（小腹痛 腹中窄狭 当脐痛）
东垣云。腹中诸痛。皆由劳役过甚。饮食失节。中气受伤。寒邪乘虚入客。阳气不通所致。
故卒然而痛。经云。得炅则痛立止。中脘痛属太阴。理中汤。脐腹痛属少阴。真武汤。小腹痛属
厥阴。当归四逆汤加吴茱萸。若夫热病腹痛。热则芍药甘草汤、黄芩汤。寒则理中汤。若脾胃素
虚人。饮食不能消克者。六君子加香、砂。若兼外感宿食者。藿香正气散。若但少腹硬满而痛。
小便利者。即是蓄血之证。桃核承气汤。小便不利者。即是溺涩之证。五苓散。有心腹大痛。欲吐不
得吐。欲泻不得泻。是名霍乱。急以盐汤灌之。其或清痰留滞于胸膈之间。食积郁结于肠胃之内。
皆能令人腹痛。痰则控涎丹。食积枳实导滞丸。
凡治腹痛。必用温散。如台芎、苍术、香附之类。白芍能治血虚腹痛。惟脉弦发热者为宜。
其性酸寒收敛。无温散之功。若气虚者服之。反伤脾胃也。绵绵而痛无增减。欲得热手按。及喜
热饮食。脉沉迟者。寒也。理中汤加肉桂、香、砂。腹痛用温药不效。痛愈甚。大便秘者。微利
之。平胃散加藿香、半夏、紫苏、木香、大黄。虚人。人参养胃汤。时痛时止。热手按而不减。
脉洪数者。热也。二陈汤加浓朴、枳实、芩、连、山栀。腹中水鸣。乃火击动其水也。二陈加芩、
连、木香、枳实、木通。虚人。六君子加香、砂、猪苓、泽泻。感暑而痛。或泻利并作。脉必虚
豁。十味香薷饮。感湿而痛。小便不利。大便溏泄。胃苓汤。如腹中常有热而痛。此为积热。调
胃承气汤下之。因客寒作痛者。脉必弦缓。小建中加炮姜。兼气郁脉沉者。更加台芎、苍术、香
附。因热作痛。脉必数疾。二陈汤加芩、连、芍药。痛甚。稍加炮姜从治之。若时痛时止。口干
恶心头眩。或泻黄沫者。火也。前药勿用炮姜。加大黄微利之。脉沉结或伏。必腹痛。痛引两胁
及肩背。皆不得俯仰者。气滞也。二陈加川芎、木香、枳壳、香附。不应。有血也。加蓬术、穿
山甲。七情内结。心腹绞痛。不能饮食。时作时发。发即欲死。七气汤选用。酒积作痛。曲 丸。
食积作痛。保和丸。虫痛者。懊 作痛。上下不定。痛有休止。或有块梗起。痛则呕吐清水。当
从虫积治之。因疝致痛者。必引睾丸。或小腹有一条梗起。宜从疝治。因触秽致痛。得热汤饮转
剧者。是臭毒攻逆也。另详本门。
小腹痛 小腹痛满有三。皆为内有留着。非虚气也。小腹正中为少阴任冲之分野。两傍为厥阴
肝经之分野。一
属燥结大肠。其证五六日大便不通。按之坚满。绕脐攻痛。小便虽利而黄赤。其脉数实有力。为
府邪实结而痛满。大承气下之。若因津血枯涩而结者。其脉虽数而不甚旺。麻仁丸、通幽汤之类。
无故而大便不通。少腹微满。尺脉虽数。而必微弱者。蜜煎导之。夏月可用猪胆导。慎不可用攻
里之药。攻之胃气受伤。必生他患也。一属热结膀胱。其证溺闭不通。按之虽满而不甚坚。弹之
有声激指。其脉数盛有力。而烦渴引饮者。昼甚。五苓散。夜剧。猪苓汤。一属血结膀胱而腹满。
其证善忘如狂。或渴欲漱水而不能饮。或喜热饮。仍不能多。小便清利。或反倍于平时。或数欠
而不清。大抵邪结膀胱阳分。热邪伤血。虽有蓄血。其人真阴不虚。则小便自清。尺脉必盛。代
抵当丸。若反倍于常时者。为邪据下焦。真阳外亡之候。本方去硝减黄倍桂加熟附六七分救之。
若缘醉饱入房。强力忍精而致少阴与任督受伤。血结阴分者。此真阴亏损。必致小便涩数。胀满
如淋也。生料济生肾气丸。红酒煎服。有妇人经行之时。交合受伤。时时不净而少腹满痛者。此
冲脉受伤也。十全大补汤倍用肉桂。若有块绞痛。喜热按。此气血虚而有瘀积也。当归生姜羊肉
汤加肉桂、吴茱萸、茯苓、芍药。不应。加人参。又有本来下元虚人。勉力劳役而致受伤。蓄血
小腹满痛者。此肝经受伤。其满必偏见于左傍也。调肝散、代抵当丸。审微甚选用可也。然亦有
右傍偏满者。此必饱食奔驰。脾阴下溜。食积痰腻留结也。当于积滞门求之。其臭毒腹痛呕逆。
另详杂门。
〔诊〕阴弦腹痛。细小紧急。皆为腹痛。 滑为痰饮。弦为冷食。阴弦或紧宜温。沉弦滑实可
下。沉伏者。为气滞。细小紧急腹中刺痛。尺脉紧脐下痛。弦急小腹痛。尺脉伏 瘕痛。细小而
