霍乱腹痛一症，又当用藿香散等法治之。王肯堂云；霍乱不吐泻，或腹胀如鼓，不得用别药，惟益元散可服。炮汤冷定，时时呷之，或连末服下，此药能降邪气，消食坠痰，和胃调中，但闻腹中有响声即是好消息，不下则吐，不吐则下，乃霍乱中妙药也(大忌姜汤米汤乌梅梅酱)。余遵是法，遇霍乱症或未吐泻，或已吐泻，用藿香叶、建神曲、大叶茶各三钱(皆能和中)，泽泻、木通各一钱(皆能降浊)，柴胡、羌活各七八分(皆能升清)煎汤，冲益元散三四钱。俟将冷服之，倘腹仍痛，仍依法进(有湿必须加苍术)，或佐以藿香散法，无不获效。又古人谓，凡暴病毋论其脉，但从其症，此诚确沦。霍乱症与一切痛症、急症，脉多伏者，斯言不可不记。又谓凡病来迅速者，俱属肝经主病(五行中最迅速者，莫若风火。肝为风火之脏故也)，此虽不仅为腹痛而言。然肝主筋，亦主痛，则痛症亦不得渭无关于肝也。霍乱症本迅速而起，故亦须少加柴胡以疏肝，或佐青皮以伐肝。
附论疝气症
腹痛亦有因疝气连及脐下(厥阴肝)、中脐(少阴肾)、脐上(太阴脾)、及两胁(少阳胆)而痛者，宜遵丹溪议，专治厥阴肝主筋主痛故也。疝虽有七(寒疝、筋疝、水疝、气疝、血疝、狐疝、颓疝)，治法总以辛香流气疏泄厥阴为主，金铃子散、左金丸、五苓散三方当合用而加减治之。凡暴疝多寒，久疝多热。如寒则重用吴萸、桂枝，或再加小茴、肉桂，热则重用黄连、川楝，或再加黄柏、木通，其南木香、青木香(即兜铃根)、橘核、鲜橘叶、鲜黄皮枝、鲜田基黄，皆辛香流气，宣络舒肝之品，合参入为佐使(沙参一两，同猪小肚煎羹，治疝气效。沙参清肺，能令肺金清肃之气下行，肺与膀胱通气化故也。三层茴香丸用沙参即此意)。倘欲再佐宣活络血之法，兼欲引药力直走至阴之域，则桃仁、归须、山甲、薤白、雄鼠矢，在所必用。至若者弱久疝，睾丸下坠，又当温散奇经，升举奇阳(经云：任脉为病，男子内结七疝，女子带下瘕聚)，固本补虚，又为最要，当归羊肉汤滋肾丸、虎潜丸皆治本法也。其小茴、炒，当归(小茴拌水炒，当归能通肝脏脉络之阳气)、兔丝子、关沙苑、杞子、鹿茸、鹿角霜、桂枝尖、白蒺藜，皆可因症商用。
心痛者，非心痛也，真心痛不治，乃心胞络与胃脘痛耳。订方遵苦辛降通一法，通则不痛矣。当更参后列各见症，辨其所因而加减治之。
丹参三钱 川楝一钱半 麦冬椂眯模BR> 破，朱砂拌匀 香附一钱 延胡椙 乌药BR> 钱 佛手二钱
加春砂仁三粒，连壳打破，同煎。
或磨檀香汁些少冲服，或加百合同煎(百合乌药名百合汤。川楝子、延胡名金铃子散。丹参砂、仁、檀香名丹参饮。三方皆治心痛)。凡心痛症用猪心一个，煎汤，去猪心，将汤代水煎药更效。久痛者，方中必须加当归、桃仁以活络血(若得食则痛缓，此由于积劳而营血虚，归桃外再加柏仁、胡麻、圆肉，原方减去川楝、延胡、乌药、春砂)。倘心痛切背(此胸痹症)宜栝蒌薤白半夏汤。
又痛因痰(痛而恶闷，呕出痰饮即宽者为痰)，加半夏、贝母、瓜蒌仁(去丹参、麦冬、香附)。因食滞(觉饱时嗳气，直至饥而后缓者，为食滞)加草果、枳实、槟榔，或麦芽、神曲(去丹参、延胡、乌药)。因寒(痛时饮热汤热酒而痛缓者为寒)加干姜、良姜(去麦冬、丹参)。因郁(痛应背心者为郁见，症似胸痹宜燥宜润当辨)加川贝母川芎(去乌药、砂仁)。因虫(心头急痛唇白毛竖口吐黄水者为虫)，加雷丸、君肉、乌梅、黄连<去丹参、麦冬、乌药、延胡、砂仁)或用槟雄丸治之。因瘀血(心头结痛，气逆上冲，啷啷有声者，为血)加苏木、三棱、蓬术，或加桃仁、红花、降香(去麦冬、砂仁、乌药)。
又有心痛频发，痛极闷死，必吐涎水而后醒者，乃寒痰积于心睥，用炒栀子一两，煎加竹沥、姜汁各一杯，冲服。有卒然大痛，无声，手足冰冷，且气冷面青，咬牙噤齿，此乃真心痛。因寒邪直犯君火，仅对时即毙。如用猪心汤煎麻黄、官桂、附子、干姜急服，或有得生者(此法出王肯堂《医镜》，谓此乃秘要妙法)。
附案(奇经心痛)
顺邑马苏隐方伯第五妾据苏隐述，每戌亥必腹痛(戌亥为至阴之时，肝肾为至阴之脏，奇经八脉皆发源于肝肾故也)，其痛始脐下渐绕脐上及两胁，以至于心，天晓则安然无恙。平日惯以八珍汤获小效，而自能渐安，今陆医与之诊，谓脉近有力，当清其源，然后永无再发，转用苦寒剂痛益增。明日再诊，谓倍有力，论脉当清，前剂转小药力不到耳，古人谓通则不痛(至若寒者温之使通，虚者补之使通医似不晓)，且每三两日始一更衣，此治必合(幽门气钝血燥，医似未明)用大承气汤加桃仁、川楝子大剂进服，大便泻后，日夜皆痛(阴阳两伤)，且频呕不食，特延君愈之。余脉之曰：症属虚寒，理宜温补。苏隐曰：脉鼓指否余曰：鼓指。曰：脉若是，安能补余曰：未进承气前纵似有力，未必鼓指。曰诚如君言，何也曰此真气虚而邪气实耳。夫胃气充足者，其脉缓，今苦寒攻伐，胃气愈伤，是以鼓指。凡实热脉重，按仍有力，今重按则软，且唇白而困倦无神，岂有余症耶少腹痛必心痛者，经云：阴维脉病苦心痛也。奇经八脉皆发源于肝肾，原当治下，因苦寒更伤中州，法不得不中下兼顾，使急逐其寒邪而复其胃气。愚见拟用吴茱萸汤合附子粳米汤加减。先进方，用野山丽参四钱，吴萸附子各二钱，炒粳米、半夏、生姜各三钱，大枣二枚，一服吐止，痛减。次日诊，仍用前方加于术三钱，炙草一钱，煎服。三日诊，脉象和缓，痛减八九转，用当归(小茴五分拌炒，仍用同煎)、紫石英(生研)各五钱，潞党、杞子各四钱，盐水炒，破故子、制香附、制蕲艾叶各一钱，服四贴后，间或加天生术、关沙苑同煎，或加野山土术、人参、北鹿茸末各一钱，另炖，冲服。调养将一月而痊。半载后因房事，痛复发，且少腹胀左尺弦劲(肾虚风动)，用转方七味，去潞党、石英、故子，加海螵蛸、白蒺藜各四钱，茜根一钱，蝎尾梢一分，二剂渐愈，后仍用归杞七味方，与配人参、茸、野术、砂仁、熟地，出入而调养，以收全功。
胁 痛
胁痛多属少阳厥阴，以两胁属少阳，又肝脉络布于胁也。治主宣络，佐以平肝。
川楝子椙夏枯草三钱 旧青皮椙BR> 醋炒 延胡索一钱半 台乌药一钱 粉丹皮棥BR> 钱，去心 双钩藤四钱
凡久痛必入络，须加桃仁，红花以活络血，或参入旋覆花汤以降络，或佐入苏子、生薏米、降香(叶氏三味惯并用)、芥子以通络。王肯堂谓：大忌陈皮、生姜、细辛，服之即令肝胀，以其能补肝故也。用青皮宜醋炒酸，能破结，直入肝经故也。痛甚者，加醋半酒杯，冲药服。
凡痛亦当知在气在血，见症各有不同痛而不臌，按之愈痛，痛无时，止瘀血作痛也。痛而且臌，得嗳即缓，痛有止时，怒气作痛也。怒气作痛加醋炒柴胡，佐青皮以伐其肝，少加木香，佐乌药以开其气，红花、当归又或酌用以和其血也(或去钩藤、延胡)。瘀血作痛加桃仁、归尾、红花(去钩藤、乌药、青皮、枯草，或少佐醋炒柴胡、川芎)，或加苏木、山查、蓬术，等若痛甚加大黄下之。此气与血见症所由，亦气与血用药所宜辨也。若微痛着于一处，此为痰痛，上拟方药不合用，必君以芥子，佐以竹沥、姜汁治之，其丝瓜络、白蒺藜、浙贝、胆星、蒌皮、青皮、黄连等，亦合佐使。
腰 痛
腰者，肾之俯，在内为少阴(肾)，在外为太阳(膀胱)，故腰痛必从二经主治。一表一里，治法攸分须明。夫邪自外来而痛者，属膀胱；虚由内生而痛者，属肾，宜填宜补而温宜通，法原不一。余尝拟补肾一方，相传而服者多效，先录存之。愚见再参末分治。
金狗脊四钱，去毛 兔丝子三钱 破故子五分，盐水，拌炒 关沙苑四钱 牛膝肉二钱，酒炒厚黄柏五分，盐水，拌炒 生杜仲三钱
或用猪腰一对，煎汤代水煎药。
