（小腹痛。）
经脉有正有别，其别分络脏腑部位，邪在正经，则注于别络，而从脏腑所
虚之部位而入焉。（胸为心肺部位，肚腹脾胃部位， 胁小腹肝胆部位，腰脊肾部位也。）
邪入则气
停液聚，痰血不行，脉络皆满，邪正相搏故痛。六淫七情，饮食劳倦，皆能致之，
不独寒也。痛脉多紧急，河间谓急脉固属寒象，然寒脉当短小而迟，若兼洪数，则
为热痛之脉。分寒热、虚实、气血、饮食、痰虫施治。寒痛∶绵绵无增减，喜热恶
寒，口中和，二便清利，脉沉迟，干姜、肉桂、吴萸、草蔻、木香、浓朴、陈皮、
香附之属。诸寒痛得热即止者，用熟艾半斤，隔白纸铺腹中，又以憨葱数枝，批作
两半片，铺艾上，再用纸盖之，慢火熨斗熨之，冷则易，觉腹中热，腹皮热难当，
仍用帛裹紧，将冷乃解。一法用炒盐熨。房事后受寒腹痛，灸神阙、气海等穴，或
炒姜、葱熨之、内服理中、（见中寒。）四逆（见厥）等汤。热痛∶时痛时止，口干舌燥，
二便结涩，喜冷恶热，脉洪数，白芍、黄芩、黄连、山栀、甘草之属。寒亦有实，
热亦有虚，热实者寒药下之，（三承气等。）寒实者热药下之。（备急丸等。）辨虚实法不一，而
可按属虚，拒按属实，尤其显著者。治虚分气血，痛时常觉虚豁，似饥非饥，
呼吸无力，气虚也，六君子（见气）加木香。若偎偎作痛，似细筋抽引不宁，又如芒刺牵
引，属血虚，四物（见血）加陈皮、甘草、木香。气滞作痛，则腹胀脉沉，木香顺气散、
七气汤，（见气）此为气实。又饮食、痰湿、死血、虫作痛，皆为实。食痛∶欲大便，便
后痛减，脉沉滑或弦。食得寒则凝，得热则行，平胃散（见伤饮食）加枳实、草蔻、半夏，
保和丸、枳术丸（二丸并见伤饮食）之属。酒积痛∶三棱、蓬术、香附、苍术、浓朴、陈皮、
茯苓，木香槟榔丸主之。多年败田螺壳 存性，加三倍于木香槟榔丸中，更加山栀、
茵陈，其效甚速。痰痛∶脉必滑，眩运吐涎，或下白积，或小便不利，（痰碍气道也。）或
得辛辣热汤则暂止，二陈（见痰饮）加苍术、香附、抚芎、枳实、姜汁。死血作痛，
脉必涩，痛有定处，元胡、归尾、五灵脂、苏木、桃仁、没药、赤芍等。或桃仁承
气汤（见血），虚者加归、地，蜜丸服，以缓除之。虫痛∶心腹懊 ，往来上下，痛有休
止，或腹中块起，恶心，吐清水，食浓味或饱即止，面色青白赤不定。蛔虫攻咬，
面必黄，（参看心痛门。）鸡汁吞万应丸（见虫。）雄黄、白矾，饭丸亦可。感湿而痛，小便不利，
大便溏泄，脉必细，胃苓汤（见泄泻。）感暑而痛∶吐利并作，脉必虚豁，十味香薷饮、六
和汤。（并见伤暑。）详霍乱门。失笑散（见心痛。）治心腹痛神效。刘寄奴末六钱，玄胡索末四
钱，姜汁热酒调服亦佳，皆通理气血之剂也。中脘痛，太阴也，理中（见中寒）、建
中（见劳倦）之类。脐腹痛，少阴也，四逆（见厥）、真武之类。（景东阳谓心脾筋结脐，胃筋脉挟脐，当
脐明属脾胃。其肾之筋脉从腰贯脊，并不及脐，当脐痛用肾经药太误。愚谓肾附于脊，正与
脐对。又胎胞初
结，中起一茎，形如莲蕊，一茎即脐蒂，莲蕊即肾。是脐乃肾之根蒂，而位又正对，则当脐痛，
虽与少阴经
无涉，而谓与肾脏无关，亦不可也。）小腹痛，厥阴也，重则正阳散、回阳丹之类，轻则当归四
逆汤（见厥。）之类。小腹痛∶因小便不利者，五苓散（见伤湿）。若小便利者，审是血证，桃
仁承气（见血）之类。若肝气郁痛者，青皮、柴胡之属。亦以可按为虚，拒按为实。气寒
血结，威灵散。气滞血凝，当归散。若连阴作痛，按之即止，为肝经血虚，四物（见血）
加牛膝、人参、炙草。又白胶香一味最妙。其有青筋见于小腹及大腹，乃肝火乘脾，
小柴胡（见寒热）合四物，加胆草、山栀。若因睾丸肿疼，牵引而痛，乃疝气病也。霍乱
腹痛，必吐利兼作，亦有不吐利者，名干霍乱。又肠痈腹痛，小腹痛并小便数，似
淋，身甲错，腹皮急，按之软，如肿状，或绕脐生疮，可辨也。又有胞痹一证，小
便不利，小腹按之痛，若沃以汤，详痹及淋二门。
（小腹部疼痛。）
