李土材曰，心腹诸痛，按《内经》之论，心痛未有不兼五脏为病者，独详于心，而略于胸腹，举一以利其
余也。心为君主，义不受邪，受邪则本经自病，名真心痛，必死不治。然经有云∶邪在心则病心痛，喜悲，时
眩仆。此言胞络受邪，在腑不在脏也。又云∶手少阴之脉，动则病嗌干心痛，渴而欲饮，此言别络受邪，
在络不在经也。其络与腑之受邪，皆因怵惕思虑，伤神涸血。而方论复分九种∶饮、食、热，冷、气、血、
悸、虫、疰。苟不能遍识病情，将何治耶？
胃属湿土，列处中焦，为水谷之海，五脏六腑，十二经脉，皆受气于此。壮者邪不能干，弱者着而即病。
偏热偏寒，水停食积，皆与真气
相搏而痛。肝木相乘为贼邪，肾寒厥逆为微邪。挟他藏而见症，当与心痛相同。但或满或胀，或呕
吐，或不能食，或吞酸，或大便难，或泻利，面浮而黄，本病与客邪又参杂而见也。
胸痛即膈痛。其与心痛别者，心痛在歧骨陷处，胸痛横满胸膈间也。其与胃脘痛别者，胃脘在心之上
也。经曰∶南风生于夏，病在心俞，在胸胁。此以胸属心也。肝虚则胸痛引背胁，肝实则胸痛不能转侧。
此又以胸属肝也。夫胸中，肺家之分野，其言心者，以心之脉从心系却上肺也。其言肝者，以肝之脉贯膈上
注肺也。胁痛旧从肝治，不知肝固内HT 胁，何以异于足少阳，手心主所过而痛者哉？若谓筋脉挟邪而痛，
何以异于经筋所过而痛者哉？故非审色按脉，熟察各经气变，卒不能万举万当也。且左右、肺肝、气血、
阴阳，亦有不可尽拘，临症者可不详察耶？
腹痛分为三部∶腹以上痛者，为太阴脾；当脐而痛者，为少阴肾；少腹痛者，为厥阴肝，及冲、任
、大小肠。每部各有五脏之变，七情之发，六气之害，五运之邪，至纷至博。苟
能辨气血、虚实、内伤、外感，而为之调剂，无不切中病情矣。
心痛有停饮，则恶心烦闷，时吐黄水，甚则摇之作水声，小胃丹或胃苓汤。食积则饱闷，噫气如败卵，
得食辄甚，香砂枳术丸加神曲、莪术。火痛，忽减忽增，口渴便闭，清中汤。外受寒，内食冷，草豆蔻丸。虚
寒者，归脾汤加姜、桂、菖蒲。气壅，攻刺而痛，沉香降气散。死血，脉必涩，饮下作呃，手拈散，甚
者桃仁承气汤。心痛而烦，发热动悸，此为虚伤，妙香散。虫痛，面上白斑，唇红能食，或食后即痛，或痛
后能食，或口中沫出，剪红丸。蛔虫，蛔动则恶心呕吐，乌梅丸、芜荑散，鬼疰，昏愦妄言，苏合香丸。热厥
心痛，金铃子散。寒厥心痛，术附汤。胃脘痛与心痛相仿，但有食积，按之满痛者，下之，大柴胡汤；虚寒
者，理中汤。
胸痛肝虚者，痛引背胁，补肝汤；肝实者，不得转侧，喜太息，柴胡疏肝散。有痰，二陈汤加姜汁。
腹痛，芍药甘草汤主之。稼穑作甘，甘者己也；曲直作酸，酸者甲也。甲己化土，此仲景妙法也。脉
缓伤水，加桂枝、生姜；脉洪伤金，加黄芩、大枣；脉涩伤血，加当归；脉弦伤气，加芍药；脉迟伤火，
加干姜。绵绵痛而无增减，欲得热手按及热饮食，其脉迟者，寒也，香砂，枳术、理中汤。冷痛，用温药
不效，大便秘者，当微利之，藿香正气散加官桂、木香、大黄。时痛时止，热手按而不散，脉大而数者，
热也，大金花丸，或黄连解毒汤。暑痛，十味香薷饮。湿痛，小便不利，大便溏，脉必细缓，胃苓汤。痰痛，
或眩晕，或吐
冷涎，或下白积、或小便不利，或得辛辣热汤则暂止，脉必滑，轻者二陈加枳壳、姜汁，重者用礞石滚痰
丸。食积，痛甚，大便后减，其脉弦，或沉滑，平胃加枳实、山楂、麦芽、砂仁、木香，甚者加大黄。酒积
痛，葛花解酲汤加三棱、莪术、茵陈。气滞必腹胀脉沉，木香顺风散。死血作痛，痛有定在而不移，脉涩
或芤。虚者四物汤料加大黄蜜丸服；实者归尾、桃仁，加童便、酒、韭汁、桃仁承气汤，或丹皮、香附，穿
山甲、降香、红花、苏木、元胡。虫痛，心腹懊 ，往来上下，痛有休止，或有块耕起，腹热善渴，面色乍
青乍白乍赤，吐青水者，虫也，椒汤吞乌梅丸安之。
夫近世治痛，有以诸痛为实，痛无补法者；有以痛则不通，通则不痛；有以痛随利减者，以为不可
易之法。不知形实病实，便闭不通乃为相宜；若形虚脉弱，食少便泄者，岂容混治？须知胀闭而痛者为实，
不胀闭者多虚；拒按者为实，可按者为虚；喜寒者多实，受热者多虚；饱则甚者多实，饥则甚者多虚；脉实
气粗者多实；脉虚气少者多虚；新病年壮者多实，久病年衰者多虚；补而不效者多实，攻而愈剧者多虚。痛
在经者，脉多弦大；痛在脏者，脉多沉微。必以望、闻、问、切四者详辨，则虚实灼然。故表虚而痛者，阳
不足也，非温经不可；里虚而痛者，阴不足也，非养营不可。上虚而痛者，以脾伤也，非补中不可；下虚而痛
者，脾肾败也，非温补命门不可。若泥痛无补法，则杀人惨于刀剑矣。
胁痛∶左痛多留血，代抵当汤；右痛多痰气，痰二陈汤，气推气散。左为肝邪，枳芎散；右为肝移邪
于肺，推气散。挟寒，理中汤加枳壳。死血，日轻夜重，或午后热，脉涩或芤，桃仁承气汤加枳壳、鳖甲。
痰饮，导痰汤加白芥子。食积，有一条扛起者是也，枳术丸加吴茱萸、黄连、神曲、山楂。肝
火盛，龙荟丸。虚冷，理中汤送黑锡丹。肝脉软，补肝汤。惊伤胁痛，桂枝散。
胁痛肝火盛，左金丸。治肝火有气郁者，看其脉沉涩，当作郁治。痛而不得伸舒，龙荟丸最快。右胁痛
，严氏推气散。左胁痛，苍术、川芎、青皮、当归、柴胡，痛甚当归龙荟丸。姜汁下。
然胁痛固属肝，常见口吐苦水，胁痛寒热，用猪胆炒黄连，入小柴胡，是胆家有火也。若夫谋虑不决，不眠
辛苦，胆气伤而作痛，用归、芍、人参、麦冬、茯神、枣仁，有火加元参，此胆虚胁痛也。
方约之曰，胁痛之症，多是肝火上升，不得条达之故。予每度其左胁痛甚者，即是肝火盛，木气实也，
宜用龙荟丸、左金丸，辛凉之剂以治之；凡右胁痛微者，即是痰疰，宜用盐煎散、顺气丸，辛温之剂以治之