热黄柏倍故子，寒故子倍黄柏(或二三倍)，痛已除再加入熟地、杞子、胡桃或鹿茸、鹿角霜，多服数贴，方免复患。凡腰痛脉沉而细者，当治少阴。时痛时止肾精亏也，即用上拟补肾方主治。时痛时热，肾水亏也，宜另用知柏八味汤治之。若脉浮而紧者，当治太阳。背肉刺痛，风客于肾腧穴也，麻黄、细辛、独活、防风、生地、当归，白芍以疏其风。郁痛畏冷寒，客于气海腧也，麻黄、附子、细辛、当归、炙草以验。其寒痛重难移，湿着于藏精所也，麻黄、苍术、白术、当归、杜仲、牛膝、茯苓、薏米、炙草，以逐其湿。
此名壅疾，谓湿气壅塞经络致痛也，忌用补剂。若专事温补，必成废疾。有寒湿、风湿、湿热之分，宜细按后列脉症加减拟方治之。
当归三钱 旧木瓜二钱，酒炒 细木通一钱半 羌活一钱半 生薏米五钱 紫苏梗一钱半防风一钱半
加生赤小豆皮五钱，同煎。
临夜发热而痛，脉濡而数者为湿热，加黄柏、麦冬同煎。昼夜憎寒作痛，脉濡而迟者为寒湿，加苍术、干姜、附子、防已、加皮(去木通、苏梗)。其肿痛走注无常，或踝，或膝，或胫，脉濡浮兼数者为风湿，加生地、牛膝(去木瓜、薏米、苏梗)。不效，再加入芒硝、大黄同煎。若嗜酒而伏酒湿毒者，辨脉与症，或兼寒、兼热、兼风，遵上三法选药施治，重加枳棋子、干葛花，以解酒毒。或用巴戟五钱(糯米拌水炒干去米)，大黄一两炒，同为末，蜜丸(名巴黄丸)温水送下五七十丸(仍须戒酒)。凡脚痛，山甲、地龙可加作引。若走动而痛上臂手，须加灵仙。另有干脚气痛不肿而躇缩，枯细当润，血清燥(宜玉竹、生地、麦冬、天冬、胡麻、石斛、牛膝、归须、鳖甲、阿胶等)。又有阴虚脚痛，足跟锨肿而红，当补肾养营(宜龟版、生地、熟地、当归、大冬、杞子仁、杜仲、玉竹、巴戟、黄柏、知母、牛膝等)，二症与脚气湿症大相反，彼此误治，必增剧。
附论痿蹙症
脚气痛，外又有所谓痿壁者，方书谓痿症。无痛，不知兼湿重者则筋缓，而痿软兼热多者则筋急而作痛，余见痿症，惯有兼痛者，医用祛风药(丹溪谓断不可作风治)、渗湿药作风湿脚气痛治，无不增剧，是以特附此症于脚气痛条中(汪石山治一人痿兼痛者，用人参二钱，黄芪一钱半，白术、茯苓、生地、麦冬各一钱，当归八分，黄柏、知母各七分，连服数贴，而痿痛愈)。夫痿有脉痿、筋痿、肉痿、骨痿之殊，原不止痿于足(更有头痿、手痿、腰痿、一身俱痿)，而经谓：诸痿生于肺热(肺主一身气化，肺燥热则血液涸而不能营养筋骨故痿)；又谓：治痿独取阳明(阳明主润宗筋，束筋骨以利机关。虚则宗筋弛纵，手足痿而不能用)，纵。诸痿商治，概可悟矣。若痿壁在下，则肝肾病多，(肝主筋，肝血伤血不营筋，则四肢不用而筋骨拘挛。肾藏精，精血相生，虚则不能灌溉诸末而营养筋骨)而肺胃亦宜兼顾，大补阴丸、滋肾丸、虎潜丸、二妙丸(若肺燥苍术可勿用)、人参固本丸皆堪选。用其玉竹、巴戟、杞子、杜仲等可参入五方加减治之(三指禅注经验方，地黄四两，黄柏知母各一两，肉桂一钱，炼蜜为丸。方书有谓：血虚四物汤二妙丸合用。气虚四君子汤二妙丸合用)加龟版、虎骨、当归、地黄(可知二妙丸亦治痿症要药)。若痿症见于上则肺热居多，东垣清燥汤在所必用，即麦冬、沙参、粳米，每日煎粥饮。似极平淡，究属神奇也(此法治消渴亦佳)。
肾开窍于耳，心亦奇窍于耳，胆脉络附于耳，老弱与久病皆属体虚失聪(聋鸣而不痛)，治在肝肾。少年或暴病，总属邪干闭窍(痛鸣聋皆有)，治在胆经，即本是议酌方，先拟清少阳络法。
羚羊角三钱，先煎 连翘壳二钱 粉丹皮一钱 苦丁茶一钱 牛蒡子一钱半 香白芷二分
气闭则耳鸣耳聋，薄荷梗、夏枯草、蔓荆子、钩藤、菊花、马勃、木通皆通窍之品，可参入加减。火郁则耳痛，菊叶、桑叶、银花、栀子亦可任加。然原方已属统治，至若肝肾虚而为聋为鸣者，宜用磁石，六味丸加龟版、五味、远志、菖蒲主治，人参、当归、杞子、菟丝沙、苑杭、菊亦可因症选用。
牙 痛
上齿脉络属足阳明胃，下齿脉络属手阳明大肠，有风痛、热痛、虫痛、寒痛、痰毒、痛瘀、血痛之分，备载本门可考。惟风热痛为尤多，因订一清络热方法。
金银花三钱 双钩藤四钱 粉丹皮一钱丝瓜络三钱 连翘壳二钱 生甘草八分
加生柏叶三钱引(上齿痛或加石膏、知母，下齿痛或加生地、秦艽)，
风痛加荆芥、防风。水亏火亢加生地、天冬、麦冬、元参(去丝瓜络连翘钩藤)。食饭后倍痛胃火旺也，必须君以石膏、知母。大便结者加生地七八钱，风化硝二三钱(亦去丝瓜三味)。
霍乱伴有腹痛这一病症，应当使用藿香散等方剂和方法来治疗。王肯堂说：霍乱如果不呕吐腹泻，或者腹部胀大如鼓，不能使用其他药物，只有益元散可以服用。将药汤炮制后冷却，不时小口啜饮，或者直接吞服散剂，此药能降逆邪气，消食化痰，调和胃气，只要听到腹中有响声就是好消息，不吐则泻，不泻则吐，这是治疗霍乱的妙药（绝对禁忌姜汤、米汤、乌梅、梅酱）。我遵循这个方法，遇到霍乱症，无论是否已经呕吐腹泻，都用藿香叶、建神曲、大叶茶各三钱（都能调和脾胃），泽泻、木通各一钱（都能降泄浊气），柴胡、羌活各七八分（都能升发清气）煎汤，冲服益元散三四钱。待药汤稍凉后服用，如果腹部仍然疼痛，仍按此法继续服用（有湿邪必须加苍术），或者配合藿香散的方法，没有不奏效的。又古人说，凡是突发疾病，不论脉象，只从症状判断，这确实是确切的论述。霍乱症与一切痛症、急症，脉象多沉伏，这话不可不记。又说凡是发病迅速的病，都属于肝经主病（五行中变化最迅速的，莫过于风火。肝是风火之脏的缘故），这虽然不仅针对腹痛而言。但肝主筋，也主痛，那么痛症也不能说与肝无关。霍乱症本来发病迅速，所以也需要少加柴胡以疏肝，或者佐以青皮以伐肝。
附论疝气症
腹痛也有因疝气牵连到脐下（厥阴肝经）、中脐（少阴肾经）、脐上（太阴脾经）、以及两胁（少阳胆经）而痛的，应当遵从丹溪的建议，专门治疗厥阴肝，因为肝主筋主痛。疝虽然有七种（寒疝、筋疝、水疝、气疝、血疝、狐疝、颓疝），治法总以辛香行气、疏泄厥阴为主，金铃子散、左金丸、五苓散三方应当合用并加减治疗。凡暴发的疝多属寒，久疝多属热。如果是寒证则重用吴茱萸、桂枝，或者再加小茴香、肉桂；如果是热证则重用黄连、川楝子，或者再加黄柏、木通。南木香、青木香（即兜铃根）、橘核、鲜橘叶、鲜黄皮枝、鲜田基黄，都是辛香行气、宣通经络、舒肝的药物，配合人参作为佐使（沙参一两，同猪小肚煎羹，治疗疝气有效。沙参清肺，能使肺金清肃之气下行，肺与膀胱通气化故也。三层茴香丸用沙参就是这个意思）。如果想要再佐以宣通活血络的方法，并且想要引导药力直达至阴之域，那么桃仁、当归须、穿山甲、薤白、雄鼠矢，是必须使用的。至于体弱久患疝气，睾丸下坠，又应当温散奇经，升举奇阳（经文说：任脉为病，男子内结七疝，女子带下瘕聚），固本补虚，又是最要紧的，当归羊肉汤、滋肾丸、虎潜丸都是治疗这种根本的方法。其中的小茴香炒制，当归（小茴拌水炒，当归能通肝脏脉络之阳气）、菟丝子、关沙苑、枸杞子、鹿茸、鹿角霜、桂枝尖、白蒺藜，都可以因症商用。
心痛，并不是心脏本身的疼痛，真心痛是不治之症，这里指的是心包络和胃脘部的疼痛。制定方剂遵循苦辛降通的方法，通则不痛了。应当参考后面列出的各种伴随症状，辨别病因并加减治疗。
丹参三钱 川楝子一钱半 麦冬二钱（捣碎，朱砂拌匀） 香附一钱 延胡索一钱 乌药一钱 佛手二钱
加春砂仁三粒，连壳打破，同煎。
或者磨少许檀香汁冲服，或者加百合同煎（百合乌药名百合汤。川楝子、延胡名金铃子散。丹参、砂仁、檀香名丹参饮。三方都治疗心痛）。凡是心痛症用一个猪心，煎汤，去掉猪心，用汤代替水煎药效果更好。久痛者，方中必须加当归、桃仁以活血通络（如果进食后疼痛缓解，这是由于积劳导致营血虚，归桃之外再加柏子仁、胡麻、桂圆肉，原方减去川楝子、延胡索、乌药、春砂仁）。如果心痛牵引背部（这是胸痹症），宜用栝蒌薤白半夏汤。
