、良姜；气虚，加参、术；血虚，加当归；大虚厥逆，加姜、附；肝火，加青黛、青皮、
黄连；痰饮，加白螺壳、滑石、南星；食积，加砂仁、香附；瘀血，加韭汁、桔梗；虫痛
，加苦楝根，或木香、槟榔；急痛，加胡椒，略用斑蝥炒过；痛不可忍，加细茶、乳香，或
石。凡痛攻走腰背，发厥呕吐，诸药不效
者，加苍
术、川芎、山栀，探吐积痰碗许乃愈。
劫痛丸丹可入唇。
寒者，九痛丸、却痛散；热者，散痛丸、通灵散；有积，神保丸；瘀血，单干漆
丸；通用手拈散、如意丹、神圣代针散。
腹痛（附腹中窄狭）
腹痛大小分阴阳，
大腹痛，多食积外邪；脐腹痛，多积热痰火；小腹痛，多瘀血及痰与溺涩；脐下
卒大痛，人中黑者，中恶客忤，不治。阴证，满腹牵痛，自利或呕，喜按少食，绵绵不减，
宜温之。阳证，腹中觉热，甚则大便闭涩，胀满怕按，时痛时止，宜下之。
寒痛绵绵热不常；
旧以虚痛喜按，实痛怕按，但寒热邪有浅深，不可太泥。经谓∶寒气入经，客于
卫分，则血涩急痛，按之热则止；寒气客于荣分，则气郁满痛，甚怕按；寒气客肠胃募原，
血络急引皮痛，按之则气血散而痛止；寒气客侠脊背俞之脉，则深按之不能及也；寒气客关
元，则气逆喘；寒气客厥阴脉络，则胁肋与小腹或阴股引痛；寒气客小肠募原之间，则血气
凝聚成积；寒气客小肠不聚，则腹痛而泄；寒气客胃，则腹痛而呕；寒气客五脏，则痛死复
生。治伤寒腹痛，详三卷。寻常外感冒寒证卒痛，吐利俱酸，喜热物熨者，五积散加
吴萸、木瓜、煨葱，或藿香正气散加木香少许；风证，桂枝汤加芍药，或胃风汤加木香；
暑证，香薷散加生姜、陈壁土、红蓼、木瓜，或五苓散；湿证，除湿汤，或香苏散加苍术
、枳壳。积热，时痛时止，痛处亦热，手不可近，便闭喜冷，宜四顺清凉饮、大承气汤、三
黄丸；老人，麻子仁丸。
食积有形便后减，
食积郁结，肠胃作痛，得大便后则减者，宜平胃散加消导药，或保和丸、枳术丸
、红丸子调之，或木香槟榔丸、大黄备急丸、神保丸、如意丹下之。又有食填胸满，心胃作
痛者，宜大吐之。
湿痰溺涩火鸣肠。
湿痰阻滞气道，必小便不利，或二便俱不利，宜芎术散。如清痰留滞胸腹作声
者，控涎丹、小胃丹。痰火痛，乃火欲升，水欲降，相击肠鸣者，二陈汤加芩、连、山栀；
如怒火攻冲，痛无定处、定时者，更加香附、芍药、青皮。又有粪结肠鸣作痛，不大便者，
大黄备急丸之类通之。如脏寒冷结肠鸣者，宜分三阴，以温药治之
。
虫痛吐水定能食，
虫痛，肚大青筋，往来绞痛，痛定能食，发作有时，不比诸痛停聚不散，乌梅丸
、化虫丸。
七情气痛痞胸膛；
七情痛，心胸痞闷，或攻注胁背。虚者，七气汤、木香匀气散、
木香化滞汤；实
者，三和散、分心气饮。
中虚全不思饮食，
中虚脾弱，隐隐冷痛，全不思食者，人参养胃汤加肉桂、吴萸、木香。素气虚挟
痰者，六君子汤加苍术。
瘀血痛必着一方。
瘀血，痛有常外，或忧思逆郁，跌扑伤瘀，或妇人经来、产后恶瘀不尽而凝，四
物汤去地黄，加桃仁、大黄、红花。又血虚郁火，燥结阻气不运而痛者，四物汤倍芍药，加
炒干姜。凡痛多属血涩，通用芍药甘草汤为主，恶寒而痛属脾肾，加肉桂；恶热而痛属脾胃
，加黄芩。脉缓伤水，加桂枝；脉涩伤血，加当归；脉迟伤寒，加干姜；脐下痛，加熟地。
惟气分诸痛，不宜芍药酸收，宜木香、槟榔、青皮、陈皮、香附辛散之。劫痛，手拈散。
初起虚温实宜荡，
虚宜辛温消散，烧脾散、蟠葱散、丁香脾积丸。果系沉寒痼冷，小腹下痛者，酒
煮当归丸。经曰∶结者散之是也。实宜辛寒推荡，经曰∶通因通用，痛随利减是也。方与积
热痛同。
久则升消理胃房；
腹属坤，久病宜和脾胃。如脉弦急，木克土也，小建中汤加当归，取芍药味酸，
于土中泻木为君；如脉沉细，水侮土也，理中汤，取干姜辛热，于土中泻水为君；如脉缓，
腹痛自利，米谷不化，平胃散加肉桂、吴萸，取苍术苦辛，泻湿土为君。胃气下陷者，加
升麻、柴胡、苍术以升之；有积者，加山楂、麦芽、枳实、黄连、木香以消之。上热下寒，
升降失常，腹痛呕吐者，黄连汤主之。疝痛引睾丸，痢痛拘急，积聚痛有形可按，肠痈痛，
脐生疮，小便如淋、脉芤，痧证痛甚，呕吐、脉沉，治见各条。
腹中窄狭性偏躁，无非痰火善为殃。
