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In general, distinguishing the deficiency and excess of various diseases through pulse diagnosis is relatively easy. However, for heart and abdominal pain syndromes, where conditions vary greatly in severity, the pulses are often difficult to differentiate. Although a slippery and forceful pulse usually indicates excess pathogenic factors (Shi Xie), and a weak and spiritless pulse usually indicates deficiency pathogenic factors (Xu Xie), this is merely the norm. Nevertheless, in cases of sudden, severe pain, the pulse often appears deep, hidden, fine, or choppy, closely resembling an extreme deficiency pattern. If one does not understand that this is due to Qi being reversed by pathogens, causing obstruction in the pulse channels leading to an abnormal deep and hidden state, it may be misjudged. This is actually a pulse of excess pathogenic factors; however, careful examination within the deep and hidden quality will reveal a stiff, string-taut, and tight sensation, indicating that cold pathogens are obstructing Yang Qi. Such pulses are common in these cases. In contrast, pain caused by fire pathogens presents differently. When encountering such pulses, one must not mistakenly diagnose them as deficiency collapse simply because they are extremely fine or minute, nor should one recklessly administer tonifying agents, as this would lead to significant errors. The method for differentiation lies in observing the patient's physical constitution to assess their usual strength, and inquiring about the etiology to determine whether the illness is new or chronic, and what triggered it. Generally, sudden acute pain with a suddenly fine or hidden pulse suggests excess pathogens, while chronic mild pain with a naturally weak pulse suggests deficiency pathogens. By applying the previously discussed methods for distinguishing deficiency and excess, and integrating medical principles into the diagnosis, one can ensure accuracy without error.

For all heart and abdominal pain syndromes, one must first distinguish between cold and heat. If there are no heat signs or heat pulses, it is definitely not caused by fire pathogens, and cooling medicines should not be used recklessly.

Regarding the treatment of heart and abdominal pain, ancient texts state: "Pain decreases with unblocking" (Tong Sui Li Jian) and "When there is free flow, there is no pain" (Tong Ze Bu Tong). These statements apply specifically to cases of closure, constipation, and solidity. If the abdomen is not firm and full, and the pain lacks accumulation or clustering, this principle cannot be applied. For pain caused by deficiency, this saying is as contradictory as ice and charcoal.

1. For pain located in the Upper Jiao (Upper Burner), if it is due to stagnation, accompanied by distension, difficult to disperse, and so severe that it is unbearable, the most effective method to quickly eliminate stagnation is emesis (Tu Fa). One should select from the emetic methods in the New Formulas. If there is no accumulation or urgent distension, but rather mild stagnation due to cold or Qi rebellion causing pain, simply regulating the Qi will lead to recovery.

2. Gastric pain syndromes are often caused by food retention, cold exposure, or disharmonious Qi. However, both food retention and cold affect Qi, as food stagnation leads to Qi blockage, and cold retention leads to Qi coagulation. Therefore, the key to treating pain is to determine if it is truly excess; if so, the primary approach should be regulating Qi, using Paqi Yin (Qi-Regulating Decoction) with modifications. For food stagnation, add digestive methods; for cold stagnation, add warming methods. If the pain is solely due to Qi rebellion, regulating the Qi alone will cure the disease. For cases unresponsive to other medicines where Qi knotting is difficult to resolve, Shenxiang San (Aromatic Powder) is excellent. For Qi stagnation and rebellion that flare up upon any trigger, the two simple formulas provided later are best.

3. Lower abdominal pain in the Lower Jiao (Lower Burner) can be caused by cold, heat, food, parasites, blood stasis, or Qi rebellion. For cases involving closure or constipation, purgation or downward-draining methods should be used, seeking the specific category of the cause for treatment.

