（心疝 心痈附）
心当歧骨陷处，居胸膈下，胃脘上，心痛与胸脘痛自别也。心为君主，义不受邪，故心痛多属心包络病。
若真心痛，经言旦发夕死，夕发旦死。由寒邪攻触，猝大痛，无声，面青气冷，手足青至节，急用麻黄、桂、
附、干姜之属温散其寒，亦死中求活也。若五脏之邪，干心包致痛，通用必应散。经云∶邪在心则心痛，喜悲，
时眩仆。此包络受邪，在腑不在脏也。经云∶手少阴之脉动，则病嗌干心痛，渴而欲饮。此言支脉受邪，在络
不在经也。经云∶厥心痛与背相控，如从后触其心，伛偻者，肾心痛也。神保丸。腹胀胸满，胃脘当心痛，
上支两胁，胃心痛也。草豆蔻丸、清热解郁汤。如以锥针刺其心，心痛甚者，脾心痛也。诃子散、复元通气
散。色苍苍如死状，终日不得太息，肝心痛也。金
铃子散，加紫降香。卧若徒居，心痛，间动作，痛益甚，色不变，肺心痛也。七气汤加枳壳、郁金。肾厥心痛，
由阴火上冲。胃厥心痛，由胃中停滞。脾厥心痛，由中焦寒逆。肝厥心痛，由火郁血分。肺厥心痛，由上焦气
分不清。经之论厥心痛，以诸痛皆肝肾气逆上攻致之，但分寒热两种。寒厥心痛者，身冷汗出，手足逆，便
利不渴心痛，脉沉细，术附汤。热厥心痛者，身热足厥，烦躁心痛，脉洪大，金铃子散、清郁汤。凡暴痛非
热，久痛非寒，宜审。经又云∶阳明有余，上归于心，滑则病心疝。生韭汁和五苓散，小茴香煎汤下。又心疝
宜疝气门求治。心痛引少腹满，上下无定处，溲便难者，取足厥阴肝。心痛腹胀啬然，大便不利，取足太阴脾。
心痛短气不足以息，取手太阴肺。心痛引背不得息，取足少阴肾。以上皆他腑脏之邪，干心而致痛，须加各
腑脏药治之。《金匮》云∶九痛丸治九种心痛。《医通》曰∶九种心痛，乃久客之剧症，即肾水乘心，香港脚攻
心等别名也。痛久血瘀，阴邪团结，故用参、附、干姜温气散邪，加野狼毒、巴霜、吴茱萸驱之，使从阴窍出。
药虽峻利，而改汤为丸，取缓攻，不取急荡也。后人因分九种心痛∶曰饮，恶心烦闷呕水，由停饮蓄注也。
胃苓汤，甚则小胃丹。曰食∶饱闷噫败卵气，由生冷食物过多也。青皮丸加砂、枳。曰寒∶外受寒，宜温散；
桂枝七气汤。内受寒，宜温利。术附汤加蔻、朴、枳、陈。寒久郁则成热，用山栀为热药响导，佐以生姜，多
用川芎开之。虚寒宜温补，归脾汤加干姜、桂心、菖蒲。肾寒乘心痛，则心悬如饥，泄痢下重。五积散。寒客
背俞，则脉血涩，注于心，相引痛。桂枝七气汤、神效丸。曰火∶痛不时发，姜汁炒山栀、少加炮姜、甘草。
若热郁痛，脉数，口渴便秘，清中汤。曰气∶脉沉结或弦，胸中气壅，攻刺作痛。沉香降气散。中气虚，按
之则痛定，二陈汤加炮姜，不应，理中汤。久服破气药太过，脉大无力，六君子汤加炮姜。曰血∶好饮热酒，
血留胃口，脉必涩或芤，饮作呃。手拈散加桔梗开提其气。虚人血瘀，四物汤加桃仁、穿山甲、桂心、降香。
曰悸∶心痛而烦，发热动悸，此为虚伤。辰砂妙香散、加味七气汤。曰虫∶面有白斑，唇红口沫能食，翦红丸。
因蛔动则呕，痛有休止，乌梅丸、
妙应丸。曰疰∶鬼疰心痛，昏愦妄言，或猝倒口噤，由感恶也。苏合香丸。此为九种心痛。若心痛脉微欲绝，
手足逆冷者，桂心三钱煎服。猝心痛，脉洪数者，黄连三钱煎服。若脉弦数，木克土也，小建中汤。取芍药
酸收，于土中泻木。如脉沉细，水侮土也，理中汤。取干姜味辛，于土中泄水。大寒客心胸，呕逆不食，气上
冲痛，不可触近，金匮大建中汤。寒痛绵绵不绝，术附汤加草果、浓朴。凡按之痛减者，气虚也，参术散。
按之痛甚者，气实也，栀萸丸。又有心痈发胸乳间，一名井疽，状如豆大，发如蜂窠，系心热盛，宜疏导心火，
凉血饮。缓则不救。小便涩者，清心散，或凉膈散去硝黄，加白芷、天花粉、木通、瞿麦。大便秘者，内固清心
散，凉膈散去硝黄，加白芷、花粉、生地。
丹溪曰∶心胃痛须分新久，若明知身受寒，口食冷物而得，其初当与温散，如桂枝七气汤。或温利之，如
九痛丸。若得之稍久则成郁，郁久必生热，热久必生火，若温散温利，即助火添邪。由是方中以山栀为热药之
响导，则邪易除，正易复，痛易安。又曰∶心胃痛，须用劫药，痛乃止。如仓猝散∶山栀四十九枚连皮炒，
大附子一个炮去皮脐，共为粗末。每三钱，水一盏，酒半盏，煎七分，入盐少许服。加川芎尤妙。能治气自
腰腹间挛急疼痛，不可屈伸，痛不可忍，自汗如洗，手足冷而垂死者。又如愈痛散∶五灵脂、延胡索、蓬术、
良姜、当归，等分为末，每三钱，醋汤调服。治急心胃痛。
(Heart Hernia [Appendix: Heart Abscess])
The heart is located in the depression below the xiphoid process, situated beneath the chest and diaphragm and above the epigastrium; therefore, heart pain (Xintong) and chest-epigastric pain are distinct conditions. The heart serves as the sovereign ruler and theoretically should not directly receive pathogenic factors; thus, heart pain mostly belongs to diseases of the Pericardium (Xinbaoluo).
