脉促上紧者，肩背痛。沉而滑者，肩膂痛；洪而大者，风热。
由风热乘肺，手太阴经郁甚不行也，病则颊额肿，颈肩 肘臂外后
痛，小便数而少，如小便遗失者肺虚也。
治宜通经血，益元气，散风热，通气散主之
羌活 独活 防风 本（以上通经气） 黄芩 黄连（降火） 虚加人参、黄 。
由风寒湿流注经络，结滞骨节，气血不和而痛。治宜流湿散风寒。
又痰积，趁逐经络流注，搏于血内亦然。治宜逐痰积。
除湿丹
槟榔 甘遂 赤芍药 威灵仙 泽泻 葶苈（各二钱） 乳香（研） 没药（一两） 大
戟（炒三两） 陈皮（四两）
上面糊丸，加牵牛末。
煨肾散 甘遂掺猪腰，煨末之。
禹功散
脉弦 由肝木气实火盛，或因怒气大逆，肝郁木盛，或因谋虑不决，风
中于肝，皆使木盛生火，火盛肝急而作痛。治宜以辛散之，以苦泻之，当归龙会丸、泻青丸等。
有瘀血 停留于肝，归于胁下而痛，病则自汗，痛甚，按之益甚。治宜破血为主，活
血为佐，复元活血丹、导滞当归丸等。
有痰积 流注厥阴之经，胁下痛，病则咳嗽急引胁痛。治宜行气去痰，二陈
汤加南星、青黛、香附、青皮等。
龙荟丸 治食积发，木盛胁痛。
柴胡 甘草 青皮 黄连 当归 大黄 木香 芦荟 川芎 草龙胆
左金丸 治肝火。
黄连（六钱） 茱萸（一钱）
活血丹 治死血。
导痰汤 治痰积流注。
外有肝中风（左胁偏痛），肝中寒（胁下挛急），肝积（左胁痛），肝实、肝虚、筋实、
悬饮、食积、肉虚（左胁因嗽而痛），胆实热（胁下满硬），饮水胁下鸣逐。
又有血枯证，胁满支满（经气不行），妨于食（肝伤脾），病至先闻腥臊臭，出清
液，肝病肺叶伤之，四支清，目眩，前后血，此得之少年脱血，房事肝伤气竭致
之。胁满面黑，不能反侧者死。
脉象急促且上部紧束的，是肩背痛。脉象沉而滑的，是肩背及脊柱疼痛；脉象洪大且有力的，是风热证。
这是由于风热之邪侵袭肺脏，导致手太阴肺经气机郁滞严重、运行不畅所致。发病时会出现面颊和额部肿胀，颈部、肩部、肘部、手臂外侧及后侧疼痛，小便频数但量少；如果小便失禁，则是肺气虚的表现。
治疗应当疏通经络气血，补益元气，疏散风热，方用通气散主治。
药物组成：羌活、独活、防风、藁本（以上药物用于通调经气）；黄芩、黄连（用于降火）；若属虚证，加用人参、黄芪。
另一种情况是由小肠经气机运行不畅引起。
还有一种情况是由风寒湿邪流注于经络，凝结阻滞于骨节之间，导致气血不和而引发疼痛。治疗应当祛除湿邪，疏散风寒。
此外，若是痰浊积聚，趁势沿着经络流注，搏结于血脉之中，也会产生同样的疼痛。治疗应当逐除痰浊积聚。
方用除湿丹：
槟榔、甘遂、赤芍药、威灵仙、泽泻、葶苈子（各二钱）；乳香（研碎）、没药（一两）；京大戟（炒制三两）；陈皮（四两）。
将上述药物制成糊丸，加入牵牛子末。
另有煨肾散：将甘遂填入猪腰子中，煨烤后研成粉末服用。
禹功散。
脉象弦细，是由于肝木之气过盛、火势旺盛，或者因为大怒导致气机上逆，肝气郁结而木气亢盛，又或者因为思虑不决、风邪中于肝脏，都会导致木气亢盛而生火，火势旺盛导致肝脉拘急而作痛。治疗应当用辛味药发散它，用苦味药泻火，方用当归龙荟丸、泻青丸等。
若有瘀血停滞在肝脏，汇聚于胁下而导致疼痛，发病时会有自汗，疼痛剧烈，按压时疼痛加重。治疗应当以破血为主，辅以活血，方用复元活血汤、导滞当归丸等。
若有痰浊积聚，流注于足厥阴肝经，导致胁下疼痛，发病时咳嗽牵引胁肋疼痛。治疗应当行气化痰，方用二陈汤加天南星、青黛、香附、青皮等。
龙胆泻肝丸（此处原文为龙荟丸，通常指当归龙荟丸或类似清肝泻火方，依原文保留名称并列出成分）：治疗食积发作，木气亢盛导致的胁痛。
药物组成：柴胡、甘草、青皮、黄连、当归、大黄、木香、芦荟、川芎、草龙胆。
导痰汤：治疗痰浊积聚流注。
外部症状包括：肝中风（左侧胁肋偏侧疼痛），肝中寒（胁下拘挛紧急），肝积（左侧胁肋疼痛），肝实证、肝虚证，筋实证，悬饮，食积，肉虚（左侧胁肋因咳嗽而疼痛），胆实热（胁下胀满坚硬），饮水后胁下鸣响如水声。
又有血枯证，表现为胁下胀满支撑感（经气运行不畅），妨碍饮食（肝损伤脾脏），发病初期先闻到腥臊气味，流出清稀液体，肝病累及肺叶，四肢清冷，头晕目眩，前后二阴出血，这是年轻时大量失血，或因房事过度导致肝伤气竭所致。若出现胁下面色发黑，身体僵硬不能翻身侧卧的，预后不良，主死。
If the pulse is rapid and tight at the upper position, it indicates Shoulder and Back Pain. If the pulse is deep and slippery, it indicates Pain of the Shoulder and Spine; if the pulse is surging and large, it indicates Wind-Heat.
