【歌】心痛当分久与新，暴婴寒气必须温。若还稍久多成郁，郁积因而作热蒸。大实痛时难以按，按之痛
定作虚论。蛔虫痛止偏能食，脉涩须知死血因。真痛在心无药疗，厥疼胃脘正当心。
【论】夫心痛者，有真、有厥。真者，邪中心君，手足
青至节即死，非药可疗。厥者，邪客于心胞络、胃脘之间，当心之分，非真心受证，故可治也。又有寒厥、热
厥之分，大实、大虚之别。古人又有九种之名∶曰饮、曰食、曰风、曰冷、曰热、曰悸、曰虫、曰疰、曰去来
痛，若此者，皆可究其因而施治也。其如陈无择云有五脏及诸经、诸腑心痛，虽言之详，而无治例，反使后学
有惑于心，故不具载，盖亦不过寒、热、表、里、虚、实之候也。丹溪云∶心脾痛，须分新久，若明知身受寒
气，口食寒物，于初病之时，当以温散、温利之剂。若得稍久而成郁，郁则蒸热，热久必生火，若欲行温剂，
宁无助火添病乎？故古方多以山栀为热药向导，则邪易伏，病易退。又审平昔喜食热物，以致死血留于胃脘，
或因痰气、食积郁滞于胃作痛者。如此等例，皆前人之所未发，后学当导而行之，斯活法也。
谨按∶世人患真心痛者极少。真心痛者，平素原有痰，卒然大痛如割，入于无声，汗出不休，舌强无言，
手足厥冷，此疾一作，死在旦夕。针灸之所不施，药力之所未及，患之者十无一生。盖寒邪直中心经，君火不
能抗敌故也。今之患心痛者，乃胃脘与心胞络痛耳。若痛极如咬，时吐清水，面清白，少光彩者，为虫头上攻。
痛时如有物阻碍，累累不得下，为胃脘停食。痛时嘈杂不宁，如饥如饱，怏怏欲吐，吐即稍宽，为痰饮停积。
痛时隐隐闷结，胸臆相引，得嗳觉宽，为忧郁所致。痛时欲近暖处，饮热酒即解，为寒客心胞络。痛时自上而
下，自闻唧唧有声，搔抓无措，眠坐不稳，心下如刮，上连胸臆，乃积血不消，为火所载，不可认以为虫而
投以虫剂也。
【脉】心痛微急，痛甚伏入。阳微阴弦，或短又数。紧实便难，滑实痰积。心痛引背，脉微而大，寸沉
而迟，关紧
数锐。
虚痛
虚弱人心痛，钱氏云∶心虚痛者，炒盐补之。以物按住而痛止者，挟虚也，二陈汤加炮姜末和之。（方见
痰证。）若久病元气虚弱，肢体怯薄，脉虚，手欲按者，六君子汤加砂仁、香附。（方见脾胃。）
实痛
因气怒而饮食，卒痛便闭，心胸高起，手不可按者，大实痛也，煮黄丸，后以 本汤去其余邪。胃脘湿热
痛，小胃丹。（方见痰证。）
煮黄丸
治大实心痛。
雄黄（一两，研） 巴豆（五钱，去皮，细研）
入白面二两研匀，水丸梧子大，每用水下数丸，如得利，不可再服，宜服 本汤去余邪。
本汤
治心痛后服。
本（半两） 苍术（一两，米泔浸，炒）
作一帖，煎服。
热厥心痛
热厥心痛者，其人必纵酒，蓄热在胃，偶遇寒郁而发，故身热足冷，痛甚则烦躁而吐，额上有汗，脉洪大。
当灸太溪、昆仑，表里俱泻之，内服金铃子散。痛止，服枳术丸以去余邪。（方见脾胃。）初痛，以盐汤探
吐，得吐就发散。心脾痛日久，则非寒也，纵有寒，亦郁而为热，二陈汤加山栀（炒黑）、川芎、香附，痛甚
者，加炮姜反佐之，（方见痰证。）或以山栀一味，入姜汁煎服。大便不通，大承气、大陷胸之类下
之。（方俱见伤食。）
金铃子散
金铃子（一两） 玄胡索（一两）
末二钱，温酒下。
寒厥心痛
寒厥心痛者，手足厥逆，遍身冷汗，甚则手足甲青黑，小便清白不渴，气微力薄，脉沉细微，术附汤。
大寒厥，暴痛，非久痛者，若久则非寒也。丹溪云∶明知身受寒气，口食寒物，初病当以温散、温利之药，草
豆蔻丸。大便闭结不通者，元戎浓朴丸。
术附汤
治寒厥心痛。
白术（二钱，炒） 甘草（一钱，炙） 黑附子（炮，一钱半）
上三味，锉作一帖，姜三片，枣二枚，水二钟，煎温服。
草豆蔻丸
寒厥心痛。
草豆蔻（一钱五分，白面裹，煨） 益智仁（八分） 陈皮（八分） 人参（去芦，八分） 黄
（蜜炙，八分） 吴茱萸（洗，去芦，八分） 僵蚕（八分） 当归（酒洗，六分） 青皮（六分，炒）