经脉有正经和别络之分，别络分别联络脏腑所在的部位。邪气如果在正经，就会注入别络，并从脏腑虚弱所在的部位侵入。（胸部是心肺所在的部位，肚腹是脾胃所在的部位，胁肋和小腹是肝胆所在的部位，腰脊是肾脏所在的部位。）邪气侵入后导致气机停滞、津液聚积，痰浊和瘀血运行不畅，脉络充盈，邪气与正气相互搏结所以产生疼痛。六淫（风、寒、暑、湿、燥、火六种外感病邪）和七情（喜、怒、忧、思、悲、恐、惊七种情志变化），以及饮食不节和劳倦过度，都能导致腹痛，并不仅仅是因为寒邪。腹痛的脉象多表现为紧急，刘河间认为急脉固然属于寒象，但是寒证的脉象应当短小且迟缓，如果兼见洪大和数象，那就是热痛的脉象。治疗时要区分寒热、虚实、气分血分、饮食积滞、痰浊虫积来进行施治。寒痛：疼痛绵绵不断且没有增减，喜欢温热厌恶寒冷，口中平和无味，大小便清利通畅，脉象沉迟，可用干姜、肉桂、吴茱萸、草豆蔻、木香、厚朴、陈皮、香附这类药物。各种寒痛遇到热就停止的，用熟艾半斤，隔着一张白纸铺在腹部，再用葱段数枝，剖成两半片，铺在艾绒上，再用纸盖住，用小火熨斗熨烫，凉了则更换，感觉到腹中发热，腹皮热得难以忍受时，仍用布帛裹紧，等到冷却后再解开。另一种方法是用炒热的盐熨烫。房事后受寒引起的腹痛，可以灸神阙穴、气海穴等穴位，或者用炒过的生姜、葱白熨烫，内服理中汤（见中寒章节）、四逆汤（见厥逆章节）等方剂。热痛：疼痛时作时止，口干舌燥，大小便干结涩滞，喜欢冷恶热，脉象洪数，可用白芍、黄芩、黄连、山栀、甘草这类药物。寒证也有实证，热证也有虚证，热实证用寒凉药攻下（如三承气汤等），寒实证用温热药攻下（如备急丸等）。辨别虚实的方法不一，但按之舒适属虚，拒按属实，这是尤其显著的特征。治疗虚证要区分气和血，疼痛时常觉得空虚，似饥非饥，呼吸无力，这是气虚，用六君子汤（见气虚章节）加木香。如果是隐隐作痛，像细筋抽引不安，又像芒刺牵引，属于血虚，用四物汤（见血虚章节）加陈皮、甘草、木香。气滞作痛，则腹胀脉沉，用木香顺气散、七气汤（见气滞章节），这属于气实。又有饮食、痰湿、死血（瘀血）、虫积引起的疼痛，都属于实证。食积痛：想大便，排便后疼痛减轻，脉象沉滑或弦。食物遇寒则凝结，遇热则通行，用平胃散（见伤饮食章节）加枳实、草豆蔻、半夏，或用保和丸、枳术丸（这两丸均见伤饮食章节）这类方剂。酒积痛：用三棱、莪术、香附、苍术、厚朴、陈皮、茯苓，以木香槟榔丸为主治。多年的败田螺壳煅存性，加入三倍于木香槟榔丸的量，再加山栀、茵陈，效果非常迅速。痰痛：脉象必定滑，头晕目眩吐涎沫，或者排出白色黏液，或者小便不利（痰阻碍气道），或者喝辛辣热汤暂时缓解，用二陈汤（见痰饮章节）加苍术、香附、抚芎（川芎的一种）、枳实、姜汁。瘀血作痛，脉象必定涩，疼痛部位固定，用延胡索、当归尾、五灵脂、苏木、桃仁、没药、赤芍等。或者用桃仁承气汤（见血证章节），体虚者加当归、地黄，制成蜜丸服用，以缓和地消除瘀血。虫痛：心腹烦闷不适，疼痛上下走窜，疼痛有间歇，或者腹部出现肿块，恶心，吐出清水，吃浓味食物或吃饱后疼痛停止，面色青、白、红不定。蛔虫攻咬，面色必定发黄（参看心痛门），用鸡汁送服万应丸（见虫证章节）。雄黄、白矾，做成饭丸也可以。感受湿邪而痛，小便不利，大便溏泄，脉象必定细，用胃苓汤（见泄泻章节）。感受暑邪而痛：呕吐和腹泻同时发作，脉象必定虚豁，用十味香薷饮、六和汤（均见伤暑章节）。详见霍乱门。失笑散（见心痛章节）治疗心腹痛神效。刘寄奴末六钱，玄胡索末四钱，用姜汁和热酒调服也很好，这些都是通理气血的药剂。中脘部疼痛，属于太阴经病变，用理中汤（见中寒章节）、建中汤（见劳倦章节）之类。脐周疼痛，属于少阴经病变，用四逆汤（见厥逆章节）、真武汤之类。（景东阳认为心脾筋结于脐，胃筋脉挟持脐部，当脐处明确属于脾胃。肾的筋脉从腰部贯穿脊柱，并不到达脐部，当脐痛使用肾经药物是大错特错的。我认为肾脏附着于脊柱，正好与脐相对。而且胎胞初结时，中间起一根茎，形状像莲蕊，这根茎就是脐蒂，莲蕊就是肾。所以脐是肾的根本蒂系，位置又正对，那么当脐痛，虽然与少阴经无关，但说与肾脏无关，也是不可以的。）小腹疼痛，属于厥阴经病变，严重的用正阳散、回阳丹之类，轻的用当归四逆汤（见厥逆章节）之类。小腹痛：因为小便不利的，用五苓散（见伤湿章节）。