由外感内伤，痛极欲死。先用盐一两，百沸汤、冷水各一碗调化，令饮尽，得吐泻痛止。阴
沙手足冷，身有红点，油灯火烧；阳沙肢温，针刺十指爪甲边出血，蘸温水重搭，膝腕有紫点，
针刺出血安。
经曰∶肝病两胁痛引少腹，善怒，何谓也？曰∶厥阴肝经之脉，自足而上，环阴器、抵少腹
，又上
贯肝膈、布胁肋，故两胁下痛引少腹。盖胁痛之证，当分左右治之。左属肝主血，有瘀血为病；
右属肺主气，有滞气为病。而脾亦系于右，其经湿胜，故痰饮流注右胁作痛。所以通论，则左属
肝火瘀血，右属气郁湿痰。虽然，若左右脉弦者，乃郁怒动肝火，肝木炽盛，则制己所胜之经脾
也，侮所不胜之经肺也。肝木乘之，右亦痛矣。如七情气结，饮食失节，冷热不调，常有郁怒者
，两胁俱痛，皆宜疏肝木为主。或有湿痰流注，颠仆伤形，所挟之证，不可执一。脉沉涩气滞，
弦涩顺，洪大逆。
主方 （左右胁痛） 柴胡 青皮 白芍 川芎 枳壳（炒。各钱半） 香附 当归（各一
钱） 龙胆草 木香 砂仁（各五分） 加姜，水煎服。
气急加桑皮、紫苏；胀加腹皮、草果、陈皮、萝卜子。左痛加黄连（吴萸炒）、桃仁（各一
钱）红花（五分）、香附、砂仁、甘草；右痛加陈皮、半夏（各一钱）、槟榔、肉桂（各五分），
去芍、芎、当归、龙胆。
当归龙荟丸 通治胁痛，因气成火者神效。
当归 龙胆草 栀子仁（大者） 黄连 大黄（酒蒸） 芦荟 青黛（各五钱） 青皮 木
香（二钱五分） 麝香（五分） 柴胡（五分）
上为末，研入芦荟、黛、麝，用神曲糊丸桐子大。每服三十丸，热浓姜汤下。
豁痰丸 治素有痰饮而致右胁痛。
陈皮 贝母 茯苓 栝蒌仁 枳实 白芥子 半夏 青皮 栀子（各一钱） 木香 甘草（
各四分） 加姜水煎。
枳壳煮散 治悲哀烦恼，有伤肝气，致两胁皆痛，筋脉拘急，腰脚重滞，股胁弯痛，四肢
不举。
防风 川芎 细辛 枳壳（炒） 桔梗（各一钱） 甘草（炙五分） 葛根（八分）
上咀，水二盏，姜三片，煎八分，食远温服。
左金丸 泻肝火行湿，为热甚之反佐。
黄连（六钱） 吴茱萸（一钱）
上为末，汤浸蒸饼，丸绿豆大。每服三十丸，滚姜汤送下。
木通散 治男、妇胁肋苦痛。
木通 青皮 川楝子（取肉一两，用巴豆去壳半两同炒黄，去巴不用） 萝卜子（炒） 莪
术木香 滑石（各半两）
上为细末，葱白汤调下，每服三钱。或煎服即愈。甚者只二服。
异香散 治腹胁痞闷。
莪术 三棱 益智 甘草（各一钱） 青皮 陈皮（各五分） 石莲肉 浓朴（姜制，三分）
上咀，水盏半，姜三片，枣二枚，煎七分，温服。
气针丸 治久积风壅，心胸筑痛，两胁似有针刺，疼痛不可忍。六脉沉伏，按之不可近，
此药屡试神效，常服疏肝气、止痛。
木香 槟榔 青皮 陈皮 大黄（各四两） 牵牛（半生半炒熟，取头末，半斤）
上为细末，炼蜜丸桐子大。每服三十丸，姜汤送下。
左痛不动移乃死血，宜活血汤（方见腹痛）。
因伤劳虚，痛久不止，宜补中益气汤（方见虚损）。
熨法 姜、葱炒热包熨，或葱、或艾、或韭、或蒜，皆可熨。
灸法 治卒胁痛。以蜡绳横度两乳中间，屈绳从乳横以趋痛胁下，灸绳尽处三十壮为度。
外贴法 芥菜子水研敷；或吴茱萸醋研敷。
由于外感邪气或内伤因素，导致疼痛剧烈，甚至痛欲死亡。首先使用一两盐，用滚开的热水和一碗冷水调和溶解，让患者全部喝下，通过呕吐和腹泻使疼痛停止。阴沙证表现为手足冰冷，身上有红点，可用油灯灯火烧灼患处；阳沙证肢体温暖，针刺十个手指指甲边缘使其出血，蘸温水后重新搭敷（注：此处指代一种急救处理手法），若膝部和腕部有紫点，针刺出血即可安宁。
经文说：“肝病导致两侧胁肋疼痛并牵引至小腹，容易发怒”，这是什么原因呢？回答说：厥阴肝经的经脉，从足部向上行走，环绕生殖器，抵达小腹，又向上贯穿肝脏和膈肌，分布于胁肋部位，所以两侧胁肋下的疼痛会牵引至小腹。大概胁痛这一病症，应当分左右来治疗。左侧属于肝，主血，若有瘀血则致病；右侧属于肺，主气，若有气滞则致病。而脾也关联于右侧，其经湿气偏胜，所以痰饮流注于右胁引起疼痛。因此通论来说，左侧属于肝火和瘀血，右侧属于气郁和湿痰。虽然如此，如果左右脉象都呈弦脉，那是因郁怒触动肝火，肝木炽盛，从而克制它所能胜的脾经，欺侮它不能胜的肺经。肝木乘虚侵袭，右侧也会疼痛。如七情之气结聚，饮食失去节制，冷热不调，常有郁怒情绪的人，两侧胁肋都会疼痛，都应以疏泄肝木为主。或者是有湿痰流注，跌打损伤形体，所夹杂的病证，不可拘泥于一种治法。脉象沉涩表示气滞，弦涩为顺证，洪大为逆证。
