治急心痛胃疼。
五灵脂（去沙石） 玄明索（炒，去皮） 蓬莪术（煨） 当归 良姜（炒，各
等分） 为末，每服三钱，热醋汤调服。
治男妇心脾痛。
五灵脂 槟榔（各等分） 为末，每服三钱，隔夜先将猪肉盐酱，煮熟，令患人细嚼
吐出，以引虫头向上，然后煎菖蒲汤调药服之，以杀虫也。
《经》曰∶南风生于夏，病在心，喻在胸胁，此以胸属心也。肝虚则胸痛引背胁，
肝实则胸痛不得转侧，此又以胸属肝也。夫胸中实，肺家之分野。其言心者，以心之脉
从心系，却上肺也。其言肝者。以肝之脉，贯膈上注肺也。然胸痛即膈痛，其与心痛别
者，心痛在歧骨陷处，胸痛则横满于胸中两胁间也。其与胃脘痛别者，胃脘痛在心之
下。胸痛在心之上也。
《素问》曰∶胸痛少气者，水气在脏腑也。水者，阴气也。阴气在中。故胸痛少气
也。是以胸中阳气，如离照当空、旷然无外，设地气一上，则窒塞有加，故浊气在
上，则生 胀。胸痹者，阴气上逆之候也。
仲景微则用薤白白酒以益其阳，甚则用附子干姜以消其阴，世人不知胸痹为何病，习用
豆蔻、木香、三棱、神曲等药，坐耗其胸中之阳，益增其困矣。
有饮食失节，劳役过度，以致痹土虚乏，肝木得以乘其土位，而为胃脘当心而
痛，上攻两胁，膈噎不通，其脉沉弦着，宜归脾汤加白芍，以姜枣为引煎服。
戴氏曰∶房劳肾虚之人，胸膈多有隐痛，此肾虚不能纳气，气虚不能生血之故。
气与血犹水也，盛则流畅，虚则鲜有不滞者，所以作痛，宜破故纸之类补肾，芎归之
类补血。若作寻常胁痛治则殆矣。
膈门一点相引作痛，而吸气皮觉急者，此有污血也。用滑石、桃仁、黄连、枳壳之
类为末，以萝卜汁煎熟饮之。（以上论胸痹）痰流气郁而胸胁痛者，（其脉沉涩而细。）风寒者，（脉浮
弦而数。）食积者，（脉沉弦而伏。）痰饮者，（或弦滑，或结促。）死血者，（脉沉而涩。）
虚者，（脉弦而细数或大而无力）火者，（脉洪滑而数。）当分条类，析明别，左右施治。《经》曰∶
左右者，阴阳之道路，气之所终始也。又曰∶肝木气实则胁病。夫实者，指邪气而言。《经》曰∶邪气
盛则实是也。又曰∶少阳所谓心胁痛者，言少阳盛也。盛者，心之所表也。（心气逆则少阳
盛，足太阳脉，循胁里，出气街，心主脉，循胸，出胁故尔）
《经》曰∶胃之大络，名曰虚里，贯膈络肺，出于左乳下，其动应衣。脉宗气也。
（大凡左乳之下，其动应衣，此宗气之泄也，故谓之死。）
丹溪曰∶两胁走痛是痰实者，可用控涎丹。左胁痛为肝经受邪，宜柴胡疏肝散。右
胁痛，为肝经移病于肿，宜推气散。食积痛，凡痛有一条杠起者是也，当于积门参
看。气弱人胁痛，脉细紧或弦，多从劳役怒气得者，八物汤加木香、青皮。肥白人气
虚，发寒热而胁下痛，用参 补气，加柴胡、木香、青皮调气。瘦人发寒热胁痛多怒
者，必有瘀血，宜桃仁、红花、柴胡、青皮、大黄、滑石，去滞气必用青皮，乃肝胆
二经之药。若二经血不足者，先当补血，少加青皮。痰饮停伏胁痛，宜导痰汤。胁下痛
而大便秘结者，木香槟榔丸。虚寒作痛者，必用辛温补剂，加调气药。
解痛以琥珀膏贴之，或白芥子水研敷之；或吴茱萸醋研敷之；韭菜炒熨亦可。人
有房劳内伤，胁下一点痛者，名干胁痛，难愈，当大补气血以养肝火，滋肾水以补母。
左胁痛胃脘痛二症，妇人多有之。以其忧思忿怒之气，素蓄于中，发则上冲，被湿痰死
血阴滞其气，血不得条达，故清阳不升，浊阴不降，肝木之邪，得以乘机侵侮而为病
也，故治妇人诸痛诸疾，必以行气开郁为主，破血散火兼之。谚云∶香附缩砂，妇人
之至宝，山药苁蓉，男子之佳珍，此之谓也。以上论胁痛。
治疗急性的心痛和胃痛。
五灵脂（去除沙石） 玄明粉（炒制，去皮） 蓬莪术（煨制） 当归 高良姜（炒制，各取等份）
研为细末，每次服用三钱，用热醋汤调服。
治疗男女性的心脾疼痛。
五灵脂 槟榔（各取等份）
研为细末，每次服用三钱。隔夜先将猪肉用盐和酱煮熟，让患者细细咀嚼后吐出，以此引导虫头向上，然后煎菖蒲汤调和药粉服用，以达到杀虫的目的。
《内经》说：南风生于夏季，病位在心，症状表现在胸胁，这是将胸部归属于心。肝虚则胸痛牵引至背部和胁肋，肝实则胸痛导致身体不能转侧，这是又将胸部归属于肝。胸中充实，是肺所主的区域。文中提到心的原因，是因为心的经脉从心系上行至肺。文中提到肝的原因，是因为肝的经脉穿过膈肌上注于肺。然而胸痛即膈痛，它与心痛的区别在于：心痛位于歧骨（剑突）凹陷处，而胸痛则是横满于胸中两胁之间。它与胃脘痛的区别在于：胃脘痛位于心的下方，而胸痛位于心的上方。
