痰核，即瘰 也，少阳经郁火所结。方用泽兰叶、花粉、薄荷、山豆根、鳖甲，热甚加
三黄
，石膏四两，贝母三钱，百草霜六钱，薄荷、苏叶各四两，甘草少许。泻加诃子，嗽加款冬
，痰加乌梅。共末，白糖丸弹子大。不拘时含化。服此丸十数日，再服酒药，其病愈尽。如
先服酒药，后服丸，其核不尽消。酒方∶都管草根三四斤，兔耳一枝箭一斤，威灵仙二两，
紫花地丁一斤，白果、南星各一斤，陈酒一坛，加火酒二、三两，煮熟，退火七日饮。
验案
王太史咯血痰核，用前胡、桔梗、干葛、半夏、甘草、茯苓、人参、归身、赤芍、生地
、苏梗。盖水少则火动，血少则热生，火病血虚，阳生阴长。药十一味，六味所以阳生阴长，五
味所以助其生发之气，气血行而痰化也。服十帖，又用米泔炒 、归各一钱五分，人参、生
姜、赤芍、连翘各一钱，前胡、防风、甘草、羌活、枳壳各五分，愈。
心痛者，心为阳脏，胃阳不足，而阴寒乘之也。攻之则气益伤，补之则气益滞。先用川
椒一味，作汤时饮，俟其心阳流通，后以八味丸治之，下元气足，则真火能升，寒邪自退。生地
心痛有属心火者，宜茯苓补心汤发之；有属寒水乘心者，茯苓、甘草伐其水邪。
小腹痛，肝肾之部，虚寒气胜也；大腹痛，脾胃之部，食积停痰也。脐右为肺，左为肝
，上为心，下为肾，中为脾。诸作痛者，皆中气不足，阳气不通所致也。（此指虚弱人而言。）中
焦痛，食积者，多用二陈加消导之药；不愈，必系寒痛，用姜、桂温之，或理中去术，加吴
萸。左右痛，大半是风；下焦痛，纯寒无热，除姜、桂，必无治法也。
诸痛，法宜温中，佐以升发，如麻黄之属。
腹痛手不可按是实，宜消导；可按稍愈者，是虚，用炮姜五分，吴萸半分，黄连、木香
各二分。盖药少而寒热均治也。
腹以下至小腹痛，俱宜温暖。若带左右痛，是挟肝火。药宜兼清凉散火，或滋阴降火之
腹痛下之而全不愈者，不可复下，宜和宣而已。
腹痛不过脐与气海，其余痛，俱中气不足，和中散最是。下焦纯寒，用和中散，少加小
茴。亦有血滞作痛者，必大小便见血，口内出血，以四物汤加延胡、香附、肉桂，从血分治
上焦宜清，中焦宜温，惟食积停痰气实人，二陈汤随所伤而加以消导。伤热者少加黄连
，有酒积者少加利湿清热药。若气虚人不可消导，六君子加砂仁、木香。
凡痛在上下左右，俱是血分，血分宜血药，求汗则愈。一见吐泻，虽痛必调理脾胃，脾
胃一转，而上下左右，皆得禀气，诸痛自愈。上焦宜清，须求吐；中焦宜和，或求下；下焦
厥阴之分，吐下无所用，法宜温暖，或达或汗出乃愈。腹之下焦，与膀胱相近，宜温而达之
，使邪从小便去也。下药从胃入于肛肠，吐药入胃上出，亦皆不渗膀胱，故曰吐下无所用也。
凡呕吐、腹痛，因于寒者，用绿豆一钱，胡椒一两，煎汤服之。
虫痛不可忍者，用胡椒一两，盐一钱，和匀纸包，外以黄泥固之， 约半焦，取出去泥
，纯研末为丸，空心服。六、七日，虫化为水，妙不可言。
腹痛温中药不愈者，用生附子、干姜、肉桂、麻黄即愈。腹痛心口痛，恶心作泻，半夏
、茯苓、苡仁各一两，陈皮一两五钱，甘草三钱，吴萸（盐水炒）一钱，共末，滚汤下二钱。
绞肠腹痛，盐水服吐；盘肠腹痛，乳香、没药为末，木香汤服。心腹痛及阴证绞肠痛，
延胡一两，桃仁五钱，乳香、没药各一钱，五灵脂五钱，醋糊丸。每服三十丸，心痛淡醋汤
下，腹痛干姜汤下，大便不通大黄汤下。
热痛发渴，里急后重，脉实；寒痛，四肢冷，自汗或无汗，脉无力。腹痛绵绵无增减者
，脉迟，属寒；乍痛乍止，脉数大，火也。痛而泻，泻而痛减者，食积。痛不移处，死血。
小便不利而痛，湿痰。腹痛引肋有声，痰饮。时痛时止，面白辱红，虫痛。腹中痛，手不可
按是实。怒气伤肝，肋刺痛，气痰。以手按腹，腹软而痛止，是虚。
热痛，先以冷水探之略愈，香连丸；寒痛，理中丸加木香、茯苓、陈皮，或和中散。
验案
一人年二十余，房事不节，因酒店饮食，遂火挟脐起，上入膈，胸腹内痛，外皮抽进，如有
物闭住胸中。用消导者有之，用温补者有之，服药愈多而病愈凶，自分必死。予诊之，思相
火自下冲上，直至头面，今火起于脐，至胸而止，乃因色欲过度，真阳不足，丹田有寒也。
作痛者，脾虚有寒，土无火生也。用乌药二钱，制附子一枚，每用附子三分，水煎服。盖附
子扶阳，乌药破滞，只此一味煎汤则极清，清则下行甚速。故五日见效，服附百枚而痛全愈。
Phlegm nodules (Tan He), also known as scrofula (Luo Li, 瘰疬), are formed by the accumulation of stagnant fire in the Shaoyang meridian. The prescription uses Zelan Ye (Lantana Leaf), Huafen (Trichosanthes Root), Bohe (Mint), Shandougen (Sophora Tonkinensis Root), and Biejia (Turtle Shell). If heat is severe, add Sanhuang (Three Yellows: Coptis Rhizome, Scutellaria Root, and Gentian Root); Shigao (Gypsum Fibrosum) four liang, Beimu (Fritillaria Bulb) three qian, Baicaoshuang (Soot from Chimney) six qian, Bohe (Mint) and Ziye (Perilla Leaf) each four liang, Gancao (Licorice Root) a small amount. If diarrhea is present, add Hezi (Chebulic Myrobalan); if coughing, add Kuandonghua (Adenophora Flower); if excessive phlegm, add Wumei (Mume Fruit). Grind all into powder, form pills the size of bullet seeds using white sugar. Suck on them at any time. After taking these pills for more than ten days, take the wine medicine to cure the disease completely. If the wine medicine is taken first and the pills later, the nodules will not disappear completely. Wine prescription: Duguan Gen Cao (Root of *Paederia scandens*) three to four jin, Tu'er Yizhijian (Herba Siegesbeckiae) one jin, Weilingxian (Salvia Miltiorrhiza or related species) two liang, Zihua Diding (Viola Yedoensis) one jin, Baiguo (Ginkgo Seed) and Nanting (Arisaema Rhizoma) each one jin, aged wine one jar, add Erliangjiu (Baijiu) two to three liang, cook thoroughly, let cool for seven days before drinking.
Case Record
Grand Historian Wang suffered from hemoptysis and phlegm nodules. He was treated with Qianhu (Peucedani Radix), Jiegeng (Platycodon Root), Gange (Puerariae Radix), Banxia (Pinellia Rhizoma), Gancao (Licorice Root), Fuling (Poria), Renshen (Ginseng Radix), Guishen (Angelicae Sinensis Radix), Chishao (Red Peony Root), and Shengdi Huang (Rehmanniae Radix). This is because when Yin water is insufficient, fire moves; when blood is deficient, heat arises. Fire diseases deplete blood leading to blood deficiency; the treatment principle is to generate Yang to nourish Yin. The eleven herbs include six to promote Yang generation and Yin growth, and five to assist their generating Qi. When Qi and Blood circulate, phlegm transforms. After taking ten doses, he used Baizhu (Atractylodes Macrocephala Rhizoma) stir-fried with rice wash water and Danggui (Angelicae Sinensis Radix) each one qian five fen, Renshen (Ginseng Radix), Shengjiang (Fresh Ginger), Chishao (Red Peony Root), Lianqiao (Forsythia Fruit) each one qian, Qianhu (Peucedani Radix), Fangfeng (Saposhnikoviae Radix), Gancao (Licorice Root), Qianghuo (Notopterygii Rhizoma et Radix), Zhike (Aurantii Fructus Immaturus) each five fen, and he recovered.