是也。
又尝论左胁痛，胃脘痛之症，妇人为多，以其忧思忿怒之气，素灌于中，发则上冲，被湿痰死血阻滞其
气，而不得条达，故作痛也。故治妇人诸痛；必以行气开郁为主，而破血散火兼之，庶乎得法矣。谚云∶香
附、缩砂，女人之至宝。此之谓也。
张景岳曰∶胁痛者，左右气血之辨，若左无气，右无血，食积痰饮岂必无涉于左乎？此谬谈也。予以为
莫若察其有形无形。盖血积有形而不移，或坚硬而拒按，气痛流行而无迹，或倏聚而倏散。若食积痰饮，皆
属有形之症，详察所因，自可识别。凡属有形之症，亦无非由气之滞，但得气行，则何聚而不散？无论是气
是血是痰，必皆兼气为主，而后随宜佐使以治之可也。
一内伤虚损，房劳肾虚之人，多有胸胁间隐隐作痛，此肝肾精虚，不能化气，气虚不能生血而然。凡人
之气血，犹
源泉也，盛则流畅，少则壅滞。故气血不虚则不滞，虚则无有不滞者。倘于此症不知培气血，而但知行滞
通经，则误矣。
王节斋曰∶凡治心腹疼痛，但是新病，须问曾何饮食，因何伤感，有无积滞，便与和中消导之药。若
日数已多，曾多服过辛温燥热之药，呕吐不纳，胸膈饱闷，口舌干燥，大小便涩难，则内有郁热矣，或
原有旧病，因感而发，绵延日久，见症如前者，俱用开郁行气、降火润燥之药，如川芎、香附、山栀、黄连、
姜汁之类。甚者再加芒硝。但治心腹久痛，须于温散药内，加苦寒、咸寒之药，温治其标，寒治其本也。
诸积诸痛，喜温而恶寒，热药与病情相合，积久成郁，而火邪深矣，郁热既深，则见寒愈逆，见热愈
喜，雨热相从，故不生他病，所谓火极而似水者也。然真气被食，阴血干枯，病日深锢而不可为矣。世人不识
，但见投热不热，误认为沉寒锢冷，而益投之，至死不悟。然则如之何？曰从治法，热因寒用，寒因热用，
伏其所主，先其所因是也。
朱丹溪曰∶心膈之痛，须分新久。病久则成郁，久郁则蒸热，古方多以山栀为热药之向导。用栀子炒，
去皮，每服十五枚，浓煎汤一呷，入生姜汁令辣，再煎小沸，又入川芎一钱，尤妙。大概胃中有热而作痛者
，用山栀不可，须佐以姜汁、台芎开之。痰发者，或用二陈汤加川芎、苍术，倍加
炒栀。痛甚者，加干姜从之，反治之法也。若用山栀并劫药不止，用元明粉，一服立止。
腹痛有寒、有热、死血、食积、湿痰。脉弦为食，脉滑为痰。湿痰多作腹痛，台芎、苍术、香附、白芷
为末，以生姜汁入汤服。大法∶主方，在气用气药，如木香、槟榔、香附、没药之类；血用血药，如当归、
川芎、桃仁、红花之类。
初得时，元气未虚，必推荡之，此通因通用之法。壮实者同。
若人虚弱衰与久病者，宜升之消之。凡心腹痛，必用温散，此是郁结不行，阻气不运，故痛。在上者多
属食，用炒干姜、苍术、川芎、白芷、香附、姜汁之类，不可用峻药攻下之。更兼行气快气药助之，
无不可者。
寒痛者，绵绵痛，无增减者是也。时痛时止者，是热也。死血痛者，痛有处，不移者也。大便利后
减者，是湿痰。东垣云∶感寒而痛，宜姜、桂，呕者加丁香。伤暑而痛，宜玉龙丸。肥人腹痛，属气兼湿痰，
宜人参、苍术、白术、半夏。或曰∶痰岂能作痛，不知气郁则痰聚，痰聚则凝，气道不得运，故痛也。如禀
受素弱，饮食过伤而腹痛者，以养胃汤加桂、茱萸各半钱，木香三分。又或理中汤、建中汤，皆可用，内加
茱萸良。绞肠痧，以樟木煎汤大吐，或白矾调汤吐之，盐汤亦可探吐，亦宜刺委中出血。
喻嘉言曰∶五脏失治，皆为心痛，理甚明晰。肾心痛者，多由阴邪上冲，故善 ，如从后触其心，
胃心痛者，多由停滞，故胸腹胀满。脾心痛者，多由寒逆中焦，故其病甚，肝心痛者，多由木火之郁，病在
血分，故色苍苍如死状。肺心痛者，多由上焦不清，病在气分，故动作则病益甚。若知其在气则顺之，在血
则行之，郁则开之，滞则逐之。火多实，则或散或清。实多虚，则或温或补。必真心痛，乃不可治。否
则得其本，随手而应也。
张景岳曰∶诸症虚实，皆可以脉辨。惟心腹痛症，脉多难辨。虽滑实有力者，固多实邪；虚弱无神者，
固多虚邪，此其常也。然暴病之极，每多沉伏细涩，最似极虚之候。不知
气为邪逆，脉道不行，而沉伏异常，此正邪实之脉。然于沉伏之中细察之，必有梗梗然弦紧之意，此必寒邪
阻遏阳气者，多有是脉。若火邪作痛，则不然也。辨此之法，但当察其形
气，以见平素强弱；问其病因，以知新久，及何所因而起。大都暴病痛急，而脉忽细伏者，多实邪；久病
痛缓，而脉本微弱者，为虚邪。论其虚实，酌之以理，参而论之，则万无一失矣。
凡治心腹痛症，已经攻击荡涤，愈而复作，或再三用之，愈作愈甚，脉反浮弦虚大，为中虚之候。速当
酌其虚实，或专补正气，或兼治邪气。若用补无碍，不可妄乱杂投，使脾胃强，则痛自愈矣。
一胸腹之痛，有无关于内，而在筋骨皮肉之间，此邪之在经，不可混作里症，必详问的当，而分其或火
或寒或气，或血滞或血虚，或淫疮邪毒，留蓄在经，庶治之无误也。
附医案∶余治一上舍，年近三旬，因食面角，午刻至初更，食及小腹下至右角间，遂停积不行，坚突
如拳，痛剧之甚。余察其明系面积已入大肠，乃与木香槟榔丸，连下二三次，其痛如故。疑药未及病，更投神
佑丸泻之，又不效。又疑药性皆寒，故滞不行，因再投备急丸，连得大泻，而坚痛毫不为减。因潜测其由不过
因面，岂无所制之？今既逐之不及，使非借气以行之不可也。计面毒非大蒜不杀，气滞非木香不行，又其滞
深道远，非精锐之向导不能得达，乃用火酒磨木香，令其嚼生蒜一瓣，而以香酒进之。一服后觉痛稍减，
三四服后，痛渐止而食渐进，方得全愈。然小腹之块，仍在半年许始得尽消。由是知欲消食滞，即大黄、巴
