产后胁痛，乃败血流入肝经，其厥阴之脉，循行胁肋，故作痛。此证有虚实，宜分治之，不可误也。如
胁下胀，手不可按，是瘀血也，宜去其血，芎归泻肝汤主之。如胁下痛，喜人按，其气闪动肋骨，状若奔
豚者，此去血太多，肝脏虚也，当归地黄汤主之。《医通》云∶胁痛宜分左右。盖左属血，血藏于肝，肝
伤有死血故痛，加减小柴胡汤。右属脾，脾有痰积则痛，加减补中益气汤。左右俱痛者，属虚，补中益
气汤加桂，下六味丸。然痰气亦有流于左胁，必与血相持而痛。血积亦
有伤于右胁，然必因脾气衰而致。又左有怒气伤肝，右有气郁伤脾，不因血与痰而痛。其间治法，善杂证
者可默悟矣。冯氏云∶产后胁痛，若肝经血瘀，延胡索散。若肝经气虚，四君子加柴胡、薄、桂。若肝
经血虚，四物加参、术、柴胡。若肾水不足，不能生肝，六味丸。若肺金势盛，克制肝木，泻白散。然若
不用姜、桂辛温，助脾肺以行药力，不惟无以施功，反添其胀矣。《尊生》云∶肋痛属气滞，归芍清肝
饮治之。盖肋与胁部位不同，不可认而为一，腋之下有骨处为肋，肋之下无骨处为胁。
芎归泻肝汤 治产后瘀血胁痛，手不可按。
归尾（一钱） 川芎 香附（童便制。各八分） 青皮 枳壳（麸炒。各六分） 桃仁（八粒，去
皮尖） 红花（四五分）
水煎熟，去滓，入酒、童便服。瘀甚，药分两或可加倍。
当归地黄汤 治产后肝血去多，胁虚而痛。
人参 当归（酒洗） 白芍（酒炒） 熟地（各一钱五分） 陈皮 炙草 桂心（各一钱）
姜枣引，水煎服。
加减小柴胡汤 治产后左胁痛。
小柴胡汤（见上卷诸痛门。）去黄芩，加丹皮、制香附、薄、桂、当归、童便。
加减补中益气汤 治产后右胁痛。
补中益气汤（见上卷诸痛门。）去升麻，加葛根、制半夏、茯苓、麸炒枳壳，生姜引。
泻白散（附加味泻白散。） 治肺火喘嗽气急，手足心发热。
桑白皮（姜汁和蜜炙） 地骨皮（各一两） 炙草（五钱） 粳米（百粒）
为散。每服四五钱。一方米不为散，用米并竹叶为引，水煎服。加橘红、桔梗，名加味泻白散。
归芍清肝饮 治产后气滞肋痛。
当归（一钱五分） 白芍 桔梗（各六分） 槟榔 枳壳（麸炒。各三分） 桂心 青木香 柴
胡（各二分五厘）
水煎服。
补中益气汤（见上卷诸痛门。） 六味丸（见上卷诸痛门，附六味地黄汤下。） 延
胡索散（见本卷小腹痛门。） 四君子汤（见上卷胎逆上逼门。） 四物汤（见上卷安胎门。）
产后胁痛，是由于败血流入肝经所致。足厥阴肝经的经脉循行经过胁肋部位，因此产生疼痛。此证有虚证和实证之分，应当分别治疗，不可误治。如果胁下胀满，手不能触碰按压，这是瘀血阻滞，适宜祛除瘀血，以芎归泻肝汤为主方治疗。如果胁下疼痛，喜欢被人按压，气息闪动肋骨，症状类似奔豚（一种气逆上冲的感觉），这是因为失血过多，肝脏虚弱所致，以当归地黄汤为主方治疗。《医通》说：胁痛应当区分左侧和右侧。大概左侧属血，血藏于肝，肝受伤有死血故而导致疼痛，使用加减小柴胡汤。右侧属脾，脾有痰积滞则导致疼痛，使用加减补中益气汤。左右两侧都痛的，属于虚证，使用补中益气汤加桂枝，并服用六味丸。然而痰气也有流注于左胁的，必定与血相互搏结而致痛。血积也有损伤右胁的，但必定是因为脾气衰弱所导致。另外，左侧因怒气伤肝，右侧因气郁伤脾，这种情况下并非因为血或痰而致痛。其中治疗方法，善于诊治杂病的医生可以默默领悟了。冯氏说：产后胁痛，如果是肝经血瘀，用延胡索散。如果是肝经气虚，用四君子汤加柴胡、薄荷、桂枝。如果是肝经血虚，用四物汤加人参、白术、柴胡。如果是肾水不足，不能滋养肝木，用六味丸。如果是肺金势盛，克制肝木，用泻白散。然而如果不使用姜、桂等辛温药物，来助益脾肺以推动药力运行，不仅无法发挥功效，反而会增加胀满。《尊生》说：肋痛属于气滞，用归芍清肝饮治疗。大概肋与胁的部位不同，不可混淆认作一处，腋下有骨头的地方称为肋，肋之下无骨头的地方称为胁。
芎归泻肝汤 治疗产后瘀血导致的胁痛，手不可触碰按压。
当归尾（一钱） 川芎 香附（用童便炮制。各八分） 青皮 枳壳（麸皮炒。各六分） 桃仁（八粒，去掉皮和尖） 红花（四五分）
用水煎煮至熟，滤去药渣，加入酒和童便服用。瘀血严重者，药物分量或许可以加倍。
当归地黄汤 治疗产后肝血流失过多，胁部空虚而疼痛。
人参 当归（酒洗） 白芍（酒炒） 熟地黄（各一钱五分） 陈皮 炙甘草 桂心（各一钱）
用生姜、大枣为引子，用水煎煮服用。
加减小柴胡汤 治疗产后左侧胁痛。
小柴胡汤（见上卷诸痛门。）去掉黄芩，加入丹皮、制香附、薄荷、桂枝、当归、童便。
加减补中益气汤 治疗产后右侧胁痛。
补中益气汤（见上卷诸痛门。）去掉升麻，加入葛根、制半夏、茯苓、麸皮炒枳壳，生姜为引子。
泻白散（附加味泻白散。） 治疗肺火引起的喘咳气急，手足心发热。
桑白皮（用姜汁拌蜂蜜炙） 地骨皮（各一两） 炙甘草（五钱） 粳米（百粒）
研成散剂。每次服用四五钱。另一法是不将米研成散，用米和竹叶为引子，用水煎煮服用。加入橘红、桔梗，名为加味泻白散。
归芍清肝饮 治疗产后气滞导致的肋痛。
当归（一钱五分） 白芍 桔梗（各六分） 槟榔 枳壳（麸皮炒。各三分） 桂心 青木香 柴胡（各二分五厘）
用水煎煮服用。
补中益气汤（见上卷诸痛门。） 六味丸（见上卷诸痛门，附在六味地黄汤下。） 延胡索散（见本卷小腹痛门。） 四君子汤（见上卷胎逆上逼门。） 四物汤（见上卷安胎门。）
Postpartum hypochondriac pain is caused by failed blood (stagnant blood) flowing into the Liver Meridian. The Foot-Jueyin Liver Meridian traverses the hypochondriac region, thus causing pain. This condition presents as either deficiency or excess and should be treated accordingly; misdiagnosis must be avoided. If there is distension under the hypochondrium that cannot be touched or pressed, it indicates blood stasis; the appropriate treatment is to remove the stasis, primarily using Xiong Gui Xie Gan Tang (Cnidium and Angelica Decoction