（心包络痛，胃脘痛。）
心为君主，义不受邪。若邪伤其脏而痛者，谓之真心痛。其证卒然大痛，切牙
噤口，舌青气冷，汗出不休，面黑，手足青过节，冷如冰，旦发夕死，夕发旦死，
不治。不忍坐视，用猪心煎取汤，入麻黄、肉桂、干姜、附子服之，以散其寒，
或可死中求生。如但见爬床搔席，面无青色，四肢不厥，声尚能出，即非真心痛，乃
心包络受邪作痛也。而包络之邪，皆由各脏腑经脉传来。如从胸痛至心，是肺
心痛；从胃脘痛至心，是胃心痛；从胁痛至心，是肝心痛；从腰痛至心，是肾心
痛，可类推之。盖五脏六腑任督各支脉，皆络于心，其邪气自支脉而乘心者，不易
人于心，而但犯其包络也。于是气血为邪所滞，邪正相击，故痛矣。
心包络痛，在胸下 骨处，稍下即为胃脘痛。胃上脘名贲门，在脐上五
寸，去 骨三寸，而痛每相连，故世俗总以心痛呼之。且有九种心痛之说，曰∶
虫、饮、食，风、冷、热、悸、疰、去来痛。丹溪云∶心膈痛须分新久，若明知身
受寒气，口食寒物，于新得之时，当与温散，或温利之。（仲景九痛丸，洁古煮黄丸之类。）病
久则郁蒸成热，若用温散温利，恐助火，须加山栀仁。气郁即痛，不必待成热也。
而概以火郁言之者，以气属阳，即属火耳，此义宜知。寒痛，寒气客于肠胃，卒
然而痛，二陈（见痰饮）、草果、干姜、吴茱萸、扶阳助胃汤、草豆蔻丸之类。热痛，
清中汤，黄连、龙胆草之属。痰积痛，星半安中汤，海蛤丸，或吐之。痰痛，湿痰
嘈杂不宁，如饥如饱，欲吐，吐即宽，二陈加草蔻、苍术。清痰流饮，漉漉有声，
攻走腰肋，胃苓汤（见泄泻）。寒痰，一月一发，或两发，或二三月一发，发时痛极，闷
死，偶怒或劳，乘势涌起，平胃（见伤饮食）加干姜、草蔻、枳壳。咳逆上气，
痰饮心痛，海蛤粉（ 。）、栝蒌实（带穣）。等分为末，米糊丸。气攻刺作痛，加味七气
汤，沉香降气散，（此及下方并见气）。正气天香散。（但忍气即发者是也。）死血作痛，脉必涩，
发作时，饮米汤下。或作呃，有时气逆腾，如虫搅，唧唧有声，勿误作虫。壮
人用桃仁承气汤（见血），弱人用归尾、川芎、丹皮、红花、苏木、玄胡索、桂心、
桃仁泥、赤曲、番降香、通草、穿山甲之属，煎成入童便、韭汁，大剂饮之，
或失笑散。虫痛如咬，面有白 ，又面色乍青乍白乍赤，唇红，吐清水，或清
黄水，时痛时止，能食，或食即痛，以虫得食而动，故痛也，饱后痛即止。化
虫丸（见虫）、川楝子、苦练根、使君子、槟榔、黄连、雷丸、乌梅，不可用花椒，太辣，
恐大惊跳，治详虫门。食痛，如有物碍，累累不下，时嗳腐气，略伤食，闷闷
作痛，平胃散（见伤饮食）加枳实、半夏、槟榔。旧有酒食痰积，一遇触犯便痛，挟
风寒者，参苏饮（见发热）加葱姜；挟怒气者，二陈，（见痰）加青皮、山栀、曲 、山楂、
草果；挟火热者，二陈加枳实、黄连、（姜汁炒。）山栀。脉坚实，不大便，心下满
痛，不可按者，实也，大柴胡（见疟）、三承气（见大便不通）下之。痛不可按为实，可按为虚，
虚者补而行之，或纯补。丹溪治许文懿公食积痰饮，往来如潮，涌上则为心脾痛，
降下则为胯痛，以制甘遂末入猪腰内煨食之，（即张子和煨肾散，方峻，勿轻用。）连泄七次，
足便能步。然多年郁结，一旦泄之，徒引动其猖獗之势，仍以吐剂达其上焦，连用
瓜蒂、黎芦、苦参等。俱吐不透，仍用附子尖三枚，和浆水以蜜饮之，方大吐胶痰
一桶。然后治及中下二焦，以朴硝、滑石、黄芩、石膏、连翘等一斤，浓煎冷冻饮料之，
四日服四斤，腹微痛，二便秘，脉歇至，于卯酉时，乃阳明之应，胃与大肠积滞未
尽也。乃作紫雪（见遗精论末）三日，服至五两，腹稍安。后又小便闭痛，饮以萝卜汁，
得吐立通。又小腹满痛，以大黄、牵牛等分，水丸服至三百丸，下如烂鱼肠者二升
许，脉不歇。又大便迸痛，与前丸，下秽物如地沥青条尺许。自病至安，脉
皆平常弦大，次年行倒仓法（见积聚）全愈。（此得于张子和，无胆识者敢乎？）
心脏作为君主之官，按理不应直接受邪。如果邪气损伤了心脏本体而导致疼痛，这被称为真心痛（心脏本体受邪引起的剧烈心痛）。其症状是突然发生剧烈疼痛，咬牙紧闭口唇，舌色发青，气息寒冷，出汗不止，面色发黑，手足青紫超过关节，冰冷如冰，早晨发病傍晚死亡，傍晚发病早晨死亡，属于不治之症。不忍心坐视不管，可用猪心煎取汤汁，加入麻黄、肉桂、干姜、附子服用，以驱散寒邪，或许能在死中求生。如果只见患者爬床搔席，面色没有青色，四肢不厥冷，声音尚能发出，这就不是真心痛，而是心包络（保护心脏的外围组织）受邪引起的疼痛。而心包络的邪气，都是由其他脏腑经脉传变而来。例如从胸痛放射至心部，称为肺心痛；从胃脘痛放射至心部，称为胃心痛；从胁肋痛放射至心部，称为肝心痛；从腰痛放射至心部，称为肾心痛，其余可类推。因为五脏六腑的任脉和督脉的各支脉，都联络于心，邪气从支脉侵犯心脏时，不容易直接进入心脏，而只是侵犯其心包络。于是气血被邪气阻滞，邪气与正气相互搏击，所以产生疼痛。
