自古诸家，或有称心腹痛者，绎其意义，概系腹痛上及心膈者，故今并录于此。
脉候 心腹痛，痛不得息，脉细小迟者生，坚大疾者死。（《脉经》）
病若腹痛，脉反浮大而长者死。（同上）
尺寸俱沉，但有关上脉，苦寒心下痛。尺中弦，少腹脐
下拘急。关上紧，心下痛。尺中紧，脐下少腹痛。关上实即痛，虚即胀满。关上浮，腹痛心下满。（同上）
诊其寸口脉沉而紧，则腹痛。尺中紧，脐下痛。脉沉迟，
腹痛。脉来触触者，少腹痛。脉阴弦则腹痛。凡腹急痛，此里之有病，其脉当沉，若细而反浮大，故当愈矣。
其人不即愈者，必当死，以其病与脉相反也。（《病源论》）
诊其脉，左手寸口人迎以前脉，手少阴经也，沉者为阴。阴虚者，病苦心腹痛，难以言，心如寒状。心
腹痛，不得息，脉细小者生，大 疾者死。心腹痛，脉沉细小细生，浮大而疾者死。（同上）
心腹痛脉沉细瘥，浮大弦长命必殂。（《脉诀》）
关脉弦中焦行痛，尺脉弦下焦作痛，亦有脉不弦而作痛者。又云∶脉细而迟者生，大而急者死。此言其
大概，然有腹痛而脉大不死者往往有之，岂可执一论哉。（《医约》）
凡诸病之虚实，辨之于脉者皆易，惟心腹痛证，则有大有小，其脉多有难辨。虽滑实有力者固多实邪，
虚弱无神者固多虚邪，此其常也。然暴痛之极者，每多沉伏细涩，最似极虚之候。不知气为邪逆，气逆则
脉道不行而沉伏异常，此正邪实之脉。然于沉伏之中细察之，必有梗梗然弦紧之意，此必寒邪阻遏阳气者多
有是脉，若火邪作痛则不然也。凡见此者，不得因其细极微极，便认为虚脱，妄用补剂，必大误矣。辨此之
法，但当察其形气，以见平素之强弱，问其病因，以知新病久病，及何所因而起。大都暴病痛急而脉忽细伏者
多实邪，久病痛缓而脉本微弱者为虚邪，再以前论虚实之法，酌之以理，参而诊之，则万无一失矣。（《景
岳》）（论虚实见于后）
源由 凡心腹痛，若非中恶霍乱，则是皆宿结冷热所为。（《肘后》）
腹痛者，由腑脏虚，寒冷之气客于肠胃募原之间，结聚不散，正气
与邪气交争相击故痛。其有阴气搏于阴经者，则腹
痛而肠鸣，谓之寒中，是阳气不足，阴气有余者也，（《病源论》）
心腹痛者，由腑脏虚弱，风寒客于其间故也。邪气发作，与正气相击，上冲于心则心痛，下攻于腹
则腹痛，下上相攻，故心腹绞痛，气不得息。（同上）
久心腹痛者，由寒客于腑脏之间，与血气相搏，随气下上，攻击心腹绞结而痛。藏气虚，邪气盛，停积
成疹，发作有时，为久心腹痛也。然心腹久痛，冷气结聚，连年积岁，日月过深，变为寒疝。（同上）
诸证要领（寒热） 腹痛按之便痛，重按却不甚痛，此
止是气痛。重按愈痛而坚者，当自有积也。气痛不可下，下之愈痛，此虚寒证也。（《苏沈》）
腹痛极多端，有冷痛、热痛、积痛、虫痛、血刺、容忤，当随证以治之。诊其关尺脉弦迟，按之便痛，
重按不甚痛者，为冷痛，可服良姜散（用良姜、甘草、丁子、人参、胡椒、萆茇）、小建中汤。如其脉
微而涩，肠鸣泄利而痛者，当于和气饮中，加炒吴茱萸，仍下桂香丸（用附、茯、肉蔻、丁、
木、桂、姜）。诊其关尺脉微紧，发热，小便赤而痛者，为热痛，可服小柴胡汤，去黄芩，加白芍药。如其
脉洪而实，大便不通而痛甚者，当以大承气汤下之而愈。若中虚气弱，饮食停积，重按愈痛而紧者，此为
积痛，其脉必弦紧而滑，救生丹（用丁、木、桂、姜、巴豆、甘草）、枳壳散（用枳壳、莪、棱、桂、姜等）
主之。或渴欲引饮，胸中痞塞，大便秘结，脉沉短而实者，宜服保安丸（用巴豆、黄连、青皮、莪术、干
姜）。若往来行痛，腹中烦热，口吐清水，脉紧实而滑者；蛔动也，宜服集效丸（见蛔虫）。妇人心腹疼痛，
脉沉而结者，此血刺也，牡丹丸（用川乌、牡丹、桃仁、桂心）
《良方》断弓弦散（即失笑散）主之。若心腹卒然而痛，其脉滑或长短小大不齐者，此为容忤，可服
苏合香丸、备急丸。（《续易简》）
有人患腹痛，其状不一，有风痛，有热痛，有冷痛，有冷积痛，有气积痛，有虫痛，有妇人经脉行而先腹
痛，有少儿疮疹出而先腹痛者。满腹虚胀，服暖药无效者，此风痛也，宜服官局，胃风汤、火 草丸，如
附子、乌头之类。大便秘结，小便赤而喜冷冻饮料食者，此热痛也，后生宜四顺饮，老人宜服大麻仁
丸，皆局方。有块起而腹痛者，皆积也。冷积则面无色瘦瘁，脉沉伏，宜于暖药中用巴豆，如官局积气丸
之类。气积多噫气，宜服嘉禾散、调气散、五膈宽中散，如茴香、丁香、木
香、沉香之类。食积则多噫酸，口出清水，恶心，宜服京三棱、蓬莪术、干漆之类，亦须兼巴豆。至于腹中
