附腹中窄狭、绞肠痧
腹痛有寒、积热、死血、食积、湿痰。脉弦，食；脉滑，痰（一作涩）。清痰多作
腹痛，台芎、苍术、香附、白芷为末，以姜汁入汤调服，大法之方若此。腹痛者，气用气
药，如木香、槟榔、香附、枳壳之类；血用血药，如当归、川芎、桃仁、红花之类。初得
元气未虚，必推荡之，此通因通用之法。久必难。壮实与初病，宜下；虚弱衰与久病，宜升之
消之。腹中水鸣，乃火击动其水也，用二陈汤加黄芩、黄连、栀子。亦有脏寒而鸣者。凡心
腹痛者，必用温散，此是郁结不行，阻气不运，故痛。在上者多属食，食能作痛，宜温散之
，如干姜、炒苍术、川芎、白芷、香附、姜汁之类，不可用峻利药攻下之。盖食得寒则凝
热则化，更兼行气快气药助之，无不可者。一老人腹痛，年高不禁下者，用川芎、苍术、香
附、白芷、干姜、茯苓、滑石之类。
戴云∶寒痛者，绵绵痛而无增减者是；时痛时止者，是热也；死血痛者，每痛有处，不
行移者是也；食积者，甚欲大便，利后痛减者是；湿痰者，凡痛必小便不利。
入方∶治酒积腹痛者，宽气紧要。
槟榔 三棱 莪术 香附 官桂 苍术 浓朴 陈皮 甘草 茯苓 木香
上为末，神曲糊丸。每服五十丸，白汤下。
〔附录〕或曰∶痰岂能痛？曰∶痰因气滞而聚，既聚则碍其路，道不得运，故作痛也。诸
，不可用参、 、白术，盖补其气，气旺不通而痛愈甚。白芍药，只治血虚腹痛，诸痛证
不可用，以酸收敛。脐下忽大痛，人中黑色者，多死。
绞肠痧作痛，以樟木煎汤大吐，或白矾调汤吐之，盐汤亦可探吐，宜刺委中出血。腹痛
用芍药。恶寒而痛，加桂；恶热而腹痛者，亦加黄柏。凡腹痛，以手重按者，属虚，宜参
术、姜、桂之属；凡腹痛，以手不可按者，属实，宜大黄、芒硝下之。凡肥人腹痛者，属
虚兼湿痰，宜参、二术、半夏。如感寒而腹痛，宜姜、桂，呕者，丁香；如伤暑而腹痛，宜
玉龙丸；如饮食过伤而痛者，宜木香槟榔丸下之；如禀受弱，饮食过伤而腹痛者，当补脾
胃而消导，宜参、术、山楂、曲 、枳实、木香；如 扑损伤而腹痛者，乃
是瘀血，宜桃仁承
痛
附方
玉龙丸 又名黄龙丸，见中暑。
木香槟榔丸 见痢类。
桃仁承气汤 见吐血类。
养胃汤 见疟类。
理中汤 见中寒类。
小建中汤
芍药（三两） 甘草（一两） 生姜（一两半） 大枣（六个） 桂枝（去皮，一两
半） 胶饴（半斤，旧有微溏或呕者去胶）
上锉。每服五钱，水盏半，姜三片，大枣一个，煎八分
，去滓，下饴胶两匙许，再煎化，温服。
腹中窄狭，须用苍术。若肥人自觉腹中窄狭，乃是湿痰流灌脏腑，不升降。燥饮用苍术
，行气用香附。如瘦人自觉腹中窄狭，乃是热气熏蒸脏腑，宜黄连、苍术。
腹痛的病因包括寒邪、积热、死血（瘀血）、食积和湿痰。脉象弦主食积；脉滑主痰饮（一说为涩脉）。清痰多引起腹痛，可用台芎、苍术、香附、白芷研成细末，用姜汁调汤服用，这是治疗的大法方剂。对于腹痛，气滞者使用理气药，如木香、槟榔、香附、枳壳等；血瘀者使用活血药，如当归、川芎、桃仁、红花等。初起时元气尚未虚弱，必须采用推荡攻下的方法，这是“通因通用”的治疗法则。但病程久了则难以攻下。体质壮实与初病者，适宜用泻下法；体质虚弱、正气衰败与久病者，适宜用升提和消导法。腹中水鸣响，是火邪扰动水液所致，可用二陈汤加黄芩、黄连、栀子。也有因脏腑虚寒而鸣响的。凡是心腹痛，必须使用温散法，这是因为郁结阻滞，气机运行不畅，所以疼痛。病位在上部的多属于食积，食物停滞能引起疼痛，适宜用温散法，如干姜、炒苍术、川芎、白芷、香附、姜汁等，不可使用峻猛的利下药攻伐。因为食物遇寒则凝结，遇热则消化，再加上行气快气的药物辅助，没有不能治愈的。有一位老人腹痛，年事已高不耐受攻下，可用川芎、苍术、香附、白芷、干姜、茯苓、滑石等药物治疗。
戴元礼说：寒痛的特点是绵绵作痛且无增减；时痛时止的是热痛；死血（瘀血）痛的特点是疼痛部位固定不移；食积痛的特点是大便急迫，排便后疼痛减轻；湿痰痛的特点是疼痛必然伴有小便不利。
入方：治疗酒积引起的腹痛，关键在于宽理气机。
槟榔、三棱、莪术、香附、官桂、苍术、浓朴、陈皮、甘草、茯苓、木香。
以上药物研为细末，用神曲糊制成丸剂。每次服用五十丸，用温水送服。
〔附录〕有人说：痰怎么能引起疼痛呢？回答说：痰因气机阻滞而聚集，既已聚集则阻碍通道，气道不得运行，所以产生疼痛。各种腹痛证，不可用人参、[此处原文缺字，推测为黄芪或类似补气药]、白术，因为补益其气，若气旺而不通畅，疼痛会更加严重。白芍药只治疗血虚引起的腹痛，其他各类痛证不可使用，因为其酸味具有收敛作用。脐下突然剧烈疼痛，人中部位发黑的，大多死亡。
绞肠痧发作疼痛，用樟木煎汤催吐，或用白矾调汤催吐，盐汤也可以探吐，适宜针刺委中穴放血。腹痛一般用芍药。恶寒且痛的，加桂枝；恶热且腹痛的，也加黄柏。凡腹痛，用手重按感到舒适的，属于虚证，适宜用人参、白术、干姜、肉桂之类；凡腹痛，用手按压疼痛加剧的，属于实证，适宜用大黄、芒硝攻下。凡肥胖之人腹痛，属于虚证兼夹湿痰，适宜用人参、苍术、白术、半夏。如果感受寒邪而腹痛，适宜用干姜、肉桂；伴有呕吐的，加丁香；如果伤暑而腹痛，适宜用玉龙丸；如果饮食过度损伤而痛，适宜用木香槟榔丸攻下；如果禀赋虚弱，饮食过度损伤而腹痛，应当补益脾胃并消食导滞，适宜用人参、白术、山楂、神曲、枳实、木香；如果跌扑损伤而腹痛，那是瘀血，适宜用桃仁承气汤。
附方：
玉龙丸 又名黄龙丸，见中暑类。
木香槟榔丸 见痢疾类。
桃仁承气汤 见吐血类。
养胃汤 见疟疾类。
理中汤 见中寒类。
小建中汤
芍药（三两） 甘草（一两） 生姜（一两半） 大枣（六个） 桂枝（去皮，一两半） 胶饴（半斤，原有轻微腹泻或呕吐者去掉胶饴）