心包络痛的位置在胸下肋骨处，再稍下方就是胃脘痛。胃的上口名为贲门，位于脐上五寸，距离前正中线旁开三寸（注：原文此处可能有脱漏或指特定定位，通常贲门居中），但疼痛往往相互关联，所以世俗总将此类疼痛统称为心痛。并且有“九种心痛”的说法，即：虫心痛、饮心痛、食心痛、风心痛、冷心痛、热心痛、悸心痛、疰心痛、去来心痛（游走性疼痛）。朱丹溪说：心膈部位的疼痛必须区分新病和久病。如果明确知道身体受了寒气，吃了寒凉食物，在新近患病时，应当使用温散法，或者温利法。（如张仲景的九痛丸、李东垣的煮黄丸之类。）如果病程长久，则郁结蒸腾化为热邪，如果再用温散温利的方法，恐怕会助长火势，必须加入山栀仁。如果是气机郁滞导致的疼痛，不一定非要等到化热才治疗。而一概用“火郁”来解释的原因，是因为气属于阳，也就属于火，这个道理应该明白。寒痛，是寒气客居于肠胃，突然发生疼痛，可用二陈汤（见痰饮章节）、草果、干姜、吴茱萸、扶阳助胃汤、草豆蔻丸之类。热痛，用清中汤，黄连、龙胆草这类药物。痰积痛，用星半安中汤、海蛤丸，或者采用吐法。痰痛表现为湿痰导致的心烦嘈杂不安，感觉像饿又像饱，想呕吐，吐出来就舒服，用二陈汤加草豆蔻、苍术。清稀痰饮流注体内，漉漉有声，攻窜腰肋，用胃苓汤（见泄泻章节）。寒痰，一个月发作一次，或两次，或两三个月发作一次，发作时疼痛极度剧烈，甚至闷厥昏死，偶尔因愤怒或劳累，趁势涌起，用平胃散（见伤饮食章节）加干姜、草豆蔻、枳壳。咳嗽气逆上冲，伴有痰饮心痛，用海蛤粉、栝蒌实（带瓤），等分为末，米糊制成丸剂。气攻刺作痛，用加味七气汤、沉香降气散（此方及下方均见气病章节）、正气天香散（凡是忍气后发作的就是这种）。死血（瘀血）作痛，脉象必然涩滞，发作时，用米汤送服药物。或者出现呃逆，有时气逆上腾，像虫子搅动一样，唧唧有声，不要误认为是虫痛。体质壮实的人用桃仁承气汤（见血病章节），体质虚弱的人用当归尾、川芎、牡丹皮、红花、苏木、玄胡索、桂心、桃仁泥、赤曲、番降香、通草、穿山甲这类药物，煎好后加入童便、韭菜汁，大剂量服用，或者用失笑散。虫痛感觉像被咬，面部有白斑，面色乍青乍白乍红，嘴唇红，吐出清水，或者清黄色的水，疼痛时作时止，能进食，或者一吃东西就痛，因为虫子得到食物就会活动，所以引起疼痛，吃饱后疼痛就停止。用化虫丸（见虫病章节）、川楝子、苦参根、使君子、槟榔、黄连、雷丸、乌梅，不可用花椒，因为太辣，恐怕引起大惊跳，详细治法见虫病门。食积痛，感觉如有物阻碍，累累不下，时常嗳出腐臭气味，稍微吃伤食物，就闷闷作痛，用平胃散（见伤饮食章节）加枳实、半夏、槟榔。原本就有酒食痰积，一旦遇到触犯因素就疼痛，挟带风寒的，用参苏饮（见发热章节）加葱姜；挟带怒气的，用二陈汤（见痰病章节）加青皮、山栀、神曲、山楂、草果；挟带火热邪气的，用二陈汤加枳实、黄连（姜汁炒）、山栀。脉象坚实，不大便，心下满痛，不能按压的，属于实证，用大柴胡汤（见疟疾病例）、三承气汤（见大便不通章节）攻下。疼痛不可按压为实证，可以按压为虚证，虚证用补益兼行气的方法，或者纯用补法。朱丹溪治疗许文懿公的食积痰饮，往来如潮水般涌动，涌上则导致心脾痛，下降则导致胯部疼痛，用制甘遂末放入猪腰内煨熟食用（这就是张子和的煨肾散，方剂峻猛，不要轻易使用），连续腹泻七次，脚就能走路了。然而多年的郁结，一旦泻下，只会引动其猖獗的势头，仍然用吐剂通达其上焦，连续使用瓜蒂、藜芦、苦参等。都吐不出来，仍然用附子尖三枚，配合浆水和蜂蜜饮用，这才大吐出一桶胶状痰涎。然后治疗中下二焦，用朴硝、滑石、黄芩、石膏、连翘等一斤，浓煎后放冷饮料下，四天服完四斤，腹部轻微疼痛，大小便闭塞，脉搏间歇停顿，在卯酉时（上午5-7点，下午5-7点，这是阳明经当令的时间），说明胃与大肠的积滞未尽。于是制作紫雪（见遗精论末尾章节），三天服用至五两，腹部稍微安宁。后来又小便闭痛，饮用萝卜汁，得以呕吐后立即通畅。又小腹满痛，用大黄、牵牛子等分，水泛为丸服用至三百丸，排出像烂鱼肠一样的秽物约二升，脉搏不再间歇。又大便迸裂疼痛，与前丸，排出像地沥青条状一尺左右的秽物。从生病到痊愈，脉象都是平常的弦大脉，次年采用倒仓法（见积聚章节）完全治愈。（这个方法得自张子和，没有胆识的人敢用吗？）
(Pericardium pain, epigastric pain.)