另外疼痛因痰引起（疼痛且感到憋闷，呕出痰饮后即宽舒的是痰），加半夏、贝母、瓜蒌仁（去掉丹参、麦冬、香附）。因食滞引起（感觉饱胀时嗳气，直到饥饿后才缓解的是食滞），加草果、枳实、槟榔，或者麦芽、神曲（去掉丹参、延胡索、乌药）。因寒引起（疼痛时喝热汤热酒而疼痛缓解的是寒），加干姜、良姜（去掉麦冬、丹参）。因郁引起（疼痛应及背部的是郁证，症状似胸痹，应当辨别燥润），加川贝母、川芎（去掉乌药、砂仁）。因虫引起（心头急痛、唇白、汗毛竖起、口吐黄水的是虫），加雷丸、菌肉、乌梅、黄连（去掉丹参、麦冬、乌药、延胡索、砂仁）或者用槟雄丸治疗。因瘀血引起（心头结痛，气逆上冲，发出声响的是血瘀），加苏木、三棱、蓬术，或者加桃仁、红花、降香（去掉麦冬、砂仁、乌药）。
又有心痛频发，痛极闷死，必须吐出涎水后才能醒来的，这是寒痰积聚在心脾，用炒栀子一两，煎汤加竹沥、姜汁各一杯，冲服。有突然剧烈疼痛，无声，手足冰冷，且气息冷面青，咬牙紧闭牙齿，这是真心痛。因寒邪直接侵犯君火，仅一个时辰就会死亡。如果用猪心汤煎麻黄、官桂、附子、干姜急服，或许有得救的（此法出自王肯堂《医镜》，说是秘要妙法）。
附案（奇经心痛）
顺邑马苏隐方伯的第五位妾室据苏隐叙述，每逢戌亥时必然腹痛（戌亥是至阴之时，肝肾是至阴之脏，奇经八脉都发源于肝肾的缘故），疼痛开始于脐下，逐渐环绕脐上及两胁，以至于心，天亮后就安然无恙。平时习惯用八珍汤获得小效，而自己也能逐渐安适，现在陆医生给他诊治，说脉象近于有力，应当清其源头，然后永远不再发作，转而使用苦寒剂，疼痛反而增加。第二天再诊，说脉更加有力，论脉应当清，前面的药剂药力不够罢了，古人说通则不痛（至于寒者温之以使其通，虚者补之以使其通，医生似乎不懂），而且每两三天才排便一次，这治疗必须结合（幽门气钝血燥，医生似乎不明白）使用大承气汤加桃仁、川楝子大剂量进服，大便泻后，日夜皆痛（阴阳两伤），并且频繁呕吐不能进食，特意请君愈诊治。我诊脉说：症属虚寒，理应温补。苏隐说：脉象鼓指吗？我说：鼓指。他说：脉象如此，怎么能补？我说：未进承气汤前，纵然看似有力，未必鼓指。他说：确实像您说的，为什么呢？我说：这是真气虚而邪气实。胃气充足的人，脉象缓，现在苦寒攻伐，胃气更伤，所以鼓指。凡实热脉重，重按仍有力量，现在重按则软，而且唇白困倦无神，难道有余症吗？少腹痛必心痛者，经文说：阴维脉病苦心痛。奇经八脉都发源于肝肾，原本应当治下，因苦寒更伤中州，法不得不中下兼顾，使急逐其寒邪而复其胃气。愚见拟用吴茱萸汤合附子粳米汤加减。先进方，用野山丽参四钱，吴茱萸、附子各二钱，炒粳米、半夏、生姜各三钱，大枣二枚，一服吐止，痛减。次日诊，仍用前方加于术三钱，炙甘草一钱，煎服。三日诊，脉象和缓，痛减八九成，转用当归（小茴五分拌炒，仍用同煎）、紫石英（生研）各五钱，潞党参、枸杞子各四钱，盐水炒，破故子、制香附、制蕲艾叶各一钱，服四贴后，间或加天生术、关沙苑同煎，或者加野山土术、人参、北鹿茸末各一钱，另炖，冲服。调养将近一个月而痊愈。半年后因房事，疼痛复发，且少腹胀，左尺脉弦劲（肾虚风动），用转方七味，去潞党参、石英、故子，加海螵蛸、白蒺藜各四钱，茜根一钱，蝎尾梢一分，二剂渐愈，后仍用归杞七味方，与人参、鹿茸、野术、砂仁、熟地，出入而调养，以收全功。
胁痛多属少阳厥阴，因为两胁属少阳，又肝脉络布于胁部。治疗主要宣通络脉，佐以平肝。
川楝子一钱半 夏枯草三钱 旧青皮一钱（醋炒） 延胡索一钱半 台乌药一钱 粉丹皮一钱（去心） 双钩藤四钱
凡久痛必入络，须加桃仁、红花以活血通络，或者参入旋覆花汤以降络，或者佐入苏子、生薏米、降香（叶氏三味惯并用）、芥子以通络。王肯堂说：大忌陈皮、生姜、细辛，服用即令肝胀，因为它们能补肝的缘故。用青皮宜醋炒酸，能破结，直入肝经的缘故。痛甚者，加醋半酒杯，冲药服。
凡痛也应当知道在气在血，见症各有不同。痛而不胀，按之愈痛，痛无定时，停止，是瘀血作痛。痛而且胀，得嗳气即缓，痛有止时，是怒气作痛。怒气作痛加醋炒柴胡，佐青皮以伐其肝，少加木香，佐乌药以开其气，红花、当归又酌情用以和其血（或者去钩藤、延胡）。瘀血作痛加桃仁、归尾、红花（去钩藤、乌药、青皮、枯草，或少佐醋炒柴胡、川芎），或者加苏木、山楂、蓬术，若痛甚加大黄下之。这是气与血的见症来源，也是气与血用药所宜辨别的。若微痛着于一处，此为痰痛，上面拟定的方药不合用，必须以芥子为主，佐以竹沥、姜汁治疗，丝瓜络、白蒺藜、浙贝、胆星、蒌皮、青皮、黄连等，也可合佐使。
腰，是肾的府邸，在内为少阴（肾），在外为太阳（膀胱），所以腰痛必须从这两经主治。一表一里，治法有所区分，必须明白。邪自外来而痛者，属膀胱；虚由内生而痛者，属肾，宜填宜补而温宜通，法原不一。我曾拟定补肾一方，相传而服者多效，先录存之。愚见再参末分治。
金狗脊四钱，去毛 菟丝子三钱 破故子五分，盐水拌炒 关沙苑四钱 牛膝肉二钱，酒炒 厚黄柏五分，盐水拌炒 生杜仲三钱
或者用猪腰一对，煎汤代水煎药。
热证黄柏倍于故子，寒证故子倍于黄柏（或二三倍），痛已除再加入熟地、枸杞子、胡桃或者鹿茸、鹿角霜，多服数贴，方免复患。凡腰痛脉沉而细者，当治少阴。时痛时止是肾精亏也，即用上面拟定的补肾方主治。时痛时热，是肾水亏也，宜另用知柏八味汤治之。若脉浮而紧者，当治太阳。背肉刺痛，是风客于肾腧穴也，用麻黄、细辛、独活、防风、生地、当归、白芍以疏其风。郁痛畏冷寒，是客于气海腧也，用麻黄、附子、细辛、当归、炙甘草以验。其寒痛重难移，是湿着于藏精所也，用麻黄、苍术、白术、当归、杜仲、牛膝、茯苓、薏米、炙甘草，以逐其湿。
此名壅疾，谓湿气壅塞经络致痛也，忌用补剂。若专事温补，必成废疾。有寒湿、风湿、湿热之分，宜细按后列脉症加减拟方治之。
当归三钱 旧木瓜二钱，酒炒 细木通一钱半 羌活一钱半 生薏米五钱 紫苏梗一钱半 防风一钱半
加生赤小豆皮五钱，同煎。
临夜发热而痛，脉濡而数者为湿热，加黄柏、麦冬同煎。昼夜憎寒作痛，脉濡而迟者为寒湿，加苍术、干姜、附子、防己、加皮（去木通、苏梗）。其肿痛走注无常，或踝，或膝，或胫，脉濡浮兼数者为风湿，加生地、牛膝（去木瓜、薏米、苏梗）。不效，再加入芒硝、大黄同煎。若嗜酒而伏酒湿毒者，辨脉与症，或兼寒、兼热、兼风，遵上三法选药施治，重加枳椇子、干葛花，以解酒毒。或者用巴戟天五钱（糯米拌水炒干去米），大黄一两炒，同为末，蜜丸（名巴黄丸）温水送下五七十丸（仍须戒酒）。凡脚痛，山甲、地龙可加作引。若走动而痛上臂手，须加灵仙。另有干脚气痛不肿而躇缩，枯细当润，血清燥（宜玉竹、生地、麦冬、天冬、胡麻、石斛、牛膝、归须、鳖甲、阿胶等）。又有阴虚脚痛，足跟锨肿而红，当补肾养营（宜龟版、生地、熟地、当归、大冬、枸杞仁、杜仲、玉竹、巴戟、黄柏、知母、牛膝等），二症与脚气湿症大相反，彼此误治，必增剧。
附论痿蹙症
脚气痛，外又有所谓痿壁者，方书谓痿症。无痛，不知兼湿重者则筋缓，而痿软兼热多者则筋急而作痛，余见痿症，惯有兼痛者，医用祛风药（丹溪谓断不可作风治）、渗湿药作风湿脚气痛治，无不增剧，是以特附此症于脚气痛条中（汪石山治一人痿兼痛者，用人参二钱，黄芪一钱半，白术、茯苓、生地、麦冬各一钱，当归八分，黄柏、知母各七分，连服数贴，而痿痛愈）。夫痿有脉痿、筋痿、肉痿、骨痿之殊，原不止痿于足（更有头痿、手痿、腰痿、一身俱痿），而经谓：诸痿生于肺热（肺主一身气化，肺燥热则血液涸而不能营养筋骨故痿）；又谓：治痿独取阳明（阳明主润宗筋，束筋骨以利机关。虚则宗筋弛纵，手足痿而不能用），纵。诸痿商治，概可悟矣。若痿壁在下，则肝肾病多，（肝主筋，肝血伤血不营筋，则四肢不用而筋骨拘挛。肾藏精，精血相生，虚则不能灌溉诸末而营养筋骨）而肺胃亦宜兼顾，大补阴丸、滋肾丸、虎潜丸、二妙丸（若肺燥苍术可勿用）、人参固本丸皆堪选。用其玉竹、巴戟、枸杞子、杜仲等可参入五方加减治之（三指禅注经验方，地黄四两，黄柏知母各一两，肉桂一钱，炼蜜为丸。方书有谓：血虚四物汤二妙丸合用。气虚四君子汤二妙丸合用）加龟版、虎骨、当归、地黄（可知二妙丸亦治痿症要药）。若痿症见于上则肺热居多，东垣清燥汤在所必用，即麦冬、沙参、粳米，每日煎粥饮。似极平淡，究属神奇也（此法治消渴亦佳）。
