【内伤胃脘痛之症】不因外感六淫，偶或伤于饮食，填塞太仓，胸前闷痛，此食积症
也。
痛则多汗，此积热症也。二便清利，手足逆冷，口吐涎沫得寒饮则甚，此积冷症也。遇气
即发，或攻注作痛，或凝结作胀，此气滞症也。日轻夜重，或唧唧作声，得寒则痛，得热暂
缓，此死血痛也。呕吐清水，面上白斑，唇红能食，时或吐蛔，此虫积症也。故云内伤之痛有七。
【内伤胃脘痛之因】饮食不节，伤其胃口，太阴升降之令，凝结壅闭，则食积之痛作
脾胃素弱，日饮水谷，不能消受，停积中脘，则成痰饮而痛；七情六欲之火，时动于中，膏
粱炙爆之热，日积于内，热久成燥，积热之痛作矣。胃阳不足，冷冻饮料内伤，阴寒凝结，
阴积冷之痛，作矣。怒则气上，思则气结，忧思日积，气不宜行，则气滞而成痛。血分素热
又喜辛辣之物，以伤其阴血，则停积于中，而成死血之痛。湿土主生生之令，饮食不谨，湿
热内生，则虫积而成痛矣。
【内伤胃脘痛之脉】沉实有食，沉滑多痰，数大为热，迟缓主寒，气滞脉沉，死血涩
【内伤胃脘痛之治】宜平胃散出入主治。若食积痛，用三棱丸治之。痰饮痛者，二陈
汤、
丸。气滞而痛者，苏子降气汤。死血作痛，红花桃仁汤。有下症，桃仁承气汤。虫积痛，
平胃散
苍术 浓朴 陈皮 甘草
三棱丸
京三棱 枳壳 浓朴 广皮 甘草
二陈汤
导痰汤 二方见痰症。
清胃汤 见齿痛。
神芎汤
大黄 黄芩 黑牵牛 滑石 薄荷 川芎
豆蔻丸
草豆蔻 吴茱萸 益智仁 青皮 姜黄 麦芽 神曲 半夏 甘草
苏子降气汤
紫苏子 半夏 前胡 浓朴 甘草 陈皮 沉香 当归
红花桃仁汤
红花 桃仁 当归尾 赤芍药 泽兰叶 楂肉 丹皮 山栀
桃仁承气汤
桃仁 大黄 甘草 桂枝 芒硝 枳壳 归尾
万应丸
麦芽 神曲 雷丸 陈皮 甘草 京三棱 莪术 槟榔 芜荑 鹤虱 使君子
家秘保和散
苍术 浓朴 半夏 广皮 枳壳 鲜麦芽 楂肉 香附 槟榔 干葛 莱菔子
共为细末，多冲萝卜汁、竹沥，拌湿晒干，研细末。白汤调服。
家秘消坚散
三棱 莪术 槟榔 枳实 香附 海石
治上部癖积，加苍术、浓朴；治下部癖积，加青皮、枳壳。
栀连二陈汤加竹茹、干葛 治呕吐作痛。
滚痰丸 治痰癖作痛。
胃痛，要分别常痛、不常痛二条；又要细详若何痛重，若何痛缓。若饮食即痛，时常气
嗳，此伤饮食也，用家秘保和散。若痛而呕恶，吐出痰涎稍减，此痰饮痛也，平胃导痰汤。
胃脘有块，常痛不休，癖积痛也，家秘消坚散。时作时止，痛而汗出者，火也。热而无滞者
，清火为急，清胃汤；热而有滞者，消滞为先，栀连保和散。遇夜痛甚，逢冷即痛，按之有
形，或饮食入胃，从半边而下，此瘀血痛也，先用三棱丸，后用桃仁承气汤。痛而能食，得
食痛减，常下虫积者，平胃散加使君子。胃中有形，按之痛极，每夜发热者，此胃痈痛也，
凡见痛症，须防发毒，无论胸胁腰背，皆要按其痛处，若按之愈痛，每夜发热，要防内
【内伤胃脘痛的症状】并非由外感六淫（风、寒、暑、湿、燥、火六种外邪）引起，偶尔因饮食不当，导致食物停滞在胃中（太仓指胃），胸前感到闷痛，这是食积证。
疼痛时伴有大量出汗，这是积热证。大小便清利通畅，手足逆冷，口吐涎沫，喝冷饮后症状加重，这是积冷证。遇到情绪波动即发作，或攻冲注作痛，或凝结导致胀满，这是气滞证。白天轻晚上重，或口中发出唧唧声，遇冷则痛，遇热暂时缓解，这是死血（瘀血）痛。呕吐清水，面部出现白斑，嘴唇红且能进食，有时吐出蛔虫，这是虫积证。所以说内伤引起的胃痛有这七种情况。
