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(Pericardium pain, epigastric pain.)

The Heart is the Sovereign Monarch and, by principle, should not be directly invaded by pathogens. If pathogens injure the Heart organ itself causing pain, it is called Zhenxin Tong (True Heart Pain). The symptoms include sudden severe pain, teeth grinding with clenched jaw, cyanosis of the tongue, cold breath, incessant sweating, black complexion, cyanosis of hands and feet extending beyond the joints, and coldness like ice. Death occurs in the morning if onset is in the evening, or in the evening if onset is in the morning; this is incurable. Out of compassion, one may decoct a pig heart to obtain its broth, add Ephedrae Herba (Mahuang), Cinnamomi Ramulus (Guizhi), Zingiberis Rhizoma (Ganjiang), and Aconiti Lateralis Radix Praeparata (Fuzi) for oral administration to disperse cold, perhaps offering a chance of survival from death. If only climbing the bed and scratching the floor are observed, without cyanosis of the face, without cold extremities, and with voice still audible, it is not True Heart Pain, but pain caused by pathogen invasion of the Pericardium (the protective sac surrounding the heart). The pathogens affecting the Pericardium are transmitted from the meridians of various zang-fu organs. For instance, pain radiating from the chest to the heart is Lung Heart Pain; from the epigastrium to the heart is Stomach Heart Pain; from the hypochondrium to the heart is Liver Heart Pain; from the lower back to the heart is Kidney Heart Pain; others can be inferred similarly. This is because the collateral branches of the Ren and Du meridians of the five zang and six fu organs all connect to the Heart. When pathogens invade from these collateral branches towards the Heart, they do not easily enter the Heart itself but rather affect its Pericardium. Consequently, qi and blood are stagnated by pathogens, and the struggle between pathogenic factors and healthy qi causes pain.

Pericardium pain is located below the sternum; slightly lower down is epigastric pain. The upper orifice of the stomach is named Fenmen (Cardia), located five cun above the umbilicus and three cun lateral to the anterior midline (Note: Textual ambiguity exists here regarding specific measurement context). However, the pains often interconnect, so laypeople generally refer to such conditions collectively as "Heart Pain." There is also a theory of "Nine Types of Heart Pain," namely: Worm Pain, Fluid Retention Pain, Food Stagnation Pain, Wind Pain, Cold Pain, Heat Pain, Palpitation Pain, Infectious/Contagious Pain, and Migratory Pain. Zhu Danxi stated: Pain in the heart and diaphragm must be distinguished by newness or chronicity. If it is known that the body has been exposed to cold or cold foods ingested, during the early stage, warm dispersing methods or warm purging methods should be used (such as Jiutong Wan [Nine-Pain Pill] by Zhang Zhongjing, or Zhuhuang Wan by Li Dongyuan). In chronic cases, stagnation steams into heat; using warm dispersing or purging methods might exacerbate fire, so Gardeniae Fructus (Shanzhiren) should be added. If pain is due to qi stagnation, treatment is necessary even before heat transformation occurs. The reason for generally attributing this to "Fire Stagnation" is that qi belongs to Yang, and thus to Fire; this principle should be understood. Cold pain results from cold pathogens lodging in the intestines and stomach, causing sudden pain; Erchen Tang (see Phlegm-Fluids chapter), Tsao Guo (Arecae Semen), Ganjiang, Evodiae Fructus (Wuzhuyu), Fuyang Zhuwei Decoction, or Caodoukou Wan may be used. Heat pain is treated with Qingzhong Tang, including Coptidis Rhizoma (Huanglian) and Gentianae Radix (Longdancao). Phlegm accumulation pain is treated with Xingban Anzhong Tang or Haige Wan, or induced vomiting. Phlegm pain manifests as discomfort and restlessness due to damp-phlegm, feeling both hungry and full, with desire to vomit providing relief; Erchen Tang plus Caodoukou and Atractylodis Rhizoma (Cangzhu) is used. Clear fluid retention moving within, producing gurgling sounds, attacking the waist and ribs, is treated with Weiling Tang (see Diarrhea chapter). Cold phlegm occurs once a month, twice, or every two to three months; upon onset, pain is extreme, leading to fainting; occasional anger or labor triggers an upsurge; Pingwei San (see Food Injury chapter) plus Ganjiang, Caodoukou, and Aurantii Fructus (Zhiqiao) is used. Cough with rebellious qi accompanied by phlegm-fluid heart pain is treated with Haige Powder and Trichosanthis Fructus (Gualou Shi, with pulp), ground equally into powder, formed into pills with rice paste. Qi attack stabbing pain is treated with Jiaqi Qi Tang, Chenxiang Jiangqi San (these and the following formula are seen in Qi disorders chapter), or Zhengqi Tianxiang San (specifically for those whose pain is triggered by suppressed anger). Fixed blood stasis pain presents with a choppy pulse; during attacks, take