古传心痛有九，循其名而责其实，纤毫难溷（混）。一曰虫，凡痛脉多伏，今反洪数者，虫也。厥名曰蛔，
长寸许，首尾通红，踞于心窝子，吮血吸精，伤心之患，莫惨于是。以雄黄、槟榔、白矾为丸，杀之而痛自除。
二曰疰，疰者，自上注下也，令人沉沉默默，心中隐隐作病，甚有疰至
灭门户而莫名其病者。脉则乍短乍长，乍涩乍细，非寻常药饵所能疗，惟苏合丸（麝香、沉香、丁香、檀香、
香附、荜茇、白术、诃子、朱砂、青木香、乌犀角各二两，薰陆香、龙脑各一两，安息香二两，另为末，用无
灰酒熬膏，上为末，用安息香膏加炼蜜为丸，每两十九，蜡包裹，温水化服）、阿魏膏（楂肉、胆星、法夏、
麦芽、神曲、黄连、连翘、阿魏、蒌仁、贝母、风化硝、枯碱、萝卜子、胡黄连，上为末，姜汤浸，蒸饼为丸。
相其本体之强弱寒热，体强而热，阿魏丸；体弱而寒，苏合丸），庶可以治。三曰风，风得火而益炽，火得风
而愈威。风而入于心，则痛之猝者也。其脉浮紧而数，以白菊、白矾为君，侯氏黑风散（白菊五钱，白矾钱半，
防风、白术、桔梗八分，人参、茯苓、秦归、川芎、干姜、细辛、牡蛎三分，共为末，温酒调），可采也。
四曰悸，有触而惊曰惊，无触而惊曰悸，悸而至于痛，则悸之甚者也。其脉虚而滑，加乳香、没药为使，李氏
养心汤（黄 、茯苓、秦归、川芎、法夏、甘草、柏子仁、枣仁、远志、五味、人参、肉桂、乳香、没药、姜
枣引），盍用之。五曰食，食入于胃，停滞未化，攻冲作痛，其脉短而涩，平胃散（苍术、浓朴、陈皮、炙草），
洵为对症之方。六曰饮，饮入于胃，攻注无常，激射作痛，其脉濡而迟，五苓散（猪苓、茯苓、焦术、泽泻、
肉桂）实为导水之剂。七曰冷，寒气犯于绛宫，脉则或迟或结，吴萸、川椒、砂仁、木香，止痛，书，何难共
证（经验方∶木香、砂仁、肉桂，等分为末，每服五分）。八曰热，火气郁于胸膈，脉则或数或促，生地、栀
子、黄连、苦楝，除痛药，确有明文
（经验方∶黑栀仁一两，干姜一钱五分，炙草一钱五分）。九曰去来痛，经脉周流，有碍则痛，过其所碍而旋
止，巡至所碍而复发。气充血足，何碍之有，不必诊脉，补之可也（经验方∶黄 、焦术、肉桂、秦归、法夏、
陈皮、茯苓、炙草、姜枣引。）顾同是心气痛也，以虫之伤人最酷者，居首；以疰之伤人最隐者，居二；以风
之伤人最速者，居三；以悸之介在可以伤，可以无伤者，居四；以饮、食之不轻伤人者，居五六；以寒、热之
恒有者，居七八；以去来痛之人皆知而能治者，居九。想古人位置之宜，亦大费踌躇矣。然名则列之有九，而
义实本之于经。曰虫痛者，经言蛔 心腹痛也；曰疰痛者，如飞尸、遁尸之类也；曰风痛者，经言肝心痛也；
曰悸痛者，手少阴之脉，起于心中也；曰食痛、饮痛者，足太阴之脉，其支上膈注心中也；曰冷痛者，寒气客
于背俞，注于心也；曰热痛者，寒气客于经脉，与热相薄也；曰去来痛者，经言气不宣通也。要皆非真心痛
也，若真心痛，手足冷至节，旦发夕死，夕发朝亡，彼医家所传之方，大半言止冷痛；本草所注之性，间有止
热痛之语。夫冷热之痛，病之最浅而最易辨者，诸书尚且聚讼，何况痛之至隐而至僻者乎。领会《灵》、《素
》微词，才是医家学问；变化本草训语，方知用药权衡。
古代流传的心痛分为九种，顺着名称去探究其实质，细微之处都难以混淆。第一种是虫痛，凡是疼痛的脉象多沉伏，现在反而洪大数急的，是虫痛。它的别名叫做蛔虫，长约一寸左右，头尾通红，盘踞在心窝处，吸食血液精华，伤害心脏的祸患，没有比这更惨痛的。用雄黄、槟榔、白矾制成丸药，杀死虫子后疼痛自然消除。
第二种是疰痛，疰，是从上往下注染的意思，让人神情沉闷抑郁，心中隐隐作痛，甚至有疰气传入导致门户封闭而不知是什么病的。脉象时而短促时而长，时而涩滞时而细弱，不是寻常药物所能治疗的，只有苏合丸（麝香、沉香、丁香、檀香、香附、荜茇、白术、诃子、朱砂、青木香、乌犀角各二两，薰陆香、龙脑各一两，安息香二两，另研为末，用无灰酒熬成膏，将上述药末加入安息香膏和炼蜜制成丸药，每两重十九丸，蜡包裹，温水送服）、阿魏膏（山楂肉、胆南星、法半夏、麦芽、神曲、黄连、连翘、阿魏、瓜蒌仁、贝母、风化硝、枯碱、萝卜子、胡黄连，以上研为末，姜汤浸泡，蒸饼为丸。根据患者本身体质的强弱寒热来选用，体质强且热的用阿魏丸；体质弱且寒的用苏合丸），才可以治疗。
