针不已，取然谷。（厥病篇下同）
心痛引背，灸刺法有四∶
其一，取足太阳经。刺节云∶取京骨、昆仑者，是其穴也。盖足太阳之正，循膂当心入散络，
故心痛引背取之也。
其二，取足少阴经。刺节云∶取京骨、昆仑不已，取然谷者，是其穴也。又经云∶肾足少阴经之
脉，所生病者，烦心心痛，视盛虚热寒陷下取之也。又经云∶心痛引腰脊欲呕，取足少阴者是也。
盖足少阴脉，贯脊络心，故亦治心痛引背也。
其三，取足少阳。经云∶心痛引背不得息，刺足少阴不已，取少阳者是也。盖手少阳之脉，散
络心脉。又三焦下俞曰委阳，是足太阳络，足太阳循膂当心入散络，故亦治心痛引背也。
其四，取督任脉。经云∶背为心相控而痛，所治天突与十椎及上纪。上纪者，胃脘也。下
纪者，关元也。又云∶心痛，当九节刺之，按已次按之，立已。不已，上下求之。得之，立已者
是也。盖十椎与九节者，督脉也；胃脘与天突者，任脉也。
厥心痛，腹胀胸满，心尤痛甚者，胃心痛也。取之大都、太白。
心痛兼胀灸刺法有二∶
其一，取足太阴。经云∶取大都、太白者，是其穴也。又经云∶脾足太阴之脉，是动则病胃
脘痛，腹胀。所生病者烦心，心下急痛者，视盛虚热寒陷下取之。又云∶心痛腹胀，啬啬然，大便
不利，取足太阴者是也。盖足太阴脉从胃上膈，注心中，故心痛腹胀者，取之也。
其二，取足阳明。经云∶胃病者腹胀，胃脘当心而痛，饮食不下，取之三里者是也。盖胃脘当
心痛者，似心痛，实非心痛也。
厥心痛，如以锥针刺其心，心痛甚者，脾心痛也，取之然谷、太溪。
脾心痛，而取然谷太溪者，故孙真人、张洁古谓之妄经也。
厥心痛，色苍苍如死状，终日不得太息，肝心痛也，取之行间、太冲。
心痛色苍如死状者取肝，其兼小肠满便溲难者亦取肝。经云∶心痛引少腹满，上下无常处，
便溲难，刺足厥阴是也。
厥心痛，卧若徒居心痛间，动作痛益甚，色不变，肺心痛也，取之鱼际、太渊。
徒居，谓闲居。间，谓痛缓。心痛，卧与闲居则痛缓，动作则益甚者，取肺。其兼短气者，
亦取肺。经云∶心痛但短气不足以息，刺手太阴者是也。
心痛不可刺者，中有盛聚，不可取于 。肠中有虫瘕及蛟 ，皆不可取以小针。心肠痛 作
痛，肿聚，往来上下行，痛有休止，腹热喜渴涎出者，是蛟 也。以手聚按而坚持之，无令得移，
以大针刺之，久持之虫不动，乃出针也。
〔《集》〕九种心痛∶间使 灵道 公孙 太冲 三里 阴陵泉
〔桑〕心气痛∶巨缺 鸠尾（各取一寸，） 兴隆（泻之）
〔《撮》〕脾脊后心疼痛∶中渚（泻之，忌补）灸心痛背上穴∶心俞 鬲俞
〔洁〕心痛脉弦，肝原穴。脉沉，肾原穴。脉涩，肺原穴。脉浮，心原穴。脉缓，脾原穴。
〔《摘》〕冷心痛∶巨缺（燔针刺之。如五脏气相干，而胁痛疝痛 癖，皆能痛至心，宜审之。）
〔《玉》〕心脾疼∶上脘（二寸半，泻） 中脘（二寸半，补多泻少）
〔《甲》〕心痛不可按，烦心，巨缺主之。心痛有虫，多涎，不得反侧，上管主之。心痛上
抢心，不欲食，支痛引鬲，建里主之。
〔《撮》〕心胸痛，并气攻∶劳宫 大陵（各三分，泻之） 内关
〔《甲》〕心痛善悲，厥逆悬心，如饥之状，心恒而惊，大陵及间使主之。心寒痛，难以俯仰，心疝气
冲胃，死不知人，中脘主之。心痛，衄哕呕血，惊恐畏人，神气不足， 门主之。
〔《难》〕阴维为病，苦心痛。（内关穴，通阴维。）
〔《甲》〕脾逆气寒，厥急烦心，善唾哕噫，胸满 呼，胃气上逆，心痛，太渊主之。（针云∶
肺胀胃逆。）心膨痛，尺泽主之。（《千金》云∶心烦闷乱，少气不足以息。）心痛，卒咳逆，
尺泽主之，出血立已。胸痹心痛，肩内麻木，天井主之。胸胁背相引而痛，呕吐不食，幽门主之。
胸痹心痛，不得息，痛无常处，临泣主之。（《千金》云∶不得反侧。）
〔丹〕心痛虽日数多，不吃饭不死，若痛止便吃物还痛，必须三五服药，方可吃物。心痛，左
手脉数热多，脉涩有死血。右手脉实是痰积，脉大必是久病。两手脉坚实不大便者下之。痛甚者
脉必伏，多用温药附子之类，不可用参术。
心脉微急，为心痛引背，食不下。（全文见治虚实法。）
〔仲〕问曰∶病腹痛有虫，其脉何以别之？师曰∶腹中痛，其脉当沉，若弦反洪大，故有蛔虫。
