脉
沉弦细动，皆是痛证。心痛在寸，腹痛在关，下部在尺，脉象显然。坚实不大便者下之，痛甚者脉
必伏。阳微阴弦短而涩者，皆心痛也。脉沉细而迟者，易治。浮大弦长，皆难治。
病
夫心痛者，即胃脘痛也。其种有九∶曰饮，曰食，曰风，曰冷，曰热，曰悸，曰虫，曰疰，曰去来痛。
名虽不同，未有不由清痰食积郁于中，七情九气触于内之所致也。治法须分新久，若明知身受寒气，口得寒
物，而病于初传之时，当以温散，或温利之药。若得稍久，则成郁矣。郁则成热，又当以温散药内加苦寒
之药，温治其标，寒治其本也。由是古方多用山栀为君，热药为之向导，则邪易伏而病易安。若纵恣口腹，
不谨调食，则病复作，必难治也，此病日久，不食亦不死。若痛方止，便吃还痛，必须三五服药后，渐
而少食，庶获痊愈。其有真心痛者，因太阳触犯心君，或污血冲心而痛极，手足青过节者，旦发而夕死，
非药所能治也。
治
诸痛不可用补气，气旺不通，而痛愈甚。故云∶通则不痛，痛则不通也。
一、凡痛在心，连两胁至两乳下，牵引背板、匙骨下而
痛者，实热也。
一、凡痛在小腹，连脐左右上下 痛，手足厥冷者，虚寒也。
一、凡心痛以物拄按则痛止者，挟虚也，以二陈汤加炒干姜和之。
一、凡心痛因平日喜食热物，所以致流于胃口作疼痛，用桃仁
承气汤下之，若轻者用韭汁、桔梗能提气，血药中兼用之。
一、凡心膈大痛，攻走腰背，发厥呕吐，诸药不效者，就吐中以鹅翎探之，出痰积碗许，而痛即止。
一、虫痛者，必面上白斑唇红，又痛后便能食，时作时止是也，用二陈汤加苦楝根皮煎服。上半
月虫头向上易治，下半月虫头向下难治。或曰痛而久卧不安，自按心腹时大叫，或青，或黄唇缓
目无精光者，虫痛也。又曰∶腹痛肚大青筋者，取虫丸主之。
一、心痛卒急无药，以盐置刀头，烧红淬入水中，乘热饮之，吐痰而愈。此法治搅肠痧，大痛已死者，立效。
谨按痛则不通，通则不痛。夫胃脘、心脾痛者，或因身受寒邪，口食冷物，内有郁热，素有顽痰、死血，
或因恼怒气滞，虫动作痛，种种不同，若不分而治之，何能愈乎？余曰∶是寒则温之，是热则清之，是痰则化
之，是血则散之，是气则顺之，是虫则杀之，庶乎临证不眩惑矣。
方
清热解郁汤（西园公方） 治心痛，即胃脘痛，一服即止。
山栀仁（炒黑，一钱半） 枳壳（面炒，一钱） 西芎（一钱） 黄连（炒，七分） 陈
皮（五分） 苍术（米泔浸，七分） 香附（一钱） 干姜（炒黑，五分） 甘草（五分）
上锉一剂，生姜三片，水煎热服。服后戒饭食大半日，渣再煎服。
仓卒散（秘方）
山栀仁（炒黑，五钱）
上锉一剂，生姜三片，煎服。一方加川芎一钱，尤妙。
一方单用栀子炒，为末，每服二三匙。心痛、腹痛姜汤调下。痢作肚痛，黄酒调下 四肢浮肿，米
饮调下；小便淋沥，白汤调下。
平气散（刘孟门传） 治心痛。
苍术（一钱五分） 栀子（一钱五分） 当归（一钱） 青皮（一钱） 陈皮（一钱） 枳
壳（一钱） 木香（一钱，临熟时入木香再煎） 甘草（三分）
上锉一剂，生姜三片，水一大碗，煎至七分，通口服。
清郁散〔批〕（按此方治心胃郁火作痛调和之剂） 治胃中有伏火，膈上有稠
痰，胃口作痛，及恶心，呕吐清水，或作酸水醋，心烦闷。
陈皮（一钱） 半夏（一钱，香油炒） 白伏苓（一钱） 苍术（一钱，米泔浸炒） 川
芎（六分） 干姜（五分，炒黑） 香附（童便炒，一钱） 神曲（炒，一钱） 黄连（姜汁炒，
一钱） 栀子（姜汁炒一钱） 甘草（三分）
上锉一剂，生姜三片，煎服。呕吐甚，加藿香四分，砂仁四分。此方为丸服亦妙。
宣气散（严发十传） 治心胃刺痛，牵引胸膈疼痛，内有实热，脉数有力者。
栀子仁（盐酒炒） 滑石 大黄 木香
上先将栀子以生姜煎汤，余药入汤内浓磨温服。在上必吐痰，在下必泻，其痛立止。外以
萝卜子炒，绢包频熨痛处。
利气丸（方见诸气门） 治心胃气滞、食积，郁热作痛。
加减柴胡汤（西园公制） 治实热凑上，心腹作痛，发热不止。
柴胡（一两） 黄芩（七钱半） 半夏（七钱半） 枳壳（一两） 赤芍（一两） 山栀
子（去壳，四两，半生半炒）
上锉一剂，生姜三片，煎服。
利气保安汤（西园公制）〔批〕（按此方治心胃实热作痛清热之剂） 治气痛，已服
通利之药，下后余热作痛，或痛在小腹者。
柴胡 青皮 枳壳 香附 郁金 木通 赤芍 山栀仁（各等分，
炒）
四圣散（段千户传） 治心痛、肚腹痛，阴证绞肠痧神效。
五灵脂（炒出烟） 桃仁（面炒黄色，去皮尖） 草乌（水泡，一日一换，浸七日，
去皮尖，切作片，用新瓦焙干，各用一两） 青黛（二钱，入药八钱，为末）
上为末，酒糊为丸，如梧桐子大。每服十五丸，或十七丸，用艾叶七片炒出烟，陈酒一钟，入锅去艾，
温艾汤送下。
一用仓卒散 治气自腰腹间攻心，痛不可忍，腹中冰冷自汗，如洗手足，挛急厥冷。
山栀子（大者四十九个，连皮捣烂炒） 大附子（一枚，泡，去皮）
上为末，每服二钱，酒煎八分温服。
丁胡三建汤〔批〕（按此方治心胃冷气作痛辛温之剂） 治冷心疼，面青唇黑，手足厥冷。
丁香 良姜 官桂（各一钱五分）
上锉一剂，水一碗，煎七分，用胡椒五十粒，炒黄色为末，调入汤药内，顿服。
救急奇方 治男妇心疼，禁了牙关欲死者。
