大意
心为君主。义不受邪。其厥心痛者。因内外犯心之胞络。或他脏邪犯心之支脉。非真心痛也。谓之厥者。诸
痛皆气逆上冲。又痛极则发厥。然厥痛亦甚少。今人所患。大半是胃脘作痛耳。（汇补）
内因
其络与府之受邪。皆因怵惕思虑。伤神耗血。是以受如持虚。而方论复分曰痰。曰食。曰热。曰气。曰血。曰悸。
曰虫。曰疰。曰饮者。亦常见之候。均宜力辨。（汇补）
痰痛
肺郁痰火。忧恚则发。（入门）心膈大痛。攻走胸背。发厥呕吐。（丹溪）嘈杂不宁。如饥如饱。怏怏欲吐。吐则稍
宽。此皆痰火为患也。（指掌）
食痛
因气而食。卒然发痛。心胸高起。按之愈痛。腹胀嗳气。不能饮食。（机要）痛时如有物阻碍。累累不得下。（指掌）
大便或闭。久而注闷。（机要）
热痛
纵酒嗜辛。蓄热在胃。偶遇寒气。热郁而发。大便不通。面带阳色。痛必作止不常。甚则躁渴吐酸。额上有汗。
（指掌） 手足温暧。或身虽热而手足寒。谓之热厥。（汇补）
寒痛
如身受寒气。口伤冷物。因而心痛。面冷唇白。口吐清水。手足厥逆。遍身冷汗。便溺清利。口和不渴。气微力
弱。痛必绵绵不已。（机要）欲近暖处。得热则缓。此因寒作痛也。（指掌）
气痛
因恼怒而发。痛时隐隐闷结。胸臆相引。得嗳觉宽。为忧郁所致。（指掌）甚则痛连胁肋。呕逆恶心。吐不得出。
坐卧不安。奔走狂叫。均宜枳壳、木香。以开其气。（汇补）
血痛
若跌扑损伤，或平日喜食热物。以致死血留于胃口。时痛时止。或饮汤水。下咽即呃。（心法）痛时从上而下。
自闻唧唧有声。搔抓无措。眠卧不稳。心下如刮。上连胸臆。乃积血不消。为火所载。非虫症也。（指掌）又有妇
人经行未尽。偶触恚怒。气郁不行。血亦留积。上攻心痛而成薄厥者。轻则开导。重则攻下。（汇补）
悸痛
内因七情。心气耗散。心血不荣。轻则怔忡惊悸。似痛非痛。（入门）肢体懒怠。或欲揉按。（指掌）重则两目赤黄。
手足青冷。亦真心痛之亚欤。（入门）
虫痛
湿热生虫。上攻于心。痛发难当。痛定能食。饥则呕沫。（入门）痛极如咬。时吐清水。或青黄绿水涎沫。面清白
而少光彩。（指掌） 或乍青乍赤。（脉经）或兼见白斑。又有蛔虫作痛。因胃气虚寒。入膈攻心而吐蛔者。宜安蛔
为主。用香油葱汁呷之。或花椒、乌梅入药同煎。
疰痛
卒感恶忤尸疰。素虚之人。挟肾经阴气上攻。神昏卒倒。痛则引背。伛偻素实之人。挟肾经阴火上冲。心痛
彻背。（入门）昏愦妄言。（汇补）
饮痛
水停心下。心火畏水。不能自安。惕惕然引痛。或如针刺。恶心烦闷。时吐黄水。按之有声。（汇补）
死症
有心痛者。卒然大痛。如有刀割。汗出不休。舌强难言。手足青至节。旦发夕死。夕发旦死。（医统）
心痛分辨
心痛在岐骨陷处。胸痛则横满胸间。胃脘痛在心之下。（准绳）
脉法
心痛者。脉必急。痛甚者。脉必伏。又热则数。痰则滑。瘀则涩。虚则濡。外寒则紧。内寒则迟。沉细
者生。弦长者死。
大凡痛甚者。脉必伏。且有厥冷昏闷自汗寒热之症。切不可疑为虚寒。即投温补。宜究病因而施治。方
为无失。
治法
久病无寒。新病无热。初病宜温宜散。久痛宜补宜和。（机要）
治分寒热
外因寒气郁遏元阳。初宜温散。久则寒郁成热。治宜清解。内因郁气者。始终是热。只宜苦寒泻火。辛热行
气为向导也。（入门）
治分虚实
心痛满闷拒按便闭者。宜利。痛随利减。所谓通则不痛也，如病后羸弱。食少体虚。因劳忍饥而发。手按痛
缓者。治宜温补。然喜按属虚。拒按属实。乃论其常耳。往往有阴寒凝结。亦令胀闷难按。必当温散。无任寒凉。（汇
补）
急救法
凡心腹痛。仓卒无药。急以盐置刀头。烧红。淬入水中。温和饮之。探吐。若痛攻走腰背。欲呕诸药不效者。二
陈加苍术、川芎、山栀探吐之。或用明矾三钱为末。以生熟水调服。探吐痰涎。亦愈。（汇补）
用药
主以二陈汤。痰加枳实、南星。食加山楂、麦芽。热加黄连、山栀。寒加干姜、浓朴。气加乌药、木香、香附。瘀
加韭汁、桃仁、延胡索。虫加槟榔、楝根。疰加沉香、木香。虚加干姜、炒盐。饮加猪苓、灯心。便闭久结。加玄明粉。
古方治九种心痛。痰用导痰汤。食用保和丸。热用清中汤。寒用温胃汤。气用调气汤。血用手拈散。悸用
妙香散。虫用万应丸。疰用苏合香丸。属虚者。加味归脾汤。认证投之。无不捷效。
【附胃脘痛】
内因 胃之上口曰贲门。与心相连。故胃脘当心而痛。亦由清痰食积郁于中。七情九气触于内。是以清
阳不升。浊阴不降。妨碍道路而为痛耳。（正传）
外候
或满或胀。或呕或吐。或噎气。或吞酸。或不能食。或大便难。或泻痢不止。或面浮面黄。本病与客邪
必参杂而见也。（必读）
治法
大率气食居多。不可骤用补剂。盖补之则气不通而痛愈甚。（医鉴）若曾服攻击之品。愈后复发。屡
发屡攻。渐至脉来浮大空虚者。又当培补。盖脾得补而气自运。痛自缓。此虚实之分也。（汇补）
用药 用药与心痛相仿。但有食积满痛者。用大柴胡汤攻下之。余参心痛用药。如克伐过多而痛者。宜
六君子汤加木香。（汇补）
【附胸痛】
胸中引胁下空痛者。肝虚也。引小腹病痛者。肾虚也。引背膊臂廉皆痛者。心火盛也。引胁肋髀外皆痛者。
胆木实也。有痰结者。有停饮者。有血瘀者。有气滞者。此皆实症也。惟作劳之人。胸痛引背。食少倦怠。遇劳
频发。此为脾肺俱虚。宜培补元气。若夫怯弱咳嗽。引痛胸中云门中府者。须防肺痈之患。（汇补）
心痛选方
二陈汤 统治心痛诸症。（方见痰症）
导痰汤 治痰痛心痛。
即二陈汤加枳实、胆星。
海蛤丸（丹溪） 治痰饮心痛。
海蛤烧为末。研极细。过数日。火毒散。用之。栝蒌仁带瓤同研。以蛤粉入栝蒌内。干湿得所为丸。每服五十丸。
保和丸 治食积心痛。（方见伤食）
清中汤（统旨） 治火症心痛。
