凡腹痛因食者，或因滞物，或因冷物，皆能停积中脘，须用前治食法加减治之，此正法也
，然又有食停小腹者。余尝治一上舍，年及三旬，因午刻食水煮面角，将至初更，食及小腹
，下至右角间，遂停积不行，而坚突如拳，大如鹅卵，其痛之剧，莫可名状。余为治之，察
其明系面积，显而无疑，然计其已入大肠，此正通则不痛之证也，乃与木香槟榔丸，连下
二三次，其痛如故。因疑药力之缓，犹未及病，乃更投神佑丸以泻之，又不效。余谓此必药
性皆寒，故滞有不行也，因再投备急丸，虽连得大泻，而坚痛毫不为减。斯时也，余计穷矣
。因潜测其由，不过因面，岂无所以制之？今既逐之不及，使非借气以行之不可也。且计面
毒非大蒜不杀，气滞非木香不行，又其滞深道远，非精锐之响导不能达，乃用火酒磨木香，
令其嚼生蒜一瓣，而以香酒送之。一服后，觉痛稍减，三四服后，痛渐止而食渐进，方得全
愈。然虽痛止食进，而小腹之块仍在，后至半年许始得消尽。由是知欲消食滞，即大黄、巴
豆犹有所不能及，而推宜行气为先也。且知饮食下行之道，乃必由小腹下右角间，而后出于
广肠，此自古无人言及者，故并笔之，用以广人之闻见。
向予荆人，年及四旬，于八月终初寒之时，偶因豪雨后中阴寒沙毒之气，忽于二鼓时，
上为呕恶，下为胸腹搅痛，势不可当。时值暮夜，药饵不及，因以盐汤探吐之，痛不为减，
遂连吐数次，其气愈升，则其痛愈剧，因而上塞喉嗌，甚至声不能出，水药毫不可入，危在
顷刻间矣。余忽忆先年曾得秘传括痧法，乃择一光滑细口瓷碗，别用热汤一钟，入香油一二
匙，却将碗口蘸油汤内，令其暖而且滑，乃两手覆执其碗，于病者背心轻轻向下刮之，以渐
加重，碗干而寒，则再浸再刮，良久，觉胸中胀滞渐有下行之意，稍见宽舒，始能出声。顷
之，忽腹中大响，遂大泻如倾，其痛遂减，幸而得活。泻后得睡，一饭顷，复通身瘙痒之极
，随发出疙瘩风饼如钱大者，不计其数，至四鼓而退。愈后细穷其义，盖以五脏之系，咸附
于背，故向下刮之，邪气亦随而降。凡毒瓦斯上行则逆，下行则顺，改逆为顺，所以得愈。虽
近有两臂刮痢之法亦能治痛，然毒深病急者，非治背不可也。至若风饼疙瘩之由，正以寒毒
之气充塞表里，经脏俱闭，故致危剧，今其脏毒既解，然后经气得行，而表里俱散也。可见
寒邪外感之毒，凡脏气未调，则表亦不解，表邪未散，则脏必不和，此其表里相关，义自如
此，故治分缓急，权衡在人矣。继后数日，一魏姓者，亦于二鼓忽患此证，治不得法，竟至
五鼓痛极而毙。遇与不遇，此其所以为命也。
凡是腹痛由饮食停滞引起的，无论是因积滞之物还是冷物所致，都能停聚在中脘部位，必须使用前面讲述的治疗食积的方法进行加减治疗，这是常规的正治法。然而，又有食物停滞在小腹的情况。我曾经治疗一位上舍（古代官职名），年龄三十岁左右，因为中午吃了水煮的面角，到了初更时分，食物下行至小腹，向下到达右侧角落之间，于是停滞积聚无法通行，坚硬突起像拳头一样大，如同鹅卵，疼痛剧烈，难以用言语形容。我为他诊治，观察其明显是面积（面食积滞）所致，显然无疑，但考虑到食物已经进入大肠，这正是“通则不痛”的证候，于是给予木香槟榔丸，连续服用二三次后，疼痛依旧如故。我怀疑药力太缓，还没有达到病灶，于是改用神佑丸来泻下，仍然无效。我认为这一定是药物性质都偏寒凉，所以导致积滞不能运行，于是再次投用备急丸，虽然接连引起大量腹泻，但坚硬的疼痛丝毫未减。在这个时候，我已经计策穷尽。于是暗中推测病因，不过是面食引起的，难道没有可以克制它的方法吗？现在既然攻逐不及，如果不借助气机来推动它，是不行的。况且面毒非大蒜不能杀灭，气滞非木香不能行散，而且积滞位置深、路途远，非精锐的药物引导不能到达，于是用火酒磨木香，让他嚼服一瓣生蒜，并用香酒送服。服用一次后，感觉疼痛稍减，服用三四次后，疼痛逐渐停止，食欲逐渐恢复，这才完全痊愈。然而虽然疼痛停止、食欲恢复，但小腹的肿块仍然存在，直到半年左右才完全消散。由此可知，想要消除食滞，即使是使用大黄、巴豆这样猛烈的药物有时也达不到效果，而推究起来，适宜以行气为首要任务。并且得知饮食下行的道路，必定是由小腹下右角间，然后出于广肠（直肠），这是自古以来没有人提及过的，所以一并记录下来，用来开阔人们的见闻。
以前我的同乡人，年龄四十岁，在八月末初寒的时候，偶然因为大雨之后受到阴寒沙毒之气的侵袭，忽然在二鼓时分，向上出现呕吐恶心，向下出现胸腹部搅动疼痛，势头不可抵挡。当时正值夜晚，药物来不及准备，于是用盐汤探吐，疼痛没有减轻，于是连续呕吐数次，气机更加上逆，则疼痛更加剧烈，以至于向上堵塞咽喉，甚至声音发不出，水和药物完全无法进入，危险就在顷刻之间。我突然想起早年曾得到秘传的括痧法，于是选择一个光滑细口的瓷碗，另外用热汤一杯，加入香油一二匙，然后将碗口蘸入油汤内，使其温暖且滑润，于是双手握住碗，在病人背部轻轻向下刮拭，逐渐加重力度，碗变干变冷时，就再浸泡再刮拭，过了很久，感觉胸中的胀滞逐渐有下行的趋势，稍微感到宽舒，才能发出声音。过了一会儿，忽然腹部大声响，于是大量腹泻如水倾泻，疼痛随即减轻，幸好得以存活。腹泻后入睡，大约一顿饭的时间，全身又极度瘙痒，随后发出像铜钱大小的疙瘩风疹，不计其数，到四鼓时分消退。痊愈后仔细探究其中的道理，大概是因为五脏的联系系附于背部，所以向下刮拭，邪气也随之下降。凡是毒瓦斯上行则逆乱，下行则顺遂，改变逆乱为顺遂，所以能够痊愈。虽然近来有刮拭两臂治疗痢疾的方法也能止痛，但对于毒深病急的情况，不治疗背部是不行的。至于风疹疙瘩的产生原因，正是因为寒毒之气充塞表里，经络脏腑全部闭塞，所以导致病情危重，现在脏毒既然解除，然后经气得以运行，表里之气都发散出去。可见外感寒邪之毒，凡是脏气没有调和，则体表也不解；表邪没有散除，则脏腑必然不和，这就是表里相关的道理，所以治疗分为缓急，权衡在于医者。后来几天，有一位姓魏的人，也在二鼓时分忽然患上此证，治疗不得法，竟然在五鼓时分因疼痛极度而死亡。遇到好医生与遇不到，这就是所谓的命运了。
