多因积冷与痰气而成宜五膈宽中散。或四七汤。加木香桂各半钱。或挝脾汤。加丁香。
膈痛而气上急者。宜苏子降气。去前胡加木香如数。
痰涎壅盛而痛者。宜小半夏茯苓汤。加枳实一钱。间进半硫丸。
心瘥。有痰饮所致。俗名饮瘥。有胃口热。食易消。故瘥素问谓之食瘥。亦类消中之状
俗
名肚瘥。痰气宜小半夏茯苓汤。加枳实一钱。胃中热。宜二陈汤加黄连一钱。或五苓散。加
桂与辰砂。
膈痛与心痛不同。心痛则在歧骨陷处。本非心痛。乃心支别络痛耳。膈痛。则痛横满胸
间。
比之心痛为轻。痛之得名。俗为之称耳。诸方称为嘈杂。烦躁。忪悸痰饮证也。五苓散、利
心小肠之热。恐非其对。不若用四物汤。十全大补汤。去桂生血而益阴。此亦非水制火之义
亦有病瘥。呷姜汤数口。或进干姜剂而愈。此膈上停寒。中有服饮。见半热则消。
臂为风寒湿所搏。或饮液流入。或因提挈重物。皆致臂痛。有肿者。有不肿者。除饮证
外。其余诸痛。并宜五积散及乌药顺气散。或蠲痹汤。
外有血虚一证。血不荣于筋。或致臂痛。宜蠲痹汤。四物汤。各半帖。和匀煎服。
乳妇如臂枕儿。伤于风寒。多有臂痛。亦宜于此选用。若坐卧为风湿所搏。或睡后手在
被外
为寒邪所袭。遂令臂痛。宜五积散。及蠲痹汤。乌药顺气散。审知是湿。蠲痹汤。每服加苍
术三匙。防己四分。或用五痹汤曾因挈重伤筋。以致臂痛。宜琥珀散。劫劳散。或和气饮。
每服加白姜黄半钱。以姜黄能入臂故也。
Often caused by the accumulation of cold pathogens and phlegm-qi obstruction, it is suitable to use Wuge Kuangzhong San (Five Diaphragms Widening the Middle Jiao Powder). Alternatively, Sizhi Tang (Four Seven Decoction) can be used with Muxiang (Aucklandiae Radix) and Guizhi (Cinnamon Twig), each half qian. Or, Zhuapi Tang (Spleen-Pounding Decoction) can be used with Dingxiang (Caryophylli Flos).
For diaphragmatic pain accompanied by urgent upward rushing of qi, Suzi Jiangqi Tang (Perilla Fruit Descending Qi Decoction) is suitable, removing Qianhu (Peucedani Radix) and adding Muxiang (Aucklandiae Radix) in the prescribed amount.
When phlegm-fluids are abundant and causing pain, Xiaobanxia Fuling Tang (Minor Pinellia and Poria Decoction) is suitable, adding Zhishi (Aurantii Fructus Immaturus) one qian. Banliu Wan (Half-Sulfur Pill) should be taken intermittently.
Xinchai (Heart Clamor/Discomfort), a condition characterized by central discomfort, is caused by phlegm-fluids, commonly known as "Yin Chai" (Fluid Clamor). If accompanied by heat in the stomach appetite leading to easy digestion of food, this type of chai is called "Shi Chai" (Food Clamor) in the *Suwen* (Plain Questions), resembling the presentation of Xiao Zhong (Consumption Syndromes). It is colloquially known as "Du Chai" (Abdominal Clamor). For cases due to phlegm-qi, Xiaobanxia Fuling Tang (Minor Pinellia and Poria Decoction) is suitable, adding Zhishi (Aurantii Fructus Immaturus) one qian. For heat in the stomach, Erchen Tang (Two Aged Herbs Decoction) with Huanglian (Coptidis Rhizoma) one qian is suitable. Or, Wuling San (Five-Ling Powder) with Guizhi (Cinnamon Twig) and Chen Sha (Cinnabar) can be used.
Diaphragmatic pain differs from heart pain. Heart pain occurs in the depression below the xiphoid process (Qigu). This is not truly heart pain, but rather pain in the collateral branches of the heart. Diaphragmatic pain involves pain filling horizontally across the chest. It is milder than heart pain. The name "pain" is merely a common designation. Various medical texts refer to it as Zaocha (Clamor), Fan Zao (Restlessness), and Song Ji (Palpitations), which belong to phlegm-fluid syndromes. Wuling San (Five-Ling Powder) drains heat from the Heart and Small Intestine, which is likely inappropriate. It is better to use Siwu Tang (Four Substances Decoction) or Shiquan Dabu Tang (Perfect Great Tonifying Decoction), removing Guizhi (Cinnamon Twig) to generate blood and nourish yin. This also does not align with the principle of "using water to control fire." There are also cases of chai where drinking a few mouthfuls of Xiaying Tang (Ginger-Sipping Decoction) or taking Ganjiang (Dried Ginger) preparations leads to recovery. This is because cold stagnates above the diaphragm and fluids remain within; upon encountering mild heat, they dissipate.
The arms are struck by wind-cold-dampness, or fluids flow into the channels, or due to lifting heavy objects, all of which cause arm pain. Some present with swelling, others without. Excluding fluid syndromes, for other types of pain, Wuji San (Five-Accumulations Powder) and Wuyao Shunqi San (Maypop Regulating Qi Powder) or Juanbi Tang (Expelling Bi Decoction) are suitable.
Additionally, there is a blood deficiency syndrome where blood fails to nourish the sinews, potentially causing arm pain. Juanbi Tang (Expelling Bi Decoction) and Siwu Tang (Four Substances Decoction) are suitable, each half a dose, mixed evenly and decocted for administration.
Nursing women who rest their arms on their children may suffer from wind-cold invasion, often resulting in arm pain; these cases are also suitable for selection among the aforementioned formulas. If sitting or lying down exposes one to wind-dampness, or if sleeping with hands outside the blanket exposes them to cold pathogens, causing arm pain, Wuji San (Five-Accumulations Powder), along with Juanbi Tang (Expelling Bi Decoction) and Wuyao Shunqi San (Maypop Regulating Qi Powder) are suitable. If it is confirmed to be dampness, add Cangzhu (Atractylodis Rhizoma) three spoons and Fangji (Stephaniae Tetrandrae Radix) four fen to each dose of Juanbi Tang (Expelling Bi Decoction). Or, use Wubi Tang (Five-Bi Decoction). For arm pain resulting from previous heavy lifting damaging the sinews, Hupo San (Amber Powder), Jie Lao San (Exhaustion-Seizing Powder), or Heqi Yin (Harmonizing Qi Infusion) are suitable. Add Bai Jianghuang (Curcumae Radix) half qian per dose, as Jianghuang enters the arm meridians.