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Exterior contraction of cold pathogenic factors, interior injury from raw and cold foods, and qi stagnation due to the seven emotions (joy, anger, worry, thought, sorrow, fear, fright).

The so-called heart pain actually refers to pain in the epigastrium. The stomach is the sea of water and grain, primarily responsible for receiving and digesting the five grains; it prefers warmth and dislikes cold. If externally invaded by cold pathogenic factors, or internally injured by raw and cold foods, combined with emotional disharmony causing qi stagnation and phlegm formation, which obstructs the ascending and descending mechanisms, resulting in clear yang qi failing to ascend and turbid yin qi failing to descend, pain ensues. Ancient formularies record nine types of heart pain: worm pain, infectious pain, wind pain, palpitation pain, food stagnation pain, fluid retention pain, cold pain, heat pain, and wandering pain. Although categorized into these nine types, none arise without dietary irregularities or cold pathogenic stagnation. Generally, all abdominal pains stem from excessive labor, irregular diet, deficiency of middle qi, allowing cold pathogens to enter through the deficiency and contend with healthy qi, causing sudden pain. Some cases involve lingering undigested food stagnating in the intestines and stomach, causing pain due to obstruction; some present with pain accompanied by vomiting; some with diarrhea; some with constipation; and true heart pain, characterized by severe pain and cyanosis of the hands and feet, is a fatal condition that cannot be cured. These symptoms vary, and one must differentiate between cold, heat, excess, and deficiency, treating according to the etiology. In clinical practice, careful examination is essential.

Zhu Danxi stated that heart pain is essentially epigastric pain; even if one does not eat for several days, death will not occur. However, if food is consumed immediately after the pain subsides, the pain will recur. One must wait for a while after taking medicine before resuming diet. Dai Yuanli stated that cold pain is continuous and unvarying; intermittent pain indicates worm pain or heat pain; fixed-location pain that does not shift indicates blood stasis pain; and food stagnation pain is relieved after defecation.

In general, heart and abdominal pains may be due to deficiency-cold, excess accumulation, worm infestation, or blood stasis. Treatment should be based on symptoms. Pain that ceases upon pressure indicates deficiency pain; pain that cannot tolerate touch or pressure indicates excess pain. Worm pain presents with pale complexion, red lips, craving for food, and intermittent occurrence during attacks. Drinking hot wine habitually can cause blood stasis to remain in the stomach, leading to pain; this pain stops when hot drinks are taken, as blood disperses with heat.

The *Mai Jue* (Pulse Classic) states: A deep and tight pulse indicates internal cold and painful counterflow in the heart; a rapid pulse on the left hand indicates excess heat; a choppy pulse indicates blood stasis; a tight and full pulse at the right cun position indicates food stagnation; a deep and fine pulse in heart/abdominal pain is appropriate, whereas a floating and large pulse indicates critical danger.