【歌】胁肋疼时统属肝，或虚或实或因痰。脉沉气郁须开导，芤涩原来死血干。食积一条常梗起，肝虚痛
在胁梢间。若然痛甚肝经火，干胁之疼疗最难。
【论】足厥阴之络，令人胁痛，皆肝胆经之所主也。丹溪云∶木气实、肝火盛、死血、痰饮、气滞、食积、
湿热皆令人胁痛。亦有肝虚血少而痛者。有因酒色劳损太过，胁下一点痛不止，名干胁痛，甚危，当大补气血，
尚难为也。若此虚实之不同也，必以脉证参之，斯得其受感之情，而用药无差忒也。
谨按∶左胁痛者，肝经受邪也。右胁痛者，肝邪入肺也。左、右胁俱痛者，肝火盛而木气实也。两胁走注
痛而有声者，痰饮也。左胁下有块，作痛不移者，死血也。右胁下有块，作痛饱闷者，食积也。咳嗽气急，发
热者，痰结痛也，久而不治，则成肺痈。劳伤身热，胁痛者，脉必虚也，宜详究之。
【脉】两胁疼痛，脉必双弦。紧细弦者，多怒气偏。沉涩而急，痰瘀之愆。
肝火盛
肝痛甚者，肝火太旺也，当归龙荟丸。轻者，小柴胡汤加黄连、龙胆草、白芍药、醋炒青皮。（方见疟疾。）
火盛者宜伐火，佐金丸。
当归龙荟丸
胆草（一两，去芦） 当归（一两，酒洗） 山栀子仁（一两，炒黑） 黄
连（一两，炒） 黄芩（一两，炒） 黄柏（一两，炒） 大黄（半两） 芦荟（半两） 木香（一钱
半） 麝香（半钱）
为丸，淡姜汤下。
左金丸
治肝火太盛。
黄连（六两） 吴茱萸（一两，汤泡）
为丸，白汤下。
木气实
胁痛脉弦数，木气实也，醋炒青皮、苍术、川芎、当归、芍药、柴胡，或小柴胡汤加醋炒青皮、川芎、胆
草，（方见疟疾。）或抑青丸。
抑青丸
治肝火，伐肝木。
黄连（不拘多少，姜汁炒）
为丸，每百丸，白汤下。
死血痛
胁痛日轻夜重或午后发热，脉芤而涩，瘀血也，四物汤加柴胡、青皮、桃仁、红花，行气药中加破血药。
食积痛
胁下一条杠起作痛者，食积也，保和丸，（方见伤食。）或吴茱萸、炒黄连、神曲、麦芽、山楂、蓬术、
青皮，或当归龙荟丸。（方见前肝火盛条下。）
湿热
湿热盛而两胁痛者，先以琥珀膏贴痛处，后以淡姜汤吞当归龙荟丸，（方见前肝火胁痛条下。）或小柴胡
汤加苍术、青皮、黄连。（方见疟疾。）
痰积
痰积胁下作痛，控涎丹或十枣汤，或二陈汤加南星、苍术、川芎、柴胡、白芥子、炒山栀仁、醋炒青皮。
（方见痰证条内。）
控涎丹
治两胁痰痛。
甘遂（面裹，煨） 大戟（制） 白芥子（炒，各等分）
上末，丸如梧子大，每五、七丸，渐加至十丸，姜汤下。
十枣汤
治痰积胁痛。
甘遂（面裹，煨，一钱） 大戟（制，一钱） 芫花（一钱）
枣子十枚，水二盏，煎八分服。
气滞
气滞胁下作痛，推气散或复元通气散、控涎丹，（方见前痰积胁痛条下。）治一身气痛。气郁者，详郁证条内。
推气散
治右胁疼痛。
枳壳（炒，五钱） 桂心（五钱） 片子姜黄（五钱） 甘草（五钱）
末之，每服二钱，姜枣汤调下。
复元通气散
木香（半两） 茴香（半两） 青皮（半两） 穿山甲（ ，七大片） 陈皮（半两） 白芷（半
两） 甘草（半两）
每服五钱，水二钟，煎八分，空心服，或作末，每服二钱，空心酒调下。
虚痛
肝血不足，悠悠痛不止者，四物汤加柴胡梢。（方见血证。）若胁下一点痛不止，此因酒色太过所致，
名干胁痛，难治。肥白人胁痛，参、 入小柴胡汤服。（方见疟疾。）
枳芎散（附方）
治左胁痛。
枳实（炒，五钱） 川芎（五钱） 粉草（炙，一钱半）
上为细末，每服二钱，姜、枣汤或酒调下。
术香调气散（附方）
治气怒伤于肝，两胁大痛难忍。
丁香（二两） 檀香（二两） 木香（二两） 白豆蔻仁（二两） 藿香叶（一两） 甘
草（一两） 砂仁（三两）
上末之，每服二钱，入盐少许，沸汤点服。
【歌诀】胁肋疼痛在总体上归属于肝脏，其病因可能是虚证、实证或因痰饮所致。若脉象沉而气机郁滞，必须采用疏导开郁的方法；若脉象芤或涩，则原因为干血（瘀血）阻滞。食积导致的疼痛常表现为胁下有条索状隆起且疼痛；肝虚引起的疼痛多位于胁肋边缘。如果疼痛剧烈且属于肝经火盛，那么治疗这种干胁痛就非常困难。