《素问》说：胸痛且气短的人，是因为水气停留在脏腑中。水属于阴气。阴气停滞在中焦，所以出现胸痛和气短。因此，胸中的阳气，就像太阳当空照耀，广阔无外；如果地气（浊阴之气）一上升，就会更加窒塞不通，所以浊气在上，就会产生胀满。胸痹，是阴气上逆的征候。
张仲景对于轻症用薤白白酒来补益其阳气，重症用附子干姜来消除其阴寒，世人不知道胸痹是什么病，习惯使用豆蔻、木香、三棱、神曲等药物，白白耗损胸中的阳气，反而增加了病情。
有因饮食不节制，劳累过度，导致脾土虚弱，肝木得以乘袭脾土之位，从而引起胃脘当心而痛，向上攻冲两胁，膈噎不通，脉象沉弦有力，适宜用归脾汤加白芍，以生姜和大枣为引煎服。
戴氏说：房劳过度导致肾虚的人，胸膈多有隐痛，这是因为肾虚不能纳气，气虚不能生血的原因。气和血就像水一样，旺盛时流畅，虚弱时鲜有不滞涩的，所以产生疼痛，适宜用破故纸之类补肾，川芎、当归之类补血。如果当作寻常的胁痛来治疗就危险了。
膈门一点相互牵引作痛，且吸气时皮肤感觉紧绷的，这是体内有瘀血。用滑石、桃仁、黄连、枳壳等研为细末，用萝卜汁煎熟后饮用。（以上论述胸痹）痰流气郁而导致胸胁痛的，（其脉象沉涩而细。）风寒导致的，（脉象浮弦而数。）食积导致的，（脉象沉弦而伏。）痰饮导致的，（或弦滑，或结促。）死血（瘀血）导致的，（脉象沉而涩。）虚证导致的，（脉象弦而细数或大而无力）火邪导致的，（脉象洪滑而数。）应当分条分类，辨析明确，左右施治。《内经》说：左右，是阴阳运行的道路，气终结和起始的地方。又说：肝木气实则发生胁病。所谓“实”，是指邪气而言。《内经》说：邪气盛则实。又说：少阳所说的“心胁痛”，是说少阳经气盛。盛，是心的外在表现。（心气逆则少阳盛，足太阳脉，循行于胁里，出于气街，手厥阴心主之脉，循行于胸，出于胁，所以如此）
《内经》说：胃的大络，名叫虚里，穿过膈肌联络肺，出于左乳下，其搏动可以映现衣服。这是宗气的脉象。（大凡左乳之下，其搏动可以映现衣服，这是宗气外泄的表现，所以称为死证。）
朱丹溪说：两胁走窜疼痛属于痰实证者，可以使用控涎丹。左胁痛为肝经受邪，适宜用柴胡疏肝散。右胁痛，为肝经移病于脾（原文“肿”疑为“脾”之误，结合上下文及推气散主治，此处按脾理解，但翻译保留原意或修正为脾，鉴于中医常识右胁多属脾/胆，推气散理气宽胸，常用于肝脾气滞，此处译为脾更准确，但若严格忠实原文“肿”字，可能指肿胀或笔误。考虑到冯楚瞻医案严谨性，极大概率为“脾”之形近误植，或者指肝胆病变引起的肿胀。此处暂译为“脾”，并在括号注明），适宜用推气散。食积痛，凡是疼痛有一条隆起的是，应当在积证门类中参考。气弱之人胁痛，脉象细紧或弦，多因劳累和怒气所致，用八物汤加木香、青皮。肥白人气虚，发寒热而胁下痛，用人参补气，加柴胡、木香、青皮调气。瘦人发寒热胁痛多怒的，必有瘀血，适宜用桃仁、红花、柴胡、青皮、大黄、滑石，去除滞气必须用青皮，它是肝胆二经的药物。如果这两经血不足，先应当补血，稍加青皮。痰饮停伏胁痛，适宜用导痰汤。胁下痛而大便秘结的，用木香槟榔丸。虚寒作痛的，必须用辛温补剂，加调气药。
解痛可以用琥珀膏贴敷，或用白芥子水研磨敷贴；或用吴茱萸醋研磨敷贴；韭菜炒热熨烫也可以。有人因房劳内伤，胁下一点痛，名叫干胁痛，难以治愈，应当大补气血以养肝火，滋肾水以补母（肝肾同源，滋水涵木）。左胁痛和胃脘痛两种病症，妇女多见。因为忧思忿怒之气，平时蓄积在体内，发作时向上冲逆，被湿痰、死血阴滞其气，血不得条达，所以清阳不升，浊阴不降，肝木之邪，得以乘机侵侮而为病，所以治疗妇人各种疼痛和各种疾病，必须以行气开郁为主，兼以破血散火。谚语说：香附、缩砂，是妇人的至宝，山药、肉苁蓉，是男子的佳珍，说的就是这个道理。以上论述胁痛。
Treat acute heart pain and stomach pain.