第三种是风痛，风得到火就会更加炽盛，火得到风就会更加威猛。风邪侵入心脏，就会导致猝然发作的疼痛。其脉象浮紧而数，以白菊、白矾为主药，侯氏黑风散（白菊五钱，白矾一钱半，防风、白术、桔梗八分，人参、茯苓、当归、川芎、干姜、细辛、牡蛎三分，共研为末，温酒调服），可以采用。
第四种是悸痛，受到触动而惊恐叫惊，没有受到触动而惊恐叫悸，悸动进而发展到疼痛，就是悸动的严重情况。其脉象虚而滑，加乳香、没药作为使药，李氏养心汤（黄芪、茯苓、当归、川芎、法半夏、甘草、柏子仁、酸枣仁、远志、五味子、人参、肉桂、乳香、没药，生姜大枣为引），为何不使用呢？
第五种是食痛，食物进入胃中，停滞未消化，攻冲引起疼痛，其脉象短而涩，平胃散（苍术、厚朴、陈皮、炙甘草），确实是对症的方剂。
第六种是饮痛，水饮进入胃中，攻注无常，激射引起疼痛，其脉象濡而迟，五苓散（猪苓、茯苓、焦白术、泽泻、肉桂）实在是引导水湿的药剂。
第七种是冷痛，寒气侵犯心脏（绛宫指心），脉象或迟或结，吴茱萸、川椒、砂仁、木香，可以止痛，书籍记载，何难共同验证（经验方：木香、砂仁、肉桂，等分为末，每次服用五分）。
第八种是热痛，火气郁结在胸膈，脉象或数或促，生地、栀子、黄连、苦楝，是除痛的药物，确有明确记载（经验方：黑栀子仁一两，干姜一钱五分，炙甘草一钱五分）。
第九种是往来痛，经脉气血周流全身，有阻碍就疼痛，经过阻碍处后又停止，巡行至阻碍处又复发。气血充盛充足，有什么阻碍呢？不必诊脉，补益即可（经验方：黄芪、焦白术、肉桂、当归、法半夏、陈皮、茯苓、炙甘草，生姜大枣为引）。
同样是心气痛，因为虫伤人最残酷，所以排在首位；因为疰伤人最隐蔽，所以排在第二位；因为风伤人最迅速，所以排在第三位；因为悸介乎于可以伤也可以不伤之间，所以排在第四位；因为饮、食不轻易伤人，所以排在第五、六位；因为寒、热是恒常存在的，所以排在第七、八位；因为往来痛人人都知道并能治疗，所以排在第九位。想古人排列位置的适宜性，也费了一番斟酌啊。然而名称虽然列出九种，但义理实际上源于经典。说虫痛，经典说蛔虫引起心腹痛；说疰痛，像飞尸、遁尸之类；说风痛，经典说肝心痛；说悸痛，手少阴心经，起于心中；说食痛、饮痛，足太阴脾经，其分支上行穿过膈肌注入心中；说冷痛，寒气客居在背俞穴，注入心脏；说热痛，寒气客居在经脉，与热气相搏结；说往来痛，经典说气机不宣通。这些都不是真心痛，如果是真心痛，手脚冰冷至关节，早上发病晚上死亡，晚上发病早上死亡，那些医家所传的方子，大半说的是止冷痛；本草所注的药性，间或有止热痛的语句。至于冷热之痛，是病情最浅显最容易辨别的，各种书籍尚且争论不休，何况疼痛最为隐蔽偏僻的呢？领会《灵枢》、《素问》的微言大义，才是医家的学问；变化运用本草的训诫语言，才知道用药的权衡之道。
Ancient traditions classify heart pain into nine types. Examining their names to investigate their realities, even the slightest details are difficult to confuse. The first is worm pain. Generally, pain pulses are often hidden (Fu pulse), but now they are surging and rapid (Hong-Shu pulse), indicating worms. Its alias is Ascaris (Hui), approximately one cun in length, with a red head and tail, residing in the epigastrium, sucking blood and essence. No harm to the heart is more tragic than this. Using Realgar (Xionghuang), Areca Seed (Binglang), and Alum (Baifan) made into pills kills the worms, and the pain naturally ceases.
