凡诸病之虚实，辨之于脉者皆易，惟心腹痛证，则有大有小，其脉多有难辨，虽滑实有
力者，固多实邪，虚弱无神者，固多虚邪，此其常也。然暴痛之极者，每多沉伏、细涩，最
似极虚之候。不知气为邪逆，气逆则脉道不行而沉伏异常，此正邪实之脉，然于沉伏之中细
察之，必有梗梗然弦紧之意，此必寒邪阻遏阳气者，多有是脉，若火邪作痛，则不然也。凡
见此者，不得因其细极、微极便认为虚脱，妄用补剂，必大误矣。辨此之法，但当察其形气
，以见平素之强弱，问其病因，以知新病久病，及何所因而起。大都暴病痛急，而脉忽细伏
者多实邪，久病痛缓，而脉本微弱者为虚邪，再以前论虚实之法酌之，以理参而诊之，则万
无一失矣。
凡心腹痛证，必须先辨寒热，如无热证热脉，则定非火邪，不得妄用凉药。
凡治心腹痛证，古云∶痛随利减，又曰∶通则不痛，此以闭结坚实者为言。若腹无坚满
，痛无结聚，则此说不可用也。其有因虚而作痛者，则此说更如冰炭。
一、凡痛在上焦者，如因停滞，既痛兼胀，不易行散，而痛极难忍者，欲其滞去速效，
无如吐之之妙，宜于新方吐法中择而用之。若无停积胀急，而或寒或气，微有凝滞而作痛者
，但顺其气，无有不愈。
一、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，宜排气饮加减主
之；食滞者兼乎消导，寒滞者兼乎温中，若止因气逆，则但理其气，病自愈矣。其有诸药不
效，气结难解者，惟神香散为妙。若气有滞逆，随触随发者，宜用后简易二方最妙。
一、下焦小腹痛者，或寒，或热，或食，或虫，或血，或气逆，皆有之。凡闭结者，利
之下之，当各求其类而治之。
一、寒滞之痛，有因内寒者，如食寒饮冷之类是也，必兼寒兼食，随其宜而治之，如上
法可也。有因外寒者，或触冒不时之寒邪，或犯客令之寒气，或受豪雨沙气之阴毒，以致心
腹搅痛，或吐或泻，或上不能吐，下不能泻，而为干霍乱危剧等证，总由寒气犯脏，或在上
焦，或在中下二焦。凡痛急在上者，用吐最妙；在中在下者，俱宜解寒行滞，以排气饮为主
加减治之，或不换金正气散，或和胃饮、平胃散、十香丸之类，皆可择用。其有寒逆之甚者
，宜四逆汤、理中汤之类主之。又神香散可解三焦之滞，当随证作引以送之。
一、血积之有腹痛者，是即蓄血证也，而血证之属有四。一、伤寒有蓄血证。成无己曰
∶邪气聚于下焦，则津液不得通，血气不得行，或溺或血，留滞于下，是生胀满而硬痛
也。若从心下至少腹硬满而痛，小便利者，则是蓄血之证，此当分而治之。其他证治详
义，并见伤寒门。一、妇人有血痛证，详见妇人门。一、跌打损伤有瘀血腹痛证，但去其瘀
而痛自愈。凡气血和平者，宜通瘀煎加减治之。其有血滞便结，邪实不通者，宜桃仁承气汤
、百顺丸主之；或血虚燥结，便闭不通者，宜玉烛散主之。一、食郁既久，而胃脘有瘀血作
痛者，生韭饮。
一、气血虚寒，不能营养心脾者，最多心腹痛证，然必以积劳积损及忧思不遂者，乃有
此病；或心、脾、肝、肾气血本虚而偶犯劳伤，或偶犯寒气及饮食不调者，亦有此证。凡虚
痛之候，每多连绵不止，而亦无急暴之势，或按之、揉之、温之、熨之痛必稍缓，其在心脾
胸胁之间者，则或为戚戚，或为慌慌，或似嘈非嘈，或饥劳更甚，或得食稍可，或
懊无迹，莫可名状，或形色青黄，或脉微气弱，是皆虚寒之证，此非甘温养血，补胃
和中不可也，宜大小营煎，理阴煎之类加减主之。若气虚者，必大加人参，阳衰者，必佐以
桂、附、干姜。丹溪曰∶诸痛不可补气。此惟邪实气滞者当避之，而曰诸痛皆然则谬矣，不
可执以为辞也。一、下虚腹痛，必因虚挟寒，或阳虚中寒者乃有之，察无形迹而喜按喜暖者
是也，治宜补阴逐寒，必宜理阴煎主之。然男子则间或有之，惟女人则因虚而痛者更多。盖
女人有月经带浊之病，所以为异，亦宜理阴煎大剂主之，余用此以活人多矣。若虚中挟滞而
血有不行者，惟决津煎为最妙。诸未尽者，详妇人门。凡治心腹痛证，已经攻击涤荡，愈而
复作，或再三用之而愈作愈甚，或脉反浮弦虚大者，皆为中虚之候，此当酌其虚实而或兼治
邪气，或专补正气。若用补无碍，则当渐进，切不可杂乱妄投，以自掣其肘，但当纯用补药
，使脾胃气强，得以营运，则邪气自不能犯，又何疼痛之有？
一、火邪热郁者，皆有心腹痛证。如火在上焦，痛而兼胀者，宜于行气导滞药中倍加山
栀、黄芩之属以治之；若有痛无胀者，或宜加芍药、生地、麦冬以佐之。若火在下焦者，宜
大厘清饮，或茵陈饮之类主之。然火在上者，必有烦热、焦渴、喜冷等证，火在下者，必有
胀热、秘结、淋涩等证，务兼脉证，察其真有火邪，方可治以寒凉，如无火证火脉，则不得
妄称为火以误治也。
一、虫痛证治，详见诸虫门。
一、痰饮停滞胸膈，亦能作痛。凡胸胁膨闷，漉漉有声，或作醋酸心呕恶，或痛连胁背
