脉∶两胁疼痛，脉必双弦；紧细弦者，多怒气偏；沉涩而急，痰瘀之愆。
左胁痛者，肝经受邪也。
疏肝散 治左胁下痛，肝积属血，或因怒气所伤，或跌扑闪挫所致，或为痛。
黄连（吴茱萸煎汁炒，二钱） 柴胡、当归（各一钱） 青皮、桃仁（研
如泥） 枳壳（麸炒。各一钱） 川芎 白芍（各七分） 红花（五分）
上锉一剂，水煎，食远服。
右胁痛者，肝邪入肺也。
推气散 治肝邪入肺，右胁痛甚，胀满不食。
片姜黄 枳壳（麸炒。各二钱） 桂心（少许） 炙甘草（五分） 一方加陈皮（一钱半） 半夏（一钱）
上锉一剂，生姜三片，水煎，食远服。
左右胁俱痛者，肝火盛而木气实也。
柴胡芎归汤 治肝火盛而木气实，胁下痛。
柴胡 川芎 白芍 青皮（去穣） 枳壳（麸炒。各一钱半） 香附 当归 龙胆草 木香（另研） 砂仁
甘草（各五分）
上锉一剂，姜一片，水煎，不拘时服。
当归龙荟丸 泻肝火盛之要药。因内有湿热，两胁痛甚，伐肝木之气。
当归 龙胆草 山栀仁 黄连 大黄（酒浸湿，火 ） 芦荟加柴胡（五钱） 青黛（各五钱） 木香
（二钱半） 麝香（五分，另研） 青皮（一两、去穣，醋炒）
上为细末，神曲糊为丸，如梧桐子大。每服二十丸，姜汤送下。
两胁走注痛而有声者，是痰饮也。二陈汤治痰饮胁下痛（方见痰症）。根据本方加枳壳、砂仁、木香、川芎、
青皮、苍术、香附、茴香，去甘草。
劳伤身热胁痛者，脉必虚也。补中益气汤治内伤劳役胁下痛（方见内伤）。根据本方加川芎、白芍、青皮、
木香、砂仁、枳壳、茴香，去黄 、白术、升麻。
咳嗽气急作热，脉滑数者，是痰结痛也。久而不治成胁痈。栝蒌枳实汤治痰结胁下痛（方见痰症）。根据本方
加白芥子、青
皮、茴香，去桔梗、片芩，发热加柴胡。
左胁下有块，作痛不移者，是死血也。活血汤治死血胁下痛（方见腹痛）。根据本方加青皮，去乌药。
右胁下有块，作痛饱闷者，是食积也。香砂平胃散治食积胁痛（方见伤食）。根据本方加青皮、木香、山楂
肉、麦芽、干姜、槟榔，去藿香、苍术。发热加柴胡，去半夏。
补遗方
平肝流气饮 治胁痛及小腹至绕脐并疝气内外疼者。当归（酒洗，一钱） 白芍（酒炒，四分）
川芎（六分） 橘皮（盐汤洗，一钱） 茯苓（去皮，一钱） 半夏（姜制） 青皮（醋炒，六分） 黄连
（酒炒，八分） 柴胡（七分） 香附（童便浸、炒，八分） 浓朴（姜汁炒，七分） 栀子（盐水拌炒，
八分） 甘草（炙去皮，四分） 吴茱萸（煮三次，去水，炒，四分）
上锉一剂，姜三片，水煎，空心热服。
一、胁肋胀痛，若大便通和，喘咳吐痰者，肝火侮肺也。用小柴胡汤加青皮、山栀清之（方见伤寒。）
一、男子房劳兼怒，风府胀闷，两胁胀痛。余作色欲损肾，怒气伤肝。用六味丸料加柴胡、当归，一剂而
安（方见补益。）
脉象：两胁疼痛，脉象必定呈现双弦；若脉象紧细而弦，多因怒气偏盛所致；若脉象沉涩且急，则是痰浊与瘀血的过失（致病原因）。
左胁疼痛，是肝经受邪。
疏肝散 治疗左胁下疼痛，肝积属于血分病变，或因怒气损伤，或因跌打闪挫引起，或表现为刺痛。
黄连（用吴茱萸煎汁炒制，二钱） 柴胡、当归（各一钱） 青皮、桃仁（研成泥状） 枳壳（麸炒，各一钱） 川芎 白芍（各七分） 红花（五分）
以上药材锉碎为一剂，加水煎煮，饭后服用。
右胁疼痛，是肝邪传入肺脏。
