胸腹、胁肋、胃脘诸痛，古人立九痛之名，其要不外寒热、虚实、气血、痰食、虫之因。惟
寒能凝结，热能消烁，寒甚厥逆上冲，热甚熏灼上炎，必使寒热平调，脏腑自能通畅，何有
于痛哉。其间夹杂各症，总不越寒热之纲领，不难参以兼治，自获病随药瘳也。至于肝脏气
逆上冲，每多胃脘当心而痛，上肢、两胁、膈咽不通，治宜降逆柔肝。仲景制乌梅丸为泄木安
中之良法，乃寒热并用，平调至法。若阳微，则从吴萸汤法。如肝阳过盛，减除吴、附，少用
椒、姜，而合梅、连、楝、芍，取苦辛酸而入厥阴，以为平降治法。若脾胃虚而肝火扰者，用
戊己六君，如金斛、木瓜、丹皮、桑叶，扶土抑木。或因郁抑不伸，用丹溪六郁汤亦妙。至于
水亏木旺，用复脉六味汤，为乙癸同源之治。大抵胸胁痛者，金铃子散加味。火郁甚者，以
佐金为良法，甚则用当归龙荟丸。若湿热疮疡，以龙胆泻肝为神剂。至肝病甚多，如头痛、
吐泻、呕逆、胀泄等候，皆属肝胃之症也。
余治各证以及气冲攻痛，诸药不效者，用仲景乌梅丸三钱，随病之虚实，酌加引经数味
煎服，有桴鼓之应，特将方义释明于后。是方也，用乌梅入肝经为君，酸乃肝之本味；臣白
芍泄火而敛阴，佐芎、归活血而滋润，使吴萸下气最速，连、楝、椒、姜清肝安蛔，是有制之
师也。若加以丹皮、桑叶，轻泄上焦火郁；羚羊、钩藤、甘菊、蒺藜、天麻，皆清肝泄火之要
品；元胡、伽南、降香，乃疏降冲逆之要药。细绎《内经》用辛补之、以酸泻之，故治肝宜酸，
若急升太过，酸收为下泄、为泻矣。然余研究病理，另获心得要义。夫肝体固赖阴血为养，
而其所以为将军之性、寄龙相之威者，以真阳之为本也。肝阴不足，固多为患，而肝阳亦为
至要。假如阳气稍微，则中土必虚，木易顺乘，浊阴随升气而上犯，亦随人之阴阳虚盛为转
移。故仲景审寒热互用大法，立乌梅丸方，是一以贯之矣。
澜按∶肝火最暴，燔灼无忌，一身之中，稍有郁结不伸者，其火则上冲，为痛、为胀、为
泄，上至头目，中至胸脘、胁肋、腹脐，下至阴囊、卵核，皆厥阴之所主。古今虽分九痛之因，
总不外寒热、阴阳，治得其要，一言而终。先生发明病理，遵仲景遗法，用乌梅丸为主方，莫
不捷效。今特录出，俾益后进非浅鲜矣。
胸腹部、胁肋部、胃脘部的各种疼痛，古人设立了“九痛”的名称，其要点不外乎由寒、热、虚、实、气、血、痰、食、虫这些因素引起。只有寒邪能使气血凝结，热邪能消烁津液，寒邪极盛时会导致四肢厥冷并向上冲逆，热邪极盛时会熏灼向上炎上，必须使寒热平衡调和，脏腑自然能够通畅，哪里还会有疼痛呢？其中夹杂的各种症状，总离不开寒热这一纲领，不难通过兼顾治疗的方法，自然能获得疾病随着药物而痊愈的效果。至于肝脏气机逆乱向上冲撞，常常表现为胃脘部当心而痛，伴有上肢、两胁、膈膜和咽喉部位不通畅，治疗应当采用降逆柔肝的方法。张仲景创制乌梅丸作为疏泄肝木、安护中焦的良法，这是寒热并用、平调阴阳的最高法则。如果阳气微弱，则遵循吴茱萸汤的治法。如果肝阳过盛，则减去吴茱萸、附子，少量使用花椒、干姜，而配合乌梅、黄连、川楝子、白芍，取苦、辛、酸的味道进入厥阴经，作为平降的治疗法则。如果脾胃虚弱而肝火干扰，使用戊己六君汤，如金斛、木瓜、丹皮、桑叶，以扶培脾土、抑制肝木。或者因为情志抑郁不能舒展，使用朱丹溪的六郁汤也很奇妙。至于肾水亏虚导致肝木旺盛，使用复脉六味汤，这是乙癸同源（肝肾同源）的治疗方法。大抵胸胁疼痛者，用金铃子散加味。火邪郁结严重的，以佐金（清肺抑肝）为良法，严重时使用当归龙荟丸。如果是湿热引起的疮疡，用龙胆泻肝汤是神效之剂。肝病非常多见，如头痛、吐泻、呕逆、胀满泄泻等症候，都属于肝胃的疾病。
我治疗各种证候以及气机上冲攻痛，其他药物无效时，使用张仲景的乌梅丸三钱，根据病情的虚实，酌情加入几味引经药煎服，有像鼓槌击鼓那样迅速见效的反应，特此将方义解释明白如下。这个方子，用乌梅入肝经作为君药，酸味是肝的本味；臣药用白芍泄火而收敛阴液，佐药用川芎、当归活血而滋润，使药吴茱萸下气速度最快，黄连、川楝子、花椒、干姜清肝安蛔，这是一支有章法的军队。如果加上丹皮、桑叶，轻泄上焦的火郁；羚羊角、钩藤、甘菊花、蒺藜、天麻，都是清肝泄火的重要药材；元胡、伽南香、降香，是疏理降逆冲气的要药。仔细推究《黄帝内经》所说的“用辛补之、以酸泻之”，所以治疗肝脏适宜用酸味，如果急升太过，酸收就变成了下泄、变成了泻法。然而我研究病理，另外获得了心得要义。肝脏的体确实依赖阴血来滋养，而其之所以具备将军的性情、寄托龙相的威严，是以真阳为本质的。肝阴不足，固然是多发病患，但肝阳也是至关重要的。假如阳气稍微不足，那么中土必然虚弱，木气容易顺势乘袭，浊阴随着上升的气而上犯，也随着人的阴阳虚盛情况而转移变化。所以张仲景审视寒热互用的大法，创立乌梅丸方，是一以贯之的道理。
澜按：肝火最为暴烈，焚烧灼烧毫无顾忌，一身之中，稍有郁结不能舒展的，其火就会向上冲撞，表现为痛、胀、泄，上至头目，中至胸脘、胁肋、腹脐，下至阴囊、睾丸，都归属于厥阴经所主。古今虽然区分九痛的成因，总不外乎寒热、阴阳，治疗得到关键，一句话就能终结。先生阐发病理，遵循张仲景遗留的方法，以乌梅丸为主方，没有不迅速见效的。现在特意记录出来，使后辈受益非浅啊。
