心腹痛不得息。脉细小迟者生。脉大而疾者死。
夫腹痛。寒气客于中焦。干于脾胃而痛者。有宿积停于肠胃者。有结滞不散而痛者。有
痛而
呕者。有痛而泻者。有痛而大便不通者。有热痛者。有虚痛者。有实痛者。有湿痰痛者。有
死血痛者。有虫痛者。种种不同。治之皆当辨其寒热虚实。随其所得之症施治。若外邪者散
之
内积者逐之。寒者温之。热者清之。虚者补之。实者泻之。泄则调之。闭则通之。血则消
之。气则顺之。虫则追之。积则消之。加以健理脾胃。调养气血。斯治之要也。
一论风寒外感。饮食内伤。七情恼怒过度。肚腹疼痛初起者。行气香苏散。（方见饮食）
一论外中寒邪。内伤冷物。肚腹绵绵痛不已。而手足厥冷者。五积散。（方见中寒）
一论肚腹疼痛。有寒有热。有食有气。治一切肚腹痛之总司也。
开郁导气汤
苍术（米泔浸炒一钱） 陈皮（五分） 香附（童便浸炒一钱） 白芷（一钱） 川芎（一钱）
白茯
苓（去皮一钱） 干姜（炒五分） 滑石（一钱） 山栀子（炒黑一钱） 神曲（一钱） 甘草（
少许）上锉一剂。水煎温服。
一论绵绵痛无增减。脉沉迟者。寒痛也。
姜桂汤
干姜 肉桂 良姜（各七分） 枳壳（去穣麸炒） 陈皮 砂仁 浓朴（姜汁炒） 吴茱萸（
炒各一钱） 香附（一钱五分） 木香（五分） 甘草（二分）
上锉。生姜煎服。痛不止。加元胡索、茴香、乳香。寒极手足冷。加附子。去吴茱萸、
良姜。泄泻。去枳壳。
一论乍痛乍止。脉数者。火痛也。
散火汤
黄连（炒） 白芍（炒） 栀子（炒） 枳壳（去穣） 浓朴（去皮） 香附 川芎（各一钱）
木香 砂仁 茴香（各五分） 甘草（三分）
上锉一剂。生姜一片。水煎。痛甚不止。加元胡索。
一论肚腹满硬。痛久不止。大便实。脉数而渴者。积热也。
枳实大黄汤
枳实 大黄 槟榔 川浓朴（各二钱） 甘草（三分） 木香（二分）
上锉一剂。水煎。温服。
一论痛不移处者。是死血也。
活血汤
当归尾 赤芍 桃仁（去皮尖） 牡丹皮 元胡索 乌药 香附子 枳壳（去穣各一钱
）红花 官桂 木香（各五分另磨汁） 川芎（七分） 甘草（二分）
上锉一剂。生姜一片。水煎服。
一论小便不利而痛。腹中勾引。胁下有声者。是湿痰也。二陈汤加减。（方见痰饮）
一论以手按之。腹软痛止者。是虚痛也。
温中汤
良姜（五分） 官桂（五分） 益智仁（一钱） 砂仁（四分） 木香（另研） 香附米 浓朴
（姜炒） 陈皮 小茴香（酒炒） 当归 甘草（各八分） 元胡索（六分）
上锉一剂。生姜煎服。
一论食积腹痛。其脉弦。其痛在上。以手重按愈痛。甚欲大便。利后其痛减是也。
加味平胃散
苍术（米泔浸炒一钱） 陈皮（一钱） 浓朴（姜炒八分） 半夏（姜炒八分） 川芎（五分）
香附（一钱） 炒枳实（一钱） 木香（八分） 神曲（炒一钱） 山楂（一钱） 干姜（七分） 甘
草（三分）
上锉一剂。生姜三片。水煎服。
一论时痛时止。面白唇红者。是虫痛也。
椒梅汤
乌梅 花椒 槟榔 枳实 木香 香附 砂仁 川楝子（去核） 肉桂 浓朴（去皮
姜炒） 干姜 甘草（炙各等分）
上锉一剂。生姜一片。水煎服。
三仙丸 治虫痛。
雄黄 白矾 槟榔（各等分）
上为末。饭丸如黍米大。每服五分。食远。白水下。干痛者。不吐不泄而但痛也。有时
者。淡食而饥则痛。浓味而饱则否也。经曰。腹内干痛者。腹内有虫。此之谓也。
一孩子腹中作痛。看看至死。腹中揣摸。似有大小块。诸医不效。余则令人慢慢以手搓
揉痛处。半日。其虫自大便出而愈。
一妇人腹痛如锥刺。每痛欲死。不敢着手。六脉洪数。此肠痈毒也。用穿山甲、炒白芷
、贝母、僵蚕、大黄。合一大剂。水煎服。打脓血自小便中出即愈。
一李仪部常患腹痛。治以补中益气加炒山栀即愈。
一朱太守因怒腹痛作泻。或两胁作胀。或胸乳作痛。或寒热往来。或小便不利。饮食不
卧。
呕吐痰沫。神思不清。此肝木乘脾土。用柴胡加山栀、炮姜、茯苓、陈皮、制黄连。一剂即
愈。（制黄连即黄连吴茱萸等分用盐水拌湿越二三日同炒焦取连用）
一人内停饮食。外感风寒。头疼发热。恶心腹痛。予以藿香正气散加香附、川芎。一服
而止
次日前病悉除。惟腹痛不止。以手重按。其痛稍止。此客寒乘虚而作也。以香砂六君加木
香、炮姜服之。睡觉。痛减六七。去二香再服。即愈。