主方（用于左右胁痛）：柴胡、青皮、白芍、川芎、枳壳（炒，各一钱半）、香附、当归（各一钱）、龙胆草、木香、砂仁（各五分）。加生姜，水煎服。
气急者加桑白皮、紫苏；腹胀者加腹皮、草果、陈皮、萝卜子。左侧疼痛加黄连（吴茱萸炒）、桃仁（各一钱）、红花（五分）、香附、砂仁、甘草；右侧疼痛加陈皮、半夏（各一钱）、槟榔、肉桂（各五分），去掉白芍、川芎、当归、龙胆草。
当归龙荟丸：通治胁痛，因气郁化火者效果神奇。
配方：当归、龙胆草、栀子仁（大的）、黄连、大黄（酒蒸）、芦荟、青黛（各五钱）、青皮、木香（二钱五分）、麝香（五分）、柴胡（五分）。
以上药物研为细末，将芦荟、青黛、麝香研入其中，用神曲糊制作成梧桐子大小的丸药。每次服用三十丸，用热浓姜汤送服。
豁痰丸：治疗素有痰饮而导致右胁痛。
配方：陈皮、贝母、茯苓、瓜蒌仁、枳实、白芥子、半夏、青皮、栀子（各一钱）、木香、甘草（各四分）。加姜水煎服。
枳壳煮散：治疗悲哀烦恼，损伤肝气，导致两侧胁肋都痛，筋脉拘挛紧急，腰脚沉重滞涩，大腿和胁肋弯曲处疼痛，四肢无法抬起。
配方：防风、川芎、细辛、枳壳（炒）、桔梗（各一钱）、甘草（炙，五分）、葛根（八分）。
以上切碎，用水两盏，生姜三片，煎至八分，饭后稍远时温服。
左金丸：泻肝火，行湿气，作为热甚时的反佐之法。
配方：黄连（六钱）、吴茱萸（一钱）。
以上研为细末，用汤浸泡蒸饼，制成绿豆大小的丸药。每次服用三十丸，用滚热的姜汤送服。
木通散：治疗男、女胁肋剧烈疼痛。
配方：木通、青皮、川楝子（取肉一两，用巴豆去壳半两同炒黄，去掉巴豆不用）、萝卜子（炒）、莪术、木香、滑石（各半两）。
以上研为细末，用葱白汤调服，每次三钱。或者煎服即愈。严重的只需服用两次。
异香散：治疗腹部和胁肋痞闷。
配方：莪术、三棱、益智、甘草（各一钱）、青皮、陈皮（各五分）、石莲肉、厚朴（姜制，三分）。
以上切碎，用水一盏半，生姜三片，大枣二枚，煎至七分，温服。
气针丸：治疗久积风壅，心胸筑筑作痛，两侧胁肋似有针刺感，疼痛难以忍受。六脉沉伏，按压时疼痛加剧不可触碰，此药屡试神效，常服可疏肝气、止痛。
配方：木香、槟榔、青皮、陈皮、大黄（各四两）、牵牛子（半生半炒熟，取头末，半斤）。
以上研为细末，炼蜜制成梧桐子大小的丸药。每次服用三十丸，用姜汤送服。
左侧疼痛固定不移的是死血（瘀血），宜用活血汤（方剂见腹痛章节）。
因劳损虚弱，疼痛长久不止，宜用补中益气汤（方剂见虚损章节）。
熨法：将姜、葱炒热包裹熨烫，或者只用葱、艾、韭菜、蒜，都可以进行熨烫。
灸法：治疗突发胁痛。用蜡绳横量两乳中间的距离，弯曲绳子从乳头横向延伸至疼痛的胁肋下方，在绳子尽头处艾灸三十壮为限度。
外贴法：用芥菜子加水研磨后敷贴；或者用吴茱萸加醋研磨后敷贴。
Due to external contraction or internal injury, the pain is so severe that death seems imminent. First, use one liang of salt, dissolved in a bowl of boiling water and a bowl of cold water mixed together. Have the patient drink it all; vomiting and diarrhea will occur, stopping the pain. In Yin Sha syndrome, the hands and feet are cold, and red spots appear on the body; these can be cauterized with an oil lamp flame. In Yang Sha syndrome, the limbs are warm; prick the edges of the fingernails on all ten fingers to bleed, then apply warm water (a specific emergency technique). If purple spots appear at the knees and wrists, pricking them to bleed brings relief.
