心为君主之官。一痛手足青至节。不治。俗谓心痛者。乃心胞络痛。或胃腕痛也。昔人
分为九种。宜辨而治之。
一曰气痛。脉沉而涩。乃七情之气郁滞所致。宜
七气汤。（五十四微温。） 百合汤。（九十微凉。）
一曰血痛。脉浮沉俱涩其病如刺。不可按扪或寒热往来。大便黑。宜
失笑散。（五十八） 三一承气汤。（五十四此方虽竣。而痛其便闭拒按者。不得不用
之。如桂枝桃仁各三钱。）
一曰痰痛。即饮痛。脉滑咳嗽。痛连胁下。或游走无定。宜伤寒十枣汤。但此方。近医
胆识不及。不敢用。宜
二陈汤。（八十二○加白芥子一钱五分皂角炒紫五分。栝蒌三钱。） 滚痰丸。（六十三
○诸药不效大便闭者。可暂用之。）
一曰火痛。脉数而实。口渴面赤。身热便秘。其痛或作或止。宜
金铃子散。（九十二） 丹参汤。（九十二） 百合汤。（九十三）
或用栀子炒熟四钱。良姜二钱研末。名越桃散。温酒送下。
加味逍遥散。送下左金丸二钱。
一曰冷痛。脉迟而微细。手足俱冷。其痛绵绵不休。宜附子理中汤。加当归肉桂木通吴
萸子。
一曰虚痛。即悸痛。脉虚细小。或短涩。心下悸。喜按。得食少愈。二便清利。宜
归脾汤。加石菖蒲一钱。（二十一） 当归补血汤。加肉桂一钱五分。（六）
一曰注痛。入山林古庙古墓。及感一切异气而痛。语言错乱。其脉乍大乍小。两手若出
两人。宜平胃散。加藿香二钱。木香一钱。调麝香七厘服。以香者天地之正气也。正能胜
邪。
一曰虫痛。脉如平人。其痛忽来忽止。闻肥甘之味更痛。（闻食而虫头上昂。）按摩稍止。
（
附子理中汤。去甘草。加乌梅三枚。川椒黄连各一钱五分。黄柏肉桂当归各一钱。水煎
服。愈后。宜服乌梅丸。（一百零七）
一曰食痛。脉实而滑。嗳腐吞酸。恶食腹胀。其痛或有一条扛起者。宜
平胃散。加麦芽谷芽山楂半夏各二钱。胀甚者。再加莱菔子生研三钱。水煎服。如初病。
食
十）又按。以上九痛。流传已久。不可不知。而高士宗医学真传。分各部用药。其法甚捷。
今重订而节录于下。
一当心之部位而痛。俗云心痛非也。乃心胞之络。不能旁达于脉故也。宜
香苏饮。加当归四钱。元胡索木通各一钱。桂枝二钱。酒水各半煎服。紫苏须用
旁小梗整条。不切碎。更能通络。（五十三）
一心脉之上则为胸膈。胸膈痛乃上焦失职。不能如雾之溉。则胸痹而痛。宜
百合汤半剂。加栝蒌皮贝母各三钱。薤白八钱。白蔻一钱五分。水煎服。（九十三）
胸膈之下两乳中间名曰膺胸。膺胸痛乃肝血力虚。气不充于期门。致冲任之血。从膺胸
而散则痛。宜
丹参饮半剂。加当归五钱。白芍金银花各三钱。红花川续断各一钱。酒水各半煎。
（九十二）
一膺胸之下则为中脘。中脘作痛。手不可近。乃内外不和。外则寒气凝于毛皮。内则垢
浊停于中脘。当审其体之虚实而施治。莫若以灯当痛处爆十余点。则寒结去而内外通。便不
痛矣。若爆后痛仍不止。实者宜五积散。虚者宜加味香苏饮。
五积散。（四十二）
香苏饮加桂枝芍药当归各三钱。细辛木通各一钱五分。吴茱萸二钱。水煎服。方中紫苏
生姜细辛桂枝。以驱外之凝寒。吴茱萸陈皮木通。以降内之浊垢。归芍香附甘草。和其气血。
安
一中脘之下。当阳明胃土之间。（铜人图中脘下一斗名建里穴）时痛时止。乃中土虚而胃气
不
和。若服行血消泄之剂过多。便宜温补。但以手重按之则痛稍平。此中土内虚。虚而且寒之
明验也。宜
香砂六君子汤。加干姜二三钱。（三） 附子理中汤。（一百零七）
一乳下两旁胸骨尽处痛者。乃上下阴阳不和。少阳枢转不利也。伤寒病中多有此症。当
助其枢转。和其气血。上下通调。则愈矣。宜
逍遥散。倍柴胡。加生姜一钱五分。（四十八）
一大腹痛者。乃太阴脾土之部。痛在内而缓。中土虚寒也。（宜理中汤。倍人参。）痛兼
内外而急。脾络不通也。（宜理中汤。倍干姜。）盖脾之大络。名曰大包。从经隧而外出于络
