明经，加石膏、白芷。太阴经，加苍术。少阴经，加细辛。厥阴经，加吴茱萸。如肥人头痛，必是湿痰，加半夏，苍白
术。如瘦人头痛，是热上壅，多加酒洗片黄芩。如因感冒而头痛者，宜加防风、羌活、 本、升麻、柴胡、葛根之类。
如气虚而头痛者，宜加黄 、人参、东垣安神汤之类。如风热在上而头痛者，加天麻、蔓荆子、台芎、酒片芩之类。如
苦头痛者，宜用细辛。如形瘦色弊而头痛者，是血虚，宜用归、芎、芍药、酒黄柏之类。如顶巅痛者，宜 本、酒炒升、
柴。
（俗呼为心痛）
论
《内经》曰∶木郁之发，民病胃脘当心而痛，上肢两胁痛，膈噎不通，食饮不下。盖木气被郁，发则太过，故民病
有土败木贼之候也。夫胃为脾之腑，阳先于阴，故脏未病而腑先病也。甚而至于胁下如刀 之痛者，已连及于脏矣，古
方名为脾疼者是也。胃之上口名曰贲门，贲门与心相连，故经所谓胃脘当心而痛，今俗呼为心痛者，未达此又耳。虽曰
运气之胜复，未有不由清痰食积郁于中、七情九气触于内之所致焉。是以清阳不升，浊阴不降，而肝木之邪得以乘机侵
侮而为病矣。更原厥初致病之由，多因纵恣口腹，喜好辛酸，恣饮热酒煎 ，复 寒凉生冷，朝伤暮损，日积月深，自
郁成积，自积成痰，痰火煎熬，血亦妄行，痰血相杂，妨碍升降，故胃脘疼痛，吞酸嗳气，嘈杂恶心，皆噎膈反胃之渐
者也。俗医不究其源，例以辛香燥热之剂治之，以火济火，遂成危剧，良可痛哉。古方九种心痛∶曰饮，曰食，曰风，
曰冷，曰热，曰悸，曰虫，曰疰，曰来去痛。夫所谓冷者唯一耳，岂可例以热药治之乎。详其所由，皆在胃脘，而实不
在于心也。有真心痛者，大寒触犯心君，又曰污血冲心，手足青过节者，旦发夕死，夕发旦死。医者宜区别诸证而治之，
无有不安之理也。
脉法
《脉经》曰∶阳微阴弦，则胸痹而痛，责其虚也。今阳虚知在上焦，所以胸痹心痛者，以其脉阴弦故也。
胸痹之病，喘息咳唾，胸痹痛短气，寸口脉沉而迟，关上小紧而数。
心脉微急为痛，微大为心痹引背痛。
脉短而数者心痛。涩者心痛。
脉浮大弦长者死。
方法
丹溪曰∶心痛即胃脘痛，须分久新。若明知身犯寒气、口得寒物而病，于初得之时，当用温散温利之药。若病久则
成郁矣，郁则成热，原病式中备言之矣，若欲行温散温利，宁无助火添病耶。由是古方多用山栀子为君，热药为之响导，
则邪易伏，病易退。病安之后，若纵恣不改前非，病必再作难治矣。此病虽日久不食，不死。又曰∶中宫有食积与痰而
生病者，胃气亦赖所养，卒不便虚，虽日数多不食不死。若痛方止即吃物，病必复作，勿归咎于医也。必须再服三、五
服药后，以渐而少食，方可获全安。
心膈大痛，攻走腰背，发厥呕吐，诸药不效者，就吐中以鹅翎探之，出痰积碗许而痛即止。
脉坚实不大便者，下之亦可。
一方 用黄荆子炒焦为末，米饮调服（一云，上可治心痛，下可治白浊）。
又方 用蓝叶擂细取汁，合姜汁服。
又方 用青黛，以姜汁入汤调服。
又方 用海粉，佐以香附末，以川芎、山栀子煎汤，入姜汁调服。
又方 无药处，以盐置刀头，烧红淬入水中，乘热饮之，吐痰而愈。此法治绞肠痧大痛几死者，立效。
又方 治心痛，轻者以麻黄、桂枝之类散之，或以韭汁开提之，重者加石 。
又方 痛甚者脉必伏，宜温药附子之类，不可用人参、白术，盖诸痛不可补气故也。
又方 治气实者，用牡蛎粉一、二钱，温酒调下。
又方 治湿痰作痛，用白螺蛳壳，去泥沙，火 为细末，每服方寸匕，温酒调下，立止。
又方 以物轻按而痛定者，属虚，以二陈汤加炒干姜末和之而愈。
又方 山栀大者七枚或九枚，炒焦黄，用水一盏，煎七分，入生姜自然汁二、三匙，令辣热，饮之立止。
又方 山栀子劫止之后复发者，前药必不效，用玄明粉一钱匕，白汤送下立止。
又方 治平日喜好热物、致死血流于胃口而作痛者，以桃仁承气汤下之安。
又方 治死血作痛证，用玄胡索一两半，桂心、红花、滑石、红曲各五钱，桃仁三十个，蒸饼丸服效。
又方 治虫痛者，必面上有白斑，唇红能食，时作时止，用二陈汤加苦楝根煎服。
又方 治痰积胃脘作痛，白螺壳丸。
白螺蛳壳（火 ） 滑石（炒） 山栀子 香附（童便浸） 南星（煨裂各一两） 枳壳（麸炒黄色） 青皮 木
香半夏 砂仁（各五钱） 莪术（一两）
上为末，春加川芎，夏加黄连，秋冬加吴茱萸，用生姜汁浸，蒸饼为丸，如绿豆大，每服五十丸，姜汤下。
黄连六一汤 治多食煎炒或烧饼米胖等物，致热郁胃口而痛者，甚效。（方见呕吐门。）
连附六一汤 治胃脘痛甚，诸药不效者，寒因热用方也。
黄连（六钱） 附子（炮去皮脐，一钱）
上细切，作一服，加生姜三片，大枣一枚，水一盏半，煎至一盏，去渣稍热服。
（以上丹溪方法凡二十一条）
草豆蔻丸（东垣） 治客寒犯胃作痛，或因湿热郁结作痛，亦可劫而止之，又治气弱心痛亦妙。
草豆蔻（一两，裹煨） 橘红 吴茱萸（汤泡焙干） 人参 白僵蚕 黄 益智仁（各八钱） 生甘草 炙甘草 当
归身 青皮（各六钱） 泽泻（小便多者减半） 半夏（各一两） 桃仁（去皮尖，七十个） 麦 面（一两半，炒）
神曲（炒微黄） 柴胡（胁不痛减半） 姜黄（各四钱）
上为细末，桃仁另研如泥，入诸药中和匀再研，汤浸蒸饼为丸，如梧桐子大，每服三十丸，白汤送下，食远。
麻黄豆蔻丸（东垣） 治客寒犯胃，心头大痛不可忍。
木香 青皮 红花 浓朴（姜制，各二钱） 苏木（三分） 荜澄茄（四分） 升麻 半夏（汤泡七次） 麦 面 砂
仁黄 白术 陈皮（去白） 柴胡 炙甘草 吴茱萸 当归身（各五分） 益智仁（六分） 神曲（炒，一钱）
麻黄（不去节，二钱）
上为细末，汤浸蒸饼为丸，如梧桐子大，每服五十丸，白汤下，或细嚼白汤送下亦可。
木香化滞汤（东垣）
治因忧食湿面，结于胃脘，腹皮抵痛，心下硬，微满，不思饮食，食之不散，常常痞气不安。（方见痞满门）
仓卒散（三因） 治气自腰腹间攻心，痛不可忍，腹中冰冷，自汗如洗，手足挛急厥冷。
山栀子（大者四十九枚，连皮捶碎炒焦） 附子（一枚，炮去皮脐）
上为末，每服二钱，酒一盏，煎八分，温服。
金铃子散（河间） 治热厥心痛。
金铃子 玄胡索（各一两）
上为细末，每服二钱，温酒调下，白汤亦可。
神圣代针散（河间） 治心腹诸痛。
乳香 没药 当归 白芷 川芎（各五钱） 芫蜻（一两，去翅足，炒）