有块起，急以手按之便不见，五更心嘈，牙关挢硬，恶心而清水出，及梦中啮齿者，此谓之虫痛，宜服官局
化虫丸，如使君子之类。又有室女妇人月经行，先腹痛，此特与诸痛不同，只可服四物汤。小儿身热足冷，
耳及尻骨冷，及眼涩者，皆疮疹候，必先腹痛，盖疹子先自肠胃中出，然后发于外，宜服葛根升
麻汤及绵煎散之类。（《医说》引《医余》）
气、血、痰、水皆能作痛，而食积伤脾，风冷入脾，与夫脾间虫动，其为痛也居多。气、血、痰、水、食
积、风冷诸证之痛，每每停聚而不散。惟虫痛则乍作乍止，来去无定，
又有呕吐清沫之为可验焉。（《直指》）
戴云∶寒痛者，绵绵痛而无增减者是。时痛时止者，是热也。死血痛者，每痛有处，不行移者是也。食
积者，甚欲大便，利后痛减者是。湿痰者，凡痛必小便不利。（《钩玄》）（按∶
丹溪曰∶痰因气滞而聚，既聚则碍其道路不得运，故作痛。）
痛证有寒热，误认之则为害不小。盖三焦痛证，因寒者常居八九，因热者十唯一二，观《内经》举痛
等论，义可知矣。盖寒则凝滞，凝滞则气逆，气逆则痛胀由生，而热则流通，多不然也。虽热证亦常有痛，然
热者必有明辨，如《内经》所言肠中痛而瘅热焦渴，则坚干不得出，闭而不通者，此因
燥结热闭，故能作痛，然必有烦热等证，乃因于火，最易见也。（《景岳》）
寒滞之痛，有因内寒者，如食寒饮冷之类是也，必兼寒兼食，随其宜而治之。有因外寒者，或触冒不时
之寒邪，或犯客令之寒气，或受豪雨沙气之阴毒，以致心腹搅痛，或吐或泻，或上不能吐，下不能泻，而
为干霍乱危剧等证。总由寒气犯脏，或在上焦，或在中下二焦。凡痛急在上者，用吐最妙；在中在下者，
俱宜解寒行滞。（同上）
虚实（有形无形血虚气虚） 腹痛，以手可重按者属虚，宜参、术、姜、桂之类；手不可按者
是实，用硝、黄下之。（《丹溪》）（按∶此本于《妇人良方》说，见疏利方法中。）
痛有虚实。凡三焦痛证，惟食滞、寒滞、气滞者最多，其有因虫、因火、因痰、因食者，皆能作痛。大
都暴痛者多有前三证，渐痛者多由后四证。但虫痛、痰痛多在中焦，火痛则三焦俱有之，血痛则多在下焦。
然惟妇人则常有血证，而男子则少也。诸如此类，但察其多滞多逆者，方是实证；如无滞逆，则不得以实论也。
辨之之法，但当察其可按者为虚，拒按者为实，久痛者多虚，暴痛者多实；得食稍可者为虚，胀满畏食
者为实。痛徐而缓，莫得其处者多虚；痛剧而坚，一定不移者为实。痛在肠脏中，有物有滞者多实；痛在
腔胁经络，不干中脏，而牵连腰背，无胀无滞者多虚。脉与证
参，虚实自辨。微实者，宜调不宜攻。大实者，或上或下，非攻不可。纯虚者，或气或血，非大补不可。
（《景岳》）（按∶《质疑录》亦有说。见痛须通利条。）
痛证当辨有形无形。无形者痛在气分，凡气病而为胀为痛者，必或胀或止而痛无常处，气聚则痛而见形，
气散则平而无迹，此无形之痛也，但宜顺气，气顺则痛自愈矣。有形者痛在血分，或为食积，凡血症食积而
为胀痛者，必痛有常处而胀无休息，不往不来，不离其处者，是有形之痛也，然
或食或血，察得所因，乃可攻而去之。此二者之当辨也。（同上）
按之痛者为实，不痛为虚。夫按则气散，即实亦有因之而痛减者，虚则气壅而为痛，复按之气愈壅，即
虚亦有因之而益痛者，正未可执此而定虚实也。若以热手久按，痛止
为寒，不止为热，此则瘥可必耳。（《医津一筏》）
若平素慎于饮食，而视其肢体瘦弱，又不饱闷，但偎偎作痛，如细筋牵引者，血虚也，若肚腹常觉空虚，
似饿非饿，翕翕作痛，呼吸如无气力者，气虚也。（《玉案》）
部位 辨验腹痛法∶在中痛，食积，痛甚欲大便，利后痛减。在左痛，死血，痛有常处而不走移。在
右痛，是痰，或得辛辣热物暂止。在下痛，蓄血，小便清利，手不可近痛处。在下痛，蓄尿，小便不利，
手不可近痛处。心至小腹硬满痛，实邪。胁至小腹引痛，痰、死血。（《捷法》）
凡至胃脘下痛者，多属食积。绕脐痛者，属火。脐左右少腹痛者，多属死血。少腹痛者，属寒。当以部
位辨之。（《司命》）
有中脘作痛，手不可近者。夫手不可近，乃内外不和，
外则寒气凝于皮毛，内则垢浊停于中脘，当审其体之虚实以施
治。有中脘之下，当阳明胃土之间，时痛时止者，乃中土虚而胃气不和。若行气消泄之剂服之过多，便宜温
补。但以手重按之则痛稍平，此中土内虚，虚而且寒之明验也。其乳下两旁胸骨尽处痛者，乃上下阴阳不和，
