张（六五） 胁胀夜甚。响动则降。七情致伤之病。（肝郁）
橘叶 香附子 川楝子 半夏 茯苓 姜渣
陈 气热攻冲。扰脘入胁。
川连 牡蛎 夏枯草 炒半夏 香附 炒白芥子
徐（四九） 劳怒阳动。左胁闪闪。腹中微满。诊脉弦搏。左甚。当先用苦辛。
郁金 山栀 半夏曲 降香末 橘红 金石斛
汤（十八） 气逆。咳血后。胁疼。（金不制木）
降香汁（八分冲） 川贝（一钱半） 鲜枇杷叶（三钱） 白蔻仁（五分） 杏仁（二钱） 橘红
（一钱）
丁 由虚里痛起。左胁下坚满。胀及脐右。大便涩滞不爽。用缓攻方法。（湿热壅滞）小温中丸。
某 痰饮搏击。胁痛。（痛兼痰饮）
半夏 茯苓 广皮 甘草 白芥子 刺蒺藜 钩藤
沈（三十） 左胁下痛。食入则安。（营络虚寒） 当归桂枝汤加肉桂。
朱（五二） 左乳傍痛绕腰腹。重按得热少缓。此属阴络虚痛。十一年不愈。亦痼疾矣。
当归（三钱） 肉桂（一钱） 小茴（七分） 丁香皮（五分） 茯苓（二钱） 淡干姜（一钱）
尤（四五） 痛从中起。绕及右胁。胃之络脉受伤。故得食自缓。但每痛发。必由下午黄昏。当阳气渐衰
而来。是有取乎辛温通络矣。
当归 茯苓 炮姜 肉桂 炙草 大枣
郭（三五） 痛必右胁中有形攻心。呕吐清涎。周身寒凛。痛止寂然无踪。此乃寒入络脉。气乘填塞
阻逆。以辛香温通法。（寒入络脉气滞）
荜茇 半夏 川楝子 延胡 吴萸 良姜 蒲黄 茯苓
汪（六八） 嗔怒动肝。寒热旬日。左季胁痛。难外舒转。此络脉瘀痹。防有见红之事。静调勿劳可愈。
（血络瘀痹）
桃仁 归须 五加皮 泽兰 丹皮 郁金
又 桃仁 归须 丹皮 桑叶 川楝子皮 黑山栀皮
又 络虚则热。液亏则风动。痛减半。有动跃之状。当甘缓理虚。炙甘草汤去姜桂。
又 痛止。便难。液耗风动为秘。议用东垣通幽法。
当归 桃仁 柏子霜 火麻仁 郁李仁 松子肉 红花
凌 肝着。胁中痛。劳怒致伤气血。
川楝子皮 炒延胡 归须 桃仁 生牡蛎 桂枝木
沈（二一） 初起形寒寒热。渐及胁肋脘痛。进食痛加。大便燥结。久病已入血络。兼之神怯瘦损。辛香
刚燥。决不可用。
白旋复花 新绛 青葱管 桃仁 归须 柏子仁
王（二四） 左前后胁板着。食后痛胀。今三年矣。久病在络。气血皆窒。当辛香缓通。
桃仁 归须 小茴 川楝子 半夏 生牡蛎 橘红 紫降香 白芥子 水泛丸。
汪 痛在胁肋。游走不一。渐至痰多。手足少力。初病两年。寝食如常。今年入夏病甚。此非脏腑
之病。乃由经脉。继及络脉。大凡经主气。络主血。久病血瘀。瘀从便下。诸家不分经络。但忽寒
忽热。宜乎无效。试服新绛一方小效。乃络方耳。议通少阳阳明之络。通则不痛矣。
归须 炒桃仁 泽兰叶 柏子仁 香附汁 丹皮 穿山甲 乳香 没药 水泛丸。
程（四八） 诊脉动而虚。左部小弱。左胁疼痛。痛势上引。得食稍安。此皆操持太甚。损及营络。五志之
阳。动扰不息。嗌干舌燥心悸。久痛津液致伤也。症固属虚。但参术归 补方。未能治及络病。
内经肝病。不越三法。辛散以理肝。酸泄以体肝。甘缓以益。肝宣辛甘润温之补。盖肝为刚脏
必柔以济之。自臻效验耳。
炒桃仁 柏子仁 新绛 归尾 橘红 琥珀
痛缓时用丸方。
真阿胶 小生地 枸杞子 柏子仁 天冬 刺蒺藜 茯神 黄菊花四两丸。
朱 肝络凝瘀。胁痛。须防动怒失血。旋复花汤加归须桃仁柏仁。
李（十九） 左胁痞积攻疼。
生牡蛎 南山楂 炒延胡 川楝子 炒桃仁 归须 丹皮 桂枝木
蒋（三六） 宿伤。左胁腹背痛。
炒桃仁 归须 炒延胡 片姜黄 五加皮 桂枝木 橘红 炒小茴
沈 暮夜五心热。嗌干。左胁痛。肝肾阴亏。（肝肾阴虚）
人参 生地 天冬 麦冬 柏子霜 生白芍
黄 左胁骨痛。易饥呕涎。肝风内震入络。（肝风入络）
生地 阿胶 生白芍 柏子仁 丹皮 泽兰
又 照前方去白芍泽兰加桃仁桑枝
又 肝胃络虚。心嘈如饥。左胁痛便燥少血。
生地 天冬 枸杞 桂圆 桃仁 柏仁
熬膏。加阿胶收。
程 胁下痛犯中焦。初起上吐下泻。春深寒热不止。病在少阳之络。（胆络血滞）
青蒿根 归须 泽兰 丹皮 红花 郁金
胡（三四） 诊脉右弦。左小弱涩。病起积劳伤阳。操持索思。五志皆逆。而肝为将军之官。谋虑出焉。故
先胁痛。晡暮阳不用事。其病渐剧。是内伤症。乃本气不足。日饵辛燥。气泄血耗。六味滋柔腻
药。原非止痛之方。不过矫前药之谬而已。内经肝病三法。治虚亦主甘缓。盖病既久。必及阳
明胃络。渐归及右。肝胃同病。人卧魂藏于肝。梦寐纷纭。伤及无形矣。议用甘药。少佐摄镇。（肝肾皆虚）
人参 枣仁 茯神 炙草 柏子仁 当归 龙骨 金箔