迟者易治。坚大疾者。数而紧者。浮大而长者。为病不应脉皆难治。痛甚而喘。脐下急大痛。人中黑者死。
腹中窄狭 肥人乃是湿痰留滞。气不升降。当行气燥湿。越曲、平胃为主。瘦人乃是阴虚火
旺。熏蒸脏腑。逍遥、佐金降火开郁为主。肥人腹中辘辘有声。须作痰治。二陈、二术为主。气
虚者。加人参。
当脐痛 当脐痛为肾虚任脉为病。六味丸加龟板灰。伤寒阳脉涩。阴脉弦。法当腹中急痛。
此为本虚受寒。小建中汤和之。
虞恒德治一壮年。寒月入水网鱼。饥甚遇凉。粥食入腹大痛。二昼夜不止。医以大黄丸不通。
又以承气下粪水而痛愈甚。诊其六脉沉伏而实。面色青黑。此大寒证。而下焦又有燥屎作痛。先
与治中汤加丁、附一帖。又灸气海二十一壮。痛减半。继以巴豆、沉香、木香作丸。如绿豆大。
生姜汤下五七丸。下五七次而愈。
又治一人。六月投渊取鱼。至深秋雨凉。半夜小腹痛甚大汗。脉沉弦细实。重取如循刀责责
然。夫腹痛脉沉弦细实。如循刀责责然。阴邪固结之象。便不当有汗。今大汗出。此必瘀血留结。
营气不能内守而渗泄于外也。且弦脉亦肝血受伤之候。与大承气加桂二服。微利痛减。连日于未
申时。复坚硬不可近。与前药加桃仁泥。下紫血升余痛止。脉虽稍减而责责然犹在。又以前药加
川附子。下大便四五行。有紫黑血如破絮者二升而愈。
汪石山治一老妇病腹痛。初从右手指冷起。渐上至头。如冷水浇灌。而腹大痛。痛则遍身大
热。热退则痛止。或过食或不食皆痛。每年发一二次。近来二三日一发。远不过三五日。用四物、
四君、二陈、七气。皆不应。汪诊之。脉皆微弱。似有似无。或二三至一止。或四五至一止。乃
阳气大虚也。用独参五钱。入陈皮七分煎服。十数帖而愈。夫四肢者诸阳之本。头者诸阳之会。
经曰。阳虚则恶寒。今指梢冷。逆上至头。则阳虚阴盛可知。阳虚不能健运而痛大作。
痛作而复热者。物极则反也。及其阴阳气衰。两不相争。则热歇而痛亦息矣。故以独参汤补之。
数年之病遂愈。
（小腹痛、腹中狭窄感、肚脐周围疼痛）
李东垣说：腹部各种疼痛，大多是因为过度劳累、饮食不节制，导致中气受损，寒邪趁虚侵入，阳气运行不通畅所致。
因此疼痛突然发作。《内经》说：得到温热后疼痛立即停止。
位于中脘部位的疼痛属于太阴病，用理中汤治疗；
位于肚脐周围的疼痛属于少阴病，用真武汤治疗；
位于小腹部的疼痛属于厥阴病，用当归四逆汤加吴茱萸治疗。
如果是热病引起的腹痛，热证用芍药甘草汤或黄芩汤；寒证用理中汤。
如果脾胃素来虚弱，饮食不能消化的人，用六君子汤加木香、砂仁。
如果兼有外感表证和宿食停滞，用藿香正气散。
如果只是小腹部坚硬胀满且疼痛，小便通畅的，就是蓄血证，用桃核承气汤。
小便不利的，就是溺涩证（排尿困难），用五苓散。
如果有心腹部剧烈疼痛，想吐却吐不出来，想泻却泻不出来，这名叫霍乱。紧急时用盐汤灌服催吐。
或者清痰留滞于胸膈之间，食积郁结在肠胃之内，都能导致人腹痛。
若是痰饮所致，用控涎丹；若是食积所致，用枳实导滞丸。
凡是治疗腹痛，必须使用温散药物，如川芎、苍术、香附之类。
白芍能治疗血虚引起的腹痛，只有脉象弦且发热的情况才适宜。
白芍的性质酸寒收敛，没有温散的功效。如果气虚的人服用，反而损伤脾胃。
疼痛绵绵不断且无增减，喜欢用热手按压，以及喜欢热饮食，脉象沉迟的，是寒证。用理中汤加肉桂、木香、砂仁。
腹痛使用温药无效，疼痛更加严重，大便秘结的，轻微通下。用平胃散加藿香、半夏、紫苏、木香、大黄。
体质虚弱者，用人参养胃汤。
疼痛时作时止，用手热按但不减轻，脉象洪数的是热证。用二陈汤加厚朴、枳实、黄芩、黄连、山栀。
腹中有水鸣声，这是火邪冲击动摇了水液。用二陈汤加黄芩、黄连、木香、枳实、木通。
体质虚弱者，用六君子汤加木香、砂仁、猪苓、泽泻。
感受暑邪而疼痛，或者伴有腹泻痢疾，脉象必定虚豁无力，用十味香薷饮。
感受湿邪而疼痛，小便不利，大便溏泄，用胃苓汤。
如果腹中经常感觉热痛，这是积热，用调胃承气汤攻下。
因客寒引起疼痛的，脉象必定弦缓，用小建中汤加炮姜。
