心腹之痛，其类有九。细迟从吉，浮大延久。
心腹之痛，其类甚多。此仅言有九者，亦举其要耳。曰饮、曰食、曰风、曰寒、
曰热、曰悸、曰虫、曰忤、曰疰。饮者，痰饮也。痰饮留中，清阳淆浊，故痛。（兼见
气喘、痞闷等证，其脉滑，宜二陈汤、丹溪海蛤丸、前胡半夏汤之类。）食者，食物也。食物停积，气碍不
行，故痛。或勉食寒凉馁败之物，扰乱中和，亦痛。（兼见胀满、呕嗳食臭、恶食等证，其脉紧滑，
宜加味枳术丸、香砂平胃散之类。）风者，风邪也。乘虚内干，邪正相搏，故痛。（兼见自汗、恶风等证，
其脉缓，宜香苏散、参苏饮之类。）寒者，寒邪也。乘虚内袭，荣脉凝泣，故痛。（兼见恶寒、呕逆、
喜温等证，其脉紧，宜五积散、苏合香丸之类。）热者，火也。火郁不发，熏蒸于中，故痛。（兼见恶热、热
中、嘈杂吞酸等证，其脉数，宜统旨清中汤、越鞠丸、左金丸之类。）悸者，心中动悸也。中气空虚，乍有
所触，不能持定，故痛。（兼见心慌、心悸、恍惚等证，其脉虚微，痛而欲按，宜黄 建中汤、补中益气汤、六君
子汤之类。）虫者，虫积也。饮食不节，寒热不时，以致虫动。虫动则攻冲上下，故痛。
（兼见面黄白斑驳、呕吐清水沃沫，或作或止，或痛处动欲痛等证，其脉大小不匀，宜九痛丸、剪红丸、芜荑散、
仲景乌梅丸、万应丸、集效丸之类。）忤者，客忤也。不正之邪，一时干忤，乱其清道，挠其运机，故痛。
（兼见吐逆、头目不清，或妄见妄言，或不知人等证，其脉数动，宜苏合丸、备急丸、紫金锭、九痛丸
之类。）疰者，尸疰也。如蛊如蛀，不识何因。或去或来，痛无定所。此得之亡人所传，即传尸气也。
（兼见骨蒸吐血、咳嗽劳损诸证，其脉微弱而数，宜于劳病门选方对证用之。）外有瘀血痛、厥心痛、真心痛三
种。瘀血痛者，痛在胃脘。或热饮食，或极呕吐，致伤胃脘，络血迸溢。瘀留于
中，气为所碍，或作或止，或食下痛甚，或饮汤水作呃。其脉涩。（宜二陈汤、桃仁、红花、
五灵脂、玄胡、香附、韭汁、藕汁、红曲之类。）厥心痛者，因诸脏腑经络有循胃口上膈者、（手太阴肺。）
有络肺下膈者、（手阳明大肠。）有下膈属胃络脾者、（足阳明胃。）有从胃别上膈注心中者、（足
太阴脾。）有络心下膈抵胃者、（手太阳小肠。）有夹脊者、（足太阳膀胱。）有络心注胸中者、（足少阴
肾。）有起于胸中，出属心包络下膈者、（手厥阴心包络。）有布膻中，散络心包下膈者、（手少
阳三焦。）有下胸中贯膈者、（足少阳胆。）有夹胃上贯膈，布胁肋者、（足厥阴肝。）有循腹里上关
元者、（奇经任脉。）有并于脊里者、（奇经督脉。）有夹脐上行，至胸中而散者、（奇经冲脉。）有入
里维络诸阴者，（奇经阴维脉。）是诸脏腑经络及任、督、冲、维之脉。气有厥逆，则经有偏
盛。而当脉所过如胃口、胸、膈、心包、膻中、脊、胁、脐、腹等处，随经相引而
痛。乃诸经之痛，岂心痛哉。（诸经之痛，则随经有兼见之证。如肺经痛，恶寒、气急、胀满、痛引缺盆，宜参
苏饮、香苏散、苏合丸之类。大肠痛，上引膈，肠鸣口干，宜四七汤、枳桔二陈汤之类。胃痛，引脾及膺乳、呕吐，
宜二陈汤、平胃散、东垣温胃汤、来复丹之类。脾痛，引胃脘、心下，腹胀善噫、善呕、食不下，宜二陈汤、香
砂平胃散、理中汤、来复丹之类。小肠痛，引膈胃，肠鸣，宜二陈汤、四七汤、苏合丸之类。膀胱痛，引腰脊，
恶寒，宜参苏饮、东垣天台乌药散。肾痛，引胸中腰脊，心如饥、上气、喝喝而喘、善恐，宜半硫丸、乌药顺气
散之类。心包痛，引包络胸胁，胸胁支满、心动、心烦、喜笑，宜二陈汤、铁瓮先生交感丹之类。三焦，痛引心包
膻中，耳鸣，宜二陈汤、越鞠丸之类。胆痛，引胸膈胁肋、口苦、善太息、振寒，宜二陈汤、温胆汤、小柴胡
汤之类。肝痛，引膈胃胁肋，嗌干、呕逆、胸满，宜二陈汤四七汤、来复丹之类。）真心痛者，真脏痛也。
盖心为一身君主，神明所居，邪不易侵，病不易及。必也真脏自虚，神明失守，致心包厥痛之邪，乘虚而入。
《难经》言其痛甚但在心。但在心，则毫不控引他处。必兼见神昏舌短，手足青冷。斯为旦发夕死，夕发旦死
之真心痛耳。以上诸痛，若脉见细迟，是气减舒徐，厥邪衰退之象，理应从吉。设
或大浮，知邪方盛。况心腹里证而得表脉，更非所宜。虽不至于殒躯，亦难愈也。
Pain in the heart and abdomen has nine categories. A fine and slow pulse indicates a favorable prognosis, while a floating and large pulse suggests a prolonged course.
