胸痹、心痛，其病如二而一，均是为膈间疼痛之称。胸痹轻者仅胸中气塞，心痛重者为真心痛。如胃
脘痛，其痛紧而下，不比胸痛之泛与真心之高。盖上焦诸痛大约如是，今
合而为篇，读者须分别而看，亦须互意相通耳。
脉候 短而数，心痛心烦。寸口沉，胸中痛引背（一云短气）。关上沉，心痛，上吞酸。寸口伏，
胸中有逆气。寸口滑，胸满逆。（《脉经》）
沉弦细动，皆气痛证。心痛在寸，腹痛在关，下部在尺，脉象显然。（《崔氏脉诀》）
左手脉数热多，脉涩有死血。右手脉紧实痰积，弦大必是久病。（《丹溪》）
诸痛若脉见细迟，是气减舒徐、厥邪衰退之象，理应从吉。设或大浮，知邪方盛，况心腹里证而得表脉，
更非所宜，虽不至于殒躯，亦难愈也。（《续焰》）
凡心痛，脉沉而迟者易治，坚大而实、浮大而长滑数者难治。（《医通》）
大凡痛甚者脉必伏，且有厥冷昏闷、自汗寒热之证，切
不可疑为虚寒，即投温补，宜究病因而施治，方为无失。（《汇补》）（按∶此本丹溪说，见后。）
源候总说 心痛者，风冷邪气乘于心也。其痛发，有死者，有不死者，有久成疹者。心为诸脏主而
藏神，其正经不可伤，伤之而痛，为真心痛，朝发夕死，夕发朝死。心有支别之络脉，其为风冷（按∶《久心
痛候》曰风冷邪热）所乘，不伤于正经者，亦令心痛，则乍间乍甚，故成疹不死。又心为火，与诸阳会合，而
手少阴心经也。若诸阳气虚，少阴之经气逆，谓之阳虚阴厥，亦令心痛，其痛引喉是也。（《病源论》）
心痛诸候，皆由邪气客于手心主之脉。盖手少阴心之经，五脏六腑君主之官也，精神所舍，诸阳所合，
其脏坚固，邪气未易以伤。是以诸邪在心，多在包络者，心主之脉也。
其候不一，有寒气卒客于脏腑，发卒痛者；有阳虚阴厥，痛
引喉者；有心背相引，善 伛偻者；有腹胀归于心而痛甚者，有急痛如针锥所刺者；有其色苍苍，终日不得
太息者；有卧则从心间痛，动作愈甚者；有发作种聚，往来上下，痛有休止者。或因于饮食，或从于外风，中
脏既虚，邪气客之，痞而不散，宜通而塞，故为痛也。若夫真心不痛，痛即实气相搏，手足厥冷，非治疗之所
及，不可不辨也。（《圣济》）
夫心为五官之主，百骸之所以听命者也。心之正经，果为风冷邪气所干，果为气血痰水所犯，则其痛掣
背胀胁，胸烦咽干，两目赤黄，手足俱青至节，朝发而暮殂矣。然心之包络，与胃口相应，往往脾痛连心，
或阳虚阴厥，亦令心下急痛。或他脏之邪，亦有客乘于心者，是则心之别脉受焉，如所谓九种心痛皆是也。（《直指》）
心痛膈痛胃脘痛之别 膈痛与心痛不同。心痛则在岐骨陷处，本非心痛，乃心支别络痛耳。膈痛则
痛横满胸间，比之心痛为轻，痛之得名，俗为之称耳。（《要诀》）
其与胃脘痛别者，胃脘在心之下，胸痛在心之上也。（《必读》）
如胃脘当心而痛，气欲绝者，胃中虚之至极，俗呼为心痛。（《试效》）
《内经》曰∶木郁之发，民病胃脘当心而痛，上支两胁，膈噎不通，食饮不下。（按∶此《六元正纪
大论》文，又《至真要大论》两见。）胃之上口，名曰贲门，贲门与心相连，故经所谓胃脘当心而痛。今
俗呼为心痛者，未达此义耳云云。致病之由，多因纵恣口腹，喜好辛酸，恣饮热酒煎爆，复餐寒凉生冷，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，故胃脘疼
痛，吞酸嗳气，嘈杂恶心，皆膈噎反胃之渐者也。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。古方九种心痛，所谓冷者唯一耳，岂可例
以热药治之乎。详其所由，皆在胃脘，而实不在于心也。（《正传》）。
或问∶丹溪言心痛即胃脘痛然乎？曰∶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，岂胃脘痛即心痛者哉。历代方论，将二者混同叙于一门，误自此始。盖心之藏君火也，是神灵之舍，与
手少阴之正经，邪皆不得而伤。其受伤者，乃手心主包络也。如包络引邪入于心之正经脏而痛者，则谓之真心
痛，必死不可治。夫心统性情，始由怵惕思虑则伤神，神伤脏乃应而心虚矣，心虚则邪干之，故手心主包络受其
邪而痛也。心主诸阳，又主血。是以因邪而阳气郁伏，过于热者痛；阳气不及，惟邪胜之者亦痛。血因邪泣在
络而不行者痛，血因邪胜而虚者亦痛。然方论虽有九种心痛，终不得圣人之旨，岂复识六淫五邪不一之因哉云
云。胃脘痛，亦如心痛有不一之因。盖胃之真，湿土也，位居中焦，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。是以足之六经自下而上，凡壮则气行而已，胃脘弱则着而
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，真气相搏为痛。惟肝木之相乘者尤甚，胃
脘当心而痛，上支两胁里急，饮食不下，膈咽不通。食则为食痹者，谓食已心下痛，吐出乃止。
（按∶此出《至真要大论》及次注。）又肾气上逆者次之，逆则寒厥入胃亦痛。夫如是，胃脘之受邪，非
止其自病者多，然胃脘逼近于心，移其邪上攻于心，为心痛者亦多。（《准绳》）
心痛者，非真心痛也，乃心胞络与胃脘痛也。然果何以知之？盖心胞络护捧其心，脉络相系，位
居心之四旁。火载痰而上升，碍其所居，胞络为痰相轧，故脂膜紧急而作痛，
遂误认以为心痛也。胃脘近心，位居心下而络于脾。饮食过多，不能克化，伤乎胃脘，病根常在，略伤饮食，
即闷闷作痛，亦误认以为心痛也。大抵痛而有痰，常觉恶心，呕去痰即宽者，即为之心胞络痛也。痛而作饱，时
