有寒、有热、死血、食积、湿痰。清痰多作腹痛，大法用台芎、苍术、香附、白芷为末，姜汁入热汤调服。痰因
气滞而阻隘道路，气不通而痛者，宜导痰解郁。气用气药，木香、槟榔、枳壳、香附之类；血用血药，川芎、当
归、红花、桃仁之类。在上者多属食，宜温散之，如干姜、苍术、川芍、白芷、香附、姜汁之类。寒痛者，理中
汤、建中汤。一云∶小建中加姜、桂、台芎、苍术、白芷、香附，呕加丁香。热痛者，二陈加芩、连、栀，甚者
加干姜。一云∶调胃承气加木香、槟榔。醉饱有欲，小腹胀痛，用当归、芍药、川芎、柴胡、青皮、吴茱萸、生甘草、
桃仁，煎服之。如胸满及食少，加茯苓、半夏、陈皮。治酒积腹痛，宽气要紧，三棱、莪术、香附、官桂、苍术、浓
朴、陈皮、甘草、茯苓、木香、槟榔。木实腹痛，手不可近，六脉沉细，实甚有汗，大承气汤加桂强壮，痛甚再可加
桃仁，再甚加附子。小腹虚寒作痛，小建中汤入方∶芍药（六两） 桂枝（二两） 甘草（二两） 大枣（七枚） 生
姜（三两） 胶饴（一升）。脾湿积黄，心腹疼痛，胃苓汤；胃虚感寒，冷而心腹疼痛气弱者，理中汤；腹大痛，脉沉实，
附子理中汤合大承气汤，煎冷服。一老人心腹大痛，而脉洪大，虚痛昏厥，不食不胜攻系者，四君子汤加当归、麻黄、
沉香。一妇人寡居，经事久不行，腹满少食，小腹时痛，形弱身热∶用当归（一钱酒浸） 熟地黄（一钱姜炒） 香附
（一钱） 川芎（一钱半） 白芍药（一钱半） 陈皮（一钱半） 黄柏（炒五分） 生甘草（三钱） 知母（炒五
分） 浓朴（五分姜制） 玄胡索（五分） 白术（二钱） 大腹皮（三钱） 红花头（火酒浸九个）
桃仁（研九个） 上 咀水煎。脾胃湿而有寒，常虚痛者，理中
汤；心腹大痛，寒热呕吐，脉沉弦者，大柴胡汤。缩砂治腹中虚痛。戴云∶寒痛者，绵绵痛而无增减者是；时痛时止
者，热也；死血痛者，每痛有处，不行移者是；食积痛者，痛甚欲大便，利后痛减者是；湿痰痛者，凡痛必小便不利。
食作痛宜温散，勿大下之，盖食得寒则凝，得温则化，更兼行气、快气药，助之无不可者。或问∶痰岂能作痛？曰∶
痰因气滞而聚，即聚则碍道路，气不得运，故作痛矣。腹中鸣者，乃火击动其水也，盖水欲下流，火欲上炎，相触而
然。亦有脏寒有水而鸣者，宜分三阴部分而治，中脘太阴，脐腹少阴，小腹厥阴。
腹痛的病因主要有寒邪、热邪、瘀血、食积和湿痰。清稀之痰常引起腹痛，治疗大法是将天台乌药散中的川芎、苍术、香附、白芷研成粉末，用姜汁加入热汤中调服。痰因气机阻滞而阻碍道路，导致气不通畅而疼痛的，适宜采用导痰解郁的方法。治气滞用理气药，如木香、槟榔、枳壳、香附之类；治血瘀用活血药，如川芎、当归、红花、桃仁之类。病位在上焦的多属于食积，适宜用温散法，如干姜、苍术、川芎、白芷、香附、姜汁之类。寒性腹痛，用理中汤或建中汤。另一种说法是：小建中汤加生姜、肉桂、台芎、苍术、白芷、香附，若伴有呕吐加丁香。热性腹痛，用二陈汤加黄芩、黄连、栀子，病情严重的加干姜。另一种说法是：调胃承气汤加木香、槟榔。醉酒后饱食且纵欲，导致小腹胀痛，用当归、芍药、川芎、柴胡、青皮、吴茱萸、生甘草、桃仁煎服。如果伴有胸满及食欲减退，加茯苓、半夏、陈皮。治疗酒积引起的腹痛，关键在于宽理气机，方用三棱、莪术、香附、官桂、苍术、厚朴、陈皮、甘草、茯苓、木香、槟榔。木实（指实证剧烈）腹痛，手不可触碰，六脉沉细，实证严重且有汗出，用大承气汤加肉桂以强壮正气，疼痛剧烈再加桃仁，疼痛更甚再加附子。小腹虚寒作痛，用小建中汤，其组成为：芍药（六两）、桂枝（二两）、甘草（二两）、大枣（七枚）、生姜（三两）、胶饴（一升）。脾湿积滞发黄，心腹疼痛，用胃苓汤；胃虚感受寒邪，寒冷导致心腹疼痛且气虚者，用理中汤；腹部剧烈疼痛，脉象沉实，用附子理中汤合大承气汤，煎好后冷服。一位老人心腹剧烈疼痛，但脉象洪大，属虚痛导致昏厥，不能耐受攻下疗法，用四君子汤加当归、麻黄、沉香。一位寡妇，月经长久不行，腹部胀满，食欲减少，小腹时常疼痛，形体虚弱且身体发热：用当归（一钱，酒浸）、熟地黄（一钱，姜炒）、香附（一钱）、川芎（一钱半）、白芍药（一钱半）、陈皮（一钱半）、黄柏（炒五分）、生甘草（三钱）、知母（炒五分）、厚朴（五分，姜制）、玄胡索（五分）、白术（二钱）、大腹皮（三钱）、红花头（火酒浸九个）、桃仁（研碎九个）。以上药物切碎，加水煎煮。脾胃湿气重而有寒邪，经常虚痛者，用理中汤；心腹剧烈疼痛，伴有寒热呕吐，脉象沉弦者，用大柴胡汤。缩砂仁可治疗腹中虚痛。戴云说：寒性腹痛，是绵绵不断的疼痛且没有增减变化；时痛时止的，是热痛；瘀血疼痛，每次疼痛都有固定部位，不移动；食积疼痛，疼痛剧烈想大便，排便后疼痛减轻；湿痰疼痛，凡是疼痛必然小便不利。食积作痛适宜温散，不要使用峻下法，因为食物遇寒则凝结，遇温则消化，再加上行气、顺气药辅助，没有不可以的。有人问：痰难道能引起疼痛吗？回答说：痰因气机阻滞而聚集，一旦聚集就会阻碍道路，气机无法运行，所以产生疼痛。腹中鸣响，是火击动水所致，因为水欲下行，火欲上炎，相互接触碰撞从而发出声音。也有脏腑有寒有水而鸣响的情况，应当分三阴经部分来治疗，中脘属太阴，脐腹属少阴，小腹属厥阴。
The causes of abdominal pain include cold, heat, stagnant blood (blood stasis), food retention, and damp-phlegm. Clear phlegm often causes abdominal pain; the general treatment principle is to powder Chuanxiong Rhizome (Chuanxiong), Atractylodis Macrocephalae Rhizoma (Baizhu), Cyperi Rhizoma (Xiangfu), and Angelicae Dahuricae Radix (Baizhi), and take them mixed with ginger juice in hot water. When phlegm obstructs the pathways due to Qi stagnation, causing pain from blocked Qi flow, it is appropriate to guide out phlegm and resolve