或问胁痛从肝治，复有可言者乎？曰肝病内舍 胁而胁痛也，则何异于心肺内舍膺胁而痛者哉。
若谓肝实病而 胁痛也，则何异于肝木不及、阳明所胜之 胁痛者哉。若谓由是厥阴肝经所过而痛也，
则何异于足少阳、手心主所过而胁痛者哉。若谓独经脉挟邪而痛也，则何异于经筋所过而痛者哉。岂
执一说而可已乎。非察色按脉，遍识各经气变，虽在一病之中，而辨其异状者，卒不能也。且夫左右
者，阴阳之道路也。是故肝生于左，肺脏于右，所以左属肝。肝脏血，肝阳也，血阴也，
乃外阳而内阴也。上属肺，肺主气，肺阴也，气阳也，外阴而内阳也。由阴阳互脏，其左胁多因留血
作痛，右胁悉是痰积作痛，其两胁之病，又可一概而言乎。若论其致病之邪，凡外之六淫，内之七情，
劳役饮食，皆足以致痰气积血之病。虽然痰气固亦有流注于左者，然必与血相搏而痛，不似右胁之痛
无关于血也。戴云∶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、川芎、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。挟外感风寒，有表证，宜芎葛汤。中脘不快，腹胁胀满，
香橘汤。腹胁疼痛，气促喘急，分气紫苏饮。悲哀伤肝，气引
两胁疼痛，枳壳煮散。右胁痛，推气散。左胁痛，枳芎散，或柴胡疏肝散。死血者，日轻夜重，或午
后热，脉短涩或芤，桃仁承气汤加鳖甲、青皮、柴胡、芎、归之属。若跌扑胁痛者，亦是死血，宜复
元活血汤、破血散瘀汤。怒气者，脉弦实有力，大剂香附合芎归之属。痰饮停伏者，脉沉弦滑，导痰
汤加白芥子。戴云∶停饮胁痛，《本事方》面丸最佳。食积痛，凡痛有一条扛起者是也。用保和丸，
或吴茱萸炒黄连，神曲、麦芽、山楂、蓬术、三棱、青皮。发寒热胁痛，觉有积块，当归龙荟丸。经
云∶肝病者，两胁下痛引少腹，善怒。又云∶肝气实则怒，左关必弦实鼓击，独大于诸脉，知肝火盛
也。龙荟丸治肝实胁痛，其人气收者，善怒是也。甚则用姜汁吞下。经云∶风木淫胜，治以辛凉是也。
因惊伤肝胁痛，桂枝散。仲景云∶胁下偏痛发热，其脉弦紧，此寒也。以温药下之，宜大黄附子汤。
煮黄丸，治胁下 癖痛如神。控涎丹，治一身气痛及胁走痛。痰挟死血，加桃仁泥。凡胁有痰流注，
二陈加南星、川芎、苍术，实者控涎丹下之。枳实散，攻中有补，虚人可用。戴云∶曾有人胁痛连膈，
进诸气药，并自大便导之，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。
肝气不足，两胁下满，筋急，不得太息，四肢
厥冷，发抢心腹痛，目不明了，爪甲枯，口面青，宜补肝汤。左胁偏痛久，宿食不消，并目KT KT
昏风泪出，见物不审，而逆风寒偏甚，宜补肝散。肝虚寒，胁下痛，胀满气急，目昏浊，视物不明，
其脉迟弱者，宜槟榔汤。肝气虚，视物不明，两胁胀满，筋脉拘急，面色青，小腹痛，用山茱萸、当
归、山药、黄 、五味子、木瓜、川芎各一两半，熟地黄、白术各一两，独活、酸枣仁各四铢为末。
每三钱匕，枣二枚，水一盏，煎取八分，空心服。房劳过多，肾虚羸怯之人，胸膈之间多有隐隐微痛，
此肾虚不能约气，气虚不能生血之故。气与血犹水也，盛则流畅，少则壅滞。故气血不虚则不滞，既
虚则鲜有不滞者，所以作痛。宜用破故纸之类补肾，芎、归之类和血，若作寻常胁痛治，即殆矣。一
人六月途行，受热过劳，性又躁暴，忽左胁痛，皮肤上一片红如碗大，发水泡疮三五点，脉七至而弦，
夜重于昼，医作肝经郁火治之，以黄连、青皮、香附、川芎、柴胡之类，进一服，其夜痛极，且增热。
次早视之，皮肤上红大如盘，水泡疮又加至三十余粒，医教以水调白矾末敷，仍于前药加青黛、龙胆
草进之，夜痛益甚，胁中如钩摘之状。次早视之，红已及半身矣，水泡又增至百数。乃载以询黄古潭，
为订一方，以大栝蒌一枚，重一二两者，连皮
捣烂，加粉草二钱，红花五分，进药少顷即得睡，比觉已不痛矣。盖病势已急，而时医执寻常泻肝正
治之剂，又多苦寒，愈资其燥，故病转增剧。水泡疮发于外者，肝郁既久，不得发越，乃侮所不胜，
故皮腠为之溃也。栝蒌味甘寒，经云泄其肝者缓其中，且其为物，柔而滑润，于郁不逆，甘缓润下，
又如油之洗物，未尝不洁，此其所以奏效之捷也欤。《九灵山房集》云∶里钟姓者，一男子病胁痛，
众医以为痈也。投诸香姜桂之属益甚。项彦章诊其脉告曰，此肾邪病，法当先温利而后竭之，投神保
丸下黑溲痛止，即令更服神芎丸，或疑其太过，彦章曰向用神保丸，以肾邪透膜，非全蝎不能引导，
然巴豆性热，非得芒硝、大黄荡涤之，后遇热必再作，乃大泄数出病已。彦章所以知男子之病者，以
阳脉弦，阴脉微涩，弦者，痛也。涩者，肾邪有余也。肾邪上薄于胁不能下，且肾方恶燥，今以燥热
发之，非得利不愈。经曰∶痛随利减，殆谓此也。云中秦文山掌教平湖，与家兄同官，每患胁痛，遇
劳忍饿则发，介家兄书来求方，予为处以人参、黄 、白术、当归、川芎、地黄、牛膝、木瓜、山茱
萸、石斛、薏苡仁、酸枣仁、柏子仁、桃仁之属，令常服之。后来谢云，自服药后，积久之疾，一朝
而愈，不复发矣。闻魏昆溟吏部，亦以劳饿得胁痛，无
大病也。而医者投以枳壳、青皮破气之药，痛愈甚，不数日而殒。予故着之以为世戒。
【诊】合腋张胁者肺下，肺下则居贲迫肺，善胁下痛。青色粗理者肝大，肝大则逼胃迫咽，则
苦膈中，且胁下痛。凡胁骨偏举者，肝偏倾，肝偏倾则胁下痛。揭唇者脾高，脾高则 引季胁而痛。
寸口脉弦者，即胁下拘急而痛，其人啬啬恶寒也。脉双弦，是两手俱弦也。沉涩是郁，细紧或弦者怒
气。
