经义
大肠病者，肠中切痛而鸣濯濯。冬日重感于寒，即泄，当脐而痛。○小肠病者，小腹痛，腰脊控睾而痛，
时窘之后。○膀胱病者，小腹偏肿而痛，以手按之，即欲小便而不得。○邪在脾胃，则病肌肉痛。阳气不足，阴
气有余，则寒中，肠鸣腹痛。（《灵枢》）
哲言
腹痛分为三部∶脐以上痛者为太阴脾，当脐痛者为少阴肾，少腹痛者为厥阴肝，及冲、任、大小肠。
每部各有五贼之变，
七情之发，六气之害，五运之邪，至纷至搏，苟能辨其气、血、虚、实、内伤、外感而为之调剂，无不切中病
情。（李士材）
腹痛有寒，有热，有虚，有实，有食积，有湿痰，有死血，有虫。大抵胃脘下大腹痛者，多属食积外邪；
绕脐痛者，多属痰火积热；脐下少腹痛者，多属寒，或瘀血，或溺涩。（《医方集解》）
腹痛乃脾家受病。或受有形而痛，或受无形而痛。盖暴伤饮食，则胃脘先痛而后入腹。暴触怒气，则两胁
先痛而后入腹。血积上焦，脾火熏蒸，则痛从腹而上攻。血积下部，胃气下陷，则痛从腹而下坠。伤于寒者，
痛无间断，得热则缓。伤于热者，痛作有时，得寒则减。因饥而痛者，过饥即痛，得食则止。因食而痛者，多
食则痛，得便乃安。吞酸腹痛，为痰郁中焦。痞闷腹痛，为气搏中州。火痛，肠内雷鸣，冲斥无定，痛处觉热，
心烦口渴。虫痛，肚大青筋，饥即咬 ，痛必吐水，痛定能食。气虚痛者，痛必喜按，呼吸短促。血虚痛者，
痛如芒刺，牵引不已。○肠痈痛者，腹重而痛，身皮甲错，绕脐生疮，小便如淋。疝痛者，大腹胀，小腹急，下
引睾丸上冲而痛。痧痛者，或吐或泻，绞痛转筋。阴毒痛者，爪甲青，面唇黑，厥逆呕吐。积聚痛者，有形可
按。痢疾痛者，后重逼迫。妇人腹痛，多关经水。胎孕。宜审之。○小腹为至阴之位，厥阴所属。有沉寒下虚，
有积热内郁，或忿怒所致。或房劳损伤，致中上二焦清纯之气，下陷于至阴之地，郁久不舒，痛连阴器，久则
元气愈虚，不能归复本位，所以痛无休止耳。然肝主疏泄，不利峻补，总宜调和气血为主。（《证治汇补》）
补编
腹中寒气，雷鸣切痛，胸胁逆满呕吐；附子粳米汤主之。○痛而闭者，浓朴三物汤主之。（《金匮》）
腹痛非一，须知患之无形、有形。无形者，如寒凝火郁，气阻营虚，及夏秋暑湿痧秽之类是也。有形者，
如蓄血食滞， 瘕、蛔、疝，及偏好成积之类是也。审其痛势之高下，辨其色脉之衰
旺，究因何起？大都在脏者，以肝、脾、肾为主；在腑者，以肠胃为先。夫脏有贼克之情，非比腑病而以通为
用也。此通字勿执攻下之谓。若通阳泄浊者，如吴茱萸汤及四逆汤法；清火泄郁者，如左金丸及金铃散法；开
通气分者，如四七汤及五磨饮法；宜攻营络者，如山甲、桃仁、归须、韭根及下瘀血汤法；缓而和者，如甘芍
汤及甘麦大枣汤法；柔而通者，如苁蓉、柏子、肉桂、当归及复脉汤加减法。至于食滞消之，蛔扰安之， 瘕
理之，内疝平之，痧秽之候以芳香解之，偏积之类究其原而治之，是皆化裁之法也。（《临证指南》）
寒滞之痛∶有内寒者，如食寒、饮冷之类，随其宜而治之。有外寒者，或触不时之寒邪，或犯客令之寒气，
或受豪雨痧气之阴毒，以致心腹搅痛，或吐、或泻，或不吐泻而为干霍乱等。总由寒气犯脏，或在上焦，或在
中、下二焦。凡痛急在上者，用吐最妙；在中、下者，俱宜解寒行滞，以排气饮为主，甚者宜四逆汤、理中汤。
又神香散可解三焦之滞，随证作引送之。○血积腹痛有四∶伤寒有蓄血证。成无己曰∶邪气聚于下焦，则津液
不通，血气不行，留滞于下，是生胀满而硬痛也，详《伤寒门》。妇人有蓄血痛证，详《妇人门》。跌打损伤
有蓄瘀腹痛证，但去其瘀而痛自愈。食郁既久而胃脘有瘀血作痛者，宜生韭饮。○气血虚寒不能营养心脾者，
最多心腹痛证。然必以积劳、积损，及忧思不遂者，乃有此病。或心、脾、肝、肾，气血本虚而犯劳伤，或犯
寒气及饮食不调者，亦有此证。凡虚痛之候，每多连绵不止，而无急暴之势，或按揉、温熨，痛必稍缓。其在
心、脾、胸、胁之间者，则或为戚戚，或为HT HT ，或似 非 ，或饥劳更甚，或得食稍可，或懊 无迹，莫可
名状。或形色青黄，或脉微气弱，是皆虚寒之证。此非甘温养血、补胃和中不可也，宜大小营煎、理阴煎之类
主之。若气虚者必加人参，阳衰者必佐以桂、附。○下虚腹痛，必因虚挟寒，或阳虚中寒，察无形迹而喜按、
喜暖者
是也。男子则间有之，惟女人居多。宜理阴煎主之。若虚中挟滞而血不行者，惟决津煎最妙。○火邪热郁，亦
有心腹痛之证。然火在上者，必烦渴喜冷；火在下者，必胀秘淋涩。务兼脉证，察其真有火邪，方可治以寒凉。
○虫痛证治详《诸虫门》。○痰饮停滞胸膈，亦能作痛。凡胸胁膨闷，漉漉有声，或作醋心呕恶，或痛连胁背
者，皆其证也。治宜清膈煎、二陈汤之类。若郁痰凝结，消之不去者，非吐法不除。○阴寒腹痛，凡男、妇有
因房室后中寒而痛积者，先用葱、姜热熨脐腹，后用理中四逆汤治之。其有痛极至危者，须灸气海等穴。（张景岳）
腹中寒痛，建中汤；热痛，黄芩芍药汤。（周慎斋）