兼有气郁且脉沉的，再加川芎、苍术、香附。
因热引起疼痛的，脉象必定数疾，用二陈汤加黄芩、黄连、白芍。
疼痛剧烈时，稍微加一点炮姜进行反佐治疗。
如果疼痛时作时止，口干恶心头晕，或者排泄黄色泡沫状物，这是火邪。前面的药不要使用炮姜，加大黄轻微通下。
脉象沉结或伏，必定腹痛，疼痛牵引两胁及肩背，都不能俯仰的，是气滞。用二陈汤加川芎、木香、枳壳、香附。
如果无效，说明有瘀血，加蓬术、穿山甲。
七情内结，心腹绞痛，不能进食，时发时止，发作时痛苦欲死，选用七气汤。
酒积作痛，用神曲丸。
食积作痛，用保和丸。
虫痛，表现为懊恼作痛，部位上下不定，疼痛有休止时间，或者有块梗起，痛时呕吐清水，应当从虫积治疗。
因疝气导致疼痛的，必定牵引睾丸，或小腹部有一条梗起，应当从疝气治疗。
因接触秽浊之气导致疼痛，喝热汤后病情加重的，这是臭毒攻逆。另在本门详细记载。
小腹痛
小腹胀满有三种情况，都是因为内有病理产物滞留，不是虚气所致。
小腹正中是少阴任脉和冲脉的分野，两旁是厥阴肝经的分野。
第一种属于燥结大肠。症状是五六天大便不通，按压时坚硬胀满，绕脐攻痛，小便虽然通畅但颜色黄赤，脉象数实有力，这是腑邪实结导致的痛满，用大承气汤攻下。
如果是因为津液血液枯涩而结滞的，脉象虽然数但不甚旺盛，用麻仁丸、通幽汤之类。
无故大便不通，少腹部微满，尺脉虽然数，但必定微弱，用蜜煎导法通便。夏天可用猪胆导法。千万不要使用攻里的药物，攻下会损伤胃气，必然产生其他病患。
第二种属于热结膀胱。症状是小便闭塞不通，按压虽然胀满但不十分坚硬，弹击时有声音激指，脉象数盛有力，且烦渴引饮，白天加重，用五苓散；夜间加剧，用猪苓汤。
第三种属于血结膀胱导致腹部胀满。症状是健忘如狂，或者口渴想漱口但不能吞咽，或者喜欢热饮但仍不能多喝，小便清澈通畅，或者反而比平时多，或者频繁打哈欠但尿不清。
大抵邪气结聚在膀胱阳分，热邪伤血，虽然有蓄血，但如果此人真阴不虚，则小便自清，尺脉必定盛大，用代抵当丸。
如果小便量反而倍于常时，这是邪气占据下焦，真阳外亡的征候。用本方去掉芒硝、减少大黄，加倍肉桂，加熟附子六七分来救治。
如果是由于醉酒后行房事，强力忍精导致少阴与任督受伤，血结在阴分，这是真阴亏损，必定导致小便涩滞频数，胀满如同淋证。用生料济生肾气丸，红酒煎服。
有妇女在经期交合受伤，时时漏下不净且少腹满痛的，这是冲脉受伤，用十全大补汤倍用肉桂。
如果有块状绞痛，喜欢热按，这是气血虚而有瘀积，用当归生姜羊肉汤加肉桂、吴茱萸、茯苓、白芍。如果无效，加人参。
又有本来下元虚损之人，勉强劳役导致受伤，蓄血在小腹满痛的，这是肝经受伤，其胀满必定偏见于左侧。用调肝散、代抵当丸，根据病情轻重选用即可。
然而也有右侧偏满的，这一定是饱食后奔驰，脾阴下溜，食积痰腻留结所致。应当在积滞门中寻求治疗方法。
那种臭毒腹痛呕吐，另在杂病门详细记载。
〔诊法〕
脉象阴部弦紧，细小紧急，都是腹痛的表现。
滑脉主痰饮，弦脉主冷食。
阴脉弦或紧适宜温法，沉脉弦滑实适宜下法。
沉伏脉，是气滞。
细小紧急，腹中刺痛，尺脉紧，脐下痛。
弦急，小腹痛。
尺脉伏，瘕痛。
细小而迟的容易治疗。
坚大疾速的，数而紧的，浮大而长的，病证与脉象不相符，都难治。
疼痛剧烈且喘息，脐下急迫大痛，人中穴发黑的，预后不良致死。
腹中狭窄感
肥胖之人多是湿痰留滞，气机升降失常，应当行气燥湿，以越鞠丸、平胃散为主。
瘦人多为阴虚火旺，熏蒸脏腑，以逍遥散、佐金丸降火开郁为主。
肥胖之人腹中辘辘有声，须当作痰证治疗，以二陈汤、二术为主。气虚者，加人参。
肚脐周围疼痛
肚脐周围疼痛是肾虚任脉发病，用六味丸加龟板灰。
伤寒病见阳脉涩、阴脉弦，法度上应当腹中急痛，这是因为本虚受寒，用小建中汤调和。
虞恒德治疗一名壮年男子，寒冬腊月入水网鱼，饥饿时遇到凉气，粥食入腹后大痛，持续两昼夜不止。医生用大黄丸未能通便，又用承气汤攻下粪水，结果疼痛更甚。诊察其六脉沉伏而实，面色青黑，这是大寒证，且下焦又有燥屎作痛。先给予治中汤加丁香、附子一帖，又灸气海穴二十一壮，疼痛减半。继而又用巴豆、沉香、木香制成丸药，如绿豆大小，生姜汤送服五七丸，排出五七次后痊愈。
