诸胁痛。各有所感。若止是冷气作楚。与 扑闪挫。宜和气饮。及乌药顺气散。或浓煎
葱白
汤。下枳壳散。左右胁。有气块而痛者。此是积聚。见诸气门积聚证。停饮胁痛。本事方而
丸。最佳。
曾有人胁痛连膈。进诸气药。并自大便导者。其痛殊甚。后用辛热补剂。下黑锡丹方愈
此
乃虚冷作痛。愈疏而愈虚耳。胁痛病在肝胆。伤寒。胁痛属少阳经。合用小柴胡汤。痛甚而
不大便者。于内加枳壳。若寻常胁痛。不系正伤寒。时身体带微热者。本事方中。枳壳煮散
用枳壳桔梗细辛芎防风各四分。干葛钱半。甘草一钱。若只是胁痛。别无杂证。其痛在左
为肝经受邪。宜用川芎枳壳甘草。其痛在右。为肝经移病于肺。宜用片姜黄枳壳桂心甘草。
此二方出严氏济生续集。加减在人。又有肝胆经。停痰伏饮。或一边胁痛。宜用严氏导痰汤
痰结成癖。间进半硫丸。盖枳壳乃治胁痛的剂。所以诸方中皆不可少。曾见潘子先说有人
胁痛。下青龙汤。痛止。兼嗽得可。此其痛必在右胁故也。灼然知是寒气作痛。枳实理中汤
为宜。戴复庵云。腹内诸般冷痛。一个枳实理中汤加减。作无限用。
腰者。肾之所附。皆属肾有寒有湿有风有虚。皆能作痛有闪挫劳役而痛者。宜生料五积
散。加炒桃仁五枚。
腰痛如锯刀所刺。大便黑。小便赤黄。或黑。由血滞腰间。名沥血腰痛。桃仁酒。调黑
神散。
若寒腰痛。见热则减。见寒则增。宜五积散。每服加吴茱萸半钱。
若湿腰痛。如坐水中。盖肾属水。久坐水湿处。或为雨露所着。湿流入肾经。以致腰痛
宜渗湿汤。不效。宜肾着汤。
若风伤而腰疼者或左或右。痛无常处。牵引两足。宜五积散。每服加防风半钱。或加全
蝎三
个尤好。小续命汤。独活寄生汤。皆可选用。仍吞三仙丹。杜仲姜汁炒研末。每一钱温酒
调。空心服。名杜仲酒治肾虚腰疼兼治风冷为患。
妇人血过多。及素患血虚致腰痛者。当益其血。见妇人门。若肾虚腰痛。转侧不能。嗜
卧疲
弱者。大建中汤。加川椒十粒。吞下腰肾丸。及生料鹿茸丸之类。仍以茴香炒研末。破开诸
腰子。作薄片。不令断。层层掺药末。水纸裹。煨熟。细嚼酒咽。
若因闪肭。或 扑伤损而痛。宜黑神散。和复元通气散。酒调下。不效。则恐有恶血停
滞。
宜先用酒调下苏合香丸。仍以五积散。每服。加大黄半钱。苏木半钱。当归倍元数。若因劳
役负重而痛。宜用和气饮。或普贤正气散。
各种胁痛，各有其致病原因。如果仅仅是冷气引起的疼痛，以及跌打闪挫造成的损伤，适宜使用和气饮、乌药顺气散，或者将葱白浓煎成汤，送服枳壳散。若左右两胁有气块且伴有疼痛，这是积聚病证，可参考气门篇中关于积聚的论述；对于停饮导致的胁痛，使用《本事方》中的丸剂效果最佳。
曾有一人胁痛牵连膈部，服用多种理气药物，并自行使用通便导滞的方法，结果疼痛反而加剧。后来改用辛热补益药剂，服用黑锡丹后才痊愈。这是因为虚冷引起的疼痛，越是疏泄越会导致正气虚弱。胁痛的病变部位在肝胆。伤寒病中，胁痛属于少阳经，应当合用小柴胡汤。如果疼痛剧烈且大便不通，可在小柴胡汤中加入枳壳。若是寻常的胁痛，并非正统的伤寒病，身体伴有轻微发热者，可使用《本事方》中的枳壳煮散，配方为：枳壳、桔梗、细辛、川芎、防风各四分，干葛一钱半，甘草一钱。如果只是胁痛，没有其他杂症，疼痛在左侧，是肝经受邪，适宜使用川芎、枳壳、甘草组成的方剂；疼痛在右侧，是肝经的病邪转移至肺，适宜使用片姜黄、枳壳、桂枝、甘草组成的方剂。这两个方子出自严氏《济生续集》，具体加减由医生根据病情决定。此外，还有肝胆经停痰伏饮，或单侧胁痛的情况，适宜使用严氏导痰汤；若痰结成癖，可间歇服用半硫丸。因为枳壳是治疗胁痛的要药，所以各种方剂中都不应缺少它。曾见潘子先说，有人患胁痛，服用青龙汤后疼痛停止，兼治咳嗽也好了，这一定是右胁疼痛的缘故。显然可知这是寒气作痛，使用枳实理中汤为宜。戴复庵说，腹内各种冷痛，用枳实理中汤加减，可以广泛使用。
