经曰。左右者阴阳之道路。盖左属阴而右属阳也。阴为血而阳为气也。左者肝也。肝藏血。
性浮。喜条达而
上升。有以抑之。则不特木郁而火亦郁。故为痛。治之宜疏肝清火理血。左金兼桃仁、红花、钩
藤、青皮之属。虚人及季胁下疼者。六味汤滋其水以润之。乙癸同源之意。亦由房劳所致也。右
者肺也。肺主气。性沉。喜清肃而下降。有以逆之。则肺苦气上逆而为痛。治之宜降气消痰。前、
桔、枳壳、陈皮之属。虚人归脾汤去 、术加延胡主之。以补其母。若香燥破血之药。非其治也。
且于中州无碍。不可克代。与外感无涉。不可发散。犯之则汗出发喘。促其毙矣。余每怪时流。
一遇胁痛。不分左右阴阳。不别气血痰火虚实闪挫之因。动称肝经受病。及用药。又以外感法治
之。致死不悟。深可悲悯。殊不知胁痛之候。治之一逆。贻祸甚速。即有知者。亦守痛无补法。
害亦相等。幸临症者慎焉。
王宇泰先生治一人。患左胁痛。外发红丹数十颗。有投以龙胆泻肝等汤。竟不效。先生曰。
肝性燥苦急。宜甘以缓之。用单味栝蒌二两。研霜煎饮。取其甘缓润下。红丹可一洗而愈也。果
如先生言。余凡遇左胁疼。烦躁面赤。脉数痰色绿者。每加之辄验。若无痰而阴亏脉虚数。汗出
无气以动。六味汤加钩藤。屡获奇效。若血凝气滞。以桃仁、红花、枳壳、醋制青皮、香附、延
胡等。或加生地、芍药、钩藤佐之。实火。左金丸亦可选用。
一友右胁痛。以自知医。用发散药。痛愈甚。气息难布。余诊其脉则微弱。特虑其不受补。
以单味贝母一两。
研细煎汤饮之。保其肺气。使清肃下行。痛即如失。盖栝蒌色绿入肝。有解毒之功。贝母色白入
肺。有保残之力。故治各不同也。夫贝母亦能解毒。用之以平肝则无济。栝蒌亦能润肺。用之于
误汗则太寒。学人不可不知。
一人患右胁痛。凡旬日。医者误用香燥。致不得坐卧。又延一友。不能治。反曰胸中有滞。
止宜消导。若痛止。必不可救。及服其药。果愈甚。病者求死。比余适止。见其苦。慰之曰。不
难疗。可一剂而愈。病者喜。伊芳兄云。痛未可止。余怪问其故。则曰。顷医者有是言。故云。余
笑曰。令弟苦痛不止欲死。医者又苦痛止不治。何大相背也。检其药。仍用消导加半夏等燥剂。
余即取素所历效自制推气散。加延胡索。命煎饮之。又适友人杨子武修至。余告其故。欣然同意。
少顷。病者数日不解带。不转动。忽下榻曰。痛愈大半。欲解衣而睡矣。当晚遂安卧。越三日。
痛虽愈。但因前久坐。气不归原。不能安枕。余以六味汤加杜仲引气下行。二剂知。四剂已。继
六味丸调理而康。盖右胁痛者。肺气之逆也。以其真阴亏损。肺不能归藏于肾水之中。故理肺之
后。继以滋阴。亦一法耳。
一人患右胁前岐骨下软肉处痛。医者用破气血药加酒煎。投三四剂。遂叫号不绝。余亦以推
气散加延胡饮之。瘥缓。但面赤脉数口干。加入生地、茯苓。去前、桔。痛稍止。又因劳心。后
加远志、当归、钩藤、杜仲。去
枳壳。乃愈。或问之曰。病名为何。余曰。此名闪肭痛。肭在脐之旁。季胁之前。曰何以知之。
曰。腽肭脐乃海狗肾之别称。则肭之命名。当在脐与肾之间也。若劳倦不节。色欲不谨。气血有
阻。则软胁前痛。宜补而调之。勿投燥剂可也。
疏肝饮 治左胁痛。
柴胡 当归 黄连（各七分茱制） 青皮（醋炒） 枳壳（麸炒） 白芍（各一钱酒炒）
川芎 红花（各五分） 桃仁（九粒研如泥）
姜一片。水煎。如兼痰喘者。不用此药。
推气散 治右胁痛。神应胜原方。
枳壳（麸炒） 前胡 山楂（各钱半） 钩藤（二钱） 甘草（三分） 广皮 葛根 桔梗（各一钱）
The *Neijing* states: The left and right sides are the pathways of Yin and Yang qi. Generally, the left belongs to Yin and the right to Yang. Yin corresponds to Blood, and Yang to Qi. The left side corresponds to the Liver. The Liver stores Blood. Its nature is light and floating. It prefers free flow and upward growth. If suppressed by factors, not only will Liver Wood become stagnant, but Fire will also be constrained. Thus, pain arises. Treatment should involve soothing the Liver, clearing Heat, and regulating Blood. Zuojin Wan (Gold Left Pill) may be used with additions such as Tao Ren (Peach Seed), Hong Hua (Safflower), Gou Teng (Uncaria Rhynchophylla), and Qing Pi (Aurantii Fructus Immaturus). For patients with deficiency constitutions or pain in the hypochondriac region below the costal margin, Liuwei Dihuang Tang (Six-Ingredient Rehmannia Decoction) is used to nourish Kidney Water to moisten. This reflects the concept of "Yi-Gui Tong Yuan" (Liver and Kidney sharing the same source). This condition is often caused by sexual exhaustion.