If it is True Heart Pain (Zhenxintong), medical classics state that onset in the morning leads to death by evening, and onset in the evening leads to death by morning. This is caused by cold pathogenic factors attacking and touching, resulting in sudden severe pain, absence of voice, cyanotic complexion, cold breath, and cyanosis of hands and feet extending to the joints. Urgent use of herbs such as Ephedrae Herba (Mahuang), Cinnamon Twig (Guizhi), Aconiti Lateralis Radix Praeparata (Fuzi), and Zingiberis Rhizoma (Ganjiang) is required to warm and disperse the cold, seeking life amidst death. If pathogenic factors from the five zang organs interfere with the pericardium causing pain, Biying San (Must-Affect Powder) is generally used. The classics say: "Pathogens in the heart cause heart pain, a tendency toward sadness, and occasional dizziness or collapse." This indicates pathogens affecting the pericardium, which is a fu organ rather than a zang organ. The classics also state: "Abnormal pulsation of the Hand Shaoyin meridian causes dry throat, heart pain, thirst, and desire to drink." This refers to pathogens affecting the collateral branches, located in the collaterals rather than the main meridians. The classics further say: "Jue heart pain pulls against the back, feeling as if touched from behind the heart, with stooping posture, is called Kidney Heart Pain (Shen Xintong)." Treat with Shenbao Wan (Divine Protection Pill). If accompanied by abdominal distension and chest fullness, pain at the epigastrium corresponding to the heart, radiating upward to both hypochondria, it is called Stomach Heart Pain (Wei Xintong). Treat with Caodoukou Wan (Cardamomum Seed Pill) or Qingre Jieyu Tang (Clear Heat and Resolve Depression Decoction). If it feels like a needle piercing the heart with severe pain, it is called Spleen Heart Pain (Pi Xintong). Treat with Hezi San (Areca Seed Powder) or Fuyuan Tongqi San (Restore Circulation and Promote Qi Powder). If the complexion is pale and dull as if dead, unable to take deep sighs all day, it is called Liver Heart Pain (Gan Xintong). Treat with Jinlingzi San (Melianthus Fruit Powder) plus Zijiangxiang (Aquilariae Lignum Resinatum). If lying down or resting causes pain, which worsens with slight movement but without color change, it is called Lung Heart Pain (Fei Xintong). Treat with Qiqi Tang (Seven-Qi Decoction) plus Zhike (Aurantii Fructus) and Yujin (Curcumae Radix). Kidney Jue heart pain is caused by Yin fire rushing upward. Stomach Jue heart pain is caused by stagnation in the stomach. Spleen Jue heart pain is caused by cold rebellion in the middle jiao. Liver Jue heart pain is caused by fire depression in the blood level. Lung Jue heart pain is caused by unclear qi mechanism in the upper jiao. The classics discuss Jue heart pain, stating that various pains are caused by rebellious qi from the liver and kidney attacking upward, divided into two types: cold and heat. Cold Jue heart pain