不应，用四物加桃仁泥、红花、升麻、麻子仁、熟大黄、槟榔，空心煎服，润以导之，痛随利减。（《六要》）
当脐痛，为肾虚，任脉为病，六味丸加龟板灰。（《医通》）（按∶《金匮翼》治当脐痛，便溺不利，
怯寒脉虚者方，用熟地、肉桂、白芍、桂枝、当归、茯苓，水煎服。）
小腹痛（互见前部位条） 小腹痛有实，有虚，有寒，有死血，有溺道不利。实者按之愈痛，宜青
皮、香附以行其气。虚者常欲手按，宜温补之。寒者，宜肉桂、吴茱、川楝肉之类。死血者，小便反利，兼
以胀急，用桃仁、红花、归尾、赤芍、生地黄、青皮、香附。小便不利者，五苓散加木通。（《统旨》）
小腹痛满有三，皆为内有留着，非虚气也。一属燥结大肠，其证大便不通。一属热结膀胱，其证溺闭不
通，按之虽满而不甚坚。一属血结膀胱而腹满。然亦有右旁偏满者，此必
饱食奔驰，脾阴下溜，食积痰腻留结也，当于积滞门求之。（《医通》）（节录）
凡腹痛因食者，或因滞物，或因冷物，皆能体积中脘，须用治食法加减治之，此正法也，然又有食停小腹
者。余尝治一上舍，年及三旬，因午刻食水煮面角，将至初更，食及小腹下，至右角间，遂停积不行，而坚突
如拳，大如鹅卵，其痛之剧，莫可名状。余为治之，察其明系面积，显而无疑，然计其已
入大肠，此正通则不痛之证也。乃与木香槟榔丸，连下二三次，其痛如故。因疑药力之缓，犹未及病，乃更
投神佑丸以泻之，又不效。余谓此必药性皆寒，故滞有不行也。因再投备急丸，虽连得大泻，而坚痛毫不
为减。斯时也余计穷矣，因潜测其由，不过因面，岂无所以制之。今既逐之不及，使非
借气以行之不可也。且计面毒非大蒜不杀，气滞非木香不
行，又其滞深道远，非精锐之向导不能达。乃用火酒磨木香，令其嚼生蒜一瓣，而以香酒送之。一服后觉痛
稍减，三四服后，痛渐止而食渐进，方得痊愈。然虽痛止食进，而小腹之块仍在，后至半年许始得消尽。由是
知欲消食滞，即大黄、巴豆犹有所不能及，而惟宜行气为先也。且知饮食下行之道，乃必由小腹下右角间而
后出于广肠也。此自古无人言及者，故并笔之，用以广人之闻见。（《景岳》）
寒痛变下利 寒中久痛不瘥，冷入于大肠，则变下痢。所以然者，肠鸣气虚故也。肠虚则泄，故
变下痢也。（《病源论》）
死证 脐下忽大痛，人中黑色者，多死。（《丹溪》）
腹痛发喘，兼脉滑死。（《捷法》）
别病 肠痛亦多端。若疼甚者，乃肠痈。（《资生》）
腹痛所因，以上论之详矣。但有因别病而致痛者，不可不明。且如疝致腹痛，必是睾丸肿疼，牵引而痛，
或边有一条，冲腹而痛。霍乱腹痛，必呕吐而作，甚有不呕吐四肢厥冷痛极者，又名搅肠沙，急用盐汤探吐，
或委中穴并十指出血。酒积腹痛，必因伤酒痛，则泄去其积，疼自止也。内生肠痈，身甲错，腹皮急，按之
濡，如肿状，腹常痛，或绕脐生疮，急宜下之。凡此数证所致腹痛，要审辨随其所因而治，
不可苟且而误人也。（《统旨》）
治法诸说 宿患心腹痛者，有积块气块， 癖日久，发歇不常者，不可取转，宜渐次消磨，可与感应
丸、温白丸、挨积丸、蓬煎丸、小理中丸，少吃数丸，常服渐渐消磨。更与和脾散、嘉禾散、参苓白术散、
四君子汤、思食丸、建脾汤、建中散、平胃散之类，助其脾胃，久而能去其根。（《和剂·
指南》）（按∶所举诸方，俱出《局方》中，宜就而考。）
寒证体虚者，五积散，生姜三片煨，葱白二根，木瓜二片，盐炒茱萸七粒同煎。热证，四顺清凉饮，治腹痛，
大便秘，小便赤，喜饮冷，以手按之转甚，不可近，病者或两手热，痛处亦热，或用大柴胡汤。（《得效》）
凡心腹痛者，必用温散，此是郁结不行，阳气不运，故痛。在上者多属食，食能作痛，宜温散之，如干
姜、炒苍术、川芎、白芷、香附、姜汁之类，不可用峻利药攻下之。盖食得寒则凝，热则化，更兼行气快气药助
之，无不可者（按∶景岳有说，见小腹痛下，宜参）。如腹中常觉有热，而暴痛暴止者，此为积热，宜调胃
承气汤之类下之。（《丹溪》）
凡心腹诸痛，宜辨其内之胀与不胀，便之闭与不闭，脉之有力与无力，口中热、口中和，痛之久暂，以
辨寒热邪正虚实。如痛而胀且闭者，浓朴三物汤攻里；兼发热者，浓朴七物汤兼表里治之。腹痛连胁痛，
脉弦紧，恶寒甚，大便秘者，大黄附子汤主之。若但胀而便不秘者，是实中之虚，宜浓朴半夏人参生姜甘
草汤。腹痛甚而不可触近，呕吐者，大建中汤主之。雷鸣切痛，呕吐者，附子粳米汤主之。腹痛下
利而厥者，通脉四逆汤主之。腹痛吐泻者，理中汤主之。若绕脐疼痛名寒疝，腹中 痛者，当归生姜羊肉汤
主之。皆起死回生之法。（《妙用》）
大人小儿，或素因口腹不节，致伤脾胃，以后或寒或食，凡有所触，即为腹痛，屡发不已，或为胀满食
减等证者，惟芍药枳术丸为最妙（系枳术丸加芍药、陈皮），宜加减用之。（《景岳》）
腹痛，因于寒，忌苦寒、下利，宜温中、辛散。因于热火，在小腹则绞痛，忌辛热、香燥、补敛，宜甘
苦寒。诸痛属实，忌补气，大热，宜破散、疏利、苦寒。诸痛属虚，忌
破气、破血、下利、发散，宜补气血、甘温。酸敛。（《本草经疏》）
治不可轻和养 俗谓脾家疼痛，出于胃虚，大率用养脾之剂，而不知受病各有自来。苟不能推究
其原，则和养等剂，掩护邪气，非徒无益，而又害之。况夫风冷入脾，尤念虑之所不到，至有荏苒岁月而不
可揣度者。有一田夫，醉饱之余，露星取快，一枕天明，自此脾疼攻刺，百药罔功，淹淹数载。后遇至人
授以《和剂》抽刀散。温酒调下，数服顿愈。则知风露之根入胃，良姜、菖蒲，为能散其邪，巴、猫借气，
为能伐其根，观此可以通一毕万矣。然而痛不复作，养脾之剂独不可继是调理之乎。疗病如濯衣，必去其
垢污，而后可以加装饰，医言意也，请借是以为喻。（《直指》）
诸痛不可用参、 、白术，盖补其气，气旺而痛愈甚。（《丹溪》）
痛须通利 舒王解痛字云∶宜通而塞则为痛。此极有理。凡痛须通利脏腑，乃能随其冷热而须用巴
豆、大黄、牵牛，此最要法。（《医说》引《医余》）
