This refers to epigastric pain (Wei Wan Tong), which must be treated differently based on whether the condition is recent or chronic. If it is clearly known to be caused by Cold, initial treatment should employ warming and dispersing methods; if the disease persists and leads to Qi stagnation (Qi Yu), which generates Heat and transforms into Fire, Gardenia Fruit (Shan Zhi) should be used as the sovereign herb, with warm herbs serving as guides (directing agents).

For pain in the stomach opening caused by Heat, Gardenia Fruit is indispensable; it must be assisted with Ginger Juice, and a large amount of Taixiong (a variety of Chuanxiong Rhizoma) should be used to open stagnation, or Er Chen Tang (Two-Cured Decoction) combined with Chuanxiong Rhizoma (Chuan Xiong) and Atractylodes Rhizoma (Cang Zhu), with doubled amounts of fried Gardenia Fruit (Chao Shan Zhi); if the pain is severe, fried Dried Ginger (Chao Gan Jiang) should be added, following the principle of contrary treatment (Fan Zhi Fa). If one habitually consumes hot-natured foods, leading to fixed blood (Si Xue / Stasis) remaining in the stomach opening causing pain, Tao Ren Cheng Qi Tang (Peach Kernel Magnolia Bark Decoction) should be used to purge; for milder cases, Leek Juice (Jiu Zhi) and Platycodon Root (Jie Geng) can be used concurrently within formulas that regulate Qi and Blood. If pressing the painful area with an object alleviates the pain, it indicates a deficiency pattern; Er Chen Tang (Two-Cured Decoction) combined with fried Dried Ginger (Chao Gan Jiang) should be used to harmonize. For worm-induced pain, characterized by white patches on the face, red lips, and good appetite, drugs such as Melia Root (Liu Gen) and Black Tin Ash (Hei Xi Hui) are appropriate. Pain that allows eating immediately after cessation, with intermittent occurrences, suggests worms: during the first half of the lunar month, when the worm's head faces upward, it is easier to treat; during the second half, when the head faces downward, it is difficult. First, consume meat broth or sugar/honey to guide the worms upward, then administer medication. The vermifuge formula consists of Melia Root (Liu Gen), Areca Seed (Bing Lang), and Pyrethrum Flower (He Shi); in summer, drink the juice; in winter, decoct a strong soup and take with Wan Ling Wan (Ten Thousand Spirit Pill), which is best. For a solid pulse accompanied by constipation, purgation is indicated; for severe pain where the pulse is likely hidden (Fu), warm herbs such as Aconite Root (Fu Zi) are suitable. Do not use Ginseng Radix (Ren Shen) or Atractylodes Macrocephala Rhizoma (Bai Zhu), as tonifying Qi is contraindicated for various pains. For epigastric pain due to Qi deficiency, Cao Dou Kou Wan (Grass Cardamom Pill) is used. For hernia pain affecting the heart, stomach, abdomen, and hypochondrium, Er Chen Tang (Two-Cured Decoction) combined with Ginseng Radix (Ren Shen), Atractylodes Macrocephala Rhizoma (Bai Zhu), and various aromatic herbs is effective. For heart-hypochondriac pain, Dried Ginger (Gan Jiang) has subtle effects; Spurge Root (Yuan Hua) fried with vinegar, mixed in equal parts and powdered, formed into honey pills, taken in small quantities, is effective. For pain aggravated by drinking hot liquids, Coptis Rhizome (Huang Lian) and Kansui Root (Gan Sui) made into pills should be taken. For epigastric pain caused by fluid retention (Ting Yin) or cold pain in winter, Gui Huang Wan (Cinnamon-Gardenia Pill) is used. For extreme heart pain, ancient formulas suggest eating dough boiled in Rehmannia Root (Sheng Di Huang) juice, which effectively expels worms. For stomach deficiency with cold invasion causing severe heart and abdominal pain in those with weak Qi, Li Zhong Tang (Regulate the Middle Decoction) is indicated. For internal injury fever with loss of appetite and stomach deficiency pain, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) combined with Grass Cardamom Seed (Cao Dou Kou) is used. For heart Qi pain, Tian Xiang San (Heavenly Fragrance Powder) consists of Angelica