有湿霍乱。腹痛而上吐下泻者是也。藿香散主之。有干霍乱者。俗名斑痧。又名搅肠痧。吐
泻不见。面色青冷。腹中绞痛。乃阴阳错乱。最恶之候。而最易治。急刺委中部分出血。明矾末
调饮探吐。或用阴阳盐汤。或用菜油探吐。兼用碗刮背上。用苎麻根蘸清菜油。刮夺命穴督脉后
顶天庭等处。后服砂仁细末数口。连嗳数十声即愈。如遍身有斑者。用油纸捻火 之。以响为度。
或用荞麦汤饮之即愈。然其要在急刺委中出血。则不死。（即十指头出血。亦是良法。按委中穴
乃两膝内弯正中处。紧对膝盖。伸足取之。）
藿香散
藿香 苍术 浓朴 陈皮 半夏 茯苓
胃脘痛之病形何如。曰。胃脘痛。即俗所谓心痛也。心不可痛。痛则立死。以心在胃脘之前。故
误指胃痛为心痛也。胃痛有食痰死血气寒火中气虚之别。方书载列甚明。无甚深微。独有一种肝
胆之火。移入于胃而热。又肝藏血。血少则肝叶硬。不肯下垂。将叶抵胃。胃受肝抵。得食则满
。愈与肝相逼。殷殷而痛者。久之变成燥症。而为膈症矣。（此一种当入膈症中同看）又有一
种胃中作酸。不觉其为酸。每进饮食。不敢多用。多则竟日闷懑。直待食过。方得稍舒。此痛是
胃中一味酸热也。若得嗳一口气。亦觉少舒。然最难得者嗳也。若嗳得重。此自下转上。必有一
口食气。或水或挟物是酸者。其下最难得泄气。并且便硬。此皆少阳厥阴二脏之气所为也。久之
亦防其变为痞膈中满等症。（此种可并入吞酸症中看）又有一种胃脘痛。是阴虚症将成。须认明白。
二阳之病发心脾。此类可通。食痛者。胸膈按之痛甚。勺水不入。兼大便闭。闻谷气则欲吐。（
以下验症甚妙）用二陈汤。或平胃散。加桔梗枳实主之。（此即长洲所谓饮食停滞。消导之也。）
痰痛者。亦不思食。口即欲食而不能食。大便不闭。二陈汤加枳壳黄芩海石主之。（食痛者消其
食。则痛自止。痰痛者治其痰。则痛自定。法固如是。然前法设有不应。即当察其脾胃何如。仍参
诊法中痰食两条本法治之。）血痛者。胸膈刺痛。（脉必濡涩）食可进。四物汤加大黄桃仁红花
主之。（亦有宜用理中汤加肉桂桃仁红花者。须因症施之）虫痛者。亦不食。然痛必时发时止。
痛则牵引手臂。或肩背上。俱如穿透不可当。必唇红。面上有白点是也。痛时不欲食。痛才止即可食。实者。化虫丸主
之。虚者。六味丸加胡黄连川楝子青黛芦荟。随症加减治之。（凡虫皆风木所化。但泻厥阴则虫自除。六味地黄丸为妙。
胡连芦荟青黛等。甚非虚症所宜。须慎用。谦按。虫痛虚者。良由土败木乘。六味汤治脾胃阴虚则可。设脾胃阳虚。恐
非所宜。盖虫乃风木所化。物必先腐。然后虫生。当崇生气为主。则用理中汤去甘草少加川椒。送乌梅安胃丸。往往神
效也。）胃脘虚痛者。得食即止。（以手按之必稍缓。）食多又痛。食过又痛。理中汤主之。（此即中气虚痛也。）肝虚燥
痛
者。亦不思食。交阴分。外按之不热。病患自言热。口渴。（大便必燥结）逍遥散加生地丹皮山栀。甚者疏肝
益肾汤。加当归主之。（气寒火三症。四明不列症治。然验症则准绳为详。治法则薛案较妥。须并参之。）
二陈汤
陈皮 半夏 茯苓 甘草
平胃散
浓朴 苍术 陈皮 甘草
化虫丸
芜荑 雷丸 胡连 芦荟 使君 三棱 莪术
有湿霍乱，表现为腹痛且上吐下泻，这是湿霍乱的症状。藿香散主治此证。还有干霍乱，俗称斑痧，又名搅肠痧，症状为无呕吐和腹泻，面色青冷，腹部绞痛，这是由于阴阳错乱所致，是最凶险的症候，但也最容易治疗。应立即针刺委中部位出血，用明矾末调水饮用并探吐，或者使用阴阳盐汤，或者用菜油探吐。同时可用碗刮背部，用苎麻根蘸取清菜油，刮拭夺命穴、督脉后顶、天庭等部位。之后服用砂仁细末数口，连打数十个嗝即可痊愈。如果遍身出现斑点，用油纸捻火烤之，以发出响声为度。或者饮用荞麦汤即可痊愈。然而关键在于急刺委中出血，这样就不会死亡。（即使十指头出血，也是良法。按：委中穴位于两膝内侧弯曲的正中处，紧对膝盖，伸直腿时取穴。）
胃脘痛的病症形态如何？回答说：胃脘痛，就是俗话所说的心痛。心脏本身不会痛，一旦心痛就会立即死亡。因为心在胃脘的前面，所以误将胃痛指认为心痛。胃痛分为食积、痰饮、死血、气滞、寒邪、火热、中气虚等不同类型。方书记载得很清楚，没有深奥微妙的地方。唯独有一种是肝胆之火移入胃部导致发热，又因为肝藏血，血少则肝叶变硬，不肯下垂，将肝叶抵住胃，胃受到肝的压迫，进食后胃满，更加与肝相逼，隐隐作痛，久而久之变成燥症，进而成为膈症。（这一种应当归入膈症中一同看待）。还有一种是胃中产生酸味，自己不觉其为酸，每次进食不敢多吃，多吃则整天闷胀，直到食物消化后才稍感舒适。这种疼痛是胃中一味酸热所致。如果能打个嗝，也会觉得稍舒，但最难得的是能打出嗝来。如果打得重，这是气自下转上，必有一股食气，或者是水或者是夹杂异物导致的酸，其下部最难泄气，并且大便干燥。这都是少阳和厥阴二脏之气作用的结果。久而久之也要防备其变为痞膈、中满等症状。（这一种可以并入吞酸症中看待）。还有一种胃脘痛，是阴虚症即将形成的征兆，必须辨认清楚。“二阳之病发心脾”，这类情况可以通观。食积痛者，胸膈部按压时疼痛加剧，滴水不进，兼有大便闭塞，闻到谷物气味就想吐。（以下辨证非常精妙）。用二陈汤，或平胃散，加桔梗、枳实主治。（这就是长洲医家所说的饮食停滞，采用消导的方法治疗）。痰痛者，也不思饮食，嘴里想吃却吃不下，大便不闭塞，用二陈汤加枳壳、黄芩、海浮石主治。（食积痛消除食积，疼痛自然停止；痰痛治疗痰饮，疼痛自然安定，方法固然如此，但如果前面的方法无效，就应当观察脾胃状况，仍参照诊法中痰食两条的本法治之）。血瘀痛者，胸膈刺痛（脉象必然濡涩），可以进食，用四物汤加大黄、桃仁、红花主治。（也有适宜用理中汤加肉桂、桃仁、红花的，须根据症状施用）。虫痛者，也不吃东西，但疼痛必定时发时止，疼痛时牵引手臂，或者肩背，都像是穿透一样难以忍受，必定嘴唇红润，面上有白点。疼痛时不想吃东西，疼痛刚停就可以吃东西。实证用化虫丸主治，虚证用六味丸加胡黄连、川楝子、青黛、芦荟，随症状加减治疗。（凡虫皆由风木所化，只要泻厥阴经气则虫自除，六味地黄丸很妙。胡黄连、芦荟、青黛等，很不适合虚症，须慎用。谦按：虫痛属虚证的，确实是由于土败木乘，六味汤治疗脾胃阴虚是可以的，如果是脾胃阳虚，恐怕就不适宜了。因为虫乃风木所化，物体必先腐烂，然后生虫，应当以培养生气为主，那么就用理中汤去甘草少加川椒，送服乌梅安胃丸，往往有神效）。胃脘虚痛者，进食后疼痛即止（用手按压必稍缓解），吃得多了又痛，吃完后又痛，用理中汤主治。（这就是中气虚痛）。肝虚燥痛者，也不思饮食，进入阴分时段，外部触摸不热，病患自述发热，口渴（大便必然干燥结硬），用逍遥散加生地、丹皮、山栀，严重的用疏肝益肾汤加当归主治。（气寒、火三症，四明医家未列出症治，但辨证则准绳医案较详细，治法则薛己医案较妥当，须一并参考）。