Heart pain occurs because the Heart is a Yang organ; if Stomach Yang is insufficient, Yin cold attacks it. Attack methods further injure Qi, while tonification methods cause Qi stagnation. First, use Chuanjiao (Zanthoxylum Bungeanum Pericarpium) alone, decocted as soup to drink. Wait until Heart Yang flows freely, then treat with Bawei Wan (Eight-Ingredient Pill). When Yuan Qi (Original Qi) in the lower jiao is sufficient, True Fire can ascend, and cold pathogens recede spontaneously. For heart pain originating from the lower abdomen due to Heart Fire, use Fuling Buxin Tang (Poria Decoction to Tonify the Heart) to disperse it; if caused by Cold Water overcoming the Heart, use Fuling (Poria) and Gancao (Licorice Root) to subdue the water pathogen.
Lower abdominal pain belongs to the Liver and Kidney regions, caused by deficiency-cold dominance; upper abdominal pain belongs to the Spleen and Stomach regions, caused by food retention and phlegm accumulation. The right side of the umbilicus corresponds to the Lung, the left to the Liver, above to the Heart, below to the Kidney, and the center to the Spleen. All pains are caused by insufficiency of Middle Qi and blockage of Yang Qi. (This refers to weak individuals.) For middle jiao pain due to food retention, use Erchen Tang (Two-Aged Herb Decoction) plus digestion-promoting herbs; if ineffective, it must be cold pain, treat with Jiang (Ginger) and Gui (Cinnamon Twig) to warm it, or Lizhong Tang (Regulate the Middle Decoction) plus Baizhu (Atractylodes Macrocephala Rhizoma) and Wuyu (Evodia Fruit). Pain on the left and right is mostly due to Wind; lower jiao pain is pure cold without heat, and besides Jiang (Ginger) and Gui (Cinnamon Twig), there is no other treatment method.
For various pains, the method should warm the middle and assist ascending and dispersing, such as using Mahuang (Ephedra Herba).
Abdominal pain that cannot be pressed is excess; use digestion-promoting methods. Abdominal pain that improves with pressure is deficiency; use Paojiang (Prepared Ginger) five fen, Wuyu (Evodia Fruit) half fen, Huanglian (Coptis Rhizome) and Muxiang (Vladimiria Root) each two fen. Because the dosage is small and treats both cold and heat.
Pain from below the abdomen to the lower abdomen should be warmed. If accompanied by left/right pain, it involves Liver Fire. Medication should combine cooling and dispersing fire, or nourishing Yin and descending fire.
If abdominal pain does not improve after purging, do not purge again; use harmonizing and unblocking methods.
Pain not exceeding the umbilicus and Qihai (CV6) indicates Middle Qi insufficiency elsewhere; Hezhong San (Harmonize the Middle Powder) is most suitable. Pure cold in the lower jiao uses Hezhong San (Harmonize the Middle Powder) with a little Xiaohui (Fennel Fruit). Pain due to blood stasis presents with blood in stool/urine and oral bleeding; treat the blood level with Siwu Tang (Four Substance Decoction) plus Yanhu (Corydalis Rhizoma), Xiangfu (Cyperus Rhizoma), and Rougui (Cinnamon Bark).
The Upper Jiao should be cleared; the Middle Jiao should be warmed. Only for those with food retention, phlegm, and excess constitution, use Erchen Tang (Two-Aged Herb Decoction) with digestion-promoting herbs based on the specific injury. For heat injury, add a little Huanglian (Coptis Rhizome); for alcohol accumulation, add dampness-draining and heat-clearing herbs. For Qi-deficient individuals, do not use digestion-promoting methods; use Liujunzi Tang (Six-Gentleman Decoction) plus Sharen (Amomum Fruit) and Muxiang (Vladimiria Root).
Pains in the upper, lower, left, and right belong to the Blood level; blood-level issues require blood-invigorating herbs, and sweating leads to recovery. Upon seeing vomiting and diarrhea, even with pain, regulate the Spleen and Stomach first. Once Spleen and Stomach function turns, Qi reaches all areas, and pains heal themselves. Upper Jiao requires clearing, seek vomiting; Middle Jiao requires harmonizing, seek purging; Lower Jiao (Jueyin division) renders vomiting and purging useless; the method should warm, or achieve recovery through venting or sweating. The lower abdomen is close to the Bladder; warm and vent to expel pathogens via urination. Purging herbs enter the intestines from the stomach; vomiting herbs exit from the stomach upwards; neither penetrates the Bladder, hence vomiting and purging are useless here.