时嗳气，直至饥而缓者，即谓之胃脘痛也。（《玉案》）
胸痹证状（心痹） 寒气客于五脏六腑，因虚而发，上冲胸间，则胸痹。胸痹之候，胸中
如满，噎塞不利，习习如痒，喉里涩，唾燥；甚者心里强痞急痛（按∶此下本《肘后》，彼作心中坚痞忽
痛），肌肉苦痹，绞急如刺，不得俯仰，胸前皮皆痛，手不能犯，胸满短气，咳唾引痛，烦闷
自汗出，或彻背膂，其脉浮而微者是也。不治，数日杀人。（《病源论》）（按∶《千金方衍义》曰∶不治之
数日杀人，极言其证之剧也。病有浅深，不可概以为限也。）
思虑烦多则损心，心虚故邪乘之，邪积而不去，则时害饮食，心里 如满，蕴蕴而痛，是谓之心痹。
诊其脉沉而弦者，心痹之候也。（同上）
虚极之人，为寒邪所客，气上奔迫，痹而不通，故为胸痹。其证云云（全取《巢氏》），是
皆闭塞而不通也。（《圣济》）
心腹痛部分 夫心胃痛及腹中诸痛，皆因劳役过甚，饮食失节，中气不足，寒邪乘虚而入客之，
故卒然而作大痛。经言得炅则止，炅者热也，以热治寒，治之正也。然腹痛有部分，脏位有高下，治之者
亦宜分之。如厥心痛者，乃寒邪客于心包络也。前人以良姜、菖蒲大辛热之味末之，酒醋调服，
其痛立止，此折之耳。真心痛者，寒邪伤其君也，手足青至节，甚则旦发夕死。胃脘痛者（原脱胃字，
今宜补），太阴也，理中、建中、草豆蔻丸之类主之。腹脐痛，少阴也，四逆汤、
姜附御寒汤之类主之。少腹痛者，厥阴也，正阳散、回阳丹、当归四逆之类主之。杂证而痛者，苦楝汤、
酒煮当归丸、丁香楝实丸之类主之。是随高下治也，更循各脏部分穴 而灸刺之。（《试效》）
凡病心腹痛者，有上中下三焦之别。上焦者，痛在膈上，此即胃脘痛也，《内经》曰胃脘当心而痛者
即此，时人以此为心痛，不知心不可痛也。中焦痛者，在中脘，脾胃间病也。下焦痛者，在脐下，肝肾大小
肠膀胱病也。凡此三者，皆有虚实寒热之不同，宜详察而治之。（《景岳》）
凡痛在心，连两胁至两乳下，牵引背饭匙骨下而痛者，实热也。凡痛在小腹，连脐左右上下 痛，手
足厥冷者，虚寒也。（《医鉴》）
寒热大实（久新） 诸心痛者，皆少阴厥气上冲也。有热厥心痛者，身热足寒，痛甚则烦躁而吐，
额自汗出，知为热也。其脉洪大，当灸太溪及昆仑，谓表里俱泻之，是谓热病汗不出，引热下行，表汗通身
而出者，愈也。灸毕服金铃子散（用金铃子、玄胡），痛止服枳术丸，去其余邪也。有大实心中痛者，因食受
时气，卒然发痛，大便或秘，久而滞闷，心胸高起，按之愈痛，不能饮食，急以煮黄丸利之（用雄黄、巴豆
），利后以 本汤（用 本、苍术）去其余邪。有寒厥心痛者，手足逆而通身冷汗出，便利溺清，或大便利而
不渴，气微力弱，急以术附汤温之。寒厥暴痛，非久病也，朝发暮死，当急救之。是知久痛无寒而暴痛非
热。（《保命集》）
心痛须辨久新。久者由冷热食物，日积月深，自郁成积，自积成痰，痰火煎熬，血亦妄行，痰血相杂
（按∶以上系凑合丹溪《正传》，丹溪说见下，《正传》文见前），此为难治。
新者一时寒热郁滞正气作痛，此为易治。（《士林余业》）
九种心痛 九种心痛∶一虫心痛，二注心痛，三风心痛，四悸心痛，五食心痛，六饮心痛，七
冷心痛，八热心痛，九去来心痛。（《千金》）
死血作痛 凡治此证，必要先问平日起居何如。假如心痛有因平日喜食热物，以致死血留于胃口
作痛，用桃仁承气汤下之，切记。轻者用韭汁、桔梗，能开提其气，血药中兼用之。（《丹溪》）
心痛，饮汤水下作哕者，有死血在中，桃仁承气汤主之。（同上）（按∶《正传》有此汤治验曰∶男子
三十五，胃脘作痛久矣，人形黄瘦，食少而胸中常若食饱。）
真心痛 有真心痛者，大寒触犯心君，又曰污血冲心。医者宜区别诸证而治之，无有
不理也。（《正传》）
或真心痛者，手足青不至节，或冷未至厥，此病未深，犹有可救，必借附子理中汤加桂心、良姜，
挽回生气可也。（《绳墨》）（按∶经文手足青，青即清字。清，寒也。诸家以为青色者，陋矣。）
平素原无心痛之疾，卒然大痛无声，面青气冷，切牙噤齿，手足如冰冷者，乃真心痛也。（《玉案》）
若暴疼，手足青黑，神昏者，不治。（《心统》）
胸胁痛浮肿 肾虚不能纳气归元，气逆而上奔，故胸膈满痛。以手摩挲，痛走背上，又从背摩挲，
则其气循胁泄于后分而痛不作矣，此气之为病固也。奈何肾虚又不能行水，故水随气奔，上乘于肺，头面两
手浮肿，气短而喘，由是血化为水，与之俱滞。况其人旧来有风，曰风、曰水、曰血、曰
气，四者合而为病，其痛非常，如沉香、木香、乌药、槟榔之类不能施其巧，治法将何如？曰∶先以
二十四味流气饮，加独活、枳壳、五灵脂、炒牵牛，入姜、蜜、乌梅同煎，咽下
养正丹二十粒、雄黄丸十粒，升降水火，引导大便。次用桑皮、紫苏、木通、阿胶、当归、桃仁、青皮、桔
梗、炒芫花、生大黄作剂，根据前煎以姜、蜜、乌梅，取尽大便黑物，即收全功。（《直指》）
类证 膈间肿痛，不能进食，但喜饮水，或咽肿，人迎盛而气口紧者，当作胃痈治之。（《医通》）
治法总说 古方用理中汤，取缓其中气则可也。然背者胸之府，或筑，或悸，或渴，或腹痛，或
寒，或腹满，其候不一，治当随宜加损也。（《圣济·胸痹》）
《千金》治寒客心痛而用大黄、黄芩，治心痛彻背而用乌头、附子之类，
治疗相反如此，要在用之随宜而已。（同上）
胸堂气隔，有肺经伏热而气隔者，有痰水在上而气隔者，大概以茯苓、半夏、枳壳、桔梗为治法。其
肺热者，如圣汤加桑白皮佐之。心下水气者，小半夏茯苓汤效。胸烦、《活人书》用山栀子。（《直指》）