Pain in the heart and abdomen has many types. The mention of only nine here is to highlight the key ones. They are: Yin (Fluid Retention), Shi (Food Stagnation), Feng (Wind), Han (Cold), Re (Heat), Ji (Palpitation), Chong (Parasites), Wu (Guest Counter-attack), and Zhu (Transmission Disease).
"Yin" refers to Phlegm-Fluids (Tan-Yin). When Phlegm-Fluids remain in the middle jiao, they confuse the clear yang with turbid yin, causing pain. (Accompanied by symptoms such as asthma and chest oppression; the pulse is slippery. Suitable formulas include Er Chen Tang [Two-Cured Decoction], Danxi Hai Ge Wan [Danxi's Clam Pill], and Qian Hu Ban Xia Tang [Peucedani Root and Pinellia Decoction].)
"Shi" refers to food. Food stagnation obstructs qi movement, causing pain. Or, if one forces cold or spoiled food into the body, it disturbs the harmonious balance, also causing pain. (Accompanied by bloating, belching with a sour/rotten odor, and aversion to food; the pulse is tight and slippery. Suitable formulas include Jia Wei Zhi Zhu Wan [Modified Immature Bitter Orange and Atractylodes Pill] and Xiang Sha Ping Wei San [Aucklandia and Amomum Powder to Calm the Stomach].)
"Feng" refers to Wind pathogen. It invades internally due to deficiency, where pathogenic factors contend with righteous qi, causing pain. (Accompanied by spontaneous sweating and aversion to wind; the pulse is moderate/slow. Suitable formulas include Xiang Su San [Aucklandia and Perilla Powder] and Shen Su Yin [Ginseng and Perilla Drink].)
"Han" refers to Cold pathogen. It attacks internally due to deficiency, causing the Ying (Nutritive) vessels to coagulate and flow sluggishly, causing pain. (Accompanied by aversion to cold, vomiting/reversal of qi, and preference for warmth; the pulse is tight. Suitable formulas include Wu Ji San [Five Accumulations Powder] and Su He Xiang Wan [Styrax Pill].)