少阳枢转不利也，伤寒病中每多此痛，当助其枢转，和其气血，上下通调则愈矣。其大腹痛者，乃太阴脾土之
部。痛在内而缓，坤土虚寒也。痛兼内外而急，脾络不通也。盖脾之大络名曰大包，从经隧而外出于络脉。今脾
络滞而不行，则内外皆痛。其有脐旁左右痛者，乃冲脉病也。冲脉当脐左右，若为寒气所凝，其冲脉之血不能上
行外达，则当脐左右而痛。当用血分之药，使胞中之血通肌达表，若用气药无裨也。（《真传》）
病有邪在经（肚皮痛） 凡胸腹之痛，有无关于内，而在筋骨皮肉之间者，此邪之在经，不可混作里
证，必须详问的确。但当分其或火、或寒、或气，或劳伤、或血滞、或血
虚，或有淫疮邪毒，留蓄在经、辨其所因，庶不致谬，而治之亦易也。（《景岳》）
肾虚不能行水，加之酒面无度，醉后辄睡，酒与水交聚于腹中，而面毒复缠滞其气，是以水渗于肚皮而
作痛矣。治法钱氏宣风散（用槟榔、陈皮、甘草、牵牛）用蜜水煎，咽下神宝丸（见《胁痛》）。俟其大便
通利，然后以青木香丸（用木香、毕澄茄、补骨脂、槟榔、牵牛）一分，安肾丸（用川乌等十二味）倍之，用
二陈汤入少盐，并生姜同煎，空心咽下，脾肾气复，自然向安。（《直指》）
感寒停食 凡大人小儿胸腹骤然大痛，其痛连延不止。甚则有如刀剜者，皆因停食，其停食皆因感
寒。或脾胃先感风寒而后饮食，即能停滞作痛，或先饮食而随感风寒，亦能
停滞作痛。因感寒停食者，不必皆多食过度而后停滞，即日
用常餐亦停滞也。是以病者莫测其致病之因，而医者亦莫知其受病之源。或以内热治而用凉药，错误甚矣；或
以消食治而用消导药，亦非对症之剂也。盖感寒停食与伤食不同。伤食者，饮食伤脾胃，内伤也。停食者，脾
胃受风寒，而饮食凝滞不运化，外感也。治伤食当以消导为主，而兼补脾胃，治停食当以发散寒邪为主，而兼
消导，此立效之术也。停食因于寒而不散其寒，虽极力消导，其食不消，其痛不止。（按∶原载用炒盐汤吐治
验，不录。）或问曰∶内热蕴积，亦能令人腹痛，与感寒停食而腹痛者，何所分别？予曰∶积热腹痛者，其痛
有时而作，亦有时而止；有时而急，亦有时而缓。停食痛者，其痛最急，连绵不止，有延至数日者，惟痛久或
有时而略缓耳。但其初失治，延至数日而后用药者，寒郁为热，难以复用发散药，当用木香槟榔丸（用木、
槟、归、芍、青皮、枳壳、牵牛、莪术、大黄、香附，黄连）与牵牛大黄丸微利之，则痛止而安。（《医述》）
瘀血 如 扑损伤而腹痛者，乃是瘀血，宜桃仁承气汤加当归、苏木、红花，入酒、童便煎服下之。
如因事损伤，或酒后涉水，血凝腹痛者，大承气加桂。（《丹溪》）（按∶又有一案，
出行血方法中，宜互参。）
一人中脘作疼，食已口吐血紫霜色，二关脉涩，乃血病
也，跌仆而致。治以生新去陈之剂，吐出片血碗许而安。（同上）
如跌扑后，腹中隐隐痛有处，是腹肠膜有损，宜活血行气兼补养之，不可妄认为痰为火，用峻利破泄药。
曾见一人醉后踢门用力，遂小腹痛不止，汤药乱投，临死小腹肿青，
方悟夕（当昔）日受病之因也。（《六要》）
当脐痛 （宜参灸法）当脐硬痛有形，多燥屎，已经攻伐
Since ancient times, various medical experts have sometimes referred to "heart and abdominal pain." Investigating its meaning, it generally refers to abdominal pain extending upwards to the heart and diaphragm area; therefore, it is recorded here together.
Pulse Diagnosis Heart and abdominal pain with severe pain causing inability to breathe: a fine, small, and slow pulse indicates survival (good prognosis), while a firm, large, and rapid pulse indicates death (poor prognosis). (*Mai Jing*)
If the symptom is abdominal pain but the pulse is unexpectedly floating, large, and long, it indicates death. (Ibid.)