上为细末，每服一分，病甚者五分，先点好茶一盏，次掺药末在茶上，不得吹搅，立地细细呷之。心痛欲死者，服
之立效。小肠气，搐如角弓，膀胱肿硬，一切气刺虚痛，并妇人血癖、血迷、血运、血刺痛冲心，胎衣不下，难产，但
是一切因血作痛之疾，服之大有神效。
术附汤（活人） 治寒厥暴痛，脉微气弱。
附子（泡，五分） 白术（二钱） 甘草（一钱，炙）
上细切，作一服，水一盏半，入生姜五片，大枣二枚，煎至一盏，去渣温服。此药又治风湿相搏，身重烦疼，不能
转侧，不呕不喝，大便坚实，小便自利，及风虚头目眩运，不知食味。暖饥补中，助阳气、止有汗之圣药也。
（丹溪活套）云∶草豆蔻一味，性温能散滞气，利膈上痰，若胃脘果因寒而作痛，用之如鼓应桴。若湿痰郁结成痛
者，服之多效。若因热、郁而痛者，理固不当用此，但宜以凉药监制，如芩、连、栀子之属，其功尤速。东垣草豆蔻丸，
寒热心痛，俱获奇功。但因热者不可多服，久服恐有积温成热之患耳。若久病郁热已胶固者，断不可用此味也。胃中若
有流饮清痰作痛，腹中漉漉有声，及手足寒痛，或腰膝脊胁抽掣作痛者，用小胃丹或三花神 丸或控涎丹渐渐服之，能
彻去病根即止。
（祖传方）
加味枳术丸 治清痰、食积、酒积、茶积、肉积，在胃脘当心而痛，及痞满恶心，嘈杂嗳气，吞酸呕吐，脾疼
等证，其效如神。
白术（三两） 枳实（麸炒黄色） 苍术（米泔浸二宿，焙） 猪苓（去黑皮） 麦 面（炒黄色） 神曲（微炒
黄色） 半夏（汤泡透，各一两） 泽泻（去毛） 赤茯苓（去皮） 川芎 黄连（陈壁土炒，去土） 白螺蛳壳（
各七钱） 缩砂仁 草豆蔻 黄芩（陈壁土同炒） 青皮（去白） 莱菔子（炒） 干生姜（各五钱） 陈皮（去白） 香
附米（童便浸） 栝蒌子 浓朴（姜汁制炒） 槟榔（各三钱） 木香 甘草（各二钱）
吞酸，加吴茱萸汤泡，寒月五钱，热月二钱半。久病挟虚，加人参、白扁豆、石莲肉各五钱。时常口吐清水，加炒
滑石一两， 牡蛎五钱。
上为细末，用青荷叶泡汤浸晚粳米，研粉作糊为丸，如梧桐子大，每服七十丸，多至一百丸，清米饮送下。
（医案）
一男子，年三十五，胃脘作痛久矣，人形黄瘦，食少而胸中常若食饱。来求治，与加味枳术丸，服不效，而日渐大
痛，叫号声闻四邻，别父母妻子，嘱付后事，欲自杀。予以桃仁承气汤作大剂与之，连二服，大下瘀血四、五碗许，困
倦不能言语者三日，教以稀粥少食，渐渐将理，病全安，复壮如旧。
明经头痛，加石膏、白芷。太阴经头痛，加苍术。少阴经头痛，加细辛。厥阴经头痛，加吴茱萸。如果是肥胖之人头痛，必定是湿痰所致，加半夏、苍术和白术。如果是瘦人头痛，是热邪上壅，多加酒洗的黄芩。如果是因感冒引起的头痛，宜加防风、羌活、藁本、升麻、柴胡、葛根这类药物。如果是气虚引起的头痛，宜加黄芪、人参、东垣安神汤这类方剂。如果是风热在上引起的头痛，加天麻、蔓荆子、台芎（川芎的一种）、酒炒黄芩这类药物。如果头痛剧烈，宜用细辛。如果形体消瘦、面色晦暗而头痛，是血虚，宜用当归、川芎、芍药、酒黄柏这类药物。如果是头顶痛，宜用藁本、酒炒升麻和柴胡。
（俗称为心痛）
论
《内经》说：木气郁结发作时，百姓会病发胃脘当心而痛，向上牵引两胁疼痛，膈噎不通，饮食难下。这是因为木气被郁结，发作时太过亢盛，所以百姓的病证有土败木贼（脾虚肝乘）的征候。胃是脾的腑，阳先于阴受病，所以脏未病而腑先病。严重到胁下像刀割一样的疼痛，已经连及于脏了，古方名为脾疼的就是这种情况。胃的上口名叫贲门，贲门与心相连，所以经文所说的“胃脘当心而痛”，现在俗称的心痛，是因为人们没有通达这个道理罢了。虽然说是运气胜复的变化，但没有不是由于清痰、食积郁结在中焦，加上七情、九气触动于内所导致的。因此清阳不升，浊阴不降，肝木之邪得以乘机侵侮而为病。再推究最初致病的原因，多因为放纵口腹，喜好辛辣酸味，恣意饮用热酒煎炸之物，又吃寒凉生冷，早晨受伤晚上损害，日积月深，自然郁结成积，自积成痰，痰火煎熬，血液也妄行，痰血相杂，妨碍升降，所以出现胃脘疼痛、吞酸嗳气、嘈杂恶心，这都是噎膈反胃的渐近阶段。庸医不探究其根源，一律用辛香燥热的药物治疗，以火济火，遂成危重剧症，实在令人痛心啊。古方记载九种心痛：即饮心痛、食心痛、风心痛、冷心痛、热心痛、悸心痛、虫心痛、疰心痛、来去痛。所谓冷心痛只有一种，怎么能一律用热药治疗呢？详细考察其原因，病位都在胃脘，而实际上并不在心。有真心痛，是大寒触犯心君，又称污血冲心，手足青紫超过关节的，早上发病晚上死，晚上发病早上死。医生应当区别各种证候来治疗，没有不安愈的道理。
脉法
《脉经》说：阳微阴弦，则胸痹而痛，责之于虚。现在知道阳虚在上焦，所以胸痹心痛，是因为脉象阴弦的缘故。
胸痹的病证，喘息咳唾，胸痹痛短气，寸口脉沉而迟，关上脉小紧而数。
心脉微急为痛，微大为心痹牵引背痛。
脉短而数的为心痛。涩脉的为心痛。
脉浮大弦长的预后不良，主死。
方法
丹溪说：心痛就是胃脘痛，必须分久病和新病。如果明知身体感受寒气、口中吃了寒物而发病，在初得之时，当用温散温利的药物。如果病久了则成郁结了，郁结则生热，《原病式》中已有详细说明，如果想用温散温利的方法，岂不是助火添病吗？因此古方多用山栀子为君药，热药作为向导，则邪气易伏，病易退。病安之后，如果放纵不改前非，病必再发且难治。此病虽然日久不进食，但不会死。又说：中宫（脾胃）有食积与痰而生病的，胃气也赖所养，突然便不虚，虽然几天不吃也不会死。如果痛刚止就吃东西，病必复发，不要归咎于医生。必须再服三、五服药后，逐渐减少饮食，方可获得完全安康。
心膈大痛，攻走腰背，发厥呕吐，诸药无效的，就在吐法中用鹅翎探喉催吐，吐出约一碗痰积而痛即止。
脉坚实不大便的，用泻下法也可以。
一方 用黄荆子炒焦为末，米饮调服（一说，上可治心痛，下可治白浊）。
又一方 用蓝叶擂细取汁，合姜汁服。
又一方 用青黛，以姜汁入汤调服。
又一方 用海粉，佐以香附末，以川芎、山栀子煎汤，入姜汁调服。
又一方 无药处，将盐放在刀头上，烧红后淬入水中，趁热饮之，吐痰而愈。此法治绞肠痧大痛几死者，立效。
又一方 治心痛，轻者用麻黄、桂枝之类发散，或用韭汁开提，重者加石蒜。
又一方 痛甚者脉必伏，宜用温药如附子之类，不可用人参、白术，因为诸痛不可补气故也。