又治疗一人，六月投渊取鱼，到了深秋雨凉半夜，小腹痛甚并大汗出，脉象沉弦细实，重按时如摸到刀锋般锐利。腹痛脉象沉弦细实，如摸到刀锋般锐利，是阴邪固结的征象，按理不应当有汗。现在大汗出，这必定是瘀血留结，营气不能内守而渗泄于外。而且弦脉也是肝血受伤的征候。给予大承气汤加桂枝服用两次，轻微通下后疼痛减轻。连日在未时申时（下午1-5点），再次出现坚硬不可触碰的情况，给前药加桃仁泥，排出紫血升余，疼痛停止。脉象虽稍减但仍有刀割感，又以前药加川附子，排出大便四五行，有紫黑血如破絮者二升而痊愈。
汪石山治疗一名老妇患腹痛。起初从右手指发冷开始，逐渐上行至头部，如冷水浇灌，而腹部大痛，痛时遍身大热，热退则痛止。无论过食或不食都会痛，每年发作一二次，近来二三日一发，远不过三五日。曾用四物汤、四君汤、二陈汤、七气汤，都不见效。汪石山诊察，脉象皆微弱，似有似无，或二三至一止，或四五至一止，这是阳气大虚。用独参汤五钱，入陈皮七分煎服，十余帖后痊愈。四肢是诸阳之本，头部是诸阳之会。《内经》说：阳虚则恶寒。现在指尖冷，逆上至头，可知阳虚阴盛。阳虚不能健运而痛大作。
疼痛发作后又发热，这是物极必反。等到阴阳气衰，两不相争，则热歇而痛亦息矣。所以用独参汤补益，数年之病遂愈。
(Small Abdominal Pain, Narrowness in the Abdomen, Pain around the Umbilicus)
Li Dongyuan stated: Various pains in the abdomen are mostly caused by excessive labor and irregular diet, which injure the Middle Qi (vital energy of the middle jiao). Cold pathogen takes advantage of the deficiency to invade. The obstruction of Yang Qi leads to pain.
Therefore, the pain occurs suddenly. The *Classic of Difficult Issues* (*Nan Jing*) states: "Pain ceases immediately upon receiving heat."
Pain at the Zhongwan (CV12) region belongs to Taiyin disease; treat with Lizhong Tang (Regulate the Middle Decoction).
Pain around the umbilicus belongs to Shaoyin disease; treat with Zhenwu Tang (True Warrior Decoction).
Small abdominal pain belongs to Jueyin disease; treat with Danggui Sini Tang (Angelica Sinensis Decoction for Reversal Cold) plus Wu Zhu Yu (Evodia Fruit).
If abdominal pain is caused by heat disease: for heat syndrome, use Shaoyao Gancao Tang (Peony and Licorice Decoction) or Huangqin Tang (Scutellaria Decoction); for cold syndrome, use Lizhong Tang.