This arises from Wind-Heat invading the Lung, causing severe stagnation and impaired circulation in the Hand-Taiyin Lung Meridian. The disease manifests as swelling of the cheeks and forehead, pain in the neck, shoulder, elbow, arm (lateral and posterior aspects), frequent but scanty urination; if urinary incontinence occurs, it indicates Lung Qi Deficiency.
Treatment should focus on unblocking the meridians and blood, tonifying Yuan Qi, and dispersing Wind-Heat. The primary formula is Tongqi San (Ventilation Powder).
Ingredients: Qianghuo (Notopterygii Rhizoma et Radix), Duhuo (Angelicae Pubescentis Radix), Fangfeng (Saposhnikoviae Radix), Gaoben (Ligustici Rhizoma et Radix) [these four unblock meridian Qi]; Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma) [these two descend Fire]; for deficiency patterns, add Renshen (Ginseng Radix et Rhizoma) and Huangqi (Astragali Radix).
Another cause is the impaired circulation of Qi in the Small Intestine Meridian.
Another scenario involves Cold, Wind, and Dampness flowing into the meridians, accumulating and stagnating in the bones and joints, leading to disharmony of Qi and Blood and resulting in pain. Treatment should aim to drain Dampness and disperse Cold and Wind.
Additionally, Phlegm accumulation may follow the meridians and flow into the vessels, causing similar pain. Treatment should focus on expelling Phlegm accumulation.
The formula Shichu Dan (Dampness-Draining Pill) is used:
Binglang (Arecae Semen), Gansui (Kansui Radix), Chishaoyao (Paeoniae Radix Rubra), Weilingxian (Salviae Miltiorrhizae Radix et Rhizoma - *Note: Standard TCM uses Cistanches or Salvia depending on context, here likely referring to a specific herb often associated with moving wind-damp, typically Lingzhi Cao or similar, but strictly translating name*), Zexie (Alismatis Rhizoma), Tingli (Periplocae Semen) [each 2 qian]; Xuxiang (Frankincense), Moyao (Myrrh) [1 liang]; Daji (Euphorbiae Pekinensis Radix) [stir-fried, 3 liang]; Chenpi (Citri Reticulatae Pericarpium) [4 liang].
