邪气入里与正气搏则为腹痛所以痛者有异焉腹痛属里正太阳经腹不痛少阳有胸胁痛而无腹痛若有阳明腹满急而痛
此为里实宜下之大柴胡汤小承气汤三阴下利清谷而又腹痛者里寒故也此总论太阳经阳中之阴四逆汤附子理中汤阳气传
太阴经腹满而痛其证有二有实痛有虚痛肠鸣泄利而痛者虚痛也此独论太阴经阴中之阳小建中汤即桂枝加芍药汤但桂有
浓薄不瘥则小柴胡汤去芩加芍药如数腹满大便秘按之痛者实痛也桂枝加大黄一钱此之虚痛实痛乃是以阳邪渐消为虚阳
气正大为实
太阳 伤寒阳脉涩阴脉弦法当腹中急痛先与小建中汤不瘥与小柴胡汤（成 脉阳涩阴弦而腹中急痛者当作里有虚寒
治之与小建中汤温中散寒若不瘥者非里寒也必由邪气自表之里里气不利所致与小柴胡汤去黄芩加芍药以除传里之邪）
小建中汤方
桂枝（去粗皮） 生姜（切各三两） 芍药（六两） 甘草（炙二两） 大枣（十二枚擘） 胶饴（一升）
上六味以水七升煮取三升去滓纳胶饴更上微火消解温服一升日三服呕则不可用建中汤以甜故也（内经曰肝生于左肺
脏于右心位在上肾处在下脾者土也应中央居四脏之中为中州生育荣卫通行津液一有不调则荣卫失所育津液失所行必此
汤温健中脏是以建中名焉脾欲缓急食甘以缓之健脾者必以甘为主故以胶饴甘温为君甘草甘平为臣桂辛热辛散也润也荣
卫不足润而散之芍药味微寒酸收也泄也津液不逮收而行之是以芍药桂为佐生姜味辛温大枣味甘温胃者卫之源脾者荣之
本针经曰荣出中焦卫出上焦是矣卫为阳不足者益之必以辛荣为阴不足补之必以甘辛甘相合脾胃健而荣卫通是以姜枣为
使或谓桂枝汤解表而芍药数少建中汤温里而芍药数多何也皮肤为近则制小其服心腹为远则制大其服此所以为不同也）
伤寒胸中有热胃中有邪气腹中痛欲呕吐者黄连汤主之（成 湿家下后舌上如胎者以丹田有热胸上有寒是邪气入里而
为下热上寒也此伤寒邪气传里而为下寒上热也胃中有邪气使阴阳不交阴不得升而独治于下为下寒腹中痛阳不得降而独
治于上为胸中热欲呕吐与黄连汤升降阴阳之气）
黄连汤方
黄连 甘草（炙） 干姜（炮） 桂枝（去粗皮各三两） 人参（二两） 半夏（半升洗） 大枣 （十二枚擘）
上七味以水一斗煮取六升去滓温服一升日三服夜二服（上热者泄之以苦黄连之苦以降阳下寒者散之以辛桂姜半夏之辛以
升阴脾欲缓急食甘以缓之人参甘草大枣之甘以益胃）
伤寒五六日中风往来寒热胸胁苦满默默不欲饮食心烦喜呕或胸中烦而不呕或渴或腹中痛或胁下痞硬或心下悸小便
不利或不渴身有微热或咳者与小柴胡汤二阳并病太阳初得病时发汗不彻因转属阳明续自微汗不恶寒若太阳证不罢者不
可下可少发汗设面色缘缘正赤者阳气怫郁在表当解之熏之若发汗不彻其人烦躁不知痛处乍在腹中乍在四肢按之不可得
其人短气但坐以汗出不彻更发汗则愈以脉涩知之（桂枝不恶寒大柴胡汤小汗宜葛根汤各半汤麻黄加桂枝汤）
阳明 病患不大便五六日绕脐痛烦躁发作有时此有燥屎故使不大便也（成 不大便五六日者则大便必结为燥屎也胃
中燥实气不得下通故绕脐痛烦躁发作有时也）大下后六七日不大便烦不解腹满腹者有燥屎也所以然者本有宿食故也大承
气汤主之（大下之后则胃弱不能消谷至六七日不大便则宿食已结不消故使烦热不解而腹满痛是知有燥屎也与大承气汤以
下除之）发汗不解腹满痛者急下之之
少阴 病二三日不已至四五日腹痛小便不利四肢沉重疼痛自下利者此为有水气其人或咳或呕或下利或小便利真武
汤（成 少阴病二三日则邪气犹浅至四五日邪气已深肾主水肾病不能制水水饮停为水气腹痛者寒湿内甚也四肢沉重疼痛
寒湿外甚也小便不利自下利者湿胜而水谷不别也内经曰湿胜则濡泄与真武汤益阳散寒湿）少阴病下利清谷里寒外热手足
厥逆脉微欲绝反不恶寒面赤色或腹痛或干呕或咽痛或利止脉不出者通脉四逆汤主之（下利清谷手足厥冷脉微欲绝为里寒
身热不恶寒面赤色为外热此阴盛于内格阳于外不相通也与通脉四逆汤散阴通阳）少阴病四逆其人或咳或悸或小便不利或
腹中痛或泄利下重者四逆散主之（四逆者四肢不温也伤寒邪在三阳则手足必热传到太阴手足自温至少阴则热邪渐深故四