者，皆其证也。宜清膈煎、二陈汤、橘皮半夏汤、《局方》四七汤，及括痰丸、润下丸之类
并皆治之。又若东垣草豆蔻丸、丹溪白螺丸，亦皆治痰之剂。若郁痰凝结，消之不去者，非
用吐法不能除也。
一、阴寒腹痛者，凡男妇有因房室之后中寒而痛极者，此阴寒也。宜先用葱、姜捣烂炒
热，或热砖之属熨其脐腹，以解其寒极凝滞之气，然后用理阴煎，或理中汤、四逆汤之类加
减治之。其有痛极至危者，须速灸神阙、气海等穴。
一、凡胸腹之痛，有无关于内，而在筋骨、皮肉之间者，此邪之在经，不可混作里证。
必须详问的确，但当分其或火，或寒，或气，或劳伤，或血滞，或血虚，或有淫疮邪毒留蓄
在经，辨其所因，庶不致谬，而治之亦易也。
一、大人小儿，或素因口腹不节，致伤脾胃，以后或寒或食，凡有所触即为腹痛，屡发
不已，或为胀满、食减等证者，惟芍药枳术丸为最妙，宜加减用之。
一、凡胸膈大痛，连及胁背，药不能纳，到口即吐者，此则无论诸药，皆可发吐，因就
其势探而吐之，则最易最捷，吐出邪滞积痰，痛可立止。若邪犹未尽，痛犹未止，则再以前
药与之，务尽其邪，无不愈者。
凡是各种疾病的虚实，通过脉象来辨别通常都比较容易，唯独心腹痛这一类病证，病情有轻有重，其脉象往往难以分辨。虽然滑实有力的脉象，大多属于实证邪气；虚弱无神的脉象，大多属于虚证邪气，这是常理。然而，突发剧烈疼痛时，脉象常常表现为沉伏、细涩，最像极虚的征候。如果不了解这是因为气机被邪气逆乱阻滞，导致脉道运行不畅而出现异常的沉伏，就会误判。这实际上是邪气实盛的脉象，但在沉伏之中仔细诊察，必定能感觉到梗梗然弦紧的意蕴，这多是寒邪阻遏阳气所致，很多此类情况都会出现这种脉象；如果是火邪引起的疼痛，则不是这样。凡是见到这种情况，不能因为脉象极其细微微弱就认为是虚脱，从而妄用补药，那一定会造成大错。辨别此法的关键，在于观察患者的形体气质，以了解平素体质的强弱；询问病因，以知晓是新病还是久病，以及是由什么原因引发的。大体上，突发急痛而脉象忽然变细伏的多为实邪；久病缓痛而脉象本来微弱的多为虚邪。再结合前面论述的辨别虚实的方法进行斟酌，以医理参合诊断，就不会有失误了。
凡是心腹痛证，必须先辨别寒热。如果没有热证和热脉，就确定不是火邪，不得妄用凉药。
凡是治疗心腹痛证，古人说：“痛随利减”，又说：“通则不痛”，这是针对闭结坚实的情况而言的。如果腹部没有坚满，疼痛没有结聚，那么这种说法就不适用了。那些因为虚损而作痛的，这种说法就更像是冰炭不相容了。
一、凡是疼痛在上焦的，如果是由于停滞引起，既痛又胀，不易行散，且疼痛剧烈难以忍受，想要迅速去除积滞见效，没有比催吐法更好的了，应该从新方吐法中选择使用。如果没有停积胀急，而是因为寒或气，轻微凝滞而作痛的，只要顺调气机，没有不痊愈的。
一、胃脘痛证，多由饮食、受寒、气机不顺引起，然而因食或因寒，也都与气有关，因为食物停滞则气机阻滞，寒气停留则气机凝结。所以治疗疼痛的要领，只要查明确实属实邪，都应当以调理气机为主，适宜用排气饮加减主治；若是食滞，兼用消导法；若是寒滞，兼用温中法；如果只是因气逆，只需调理气机，病自然痊愈。如果有诸药无效，气结难解的，只有神香散最为奇妙。如果气机有滞逆，随触动随即发作的，适宜用后面提供的两个简易方剂最为巧妙。
一、下焦小腹痛，可能是寒、热、食、虫、血、气逆等原因引起的，都有可能出现。凡是闭结的，通过通利或攻下治疗，应当分别求其病因类别进行治疗。
一、寒滞引起的疼痛，有因内寒的，如吃冷食冷饮之类，必然兼有寒和食，根据适宜情况治疗，如上法即可。有因外寒的，或是触犯不时之寒邪，或是冒犯客令之寒气，或是遭受豪雨沙尘之气中的阴毒，以致心腹搅痛，或者呕吐或者腹泻，或者上不能吐下不能泻，形成干霍乱等危重证候，总归是寒气侵犯脏腑，或在在上焦，或在中下二焦。凡是疼痛紧急在上部的，用吐法最妙；在中间在下部的，都适宜解寒行滞，以排气饮为主加减治疗，或者不换金正气散，或者和胃饮、平胃散、十香丸之类，都可以选择使用。其中有寒逆严重的，适宜用四逆汤、理中汤之类主治。另外神香散可以解除三焦的滞塞，应当随证作为引经药送服。
一、血积导致的腹痛，就是蓄血证，而血证所属的有四类。一是伤寒有蓄血证。成无己说：“邪气聚集在下焦，则津液不得通畅，血气不得运行，或小便不利或便血，留滞于下，产生胀满和硬痛。”如果从心下直到小腹硬满而痛，小便通利的，就是蓄血证，这应当分开治疗。其他证治的详细含义，并见伤寒门。二是妇女有血痛证，详见妇人门。三是跌打损伤有瘀血腹痛证，只要去除瘀血疼痛自然痊愈。凡是气血平和的，适宜用通瘀煎加减治疗。如果有血滞大便干结，邪实不通的，适宜用桃仁承气汤、百顺丸主治；或者是血虚燥结，便秘不通的，适宜用玉烛散主治。四是食郁日久，而胃脘有瘀血作痛的，用生韭饮。
