心胃疼 有九种 真心痛不治。今所云心痛者，皆心胞络及胃脘痛也。共有九种，宜细辨之。
辨虚实 明轻重 虚者喜按，得食则止，脉无力。实者拒按，得食愈痛，脉有力。二症各有轻重。
痛不通 气血壅 痛则不通，气血壅滞也。
通不痛 调和奉 通则不痛，气血调和也。高士宗云∶通之之法，各有不同。调气以和
血，调血以和气，通也。上逆者使之下行，中结者使之旁达，亦通也。虚者助之使通，寒者
温之使通，无非通之之法也。若必以下泄为通，则妄矣。
一虫痛 乌梅丸 虫痛，时痛时止，唇舌上有白花点，得食愈痛。虫为厥阴风木之化，宜乌梅丸。
二注痛 苏合研 入山林古庙及见非常之物，脉乍大乍小，两手若出两人，宜苏合丸，研而灌之。
三气痛 香苏专 因大怒及七情之气作痛，宜香苏饮，加元胡索二钱，七气汤亦妙。又
方，用百合一两、乌药三钱，水煎服。
四血痛 失笑先 瘀血作痛，痛如刀割，或有积块，脉涩，大便黑，宜桃仁承气汤、失笑散。
五悸痛 妙香诠 悸痛，即虚痛也。痛有作止，喜按，得食稍止，脉虚弱，宜妙香散或
理中汤，加肉桂、木香主之。
六食痛 平胃煎 食积而痛，嗳腐吞酸，其痛有一条扛起者，宜平胃散，加山楂、谷芽
主之，伤酒，再加葛根三钱、砂仁一钱。然新伤吐之、久伤下之为正法。
七饮痛 二陈咽 停饮作痛，时吐清水，或胁下有水声，宜二陈汤，加白术、泽泻主之
。甚者，十枣汤之类，亦可暂服。
八冷痛 理中全 冷痛∶身凉、脉细、口中和，宜理中汤，加附子、肉桂主之。兼呕者
，吴茱萸汤主之。
九热痛 金铃痊 热痛∶身热、脉数、口中热，宜金铃子、元胡索各二两，研末，黄酒
送下二钱。名金铃子散，甚效。如热甚者，用黄连、栀子之类，入生姜汁治之。
腹中痛 照诸篇 脐上属太阴，中脐属少阴，脐下属厥阴，两胁属少阳、厥阴之交界地
面，宜分治之。然其大意，与上相同。
金匮法 可回天 《金匮要略》中诸议论，皆死症求生之法。
诸方论 要拳拳 《中庸》云∶得一善则拳拳服膺，而弗失之矣。腹满痛而下利者，虚
也。吐泻而痛，太阴证也，宜理中汤；雷鸣、切痛、呕吐者，寒气也，宜附子粳米汤。此以
下利而知其虚也。胸满痛而大便闭者，实也。闭痛而不发热者，宜浓朴三物汤专攻其里；闭
痛而兼发热者，宜浓朴七物汤兼通表里；闭痛、发热、痛连胁下、脉紧弦者，宜大黄附子汤
温下并行，此以便闭而知其实也。若绕脐疼痛，名寒疝，乌头煎之峻，不敢遽用，而当归
生姜羊肉汤之妙，更不可不讲也。
又胸痹 非偶然 胸膺之上，人身之太空也。宗气积于此，非偶然也。
薤白酒 妙转旋 栝蒌薤白白酒汤或加半夏或加枳实、薤白桂枝汤之类，皆转旋妙用。
虚寒者 建中填 心胸大寒，痛呕不能饮食，寒气上冲，有头足，不可触近，宜大建中
汤主之。上中二焦，为寒邪所痹，故以参姜启上焦之阳，合饴糖以创建中气，而又加椒性之
下行，降逆上之气，复下焦之阳，为补药主方。
心胃疼痛共有九种类型，其中真心痛无法治愈。现在所说的“心痛”，实际上都是心包络和胃脘部的疼痛。这九种类型需要仔细辨别。
辨别虚实，明确轻重：虚证喜欢按压，进食后疼痛停止，脉象无力；实证拒绝按压，进食后疼痛加剧，脉象有力。这两种症状各有轻重之分。
疼痛是因为气血不通畅，气血发生壅滞导致疼痛；通畅则不疼痛，因为气血调和。高士宗说：“通”的方法各不相同。调理气机以调和血液，调理血液以和气，这就是“通”。上逆的气使其下行，中结的气使其旁达，这也是“通”。虚证通过补益使其通畅，寒证通过温煦使其通畅，无非都是“通”的方法。如果一定要用泻下法作为“通”，那就错了。
第一种是虫痛：使用乌梅丸。虫痛表现为时痛时止，唇舌上有白花点，进食后疼痛加剧。虫痛属于厥阴风木之化，适宜用乌梅丸。
