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The Heart is the Official of the Sovereign, and the entire body obeys its command. Therefore, if any of the Five Zang Organs fails to be regulated properly, it can all result in Heart Pain (Xintong). The classics clearly explain that acupuncture treatment should be differentiated by meridians.

Regarding the use of golden needles (acupuncture) and herbal medicine, one must examine the condition in great detail. Kidney Heart Pain is mostly caused by the upward rushing of Yin pathogens, so patients tend to bend forward. If pressure is applied to the heart area from behind, the pain intensifies. Stomach Heart Pain is mostly caused by stagnation, resulting in chest and abdominal distension and fullness. Spleen Heart Pain is mostly due to Cold pathogenic factors counterflowing into the Middle Jiao, making the condition severe. Liver Heart Pain is mostly due to the depression of Wood and Fire, affecting the Blood level, causing the complexion to appear pale blue-green as if dead. Lung Heart Pain is mostly due to turbidity in the Upper Jiao, affecting the Qi level, so movement exacerbates the pain. If the pathology is in Qi, one should regulate it; if in Blood, one should invigorate it; if depressed, one should disperse it; if stagnant, one should unblock it. If Heat is excess, one should clear and dissipate it; if Cold is deficiency, one should warm and tonify it. In this way, efficacy will be achieved readily. For Heart Pain involving various meridians, where the heart and back pull against each other, with heart pain radiating to the back and back pain radiating to the heart, one should urgently warm the meridians. For Heart Pain involving various Fu Organs, characterized by difficulty in bending and stretching, upward rushing of Qi from the lower abdomen, sudden loss of consciousness, vomiting, and diarrhea, with a sharp and acute progression, one should urgently warm the Fu Organs. When Zang pathogens invade the Heart, it is called True Heart Pain (Zhenxintong). If hands and feet turn cyan up to the joints and the condition is incurable, one should urgently warm the Pericardium (Xinbao) and guide the pathogen out through other meridians. However, when Heart Pain is severe, the pulse will inevitably become deep and hidden (Fu), because the Heart governs the vessels and cannot withstand the severe pain, causing the pulse to hide naturally. One must not mistake this hidden pulse and confused spirit for Heart Deficiency, nor use Rehmanniae Radix (Dihuang) and Atractylodis Macrocephalae Rhizoma (Baizhu) to tonify. Generally, pathogens are dispersed by warming herbs but not by cold and cloying herbs; thus, caution is essential. Only after warming and dispersing can one proceed with balanced Yin-Yang tonification.

Later generations have stated regarding the treatment of pain: "Pain has no tonification method"; "Unblocked means no pain, blocked means pain"; "Pain decreases with purgation." People recite these as immutable laws. For all pain syndromes, they rigidly apply these methods, unaware that pain accompanied by obstruction can indeed be treated with unblocking/purgation, as stated in the classics: "Heat binding the Small Intestine, leading to obstruction and blockage." However, pain accompanied by diarrhea should not be treated with purgation, as stated in the classics: "Cold invading the Small Intestine, leading to post-diarrhea and abdominal pain." Wang Jinggong's explanation of the characters "Tong" (pain) and "Li" (benefit/purgation) is most exquisite. He said: "This is the method for treating Excess," and added: "All pains are due to Cold, and pain decreases with Li." Later generations interpreted "Li" as "Xià" (purgation/lowering). Suppose pain is in the Exterior, it is Excess; pain in the Interior, it is Excess; pain in Blood and Qi, it is also Excess. Therefore, pain in the Exterior is cured by sweating; pain in the Interior is cured by purging; pain in Qi and Blood is cured by dispersing and regulating. How can "Li" simply mean purgation? It should be interpreted as "Tong" (unblocking/penetrating). This view is excellent and grasps the method for treating Excess. However, pain syndromes also have Deficiency and Excess distinctions, and treatments involve both Tonification and Purging. The method of differentiation must be detailed. Pain with distension and closure is mostly Excess; without distension or closure, mostly Deficiency. Pain that rejects pressure is Excess; pain that accepts pressure is Deficiency. Preference for cold indicates Excess; preference for heat indicates Deficiency. Worsening after eating suggests Excess; worsening on an empty stomach suggests Deficiency. A solid pulse and coarse breath suggest Excess; a deficient pulse and weak breath suggest Deficiency. Recent illness in young adults suggests Excess; worsening with aggressive treatment suggests Deficiency. Pain in the meridians often presents with a wiry and large pulse; pain in the Zang organs often presents with a deep and faint pulse. By comprehensively observing pulse and symptoms, Deficiency and Excess will become clear. Can Excess patterns be treated with purgation, while Deficiency patterns also use purgation? If purgation is used inappropriately, the harm is profound. For pain due to Exterior Deficiency, Yang is insufficient, and warming the meridians is indispensable. For pain due to Interior Deficiency, Yin is insufficient, and nourishing Ying (Nutritive Qi) is indispensable. For pain due to Upper Deficiency, the Heart and Spleen are severely damaged, and tonifying the Middle Jiao is indispensable. For pain due to Lower Deficiency, there is collapse, leakage, and loss of Yang, requiring urgent rescue of the Spleen and Kidney and warming the Mingmen (Gate of Vitality). There are many cases of treating pain with warming and tonification. Why do physicians rigidly adhere to the saying "Pain cannot be treated with Qi tonification"? Is this truly a good method?