黄连 山栀（各一钱） 陈皮 茯苓（各一钱半） 半夏（一钱） 甘草（七分）
草豆蔻（五分） 生姜（一片）
水煎。
术桂汤（东垣） 治寒湿所客。身体沉重。胃脘心痛。面痿黄。
桂枝 草豆蔻 半夏 炒曲（各五分） 白术（八分） 陈皮（一钱） 炙甘草（二分）
水煎服。
温胃汤（东垣） 治服寒药过多。致脾胃虚弱。胃脘作痛。
白蔻仁（三分） 益智仁 砂仁 浓朴 甘草 干姜
姜黄（各二分） 人参（三分） 陈皮（七分）
水煎服。
调气汤 治气逆心痛。
香附（上） 乌药（中） 陈皮（中） 青皮（下） 砂仁（下） 甘草（下） 木香（下） 藿香（中）
水煎服。
手拈散（奇效） 治血瘀心痛。
延胡索 五灵脂 没药 草果（等分）
为末。每服三钱。热酒调下。
失笑散 治妇人心痛气刺不可忍。
五灵脂（净好者） 蒲黄（等分）
为末。每服二钱。用醋一勺熬成膏。再入水一盏。煎七分服。
妙香散（良方） 治心虚悸痛。精神恍惚。
人参 茯苓 茯神 山药 远志 黄 （各一钱）
桔梗 甘草（各五分） 木香（二分） 辰砂（三分） 麝香（一分）
为末。每服。温酒调下。
万应丸 治虫积心痛。
黑牵牛 大黄 槟榔（各八两） 雷丸 木香（各一两） 沉香（五钱） 糊丸。
苏合香丸 治疰心痛。（方见似中风）
归脾汤 治虚心痛。（方见中风）
大柴胡汤 治心脾胃脘积热。壅滞作痛而便闭者。
连理汤
即理中汤加黄连。
一法。用香附醋炒为末。高良姜略炒为末。俱各收贮。因寒作痛者。用良姜二钱、香附一钱。因气心痛者。香
附二钱、良姜一钱。和匀。以热米饮。和姜汁一匙。盐一捻。调服即止。
治九种心疼（家秘）
木香 生矾 胡椒（各一两） 共为末。捣黑枣肉为丸。每服一钱。姜汤下。地腊日合。
又方
玄胡索 荔枝核（等分）
焙燥为末。每样一钱二分。砂糖汤下。
【大意】
心为君主之官，原则上不应受邪气侵袭。所谓厥心痛，是因为内外邪气侵犯心的包络，或其他脏腑的邪气侵犯心的支脉所致，并非真正的真心痛。称为“厥”，是因为各种疼痛都是气逆上冲；又因疼痛剧烈时可导致昏厥。然而厥痛的情况也很少见。如今人们所患的，大半是胃脘部作痛罢了。（出自《证治汇补》）
【内因】
经络与腑脏受邪，都是因为惊恐思虑，损伤心神、耗伤血液，因此身体空虚易受邪气入侵。而方论中又进一步分为痰、食、热、气、血、悸、虫、疰、饮九种，这也是常见的证候，都应当仔细辨别。（出自《证治汇补》）
【痰痛】
肺郁结痰火，因忧怒而发作。（出自《医宗入门》）心膈部位剧烈疼痛，放射至胸背，伴有昏厥呕吐。（出自朱丹溪）嘈杂不安，似饥非饥，似饱非饱，心中郁闷想吐，吐出后稍感舒缓，这都是痰火为患。（出自《景岳全书·杂证谟·指掌》）
【食痛】
因气滞而进食，突然发作疼痛，心胸部位高起，按压时疼痛加剧，腹胀嗳气，不能饮食。（出自《医学机要》）疼痛时感觉如有物阻碍，累累然不得下行。（出自《景岳全书·杂证谟·指掌》）大便或闭结，久而久之感到闷窒。（出自《医学机要》）
【热痛】
纵酒嗜食辛辣，热气蓄积在胃，偶尔遇到寒气，热郁而发作。大便不通，面色呈现阳热之色，疼痛必定发作停止无常，严重时烦躁口渴、吐酸水，额头上有汗。（出自《景岳全书·杂证谟·指掌》）手足温暖，或者身体虽热但手足寒冷，这称为热厥。（出自《证治汇补》）
【寒痛】
如身体感受寒气，或口吃冷物，因而引起心痛，面色发冷、嘴唇苍白，口吐清水，手足厥冷，全身冷汗，大小便清利，口中和缓不渴，气息微弱、体力虚弱，疼痛必定绵绵不断。（出自《医学机要》）喜欢靠近温暖的地方，得到热敷则缓解，这是因寒引起的疼痛。（出自《景岳全书·杂证谟·指掌》）
【气痛】
因恼怒而发作，疼痛时隐隐闷结，牵引胸臆，打嗝后感觉舒缓，这是由忧郁所致。（出自《景岳全书·杂证谟·指掌》）严重时疼痛牵连胁肋，呕逆恶心，想吐却吐不出，坐卧不安，奔走狂叫，均宜使用枳壳、木香来行气开郁。（出自《证治汇补》）
【血痛】
若是跌扑损伤，或平日喜食热物，导致死血留滞在胃口，时而疼痛时而停止，或者喝汤水，咽下即呃逆。（出自《景岳全书·杂证谟·心法》）疼痛时从上而下，能听到唧唧有声，搔抓无措，睡眠不安稳，心下感觉如刮擦一般，向上连及胸臆，这是积血不消，被火邪所载，不是虫症。（出自《景岳全书·杂证谟·指掌》）又有妇女月经未尽，偶然触怒，气郁不行，血亦留积，上攻心痛而成薄厥的，轻则用疏导法，重则用攻下法。（出自《证治汇补》）
【悸痛】
内因为七情所伤，心气耗散，心血不荣养，轻则怔忡惊悸，似痛非痛。（出自《医宗入门》）肢体懒怠，或者想要揉按。（出自《景岳全书·杂证谟·指掌》）重则两目赤黄，手足青冷，这也是真心痛的次一等证候吧。（出自《医宗入门》）
【虫痛】
湿热生虫，上攻于心，疼痛发作难以忍受，痛定之后能进食，饥饿时则呕吐涎沫。（出自《医宗入门》）疼痛极剧如咬啮，时常吐清水，或青黄绿水样的涎沫，面色清白而无光彩。（出自《景岳全书·杂证谟·指掌》）或者脸色乍青乍赤。（出自《脉经》）或者兼见白斑。又有蛔虫作痛，因胃气虚寒，蛔虫入膈攻心而吐蛔的，宜以安蛔为主，用香油、葱汁慢慢呷服，或者花椒、乌梅入药同煎。
【疰痛】
突然感受恶忤尸疰，素体虚弱之人，挟带肾经阴气上攻，神志昏迷突然跌倒，疼痛牵引背部，弯腰曲背；素体充实之人，挟带肾经阴火上冲，心痛彻背。（出自《医宗入门》）神志昏乱胡言乱语。（出自《证治汇补》）
【饮痛】
水饮停聚在心下，心火畏惧水邪，不能自安，惕惕然引致疼痛，或者如针刺般疼痛，恶心烦闷，时常吐黄水，按压时有水声。（出自《证治汇补》）
【死症】