肾开窍于耳，心亦开窍于耳，胆脉络附于耳，老弱与久病皆属体虚失聪（聋鸣而不痛），治在肝肾。少年或暴病，总属邪干闭窍（痛鸣聋皆有），治在胆经，即本是议酌方，先拟清少阳络法。
羚羊角三钱，先煎 连翘壳二钱 粉丹皮一钱 苦丁茶一钱 牛蒡子一钱半 香白芷二分
气闭则耳鸣耳聋，薄荷梗、夏枯草、蔓荆子、钩藤、菊花、马勃、木通皆通窍之品，可参入加减。火郁则耳痛，菊叶、桑叶、银花、栀子亦可任加。然原方已属统治，至若肝肾虚而为聋为鸣者，宜用磁石，六味丸加龟版、五味、远志、菖蒲主治，人参、当归、枸杞子、菟丝子、沙苑、杭菊亦可因症选用。
上齿脉络属足阳明胃，下齿脉络属手阳明大肠，有风痛、热痛、虫痛、寒痛、痰毒、痛瘀、血痛之分，备载本门可考。惟风热痛为尤多，因订一清络热方法。
金银花三钱 双钩藤四钱 粉丹皮一钱 丝瓜络三钱 连翘壳二钱 生甘草八分
加生柏叶三钱引（上齿痛或加石膏、知母，下齿痛或加生地、秦艽），
风痛加荆芥、防风。水亏火亢加生地、天冬、麦冬、元参（去丝瓜络、连翘、钩藤）。食饭后倍痛胃火旺也，必须君以石膏、知母。大便结者加生地七八钱，风化硝二三钱（亦去丝瓜三味）。
Abdominal pain accompanied by Huoluan (acute vomiting and diarrhea) should be treated with Fanghuo San (Agarwood Powder) and other methods. Wang Kentang stated: In cases of Huoluan without vomiting or diarrhea, or with abdominal distension like a drum, other medicines should not be used; only Yiyuan San (Benefit the Prime Powder) is suitable. The decoction should be prepared, cooled, and sipped occasionally, or the powder can be taken directly. This medicine can subdue pathogenic qi, resolve food stagnation and phlegm, harmonize the stomach, and regulate the middle jiao. Hearing sounds in the abdomen is a good sign; if there is no vomiting, there will be diarrhea, and if no diarrhea, then vomiting. It is an excellent medicine for Huoluan (strictly avoid ginger soup, rice soup, dark plum, and plum sauce). I follow this method: for Huoluan symptoms, whether vomiting/diarrhea has occurred or not, I use Huoxiang Ye (Patchouli Leaf), Jianshenqu (Medicated Leaven from Jian), and Dayecha (Large-leaf Tea), each 3 qian (all can harmonize the middle jiao); Zexie (Alisma Rhizome) and Mutong (Akebia Caulis), each 1 qian (all can descend turbidity); Chaihu (Bupleurum Root) and Qianghuo (Notopterygium Rhizome), each 7-8 fen (all can ascend clear yang). Decoct in water, mix with 3-4 qian of Yiyuan San. Take when slightly cool. If abdominal pain persists, continue according to this method (if dampness is present, add Cangzhu (Atractylodes Rhizome)); or assist with the method of Fanghuo San. Effectiveness is invariably achieved. Furthermore, ancients said that for sudden diseases, regardless of the pulse, one should judge based on symptoms; this is indeed an accurate discussion. In Huoluan and all painful or acute conditions, the pulse is often hidden/fu (deep and imperceptible); this statement must be remembered. It is also said that diseases with rapid onset belong to the Liver Meridian (among the Five Elements, wind and fire are the most rapid; the Liver is the organ of wind and fire). Although this is not solely regarding abdominal pain, since the Liver governs sinews and pain, painful conditions cannot be said to have no relation to the Liver. Huoluan naturally has a rapid onset, so it is necessary to add a small amount of Chaihu to soothe the Liver, or assist with Qingpi (Citrus Reticulata Green Peel) to subdue the Liver.
