面为阳明部分。而阳维起于诸阳之会。皆在于面。故面痛皆因于火。而有虚实之殊。暴痛多实。
久痛多虚。高者抑之。郁者开之。血热者凉之。气虚者补之。不可专以苦寒降火为事。许学士治
鼻间痛。或麻痹不仁。如是数年。忽一日连口唇颊车发际皆痛。不能开口言语。饮食皆妨。在
与颊上常如糊。手触之则痛。此足阳明经络受风毒。传入经络。血凝滞而不行。故有此证。或
以续命与之不效。以犀角升麻汤与之。数目愈。夫足阳明胃也。胃中腥膻五味。无所不纳。其腐
熟水谷之毒。皆聚于胃。故方以犀角为主。升麻佐之。专解饮食之毒。余皆涤除风热之药也。有
老人过劳。饥则面痛。补中益气加芩、栀、连翘、鼠粘、黑参。因郁结积成胃热。遂患面痛。越
鞠丸加山栀、连翘、贝母、橘红之类。
灵枢云。邪在心则心痛。喜悲时眩仆。（此言胞络受邪。在腑不在脏也。）手少阴之脉动。
则病嗌干心痛。渴而欲饮。（此言别络受邪。在络不在经也。）厥心痛。与背相控。善 。如从
后触其心。伛偻者。肾心痛也。腹胀胸满。心痛尤甚。胃心痛也。如以锥针刺其心。心痛甚者。
脾心痛也。色苍苍如死状。终日不得太息。肝心痛也。卧若徒居。心痛间。动作痛益甚。色不变。
肺心痛也。真心痛。手足青至节。心痛甚。旦发夕死。夕发旦死。
五脏之滞。皆为心病肾心痛者。多由阴火上冲之故。胃心痛者。多由停滞。脾心痛者。多由
寒逆中焦。肝心痛者。多由木火之郁。病在血分。肺心痛者。多由上焦不清。病在气分。若知其
在气则顺之。在血则行之。郁则开之。滞则通之。火多实。则或散或清之。寒多虚。则或温或补
之。必真心痛者。乃不可治。否则但得其本。则必随手而应也。
金匮云。九痛丸治九种心痛。兼治卒中恶腹胀痛。口不能言。又治连年积冷。流注心胸痛。
并冷冲上气。落马坠车。血疾等皆主之。忌口如常法。
仲景于胸痹后附此方。治九种心痛。以其久着之邪不同暴病。故药则加峻。而汤改为丸。取
缓攻不取急荡也。九种心痛。乃久客之剧证。即肾水乘心。香港脚攻心等别名也。痛久血瘀。阴邪
团结。故用参、附温气散邪。药中加生野狼芽、巴豆、吴茱萸驱之使从阴窍而出。以其邪据胃中。
结成坚垒。非直捣其巢。终不去也。后人心痛分为九种。曰饮。曰食。曰气。曰血。曰冷。曰热。
曰悸。曰虫。曰疰。虽祖此义。而实未详内经金匮之旨也。
论曰。诸心痛者。皆手少阴厥气上冲也。有热厥心痛者。身热足寒。痛甚则烦躁而吐。额上
自汗。其脉洪大。知为热也。先宜越婢汤汗之。次用金铃子散清之。有火实心痛者。因受时气。
卒然发痛。大便或秘。久而注闷。心腹高起。按之愈痛。不能饮食。急以凉膈散利之。不应。为
食积痰饮留结也。煮黄丸、水煮金花丸选用。有寒厥心痛者。手足逆而通身冷汗出。或大便利而
不渴。气力微弱。其脉沉细。急以术附汤温之。寒厥暴病非久病也。朝发夕死。当急救之。久痛
非寒。暴痛非热。不可不察。凡言心痛。都属胃脘。丹溪云。外受寒者。当温散。内受寒者。当
温利。病久属郁。郁则热。用山栀为热药之向导。必佐以生姜汁。多用台芎开之。或二陈加川芎、
苍术。倍加姜汁炒山栀。如痛甚者。加炮姜。为从治之法也。外吸凉风。内伤冷物。寒客于胃。
则卒然而痛。二陈加草豆菀、干姜、吴茱萸。日久发热。加姜汁炒川连、山栀。心腹绞痛如刺。
两胁胀满。千金高良姜汤。脉实坚。按之心下满痛者为实。大柴胡汤。脉弦数者。是木克土也。
治之以小建中汤。取芍药味酸。于土中泻木。如脉沉细。是水来侮土。治以理中汤。取干姜味辛。
于土中泻水。大寒
客于心胸作痛。则呕逆不能食。腹中寒气上冲。痛不可按者。金匮三物大建中汤。上散浊饮寒气。
下安太阴。寒气作痛。绵绵不绝。无增无减。术附汤加草豆蔻、浓朴。风冷邪气。入乘心络。或
腑脏暴感寒气。上乘于心。卒然心痛。或引背膂。经久不瘥。崔氏乌头丸。凡心痛脉沉而迟者易
治。坚大而实。浮大而长滑数者难治。因冷积痰气而痛者。理中汤去人参。加苓、半、丁香、木
香、白豆蔻。或四七汤加木香、肉桂。痛而气上急者。苏子降气汤去前胡加木香。痰涎壅盛而痛。
小半夏茯苓汤加枳实。间进半硫丸。郁痰作痛。或因恚怒劳力酒食而发。发则自下逆冲而上。后
必作寒热。以郁必从少阳而发出于外。其脉必数。其热与痛忽重忽轻。其证多渴而大便秘。治宜
清中蠲痛汤。痰积作痛。脉滑而实。恶心烦满。时吐酸水。此因气滞。碍其道路。不得营运而作
痛。清中汤加香附、苍术、南星、滑石、木香、海石之类。如痰甚者。导痰汤加白螺蛳壳 过一