脾脉微滑，为蛊毒蝮蝎腹热。（全文见治虚实法）
〔《脉》〕关上脉紧而滑者，蛔毒。脉沉而滑者，寸白。肘后粗，以下三四寸热者，肠中有虫。
（全文见诊。）真心痛，手足青至节，心痛甚，旦发夕死，夕发旦死。
心痛牵引背部，灸刺治疗方法有四种：
其一，取足太阳经。《刺节真邪》说：取京骨、昆仑穴，就是这些穴位。因为足太阳经的正气，沿着脊柱两旁肌肉下行，当心处进入并散布络脉，所以心痛牵引背部时取用此经。
其二，取足少阴经。《刺节真邪》说：取京骨、昆仑穴无效时，取然谷穴，就是这些穴位。又《内经》说：肾足少阴经脉所生的疾病中，烦心、心痛，需根据脉象的盛虚、热寒及陷下情况来选取穴位。又《内经》说：心痛牵引腰脊且想呕吐，应取足少阴经，就是这个道理。因为足少阴经脉贯穿脊柱并联络心脏，所以也能治疗心痛牵引背部。
其三，取足少阳经。《内经》说：心痛牵引背部且呼吸不畅，针刺足少阴经无效时，取足少阳经，就是这个道理。因为手少阳经脉散布络于心脉。另外三焦的下合穴叫委阳，它是足太阳经的络穴，足太阳经沿着脊柱两旁肌肉下行，当心处进入并散布络脉，所以也能治疗心痛牵引背部。
其四，取督脉和任脉。《内经》说：背部像被心牵引控制而疼痛，治疗的穴位有天突、第十椎（至阳穴附近）以及上纪（中脘穴）。上纪指的是胃脘部（中脘穴）。下纪指的是关元穴。又说：心痛，应当在第九胸椎棘突下（灵台穴）针刺，按压后次按之，疼痛立即停止。如果无效，就在上下寻找穴位。找到合适的穴位，疼痛立即停止，就是这个道理。因为第十椎和第九节属于督脉；胃脘（中脘）和天突属于任脉。
厥心痛，伴有腹胀胸满，心脏特别疼痛严重的，是胃心痛。取大都、太白穴。
心痛兼有胀满，灸刺治疗方法有两种：
其一，取足太阴经。《内经》说：取大都、太白穴，就是这些穴位。又《内经》说：脾足太阴经脉发生变动则生病，表现为胃脘痛、腹胀。其所生的疾病中，烦心、心下急痛的，需根据脉象的盛虚、热寒及陷下情况来选取穴位。又说：心痛伴腹胀，身体啬啬恶寒，大便不通利，取足太阴经，就是这个道理。因为足太阴经脉从胃上行穿过膈肌，注入心中，所以心痛腹胀时取用此经。
其二，取足阳明经。《内经》说：胃病表现为腹胀，胃脘当心而痛，饮食不下，取足三里穴，就是这个道理。因为胃脘当心而痛，看似心痛，实际上并非真正的心痛。
厥心痛，感觉像锥子刺入心脏，心痛非常剧烈的，是脾心痛。取然谷、太溪穴。
治疗脾心痛取然谷、太溪穴，所以孙思邈、张洁古称之为误治经络。
厥心痛，面色青苍如死状，整天不能深呼吸叹息，是肝心痛。取行间、太冲穴。
心痛面色青苍如死状的，取肝经穴位。如果兼有小肠胀满、小便困难，也取肝经穴位。《内经》说：心痛牵引少腹满闷，上下无常处，小便困难，针刺足厥阴经，就是这个道理。
厥心痛，躺着或闲居时心痛减轻，活动时疼痛加剧，面色不变，是肺心痛。取鱼际、太渊穴。
“徒居”指闲居。“间”指痛缓。心痛在躺卧和闲居时疼痛缓解，活动时加剧的，取肺经穴位。如果兼有短气的症状，也取肺经穴位。《内经》说：心痛只是短气不足以息的，针刺手太阴经，就是这个道理。
心痛不可针刺的情况，是因为体内有实邪积聚，不可取用毫针。肠中有虫瘕及蛟螣（一种大虫），都不可用小针治疗。心肠痛发作时疼痛，肿胀积聚，往来上下移动，疼痛有休止时间，腹部发热喜欢口渴、流涎水的，这是蛟螣。用手聚拢按住并坚持固定它，不让它移动，用大针刺入，长时间留针，虫子不动了，然后出针。
〔《针灸大成》〕九种心痛：间使、灵道、公孙、太冲、足三里、阴陵泉。
〔桑氏〕心气痛：巨阙、鸠尾（各取一寸）、内关（泻法）。
〔《针灸聚英》〕脾脊后心疼痛：中渚（泻法，忌补）。灸心痛背上穴位：心俞、膈俞。
〔张洁古〕心痛脉弦，取肝原穴。脉沉，取肾原穴。脉涩，取肺原穴。脉浮，取心原穴。脉缓，取脾原穴。
〔《针灸摘玄》〕冷心痛：巨阙（烧针针刺它。如果是五脏之气相互干扰，导致胁痛、疝痛、癖块，都能引起心痛，应当仔细审察。）
〔《玉龙歌》〕心脾疼：上脘（二寸半，泻法）、中脘（二寸半，补多泻少）。
〔《甲乙经》〕心痛不可按压，心烦，巨阙主治。心痛有虫，多涎水，不能翻身侧卧，上管（上脘）主治。心痛向上冲击心胸，不想吃东西，支撑疼痛牵引膈部，建里主治。