如果小便通利的，审查是否是血证，用桃仁承气汤（见血证章节）之类。如果是肝气郁结疼痛的，用青皮、柴胡这类药物。同样是以按之舒适为虚，拒按为实。气寒血结，用威灵散。气滞血凝，用当归散。如果连及阴部作痛，按压即止，为肝经血虚，用四物汤（见血虚章节）加牛膝、人参、炙甘草。另外单用白胶香一味最好。如果有青色筋脉出现在小腹及大腹，这是肝火乘脾，用小柴胡汤（见寒热章节）合四物汤，加龙胆草、山栀。如果是因为睾丸肿痛，牵引而痛，这是疝气病。霍乱腹痛，必定呕吐和腹泻同时发作，也有不吐不泻的，名叫干霍乱。还有肠痈腹痛，小腹痛并伴有小便频数，类似淋证，身体皮肤粗糙如鳞甲，腹皮紧张，按压柔软，像肿状，或者绕脐生疮，可以辨别。还有胞痹一证，小便不利，小腹按压疼痛，感觉像用水浇一样灼热，详见痹证及淋证二门。
(Small abdominal pain.)
Meridians have regular (Zheng) and collateral (Bie) branches. The collateral branches respectively connect to the regions of the Zang-Fu organs. If pathogenic factors are in the regular meridians, they flow into the collateral branches and enter from the regions where the Zang-Fu organs are deficient. (The chest is the region of the Heart and Lung; the abdomen is the region of the Spleen and Stomach; the hypochondrium and small abdomen are the regions of the Liver and Gallbladder; the lower back and spine are the region of the Kidney.) When pathogens enter, Qi stagnates and fluids accumulate, phlegm and blood stasis fail to circulate, meridians become full, and the struggle between pathogenic factors and healthy Qi causes pain. The Six Excesses (Wind, Cold, Summerheat, Dampness, Dryness, Fire), Seven Emotions (Joy, Anger, Worry, Thought, Grief, Fear, Fright), improper diet, and overexertion can all cause this, not just Cold. Pain pulses are mostly tight and urgent. Liu Hejian stated that a tight pulse certainly belongs to Cold manifestations, but a Cold pulse should be short, small, and slow. If it is accompanied by a surging and rapid quality, it is the pulse of Heat pain. Treatment should be differentiated based on Cold/Heat, Deficiency/Excess, Qi/Blood, Food retention, Phlegm, and Parasites.