第二种是注痛（中邪气）：使用苏合丸。进入山林古庙或见到异常之物后发病，脉象忽大忽小，两手脉搏感觉像两个人一样，适宜用苏合丸，研碎后灌服。
第三种是气痛：专治用香苏饮。因大怒及七情之气引发的疼痛，适宜用香苏饮，加元胡索二钱，七气汤也很好。另一个方子，用百合一两、乌药三钱，水煎服用。
第四种是血痛：先用失笑散。瘀血引起的疼痛，痛如刀割，或有积块，脉象涩，大便黑色，适宜用桃仁承气汤、失笑散。
第五种是悸痛：妙香散可解。悸痛即虚痛。疼痛时有时无，喜欢按压，进食后稍缓解，脉象虚弱，适宜用妙香散或理中汤，加肉桂、木香为主治疗。
第六种是食痛：平胃散煎服。食积导致的疼痛，嗳气腐臭、吞酸，疼痛有一条线扛起的感觉，适宜用平胃散，加山楂、谷芽为主治疗。如果是伤酒，再加葛根三钱、砂仁一钱。然而新近受伤宜催吐，久积宜泻下，这才是正法。
第七种是饮痛（水饮停聚）：二陈汤咽下。停饮导致的疼痛，时常吐出清水，或胁下有水流声，适宜用二陈汤，加白术、泽泻为主治疗。严重的，十枣汤之类也可以暂时服用。
第八种是冷痛：理中汤周全。冷痛表现为身体凉、脉细、口中平和，适宜用理中汤，加附子、肉桂为主治疗。兼有呕吐的，用吴茱萸汤主治。
第九种是热痛：金铃子散痊愈。热痛表现为身热、脉数、口中热，适宜用金铃子、元胡索各二两，研成末，黄酒送服二钱。名为金铃子散，效果很好。如果热势严重，用黄连、栀子之类，加入生姜汁治疗。
腹部疼痛：参照诸篇论述。脐上属太阴经，脐中部属少阴经，脐下属厥阴经，两胁部属少阳、厥阴经的交界地面，应当分别治疗。但其大意与上述相同。
《金匮要略》的法度：可以挽回生命。《金匮要略》中的各种议论，都是针对死症求生的方法。
各方论述：要诚心牢记。《中庸》说：“得一善则拳拳服膺，而弗失之矣。”腹满痛且下利的，是虚证。吐泻且痛，是太阴证，适宜用理中汤；肠鸣、剧烈疼痛、呕吐的，是寒气，适宜用附子粳米汤。这是通过下利来判断其为虚证。胸满痛且大便闭结的，是实证。闭痛且不发热的，适宜用厚朴三物汤专门攻里；闭痛且兼发热的，适宜用厚朴七物汤兼通表里；闭痛、发热、疼痛牵连胁下、脉紧弦的，适宜用大黄附子汤温下并行，这是通过便闭来判断其为实证。如果绕脐疼痛，名为寒疝，乌头煎药力峻猛，不敢轻易使用，而当归生姜羊肉汤的妙处，更不可不讲求。
又有胸痹：并非偶然发生。胸膺之上，是人体太空所在。宗气积聚于此，并非偶然。
薤白白酒：妙在转旋。栝蒌薤白白酒汤，或者加半夏，或者加枳实、薤白桂枝汤之类，都有转旋的妙用。
虚寒者：建中汤填补。心胸大寒，疼痛呕吐不能饮食，寒气上冲，如有头足状，不可触碰靠近，适宜用大建中汤主治。上中二焦被寒邪痹阻，所以用人参、干姜开启上焦之阳，配合饴糖以创建中气，又加花椒性味之下行，降逆上之气，恢复下焦之阳，这是补剂的主方。
Heart and stomach pain has nine types, among which Zhenxin Tong (True Heart Pain) is incurable. What is currently referred to as "heart pain" actually refers to pain in the Xinbaoluo (Pericardium Meridian) and Weiwuan (Stomach Epigastrium). There are nine types in total, which should be carefully differentiated.
