夫心者，君主之官，一身之所听命焉。故五脏失治，皆为心痛之病，经中刺治分经，理
甚明悉。
若是金针用药，尤宜详察。肾心痛者，多由阴邪上冲，故善 。如从后触其心，胃心痛者，
多由停滞，故胸腹胀满。脾心痛者，多当寒逆中焦，故其病甚。肝心痛者，多由木火之郁，
病在血分，故色苍苍如死状。肺心痛者，多由上焦不清，病在气分，故动作则痛益甚。若知
在气则顺之，在血则行之，郁则开之，滞则通之，火多实则清之散之，寒多虚则温之补之
，必
随手取效也。凡诸经心痛，心与背相引，心痛彻背，背痛彻心，宜急温其经。诸府心痛，难
以俯仰，小腹上冲，卒不知人，呕吐泄泻，其势甚锐，急宜温其腑。至脏邪乘心，名真心痛
，手足青至节，不可救药者，多宜急温其心包，并注邪别脉。然心痛甚者，脉必伏，以心主
脉，不胜其痛，其脉自伏也，切不可因其脉伏神乱。骇为心虚，而用地黄、白术补之。盖邪
得温药则散，得寒腻药则不散，不可不慎之也，温散之后，方可阴阳平补之。
后世治痛之地，有曰痛无补法者；有曰通则不痛，痛则不通者，有曰痛随利减者，人皆
传诵
以此为不易之。法凡是痛证，无不执而用之，不知痛而闭者，固可通之。如经云∶热结小肠
，
闭而不通之类是也。痛而泄者，不可通也，如经云∶寒客小肠，后泄腹痛之类是也。观王荆
公解痛利二字最妙，曰∶治实法，云∶诸痛为寒，痛随利减，后世以利为下也。假令痛在表
者
，实也；痛在里者，实也；痛在血与气者，亦实也。故在表者，汗之即愈；在里者，下之
即
愈；或在气血者，散之行之即愈，岂可以利为下乎？宜作通字训则可。此说甚善，得治实之
法矣。然痛证亦有虚实，治法亦有补泻，其辨之之法，不可不详。凡痛而胀闭者多实，不胀
不闭者多虚；痛而拒按者为实，可按者为虚；喜寒者多实，爱热者多虚；饱而甚者多实，饥
而甚者多虚；脉实气粗者多实，脉虚气少者多虚；新病壮年者多实，愈攻愈剧者多虚。痛在
经者脉多弦大，痛在脏者脉多沉微，必普脉证而察之，则虚实自有明。辨实者可利，虚者亦
可利乎？不当利而利之，为害不浅。凡治表虚而痛者，阳不足也，非温经不可。里虚而痛者
，
阴不足也，非养营不可。上虚而痛者，心脾实伤也，非补中不可。下虚而痛者，脱泄亡阳也
，
非速救脾肾温补命门不可。夫以温补而治痛者，非不多也，奈何医者专执痛不可补气之说，
岂良法哉？
心，是君主之官，全身都听从它的指挥。因此，五脏如果失调，都会导致心痛病，经络中针刺治疗分经论治，道理非常明白透彻。
至于使用金针（针灸）和药物，尤其应当详细考察。肾心痛，多由阴寒邪气上冲所致，所以患者喜欢弯腰曲背。如果从背后触动心脏部位，疼痛会加剧；胃心痛，多由食积停滞所致，所以胸腹胀满；脾心痛，多因寒邪逆犯中焦所致，所以病情严重；肝心痛，多由木火郁结所致，病在血分，所以面色青苍，如同死状；肺心痛，多由上焦不清爽所致，病在气分，所以活动时疼痛更加剧烈。如果知道病在气分，就顺其气机；病在血分，就行其血液；郁结的就开散它，停滞的就疏通它；火热偏盛且属实证的，就清解消散它；寒邪偏盛且属虚证的，就温补它。这样必定能随手取得疗效。