一妇人脐腹疼痛。不省人事。只此一服立止。人不知者。云是心气痛。误矣。余用白芷
、五灵脂、木通去皮。三味等分。每服五钱。醋水各半盏。煎至七分服。
一论白芍味酸微寒。补中焦之药。得炙甘草为辅。治腹中痛之圣药也。如夏中热腹痛。
少加黄芩。若恶寒腹痛。只少加肉桂一钱。白芍三钱。甘草一钱五分。此三味为治寒腹
痛。
此仲景神品药也。如深秋腹痛。更加桂枝三钱。如冬月大寒。腹中冷痛。加桂枝一钱五分。
水二盏煎服。
心腹疼痛剧烈，无法平复。脉象细小迟缓的，预后良好；脉象大而急促的，预后不良（主死）。
腹痛的原因，多是寒气侵袭中焦，干扰脾胃所致而引发疼痛；也有宿食积滞停留在肠胃中的；有气机结滞不散而痛的；有疼痛伴随呕吐的；有疼痛伴随腹泻的；有疼痛伴随大便不通的；有热性疼痛的；有虚性疼痛的；有实性疼痛的；有湿痰引起的疼痛的；有瘀血引起的疼痛的；有虫积引起的疼痛的。情况种种不同，治疗时都应当辨别其寒、热、虚、实的性质，根据所获得的证候进行施治。如果是外邪引起的，就用发散的方法；如果是内积引起的，就用攻逐的方法。寒者用温法，热者用清法，虚者用补法，实者用泻法。泄泻的就调理它，闭结的就通利它。瘀血的就消散它，气滞的就顺气它。虫积的就驱虫它，积滞的就消导它。再加上健运调理脾胃，调养气血，这就是治疗的要领。
第一段论述因风寒外感、饮食内伤、七情恼怒过度，导致肚腹疼痛初起的情况。使用行气香苏散。（方剂见“饮食”章节）
第二段论述因外受寒邪、内伤冷物，导致肚腹绵绵作痛不止，且手足厥冷的情况。使用五积散。（方剂见“中寒”章节）
第三段论述肚腹疼痛，无论有寒有热、有食积有气滞，皆可治疗一切肚腹痛的通用方剂。
开郁导气汤
苍术（米泔水浸泡后炒制一钱） 陈皮（五分） 香附（童便浸泡后炒制一钱） 白芷（一钱） 川芎（一钱）
白茯苓（去皮一钱） 干姜（炒制五分） 滑石（一钱） 山栀子（炒黑一钱） 神曲（一钱） 甘草（少许）
以上药材锉碎为一剂，加水煎煮，温服。
第四段论述疼痛绵绵无增减，脉象沉迟的，属于寒痛。
姜桂汤
干姜 肉桂 良姜（各七分） 枳壳（去瓤，麸皮炒） 陈皮 砂仁 浓朴（姜汁炒） 吴茱萸（炒制各一钱） 香附（一钱五分） 木香（五分） 甘草（二分）
以上药材锉碎，加生姜煎服。如果疼痛不止，加入元胡索、茴香、乳香。如果寒极导致手足冰冷，加入附子，去掉吴茱萸、良姜。如果出现泄泻，去掉枳壳。
第五段论述疼痛乍停乍起，脉象数的，属于火痛（热痛）。
散火汤
黄连（炒制） 白芍（炒制） 栀子（炒制） 枳壳（去瓤） 浓朴（去皮） 香附 川芎（各一钱）
木香 砂仁 茴香（各五分） 甘草（三分）
以上药材锉碎为一剂，加生姜一片，水煎。如果疼痛剧烈不止，加入元胡索。
第六段论述肚腹满硬，疼痛日久不止，大便干结，脉数且口渴的，属于积热。
枳实大黄汤
枳实 大黄 槟榔 川浓朴（各二钱） 甘草（三分） 木香（二分）
以上药材锉碎为一剂，水煎，温服。
第七段论述疼痛部位不移动的，是瘀血疼痛。
活血汤
当归尾 赤芍 桃仁（去皮尖） 牡丹皮 元胡索 乌药 香附子 枳壳（去瓤各一钱） 红花 官桂 木香（各五分，另磨取汁） 川芎（七分） 甘草（二分）
以上药材锉碎为一剂，加生姜一片，水煎服。
第八段论述小便不利且疼痛，腹部牵引不适，胁下有声响的，是湿痰疼痛。使用二陈汤加减。（方剂见“痰饮”章节）
第九段论述用手按压腹部，腹部变软且疼痛停止的，是虚痛。
温中汤
良姜（五分） 官桂（五分） 益智仁（一钱） 砂仁（四分） 木香（另研细末） 香附米 浓朴（姜炒） 陈皮 小茴香（酒炒） 当归 甘草（各八分） 元胡索（六分）
以上药材锉碎为一剂，加生姜煎服。
第十段论述食积腹痛，脉象弦，疼痛部位在上腹部，用手重按时疼痛加剧，很想大便，排便后疼痛减轻的，就是这种情况。
加味平胃散
苍术（米泔水浸泡后炒制一钱） 陈皮（一钱） 浓朴（姜炒八分） 半夏（姜炒八分） 川芎（五分）
香附（一钱） 炒枳实（一钱） 木香（八分） 神曲（炒制一钱） 山楂（一钱） 干姜（七分） 甘草（三分）
以上药材锉碎为一剂，加生姜三片，水煎服。
第十一段论述疼痛时作时止，面色苍白嘴唇红的，是虫痛。
椒梅汤