豆犹有所不能及，而惟宜以行气为先也。且知饮食下行之道，必由小腹下右角间，而后出于广肠。此自古无人
言及者，因笔之广闻见云。
李士材说，心腹部的各种疼痛，根据《内经》的论述，心痛没有不兼涉五脏病变的，只是详细论述了心脏，而简略论述了胸腹部，这是举出一例以推及其他。心为君主之官，按理不应受邪气侵袭；若受邪气侵袭，则是本经自病，称为真心痛，必定死亡且无法治疗。然而经文又说：邪气在心则导致心痛，喜欢悲伤，时常眩晕跌倒。这说的是心包络受邪，病位在腑而非脏。又说：手少阴心经的脉动异常，会导致咽喉干燥、心痛、口渴想喝水，这说的是别络受邪，病位在络脉而非经脉。这些络脉和腑受邪，都是因为惊恐思虑，损伤神志、耗竭血液。而后世的方论又将其分为九种：饮、食、热、冷、气、血、悸、虫、疰。如果不能全面识别病情，该如何治疗呢？
胃属于湿土，位于中焦，是水谷汇聚的海，五脏六腑、十二经脉的气血都由此受纳。身体强壮的人，邪气不能侵犯；身体虚弱的人，邪气停留就会立即发病。偏热或偏寒，水液停聚或食物积滞，都会与真气相搏结而产生疼痛。肝木乘克脾胃为贼邪，肾寒厥逆为微邪。夹杂其他脏腑的症状出现时，应当与心痛的治疗原则相同。但症状可能表现为胀满、呕吐、不能进食、吞酸、大便困难或腹泻，面色浮肿发黄，本病与客邪相互混杂出现。
胸痛即膈痛。它与心痛的区别在于：心痛在歧骨（剑突）凹陷处，胸痛则是横贯胸膈之间。它与胃脘痛的区别在于：胃脘位于心的上方。经文说：南风生于夏季，病在心俞，部位在胸胁。这是将胸归属于心。肝虚则胸痛牵引背胁，肝实则胸痛导致身体不能转动。这又是将胸归属于肝。胸中是肺所主的分野，之所以说心，是因为心的脉络从心系向上经过肺。之所以说肝，是因为肝的脉络贯穿膈肌向上注入肺。胁痛过去多从肝论治，却不知道肝确实内连胁部，这与足少阳胆经、手厥阴心包经经过之处而疼痛有何不同？如果说筋脉挟带邪气而痛，这与经筋经过之处而疼痛又有何区别？所以如果不仔细诊察面色、按压脉象，熟查各经气的变化，就不能做到万无一失。而且左右、肺肝、气血、阴阳，也有不可完全拘泥的地方，临症者能不详细考察吗？
腹痛分为三部：腹部以上疼痛的，属于太阴脾；肚脐周围疼痛的，属于少阴肾；小腹疼痛的，属于厥阴肝，以及冲脉、任脉、大肠和小肠。每一部都有五脏的变化、七情的情志发作、六淫外邪的危害、五运六气的邪气，纷繁复杂。如果能辨别气血、虚实、内伤、外感，并进行调理，就能切中病情。
心痛伴有停饮，则恶心烦闷，时常吐出黄水，严重时摇动身体可听到水声，用大胃丹或胃苓汤。食积则饱闷，嗳气有腐败卵臭味，进食后加重，用香砂枳术丸加神曲、莪术。火痛，忽轻忽重，口渴便秘，用清中汤。外受寒邪，内食生冷，用草豆蔻丸。虚寒者，用归脾汤加生姜、肉桂、石菖蒲。气机壅滞，攻刺样疼痛，用沉香降气散。死血（瘀血），脉必涩，服药后打呃，用手拈散，严重的用桃仁承气汤。心痛伴心烦、发热、心悸，这是虚损所致，用妙香散。虫痛，面部有白斑，嘴唇红能进食，或进食后立即痛，或痛后能进食，或口中流涎沫，用剪红丸。蛔虫，蛔虫动则恶心呕吐，用乌梅丸、芜荑散。鬼疰（一种传染性痨病），昏沉谵语，用苏合香丸。热厥心痛，用金铃子散。寒厥心痛，用术附汤。胃脘痛与心痛相似，但有食积，按压时胀满疼痛的，用泻下法，用大柴胡汤；虚寒者，用理中汤。
胸痛属肝虚的，疼痛牵引背胁，用补肝汤；肝实的，身体不能转侧，喜欢叹气，用柴胡疏肝散。有痰的，用二陈汤加姜汁。
腹痛，用芍药甘草汤主治。稼穑作甘味，甘味对应己土（脾）；曲直作酸味，酸味对应甲木（肝）。甲己化土，这是张仲景的妙法。脉缓提示伤水（肾），加桂枝、生姜；脉洪提示伤金（肺），加黄芩、大枣；脉涩提示伤血，加当归；脉弦提示伤气，加芍药；脉迟提示伤火（心），加干姜。绵绵作痛而无增减，喜欢热手按压及热饮食，脉迟的，是寒证，用香砂、枳术、理中汤。冷痛，用温药无效，大便秘结的，应当轻微通利，用藿香正气散加官桂、木香、大黄。时痛时止，热手按压而不缓解，脉大而数的，是热证，用大金花丸，或黄连解毒汤。暑痛，用十味香薷饮。湿痛，小便不利，大便溏薄，脉必细缓，用胃苓汤。痰痛，或眩晕，或吐冷涎，或下白黏物，或小便不利，或得辛辣热汤则暂时缓解，脉必滑，轻的用二陈汤加枳壳、姜汁，重的用礞石滚痰丸。食积，疼痛剧烈，大便后减轻，脉弦或沉滑，用平胃散加枳实、山楂、麦芽、砂仁、木香，严重的加大黄。酒积痛，用葛花解酲汤加三棱、莪术、茵陈。气滞必然腹胀脉沉，用木香顺风散。死血作痛，疼痛部位固定不移，脉涩或芤。虚的用四物汤料加大黄制成蜜丸服用；实的用归尾、桃仁，加童便、酒、韭汁、桃仁承气汤，或加牡丹皮、香附、穿山甲、降香、红花、苏木、元胡。虫痛，心腹懊恼不适，疼痛往来上下，有休止时间，或有块状隆起，腹部热善渴，面色乍青乍白乍赤，吐青水的，是虫证，用椒汤送服乌梅丸以安蛔。
近代治疗疼痛，有的认为诸痛皆为实证，痛无补法；有的认为痛则不通，通则不痛；有的认为痛随利减，视其为不可改变的方法。不知道形体壮实、病属实证，大便闭塞不通才适宜用泻法；如果形体虚弱、脉弱、食少便泄的，岂能混同治疗？须知胀闭而痛的为实证，不胀闭的多为虚证；拒按的为实证，可按的为虚证；喜冷的多为实证，喜热的多为虚证；饱则疼痛加重的多为实证，饥则疼痛加重的多为虚证；脉实气粗的多为实证；脉虚气少的多为虚证；新病年壮的多为实证，久病年衰的多为虚证；补益无效的多为实证，攻伐后病情加剧的多为虚证。痛在经络的，脉多弦大；痛在脏腑的，脉多沉微。必须以望、闻、问、切四诊详辨，则虚实分明。所以表虚而痛的，是阳气不足，非温经不可；里虚而痛的，是阴血不足，非养营不可；上虚而痛的，是脾受伤，非补中益气不可；下虚而痛的，是脾肾败坏，非温补命门不可。如果拘泥于痛无补法，则杀人比刀剑还惨烈。
