（附∶心痛）
总括 心痛原来在胃脘，若还真者是膏肓；九种根因须审问，寒食虫火更多防。
脉法 洪大属火，热滑大属痰，右手实属积，沉滑有食，弦迟有寒。沉细而实者可治，坚大而实，浮大而长，滑
而
利，数而紧皆难治。其心痛手足俱青至节者不治。
《内经》曰∶少阳司天，风行于地，心痛、胃脘痛、膈不通。又云∶木郁之发，民病胃脘当心而痛，上交两胁，膈
臆不通，食饮不下，盖风木之气被郁，发则太过，故民病有土败木贼之候也。然心与胃各一脏，其病形不同，因胃脘痛
处在心下，故有当心而痛之名，乃丹溪有胃脘痛即心痛，此言非也。盖胃是真湿土也，胃居中焦，禀冲和之气，多气多
血，是水谷之海，为三阳之总司，五脏六腑十二经脉皆受气于此，是以壮则气行而愈，弱则着而成病。其冲和之气，变
至偏寒偏热，因之水谷不消，停留水饮食积，真气相搏，以致清阳不升，浊阴不降，而肝木之邪，得以乘机侵侮，而为
病矣。然致病之因多因纵恣腹口，喜好辛酸生冷煎 脆硬之物，朝伤暮损，日积月深，自郁成积，自积成痰，痰火煎熬，
血亦妄行，痰血相杂，妨碍升降，故胃脘作痛。俗医不究其源，例以辛香燥热之剂治之，以火济火，遂成危剧，良可痛
哉！古方有九种心痛∶曰饮、曰食、曰风、曰冷、曰热、曰悸、曰虫、曰疰、曰去来痛。夫所谓冷者特一耳！贵在医者
神悟，不可例以热药治之也，详其所由，皆在胃脘而实不在心也，有寒、热、火、实、死血、食积、痰、虫之异耳。
寒厥痛者，手足冷而通身冷汗出，便利溺清，或大便利而不渴，气微力弱，宜以术附汤温之。
热厥痛者，身热足冷，痛甚则烦躁而吐，额自汗出，脉洪大，宜以金铃子散加减之。
火实痛者，因气而食，卒然发痛，大便或闭，久而注闷，心胸高起，按之愈痛，不能饮食，宜微利之。
死血痛者，痛有常处，不动移者是也。
食积者，痛甚欲大便，去后痛减者是也。
痰痛者，隐隐然，痛得辛热汤则暂止者，此痰也。
真心痛者，必死不可治。盖谓包络引邪入于心之正经耳。夫心之脏，君火也。是神灵之舍与手少阴之经，皆不得而受伤
故也。又平时喜食热物，以致死血留于胃口，作痛者宜桃仁承气汤下之。
补遗
丹溪曰∶凡胃脘痛必用温药，此是郁结不行，阻气不运，故痛在下者多属湿，宜温利之。
大凡心痛须分新久，若明知身受寒气、口吃寒物而得者，于初得之时，当温散或温利。若病得之稍久则成郁，久郁
则成热，热久而生火，《原病式》中备言之矣。若欲行温散温利，宁无助火添病耶，由是多以山栀为热药之向导，则邪
易伏，病易退，正气伏而愈矣！用山栀十五枚（大者九枚），去皮炒黑，煎，佐以姜汁，令辣服之，或加川芎一钱，或
以二陈加川芎、苍术、倍子煎服，甚者加干姜，轻者以麻黄桂枝之类散之。气虚人胃脘作痛，草豆蔻丸服之。
〔附方〕
草豆蔻丸 草豆蔻 橘红 人参 干姜 黄 益智 当归 青皮 泽泻 半夏 桃仁 麦芽 神曲 姜黄
柴胡为末，炊饼和为丸，姜汤下，加吴茱萸、生熟甘草。
术附汤 见惊风症内。
金铃子散 金铃子肉 元胡索（各一两） 为末，服之，痛止服枳术丸。
枳术丸 枳实 白术
桃仁承气汤 见痢疾症内。
（附：心痛）
总括：心痛原本位于胃脘部，若要辨别真正的真心痛，则病位在膏肓；九种心痛的根源需要仔细审问，寒、食、虫、火等因素更需多加防范。
脉法：脉象洪大属于火证，脉象热滑大属于痰证，右手脉实属于积滞，脉沉滑表示有食积，脉弦迟表示有寒邪。脉象沉细而实的可以治疗，脉象坚大而实、浮大而长、滑利、数而紧的都难以治疗。如果心痛伴随手足发青直至关节，则属不治之症。
