pain spoken of by the ancients.
Jiutong Wan formula: Three liang of processed aconite (Fuzi), one liang of raw wolf's tooth (Shenglangya), roasted until fragrant, one liang of croton seed (Badou), skin and heart removed, prepared by simmering, ground to a paste-like consistency, one liang each of ginseng, dried ginger, and Evodia fruit (Wuzhuyu). Grind all six ingredients into powder, mix with refined honey into pills the size of parasol tree seeds, and take with wine. Strong individuals initially take three pills, three times daily; weaker individuals take two pills. Ancient records also state that this formula concurrently treats sudden attack of malign qi (zhong e), abdominal distension with pain, and inability to speak; it also treats years of accumulated cold, rheum flowing into the chest and heart with pain, as well as cold swelling with upward counterflow of qi, injuries from falling from horses or carriages with blood stasis — all treated with this main formula. Dietary restrictions follow conventional methods.
The core pathological framework of this chapter is encapsulated in the opening phrase "yang faint and yin wiry."
Therefore, the main treatment principle of this chapter is to unblock yang and disperse bi (obstruction).
Gualou Xiebai Baijiu Tang serves as the foundational formula: Trichosanthes fruit widens the chest and clears phlegm; Chinese chive is acrid and warm, unblocking yang and dispersing accumulations; white wine is acrid and warm, guiding the medicinal potency. Later generations refer to this category of formulas as "Gualou Xiebai formulas," establishing them as the classic paradigm for treating chest bi.
Building from the foundational formula, Zhongjing repeatedly demonstrates the approach of "modifying according to presenting patterns":
It can be seen that this chapter does not merely provide fixed formulas, but rather unfolds layer by layer around the overall pathology of "yang faint and yin wiry," according to the different emphases of phlegm, rheum, qi, cold, and deficiency.
The descriptions of "chest bi and heart pain" in this chapter — such as "chest and back pain," "shortness of breath," and "heart pain penetrating to the back" — bear certain similarities to what modern medicine calls chest pain and angina pectoris, but cannot be directly equated with any specific heart disease in modern medicine. In Chinese medicine, "chest bi" is a syndrome complex summarized by symptoms and pathology, not equivalent to diagnoses such as coronary artery disease or myocardial infarction.
"Yang faint and yin wiry" can be understood as the ancients' functional summary of cardiopulmonary function and circulatory status. It suggests that once chest yang becomes deficient, yin cold and phlegm-rheum readily stagnate, affecting qi movement. This line of thinking offers insights into the relationship between "deficiency-cold and circulatory stasis" for modern readers, but pulse diagnosis cannot substitute for modern examination methods.
Among the formulas in this chapter, medicinals such as Wutou (aconite), Fuzi (prepared aconite), Badou (croton seed), and Shenglangya (raw wolf's tooth) are all notably toxic. Wutou, Badou, and Shenglangya in particular are strictly prohibited from self-preparation and self-administration in modern times. The ancients maintained cautious practices of strict processing, starting with small doses, and "if no effect, gradually increase," yet under the historical conditions of the time, safety remained limited. These formulas are for academic study only and must not be followed as prescriptions for self-medication or used independently.
Additionally, the "white wine" in the original formulas does not refer to modern high-proof liquor. Throughout history, most scholars consider it to refer to rice wine or clear wine of a similar nature, mainly utilized for its acrid-warm property in unblocking yang and assisting the upward movement of medicinal potency; specific understanding remains debated and should not be simplistically equated to modern liquor.
This content is based on classical Chinese medical texts and is provided solely for traditional cultural study and research purposes. It does not constitute any medical diagnosis, medication, or treatment advice. Please seek timely medical attention if you experience discomfort.