Dahurica Root (Bai Zhi), Aconite Root (Chuan Wu), Arisaema Rhizome (Nan Xing), and Pinellia Tuber (Ban Xia). For elderly patients with severe heart/abdominal pain, a surging yet deficient pulse, coma, inability to eat, who cannot tolerate aggressive single-herb treatments, Si Jun Zi Tang (Four Gentlemen Decoction) combined with Dang Gui, Ephedra Stem (Ma Huang), and Agarwood (Chen Xiang) is prescribed. For severe pain in the heart/diaphragm radiating to the waist and back with fainting and inability to retain food/medicine, induce vomiting via probing during emesis; once about a bowl of phlegm accumulation is expelled, the pain stops naturally. For obese individuals with epigastric pain (heart pain) or stagnant Qi in the Zhongwan point, Cao Dou Kou Wan (Grass Cardamom Pill) is used: White Cardamom Seed (Bai Dou Kou, 3 qian), Atractylodes Rhizoma (Bai Zhu), Burreed Tuber (San Leng), Grass Cardamom Seed (Cao Dou Kou), Pinellia Tuber (Ban Xia, 1 liang each), Amomum Fruit (Sha Ren), Turmeric Rhizome Pian (Pian Jiang Huang), Immature Bitter Orange (Zhi Shi), Green Tangerina Peel (Qing Pi), Galangal Rhizome (Liang Jiang, alternatively Dried Ginger), Tangerine Peel (Chen Pi), Cinnamon Bark (Gui Pi), Clove (Ding Xiang), Curcuma Tuber (Peng Zhu), Aucklandia Root (Mu Xiang), Patchouli Leaf (Huo Xiang), and Xiao Cao (5 qian each). Form into pills using Ginger Juice and steamed wheat cake, take 60–70 pills with plain water. Hei Wan (Black Pill) treats epigastric pain: Sour Plum (Wu Mei, pitted), Apricot Seed (Xing Ren, peeled and de-seeded), Croton Seed (Ba Dou, peeled, membrane removed, oil extracted), Amomum Fruit (Sha Ren, 14 seeds each), soot from kitchen chimneys (Bai Cao Shuang, 2 qian), Pinellia Tuber (Ban Xia, 21 pieces). Pound into pills, take several pills at a time. Bei Ji Wan (Emergency Aid Pill) treats sudden heart/abdominal pain and chest fullness from food impaction: Rhubarb (Da Huang, 1 qian), Croton Seed (Ba Dou, oil removed, 5 fen), Dried Ginger (Gan Jiang, 5 fen). Honey-pill, take 3–5 pills. If the medicine acts quickly upon swallowing to relieve heart pain, but hiccups occur after drinking water, there is fixed blood (stasis) inside; purge with Tao Ren Cheng Qi Tang (Peach Kernel Magnolia Bark Decoction). A rapid pulse on the left hand indicates excess heat; a choppy pulse indicates fixed blood; a solid pulse on the right hand indicates phlegm accumulation; a large pulse indicates chronic disease. Heart pain formula: Cornus Fruit (Zhu Yu, washed in boiling water), Gardenia Fruit (Shan Zhi, fried and husked), Coptis Rhizome (Huang Lian, fried), Talcum (Hua Shi, 5 qian each), Lychee Seed (Li He, burnt to retain character, 3 qian). Powder these, form pills with Ginger Juice and steamed wheat cake. Another formula: Powder fried Gardenia kernel, take with Ginger Tea; for cold pain, add fried Grass Cardamom Seed powder pills. Another formula: Atractylodes Macrocephala Rhizoma (Bai Zhu, 5 qian), White Peony Root (Bai Shao Yao), Amomum Fruit (Sha Ren), Pinellia Tuber (Ban Xia, soaked in boiling water, 3 qian each), Dang Gui, Peach Kernel (Tao Ren), Coptis Rhizome (Huang Lian, de-stamen), Medicated Leaven (Shen Qu, fried), Tangerine Peel (Chen Pi, 2 qian each), Evodia Fruit (Wu Zhu Yu, 1.5 qian), Silkworm (Jiang Can, fried), Cornus Fruit (Zhu Yu, 1 qian), Gardenia Fruit (Shan Zhi, husked, fried until scorched, 6 qian). Powder these, form pills like peppercorns using steamed wheat cake, wash with Rehmannia Root wine, decoct with fresh ginger, take 20 pills with the decoction. Alternatively, use Long Pepper (Bi Bo, 0.5 liang) powdered, mixed with vinegar into balls to swallow. Another formula: Cinnamon Twig (Gui Zhi), Ephedra Stem (Ma Huang), Alkali Stone (Shi Jian) in equal parts, powdered, soaked in Ginger Juice, formed into pills with steamed wheat cake, take 15 pills with hot, spicy Ginger Soup; this mostly treats "bing tong" (likely a specific type of pain). Another formula: Vitex Fruit (Huang Jing Zi) fried until scorched, powdered, taken with rice drink. Another formula: Calcined