The Classic states: "Liver disease causes pain in both hypochondriac regions radiating to the lower abdomen, accompanied by irritability." What is the reason? The answer is: The Jueyin Liver meridian ascends from the foot, circles the genitalia, reaches the lower abdomen, then pierces through the liver and diaphragm, distributing along the hypochondriac regions. Therefore, pain in the bilateral hypochondriac regions radiates to the lower abdomen. Generally, hypochondriac pain should be treated differently based on the side. The left belongs to the Liver, which governs Blood; pathology arises from blood stasis. The right belongs to the Lung, which governs Qi; pathology arises from Qi stagnation. The Spleen is also associated with the right side; its meridian is prone to dampness excess, causing phlegm-fluids to flow into the right hypochondrium causing pain. Thus, in general terms, the left involves Liver Fire and blood stasis, while the right involves Qi depression and damp-phlegm. However, if the pulse is wiry on both sides, it indicates Liver Fire stirred by emotional depression. Excessive Liver Wood overacts on the Earth (Spleen) it normally controls and insults the Metal (Lung) it cannot control. When Liver Wood invades, the right side also hurts. For those with Qi knotting due to seven emotions, irregular diet, improper temperature regulation, and frequent anger, both hypochondriac regions may hurt. Treatment should primarily focus on soothing Liver Wood. Cases involving damp-phlegm accumulation or trauma require flexible approaches, not rigid adherence to one method. A deep and choppy pulse indicates Qi stagnation; wiry and choppy is favorable, while surging and large is unfavorable.
Main Formula (for bilateral hypochondriac pain): Chai Hu (Bupleuri Radix), Qing Pi (Aurantii Fructus Immaturus), Bai Shao (Paeoniae Radix Alba), Chuan Xiong (Chuanxiong Rhizoma), Zhi Ke (Aurantii Fructus, stir-fried) [each 1.5 qian], Xiang Fu (Cyperi Rhizoma), Dang Gui (Angelicae Sinensis Radix) [each 1 qian], Long Dan Cao (Gentianae Radix), Mu Xiang (Aucklandiae Radix), Sha Ren (Amomi Fructus) [each 0.5 qian]. Add fresh ginger, decoct in water, and take orally.
For shortness of breath, add Sang Bai Pi (Mori Cortex) and Zi Su (Perillae Folium); for distension, add Fu Pi (Arecae Pericarpium), Cao Guo (Tsaoko Fructus), Chen Pi (Citri Reticulatae Pericarpium), and Luo Bo Zi (Raphani Semen). For left-sided pain, add Huang Lian (Coptidis Rhizoma, stir-fried with Wu Zhu Yu), Tao Ren (Persicae Semen) [each 1 qian], Hong Hua (Carthami Flos) [0.5 qian], Xiang Fu, Sha Ren, and Gan Cao (Licorice Root). For right-sided pain, add Chen Pi, Ban Xia (Pinelliae Rhizoma) [each 1 qian], Bing Lang (Areca Seed), Rou Gui (Cinnamomi Cortex) [each 0.5 qian]; remove Bai Shao, Chuan Xiong, Dang Gui, and Long Dan Cao.
Danggui Longhui Wan (Angelica and Gentian Pill): Universally treats hypochondriac pain caused by Qi transforming into Fire, showing miraculous efficacy.
Ingredients: Dang Gui, Long Dan Cao, Zhi Zi Ren (Gardeniae Semen, large ones), Huang Lian, Da Huang (Rhei Radix et Rhizoma, steamed with wine), Lu Hui (Aloe), Qing Dai (Indigo Naturalis) [each 5 qian], Qing Pi, Mu Xiang [2.5 qian], She Xiang (Moschus) [0.5 qian], Chai Hu [0.5 qian].