Appendix on Hernia Syndrome
Abdominal pain may also be caused by hernia affecting the area below the navel (Jueyin Liver), mid-navel (Shaoyin Kidney), above the navel (Taiyin Spleen), and both hypochondriac regions (Shaoyang Gallbladder). One should follow Danxi's advice to specifically treat the Jueyin Liver, as the Liver governs sinews and pain. Although there are seven types of hernia (Cold Hernia, Sinew Hernia, Water Hernia, Qi Hernia, Blood Hernia, Fox Hernia, Scrotal Hernia), the treatment principle generally focuses on acrid-aromatic qi-moving and draining the Jueyin. Jinlingzi San (Corydalis Powder), Zuojin Wan (Left Metal Pill), and Wuling San (Five-Ling Powder) should be combined and modified for treatment. Acute hernias are mostly cold; chronic hernias are mostly heat. For cold, heavily use Wu Zhu Yu (Evodia Fruit) and Guizhi (Cinnamon Twig), or add Xiaohui Xiang (Fennel Fruit) and Rougui (Cinnamon Bark); for heat, heavily use Huanglian (Coptis Rhizome) and Chuan Lian Zi (Sichuan Chinaberry Seed), or add Huangbai (Phellodendron Bark) and Mutong (Akebia Caulis). Nanmuxiang (Aquilaria Wood), Qingmuxiang (Villarsia Stem), Juhe (Tangerine Seed), fresh Juye (Tangerine Leaf), fresh Huangpizhi (Yellow Skin Branch), and fresh Tianjihuang (Centella Asiatica) are all acrid-aromatic qi-moving, meridian-dredging, and liver-soothing substances, used as assistants with Renshen (Ginseng Root) (Shashen (Adenophora Root) 1 liang, decocted with pig bladder into a soup, effectively treats hernia. Shashen clears the Lung, allowing the clear and descending qi of Lung Metal to go down, as the Lung communicates with the Bladder for gasification. The use of Shashen in San Ceng Huixiang Wan reflects this idea). If one wishes to further assist with methods to promote blood circulation in meridians and guide medicinal power directly to the yin domains, Taoren (Peach Kernel), Guixu (Dangelica Root Tip), Shanjiya (Pangolin Scale), Xiebai (Allium Macrostemon Bulb), and Xiongshoushi (Male Rat Feces) are essential. For those with weak constitutions and chronic hernia with testicular descent, one must warm and disperse the extraordinary vessels and raise the extraordinary yang (The Classic states: Disease of the Ren Mai results in seven types of internal hernia in men and leukorrhea/masses in women). Consolidating the root and tonifying deficiency is crucial; Danggui Yangrou Tang (Angelica Mutton Soup), Zishen Wan (Kidney-Nourishing Pill), and Hujian Wan (Tiger-Kneading Pill) are all fundamental treatments. Xiaohui Xiang (Stir-fried), Danggui (stir-fried with Xiaohui Xiang in water, Danggui can unblock the yang qi of Liver meridians), Tusizi (Dodder Seed), Guan Shayuan (Astragalus Complanatus Seed), Gouqi Zi (Goji Berry), Lurong (Deer Antler Lu), Lujiaoshuang (Deer Horn Frost), Guizhi Jian (Cinnamon Twig Tip), and Baijili (Tribulus Fruit) can all be used clinically according to symptoms.
Heart Pain
"Heart pain" here does not refer to actual heart pain; Zhenxintong (True Heart Pain) is incurable. It refers to pain in the Pericardium Luo and the epigastrium. The prescribed formula follows the method of bitter-sweet descending and unblocking; unblocking leads to cessation of pain. One must refer to the accompanying symptoms listed later to differentiate the cause and modify the prescription accordingly.
Danshen (Salvia Root) 3 qian, Chuanlian Zi (Sichuan Chinaberry Seed) 1.5 qian, Maidong (Ophiopogon Tuber) 2 qian (crushed, mixed with Zhusha (Cinnabar)), Xiangfu (Cyperus Rhizome) 1 qian, Yanhusuo (Corydalis Rhizome) 1 qian, Wuyao (Lindera Root) 1 qian, Foshou (Finger Citron) 2 qian.
Add Chunsharen (Amomum Villosum Fruit) 3 grains, cracked with shell, decoct together.
Alternatively, grind a little Tanxiang (Sandalwood) juice to wash down, or add Baihe (Lily Bulb) to decoct (Baihe + Wuyao is named Baihe Tang; Chuanlian Zi + Yanhusuo is named Jinlingzi San; Danshen + Sharen + Tanxiang is named Danshen Yin. All three formulas treat heart pain). For any heart pain syndrome, use one pig heart, decoct in water, remove the heart, and use the broth to decoct the herbs for better efficacy. For chronic pain, Danggui (Angelica Sinensis) and Taoren (Peach Kernel) must be added to invigorate blood and unblock collaterals (If pain relieves after eating, this is due to accumulation of labor causing Ying-Blood deficiency; besides Danggui and Taoren, add Bairen (Biota Seed), Huma (Sesame Seed), and Yuanrou (Longan Aril); remove Chuanlian Zi, Yanhusuo, Wuyao, and Chunsharen from the original formula). If heart pain radiates to the back (this is Xiongbi syndrome/Chest Bi), use Gualou Xiebai Banxia Tang (Trichosanthes, Macrostemon, and Pinellia Decoction).
