脉
心腹痛不得息，脉细小迟者，生；脉大而急者，死。腹痛，脉反浮大而长者，死。脐下忽
大痛，人中黑者，皆死。尺脉弦则腹痛。
病
凡腹痛，有寒有热，有死血，有食积，有湿痰，有虚有实。若绵绵痛而无增减者，是寒也；时痛时止者，
热也；每痛有处不行移者，死血也；痛甚欲大便，利后痛减者，食积也；痛而小便不利者，湿痰也。
经云∶腹满按之不痛为虚，按之痛者为实。
凡腹中痛甚，饮凉水一盏，其痛稍可者，属热痛，当用凉药清之；清之不已，而或绕脐硬痛，大便闭
实烦渴，用凉药下之，利气丸之类。若饮水愈加作痛，属寒痛，用温药和之；和之不已，而或
四肢厥冷，腹痛呕吐泻痢，急服热药救之，附子理中汤之类，须详脉力有无。
腹痛，气用气药，如木香，槟榔、香附、枳壳之类；血用血药，如当归，川芎、桃仁、红花之类。
如腹中常觉有热，而暴痛暴止者，此为积热，宜调胃承气汤下之。
如腹痛全不思饮食，其人本体素弱，而复冷痛者，以人参养胃汤加肉桂、木香、吴茱萸，或理中汤
加良姜、吴茱萸。
如饮食过伤而腹痛者，宜利气丸下之，并食郁气滞作痛。
凡人腹痛，至于腹中有块起，急以手按之便不见，五更心嘈，牙关矫硬，恶心而清水出，及梦
中啮齿者，此谓之虫痛，宜服化虫丸加使君子。
方
开郁导气汤（西园公制）〔批〕（按此方治腹痛有热者，并一切腹痛之总司也） 治诸
般肚腹疼痛，一服立止。
苍术（米泔浸制，一钱） 陈皮（五分） 香附（童便浸炒，一钱） 白芷（一钱） 川芎（一钱）
茯苓（一钱） 干姜（炒，五分） 滑石（一钱） 山栀子（炒，一钱） 神曲（炒，一钱） 甘草（少许）
上锉一剂，水煎，温服。
行气香苏饮〔批〕（按此方治腹痛有寒者） 治因气恼，或感寒，或伤食，一切肚腹疼痛。方见伤食。
四合饮（云林制）〔批〕（按此方治痰积而气滞，而腹痛者）
陈皮 半夏 茯苓 紫苏 浓朴 香附 枳壳 郁金 甘草（各等分）
上锉一剂，生姜煎服。
消瘀饮（秘方）〔批〕（按此方治瘀血而腹痛者）
当归 芍药 生地黄 桃仁 红花 苏木 大黄（三钱） 芒硝（三钱） 甘草
上锉一剂，水一钟半，煎至八分，入大黄煎，再入芒硝，温服。
肚腹疼痛如锥剜不可忍者，用白芍、黄连、甘草各三钱，金华酒一钟，水一钟，煎服。
脉象
心腹部疼痛导致呼吸受阻，若脉象细小而迟缓的，预后良好（可生）；若脉象大而急迫的，预后不良（主死）。腹痛时，脉象反而呈现浮大且长的，预后不良（主死）。脐下突然剧烈疼痛，且人中部位发黑的，均主死亡。尺部脉象弦硬的，则会出现腹痛。
病症
凡是腹痛，病因有寒、热、瘀血、食积、湿痰，以及虚证和实证之分。如果是绵绵作痛且没有增减变化的，属于寒证；如果时痛时止的，属于热证；如果每次疼痛位置固定不移的，属于瘀血证；如果疼痛剧烈想要大便，排便后疼痛减轻的，属于食积证；如果疼痛伴有小便不利的，属于湿痰证。
《内经》说：腹部胀满，按压时不痛的属于虚证，按压时痛的属于实证。
凡是腹中疼痛剧烈，喝下一盏凉水，疼痛稍微缓解的，属于热痛，应当用凉药清热；如果清热无效，或者出现绕脐硬痛、大便闭塞不通、烦躁口渴的症状，应用凉药攻下，如利气丸之类的方剂。如果喝水后疼痛加剧的，属于寒痛，应当用温药调和；如果调和无效，或者出现四肢厥冷、腹痛呕吐、腹泻痢疾的症状，应立即服用热药急救，如附子理中汤之类的方剂，必须详细诊察脉力的有无。
对于腹痛，气滞者使用理气药，如木香、槟榔、香附、枳壳等；血瘀者使用活血药，如当归、川芎、桃仁、红花等。
如果腹中常觉发热，但疼痛突然发作又突然停止的，这是积热，适宜用调胃承气汤攻下。
如果腹痛完全不想吃东西，患者本身体质素来虚弱，又加上冷痛的，用人参养胃汤加入肉桂、木香、吴茱萸，或者理中汤加入高良姜、吴茱萸。
如果是饮食过度损伤导致的腹痛，适宜用利气汤攻下，这也适用于因食郁气滞引起的疼痛。
凡是人患腹痛，直到腹中有肿块突起，急忙用手按压就消失不见，五更时分心中嘈杂不安，牙关僵硬，恶心并吐出清水，以及在睡梦中磨牙的，这叫做虫痛，适宜服用化虫丸加使君子。
方剂
开郁导气汤（西园公配制）〔批注〕（按：此方治疗腹痛属热者，是治疗各种腹痛的总纲方） 治疗各种肚腹疼痛，服一剂立即停止。
苍术（米泔水浸泡制成，一钱） 陈皮（五分） 香附（童便浸泡炒制，一钱） 白芷（一钱） 川芎（一钱）
茯苓（一钱） 干姜（炒制，五分） 滑石（一钱） 山栀子（炒制，一钱） 神曲（炒制，一钱） 甘草（少许）
以上药材锉碎为一剂，用水煎煮，温服。
行气香苏饮〔批注〕（按：此方治疗腹痛属寒者） 治疗因气恼、或受寒、或伤食引起的一切肚腹疼痛。方剂见“伤食”章节。
四合饮（云林配制）〔批注〕（按：此方治疗痰积气滞导致的腹痛）
陈皮 半夏 茯苓 紫苏 浓朴 香附 枳壳 郁金 甘草（各等分）
以上药材锉碎为一剂，用生姜煎服。
消瘀饮（秘方）〔批注〕（按：此方治疗瘀血导致的腹痛）
