论腹痛三症
天师曰∶堕治者，不能下降，用药以堕之也。如腹中痛，手按痛甚，或胸中伤食，手不可按者，皆
宜堕之也。方用白术二钱，枳壳三钱，白芍三钱，甘草一钱，山楂二十粒，麦芽三钱，浓朴一钱，水煎
服，（〔批〕速腐汤。）论理，胸中既然伤食，但用麦芽、浓朴、山楂、枳壳消之足矣，何以又加白术
与白芍？盖伤食而食不能化，所以结在心胸，以致作痛，若徒消食而不健脾胃之气，则土亏而物难
速腐。故必用白术以健其胃口之气，以生其脾内之阴，则土气有余，何难消食。然而心胸饱闷，则肝经
乘我之困，来侵脾胃之土，又加白芍以平肝木，则木弱而脾胃之土自安，自可顺还以化糟粕矣。此堕治
之妙法也。至于邪气挟食，存于大肠，大肠之内火气炎蒸，夹食作祟，故痛而不可手按。是食已离脾胃，
可攻之直下。方用大黄三钱，芒硝一钱，浓朴一钱，柴胡一钱，黄芩一钱、甘草一钱治之。此即大承气汤
也。此方之妙，全在用大黄、芒硝二味。盖大黄性凉而散，又善走而不守；芒硝性更紧于大黄，但其味实
热，佐之黄芩，则相济有功；尤妙仍用柴胡，以舒其肝经之邪气；又佐以浓朴之祛荡；若邪甚者，或再加
枳实，尤易成功。此堕之又一法也。
张公曰∶不可思议之论，予何言耶。必欲予言，又有一症相商。有人成痞块之症，一时发作，而腹痛
亦不可手按者，亦可用下堕之法，盖乘其邪动而堕之也。方用枳实一两，白术二两，马粪炒焦五钱，酒煎
服。盖马粪最能安痛，又不伤气，且又能逐邪而化物，药箱中最宜先备而不用也，盖仓猝间不可即得。此
物愈久愈妙。不必多用至五钱，即一二钱用之，无不奇妙，今况用之五钱乎；况又与枳实同用，则积块自
消。然而徒消其积，未免恐伤脾阴，又佐以白术二两，大健其脾气，则马粪与枳实，可以施其祛荡之功。
此又堕治之妙法也。
华君曰∶亦未传。
雷公曰∶我尚有堕治之方。如人腹痛手不可按，方用枳实一钱，大黄二钱，生甘草一钱，白芍五钱，乳
香末一钱，水煎服。此方之妙，用攻于和解之中。不十分攻邪，而邪自
退舍。此堕治之最善者也。（〔批〕天师云∶此方妙极，可师之。）
陈士铎说：堕治法，是指病邪不能自然下行，用药促使病邪下行的治疗方法。例如腹部疼痛，用手按压时疼痛加剧，或者胸中因饮食停滞不适，手不可触碰的，都适宜用堕治法。方剂使用白术二钱，枳壳三钱，白芍三钱，甘草一钱，山楂二十粒，麦芽三钱，厚朴一钱，加水煎煮后服用。（批注：速腐汤。）按理说，胸中既然有饮食停滞，只用麦芽、厚朴、山楂、枳壳来消食导滞就足够了，为什么还要加入白术和白芍呢？这是因为饮食停滞导致食物无法消化，所以结聚在心胸部位，从而引起疼痛。如果仅仅消除积食而不健运脾胃之气，那么脾气虚弱而食物难以快速腐熟消化。因此必须用白术来健旺胃气，以滋生脾阴，这样土气（脾胃之气）充足，消除积食又有何难处。然而心胸饱闷时，肝经会乘虚侵袭我之困顿，侵犯脾胃之土，又加入白芍来平抑肝木，这样肝木减弱，脾胃之土自然安宁，就可以顺利转化糟粕了。这是堕治法的精妙之处。至于邪气挟带积食，存留于大肠，大肠内火气炎蒸，夹带积食作祟，所以疼痛且不可用手按压。此时食物已经离开脾胃，可以直接攻下使其下行。方剂使用大黄三钱，芒硝一钱，厚朴一钱，柴胡一钱，黄芩一钱，甘草一钱来治疗。这就是大承气汤。此方的精妙之处，全在于使用大黄、芒硝两味药。因为大黄性凉而散，又善于走窜而不固守；芒硝的性质比大黄更峻急，但其味实热，佐以黄芩，则相互补益有功；尤其妙在仍用柴胡，来疏解肝经的邪气；又佐以厚朴来祛荡积滞；如果邪气严重的，或许再加枳实，更容易成功。这是堕治法的另一种方法。
张公说：真是不可思议的论述，我还有什么话可说呢。如果一定要我说，还有一个病症可以商量。有人患有痞块症，一时发作，腹痛也不可用手按压的，也可以用下堕之法，趁着邪气动摇之时将其堕下。方剂使用枳实一两，白术二两，马粪炒焦五钱，用酒煎煮后服用。因为马粪最能安止痛痛，又不伤正气，而且又能驱逐邪气并化解积物，是药箱中最应该预先准备却往往不用的东西，因为仓促之间不可能立即得到。这种药物越久越好。不必多用至五钱，即使只用一二钱，效果也无不奇妙，何况现在用了五钱呢；况且又与枳实同用，那么积块自然消散。然而如果只消除积滞，恐怕会损伤脾阴，所以又佐以白术二两，大力健旺脾气，那么马粪与枳实，就可以发挥其祛荡之功。这又是堕治法的精妙之处。
华君说：这也是未流传的方法。
雷公说：我还有堕治的方子。如人腹痛手不可按压，方剂使用枳实一钱，大黄二钱，生甘草一钱，白芍五钱，乳香末一钱，加水煎煮后服用。此方的精妙之处，在于攻伐之中包含和解之意。不过分攻逐邪气，而邪气自然退避。这是堕治法中最善妙的。（批注：天师说：此方极其精妙，值得效法。）
Chen Shiduo said: The method of "Duo Zhi" (descending treatment) refers to a therapeutic approach where pathogenic factors fail to descend naturally, and medication is used to promote their downward movement. For instance, in cases of abdominal pain that worsens upon palpation, or chest discomfort due to food stagnation where the area cannot be touched, the descending treatment is appropriate. The prescription consists of Atractylodis Macrocephalae Rhizoma (Baizhu, 白术) 2 qian, Aurantii Fructus Immaturus (Zhike, 枳壳) 3 qian, Paeoniae Radix Alba (Baishao, 白芍) 3 qian, Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) 1 qian, Crataegi Fructus (Shanzha, 山楂) 20 grains, Hordeum Vulgare Fructus cum Spica (Maiya, 麦芽) 3 qian, and Magnoliae Officinalis Cortex (Houpo, 厚朴) 1 qian, decocted in water and taken orally. (Annotation: Su Fu Tang / Rapid Rotting Decoction.) Logically, if there is food stagnation in the chest, using Maiya, Houpo, Shanzha, and Zhike for digestion should suffice. Why add Baizhu and Baishao? This is because food stagnation leads to indigestion, causing accumulation in the chest and heart region, resulting in pain. If one merely eliminates the food stagnation without strengthening the Qi of the Spleen and Stomach, the Earth element will be deficient, making it difficult for food to rot and digest quickly. Therefore, Baizhu must be used to strengthen Stomach Qi and generate Yin within the Spleen, ensuring sufficient Earth Qi, which makes eliminating food stagnation easy. However, when the chest feels full and stifled, the Liver Meridian may take advantage of this weakness to invade the Earth of the Spleen and Stomach. Adding