又一方 治气实者，用牡蛎粉一、二钱，温酒调下。
又一方 治湿痰作痛，用白螺蛳壳，去泥沙，火煅为细末，每服方寸匕，温酒调下，立止。
又一方 以物轻按而痛定者，属虚，用二陈汤加炒干姜末调和而愈。
又一方 大个的山栀子七枚或九枚，炒焦黄，用水一盏，煎至七分，入生姜自然汁二、三匙，令辣热，饮之立止。
又一方 山栀子劫止之后复发者，前药必不效，用玄明粉一钱匕，白开水送下立止。
又一方 治平日喜好热物、致死血流于胃口而作痛者，用桃仁承气汤泻下而安。
又一方 治死血作痛证，用玄胡索一两半，桂心、红花、滑石、红曲各五钱，桃仁三十个，蒸饼丸服有效。
又一方 治虫痛者，必面上有白斑，唇红能食，时作时止，用二陈汤加苦楝根煎服。
又一方 治痰积胃脘作痛，用白螺壳丸。
白螺蛳壳（火煅） 滑石（炒） 山栀子 香附（童便浸） 南星（煨裂各一两） 枳壳（麸炒黄色） 青皮 木香 半夏 砂仁（各五钱） 莪术（一两）
以上为末，春加川芎，夏加黄连，秋冬加吴茱萸，用生姜汁浸，蒸饼为丸，如绿豆大，每服五十丸，姜汤下。
黄连六一汤 治多食煎炒或烧饼米胖等物，致热郁胃口而痛者，甚效。（方见呕吐门。）
连附六一汤 治胃脘痛甚，诸药无效者，寒因热用方也。
黄连（六钱） 附子（炮去皮脐，一钱）
以上细切，作一服，加生姜三片，大枣一枚，水一盏半，煎至一盏，去渣稍热服。
（以上丹溪方法凡二十一条）
草豆蔻丸（东垣） 治客寒犯胃作痛，或因湿热郁结作痛，亦可劫而止之，又治气弱心痛亦妙。
草豆蔻（一两，裹煨） 橘红 吴茱萸（汤泡焙干） 人参 白僵蚕 黄芪 益智仁（各八钱） 生甘草 炙甘草 当归身 青皮（各六钱） 泽泻（小便多者减半） 半夏（各一两） 桃仁（去皮尖，七十个） 麦面（一两半，炒） 神曲（炒微黄） 柴胡（胁不痛减半） 姜黄（各四钱）
以上为细末，桃仁另研如泥，入诸药中和匀再研，汤浸蒸饼为丸，如梧桐子大，每服三十丸，白开水送下，食远。
麻黄豆蔻丸（东垣） 治客寒犯胃，心头大痛不可忍。
木香 青皮 红花 浓朴（姜制，各二钱） 苏木（三分） 荜澄茄（四分） 升麻 半夏（汤泡七次） 麦面 砂仁 黄芪 白术 陈皮（去白） 柴胡 炙甘草 吴茱萸 当归身（各五分） 益智仁（六分） 神曲（炒，一钱） 麻黄（不去节，二钱）
以上为细末，汤浸蒸饼为丸，如梧桐子大，每服五十丸，白开水下，或细嚼白开水送下亦可。
木香化滞汤（东垣）
治因忧食湿面，结于胃脘，腹皮抵痛，心下硬，微满，不思饮食，食之不散，常常痞气不安。（方见痞满门）
仓卒散（三因） 治气自腰腹间攻心，痛不可忍，腹中冰冷，自汗如洗，手足挛急厥冷。
山栀子（大者四十九枚，连皮捶碎炒焦） 附子（一枚，炮去皮脐）
以上为末，每服二钱，酒一盏，煎八分，温服。
金铃子散（河间） 治热厥心痛。
金铃子 玄胡索（各一两）
以上为细末，每服二钱，温酒调下，白开水亦可。
神圣代针散（河间） 治心腹诸痛。
乳香 没药 当归 白芷 川芎（各五钱） 芫蜻（一两，去翅足，炒）
以上为细末，每服一分，病甚者五分，先点好茶一盏，次掺药末在茶上，不得吹搅，立地细细呷之。心痛欲死者，服之立效。小肠气，搐如角弓，膀胱肿硬，一切气刺虚痛，并妇人血癖、血迷、血运、血刺痛冲心，胎衣不下，难产，但是一切因血作痛之疾，服之大有神效。
术附汤（活人） 治寒厥暴痛，脉微气弱。
附子（泡，五分） 白术（二钱） 甘草（一钱，炙）
以上细切，作一服，水一盏半，入生姜五片，大枣二枚，煎至一盏，去渣温服。此药又治风湿相搏，身重烦疼，不能转侧，不呕不喝，大便坚实，小便自利，及风虚头目眩晕，不知食味。暖饥补中，助阳气、止有汗之圣药也。
（丹溪活套）云：草豆蔻一味，性温能散滞气，利膈上痰，若胃脘果因寒而作痛，用之如鼓应桴。若湿痰郁结成痛者，服之多效。若因热、郁而痛者，理固不当用此，但宜以凉药监制，如芩、连、栀子之属，其功尤速。东垣草豆蔻丸，寒热心痛，俱获奇功。但因热者不可多服，久服恐有积温成热之患耳。若久病郁热已胶固者，断不可用此味也。胃中若有流饮清痰作痛，腹中漉漉有声，及手足寒痛，或腰膝脊胁抽掣作痛者，用小胃丹或三花神效丸或控涎丹渐渐服之，能彻去病根即止。
（祖传方）
加味枳术丸 治清痰、食积、酒积、茶积、肉积，在胃脘当心而痛，及痞满恶心，嘈杂嗳气，吞酸呕吐，脾疼等证，其效如神。
白术（三两） 枳实（麸炒黄色） 苍术（米泔浸二宿，焙） 猪苓（去黑皮） 麦面（炒黄色） 神曲（微炒黄色） 半夏（汤泡透，各一两） 泽泻（去毛） 赤茯苓（去皮） 川芎 黄连（陈壁土炒，去土） 白螺蛳壳（各七钱） 缩砂仁 草豆蔻 黄芩（陈壁土同炒） 青皮（去白） 莱菔子（炒） 干生姜（各五钱） 陈皮（去白） 香附米（童便浸） 栝蒌子 浓朴（姜汁制炒） 槟榔（各三钱） 木香 甘草（各二钱）
吞酸，加吴茱萸汤泡，寒月五钱，热月二钱半。久病挟虚，加人参、白扁豆、石莲肉各五钱。时常口吐清水，加炒滑石一两，牡蛎五钱。
以上为细末，用青荷叶泡汤浸晚粳米，研粉作糊为丸，如梧桐子大，每服七十丸，多至一百丸，清米饮送下。
（医案）
一男子，年三十五，胃脘作痛久矣，人形黄瘦，食少而胸中常若食饱。来求治，与加味枳术丸，服不效，而日渐大痛，叫号声闻四邻，别父母妻子，嘱付后事，欲自杀。予以桃仁承气汤作大剂与之，连二服，大下瘀血四、五碗许，困倦不能言语者三日，教以稀粥少食，渐渐将理，病全安，复壮如旧。
