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The *Classic of Difficult Issues* (Jing Yue) states: "When Wood Qi is depressed and erupts, the people suffer from pain in the epigastrium centered on the heart." The Stomach is the Fu organ of the Spleen; Yang pathogenesis precedes Yin, thus the Zang organs are not yet diseased while the Fu organs become diseased first. In severe cases, this leads to stabbing pain under the hypochondrium, indicating that the disease has extended to the Zang organs. The lower opening of the Stomach is named the Cardia (Benmen), which connects with the Heart, commonly referred to as Heart Pain. Although it is said to be caused by the winning and revenging Qi of the Five Movements (Wu Yun), none arise without clear Phlegm and Food Retention stagnating in the Central Palace (Middle Jiao); nor do they form without the Seven Emotions and Nine Qi disturbing the internal organs. The causes of disease often stem from indulging in eating and drinking, favoring sour, spicy, hot, and pungent foods, fried and roasted items, alcohol, and fishy meats, mixed with raw and cold foods. Injury occurs in the morning and damage in the evening; day after day, month after month, Phlegm accumulates and Blood stasis forms, obstructing the ascending and descending mechanisms. Thus, these are the precursors to acid regurgitation, gastric discomfort (Za Cha), vomiting and hiccups, dysphagia (Ye Ge), and food regurgitation (Fan Wei). The pulse at the Cun Kou position is deep and slow; the pulse at the Guan position is slightly tight and rapid. Initial treatment temporarily employs acrid-warm dispersing methods; later, one should nourish Righteous Qi while simultaneously eliminating Evil.

Main Formula (for Qi Depression with Phlegm-Fire): Fuxiong (Ligusticum Chuanxiong Rhizoma), Ganjiang (Prepared Ginger Rhizome), Cangzhu (Atractylodis Rhizoma), Zhizi (Gardeniae Fructus stir-fried with Ginger Juice until charred), Chenpi (Citri Reticulatae Pericarpium), Banxia (Pinelliae Rhizoma prepared with Ginger Juice), Fuling (Poria) — each 1 qian; Caodoukou (Grain of Paradise Seed crushed), Gancao (Licorice Root) — each 5 fen; Shengjiang (Fresh Ginger Slice, 5 pieces). Decoct in water and take during acute pain episodes. One may only resume diet half a day after pain cessation; immediate ingestion will cause pain recurrence.

For Cold Pain, remove Zhizi and add Muxiang (Aucklandiae Radix) and Sharen (Amomi Fructus); if pain persists, add Lingzhi (Trogopteri Dung) and Xuanhusu (Corydalis Rhizoma); if pain is severe, add Ruxiang (Boswelliae Resin) and Moyao (Commiphora Resin).

Caodoukou Wan (Grain of Paradise Pill): Treats pain caused by Exogenous Cold invading the Stomach, as well as various pains involving the Heart, Spleen, and Bao Luo (Pericardium Collaterals), or alternating cold and heat pain due to Damp-Heat stagnation.

Formula: Caodoukou (wrapped in dough and baked, skin removed, 1 qian 4 fen), Yizhi (Alpiniae Oxyphyllae Fructus), Chenpi, Jiangcan (Bombyx Batryticatus), Yanhusuo (Corydalis Rhizoma), Huangqi (Astragali Radix), Wuyu (Evodiae Fructus) — each 8 fen; Gancao (3 fen), Zhigancao (Honey-fried Licorice Root), Danggui (Angelicae Sinensis Radix), Qingpi (Citri Reticulatae Pericarpium Viride), Shenqu (Massa Medicata Fermentata), Jianghuang (Curcumae Longae Rhizoma) — each 4 fen; Zexie (Alismatis Rhizoma, 1 qian; reduce by half if urination is frequent), Taoren (Persicae Semen, 7 seeds, skin and tips removed, ground separately), Chaihu (Bupleuri Radix, 4 fen, adjust according to hypochondriac pain), Banxia (Prepared, 4 fen).

Except for Taoren which is ground separately, grind the remaining herbs into powder. Use steamed cake paste to make pills the size of mung beans. Take 30 pills per dose, swallowed with plain warm water on an empty stomach. For pain due to Heat Jue (Cold Extremities with Internal Heat), use Jinlingzi San; for severe Excess Pain, use Sanhua Shenyao Wan (see Phlegm section for formula).