【内伤胃脘痛的病因】饮食不节制，损伤胃口，导致太阴脾肺升降功能失常，凝结壅闭，于是产生食积之痛；脾胃素来虚弱，每日摄入水谷，无法消化承受，停积在中脘，从而形成痰饮而致痛；七情六欲之火，时常动于体内，膏粱厚味及炙烤爆炒食物的热气，日积月累于内，热久化燥，积热之痛就产生了。胃阳不足，冷冻饮料内伤，阴寒凝结，阴积冷之痛就产生了。愤怒则气上逆，思虑则气结聚，忧思日积，气机不宜运行，于是气滞而成痛。血分素来有热又喜好辛辣之物，以损伤其阴血，于是停积于中，形成死血之痛。湿土主生生之令，饮食不谨慎，湿热内生，于是虫积而成痛。
【内伤胃脘痛的脉象】脉沉实表示有食积，脉沉滑表示多痰，脉数大表示有热，脉迟缓表示有寒，气滞脉象沉，死血脉象涩。
【内伤胃脘痛的治疗】宜用平胃散加减主治。若是食积痛，用三棱丸治疗。痰饮痛者，用二陈汤、丸。气滞而痛者，用苏子降气汤。死血作痛，用红花桃仁汤。有下焦实证，用桃仁承气汤。虫积痛，用平胃散。
平胃散：苍术、浓朴、陈皮、甘草。
三棱丸：京三棱、枳壳、浓朴、广皮、甘草。
二陈汤、导痰汤：二方见痰症章节。
清胃汤：见齿痛章节。
神芎汤：大黄、黄芩、黑牵牛、滑石、薄荷、川芎。
豆蔻丸：草豆蔻、吴茱萸、益智仁、青皮、姜黄、麦芽、神曲、半夏、甘草。
苏子降气汤：紫苏子、半夏、前胡、浓朴、甘草、陈皮、沉香、当归。
红花桃仁汤：红花、桃仁、当归尾、赤芍药、泽兰叶、楂肉、丹皮、山栀。
桃仁承气汤：桃仁、大黄、甘草、桂枝、芒硝、枳壳、归尾。
万应丸：麦芽、神曲、雷丸、陈皮、甘草、京三棱、莪术、槟榔、芜荑、鹤虱、使君子。
家秘保和散：苍术、浓朴、半夏、广皮、枳壳、鲜麦芽、楂肉、香附、槟榔、干葛、莱菔子。共为细末，多冲萝卜汁、竹沥，拌湿晒干，研细末。白开水调服。
家秘消坚散：三棱、莪术、槟榔、枳实、香附、海石。治上部癖积，加苍术、浓朴；治下部癖积，加青皮、枳壳。
栀连二陈汤加竹茹、干葛：治呕吐作痛。
滚痰丸：治痰癖作痛。
胃痛，要分别常痛、不常痛两条；又要详细详察若何痛重，若何痛缓。若饮食后即痛，时常嗳气，这是伤饮食，用家秘保和散。若痛而呕恶，吐出痰涎后稍减，这是痰饮痛，用平胃导痰汤。胃脘有块，常痛不休，是癖积痛，用家秘消坚散。时作时止，痛而汗出者，是火。热而无滞者，清火为急，用清胃汤；热而有滞者，消滞为先，用栀连保和散。遇夜痛甚，逢冷即痛，按之有形，或饮食入胃，从半边而下，这是瘀血痛，先用三棱丸，后用桃仁承气汤。痛而能食，得食痛减，常下虫积者，用平胃散加使君子。胃中有形，按之痛极，每夜发热者，这是胃痈痛也。凡见痛症，须防发毒，无论胸胁腰背，皆要按其痛处，若按之愈痛，每夜发热，要防内……
[Symptoms of Internal Injury Epigastric Pain] Not caused by external contraction of the Six Evils (Wind, Cold, Summerheat, Dampness, Dryness, Fire), but occasionally due to dietary injury, causing food to block the Tai Cang (Stomach), with stuffiness and pain in the chest. This is a Food Stagnation pattern.