胁痛：左侧痛多留瘀血，用代抵当汤；右侧痛多痰气阻滞，痰重用二陈汤，气重用推气散。左侧为肝邪，用枳芎散；右侧为肝移邪于肺，用推气散。挟寒的，用理中汤加枳壳。死血的，日轻夜重，或午后发热，脉涩或芤，用桃仁承气汤加枳壳、鳖甲。痰饮的，用导痰汤加白芥子。食积的，有一条扛起感的，用枳术丸加吴茱萸、黄连、神曲、山楂。肝火盛的，用龙荟丸。虚冷的，用理中汤送服黑锡丹。肝脉软的，用补肝汤。惊伤导致的胁痛，用桂枝散。
胁痛肝火盛，用左金丸。治疗肝火伴有气郁的，看其脉沉涩，当作郁证治疗。疼痛而不得舒展，用龙荟丸最快。右胁痛，用严氏推气散。左胁痛，用苍术、川芎、青皮、当归、柴胡，痛甚的用当归龙荟丸，姜汁送服。
然而胁痛固然属于肝，常见口吐苦水，胁痛伴寒热，用猪胆汁炒黄连，加入小柴胡汤，这是胆家有火。如果是谋虑不决，失眠辛苦，胆气受伤而作痛，用人参、麦冬、茯神、枣仁、当归、芍药，有火的加玄参，这是胆虚胁痛。
方约之说，胁痛之症，多是肝火上升，不得条达的缘故。我每次推测左胁痛严重的，就是肝火盛，木气实，宜用龙荟丸、左金丸等辛凉剂治疗；凡是右胁痛轻微的，就是痰疰，宜用盐煎散、顺气丸等辛温剂治疗，这是正确的。
我又曾论述左胁痛、胃脘痛之症，妇女居多，因为她们忧思忿怒之气，素来灌注于中焦，发作时上冲，被湿痰死血阻滞气机，而不能条达，所以作痛。所以治疗妇人各种疼痛，必须以行气开郁为主，兼以破血散火，这才符合法度。谚语说：香附、缩砂，是女人的至宝。说的就是这个道理。
张景岳说：胁痛要辨别左右气血，如果说左边无气、右边无血，食积痰饮难道一定不涉及左边吗？这是谬谈。我认为不如观察是有形还是无形。血积有形且位置固定，或坚硬拒按；气痛流行无定迹，或忽聚忽散。至于食积痰饮，都属于有形之症，详细考察病因，自然可以识别。凡属有形之症，也无非是由气滞引起，只要气行，什么积聚不能消散？无论是气、血、痰，都必须兼以调气为主，然后酌情佐使治疗即可。
有一类内伤虚损、房劳肾虚之人，多有胸胁间隐隐作痛，这是肝肾精虚，不能化气，气虚不能生血所致。人的气血，如同源泉，旺盛则流畅，稀少则壅滞。所以气血不虚则不滞，虚则无不滞者。如果对这种病症不知培补气血，而只知道行滞通经，那就错了。
王节斋说：凡是治疗心腹疼痛，只要是新病，必须询问是否饮食不当，因何感受外邪，有无积滞，给予和中消导的药物。如果日子已久，曾多服过辛温燥热药物，呕吐不纳，胸膈饱闷，口舌干燥，大小便涩难，则内有郁热了。或者原有旧病，因感邪而发，绵延日久，症状如前所述，都用开郁行气、降火润燥的药物，如川芎、香附、山栀、黄连、姜汁之类。严重的再加芒硝。但治疗心腹久痛，必须在温散药内，加入苦寒、咸寒的药物，温治其标，寒治其本。
各种积滞疼痛，喜温恶寒，热药与病情相合，积久成郁，火邪深重，郁热既深，则见寒愈逆，见热愈喜，热与热相从，故不生他病，所谓“火极似水”。然而真气被食积所伤，阴血干枯，病日深锢而不可为矣。世人不懂，只见投热药后不发热，误认为是沉寒锢冷，而继续投以热药，至死不悟。那该怎么办呢？回答说：采用从治法，热因寒用，寒因热用，伏其所主，先其所因。
朱丹溪说：心膈之痛，须分新久。病久则成郁，久郁则蒸热，古方多以山栀作为热药的向导。用栀子炒，去皮，每服十五枚，浓煎汤一杯，入生姜汁令辣，再煎小沸，又入川芎一钱，尤其妙。大概胃中有热而作痛的，用山栀不可，须佐以姜汁、台芎开之。痰发者，或用二陈汤加川芎、苍术，倍加炒栀。痛甚的，加干姜从之，这是反治之法。如果用山栀并劫药不止，用元明粉，一服立止。
腹痛有寒、有热、死血、食积、湿痰。脉弦为食积，脉滑为痰。湿痰多作腹痛，用台芎、苍术、香附、白芷为末，以生姜汁入汤服。大法：主方，在气用气药，如木香、槟榔、香附、没药之类；在血用血药，如当归、川芎、桃仁、红花之类。
初得病时，元气未虚，必须推荡之，这是通因通用的方法。体质壮实者也适用。
如果人虚弱衰老与久病者，宜升之消之。凡心腹痛，必用温散，这是因为郁结不行，阻气不运，所以痛。在上部的多属食积，用炒干姜、苍术、川芎、白芷、香附、姜汁之类，不可用峻药攻下。更兼行气快气药助之，无不可者。
寒痛者，绵绵作痛，无增减的是。时痛时止的，是热证。死血痛者，疼痛有固定处，不移位的。大便通畅后减轻的，是湿痰。东垣说：感寒而痛，宜姜、桂，呕者加丁香。伤暑而痛，宜玉龙丸。肥人腹痛，属气兼湿痰，宜人参、苍术、白术、半夏。有人说：痰怎么能作痛？不知道气郁则痰聚，痰聚则凝，气道不得运行，所以痛。如禀赋素弱，饮食过伤而腹痛者，以养胃汤加桂、茱萸各半钱，木香三分。或者理中汤、建中汤，皆可用，内加茱萸良。绞肠痧，以樟木煎汤大吐，或白矾调汤吐之，盐汤亦可探吐，亦宜刺委中出血。
喻嘉言说：五脏失治，皆为心痛，道理很明晰。肾心痛者，多由阴邪上冲，故善恐，如从后触其心；胃心痛者，多由停滞，故胸腹胀满；脾心痛者，多由寒逆中焦，故其病甚；肝心痛者，多由木火之郁，病在血分，故色苍苍如死状；肺心痛者，多由上焦不清，病在气分，故动作则病益甚。若知其在气则顺之，在血则行之，郁则开之，滞则逐之。火多实，则或散或清。实多虚，则或温或补。只有真心痛，乃不可治。否则得其本，随手而应也。