脉。今脾络滞而不行。则内外皆痛。（理中汤倍干姜。服之不应者。再加肉桂一钱五分。木
通一钱。）太阳篇云。伤寒。阳脉涩。阴脉弦。法当腹中急痛。先与小建中汤。不瘥者。与
小柴胡汤。此先补益于内。而后枢转于外也。
一脐旁左右痛者。乃冲脉病。冲脉当脐左右。若为寒气所凝。其冲脉之血。不能上行外
达。则当脐左右而痛。当用血分之药。使胞中之血。通达肌表。若用气药。无裨也。宜当归
四逆。加生姜吴茱萸汤。水酒各半煎服。或用四物汤。（九） 去地黄。加肉桂一钱。生黄
生姜各三钱。炙甘草红花各一钱。水酒煎服。
一脐中痛不可忍喜按者。肾气虚寒也。宜通脉四逆汤。加白芍三钱。若脉沉实口中热渴
腹
三一承气汤。（五十四）
一脐下痛者。乃少阴水脏太阳水腑。不得阳热之气以施行。致阴寒凝结而痛。少阴水脏
虚寒。用真武汤温之。太阳水腑虚寒。用桂枝汤。加熟附子茯苓温之。○按士材必读云。脐
上痛。属脾。脐下痛。属肝。当脐痛。属肾。此臆说也。不可从。又脐下痛。有火逼膀胱。
小便不利而痛者。宜五苓散。亦有阴虚阳气不化。小便点滴俱无胀痛者。宜通关丸。有燥屎
者。辨法方治。见上条。
通关丸。（五十一）
一小腹两旁谓之少腹。少腹痛乃厥阴肝脏之部。又为胞中之血海。盖胞中之水。主于少
阴。胞中之血。主于厥阴也。痛者。厥阴肝气。不合胞中之血而上行也。肝脏不虚者。当疏
通以使之上。（宜香苏饮。加柴胡三钱。当归白芍各二钱。生橘叶三片。）肝脏虚者。当补益
以助其下。（宜乌梅丸。以米汤送下二钱。一日三服。）盖厥阴不从标本。从中见少阳之气。
使厥阴上合乎少阳。则不痛矣。 两旁季胁痛者。肝气虚也。（当归四逆汤。加阿胶。四君
子汤。去白术。加当归粳米与乌梅丸。五服。）两胁之上痛者。少阳之气不和也。（宜小柴胡
汤。去枣。加牡蛎青皮。）时法用左金丸。愚按。凡心腹诸痛。宜辨其内之胀与不胀。便之
闭
与不闭。脉之有力与无力。口中热。口中和。痛之久暂。以辨寒。热。邪。正。虚。实。如
痛而胀且闭者。浓朴三物汤。攻里兼发热者。浓朴七物汤。兼表里治之。腹痛连胁痛。脉弦
紧。恶寒甚大便秘者。大黄附子汤主之。若但胀而便不秘者。是实中之虚。宜浓朴半夏人参
生姜甘草汤。腹痛甚而不可触近呕吐者。大建中汤主之。雷鸣切痛呕吐者。附子粳米汤主之。
腹痛下利而厥者。通脉四逆汤主之。腹痛吐泻者。理中汤主之。若绕脐疼痛。名寒疝腹中病
痛者。当归生姜羊肉汤主之。皆起死回生之法。时医不讲久矣。予着有金匮浅注十六卷。医
诀三卷。辨之颇详。宜查对勿误。
心是君主之官。一旦出现疼痛且手足青紫至关节，属于不治之症。民间所谓的心痛，实际上是心包络的疼痛，或者是胃脘部的疼痛。古人将其分为九种类型，应当辨别清楚后进行治疗。
第一种是气痛。脉象沉而涩，是由于七情之气郁滞所致。适宜使用七气汤。（见第五十四页，微温。）百合汤。（见第九十页，微凉。）
第二种是血痛。脉象浮取和沉取都涩，病痛如针刺般，不可按压触摸，或者寒热往来，大便黑色。适宜使用失笑散。（见第五十八页）三一承气汤。（见第五十四页，此方虽然峻猛，但对于大便闭结、拒按的疼痛，不得不使用它。例如桂枝、桃仁各三钱。）
第三种是痰痛，也就是饮痛。脉滑，伴有咳嗽，疼痛牵连胁下，或者游走不定。适宜使用伤寒论中的十枣汤。但是这个方子，近代医生胆识不足，不敢使用。适宜使用二陈汤。（见第八十二页○加白芥子一钱五分，皂角炒至紫色五分，栝蒌三钱。）滚痰丸。（见第六十三页○如果诸药无效且大便闭结，可以暂时使用它。）
第四种是火痛。脉数而实，口渴面红，身体发热，便秘。其疼痛有时发作有时停止。适宜使用金铃子散。（见第九十二页）丹参汤。（见第九十二页）百合汤。（见第九十三页）
或者用栀子炒熟四钱，良姜二钱研成末，名为越桃散，用温酒送服。
