【歌】胁肋疼时统属肝，或虚或实或因痰。脉沉气郁须开导，芤涩原来死血干。食积一条常梗起，肝虚痛
在胁梢间。若然痛甚肝经火，干胁之疼疗最难。
【论】足厥阴之络，令人胁痛，皆肝胆经之所主也。丹溪云∶木气实、肝火盛、死血、痰饮、气滞、食积、
湿热皆令人胁痛。亦有肝虚血少而痛者。有因酒色劳损太过，胁下一点痛不止，名干胁痛，甚危，当大补气血，
尚难为也。若此虚实之不同也，必以脉证参之，斯得其受感之情，而用药无差忒也。
谨按∶左胁痛者，肝经受邪也。右胁痛者，肝邪入肺也。左、右胁俱痛者，肝火盛而木气实也。两胁走注
痛而有声者，痰饮也。左胁下有块，作痛不移者，死血也。右胁下有块，作痛饱闷者，食积也。咳嗽气急，发
热者，痰结痛也，久而不治，则成肺痈。劳伤身热，胁痛者，脉必虚也，宜详究之。
【脉】两胁疼痛，脉必双弦。紧细弦者，多怒气偏。沉涩而急，痰瘀之愆。
肝火盛
肝痛甚者，肝火太旺也，当归龙荟丸。轻者，小柴胡汤加黄连、龙胆草、白芍药、醋炒青皮。（方见疟疾。）
火盛者宜伐火，佐金丸。
当归龙荟丸
胆草（一两，去芦） 当归（一两，酒洗） 山栀子仁（一两，炒黑） 黄
连（一两，炒） 黄芩（一两，炒） 黄柏（一两，炒） 大黄（半两） 芦荟（半两） 木香（一钱
半） 麝香（半钱）
为丸，淡姜汤下。
左金丸
治肝火太盛。
黄连（六两） 吴茱萸（一两，汤泡）
为丸，白汤下。
木气实
胁痛脉弦数，木气实也，醋炒青皮、苍术、川芎、当归、芍药、柴胡，或小柴胡汤加醋炒青皮、川芎、胆
草，（方见疟疾。）或抑青丸。
抑青丸
治肝火，伐肝木。
黄连（不拘多少，姜汁炒）
为丸，每百丸，白汤下。
死血痛
胁痛日轻夜重或午后发热，脉芤而涩，瘀血也，四物汤加柴胡、青皮、桃仁、红花，行气药中加破血药。
食积痛
胁下一条杠起作痛者，食积也，保和丸，（方见伤食。）或吴茱萸、炒黄连、神曲、麦芽、山楂、蓬术、
青皮，或当归龙荟丸。（方见前肝火盛条下。）
湿热
湿热盛而两胁痛者，先以琥珀膏贴痛处，后以淡姜汤吞当归龙荟丸，（方见前肝火胁痛条下。）或小柴胡
汤加苍术、青皮、黄连。（方见疟疾。）
痰积
痰积胁下作痛，控涎丹或十枣汤，或二陈汤加南星、苍术、川芎、柴胡、白芥子、炒山栀仁、醋炒青皮。
（方见痰证条内。）
控涎丹
治两胁痰痛。
甘遂（面裹，煨） 大戟（制） 白芥子（炒，各等分）
上末，丸如梧子大，每五、七丸，渐加至十丸，姜汤下。
十枣汤
治痰积胁痛。
甘遂（面裹，煨，一钱） 大戟（制，一钱） 芫花（一钱）
枣子十枚，水二盏，煎八分服。
气滞
气滞胁下作痛，推气散或复元通气散、控涎丹，（方见前痰积胁痛条下。）治一身气痛。气郁者，详郁证条内。
推气散
治右胁疼痛。
枳壳（炒，五钱） 桂心（五钱） 片子姜黄（五钱） 甘草（五钱）
末之，每服二钱，姜枣汤调下。
复元通气散
木香（半两） 茴香（半两） 青皮（半两） 穿山甲（ ，七大片） 陈皮（半两） 白芷（半
两） 甘草（半两）
每服五钱，水二钟，煎八分，空心服，或作末，每服二钱，空心酒调下。
虚痛
肝血不足，悠悠痛不止者，四物汤加柴胡梢。（方见血证。）若胁下一点痛不止，此因酒色太过所致，
名干胁痛，难治。肥白人胁痛，参、 入小柴胡汤服。（方见疟疾。）
枳芎散（附方）
治左胁痛。
枳实（炒，五钱） 川芎（五钱） 粉草（炙，一钱半）
上为细末，每服二钱，姜、枣汤或酒调下。
术香调气散（附方）
治气怒伤于肝，两胁大痛难忍。
丁香（二两） 檀香（二两） 木香（二两） 白豆蔻仁（二两） 藿香叶（一两） 甘
草（一两） 砂仁（三两）
上末之，每服二钱，入盐少许，沸汤点服。
[Song Verse] Pain in the hypochondrium and ribs generally belongs to the Liver; it may be due to deficiency, excess, or phlegm. If the pulse is deep and qi is stagnant, guiding and unblocking methods are required; if the pulse is knotted (Kou) or choppy (Se), it is originally caused by dried blood (stasis). Food stagnation often presents with a raised ridge-like sensation and pain. Pain from Liver deficiency occurs at the edges of the hypochondrium. If the pain is severe due to Liver fire, treating this "dry hypochondriac pain" is extremely difficult.