《内经》说：少阳司天之年，风气流行于地，会出现心痛、胃脘痛、膈部气机不通的症状。又说：木气郁结发作时，百姓会得胃脘当心而痛，疼痛向上波及两胁，膈部和胸臆气机不通，饮食难下，这是因为风木之气被郁结，发作时太过亢盛，所以百姓出现土败木贼的征候。然而心和胃各是一脏，它们的病症表现不同，因为胃脘痛的位置在心下，所以有“当心而痛”的名称，这是朱丹溪所说的“胃脘痛即心痛”，这种说法是不对的。胃是真湿土，位居中焦，禀受冲和之气，多气多血，是水谷之海，是三阳经的总司，五脏六腑十二经脉的气都来源于此，所以身体强壮时气机运行通畅而健康，身体虚弱时气机停滞而成病。胃中的冲和之气，若变为偏寒或偏热，导致水谷不消化，停留为水饮和食积，真气与邪气相搏结，致使清阳不升，浊阴不降，肝木之邪得以趁机侵犯侮害脾胃，从而发病。致病的原因多因放纵口腹，喜好辛辣、酸味、生冷、煎炸、酥脆坚硬的食物，早晨受伤晚上受损，日积月累，由郁结成积，由积成痰，痰火煎熬，血液妄行，痰血混杂，妨碍气机升降，所以胃脘作痛。庸医不探究病因源头，一概用辛香燥热的药物治疗，以火助火，于是造成危重局面，实在令人痛心！古方中有九种心痛：分别是饮、食、风、冷、热、悸、虫、疰、去来痛。所谓的“冷”只是其中一种罢了！关键在于医生要有神妙的悟性，不能一概用热药治疗。详细考察其成因，病位都在胃脘而实际上不在心，区别在于有寒、热、火、实、死血、食积、痰、虫的不同。
寒厥痛：手足寒冷且全身冷汗出，大小便通利且小便清长，或者大便通利且不口渴，气息微弱体力虚弱，适宜用术附汤温补治疗。
热厥痛：身体发热足部寒冷，疼痛剧烈则烦躁呕吐，额头自汗出，脉象洪大，适宜用金铃子散加减治疗。
火实痛：因气滞和食积，突然发作疼痛，大便有时闭塞，时间久了感到闷胀，心胸部位高起，按压后疼痛加剧，不能进食，适宜轻微通利大便。
真心痛：必定死亡，不可治愈。这是指心包络引邪进入心的正经。心脏作为脏器，属于君火，是神灵居住的地方以及手少阴经所主，都不容易受到损伤，所以说真心痛难治。另外，平时喜欢吃热物，导致死血停留在胃口，引起疼痛的，适宜用桃仁承气汤攻下治疗。
补遗：
朱丹溪说：凡是胃脘痛必须使用温药，这是因为郁结不行，阻碍气机运行，所以疼痛在下部的多属于湿证，适宜温通利湿治疗。
大凡心痛需要区分新病和久病，如果明确知道是因为感受寒气、食用寒物而得的，在刚发病时，应当温散或温利。如果病情持续稍久则形成郁结，久郁则化热，热久而生火，《原病式》中对此已有详尽论述。如果想要进行温散温利，难道不会助火添病吗？因此多用山栀作为热药的向导，这样邪气容易伏藏，疾病容易消退，正气潜伏而痊愈！用法是用山栀十五枚（大的九枚），去皮炒黑，煎煮，佐以姜汁，令其辛辣服用，或者加川芎一钱，或者用二陈汤加川芎、苍术、倍子煎服，严重的加干姜，轻的用麻黄、桂枝之类发散。气虚之人胃脘作痛，服用草豆蔻丸。
〔附方〕
草豆蔻丸：草豆蔻、橘红、人参、干姜、黄芪、益智仁、当归、青皮、泽泻、半夏、桃仁、麦芽、神曲、姜黄。以上药材研为末，用蒸饼和制成丸剂，姜汤送服，可加吴茱萸、生甘草、熟甘草。
(Attachment: Heart Pain)
General Summary: Heart pain originally originates in the epigastrium. To distinguish true heart pain, the pathology lies in the Gaohuang region (a deep internal area). The root causes of the nine types of heart pain must be carefully investigated; cold, food stagnation, parasites, and fire require extra caution.