For vomiting and abdominal pain due to cold, use Ludou (Mung Bean) one qian and Hujiao (Black Pepper) one liang, decoct in water and drink.
For unbearable worm pain, mix Hujiao (Black Pepper) one liang and Yan (Salt) one qian, wrap in paper, seal with yellow mud, bake until half-charred, remove mud, grind to powder, make pills, take on an empty stomach. In six or seven days, worms turn to water, miraculous effect.
For abdominal pain unresponsive to warming herbs, use Sheng Fuzi (Raw Aconite Lateralis Radix Preparata), Ganjiang (Dried Ginger), Rougui (Cinnamon Bark), and Mahuang (Ephedra Herba) for immediate relief. For abdominal pain with epigastric pain, nausea, and diarrhea, use Banxia (Pinellia Rhizoma), Fuling (Poria), Yiren (Coix Seed) each one liang, Chenpi (Citrus Reticulata Peel) one liang five qian, Gancao (Licorice Root) three qian, Wuyu (Evodia Fruit, salt-fried) one qian, grind to powder, take two qian with boiling water.
For strangulating intestinal pain, take with salt water to induce vomiting; for coiled intestinal pain, take Rushi (Olibanum) and Moyao (Myrrha) powder with Muxiang (Vladimiria Root) decoction. For heart/abdominal pain and Yin-strangulating pain, use Yanhu (Corydalis Rhizoma) one liang, Taoren (Prunus Persica Seed) five qian, Rushi (Olibanum) and Moyao (Myrrha) each one qian, Wulingzhi (Trogopterus Dung) five qian, form pills with vinegar paste. Take thirty pills per dose: for heart pain, take with light vinegar water; for abdominal pain, take with Ginger decoction; for constipation, take with Dahuang (Rhubarb Root and Rhizome) decoction.
Heat pain presents with thirst, tenesmus, and excess pulse; cold pain presents with cold limbs, spontaneous sweating or no sweating, and weak pulse. Continuous abdominal pain without fluctuation with a slow pulse indicates cold; intermittent pain with rapid/large pulse indicates fire. Pain followed by diarrhea where pain decreases indicates food retention. Fixed pain indicates dead blood (blood stasis). Pain with difficulty urinating indicates damp-phlegm. Abdominal pain radiating to ribs with sound indicates phlegm-fluid retention. Intermittent pain with pale face and red spots indicates worm pain. Abdominal pain that cannot be pressed is excess. Anger injuring the Liver causes stabbing rib pain due to Qi-phlegm. Pressing the abdomen resulting in softness and pain cessation indicates deficiency.
For heat pain, test with cold water for slight relief, then use Xianglian Wan (Coptis and Aucklandia Pill); for cold pain, use Lizhong Wan (Regulate the Middle Pill) plus Muxiang (Vladimiria Root), Fuling (Poria), Chenpi (Citrus Reticulata Peel), or Hezhong San (Harmonize the Middle Powder).
Case Record
A man in his twenties, due to sexual indiscretion and improper diet at a tavern, experienced ministerial fire carrying heat rising from the umbilicus, entering the diaphragm, causing internal chest and abdominal pain, skin contraction, and a sensation of obstruction in the chest. Some used digestion-promoting methods, others used warming-tonifying methods. The more medicine he took, the worse the condition became, and he believed he would surely die. I diagnosed him and reasoned that ministerial fire surged upward from below to the head and face. Here, fire started at the umbilicus and stopped at the chest, caused by excessive lust, insufficiency of True Yang, and cold in the Dantian. The pain was due to Spleen deficiency with cold, Earth lacking Fire generation. Use Wuyao (Lindera Root) two qian and Zhifuzi (Prepared Aconite Lateralis Radix) one piece. Each time use three fen of Fuzi, decoct in water and drink. Fuzi supports Yang, Wuyao breaks stagnation. Decocting only this herb yields a very clear liquid, which descends rapidly. Thus, improvement was seen in five days, and after taking a hundred pieces of Fuzi, the pain completely healed.