即胃脘痛，须分久、新治，若明知是寒，初当温散；病久成郁，郁生热而成火，故用山栀为君，以热药为向导。
胃口有热而作痛者，非栀子不可，须佐以姜汁，多用台芎开之，或用二陈汤加川芎、苍术，倍加炒山栀；如痛甚者，加
炒干姜，从乎反治之法。如平日喜食热物，以致死血留于胃口作痛者，用桃仁承气汤下之；若轻者，以韭汁、桔梗，
能开提气血药中兼用之。以物拄按痛处而痛定者，挟虚也，用二陈汤加炒干姜和之，有虫痛者，面上白斑、唇红、能
食是也，以苦楝根、黑锡灰之类。痛后便能食，时作时止。上半月虫头向上易治，下半月向下难治。先以肉汁或以糖蜜
吃下，引虫向上，然后用药。打虫方∶楝根、槟榔、鹤
虱，夏取汁饮，冬煎浓汤下万灵丸最好。脉实不大便者，下之痛甚者，脉必伏，宜温药，如附子之类。勿用参、术，
诸痛不可补气故也。气虚入胃脘作痛，草豆蔻丸。心胃腹胁疝痛，二陈汤加参、术，并诸香药治效。心胁痛，干
姜微妙，芫花醋炒，等分为末，蜜丸，每服数粒。热饮痛，黄连、甘遂作丸服之。停饮心胃痛，或冬寒痛，桂黄
丸。心极痛，古方用生地黄汁调面煮食，打下虫甚效。胃虚感寒，心腹痛甚，气弱者，理中汤。内伤发热不食，
胃虚作痛，补中益气汤加草豆蔻。心气痛，天香散方∶白芷、川乌、南星、半夏。老人心腹大痛，脉洪大而虚，昏
厥不食，不胜一味攻击之药，四君子汤加当归、麻黄、沉香。心膈大痛，攻走腰背发厥，药食不纳者，就吐中探吐，
出痰积碗许而痛自止。肥人胃脘当心痛，或痞气在中脘不散，草豆蔻丸∶白豆蔻（三钱） 白术 三棱 草豆蔻
半夏（各一两） 砂仁 片姜黄 枳实 青皮 良姜（一作干姜） 陈皮 桂皮 丁香 蓬术 木香 藿香 小草（各
五钱
）姜汁蒸饼丸，每服六七十丸，白汤下。黑丸子，治胃脘疼∶乌梅（去核） 杏仁（去皮尖） 巴豆（去皮膜心油）
砂仁（各十四枚） 百草霜（二钱） 半夏（二十一枚） 上杵为丸，每服十数粒。备急丸，治心腹厥痛食填胸膈∶大
黄（一钱） 巴豆（去油五分） 干姜（五分） 上蜜丸，每服三五粒。药下咽便速行心痛，饮汤水下作哕者，有死血
在中，桃仁承气汤下之。左手脉数热多，脉涩有死血，右手脉实痰积，脉大，必是久病。心痛方∶茱萸（汤洗） 山栀
（炒去壳） 黄连（炒） 滑石（各五钱） 荔核（烧存性三钱） 上末之，姜汁蒸饼丸服。又
方∶炒山栀仁为末，姜汤服丸亦可，如冷痛加草豆蔻炒为末丸服之。又方∶白术（五钱） 白芍药 砂仁 半夏（汤泡
）当归（各三钱） 桃仁 黄连（去须） 神曲（炒） 陈皮（各二钱） 吴茱萸（一钱半）
僵蚕（炒） 茱萸（一钱） 山栀（去壳炒焦六钱） 上末炊饼丸，如椒粒大，以生地黄酒洗净，同生姜煎汤下二十
丸。别用荜茇半两为末，醋调捏成团子吞之。又方∶桂枝、麻黄、石碱等分为末，姜汁浸，炊饼为丸，用热辣姜
汤下十五丸，多治饼痛。又方∶黄荆子炒焦为末，米饮调下。又方∶蛤粉、香附末，以川芎、山栀煎汤，入姜汁调，令
热辣服之。又方∶半夏切碎，香油炒为末，姜汁炊饼丸，姜汤下二十丸，亦治吼喘。凡治气痛，一身腔子里痛，皆须
用些少木香于药中，方得开通。草豆蔻丸，客寒犯胃痛者宜此，热亦可止，可一二服∶草豆蔻（面裹煨一钱四分） 吴
茱萸（洗焙） 益智仁 人参 黄 白僵蚕 橘皮（各八分） 生甘草 炙甘草 当归身 青皮（各六分）
片姜黄 神曲（炒） 柴胡（各四分） 半夏（汤泡） 泽泻（各一钱） 麦芽（炒一钱半） 桃仁（七枚汤泡，
去皮尖） 上除桃仁另研如泥外，余为细末，同和匀，汤浸蒸饼为丸，如梧桐子大，每服五七十丸，食远
白汤下。看病势斟酌用之，小便多泽泻减半，柴胡详胁下痛多少用。草豆蔻丸，治气馁弱人心痛，甚妙。青黛治心
热痛、虫痛，与姜汁入汤调服，或以蓝叶杵汁与姜汁和服之。如遇无药去处，用一小瓶贮水，将盐放刀头上，火中
烧红淬水中，令患人热饮之。心痛或用山栀并劫药，止后复发，用前药必不效，服玄明粉一服立止。海粉加香附
末，同姜汁服，能治心痛，不可入煎药。内伤发热不食，胃口作痛者，补中益气加草豆蔻，热痛加栀子。心痛气实
者，用单味牡蛎， 为粉，酒调二钱服之。有食伤胃口而痛者，当消导之。有瘀血留滞胃口作痛者，用破血药。
心疼或有痰者，以明矾溶开就丸，如芡实大，热姜汁吞下一丸。一人脉涩，心脾常疼，白术、半夏、苍术、枳实、神
曲、香附、茯苓、台芎、上末之，神曲糊丸服。一人心
痛、疝痛，炒山栀 香附（各一两） 苍术 神曲 麦芽（各五钱） 半夏（七钱） 乌梅 石碱（各三钱） 桂
枝（一钱五分） 上末之，姜汁炊饼为丸，每服百丸，姜汤下。冬去桂枝。一人饮热酒食物，梗塞胸痛，有死血，用
白术、贝母、麦芽、香附、栝蒌、桃仁、杏仁、牡丹皮、生甘草、葛根、山栀、黄芩、红花、
荜澄茄，上为末，或丸或散，任意服。其余治法详见《医要》。
This refers to epigastric pain (Wei Wan Tong), which must be treated differently based on whether the condition is recent or chronic. If it is clearly known to be caused by Cold, initial treatment should employ warming and dispersing methods; if the disease persists and leads to Qi stagnation (Qi Yu), which generates Heat and transforms into Fire, Gardenia Fruit (Shan Zhi) should be used as the sovereign herb, with warm herbs serving as guides (directing agents).
