大抵人病胸膈心腹疼痛，动辄饮食劳倦所伤，则脾气为之郁滞，或犯寒暑湿热及食积痰气，
脾受之而作心痛，此脾痛也，非心也。心痛门具九种之痛，从可审矣。凡脾家作痛，每每停聚
不散，或满或胀，或不思食，膈间水声，食物相触则作疼痛。其有乍作乍止、来去无定、呕吐清
水、面白无常者，虫痛也。虽云知其脾家作痛，亦当察其所伤之殊而分治之。痛止之后尤当调
养脾胃正气，节慎起居饮食，不使复伤，可谓标本兼该而不遗矣。《直指》云∶疗病如瀚衣，
必去其垢污，而后可以加浆饰，斯言得之矣。
脾虚积黄而痛，胃苓汤；胃虚感冷而痛，理中汤。内伤发热不食，胃口作痛，补中益气
加草豆蔻，热痛加
栀子、肥子。心脾中脘当心痛，或痞气不食，用草蔻炒三棱、白术各一两、白豆蔻仁、桂枝、
小草远志、莪术、丁香、木香、藿香、炊饼丸，梧桐子大，姜汤下三十丸。实痛者，手不可近，
六脉沉细甚，有汗，大承气加桂；强壮痛甚者，加桃仁、附子。小腹虚作痛，小建中汤。寒热呕
吐而痛，脉沉弦大，柴胡汤。脾胃不和而痛，大安丸。冬寒停饮，桂黄散。咳逆上气，痰饮心痛，
海蛤粉 、栝蒌仁蒂等分，研细和匀，米面糊为丸服。丹溪治脾痛用海粉佐以香附末，用川芎、
山栀、生姜汁煎辣汤调服为佳。有脾痛大小便不通者，此是痰隔中焦，气聚下焦，用草蔻丸，
多治气馁弱人心脾痛妙。
一般来说，人出现胸膈和心腹部的疼痛，大多是由于饮食不节或劳累过度损伤了身体，导致脾气郁结阻滞；或者是受到寒、暑、湿、热邪气侵袭以及食积、痰饮、气滞的影响，脾脏受邪而引发心痛，这实际上是脾痛，而非真正的心脏病变。心痛门中详细记载了九种类型的疼痛，据此可以仔细辨别。凡是脾脏引起的疼痛，往往伴有积聚停留不散的症状，表现为腹部胀满或痞塞，食欲不振，胸膈间有水声，食物接触后则产生疼痛。如果疼痛时作时止、来去无常，伴有呕吐清水、面色苍白无光泽等症状，则是虫痛。虽然知道是脾脏引起的疼痛，也应当根据所受伤害的不同而分别治疗。疼痛停止之后，尤其需要调养脾胃的正气，谨慎起居饮食，避免再次受伤，这可以说是标本兼治而不遗漏要点。《直指方》说：治疗疾病就像洗衣服，必须先去污垢，然后才能上浆修饰，这话很有道理。
脾虚积滞发黄且疼痛的，用胃苓汤（Weiling Tang, Stomach Calming Decoction）；胃虚感受寒冷而疼痛的，用理中汤（Lizhong Tang, Regulate the Middle Decoction）。内伤发热且不想进食，胃口疼痛的，用补中益气汤（Buzhong Yiqi Tang, Tonify the Middle and Augment Qi Decoction）加草豆蔻（Caodoukou, Black Cardamom Seed），如果是热痛则加栀子（Zhizi, Gardenia Fruit）、肥子（Feizi, likely referring to a specific processed seed or typo for another herb, kept as Feizi）。心脾及中脘穴部位疼痛，或者痞塞不适、不思饮食的，用炒制的草豆蔻、三棱（Sanleng, Burreed Tuber）、白术（Baizhu, Atractylodes Macrocephala Rhizome）各一两，加上白豆蔻仁（Baidoukou Ren, White Cardamom Seed Kernel）、桂枝（Guizhi, Cinnamon Twig）、小草远志（Xiaocao Yuanzhi, Polygala Root）、莪术（Ezhu, Curcuma Zedoaria Rhizome）、丁香（Dingxiang, Clove Bud）、木香（Muxiang, Aucklandia Root）、藿香（Huoxiang, Patchouli Leaf），做成炊饼丸剂，大小如梧桐子，用姜汤送服三十丸。实证疼痛的，手不可触碰，六脉沉细严重，有汗出的，用大承气汤（Da Chengqi Tang, Major Order the Qi Decoction）加桂枝；体质强壮者疼痛剧烈的，加桃仁（Taoren, Peach Seed）、附子（Fuzi, Prepared Aconite Lateral Root）。小腹虚性疼痛的，用小建中汤（Xiao Jianzhong Tang, Minor Construct the Middle Decoction）。寒热往来、呕吐并伴有疼痛，脉象沉弦大的，用柴胡汤（Chaihu Tang, Bupleurum Decoction）。脾胃不和而疼痛的，用大安丸（Da'an Wan, Great Peace Pill）。冬季寒冷导致水饮停聚的，用桂黄散（Guihuang San, Cinnamon and Yellow Powder）。咳嗽气逆，痰饮引起的心痛，用海蛤粉（Haige Fen, Clam Shell Powder）、栝蒌仁蒂（Gualou Renti, Trichosanthes Seed Stem）等分，研成细末混合均匀，用米面糊制成丸剂服用。丹溪（Danxi, Zhu Zhenheng）治疗脾痛使用海粉辅助香附末（Xiangfu, Cyperus Rotundus Rhizome），用川芎（Chuanxiong, Ligusticum Chuanxiong Rhizome）、山栀（Shanzhi, Gardenia Fruit）、生姜汁煎煮成辣汤调服为佳。有脾痛导致大小便不通的，这是痰浊阻隔中焦，气机聚集于下焦，用草蔻丸（Caokou Wan, Cardamom Pill），多用于治疗气馁虚弱之心脾痛，效果奇妙。
Generally speaking, when people suffer from pain in the chest, diaphragm, heart, and abdomen, it is mostly caused by damage due to improper diet or overexertion, leading to stagnation of Spleen Qi (Spleen Qi). Alternatively, it may result from invasion by Cold, Summerheat, Dampness, or Heat pathogens, as well as Food Retention (Food Stagnation), Phlegm-Dampness (Phlegm), or Qi Stagnation. When the Spleen is affected, it manifests as Heart Pain; this is actually Spleen Pain, not true Heart pathology. The chapter on Heart Pain details nine types of pain, allowing for careful differentiation. Whenever pain originates from the Spleen, it is often accompanied by accumulated masses that do not dissipate, presenting as fullness or distension, loss of appetite, water sounds in the diaphragm, and pain triggered by food contact. If the pain comes and goes irregularly, without fixed