乌梅 花椒 槟榔 枳实 木香 香附 砂仁 川楝子（去核） 肉桂 浓朴（去皮，姜炒） 干姜 甘草（炙制，各等分）
以上药材锉碎为一剂，加生姜一片，水煎服。
三仙丸，治疗虫痛。
雄黄 白矾 槟榔（各等分）
以上药材研为粉末，用饭做成如黍米大小的丸剂。每次服用五分，在饭后很久服用，白开水送下。所谓“干痛”，是指不吐不泻但只是疼痛的情况。所谓“有时”，是指吃淡食饥饿时疼痛，吃浓味食物饱食时则不痛。经书说：腹内干痛的，是因为腹内有虫，说的就是这个道理。
有一个孩子腹中作痛，眼看就要死去，在腹中揣摸，似乎有大小肿块，各位医生治疗无效。我让人慢慢用手搓揉疼痛处，半天后，虫子随大便排出而痊愈。
有一个妇人腹痛如锥刺般，每次疼痛欲死，不敢让人触碰，六脉洪数，这是肠痈毒。使用穿山甲、炒白芷、贝母、僵蚕、大黄，合为一剂，水煎服。排出脓血从小便中出来即痊愈。
有一位朱太守因愤怒导致腹痛并腹泻，有时两胁胀满，有时胸乳疼痛，有时寒热往来，有时小便不利，饮食不进，卧睡不安，呕吐痰沫，神志不清。这是肝木乘脾土所致，用柴胡加山栀、炮姜、茯苓、陈皮、制黄连治疗，一剂即愈。（制黄连即黄连与吴茱萸等分，用盐水拌湿，放置二三天同炒焦，取出黄连使用）
一个人体内停积饮食，体外感受风寒，头疼发热，恶心腹痛。我用藿香正气散加香附、川芎治疗，一服药后症状停止。第二天之前的病证全部消除，只有腹痛不止，用手重按时，疼痛稍止。这是客寒乘虚而入所致。用香砂六君子汤加木香、炮姜服用。睡觉醒来后，疼痛减少六七成，去掉木香、砂仁再服用，即痊愈。
有一个妇人脐腹疼痛，昏迷不省人事，只服这一剂药立刻停止。不知情的人，说是心气痛，这是错误的。我用白芷、五灵脂、木通（去皮），三味药等分，每次服用五钱，醋和水各半盏，煎至七分，服用。
第十二段论述白芍味酸微寒，是补益中焦的药物。得到炙甘草作为辅助，是治疗腹中痛的圣药。如果在夏季中暑腹痛，少加黄芩。如果恶寒腹痛，只少加肉桂一钱，白芍三钱，甘草一钱五分。这三味药是治疗寒性腹痛的。
这是张仲景的神品药物。如在深秋腹痛，再加桂枝三钱。如果在冬季大寒，腹中冷痛，加桂枝一钱五分，水二盏煎服。
Heart and abdominal pain that is severe and unrelenting. A pulse that is fine, small, and slow indicates survival (favorable prognosis). A pulse that is large and rapid indicates death (unfavorable prognosis).
Abdominal pain is often caused by cold pathogenic qi invading the middle jiao (middle burner), disturbing the spleen and stomach, leading to pain. It may also be caused by accumulated food stagnation remaining in the intestines and stomach; by qi binding and failing to disperse; by pain accompanied by vomiting; by pain accompanied by diarrhea; by pain accompanied by constipation; by heat-type pain; by deficiency-type pain; by excess-type pain; by damp-phlegm type pain; by blood stasis type pain; or by parasite type pain. The conditions vary greatly. Treatment must distinguish between cold, heat, deficiency, and excess, and therapy should be administered