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The distending pain in the hypochondrium is similar to that in the chest, but with slight differences: chest distending pain is often caused by retained food (retained food), whereas hypochondriac distending pain is usually not caused by retained food. However, there are cases where retained food in the chest and abdomen causes distending pain that extends to the hypochondrium. Epidemic heat-toxin causing hypochondriac distending pain results from disorders of phlegm (Phlegm), qi (Qi), and blood (Blood). Among these, there are cases of distension without pain, pain without distension, and simultaneous distension and pain. For distension without pain, it indicates pathogenic factors remaining at the Membranous Origin (Membranous Origin) without transmission; Da Yuan Yin (Origin-Reaching Decoction) is appropriate. If accompanied by alternating chills and fever, Da Chai Hu Tang (Minor Bupleurum Decoction) is indicated. For pain without distension, the pathogen is distributed along the Shaoyang (Lesser Yang) meridian; Xiao Chai Hu Tang (Greater Bupleurum Decoction) is suitable. For simultaneous distension and pain, treatment should distinguish between left and right sides. The left side pertains to blood disorders; use Xiao Chai Hu Tang removing Ren Shen (Ginseng Root), adding Yan Hu Suo (Corydalis Rhizome), Gui Wei (Angelica Sinensis Tail), Hong Hua (Safflower), and Tao Ren (Peach Seed). In severe cases, add E Zhu (Curcuma Zedoary Rhizome), San Leng (Burreed Tuber), San Qi (Notoginseng Root), and Wu Ling Zhi (Trogopterus Dung). The right side pertains to phlegm and qi disorders. For phlegm, double the Ban Xia (Pinellia Tuber) in Da Chai Hu Tang, add Mu Li (Oyster Shell), Lai Fu Zi (Radish Seed); in severe cases, add Bai Jie Zi (White Mustard Seed), Gan Sui (Kansui Root), Da Ji (Euphorbia Pekinensis Root), and Yuan Hua (Genkwa Flower). For qi disorders, add Qing Pi (Citrus Unripe Peel), Lai Fu Zi, Mu Xiang (Aucklandia Root), and Da Fu Pi (Areca Peel). Pain caused by phlegm and qi has no fixed location and exhibits gathering and dispersing characteristics. When phlegm dissipates, discomfort may persist; when qi dissipates, no discomfort remains. If hypochondriac pain worsens after repeated sweating, purging, or clearing heat and promoting urination, it indicates a deficiency syndrome. Qi deficiency inevitably leads to vomiting and diarrhea; treatment focuses on tonifying qi. Blood deficiency inevitably leads to irritability and fever; treatment focuses on nourishing blood. This scenario accounts for only one or two out of ten cases.

Hypochondriac pain differs from chest and abdominal pain. The chest and abdomen are like major thoroughfares; blockage there cannot last long. The hypochondrium is like a secluded alley; blockage there is difficult to clear. Medication must understand this principle. Although epidemic hypochondriac pain varies by phlegm, qi, and blood, it generally involves heat. Huang Qin (Scutellaria Root) is the principal herb. If other heat symptoms exist, Huang Lian (Coptis Rhizome) and Shan Zhi (Gardenia Fruit) are also necessary. Hypochondriac pain in other diseases may be cold or heat, which is not covered here.

Epidemic abdominal distending pain is due to retained food bound by pathogenic heat in seven or eight out of ten cases; it is due to qi, blood, phlegm, or water retention in two or three out of ten cases. The abdomen is the main domain of the Stomach (Stomach) and Small Intestine (Small Intestine), distinct from the chest, hypochondrium, and lower abdomen. Abdominal distension without pain belongs to qi-level disorders, indicating scattered grain and water that have not dried into accumulation. Qi-level pulse is often deep or wiry; grain/water-level pulse is slippery. Qi-level distension covers the entire abdomen; grain/water-level distension has boundaries. For qi-level disorders, Hou Po (Magnolia Bark), Da Fu Pi, Qing Pi, Chen Pi (Aged Tangerine Peel), Zhi Ke (Aurantium Fruit), and Jie Geng (Platycodon Root) are primary. For grain/water disorders, Ban Xia, Shan Zha (Hawthorn Fruit), Mai Ya (Barley Sprout), Shen Qu (Medicated Leaven), Lai Fu Zi, and Zhi Shi (Immature Aurantium Fruit) are primary. Since epidemics are heat syndromes, abdominal distension should be cleared of heat, combined with regulating qi and digesting food. If the tongue coating is predominantly yellow, even if distended but not painful, it indicates the pathogen has transmitted to the Stomach; Xiao Cheng Qi Tang (Minor Order the Qi Decoction) should be used to purge.

Pain without distension belongs to blood-level disorders, or to dry accumulation of grain/water, or cold syndromes in other diseases. Epidemics are always heat syndromes. If pain is tender to pressure but without hardness, add Chi Shao (Red Peony Root) to formulas that clear interior heat. If pain is tender to pressure with hardness, use Tiao Wei Cheng Qi Tang (Regulate the Stomach Order the Qi Decoction).

Simultaneous distension and pain:痞满 (stifling-fullness) belongs to qi, while dry excess belongs to blood. This is a great excess and great heat syndrome; Da Cheng Qi Tang (Major Order the Qi Decoction) is indicated. Various diseases causing abdominal distending pain or spontaneous diarrhea should be attributed to deficiency-cold. However, spontaneous diarrhea in epidemics is "heat binding with lateral flow" (excess-heat binding with leakage); purging will stop it. Do not mistake it for deficiency-cold. If distension and pain prefer warmth/dryness, or involve aversion to cold and cold limbs, and clearing/cooling treatments worsen the condition, or the right Guan pulse is slow and tight, this is not the original disease. It is caused by excessive drinking due to thirst, or by using cooling treatments too excessively or too early. In such cases, warm-drying methods should be prioritized. Do not adhere rigidly to one approach. Note that this is iatrogenic error, not the treatment of the primary disease.