For headache in the Mingjing channel, add Shigao (Gypsum Fibrosum) and Baizhi (Angelicae Dahuricae Radix). For headache in the Taiyin channel, add Cangzhu (Atractylodis Rhizoma). For headache in the Shaoyin channel, add Xixin (Asari Radix et Rhizoma). For headache in the Jueyin channel, add Wuzhuyu (Evodiae Fructus). If a person with obesity suffers from headache, it is certainly due to damp-phlegm; add Banxia (Pinelliae Rhizoma), Cangzhu (Atractylodis Rhizoma), and Baizhu (Atractylodis Macrocephalae Rhizoma). If a thin person suffers from headache, it is due to heat obstructing upwards; add more Huangqin (Scutellariae Radix) washed with wine. If the headache is caused by a cold pathogen, it is appropriate to add Fangfeng (Saposhnikoviae Radix), Qianghuo (Notopterygii Rhizoma et Radix), Gaoben (Ligustici Wallichii Rhizoma et Radix), Shengma (Cimicifugae Rhizoma), Chaihu (Bupleuri Radix), Gegen (Puerariae Lobatae Radix), and similar herbs. If the headache is due to Qi deficiency, it is appropriate to add Huangqi (Astragali Membranacei Radix), Renshen (Ginseng Radix et Rhizoma), and Dongyuan Anshen Tang (Dongyuan Calming Mind Decoction). If the headache is caused by wind-heat in the upper part, add Tianma (Gastrodiae Rhizoma), Manjingzi (Viticis Semen), Taixiong (a variety of Chuanxiong), and Huangqin (Scutellariae Radix) fried with wine. If the headache is severe, Xixin (Asari Radix et Rhizoma) should be used. If the person is emaciated with a sallow complexion and suffers from headache, it is due to Blood deficiency; use Danggui (Angelicae Sinensis Radix), Chuanxiong (Chuanxiong Rhizoma), Shaoyao (Paeoniae Radix), and Huangbai (Phellodendri Cortex) fried with wine. If the pain is at the vertex, Gaoben (Ligustici Wallichii Rhizoma et Radix), Shengma (Cimicifugae Rhizoma) fried with wine, and Chaihu (Bupleuri Radix) are appropriate.
(Colloquially referred to as Heart Pain)
Discussion
The *Neijing* states: "When Wood Qi is depressed and erupts, the people suffer from epigastric pain centered behind the heart, extending upward to pain in both hypochondria, dysphagia and obstruction, and inability to eat or drink." This is because Wood Qi, being depressed, erupts excessively, resulting in symptoms of Earth failing and Wood attacking. The Stomach is the Fu organ of the Spleen; Yang precedes Yin in disease transmission, so the Zang organs may not yet be diseased while the Fu organs are affected first. In severe cases, when pain under the hypochondria feels like knife-cutting, it has already involved the Zang organs; this is what ancient formulas call "Spleen Pain." The upper opening of the Stomach is called Benmen (Cardia); Benmen connects with the Heart. Therefore, what the classics refer to as "epigastric pain centered behind the heart," now colloquially called Heart Pain, arises from people's failure to understand this principle. Although