Baishao pacifies the Liver Wood; thus, with weakened Wood, the Earth of the Spleen and Stomach remains secure, allowing for the smooth transformation of waste. This is the subtlety of the descending treatment. Regarding cases where pathogenic factors carry food stagnation into the Large Intestine, where internal fire steams and stirs up the stagnation causing severe pain unrelieved by touch, the food has already left the Spleen and Stomach and can be directly purged downwards. The prescription uses Rhei Radix et Rhizoma (Dahuang, 大黄) 3 qian, Natrii Sulfas (Mangxiao, 芒硝) 1 qian, Magnoliae Officinalis Cortex (Houpo, 厚朴) 1 qian, Bupleuri Radix (Chaihu, 柴胡) 1 qian, Scutellariae Radix (Huangqin, 黄芩) 1 qian, and Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) 1 qian. This is Da Cheng Qi Tang (Major Order the Qi Decoction). The brilliance of this formula lies entirely in the use of Dahuang and Mangxiao. Dahuang is cool and dispersing, adept at moving freely without staying put; Mangxiao is even more intense than Dahuang, possessing a solid heat nature. Assisted by Huangqin, they complement each other effectively. Particularly ingenious is the continued use of Chaihu to soothe pathogenic factors in the Liver Meridian, assisted by Houpo to sweep away stagnation. If the pathogen is severe, adding Aurantii Fructus Immaturus (Zhishi, 枳实) may facilitate success further. This is another method of descending treatment.
Mr. Zhang said: This is an inconceivable discussion; what words can I add? If compelled to speak, there is another symptom to discuss. Some individuals suffer from Pi Kuai (痞块 - mass/lump syndrome), which flares up suddenly with abdominal pain that cannot be touched. The descending method can also be applied here, taking advantage of the moment when the pathogen is active to drive it down. The prescription uses Aurantii Fructus Immaturus (Zhishi, 枳实) 1 liang, Atractylodis Macrocephalae Rhizoma (Baizhu, 白术) 2 liang, and Equini Feces (Mafen, 马粪) stir-fried until charred 5 qian, decocted in wine and taken orally. Equini Feces is best at calming pain without damaging Qi, and it can expel pathogens and transform accumulations. It is an item that should always be prepared in the medicine cabinet but often goes unused because it is not readily available in emergencies. The older the better. One does not need to use as much as 5 qian; even 1-2 qian yields miraculous results, let alone using 5 qian now. Moreover, combined with Zhishi, the masses will naturally dissipate. However, merely eliminating the accumulation might risk injuring Spleen Yin, so 2 liang of Baizhu is added to strongly strengthen Spleen Qi, allowing the Equini Feces and Zhishi to exert their sweeping effects. This is yet another subtle method of descending treatment.
Mr. Hua said: This is also an untransmitted method.
Lord Lei said: I still have formulas for descending treatment. For abdominal pain where the abdomen cannot be touched, the prescription uses Aurantii Fructus Immaturus (Zhishi, 枳实) 1 qian, Rhei Radix et Rhizoma (Dahuang, 大黄) 2 qian, Raw Glycyrrhizae Radix et Rhizoma (Sheng Gancao, 生甘草) 1 qian, Paeoniae Radix Alba (Baishao, 白芍) 5 qian, and Frankincense Residue (Ruxiang Mo, 乳香末) 1 qian, decocted in water and taken orally. The brilliance of this formula lies in incorporating attacking methods within harmonizing strategies. By not excessively attacking the pathogen, the pathogen retreats on its own. This is the most excellent form of descending treatment. (Annotation: Lord Tian Shi said: This formula is extremely brilliant and worthy of emulation.)