凡言通则不痛、痛则不通之说甚是。夫痛随利止之说，不特通大便曰利，而食滞于胃，消之则效，痰涎壅
结者，导之越之则苏，挟外感阴阳不交通者疏解之，血瘀结者导滑之，二便闭涩者通之润之，是皆痛随利止之
义也。气得中和曰正气而不疼，若偏即曰邪气，闭而作痛矣。凡治积聚气痛者，慎勿辄泥以诸痛忌用参、术
之说为戒，是虚而脾疼者受害多矣。（《会元》）
夫通则不痛，理也，但通之之法各有不同。调气以和血，调血以和气，通也。下逆者使之上行，中结者
使之旁达，亦通也。虚者助之使通，寒者温之使通，无非通之之法也。
若必以下泄为通，则妄矣。（《真传》）
《灵枢》云∶病痛者，阴也。又云∶无形而痛者，阴之类也，其阳完而阴伤之也，急治其阳，无攻其阴
矣。阳者气也，是痛病当先治气。顾气有虚有实，实者邪气实，虚者正气虚。邪实者以手按之而痛，痛则宜
通；正虚者以手按之则止，止则宜补。丹溪猥云诸痛不宜补气，夫实者固不宜补，岂有虚者而亦不宜补乎。故
凡痛而胀闭者多实，不胀不闭者多虚。痛而喜寒者多实热，喜热者多虚寒。饱而甚者多实，饥则甚者多虚。脉
实气粗者多实，脉虚气小者多虚。新病壮年者多实，久病年衰者多虚。补而不效者多实，（按∶此二
句原无，据《必读》补。）愈攻愈剧者多虚。痛在经者脉弦大，痛在脏者脉沉微。兼脉症以参之，而虚实
自辨。是以治表虚痛者，阳不足也，非温经不可，里虚痛者，阴不足也，非养营不可。上虚而痛者，心脾受
伤也，非补中不可；下虚而痛者，脱泄亡阴也，非速救脾肾、温补命门不可。凡属诸痛之虚者，不可以不补
也。有曰通则不痛，又曰痛随利减，人皆以为不易之法，不知此为治实痛者言也。故王海藏解痛利二字，不
可以利为下，宜作通字训（按∶此出《续医说》，以为海藏者误矣。《类经》引王荆公亦误），
此说甚善。明哲如丹溪，徒曰诸痛不可补气，则失矣。（《质疑录》）
治有宜补 或曰∶诸痛与瘦黑人，及阴虚火动，参、 在所当禁，今用之顾效谓何？曰∶药无
常性，以血药引之则从血，以气药引之则从气，佐之以热则热，佐之以寒则寒，在人善用之耳。况人参不
特补气，亦能补血，故曰气血弱，当从长沙而用人参是也。所谓诸痛禁用参、 者，以暴病形实
者言耳。若年高气血衰弱，不用补法，气何由行，痛何由止，
经曰壮者气行则愈是也。（《类案》）（按∶此本出《石山居士传》。）
其人本体原弱，或大病后气血两虚，不可拘于诸痛不可用参、 之语，急投温补重剂，四君子、理中
加顺气药。（《司命》）
凡治心腹痛证，已经攻击涤荡，愈而复作，或再三用之而愈作愈甚，或脉反浮弦虚大者，皆为中虚之候。
此当酌其虚实，而或兼治邪气，或专补正气。若用补无碍，则当渐进，切不可杂乱妄投，以自掣其肘。但当纯
用补药，使脾胃气强，得以营运，则邪气自不能犯，又何疼痛之有。（《景岳》）
虚痛虽有气血寒热之分，然皆主于气郁滞，气不滞则痛无由生。气虚则气行迟，迟则郁滞而痛，血虚
则气行疾，疾则前气未行而后气又至，亦令郁滞而痛。故气虚补气，血虚补血，俾阴中有阳，阳中有阴，及
其漏下二刻，一周循环之常，痛自愈也。（《医津一筏》）
治有宜开郁降火 凡治心腹疼痛，但是新病，须问曾服何饮食，因何伤感，有无积滞，便与和中消导
之药。若日数已多，曾多服辛温燥热之药，呕吐不纳，胸膈饱闷，口舌干燥，大小便涩难，则内有郁热矣。或
原有旧病，因感而发，绵延日久，见证如前者，俱用开郁行气、降火润燥之药，如川芎、香附、炒山栀、黄
连、姜汁之类，甚者再加芒硝。但治心腹久痛，须于温散药内，加苦寒、咸寒之药，温治其标，寒治
其本也。（《杂着》）（按∶此说本于丹溪，见《心痛》中。又《会元》有说，欠核不录。）
温中诸方 治久寒疾，胸腹中痛，时下痢，当归汤方。
当归（二两） 甘草 柑皮（各二两） 附子（一两） 干姜（四两）
上五味 咀，以水八升，煮取二升，分三服，日三。
（《千金》）又治久寒宿疾，胸腹中痛，短气，时滞下痢，当归汤，于本方去甘草、柑皮，加桂心。
治卒心腹绞痛如刺，两胁支满，烦闷不可忍，高良姜汤方。
高良姜（五两） 浓朴（二两） 当归 桂心（各三两）
上四味 咀，以水八升，煮取一升八合，分三服，日二。若一服痛止，便停，不须更服。若
强人为二服，劣人分三服。（同上）
小建中汤，治腹中切痛。尝有人患心腹切痛不可忍，累用良医治之皆不效，灸十余处亦不瘥。士人陈
承善医，投一药遂定。问之，乃小建中汤也。此药偏治腹中虚寒，补血，尤主腹痛。常人见其药性温平，未必
信之。古人补虚止用此体面药，不须附子、硫黄。承用此药治腹痛如神。（苏沈）或吐或泻，状如霍乱，及冒涉
湿寒，贼风入腹，拘急切痛，加附子三分，名附子建中汤。（《易简》）
理中汤，内虚腹痛，加桂枝、甘草（炙）、芍药、生姜、大枣、胶饴，名二中汤。加者是小建中汤方，
故名。（《会解》）（按∶此方本出《阴证略例》，宜参《伤寒·太阴病》。）
一壮年男子，寒月入水网鱼，饥甚，遇凉粥食之，腹大痛，二昼夜不止。一医先与大黄丸，不通，又与
大承气汤，下粪水而痛愈甚。召予治。诊其六脉皆沉伏而实，面青黑色。予曰∶此大寒证，及下焦有燥屎作
痛。先与丁附治中汤一帖，又与灸气海穴二十一壮，痛减半。继以江子加陈皮、木香作
丸，如绿豆大，生姜汁送下五粒，五、七次平安。（《正传》）
或日虽久，凉剂不应，脉虽洪大，按之不鼓，亦属伏阴，理中汤加熟附子一片，浸冷服。（《六要》）
戴复庵云∶腹内诸般冷痛，一个枳实理中汤加减，作无限用。（《要诀》）
集香散，治心脾疼。（边学谕传。）
白术（三两） 茯苓（六两去皮） 人参（半两去芦） 丁香（半两） 木香（三两） 甘草（半两炙）
上为细末，每服二钱，生姜一片，沸汤调服。（《叶氏》）
浓朴温中汤，治脾胃虚寒，心腹胀满，及秋冬客寒犯胃，时作疼痛。
浓朴（姜制） 橘皮（去白各一两） 甘草（炙） 草豆蔻仁 茯苓（去皮） 木香（各五钱） 干姜（七分）