The second is Zhu (infectious/contagious) pain. "Zhu" means transmitting from above downwards, causing lethargy and silence, with a dull ache in the heart. In severe cases, the pathogen may enter and close the doors, leaving one unaware of the illness. The pulse may be suddenly short or long, suddenly choppy or fine. It cannot be treated by ordinary medicines; only Suhexiang Wan (Suhexiang Pill: Musk, Agarwood, Clove, Sandalwood, Cyperus Rhizome, Long Pepper, Atractylodes Macrocephala Rhizome, Chebula Fruit, Cinnabar, Liquidambar Resin, Water Buffalo Horn each 2 liang, Frankincense, Borneol each 1 liang, Benzoin 2 liang, separately ground into powder, boiled with pure wine to make a paste, mixed with the other powders and refined honey into pills, each liang yields nineteen pills, wrapped in wax, taken dissolved in warm water) andawei Gao (Awei Paste: Hawthorn Flesh, Arisaema Cum Bile, Pinellia Preparata, Malt, Medicated Leaven, Coptis Rhizome, Forsythia Fruit, Asafoetida, Trichosanthes Seed, Fritillaria Bulb, Efflorescent Mirabilite, Calcined Alkali, Radish Seed, Picrorhiza Rhizome, all ground into powder, soaked in ginger juice, formed into pills with steamed bread dough) can treat it. One must select based on the patient's constitution: if strong and hot, use Awei Wan; if weak and cold, use Suhexiang Wan.
The third is wind pain. Wind becomes fiercer with fire, and fire becomes more vigorous with wind. When wind enters the heart, sudden pain occurs. The pulse is floating, tight, and rapid. Using White Chrysanthemum (Baiju) and Alum (Baifan) as chief herbs, Hou's Black Wind Powder (Hou's Heifeng San: White Chrysanthemum 5 qian, Alum 1.5 qian, Saposhnikovia Root, Atractylodes Macrocephala Rhizome, Platycodon Root 8 fen, Ginseng, Poria, Angelica Sinensis, Ligusticum Wallichii Rhizome, Dried Ginger, Asarum, Oyster Shell 3 fen, all ground into powder, taken with warm wine) can be adopted.
