胁痛之虚实又何以辨之胁痛属之肝肝经本是至阴之位宜乎痛皆阴症也不知肝虽属阴而气
则属阳或
一时感冒风邪两胁作痛痰壅上焦中腕不痛结成老痰欲吐不能欲下不得亦最苦之症也法当用
舒
肝散风之药逍遥散最妙之方也至于肝气之虚一旦触动怒气伤其肝血亦两胁作痛其症亦与前症
相
似但无欲吐不能欲咽不下之状论理亦可用逍遥散以舒解之然而本方药味虽佳而分两欠重吾今
更立一方名为平肝舒怒饮治因怒胁痛甚效或因郁而作痛者亦无不神一剂而痛如失此方之妙
妙
在芍药用至一两之多则肝木得酸而自平况又佐之当归之补血以生肝又佐之各品相辅之宜则肝
气之郁解而两胁又何能作痛哉倘不知用此一旦用小柴胡等汤虽亦能去痰而旷日迟久不能如此
方之神速耳
平肝舒怒饮
柴胡(二钱) 白芍(一两) 炒栀子(三钱) 当归(一两) 白芥子(三钱) 车前子(三钱) 白术
(三钱) 枳壳(一钱) 丹皮(三钱) 神曲(一钱) 麦芽(二钱) 山楂(十粒)水煎服
腹痛之虚实又何以辨之腹居至阴之下以痛之皆阴症也既是阴症宜虚而非实矣谁知痛之不
同有
虚有实之异乎实痛何以辨之按之必手不可近此乃燥屎结成于大肠之内火迫于脏腑之间伤寒日
久最多此病此乃实邪而非虚病之可比方当下之为妙仲景张公有大柴胡乘气亦可选用然而非专
治腹痛也吾今另立一方专治腹痛之症实有神效名为涤邪救痛汤此方虽有大黄之下邪而即有当
归生地之生血以活血总然有枳实之推荡而无妨亦攻补并施之妙法也倘腹痛而身有寒邪未散本
方中加柴胡一钱足矣余可不必增入一剂而邪散秽出身即凉而痛如失至于腹痛虚症大约畏寒畏
食喜热手之相熨喜健人之按摩盖虚寒之气留于下焦之故也其大便必溏而小便必然清冷一问可
知无多深辨方用祛寒止痛汤此方妙在用白术为君以利其腰脐之气气湿而寒温之气不能留于腹
中自然邪从小便而出而疼痛之苦顿除也倘以轻清之味和解之未必奏功如神至此
涤邪救痛汤
大黄(五钱) 红花(一钱) 生地(五钱) 当归(五钱) 枳实(一钱) 浓朴(一钱) 天花粉(一
钱) 甘草(一钱)水煎服
祛寒止痛汤
白术(一两) 肉桂(二钱) 甘草(一钱) 吴茱萸(五分) 砂仁(三粒) 藿香(一钱) 人参(二
钱) 半夏(一钱)水煎服
胁痛的虚实又该如何辨别呢?胁痛归属于肝脏,肝经所处的位置属于至阴之地,按理说疼痛都应该是阴证。然而不知道的是,肝虽然属性为阴,但其气则属于阳。如果一时之间感受了风邪,导致两胁疼痛,或者痰浊壅塞在上焦,中脘部不痛,结成老痰,想要呕吐却吐不出来,想要排泄却又排不出去,这也是极其痛苦的病症。治疗方法应当使用疏肝散风的药物,逍遥散是最妙的方剂。至于肝气虚弱,一旦触动怒气损伤了肝血,也会导致两胁疼痛,其症状也与前面的病症相似,只是没有想吐吐不出、想咽咽不下的状况。从理论上讲也可以使用逍遥散来舒解。然而这个方子的药味虽然好,但分量偏轻。我现在另外设立一个方子,名为平肝舒怒饮,治疗因愤怒导致的胁痛非常有效;如果是因郁结而作痛的,也没有不是服用一剂后疼痛立刻消失的。这个方子的妙处在于白芍用到一两之多,这样肝木得到酸味的作用自然就能平息,况且又佐以当归补血以滋养肝脏,再加上其他药物的相辅相成,肝气的郁结得以解除,两胁又怎么能疼痛呢?倘若不知道使用此方,一旦使用小柴胡汤等方剂,虽然也能去除痰浊,但旷日持久,不能像这个方子那样神速。
平肝舒怒饮
柴胡(二钱) 白芍(一两) 炒栀子(三钱) 当归(一两) 白芥子(三钱) 车前子(三钱) 白术(三钱) 枳壳(一钱) 丹皮(三钱) 神曲(一钱) 麦芽(二钱) 山楂(十粒) 水煎服
腹痛的虚实又该如何辨别呢?腹部位于至阴之下,既然疼痛都是阴证,理应属于虚证而非实证。谁知疼痛的不同,有虚证和实证的差异。如何辨别实证疼痛呢?按压时患者必定拒绝触碰,这是因为燥屎结在大肠之内,火热逼迫于脏腑之间。伤寒日久最多出现这种病,这是实邪而不是虚病可以相比的,此时应当用攻下法才为妙。张仲景公的大柴胡汤也可以选用,然而这并不是专门治疗腹痛的方子。我现在另外设立一个方子,专门治疗腹痛的病症,确实有神效,名为涤邪救痛汤。这个方子虽然有大黄攻下邪气,但同时又有当归、生地滋养血液以活血,纵然有枳实的推荡作用也无妨,这也是攻补兼施的妙法。倘若腹痛且身体有寒邪未散,在本方中加入一钱柴胡即可,其余不必增加。服用一剂后邪气消散、秽物排出,身体变凉,疼痛立刻消失。至于腹痛的虚证,大约表现为畏寒、畏食、喜欢热手熨烫、喜欢他人按摩,这是因为虚寒之气留滞于下焦的缘故。其大便必然溏薄,小便必然清冷,一问便知,无需过多深辨。方用祛寒止痛汤。这个方子的妙处在于用白术作为君药,以疏通腰脐之气,气行则湿化,寒温之气不能留滞于腹中,自然邪气从小便而出,疼痛之苦顿时消除。倘若用轻清的味道来和解,未必能奏效如神。至此结束。
涤邪救痛汤
大黄(五钱) 红花(一钱) 生地(五钱) 当归(五钱) 枳实(一钱) 浓朴(一钱) 天花粉(一钱) 甘草(一钱) 水煎服
祛寒止痛汤
白术(一两) 肉桂(二钱) 甘草(一钱) 吴茱萸(五分) 砂仁(三粒) 藿香(一钱) 人参(二钱) 半夏(一钱) 水煎服
