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Pingsha (Commentary): The content from the beginning of this chapter to "shape in the middle and upper part" is found in *Ling Shu* (Spiritual Pivot), Volume 5, Chapter 24, "Jue Bing" (Jue Diseases). The content from "heart pain radiating to the waist and spine" to "obtained and immediately resolved" is found in *Ling Shu*, Volume 5, Chapter 26, "Za Bing" (Miscellaneous Diseases). The content from "Xin Shan sudden pain" to the end of the chapter is found in *Ling Shu*, Volume 5, Chapter 23, "Re Bing" (Heat Diseases). Furthermore, the entire content from the beginning to the end of the chapter is also found in *Jia Yi Jing* (The Systematic Classic of Acupuncture and Moxibustion), Volume 9, Chapter 2.

Jue Heart Pain (Jue Xin Tong) characterized by pain pulling the back, feeling as if something is touching the heart from behind, accompanied by stooping or curvature of the spine, is Kidney Jue Heart Pain (Shen Xin Tong). First, select Jinggu (BL-64) and Kunlun (BL-60); if needling does not resolve it, then select Rangu (KI-2). (The Foot-Shaoyin Kidney Meridian penetrates the spine, belongs to the Kidney, and connects with the Heart. Thus, when Kidney Qi rebels, it causes heart pain that pulls the back. Since the Kidney is located posteriorly, Kidney heart pain feels like an object touching the heart from behind causing pain, resulting in a curved spine. Jinggu is located below the large bone on the lateral side of the foot at the junction of red and white flesh; it is where the Foot-Taiyang Bladder Meridian passes. Kunlun is located above the external malleolus and calcaneus; it is where the Foot-Taiyang Bladder Meridian runs. Rangu is located below the prominent bone anterior to the internal malleolus; it is where the Foot-Shaoyin Kidney Meridian flows. Therefore, all points for Kidney Jue Heart Pain are selected here.)

Jue Heart Pain characterized by abdominal distension, chest fullness, and severe heart pain is Stomach Jue Heart Pain (Wei Xin Tong). Select Dadu (SP-3) and Taibai (SP-3). (The Foot-Yangming Stomach Meridian belongs to the Stomach and connects with the Spleen. The Foot-Taiyin Spleen Meridian flows into Dadu, located in the depression distal to the metatarsophalangeal joint of the great toe; it pours into Taibai, located in the depression below the medial malleolar bone. A branch diverges upward through the diaphragm and pours into the Heart. The Spleen and Stomach govern water and grain; excess water and grain lead to abdominal distension and increased chest fullness. This is a Fu organ disease treated by selecting the Shu points of the Zang organs.)

Jue Heart Pain characterized by pain like a cone piercing the heart, with severe heart pain, is Spleen Jue Heart Pain (Pi Xin Tong). Select Rangu (KI-2) and Taixi (KI-3). (Rangu is where the Foot-Shaoyin Kidney Meridian flows, located in the depression below the prominent bone anterior to the internal malleolus; Taixi is where the Foot-Shaoyin Kidney Meridian pours, located in the arterial depression above the internal malleolus [Note: Commentary corrects 'external' to 'internal']. Both are Flowing and Pouring points of the Foot-Shaoyin Kidney Meridian. When Spleen Qi overacts on the Heart causing pain, one can treat the Spleen's Shu point. However, treating the Foot-Shaoyin Kidney Meridian points here is because Spleen is Earth and Kidney is Water; Earth should control Water, but Water counter-attacks Spleen Earth, causing Spleen pathology affecting the Heart. Thus, distant points from the disease source are selected.)

Jue Heart Pain characterized by a pale cyan complexion resembling death, and inability to sigh deeply throughout the day, is Liver Jue Heart Pain (Gan Xin Tong). Select Xingjian (LR-2) and Taichong (LR-3). ("Cang cang" refers to cyan color, indicating Liver disease. Inability to sigh deeply occurs because the Liver governs inhalation; now inhalation causes pain, preventing exhalation and deep sighing. Taichong is located two cun distal to the metatarsophalangeal joint of the great toe in the depression; it is where the Foot-Jueyin Liver Meridian pours.)