张景岳说：诸症虚实，皆可以通过脉象辨别。唯独心腹痛症，脉多难辨。虽然滑实有力者，固多实邪；虚弱无神者，固多虚邪，这是常理。然而暴病之极，每多沉伏细涩，最似极虚之候。不知道这是气为邪逆，脉道不行，而沉伏异常，这正是邪实之脉。然而在沉伏之中细察之，必有梗梗然弦紧之意，这必是寒邪阻遏阳气者，多有此脉。若火邪作痛，则不然。辨别此法，但当察其形气，以见平素强弱；问其病因，以知新久，及何所因而起。大都暴病痛急，而脉忽细伏者，多实邪；久病痛缓，而脉本微弱者，为虚邪。论其虚实，酌之以理，参而论之，则万无一失矣。
凡治疗心腹痛症，已经攻击荡涤，愈而复作，或再三用之，愈作愈甚，脉反浮弦虚大，为中虚之候。速当酌其虚实，或专补正气，或兼治邪气。若用补无碍，不可妄乱杂投，使脾胃强，则痛自愈矣。
有一类胸腹之痛，有无关于内脏，而在筋骨皮肉之间，此邪之在经，不可混作里症，必详问的当，而分其或火或寒或气，或血滞或血虚，或淫疮邪毒，留蓄在经，庶治之无误也。
附医案：我治疗一位上舍（国子监学生），年近三十，因吃面角，中午到初更时分，食物积在小腹下至右角间，遂停积不行，坚突如拳，痛剧之甚。我察其明系面积已入大肠，乃给予木香槟榔丸，连下二三次，其痛如故。怀疑药力未及病所，更投神佑丸泻之，又不效。又疑药性皆寒，故滞不行，因再投备急丸，连得大泻，而坚痛毫不为减。于是潜测其缘由不过因面食，岂无所制之？今既逐之不及，使非借气以行之不可也。计面毒非大蒜不杀，气滞非木香不行，又其滞深道远，非精锐之向导不能得达，乃用火酒磨木香，令其嚼生蒜一瓣，而以香酒进之。一服后觉痛稍减，三四服后，痛渐止而食渐进，方得全愈。然小腹之块，仍在半年许始得尽消。由是知欲消食滞，即大黄、巴豆犹有所不能及，而惟宜以行气为先也。且知饮食下行之道，必由小腹下右角间，而后出于广肠。此自古无人言及者，因笔之广闻见云。
Li Shicai stated that various pains in the heart and abdomen, according to the discussions in *Neijing* (The Inner Canon), heart pain invariably involves pathological changes of the five Zang organs. The text details heart pathology while briefly mentioning the chest and abdomen, using one example to illustrate the rest. The Heart is the Sovereign Monarch and theoretically should not be invaded by pathogenic factors; if invaded, it constitutes a disease of its own meridian, termed *Zhenxintong* (True Heart Pain), which is invariably fatal and untreatable. However, the classics state: "When pathogens affect the Heart, it causes heart pain, a tendency toward sadness, and occasional dizziness or fainting." This refers to pathogens affecting the Pericardium (Pericardium Collateral), indicating the pathology is in the Fu organs rather than the Zang organs. It also states: "Abnormal movement of the Shaoyin Meridian of the Hand-Taiyin leads to dry throat, heart pain, thirst, and desire to drink," referring to pathogens affecting the collateral vessels, indicating the pathology is in the collaterals rather than the main meridians. Pathogens affecting these collaterals and Fu organs are caused by fright, anxiety, and overthinking, which damage the Spirit (Shen) and deplete Blood. Later medical theories further classify these into nine types: Fluid Retention (Yin), Food Stagnation (Shi), Heat (Re), Cold (Leng), Qi Stagnation (Qi), Blood Stasis (Xue), Palpitations (Ji), Parasites (Chong), and Infectious Wasting (Zhu). Without comprehensive recognition of these conditions, how can treatment be effective?
