经义
厥心痛，与背相控，善螈，如从后触其心；伛偻者，肾心痛也。○腹胀胸满，心痛尤甚，胃心痛也。
○如以锥针刺其心，心痛甚者，脾心痛也。○色苍苍如死状，终日不得太息，肝心痛也。○卧若徒居，心痛间，
动作痛益甚，色不变，肺心痛也。○真心
痛，手足青至节。心痛甚，旦发夕死、夕发旦死。（《灵枢》）
哲言
心寂则痛微，心躁则痛甚。百端之起，皆自心生。（王太仆）
诸经心痛，心与背相引，心痛彻背、背痛彻心。诸腑心痛，难以俯仰，小腹上冲，卒不知人，呕吐泄泻。（陈无择）
心包络痛，痛彻背，寒热皆痛。胃痛，胃脘当心处痛，其因多端。脾痛，脾脉络心，痛不下食。胸痛，心
之俞，胆之脉络，痛引背胁。膈痛，心胃之间，横满而痛。（《医阶辨证》）
《内经》论心痛，未有不兼五脏为病者。独详于心，而略于胸腹，举一以例其余也。心为君主，义不受
邪；受邪则本经自病，名真心痛，死不治。然《经》有云∶邪在心则病心痛，喜悲，时眩仆。此言包络受邪，
在腑不在脏也。又云∶手少阴之脉，动则病嗌干，心痛，渴而欲饮。此言包络受邪，在络不在经也。其络与腑
之受邪，皆因怵惕思虑，伤神涸血，是以受如持虚。而方论复分九种∶曰饮、曰食、曰热、曰冷、曰气、曰血、
曰悸、曰虫、曰疰。苟不能遍识病因，将何以为治耶？胃属湿土，列处中焦，为水谷之海。五脏六腑十二经脉，
皆受气于此。壮者邪不能干，弱者着而为病。偏热、偏寒、水停、食积，皆与真气相搏而痛。肝木相乘为贼邪，
肾寒厥逆为微邪。挟他脏而见证，当与心痛相同。但或满、或胀、或呕吐、或不能食、或吞酸、或大便难、或
泻痢，面浮而黄，本病与客邪必参杂而见也。胸痛即膈痛，其与心痛别者∶心痛在岐骨陷处，胸痛则横满胸间
也。其与胃脘痛别者，胃脘痛在心下，胸痛在心上也。《经》曰∶南风生于夏，病在心，俞在胸胁。此以胸属
心也。肝虚则胸痛引背胁，肝实则胸痛不得转侧。此以胸属肝也。夫胸中实肺家之分野，其言心者，以心脉从
心系上肺也；其言肝者，以肝脉贯膈注肺也。（李士材）
胃痛有食、痰、死血、气、寒、火、中气虚之别，方书载列甚明。独有一种肝胆之火，移入于胃。肝藏
血，血少则肝叶硬不肯下垂，
肝叶抵胃，胃受肝抵，得食则满，愈与肝相逼，殷殷而痛者，久变燥证而成隔矣。（《己任编》）
补编
心胸中大寒痛，呕不能饮食，腹中寒，上冲皮起，出见有头足，上下痛不可触近，大建中汤主之。○心中
寒者，其人病心如啖蒜状。剧者心痛彻背、背痛彻心，譬如虫疰。其脉浮者，自吐乃愈。○心痛彻背，背痛彻心，
乌头赤石脂圆主之。（《金匮》）
五脏之滞，皆为心痛。肾心痛者，多由阴火上冲。胃心痛者，多由停滞。脾心痛者，多由寒逆中焦。肝
心痛者，多由木火之郁，病在血分。肺心痛者，多由上焦不清，病在气分。知其在气则顺之，在血则行之，郁
则开之，滞则通之，火多实则或散、或清，寒多虚则或温、或补。必真心痛也，乃不可治。否则，但得其本，
则必随手而应也。（张路玉）
凡心痛乃包络病，不在心也。或因君火衰微，大寒触犯，抑或瘀血冲心，卒然大痛无声，舌青气冷，汗出
不休，手足青冷过节，此为真心痛。旦发夕死，夕发旦死。若不忍坐视，或使心经寒散，亦可死中求活∶用猪
心汤煎麻黄、桂、附、干姜。如面无青色，四肢不厥，痛亦不至无声，则非真心痛。或寒、痰、虫、食，上干
包络，各从其类，审脉用药。（沈金鳌）
厥心痛一证，古人辨论者，多且精矣！兹不复赘。但厥心痛与胃脘痛，情状似一，而证实有别。世人因
《内经》胃脘当心而痛一语，往往混视。不知厥心痛为五脏之气厥而入心包络，胃实与焉。则心痛与胃痛，不
得不各分一门。案中闻雷被惊者，用逍遥散去柴胡，加钩藤、丹皮治之；以其肝阳上逆，不容升达，为之养血