Pulse Diagnosis: A洪大 (Hongda, surging and large) pulse indicates Fire. A热滑大 (Reshua da, hot, slippery, and large) pulse indicates Phlegm. A full pulse on the right hand indicates Accumulation. A沉滑 (Chen-hua, deep and slippery) pulse indicates Food Stagnation. A弦迟 (Xianchi, wiry and slow) pulse indicates Cold. A 沉细而实 (Chen-xi er shi, deep, fine, and full) pulse is treatable. A 坚大而实 (Jian-da er shi, firm, large, and full), 浮大而长 (Fu-da er chang, floating, large, and long), 滑而利 (Hua er li, slippery and free-flowing), or 数而紧 (Shu er jin, rapid and tight) pulses are difficult to treat. If heart pain is accompanied by cyanosis of the hands and feet extending to the joints, it is incurable.
The *Neijing* states: In years when Shaoyang governs the climate, wind qi circulates on the earth, leading to symptoms such as heart pain, epigastric pain, and obstruction of the diaphragm. It also says: When Wood qi is depressed and erupts, people suffer from epigastric pain centered behind the heart, radiating upward to both hypochondria, with obstruction in the diaphragm and chest, and inability to eat or drink. This occurs because Wind-Wood qi is depressed and becomes excessive upon eruption, resulting in signs of Earth failing and Wood attacking. However, the Heart and Stomach are distinct organs with different pathological manifestations. Because the location of epigastric pain is below the heart, it is named "pain centered behind the heart." Zhu Danxi's statement that "epigastric pain is heart pain" is incorrect. The Stomach is True Wet Earth, located in the Middle Jiao, endowed with harmonious qi, rich in qi and blood, serving as the Sea of Water and Grain, and the commander of the Three Yang meridians. The qi of the five zang and six fu organs and twelve meridians all derive from it. Thus, when robust, qi flows freely and health is maintained; when weak, qi stagnates and disease arises. If the harmonious qi of the Stomach shifts towards excess cold or heat, water and grain fail to digest, remaining as fluid retention and food accumulation. True qi contends with pathogenic factors, causing clear yang to fail to ascend and turbid yin to fail to descend. The evil of Liver Wood then takes the opportunity to invade and harass, causing disease. Etiologically, this often results from indulgence in eating, favoring pungent, sour, cold, raw, fried, crispy, or hard foods. Damage accumulates day by day, forming depression, then accumulation, then phlegm. Phlegm-fire simmering causes blood to move recklessly. Phlegm and blood mix, obstructing ascending and descending mechanisms, resulting in epigastric pain. Quack doctors, failing to investigate the source, indiscriminately use pungent, aromatic, dry, and hot medicines, adding fire to fire, thus creating critical conditions, which is truly lamentable. Ancient formulas describe nine types of heart pain: Yin (Fluid), Shi (Food), Feng (Wind), Leng (Cold), Re (Heat), Ji (Palpitation), Chong (Parasite), Zhu (Infectious/Contagious), and Qulai Tong (Wandering Pain). "Cold" is merely one type. The key lies in the physician's intuitive understanding; one must not indiscriminately use hot medicines. Examining the causes closely, the pathology is in the epigastrium, not actually in the Heart, differing only in being Cold, Heat, Fire, Excess, Dead Blood, Food Stagnation, Phlegm, or Parasites.
Cold-Jue Pain: Hands and feet are cold, whole body sweats cold sweat, bowel movements and urination are free with clear urine, or bowels are loose without thirst, with faint qi and weak strength. Treat with Shu Fu Tang (Atractylodes and Aconite Decoction) to warm.