presents with cold sweat, cold extremities, normal bowel/bladder function without thirst, and a deep, fine pulse; treat with Shu Fu Tang (Atractylodes and Aconite Decoction). Heat Jue heart pain presents with body heat, cold feet, irritability, heart pain, and a surging, large pulse; treat with Jinlingzi San or Qingyu Tang (Clear Depression Decoction). Generally, acute pain is rarely due to heat, while chronic pain is rarely due to cold; careful examination is necessary. The classics also say: "Excess in the Yangming meridian returns heat to the heart; a slippery pulse indicates Heart Hernia." Treat with raw Chinese Chive Juice (Shengjiuzhi) mixed with Wuling San (Five-Ingredient Powder with Poria), taken with Fennel Decoction (Xiaohuixiang Jiantang). Additionally, heart hernia should be treated via the Hernia Gate methods. Heart pain pulling to the lower abdomen with fullness, moving up and down without fixed location, and difficulty urinating/defecating, should be treated by selecting points on the Foot Jueyin Liver Meridian. Heart pain with abdominal distension and tight discomfort, with difficult defecation, should be treated by selecting points on the Foot Taiyin Spleen Meridian. Heart pain with shortness of breath and insufficient respiration should be treated by selecting points on the Hand Taiyin Lung Meridian. Heart pain pulling to the back with breathing difficulty should be treated by selecting points on the Foot Shaoyin Kidney Meridian. All these are pains caused by pathogens from other zang-fu organs interfering with the heart, requiring the addition of herbs targeting those specific organs. *Jinkui Yaolue* states: Jiutong Wan (Nine-Pain Pill) treats nine types of heart pain. *Yitong* states: Nine types of heart pain are severe syndromes of long-standing pathogens, synonymous with Kidney Water Overacting on Heart or Leg Qi Attacking Heart. Long-standing pain leads to blood stasis and accumulation of yin pathogens; thus, Ginseng Radix (Renshen), Prepared Aconite Root (Fuzi), and Dried Ginger (Ganjiang) are used to warm qi and dispel pathogens, added with Euphorbiae Pekinensis Radix (Yelangdu), Crotonis Fructus (Babang), and Evodiae Fructus (Wuzhuyu) to drive them out through the yin orifices. Although the medication is harsh, changing decoction to pill form aims for slow attack rather than rapid purgation. Later scholars divided heart pain into nine types:
1. Drink Pain (Yin): Nausea, vexation, vomiting clear fluid, caused by retained fluids accumulating. Treat with Weiling Tang (Stomach-Ling Decoction); if severe, Xiaowei Dan (Small Stomach Pill).