加味逍遥散，送服左金丸二钱。
第五种是冷痛。脉迟而微细，手足俱冷。其疼痛绵绵不休。适宜使用附子理中汤，加入当归、肉桂、木通、吴茱萸子。
第六种是虚痛，也就是悸痛。脉虚细小，或者短涩，心下部悸动，喜欢按压，进食后稍有好转，大小便清利。适宜使用归脾汤，加入石菖蒲一钱。（见第二十一页）当归补血汤，加入肉桂一钱五分。（见第六页）
第七种是注痛（中邪气之痛）。进入山林古庙古墓，以及感受一切异气而引发的疼痛，语言错乱。其脉象忽大忽小，两手脉象仿佛出自两人之手。适宜使用平胃散，加入藿香二钱，木香一钱，调服麝香七厘服用。因为香气是天地间的正气，正气能够战胜邪气。
第八种是虫痛。脉象如同常人。其疼痛忽然来忽然止，闻到肥甘厚味的食物疼痛更甚。（闻到食物气味时，蛔虫头部昂起。）按摩后稍能缓解。
（附子理中汤，去掉甘草，加入乌梅三枚，川椒、黄连各一钱五分，黄柏、肉桂、当归各一钱，水煎服。痊愈后，适宜服用乌梅丸。（见第一百零七页）
第九种是食痛。脉实而滑，嗳气腐臭，吞酸，厌恶饮食，腹胀。其疼痛有时像有一条筋扛起一样。适宜使用平胃散，加入麦芽、谷芽、山楂、半夏各二钱。胀得厉害时，再加莱菔子生研三钱，水煎服。如果是初病，吃了……（此处原文似有缺漏或断句问题，依文意推测为饮食不当），又按：以上九种疼痛，流传已久，不可不知道。而高士宗在《医学真传》中，将各部用药分开论述，这种方法非常快捷。现在重新修订并节录如下。
第一，当心之部位而痛。俗云心痛是不对的，这是心包的络脉，不能旁达于经脉的缘故。适宜使用香苏饮，加入当归四钱，元胡索、木通各一钱，桂枝二钱，酒水各半煎服。紫苏必须使用旁边的小梗整条，不切碎，更能疏通络脉。（见第五十三页）
第二，心脉之上则为胸膈。胸膈痛是因为上焦失职，不能像雾露那样灌溉，则导致胸痹而痛。适宜使用百合汤半剂，加入栝蒌皮、贝母各三钱，薤白八钱，白蔻一钱五分，水煎服。（见第九十三页）
第三，胸膈之下两乳中间名曰膺胸。膺胸痛是因为肝血力虚，气不能充盈于期门穴，导致冲任之血从膺胸散开而疼痛。适宜使用丹参饮半剂，加入当归五钱，白芍、金银花各三钱，红花、川续断各一钱，酒水各半煎。（见第九十二页）
第四，膺胸之下则为中脘。中脘作痛，手不可靠近，这是内外不和。外则是寒气凝结于皮毛，内则是垢浊停滞于中脘。应当审察体质的虚实而施治。不如用灯草在痛处爆灸十余点，则寒结去除而内外通畅，就不痛了。如果爆灸后疼痛仍不止，实证适宜使用五积散，虚证适宜使用加味香苏饮。
五积散。（见第四十二页）
香苏饮加入桂枝、芍药、当归各三钱，细辛、木通各一钱五分，吴茱萸二钱，水煎服。方中紫苏、生姜、细辛、桂枝，用来驱散外部的凝寒；吴茱萸、陈皮、木通，用来降泄内部的浊垢；当归、芍药、香附、甘草，调和气血。
第五，中脘之下，处于阳明胃土之间。（铜人图中，中脘下一寸名为建里穴）疼痛时发时止，这是中土虚弱而胃气不和。如果服用行血消导的药剂过多，就适宜温补。但以手重按则疼痛稍平，这是中土内部虚弱，虚而且寒的明显验证。适宜使用香砂六君子汤，加入干姜二三钱。（见第三页）附子理中汤。（见第一百零七页）
第六，乳下两旁胸骨尽处疼痛，这是上下阴阳不和，少阳枢机转动不利。伤寒病中多有此症，应当帮助其枢机转动，调和气血，上下通调，则痊愈。适宜使用逍遥散，加倍柴胡，加入生姜一钱五分。（见第四十八页）
第七，大腹痛者，是太阴脾土的部属。疼痛在内且缓，是中土虚寒。（适宜理中汤，加倍人参。）疼痛兼及内外且急，是脾络不通。（适宜理中汤，加倍干姜。）脾的大络，名叫大包，从经隧向外出于络脉。如今脾络滞涩而不运行，则内外皆痛。（理中汤加倍干姜，服用后无效的，再加肉桂一钱五分，木通一钱。）《伤寒论·太阳篇》说：伤寒，阳脉涩，阴脉弦，法当腹中急痛。先给予小建中汤，不愈的，给予小柴胡汤。这是先在内部补益，然后在外部枢转的方法。