The Heart is the Sovereign Monarch and, by principle, should not be directly invaded by pathogens. If pathogens injure the Heart organ itself causing pain, it is called Zhenxin Tong (True Heart Pain). The symptoms include sudden severe pain, teeth grinding with clenched jaw, cyanosis of the tongue, cold breath, incessant sweating, black complexion, cyanosis of hands and feet extending beyond the joints, and coldness like ice. Death occurs in the morning if onset is in the evening, or in the evening if onset is in the morning; this is incurable. Out of compassion, one may decoct a pig heart to obtain its broth, add Ephedrae Herba (Mahuang), Cinnamomi Ramulus (Guizhi), Zingiberis Rhizoma (Ganjiang), and Aconiti Lateralis Radix Praeparata (Fuzi) for oral administration to disperse cold, perhaps offering a chance of survival from death. If only climbing the bed and scratching the floor are observed, without cyanosis of the face, without cold extremities, and with voice still audible, it is not True Heart Pain, but pain caused by pathogen invasion of the Pericardium (the protective sac surrounding the heart). The pathogens affecting the Pericardium are transmitted from the meridians of various zang-fu organs. For instance, pain radiating from the chest to the heart is Lung Heart Pain; from the epigastrium to the heart is Stomach Heart Pain; from the hypochondrium to the heart is Liver Heart Pain; from the lower back to the heart is Kidney Heart Pain; others can be inferred similarly. This is because the collateral branches of the Ren and Du meridians of the five zang and six fu organs all connect to the Heart. When pathogens invade from these collateral branches towards the Heart, they do not easily enter the Heart itself but rather affect its Pericardium. Consequently, qi and blood are stagnated by pathogens, and the struggle between pathogenic factors and healthy qi causes pain.
