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In the height of summer, if there is profuse diarrhea (Dongxie), cold extremities, aversion to cold, pain in the epigastrium at the heart's location, radiating from the abdomen to the hypochondrium, transforming into dysentery (Zhixia), accompanied by vomiting, hiccups, and inability to eat. People often treat it as heatstroke or cholera, which worsens the condition.

The pulse at the cun, guan, and chi positions on both hands is all faint, short, deep, and weak, not corresponding with respiration; this indicates extreme Yin-cold. If warming is not urgently applied, there will be no hope for life. Subsequently, ginger and aconite were administered several times, interspersed with elixir pills. As the pulse became slightly forceful and cold extremities gradually receded, further administration of ginger and aconite led to stability after seven days.

Jue Heartache refers to pain caused by disorders of other organs affecting the heart, which all have treatments. Zhenxin Tong (True Heartache) refers to pain originating from the heart itself; thus, if it starts in the evening, death occurs by morning, and if it starts in the morning, death occurs by evening, representing an untreatable critical condition. However, if the meridians and collaterals of the heart are diseased, and the pathology is at the biao (superficial/meridional level), the heart may also hurt but remains treatable. The Classics state: "When the Hand-Shaoyin Heart Meridian is disturbed, it causes dryness of the throat, heartache, thirst, and desire to drink." Also, diseases generated by the Hand-Shaoyin Heart Meridian include heartache and heat in the palm; these should be treated by needling according to whether the pulse is full or empty, hot or cold, or sunken. Furthermore, the text states: "The Luo-connecting vessel of the Hand-Jueyin Pericardium is named Neiguan, located two cun above the wrist crease, emerging between the two tendons. In excess conditions causing heartache, needle between the two tendons." It also says: "Pathogenic factors in the heart cause heartache, frequent sadness, dizziness, and collapse; regulate its Shu-Stream points based on excess or deficiency."

[Acute Heartache] If the pulse is surging and rapid, indicating excessive internal heat, use the single prescriptions of Coptis Rhizome (Huanglian) or Gentian Root (Longdancao) decoction. If there is no heat, treat with things like Lychee Seed (Lizhihe). If acute heartache is caused by invasion of foul pathogens (Zhong'e), accompanied by abdominal distension and constipation, treat with Zouma Tang. The *Haishang Fang* emergency prescription for men and women suffering from severe heartache with locked jaw and impending death uses three to five roots of aged green onion white parts from the previous year, peeled and stripped of leaves, pounded into a paste. Pry open the patient's mouth, spoon the paste into the throat, and wash it down with four liang of sesame oil. The amount of oil is not fixed, but once the onion paste enters the throat, the patient will likely revive. Another method, taking a cup of sesame oil in one dose, is also effective.

The Classics state: "When pathogenic factors lodge in the Luo-connecting vessels of the Foot-Shaoyin Kidney Meridian, they cause sudden heartache, acute distension, and fullness/stiffness in the chest and hypochondrium without accumulation. Prick the point anterior to Ran Gu to bleed. After about the time it takes to eat a meal, it resolves. If not resolved, treat left with right points, right with left points. For newly onset disease, it resolves in five days."

[Diaphragm Pain] Differs from heartache. Heartache is located at the depression of the xiphoid process (Qigu); it is fundamentally not heartache but pain of the heart's branch collateral. Diaphragm pain involves pain filling the chest horizontally, which is milder than heartache. The name is merely a colloquial designation. Various formulas describe symptoms such as restlessness, palpitations, etc. Wuling San drains heat from the Heart and Small Intestine, which is likely inappropriate. Instead, use Siwu Tang or Shiquan Dabu Tang minus Cinnamon Twig (Guizhi) to generate blood and nourish Yin, embodying the principle of using water to control fire. Diaphragm pain often results from accumulated cold and phlegm-q stagnation. Suitable formulas include Wuge Kuanzhong San, or Sqi Tang added with Aucklandiae Radix (Muxiang) and Cinnamon Twig (Guizhi) half qian each, or Zhuapi Tang added with Muxiang. If diaphragm pain is accompanied by urgent rising qi, use Suzi Jiangqi Tang minus Peucedani Radix (Qianhu) added with Muxiang in equal amounts. If pain is due to abundant phlegm-fluids, use Xiao Banxia Fuling Tang added with Immature Bitter Orange (Zhishi) one qian, intermittently administering Banshu Wan.

[Xin Chai] Also caused by phlegm-fluids, commonly known as Yin Chai. Some cases involve stomach heat where food digests easily, leading to hunger/chai. The *Suwen* calls this Shi Chai, resembling Xiaozhong (wasting-thirst) patterns, commonly known as Du Chai. For phlegm-q stagnation, use Xiao Banxia Fuling Tang added with Zhishi one qian. For stomach heat, use Erchen Tang added with Huanglian one qian, or Wuling San minus Guizhi added with Cinnabar (Chensha). There are also cases of post-illness weakness where drinking a few mouthfuls of Ginger Decoction or taking dried ginger preparations leads to recovery; this is because cold stagnates above the diaphragm and hidden fluids reside within, dissolving upon encountering acrid-warm substances. When I served as a tutor in the Imperial Library, my teacher Mr. Han Jingtang often suffered from diaphragm pain. His pulse was surging, large, and choppy. I used Gardenia Seed (Shanzhiren), Red Fermented Rice Qu (Chiqu), Thoroughwort Stem (Tongcao), Barley Sprout (Dayamai), Cyperus Rhizome (Xiangfu), Angelica Sinensis (Danggui), and Ligusticum Rhizome (Chuanxiong) decocted in water, adding ginger juice, leek juice, child's urine (Tongbian), and bamboo sap (Zhuli). He drank it and the pain stopped. One day, due to fatigue and hunger, the pain flared severely. He urgently invited me to the heating room and asked, "I woke up with severe pain, couldn't wait for you. I took my brother's medicine. Upon swallowing, it felt like knife cuts, and the pain intensified unbearably. Why?" I said, "Was it Erchen Tang, Pingwei San, Lindera Root (Wuyao), or Perilla Leaf (Zisu)?" He replied, "Yes." I said, "Then why wonder at the worsening? Since it arises from labor and hunger and stops with fullness and rest, it is clearly deficiency. Administer Shiquan Dabu Tang. After one dose, the pain ceased."

[Pulse Diagnosis] Pulses are mostly seen at the Right Guan position. Yin-Choppy pulse indicates pain. Slightly hurried indicates pain. Slightly large indicates Xin Bi (Heart Bi) with back pain radiating. Short and rapid indicates pain. Choppy indicates pain. Severe pain implies a hidden (Fu) pulse. A large pulse indicates chronic disease. Surging, large, and rapid indicates Fire-Heat. Slippery and large indicates Phlegm. Excess pulse at the Right Hand indicates Phlegm accumulation. Deep and slippery indicates retained food. Choppy and slow indicates Cold. Deep, fine, and slow pulses are treatable. Firm, large, and excess; floating, large, and long; slippery and free-flowing; rapid and tight pulses are all difficult to treat. In Zhenxin Tong, if hands and feet turn blue up to the joints, it is untreatable.