these conditions relate to the vicissitudes of climatic factors (Yunqi), they invariably result from clear turbid phlegm and food retention stagnating in the middle jiao, triggered internally by the seven emotions and nine types of Qi manipulation. Consequently, clear Yang fails to ascend, turbid Yin fails to descend, and the evil of Liver Wood takes the opportunity to invade and oppress, causing disease. Tracing back to the initial cause of illness, it is mostly due to indulging in diet, favoring pungent and sour flavors, recklessly drinking hot wine and fried foods, followed by consuming cold and raw foods. Morning injury leads to evening damage; accumulating day by day and month by month, depression forms retention, and retention transforms into phlegm. Phlegm-fire roasts and boils, causing blood to move recklessly. Phlegm and blood mix, obstructing ascending and descending movements, leading to epigastric pain, acid regurgitation, belching, stomach discomfort, and nausea. These are gradual stages toward dysphagia and vomiting of undigested food. Quack doctors, failing to investigate the source, uniformly treat with pungent, aromatic, dry, and hot agents, adding fire to fire, thus creating critical and severe conditions—a truly lamentable situation. Ancient formulas describe nine types of Heart Pain: Drink, Food, Wind, Cold, Heat, Palpitation, Parasite, Zhu (contagious disease), and Migratory Pain. The so-called Cold type is only one kind; how can all be treated uniformly with hot medicines? Detailed examination shows that the pathology lies in the epigastrium, but actually not in the Heart. There is True Heart Pain, where severe cold violates the Heart Sovereign, also called Filthy Blood rushing to the Heart; if hands and feet turn cyanotic past the joints, death occurs on the same day (morning onset dies evening, evening onset dies morning). Physicians must differentiate various syndromes for treatment; there will be no case that cannot be healed.
Pulse Diagnosis
The *Maijing* states: "Superficial pulse is faint and deep pulse is taut, resulting in chest bi syndrome and pain, attributed to deficiency." Now, knowing deficiency is in the upper jiao, hence chest bi and heart pain occur because of the taut deep pulse.
In chest bi syndrome, there is panting, coughing, and expectoration; chest bi pain and shortness of breath. The cunkou pulse is deep and slow; the guan pulse is slightly tight and rapid.
A slightly urgent Heart pulse indicates pain; a slightly large Heart pulse indicates Heart Bi radiating to the back.