Differentiate Deficiency and Excess, Clarify Severity: Deficiency patterns prefer pressure, pain stops after eating, and the pulse is weak. Excess patterns reject pressure, pain worsens after eating, and the pulse is forceful. Both symptoms have varying degrees of severity.
Pain arises from obstruction; Qi and Blood stagnation causes pain. Unobstructed means no pain because Qi and Blood are harmonious. Gao Shizong stated: "The methods of 'unblocking' vary." Regulating Qi to harmonize Blood, and regulating Blood to harmonize Qi constitutes unblocking. Directing upward-rebellious Qi downward, and dispersing central knotting Qi laterally also constitute unblocking. For deficiency, tonification promotes unblocking; for cold, warming promotes unblocking. All are methods of unblocking. If one insists on using purgation as the only method of unblocking, it would be erroneous.
First is Chong Tong (Worm Pain): Use Wumei Wan (Mume Pill). Worm pain presents with intermittent pain, white spots on the lips and tongue, and worsening pain upon eating. Worm pain transforms according to Jueyin Wind-Wood, so Wumei Wan is appropriate.
Second is Zhu Tong (Infestation/Pathogenic Injection Pain): Use Suhe Wan (Styrax Pill). Onset occurs after entering mountains, ancient temples, or seeing unusual objects. The pulse fluctuates between large and small, and the pulses in both hands feel like two different people. Suhe Wan, ground and administered via gavage, is appropriate.
Third is Qi Tong (Qi Stagnation Pain): Xiangsu Yin (Fragrant Perilla Decoction) is specialized. Pain caused by severe anger and emotional Qi stagnation is treated with Xiangsu Yin, adding 2 qian of Yuanhusuo (Corydalis Rhizome). Qiqi Tang (Seven Qi Decoction) is also excellent. Another prescription uses 1 liang of Baihe (Lily Bulb) and 3 qian of Wuyao (Lindera Root), decocted in water.
Fourth is Xue Tong (Blood Stasis Pain): Start with Shixiao San (Marvelous Powder). Pain caused by blood stasis feels like knife-cutting, may present with masses, the pulse is choppy, and stool is black. Taoren Chengqi Tang (Peach Kernel and Rhubarb Decoction) and Shixiao San are appropriate.
Fifth is Ji Tong (Palpitation Pain): Miaoxiang San (Wonderful Fragrance Powder) resolves it. Ji Tong is essentially deficiency pain. Pain comes and goes, prefers pressure, slightly alleviates after eating, and the pulse is weak. Miaoxiang San or Lizhong Tang (Regulate the Middle Decoction) added with Rougui (Cinnamon Bark) and Muxiang (Aucklandia Root) are indicated.
Sixth is Shi Tong (Food Retention Pain): Pingwei San (Calm the Stomach Powder) decocted. Pain due to food retention presents with belching of rotten smells, acid regurgitation, and a sensation of a band-like pain. Pingwei San added with Shanzha (Hawthorn Fruit) and Guya (Sprouted Millet) is primary. For alcohol injury, add 3 qian of Gegen (Kudzu Root) and 1 qian of Sharen (Amomum Fruit). However, for acute injury, vomiting is the correct method; for chronic retention, purging is the correct method.
Seventh is Yin Tong (Fluid Retention Pain): Erchen Tang (Two Aged Decoction) swallowed. Pain due to retained fluids presents with frequent spitting of clear fluid or sound of water under the hypochondrium. Erchen Tang added with Baizhu (Atractylodes Macrocephala Rhizome) and Zexie (Alisma Rhizome) is primary. In severe cases, Shizao Tang (Ten Jujube Decoction) can be taken temporarily.