【论述】足厥阴肝经的络脉受邪，会导致胁痛，这都由肝胆二经所主管。朱丹溪说：木气过实、肝火旺盛、死血（瘀血）、痰饮、气机阻滞、食积、湿热等因素都会导致胁痛。也有因肝血亏虚、血液不足而引发疼痛的情况。有的因为饮酒、房事过度及劳累损伤太过，导致胁下某一点疼痛不止，称为“干胁痛”，病情非常危重，应当大补气血，但也难以治愈。这就是虚实不同的情况，必须将脉象与症状结合起来参详，才能了解致病的原因，从而用药没有差错。
谨按：左胁疼痛，是肝经受邪所致。右胁疼痛，是肝邪传入肺脏所致。左右两胁都疼痛，是肝火旺盛且木气过实所致。两胁疼痛游走不定且伴有声响的，是痰饮所致。左胁下有肿块，疼痛位置固定不移的，是瘀血所致。右胁下有肿块，疼痛且伴有饱胀闷感的，是食积所致。咳嗽气急，发热的，是痰结引起的疼痛，若久治不愈，则会形成肺痈。劳伤导致身体发热、胁痛的，脉象必然虚弱，应当详细探究。
【脉诊】两胁疼痛，脉象必定呈现双弦脉。脉象紧细而弦的，多由愤怒偏激引起。脉象沉涩而急促的，是痰浊和瘀血的过失（致病因素）。
肝火盛
肝痛剧烈的，是肝火太旺，使用当归龙荟丸。轻症的，用小柴胡汤加黄连、龙胆草、白芍药、醋炒青皮。（方剂见疟疾条下。）
火盛者宜清泻火热，使用佐金丸。
当归龙荟丸
组成：龙胆草（一两，去芦头）、当归（一两，酒洗）、山栀子仁（一两，炒黑）、黄连（一两，炒）、黄芩（一两，炒）、黄柏（一两，炒）、大黄（半两）、芦荟（半两）、木香（一钱半）、麝香（半钱）。
制法与服法：制成丸剂，用淡姜汤送服。
左金丸
主治：肝火太盛。
组成：黄连（六两）、吴茱萸（一两，开水泡过）。
制法与服法：制成丸剂，用白开水送服。
木气实
胁痛脉象弦数，属于木气过实，可用醋炒青皮、苍术、川芎、当归、芍药、柴胡，或小柴胡汤加醋炒青皮、川芎、龙胆草，（方剂见疟疾条下），或者使用抑青丸。
抑青丸
主治：肝火，清伐肝木。
组成：黄连（不限多少，用姜汁炒）。
制法与服法：制成丸剂，每次服用一百丸，用白开水送服。
死血痛（瘀血痛）
胁痛白天轻晚上重，或午后发热，脉象芤而涩，这是瘀血所致，使用四物汤加柴胡、青皮、桃仁、红花，在行气药中加入破血药。
食积痛
胁下一条杠状隆起并疼痛的，是食积所致，使用保和丸，（方剂见伤食条下），或者使用吴茱萸、炒黄连、神曲、麦芽、山楂、蓬术、青皮，或者当归龙荟丸。（方剂见前文肝火盛条下。）
湿热
湿热盛而导致两胁疼痛的，先用琥珀膏贴敷疼痛处，后用淡姜汤吞服当归龙荟丸，（方剂见前文肝火胁痛条下），或者小柴胡汤加苍术、青皮、黄连。（方剂见疟疾条下。）
痰积
痰积在胁下引起疼痛，使用控涎丹或十枣汤，或者二陈汤加天南星、苍术、川芎、柴胡、白芥子、炒山栀子仁、醋炒青皮。（方剂见痰证条内。）
控涎丹
主治：两胁痰痛。
组成：甘遂（面粉包裹，煨制）、大戟（炮制）、白芥子（炒，各等分）。
制法与服法：研为细末，制成如梧桐子大小的丸剂，每次五至七丸，逐渐增加至十丸，用姜汤送服。
十枣汤
主治：痰积引起的胁痛。
组成：甘遂（面粉包裹，煨制，一钱）、大戟（炮制，一钱）、芫花（一钱）。
制法与服法：大枣十枚，水两盏，煎至八分，服用。
气滞
气滞导致胁下疼痛，使用推气散或复元通气散、控涎丹，（方剂见前文痰积胁痛条下），治疗全身气痛。气郁者，详见郁证条内。
推气散
主治：右胁疼痛。
组成：枳壳（炒，五钱）、桂心（五钱）、片子姜黄（五钱）、甘草（五钱）。
制法与服法：研为细末，每次服用二钱，用姜枣汤调服。
复元通气散
组成：木香（半两）、茴香（半两）、青皮（半两）、穿山甲（炮制，七大片）、陈皮（半两）、白芷（半两）、甘草（半两）。
制法与服法：每次服用五钱，水两钟，煎至八分，空腹服用；或者研为细末，每次服用二钱，空腹时酒调服。
虚痛
肝血不足，隐隐作痛不止的，使用四物汤加柴胡梢。（方剂见血证条下。）如果胁下某一点疼痛不止，这是由于饮酒和房事过度所致，称为干胁痛，难以治疗。肥胖之人胁痛，用人参、[此处原文缺字，推测为茯苓或其他补气药，依原文保留]加入小柴胡汤服用。（方剂见疟疾条下。）