一、气血虚寒，不能营养心脾的，最多见心腹痛证，但一定是因为积劳积损及忧思不遂的人，才会有此病；或者心、脾、肝、肾气血本虚而偶然遭受劳伤，或者偶然遭受寒气及饮食不调的，也有此证。凡是虚痛的证候，大多连绵不止，而且没有急暴之势，或者按压、揉搓、温热、熨烫后疼痛必稍缓解，在心脾胸胁之间的，或者感到忧愁，或者感到心慌，或者似嘈杂非嘈杂，或者饥饿劳累时更严重，或者进食后稍好，或者懊恼无迹，无法名状，或者面色青黄，或者脉微气弱，这些都是虚寒的证候，这不是甘温养血、补胃和中不可治愈的，适宜用大小营煎、理阴煎之类加减主治。如果气虚的，必须大量加入人参；阳衰的，必须佐以桂枝、附子、干姜。丹溪说：“各种疼痛不可补气。”这仅适用于邪实气滞者应当避开补气，如果说所有疼痛都是如此那就错了，不可固执地以此为借口。
一、下虚腹痛，必定是因为虚挟寒，或者阳虚中寒才会有的，观察没有有形积滞而喜欢按揉喜欢温暖的，就是这种情况，治疗适宜补阴逐寒，必须适宜用理阴煎主治。然而男子间或有此情况，只有女人因为虚而痛的更多。大概女人有月经带浊的病，所以有所不同，也适宜用理阴煎大剂量主治，我使用这个方子救活了很多病人。如果虚中挟滞而血行不畅的，只有决津煎最为奇妙。其余未尽的内容，详见妇人门。凡是治疗心腹痛证，已经经过攻击涤荡，好了又复发，或者再三使用后好了又发作且越来越严重，或者脉象反而浮弦虚大的，都是中气虚弱的征候，这应当斟酌虚实而或者兼治邪气，或者专补正气。如果用补药没有妨碍，则应当渐进，切不可杂乱妄投，以免自相掣肘，只应当纯用补药，使脾胃气强，得以营运，那么邪气自然不能侵犯，又有什么疼痛呢？
一、火邪热郁的，都有心腹痛证。如火在上焦，痛而兼胀的，适宜在行气导滞药中加倍加入山栀、黄芩之类的来治疗；如果有痛无胀的，或者适宜加芍药、生地、麦冬来辅助治疗。如果火在下焦的，适宜用大厘清饮，或者茵陈饮之类主治。然而火在上者的，必有烦热、焦渴、喜冷等证，火在下者的，必有胀热、秘结、淋涩等证，务必兼看脉证，查明确实真有火邪，才可以治疗以寒凉药，如果没有火证火脉，就不得妄称为火而误治。
一、虫痛证治，详见诸虫门。
一、痰饮停滞胸膈，也能引起疼痛。凡是胸胁膨闷，漉漉有声，或者作酸醋心呕恶，或者疼痛牵连胁背的，都是它的证候。适宜用清膈煎、二陈汤、橘皮半夏汤、《局方》四七汤，以及括痰丸、润下丸之类共同治疗。另外如果东垣草豆蔻丸、丹溪白螺丸，也都是治痰的方剂。如果是郁痰凝结，消之不去的，不用吐法不能除去。
一、阴寒腹痛，凡男女有因房事之后中寒而疼痛剧烈的，这是阴寒。适宜先用葱、姜捣烂炒热，或者用热砖之类熨烫其脐腹，以解除其寒极凝滞之气，然后用理阴煎，或者理中汤、四逆汤之类加减治疗。其中有疼痛剧烈至危重的，须速灸神阙、气海等穴位。
一、凡是胸腹之痛，有无关于内脏，而在筋骨、皮肉之间的，这是邪气在经络，不可混同作里证处理。必须详细询问确切，但应当分辨是火、是寒、是气、是劳伤、是血滞、是血虚，或者有淫疮邪毒留蓄在经络，辨别其原因，才不至于谬误，而治疗也容易了。
一、大人小儿，或者平素因为口腹不节制，导致损伤脾胃，以后或者遇寒或者遇食，凡有所触动即为腹痛，屡次发作不已，或者为胀满、食减等证候的，只有芍药枳术丸最为奇妙，适宜加减使用。
一、凡是胸膈大痛，连及胁背，药物不能吞咽，到口即吐的，这无论什么药，都可以发吐，因此顺着势头探喉催吐，则最容易最快捷，吐出邪滞积痰，疼痛可立即停止。如果邪气未尽，疼痛仍未停止，则再用前面的药给予患者，务求尽除邪气，没有不痊愈的。
In general, distinguishing the deficiency and excess of various diseases through pulse diagnosis is relatively easy. However, for heart and abdominal pain syndromes, where conditions vary greatly in severity, the pulses are often difficult to differentiate. Although a slippery and forceful pulse usually indicates excess pathogenic factors (Shi Xie), and a weak and spiritless pulse usually indicates deficiency