Additionally, if pain is due to Phlegm (pain with oppression, relief after vomiting phlegm-fluid is Phlegm), add Banxia (Pinellia Tuber), Beimu (Fritillaria Bulb), and Gualou Ren (Trichosanthes Seed) (remove Danshen, Maidong, Xiangfu). If due to Food Stagnation (fullness with belching, relief only when hungry is Food Stagnation), add Caoguo (Tsaoko Fruit), Zhishi (Immature Bitter Orange), Binglang (Areca Seed), or Maiya (Barley Sprout) and Shenqu (Medicated Leaven) (remove Danshen, Yanhusuo, Wuyao). If due to Cold (relief after drinking hot soup/wine is Cold), add Ganjiang (Dried Ginger) and Liangjiang (Galangal Rhizome) (remove Maidong, Danshen). If due to Stagnation/Qi-Stagnation (pain radiating to back indicates Stagnation, symptoms resemble Chest Bi, distinguish between dry and moist), add Chuanbeimu (Fritillaria Cirrhosa Bulb) and Chuanxiong (Ligusticum Rhizome) (remove Wuyao, Sharen). If due to Parasites (urgent heart pain, pale lips, erect hair, vomiting yellow fluid is Parasites), add Leiwan (Polyzoa), Junrou (Nutmeg Flesh), Wumei (Dark Plum), and Huanglian (Coptis Rhizome) (remove Danshen, Maidong, Wuyao, Yanhusuo, Sharen) or use Bingxiong Wan (Areca and Asarum Pill). If due to Blood Stasis (knotted heart pain, rebellious Qi rushing up, gurgling sounds is Blood Stasis), add Sumu (Sappan Wood), Sanleng (Sparganium Rhizome), Pengze (Curcuma Zedoaria Rhizome), or add Taoren (Peach Kernel), Honghua (Carthamus Flower), Jiangxiang (Dragon's Blood) (remove Maidong, Sharen, Wuyao).
There are also cases of frequent heart pain, extreme pain leading to fainting, requiring vomiting of saliva/water to regain consciousness; this is Cold-Phlegm accumulating in the Heart and Spleen. Use 1 liang of stir-fried Zhizi (Gardenia Fruit), decoct, add Zhuli (Bamboo Sap) and Jiangzhi (Ginger Juice) 1 cup each, and take mixed. There are cases of sudden severe pain, silent, with cold hands/feet, cold breath, blue face, clenched teeth and jaw; this is Zhenxintong (True Heart Pain). Due to Cold Pathogen directly attacking the Minister Fire, death occurs within one shichen (two hours). If using Pig Heart Soup to decoct Mahuang (Ephedra Herb), Guanzi Gui (Cassia Twig), Fuzi (Aconite Root), and Ganjiang (Dried Ginger) and taking urgently, survival is possible (This method comes from Wang Kentang's "Yi Jing", stating it is a secret and miraculous method).
Attached Case (Extraordinary Vessel Heart Pain)
The fifth concubine of Magistrate Ma Suyin of Shunyi, according to Suyin's account, always suffered abdominal pain during Xu-Hai hours (Xu-Hai are times of extreme Yin; Liver and Kidney are organs of extreme Yin; the Eight Extraordinary Vessels all originate from Liver and Kidney). The pain starts below the navel, gradually circles up around the navel and to the hypochondriac regions, reaching the heart, but resolves peacefully at dawn. Usually, Bazhen Tang (Eight-Treasure Decoction) provided slight relief, allowing self-recovery. However, Doctor Lu diagnosed her, saying the pulse was near-strong, suggesting clearing the source to prevent recurrence, and switched to bitter-cold agents, which increased pain. Re-examination next day showed even stronger pulse; Lu argued the pulse required clearing and the previous dose was too weak. Ancients say "unblocking stops pain" (though warming the cold to unblock, tonifying deficiency to unblock, doctors seem ignorant of this). Bowel movements occurred only every 2-3 days. Treatment must combine... (Hanyuan Qi dullness and Blood dryness, doctor seems unclear). Use Dachengqi Tang (Major Order the Qi Decoction) with Taoren (Peach Kernel) and Chuanlian Zi (Sichuan Chinaberry Seed) in large doses. After bowel movement, pain persisted day and night (Injury to both Yin and Yang), with frequent vomiting and inability to eat. Dr. Junyu was invited. My pulse diagnosis: Syndrome belongs to Deficiency-Cold,理应温补 (should be warmed and tonified). Suyin asked: Is the pulse buoyant? I said: Yes. He said: With such a pulse, how can we tonify? I said: Before taking Dachengqi Tang, although it seemed strong, it might not have been buoyant. He said: Truly as you say, why? I said: This is True Qi deficiency and Pathogenic Qi excess. When Stomach Qi is sufficient, the pulse is slow. Now, bitter-cold attack has injured Stomach Qi further, hence the buoyancy. Real-Heat pulses are heavy and remain strong upon deep pressure; now it is soft upon deep pressure, and lips are white with fatigue and lack of spirit. Could this be an Excess syndrome? Less abdominal pain necessarily involving heart pain: The Classic says "Disease of Yinwei Mai causes heart pain." The Eight Extraordinary Vessels originate from Liver and Kidney, originally treating the lower body. Due to bitter-cold injuring the Middle Jiao further, the method must address both middle and lower, urgently expelling Cold Pathogen and restoring Stomach Qi. My opinion proposes modifying Wuzhuyu Tang (Evodia Decoction) combined with Fuzi Jingmi Tang (Aconite and Rice Decoction). First prescription: Yeshanshenli (Wild Mountain Ginseng) 4 qian, Wu Zhu Yu (Evodia Fruit) and Fuzi (Aconite Root) 2 qian each, stir-fried Jingmi (Rice), Banxia (Pinellia Tuber), Shengjiang (Fresh Ginger) 3 qian each, Dazao (Jujube) 2 pieces. After one dose, vomiting stopped, pain decreased. Next day: Same formula plus Baizhu (Atractylodes Macrocephala Rhizome) 3 qian, Zhi Cao (Honey-fried Licorice Root) 1 qian, decoct. Third day: Pulse became harmonious and slow, pain reduced by 80-90%. Switched to Danggui (Angelica Sinensis) (stir-fried with 5 fen Xiaohui Xiang, still decocted together) and Zhi Shiying (Fluorite) (raw ground) 5 qian each, Ludangshen (Codonopsis Root) and Gouqi Zi (Goji Berry) 4 qian each (salt-water stir-fried), Pogu Zi (Psoralea Fruit), Zhi Xiangfu (Cyperi Rhizoma), Zhi Qiaiye (Mugwort Leaf) 1 qian each. After four doses, occasionally add Tianshengzhu (Natural Atractylodes) and Guan Shayuan (Astragalus Complanatus Seed) to decoct, or add Yeshanshutu (Wild Mountain Atractylodes), Renshen (Ginseng Root), Bei Lurong (Northern Deer Antler) powder 1 qian each, separately stewed and taken mixed. Recovered after nearly one month of recuperation. Half a year later, pain recurred due to sexual activity, with lower abdominal distension and left Chi pulse string-taut and forceful (Kidney deficiency with Wind stirring). Used modified seven-ingredient formula, removing Ludangshen, Zhi Shiying, Pogu Zi, adding Haipiaoxiao (Cuttlefish Bone) and Baijili (Tribulus Fruit) 4 qian each, Qianggen (Rubia Root) 1 qian, Xiewei Shao (Scorpion Tail) 1 fen. Two doses led to gradual improvement. Afterwards, continued with Guiqi Seven-Ingredient Formula, combined with Renshen, Lurong, Yeshu, Sharen, Shudi (Rehmannia Root), adjusting to complete recovery.
Hypochondriac Pain
Hypochondriac pain mostly belongs to Shaoyang and Jueyin, as the hypochondriac region belongs to Shaoyang, and the Liver meridian spreads through it. Treatment primarily dredges collaterals, assisted by calming the Liver.
Chuanlianzi (Sichuan Chinaberry Seed) 1.5 qian, Xiakucao (Prunella Spike) 3 qian, Jiu Qingpi (Old Tangerine Green Peel) 1 qian (vinegar-fried), Yanhusuo (Corydalis Rhizome) 1.5 qian, Tai Wuyao (Lindera Root) 1 qian, Fen Danpi (Moutan Cortex) 1 qian (core removed), Shuang Gouteng (Uncaria Rhynchophylla) 4 qian.
Add fresh Juyouye (Orange/Pomelo Leaf) cut up, and Qingcongguan (Green Onion Tube) cut into inches, each 3 qian.