枳芎散（附方）
主治：左胁痛。
组成：枳实（炒，五钱）、川芎（五钱）、粉草（炙，一钱半）。
制法与服法：研为细末，每次服用二钱，用姜、枣汤或酒调服。
术香调气散（附方）
主治：因气怒伤肝，导致两胁剧烈疼痛难以忍受。
组成：丁香（二两）、檀香（二两）、木香（二两）、白豆蔻仁（二两）、藿香叶（一两）、甘草（一两）、砂仁（三两）。
制法与服法：研为细末，每次服用二钱，加入少许盐，用沸水冲服。
[Song Verse] Pain in the hypochondrium and ribs generally belongs to the Liver; it may be due to deficiency, excess, or phlegm. If the pulse is deep and qi is stagnant, guiding and unblocking methods are required; if the pulse is knotted (Kou) or choppy (Se), it is originally caused by dried blood (stasis). Food stagnation often presents with a raised ridge-like sensation and pain. Pain from Liver deficiency occurs at the edges of the hypochondrium. If the pain is severe due to Liver fire, treating this "dry hypochondriac pain" is extremely difficult.
[Discussion] The collaterals of the Foot Jueyin Liver meridian can cause hypochondriac pain, which is primarily governed by the Liver and Gallbladder meridians. Danxi stated: Excess Wood qi, excessive Liver fire, dried blood (stasis), phlegm-fluids, qi stagnation, food stagnation, and damp-heat all cause hypochondriac pain. There are also cases where pain arises from Liver blood deficiency and insufficiency. Some cases result from excessive drinking, sexual indulgence, and overwork, leading to persistent pain at a specific point under the hypochondrium, known as "dry hypochondriac pain." This is very critical; although one should tonify Qi and Blood significantly, it remains difficult to cure. These differences between deficiency and excess must be analyzed by correlating pulses and symptoms to understand the nature of the pathogenic factor and ensure accurate medication.