有人问：胁痛从肝脏论治，还有其他的说法吗？回答说：肝病内在于胁部而导致胁痛，这与心肺内在于膺部和胁部而致痛的道理有何不同呢？如果说这是肝实证导致的胁痛，那与肝木气不足、阳明燥金之气偏胜所致的胁痛又有何区别呢？如果说这是因为厥阴肝经循行经过此处而疼痛，那与足少阳胆经、手厥阴心包经循行经过此处而致胁痛又有何不同呢？如果说仅仅是经脉挟带邪气而痛，那与经筋循行经过此处而痛又有何区别呢？难道拘执于一种说法就可以治愈疾病了吗？如果不能通过观察面色、诊察脉象，全面识别各经络的气机变化，即使是在同一种疾病中，也无法辨别其不同的症状表现。况且左右两侧，是阴阳之气运行的道路。所以肝气生于左侧，肺气藏于右侧，因此左侧归属于肝。肝体藏血，肝用属阳，血属阴，这是外阳而内阴。上部关联肺脏，肺主气，肺属阴，气属阳，这是外阴而内阳。由于阴阳互根互用，左侧胁痛多因瘀血停留所致，右侧胁痛完全是由痰积引起，两胁的疾病，怎么能一概而论呢？如果论述致病的原因，凡是外在的六淫邪气，内在的七情刺激，以及劳役过度、饮食不节，都足以导致痰、气、瘀血的病变。虽然痰气和瘀血确实也有流注于左侧的情况，但必然与血相搏结而痛，不像右侧胁痛那样与血无关。戴元礼说：伤寒引起的胁痛属于少阳经，应当合用小柴胡汤（小柴胡汤）。疼痛剧烈且大便不通者，在方中加入枳壳。如果是普通的胁痛，不属于典型的伤寒病，身体伴有轻微发热者，《太平惠民和剂局方》中的枳壳煮散，使用枳壳、桔梗、细辛、川芎、防风各四分，干葛钱半，甘草一钱。如果只是胁痛，没有其他杂症，疼痛在左侧，为肝经受邪，宜用川芎、枳壳、甘草。疼痛在右侧，为肝经病邪传移于肺，宜用片姜黄、枳壳、桂心、甘草。这两个方子出自严用和的《济生续集》，加减运用在于医生。又有肝胆经停聚痰饮，或单侧胁痛，宜用严氏导痰汤。痰结成癖块，间歇服用半硫丸。因为枳壳是治疗胁痛的要药，所以在各方中都不能缺少。曾听潘子先说，有人胁痛，服用青龙汤后疼痛停止，兼有咳嗽也好了，这疼痛一定在右胁的缘故。明确知道是寒气作痛，宜用枳实理中汤。挟带外感风寒，有表证，宜用芎葛汤。中脘部不适，腹部和胁部胀满，用香橘汤。腹部和胁部疼痛，气促喘急，用分气紫苏饮。悲哀伤肝，气机牵引两胁疼痛，用枳壳煮散。右胁痛，用推气散。左胁痛，用枳芎散，或者柴胡疏肝散。死血（瘀血）作痛，表现为白天轻晚上重，或者午后发热，脉短涩或芤，用桃仁承气汤加鳖甲、青皮、柴胡、川芎、当归等药。如果是跌打损伤导致的胁痛，也是死血，宜用复元活血汤、破血散瘀汤。因怒气导致的，脉弦实有力，大剂量使用香附配合川芎、当归等药。痰饮停伏者，脉沉弦滑，用导痰汤加白芥子。戴元礼说：停饮导致的胁痛，《本事方》中的黑锡丹最佳。食积疼痛，凡是疼痛有一条线扛起感觉的就是。用保和丸，或者吴茱萸炒黄连，神曲、麦芽、山楂、蓬术、三棱、青皮。发寒热且胁痛，感觉有积块，用当归龙荟丸。《内经》说：肝病的人，两胁下痛牵引少腹，容易发怒。又说：肝气实则易怒，左关脉必弦实鼓击，独大于其他脉象，可知肝火盛。龙荟丸治疗肝实胁痛，其人性格收敛、易怒的适用。严重时可用姜汁送服。《内经》说：风木淫胜，用辛凉药物治疗，就是这个意思。因惊吓伤肝导致的胁痛，用桂枝散。张仲景说：胁下偏痛发热，脉弦紧，这是寒证。用温下药治疗，宜用大黄附子汤。煮黄丸，治疗胁下癖块疼痛如神效。控涎丹，治疗全身气痛及胁部游走性疼痛。痰挟死血，加桃仁泥。凡胁下有痰流注，二陈汤加南星、川芎、苍术，实证用控涎丹攻下。枳实散，攻中有补，虚人可用。戴元礼说：曾有人胁痛连及膈部，进服各种理气药，并用大便导法，疼痛反而更严重，后来用辛热补剂，服用黑锡丹才痊愈。这是虚冷作痛，越疏利就越虚弱。肝气不足，两胁下胀满，筋脉拘急，不能深呼吸，四肢厥冷，发作抢心痛腹痛，眼睛看不清楚，指甲枯槁，口唇面部青色，宜用补肝汤。左胁偏痛日久，宿食不消，并目眩昏花、迎风流泪，视物不清，且逆受风寒较重，宜用补肝散。肝虚寒，胁下痛，胀满气急，目昏浊，视物不明，脉迟弱者，宜用槟榔汤。肝气虚，视物不明，两胁胀满，筋脉拘急，面色青，小腹痛，用山茱萸、当归、山药、黄芪、五味子、木瓜、川芎各一两半，熟地黄、白术各一两，独活、酸枣仁各四铢，研为末。每次取三钱匕，大枣两枚，水一盏，煎取八分，空腹服用。房事过多，肾虚羸弱之人，胸膈之间多有隐隐微痛，这是肾虚不能约束气，气虚不能生血的缘故。气与血就像水一样，旺盛则流畅，少则壅滞。所以气血不虚就不会滞涩，既然虚了，很少有不会滞涩的，因此作痛。宜用补骨脂之类补肾，川芎、当归之类和血，如果当作普通胁痛治疗，就危险了。有一人六月赶路，受热过劳，性情又急躁暴戾，忽然左胁痛，皮肤上一片红如碗大，发出水泡疮三五点，脉七至而弦，夜间重于白天，医生当作肝经郁火治疗，用黄连、青皮、香附、川芎、柴胡等药，服下一剂后，当晚疼痛极度加剧，且增加发热。次日早上看，皮肤上红色扩大如盘，水泡疮又增加到三十多粒，医生建议用水调白矾末外敷，仍在前方中加入青黛、龙胆草内服，夜晚疼痛更加厉害，胁中像被钩摘一样的痛苦。次日早上看，红色已蔓延到半身，水泡又增加到上百个。于是载着病人去咨询黄古潭，为他订一方，用大栝蒌一枚，重一二两的，连皮捣烂，加粉甘草二钱，红花五分，服药片刻后即能入睡，醒来已经不痛了。大概病情紧急，而当时医生拘执于寻常泻肝的正治之剂，又多苦寒，更加助长其燥性，所以病情转剧。水泡疮发于外部，是因为肝郁已久，不得发散，于是侮其所不胜（脾土），所以皮肤腠理溃烂。栝蒌味甘寒，《内经》说泄肝者缓其中，而且它质地柔润滑利，对于郁结不逆，甘缓润下，又像油洗东西，没有不干净的，这就是它奏效迅速的原因吧。《九灵山房集》记载：里钟姓的人，一个男子患胁痛，众医认为是痈疽。投以各种香燥姜桂类药物，病情加重。项彦章诊其脉告诉他说，这是肾邪病，法当先温利而后竭之，投神保丸使黑色溲便排出，疼痛停止，随即令再服神芎丸，有人怀疑太过，彦章说先前用神保丸，因为肾邪透膜，非全蝎不能引导，然而巴豆性热，非得芒硝、大黄荡涤之，否则遇热必复发，于是大泄数次病愈。彦章之所以知道男子的病，是因为阳脉弦，阴脉微涩，弦者痛也，涩者肾邪有余也。肾邪上迫于胁不能下行，且肾恶燥，现在用燥热激发它，非得通利才能痊愈。经上说：痛随利减，大概说的就是这种情况。云中秦文山任平湖掌教，与家兄同官，每患胁痛，遇到劳累忍饿就发作，介家兄写信来求方，我给他处以人参、黄芪、白术、当归、川芎、地黄、牛膝、木瓜、山茱萸、石斛、薏苡仁、酸枣仁、柏子仁、桃仁等药，令常服。后来感谢说，自服药后，积久之疾，一朝而愈，不再复发。听说魏昆溟吏部，也因劳累饥饿得胁痛，无大病。而医者投以枳壳、青皮破气之药，疼痛更甚，不数日而死。我特意写下这些作为世人的警戒。