有心痛患者，突然剧烈疼痛，如同刀割，出汗不止，舌强难言，手足青紫直至关节，早晨发病傍晚死亡，傍晚发病早晨死亡。（出自《医统》）
【心痛分辨】
心痛位于歧骨（剑突）陷处，胸痛则是横满胸间，胃脘痛在心之下。（出自《医学准绳六要》）
【脉法】
心痛者，脉象必定紧急；疼痛剧烈的，脉象必定沉伏。又有热则脉数，痰则脉滑，瘀则脉涩，虚则脉濡，外寒则脉紧，内寒则脉迟。脉象沉细者预后良好，弦长者预后不良。
大凡疼痛剧烈的，脉象必定沉伏，且伴有厥冷、昏闷、自汗、寒热等症状，切不可误认为是虚寒，立即投用温补药物。应当探究病因进行治疗，这样才不会失误。
【治法】
久病多无寒，新病多无热。初病宜温宜散，久痛宜补宜和。（出自《医学机要》）
【治分寒热】
外因寒气郁遏元阳，初期宜温散，日久则寒郁化热，治疗宜清解。内因郁气者，始终是热，只宜苦寒泻火，以辛热药行气作为向导。（出自《医宗入门》）
【治分虚实】
心痛伴满闷、拒按、便秘的，宜通利。疼痛随通利而减轻，这就是所谓的“通则不痛”。如果是病后羸弱，食少体虚，因劳累忍饥而发作，手按疼痛缓解的，治疗宜温补。喜按属虚，拒按属实，这是常理。往往有阴寒凝结，也会导致胀闷难按，必须温散，不可任其寒凉。（出自《证治汇补》）
【急救法】
凡是心腹痛，仓促无药，急取盐置于刀头，烧红，淬入水中，温和后饮下，并探吐。若疼痛攻走腰背，欲呕且诸药无效的，用二陈汤加苍术、川芎、山栀探吐。或者用明矾三钱研末，以生熟水调服，探吐痰涎，也能痊愈。（出自《证治汇补》）
【用药】
主方以二陈汤为基础。痰多加枳实、南星；食多加山楂、麦芽；热多加黄连、山栀；寒多加干姜、浓朴；气多加乌药、木香、香附；瘀多加韭汁、桃仁、延胡索；虫多加槟榔、楝根；疰多加沉香、木香；虚多加干姜、炒盐；饮多加猪苓、灯心草。大便闭结日久，加玄明粉。
古方治疗九种心痛：痰痛用导痰汤，食痛用保和丸，热痛用清中汤，寒痛用温胃汤，气痛用调气汤，血痛用手拈散，悸痛用妙香散，虫痛用万应丸，疰痛用苏合香丸。属虚的，用加味归脾汤。辨证投药，无不捷效。
【附：胃脘痛】
【内因】胃的上口叫贲门，与心相连，所以胃脘当心而痛。也是由于清痰食积郁结于中焦，七情九气触动于内，导致清阳不升，浊阴不降，妨碍道路而为痛。（出自《丹溪心法·正传》）
【外候】或者满或者胀，或者呕或者吐，或者噎气，或者吞酸，或者不能食，或者大便难，或者泻痢不止，或者面浮面黄，本病与客邪必然参杂而见。（出自《医学必读》）
【治法】大体上气滞食积居多，不可骤用补剂。因为补益则气不通而疼痛更甚。（出自《医鉴》）如果曾服用攻伐之品，愈后复发，屡发屡攻，渐至脉来浮大空虚的，又应当培补。因为脾得补而气自运，疼痛自缓，这是虚实之分。（出自《证治汇补》）
【用药】用药与心痛相仿，但有食积满痛的，用大柴胡汤攻下之，其余参考心痛用药。如克伐过多而痛的，宜用六君子汤加木香。（出自《证治汇补》）
【附：胸痛】
胸中牵引胁下空痛的，是肝虚。牵引小腹疼痛的，是肾虚。牵引背膊臂廉皆痛的，是心火盛。牵引胁肋髀外皆痛的，是胆木实。有痰结的，有停饮的，有血瘀的，有气滞的，这些都是实证。只有劳作之人，胸痛引背，食少倦怠，遇劳频发，这是脾肺俱虚，宜培补元气。至于怯弱咳嗽，牵引痛在胸中云门、中府穴处的，须防肺痈之患。（出自《证治汇补》）
【心痛选方】
二陈汤 统治心痛诸症。（方见痰症）
导痰汤 治痰痛心痛。
即二陈汤加枳实、胆南星。
海蛤丸（朱丹溪） 治痰饮心痛。
海蛤烧为末，研极细，过数日，火毒散去，再用。栝蒌仁带瓤同研，以蛤粉入栝蒌内，干湿适宜为丸。每服五十丸。
保和丸 治食积心痛。（方见伤食）
清中汤（《统旨》） 治火症心痛。
黄连、山栀（各一钱），陈皮、茯苓（各一钱半），半夏（一钱），甘草（七分），草豆蔻（五分），生姜（一片）。水煎。
术桂汤（李东垣） 治寒湿所客，身体沉重，胃脘心痛，面色痿黄。
桂枝、草豆蔻、半夏、炒神曲（各五分），白术（八分），陈皮（一钱），炙甘草（二分）。水煎服。
温胃汤（李东垣） 治服寒药过多，致脾胃虚弱，胃脘作痛。
白蔻仁（三分），益智仁、砂仁、浓朴、甘草、干姜、姜黄（各二分），人参（三分），陈皮（七分）。水煎服。
调气汤 治气逆心痛。
香附（治上）、乌药（治中）、陈皮（治中）、青皮（治下）、砂仁（治下）、甘草（治下）、木香（治下）、藿香（治中）。水煎服。
手拈散（《奇效良方》） 治血瘀心痛。
延胡索、五灵脂、没药、草果（等分）。为末，每服三钱，热酒调下。
失笑散 治妇人心痛气刺不可忍。
五灵脂（净好者）、蒲黄（等分）。为末，每服二钱，用醋一勺熬成膏，再入水一盏，煎七分服。
妙香散（《良方》） 治心虚悸痛，精神恍惚。
人参、茯苓、茯神、山药、远志、黄芪（各一钱），桔梗、甘草（各五分），木香（二分），辰砂（三分），麝香（一分）。为末，每服，温酒调下。
万应丸 治虫积心痛。
黑牵牛、大黄、槟榔（各八两），雷丸、木香（各一两），沉香（五钱）。糊丸。
苏合香丸 治疰心痛。（方见似中风）
归脾汤 治虚心痛。（方见中风）
大柴胡汤 治心脾胃脘积热，壅滞作痛而便闭者。
连理汤
即理中汤加黄连。
一法：用香附醋炒为末，高良姜略炒为末，俱各收贮。因寒作痛者，用良姜二钱、香附一钱；因气心痛者，香附二钱、良姜一钱。和匀，以热米饮，和姜汁一匙、盐一捻，调服即止。
治九种心疼（家秘）
木香、生矾、胡椒（各一两）。共为末，捣黑枣肉为丸。每服一钱，姜汤下。地腊日合。
又方
玄胡索、荔枝核（等分）。焙燥为末。每样一钱二分，砂糖汤下。
[General Principle]