推气散 治疗肝邪入肺，右胁疼痛剧烈，胀满不想进食。
片姜黄 枳壳（麸炒，各二钱） 桂心（少许） 炙甘草（五分） 一方加陈皮（一钱半） 半夏（一钱）
以上药材锉碎为一剂，加生姜三片，加水煎煮，饭后服用。
左右两胁都疼痛，是肝火旺盛且木气实盛。
柴胡芎归汤 治疗肝火旺盛且木气实盛，胁下疼痛。
柴胡 川芎 白芍 青皮（去瓤） 枳壳（麸炒，各一钱半） 香附 当归 龙胆草 木香（另研） 砂仁 甘草（各五分）
以上药材锉碎为一剂，加姜一片，加水煎煮，不拘时间服用。
当归龙荟丸 泻除肝火旺盛的重要药物。因体内有湿热，两胁疼痛剧烈，克制肝木之气。
当归 龙胆草 山栀仁 黄连 大黄（酒浸湿，火煨） 芦荟加柴胡（五钱） 青黛（各五钱） 木香（二钱半） 麝香（五分，另研） 青皮（一两，去瓤，醋炒）
以上制成细末，用神曲糊制作成丸药，如梧桐子大小。每次服用二十丸，姜汤送服。
两胁走窜疼痛且伴有声音的，是痰饮病。二陈汤治疗痰饮引起的胁下痛（方剂见痰症章节）。根据本方加枳壳、砂仁、木香、川芎、青皮、苍术、香附、茴香，去掉甘草。
劳损导致身体发热、胁痛的，脉象必定虚弱。补中益气汤治疗内伤劳役引起的胁下痛（方剂见内伤章节）。根据本方加川芎、白芍、青皮、木香、砂仁、枳壳、茴香，去掉黄芪、白术、升麻。
咳嗽气急并伴有发热，脉象滑数的，是痰结引起的疼痛。久治不愈会形成胁痈。栝蒌枳实汤治疗痰结引起的胁下痛（方剂见痰症章节）。根据本方加白芥子、青皮、茴香，去掉桔梗、黄芩，发热加柴胡。
左胁下有肿块，疼痛位置固定不移的，是死血（瘀血）。活血汤治疗死血引起的胁下痛（方剂见腹痛章节）。根据本方加青皮，去掉乌药。
右胁下有肿块，疼痛且伴有饱闷感的，是食积。香砂平胃散治疗食积引起的胁痛（方剂见伤食章节）。根据本方加青皮、木香、山楂肉、麦芽、干姜、槟榔，去掉藿香、苍术。发热加柴胡，去掉半夏。
补遗方
平肝流气饮 治疗胁痛以及从小腹至绕脐并伴有疝气内外疼痛者。当归（酒洗，一钱） 白芍（酒炒，四分） 川芎（六分） 橘皮（盐汤洗，一钱） 茯苓（去皮，一钱） 半夏（姜制） 青皮（醋炒，六分） 黄连（酒炒，八分） 柴胡（七分） 香附（童便浸、炒，八分） 浓朴（姜汁炒，七分） 栀子（盐水拌炒，八分） 甘草（炙去皮，四分） 吴茱萸（煮三次，去水，炒，四分）
以上药材锉碎为一剂，加姜三片，加水煎煮，空腹热服。
一、胁肋胀痛，如果大便通畅调和，但出现喘咳吐痰的，是肝火侮犯肺脏。用小柴胡汤加青皮、山栀清泄（方剂见伤寒章节）。
一、男子房劳过度兼发怒，风府穴处胀闷，两胁胀痛。我认为这是色欲损伤肾气，怒气损伤肝脏。使用六味地黄丸的药料加柴胡、当归，一剂后即可安宁（方剂见补益章节）。
Pulse: Pain in both hypochondria is accompanied by a double wiry pulse; if the pulse is tight, fine, and wiry, it is mostly due to excessive anger; if the pulse is deep, choppy, and rapid, it indicates errors caused by phlegm and blood stasis.
