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Li Shicai stated that various pains in the heart and abdomen, according to the discussions in *Neijing* (The Inner Canon), heart pain invariably involves pathological changes of the five Zang organs. The text details heart pathology while briefly mentioning the chest and abdomen, using one example to illustrate the rest. The Heart is the Sovereign Monarch and theoretically should not be invaded by pathogenic factors; if invaded, it constitutes a disease of its own meridian, termed *Zhenxintong* (True Heart Pain), which is invariably fatal and untreatable. However, the classics state: "When pathogens affect the Heart, it causes heart pain, a tendency toward sadness, and occasional dizziness or fainting." This refers to pathogens affecting the Pericardium (Pericardium Collateral), indicating the pathology is in the Fu organs rather than the Zang organs. It also states: "Abnormal movement of the Shaoyin Meridian of the Hand-Taiyin leads to dry throat, heart pain, thirst, and desire to drink," referring to pathogens affecting the collateral vessels, indicating the pathology is in the collaterals rather than the main meridians. Pathogens affecting these collaterals and Fu organs are caused by fright, anxiety, and overthinking, which damage the Spirit (Shen) and deplete Blood. Later medical theories further classify these into nine types: Fluid Retention (Yin), Food Stagnation (Shi), Heat (Re), Cold (Leng), Qi Stagnation (Qi), Blood Stasis (Xue), Palpitations (Ji), Parasites (Chong), and Infectious Wasting (Zhu). Without comprehensive recognition of these conditions, how can treatment be effective?

The Stomach belongs to Damp Earth and resides in the Middle Jiao. It is the Sea of Water and Grain, from which the Qi of the Five Zang and Six Fu organs and the Twelve Meridians is derived. In robust individuals, pathogens cannot invade; in weak individuals, pathogens lodge and cause immediate illness. Deviations toward Heat or Cold, Fluid Retention, or Food Stagnation all contend with True Qi, resulting in pain. Liver Wood overacting on Spleen Earth is considered a "Thief Evil," while Kidney Cold and Reversal are considered "Minor Evils." Symptoms may involve other Zang organs and should follow principles similar to those for heart pain. However, symptoms may manifest as fullness, distension, vomiting, anorexia, acid regurgitation, constipation, or diarrhea, accompanied by puffy and yellowish complexion, where the primary disease and external pathogens intermingle.

Chest pain is synonymous with Diaphragm pain. It differs from heart pain in location: heart pain occurs at the depression below the xiphoid process (Qigu), whereas chest pain extends horizontally across the chest and diaphragm. It differs from epigastric pain because the epigastrium is located above the heart. The classics state: "Southern winds arise in summer, causing diseases in the Heart-Shu point, manifesting in the chest and hypochondrium." This associates the chest with the Heart. Liver deficiency causes chest pain radiating to the back and hypochondrium, while Liver excess causes chest pain preventing body turning. This associates the chest with the Liver. The chest is the domain of the Lung; references to the Heart exist because the Heart meridian ascends from the Heart connection through the Lung. References to the Liver exist because the Liver meridian passes through the diaphragm and ascends to connect with the Lung. Hypochondriac pain has traditionally been treated via the Liver, but one must distinguish it from pain along the Foot-Shaoyang Gallbladder and Hand-Jueyin Pericardium meridians. If attributed to tendons and vessels harboring pathogens, how does it differ from pain along the Jingjin (Muscular Regions)? Therefore, without careful observation of complexion, palpation of pulses, and thorough examination of Qi transformations in each meridian, accurate treatment is impossible. One must also consider that left/right, Lung/Liver, Qi/Blood, and Yin/Yang distinctions require detailed clinical scrutiny and cannot be rigidly applied.

Abdominal pain is divided into three regions: pain in the upper abdomen belongs to the Taiyin Spleen; pain around the umbilicus belongs to the Shaoyin Kidney; and pain in the lower abdomen belongs to the Jueyin Liver, as well as the Chong and Ren meridians, Large Intestine, and Small Intestine. Each region involves variations of the Five Zang, emotional disturbances, Six Exogenous Factors, and Five Movements evils, making the presentation complex. By distinguishing Qi and Blood, Deficiency and Excess, Internal Injury, and External Contraction, appropriate regulation can effectively address the condition.

