〔丹〕心痛即胃脘痛。凡心痛，必用温药。此是郁结不行，阻气不运，故痛在下者多属食，
宜温利之。大凡心膈痛，须分新久，若明知身受寒气，口吃寒物而得者，于初得之日，当与温散
或温利之。
温散，谓治身受寒气于外者，如陈无择麻黄桂枝汤，治外因心痛之类是也。（方见表条。）
温利，谓治口食寒物于里者，如仲景九痛丸、洁古煮黄丸，治大实心痛之类是也。（方见实条。）
若曰∶病得之稍久则成郁，久郁则蒸热，热久必生火，《原病式》中备言之矣。若欲行温
散温利，宁无助火添病耶？由是方中多以山栀为热药之向导，则邪易伏，病易退，正气复而病安矣。
然病安之后，若恣纵口味，不改前非，病复作时，乃委咎于医，误也。大概胃口有热而作痛，非山
栀不可，须姜汁佐之，多用台芎开之。用山栀炒去皮，每十五枚，煎浓汤一呷，入姜汁令辣，再煎少
沸，吞九枚，加川芎一钱尤妙。又方，用山栀去壳炒黄为末，以姜汁调粥丸。有寒者，加草豆蔻末
丸服之。
又方 治气实心痛。
山栀（去壳，炒焦，六钱） 香附（一钱） 茱萸（一钱）
上为末，炊饼丸如花椒大。以生地黄用酒洗净，同生姜煎汤下二十丸，外用胡椒、荜茇各半
两为末，以醋调捏成丸子吞之。
心痛方
黄连（炒） 山栀（炒） 茱萸（各五钱） 荔枝核（烧存性为末，三钱） 滑石
上为末，姜汁化炊饼为丸。
又方治心痛。
白术 白芍药 砂仁 半夏 当归（各三钱） 桃仁 甘草 黄连 神曲（炒） 陈皮 吴茱
萸（各一钱半） 僵蚕 人参（各一钱）
又方 二陈汤加川芎、苍术，倍加炒栀。痛甚者加炒干姜。此从治反治之法。
〔《保》〕寒厥心痛者，手足逆，而通身冷汗出，便利溺清，或大便利而不渴，气微力弱，急
宜以术附汤温之。寒厥暴痛，非久病也，朝发暮死，宜急救之，是知久病非寒，暴病非热也。
术附汤治寒厥暴心痛，脉微气弱。（即仲景术附汤也。）
附子（炮去皮脐，一两） 白术（四两） 甘草（炙，一两）
上粗末，附子令匀，每三钱，水一盏半，姜五片，枣一枚，煎至一盏去渣，温服食前。
〔罗〕胃脘当心而痛治验 漕运使崔君长男云卿，年二十五，体本丰肥，奉养膏粱，时时有热
证，友人劝食寒凉物，因服寒药，至元庚辰秋疟发，医以砒霜等药治之，新汲水下，禁食热物，疟
病未除，反添吐泻，脾胃复伤，中气愈虚，腹痛肠鸣，时复胃脘当心而痛，不任其苦，屡医未效，
至冬不瘥。延至四月间，劳役烦恼过度，前证大作，请予治之。诊视脉得弦细而微，手足稍冷，
面色清黄不泽，情思不乐，恶人烦冗，饮食减少，微饱则心下痞闷，呕吐酸水，每发作冷汗时出，
气促闷乱不安，须人额相抵而坐，少时易之。予思《内经》云∶中气不足，溲便为之变，肠为之
苦鸣。下气不足，则为痿厥心冤。又曰∶寒气客于肠胃之间，则卒然而痛，得热则已。非甘辛大
热之剂，则不能愈，遂制一方名曰扶阳助胃汤。
附子（炮，去皮脐，二钱） 干姜（炮，一钱半） 草豆蔻 益智仁 拣参 甘草（炙） 官桂
白芍药（各一钱） 吴茱萸 陈皮 白术（各五分）
《内经》曰∶寒淫于内，治以辛热，佐以苦温。附子、干姜大辛热，温中散寒，故以为君。草
豆蔻、益智仁辛甘大热，治客寒犯胃为佐。脾不足者，以甘补之，炙甘草甘温，白术、陈皮苦温，
补脾养气。水挟木气亦来侮土，故作急痛。桂辛热以退寒水，芍药味酸以泻木来克土。吴茱萸苦热，
泄厥气上逆于胸中为使。上锉如麻
豆大，都作一服，水二盏，姜三片，枣二枚，同煎至一盏去渣，温服食前。三服大势去，痛减半。至
秋先灸中脘三七壮，以助胃气。次灸气海百余壮，生发元气，滋荣百脉，以还少丹服之，喜饮
食，添肌肉，皮肤润泽。明年春，灸三里二七壮，乃胃之合穴，亦助胃气，引气下行，又以芳香
助脾，服育气汤加白檀香平治之。戒以惩忿窒欲，慎言语，节饮食，一年而平复。
〔《保》〕热厥心痛者，身热足冷，痛甚则烦躁而吐，额上自汗，知为热也。其脉洪大，宜灸
太溪、昆仑，表里俱泻之，是为热病引热下行，汗通身出者安也。灸后与金铃子散，痛止服枳实
白术丸，去其余邪也。
金铃子散治热厥心痛，或作或止，久不愈者。
金铃子 玄胡索（各一两）
上为末，每服三钱，酒调下。痛止与枳术丸。
〔《外》〕疗峭心痛。熊胆如大豆许，和水服大效。（本草∶熊胆味苦寒。）
〔仲〕心中寒者，其人病心中如啖蒜状，剧者心痛彻背，背痛彻心，譬如蛊注，其脉浮者，
自吐乃愈。
经云∶寒气客于背俞之脉，则血脉涩，血脉涩则血虚，血虚则痛。其俞注于心，故相引而痛。
按之则热气至，热气至则痛止矣。此亦寒气客心背而痛也。
心痛彻背，背痛彻心，乌头赤石脂丸主之。
蜀椒（一两） 乌头（炮，一分） 附子（炮，半两） 干姜（炮，一两） 赤石脂（一两）
上五味，为末蜜丸如桐子大。先食服一丸，日服三，不效稍加服。
胸痹不得卧，心痛彻背者，栝蒌薤白半夏汤主之。
栝蒌实（一枚） 薤白（三两） 白酒（一斗） 半夏（半升）
上四味，同煮至四升，服一升，日三服。
心胸中大寒痛，呕不能饮食，腹中寒上冲皮起，出见有头足，上下痛而不可触近，大建中汤
主之。
蜀椒（二合，去汗） 干姜（四两） 人参（二两）
上三味，以水四升，煮取二升去渣，纳胶饴一升，微火煎取一升半，分温再服。如一炊顷，
可饮粥二升，后更服，当一日食糜，温覆之。
心中痞，厥逆心悬痛，桂枝生姜枳实汤主之。
桂枝 生姜（各一两） 枳实（五个）
上三味，以水六升，煮取三升，分温三服。
〔《圣》〕治寒疝心痛，四肢逆冷，全不饮食。用桂心二两去皮，捣罗为散，不计时候，
热酒调下一钱匕。
〔世〕果附汤治寒气心痛。
附子 草果 良姜（等分）
以酒煎服，立效。
〔罗〕二姜丸养脾温胃，去冷消痰。大治心脾疼，宽胸下气进饮食，及一切冷物所伤，并
皆治之。
干姜（炮） 良姜
上等分，为细末，面糊丸如桐子大。每服十五丸至二十丸，食后陈皮汤。妊娠妇人不宜服。
上方，辛甘热以散寒结。
〔世〕治心痛累效。冰梅一个去核，生硫黄为末，相和捣匀，以可丸为度，作一丸，白汤下
立愈，病不再作。
上方，酸热以收散寒，凡服辛剂反甚者，改服酸剂立愈也。
〔丹〕客寒犯胃，草豆蔻丸主之。热亦宜用，止可一二服。
草豆蔻（一钱四分，面裹煨熟，去皮脐） 吴茱萸（汤泡洗，焙干） 益智仁 僵蚕（炒）
归身 青皮（各六分） 神曲 姜黄（各四分） 生甘草（三分） 桃仁（去皮，七个） 半夏（汤泡
七次，一钱） 泽泻（一钱，小便利减半） 麦 （炒黄，一钱半） 炙甘草（六分） 柴胡（四分，
详胁下痛多少与之） 人参 黄 陈皮
上一十八味，除桃仁另研如泥外，为极细末同研匀，汤浸炊饼为丸，如桐子大。每服三
十丸，热白汤送下，食远，旋斟酌多少用之。
监县之 ，年五十余，春末心脾疼，自言腹胀满，手足寒过肘膝，须绵裹火烘，胸襟畏热，
却喜掀露，得风凉则快，脉皆沉细而涩，稍重则绝，轻取似弦而短，口渴干而喜热饮，谷肉全不
食。遂以草豆蔻丸三倍，加黄连、滑石、炒神曲为丸，白术为君，茯苓为佐，陈皮为使，作
汤送下一百丸，服至二斤，诸证皆愈。
以物柱按而痛者挟虚，以二陈汤加炒干姜和之。
按之痛止者为虚，治法并见寒心痛条。丹溪云∶草豆蔻丸治气馁弱人心痛。方见寒热通用条。
〔仲〕九痛丸治九种心痛。
附子（三两，炮） 生野狼牙（一两，炙香） 巴豆（一两，去皮心，炒，研如脂） 人参
干姜 吴茱萸（各一两）
上六味为末，炼蜜丸如桐子大。酒下。强人初服三丸，日三服。弱者二丸。兼治卒中恶，
腹胀痛，口不能言，又治连年积冷流注心胸痛，并冷肿上气，落马坠车血疾等证皆主之。忌口如
常法。