腰部是肾脏所依附的部位，腰痛都归属于肾。无论是寒、湿、风还是虚，都能引起疼痛。如果是因闪挫、劳役过度而致的疼痛，适宜使用生料五积散，加炒桃仁五枚。
腰痛如锯刀切割刺痛，大便发黑，小便赤黄或黑色，这是由于瘀血停滞腰间，名为沥血腰痛。可用桃仁酒调服黑神散。
如果是寒性腰痛，遇热则减轻，遇寒则加重，适宜使用五积散，每服药量中加入吴茱萸半钱。
如果是湿性腰痛，感觉像坐在水中一样，因为肾属水，久坐潮湿之处，或被雨露淋湿，湿气流入肾经，导致腰痛，适宜使用渗湿汤；如果无效，适宜使用肾着汤。
如果是风邪侵袭导致的腰疼，疼痛部位或在左或在右，痛处不固定，牵引双腿，适宜使用五积散，每服药量中加入防风半钱，或者加入全蝎三个效果更好。小续命汤、独活寄生汤也都可选用。同时吞服三仙丹。杜仲用姜汁炒后研成末，每次一钱，用温酒调服，空腹服用，名为杜仲酒，用于治疗肾虚腰痛，兼治风冷为患。
妇女因失血过多，以及素来患有血虚导致腰痛者，应当补血，详见妇人门。如果是肾虚腰痛，转身侧卧困难，嗜睡疲弱，适宜使用大建中汤，加川椒十粒，吞服下腰肾丸及生料鹿茸丸之类。仍以茴香炒后研成末，剖开各种动物肾脏，切成薄片，不要切断，层层撒上药末，用水纸包裹，煨熟，细细咀嚼后用酒咽下。
如果是因闪挫或跌扑损伤而疼痛，适宜使用黑神散，配合复元通气散，用酒调服。如果无效，则恐怕有恶血停滞，宜先用酒调服苏合香丸，然后仍用五积散，每服药量中加入大黄半钱，苏木半钱，当归用量加倍。如果是因劳役负重而疼痛，适宜使用和气饮，或普贤正气散。
Various hypochondriac pains have different causative factors. If the pain is solely caused by cold qi or due to contusions and sprains, Heqi Yin (Harmonizing Qi Decoction) or Wuyao Shunqi San (Lindera Powder to Smooth Qi) should be used. Alternatively, a strong decoction of scallion white (Congbai) can be administered with Zhike San (Bitter Orange Powder). If there are palpable masses in the left or right hypochondrium accompanied by pain, this indicates accumulation disorders (Jiju); refer to the section on Qi Disorders for details. For hypochondriac pain caused by retained fluid, the pills from *Bencao Fang* are most effective.