The Heart is the Sovereign and, in principle, should not be invaded by pathogenic factors. The so-called Jue Xin Tong (Jue-type Heart Pain) occurs when internal or external pathogens invade the Pericardium (the protective membrane surrounding the heart), or when pathogens from other organs invade the collateral branches of the Heart. It is not true Zhen Xin Tong (True Heart Pain). It is called "Jue" because various pains involve Qi counterflow upward; furthermore, extreme pain can lead to fainting (Jue). However, Jue pain is rare. What people suffer from today is mostly pain in the Epigastrium (upper central abdomen/stomach area). (From *Zhengzhi Huibu*)
[Etiology: Internal Factors]
Pathogens invading the collaterals and Fu organs are caused by fright, fear, and overthinking, which damage the Spirit (Shen) and consume Blood. Thus, the body becomes empty and susceptible to invasion. Formulas further classify these into Phlegm, Food Stagnation, Heat, Qi, Blood, Palpitations, Parasites, Malaria-like infection (Zhu), and Fluid Retention. These are common syndromes and must be carefully differentiated. (From *Zhengzhi Huibu*)
[Pain due to Phlegm]
Lung Qi stagnation with Phlegm-Fire, triggered by worry and anger. (From *Yizong Rumen*) Severe pain in the Heart and Diaphragm, radiating to the chest and back, accompanied by fainting and vomiting. (From Zhu Danxi) A sensation of discomfort and hunger mixed with fullness, depression, and urge to vomit, relieved slightly after vomiting. This is all caused by Phlegm-Fire. (From *Jingyue Quanshu*)
[Pain due to Food Stagnation]
Pain starts suddenly due to Qi stagnation affecting digestion. The chest and heart area appear elevated, and pain worsens upon pressure. There is abdominal distension, belching, and inability to eat. (From *Yixue Jiyao*) During pain, there is a sensation of obstruction, as if something is stuck and cannot descend. (From *Jingyue Quanshu*) Stool may be constipated, leading to prolonged stuffiness. (From *Yixue Jiyao*)
[Pain due to Heat]
Indulgence in alcohol and spicy foods leads to heat accumulation in the Stomach. Upon encountering cold air, the heat becomes trapped and erupts. There is constipation, a face showing signs of Yang heat, and pain that comes and goes irregularly. In severe cases, there is irritability, thirst, and sour regurgitation, with sweat on the forehead. (From *Jingyue Quanshu*) Hands and feet are warm, or the body is hot while hands and feet are cold, known as Re Jue (Heat Jue). (From *Zhengzhi Huibu*)