If the pulses at Cun, Guan, and Chi are all deep, but only the Guan position has a pulse, the patient suffers from cold sensation and pain in the epigastrium. A wiry pulse at Chi indicates tension and urgency in the lower abdomen and below the navel. A tight pulse at Guan indicates pain in the epigastrium. A tight pulse at Chi indicates pain below the navel and in the lower abdomen. An excess pulse at Guan indicates pain, while a deficient pulse indicates distension and fullness. A floating pulse at Guan indicates abdominal pain and fullness in the epigastrium. (Ibid.)
Palpating the Cun Kou pulse, if it is deep and tight, there is abdominal pain. A tight pulse at Chi indicates pain below the navel. A deep and slow pulse indicates abdominal pain. A pulsating pulse ("Chu Chu") indicates lower abdominal pain. A Yin pulse that is wiry indicates abdominal pain. Whenever there is urgent abdominal pain, it indicates disease in the interior, and the pulse should be deep. If it is fine but unexpectedly floating and large, the condition should improve.
If the patient does not recover immediately, death is inevitable because the disease contradicts the pulse. (*Zhu Bing Yuan Hou Lun*)
Palpating the pulse, the pulse before the Ren Ying point on the left hand Cun Kou belongs to the Hand Shaoyin Meridian; deep palpation yields Yin. In cases of Yin deficiency, the patient suffers from heart and abdominal pain, difficulty speaking, and a sensation of cold in the heart. For heart and abdominal pain with inability to breathe, a fine pulse indicates survival, while a large and rapid pulse indicates death. For heart and abdominal pain, a deep, fine, and small pulse indicates survival, while a floating, large, and rapid pulse indicates death. (Ibid.)