Heart pain with Fluid Retention presents with nausea, vexation, frequent vomiting of yellow fluid, and audible splashing sounds upon shaking; treat with Dawei Wan or Weiling Tang. Food Stagnation presents with fullness, belching with a rotten egg odor, worsening after eating; treat with Xiangsha Zhizhu Wan plus Shenqu and Ezhu. Fire Pain presents with fluctuating intensity, thirst, and constipation; treat with Qingzhong Tang. External Cold combined with internal consumption of cold foods requires Caodoukou Wan. Deficiency-Cold requires Guipi Tang plus Shengjiang, Rougui, and Changpu. Qi Stagnation presenting with stabbing pain requires Chenxiang Jiangqi San. Blood Stasis presents with a choppy pulse and hiccups after drinking; treat with Shounian San, or Taoren Chengqi Tang for severe cases. Heart pain with vexation, fever, and palpitations indicates Deficiency injury; treat with Miaoxiang San. Parasite pain presents with white spots on the face, red lips, appetite, pain immediately after eating or after pain subsides, or salivation; treat with Jianhong Wan. Ascaris moving causes nausea and vomiting; treat with Wumei Wan or Wuyang San. Gui Zhu (Infectious wasting disease) causing confusion and delirium is treated with Suhexiang Wan. Heat Jue Heart Pain is treated with Jinlingzi San. Cold Jue Heart Pain is treated with Shufu Tang. Epigastric pain resembles heart pain; if accompanied by food stagnation and tenderness/fullness on pressure, use Da Chaihu Tang. For Deficiency-Cold, use Lizhong Tang.

Chest pain due to Liver Deficiency, radiating to the back and hypochondrium, is treated with Bugan Tang. Liver Excess causing inability to turn and sighing is treated with Chaihu Shugan San. Phlegm accumulation requires Erchen Tang plus Jiangzhi. Abdominal pain is primarily treated with Shaoyao Gancao Tang. Based on the theory that "Sweet corresponds to Ji (Earth/Spleen)" and "Acid corresponds to Jia (Wood/Liver)," Jia and Ji transform into Earth, a profound method of Zhang Zhongjing. A slow pulse indicating Water injury adds Guizhi and Shengjiang; a surging pulse indicating Metal injury adds Huangqin and Dazao; a choppy pulse indicating Blood injury adds Danggui; a wiry pulse indicating Qi injury adds Shaoyao; a slow pulse indicating Fire injury adds Ganjiang. Continuous pain without fluctuation, relieved by heat and warm drinks, with a slow pulse, indicates Cold; treat with Xiangsha, Zhizhu, or Lizhong Tang. Cold pain unresponsive to warming herbs with constipation requires mild purgation with Huoxiang Zhengqi San plus Guigui, Muxiang, and Dahuang. Intermittent pain, unrelieved by heat, with a large and rapid pulse, indicates Heat; treat with Dajinhua Wan or Huanglian Jiedu Tang. Summerheat pain requires Shiwei Xiangru Yin. Dampness pain with difficult urination, loose stools, and a fine-slow pulse requires Weiling Tang. Phlegm pain with dizziness, cold saliva, white discharge, difficult urination, or temporary relief from spicy hot drinks, with a slippery pulse, is treated with Erchen Tang plus Zhike and Jiangzhi for mild cases, or Mengshi Guntan Wan for severe cases. Severe food stagnation pain relieved by defecation, with wiry or deep-slippery pulses, requires Pingwei San plus Zhishi, Shanzha, Maiya, Sharen, and Muxiang, adding Dahuang for severe cases. Wine accumulation pain requires Gegua Jieying Tang plus Sanleng, Ezhu, and Yichen. Qi Stagnation with abdominal distension and deep pulse requires Muxiang Shunfeng San. Blood Stasis pain with fixed location and choppy or hollow pulse is treated with Siwu Tang decoction plus Dahuang honey pills for Deficiency, or Guibei, Taoren, Tongbian, wine, leek juice, Taoren Chengqi Tang, Mudanpi, Xiangfu, Chuanshanjia, Jiangxiang, Honghua, Sumu, and Yuanhu for Excess. Parasite pain with cardiac/abdominal discomfort, wandering pain, intervals of relief, rising masses, abdominal heat, thirst, changing facial colors, and vomiting green water indicates parasites; treat with Wumei Wan swallowed in Pepper Decoction.