第八，脐旁左右疼痛，这是冲脉的病。冲脉正当脐左右，如果被寒气所凝，冲脉之血不能上行外达，则当脐左右而痛。应当使用血分的药物，使胞中之血通达肌表。如果使用气药，没有益处。适宜使用当归四逆汤，加入生姜、吴茱萸汤，水酒各半煎服。或者使用四物汤。（见第九页）去掉地黄，加入肉桂一钱，生黄芪、生姜各三钱，炙甘草、红花各一钱，水酒煎服。
第九，脐中疼痛不可忍受，喜欢按压，这是肾气虚寒。适宜使用通脉四逆汤，加入白芍三钱。如果脉沉实，口中热渴，腹部……（此处原文似有断句或排版错误，结合下文“三一承气汤”，推测此处可能指若脉沉实、口热渴、腹满痛拒按等实热证，则用三一承气汤。但原文逻辑略显跳跃，依字面翻译）三一承气汤。（见第五十四页）
第十，脐下疼痛，这是少阴水脏（肾）、太阳水腑（膀胱）不得阳热之气以施行，导致阴寒凝结而痛。少阴水脏虚寒，用真武汤温之。太阳水腑虚寒，用桂枝汤，加入熟附子、茯苓温之。○按士材《必读》说：脐上痛，属脾；脐下痛，属肝；当脐痛，属肾。这是臆说，不可听从。另外，脐下痛，有火逼膀胱，小便不利而痛的，适宜使用五苓散。也有阴虚阳气不化，小便点滴俱无胀痛者，适宜使用通关丸。有燥屎的，辨证方法方治，见上一条。
通关丸。（见第五十一页）
第十一，小腹两旁称为少腹。少腹痛是厥阴肝脏的部属，又是胞中的血海。盖胞中的水，主于少阴；胞中的血，主于厥阴。疼痛，是因为厥阴肝气不合胞中之血而上行。肝脏不虚者，应当疏通使其上行。（适宜香苏饮，加入柴胡三钱，当归、白芍各二钱，生橘叶三片。）肝脏虚者，应当补益以助其下行。（适宜乌梅丸，以米汤送下二钱，一日三次服用。）盖厥阴不从标本，从中见少阳之气，使厥阴上合乎少阳，则不痛了。两旁季胁疼痛，是肝气虚。（当归四逆汤，加入阿胶；四君子汤，去掉白术，加入当归、粳米与乌梅丸，五服。）两胁之上疼痛，是少阳之气不和。（适宜小柴胡汤，去掉大枣，加入牡蛎、青皮。）时医常用左金丸。我按：凡是心腹诸痛，应当辨别内部是否胀满，大便是否闭结，脉象有力还是无力，口中热还是口中和，疼痛的时间久暂，以此辨别寒、热、邪、正、虚、实。如疼痛且胀且闭者，用浓朴三物汤攻里；兼发热者，用浓朴七物汤，表里同治。腹痛连胁痛，脉弦紧，恶寒甚重，大便秘结者，大黄附子汤主治。若只是胀而大便不秘结，这是实中之虚，适宜用浓朴半夏人参生姜甘草汤。腹痛剧烈而不可触近呕吐者，大建中汤主治。雷鸣切痛呕吐者，附子粳米汤主治。腹痛下利而四肢厥冷者，通脉四逆汤主治。腹痛吐泻者，理中汤主治。若绕脐疼痛，名为寒疝腹中病痛者，当归生姜羊肉汤主治。这些都是起死回生的方法。当时的医生不讲求这些已经很久了。我著有《金匮浅注》十六卷，《医诀》三卷，辨析得很详细，适宜查对以免误诊。
The Heart is the official of the Sovereign. If pain occurs accompanied by cyanosis of the hands and feet extending to the joints, it is incurable. What the common people call "Heart Pain" is actually pain of the Pericardium Collaterals (Xin Bao Luo) or epigastric pain. Ancients divided it into nine types, which should be differentiated and treated accordingly.