Heart and abdominal pain with a deep, fine pulse leads to recovery; a floating, large, wiry, and long pulse leads to certain death. (*Mai Jue*)
A wiry pulse at Guan indicates pain due to Qi stagnation in the Middle Jiao; a wiry pulse at Chi indicates pain in the Lower Jiao. There are also cases where pain occurs without a wiry pulse. It is also said: a fine and slow pulse indicates survival, while a large and urgent pulse indicates death. This describes the general rule. However, there are often cases of abdominal pain with a large pulse that do not result in death. How can one adhere rigidly to a single theory? (*Yi Yue*)
For most diseases, distinguishing excess and deficiency through the pulse is easy. However, for heart and abdominal pain, the pulse varies greatly and is often difficult to distinguish. Although a slippery, excess, and forceful pulse mostly indicates excess pathogens, and a weak, spiritless pulse mostly indicates deficiency pathogens, this is the norm. Yet, in cases of sudden extreme pain, the pulse is often deep, hidden, fine, and choppy, closely resembling an extreme deficiency pattern. If one does not understand that Qi is reversed by pathogens, and Qi reversal causes the pulse channel to obstruct and become abnormally deep and hidden, this is actually a pulse of pathogenic excess. Careful examination within the deep and hidden quality will reveal a stiff, wiry, and tight sensation. This is mostly caused by Cold pathogens obstructing Yang Qi; Fire pathogens causing pain present differently. Upon seeing such signs, one must not mistake the extremely fine and minute pulse for collapse and blindly use tonifying agents, which would be a major error. The method to distinguish this is to observe the patient's physique and constitution to know their usual strength, ask about the cause to determine if it is a new or chronic disease, and identify the origin. Generally, sudden severe pain with an unexpectedly fine and hidden pulse indicates excess pathogens, while chronic mild pain with a naturally weak pulse indicates deficiency pathogens. Combining these with previous theories on excess and deficiency, reasoning carefully, and correlating with diagnosis ensures no mistakes. (*Jing Yue Quan Shu*) (Discussion on excess and deficiency follows)
Etiology All heart and abdominal pain, unless it is Zhong E (sudden poisoning/miasma) or Huo Luan (cholera-like syndrome), is caused by accumulated Cold or Heat. (*Zhou Hou Bei Ji Fang*)
Abdominal pain arises from deficiency of the Zang-Fu organs, allowing Cold Qi to lodge between the intestines, stomach, and Mu-Yuan (interstitial spaces), accumulating without dispersing. The Righteous Qi and Pathogenic Qi clash, causing pain. If Yin Qi clashes with the Yin meridians, abdominal pain with borborygmus occurs, called Han Zhong (Cold Center), indicating insufficient Yang Qi and excess Yin Qi. (*Zhu Bing Yuan Hou Lun*)
Heart and abdominal pain is caused by weakness of the Zang-Fu organs and invasion of Wind-Cold. When the pathogen attacks and clashes with the Righteous Qi, rising to the heart causes heart pain, descending to the abdomen causes abdominal pain. Their mutual attack causes severe twisting pain in the heart and abdomen, with inability to breathe smoothly. (Ibid.)
Chronic heart and abdominal pain is caused by Cold lodging between the Zang-Fu organs, clashing with Blood and Qi, moving up and down with Qi, attacking the heart and abdomen causing twisting pain. With deficient Zang Qi and strong Pathogenic Qi, accumulation forms rashes/nodules, occurring intermittently, becoming chronic heart and abdominal pain. However, chronic cold pain with Cold Qi accumulation over years deepens and transforms into Han Shan (Cold Hernia). (Ibid.)
Key Symptoms (Cold and Heat) Abdominal pain that hurts upon light pressure but not significantly upon heavy pressure is merely Qi pain. Pain that worsens with heavy pressure and feels hard indicates accumulation. Qi pain should not be treated with purgatives; purging worsens it, indicating a Deficient-Cold pattern. (*Su Shen Liang Fang*)
Abdominal pain has many types: Cold pain, Heat pain, Accumulation pain, Worm pain, Blood Stabbing pain, and Rong Wu (unexpected encounter/pathogen). Treatment must follow the syndrome.
If Guan and Chi pulses are wiry and slow, hurting on light pressure but not heavy pressure, it is Cold pain. Treat with Liang Jiang San (Gao Liang Jiang, Gan Cao, Ding Xiang, Ren Shen, Hu Jiao, Bi Bo) or Xiao Jian Zhong Tang. If the pulse is faint and choppy, with borborygmus, diarrhea, and pain, add Chao Wu Zhu Yu to He Qi Yin, and administer Gui Xiang Wan (Fu Zi, Fu Ling, Rou Dou Kou, Ding Xiang, Mu Xiang, Rou Gui, Gan Jiang).
If Guan and Chi pulses are faintly tight, with fever, red and painful urination, it is Heat pain. Treat with Xiao Chai Hu Tang, removing Huang Qin, adding Bai Shao Yao. If the pulse is洪 (Hong/Surging) and excess, with constipation and severe pain, purge with Da Cheng Qi Tang.