The right side corresponds to the Lung. The Lung governs Qi. Its nature is sinking and still. It prefers clear descending. If disturbed by contrary factors, Lung Qi suffers from rebellion upward, causing pain. Treatment should involve descending Qi and resolving Phlegm. Drugs such as Qian Hu (Peucedani Radix), Jie Geng (Platycodonis Radix), Zhi Ke (Aurantii Fructus), and Chen Pi (Citri Reticulatae Pericarpium) may be used. For deficient patients, Guipi Tang (Restore the Spleen Decoction) with Bai Zhu (Atractylodis Macrocephalae Rhizoma) and Ren Shen (Ginseng Radix et Rhizoma) removed, and Yan Hu Suo (Corydalis Rhizoma) added, serves as the main prescription. This aims to tonify the Mother organ (Earth/Spleen to generate Metal/Lung). Using aromatic-dry and blood-breaking drugs is inappropriate. Moreover, this disease does not affect the Middle Jiao (Spleen and Stomach); it should not be treated with draining methods that damage healthy Qi. It is unrelated to Exogenous pathogens; dispersing methods should not be used. Misuse of dispersing methods leads to sweating and panting, accelerating death. I often criticize contemporary physicians who, upon encountering hypochondriac pain, fail to distinguish between left/right, Yin/Yang, or causes such as Qi/Blood stagnation, Phlegm/Fire, Deficiency/Excess, or strain. They indiscriminately attribute it to the Liver Meridian. When prescribing, they use treatments for Exogenous diseases, leading to patient death without realization, which is deeply pitiable. One must know that for hypochondriac pain, incorrect treatment causes rapid harm. Even knowledgeable practitioners who stick solely to pain relief without tonification cause equal damage. Clinicians must exercise caution.
Mr. Wang Yutai treated a patient suffering from left-sided hypochondriac pain with dozens of red rashes on the skin. A physician prescribed Longdan Xiegan Tang (Gentiana Decoction to Drain the Liver), which was ineffective. Mr. Wang said: "The Liver's nature is dry and suffers from tension; it requires Sweet flavors to relax." He prescribed a single herb, Gua Lou (Trichosanthis Fructus), two liang, ground into powder and decocted. Utilizing its sweet, relaxing, and descending properties, the red rashes healed after one wash. As predicted, it worked. Whenever I encounter left-sided hypochondriac pain accompanied by irritability, red face, rapid pulse, and green sputum, adding Gua Lou proves effective. In cases of Yin deficiency with weak, rapid pulse, sweating, and lack of energy to move, Liuwei Dihuang Tang plus Gou Teng yields miraculous results. For Blood stasis and Qi stagnation, Tao Ren, Hong Hua, Zhi Ke, Vinegar-processed Qing Pi, Xiang Fu (Cyperi Rhizoma), and Yan Hu Suo are used, possibly supplemented with Sheng Di Huang (Rehmanniae Radix), Bai Shao (Paeoniae Radix Alba), and Gou Teng. For Excess Heat, Zuojin Wan is also可选 (selectable).
A friend suffered from right-sided hypochondriac pain. Self-medicating with dispersing herbs worsened the pain and made breathing difficult. His pulse was weak. Fearing he could not tolerate tonics, I prescribed a single herb, Bei Mu (Fritillariae Bulbus), one liang, finely ground and decocted. This protected Lung Qi, allowing clear descent, and the pain vanished immediately. Gua Lou enters the Liver due to its green color and has detoxifying properties; Bei Mu enters the Lung due to its white color and preserves residual Qi. Hence, treatments differ. Although Bei Mu can detoxify, it is useless for calming the Liver. Although Gua Lou can moisten the Lung, it is too cold if used after erroneous sweating. Students of medicine must understand this.