上为粗散，每服五钱匕，水二盏，生姜三片，煎至一盏，去渣温服食前，忌一切冷物。（《内外伤辨》）
No response was observed. Use Siwu Tang (Four Substances Decoction) added with Peach Kernel Paste (Taoren Ni), Safflower (Honghua), Cimicifugae Rhizoma (Shengma), Cannabis Seed (Maziren), Prepared Rhubarb (Shu Dahuang), and Areca Seed (Binglang). Decoct and take on an empty stomach to moisten and guide out the accumulation; pain decreases as bowel movements become unobstructed. (*Liu Yao*)
Pain around the umbilicus indicates Kidney Deficiency and disease of the Ren Mai (Conception Vessel). Use Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) added with Ash of Tortoise Shell (Guiban Hui). (*Yi Tong*) (Note: *Jinkui Yi* treats periumbilical pain with difficulty in urination and defecation, aversion to cold, and a deficient pulse using Prepared Rehmannia Root (Shudi), Cinnamon Bark (Rougui), White Peony Root (Baishao), Cinnamon Twig (Guizhi), Angelica Sinensis (Danggui), and Poria (Fuling), decocted in water.)
Hypogastric pain (see also the section on location above). Hypogastric pain can be due to Excess, Deficiency, Cold, Fixed Blood Stasis (Sixin Xue), or obstruction of the urinary tract. In Excess patterns, pain worsens upon pressure; use Green Tangerine Peel (Qingpi) and Cyperus Rhizome (Xiangfu) to move Qi. In Deficiency patterns, there is a desire to press with hands; use warming and tonifying methods. In Cold patterns, use Cinnamon Bark (Rougui), Evodia Fruit (Wuzhuyu), and Toosendan Fruit (Chuanlianrou). In Fixed Blood Stasis patterns, urination is surprisingly clear, accompanied by distension and urgency; use Peach Kernel (Taoren), Safflower (Honghua), Angelica Sinensis Tail (Guiwei), Red Peony Root (Chishao), Raw Rehmannia Root (Shengdihuang), Green Tangerine Peel (Qingpi), and Cyperus Rhizome (Xiangfu). For obstructed urination, use Wuling San (Five-Ling Powder) added with Akebia Caulis (Mutong). (*Tongzhi*)
There are three types of hypogastric fullness, all caused by internal retention rather than deficient Qi. One type belongs to Dryness Constipation in the Large Intestine, characterized by inability to pass stool. Another belongs to Heat Binding in the Bladder, characterized by inability to urinate; palpation reveals fullness but not extreme hardness. The third belongs to Blood Binding in the Bladder causing abdominal fullness. However, right-sided偏侧 fullness must be due to food stagnation and phlegm-dampness retention following overeating and vigorous exercise, which causes Spleen Yin to descend; this should be sought in the Food Stagnation chapter. (*Yi Tong*) (Excerpt)