"Re" is Fire. Fire depression fails to disperse, steaming within the interior, causing pain. (Accompanied by aversion to heat, internal heat, acid regurgitation; the pulse is rapid. Suitable formulas include Tong Zhi Qing Zhong Tang [Tong Zhi Decoction to Clear the Middle], Yue Ju Wan [Freeing Depression Pill], and Zuo Jin Wan [Left Metal Pill].)
"Ji" refers to palpitations in the heart. The Middle Qi is empty; upon slight stimulation, it cannot maintain stability, causing pain. (Accompanied by panic, palpitations, and mental confusion; the pulse is deficient and minute, and the pain prefers pressure. Suitable formulas include Huang Qi Jian Zhong Tang [Astragalus Decoction to Establish the Middle], Bu Zhong Yi Qi Tang [Tonify the Middle and Augment the Qi Decoction], and Liu Jun Zi Tang [Six-Gentleman Decoction].)
"Chong" refers to parasitic accumulation. Irregular diet and improper cold/heat lead to parasite agitation. As parasites move and attack up and down, pain occurs. (Accompanied by mottled yellow-white complexion, vomiting of clear water/froth, intermittent pain, or throbbing at the pain site; the pulse is irregular in size. Suitable formulas include Jiu Tong Wan [Nine-Pain Pill], Jian Hong Wan [Cutting Red Pill], Wu Yi San [Corydalis Powder], Zhang Zhongjing's Wu Mei Wan [Mume Pill], Wan Ying Wan [Ten-Thousand-Efficacy Pill], and Ji Xiao Wan [Collecting Efficacy Pill].)
"Wu" refers to Guest Counter-attack (Ke Wu). Evil qi suddenly invades and counter-attacks, disturbing the clear pathways and disrupting transport mechanisms, causing pain. (Accompanied by vomiting/reversal, unclear head/eyes, hallucinations/wandering speech, or unconsciousness; the pulse is rapid and agitated. Suitable formulas include Su He Wan [Styrax Pill], Bei Ji Wan [Emergency Aid Pill], Zi Jin Ding [Purple Gold锭], and Jiu Tong Wan [Nine-Pain Pill].)
"Zhu" refers to Corpse Zhu (a contagious wasting disease). It resembles gu poison or worm erosion, with unknown etiology. It comes and goes, with pain having no fixed location. This is transmitted from the deceased, known as "Transmitting Corpse Qi." (Accompanied by bone-steaming fever, hemoptysis, cough, and consumptive diseases; the pulse is weak and rapid. Select formulas from the Consumptive Disease chapter for symptomatic treatment.)
Externally, there are three other types: Yu Xue Tong (Blood Stasis Pain), Jue Xin Tong (Jue Heart Pain), and Zhen Xin Tong (True Heart Pain).
Yu Xue Tong (Blood Stasis Pain): Pain is located in the epigastrium. Caused by hot beverages or severe vomiting damaging the stomach collaterals, leading to blood extravasation. Blood stasis remains in the middle, obstructing qi. Pain is intermittent, worsens after eating, or causes hiccups when drinking liquids. The pulse is choppy. (Suitable herbs/formulas include Er Chen Tang [Two-Cured Decoction], Tao Ren [Peach Seed], Hong Hua [Safflower], Wu Ling Zhi [Trogopterus Dung], Yuan Hu [Corydalis Rhizome], Xiang Fu [Cyperus Rhizome], Jiu Zhi [Leek Juice], Ou Zhi [Lotus Root Juice], and Hong Qu [Red Yeast Rice].)