2. Food Pain (Shi): Fullness, belching with rotten egg odor, caused by excessive consumption of cold/raw foods. Treat with Qingpi Wan (Green Peel Pill) plus Amomi Fructus Rotundus (Sharen) and Aurantii Fructus (Zhishi).
3. Cold Pain (Han): External cold requires warming and dispersing; treat with Guizhi Qiqi Tang (Cinnamon Twig Seven-Qi Decoction). Internal cold requires warming and promoting flow; treat with Shu Fu Tang plus Cardamomum Seed (Doukou), Magnoliae Officinalis Cortex (Houpo), Aurantii Fructus (Zhishi), and Citri Reticulatae Pericarpium (Chenpi). Long-standing cold depression turns to heat; use Gardeniae Fructus (Shanzhi) as a guide for heat-resolving herbs, assisted by Zingiberis Rhizoma Recens (Shengjiang), and frequently use Ligusticum Chuanxiong Rhizoma (Chuanxiong) to open depression. Deficiency-cold requires warming and tonifying; treat with Guipi Tang (Restore the Spleen Decoction) plus Ganjiang, Cinnamomi Cortex (Guixin), and Acori Tatarinowii Rhizoma (Changpu). Kidney cold overacting on the heart causes a hanging sensation like hunger with dysentery/heaviness; treat with Wuji San (Five Accumulations Powder). Cold invading back shu points causes blood stasis flowing to the heart, causing mutual pulling pain; treat with Guizhi Qiqi Tang or Shenxiao Wan (Divine Effect Pill).
4. Fire Pain (Huo): Intermittent pain; treat with Gardeniae Fructus stir-fried with ginger juice, plus a little prepared Ginger and Glycyrrhizae Radix et Rhizoma (Gancao). If heat depression causes pain with rapid pulse, thirst, and constipation, treat with Qingzhong Tang (Clear Middle Decoction).
5. Qi Pain (Qi): Deep-knotted or wiry pulse, chest qi congestion, stabbing pain. Treat with Chenxiang Jiangqi San (Aquilaria Descend Qi Powder). Middle qi deficiency, pain relieved by pressure: Erchen Tang plus prepared Ginger; if ineffective, Lizhong Tang. Excessive use of qi-breaking drugs leading to large, weak pulse: Liujunzi Tang plus prepared Ginger.
6. Blood Pain (Xue): Preference for hot wine, blood stagnating in the stomach area, pulse must be choppy or hollow, hiccup upon drinking. Treat with Shounian San (Hand-Catching Powder) plus Platycodonis Radix (Jiegeng) to lift qi. Deficient persons with blood stasis: Siwu Tang plus Persicae Semen (Taoren), Manis Squama (Chuanshanjia), Cinnamomi Cortex (Guixin), and Aquilariae Lignum Resinatum (Jiangxiang).
7. Palpitation Pain (Ji): Heart pain with vexation, fever, and palpitations, indicating deficiency injury. Treat with Chen_sha Miaoxiang San (Cinnabar Miraculous Fragrance Powder) or Jiawei Qiqi Tang (Modified Seven-Qi Decoction).
8. Worm Pain (Chong): White spots on face, red lips, foaming mouth, good appetite. Treat with Jianhong Wan (Cut Red Pill). Vomiting due to roundworm movement, pain with intervals: Wumei Wan (Mume Pill) or Miaoying Wan (Wonderful Response Pill).
9. Invasion Pain (Zhu): Ghost invasion heart pain, confusion, delirium, or sudden collapse with locked jaw, caused by evil qi infection. Treat with Suhe Xiang Wan (Styrax Pill). These are the nine types of heart pain.
