盛暑洞泄，厥逆恶寒，胃脘当心而痛，自腹引胁，转为滞下，呕哕不食，人皆以中暑霍乱治之益甚。
脉三部俱微短沉弱，不应呼吸，此阴寒极矣。不亟温之，则无生意。遂以姜、附三四进，间以丹药，
脉稍有力，厥逆渐退，更服姜、附，七日而安。厥心痛者，他脏病干之而痛，皆有治也。真心痛者，
心脏自病而痛，故夕发旦死，旦发夕死，无治也。然心脏之经络有病，在标者，其心亦痛而有治。经
云∶心手少阴之脉，是动则病嗌干心痛，渴而欲饮。又心主手少阴之脉，所生病者，心痛，掌中热，
皆视盛、虚、热、寒、陷下取之。又经云∶手心主之别，名曰内关，去腕二寸，出于两筋之间。实则
心痛，取之两筋间也。又云∶邪在心则病心痛喜悲，时眩仆，视有余不及，调其俞是也。
【卒急心痛】若脉洪大而数，其人火热盛者，用前黄连、龙胆草单方饮之。若无热者，荔枝核之类治之。若中
恶心
痛，腹胀大便不通者，走马汤治之。《海上方》急救男子妇人心疼，牙关紧急欲死者，用隔年陈葱白
三五根，去皮须叶，擂为膏，将病患口斡开，用匙将膏送入咽喉，用香油四两灌送下，油不以多少，
但得葱下喉，其人必苏。一方，用香油顿服一盏亦妙。
经云∶邪客于足少阴之络，令人卒心痛，暴胀，胸胁支满，无积者，刺然骨之前出血，如食顷而已，
不已，左取右，右取左，病新发者，五日已。
【膈痛】与心痛不同，心痛则在岐骨陷处，本非心痛，乃心支别络痛耳。膈痛则痛横满胸间，比之心痛为
轻，痛之得名，俗为之称耳。诸方称为烦躁忪悸，皆其证也。五苓散泻心、小肠之热，恐非其对，不
若用四物汤、十全大补汤去桂，生血而益阴，此以水制火之义。膈痛多因积冷与痰气而成，宜五膈宽
中散，或四七汤加木香、桂各半钱，或挝脾汤加木香。膈痛而气上急者，宜苏子降气汤去前胡加木香
如数。痰涎壅盛而痛者，宜小半夏茯苓汤加枳实一钱，间进半硫丸。
【心瘥】亦痰饮所致，俗名饮瘥。有胃口热食易消故瘥。《素问》谓之食瘥，亦类消中之状，俗名肚瘥。
痰气，宜小半夏茯苓汤加枳实一钱。胃中热宜二陈汤加黄连一钱，或五苓散去桂加辰砂。亦有病瘥，
呷姜汤数口，或进干姜剂而愈，此膈上停寒，中有伏饮，见辛热则消。予读中秘书时，馆师韩敬堂先
生，常患膈痛，诊其脉洪大而
涩，予用山栀仁、赤曲、通草、大麦芽、香附、当归、川芎煎汤，加姜汁、韭汁、童便、竹沥之类，
饮之而止。一日劳倦忍饥，痛大发，亟邀予至火房问曰，晨起痛甚，不能待公，服家兄药，药下咽如
刀割，痛益甚，不可忍，何也？予曰，得非二陈、平胃、乌药、紫苏之属乎，曰然。曰是则何怪乎其
增病也。夫劳饿而发，饱逸则止，知其虚也。饮以十全大补汤，一剂而痛止。
【诊】脉多见于右关，阴弦为痛。微急为痛。微大为心痹引背痛。短数为痛。涩为痛。痛甚者，
脉必伏。大是久病。洪大数，属火热。滑大属痰。右手实者，痰积。沉滑者，有宿食。弦迟者，有寒。
沉细而迟者，可治。坚大而实，浮大而长，滑而利，数而紧，皆难治。真心痛，手足俱青至节者，不
治。
盛暑时节出现洞泄（剧烈腹泻），四肢厥冷，恶寒，胃脘部当心处疼痛，疼痛从腹部牵引至胁肋，进而转变为痢疾（滞下），伴有呕吐、呃逆、无法进食。人们都将其当作中暑或霍乱来治疗，结果病情反而加重。
诊察脉象，寸、关、尺三部脉均呈现微、短、沉、弱的特征，脉搏跳动与呼吸不相应，这是阴寒极盛的表现。如果不紧急进行温阳散寒治疗，患者将无生机。于是连续多次服用干姜、附子等温热药物，间或使用丹药，脉象逐渐有力，四肢厥冷症状逐渐消退，继续服用姜、附类药物，七日后病情安定。
厥心痛，是指其他脏腑的病变干扰心脏而导致的疼痛，都有治疗方法。真心痛，是指心脏本身患病而导致的疼痛，所以傍晚发作早晨死亡，早晨发作傍晚死亡，属于无药可治的危重症。然而，如果心脏的经络发生病变，病位在标（浅表或经络层面）的，心脏也会疼痛，但仍有治愈可能。《内经》记载：手少阴心经是动则病咽喉干燥、心痛，口渴想饮水。又手少阴心经所生病者，包括心痛、手掌心发热，都应视其脉气的盛、虚、热、寒、陷下等情况进行针刺取穴。又经文记载：手厥阴心包络的别络，名叫内关穴，距离腕横纹二寸，出于两筋之间。实证表现为心痛，应取两筋之间的内关穴。又经文说：邪气侵犯心脏则导致心痛、喜欢悲伤、时常眩晕跌倒，应视其有余或不足，调理其俞穴即可。
【卒急心痛】如果脉象洪大且数，患者体内火热炽盛，使用前面提到的黄连、龙胆草单方煎服。如果没有热象，用荔枝核之类药物治疗。如果是中恶（感受秽浊之气）导致的心痛，伴有腹胀、大便不通，用走马汤治疗。《海上方》急救男子妇人心痛，牙关紧闭欲死者，用隔年的陈葱白三五根，去掉皮须和叶子，捣烂成膏状，撬开患者嘴巴，用勺子将膏送入咽喉，再用四两香油灌送下去，香油不限多少，只要葱膏进入喉咙，人必定苏醒。另一方法，顿服一盏香油也很好。
经文记载：邪气客居足少阴肾经的络脉，使人突然心痛，暴胀，胸胁支撑满闷，没有积滞物的，刺然骨之前的穴位出血，大约一顿饭的时间就好了，如果不好，左病取右穴，右病取左穴，新发的病，五天可愈。
【膈痛】与心痛不同，心痛位于歧骨（剑突）凹陷处，本不是心痛，而是心的支别络疼痛。膈痛则是疼痛横跨充满胸间，比心痛轻，这种痛的名称，是世俗的称呼罢了。各方书称为烦躁、心悸，都是它的证候。五苓散能泻心和小肠的热，恐怕不对症，不如用四物汤、十全大补汤去掉桂枝，以生血益阴，这是以水制火的意思。膈痛多因积冷和痰气而成，宜用五膈宽中散，或者四七汤加木香、桂枝各半钱，或者挝脾汤加木香。膈痛且气上冲急促的，宜用苏子降气汤去掉前胡加木香如数。痰涎壅盛而痛的，宜用小半夏茯苓汤加枳实一钱，间或服用半硫丸。
