平按∶此篇自篇首至形中上者，见《灵枢》卷五第二十四《厥病》篇。自心痛引腰
脊至得之立已，见《灵枢》卷五第二十六《杂病》篇。自心疝暴痛至末，见《灵枢》卷
五第二十三《热病》篇。又自篇首至末，见《甲乙》经卷九第二。
厥心痛，与背相控，如从后触其心，伛偻者，肾心痛也，先取京骨、昆仑，发针不
已，取然谷。（肾脉足少阴贯脊属肾络心，故肾气失逆，令心痛控背。肾在于后，故肾
病痛心，如物从后触心而痛，脊背伛偻也。京骨，在足外侧大骨下赤白肉际，肾腑足太
阳脉所过；昆仑，在足外踝跟骨上，足太阳脉所行；然骨，在足内踝前起大骨下，足少
阴脉所流，故肾心痛皆取之也。平按∶控下《灵枢》、《甲乙》有善螈二字。伛上《甲
乙》有身字，发针
下有立已二字。注肾在于后，袁刻肾作背。）厥心痛，腹胀胸满，心尤痛甚，胃心痛也，
取之大都、太白。（胃脉足阳明属胃络脾。脾脉足太阴流于大都，在足大趾本节后陷中；
注于太白，在足内侧核骨下陷中，支者别胃上膈注心中。脾胃主水谷，水谷有余则腹胀
胸满尤大也。此腑病取于脏输也。平按∶《甲乙》腹胀胸满作暴泄腹胀满。）厥心痛，
痛如锥针刺其心，心痛甚者，脾心痛也，取之然谷、太溪。（然谷，足少阴脉所流，在
足内踝前起大骨下陷中；太溪，足少阴脉所注，在足外踝骨上动脉陷中，并是足少阴流
注。脾气乘心，心痛，可疗脾之输穴。今疗肾足少阴流注之穴者，以脾是土，肾为水，
土当克水，水反乘脾，脾乃与心为病，故远疗病输也。平按∶《灵枢》锥上有以字。
《甲乙》锥下无针字。注足外踝骨上，检《甲乙经》，太溪在足内踝后跟骨上动脉陷中，
且阴脉内联，外踝应是内踝之误，踝下脱后跟二字。）厥心痛，色仓仓如死状，终日不
得太息，肝心痛也，取之行间、太冲。（仓仓，青色也，肝病也。不得太息，肝主吸气，
今吸气已痛，不得出气太息也。太冲，右足大趾本节后二寸陷者，足厥阴脉所注。平按∶
《灵枢》、《甲乙》仓仓作苍苍。注右足，右字当系在字传抄之讹，检《甲乙经》，太
冲穴在足大趾本节后二寸，或曰一寸五分，陷者中，《素问·刺腰痛论》注云在足大趾
本节后内间二寸陷者中，并无左右足之分，故知右为在之误也。）厥心痛，卧若徙居，心
痛间，动作痛益甚，色不变，肺心痛也，取之鱼际、太泉。（肺主于气，气以流动，流
动之气乘心，故心痛卧若移居至于他处也。以气流动，故心痛间也。动作益气所病，
故益甚也。肺气是心微邪，不能令色变。鱼际，在大指本节后内侧散脉中，手太阴脉之
所留。太泉，在手掌后陷者中，手太阴脉之所注也。平按∶徙居《灵枢》作徒居，太泉
作太渊，说见前。）真心痛，手足 至节，心痛甚，旦
发夕死，夕发旦死。（心不受邪，受邪甚者痛聚于心，气亦聚心，故手足冷，所以死速
也。平按∶ 今本《灵枢》作清，道藏本《灵枢》作 ，《甲乙》作青。）心痛不可刺
者，中有盛聚，不可取于输，肠中有虫瘕及 ，皆不可取小针。（心痛甚取输无益者，
乃是肠中有虫瘕 。肠中长虫也，音HT 。可以手按，用大针刺之，不可用小针。平按∶
输《灵枢》作 ，《甲乙》作俞。 《灵枢》、《甲乙》作蛟。）心腹痛， 作痛肿聚，
往来上下行，痛有休止，腹热善渴涎出者，是 也，以手聚按而坚持之，姑令得移，
以大针刺之，久持之，虫不动，及出针也， 腹 痛形中上者。（ ，聚结也，奴通反。
谓心腹之内，虫聚而痛 ，懊 然也。虫食而聚，犹若肿聚也。食已而散，故休止也。
又聚扰于胃，故热渴涎出也。若 相HT ，所以 称 也。HT 亦 ，普耕反，满也。谓虫
聚心腹满，如肿聚高起，故曰形中上者也。平按∶《灵枢》心腹作心肠。腹热善渴涎出
者，《灵枢》善作喜，《甲乙》作腹中热渴HT 者，注∶“ HT 音涎。”姑令《灵枢》、
《甲乙》作无令。及出针，及《灵枢》、《甲乙》作乃。《甲乙》无“ 腹 痛形中上
者”八字。 《灵枢》音烹。注犹若肿聚，肿袁刻作种。）
心痛，引腰脊，欲呕，取足少阴。（足少阴脉行腰脊，上至心，故心痛引腰脊欲呕，