Whenever abdominal pain is caused by food stagnation, whether due to stagnant matter or cold substances, all can accumulate in the Zhongwan (Middle Jiao/Epigastrium) area. It is necessary to use the previously mentioned methods for treating food stagnation with modifications; this is the standard orthodox treatment. However, there are cases where food stops in the lower abdomen. I once treated a Shanshe (an official title), who was around thirty years old. Because he ate boiled dough dumplings at noon, by the time of Chugeng (early evening), the food had moved down to the lower abdomen, specifically stopping between the right corner and below. It accumulated and could not move, becoming hard and protruding like a fist, as large as a goose egg. The pain was severe and indescribable. Upon examination, it was clearly evident that this was caused by wheat flour accumulation (mianji). Considering the food had entered the Large Intestine, this presented a pattern of "obstruction causing pain" (tong ze bu tong - though here implying obstruction needs clearing). Therefore, I administered Muxiang Binglang Wan (Pinellia and Areca Pill). After taking it two or three times consecutively, the pain remained unchanged. Suspecting the medication's action was too slow and had not yet reached the disease site, I switched to Shenyou Wan (Divine Protection Pill) to purge, but it was also ineffective. I reasoned that since the properties of these medicines were likely cold, they failed to resolve the stagnation. Consequently, I administered Beiji Wan (Emergency Aid Pill). Although it induced significant diarrhea, the hardness and pain did not diminish at all. At this point, my strategies were exhausted. I secretly analyzed the cause: it was merely due to wheat flour. Was there no way to counteract it? Since direct purgation had failed, unless we utilized Qi movement to propel it, success would be impossible. Moreover, garlic is needed to neutralize wheat toxicity, and Muxiang (Aucklandiae Radix) is needed to move Qi stagnation. Given the deep location and long distance of the stagnation, only a potent guide drug could reach it. Thus, I prepared Muxiang ground in Huojiu (Fire Wine), instructed him to chew one clove of raw garlic, and washed it down with the fragrant wine mixture. After one dose, the pain slightly decreased. After three or four doses, the pain gradually ceased, appetite returned, and full recovery was achieved. However, although the pain stopped and appetite improved, the mass in the lower abdomen persisted until it completely dissipated after about half a year. From this, we learn that even powerful drugs like Dahuang (Rhei Radix et Rhizoma) and Badou (Crotonis Fructus) may fail to eliminate food stagnation; thus, promoting Qi movement should be prioritized. Furthermore, this case reveals that the pathway for dietary descent must pass through the lower right corner of the lower abdomen before exiting via the Changchang (Large Intestine/Rectum). This anatomical insight has never been mentioned before, so I record it here to broaden knowledge.