The first is Qi Pain. The pulse is deep and choppy, caused by stagnation of Qi due to the Seven Emotions. It is suitable to use Qi Qi Tang (Seven Qi Decoction). [See p. 54, slightly warm.] Bai He Tang (Lily Bulb Decoction). [See p. 90, slightly cool.]
The second is Blood Pain. The pulse is choppy on both superficial and deep palpation. The disease feels like stabbing, cannot be pressed or touched, or there is alternating chills and fever, and black stool. It is suitable to use Shi Xiao San (Laughing Off Powder). [See p. 58] San Yi Cheng Qi Tang (Three-One Purging Decoction). [See p. 54, although this formula is potent, it must be used for pain with constipation and abdominal refusal to pressure. For example, Gui Zhi (Cinnamon Twig) and Tao Ren (Peach Seed) each 3 qian.]
The third is Phlegm Pain, also known as Fluid Pain. The pulse is slippery, accompanied by cough, pain radiating to the hypochondrium, or wandering without a fixed location. It is suitable to use Shi Zao Tang (Ten Jujube Decoction) from *Shang Han Lun*. However, modern physicians lack the courage and discernment to use it. It is suitable to use Er Chen Tang (Two-Aged Decoction). [See p. 82 ○ Add Bai Jie Zi (White Mustard Seed) 1.5 qian, Sao Jiao (Tamarisk Fruit) fried until purple 0.5 fen, Gua Lou (Trichosanthes Root) 3 qian.] Gun Tan Wan (Rolling Phlegm Pill). [See p. 63 ○ If other medicines are ineffective and there is constipation, it can be used temporarily.]
The fourth is Fire Pain. The pulse is rapid and full. There is thirst, red face, body heat, and constipation. The pain may come and go. It is suitable to use Jin Ling Zi San (Melia Toosendan Powder). [See p. 92] Dan Shen Tang (Salvia Miltiorrhiza Decoction). [See p. 92] Bai He Tang (Lily Bulb Decoction). [See p. 93]
Alternatively, use Zhi Zi (Gardenia Fruit) roasted 4 qian, Liang Jiang (Galangal Rhizome) 2 qian, ground into powder, named Yue Tao San (Osmanthus Powder), taken with warm wine.
Jia Wei Xiao Yao San (Modified Free and Easy Wanderer Powder) to send down Zuo Jin Wan (Left Metal Pill) 2 qian.
The fifth is Cold Pain. The pulse is slow and thready/fine. Hands and feet are cold. The pain is continuous and unceasing. It is suitable to use Fu Zi Li Zhong Tang (Aconite Spleen-Regulating Decoction), added with Dang Gui (Angelica Sinensis), Rou Gui (Cinnamon Bark), Mu Tong (Akebia Stem), Wu Yu Zi (Evodia Fruit).
The sixth is Deficiency Pain, also known as Palpitation Pain. The pulse is deficient, small and fine, or short and choppy. There is palpitations in the epigastrium, preference for pressure, slight improvement after eating, and clear urination and defecation. It is suitable to use Gui Pi Tang (Spleen-Restoring Decoction), added with Shi Chang Pu (Acorus Rhizome) 1 qian. [See p. 21] Dang Gui Bu Xue Tang (Angelica Tonifying Blood Decoction), added with Rou Gui (Cinnamon Bark) 1.5 qian. [See p. 6]
The seventh is Zhu Pain (Infection/Posession Pain). Caused by entering mountains, forests, ancient temples, tombs, or being affected by all kinds of abnormal qi, leading to pain and confused speech. The pulse fluctuates between large and small; the pulses in both hands seem to come from two different people. It is suitable to use Ping Wei San (Stomach-Pacifying Powder), added with Huo Xiang (Patchouli Herb) 2 qian, Mu Xiang (Costus Root) 1 qian, mixed with She Xiang (Musk) 7 li for oral administration. Fragrance is the righteous qi of heaven and earth; righteousness can overcome evil.
The eighth is Worm Pain. The pulse is like that of a healthy person. The pain comes suddenly and stops suddenly, worsening upon smelling rich and sweet foods. (When smelling food, the worms raise their heads.) Massage provides slight relief.