取少阴脉输穴也。）心痛，腹胀啬啬然，大便不利，取足太阴。（足太阴脉主腹，故取
足太阴输穴。啬啬，恶寒之貌也。平按∶啬啬《甲乙》作涩涩。）心痛，引背不得息，
刺足少阴；不已，取手少阳。（足少阴脉贯脊络心，手少阳脉主三焦气，故心痛引背不
得息，取此二经输穴疗主病者也。平按∶手少阳《甲乙》作手少阴。）心痛，少腹满，
上下无常处，便溲难，刺足厥阴。（足厥阴脉环阴器抵少腹，故少腹满便溲难，取此脉
输穴所主病者。平按∶
《灵枢》、《甲乙》少腹上有引字。）心痛，但短气不足以息，刺手太阴。（手太阴主
于气息，故气短息不足，取此脉疗主输穴。）心痛，当九节刺之；不已，刺按之立已；
不已，上下求之，得之立已。（《明堂》第九节下两旁是肝输，中央是筋缩，皆不言疗
心痛。此经言疗取之，刺此节不已，于上下背输寻之，有疗心痛取之。平按∶刺之不已
《灵枢》作刺之按已。）
心疝暴痛，取足太阴、厥阴，尽刺去其血络。（足太阴注心中，足厥阴从肝注肺，
故心暴疝，取此二脉，去其血络也。平按∶《甲乙》作尽刺之血络。）
平按：本篇从篇首到“形中上者”的内容，见于《灵枢》卷五第二十四《厥病》篇。从“心痛引腰脊”到“得之立已”的内容，见于《灵枢》卷五第二十六《杂病》篇。从“心疝暴痛”到篇末的内容，见于《灵枢》卷五第二十三《热病》篇。另外，从篇首到篇末的全部内容，也见于《甲乙经》卷九第二。
厥心痛，疼痛牵引背部，感觉像有人从背后触碰心脏，身体弯曲驼背的，是肾心痛，应先取京骨穴、昆仑穴，针刺后若症状未缓解，再取然谷穴。（足少阴肾脉贯穿脊柱并归属于肾，联络心脏，所以肾气逆乱，导致心痛牵引背部。肾脏位于后方，所以肾心痛时，感觉像有物体从后面触动心脏而疼痛，脊背弯曲驼背。京骨穴，位于足外侧大骨下方赤白肉际处，是足太阳膀胱脉经过的地方；昆仑穴，位于足外踝与跟骨之间上方，是足太阳膀胱脉运行的路径；然谷穴，位于足内踝前起大骨下方，是足少阴肾脉所流的穴位，所以肾心痛都取这些穴位治疗。）
厥心痛，腹部胀满，胸部憋闷，心脏特别疼痛剧烈的，是胃心痛，取大都穴、太白穴。（足阳明胃脉归属于胃并联络脾脏。足太阴脾脉流注于大都穴，位于足大趾本节后方的凹陷中；注入太白穴，位于足内侧核骨下方的凹陷中，其分支别出向上穿过膈肌注入心中。脾胃主管水谷运化，水谷有余则导致腹部胀满、胸部憋闷更加严重。这是腑病却取用脏的输穴治疗。）
厥心痛，疼痛像锥子针刺心脏一样，心痛非常剧烈的，是脾心痛，取然谷穴、太溪穴。（然谷穴，是足少阴肾脉所流的穴位，位于足内踝前起大骨下方的凹陷中；太溪穴，是足少阴肾脉所注的穴位，位于足内踝后方跟骨上方的动脉凹陷中，都是足少阴肾脉的流注穴位。脾气乘袭心脏导致心痛，可以治疗脾的输穴。现在治疗肾足少阴肾脉的流注穴位，是因为脾属土，肾属水，土应当克水，但水反来乘袭脾土，脾从而与心脏发生病变，所以远道取病源的输穴治疗。）
厥心痛，面色青苍苍白如同死状，整天不能长舒一口气的，是肝心痛，取行间穴、太冲穴。（仓仓，即青色，是肝病的表现。不能长舒一口气，因为肝主吸气，现在吸气时疼痛，无法呼出气体进行深呼吸。太冲穴，位于足大趾本节后二寸的凹陷处，是足厥阴肝脉所注的穴位。）
厥心痛，躺卧或移动居住地点时，心痛暂时缓解，活动时疼痛加剧，面色没有变化的，是肺心痛，取鱼际穴、太渊穴。（肺主管气，气以流动为特性，流动的气乘袭心脏，所以心痛在躺卧或移动到其他地方时会暂时缓解。因为气是流动的，所以心痛会间歇性缓解。活动会加重气的运行，进而加重患病部位的症状，所以疼痛加剧。肺气是心的轻微邪气，不能使面色改变。鱼际穴，位于手拇指本节后内侧散乱的脉络中，是手太阴肺脉停留的地方。太渊穴，位于手掌后方的凹陷处，是手太阴肺脉所注的穴位。）
真心痛，手足冰冷到达肘膝关节，心痛非常剧烈，早晨发病晚上死亡，晚上发病第二天早晨死亡的。（心脏不受邪气侵袭，如果受邪严重，疼痛聚集于心，气也聚集于心，所以手足冰冷，因此死亡迅速。）