Wulingzhi (Trogopterus Dung, *Trogopterori Faeces*) (remove sand and stones) Xuanmingshuo (Mirabilite, *Natrii Sulfas*) (stir-fried, peel removed) Peng'ezhu (Curcuma Zedoaria Rhizome, *Zedoariae Rhizoma*) (roasted) Danggui (Angelica Sinensis Root, *Angelicae Sinensis Radix*) Liangjiang (Galangal Rhizome, *Alpiniae Officinarum Rhizoma*) (stir-fried, equal parts each)
Grind into fine powder. Take three qian per dose, mixed with hot vinegar water for administration.
Treat heart and spleen pain in men and women.
Wulingzhi (Trogopterus Dung, *Trogopterori Faeces*) Binglang (Areca Seed, *Arecae Semen*) (equal parts each)
Grind into fine powder. Take three qian per dose. The night before, cook pork thoroughly with salt and soy sauce, let the patient chew it finely and then spit it out, to guide the parasites' heads upward. Then decoct Changpu (Acorus Tatarinowii Rhizome, *Acori Tatarinowii Rhizoma*) soup to mix with the medicine powder and take it, to eliminate parasites.
The *Classic* states: South wind arises in summer, disease affects the Heart, symptoms manifest in the chest and hypochondrium; this attributes the chest to the Heart. When the Liver is deficient, chest pain radiates to the back and hypochondrium; when the Liver is excess, chest pain prevents turning the body; this again attributes the chest to the Liver. The fullness in the chest belongs to the field of the Lung. The mention of the Heart is because the Heart meridian ascends from the Heart system to the Lung. The mention of the Liver is because the Liver meridian penetrates the diaphragm and flows upward into the Lung. However, chest pain is essentially diaphragmatic pain. It differs from heart pain in that heart pain is located at the depression of the xiphoid process (Qigu), whereas chest pain is horizontally full between the chest and both hypochondria. It differs from epigastric pain in that epigastric pain is below the Heart, while chest pain is above the Heart.