〔洁〕煮黄丸 治大实心痛。（方见饮食内伤。）
本汤治大实心痛，大便已利，宜以此彻其痛也。
本（半两） 苍术（一两）
上锉，每服一两，水二盏煎至半盏，温服。
上寒实。
〔仲〕按之心下满痛者，此为实也，当下之，宜大柴胡汤。（方见伤寒。）
〔子和〕一将军病心痛不可忍。戴人曰∶此非心痛，乃胃脘当心痛也。《内经》曰∶岁木太过，
民病胃脘当心而痛。乃与神佑丸一百余粒，病不减。或曰∶此胃脘有寒，宜温补，不宜与凉剂。将
军素知戴人明了，复求
药于戴人，戴人复与神佑丸二百粒作一服，大下六七行立愈。（神佑丸方见水肿门。）
上热实。
〔丹〕蒋氏子年十六，久疟方愈十日，而心脾大痛，两手脉皆伏，痛稍杀时，气口紧盛，余脉皆
弦实而细。予曰∶此宿食也。询之，因食冷油煎堆子。遂以小胃丹，津咽十余粒，仍断饮食，经三日，
凡与小胃丹十二次，痛不作，至晚下忽大痛，连及两胁。予曰∶此必与谷太早。问之果然。遂断其
饮食，亦不与药，盖宿积已因小胃而稍解其痛，又因新谷与余积相并而复作，若又攻击，必大伤胃气，
所以不与药。又断食三日，其家大恐，以为不救，时有怨言。予曰∶六日不能思食，强禁不与，方成
恶候，待其索食与之，又须较量方可。至夜更余，心嘈索食，予先用白术、黄连、陈皮作丸子，遂
以热汤下七八十丸，以除其嘈杂。若以为饥而与粥，其痛必如前矣。其家苦欲与。予询病者膈间莫尚闷
否？答曰∶或才饥作，必继之薄闷。今虽未甚快然，亦未尝思食。过两时许，又索食，予以前丸与之。
如是者，又一昼夜，饥不再作，人亦昏困思睡。予教以用稀粥减平日之半，两日禁其杂食，调理半月
而安。（小胃丹方见饮食内伤。）
〔《保》〕心痛用小胃丹，津下十五丸。
上渐除热宿食积法。
〔世〕木香丸治食积心痛。
木香 丁香 三棱 蓬术 青皮 陈皮（各二钱半） 槟榔（二钱） 白豆蔻（一钱） 巴豆
肉（十五粒，用醋煮令无白心）
上末，醋糊丸，麻子大。
〔《本》〕治一切积聚有饮，心痛， 砂丸。
砂 三棱（另末） 干姜 香白芷 巴豆（去油。各半两） 大黄（另末） 干漆（各半两）
木香 青皮 胡椒（各一分） 槟榔 肉豆蔻（各一个）
上为细末，酽醋二升，煎五七沸，后下三棱、大黄末，同煎五七沸，入 砂同煎成膏，稀稠得
所，入诸药
和匀，杵丸如绿豆大，年深成块，生姜汤下四五丸。食积，熟水下。白痢，干姜汤下。赤痢，甘
草汤。白痢，当归汤，葱酒亦得。
〔洁〕浓朴丸、紫菀丸 治积聚心痛。（浓朴丸方见翻胃，紫菀丸方见积块。）
〔仲〕心伤者，其人劳役，即头面赤而下重，心中痛而自烦，发热脐跳，其脉弦，此为心脏所
伤也。
〔丹〕心痛轻者散之，麻黄、桂枝，重者加石碱，用川芎、苍术、炒山栀作丸服。
桂枝 麻黄 石碱
上为末，姜汁浸，炊饼为丸，桐子大。热姜汤下十五丸。如服丸数多，又治痰饮。
〔无〕麻黄桂枝汤治外因心痛，恶寒发热，内攻五脏，拘急不得转侧。
麻黄（去节，汤浸焙） 桂心 芍药 细辛（去苗） 干姜 甘草（炙。各七钱半）
半夏 香附（各五钱）
上锉，每五钱，水盏半，生姜五片，煎七分去渣，食前服，大便秘入大黄，量虚实加减。
〔世〕治心疼甚效。
槟榔 桂心 葛根 甘草 细辛 半夏 桔梗 枳壳 川芎 防风
上等分，惟甘草半之，水煎服。有人心疼，诸药不效，服此愈。
〔丹〕青岩刘山长子，年三十六岁，得心疼十八年矣。因酒饮牛乳，病发时，饮食无碍。得病
八年后，盛暑及沐浴饮食时，皆无汗，中间更医不一，悉以丁附诸丹等热药治之。至是黄瘦食减，
若不胜衣，痛作时须以一物拄之。诊其脉，皆三至弦弱而涩。未风先寒，大便或闭或泄，最苦是
胸膈吞酸。七月内，遂以二陈汤加白术、黄连、黄芩、桃仁、郁李仁、泽泻，每旦用此药饮而出之，
所吐皆苦黑水，杂以如浸木耳片者。此日却再与两帖，饮而不出，如此两月，近二百余帖，涩脉
渐退，至数渐添。忽一日诊其脉纯弦，渐有充满之状，时正立冬后，颇暄暖，意其必欲作汗，又
意其血气未充，汗难以发。以人参、黄 、芍药、当归、陈皮、半夏、甘草，调理二日，此时痛虽
缓，每昼夜一二作。至第三日，与麻黄、苍术、当归、川芎、甘草等药，才下咽，目
上视口噤，面无神色。予呼之不应，见其四肢不收，急以左手抱其头，就坐于床，以右手拇指
捻其人中，须臾而愈，通体汗如雨。自此痛不复作，但人倦，食未增耳。续又大为咽酸所苦，每
【朱丹溪】心痛即是胃脘痛。凡是心痛，必须使用温性药物。这是因为气机郁结不畅，阻碍了气的运行，所以疼痛部位在下部的多属于食积，适宜用温通利下的方法治疗。大凡心膈部位的疼痛，必须区分新病和久病。如果明确知道是因为身体感受寒邪，或口食生冷食物而导致的，在刚发病的日子里，应当给予温散或温利的方药。
所谓“温散”，是指治疗因外感寒邪于体表的病症，例如陈无择的麻黄桂枝汤，就是治疗外因所致心痛的例子。（方剂见表证条。）
所谓“温利”，是指治疗因内伤生冷食物于体内的病症，例如张仲景的九痛丸、李洁古的煮黄丸，就是治疗大实心痛（实证剧烈心痛）的例子。（方剂见实证条。）
如果说：疾病时间久了就会形成郁滞，长期郁滞则会蒸腾发热，热久了必然生火，《原病式》中对此已有详尽论述。如果想要施行温散或温利之法，难道不会助长火势、增加病情吗？因此，在方剂中多以山栀作为热药的向导，这样邪气容易伏藏，疾病容易消退，正气恢复而病愈。然而病愈之后，如果放纵口味，不改正以前的错误，当疾病复发时，却将过错推卸给医生，这是错误的。大概胃口有热而引发疼痛，非山栀不可，必须用姜汁辅助，多用台芎（川芎的一种）来开郁。使用方法是将山栀炒后去皮，取十五枚，煎浓汤一口量，加入姜汁使其辛辣，再煮沸片刻，吞服九枚，加川芎一钱效果更佳。另一个方子，用山栀去壳炒黄研末，以姜汁调粥做成丸药。如果有寒象，加草豆蔻末制成丸药服用。
又一个方子，治疗气实型心痛。
山栀（去壳，炒焦，六钱） 香附（一钱） 吴茱萸（一钱）
以上研为细末，用蒸饼做丸，如花椒大小。用生地黄洗净，同生姜煎汤送服二十丸。外用胡椒、荜茇各半两研末，用醋调成丸子吞服。
心痛方
黄连（炒） 山栀（炒） 吴茱萸（各五钱） 荔枝核（烧至存性研末，三钱） 滑石
以上研为细末，用姜汁化开蒸饼做成丸药。
又一个方子治疗心痛。
白术 白芍药 砂仁 半夏 当归（各三钱） 桃仁 甘草 黄连 神曲（炒） 陈皮 吴茱萸（各一钱半） 僵蚕 人参（各一钱）
又一个方子：二陈汤加川芎、苍术，加倍使用炒山栀。疼痛剧烈的加炒干姜。这是从治和反治的方法。
【《保命集》】寒厥心痛的症状是，手足逆冷，全身冷汗出，大小便清长，或者大便通畅但不口渴，气息微弱，体力虚弱，急需用术附汤温补。寒厥引起的突发剧痛，不是久病，早晨发作晚上可能死亡，应该急救，由此可知久病多非纯寒，暴病多非纯热。
术附汤治疗寒厥突发心痛，脉微气弱。（即张仲景的术附汤。）
附子（炮制，去皮脐，一两） 白术（四两） 甘草（炙，一两）
以上捣成粗末，混合均匀，每次取三钱，加水一盏半，生姜五片，大枣一枚，煎至一盏，去渣，饭前温服。
