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The Heart is the official of the Sovereign. If pain occurs accompanied by cyanosis of the hands and feet extending to the joints, it is incurable. What the common people call "Heart Pain" is actually pain of the Pericardium Collaterals (Xin Bao Luo) or epigastric pain. Ancients divided it into nine types, which should be differentiated and treated accordingly.

The first is Qi Pain. The pulse is deep and choppy, caused by stagnation of Qi due to the Seven Emotions. It is suitable to use Qi Qi Tang (Seven Qi Decoction). [See p. 54, slightly warm.] Bai He Tang (Lily Bulb Decoction). [See p. 90, slightly cool.]

The second is Blood Pain. The pulse is choppy on both superficial and deep palpation. The disease feels like stabbing, cannot be pressed or touched, or there is alternating chills and fever, and black stool. It is suitable to use Shi Xiao San (Laughing Off Powder). [See p. 58] San Yi Cheng Qi Tang (Three-One Purging Decoction). [See p. 54, although this formula is potent, it must be used for pain with constipation and abdominal refusal to pressure. For example, Gui Zhi (Cinnamon Twig) and Tao Ren (Peach Seed) each 3 qian.]

The third is Phlegm Pain, also known as Fluid Pain. The pulse is slippery, accompanied by cough, pain radiating to the hypochondrium, or wandering without a fixed location. It is suitable to use Shi Zao Tang (Ten Jujube Decoction) from *Shang Han Lun*. However, modern physicians lack the courage and discernment to use it. It is suitable to use Er Chen Tang (Two-Aged Decoction). [See p. 82 ○ Add Bai Jie Zi (White Mustard Seed) 1.5 qian, Sao Jiao (Tamarisk Fruit) fried until purple 0.5 fen, Gua Lou (Trichosanthes Root) 3 qian.] Gun Tan Wan (Rolling Phlegm Pill). [See p. 63 ○ If other medicines are ineffective and there is constipation, it can be used temporarily.]

The fourth is Fire Pain. The pulse is rapid and full. There is thirst, red face, body heat, and constipation. The pain may come and go. It is suitable to use Jin Ling Zi San (Melia Toosendan Powder). [See p. 92] Dan Shen Tang (Salvia Miltiorrhiza Decoction). [See p. 92] Bai He Tang (Lily Bulb Decoction). [See p. 93]
Alternatively, use Zhi Zi (Gardenia Fruit) roasted 4 qian, Liang Jiang (Galangal Rhizome) 2 qian, ground into powder, named Yue Tao San (Osmanthus Powder), taken with warm wine.
Jia Wei Xiao Yao San (Modified Free and Easy Wanderer Powder) to send down Zuo Jin Wan (Left Metal Pill) 2 qian.

The fifth is Cold Pain. The pulse is slow and thready/fine. Hands and feet are cold. The pain is continuous and unceasing. It is suitable to use Fu Zi Li Zhong Tang (Aconite Spleen-Regulating Decoction), added with Dang Gui (Angelica Sinensis), Rou Gui (Cinnamon Bark), Mu Tong (Akebia Stem), Wu Yu Zi (Evodia Fruit).

The sixth is Deficiency Pain, also known as Palpitation Pain. The pulse is deficient, small and fine, or short and choppy. There is palpitations in the epigastrium, preference for pressure, slight improvement after eating, and clear urination and defecation. It is suitable to use Gui Pi Tang (Spleen-Restoring Decoction), added with Shi Chang Pu (Acorus Rhizome) 1 qian. [See p. 21] Dang Gui Bu Xue Tang (Angelica Tonifying Blood Decoction), added with Rou Gui (Cinnamon Bark) 1.5 qian. [See p. 6]

The seventh is Zhu Pain (Infection/Posession Pain). Caused by entering mountains, forests, ancient temples, tombs, or being affected by all kinds of abnormal qi, leading to pain and confused speech. The pulse fluctuates between large and small; the pulses in both hands seem to come from two different people. It is suitable to use Ping Wei San (Stomach-Pacifying Powder), added with Huo Xiang (Patchouli Herb) 2 qian, Mu Xiang (Costus Root) 1 qian, mixed with She Xiang (Musk) 7 li for oral administration. Fragrance is the righteous qi of heaven and earth; righteousness can overcome evil.