There is damp-type Huoluan (acute vomiting and diarrhea), characterized by abdominal pain accompanied by upper vomiting and lower diarrhea. Huoxiang San (Patchouli Powder) is the primary prescription for this condition. There is also dry-type Huoluan, commonly known as Bansha (Spotted Sha), alternatively called Jiaochangsha (Intestine-Twisting Sha). Its symptoms include absence of vomiting and diarrhea, bluish-cold complexion, and severe cramping abdominal pain. This results from the disorder of Yin and Yang, representing a most ominous prognosis, yet it is also the easiest to treat. One should urgently prick the Weizhong area to induce bleeding, drink a mixture of alum powder with water to induce vomiting via probing, or use Yinyang salt soup, or vegetable oil to induce vomiting. Simultaneously, scrape the back using a bowl, dipping roots of Boehmeria nivea (Ramie root) in clear vegetable oil, scraping acupoints such as Duoming, Houding of the Governor Vessel, and Tianting. Afterwards, take a few mouthfuls of fine Sandaren powder (Amomum fruit powder); after belching dozens of times, recovery occurs. If spots appear all over the body, roast them with an oil-paper torch until they pop; or simply drink buckwheat soup for recovery. However, the key lies in urgently pricking Weizhong to bleed, ensuring survival. (Even bleeding from the ten fingertips is a good method. Note: Weizhong [BL40] is located at the midpoint of the transverse crease of the popliteal fossa, directly opposite the knee, taken with the leg extended.)
Huoxiang San
Patchouli Rhizome (Huoxiang) Atractylodes Rhizome (Cangzhu) Magnolia Bark (Nongpu) Tangerine Peel (Chenpi) Pinellia Tuber (Banxia) Poria Sclerotium (Fuling)
What is the clinical presentation of Stomach-epigastric Pain? It is said that Stomach-epigastric pain is what is colloquially referred to as Heart pain. The Heart itself cannot feel pain; if it does, death is immediate. Because the Heart lies anterior to the stomach epigastrium, gastric pain is mistakenly identified as heart pain. Gastric pain is differentiated into types caused by food retention, phlegm-dampness, static blood, Qi stagnation, cold pathogen, fire-heat, and deficiency of Middle Qi. Medical