Heat-Jue Pain: Body is hot while feet are cold. Severe pain causes irritability and vomiting, spontaneous sweating on the forehead, and a Hongda (surging and large) pulse. Treat with Jin Ling Zi San (Melia Seed Powder) with modifications.
Fire-Excess Pain: Caused by Qi stagnation and Food accumulation, sudden onset of pain. Bowels may be closed. After a long time, there is stuffiness and distension, the chest and heart area protrude, pressing increases pain, and eating is impossible. Treat with mild purgation.
Dead Blood Pain: Pain is fixed in one location and does not shift.
Food Stagnation Pain: Pain is severe with an urge to defecate; pain decreases after defecation.
Phlegm Pain: Dull pain that temporarily stops after taking pungent-hot decoctions.
True Heart Pain: Must result in death and is incurable. This refers to the Pericardium drawing evil into the proper meridian of the Heart. The Heart organ belongs to Minister Fire (Note: Text says Jun Huo/Emperor Fire, but context implies vulnerability via Pericardium), the residence of the Spirit, and the Hand-Shaoyin meridian, which are generally protected from injury. Additionally, if one usually likes eating hot foods, causing dead blood to remain at the stomach opening and cause pain, treat with Tao Ren Cheng Qi Tang (Peach Kernel and Rhubarb Decoction) to purge.
Supplementary Notes:
Zhu Danxi said: For all epigastric pain, warm medicines must be used. This is because depression prevents flow, obstructing qi movement. Therefore, pain located lower down mostly belongs to Dampness and should be treated with warming and draining methods.
Generally, heart pain must be distinguished by newness or chronicity. If clearly caused by external cold exposure or ingestion of cold substances, during the initial stage, one should use warming dispersal or warming drainage. If the disease persists for a while, it forms depression; long-term depression generates heat; long-term heat generates fire, as detailed in the *Yuan Bing Shi*. If one attempts warming dispersal or drainage at this stage, would it not assist fire and worsen the disease? Therefore, Gardenia (Shan Zhi) is often used as a guide for heat-clearing medicines, allowing evil to be subdued and disease to recede, so that righteous qi can recover. Use fifteen Gardenias (nine large ones), remove skin, stir-fry until black, decoct, add ginger juice to make it pungent, and take. Alternatively, add one qian of Chuanxiong, or use Er Chen Tang plus Chuanxiong and Cangzhu, doubling the dosage of Banxia, decoct and take. For severe cases, add Ganjiang (Dried Ginger); for mild cases, disperse with Mahuang (Ephedra) and Guizhi (Cinnamon Twig). For those with Qi deficiency suffering epigastric pain, take Caodoukou Wan (Cardamom Pill).
[Attached Formulas]
Caodoukou Wan (Cardamom Pill): Caodoukou (Tsaoko Cardamom Fruit), Juhong (Exocarpium Citri Reticulatae), Renshen (Ginseng Root), Ganjiang (Dried Ginger), Huangqi (Astragalus Root), Yizhi (Alpinia Oxyphylla Fruit), Danggui (Angelica Sinensis Root), Qingpi (Green Tangerina Peel), Zexie (Alisma Rhizome), Banxia (Pinellia Tuber), Taoren (Peach Seed), Maiya (Hordeum Germinatum), Shenqu (Massa Medicata Fermentata), Jianghuang (Curcuma Longa Rhizome). Grind into powder, mix with steamed dough to form pills, take with Ginger Decoction. Can add Wuzhuyu (Evodia Fruit), Sheng Gancao (Raw Licorice Root), and Shu Gancao (Prepared Licorice Root).
Shu Fu Tang (Atractylodes and Aconite Decoction): See section on Convulsions.
Jin Ling Zi San (Melia Seed Powder): Jinlingzi Rou (Sarcotesta of Melia Toosendan), Yuanhusuo (Corydalis Rhizome) (one liang each). Grind into powder, take. After pain ceases, take Zhizhu Wan (Immortelle and Atractylodes Macrocephala Pill).
Zhizhu Wan (Immortelle and Atractylodes Macrocephala Pill): Zhishi (Immature Bitter Orange), Baizhu (Atractylodes Macrocephala Rhizome).
Tao Ren Cheng Qi Tang (Peach Kernel and Rhubarb Decoction): See section on Dysentery.