【诊法】腋下张开、胁部外挺的是肺下，肺下则居于贲门压迫肺脏，容易胁下痛。面色青、纹理粗糙的是肝大，肝大则逼迫胃和咽，导致膈中不适，且胁下痛。凡胁骨偏斜隆起的是肝偏倾，肝偏倾则胁下痛。嘴唇掀开的是脾高，脾高则牵引季胁而痛。寸口脉弦，即胁下拘急而痛，其人啬啬恶寒。脉双弦，是指两手脉俱弦。脉沉涩是气郁，脉细紧或弦是怒气所致。
Someone asked: Regarding hypochondriac pain treated from the Liver, are there other perspectives? The reply was: If Liver disease involves internally and causes hypochondriac pain, how is it different from Heart and Lung diseases involving internally in the chest and hypochondrium causing pain? If one claims this is due to Liver Excess causing hypochondriac pain, how does it differ from hypochondriac pain caused by insufficient Wood Qi or prevailing Yangming Metal Qi? If one argues it is because the Jueyin Liver Meridian passes through here causing pain, how is it different from hypochondriac pain caused by the Foot Shaoyang Gallbladder Meridian or Hand Jueyin Pericardium Meridian passing through? If one asserts it is merely meridians carrying pathogenic factors causing pain, how is it different from tendons-muscles pathways causing pain? Can one cure disease by adhering rigidly to a single theory? Without observing complexion and palpating pulses, and comprehensively recognizing Qi transformations of each meridian, even within a single disease, one cannot distinguish its varied manifestations. Furthermore, the left and right sides are the pathways of Yin and Yang. Thus, Liver Qi arises on the left, Lung Qi resides on the right; hence the left belongs to the Liver. The Liver stores Blood (Blood), and Liver Yang is functional; Blood is Yin, representing Outer Yang and Inner Yin. The upper part relates to the Lung, which governs Qi; Lung is Yin, Qi is Yang, representing Outer Yin and Inner Yang. Due to the mutual interaction of Yin and Yang, left-sided hypochondriac pain is mostly due to retained Blood stasis, while right-sided hypochondriac pain is entirely due to Phlegm accumulation. How can diseases of both hypochondria be discussed uniformly? Regarding etiology, external Six Evils, internal Seven Emotions, overwork, and dietary irregularities