4. Pain due to cold stagnation may arise from internal cold, such as consuming cold foods or drinks, which involves both cold and food; treat according to suitability as described above. It may also arise from external cold, such as exposure to untimely cold pathogens, invading cold air, or yin toxicity from heavy rain and sand dust, leading to churning pain in the heart and abdomen, vomiting or diarrhea, or inability to vomit or defecate, resulting in critical conditions like Dry Huoluan (Gastrointestinal Turmoil). This is generally due to cold pathogens invading the Zang organs, affecting the Upper Jiao or the Middle and Lower Jiao. For urgent pain in the upper part, emesis is best. For pain in the middle or lower parts, resolving cold and promoting stagnation resolution is appropriate, primarily using Paqi Yin with modifications. Alternatives include Buhuanjin Zhengqi San (Huanjin Zhengqi Powder), Hewei Yin (Stomach-Harmonizing Decoction), Pingwei San (Stomach-Pacifying Powder), or Shixiang Wan (Ten-Aromatic Pill). For severe cold rebellion, Sini Tang (Frigid Extremities Decoction) or Lizhong Tang (Center-Warming Decoction) are indicated. Additionally, Shenxiang San can resolve stagnation in the Three Jiao and should be used as a guiding agent according to the syndrome.

5. Abdominal pain caused by blood accumulation is known as Blood Accumulation Syndrome (Xue Ji Zheng). There are four categories of blood-related pain:
First, Blood Accumulation in Cold Damage (Shanghan). Cheng Wuji stated: "When pathogens gather in the Lower Jiao, body fluids cannot circulate freely, and Qi and blood cannot move, leading to retention below, causing distension, fullness, hardness, and pain." If there is hardness, fullness, and pain from the epigastrium down to the lower abdomen, with free urination, it is a Blood Accumulation syndrome, requiring differentiated treatment. Details are found in the Cold Damage section.
Second, Blood Pain in women, detailed in the Women's Diseases section.
Third, Abdominal pain from blood stasis due to trauma. Removing the stasis cures the pain. For those with harmonious Qi and blood, Tongyu Jian (Blood-Unblocking Decoction) with modifications is suitable. For blood stagnation with constipation and excess pathogens blocking flow, Taoren Chengqi Tang (Peach Kernel and Rhubarb Decoction) or Baishun Wan (Baishun Pill) are indicated. For blood deficiency with dry constipation and blockage, Yuzhu San (Jade Candle Powder) is indicated.
Fourth, for long-standing food depression leading to blood stasis pain in the epigastrium, Shengjiu Yin (Raw Leek Decoction) is used.

6. Heart and abdominal pain is most common when Qi and blood are deficient and cold, failing to nourish the Heart and Spleen. This typically occurs in individuals with accumulated fatigue, damage, and unresolved sorrow or worry. It may also occur in those with inherent deficiency of Qi and blood in the Heart, Spleen, Liver, and Kidney who suffer accidental labor injury, cold exposure, or dietary irregularity. Deficiency pain tends to be continuous without sudden intensity. It often alleviates with pressure, rubbing, warming, or moxibustion. Pain in the Heart, Spleen, chest, and hypochondrium may feel like lingering sorrow, palpitations, a sensation similar to but distinct from acid regurgitation, worsening with hunger or fatigue, or improving slightly after eating. It may be indescribable, accompanied by bluish-yellow complexion, fine pulse, and weak Qi. These are deficiency-cold patterns, requiring sweet-warm herbs to nourish blood, tonify the Stomach, and harmonize the interior. Xiaoying Jian (Minor Ying Decoction) or Daying Jian (Major Ying Decoction), and Liyin Jian (Nourishing Yin Decoction) with modifications are suitable. For Qi deficiency, add large doses of Renshen (Ginseng Root); for Yang decline, add Guizhi (Cinnamon Twig), Fuzi (Aconite Root), and Ganjiang (Dried Ginger). Danxi stated: "Pain should not be treated with Qi-tonifying herbs." This applies only to cases of excess pathogens and Qi stagnation; claiming it applies to all pain is erroneous and should not be rigidly adhered to.