腹属坤土，久病宜和脾胃。如脉弦急，木克土也；用建中汤，取芍药味酸，于土中泻木。如脉沉细，水侮
土也；用理中汤，取干姜味辛，于土中泻水。如脉沉缓，腹痛自利，水谷不化；用平胃散，取苍术味苦，于土
中泻湿。胃气陷者加升麻、柴胡以升之，有食积者，加山楂、麦芽以消之。（《医学入门》）
脉候
凡病虚、实，辨脉皆易；惟心腹痛，脉多难辨。虽滑实有力者多实，虚弱无神者多虚，此其常也。然暴痛
之极，每多沉伏、细涩，最似极虚。不知气为邪逆，则脉道不行，因而沉伏。然细察之，必有梗梗然弦紧之意，
此必寒邪阻遏阳气，多有是脉。若火邪作痛则不然，不得因其细微认为虚脱。妄用补剂，必大误矣。但当察其
形气，以见平素之强弱，问其病因，以知新病、久病。大都暴痛脉忽细伏多实，久痛脉本微弱为虚。（张景岳）
选案
方某病腹痛。磊块起落，如波浪然，昼轻夜重。医用辛香理气，不验。诊脉浮缓弦小，重按似涩。谓曰∶
此血病，作气治谬矣。彼谓血则有形，今发时虽有块磊，然痛减则无迹，非气而何？不知有形者，血积也；无
形者，血滞也。滞视积略轻耳。若作
气论，则前药胡不验？用四物汤加棱、莪、乳香、没药，服之霍然。（汪石山）
一妇腹痛两月，或以为寒、为热、为气、为虚、为食、为虫，遍尝试之，其痛转加。一医与膏药如斗，满
腹贴之，其痛益剧。欲揭去膏药，火熨油调，百计不脱。予见其面色苍黑，肤燥若树皮，六脉洪数，问其痛何
在？解衣露腹，始知膏药贴牢之故。叩其不能举步之由，妇曰∶非力弱不能行，乃左脚不可动，动即痛应于心。
予思色脉皆非死候，胡治而益剧也？此必肠痈，左脚莫能举，是其征矣。与营卫返魂汤四剂，加银花为君，酒
水煎服。一帖痛减，二帖下臭脓半桶，痛全减，腹上膏药自脱。四帖服完，妇来诣谢，见者皆惊。（孙一奎）
孙丙章患吐血，咳嗽发热，肌减食少，怔忡不寐，脐右有块作痛。医药不应，病势增剧。诊脉左寸芤大，
右关结滞，两尺洪盛。予曰∶此思郁伤脾，不能统血，血虚发热，血燥作痛。其块必不阔而长，不横而竖，形
似镰刀，非瘀、非痞，乃脾也。脾居胃右，血盈则润而软，血少则燥而痛。亟救三阴，病尚可痊。用归脾汤去
木香加白芍、五味，煎送都气丸，守服而愈。（杨乘六）
凡腹痛因食者，皆停积中脘，然又有食停小腹者。予治一上舍，因午刻食面角，至初更食及小腹，下至
右角间，停积不行，坚突如拳，痛剧莫可名状。察其明系面积，计已入肠，此正通则不痛之证。初与木香槟榔
丸，下二、三次，其痛如故。因疑药缓，更投神佑丸，又不效。余谓此必药性寒滞不行，再投备急丸，虽连得
大泻，而坚痛不减。潜测其由，不过因面，岂无所以制之？今既逐之不及，非借气行之不可。计面毒非大蒜不
杀，气滞非木香不行，滞深道远，非精锐之响导不能达。乃用火酒磨木香，令嚼蒜瓣，香酒送之。一服痛减，
三四服后，其痛渐止。然小腹之块，后至半年始消。由是知欲消食滞，即巴、黄犹不能及，而推行气为先。且
知欲食下行之道，乃必由小腹下右角而后出于广肠。
此自古无言及，笔之以广闻见。（张景岳）
一牧童秋初病患满腹胀痛，茶水入口即吐。初服驱暑消食药，不应；又进承气汤，亦不效。缠绵多日，
形容枯槁，奄奄待毙。或教以爆竹火药，烧酒调敷满腹，只留肚脐不敷，药干拭去，又重调敷。如此数次，大
便畅行，痛止而愈。（《见闻录》）
附脐痛
病患脐肿反出者，此为脾先死。（《难经》）
脐筑湫痛，命将难全。（张仲景）
瘦人绕脐痛，必有风冷。谷气不行而反下之，其气必冲。（《金匮》）
脐者，齐也，言其上下齐也。伸臂指天，舒足至地，以绳量之，则中正当脐。天枢之穴，正当脐两旁各
二寸，是为身半也。
夫人之脐也，受生之初，父母精血，凝结成胎。在母腹中，母呼儿呼，母吸儿吸，是一身脐带，如花果
在枝而通蒂也。既生之后，从口呼吸，脐门自闭。既长之后，外耗精神，内伤生冷，真气不得条畅。所以蒸脐
固蒂，如水灌土培，草木自茂也。（《医学入门》）
胃之上口曰贲门，胃之下口曰幽门。计胃长二尺六寸，则当脐正属胃之部分。脾之筋脉结于脐，胃之筋
脉亦挟于脐，至肾之筋脉从腰贯脊，并不及脐。以大腹、少腹属肝、脾，犹未尽然。而以脐腹属肾，殊不可解。
然则脐腹究何所属？曰∶属胃。胃脾相表里，属胃仍属脾也。《难经》曰∶脐上痛，心证也；脐下痛，肾证也；
脐右痛，肺证也；脐左痛，肝证也；脐之上、下、左、右。《难经》既分属心、肾、肺、肝，土居中央，脐腹
非属脾胃乎？
肠痈为病，绕脐生疮，或脓从脐出。（《东垣十书》）
水肿，脐突出者死。（朱丹溪）
附方
营卫返魂汤 生首乌、当归、赤芍、小茴、木通、甘草节、
银花、贝母、枳壳、白芷水酒煎服。
治阴证腹痛方 用鸡蛋七枚煮熟，银簪拨开一孔，合病患脐上，将手护住，稍凉即换，蛋完痛止。剖验蛋
黄，其色变黑。
验阴证腹痛法 用鸡蛋一枚煮熟，银器乘热插通，合病患脐上，将手护住。食顷，取出银器验之，如系阴
证，银色变黑。
【经典论述】
