[总诀]大腹中州总属脾，虚寒实热辨毫厘。木邪水湿皆为寇，痰血蛔虫亦易治。
（伯未按∶腹痛症极多变化，宜及早检查。）
大腹绞痛，闭闷不得吐泻者，脾实而热闭也。宜加味三物汤。
枳壳（一钱） 浓朴（一钱） 大黄（一钱） 白芍（三钱） 黄芩（三钱） 杏仁（三钱） 甘草（一
钱）
歌曰∶腹中闭闷痛难禁，三物汤加芍与芩。
脾实当攻休畏忌，大黄枳朴杏甘寻。
腹中切痛，兼见吐泻厥冷者，脾虚发霍乱也。宜仲景理中汤。
人参（三钱） 白术（三钱） 干姜（三钱） 甘草（炙，二钱）
歌曰∶霍乱多缘土气虚，腹间切痛势难舒。
干姜草术同参用，调理中宫病自祛。
（伯未按∶危殆时，急用生姜蘸高粱酒擦四肢。）
腹中胀满，饭后倦怠反饱者，脾虚少运化也。宜加味六君汤。
木香（一钱） 砂仁（二钱） 白术（三钱） 云苓（三钱） 人参（三钱） 甘草（一钱） 陈皮（二
钱） 半夏（二钱） 生姜（三钱） 大枣（三枚） 芡实（三钱） 麦芽（一钱）
歌曰∶饭余反饱用参苓，术半香砂效最灵。
姜芡麦芽除腹满，陈皮甘枣善调停。
腹中胀满，兼见大便溏泄者，湿甚则濡泄也。宜时方胃苓汤。
云苓（三钱） 猪苓（三钱） 苍术（三钱） 白术（三钱） 陈皮（二钱） 大枣（二枚） 桂枝（二
钱） 白芍（二钱） 甘草（一钱） 浓朴（一钱） 泽泻（二钱） 生姜（三片）
歌曰∶腹满还兼大便溏，二苓二术枣陈姜。
建中桂芍甘同朴，除湿仍加泽泻详。
腹中疼痛，有物自脐冲上者，肾气之奔豚也。宜肾气奔豚汤。
桂枝（三钱） 云苓（三钱） 白术（二钱） 甘草（二钱） 苡仁（三钱） 大枣（二枚） 附子（炮
，三钱）
歌曰∶肾气奔豚脐上冲，桂苓术草古方宗。
苡仁附子重加入，大枣和中煮要浓。
腹中疼痛，有物自左冲上者，肝气之奔豚也。宜肝气奔
豚汤。
吴萸（一钱） 黄连（三钱） 云苓（二钱） 荔核（研，三枚） 乌梅（二枚） 香附（研，三钱）
牡蛎（研，三钱）
歌曰∶奔豚冲左属肝经，荔核梅连取用灵。
香附吴萸同理气，再加牡蛎及云苓。
（伯未按∶可加李根白皮二钱，效尤捷。）
腹中大痛，有物突起拒摩者，虚寒见实象也。宜大建中原方。
人参（三钱） 蜀椒（二钱） 干姜（二钱） 饴糖（三钱）
歌曰∶有物攻冲拒按摩，腹间突起痛难过。
虚寒实象姜椒用，参共饴糖胃气和。
腹痛喜按，舌上有白花点者，内有蛔虫扰也。宜醋制乌梅丸。
当归（三钱） 党参（三钱） 黄连（三钱） 黄柏（二钱） 细辛（一钱） 桂枝（三钱） 附片（三
钱） 干姜（二钱） 川椒（二钱） 乌梅（蒸去核，七枚）
歌曰∶舌上缘何起白花，蛔虫内扰痛频加。
归参连柏辛椒共，桂附姜梅醋制夸。
（伯未按∶小儿可用使君子炒食。）
腹中绞痛，串走两胁鸣痛者，痰饮之积聚也。宜加味二陈汤。
陈皮（三钱） 半夏（三钱） 云苓（三钱） 前胡（二钱） 甘草（一钱）
白芥子（二钱） 苏枝（二钱）
歌曰∶腹中绞痛胁常鸣，陈夏云苓甘草行。
再用苏枝通络脉，前胡白芥使痰清。
（伯未按∶服之不验，可加芫花五分。）
腹中刺痛，脉涩痛如刀锥者，瘀血之阻滞也。宜加减桃仁汤。
桃仁（三钱） 蒲黄（三钱） 赤芍（三钱） 白芍（三钱） 归尾（三钱） 灵脂（二钱） 黄芩（三
钱） 川芎（一钱） 香附（三钱） 甘草（一钱） 郁金（一钱） 青木香（二钱）
歌曰∶腹中刺痛主桃仁，二芍芩归芎草均。
香附蒲黄脂郁木，酒军慎用告医人。
腹中猝痛，由伤风邪而得者，肝气侮脾土也。宜柴胡桂枝汤。
柴胡（二钱） 桂枝（二钱） 半夏（三钱） 人参（三钱） 青皮（一钱） 黄芩（二钱） 白芍（二
钱） 甘草（一钱） 大枣（二枚） 生姜（三片）
歌曰∶腹中猝痛系风伤，土侮脾经参枣姜。
夏草青皮芩桂合，柴胡白芍细商量。
腹中猝痛，由伤邪祟而得者，皆血乱正气也。宜加减正气散。
苍术（三钱） 陈皮（一钱） 木香（一钱） 党参（三钱） 云苓（三钱） 桂心（二钱） 天麻（二
钱） 半夏（二钱） 大枣（三枚） 生姜（五片） 龙骨（三钱） 麝香（少许）
歌曰∶邪祟伤人腹痛增，苍苓陈夏有奇能。
天麻麝木同龙骨，桂枣姜参正气升。
[General Verse] Diseases of the great abdomen generally belong to the Spleen; one must distinguish between deficiency-cold and excess-heat with precision. Liver Wood invasion and water-dampness are both pathogens, while phlegm, blood stasis, and ascariasis are also easy to treat.