【罗天益】胃脘当心而痛的治验：漕运使崔君长子云卿，二十五岁，体质原本丰肥，饮食膏粱厚味，时常有热证表现。友人劝食寒凉之物，于是服用寒药。至元庚辰年秋天疟疾发作，医生用砒霜等药物治疗，用新汲水下服，禁止食用热物。疟疾未除，反而增添了呕吐腹泻，脾胃再次受伤，中气更加虚弱，腹痛肠鸣，时常出现胃脘当心而痛，无法忍受其痛苦，多次就医无效，直到冬天也未痊愈。延至四月间，因劳役烦恼过度，前述症状大作，请我诊治。诊脉得弦细而微，手足稍冷，面色清黄无光泽，心情不乐，厌恶人事烦冗，饮食减少，稍微吃饱则心下痞闷，呕吐酸水，每次发作时冷汗出，气促闷乱不安，需要让人额头相抵坐着休息，过一会儿才能缓解。我思考《内经》说：中气不足，小便和大便会发生变化，肠道会发出鸣响。下气不足，则会导致痿厥和心中冤抑作痛。又说：寒气客居在肠胃之间，就会突然疼痛，得到温热就会停止。如果不是甘辛大热的药剂，就不能治愈，于是配制一方名为扶阳助胃汤。
附子（炮制，去皮脐，二钱） 干姜（炮制，一钱半） 草豆蔻 益智仁 拣选的人参 甘草（炙） 官桂 白芍药（各一钱） 吴茱萸 陈皮 白术（各五分）
《内经》说：寒邪淫溢于内，用辛热药物治疗，辅以苦温药物。附子、干姜大辛大热，能温中散寒，所以作为君药。草豆蔻、益智仁辛甘大热，治疗客寒犯胃，作为佐药。脾不足的，用甘味补益，炙甘草甘温，白术、陈皮苦温，补脾养气。水气挟带木气来侮土，所以发生急痛。桂枝辛热以退寒水，芍药味酸以泻木气克制土气。吴茱萸苦热，泄厥逆之气上冲胸中，作为使药。以上切碎如麻豆大，共为一服，加水二盏，生姜三片，大枣二枚，同煎至一盏，去渣，饭前温服。服三剂后大势已去，疼痛减半。到秋天先灸中脘穴三七壮，以助胃气。接着灸气海穴百余壮，生发元气，滋养百脉，服用还少丹，喜欢饮食，肌肉增加，皮肤润泽。第二年春天，灸足三里穴二七壮，这是胃的合穴，也能助胃气，引气下行，又用芳香药物助脾，服用育气汤加白檀香平治。告诫他戒除愤怒，节制欲望，慎言语，节饮食，一年而康复。
【《保命集》】热厥心痛的症状是，身热足冷，疼痛剧烈则烦躁而吐，额头自汗，知道这是热证。其脉洪大，宜灸太溪、昆仑穴，表里俱泻，这是热病引热下行，汗出遍身者安。灸后给予金铃子散，痛止后服用枳实白术丸，去除其余邪。
金铃子散治疗热厥心痛，或作或止，久不愈者。
金铃子 玄胡索（各一两）
以上研为细末，每次服三钱，酒调下。痛止后与枳术丸。
【《外台秘要》】疗峭心痛。熊胆如大豆大小，和水服下，效果显著。（本草记载：熊胆味苦寒。）
【张仲景】心中寒的患者，病人感觉心中像吃了蒜一样辛辣难受，严重的疼痛放射至背部，背痛放射至心脏，如同蛊注病，其脉浮的，自行呕吐后痊愈。
经文说：寒气客居在背俞之脉，则血脉涩滞，血脉涩滞则血虚，血虚则痛。其俞穴注于心，所以相互牵引而痛。按压则热气至，热气至则痛止。这也是寒气客居心背而致的疼痛。
心痛放射至背部，背痛放射至心脏，用乌头赤石脂丸主治。
蜀椒（一两） 乌头（炮制，一分） 附子（炮制，半两） 干姜（炮制，一两） 赤石脂（一两）
以上五味药，研为细末，炼蜜为丸，如梧桐子大。空腹服一丸，每日三次，无效稍加剂量。
胸痹不能卧，心痛放射至背部的，用栝蒌薤白半夏汤主治。
栝蒌实（一枚） 薤白（三两） 白酒（一斗） 半夏（半升）
以上四味药，同煮至四升，服一升，每日三次。
心胸中大寒痛，呕吐不能饮食，腹中寒气上冲皮起，出现有头足的肿块，上下疼痛且不可触碰，用大建中汤主治。
蜀椒（二合，去汗） 干姜（四两） 人参（二两）
以上三味药，加水四升，煮取二升，去渣，加入胶饴一升，微火煎取一升半，分两次温服。如一顿饭的时间，可饮粥二升，之后再服，应当一天吃糜粥，注意保暖。
心中痞满，厥逆心悬痛，用桂枝生姜枳实汤主治。
桂枝 生姜（各一两） 枳实（五个）
以上三味药，加水六升，煮取三升，分三次温服。
【《圣济总录》】治疗寒疝心痛，四肢逆冷，完全不能饮食。用桂心二两去皮，捣罗为散，不限时候，热酒调下一钱匕。
【世传方】果附汤治疗寒气心痛。
附子 草果 良姜（等分）
以酒煎服，立即见效。
【罗天益】二姜丸养脾温胃，去冷消痰。主要治疗心脾疼，宽胸下气增进饮食，以及一切冷物所伤，都加以治疗。
干姜（炮制） 良姜
以上等分，为细末，面糊丸如梧桐子大。每次服十五丸至二十丸，饭后陈皮汤送下。妊娠妇人不宜服用。
上方，辛甘热以散寒结。
【世传方】治疗心痛屡效。冰梅一个去核，生硫黄研末，混合捣匀，以能做成丸药为度，做成一丸，白开水送下，立即痊愈，病不再发作。
上方，酸热以收散寒，凡是服用辛散剂反而加重的，改服酸剂立即痊愈。
【朱丹溪】客寒犯胃，用草豆蔻丸主治。热证也适宜使用，只可服用一二剂。
草豆蔻（一钱四分，面裹煨熟，去皮脐） 吴茱萸（汤泡洗，焙干） 益智仁 僵蚕（炒） 归身 青皮（各六分） 神曲 姜黄（各四分） 生甘草（三分） 桃仁（去皮，七个） 半夏（汤泡七次，一钱） 泽泻（一钱，小便利减半） 麦 （炒黄，一钱半） 炙甘草（六分） 柴胡（四分，根据胁下痛多少而定） 人参 黄芪 陈皮
以上十八味药，除桃仁另研如泥外，其余为极细末同研匀，汤浸蒸饼为丸，如梧桐子大。每次服三十丸，热白开水送下，食远时服用，随时斟酌用量。
监县的某位官员，五十多岁，春末心脾疼，自称腹胀满，手足寒冷超过肘膝，需要用绵包裹火烘，胸襟怕热，却喜欢掀开暴露，吹风凉爽则舒适，脉皆沉细而涩，重按则绝，轻取似弦而短，口渴干燥而喜热饮，谷肉全不进食。于是用草豆蔻丸三倍量，加黄连、滑石、炒神曲为丸，以白术为君药，茯苓为佐药，陈皮为使药，作汤送下一百丸，服至二斤，诸证皆愈。
以物体按压而痛者挟虚，用二陈汤加炒干姜调和。
按压后痛止者为虚，治法并见寒心痛条。丹溪说：草豆蔻丸治疗气馁弱人心痛。方剂见寒热通用条。
【张仲景】九痛丸治疗九种心痛。
附子（三两，炮制） 生野狼牙（一两，炙香） 巴豆（一两，去皮心，炒，研如脂） 人参 干姜 吴茱萸（各一两）
以上六味药为末，炼蜜为丸如梧桐子大。酒送下。强壮之人初服三丸，每日三次。体弱者二丸。兼治卒中恶气，腹胀痛，口不能言，又治连年积冷流注心胸痛，以及冷肿上气，落马坠车血疾等证都主治。忌口如常法。
【李洁古】煮黄丸 治疗大实心痛。（方剂见饮食内伤。）
本汤治疗大实心痛，大便已通利，宜以此彻其痛。
本（半两） 苍术（一两）
以上切碎，每次服一两，加水二盏煎至半盏，温服。
上属寒实。
【张仲景】按之心下满痛者，此为实证，当下之，宜大柴胡汤。（方剂见伤寒。）
【张子和】一位将军患心痛不可忍受。戴人（张子和号）说：这不是心痛，乃是胃脘当心而痛。《内经》说：岁木太过，民病胃脘当心而痛。于是给予神佑丸一百余粒，病不减。有人说：此胃脘有寒，宜温补，不宜与凉剂。将军素知戴人明了医理，再次求药于戴人，戴人再次给予神佑丸二百粒作一服，大下六七行立即痊愈。（神佑丸方见水肿门。）
上属热实。
【朱丹溪】蒋氏之子十六岁，久疟刚愈十日，而心脾大痛，两手脉皆伏，痛稍减时，气口紧盛，余脉皆弦实而细。我说：这是宿食。询问得知，因食冷油煎堆子。于是用小胃丹，津液咽下十余粒，仍断饮食，经过三天，凡与小胃丹十二次，痛不作，至晚下忽然大痛，连及两胁。我说：这必定是与谷太早。问之果然。于是断其饮食，也不给药，因为宿积已经因小胃丹而稍解其痛，又因新谷与余积相并而复作，如果再攻击，必大伤胃气，所以不给药。又断食三日，其家属非常恐惧，认为无法救治，时有怨言。我说：六日不能思食，强行禁食不给，才形成恶候，等待他索要食物给他，又须衡量方可。至夜更余，心中嘈杂索要食物，我先用白术、黄连、陈皮做丸子，遂以热汤下七八十丸，以除其嘈杂。如果以为饥而与粥，其痛必如前矣。其家属苦苦想要给粥。我询问病人膈间是否尚且闷否？回答说：有时饥饿发作，必继之以薄闷。现在虽然不是很痛快，但也未曾想进食。过了两个多小时，又索要食物，我用前面的丸子给他。像这样，又一昼夜，饥饿不再发作，人也昏困想睡。我教他用稀粥减平日之半，两天禁其杂食，调理半月而安。（小胃丹方见饮食内伤。）