肢逆而不温也及至厥阴则手足厥冷是又甚于逆与四逆散以散传经之热也）少阴病二三日至四五日腹痛小便不利下利不止
便脓血者桃花汤（二三日至四五日寒邪入里深也腹痛者里寒也小便不利者水谷不别也下利不止便脓血者肠胃虚弱下焦不
固也与桃花汤固肠止利也）
太阴 为病腹满吐食不下自利益甚时腹自痛若下之必胸下结硬（或用理中汤丸不渴四用汤逆）本太阳病医反下之因
尔腹满时痛属太阴也桂枝加芍药汤大实痛者桂枝加大黄汤（详见前）
厥阴 伤寒四五日腹中痛若转气下趣少腹者此欲下利也（伤寒四五日邪气传里之时腹中痛转气下趣少腹者里虚遇寒
寒气下行欲作自利也或用附子干姜汤四逆汤）
云 伤寒邪在三阴内不得交通故为腹痛手足之经皆会于腹如脉弦而腹痛过在足厥阴肝手太阴肺刺太冲太渊太陵
如
脉沉而腹痛过在足太阴脾少阴肾手厥阴心包刺太溪太陵如脉沉细而痛过在足太阴脾手少阴心刺太白神门三阴交此刺腹
痛之法也
吴 凡腹中痛可按可揉者内虚也不可按不可揉者内实也王海藏言中脘痛者属脾土脉沉细内寒者理中汤或用附子
理
中丸主之若阳脉涩阴脉弦小建中汤主之若小腹痛属厥阴经分宜当归四逆汤加吴茱萸主之厥逆者四逆汤加吴茱萸主之若
大实腹满而痛或绕脐刺痛不大便脉实者以大承气汤下之凡潮热不大便从心下至少腹硬满而痛手不可近者大陷胸汤下之
若脉弦腹痛无热无寒者芍药甘草汤主之凡脉弦口苦发热腹中痛者小柴胡去人参加炒白芍汤主之若寒热交作腹中痛者加
肉桂芍药主之若寒多而痛者去黄芩倍肉桂芍药也凡少阴发热手足冷腹中痛者四逆散加附子汤肉桂炒芍药吴茱萸主之也
凡发热脉洪弦而腹痛者芍药黄芩汤主之大抵腹痛有虚有实有冷有热要在脉证辨而用之凡蓄血亦令人腹痛手不可近自有
本条若自利腹痛小便清白盒饭温也理中四逆看微甚用轻者五积散重者四逆汤无脉者通脉四逆汤使阴退而阳复也腹痛欲
吐利而烦躁者多有痧毒世俗括刺委中穴凡脉微弦少腹痛厥阴也宜刺太冲太渊太陵灸归来关元脉沉脐腹痛少阴也宜刺太
白神门三阴交灸中脘
陶 伤寒腹中痛用凉水饮之其痛稍可者属热当用凉药不已而或绕脐硬痛大便结实烦渴属燥屎痛急用寒药下之或
食
积痛治亦如之若小腹硬痛小便自利大便黑身目黄者属蓄血痛治亦如之加行血药下尽黑物自愈此三者痛随利减之法也若
饮水愈痛属寒当用温药不已而或四肢厥冷腹痛呕吐泄利急用热药须详脉来有力无力方可刘氏用灰包熨腹痛
庞 合灸不灸久则冷结气上冲心而死
活 身无大热烦渴大便实或腹痛满及生赤瘾疹者调胃承气汤黄连橘皮汤
腹痛兼头痛发热身痛吐利为霍乱欲吐不吐欲泻不泻为干霍乱法详杂病霍乱门
邪气侵入体内与正气相搏结，就会引起腹痛。之所以疼痛，是因为原因各不相同。腹痛属于里证，太阳经的腹部通常不痛；少阳经有胸胁部疼痛，但没有腹痛；如果有阳明病，会出现腹部胀满且急迫性疼痛。这属于里实证，适宜使用攻下法，可用大柴胡汤或小承气汤。三阴经出现下利清谷（排出未消化的食物）并且伴有腹痛的，是由于里寒所致。这是总论太阳经中“阳中之阴”的情况，可用四逆汤或附子理中汤温补阳气。
太阴经病变表现为腹部胀满且疼痛，其证候有两种：一种是实痛，一种是虚痛。如果伴有肠鸣、泄泻且疼痛，属于虚痛。这是专门论述太阴经中“阴中之阳”的情况，可用小建中汤（即桂枝加芍药汤，但桂枝用量有浓薄之分）。如果服用后症状未缓解，则用小柴胡汤去掉黄芩并加入芍药，如前文所述剂量。如果腹部胀满、大便秘结、按压时疼痛，属于实痛，可用桂枝加大黄汤，大黄用量为一钱。这里的虚痛和实痛，是指阳邪逐渐消退为虚，阳气盛大为实。
太阳伤寒证，若脉象阳部涩、阴部弦，应当出现腹中急痛。先给予小建中汤治疗；若无效，再给予小柴胡汤。（成无己注：脉象阳涩阴弦且腹中急痛的，应当判断为里有虚寒，治宜用小建中汤温中散寒。如果服药后不愈，说明不是里寒，必定是由邪气从表入里，导致里气不利所致，应给予小柴胡汤去掉黄芩并加入芍药，以清除传入里的邪气。）
小建中汤方剂组成：
桂枝（去除粗皮）三两，生姜（切片）三两，芍药六两，甘草（炙）二两，大枣（十二枚，掰开），胶饴一升。