桂圆肉煮浓汁。捣丸。
胁痛一症。多属少阳厥阴。伤寒胁痛。皆在少阳胆经。以胁居少阳之部。杂症胁痛。皆属厥
阴肝经。以肝脉布于胁肋。故仲景旋复花汤。河间金铃子散。及先生辛温通络。甘缓理虚。
温柔通补。辛泄宣瘀等法。皆治肝着胁痛之剂。可谓曲尽病情。诸法毕备矣。然其症有虚
有实。有寒有热。不可概论。苟能因此扩充。再加详审。则临症自有据矣。（邹时乘）
徐评 案中用药。颇能变通。心思有不可及处。惟用补之处。未免太重耳。
Zhang (65 years old): Distension in the hypochondrium, worsening at night. Pain alleviates with body movement. This is a disease caused by emotional injury (Liver Qi Stagnation).
Citrus Aurantium Fructus Immaturus (Juye), Cyperi Rhizoma (Xiangfuzi), Toosendan Fruit (Chuanlianzi), Pinellia Tuber (Banxia), Poria (Fuling), Ginger Dregs (Jiangzha)
Chen: Heat of Qi rushing upward. Disturbing the epigastrium and extending to the hypochondrium.
Coptis Rhizome (Chuanlian), Oyster Shell (Muli), Prunella Spike (Xiakucao), Stir-fried Pinellia Tuber (Chao Banxia), Cyperi Rhizoma (Xiangfu), Stir-fried White Mustard Seed (Chao Baijiezi)
Xu (49 years old): Labor and anger cause Yang Qi to move recklessly. A flickering sensation in the left hypochondrium. Slight fullness in the abdomen. The pulse is wiry and forceful, more pronounced on the left. Bitter-pungent method should be used first.
Curcuma Aromatica Rhizome (Yujin), Gardenia Fruit (Shanzhi), Fermented Pinellia Paste (Banxia Qu), Aquilaria Lignum Resinatum (Jiangxiang Mo), Citrus Reticulata Pericarpium (Juhong), Dendrobium Stem (Jinshihu)
Tang (18 years old): Rebellious Qi. Hypochondriac pain after coughing up blood. (Metal fails to control Wood).
Aquilaria Lignum Resinatum Juice (Bafen, taken with liquid), Fritillaria Bulb (Qianban), Fresh Loquat Leaf (Sanqian), Amomum Fructus (Wufen), Apricot Seed (Erqian), Citrus Reticulata Pericarpium (Qian)
Ding: Pain starts from Xuliri point, spreading to the left lower hypochondrium, hard and full, distending to the right of the umbilicus. Stool is dry and difficult to pass smoothly. Use a mild purgative method. (Damp-Heat Obstruction). Xiaowenzhong Wan.