隔年老葱白三五根，去皮、须、叶，捣成膏，将病患斡开口，用铜匙将膏送入喉中，用香油四两灌送，
但得葱膏下喉。少时将腹中所停虫病等物化为黄水，微利为佳，永不再发。
追虫丸 治虫咬心痛。
干漆（五钱，炒去烟） 雄黄（二钱五分） 巴豆霜（一钱）
上为末，面糊为丸，如黍米大。每服十二三丸，有子苦楝根皮煎汤送下。
小金丹〔批〕（按此方治心胃虫攻作痛追逐之剂） 治虫之作痛，时痛时止，
痛则攻心，口吐清水，人中鼻唇一时青黑者是。
雄黄（一钱） 姜黄（一钱） 巴豆（去油，一钱） 三柰（一钱） 丁香（二十五个） 人言（三分）
上为末，用红枣煮熟去核为丸，如粟米六。每服四、五丸，五六岁儿用六、
七丸，或八、九丸，艾叶煎汤，入醋少许，不拘时送下。
心红散（徐蓟川传） 治心痛气痛，及治孕妇心疼。
银朱 鸡粪（炒焦干，为末）
上二味，各等分，和一处。每服一钱，熟黄酒调服，即出冷汗立止。
治一切心腹胸腰背疼痛和锥刺（秘方）
花椒为细末，醋和为饼，贴痛处，上用艾捣烂铺上，发火烧艾，痛即止。
加味枳术丸 治清痰，酒积、食积、茶积、肉积，在胃脘当心而痛，
及痞满恶心嘈杂，嗳气吞酸，呕吐脾痰等证，其效如神。
白术（三两） 枳实（面炒黄色） 苍术（米泔浸三宿，焙） 猪苓（去黑皮） 川芎
麦面（炒黄色） 神曲（炒微色） 半夏（汤泡透，各一两） 泽泻（去毛） 赤茯苓
（去皮） 黄连（陈壁土炒） 白螺蛳壳（炮，各七钱） 缩砂仁 草豆蔻 黄芩（陈壁
土炒） 青皮（去白） 莱菔子（炒） 干生姜（各五钱） 陈皮 栝蒌子 香附子
（童便炒） 浓朴（姜汁制炒） 槟榔（各三钱） 木香（二钱） 甘草（二钱）
吞酸，加吴茱萸汤泡，寒月五钱，热月二钱五分；久病挟虚，
加人参、白扁豆、石肉各五钱。时常口吐清水，加炒滑石一两，牡蛎五钱。
上为细末，用青荷叶泡汤浸，晚粳米研粉，作糊为丸，如梧桐
子大。每服七十丸，多至一百丸，清米饮送下。
Pulse
A deep (Chen), wiry (Xian), fine (Xi), or moving (Dong) pulse are all signs of pain syndromes. Pain in the heart region manifests in the Cun position, abdominal pain in the Guan position, and lower body pain in the Chi position; the pulse indications are clear. For those with a firm pulse accompanied by constipation, purgation should be used. In cases of severe pain, the pulse will likely be hidden (Fu). A short and choppy (Se) pulse with weak Yang and wiry Yin indicates Heart pain. A deep, fine, and slow pulse is easy to treat. A floating, large, wiry, and long pulse is difficult to treat.
Regarding Heart pain: It is essentially epigastric pain (Wei Wan Tong). There are nine types: caused by fluid retention (Yin), food stagnation (Shi), wind (Feng), cold (Leng), heat (Re), palpitations (Ji), parasites (Chong), malarious infection (Zhu), and intermittent pain (Qu Lai Tong). Although the names differ, none arise without phlegm-fluid and food stagnation obstructing the middle Jiao, triggered internally by the Seven Emotions (Qi Qing) and Nine Qi disturbances. Treatment must distinguish between new and chronic conditions. If it is known that the body has been exposed to cold pathogens or ingested cold substances, and the disease is in its initial transmission stage, warming and dispersing or warming and unblocking herbs should be used. If the