Previously, a fellow townsman of mine, aged forty, was affected by Yin-cold and sandy toxic qi following heavy rains at the end of August when the weather turned cold. Suddenly, during Ergu (late night), he experienced vomiting and nausea upwards, and twisting abdominal pain downwards, with an unstoppable momentum. As it was night and medicine was unavailable, I used salt water to induce vomiting. The pain did not subside; instead, repeated vomiting caused the Qi to rise further, exacerbating the pain until it blocked the throat, rendering him unable to speak or swallow water or medicine. He was in critical condition, facing imminent death. I suddenly recalled a secret method of Kuosha (Scraping Therapy) I had learned years ago. I selected a smooth, narrow-mouthed porcelain bowl, poured a cup of hot water, added one or two spoons of sesame oil, dipped the rim of the bowl into the warm oily water to make it slippery, and held the bowl with both hands. I gently scraped downwards along the patient's back, gradually increasing pressure. When the bowl became dry and cold, I re-dipped and continued scraping. After a while, he felt the chest distension and stagnation beginning to descend, feeling somewhat relieved, and was able to produce sounds. Soon after, loud rumbling occurred in the abdomen, followed by profuse watery diarrhea, and the pain subsided. He fortunately survived. After sleeping post-diarrhea, roughly the time it takes to eat one meal, his entire body became extremely itchy, and numerous wheals resembling coins erupted, which receded by Sigeng (midnight). Upon careful reflection after recovery, the principle is that the connections of the Five Zang Organs attach to the back; thus, downward scraping causes the pathogenic factors to descend. Generally, if toxic vapors ascend, they become rebellious; if they descend, they become compliant. Changing rebellion to compliance leads to healing. Although there is a recent method of scraping the arms to treat dysentery and relieve pain, for cases with deep toxicity and acute illness, treating the back is essential. Regarding the origin of the wheals, it is precisely because cold-toxic qi filled the exterior and interior, closing the meridians and organs, leading to critical severity. Now that the organ toxicity was resolved, the Meridian Qi could flow, dispersing both exterior and interior pathogens. This demonstrates that for external cold-toxic invasion, if the Zang Qi is unharmonized, the exterior will not release; if exterior pathogens are not scattered, the Zang organs will inevitably be disharmonious. This illustrates the interrelationship between exterior and interior. Treatment priorities depend on the urgency, relying on the physician's judgment. A few days later, a man surnamed Wei suffered from this same condition at Ergu. Due to improper treatment, he died from extreme pain by Wugu (early morning). Whether one encounters effective treatment or not determines fate.