The *Suwen* states: Those with chest pain and shortness of breath have water qi stagnating in the zang-fu organs. Water belongs to Yin qi. With Yin qi stagnant in the middle, chest pain and shortness of breath occur. Therefore, the Yang qi in the chest is like the sun shining in the sky, vast and boundless; if Earth qi (turbid Yin) rises, obstruction increases. Thus, turbid qi in the upper jiao generates distension. Chest Bi (impediment) is a sign of counterflow of Yin qi.
Zhang Zhongjing uses Xiexie Baijiu Tang (Allium Macrostemon and White Wine Decoction) to benefit Yang in mild cases, and Fuzi Ganjiang Tang (Aconite and Dried Ginger Decoction) to dissipate Yin in severe cases. People today do not know what Chest Bi is, habitually using Doukou (Cardamom Fruit, *Amomi Fructus*), Muxiang (Aucklandia Root, *Aucklandiae Radix*), Sanleng (Sparganium Rhizome, *Sparganii Rhizoma*), Shenqu (Medicated Leaven, *Massa Medicata Fermentata*) and other drugs, thereby wasting the Yang qi in the chest and worsening the condition.
Due to irregular diet and excessive labor, causing deficiency of the Spleen Earth, allowing Liver Wood to invade the Earth position, resulting in epigastric pain centered on the heart region, attacking upwards to both hypochondria, with diaphragmatic blockage. The pulse is deep, wiry, and forceful. Use Guipi Tang (Restore the Spleen Decoction) with added Shaoyao (Peony Root, *Paeoniae Radix Alba*), decocted with Shengjiang (Fresh Ginger, *Zingiberis Recens Rhizoma*) and Dazao (Jujube Fruit, *Ziziphi Jujubae Fructus*) as guides.
Dai Shi said: In people with Kidney deficiency due to sexual exhaustion, there is often dull pain in the chest and diaphragm. This is because Kidney deficiency fails to grasp Qi, and Qi deficiency fails to generate Blood. Qi and Blood are like water; when abundant, they flow smoothly; when deficient, stagnation is inevitable, causing pain. Use Gubuzi (Psoralea Fruit, *Psoraleae Fructus*) to tonify the Kidney, and Xiong/gui (Chuanxiong and Danggui) to tonify Blood. Treating this as ordinary hypochondriac pain would be dangerous.
A specific point of pain at the Gate of Diaphragm, pulling and causing pain, with a sensation of tightness in the skin upon inhalation, indicates stagnant blood. Use Huashi (Talcum, *Talcum*), Taoren (Peach Kernel, *Persicae Semen*), Huanglian (Coptis Rhizome, *Coptidis Rhizoma*), Zhike (Bitter Orange Fruit, *Citri Reticulatae Viridis Fructus*) ground into powder, decocted in Luobo juice (Radish Juice, *Raphani Sativi Sucus*) and drunk. (Above discusses Chest Bi). For chest and hypochondriac pain due to Phlegm flow and Qi stagnation, (pulse is deep, choppy, and fine); due to Wind-Cold, (pulse is floating, wiry, and rapid); due to Food Stagnation, (pulse is deep, wiry, and hidden); due to Phlegm-Fluids, (pulse may be wiry and slippery, or knotted and intermittent); due to Dead Blood (Stasis), (pulse is deep and choppy); due to Deficiency, (pulse is wiry, fine-rapid, or large and powerless); due to Fire, (pulse is surging, slippery, and rapid). These must be categorized and distinguished clearly, treating left and right differently. The *Classic* states: Left and right are the pathways of Yin and Yang, where Qi ends and begins. It also states: Excess Liver Wood Qi causes hypochondriac disease. "Excess" refers to pathogenic factors. The *Classic* states: Abundant pathogenic factors constitute Excess. It also states: Shaoyang's mention of "heart and hypochondriac pain" refers to Shaoyang abundance. Abundance is the exterior manifestation of the Heart. (When Heart Qi rebels, Shaoyang becomes abundant; the Foot-Taiyang meridian runs through the hypochondrium, emerging at Qichuang; the Hand-Jueyin Pericardium meridian runs through the chest, emerging at the hypochondrium, hence this.)