〔《针灸聚英》〕心胸痛，并伴有气攻冲：劳宫、大陵（各三分，泻法）、内关。
〔《甲乙经》〕心痛容易悲伤，厥逆悬心，像饥饿的感觉，心脏经常惊恐，大陵及间使主治。心寒痛，难以俯仰，心疝气冲胃，昏迷不省人事，中脘主治。心痛，鼻出血、呃逆、呕血，惊恐畏人，神气不足，神门主治。
〔《难经》〕阴维脉发病，苦于心痛。（内关穴，通阴维脉。）
〔《甲乙经〕脾逆气寒，厥急烦心，喜欢唾沫、呃逆、嗳气，胸满呻吟，胃气上逆，心痛，太渊主治。（针刺理论说：肺胀胃逆。）心膨痛，尺泽主治。（《千金方》说：心烦闷乱，少气不足以息。）心痛，突然咳嗽气逆，尺泽主治，出血立止。胸痹心痛，肩内麻木，天井主治。胸胁背相互牵引而痛，呕吐不食，幽门主治。胸痹心痛，呼吸不畅，疼痛无常处，临泣主治。（《千金方》说：不能翻身侧卧。）
〔朱丹溪〕心痛虽然日子多，不吃东西不会死，如果痛止了就吃东西还会痛，必须吃三五服药后，才可以吃东西。心痛，左手脉数表示热多，脉涩表示有死血。右手脉实表示是痰积，脉大一定是久病。两手脉坚实且不大便的，用泻下法。疼痛剧烈的，脉必伏，多用温药附子之类，不可用人参、白术。
心脉微急，为心痛牵引背部，饮食不下。（全文见治虚实法。）
〔张仲景〕问：病腹痛有虫，其脉象如何辨别？老师说：腹中痛，其脉应当沉，如果反见洪大，所以有蛔虫。
脾脉微滑，为蛊毒蝮蝎腹热。（全文见治虚实法）
〔《脉诀》〕关上脉紧而滑的，是蛔毒。脉沉而滑的，是寸白虫。肘后粗，以下三四寸发热的，肠中有虫。
（全文见诊法。）真心痛，手足青紫直到关节，心痛剧烈，早上发作晚上死，晚上发作早上死。
If acupuncture is ineffective, select the Rangu (KI2) acupoint. (This sentence corresponds to the content in the "Jue Bing" chapter.)
For heart pain radiating to the back, there are four moxibustion and acupuncture treatment methods:
First, select the Foot-Taiyang Bladder Meridian. The *Cijie Zhenye* states: selecting Jinggu (BL64) and Kunlun (BL60) are these points. This is because the true qi of the Foot-Taiyang meridian follows along the paraspinal muscles, enters at the level of the heart, and spreads through collateral vessels; therefore, for heart pain radiating to the back, this meridian is selected.
Second, select the Foot-Shaoyin Kidney Meridian. The *Cijie Zhenye* states: if selecting Jinggu (BL64) and Kunlun (BL60) is ineffective, select Rangu (KI2); these are the points. Furthermore, the classics state: regarding diseases generated by the Foot-Shaoyin Kidney Meridian, such as vexation, restlessness, and heart pain, selection should be based on whether the pulse indicates excess