The eighth is Worm Pain. The pulse is like that of a healthy person. The pain comes suddenly and stops suddenly, worsening upon smelling rich and sweet foods. (When smelling food, the worms raise their heads.) Massage provides slight relief.
(Fu Zi Li Zhong Tang, remove Gan Cao (Licorice Root), add Wu Mei (Mume Fruit) 3 pieces, Chuan Jiao (Sichuan Pepper) and Huang Lian (Coptis Rhizome) each 1.5 qian, Huang Bo (Phellodendron Bark), Rou Gui (Cinnamon Bark), Dang Gui (Angelica Sinensis) each 1 qian, decoct in water and take. After cure, it is suitable to take Wu Mei Wan (Mume Pill). [See p. 107])

The ninth is Food Pain. The pulse is full and slippery. There is belching with rotten smell, acid regurgitation, aversion to food, and abdominal distension. The pain sometimes feels like a tendon is pulling up. It is suitable to use Ping Wei San (Stomach-Pacifying Powder), added with Mai Ya (Barley Sprout), Gu Ya (Rice Sprout), Shan Zha (Hawthorn Fruit), Ban Xia (Pinellia Tuber) each 2 qian. If distension is severe, add Lai Fu Zi (Radish Seed) raw-ground 3 qian, decoct in water and take. If it is an initial illness... [Text fragment]. Note: The above nine pains have been passed down for a long time and must not be ignored. Gao Shizong, in *Yi Xue Zhen Chuan* (True Transmission of Medical Science), separated medication by body parts, a method that is very swift. Now revised and excerpted below.

First, pain in the region of the Heart. Commonly called Heart Pain, but incorrect. This is because the collaterals of the Pericardium cannot reach the meridians laterally. It is suitable to use Xiang Su Yin (Perilla Infusion), added with Dang Gui (Angelica Sinensis) 4 qian, Yuan Hu Suo (Corydalis Rhizome) and Mu Tong (Akebia Stem) each 1 qian, Gui Zhi (Cinnamon Twig) 2 qian, decoct in half water and half wine. Zi Su (Perilla Leaf) must use the small side stems whole, not chopped, to better unblock collaterals. [See p. 53]

Second, above the Heart meridian is the Chest and Diaphragm. Chest and Diaphragm pain is due to dysfunction of the Upper Jiao, failing to irrigate like mist, leading to Chest Bi (Obstruction) and pain. It is suitable to use half dose of Bai He Tang (Lily Bulb Decoction), added with Gua Lou Pi (Trichosanthes Peel) and Bei Mu (Fritillaria Bulb) each 3 qian, Xie Bai (Macrostemon Bulb) 8 qian, Bai Kou (Cardamom Fruit) 1.5 qian, decoct in water and take. [See p. 93]

Third, below the chest and diaphragm, between the two breasts, is called Ying Xiong (Anterior Chest). Ying Xiong pain is due to deficiency of Liver Blood, where Qi fails to fill the Qimen point, causing blood from the Chong and Ren vessels to scatter through the anterior chest, resulting in pain. It is suitable to use half dose of Dan Shen Yin (Salvia Infusion), added with Dang Gui (Angelica Sinensis) 5 qian, Bai Shao (White Peony Root), Jin Yin Hua (Honeysuckle Flower) each 3 qian, Hong Hua (Carthamus Flower), Chuan Xu Duan (Dipsacus Root) each 1 qian, decoct in half water and half wine. [See p. 92]

Fourth, below the anterior chest is Zhong Wan (Middle Epigastrium). Pain at Zhong Wan, intolerant to touch, indicates disharmony of interior and exterior. Externally, cold qi condenses in the skin and hair; internally, turbid filth stagnates in the Zhong Wan. Treatment should assess the constitution's deficiency or excess. It is best to apply moxibustion with lamp wick on the painful spot more than ten times, so that cold condensation is removed and interior-exterior communication is restored, stopping the pain. If pain persists after moxibustion, excess patterns suit Wu Ji San (Five Accumulations Powder), and deficiency patterns suit Jia Wei Xiang Su Yin (Modified Perilla Infusion).
Wu Ji San (Five Accumulations Powder). [See p. 42]
Xiang Su Yin added with Gui Zhi (Cinnamon Twig), Shao Yao (Peony Root), Dang Gui (Angelica Sinensis) each 3 qian, Xi Xin (Asarum Root), Mu Tong (Akebia Stem) each 1.5 qian, Wu Zhu Yu (Evodia Fruit) 2 qian, decoct in water and take. In the formula, Zi Su (Perilla Leaf), Sheng Jiang (Fresh Ginger), Xi Xin (Asarum Root), Gui Zhi (Cinnamon Twig) drive out external condensed cold; Wu Zhu Yu (Evodia Fruit), Chen Pi (Citrus Peel), Mu Tong (Akebia Stem) descend internal turbid filth; Dang Gui (Angelica Sinensis), Shao Yao (Peony Root), Xiang Fu (Cyperus Rhizome), Gan Cao (Licorice Root) harmonize Qi and Blood.

