《经》云∶“肝病者，两胁下痛，引少腹，善怒。”又云∶“肝气实则怒，其脉当弦急
数实，其口当酸，其痛必甚，或烦渴二便不通。”
龙荟丸方
龙胆草 当归（并酒洗） 栀子 黄连 黄柏 黄芩（各一两） 大黄（酒洗，八钱） 青黛 芦荟
（各五钱） 木香（二钱半） 麝香（五分
蜜丸小豆大，姜汤下二、三十丸。
栝蒌汤\x 治左胁痛。
大栝蒌一只，重一、二两者，连皮捣烂，粉甘草二钱，红花五分，水煎服。
盖柴胡、龙荟、青黛、龙胆之类，苦寒益资其燥，而栝蒌柔而滑润，于郁不逆，甘缓润
下，故奏效捷也。
《内经》云∶“病胁下满气息，二、三岁不已，病名曰息积。”“夫消息者，阴阳之更
事也。今气聚于胁下，息而不消，则积而不散，故满逆而为病。然气不在胃，故不妨于食，
特害于气而已，治宜导引服药，药不可独治，盖导引能行积气，药力亦藉导引而行故也”。
推气散 治右胁痛，胀满不食。
片姜黄 枳壳 桂心（各三钱） 炙草（三钱
为末，每服二钱，姜枣汤调下，食远服。
赤茯苓汤 治息积胁下，气逆满闷。
赤茯苓 桂心 陈皮（半两，炒） 高良姜（一两） 大腹皮（五钱） 甘草（一分） 吴茱萸（三分
每服三钱 水煎，日二服。
白术丸
白术（陈土炒） 枳实（麸炒） 桂心（各一两半） 人参 陈皮 炙草 桔梗（各一两
上为末，蜜丸梧子大，空心酒下三十丸，日二。胁痛，左属肝主血，右属肺主气，多
痰积，然悲哀恼怒，郁伤肝气，两胁骨疼痛，筋脉拘急，腰脚重滞是也。
\x枳壳煮散
枳壳（四两先煮） 细辛 桔梗 防风 川芎（各二两） 葛根（一两半） 甘草（一两
为粗末，每服四钱，水一盏半，姜枣同煎至七分，空心食前服。
尤在泾云∶悲哀烦恼，肝气致郁，枳壳能通三焦之气，故以为君。肝欲散，故用细辛、
川芎
、桔梗之辛以散之。肝苦急，故用甘草之甘以缓之。其用防、葛者，悲则气敛，借风药以张
之也。
《黄帝内经》说：“肝脏有病，两侧胁肋下疼痛，牵引至小腹，容易发怒。”又说：“肝气实盛则易怒，其脉象应当弦急、数而有力，口中发酸，疼痛必然剧烈，或者出现心烦口渴、大小便不通畅的症状。”
龙荟丸方剂组成：
龙胆草、当归（均用酒清洗）、栀子、黄连、黄柏、黄芩（各一两），大黄（用酒清洗，八钱），青黛、芦荟（各五钱），木香（二钱半），麝香（五分）。
制成蜜丸，大小如小豆，用姜汤送服二十到三十丸。
栝蒌汤：治疗左侧胁痛。
大栝蒌一个，重量在一两到二两者，连皮捣烂，粉甘草二钱，红花五分，用水煎煮后服用。
大概是因为柴胡、龙荟丸、青黛、龙胆草这类药物，苦寒之性更加助长燥热；而栝蒌质地柔润滑利，对于气郁不会造成逆乱，具有甘缓润下的作用，所以见效迅速。
《内经》说：“如果病症表现为胁下胀满、呼吸异常，经过两三年不愈，这种病名叫‘息积’。”“所谓消息，是指阴阳的交替变化。如今气聚集在胁下，停滞而不能消散，于是积聚不散，导致胀满逆乱而发病。然而气并不在胃中，所以不影响进食，只是损害气的运行罢了，治疗适宜采用导引术配合服药。药物不能单独治疗，因为导引术能够运行积聚之气，药力也借助导引术才能发挥作用。”
推气散：治疗右侧胁痛，伴有胀满和食欲不振。
片姜黄、枳壳、桂心（各三钱），炙甘草（三钱）。
研为细末，每次服用二钱，用姜枣汤调服，在饭后较远的时间服用。
赤茯苓汤：治疗息积导致的胁下不适，气逆胀闷。
赤茯苓、桂心、陈皮（半两，炒制）、高良姜（一两）、大腹皮（五钱）、甘草（一分）、吴茱萸（三分）。
每次服用三钱，用水煎煮，每日服用两次。
白术丸：
白术（用陈土炒制）、枳实（用麦麸炒制）、桂心（各一两半），人参、陈皮、炙甘草、桔梗（各一两）。
以上药材研为细末，用蜂蜜制成梧桐子大小的丸剂，空腹时用酒送服三十丸，每日两次。
胁痛方面，左侧属于肝，主血；右侧属于肺，主气，多伴有痰积。然而悲哀恼怒会损伤肝气，导致两侧肋骨骨骼疼痛，筋脉拘挛紧急，腰脚沉重滞涩，这就是上述症状的表现。
枳壳煮散：
枳壳（四两，先煎煮）、细辛、桔梗、防风、川芎（各二两），葛根（一两半），甘草（一两）。
制成粗末，每次服用四钱，用水一盏半，加入生姜和大枣同煎至七分量，空腹及饭前服用。
尤在泾说：“悲哀烦恼导致肝气郁结，枳壳能够疏通三焦的气机，所以作为君药。肝喜疏散，所以使用细辛、川芎、桔梗的辛味来疏散它。肝怕急迫，所以使用甘草的甘味来缓和它。使用防风、葛根的原因在于，悲伤会导致气机收敛，借风药的升散之力来张开气机。”
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: "In liver diseases, there is pain under both hypochondria, radiating to the lower abdomen, and irritability." It further states: "When Liver Qi is excess, anger occurs; the pulse should be wiry, rapid, forceful, and full; the mouth tastes sour; the pain must be severe; or there may be vexation, thirst, and obstruction of urination and defecation."
