脉
脉双弦者，肝气有余，两胁作痛。
病
夫胁痛者，厥阴肝经为病也。其病自两胁下痛引小腹，亦当视内外所感之邪而治之。若因暴怒伤触悲哀
气结，饮食过度，冷热失调，颠仆伤形，或痰积流注于血，与血相搏，皆能为痛，此内因也；若伤寒少阳，耳
聋胁痛，风寒所袭而为胁痛，此外因也。治之
当以散结顺气，化痰和血为主，平其肝而导其气，则无有不愈矣。
治
胁痛者，肝火盛，木气实也。有死血，有痰流注，有肝急者。
一、木气实，用苍术、川芎、青皮、柴胡、芍药、甘草，水煎服。
一、痛甚者，肝火盛，以当归龙荟丸姜汤下，泻肝火之要药也。
一、死血作痛，用桃仁去皮留尖，红花酒拌焙干，川芎，香附童便浸，青皮，水煎服。
一、肝苦急，食辛以散之，川芎、苍术，血病入血药中，苦者，恶也、嫌也。或小柴胡汤亦效。
一、凡胁痛皆是肝木有余也，用小柴胡汤加青皮、川芎、芍药、龙胆草。
一、凡胁痛用青皮，必须用醋炒过。
一、凡瘀血作痛，用小柴胡汤合四物汤，加桃仁、红花、乳
香、没药煎服，痛甚而元气实者，桃仁承气汤下之。
方
枳壳散 治胁间如物刺，是气实也。
枳壳（面炒黄，一两五钱） 甘草（炙，七钱五分）
上为末，每二钱，浓煎葱白汤下，不拘时服。
当归龙荟丸 治泻肝火盛之要药，因内有湿热，两胁痛甚，伐肝木之气。
当归 龙胆草 山栀子 黄连 大黄（酒湿火煨） 芦荟 青黛（各五
钱） 木香（二钱五分） 麝香（五分，另研） 加柴胡（五钱） 青皮（一钱）
上为细末，神曲为丸，如梧桐子大。每服二十丸，姜汤下。
治妇人胁痛。
香附子（四两，醋一碗，盐一两煮干） 白芍药（二两） 肉桂（二两） 玄胡索（炒，二两）
上为末，每服三钱，空心滚汤调。
治诸痛熨法
韭菜根，捣烂，醋拌炒，绢包熨痛处。
病症
所谓胁痛，属于厥阴肝经的病变。其症状表现为从两侧胁肋下疼痛牵引至小腹，治疗时应当根据内外所感受的病邪进行辨证施治。如果是因突然暴怒、悲伤触动导致气机郁结，饮食过量，冷热失调，跌打损伤形体，或者痰饮积聚流注于血脉之中，与血液相互搏结，这些都能引起疼痛，这属于内因；如果是伤寒少阳证出现的耳聋和胁痛，或是风寒侵袭导致的胁痛，这属于外因。治疗时应当以散结顺气、化痰和血为主要原则，平抑肝气并疏导气机，那么没有不能治愈的。
治疗方法
胁痛，是由于肝火旺盛，木气（肝气）实盛所致。病因包括有瘀血阻滞、有痰饮流注、有肝气急迫等情况。
一、若是木气实盛，使用苍术、川芎、青皮、柴胡、芍药、甘草，用水煎煮后服用。
一、若疼痛剧烈，属于肝火旺盛，用当归龙荟丸配合姜汤送服，这是泻除肝火的要药。
一、若是瘀血引起的疼痛，使用桃仁（去皮保留尖端）、红花（用酒拌和后焙干）、川芎、香附（用童子尿浸泡）、青皮，用水煎煮后服用。
一、肝气苦于急迫，应用辛味药物来发散它，可用川芎、苍术；若为血病，则加入活血药物中。“苦”在这里意为厌恶、嫌弃（指肝喜条达而恶抑郁，或指苦味药的作用）。也可以使用小柴胡汤，同样有效。
一、凡是胁痛都是肝木之气有余，使用小柴胡汤加上青皮、川芎、芍药、龙胆草。
一、凡是瘀血引起的疼痛，使用小柴胡汤合四物汤，加入桃仁、红花、乳香、没药煎煮后服用；如果疼痛剧烈且元气充实者，用桃仁承气汤攻下之。
方剂
枳壳散 治疗胁肋间感觉像被物体刺扎一样的疼痛，这是气实所致。
枳壳（面粉炒至微黄，一两五钱） 甘草（炙烤，七钱五分）
将上述药材研为细末，每次取二钱，用浓煎的葱白汤送服，不限时间服用。
当归龙荟丸 治疗泻除肝火旺盛的要药，适用于体内有湿热，两胁疼痛剧烈，旨在伐除肝木之气。
当归 龙胆草 山栀子 黄连 大黄（酒浸后湿火煨制） 芦荟 青黛（各五钱） 木香（二钱五分） 麝香（五分，单独研磨） 加柴胡（五钱） 青皮（一钱）
将上述药材研为细末，用神曲糊制成丸剂，大小如梧桐子。每次服用二十丸，用姜汤送服。
治疗妇女胁痛。
香附子（四两，用一碗醋和一两盐煮至干透） 白芍药（二两） 肉桂（二两） 玄胡索（炒制，二两）
将上述药材研为细末，每次服用三钱，空腹时用滚开水调服。
Pulse
When the pulse is double-wiry (Shuang Xian), it indicates excess Liver Qi, resulting in pain in both hypochondriac regions.
