少止，火过复疼，至九壮身体回阳，十五壮热汗出乃愈。嗟乎！寒之中人深也，即用热药如姜、附，亦未见
速效，艾火之功神矣哉。（《星海》）
房事后受寒腹痛，灸神阙、气海等穴，或炒姜、葱熨之。（《医碥》）
脉候 弦而紧，胁痛，脏伤有瘀血（一作有寒血）。
（《脉经》）
寸口脉弦而滑，弦则为痛，滑则为实，痛即为急，实即为踊，痛踊相搏，即胸胁抢急。（同上）（按∶
《病源论》踊作跃，痛踊作弦滑，抢急下有痛也字。）
诊其脉弦而急，胁下如刀刺，状如飞尸，至困不死。左手脉大，右手脉小，病右胁下痛。寸口
脉双弦，则胁下拘急，其人涩涩而寒。（《病源论》）
其脉弦涩者顺，洪大者逆。（《奇效》）
脉双弦者，肝气有余，两胁作痛。（《正传》）（按∶《医统》曰∶双弦者，两手俱弦也。）
细紧或弦者，怒气。（《医统》）
沉涩是郁。（《准绳》）（按∶《准绳》本丹溪。）
病系胆肝肾三脉 邪气客于足少阳之络，令人胁痛、咳、汗出。阴气击于肝，寒气客于脉中，则
血泣脉急，引胁与小腹。（《病源论》）
胸胁痛者，由胆与肝及肾之支脉虚，为寒气所乘故也云云。此三经之支脉，并循行胸胁。邪气乘于胸
胁，故伤其经脉。邪气之与正气交击，故令胸胁相引而急痛也。（同上）
夫胁痛之病，医经云∶两胁者肝之候。又云∶肝病者两胁下痛。多因疲极嗔怒，悲哀烦恼，谋虑惊忧，
致伤肝脏。肝脏既伤，积气攻注，次于左则左胁痛，攻于右则右胁痛，移逆两胁则两胁俱痛。久而不愈，流
注筋脉，或腰脚重坠，或两股筋急，或四肢不举，渐至脊膂挛急疼痛，气遇风搏，则胁下结块，气遇寒搏，
则胁肋骨痛，下连小腹，上引心端。（《济生续》）
左右血气（宜参治例《要诀》文）左右胁者，阴阳之道路也，故肝生于左，肺藏于右。以左属
肝而藏血，肝阳也，血阴也，乃为外阳而内阴也。右属肺而主气，肺阴也，气阳也，乃为外阴而内阳也。或谓
肝血蓄于左胁，作块而痛者，为肝积，名肥气也。肝气郁于右胁，痞硬而痛，咳喘，为肺积，
名息贲也。而脾所系于右，其经湿胜，故痰饮湿能化之，
随经流入于右。左胁痛者，多因留血而作。右胁痛者，悉是痰气。两胁痛者，岂可一概而言哉。论病之由，当
分外之六淫，内之五邪。若暴怒伤触，悲哀气结，饮食过度，冷热失调，颠仆伤形者，或因痰积流注于右，与
血相搏，皆能为痛。张仲景论伤寒少阳耳聋胁痛甚者，此是肝胆之气郁而作
痛。且胁痛之病，诸经论之详矣。（《奇效》）
凡外之六淫，内之七情，劳役饮食，皆足以致痰气积血之病。虽然痰气固亦有流注于左者，然必与
血相搏而痛，不似右胁之痛无关于血也。（《准绳》）
胁痛有左右血气之辨，其在诸家之说，有谓肝位于左而藏血，肺位于右而藏气，故病在左者为血积，病
在右者为气郁。脾气亦系于右，故湿痰流注者亦在右。若执此说，则左岂无气，右岂无血，食积痰饮岂必无涉
于左乎。古无是说，此实后世之谬谈，不足凭也。然则在气在血何以辨之？但察其有形无形可知之矣。盖血积