are sufficient to cause disorders of Phlegm, Qi stagnation, and Blood stasis. Although Phlegm and Qi may indeed flow to the left, they must contend with Blood to cause pain, unlike right-sided pain which is unrelated to Blood. Dai Yuanli stated: Hypochondriac pain due to Cold Damage belongs to the Shaoyang Meridian; Xiao Chai Hu Tang (Minor Bupleurum Decoction) should be combined. For severe pain with constipation, add Zhi Qiao (Immature Bitter Orange). For ordinary hypochondriac pain not belonging to typical Cold Damage, accompanied by slight fever, use Zhi Qiao Zhu San (Bitter Orange Decoction) from *Taiping Huimin Heji Jufang*, comprising Zhi Qiao, Jie Geng, Xi Xin, Chuan Xiong, Fang Feng each 4 fen, Ge Gen 1.5 qian, Gan Cao 1 qian. If there is only hypochondriac pain without other symptoms, pain on the left indicates Liver Meridian pathogen invasion, suitable for Chuan Xiong, Zhi Qiao, Gan Cao. Pain on the right indicates Liver pathology transferring to the Lung, suitable for Pian Jiang Huang, Zhi Qiao, Gui Xin, Gan Cao. These two formulas are from Yan Yonghe's *Jisheng Xu Ji*; modifications depend on the physician. For Phlegm and fluid retention in the Liver and Gallbladder meridians, or unilateral hypochondriac pain, Yan Shi Dao Tan Tang (Phlegm-Expelling Decoction) is appropriate. For Phlegm forming masses, administer Ban Liu Wan intermittently. Since Zhi Qiao is a key herb for treating hypochondriac pain, it is indispensable in various formulas. Pan Zixian once mentioned a case where hypochondriac pain ceased after administering Qing Long Tang, along with cough resolution; this pain must have been on the right side. Clearly identifying cold-induced pain, Zhi Shi Li Zhong Tang is suitable. With exogenous Wind-Cold and exterior signs, Xiong Ge Tang is indicated. Discomfort in the Zhongwan region with abdominal and hypochondriac distension calls for Xiang Ju Tang. Abdominal and hypochondriac pain with shortness of breath and wheezing requires Fen Qi Zi Su Yin. Sorrow injuring the Liver, with Qi drawing both hypochondria into pain, uses Zhi Qiao Zhu San. Right hypochondriac pain uses Tui Qi San. Left hypochondriac pain uses Zhi Xiong San or Chai Hu Shu Gan San. Blood stasis pain presents as lighter by day and heavier by night, or afternoon fever, with short, choppy, or knotted pulse; Tao Ren Cheng Qi Tang plus Bie Jia, Qing