Chronic pain inevitably enters the collaterals; must add Taoren (Peach Kernel) and Honghua (Carthamus Flower) to invigorate blood and unblock collaterals, or incorporate Xuanfuhua Tang (Inula Decoction) to descend collaterals, or assist with Suzi (Perilla Seed), Sheng Yimi (Raw Coix Seed), Jiangxiang (Dragon's Blood) (Ye Tianshi's three ingredients often used together), and Zijie (Mustard Seed) to unblock collaterals. Wang Kentang stated: Strictly avoid Chenpi (Tangerine Peel), Shengjiang (Fresh Ginger), and Xixin (Asarum Root); taking them causes Liver distension because they can tonify the Liver. Qingpi (Citrus Reticulata Green Peel) should be vinegar-fried to enhance acidity, breaking stagnation and entering the Liver meridian directly. For severe pain, add half a wine cup of vinegar to wash down the medicine.
One must also know whether pain is in Qi or Blood, as symptoms differ. Pain without distension, worsening on pressure, intermittent pain indicates Blood Stasis pain. Pain with distension, relieved by belching, with intervals indicates anger-induced pain. Anger-induced pain adds Cu Chao Chaihu (Vinegar-fried Bupleurum Root) assisting Qingpi to subdue Liver, with small amounts of Muxiang (Aucklandia Root) assisting Wuyao to move Qi, and Honghua (Carthamus Flower) and Danggui (Angelica Sinensis) optionally to harmonize Blood (or remove Gouteng, Yanhusuo). Blood stasis pain adds Taoren (Peach Kernel), Weitail (Angelica Tail), Honghua (Carthamus Flower) (remove Gouteng, Wuyao, Qingpi, Xiakucao, or add small amounts of vinegar-fried Chaihu, Chuanxiong), or add Sumu (Sappan Wood), Shanzha (Hawthorn Fruit), Pengze (Curcuma Zedoaria Rhizome); if pain is severe, add Dahuang (Rhubarb Root) to purge. This distinguishes Qi and Blood symptoms and appropriate medications. If mild pain is localized, it is Phlegm pain; if the proposed formula is unsuitable, use Zijie (Mustard Seed) as chief, assisting with Zhuli (Bamboo Sap) and Jiangzhi (Ginger Juice). Sigualuo (Luffa Vine), Baijili (Tribulus Fruit), Zhebei (Fritillaria Thunbergii Bulb), Danning (Arisaema Cum Bile), Loupi (Trichosanthes Peel), Qingpi (Citrus Reticulata Green Peel), Huanglian (Coptis Rhizome) can also serve as assistants.
Lower Back Pain
The lower back is the mansion of the Kidney. Internally it is Shaoyin (Kidney), externally it is Taiyang (Bladder). Therefore, lower back pain must be treated via these two meridians. Exterior and interior require distinct treatment methods. Pain from external pathogens belongs to the Bladder; pain from internal deficiency belongs to the Kidney, requiring filling, tonifying, warming, and unblocking; methods vary. I once drafted a Kidney-tonifying formula, widely transmitted and effective; I record it here first. My opinion further divides treatment.
Jin Gouji (Drynaria Rhizome) 4 qian (de-haired), Tusizi (Dodder Seed) 3 qian, Pogu Zi (Psoralea Fruit) 5 fen (salt-water stir-fried), Guan Shayuan (Astragalus Complanatus Seed) 4 qian, Niuxi (Achyranthes Root) 2 qian (wine-fried), Hou Huangbai (Phellodendron Bark) 5 fen (salt-water stir-fried), Sheng Duzhong (Eucommia Bark) 3 qian.
Alternatively, use one pair of pig kidneys, decoct in water to replace water for decocting herbs.
For Heat, double Huangbai relative to Pogu Zi; for Cold, double Pogu Zi relative to Huangbai (or 2-3 times). Once pain is gone, add Shudi (Prepared Rehmannia Root), Gouqi Zi (Goji Berry), Hetao (Walnut Kernel) or Lurong (Deer Antler Lu), Lujiaoshuang (Deer Horn Frost), taking several doses to prevent recurrence. For lower back pain with deep-thin pulse, treat Shaoyin. Intermittent pain indicates Kidney Essence deficiency; use the aforementioned Kidney-tonifying formula. Intermittent pain with heat indicates Kidney Water deficiency; use Zhibai Bawei Tang (Anemarrhena, Phellodendron, and Eight-Ingredient Decoction). If pulse is floating and tight, treat Taiyang. Stabbing back pain indicates Wind lodging at Shenshu (BL23); use Mahuang (Ephedra Herb), Xixin (Asarum Root), Duhuo (Angelica Pubescens Root), Fangfeng (Saposhnikovia Root), Shengdi (Rehmannia Root), Danggui (Angelica Sinensis), Baishao (White Peony Root) to disperse Wind. Depressive pain with aversion to cold indicates lodging at Qihai (BL24); use Mahuang (Ephedra Herb), Fuzi (Aconite Root), Xixin (Asarum Root), Danggui (Angelica Sinensis), Zhi Cao (Honey-fried Licorice Root). Heavy, immobile Cold pain indicates Dampness lodging in the storage of Essence; use Mahuang (Ephedra Herb), Cangzhu (Atractylodes Rhizome), Baizhu (Atractylodes Macrocephala Rhizome), Danggui (Angelica Sinensis), Duzhong (Eucommia Bark), Niuxi (Achyranthes Root), Fuling (Poria), Yimi (Coix Seed), Zhi Cao (Honey-fried Licorice Root) to expel Dampness.
Qi Leg Pain
This is called Yong Ji (Obstructive Disease), meaning Dampness obstructing meridians causing pain. Tonics are contraindicated. Specialized warming and tonifying will surely lead to disability. It is divided into Cold-Damp, Wind-Damp, and Damp-Heat. Carefully analyze the following pulse/symptoms to modify prescriptions.
Danggui (Angelica Sinensis) 3 qian, Jiu Mugua (Quince Fruit) 2 qian (wine-fried), Xi Mutong (Akebia Caulis) 1.5 qian, Qianghuo (Notopterygium Rhizome) 1.5 qian, Sheng Yimi (Raw Coix Seed) 5 qian, Zi Sugeng (Perilla Stem) 1.5 qian, Fangfeng (Saposhnikovia Root) 1.5 qian.
Add Sheng Chixiaodou Pi (Red Bean Skin) 5 qian, decoct together.
Night fever with pain, soggy-rapid pulse indicates Damp-Heat; add Huangbai (Phellodendron Bark) and Maidong (Ophiopogon Tuber) to decoct. Day-night aversion to cold with pain, soggy-slow pulse indicates Cold-Damp; add Cangzhu (Atractylodes Rhizome), Ganjiang (Dried Ginger), Fuzi (Aconite Root), Fangji (Stephania Root), Jiaapi (Dictamnus Bark) (remove Mutong, Sugeng). Swelling/pain moving unpredictably, ankle/knee/shin, soggy-floating-rapid pulse indicates Wind-Damp; add Shengdi (Rehmannia Root), Niuxi (Achyranthes Root) (remove Mugua, Yimi, Sugeng). If ineffective, add Mangxiao (Mirabilite) and Dahuang (Rhubarb Root) to decoct. For those addicted to alcohol harboring Wine-Damp-Toxin, differentiate pulse/symptoms, combining Cold/Heat/Wind, selecting drugs per the above three methods, heavily adding Zhizige (Ardisia Seed) and Ganhua (Kudzu Flower) to resolve Wine-Toxin. Alternatively, use Bajitian (Morinda Root) 5 qian (stir-fried with glutinous rice until dry, remove rice) and Dahuang (Rhubarb Root) 1 liang (stir-fried), grind to powder, make honey pills (named Bahuang Wan), take 50-70 pills with warm water (must abstain from alcohol). For leg pain, Shanjiya (Pangolin Scale) and Dilong (Earthworm) can be added as guides. If walking causes pain to ascend to arms/hands, add Lingxian (Spatholobus Stem). Dry Qi Leg presents without swelling, with curling/shrinking, dry/thin tendons requiring moistening, clear blood/dryness (suitable for Yuzhu (Polygonatum Rhizome), Shengdi (Rehmannia Root), Maidong (Ophiopogon Tuber), Tandong (Asparagus Tuber), Huma (Sesame Seed), Shihu (Dendrobium Stem), Niuxi (Achyranthes Root), Guixu (Angelica Root Tip), Biejia (Turtle Shell), Ejiao (Donkey-hide Gelatin)). Yin-deficiency leg pain presents with red/swollen heels, requiring Kidney tonification and Ying nourishment (suitable for Guiban (Turtle Shell), Shengdi (Rehmannia Root), Shudi (Prepared Rehmannia Root), Danggui (Angelica Sinensis), Datong (likely Tandong/Ophiopogon), Gouqiren (Goji Berry), Duzhong (Eucommia Bark), Yuzhu (Polygonatum Rhizome), Bajitian (Morinda Root), Huangbai (Phellodendron Bark), Zhimu (Anemarrhena Rhizome), Niuxi (Achyranthes Root)). These two syndromes are opposite to Damp Qi Leg; misdiagnosis worsens condition.