Chest and abdominal pain, hypochondriac pain, and epigastric pain were categorized by ancient physicians into "Nine Types of Pain" (Jiu Tong). The key factors are not beyond cold, heat, deficiency, excess, qi, blood, phlegm, food stagnation, and parasites. Cold causes coagulation and condensation, while heat causes consumption and melting. When cold is severe, it leads to cold limbs (Jue Ni) with upward rushing; when heat is severe, it scorches and flares upward. One must balance cold and heat so that the zang-fu organs can flow freely, eliminating pain. Mixed symptoms generally fall under the guidelines of cold and heat, and can be treated concurrently, leading to recovery as the medicine takes effect. Regarding liver qi rebellion rushing upward, it often manifests as epigastric pain centered behind the heart, accompanied by obstruction in the upper limbs, both hypochondria, diaphragm, and throat. Treatment should focus on descending rebellious qi and softening the liver. Zhang Zhongjing formulated Wu Mei Wan (Mume Pill) as an excellent method to drain wood (liver) and stabilize the middle jiao, employing both cold and heat to achieve perfect balance. If yang is deficient, follow the method of Wu Zhu Yu Tang (Evodia Decoction). If liver yang is excessive, remove Evodia (Wu Zhu Yu) and Aconite (Fu Zi), use small amounts of Zanthoxylum (Hua Jiao) and Ginger (Sheng Jiang), and combine Mume Fruit (Wu Mei), Coptis (Lian), Toosendan (Chuan Lian Zi), and White Peony Root (Bai Shao). This utilizes bitter, acrid, and sour flavors to enter the Jueyin channel, serving as a method for pacifying and descending. If spleen and stomach are deficient with liver fire disturbance, use Wu Ji Liu Jun Tang (Five-Elder Six-Gentleman Decoction) with herbs such as Dendrobium (Jin Hu), Papaya (Mu Gua), Moutan Bark (Dan Pi), and Mulberry Leaf (Sang Ye) to support earth and suppress wood. If due to depression and failure of free flow, Zhu Danxi's Liu Yu Tang (Six-Stagnation Decoction) is also effective. For kidney yin deficiency leading to hyperactive liver wood, use Mai Mai Gan Lu Tang (Recovering Pulse Sweet Dew Decoction) combined with Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia), representing the treatment based on the common source of Yi (Liver/Wood) and Gui (Kidney/Water). Generally, for chest and hypochondriac pain, add modifications to Jin Ling Zi San (Melia Dispersion). For severe fire stagnation, assisting metal (clearing lung to subdue liver) is a good method; if severe, use Dang Gui Long Hui Wan (Angelica Dragon Bile Pill). For damp-heat sores and ulcers, Long Dan Xie Gan Tang (Gentian Liver-Draining Decoction) is a miraculous agent. Liver diseases are numerous, including headache, vomiting and diarrhea, retching, distension, and diarrhea, all belonging to liver-stomach disorders.