Pain accompanied by profuse sweating indicates Heat Accumulation. Clear and free urination and defecation, cold extremities, spitting of saliva, and worsening after drinking cold beverages indicate Cold Accumulation. Onset triggered by emotional fluctuations, or pain radiating and attacking, or凝 condensation causing distension, indicates Qi Stagnation. Lighter during the day and heavier at night, or making chirping sounds, pain worsened by cold and temporarily relieved by heat, indicates Dead Blood (Blood Stasis) pain. Vomiting clear water, white spots on the face, red lips with ability to eat, and occasional expulsion of roundworms indicate Parasite Accumulation. Thus it is said that internal injury pain has seven types.
[Etiology of Internal Injury Epigastric Pain] Irregular diet damages the stomach opening, disrupting the ascending and descending functions of the Taiyin (Spleen and Lung), leading to condensation and obstruction, resulting in Food Stagnation pain; if the Spleen and Stomach are inherently weak, daily intake of food and water cannot be digested and absorbed, stagnating in the Zhongwan region, forming Phlegm-Fluid and causing pain; the fire of the Seven Emotions and Six Desires often stirs internally, and the heat from rich foods and fried/grilled items accumulates inside day by day, turning into dryness over time, resulting in Heat Accumulation pain. Insufficient Stomach Yang, internal injury from frozen/cold drinks, leads to Yin-Cold condensation, resulting in Yin Cold Accumulation pain. Anger causes Qi to rise, excessive thinking causes Qi to knot; accumulated worry and thought hinder Qi movement, leading to Qi Stagnation and pain. If the Blood level is inherently hot and one prefers spicy foods, damaging Yin-Blood, stagnation occurs in the middle, forming Dead Blood pain. The Earth element governs the generative function; careless diet generates internal Damp-Heat, leading to Parasite Accumulation pain.
[Pulse Patterns of Internal Injury Epigastric Pain] A deep and forceful pulse indicates Food Stagnation; a deep and slippery pulse indicates much Phlegm; a rapid and large pulse indicates Heat; a slow and delayed pulse indicates Cold; Qi Stagnation presents with a deep pulse; Dead Blood presents with a choppy pulse.
[Treatment of Internal Injury Epigastric Pain] Pingwei San (Calm the Stomach Powder) should be used as a base formula with modifications. For Food Stagnation pain, Sanleng Wan (Burreed Bulb Pill) is used. For Phlegm-Fluid pain, Erchen Tang (Two-Aged Decoction) or its pill form is used. For Qi Stagnation pain, Suzi Jiangqi Tang (Perilla Seed Descending Qi Decoction) is used. For Dead Blood pain, Honghua Taoren Tang (Safflower and Peach Kernel Decoction) is used. If there are excess signs requiring purgation, Tao Ren Cheng Qi Tang (Peach Kernel Order the Qi Decoction) is used. For Parasite Accumulation pain, Pingwei San is used.
Pingwei San: Cangzhu (Atractylodis Rhizoma), Nongpu (Magnoliae Officinalis Cortex), Chenpi (Citri Reticulatae Pericarpium), Gancao (Glycyrrhizae Radix et Rhizoma).
Sanleng Wan: Jingsanleng (Sparganii Rhizoma), Zhike (Aurantii Fructus), Nongpu (Magnoliae Officinalis Cortex), Guangpi (Citri Reticulatae Pericarpium), Gancao (Glycyrrhizae Radix et Rhizoma).
Erchen Tang (Two-Aged Decoction) and Daotan Tang (Phlegm-Resolving Decoction): See Phlegm Symptoms section.
Qingwei Tang (Clear the Stomach Decoction): See Toothache section.
Shenxiong Tang: Dahuang (Rhei Radix et Rhizoma), Huangqin (Scutellariae Radix), Heiqian Niu (Pharbitidis Semen), Huashi (Talcum), Bohe (Menthae Haplocalycis Herba), Chuanxiong (Ligustici Chuanxiong Rhizoma).
Doukou Wan: Caodoukou (Alpiniae Katsumadai Semen), Wuzhuyu (Evodiae Fructus), Yizhiren (Alpiniae Oxyphyllae Semen), Qingpi (Citri Reticulatae Pericarpium Viride), Jianghuang (Curcumae Longae Rhizoma), Maiya (Hordei Fructus Germinatus), Shenqu (Massa Medicata Fermentata), Banxia (Pinelliae Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma).
