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[Da] When women experience distending pain in both hypochondria, it is caused by deficiency and weakness of the zang-fu organs, disharmony of qi and blood, and invasion of wind-cold pathogens into the intestines and stomach. The pathogenic factors affect the uterine collaterals, where they contend with qi and blood, leading to stagnation, cold accumulation, and failure of free flow. The struggle between evil and righteous qi causes impact and shock, resulting in distending pain in both hypochondria.

[Xue] Master Dongyuan stated: Pain in the chest and hypochondria, bitter taste in the mouth, dry tongue, alternating chills and fever, nausea and vomiting, fullness and oppression in the four limbs, dribbling urination or difficult defecation, and acute abdominal pain are due to the reckless movement of Liver Wood qi. I believe that if the aforementioned symptoms are caused by sudden anger injuring blood, Xiao Chai Hu Tang (Minor Decoction of Bupleurum) combined with Chuanxiong Rhizoma (Chuanxiong), Radix Angelicae Sinensis (Danggui), and Gardeniae Fructus (Shanzhi) should be used. If there is qi deficiency, Si Wu Tang (Four Substances Decoction) combined with Ginseng Radix et Rhizoma (Renshen), Atractylodis Macrocephalae Rhizoma (Baizhu), Bupleuri Radix (Chaihu), and Gardeniae Fructus (Shanzhi) should be used. If chronic anger injures qi, Liu Jun Zi Tang (Six Gentlemen Decoction) combined with Chuanxiong Rhizoma (Chuanxiong), Radix Angelicae Sinensis (Danggui), and Gardeniae Fructus (Shanzhi) should be used. If both qi and blood are deficient, Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) should be used. If there is abdominal pain during menstruation accompanied by chills/fever or afternoon fever, or irregular menstruation, fever with phlegm and cough, poor appetite, lethargy, and body pain, Ba Zhen Tang (Eight Treasures Decoction) combined with Bupleuri Radix (Chaihu) and Moutan Cortex (Danpi) should be used. If there is hypochondriac distension with fever, thirst with expectoration of phlegm, or dribbling urination, cervical lymphadenopathy, night sweats, hematochezia, and various bleeding disorders, Liu Wei Di Huang Wan should be used. If there is distension in both hypochondria, blurred vision, tendon spasm, greenish complexion, lower abdominal pain, or urinary dysfunction, Bu Gan San (Liver-Nourishing Powder) should be used. If aromatic and drying agents are indiscriminately used, they will damage the clear and harmonious qi, preventing blood generation and causing various syndromes. Master Danxi stated: For right-sided hypochondriac pain, Tui Qi San, Xiao Long Hui Wan, Dang Gui Long Hui Wan, Kong Xian Dan, Yi Qing Wan, and Shi Zao Tang may be used. These are formulas for conditions where both disease qi and healthy qi are excess; users must exercise caution. One woman with a quick temper experienced hematemesis, fever, and distending pain in both hypochondria, worsening in the late afternoon. This was due to anger injuring the Liver and causing deficiency of both qi and blood. In the morning, she took Xiao Yao San (Free and Easy Wanderer Powder) with added fried black Gardeniae Fructus (Shanzhi), Phellodendri Cortex (Huangbai), Fritillariae Bulbus (Beimu), Platycodonis Radix (Jiegeng), and Ophiopogonis Radix (Maidong); in the evening, she took Di Huang Wan (Rehmannia Pill) delivered by Gui Pi Tang (Restore the Spleen Decoction), and was cured. Another widow experienced internal heat, afternoon fever, soreness and numbness of the limbs, and frequent expectoration of phlegm. Some physicians used formulas to clear heat and transform phlegm, leading to throat discomfort, leukorrhea, and abdominal distension; others used formulas to move qi and dispel blood stasis, leading to chest pain and discomfort, and intermittent limb numbness. This was due to depression and anger injuring the Liver and Spleen, exacerbated by inappropriate medication. I treated her by using Gui Pi Tang (Restore the Spleen Decoction) in the morning to resolve Spleen depression and generate Spleen qi, and Jia Wei Xiao Yao San (Modified Free and Easy Wanderer Powder) in the evening to clear Liver fire and generate Liver blood. After more than one hundred doses, she was cured. Later, due to anger, her food intake decreased daily, and her limbs became intermittently numb. This was Liver fire insulting the Earth (Spleen). She was cured using Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) with added Gardeniae Fructus (Shanzhi), Poria (Fuling), and Pinelliae Rhizoma (Banxia). Again, due to dietary irregularity and anger, her limb numbness worsened, and menstruation flowed profusely. Her pulse was floating, surging, and rapid. This indicated that the Spleen was injured by the Liver and failed to control blood, leading to metrorrhagia. The Liver qi was deficient, and yin blood was depleted, resulting in a large pulse. Subsequently, Liu Jun Zi Tang (Six Gentlemen Decoction) with added Chuanxiong Rhizoma (Chuanxiong), Radix Angelicae Sinensis (Danggui), and Prepared Zingiberis Rhizoma (Paojiang) stopped the bleeding. Then, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) with added Prepared Zingiberis Rhizoma (Paojiang), Poria (Fuling), and Pinelliae Rhizoma (Banxia) restored the yuan qi. Finally, she was recovered through regulation with Gui Pi Tang (Restore the Spleen Decoction) and Xiao Yao San (Free and Easy Wanderer Powder).

