金铃子散（《保命》）
金铃子 延胡索（各一两）
上为末，每服三钱，酒调下，痛止，与枳术丸。
左金丸
川黄连（六两，盐水炒） 吴茱萸（去闭口，盐水浸一伏时，一两）
上为末，水泛为丸，或粥糊丸，每服三十丸，开水送下。
《机要》云∶热厥心痛者，身热足寒，痛甚则烦躁而吐，其脉浮大而洪，当灸太 、昆仑，
谓表里俱泻之，是为热病。汗不出，引热下行，表汗通身而出者愈也。灸毕，服金铃子散则
愈。痛止，服枳术丸，去其余邪也。
丹溪云∶心膈痛，曾服香燥热药，复作复结，转深转痼，宜山栀炒黑二两，香附盐水浸
两，川芎一两，黄芩、黄连并酒炒，木香、槟榔各二钱五分，赤曲、番降香各五钱，芒硝二
钱，为末，生姜汁、童子小便各半盏，调二钱，痛时服。
大建中汤
蜀椒（二合，炒去汗） 干姜（四两） 人参（二两）
以水四升，煮取二升，去滓，内胶饴一升，微火煎取一升半，分温再服，如一炊顷，可
饮粥二升，后更服，当一日食糜粥温复之。
扶阳益胃汤
附子（炮，去皮脐，二钱） 干姜（炮，一钱半） 草豆蔻 益智仁 官桂 白芍 甘草
人参（各一钱） 吴茱萸 陈皮 白术（各五钱）
上锉如麻豆大，都作一服，水二盏，姜三片，枣二枚，同煎至一盏，去滓，温服食前。
罗谦甫治漕运使崔君长男云卿，年二十五，体本丰肥，奉养膏粱，时时有热证。友人劝
进寒
凉药，食寒物。至元庚辰秋发疟，医以砒霜等药治之，新汲水下，禁食热物。疟病未除，反
添吐泻，脾胃复伤，中气愈虚，腹痛肠鸣，时复胃脘当心而痛，不任其苦，屡医未效，至冬
不瘥。延至四月，劳役烦恼过度，前症大作，请余治之。诊得脉弦细而微，手足稍冷，面色
青黄不泽，情思不乐，恶人烦扰，饮食减少，微饱则心下痞闷，呕吐酸水，每发作，冷汗时
出，气促不安，须人额相抵而坐，少时易之。予思《内经》，中气不足，溲便为之变，肠为
之苦鸣；下气不足，则乃为痿厥心 。又曰寒气客于肠胃之间，则卒然而痛，得热则已，非
甘辛大热之剂，则不能愈。遂制此方。经曰∶寒淫于内，治以辛热，佐以苦温。附子、干姜
大辛热，温中散寒，故以为君；草豆蔻、益智仁辛苦温，治客寒犯胃为佐；脾不足者以甘补
之，
水，芍药味酸，以泻木来克土；吴茱萸苦热，泻厥气上逆于胸中为使。三服大势去，痛减半
。至秋先灸中脘三七壮，以助胃气，次灸气海百余壮，生发元气，滋荣百脉，以还少丹服之
。喜饮食，添肌肉，皮肤润泽。明年春灸三里二七壮，乃胃之合穴，亦助胃气，引气下行，
又以芳香助脾，服育气汤加白檀香平治之，戒以惩忿窒欲，慎言语，节饮食，一年而平复。
《金匮》治心痛彻背、寒冷者方
赤石脂 干姜 蜀椒（各四分） 附子（炮，二分） 乌头（炮，一分）
上为末，蜜丸梧子大，先食服一丸，日三，不住稍增之。
余尝治一香山人，心痛，问之则服药已一月矣，向左卧则右痛，向右卧则左痛，仰卧则
前，偃卧则痛在背，坐立则痛在上，无一刻少安。余曰∶此中虚，与以小建中汤重用饴糖、
炙甘草，四剂而安。（鹤年）
金铃子散（出自《保命集》）
金铃子、延胡索（各一两）
将上述药材研为细末，每次服用三钱，用酒调服。疼痛停止后，改服枳术丸。
左金丸
川黄连（六两，用盐水炒制）、吴茱萸（去除闭口者，用盐水浸泡一昼夜，一两）
将上述药材研为细末，用水泛丸，或用米粥糊制作成丸剂，每次服用三十丸，用开水送下。
《医学机要》记载：热厥心痛的症状是身体发热而足部寒冷，疼痛剧烈时出现烦躁和呕吐，脉象浮大而洪大。应当艾灸太冲穴、昆仑穴，这属于表里双泻的方法，这是治疗热病。如果不出汗，就引导热邪下行，待全身出汗则痊愈。艾灸结束后，服用金铃子散即可痊愈。疼痛停止后，服用枳术丸以清除残留的病邪。
朱丹溪说：心膈痛，如果曾经服用过香燥温热药物，导致病情反复发作且结聚加深，变得顽固难愈。适宜使用炒黑山栀子二两，盐水浸过的香附二两，川芎一两，黄芩、黄连均用酒炒，木香、槟榔各二钱五分，赤曲、番降香各五钱，芒硝二钱，研为细末。用生姜汁、童子小便各半盏，调和二钱药末，在疼痛发作时服用。
大建中汤
蜀椒（二合，炒至出油汗）、干姜（四两）、人参（二两）
用水四升，煮取二升药液，去渣，加入胶饴一升，用小火煎取一升半，分两次温服。服药后约一顿饭的时间，可以喝二升粥，之后再次服药，应当全天食用糜粥并注意保暖。
扶阳益胃汤
附子（炮制，去皮脐，二钱）、干姜（炮制，一钱半）、草豆蔻、益智仁、官桂、白芍、甘草、人参（各一钱）、吴茱萸、陈皮、白术（各五钱）