For pain in the stomach opening caused by Heat, Gardenia Fruit is indispensable; it must be assisted with Ginger Juice, and a large amount of Taixiong (a variety of Chuanxiong Rhizoma) should be used to open stagnation, or Er Chen Tang (Two-Cured Decoction) combined with Chuanxiong Rhizoma (Chuan Xiong) and Atractylodes Rhizoma (Cang Zhu), with doubled amounts of fried Gardenia Fruit (Chao Shan Zhi); if the pain is severe, fried Dried Ginger (Chao Gan Jiang) should be added, following the principle of contrary treatment (Fan Zhi Fa). If one habitually consumes hot-natured foods, leading to fixed blood (Si Xue / Stasis) remaining in the stomach opening causing pain, Tao Ren Cheng Qi Tang (Peach Kernel Magnolia Bark Decoction) should be used to purge; for milder cases, Leek Juice (Jiu Zhi) and Platycodon Root (Jie Geng) can be used concurrently within formulas that regulate Qi and Blood. If pressing the painful area with an object alleviates the pain, it indicates a deficiency pattern; Er Chen Tang (Two-Cured Decoction) combined with fried Dried Ginger (Chao Gan Jiang) should be used to harmonize. For worm-induced pain, characterized by white patches on the face, red lips, and good appetite, drugs such as Melia Root (Liu Gen) and Black Tin Ash (Hei Xi Hui) are appropriate. Pain that allows eating immediately after cessation, with intermittent occurrences, suggests worms: during the first half of the lunar month, when the worm's head faces upward, it is easier to treat; during the second half, when the head faces downward, it is difficult. First, consume meat broth or sugar/honey to guide the worms upward, then administer medication. The vermifuge formula consists of Melia Root (Liu Gen), Areca Seed (Bing Lang), and Pyrethrum Flower (He Shi); in summer, drink the juice; in winter, decoct a strong soup and take with Wan Ling Wan (Ten Thousand Spirit Pill), which is best. For a solid pulse accompanied by constipation, purgation is indicated; for severe pain where the pulse is likely hidden (Fu), warm herbs such as Aconite Root (Fu Zi) are suitable. Do not use Ginseng Radix (Ren Shen) or Atractylodes Macrocephala Rhizoma (Bai Zhu), as tonifying Qi is contraindicated for various pains. For epigastric pain due to Qi deficiency, Cao Dou Kou Wan (Grass Cardamom Pill) is used. For hernia pain affecting the heart, stomach, abdomen, and hypochondrium, Er Chen Tang (Two-Cured Decoction) combined with Ginseng Radix (Ren Shen), Atractylodes Macrocephala Rhizoma (Bai Zhu), and various aromatic herbs is effective. For heart-hypochondriac pain, Dried Ginger (Gan Jiang) has subtle effects; Spurge Root (Yuan Hua) fried with vinegar, mixed in equal parts and powdered, formed into honey pills, taken in small quantities, is effective. For pain aggravated by drinking hot liquids, Coptis Rhizome (Huang Lian) and Kansui Root (Gan Sui) made into pills should be taken. For epigastric pain caused by fluid retention (Ting Yin) or cold pain in winter, Gui Huang Wan (Cinnamon-Gardenia Pill) is used. For extreme heart pain, ancient formulas suggest eating dough boiled in Rehmannia Root (Sheng Di Huang) juice, which effectively expels worms. For stomach deficiency with cold invasion causing severe heart and abdominal