【《保命集》】心痛用小胃丹，津下十五丸。
上述逐渐清除热宿食积的方法。
【世传方】木香丸治疗食积心痛。
木香 丁香 三棱 蓬术 青皮 陈皮（各二钱半） 槟榔（二钱） 白豆蔻（一钱） 巴豆肉（十五粒，用醋煮令无白心）
以上研末，醋糊丸，麻子大。
【《本草》】治疗一切积聚有饮，心痛，硇砂丸。
硇砂 三棱（另研末） 干姜 香白芷 巴豆（去油。各半两） 大黄（另研末） 干漆（各半两） 木香 青皮 胡椒（各一分） 槟榔 肉豆蔻（各一个）
以上为细末，酽醋二升，煎五七沸，后下三棱、大黄末，同煎五七沸，入硇砂同煎成膏，稀稠得当，入诸药和匀，杵丸如绿豆大，年深成块，生姜汤下四五丸。食积，熟水下。白痢，干姜汤下。赤痢，甘草汤。白痢，当归汤，葱酒亦得。
【李洁古】浓朴丸、紫菀丸 治疗积聚心痛。（浓朴丸方见翻胃，紫菀丸方见积块。）
【张仲景】心脏受损的人，其人劳役，即头面赤而下重，心中痛而自烦，发热脐跳，其脉弦，此为心脏所伤。
【朱丹溪】心痛轻者散之，麻黄、桂枝，重者加石碱，用川芎、苍术、炒山栀作丸服。
桂枝 麻黄 石碱
以上为末，姜汁浸，炊饼为丸，桐子大。热姜汤下十五丸。如服丸数多，又治痰饮。
【陈无择】麻黄桂枝汤治疗外因心痛，恶寒发热，内攻五脏，拘急不得转侧。
麻黄（去节，汤浸焙） 桂心 芍药 细辛（去苗） 干姜 甘草（炙。各七钱半） 半夏 香附（各五钱）
以上切碎，每次五钱，水盏半，生姜五片，煎七分去渣，食前服，大便秘入大黄，量虚实加减。
【世传方】治疗心疼甚效。
槟榔 桂心 葛根 甘草 细辛 半夏 桔梗 枳壳 川芎 防风
以上等分，惟甘草减半，水煎服。有人心疼，诸药不效，服此愈。
【朱丹溪】青岩刘山长子，三十六岁，得心疼十八年了。因饮酒喝牛乳，病发时，饮食无碍。得病八年后，盛暑及沐浴饮食时，皆无汗，中间更换医生不一，悉以丁附诸丹等热药治疗。至此黄瘦食减，若不胜衣，痛作时须以一物拄之。诊其脉，皆三至弦弱而涩。未风先寒，大便或闭或泄，最苦是胸膈吞酸。七月内，遂以二陈汤加白术、黄连、黄芩、桃仁、郁李仁、泽泻，每旦用此药饮而出之，所吐皆苦黑水，杂以如浸木耳片者。此日却再与两帖，饮而不出，如此两月，近二百余帖，涩脉渐退，至数渐添。忽一日诊其脉纯弦，渐有充满之状，时正立冬后，颇暄暖，意其必欲作汗，又意其血气未充，汗难以发。以人参、黄芪、芍药、当归、陈皮、半夏、甘草，调理二日，此时痛虽缓，每昼夜一二作。至第三日，与麻黄、苍术、当归、川芎、甘草等药，才下咽，目上视口噤，面无神色。予呼之不应，见其四肢不收，急以左手抱其头，就坐于床，以右手拇指捻其人中，须臾而愈，通体汗如雨。自此痛不复作，但人倦，食未增耳。续又大为咽酸所苦，每
[Zhu Danxi] Heart pain is essentially epigastric pain. For all heart pain, warm-natured herbs must be used. This is due to qi stagnation and obstruction of qi movement; therefore, pain located lower down mostly belongs to food retention and is suitable for treatment with warming and purging methods. Generally, pain in the heart and diaphragm region must be distinguished as either new or chronic. If it is known that the condition was caused by external cold invasion or ingestion of cold foods, on the day of onset, warming dispersal or warming purgation should be administered.
"Warming dispersal" refers to treating external cold affecting the exterior, such as Chen Wuyue's Mahuang Guizhi Tang (Cinnamon Twig and Ephedra Decoction), which treats heart pain caused by external factors. (Formula see Exterior Syndrome section.)
"Warming purgation" refers to treating internal cold from ingested cold foods, such as Zhang Zhongjing's Jiutong Wan (Nine Pains Pill) and Li Jiegu's Zhuhuang Wan (Boiled Yellow Pill), which treat severe excess-type heart pain. (Formula see Excess Syndrome section.)
One might argue: Diseases persisting for a long time become stagnant; long-term stagnation generates heat; prolonged heat inevitably produces fire, as detailed in *Yuan Bing Shi* (Original Causes of Disease). If one were to use warming dispersal or purgation, would it not aid fire and worsen the illness? Therefore, Gardenia (Zhizi) is often added to formulas as a guide for heat-clearing herbs, allowing pathogens to be subdued, diseases to recede, righteous qi to recover, and health to be restored. However, after recovery, if one indulges in dietary habits without correcting past errors, and the disease recurs, blaming the physician is mistaken. Generally, for stomach heat causing pain, Gardenia (Zhizi) is indispensable, assisted by ginger juice, and often combined with