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Capítulo 11 de 27
金匮要略
This chapter specifically discusses chest bi (a category of disorders characterized by the blockage of yang qi in the chest, manifesting mainly as chest oppression and chest pain), heart pain, and shortness of breath—their pulses, syndromes, and treatments.
Zhang Zhongjing first addresses pulse diagnosis: one must distinguish between "excess" and "deficiency." If there appears yang faint with yin stringlike—that is, the cun pulse is faint, indicating insufficiency of yang qi in the upper burner; the chi pulse is stringlike, indicating exuberance of yin cold in the lower burner—chest bi with pain will occur. Why is this so? The fundamental reason lies in the extreme deficiency of upright qi. Now that we know yang deficiency resides in the upper burner, chest bi and heart pain arise; and because the yin cold qi is exuberant, pain manifests.
In those who ordinarily show no obvious deficiency manifestations, and who have no exterior symptoms such as aversion to cold or fever, yet experience shortness of breath with difficulty in continuous breathing, this belongs to the excess pattern (mostly due to retained phlegm-fluid, qi stagnation, or other pathogenic factors causing blockage).
The typical presentation of chest bi is: panting, coughing, spitting saliva, pain in the chest and back, and shortness of breath. The cun pulse is deep and slow, while the guan pulse is small and tight-rapid. Treat with Gualou Xiebai Baijiu Tang as the primary formula.
Gualou Xiebai Baijiu Tang formula: One Gualou shi (Trichosanthes fruit), crushed; ban Xia (Pinellia) half a jin; bai jiu (wine) seven sheng. Boil the three ingredients together, reduce to two sheng, and take warm in two divided doses.
If chest bi is severe enough that the patient cannot lie flat, with heart pain radiating to the back, treat with Gualou Xiebai Banxia Tang as the primary formula.
Gualou Xiebai Banxia Tang formula: One Gualou shi, Xiebai three liang, Banxia half a jin, bai jiu one dou. Boil the four ingredients together, reduce to four sheng, take one sheng warm, three times daily.
When chest bi is accompanied by stuffiness and fullness below the heart, with qi stagnating and binding in the chest, a sensation of fullness in the chest, and counterflow qi from the hypochondria rushing upward toward the chest and heart, treat with Zhishi Xiebai Guizhi Tang as the primary formula; Renshen Tang may also be used as the primary formula. (In the original text, "ren tang" should read "Renshen Tang.")
Zhishi Xiebai Guizhi Tang formula: Zhishi four pieces, Houpo four liang, Xiebai half a jin, Guizhi one liang, Gualou shi one piece, crushed. For the five ingredients, use five sheng of water. First boil Zhishi and Houpo to obtain two sheng, remove the dregs, then add the remaining herbs and boil for a few more turns. Take warm in three divided doses.
Renshen Tang formula: Renshen, Gancao, Ganjiang, and Baizhu, three liang each. Boil the four ingredients in eight sheng of water to obtain three sheng. Take one sheng warm, three times daily.
For chest bi with qi blockage in the chest and shortness of breath, use Fuling Xingren Gancao Tang as the primary formula; Ju Zhi Jiang Tang may also be used as the primary formula.
Fuling Xingren Gancao Tang formula: Fuling three liang, Xingren fifty pieces, Gancao one liang. Boil the three ingredients in one dou of water to obtain five sheng. Take one sheng warm, three times daily. If not cured, it may be taken again.
Ju Zhi Jiang Tang formula: Jupi one jin, Zhishi three liang, Shengjiang half a jin. Boil the three ingredients in five sheng of water to obtain two sheng. Take warm in two divided doses. (According to Zhouhou Beiji Fang and Qianjin Fang, this formula treats chest bi with chest blockage and distension, a sensation of something stuck in the throat with slight itching, a dry throat, and spitting dry phlegm particles.)
For chest bi with pain that alternates between easing and worsening, with irregular intensity, use Yiyi Fuzi San as the primary formula.
Yiyi Fuzi San formula: Yiyiren fifteen liang, large Fuzi ten pieces, processed. Grind the two ingredients into powder. Take one Fangcun spoon each time, three times daily.
For stuffiness and blockage below the heart, with various qi counterflows, and a suspended, pulling pain in the epigastric region, use Guizhi Shengjiang Zhishi Tang as the primary formula.