钱。停饮恶心烦闷。时吐黄水。腹中辘辘有声而痛。胃苓汤。胸痛短气者。水气在脏腑也。轻者
五苓散。重者用子和法取之。有痰。二陈汤加姜汁。气郁脉沉伏。或结或弦。胸中气壅。攻刺胀
痛。沉香降气散。中气虚。按之则痛定。二陈加炮姜。不应。理中汤。病久服耗气药太过。脉大
或数无力。亦为中气虚。六君子加炮姜。心膈大痛。发厥呕逆。诸药不纳者。趁势以鹅翎探吐。
痰尽而痛愈。凡按之痛减者为虚。宜酸收。不宜辛散。心痛属火。不时举发者。山栀姜汁炒黑。
少加炮姜、甘草。一服立止。平日好饮热酒。致死血留于胃口作痛。脉必涩或芤。饮下作呃。口
中作血腥气。手拈散加桔梗开提其气。胃气虚人。不能行其药力者。加人参二三钱。用相反之味。
激其性以搜血也。壮盛者代。抵当丸加干漆灰。虚弱人。四物汤加桃仁、穿山甲、桂心、蓬术、
赤降香煎服。卒中恶心痛。用苦参一两。酢煮顿服。老弱者。分二三服。若脉微欲绝。手足逆冷。
肉桂一两。水煮分三服
效。虫痛。鹤虱一味为末。蜜丸。蜜汤下四五十丸。慎酒肉。取有形滓以入虫口也。胃脘痛吐虫。
曾服打积药不愈。是中气伤。当调中气为主。虫痛面有白斑。唇红能食。或口中沫出。当以祛虫
法治之。因蛔作痛。痛有休止。令人吐蛔。蛔动故也。用川椒、乌梅、黄连、槟榔煎服。膈上隐
隐作痛。坐不得卧。而吐臭秽痰涎。当作肺痈治之。膈间肿痛。不能进食。但喜饮水。或咽肿。
人迎盛而气口紧者。当作胃痈治之。
心疝 肾气逆上攻痛。必从脐下上升。小便难。此名心疝。生韭汁和五苓散。以茴香煎汤下。
或有疝气冲心而痛者。当于疝门求治。亦有香港脚攻心而痛者。则于香港脚门求治可也。
心瘥 因胃口热。食易消。故瘥。素问谓之食瘥。为痰火鼓动所致。亦类中消。小半夏茯苓
汤加枳实。胃中火蕴而瘥。二陈加川连。或五苓散加辰砂。亦有病瘥。呷姜汤数口。或进干姜温
剂而愈。此膈上停寒。中有伏饮。见辛热则消也。
〔诊〕心脉微急为痛。短而数心痛。涩则心痛。脉浮大弦长者死。沉细者生。胃脉微滑为痰饮。
滑实为宿食。沉紧为冷积。沉涩为气滞。数为火。浮为风。弦为血。忽大忽小者。为虫也。
东垣治一妊妇。冬至因恸哭。口吸风寒。忽病心痛不可忍。浑身冷气欲绝。曰。此乃客寒犯
胃。故胃脘当心而痛。急与草豆蔻、半夏、生姜、炙甘草、益智仁之类。或曰。半夏有毒。重妊
服之可乎。曰。乃有故而用也。岐伯曰。有故无陨也。服之遂愈。
滑伯仁治一妇。盛暑洞泄。厥逆恶寒。胃脘当心而痛。引腹引胁。转为滞下。呕哕不食。医
以中暑霍乱治之益剧。脉
三部俱微短沉弱。不应呼吸。曰。此阴寒极矣。不亟温之。则无生理。内经虽曰用热远热。又曰
有假其气。则无禁也。于是以姜、附温剂三四进。间与来复丹。脉稍有力。厥逆渐退。更与姜、
附七日。诸证悉去。遂以丸药除其滞下而安。江应宿治一人。心脾痛。积十年矣。时发则连日呻
吟减食。遍试诸方罔效。诊之。六脉弦数。曰。此火郁耳。投姜汁炒川连、山栀泻火为君。川芎、
香附、橘皮、枳壳开郁理气为臣。反佐炮姜从治为使。一服而愈。再与平胃散加姜汁炒川连、山
栀。神曲糊丸。以刈其根。不复举矣。
李士材治张侗初。善怒善郁。且酬应繁剧。胸中痛甚。夜不成寐。医用菖蒲、枳、朴、木香、
豆蔻。殊不知此证属虚。虚则浊阴不降。神气失守。故痛且寤也。遂以归脾汤。倍用人参、当归。
不十剂而胸次快然安寝。
又治宋敬夫心腹大痛。伛偻不能仰。日服行气和血药罔效。其脉左滑而急。其气不能以息。
偶一咳攒眉欲绝。为心疝无疑。以生姜饮粥。取小 香、川楝子、青木香、广木香、吴茱萸、木
通、延胡索、归身、青皮。一服而痛减。五日而安。
面部属于阳明经的分布区域。阳维脉起于各阳经交会之处，都汇聚在面部。因此面痛都是由火邪引起，但有虚证和实证的差别。突发疼痛多属实证，久痛多属虚证。治疗原则是：病位高的用抑制法，气机郁结的用开散法，血热的用凉血法，气虚的用补益法。不能专门以苦寒药物降火作为唯一手段。
许学士治疗鼻间疼痛，或者麻木不仁，像这样持续数年。忽然有一天连口唇、颊车穴、发际线都疼痛，不能开口说话，饮食都受影响，脸颊上常常像糊了一层东西，手触碰就痛。这是足阳明经络感受风毒，传入经络，血液凝滞而不运行，所以出现这种证候。有人用续命汤给他治疗没有效果，改用犀角升麻汤，几次服用就好了。足阳明胃经，胃中腥膻五味，无所不纳。其腐熟水谷产生的毒素，都聚集在胃里。所以方子以犀角为主药，升麻为佐药，专门解除饮食之毒。其余都是清除风热的药物。