pathogenic factors (Xu Xie), this is merely the norm. Nevertheless, in cases of sudden, severe pain, the pulse often appears deep, hidden, fine, or choppy, closely resembling an extreme deficiency pattern. If one does not understand that this is due to Qi being reversed by pathogens, causing obstruction in the pulse channels leading to an abnormal deep and hidden state, it may be misjudged. This is actually a pulse of excess pathogenic factors; however, careful examination within the deep and hidden quality will reveal a stiff, string-taut, and tight sensation, indicating that cold pathogens are obstructing Yang Qi. Such pulses are common in these cases. In contrast, pain caused by fire pathogens presents differently. When encountering such pulses, one must not mistakenly diagnose them as deficiency collapse simply because they are extremely fine or minute, nor should one recklessly administer tonifying agents, as this would lead to significant errors. The method for differentiation lies in observing the patient's physical constitution to assess their usual strength, and inquiring about the etiology to determine whether the illness is new or chronic, and what triggered it. Generally, sudden acute pain with a suddenly fine or hidden pulse suggests excess pathogens, while chronic mild pain with a naturally weak pulse suggests deficiency pathogens. By applying the previously discussed methods for distinguishing deficiency and excess, and integrating medical principles into the diagnosis, one can ensure accuracy without error.
For all heart and abdominal pain syndromes, one must first distinguish between cold and heat. If there are no heat signs or heat pulses, it is definitely not caused by fire pathogens, and cooling medicines should not be used recklessly.