大肠发生病变时，肠中剧烈疼痛且伴有鸣响。如果在冬天再次感受寒邪，就会腹泻，疼痛部位在肚脐周围。○小肠发生病变时，小腹部疼痛，腰部及脊柱牵引睾丸疼痛，时常感到窘迫并想排便。○膀胱发生病变时，小腹部偏侧肿胀且疼痛，用手按压，就想小便却排不出来。○病邪在脾胃，就会引起肌肉疼痛。如果阳气不足，阴气有余，就会产生寒中证候，出现肠鸣腹痛。（出自《灵枢》）
【名家言论】
腹痛可以分为三个部位：肚脐以上的疼痛属于太阴脾经病变，肚脐正中的疼痛属于少阴肾经病变，小腹部的疼痛属于厥阴肝经以及冲脉、任脉、大小肠的病变。
每个部位都有五行相克（五贼）的变化，七情（喜、怒、忧、思、悲、恐、惊）的引发，六淫（风、寒、暑、湿、燥、火）的危害，以及五运（木、火、土、金、水）之邪气的侵袭，各种因素纷至沓来相互搏结。如果能够辨别是气病还是血病，是虚证还是实证，是内伤还是外感，并进行相应的调理，没有不切中病情的。（李士材）
腹痛有寒痛、热痛、虚痛、实痛，还有食积、湿痰、死血（瘀血）、虫积等类型。大致而言，胃脘下方大腹部的疼痛，多属于食积或外邪；绕脐疼痛，多属于痰火积热；脐下小腹部的疼痛，多属于寒证，或是瘀血，或是小便不利。（《医方集解》）
腹痛是脾脏受病。或者是受到有形之邪而痛，或者是受到无形之邪而痛。如果是突然饮食受伤，那么胃脘先痛然后波及腹部。如果是突然触怒生气，那么两胁先痛然后波及腹部。如果瘀血积聚在上焦，脾火熏蒸，那么疼痛从腹部向上攻冲。如果瘀血积聚在下部，胃气下陷，那么疼痛从腹部向下坠胀。被寒邪所伤，疼痛无间断，得热则缓解。被热邪所伤，疼痛发作有时，得寒则减轻。因为饥饿而痛的，过度饥饿就痛，进食后停止。因为饮食而痛的，多吃就痛，大便通畅后才安适。吞酸伴腹痛，是痰郁阻在中焦。痞闷伴腹痛，是气机搏结在中州。火邪致痛，肠内雷鸣，冲逆不定，痛处感觉发热，心烦口渴。虫积致痛，肚子大且有青筋暴露，饥饿时咬啮作痛，痛时必吐清水，痛止后能进食。气虚致痛，疼痛喜欢按压，呼吸短促。血虚致痛，疼痛如芒刺扎入，牵引不止。○肠痈致痛，腹部沉重且痛，皮肤粗糙如鳞甲，绕脐生疮，小便像淋证一样涩痛。疝气致痛，大腹胀满，小腹急迫，向下牵引睾丸上冲而痛。痧毒致痛，或者呕吐或者腹泻，绞痛转筋。阴毒致痛，指甲青紫，面色嘴唇发黑，四肢厥冷呕吐。积聚致痛，可以摸到有形之物。痢疾致痛，里急后重逼迫感。妇女腹痛，多与月经、胎孕有关。应当仔细审察。○小腹是至阴之位，归属于厥阴肝经。有沉寒下虚，有积热内郁，或者由忿怒所致。或者因房劳损伤，导致中上二焦清纯之气，下陷于至阴之地，郁久不能舒展，疼痛牵连阴器，时间久了元气更加虚弱，不能回归本位，所以疼痛没有休止的时候。然而肝主疏泄，不宜使用峻猛补益之法，总宜以调和气血为主。（《证治汇补》）
【补编】
腹中有寒气，肠鸣剧烈疼痛，胸胁气逆满闷呕吐；用附子粳米汤主治。○腹痛且大便闭结不通的，用厚朴三物汤主治。（《金匮要略》）
腹痛原因不一，必须知道患病是有形的还是无形的。无形的，如寒凝火郁、气阻营虚，以及夏秋季节的暑湿、痧秽之类。有形的，如蓄血、食滞、瘕聚、蛔虫、疝气，以及偏好形成积聚之类。审察疼痛势态的高低，辨别面色脉象的盛衰，探究起因是什么？大多在脏的，以肝、脾、肾为主；在腑的，以肠胃为先。脏腑之间有相克的关系，不像腑病那样以通利为用。这个“通”字不要执着理解为攻下法。如果是通阳泄浊的，如吴茱萸汤及四逆汤的方法；清火泄郁的，如左金丸及金铃散的方法；开通气分的，如四七汤及五磨饮子的方法；适宜攻逐营络瘀血的，如山甲、桃仁、归须、韭根及下瘀血汤的方法；缓和柔和的，如甘芍汤及甘麦大枣汤的方法；柔润而通的，如肉苁蓉、柏子仁、肉桂、当归及复脉汤加减的方法。至于食滞的予以消导，蛔虫扰动的予以安抚，瘕聚的予以理散，内疝的予以平复，痧秽的证候用芳香之法解除，偏积之类的探究其本源而治疗，这些都是灵活变通的方法。（《临证指南医案》）
寒滞引起的疼痛：有内寒的，如吃生冷食物、喝冷饮之类，根据具体情况治疗。有外寒的，或者触犯非时之寒邪，或者侵犯客令之寒气，或者遭受豪雨痧气的阴毒，以致心腹搅痛，或者呕吐，或者腹泻，或者不吐泻而表现为干霍乱等。总由寒气侵犯脏腑，或者在上焦，或者在中、下二焦。凡是疼痛急迫在上的，用吐法最妙；在中、下部的，都适宜解寒行滞，以排气饮为主，严重的适宜用四逆汤、理中汤。另外神香散可以解除三焦的滞气，随证作为引药送服。○血积腹痛有四类：伤寒有蓄血证。成无己说：邪气聚集在下焦，津液不通，血气不行，留滞在下，产生胀满而硬痛，详见《伤寒门》。妇女有蓄血痛证，详见《妇人门》。跌打损伤有蓄瘀腹痛证，只要去除瘀血疼痛自然痊愈。食郁日久且胃脘有瘀血作痛的，适宜用生韭饮。○气血虚寒不能营养心脾的，最多见心腹痛证。然而必定是由于积劳、积损，以及忧思不畅的人，才会有此病。或者心、脾、肝、肾气血本虚又犯劳伤，或者犯寒气及饮食不调的，也有此证。