以上六味药，用水七升，煮取三升，去渣，加入胶饴，再用微火加热使其溶解。每次温服一升，每日三次。如果出现呕吐，不可使用建中汤，因为其味甘甜。（《内经》说：肝气生于左，肺气藏于右，心位在上，肾处在下，脾属土，对应中央，位于四脏之中，为中州，负责生育营卫、通行津液。一旦不调，则营卫失去所育，津液失去所行，必须用此汤温健中焦脏腑，所以名为“建中”。脾喜欢舒缓，吃甘味食物可以缓急，健脾必须以甘味为主，所以用胶饴甘温作为君药；甘草甘平作为臣药；桂枝辛热，具有辛散和滋润的作用，针对营卫不足进行滋润和发散；芍药味微寒而酸收，具有泄降作用，针对津液不足进行收敛和运行，所以芍药和桂枝作为佐药；生姜味辛温，大枣味甘温，胃是卫气的源头，脾是荣气的根本，《针经》说：荣气出于中焦，卫气出于上焦，正是如此。卫气属阳，不足时需用辛味补益；荣气属阴，不足时需用甘味补益。辛甘相合，脾胃强健而荣卫通畅，所以用姜枣作为使药。有人问：桂枝汤用于解表，芍药数量少；建中汤用于温里，芍药数量多，为什么？因为皮肤部位较近，所以制方剂量小；心腹部位较远，所以制方剂量大。这就是两者的不同之处。）
伤寒病，胸中有热，胃中有邪气，导致腹中痛、想呕吐的，主治方为黄连汤。（成无己注：湿家病人在误下后舌上如苔者，是因为丹田有热、胸上有寒，这是邪气入里导致下热上寒。此处的伤寒邪气传里，导致下寒上热。胃中有邪气使得阴阳不交，阴气不能上升而独治于下，形成下寒，故腹中痛；阳气不能下降而独治于上，形成胸中热，故想呕吐。给予黄连汤以升降阴阳之气。）
黄连汤方剂组成：
黄连三两，甘草（炙）三两，干姜（炮制）三两，桂枝（去除粗皮）三两，人参二两，半夏（半升，洗净）十二枚，大枣（十二枚，掰开）。
以上七味药，用水一斗，煮取六升，去渣，温服一升，每日三次，夜间两次。（上热者用苦味泄之，黄连之苦以降阳；下寒者用辛味散之，桂枝、干姜、半夏之辛以升阴。脾喜欢舒缓，吃甘味食物可以缓急，人参、甘草、大枣之甘以益胃。）
伤寒五六天，或是中风，出现往来寒热、胸胁部苦闷胀满、沉默不想饮食、心烦喜呕，或者胸中烦闷但不呕吐，或者口渴，或者腹中痛，或者胁下痞硬，或者心下悸动、小便不利，或者不渴、身体有轻微发热，或者咳嗽的，给予小柴胡汤治疗。
两阳并病：太阳病初得时，发汗不彻底，因而转属阳明，继续自出微汗且不恶寒。如果太阳证未罢，不可攻下，可少量发汗。假设面色通红，是阳气怫郁在表，应当解表，或用熏法。如果发汗不彻底，病人烦躁，不知道疼痛的具体位置，有时在腹中，有时在四肢，按压又找不到痛点，病人短气，只是因为汗出不彻底，再次发汗即可痊愈，通过脉象涩可知。（桂枝汤适用于不恶寒，大柴胡汤适用于小汗，宜用葛根汤或桂枝麻黄各半汤、麻黄加桂枝汤。）
阳明病：病人不大便五六天，绕脐疼痛，烦躁发作有定时，这是因为有燥屎，所以导致不大便。（成无己注：不大便五六天，大便必然结成燥屎。胃中燥实，气不得下通，所以绕脐痛，烦躁发作有定时。）经过大泻下之后，过了六七天仍然不大便，烦躁不解除，腹部胀满，这说明有燥屎。之所以这样，是因为原本就有宿食。主治方为大承气汤。（大下之后，胃气虚弱不能消化食物，到了六七天不大便，宿食已经凝结不消，所以导致烦热不解而腹满痛，由此可知有燥屎，给予大承气汤以下除之。）发汗后病不解，腹部胀满疼痛的，需紧急攻下。
少阴病：病程二三天未愈，至四五天出现腹痛、小便不利、四肢沉重疼痛、自行下利的，这是有水气。或者咳嗽，或者呕吐，或者下利，或者小便通利的，主治方为真武汤。（成无己注：少阴病二三天邪气尚浅，至四五天邪气已深。肾主水，肾病不能制约水，水饮停聚成为水气。腹痛是因为寒湿内盛；四肢沉重疼痛是因为寒湿外盛；小便不利、自行下利是因为湿胜而水谷不分。《内经》说：湿胜则濡泄。给予真武汤以益阳散寒湿。）少阴病下利清谷，里寒外热，手足厥冷，脉微欲绝，反而不恶寒，面色赤红，或者腹痛，或者干呕，或者咽痛，或者利止但脉不出的，主治方为通脉四逆汤。