depression. For Qi stagnation, use Qi-regulating herbs such as Aquilariae Lignum Resinatum (Muxiang), Arecae Semen (Binglang), Aurantii Fructus (Zhiqiao), and Cyperi Rhizoma (Xiangfu); for blood stasis, use blood-invigorating herbs such as Chuanxiong Rhizome (Chuanxiong), Angelicae Sinensis Radix (Danggui), Carthami Flos (Honghua), and Persicae Semen (Taoren). Cases located in the upper jiao mostly belong to food retention and should be treated with warming and dispersing methods, using herbs like Dried Ginger (Ganjiang), Atractylodis Macrocephalae Rhizoma (Baizhu), Chuanxiong Rhizome (Chuanxiong), Angelicae Dahuricae Radix (Baizhi), Cyperi Rhizoma (Xiangfu), and ginger juice. For cold-type abdominal pain, use Lizhong Decoction or Jianzhong Decoction. Another view states: modify Xiaojianzhong Decoction by adding Fresh Ginger (Shengjiang), Cinnamon Twig (Guizhi), Taixiong, Atractylodis Macrocephalae Rhizoma (Baizhu), Angelicae Dahuricae Radix (Baizhi), and Cyperi Rhizoma (Xiangfu); add Illicium Fructus Anisatus (Dingxiang) if vomiting occurs. For heat-type abdominal pain, use Erchen Decoction modified with Scutellariae Radix (Huangqin), Coptidis Rhizoma (Huanglian), and Gardeniae Fructus (Zhizi); for severe cases, add Dried Ginger (Ganjiang). Another view suggests modifying Tiaowei Chengqi Decoction with Aquilariae Lignum Resinatum (Muxiang) and Arecae Semen (Binglang). After excessive drinking and feasting, combined with sexual indulgence, leading to distending pain in the lower abdomen, use Danggui, Shaoyao, Chuanxiong, Bupleuri Radix (Chaihu), Citri Reticulatae Pericarpium (Qingpi), Evodiae Fructus (Wuzhuyu), Raw Licorice Root (Sheng Gancao), and Persicae Semen (Taoren) decocted and taken orally. If accompanied by chest fullness and poor appetite, add Poria (Fuling), Pinelliae Tuber (Banxia), and Citri Reticulatae Pericarpium (Chenpi). To treat abdominal pain caused by alcohol accumulation, the key is to broaden and regulate Qi, using Sanleng, Ezhu, Xiangfu, Guigui, Baizhu, Magnoliae Officinalis Cortex (Houpo), Chenpi, Gancao, Fuling, Muxiang, and Binglang. For severe excess-type abdominal pain where the abdomen is tender to touch, six pulses are deep and fine, with severe excess symptoms and sweating, use Dachengqi Decoction plus Cinnamon Twig (Guizhi) to strengthen the body; if pain is severe, add Persicae Semen (Taoren); if even more severe, add Aconiti Lateralis Radix Praeparata (Fuzi). For deficiency-cold causing pain in the lower abdomen, use Xiaojianzhong Decoction, composed of: Paeoniae Radix Alba (Shaoyao, 6 liang), Cinnamon Twig (Guizhi, 2 liang), Glycyrrhizae Radix et Rhizoma (Gancao, 2 liang), Jujubae Fructus (Dazao, 