Certain Patient: Phlegm-fluids clashing, causing hypochondriac pain. (Pain accompanied by phlegm-fluids).
Pinellia Tuber (Banxia), Poria (Fuling), Tangerine Peel (Guangpi), Licorice Root (Gancao), White Mustard Seed (Baijiezi), Tribulus Fruit (Cijili), Uncaria Ramulus (Gouteng)
Shen (30 years old): Pain in the left lower hypochondrium, relieved by eating. (Deficiency-Cold of Ying Collaterals). Dangui Guizhi Tang plus Cinnamon Bark (Rougui).
Zhu (52 years old): Pain beside the left breast, wrapping around the waist and abdomen. Slightly relieved by heavy pressure and heat. This belongs to Deficiency-Pain of Yin Collaterals. Unhealed for eleven years, it is also a stubborn disease.
Angelica Sinensis Radix (Sanqian), Cinnamon Twig (Yiqian), Small Fennel (Qifen), Clove Bud Skin (Wufen), Poria (Erqian), Dried Ginger (Yiqian)
You (45 years old): Pain originates from the middle jiao, wrapping to the right hypochondrium. The collaterals of the Stomach are injured, so relief occurs after eating. However, each pain attack must occur in the late afternoon or dusk, when Yang Qi gradually declines. Therefore, pungent-warm collateral-unblocking method is required.
Angelica Sinensis Radix (Danggui), Poria (Fuling), Roasted Ginger (Paojiang), Cinnamon Twig (Rougui), Honey-fried Licorice Root (Zhigancao), Jujube (Dazao)
Guo (35 years old): Pain inevitably involves a palpable mass in the right hypochondrium attacking the heart, vomiting clear saliva, whole-body cold shivering, silence after pain stops. This is Cold entering the collaterals, Qi filling and obstructing reversely. Use pungent-aromatic warm-unblocking method. (Cold entering collaterals, Qi stagnation).
Long Pepper Fruit (Bibo), Pinellia Tuber (Banxia), Toosendan Fruit (Chuanlianzi), Corydalis Rhizome (Yanhu), Evodia Fruit (Wuyu), Galangal Rhizome (Liangjiang), Safflower Seed (Puhuang), Poria (Fuling)
Wang (68 years old): Anger stirs Liver Qi, chills and fever for ten days. Left costal margin pain, difficult to stretch outward. This is collateral obstruction due to blood stasis, preventing hematemesis/hemoptysis. Quiet adjustment without labor can lead to recovery. (Blood Collateral Obstruction).
Peach Kernel (Taoren), Angelica Sinensis Radix Tip (Guixu), Eucommia Bark (Wujiapi), Lyonia Berry (Zelan), Moutan Cortex (Danpi), Curcuma Aromatica Rhizome (Yujin)
Another prescription: Peach Kernel (Taoren), Angelica Sinensis Radix Tip (Guixu), Moutan Cortex (Danpi), Mulberry Leaf (Sangye), Toosendan Fruit Peel (Chuanlianzi Pi), Gardenia Fruit Peel (Heishanzhi Pi)
Another prescription: Deficiency of collaterals generates Heat; deficiency of fluids causes Wind stirring. Pain reduced by half, with a jumping sensation. Sweet-mild method should be used to manage deficiency. Zhigancao Tang minus Ginger and Cinnamon.
Another prescription: Pain stopped, but difficulty in defecation. Fluid consumption and Wind stirring cause constipation. Propose using Dongyuan's Tongyou method.
Angelica Sinensis Radix (Danggui), Peach Kernel (Taoren), Platycladus Seed Coat (Baizishuang), Hemp Seed (Huomaren), Prunus Armeniaca Seed (Yuliren), Pine Nut (Songzirou), Carthamus Flower (Honghua)
Ling: Gan Zhu disease. Pain in the hypochondrium. Qi and Blood damaged by labor and anger.
Toosendan Fruit Peel (Chuanlianzi Pi), Stir-fried Corydalis Rhizome (Chao Yanhu), Angelica Sinensis Radix Tip (Guixu), Peach Kernel (Taoren), Raw Oyster Shell (Sheng Muli), Cinnamon Twig Wood (Guizhi Mu)
Shen (21 years old): Initially exposed to cold with chills and fever, gradually extending to hypochondriac and epigastric pain. Pain worsens after eating. Dry stool. Long-standing disease has entered blood collaterals. Accompanied by spirit timidity and emaciation. Pungent-aromatic and rigid-dry drugs must absolutely not be used.