真心果痛，不知能愈否乎？然则执剂之法何如？曰∶热者凉之，寒者温之，感受风邪者散之，顺气调血，
逐水豁痰，此其要略耳。（同上）
痛甚者脉必伏，用温药附子之类，不可用参、术。脉坚实，不大便者，下之。心痛用山栀并劫药止之。
若又复发，前药必不效，可用玄明粉，一服立止。胃脘有湿而痛者，宜小胃丹下之。（《丹溪》）
（小胃丹用芫花、大戟、甘遂、黄柏、大黄。）
凡膈痛，多因积冷与痰气而成，宜五膈宽中散，或四七汤加木香、桂各半钱，或挝脾汤（用麻油、良姜、
茴香、甘草）加丁香。膈痛而气上急者，宜苏子降气汤，去前胡，加
木香如数。痰涎壅盛而痛者，宜小半夏茯苓汤加枳实一钱，间进半硫丸。（《要诀》）
胸痛，木香、郁金二味，气郁痛者倍木香，血郁痛者倍郁金，为末，每服二钱，老酒下，虚者加人参。痰
饮痛，轻者小陷胸汤，重者大陷胸丸治之。若痰唾稠粘，则用控涎丹。（《医碥》）
胃脘痛∶因火者，忌补敛、燥热，宜降、苦寒，甘寒、咸寒、辛寒。因寒者，忌破气、滞腻、苦寒、宜辛
胸痹与心痛，病名虽异，实则同源，均指膈间部位的疼痛。轻度的胸痹仅表现为胸中气机阻滞，而严重的心痛则称为“真心痛”。至于胃脘痛，其疼痛部位偏下且紧束，不同于胸痛的弥漫性及真心痛的高位发作。大致而言，上焦的各种疼痛多属此类，现将它们合为一篇论述，读者需仔细分辨，同时注意各证候间的内在联系。
脉象诊断：脉短而数，主心痛伴心烦；寸口脉沉，主胸中痛牵引至背部（一说为短气）；关部脉沉，主心痛伴吞酸；寸口脉伏，主胸中有逆气；寸口脉滑，主胸满伴气逆。（出自《脉经》）
脉象沉、弦、细、动，均为气滞疼痛的征象。心痛多见于寸口脉，腹痛多见于关部脉，下部疾病多见于尺部脉，脉象表现十分明显。（出自《崔氏脉诀》）
左手脉数表示热盛，脉涩表示有瘀血；右手脉紧实表示有痰积，脉弦大必定是久病。（出自朱丹溪）
各种疼痛若脉象见细迟，这是正气虚弱、舒缓、厥邪衰退的迹象，理应预后良好。如果脉象大浮，说明邪气正盛，况且心腹里的病症却出现表脉，更是不宜，虽然不至于死亡，但也难以痊愈。（出自《续焰》）
凡是心痛，脉象沉而迟缓者容易治疗，脉象坚大坚实、浮大长滑数者难治。（出自《医学入门》）
大凡疼痛剧烈的，脉象必然伏匿，且伴有四肢厥冷、昏闷、自汗、寒热等症状，切不可误认为是虚寒证而立即投用温补药物，应当探究病因再施治，这样才不会失误。（出自《汇补》）（按：此观点本源于丹溪，见后文。）
病因总论：心痛，是由于风冷邪气侵袭心脏所致。疼痛发作时，有的致死，有的不死，有的日久形成慢性疾患。心为五脏之主，藏神，其正经不可受伤，若伤及正经而痛，称为“真心痛”，早晨发病傍晚死亡，傍晚发病早晨死亡。心有分支络脉，若被风冷（按：《诸病源候论·久心痛候》说是风冷邪热）所乘，但未伤及正经，也会引起心痛，疼痛时轻时重，因此形成慢性病而不死。另外，心属火，与诸阳会合，归属于手少阴心经。若诸阳之气虚弱，少阴经气上逆，称为“阳虚阴厥”，也会导致心痛，其特点是疼痛牵引咽喉。（出自《诸病源候论》）
心痛的各类证候，都是由邪气客居在手厥阴心包络之脉所致。因为手少阴心经是五脏六腑的君主，是精神所舍，诸阳汇聚之处，脏气坚固，邪气不易直接伤害。所以各种邪气侵犯心脏，多在包络（心包），即心主之脉。
其症状不一，有寒气突然客居脏腑，引发突发剧痛的；有阳虚阴厥，疼痛牵引咽喉的；有心背相互牵引，喜欢弯腰曲背的；有腹胀波及心脏而疼痛剧烈的；有急痛如针锥刺扎的；面色苍白，整天不能深长呼吸的；平卧时从心窝处疼痛，活动后加重的；疼痛呈阵发性，上下游走，疼痛有休止时间的。或因饮食不当，或感受外风，内脏既已虚弱，邪气客居其中，痞塞不散，该通利反而闭塞，所以发生疼痛。若是真正的“真心痛”不痛（注：此处原文逻辑似有歧义，结合上下文意指非真心痛的情况），而是实气相搏，手足厥冷，这就不是普通治疗能达到的了，必须加以辨别。（出自《圣济总录》）
心是五官的主宰，全身骨骼肢体都听命于心。心的正经，如果被风冷邪气干扰，被气血痰水侵犯，那么疼痛会牵引背部、胁肋胀满、心中烦闷、咽干、两目赤黄、手足发青直至关节，早晨发病晚上就会死亡。然而心包络与胃口相应，往往脾痛牵连心脏，或者因阳虚阴厥，也导致心下急痛。其他脏腑的邪气，也有客居侵犯心脏的，这就是心的别脉受邪，也就是所谓的“九种心痛”。（出自《医学正传》引《直指方》意）
心痛、膈痛、胃脘痛的区别：膈痛与心痛不同。心痛位于歧骨（剑突）凹陷处，本来就不是真正的心脏痛，而是心脏分支络脉的疼痛。膈痛则是疼痛横贯胸间，比心痛轻，之所以得名，只是世俗的习惯称呼罢了。（出自《医家四要》）
它与胃脘痛的区别在于，胃脘位于心之下，胸痛位于心之上。（出自《景岳全书》引《必读》意）
如果胃脘当心而痛，气欲绝者，是胃中虚损到了极点，世俗称之为心痛。（出自《医学发明》）
《黄帝内经》说：木气郁结发作时，百姓易患胃脘当心而痛，向上支撑两胁，膈噎不通，饮食不下。（按：此语出自《素问·六元正纪大论》，又在《素问·至真要大论》中出现两次。）胃的上口，名叫贲门，贲门与心相连，所以经文说胃脘当心而痛。现在世俗称之为心痛的人，是不明白这个道理罢了。致病的缘由，多因放纵口腹，喜好辛辣酸味，恣意饮用热酒、煎炸食物，又进食寒凉生冷，早晨受伤晚上损害，日积月累，自行郁结成积，由积成痰，痰火煎熬，血液妄行，痰血混杂，妨碍气机升降，所以导致胃脘疼痛、吞酸嗳气、嘈杂恶心，这都是膈噎、反胃的前兆。庸医不究其根源，一律用辛香燥热的药物治疗，以火助火，遂成危重局面，实在令人痛心。古方所说的九种心痛，所谓因冷引起的只有一种，怎么能一概用热药治疗呢？详细考察其成因，都在胃脘，而实际上并不在于心。（出自《医学正传》）
