治右胁痛。
枳壳（一钱） 郁金（一钱） 桂心 甘草（炙，各五分） 桔梗 陈皮（各八分） 姜（二片） 枣（二枚
水煎散
治肝气燥急而胁痛，或发水泡。
大栝蒌（连皮捣烂，一枚） 粉甘草（二钱） 红花（七分
水煎服。
按∶郁火日久，肝气燥急，不得发越，故皮肤起泡，转为胀痛。经云∶损其肝者，缓其
中。栝蒌为物，甘缓而润，于郁不逆，又如油之洗物，滑而不滞，此其所以奏功也。
胃脘痛，治法与心痛相仿，但停食一症，其胀痛连胸者，吐之，胀痛连腹者，下之。其
食积之轻者，则用神术散消之。又有胃脘痈症，呕而吐脓血者，不得妄治。书云∶呕家有脓不
须治呕，脓尽自愈。
神术散 （方见食中。
腹中痛，其寒热、食积、气血、虫蛊，辨法亦与心痛相符。惟有肝木乘脾、搅肠痧、腹
内痈，兹三症有不同耳。经云∶诸痛皆属于肝，肝木乘脾，则腹痛，仲景以芍药甘草汤主之
甘草味甘，甘者，己也，芍药味酸，酸者，甲也，甲己化土，则肝木平，而腹痛止矣。伤
寒症中，有由少阳传入太阴而腹痛者，柴胡汤加芍药。有因误下传入太阴而腹痛者，桂枝汤
加芍药，即同此意。寻常腹痛，全在寒热、食积，分别详明为主。凡腹痛乍作乍止，脉洪有
力，热也，以芍药甘草汤加黄连清之。若嗳腐吞酸，饱闷膨胀，腹中有一条扛起者，是食积
也，保和丸消之。消之而痛不止，便闭不行，腹痛拒按者，三黄枳术丸下之。设或下后仍痛
以手按其腹，若更痛者，积未尽也，仍用平药再消之。若按之痛止者，积已去而中气虚也
五味异功散补之。若消导攻下之后，渐变寒中，遂至恶冷喜热，须易温中之剂。此火痛兼
食之治法也。若腹痛绵绵不减，脉迟无力者，寒也，香砂理中汤温之。若兼饱闷胀痛，是有
食积，不便骤补，香砂二陈汤，加姜、桂、楂、芽、浓朴，温而消之。消之而痛不止，大便
反闭，名曰阴结，以木香丸热药下之，下后，仍以温剂和之。如寒痛兼食之治法也。若因浊
气壅塞，走注疼痛，木香调气散散之。若因瘀血积聚，呆痛不移，泽兰汤行之。虫啮而痛，
唇有斑点，饥时更甚，化虫丸消之。伤暑霍乱，四味香薷饮解之，更有干霍乱症，欲吐不得吐
欲泻不能泻，变在须臾，俗名搅肠痧是也，更有遍体紫黑者，名曰乌痧胀，急用烧盐，和
阴阳水吐之。或用四陈汤服之，外用武侯平安散，点左右大眼角，其人即苏。其腹内痈一症
当脐肿痛，转侧作水声，小便如淋，千金牡丹皮散化之。古方治腹痛症，多以寒者为
虚，热者为实，未尽然也，盖寒证亦有实痛者，热证亦有虚痛者，如寒痛兼食，则为实矣，
挟热久痢，则为虚矣，凡看症之法，寒热虚实，互相辨明，斯无误也。
治疗右胁部疼痛。
枳壳（一钱） 郁金（一钱） 桂心 甘草（炙，各五分） 桔梗 陈皮（各八分） 生姜（二片） 大枣（二枚）
用水煎煮后服用散剂。
治疗因肝气燥急导致的胁痛，或者皮肤出现水泡。
大栝蒌（连皮捣烂，一枚） 粉甘草（二钱） 红花（七分）
用水煎煮后服用。
按语：郁结之火日久，导致肝气燥急，无法疏泄发散，所以皮肤起泡，转变为胀痛。《内经》说：“损伤肝脏的，要缓和其中焦。”栝蒌这种药物，性质甘缓而滋润，对于郁结之气不违背（即不逆其性），又如同油清洗物体一样，滑利而不滞涩，这就是它能奏效的原因。
胃脘疼痛，治疗方法与心痛相似，但如果是停食这一症状，疼痛牵连胸部的，用吐法；疼痛牵连腹部的，用下法。如果是轻微的食积，则使用神术散来消除它。又有胃脘痈症，呕吐并吐出脓血的，不能胡乱治疗。书上说：“有呕吐脓血的人不需要专门治呕，脓血排尽自然痊愈。”
神术散 （方剂见“伤食”章节）。
腹部疼痛，其寒热、食积、气血、虫蛊的辨别方法也与心痛相符。只有肝木乘脾、搅肠痧、腹内痈这三种病症有所不同。《内经》说：“各种疼痛大多归属于肝”，肝木乘脾，就会腹痛，张仲景用芍药甘草汤主治。甘草味甘，甘对应天干中的己土；芍药味酸，酸对应天干中的甲木，甲己化土，则肝木平和，腹痛也就停止了。在伤寒病症中，有由少阳传入太阴而导致腹痛的，用柴胡汤加芍药。有因误用下法传入太阴而导致腹痛的，用桂枝汤加芍药，这其中的道理是相同的。寻常腹痛，关键在于对寒热、食积进行详细分辨。凡是腹痛发作有时、停止有时，脉象洪大有力，属于热证，用芍药甘草汤加黄连来清热。如果嗳气带有腐臭味、吞酸、饱闷膨胀，腹部有一条筋脉隆起，这是食积，用保和丸来消导。消导后疼痛不止，大便不通，腹痛拒按的，用三黄枳术丸来攻下。假如攻下后仍然疼痛，用手按压腹部，如果按压时疼痛加剧，说明积滞未尽，仍需用平和的药物再次消导。如果按压后疼痛停止，说明积滞已去但中气虚弱，用五味异功散来补益。如果在消导攻下之后，逐渐变为中焦虚寒，以至于怕冷喜热，必须改用温中的方剂。这是火痛兼食积的治疗方法。如果腹痛绵绵不断，脉象迟而无力，属于寒证，用香砂理中汤来温中。如果兼有饱闷胀痛，是有食积，不便立即进补，用香砂二陈汤，加入生姜、肉桂、山楂、麦芽、厚朴，温中兼以消导。