7. Lower deficiency abdominal pain is caused by deficiency combined with cold, or Yang deficiency with middle cold. It presents without tangible masses and is relieved by pressure and warmth. Treatment requires nourishing Yin and dispelling cold, primarily using Liyin Jian (Nourishing Yin Decoction). This is less common in men but frequent in women due to menstrual disorders and leukorrhea. Large doses of Liyin Jian are suitable. I have saved many lives with this formula. For deficiency with stagnation and blood non-flow, Juejin Jian (Decoction for Opening the Vessels) is best. Further details are in the Women's Diseases section.
For heart and abdominal pain syndromes that recur after aggressive cleansing treatments, or worsen with repeated use, or present with floating, string-taut, deficient, or large pulses, these indicate Middle Qi deficiency. One must balance treating pathogens and tonifying healthy Qi. If tonification is safe, proceed gradually. Do not mix remedies indiscriminately, which hinders progress. Purely tonifying herbs strengthen Spleen and Stomach Qi, enabling proper circulation, preventing pathogen invasion, and eliminating pain.

8. Fire pathogens and heat depression cause heart and abdominal pain. For fire in the Upper Jiao with pain and distension, add large doses of Zhizi (Gardenia Fruit) and Huangqin (Scutellaria Root) to Qi-regulating and stagnation-resolving herbs. For pain without distension, add Shaoyao (Peony Root), Shengdi (Rehmannia Root), and Maidong (Ophiopogon Tuber) as assistants. For fire in the Lower Jiao, Dali Qing Yin (Great Clearing Decoction) or Yinchin Yin (Artemisia Decoction) are indicated. Fire in the upper part presents with irritability, heat, thirst, and preference for cold. Fire in the lower part presents with distending heat, constipation, and dysuria. One must examine both pulse and symptoms to confirm true fire before using cold-cooling herbs. Without fire signs or pulses, do not diagnose fire to avoid mismanagement.

9. Parasitic pain treatment is detailed in the Parasites section.

10. Phlegm-fluid retention in the chest and diaphragm can cause pain. Symptoms include chest and hypochondriac distension and stuffiness, gurgling sounds, sour taste with heartburn and nausea, or pain radiating to the back. Treat with Qingge Jian (Clear Diaphragm Decoction), Erchen Tang (Two-Aged Decoction), Jupi Banxia Tang (Tangerine Peel and Pinellia Decoction), Siqi Tang (Four-Seven Decoction) from the Bureau Formula, Kuotan Wan (Phlegm-Coagulating Pill), or Runxia Wan (Moistening Downward-Decreasing Pill). Dongyuan's Caodoukou Wan (Cardamom Pill) and Danxi's Bailuo Wan (White Snail Pill) are also phlegm-resolving agents. For condensed depressive phlegm that cannot be resolved by other means, emesis is necessary.

11. Yin-cold abdominal pain occurs in men and women who experience severe pain after sexual intercourse followed by cold exposure. This is Yin-cold. Initially, apply hot compresses of crushed green onion and ginger fried hot, or hot bricks, to the umbilicus and abdomen to resolve extreme cold stagnation. Then treat with Liyin Jian (Nourishing Yin Decoction), Lizhong Tang (Center-Warming Decoction), or Sini Tang (Frigid Extremities Decoction) with modifications. For critical pain, urgently moxa Shenque (CV-8) and Qihai (CV-6).

12. Chest and abdominal pain unrelated to internal organs but located in tendons, bones, skin, and flesh indicates pathogens in the meridians. Do not confuse this with interior syndromes. Carefully inquire to distinguish whether it is fire, cold, Qi, labor injury, blood stasis, blood deficiency, or toxic pathogens from sores retained in the meridians. Identifying the cause prevents error and facilitates treatment.

13. Adults and children with chronic spleen and stomach damage due to dietary indiscretion may experience recurrent abdominal pain triggered by cold or food, accompanied by distension or reduced appetite. Shaoyao Zhizhu Wan (Peony and Atractylodes Pill) is best, used with modifications.

14. Severe chest and diaphragmatic pain radiating to the hypochondrium and back, where medication cannot be swallowed and is immediately vomited, requires emesis regardless of the specific medicine. Induce vomiting along the natural trend to expel pathogens, stagnation, and accumulated phlegm, stopping pain immediately. If pathogens remain and pain persists, repeat the previous prescription until pathogens are fully eliminated, ensuring recovery.