condition persists for some time, stagnation (Yu) forms. Stagnation generates heat; thus, bitter-cold herbs should be added to the warming dispersing agents. The warming herbs treat the branch (symptoms), while the cold herbs treat the root (stagnant heat). Therefore, ancient formulas often use Gardenia seed (Shan Zhi Ren) as the sovereign herb, guided by hot herbs, so that pathogenic factors are easily subdued and the disease resolved. If one indulges in diet and fails to regulate eating habits, the disease will recur and become difficult to treat. This chronic condition may not lead to death even without food intake. If eating immediately after pain subsides triggers pain again, one must take three to five doses of medicine before gradually reducing food intake to achieve recovery. In cases of True Heart Pain (Zhen Xin Tong), where the Taiyang channel offends the Heart Sovereign or foul blood rushes to the heart causing extreme pain, with cyanosis extending past the joints of hands and feet, death occurs if onset is in the morning and by evening; this is beyond the reach of medicinal treatment.
Treatment
All pains should not be treated with Qi-tonifying herbs, as excessive Qi leads to obstruction and worsens pain. Thus it is said: "Unblocked means no pain; pain means unblocked."
1. Pain located in the heart/chest, radiating to both hypochondria down to below the breasts, pulling into the back, scapulae, and infraclavicular region indicates Excess-Heat.
2. Pain located in the lower abdomen, radiating around the umbilicus up, down, left, and right, with cold extremities indicates Deficiency-Cold.
3. Heart pain that stops when pressed or supported indicates accompanying Deficiency; treat with Er Chen Tang (Two-Aged Powder) combined with stir-fried Dried Ginger (Chao Gan Jiang).
4. Heart pain caused by a habit of consuming hot foods, leading to heat flowing into the stomach opening causing pain, should be purged with Tao Ren Cheng Qi Tang (Peach Kernel Decoction to Order the Qi). For mild cases, Leek Juice (Jiu Zhi) and Platycodon Root (Jie Geng) can lift Qi and be used alongside blood-invigorating herbs.