以平调也。积劳损伤者，用归、鹿、姜、桂、桃仁、半夏治之；以其劳伤血痹，无徒破气，为之通络以和营也。
脾厥心痛者，用良姜、姜黄、茅术、丁香、草果、浓朴治之；以其脾寒气厥，病在脉络，为之辛香以开通也。
重按而痛稍衰者，用人参、
桂枝、川椒、炙草、白蜜治之；以其心营受伤，攻劫难施，为之辛甘以化阳也。○阳明乃十二经脉之长，其作
痛之因甚多。盖胃者汇也，乃冲繁要道，为患最易。习俗辛香温燥，不容一例而施。然其要在初病在经，久痛
入络。以经主气，络主血，凡气既久阻，血亦应病，循行之脉络自痹，而辛香理气、辛柔和血之法，实为必然
之理。又如饱食痛甚，得食痛缓，有宜补、不宜补之分。寒、温两法，从乎喜暖、喜凉；滋、燥之殊，询其便
涩、便滑。至于饮停必吞酸，食滞当嗳腐。厥气无形，瘀伤有象。蛔虫动扰，痛而吐沫。痰湿壅塞，吐而脉滑。
营气两虚， 辣动悸。肝阳冲克，烦渴呕逆。阴邪之势，其来必速；郁火之患，由渐而剧。（《临证指南》）
胃脘痛证，多有因食、因寒、因气不顺者。然因食、因寒，亦无不皆关于气。盖食停则气滞，寒留则气凝。
所以治痛之要，但察其果属实邪，皆当以理气为主。食滞者兼乎消导，寒滞者兼乎温中。（张景岳）
胃脘痛大率气、食居多，不可骤用补剂。盖补之则气不通而痛愈甚。若曾服攻击之品，屡发屡攻，渐至脉
大空虚者，又当培补。盖脾得补而气自运，痛自缓。此虚实之分也。（《证治汇补》）
胃与包络近，俗谓之心痛，非也。真心痛则旦发夕死，夕发旦死，无药可救者也。盖阳明中土，乃水谷之
道路。多气多血，运化精微，通于脾而灌溉四脏，为后天之本。人生酒色过度、七情乖违、饥饱不节，胃脘因
之而痛，有寒、热、气、血、痰、虫、食滞、内虚之不同。治虽各别，然总不外虚、实、寒、热、气、血之辨
也。夫痛而虚者必喜按，痛而实者必拒按。寒者得温稍定，热者饮冷稍安。中焦寒则气虚不运，或生痰饮，或
蓄瘀血或蛔虫上逆。中焦热，则气阻不行，或吐酸味，或吐苦汁，或食停蛔动。如真如其为虚寒痛也，则塞因
塞用以补之；真知其为实热痛也，则通因通用以泻之。虚寒而挟食、挟瘀、生痰、生
虫者，以温补药中消之、逐之；实热而挟食、挟瘀、吐蛔、呕酸者，以清凉药中攻之、伐之。虽然，胃间受病，
人所易知；肝木凌脾，人亦易晓。若男子肝肾亏，挟虚火而上逆；妇人冲任弱，挟肝阳而上升，多有胃脘痛证。
医家不察病原，非投辛温耗气，即用清凉败血，愈治愈甚。《经》曰∶冲脉起于气街，并少阴之经，挟脐上行，
至胸中而散。任脉起于中极，上毛际，循腹里，上关元，至咽喉。可见胃脘之痛，有自下而上、由肾而胃，勿
泥中焦为病，何也？冲任二脉与阳明之脉，两相照应。冲任虚则鼓动阳明之火结聚不散，而筋脉失荣，痛之所
由生也。治须填补真元，以生津液；导引元阳，以补真气。又有肝阴久亏，肝叶枯燥，抵塞胃脘，痛不可耐者，
法宜六味饮乙癸同治；参乳汤气血双救。高鼓峰之论，医者亦曾闻之乎？大抵肝主疏泄，郁则木不舒而侮所不
胜。肾为胃关，虚则精气耗而累及中土。至于气分有余之痛，延胡、香附有奇验；不足之痛，人参、桂、附有
殊功。血分有余之痛，桃仁、瓦楞可立应；不足之痛，当归、熟地亦取效。而敢云通则不痛者尽病之情哉？
丹溪曰∶诸痛不宜补气。此惟邪实气滞者当避之，而曰诸痛皆然，吾不信也。（《会心录》）
房劳肾虚之人，胸膈多有隐痛。此肾虚不能纳气，气虚不能生血之故。夫气与血，犹水也，盛则流畅，虚
则鲜有不滞者。宜破故纸之类补肾，地、归之类补血。若作寻常痛治，殆矣。（戴元礼）
凡胃脘痛、大便燥结者，肝血虚也，疏肝益肾汤主之。逍遥散所不能愈者，此方妙。（高鼓峰）
肝痛一证，四明实补胃脘诸痛治法之所未及。予每祖其意，以治肝经血少者，加味逍遥散加生地。血少而