有一位老人过度劳累，饥饿时面部疼痛，用补中益气汤加黄芩、栀子、连翘、牛蒡子、玄参治疗。因为郁结积成胃热，于是患上面痛，用越鞠丸加山栀、连翘、贝母、橘红之类治疗。
《灵枢》说：邪气在心则心痛，喜欢悲伤，时常眩晕仆倒。（这是说心包络受邪，病在腑不在脏。）手少阴心经的脉动异常，则咽喉干燥、心痛、口渴想喝水。（这是说别络受邪，病在络不在经。）厥心痛，疼痛牵引背部，容易痉挛，好像从背后触碰到心脏，弯腰曲背的，是肾心痛。腹胀胸满，心痛特别严重的，是胃心痛。像被锥子针刺心脏，心痛剧烈的，是脾心痛。面色苍苍像死状，整天不能深呼吸，是肝心痛。躺着或静坐时心痛缓解，活动后疼痛加重，面色不变，是肺心痛。真心痛，手足青紫直到关节，心痛剧烈，早晨发病晚上死亡，晚上发病早晨死亡。
五脏的气滞，都会导致心病。肾心痛，多由阴火上冲的缘故。胃心痛，多由停滞引起。脾心痛，多由寒逆在中焦。肝心痛，多由木火郁结，病在血分。肺心痛，多由上焦不清，病在气分。如果知道病在气分就顺其气机，病在血分就活血行血，郁结就开散，停滞就通利。火邪多实证，就用发散或清泻的方法；寒邪多虚证，就用温补的方法。只有真心痛，是不可治疗的。否则只要找到根本原因，必然随手而效。
《金匮要略》说：九痛丸治疗九种心痛，兼治卒中恶腹胀痛，口不能说话。又治疗连年积冷，流注心胸痛，以及冷冲上气，落马坠车，血疾等都主治。忌口如常规方法。
张仲景在胸痹篇后附上这个方子，治疗九种心痛。因为久着的邪气不同于暴病，所以药力峻猛，将汤剂改为丸剂，取缓攻而不取急荡的意思。九种心痛，是久客之邪的严重证候，也就是肾水乘心、香港脚攻心等别名。痛久导致血瘀，阴邪团结，所以用人参、附子温气散邪。药中加入生野狼芽、巴豆、吴茱萸驱除邪气，使其从阴窍排出。因为邪气占据胃中，结成坚垒，不直捣其巢穴，终不能去除。后来人心痛分为九种：曰饮、曰食、曰气、曰血、曰冷、曰热、曰悸、曰虫、曰疰。虽然沿袭这个意义，但实际上没有详细阐明《内经》和《金匮》的宗旨。
论述说：各种心痛，都是手少阴厥气上冲。有热厥心痛，身体发热足部寒冷，痛甚则烦躁呕吐，额头自汗，脉象洪大，知道是热证。先宜用越婢汤发汗，次用金铃子散清泻。有火实心痛，因感受时气，突然发作疼痛，大便或秘结，久而闷胀，心腹高起，按压更痛，不能饮食，急用凉膈散通利。如果不效，是因为食积痰饮留结，选用煮黄丸、水煮金花丸。有寒厥心痛，手足逆冷且通身冷汗出，或大便通畅而不渴，气力微弱，脉象沉细，急用术附汤温补。寒厥暴病不是久病，早晨发病晚上死亡，应当急救。久痛非寒，暴痛非热，不可不仔细考察。凡是说心痛，都属于胃脘部位。朱丹溪说：外受寒者，当温散；内受寒者，当温利。病久属郁，郁则化热，用山栀作为热药的向导，必须佐以生姜汁，多用台芎开散。或者二陈汤加川芎、苍术，倍加姜汁炒山栀。如果痛甚者，加炮姜，这是从治的方法。外吸凉风，内伤冷物，寒气客于胃，则突然疼痛，用二陈汤加草豆蔻、干姜、吴茱萸。日久发热，加姜汁炒川连、山栀。心腹绞痛如刺，两胁胀满，用千金高良姜汤。脉实坚，按之心下满痛的是实证，用大柴胡汤。脉弦数的是木克土，用小建中汤治疗，取芍药味酸，在土中泻木。如果脉沉细，是水来侮土，用理中汤治疗，取干姜味辛，在土中泻水。大寒客于心胸作痛，则呕逆不能食，腹中寒气上冲，痛不可按压，用《金匮》三物大建中汤。上散浊饮寒气，下安太阴。寒气作痛，绵绵不绝，无增无减，用术附汤加草豆蔻、浓朴。风冷邪气，入乘心络，或腑脏暴感寒气，上乘于心，突然心痛，或牵引背脊，经久不愈，用崔氏乌头丸。凡心痛脉沉而迟者易治，坚大而实，浮大而长滑数者难治。因冷积痰气而痛，用理中汤去人参，加茯苓、半夏、丁香、木香、白豆蔻。或者四七汤加木香、肉桂。痛而气上急者，用苏子降气汤去前胡加木香。痰涎壅盛而痛，用小半夏茯苓汤加枳实，间进半硫丸。郁痰作痛，或因恚怒劳力酒食而发，发作时自下逆冲而上，后必作寒热，因为郁必从少阳而发出于外，其脉必数，其热与痛忽重忽轻，其证多渴而大便秘，治宜清中蠲痛汤。痰积作痛，脉滑而实，恶心烦满，时吐酸水，这是因为气滞，碍其道路，不得营运而作痛，用清中汤加香附、苍术、南星、滑石、木香、海浮石之类。如果痰甚者，用导痰汤加白螺蛳壳过一钱。