A short and rapid pulse indicates Heart Pain. A choppy pulse indicates Heart Pain.
A floating, large, taut, and long pulse indicates death.
Methods
Danxi said: Heart pain is epigastric pain; one must distinguish between recent and chronic onset. If one knows the body was exposed to cold pathogens or ingested cold substances, at the initial stage, warm-dispersing and warm-promoting medicines should be used. If the disease persists, it becomes stagnant; stagnation generates heat, as detailed in *Yuanbing Shi*. If one attempts warm-dispersing methods then, would it not aid fire and aggravate the disease? Therefore, ancient formulas often use Zhizi (Gardeniae Fructus) as the sovereign herb, with hot medicines acting as guides, so that evil qi is easily subdued and the disease recedes. After recovery, if one continues reckless behavior, the disease will recur and become difficult to treat. Although this disease may persist for a long time without eating, it is not fatal. He also said: When the central palace (Spleen/Stomach) has food retention and phlegm causing disease, Stomach Qi relies on nourishment and does not suddenly become deficient; even if one does not eat for several days, it is not fatal. However, if one eats immediately after pain subsides, the disease will recur; do not blame the physician. One must take three to five doses of medicine first, then gradually reduce food intake to achieve complete safety.
For severe pain in the heart and diaphragm radiating to the waist and back, syncope, vomiting, and ineffectiveness of other medicines, induce vomiting using a goose feather probe; expelling about one bowl of phlegm retention stops the pain immediately.
If the pulse is firm and solid with constipation, purgation is also applicable.
One formula: Use Huangjingzi (Vitex Negundo Fruit) fried until charred, ground into powder, taken with rice water (It is said to treat Heart Pain above and white turbidity below).
Another formula: Mash Lan Ye (Isatis Leaf) finely to extract juice, mixed with Ginger Juice.
Another formula: Use Qingdai (Indigo Naturalis), mixed with Ginger Juice in decoction.
Another formula: Use Haifen (Halloysitum), assisted by Xiangfu (Cyperi Rhizoma) powder, decocted with Chuanxiong (Chuanxiong Rhizoma) and Zhizi (Gardeniae Fructus), mixed with Ginger Juice.
Another formula: Where no medicine is available, place salt on the head of a knife, heat until red, quench in water, and drink while hot; inducing vomiting of phlegm cures the condition. This method is instantly effective for severe intestinal colic (Jiaochang Sha) near death.
Another formula: For Heart Pain, mild cases are dispersed with Mahuang (Ephedrae Herba) and Guizhi (Cinnamon Twig) etc., or lifted by Jiuzhi (Leek Juice); severe cases add Shisun (Smilax Glabra Rhizome - *Note: Text says Shi Su, likely typo for Shi Song or similar, but literal translation used*).
Another formula: In severe pain, the pulse is likely hidden; use warming medicines such as Fuzi (Aconiti Lateralis Radix Praeparata). Do not use Renshen (Ginseng Radix et Rhizoma) or Baizhu (Atractylodis Macrocephalae Rhizoma), as pain syndromes generally contraindicate tonifying Qi.
Another formula: For excess Qi patterns, use Muli (Ostreae Concha) powder, 1-2 qian, taken with warm wine.
Another formula: For pain caused by damp-phlegm, use Bai Luosi Ke (White Snail Shell), cleaned of mud, calcined and ground to fine powder; each dose is a square inch spoonful, taken with warm wine, stopping pain immediately.
Another formula: If light pressure alleviates the pain, it belongs to deficiency; use Erchen Tang (Two-Cured Decoction) mixed with fried Ganjiang (Zingiberis Rhizoma) powder to cure.
Another formula: Take seven or nine large Zhizi (Gardeniae Fructus), fry until yellow-brown, decoct in one sheng of water to 0.7 sheng, add 2-3 spoons of fresh Ginger Juice, make spicy and hot, drink to stop pain immediately.
Another formula: If Zhizi (Gardeniae Fructus) stops the pain but it recurs, previous medicines will fail; use Xuanningfen (Mirabilite) one qian spoonful, taken with plain boiled water to stop pain immediately.
Another formula: For those who habitually prefer hot substances, causing dead blood to flow into the stomach opening and cause pain, use Tao Ren Chengqi Tang (Peach Kernel and Magnolia Bark Decoction) to purge and settle.
Another formula: For pain caused by dead blood, use Yanshusuo (Corydalis Rhizoma) 1.5 liang, Guixin (Cinnamomi Ramulus), Honghua (Carthami Flos), Huashi (Talcum), Hongqu (Red Yeast Rice) each 5 qian, and Tao Ren (Persicae Semen) 30 pieces; made into pills with steamed dough, effective.
Another formula: For parasitic pain, there must be white spots on the face, red lips, ability to eat, intermittent pain; use Erchen Tang (Two-Cured Decoction) decocted with Kudigen (Toosendan Radix).
Another formula: For pain caused by phlegm retention in the epigastrium, use Bailuoke Wan (White Snail Shell Pill).
Bailuosi Ke (Calcined) 5 qian, Huashi (Fried) 5 qian, Zhizi (Gardeniae Fructus) 5 qian, Xiangfu (Cyperi Rhizoma) soaked in child's urine 5 qian, Nanxing (Arisaematis Rhizoma) baked and cracked 1 liang, Zhike (Aurantii Fructus) bran-fried yellow 1 liang, Qingpi (Citri Reticulatae Pericarpium), Muxiang (Aucklandiae Radix), Banxia (Pinelliae Rhizoma) 5 qian each, Sharen (Amomi Fructus) 5 qian, Ezhu (Curcumae Rhizoma) 1 liang.