有形而不移，或坚硬而拒按，气痛流行而无迹，或倏聚而倏散。若食积痰饮皆属有形之证，第详察所因，自可
识别。且凡属有形之证，亦无非由气之滞，但得气行，则何聚不散。是以凡治此者，无论是血是痰，必皆兼气
为主，而后随宜佐使以治之，庶得肯綮之法，无不善矣。（《景岳》）
胁痛一证，部位虽肝胆所主，而经文有心、肝、太阳、少阳之异，且有饮食、色欲、劳伤、传移诸候。
虽前贤凭理立论，以湿痰、死血、气虚等因分别左右，不过明左肝右肺部位，然左右皆肝胆经络，不必泥也。
况痛有由胁而入膈者，有由胸腹而移胁者，有自胁而上为巅疾者，有自胁而下流足膝者。症因各异，而总不越
乎肝胆之经，但不可徒执肝胆为治，当凭各症之因而立法施治，庶有济也。惟胁内隐痛，咳则震
动如裂，且因痛裂之难当，而欲咳不得咳者，此实肺邪之结，多见于右。若见于左者，仍在肝也。（《
医级》）
源候诸说 胁痛，肝火盛，木质实，有死血，有痰流注，肝急。（《丹溪》）
肝火盛、木气实而胁痛者，或因怒气太逆，肝气郁甚，谋虑不决，风中于肝，皆使木气甚，火盛则肝
急矣。经云∶肝苦急，急食辛以散之。抚芎、苍术（按∶《心法》更曰青皮、当归之类）或小柴胡汤之属。死
血、瘀血、恶血停留于肝，归于胁下而痛，其病则自汗，按之益痛甚，宜破血行气。气弱人胁下痛，脉细紧或
弦，多以劳役怒气得之，宜八物汤加木香、青皮，或加官桂。（《医统》引丹溪）（死血证更见行血诸方中。）
岁木太过，肝气旺盛，两胁充满，莫能舒泄，壅胀为痛，势急难支，此肝火之盛为之也。稀涎宿痰，留注
两胁，或僻一胁，绵绵隐痛，或作或止，一有呕恶，则吊动掣痛，久则形肿色赤，坚硬不移，若以肿毒治之增剧
，此痰气之结为之也。心生血，肝纳血，肝有热则妄行，注于胁则胁痛，或紫黑，或结块，上部抵当汤，中部
桃仁承气汤，皆称捷效，此污血之积为之也。又岁金肃烈，制木太过，致肝气郁而不伸，两胁痛而不止，此须
抑金扶木，泻有余而补不足，使两气和平，则痛自止，此肝被郁为之也。（按∶止就岁气为辨，遇泥难从，然
分肝盛、肝郁者，或有其理。）又有饮食填塞太阴，肝气被压，然肝者将军之官，其性猛烈，不受压制，上冲
之则胃脘痛，横行之则两胁痛，惟消食顺气，少兼温散，则食下而肝气自舒，胁痛自止。有医言胁下一条杠起作
痛者，食积也。夫饮食入胃，安得出胁而为杠起，必食积偏坠一边而近胁作痛，故医云然，孰信哉？信于理而已
矣。又有挫闪跌扑一症，或气郁，或血积，亦作胁痛，若以凉药治之，则痛益甚，须用行血行气之剂，而兼温
药以散之辄效。又有阳虚、阴虚二症、皆属之不足，非可有以余者例治也。（《司命》）
死血者，日轻夜重，或午后热，脉短涩或芤，桃仁承气汤加鳖甲、青皮、柴胡、芎、归之属。（按∶
《颐生微论》有左胁痛用桃仁承气汤加干漆治验，当参。）若跌扑胁痛者，亦是死血，宜复元活血汤、破血散
瘀汤（此东垣方，用羌、防、桂、翘、归、柴、蛭、麝、苏木）。怒气者，脉弦实有力，大剂香附合芎、归之