消导后疼痛不止，大便反而闭塞，名叫阴结，用木香丸这类热性药物攻下，攻下后，仍用温和的药物调和。这如同寒痛兼食积的治疗方法。如果是因为浊气壅塞，游走性疼痛，用木香调气散来行气。如果是因为瘀血积聚，疼痛固定不移，用泽兰汤来活血。像虫子咬噬一样的疼痛，嘴唇上有斑点，饥饿时更严重，用化虫丸来杀虫。伤暑霍乱，用四味香薷饮来解表祛暑。还有干霍乱症，想吐吐不出，想拉拉不出，病情变化极快，俗称搅肠痧。还有全身皮肤紫黑的，名叫乌痧胀，急用烧盐，配合阴阳水催吐。或者服用四陈汤，外用武侯平安散，点刺左右大眼角，病人即可苏醒。至于腹内痈这一病症，肚脐周围肿痛，转身时有水声，小便像淋病一样，用千金牡丹皮散来化解。古方治疗腹痛症，多认为寒证属于虚，热证属于实，这并不完全正确，因为寒证也有实痛，热证也有虚痛。比如寒痛兼食积，就属于实；挟带热邪的久痢，就属于虚。凡看诊的方法，寒热虚实，互相辨别清楚，就不会有误。
To treat pain in the right hypochondrium.
Zhiqiao (Fructus Aurantii, 1 qian) Yujin (Radix Curcumae Longae, 1 qian) Guixin (Cortex Cinnamomi) Gancao (Radix Glycyrrhizae, prepared, each 0.5 qian) Jiegeng (Radix Platycodonis) Chenpi (Pericarpium Citri Reticulatae, each 0.8 fen) Shengjiang (Rhizoma Zingiberis Recens, 2 slices) Dazao (Fructus Jujubae, 2 pieces)
Decoct with water and take as a powder suspension.
To treat hypochondriac pain caused by dryness and urgency of Liver Qi, or the appearance of blisters on the skin.
Gualou (Fructus Trichosanthis, crushed with peel, 1 piece) Fen Gancao (Radix Glycyrrhizae Preparata, 2 qian) Honghua (Flos Carthami, 0.7 fen)
Decoct with water and take orally.
Note: Stagnant fire for a long time causes dryness and urgency of Liver Qi, which cannot be vented, leading to skin blisters and transforming into distending pain. The Classic states: "When the Liver is damaged, soothe the Middle Jiao." Gualou is sweet, soothing, and moistening; it does not oppose stagnation, much like oil cleaning objects—slippery without stagnation. This is why it achieves its effect.
Pain in the epigastrium is treated similarly to heart pain. However, regarding food retention: if distending pain radiates to the chest, induce vomiting; if it radiates to the abdomen, purge. For mild food accumulation, use Shenzhu San to resolve it. There is also a condition of epigastric abscess where the patient vomits pus and blood; do not treat rashly. The text says: "For those vomiting pus, there is no need to specifically stop the vomiting; once the pus is exhausted, it will heal itself."