Chuanxiong (Rhizoma Chuanxiong) to open stagnation. The method is to stir-fry Gardenia (Zhizi), remove the skin, take fifteen fruits, decoct into a strong liquid equivalent to one sip, add ginger juice until spicy, boil briefly, and swallow nine fruits. Adding one qian of Chuanxiong is particularly effective. Another formula uses Gardenia (Zhizi), shelled and stir-fried yellow, ground into powder, mixed with ginger juice and congee to form pills. If cold signs are present, add powder of Tsaoko Cardamom Seed (Caodoukou) to form pills.
Another formula for Qi-excess type heart pain:
Gardenia (Zhizi) (shelled, stir-fried scorched, 6 qian) Cyperus Rhizome (Xiangfu) (1 qian) Evodia Fruit (Zhu Yu) (1 qian)
Grind into powder, make pills using steamed wheat dough, size of Sichuan pepper grains. Wash fresh Rehmannia Root (Sheng Dihuang) with wine, decoct with fresh ginger slices, and take twenty pills with this soup. Externally, use Pepper (Hujiao) and Long Pepper Fruit (Bibo), half liang each, ground into powder, mixed with vinegar to form pills for swallowing.
Heart Pain Formula:
Coptis Rhizome (Huanglian) (stir-fried) Gardenia (Zhizi) (stir-fried) Evodia Fruit (Zhu Yu) (5 qian each) Lychee Seed (Lizhi He) (burnt to retain nature, ground, 3 qian) Talcum (Huashi)
Grind into powder, mix with ginger juice and steamed wheat dough to form pills.
Another formula for heart pain:
Atractylodes Macrocephala Rhizome (Baizhu) White Peony Root (Baishao) Amomum Fruit (Sharen) Pinellia Tuber (Banxia) Angelica Sinensis Root (Danggui) (3 qian each) Peach Kernel (Taoren) Licorice Root (Gancao) Coptis Rhizome (Huanglian) Medicated Leaven (Shenqu) (stir-fried) Tangerine Peel (Chenpi) Evodia Fruit (Wuzhuyu) (1.5 qian each) Silkworm (Jiangcan) Ginseng Root (Renshen) (1 qian each)
Another formula: Erchen Tang (Two-Cured Decoction) plus Chuanxiong (Rhizoma Chuanxiong) and Atractylodes Rhizome (Cangzhu), with double the amount of stir-fried Gardenia (Zhizi). For severe pain, add stir-fried Dried Ginger (Ganjiang). This follows the method of following treatment and counter-treatment.
[From *Baoming Ji*] Cold-Jue type heart pain presents with cold extremities extending upwards, profuse cold sweat over the whole body, clear urine and stool, or frequent loose stools without thirst, weak breath, and low energy. It urgently requires warming with Shu Fu Tang (Atractylodes and Aconite Decoction). Sudden severe pain from Cold-Jue is not a chronic disease; morning onset may lead to evening death, requiring emergency rescue. Thus, chronic diseases are rarely pure cold, and sudden diseases are rarely pure heat.
Shu Fu Tang treats sudden Cold-Jue heart pain with faint pulse and weak qi. (This is Zhang Zhongjing's Shu Fu Tang.)
Prepared Aconite Root (Fuzi) (prepared, peel and navel removed, 1 liang) Atractylodes Macrocephala Rhizome (Baizhu) (4 liang) Prepared Licorice Root (Zhi Gancao) (1 liang)
Coarsely grind, mix evenly. Take 3 qian per dose, add 1.5 cups of water, 5 slices of ginger, 1 jujube. Decoct to 1 cup, strain, and take warm before meals.