If Spleen/Stomach Qi is weak with food stagnation, worsening pain and tightness on heavy pressure, it is Accumulation pain. The pulse is wiry, tight, and slippery. Treat with Jiu Sheng Dan (Ding Xiang, Mu Xiang, Rou Gui, Gan Jiang, Ba Dou, Gan Cao) or Zhi Ke San (Zhi Ke, E Zhu, San Leng, Rou Gui, Gan Jiang).
If thirsty for drinks, chest stuffiness, constipation, with a deep, short, and excess pulse, take Bao An Wan (Ba Dou, Huang Lian, Qing Pi, E Zhu, Gan Jiang).
If pain wanders, abdominal irritability, vomiting clear fluid, with a tight, excess, and slippery pulse, it is Roundworm movement. Take Ji Xiao Wan (see Roundworm section).
For women with heart and abdominal pain and a deep, knotted pulse, it is Blood Stabbing pain. Treat with Mu Dan Wan (Chuan Wu, Mu Dan Pi, Tao Ren, Gui Xin) or Duan Gong Xian San (Shi Xiao San) from *Liang Fang*.
If heart and abdominal pain occur suddenly, with a slippery or irregular pulse (varying length/size), it is Rong Wu. Take Su He Xiang Wan or Bei Ji Wan. (*Xu Yi Jian Fang*)
Someone suffered abdominal pain with varied symptoms: Wind pain, Heat pain, Cold pain, Cold Accumulation pain, Qi Accumulation pain, Worm pain, pre-menstrual abdominal pain in women, and pre-rash abdominal pain in children. Full abdominal distension unresponsive to warming herbs indicates Wind pain. Take Official Formula Wei Feng Tang or Huo Cao Wan (Fu Zi, Wu Tou). Constipation, red urine, craving cold drinks/food indicates Heat pain. Young people take Si Shun Yin; elderly take Da Ma Ren Wan (both Official Formulas). Masses with pain indicate Accumulation. Cold accumulation presents with pale, emaciated appearance and deep-hidden pulse; treat warming herbs with Ba Dou, e.g., Official Formula Ji Qi Wan. Qi accumulation features belching; take Jia He San, Tiao Qi San, Wu Ge Kuan Zhong San (Hui Xiang, Ding Xiang, Mu Xiang, Chen Xiang). Food accumulation features sour belching, clear fluid vomiting, nausea; treat with Jing San Leng, Peng E Zhu, Gan Qi, also using Ba Dou. Masses in abdomen that disappear on pressure, morning heartburn, jaw stiffness, nausea with clear fluid, and teeth grinding indicate Worm pain. Take Official Formula Hua Chong Wan (Shi Jun Zi). Pre-menstrual pain in virgins/women differs; take Si Wu Tang. Children with fever, cold feet, cold ears/tailbone, dry eyes show Rash signs,必先 abdominal pain as rash emerges from intestines then skin. Take Ge Gen Sheng Ma Tang or Mian Jian San. (*Yi Shuo* citing *Yi Yu*)
Qi, Blood, Phlegm, and Water can all cause pain. Food injury to Spleen, Wind-Cold entering Spleen, and worms in Spleen cause much pain. Pain from Qi, Blood, Phlegm, Water, Food Accumulation, and Wind-Cold often lingers. Only Worm pain comes and goes unpredictably, verified by vomiting clear fluid. (*Zhi Fang*)
Dai Yun says: Cold pain is continuous without fluctuation. Intermittent pain is Heat pain. Fixed-location pain that does not move is Dead Blood pain. Pain relieved after defecation is Food Accumulation. Pain with difficult urination is Damp-Phlegm. (*Gou Xuan*) (Note: Zhu Danxi said: Phlegm gathers due to Qi stagnation; once gathered, it blocks pathways, causing pain.)
Pain syndromes have Cold and Heat; misidentification causes great harm. Most Three Jiao pain is due to Cold (80-90%), rarely Heat (10-20%). As per *Nei Jing*, Cold causes stagnation, Qi reversal, and pain/distension. Heat flows freely. Although Heat pain exists, it must be distinguished, e.g., *Nei Jing* mentions intestinal pain with intense heat/thirst leading to dry stool obstruction. This is Dryness-Heat closure causing pain, accompanied by irritability/heat, easily identified. (*Jing Yue Quan Shu*)
Cold stagnation pain includes Internal Cold (e.g., eating cold food/drink), requiring treatment based on Cold and Food factors. External Cold includes exposure to untimely Cold, seasonal Cold, or damp/cold mist, causing heart/abdominal twisting pain, vomiting/diarrhea, or Gan Huo Luan (dry cholera) where neither vomiting nor diarrhea occurs. Total Cold invading Zang organs, in Upper or Middle/Lower Jiao. Urgent upper pain benefits from emesis; middle/lower pain requires resolving Cold and moving stagnation. (Ibid.)