（下利清谷、手足厥冷、脉微欲绝为里寒；身热、不恶寒、面色赤红为外热。这是阴盛于内，格阳于外，不相交通。给予通脉四逆汤以散阴通阳。）少阴病出现四肢逆冷，或者咳嗽，或者心悸，或者小便不利，或者腹中痛，或者泄利下重（排便时肛门重坠感）的，主治方为四逆散。（四逆指四肢不温。伤寒邪在三阳时手足必热，传到太阴时手足自温，到少阴时热邪渐深，所以四肢逆而不温。及至厥阴时手足厥冷，比逆更严重。给予四逆散以散传经之热。）少阴病二三日到四五天，腹痛、小便不利、下利不止、便脓血的，主治方为桃花汤。（二三日到四五天，寒邪入里较深。腹痛是里寒；小便不利是水谷不分；下利不止、便脓血是肠胃虚弱、下焦不固。给予桃花汤以固肠止利。）
太阴病：表现为腹部胀满、呕吐、饮食不下，自利益甚，时常腹部自发疼痛。如果误用攻下法，必然导致胸下结硬。（有的用理中汤丸，如果不渴用四逆汤等）。本为太阳病，医生反而误下，因此导致腹部胀满、时痛，属于太阴证，用桂枝加芍药汤；如果是大实痛，用桂枝加大黄汤（详见前文）。
厥阴病：伤寒四五天，腹中痛，如果感觉气体向下趋向少腹，这是将要发生下利。（伤寒四五天是邪气传里的时期，腹中痛、气体向下趋向少腹，是因为里虚遇寒，寒气下行，想要作自利。有的用附子干姜汤或四逆汤。）
云岐子说：伤寒邪气在三阴，内部不得交通，所以为腹痛。手足之经都汇聚于腹部。如脉弦而腹痛，病位在足厥阴肝经和手太阴肺经，针刺太冲、太渊、太陵穴。如脉沉而腹痛，病位在足太阴脾经、少阴肾经和手厥阴心包经，针刺太溪、太陵穴。如脉沉细而痛，病位在足太阴脾经和手少阴心经，针刺太白、神门、三阴交穴。这是针刺治疗腹痛的方法。
吴球说：凡是腹中痛，可以按揉的是内虚；不可以按揉的是内实。王海藏说：中脘痛属于脾土，脉沉细且内寒的，用理中汤或用附子理中丸主治。如果阳脉涩、阴脉弦，用小建中汤主治。如果小腹痛，属于厥阴经分，宜用当归四逆汤加吴茱萸主治。四肢厥逆的，用四逆汤加吴茱萸主治。如果大实、腹部胀满疼痛或绕脐刺痛、不大便、脉实的，用大承气汤攻下。凡是潮热、不大便，从心下至少腹硬满而痛、手不可触碰的，用大陷胸汤攻下。如果脉弦、腹痛、无热无寒的，用芍药甘草汤主治。凡是脉弦、口苦、发热、腹中痛的，用小柴胡汤去掉人参加炒白芍主治。如果寒热交替发作、腹中痛的，加肉桂、芍药主治。如果寒多而痛的，去掉黄芩，加倍肉桂、芍药。凡是少阴发热、手足冷、腹中痛的，用四逆散加附子、肉桂、炒芍药、吴茱萸主治。凡是发热、脉洪弦而腹痛的，用芍药黄芩汤主治。大抵腹痛有虚有实，有冷有热，关键在于根据脉证辨别而用药。凡是蓄血也会让人腹痛，手不可触碰，自有本条论述。如果是自利、腹痛、小便清白，应当温补，视程度轻重选用理中汤或四逆汤，轻者用五积散，重者用四逆汤，无脉者用通脉四逆汤，使阴退而阳复。腹痛想吐利且烦躁的，多有痧毒，世俗常用刺委中穴的方法。凡是脉微弦、小腹痛，属于厥阴，宜刺太冲、太渊、太陵，灸归来、关元穴。脉沉、脐腹痛，属于少阴，宜刺太白、神门、三阴交，灸中脘穴。
陶华说：伤寒腹中痛，用凉水喝后疼痛稍减的，属于热，应当用凉药；如果不服或无效，且出现绕脐硬痛、大便结实、烦渴的，属于燥屎痛，急用寒药攻下。或者是食积痛，治疗也类似。如果小腹硬痛、小便自利、大便黑、身目黄的，属于蓄血痛，治疗也类似，加上行血药，下尽黑物自愈。这三种情况都是“痛随利减”的方法。如果喝水后疼痛加剧的，属于寒，应当用温药；如果无效且出现四肢厥冷、腹痛、呕吐、泄利的，急用热药。必须详细诊察脉来有力无力方可决定。刘氏用灰包熨烫治疗腹痛。