将上述药材锉碎如麻豆大小，作为一剂服用。加水二盏，生姜三片，大枣二枚，同煎至一盏，去渣，饭前温服。
罗谦甫治疗漕运使崔君长男云卿，年龄二十五岁，体质原本丰肥，饮食膏粱厚味，时常有热证表现。友人劝他服用寒凉药物，吃寒性食物。至元庚辰年秋季患疟疾，医生用砒霜等药物治疗，并用新汲水送服，禁止食用热物。疟疾未除，反而增添了呕吐腹泻症状，脾胃再次受伤，中气更加虚弱，腹痛肠鸣，时常胃脘当心部位疼痛，难以忍受其痛苦，多次就医无效，直到冬天仍未痊愈。拖延到四月，因劳役烦恼过度，之前的病症大作，请我诊治。诊得脉象弦细而微弱，手足稍冷，面色青黄无光泽，情绪不乐，厌恶他人烦扰，饮食减少，微饱则心下痞闷，呕吐酸水，每次发作时冷汗不时流出，气促不安，需要与人额头相抵坐着，片刻后换人。我思考《内经》，中气不足，大小便就会异常，肠中会发出鸣响；下气不足，就会发生痿厥心痛。又说寒气客居在肠胃之间，就会突然疼痛，得到热邪缓解，如果不是甘辛大热的药剂，就不能痊愈。于是制定此方。经书说：寒邪内侵，用辛热药物治疗，辅以苦温药物。附子、干姜大辛大热，能温中散寒，所以作为君药；草豆蔻、益智仁辛苦温，治疗客寒犯胃作为佐药；脾不足用甘味补益，芍药味酸，用来泻肝木来克制脾土；吴茱萸苦热，泻厥逆之气上冲胸中作为使药。服用三剂后大势已去，疼痛减半。到了秋天先灸中脘穴三七壮，以助胃气，接着灸气海穴百余壮，生发元气，滋养百脉，服用还少丹。喜欢饮食，增加肌肉，皮肤润泽。第二年春天灸足三里穴二七壮，这是胃的合穴，也能助胃气，引气下行，又用芳香药物助脾，服用育气汤加白檀香平治，告诫他要戒除愤怒和节制欲望，慎言语，节饮食，一年后康复。
《金匮要略》治疗心痛放射至背部、伴有寒冷感的方剂
赤石脂、干姜、蜀椒（各四分）、附子（炮制，二分）、乌头（炮制，一分）
将上述药材研为细末，用蜂蜜制成梧桐子大小的丸剂，饭前服用一丸，每日三次，逐渐增加剂量。
我曾治疗一位香山人，患心痛，询问得知他已经服药一个月了，向左卧则右侧疼痛，向右卧则左侧疼痛，仰卧则前方疼痛，俯卧则背部疼痛，坐立则上方疼痛，没有一刻安宁。我说：这是中气虚，给予小建中汤重用饴糖、炙甘草，服用四剂后安稳。（鹤年注）
Jinlingzi San (from *Baoming Ji*)
*Jinlingzi* and *Yanhusuo* (each 1 liang)
Grind the above herbs into fine powder. Take 3 qian each time, mixed with wine. After pain subsides, administer Zhizhu Wan.
Zuojin Wan
*Chuan Huanglian* (6 liang, stir-fried with salt water), *Wuzhuyu* (remove closed-mouth ones, soak in salt water for one full day, 1 liang)
Grind the above herbs into fine powder. Form pills using water or rice paste. Take 30 pills each time, swallowed with boiled water.
*Jiyao* states: In heat jue heart pain, the body is hot while the feet are cold. When pain is severe, irritability and vomiting occur. The pulse is floating, large, and surging. Moxibustion should be applied to Taichong (LR3) and Kunlun (BL60). This represents simultaneous draining of the exterior and interior, treating it as a heat disease. If sweat does not occur, guide the heat downward; when general sweating occurs, the patient will recover. After moxibustion, administer Jinlingzi San for recovery. Once pain stops, take Zhizhu Wan to eliminate residual pathogenic factors.