(Fu Zi Li Zhong Tang, remove Gan Cao (Licorice Root), add Wu Mei (Mume Fruit) 3 pieces, Chuan Jiao (Sichuan Pepper) and Huang Lian (Coptis Rhizome) each 1.5 qian, Huang Bo (Phellodendron Bark), Rou Gui (Cinnamon Bark), Dang Gui (Angelica Sinensis) each 1 qian, decoct in water and take. After cure, it is suitable to take Wu Mei Wan (Mume Pill). [See p. 107])
The ninth is Food Pain. The pulse is full and slippery. There is belching with rotten smell, acid regurgitation, aversion to food, and abdominal distension. The pain sometimes feels like a tendon is pulling up. It is suitable to use Ping Wei San (Stomach-Pacifying Powder), added with Mai Ya (Barley Sprout), Gu Ya (Rice Sprout), Shan Zha (Hawthorn Fruit), Ban Xia (Pinellia Tuber) each 2 qian. If distension is severe, add Lai Fu Zi (Radish Seed) raw-ground 3 qian, decoct in water and take. If it is an initial illness... [Text fragment]. Note: The above nine pains have been passed down for a long time and must not be ignored. Gao Shizong, in *Yi Xue Zhen Chuan* (True Transmission of Medical Science), separated medication by body parts, a method that is very swift. Now revised and excerpted below.
First, pain in the region of the Heart. Commonly called Heart Pain, but incorrect. This is because the collaterals of the Pericardium cannot reach the meridians laterally. It is suitable to use Xiang Su Yin (Perilla Infusion), added with Dang Gui (Angelica Sinensis) 4 qian, Yuan Hu Suo (Corydalis Rhizome) and Mu Tong (Akebia Stem) each 1 qian, Gui Zhi (Cinnamon Twig) 2 qian, decoct in half water and half wine. Zi Su (Perilla Leaf) must use the small side stems whole, not chopped, to better unblock collaterals. [See p. 53]
Second, above the Heart meridian is the Chest and Diaphragm. Chest and Diaphragm pain is due to dysfunction of the Upper Jiao, failing to irrigate like mist, leading to Chest Bi (Obstruction) and pain. It is suitable to use half dose of Bai He Tang (Lily Bulb Decoction), added with Gua Lou Pi (Trichosanthes Peel) and Bei Mu (Fritillaria Bulb) each 3 qian, Xie Bai (Macrostemon Bulb) 8 qian, Bai Kou (Cardamom Fruit) 1.5 qian, decoct in water and take. [See p. 93]
Third, below the chest and diaphragm, between the two breasts, is called Ying Xiong (Anterior Chest). Ying Xiong pain is due to deficiency of Liver Blood, where Qi fails to fill the Qimen point, causing blood from the Chong and Ren vessels to scatter through the anterior chest, resulting in pain. It is suitable to use half dose of Dan Shen Yin (Salvia Infusion), added with Dang Gui (Angelica Sinensis) 5 qian, Bai Shao (White Peony Root), Jin Yin Hua (Honeysuckle Flower) each 3 qian, Hong Hua (Carthamus Flower), Chuan Xu Duan (Dipsacus Root) each 1 qian, decoct in half water and half wine. [See p. 92]
Fourth, below the anterior chest is Zhong Wan (Middle Epigastrium). Pain at Zhong Wan, intolerant to touch, indicates disharmony of interior and exterior. Externally, cold qi condenses in the skin and hair; internally, turbid filth stagnates in the Zhong Wan. Treatment should assess the constitution's deficiency or excess. It is best to apply moxibustion with lamp wick on the painful spot more than ten times, so that cold condensation is removed and interior-exterior communication is restored, stopping the pain. If pain persists after moxibustion, excess patterns suit Wu Ji San (Five Accumulations Powder), and deficiency patterns suit Jia Wei Xiang Su Yin (Modified Perilla Infusion).
Wu Ji San (Five Accumulations Powder). [See p. 42]
Xiang Su Yin added with Gui Zhi (Cinnamon Twig), Shao Yao (Peony Root), Dang Gui (Angelica Sinensis) each 3 qian, Xi Xin (Asarum Root), Mu Tong (Akebia Stem) each 1.5 qian, Wu Zhu Yu (Evodia Fruit) 2 qian, decoct in water and take. In the formula, Zi Su (Perilla Leaf), Sheng Jiang (Fresh Ginger), Xi Xin (Asarum Root), Gui Zhi (Cinnamon Twig) drive out external condensed cold; Wu Zhu Yu (Evodia Fruit), Chen Pi (Citrus Peel), Mu Tong (Akebia Stem) descend internal turbid filth; Dang Gui (Angelica Sinensis), Shao Yao (Peony Root), Xiang Fu (Cyperus Rhizome), Gan Cao (Licorice Root) harmonize Qi and Blood.