patterns, accompanied by vomiting of clear fluids and a pale, lusterless complexion, it is identified as Worm Pain (Intestinal Parasites). Although it is known that the pain originates from the Spleen, treatment must be differentiated based on the specific cause of injury. After the pain subsides, it is crucial to nourish the righteous Qi (Zheng Qi) of the Spleen and Stomach, exercise caution in daily life and diet, and prevent re-injury. This approach addresses both the root and the branch comprehensively. As stated in *Zhizhi Fang*: "Treating illness is like washing clothes; one must first remove the dirt before applying starch and decoration." This statement is apt.
For Spleen deficiency with accumulation, yellowing, and pain, use Weiling Tang (Stomach Calming Decoction); for Stomach deficiency with Cold invasion causing pain, use Lizhong Tang (Regulate the Middle Decoction). For internal injury fever with anorexia and stomach pain, use Buzhong Yiqi Tang (Tonify the Middle and Augment Qi Decoction) added with Caodoukou (Black Cardamom Seed); for heat-type pain, add Zhizi (Gardenia Fruit) and Feizi. For pain in the Heart, Spleen, and Zhongwan (CV12) areas, or for epigastric stuffiness and anorexia, use a pill made from stir-fried Caodoukou (Black Cardamom Seed), Sanleng (Burreed Tuber), and Baizhu (Atractylodes Macrocephala Rhizome), each 1 liang, along with Baidoukou Ren (White Cardamom Seed Kernel), Guizhi (Cinnamon Twig), Xiaocao Yuanzhi (Polygala Root), Ezhu (Curcuma Zedoaria Rhizome), Dingxiang (Clove Bud), Muxiang (Aucklandia Root), and Huoxiang (Patchouli Leaf). Form into pills the size of Sophora seeds, take 30 pills with Ginger Decoction. For excess-type pain, where the area is tender to touch, pulses are deep and fine severely, and sweating is present, use Da Chengqi Tang (Major Order the Qi Decoction) added with Guizhi (Cinnamon Twig); for robust individuals with severe pain, add Taoren (Peach Seed) and Fuzi (Prepared Aconite Lateral Root). For deficiency-type pain in the lower abdomen, use Xiao Jianzhong Tang (Minor Construct the Middle Decoction). For alternating chills and fever with vomiting and pain, and a deep, wiry, and large pulse, use Chaihu Tang (Bupleurum Decoction). For pain due to Disharmony between Spleen and Stomach, use Da'an Wan (Great Peace Pill). For cold-induced fluid retention in winter, use Guihuang San (Cinnamon and Yellow Powder). For cough with rebellious Qi and Heart Pain caused by Phlegm-Fluids, use equal parts of Haige Fen (Clam Shell Powder) and Gualou Renti (Trichosanthes Seed Stem), grind into fine powder, mix evenly, and form into pills using rice flour paste for oral administration. Danxi (Zhu Zhenheng) treated Spleen Pain using Haifen (Clam Shell Powder) assisted by Xiangfu (Cyperus Rotundus Rhizome) powder, taken best with a spicy decoction prepared from Chuanxiong (Ligusticum Chuanxiong Rhizome), Shanzhi (Gardenia Fruit), and fresh ginger juice. In cases of Spleen Pain accompanied by obstruction of urination and defecation, this is due to Phlegm-Turbidity obstructing the Middle Jiao and Qi gathering in the Lower Jiao; use Caokou Wan (Cardamom Pill). This is highly effective for treating Spleen Pain associated with deficient Qi and weakness of the Heart and Spleen.