[Luo Tianyi] Case Report of Epigastric Pain at the Heart Center: Cui Yunqing, eldest son of the Transport Commissioner, aged 25, originally robust and fat, accustomed to rich and fatty foods, frequently showing heat symptoms. Friends advised eating cooling foods, so he took cold medicines. In autumn of Gengchen year, malaria occurred. Physicians treated him with arsenic and other drugs, given with fresh well-water, and forbidden hot foods. Malaria was not cured; instead, vomiting and diarrhea increased, further injuring the spleen and stomach, weakening middle qi. Abdominal pain and borborygmus occurred, along with recurrent epigastric pain at the heart center. He could not bear the suffering; multiple treatments failed, and he remained unwell through winter. By April, excessive labor and worry exacerbated the condition. I examined him: pulse was wiry, fine, and faint; extremities slightly cold; complexion clear-yellow and lusterless; mood depressed; aversion to social bustle; reduced appetite; slight fullness led to chest oppression; vomiting sour fluid; attacks accompanied by cold sweat, shortness of breath, restlessness, requiring support with forehead touching another person to sit; relieved after a while. Reflecting on *Neijing*: "Deficiency of middle qi causes changes in urination and defecation, and intestinal borborygmus." "Deficiency of descending qi leads to flaccidity, jue, and heart oppression." Also: "Cold pathogen lodging between stomach and intestines causes sudden pain, relieved by warmth." Without sweet, acrid, and large-hot agents, cure is impossible. Thus, I formulated Fuyang Zhuwei Tang (Support Yang and Assist Stomach Decoction).
Prepared Aconite Root (Fuzi) (prepared, peel and navel removed, 2 qian) Prepared Dried Ginger (Pao Ganjiang) (1.5 qian) Tsaoko Cardamom Seed (Caodoukou) Alpinia Oxyphylla Fruit (Yizhiren) Selected Ginseng Root (Jianshen) Prepared Licorice Root (Zhi Gancao) Official Cassia Bark (Guangui) White Peony Root (Baishao) (1 qian each) Evodia Fruit (Wuzhuyu) Tangerine Peel (Chenpi) Atractylodes Macrocephala Rhizome (Baizhu) (0.5 qian each)
*Neijing* states: "When cold invades internally, treat with acrid-hot herbs, assist with bitter-warm herbs." Aconite and Dried Ginger are acrid-hot, warming middle and dispersing cold, thus serving as Sovereign herbs. Tsaoko Cardamom Seed and Alpinia Oxyphylla Fruit are acrid-sweet and large-hot, treating invading cold attacking the stomach, serving as Minister herbs. "Spleen deficiency is tonified with sweet"; Prepared Licorice Root is sweet-warm; Atractylodes and Tangerine Peel are bitter-warm, tonifying spleen and nourishing qi. Water qi carrying Wood qi insults Earth, causing acute pain. Cassia Bark is acrid-hot to dispel cold water; White Peony is sour to drain Wood qi overcoming Earth. Evodia Fruit is bitter-hot to drain rebellious jue qi rising to the chest, serving as Envoy herbs. Cut like hemp seeds. One dose: add 2 cups water, 3 ginger slices, 2 jujubes. Decoct to 1 cup, strain, take warm before meals. After three doses, major symptoms subsided, pain halved. In autumn, moxa Zhongwan (CV12) 21 moxa cones to assist stomach qi. Then moxa Qihai (CV6) over 100 cones to generate yuan qi, nourish vessels, and administer Hushao Dan (Restore Youth Pill). Appetite improved, muscles increased, skin became lustrous. Next spring, moxa Zusanli (ST36) 14 cones, the He-Sea point of the Stomach, also assisting stomach qi and guiding qi downward. Used aromatic herbs to assist spleen, administered Yuqi Tang (Nourish Qi Decoction) with White Sandalwood Powder (Baitan Xiang) for flat treatment. Advised to control anger, restrain desires, guard speech, and regulate diet. Recovered in one year.
[From *Baoming Ji*] Heat-Jue heart pain presents with body heat and cold feet; severe pain causes irritability and vomiting; forehead sweats spontaneously, indicating heat. Pulse is surging and large. Moxibustion at Taixi (KI3) and Kunlun (BL60) is indicated to drain both interior and exterior. This draws heat downward in heat diseases; sweating over the whole body indicates safety. After moxibustion, administer Jinlingzi San (Melianthus Powder); after pain stops, take Zhishi Baizhu Wan (Immature Bitter Orange and Atractylodes Pill) to eliminate residual pathogens.
Jinlingzi San treats Heat-Jue heart pain, intermittent and chronic.
Melianthus Fruit (Jinlingzi) Corydalis Rhizome (Yanyhusuo) (1 liang each)
Grind into powder. Take 3 qian per dose, mixed with wine. After pain stops, give Zhizhu Wan.
[From *Waitai Miyao*] Treats Qiao heart pain. Bear Gallbladder Stone (Xiongdan), size of soybean, mixed with water and taken orally, highly effective. (Compendium notes: Bear Gallbladder Stone is bitter and cold.)
[Zhang Zhongjing] When cold lodges in the heart, the patient feels as if eating garlic in the heart region. Severe cases involve heart pain radiating to the back, and back pain radiating to the heart, resembling gu infestation. If the pulse is floating, spontaneous vomiting leads to recovery.
The classic states: "When cold lodges in the Back-Shu channels, blood vessels become sluggish; sluggish vessels lead to blood deficiency; blood deficiency causes pain." The Shu points connect to the heart, hence mutual牵引 pain. Pressing brings heat; heat arrival stops pain. This is also pain caused by cold lodging in the heart and back.
For heart pain radiating to the back and back pain radiating to the heart, Wutou Chishizhi Wan (Aconite and Red Kaolin Pill) is the primary treatment.
Sichuan Pepper (Shujiao) (1 liang) Prepared Aconite Root (Wutou) (prepared, 1 fen) Prepared Aconite Root (Fuzi) (prepared, 0.5 liang) Prepared Dried Ginger (Pao Ganjiang) (1 liang) Red Kaolin (Chishizhi) (1 liang)
Grind five ingredients into powder, mix with refined honey to form pills the size of paulownia seeds. Take one pill on an empty stomach, three times daily. Increase dosage slightly if ineffective.
For chest bi syndrome unable to lie down, with heart pain radiating to the back, Gualou Xiebai Banxia Tang (Trichosanthes Fruit, Macrostem Onion, and Pinellia Decoction) is the primary treatment.
Trichosanthes Fruit (Gualou Shi) (1 fruit) Macrostem Onion (Xiebai) (3 liang) White Wine (Baijiu) (1 dou) Pinellia Tuber (Banxia) (0.5 sheng)
Decoct four ingredients together until 4 sheng remain. Take 1 sheng, three times daily.
For severe cold pain in the heart and chest, vomiting preventing food intake, cold qi rushing up in the abdomen creating visible head-and-tail masses, pain everywhere and untouchable, Da Jianzhong Tang (Great Construct Middle Decoction) is the primary treatment.
Sichuan Pepper (Shujiao) (2 he, drained) Prepared Dried Ginger (Pao Ganjiang) (4 liang) Ginseng Root (Renshen) (2 liang)
Decoct three ingredients in 4 cups of water until 2 cups remain, strain. Add 1 cup of malt sugar (Jiaoyi), simmer gently until 1.5 cups remain. Divide into two warm doses. After about one meal's time, drink 2 cups of rice gruel, then take the next dose. Consume only millet gruel for the day, keep warm.
For central bloating, jue reversal with hanging heart pain, Guizhi Shengjiang Zhishi Tang (Cinnamon Twig, Fresh Ginger, and Immature Bitter Orange Decoction) is the primary treatment.