Grind all into fine powder. Mix in Lu Hui, Qing Dai, and She Xiang. Use Shen Qu (Medicated Leaven) paste to form pills the size of tung seeds. Take 30 pills each time, washed down with hot, strong ginger tea.
Huotan Wan (Phlegm-Expelling Pill): Treats right-sided hypochondriac pain caused by pre-existing phlegm-fluids.
Ingredients: Chen Pi, Bei Mu (Fritillariae Bulbus), Fu Ling (Poria), Gua Lou Ren (Trichosanthis Semen), Zhi Shi (Aurantii Fructus Immaturus), Bai Jie Zi (Sinapis Semen), Ban Xia, Qing Pi, Zhi Zi [each 1 qian], Mu Xiang, Gan Cao [each 0.4 qian]. Add ginger water, decoct, and take.
Zhi Ke Zhu San (Immature Bitter Orange Decoction Powder): Treats hypochondriac pain in both sides caused by grief and worry injuring Liver Qi, leading to tendon and vessel spasm, heaviness and stiffness in the waist and legs, pain in the groin and hypochondrium, and inability to move the limbs.
Ingredients: Fang Feng (Saposhnikoviae Radix), Chuan Xiong, Xi Xin (Asari Radix et Rhizoma), Zhi Ke (stir-fried), Jie Geng (Platycodonis Radix) [each 1 qian], Gan Cao (roasted) [0.5 qian], Ge Gen (Puerariae Lobatae Radix) [0.8 qian].
Cut into pieces. Decoct two cups of water with three slices of ginger until reduced to 0.8 cup. Take warm after meals.
Zuo Jin Wan (Left Metal Pill): Purges Liver Fire and moves dampness, serving as a counter-agent for extreme heat.
Ingredients: Huang Lian [6 qian], Wu Zhu Yu (Evodiae Fructus) [1 qian].
Grind into powder. Soak in broth, steam with leavened bread dough, and form pills the size of mung beans. Take 30 pills each time, washed down with boiling ginger tea.
Mutong San (Akebia Decoction Powder): Treats severe hypochondriac pain in men and women.
Ingredients: Mutong (Akebiae Caulis), Qing Pi, Chuan Li Zi (Toosendan Fructus, flesh 1 liang stir-fried with half a liang of shelled Ba Dou until yellow, discard Ba Dou), Luo Bo Zi (stir-fried), E Zhu (Curcumae Rhizoma), Mu Xiang, Hua Shi (Talcum) [each 0.5 liang].
Grind into fine powder. Take 3 qian each time, mixed with scallion white soup. Alternatively, decoct and take. Recovery usually occurs quickly; severe cases resolve in two doses.
Yixiang San (Rare Fragrance Powder): Treats epigastric and hypochondriac fullness and oppression.
Ingredients: E Zhu, San Leng (Sparganii Rhizoma), Yi Zhi (Alpiniae Oxyphyllae Fructus), Gan Cao [each 1 qian], Qing Pi, Chen Pi [each 0.5 qian], Shi Lian Rou (Nelumbinis Plumula), Hou Po (Magnoliae Officinalis Cortex, processed with ginger) [0.3 qian].
Cut into pieces. Decoct one and a half cups of water with three slices of ginger and two jujubes until reduced to 0.7 cup. Take warm.
Qizhen Wan (Qi-Needle Pill): Treats long-standing wind obstruction causing throbbing chest pain, needle-like stabbing pain in both hypochondriac regions, unbearable pain, deep and hidden pulses in all six positions, and tenderness to touch. This formula has proven miraculously effective and soothes Liver Qi and stops pain with regular use.
Ingredients: Mu Xiang, Bing Lang, Qing Pi, Chen Pi, Da Huang [each 4 liang], Qian Niu (Pharbitidis Semen, half raw half stir-fried, using the finest powder, 0.5 jin).
Grind into fine powder. Form pills with refined honey, sized like tung seeds. Take 30 pills each time, washed down with ginger tea.
If left-sided pain is fixed and unchanging, it is dead blood (blood stasis); use Huoxue Tang (Blood-Invigorating Decoction) (see Abdominal Pain chapter).
If pain persists for a long time due to labor-induced deficiency, use Buzhong Yiqi Tang (Middle-Qi-Reinforcing Decoction) (see Deficiency Damage chapter).
Warming Compress Method: Stir-fry ginger and scallions until hot, wrap in cloth, and compress. Ginger alone, mugwort, leeks, or garlic can also be used for compression.
Moxibustion Method: For sudden hypochondriac pain. Measure horizontally between the nipples with a wax cord. Bend the cord from the nipple laterally towards the painful hypochondrium. Moxa-burn thirty burns at the end of the cord.
External Application Method: Grind mustard seeds with water and apply; or grind Wu Zhu Yu with vinegar and apply.