心痛不可针刺的，是因为体内有盛实的积聚，不能取用输穴，如果是肠中有虫瘕以及蛟蛕（一种肠道寄生虫），都不可用小针治疗。（心痛剧烈时取输穴没有益处，这是因为肠中有虫瘕。肠中的长虫，音同“HT”。可以用手按压，使用大针刺治，不可用小针。）
心腹痛，因虫聚结而疼痛肿胀积聚，疼痛上下往来行走，疼痛有休止时间，腹部发热、喜欢口渴、流口水的，是蛟蛕病，用手聚拢按住并坚持固定它，姑且让它能够移动，然后用大针刺治，长时间持针，虫子不动了，再出针。这种腹痛形态表现为中部隆起。（蛕，指聚结，读音通“奴”的反切。谓心腹之内，虫类聚结而疼痛，懊恼难受的样子。虫子进食后聚结，就像肿胀积聚一样。吃完东西后虫散开，所以疼痛有休止。又扰动于胃，所以出现腹部发热、口渴、流口水。如果虫相合，所以称为蛕。蛕也是满的意思，读音通“普耕”，意为满。谓虫聚积在心腹导致腹胀，像肿胀积聚高起，所以说形态中部隆起。）
心痛，牵引腰脊，想要呕吐，取足少阴肾经。（足少阴肾脉行于腰脊，上行至心脏，所以心痛牵引腰脊且想呕吐，取少阴脉的输穴治疗。）
心痛，腹部胀满伴有恶寒感，大便不通利，取足太阴脾经。（足太阴脾经主管腹部，所以取足太阴脾经的输穴。啬啬，是恶寒的样子。）
心痛，牵引背部导致呼吸不畅，针刺足少阴肾经；如果不愈，取手少阳三焦经。（足少阴肾脉贯穿脊柱联络心脏，手少阳三焦经主管三焦之气，所以心痛牵引背部导致呼吸不畅，取这两条经脉的输穴治疗主要病症。）
心痛，小腹部胀满，疼痛上下无常处，大小便困难，针刺足厥阴肝经。（足厥阴肝脉环绕生殖器抵达小腹，所以小腹胀满、大小便困难，取此脉的输穴治疗主要病症。）
心痛，只是短气不足以呼吸，针刺手太阴肺经。（手太阴肺经主管气息，所以气短呼吸不足，取此脉的治疗输穴。）
心痛，应当在第九节脊椎处针刺；如果不愈，针刺并按压患处立即见效；如果不愈，上下寻找病应点，找到后针刺立即见效。（《明堂》记载第九节下两旁是肝的输穴，中央是筋缩穴，都不说治疗心痛。此经文说治疗取用这些穴位，针刺此节无效，就在上下背部的输穴中寻找，有能治疗心痛的穴位可取。）
心疝突然剧痛，取足太阴脾经、足厥阴肝经，全部刺去其血络。（足太阴脾经注入心中，足厥阴肝经从肝脏注入肺脏，所以心脏突发疝痛，取这两条经脉，去除其血络中的瘀血。）
Pingsha (Commentary): The content from the beginning of this chapter to "shape in the middle and upper part" is found in *Ling Shu* (Spiritual Pivot), Volume 5, Chapter 24, "Jue Bing" (Jue Diseases). The content from "heart pain radiating to the waist and spine" to "obtained and immediately resolved" is found in *Ling Shu*, Volume 5, Chapter 26, "Za Bing" (Miscellaneous Diseases). The content from "Xin Shan sudden pain" to the end of the chapter is found in *Ling Shu*, Volume 5, Chapter 23, "Re Bing" (Heat Diseases). Furthermore, the entire content from the beginning to the end of the chapter is also found in *Jia Yi Jing* (The Systematic Classic of Acupuncture and Moxibustion), Volume 9, Chapter 2.