Longhui Wan (Dragon Gallbladder Pill) Formula:
Longdan Cao (Gentianae Radix), Danggui (Angelicae Sinensis Radix) (both washed with wine), Zhizi (Gardeniae Fructus), Huanglian (Coptidis Rhizoma), Huangbai (Phellodendri Cortex), Huangqin (Scutellariae Radix) (each 1 liang), Dahuang (Rhei Radix et Rhizoma) (washed with wine, 8 qian), Qingdai (Indigo Naturalis), Lvhui (Aloe) (each 5 qian), Muxiang (Aucklandiae Radix) (2.5 qian), Shexiang (Moschus) (0.5 fen).
Made into honey pills, size of small beans, taken with ginger decoction, 20-30 pills per dose.
Gualou Tang (Trichosanthes Decoction): Treats left-sided hypochondriac pain.
One large Gualou (Trichosanthis Fructus), weighing 1-2 liang, smashed with peel included, Fen Gancao (Licorice Root) 2 qian, Honghua (Carthami Flos) 0.5 fen, decocted in water and taken orally.
Generally, herbs such as Chaihu (Bupleuri Radix), Longhui Wan, Qingdai, and Longdan Cao are bitter and cold, which may exacerbate dryness; whereas Gualou is soft, smooth, and moistening, it does not oppose stagnation, has a sweet,緩 (soothing) and moistening downward effect, thus achieving quick results.
The *Neijing* states: "If the disease presents with fullness under the hypochondria and abnormal breathing, persisting for two or three years without resolution, the disease is named 'Xi Ji' (Breathing Accumulation)." "What is called 'xi xi' refers to the alternating events of Yin and Yang. Now, if Qi gathers under the hypochondria, remains stagnant and does not dissipate, it accumulates and does not scatter, leading to fullness and rebellion causing disease. However, since the Qi is not in the Stomach, eating is not hindered; only the movement of Qi is harmed. Treatment should employ Daoyin (guiding and pulling exercises) combined with medication. Medication alone cannot treat this, because Daoyin can move accumulated Qi, and medicinal power also relies on Daoyin to act."
Tuiqi San (Pushing Qi Powder): Treats right-sided hypochondriac pain, distension, fullness, and anorexia.
Pian Jianghuang (Curcumae Longae Rhizoma), Zhiqiao (Aurantii Fructus), Guixin (Cinnamomi Ramulus) (each 3 qian), Zhi Cao (Prepared Licorice Root) (3 qian).
Grind into powder, take 2 qian per dose, mixed with Ginger-Jujube Decoction, taken well after meals.
Chifuling Tang (Red Poria Decoction): Treats Xi Ji affecting the hypochondria, with rebellious Qi, fullness, and oppression.
Chifuling (Polyporus Umbellatus), Guixin (Cinnamomi Ramulus), Chenpi (Citri Reticulatae Pericarpium) (half liang, stir-fried), Gaoliangjiang (Alpiniae Officinarum Rhizoma) (1 liang), Dafupi (Arecae Pericarpium) (5 qian), Gancao (Licorice Root) (1 fen), Wuzhuyu (Evodiae Fructus) (3 fen).
Take 3 qian per dose, decoct in water, twice daily.
Baizhu Wan (Atractylodes Macrocephala Pill):
Baizhu (Atractylodis Macrocephalae Rhizoma) (stir-fried with old soil), Zhishi (Aurantii Fructus Immaturus) (stir-fried with bran), Guixin (Cinnamomi Ramulus) (each 1.5 liang), Renshen (Ginseng Radix), Chenpi (Citri Reticulatae Pericarpium), Zhi Cao (Prepared Licorice Root), Jiegeng (Platycodonis Radix) (each 1 liang).
Grind the above into powder, make into honey pills the size of wu zi (wu berry seeds), take 30 pills with wine on an empty stomach, twice daily.
Regarding hypochondriac pain, the left side belongs to the Liver and governs Blood; the right side belongs to the Lung and governs Qi, often accompanied by Phlegm accumulation. However, sorrow and anger injure Liver Qi, causing pain in the bones of both hypochondria, spasm and tension of sinews and vessels, and heaviness and stiffness of the waist and legs. This describes the aforementioned symptoms.
Zhiqiao Zhu San (Boiled Zhiqiao Powder):
Zhiqiao (Aurantii Fructus) (4 liang, boiled first), Xixin (Asari Radix et Rhizoma), Jiegeng (Platycodonis Radix), Fangfeng (Saposhnikoviae Radix), Chuanxiong (Ligustici Chuanxiong Rhizoma) (each 2 liang), Gegen (Puerariae Lobatae Radix) (1.5 liang), Gancao (Licorice Root) (1 liang).
Make into coarse powder, take 4 qian per dose, with one and a half cups of water, decoct with Ginger and Jujube until seven-tenths remain, take on an empty stomach and before meals.
You Zaijing stated: "Sorrow and distress cause Liver Qi to become depressed. Zhiqiao can unblock the Qi of the Triple Burner, so it is used as the Sovereign herb. The Liver desires dispersion, so Xixin, Chuanxiong, and Jiegeng are used for their acridity to disperse it. The Liver suffers from urgency, so Gancao is used for its sweetness to moderate it. The use of Fangfeng and Gegen is because grief causes Qi to contract; wind herbs are borrowed to expand it."