Fifth, below Zhong Wan is the area of Yangming Stomach Earth. (In the Copper Man diagram, one cun below Zhong Wan is Jian Li point). Pain that comes and goes indicates deficiency of Middle Earth and disharmony of Stomach Qi. If too many blood-moving and purgative medicines are taken, warming and tonifying become appropriate. Pressing heavily with hand relieves pain slightly, which is clear evidence of internal deficiency and cold of Middle Earth. It is suitable to use Xiang Sha Liu Jun Zi Tang (Atractylodes and Amomum Six Gentlemen Decoction), added with Gan Jiang (Dried Ginger) 2-3 qian. [See p. 3] Fu Zi Li Zhong Tang (Aconite Spleen-Regulating Decoction). [See p. 107]

Sixth, pain at the ends of the ribs below the breasts indicates disharmony of upper and lower Yin and Yang, and unfavorable pivot function of Shaoyang. This symptom often appears in Shang Han diseases. One should assist the pivot function, harmonize Qi and Blood, and ensure smooth regulation of upper and lower, then recovery occurs. It is suitable to use Xiao Yao San (Free and Easy Wanderer Powder), doubling Chai Hu (Bupleurum Root), adding Sheng Jiang (Fresh Ginger) 1.5 qian. [See p. 48]

Seventh, great abdominal pain belongs to the Taiyin Spleen Earth region. Pain inside and slow indicates Middle Earth deficiency and cold. (Suit Li Zhong Tang, double Ren Shen (Ginseng Root).) Pain involving interior and exterior and urgent indicates obstruction of Spleen collaterals. (Suit Li Zhong Tang, double Gan Jiang (Dried Ginger).) The great collateral of the Spleen is named Da Bao. It emerges from the meridians to the collaterals externally. Now, if Spleen collaterals are stagnant and do not flow, both interior and exterior hurt. (Li Zhong Tang double Gan Jiang (Dried Ginger); if ineffective, add Rou Gui (Cinnamon Bark) 1.5 qian, Mu Tong (Akebia Stem) 1 qian.) *Shang Han Lun · Taiyang Chapter* says: In Shang Han, if Yang pulse is choppy and Yin pulse is string-taut, the law dictates acute abdominal pain. First give Xiao Jian Zhong Tang (Minor Construct the Middle Decoction); if not cured, give Xiao Chai Hu Tang (Minor Bupleurum Decoction). This is first tonifying internally, then pivoting externally.

Eighth, pain around the left and right of the umbilicus is a disease of the Chong Mai (Penetrating Vessel). The Chong Mai runs alongside the umbilicus. If congealed by cold qi, blood of the Chong Mai cannot ascend and reach outward, causing pain around the umbilicus. Medicines of the Blood aspect should be used to make blood of the Uterus/Bao Zhong reach the muscle surface. Using Qi medicines is of no benefit. It is suitable to use Dang Gui Si Ni Tang (Angelica Four Reversal Decoction), added with Sheng Jiang (Fresh Ginger), Wu Zhu Yu Tang (Evodia Infusion), decoct in half water and half wine. Or use Si Wu Tang (Four Substances Decoction). [See p. 9] Remove Di Huang (Rehmannia Root), add Rou Gui (Cinnamon Bark) 1 qian, Sheng Huang Qi (Astragalus Root), Sheng Jiang (Fresh Ginger) each 3 qian, Zhi Gan Cao (Honey-fried Licorice Root), Hong Hua (Carthamus Flower) each 1 qian, decoct in water and wine.

Ninth, pain in the umbilicus unbearable, preferring pressure, indicates Kidney Qi deficiency and cold. It is suitable to use Tong Mai Si Ni Tang (Unblocking Pulse Four Reversal Decoction), added with Bai Shao (White Peony Root) 3 qian. If the pulse is deep and full, mouth hot and thirsty, abdomen... [Text fragment implies excess heat pattern] San Yi Cheng Qi Tang (Three-One Purging Decoction). [See p. 54]