Jue Heart Pain (Jue Xin Tong) characterized by pain pulling the back, feeling as if something is touching the heart from behind, accompanied by stooping or curvature of the spine, is Kidney Jue Heart Pain (Shen Xin Tong). First, select Jinggu (BL-64) and Kunlun (BL-60); if needling does not resolve it, then select Rangu (KI-2). (The Foot-Shaoyin Kidney Meridian penetrates the spine, belongs to the Kidney, and connects with the Heart. Thus, when Kidney Qi rebels, it causes heart pain that pulls the back. Since the Kidney is located posteriorly, Kidney heart pain feels like an object touching the heart from behind causing pain, resulting in a curved spine. Jinggu is located below the large bone on the lateral side of the foot at the junction of red and white flesh; it is where the Foot-Taiyang Bladder Meridian passes. Kunlun is located above the external malleolus and calcaneus; it is where the Foot-Taiyang Bladder Meridian runs. Rangu is located below the prominent bone anterior to the internal malleolus; it is where the Foot-Shaoyin Kidney Meridian flows. Therefore, all points for Kidney Jue Heart Pain are selected here.)
Jue Heart Pain characterized by abdominal distension, chest fullness, and severe heart pain is Stomach Jue Heart Pain (Wei Xin Tong). Select Dadu (SP-3) and Taibai (SP-3). (The Foot-Yangming Stomach Meridian belongs to the Stomach and connects with the Spleen. The Foot-Taiyin Spleen Meridian flows into Dadu, located in the depression distal to the metatarsophalangeal joint of the great toe; it pours into Taibai, located in the depression below the medial malleolar bone. A branch diverges upward through the diaphragm and pours into the Heart. The Spleen and Stomach govern water and grain; excess water and grain lead to abdominal distension and increased chest fullness. This is a Fu organ disease treated by selecting the Shu points of the Zang organs.)
Jue Heart Pain characterized by pain like a cone piercing the heart, with severe heart pain, is Spleen Jue Heart Pain (Pi Xin Tong). Select Rangu (KI-2) and Taixi (KI-3). (Rangu is where the Foot-Shaoyin Kidney Meridian flows, located in the depression below the prominent bone anterior to the internal malleolus; Taixi is where the Foot-Shaoyin Kidney Meridian pours, located in the arterial depression above the internal malleolus [Note: Commentary corrects 'external' to 'internal']. Both are Flowing and Pouring points of the Foot-Shaoyin Kidney Meridian. When Spleen Qi overacts on the Heart causing pain, one can treat the Spleen's Shu point. However, treating the Foot-Shaoyin Kidney Meridian points here is because Spleen is Earth and Kidney is Water; Earth should control Water, but Water counter-attacks Spleen Earth, causing Spleen pathology affecting the Heart. Thus, distant points from the disease source are selected.)
Jue Heart Pain characterized by a pale cyan complexion resembling death, and inability to sigh deeply throughout the day, is Liver Jue Heart Pain (Gan Xin Tong). Select Xingjian (LR-2) and Taichong (LR-3). ("Cang cang" refers to cyan color, indicating Liver disease. Inability to sigh deeply occurs because the Liver governs inhalation; now inhalation causes pain, preventing exhalation and deep sighing. Taichong is located two cun distal to the metatarsophalangeal joint of the great toe in the depression; it is where the Foot-Jueyin Liver Meridian pours.)