medicine with rice soup. Or there may be hiccups, with qi rebelling upwards, feeling like insects churning, making chirping sounds; do not mistake this for worm pain. Robust individuals use Taoren Chengqi Tang (see Blood disorders chapter); frail individuals use Dangguiweiba, Chuanxiong Rhizoma (Chuanxiong), Moutan Cortex (Danpi), Carthami Flos (Honghua), Sappanwood (Suman), Cyperi Rhizoma (Yanhusuo), Cinnamomi Cortex (Guixin), Taoren paste, Chi Qu, Red Sandalwood (Xiangchen), Trogopterori Faeces (Piaoxiaofen - Note: Text says 'Fan Jiangxiang' which is likely Aquilaria/Sandalwood variant or typo, interpreted here as aromatic qi-moving herb), and Trogopteri Dung (Tongcao - Note: Text says 'Tongcao' usually Pherocaulis, but context suggests blood-invigorating combo, sticking to text: Tongcao), and Pangolin Scales (Chuanshanjia), decocted, then mixed with child's urine and Chinese chive juice, taken in large doses, or Shixiao San. Worm pain feels like biting, with white spots on the face, complexion alternating between cyanotic, pale, and red, red lips, vomiting clear water or yellowish fluid, pain coming and going, ability to eat, or pain immediately after eating because worms move when fed, so pain occurs; pain stops after fullness. Huachong Wan (see Worm chapter), Toosendan Fructus (Chuanlianzi), Sophorae Root (Kulian Gen), Quisqualis Fructus (Shijunzi), Areca Seed (Binglang), Coptidis Rhizoma (Huanglian), Osmundae Spora (Leiwu), and Mume Fructus (Wumei) are used; Sichuan Pepper (Huajiao) must not be used as it is too pungent and may cause severe palpitations; detailed treatment is in the Worm section. Food stagnation pain feels like an obstruction, heavy and unyielding, with frequent belching of rotten smells, dull pain after slight dietary injury; Pingwei San plus Zhi Shi, Banxia, and Binglang is used. For pre-existing alcohol/food/phlegm accumulation, pain triggered by contact: if complicated by wind-cold, Shen Su Yin (see Fever chapter) plus Scallion Stem (Congbai) and Ginger; if complicated by anger, Erchen Tang plus Qingpi, Zhizi, Shenqu, Hawthorn Fruit (Shanzha), and Caoguo; if complicated by heat-fire, Erchen Tang plus Zhi Shi, Huanglian (stir-fried with ginger juice), and Zhizi. If the pulse is firm, there is no bowel movement, subcostal fullness and pain that cannot be pressed, it is excess; Da Chaihu Tang (see Malaria chapter) or Three Chengqi Decoctions (see Constipation chapter) should be used to purge. Unbearable pressing indicates excess; bearable pressing indicates deficiency. Deficiency is treated with tonification combined with regulation, or pure tonification. Zhu Danxi treated Duke Xu Wenyi’s food stagnation and phlegm-fluid retention, which surged like tides; surging upward caused heart-spleen pain, descending caused hip pain. He used prepared Kansui Radix powder baked inside a pig kidney for consumption (this is Zhang Hezi’s Wei Shen San, a harsh formula, do not use lightly). After seven episodes of diarrhea, the patient could walk. However, long-standing stagnation, once purged, merely incites rampant momentum. Therefore, emetics were used to reach the upper jiao, continuously using Citri Reticulatae Pericarpium (Gua Di - actually Geng Ti/Dadi), Veratrum Nigrum (Lilu), and Sophorae Radix (Kushen). Vomiting failed to expel everything. Then, three tips of Aconiti Lateralis Radix (Fuzui) were mixed with fermented grain water and honey for drinking, resulting in the massive vomiting of one bucket of gelatinous phlegm. Subsequently, the middle and lower jiao were treated with Glauber's Salt (Puxiao), Talcum (Huashi), Scutellariae Radix (Huangqin), Gypsum Fibrosum (Shigao), and Forsythiae Fructus (Lianqiao), totaling one jin, decocted strongly and drunk cold. Four jin were consumed over four days. Mild abdominal pain occurred, constipation and urinary retention developed, and the pulse became intermittent. At Mao and You hours (corresponding to Yangming meridian time, indicating Stomach and Large Intestine accumulation was not exhausted), Zixue (Purple Snow) was prepared (see End of Premature Ejaculation discussion chapter). Five liang were taken over three days, bringing slight abdominal relief. Later, painful urinary retention occurred; radish juice was drunk, leading to immediate relief after vomiting. Lower abdominal fullness and pain were treated with equal parts Rhubarbi Radix et Rhizoma (Dahuang) and Pharbitidis Semen (Qianniu), made into water pills, taken until 300 pills were consumed, passing about two sheng of feces resembling rotten fish intestines; the pulse ceased to be intermittent. Bowel movement bursting pain was treated with the same pills, passing filth resembling asphalt strips of about one chi length. From illness to recovery, the pulse remained normally wiry and large. The next year, Dao Cang Fa (Inversion Warehouse Method) was employed (see Accumulation-Mass chapter), resulting in complete cure. (This method was derived from Zhang Hezi; would anyone without courage dare to use it?)