外感寒邪 内伤生冷 七情气结
夫心痛者是胃脘当心痛也盖胃为水谷之海主容纳五谷喜温而恶寒或外受寒冷之邪或内伤
生冷之物及七情不顺郁结成痰妨碍升降是以清阳之气不升浊阴之气不降而为痛矣古方心痛有
九种曰虫痛曰疰痛曰风痛曰悸痛曰食痛曰饮痛曰寒痛曰热痛曰来去痛是也其痛虽分九种未有
不因饮食寒邪郁结而成也大抵腹中诸痛皆由劳役过甚饮食不节中气不足寒邪乘虚而入与气相
搏故猝然而痛也有宿食停于肠胃结滞而作痛者有痛而呕者有痛而泄者有痛而大便不通者有真
心痛者其痛甚手足青者死不治症各不同当辨其寒热虚实随其所得之由而施治之临病之际尚宜
审焉
丹溪云心痛即胃脘痛虽日数多不吃食不死若痛方止便与饮食其痛复作必须药后少待方与
饮食戴云寒痛者绵绵痛而无增减者是也时痛时止是虫与热也死血痛者每痛有常处不行移者是
也食积痛者痛欲大便利后则痛减者是也
凡心腹痛有虚寒实积虫啮死血当验症处治有以物抵按痛处即止者是虚痛若不能近手摩按
者是实痛亦有虫痛者发则面斑白唇红思食时作时止此虫啮痛也有素好饮热酒以致死血留于胃
口亦能作痛遇热饮则痛止是血得热则散也
外感寒邪，内伤生冷食物，加上七情（喜、怒、忧、思、悲、恐、惊）导致的气机郁结。
所谓心痛，实际上是指胃脘部的心痛。因为胃是水谷之海，主要功能是容纳和消化五谷，它喜欢温暖而厌恶寒冷。如果外部受到寒冷的邪气侵袭，或者内部损伤了生冷食物，再加上七情不畅导致气机郁结形成痰饮，阻碍了气机的升降运动，使得清阳之气不能上升，浊阴之气不能下降，从而产生疼痛。古代方书中记载的心痛有九种：虫痛、注痛、风痛、悸痛、食痛、饮痛、寒痛、热痛、来去痛。虽然疼痛分为这九种，但没有不是因为饮食不当或寒邪郁结而形成的。大抵腹部各种疼痛，都是由过度劳累、饮食不节制、中气不足，导致寒邪乘虚而入，与正气相搏结，所以突然发生疼痛。有的因为宿食停滞在肠胃，结滞不通而作痛；有的疼痛伴随呕吐；有的疼痛伴随腹泻；有的疼痛伴有大便不通；还有真心痛，疼痛剧烈，手足发青，属于死症，无法治愈。这些症状各不相同，应当辨别其寒热虚实，根据致病的原因进行治疗。面对疾病时，还应当仔细审察。
朱丹溪说：心痛就是胃脘痛，即使好几天不吃东西也不会死；但如果疼痛刚停止就给予饮食，疼痛就会复发，必须在服药后稍等一段时间才能进食。戴元礼说：寒痛是绵绵不断的疼痛，没有增减；时痛时止的是虫痛和热痛；死血痛是每次疼痛都有固定的位置，不移动；食积痛是想要大便，排便后疼痛减轻。
凡是心腹痛，有虚寒、实积、虫咬、死血等情况，应当根据症状进行治疗。如果用物体按压疼痛处，疼痛就停止的，是虚痛；如果不能忍受手摸按压的，是实痛。也有虫痛，发作时面色苍白、嘴唇红润、想吃东西，时作时止，这是虫咬痛。也有平时喜欢喝热酒，导致死血停留在胃部，也能引起疼痛，遇到热饮则疼痛停止，这是因为血液得热则消散。
《脉诀》说：脉象沉紧，心中逆冷疼痛；左手脉数表示热多，脉涩表示死血；右手寸口脉紧盛表示有食积；心腹痛脉象沉细为宜，若出现浮大脉象则病情危重。
Exterior contraction of cold pathogenic factors, interior injury from raw and cold foods, and qi stagnation due to the seven emotions (joy, anger, worry, thought, sorrow, fear, fright).
The so-called heart pain actually refers to pain in the epigastrium. The stomach is the sea of water and grain, primarily responsible for receiving and digesting the five grains; it prefers warmth and dislikes cold. If externally invaded by cold pathogenic factors, or internally injured by raw and cold foods, combined with emotional disharmony causing qi stagnation and phlegm formation, which obstructs the ascending and descending mechanisms, resulting in clear yang qi failing to ascend and turbid yin qi failing to descend, pain ensues. Ancient formularies record nine types of heart pain: worm pain, infectious pain, wind pain, palpitation pain, food stagnation pain, fluid retention pain, cold pain, heat pain, and wandering pain. Although categorized into these nine types, none arise without dietary irregularities or cold pathogenic stagnation. Generally, all abdominal pains stem from excessive labor, irregular diet, deficiency of middle qi, allowing cold pathogens to enter through the deficiency and contend with healthy qi, causing sudden pain. Some cases involve lingering undigested food stagnating in the intestines and stomach, causing pain due to obstruction; some present with pain accompanied by vomiting; some with diarrhea; some with constipation; and true heart pain, characterized by severe pain and cyanosis of the hands and feet, is a fatal condition that cannot be cured. These symptoms vary, and one must differentiate between cold, heat, excess, and deficiency, treating according to the etiology. In clinical practice, careful examination is essential.
Zhu Danxi stated that heart pain is essentially epigastric pain; even if one does not eat for several days, death will not occur. However, if food is consumed immediately after the pain subsides, the pain will recur. One must wait for a while after taking medicine before resuming diet. Dai Yuanli stated that cold pain is continuous and unvarying; intermittent pain indicates worm pain or heat pain; fixed-location pain that does not shift indicates blood stasis pain; and food stagnation pain is relieved after defecation.
In general, heart and abdominal pains may be due to deficiency-cold, excess accumulation, worm infestation, or blood stasis. Treatment should be based on symptoms. Pain that ceases upon pressure indicates deficiency pain; pain that cannot tolerate touch or pressure indicates excess pain. Worm pain presents with pale complexion, red lips, craving for food, and intermittent occurrence during attacks. Drinking hot wine habitually can cause blood stasis to remain in the stomach, leading to pain; this pain stops when hot drinks are taken, as blood disperses with heat.
The *Mai Jue* (Pulse Classic) states: A deep and tight pulse indicates internal cold and painful counterflow in the heart; a rapid pulse on the left hand indicates excess heat; a choppy pulse indicates blood stasis; a tight and full pulse at the right cun position indicates food stagnation; a deep and fine pulse in heart/abdominal pain is appropriate, whereas a floating and large pulse indicates critical danger.