Abdominal pain caused by food, whether due to stagnant matter or cold items, leads to fullness in the Zhongwan region. It must be treated with food-resolving methods as a standard approach. However, food can also stagnate in the lower abdomen. I once treated a scholar-official, aged thirty, who ate boiled dumplings at noon. By early evening, the food had descended to the lower abdomen, stopping between the lower right corner. It accumulated, becoming hard and protruding like a fist, the size of a goose egg, with excruciating pain. Examination confirmed obvious food stagnation. Since it had entered the Large Intestine, this is a case where "unobstruction relieves pain." I administered Muxiang Binglang Wan (Pinellia and Areca Pill); after two or three bowel movements, pain persisted. Suspecting the medicine was too slow, I switched to Shenyou Wan (Divine Protection Pill) for purgation, which also failed. I reasoned that since the drugs were cold in nature, the stagnation could not move. I then administered Beiji Wan (Emergency Aid Pill); although large bowel movements occurred, the hardness and pain remained unchanged. At this point, I was at a loss. Upon reflection, since it was merely dough, there must be a way to counteract it. Since direct purgation failed, we must rely on Qi movement. Dough toxicity is best countered by Garlic; Qi stagnation is best moved by Aucklandia Root (Muxiang). Given the deep and distant location of the stagnation, a potent guide is needed. I used Aucklandia Root ground in wine, instructed him to chew one clove of raw garlic, and wash it down with the aromatic wine. After one dose, pain slightly decreased; after three to four doses, pain ceased and appetite returned, leading to recovery. However, the mass in the lower abdomen remained, disappearing only after half a year. This shows that to resolve food stagnation, even Rhubarb (Dahuang) or Croton Seed (Badou) may fail, whereas moving Qi is primary. Furthermore, dietary substances must pass through the lower right corner of the lower abdomen before exiting via the Changchang (Large Intestine/Rectum). This has never been mentioned before, so I record it to broaden knowledge. (*Jingyue*)