or deficiency, heat or cold, or sinking/collapse. Also, the classics state: for heart pain radiating to the waist and spine accompanied by nausea, one should select the Foot-Shaoyin Meridian. This is because the Foot-Shaoyin meridian penetrates the spine and connects with the heart, thus it can also treat heart pain radiating to the back.
Third, select the Foot-Shaoyang Gallbladder Meridian. The classics state: for heart pain radiating to the back with dyspnea, if needling the Foot-Shaoyin is ineffective, select the Shaoyang Meridian. This is because the Hand-Shaoyang Sanjiao Meridian spreads and connects with the heart vessels. Additionally, the lower He-Sea point of the Sanjiao is Weiyang (BL39), which is a collateral point of the Foot-Taiyang Bladder Meridian. Since the Foot-Taiyang meridian follows along the paraspinal muscles and enters/spreads at the heart level, it can also treat heart pain radiating to the back.
Fourth, select the Du Mai (Governing Vessel) and Ren Mai (Conception Vessel). The classics state: when the back feels as if controlled by the heart causing pain, the treated points include Tiantu (CV22), the area around the tenth thoracic vertebra, and Shangji (Zhongwan, CV12). Shangji refers to the epigastrium (Zhongwan, CV12). Xiaji refers to Guanyuan (CV4). It also states: for heart pain, needle at the ninth vertebral segment (Lingtai, GV10); after pressing, press again, and the pain will stop immediately. If ineffective, search above and below. Finding the correct point stops the pain immediately. This is because the tenth vertebra and the ninth segment belong to the Du Mai; the epigastrium (Zhongwan, CV12) and Tiantu (CV22) belong to the Ren Mai.