凡是各经的心痛，心和背部相互牵引，心痛放射到背部，背痛放射到心脏，应当紧急温通其经脉。各腑的心痛，难以俯身和仰身，小腹有气上冲，突然昏不知人，呕吐泄泻，病势急骤锐利，应当紧急温通其腑脏。至于脏邪侵犯心脏，称为真心痛，手足青紫直到关节，不可救治的，多宜紧急温通心包络，并引导邪气从其他经脉排出。然而心痛剧烈的，脉象必然沉伏，因为心主血脉，承受不住剧烈疼痛，脉象自然沉伏，切不可因为脉伏、神志混乱，就惊骇地认为是心气虚弱，而用地黄、白术来补益。大概邪气遇到温药就能消散，遇到寒凉腻滞的药就不能消散，不可不谨慎啊，温散之后，才可以进行阴阳平补。
后世治疗疼痛的地方，有人说“痛无补法”；有人说“通则不痛，痛则不通”；有人说“痛随利减”，人们都传诵这些说法，认为这是不可改变的方法。凡是疼痛病症，无不固执地应用这些方法，不知道疼痛伴有闭塞的，固然可以通下。如经文所说：热结小肠，闭塞不通之类就是这种情况。疼痛伴有泄泻的，不可以用通下法，如经文所说：寒邪客于小肠，后泄腹痛之类就是这种情况。看王荆公解释“痛”和“利”两个字最精妙，他说：“治实法”，又说：“诸痛为寒，痛随利减”，后世把“利”理解为“下法”。假如疼痛在表，是实证；疼痛在里，是实证；疼痛在血和气，也是实证。所以在表的，发汗即愈；在里的，攻下即愈；或在气血的，发散行气即愈，怎么可以把“利”理解为“下法”呢？应该解释为“通”字才合适。这种说法很好，得到了治疗实证的方法。然而疼痛病症也有虚实之分，治疗方法也有补泻之别，辨别它们的方法，不可不详细。凡是疼痛且胀满闭塞的多属实证，不胀满不闭塞的多属虚证；疼痛且拒绝按压的是实证，可以按压的是虚证；喜欢冷的是实证，喜爱热的是虚证；饱食后疼痛加重的多属实证，饥饿时疼痛加重的多属虚证；脉实气粗的多属实证，脉虚气少的多属虚证；新病壮年多属实证，越攻伐越严重的多属虚证。疼痛在经脉的，脉象多弦大；疼痛在脏腑的，脉象多沉微，必须普遍诊察脉象和症状，那么虚实自然明了。辨别出实证的可以用通利法，虚证的也可以用通利法吗？不应当通利而通利了，危害不小。凡是治疗表虚而痛的，是阳气不足，不温通经脉不行。里虚而痛的，是阴血不足，不滋养营血不行。上虚而痛的，是心脾严重受损，不补益中气不行。下虚而痛的，是脱泄亡阳，不迅速救脾肾、温补命门不行。用温补法治疗疼痛的情况，不是不多见，奈何医生专门固执“痛不可补气”的说法，这难道是良法吗？
The Heart is the Official of the Sovereign, and the entire body obeys its command. Therefore, if any of the Five Zang Organs fails to be regulated properly, it can all result in Heart Pain (Xintong). The classics clearly explain that acupuncture treatment should be differentiated by meridians.