The Stomach belongs to Damp Earth and resides in the Middle Jiao. It is the Sea of Water and Grain, from which the Qi of the Five Zang and Six Fu organs and the Twelve Meridians is derived. In robust individuals, pathogens cannot invade; in weak individuals, pathogens lodge and cause immediate illness. Deviations toward Heat or Cold, Fluid Retention, or Food Stagnation all contend with True Qi, resulting in pain. Liver Wood overacting on Spleen Earth is considered a "Thief Evil," while Kidney Cold and Reversal are considered "Minor Evils." Symptoms may involve other Zang organs and should follow principles similar to those for heart pain. However, symptoms may manifest as fullness, distension, vomiting, anorexia, acid regurgitation, constipation, or diarrhea, accompanied by puffy and yellowish complexion, where the primary disease and external pathogens intermingle.
Chest pain is synonymous with Diaphragm pain. It differs from heart pain in location: heart pain occurs at the depression below the xiphoid process (Qigu), whereas chest pain extends horizontally across the chest and diaphragm. It differs from epigastric pain because the epigastrium is located above the heart. The classics state: "Southern winds arise in summer, causing diseases in the Heart-Shu point, manifesting in the chest and hypochondrium." This associates the chest with the Heart. Liver deficiency causes chest pain radiating to the back and hypochondrium, while Liver excess causes chest pain preventing body turning. This associates the chest with the Liver. The chest is the domain of the Lung; references to the Heart exist because the Heart meridian ascends from the Heart connection through the Lung. References to the Liver exist because the Liver meridian passes through the diaphragm and ascends to connect with the Lung. Hypochondriac pain has traditionally been treated via the Liver, but one must distinguish it from pain along the Foot-Shaoyang Gallbladder and Hand-Jueyin Pericardium meridians. If attributed to tendons and vessels harboring pathogens, how does it differ from pain along the Jingjin (Muscular Regions)? Therefore, without careful observation of complexion, palpation of pulses, and thorough examination of Qi transformations in each meridian, accurate treatment is impossible. One must also consider that left/right, Lung/Liver, Qi/Blood, and Yin/Yang distinctions require detailed clinical scrutiny and cannot be rigidly applied.
Abdominal pain is divided into three regions: pain in the upper abdomen belongs to the Taiyin Spleen; pain around the umbilicus belongs to the Shaoyin Kidney; and pain in the lower abdomen belongs to the Jueyin Liver, as well as the Chong and Ren meridians, Large Intestine, and Small Intestine. Each region involves variations of the Five Zang, emotional disturbances, Six Exogenous Factors, and Five Movements evils, making the presentation complex. By distinguishing Qi and Blood, Deficiency and Excess, Internal Injury, and External Contraction, appropriate regulation can effectively address the condition.
Heart pain with Fluid Retention presents with nausea, vexation, frequent vomiting of yellow fluid, and audible splashing sounds upon shaking; treat with Dawei Wan or Weiling Tang. Food Stagnation presents with fullness, belching with a rotten egg odor, worsening after eating; treat with Xiangsha Zhizhu Wan plus Shenqu and Ezhu. Fire Pain presents with fluctuating intensity, thirst, and constipation; treat with Qingzhong Tang. External Cold combined with internal consumption of cold foods requires Caodoukou Wan. Deficiency-Cold requires Guipi Tang plus Shengjiang, Rougui, and Changpu. Qi Stagnation presenting with stabbing pain requires Chenxiang Jiangqi San. Blood Stasis presents with a choppy pulse and hiccups after drinking; treat with Shounian San, or Taoren Chengqi Tang for severe cases. Heart pain with vexation, fever, and palpitations indicates Deficiency injury; treat with Miaoxiang San. Parasite pain presents with white spots on the face, red lips, appetite, pain immediately after eating or after pain subsides, or salivation; treat with Jianhong Wan. Ascaris moving causes nausea and vomiting; treat with Wumei Wan or Wuyang San. Gui Zhu (Infectious wasting disease) causing confusion and delirium is treated with Suhexiang Wan. Heat Jue Heart Pain is treated with Jinlingzi San. Cold Jue Heart Pain is treated with Shufu Tang. Epigastric pain resembles heart pain; if accompanied by food stagnation and tenderness/fullness on pressure, use Da Chaihu Tang. For Deficiency-Cold, use Lizhong Tang.