停饮恶心烦闷，时吐黄水，腹中辘辘有声而痛，用胃苓汤。胸痛短气，是水气在脏腑，轻者用五苓散，重者用子和法攻逐。有痰，用二陈汤加姜汁。气郁脉沉伏，或结或弦，胸中气壅，攻刺胀痛，用沉香降气散。中气虚，按之则痛定，用二陈汤加炮姜。不效，用理中汤。病久服耗气药太过，脉大或数无力，也是中气虚，用六君子汤加炮姜。心膈大痛，发厥呕逆，诸药不纳者，趁势用鹅翎探吐，痰尽而痛愈。凡按之痛减者为虚，宜酸收，不宜辛散。心痛属火，不时举发者，用山栀姜汁炒黑，少加炮姜、甘草，一服立止。平日好饮热酒，致死血留于胃口作痛，脉必涩或芤，饮下作呃，口中作血腥气，用手拈散加桔梗开提其气。胃气虚人，不能行其药力者，加人参二三钱，用相反之味，激其性以搜血。壮盛者用抵当丸加干漆灰。虚弱人，用四物汤加桃仁、穿山甲、桂心、蓬术、赤降香煎服。卒中恶心痛，用苦参一两，醋煮顿服。老弱者，分二三服。如果脉微欲绝，手足逆冷，用肉桂一两，水煮分三服有效。虫痛，鹤虱一味为末，蜜丸，蜜汤下四五十丸，慎酒肉，取有形滓以入虫口。胃脘痛吐虫，曾服打积药不愈，是中气伤，当调中气为主。虫痛面有白斑，唇红能食，或口中沫出，当以祛虫法治之。因蛔作痛，痛有休止，令人吐蛔，是蛔动故也，用川椒、乌梅、黄连、槟榔煎服。膈上隐隐作痛，坐不得卧，而吐臭秽痰涎，当作肺痈治之。膈间肿痛，不能进食，但喜饮水，或咽肿，人迎盛而气口紧者，当作胃痈治之。
心疝：肾气逆上攻痛，必从脐下上升，小便难，此名心疝，用生韭汁和五苓散，以茴香煎汤下。或者有疝气冲心而痛者，当于疝门求治。也有香港脚攻心而痛者，则于香港脚门求治可也。
心瘥：因胃口热，食易消，故瘥。《素问》谓之食瘥，为痰火鼓动所致，亦类中消，用小半夏茯苓汤加枳实。胃中火蕴而瘥，用二陈汤加川连。或者五苓散加辰砂。也有病瘥，呷姜汤数口，或者进干姜温剂而愈。这是膈上停寒，中有伏饮，见辛热则消也。
〔诊〕心脉微急为痛，短而数心痛，涩则心痛，脉浮大弦长者死，沉细者生。胃脉微滑为痰饮，滑实为宿食，沉紧为冷积，沉涩为气滞，数为火，浮为风，弦为血，忽大忽小者，为虫也。
李东垣治疗一位孕妇，冬至因痛哭，口吸风寒，忽然病心痛不可忍，浑身冷气欲绝。他说：这是客寒犯胃，所以胃脘当心而痛。急用草豆蔻、半夏、生姜、炙甘草、益智仁之类。有人说：半夏有毒，重孕服之可以吗？他说：乃有故而用也。岐伯说：有故无陨也。服之遂愈。
滑伯仁治疗一位妇人，盛暑洞泄，厥逆恶寒，胃脘当心而痛，引腹引胁，转为滞下，呕哕不食。医生以中暑霍乱治之益剧。脉三部俱微短沉弱，不应呼吸。他说：这是阴寒极矣，不亟温之，则无生理。《内经》虽曰用热远热，又曰有假其气，则无禁也。于是以姜、附温剂三四进，间与来复丹。脉稍有力，厥逆渐退。更与姜、附七日，诸证悉去，遂以丸药除其滞下而安。
江应宿治疗一人，心脾痛，积十年矣。时发则连日呻吟减食，遍试诸方罔效。诊之，六脉弦数。他说：这是火郁耳。投姜汁炒川连、山栀泻火为君，川芎、香附、橘皮、枳壳开郁理气为臣，反佐炮姜从治为使。一服而愈。再与平胃散加姜汁炒川连、山栀，神曲糊丸，以刈其根，不复举矣。
李士材治疗张侗初，善怒善郁，且酬应繁剧，胸中痛甚，夜不成寐。医生用菖蒲、枳、朴、木香、豆蔻。殊不知此证属虚，虚则浊阴不降，神气失守，故痛且寤也。遂以归脾汤，倍用人参、当归，不十剂而胸次快然安寝。
又治疗宋敬夫心腹大痛，伛偻不能仰，日服行气和血药罔效。其脉左滑而急，其气不能以息，偶一咳攒眉欲绝，为心疝无疑。以生姜饮粥，取小茴香、川楝子、青木香、广木香、吴茱萸、木通、延胡索、归身、青皮。一服而痛减，五日而安。
The face is the domain of the Yangming channel. The Yangwei Vessel originates from the convergence of all Yang channels and gathers at the face. Therefore, facial pain is caused by Fire pathogenic factors, but there are distinctions between deficiency and excess patterns. Sudden pain is mostly excess; chronic pain is mostly deficiency. For high-lying conditions, suppress them; for stagnation, open and disperse them; for blood heat, cool it; for Qi deficiency, tonify it. One cannot solely rely on bitter-cold herbs to descend Fire.
