腹属阴属里。故阳明里症是腹满。三阴俱有腹满。太阳汗后腹满。脾胃不和也。
二陈汤加浓朴和之。阳明潮热腹满。燥矢也。下之。身黄小水不利腹满。湿热也。茵陈蒿汤。
邵评∶腹满有汗后脾胃不和之虚满。有燥矢湿热二症之实满。当分因施治。
太阴腹满。有虚寒。如腹满时痛。食不下。吐利交作是也。理中汤加浓朴。有实热。如
腹满大痛。咽干便秘。或发黄。或暴下赤黄。此脾家实热。为转属阳明。宜承气加减。（合参准绳金鉴）
邵评∶腹满有虚寒。是太阴本症。宜温中。有实热。是太阴转属阳明。宜下之。
邪气入里。与正气相搏。则腹痛。故太阳无腹痛。少阳有胁痛而无腹痛。阳明里症有腹痛。三阴俱有
腹痛。当分部位。中脘痛属脾。脉沉迟者内寒。理中汤。阳脉涩。阴脉弦。小建中汤。
邵评∶三阳惟阳明。有腹痛。三阴俱有腹痛。须分部位。当察其所痛之因。分别施
治。
少腹痛属厥阴界分。四肢逆冷。小便清白。是冷结膀胱。宜当归四逆加吴茱萸生
姜汤温之。如不厥冷。小便自利者。是血蓄膀胱。宜桃仁承气汤。小便不利者。
是水蓄膀胱。五苓散。大小便俱不利者。是水热蓄积。八正散。
邵评∶少腹痛有血蓄、水蓄、水与热俱蓄三因分别。治法甚精。惟桃仁承气之大黄。宜用醋炒。
若大实。小腹满痛。或绕脐攻痛。不大便。脉实者。承气汤。
邵评∶胃腑热实。燥屎作痛。故用下法。
发热口渴。脉弦洪而腹痛者。属脾热。芍药黄芩汤。腹痛欲吐利。烦躁饱闷者。防
痧毒。当刺委中、少商等穴。（合参准绳金鉴）
邵评∶痧秽内滞。气闭作痛。治宜芳香开泄。
按腹痛有虚实。按之痛甚属实。按之痛减属虚。有寒热。自下逆攻而上者。火也。自
上奔迫于下者。寒也。又伤寒腹痛。以凉水试之。其痛稍可者。热也。转甚者。寒也。
邵评∶辨明虚实寒热痛势之不同。甚精。
又评∶试辨寒热之法亦当。
The abdomen belongs to Yin and is located in the interior. Therefore, interior syndromes of Yangming manifest as abdominal fullness. Abdominal fullness can also occur in all three Yin meridians. Abdominal fullness after sweating therapy in Taiyang syndrome indicates disharmony between the Spleen and Stomach. Erchen Tang (Two Aged Decoction) with Houpo (Magnolia Bark) should be used to harmonize it. In Yangming syndrome, tidal fever accompanied by abdominal fullness indicates dry fecal impaction; purgation should be applied. Jaundice, difficulty in urination, and abdominal fullness indicate damp-heat accumulation; Yinchen Hao Tang (Artemisia Capillaris Decoction) is indicated.
Shao's Commentary: Abdominal fullness includes deficiency-type fullness caused by Spleen-Stomach disharmony after sweating, and excess-type fullness caused by dry feces or damp-heat. Treatment must be tailored to the etiology.
In Taoyin syndrome, abdominal fullness may present as deficiency-cold, such as abdominal fullness with intermittent pain, inability to eat, and alternating vomiting and diarrhea. Lizhong Tang (Regulate the Middle Decoction) with Houpo (Magnolia Bark) is indicated. It may also present as excess-heat, such as severe abdominal fullness and pain, dry throat, constipation, jaundice, or sudden passage of red-yellow loose stools. This represents excess-heat in the Spleen system, indicating a transition to Yangming syndrome; Chengqi Tang formulas should be modified accordingly. (Referenced from *Shanghan He Can* and *Yizong Jinjian*)
Shao's Commentary: Deficiency-cold abdominal fullness is the primary syndrome of Taoyin, warranting warming the middle. Excess-heat abdominal fullness indicates a transition from Taoyin to Yangming, warranting purgation.
When pathogenic factors enter the interior and contend with healthy Qi, abdominal pain occurs. Thus, Taiyang syndrome does not present with abdominal pain; Shaoyang syndrome presents with hypochondriac pain but no abdominal pain; Yangming interior syndrome presents with abdominal pain; and all three Yin syndromes may present with abdominal pain. The location of pain must be differentiated. Pain in the Zhongwan region belongs to the Spleen; a deep and slow pulse indicates internal cold, treated with Lizhong Tang (Regulate the Middle Decoction). A choppy pulse on the Yang position and a string-taut pulse on the Yin position indicates treatment with Xiaojianzhong Tang (Minor Construct the Middle Decoction).
Shao's Commentary: Among the Three Yang syndromes, only Yangming presents with abdominal pain, while all Three Yin syndromes may present with it. One must distinguish the location and investigate the cause of the pain to apply appropriate treatment.
Pain in the lower abdomen belongs to the Jueyin meridian. Cold limbs and clear, white urine indicate cold binding in the Bladder, treated with Danggui Sini Jia Wuzhuyu Shengjiang Tang (Angelica Sinensis Decoction Modified with Evodia and Fresh Ginger) to warm the channels. If there are no cold limbs and urination is free, blood stasis is accumulating in the Bladder, treated with Tao Ren Chengqi Tang (Apricot Seed Purgative Decoction). If urination is difficult, water retention is in the Bladder, treated with Wuling San (Five-Ling Powder). If both urination and defecation are difficult, water and heat are accumulated, treated with Bazheng San (Eight-Righteousness Powder).
Shao's Commentary: Lower abdominal pain has three etiologies: blood stasis, water retention, and combined water-heat accumulation. The differentiation and treatment are exquisite. Note that the Dahuang (Rhubarb Root) in Tao Ren Chengqi Tang should be stir-fried with vinegar. In cases of major excess, if the lower abdomen is full and painful, or if there is periumbilical attacking pain with constipation and a forceful pulse, Chengqi Tang is indicated.
Shao's Commentary: Heat-excess in the Stomach-Fu organ causes pain due to dry feces; thus, purgation is used.
Fever, thirst, string-taut and surging pulse, and abdominal pain indicate Spleen-heat, treated with Shaoyao Huangqin Tang (Peony and Scutellaria Decoction). Abdominal pain with urge to vomit or diarrhea, irritability, and distension suggests toxic sha (sand-poison); acupoints Weizhong (BL40) and Shaoshang (LU11) should be pricked. (Referenced from *Shanghan He Can* and *Yizong Jinjian*)
Shao's Commentary: Accumulation of sha-toxicity obstructs Qi mechanism causing pain; treatment requires aromatic opening and draining methods.
Abdominal pain involves deficiency and excess. Tenderness worsening upon pressure indicates excess; tenderness alleviating upon pressure indicates deficiency. There is also a distinction between cold and heat. Pain rushing upward from below indicates Fire (Heat); pain pressing downward from above indicates Cold. Additionally, for abdominal pain in Shanghan, testing with cool water: if pain slightly relieves, it is Heat; if pain worsens, it is Cold.
Shao's Commentary: Differentiating the nature of pain regarding deficiency/excess and cold/heat is very precise.
Further Commentary: The method of testing to differentiate cold and heat is also appropriate.