神曲（炒，四分） 姜黄（四分） 柴胡（四分） 半夏（一钱，姜制） 泽泻（去毛，一钱） 桃仁（七
个，泡，去皮、尖） 麦芽（炒，一钱） 甘草（生三分，炙三分）
上为细末，汤浸蒸饼丸如梧桐子大，每三十丸。
元戎浓朴丸
浓朴（三两，姜炒） 黄连（二两半，炒） 吴茱萸（汤泡七次，二两） 干姜（炮，二两） 巴
豆（一两，另研） 人参（一两，去芦） 川乌（炮，一两）
末之，入豆霜匀，蜜和丸桐子大，每三丸，以利为度。
痰积食积心痛
痰饮积滞于胃脘，当心而痛，墙上陈螺蛳壳 存性、炒苍术、海石、山栀、香附、南星各二两，枳壳、青
皮、木香、半夏、砂仁各半两，糊丸，姜汤送下。食积痛，保和丸。（方见伤食。）
瘀血痛
平昔喜食热物，致死血留于胃口作痛者，脉沉而芤涩。在上者，四物汤加桃仁、红花、丹皮、枳壳、玄
胡索。（方见血证。）轻者，韭汁、桔梗开之。重者，桃仁承气汤下之。（方见血证。）
虫痛疰痛
蛔虫攻入心膈作痛者，痛定便能食。面上有白斑，唇红，治以苦楝、锡灰，或乌梅丸，或集效丸。蛔虫
攻啮，心痛恶心而吐，川椒汤下乌梅丸。疰心痛者，十疰病皆心痛，化虫丸，辣蓼草煎汤饮之。
乌梅丸
治蛔虫上攻痛。
乌梅（七十五个） 细辛（一两五钱） 附子（炮，一两五钱） 人参（一两五钱） 黄柏（一两五
钱） 桂枝（一两五钱） 干姜（二两五钱） 黄连（四两） 川椒（五钱） 当归（五钱）
末之，以苦酒渍乌梅一宿，去核蒸烂，捣成膏，少加蜜和丸如梧桐子大，每十丸，加至二十丸，食前服。
集效丸
治蛔厥心痛。
木香（二钱五分） 鹤虱（炒，二钱半） 槟榔（二钱五分） 诃子（二钱五分） 芜荑（炒，二钱
半） 附子（炮，二钱半） 干姜（炮，二钱五分） 大黄（一两半，蒸熟） 乌梅肉（一两，捣烂）
末之，蜜丸如梧桐子大，每服三十丸，空心时陈皮汤送
下。
化虫丸
服之虫化为水。
胡粉（炒，五钱） 鹤虱（三钱） 白矾（五钱） 槟榔（五钱） 苦楝根（五钱）
上为细末，糊丸梧子大，每服五十丸，温浆水入芝麻油一、二点，打匀下之，米饮亦可，不拘时候，其
虫小者化为水，大者自下。
[Verse] Heart pain should be distinguished by the duration of the disease, whether new or old. Sudden heart pain caused by cold pathogen invasion must be treated with warming methods. If the course is slightly longer, it often results in Qi stagnation; prolonged stagnation generates heat and steaming. Severe excess-type pain is difficult to tolerate pressure (refuses pressure); if it prefers pressure, it is diagnosed as deficiency. Pain caused by roundworms stops when the patient can eat; a choppy pulse indicates blood stasis (dead blood). True heart pain affects the Heart organ itself and is incurable by medicine; Jue heart pain affects the epigastrium, located just below the heart pit.