凡是虚痛的证候，往往连绵不止，而没有急暴之势，或者按揉、温熨，疼痛必然稍缓。在心、脾、胸、胁之间的，或者表现为郁郁不乐，或者表现为心中烦闷，或者似痛非痛，或者饥饿劳累时更甚，或者进食后稍好，或者懊恼无迹，难以名状。或者面色青黄，或者脉微气弱，这都是虚寒的证候。这不是甘温养血、补胃和中不可治愈的，适宜用大小营煎、理阴煎之类主治。如果是气虚的必须加人参，阳衰的必须佐以桂枝、附子。○下虚腹痛，必定是因为虚挟寒，或者阳虚中寒，观察没有有形之迹且喜欢按压、喜欢温暖的，就是这种情况。男子间或有之，只有女人居多。适宜用理阴煎主治。如果虚中挟滞且血行不畅的，只有决津煎最妙。○火邪热郁，也有心腹痛的证候。然而火在上面的，必定烦躁口渴喜冷饮；火在下面的，必定胀满便秘小便涩痛。务必兼看脉证，察知确实有火邪，才可以治疗以寒凉之法。○虫积痛证的诊治详见《诸虫门》。○痰饮停滞胸膈，也能引起疼痛。凡是胸胁膨闷，漉漉有声，或者反酸恶心呕吐，或者疼痛牵连胁背的，都是它的证候。治疗适宜用清膈煎、二陈汤之类。如果是郁痰凝结，消导不去的，不用吐法不能除去。○阴寒腹痛，凡是男女有因房事后受寒而疼痛积聚的，先用葱、姜热熨脐腹，后用理中汤、四逆汤治疗。其中有疼痛极度危重的，需要灸气海等穴位。（张景岳）
腹部属坤土，久病适宜调和脾胃。如果脉弦急，是木克土；用建中汤，取芍药味酸，在土中泻木。如果脉沉细，是水侮土；用理中汤，取干姜味辛，在土中泻水。如果脉沉缓，腹痛自利，水谷不化；用平胃散，取苍术味苦，在土中泻湿。胃气下陷的加升麻、柴胡以升提，有食积的加山楂、麦芽以消导。（《医学入门》）
【脉候】
凡是病有虚、实，辨别脉象都容易；只有心腹痛，脉象多难辨别。虽然滑实有力的多属实证，虚弱无神的多的多属虚证，这是常理。然而暴痛至极，往往多见沉伏、细涩，极像极虚。不知道这是因为气被邪气逆乱，脉道不行，因而沉伏。然而仔细察辨，必有梗梗然弦紧之意，这必定是寒邪阻遏阳气，多有这种脉象。如果是火邪作痛就不是这样，不要因为脉细微就认为是虚脱。妄用补剂，必定是大错。只应当察辨病人的形体气质，以了解平素的强弱，询问病因，以知晓新病、久病。大都暴痛脉忽细伏的多属实证，久痛脉本微弱的是虚证。（张景岳）
【选案】
方某患腹痛。肿块起落，像波浪一样，白天轻晚上重。医生用辛香理气药，无效。诊脉浮缓弦小，重按似涩。我说：这是血病，当作气治是错误的。他认为血是有形的，现在发作时虽然有块磊，但痛减就没有痕迹，不是气是什么？不知道有形的是血积；无形的是血滞。滞比积稍微轻一点罢了。如果当作气论治，为什么前面的药不效？用四物汤加三棱、莪术、乳香、没药，服用后霍然痊愈。（汪石山）
一位妇人腹痛两个月，有人以为是寒、热、气、虚、食、虫，遍尝各种治疗方法，疼痛反而加重。一位医生给她贴斗大的膏药，满腹贴上，疼痛更加剧烈。想要揭去膏药，用火烤、油调，百计无法脱落。我看她面色苍黑，皮肤干燥像树皮，六脉洪数，问她的痛在哪里？解开衣服露出腹部，才知道膏药贴牢的缘故。问她不能举步的原因，妇人说：不是力气弱不能行走，而是左脚不能动，一动就心痛相应。我思考色脉都不是死候，为什么治疗反而加剧呢？这一定是肠痈，左脚不能举起，就是它的征象了。给予营卫返魂汤四剂，加金银花为君药，酒水煎服。一帖疼痛减轻，二帖排出臭脓半桶，疼痛全减，腹上膏药自行脱落。四帖服完，妇人前来致谢，见到的人都惊讶。（孙一奎）
孙丙章患吐血，咳嗽发热，肌肉消瘦食欲减少，怔忡失眠，脐右侧有块作痛。医药无效，病势加剧。诊脉左寸芤大，右关结滞，两尺洪盛。我说：这是思虑忧郁伤脾，不能统血，血虚发热，血燥作痛。那个肿块一定不宽而长，不横而竖，形状像镰刀，不是瘀血，不是痞块，乃是脾的病。脾位于胃的右边，血充盈则滋润柔软，血少则干燥疼痛。亟需救三阴，病还可以痊愈。用归脾汤去掉木香加白芍、五味子，煎药送服都气丸，坚持服用而愈。（杨乘六）
凡是腹痛因饮食引起的，都是停积在中脘，然而又有食停在小腹的。我治疗一位上舍（官职名），因为中午吃了面角，到初更时分感到小腹疼痛，下到右角之间，停积不行，坚硬突起如拳头，疼痛剧烈难以名状。察明确实是面积，估计已经入肠，这正是通则不痛的证候。起初给木香槟榔丸，下了二三次，疼痛依旧。因此怀疑药力缓慢，又投神佑丸，也不见效。我认为这必定是药性寒滞不行，再投备急丸，虽然连得大泻，但坚痛不减。暗中推测其原因，不过是面食，难道没有东西能制它吗？现在已经驱逐不及，不借助气行是不行的。考虑到面毒非大蒜不能杀，气滞非木香不能行，滞深道远，非精锐的向导不能到达。于是用火酒磨木香，让他嚼蒜瓣，香酒送服。一服疼痛减轻，三四服后，疼痛逐渐停止。然而小腹的肿块，直到半年后才消退。由此可知想要消除食滞，即使是巴豆、大黄也不能达到效果，而推行气机为先。并且知道食物下行的道路，必然是经过小腹下右角然后出于广肠。
这是自古以来没有人提及的，记录下来以广见闻。（张景岳）