Pericardium pain is located below the sternum; slightly lower down is epigastric pain. The upper orifice of the stomach is named Fenmen (Cardia), located five cun above the umbilicus and three cun lateral to the anterior midline (Note: Textual ambiguity exists here regarding specific measurement context). However, the pains often interconnect, so laypeople generally refer to such conditions collectively as "Heart Pain." There is also a theory of "Nine Types of Heart Pain," namely: Worm Pain, Fluid Retention Pain, Food Stagnation Pain, Wind Pain, Cold Pain, Heat Pain, Palpitation Pain, Infectious/Contagious Pain, and Migratory Pain. Zhu Danxi stated: Pain in the heart and diaphragm must be distinguished by newness or chronicity. If it is known that the body has been exposed to cold or cold foods ingested, during the early stage, warm dispersing methods or warm purging methods should be used (such as Jiutong Wan [Nine-Pain Pill] by Zhang Zhongjing, or Zhuhuang Wan by Li Dongyuan). In chronic cases, stagnation steams into heat; using warm dispersing or purging methods might exacerbate fire, so Gardeniae Fructus (Shanzhiren) should be added. If pain is due to qi stagnation, treatment is necessary even before heat transformation occurs. The reason for generally attributing this to "Fire Stagnation" is that qi belongs to Yang, and thus to Fire; this principle should be understood. Cold pain results from cold pathogens lodging in the intestines and stomach, causing sudden pain; Erchen Tang (see Phlegm-Fluids chapter), Tsao Guo (Arecae Semen), Ganjiang, Evodiae Fructus (Wuzhuyu), Fuyang Zhuwei Decoction, or Caodoukou Wan may be used. Heat pain is treated with Qingzhong Tang, including Coptidis Rhizoma (Huanglian) and Gentianae Radix (Longdancao). Phlegm accumulation pain is treated with Xingban Anzhong Tang or Haige Wan, or induced vomiting. Phlegm pain manifests as discomfort and restlessness due to damp-phlegm, feeling both hungry and full, with desire to vomit providing relief; Erchen Tang plus Caodoukou and Atractylodis Rhizoma (Cangzhu) is used. Clear fluid retention moving within, producing gurgling sounds, attacking the waist and ribs, is treated with Weiling Tang (see Diarrhea chapter). Cold phlegm occurs once a month, twice, or every two to three months; upon onset, pain is extreme, leading to fainting; occasional anger or labor triggers an upsurge; Pingwei San (see Food Injury chapter) plus Ganjiang, Caodoukou, and Aurantii Fructus (Zhiqiao) is used. Cough with rebellious qi accompanied by phlegm-fluid heart pain is treated with Haige Powder and Trichosanthis Fructus (Gualou Shi, with pulp), ground equally into powder, formed into pills with rice paste. Qi attack stabbing pain is treated with Jiaqi Qi Tang, Chenxiang Jiangqi San (these and the following formula are seen in Qi disorders chapter), or Zhengqi Tianxiang San (specifically for those whose pain is triggered by suppressed anger). Fixed blood stasis pain presents with a choppy pulse; during attacks, take medicine with rice soup. Or there may be hiccups, with qi rebelling upwards, feeling like insects churning, making chirping sounds; do not mistake this for worm pain. Robust individuals use Taoren Chengqi Tang (see Blood disorders chapter); frail individuals use Dangguiweiba, Chuanxiong Rhizoma (Chuanxiong), Moutan Cortex (Danpi), Carthami Flos (Honghua), Sappanwood (Suman), Cyperi Rhizoma (Yanhusuo), Cinnamomi Cortex (Guixin), Taoren paste, Chi Qu, Red Sandalwood (Xiangchen), Trogopterori Faeces (Piaoxiaofen - Note: Text says 'Fan Jiangxiang' which is likely Aquilaria/Sandalwood variant or typo, interpreted here as aromatic qi-moving herb), and Trogopteri Dung (Tongcao - Note: Text says 'Tongcao' usually Pherocaulis, but context suggests blood-invigorating combo, sticking to text: Tongcao), and Pangolin Scales (Chuanshanjia), decocted, then mixed with child's urine and Chinese chive juice, taken in large doses, or Shixiao San. Worm pain feels like biting, with white spots on the