Cold pain transforming into dysentery. Long-standing cold pain that does not heal allows cold to enter the Large Intestine, transforming into dysentery. This occurs because of intestinal rumbling and Qi deficiency. When the intestine is deficient, diarrhea ensues, thus transforming into dysentery. (*Bingyuan Lun*)
Death signs. Sudden severe pain below the umbilicus combined with blackening of the area between the nose and upper lip (Ren Zhong) indicates death. (*Danxi*)
Abdominal pain accompanied by asthma and a slippery pulse indicates death. (*Jiefah*)
Differentiation of other diseases. Intestinal abscess (Chang Yong) presents in many ways. Severe pain indicates intestinal abscess. (*Zisheng*)
The causes of abdominal pain have been discussed in detail above. However, pain caused by other diseases must be clearly understood. For example, hernia-induced abdominal pain involves swollen and painful testicles with radiating pain, or a cord-like structure rushing into the abdomen causing pain. Cholera-induced abdominal pain involves vomiting; severe cases may lack vomiting but present with cold limbs and extreme pain, also known as "Intestine-Churning Sand," requiring salt water-induced emesis or bleeding from Weizhong (BL40) and Shi-xuan (EX-UE11) points. Wine-stagnation abdominal pain results from alcohol injury; resolving the stagnation stops the pain. Internal intestinal abscess presents with rough skin (like fish scales), tense abdominal wall that is soft upon pressure, constant abdominal pain, or ulcers around the umbilicus; urgent purgation is required. For these various causes of abdominal pain, one must carefully differentiate and treat according to the cause, avoiding rash errors. (*Tongzhi*)
Various treatment theories. Patients with chronic heart and abdominal pain, having masses or Qi blocks, with long-standing Pi accumulations and irregular attacks, should not undergo forceful rotation or strong purgation. Instead, gradual resolution is suitable. Gan Ying Wan, Wenbai Wan, Aiji Wan, Pengjian Wan, or Xiaolizhong Wan may be given in small amounts frequently for long-term gradual resolution. Additionally, Hepi San, Jiahe San, Shenling Baizhu San, Sijunzi Tang, Sixi Wan, Jianpi Tang, Jianzhong San, or Pingwei San can be used to support the Spleen and Stomach, eventually eliminating the root cause. (*Heji Zhinan*) (Note: All listed formulas are from *Jufang*; verify accordingly.)