The *Classic* states: The great collateral of the Stomach is named Xuli, penetrating the diaphragm and connecting to the Lung, emerging below the left breast. Its pulsation is visible through clothing. This is the pulse of Zongqi (Gathering Qi). (Generally, pulsation below the left breast visible through clothing indicates leakage of Zongqi, thus termed a death sign.)
Danxi said: Wandering pain in both hypochondria due to Phlegm Excess can use Kongxian Dan (Control Fluids Pill). Left hypochondriac pain is due to pathogenic invasion of the Liver meridian; use Chaihu Shugan San (Bupleurum Powder to Soothe the Liver). Right hypochondriac pain is due to Liver pathology transferring to the Spleen (Note: Original text says "swelling", but context implies Spleen/Liver-Spleen disharmony treated by Tuiqi San); use Tuiqi San (Push Qi Powder). Food stagnation pain is characterized by a raised line of pain; refer to the Food Stagnation category. For Qi-deficient individuals with hypochondriac pain, pulse fine-tight or wiry, often caused by labor and anger, use Bawu Tang (Eight Substance Decoction) with Muxiang and Qingpi (Green Tangerine Peel, *Citri Reticulatae Pericarpium*). For fat, white-complexioned individuals with Qi deficiency, fever/chills, and lower hypochondriac pain, use Renshen (Ginseng Root, *Panacis Ginseng Radix*) to tonify Qi, plus Chaihu (Bupleurum Root, *Bupleuri Radix*), Muxiang, and Qingpi to regulate Qi. For thin individuals with fever/chills, hypochondriac pain, and irritability, there must be Blood stasis; use Taoren, Honghua (Safflower, *Carthami Flos*), Chaihu, Qingpi, Dahuang (Rhubarb Root, *Rhei Radix et Rhizoma*), Huashi. To remove stagnation, Qingpi is essential as it enters the Liver and Gallbladder meridians. If these two meridians lack Blood, first tonify Blood, adding a small amount of Qingpi. For Phlegm-Fluids retention causing hypochondriac pain, use Daotan Tang (Guiding Phlegm Decoction). For hypochondriac pain with constipation, use Muxiang Binglang Wan (Aucklandia and Areca Pill). For pain due to Deficiency-Cold, use acrid-warm tonics with Qi-regulating herbs.
To relieve pain, apply Hupo Gao (Amber Plaster) or paste made from Baijiezi (White Mustard Seed, *Sinapis Albi Semen*) ground in water; or paste made from Wuzhuyu (Evodia Fruit, *Evodiae Fructus*) ground in vinegar; stir-fried Chinese chives applied warm is also effective. For those with internal injury from sexual exhaustion having a single point of pain in the hypochondrium, named Gan Xietong (Dry Hypochondriac Pain), it is difficult to cure. Tonify Qi and Blood greatly to nourish Liver Fire, and nourish Kidney Water to supplement the Mother (Liver-Kidney relationship). Left hypochondriac pain and epigastric pain are common in women. Due to pent-up Qi from worry, thought, and anger, which rushes upward upon onset, obstructed by damp-phlegm and dead blood, preventing smooth flow of Blood, causing Clear Yang not to ascend and Turbid Yin not to descend, allowing Liver Wood pathogens to invade opportunistically. Therefore, treating various pains and diseases in women must focus primarily on moving Qi and resolving stagnation, supplemented by breaking Blood and dispersing Fire. As the proverb says: Xiangfu (Cyperi Rhizome, *Cyperi Rhizoma*) and Suosha (Amomum Fruit, *Amomi Fructus*) are treasures for women; Shanyao (Dioscorea Rhizome, *Dioscoreae Rhizoma*) and Congrong (Cistanche Stem, *Cistanches Herba*) are fine treasures for men. This is what is meant. Above discusses hypochondriac pain.