Jue Heart Pain accompanied by abdominal distension and chest fullness, with severe heart pain, is Stomach Heart Pain. Select Dadu (SP2) and Taibai (SP3).
For heart pain accompanied by distension, there are two moxibustion and acupuncture treatment methods:
First, select the Foot-Taiyin Spleen Meridian. The classics state: selecting Dadu (SP2) and Taibai (SP3) are these points. Also, the classics state: when the Foot-Taiyin Spleen Meridian undergoes pathological changes, it causes disease manifesting as epigastric pain and abdominal distension. Diseases generated include vexation and urgent pain below the heart; selection should be based on excess/deficiency, heat/cold, or sinking/collapse. It also states: for heart pain with abdominal distension, feeling chilly, and difficulty defecating, select the Foot-Taiyin Meridian. This is because the Foot-Taiyin meridian ascends from the stomach, passes through the diaphragm, and injects into the heart; thus, for heart pain and abdominal distension, this meridian is selected.
Second, select the Foot-Yangming Stomach Meridian. The classics state: stomach disease manifests as abdominal distension, epigastric pain centered at the heart region, and inability to eat; select Zusanli (ST36). This is because epigastric pain centered at the heart resembles heart pain but is actually not true heart pain.
Jue Heart Pain, feeling as if pierced by an awl, with severe heart pain, is Spleen Heart Pain. Select Rangu (KI2) and Taixi (KI3).
Treating Spleen Heart Pain by selecting Rangu and Taixi was considered erroneous by Sun Simiao and Zhang Jiegu.
Jue Heart Pain with a cyan/dead-like complexion and inability to take deep breaths all day is Liver Heart Pain. Select Xingjian (LR2) and Taichong (LR3).
For heart pain with a cyan/dead-like complexion, select Liver meridian points. If accompanied by fullness in the Small Intestine and difficult urination, also select Liver meridian points. The classics state: for heart pain radiating to the lower abdomen with fullness, moving up and down without fixed location, and difficult urination, needle the Foot-Jueyin Liver Meridian.
Jue Heart Pain that eases when lying down or resting, but worsens with movement, with unchanged complexion, is Lung Heart Pain. Select Yuji (LU10) and Taiyuan (LU9).
"Tujū" means resting/idling. "Jian" means pain easing. When heart pain eases during rest and worsens with activity, select the Lung meridian. If accompanied by shortness of breath, also select the Lung meridian. The classics state: for heart pain characterized only by shortness of breath and insufficient respiration, needle the Hand-Taiyin Lung Meridian.
Heart pain that cannot be needled occurs when there is substantial accumulation inside; fine needles should not be used. If there are intestinal parasites or large worms (Jiaoteng), fine needles must not be used. When heart-intestinal pain occurs with swelling and accumulation moving up and down, with intermittent pain, abdominal heat, thirst, and salivation, this is Jiaoteng (large worm). Press and hold firmly with the hand to prevent movement, insert a large needle, retain it until the worm stops moving, then remove the needle.
[From *Jicheng*] Nine types of heart pain: Neiguan (PC6), Lingdao (HT4), Gongsun (SP4), Taichong (LR3), Zusanli (ST36), Yinlingquan (SP9).
[Sang's method] Heart Qi pain: Juque (CV14), Jiawei (CV15) (each 1 cun depth), Neiguan (PC6) (reduce method).
[From *Ju Ying*] Pain in the back between spleen and spine: Zhongzhu (TE3) (reduce method, avoid tonification). Moxibustion points on the back for heart pain: Xinshu (BL15), Geshu (BL17).
[Zhang Jiegu] Heart pain with wiry pulse: select Liver Yuan-source point. Deep pulse: select Kidney Yuan-source point. Choppy pulse: select Lung Yuan-source point. Floating pulse: select Heart Yuan-source point. Slow pulse: select Spleen Yuan-source point.