Excess and Deficiency (Formless/Formless, Blood/Qi Deficiency) Abdominal pain tolerating heavy pressure is Deficiency; treat with Ren Shen, Bai Zhu, Gan Jiang, Rou Gui. Pain intolerant to touch is Excess; purge with Xiao Shi, Da Huang. (*Dan Xi Xin Fa*) (Note: Based on *Fu Ren Liang Fang*, see Purging methods.)
Pain has excess and deficiency. Three Jiao pain is mostly Food, Cold, or Qi stagnation. Worm, Fire, Phlegm, and Food causes also exist. Sudden pain usually involves the first three; gradual pain involves the latter four. Worm and Phlegm pain is mostly Middle Jiao; Fire pain affects all Three Jiao; Blood pain is mostly Lower Jiao. Women often have Blood patterns; men rarely. Generally, patterns with much stagnation/reversal are Excess; without stagnation/reversal, they are not Excess.
Differentiation: Tolerable pressure is Deficiency; refusal of pressure is Excess. Chronic pain is mostly Deficiency; sudden pain is mostly Excess. Relief with food is Deficiency; distension/fear of food is Excess. Slow, vague pain is Deficiency; severe, fixed, hard pain is Excess. Pain in intestines with masses/stagnation is Excess; pain in ribs/channels referring to back without distension/stagnation is Deficiency. Correlate pulse and symptoms to distinguish. Mild Excess needs regulation, not attack. Severe Excess needs attack (upper or lower). Pure Deficiency needs major tonification (Qi or Blood). (*Jing Yue Quan Shu*) (Note: *Zhi Yi Lu* also discusses. See "Pain Requires Unblocking" section.)
Pain must be distinguished as Formless or Formed. Formless pain is in Qi level. Qi disorders causing distension/pain vary in location; Qi gathering causes pain/form, Qi scattering brings relief/no trace. This is Formless pain, treat by smoothing Qi. Formed pain is in Blood level, e.g., Food Accumulation. Blood/Food pain has fixed location and constant distension, not wandering. This is Formed pain. Identify cause (Food or Blood) to purge/remove. These two must be distinguished. (Ibid.)
Pressing causes pain = Excess; no pain = Deficiency. Pressing scatters Qi; even Excess may relieve pain with pressure. Deficiency causes Qi congestion/pain; pressing increases congestion/pain. Thus, one cannot rigidly define excess/deficiency by pressure alone. However, using warm hands for long pressure: pain cessation indicates Cold; persistence indicates Heat. This is reliable. (*Yi Jin Yi Fa*)
If diet is careful, limbs are thin/weak, no fullness, but slight pain like tendon pulling, it is Blood Deficiency. If abdomen feels empty, hungry-but-not-hungry, fluttering pain, breathing lacks strength, it is Qi Deficiency. (*Yu An*)
Location Differentiation Methods:
Pain in center: Food Accumulation. Severe pain, desire to defecate, relief after stool.
Pain on left: Dead Blood. Fixed location, non-migratory.
Pain on right: Phlegm. Temporary relief with spicy/hot items.
Pain in lower: Blood Retention. Clear urination, intolerance to touch.
Pain in lower: Urine Retention. Difficult urination, intolerance to touch.
Heart to lower abdomen hard/full/pain: Excess Pathogen.
Ribs to lower abdomen radiating pain: Phlegm, Dead Blood. (*Jie Fa*)
Pain below epigastrium: Mostly Food Accumulation. Periumbilical pain: Fire. Left/right lower abdominal pain: Mostly Dead Blood. Lower abdominal pain: Cold. Distinguish by location. (*Si Ming*)
Epigastric pain intolerant to touch: Exterior/Interior disharmony. Exterior Cold condenses on skin/hair; Interior turbidity stops in epigastrium. Assess constitution for treatment.
Pain below epigastrium, in Yangming Stomach Earth area, intermittent: Middle Earth Deficiency, Stomach Qi disharmony. Overuse of Qi-moving/dispersing herbs requires warming tonification. Heavy pressure relieves pain slightly: clear sign of Middle Earth internal deficiency, deficient and cold.
Pain at ends of sternum below breasts: Upper/Lower Yin-Yang disharmony, Shaoyang pivot dysfunction. Common in Shang Han, treat by aiding pivot, harmonizing Qi/Blood, regulating upper/lower.