Pi, Chai Hu, Chuan Xiong, Dang Gui is used. Traumatic hypochondriac pain is also blood stasis, suitable for Fu Yuan Huo Xue Tang or Po Xue San Yu Tang. Anger-induced pain features wiry, full, and forceful pulse; large doses of Xiang Fu combined with Chuan Xiong and Dang Gui are used. Phlegm-fluid retention shows deep, wiry, slippery pulse; Dao Tan Tang plus Bai Jie Zi is indicated. Dai Yuanli noted: For fluid-retention hypochondriac pain, Hei Xi Dan from *Ben Shi Fang* is best. Food-stagnation pain, characterized by a sensation of a line lifting the pain, is treated with Bao He Wan or Coptis stir-fried with Evodia, Shen Qu, Mai Ya, Shan Zha, Peng Ze, San Leng, Qing Pi. Fever and chills with hypochondriac pain and palpable masses require Dang Gui Long Hui Wan. The *Classic* states: Liver disease causes pain in both hypochondria radiating to the lower abdomen, with irritability. It also says: Liver Qi excess leads to anger; the left Guan pulse will be wiry, full, and striking, larger than others, indicating strong Liver Fire. Long Hui Wan treats Liver-excess hypochondriac pain in individuals who are reserved and irritable. Severe cases may use Ginger Juice to swallow. The *Classic* states: When Wind-Wood prevails excessively, treat with Acrid-Cool methods. Startle-injury to the Liver causing hypochondriac pain uses Gui Zhi San. Zhang Zhongjing said: Unilateral hypochondriac pain with fever and wiry-tight pulse indicates Cold; treat with warming purgatives, Da Huang Fu Zi Tang is suitable. Zhu Huang Wan treats hypochondriac mass pain effectively. Kong Xian Dan treats general Qi pain and wandering hypochondriac pain. For Phlegm with blood stasis, add Tao Ren paste. For Phlegm flowing in the hypochondrium, Er Chen Tang plus Nan Xing, Chuan Xiong, Cang Zhu is used; for excess patterns, Kong Xian Dan purges. Zhi Shi San contains both attacking and tonifying properties, suitable for deficient persons. Dai Yuanli recounted a case of hypochondriac pain radiating to the diaphragm; after using Qi-regulating herbs and bowel purgatives, pain worsened. Later, Acrid-Warm tonics and Hei Xi Dan cured it. This was deficiency-cold pain; further draining increased deficiency. Liver Qi deficiency causes bilateral hypochondriac fullness, tendon tension, inability to take deep breaths, cold limbs, sudden heart/abdominal pain, blurred