[From *Zhai Xuan*] Cold Heart Pain: Juque (CV14) (burning needle). If the qi of the five zang organs interferes with each other, causing hypochondriac pain, hernia pain, or masses that all lead to heart pain, careful differentiation is required.
[From *Yu Long Ge*] Heart-Spleen pain: Shangwan (CV13) (2.5 cun, reduce), Zhongwan (CV12) (2.5 cun, more tonify than reduce).
[From *Jia Yi Jing*] Heart pain that cannot be pressed, with vexation: Juque (CV14) governs. Heart pain with parasites, excessive saliva, inability to turn over: Shangwan (CV13) governs. Heart pain rushing upward to the chest, loss of appetite, supporting pain radiating to the diaphragm: Jianli (CV11) governs.
[From *Ju Ying*] Chest and heart pain with qi attacking: Laogong (PC8), Daling (PC7) (each 0.3 cun, reduce), Neiguan (PC6).
[From *Jia Yi Jing*] Heart pain with sadness, jue inversion with suspended heart sensation, feeling like hunger, frequent palpitations/fright: Daling (PC7) and Neiguan (PC6) govern. Cold heart pain, difficulty bending and stretching, heart hernia qi rushing to the stomach, coma: Zhongwan (CV12) governs. Heart pain with epistaxis, hiccups, hematemesis, fright, fearfulness, deficient spirit: Shenmen (HT7) governs.
[From *Nan Jing*] Illness of the Yin Wei Mai causes suffering heart pain. (Neiguan PC6 connects with the Yin Wei Mai.)
[From *Jia Yi Jing*] Spleen rebellion with cold qi, jue urgency, vexation, frequent spitting, hiccups, belching, chest fullness, groaning, stomach qi rebelling upward, heart pain: Taiyuan (LU9) governs. (Acupuncture theory states: Lung distension and stomach rebellion.) Heart distension pain: Chize (LU5) governs. (*Qian Jin Fang* states: vexation, restlessness, shortness of breath, insufficient respiration). Heart pain with sudden cough and rebellious qi: Chize (LU5) governs; bleeding stops the pain immediately. Thoracic bi heart pain with numbness in the medial shoulder: Tianjing (TE10) governs. Pain radiating between chest, hypochondrium, and back, vomiting, inability to eat: Youmen (ST21) governs. Thoracic bi heart pain with dyspnea, pain moving without fixed location: Linqi (GB41) governs. (*Qian Jin Fang* states: inability to turn over.)
[Zhu Danxi] Although heart pain persists for many days, death does not occur from fasting. However, eating when pain stops causes recurrence. One must take medicine for three to five doses before eating. For heart pain, a rapid pulse on the left hand indicates excess heat; a choppy pulse indicates static blood. A solid pulse on the right hand indicates phlegm accumulation; a large pulse indicates chronic disease. If pulses on both hands are firm and solid with constipation, use purgatives. For severe pain, the pulse is likely hidden; use warming herbs like Fuzi (Aconite Lateralis Radix Praeparata); do not use Renshen (Ginseng Radix) or Baizhu (Atractylodis Macrocephalae Rhizoma).
A slightly hurried Heart pulse indicates heart pain radiating to the back and inability to eat. (Full text see Treatment of Excess and Deficiency Methods.)
[Zhang Zhongjing] Question: How to differentiate the pulse for abdominal pain caused by parasites? Master said: Abdominal pain usually presents with a deep pulse. If it is instead flooding and large, it indicates Ascaris lumbricoides.
A slightly slippery Spleen pulse indicates蛊毒 (Gu poison) or viper/scorpion-induced abdominal heat. (Full text see Treatment of Excess and Deficiency Methods)
[From *Mai Jue*] Tight and slippery pulse at Guan position indicates Ascaris toxin. Deep and slippery pulse indicates Taenia saginata (rice tapeworm). Heat extending three to four inches below the elbow crease indicates intestinal parasites.
(Full text see Diagnosis.) True Heart Pain: hands and feet turn cyan up to the joints, severe heart pain; morning onset leads to evening death, evening onset leads to morning death.