一个牧童秋初患病，满腹胀痛，茶水入口即吐。起初服用驱暑消食药，无效；又进承气汤，也不见效。缠绵多日，形容枯槁，奄奄待毙。有人教他用爆竹火药，烧酒调敷满腹，只留肚脐不敷，药干拭去，又重新调敷。如此数次，大便畅行，痛止而愈。（《见闻录》）
【附脐痛】
病人脐部肿胀反出的，这是脾脏先死。（《难经》）
脐部筑筑跳动疼痛，性命难保。（张仲景）
瘦人绕脐痛，必定有风冷。谷气不行反而用下法，气必上冲。（《金匮要略》）
脐，就是齐的意思，指上下齐平。伸臂指天，舒足至地，用绳子量，中间正当脐。天枢穴，正当脐两旁各二寸，这是身半的位置。
人的脐，在受孕之初，父母精血，凝结成胎。在母腹中，母亲呼孩子呼，母亲吸孩子吸，是一身脐带，如果花果在枝头连着蒂一样。出生后，从口呼吸，脐门自动关闭。长大后，外耗精神，内伤生冷，真气不得条畅。所以蒸脐固蒂，就像浇水培土，草木自然茂盛。（《医学入门》）
胃的上口叫贲门，胃的下口叫幽门。计算胃长二尺六寸，那么正当脐的部位属于胃的部分。脾的筋脉结于脐，胃的筋脉也夹于脐，到了肾的筋脉从腰贯穿脊背，并不涉及脐。以大腹、少腹属于肝、脾，尚且不完全正确。而以脐腹属于肾，特别难以理解。那么脐腹究竟属于什么？回答说：属于胃。胃脾相表里，属胃仍然属脾。《难经》说：脐上痛，是心病；脐下痛，是肾病；脐右痛，是肺病；脐左痛，是肝病；脐的上、下、左、右。《难经》既然分属心、肾、肺、肝，土居中央，脐腹不属于脾胃吗？
肠痈发病，绕脐生疮，或者脓从脐流出。（《东垣十书》）
水肿，脐突出的，死。（朱丹溪）
【附方】
营卫返魂汤 生首乌、当归、赤芍、小茴香、木通、甘草节、银花、贝母、枳壳、白芷，水酒煎服。
治阴证腹痛方 用鸡蛋七个煮熟，银簪拨开一孔，合在病患脐上，用手护住，稍凉就换，蛋吃完疼痛停止。剖验蛋黄，颜色变黑。
验阴证腹痛法 用鸡蛋一枚煮熟，银器趁热插通，合在病患脐上，用手护住。过一会儿，取出银器检验，如果是阴证，银色变黑。
[Classical Discourse]
When the Large Intestine is diseased, there is severe pain in the intestines accompanied by gurgling sounds. If cold pathogen is contracted again in winter, diarrhea occurs with pain around the umbilicus. ○ When the Small Intestine is diseased, there is pain in the lower abdomen, with pain radiating from the waist and spine to the testicles, often accompanied by a sense of urgency and desire to defecate. ○ When the Bladder is diseased, there is swelling and pain on one side of the lower abdomen; pressing with the hand induces the urge to urinate but results in inability to do so. ○ When pathogenic factors affect the Spleen and Stomach, muscle pain occurs. If Yang Qi is insufficient and Yin Qi is excessive, Cold Syndrome in the Middle Jiao manifests as intestinal gurgling and abdominal pain. (From *Ling Shu*)
[Masters' Opinions]
Abdominal pain can be divided into three regions: pain above the umbilicus belongs to Taiyin Spleen disease; pain at the umbilicus belongs to Shaoyin Kidney disease; pain in the lower abdomen belongs to Jueyin Liver disease, as well as Chong Mai (Penetrating Vessel), Ren Mai (Conception Vessel), Large Intestine, and Small Intestine.
