心痛从来言无真正之病不知心痛未尝无真也但有阴阳之分耳大约阳病之痛犯心者多不救
阴病
之痛犯心者多难医阳病乃火也火邪犯心有膻中之障隔而火势不能直冲于心泻其胃中之火而心
安矣其故何也邪火与心火本是同类火与火合气焰虽殊而热性何殊也原无相克之嫌故火退而君
火自息何至有自焚之祸若阴病乃寒也寒邪直犯乎心虽有膻中之障隔而寒气冲天直中皇居相臣
不当其锋先自逃遁于他处而天王有不下堂而走乎盖寒水克心火立时可以扑灭较阳症而更重也
故朝发夕死夕发旦死医之少迟已多不救况用药之不得其宜何怪其骤亡也人见其亡之骤谓其真
正心痛其实非真正心痛也治之得宜何尝不可救哉然则心痛之阴阳又乌可不辨之乎若阳症也必
彻夜竟日疼痛呼号双目必红口必渴引饮得凉水而少止与之食而更痛手不可按按之而痛必甚身
上必然有汗日重而夜少轻此乃邪火作祟于胃中上冲膻中耳用泻火神丹下喉而痛即定矣此方之
妙妙在栀子用之太多始能直折其郁抑之火而苍术茯苓又去其湿湿去则不生热而火势自衰又加
之贯众以去秽乳香木香以止痛用甘草之多则栀子不至太凉反得其调剂之宜而枳壳化食食消
则火随食而下行矣又虑邪火大旺若不顺从其性则火势炎上恐拒隔而不受用干姜之炒黑去
其太热引栀子之类于下行又得其前导之功也药性既然相宜功效岂不立奏乎所以甫下喉而
痛
即定也若阴症也必感寒而得之其症小腹先痛而后入心口吐清水与之茶即吐出手足青甚而卵缩
角弓反张此阴寒之气犯心其来甚速苟能以生姜半斤捣碎炒热敷于心腹之间则寒邪少减即用生
姜
三两捣碎饮之亦能生者然终乃一时急救之法而非万年济人之术也用祛寒定痛汤救之实神刻不
可缓速行救之下喉亦生否则难救矣此方之妙妙在用白术之多直入腰脐之内者何也寒气之入原
从脐内先入若不急杜其来路则邪无顾忌往前直奔心包之络如何当其贼势之横行余故用白术
以绝之也然非多加则势孤力薄寒邪亦何所畏而反顾哉故必多加而后可以取效然徒用白术之多
而
无附子肉桂之热药是犹兵众而将非摧锋陷阵之帅则兵卒不前贼又何所畏忌故必用附子肉桂也
然
徒用附子肉桂斩杀诛戮而不分散寒邪之势则敌人团聚尤难解纷余所以又用茯苓引寒邪之下行
也又虑心君寒甚无火以温其中譬如群贼围困皇宫虽有勤王之将而无导引之师则外虽有声援之
兵而内无接应非得亲信之臣又何以交通内外余所以又用菖蒲引桂附人心而卫君也愿人敬守吾
方以治真正之心痛无不手到成功倘见病势少轻前二方少减分两亦未为不可
泻火神丹
栀子(五钱) 白芍(三钱) 乳香(一钱) 广木香(一钱) 贯众(三钱) 甘草(三钱) 枳壳(一
钱) 炒黑干姜(一钱) 茯苓(五钱) 苍术(三钱)水煎服
祛寒定痛汤
附子(三钱) 白术(三两) 肉桂(三钱) 人参(三钱) 菖蒲(一钱) 茯苓(五钱)水煎服
心痛这一病症,历来被认为没有真正的病证,其实不知道心痛并非没有真病,只是有阴阳之分罢了。大致而言,阳病侵犯心脏的疼痛,大多难以救治;阴病侵犯心脏的疼痛,大多难以医治。
所谓阳病,就是火邪。火邪侵犯心脏,虽然有膻中穴作为屏障阻隔,但火势不能直接冲撞心脏,只需泻去胃中的火邪,心脏就能安宁。这是什么原因呢?因为邪火与心火本是同类,火与火相合,虽然气焰不同,但热性并无差异,原本就没有相互克制的嫌疑,所以邪火退去后,君火自然平息,怎会有自焚的灾祸呢?
至于阴病,则是寒邪。寒邪直接侵犯心脏,虽然有膻中的阻隔,但寒气冲天,直中皇宫(指心脏),宰相大臣(指其他脏腑或经络)抵挡不住锋芒,先自行逃遁到别处,而君王(心脏)不得不离开殿堂逃跑吗?这是因为寒水克制心火,立时就可以将其扑灭,比阳症更加严重。所以早晨发病傍晚死亡,傍晚发病次日清晨死亡,医生如果稍加迟缓,大多已经无法救治,更何况用药不当呢?这又怎能怪它突然死亡呢?人们看到它死得迅速,认为这是真正的心痛,其实并不是真正的心痛。如果治疗得当,何尝不可救活呢?既然如此,心痛是阳还是阴,又怎么可以不加以辨别呢?