Note: Pain on the left side indicates pathogenic invasion of the Liver meridian. Pain on the right side indicates Liver pathogen entering the Lung. Pain on both sides indicates excessive Liver fire and excess Wood qi. Wandering pain in both hypochondria accompanied by sounds indicates phlegm-fluids. A fixed mass with immovable pain on the left side indicates dried blood (stasis). A mass with pain and fullness/stuffiness on the right side indicates food stagnation. Cough, shortness of breath, and fever indicate pain from phlegm accumulation; if untreated for a long time, it becomes Lung Abscess. Fatigue injury causing body heat and hypochondriac pain implies a deficient pulse, which requires careful investigation.
[Pulse Diagnosis] Hypochondriac pain typically presents with a double-wiry pulse. A tight, fine, and wiry pulse suggests anger bias. A deep, choppy, and rapid pulse indicates errors due to phlegm and stasis.
Excessive Liver Fire
Severe Liver pain indicates excessive Liver fire; use Danggui Longhui Wan. For mild cases, use Xiaochaihu Tang added with Huanglian, Longdancao, Baishao, and Cu Chao Qingpi. (Formula see Malaria section.)
For excessive fire, clear the fire using Zuojin Wan.
Danggui Longhui Wan
Composition: Dancao (Longdan Cao, Gentianae Radix, 1 liang, remove rhizome), Danggui (Angelicae Sinensis Radix, 1 liang, wine-washed), Shanzhizi Ren (Gardeniae Fructus, 1 liang, stir-fried until black), Huanglian (Coptidis Rhizoma, 1 liang, stir-fried), Huangqin (Scutellariae Radix, 1 liang, stir-fried), Huangbai (Phellodendri Cortex, 1 liang, stir-fried), Dahuang (Rhei Radix et Rhizoma, 0.5 liang), Lvhui (Aloe, 0.5 liang), Muxiang (Aucklandiae Radix, 1.5 qian), Shexiang (Moschus, 0.5 qian).
Preparation and Administration: Make into pills, take with light ginger soup.
Zuojin Wan
Indication: Excessive Liver fire.
Composition: Huanglian (Coptidis Rhizoma, 6 liang), Wuzhuyu (Evodiae Fructus, 1 liang, soaked in water).
Preparation and Administration: Make into pills, take with plain boiled water.
Excess Wood Qi
Hypochondriac pain with a wiry and rapid pulse indicates excess Wood qi. Use Cu Chao Qingpi, Cangzhu, Chuanxiong, Danggui, Shaoyao, Chaihu, or Xiaochaihu Tang added with Cu Chao Qingpi, Chuanxiong, and Dancao. (Formula see Malaria section), or Yiqing Wan.
Yiqing Wan
Indication: Liver fire, subduing Liver Wood.
Composition: Huanglian (Coptidis Rhizoma, any amount, stir-fried with ginger juice).
Preparation and Administration: Make into pills, take 100 pills each time with plain boiled water.
Stasis Pain (Dead Blood Pain)
Hypochondriac pain that is lighter during the day and heavier at night, or afternoon fever, with a Kou (knotted) and Se (choppy) pulse, indicates blood stasis. Use Siwu Tang added with Chaihu, Qingpi, Taoren, Honghua. Add blood-breaking herbs among qi-moving herbs.
Food Stagnation Pain
A raised ridge-like sensation with pain under the hypochondrium indicates food stagnation. Use Baohe Wan. (Formula see Food Injury section), or Wuzhuyu, Chao Huanglian, Shenqu, Maiya, Shanzha, Pengzhu, Qingpi, or Danggui Longhui Wan. (Formula see previous Liver Fire Excess section.)
Damp-Heat
When damp-heat is abundant causing bilateral hypochondriac pain, first apply Hupo Gao to the painful area, then swallow Danggui Longhui Wan with light ginger soup. (Formula see previous Liver Fire Hypochondriac Pain section), or Xiaochaihu Tang added with Cangzhu, Qingpi, Huanglian. (Formula see Malaria section.)