【心瘥】也是由痰饮所致，俗名饮瘥。有胃口热、食物易消化所以容易感到饥饿（瘥通“差”，此处指病后恢复期或特定状态，原文语境似指善饥或病后虚损感，结合下文“食瘥”、“消中”，此处指类似消渴病的善饥症状）。《素问》称之为食瘥，也类似消中的症状，俗名肚瘥。若是痰气所致，宜用小半夏茯苓汤加枳实一钱。胃中热宜用二陈汤加黄连一钱，或者五苓散去桂枝加辰砂。也有因病后虚弱，喝几口姜汤，或者服用干姜制剂而痊愈的，这是因为膈上有停寒，中有伏饮，见到辛热药物则消散。我读中秘书时，馆师韩敬堂先生，常患膈痛，诊其脉洪大而涩，我用山栀仁、赤曲、通草、大麦芽、香附、当归、川芎煎汤，加入姜汁、韭汁、童便、竹沥之类，饮用后疼痛停止。有一天劳累疲倦且忍饥，疼痛大发，急忙邀请我到火房问道：“早晨起来疼痛厉害，不能等待您来，服用了家兄的药，药咽下去像刀割一样，疼痛更加厉害，难以忍受，为什么呢？”我说：“莫非是二陈汤、平胃散、乌药、紫苏之类的药吗？”他说：“是的。”我说：“那为什么奇怪于病情加重呢？因为劳累饥饿而发作，饱食安逸则停止，可知这是虚证。给予十全大补汤，一剂后疼痛停止。”
【诊法】脉象多见于右关部，阴弦脉主痛。脉微急主痛。脉微大主心痹并牵引背痛。脉短数主痛。脉涩主痛。疼痛剧烈的，脉象必然伏匿。脉大是久病。脉洪大数，属于火热。脉滑大属于痰。右手脉实者，为痰积。脉沉滑者，有宿食。脉弦迟者，有寒。脉沉细而迟者，可治。脉坚大而实，浮大而长，滑而利，数而紧，都难治。真心痛，手足发青直至关节的，不治。
In the height of summer, if there is profuse diarrhea (Dongxie), cold extremities, aversion to cold, pain in the epigastrium at the heart's location, radiating from the abdomen to the hypochondrium, transforming into dysentery (Zhixia), accompanied by vomiting, hiccups, and inability to eat. People often treat it as heatstroke or cholera, which worsens the condition.
The pulse at the cun, guan, and chi positions on both hands is all faint, short, deep, and weak, not corresponding with respiration; this indicates extreme Yin-cold. If warming is not urgently applied, there will be no hope for life. Subsequently, ginger and aconite were administered several times, interspersed with elixir pills. As the pulse became slightly forceful and cold extremities gradually receded, further administration of ginger and aconite led to stability after seven days.
Jue Heartache refers to pain caused by disorders of other organs affecting the heart, which all have treatments. Zhenxin Tong (True Heartache) refers to pain originating from the heart itself; thus, if it starts in the evening, death occurs by morning, and if it starts in the morning, death occurs by evening, representing an untreatable critical condition. However, if the meridians and collaterals of the heart are diseased, and the pathology is at the biao (superficial/meridional level), the heart may also hurt but remains treatable. The Classics state: "When