Regarding the use of golden needles (acupuncture) and herbal medicine, one must examine the condition in great detail. Kidney Heart Pain is mostly caused by the upward rushing of Yin pathogens, so patients tend to bend forward. If pressure is applied to the heart area from behind, the pain intensifies. Stomach Heart Pain is mostly caused by stagnation, resulting in chest and abdominal distension and fullness. Spleen Heart Pain is mostly due to Cold pathogenic factors counterflowing into the Middle Jiao, making the condition severe. Liver Heart Pain is mostly due to the depression of Wood and Fire, affecting the Blood level, causing the complexion to appear pale blue-green as if dead. Lung Heart Pain is mostly due to turbidity in the Upper Jiao, affecting the Qi level, so movement exacerbates the pain. If the pathology is in Qi, one should regulate it; if in Blood, one should invigorate it; if depressed, one should disperse it; if stagnant, one should unblock it. If Heat is excess, one should clear and dissipate it; if Cold is deficiency, one should warm and tonify it. In this way, efficacy will be achieved readily. For Heart Pain involving various meridians, where the heart and back pull against each other, with heart pain radiating to the back and back pain radiating to the heart, one should urgently warm the meridians. For Heart Pain involving various Fu Organs, characterized by difficulty in bending and stretching, upward rushing of Qi from the lower abdomen, sudden loss of consciousness, vomiting, and diarrhea, with a sharp and acute progression, one should urgently warm the Fu Organs. When Zang pathogens invade the Heart, it is called True Heart Pain (Zhenxintong). If hands and feet turn cyan up to the joints and the condition is incurable, one should urgently warm the Pericardium (Xinbao) and guide the pathogen out through other meridians. However, when Heart Pain is severe, the pulse will inevitably become deep and hidden (Fu), because the Heart governs the vessels and cannot withstand the severe pain, causing the pulse to hide naturally. One must not mistake this hidden pulse and confused spirit for Heart Deficiency, nor use Rehmanniae Radix (Dihuang) and Atractylodis Macrocephalae Rhizoma (Baizhu) to tonify. Generally, pathogens are dispersed by warming herbs but not by cold and cloying herbs; thus, caution is essential. Only after warming and dispersing can one proceed with balanced Yin-Yang tonification.
Later generations have stated regarding the treatment of pain: "Pain has no tonification method"; "Unblocked means no pain, blocked means pain"; "Pain decreases with purgation." People recite these as immutable laws. For all pain syndromes, they rigidly apply these methods, unaware that pain accompanied by obstruction can indeed be treated with unblocking/purgation, as stated in the classics: "Heat binding the Small Intestine, leading to obstruction and blockage." However, pain accompanied by diarrhea should not be treated with purgation, as stated in the classics: "Cold invading the Small Intestine, leading to post-diarrhea and abdominal pain." Wang Jinggong's explanation of the characters "Tong" (pain) and "Li" (benefit/purgation) is most exquisite. He said: "This is the method for treating Excess," and added: "All pains are due to Cold, and pain decreases with Li." Later generations interpreted "Li" as "Xià" (purgation/lowering). Suppose pain is in the Exterior, it is Excess; pain in the Interior, it is Excess; pain in Blood and Qi, it is also Excess. Therefore, pain in the Exterior is cured by sweating; pain in the Interior is cured by purging; pain in Qi and Blood is cured by dispersing and regulating. How can "Li" simply mean purgation? It should be interpreted as "Tong" (unblocking/penetrating). This view is excellent and grasps the method for treating Excess. However, pain syndromes also have Deficiency and Excess distinctions, and treatments involve both Tonification and Purging. The method of differentiation must be detailed. Pain with distension and closure is mostly Excess; without distension or closure, mostly Deficiency. Pain that rejects pressure is Excess; pain that accepts pressure is Deficiency. Preference for cold indicates Excess; preference for heat indicates Deficiency. Worsening after eating suggests Excess; worsening on an empty stomach suggests Deficiency. A solid pulse and coarse breath suggest Excess; a deficient pulse and weak breath suggest Deficiency. Recent illness in young adults suggests Excess; worsening with aggressive treatment suggests Deficiency. Pain in the meridians often presents with a wiry and large pulse; pain in the Zang organs often presents with a deep and faint pulse. By comprehensively observing pulse and symptoms, Deficiency and Excess will become clear. Can Excess patterns be treated with purgation, while Deficiency patterns also use purgation? If purgation is used inappropriately, the harm is profound. For pain due to Exterior Deficiency, Yang is insufficient, and warming the meridians is indispensable. For pain due to Interior Deficiency, Yin is insufficient, and nourishing Ying (Nutritive Qi) is indispensable. For pain due to Upper Deficiency, the Heart and Spleen are severely damaged, and tonifying the Middle Jiao is indispensable. For pain due to Lower Deficiency, there is collapse, leakage, and loss of Yang, requiring urgent rescue of the Spleen and Kidney and warming the Mingmen (Gate of Vitality). There are many cases of treating pain with warming and tonification. Why do physicians rigidly adhere to the saying "Pain cannot be treated with Qi tonification"? Is this truly a good method?