Pain in the left hypochondrium indicates pathogenic factors affecting the Liver Meridian.
Shugan San (Liver-Soothing Powder) treats pain under the left hypochondrium. Liver accumulation belongs to the blood aspect; it may be caused by injury from anger, or by falls and sprains, or manifest as stabbing pain.
Coptidis Rhizoma (Stir-fried with juice of Evodiae Fructus decoction, 2 qian) Bupleuri Radix, Angelicae Sinensis Radix (each 1 qian) Aurantii Fructus Pericarpium, Persicae Semen (pounded into paste) Aurantii Fructus Immaturus (bran-stir-fried, each 1 qian) Chuanxiong Rhizoma, Paeoniae Radix Alba (each 0.7 qian) Carthami Flos (0.5 qian)
The above herbs are coarsely crushed for one dose, decocted in water, and taken after meals.
Pain in the right hypochondrium indicates liver pathogenic factors invading the Lung.
Tuiqi San (Pushing-Qi Powder) treats liver pathogenic factors invading the lung, severe pain in the right hypochondrium, distension, fullness, and loss of appetite.
Curcumae Longae Rhizoma Aurantii Fructus Immaturus (bran-stir-fried, each 2 qian) Cinnamomi Cortex (a small amount) Glycyrrhizae Radix et Rhizoma Praeparata cum Melle (0.5 qian) Another prescription adds Citri Reticulatae Pericarpium (1.5 qian) Pinelliae Tuber (1 qian)
The above herbs are coarsely crushed for one dose, with three slices of Zingiberis Rhizoma Recens, decocted in water, and taken after meals.
Pain in both left and right hypochondria indicates excessive liver fire and excess wood qi.
Chaihu Xiongui Tang (Bupleurum, Chuanxiong, and Angelica Decoction) treats excessive liver fire and excess wood qi causing pain under the hypochondria.
Bupleuri Radix Chuanxiong Rhizoma Paeoniae Radix Alba Aurantii Fructus Pericarpium (remove pith) Aurantii Fructus Immaturus (bran-stir-fried, each 1.5 qian) Cyperi Rhizoma Angelicae Sinensis Radix Gentianae Radix Aucklandiae Radix (separately ground) Amomi Fructus Glycyrrhizae Radix et Rhizoma (each 0.5 qian)
The above herbs are coarsely crushed for one dose, with one slice of ginger, decocted in water, and taken at any time.
Danggui Longhui Wan (Angelica and Gentian Pill) is a key medicine for purging excessive liver fire. Due to internal damp-heat, causing severe pain in both hypochondria, it suppresses the qi of liver wood.
Angelicae Sinensis Radix Gentianae Radix Gardeniae Semen Coptidis Rhizoma Rheum Radix et Rhizoma (moistened with wine, roasted) Aloe plus Bupleuri Radix (5 qian) Indigo Naturalis (each 5 qian) Aucklandiae Radix (2.5 qian) Moschus (0.5 qian, separately ground) Aurantii Fructus Pericarpium (1 liang, remove pith, vinegar-stir-fried)
The above are made into fine powder, bound with a paste of Massae Fermentatae Medicamentosa, and formed into pills the size of Sophora seeds. Take 20 pills per dose, washed down with ginger soup.
Wandering pain in both hypochondria accompanied by sounds indicates phlegm-fluid retention. Erchen Tang (Two-Aged Decoction) treats hypochondriac pain caused by phlegm-fluid retention (formula see Phlegm Syndrome chapter). Based on this formula, add Aurantii Fructus Immaturus, Amomi Fructus, Aucklandiae Radix, Chuanxiong Rhizoma, Aurantii Fructus Pericarpium, Atractylodis Rhizoma, Cyperi Rhizoma, and Foeniculi Fructus; remove Glycyrrhizae Radix et Rhizoma.