(Bonan's Note: Abdominal pain presents with extreme variability; early examination is advisable.)
Severe colicky pain in the abdomen, accompanied by obstruction and fullness without ability to vomit or diarrhea, indicates Spleen Excess with Heat Closure. The appropriate formula is Modified Sanwu Tang (Three-Ingredient Decoction).
Zhiqiao (Fructus Aurantii, 1 qian) Houpo (Cortices Magnoliae Officinalis, 1 qian) Dahuang (Radix et Rhizoma Rhei, 1 qian) Baishao (Radix Paeoniae Alba, 3 qian) Huangqin (Radix Scutellariae, 3 qian) Xingren (Semen Armeniacae Amarum, 3 qian) Gancao (Radix Glycyrrhizae, 1 qian)
Verse: Obstruction and fullness in the abdomen cause unbearable pain, add Baishao and Huangqin to Sanwu Tang.
For Spleen Excess, attack without fear or hesitation; seek Dahuang, Zhiqiao, Houpo, Xingren, and Gancao.
Cutting pain in the abdomen, accompanied by vomiting, diarrhea, and cold limbs, indicates Huoluan (Cholera-like syndrome) caused by Spleen Deficiency. The appropriate formula is Lizhong Tang (Regulate the Middle Decoction) by Zhang Zhongjing.
Renshen (Radix Ginseng, 3 qian) Baizhu (Rhizoma Atractylodis Macrocephalae, 3 qian) Ganjiang (Rhizoma Zingiberis Recens, 3 qian) Gancao (Radix Glycyrrhizae, roasted, 2 qian)
Verse: Huoluan often stems from deficiency of Earth Qi; cutting pain in the abdomen is difficult to relieve.
Ganjiang, Gancao, Baizhu, and Renshen used together regulate the Central Palace, and the disease will naturally dissipate.
(Bonan's Note: In critical conditions, urgently rub the four limbs with fresh ginger dipped in sorghum liquor.)
Abdominal distension, fatigue, and a sensation of fullness after meals indicate Spleen Deficiency with weak transformation and transportation. The appropriate formula is Modified Liu Jun Zi Tang (Six-Gentlemen Decoction).
Muxiang (Radix Aucklandiae, 1 qian) Sharen (Fructus Amomi Rotundus, 2 qian) Baizhu (Rhizoma Atractylodis Macrocephalae, 3 qian) Yunling (Poria, 3 qian) Renshen (Radix Ginseng, 3 qian) Gancao (Radix Glycyrrhizae, 1 qian) Chenpi (Pericarpium Citri Reticulatae, 2 qian) Banxia (Rhizoma Pinelliae Ternatae, 2 qian) Shengjiang (Rhizoma Zingiberis Recens, 3 qian) Dazao (Fructus Jujubae, 3 pieces) Qianshi (Semen Nelumbinis, 3 qian) Maiya (Fructus Hordei Germinatus, 1 qian)
Verse: For postprandial fullness, use Renshen and Yunling; Baizhu, Banxia, Muxiang, and Sharen are most effective.
Shengjiang, Qianshi, and Maiya remove abdominal distension; Chenpi, Gancao, and Dazao harmonize well.
Abdominal distension accompanied by loose stools indicates Ru Xie (Damp Diarrhea) due to excessive dampness. The appropriate formula is Weiling Tang (Stomach-Calm Decoction) from contemporary prescriptions.