for Draining the Liver). If there is pain under the hypochondrium that is relieved by pressure, with qi moving abruptly along the ribs resembling Ben Tun (a sensation of qi rushing upward like a bull), this results from excessive blood loss leading to Liver deficiency; the primary treatment is Dang Gui Di Huang Tang (Angelica and Rehmannia Decoction). *Yi Tong* states: Hypochondriac pain should be distinguished by left and right sides. Generally, the left side pertains to blood; since blood is stored in the Liver, injury to the Liver with stagnant blood causes pain, treated with Jia Jian Xiao Chai Hu Tang (Modified Minor Bupleurum Decoction). The right side pertains to the Spleen; accumulation of phlegm in the Spleen causes pain, treated with Jia Jian Bu Zhong Yi Qi Tang (Modified Tonify the Middle and Augment the Qi Decoction). Pain on both sides indicates deficiency, treated with Bu Zhong Yi Qi Tang plus Rou Gui (Cinnamon Bark), accompanied by Liu Wei Wan (Six-Ingredient Pill with Rehmannia). However, phlegm-qi may also flow to the left hypochondrium, where it contends with blood causing pain. Blood stasis may also affect the right hypochondrium, but this invariably stems from Spleen Qi decline. Furthermore, anger injuring the Liver affects the left side, while Qi stagnation injuring the Spleen affects the right side; in these cases, pain is not due to blood or phlegm. Physicians skilled in treating miscellaneous diseases can intuitively grasp these methods. Feng Shi states: For postpartum hypochondriac pain, if it is due to blood stasis in the Liver Meridian, use Yan Hu Suo San (Corydalis Powder); if due to Qi deficiency in the Liver Meridian, use Si Jun Zi Tang (Four Gentlemen Decoction) plus Chai Hu (Bupleurum), Bo He (Mint), and Gui Zhi (Cinnamon Twig); if due to Blood deficiency in the Liver Meridian, use Si Wu Tang (Four Substances Decoction) plus Ren Shen (Ginseng) and Bai Zhu (Atractylodes Macrocephala), plus Chai Hu; if Kidney Water is insufficient to nourish Liver Wood, use Liu Wei Wan; if Lung Metal is overly vigorous and suppresses Liver Wood, use Xie Bai San (Drain White Powder). However, without using acrid-warm herbs such as Sheng Jiang (Fresh Ginger) and Rou Gui (Cinnamon Bark) to assist the Spleen and Lung in promoting the action of the medicine, not only will efficacy fail, but distension will increase. *Zun Sheng* states: Rib pain belongs to Qi stagnation, treated with Gui Shao Qing Gan Yin (Angelica and Peony Decoction for Clearing the Liver). Note that the rib area and the hypochondrium are anatomically distinct and should not be conflated: the area under the armpit with bone is called the rib (Lei), while the area below the ribs without bone is called the hypochondrium (Xie).