[Pain due to Cold]
Caused by exposure to cold or ingestion of cold substances, resulting in Heart pain. The face is cold, lips are pale, and clear fluid is vomited. Hands and feet are cold (Jue), with cold sweat all over the body. Urine and stool are clear and profuse. The mouth feels neutral without thirst. Qi is weak, and pain is continuous and lingering. (From *Yixue Jiyao*) The patient desires warmth, and relief comes with heat. This is pain caused by Cold. (From *Jingyue Quanshu*)
[Pain due to Qi Stagnation]
Triggered by anger. The pain is dull and knotted, pulling at the chest. Relief comes with belching, caused by depression. (From *Jingyue Quanshu*) In severe cases, pain radiates to the hypochondrium, with nausea, retching without output, restlessness, running around, and screaming. Zhike (Fructus Aurantii) and Muxiang (Radix Aucklandiae) should be used to move Qi. (From *Zhengzhi Huibu*)
[Pain due to Blood Stasis]
Due to trauma or habitual consumption of hot foods, causing dead blood to remain in the stomach area. Pain comes and goes. Drinking water may trigger hiccups immediately upon swallowing. (From *Jingyue Quanshu*) Pain moves downward, accompanied by gurgling sounds. The patient scratches uncontrollably and sleeps poorly. The epigastrium feels like it is being scraped, extending up to the chest. This is accumulated blood not resolved, carried by Fire, not parasites. (From *Jingyue Quanshu*) In women, if menstruation is incomplete and anger is provoked, Qi stagnates, Blood accumulates, and attacks the Heart causing Bo Jue (Thin Jue). Mild cases require guiding/dispersing; severe cases require purging. (From *Zhengzhi Huibu*)
[Pain due to Palpitations]
Internal cause: Seven Emotions deplete Heart Qi and fail to nourish Heart Blood. Mild cases present as palpitations and fright, feeling like pain but not quite. (From *Yizong Rumen*) Limbs feel lazy, and the patient desires rubbing/massage. (From *Jingyue Quanshu*) Severe cases show red/yellow eyes and cyanotic/cold hands and feet, representing a lesser degree of True Heart Pain. (From *Yizong Rumen*)