属。痰饮停伏者，脉沉弦滑，导痰汤加白芥子。房劳过多，肾虚羸怯之人，胸膈之间多有隐隐微痛，此肾虚不能
约气，气虚不能生血之故。气与血犹水也，盛则流畅，少则壅滞。故气血不虚则不滞，既虚则鲜有不滞者，所
以作痛，宜用破故纸之类补肾，芎、归之类和血。若作寻常胁痛治，即殆矣。（《准绳》）
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（《订补指掌》）
胁肋痛，肝经病也。盖肝与胆二经之脉布胁肋，肝火盛，木气实，故流于 胁肋间而作痛。凡人肩下
曰膊，膊下曰 ， 对腋，腋下为 ， 下为胁，胁后为肋，肋下为季肋，俗名肋稍，季肋之下为腰，部分如
此。今 胁肋痛，固由于肝经之实，而所谓肝邪者，不越气、血、食、痰、风寒五端。试先言五者之由，再详
症之所属。一曰气郁，由大怒气逆，或谋虑不决，皆令肝火动甚，以致 胁肋痛。（宜枳
壳煮散、枳壳散、桂枝汤、小龙荟丸。）一曰死血，由恶血
停留于肝，居于胁下，以致 胁肋痛，按之则痛益甚。（宜小柴胡汤合四物汤，加桃仁、红花、乳香、没药，或
桃仁承气汤、复元活血汤。）一曰痰饮，由痰饮流注于厥阴之经，以致 胁肋痛，痛则咳嗽气急。（宜控涎
丹云云。）一曰食积，由食停胁下，有一条扛起，以致 胁肋痛。（宜神保丸，以枳实汤吞下。又当归龙荟
丸。）一曰风寒，由外感风寒之邪，留着胁下，以致 胁肋痛。（宜芎葛汤、小柴胡汤加枳壳、桔梗。）此
五者皆足致痛，而惟怒气、瘀血居多也。至 胁肋地分，本近一处，故其为痛，亦不必细分何部，只以胁
痛概之。（《尊生书》）
肝血不足，悠悠痛不止者，四物汤加柴胡梢。若胁下
一点痛不止，此因酒色太过所致，名干胁痛，难治。（《指掌》）
瘀血作痛者，痛而不膨，按之亦痛，不按亦痛，其痛无时而息也。怒气作痛者，痛而且膨，得嗳则缓，已
而复痛，其痛有时而息也。此非血与气之辨乎。（《玉案》）
肝虚者，肝经虚也，阴虚则脉绌急。肝之脉贯膈布胁肋，阴虚血燥，则经脉失养而痛。其症胁下筋急，
不得太息，目昏不明，爪枯色青，遇劳即甚，或忍饥即发者是也。（《金匮翼》）
季胁痛 盖季胁两肋稍之处，肝之下，胆之位也。痛甚而下连少腹者亦是死血，痛不甚而止
于一处者痰也。（《玉案》）
季胁痛无不因肾虚者，加减八味丸（系去附子加五味子）、肾气丸选用。（《医通》）
治例 胁肋疼痛，服木通散（亦可治男子，出《明理
方》）。心下胁肋少腹疼痛，皆素有积寒，而温暖汤散亦可
主治，甚者以温药下之。心下与少腹痛，诸书并有效方，而胁肋下痛，鲜获治法。（《妇人良方》）
阴阳气滞，邪气未尽，五积散去麻黄，加茴香、青木香、桃仁、橘叶，小柴胡汤、本事芎葛汤、枳
壳散。饮食气郁连乳痛，沉香汤（按∶当单味煎汤）下红丸子。痛连小腹发欲死，新复元通气散、葱汤调下神
保丸。兼肿，二十四味流气饮下神保丸。（《永类》）（节录。）