Ling Bao San: Treats women with blood and qi attacking and stabbing, with pain radiating to both hypochondria.
Cardamomum (Dingxiang), Costus Root (Muxiang), Frankincense (Ruxiang), Corydalis Rhizoma (Yanhusuo), Radix Angelicae Sinensis (Danggui), White Peony Root (Baishaoyao) (equal parts).
Grind into fine powder. Take two qian each time, mixed with warm wine before meals.

Caodoukou San: Treats women with Spleen-Stomach deficiency, with qi attacking both hypochondria causing distending pain.
Areca Seed (Caodoukou), Chebula Fruit Flesh (Hezi Rou) (each 1 liang), Cinnamon Twig (Guixin), Platycodonis Radix (Kugeng), Magnolia Bark (Nongpu) (each 3 fen), Licorice Root (Gancao) (1 fen), Chuanxiong Rhizoma (Chuanxiong), Radix Angelicae Sinensis (Danggui), Dried Ginger (Ganjiang), Areca Nut (Binglang) (each 0.5 liang).
Grind into coarse powder. Take 4 qian each time, decocted in one sheng of water until reduced to 0.7 sheng. Strain and take hot before meals.

[Zi] San: Treats women with deficiency-cold of the zang-fu organs, with old cold qi attacking, causing distending pain in both hypochondria and restlessness in sitting and lying.
[Zi], Corydalis Rhizoma (Yanhusuo), Peach Kernel (Taoren), Amber (Hupo), Radix Angelicae Sinensis (Danggui), Cinnamon Twig (Guixin) (each 1 liang), Red Peony Root (Chishaoyao), Costus Root (Muxiang), Myrrh (Moyao) (each 0.5 liang).
Grind into powder. Take 2 qian each time, mixed with warm wine.

Ren Shen Zi Jin Wan: Treats women with disharmony of Ying and Wei, stabbing pain in the heart and abdomen, fullness and oppression in the chest and diaphragm, and loss of appetite.
Zijin Pi, Atractylodis Rhizoma (Cangzhu), Acori Tatarinowii Rhizoma (Shichangpu) (each 1 liang), Cyperi Rhizoma (Xiangfuzi) (2 liang), Ginseng Radix et Rhizoma (Renshen) (0.5 liang), Costus Root (Muxiang) (3 qian).
Grind into powder, make pills with rice paste the size of wutong seeds. Swallow 30 pills with ginger soup after meals.

Qi Zhen Wan: Treats long-standing accumulation of wind obstruction, unblocking qi stagnation, emptying the chest and diaphragm, and stopping stabbing pain.
Costus Root (Muxiang), Green Tangerine Peel (Qingpi) (remove white pith), Rhubarb (Dahuang) (processed), Areca Nut (Binglang) (each 1 liang), Black Morning Glory Seed (Heiqianniu) (2 liang, half raw, half fried).
Grind into powder, make pills with refined honey the size of wutong seeds. Take 30 pills with warm water.