燥者，疏肝益肾汤加当归，或左归饮加柴、芍。或滋肾生肝，或滋肾清肝，随证选方，无不立应。若从痰火寒
食等因求之，失之远矣。（杨乘六）
脉候
心痛，脉沉迟者易治；坚大数者难治。（《张氏医通》）
选案
一妇人胃脘痛，勺水不入，寒热往来。或从火治，用芩、连栀、柏；或从寒治，用姜、桂、茱萸。辗转月
余，形体羸瘦，六脉弦数，几于毙矣。予曰∶此肝痛，非胃痛也。其病起于郁结生火，阴血受伤，肝肾干枯，
燥迫成痛。医复投以苦寒、辛热之剂，胃脘重伤，其能瘳乎？急以滋肾生肝饮与之，一昼夜尽三大剂。五鼓熟
寐，次日痛定。再用加味归脾汤，加麦冬、五味，十剂而愈。（《己任编》）
宋徽庙食冰，因致胃痛。国医不效，召杨吉老诊之，主理中汤。上曰∶服之屡矣。吉老曰∶所进汤使不同。
陛下之疾，得之食冰，臣请以冰煎药。一服而愈，此同气相求之义也。（吴鹤皋）
附方
治心胃痛方 用獭肝焙干为末，酒冲服即愈。
又方 用牡蛎火 、研粉，痛时开水调服数钱，立止。
【经典理论】
厥心痛（由其他脏腑病变引发的心痛），疼痛牵引背部，伴有肌肉抽搐，感觉像有人从背后撞击心脏；身体蜷缩弯腰的，是肾心痛。○腹部胀满、胸部憋闷，心痛特别剧烈的，是胃心痛。
○疼痛像被锥子针刺心脏一样，心痛非常严重的，是脾心痛。○面色青灰如同死状，整天无法深呼吸，是肝心痛。○躺着或静居时心痛缓解，活动时疼痛加剧，面色没有改变，是肺心痛。○真心痛（心脏本经受邪所致的心痛），手足青紫直至关节。心痛剧烈，早晨发病晚上死亡，晚上发病第二天早上死亡。（出自《灵枢》）
【名家言论】
心神宁静则疼痛轻微，心神烦躁则疼痛剧烈。各种病因的产生，都源于心。（王冰）
各经引起的心痛，心与背部相互牵引，心痛放射至背部、背痛放射至心脏。各腑引起的心痛，难以俯仰，小腹气向上冲，突然昏倒不省人事，呕吐腹泻。（陈无择）
心包络痛，疼痛放射至背部，无论寒证热证都会疼痛。胃痛，疼痛位于胃脘当心处，成因多种多样。脾痛，脾经络脉连接心脏，导致不能进食。胸痛，涉及心的俞穴和胆的脉络，疼痛牵引背部和胁肋。膈痛，位于心胃之间，横贯胸腹感到胀满而痛。（出自《医阶辨证》）
《内经》论述心痛，没有不兼及五脏病变的。只是详细论述了心，而简略了胸腹，通过一例来类推其余情况。心为君主之官，按理不应受邪；若受邪则是本经自病，称为真心痛，死亡且无法治愈。然而《内经》说：邪气在心则病心痛，喜欢悲伤，时常眩晕仆倒。这是说心包络受邪，病在腑不在脏。又说：手少阴心经的经脉异常，就会发生咽喉干燥、心痛、口渴想喝水的症状。这是说心包络受邪，病在络脉不在经脉。其络脉和腑受邪，都是因为惊恐思虑，损伤神志、耗竭血液，因此容易受邪，就像拿着空容器接东西一样容易。而方书又分为九种类型：饮、食、热、冷、气、血、悸、虫、注。如果不能遍识病因，怎么进行治疗呢？胃属湿土，位居中焦，是水谷汇聚的海洋。五脏六腑十二经脉，都从这里获取气血。强壮的人邪气不能侵犯，虚弱的人邪气停留而致病。偏热、偏寒、水液停聚、食物积滞，都与真气相搏结而产生疼痛。肝木乘克脾胃为贼邪，肾寒厥逆为微邪。夹杂其他脏腑的症状表现，应当与心痛相同。但可能表现为胀满、或腹胀、或呕吐、或不能进食、或吞酸、或大便困难、或腹泻痢疾，面部浮肿且发黄，本病与客邪必然混杂出现。胸痛即膈痛，它与心痛的区别在于：心痛在歧骨陷处（剑突下），胸痛则是横贯整个胸间。它与胃脘痛的区别在于，胃脘痛在心下（剑突下），胸痛在心上（胸骨后）。《内经》说：南风生于夏季，病在心，俞穴在胸胁。这是以胸归属于心。肝虚则胸痛牵引背胁，肝实则胸痛导致身体不能转侧。这是以胸归属于肝。胸中实际上是肺的分野，文中说“心”，是因为心脉从心系上行至肺；文中说“肝”，是因为肝脉贯穿膈肌注入肺。（李士材）