Cinnamon Twig (Guizhi) Fresh Ginger (Shengjiang) (1 liang each) Immature Bitter Orange (Zhishi) (5 pieces)
Decoct three ingredients in 6 cups of water until 3 cups remain. Divide into three warm doses.
[From *Shengji Zonglu*] Treats Hanhan heart pain with cold extremities and complete anorexia. Use Cassia Bark (Guixin) 2 liang, peeled and ground into powder. Take 1 qian with hot wine at any time.
[Worldly Formula] Guo Fu Tang treats cold qi heart pain.
Aconite Root (Fuzi) Tsaoko Cardamom Seed (Caoguo) Galangal Root (Liangjiang) (equal parts)
Decoct in wine, immediate effect.
[Luo Tianyi] Erjiang Wan (Two-Ginger Pill) nourishes spleen, warms stomach, dispels cold, and resolves phlegm. Primarily treats heart-spleen pain, opens chest, directs qi downward, promotes appetite, and treats all injuries from cold substances.
Prepared Dried Ginger (Pao Ganjiang) Galangal Root (Liangjiang)
Equal parts, grind into fine powder, make pills with flour paste, size of paulownia seeds. Take 15-20 pills per dose, after meals with Tangerine Peel Decoction. Not suitable for pregnant women.
Above formula uses acrid-sweet-hot properties to disperse cold knots.
[Worldly Formula] Highly effective for heart pain. One Ice Plum (Bingmei), pitted, mixed with raw Sulfur (Liuhuang) powder, pounded uniformly to form one pill. Take with plain boiled water, immediate cure, no recurrence.
Above formula uses acid-hot properties to consolidate and disperse cold. For those worsening with acrid agents, switching to acid agents brings immediate relief.
[Zhu Danxi] For invading cold attacking the stomach, Caodoukou Wan (Tsaoko Cardamom Pill) is primary. It is also suitable for heat patterns, but only for 1-2 doses.
Tsaoko Cardamom Seed (Caodoukou) (1.4 qian, wrapped in flour, baked ripe, peel/navel removed) Evodia Fruit (Wuzhuyu) (soaked in boiling water, washed, dried) Alpinia Oxyphylla Fruit (Yizhiren) Silkworm (Jiangcan) (stir-fried) Angelica Sinensis Root (Guishen) Tangerine Peel (Qingpi) (0.6 qian each) Medicated Leaven (Shenqu) Turmeric Rhizome (Jianghuang) (0.4 qian each) Raw Licorice Root (Sheng Gancao) (0.3 qian) Peach Kernel (Taoren) (pitted, 7 pieces) Pinellia Tuber (Banxia) (boiled seven times, 1 qian) Alisma Rhizome (Zexie) (1 qian, reduce by half if urination is free) Coix Seed (Yiyiren) (stir-fried yellow, 1.5 qian) Prepared Licorice Root (Zhi Gancao) (0.6 qian) Bupleurum Root (Chaihu) (0.4 qian, adjust based on hypochondriac pain severity) Ginseng Root (Renshen) Astragalus Root (Huangqi) Tangerine Peel (Chenpi)
Grind eighteen ingredients (except peach kernel which is pounded into paste) into extremely fine powder, mix well. Make pills with soaked steamed wheat dough, size of paulownia seeds. Take 30 pills per dose with hot plain water, far from meals, adjusting quantity as needed.
Magistrate [Name Redacted], over 50 years old, suffered heart-spleen pain in late spring, complaining of abdominal distension, cold extremities exceeding elbows and knees, requiring cloth-wrapped heat sources, yet fearing heat in the chest, preferring exposure, feeling relief from cool wind. Pulses were deep, fine, and choppy; heavy pressure vanished; light pressure felt wiry and short. Thirsty and dry, preferring hot drinks, refusing grain and meat. Prescribed Caodoukou Wan tripled, adding Coptis Rhizome (Huanglian), Talcum (Huashi), and stir-fried Medicated Leaven (Shenqu) as pills, with Atractylodes Macrocephala Rhizome (Baizhu) as Sovereign, Alisma Rhizome (Fuling) as Minister, and Tangerine Peel (Chenpi) as Envoy. Administered 100 pills with decoction. After consuming 2 jin, all symptoms resolved.
Pain aggravated by pressure indicates deficiency mixed with excess; harmonize with Erchen Tang (Two-Cured Decoction) plus stir-fried Dried Ginger (Ganjiang).
Pain relieved by pressure indicates deficiency; treatment methods see Cold Heart Pain section. Danxi said: Caodoukou Wan treats heart pain from qi exhaustion. Formula see Cold-Heat Common Use section.
[Zhang Zhongjing] Jiutong Wan (Nine Pains Pill) treats nine types of heart pain.
Prepared Aconite Root (Fuzi) (3 liang, prepared) Raw Wild Wolf-Tooth Herb (Sheng Yelangya) (1 liang, roasted fragrant) Croton Seed (Badou) (1 liang, peel/core removed, stir-fried, pounded to fat) Ginseng Root (Renshen) Prepared Dried Ginger (Pao Ganjiang) Evodia Fruit (Wuzhuyu) (1 liang each)
Grind six ingredients into powder, refine honey to form pills size of paulownia seeds. Take with wine. Strong adults start with 3 pills, three times daily. Weak patients take 2 pills. Also treats sudden evil qi attack, abdominal distension/pain, inability to speak, chronic cold accumulation flowing to heart/chest pain, cold swelling with upward qi, trauma bleeding, etc. Dietary restrictions apply as usual.
[Li Jiegu] Zhuhuang Wan (Boiled Yellow Pill) treats severe excess heart pain. (Formula see Food Injury section.)
Ben Tang (Root Decoction) treats severe excess heart pain after bowel movement has cleared; use this to彻底 relieve pain.
Ben (Half liang) Atractylodes Rhizome (Cangzhu) (1 liang)
Cut coarsely. Take 1 liang per dose, add 2 cups water, decoct to half cup, take warm.
Above is Cold-Excess.
[Zhang Zhongjing] Fullness and pain in the epigastrium upon pressure indicates excess; purge it. Da Chaihu Tang (Major Bupleurum Decoction) is indicated. (Formula see Shanghan section.)
[Zihe Zheng] A General suffered unbearable heart pain. Dairen (Zihe Zheng's pseudonym) said: This is not heart pain, but epigastric pain at the heart center. *Neijing* states: "When Wood qi is excessive in the year, people suffer epigastric pain at the heart center." Prescribed Shenyue Wan (Divine Protection Pill) over 100 pellets. No improvement. Someone said: Stomach has cold, should warm/tonify, not cool. The General knew Dairen was skilled, sought medicine again. Dairen gave Shenyue Wan 200 pellets in one dose. Profuse diarrhea 6-7 times led to immediate cure. (Shenyue Wan formula see Edema section.)
Above is Heat-Excess.