Regarding the treatment of heart and abdominal pain, ancient texts state: "Pain decreases with unblocking" (Tong Sui Li Jian) and "When there is free flow, there is no pain" (Tong Ze Bu Tong). These statements apply specifically to cases of closure, constipation, and solidity. If the abdomen is not firm and full, and the pain lacks accumulation or clustering, this principle cannot be applied. For pain caused by deficiency, this saying is as contradictory as ice and charcoal.
1. For pain located in the Upper Jiao (Upper Burner), if it is due to stagnation, accompanied by distension, difficult to disperse, and so severe that it is unbearable, the most effective method to quickly eliminate stagnation is emesis (Tu Fa). One should select from the emetic methods in the New Formulas. If there is no accumulation or urgent distension, but rather mild stagnation due to cold or Qi rebellion causing pain, simply regulating the Qi will lead to recovery.
2. Gastric pain syndromes are often caused by food retention, cold exposure, or disharmonious Qi. However, both food retention and cold affect Qi, as food stagnation leads to Qi blockage, and cold retention leads to Qi coagulation. Therefore, the key to treating pain is to determine if it is truly excess; if so, the primary approach should be regulating Qi, using Paqi Yin (Qi-Regulating Decoction) with modifications. For food stagnation, add digestive methods; for cold stagnation, add warming methods. If the pain is solely due to Qi rebellion, regulating the Qi alone will cure the disease. For cases unresponsive to other medicines where Qi knotting is difficult to resolve, Shenxiang San (Aromatic Powder) is excellent. For Qi stagnation and rebellion that flare up upon any trigger, the two simple formulas provided later are best.
3. Lower abdominal pain in the Lower Jiao (Lower Burner) can be caused by cold, heat, food, parasites, blood stasis, or Qi rebellion. For cases involving closure or constipation, purgation or downward-draining methods should be used, seeking the specific category of the cause for treatment.