Suzi Jiangqi Tang: Zisu Zi (Perillae Fructus), Banxia (Pinelliae Rhizoma), Qianhu (Peucedani Radix), Nongpu (Magnoliae Officinalis Cortex), Gancao (Glycyrrhizae Radix et Rhizoma), Chenpi (Citri Reticulatae Pericarpium), Chenxiang (Aquilariae Lignum Resinatum), Danggui (Angelicae Sinensis Radix).
Honghua Taoren Tang: Honghua (Carthami Flos), Taoren (Persicae Semen), Danggui Wei (Angelicae Sinensis Radix Caudex), Chi Shaoyao (Paeoniae Radix Rubra), Zelan Ye (Leonuri Herba), Zharon (Crataegi Fructus), Danpi (Moutan Cortex), Shanzhi (Gardeniae Fructus).
Tao Ren Cheng Qi Tang: Taoren (Persicae Semen), Dahuang (Rhei Radix et Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma), Guizhi (Cinnamomi Ramulus), Mangxiao (Natrii Sulfas), Zhike (Aurantii Fructus), Guiwei (Angelicae Sinensis Radix Caudex).
Wanying Wan: Maiya (Hordei Fructus Germinatus), Shenqu (Massa Medicata Fermentata), Leiwan (Oxyuris Vermiformis), Chenpi (Citri Reticulatae Pericarpium), Gancao (Glycyrrhizae Radix et Rhizoma), Jingsanleng (Sparganii Rhizoma), Ezhu (Curcumae Rhizoma), Binglang (Arecae Semen), Wuyi (Meliosmae Fructus), Heshi (Chrysanthemi Indici Flos), Shijunzi (Quisqualis Fructus).
Jiami Baohe San: Cangzhu (Atractylodis Rhizoma), Nongpu (Magnoliae Officinalis Cortex), Banxia (Pinelliae Rhizoma), Guangpi (Citri Reticulatae Pericarpium), Zhike (Aurantii Fructus), Xian Maiya (Fresh Hordei Fructus Germinatus), Zharon (Crataegi Fructus), Xiangfu (Cyperi Rhizoma), Binglang (Arecae Semen), Gange (Puerariae Radix), Laifuzi (Raphani Semen). Grind into fine powder, mix well with radish juice and bamboo sap, moisten, dry, and grind into fine powder. Take with warm water.
Jiami Xiaojian San: Sanleng (Sparganii Rhizoma), Ezhu (Curcumae Rhizoma), Binglang (Arecae Semen), Zhishi (Aurantii Fructus Immaturus), Xiangfu (Cyperi Rhizoma), Haishi (Aragonitum). For upper Jiao Pi Ji (accumulations), add Cangzhu (Atractylodis Rhizoma) and Nongpu (Magnoliae Officinalis Cortex); for lower Jiao Pi Ji, add Qingpi (Citri Reticulatae Pericarpium Viride) and Zhike (Aurantii Fructus).
Zhilian Erchen Tang plus Zhuru (Bambusae Caulis in Taenia) and Gange (Puerariae Radix): Treats vomiting with pain.
Guntan Wan: Treats Phlegm-Pi Ji pain.
Epigastric pain must be distinguished into frequent and infrequent pain; one must also carefully examine whether the pain is severe or mild. If pain occurs immediately after eating and is accompanied by frequent belching, it is Dietary Injury; use Jiami Baohe San. If pain is accompanied by nausea and vomiting, and relief follows the expulsion of phlegm-saliva, it is Phlegm-Fluid pain; use Pingwei Daotan Tang. If there is a mass in the epigastrium with constant unceasing pain, it is Pi Ji pain; use Jiami Xiaojian San. If pain comes and goes, accompanied by sweating, it is Fire. If there is heat without stagnation, clearing heat is urgent; use Qingwei Tang. If there is heat with stagnation, resolving stagnation takes precedence; use Zhilian Baohe San. If pain is severe at night and triggered by cold, with palpable masses, or if food entering the stomach flows down only one side, it is Blood Stasis pain; first use Sanleng Wan, then Tao Ren Cheng Qi Tang. If pain allows eating and is relieved by food, with frequent passage of worms, use Pingwei San plus Shijunzi (Quisqualis Fructus). If there is a palpable mass in the stomach, extreme tenderness upon pressure, and nightly fever, this is Stomach Abscess pain. Whenever seeing pain symptoms, one must guard against the development of toxic sores; regardless of location in the chest, hypochondrium, waist, or back, press the painful area. If pressing increases pain and there is nightly fever, one must guard against internal...