有人问：丹溪说心痛就是胃脘痛，是这样吗？回答说：心和胃各是一脏，病情表现不同。因为胃脘痛的位置在心下，所以有“当心而痛”的名称，难道胃脘痛就是心痛吗？历代方书，将二者混同叙述在一门中，错误从此开始。大概心藏君火，是神灵之舍，与手少阴正经，邪气都不能直接伤害。受到伤害的，乃是手厥阴心包络。如果包络引邪进入心的正经脏而痛，就称为“真心痛”，必死不可治。心统摄情志，起初由惊恐思虑损伤心神，神伤则脏气相应而心虚，心虚则邪气干犯，所以手厥阴心包络受邪而痛。心主诸阳，又主血。因此因邪气导致阳气郁伏，过于热盛的会痛；阳气不足，只有邪气胜的也会痛。血液因邪气凝滞在络脉而不流通的会痛，血液因邪气胜而虚弱的也会痛。然而方书中虽有九种心痛的说法，终究没有领会圣人的旨意，哪里还能认识六淫五邪不一的病因呢？胃脘痛，也像心痛一样有多种成因。胃的本质是湿土，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由此受纳。所以足三阳经自下而上，强壮时气机运行通畅，胃脘虚弱时邪气留着而成病，其冲和之气变为偏寒或偏热，因此导致水谷不消化，停留为水饮食积，真气与邪气相搏而痛。其中肝木相乘最为严重，导致胃脘当心而痛，向上支撑两胁，里急，饮食不下，膈咽不通。进食后成为“食痹”，谓进食后心下痛，吐出才停止。（按：此语出自《素问·至真要大论》及其注释。）其次是肾气上逆，逆则寒厥入胃也会痛。像这样，胃脘受邪，不仅仅是自身生病的多，然而胃脘逼近心脏，移其邪气上攻于心，成为心痛的也很多。（出自《医学纲目》）
心痛，并非真心痛，乃是心包络痛与胃脘痛。然而怎么知道呢？大概心包络护卫着心，脉络相连，位居心的四周。火载痰上升，阻碍其居所，包络被痰挤压，所以脂膜紧急而作痛，于是误认为心痛。胃脘靠近心，位居心下并与脾相连。饮食过多，不能消化，损伤胃脘，病根常在，稍微饮食不慎，就闷闷作痛，也误认为心痛。大抵疼痛伴有痰，常觉恶心，呕出痰后即缓解的，就是心包络痛。疼痛伴有饱胀感，时时嗳气，直到饥饿时才缓解的，就称为胃脘痛。（出自《玉机微义》）
胸痹的症状（心痹）：寒气客居于五脏六腑，因正气虚弱而发作，向上冲至胸间，则形成胸痹。胸痹的症状，胸中感觉胀满，噎塞不利，皮肤习习如痒，喉咙干燥涩滞，唾沫干燥；严重的感到心里强直痞塞急痛（按：以下本于《肘后备急方》，彼处写作心中坚痞忽痛），肌肉苦于痹阻，绞痛如刺，不能俯仰，胸前皮肤皆痛，手不能触碰，胸满短气，咳嗽吐唾牵引疼痛，烦闷自汗出，或者疼痛彻及背部脊柱，其脉浮而微，就是这种情况。若不治疗，数日内可致死。（出自《诸病源候论》）（按：《千金方衍义》说：不治之数日杀人，极言其证候之剧烈。病有浅深，不可一概以此期限衡量。）
思虑烦多则损伤心，心虚故邪气乘之，邪气积聚不去，则时常影响饮食，心里胀满，隐隐作痛，这称为心痹。诊察其脉沉而弦的，是心痹的征候。（同上）
极度虚弱之人，被寒邪客居，气向上奔迫，痹阻不通，所以为胸痹。其症状如上所述（全取《巢氏病源》内容），这些都是闭塞不通的表现。（出自《圣济总录》）
心腹痛的部位区分：心胃痛及腹中各种疼痛，都是因为劳役过度，饮食失节，中气不足，寒邪乘虚而入客居，所以突然发作大痛。经文说得热则痛止，“炅”就是热的意思，用热治寒，是正确的治法。然而腹痛有部位之分，脏腑位置有高下，治疗者也应当区分。如厥心痛，是寒邪客于心包络。前人用良姜、石菖蒲等大辛大热的药研末，酒醋调服，疼痛立刻停止，这是折服邪气的方法。真心痛，是寒邪伤了心君，手足发青至关节，严重时早晨发病晚上死亡。胃脘痛（原脱“胃”字，今应补上），属于太阴经，用理中汤、建中汤、草豆蔻丸等主治。腹脐痛，属于少阴经，用四逆汤、姜附御寒汤等主治。小腹痛，属于厥阴经，用正阳散、回阳丹、当归四逆汤等主治。杂证疼痛，用苦楝汤、酒煮当归丸、丁香楝实丸等主治。这是根据病位高下来治疗，再顺着各脏腑部分的穴位进行灸刺。（出自《医学发明》）
凡是患心腹痛的，有上、中、下三焦的区别。上焦，疼痛在膈以上，这就是胃脘痛，《内经》说胃脘当心而痛就是指此，当时人把它当作心痛，不知道心本身是不会痛的。中焦痛，在中脘，是脾胃之间的病。下焦痛，在脐下，是肝肾大小肠膀胱的病。这三种情况，都有虚实寒热的不同，应当详细察辨后治疗。（出自《景岳全书》）
凡是疼痛在心，连及两胁至两乳下，牵引后背肩胛骨下而痛的，属实热。凡是疼痛在小腹，连及脐部左右上下痛，手足厥冷的，属虚寒。（出自《医宗金鉴》）
寒热大实（新久）：各种心痛，都是少阴经厥气上冲所致。有热厥心痛的，身体发热脚冷，痛甚则烦躁呕吐，额头自汗出，可知是热证。其脉洪大，应当灸太溪穴和昆仑穴，谓之表里双泻，这是热病汗不出，引导热邪下行，使全身出汗而愈。灸完后服用金铃子散（用金铃子、玄胡索），痛止后服用枳术丸，以去除其余邪。有大实心中痛的，因饮食感受时气，突然发作疼痛，大便或秘结，久而滞闷，心胸高处隆起，按压更痛，不能饮食，急用煮黄丸通利（用雄黄、巴豆），通便后用藁本汤（用藁本、苍术）去除其余邪。有寒厥心痛的，手足逆冷且全身冷汗出，二便清利，或大便通利但不渴，气微力弱，急用术附汤温之。寒厥暴痛，不是久病，早晨发病晚上死亡，应当急救。由此可知久痛无寒而暴痛非热。（出自《兰室秘藏》）