Cold pain: A continuous, unvarying pain, preferring warmth and disliking cold, with a neutral taste in the mouth, clear and free urination and defecation, and a deep, slow pulse. Herbs such as Ganjiang (Dried Ginger), Rougui (Cinnamon Bark), Wuyu (Evodia Fruit), Caodoukou (Black Cardamom), Muxiang (Aucklandia Root), Houpo (Magnolia Bark), Chenpi (Tangerine Peel), and Xiangfu (Cyperus Rhizome) may be used. For various cold pains that cease upon exposure to heat, use half a jin of Shuai Ai (Prepared Mugwort Leaf). Place it on the abdomen covered by a sheet of white paper, then lay several stalks of Congbai (Scallion White), split in half, over the mugwort, cover with paper again, and apply heat slowly using an iron. Replace when cool. When heat is felt in the abdomen and the skin becomes too hot to bear, wrap tightly with cloth and only remove when cooled. Another method is to use stir-fried salt for moxibustion-like warming. For abdominal pain caused by Cold after sexual intercourse, moxa points such as Shenque (CV-8) and Qihai (CV-6), or apply stir-fried Ginger and Scallion externally, and internally administer Lizhong Tang (Ginseng and Dried Ginger Decoction) (see Middle Cold) or Sini Tang (Frigid Extremities Decoction) (see Jue syndrome).
Heat pain: Intermittent pain, dry mouth and tongue, constipation and difficult urination, preference for cold and aversion to heat, with a surging and rapid pulse. Herbs such as Baishao (White Peony Root), Huangqin (Scutellaria Root), Huanglian (Coptis Rhizome), Shanzhi (Gardenia Fruit), and Gancao (Licorice Root) may be used. Cold patterns also have Excess types, and Heat patterns have Deficiency types. Heat Excess is treated with cold purgatives (e.g., San Chengqi Tang variants); Cold Excess is treated with warm purgatives (e.g., Beijiji Wan). Methods to differentiate Deficiency and Excess vary, but tenderness upon pressure indicates Deficiency, while resistance to pressure indicates Excess, which is particularly significant. Treating Deficiency requires distinguishing Qi and Blood. If pain feels hollow, resembling hunger without actual hunger, and breathing is weak, it is Qi Deficiency; treat with Liujunzi Tang (Six Gentlemen Decoction) (see Qi Deficiency) plus Muxiang. If the pain is dull, feeling like fine tendons pulling uneasily, or like thorns dragging, it is Blood Deficiency; treat with Siwu Tang (Four Substance Decoction) (see Blood Deficiency) plus Chenpi, Gancao, and Muxiang. Qi stagnation causing pain presents with abdominal distension and a deep pulse; treat with Muxiang Shunqi San or Qi Qi Tang (see Qi Stagnation), indicating Qi Excess. Additionally, pain from food, damp-phlegm, dead blood (stasis), and parasites are all Excess.
Food retention pain: Desire to defecate, pain relieved after defecation, pulse deep-slippery or wiry. Food congeals in Cold and moves in Heat. Treat with Pingwei San (Peaceful Stomach Powder) (see Food Injury) plus Zhishi (Immature Bitter Orange), Caodoukou, and Banxia, or Baohe Wan (Preserve Harmony Pill) and Zhizhu Wan (Immature Bitter Orange and Atractylodes Pill) (both see Food Injury). Wine accumulation pain: Use Sanleng (Zedoary Rhizome), E Zhu (Curcuma Rhizome), Xiangfu, Cangzhu (Atractylodes Rhizome), Houpo, Chenpi, and Fuling (Poria). The primary formula is Muxiang Binglang Wan (Aucklandia and Betel Nut Pill). Add calcined shells of old field snails at three times the dose of Muxiang Binglang Wan, plus Shanzhi and Yinchen (Artemisia Capillaris), for rapid effect.
Phlegm pain: Pulse must be slippery, accompanied by dizziness, salivation, discharge of white mucus, or difficulty urinating (phlegm obstructing the Qi pathway), or temporary relief with spicy hot drinks. Treat with Erchen Tang (Two Aged Ingredients Decoction) (see Phlegm-Fluids) plus Cangzhu, Xiangfu, Fuxiong (Chuanxiong), Zhishi, and Jiangzhi (Ginger Juice). Dead blood (stasis) pain: Pulse must be choppy, pain fixed in location. Use Yanhusuo (Corydalis Rhizome), Guiwei (Angelica Sinensis Tail), Wulingzhi (Trogopterus Dung), Sumu (Sappan Wood), Taoren (Peach Kernel), Moyao (Myrrh), and Chishao (Red Peony Root). Or use Tao Ren Cheng Qi Tang (Peach Kernel and Magnesium Chloride Decoction) (see Blood Syndromes); for Deficient patients, add Danggui (Angelica Sinensis) and Dihuang (Rehmannia Root), form into honey pills, and take to resolve gradually.