以上药物切碎。每次服用五钱，用水一盏半，生姜三片，大枣一个，煎至八分，去渣，加入饴糖两匙左右，再煎化，温服。
腹中感觉狭窄，必须使用苍术。如果肥胖的人自觉腹中狭窄，乃是湿痰流注脏腑，导致气机不升降。燥湿饮用苍术，行气用香附。如果瘦人自觉腹中狭窄，乃是热气熏蒸脏腑，适宜用黄连、苍术。
Abdominal pain may be caused by cold, accumulated heat, dead blood (blood stasis), food accumulation, and damp-phlegm. A wiry pulse indicates food accumulation; a slippery pulse indicates phlegm (or alternatively, a choppy pulse). Clear phlegm often causes abdominal pain; a standard formula involves grinding Taixiong (Ligusticum Chuanxiong Rhizoma), Cangzhu (Atractylodis Rhizoma), Xiangfu (Cyperus Rotundus Rhizome), and Baizhi (Angelicae Dahuricae Radix) into powder, mixing with ginger juice in decoction for oral administration. For abdominal pain due to qi stagnation, use qi-regulating herbs such as Muxiang (Aucklandiae Radix), Binglang (Arecae Semen), Xiangfu, and Zhike (Aurantii Fructus); for blood stasis, use blood-invigorating herbs such as Danggui (Angelicae Sinensis Radix), Chuanxiong, Taoren (Persicae Semen), and Honghua (Carthami Flos). In the early stage when primordial qi is not yet deficient, purgative methods must be employed; this is the principle of "treating obstruction with unblocking agents" (Tong Yin Tong Yong). However, if the disease has persisted for a long time, purgation becomes difficult. Those who are robust or in the acute phase should undergo purgation; those who are weak, debilitated, or suffering from chronic illness should undergo lifting and resolving methods. Borborygmus in the abdomen indicates fire disturbing water; Erchen Tang (Two-Cured Decoction) added with Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), and Zhizi (Gardeniae Fructus) may be used. Alternatively, borborygmus may result from internal organ cold. Heart and abdominal pain generally require warming and dispersing methods because stagnation obstructs qi movement. Pain located uppermost is often due to food retention; warming and dispersing agents like Ganjiang (Zingiberis Rhizoma), fried Cangzhu, Chuanxiong, Baizhi, Xiangfu, and ginger juice are suitable. Harsh purgatives should not be used, as food congeals with cold and transforms with heat; combined with qi-moving herbs, recovery is assured. An elderly patient with abdominal pain who cannot tolerate purgation may be treated with Chuanxiong, Cangzhu, Xiangfu, Baizhi, Ganjiang, Fuling (Poria), and Huashi (Talcum).