pain in those with weak Qi, Li Zhong Tang (Regulate the Middle Decoction) is indicated. For internal injury fever with loss of appetite and stomach deficiency pain, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) combined with Grass Cardamom Seed (Cao Dou Kou) is used. For heart Qi pain, Tian Xiang San (Heavenly Fragrance Powder) consists of Angelica Dahurica Root (Bai Zhi), Aconite Root (Chuan Wu), Arisaema Rhizome (Nan Xing), and Pinellia Tuber (Ban Xia). For elderly patients with severe heart/abdominal pain, a surging yet deficient pulse, coma, inability to eat, who cannot tolerate aggressive single-herb treatments, Si Jun Zi Tang (Four Gentlemen Decoction) combined with Dang Gui, Ephedra Stem (Ma Huang), and Agarwood (Chen Xiang) is prescribed. For severe pain in the heart/diaphragm radiating to the waist and back with fainting and inability to retain food/medicine, induce vomiting via probing during emesis; once about a bowl of phlegm accumulation is expelled, the pain stops naturally. For obese individuals with epigastric pain (heart pain) or stagnant Qi in the Zhongwan point, Cao Dou Kou Wan (Grass Cardamom Pill) is used: White Cardamom Seed (Bai Dou Kou, 3 qian), Atractylodes Rhizoma (Bai Zhu), Burreed Tuber (San Leng), Grass Cardamom Seed (Cao Dou Kou), Pinellia Tuber (Ban Xia, 1 liang each), Amomum Fruit (Sha Ren), Turmeric Rhizome Pian (Pian Jiang Huang), Immature Bitter Orange (Zhi Shi), Green Tangerina Peel (Qing Pi), Galangal Rhizome (Liang Jiang, alternatively Dried Ginger), Tangerine Peel (Chen Pi), Cinnamon Bark (Gui Pi), Clove (Ding Xiang), Curcuma Tuber (Peng Zhu), Aucklandia Root (Mu Xiang), Patchouli Leaf (Huo Xiang), and Xiao Cao (5 qian each). Form into pills using Ginger Juice and steamed wheat cake, take 60–70 pills with plain water. Hei Wan (Black Pill) treats epigastric pain: Sour Plum (Wu Mei, pitted), Apricot Seed (Xing Ren, peeled and de-seeded), Croton Seed (Ba Dou, peeled, membrane removed, oil extracted), Amomum Fruit (Sha Ren, 14 seeds each), soot from kitchen chimneys (Bai Cao Shuang, 2 qian), Pinellia Tuber (Ban Xia, 21 pieces). Pound into pills, take several pills at a time. Bei Ji Wan (Emergency Aid Pill) treats sudden heart/abdominal pain and chest fullness from food impaction: Rhubarb (Da Huang, 1 qian), Croton Seed (Ba Dou, oil removed, 5 fen), Dried Ginger (Gan Jiang, 5 fen). Honey-pill, take 3–5 pills. If the medicine acts quickly upon swallowing to relieve heart pain, but hiccups occur after drinking water, there is fixed blood (stasis) inside; purge with Tao Ren Cheng Qi Tang (Peach Kernel Magnolia Bark Decoction). A rapid pulse on the left hand indicates excess heat; a choppy pulse indicates fixed blood; a solid pulse on the right hand indicates phlegm accumulation; a large pulse indicates chronic disease. Heart pain formula: Cornus Fruit (Zhu Yu, washed in boiling water), Gardenia Fruit (Shan Zhi, fried and husked), Coptis Rhizome (Huang Lian, fried), Talcum (Hua Shi, 5 qian each), Lychee Seed (Li He, burnt to retain character, 3 qian). Powder these, form pills with Ginger Juice and steamed wheat cake. Another formula: Powder fried Gardenia kernel, take with Ginger Tea; for cold pain, add fried Grass Cardamom Seed powder pills. Another formula: Atractylodes Macrocephala Rhizoma (Bai Zhu, 5 qian), White Peony Root (Bai Shao Yao), Amomum Fruit (Sha Ren), Pinellia Tuber (Ban Xia, soaked in boiling water, 3 qian each), Dang Gui, Peach Kernel (Tao Ren), Coptis Rhizome (Huang Lian, de-stamen), Medicated Leaven (Shen Qu, fried), Tangerine Peel (Chen Pi, 2 qian each), Evodia Fruit (Wu Zhu Yu, 1.5 qian), Silkworm (Jiang Can, fried), Cornus Fruit (Zhu Yu, 1 qian), Gardenia Fruit (Shan Zhi, husked, fried until scorched, 6 qian). Powder these, form pills like peppercorns using steamed wheat cake, wash with Rehmannia Root wine, decoct with fresh ginger, take 20 pills with the decoction. Alternatively, use Long Pepper (Bi Bo, 0.5 liang) powdered, mixed with vinegar into balls to swallow. Another formula: Cinnamon Twig (Gui Zhi), Ephedra Stem (Ma Huang), Alkali Stone (Shi Jian) in equal parts, powdered, soaked in Ginger Juice, formed into pills with steamed wheat cake, take 15 pills with hot, spicy Ginger Soup; this mostly treats "bing tong" (likely a specific type of pain). Another formula: Vitex Fruit (Huang Jing Zi) fried until scorched, powdered, taken with rice drink. Another formula: Calcined Shellfish Powder (Ha Fen), Cyperus Rhizome (Xiang Fu) powder, decoct Ligusticum Rhizome (Chuan Xiong) and Gardenia Fruit (Shan Zhi), mix with Ginger Juice, and take while hot and spicy. Another formula: Pinellia Tuber (Ban Xia) chopped, fried in sesame oil, powdered, formed into pills with Ginger Juice and steamed wheat cake, take 20 pills with Ginger Soup; also treats wheezing. In treating Qi pain involving the whole body cavity, a small amount of Aucklandia Root (Mu Xiang) must be added to the formula to ensure unblocking. Cao Dou Kou Wan (Grass Cardamom Pill) is suitable for stomach pain caused by external Cold invading the stomach, and can also stop heat pain; take one or two doses: Grass Cardamom Seed (Cao Dou Kou, wrapped in flour and baked, 1.4 qian), Evodia Fruit (Wu Zhu Yu, washed and dried), Alpinia Oxyphylla Fruit (Yi Zhi Ren), Ginseng Radix (Ren Shen), Astragalus Root (Huang Qi), White Silkworm (Bai Jiang Can), Tangerine Peel (Ju Pi, 8 fen each), Raw Licorice Root (Sheng Gan Cao), Roasted Licorice Root (Zhi Gan Cao), Dang Gui Body (Dang Gui Shen), Green Tangerina Peel (Qing Pi, 6 fen each), Turmeric Rhizome Pian (Pian Jiang Huang), Medicated Leaven (Shen Qu, fried), Bupleurum Root (Chai Hu, 4 fen each), Pinellia