according to the specific syndrome obtained. If caused by external pathogens, use dispersing methods; if caused by internal accumulation, use purging methods. For cold, use warming methods; for heat, use clearing methods; for deficiency, use tonifying methods; for excess, use draining methods. For diarrhea, regulate it; for obstruction/constipation, unblock it. For blood stasis, resolve it; for qi stagnation, soothe it. For parasites, expel them; for accumulation, dissipate it. Additionally, strengthen and regulate the spleen and stomach, and nourish and regulate qi and blood. This is the essence of treatment.
Section 1 discusses abdominal pain arising from external contraction of wind-cold, internal injury from diet, and excessive emotional anger/frustration at the initial stage. Use Xingqi Xiangsu San (Qi-Regulating Fragrant Perilla Powder). (Formula see "Dietary Injury" section)
Section 2 discusses continuous, lingering abdominal pain with cold extremities due to external contraction of cold pathogenic qi and internal injury from cold substances. Use Wuji San (Five Accumulations Powder). (Formula see "Middle Cold" section)
Section 3 discusses abdominal pain regardless of cold or heat, food stagnation or qi stagnation; this is the general formula for all types of abdominal pain.
Kaiyu Daoqi Tang (Depression-Resolving Qi-Guiding Decoction)
Cangzhu (Coix Seed Water-soaked and stir-fried, 1 qian) Chenpi (0.5 qian) Xiangfu (Child's urine-soaked and stir-fried, 1 qian) Baizhi (1 qian) Chuanxiong (1 qian)
Baifuling (Peeled, 1 qian) Ganjiang (Stir-fried, 0.5 qian) Huashi (1 qian) Shanzhizi (Stir-fried until black, 1 qian) Shenqu (1 qian) Gancao (A little)
Crush these ingredients into one dose. Decoct in water and take warm.