Contemporary treatments often assume all pain is Excess and admits no tonification, or adhere strictly to "pain implies blockage, blockage implies pain" and "pain decreases with purgation." However, these apply only to Excess patterns with solid bodies and constipation. Weak bodies with weak pulses, poor appetite, and diarrhea require different approaches. Distension and blockage indicate Excess; lack thereof suggests Deficiency. Rejection of pressure indicates Excess; acceptance suggests Deficiency. Preference for cold suggests Excess; preference for heat suggests Deficiency. Worsening after eating suggests Excess; worsening on an empty stomach suggests Deficiency. Full pulse and coarse breathing suggest Excess; deficient pulse and weak breath suggest Deficiency. Acute onset in youth suggests Excess; chronic duration in old age suggests Deficiency. Failure of tonification suggests Excess; aggravation by purgation suggests Deficiency. Pain in meridians shows wiry-large pulses; pain in Zang organs shows deep-micro pulses. Only through thorough Four Diagnostic methods can Deficiency and Excess be clearly distinguished. Exterior Deficiency pain requires warming the meridians; Interior Deficiency pain requires nourishing the Ying (Nutritive) level. Upper Deficiency pain requires tonifying the Middle (Spleen); Lower Deficiency pain requires warming and tonifying the Mingmen (Gate of Vitality). Adhering to "pain admits no tonification" is lethal.

Hypochondriac pain on the left often indicates Blood Stasis, treated with Dai Dang Tang. Right-sided pain often indicates Phlegm-Qi stagnation, treated with Erchen Tang for phlegm and Tuiqi San for Qi. Left-sided Liver evil is treated with Zhixiong San; right-sided Liver transferring evil to Lung is treated with Tuiqi San. Cold complication requires Lizhong Tang plus Zhike. Blood Stasis with lighter symptoms by day, heavier by night, or afternoon fever, and choppy/hollow pulse, requires Taoren Chengqi Tang plus Zhike and Biejia. Phlegm-Fluid requires Daotan Tang plus Baijiezi. Food stagnation with a sensation of a raised cord requires Zhizhu Wan plus Wuzhuyu, Huanglian, Shenqu, and Shanzha. Liver Fire Excess requires Longhui Wan. Deficiency-Cold requires Lizhong Tang delivering Heixi Dan. Soft Liver pulse requires Bugan Tang. Shock-induced hypochondriac pain requires Guizhi San.

For Liver Fire Excess hypochondriac pain, use Zuojin Wan. For Liver Fire with Qi Depression (deep-choppy pulse), treat the depression. Pain with inability to stretch is best treated with Longhui Wan. Right hypochondriac pain uses Yan's Tuiqi San. Left hypochondriac pain uses Cangzhu, Chuanxiong, Qingpi, Danggui, and Chaihu; severe cases use Danggui Longhui Wan delivered with Jiangzhi. Although hypochondriac pain belongs to the Liver, bitter vomiting and alternating chills/fever indicate Gallbladder Fire, treated with Huanglian stir-fried with Pig Gallbladder juice added to Xiaochaihu Tang. Insomnia and indecision damaging Gallbladder Qi cause pain, treated with Danggui, Shaoyao, Renshen, Maidong, Fushen, and Suanzaoren; add Xuanshen if Fire is present, constituting Deficient Gallbladder hypochondriac pain.