For individuals with inherent Spleen-Stomach deficiency who cannot digest food, use Liujunzi Tang (Six Gentlemen Decoction) plus Xiangru (Amomum Fruit) and Sharen (Tsaoko Cardamom).
If accompanied by external contraction and retained food, use Huoxiang Zhengqi San (Patchouli Powder to Rectify the Qi).
If there is only hardness and fullness with pain in the lower abdomen, and urination is free, this is a Blood Stasis syndrome; treat with Taohé Chengqi Tang (Peach Kernel Decoction to Order the Qi).
If urination is difficult, this is a Urinary Obstruction syndrome; treat with Wuling San (Five-Atractylodes Powder).
If there is severe pain in the heart and abdomen, with an urge to vomit but unable to do so, and an urge to defecate but unable to do so, this is named Huoluan (Cholera-like disorder). Urgently administer salt water to induce vomiting.
Alternatively, clear phlegm stagnating in the chest and diaphragm, or food retention knotting in the intestines and stomach, can all cause abdominal pain.
If due to Phlegm, use Kongxian Dan (Draining Fluids Pill). If due to Food Retention, use Zhishi Daoshi Wan (Immature Bitter Orange Pill to Guide out Retention).
Generally, treating abdominal pain requires warm-dispersing herbs, such as Taixiong (Sichuan Lovage Rhizome), Cangzhu (Atractylodes Rhizome), Xiangfu (Cyperus Rhizome).
Baishao (White Peony Root) can treat blood-deficiency abdominal pain, suitable only when the pulse is wiry and accompanied by fever.
Its nature is sour, cold, and astringent, lacking warm-dispersing properties. If taken by those with Qi deficiency, it damages the Spleen and Stomach.