Dai Yuanli stated: Cold pain presents as continuous dull pain without fluctuation; intermittent pain indicates heat; blood stasis pain is fixed in location and does not migrate; food accumulation pain is characterized by an urge to defecate with pain relief after bowel movement; damp-phlegm pain is invariably accompanied by dysuria.
For treating alcohol-induced abdominal pain, regulating qi is crucial.
Binglang, Sanleng (Sparganii Rhizoma), Ezhu (Curcumae Rhizoma), Xiangfu, Guangui (Cinnamomi Ramulus), Cangzhu, Houpo (Magnoliae Officinalis Cortex), Chenpi (Citri Reticulatae Pericarpium), Gancao (Glycyrrhizae Radix et Rhizoma), Fuling, Muxiang.
Grind these into powder, bind with dough made from Shenqu (Massa Medicata Fermentata), and form pills. Take 50 pills per dose with warm water.
[Appendix] Some ask: Can phlegm cause pain? The answer is: Phlegm accumulates due to qi stagnation; once accumulated, it obstructs pathways, preventing qi circulation, thus causing pain. In various abdominal pain syndromes, Renshen (Ginseng Radix), [missing character], and Baizhu (Atractylodis Macrocephalae Rhizoma) should not be used, as tonifying qi when it is stagnant exacerbates pain. Shaoyao (Paeoniae Radix Alba) treats only blood-deficiency abdominal pain and should not be used for other pain syndromes due to its sour astringent nature. Sudden severe pain below the umbilicus with black discoloration of the Renzhong area (philtrum) is often fatal.
Jiaochangsha (intestine-twisting colic) causing pain can be treated by inducing vomiting with Camphorwood (Camphorae Lignum) decoction, or alum-water decoction, or salt-water induced emesis; bleeding at Weizhong (BL40) is also indicated. Abdominal pain generally uses Shaoyao. If accompanied by aversion to cold, add Guizhi (Cinnamomi Ramulus); if accompanied by aversion to heat, add Huangbai (Phellodendri Cortex). For abdominal pain relieved by firm pressure, it is deficiency; use Renshen, Baizhu, Ganjiang, Rougui (Cinnamomi Cortex). For abdominal pain aggravated by pressure, it is excess; use Dahuang (Rhei Radix et Rhizoma) and Mangxiao (Natrii Sulfas) for purgation. Abdominal pain in obese individuals indicates deficiency with damp-phlegm; use Renshen, Cangzhu, Baizhu, and Banxia (Pinelliae Rhizoma). If caused by cold invasion, use Ganjiang and Guizhi; if vomiting occurs, add Dingxiang (Caryophylli Flos). If caused by summerheat, use Yulong Wan (Jade Dragon Pill); if caused by dietary excess, use Muxiang Binglang Wan (Aucklandia and Areca Pill) for purgation. If caused by constitutional weakness and dietary excess, tonify spleen and stomach while promoting digestion using Renshen, Baizhu, Shanzha (Crataegi Fructus), Shenqu, Zhishi (Aurantii Fructus Immaturus), and Muxiang. If caused by trauma, it is blood stasis; use Tao Ren Cheng Qi Tang (Peach Kernel and Magnolia Decoction).
Supplementary Formulas:
Yulong Wan (Jade Dragon Pill), also known as Huanglong Wan (Yellow Dragon Pill), see Summerheat.
Muxiang Binglang Wan, see Dysentery.
Tao Ren Cheng Qi Tang, see Hematemesis.
Yangwei Tang (Stomach-Nourishing Decoction), see Malaria.
Lizhong Tang (Regulate the Middle Decoction), see Cold Damage.
Xiao Jianzhong Tang (Minor Construct the Middle Decoction)
Shaoyao (3 liang), Gancao (1 liang), Shengjiang (1.5 liang), Dazao (6 pieces), Guizhi (de-barked, 1.5 liang), Jiyi (half jin; omit Jiyi if mild diarrhea or vomiting exists).
Cut the herbs. For each dose, take 5 qian, add 1.5 cups of water, 3 slices of ginger, and 1 jujube. Decoct until 80% remains, strain, then add 2 spoons of maltose syrup, re-heat until dissolved, and take warm.
A sensation of tightness in the abdomen requires Cangzhu. If an obese person feels abdominal tightness, it is due to damp-phlegm flooding the organs, impairing ascending and descending functions. Use Cangzhu to dry dampness and Xiangfu to move qi. If a thin person feels abdominal tightness, it is due to heat steaming the organs; use Huanglian and Cangzhu.