Appendix on Wei Syndrome (Atrophy)
Besides Qi Leg pain, there is Wei Bi (Atrophy Flaccidity), referred to in medical texts as Wei Syndrome. No pain; however, if accompanied by heavy Dampness, sinews relax leading to flaccidity; if accompanied by much Heat, sinews contract causing pain. I often see Wei syndrome with pain. Doctors treating with Wind-dispelling drugs (Danxi said never treat as Wind) or Damp-draining drugs as Wind-Damp Qi Leg pain invariably worsens it. Thus, I attach this syndrome under Qi Leg pain (Wang Shishan treated a person with Wei and pain using Renshen (Ginseng Root) 2 qian, Huangqi (Astragalus Root) 1.5 qian, Baizhu (Atractylodes Macrocephala Rhizome), Fuling (Poria), Shengdi (Rehmannia Root), Maidong (Ophiopogon Tuber) 1 qian each, Danggui (Angelica Sinensis) 8 fen, Huangbai (Phellodendron Bark), Zhimu (Anemarrhena Rhizome) 7 fen each; continuous doses cured Wei and pain). Wei has distinctions of Mai Wei (Vessel Atrophy), Jin Wei (Sinew Atrophy), Rou Wei (Muscle Atrophy), Gu Wei (Bone Atrophy); it is not limited to feet (there is Head Wei, Hand Wei, Waist Wei, Whole Body Wei). Classics state: All Weis arise from Lung Heat (Lung governs Qi transformation of the body; Lung dryness-heat dries blood, failing to nourish sinews/bones, causing Wei). Also: Treat Wei by focusing on Yangming (Yangming moistens Zongjin, binds sinews/bones to facilitate joints. Deficiency leads to Zongjin flaccidity, making limbs useless). Understanding this allows grasping general treatment principles. If Wei is in the lower body, Liver/Kidney disease is common (Liver governs sinews; Liver Blood injury fails to nourish sinews, causing limb immobility and spasm. Kidney stores Essence; Essence/Blood generate each other; deficiency fails to irrigate extremities/nourish sinews/bones). Lung/Stomach should also be considered. Dabu Yin Wan (Great Yin Pill), Zishen Wan (Kidney-Nourishing Pill), Hujian Wan (Tiger-Kneading Pill), Ermiao Wan (Two-Awesome Pill) (avoid Cangzhu if Lung is dry), Renshen Guben Wan (Ginseng Root-Solidifying Pill) are selectable. Yuzhu, Bajitian, Gouqi Zi, Duzhong can be incorporated into these five formulas for modification (San Zhi Chan notes empirical formula: Dihuang 4 liang, Huangbai/Zhimu 1 liang each, Rougui 1 qian, refined honey pills. Texts say: Blood deficiency combines Siwu Tang with Ermiao Wan; Qi deficiency combines Sijunzi Tang with Ermiao Wan). Add Guiban (Turtle Shell), Hugutou (Tiger Bone - *note: modern substitutes recommended*), Danggui (Angelica Sinensis), Dihuang (Rehmannia Root) (indicating Ermiao Wan is also key for Wei). If Wei appears in the upper body, Lung Heat is predominant; Dongyuan Qingzao Tang (Clear Dryness Decoction) is essential. Or Maidong (Ophiopogon Tuber), Shashen (Adenophora Root), Jingmi (Rice) decocted daily as porridge drink. Seems plain but is miraculous (also good for Xiao Ke/Wasting-Thirst).
Ear Pain (Tinnitus and Deafness differentiated similarly)
Kidney opens to ears; Heart also opens to ears; Gallbladder meridian attaches to ears. Old/weak and chronic illness belong to Body Deficiency causing deafness/tinnitus (deaf/tinnitus without pain), treated in Liver/Kidney. Youth or acute illness belongs to Pathogen blocking orifices (pain/tinnitus/deafness all occur), treated in Gallbladder Meridian. Based on this discussion, draft a formula, initially proposing Clear Shaoyang Collateral method.
Lingyangjiao (Antelope Horn) 3 qian (decoct first), Liaoqiao Qiao (Forsythia Husk) 2 qian, Fen Danpi (Moutan Cortex) 1 qian, Kudingcha (Ilex Kudingcha Leaf) 1 qian, Niubangzi (Arctium Seed) 1.5 qian, Xiang Baizhi (Angelica Dahurica Root) 2 fen.
Add Xian Lian Geng (Lotus Stem) 3 qian, cut; Xian Lian Ye Bian (Lotus Leaf Edge) 3 qian, cut up as guides.
Qi blockage causes tinnitus/deafness; Bohe Geng (Mint Stem), Xiakucao (Prunella Spike), Manjingzi (Vitex Seed), Gouteng (Uncaria Rhynchophylla), Juhua (Chrysanthemum Flower), Mabo (Fly Agaric - *likely typo for another herb, possibly Ma Bo/Ma Bo Zi*), Mutong (Akebia Caulis) are all orifice-unblocking substances, usable in modifications. Fire stagnation causes ear pain; Juye (Chrysanthemum Leaf), Sangye (Mulberry Leaf), Yinhua (Honeysuckle Flower), Zhizi (Gardenia Fruit) can be added. The original formula already covers general treatment. For Liver/Kidney deficiency causing deafness/tinnitus, use Cishi (Magnetite), Liuwei Wan (Six-Ingredient Pill) with Guiban (Turtle Shell), Wuweizi (Schisandra Berry), Yuanzhi (Polygala Root), Changpu (Acorus Rhizome). Renshen (Ginseng Root), Danggui (Angelica Sinensis), Gouqi Zi (Goji Berry), Tusizi (Dodder Seed), Shayuan (Astragalus Complanatus Seed), Hangju (Hangzhou Chrysanthemum) can be selected based on symptoms.
Tooth Pain
Upper teeth meridian belongs to Foot-Yangming Stomach; lower teeth meridian belongs to Hand-Yangming Large Intestine. Divided into Wind Pain, Heat Pain, Worm Pain, Cold Pain, Phlegm-Toxin Pain, Stasis Pain, Blood Pain, detailed in this section for reference. Wind-Heat pain is most common, so a Clear Collateral-Heat method is prescribed.
Jinyinhua (Honeysuckle Flower) 3 qian, Shuang Gouteng (Uncaria Rhynchophylla) 4 qian, Fen Danpi (Moutan Cortex) 1 qian, Sigualuo (Luffa Vine) 3 qian, Liaoqiao Qiao (Forsythia Husk) 2 qian, Sheng Gancao (Licorice Root) 8 fen.
Add Sheng Baiye (Platycladus Leaf) 3 qian as guide (Upper tooth pain may add Shigao (Gypsum), Zhimu (Anemarrhena Rhizome); Lower tooth pain may add Shengdi (Rehmannia Root), Qinjiao (Gentiana Macrophylla Root)).
Wind pain adds Jingjie (Schizonepeta Spike), Fangfeng (Saposhnikovia Root). Water deficiency/Fire hyperactivity adds Shengdi (Rehmannia Root), Tandong (Asparagus Tuber), Maidong (Ophiopogon Tuber), Yuanshen (Scrophularia Root) (remove Sigualuo, Liaoqiao, Gouteng). Pain doubling after meals indicates Stomach Fire excess; must use Shigao (Gypsum) and Zhimu (Anemarrhena Rhizome) as chief. Constipation adds Shengdi (Rehmannia Root) 7-8 qian, Fenghua Xiao (Weathered Mirabilite) 2-3 qian (also remove Sigualuo three ingredients).