腹中自觉窄狭，神昏性躁，乃湿痰浊气攻于心脾，以致升降失常，肥人多湿痰，
宜二陈汤加苍术燥湿，香附行气；瘦人多火，宜二陈汤加黄连清热，苍术流湿；心神不敛者
，俱加远志、麦门冬、酸枣仁。血气虚者，六君子汤加芎、归养血流湿，自然平复。
Rhizoma Zingiberis (Shengjiang, 生姜) [Note: Context implies Rhizoma Alpiniae Officinarum/Liangjiang based on text "Liangjiang"]; for Qi deficiency, add Ginseng Radix et Rhizoma (Renshen, 人参) and Atractylodis Macrocephalae Rhizoma (Baizhu, 白术); for Blood deficiency, add Angelicae Sinensis Radix (Danggui, 当归); for severe deficiency with cold extremities and reversal, add Zingiberis Rhizoma (Shengjiang, 生姜) and Aconiti Lateralis Radix Praeparata (Fuzi, 附子); for Liver Fire, add Indigo Naturalis (Qingdai, 青黛), Tangerini Pericarpium Viride (Qingpi, 青皮), and Coptidis Rhizoma (Huanglian, 黄连); for Phlegm-Fluid retention, add Concha Vivipari (Bailuoke, 白螺壳), Talcum (Huashi, 滑石), and Pinelliae Rhizoma Preparatum (Nanxing, 南星); for Food Stagnation, add Amomi Fructus Rotundus (Sharen, 砂仁) and Cyperi Rhizoma (Xiangfu, 香附); for Blood Stasis, add Juice of Allii Tuberosi (Jiuji, 韭汁) and Platycodonis Radix (Jiegeng, 桔梗); for Worm Pain, add Radix Meliae Toosendan (Kulian Gen, 苦楝根), or Cyperi Rhizoma (Muxiang, 木香) and Arecae Semen (Binglang, 槟榔); for acute pain, add Piperis Fructus (Hujiao, 胡椒), used slightly with processed Mylabris (Banmao, 斑蝥); for unbearable pain, add Fine Tea (Xicha, 细茶) and Olibanum (Ruxiang, 乳香), or Shi (Stone, 石); for pain radiating to the lower back accompanied by fainting and vomiting, unresponsive to other medicines, add Atractylodis Rhizoma (Cangzhu, 苍术), Ligustici Chuanxiong Rhizoma (Chuanxiong, 川芎), and Gardeniae Fructus (Shanzhi, 山栀), induce vomiting to expel about one bowl of accumulated phlegm for recovery. Jietong Wan/Dan can be held in the lips.