Another patient suffered from right-sided hypochondriac pain for ten days. A physician erroneously used aromatic-dry drugs, rendering the patient unable to sit or lie down. Another friend was consulted but failed to cure, claiming chest stagnation required digestion-promoting herbs, warning that cessation of pain would mean certain death. After taking these drugs, the condition worsened. The patient sought death. I happened to stop by, saw his suffering, and comforted him: "Not difficult to treat; one dose will cure." The patient was pleased. His brother said: "The pain cannot stop." I asked why. He replied: "The doctor just said so." I laughed: "Your brother suffers unbearable pain wanting death, yet the doctor says cessation of pain means untreatability. How contradictory!" Examining his prescription, it contained digestive aids plus Ban Xia (Pinelliae Rhizoma) and other drying agents. I immediately administered my self-made Tuiqi San (Push Qi Powder) with Yan Hu Suo. My friend Yang Ziwuxiu arrived, agreed enthusiastically. Soon, the patient, who had not loosened his belt or moved for days, got out of bed saying: "Pain reduced by more than half, want to undress and sleep." He slept peacefully that night. Three days later, although pain resolved, prolonged sitting prevented Qi from returning to its origin, causing insomnia. I used Liuwei Dihuang Tang with Du Zhong (Eucommiae Cortex) to guide Qi downward. Two doses showed effect; four doses cured. Subsequent regulation with Liuwei Wan led to full recovery. Right-sided hypochondriac pain is typically rebellious Lung Qi. Due to True Yin depletion, the Lung cannot store itself in Kidney Water. Therefore, after regulating the Lung, nourishing Yin is another method.
One patient suffered pain in the soft flesh below the xiphoid process on the right anterior hypochondrium. A physician prescribed blood-breaking and Qi-moving herbs decocted with wine for three to four doses, causing incessant crying. I administered Tuiqi San with Yan Hu Suo, alleviating the condition. However, the patient had a red face, rapid pulse, and dry mouth. I added Sheng Di Huang and Fu Ling (Poria), removing Qian Hu and Jie Geng. Pain subsided slightly. Due to mental overwork, I later added Yuan Zhi (Polygalae Radix), Dang Gui (Angelicae Sinensis Radix), Gou Teng, and Du Zhong, removing Zhi Ke. Only then did he recover. Asked about the diagnosis, I said: "This is called Shanna Pain (Strain and Nerve Pain)." Na is located beside the umbilicus, anterior to the costal margin. Why do I know this? "Tan Na Qi" is an alias for Sea Dog Kidney; thus, 'Na' refers to the area between the umbilicus and Kidney. Irregular labor and excessive sexual activity cause Qi and Blood obstruction, leading to pain in the soft hypochondrium. Tonification and regulation are indicated; avoid drying agents.
Shugan Yin (Liver-Soothing Drink): Treats left-sided hypochondriac pain.
Chai Hu (Bupleuri Radix), Dang Gui (Angelicae Sinensis Radix), Huang Lian (Coptidis Rhizoma) [each 0.7 qian, processed with Wu Zhu Yu (Evodiae Fructus)], Qing Pi (Aurantii Fructus Immaturus) [vinegar-fried], Zhi Ke (Aurantii Fructus) [bran-fried], Bai Shao (Paeoniae Radix Alba) [each 1 qian, wine-fried], Chuan Xiong (Ligustici Chuanxiong Rhizoma), Hong Hua (Carthami Flos) [each 0.5 qian], Tao Ren (Persicae Semen) [9 grains, ground to paste].
One slice of Sheng Jiang (Zingiberis Rhizoma Recens). Decoct in water. Do not use if complicated by Phlegm and panting.
Tuiqi San (Push Qi Powder): Treats right-sided hypochondriac pain. Original formula from Shenyingshengyuan.
Zhi Ke (Aurantii Fructus) [bran-fried], Qian Hu (Peucedani Radix), Shan Zha (Crataegi Fructus) [each 1.5 qian], Gou Teng (Uncariae Ramulus cum Uncis) [2 qian], Gan Cao (Glycyrrhizae Radix et Rhizoma) [0.3 qian], Guang Pi (Citri Reticulatae Pericarpium), Ge Gen (Puerariae Lobatae Radix), Jie Geng (Platycodonis Radix) [each 1 qian].