[Discussion] The collaterals of the Foot Jueyin Liver meridian can cause hypochondriac pain, which is primarily governed by the Liver and Gallbladder meridians. Danxi stated: Excess Wood qi, excessive Liver fire, dried blood (stasis), phlegm-fluids, qi stagnation, food stagnation, and damp-heat all cause hypochondriac pain. There are also cases where pain arises from Liver blood deficiency and insufficiency. Some cases result from excessive drinking, sexual indulgence, and overwork, leading to persistent pain at a specific point under the hypochondrium, known as "dry hypochondriac pain." This is very critical; although one should tonify Qi and Blood significantly, it remains difficult to cure. These differences between deficiency and excess must be analyzed by correlating pulses and symptoms to understand the nature of the pathogenic factor and ensure accurate medication.
Note: Pain on the left side indicates pathogenic invasion of the Liver meridian. Pain on the right side indicates Liver pathogen entering the Lung. Pain on both sides indicates excessive Liver fire and excess Wood qi. Wandering pain in both hypochondria accompanied by sounds indicates phlegm-fluids. A fixed mass with immovable pain on the left side indicates dried blood (stasis). A mass with pain and fullness/stuffiness on the right side indicates food stagnation. Cough, shortness of breath, and fever indicate pain from phlegm accumulation; if untreated for a long time, it becomes Lung Abscess. Fatigue injury causing body heat and hypochondriac pain implies a deficient pulse, which requires careful investigation.
[Pulse Diagnosis] Hypochondriac pain typically presents with a double-wiry pulse. A tight, fine, and wiry pulse suggests anger bias. A deep, choppy, and rapid pulse indicates errors due to phlegm and stasis.
Excessive Liver Fire
Severe Liver pain indicates excessive Liver fire; use Danggui Longhui Wan. For mild cases, use Xiaochaihu Tang added with Huanglian, Longdancao, Baishao, and Cu Chao Qingpi. (Formula see Malaria section.)
For excessive fire, clear the fire using Zuojin Wan.
Danggui Longhui Wan
Composition: Dancao (Longdan Cao, Gentianae Radix, 1 liang, remove rhizome), Danggui (Angelicae Sinensis Radix, 1 liang, wine-washed), Shanzhizi Ren (Gardeniae Fructus, 1 liang, stir-fried until black), Huanglian (Coptidis Rhizoma, 1 liang, stir-fried), Huangqin (Scutellariae Radix, 1 liang, stir-fried), Huangbai (Phellodendri Cortex, 1 liang, stir-fried), Dahuang (Rhei Radix et Rhizoma, 0.5 liang), Lvhui (Aloe, 0.5 liang), Muxiang (Aucklandiae Radix, 1.5 qian), Shexiang (Moschus, 0.5 qian).
Preparation and Administration: Make into pills, take with light ginger soup.
Zuojin Wan
Indication: Excessive Liver fire.
Composition: Huanglian (Coptidis Rhizoma, 6 liang), Wuzhuyu (Evodiae Fructus, 1 liang, soaked in water).
Preparation and Administration: Make into pills, take with plain boiled water.
Excess Wood Qi
Hypochondriac pain with a wiry and rapid pulse indicates excess Wood qi. Use Cu Chao Qingpi, Cangzhu, Chuanxiong, Danggui, Shaoyao, Chaihu, or Xiaochaihu Tang added with Cu Chao Qingpi, Chuanxiong, and Dancao. (Formula see Malaria section), or Yiqing Wan.
Yiqing Wan
Indication: Liver fire, subduing Liver Wood.
Composition: Huanglian (Coptidis Rhizoma, any amount, stir-fried with ginger juice).
Preparation and Administration: Make into pills, take 100 pills each time with plain boiled water.
Stasis Pain (Dead Blood Pain)
Hypochondriac pain that is lighter during the day and heavier at night, or afternoon fever, with a Kou (knotted) and Se (choppy) pulse, indicates blood stasis. Use Siwu Tang added with Chaihu, Qingpi, Taoren, Honghua. Add blood-breaking herbs among qi-moving herbs.