The deficiency and excess of hypochondriac pain (Hypochondriac Pain) should be differentiated as follows: Hypochondriac pain is associated with the Liver. Since the Liver meridian resides in a position of extreme Yin, one might assume that such pain always constitutes a Cold syndrome (Yin Syndrome). However, although the Liver organ belongs to Yin, its Qi belongs to Yang. If wind-pathogen invades temporarily, causing pain in both hypochondria, or if phlegm turbidity obstructs the Upper Jiao without pain in the Zhongwan region, forming old phlegm that creates a distressing condition where one desires to vomit but cannot, or desires to defecate but cannot, this is also an extremely painful syndrome. The treatment method should employ herbs that soothe the Liver and disperse wind; Xiaoyao San (Free and Easy Wanderer Powder) is the most excellent formula. Regarding deficiency of Liver Qi, once anger is triggered and damages Liver Blood, it also causes pain in both hypochondria. The symptoms are similar to the aforementioned condition, except for the absence of the desire to vomit without success or difficulty swallowing. Theoretically, Xiaoyao San could also be used to soothe and resolve this. However, although the ingredients of this formula are good, their dosages are relatively light. I now establish a new formula named Pinggan Shunu Yin (Soothe Liver and Calm Anger Decoction), which is highly effective for hypochondriac pain caused by anger. For pain caused by depression/stagnation, one dose often results in immediate relief. The brilliance of this formula lies in using Bai Shao (Radix Paeoniae Alba) up to 1 liang; thus, the Liver Wood is calmed by the sour flavor. Furthermore, it is assisted by Dang Gui (Radix Angelicae Sinensis) to nourish blood and generate Liver essence, along with other complementary herbs. When Liver Qi stagnation is resolved, how can hypochondriac pain persist? If one fails to use this formula and instead uses Xiao Chai Hu Tang (Minor Bupleurum Decoction) or similar formulas, although they can remove phlegm, the process is prolonged and lacks the miraculous speed of this formula.
