左胁痛为肝气有余，宜小柴胡加四物。左属肝，属血，痛为肝气有余，有余便是火，火
郁则血凝，故以柴胡泻肝气，四物和肝血。
右胁痛为肺气不降，血中之气病也，宜芎归芍药汤加乌药、青皮、肉桂、陈皮调之。右
属气，痛为气滞，气滞则血凝，故以乌药、青皮、陈皮调气，芎、归、芍药、肉桂和血。
饮食劳役而致两胁痛者，左，补中益气汤加白芍，右，补中加青皮。盖左宜破血，右宜
破气。两胁下痛，上穿助，系气血有火，用药止痛，必因肉桂，有行有补乃愈。河间法也。
左胁痛宜升提，枳实、川芎各五钱，炙甘草二钱，共末，酒调下。
右胁痛，宜降气，枳壳、桂心各四钱，姜黄四钱，炙甘草二钱，共末，姜、枣汤下。
两胁痛，宜行气行血。人参、枳实、白芍、川芎各五钱，共细末。每服二钱，姜汤下。
凡内伤胁痛不止，生香油一杯，生蜜一杯，和匀服，一二次即愈。
或饮冷水而致胁痛者，用干姜、肉桂，但温而不散，必用补中益气汤加附子，其痛即止
验案
一人因房事不遂意，左胁痛如刀刺，中脘痛则急死，日日如此。痛已四年，诸医不效。
因多服开郁调气药，大便结燥。予诊之，用木香散胸中结气，川芎去肋胸痛，郁金下气止痛，三
味各三钱，当归、生地、黑山栀、贝母、陈皮、香附、炮姜各五钱，解郁消痰，养血顺气温
中，黑芝麻三合滑肠，白檀香三钱调气，甘草二钱和中，酒煮常服，酒完痛止。
一妇有孕六月，左胁痛如刀割，喘嗽气促，不能安卧，身热汗出，痛甚则厥，厥则脉绝
。先服黄 、枳壳、肉桂、川连、苏梗、杏仁。右胁痛稍止而气更促，此因肺虚气不降也。用人
参三钱，川附、肉桂各五分，甘草八分，黄 、白芍各一钱，砂仁末一钱。三帖愈。盖妇人
重身，有故则毒药无殒，所以肉桂之下胎而适足以安胎也。
Left hypochondriac pain is due to excess Liver Qi, and Xiao Chai Hu Tang (Minor Bupleurum Decoction) combined with Si Wu Tang (Four Substance Decoction) is appropriate. The left side corresponds to the Liver and Blood; pain indicates excess Liver Qi. Excess generates Fire, and when Fire is constrained, Blood coagulates. Therefore, Chai Hu (Bupleuri Radix) is used to drain Liver Qi, and Si Wu Tang harmonizes Liver Blood.
Right hypochondriac pain is due to the failure of Lung Qi to descend, representing a disorder of Qi within the Blood. Xiong Gui Shao Yao Tang (Ligusticum, Angelica, and Peony Decoction) added with Wu Yao (Linderae Radix), Qing Pi (Citri Reticulatae Pericarpium Viride), Rou Gui (Cinnamomi Cortex), and Chen Pi (Citri Reticulatae Pericarpium) should be used for regulation. The right side corresponds to Qi; pain results from Qi stagnation. Stagnation of Qi leads to coagulation of Blood. Thus, Wu Yao, Qing Pi, and Chen Pi regulate Qi, while Chuan Xiong (Ligustici Chuanxiong Rhizoma), Dang Gui (Angelicae Sinensis Radix), Bai Shao (Paeoniae Radix Alba), and Rou Gui harmonize Blood.
Hypochondriac pain caused by improper diet and overexertion: for the left side, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) added with Bai Shao is indicated; for the right side, add Qing Pi to Bu Zhong Yi Qi Tang. This is because the left side requires breaking Blood stasis, while the right side requires moving Qi stagnation. Pain in both hypochondria radiating upward to the costal margin indicates Fire in Qi and Blood. To relieve pain with herbs, Rou Gui must be included, as it provides both dispersing and tonifying effects for recovery. This is the method of He Jian (Liu Wansu).