Shenzhu San (Formula see section on Food Retention).
Abdominal pain differentiation for cold-heat, food retention, qi-blood, and parasites follows similar principles to heart pain. Only three conditions differ: Liver Wood overacting on Spleen, Jiaochang Sha (Intestinal Twisting Colic), and intra-abdominal abscess. The Classic states: "All pains belong to the Liver." When Liver Wood overacts on the Spleen, abdominal pain occurs; Zhang Zhongjing uses Shaoyao Gancao Tang (Peony and Licorice Decoction) as the primary treatment. Gancao is sweet; Sweet corresponds to Ji (Earth); Shaoyao is sour; Sour corresponds to Jia (Wood). Jia and Ji transform into Earth, thereby calming Liver Wood and stopping abdominal pain. In Cold Damage syndromes, abdominal pain transmitted from Shaoyang to Taiyin is treated with Chaihu Tang (Bupleurum Decoction) plus Shaoyao. Abdominal pain due to erroneous purging transmitting to Taiyin is treated with Guizhi Tang (Cinnamon Twig Decoction) plus Shaoyao; the principle is the same. For common abdominal pain, the key lies in clearly distinguishing between cold-heat and food retention. If abdominal pain comes and goes, with a surging and forceful pulse, it is Heat; clear it with Shaoyao Gancao Tang plus Huanglian (Rhizoma Coptidis). If accompanied by belching with a rotten odor, acid regurgitation, fullness, bloating, and a raised band-like structure in the abdomen, it is Food Retention; resolve it with Baohe Wan (Preserve Harmony Pill). If pain persists after resolution, with constipation and tenderness upon pressure, purge it with Sanhuang Zhizhu Wan (Three Yellows and Atractylodes Pill). If pain persists after purging, and pressing the abdomen increases pain, the accumulation is not yet exhausted; continue resolving with mild medicines. If pressing stops the pain, the accumulation is gone but Middle Qi is deficient; tonify with Wumei Yigong San (Five-Ingredient Extraordinary Efficacy Powder). If, after resolving and purging, the condition gradually turns to Cold in the Middle, causing aversion to cold and preference for warmth, switch to warming formulas. This is the method for Fire Pain combined with Food Retention. If abdominal pain is continuous and unrelenting, with a slow and weak pulse, it is Cold; warm it with Xiangsha Lizhong Tang (Amomum and Aucklandia Decoction for Regulating the Middle). If accompanied by fullness and distending pain, indicating food retention, do not tonify hastily; use Xiangsha Erchen Tang (Amomum and Aucklandia Decoction for Regulating Phlegm-Dampness) added with Shengjiang (Fresh Ginger), Rougui (Cortex Cinnamomi), Shanzha (Fructus Crataegi), Maiya (Fructus Hordei Germinatus), and Houpo (Cortex Magnoliae Officinalis) to warm and resolve. If pain persists after resolution with constipation, it is called Yin Constipation; purge with Muxiang Wan (Aucklandia Pill) using hot medicines, then harmonize with mild medicines afterward, similar to treating Cold Pain with Food Retention. If pain is caused by turbid Qi obstruction and wandering pain, disperse it with Muxiang Tiaoqi San (Aucklandia Decoction for Regulating Qi). If pain is fixed and immovable due to Blood Stasis accumulation, move it with Zelan Tang (Lycopus Decoction). If pain feels like insect bites, with spots on the lips and worsening when hungry, eliminate parasites with Huachong Wan (Parasite Elimination Pill). For Summerheat-induced Huoluan (Vomiting and Diarrhea), resolve with Siwei Xiangru Yin (Four-Ingredient Elsholtzia Decoction). There is also Dry Huoluan, characterized by inability to vomit or defecate, changing rapidly, commonly known as Jiaochang Sha. If the whole body turns purple-black, it is named Wusha Zhang (Black Toxin Swelling); urgently induce vomiting with salted water mixed with Yin-Yang water. Alternatively, administer Sichun Tang (Four Olds Decoction), and externally apply Wuhou Ping'an San (Marquis Wu's Peaceful Powder) to prick the outer corners of both eyes, and the patient will recover. As for intra-abdominal abscess, characterized by swelling and pain around the umbilicus, water sounds when turning, and dysuria-like urination, resolve it with Qianjin Mudan Pi San (Millennium Tree Peony Bark Powder). Ancient formulas often considered Cold patterns as Deficiency and Heat patterns as Excess, which is not entirely accurate. Cold patterns can have Excess pain, and Heat patterns can have Deficiency pain. For instance, Cold pain with food retention becomes Excess; prolonged dysentery with Heat becomes Deficiency. In diagnosis, clearly distinguish between Cold, Heat, Excess, and Deficiency to avoid errors.