Phlegm Accumulation
Pain in the hypochondrium due to phlegm accumulation: use Kongxian Dan or Shizao Tang, or Erchen Tang added with Nanxing, Cangzhu, Chuanxiong, Chaihu, Baijiezi, Chao Shanzhiren, Cu Chao Qingpi. (Formula see Phlegm Syndrome section.)
Kongxian Dan
Indication: Phlegm pain in both hypochondria.
Composition: Gansui (wrapped in flour, roasted), Daji (processed), Baijiezi (Stemonae Semen, stir-fried, equal parts).
Preparation and Administration: Grind into powder, make pills the size of wu zi (catalpa seeds). Take 5-7 pills initially, gradually increasing to 10 pills, taken with ginger soup.
Shizao Tang
Indication: Hypochondriac pain due to phlegm accumulation.
Composition: Gansui (wrapped in flour, roasted, 1 qian), Daji (processed, 1 qian), Yuanhua (Genkwa Flos, 1 qian).
Preparation and Administration: Ten dates, two cups of water, decoct to eight-tenths volume, take orally.
Qi Stagnation
Pain in the hypochondrium due to qi stagnation: use Tuiqi San or Fuyuan Tongqi San, Kongxian Dan. (Formula see previous Phlegm Accumulation Hypochondriac Pain section), to treat whole-body qi pain. For qi depression, refer to the Depression Syndrome section.
Tuiqi San
Indication: Right hypochondriac pain.
Composition: Zhike (Aurantii Fructus, stir-fried, 5 qian), Guixin (Cinnamomi Cortex, 5 qian), Pianzi Jianghuang (Curcumae Radix, 5 qian), Gancao (Glycyrrhizae Radix et Rhizoma, 5 qian).
Preparation and Administration: Grind into fine powder, take 2 qian each time, mixed with ginger and date soup.
Fuyuan Tongqi San
Composition: Muxiang (Aucklandiae Radix, 0.5 liang), Huixiang (Foeniculi Fructus, 0.5 liang), Qingpi (Citri Reticulatae Pericarpium Viride, 0.5 liang), Chuanshanjia (Manis Squama, processed, seven large slices), Chenpi (Citri Reticulatae Pericarpium, 0.5 liang), Baizhi (Angelicae Dahuricae Radix, 0.5 liang), Gancao (Glycyrrhizae Radix et Rhizoma, 0.5 liang).
Preparation and Administration: Take 5 qian each time, two cups of water, decoct to eight-tenths volume, take on an empty stomach; or grind into powder, take 2 qian each time, mixed with wine on an empty stomach.
Deficiency Pain
Insufficient Liver blood causing lingering pain: use Siwu Tang added with Chaihu Shao. (Formula see Blood Syndrome section). If pain persists at a single point under the hypochondrium, it is caused by excessive drinking and sexual indulgence, named "dry hypochondriac pain," which is difficult to treat. For hypochondriac pain in obese individuals, add Renshen [and other ingredients] to Xiaochaihu Tang. (Formula see Malaria section.)
Zhixiong San (Attached Formula)
Indication: Left hypochondriac pain.
Composition: Zhishi (Aurantii Fructus, stir-fried, 5 qian), Chuanxiong (Ligustici Chuanxiong Rhizoma, 5 qian), Fengcao (Glycyrrhizae Radix et Rhizoma, roasted, 1.5 qian).
Preparation and Administration: Grind into fine powder, take 2 qian each time, mixed with ginger and date soup or wine.
Shuxiang Tiaoqi San (Attached Formula)
Indication: Liver injury due to anger, causing unbearable severe pain in both hypochondria.
Composition: Dingxiang (Caryophylli Flos, 2 liang), Tanxiang (Santalum Album Lignum, 2 liang), Muxiang (Aucklandiae Radix, 2 liang), Baidoukou Ren (Cardamomi Fructus, 2 liang), Huoxiangye (Agastachis Herba, 1 liang), Gancao (Glycyrrhizae Radix et Rhizoma, 1 liang), Sharen (Amomi Fructus, 3 liang).
Preparation and Administration: Grind into powder, take 2 qian each time, add a little salt, and take with boiling water.