心痛须辨别新久。久病是由冷热食物，日积月累，自行郁结成积，由积成痰，痰火煎熬，血液妄行，痰血混杂（按：以上系凑合丹溪《医学正传》，丹溪观点见下文，《正传》原文见前），这属于难治。新病是一时寒热郁滞正气作痛，这属于易治。（出自《士林余业》）
九种心痛：一虫心痛，二注心痛，三风心痛，四悸心痛，五食心痛，六饮心痛，七冷心痛，八热心痛，九去来心痛（往来不定）。（出自《备急千金要方》）
死血作痛：凡是治疗此证，必须先询问平日起居如何。假如心痛是因为平日喜食热物，导致死血留于胃口作痛，用桃仁承气汤攻下，切记。轻的用韭汁、桔梗，能开提其气，在血药中兼用。（出自朱丹溪）
心痛，喝汤水时打嗝的，是有死血在中，用桃仁承气汤主治。（同上）（按：《医学正传》有此汤治验记载：男子三十五岁，胃脘痛已久，形体黄瘦，食少而胸中常感觉像吃饱了一样。）
真心痛：有真心痛，是大寒触犯心君，又称污血冲心。医生应当区别各种证候而治疗，没有不治好的。（出自《医学正传》）
如果是真心痛，手足发青不到关节，或者冷未到厥逆程度，此病未深，还有可救的希望，必须借助理中汤加桂心、良姜，挽回生气才可以。（出自《医宗绳墨》）（按：经文中“手足青”，青即清字。清，寒也。各家认为是青色，是浅陋的看法。）
平素原本无心痛疾病，突然大痛无声，面青气冷，咬牙闭口，手足如冰冷者，乃是真心痛。（出自《玉机微义》）
如果暴疼，手足青黑，神志昏迷的，不治。（出自《证治准绳》引《心统》意）
胸胁痛浮肿：肾虚不能纳气归元，气逆而上奔，所以胸膈满痛。用手抚摸，疼痛走窜到背上，又从背部抚摸，则气循胁部泄于后方而疼痛不再发作，这是气之为病的确切表现。无奈肾虚又不能行水，所以水随气奔，上乘于肺，头面两手浮肿，气短而喘，由此血化为水，与之俱滞。何况其人旧来有风疾，曰风、曰水、曰血、曰气，四者合而为病，其痛非常，像沉香、木香、乌药、槟榔之类不能施展巧妙，治法将如何？回答说：先用二十四味流气饮，加独活、枳壳、五灵脂、炒牵牛子，入姜、蜜、乌梅同煎，咽下养正丹二十粒、雄黄丸十粒，升降水火，引导大便排出。次用桑白皮、紫苏、木通、阿胶、当归、桃仁、青皮、桔梗、炒芫花、生大黄作剂，根据前面方法煎服，加入姜、蜜、乌梅，取尽大便黑物，即可收全功。（出自《济生拔萃》引《直指方》意）
类证：膈间肿痛，不能进食，但喜饮水，或咽肿，人迎脉盛而气口脉紧的，应当当作胃痈治疗。（出自《医学入门》）
治法总论：古方用理中汤，取其缓和其中气即可。然而背是胸的府邸，或有筑动感，或心悸，或口渴，或腹痛，或恶寒，或腹满，其症状不一，治疗应当随宜加减。（出自《圣济总录·胸痹》）
《千金方》治寒客心痛而用大黄、黄芩，治心痛彻背而用乌头、附子之类，治疗相反如此，关键在于用药随宜而已。（同上）
胸堂气隔，有肺经伏热而导致气隔的，有痰水在上而导致气隔的，大概以茯苓、半夏、枳壳、桔梗为治法。肺热者，如圣汤加桑白皮辅助。心下水气者，小半夏茯苓汤有效。胸烦，《活人书》用山栀子。（出自《济生拔萃》引《直指方》意）
真心果真痛，不知能治愈否？那么执掌药剂的方法如何？回答说：热的用凉药，寒的用温药，感受风邪的疏散它，顺气调血，逐水豁痰，这是大概的要略。（同上）
疼痛剧烈的脉必伏，用温药如附子之类，不可用人参、白术。脉坚实，不大便的，攻下它。心痛用山栀并劫药止之。如果又复发，前药必不效，可用玄明粉，一服立止。胃脘有湿而痛的，宜用小胃丹攻下。（出自朱丹溪）
凡是膈痛，多因积冷与痰气而成，宜用五膈宽中散，或四七汤加木香、桂枝各半钱，或挝脾汤（用麻油、良姜、茴香、甘草）加丁香。膈痛而气上急的，宜用苏子降气汤，去前胡，加木香如数。痰涎壅盛而痛的，宜用小半夏茯苓汤加枳实一钱，间进半硫丸。（出自《医家四要》）
胸痛，木香、郁金两味药，气郁痛者倍用木香，血郁痛者倍用郁金，研为末，每服二钱，老酒送下，虚者加人参。痰饮痛，轻者用小陷胸汤，重者用大陷胸丸治疗。若痰唾稠粘，则用控涎丹。（出自《医碥》）
Xiongbi (Chest Bi) and Xintong (Heart Pain), though named differently, share the same origin, both referring to pain in the region of the diaphragm. Mild cases of Xiongbi manifest only as Qi obstruction in the chest, whereas severe Xintong is termed "Zhenxintong" (True Heart Pain). In contrast, Weiwantong (Stomach Epigastrium Pain) presents with pain that is lower and constricting, differing from the diffuse nature of chest pain and the high location of True Heart Pain. Generally, pains in the Upper Jiao (Upper Burner) are of this type; they are combined here for discussion, requiring readers to distinguish carefully while understanding their interconnections.