5. For severe pain in the heart and diaphragm radiating to the waist and back, accompanied by syncope and vomiting, where other medicines fail, induce vomiting using a goose feather probe. Expelling about a bowl of phlegm accumulation will stop the pain immediately.
6. Parasitic pain is characterized by white patches on the face and red lips; the patient can eat after pain episodes, and pain comes and goes intermittently. Treat with Er Chen Tang (Two-Aged Powder) plus bark of Toosendan Root (Ku Lian Gen Pi). In the first half of the lunar month, when parasite heads face upward, it is easier to treat; in the second half, when heads face downward, it is difficult. Another view states: pain with restlessness, screaming upon self-palpation of the heart/abdomen, cyanotic or flaccid yellow lips, and spiritless eyes indicates parasitic pain. Also: abdominal distension with prominent blue veins indicates parasitic pain, treated with Chong Wan (Parasite Pill).
7. For sudden acute heart pain without medicine available, place salt on the head of a knife, heat until red, quench in water, and drink while hot. Vomiting phlegm cures the condition. This method is highly effective for Jiao Chang Sha (Intestinal Twisting Malaria/Acute Abdominal Colic), even in patients who appear dead.
Commentary: Pain implies blockage; unblockage implies no pain. Epigastric pain or Heart/Spleen pain may result from external cold pathogens, ingestion of cold foods, internal stagnant heat, pre-existing stubborn phlegm or dead blood, or Qi stagnation due to anger, or parasite movement. Since causes vary, they must be treated differently. I say: Cold requires warming, Heat requires clearing, Phlegm requires resolving, Blood stasis requires dispersing, Qi stagnation requires smoothing, and Parasites require eliminating. This prevents confusion in clinical practice.
Formulas
Qing Re Jie Yu Tang (Clear Heat and Resolve Stagnation Decoction - Formula of Xi Yuan Gong): Treats Heart pain, i.e., epigastric pain; pain stops after one dose.
Gardenia Seed (Stir-fried black, 1.5 qian) / Bitter Orange Peel (Stir-fried with flour, 1 qian) / Western Angelica Root (1 qian) / Coptis Rhizome (Stir-fried, 0.7 qian) / Tangerine Peel (0.5 qian) / Atractylodes Rhizome (Soaked in rice wash water, 0.7 qian) / Cyperus Rhizome (1 qian) / Dried Ginger (Stir-fried black, 0.5 qian) / Licorice Root (0.5 qian).
Decoct one dose with three slices of fresh ginger in water; take warm. Fast for half a day after taking; decoct dregs again for a second dose.
Cang Cu San (Sudden Relief Powder - Secret Recipe):
Gardenia Seed (Stir-fried black, 5 qian).
Decoct one dose with three slices of fresh ginger. Another version adds Ligusticum Wallichii (Chuan Xiong, 1 qian), which is excellent.
Another method: Use only stir-fried Gardenia, powdered. Take 2-3 spoons. For Heart/Abdominal pain, mix with Ginger Decoction. For dysentery with abdominal pain, mix with Yellow Wine. For limb edema, mix with Rice Drink. For dribbling urination, mix with plain water.
Ping Qi San (Calming Qi Powder - Transmitted by Liu Mengmen): Treats Heart pain.
Atractylodes Rhizome (1.5 qian) / Gardenia Fruit (1.5 qian) / Angelica Sinensis (1 qian) / Green Citrus Peel (1 qian) / Tangerine Peel (1 qian) / Bitter Orange Peel (1 qian) / Costus Root (1 qian, add near completion and simmer) / Licorice Root (0.3 qian).
Decoct one dose with three slices of fresh ginger in a large bowl of water until reduced to 70%; take orally in one go.
Qing Yu San [Note] (Formula for harmonizing Heart/Stomach郁Fire pain): Treats latent fire in the stomach, thick phlegm in the diaphragm, stomach opening pain, nausea, vomiting clear fluid or sour acid, irritability, and stifling sensation.
Tangerine Peel (1 qian) / Pinellia Tuber (1 qian, stir-fried in sesame oil) / Poria (1 qian) / Atractylodes Rhizome (1 qian, soaked in rice wash and stir-fried) / Ligusticum Wallichii (0.6 qian) / Dried Ginger (0.5 qian, stir-fried black) / Cyperus Rhizome (1 qian, stir-fried in child's urine) / Medicated Leaven (1 qian, stir-fried) / Coptis Rhizome (1 qian, stir-fried in ginger juice) / Gardenia Fruit (1 qian, stir-fried in ginger juice) / Licorice Root (0.3 qian).