Fifth, below Zhong Wan is the area of Yangming Stomach Earth. (In the Copper Man diagram, one cun below Zhong Wan is Jian Li point). Pain that comes and goes indicates deficiency of Middle Earth and disharmony of Stomach Qi. If too many blood-moving and purgative medicines are taken, warming and tonifying become appropriate. Pressing heavily with hand relieves pain slightly, which is clear evidence of internal deficiency and cold of Middle Earth. It is suitable to use Xiang Sha Liu Jun Zi Tang (Atractylodes and Amomum Six Gentlemen Decoction), added with Gan Jiang (Dried Ginger) 2-3 qian. [See p. 3] Fu Zi Li Zhong Tang (Aconite Spleen-Regulating Decoction). [See p. 107]
Sixth, pain at the ends of the ribs below the breasts indicates disharmony of upper and lower Yin and Yang, and unfavorable pivot function of Shaoyang. This symptom often appears in Shang Han diseases. One should assist the pivot function, harmonize Qi and Blood, and ensure smooth regulation of upper and lower, then recovery occurs. It is suitable to use Xiao Yao San (Free and Easy Wanderer Powder), doubling Chai Hu (Bupleurum Root), adding Sheng Jiang (Fresh Ginger) 1.5 qian. [See p. 48]
Seventh, great abdominal pain belongs to the Taiyin Spleen Earth region. Pain inside and slow indicates Middle Earth deficiency and cold. (Suit Li Zhong Tang, double Ren Shen (Ginseng Root).) Pain involving interior and exterior and urgent indicates obstruction of Spleen collaterals. (Suit Li Zhong Tang, double Gan Jiang (Dried Ginger).) The great collateral of the Spleen is named Da Bao. It emerges from the meridians to the collaterals externally. Now, if Spleen collaterals are stagnant and do not flow, both interior and exterior hurt. (Li Zhong Tang double Gan Jiang (Dried Ginger); if ineffective, add Rou Gui (Cinnamon Bark) 1.5 qian, Mu Tong (Akebia Stem) 1 qian.) *Shang Han Lun · Taiyang Chapter* says: In Shang Han, if Yang pulse is choppy and Yin pulse is string-taut, the law dictates acute abdominal pain. First give Xiao Jian Zhong Tang (Minor Construct the Middle Decoction); if not cured, give Xiao Chai Hu Tang (Minor Bupleurum Decoction). This is first tonifying internally, then pivoting externally.
Eighth, pain around the left and right of the umbilicus is a disease of the Chong Mai (Penetrating Vessel). The Chong Mai runs alongside the umbilicus. If congealed by cold qi, blood of the Chong Mai cannot ascend and reach outward, causing pain around the umbilicus. Medicines of the Blood aspect should be used to make blood of the Uterus/Bao Zhong reach the muscle surface. Using Qi medicines is of no benefit. It is suitable to use Dang Gui Si Ni Tang (Angelica Four Reversal Decoction), added with Sheng Jiang (Fresh Ginger), Wu Zhu Yu Tang (Evodia Infusion), decoct in half water and half wine. Or use Si Wu Tang (Four Substances Decoction). [See p. 9] Remove Di Huang (Rehmannia Root), add Rou Gui (Cinnamon Bark) 1 qian, Sheng Huang Qi (Astragalus Root), Sheng Jiang (Fresh Ginger) each 3 qian, Zhi Gan Cao (Honey-fried Licorice Root), Hong Hua (Carthamus Flower) each 1 qian, decoct in water and wine.
Ninth, pain in the umbilicus unbearable, preferring pressure, indicates Kidney Qi deficiency and cold. It is suitable to use Tong Mai Si Ni Tang (Unblocking Pulse Four Reversal Decoction), added with Bai Shao (White Peony Root) 3 qian. If the pulse is deep and full, mouth hot and thirsty, abdomen... [Text fragment implies excess heat pattern] San Yi Cheng Qi Tang (Three-One Purging Decoction). [See p. 54]
Tenth, pain below the umbilicus indicates that the Shaoyin Water Organ (Kidney) and Taiyang Water Bowel (Bladder) fail to receive Yang heat qi to perform functions, leading to Yin-cold condensation and pain. Shaoyin Water Organ deficiency-cold uses Zhen Wu Tang (True Warrior Decoction) to warm. Taiyang Water Bowel deficiency-cold uses Gui Zhi Tang (Cinnamon Twig Decoction), added with Shu Fu Zi (Prepared Aconite), Fu Ling (Poria) to warm. ○ According to Shicai's *Bi Du*, pain above the umbilicus belongs to Spleen; pain below the umbilicus belongs to Liver; pain at the umbilicus belongs to Kidney. This is speculative theory and should not be followed. Also, pain below the umbilicus can be caused by fire forcing the Bladder, with difficult urination and pain; suitable Wu Ling San (Five-Ingredient Powder with Poria). There are also cases of Yin deficiency with Yang failing to transform, with no urine output and distending pain; suitable Tong Guan Wan (Passing Through Pill). Cases with dry stool, differentiation methods and formulas, see previous item.