Parasite pain: Visceral restlessness, pain moving up and down, intermittent pain, abdominal masses, nausea, vomiting of clear fluid, pain stopping after eating rich flavors or becoming full, complexion fluctuating between green, white, and red. Ascaris attack causes yellow complexion (see Heart Pain section). Swallow Wanying Wan (Universal Pill) (see Parasites) with chicken juice. Xionghuang (Realgar) and Baifan (Alum) made into rice pills are also effective.
Pain from Dampness: Difficulty urinating, loose stools, pulse must be fine. Treat with Weiling Tang (Gastrodia and Poria Decoction) (see Diarrhea). Pain from Summerheat: Vomiting and diarrhea occurring together, pulse must be hollow and weak. Treat with Shiwei Xiangru Yin (Ten-Ingredient Mosla Drink) or Liuhe Tang (Harmonizing Six Harmonies Decoction) (both see Summerheat Injury). See Huoluan section. Shixiao San (Dispel Stasis Powder) (see Heart Pain) is miraculous for heart and abdominal pain. Liuju Nu powder 6 qian, Yuanhusuo powder 4 qian, mixed with ginger juice and hot wine is also good; these are agents that regulate Qi and Blood.
Middle epigastrium pain belongs to Taiyin; treat with Lizhong Tang (see Middle Cold) or Jianzhong Tang (Establish the Middle Decoction) (see Fatigue/Overwork). Periumbilical pain belongs to Shaoyin; treat with Sini Tang (see Jue) or Zhenwu Tang (True Warrior Decoction). Jing Dongyang argued that the tendons of Heart/Spleen knot at the navel, and Stomach tendons flank it, so periumbilical pain belongs to Spleen/Stomach. Kidney tendons run from waist through spine and do not reach the navel, so treating periumbilical pain with Kidney channel herbs is a great error. I argue that the Kidney attaches to the spine, directly opposite the navel. Furthermore, when the fetal sac first forms, a stem rises from the center, shaped like a lotus stamen; this stem is the umbilical cord, and the stamen represents the Kidney. Thus, the navel is the root of the Kidney, positioned directly opposite; therefore, although periumbilical pain may not involve the Shaoyin meridian, claiming it has no relation to the Kidney is incorrect.
Small abdominal pain belongs to Jueyin. Severe cases use Zhengyang San or Huiyang Dan; mild cases use Danggui Sini Tang (Angelica Sinensis Decoction for Frigid Extremities) (see Jue). Small abdominal pain due to difficulty urinating: treat with Wuling San (Five-Ling Powder) (see Dampness Injury). If urination is free, examine if it is a Blood syndrome; use Tao Ren Cheng Qi Tang (see Blood Syndromes). If due to Liver Qi stagnation pain: use Qingpi (Green Tangerine Peel) and Chaihu (Bupleurum Root). Again, tenderness indicates Deficiency, resistance indicates Excess. Cold Qi and congealed Blood: use Weiling San. Qi stagnation and Blood coagulation: use Danggui San. If pain extends to the genitals and stops upon pressure, it is Liver Channel Blood Deficiency; treat with Siwu Tang (see Blood Deficiency) plus Niuxi (Achyranthes Root), Renshen (Ginseng), and Zhi Cao (Honey-fried Licorice). Alternatively, using only Baijiaoxiang (Dragon's Blood Resin) is excellent. If blue veins appear in the small and large abdomen, this is Liver Fire invading Spleen; treat with Xiao Chaihu Tang (Minor Bupleurum Decoction) (see Cold/Heat) combined with Siwu Tang, plus Longdancao (Gentian Root) and Shanzhi. If testicular swelling and pain radiate, it is a Hernia disease.
Huoluan abdominal pain involves simultaneous vomiting and diarrhea, though some cases have neither, called Gan Huoluan (Dry Huoluan). Also, Changyong (Intestinal Abscess) abdominal pain: small abdominal pain with frequent urination resembling Lin syndrome, rough skin like fish scales, tense abdominal wall but soft upon pressure, resembling swelling, or sores around the navel; this can be distinguished. There is also a condition called Baobi (Bladder Bi): difficulty urinating, pain upon pressing the small abdomen, feeling as if scalded by hot water; see Bi Syndrome and Lin Syndrome sections.