心痛辨
心痛之症有二，一则寒邪侵心而痛，一则火气焚心而痛。
寒气侵心者，手足反温；火气焚心者，手足反凉；以此辨之最得矣。心不可使痛，或寒、或火，皆冲心包耳。
寒痛
寒痛方用∶
良姜（三钱） 肉桂（一钱） 白术（三钱） 草乌（一钱） 贯仲（三钱） 甘草（一钱）
水煎服。
热痛
热痛方用∶
炒栀子（三钱） 白芍（五钱） 柴胡（一钱） 半夏（一钱） 甘草（一钱）
水煎服。
心口痛
〔此症方用〕∶
大枣（一个，去皮核） 胡椒（七个）
共捣烂和匀，米汤送下即愈。
又方∶
一个乌枚两个枣，七个杏仁一块捣，男酒女醋送下去，不害心痛直到老。
久病心痛
〔心痛，人以为病在心也。不知〕心乃神明之君，一毫邪不可干犯，犯则立死。〔人病心痛〕，终年累月而不
愈者，〔非心痛也〕，乃邪犯心包络也。但邪有寒热之辨∶〔寒邪之犯〕必恶寒，见水如仇雠，火慰之则快。方用∶
苍术（二钱） 白术（五钱） 当归（一两） 肉桂（一钱） 良姜（一钱）
水煎服。
〔此寒邪犯包络之方也。〕
〔更有热邪来犯包络者，热邪之犯〕，见水喜悦，手按之而转痛也。方用∶
白芍（一两） 炒栀子（三钱） 当归（三钱） 生地（五钱） 陈皮（八分） 甘草（一钱）
水煎服。
寒热二症，皆责之于肝也。肝属木，心属火，木衰不能生火，则包络寒矣，是宜补肝而邪自退。若包络之热，
亦由于肝经之热也，泻其肝木，而火自消矣。
火结腹痛
人有腹中痛不可忍，按之愈痛，口渴，饮以凉水，则痛少止，少倾，依然大痛，此火结在大小肠也。若不急
治，一时气绝，方用定痛如神汤∶
栀子（三钱） 白芍（五钱） 茯苓（一两） 苍术（三钱） 大黄（一钱） 浓朴（一钱） 甘草（一钱）
水煎服。
此方舒肝经之气，利膀胱之水，泻火逐瘀。
冷气腹痛
冷气心腹痛，方用火龙丹∶
硫黄（一两，醋制） 胡椒（一钱） 白矾（四钱）
醋打荞麦面为丸，桐子大，每日服二十五丸，米汤下。
痞块腹痛
腹中有痞块，一时发作而痛，不可手按者，方用∶
枳实（一两） 白术（二两） 马粪（五钱）
炒焦酒煎服。
〔盖马粪最能安痛，又不伤气，且能逐邪而化物，况又与枳实同用，则积块日消，然而徒消其积，未免恐伤脾
阴，又佐以白术二两，大健其脾气，则马粪与枳实，可以施其祛荡之功，此堕治之妙法也。
胃气痛
人病不能饮食；或能饮食而不消化，作痛作满，或兼上吐下泻，此肝木来克脾土也。〔平其肝木，则脾胃之土
得养，而前症俱愈矣。〕方用∶
当归（二钱） 白芍（三钱） 柴胡（二钱） 茯苓（三钱） 白术（三钱） 甘草（一钱） 白芥子（一钱）
水煎服。
有火加栀子二钱，无火加肉桂二钱，有食加山楂三钱；伤米食加枳壳一钱、麦芽一钱；有痰加半夏一钱。（方中
虽有白术、茯苓，乃脾胃之品，然其性亦能入肝。白芍、当归、柴胡，则纯是肝经之正药，有此三味直入肝经，则
各药无不尽入肝以平木，木平则脾胃之土安然，遂有食则化食，有痰则祛痰，有火则散火，有寒则去寒，有不功效
立奏者乎？此右病而左治之一法也。）
食生冷心脾痛
治食生冷心脾痛，方用∶
用陈吴茱萸五、六十粒，水一大盏，煎取汁去滓，入平胃散三钱，再煎热服。
Differentiation of Heart Pain
There are two types of heart pain: one is caused by cold pathogen invading the heart, and the other by fire qi burning the heart.
When cold pathogen invades the heart, the hands and feet become warm; when fire qi burns the heart, the hands and feet become cool. This distinction is most accurate. The heart itself should not feel pain; whether due to cold or fire, it is actually the Pericardium (Xin Bao) that is affected.
Cold Pain
Formula for Cold Pain:
Rhizoma Alpiniae Officinarum (Liangjiang, 3 qian), Cinnamon Twig (Rougui, 1 qian), Poria (Baizhu, 3 qian), Aconitum Carmichaelii Lateralis Radix Preparata (Caowu, 1 qian), Aspidistra Root (Guanzhong, 3 qian), Licorice Root (Gancao, 1 qian).
Decoct in water and take orally.
Heat Pain
Formula for Heat Pain:
Fried Gardenia Fruit (Chao Zhizi, 3 qian), White Peony Root (Baishao, 5 qian), Bupleurum Root (Chaihu, 1 qian), Pinellia Tuber (Banxia, 1 qian), Licorice Root (Gancao, 1 qian).
Decoct in water and take orally.
Pain at the Heart Orifice
Formula for this condition:
Jujube Fruit (Dazao, 1 piece, skin and pit removed), Black Pepper (Hujiao, 7 grains).
Mash together evenly and take with rice soup for immediate cure.