Dull pain that is constant without fluctuation, relieved by hot hand pressure, and preference for hot drinks, with a deep and slow pulse, indicates Cold. Treat with Lizhong Tang plus Rougui (Cinnamon Bark), Xiangru, and Sharen.
If warm medicines fail and pain worsens with constipation, mildly purge using Pingwei San (Maintain the Stomach Powder) plus Huoxiang (Patchouli), Banxia (Pinellia Tuber), Zisu (Perilla Leaf), Muxiang (Aucklandia Root), and Dahuang (Rhubarb Rhizome).
For deficient persons, use Renshen Yangwei Tang (Ginseng Decoction to Nourish the Stomach).
Intermittent pain, not relieved by hot pressure, with a surging and rapid pulse, indicates Heat. Treat with Erchen Tang (Two Aged Substances Decoction) plus Houpo (Magnolia Bark), Zhishi (Immature Bitter Orange), Huangqin (Scutellaria Root), Huanglian (Coptis Rhizome), and Shanzhi (Gardenia Fruit).
Borborygmus (rumbling sound) in the abdomen indicates Fire agitating Water. Treat with Erchen Tang plus Huangqin, Huanglian, Muxiang, Zhishi, and Mutong (Akebia Stem).
For deficient persons, use Liujunzi Tang plus Xiangru, Sharen, Zhuling (Polyporus), and Zexie (Alisma Rhizome).
Pain caused by Summerheat, possibly with diarrhea/dysentery, presents with a vacuous and hollow pulse. Treat with Shiwei Xiangru Yin (Ten-Ingredient Patchouli Decoction).
Pain caused by Dampness, with urinary difficulty and loose stools, treat with Weiling Tang (Atractylodes and Poria Decoction).
If there is chronic heat and pain in the abdomen, this is Accumulated Heat. Purge with Tiaowei Chengqi Tang (Regulate the Stomach and Order the Qi Decoction).
Pain caused by exogenous Cold presents with a wiry and slow pulse. Treat with Xiaojianzhong Tang (Minor Construct the Middle Decoction) plus Paojiang (Prepared Ginger).
If accompanied by Qi Stagnation with a deep pulse, add Taixiong, Cangzhu, and Xiangfu.
Pain caused by Heat presents with a rapid and hurried pulse. Treat with Erchen Tang plus Huangqin, Huanglian, and Baishao.
If pain is severe, add a small amount of Paojiang for counter-treatment (antidotal therapy).
If pain is intermittent, with dry mouth, nausea, dizziness, or vomiting yellow foam, this is Fire. Do not use Paojiang in the previous formulas; add Dahuang to mildly purge.
Deep, knotted, or hidden pulses indicate abdominal pain. Pain radiating to both hypochondria and shoulder/back, preventing flexion and extension, indicates Qi Stagnation. Treat with Erchen Tang plus Chuanxiong (Sichuan Lovage Rhizome), Muxiang, Zhike (Bitter Orange Peel), and Xiangfu.
If ineffective, there is Blood Stasis. Add Pengzhu (Curcuma Zedoaria Rhizome) and Chuanshanjia (Pangolin Scales).
Internal emotional constraint causing severe heart/abdominal colic, inability to eat, intermittent attacks, feeling like death during attacks: select Qiqi Tang (Seven Emotions Decoction).
Pain from Wine Retention: Qu Wan (Medicated Leaven Pill).
Pain from Food Retention: Baohe Wan (Preserve Harmony Pill).
Pain from Parasites:表现为 "Ao'ao" (restless discomfort) pain, moving up and down, with intervals of relief, palpable masses, and vomiting clear fluid during attacks. Treat as Parasitic Accumulation.
Pain caused by Hernia: necessarily radiating to the testicles, or a cord-like mass rising in the lower abdomen. Treat as Hernia.
Pain caused by contact with foul/toxic substances, worsening with hot drinks: this is Foul Toxin attacking upwards. See detailed discussion in this chapter.
Small Abdominal Pain
There are three types of small abdominal fullness/pain, all due to internal retention, not deficient Qi.
The center of the lower abdomen is the domain of the Shaoyin, Ren Mai (Conception Vessel), and Chong Mai (Penetrating Vessel). The sides are the domain of the Jueyin Liver Meridian.