Madam Deng, aged fifty, suddenly experienced qi pain and was cured by Shen Bao Wan. Within one or two days, the pain recurred. She took another 60-70 pills of Shen Bao Wan, resulting in constipation and worsening of the condition. There were cases where Chenxiang (Aquilaria Lignum), Muxiang (Costus Root), Jiang (Ginger), Guixin (Cinnamon Twig), and Shaoyao (Peony Root) were needed but not dared to be administered. The pain was severe, feeling like impacts on the heart, back, and both hypochondria, as if two pieces of firewood crossed and pinned the heart and hypochondria, with cries reaching the sky.

I was summoned to diagnose her. The six pulses were deep and hidden, appearing and disappearing intermittently. Everyone asked what to do. I said: The pulses of the nine pains are not reliable standards; treatment should be based on syndrome differentiation. Observing that she had a robust and plump physique, and asking about her bowel movements, I found she had not defecated for several days. I said: This is excess pain. Although there may not be distension, pressing causes severe pain and cannot be tolerated by touch, indicating a major excess syndrome. The Classics state: For major fullness and excess, purgatives can be used. Thus, I administered 500-600 pills of Qi Zhen Wan, and she was cured that evening. Later, in the year Jiwei in Jinling, the wife of a family official named Xun suffered from heart and hypochondriac distending pain. Various physicians administered Muxiang (Costus Root), Chenxiang (Aquilaria Lignum), Binglang (Areca Nut), Dafufu (Areca Peel), Shaoyao (Peony Root), Jiang (Ginger), and Guixin (Cinnamon Twig), which worsened the condition. I was summoned to diagnose her. The six pulses were wiry, tight, yet harmonious, unlike typical pathological pulses. However, during diagnosis, both hands felt hot like fire, indicating excess pain. Everyone asked how to treat it. I said: Generally, stabbing pain in the heart and abdomen should not be immediately treated as deficiency-cold. Two doctors replied: If it is not cold, what is it? Heat generates wind, and cold generates qi [stagnation]. I said: Not so. The Nan Jing states: Deficiency causes itching, excess causes pain. Also, Zhang Zhongjing stated: For abdominal pain, use Guizhi Jia Shaoyao Tang (Cinnamon Twig Decoction plus Peony Root); for severe pain, use Guizhi Jia Dahuang Tang (Cinnamon Twig Decoction plus Rhubarb). The official said: She has always been frail. I said: There is a way to distinguish. When the pain occurs, have a maid press the area. If the pain stops, it is deficiency-cold. If pressing increases the pain and makes it intolerable to touch, it is excess pain. I ordered the maid to press, and she could not tolerate it, crying out excessively. I said: This is clearly excess-heat. Da Chai Hu Tang (Major Bupleurum Decoction) should be used. The others did not agree. I had them sign a statement of responsibility and administered the formula. After eight doses, she was cured.

Discussion on Hypochondriac Pain and Administration of Mutong San (also effective for men):
Pain in the epigastrium, hypochondria, and lower abdomen is usually due to accumulated cold. Warm decoctions and powders can primarily treat this; for severe cases, warm purgatives should be used. Epigastric and lower abdominal pain have effective prescriptions in various books, but methods for treating hypochondriac pain are rare.

Mutong San: Highly effective for hypochondriac pain, and also treats pain in the epigastrium, hypochondria, and radiating lower abdomen.
Akebia Caulis (Mutong) (remove nodes), Green Tangerine Peel (Qingpi) (remove white pith), Toosendan Fructus (Chuanlianzi) (remove skin and seeds, each 1 liang. For these three ingredients, use 0.5 liang of Croton Seed (Badou), stir-fry until yellow, remove Badou), Rapeseed (Luobozhong) (fried), Agarwood (Bo Shang Xiang) (1 liang, fried), Curcuma Zedoaria (Ezhu), Costus Root (Muxiang), Talcum (Huashi) (each 0.5 liang).
Grind into fine powder. Mix with decocted scallion and white wine, take 3 qian. One dose cures. Severe cases require no more than two doses.

