《内经》之论心痛，未有不兼五脏为痛者，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，必死不治。然经有云∶邪在心则病心痛，喜悲
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
言别络受邪，在络不在经也。其络与府以邪，皆因怵惕思虑，伤神涸血，是以受如持虚。而
分论九种。曰饮、曰食、曰热、曰冷、曰气、曰血、曰悸、曰虫、曰疰，苟不能遍识病形，
将何以为治耶？胃属刚土，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，怯者着而为病。偏热偏寒，水停食积，皆与真气相薄而痛。肝木相乘为贼邪，肾寒
厥逆为微邪，挟他藏而见证，当与心痛相同，但或泻或胀，或呕吐，或不能食，或吞酸，或
大便难，或泻利面浮而黄。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
歧
骨陷处，胸痛则横满胸间也。其与胃脘痛别者，胃脘在心之下，胸痛在心之上。经曰∶南风
生于夏，病在心， 在胸胁，此以胁属心也。肝虚则胸痛引背胁，肝实则胸痛不能转侧。此
又以胸属肝也，夫胸中实肺家之分野，其言心者，以心之脉，从心系却上肺也。其言肝者，
以肝之脉贯膈，上注于肺也，胁痛旧从肝治，不知肝固内舍膺胁，何以异于心肺，内舍膺胁
哉？若谓肝经所过而痛。何以异于足少阳心主所过而痛哉？若谓经脉挟邪而痛。何以异于经脉
所过而痛哉？故非察色按脉，细审各经气变，卒不能万举万当也，且左右肝肫气血阴阳，亦
有
不可尽拘，而临证者可无详察耶。腹痛分为三部，脐以上痛者，为太阴脾；当脐而痛者，为
少阴
肾；少腹痛者，为厥阴肝，及大小肠冲任四经，每部各有五贼之变，七情之发，六气之苦，
五运之邪，至纷至博，苟能辨气血虚实，内伤外感而为之调剂，未有不中痛情者矣。
《黄帝内经》中关于心痛的论述，没有不兼及五脏疼痛的，只是详细论述了心脏而简略提及胸腹，这是通过一例来类推其余的情况。心为君主之官，按义理不应受邪气侵袭；若受邪气则为本经自病，称为真心痛，必定死亡且无法治愈。然而经典中有记载：邪气在心则导致心痛，伴有悲伤、眩晕仆倒的症状，这说的是心包络受邪，病位在腑而非脏。又有记载说：手少阴心经脉动异常，则出现咽喉干燥、心痛、口渴想饮水的症状，这说的是别络受邪，病位在络脉而非经脉。这些络脉和腑受到邪气，都是因为惊恐思虑，损伤神志、耗竭血液，因此邪气容易乘虚而入。对此又分为九种类型：饮、食、热、冷、气、血、悸、虫、疰，如果不能全面识别各种病状，将如何进行治疗呢？胃属于刚土，位居中焦，是水谷汇聚的大海，五脏六腑十二经脉的气血都由此获取。身体强壮的人邪气不能侵犯，体弱的人邪气停留而致病。偏热或偏寒，水液停聚或食物积滞，都会与真气相搏结而导致疼痛。肝木相乘成为贼邪，肾寒厥逆成为微邪，夹杂其他脏腑病变而出现症状，应当与心痛相似，但可能表现为腹泻或腹胀，呕吐，不能进食，吞酸，大便困难，或者腹泻、面部浮肿且面色黄。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：心痛位于歧骨（剑突）凹陷处，胸痛则是横满于胸间。它与胃脘痛的区别在于：胃脘位于心的下方，胸痛位于心的上方。经典说：南风生于夏季，病在心，表现在胸胁，这是认为胁部归属于心。肝虚则胸痛牵引背部和胁肋，肝实则胸痛导致身体不能转侧。这又是认为胸部归属于肝。实际上，胸中实为肺所主的分野，文中说“心”，是因为心的经脉从心系向上连接肺。文中说“肝”，是因为肝的经脉贯穿膈肌，向上注入肺中。胁痛过去多从肝论治，却不知道肝确实内舍于膺部和胁肋，这与心肺内舍于膺胁有何不同？如果说因为肝经经过此处而痛，那与足少阳胆经、手厥阴心包经经过此处而痛有何区别？如果说因为经脉挟带邪气而痛，那与经脉经过之处因邪气而痛有何区别？所以如果不观察面色、按压脉搏，仔细审查各经气的变化，就不能做到万无一失。而且左右肝脏的气血阴阳，也有不可完全拘泥的地方，临证时怎能不详细考察呢？腹痛分为三部：脐以上疼痛的，属于太阴脾；当脐疼痛的，属于少阴肾；少腹疼痛的，属于厥阴肝，以及大小肠、冲脉、任脉这四条经脉，每部各有五贼的变化、七情引发的病变、六气带来的痛苦、五运产生的邪气，情况纷繁复杂，如果能辨别气血虚实，区分内伤外感并进行调理，就没有不切中病情要害的了。
The *Neijing* (Yellow Emperor's Inner Classic) discusses heart pain without excluding pain involving 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, by principle, should not be invaded by pathogenic factors. If invaded, it constitutes a disease of its own meridian, termed *Zhenxintong* (True Heart Pain), which is invariably fatal and incurable. However, classics state: "Pathogens in the Heart cause heart pain, with a tendency toward sadness, dizziness, and collapse." This refers to pathogens invading the Pericardium (Pericardium Meridian of Hand-Jueyin), affecting the fu organ rather than the zang organ. It also states: "Abnormal pulsation of the Shaoyin meridian of Hand causes dryness of the throat, heart pain, thirst, and desire to drink." This refers to pathogens invading the collateral vessels, affecting the collaterals rather than the main meridians. Such invasion of collaterals and fu organs results from fright and excessive thinking, which damage the spirit and deplete blood, making the body vulnerable to empty invasion. These are further categorized 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 disease). Without comprehensive recognition of these pathological forms, how can treatment be administered?