Xu Xueshi treated a case of nasal pain, or numbness and insensitivity, lasting for several years. Suddenly, one day, the lips, Jiache acupoint (ST6), and hairline all became painful, making it impossible to open the mouth or speak, and hindering eating and drinking. The cheeks felt as if covered with paste, and touching caused pain. This was due to Wind-toxin affecting the Foot-Yangming channel and collaterals, transmitting into the collaterals, causing blood stasis and obstruction, thus resulting in this syndrome. Some administered Xuming Tang (Cure-all Decoction) without effect. Using Xijiao Shengma Tang (Rhinoceros Horn and Cimicifuga Decoction), it healed after several doses. The Foot-Yangming Stomach channel accepts all flavors, including fishy and strong odors. The toxins generated from rotting and ripening food and water accumulate in the Stomach. Therefore, the formula uses Rhinoceros Horn (Xijiao) as the chief herb and Cimicifuga (Shengma) as an assistant, specifically to resolve dietary toxins. The remaining herbs clear Wind-Heat.
An elderly man suffered from excessive fatigue; his face hurt when hungry. He was treated with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) plus Huangqin (Scutellaria Root), Zhizi (Gardenia Fruit), Lianqiao (Forsythia Fruit), Niubangzi (Arctium Seed), and Xuanshen (Scrophularia Root). Because depression and accumulation led to Stomach Heat, he developed facial pain. He was treated with Yueju Wan (Pill to Resolve Depression) plus Zhizi, Lianqiao, Beimu (Fritillaria Bulb), and Juhong (Tangerine Peel).