胃痛有食积、痰饮、死血、气滞、寒邪、火邪、中气虚的区别，方书记载得很清楚。唯独有一种是肝胆之火，移入于胃。肝藏血，血少则肝叶变硬不肯下垂，肝叶抵住胃，胃受到肝叶的压迫，进食后胃部胀满，更加逼迫肝叶，隐隐作痛的，日久变为燥证而成噎膈。（出自《己任编》）
【补编】
心胸中大寒痛，呕吐不能饮食，腹中有寒气，气上冲皮肤，突起如头足状，上下疼痛不可触碰，用大建中汤主治。○心中受寒者，病人感觉心里像吃了大蒜一样辛辣难受。剧痛者心痛彻背、背痛彻心，如同虫注病。脉象浮的，自然呕吐后痊愈。○心痛彻背，背痛彻心，用乌头赤石脂丸主治。（出自《金匮要略》）
五脏的气机阻滞，都会导致心痛。肾心痛，多由阴火上冲引起。胃心痛，多由停滞引起。脾心痛，多由寒邪逆犯中焦引起。肝心痛，多由木火郁结引起，病在血分。肺心痛，多由上焦不清引起，病在气分。知道病在气分就要顺气，在血分就要活血，郁结就要开郁，停滞就要通利，火盛属实就要发散或清热，寒盛属虚就要温补。只有真心痛，才是不可治愈的。否则，只要抓住根本，治疗必然随手应验。（张路玉）
凡是心痛都是包络的病，不在心本身。或者因为君火衰微，大寒触犯，或者瘀血冲心，突然剧烈疼痛无声，舌色青紫，气息寒冷，汗出不止，手足青冷超过关节，这就是真心痛。早晨发病晚上死，晚上发病第二天早上死。如果不忍心坐视不管，或者使心经寒气消散，也可以在死中求活：用猪心汤煎煮麻黄、桂枝、附子、干姜。如果面色没有青色，四肢不厥冷，疼痛也不至于无声，那就不是真心痛。可能是寒、痰、虫、食，上扰包络，各自根据病因类别，审察脉象用药。（沈金鳌）
厥心痛这一证候，古人的辨析讨论非常多且精辟！这里不再赘述。但是厥心痛与胃脘痛，情状相似，但实证性质不同。世人因为《内经》中“胃脘当心而痛”这句话，往往混淆看待。不知道厥心痛是五脏之气厥逆进入心包络，胃也参与其中。那么心痛与胃痛，不得不各分一门。案中有因听到雷声受惊的，用逍遥散去柴胡，加钩藤、丹皮治疗；因为其肝阳上逆，不容升达，为之养血以平调。因积劳损伤的，用当归、鹿角胶、干姜、桂枝、桃仁、半夏治疗；因为其劳伤导致血痹，不能单纯破气，为之通络以调和营血。脾厥心痛，用良姜、姜黄、茅术、丁香、草果、厚朴治疗；因为其脾寒气厥，病在脉络，为之用辛香药物开通。重按后疼痛稍减的，用人参、桂枝、川椒、炙甘草、白蜜治疗；因为其心营受伤，攻伐难施，为之用辛甘药物化生阳气。○阳明经是十二经脉之长，其产生疼痛的原因很多。胃是汇合之处，乃是冲要之道，最容易患病。习俗多用辛香温燥药，不能一概施用。但其关键在于初病在经，久痛入络。因为经主气，络主血，凡气机长久阻滞，血也会随之生病，循行的脉络自然痹阻，所以辛香理气、辛柔和血的方法，实在是必然的道理。又如饱食后疼痛加重，进食后疼痛缓解，这就有宜补和不宜补的区别。寒、温两法，取决于喜暖还是喜凉；滋、燥的不同，询问其大便干涩还是滑泄。至于饮水停聚必然吞酸，食物停滞应当嗳腐。厥气无形，瘀伤有迹。蛔虫动扰，疼痛并吐沫。痰湿壅塞，呕吐且脉滑。营气两虚，心悸跳动。肝阳冲克，烦渴呕逆。阴邪之势，来得必定迅速；郁火之患，逐渐加剧。（出自《临证指南》）
胃脘痛证，多有因饮食、因寒邪、因气机不顺引起的。然而因饮食、因寒邪，也没有不涉及气的。因为食物停聚则气滞，寒邪停留则气凝。所以治疗疼痛的关键，只要考察确实属于实邪，都应当以理气为主。食滞的兼用消导，寒滞的兼用温中。（张景岳）
胃脘痛大体上气滞、食积居多，不可骤然使用补剂。因为补益则气不通畅而疼痛更甚。如果曾经服用过攻伐的药物，屡次发作屡次攻伐，渐渐导致脉象大而空虚的，又应当培补。因为脾得到补益则气自然运化，疼痛自然缓解。这是虚实之分。（《证治汇补》）