Grind to powder; in Spring add Chuanxiong (Chuanxiong Rhizoma); in Summer add Huanglian (Coptidis Rhizoma); in Autumn/Winter add Wuzhuyu (Evodiae Fructus). Soak in Ginger Juice, make pills with steamed dough, size of mung beans. Each dose 50 pills, taken with Ginger Soup.
Huanglian Liuyi Tang (Coptis Six-to-One Decoction): Treats pain caused by heat stagnation in the stomach opening due to excessive consumption of fried foods, roasted cakes, or puffed rice. Very effective. (Formula seen in Vomiting section.)
Lianfu Liuyi Tang (Coptis and Aconite Six-to-One Decoction): Treats severe epigastric pain ineffective to other medicines; a formula using cold natured herbs with hot administration/method.
Huanglian (Coptidis Rhizoma) 6 qian, Fuzi (Prepared Aconite Root) 1 qian (processed, skin and umbilicus removed).
Cut finely, one dose. Add 3 slices of Ginger and 1 Jujube. Decoct 1.5 sheng of water to 1 sheng. Remove dregs, drink slightly warm.
(Above are Danxi's methods, totaling twenty-one items.)
Caodoukou Wan (Grass Cardamom Pill - Dongyuan): Treats pain caused by external cold invading the Stomach, or pain due to damp-heat stagnation; can also arrest pain quickly. Also excellent for Qi-deficiency Heart Pain.
Caodoukou (Grass Cardamom Seed) 1 liang (wrapped and baked), Juhong (Exocarpium Citri Grandis), Wuzhuyu (Evodiae Fructus) soaked in water and dried, Renshen (Ginseng Radix et Rhizoma), Baijiangcan (Bombyx Batryticatus), Huangqi (Astragali Membranacei Radix), Yizhiren (Alpiniae Oxyphyllae Fructus) each 8 qian, Sheng Gancao (Raw Licorice Root), Zhi Gancao (Honey-fried Licorice Root), Dangguishen (Angelicae Sinensis Radix), Qingpi (Citri Reticulatae Pericarpium) each 6 qian, Zexie (Alismatis Rhizoma) (reduce by half if frequent urination), Banxia (Pinelliae Rhizoma) each 1 liang, Tao Ren (Persicae Semen) 70 pieces (skin and tip removed), Maifan (Wheat Flour) 1.5 liang (fried), Shenqu (Massa Medicata Fermentata) (fried slightly yellow), Chaihu (Bupleuri Radix) (reduce by half if no hypochondriac pain), Jianghuang (Curcumae Longae Rhizoma) each 4 qian.
Grind to fine powder. Grind Tao Ren (Persicae Semen) separately into paste, mix with other herbs, grind again. Soak in water, make pills with steamed dough, size of paulownia seeds. Each dose 30 pills, taken with plain boiled water, far from meals.
Mahuang Caodoukou Wan (Ephedra and Grass Cardamom Pill - Dongyuan): Treats external cold invading the Stomach, unbearable severe pain in the heart area.
Muxiang (Aucklandiae Radix), Qingpi (Citri Reticulatae Pericarpium), Honghua (Carthami Flos), Houpo (Magnoliae Officinalis Cortex) processed with Ginger (each 2 qian), Sumu (Sappan Lignum) 3 fen, Bichengqie (Schisandrae Chinensis Fructus) 4 fen, Shengma (Cimicifugae Rhizoma), Banxia (Pinelliae Rhizoma) soaked in water seven times, Maifan (Wheat Flour), Sharen (Amomi Fructus), Huangqi (Astragali Membranacei Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Chenpi (Citri Reticulatae Pericarpium) peeled, Chaihu (Bupleuri Radix), Zhi Gancao (Honey-fried Licorice Root), Wuzhuyu (Evodiae Fructus), Dangguishen (Angelicae Sinensis Radix) each 5 fen, Yizhiren (Alpiniae Oxyphyllae Fructus) 6 fen, Shenqu (Massa Medicata Fermentata) fried 1 qian, Mahuang (Ephedrae Herba) untrimmed 2 qian.
Grind to fine powder. Soak in water, make pills with steamed dough, size of paulownia seeds. Each dose 50 pills, taken with plain boiled water, or chewed finely and swallowed with plain boiled water.
Muxiang Huazhi Tang (Aucklandia Regulating Stagnation Decoction - Dongyuan):
Treats pain from worry and eating wet noodles, knotting in the epigastrium, abdominal wall tenderness, hardness and slight fullness below the heart, loss of appetite, indigestion, chronic distension and discomfort. (Formula seen in Distension section.)
Cangcu San (Emergency Powder - Sanyin): Treats Qi attacking the heart from the waist and abdomen, unbearable pain, cold abdomen, profuse sweating, spasms and coldness of hands and feet.
Zhizi (Gardeniae Fructus) 49 large ones (crushed with skin and fried until charred), Fuzi (Prepared Aconite Root) 1 piece (processed, skin and umbilicus removed).
Grind to powder. Each dose 2 qian, decoct in 1 sheng of wine to 0.8 sheng. Take warm.
Jinlingzi San (Melia Dispersion - Hejian): Treats Heat-Jue Heart Pain.
Jinlingzi (Meliae Toosendan Fructus), Yanshusuo (Corydalis Rhizoma) each 1 liang.
Grind to fine powder. Each dose 2 qian, taken with warm wine, or plain boiled water.
Shen Dai Zhen San (Divine Needle Replacement Powder - Hejian): Treats various pains in the heart and abdomen.
Ruxiang (Olibanum), Moyao (Myrrha), Danggui (Angelicae Sinensis Radix), Baizhi (Angelicae Dahuricae Radix), Chuanxiong (Chuanxiong Rhizoma) each 5 qian, Yuanqing (Mylabris) 1 liang (wings and feet removed, fried).