Another formula:
One Myrobalan (Wumei), two Jujubes, seven Apricot Kernels (Xingren), mashed together. Men should take with wine, women with vinegar, to prevent heart pain until old age.
Chronic Heart Pain
Heart pain is often thought to be a disease of the Heart. However, the Heart is the sovereign of spirit (Shenming), and no pathogen should invade it; if invaded, death occurs immediately. Chronic heart pain lasting months or years is not a disease of the Heart itself, but rather pathogens invading the Pericardium Collateral (Xin Baoluo). Pathogens can be differentiated as cold or heat:
When cold pathogen invades, there is aversion to cold, hatred of water, and relief from warmth. Formula:
Atractylodes Macrocephala Rhizome (Cangzhu, 2 qian), Atractylodes Rhizome (Baizhu, 5 qian), Angelica Sinensis Root (Danggui, 1 liang), Cinnamon Twig (Rougui, 1 qian), Rhizoma Alpiniae Officinarum (Liangjiang, 1 qian).
Decoct in water and take orally.
This is the formula for cold pathogen invading the Pericardium Collateral.
If heat pathogen invades the Pericardium Collateral, the patient feels pleasure upon seeing water, and pain worsens upon palpation. Formula:
White Peony Root (Baishao, 1 liang), Fried Gardenia Fruit (Chao Zhizi, 3 qian), Angelica Sinensis Root (Danggui, 3 qian), Rehmannia Root (Shengdi, 5 qian), Tangerine Peel (Chenpi, 8 fen), Licorice Root (Gancao, 1 qian).
Decoct in water and take orally.
Both cold and heat symptoms are attributed to the Liver. The Liver belongs to Wood, and the Heart to Fire. If Liver Wood is weak and cannot generate Heart Fire, the Pericardium becomes cold; thus, tonifying the Liver will cause the pathogen to recede. If the Pericardium is heated, it is also due to heat in the Liver Channel; purging Liver Wood will extinguish the fire.
Fire-Condensation Abdominal Pain
Abdominal pain so severe it is unbearable, worsening on pressure, accompanied by thirst. Drinking cold water provides temporary relief, but severe pain returns shortly after. This indicates fire condensing in the Large Intestine and Small Intestine. If not treated urgently, it may lead to sudden qi collapse. Use Ding Tong Ru Shen Tang:
Gardenia Fruit (Zhizi, 3 qian), White Peony Root (Baishao, 5 qian), Poria (Fuling, 1 liang), Atractylodes Macrocephala Rhizome (Cangzhu, 3 qian), Rhubarb Root (Dahuang, 1 qian), Magnolia Bark (N Hou, 1 qian), Licorice Root (Gancao, 1 qian).
Decoct in water and take orally.
This formula soothes Liver Qi, promotes Bladder water metabolism, purges fire, and expels stasis.
Cold-Qi Abdominal Pain
For abdominal pain caused by cold qi, use Huo Long Dan:
Sulfur (Liuhuang, 1 liang, processed with vinegar), Black Pepper (Hujiao, 1 qian), Alum (Baifan, 4 qian).
Make pills with vinegar-doughed buckwheat flour, size of Sophora seeds. Take 25 pills daily with rice soup.
Mass Abdominal Pain
For abdominal masses causing sudden, unbearable pain that worsens on pressure:
Immature Bitter Orange (Zhishi, 1 liang), Atractylodes Rhizome (Baizhu, 2 liang), Horse Manure (Ma Fen, 5 qian).
Stir-fry until charred, decoct in wine, and take orally.
Horse manure effectively relieves pain without damaging qi, expels pathogens, and transforms accumulation. Combined with Immature Bitter Orange, it gradually dissipates masses. To prevent damage to Spleen Yin from pure draining, Atractylodes Rhizome strongly strengthens Spleen Qi, allowing the draining herbs to work safely. This is a subtle method of treating accumulation.
Stomach Qi Pain
Inability to eat, or eating without digestion leading to pain and fullness, possibly with vomiting and diarrhea, indicates Liver Wood overacting on Spleen Earth. Calming Liver Wood nourishes Spleen Earth, resolving these symptoms. Formula:
Angelica Sinensis Root (Danggui, 2 qian), White Peony Root (Baishao, 3 qian), Bupleurum Root (Chaihu, 2 qian), Poria (Fuling, 3 qian), Atractylodes Rhizome (Baizhu, 3 qian), Licorice Root (Gancao, 1 qian), White Mustard Seed (Baijiezi, 1 qian).
Decoct in water and take orally.
Add Gardenia (Zhizi, 2 qian) if heat is present; add Cinnamon Twig (Rougui, 2 qian) if no heat. Add Hawthorn Fruit (Shanzha, 3 qian) for food stagnation; add Immature Bitter Orange (Zhiqiao, 1 qian) and Malt (Maiya, 1 qian) for grain stagnation; add Pinellia Tuber (Banxia, 1 qian) for phlegm.
Although Atractylodes and Poria are Spleen herbs, they also enter the Liver. White Peony, Angelica, and Bupleurum specifically enter the Liver Channel. These three guide all herbs to calm Liver Wood. Once Wood is balanced, Spleen Earth is secure, digesting food, resolving phlegm, clearing heat, and dispelling cold efficiently. This is a method of treating the left (Liver/Wood) to cure the right (Spleen/Stomach).
Heart-Spleen Pain from Raw/Cold Food
For heart-spleen pain caused by consuming raw/cold foods:
Take 50-60 grains of aged Evodia Fruit (Wuzhuyu), decoct in one large cup of water, strain, add Ping Wei San (3 qian), re-decoct until hot, and take orally.