胃与包络位置相近，俗称为心痛，这是不对的。真心痛则早晨发病晚上死，晚上发病第二天早上死，无药可救。因为阳明中土，是水谷的道路。多气多血，运化精微，通达于脾而灌溉四脏，为后天之本。人生酒色过度、七情违和、饥饱不节，导致胃脘疼痛，有寒、热、气、血、痰、虫、食滞、内虚的不同。治疗虽然各不相同，但总不外乎虚、实、寒、热、气、血的辨别。疼痛而属虚的必定喜欢按压，疼痛而属实的必定拒绝按压。寒证得温热稍定，热证饮冷稍安。中焦寒则气虚不运，或生痰饮，或蓄瘀血或蛔虫上逆。中焦热，则气阻不行，或吐酸味，或吐苦汁，或食停蛔动。如果真是虚寒痛，就用塞因塞用的方法以补益；真知其为实热痛，就用通因通用的方法以泻下。虚寒而挟带食积、瘀血、生痰、生虫的，在温补药中消除、驱逐；实热而挟带食积、瘀血、吐蛔、呕酸的，在清凉药中攻伐。虽然如此，胃间受病，人们容易知道；肝木凌脾，人们也容易明白。如果是男子肝肾亏虚，挟虚火而上逆；妇人冲任虚弱，挟肝阳而上升，多有胃脘痛证。医生不考察病原，不是投用辛温耗气，就是用清凉败血，越治越严重。《内经》说：冲脉起于气街，并少阴之经，挟脐上行，至胸中而散。任脉起于中极，上毛际，循腹里，上关元，至咽喉。可见胃脘之痛，有自下而上、由肾传至胃的，不要拘泥于中焦为病，为什么呢？冲任二脉与阳明之脉，两相照应。冲任虚则鼓动阳明之火结聚不散，而筋脉失养，疼痛由此产生。治疗需要填补真元，以生津液；导引元阳，以补真气。又有肝阴久亏，肝叶枯燥，抵塞胃脘，疼痛不可忍受的，法宜六味地黄丸乙癸同治；参乳汤气血双救。高鼓峰的论述，医生们也曾听说过吗？大抵肝主疏泄，郁结则木气不舒而侮所不胜。肾为胃关，虚则精气耗损而累及中土。至于气分有余的疼痛，延胡索、香附有奇效；不足的疼痛，人参、桂枝、附子有特殊功效。血分有余的疼痛，桃仁、瓦楞子可立即见效；不足的疼痛，当归、熟地也能取效。却敢声称“通则不痛”能概括所有病情吗？朱丹溪说：诸痛不宜补气。这仅适用于邪实气滞者应当避免，如果说所有疼痛都这样，我不相信。（《会心录》）
房劳导致肾虚的人，胸膈多有隐痛。这是肾虚不能纳气，气虚不能生血的原因。气和血，就像水一样，旺盛则流畅，虚弱则鲜有不滞涩的。宜用破故纸之类补肾，地黄、当归之类补血。如果当作普通疼痛治疗，就危险了。（戴元礼）
凡是胃脘痛、大便燥结的，是肝血虚，用疏肝益肾汤主治。逍遥散不能治愈的，此方奇妙。（高鼓峰）
肝痛这一证候，四明人杨乘六补充了胃脘诸痛治法所未涉及的方面。我每每遵循他的意思，治疗肝经血少的，用加味逍遥散加生地。血少而燥的，用疏肝益肾汤加当归，或左归饮加柴胡、芍药。或滋肾生肝，或滋肾清肝，随证选方，无不立即见效。如果从痰火寒食等原因去寻求，就相差太远了。（杨乘六）
[Classical Theory]
Jue Xintong (Heart pain induced by dysfunction of other zang-fu organs), with pain radiating to the back, accompanied by muscle twitching, feeling as if someone is striking the heart from behind; those who are stooped and bent are suffering from Shen Xintong (Kidney Heart Pain). ○ Abdominal distension and chest fullness, with severe heart pain, indicate Wei Xintong (Stomach Heart Pain).