For Cold patterns, use Jiutong Wan (Nine-Pain Pill) andquetong San (Pain-Relieving Powder); for Heat patterns, use Santong Wan (Pain-Scattering Pill) and Tongling San (Spirit-Connecting Powder); for accumulation, use Shenbao Wan (Divine Protection Pill); for Blood Stasis, use Ganqi Wan (Dry Lacquer Pill) alone; commonly used formulas include Shou Niansan (Hand-Picking Powder), Ruyi Dan (As-Desired Pill), and Shensheng Daizhen San (Divine Needle-Replacement Powder).
Abdominal Pain (with a sensation of narrowness in the abdomen)
Abdominal pain is differentiated into Yin and Yang based on location: Greater abdominal pain is mostly due to Food Stagnation and external pathogens; periumbilical pain is mostly due to accumulated Heat, Phlegm, and Fire; lesser abdominal pain is mostly due to Blood Stasis, Phlegm, and difficult urination; sudden severe pain below the umbilicus with blackening of the philtrum indicates Zhong'e (Evil Invasion) or Ke Wu (Guest Hostility), which is untreatable. Yin patterns manifest as full abdominal pulling pain, spontaneous diarrhea or vomiting, preference for pressure and reduced appetite, with continuous mild pain, suitable for warming treatment. Yang patterns manifest as a feeling of heat in the abdomen, severe cases with constipation, distension, aversion to pressure, and intermittent pain, suitable for purgative treatment.
Cold pain is continuous with infrequent Heat;
Traditionally, it was believed that Deficiency pain prefers pressure while Excess pain fears pressure, but Cold and Heat pathogens have varying depths, so one should not be too rigid. The Classic states: When Cold Qi enters the meridians and lodges in the Wei (Defensive) level, blood becomes stagnant causing acute pain, which stops when pressure generates heat; when Cold Qi lodges in the Ying (Nutritive) level, Qi stagnation causes distending pain, often fearing pressure; when Cold Qi lodges in the Mu Yuan (Diaphragmatic Origin) of the stomach and intestines, blood vessels contract pulling the skin, causing pain that stops when pressed as Qi and Blood disperse; when Cold Qi lodges in the meridians along the spine and Back-Shu points, deep pressing cannot reach the disease site; when Cold Qi lodges at Guanyuan (CV4), Qi rebels causing wheezing; when Cold Qi lodges in the Jueyin meridians, the hypochondrium, lower abdomen, or inner thigh may experience pulling pain; when Cold Qi lodges between the Mu Yuan of the Small Intestine, Qi and Blood condense forming masses; when Cold Qi lodges in the Small Intestine preventing its gathering function, abdominal pain and diarrhea occur; when Cold Qi lodges in the Stomach, abdominal pain and vomiting occur; when Cold Qi lodges in the Five Zang Organs, pain is severe enough to cause death followed by revival. For treating abdominal pain caused by Shanghan (Cold Damage), see Volume 3. For common external Cold invasion with sudden pain, sour vomiting and diarrhea, and preference for hot compresses, use Wujie San (Five Accumulations Powder) with Evodiae Fructus (Wuyu, 吴茱萸) and Papaveris Semen (Mugua, 木瓜), or Huoxiang Zhengqi San (Agastache Powder to Rectify the Qi) with a small amount of Aucklandiae Radix (Muxiang, 木香); for Wind patterns, use Guizhi Tang (Cinnamon Twig Decoction) with Paeoniae Radix Alba (Shaoyao, 芍药), or Weifeng Tang (Stomach Wind Decoction) with Muxiang; for Summerheat patterns, use Xiangru San (Elsholtzia Powder) with Zingiberis Rhizoma Recens (Shengjiang, 生姜), Chen Bitu (Old Wall Soil), Polygoni Multiflori Vine (Hongliao, 红蓼), and Mugua, or Wuling San (Five-Ling Powder); for Dampness patterns, use Chushi Tang (Dampness-Removing Decoction) or Xiangsu San (Aucklandia and Perilla Powder) with Cangzhu and Aurantii Fructus (Zhike, 枳壳). For Accumulated Heat patterns, intermittent pain with heat at the painful site, intolerance to touch, constipation, and preference for cold, use Sishun Qingliang Yin (Four-Obedient Cooling Drink), Dachengqi Tang (Major Order the Qi Decoction), or Sanhuang Wan (Three-Yellow Pill); for the elderly, use Maziren Wan (Hemp Seed Pill).