Jue Heart Pain that alleviates when lying down or changing location, worsens with movement, and shows no change in complexion is Lung Jue Heart Pain (Fei Xin Tong). Select Yuji (LU-10) and Taiyuan (LU-9). (The Lung governs Qi, which moves freely. Moving Qi overacting on the Heart causes heart pain that alleviates when lying down or moving to another place. Because Qi moves, the pain is intermittent. Movement increases Qi flow, aggravating the diseased area, so pain worsens. Lung Qi is a minor pathogen for the Heart and cannot alter the complexion. Yuji is located in the scattered vessels medial to the metacarpophalangeal joint of the thumb; it is where the Hand-Taiyin Lung Meridian stays. Taiyuan is located in the depression posterior to the palm; it is where the Hand-Taiyin Lung Meridian pours.)

True Heart Pain (Zhen Xin Tong) characterized by cold limbs extending to the elbows and knees, severe heart pain, death if onset occurs in the morning and resolves in the evening, or death if onset occurs in the evening and resolves in the next morning. (The Heart does not accept pathogens easily. If severely affected, pain gathers in the Heart, and Qi also gathers in the Heart, causing cold limbs and rapid death.)

Heart pain that cannot be needled indicates the presence of substantial accumulation within; Shu points should not be selected. If there are intestinal parasites (Chong Jia) or Jiao Tong (intestinal worms), small needles must not be used. (When heart pain is severe, selecting Shu points is ineffective because there are intestinal parasites. Long worms in the intestine can be pressed manually and treated with large needles, not small ones.)

Heart and abdominal pain characterized by swelling and accumulation due to parasite clustering, pain moving up and down, pain with intervals of cessation, abdominal heat, thirst, and salivation is Jiao Tong disease. Press and hold firmly with the hand to immobilize the mass, allow it to move slightly, then use a large needle. Hold the needle for a long time until the worm stops moving, then withdraw the needle. This abdominal pain presents with a bulging shape in the center. ("Tong" refers to clustering. Inside the heart and abdomen, parasites cluster causing painful distress. After feeding, they cluster like swelling. They disperse after eating, hence the pain ceases. They disturb the Stomach, causing heat, thirst, and salivation. If parasites combine, it is called Tong. Tong also means fullness. Parasites clustering in the heart and abdomen cause fullness, rising like swelling, hence described as "shape in the middle and upper.")

Heart pain radiating to the waist and spine with desire to vomit: select the Foot-Shaoyin Meridian. (The Foot-Shaoyin Meridian travels along the waist and spine, ascending to the Heart. Thus, heart pain radiating to the waist and spine with nausea is treated by selecting Shu points of the Shaoyin Meridian.)

Heart pain with abdominal distension, aversion to cold, and difficult defecation: select the Foot-Taiyin Meridian. (The Foot-Taiyin Meridian governs the abdomen, so Shu points of the Foot-Taiyin Meridian are selected. "Se se" describes aversion to cold.)

Heart pain radiating to the back with dyspnea: needle the Foot-Shaoyin Meridian; if ineffective, select the Hand-Shaoyang Meridian. (The Foot-Shaoyin Meridian penetrates the spine and connects with the Heart; the Hand-Shaoyang Sanjiao Meridian governs Sanjiao Qi. Thus, heart pain radiating to the back with dyspnea is treated by selecting Shu points of these two meridians.)

Heart pain with lower abdominal fullness, pain moving irregularly, and difficulty in urination and defecation: needle the Foot-Jueyin Meridian. (The Foot-Jueyin Meridian circles the genitalia and reaches the lower abdomen. Thus, lower abdominal fullness and difficulty in urination/defecation are treated by selecting Shu points of this meridian.)

Heart pain characterized only by shortness of breath and insufficient respiration: needle the Hand-Taiyin Meridian. (The Hand-Taiyin Meridian governs respiration; thus, shortness of breath is treated by selecting its therapeutic Shu point.)

Heart pain: needle the ninth vertebral segment. If ineffective, needle and press the area for immediate relief. If still ineffective, search above and below; upon finding the responsive point, needle for immediate relief. (The *Ming Tang* states that the bilateral points below the ninth vertebra are Liver Shu points, and the central point is Jinsuo, neither indicated for heart pain. This text indicates treatment via these points. If needling this segment fails, search the dorsal Shu points above and below for those effective for heart pain.)

Xin Shan (Heart Hernia) with sudden severe pain: select the Foot-Taiyin and Foot-Jueyin Meridians, and thoroughly needle away blood collaterals. (The Foot-Taiyin Meridian pours into the Heart; the Foot-Jueyin Meridian flows from the Liver to the Lung. Thus, sudden heart hernia pain is treated by selecting these two meridians and removing blood from their collaterals.)