Tenth, pain below the umbilicus indicates that the Shaoyin Water Organ (Kidney) and Taiyang Water Bowel (Bladder) fail to receive Yang heat qi to perform functions, leading to Yin-cold condensation and pain. Shaoyin Water Organ deficiency-cold uses Zhen Wu Tang (True Warrior Decoction) to warm. Taiyang Water Bowel deficiency-cold uses Gui Zhi Tang (Cinnamon Twig Decoction), added with Shu Fu Zi (Prepared Aconite), Fu Ling (Poria) to warm. ○ According to Shicai's *Bi Du*, pain above the umbilicus belongs to Spleen; pain below the umbilicus belongs to Liver; pain at the umbilicus belongs to Kidney. This is speculative theory and should not be followed. Also, pain below the umbilicus can be caused by fire forcing the Bladder, with difficult urination and pain; suitable Wu Ling San (Five-Ingredient Powder with Poria). There are also cases of Yin deficiency with Yang failing to transform, with no urine output and distending pain; suitable Tong Guan Wan (Passing Through Pill). Cases with dry stool, differentiation methods and formulas, see previous item.
Tong Guan Wan (Passing Through Pill). [See p. 51]

Eleventh, the sides of the lower abdomen are called Shao Fu (Lesser Abdomen). Shao Fu pain belongs to the Jueyin Liver region, and is also the Sea of Blood of the Bao Zhong (Uterus/Womb). The water of the Bao Zhong is governed by Shaoyin; the blood of the Bao Zhong is governed by Jueyin. Pain occurs because Jueyin Liver Qi does not combine with the blood of the Bao Zhong to ascend. If the Liver is not deficient, one should unblock and guide it upward. (Suit Xiang Su Yin, add Chai Hu (Bupleurum Root) 3 qian, Dang Gui (Angelica Sinensis), Bai Shao (White Peony Root) each 2 qian, Sheng Ju Ye (Fresh Tangerine Leaf) 3 slices.) If the Liver is deficient, one should tonify and assist its descent. (Suit Wu Mei Wan (Mume Pill), sent down with rice soup 2 qian, three times a day.) Jueyin does not follow the standard or root, but follows the intermediate appearance of Shaoyang Qi. Making Jueyin connect upward with Shaoyang stops the pain. Pain in the lateral costal margin indicates Liver Qi deficiency. (Dang Gui Si Ni Tang, add E Jiao (Donkey-hide Gelatin); Si Jun Zi Tang (Four Gentlemen Decoction), remove Bai Zhu (Atractylodes Macrocephala Rhizome), add Dang Gui (Angelica Sinensis), Jing Mi (Rice Grain) with Wu Mei Wan (Mume Pill), five doses.) Pain above the two hypochondria indicates disharmony of Shaoyang Qi. (Suit Xiao Chai Hu Tang (Minor Bupleurum Decoction), remove Da Zao (Jujube Fruit), add Mu Li (Oyster Shell), Qing Pi (Citrus Aurantium Peel)). Contemporary doctors often use Zuo Jin Wan (Left Metal Pill). I note: For all heart and abdominal pains, one should differentiate whether there is internal distension or not, whether stool is closed or not, whether the pulse is forceful or weak, whether the mouth is hot or neutral, and the duration of pain, to differentiate Cold, Heat, Pathogen, Righteousness, Deficiency, and Excess. If pain with distension and closure, use Hou Po San Wu Tang (Magnolia Bark Three Substance Decoction) to purge the interior; if accompanied by fever, use Hou Po Qi Wu Tang (Magnolia Bark Seven Substance Decoction) to treat both exterior and interior. Abdominal pain radiating to hypochondria, string-taut pulse, severe aversion to cold, and constipation, Da Huang Fu Zi Tang (Rhubarb and Aconite Decoction) governs. If only distended but stool not closed, this is Excess within Deficiency, suitable Hou Po Ban Xia Ren Shen Sheng Jiang Gan Cao Tang (Magnolia Bark, Pinellia, Ginseng, Ginger, Licorice Decoction). Severe abdominal pain intolerant to touch with vomiting, Da Jian Zhong Tang (Major Construct the Middle Decoction) governs. Thunderous rumbling and cutting pain with vomiting, Fu Zi Bing Mi Tang (Aconite and Rice Decoction) governs. Abdominal pain with diarrhea and cold limbs, Tong Mai Si Ni Tang (Unblocking Pulse Four Reversal Decoction) governs. Abdominal pain with vomiting and diarrhea, Li Zhong Tang (Spleen-Regulating Decoction) governs. If periumbilical pain, named Han Shan (Cold Hernia) abdominal disease pain, Dang Gui Sheng Yang Rou Tang (Angelica, Ginger, and Mutton Decoction) governs. These are all methods to revive the dying. Contemporary doctors have neglected these for a long time. I wrote *Jin Gui Qian Zhu* (Light Commentary on Golden Cabinet) sixteen volumes and *Yi Jue* (Medical Aphorisms) three volumes, with detailed differentiation. It is suitable to check against them to avoid errors.