vision, brittle nails, and bluish lips/face; Bu Gan Tang is indicated. Chronic left-sided hypochondriac pain with undigested food, dizziness, wind-tearing, unclear vision, and sensitivity to Wind-Cold requires Bu Gan San. Liver deficiency-cold with hypochondriac pain, distension,急促 breathing, blurry vision, and slow-weak pulse calls for Bing Lang Tang. Liver Qi deficiency with unclear vision, bilateral hypochondriac distension, tendon tension, bluish face, and lower abdominal pain uses Shan Zhu Yu, Dang Gui, Shan Yao, Huang Qi, Wu Wei Zi, Mu Gua, Chuan Xiong each 1.5 liang, Shu Di Huang, Bai Zhu each 1 liang, Du Huo, Suan Zao Ren each 4 zhu, powdered. Take 3 qian bi, 2 dates, 1 cup water, decoct to 0.8 cup, take empty stomach. Excessive sexual activity leading to Kidney deficiency and emaciation often causes vague chest/diaphragm pain due to Kidney failing to constrain Qi and Qi failing to generate Blood. Qi and Blood are like water; abundant flows freely, scant becomes stagnant. Thus, non-deficient Qi/Blood do not stagnate; deficiency leads to stagnation and pain. Use Gu Bo Zhi to tonify Kidney, Chuan Xiong/Dang Gui to harmonize Blood. Treating this as ordinary hypochondriac pain is dangerous. A man traveling in June suffered heat and overwork, had an irritable temperament, and suddenly developed left hypochondriac pain with a bowl-sized red patch and 3-5 vesicles. Pulse was rapid (7 beats per breath) and wiry, worse at night. Physicians treated it as Liver depression-fire with Huang Lian, Qing Pi, Xiang Fu, Chuan Xiong, Chai Hu. After one dose, pain intensified with fever. Next morning, redness expanded to plate-size, vesicles increased to 30+. Physician advised Alum powder externally and added Qing Dai, Long Dan Cao internally. Night pain became agonizing ("like being hooked"). Next morning, redness covered half the body, vesicles numbered in hundreds. Consulted Huang Gutan, who prescribed one large Gua Lou (1-2 liang), smashed with skin, plus Gan Cao 2 qian, Hong Hua 5 fen. Patient slept shortly after taking medicine and woke pain-free. The condition was acute, but physicians rigidly applied standard Liver-draining agents, mostly Bitter-Cold, exacerbating dryness. Vesicles appeared externally because prolonged Liver depression failed to vent, insulting the unconquered (Spleen Earth), causing skin breakdown. Gua Lou is sweet