The fourth is palpitation pain. Palpitation caused by external stimulation is called Jing (fright); palpitation without external stimulation is called Ji (palpitation). When palpitation progresses to pain, it is severe palpitation. The pulse is deficient and slippery. Adding Frankincense (Ruxiang) and Myrrh (Moyao) as assistant herbs, Li's Nourishing Heart Decoction (Li's Yangxin Tang: Astragalus Membranaceus Root, Poria, Angelica Sinensis, Ligusticum Wallichii Rhizome, Pinellia Preparata, Licorice Root, Biota Seed, Ziziphus Jujuba Seed, Polygala Root, Schisandra Berry, Ginseng, Cinnamon Twig, Frankincense, Myrrh, taken with Ginger and Jujube) should be used.
The fifth is food stagnation pain. Food enters the stomach, stagnates, and fails to digest, attacking and causing pain. The pulse is short and choppy. Pingwei San (Pingwei Powder: Atractylodes Rhizome, Magnolia Bark, Tangerine Peel, Honey-fried Licorice Root) is indeed the appropriate formula.
The sixth is fluid retention pain. Fluids enter the stomach, move unpredictably, and cause shooting pain. The pulse is soggy and slow. Wuling San (Wuling Powder: Polyporus, Poria, Roasted Atractylodes Rhizome, Alisma Rhizome, Cinnamon Twig) is truly a diuretic agent.
The seventh is cold pain. Cold qi invades the heart (Jianggong refers to the heart). The pulse may be slow or knotted. Evodia Fruit, Sichuan Pepper, Amomum Fruit, and Costus Root relieve pain. This is confirmed in texts (Empirical Formula: Costus Root, Amomum Fruit, Cinnamon Twig, equal parts ground into powder, take 5 fen per dose).
The eighth is heat pain. Fire qi stagnates in the chest and diaphragm. The pulse may be rapid or hurried. Rehmannia Root, Gardenia Fruit, Coptis Rhizome, and Melia Azedarach Root Bark are pain-relieving drugs, clearly documented (Empirical Formula: Black Gardenia Seed 1 liang, Dried Ginger 1.5 qian, Honey-fried Licorice Root 1.5 qian).
The ninth is wandering pain. Meridian qi flows throughout the body; obstruction causes pain, cessation occurs after passing the obstruction, and recurrence happens when reaching the obstruction again. If qi and blood are abundant, there is no obstruction. Pulse diagnosis is unnecessary; tonification suffices (Empirical Formula: Astragalus Membranaceus Root, Roasted Atractylodes Rhizome, Cinnamon Twig, Angelica Sinensis, Pinellia Preparata, Tangerine Peel, Poria, Honey-fried Licorice Root, taken with Ginger and Jujube).
Although all are heart qi pains, worm pain is placed first because it is the most cruel; Zhu pain is second because it is the most hidden; wind pain is third because it acts fastest; palpitation pain is fourth because it ranges between harmful and harmless; food and fluid pain are fifth and sixth because they rarely harm severely; cold and heat pains are seventh and eighth because they are constant; wandering pain is ninth because everyone knows how to treat it. The ancients' arrangement required considerable deliberation. However, although nine names are listed, their meanings originate from the Classics. Worm pain corresponds to the Classic's statement on Ascaris causing heart and abdominal pain; Zhu pain corresponds to conditions like Flying Corpse or Escaping Corpse; wind pain corresponds to the Classic's "Liver Heart Pain"; palpitation pain corresponds to the Hand Shaoyin Heart Meridian originating in the heart; food and fluid pain correspond to the Foot Taiyin Spleen Meridian branch ascending through the diaphragm to the heart; cold pain corresponds to cold qi lodging in the Back-Shu points and injecting into the heart; heat pain corresponds to cold qi lodging in the meridians clashing with heat; wandering pain corresponds to the Classic's statement on qi failing to circulate freely. None of these are True Heart Pain. True Heart Pain presents with cold limbs extending to the joints, death within a day if onset in the morning, or death within a day if onset in the evening. Most formulas transmitted by physicians address cold pain; Materia Medica notes occasionally mention relieving heat pain. For cold and heat pain, which are the shallowest and easiest to differentiate, various books still debate extensively. How much more so for pain that is deeply hidden and obscure? Grasping the subtle words of the *Ling Shu* and *Su Wen* constitutes medical scholarship; mastering the application of Materia Medica principles reveals the balance of medication.