[Zhu Danxi] Jiang family's son, 16 years old, recovered from chronic malaria ten days prior, now suffered severe heart-spleen pain. Both wrists pulses were hidden. When pain subsided slightly, Qi Kou (Lung pulse) was tight and full, remaining pulses wiry, solid, and fine. I said: This is retained food. Inquiry revealed consumption of cold oil-fried cakes. Prescribed Xiaowei Dan (Minor Stomach Pill), swallowed with saliva, 10+ pellets. Continued fasting. Over three days, administered Xiaowei Dan twelve times. Pain ceased. Late night, sudden severe pain radiating to hypochondria. I said: Likely introduced food too early. Confirmed. Withheld food and medicine. Retained accumulation had been partially resolved by Xiaowei Dan; new food combined with residual accumulation caused recurrence. Further attack would severely damage stomach qi. Withheld food for three more days. Family panicked, feared death, complained. I said: Six days without desire for food, forced abstinence creates bad prognosis. Wait for request for food, then measure carefully. Late night, heart palpitations/request for food. First gave pills of Atractylodes Macrocephala Rhizome (Baizhu), Coptis Rhizome (Huanglian), Tangerine Peel (Chenpi) with hot water, 70-80 pills, to resolve palpitations. Giving porridge for hunger would cause pain as before. Family insisted on giving food. I asked if chest felt oppressed when hungry? Answer: Hunger triggers mild oppression. Now not very comfortable, but no desire to eat. Two hours later, requested food again. Gave previous pills. This continued another day and night. Hunger ceased, patient became drowsy. Advised half-normal thin porridge, forbid miscellaneous food for two days, regulate for half month. Recovered. (Xiaowei Dan formula see Food Injury section.)
[From *Baoming Ji*] For heart pain, use Xiaowei Dan (Minor Stomach Pill), swallow 15 pills.
Above gradually clears heat, retained food, and accumulation.
[Worldly Formula] Muxiang Wan (Aucklandia Pill) treats food-stagnation heart pain.
Aucklandia Root (Muxiang) Clove Ding (Dingxiang) Burreed Tuber (Sanleng) Curcuma Zedoaria Rhizome (Pengze) Tangerine Peel (Qingpi) Tangerine Peel (Chenpi) (2.5 qian each) Areca Nut (Binglang) (2 qian) White Cardamom Fruit (Baidoukou) (1 qian) Croton Seed Meat (Badou Rou) (15 pellets, boiled in vinegar until no white center)
Grind into powder, make pills with vinegar paste, size of hemp seed.
[From *Bencao*] Treats all accumulations with fluid retention and heart pain, Naosha Wan (Sal Ammoniac Pill).
Sal Ammoniac (Naosha) Burreed Tuber (Sanleng) (separately ground) Prepared Dried Ginger (Pao Ganjiang) Angelica Dahurica Root (Xiangbaizhi) Croton Seed (Badou) (de-oiled, 0.5 liang each) Rhubarb Root (Dahuang) (separately ground) Dry Lacquer (Ganqi) (0.5 liang each) Aucklandia Root (Muxiang) Tangerine Peel (Qingpi) Black Pepper (Hejiao) (0.1 fen each) Areca Nut (Binglang) Nutmeg (Roudoukou) (1 each)
Grind into fine powder. Boil strong vinegar 2 sheng for 5-7 boils. Add Sanleng and Dahuang powders, boil 5-7 boils. Add Sal Ammoniac, boil into paste, proper consistency. Mix with other herbs, pound into pills size of mung beans. If aged/clumped, take 4-5 pills with Ginger Decoction. For food stagnation, take with cooked water. For white dysentery, take with Dried Ginger Decoction. For red dysentery, take with Licorice Decoction. For white dysentery, take with Angelica Sinensis Decoction; Scallion and wine also acceptable.
[Li Jiegu] Houpo Wan (Magnolia Bark Pill), Ziwan Wan (Aster Pill) treat accumulation heart pain. (Houpo Wan formula see Fanwei; Ziwan Wan formula see Jikuai.)
[Zhang Zhongjing] Heart injury manifests as: after labor, red face and heaviness below, heart pain with self-irritation, fever, umbilical pulsation, wiry pulse. This is heart injury.
[Zhu Danxi] Mild heart pain: disperse with Mahuang (Ephedra) and Guizhi (Cinnamon Twig). Severe cases: add Stone Alkali (Shijian). Form pills with Chuanxiong (Rhizoma Chuanxiong), Cangzhu (Atractylodes Rhizome), and stir-fried Zhizi (Gardenia).
Cinnamon Twig (Guizhi) Ephedra Stem (Mahuang) Stone Alkali (Shijian)
Grind into powder, soak in ginger juice, make pills with steamed wheat dough, size of paulownia seeds. Take 15 pills with hot ginger decoction. Higher doses also treat phlegm-fluid retention.
[Chen Wuyue] Mahuang Guizhi Tang (Ephedra and Cinnamon Twig Decoction) treats external cause heart pain with aversion to cold, fever, internal attack on five zang organs, spasms preventing turning/side movements.
Ephedra Stem (Mahuang) (remove joints, boil/bake) Cassia Bark (Guixin) White Peony Root (Shaoyao) Asarum Root (Xixin) (remove roots) Prepared Dried Ginger (Pao Ganjiang) Prepared Licorice Root (Zhi Gancao) (7.5 qian each) Pinellia Tuber (Banxia) Cyperus Rhizome (Xiangfu) (5 qian each)
Cut coarsely. Take 5 qian per dose, 1.5 cups water, 5 ginger slices. Decoct to 70%, strain, take before meals. For constipation, add Rhubarb Root (Dahuang); adjust based on excess/deficiency.
[Worldly Formula] Highly effective for severe heartache.
Areca Nut (Binglang) Cassia Bark (Guixin) Kudzu Root (Gegen) Licorice Root (Gancao) Asarum Root (Xixin) Pinellia Tuber (Banxia) Platycodon Root (Jiegeng) Immature Bitter Orange (Zhike) Chuanxiong Rhizome (Chuanxiong) Saposhnikovia Root (Fangfeng)
Equal parts, Licorice half amount. Decoct in water and take. Someone with heartache, unresponsive to other drugs, cured by this.
[Zhu Danxi] Eldest son of Liu Shan from Qingyan, 36 years old, suffered heartache for 18 years. Triggered by drinking cow milk with alcohol. During attacks, eating/drinking was unaffected. After 8 years of illness, during summer heat, bathing, and eating, there was no sweating. Multiple doctors treated with hot drugs like Ding (Cloves) and Fu (Aconite) pills. Result: yellow, emaciated, reduced appetite, clothes hung loosely, pain required leaning on an object. Pulses: three beats per respiration, wiry, weak, choppy. Chills before wind, stool alternating closure/diarrhea, worst symptom: chest/diaphragm acid regurgitation. In July, prescribed Erchen Tang (Two-Cured Decoction) plus Atractylodes Macrocephala Rhizome (Baizhu), Coptis Rhizome (Huanglian), Scutellaria Root (Huangqin), Peach Kernel (Taoren), Prunus Armeniaca Seed (Yuliren), Alisma Rhizome (Zexie). Taken every morning to induce vomiting. Vomit consisted of bitter black water mixed with wood ear-like flakes. Given two more doses that day, vomit stopped. Over two months, nearly 200 doses, choppy pulse gradually retreated, beat frequency increased. Suddenly, pulse became purely wiry, filling sensation. Post-Lidong, warm weather suggested impending sweating, but qi/blood insufficient for sweat. Regulated with Ginseng Root (Renshen), Astragalus Root (Huangqi), White Peony Root (Baishao), Angelica Sinensis Root (Danggui), Tangerine Peel (Chenpi), Pinellia Tuber (Banxia), Licorice Root (Gancao) for two days. Pain eased but occurred 1-2 times daily. On third day, gave Ephedra Stem (Mahuang), Atractylodes Rhizome (Cangzhu), Angelica Sinensis Root (Danggui), Chuanxiong Rhizome (Chuanxiong), Licorice Root (Gancao). Upon swallowing, eyes rolled up, jaw clenched, face lost color. Unresponsive to calls, limbs relaxed. Quickly held head with left hand, seated on bed, pinched Renzhong (GV26) with right thumb. Recovered instantly, profuse sweating like rain. Pain never returned, only fatigue and unchanged appetite. Subsequently suffered greatly from throat acid regurgitation, every