the Hand-Shaoyin Heart Meridian is disturbed, it causes dryness of the throat, heartache, thirst, and desire to drink." Also, diseases generated by the Hand-Shaoyin Heart Meridian include heartache and heat in the palm; these should be treated by needling according to whether the pulse is full or empty, hot or cold, or sunken. Furthermore, the text states: "The Luo-connecting vessel of the Hand-Jueyin Pericardium is named Neiguan, located two cun above the wrist crease, emerging between the two tendons. In excess conditions causing heartache, needle between the two tendons." It also says: "Pathogenic factors in the heart cause heartache, frequent sadness, dizziness, and collapse; regulate its Shu-Stream points based on excess or deficiency."
[Acute Heartache] If the pulse is surging and rapid, indicating excessive internal heat, use the single prescriptions of Coptis Rhizome (Huanglian) or Gentian Root (Longdancao) decoction. If there is no heat, treat with things like Lychee Seed (Lizhihe). If acute heartache is caused by invasion of foul pathogens (Zhong'e), accompanied by abdominal distension and constipation, treat with Zouma Tang. The *Haishang Fang* emergency prescription for men and women suffering from severe heartache with locked jaw and impending death uses three to five roots of aged green onion white parts from the previous year, peeled and stripped of leaves, pounded into a paste. Pry open the patient's mouth, spoon the paste into the throat, and wash it down with four liang of sesame oil. The amount of oil is not fixed, but once the onion paste enters the throat, the patient will likely revive. Another method, taking a cup of sesame oil in one dose, is also effective.
The Classics state: "When pathogenic factors lodge in the Luo-connecting vessels of the Foot-Shaoyin Kidney Meridian, they cause sudden heartache, acute distension, and fullness/stiffness in the chest and hypochondrium without accumulation. Prick the point anterior to Ran Gu to bleed. After about the time it takes to eat a meal, it resolves. If not resolved, treat left with right points, right with left points. For newly onset disease, it resolves in five days."