Great abdominal pain: Taiyin Spleen Earth area. Internal mild pain: Kun Earth Deficient-Cold. Internal/External urgent pain: Spleen Collateral obstruction. Great Spleen Collateral named Da Bao, exits collaterals from channels. Spleen collateral stagnation causes internal/external pain.
Periumbilical left/right pain: Chong Mai disease. Chong Mai runs periumbilically. Cold condensation prevents blood from ascending/reaching exterior, causing periumbilical pain. Use Blood-level herbs to move uterine blood to muscles/skin; Qi herbs are useless. (*Zhen Chuan*)
Pathogens in Meridians (Abdominal Wall Pain) Chest/abdominal pain unrelated to interior, located in sinews/bones/skin/flesh, is pathogen in meridians. Do not confuse with interior syndrome. Ask carefully. Differentiate Fire, Cold, Qi, Labor Injury, Blood Stasis, Blood Deficiency, or Venereal toxins lingering in meridians. Identify cause to avoid error and facilitate treatment. (*Jing Yue Quan Shu*)
Kidney Deficiency failing to move Water, plus excessive alcohol, sleeping after drunkenness, causes wine/water accumulation in abdomen. Face toxin stagnates Qi, water seeps into abdominal wall causing pain. Treat with Qian Shi Xuan Feng San (Bing Lang, Chen Pi, Gan Cao, Qian Niu) boiled in honey water, swallow Shen Bao Wan (see Hypochondriac Pain). After bowel movement, take Qing Mu Xiang Wan (Mu Xiang, Bi Cheng Qie, Bu Gu Zhi, Bing Lang, Qian Niu) 1 part, An Shen Wan (Chuan Wu etc. 12 ingredients) 2 parts, with Er Chen Tang + salt + ginger, taken empty stomach. Spleen/Kidney Qi recovers, naturally stabilizes. (*Zhi Fang*)
Cold Invasion with Food Stagnation Sudden severe chest/abdominal pain in adults/children, continuous, knife-like, is due to Food Stagnation caused by Cold Invasion. Spleen/Stomach catches Wind-Cold then eats (stagnates/pains), or eats then catches Wind-Cold (stagnates/pains). Cold-induced food stagnation doesn't require overeating; normal meals can stagnate. Patients don't know cause; doctors don't know source. Treating as Internal Heat with cooling herbs is wrong. Treating as simple food injury with digestive herbs is also incorrect. Cold-invasion food stagnation differs from Food Injury. Food Injury damages Spleen/Stomach internally. Food Stagnation (Cold type): Spleen/Stomach affected by Wind-Cold, food凝滞 (coagulates/stagnates) without transformation, externally contracted. Treat Food Injury with digestion primarily, supplementing Spleen/Stomach. Treat Cold-Stagnation with dispersing Cold primarily, supplementing digestion. This is effective. Dispersing Cold is essential; without it, digestion fails, pain persists. (Original case of salt water emesis omitted.)
Q: Internal Heat accumulation also causes abdominal pain. Difference from Cold-Stagnation pain?
A: Heat pain comes/goes, urgent/relaxed intermittently. Cold-Stagnation pain is most urgent, continuous, lasting days, only slightly easing when chronic. If initial treatment missed, delaying days turns Cold to Heat, dispersing herbs ineffective. Use Mu Xiang Bing Lang Wan (Mu Xiang, Bing Lang, Dang Gui, Bai Shao, Qing Pi, Zhi Ke, Qian Niu, E Zhu, Da Huang, Xiang Fu, Huang Lian) or Qian Niu Da Huang Wan to mildly purge, stopping pain. (*Yi Shu*)
Blood Stasis Abdominal pain after trauma is Blood Stasis. Treat Tao Ren Cheng Qi Tang + Dang Gui, Su Mu, Hong Hua, decocted with Wine and Tong Bian (child's urine). Trauma or wading in water after drinking causing Blood coagulation pain: Da Cheng Qi Tang + Gui Zhi. (*Dan Xi Xin Fa*) (Note: Another case in Blood Moving methods, cross-reference.)
One person had epigastric pain, vomited purple-blood after eating, Guan pulses choppy, Blood disease from fall. Treated with generating new/removing old formula, vomited bowl of blood, recovered. (Ibid.)
After trauma, dull localized abdominal pain indicates intestinal membrane damage. Promote Blood circulation, move Qi, tonify. Do not mistake for Phlegm/Fire using harsh purgatives. Saw one man kicking door drunk, lower abdominal pain continued. Random medicines administered. Before death, lower abdomen swollen/blue. Realized cause was previous day's injury. (*Liu Yao*)
Periumbilical Pain (See Moxibustion Methods) Hard, painful, tangible mass at navel: mostly Dry Stool. Already purged...