**Pulse Diagnosis:** A short and rapid pulse indicates Xintong accompanied by heart vexation; a sunken pulse at the Cun position (cun kou) indicates chest pain radiating to the back (or alternatively, shortness of breath); a sunken pulse at the Guan position indicates Xintong with acid regurgitation; a hidden (Fu) pulse at the Cun position indicates rebellious Qi in the chest; and a slippery (Hua) pulse at the Cun position indicates chest fullness with rebellious Qi. (*Mai Jing*)
Sunken, wiry, thin, and moving pulses are all signs of Qi stagnation pain. Xintong typically appears at the Cun position, abdominal pain at the Guan position, and lower body diseases at the Chi position; the pulse manifestations are distinct. (*Cui Shi Mai Jue*)
A rapid pulse on the left hand indicates excess heat, while a choppy (Se) pulse indicates static blood. A tight and solid pulse on the right hand indicates phlegm accumulation, and a wiry and large pulse signifies chronic disease. (Zhu Danxi)
If various pains present with thin and slow pulses, it indicates deficient Qi, relaxation, and the decline of Jue pathogenic factors, suggesting a favorable prognosis. However, if the pulse is large and floating, it indicates flourishing pathogens. Furthermore, internal heart/abdominal conditions presenting with exterior pulses are inappropriate; although not necessarily fatal, recovery will be difficult. (*Xu Yan*)
Generally, Xintong with a sunken and slow pulse is easy to treat, whereas one with a firm, large, solid, floating, long, slippery, or rapid pulse is difficult to treat. (*Yi Tong*)
In cases of severe pain, the pulse is invariably hidden, accompanied by cold limbs, dizziness, fainting, spontaneous sweating, and alternating chills and fever. One must not mistake this for deficiency-cold and immediately administer warming tonics; rather, the etiology must be investigated before treatment to avoid error. (*Hui Bu*) (Note: This view originates from Danxi, see below.)
**General Etiology:** Xintong is caused by wind-cold pathogenic factors invading the Heart. Upon onset, some cases are fatal, some are not, and some become chronic. The Heart is the master of the five Zang organs and houses the Shen (Spirit); its main meridians should not be injured. Injury to the main meridians causes pain known as "Zhenxintong" (True Heart Pain), which can lead to death within hours (morning onset leads to evening death, evening onset leads to morning death). The Heart has branch collaterals; if invaded by wind-cold (note: *Jiu Xintong Hou* specifies wind-cold and evil heat) without injuring the main meridians, it also causes Xintong, characterized by intermittent severity, thus becoming a chronic condition without death. Additionally, the Heart belongs to Fire and converges with Yang Qi, corresponding to the Hand Shaoyin Heart Meridian. If Yang Qi is deficient and Shaoyin meridian Qi rebels, it is called "Yang Deficiency Yin Jue," causing Xintong characterized by pain radiating to the throat. (*Bing Yuan Lun*)
Various syndromes of Xintong arise from pathogenic factors lodging in the Hand Jueyin Pericardium Meridian. The Hand Shaoyin Heart Meridian is the ruler of the five Zang and six Fu organs, the residence of the Spirit, and the convergence of Yang Qi; its organ qi is robust, making it resistant to direct pathogenic invasion. Therefore, when pathogens invade the Heart, they usually affect the Pericardium (Bao Luo), i.e., the Heart Master's meridian.
Symptoms vary: sudden lodging of cold Qi in the Zang-Fu causing acute pain; Yang deficiency Yin Jue with pain radiating to the throat; mutual牵引 (traction) between heart and back, with a preference for stooping; abdominal distension affecting the heart causing severe pain; acute stabbing pain like needle pricks; pale complexion with inability to sigh deeply throughout the day; pain originating from the epigastrium when lying down, worsening with movement; paroxysmal pain migrating up and down with intervals; pain due to dietary irregularities or external wind; internal deficiency allowing pathogenic lodging, causing stagnation and blockage leading to pain. If it is not True Heart Pain but rather real Qi clashing, causing cold limbs, it is beyond ordinary therapeutic reach and requires careful differentiation. (*Sheng Ji Zong Lu*)
The Heart is the master of the five sense organs and commands the entire body. If the Heart's main meridians are disturbed by wind-cold or invaded by Qi, blood, phlegm, and water, pain will pull to the back, distend the flanks, cause chest vexation, dry throat, red/yellow eyes, and cyanosis of hands and feet to the joints, leading to death from morning to evening. However, the Pericardium corresponds to the stomach opening; often spleen pain connects to the heart, or Yang deficiency Yin Jue causes urgent pain below the heart. Pathogens from other Zang may also invade the Heart via its collateral branches, constituting the so-called "Nine Types of Heart Pain." (*Zhi Zhi Fang*)
**Distinction between Heart Pain, Diaphragm Pain, and Stomach Epigastrium Pain:** Diaphragm pain differs from Heart Pain. Heart pain is located at the depression of the xiphoid process; it is not true Heart Pain but pain in the Heart's branch collaterals. Diaphragm pain involves pain spanning the chest, lighter than Heart Pain, named merely by common custom. (*Yao Jue*)
It differs from Stomach Epigastrium Pain because the epigastrium is below the Heart, while chest pain is above the Heart. (*Bi Du*)
If the epigastrium hurts as if centered on the heart, with Qi nearly exhausted, it is extreme deficiency of the Stomach, commonly called Heart Pain by laypeople. (*Shi Xiao*)
The *Nei Jing* states: When Wood Qi is depressed and erupts, people suffer from epigastric pain centered on the heart, supporting upward to both flanks, diaphragmatic obstruction, and inability to swallow food/drink. (From *Liu Yuan Zheng Ji Da Lun* and *Zhi Yao Da Lun*). The upper opening of the Stomach is the Benmen (贲门), connected to the Heart; hence the text says epigastric pain centered on the heart. Those calling it Heart Pain today misunderstand this. Etiology often stems from indulging in diet, favoring spicy/sour foods, drinking hot wine/fried foods, and eating cold/raw items. Day after day, this leads to stagnation, accumulation, phlegm formation, phlegm-fire simmering, erratic blood flow, and mixing of phlegm and blood, obstructing ascending/descending mechanisms. Thus, epigastric pain, acid regurgitation, belching,嘈杂 (gluttonous hunger/discomfort), and nausea occur, progressing toward diaphragmatic obstruction and reverse peristalsis. Quack doctors fail to investigate the source, treating uniformly with acrid-aromatic-dry-hot agents, adding fire to fire, leading to critical conditions. Ancient formulas mention nine types of Heart Pain, but only one is due to cold; how can all be treated with hot medicines? Detailed examination shows the pathology lies in the epigastrium, not the Heart. (*Zheng Chuan*)