Xiong Gui Xie Gan Tang (Cnidium and Angelica Decoction for Draining the Liver): Treats postpartum hypochondriac pain due to blood stasis, where the area cannot be touched.
Dang Gui Wei (Tail of Angelica Sinensis) (1 qian), Chuan Xiong (Ligusticum Chuanxiong), Xiang Fu (Cyperus Rotundus, processed with Tong Bian/Child's Urine) (each 8 fen), Qing Pi (Green Tangerina Peel), Zhi Ke (Aurantii Fructus, bran-fried) (each 6 fen), Tao Ren (Persicae Semen, skin and tip removed) (8 grains), Hong Hua (Carthami Flos) (4-5 fen).
Decoct in water until cooked, strain, and administer with wine and Tong Bian. If stasis is severe, dosages may be doubled.
Dang Gui Di Huang Tang (Angelica and Rehmannia Decoction): Treats postpartum hypochondriac pain due to deficiency from excessive blood loss.
Ren Shen (Ginseng Radix et Rhizoma), Dang Gui (Angelicae Sinensis Radix, washed with wine), Bai Shao (Paeoniae Radix Alba, fried with wine), Shu Di Huang (Rehmanniae Radix Praeparata) (each 1.5 qian), Chen Pi (Citri Reticulatae Pericarpium), Zhi Cao (Licorice Root, honey-fried), Gui Xin (Cinnamomi Cortex) (each 1 qian).
Use Sheng Jiang (Fresh Ginger) and Da Zao (Jujubae Fructus) as guides, decoct in water, and take orally.
Jia Jian Xiao Chai Hu Tang (Modified Minor Bupleurum Decoction): Treats postpartum left-sided hypochondriac pain.
Xiao Chai Hu Tang (see Upper Volume, Section on Various Pains): Remove Huang Qin (Scutellariae Radix), add Dan Pi (Moutan Cortex), Zhi Xiang Fu (Processed Cyperi Rhizoma), Bo He (Menthae Haplocalycis Herba), Gui Zhi (Cinnamomi Ramulus), Dang Gui (Angelicae Sinensis Radix), and Tong Bian.
Jia Jian Bu Zhong Yi Qi Tang (Modified Tonify the Middle and Augment the Qi Decoction): Treats postpartum right-sided hypochondriac pain.
Bu Zhong Yi Qi Tang (see Upper Volume, Section on Various Pains): Remove Sheng Ma (Cimicifugae Rhizoma), add Ge Gen (Puerariae Lobatae Radix), Zhi Ban Xia (Pinelliae Tuber, processed), Fu Ling (Poria), Zhi Ke (Aurantii Fructus, bran-fried), with Sheng Jiang as guide.
Xie Bai San (Drain White Powder) (with Jia Wei Xie Bai San / Modified Drain White Powder): Treats wheezing, cough, and急促 breathing due to Lung Fire, with heat in the palms and soles.
Sang Bai Pi (Mori Cortex, stir-baked with ginger juice and honey), Di Gu Pi (Lycii Cortex) (each 1 liang), Zhi Cao (Licorice Root, honey-fried) (5 qian), Jing Mi (Oryza Sativa Grain) (100 grains).
Grind into powder. Take 4-5 qian per dose. Another method: do not grind the rice into powder; use rice and Zhu Ye (Bambusae Folium) as guides, decoct in water, and take orally. Adding Ju Hong (Citri Reticulatae Pericarpium Rubrum) and Jie Geng (Platycodonis Radix) creates Jia Wei Xie Bai San.
Gui Shao Qing Gan Yin (Angelica and Peony Decoction for Clearing the Liver): Treats postpartum rib pain due to Qi stagnation.
Dang Gui (Angelicae Sinensis Radix) (1.5 qian), Bai Shao (Paeoniae Radix Alba), Jie Geng (Platycodonis Radix) (each 6 fen), Bing Lang (Arecae Semen), Zhi Ke (Aurantii Fructus, bran-fried) (each 3 fen), Gui Xin (Cinnamomi Cortex), Qing Mu Xiang (Aucklandiae Radix), Chai Hu (Bupleuri Radix) (each 2.5 li).
Decoct in water and take orally.
Bu Zhong Yi Qi Tang (see Upper Volume, Section on Various Pains). Liu Wei Wan (see Upper Volume, Section on Various Pains, attached under Liu Wei Di Huang Tang). Yan Hu Suo San (see this Volume, Section on Lower Abdominal Pain). Si Jun Zi Tang (see Upper Volume, Section on Fetal Reversal Pressing Upward). Si Wu Tang (see Upper Volume, Section on Calming the Fetus).