face, complexion alternating between cyanotic, pale, and red, red lips, vomiting clear water or yellowish fluid, pain coming and going, ability to eat, or pain immediately after eating because worms move when fed, so pain occurs; pain stops after fullness. Huachong Wan (see Worm chapter), Toosendan Fructus (Chuanlianzi), Sophorae Root (Kulian Gen), Quisqualis Fructus (Shijunzi), Areca Seed (Binglang), Coptidis Rhizoma (Huanglian), Osmundae Spora (Leiwu), and Mume Fructus (Wumei) are used; Sichuan Pepper (Huajiao) must not be used as it is too pungent and may cause severe palpitations; detailed treatment is in the Worm section. Food stagnation pain feels like an obstruction, heavy and unyielding, with frequent belching of rotten smells, dull pain after slight dietary injury; Pingwei San plus Zhi Shi, Banxia, and Binglang is used. For pre-existing alcohol/food/phlegm accumulation, pain triggered by contact: if complicated by wind-cold, Shen Su Yin (see Fever chapter) plus Scallion Stem (Congbai) and Ginger; if complicated by anger, Erchen Tang plus Qingpi, Zhizi, Shenqu, Hawthorn Fruit (Shanzha), and Caoguo; if complicated by heat-fire, Erchen Tang plus Zhi Shi, Huanglian (stir-fried with ginger juice), and Zhizi. If the pulse is firm, there is no bowel movement, subcostal fullness and pain that cannot be pressed, it is excess; Da Chaihu Tang (see Malaria chapter) or Three Chengqi Decoctions (see Constipation chapter) should be used to purge. Unbearable pressing indicates excess; bearable pressing indicates deficiency. Deficiency is treated with tonification combined with regulation, or pure tonification. Zhu Danxi treated Duke Xu Wenyi’s food stagnation and phlegm-fluid retention, which surged like tides; surging upward caused heart-spleen pain, descending caused hip pain. He used prepared Kansui Radix powder baked inside a pig kidney for consumption (this is Zhang Hezi’s Wei Shen San, a harsh formula, do not use lightly). After seven episodes of diarrhea, the patient could walk. However, long-standing stagnation, once purged, merely incites rampant momentum. Therefore, emetics were used to reach the upper jiao, continuously using Citri Reticulatae Pericarpium (Gua Di - actually Geng Ti/Dadi), Veratrum Nigrum (Lilu), and Sophorae Radix (Kushen). Vomiting failed to expel everything. Then, three tips of Aconiti Lateralis Radix (Fuzui) were mixed with fermented grain water and honey for drinking, resulting in the massive vomiting of one bucket of gelatinous phlegm. Subsequently, the middle and lower jiao were treated with Glauber's Salt (Puxiao), Talcum (Huashi), Scutellariae Radix (Huangqin), Gypsum Fibrosum (Shigao), and Forsythiae Fructus (Lianqiao), totaling one jin, decocted strongly and drunk cold. Four jin were consumed over four days. Mild abdominal pain occurred, constipation and urinary retention developed, and the pulse became intermittent. At Mao and You hours (corresponding to Yangming meridian time, indicating Stomach and Large Intestine accumulation was not exhausted), Zixue (Purple Snow) was prepared (see End of Premature Ejaculation discussion chapter). Five liang were taken over three days, bringing slight abdominal relief. Later, painful urinary retention occurred; radish juice was drunk, leading to immediate relief after vomiting. Lower abdominal fullness and pain were treated with equal parts Rhubarbi Radix et Rhizoma (Dahuang) and Pharbitidis Semen (Qianniu), made into water pills, taken until 300 pills were consumed, passing about two sheng of feces resembling rotten fish intestines; the pulse ceased to be intermittent. Bowel movement bursting pain was treated with the same pills, passing filth resembling asphalt strips of about one chi length. From illness to recovery, the pulse remained normally wiry and large. The next year, Dao Cang Fa (Inversion Warehouse Method) was employed (see Accumulation-Mass chapter), resulting in complete cure. (This method was derived from Zhang Hezi; would anyone without courage dare to use it?)