如果是阳症,必定彻夜整日疼痛,呼号不止,双目必然发红,口必然干渴想喝水,喝凉水能稍微缓解,进食则疼痛加重,手不能按压,按压则疼痛更甚,身上必然有汗,白天重而夜间轻。这是邪火在胃中作祟,上冲至膻中。使用“泻火神丹”,药一下喉疼痛即刻停止。这个方子的妙处,在于栀子用量太多,才能直接折服郁结压抑的火邪;苍术、茯苓又能去除湿气,湿气去除则不再生热,火势自然衰退;再加上贯众以去除秽浊,乳香、木香以止痛;用大量的甘草,则栀子不至于太凉,反而得到调剂的适宜;枳壳消化食积,食积消解则火随着食物下行。又担心邪火大旺,如果不顺从其性质,火势炎上,恐怕会拒斥药物而不受纳,所以用炒黑的干姜去掉其太热的特性,引导栀子等药下行,又起到前导的作用。药性既然相宜,功效岂能不立即奏效?所以药一下喉,疼痛就停止了。
如果是阴症,必定是因为感受寒邪而得病。症状是小腹先痛,然后痛入心脏,口吐清水,给茶喝就会吐出,手足发青,甚至睾丸收缩,角弓反张。这是阴寒之气侵犯心脏,来得非常迅速。如果能用生姜半斤捣碎,炒热后敷在心腹之间,则寒邪稍微减轻;再用生姜三两捣碎饮用,也能产生生机。但这终究只是一时的急救方法,而非万年济世之术。应用“祛寒定痛汤”来救治,实在神奇,一刻也不能迟缓,迅速施救,药一下喉也能生还,否则就难救了。这个方子的妙处,在于大量使用白术,直接深入腰脐内部。为什么呢?寒气入侵原本从脐内先进入,如果不紧急阻断它的来路,则邪气无所顾忌地直奔心包之络,怎么能抵挡贼势的横行呢?所以我用白术来绝断它。然而如果不是大量使用,则势力孤单力量薄弱,寒邪又有什么可畏惧而回头呢?所以必须大量使用后才能取效。然而,如果只大量使用白术,而没有附子、肉桂这些热药,就像军队众多但没有能摧锋陷阵的主帅,士兵就不会前进,贼寇又有什么可畏惧忌惮的呢?所以必须使用附子、肉桂。然而,如果只使用附子、肉桂进行斩杀诛戮,而不分散寒邪的势力,则敌人团聚,尤其难以解决纷争。所以我又用茯苓引导寒邪下行。又担心心脏君主寒邪太重,体内无火以温暖其中,譬如群贼围困皇宫,虽然有勤王的将领,却没有引导的军队,那么外面虽有声援的兵力,而内部没有接应,非得亲信的大臣,又凭什么沟通内外呢?所以我用菖蒲引导桂枝、附子进入心脏,以护卫君主。希望人们恭敬遵守我的方子来治疗真正的心痛,无不手到成功。倘若见到病情稍微减轻,前两个方子减少分量也是可以的。
泻火神丹:栀子(五钱)、白芍(三钱)、乳香(一钱)、广木香(一钱)、贯众(三钱)、甘草(三钱)、枳壳(一钱)、炒黑干姜(一钱)、茯苓(五钱)、苍术(三钱)。水煎服。
Pain in the heart region has long been said to lack a "true" disease; however, it is unknown that pain in the heart does indeed have a true pathology, distinguished only by Yin and Yang. Generally speaking, pain invading the Heart due to Yang disorders is mostly incurable, while pain invading the Heart due to Yin disorders is mostly difficult to treat.
Yang disorders refer to Fire pathogenic factors. When Fire invades the Heart, although the *Shanzhong* (Chest Center/Pericardium area) acts as a barrier preventing the Fire from directly assaulting the Heart, clearing the Fire in the Stomach will calm the Heart. Why is this? Because pathogenic Fire and Heart Fire are of the same category; when Fire combines with Fire, although their manifestations differ, their hot nature is identical. There is originally no suspicion of mutual overcoming; thus, when the pathogenic Fire recedes, the Ministerial Fire naturally subsides, avoiding the disaster of self-incineration.
In contrast, Yin disorders involve Cold pathogenic factors. Cold invades the Heart directly; despite the barrier of the *Shanzhong*, the Cold Qi rushes upward, striking straight at the Imperial Residence (the Heart). The "Prime Minister" (other organs or meridians) cannot withstand the sharp edge and flees first to other places, leaving the "Heavenly King" (Heart) forced to abandon its palace. This is because Water overcomes Fire; the Cold Water can extinguish Heart Fire instantly, making it more severe than Yang disorders. Therefore, if onset occurs in the morning, death follows by evening; if onset occurs in the evening, death follows by morning. If medical treatment is delayed even slightly, rescue is often impossible. How much more so if the medication is inappropriate? It is no wonder such sudden death occurs. Observers see the rapid demise and assume it is "true" heart pain, but it is not truly heart pain. If treated appropriately, could it not be saved? Therefore, how can one fail to distinguish between Yin and Yang in heart pain?
