## Rule out the heart first
**If you have chest pain right now that is crushing, squeezing, or spreading to your arm, jaw, or back — or that comes with shortness of breath, sweating, or nausea — call 911. Do not wait, and do not drive yourself.**
Most chest and rib pain is not the heart. A rib bruised by a seatbelt. A side that catches every time you breathe in, cough, or turn in bed. A tight band across the chest in a hard week. A burning behind the breastbone after meals. These are among the most anxious complaints we see, precisely because the chest is where the heart is — and once the heart has been checked and cleared, people are often left with a pain that has no name and no plan.
The Donguibogam, the 1613 master text, covers this ground in two chapters: the Chest, which is mostly about pain in the centre, and the Ribside, which covers the flanks and ribs. We translated both in full.
[→ The Chest — full translated chapter]
[→ The Ribside — full translated chapter]
## Much of what is called heart pain is the stomach
The Chest chapter opens its discussion of pain with a correction. What people call heart pain, it says, is a mistake: look at the causes of all nine kinds and they are in the stomach, not the heart. Its reasoning is anatomical — the upper opening of the stomach sits right behind the heart, so a pain there is felt where the heart is.
Four hundred years later, that is still the most common explanation for chest pain once the heart has been ruled out. A burning or gnawing pain in the centre of the chest or just below the breastbone, worse after meals, lying down, or very hot food and drink, often belongs to the stomach and oesophagus. The chapter even names the habit of eating food very hot as a cause of a fixed, stabbing pain at the top of the stomach. If this sounds like yours, read more here — [Digestive health]
The chapter adds a simple observation about this kind of pain that is still good advice: resting the stomach for a while does no harm, but eating freely the moment the pain eases is what brings it straight back.
## The side of the chest belongs to the Liver
The Ribside chapter gives the side of the chest its own anatomy — the armpit, then the ribbed side below it, then the floating ribs at the bottom — and assigns the whole territory to the Liver and Gallbladder channels, which spread across the ribs. Pain along the side of the chest is read through those channels first.
It names five causes of rib-side pain: Qi that has become stuck, Blood that has become static, phlegm, undigested food, and wind and cold. Each has its own signs.
## Press on it
The chapter's most useful test costs nothing. Where the pain comes from static Blood, it says, pressing makes it worse. Where it comes from stuck Qi, it eases under the hand.
A rib that is exquisitely tender to touch, worse at night, after a fall or a blow, is a Blood pain. A tight, aching side that feels better when you press into it, that comes and goes with your mood, is a Qi pain. They are treated differently.
## After a fall, a blow, or an accident
The chapter is direct about injury: where rib-side pain follows a fall or a blow, it is bad blood flowing down and lodging below the ribs. It notes that this kind of pain tends to be worse at night or in the afternoon.
It also records something every clinician who treats accident patients will recognize. A particular pulse, it says, with pain under the ribs, fullness, dizziness, headache, and pain in the low back, "was got long ago from a fall." Old injuries to the trunk can keep generating pain long after the bruise has faded — and they respond to being treated as injuries, not only as pain.
## Anger, stress, and the decisions that won't settle
The chapter names two emotional causes of rib-side pain with unusual precision: great rage with the Qi rushing upward, and "plans and deliberations that cannot be settled." Both, it says, stir the Liver's fire until the side of the chest hurts. It adds that a person who is quick-tempered and often angry tends to have pain in the abdomen and ribs that comes and goes.
The Chest chapter makes the same point about the centre of the chest. Of the seven emotions, it says, six bind the Qi and cause pain; only joy scatters it. It records a man who developed chest pain after hearing that his father had been killed, which grew over a month into a hard knot that no medicine could move. The physician played the fool until the patient laughed so hard he had to turn his face to the wall. Within days the knot was gone.
That case is four hundred years old, and its point is modern: chest tightness and pain that follow grief, anger, or long stress are real, and they are treatable. If yours comes with anxiety or panic, read more here — [Anxiety, insomnia & mental health]
## Full, but not painful
The Chest chapter also describes a feeling many patients struggle to put into words: a fullness and oppression under the breastbone with no real pain, and nothing to see from outside. It calls this glomus, and separates it carefully from visible bloating. The distinction matters, because the oppression felt within is treated by opening and moving, not by settling the stomach alone.
## What treatment looks like here
Acupuncture is the main tool. For pain of the ribs and flanks, the Ribside chapter's first choice is TE6 Zhigou with TE5 Waiguan on the forearm, together with LI11 Quchi at the elbow — points that can be reached without undressing, which matters when breathing and moving hurt. For pain in both sides, it uses GB44 Zuqiaoyin and LR1 Dadun at the toes and LR2 Xingjian on the foot. For pain at the top of the stomach, the Chest chapter lists PC5 Jianshi on the forearm and SP4 Gongsun on the foot among others.
Both chapters share a principle that shapes the herbal side: where there is pain, something is not passing — "what passes does not hurt; what does not pass hurts." For the same reason, the Chest chapter warns that pain should not be treated with tonics that strengthen the Qi without first freeing it; the pain only gets worse. From the chapters:
[Sosiho-tang 小柴胡湯] — the base formula for rib-side pain, adjusted for the cause
[Danggwiyonghoe-hwan 當歸龍薈丸] — for rib-side pain from anger and Liver fire
[Jigak-san 枳殼散] — for rib-side pain from stuck Qi
[Jigung-san 枳芎散] — for pain of the left side
[Chugi-san 推氣散] — for pain of the right side
[Samul-tang 四物湯] — combined with Sosiho-tang for pain after injury, worse at night
A bruised rib from an accident usually improves over several weeks, and treatment aims to make breathing, sleeping, and moving easier in the meantime. Rib-side and chest pain tied to stress often eases quickly once it is addressed, though it tends to return with the next hard stretch unless the pattern underneath is treated.
## Please read this part
Chest pain is the one symptom where the heart must be ruled out first, every time.
**Call 911 if you have:** chest pain that is crushing, squeezing, or heavy, or that spreads to the arm, jaw, neck, or back; chest pain with shortness of breath, sweating, nausea, or light-headedness; sudden sharp chest pain with difficulty breathing; chest pain after an accident with trouble breathing; or coughing up blood.
**Get evaluated before starting here if you have:** chest pain that comes on with exertion and eases with rest; rib pain after an accident or fall that hasn't been examined or imaged; pain on one side of the chest with a cough or fever; a burning pain on one side followed by a rash, which can be shingles and should be treated early; or a single fixed point of pain that never lets up, especially with weight loss.
Both 1613 chapters draw the same lines. The Chest chapter sets "true heart pain" apart from everything else — severe pain with the hands and feet blue to the joints, death within the day — and offers no treatment for it. The Ribside chapter describes a cough that drags pain into the side, which is fluid around the lung, and treats a single unrelenting point of pain in a wasting patient as very grave. Those instincts are exactly right.
**This approach may help if you're dealing with:** rib pain after a car accident or fall, once medically evaluated · a bruised or strained rib that hurts to breathe or turn · pain along the side of the chest · chest tightness with stress, anxiety, or grief · non-cardiac chest pain after the heart has been cleared · burning behind the breastbone with digestive symptoms · a sense of fullness or oppression under the breastbone.
The Donguibogam translation project at formulas.raahacupuncture.com is researched and translated by Eui Young (Justin) Chung, L.Ac., Dipl. O.M. — the same clinician you'll see in the treatment room.