Section 4 discusses lingering pain without increase or decrease, with a deep and slow pulse, indicating cold pain.
Jianggui Tang (Ginger and Cinnamon Decoction)
Ganjiang Rougui Liangjiang (Each 0.7 fen) Zhike (De-rinded, bran-stir-fried) Chenpi Sharen Nongpu (Ginger juice-stir-fried) Wuzhuyu (Stir-fried, each 1 qian) Xiangfu (1.5 qian) Muxiang (0.5 qian) Gancao (0.2 fen)
Crush these ingredients. Decoct with fresh ginger and take. If pain persists, add Yuanhusuo, Huixiang, and Ruxiang. If extreme cold causes cold hands and feet, add Fuzi, and remove Wuzhuyu and Liangjiang. If diarrhea occurs, remove Zhike.
Section 5 discusses intermittent pain with a rapid pulse, indicating fire pain (heat pain).
Sanhuo Tang (Fire-Scattering Decoction)
Huanglian (Stir-fried) Baishao (Stir-fried) Zhizi (Stir-fried) Zhike (De-rinded) Nongpu (Peeled) Xiangfu Chuanxiong (Each 1 qian)
Muxiang Sharen Huixiang (Each 0.5 qian) Gancao (0.3 fen)
Crush these ingredients into one dose. Add one slice of fresh ginger, decoct in water. If pain is severe and persistent, add Yuanhusuo.
Section 6 discusses abdominal fullness and hardness, long-standing unrelenting pain, solid stool, rapid pulse, and thirst, indicating accumulated heat.
Zhishi Dahuang Tang (Immature Bitter Orange and Rhubarb Decoction)
Zhishi Dahuang Binglang Chuan Nongpu (Each 2 qian) Gancao (0.3 fen) Muxiang (0.2 fen)
Crush these ingredients into one dose. Decoct in water and take warm.
Section 7 discusses pain that does not shift location, indicating blood stasis.
Huoxue Tang (Blood-Invigorating Decoction)
Dangguwei Chi Shao Taoren (De-pitted and de-skinened) Mudanpi Yuanhusuo Wuyao Xiangfuzi Zhike (De-rinded, each 1 qian) Honghua Guanzi Muxiang (Each 0.5 qian, separately ground for juice) Chuanxiong (0.7 qian) Gancao (0.2 fen)
Crush these ingredients into one dose. Add one slice of fresh ginger, decoct in water and take.
Section 8 discusses pain with difficult urination, abdominal pulling discomfort, and sounds in the hypochondrium, indicating damp-phlegm pain. Use Erchen Tang modified. (Formula see "Phlegm-Fluids" section)
Section 9 discusses softening of the abdomen and cessation of pain upon manual pressure, indicating deficiency pain.
Wenzhong Tang (Warm-the-Middle Decoction)
Liangjiang Guanzi Yizhiren Sharen (0.4 qian) Muxiang (Separately ground) Xiangfumii Nongpu (Ginger-stir-fried) Chenpi Xiaohuixiang (Wine-stir-fried) Danggui Gancao (Each 0.8 qian) Yuanhusuo (0.6 qian)
Crush these ingredients into one dose. Decoct with fresh ginger and take.
Section 10 discusses food stagnation abdominal pain, with a wiry pulse, pain located in the upper abdomen, increased pain upon heavy manual pressure, strong urge to defecate, and pain relief after defecation.
Jiawei Pingwei San (Modified Pingwei Powder)
Cangzhu (Coix Seed Water-soaked and stir-fried, 1 qian) Chenpi (1 qian) Nongpu (Ginger-stir-fried, 0.8 qian) Banxia (Ginger-stir-fried, 0.8 qian) Chuanxiong (0.5 qian)
Xiangfu (1 qian) Chao Zhishi (1 qian) Muxiang (0.8 qian) Shenqu (Stir-fried, 1 qian) Shanzha (1 qian) Ganjiang (0.7 qian) Gancao (0.3 fen)
Crush these ingredients into one dose. Add three slices of fresh ginger, decoct in water and take.