4. Pain due to cold stagnation may arise from internal cold, such as consuming cold foods or drinks, which involves both cold and food; treat according to suitability as described above. It may also arise from external cold, such as exposure to untimely cold pathogens, invading cold air, or yin toxicity from heavy rain and sand dust, leading to churning pain in the heart and abdomen, vomiting or diarrhea, or inability to vomit or defecate, resulting in critical conditions like Dry Huoluan (Gastrointestinal Turmoil). This is generally due to cold pathogens invading the Zang organs, affecting the Upper Jiao or the Middle and Lower Jiao. For urgent pain in the upper part, emesis is best. For pain in the middle or lower parts, resolving cold and promoting stagnation resolution is appropriate, primarily using Paqi Yin with modifications. Alternatives include Buhuanjin Zhengqi San (Huanjin Zhengqi Powder), Hewei Yin (Stomach-Harmonizing Decoction), Pingwei San (Stomach-Pacifying Powder), or Shixiang Wan (Ten-Aromatic Pill). For severe cold rebellion, Sini Tang (Frigid Extremities Decoction) or Lizhong Tang (Center-Warming Decoction) are indicated. Additionally, Shenxiang San can resolve stagnation in the Three Jiao and should be used as a guiding agent according to the syndrome.
5. Abdominal pain caused by blood accumulation is known as Blood Accumulation Syndrome (Xue Ji Zheng). There are four categories of blood-related pain:
First, Blood Accumulation in Cold Damage (Shanghan). Cheng Wuji stated: "When pathogens gather in the Lower Jiao, body fluids cannot circulate freely, and Qi and blood cannot move, leading to retention below, causing distension, fullness, hardness, and pain." If there is hardness, fullness, and pain from the epigastrium down to the lower abdomen, with free urination, it is a Blood Accumulation syndrome, requiring differentiated treatment. Details are found in the Cold Damage section.
Second, Blood Pain in women, detailed in the Women's Diseases section.
Third, Abdominal pain from blood stasis due to trauma. Removing the stasis cures the pain. For those with harmonious Qi and blood, Tongyu Jian (Blood-Unblocking Decoction) with modifications is suitable. For blood stagnation with constipation and excess pathogens blocking flow, Taoren Chengqi Tang (Peach Kernel and Rhubarb Decoction) or Baishun Wan (Baishun Pill) are indicated. For blood deficiency with dry constipation and blockage, Yuzhu San (Jade Candle Powder) is indicated.
Fourth, for long-standing food depression leading to blood stasis pain in the epigastrium, Shengjiu Yin (Raw Leek Decoction) is used.
6. Heart and abdominal pain is most common when Qi and blood are deficient and cold, failing to nourish the Heart and Spleen. This typically occurs in individuals with accumulated fatigue, damage, and unresolved sorrow or worry. It may also occur in those with inherent deficiency of Qi and blood in the Heart, Spleen, Liver, and Kidney who suffer accidental labor injury, cold exposure, or dietary irregularity. Deficiency pain tends to be continuous without sudden intensity. It often alleviates with pressure, rubbing, warming, or moxibustion. Pain in the Heart, Spleen, chest, and hypochondrium may feel like lingering sorrow, palpitations, a sensation similar to but distinct from acid regurgitation, worsening with hunger or fatigue, or improving slightly after eating. It may be indescribable, accompanied by bluish-yellow complexion, fine pulse, and weak Qi. These are deficiency-cold patterns, requiring sweet-warm herbs to nourish blood, tonify the Stomach, and harmonize the interior. Xiaoying Jian (Minor Ying Decoction) or Daying Jian (Major Ying Decoction), and Liyin Jian (Nourishing Yin Decoction) with modifications are suitable. For Qi deficiency, add large doses of Renshen (Ginseng Root); for Yang decline, add Guizhi (Cinnamon Twig), Fuzi (Aconite Root), and Ganjiang (Dried Ginger). Danxi stated: "Pain should not be treated with Qi-tonifying herbs." This applies only to cases of excess pathogens and Qi stagnation; claiming it applies to all pain is erroneous and should not be rigidly adhered to.