○ Pain like being pierced by an awl or needle in the heart, with extreme severity, indicates Pi Xintong (Spleen Heart Pain). ○ Pale blue complexion resembling a corpse, unable to take deep breaths all day, indicates Gan Xintong (Liver Heart Pain). ○ Pain alleviates when lying still or resting, but worsens with movement, with unchanged complexion, indicates Fei Xintong (Lung Heart Pain). ○ Zhen Xintong (True Heart Pain, where the heart meridian itself is affected), with cyanosis of hands and feet extending to the joints. Severe heart pain; if occurring in the morning, death follows in the evening; if in the evening, death follows in the morning. (From *Ling Shu*)
[Masters' Discourses]
When the mind is tranquil, pain is mild; when agitated, pain is severe. All ailments arise from the heart. (Wang Bing)
Heart pain caused by various meridians involves mutual pulling between the heart and back, heart pain penetrating to the back, and back pain penetrating to the heart. Heart pain caused by various fu organs involves difficulty in bending and stretching, qi rushing up from the lower abdomen, sudden loss of consciousness, vomiting, and diarrhea. (Chen Wuze)
Xinbaoluo Tong (Pericardium Pain) involves pain radiating to the back, painful regardless of cold or heat patterns. Wei Tong (Stomach Pain) occurs at the epigastrium corresponding to the heart, with diverse causes. Pi Tong (Spleen Pain) involves the spleen meridian connecting to the heart, leading to inability to eat. Xiong Tong (Chest Pain) involves the shu points of the heart and the meridian network of the gallbladder, with pain radiating to the back and hypochondrium. Ge Tong (Diaphragm Pain) occurs between the heart and stomach, characterized by transverse fullness and pain. (From *Yi Jie Bian Zheng*)
The *Nei Jing* discusses heart pain without excluding diseases of the five zang organs. It details the heart while briefly mentioning the chest and abdomen, using one example to illustrate the rest. The Heart is the sovereign ruler and theoretically should not be affected by pathogens; if affected, it is a disease of its own meridian, named Zhen Xintong (True Heart Pain), which is fatal and incurable. However, the Classics state: "Pathogens in the heart cause heart pain, sadness, and occasional dizziness/fainting." This refers to pathogens affecting the Xinbaoluo (Pericardium), located in the fu aspect rather than the zang aspect. It also states: "Abnormalities in the Hand Shaoyin meridian cause dry throat, heart pain, thirst, and desire to drink." This refers to pathogens affecting the Xinbaoluo, located in the collateral level rather than the main meridian. Collaterals and fu organs are susceptible due to fright and overthinking, which damage spirit and deplete blood, making them vulnerable like empty vessels. Formulas further classify causes into nine types: Yin (Fluid retention), Shi (Food stagnation), Re (Heat), Leng (Cold), Qi (Qi stagnation), Xue (Blood stasis), Ji (Palpitations), Chong (Parasites), and Zhu (Infectious/Contagious). Without recognizing these causes, how can treatment proceed? The Stomach belongs to damp earth, resides in the middle jiao, and is the sea of water and grain. All five zang and six fu organs and twelve meridians receive qi from here. In robust individuals, pathogens cannot invade; in weak individuals, pathogens settle and cause disease. Bias towards heat or cold, fluid retention, or food stagnation all contend with true qi to cause pain. Liver Wood overacting on Spleen/Stomach is a "robber pathogen"; Kidney Cold and reversal are minor pathogens. Symptoms mixed with other zang organs resemble heart pain. Manifestations may include fullness, distension, vomiting, anorexia, acid regurgitation, constipation, or dysentery, with facial edema and yellowness; the primary disease and external pathogens inevitably mix. Chest pain is equivalent to diaphragm pain. Its distinction from heart pain lies in location: heart pain is at the xiphoid process depression, while chest pain is transversely full across the chest. Its distinction from epigastric pain lies in location: epigastric pain is below the heart (xiphoid), while chest pain is above the heart (sternum). The Classics say: "South wind arises in summer, disease affects the heart, shu points are in the chest and hypochondrium." This associates the chest with the Heart. Liver deficiency causes chest pain radiating to the back and hypochondrium; Liver excess causes chest pain preventing turning of the body. This associates the chest with the Liver. The chest is actually the domain of the Lung; references to the "Heart" occur because the heart meridian ascends from the heart system to the lung; references to the "Liver" occur because the liver meridian pierces the diaphragm and enters the lung. (Li Shicai)
Wei Tong (Stomach Pain) differs by food, phlegm, dead blood, qi, cold, fire, and deficiency of middle qi, clearly recorded in formula books. Uniquely, there is a type where fire from the Liver and Gallbladder transfers to the Stomach. The Liver stores blood; when blood is deficient, liver lobes become hard and fail to descend, pressing against the stomach. The stomach, compressed by the liver, becomes full after eating, increasing pressure on the liver, causing dull pain. Over time, this transforms into a dry condition resulting in Yige (Dysphagia). (From *Jiren Bian*)