The Stomach belongs to Yang Earth, situated in the Middle Jiao, serving as the sea of water and grain. The qi of the five zang organs, six fu organs, and twelve meridians all derive from it. In robust individuals, pathogens cannot invade; in weak individuals, pathogens linger and cause disease. Deviations toward heat or cold, fluid retention, or food stagnation all contend with true qi, resulting in pain. Liver Wood overacting constitutes a "thief pathogen"; Kidney Cold with reversal constitutes a "minor pathogen." When mixed with manifestations from other zang organs, the presentation resembles heart pain, but may include diarrhea or distension, vomiting, inability to eat, acid regurgitation, difficulty defecating, or diarrhea with facial edema and yellowish complexion. The primary disease and exogenous pathogens inevitably present together. Chest pain is synonymous with diaphragm pain. Its distinction from heart pain lies in location: heart pain occurs at the depression below the xiphoid process (Qigu), whereas chest pain fills the chest horizontally. Its distinction from epigastric pain lies in location: the epigastrium is below the heart, while chest pain is above the heart. The classics state: "South wind arises in summer, diseases affect the Heart, manifesting in the chest and hypochondrium," implying the hypochondrium belongs to the Heart. Liver deficiency causes chest pain radiating to the back and hypochondrium; Liver excess causes chest pain preventing turning of the body. This implies the chest belongs to the Liver. Indeed, the chest is the domain of the Lung. References to the Heart arise because the Heart meridian ascends from the Heart system to connect with the Lung. References to the Liver arise because the Liver meridian penetrates the diaphragm and ascends to pour into the Lung. Hypochondriac pain has traditionally been treated via the Liver. However, the Liver indeed houses itself in the pectoral region and hypochondrium; how does this differ from the Heart and Lung housing themselves there? If pain is due to the Liver meridian passing through, how does it differ from pain caused by the Foot-Shaoyang Gallbladder or Hand-Jueyin Pericardium meridians passing through? If pain is due to meridians harboring pathogens, how does it differ from pain simply occurring where meridians pass? Therefore, without observing complexion and palpating pulses, and carefully examining qi transformations in each meridian, one cannot achieve infallible accuracy. Furthermore, the qi, blood, yin, and yang of the left and right Livers have aspects that cannot be rigidly adhered to; must not clinicians examine meticulously during practice?
Abdominal pain is divided into three regions: pain above the umbilicus belongs to the Taiyin Spleen; pain at the umbilicus belongs to the Shaoyin Kidney; pain in the lower abdomen belongs to the Jueyin Liver, as well as the Large Intestine, Small Intestine, Chong Mai, and Ren Mai. Each region involves variations of the Five Thieves, emissions of the Seven Emotions, hardships of the Six Qi, and pathogens of the Five Movements. The situations are complex and extensive. If one can differentiate between deficiency and excess of qi and blood, and distinguish between internal injury and external contraction for appropriate regulation, no treatment will miss the mark of the pathology.