Food Stagnation has tangible form and pain reduces after defecation;
For pain caused by Food Stagnation and intestinal blockage that reduces after defecation, use Pingwei San (Calm the Stomach Powder) with digestive herbs, or Baohe Wan (Preserve Harmony Pill), Zhizhu Wan (Immature Bitter Orange and Atractylodes Pill), or Hongwanzi (Red Pill) for regulation, or purge with Muxiang Binglang Wan (Aucklandia and Areca Pill), Dahuang Beiji Wan (Rhubarb Emergency Pill), Shenbao Wan, or Ruyi Dan. For food filling the chest causing fullness and heart/stomach pain, induce vomiting.
Damp-Phlegm obstruction leads to difficult urination, Fire resonates in the intestines.
When Damp-Phlegm obstructs the Qi pathway, urination is necessarily difficult, or both urine and stool are difficult, use Xiongzhu San (Peony and Atractylodes Powder). For clear Phlegm滞留 in the chest and abdomen making sounds, use Kongxian Dan (Saliva-Controlling Pill) or Xiaowei Dan (Small Stomach Pill). Phlegm-Fire pain, where Fire desires to rise and Water desires to descend, striking each other causing borborygmus, use Erchen Tang (Two-Aged Decoction) with Scutellariae Radix (Huangqin, 黄芩), Huanglian, and Shanzhi; if Angry Fire attacks with pain having no fixed location or time, add Xiangfu, Shaoyao, and Qingpi. For fecal impaction with borborygmus and pain without defecation, use Dahuang Beiji Wan to unblock. For Cold-Damp causing intestinal borborygmus, differentiate the Three Yin channels and treat with warming medicines.
Worm pain involves vomiting water, yet the patient can eat;
Worm pain presents with a large abdomen and visible blue veins, colicky pain moving around, ability to eat when pain subsides, and regular episodes, unlike other pains that remain stationary. Use Wumei Wan (Mume Pill) or Huachong Wan (Worm-Transforming Pill).
Seven Emotions Qi pain causes chest fullness;
Pain from Seven Emotions manifests as chest stuffiness or radiation to the hypochondrium and back. For Deficiency, use Qiqi Tang (Seven-Qi Decoction), Muxiang Yunqi San (Aucklandia Regulating Qi Powder), or Muxiang Huazhi Tang (Aucklandia Resolving Stagnation Decoction); for Excess, use Sanhe San (Three-Harmonies Powder) or Fenxin Qi Yin (Separate Heart Qi Drink).
Middle Jiao deficiency leads to complete loss of appetite;
For Middle Jiao deficiency and Spleen weakness with dull cold pain and no desire to eat, use Renshen Yangwei Tang (Ginseng Nourishing Stomach Decoction) with Rougui (Cinnamon Bark), Wuyu, and Muxiang. For those with chronic Qi deficiency and Phlegm, use Liujunzi Tang (Six-Gentlemen Decoction) with Cangzhu.
Blood Stasis pain is always localized.