Decoct one dose with three slices of fresh ginger. For severe vomiting, add Agastache (Huo Xiang, 0.4 qian) and Amomum Fructus (Sha Ren, 0.4 qian). Making pills is also effective.
Xuan Qi San (Promoting Qi Flow Powder - Transmitted by Yan Fa Shi): Treats stabbing Heart/Stomach pain radiating to chest/diaphragm, with internal excess heat and rapid, forceful pulse.
Gardenia Seed (Salt-wine stir-fried) / Talcum (Hua Shi) / Rhubarb (Da Huang) / Costus Root (Mu Xiang).
First decoct Gardenia in ginger water, then grind remaining herbs in the liquid; take warm. Upper action induces phlegm vomiting; lower action induces diarrhea; pain stops immediately. Externally, stir-fried Radish Seed (Lai Fu Zi) wrapped in silk can be frequently applied to the painful area.
Li Qi Wan (Promoting Qi Flow Pill): See Qi Channel section. Treats Heart/Stomach Qi stagnation, food stagnation, and stagnant heat pain.
Jia Jian Chai Hu Tang (Modified Bupleurum Decoction - Formulated by Xi Yuan Gong): Treats excess heat gathering above, causing Heart/abdominal pain and persistent fever.
Bupleurum Root (Chai Hu, 1 liang) / Scutellaria Root (Huang Qin, 0.75 liang) / Pinellia Tuber (0.75 liang) / Bitter Orange Peel (1 liang) / Red Peony Root (Chi Shao, 1 liang) / Gardenia Fruit (Quelled shell, 4 liang, half raw half stir-fried).
Decoct one dose with three slices of fresh ginger.
Li Qi Bao An Tang (Promoting Qi and Ensuring Safety Decoction - Formulated by Xi Yuan Gong) [Note] (Formula for clearing heat in Heart/Stomach excess heat pain): Treats Qi pain where purgatives have been taken, residual heat causes pain post-purgation, or pain in the lower abdomen.
Bupleurum Root / Green Citrus Peel / Bitter Orange Peel / Cyperus Rhizome / Curcuma Tuber (Yu Jin) / Akebia Stem (Mu Tong) / Red Peony Root / Gardenia Seed (Equal parts, stir-fried).
Si Sheng San (Four Sages Powder - Transmitted by Duan Qianhu): Highly effective for Heart pain, abdominal pain, Yin syndrome intestinal twisting colic.
Trogopterus Dung (Wu Ling Zhi, stir-fried until smoke rises) / Peach Kernel (Mian stir-fried yellow, skin and tip removed) / Aconite Lateral Root (Cao Wu, soaked in water, changed daily, soaked 7 days, skin/tip removed, sliced, dried on new tile, 1 liang each) / Indigo Naturalis (Qing Dai, 2 qian, mixed with 8 qian of powder).
Powdered, bound with wine paste into pills like Sophora seeds. Take 15-17 pills. Stir-fry 7 mugwort leaves until smoking, add aged wine, remove leaves, and send down with warm mugwort-infused wine.
Alternative: Use Cang Cu San. Treats Qi attacking the heart from waist/abdomen, unbearable pain, icy cold abdomen with spontaneous sweating, cold limbs like washed hands, cramping and coldness.
Gardenia Fruit (49 large ones, smashed with skin and stir-fried) / Large Aconite Root (1 piece, soaked, skin removed).
Powdered. Take 2 qian, decoct in wine to 80% volume, take warm.
Ding Hu San Jian Tang [Note] (Formula for辛-Warm treatment of Cold Qi Heart/Stomach pain): Treats Cold Heart pain, cyanotic face/black lips, cold extremities.
Clove (Ding Xiang) / Galangal (Liang Jiang) / Cassia Bark (Guan Gui) (1.5 qian each).
Decoct one dose in one bowl of water until 70% remains. Grind 50 peppercorns (Hu Jiao) stir-fried yellow into powder, mix into the decoction, take in one dose.