For Cold patterns with body deficiency, use Wuji San (Five Accumulations Powder) with three slices of roasted Ginger, two stalks of Scallion White, two slices of Chaenomel Fructus (Mu Gua), and seven grains of Salt-fried Evodia Fruit (Zhuyu). For Heat patterns, use Sishun Qingliang Yin to treat abdominal pain, constipation, red urine, preference for cold drinks, worsening pain upon pressure, intolerance to touch, hot hands, and hot pain sites; or use Da Chaihu Tang. (*Defxiao*)
All heart and abdominal pain requires warming and dispersing methods because stagnation prevents Yang Qi circulation. Pain located upper often relates to food; food causes pain and responds to warming dispersal, e.g., Dried Ginger (Ganjiang), Stir-fried Atractylodes Macrocephala Rhizome (Cao Cangzhu), Ligusticum Rhizome (Chuanxiong), Angelica Dahurica (Baizhi), Cyperus Rhizome (Xiangfu), and Ginger Juice. Harsh purgatives should not be used. Food congeals with cold and melts with heat; adding Qi-moving herbs ensures efficacy. (Note: Jingyue has comments on lower abdominal pain; refer to them.) If the abdomen feels constantly hot but pain is sudden and brief, this is accumulated heat; use Tiaowei Chengqi Tang to purge. (*Danxi*)
For all heart and abdominal pains, distinguish internal fullness vs. none, bowel closure vs. openness, pulse strength vs. weakness, mouth heat vs. neutrality, and pain duration to differentiate Cold/Heat, Pathogenic/Healthy, and Excess/Deficiency. Pain with fullness and closure requires Houpo Sanwu Tang to attack the interior; if accompanied by fever, use Houpo Qiwu Tang to treat both exterior and interior. Abdominal pain radiating to flanks, wiry-tight pulse, severe aversion to cold, and constipation require Dahuang Fuzi Tang. If only fullness without constipation, this is Excess within Deficiency; use Houpo Banxia Rensheng Yangancao Tang. Severe abdominal pain intolerable to touch with vomiting requires Da Jianzhong Tang. Borborygmus and cutting pain with vomiting require Fuzi Jiangmi Tang. Abdominal pain with dysentery and cold limbs requires Tongmai Sini Tang. Abdominal pain with vomiting and diarrhea requires Lizhong Tang. Periumbilical pain named Han Shan (Cold Hernia) or general abdominal pain requires Danggui Shengyang Roushou Tang. These are life-saving methods. (*Miuyong*)
Adults and children who damage the Spleen and Stomach due to dietary indiscretion, triggering abdominal pain upon exposure to cold or food, recurring frequently, or presenting with fullness and reduced appetite, are best treated with Shaoyao Zhizhu Wan (Atractylodes and Immature Bitter Orange Pill with Peony, i.e., Zhizhu Wan plus Shaoyao and Chenpi). Adjust as needed. (*Jingyue*)
Abdominal pain due to Cold contraindicates Bitter-Cold and purgative herbs; use Warming-Middle and Acrid-Dispersal methods. Abdominal pain due to Fire-Heat, especially cramping in the lower abdomen, contraindicates Acrid-Warm, Fragrant-Dry, and Tonifying-Astringent herbs; use Sweet-Bitter-Cold methods. Excess pain contraindicates Qi-tonifying and Great-Heat herbs; use Breaking-Scattering, Unblocking-Draining, and Bitter-Cold methods. Deficient pain contraindicates Qi-breaking, Blood-breaking, purgative, and Dispersing herbs; use Qi-and-Blood tonification, Sweet-Warm, and Sour-Astringent methods. (*Bencao Jingshu*)
Treatment should not lightly rely on harmonizing and nourishing. Folk belief attributes Spleen pain to Stomach deficiency, generally using Spleen-nourishing agents, unaware that causes vary. Without investigating the root, harmonizing/nourishing agents shield pathogens, causing harm. Wind-cold invading the Spleen is often overlooked, sometimes lingering for years. A farmer slept outdoors after heavy eating/drinking, developing stabbing Spleen pain unresponsive to hundreds of medicines for years. Later, he received Choudao San from *Heji Ju Fang*. Taken with warm wine, it cured him quickly. Thus, wind/dew pathogens in the Stomach are dispersed by Galangal (Liangjiang) and Acorus (Changpu), while Croton (Badou) and Cat-eye Castor (Maotao) leverage Qi to eradicate roots. This illustrates broader principles. Yet, if pain ceases, can Spleen-nourishing agents not continue regulation? Treating illness is like washing clothes: remove dirt before decoration. Doctors' intent is similar. (*Zhizhi*)
Various pains contraindicate Ginseng (Renshen), Astragalus (Huangqi), and Atractylodes (Baizhu) because tonifying Qi exacerbates pain when Qi is excessive. (*Danxi*)
Pain requires unobstruction. King Shu explained "pain" as blockage where flow should be free. This is logical. Pain requires unblocking organs to apply appropriate herbs like Croton (Badou), Rhubarb (Dahuang), or Morning Glory Seed (Qianniu) based on cold/heat. This is crucial. (*Yishuo* citing *Yiyu*)