Yunling (Poria, 3 qian) Zhuling (Polyporus, 3 qian) Cangzhu (Rhizoma Atractylodis Lanceae, 3 qian) Baizhu (Rhizoma Atractylodis Macrocephalae, 3 qian) Chenpi (Pericarpium Citri Reticulatae, 2 qian) Dazao (Fructus Jujubae, 2 pieces) Guizhi (Ramulus Cinnamomi, 2 qian) Baishao (Radix Paeoniae Alba, 2 qian) Gancao (Radix Glycyrrhizae, 1 qian) Houpo (Cortices Magnoliae Officinalis, 1 qian) Zexie (Rhizoma Alismatis, 2 qian) Shengjiang (Rhizoma Zingiberis Recens, 3 slices)
Verse: Distension with loose stools requires Er Ling and Er Zhu, along with Dazao, Chenpi, and Shengjiang.
Guizhi, Baishao, Gancao, and Houpo work together; for removing dampness, carefully add Zexie.
Abdominal pain with a sensation of Qi rushing upward from the umbilicus indicates Ben Tun (Running Piglet Syndrome) of Kidney Qi. The appropriate formula is Shenqi Bentun Tang (Kidney-Qi Running Piglet Decoction).
Guizhi (Ramulus Cinnamomi, 3 qian) Yunling (Poria, 3 qian) Baizhu (Rhizoma Atractylodis Macrocephalae, 2 qian) Gancao (Radix Glycyrrhizae, 2 qian) Yiren (Semen Coicis, 3 qian) Dazao (Fructus Jujubae, 2 pieces) Fuzi (Radix Aconiti Lateralis Preparata, 3 qian)
Verse: Kidney-Qi Ben Tun rushes up from the umbilicus, following the ancient principle of Guizhi, Yunling, Baizhu, and Gancao.
Add Yiren and Fuzi heavily; Dazao harmonizes the middle, boil thickly.
Abdominal pain with a sensation of Qi rushing upward from the left side indicates Ben Tun (Running Piglet Syndrome) of Liver Qi. The appropriate formula is Ganqi Bentun Tang (Liver-Qi Running Piglet Decoction).
Wuyu (Fructus Evodiae, 1 qian) Huanglian (Rhizoma Coptidis, 3 qian) Yunling (Poria, 2 qian) Lihe (Fructus Litchi, ground, 3 pieces) Wumei (Fructus Mume, 2 pieces) Xiangfu (Rhizoma Cyperi Rotundi, ground, 3 qian) Muli (Concha Ostreae, ground, 3 qian)
Verse: Ben Tun rushing to the left belongs to the Liver Meridian; Lihe, Wumei, and Huanglian are used flexibly.
Xiangfu and Wuyu regulate Qi together; add Muli and Yunling.
(Bonan's Note: Adding Libaipi [Cortex Li Radicis], 2 qian, yields especially rapid results.)
Severe abdominal pain with a protruding mass that rejects pressure indicates a Deficiency-Cold condition presenting with Excess signs. The appropriate formula is Da Jian Zhong Tang (Great Construct the Middle Decoction).
Renshen (Radix Ginseng, 3 qian) Shujiao (Fructus Zanthoxyli, 2 qian) Ganjiang (Rhizoma Zingiberis Recens, 2 qian) Yitang (Maltose, 3 qian)
Verse: A mass attacks and rejects massage; protrusion in the abdomen causes unbearable pain.
For deficiency-cold with excess signs, use Ganjiang and Shujiao; Renshen and Yitang harmonize the Stomach Qi.
Abdominal pain relieved by pressing, with white flower-like spots on the tongue, indicates internal disturbance by Ascaris (roundworms). The appropriate formula is Cu Zhi Wumei Wan (Vinegar-Processed Mume Pill).
Danggui (Radix Angelicae Sinensis, 3 qian) Dangshen (Radix Codonopsis, 3 qian) Huanglian (Rhizoma Coptidis, 3 qian) Huangbai (Cortex Phellodendri, 2 qian) Xixin (Herba Asari, 1 qian) Guizhi (Ramulus Cinnamomi, 3 qian) Fupian (Radix Aconiti Lateralis Preparata, 3 qian) Ganjiang (Rhizoma Zingiberis Recens, 2 qian) Chuanjiao (Fructus Zanthoxyli, 2 qian) Wumei (Fructus Mume, steamed and pitted, 7 pieces)
Verse: Why do white flowers appear on the tongue? Internal disturbance by roundworms increases frequent pain.