当归 芍药 生地黄 桃仁 红花 苏木 大黄（三钱） 芒硝（三钱） 甘草
以上药材锉碎为一剂，用水一钟半，煎至八分，先放入大黄煎煮，再放入芒硝，温服。
Pulse
Heart and abdominal pain causing inability to breathe: if the pulse is fine, small, and slow, survival is indicated; if the pulse is large and rapid, death is indicated. In abdominal pain, if the pulse is surprisingly floating, large, and long, death is indicated. Sudden severe pain below the umbilicus accompanied by blackening of the area between the nose and upper lip (Ren Zhong) both indicate death. A wiry pulse at the Chi position indicates abdominal pain.
Diseases
Abdominal pain may be caused by cold, heat, stagnant blood, food accumulation, damp-phlegm, deficiency, or excess. If the pain is continuous without fluctuation, it is due to cold; if the pain comes and goes intermittently, it is due to heat; if the pain is fixed in one location and does not shift, it is due to stagnant blood; if the pain is severe with an urge to defecate, and relief follows defecation, it is due to food accumulation; if the pain is accompanied by difficult urination, it is due to damp-phlegm.
The Classics state: Abdominal fullness that is painless upon palpation indicates deficiency; fullness that is painful upon palpation indicates excess.
When abdominal pain is severe, drinking a cup of cool water provides slight relief: this indicates heat-pain, which should be treated with cooling herbs to clear heat. If clearing heat fails and symptoms include hard, painful wrapping around the umbilicus, constipation, restlessness, and thirst, cooling purgatives should be used, such as Liqi Wan (Qi-Regulating Pill). If drinking water exacerbates the pain, it indicates cold-pain, which should be treated with warming herbs to harmonize. If harmonizing fails and symptoms include cold limbs, abdominal pain, vomiting, diarrhea, and dysentery, hot herbs must be taken urgently for rescue, such as Fuzi Lizhong Tang (Aconite and Immature Ginger Decoction), after carefully assessing the presence or absence of pulse strength.