Section 11 discusses intermittent pain with pale face and red lips, indicating parasite pain.
Jiaomei Tang (Pepper and Plum Decoction)
Wumei Huajiao Binglang Zhishi Muxiang Xiangfu Sharen Chuannanzi (De-seeded) Rougui Nongpu (Peeled, Ginger-stir-fried) Ganjiang Gancao (Roasted, equal parts)
Crush these ingredients into one dose. Add one slice of fresh ginger, decoct in water and take.
Sanxian Wan (Three Immortals Pill), treats parasite pain.
Xionghuang Baifan Binglang (Equal parts)
Grind these ingredients into powder. Form pills the size of millet seeds using rice paste. Take 0.5 qian per dose, well after meals, with plain water. "Dry pain" refers to pain without vomiting or diarrhea. "Intermittent pain" refers to pain occurring when hungry after eating bland food, but not occurring when full after eating rich food. The classics state: Dry pain inside the abdomen is due to parasites within the abdomen. This is what is meant.
A child suffered from abdominal pain, appearing near death. Palpation of the abdomen revealed masses of varying sizes. Various physicians failed to treat him. I instructed someone to slowly rub and knead the painful area with their hands. After half a day, the parasites were expelled via stool, and he recovered.
A woman suffered from abdominal pain like needle pricks, dying with each episode, afraid to let anyone touch her. Her six pulses were surging and rapid. This was intestinal abscess toxicity. Use Shan Jianjia (Pangolin Scales), Chao Baizhi, Beimu, Jiangcan, and Dahuang. Combine into one large dose, decoct in water and take. Pus and blood discharged from the urine indicate recovery.
Official Li suffered frequently from abdominal pain. He was treated with Buzhong Yiqi Tang plus stir-fried Shanzhi, and recovered.
Prefect Zhu suffered from abdominal pain and diarrhea due to anger. Sometimes his hypochondrium felt distended, sometimes his chest and breasts hurt, sometimes he had alternating chills and fever, sometimes difficult urination, loss of appetite, inability to lie down, vomiting of phlegm foam, and unclear mental thoughts. This was Liver Wood overacting on Spleen Earth. He was treated with Chaihu plus Shanzhi, Paojiang, Fuling, Chenpi, and Zhi Huanglian. He recovered after one dose. (Zhi Huanglian is prepared by mixing equal parts Huanglian and Wuzhuyu with salt water, letting them sit for two to three days, stir-frying together until scorched, and then using only the Huanglian.)
A person had internal food stagnation and external contraction of wind-cold, presenting with headache, fever, nausea, and abdominal pain. I prescribed Huoxiang Zhengqi San plus Xiangfu and Chuanxiong. Symptoms ceased after one dose. The next day, previous symptoms resolved completely, except for persistent abdominal pain, which subsided slightly upon heavy manual pressure. This was guest cold taking advantage of deficiency. He was treated with Xiangsha Liujun Zi Tang plus Muxiang and Paojiang. Upon waking from sleep, pain reduced by sixty to seventy percent. Muxiang and Sharen were removed, and he took the remainder, recovering fully.
A woman suffered from umbilical and abdominal pain, losing consciousness. One single dose stopped it immediately. Those unaware claimed it was Heart Qi pain, which was incorrect. I used Baizhi, Wulingzhi, and Mutong (peeled), in equal parts. Take 5 qian per dose, decoct in half vinegar and half water until reduced to 0.7 portion, and take.
Section 12 discusses Baishao (White Peony Root), which is sour and slightly cold, a herb that tonifies the middle jiao. Assisted by Zhi Gancao (Honey-fried Licorice), it is the supreme medicine for treating abdominal pain. In summer heat-induced abdominal pain, add a small amount of Huangqin. For cold-induced abdominal pain with aversion to cold, add only a small amount of Rougui (1 qian), Baishao (3 qian), and Gancao (1.5 qian). These three herbs are the divine formula for treating cold abdominal pain.
This is Zhang Zhongjing's divine formula. For autumn abdominal pain, add Guizhi (3 qian). For winter extreme cold with cold abdominal pain, add Guizhi (1.5 qian), decoct in two portions of water, and take.