White Inula Flower (Baixuanfuhua), New Crimson Fabric (Xinjiang), Green Onion Tube (Qingcongguan), Peach Kernel (Taoren), Angelica Sinensis Radix Tip (Guixu), Platycladus Seed (Baiziren)
Wang (24 years old): Left anterior and posterior hypochondrium feels stiff and fixed. Pain and distension after eating. For three years now. Long-standing disease in collaterals, Qi and Blood both obstructed. Should use pungent-aromatic mild unblocking method.
Peach Kernel (Taoren), Angelica Sinensis Radix Tip (Guixu), Small Fennel (Xiaohui), Toosendan Fruit (Chuanlianzi), Pinellia Tuber (Banxia), Raw Oyster Shell (Sheng Muli), Citrus Reticulata Pericarpium (Juhong), Purple Aquilaria Lignum Resinatum (Zijiangxiang), White Mustard Seed (Baijiezi), Water-pill.
Wang: Pain in the hypochondrium, wandering and inconsistent. Gradually leading to excessive phlegm, weakness in hands and feet. First two years of illness, sleep and appetite were normal. This summer the illness worsened. This is not a Zang-Fu disease, but arises from meridians, subsequently involving collaterals. Generally, meridians govern Qi, collaterals govern Blood. Long-standing disease leads to blood stasis, stasis passes down via stool. Various physicians do not distinguish between meridians and collaterals, merely experiencing alternating chills and fever, hence ineffective. Trying Xinjiang formula yields slight effect; this is indeed a formula for treating collaterals. Propose unblocking Shaoyang and Yangming collaterals. Unblocked means no pain.
Angelica Sinensis Radix Tip (Guixu), Stir-fried Peach Kernel (Chao Taoren), Lyonia Berry (Zelan Ye), Platycladus Seed (Baiziren), Cyperi Rhizoma Juice (Xiangfu Zhi), Moutan Cortex (Danpi), Pangolin Scale (Chuanshanjia), Frankincense (Ruxiang), Myrrh (Moyao), Water-pill.
Cheng (48 years old): Pulse is moving and deficient, left side small and weak. Left hypochondriac pain, pain radiating upward, slightly relieved by eating. All due to excessive mental exertion, damaging Ying collaterals. Yang of the Five Emotions moves and disturbs incessantly, dry throat, dry tongue, palpitations, long-term pain damages body fluids. The syndrome is indeed deficiency, but Ginseng, Atractylodes, and Angelica tonifying formulas cannot treat collateral diseases. The Nei Jing states that treating Liver diseases does not exceed three methods: Pungent-dispersing to regulate Liver, Sour-draining to calm Liver, Sweet-mild to benefit Liver. Promote pungent-sweet-moist-warm tonification. Since Liver is a rigid organ, it must be assisted with softening/moistening to achieve efficacy.
Stir-fried Peach Kernel (Chao Taoren), Platycladus Seed (Baiziren), New Crimson Fabric (Xinjiang), Angelica Sinensis Radix Tail (Guiwei), Citrus Reticulata Pericarpium (Juhong), Amber (Hupo)
When pain eases, use pill formula.
True Donkey-hide Gelatin (Zhen Ejiao), Little Rehmannia Root (Xiao Shengdi), Goji Berry (Gouqizi), Platycladus Seed (Baiziren), Asparagus Tuber (Tiantong), Tribulus Fruit (Cijili), Spirit Poria (Fushen), Yellow Chrysanthemum (Huangjuhua), 4 liang pills.
Zhu: Liver collateral coagulation and blood stasis, hypochondriac pain. Must prevent bleeding due to anger. Xuanfuhua Tang plus Angelica Sinensis Radix Tip (Guixu), Peach Kernel (Taoren), Platycladus Seed (Bairen).
Li (19 years old): Left hypochondriac mass accumulation attacking with pain.
Raw Oyster Shell (Sheng Muli), Southern Hawthorn Fruit (Nanshanza), Stir-fried Corydalis Rhizome (Chao Yanhu), Toosendan Fruit (Chuanlianzi), Stir-fried Peach Kernel (Chao Taoren), Angelica Sinensis Radix Tip (Guixu), Moutan Cortex (Danpi), Cinnamon Twig Wood (Guizhi Mu)
Jiang (36 years old): Old injury. Left hypochondriac, abdominal, and back pain.