[Supplement]
Severe cold pain in the heart and chest, vomiting with inability to eat, cold in the abdomen, qi rushing up causing skin to bulge with visible head-like and foot-like shapes, unbearable tenderness upon touch, treated with Da Jian Zhong Tang. ○ Cold in the heart makes the patient feel as if eating garlic. Severe cases involve heart pain penetrating to the back and back pain penetrating to the heart, resembling parasitic pain. If the pulse is floating, spontaneous vomiting leads to recovery. ○ Heart pain penetrating to the back, back pain penetrating to the heart, treated with Wutou Chishizhi Wan. (From *Jin Gui Yao Lue*)
Stagnation in any of the five zang organs causes heart pain. Shen Xintong is mostly due to yin fire rushing upward. Wei Xintong is mostly due to stagnation. Pi Xintong is mostly due to cold rebellion in the middle jiao. Gan Xintong is mostly due to wood-fire depression, involving the blood level. Fei Xintong is mostly due to unclear upper jiao, involving the qi level. Knowing it is in the qi level requires smoothing qi; in the blood level, moving blood; depressed, opening depression; stagnant, unblocking stagnation; excessive fire/excess, dispersing or clearing; excessive cold/deficiency, warming or tonifying. Only Zhen Xintong is incurable. Otherwise, grasping the root ensures immediate efficacy. (Zhang Luzhu)
All heart pain is a disease of the Pericardium, not the Heart itself. It may be due to decline of Sovereign Fire, invasion of severe cold, or blood stasis rushing to the heart, causing sudden severe silent pain, cyanotic tongue, cold breath, continuous sweating, and cyanosis/coldness of hands and feet beyond the joints. This is Zhen Xintong. Morning onset leads to evening death; evening onset leads to morning death. If unwilling to watch passively, to disperse cold in the heart meridian and seek life from death: decoct Pig Heart with Mahuang (Ephedrae Herba), Guizhi (Cinnamon Twig), Fuzi (Aconiti Lateralis Radix Praeparata), and Ganjiang (Zingiberis Rhizoma). If the face is not cyanotic, limbs are not cold/reversed, and pain is not silent, it is not Zhen Xintong. It may be cold, phlegm, parasites, or food affecting the Pericardium; treat according to category and pulse. (Shen Jin'ao)
Regarding Jue Xintong, ancient discussions are numerous and precise; no need to repeat. However, Jue Xintong and Wei Wan Tong (Epigastric Pain) look similar but differ in pathology. People often confuse them due to the *Nei Jing* phrase "epigastric pain corresponds to the heart." They do not realize that Jue Xintong is qi rebellion from five zang organs entering the Pericardium, involving the Stomach. Thus, Heart Pain and Stomach Pain must be separated. Case: A patient frightened by thunder was treated with Xiaoyao San removing Chaihu, adding Gouteng (Uncariae Ramulus cum Uncis) and Danpi (Moutan Cortex) because Liver Yang was rebelling and could not ascend; nourished blood to calm and regulate. Case: Injury from chronic fatigue was treated with Danggui (Angelicae Sinensis Radix), Lujiaojiao (Colla Cornus Asini), Ganjiang, Guizhi, Taoren (Persicae Semen), and Banxia (Pinelliae Rhizoma) because fatigue injured blood causing bi-syndrome; cannot merely break qi, must unblock collaterals to harmonize Ying. Pi Jue Xintong was treated with Liangjiang (Alpiniae Officinarum Rhizoma), Jianghuang (Curcumae Longae Rhizoma), Maoshu (Atractylodis Rhizoma), Dingxiang (Syzygii Aromatis Flos), Caoguo (Tsaoko Fructus), and Houpo (Magnoliae Officinalis Cortex) because Spleen cold and qi rebellion affected collaterals; used acrid-aromatics to open. Case: Pain relieved by deep pressure was treated with Renshen (Ginseng Radix), Guizhi, Chuanjiao (Zanthoxyli Fructus), Zhigancao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle), and Baimi (Mel) because Heart Ying was injured and harsh attack was difficult; used acrid-sweet to transform Yang. ○ Yangming is the leader of the twelve meridians, with many causes of pain. The Stomach is a convergence point, a busy thoroughfare, prone to illness. Customarily using acrid-aromatic warm-dry herbs is not applicable to all cases. The key is: early disease is in the meridians, long-term pain enters the collaterals. Meridians govern Qi, collaterals govern Blood. Long-term Qi obstruction leads to Blood pathology, blocking circulation; thus, acrid-aromatics to regulate Qi and acrid-sweet to harmonize Blood are necessary principles. For example, pain worsening after full meals and alleviating after eating distinguishes whether tonification is suitable. Cold/Warm methods depend on preference for warmth/coolness; Moistening/Drying depends on stool consistency. Fluid retention causes acid regurgitation; food stagnation causes belching with rotten smell. Rebellion Qi is formless; blood injury has signs. Roundworm disturbance causes pain with frothy saliva. Phlegm-damp obstruction causes vomiting with slippery pulse. Deficiency of Ying and Qi causes palpitations. Liver Yang clashing causes irritability, thirst, vomiting. Yin pathogenic factors arrive quickly; Depressed Fire worsens gradually. (From *Lin Zheng Zhi Nan*)