Tong Guan Wan (Passing Through Pill). [See p. 51]
Eleventh, the sides of the lower abdomen are called Shao Fu (Lesser Abdomen). Shao Fu pain belongs to the Jueyin Liver region, and is also the Sea of Blood of the Bao Zhong (Uterus/Womb). The water of the Bao Zhong is governed by Shaoyin; the blood of the Bao Zhong is governed by Jueyin. Pain occurs because Jueyin Liver Qi does not combine with the blood of the Bao Zhong to ascend. If the Liver is not deficient, one should unblock and guide it upward. (Suit Xiang Su Yin, add Chai Hu (Bupleurum Root) 3 qian, Dang Gui (Angelica Sinensis), Bai Shao (White Peony Root) each 2 qian, Sheng Ju Ye (Fresh Tangerine Leaf) 3 slices.) If the Liver is deficient, one should tonify and assist its descent. (Suit Wu Mei Wan (Mume Pill), sent down with rice soup 2 qian, three times a day.) Jueyin does not follow the standard or root, but follows the intermediate appearance of Shaoyang Qi. Making Jueyin connect upward with Shaoyang stops the pain. Pain in the lateral costal margin indicates Liver Qi deficiency. (Dang Gui Si Ni Tang, add E Jiao (Donkey-hide Gelatin); Si Jun Zi Tang (Four Gentlemen Decoction), remove Bai Zhu (Atractylodes Macrocephala Rhizome), add Dang Gui (Angelica Sinensis), Jing Mi (Rice Grain) with Wu Mei Wan (Mume Pill), five doses.) Pain above the two hypochondria indicates disharmony of Shaoyang Qi. (Suit Xiao Chai Hu Tang (Minor Bupleurum Decoction), remove Da Zao (Jujube Fruit), add Mu Li (Oyster Shell), Qing Pi (Citrus Aurantium Peel)). Contemporary doctors often use Zuo Jin Wan (Left Metal Pill). I note: For all heart and abdominal pains, one should differentiate whether there is internal distension or not, whether stool is closed or not, whether the pulse is forceful or weak, whether the mouth is hot or neutral, and the duration of pain, to differentiate Cold, Heat, Pathogen, Righteousness, Deficiency, and Excess. If pain with distension and closure, use Hou Po San Wu Tang (Magnolia Bark Three Substance Decoction) to purge the interior; if accompanied by fever, use Hou Po Qi Wu Tang (Magnolia Bark Seven Substance Decoction) to treat both exterior and interior. Abdominal pain radiating to hypochondria, string-taut pulse, severe aversion to cold, and constipation, Da Huang Fu Zi Tang (Rhubarb and Aconite Decoction) governs. If only distended but stool not closed, this is Excess within Deficiency, suitable Hou Po Ban Xia Ren Shen Sheng Jiang Gan Cao Tang (Magnolia Bark, Pinellia, Ginseng, Ginger, Licorice Decoction). Severe abdominal pain intolerant to touch with vomiting, Da Jian Zhong Tang (Major Construct the Middle Decoction) governs. Thunderous rumbling and cutting pain with vomiting, Fu Zi Bing Mi Tang (Aconite and Rice Decoction) governs. Abdominal pain with diarrhea and cold limbs, Tong Mai Si Ni Tang (Unblocking Pulse Four Reversal Decoction) governs. Abdominal pain with vomiting and diarrhea, Li Zhong Tang (Spleen-Regulating Decoction) governs. If periumbilical pain, named Han Shan (Cold Hernia) abdominal disease pain, Dang Gui Sheng Yang Rou Tang (Angelica, Ginger, and Mutton Decoction) governs. These are all methods to revive the dying. Contemporary doctors have neglected these for a long time. I wrote *Jin Gui Qian Zhu* (Light Commentary on Golden Cabinet) sixteen volumes and *Yi Jue* (Medical Aphorisms) three volumes, with detailed differentiation. It is suitable to check against them to avoid errors.