In my treatment of various syndromes and pain caused by qi rushing upward where other medicines failed, I used Zhang Zhongjing's Wu Mei Wan (Mume Pill) at 3 qian, adding several meridian-guiding herbs according to the deficiency or excess of the disease, decocted and taken orally. It yields rapid results like a drumstick striking a drum. Hereafter, I explain the rationale of this formula. In this prescription, Wu Mei (Mume Fruit) enters the Liver channel as the Sovereign herb; its sour taste is the natural flavor of the Liver. Bai Shao (White Peony Root) acts as the Minister to drain fire and astringe yin. Chuan Xiong (Sichuan Lovage Rhizome) and Dang Gui (Chinese Angelica Root) act as Assistants to invigorate blood and moisten. Wu Zhu Yu (Evodia Fruit) acts as the Envoy to descend qi most rapidly. Lian (Coptis Rhizome), Chuan Lian Zi (Toosendan Fruit), Hua Jiao (Zanthoxylum Pericarpium), and Sheng Jiang (Fresh Ginger) clear the liver and calm roundworms. Thus, it is an organized army. Adding Dan Pi (Moutan Bark) and Sang Ye (Mulberry Leaf) lightly drains upper jiao fire stagnation. Ling Yang Jiao (Antelope Horn), Gou Teng (Uncaria Ramulus), Gan Ju (Chrysanthemum Flower), Ji Li (Tribulus Fruit), and Tian Ma (Gastrodia Rhizome) are essential products for clearing the liver and draining fire. Yan Hu Suo (Corydalis Rhizome), Nan Chen Xiang (Agarwood), and Jiang Xiang (Sandalwood) are key medicines for dispersing and descending rebellious qi. Carefully studying the *Nei Jing* (Inner Canon), which states "tonify with acrid, drain with sour," treating the liver suits sour flavors. If ascending is too urgent, sour astringency becomes descending and draining. However, through researching pathology, I have gained unique insights. The substance of the Liver relies on yin-blood for nourishment, but its nature as a General and its authority as Dragon and Phosphorus Fire are rooted in true yang. Liver yin deficiency is indeed a source of many ailments, but liver yang is also crucial. If yang is slightly deficient, the Middle Earth (Spleen/Stomach) will be weak, and Wood easily overacts on Earth. Turbid yin rises with the qi and offends upwards, shifting according to the person's yin-yang deficiency or excess. Therefore, Zhang Zhongjing's principle of using cold and heat mutually establishes the Wu Mei Wan (Mume Pill), consistent throughout.
Commentary by Lan: Liver fire is the most violent, scorching without restraint. In the body, any slight stagnation and failure of free flow causes the fire to rush upward, manifesting as pain, distension, or diarrhea. It reaches up to the head and eyes, mid-level to the chest, epigastrium, hypochondria, and umbilicus, and down to the scrotum and testes, all governed by the Jueyin channel. Although ancient and modern texts distinguish nine causes of pain, they ultimately do not exceed cold/heat and yin/yang. Grasping the key to treatment concludes it in one word. The Master elucidated pathology, followed Zhang Zhongjing's legacy, and used Wu Mei Wan (Mume Pill) as the main formula, achieving swift efficacy in all cases. I record this now so that future generations may benefit significantly.