First type: Dryness accumulation in the Large Intestine. Symptoms: Constipation for 5-6 days, hardness/fullness on palpation, pain surrounding the umbilicus, urine is free but yellow-red, pulse is rapid, excess, and forceful. This is Fu-organ Excess accumulation causing pain/fullness. Purge with Dachengqi Tang (Major Order the Qi Decoction).
If due to dryness from fluid/blood depletion: pulse is rapid but not vigorous. Use Mahuang Wan (Hemp Seed Pill) or Tongyou Tang (Unblocking the Source Decoction).
Idiopathic constipation with slight lower abdominal fullness, where the Chi (Cun Cun) pulse is rapid but weak: use Honey Suppository (Mi Jian Dao). In summer, use Pig Gallbladder Suppository. Strictly avoid purgatives, as they damage Stomach Qi and cause other diseases.
Second type: Heat accumulation in the Bladder. Symptoms: Urinary retention, fullness on palpation but not hard, resonant sound on percussion, pulse is rapid, abundant, and forceful, with irritability, thirst, and desire to drink. Worse during the day: treat with Wuling San. Worse at night: treat with Zhuling Tang (Polyporus Decoction).
Third type: Blood accumulation in the Bladder causing abdominal fullness. Symptoms: Forgetfulness resembling mania, or thirst wanting to rinse mouth but not swallow, or preference for hot drinks but unable to drink much. Urine is clear and free, or even more than usual, or frequent dribbling without clearing.
Generally, if pathogen knots in the Yang aspect of the Bladder, Heat injures Blood. Even with Blood Stasis, if True Yin is not deficient, urine remains clear, and Chi pulse is vigorous. Treat with Dai Dandang Wan (Substitute Dang Gui Pill).
If urine volume doubles the norm, it indicates Pathogen occupying the Lower Jiao and True Yang escaping externally. Modify the formula by removing Mangxiao (Mirabilite), reducing Dahuang, doubling Rougui, and adding Shufu Zi (Prepared Aconite Root) 0.6-0.9g to rescue.
If caused by intercourse after drunkenness/full meals, or forcing semen retention, injuring Shaoyin, Ren, and Du vessels, leading to Blood knotting in the Yin aspect: this is True Yin deficiency, causing difficult/frequent urination and fullness resembling strangury. Use Shengliao Jisheng Shenqi Wan (Raw Ingredients Jisheng Kidney Qi Pill), decocted with red wine.
In women, injury during intercourse during menstruation causes continuous leakage and lower abdominal fullness/pain: this is Chong Mai injury. Use Shiquan Dabu Tang (Ten Complete Tonifying Decoction) with doubled Rougui.
If there is a mass with colic, relieved by heat: this is Qi/Blood deficiency with Blood Stasis. Use Danggui Shengyang Roushou Tang (Angelica, Ginger, and Lamb Soup) plus Rougui, Wu Zhuyu, Fuling (Poria), and Baishao. If ineffective, add Renshen (Ginseng Root).
For those with inherent Lower Yuan deficiency, injured by forced labor, causing Blood Stasis in the lower abdomen with fullness/pain: this is Liver Meridian injury. Fullness appears predominantly on the left side. Use Tiaogan San (Regulate Liver Powder) or Dai Dandang Wan, selected based on severity.
However, right-sided predominance is often due to eating full then running, causing Spleen Yin to sink, with food retention and phlegm-dampness knotting. Seek treatment in the Food Retention chapter.
Foul toxin abdominal pain/vomiting: see Miscellaneous Diseases chapter.
[Diagnosis]
Yin-wiry, fine, tight, and urgent pulses all indicate abdominal pain.
Slippery pulse indicates Phlegm-Fluid. Wiry pulse indicates Cold Food.
Yin-wiry or tight pulses suit warming methods. Deep-wiry-slippery-excess pulses suit purging methods.
Deep-hidden pulse indicates Qi Stagnation.
Fine-tight-urgent pulse with stabbing abdominal pain, Tight Chi pulse indicates pain below the umbilicus.
Wiry-rapid pulse indicates small abdominal pain.
Hidden Chi pulse indicates Jia-mass (accumulation) pain.
Fine-slow pulses are easy to treat.
Hard-large-rapid pulses, Rapid-tight pulses, Floating-large-long pulses indicate mismatch between disease and pulse; these are difficult to treat.
