胁满痛与胸满痛同，而微有不同者，胸满痛有宿食为病，胁满痛无宿食为病，乃亦有因宿食在胸腹而满痛及
胁者。时疫胁满痛，是痰、气、血三者为病，其中亦有满而不痛、痛而不满，满痛并作之分。其满而不痛者，募原
之邪未经传变，宜达原饮，兼寒热往来者，大柴胡汤。痛而不满者，邪分布于少阳之经，宜小柴胡汤。满痛并作
者，当分左右。左属血，小柴胡去人参，加延胡、归尾、红花、桃仁，甚者加莪术、三棱、三七、五灵脂。右属痰
与气。痰，大柴胡倍半夏，加牡蛎、莱菔子，甚则白芥子、甘遂、大戟、芫花。气，加青皮、莱菔子、木香、大
腹皮。痰与气痛，皆无常所而有聚散。痰散仍有所苦，气散则无所苦。若屡经汗、下、清利而胁痛更甚者，虚证
也。气虚必呕利，养气为主；血虚必烦热，养血为主，此亦十中一、二。
胁痛与胸腹痛不同。胸腹譬之冲衢，塞不能久；胁则譬之僻巷，塞则难开，用药须明此意。时疫胁痛虽有痰、
气、血之殊，而总不离乎热，黄芩是为主药。若别有热证者，黄连、山栀又所必需，他病胁痛，有寒、有热，不在此例。
时疫腹满痛，属宿食为邪热所结者，十之七、八；属气、血、痰、水者，十之二、三。盖腹为胃与小肠之正
界，非胸、胁、少腹之地可比。腹满而不痛者，属邪在气分，属水谷散漫而未燥结。气分脉多沉，或弦，水谷脉
滑；气分通腹皆满，水谷满有分界；气分者，浓朴、大腹皮、青皮、陈皮、枳、桔为主，水谷者，半夏、山楂、麦
芽、神曲、莱菔子、枳实为主。时疫为热证，腹满亦当清
热，兼以顺气消食可也。若舌多黄苔，虽满而不痛，为邪已传胃，宜小承气汤下之。
痛而不满者，属邪在血分，属水谷燥结诸病、他病或有属冷者。时疫总属热证，痛不可按而无硬处者，
于清里方中加赤芍。不可按而有硬处者，调胃承气汤。
满痛兼作为痞满在气，燥实在血，大实大热之证，大承气汤。诸病腹满痛或兼自利，当责之虚冷，时疫自利属热
结旁流，下之则止，不可疑为虚冷。若满痛而喜燥、喜温，或恶寒，手足冷，清利之益甚，或右关迟紧，此非本
病，乃因烦渴、饮冷太过，或用清凉太过、太早之所致，又当以温燥为主，不可执一。然此亦治药弊，非治本病也。
胁部胀满疼痛与胸部胀满疼痛相似，但又有细微区别：胸部胀满疼痛多由宿食停滞致病，而胁部胀满疼痛通常并非由宿食引起，但也有因胸腹间有宿食导致胀满疼痛波及胁部的情况。时行疫病引起的胁部胀满疼痛，是由痰、气、血三者失调所致，其中也有仅胀不痛、仅痛不胀，以及胀与痛同时并发的不同情况。对于仅胀不痛的，是邪气停留在募原（半表半里之膜原）尚未传变，适宜使用达原饮；若兼有寒热往来症状的，适宜使用大柴胡汤。对于仅痛不胀的，是邪气分布于少阳经，适宜使用小柴胡汤。对于胀与痛同时并发的，应当区分左右两侧治疗。左侧属于血分病变，用小柴胡汤去掉人参，加入延胡索、当归尾、红花、桃仁，病情严重的加入莪术、三棱、三七、五灵脂。右侧属于痰与气的病变。若是痰证，用大柴胡汤加倍半夏用量，加入牡蛎、莱菔子，病情严重的加入白芥子、甘遂、大戟、芫花。若是气证，加入青皮、莱菔子、木香、大腹皮。痰和气引起的疼痛，位置都不固定，且有聚散变化的特点。痰邪消散后仍会有不适感，气邪消散后则没有痛苦。如果经过多次发汗、攻下、清热利湿治疗后，胁痛反而加重的，属于虚证。气虚必然伴有呕吐腹泻，治疗以补气为主；血虚必然伴有烦躁发热，治疗以养血为主，这种情况在十例中只占一、二例。
胁痛与胸腹痛不同。胸腹部好比交通要道，堵塞不能持久；胁部好比偏僻小巷，堵塞则难以疏通，用药必须明白这个道理。时行疫病引起的胁痛虽然分为痰、气、血的不同，但总离不开热邪，黄芩是主要药物。如果有其他热证表现，黄连、山栀也是必需的，其他疾病引起的胁痛，有寒证也有热证，不在此列。
时行疫病引起的腹部胀满疼痛，属于宿食被邪热结滞的，占十分之七、八；属于气、血、痰、水阻滞的，占十分之二、三。因为腹部是胃和小肠的主要区域，不同于胸、胁、少腹的部位。腹部胀满但不疼痛的，属于邪气在气分，属于水谷之气散漫而未燥结成实。气分的脉象多沉或弦，水谷的脉象滑；气分导致的胀满遍布全腹，水谷导致的胀满有界限；气分病变，以厚朴、大腹皮、青皮、陈皮、枳壳、桔梗为主药；水谷病变，以半夏、山楂、麦芽、神曲、莱菔子、枳实为主药。时行疫病属于热证，腹部胀满也应当清热，兼以顺气消食即可。如果舌苔多呈黄色，虽然胀满但不疼痛，说明邪气已传入胃腑，适宜用小承气汤攻下。
疼痛但不胀满的，属于邪气在血分，属于水谷燥结的各种疾病，其他疾病有的属于寒证。时行疫病总属热证，疼痛且拒按但没有硬块的，在清里热的方剂中加入赤芍。疼痛拒按且有硬块的，使用调胃承气汤。
胀满与疼痛同时发作，痞满属于气分，燥实属于血分，这是大实大热的证候，使用大承气汤。各种疾病引起的腹部胀满疼痛或兼有自发性腹泻，应当责之于虚寒证，但时行疫病的自发性腹泻属于热结旁流（实热内结，迫津下泄），攻下后即可停止，不可怀疑为虚寒证。如果胀满疼痛且喜欢干燥温暖，或怕冷，手脚冰凉，使用清热利湿药反而加重，或者右关脉迟紧，这不属于本病，而是因烦渴饮水过多，或使用清凉药太过、太早所导致的，此时又应当以温燥药为主，不可固执一端。然而这也是治疗失误造成的后果，并非治疗本病的方法。