Jiu Ji Qi Fang (Emergency Miracle Formula): Treats Heart/abdominal pain in men/women with locked jaw and impending death.
Old green onion whites (3-5 stalks), peel/remove roots/leaves, mash into paste. Pry open patient's mouth, insert paste with copper spoon, follow with 4 liang of sesame oil. Once paste enters throat, parasites/toxins in abdomen turn to yellow water; slight diarrhea is ideal; prevents recurrence.
Zhui Chong Wan (Parasite-Chasing Pill): Treats parasitic Heart pain.
Dry Lacquer (Gan Qi, 5 qian, stir-fried to remove smoke) / Realgar (Xiong Huang, 2.5 qian) / Croton Seed Frost (Ba Dou Shuang, 1 qian).
Powdered, bound with flour paste into pills like millet grains. Take 12-13 pills. Can be sent down with Toosendan Root decoction.
Xiao Jin Dan [Note] (Formula for chasing parasites causing Heart/Stomach pain): Treats intermittent parasitic pain attacking the heart, vomiting clear fluid, cyanosis/blackening of philtrum/nose/lips.
Realgar (1 qian) / Turmeric (Jiang Huang, 1 qian) / Croton Seed (De-oiled, 1 qian) / Sand Ginger (San Nai, 1 qian) / Clove (25 pieces) / Arsenic Trioxide (Ren Yan, 0.3 qian).
Powdered, bound with cooked red dates (pitted) into pills like millet grains. Take 4-5 pills (6-9 for children 5-6 years old). Send down with Mugwort decoction with a little vinegar, anytime.
Xin Hong San (Heart Red Powder - Transmitted by Xu Jichuan): Treats Heart/Qi pain and pregnant women's Heart pain.
Silver Cinnabar (Yin Zhu) / Chicken Manure (Stir-fried dry to ash, powdered).
Mix equal parts. Take 1 qian with熟 Yellow Wine; cold sweat ensues and pain stops immediately.
Secret Recipe for All Heart/Abdominal/Chest/Waist/Back Pain like Needle Stabs:
Grind Sichuan Pepper (Hua Jiao) to fine powder, mix with vinegar into cakes, apply to pain site. Cover with mashed Mugwort, ignite and burn Mugwort; pain stops.
Jia Wei Zhi Zhu Wan (Modified Immature Bitter Orange and Atractylodes Pill): Treats clear phlegm, alcohol/food/tea/meat stagnation causing central epigastric pain, fullness, nausea, acidity, belching, vomiting spleen-phlegm. Effect is miraculous.
Atractylodes Macrocephala (Bai Zhu, 3 liang) / Immature Bitter Orange (Zhi Shi, flour-stir-fried yellow) / Atractylodes Rhizome (Soaked 3 nights in rice wash, dried) / Polyporus (Zhu Ling, skin removed) / Ligusticum Wallichii / Wheat Flour (Stir-fried yellow) / Medicated Leaven (Lightly stir-fried) / Pinellia Tuber (Soaked in boiling water, 1 liang each) / Alisma (Ze Xie, hair removed) / Red Poria (Skin removed) / Coptis Rhizome (Stir-fried with old wall soil) / White Conch Shell (Pao, 7 qian each) / Amomum Fructus / Cardamom (Cao Dou Kou) / Scutellaria Root (Stir-fried with old wall soil) / Green Citrus Peel (White part removed) / Radish Seed (Stir-fried) / Dried Ginger (5 qian each) / Tangerine Peel / Trichosanthes Seed / Cyperus Rhizome (Child's urine stir-fried) / Magnolia Bark (Ginger juice processed/stir-fried) / Areca Seed (3 qian each) / Costus Root (2 qian) / Licorice Root (2 qian).
For acid regurgitation, add Evodia (Wu Zhu Yu) soaked in water (5 qian in cold months, 2.5 qian in hot months). For chronic deficiency, add Codonopsis (Ren Shen), White Hyacinth Bean (Bai Bian Dou), and Dendrobium (Shi Rou) at 5 qian each. For frequent vomiting of clear fluid, add stir-fried Talcum (1 liang) and Oyster Shell (Mu Li, 5 qian).
Powdered, bound with Green Lotus Leaf infusion and Late-Japonica Rice powder paste into pills like Sophora seeds. Take 70-100 pills with clear rice drink.