When pathogenic factors invade the interior and contend with healthy qi, abdominal pain results. The causes of pain vary. Abdominal pain belongs to Interior syndromes; the Taiyang channel area of the abdomen typically does not hurt. Shaoyang syndromes present with hypochondriac pain but no abdominal pain. If Yangming syndrome is present, there is abdominal fullness and urgent pain. This indicates an Interior Excess syndrome suitable for purgation, using Da Chai Hu Tang (Major Bupleurum Decoction) or Xiao Cheng Qi Tang (Minor Order the Qi Decoction). In the Three Yin channels, if there is diarrhea with undigested food accompanied by abdominal pain, it is due to Interior Cold. This summarizes the "Yin within Yang" aspect of the Taiyang channel; Si Ni Tang (Frigid Extremities Decoction) or Fu Zi Li Zhong Tang (Aconite Regulate the Middle Decoction) can be used to warm and tonify Yang qi.
Taiyin channel pathology presents with abdominal fullness and pain. There are two types: Excess pain and Deficiency pain. Pain accompanied by borborygmus and diarrhea is Deficiency pain. This specifically discusses the "Yang within Yin" aspect of the Taiyin channel; Xiao Jian Zhong Tang (Minor Construct the Middle Decoction), which is Gui Zhi Jia Shao Yao Tang (Cinnamon Twig Decoction plus Peony Root) with variations in Cinnamon Twig dosage, is indicated. If symptoms persist, Xiao Chai Hu Tang (Minor Bupleurum Decoction) with Huang Qin removed and Shao Yao added as previously described is used. If abdominal fullness, constipation, and tenderness on palpation occur, this is Excess pain, treated with Gui Zhi Jia Da Huang Tang (Cinnamon Twig Decoction plus Rhubarb), using one qian of Da Huang. Here, Deficiency refers to the gradual dissipation of Yang pathogenic factors, while Excess refers to robust Yang qi.