7 pieces), Fresh Ginger (Shengjiang, 3 liang), and Malt Sugar (Jiaoyi, 1 sheng). For spleen dampness accumulation with jaundice and heart/abdominal pain, use Weiling Decoction; for stomach deficiency with cold invasion causing cold heart/abdominal pain and weak Qi, use Lizhong Decoction; for severe abdominal pain with deep and solid pulses, use Fuzi Lizhong Decoction combined with Dachengqi Decoction, taken cold after decoction. An elderly person suffered severe heart/abdominal pain but had a flooding pulse, indicating deficiency pain leading to fainting; since they could not tolerate purgative treatments, use Sijunzi Decoction plus Danggui, Ephedrae Herba (Mahuang), and Aquilariae Lignum Resinatum (Chenxiang). A widow whose menstruation had long ceased presented with abdominal fullness, poor appetite, occasional lower abdominal pain, weak physique, and low-grade fever: use Danggui (1 qian, soaked in wine), Shudihuang (1 qian, stir-fried with ginger), Xiangfu (1 qian), Chuanxiong (1.5 qian), Baishao (1.5 qian), Chenpi (1.5 qian), Huangbai (0.5 qian, stir-fried), Sheng Gancao (3 qian), Zhimu (0.5 qian, stir-fried), Houpo (0.5 qian, processed with ginger), Yanhusuo (0.5 qian), Baizhu (2 qian), Dadupi (3 qian), Honghua tou (9 heads, soaked in fire wine), and Taoren (9 seeds, crushed). Cut the herbs and decoct in water. For spleen/stomach dampness with cold causing frequent deficiency pain, use Lizhong Decoction; for severe heart/abdominal pain with alternating chills and fever, vomiting, and deep-wiry pulses, use Daichaihu Decoction. Amomum Fructus (Suosha) treats deficiency pain in the abdomen. Dai Yun stated: Cold pain is continuous without fluctuation; intermittent pain indicates heat; blood stasis pain has a fixed location and does not migrate; food retention pain is severe with an urge to defecate, relieving after bowel movement; damp-phlegm pain is always accompanied by difficult urination. For pain caused by food, warming and dispersing is suitable; do not use strong purgatives, as food congeals with cold and transforms with warmth. Adding Qi-moving and Qi-smoothing herbs aids this process. Question: Can phlegm cause pain? Answer: Phlegm accumulates due to Qi stagnation; once accumulated, it obstructs pathways, preventing Qi circulation, thus causing pain. Abdominal rumbling is caused by fire striking water; water desires to flow down while fire desires to rise, and their interaction creates the sound. There are also cases of organ cold and water retention causing rumbling, which should be treated according to the three Yin meridians: Zhongwan belongs to Taiyin, umbilical area to Shaoyin, and lower abdomen to Jueyin.