Q: Danxi said Heart Pain is Stomach Epigastrium Pain; is this true? A: Heart and Stomach are distinct organs with different presentations. Because epigastric pain is located below the heart, it is named "pain centered on the heart"; does this mean epigastric pain is Heart Pain? Mixing them in ancient texts started this error. The Heart houses Ministerial Fire and is the residence of Spirit; its main Shaoyin meridians are not easily injured by pathogens. What gets injured is the Hand Jueyin Pericardium. If the Pericardium transmits pathogens to the Heart's main meridians, it is called "True Heart Pain," which is fatal. The Heart governs emotions; fright and overthinking damage Shen, leading to Heart deficiency and pathogenic invasion of the Pericardium. The Heart governs Yang and Blood. Thus, pain occurs if Yang is depressed and excessive heat arises, or if Yang is insufficient and pathogens prevail. Pain also occurs if blood stagnates in collaterals due to pathogens or if blood becomes deficient due to pathogens. Although formulas list nine types of Heart Pain, they miss the sage's intent and fail to recognize diverse etiologies of Six Excesses and Five Evils. Stomach epigastric pain also has diverse causes. The Stomach is wet earth, located in the Middle Jiao, possessing harmonious Qi, abundant Qi and blood, serving as the sea of water and grain and commander of Three Yang meridians. All twelve meridians receive Qi here. When healthy, Qi flows freely; when weak, pathogens lodge causing disease. Harmonious Qi turns to excess cold or heat, leading to undigested food/water retention and conflict with True Qi causing pain. Liver Wood overacting is particularly severe, causing epigastric pain centered on the heart, supporting flanks, urgency, inability to eat, and diaphragmatic/throat obstruction. Food impaction ("Shi Bi") causes pain after eating, relieved by vomiting. (From *Zhi Yao Da Lun*). Next is Kidney Qi rebelling upward; rebellion brings cold Jue into the Stomach causing pain. Thus, epigastric pathology is not just self-disease; proximity to the Heart allows pathogens to attack upward, causing Heart Pain. (*Zhun Sheng*)
Heart Pain is not True Heart Pain but Pericardium pain and Stomach Epigastrium Pain. How do we know? The Pericardium protects the Heart, connected by vessels, surrounding the Heart. Fire carrying Phlegm rises, obstructing its residence; the Pericardium is compressed by Phlegm, causing tense fat membranes and pain, mistaken for Heart Pain. The Stomach epigastrium is near the Heart, below it, connected to the Spleen. Overeating damages the Stomach epigastrium; the root remains, and slight dietary errors cause dull pain, also mistaken for Heart Pain. Generally, pain with Phlegm, nausea, relief after vomiting Phlegm, indicates Pericardium pain. Pain with fullness, frequent belching, relief upon hunger, indicates Stomach Epigastrium pain. (*Yu An*)
**Chest Bi Symptoms (Heart Bi):** Cold Qi lodges in the five Zang and six Fu organs, erupts due to deficiency, and rushes upward to the chest, causing Chest Bi. Symptoms include chest fullness, dysphagia, itching sensation, dry/stiff throat, dry saliva; severely, strong palpitations and urgent pain in the heart region (note: based on *Zhou Hou*, described as sudden hard palpitations), muscle Bi, cramping/stabbing pain preventing bending/straightening, tenderness of anterior chest skin untouchable, chest fullness, shortness of breath, coughing/salivating inducing pain, vexation, spontaneous sweating, or pain radiating to the back/spine. Pulse is floating and fine. Untreated, it kills within days. (*Bing Yuan Lun*) (Note: *Qian Jin Fang Yan Yi* says "kills within days" emphasizes severity; disease depth varies, so this limit is not absolute.)
Excessive thinking damages the Heart; Heart deficiency allows pathogens to invade. Accumulated pathogens not expelled harm appetite, cause chest fullness and dull pain, termed Heart Bi. Sunken and wiry pulse indicates Heart Bi. (Same source)
Extreme deficiency allows cold pathogens to lodge, Qi rushing upward causing Bi obstruction, resulting in Chest Bi. Symptoms as above (*Chao Shi*), all indicating blockage. (*Sheng Ji*)
**Heart/Abdominal Pain Localization:** Heart/Stomach and abdominal pains result from overwork, dietary irregularity, Middle Qi deficiency, and cold pathogens invading due to weakness, causing sudden severe pain. Classics state pain stops with warmth ("Jiong" means heat); using heat to treat cold is correct. Abdominal pain has locations; Zang positions vary high/low, so treatment must differ. Jue Xintong is cold lodging in the Pericardium. Ancients used dried ginger/acorus (acrid-hot) powder with wine/vinegar to stop pain instantly, suppressing the pathogen. True Heart Pain is cold injuring the Ruler; cyanosis to joints, death morning/evening. Stomach Epigastrium Pain (missing "Stomach" in original, added here) belongs to Taiyin, treated with Lizhong Tang, Jianzhong Tang, Caodoukou Wan. Umbilical pain belongs to Shaoyin, treated with Sini Tang, Jiangfu Yuhan Tang. Lower abdominal pain belongs to Jueyin, treated with Zhengyang San, Huiyang Dan, Danggui Sini Tang. Miscellaneous pain treated with Kulian Tang, Jiuzhu Danggui Wan, Dingxiang Lianshi Wan. Treatment follows height/depth and acupuncture/moxibustion points of respective Zang. (*Shi Xiao*)
Heart/Abdominal pain distinguishes Upper/Middle/Lower Jiao. Upper Jiao: pain above diaphragm, i.e., Stomach Epigastrium Pain (*Nei Jing*: "epigastric pain centered on heart"); people mistake it for Heart Pain, not knowing the Heart itself does not hurt. Middle Jiao: pain at Zhongwan, Spleen/Stomach disease. Lower Jiao: pain below umbilicus, Liver/Kidney/Intestines/Bladder disease. All three have deficiency/excess/cold/heat variations requiring detailed differentiation. (*Jing Yue*)
Pain in the heart extending to flanks/breasts, pulling to back/scapula is Excess-Heat. Pain in lower abdomen extending around umbilicus with cold limbs is Deficiency-Cold. (*Yi Jian*)
**Cold/Heat/Excess (New/Old):** All Heart Pain involves Shaoyin Jue Qi rushing upward. Heat Jue Xintong: body heat, cold feet, severe pain with vexation/vomiting, forehead sweating, pulse large/huge. Moxa Taixi and Kunlun (table-interior draining) to guide heat down, inducing whole-body sweat for cure. After moxa, use Jinlingzi San (Jinlingzi, Yanhusuo); after pain stops, use Zhizhu Wan to clear residual pathogen. Great Excess Heart Pain: due to diet/time-pathogen, sudden pain, constipation, stagnation, chest elevation, worse on pressure, anorexia. Urgently use Zhu Huang Wan (Xionghuang, Badou) to purge; afterwards use Gaoben Tang (Gaoben, Cangzhu) to clear residual pathogen. Cold Jue Xintong: cold limbs, whole-body cold sweat, clear urination/stool, or loose stool without thirst, weak Qi/pulse. Urgently use Shufu Tang to warm. Cold Jue acute pain is not chronic; morning onset evening death, requires emergency rescue. Thus, chronic pain is not cold, acute pain is not heat. (*Bao Ming Ji*)
Differentiate Heart Pain by duration. Chronic: caused by cold/hot foods accumulating over time, forming stagnation/phlegm, phlegm-fire simmering, blood erratic, phlegm-blood mixing (note: combines Danxi *Zheng Chuan* views); difficult to treat. Acute: temporary cold/heat stagnation affecting Righteous Qi; easy to treat. (*Shilin Yu Ye*)
**Nine Types of Heart Pain:** 1. Worm, 2. Transfer (Zhu), 3. Wind, 4. Palpitation, 5. Food, 6. Drink, 7. Cold, 8. Heat, 9. Migratory (Qu Lai). (*Qian Jin*)
**Static Blood Pain:** Inquiry into daily habits is essential. If pain is due to liking hot foods causing static blood in stomach opening, use Tao Ren Cheng Qi Tang to purge. Note this. Mild cases use leek juice/Jiegeng to lift Qi, combined with blood-invigorating herbs. (Danxi)
Heart pain with hiccups when drinking water indicates static blood inside; treat with Tao Ren Cheng Qi Tang. (Same) (Note: *Zheng Chuan* case: 35yo male, chronic epigastric pain, sallow/emaciated, low appetite, feeling full in chest.)