Each region undergoes changes due to the Five Elements' destructive cycle (Five Thieves), the Seven Emotions (Joy, Anger, Worry, Pensiveness, Sorrow, Fear, Fright), the Six Exogenous Pathogens (Wind, Cold, Summer-heat, Dampness, Dryness, Fire), and the Five Movements (Wood, Fire, Earth, Metal, Water) pathogenic factors. These elements converge and interact. If one can distinguish whether the pathology involves Qi or Blood, Deficiency or Excess, Internal Injury or External Contraction, and apply appropriate regulation, the treatment will invariably hit the mark. (Li Shicai)
Abdominal pain may be caused by Cold, Heat, Deficiency, Excess, Food Stagnation, Damp-Phlegm, Fixed Blood Stasis, or Parasites. Generally speaking, pain in the greater abdomen below the epigastrium mostly belongs to Food Stagnation or external pathogens; periumbilical pain mostly belongs to Phlegm-Fire and accumulated heat; pain below the umbilicus in the lower abdomen mostly belongs to Cold, Blood Stasis, or dysuria. (*Yi Fang Ji Jie*)
Abdominal pain is a disease of the Spleen. It may result from either tangible or intangible pathogens. If diet is suddenly injured, pain starts in the epigastrium and then spreads to the abdomen. If anger is suddenly provoked, pain starts in the hypochondrium and then spreads to the abdomen. If blood stasis accumulates in the Upper Jiao and Spleen Fire steams upward, pain attacks upward from the abdomen. If blood stasis accumulates in the Lower Jiao and Stomach Qi sinks downward, pain drags downward from the abdomen. Pain caused by Cold has no interruption and relieves with warmth. Pain caused by Heat occurs intermittently and relieves with cold. Pain due to hunger appears when overly hungry and stops after eating. Pain due to food worsens with overeating and resolves after bowel movement. Acid regurgitation with abdominal pain indicates Phlegm stagnation in the Middle Jiao. Distension and stuffiness with abdominal pain indicate Qi conflict in the Central Region. Fire-induced pain features intestinal rumbling, erratic rushing, heat sensation at the painful site, restlessness, thirst, and irritability. Parasite-induced pain features a distended abdomen with visible blue veins, biting pain when hungry, vomiting of clear fluid during pain, and ability to eat when pain subsides. Qi Deficiency pain favors pressure and is accompanied by shortness of breath. Blood Deficiency pain feels like thorn pricks and persists with radiation. ○ Intestinal Abscess pain features heavy abdominal pain, rough skin like scales, sores around the umbilicus, and dysuria-like symptoms. Hernia pain features distension of the greater abdomen, urgency in the lower abdomen, and pain radiating downward to the testicles with upward rushing. Sha Poison pain features vomiting or diarrhea, cramping pain, and tendon twitching. Yin Toxin pain features cyanotic nails, black face and lips, cold limbs, and vomiting. Accumulation pain features palpable masses. Dysentery pain features tenesmus. Women's abdominal pain is often related to menstruation or pregnancy; careful examination is required. ○ The lower abdomen is the position of Extreme Yin, belonging to Jueyin Liver. It may involve deep Cold and Lower Deficiency, internal accumulation of Heat, or emotional anger. Sexual exhaustion may cause pure Qi from the Middle and Upper Jiao to sink into the Extreme Yin position, stagnating for a long time without relief, causing pain connected to the genitalia. Over time, Yuan Qi becomes more deficient and cannot return to its original position, resulting in ceaseless pain. Since the Liver governs free flow, harsh tonification is contraindicated; the main approach should be harmonizing Qi and Blood. (*Zheng Zhi Hui Bu*)
[Supplement]
Cold Qi in the abdomen causes rumbling and cutting pain, with fullness and vomiting in the chest and hypochondrium; Fuzi Jingmi Tang (Aconite and Rice Decoction) is indicated. ○ Abdominal pain with constipation is treated with Houpo Sanwu Tang (Magnolia Bark Three-Ingredient Decoction). (*Jin Gui Yao Lue*)
Abdominal pain has various causes; one must determine if the pathology is tangible or intangible. Intangible types include Cold condensation, Fire stagnation, Qi obstruction, Ying (Nutritive) Deficiency, and Summer-heat/Dampness/Sha Poison in summer and autumn. Tangible types include Blood Stasis, Food Retention, Masses (Jia), Roundworms, Hernia, and habitual accumulation formation. One must examine the height and depth of the pain, distinguish the flourishing or declining state of complexion and pulse, and investigate the origin. Pathologies in Zang organs primarily involve the Liver, Spleen, and Kidney; pathologies in Fu organs primarily involve the Intestines and Stomach. Zang organs have mutual overcoming relationships, unlike Fu organs which use unblocking as their function. This "unblocking" should not be rigidly interpreted as purgation. For unblocking Yang and draining turbidity, methods like Wuzhuyu Tang (Evodia Decoction) and Sini Tang (Frigid Extremities Decoction) are used; for clearing Fire and draining stagnation, methods like Zuojin Wan (Left Metal Pill) and Jinling San (Golden Bell Powder) are used; for opening Qi dynamics, methods like Siqi Tang (Four-Seven Decoction) and Wumo Yin (Five-Mortar Drink) are used; for attacking Ying and Collateral blood stasis, materials like Shan Jia (Pangolin Scale), Tao Ren (Peach Kernel), Gui Xu (Twig of Angelica), Jiu Gen (Rhizome of Allium tuberosum), and Xiayuxue Tang (Downward Expelling Blood Decoction) are used; for gentle and harmonious approaches, Gan Shao Tang (Licorice and Peony Decoction) and Ganmai Dazao Tang (Licorice, Wheat, and Jujube Decoction) are used; for soft and unblocking approaches, materials like Rongrong (Cistanche), Baizi (Biota Seed), Rougui (Cinnamon Bark), Danggui (Angelica Sinensis), and modified Fumai Tang (Restore Pulse Decoction) are used. For Food Stagnation, resolve it; for Parasite disturbance, calm it; for Masses, disperse them; for Internal Hernia, level them; for Sha Poison conditions, resolve with aromatic methods; for habitual accumulations, treat based on the root. These are all flexible modification methods. (*Lin Zheng Zhi Nan Yi An*)