Food Stagnation Pain
A raised ridge-like sensation with pain under the hypochondrium indicates food stagnation. Use Baohe Wan. (Formula see Food Injury section), or Wuzhuyu, Chao Huanglian, Shenqu, Maiya, Shanzha, Pengzhu, Qingpi, or Danggui Longhui Wan. (Formula see previous Liver Fire Excess section.)
Damp-Heat
When damp-heat is abundant causing bilateral hypochondriac pain, first apply Hupo Gao to the painful area, then swallow Danggui Longhui Wan with light ginger soup. (Formula see previous Liver Fire Hypochondriac Pain section), or Xiaochaihu Tang added with Cangzhu, Qingpi, Huanglian. (Formula see Malaria section.)
Phlegm Accumulation
Pain in the hypochondrium due to phlegm accumulation: use Kongxian Dan or Shizao Tang, or Erchen Tang added with Nanxing, Cangzhu, Chuanxiong, Chaihu, Baijiezi, Chao Shanzhiren, Cu Chao Qingpi. (Formula see Phlegm Syndrome section.)
Kongxian Dan
Indication: Phlegm pain in both hypochondria.
Composition: Gansui (wrapped in flour, roasted), Daji (processed), Baijiezi (Stemonae Semen, stir-fried, equal parts).
Preparation and Administration: Grind into powder, make pills the size of wu zi (catalpa seeds). Take 5-7 pills initially, gradually increasing to 10 pills, taken with ginger soup.
Shizao Tang
Indication: Hypochondriac pain due to phlegm accumulation.
Composition: Gansui (wrapped in flour, roasted, 1 qian), Daji (processed, 1 qian), Yuanhua (Genkwa Flos, 1 qian).
Preparation and Administration: Ten dates, two cups of water, decoct to eight-tenths volume, take orally.
Qi Stagnation
Pain in the hypochondrium due to qi stagnation: use Tuiqi San or Fuyuan Tongqi San, Kongxian Dan. (Formula see previous Phlegm Accumulation Hypochondriac Pain section), to treat whole-body qi pain. For qi depression, refer to the Depression Syndrome section.
Tuiqi San
Indication: Right hypochondriac pain.
Composition: Zhike (Aurantii Fructus, stir-fried, 5 qian), Guixin (Cinnamomi Cortex, 5 qian), Pianzi Jianghuang (Curcumae Radix, 5 qian), Gancao (Glycyrrhizae Radix et Rhizoma, 5 qian).
Preparation and Administration: Grind into fine powder, take 2 qian each time, mixed with ginger and date soup.
Fuyuan Tongqi San
Composition: Muxiang (Aucklandiae Radix, 0.5 liang), Huixiang (Foeniculi Fructus, 0.5 liang), Qingpi (Citri Reticulatae Pericarpium Viride, 0.5 liang), Chuanshanjia (Manis Squama, processed, seven large slices), Chenpi (Citri Reticulatae Pericarpium, 0.5 liang), Baizhi (Angelicae Dahuricae Radix, 0.5 liang), Gancao (Glycyrrhizae Radix et Rhizoma, 0.5 liang).
Preparation and Administration: Take 5 qian each time, two cups of water, decoct to eight-tenths volume, take on an empty stomach; or grind into powder, take 2 qian each time, mixed with wine on an empty stomach.
Deficiency Pain
Insufficient Liver blood causing lingering pain: use Siwu Tang added with Chaihu Shao. (Formula see Blood Syndrome section). If pain persists at a single point under the hypochondrium, it is caused by excessive drinking and sexual indulgence, named "dry hypochondriac pain," which is difficult to treat. For hypochondriac pain in obese individuals, add Renshen [and other ingredients] to Xiaochaihu Tang. (Formula see Malaria section.)
Zhixiong San (Attached Formula)
Indication: Left hypochondriac pain.
Composition: Zhishi (Aurantii Fructus, stir-fried, 5 qian), Chuanxiong (Ligustici Chuanxiong Rhizoma, 5 qian), Fengcao (Glycyrrhizae Radix et Rhizoma, roasted, 1.5 qian).
Preparation and Administration: Grind into fine powder, take 2 qian each time, mixed with ginger and date soup or wine.
Shuxiang Tiaoqi San (Attached Formula)
Indication: Liver injury due to anger, causing unbearable severe pain in both hypochondria.
Composition: Dingxiang (Caryophylli Flos, 2 liang), Tanxiang (Santalum Album Lignum, 2 liang), Muxiang (Aucklandiae Radix, 2 liang), Baidoukou Ren (Cardamomi Fructus, 2 liang), Huoxiangye (Agastachis Herba, 1 liang), Gancao (Glycyrrhizae Radix et Rhizoma, 1 liang), Sharen (Amomi Fructus, 3 liang).
Preparation and Administration: Grind into powder, take 2 qian each time, add a little salt, and take with boiling water.