texts describe these clearly without profound subtleties. Uniquely, there is a type where Fire from the Liver and Gallbladder transfers into the Stomach causing heat. Since the Liver stores Blood, Blood deficiency causes the Liver lobes to become hard and fail to descend properly, pressing against the Stomach. When the Stomach receives this pressure, eating fills it, exacerbating the compression by the Liver, resulting in dull pain. Over time, this transforms into a Dryness syndrome, leading to Ge Syndrome (dysphagia/choking sensation). (This type should be viewed together with Ge Syndrome). Another type involves sourness in the Stomach, which the patient does not consciously recognize as sour. They dare not eat much; excessive intake causes whole-day oppression, relieving only slightly after digestion. This pain is due to a specific Sour-Heat in the Stomach. Belching brings slight relief, but belching is rare. Forceful belching indicates Qi rising from below, often carrying food gas, water, or foreign matter causing acidity. Lower expulsion of Qi is difficult, accompanied by hard stools. These are caused by the Qi of the Shaoyang and Jueyin organs. Over time, one must guard against transformation into Pi (obstruction), Ge (choking), or Zhongman (abdominal fullness) syndromes. (This type can be included under Sour Regurgitation). Another type of Stomach-epigastric pain indicates the impending formation of Yin Deficiency syndrome, requiring careful identification. "Diseases of the Two Yangs originate in the Heart and Spleen"; this category can be generalized. Food-retention pain presents with severe tenderness upon palpation of the chest and diaphragm, inability to swallow even a spoonful of water, constipation, and nausea upon smelling grain odors. (The following symptom verification is excellent). Use Erchen Tang (Two-Cured Decoction) or Pingwei San (Stomach-Pacifying Powder) with Jiegeng (Platycodon Root) and Zhishi (Immature Bitter Orange). (This corresponds to the Changzhou school's concept of food stagnation treated by promoting digestion). Phlegm-pain presents with loss of appetite, desire to eat but inability to do so, normal bowel movements. Use Erchen Tang with Zhike (Aurantium Fruit), Huangqin (Scutellaria Root), and Haishi (Floating Limestone). (Food pain stops when food is resolved; phlegm pain stabilizes when phlegm is treated. Although this is the standard method, if previous methods fail, observe the Spleen and Stomach status and refer to the