[Diaphragm Pain] Differs from heartache. Heartache is located at the depression of the xiphoid process (Qigu); it is fundamentally not heartache but pain of the heart's branch collateral. Diaphragm pain involves pain filling the chest horizontally, which is milder than heartache. The name is merely a colloquial designation. Various formulas describe symptoms such as restlessness, palpitations, etc. Wuling San drains heat from the Heart and Small Intestine, which is likely inappropriate. Instead, use Siwu Tang or Shiquan Dabu Tang minus Cinnamon Twig (Guizhi) to generate blood and nourish Yin, embodying the principle of using water to control fire. Diaphragm pain often results from accumulated cold and phlegm-q stagnation. Suitable formulas include Wuge Kuanzhong San, or Sqi Tang added with Aucklandiae Radix (Muxiang) and Cinnamon Twig (Guizhi) half qian each, or Zhuapi Tang added with Muxiang. If diaphragm pain is accompanied by urgent rising qi, use Suzi Jiangqi Tang minus Peucedani Radix (Qianhu) added with Muxiang in equal amounts. If pain is due to abundant phlegm-fluids, use Xiao Banxia Fuling Tang added with Immature Bitter Orange (Zhishi) one qian, intermittently administering Banshu Wan.
[Xin Chai] Also caused by phlegm-fluids, commonly known as Yin Chai. Some cases involve stomach heat where food digests easily, leading to hunger/chai. The *Suwen* calls this Shi Chai, resembling Xiaozhong (wasting-thirst) patterns, commonly known as Du Chai. For phlegm-q stagnation, use Xiao Banxia Fuling Tang added with Zhishi one qian. For stomach heat, use Erchen Tang added with Huanglian one qian, or Wuling San minus Guizhi added with Cinnabar (Chensha). There are also cases of post-illness weakness where drinking a few mouthfuls of Ginger Decoction or taking dried ginger preparations leads to recovery; this is because cold stagnates above the diaphragm and hidden fluids reside within, dissolving upon encountering acrid-warm substances. When I served as a tutor in the Imperial Library, my teacher Mr. Han Jingtang often suffered from diaphragm pain. His pulse was surging, large, and choppy. I used Gardenia Seed (Shanzhiren), Red Fermented Rice Qu (Chiqu), Thoroughwort Stem (Tongcao), Barley Sprout (Dayamai), Cyperus Rhizome (Xiangfu), Angelica Sinensis (Danggui), and Ligusticum Rhizome (Chuanxiong) decocted in water, adding ginger juice, leek juice, child's urine (Tongbian), and bamboo sap (Zhuli). He drank it and the pain stopped. One day, due to fatigue and hunger, the pain flared severely. He urgently invited me to the heating room and asked, "I woke up with severe pain, couldn't wait for you. I took my brother's medicine. Upon swallowing, it felt like knife cuts, and the pain intensified unbearably. Why?" I said, "Was it Erchen Tang, Pingwei San, Lindera Root (Wuyao), or Perilla Leaf (Zisu)?" He replied, "Yes." I said, "Then why wonder at the worsening? Since it arises from labor and hunger and stops with fullness and rest, it is clearly deficiency. Administer Shiquan Dabu Tang. After one dose, the pain ceased."
[Pulse Diagnosis] Pulses are mostly seen at the Right Guan position. Yin-Choppy pulse indicates pain. Slightly hurried indicates pain. Slightly large indicates Xin Bi (Heart Bi) with back pain radiating. Short and rapid indicates pain. Choppy indicates pain. Severe pain implies a hidden (Fu) pulse. A large pulse indicates chronic disease. Surging, large, and rapid indicates Fire-Heat. Slippery and large indicates Phlegm. Excess pulse at the Right Hand indicates Phlegm accumulation. Deep and slippery indicates retained food. Choppy and slow indicates Cold. Deep, fine, and slow pulses are treatable. Firm, large, and excess; floating, large, and long; slippery and free-flowing; rapid and tight pulses are all difficult to treat. In Zhenxin Tong, if hands and feet turn blue up to the joints, it is untreatable.