Danxi stated: For chest and diaphragm pain, if fragrant, dry, and hot medicines have been taken previously, causing recurrent attacks and deepening stagnation leading to stubborn chronicity, it is appropriate to use 2 liang of blackened fried Gardenia (*Shanzhi*), 2 liang of Cyperus (*Xiangfu*) soaked in salt water, 1 liang of Ligusticum (*Chuanxiong*), 1 liang each of Scutellaria (*Huangqin*) and Coptis (*Huanglian*) stir-fried with wine, 2.5 qian each of Aucklandia (*Muxiang*) and Areca Seed (*Binglang*), 5 qian each of Red Qu (*Chiqu*) and Sappan Wood (*Fan Jiangxiang*), and 2 qian of Mirabilite (*Mangxiao*). Grind into powder. Mix 2 qian of powder with half a cup of fresh ginger juice and half a cup of urine from an uncircumcised boy. Take during pain episodes.
Dajianzhong Tang
*Shujiao* (2 he, stir-fried until oil appears), *Ganjiang* (4 liang), *Renshen* (2 liang)
Add 4 sheng of water, boil to obtain 2 sheng of liquid. Remove dregs. Add 1 sheng of malt sugar (*Ji Yi*). Simmer over low heat to obtain 1.5 sheng. Divide into two warm doses. About the time of one meal, drink 2 sheng of rice gruel. Then take the remaining dose again. The patient should consume millet gruel throughout the day and keep warm.
Fuyang Yiwetang
*Fuzi* (processed, skin and umbilicus removed, 2 qian), *Ganjiang* (processed, 1.5 qian), *Caodoukou*, *Yizhiren*, *Guangui*, *Baishao*, *Gancao*, *Renshen* (each 1 qian), *Wuzhuyu*, *Chenpi*, *Baizhu* (each 5 qian)
Cut the herbs into pieces the size of hemp seeds. Combine as one dose. Add 2 zhan of water, 3 slices of ginger, and 2 dates. Decoct together until 1 zhan remains. Remove dregs. Take warm before meals.