For abdominal pain due to Qi stagnation, use Qi-regulating herbs such as Muxiang (Costus Root), Binglang (Areca Seed), Xiangfu (Cyperus Rhizome), and Zhiqiao (Bitter Orange); for blood stasis, use blood-invigorating herbs such as Danggui (Angelica Sinensis), Chuanxiong (Ligusticum Rhizome), Taoren (Peach Kernel), and Honghua (Safflower).
If the abdomen often feels hot, but pain attacks suddenly and stops abruptly, this is accumulated heat, suitable for treatment with Tiaowei Chengqi Tang (Stomach-Regulating Major Order the Qi Decoction) to purge.
If abdominal pain causes complete loss of appetite, and the patient has a constitutionally weak body combined with cold-pain, use Renshen Yangwei Tang (Ginseng Stomach-Nourishing Decoction) added with Rougui (Cinnamon Bark), Muxiang (Costus Root), and Wuzhuyu (Evodia Fruit), or Lizhong Tang (Central-Regulating Decoction) added with Liangjiang (Galangal Rhizome) and Wuzhuyu (Evodia Fruit).
If abdominal pain results from overeating, use Liqi Wan (Qi-Regulating Pill) to purge; this also applies to pain caused by food stagnation and Qi obstruction.
When abdominal pain presents with a mass rising in the abdomen that disappears upon immediate manual pressure, mental discomfort at dawn (Wu Geng), jaw stiffness, nausea with clear fluid regurgitation, and teeth grinding during sleep, this is called worm-pain, suitable for Huachong Wan (Worm-Dissipating Pill) added with Shijunzi (Quinine Tree Seed).
Formulas
Kaiyu Daoqi Tang (Depression-Resolving and Qi-Guiding Decoction) [Prepared by Xiyuan Gong] [Commentary: This formula treats abdominal pain due to heat and serves as a general prescription for all types of abdominal pain.] Treats various types of abdominal pain; relief occurs immediately after one dose.
Cangzhu (Rice bran water soaked and processed, 1 qian) Chenpi (5 fen) Xiangfu (Child's urine soaked and stir-fried, 1 qian) Baizhi (1 qian) Chuanxiong (1 qian)
Fuling (1 qian) Ganjiang (Stir-fried, 5 fen) Huashi (Talcum, 1 qian) Shanzhizi (Stir-fried, 1 qian) Shenqu (Stir-fried, 1 qian) Gancao (A small amount)
Crush these ingredients into one dose, decoct in water, and take warm.
Xingqi Xiangsu Yin (Qi-Moving and Perilla Decoction) [Commentary: This formula treats abdominal pain due to cold.] Treats all abdominal pain caused by emotional anger, cold invasion, or food injury. See the "Food Injury" section for the formula.
Sihe Yin (Four-Harmony Decoction) [Prepared by Yunlin] [Commentary: This formula treats abdominal pain due to phlegm accumulation and Qi stagnation.]
Chenpi (Tangerine Peel) Banxia (Pinellia Tuber) Fuling (Poria) Zisu (Perilla Leaf) Nongpo (Magnolia Bark) Xiangfu (Cyperus Rhizome) Zhiqiao (Bitter Orange) Yujin (Curcuma Rhizome) Gancao (Licorice Root) (Equal parts)
Crush these ingredients into one dose, decoct with fresh ginger, and take.
Xiaoyu Yin (Blood-Stasis-Dispersing Decoction) [Secret Formula] [Commentary: This formula treats abdominal pain due to blood stasis.]
Danggui (Angelica Sinensis) Shaoyao (Peony Root) Shengdihuang (Rehmannia Root) Taoren (Peach Kernel) Honghua (Safflower) Sumu (Calamus Wood) Dahuang (Rhubarb Root, 3 qian) Mangxiao (Mirabilite, 3 qian) Gancao (Licorice Root)
Crush these ingredients into one dose, add 1.5 zhong of water, decoct until 0.8 zhong remains, add Dahuang (Rhubarb Root) and decoct again, then add Mangxiao (Mirabilite), and take warm.
For unbearable abdominal pain described as feeling like being pierced by an awl, use Baishao (White Peony Root), Huanglian (Coptis Rhizome), and Gancao (Licorice Root), each 3 qian, mixed with 1 zhong of Jinhua wine and 1 zhong of water, decocted and taken.