Fatigue-induced body heat and hypochondriac pain indicate a deficient pulse. Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) treats hypochondriac pain caused by internal injury and overwork (formula see Internal Injury chapter). Based on this formula, add Chuanxiong Rhizoma, Paeoniae Radix Alba, Aurantii Fructus Pericarpium, Aucklandiae Radix, Amomi Fructus, Aurantii Fructus Immaturus, and Foeniculi Fructus; remove Astragali Radix, Atractylodis Macrocephalae Rhizoma, and Cimicifugae Rhizoma.
Cough, shortness of breath, fever, and a slippery-rapid pulse indicate pain caused by phlegm nodulation. If untreated for a long time, it becomes a hypochondriac abscess. Gualou Zhishi Tang (Trichosanthes Fruit and Aurantium Decoction) treats hypochondriac pain caused by phlegm nodulation (formula see Phlegm Syndrome chapter). Based on this formula, add Mustard Seed, Aurantii Fructus Pericarpium, and Foeniculi Fructus; remove Platycodonis Radix and Scutellariae Radix; add Bupleuri Radix if there is fever.
A mass under the left hypochondrium that causes fixed, unchanging pain indicates dead blood (blood stasis). Huoxue Tang (Invigorate Blood Decoction) treats hypochondriac pain caused by dead blood (formula see Abdominal Pain chapter). Based on this formula, add Aurantii Fructus Pericarpium; remove Linderae Cortex.
A mass under the right hypochondrium that causes pain with fullness and stuffiness indicates food stagnation. Xiangsha Pingwei San (Costus and Amomi Powder to Calm the Stomach) treats hypochondriac pain caused by food stagnation (formula see Food Injury chapter). Based on this formula, add Aurantii Fructus Pericarpium, Aucklandiae Radix, Crataegi Fructus, Malto, Zingiberis Rhizoma Preparatum, and Arecae Semen; remove Pogostemonis Herba and Atractylodis Rhizoma; add Bupleuri Radix and remove Pinelliae Tuber if there is fever.
Supplementary Formulas
Pinggan Liuqi Yin (Liver-Calming and Qi-Flowing Decoction) treats hypochondriac pain, pain from the lower abdomen wrapping around the navel, and internal/external pain of hernia. Angelicae Sinensis Radix (wine-washed, 1 qian) Paeoniae Radix Alba (wine-stir-fried, 0.4 qian) Chuanxiong Rhizoma (0.6 qian) Citri Reticulatae Pericarpium (salt-water washed, 1 qian) Poria (peeled, 1 qian) Pinelliae Tuber (prepared with ginger) Aurantii Fructus Pericarpium (vinegar-stir-fried, 0.6 qian) Coptidis Rhizoma (wine-stir-fried, 0.8 qian) Bupleuri Radix (0.7 qian) Cyperi Rhizoma (steeped in child's urine, stir-fried, 0.8 qian) Magnoliae Officinalis Cortex (ginger-juice stir-fried, 0.7 qian) Gardeniae Fructus (mixed with salt water, stir-fried, 0.8 qian) Glycyrrhizae Radix et Rhizoma (roasted, peeled, 0.4 qian) Evodiae Fructus (boiled three times, discard water, stir-fried, 0.4 qian)
The above herbs are coarsely crushed for one dose, with three slices of ginger, decocted in water, and taken hot on an empty stomach.
First, distending pain in the hypochondriac region, if bowel movements are smooth but accompanied by wheezing, coughing, and expectoration, indicates liver fire insulting the lungs. Use Xiaochaihu Tang (Minor Bupleurum Decoction) plus Aurantii Fructus Pericarpium and Gardeniae Fructus to clear it (formula see Cold Damage chapter).
Second, in men, sexual exhaustion combined with anger causes distension and stuffiness at the Fengfu point (GV16) and distending pain in both hypochondria. I consider this kidney damage from lust and liver injury from anger. Use the ingredients of Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) plus Bupleuri Radix and Angelicae Sinensis Radix; one dose brings peace (formula see Tonification chapter).