Danggui, Dangshen, Huanglian, Huangbai, Xixin, and Chuanjiao are combined; Guizhi, Fupian, Ganjiang, and Wumei are praised for vinegar processing.
(Bonan's Note: Children can consume fried Shijunzi [Quisqualis Fructus].)
Colicky pain in the abdomen radiating to both hypochondria with borborygmus indicates accumulation of Phlegm-Fluid. The appropriate formula is Modified Er Chen Tang (Two-Aged Decoction).
Chenpi (Pericarpium Citri Reticulatae, 3 qian) Banxia (Rhizoma Pinelliae Ternatae, 3 qian) Yunling (Poria, 3 qian) Qianhu (Radix Peucedani, 2 qian) Gancao (Radix Glycyrrhizae, 1 qian) Baijiezi (Semen Sinapis Albæ, 2 qian) Suzhi (Caulis Perillae, 2 qian)
Verse: Colicky pain with borborygmus in the hypochondria; Chenpi, Banxia, Yunling, and Gancao move Qi.
Use Suzhi to unblock collaterals; Qianhu and Baijiezi clear phlegm.
(Bonan's Note: If ineffective, add Yuanhua [Flos Genkwa], 5 fen.)
Stabbing pain in the abdomen with a choppy pulse, feeling like knife or awl insertion, indicates obstruction by Blood Stasis. The appropriate formula is Modified Tao Ren Tang (Peach Kernel Decoction).
Taoren (Semen Persicae, 3 qian) Puhuang (Pollinis Typhae, 3 qian) Chishao (Radix Paeoniae Rubra, 3 qian) Baishao (Radix Paeoniae Alba, 3 qian) Guiwei (Cauda Radicis Angelicae Sinensis, 3 qian) Lingzhi (Resina Trogopterori, 2 qian) Huangqin (Radix Scutellariae, 3 qian) Chuanxiong (Rhizoma Chuanxiong, 1 qian) Xiangfu (Rhizoma Cyperi Rotundi, 3 qian) Gancao (Radix Glycyrrhizae, 1 qian) Yujin (Rhizoma Curcumae Longae, 1 qian) Qingmuxiang (Radix Aucklandiae Suppleae, 2 qian)
Verse: Stabbing abdominal pain is primarily treated with Taoren; Chishao, Baishao, Huangqin, Danggui, Chuanxiong, and Gancao are balanced.
Xiangfu, Puhuang, Lingzhi, Yujin, and Qingmuxiang are used; warn physicians to use Jiujun (Jiu Dahuang) cautiously.
Sudden abdominal pain caused by Wind pathogen invasion indicates Liver Qi invading Spleen Earth. The appropriate formula is Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction).
Chaihu (Radix Bupleuri, 2 qian) Guizhi (Ramulus Cinnamomi, 2 qian) Banxia (Rhizoma Pinelliae Ternatae, 3 qian) Renshen (Radix Ginseng, 3 qian) Qingpi (Pericarpium Citri Reticulatae Viride, 1 qian) Huangqin (Radix Scutellariae, 2 qian) Baishao (Radix Paeoniae Alba, 2 qian) Gancao (Radix Glycyrrhizae, 1 qian) Dazao (Fructus Jujubae, 2 pieces) Shengjiang (Rhizoma Zingiberis Recens, 3 slices)
Verse: Sudden abdominal pain is due to wind injury; Earth invading Spleen uses Renshen, Dazao, and Shengjiang.
Banxia, Gancao, Qingpi, Huangqin, and Guizhi combine; Chaihu and Baishao require careful consideration.
Sudden abdominal pain caused by evil spirits/pathogens indicates chaotic Blood and damaged Righteous Qi. The appropriate formula is Modified Zhengqi San (Regulate Qi Powder).
Cangzhu (Rhizoma Atractylodis Lanceae, 3 qian) Chenpi (Pericarpium Citri Reticulatae, 1 qian) Muxiang (Radix Aucklandiae, 1 qian) Dangshen (Radix Codonopsis, 3 qian) Yunling (Poria, 3 qian) Guixin (Cortex Cinnamomi, 2 qian) Tianma (Rhizoma Gastrodiae, 2 qian) Banxia (Rhizoma Pinelliae Ternatae, 2 qian) Dazao (Fructus Jujubae, 3 pieces) Shengjiang (Rhizoma Zingiberis Recens, 5 slices) Longgu (Os Draconis, 3 qian) Shexiang (Moschus, a little)
Verse: Evil spirits injuring people increase abdominal pain; Cangzhu, Yunling, Chenpi, and Banxia have miraculous abilities.
Tianma, Shexiang, and Muxiang combined with Longgu; Guixin, Dazao, Shengjiang, and Dangshen raise Zheng Qi.