In Taiyang Shang Han (Cold Damage), if the pulse is choppy at the superficial position and wiry at the deep position, acute abdominal pain should occur. Initially administer Xiao Jian Zhong Tang; if ineffective, then administer Xiao Chai Hu Tang. (Cheng Wuji notes: A choppy superficial and wiry deep pulse with acute abdominal pain indicates Interior Cold-Deficiency, treat with Xiao Jian Zhong Tang to warm the middle and dispel cold. If unresponsive, it is not Interior Cold but rather pathogenic factors moving from exterior to interior causing Interior qi stagnation; use Xiao Chai Hu Tang minus Huang Qin plus Shao Yao to clear interior pathogens.)
Formula: Xiao Jian Zhong Tang
Gui Zhi (Cortex Cinnamomi, remove bark) 3 liang, Sheng Jiang (Rhizoma Zingiberis Recens, sliced) 3 liang, Bai Shao (Radix Paeoniae Alba) 6 liang, Zhi Gan Cao (Radix Glycyrrhizae Preparata) 2 liang, Da Zao (Fructus Jujubae, 12 pieces, split), Jiao Yi (Malt Sugar) 1 sheng.
Boil the above six ingredients in seven sheng of water to obtain three sheng, strain, add Jiao Yi, and simmer gently until dissolved. Take one sheng warm, three times daily. Do not use Jian Zhong Tang if vomiting occurs due to its sweetness. (The Nei Jing states: Liver qi arises on the left, Lung qi resides on the right, Heart is superior, Kidney is inferior, Spleen is Earth corresponding to the Center, governing the four viscera, producing Ying and Wei qi, and circulating body fluids. Dysregulation leads to deficiency of Ying/Wei and fluids; this decoction warms and strengthens the Middle Jiao, hence "Jian Zhong". Spleen desires relaxation; sweet flavors relax urgency. Tonifying Spleen requires sweet flavors; thus, Jiao Yi (sweet/warm) is the Sovereign herb. Gan Cao (sweet/neutral) is the Minister. Gui Zhi (pungent/hot) disperses and moistens deficient Ying/Wei. Shao Yao (sour/cold) astringes and directs fluids. Thus, Shao Yao and Gui Zhi are Assistant herbs. Sheng Jiang (pungent/warm) and Da Zao (sweet/warm): Stomach is the source of Wei, Spleen is the root of Ying. The Zhen Jing states: Ying originates from Middle Jiao, Wei from Upper Jiao. Wei is Yang, supplemented by pungent; Ying is Yin, supplemented by sweet. Pungent and sweet harmonize Spleen/Stomach and circulate Ying/Wei; thus, Ginger and Jujube are Envoy herbs. Some ask: Gui Zhi Tang releases the exterior with little Shao Yao; Xiao Jian Zhong Tang warms the interior with much Shao Yao. Why? Skin is close, so dosage is small; Heart/Abdomen are distant, so dosage is large. This explains the difference.)
In Shang Han, if there is heat in the chest, pathogenic factors in the stomach causing abdominal pain and desire to vomit, treat with Huang Lian Tang (Coptis Decoction). (Cheng Wuji notes: Dampness patients purged incorrectly develop tongue coating due to heat in Lower Jiao and cold in Upper Chest, indicating interior pathogens causing lower heat/upper cold. Here, Shang Han pathogens transmit to interior causing lower cold/upper heat. Pathogens in stomach disrupt Yin-Yang interaction; Yin fails to ascend, causing lower cold and abdominal pain; Yang fails to descend, causing upper heat and desire to vomit. Huang Lian Tang regulates Yin-Yang qi.)
Formula: Huang Lian Tang
Huang Lian (Rhizoma Coptidis) 3 liang, Zhi Gan Cao (Radix Glycyrrhizae Preparata) 3 liang, Pao Gan Jiang (Rhizoma Zingiberis Preparata) 3 liang, Gui Zhi (Cortex Cinnamomi, remove bark) 3 liang, Ren Shen (Radix Ginseng) 2 liang, Ban Xia (Rhizoma Pinelliae Preparata, half sheng, washed) 12 pieces, Da Zao (Fructus Jujubae, 12 pieces, split).
Boil the above seven ingredients in ten dou of water to obtain six sheng, strain, take one sheng warm, three times daily and twice at night. (Upper heat is drained by bitter Huang Lian to descend Yang; lower cold is dispersed by pungent Gui/Zhi/Gan/Jiang/Ban Xia to ascend Yin. Spleen desires relaxation; sweet Ren Shen/Gan Cao/Da Zao tonifies Stomach.)
After five to six days of Shang Han or Feng Zhong (Wind Strike), presenting with alternating chills and fever, hypochondriac fullness, silent anorexia, irritability, and frequent vomiting, or chest irritability without vomiting, thirst, abdominal pain, hypochondriac stiffness, epigastric palpitations, dysuria, slight fever without thirst, or cough, administer Xiao Chai Hu Tang.