Fang Yuezhi stated that hypochondriac pain is mostly due to ascending Liver Fire obstructing free flow. Severe left-sided pain indicates strong Liver Fire and Wood Excess, treated with Longhui Wan or Zuojin Wan (acrid-cool agents). Mild right-sided pain indicates Phlegm-Zhu, treated with Yanjian San or Shunqi Wan (acrid-warm agents). He noted that left hypochondriac and epigastric pain are common in women due to suppressed anger and worry, leading to Qi rushing upward and being blocked by Phlegm and Blood Stasis. Treatment for women's pain must prioritize moving Qi and resolving depression, supplemented by breaking blood and dispersing fire. As the proverb says: Xiangfu and Suosha are treasures for women.

Zhang Jingyue argued against the notion that left side lacks Qi and right side lacks Blood, stating that Food Stagnation and Phlegm-Fluid certainly affect the left. He proposed distinguishing between Formless (Qi) and Formed (Blood/Phlegm/Food) pathologies. Blood stasis is formed, fixed, hard, and rejects pressure; Qi pain is migratory and fleeting. Since all formed pathologies stem from Qi stagnation, treating Qi is primary, followed by specific remedies.

Internal injury and deficiency, particularly Kidney Deficiency from sexual exhaustion, often cause dull chest-hypochondriac pain due to Essence deficiency failing to generate Qi, and Qi deficiency failing to generate Blood. Qi and Blood are like a spring; abundant means flow, scarce means stagnation. Tonifying Qi and Blood is essential; merely moving stagnation is erroneous.

Wang Jiezhai stated that for new heart-abdominal pain, inquire about diet and external contraction, and use harmonizing and digesting herbs. For chronic cases with prior excessive use of acrid-warm-dry herbs, leading to vomiting, fullness, dry mouth/tongue, and difficult urination/defecation, there is internal Depressed Heat. Use herbs to resolve depression, move Qi, descend Fire, and moisten dryness, such as Chuanxiong, Xiangfu, Shanzhi, Huanglian, and Jiangzhi; add Mangxiao for severe cases. For chronic pain, combine acrid-warm dispersants with bitter-cold/salty-cold herbs to treat the branch with warmth and the root with cold.

All accumulations and pains prefer warmth and dislike cold. Prolonged use of heat herbs can lead to Deepened Depression and Fire. When Fire is extreme, it mimics Water (Cold signs). However, this damages True Qi and dries Yin Blood. Laypeople mistake this for Deep Cold and continue heating, worsening the condition. The solution is Congruent Treatment (Congzhi): using heat with cold administration, or cold with heat administration, addressing the root cause.

Zhu Danxi stated that chest/diaphragm pain must be distinguished by duration. Chronic pain becomes Depression, generating Heat. Gardenia (Zhizi) is used as a guide. Fried Zhizi (15 seeds) decocted strongly with Ginger Juice and Chuanxiong is effective. For Stomach Heat pain, Zhizi alone is insufficient; combine with Jiangzhi and Taixiong. For Phlegm attacks, Erchen Tang plus Chuanxiong, Cangzhu, and extra fried Zhizi. For severe pain, add Ganjiang (contrary treatment). If Zhizi and astringents fail, use Yuanmingfen for immediate relief.

Abdominal pain categories include Cold, Heat, Blood Stasis, Food Stagnation, and Damp-Phlegm. Wiry pulse indicates Food; Slippery pulse indicates Phlegm. Damp-Phlegm abdominal pain is treated with Taixiong, Cangzhu, Xiangfu, and Baizhi powder taken with Ginger Juice. General principle: Qi disorders use Qi-moving herbs (Muxiang, Binglang, Xiangfu, Moyao); Blood disorders use Blood-invigorating herbs (Danggui, Chuanxiong, Taoren, Honghua). Early stage with intact Yuan Qi requires purgation (Tong Yin Yong Tong method). Robust patients follow suit.