Jue Xin Tong (Jue Heart Pain): Caused by various zang-fu meridians that pass through the stomach opening to the diaphragm (Hand-Taiyin Lung), connect to the lung below the diaphragm (Hand-Yangming Large Intestine), descend below the diaphragm to belong to the stomach and connect to the spleen (Foot-Yangming Stomach), branch from the stomach above the diaphragm to enter the heart (Foot-Taiyin Spleen), connect to the heart below the diaphragm reaching the stomach (Hand-Taiyang Small Intestine), run alongside the spine (Foot-Taiyang Bladder), connect to the heart entering the chest (Foot-Shaoyin Kidney), originate in the chest, exit to belong to the Pericardium below the diaphragm (Hand-Jueyin Pericardium), spread in the Shanzhong region, scatter to connect to the Pericardium below the diaphragm (Hand-Shaoyang Sanjiao), descend through the chest piercing the diaphragm (Foot-Shaoyang Gallbladder), flank the stomach ascending through the diaphragm spreading to the hypochondrium (Foot-Jueyin Liver), follow the interior of the abdomen ascending to Guanyuan (Extraordinary Vessel Ren Mai), merge into the spinal interior (Extraordinary Vessel Du Mai), flank the navel ascending to the chest and dispersing (Extraordinary Vowel Chong Mai), or enter the interior to link the yin vessels (Extraordinary Vessel Yin Wei Mai). If qi rebels in these meridians and extraordinary vessels, the meridians become excessively full. Pain follows the meridian pathways through areas like the stomach opening, chest, diaphragm, pericardium, Shanzhong, spine, hypochondrium, navel, and abdomen. This is pain of the various meridians, not true heart pain. (Symptoms vary by meridian: Lung meridian pain includes aversion to cold, shortness of breath, distension, pain radiating to the Supraclavicular Fossa; treat with Shen Su Yin, Xiang Su San, Su He Wan. Large Intestine meridian pain radiates to the diaphragm, with borborygmus and dry mouth; treat with Si Qi Tang, Zhi Jie Er Chen Tang. Stomach meridian pain radiates to the spleen/chest/breasts, with vomiting; treat with Er Chen Tang, Ping Wei San, Dongyuan Wen Wei Tang, Lai Fu Dan. Spleen meridian pain radiates to the epigastrium/xin-xia, with abdominal distension, belching, vomiting, poor appetite; treat with Er Chen Tang, Xiang Sha Ping Wei San, Li Zhong Tang, Lai Fu Dan. Small Intestine meridian pain radiates to the diaphragm/stomach, with borborygmus; treat with Er Chen Tang, Si Qi Tang, Su He Wan. Bladder meridian pain radiates to the lower back/spine, with aversion to cold; treat with Shen Su Yin, Dongyuan Tian Tai Wu Yao San. Kidney meridian pain radiates to the chest/lower back/spine, with hunger-like sensation, rebellious qi, wheezing, fear; treat with Ban Liu Wan, Wu Yao Shun Qi San. Pericardium meridian pain radiates to the chest/hypochondrium, with fullness, palpitations, irritability, laughter; treat with Er Chen Tang, Tie Weng Xian Sheng Jiao Gan Dan. Sanjiao meridian pain radiates to the pericardium/Shanzhong, with tinnitus; treat with Er Chen Tang, Yue Ju Wan. Gallbladder meridian pain radiates to the chest/diaphragm/hypochondrium, with bitter taste, sighing, chills; treat with Er Chen Tang, Wen Dan Tang, Xiao Chai Hu Tang. Liver meridian pain radiates to the diaphragm/stomach/hypochondrium, with dry throat, vomiting, chest fullness; treat with Er Chen Tang, Si Qi Tang, Lai Fu Dan.)
Zhen Xin Tong (True Heart Pain): This is pain of the True Zang. The Heart is the monarch of the body, dwelling place of the Spirit (Shen); pathogens rarely invade, and diseases rarely reach it. Only when the True Zang itself is deficient and the Spirit loses its residence can the pathogenic factors of Pericardium Jue pain enter due to deficiency. The *Nanjing* states its pain is severe and confined to the heart. Since it is confined to the heart, it does not radiate to other areas. It must be accompanied by coma, short tongue, and cyanosis/coldness of hands and feet. This is the True Heart Pain that leads to death on the same day it appears (morning onset, evening death; evening onset, morning death).
Regarding the aforementioned pains, if the pulse is fine and slow, it indicates qi deficiency and relaxation, suggesting the decline of rebellious evil; the prognosis should be favorable. If the pulse is large and floating, it indicates the pathogen is flourishing. Moreover, an interior heart/abdominal condition presenting with exterior pulses is highly inappropriate. Although it may not lead to death, recovery will be difficult.