Pinggan Shunu Yin (Soothe Liver and Calm Anger Decoction)
Chai Hu (Bupleuri Radix, 2 qian), Bai Shao (Radix Paeoniae Alba, 1 liang), Chao Zhi Zi (Gardeniae Fructus, roasted, 3 qian), Dang Gui (Radix Angelicae Sinensis, 1 liang), Bai Jie Zi (Brassicae Semen Album, 3 qian), Che Qian Zi (Plantaginis Semen, 3 qian), Bai Zhu (Atractylodis Macrocephalae Rhizoma, 3 qian), Zhi Ke (Aurantii Fructus, 1 qian), Dan Pi (Moutan Cortex, 3 qian), Shen Qu (Massa Medicata Fermentata, 1 qian), Mai Ya (Hordei Fructus Germinatus, 2 qian), Shan Zha (Crataegi Fructus, 10 pieces). Decoct in water and take orally.
The differentiation of deficiency and excess in abdominal pain (Abdominal Pain) is as follows: The abdomen resides below the extreme Yin. Since the pain is considered a Yin syndrome, it should theoretically be deficiency rather than excess. Yet, pain varies significantly between deficiency and excess syndromes. How to identify excess abdominal pain? It is characterized by severe tenderness where the patient refuses pressure (abdominal rigidity/tenderness). This occurs when dry stool accumulates in the Large Intestine, and fire forces its way through the organs. In prolonged Taiyang disease (Taiyang Disease), this condition is common. This represents excess pathogenic factors, distinct from deficiency diseases, and requires purgative therapy. Zhang Zhongjing’s Da Chai Hu Tang (Major Bupleurum Decoction) may also be selected, though it is not specifically designed for abdominal pain. I now establish a new formula specifically for abdominal pain, named Dixie Jiutong Tang (Eliminate Pathogen and Relieve Pain Decoction), which proves miraculously effective. Although this formula contains Da Huang (Rhei Radix et Rhizoma) to purge pathogens, it simultaneously includes Dang Gui (Radix Angelicae Sinensis) and Sheng Di Huang (Rehmanniae Radix) to nourish blood and promote circulation. Despite the pushing action of Zhi Shi (Aurantii Fructus Immaturus), this does not hinder the strategy; it exemplifies the brilliant method of combining purgation with tonification. If abdominal pain is accompanied by unresolved exterior cold, add 1 qian of Chai Hu (Bupleuri Radix) to this formula; no other additions are necessary. After one dose, the pathogen dissipates, turbid matter is expelled, the body cools, and pain vanishes. As for deficiency-type abdominal pain, symptoms typically include aversion to cold, aversion to food, preference for warm compresses, and preference for massage. This is due to deficiency-cold lingering in the Lower Jiao. Stool is invariably loose, and urine clear and cold. Inquiry suffices for diagnosis without deep differentiation. The prescribed formula is Quhan Zhitong Tang (Dispel Cold and Stop Pain Decoction). The efficacy of this formula lies in using Bai Zhu (Atractylodis Macrocephalae Rhizoma) as the sovereign herb to benefit the Qi of the waist and umbilical region. When Qi moves, dampness transforms, and cold-warm pathogens cannot linger in the abdomen. Naturally, pathogens exit via urination, and pain is instantly relieved. Using mild and clearing herbs for harmonization would likely fail to achieve such miraculous results.
Dixie Jiutong Tang (Eliminate Pathogen and Relieve Pain Decoction)
Da Huang (Rhei Radix et Rhizoma, 5 qian), Hong Hua (Carthami Flos, 1 qian), Sheng Di Huang (Rehmanniae Radix, 5 qian), Dang Gui (Radix Angelicae Sinensis, 5 qian), Zhi Shi (Aurantii Fructus Immaturus, 1 qian), Hou Po (Magnoliae Officinalis Cortex, 1 qian), Tian Hua Fen (Trichosanthis Radix, 1 qian), Gan Cao (Glycyrrhizae Radix et Rhizoma, 1 qian). Decoct in water and take orally.
Quhan Zhitong Tang (Dispel Cold and Stop Pain Decoction)
Bai Zhu (Atractylodis Macrocephalae Rhizoma, 1 liang), Rou Gui (Cinnamomi Cortex, 2 qian), Gan Cao (Glycyrrhizae Radix et Rhizoma, 1 qian), Wu Zhu Yu (Evodiae Fructus, 0.5 fen), Sha Ren (Amomi Fructus, 3 grains), Huo Xiang (Pogostemonis Herba, 1 qian), Ren Shen (Ginseng Radix, 2 qian), Ban Xia (Pinelliae Rhizoma, 1 qian). Decoct in water and take orally.