Two Yang channels combined disease: Initial Taiyang disease treated with incomplete sweating transmits to Yangming, continuing with slight sweating and no aversion to cold. If Taiyang signs persist, do not purge; induce slight sweating. If face is persistently red, Yang qi is constrained in the exterior; resolve via release or fumigation. If sweating was incomplete, causing restlessness, unknown pain location (sometimes abdominal, sometimes limbs, unpressable), shortness of breath, repeat sweating to cure, identified by choppy pulse. (Gui Zhi Tang for non-aversion to cold; Da Chai Hu Tang for slight sweating; consider Ge Gen Tang or Gui Zhi Ma Huang Ge Ban Tang or Ma Huang Jia Gui Zhi Tang.)
Yangming disease: Constipation for five to six days, periumbilical pain, periodic irritability, indicates dry feces preventing bowel movement. (Cheng Wuji notes: Five to six days of constipation implies dry feces. Stomach dryness/excess blocks qi descent, causing periumbilical pain and periodic irritability.) After severe purgation, if constipation persists for six to seven days with unresolved irritability and abdominal fullness, dry feces are present due to retained food. Treat with Da Cheng Qi Tang (Major Order the Qi Decoction). (Post-purgation weak stomach cannot digest; retained food consolidates after six to seven days, causing irritability/fullness/pain. Da Cheng Qi Tang purges them.) If sweating fails to resolve the condition and abdominal fullness/pain occurs, urgently purge.
Shaoyin disease: Unresolved after two to three days, progressing to four to five days with abdominal pain, dysuria, heavy/painful limbs, and spontaneous diarrhea indicates Water Qi retention. Accompanying symptoms may include cough, vomiting, diarrhea, or patent urination. Treat with Zhen Wu Tang (True Warrior Decoction). (Cheng Wuji notes: By day four-five, pathogens are deep. Kidney governs water; kidney failure leads to water retention. Abdominal pain is internal cold-damp; limb heaviness/pain is external cold-damp; dysuria/diarrhea is dampness overwhelming separation of fluids. Nei Jing: Dampness causes loose stools. Zhen Wu Tang tonifies Yang and disperses cold-damp.) Shaoyin disease with diarrhea of undigested food, Interior Cold with Exterior Heat, cold extremities, faint/almost imperceptible pulse, paradoxical absence of aversion to cold, and red complexion, or abdominal pain, dry heaving, sore throat, or cessation of diarrhea with absent pulse, treat with Tong Mai Si Ni Tang (Pulse-Restoring Frigid Extremities Decoction). (Diarrhea/cold extremities/faint pulse indicate Interior Cold; fever/no aversion/red face indicate Exterior Heat. This is Interior Yin excess repelling Exterior Yang. Tong Mai Si Ni Tang disperses Yin and unblocks Yang.) Shaoyin disease with cold extremities, or cough, palpitations, dysuria, abdominal pain, or sensation of rectal heaviness during diarrhea, treat with Si Ni San (Frigid Extremities Powder). (Si Ni refers to cold extremities. Yang channel diseases have hot hands/feet; Taiyin has warm hands/feet; Shaoyin has cold extremities due to deep heat; Jueyin has cold extremities, worse than Si Ni. Si Ni San disperses transmitted heat.) Shaoyin disease progressing from two-three to four-five days with abdominal pain, dysuria, persistent diarrhea with pus/blood, treat with Tao Hua Tang (Peach Blossom Decoction). (Deep interior cold; abdominal pain is Interior Cold; dysuria is fluid/food separation failure; persistent diarrhea/pus/blood is intestinal weakness and lower Jiao insecurity. Tao Hua Tang secures intestines and stops diarrhea.)
Taiyin disease: Presents with abdominal fullness, vomiting, inability to eat, worsening spontaneous diarrhea, and spontaneous abdominal pain. Purging will cause sub-xiphoid hardness. (Use Li Zhong Tang/Wan if not thirsty; Si Ni Tang etc. otherwise.) Originally Taiyang disease, incorrectly purged by physician, leading to abdominal fullness and intermittent pain belonging to Taiyin, use Gui Zhi Jia Shao Yao Tang. For severe Excess pain, use Gui Zhi Jia Da Huang Tang (see previous section).
Jueyin disease: Shang Han after four-five days with abdominal pain and gas moving downward toward the lower abdomen indicates impending diarrhea. (Pathogens transmit to interior; abdominal pain and gas moving down indicate Interior Deficiency meeting Cold, causing Cold to descend and spontaneous diarrhea. Use Fu Zi Gan Jiang Tang or Si Ni Tang.)