[Pain due to Parasites]
Damp-Heat generates parasites that attack the Heart. Pain is unbearable. After pain subsides, appetite returns; hunger causes vomiting of saliva. (From *Yizong Rumen*) Pain is extreme, like biting. Clear fluid or green/yellow watery saliva is vomited. The face is pale and lusterless. (From *Jingyue Quanshu*) Complexion may fluctuate between blue/green and red. (From *Maijing*) White spots may appear. For roundworm pain due to Stomach Qi deficiency and Cold, where worms enter the Diaphragm and attack the Heart causing vomiting of worms, the priority is to calm the worms. Drink sesame oil with scallion juice, or decoct Huajiao (Pericarpium Zanthoxyli) and Wumei (Fructus Mume).
[Pain due to Zhu (Malaria-like/Infectious)]
Sudden contraction of evil influences/Zhu pathogens. In deficient individuals, Kidney Yin Qi attacks upward, causing coma and sudden collapse. Pain pulls to the back, causing stooping. In robust individuals, Kidney Yin Fire rushes upward, causing Heart pain penetrating to the back. (From *Yizong Rumen*) Confusion and delirious speech. (From *Zhengzhi Huibu*)
[Pain due to Fluid Retention]
Water stops below the Heart. Heart Fire fears Water and cannot settle, causing fearful, pulling pain, or stabbing pain. Nausea, vexation, frequent vomiting of yellow water, and audible fluid sounds upon pressure. (From *Zhengzhi Huibu*)
[Death Syndromes]
Heart pain patients experience sudden, severe pain like knife cutting, incessant sweating, stiff tongue and difficulty speaking, and cyanosis of hands and feet reaching the joints. Morning onset leads to evening death; evening onset leads to morning death. (From *Yitong*)
[Differentiation of Heart Pain]
Heart pain is located at the depression of the xiphoid process. Chest pain fills the chest horizontally. Epigastric pain is below the Heart. (From *Yixue Zhunsheng*)
[Pulse Diagnosis]
In Heart pain, the pulse is necessarily rapid/tight. In severe pain, the pulse is necessarily deep/fixed. Heat presents with a rapid pulse; Phlegm with a slippery pulse; Stasis with a choppy pulse; Deficiency with a soft pulse; External Cold with a tight pulse; Internal Cold with a slow pulse. Deep and fine pulses indicate survival; wiry and long pulses indicate death.