[Dissertation] Heart pain is divided into True Heart Pain and Jue Heart Pain. True Heart Pain occurs when pathogens directly invade the Heart Monarch (the Heart organ itself); symptoms include cyanosis of the hands and feet extending to the joints, leading to death, which cannot be cured by medicine. Jue Heart Pain occurs when pathogens lodge between the Pericardium Collateral and the epigastrium, at the location of the heart pit; it does not affect the Heart organ itself, so it is treatable. There are also distinctions between Cold Jue and Heat Jue, and between severe Excess and severe Deficiency. The ancients named nine types of heart pain: Drink (Yin), Food (Shi), Wind (Feng), Cold (Leng), Heat (Re), Palpitation (Ji), Worm (Chong), Zhuan (Zhu), and Migrating Pain (Qu Lai Tong). For these conditions, one can investigate the etiology and apply treatment. Chen Wuyue mentioned heart pain related to the five Zang organs, various meridians, and six Fu organs; although his description was detailed, he provided no specific treatment examples, causing confusion for later students. Therefore, they are not recorded here, as they essentially fall under the patterns of Cold, Heat, Exterior, Interior, Deficiency, and Excess. Zhu Danxi stated: For heart-spleen pain, one must distinguish between new and old diseases. If it is known that the patient suffered from cold exposure or ingested cold foods, at the onset of the disease, warming dispersing and warming promoting agents should be used. If the disease persists and forms stagnation, stagnation generates heat; prolonged heat produces fire. Using warming tonics in such cases would only assist fire and worsen the disease. Therefore, ancient formulas often use Gardenia (Shan Zhi) as a guide for heat-clearing herbs, allowing pathogens to subside and diseases to recede. One must also examine patients who habitually enjoy hot foods, leading to dead blood remaining in the epigastrium, or pain caused by phlegm-Qi or food accumulation stagnating in the stomach. Such cases were not fully expounded by predecessors; later students should adopt and practice these methods, which constitutes flexible treatment.
Note: True Heart Pain is rare among people. Patients with True Heart Pain usually have pre-existing phlegm; suddenly, severe pain like cutting occurs, accompanied by silence, incessant sweating, stiff tongue with inability to speak, and cold extremities. Once this disease manifests, death occurs within a day or evening. Acupuncture cannot be applied, and medicinal power cannot reach the site; ten out of ten patients die. This is because cold pathogens directly strike the Hand-Shaoyin Heart Meridian, and the Heart's Minister Fire cannot resist the enemy. Current cases of "heart pain" are actually pain in the epigastrium and the Pericardium Collateral. If the pain is extremely severe like biting, with frequent vomiting of clear fluid, pale complexion lacking luster, it is due to worm pathogens attacking upwards. If there is a sensation of obstruction during pain, feeling full and unable to descend, it is due to food retention in the epigastrium. If there is discomfort and restlessness during pain, feeling neither hungry nor full, with a desire to vomit and relief after vomiting, it is due to phlegm-fluid retention. If the pain is dull and knotted, radiating to the chest, relieved by belching, it is caused by depression. If the patient desires warmth and relief comes from drinking hot wine, it is due to cold pathogens lodging in the Pericardium Collateral. If the pain moves downwards from above, accompanied by gurgling sounds, restlessness in sitting and lying, scraping sensation in the epigastrium radiating to the chest, it is due to uneliminated accumulated blood carried by fire; do not mistake it for worm pain and administer vermifuges.
[Pulse Diagnosis] Heart pain presents with a slightly tight pulse; when pain is severe, the pulse may be deep and hidden. A pulse that is superficially weak and deeply wiry, or short and rapid. Tight and solid pulse with constipation indicates phlegm accumulation (slippery and solid). Heart pain radiating to the back presents with a pulse that is slightly large; Cun position is deep and slow, Guan position is tight, rapid, and sharp.
Deficiency Pain
In patients with weak constitution suffering from heart pain, Qian Yi stated: For Heart deficiency pain, roasted salt can be used to tonify. If pressing on the area stops the pain, it indicates accompanying deficiency; use Er Chen Tang (Two-Cured Decoction) with roasted Ginger Powder mixed. (Formula see Phlegm Syndrome chapter.) For chronic illness with Yuan Qi deficiency, frail limbs, weak pulse, and preference for abdominal pressure, use Liu Jun Zi Tang (Six-Gentlemen Decoction) with Amomum (Sha Ren) and Cyperus (Xiang Fu). (Formula see Spleen-Stomach chapter.)