Severe pain with panting, urgent large pain below the umbilicus, blackening of the philtrum: fatal prognosis.
Narrowness in the Abdomen
Obese individuals: Wet-Phlegm retention, Qi ascent/descent dysfunction. Regulate Qi and dry dampness. Yueju Wan (Regulating Depression Pill) and Pingwei San are primary.
Thin individuals: Yin deficiency with Fire hyperactivity steaming the Zang-Fu. Xiaoyao San (Free and Easy Wanderer Powder) and Zuojin Wan (Support Metal Pill) to descend Fire and resolve depression.
Obese individuals with borborygmus: Treat as Phlegm. Erchen Tang and Erzhu (Two Atractylodes) are primary. Add Renshen for Qi deficiency.
Pain around the Umbilicus
Umbilical pain indicates Kidney deficiency and Ren Mai disease. Use Liuwei Wan (Six-Ingredient Pill) plus Guiban Hui (Tortoise Shell Ash).
In Cold Damage, if Yang pulse is choppy and Yin pulse is wiry, acute abdominal pain is expected. This is due to root deficiency with Cold invasion. Harmonize with Xiaojianzhong Tang.
Yu Hengde treated a strong young man who fished in cold water in winter. Hungry and exposed to cool air, he ate porridge and suffered severe abdominal pain for two days/nights. Doctors used Dahuang Wan (Rhubarb Pill) without success, then Chengqi Tang to purge fecal water, worsening pain. Pulse was deep, hidden, and excess. Complexion was blue-black. This was Major Cold with dry stool in the Lower Jiao. First, gave Zhizhong Tang (Regulate the Middle Decoction) plus Dingxiang (Clove) and Fuzi (Aconite) for one dose. Moxibustion on Qihai (CV6) for 21 cones reduced pain by half. Then made pills with Badou (Croton Seed), Chenxiang (Agarwood), and Muxiang, size of mung beans. Taken with ginger soup, 5-7 pills per dose. After 5-7 bowel movements, cured.
He also treated another person who fished in deep water in June. By late autumn rain/coolness, midnight severe lower abdominal pain with profuse sweating. Pulse was deep, wiry, fine, and excess; heavy pressure felt like touching a knife edge ("ze ze"). Deep-wiry-fine-excess pulse with knife-edge sensation indicates Yin pathogen consolidation. Sweating should not occur. Profuse sweating indicates Blood Stasis retention, Ying Qi failing to hold internally and leaking out. Wiry pulse also indicates Liver Blood injury. Gave Dachengqi Tang plus Guizhi (Cinnamon Twig) twice. Mild purgation reduced pain. On subsequent days at Wei/Shen hours (1-5 PM), hardness returned, intolerable to touch. Added Tao Ren (Peach Kernel) paste to previous formula. Passed over a sheng of purple blood; pain stopped. Pulse slightly improved but knife-edge sensation remained. Added Chuan Fuzi (Sichuan Aconite) to previous formula. Passed 4-5 stools, including 2 sheng of purple-black blood like broken cotton; cured.
Wang Shishan treated an old woman with abdominal pain. Started with cold right fingers ascending to head like cold water pouring, with severe abdominal pain. Body became hot during pain, pain ceased when heat subsided. Pain occurred regardless of eating or fasting. Frequency increased from 1-2 times/year to every 2-3 days recently. Previous treatments with Siwu Tang, Sijunzi Tang, Erchen Tang, Qiqi Tang failed. Wang diagnosed weak, almost imperceptible pulses, with interruptions (every 2-3 beats or 4-5 beats). This indicated Major Yang Deficiency. Used Dushen Tang (Single Ginseng Decoction) 5 qian with Chenpi (Tangerine Peel) 0.7 fen, decocted and taken. Cured after ~10 doses. Limbs are the root of Yang; Head is the meeting of Yang. Classic says: "Yang deficiency leads to aversion to cold." Finger cold ascending to head confirms Yang deficiency/Yin excess. Yang deficiency fails to move/nourish, causing severe pain. Pain followed by heat is "extreme reverses." When Yin/Yang Qi decline and cease fighting, heat stops and pain rests. Thus, tonify with Dushen Tang. Years of illness cured.