Generally, severe pain presents with a fixed/deep pulse, accompanied by cold limbs, confusion, spontaneous sweating, and chills/fever. Do not mistake this for Deficiency-Cold and immediately administer warming tonics. Investigate the etiology and treat accordingly to avoid error.
[Therapeutic Principles]
Chronic illness rarely involves Cold; acute illness rarely involves Heat. Acute cases should be warmed and dispersed; chronic pain should be tonified and harmonized. (From *Yixue Jiyao*)
[Treatment Differentiated by Cold and Heat]
External Cold constrains Yuan Yang; initially treat with warming dispersion. Long-term Cold stagnation transforms into Heat; treat with clearing and resolving. Internal Qi stagnation is always Heat; treat with bitter-cold to drain Fire, using acrid-hot herbs to guide Qi movement. (From *Yizong Rumen*)
[Treatment Differentiated by Deficiency and Excess]
Heart pain with fullness, refusal of pressure, and constipation requires purgation/drainage. Pain decreases with drainage, illustrating "Unblocked means no pain." If weakness follows illness, with poor appetite and deficiency, triggered by fatigue and hunger, and relieved by pressure, treat with warming tonification. Desire for pressure indicates Deficiency; refusal indicates Excess. This is the general rule. However, Yin-Cold coagulation can also cause distension and intolerance to pressure, requiring warming dispersion, never allowing cold-natured herbs. (From *Zhengzhi Huibu*)
[Emergency Methods]
For sudden Heart/Abdominal pain without medicine: Place salt on a knife head, heat until red, quench in water, drink when warm, and induce vomiting. If pain radiates to back/waist and vomiting fails to respond to drugs, use Er Chen Tang plus Cangzhu, Chuanxiong, and Shanzhi to induce vomiting. Or use Mingfan (Alum) 3 qian powdered, mixed with raw/cooked water, to induce vomiting of phlegm-fluids. (From *Zhengzhi Huibu*)
[Medication]
Base formula: Er Chen Tang. Add Zhishi and Nanxing for Phlegm; Shanzha and Maiya for Food; Huanglian and Shanzhi for Heat; Ganjiang and Houpo for Cold; Wuyao, Muxiang, Xiangfu for Qi; Jiuzhi, Taoren, Yanhusuo for Stasis; Binglang and Ligen for Parasites; Chenxiang and Muxiang for Zhu; Ganjiang and fried salt for Deficiency; Zhuling and Dengxin for Fluids. For chronic constipation, add Xuanmingfen.
Ancient formulas for Nine Types of Heart Pain: Phlegm uses Daotan Tang; Food uses Baohe Wan; Heat uses Qingzhong Tang; Cold uses Wenwei Tang; Qi uses Tiaoqi Tang; Blood uses Shounian San; Palpitations uses Miaoxiang San; Parasites uses Wanying Wan; Zhu uses Suhexiang Wan. For Deficiency, use Jiawei Guipi Tang. Correct diagnosis ensures swift efficacy.
[Appendix: Epigastric Pain]
[Etiology] The upper opening of the Stomach is the Jie Men (Brenmen), connected to the Heart, hence Epigastric pain feels centered at the Heart. It is caused by clear Phlegm and Food Stagnation obstructing the Middle Jiao, and Seven Emotions/Nine Qi disturbing internally, preventing Clear Yang from ascending and Turbid Yin from descending, blocking the pathway and causing pain. (From *Danxi Xinfa*)
[Manifestations] Fullness or distension, vomiting or regurgitation, hiccuping, acid reflux, anorexia, difficult defecation, persistent diarrhea/dysentery, facial edema or sallow complexion. The primary disease and exogenous pathogens often mix. (From *Yixue Bidu*)
[Treatment] Mostly Qi and Food issues; do not use tonics abruptly, as tonification blocks Qi and worsens pain. (From *Yijian*) If previous aggressive treatments led to recurrence and a floating/vacuous pulse, tonification is needed. Spleen tonification moves Qi and relieves pain, distinguishing Deficiency from Excess. (From *Zhengzhi Huibu*)
[Medication] Similar to Heart Pain. For Food Stagnation with fullness/pain, use Daxiehu Tang to purge. Otherwise refer to Heart Pain medications. If pain results from excessive purging, use Liujunzi Tang plus Muxiang. (From *Zhengzhi Huibu*)
[Appendix: Chest Pain]
Chest pain pulling to empty hypochondrium indicates Liver Deficiency. Pulling to lower abdomen indicates Kidney Deficiency. Pulling to back/shoulders/arms indicates Excess Heart Fire. Pulling to hypochondrium/thigh exterior indicates Excess Gallbladder Wood. Causes include Phlegm knots, Fluid retention, Blood stasis, and Qi stagnation; these are Excess syndromes. Laborers with chest pain pulling to back, poor appetite, fatigue, and frequent episodes upon exertion have Spleen/Lung Deficiency; tonify Yuan Qi. Weakness with cough and pain in Yunmen/Zhongfu points suggests risk of Lung Abscess. (From *Zhengzhi Huibu*)
[Selected Formulas for Heart Pain]
Er Chen Tang: Governs all Heart Pain syndromes. (See Phlegm Syndromes)
Daotan Tang: Treats Phlegm-type Heart Pain.