Wei Wan Tong (Epigastric Pain) is often due to food, cold, or disharmonious Qi. However, food and cold always relate to Qi. Food stagnation causes Qi stagnation; Cold retention causes Qi condensation. Therefore, the key to treating pain is to identify excess pathogens and prioritize regulating Qi. Food stagnation requires digestion-promoting herbs; Cold stagnation requires middle-warming herbs. (Zhang Jingyue)
Wei Wan Tong is mostly Qi and Food, so tonics should not be used abruptly. Tonifying blocks Qi and worsens pain. If previous attacks were frequent, leading to a large and empty pulse, tonification is then required. Tonifying the Spleen moves Qi and relieves pain. This distinguishes deficiency and excess. (From *Zheng Hui Hui Bu*)
The Stomach is close to the Pericardium, vulgarly called Heart Pain, which is incorrect. Zhen Xintong is fatal within a day, incurable. Yangming Middle Earth is the pathway for food and drink. Rich in Qi and Blood, it transforms essences, connects to the Spleen, and irrigates the four zang, serving as the Post-Heaven Root. Excessive alcohol/sex, emotional discord, irregular eating cause Wei Wan Tong, varying by cold, heat, qi, blood, phlegm, parasites, food stagnation, and internal deficiency. Treatments vary but fundamentally distinguish deficiency/excess and cold/heat/qi/blood. Deficient pain prefers pressure; Excess pain rejects pressure. Cold pain eases with warmth; Heat pain eases with cold drinks. Middle Jiao Cold causes Qi deficiency/stagnation, generating phlegm-fluid, blood stasis, or rebellious roundworms. Middle Jiao Heat causes Qi blockage, acid/bitter regurgitation, or food stagnation with roundworm movement. True deficiency-cold pain uses "treat obstruction with tonification" (Se Yuan Sai Yong); true excess-heat pain uses "treat flow with purging" (Tong Yuan Tong Yong). Deficiency-cold with food/stasis/phlegm/worms requires elimination/draining within warm-tonifying formulas. Excess-heat with food/stasis/vomiting worms/acid requires attacking/cutting within cooling formulas. Although Stomach disease and Liver Wood insulting Spleen are common, Men with Kidney/Liver deficiency carrying deficient fire upward, and Women with weak Chong/Ren meridians carrying Liver Yang upward, often present with Wei Wan Tong. Doctors failing to identify the root use acrid-warm draining Qi or cooling-blood herbs, worsening the condition. The Classics state: Chong Mai starts at Qichong, runs alongside Shaoyin, flanks the navel to the chest. Ren Mai starts at Zhongji, rises along the abdomen to the throat. Thus, Wei Wan Tong can ascend from below, from Kidney to Stomach; do not stick to Middle Jiao pathology. Chong and Ren meridians correspond with Yangming. Deficiency in Chong/Ren stirs Yangming fire to accumulate, starving sinews/vessels, causing pain. Treatment must fill True Yuan to generate fluids; guide Yuan Yang to supplement True Qi. Another case: Long-term Liver Yin deficiency causes dry Liver lobes blocking the stomach, unbearable pain. Method: Liuwei Dihuang Wan treating Liver/Kidney together (Yi-Gi Tong Zhi); Canru Tang saving Qi/Blood. Have you heard Dr. Gao Gugeng's theory? Liver governs free flow; depression causes Wood stagnation insulting the unconquerable. Kidney is the Gate of the Stomach; deficiency drains essence affecting Middle Earth. For Qi-level excess pain, Yanhu Suo (Corydalis Rhizoma) and Xiangfu (Cyperi Rhizoma) are miraculous; for deficiency, Renshen, Guizhi, Fuzi are effective. For Blood-level excess pain, Taoren and Walengzi (Arcaea Concha) work instantly; for deficiency, Danggui and Shudi (Rehmanniae Radix Preparata) are effective. Who dares claim "unblocked means no pain" covers all cases? Zhu Danxi said: Pain generally avoids tonifying Qi. This applies only to excess/pathogen stagnation; saying all pain avoids it, I do not believe. (From *Huixin Lu*)
Those with Kidney deficiency from sexual exhaustion often have dull pain in the chest/diaphragm. This is due to Kidney failing to grasp Qi, and Qi failing to generate Blood. Qi and Blood are like water: abundant flows freely, deficient stagnates. Use Pogu Zhi (Psoraleae Fructus) to tonify Kidney, Dihuang and Danggui to tonify Blood. Treating as ordinary pain is dangerous. (Dai Yuanli)
For Wei Wan Tong with dry stools, it is Liver Blood deficiency, treated with Shugan Yishen Tang. Effective where Xiaoyao San fails. (Gao Gugeng)
Gan Tong (Liver Pain) addresses gaps in treating epigastric pains. I follow his intent: for Liver meridian blood deficiency, add Shengdi (Rehmanniae Radix) to Jiawei Xiaoyao San. For blood deficiency with dryness, add Danggui to Shugan Yishen Tang, or Chaihu/Shao Yao to Zuogui Yin. Either nourish Kidney to generate Liver, or nourish Kidney to clear Liver. Select formulas based on syndrome; results are immediate. Seeking causes in phlegm/fire/cold/food is far off. (Yang Chengliu)