Weak, elderly, or chronic patients require lifting and resolving. Heart-abdominal pain generally requires warm dispersants due to Qi stagnation. Upper pain (often Food) uses fried Ganjiang, Cangzhu, Chuanxiong, Baizhi, Xiangfu, Jiangzhi; avoid harsh purgatives. Add Qi-moving herbs. Cold pain is continuous without fluctuation. Intermittent pain is Heat. Fixed pain is Blood Stasis. Relief after bowel movement is Damp-Phlegm. Dongyuan stated: Cold pain uses Jiang/Gui, add Dingxiang if vomiting; Summerheat pain uses Yulong Wan. Obese patients' abdominal pain (Qi + Damp-Phlegm) uses Renshen, Cangzhu, Baizhu, Banxia. Phlegm causes pain via Qi depression leading to Phlegm condensation blocking Qi flow. Weak constitution with dietary injury uses Yangwei Tang plus Guizhi, Wuzhuyu, and Muxiang; Lizhong Tang or Jianzhong Tang with Wuzhuyu are also suitable. Jiaochangsha (intestinal cramping) requires emesis with Camphor wood decoction, Alum water, or Salt water, or bleeding at Weizhong point.

Yu Jiayan stated that mismanagement of the Five Zang causes heart pain. Kidney Heart Pain (Yin evil ascending, fear) resembles touch from behind. Stomach Heart Pain (stagnation) causes chest/abdominal fullness. Spleen Heart Pain (Cold reversing in Middle Jiao) is severe. Liver Heart Pain (Wood-Fire depression, Blood level) causes pale/dead-like complexion. Lung Heart Pain (Upper Jiao turbidity, Qi level) worsens with movement. Treat Qi by smoothing, Blood by moving, Depression by opening, Stagnation by expelling. Fire Excess uses dispersing/clearing; Deficiency uses warming/tonifying. Only True Heart Pain is untreatable; otherwise, addressing the root ensures success.

Zhang Jingyue stated that Deficiency/Excess is usually pulse-differentiable, but heart-abdominal pain pulses are difficult. Sliding-strong pulses indicate Excess; weak-lifeless pulses indicate Deficiency. However, acute severe illness may show deep-hidden-fine-choppy pulses mimicking Deficiency, actually caused by Qi rebellion blocking the pulse vessel (Excess). Careful palpation reveals string-tight tension, indicating Cold blocking Yang. Fire pain differs. Differentiate by observing constitution (strong/weak) and history (acute/chronic). Acute severe pain with sudden fine-hidden pulse suggests Excess; chronic mild pain with inherently weak pulse suggests Deficiency. Reasoned analysis prevents error.

If heart-abdominal pain recurs after purgation, worsening with repeated treatment and showing floating-wiry-deficient-large pulse, it indicates Middle Deficiency. Adjust based on Deficiency/Excess, tonifying Qi or treating pathogens. Strengthening Spleen/Stomach heals pain.

Pain in muscles/bones/skin must not be confused with Interior Zang-Fu disease. Differentiate Fire, Cold, Qi, Blood Stasis, Blood Deficiency, or Toxic Sores lingering in meridians.

Medical Case: I treated a student, nearly 30, who ate dough sticks. By evening, food accumulated in the lower abdomen/right corner, forming a hard mass like a fist, causing severe pain. Suspecting food stagnation in the Large Intestine, I administered Muxiang Binglang Wan, causing multiple bowel movements, but pain persisted. I then used Shenyuan Wan for purgation, ineffective. Suspecting cold nature of previous herbs, I used Beiji Wan, causing severe diarrhea, yet pain remained. I deduced that面食 (wheat/gluten) toxicity requires Garlic, and Qi stagnation requires Muxiang. Given the deep location, I prepared Muxiang ground in fiery wine, had him chew raw garlic, and administer the mixture. After one dose, pain decreased; after three to four doses, pain ceased, appetite returned, and he recovered. The abdominal mass took six months to fully resolve. This demonstrates that for food stagnation, even Dahuang or Badou may be insufficient; moving Qi is paramount. It also confirms the pathway of digestion exits via the lower right abdomen into the rectum, a previously undocumented anatomical insight.