diagnostic principles for Phlegm and Food). Blood-stasis pain presents with stabbing pain in the chest and diaphragm (pulse must be soggy and choppy), ability to eat. Use Siwu Tang (Four Substances Decoction) with Dahuang (Rhubarb Root), Taoren (Peach Kernel), and Honghua (Safflower). (Some cases may suit Lizhong Tang with Rougui (Cinnamon Bark), Taoren, and Honghua, depending on symptoms). Worm-pain presents with anorexia, intermittent pain, radiation to arms or shoulders like piercing pain, red lips, and white spots on the face. No appetite during pain, but appetite returns immediately after pain ceases. Excess patterns are treated with Huachong Wan (Worm-Expelling Pill); deficiency patterns with Liuwei Wan (Six-Ingredient Pill) plus Huhuanglian (Phellodendron Bark), Chuanlianzi (Sichuan Chinaberry Seed), Qingdai (Indigo Naturalis), and Lvhui (Aloe). (All worms transform from Wind-Wood; draining Jueyin removes worms; Liuwei Dihuang Wan is excellent. Huhuanglian, Lvhui, Qingdai are unsuitable for deficiency; use cautiously. Qian notes: Deficient worm-pain arises from Earth failure allowing Wood to overcome. Liuwei Tang treats Spleen-Stomach Yin deficiency well, but is unsuitable for Spleen-Stomach Yang deficiency. Since worms transform from Wind-Wood, objects must rot before worms arise; focus on generating Qi. Use Lizhong Tang minus Gancao, add少量 Chuanjiao, delivered with Wumei Anwei Wan, often achieving miraculous effects). Stomach-deficiency pain stops upon eating (relieved by pressure), recurs with overeating or post-prandially. Treat with Lizhong Tang. (This is Middle Qi deficiency pain). Liver-deficiency dryness-pain presents with anorexia, worsening during Yin hours, cool exterior touch despite patient's subjective fever and thirst (dry stool). Use Xiaoyao San with Shengdi (Rehmannia Root), Danpi (Moutan Bark), and Shanzhi (Gardenia Fruit). Severe cases use Shugan Yishen Tang with Danggui. (Qi-cold and Fire syndromes were not listed by Siming physicians, but Zhunsheng's symptom differentiation is detailed, while Xue Ji's treatment principles are sound; consult both).
Erchen Tang
Tangerine Peel (Chenpi) Pinellia Tuber (Banxia) Poria Sclerotium (Fuling) Licorice Root (Gancao)
Pingwei San
Magnolia Bark (Nongpu) Atractylodes Rhizome (Cangzhu) Tangerine Peel (Chenpi) Licorice Root (Gancao)
Huachong Wan
Toosendan Fruit (Wuyi) Polyporus (Leiwu) Phellodendron Bark (Hulian) Aloe (Luhui) Quinine Tree Seed (Shijunzi) Burreed Tuber (Sanleng) Curcuma Rhizome (Ezhu)