**True Heart Pain:** Caused by severe cold touching the Heart Ruler, or turbid blood rushing to the Heart. Physicians must differentiate and treat accordingly; no case is incurable if differentiated properly. (*Zheng Chuan*)
If True Heart Pain presents with cyanosis not reaching joints, or cold not yet Jue, the disease is shallow and salvageable. Use Lizhong Tang plus Guixin (Cinnamon Bark) and Liangjiang (Galangal) to restore life. (*Sheng Mo*) (Note: "Qing" in classics means cold, not blue color; interpreting as blue is superficial.)
Sudden severe pain without sound, pale face, cold breath, teeth grinding/jaw locking, ice-cold limbs in a person without prior Heart Pain history indicates True Heart Pain. (*Yu An*)
Acute pain with black/cyan hands-feet and coma is incurable. (*Xin Tong*)
**Chest/Hypochondriac Pain with Edema:** Kidney deficiency fails to grasp Qi, causing Qi rebellion and chest/diaphragm fullness/pain. Rubbing moves pain to back; rubbing back moves Qi along flanks to posterior, relieving pain. This is Qi pathology. Kidney also fails to move Water; Water follows Qi to Lung, causing facial/hand edema, shortness of breath/wheezing, blood transforming to water, stagnating together. Pre-existing wind complicates matters. Wind/Water/Blood/Qi combine causing unusual pain; aromatic herbs (Chenxiang, Muxiang, Wuyao, Binglang) fail. Treatment: First, Ershisi Wei Liuqi Yin plus Duhuo, Zhike, Wulingzhi, fried Qian Niu, decocted with Ginger/Honey/Sour Plum. Swallow Yangzheng Dan (20 pills) and Xionghuang Wan (10 pills) to regulate Water/Fire and guide bowel movements. Second, Sangpi, Zisu, Mutong, Ejiao, Danggui, Taoren, Qingpi, Jiegeng, fried Yuanhua, raw Dahuang decocted similarly with Ginger/Honey/Sour Plum until black stool passes, achieving cure. (*Zhi Zhi*)
**Similar Syndromes:** Diaphragm swelling/pain, inability to eat, craving water, or swollen throat, with vigorous Renying pulse and tight Qikou pulse, should be treated as Stomach Abscess. (*Yi Tong*)
**General Treatment Principles:** Ancient formulas use Lizhong Tang to缓 (slow/relax) Middle Qi. However, the Back is the mansion of the Chest; symptoms vary (trembling, palpitations, thirst, abdominal pain, cold, fullness), so treatment must be adjusted accordingly. (*Sheng Ji · Xiongbi*)
*Qian Jin* uses Dahuang/Huangqin for cold invading Heart pain, but Wutou/Fuzi for pain penetrating to back; treatments seem opposite but depend on appropriate application. (Same)
Chest Qi obstruction: due to latent Lung Heat or Phlegm-Water above. General method: Fuling, Banxia, Zhike, Jiegeng. For Lung Heat, Risheng Tang plus Sangbaipi. For Heart-Stomach Water Qi, Xiaobanxia Fuling Tang is effective. For chest vexation, *Huoren Shu* uses Shanzhizi. (*Zhi Zhi*)
Can True Heart Pain be cured? Method: Cool heat, warm cold, disperse wind pathogens, regulate Qi/blood, drain water/resolve phlegm. These are the essentials. (Same)
Severe pain with hidden pulse: use warming agents like Fuzi, avoid Renshen/Baizhu. Firm pulse with constipation: purge. Heart pain: use Shanzhi and astringents. Recurrence: previous meds fail; use Xuanming Fen for immediate relief. Wetness in epigastrium causing pain: purge with Xiaowei Dan. (Danxi)
(Xiaowei Dan: Yuanhua, Daji, Gansui, Huangbai, Dahuang.)
Diaphragm pain: mostly due to accumulated cold and Phlegm-Qi. Use Wuge Kuanzhong San, or Siqi Tang plus Muxiang/Guizhi (0.5 qian each), or Zhuapi Tang (Hemp oil, Liangjiang, Huixiang, Gancao) plus Dingxiang. Diaphragm pain with urgent rising Qi: Suzi Jiangqi Tang, remove Qianhu, add Muxiang. Profuse Phlegm-saliva pain: Xiaobanxia Fuling Tang plus Zhishi (1 qian), alternate with Banshu Wan. (*Yao Jue*)
Chest pain: Muxiang and Yujin. For Qi stagnation pain, double Muxiang; for Blood stagnation pain, double Yujin. Powder form, 2 qian per dose with old wine; add Renshen for deficiency. Phlegm-fluid pain: mild cases Xiaoxianxiong Tang, severe cases Daxianxiong Wan. Thick sticky saliva: Kongyan Dan. (*Yi Bie*)
Epigastric Pain: Due to Fire: avoid tonifying/astringent/dry-hot; use descending/bitter-cold/sweet-cold/salty-cold/acrid-cold. Due to Cold: avoid Qi-breaking/stagnant-greasy/bitter-cold; use acrid...