The distending pain in the hypochondrium is similar to that in the chest, but with slight differences: chest distending pain is often caused by retained food (retained food), whereas hypochondriac distending pain is usually not caused by retained food. However, there are cases where retained food in the chest and abdomen causes distending pain that extends to the hypochondrium. Epidemic heat-toxin causing hypochondriac distending pain results from disorders of phlegm (Phlegm), qi (Qi), and blood (Blood). Among these, there are cases of distension without pain, pain without distension, and simultaneous distension and pain. For distension without pain, it indicates pathogenic factors remaining at the Membranous Origin (Membranous Origin) without transmission; Da Yuan Yin (Origin-Reaching Decoction) is appropriate. If accompanied by alternating chills and fever, Da Chai Hu Tang (Minor Bupleurum Decoction) is indicated. For pain without distension, the pathogen is distributed along the Shaoyang (Lesser Yang) meridian; Xiao Chai Hu Tang (Greater Bupleurum Decoction) is suitable. For simultaneous distension and pain, treatment should distinguish between left and right sides. The left side pertains to blood disorders; use Xiao Chai Hu Tang removing Ren Shen (Ginseng Root), adding Yan Hu Suo (Corydalis Rhizome), Gui Wei (Angelica Sinensis Tail), Hong Hua (Safflower), and Tao Ren (Peach Seed). In severe cases, add E Zhu (Curcuma Zedoary Rhizome), San Leng (Burreed Tuber), San Qi (Notoginseng Root), and Wu Ling Zhi (Trogopterus Dung). The right side pertains to phlegm and qi disorders. For phlegm, double the Ban Xia (Pinellia Tuber) in Da Chai Hu Tang, add Mu Li (Oyster Shell), Lai Fu Zi (Radish Seed); in severe cases, add Bai Jie Zi (White Mustard Seed), Gan Sui (Kansui Root), Da Ji (Euphorbia Pekinensis Root), and Yuan Hua (Genkwa Flower). For qi disorders, add Qing Pi (Citrus Unripe Peel), Lai Fu Zi, Mu Xiang (Aucklandia Root), and Da Fu Pi (Areca Peel). Pain caused by phlegm and qi has no fixed location and exhibits gathering and dispersing characteristics. When phlegm dissipates, discomfort may persist; when qi dissipates, no discomfort remains. If hypochondriac pain worsens after repeated sweating, purging, or clearing heat and promoting urination, it indicates a deficiency syndrome. Qi deficiency inevitably leads to vomiting and diarrhea; treatment focuses on tonifying qi. Blood deficiency inevitably leads to irritability and fever; treatment focuses on nourishing blood. This scenario accounts for only one or two out of ten cases.