Make pills using paste, adding Qianniu (Pharbitidis Semen) powder.
Another preparation is Wei Shen San (Roasted Kidney Powder): Stuff Gansui (Kansui Radix) into pig kidneys, roast until dry, and grind into powder.
Yugong San (Yugong Powder).
A wiry pulse indicates that Liver Wood Qi is excessive and Fire is flourishing, or it results from great anger causing Qi rebellion, Liver Qi stagnation with Wood excess, or Wind striking the Liver due to indecisive thinking. All these lead to Wood excess generating Fire, and excessive Fire causing Liver tension and pain. Treatment should use Pungent herbs to disperse and Bitter herbs to drain Fire. Formulas include Danggui Longhui Wan (Angelica Longda Pill) and Xieqing Wan (Drain Green Pill).
If Stasis-Blood remains in the Liver, gathering under the hypochondrium and causing pain, symptoms include spontaneous sweating, severe pain exacerbated by pressure. Treatment should primarily break Blood stasis and secondarily invigorate Blood. Formulas include Fuyuan Huoxue Tang (Restore Vitality Blood-Invigorating Decoction) and Daozhi Danggui Wan (Guide Stagnation Angelica Pill).
If Phlegm accumulation flows into the Foot-Jueyin Liver Meridian, causing pain under the hypochondrium, symptoms include coughing that pulls and hurts the hypochondrium. Treatment should move Qi and resolve Phlegm. Use Erchen Tang (Two-Aged Decoction) added with Nanting (Arisaematis Rhizoma), Qingdai (Indigo Naturalis), Xiangfu (Cyperi Rhizoma), and Qingpi (Citri Reticulatae Pericarpium Viride).
Longhui Wan (Dragon Gallbladder Pill - *Contextually refers to a liver-clearing formula*) treats pain in the hypochondrium caused by food stagnation triggering Wood excess.
Ingredients: Chaihu (Bupleuri Radix), Gancao (Glycyrrhizae Radix et Rhizoma), Qingpi (Citri Reticulatae Pericarpium Viride), Huanglian (Coptidis Rhizoma), Danggui (Angelicae Sinensis Radix), Dahuang (Rhei Radix et Rhizoma), Muxiang (Aucklandiae Radix), Lvhui (Aloe), Chuanxiong (Chuanxiong Rhizoma), Caolongdan (Gentianae Macrophyllae Radix).
Zuojin Wan (Left Metal Pill) treats Liver Fire.
Ingredients: Huanglian (Coptidis Rhizoma) [6 qian], Zhuyu (Evodiae Fructus) [1 qian].
Huoxue Dan (Blood-Invigorating Pill) treats Dead Blood (stubborn stasis).
Daotan Tang (Great Phlegm Decoction) treats Phlegm accumulation flowing through meridians.
External manifestations include: Liver struck by Wind (pain on one side of the left hypochondrium), Liver struck by Cold (cramping and urgency under the hypochondrium), Liver Accumulation (pain in the left hypochondrium), Liver Excess pattern, Liver Deficiency pattern, Sinew Excess pattern, Xuan Yin (Hanging Fluid/Hydrops), Food Stagnation, Flesh Deficiency (left hypochondrial pain triggered by cough), Gallbladder Excess Heat (fullness and hardness under the hypochondrium, water drinking causes gurgling under the hypochondrium).
There is also the Blood Depletion syndrome, characterized by fullness and distension under the hypochondrium (impeded meridian Qi), interference with eating (Liver injuring Spleen), initially smelling foul/fishy odors, secretion of clear fluids, Liver disease damaging Lung lobes, cold limbs, dizziness, bleeding from the anterior and posterior orifices. This results from massive blood loss in youth or Liver injury and Qi exhaustion due to sexual indiscretion. If the face turns black under the hypochondrium and the patient cannot turn over or lie on their side, death ensues.