The *Ling Shu* states: "Pathogens in the Heart cause Heart pain, with a tendency toward sadness, dizziness, and collapse." (This refers to pathogens in the Pericardium Collateral, involving the Fu organs rather than the Zang organs.) When the pulse of the Hand-Shaoyin channel moves abnormally, it causes dry throat, Heart pain, thirst, and desire to drink. (This refers to pathogens in the Luo-connecting vessels, involving the collaterals rather than the main channels.) Jue Heart pain involves pain radiating to the back, spasms, and a sensation as if touched from behind, with stooping posture; this is Kidney Heart pain. Abdominal distension and chest fullness with severe Heart pain indicate Stomach Heart pain. Pain like being pierced by an awl, with intense Heart pain, indicates Spleen Heart pain. A pale, corpse-like complexion with inability to take deep breaths all day indicates Liver Heart pain. Pain that alleviates when lying still but worsens with movement, with unchanged complexion, indicates Lung Heart pain. True Heart pain presents with cyanosis of hands and feet extending to the joints, severe Heart pain, death within the same day of onset (morning onset leads to evening death; evening onset leads to morning death).
Stagnation in the Five Zang organs can all lead to Heart disease. Kidney Heart pain is often due to Yin Fire rushing upward. Stomach Heart pain is often due to stagnation. Spleen Heart pain is often due to Cold counterflow in the Middle Jiao. Liver Heart pain is often due to Wood-Fire depression, involving the Blood level. Lung Heart pain is often due to turbidity in the Upper Jiao, involving the Qi level. If the pathology is in the Qi level, regulate the Qi; if in the Blood level, invigorate the Blood. For depression, open and disperse; for stagnation, unblock and promote. Fire patterns are mostly excess, so use dispersing or clearing methods. Cold patterns are mostly deficiency, so use warming or tonifying methods. Only True Heart pain is incurable. Otherwise, addressing the root cause yields immediate results.
The *Jin Gui Yao Lue* states: Jiutong Wan (Nine-Pain Pill) treats nine types of Heart pain, and also stroke-induced abdominal distension and pain, inability to speak. It treats chronic cold accumulation flowing into the chest and Heart, cold rising Qi, injuries from falling off horses or cars, and blood disorders. Dietary restrictions apply as usual.
Zhang Zhongjing appended this formula after the section on Chest Bi to treat nine types of Heart pain. Because chronic pathogens differ from acute diseases, the medication is potent, and the decoction is changed to pills to achieve slow attack rather than rapid purging. The nine types of Heart pain are severe syndromes of long-standing pathogens, synonymous with Kidney Water overacting on the Heart or Hongjiao (Beriberi) attacking the Heart. Chronic pain leads to Blood stasis and Yin pathogen aggregation. Therefore, Ginseng and Aconite are used to warm Qi and scatter pathogens. Raw Wild Lilyturf (Yelangya), Croton seed (Baidu), and Evodia (Wuzhuyu) are added to expel pathogens via the Yin orifices. Since pathogens occupy the Stomach and form hard masses, direct assault on the nest is necessary for removal. Later physicians divided Heart pain into nine types: Drink, Food, Qi, Blood, Cold, Heat, Palpitation, Parasite, and Zhu (contagious disease). Although following this meaning, they failed to fully elucidate the principles of the *Nei Jing* and *Jin Gui*.
Discussion: All Heart pains result from Jue Qi of the Hand-Shaoyin channel rushing upward. Heat Jue Heart pain presents with body heat and cold feet; severe pain causes irritability and vomiting, sweating on the forehead, and a洪大 (Surging-Large) pulse, indicating Heat. Initially use Yebip Tang (Yema Decoction) to induce sweating, then Jinlingzi San (Golden Bell Powder) to clear Heat. Fire Excess Heart pain arises from seasonal pathogens, sudden pain, constipation, prolonged stuffiness, bulging heart/abdomen, tenderness on pressure, and inability to eat. Urgently use Liangge San (Cool the Diaphragm Powder) to purge. If ineffective, it is due to Food retention and Phlegm-Drink accumulation; choose Zhuhuang Wan or Shuizhu Jinhua Wan. Cold Jue Heart pain presents with cold extremities, whole-body cold sweat, clear stool without thirst, weak Qi, and a 沉细 (Deep-Thready) pulse. Urgently use Zhufu Tang (Atractylodes and Aconite Decoction) to warm. Cold Jue is an acute condition, not chronic; morning onset leads to evening death, requiring emergency treatment. Chronic pain is not Cold; sudden pain is not Heat; this must be examined carefully. Generally, "Heart pain" refers to the Epigastrium. Zhu Danxi stated: External Cold requires warming and dispersing; Internal Cold requires warming and promoting drainage. Chronic illness involves depression, which generates Heat; use Zhizi (Gardenia) guided by Ginger Juice, assisted by Taixiong (Taiwan Chuanxiong). Or Erchen Tang plus Chuanxiong and Cangzhu, with doubled Ginger-fried Zhizi. For severe pain, add Paojiang (Prepared Ginger) as a reverse treatment method. External exposure to cool wind and internal injury from cold foods cause sudden pain due to Cold lodging in the Stomach; use Erchen Tang plus Caodoukou (Cardamom), Ganjiang (Dried Ginger), and Wuzhuyu. Long-term heat generation adds Ginger-fried Huanglian (Coptis) and Zhizi. Cramping Heart/Abdominal pain like stabbing with full hypochondriac distension calls for Qianjin Gaoliangjiang Tang (Thousand Years Galangal Decoction). Solid and firm pulse with fullness and pain below the heart indicates Excess; use Daxiehu Tang (Major Rhabarber and Magnolia Decoction). Wiry-rapid pulse indicates Wood overcoming Earth; treat with Xiaojianzhong Tang (Minor Construct the Middle Decoction), using Sour Peony to drain Wood within Earth. Deep-thready pulse indicates Water insulting Earth; treat with Lizhong Tang (Regulate the Middle Decoction), using Acrid Dried Ginger to drain Water within Earth. Severe Cold lodging in the chest/Heart causes vomiting, inability to eat, and upward rushing Cold pain intolerable to pressure; use Jin Gui Sanwu Dajianzhong Tang (Three-Ingredient Major Construct the Middle Decoction) to scatter turbid drinks and Cold above and calm the Taiyin below. Lingering Cold pain without fluctuation uses Zhufu Tang plus Caodoukou and Houpo (Magnolia Bark). Wind-Cold pathogens entering the Heart collateral or acute Cold affecting viscera and ascending to the Heart cause sudden Heart pain or radiation to the back; use Cui Shi Wutou Wan (Cui's Aconite Pill). Heart pain with deep-slow pulse is easy to treat; solid-large-floating-long-slippery-rapid pulse is difficult. Cold accumulation and Phlegm-Qi pain uses Lizhong Tang minus Ren Shen, plus Fuling (Poria), Banxia (Pinellia), Dingxiang (Clove), Muxiang (Aucklandia), and Baiddoukou (White Cardamom). Or Siqi Tang plus Muxiang and Rougui (Cinnamon Bark). Pain with urgent upward Qi uses Suzi Jiangqi Tang minus Qianhu plus Muxiang. Profuse Phlegm-Saliva pain uses Xiao Banxia Fuling Tang plus Zhishi (Immature Bitter Orange), with intermittent Banshu Wan (Half-Sulfur Pill). Depressive Phlegm pain triggered by anger, labor, alcohol, or food rises from below, followed by alternating chills and fever (as depression emerges from Shaoyang); pulse is rapid, pain/heat fluctuates, thirst and constipation occur; treat with Qingzhong Juan Tong Tang (Clear the Middle and Eliminate Pain Decoction). Phlegm accumulation pain with slippery-solid pulse, nausea, fullness, and sour regurgitation is due to Qi stagnation blocking circulation; use Qingzhong Tang plus Xiangfu (Cyperus), Cangzhu, Nanting (Arisaema), Huashi (Talc), Muxiang, and Haishi (Sea Shell). Severe phlegm uses Daotan Tang plus Bai Luosike (River Snail Shell) exceeding one qian. Fluid retention with nausea, fullness, yellow water regurgitation, and borborygmus uses Weiling Tang (Guizhi and Poria Decoction). Chest pain with shortness of breath indicates Water-Qi in viscera; mild cases use Wuling San (Five-Ingredient Poria Powder), severe cases use Zhang Zihe’s purgative method. With Phlegm, use Erchen Tang plus Ginger Juice. Qi depression with deep-hidden, knotted, or wiry pulse and chest oppression/stabbing pain uses Chenxiang Jiangqi San (Agarwood Descending Qi Powder). Middle Qi deficiency with pain relief upon pressure uses Erchen Tang plus Paojiang; if ineffective, Lizhong Tang. Overuse of Qi-consuming drugs in chronic illness leading to large/rapid-weak pulse indicates Middle Qi deficiency; use Liu Junzi Tang plus Paojiang. Severe Heart/Diaphragm pain with syncope, vomiting, and drug rejection requires inducing vomiting with goose feather to expel Phlegm and relieve pain. Pain relieved by pressure is deficiency; use Sour astringents, avoid Acrid dispersants. Intermittent Fire-type Heart pain uses Ginger-fried blackened Zhizi with small amounts of Paojiang and Gancao (Licorice); one dose stops it. Chronic hot wine consumption causing Blood stasis in the stomach causes pain with choppy or hollow pulse, hiccup after drinking, and bloody taste; use Shou Nian San plus Jiegeng (Platycodon) to lift Qi. For weak Stomach Qi unable to move medicine, add 2-3 qian of Renshen (Ginseng); use opposing flavors to stimulate blood search. Robust patients use Didang Wan plus Dry Lacquer Ash. Weak patients use Siwu Tang plus Taoren (Peach Kernel), Chuanshanjia (Pangolin Scale), Guixin (Cinnamon Heart), Pengzhu (Curcuma), and Chi Jiangxiang (Red Agarwood). Sudden nausea/pain uses 1 liang of Kushen (Sophora) boiled in vinegar; divide for old/weak patients. If pulse is faint/perishing with cold extremities, use 1 liang of Rougui boiled in water, divided into three doses. Parasite pain uses Heshen (Nematode killer) powder honey-pilled; take 40-50 pills with honey water; avoid meat/alcohol. Stomach pain with parasite vomiting unresponsive to expulsion drugs indicates Middle Qi injury; focus on regulating Middle Qi. Parasite pain with white spots on face, red lips, good appetite, or foamy saliva requires anti-parasite therapy. Pinworm pain is intermittent with vomiting worms due to worm movement; use Chuanjiao (Sichuan Pepper), Wumei (Mume Fruit), Huanglian, and Binglang (Betel Nut). Dull upper diaphragm pain preventing lying down with foul phlegm suggests Lung Abscess. Swelling/pain in diaphragm preventing eating but preferring water, or swollen throat, with prominent Renying (Carotid) and tight Qikou (Radial) pulses suggests Stomach Abscess.