Pain from Cold Stagnation: Internal Cold, such as from eating cold foods or drinking cold liquids, is treated according to suitability. External Cold, triggered by non-seasonal Cold pathogens, Guest Command Cold Qi, or Yin Toxin from heavy rain and Sha Qi, causes churning pain in the heart and abdomen, possibly with vomiting, diarrhea, or dry Huoluan (Spasm Disorder). This is generally due to Cold invading Zang organs, located in the Upper or Middle/Lower Jiao. For urgent pain in the upper region, emesis is best; for Middle/Lower regions, resolving Cold and moving stagnation with Paiqi Yin (Qi-Expelling Drink) is suitable, with Sini Tang or Lizhong Tang for severe cases. Shenxiang San can resolve Three Jiao stagnation and is taken as an adjuvant. ○ There are four types of Blood Stasis Abdominal Pain: Shanghan (Cold Damage) includes Xueyu (Blood Stasis) syndrome. Cheng Wuji stated: When pathogenic factors gather in the Lower Jiao, body fluids are blocked, Qi and Blood do not circulate, stagnating below, causing distension, hardness, and pain (see *Shanghan Men*). Women have Xueyu pain syndromes (see *Furen Men*). Trauma injuries cause Xuyu (Accumulated Stasis) abdominal pain; removing the stasis cures the pain. Long-term Food Depression with gastric blood stasis pain is treated with Shengjiu Yin (Raw Leek Drink). ○ Qi and Blood Deficiency-Cold failing to nourish Heart and Spleen most commonly causes Heart-Abdominal pain. This occurs in cases of chronic fatigue, damage, and unresolved worry/pensiveness. Even if Heart, Spleen, Liver, or Kidney Qi/Blood are originally deficient, trauma, Cold invasion, or dietary irregularity can cause this. Deficiency pain tends to be continuous without acute intensity, and pressing or warming provides slight relief. Pain in the Heart, Spleen, Chest, or Hypochondrium may manifest as depression, inner vexation, vague discomfort, worsening with hunger/fatigue, or slight improvement with food. Complexion may be greenish-yellow, pulse faint, Qi weak; these are Deficiency-Cold signs. Sweet-Warm Blood Tonification and Stomach Harmonization are essential; Xiaodaying Jian and Liyin Jian are indicated. Add Ginseng for Qi Deficiency; add Cinnamon Twig and Aconite Root for Yang Decline. ○ Lower Deficiency abdominal pain is due to Deficiency with Cold or Yang Deficiency with Middle Cold, characterized by lack of tangible signs, preference for pressure and warmth. More common in women than men. Liyin Jian is indicated. If Deficiency with Stagnation and poor Blood flow exists,iejing Jian (Deciding Fluid Decoction) is best. ○ Fire Pathogen and Heat Stagnation also cause Heart-Abdominal pain. Fire in the Upper causes irritability, thirst, and preference for cold; Fire in the Lower causes distension, constipation, and dysuria. Pulse and symptoms must confirm true Fire before using Cold/Cooling treatments. ○ Parasite pain diagnosis/treatment see *Zhu Chong Men*. ○ Phlegm-Fluid retention in Thoracic Diaphragm causes pain. Symptoms include chest/hypochondrial distension, gurgling sounds, acid regurgitation/vomiting, or pain radiating to back/hypochondrium. Qingge Jian or Erchen Tang are indicated. If Depressive Phlegm is condensed and resistant to resolution, emesis is required. ○ Yin-Cold abdominal pain, occurring after intercourse in both sexes, is first treated with hot compresses of Scallion and Ginger on the umbilicus/abdomen, followed by Lizhong Tang and Sini Tang. For critical pain, moxibustion on Qihai (CV6) etc. is needed. (Zhang Jingyue)
Cold abdominal pain: Jianzhong Tang (Middle-Building Decoction); Heat pain: Huangqin Shaoyao Tang (Scutellaria and Peony Decoction). (Zhou Shenzhai)
The Abdomen belongs to Kun Earth; chronic illness requires harmonizing Spleen and Stomach. String-tight pulse indicates Wood overcoming Earth; use Jianzhong Tang, utilizing Sour Peony to drain Wood within Earth. Deep-thin pulse indicates Water insulting Earth; use Lizhong Tang, utilizing Pungent Dried Ginger to drain Water within Earth. Deep-slow pulse with abdominal pain, spontaneous diarrhea, and undigested food indicates Dampness; use Pingwei San, utilizing Bitter Atractylodes to drain Dampness within Earth. Add Shengma and Chaihu for sinking Stomach Qi; add Shanzha and Maiya for Food Stagnation. (*Yi Xue Ru Men*)
[Pulse Diagnosis]
Differentiating Deficiency and Excess via pulses is generally easy; however, Heart-Abdominal pain pulses are difficult to distinguish. While slippery/excess-strong pulses usually indicate Excess, and weak/lifeless pulses usually indicate Deficiency, this is the norm. However, extreme acute pain often presents with deep-hidden, fine, or choppy pulses, resembling extreme Deficiency. This is because Qi is reversed by pathogens, blocking the pulse vessel, causing deep-hiding. Careful observation reveals a stiff, string-tight quality, indicating Cold Pathogen obstructing Yang Qi. Fire-induced pain differs; do not mistake subtle pulses for Collapse. Misusing tonics causes major errors. Observe physical constitution to know baseline strength; ask etiology to distinguish new vs. old disease. Acute pain with sudden fine-hidden pulses is mostly Excess; chronic pain with inherently weak pulses is Deficiency. (Zhang Jingyue)
[Selected Cases]
Patient Fang suffered abdominal pain. Masses rose and fell like waves, lighter by day, heavier by night. Doctors used pungent-aromatic Qi-moving herbs without effect. Pulse was floating-slow-string-small, coarse pressure felt choppy. I said: This is Blood disease; treating as Qi is wrong. He argued Blood is tangible, yet masses vanish when pain subsides, implying Qi. I explained: Tangible is Blood Accumulation; intangible is Blood Stagnation. Stagnation is milder than Accumulation. If it were Qi, why did previous medicines fail? Prescribed Siwu Tang (Four-Substance Decoction) plus Sanleng (Burreed Tuber), Ezhu (Curcuma Zedoaria), Rushiang (Frankincense), Moyao (Myrrh). Patient recovered instantly. (Wang Shishan)