Hypochondriac pain differs from chest and abdominal pain. The chest and abdomen are like major thoroughfares; blockage there cannot last long. The hypochondrium is like a secluded alley; blockage there is difficult to clear. Medication must understand this principle. Although epidemic hypochondriac pain varies by phlegm, qi, and blood, it generally involves heat. Huang Qin (Scutellaria Root) is the principal herb. If other heat symptoms exist, Huang Lian (Coptis Rhizome) and Shan Zhi (Gardenia Fruit) are also necessary. Hypochondriac pain in other diseases may be cold or heat, which is not covered here.
Epidemic abdominal distending pain is due to retained food bound by pathogenic heat in seven or eight out of ten cases; it is due to qi, blood, phlegm, or water retention in two or three out of ten cases. The abdomen is the main domain of the Stomach (Stomach) and Small Intestine (Small Intestine), distinct from the chest, hypochondrium, and lower abdomen. Abdominal distension without pain belongs to qi-level disorders, indicating scattered grain and water that have not dried into accumulation. Qi-level pulse is often deep or wiry; grain/water-level pulse is slippery. Qi-level distension covers the entire abdomen; grain/water-level distension has boundaries. For qi-level disorders, Hou Po (Magnolia Bark), Da Fu Pi, Qing Pi, Chen Pi (Aged Tangerine Peel), Zhi Ke (Aurantium Fruit), and Jie Geng (Platycodon Root) are primary. For grain/water disorders, Ban Xia, Shan Zha (Hawthorn Fruit), Mai Ya (Barley Sprout), Shen Qu (Medicated Leaven), Lai Fu Zi, and Zhi Shi (Immature Aurantium Fruit) are primary. Since epidemics are heat syndromes, abdominal distension should be cleared of heat, combined with regulating qi and digesting food. If the tongue coating is predominantly yellow, even if distended but not painful, it indicates the pathogen has transmitted to the Stomach; Xiao Cheng Qi Tang (Minor Order the Qi Decoction) should be used to purge.
Pain without distension belongs to blood-level disorders, or to dry accumulation of grain/water, or cold syndromes in other diseases. Epidemics are always heat syndromes. If pain is tender to pressure but without hardness, add Chi Shao (Red Peony Root) to formulas that clear interior heat. If pain is tender to pressure with hardness, use Tiao Wei Cheng Qi Tang (Regulate the Stomach Order the Qi Decoction).
Simultaneous distension and pain:痞满 (stifling-fullness) belongs to qi, while dry excess belongs to blood. This is a great excess and great heat syndrome; Da Cheng Qi Tang (Major Order the Qi Decoction) is indicated. Various diseases causing abdominal distending pain or spontaneous diarrhea should be attributed to deficiency-cold. However, spontaneous diarrhea in epidemics is "heat binding with lateral flow" (excess-heat binding with leakage); purging will stop it. Do not mistake it for deficiency-cold. If distension and pain prefer warmth/dryness, or involve aversion to cold and cold limbs, and clearing/cooling treatments worsen the condition, or the right Guan pulse is slow and tight, this is not the original disease. It is caused by excessive drinking due to thirst, or by using cooling treatments too excessively or too early. In such cases, warm-drying methods should be prioritized. Do not adhere rigidly to one approach. Note that this is iatrogenic error, not the treatment of the primary disease.