Chest pain due to Liver Deficiency, radiating to the back and hypochondrium, is treated with Bugan Tang. Liver Excess causing inability to turn and sighing is treated with Chaihu Shugan San. Phlegm accumulation requires Erchen Tang plus Jiangzhi. Abdominal pain is primarily treated with Shaoyao Gancao Tang. Based on the theory that "Sweet corresponds to Ji (Earth/Spleen)" and "Acid corresponds to Jia (Wood/Liver)," Jia and Ji transform into Earth, a profound method of Zhang Zhongjing. A slow pulse indicating Water injury adds Guizhi and Shengjiang; a surging pulse indicating Metal injury adds Huangqin and Dazao; a choppy pulse indicating Blood injury adds Danggui; a wiry pulse indicating Qi injury adds Shaoyao; a slow pulse indicating Fire injury adds Ganjiang. Continuous pain without fluctuation, relieved by heat and warm drinks, with a slow pulse, indicates Cold; treat with Xiangsha, Zhizhu, or Lizhong Tang. Cold pain unresponsive to warming herbs with constipation requires mild purgation with Huoxiang Zhengqi San plus Guigui, Muxiang, and Dahuang. Intermittent pain, unrelieved by heat, with a large and rapid pulse, indicates Heat; treat with Dajinhua Wan or Huanglian Jiedu Tang. Summerheat pain requires Shiwei Xiangru Yin. Dampness pain with difficult urination, loose stools, and a fine-slow pulse requires Weiling Tang. Phlegm pain with dizziness, cold saliva, white discharge, difficult urination, or temporary relief from spicy hot drinks, with a slippery pulse, is treated with Erchen Tang plus Zhike and Jiangzhi for mild cases, or Mengshi Guntan Wan for severe cases. Severe food stagnation pain relieved by defecation, with wiry or deep-slippery pulses, requires Pingwei San plus Zhishi, Shanzha, Maiya, Sharen, and Muxiang, adding Dahuang for severe cases. Wine accumulation pain requires Gegua Jieying Tang plus Sanleng, Ezhu, and Yichen. Qi Stagnation with abdominal distension and deep pulse requires Muxiang Shunfeng San. Blood Stasis pain with fixed location and choppy or hollow pulse is treated with Siwu Tang decoction plus Dahuang honey pills for Deficiency, or Guibei, Taoren, Tongbian, wine, leek juice, Taoren Chengqi Tang, Mudanpi, Xiangfu, Chuanshanjia, Jiangxiang, Honghua, Sumu, and Yuanhu for Excess. Parasite pain with cardiac/abdominal discomfort, wandering pain, intervals of relief, rising masses, abdominal heat, thirst, changing facial colors, and vomiting green water indicates parasites; treat with Wumei Wan swallowed in Pepper Decoction.
Contemporary treatments often assume all pain is Excess and admits no tonification, or adhere strictly to "pain implies blockage, blockage implies pain" and "pain decreases with purgation." However, these apply only to Excess patterns with solid bodies and constipation. Weak bodies with weak pulses, poor appetite, and diarrhea require different approaches. Distension and blockage indicate Excess; lack thereof suggests Deficiency. Rejection of pressure indicates Excess; acceptance suggests Deficiency. Preference for cold suggests Excess; preference for heat suggests Deficiency. Worsening after eating suggests Excess; worsening on an empty stomach suggests Deficiency. Full pulse and coarse breathing suggest Excess; deficient pulse and weak breath suggest Deficiency. Acute onset in youth suggests Excess; chronic duration in old age suggests Deficiency. Failure of tonification suggests Excess; aggravation by purgation suggests Deficiency. Pain in meridians shows wiry-large pulses; pain in Zang organs shows deep-micro pulses. Only through thorough Four Diagnostic methods can Deficiency and Excess be clearly distinguished. Exterior Deficiency pain requires warming the meridians; Interior Deficiency pain requires nourishing the Ying (Nutritive) level. Upper Deficiency pain requires tonifying the Middle (Spleen); Lower Deficiency pain requires warming and tonifying the Mingmen (Gate of Vitality). Adhering to "pain admits no tonification" is lethal.
Hypochondriac pain on the left often indicates Blood Stasis, treated with Dai Dang Tang. Right-sided pain often indicates Phlegm-Qi stagnation, treated with Erchen Tang for phlegm and Tuiqi San for Qi. Left-sided Liver evil is treated with Zhixiong San; right-sided Liver transferring evil to Lung is treated with Tuiqi San. Cold complication requires Lizhong Tang plus Zhike. Blood Stasis with lighter symptoms by day, heavier by night, or afternoon fever, and choppy/hollow pulse, requires Taoren Chengqi Tang plus Zhike and Biejia. Phlegm-Fluid requires Daotan Tang plus Baijiezi. Food stagnation with a sensation of a raised cord requires Zhizhu Wan plus Wuzhuyu, Huanglian, Shenqu, and Shanzha. Liver Fire Excess requires Longhui Wan. Deficiency-Cold requires Lizhong Tang delivering Heixi Dan. Soft Liver pulse requires Bugan Tang. Shock-induced hypochondriac pain requires Guizhi San.
For Liver Fire Excess hypochondriac pain, use Zuojin Wan. For Liver Fire with Qi Depression (deep-choppy pulse), treat the depression. Pain with inability to stretch is best treated with Longhui Wan. Right hypochondriac pain uses Yan's Tuiqi San. Left hypochondriac pain uses Cangzhu, Chuanxiong, Qingpi, Danggui, and Chaihu; severe cases use Danggui Longhui Wan delivered with Jiangzhi. Although hypochondriac pain belongs to the Liver, bitter vomiting and alternating chills/fever indicate Gallbladder Fire, treated with Huanglian stir-fried with Pig Gallbladder juice added to Xiaochaihu Tang. Insomnia and indecision damaging Gallbladder Qi cause pain, treated with Danggui, Shaoyao, Renshen, Maidong, Fushen, and Suanzaoren; add Xuanshen if Fire is present, constituting Deficient Gallbladder hypochondriac pain.
Fang Yuezhi stated that hypochondriac pain is mostly due to ascending Liver Fire obstructing free flow. Severe left-sided pain indicates strong Liver Fire and Wood Excess, treated with Longhui Wan or Zuojin Wan (acrid-cool agents). Mild right-sided pain indicates Phlegm-Zhu, treated with Yanjian San or Shunqi Wan (acrid-warm agents). He noted that left hypochondriac and epigastric pain are common in women due to suppressed anger and worry, leading to Qi rushing upward and being blocked by Phlegm and Blood Stasis. Treatment for women's pain must prioritize moving Qi and resolving depression, supplemented by breaking blood and dispersing fire. As the proverb says: Xiangfu and Suosha are treasures for women.
Zhang Jingyue argued against the notion that left side lacks Qi and right side lacks Blood, stating that Food Stagnation and Phlegm-Fluid certainly affect the left. He proposed distinguishing between Formless (Qi) and Formed (Blood/Phlegm/Food) pathologies. Blood stasis is formed, fixed, hard, and rejects pressure; Qi pain is migratory and fleeting. Since all formed pathologies stem from Qi stagnation, treating Qi is primary, followed by specific remedies.
Internal injury and deficiency, particularly Kidney Deficiency from sexual exhaustion, often cause dull chest-hypochondriac pain due to Essence deficiency failing to generate Qi, and Qi deficiency failing to generate Blood. Qi and Blood are like a spring; abundant means flow, scarce means stagnation. Tonifying Qi and Blood is essential; merely moving stagnation is erroneous.