A woman had abdominal pain for two months. Diagnosed as Cold, Heat, Qi, Deficiency, Food, or Parasites, all treatments failed, worsening pain. A doctor applied large plasters covering the whole abdomen, intensifying pain. Attempts to remove them with fire/oil failed. Her complexion was dark/black, skin dry like tree bark, six pulses flooding-numerous. Upon exposing the abdomen, the plaster's adhesion was revealed. She could not lift her left leg; moving it caused heart pain. Colors/pulses were not terminal; why did treatment worsen it? Likely Intestinal Abscess; inability to lift left leg is a sign. Prescribed Yingwei Fanhun Tang (Nutritive-Defensive Soul-Returning Decoction) for four doses, with Yinhua (Honeysuckle) as chief herb, decocted in water/wine. One dose reduced pain; two doses expelled foul pus (half bucket), pain ceased, plaster fell off naturally. After four doses, she returned to thank me; observers were amazed. (Sun Yikui)
Sun Bingzhang suffered hematemesis, cough, fever, emaciation, loss of appetite, palpitations, insomnia, and a painful mass at the right umbilicus. Medications failed, condition worsened. Left Cun pulse was hollow-large; Right Guan was knotted-stagnant; both Chi pulses were flooding-abundant. I said: Thought/Worry injured Spleen, failing to control Blood; Blood Deficiency causes Fever, Blood Dryness causes Pain. The mass is likely narrow-long, vertical, sickle-shaped, neither Stasis nor Pi (Stagnation), but Spleen pathology. Spleen is right of Stomach; Blood-full means moist/soft, Blood-deficient means dry/painful. Urgently save the Three Yin channels; recovery is possible. Used Guipi Tang (Spleen-Restoring Decoction) minus Muxiang, plus Baishao (White Peony) and Wuweizi (Schisandra), taken with Duqi Wan (Duqi Pill). Continued until cured. (Yang Chengliu)
Abdominal pain due to food usually stagnates in Zhongwan (Epigastrium), but sometimes in the Lower Abdomen. I treated an official who ate dough sticks at noon; by early evening, pain occurred in the lower abdomen/right corner, stagnant and hard like a fist, excruciating. Clearly Food Area entering the intestine, a "Unblocking leads to no pain" case. Initially gave Muxiang Binglang Wan, passed stool 2-3 times, pain unchanged. Suspected slow action, gave Shenyao Wan, ineffective. I reasoned the medicine's Cold/Stagnant nature prevented action; gave Beiji Wan. Though massive purging occurred, hardness/pain persisted. Secretly deducing the cause: Dough. Is there nothing to counteract it? Purging failed; Qi movement is necessary. Dough toxin is killed by Garlic; Qi stagnation moved by Muxiang. Deep stagnation requires sharp guides. Prepared Muxiang in hot wine, had him chew garlic cloves, washed down with fragrant wine. One dose reduced pain; 3-4 doses stopped it. However, the lower abdominal mass took half a year to dissipate. Thus, eliminating Food Stagnation, even with Radix Euphorbiae Humifusa (Daji) or Rhizoma Rhei (Dahuang) is insufficient; promoting Qi movement is primary. Also, food下行 (descending) route passes through lower right abdomen to Changchang (Large Intestine). This was never recorded before; writing it to broaden knowledge. (Zhang Jingyue)
A shepherd boy in early autumn suffered full abdominal distension/pain, vomiting all fluids immediately. Initial cooling/digestive herbs failed; Chengqi Tang (Gut-Purging Decoction) failed. Days passed, emaciated, near death. Someone suggested applying firecracker gunpowder mixed with liquor to the abdomen (excluding umbilicus). Repeated applications led to smooth bowel movement, pain cessation, and cure. (*Jianwen Lu*)
[Appendix: Umbilical Pain]
Umbilical swelling and protrusion indicates Spleen death. (*Nan Jing*)
Umbilical throbbing pain indicates impending death. (Zhang Zhongjing)
Thin persons with periumbilical pain have Wind-Cold. If Grain Qi does not move and purgatives are used, Qi will rush upward. (*Jin Gui Yao Lue*)
Umbilicus (Qi) means alignment. Measuring from arm to foot, the center aligns with the umbilicus. Tianshu (ST25) is 2 cun lateral to the umbilicus, marking the mid-body.
The umbilicus originates from parental essence/blood congealing into the fetus. In utero, mother/child breathe together via the umbilical cord, like fruit on a branch. After birth, breathing via mouth closes the umbilical gate. As one grows, external spirit consumption and internal Cold injury prevent True Qi from flowing freely. Steaming the umbilicus consolidates the root, like watering soil to promote plant growth. (*Yi Xue Ru Men*)
Stomach's upper opening is Benmen (Cardia); lower opening is Youmen (Pylorus). Stomach length is 2 chi 6 cun; the umbilicus corresponds to the Stomach area. Spleen meridians knot at the umbilicus; Stomach meridians flank it. Kidney meridians run from waist/spine, not reaching the umbilicus. Assigning Greater/Lower Abdomen to Liver/Spleen is incomplete. Assigning Umbilical Abdomen to Kidney is inexplicable. So, what does it belong to? Answer: Stomach. Stomach/Spleen are Interior-Exterior pairs; belonging to Stomach implies belonging to Spleen. *Nan Jing* states: Pain above umbilicus is Heart; below is Kidney; right is Lung; left is Liver. Since *Nan Jing* assigns these to Heart/Kidney/Lung/Liver, and Earth is central, does Umbilical Abdomen not belong to Spleen/Stomach?
Intestinal Abscess causes periumbilical sores or pus discharge from umbilicus. (*Dongyuan Shi Shu*)
Edema with umbilical protrusion indicates death. (Zhu Danxi)
[Attached Formulas]
Yingwei Fanhun Tang (Nutritive-Defensive Soul-Returning Decoction): Sheng Shouwu (Polygonum Multiflorum), Danggui (Angelica Sinensis), Chishao (Red Peony), Xiaohui (Fennel), Mutong (Akebia), Gancao Jie (Licorice Joint), Yinhua (Honeysuckle), Beimu (Fritillaria), Zhike (Aurantium), Baizhi (Angelica Dahurica). Decoct in water/wine.
Formula for Yin Syndrome Abdominal Pain: Boil 7 eggs. Poke hole with silver hairpin, place on patient's umbilicus, hold warm. Replace when cool. Pain stops when eggs are finished. Inspect yolk; color turns black.
Test for Yin Syndrome Abdominal Pain: Boil 1 egg. Insert heated silver utensil through it, place on umbilicus, hold warm. Remove after a while. Inspect silver; if Yin Syndrome, silver turns black.