Guizhi Shengjiang Zhishi Tang formula: Guizhi three liang, Shengjiang three liang, Zhishi five pieces. Boil the three ingredients in six sheng of water to obtain three sheng. Take warm in three divided doses.
For heart pain that penetrates to the back, and back pain that penetrates to the precordial region, use Wutou Chishizhi Wan as the primary formula.
Wutou Chishizhi Wan formula: Shujiao one liang (some say two fen), Wutou one fen, processed, Fuzi half a liang, processed (some say one fen), Ganjiang one liang (some say one fen), Chishizhi one liang (some say two fen). Grind the five ingredients into powder, form into pills the size of wutong seeds with honey. Take one pill before meals, three times daily. If pain does not resolve, the dose may be slightly increased.
Jiu Tong Wan: Treats what the ancients called the nine types of heart pain.
Jiu Tong Wan formula: Fuzi three liang, processed; raw Langya one liang, roasted fragrant; Badou one liang, with skin and heart removed, boiled, ground to a paste-like consistency; Renshen, Ganjiang, Wuzhuyu, one liang each. Grind the six ingredients into powder, form into pills the size of tong seeds with refined honey, and take with wine. A strong person initially takes three pills, three times daily; a weak person takes two pills. The ancients also recorded that this formula treats sudden attack of zhong'e (sudden blockage by pestilent qi), abdominal distension and pain, and inability to speak; it also treats accumulations of cold over many years, flowing into the chest and heart with pain, as well as cold swelling, qi rising, injuries from falling off horses or carriages with blood stasis—all treated with this formula. Dietary contraindications follow standard methods.
The overarching pathological mechanism of this chapter is the opening statement: "yang faint with yin stringlike."
Therefore, the main treatment principle of this chapter is to free yang and dissipate bi.
Gualou Xiebai Baijiu Tang serves as the foundational formula: Gualou shi broadens the chest and disperses phlegm, Xiebai is acrid-warm and unblocks yang to scatter accumulation, and bai jiu is acrid-warm to move the medicinal force. Later generations have called this category of formulas "Gualou Xiebai formulas," establishing them as the classic paradigm for treating chest bi.
From this foundational formula, Zhongjing repeatedly demonstrates the approach of "modifying according to syndromes":
It can be seen that this chapter does not merely provide a single fixed formula, but rather revolves around the overarching pathology of "yang faint with yin stringlike," unfolding treatment methods layer by layer according to the different emphases of phlegm, fluid, 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 the back"—bear some resemblance to certain presentations of what is today called chest pain and angina pectoris, but they cannot be directly equated with any specific heart disease in modern medicine. In Chinese medicine, "chest bi" is a syndrome group summarized by symptoms and pathology, and does not equate to diagnoses such as coronary artery disease or myocardial infarction.
"Yang faint with yin stringlike" can be understood as the ancients' functional summary of cardiopulmonary function and circulatory status. It suggests that once yang qi in the chest becomes deficient, yin cold and phlegm-fluid tend to stagnate, affecting the movement of qi. This line of thinking offers insights into the relationship between "deficiency-cold and impaired circulation" in modern terms, but pulse diagnosis cannot substitute for modern examinations.
Among the formulas in this chapter, Wutou, Fuzi, Badou, and raw Langya are all noticeably toxic. In particular, Wutou, Badou, and raw Langya are strictly forbidden for self-preparation and self-administration in modern times. The ancients employed rigorous processing methods, small initial doses, and a cautious approach of "if not effective, slightly increase," but under the historical conditions of their time, safety was nonetheless limited. These formulas are provided for academic study only; they must not be filled or used on one's own.
Additionally, the "bai jiu" in the original formulas is not modern high-proof liquor. Throughout history, most scholars believe it refers to rice wine or clear wine of some kind, primarily taken for its acrid-warm properties of freeing yang and assisting the medicinal force to ascend; specific understanding remains debated, and it should not be simplistically equated with modern liquor.
This content is based on classical Chinese medical texts and is provided solely for the study of traditional culture and scholarship. It does not constitute any medical diagnosis, prescription, or treatment advice. If you feel unwell, please seek medical attention promptly.