Excess Pain
Sudden pain with constipation following anger and eating, with a raised chest/epigastric region and refusal to touch, is severe excess pain. Use Zhu Huang Wan (Boiled Yellow Pill), followed by Ben Tang to eliminate residual pathogens. Damp-heat pain in the epigastrium uses Xiao Wei Dan (Small Stomach Pill). (Formula see Phlegm Syndrome chapter.)
Zhu Huang Wan
Treats severe excess heart pain.
Realgar (1 liang, ground) Croton Seed (5 qian, peeled, finely ground)
Mix with 2 liang of white flour, make pills the size of Sophora seeds with water. Take several pills with water per dose. If diarrhea occurs, stop taking it; take Ben Tang to remove residual pathogens.
Ben Tang
To be taken after treating heart pain.
Ben (0.5 liang, note: text likely missing character, retained as is) Atractylodes Macrocephala (1 liang, soaked in rice wash water, fried)
Make one dose, decoct and drink.
Heat Jue Heart Pain
Patients with Heat Jue Heart Pain indulge in alcohol, accumulating heat in the stomach. Upon encountering cold constraint, it erupts. Symptoms include body heat with cold feet, irritability and vomiting when pain is severe, sweating on the forehead, and a surging-large pulse. Moxibustion should be applied to Taixi (KI3) and Kunlun (BL60) to drain both interior and exterior. Internally take Jin Ling Zi San (Melia Dispersion). After pain subsides, take Zhi Zhu Wan (Aurantium and Atractylodes Pill) to remove residual pathogens. (Formula see Spleen-Stomach chapter.) At the onset of pain, induce vomiting with salt water; vomiting allows for dispersal. For heart-spleen pain persisting for a long time, it is not cold; even if cold exists, it transforms into heat due to stagnation. Use Er Chen Tang with Gardenia (charred black), Ligusticum (Chuan Xiong), and Cyperus (Xiang Fu). For severe pain, add roasted Ginger as an antagonist. (Formula see Phlegm Syndrome chapter.) Alternatively, use Gardenia alone with ginger juice. For constipation, use Da Cheng Qi Tang or Da Xian Xiong Tang to purge. (Formulas see Food Injury chapter.)
Jin Ling Zi San
Melia Fruit (1 liang) Corydalis Rhizome (1 liang)
Grind to powder. Take 2 qian with warm wine.
Cold Jue Heart Pain
Patients with Cold Jue Heart Pain have cold extremities, profuse cold sweat, and in severe cases, cyanotic-black fingernails/toenails. Urine is clear and abundant, no thirst, faint qi and weak strength, pulse is deep, fine, and minute. Use Shu Fu Tang.
For Great Cold Jue, sudden pain (not chronic pain; chronic pain is not cold). Zhu Danxi said: If it is known that the patient suffered cold exposure and ingested cold foods, at the onset, use warming dispersing and warming promoting drugs, such as Cao Dou Kou Wan. For constipation, use Yuan Rong Hou Po Wan.
Shu Fu Tang
Treats Cold Jue Heart Pain.
Atractylodes Macrocephala (2 qian, fried) Licorice Root (1 qian, honey-fried) Prepared Aconite Root (Pao, 1.5 qian)
Cut these three ingredients into one dose. Add 3 slices of ginger and 2 jujubes. Decoct with 2 zhong of water and take warm.
Cao Dou Kou Wan
Treats Cold Jue Heart Pain.
Cardamom (1.5 qian, wrapped in white flour, baked) Alpinia Oxyphylla (8 fen) Tangerine Peel (8 fen) Ginseng Root (de-rhizome, 8 fen) Astragalus Root (honey-fried, 8 fen) Evodia Fruit (washed, de-rhizome, 8 fen) Silkworm (8 fen) Angelica Sinensis (wine-washed, 6 fen) Green Tangerine Peel (6 fen, fried) Fermented Wheat Dough (fried, 4 fen) Turmeric (4 fen) Bupleurum Root (4 fen) Pinellia Tuber (1 qian, ginger-processed) Alisma Rhizome (de-hairs, 1 qian) Peach Kernel (7 pieces, soaked, peeled, de-tip) Malt (fried, 1 qian) Licorice Root (raw 3 fen, honey-fried 3 fen)
Grind to fine powder. Soak in soup, steam steamed cake, make pills the size of Sophora seeds. Take 30 pills per dose.