If heart pain has a faint pulse nearly absent and cold extremities, treat with three qian of Cinnamomi Cortex (Guixin) decocted. For sudden heart pain with surging-rapid pulse, treat with three qian of Coptidis Rhizoma (Huanglian) decocted. If the pulse is wiry-rapid, indicating Wood overcoming Earth, treat with Xiaojianzhong Tang (Minor Construct the Middle Decoction). Use the sour-astringent property of Paeoniae Radix Alba (Shaoyao) to drain Wood within Earth. If the pulse is deep-fine, indicating Water insulting Earth, treat with Lizhong Tang. Use the pungent flavor of Zingiberis Rhizoma (Ganjiang) to drain Water within Earth. Severe cold lodging in the chest/heart with vomiting, inability to eat, qi rushing upward causing pain, and intolerance to touch: treat with Da Jianzhong Tang from *Jinkui*. Continuous mild cold pain: treat with Shu Fu Tang plus Tsao-kuo (Caoguo) and Houpo. Pain relieved by pressure indicates qi deficiency: treat with Shenzhu San (Ginseng and Atractylodes Powder). Pain aggravated by pressure indicates qi excess: treat with Zhinyu Wan (Gardeniae and Evodia Pill).
Additionally, Heart Abscess (Xinyong) develops between the chest and breasts, also known as Jingju (Well Carbuncle), sized like a bean, resembling a honeycomb when erupting, caused by excessive heart heat. It requires guiding out heart fire using Liangxue Yin (Cool Blood Decoction). If neglected, it becomes incurable. For astringent urine: treat with Qingxin San (Clear Heart Powder) or Liangge San (Cool Diaphragm Powder) minus Mangxiao (Natrii Sulfas) and Dahuang (Rhei Radix et Rhizoma), plus Baizhi (Angelicae Dahuricae Radix), Tianhuafen (Trichosanthis Radix), Mutong (Akebiae Caulis), and Qumai (Dianthi Herba). For constipation: treat with Neigu Qingxin San (Inner-Stabilizing Clear Heart Powder) or Liangge San minus Mangxiao and Dahuang, plus Baizhi, Tianhuafen, and Shengdi Huang (Rehmanniae Radix).
Zhu Danxi said: Heart-stomach pain must be distinguished by newness or duration. If clearly caused by external cold or ingestion of cold food, initially treat with warming dispersion, such as Guizhi Qiqi Tang. Or warming promotion, such as Jiutong Wan. If prolonged, it forms depression; long-standing depression generates heat; long-standing heat generates fire. Using warming dispersion/promotion then would aid fire and add pathogens. Therefore, in formulas, Gardeniae Fructus (Shanzhi) is used as a guide for heat-resolving herbs, allowing pathogens to be easily removed, healthy qi to recover, and pain to settle. He also said: For heart-stomach pain, 'robber' drugs (strong analgesics) are needed to stop pain. Example: Cangcu San (Sudden Stop Powder): Forty-nine Gardeniae Fructus (Shanzhi) stir-fried with skin, one large Prepared Aconite Root (Fuzi) processed peeled and navel removed, ground into coarse powder. Take three qian each time, decoct with one cup water and half cup wine until seven-tenths remain, add a little salt and take. Adding Chuanxiong is excellent. It treats spasm-pain from waist/abdomen, inability to bend/extend, unbearable pain, profuse sweating, cold extremities nearing death. Another example: Yutong San (Pain-Relief Powder): Psoraleae Fructus (Wulingzhi), Corydalis Rhizoma (Yanhusuo), Curcuma Longa Rhizoma (Pengzhu), Alpiniae Officinarum Rhizoma (Liangjiang), and Angelicae Sinensis Radix (Danggui), equal parts ground to powder. Take three qian each time, mixed with vinegar-water. Treats acute heart-stomach pain.