San Wan San: Treats middle jiao deficiency and痞 (fullness), qi pain in both hypochondria, edema of face, eyes, hands, and feet, constipation, and also treats Hongjiaojiao (Beriberi/Lower limb swelling).
Areca Peel (Dafupi), Perilla Leaf (Zisu), Aquilaria Lignum (Chenxiang), Dried Quince (Gan Mugua), Angelica Pubescens Root (Duhuo) (each 1 liang), Atractylodis Macrocephalae Rhizoma (Baizhu), Chuanxiong Rhizoma (Chuanxiong), Costus Root (Muxiang), Licorice Root (Gancao), Tangerine Peel (Chenpi), Areca Nut (Binglang) (each 3 fen).
Cut into small pieces. Take 3 qian each time, decoct in one sheng of water until reduced to 0.7 sheng. Strain and take hot on an empty stomach, and again at noon. In autumn of the year Wuwu in the capital, there was a woman with middle jiao deficiency and fullness, abdominal distension and pain, constipation, and weak six pulses. Various physicians' medications were ineffective. I administered this prescription, and she was cured before finishing one dose.

Supplement: Qingmuxiang Wan (Green Aromatic Musk Pill), Chenxiang Jiangqi Tang (Aquilaria Descending Qi Decoction), Xiao Wuchen Tang (Minor Dark Sink Decoction), and Simo Tang (Four Mortars Decoction) from Ju Fang can all be used.

[Xue] Zuo Jin Wan (also known as Si Jin Wan): Treats Liver fire causing chest and hypochondriac distending pain, or alternating chills and fever, headache and eye pain, loose stools, difficult urination, lower abdominal pain, and all syndromes of Liver fire.
Coptis Rhizome (Huanglian) (fried, 6 liang), Evodia Fruit (Wuzhuyu) (1 liang, boiled in water for slices).
Grind into powder, make pills with congee. Take with decoction of Atractylodis Macrocephalae Rhizoma (Baizhu) and Tangerine Peel (Chenpi).

Dang Gui Long Hui Wan: Treats excess fire of the Liver channel, chest and hypochondriac distending pain, or constipation, and scanty/difficult urination. Suitable for all excess fire of the Liver channel.
Radix Angelicae Sinensis (Danggui), Gentian Root (Longdancao) (fried until scorched), Gardeniae Fructus (Zhizi Ren) (fried), Coptis Rhizome (Huanglian) (fried), Scutellaria Root (Huangqin) (fried, each 1 liang), Rhubarb (Dahuang) (fried), Aloe (Lvhui), Indigo Naturalis (Qingdai) (each 5 qian), Costus Root (Muxiang) (2.5 qian), Moschus (Shexiang) (separately ground, 5 fen).
Grind into powder, make pills with Massae Fermentatae Medicinatae (Shenqu) paste the size of wutong seeds. Take 20 pills each time with ginger soup.

Bu Gan San: Treats deficiency of qi and blood in the Liver and Kidney channels, causing hypochondriac distension and pain, or dizziness with hypochondriac distension, chills/fever, generalized body pain, and irregular menstruation.
Cornus Fruit (Shanzhuyu Rou), Radix Angelicae Sinensis (Danggui), Schisandrae Fructus (Wuweizi) (fried, pounded), Dioscorea Rhizome (Shanyao), Astragalus Root (Huangqi) (fried), Chuanxiong Rhizoma (Chuanxiong), Chaenomelis Fructus (Mu Gua) (each 0.5 liang), Prepared Rehmannia Root (Shudihuang) (homemade), Atractylodis Macrocephalae Rhizoma (Baizhu) (fried, each 1 qian), Angelica Pubescens Root (Duhuo), Sour Jujube Seed (Suanzaoren) (fried, each 4 liang).
Grind into powder. Take 5 qian each time, decoct with water infused with dates.