Eighth is Leng Tong (Cold Pain): Lizhong Tang is comprehensive. Cold pain presents with cool body, fine pulse, and neutral mouth sensation. Lizhong Tang added with Fuzi (Prepared Aconite Lateral Root) and Rougui (Cinnamon Bark) is primary. If accompanied by vomiting, Wuzhuyu Tang (Evodia Decoction) is primary.
Ninth is Re Tong (Heat Pain): Jinlingzi San (Melia Dispersion) cures. Heat pain presents with fever, rapid pulse, and hot mouth sensation. Jinlingzi (Melia Seed) and Yuanhusuo (Corydalis Rhizome), each 2 liang, ground into powder and taken with yellow wine, 2 qian per dose. It is named Jinlingzi San and is very effective. If heat is severe, use Huanglian (Coptis Rhizome) and Zhizi (Gardenia Fruit) with fresh ginger juice.
Abdominal Pain: Refer to various chapters. Above the umbilicus belongs to Taiyin, at the level of the umbilicus belongs to Shaoyin, below the umbilicus belongs to Jueyin, and the hypochondrium is the junction of Shaoyang and Jueyin. Treatment should be differentiated accordingly. However, the general principle is the same as above.
Jinkui Methods: Can reverse heaven (save lives). The discussions in Jinkui Yaolue (Essential Prescriptions of the Golden Cabinet) are all methods for saving lives from critical conditions.
Discussions on Various Formulas: Must be cherished. The Doctrine of the Mean states: "Attaining one good thing, hold it firmly in heart and never lose it." Abdominal fullness and pain with diarrhea indicate deficiency. Vomiting, diarrhea, and pain indicate Taiyin syndrome, treated with Lizhong Tang. Borborygmus, cutting pain, and vomiting indicate cold, treated with Fuzi Jingmi Tang (Aconite and Rice Decoction). This diagnoses deficiency through diarrhea. Chest fullness and pain with constipation indicate excess. Constipation and pain without fever are treated with Houpo Sanwu Tang (Magnolia Bark Three-Ingredient Decoction) to attack the interior exclusively. Constipation and pain with fever are treated with Houpo Qiyu Tang (Magnolia Bark Seven-Ingredient Decoction) to address both exterior and interior. Constipation, fever, pain radiating to hypochondrium, and tight-stringy pulse are treated with Dahuang Fuzi Tang (Rhubarb and Aconite Decoction) for simultaneous warming and purging. This diagnoses excess through constipation. If pain surrounds the umbilicus, it is named Hanshan (Cold Hernia). Wu Tou Jian (Veratrum Decoction) is too harsh to use rashly; the efficacy of Danggui Shengjiang Yangrou Tang (Angelica, Ginger, and Mutton Decoction) must be studied.
Regarding Xiongbi (Chest Bi): It does not occur by chance. The upper chest is the great void of the human body. Zongqi (Pectoral Qi) accumulates here; it is not accidental.
Xiejiu (Leek Juice and Wine): Marvelous rotation. Gualou Xiebai Jiubai Tang (Trichosanthes, Chinese Leek, and White Wine Decoction), or those added with Banxia (Pinellia Tuber), or Zhishi (Bitter Orange) and Xiebai Guizhi Tang (Chinese Leek and Cinnamon Twig Decoction), all possess marvelous rotational effects.
Deficiency-Cold: Jianzhong Tang fills. Severe cold in the heart and chest, with pain, vomiting, inability to eat, and cold qi rushing upward creating a sensation of head and feet that cannot be touched, is treated with Da Jianzhong Tang (Great Construct the Middle Decoction). The upper and middle jiao are bi-blocked by cold pathogen. Therefore, Renshen (Ginseng Root) and Jiang (Dried Ginger) are used to open Yang in the upper jiao, combined with Yitang (Maltose) to construct Middle Qi. Additionally, the descending nature of Jiao (Sichuan Pepper) is used to direct rebellious Qi downward and restore Yang in the lower jiao. This is the main formula for tonics.