Blood Stasis pain is fixed in location, or due to worry/thought rebellion/depression, trauma, or women's menstrual/postpartum lochia remaining and coagulating. Use Siwu Tang (Four-Materials Decoction) removing Rehmanniae Radix (Dihuang, 地黄), adding Persicae Semen (Taoren, 桃仁), Dahuang, and Carthami Flos (Honghua, 红花). For Blood Deficiency with constrained Fire, dryness/blockage hindering Qi movement causing pain, use Siwu Tang doubling Shaoyao, adding fried Shengjiang. Generally, pain belongs to Blood stagnation; commonly use Shaoyao Gancao Tang (Peony and Licorice Decoction) as the main formula. Pain with aversion to Cold belongs to Spleen/Kidney, add Rougui; pain with aversion to Heat belongs to Stomach/Spleen, add Huangqin. Slow pulse indicates Water injury, add Guizhi; choppy pulse indicates Blood injury, add Danggui; delayed pulse indicates Cold Damage, add Ganjiang (Dried Ginger); pain below the umbilicus, add Shudi (Prepared Rehmannia). For Qi-level pains, avoid Shaoyao's astringency; use Muxiang, Binglang, Qingpi, Chenpi, and Xiangfu for dispersing. For seizing pain, use Shou Niansan.
Early stage: Deficiency requires warming dispersion, Excess requires purging;
Deficiency requires acrid-warm dispersion: Shaopi San (Spleen-Burning Powder), Pancong San (Scallion-Coiling Powder), Dingxiang Pi Ji Wan (Clove Spleen-Accumulation Pill). If truly Deep-Cold and Chronic-Cold with lower abdominal pain, use Jiuzhu Dangui Wan (Wine-Boiled Angelica Pill). The Classic says: Disperse what is knotted. Excess requires acrid-cold pushing/purging: The Classic says: Treat obstruction with unblocking methods; pain decreases with relief. Formulas are the same as for Accumulated Heat pain.
Long-standing illness requires ascending and eliminating, regulating the Stomach and Intestines;
The abdomen belongs to Kun (Earth); long-term illness requires harmonizing Spleen and Stomach. If the pulse is wiry and urgent, Wood overacts on Earth; use Xiaojianzhong Tang (Minor Construct the Middle Decoction) with Danggui, using Shaoyao's sour taste to drain Wood within Earth as the sovereign herb; if the pulse is deep and fine, Water insults Earth; use Lizhong Tang (Regulate the Middle Decoction), using Ganjiang's acrid-hot nature to drain Water within Earth as the sovereign herb; if the pulse is slow, with abdominal pain, spontaneous diarrhea, and undigested food, use Pingwei San with Rougui and Wuyu, using Cangzhu's bitter-acrid nature to drain Damp-Earth as the sovereign herb. For sinking Stomach Qi, add Shengma, Chaihu, and Cangzhu to ascend; for accumulation, add Hawthorn Fruit (Shanzha, 山楂), Maltae Fructus (Maiya, 麦芽), Zhi Shi (Immature Bitter Orange), Huanglian, and Muxiang to eliminate. For Upper Heat and Lower Cold with abnormal ascending/descending, abdominal pain, and vomiting, use Huanglian Tang (Coptis Decoction). Hernia pain radiating to the testicles, dysentery pain with spasms, mass pain palpable, intestinal abscess pain, umbilical sores, stranguria-like urination with a hollow pulse, severe Sha syndrome pain, vomiting with a deep pulse—treatments are detailed in respective sections.
Narrowness in the abdomen indicates irritability, caused by Phlegm-Fire misfortune.
A subjective sensation of abdominal narrowness with mental confusion and irritability is caused by Damp-Phlegm and turbid Qi attacking the Heart and Spleen, leading to abnormal ascending/descending. Fat people tend to have Damp-Phlegm; use Erchen Tang with Cangzhu to dry Dampness and Xiangfu to move Qi. Thin people tend to have Fire; use Erchen Tang with Huanglian to clear Heat and Cangzhu to flow Dampness. For unconverged Heart Spirit, add Yuanzhi (Polygalae Radix), Maidong (Ophiopogonis Radix), and Suanzaoren (Ziziphus Seed). For Qi and Blood deficiency, use Liujunzi Tang with Chuanxiong and Danggui to nourish Blood and flow Dampness, leading to natural recovery.