Tuber (Ban Xia, soaked in boiling water), Alisma Rhizome (Ze Xie, 1 qian), Barley Sprout (Mai Ya, fried, 1.5 qian), Peach Kernel (Tao Ren, 7 seeds, soaked in boiling water, peeled and de-seeded). Except for Peach Kernel which is ground separately into a paste, powder the rest, mix evenly, form pills with steamed wheat cake soaked in water, size of Sophora seeds, take 50–70 pills after meals with plain water. Adjust dosage based on disease progression; reduce Alisma Rhizome (Ze Xiei) by half if urination is frequent; adjust Bupleurum Root (Chai Hu) according to the severity of hypochondriac pain. Cao Dou Kou Wan (Grass Cardamom Pill) is excellent for heart pain due to depleted Qi and weakness. Qing Dai (Indigo Naturalis) treats heart heat pain and worm pain; mix with Ginger Juice in decoction, or crush Indigo Leaf (Lan Ye) for juice and mix with Ginger Juice to take. If no medicine is available, fill a small bottle with water, place salt on a knife blade, heat the blade red-hot in fire, quench it in the water, and have the patient drink it hot. If heart pain treated with Gardenia Fruit and strong analgesics recurs after relief, previous medicines will fail; take Xuan Ming Fen (Mirabilite) once to stop it immediately. Hai Fen (Sea Powder) mixed with Cyperus Rhizome (Xiang Fu) powder and taken with Ginger Juice can treat heart pain, but should not be decocted. For internal injury fever, loss of appetite, and stomach opening pain, use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) plus Grass Cardamom Seed (Cao Dou Kou); for heat pain, add Gardenia Fruit (Shan Zhi). For heart pain with excess Qi, use single-herb Oyster Shell (Mu Li) powdered, mixed with wine, take 2 qian. For pain caused by food injuring the stomach opening, use digestive methods. For pain caused by blood stasis remaining in the stomach opening, use blood-breaking herbs. For heart ache with phlegm, dissolve Alum (Ming Fan) and form pills the size of Euryale Seed (Qian Shi), swallow one pill with hot Ginger Juice. Case 1: Choppy pulse, frequent heart/spleen pain; use Bai Zhu, Ban Xia, Cang Zhu, Zhi Shi, Shen Qu, Xiang Fu, Fu Ling, Taixiong, powder them, form pills with Shen Qu paste. Case 2: Heart pain and hernia pain; fried Shan Zhi, Xiang Fu (1 liang each), Cang Zhu, Shen Qu, Mai Ya (5 qian each), Ban Xia (7 qian), Wu Mei, Shi Jian (3 qian each), Gui Zhi (1.5 qian). Powder, form pills with Ginger Juice and steamed wheat cake, take 100 pills with Ginger Soup. Remove Gui Zhi in winter. Case 3: After drinking hot wine/eating, experienced chest blockage and pain with fixed blood; use Bai Zhu, Bei Mu, Mai Ya, Xiang Fu, Gua Lou, Tao Ren, Xing Ren, Mu Dan Pi, Sheng Gan Cao, Ge Gen, Shan Zhi, Huang Qin, Hong Hua, Bi Cheng Qie. Powder, take as pills or powder as desired. Other treatments are detailed in *Yi Yao*.