Xin Shan (Heart Hernia): Kidney Qi rushes upward causing pain rising from below the umbilicus with difficult urination. Use raw Leek Juice mixed with Wuling San, taken with Fennel decoction. For Hernia Qi attacking the Heart, treat in the Hernia section. For Hongjiao attacking the Heart, treat in the Hongjiao section.
Xin Chai (Heart Emaciation): Due to Stomach Heat causing easy digestion. Suwen calls it Food Emaciation, caused by Phlegm-Fire agitation, similar to Middle Xiao (Middle Consumptive Thirst). Use Xiao Banxia Fuling Tang plus Zhishi. Stomach Fire accumulation emaciation uses Erchen Tang plus Huanglian, or Wuling San plus Zhusha (Cinnabar). Some emaciation cases heal with Ginger Soup or Dried Ginger warming agents due to upper diaphragm Cold and hidden fluid resolving with pungent-warmth.
[Diagnosis] Heart pulse slightly urgent indicates pain; short-rapid indicates Heart pain; choppy indicates Heart pain. Floating-large-wiry-long pulse indicates death; deep-thready indicates survival. Stomach pulse slightly slippery indicates Phlegm-Drink; slippery-solid indicates retained food; deep-tight indicates Cold accumulation; deep-choppy indicates Qi stagnation; rapid indicates Fire; floating indicates Wind; wiry indicates Blood; fluctuating size indicates Parasites.
Li Dongyuan treated a pregnant woman who, after weeping at winter solstice and inhaling Wind-Cold, suffered unbearable Heart pain and extreme cold. He diagnosed Guest Cold invading the Stomach causing epigastric pain. He prescribed Caodoukou, Banxia, Shengjiang (Fresh Ginger), Zhi Gancao (Honey-fried Licorice), and Yizhiren (Alpinia Oxyphylla). When asked about Banxia toxicity in pregnancy, he cited Qibo: "With pathology, no destruction occurs." She recovered.
Hua Borun treated a woman with summer diarrhea, cold limbs, aversion to cold, epigastric pain radiating to abdomen/hypochondrium, turning into dysentery with vomiting. Misdiagnosed as Summerheat-Huo Luan, she worsened. Pulse was micro-short-deep-weak in all three positions. He diagnosed extreme Yin Cold and prescribed Ginger-Aconite warming agents and Laifu Dan. After seven days of warming, symptoms resolved, and pills cleared dysentery.
Jiang Yingsu treated a man with ten-year Heart/Spleen pain, groaning and reduced intake. Pulse was wiry-rapid. He diagnosed Fire Depression, prescribing Ginger-fried Huanglian and Zhizi as chief, Chuanxiong, Xiangfu, Chenpi, Zhike as ministers, and Paojiang as assistant for reverse treatment. One dose cured; Pingwei San with herbal pills eradicated the root.
Li Shicai treated Zhang Tongchu, prone to anger/depression, with severe chest pain and insomnia. Previous doctors used aromatic/dispersing herbs. Li diagnosed deficiency causing turbid Yin failure to descend and Spirit loss. He prescribed Guipi Tang with doubled Renshen and Danggui, curing him in ten doses.
He also treated Song Jingfu with severe Heart/Abdominal pain, stooping, unresponsive to Qi/Blood regulators. Left pulse was slippery-rapid, breathing difficult, coughing induced despair. Diagnosed as Xin Shan, he prescribed Ginger porridge with Xiaohuixiang, Chuanlianzi, Qingmuxiang, Guangmuxiang, Wuzhuyu, Mutong, Yanhusuo, Dangshen, and Qingpi. Pain reduced in one dose, resolved in five days.