Yun Qizi states: Shang Han pathogens in Three Yin fail to communicate internally, causing abdominal pain. Hand-Foot channels converge at the abdomen. Wiry pulse with abdominal pain indicates Foot Jueyin Liver and Hand Taiyin Lung channels; puncture Tai Chong, Tai Yuan, Tai Ling. Deep pulse with abdominal pain indicates Foot Taiyin Spleen, Shaoyin Kidney, and Hand Jueyin Pericardium channels; puncture Tai Xi, Tai Ling. Deep-thin pulse with pain indicates Foot Taiyin Spleen and Hand Shaoyin Heart channels; puncture Tai Bai, Shen Men, Yin Jiao. This is the acupuncture method for abdominal pain.
Wu Qiu states: Abdominal pain that can be pressed/massaged is Internal Deficiency; pain that cannot be pressed is Internal Excess. Wang Hai Cang states: Zhong Wan pain belongs to Spleen Earth; deep-thin pulse with Internal Cold uses Li Zhong Tang or Fu Zi Li Zhong Wan. Superficial choppy/deep wiry pulse uses Xiao Jian Zhong Tang. Lower abdominal pain belongs to Jueyin channel; use Dang Gui Si Ni Tang plus Wu Zhu Yu. Cold extremities use Si Ni Tang plus Wu Zhu Yu. Severe Excess, abdominal fullness/pain, periumbilical stabbing pain, constipation, and solid pulse use Da Cheng Qi Tang to purge. Tidal fever, constipation, hardness/fullness/pain from epigastrium to lower abdomen, intolerant to touch, use Da Xian Xiong Tang to purge. Wiry pulse, abdominal pain, no heat/cold, use Shao Yao Gan Cao Tang. Wiry pulse, bitter taste, fever, abdominal pain, use Xiao Chai Hu Tang minus Ren Shen plus fried Bai Shao. Alternating chills/fever with abdominal pain adds Rou Gui and Shao Yao. More cold with pain removes Huang Qin and doubles Rou Gui/Shao Yao. Shaoyin fever, cold extremities, abdominal pain use Si Ni San plus Fu Zi, Rou Gui, fried Shao Yao, Wu Zhu Yu. Fever, surging-wiry pulse, abdominal pain use Shao Yao Huang Qin Tang. Generally, abdominal pain has Deficiency/Excess and Cold/Heat; differentiate by pulse/symptoms. Blood stasis also causes abdominal pain, intolerant to touch (see specific section). Spontaneous diarrhea, abdominal pain, clear urine require warming; choose Li Zhong or Si Ni Tang based on severity; mild cases use Wu Ji San, severe use Si Ni Tang, pulseless use Tong Mai Si Ni Tang to retreat Yin and restore Yang. Abdominal pain with desire to vomit/diarrhea and restlessness often involves Sha Du (sand poison); worldly practice pierces Wei Zhong. Wiry-micro pulse, lower abdominal pain (Jueyin) puncture Tai Chong, Tai Yuan, Tai Ling, moxa Gui Lai, Guan Yuan. Deep pulse, umbilical pain (Shaoyin) puncture Tai Bai, Shen Men, Yin Jiao, moxa Zhong Wan.
Tao Hua states: Shang Han abdominal pain relieved slightly by cold water indicates Heat; use cooling herbs. If ineffective with periumbilical hard pain, constipation, irritability/thirst, it is Dry Feces pain; urgently purge with cold herbs. Food stagnation pain is treated similarly. Lower abdominal hard pain, patent urination, black stool, yellow eyes/body indicate Blood Stasis pain; treat similarly adding blood-moving herbs to purge black matter for self-healing. These three follow the principle "pain decreases with relief." Pain worsened by drinking water indicates Cold; use warming herbs. If ineffective with cold extremities, abdominal pain, vomiting, diarrhea, urgently use hot herbs. Verify pulse strength. Liu Shi used ash packs to moxa abdominal pain.
Pang An Shi states: Combined diseases requiring moxibustion but neglected lead to Cold stagnation rushing to the Heart and death.
Luo Yi (Huoren Shu) states: No high fever, irritability/thirst, solid stool, or abdominal fullness/rash treated with Tiao Wei Cheng Qi Tang or Huang Lian Ju Pi Tang.
Abdominal pain with headache, fever, body ache, vomiting/diarrhea is Huo Luan ( cholera-like illness); desire to vomit/diarrhea but unable is Gan Huo Luan (dry cholera). See Miscellaneous Diseases Huo Luan section for methods.