and cold; the *Classic* says "drain the Liver by soothing the center." Its texture is soft and slippery, not opposing stagnation, sweet-soothing and moistening-purging, like oil cleaning dirt. This explains its rapid efficacy. *Jiu Ling Shan Fang Ji* records: A man named Zhong had hypochondriac pain; doctors diagnosed abscess. Aromatic, Ginger, Cinnamon drugs worsened it. Xiang Yanzhang diagnosed Kidney Evil via pulse, advised warming/moving then exhausting. Shen Bao Wan induced black urine, stopping pain. Then Shen Xiong Wan was given. Doubts arose about intensity. Xiang explained Shen Bao Wan used Quan Xie to guide Kidney evil through membranes; Ba Dou is hot, requiring Mang Xiao/Da Huang to purge, otherwise recurrence upon heat exposure. Profuse purgation cured him. Xiang knew it was male pathology because Yang pulse was wiry (pain), Yin pulse slightly choppy (Kidney excess). Kidney evil pressed upward on hypochondrium but couldn't descend; Kidney dislikes dryness, now aggravated by dry-heat, requiring purgation. The *Classic* says "pain decreases with purgation." Qin Wenshan from Yunzhong served as Pinghu instructor with my elder brother, suffering hypochondriac pain triggered by fatigue/hunger. My brother requested a formula. I prescribed Ren Shen, Huang Qi, Bai Zhu, Dang Gui, Chuan Xiong, Di Huang, Niu Xi, Mu Gua, Shan Zhu Yu, Shi Hu, Yi Yi Ren, Suan Zao Ren, Bai Zi Ren, Tao Ren. Regular use cured chronic illness instantly. Wei Kunming, a ministry official, also got hypochondriac pain from fatigue/hunger, no major disease. Doctors gave Zhi Qiao, Qing Pi to break Qi; pain worsened, died in days. I record this as a warning.
[Diagnosis] Axillary opening and flaring ribs indicate low-positioned Lung; low Lung presses on the贲 (cardia) compressing the Lung, prone to hypochondriac pain. Blue complexion with coarse texture indicates enlarged Liver; enlarged Liver presses Stomach and pharynx, causing diaphragmatic discomfort and hypochondriac pain. Prominent lateral rib bones indicate tilted Liver; tilted Liver causes hypochondriac pain. Everted lips indicate high-positioned Spleen; high Spleen pulls costal margin causing pain. Cunkou pulse wiry indicates hypochondriac tension/pain and aversion to cold. Double-wiry pulse means both hands are wiry. Deep-choppy pulse indicates stagnation; fine-tight or wiry pulse indicates anger.