Disease
Hypochondriac pain (Xie Tong) is a disease of the Jueyin Liver Meridian. The pathology involves pain radiating from the bilateral hypochondrium to the lower abdomen. Treatment should be based on the differentiation of internal and external pathogenic factors. If caused by sudden rage or grief leading to Qi stagnation, overeating, imbalance of cold and heat, physical trauma, or phlegm accumulation flowing into the blood vessels and clashing with blood, these constitute internal causes; if caused by Shaoyang syndrome of Cold Damage presenting with deafness and hypochondriac pain, or by invasion of Wind-Cold, these constitute external causes. Treatment should primarily focus on dissipating nodules, regulating Qi, resolving phlegm, and harmonizing blood. By pacifying the Liver and guiding the flow of Qi, cure can be achieved.
Treatment Methods
Hypochondriac pain is caused by excessive Liver Fire and excess Wood Qi (Liver Qi). Etiologies include blood stasis, phlegm flow, and Liver urgency.
1. For excess Wood Qi, use Cang Zhu (Atractylodis Rhizoma), Chuan Xiong (Ligustici Chuanxiong Rhizoma), Qing Pi (Citri Reticulatae Pericarpium Viride), Chai Hu (Bupleuri Radix), Shao Yao (Paeoniae Radix Alba), and Gan Cao (Glycyrrhizae Radix et Rhizoma). Decoct in water and take orally.
2. For severe pain due to excessive Liver Fire, administer Danggui Longhui Wan (Angelica Sinensis and Aloe Pill) with Ginger Decoction. This is a key formula for purging Liver Fire.
3. For pain caused by blood stasis, use Tao Ren (Persicae Semen) [skin removed, tip retained], Hong Hua (Carthami Flos) [mixed with wine and dried], Chuan Xiong, Xiang Fu (Cyperi Rhizoma) [soaked in child's urine], and Qing Pi. Decoct in water and take orally.
4. When the Liver suffers from urgency, pungent substances should be used to disperse it. Use Chuan Xiong and Cang Zhu. For blood diseases, add them to blood-invigorating formulas. "Ku" (bitter) here implies aversion or dislike. Xiaochaihu Tang (Minor Bupleurum Decoction) is also effective.
5. All cases of hypochondriac pain are due to excess Liver Wood. Use Xiaochaihu Tang (Minor Bupleurum Decoction) added with Qing Pi, Chuan Xiong, Shao Yao, and Long Dan Cao (Gentianae Radix).
6. When using Qing Pi for hypochondriac pain, it must be stir-fried with vinegar.
7. For pain caused by blood stasis, use Xiaochaihu Tang (Minor Bupleurum Decoction) combined with Siwu Tang (Four Substances Decoction), added with Tao Ren, Hong Hua, Rush Xiang (Olibanum), and Moyao (Myrrha). Decoct and take orally. If pain is severe and the Yuan Qi (Original Qi) is sufficient, administer Taoren Chengqi Tang (Peach Kernel and Magnolia Bark Decoction) to purge downward.
Formulas
Zhike San (Bitter Orange Powder) treats stabbing pain in the hypochondrium as if pierced by an object, indicating excess Qi.
Zhike (Fructus Aurantii) [stir-fried with flour until yellow, 1 liang 5 qian] Gancao (Radix Glycyrrhizae) [roasted, 7 qian 5 fen]
Grind into powder. Take 2 qian each time, administered with strong decoction of Cong Bai (Scallion White). Take at any time.
Danggui Longhui Wan (Angelica Sinensis and Aloe Pill) is a key medicine for purging excessive Liver Fire, suitable for damp-heat internally causing severe hypochondriac pain, aiming to subdue Liver Wood Qi.
Danggui (Angelicae Sinensis Radix), Longdan Cao (Gentianae Radix), Shanzhizi (Gardeniae Fructus), Huanglian (Coptidis Rhizoma), Dahuang (Rhei Radix et Rhizoma) [steeped in wine and roasted with moisture], Lvhui (Aloe), Qingdai (Indigo Naturalis) [each 5 qian], Muxiang (Aucklandiae Radix) [2 qian 5 fen], Shexiang (Moschus) [5 fen, separately ground]. Add Chai Hu (5 qian) and Qing Pi (1 qian).
Grind into fine powder, make pills with Shenqu (Medicated Leaven) the size of Sophora seeds. Take 20 pills each time with Ginger Decoction.
Treats hypochondriac pain in women.
Xiangfu Zi (Cyperi Rhizoma) [4 liang, boiled dry in one bowl of vinegar and 1 liang salt], Baishao Yao (Paeoniae Radix Alba) [2 liang], Rougui (Cinnamomi Cortex) [2 liang], Yanhusuo (Corydalis Rhizoma) [roasted, 2 liang].
Grind into powder. Take 3 qian each time, mixed with boiling water on an empty stomach.
External application method for treating various pains.
Jiucai Gen (Allii Tuberosi Radix) is mashed, mixed with vinegar, stir-fried, wrapped in silk cloth, and applied as a hot compress to the painful area.