脉
脉双弦者，肝气有余，两胁作痛。
病
夫胁痛者，厥阴肝经为病也。其病自两胁下痛引小腹，亦当视内外所感之邪而治之。若因暴怒伤触悲哀
气结，饮食过度，冷热失调，颠仆伤形，或痰积流注于血，与血相搏，皆能为痛，此内因也；若伤寒少阳，耳
聋胁痛，风寒所袭而为胁痛，此外因也。治之
当以散结顺气，化痰和血为主，平其肝而导其气，则无有不愈矣。
治
胁痛者，肝火盛，木气实也。有死血，有痰流注，有肝急者。
一、木气实，用苍术、川芎、青皮、柴胡、芍药、甘草，水煎服。
一、痛甚者，肝火盛，以当归龙荟丸姜汤下，泻肝火之要药也。
一、死血作痛，用桃仁去皮留尖，红花酒拌焙干，川芎，香附童便浸，青皮，水煎服。
一、肝苦急，食辛以散之，川芎、苍术，血病入血药中，苦者，恶也、嫌也。或小柴胡汤亦效。
一、凡胁痛皆是肝木有余也，用小柴胡汤加青皮、川芎、芍药、龙胆草。
一、凡胁痛用青皮，必须用醋炒过。
一、凡瘀血作痛，用小柴胡汤合四物汤，加桃仁、红花、乳
香、没药煎服，痛甚而元气实者，桃仁承气汤下之。
方
枳壳散 治胁间如物刺，是气实也。
枳壳（面炒黄，一两五钱） 甘草（炙，七钱五分）
上为末，每二钱，浓煎葱白汤下，不拘时服。
当归龙荟丸 治泻肝火盛之要药，因内有湿热，两胁痛甚，伐肝木之气。
当归 龙胆草 山栀子 黄连 大黄（酒湿火煨） 芦荟 青黛（各五
钱） 木香（二钱五分） 麝香（五分，另研） 加柴胡（五钱） 青皮（一钱）
上为细末，神曲为丸，如梧桐子大。每服二十丸，姜汤下。
治妇人胁痛。
香附子（四两，醋一碗，盐一两煮干） 白芍药（二两） 肉桂（二两） 玄胡索（炒，二两）
上为末，每服三钱，空心滚汤调。
治诸痛熨法
韭菜根，捣烂，醋拌炒，绢包熨痛处。
Pulse
When the pulse is double-wiry (Shuang Xian), it indicates excess Liver Qi, resulting in pain in both hypochondriac regions.
Disease
Hypochondriac pain (Xie Tong) is a disease of the Jueyin Liver Meridian. The pathology involves pain radiating from the bilateral hypochondrium to the lower abdomen. Treatment should be based on the differentiation of internal and external pathogenic factors. If caused by sudden rage or grief leading to Qi stagnation, overeating, imbalance of cold and heat, physical trauma, or phlegm accumulation flowing into the blood vessels and clashing with blood, these constitute internal causes; if caused by Shaoyang syndrome of Cold Damage presenting with deafness and hypochondriac pain, or by invasion of Wind-Cold, these constitute external causes. Treatment should primarily focus on dissipating nodules, regulating Qi, resolving phlegm, and harmonizing blood. By pacifying the Liver and guiding the flow of Qi, cure can be achieved.
Treatment Methods
Hypochondriac pain is caused by excessive Liver Fire and excess Wood Qi (Liver Qi). Etiologies include blood stasis, phlegm flow, and Liver urgency.
1. For excess Wood Qi, use Cang Zhu (Atractylodis Rhizoma), Chuan Xiong (Ligustici Chuanxiong Rhizoma), Qing Pi (Citri Reticulatae Pericarpium Viride), Chai Hu (Bupleuri Radix), Shao Yao (Paeoniae Radix Alba), and Gan Cao (Glycyrrhizae Radix et Rhizoma). Decoct in water and take orally.
2. For severe pain due to excessive Liver Fire, administer Danggui Longhui Wan (Angelica Sinensis and Aloe Pill) with Ginger Decoction. This is a key formula for purging Liver Fire.
3. For pain caused by blood stasis, use Tao Ren (Persicae Semen) [skin removed, tip retained], Hong Hua (Carthami Flos) [mixed with wine and dried], Chuan Xiong, Xiang Fu (Cyperi Rhizoma) [soaked in child's urine], and Qing Pi. Decoct in water and take orally.
4. When the Liver suffers from urgency, pungent substances should be used to disperse it. Use Chuan Xiong and Cang Zhu. For blood diseases, add them to blood-invigorating formulas. "Ku" (bitter) here implies aversion or dislike. Xiaochaihu Tang (Minor Bupleurum Decoction) is also effective.
5. All cases of hypochondriac pain are due to excess Liver Wood. Use Xiaochaihu Tang (Minor Bupleurum Decoction) added with Qing Pi, Chuan Xiong, Shao Yao, and Long Dan Cao (Gentianae Radix).
6. When using Qing Pi for hypochondriac pain, it must be stir-fried with vinegar.
7. For pain caused by blood stasis, use Xiaochaihu Tang (Minor Bupleurum Decoction) combined with Siwu Tang (Four Substances Decoction), added with Tao Ren, Hong Hua, Rush Xiang (Olibanum), and Moyao (Myrrha). Decoct and take orally. If pain is severe and the Yuan Qi (Original Qi) is sufficient, administer Taoren Chengqi Tang (Peach Kernel and Magnolia Bark Decoction) to purge downward.
Formulas
Zhike San (Bitter Orange Powder) treats stabbing pain in the hypochondrium as if pierced by an object, indicating excess Qi.
Zhike (Fructus Aurantii) [stir-fried with flour until yellow, 1 liang 5 qian] Gancao (Radix Glycyrrhizae) [roasted, 7 qian 5 fen]
Grind into powder. Take 2 qian each time, administered with strong decoction of Cong Bai (Scallion White). Take at any time.
Danggui Longhui Wan (Angelica Sinensis and Aloe Pill) is a key medicine for purging excessive Liver Fire, suitable for damp-heat internally causing severe hypochondriac pain, aiming to subdue Liver Wood Qi.
Danggui (Angelicae Sinensis Radix), Longdan Cao (Gentianae Radix), Shanzhizi (Gardeniae Fructus), Huanglian (Coptidis Rhizoma), Dahuang (Rhei Radix et Rhizoma) [steeped in wine and roasted with moisture], Lvhui (Aloe), Qingdai (Indigo Naturalis) [each 5 qian], Muxiang (Aucklandiae Radix) [2 qian 5 fen], Shexiang (Moschus) [5 fen, separately ground]. Add Chai Hu (5 qian) and Qing Pi (1 qian).
Grind into fine powder, make pills with Shenqu (Medicated Leaven) the size of Sophora seeds. Take 20 pills each time with Ginger Decoction.
Treats hypochondriac pain in women.
Xiangfu Zi (Cyperi Rhizoma) [4 liang, boiled dry in one bowl of vinegar and 1 liang salt], Baishao Yao (Paeoniae Radix Alba) [2 liang], Rougui (Cinnamomi Cortex) [2 liang], Yanhusuo (Corydalis Rhizoma) [roasted, 2 liang].
Grind into powder. Take 3 qian each time, mixed with boiling water on an empty stomach.
External application method for treating various pains.
Jiucai Gen (Allii Tuberosi Radix) is mashed, mixed with vinegar, stir-fried, wrapped in silk cloth, and applied as a hot compress to the painful area.