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The Heart belongs to the Shaoyin (Lesser Yin) Ministerial Fire, serves as the master of the Zang-Fu organs, and is the residence of the Spirit (Shen); thus, pathogenic factors generally cannot invade it. If invaded, the Heart is damaged and the Spirit departs, inevitably resulting in blackening of the face and eyes, and cyanosis of the hands and feet extending to the joints. This is termed "Zhen Xin Tong" (True Heartache), where morning onset leads to death by evening. The "Xin Tong" (Heartache) described today is actually pain arising from Stomach Qi at the epigastrium; upon treatment, the pain ceases. If pain occurs after eating, the treatment method must be differentiated based on whether the condition is new or chronic.

In the initial stage, if it is known to be caused by cold exposure or consumption of cold/raw foods, warming and dispersing methods may be used, such as Caodoukou (Grains of Paradise Seed), Zhike (Aurantii Fructus), Zhishi (Aurantii Fructus Immaturus), and Shanzhi (Gardeniae Fructus). Danxi (Zhu Zhenheng) utilized Mahuang Tang (Ephedra Decoction) and Guizhi Tang (Cinnamon Twig Decoction). If the pulse is firm and solid, warming and purgative medicines should be used, such as Beiji Wan (Emergency Pill), while Danxi used Chenqi Tang (Chenqi Decoction). If the condition persists for a while, it transforms into stagnant heat; using warming and dispersing methods at this stage would only assist the fire and exacerbate the pain. Ancient formulas often use Shanzhi as the principal herb, assisted by Jiangzhi (Ginger Juice). There is no tonifying method for this type of pain; Ren Shen (Ginseng Root) and Baizhu (Atractylodes Rhizome) should not be used. This syndrome is merely due to Phlegm-Fire and Food Retention. Inducing severe vomiting and diarrhea is particularly beneficial.

If the pain radiates to the lower back, accompanied by cold extremities (Jue), vomiting, and inability to retain any medication, this indicates Ascaris (Roundworm). Using a goose feather to probe and extract approximately one bowl of phlegm will stop the pain. Generally, it is appropriate to resolve phlegm and descend fire. For new conditions, use warming and dispersing methods.

Formula for Descending Fire and Resolving Phlegm:
Zhishi (Aurantii Fructus Immaturus), Zhike (Aurantii Fructus), Shanzhi (Gardeniae Fructus), Huanglian (Coptidis Rhizoma), Chuanxiong (Ligustici Chuanxiong Rhizoma), Chenpi (Citri Reticulatae Pericarpium), Bai Jiegeng (Platycodonis Radix), Huafen (Trichosanthis Radix), Xiangfu (Cyperi Rhizoma), Jiang Zhi Banxia (Pinelliae Tuber Prepared with Ginger).

For new conditions, remove Huanglian and add Mahuang (Ephedrae Herba) and Houpo (Magnoliae Officinalis Cortex); for severe pain, add Yuanmingfen (Natrii Sulfas) and Shigao (Gypsum Fibrosum); for excessive fire, add Qingdai (Indigo Naturalis); for severe phlegm, add Haishi (Spongilia) and Danning (Arisaematis Cum Bile). If there is a preference for hot foods, it indicates that dead blood (Blood Stasis) is stagnating in the stomach area; Taoren Chengqi Tang (Peach Kernel and Rhubarb Decoction) should be used to purge it.

Another Formula:
Yanhusuo (Corydalis Rhizoma) (1 liang), Houpo (Magnoliae Officinalis Cortex) (5 qian), Huashi (Talcum) (5 qian), Honghua (Carthami Flos) (5 qian), Gui Shao (Radix Angelicae Sinensis Caudex) (5 qian), Hongqu (Red Yeast Rice) (5 qian), Taoren (Persicae Semen) (30 grains).
Grind into a paste and form pills with steamed wheat dumpling dough. For pain caused by dampness flowing into the epigastrium, Xiaowei Dan (Minor Stomach Pill) is appropriate. For pain caused by worms attacking the heart, see the section on Worms. For pain caused by Cold Evil lodging in the Pericardium Collateral, or pain caused by Pi Xi (Masses and Accumulations) attacking the heart, this is called Baoxin Shunqi Lizhong Tang (Embracing Heart, Regulating Qi, and Warming the Middle Decoction).
Wuyao (Linderae Radix), Xiangfu (Cyperi Rhizoma), Cangzhu (Atractylodis Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma), Ganjiang (Zingiberis Rhizoma).

Alternatively, use Zhike (Aurantii Fructus), Qingpi (Citri Reticulatae Pericarpium Viride), Muxiang (Aucklandiae Radix), Pengzhu (Curcumae Longae Rhizoma), Banxia (Pinelliae Tuber); Zhishi (Aurantii Fructus Immaturus) is also acceptable. Danxi used Caodoukou (Grains of Paradise Seed). This combination is suitable for both Cold and Heat syndromes and treats the Nine Types of Heartache: Shichangpu (Acori Tatarinowii Rhizoma), Chishao (Paeoniae Radix Rubra), Mutong (Akebiae Caulis), Wulingzhi (Trogopterori Faeces).