There was a case where a patient suffered from hypochondriac pain radiating to the diaphragm. After taking various qi-regulating herbs and self-administering purgatives to unblock the bowels, the pain intensified significantly. It was only after administering warm-hot tonifying agents and Heixi Dan (Black Tin Pill) that the condition resolved. This was pain due to deficiency-cold; excessive draining further depleted the righteous qi. Hypochondriac pain involves the Liver and Gallbladder. In Shaoyang disease (Taiyang disease involving the Shaoyang channel), hypochondriac pain belongs to the Shaoyang channel, and Xiao Chaihu Tang (Minor Bupleurum Decoction) should be combined. If the pain is severe and accompanied by constipation, add Zhishi (Aurantii Fructus) to the formula. For ordinary hypochondriac pain not caused by standard exogenous febrile diseases, but with slight body heat, use the Zhige Decoction from *Bencao Fang*: Zhishi (Aurantii Fructus), Jiegeng (Platycodonis Radix), Xixin (Asari Radix et Rhizoma), Xiong (Chuanxiong Rhizoma), Fangfeng (Saposhnikoviae Radix) each 4 fen, Gegen (Puerariae Lobatae Radix) 1.5 qian, Gancao (Glycyrrhizae Radix et Rhizoma) 1 qian. If it is merely hypochondriac pain without other symptoms, pain on the left indicates pathogenic invasion of the Liver channel, treated with Chuanxiong, Zhishi, and Gancao. Pain on the right indicates the Liver channel pathology transferring to the Lung, treated with Pian Jianghuang (Curcumae Longae Rhizoma), Zhishi, Guizhi (Cinnamomi Ramulus), and Gancao. These two formulas originate from Yan Shi's *Jisheng Xuji*; modifications depend on clinical judgment. Additionally, for phlegm-fluid retention in the Liver and Gallbladder channels or unilateral hypochondriac pain, Yan Shi's Daotan Tang (Great Phlegm-Resolving Decoction) is suitable. If phlegm forms into a mass (Pi), Banliu Wan (Half-Sulfur Pill) may be taken intermittently. Since Zhishi is a key herb for treating hypochondriac pain, it is indispensable in various formulas. Pan Zixian reported a case where Qinglong Tang (Green Dragon Decoction) stopped the pain and also cured coughing; this indicated pain in the right hypochondrium, clearly due to cold qi, making Zhishi Lizhong Tang (Bitter Orange and Poria Decocted with Ginseng and Ginger Decoction) appropriate. Dai Fu'an stated that for various cold pains in the abdomen, modified Zhishi Lizhong Tang can be widely used.
The waist is the residence of the Kidney. All types of lumbago belong to the Kidney, whether caused by cold, dampness, wind, or deficiency. Lumbago due to sprains or overexertion should be treated with Shengliao Wuji San (Unprocessed Five Accumulations Powder) plus five fried Taoren (Persicae Semen).
Lumbago feeling like sawing or stabbing, with black stool and dark yellow or black urine, is caused by blood stasis in the waist region, named Lixue Yaotong (Dripping Blood Lumbago). Treat with Heishen San (Black Divine Powder) mixed with peach kernel wine.
For cold-type lumbago, which alleviates with heat and worsens with cold, use Wuji San with added Wuzhuyu (Evodiae Fructus) half a qian per dose.
For damp-type lumbago, feeling as if sitting in water, since the Kidney governs water, prolonged sitting in damp places or exposure to rain and dew allows dampness to enter the Kidney channel, causing lumbago. Use Shenshi Tang (Dampness-Percolating Decoction); if ineffective, use Shenzhe Tang (Kidney-Clothing Decoction).
For lumbago caused by wind invasion, with pain shifting between left and right, unpredictable location, and radiating to both legs, use Wuji San with added Fangfeng (Saposhnikoviae Radix) half a qian per dose, or add three Quanxie (Scorpio) for better effect. Xiaoxuming Tang (Minor Rescue Life Decoction) and Duhuo Jisheng Tang (Angelica Pubescens and Sangjisheng Decoction) are also selectable options. Swallow Sanxian Dan (Three Immortals Pill) concurrently. Stir-fried Du Zhong (Eucommiae Cortex) processed with ginger juice and powdered, one qian per dose, taken with warm wine on an empty stomach, named Du Zhong Jiu (Eucommia Wine), treats Kidney-deficiency lumbago and wind-cold pathologies.
For women with excessive blood loss or chronic blood deficiency causing lumbago, nourish the blood; see the Women's Section. For Kidney-deficiency lumbago with inability to turn or lie down, lethargy, and weakness, use Da Jianzhong Tang (Major Construct the Middle Decoction) with ten Sichuan pepper grains, swallowed with Yao Shen Wan (Waist-Kidney Pill) and Shengliao Lurong Wan (Unprocessed Deer Antler Pill). Roast Fenhui (Foeniculi Fructus), powder it, slice animal kidneys thinly without cutting through, layer with the powder, wrap in wet paper, and bake until cooked. Chew thoroughly and swallow with wine.
For pain due to sprains or contusions, use Heishen San combined with Fuyuan Tongqi San, taken with wine. If ineffective, malignant blood stasis may be present; first administer Suhexiang Wan (Styrax Pill) with wine, then continue with Wuji San adding Dahuang (Rhei Radix et Rhizoma) half a qian, Sumu (Sappanwood) half a qian, and double the amount of Danggui (Angelicae Sinensis Radix). For pain due to laborious work or heavy lifting, use Heqi Yin or Puxian Zhengqi San.