The saying "Unobstruction relieves pain, pain implies unobstruction" is correct. "Pain subsides with unobstruction" (Li) refers not only to bowel movements but also to resolving food stagnation in the Stomach, guiding phlegm-fluid retention, releasing external pathogens affecting Yin-Yang communication, sliding blood stasis, and unblocking/moistening difficult urination/defecation. Balanced Qi is Healthy Qi and painless; deviation creates Pathogenic Qi and pain. When treating Qi-stagnation masses, do not rigidly adhere to "contraindicate Renshen/Baizhu for all pain"; many suffer from Deficient Spleen pain. (*Huiyuan*)
"Unobstruction relieves pain" is principle, but methods vary. Regulating Qi to harmonize Blood, regulating Blood to harmonize Qi is unobstruction. Directing upward reversal downward, or lateral dispersion of central knots is unobstruction. Tonifying deficiency to enable flow, warming cold to enable flow—all are unobstruction. Equating unobstruction solely with purgation is wrong. (*Zhuan*)
*Ling Shu* states: Pain is Yin. Formless pain belongs to Yin; Yang is intact but Yin is injured. Urgently treat Yang, do not attack Yin. Yang represents Qi; thus, treat Qi first in pain. Qi has Deficiency and Excess. Excess is Pathogenic Qi excess; pressing increases pain, requiring unobstruction. Deficiency is Healthy Qi deficiency; pressing stops pain, requiring tonification. Danxi wrongly claimed all pains contraindicate Qi tonification. Excess indeed shouldn't be tonified, but what of Deficiency? Pain with fullness/closure is mostly Excess; without, mostly Deficiency. Pain preferring cold is mostly Excess-Heat; preferring heat is mostly Deficiency-Cold. Worse after eating is Excess; worse on hunger is Deficiency. Full pulse/rough breath is Excess; weak pulse/small breath is Deficiency. New illness/youth is Excess; chronic illness/elderly is Deficiency. Ineffective tonification suggests Excess; worsening with attack suggests Deficiency. Pain in meridians shows wiry-large pulse; pain in zang organs shows deep-micro pulse. Combine pulse/symptoms to differentiate. Table-deficiency pain requires warming meridians; Interior-deficiency pain requires nourishing Ying. Upper-deficiency pain (Heart/Spleen injury) requires Middle-tonification; Lower-deficiency pain (collapse/Yin loss) requires urgent Spleen/Kidney rescue and Mingmen warming. All deficient pains require tonification. Some cite "unobstruction relieves pain" as absolute, but this applies to Excess pain. Wang Haicang interpreted "Li" as "Tong" (unobstruction), not purgation. This is sound. Danxi's blanket ban on Qi tonification was erroneous. (*Zhiyi Lu*)
Tonification indications. Question: Contraindications for Renshen/Huangqi in pain, thin dark-skinned individuals, and Yin-deficiency fire hyperactivity exist, yet they work now? Answer: Herbs have no fixed nature; guided by Blood herbs they enter Blood, by Qi herbs they enter Qi, aided by Hot/Cold they become Hot/Cold. Skillful application matters. Renshen tonifies both Qi and Blood. Thus, for Qi/Blood weakness, follow Zhang Zhongjing (Changsha) using Renshen. The contraindication applies to acute Excess patterns. For elderly with Qi/Blood weakness, without tonification, how can Qi move and pain stop? *"Strong individuals recover as Qi moves"* confirms this. (*Lei An*) (Note: Originally from *Shishan Juzi Zhuan*.)
Inherently weak constitution or post-major illness Qi/Blood deficiency should not strictly follow "contraindicate Renshen/Huangqi for pain." Immediately use heavy Warming-Tonifying formulas like Sijunzi Tang or Lizhong Tang with Qi-moving herbs. (*Siming*)
For heart/abdominal pain repeatedly attacked and cleared, recurring or worsening, or showing floating-wiry-deficient-large pulses, this indicates Middle Deficiency. Balance Deficiency/Excess, either treating pathogen or tonifying Healthy Qi. If tonification is safe, proceed gradually. Do not mix杂乱ly. Pure tonification strengthens Spleen/Stomach Qi, enabling circulation, preventing pathogen invasion, and eliminating pain. (*Jingyue*)
Deficient pain varies by Qi/Blood/Cold/Heat but centers on Qi stagnation. No stagnation, no pain. Qi deficiency slows Qi flow, causing stagnation/pain. Blood deficiency speeds Qi flow, causing collision/stagnation/pain. Tonify Qi for Qi deficiency, Blood for Blood deficiency, balancing Yin/Yang until normal circulation resumes, relieving pain. (*Yijin Yifa*)
Opening depression and descending fire indications. For new heart/abdominal pain, inquire about diet, trauma, or stagnation, then use Harmonizing/Digestive herbs. If chronic, with prior Acrid-Warm-Dry usage causing vomiting, chest fullness, dry mouth/tongue, and difficult urination/defecation, internal郁热 (Depressed Heat) exists. For old diseases triggered by sensation, prolonged course, use Opening-Depression, Qi-moving, Fire-descending, Moistening herbs like Chuanxiong, Xiangfu, Stir-fried Gardenia (Shanzhi), Coptis Rhizome (Huanglian), Ginger Juice. Severe cases add Mirabilite (Mangxiao). For chronic heart/abdominal pain, add Bitter-Cold/Salty-Cold herbs to Warming-Dispersal base: Warm treats symptoms, Cold treats root. (*Zazhuo*) (Note: Based on Danxi, see *Xintong*. *Huiyuan* has comments omitted.)