Wang Jiezhai stated that for new heart-abdominal pain, inquire about diet and external contraction, and use harmonizing and digesting herbs. For chronic cases with prior excessive use of acrid-warm-dry herbs, leading to vomiting, fullness, dry mouth/tongue, and difficult urination/defecation, there is internal Depressed Heat. Use herbs to resolve depression, move Qi, descend Fire, and moisten dryness, such as Chuanxiong, Xiangfu, Shanzhi, Huanglian, and Jiangzhi; add Mangxiao for severe cases. For chronic pain, combine acrid-warm dispersants with bitter-cold/salty-cold herbs to treat the branch with warmth and the root with cold.
All accumulations and pains prefer warmth and dislike cold. Prolonged use of heat herbs can lead to Deepened Depression and Fire. When Fire is extreme, it mimics Water (Cold signs). However, this damages True Qi and dries Yin Blood. Laypeople mistake this for Deep Cold and continue heating, worsening the condition. The solution is Congruent Treatment (Congzhi): using heat with cold administration, or cold with heat administration, addressing the root cause.
Zhu Danxi stated that chest/diaphragm pain must be distinguished by duration. Chronic pain becomes Depression, generating Heat. Gardenia (Zhizi) is used as a guide. Fried Zhizi (15 seeds) decocted strongly with Ginger Juice and Chuanxiong is effective. For Stomach Heat pain, Zhizi alone is insufficient; combine with Jiangzhi and Taixiong. For Phlegm attacks, Erchen Tang plus Chuanxiong, Cangzhu, and extra fried Zhizi. For severe pain, add Ganjiang (contrary treatment). If Zhizi and astringents fail, use Yuanmingfen for immediate relief.
Abdominal pain categories include Cold, Heat, Blood Stasis, Food Stagnation, and Damp-Phlegm. Wiry pulse indicates Food; Slippery pulse indicates Phlegm. Damp-Phlegm abdominal pain is treated with Taixiong, Cangzhu, Xiangfu, and Baizhi powder taken with Ginger Juice. General principle: Qi disorders use Qi-moving herbs (Muxiang, Binglang, Xiangfu, Moyao); Blood disorders use Blood-invigorating herbs (Danggui, Chuanxiong, Taoren, Honghua). Early stage with intact Yuan Qi requires purgation (Tong Yin Yong Tong method). Robust patients follow suit.
Weak, elderly, or chronic patients require lifting and resolving. Heart-abdominal pain generally requires warm dispersants due to Qi stagnation. Upper pain (often Food) uses fried Ganjiang, Cangzhu, Chuanxiong, Baizhi, Xiangfu, Jiangzhi; avoid harsh purgatives. Add Qi-moving herbs. Cold pain is continuous without fluctuation. Intermittent pain is Heat. Fixed pain is Blood Stasis. Relief after bowel movement is Damp-Phlegm. Dongyuan stated: Cold pain uses Jiang/Gui, add Dingxiang if vomiting; Summerheat pain uses Yulong Wan. Obese patients' abdominal pain (Qi + Damp-Phlegm) uses Renshen, Cangzhu, Baizhu, Banxia. Phlegm causes pain via Qi depression leading to Phlegm condensation blocking Qi flow. Weak constitution with dietary injury uses Yangwei Tang plus Guizhi, Wuzhuyu, and Muxiang; Lizhong Tang or Jianzhong Tang with Wuzhuyu are also suitable. Jiaochangsha (intestinal cramping) requires emesis with Camphor wood decoction, Alum water, or Salt water, or bleeding at Weizhong point.
Yu Jiayan stated that mismanagement of the Five Zang causes heart pain. Kidney Heart Pain (Yin evil ascending, fear) resembles touch from behind. Stomach Heart Pain (stagnation) causes chest/abdominal fullness. Spleen Heart Pain (Cold reversing in Middle Jiao) is severe. Liver Heart Pain (Wood-Fire depression, Blood level) causes pale/dead-like complexion. Lung Heart Pain (Upper Jiao turbidity, Qi level) worsens with movement. Treat Qi by smoothing, Blood by moving, Depression by opening, Stagnation by expelling. Fire Excess uses dispersing/clearing; Deficiency uses warming/tonifying. Only True Heart Pain is untreatable; otherwise, addressing the root ensures success.
Zhang Jingyue stated that Deficiency/Excess is usually pulse-differentiable, but heart-abdominal pain pulses are difficult. Sliding-strong pulses indicate Excess; weak-lifeless pulses indicate Deficiency. However, acute severe illness may show deep-hidden-fine-choppy pulses mimicking Deficiency, actually caused by Qi rebellion blocking the pulse vessel (Excess). Careful palpation reveals string-tight tension, indicating Cold blocking Yang. Fire pain differs. Differentiate by observing constitution (strong/weak) and history (acute/chronic). Acute severe pain with sudden fine-hidden pulse suggests Excess; chronic mild pain with inherently weak pulse suggests Deficiency. Reasoned analysis prevents error.
If heart-abdominal pain recurs after purgation, worsening with repeated treatment and showing floating-wiry-deficient-large pulse, it indicates Middle Deficiency. Adjust based on Deficiency/Excess, tonifying Qi or treating pathogens. Strengthening Spleen/Stomach heals pain.
Pain in muscles/bones/skin must not be confused with Interior Zang-Fu disease. Differentiate Fire, Cold, Qi, Blood Stasis, Blood Deficiency, or Toxic Sores lingering in meridians.
Medical Case: I treated a student, nearly 30, who ate dough sticks. By evening, food accumulated in the lower abdomen/right corner, forming a hard mass like a fist, causing severe pain. Suspecting food stagnation in the Large Intestine, I administered Muxiang Binglang Wan, causing multiple bowel movements, but pain persisted. I then used Shenyuan Wan for purgation, ineffective. Suspecting cold nature of previous herbs, I used Beiji Wan, causing severe diarrhea, yet pain remained. I deduced that面食 (wheat/gluten) toxicity requires Garlic, and Qi stagnation requires Muxiang. Given the deep location, I prepared Muxiang ground in fiery wine, had him chew raw garlic, and administer the mixture. After one dose, pain decreased; after three to four doses, pain ceased, appetite returned, and he recovered. The abdominal mass took six months to fully resolve. This demonstrates that for food stagnation, even Dahuang or Badou may be insufficient; moving Qi is paramount. It also confirms the pathway of digestion exits via the lower right abdomen into the rectum, a previously undocumented anatomical insight.