Jue Heart Pain that alleviates when lying down or changing location, worsens with movement, and shows no change in complexion is Lung Jue Heart Pain (Fei Xin Tong). Select Yuji (LU-10) and Taiyuan (LU-9). (The Lung governs Qi, which moves freely. Moving Qi overacting on the Heart causes heart pain that alleviates when lying down or moving to another place. Because Qi moves, the pain is intermittent. Movement increases Qi flow, aggravating the diseased area, so pain worsens. Lung Qi is a minor pathogen for the Heart and cannot alter the complexion. Yuji is located in the scattered vessels medial to the metacarpophalangeal joint of the thumb; it is where the Hand-Taiyin Lung Meridian stays. Taiyuan is located in the depression posterior to the palm; it is where the Hand-Taiyin Lung Meridian pours.)
True Heart Pain (Zhen Xin Tong) characterized by cold limbs extending to the elbows and knees, severe heart pain, death if onset occurs in the morning and resolves in the evening, or death if onset occurs in the evening and resolves in the next morning. (The Heart does not accept pathogens easily. If severely affected, pain gathers in the Heart, and Qi also gathers in the Heart, causing cold limbs and rapid death.)
Heart pain that cannot be needled indicates the presence of substantial accumulation within; Shu points should not be selected. If there are intestinal parasites (Chong Jia) or Jiao Tong (intestinal worms), small needles must not be used. (When heart pain is severe, selecting Shu points is ineffective because there are intestinal parasites. Long worms in the intestine can be pressed manually and treated with large needles, not small ones.)
Heart and abdominal pain characterized by swelling and accumulation due to parasite clustering, pain moving up and down, pain with intervals of cessation, abdominal heat, thirst, and salivation is Jiao Tong disease. Press and hold firmly with the hand to immobilize the mass, allow it to move slightly, then use a large needle. Hold the needle for a long time until the worm stops moving, then withdraw the needle. This abdominal pain presents with a bulging shape in the center. ("Tong" refers to clustering. Inside the heart and abdomen, parasites cluster causing painful distress. After feeding, they cluster like swelling. They disperse after eating, hence the pain ceases. They disturb the Stomach, causing heat, thirst, and salivation. If parasites combine, it is called Tong. Tong also means fullness. Parasites clustering in the heart and abdomen cause fullness, rising like swelling, hence described as "shape in the middle and upper.")
Heart pain radiating to the waist and spine with desire to vomit: select the Foot-Shaoyin Meridian. (The Foot-Shaoyin Meridian travels along the waist and spine, ascending to the Heart. Thus, heart pain radiating to the waist and spine with nausea is treated by selecting Shu points of the Shaoyin Meridian.)
Heart pain with abdominal distension, aversion to cold, and difficult defecation: select the Foot-Taiyin Meridian. (The Foot-Taiyin Meridian governs the abdomen, so Shu points of the Foot-Taiyin Meridian are selected. "Se se" describes aversion to cold.)
Heart pain radiating to the back with dyspnea: needle the Foot-Shaoyin Meridian; if ineffective, select the Hand-Shaoyang Meridian. (The Foot-Shaoyin Meridian penetrates the spine and connects with the Heart; the Hand-Shaoyang Sanjiao Meridian governs Sanjiao Qi. Thus, heart pain radiating to the back with dyspnea is treated by selecting Shu points of these two meridians.)
Heart pain with lower abdominal fullness, pain moving irregularly, and difficulty in urination and defecation: needle the Foot-Jueyin Meridian. (The Foot-Jueyin Meridian circles the genitalia and reaches the lower abdomen. Thus, lower abdominal fullness and difficulty in urination/defecation are treated by selecting Shu points of this meridian.)
Heart pain characterized only by shortness of breath and insufficient respiration: needle the Hand-Taiyin Meridian. (The Hand-Taiyin Meridian governs respiration; thus, shortness of breath is treated by selecting its therapeutic Shu point.)
Heart pain: needle the ninth vertebral segment. If ineffective, needle and press the area for immediate relief. If still ineffective, search above and below; upon finding the responsive point, needle for immediate relief. (The *Ming Tang* states that the bilateral points below the ninth vertebra are Liver Shu points, and the central point is Jinsuo, neither indicated for heart pain. This text indicates treatment via these points. If needling this segment fails, search the dorsal Shu points above and below for those effective for heart pain.)
Xin Shan (Heart Hernia) with sudden severe pain: select the Foot-Taiyin and Foot-Jueyin Meridians, and thoroughly needle away blood collaterals. (The Foot-Taiyin Meridian pours into the Heart; the Foot-Jueyin Meridian flows from the Liver to the Lung. Thus, sudden heart hernia pain is treated by selecting these two meridians and removing blood from their collaterals.)