(Composition: Er Chen Tang + Zhishi, Dannanxing)
Haige Wan (Zhu Danxi): Treats Phlegm-Fluid Heart Pain.
Calcined Haige (Clam Shell) powder, finely ground, aged to remove fire toxicity. Mix with Gualou Ren (including rind) and Haifei powder. Form pills. Take 50 pills per dose.
Baohe Wan: Treats Food Stagnation Heart Pain. (See Food Injury)
Qingzhong Tang (*Tongzhi*): Treats Fire-type Heart Pain.
Huanglian, Shanzhi (1 qian each); Chenpi, Fuling (1.5 qian each); Banxia (1 qian); Gancao (0.7 qian); Caodoukou (0.5 qian); Shengjiang (1 slice). Decoct in water.
Shugui Tang (Li Dongyuan): Treats Cold-Damp invasion, heavy body, Epigastric Heart Pain, sallow complexion.
Guizhi, Caodoukou, Banxia, Chaoqu (0.5 fen each); Baizhu (0.8 fen); Chenpi (1 qian); Zhi Gancao (0.2 fen). Decoct in water.
Wenwei Tang (Li Dongyuan): Treats Epigastric pain due to excessive cold medicine damaging Spleen/Stomach.
Baikouren (0.3 fen); Yizhiren, Sharen, Houpo, Gancao, Ganjiang, Jianghuang (0.2 fen each); Renshen (0.3 fen); Chenpi (0.7 fen). Decoct in water.
Tiaoqi Tang: Treats Qi-reversal Heart Pain.
Xiangfu (Upper), Wuyao (Middle), Chenpi (Middle), Qingpi (Lower), Sharen (Lower), Gancao (Lower), Muxiang (Lower), Huoxiang (Middle). Decoct in water.
Shounian San (*Qixiao Liangfang*): Treats Blood Stasis Heart Pain.
Yanhusuo, Wulingzhi, Moyao, Caoguo (equal parts). Powder. Take 3 qian with hot wine.
Shixiao San: Treats unbearable stabbing Heart Pain in women.
Wulingzhi (pure), Puhuang (equal parts). Powder. Take 2 qian. Simmer with 1 spoon vinegar to paste, add 1 cup water, decoct to 0.7 cup.
Miaoxiang San (*Liangfang*): Treats Heart Deficiency Palpitation Pain, mental恍惚 (fluctuation).
Renshen, Fuling, Fushen, Shanyao, Yuanzhi, Huangqi (1 qian each); Jiegeng, Gancao (0.5 fen each); Muxiang (0.2 fen); Chencha (0.3 fen); Shexiang (0.1 fen). Powder. Take with warm wine.
Wanying Wan: Treats Parasite Accumulation Heart Pain.
Heiqianniu, Dahuang, Binglang (8 liang each); Leiwu, Muxiang (1 liang each); Chenxiang (5 qian). Paste pills.
Suhexiang Wan: Treats Zhu-type Heart Pain. (See Stroke-like Syndromes)
Guipi Tang: Treats Heart Deficiency Pain. (See Stroke Syndromes)
Daxiehu Tang: Treats Heat accumulation in Heart/Spleen/Stomach/Epigastrium causing stagnation pain and constipation.
Lianli Tang
(Lizhong Tang + Huanglian)
Alternative Method: Vinegar-fried Xiangfu powder and lightly fried Gaoliangjiang powder stored separately. For Cold pain: 2 qian Gaoliangjiang + 1 qian Xiangfu. For Qi pain: 2 qian Xiangfu + 1 qian Gaoliangjiang. Mix well. Take with hot rice water, 1 spoon ginger juice, and a pinch of salt. Stops pain immediately.
Treating Nine Types of Heart Pain (Family Secret)
Muxiang, Shengfan, Hujiao (1 liang each). Powder. Mix with black date pulp for pills. Take 1 qian with Ginger Tea. Prepared on Di La Day.
Another Formula
Xuansu, Lizhihe (equal parts). Dry roast and powder. Take 1.2 qian of each with Sugar Water.