Shellfish Powder (Ha Fen), Cyperus Rhizome (Xiang Fu) powder, decoct Ligusticum Rhizome (Chuan Xiong) and Gardenia Fruit (Shan Zhi), mix with Ginger Juice, and take while hot and spicy. Another formula: Pinellia Tuber (Ban Xia) chopped, fried in sesame oil, powdered, formed into pills with Ginger Juice and steamed wheat cake, take 20 pills with Ginger Soup; also treats wheezing. In treating Qi pain involving the whole body cavity, a small amount of Aucklandia Root (Mu Xiang) must be added to the formula to ensure unblocking. Cao Dou Kou Wan (Grass Cardamom Pill) is suitable for stomach pain caused by external Cold invading the stomach, and can also stop heat pain; take one or two doses: Grass Cardamom Seed (Cao Dou Kou, wrapped in flour and baked, 1.4 qian), Evodia Fruit (Wu Zhu Yu, washed and dried), Alpinia Oxyphylla Fruit (Yi Zhi Ren), Ginseng Radix (Ren Shen), Astragalus Root (Huang Qi), White Silkworm (Bai Jiang Can), Tangerine Peel (Ju Pi, 8 fen each), Raw Licorice Root (Sheng Gan Cao), Roasted Licorice Root (Zhi Gan Cao), Dang Gui Body (Dang Gui Shen), Green Tangerina Peel (Qing Pi, 6 fen each), Turmeric Rhizome Pian (Pian Jiang Huang), Medicated Leaven (Shen Qu, fried), Bupleurum Root (Chai Hu, 4 fen each), Pinellia Tuber (Ban Xia, soaked in boiling water), Alisma Rhizome (Ze Xie, 1 qian), Barley Sprout (Mai Ya, fried, 1.5 qian), Peach Kernel (Tao Ren, 7 seeds, soaked in boiling water, peeled and de-seeded). Except for Peach Kernel which is ground separately into a paste, powder the rest, mix evenly, form pills with steamed wheat cake soaked in water, size of Sophora seeds, take 50–70 pills after meals with plain water. Adjust dosage based on disease progression; reduce Alisma Rhizome (Ze Xiei) by half if urination is frequent; adjust Bupleurum Root (Chai Hu) according to the severity of hypochondriac pain. Cao Dou Kou Wan (Grass Cardamom Pill) is excellent for heart pain due to depleted Qi and weakness. Qing Dai (Indigo Naturalis) treats heart heat pain and worm pain; mix with Ginger Juice in decoction, or crush Indigo Leaf (Lan Ye) for juice and mix with Ginger Juice to take. If no medicine is available, fill a small bottle with water, place salt on a knife blade, heat the blade red-hot in fire, quench it in the water, and have the patient drink it hot. If heart pain treated with Gardenia Fruit and strong analgesics recurs after relief, previous medicines will fail; take Xuan Ming Fen (Mirabilite) once to stop it immediately. Hai Fen (Sea Powder) mixed with Cyperus Rhizome (Xiang Fu) powder and taken with Ginger Juice can treat heart pain, but should not be decocted. For internal injury fever, loss of appetite, and stomach opening pain, use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) plus Grass Cardamom Seed (Cao Dou Kou); for heat pain, add Gardenia Fruit (Shan Zhi). For heart pain with excess Qi, use single-herb Oyster Shell (Mu Li) powdered, mixed with wine, take 2 qian. For pain caused by food injuring the stomach opening, use digestive methods. For pain caused by blood stasis remaining in the stomach opening, use blood-breaking herbs. For heart ache with phlegm, dissolve Alum (Ming Fan) and form pills the size of Euryale Seed (Qian Shi), swallow one pill with hot Ginger Juice. Case 1: Choppy pulse, frequent heart/spleen pain; use Bai Zhu, Ban Xia, Cang Zhu, Zhi Shi, Shen Qu, Xiang Fu, Fu Ling, Taixiong, powder them, form pills with Shen Qu paste. Case 2: Heart pain and hernia pain; fried Shan Zhi, Xiang Fu (1 liang each), Cang Zhu, Shen Qu, Mai Ya (5 qian each), Ban Xia (7 qian), Wu Mei, Shi Jian (3 qian each), Gui Zhi (1.5 qian). Powder, form pills with Ginger Juice and steamed wheat cake, take 100 pills with Ginger Soup. Remove Gui Zhi in winter. Case 3: After drinking hot wine/eating, experienced chest blockage and pain with fixed blood; use Bai Zhu, Bei Mu, Mai Ya, Xiang Fu, Gua Lou, Tao Ren, Xing Ren, Mu Dan Pi, Sheng Gan Cao, Ge Gen, Shan Zhi, Huang Qin, Hong Hua, Bi Cheng Qie. Powder, take as pills or powder as desired. Other treatments are detailed in *Yi Yao*.