For left hypochondriac pain, Qi should be lifted. Use Zhi Shi (Aurantii Fructus Immaturus) and Chuan Xiong each at 5 qian, and Zhi Gan Cao (Prepared Licorice Root) at 2 qian. Grind into powder and take with wine.
For right hypochondriac pain, Qi should be descended. Use Zhi Ke (Aurantii Fructus) and Gui Xin (Cinnamon Heart) each at 4 qian, Jiang Huang (Curcumae Longae Rhizoma) at 4 qian, and Zhi Gan Cao at 2 qian. Grind into powder and take with decoction of fresh ginger and jujube.
For pain in both hypochondria, move Qi and invigorate Blood. Use Ren Shen (Ginseng Radix), Zhi Shi, Bai Shao, and Chuan Xiong each at 5 qian. Grind into fine powder. Take 2 qian per dose with ginger water.
For persistent hypochondriac pain due to internal injury, mix one cup of raw sesame oil with one cup of raw honey and consume. It will heal after one or two doses.
If hypochondriac pain is caused by drinking cold water, use Gan Jiang (Zingiberis Rhizoma) and Rou Gui. However, since they are warm but not dispersing, Bu Zhong Yi Qi Tang added with Fu Zi (Aconiti Lateralis Radix Praeparata) is required to stop the pain immediately.
Case Record
A man suffered from left hypochondriac pain like knife stabbing due to unsatisfactory sexual activity. Pain at the Zhongwan point (CV12) was so severe it felt like impending death, occurring daily. This persisted for four years without effect from various physicians. Due to excessive intake of Qi-regulating and depression-resolving herbs, his stool became dry and hard. Upon diagnosis, I prescribed Mu Xiang (Aucklandiae Radix) to scatter chest congestion, Chuan Xiong to relieve rib and chest pain, and Yu Jin (Curcumae Radix) to descend Qi and stop pain; each at 3 qian. Dang Gui, Sheng Di Huang (Rehmanniae Radix), Hei Shan Zhi (Gardeniae Fructus Carbonized), Bei Mu (Fritillariae Cirrhosae Bulbus), Chen Pi, Xiang Fu (Cyperi Rhizoma), and Pao Jiang (Zingiberis Rhizoma Preparatum) were each used at 5 qian to resolve depression, eliminate phlegm, nourish Blood, smooth Qi, warm the middle, and moisten the intestines with 3 he of black sesame seeds. Bai Tan Xiang (Santalum Album Lignum) at 3 qian regulated Qi, and Gan Cao (Licorice Root) at 2 qian harmonized the middle. Taken frequently after decocting in wine, the pain ceased upon finishing the wine.
A pregnant woman at six months gestation experienced left hypochondriac pain like knife cutting, wheezing, coughing, shortness of breath, inability to lie flat, fever, sweating, syncope during severe pain, and absent pulse during syncope. Initially, she took Huang Bo (Phellodendri Cortex), Zhi Ke, Rou Gui, Huang Lian (Coptidis Rhizoma), Su Geng (Perillae Caulis), and Xing Ren (Armeniacae Semen Amarum). Right hypochondriac pain subsided slightly, but shortness of breath worsened, indicating Lung deficiency and failure of Qi to descend. She was given Ren Shen at 3 qian, Chuan Fu Zi (Aconiti Radix Preparata) and Rou Gui each at 0.5 qian, Gan Cao at 0.8 qian, Huang Qin (Scutellariae Radix) and Bai Shao each at 1 qian, and Sha Ren (Amomi Fructus) powder at 1 qian. She recovered after three doses. Generally, in pregnant women, "if there is an existing pathology, toxic drugs do not cause harm." Thus, although Rou Gui typically induces abortion, here it served to calm the fetus.