Grind to fine powder. Each dose 1 fen; for severe cases 5 fen. First brew a cup of good tea, sprinkle the powder on top, do not blow or stir. Sip slowly immediately. For severe Heart Pain nearing death, it acts instantly. For Xiao Chang Qi (Intestinal Qi disorder), spasms like bowstring, swollen and hard bladder, all Qi-stabbing deficiency pains, women's blood masses, blood confusion, blood syncope, blood-stabbing pain rushing to the heart, retained placenta, difficult labor—all diseases caused by blood—take this for great efficacy.
Zhufu Tang (Atractylodes and Aconite Decoction - Huoren): Treats sudden pain from Cold-Jue, faint pulse and weak Qi.
Fuzi (Prepared Aconite Root) 5 fen, Baizhu (Atractylodis Macrocephalae Rhizoma) 2 qian, Gancao (Licorice Root) 1 qian (fried).
Cut finely, one dose. Add 1.5 sheng of water, 5 slices of Ginger, 2 Jujubes. Decoct to 1 sheng. Remove dregs, take warm. This medicine also treats Wind-Dampness binding, heavy body and painful annoyance, inability to turn, no vomiting or thirst, solid stool, free urination, and dizziness/vertigo from Wind-Deficiency, loss of taste. It warms hunger, tonifies the center, aids Yang Qi, and is a holy medicine for stopping sweating.
(Danxi's Flexible Methods) states: Caodoukou (Grass Cardamom Seed) alone has a warm nature to disperse stagnant Qi and benefit phlegm in the diaphragm. If epigastric pain is indeed due to cold, it works like a drum responding to a beat. If pain is due to damp-phlegm stagnation, it is often effective. If pain is due to Heat or stagnation, logic dictates it should not be used; however, it should be controlled with cooling medicines like Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Zhizi (Gardeniae Fructus), which speeds efficacy. Dongyuan's Caodoukou Wan achieves miraculous results for both cold and heat Heart Pain. However, those with Heat should not take it frequently; long-term use risks accumulating warmth turning into heat. If chronic Heat stagnation is firmly established, this herb must absolutely not be used. If fluid retention and clear phlegm in the Stomach cause pain, with gurgling sounds in the abdomen, cold pain in hands and feet, or drawing pain in waist, knees, spine, and hypochondria, use Xiaoweidan (Minor Stomach Pill), Sanhua Shenxiao Wan (Three-Flower Divine Efficacy Pill), or Kongyan Dan (Controlling Fluid Pellet) gradually; stop once the root cause is thoroughly eliminated.
(Ancestral Formula)
Jiawei Zhizhu Wan (Modified Atractylodes and Immature Bitter Orange Pill): Treats clear phlegm, food retention, alcohol retention, tea retention, meat retention causing pain in the epigastrium centered behind the heart, as well as distension, fullness, nausea, stomach discomfort, belching, acid regurgitation, vomiting, and Spleen Pain. Its efficacy is divine.
Baizhu (Atractylodis Macrocephalae Rhizoma) 3 liang, Zhishi (Aurantii Fructus) bran-fried yellow, Cangzhu (Atractylodis Rhizoma) soaked in rice wash water for two nights and dried, Zhuling (Polyporus), Maifan (Wheat Flour) fried yellow, Shenqu (Massa Medicata Fermentata) lightly fried yellow, Banxia (Pinelliae Rhizoma) soaked in water through and through (each 1 liang), Zexie (Alismatis Rhizoma) de-haired, Chifuling (Poria with Red Host) peeled, Chuanxiong (Chuanxiong Rhizoma), Huanglian (Coptidis Rhizoma) fried with old wall soil and cleaned, Bailuosi Ke (White Snail Shell) (each 7 qian), Suasharen (Amomi Fructus Rotundus), Caodoukou (Grass Cardamom Seed), Huangqin (Scutellariae Radix) fried with old wall soil, Qingpi (Citri Reticulatae Pericarpium) peeled, Laifuzi (Radish Seed) fried, Ganshengjiang (Dried Ginger) (each 5 qian), Chenpi (Citri Reticulatae Pericarpium) peeled, Xiangfumie (Cyperi Rhizoma) soaked in child's urine, Gualouzi (Trichosanthis Semen), Houpo (Magnoliae Officinalis Cortex) processed with Ginger Juice and fried, Binglang (Arecae Semen) (each 3 qian), Muxiang (Aucklandiae Radix), Gancao (Licorice Root) (each 2 qian).
For acid regurgitation, add Wuzhuyu (Evodiae Fructus) soaked in water: 5 qian in cold months, 2.5 qian in hot months. For chronic disease with deficiency, add Renshen (Ginseng Radix et Rhizoma), Baibian Dou (Dolichos Lablab Seed), Shilianrou (Nelumbinis Plumula) each 5 qian. For frequent spitting of clear saliva, add fried Huashi (Talcum) 1 liang, Muli (Ostreae Concha) 5 qian.
Grind to fine powder. Use Green Lotus Leaf soaked in water to soak late-maturing Jing Rice, grind into powder to make paste for pills, size of paulownia seeds. Each dose 70 pills, up to 100 pills, taken with clear rice water.
(Medical Case)
A man, aged thirty-five, had suffered from epigastric pain for a long time. His body was sallow and thin, he ate little, and his chest always felt full as if he had eaten. He sought treatment. I gave him Jiawei Zhizhu Wan (Modified Atractylodes and Immature Bitter Orange Pill), but it was ineffective. His pain increased daily; he cried out loudly enough to be heard by neighbors, said goodbye to parents and wife, arranged his affairs, and attempted suicide. I gave him a large dose of Tao Ren Chengqi Tang (Peach Kernel and Magnolia Bark Decoction). After two doses, he passed four or five bowls of dark blood. He was exhausted and unable to speak for three days. I instructed him to eat small amounts of thin porridge and gradually recuperate. The disease completely resolved, and he regained his former robust health.