心腹痛各有不同，有瘀血凝结，有饮食停滞者，有风冷客进者，《指掌》分为各类，未免烦衍。吾总归一
门，大抵初痛总宜服生化汤，去瘀生新，二三剂，当有痛即止矣。如或瘀积小腹不散，转侧若刀锥刺痛者，手不
可按，痛而不移者，用失笑丸主之，佐花蕊石散二钱，瘀行痛止。如感风寒者，必口鼻气冷。停食者，必吞酸满
闷。二此者俱用二香散主之。若中气虚寒，腹中冷痛，必喜热物熨之，喜手按而痛稍缓，用理中汤加肉桂温之。
如小腹气从下逆，冲而上痛，连心腹者，忽聚忽散，此皆瘕气也，另用橘核丸主之。如小腹有块，手不可按
者，瘀血壅滞，名曰儿枕痛，并用失笑丸。若瘀不散，久防生肠痈，即于后编查看，审细治之。
生化汤（见前玉门不闭或加肉桂）失笑丸（见前包衣不下）花蕊石散（见前）。
二香散
香附（二钱） 广木香（一钱） 砂仁（五分） 陈皮（五分） 炙草（五分） 炮姜（一钱） 生姜（一片）
水煎服。
理中汤
白术（二钱） 炙草（七分） 干姜（一钱） 人参（一钱）
煎服。有加附子，名附子理中汤。
橘核丸
橘核（盐酒炒，二两） 小茴香 川楝子（煨去肉） 桃仁（炒去皮尖，双仁不用） 香附 山楂核（炒）
以上各一两为末，红花、广木香各（五钱）为末，神曲（三两），打糊为丸，每服三钱，开水下。
心腹痛的病因各不相同，有的因瘀血凝结所致，有的因饮食停滞引起，有的因风冷之邪侵入导致。《指掌》将其分为各类，未免过于繁琐冗杂。我将其统归为一门，大抵产后初起疼痛，总宜服用生化汤，以祛除瘀血、生成新血，服用二三剂后，疼痛应当停止。如果瘀积在小腹不散，转动身体时感觉像刀锥刺痛一样，手不能触碰，疼痛位置固定不移，使用失笑丸为主方，佐以花蕊石散二钱，待瘀血行散则疼痛停止。如果是感受风寒，必然口鼻呼出之气寒冷。如果是饮食停滞，必然有吞酸、胸脘满闷的症状。这两种情况均使用二香散为主方治疗。如果是中气虚寒，腹部冷痛，必然喜欢用热物熨烫，喜欢用手按压且疼痛稍缓解，使用理中汤加入肉桂以温补。如果小腹有气从下向上逆冲，导致上腹部和心部疼痛，疼痛忽聚忽散，这都属于瘕气（积聚之气），另用橘核丸为主方治疗。如果小腹有肿块，手不可触碰，这是瘀血壅滞所致，名为儿枕痛，同样使用失笑丸。如果瘀血不散，久则防止发展为肠痈（肠道脓肿），即参考后编内容，仔细审察并治疗。
生化汤（见前文玉门不闭条，或可加肉桂）。失笑丸（见前文包衣不下条）。花蕊石散（见前文）。
二香散
香附（二钱） 广木香（一钱） 砂仁（五分） 陈皮（五分） 炙甘草（五分） 炮姜（一钱） 生姜（一片）
水煎服。
理中汤
白术（二钱） 炙甘草（七分） 干姜（一钱） 人参（一钱）
煎服。若加入附子，名为附子理中汤。
橘核丸
橘核（盐酒炒，二两） 小茴香 川楝子（煨去肉） 桃仁（炒去皮尖，双仁不用） 香附 山楂核（炒）
以上各一两研为末，红花、广木香各五钱研为末，神曲三两，打糊为丸，每次服用三钱，开水送服。
Pain in the heart and abdomen varies in etiology; it may be caused by coagulation of blood stasis, stagnation of food, or invasion of wind-cold pathogens. The *Zhi Zhang* (Hand-Held Guide) divides these into various categories, which is somewhat tedious and redundant. I consolidate them into a single category. Generally, for initial postpartum pain, it is advisable to administer Shenghua Tang (Decoction for Generating the New) to remove blood stasis and generate new blood. After two or three doses, the pain should cease. If blood stasis accumulates in the lower abdomen and does not dissipate, causing stabbing pain like knife blades or awls upon turning, with tenderness to touch and fixed location of pain, Shixiao Wan (Wan That Makes One Laugh) should be used as the principal formula, assisted by Huarui Shi San (Powder of Flower Ochre Stone), two qian. Once the stasis moves, the pain will stop. If affected by wind-cold, there must be cold breath from the mouth and nose. If food is stagnant, there must be acid regurgitation and chest/epigastric fullness. Both of these conditions are treated with Erxiang San (Two Fragrances Powder) as the principal formula. If there is deficiency-cold of the middle qi, causing cold pain in the abdomen, there will be a preference for warming with hot objects and relief upon manual pressure; Lizhong Tang (Decoction for Regulating the Middle) with Rougui (Cinnamon Twig) added should be used to warm the interior. If qi rebels upward from the lower abdomen, causing pain radiating to the heart and abdomen, with pain that gathers and scatters intermittently, this is all due to Zha Qi (accumulated qi masses); Juhe Wan (Wan of Tangerine Seeds) should be used separately as the principal formula. If there is a mass in the lower abdomen that cannot be touched, this is obstruction by blood stasis, named Erzhen Tong (Placental Pillow Pain). Shixiao Wan should also be used here. If the stasis does not dissipate, one must long-term guard against the development of Chang Yong (Intestinal Abscess); refer to the later section for detailed examination and treatment.
Shenghua Tang (See previous section on "Closure Failure of the Jade Gate"; Cinnamon Twig may be added). Shixiao Wan (See previous section on "Retention of Fetal Membranes"). Huarui Shi San (See previous section).
Erxiang San
Xiangfu (Rhizoma Cyperi, 2 qian) Guangmuxiang (Ligusticum Chuanxiong Rhizome, 1 qian) Sharen (Fructus Amomi Rotundus, 0.5 qian) Chenpi (Pericarpium Citri Reticulatae, 0.5 qian) Zhigancao (Radix Glycyrrhizae Preparata, 0.5 qian) Paojiang (Rhizoma Zingiberis Preparatum, 1 qian) Shengjiang (Rhizoma Zingiberis Recens, 1 slice)
Decoct in water and take orally.
Lizhong Tang
Baizhu (Atractylodis Macrocephalae Rhizoma, 2 qian) Zhigancao (Radix Glycyrrhizae Preparata, 0.7 qian) Ganjiang (Rhizoma Zingiberis, 1 qian) Renshen (Radix Ginseng, 1 qian)
Decoct and take orally. If Fuzi (Radix Aconiti Lateralis Preparata) is added, it is named Fuzi Lizhong Tang.
Juhe Wan
Juhe (Semen Citri Reticulatae, stir-fried with salt wine, 2 liang) Xiaohuixiang (Fructus Foeniculi) Chuanlianzi (Semen Toosendan, baked to remove flesh) Taoren (Semen Persicae, stir-fried, skin and tips removed, double-kernel ones not used) Xiangfu (Rhizoma Cyperi) Shanzhahé (Endocarpium Crataegi, stir-fried)
The above ingredients, each one liang, are ground into powder. Honghua (Flos Carthami) and Guangmuxiang (Rhizoma Ligustici Chuanxiong) are each five qian, ground into powder. Shenqu (Massa Medicata Fermentata, 3 liang) is made into paste to form pills. Take three qian per dose, washed down with boiled water.