7. Lower deficiency abdominal pain is caused by deficiency combined with cold, or Yang deficiency with middle cold. It presents without tangible masses and is relieved by pressure and warmth. Treatment requires nourishing Yin and dispelling cold, primarily using Liyin Jian (Nourishing Yin Decoction). This is less common in men but frequent in women due to menstrual disorders and leukorrhea. Large doses of Liyin Jian are suitable. I have saved many lives with this formula. For deficiency with stagnation and blood non-flow, Juejin Jian (Decoction for Opening the Vessels) is best. Further details are in the Women's Diseases section.
For heart and abdominal pain syndromes that recur after aggressive cleansing treatments, or worsen with repeated use, or present with floating, string-taut, deficient, or large pulses, these indicate Middle Qi deficiency. One must balance treating pathogens and tonifying healthy Qi. If tonification is safe, proceed gradually. Do not mix remedies indiscriminately, which hinders progress. Purely tonifying herbs strengthen Spleen and Stomach Qi, enabling proper circulation, preventing pathogen invasion, and eliminating pain.
8. Fire pathogens and heat depression cause heart and abdominal pain. For fire in the Upper Jiao with pain and distension, add large doses of Zhizi (Gardenia Fruit) and Huangqin (Scutellaria Root) to Qi-regulating and stagnation-resolving herbs. For pain without distension, add Shaoyao (Peony Root), Shengdi (Rehmannia Root), and Maidong (Ophiopogon Tuber) as assistants. For fire in the Lower Jiao, Dali Qing Yin (Great Clearing Decoction) or Yinchin Yin (Artemisia Decoction) are indicated. Fire in the upper part presents with irritability, heat, thirst, and preference for cold. Fire in the lower part presents with distending heat, constipation, and dysuria. One must examine both pulse and symptoms to confirm true fire before using cold-cooling herbs. Without fire signs or pulses, do not diagnose fire to avoid mismanagement.
9. Parasitic pain treatment is detailed in the Parasites section.
10. Phlegm-fluid retention in the chest and diaphragm can cause pain. Symptoms include chest and hypochondriac distension and stuffiness, gurgling sounds, sour taste with heartburn and nausea, or pain radiating to the back. Treat with Qingge Jian (Clear Diaphragm Decoction), Erchen Tang (Two-Aged Decoction), Jupi Banxia Tang (Tangerine Peel and Pinellia Decoction), Siqi Tang (Four-Seven Decoction) from the Bureau Formula, Kuotan Wan (Phlegm-Coagulating Pill), or Runxia Wan (Moistening Downward-Decreasing Pill). Dongyuan's Caodoukou Wan (Cardamom Pill) and Danxi's Bailuo Wan (White Snail Pill) are also phlegm-resolving agents. For condensed depressive phlegm that cannot be resolved by other means, emesis is necessary.
11. Yin-cold abdominal pain occurs in men and women who experience severe pain after sexual intercourse followed by cold exposure. This is Yin-cold. Initially, apply hot compresses of crushed green onion and ginger fried hot, or hot bricks, to the umbilicus and abdomen to resolve extreme cold stagnation. Then treat with Liyin Jian (Nourishing Yin Decoction), Lizhong Tang (Center-Warming Decoction), or Sini Tang (Frigid Extremities Decoction) with modifications. For critical pain, urgently moxa Shenque (CV-8) and Qihai (CV-6).
12. Chest and abdominal pain unrelated to internal organs but located in tendons, bones, skin, and flesh indicates pathogens in the meridians. Do not confuse this with interior syndromes. Carefully inquire to distinguish whether it is fire, cold, Qi, labor injury, blood stasis, blood deficiency, or toxic pathogens from sores retained in the meridians. Identifying the cause prevents error and facilitates treatment.
13. Adults and children with chronic spleen and stomach damage due to dietary indiscretion may experience recurrent abdominal pain triggered by cold or food, accompanied by distension or reduced appetite. Shaoyao Zhizhu Wan (Peony and Atractylodes Pill) is best, used with modifications.
14. Severe chest and diaphragmatic pain radiating to the hypochondrium and back, where medication cannot be swallowed and is immediately vomited, requires emesis regardless of the specific medicine. Induce vomiting along the natural trend to expel pathogens, stagnation, and accumulated phlegm, stopping pain immediately. If pathogens remain and pain persists, repeat the previous prescription until pathogens are fully eliminated, ensuring recovery.