Yuan Rong Hou Po Wan
Magnolia Bark (3 liang, ginger-fried) Coptis Rhizome (2.5 liang, fried) Evodia Fruit (soaked in water 7 times, 2 liang) Dried Ginger (roasted, 2 liang) Croton Seed (1 liang, separately ground) Ginseng Root (1 liang, de-rhizome) Aconite Lateral Root (roasted, 1 liang)
Grind to powder, mix evenly with bean frost, bind with honey into pills the size of Sophora seeds. Take 3 pills per dose, until bowel movement occurs.
Phlegm Accumulation and Food Accumulation Heart Pain
Phlegm-fluids stagnate in the epigastrium, causing pain at the heart pit. Use old snail shells from walls (preserved nature), fried Atractylodes Macrocephala, Pumice Stone, Gardenia, Cyperus, and Arisaema Cum Bile each 2 liang. Fructus Aurantii, Green Tangerine Peel, Costus Root, Pinellia Tuber, and Amomum each 0.5 liang. Bind with paste, take with ginger decoction. For food accumulation pain, use Bao He Wan. (Formula see Food Injury chapter.)
Blood Stasis Pain
Habitual consumption of hot foods leads to dead blood remaining in the stomach opening, causing pain. Pulse is deep, empty, and choppy. For upper jiao involvement, use Si Wu Tang (Four Substances Decoction) with Peach Kernel, Safflower, Moutan Cortex, Fructus Aurantii, and Corydalis Rhizome. (Formula see Blood Syndrome chapter.) For mild cases, use leek juice and Platycodon Root to open stagnation. For severe cases, use Tao Ren Cheng Qi Tang to purge. (Formula see Blood Syndrome chapter.)
Worm Pain and Zhu Pain
When Ascaris attacks the heart diaphragm causing pain, the patient can eat once the pain stops. White spots on the face and red lips indicate this condition. Treat with Toosendan Fruit, Tin Ash, or use Wu Mei Wan or Ji Xiao Wan. When Ascaris bites causing heart pain, nausea, and vomiting, take Wu Mei Wan with Sichuan Pepper Soup. For Zhu Heart Pain, all ten types of Zhu diseases cause heart pain; use Hua Chong Wan, drunk with Polygonum Hydropiper decoction.
Wu Mei Wan
Treats pain from Ascaris attacking upwards.
Mume Fruit (75 pieces) Asarum (1.5 liang) Prepared Aconite Root (1.5 liang) Ginseng Root (1.5 liang) Phellodendron Bark (1.5 liang) Cinnamon Twig (1.5 liang) Dried Ginger (2.5 liang) Coptis Rhizome (4 liang) Sichuan Pepper (5 qian) Angelica Sinensis (5 qian)
Grind to powder. Soak Mume Fruit in vinegar overnight, remove pits, steam until soft, mash into paste. Add small amount of honey, make pills the size of Sophora seeds. Take 10 pills initially, increase to 20 pills, before meals.
Ji Xiao Wan
Treats Ascaris Jue Heart Pain.
Costus Root (2.5 qian) Chrysanthemum Seed (fried, 2.5 qian) Areca Seed (2.5 qian) Chebula Fruit (2.5 qian) Myrobalan (fried, 2.5 qian) Prepared Aconite Root (2.5 qian) Dried Ginger (roasted, 2.5 qian) Rhubarb (1.5 liang, steamed ripe) Mume Flesh (1 liang, mashed)
Grind to powder, bind with honey into pills the size of Sophora seeds. Take 30 pills per dose, on an empty stomach with Tangerine Peel decoction.
Hua Chong Wan
Causes worms to turn into water upon ingestion.
Lead Carbonate (fried, 5 qian) Chrysanthemum Seed (3 qian) Alum (5 qian) Areca Seed (5 qian) Toosendan Root (5 qian)
Grind to fine powder, bind with paste into pills the size of Sophora seeds. Take 50 pills per dose. Mix with warm grain water and 1-2 drops of sesame oil, stir well and swallow. Rice drink is also acceptable. Anytime. Small worms turn into water; large worms pass naturally.