Stir-fried Peach Kernel (Chao Taoren), Angelica Sinensis Radix Tip (Guixu), Stir-fried Corydalis Rhizome (Chao Yanhu), Turmeric Rhizome Slice (Pian Jianghuang), Eucommia Bark (Wujiapi), Cinnamon Twig Wood (Guizhi Mu), Citrus Reticulata Pericarpium (Juhong), Stir-fried Small Fennel (Chao Xiaohui)
Shen: Evening five-center heat, dry throat. Left hypochondriac pain. Liver-Kidney Yin Deficiency. (Liver-Kidney Yin Deficiency).
Ginseng Root (Renshen), Rehmannia Root (Shengdi), Asparagus Tuber (Tiantong), Ophiopogon Tuber (Maidong), Platycladus Seed Coat (Baizishuang), Raw White Peony Root (Sheng Baishao)
Huang: Left hypochondriac bone pain, easy hunger, vomiting saliva. Internal Liver Wind shaking into collaterals. (Liver Wind entering collaterals).
Rehmannia Root (Shengdi), Donkey-hide Gelatin (Ejiao), Raw White Peony Root (Sheng Baishao), Platycladus Seed (Baiziren), Moutan Cortex (Danpi), Lyonia Berry (Zelan)
Another prescription: Follow previous formula, remove White Peony Root and Lyonia Berry, add Peach Kernel and Mulberry Branch.
Another prescription: Liver-Stomach collateral deficiency, heart burning like hunger, left hypochondriac pain, dry stool, little blood.
Rehmannia Root (Shengdi), Asparagus Tuber (Tiantong), Goji Berry (Gouqi), Longan Aril (Guiyuan), Peach Kernel (Taoren), Platycladus Seed (Bairen)
Decoct into paste, add Donkey-hide Gelatin to finish.
Cheng: Pain under hypochondrium invading Middle Jiao. Initially vomiting and diarrhea, spring deep chills and fever unceasing. Disease in Shaoyang collaterals. (Gallbladder Collateral Blood Stasis).
Artemisia Annua Root (Qinghao Gen), Angelica Sinensis Radix Tip (Guixu), Lyonia Berry (Zelan), Moutan Cortex (Danpi), Carthamus Flower (Honghua), Curcuma Aromatica Rhizome (Yujin)
Hu (34 years old): Pulse right wiry, left small, weak, choppy. Illness started from accumulated fatigue injuring Yang, excessive mental work and thinking, all Five Emotions reversed. Liver is the General, planning arises from it. Hence hypochondriac pain first. At dusk, Yang is inactive, illness gradually worsens. This is an internal injury syndrome, root Qi deficiency. Daily taking pungent-dry drugs causes Qi leakage and Blood consumption. Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) is moist, soft, and cloying, originally not a pain-relieving formula, merely correcting the error of previous drugs. Nei Jing Liver disease three methods, treating deficiency also emphasizes sweet-mild. Since illness is long, it must involve Yangming Stomach collaterals, gradually shifting to the right, Liver and Stomach diseased together. When sleeping, Hun stores in Liver, dreams are chaotic, injuring formless Qi. Propose using sweet medicine, assisting slightly with anchoring/settling method. (Liver-Kidney Both Deficient).
Ginseng Root (Renshen), Ziziphus Seed (Zaoren), Spirit Poria (Fushen), Honey-fried Licorice Root (Zhigancao), Platycladus Seed (Baiziren), Angelica Sinensis Radix (Danggui), Dragon Bone (Longgu), Gold Foil (Jinbo)
Longan Aril boiled in thick juice, pounded into pills.
Hypochondriac pain mostly belongs to Shaoyang and Jueyin. Shaoyang hypochondriac pain in Shanghan is all in Shaoyang Gallbladder Meridian, as hypochondrium resides in Shaoyang region. Miscellaneous disease hypochondriac pain all belongs to Jueyin Liver Meridian, as Liver meridian distributes over hypochondrium and ribs. Thus Zhang Zhongjing's Xuanfuhua Tang, He Jian's Jinlingzi San, and Mr.'s pungent-warm collateral-unblocking, sweet-mild deficiency-managing, gentle warm-tonifying, pungent-draining blood-stasis-resolving methods are all agents for treating Gan Zhu hypochondriac pain. Truly exhausting the pathology, all methods prepared. However, syndromes have deficiency/excess, cold/heat, cannot be generalized. If one can expand upon this, adding detailed examination, then clinical practice will have basis. (Zou Shicheng)
Xu's Comment: Medications in cases show great flexibility, mind beyond reach. Only where tonification is used, it is somewhat too heavy.