Luo Qianfu treated Cui Yunqing, eldest son of the Transport Commissioner. He was 25 years old, originally robust and fat, accustomed to rich and fatty foods, often presenting with heat syndromes. Friends advised him to take cold-cooling medicines and eat cold foods. In autumn of the Gengchen year of Zhiyuan, he contracted malaria. Physicians treated him with arsenic and other drugs, administered with fresh well water, and prohibited hot foods. The malaria did not subside; instead, vomiting and diarrhea were added. The spleen and stomach were injured again, middle qi became more deficient, abdominal pain and borborygmus occurred, and epigastric pain centered behind the heart appeared frequently. He could not bear the suffering, and multiple treatments failed. By winter, he had not recovered. By April, due to excessive labor and worry, previous symptoms worsened significantly. I was invited to treat him. The pulse was wiry, thin, and faint. Hands and feet were slightly cold. Complexion was greenish-yellow and lusterless. Mood was depressed, aversion to disturbance, reduced appetite. Slight fullness caused epigastric stuffiness. Vomiting of sour fluid occurred. During attacks, cold sweat appeared intermittently. Breathing was rapid and uneasy. He needed to sit leaning forehead-to-forehead with someone else. I reflected on the *Neijing*: "When middle qi is insufficient, urination and defecation become abnormal, and the intestines make sounds." "When lower qi is insufficient, atrophy and cold extremities with heart pain occur." It also states: "When cold pathogen lodges between the stomach and intestines, sudden pain occurs, relieved by heat." Without sweet, acrid, and greatly hot agents, it cannot be cured. Thus, this formula was created. The classic says: "For cold invading internally, treat with acrid-hot agents, assisted by bitter-warm agents." *Fuzi* and *Ganjiang* are greatly acrid and hot, warming the middle and dispersing cold, serving as sovereign herbs. *Caodoukou* and *Yizhiren* are acrid-bitter and warm, treating external cold invading the stomach, serving as minister herbs. "What is deficient in the spleen, tonify with sweet." *Baishao* is sour, used to drain liver wood to prevent it from overcoming earth. *Wuzhuyu* is bitter and hot, draining rebellious jue qi ascending to the chest, serving as envoy herbs. After three doses, the major trend subsided, and pain halved. In autumn, first apply 27 moxa cones to Zhongwan (CV12) to assist stomach qi, then apply over 100 cones to Qihai (CV6) to generate primordial qi and nourish all vessels. Administer Hushao Dan. Appetite improved, muscle mass increased, skin became lustrous. In spring of the following year, apply 14 cones to Zusanli (ST36), the confluent point of the stomach, to assist stomach qi and guide qi downward. Use aromatic herbs to assist the spleen. Administer Yuqi Tang with added White Sandalwood (*Baitanxiang*) for balanced treatment. Advised to control anger, restrain desires, guard speech, and regulate diet. Recovered completely after one year.
Formula from *Jingui Yaolue* for heart pain radiating to the back with cold sensation
*Chishizhi*, *Ganjiang*, *Shujiao* (each 4 fen), *Fuzi* (processed, 2 fen), *Wutou* (processed, 1 fen)
Grind into powder. Make pills the size of wu-tzu seeds with honey. Take one pill before meals, three times daily. Gradually increase the dose as tolerated.
I once treated a man from Xiangshan suffering from heart pain. Upon inquiry, he reported taking medicine for a month. Lying on his left side caused right-sided pain; lying on his right side caused left-sided pain; supine position caused anterior pain; prone position caused back pain; sitting or standing caused upper pain. He had no moment of relief. I said: "This is deficiency of the middle. Prescribe Xiaojianzhong Tang with heavy dosage of malt sugar and roasted licorice." After four doses, he stabilized. (Note by Henian)