If it is a Yang disorder, the pain persists through the night and day, accompanied by crying out. The eyes must be red, and the mouth dry with a desire to drink cold water, which provides slight relief. Eating aggravates the pain, and pressure on the abdomen worsens it significantly. Sweating is inevitable on the body, with symptoms heavier during the day and lighter at night. This is caused by pathogenic Fire disturbing the Stomach and rushing up to the *Shanzhong*. Using *Xiehuo Shendan* (Fire-Draining Divine Elixir), the pain ceases immediately upon ingestion. The brilliance of this formula lies in the heavy use of Gardenia (*Zhi Zi*) to directly suppress depressed Fire; Atractylodes (*Cang Zhu*) and Poria (*Fu Ling*) remove Dampness; once Dampness is gone, Heat is not generated, and Fire power naturally declines. Additionally, Houttuynia (*Guan Zhong*) removes turbidity, Frankincense (*Ruxiang*) and Costus Root (*Muxiang*) stop pain. A large dose of Licorice (*Gan Cao*) prevents Gardenia from being too cold, achieving proper modulation. Immature Bitter Orange (*Zhi Ke*) digests food stagnation; once food is cleared, Fire descends with the food. Furthermore, fearing that excessive pathogenic Fire might reject the medicine due to its ascending nature, blackened dried ginger (*Chao Hei Gan Jiang*) is used to remove excessive heat and guide Gardenia downward, providing leading action. Since the medicinal properties are harmonious, efficacy is immediate. Thus, pain stops as soon as the medicine enters the throat.
If it is a Yin disorder, it results from contracting Cold. Symptoms include initial pain in the lower abdomen spreading to the heart, vomiting clear fluid, vomiting tea when given, cyanosis of hands and feet, testicular retraction, and opisthotonos. This is Yin-Cold Qi invading the Heart, arriving very rapidly. If half a jin of fresh ginger is crushed, stir-fried until hot, and applied to the heart and abdomen, the Cold pathogen will decrease slightly. Drinking three liang of crushed fresh ginger can also restore vitality. However, this is merely a temporary emergency method, not a perpetual remedy for saving people. One should use *Quhan Dingtong Tang* (Cold-Expelling Pain-Stopping Decoction) for rescue, which is miraculous. Delay is not an option; prompt administration leads to survival, otherwise rescue is difficult. The brilliance of this formula lies in the massive use of Atractylodes Macrocephala (*Bai Zhu*), which enters deeply into the waist and navel area. Why? Because Cold invasion originally enters through the navel. If the source is not urgently blocked, the pathogen will rush fearlessly to the Pericardium collaterals, unable to be resisted against the rampant aggression. Therefore, Bai Zhu is used to cut off the pathogen. However, without a large dose, the force is weak, and the Cold pathogen would not recoil. Hence, a large dose is necessary for efficacy. Yet, relying solely on abundant Bai Zhu without hot herbs like Aconite (*Fuzi*) and Cinnamon Bark (*Rou Gui*) is like having an army without a general capable of breaking lines; the troops will not advance, and the enemy will not fear. Thus, Fuzi and Rou Gui are essential. However, using only Fuzi and Rou Gui for attack without dispersing the Cold pathogen's cohesion makes the "enemy" united and hard to disperse. Therefore, Fu Ling is used to guide the Cold downward. Additionally, fearing the Heart Monarch is too cold and lacks internal warmth—like a palace besieged by bandits where loyal generals exist but lack guiding troops, resulting in no internal support despite external reinforcements—a trusted minister is needed to communicate inside and outside. Thus, Acorus (*Chang Pu*) is used to guide Cinnamon and Aconite into the Heart to guard the Monarch. I hope people strictly follow my formulas to treat true heart pain, achieving success effortlessly. If the condition lightens slightly, reducing the dosage of the previous two formulas is acceptable.
*Xiehuo Shendan* (Fire-Draining Divine Elixir): Gardenia Fruit (*Zhi Zi*, 5 qian), White Peony Root (*Bai Shao*, 3 qian), Liquidambar Resin (*Ruxiang*, 1 qian), Aucklandia Root (*Guang Muxiang*, 1 qian), Houttuynia Rhizome (*Guan Zhong*, 3 qian), Licorice Root (*Gan Cao*, 3 qian), Immature Bitter Orange (*Zhi Ke*, 1 qian), Blackened Dried Ginger (*Chao Hei Gan Jiang*, 1 qian), Poria (*Fu Ling*, 5 qian), Brown Atractylodes Rhizome (*Cang Zhu*, 3 qian). Decoct in water and take orally.
*Quhan Dingtong Tang* (Cold-Expelling Pain-Stopping Decoction): Prepared Aconite Root (*Fuzi*, 3 qian), Atractylodes Macrocephala Rhizome (*Bai Zhu*, 3 liang), Cinnamon Bark (*Rou Gui*, 3 qian), Ginseng Root (*Renshen*, 3 qian), Acorus Tatarinowii Rhizome (*Chang Pu*, 1 qian), Poria (*Fu Ling*, 5 qian). Decoct in water and take orally.