Warming-Middle Formulas. For chronic cold disease, chest/abdominal pain, intermittent dysentery, Danggui Tang.
Danggui (2 liang), Gancao, Ganpi (each 2 liang), Fuzi (1 liang), Ganjiang (4 liang).
Chop five ingredients, boil in 8 sheng water to 2 sheng, divide into 3 doses, 3 times daily. (*Qianjin*)
Also for chronic cold, chest/abdominal pain, shortness of breath, intermittent dysentery, Danggui Tang: Remove Gancao/Ganpi from above, add Guixin.
For sudden severe stabbing heart/abdominal pain, flank fullness, unbearable restlessness, Gaoliangjiang Tang.
Gaoliangjiang (5 liang), Houpo (2 liang), Danggui, Guixin (each 3 liang).
Chop four ingredients, boil in 8 sheng water to 1.8 sheng, divide into 3 doses, 2 times daily. Stop if pain ceases after one dose. Strong patients take 2 doses, weak patients 3. (Same source)
Xiao Jianzhong Tang treats cutting abdominal pain. A patient suffered unbearable heart/abdominal pain, unresponsive to doctors and moxibustion. Scholar Chen Cheng cured him instantly with Xiao Jianzhong Tang. This formula treats abdominal deficiency-cold, nourishes Blood, specifically abdominal pain. Commoners doubt its mild nature, but ancients used it for deficiency without Fuzi/Sulfur. Chen Cheng used it miraculously. (*Su Shen*) Add Fuzi (3 fen) for vomiting/diarrhea resembling cholera, damp-cold exposure, or wind entering abdomen causing cramping pain; name Fuzi Jianzhong Tang. (*Yijian*)
Lizhong Tang for internal deficiency abdominal pain: Add Guizhi, Zhi Gancao, Shaoyao, Shengjiang, Dazao, Yitang to form Erzhong Tang (named after Xiao Jianzhong Tang components). (*Huijie*) (Note: From *Yinzheng Lueli*; refer to *Shanghan Taiyin Disease*.)
A young man fished in winter water, very hungry, ate cold porridge, developed severe abdominal pain lasting two days/nights. Doctor gave Dahuang Wan (no effect), then Dachengqi Tang (passed feces/water, pain worsened). I examined: six pulses deep/fixed/excess, face blue-black. Diagnosis: Major Cold syndrome with dry stool in lower Jiao. Gave Dingfu Zhizhong Tang (one dose) and moxa Qihai (21 cones); pain halved. Then made pills of Jiangzi (Croton seed) with Chenpi/Muxiang, bean-sized, taken with Ginger Juice (5 pills, 5-7 times); recovered safely. (*Zhengzhuan*)
If chronic, cold formulas fail, pulse large but hollow on pressure, this is Hidden Yin. Lizhong Tang + 1 slice Prepared Fuzi, taken cold. (*Liuyao*)
Dai Fu'an said: For all kinds of cold abdominal pain, Zhi Shi Lizhong Tang adjusted infinitely. (*Yaojue*)
Jixiang San treats Heart/Spleen pain. (Bian Xueyu biography)
Baizhu (3 liang), Fuling (6 liang peeled), Renshen (0.5 liang de-rooted), Dingxiang (0.5 liang), Muxiang (3 liang), Zhi Gancao (0.5 liang).
Powder. Take 2 qian each time with 1 slice Ginger and boiling water. (*Ye Shi*)
Houpo Wenzhong Tang treats Spleen/Stomach deficiency-cold, chest/abdominal fullness, and autumn/winter external cold attacking Stomach causing periodic pain.
Jiang Zhi Houpo, Qu Bai Jupi (each 1 liang), Zhi Gancao, Caodoukou Ren, Qu Pi Fuling, Muxiang (each 5 qian), Ganjiang (7 fen).
Coarse powder. Take 5 qianbi with 2 zhan water, 3 slices Ginger, boil to 1 zhan, strain, take warm before meals. Avoid all cold foods. (*Neiwai Shangbian*)