痛甚者，肝火盛，以当归龙荟丸，姜汤下之，是泻火（按∶《纲目》作肝）之要药。死血，用桃仁、红
花、川芎。痰流注，以二陈汤加南星、苍术、川芎。有火盛者，当伐肝木。有气郁而胸胁痛者，看其脉沉涩，
当作郁治。痛而不得伸舒者，蜜丸龙荟丸最快。胁下有食积一条扛起，用吴茱萸、炒黄连。（《丹溪》）
曾有人胁痛连膈，进诸气药，并自大便导者，其痛殊甚，后用辛热补剂下黑锡丹方愈，此乃虚冷作痛，
愈疏而愈虚耳。胁痛病在肝胆，伤寒胁痛属少阳经，合用小柴胡汤；痛甚而不大便者，于内加枳壳。若寻
常胁痛，不系正伤寒，时身体带微热者，《本事方》中枳壳煮散。若只是胁痛，别无杂证，其痛在左为肝经受
邪，宜用川芎、枳壳、甘草；其痛在右，为肝经移病于肺，宜用片子姜黄、枳壳、桂心、甘草。此二方出严
氏《济生续集》，加减在人。又有肝胆经停痰伏饮，或一边胁痛，宜用严氏导痰汤。痰结成癖，间进半
硫丸。盖枳壳乃治胁痛的剂，所以诸方中皆不可少。曾见潘子先说有人胁痛，下青龙汤痛止，兼嗽得可，此
其痛必在右胁故也。灼然知是寒气作痛，枳实理中汤为宜。（《要诀》）
治之当以散结顺气，化痰和血为主，平其肝而导其滞，则无不愈矣。（《选要》）
胁痛二、三年不已者，乃痰瘀结成积块，肝积肥气，肺积息贲，发作有时。虽皆肝木有余，不可峻攻，宜
枳术丸加官桂、陈皮、桔梗、甘草，蜜丸服，或复元通气散。（《入门》）
去滞气须用青皮，乃肝胆二经药，人多怒，胁下有郁积者，固宜。（《六要》）
治不可过用降气 胁者，肝胆之区。肝为尽阴，喜条达而恶凝滞，胆无别窍，喜升发而恶抑郁。故
凡木郁不舒，而气无所泄，火无所越，胀甚惧按者，又当疏散升发以达之。
不可过用降气，致木愈郁而痛愈甚也。（《汇补》）
妇人治法 尝论夫左胁痛、胃脘痛二证，妇人多有之。以其忧思忿怒之气素蓄于中，发则上冲，被湿痰
死血阻滞其气而不得条达，故作痛也。故治妇人诸痛诸疾，必以行气开郁为主，而破血散火兼之，庶乎得
法矣。（《心法附余》）
疏肝诸方 治悲哀烦恼伤肝气，致两胁骨疼，筋脉紧急，腰脚重滞，两股筋急，两胁牵痛，四肢不
能举，渐至脊膂挛急。此药大治胁痛，枳壳煮散。
枳壳（去穣麸炒黄） 细辛（去叶） 桔梗（炒） 防风（去钗股） 川芎（各四两） 葛
根（一两半） 甘草（二两炙）
上粗末，每服四钱，水一盏半，姜三片，煎至七分去滓，空心食前温服。（《本事》）
大柴胡汤，治胁痛，口燥渴饮水，痛不可忍。（《医林集要》）
伤寒胁痛，小柴胡汤，加白牡蛎粉研碎，枳壳去穣切片，各半钱煎。（《得效》）《奇效》名加味小柴胡汤。
多怒之人，腹胁时常作痛者，小柴胡加川芎、芍药、青
皮之类，痛甚者，就以煎药送下当归龙荟丸。（《丹溪》）
左金丸，治肝火，一名回令丸。
黄连（六两一本作芩） 吴茱萸（一两或半两）
上为末，水丸，或蒸饼丸，白汤下五十丸。（《同上》）（按∶此本《圣惠》茱萸丸，见泄泻）又抑
青丸，泻肝火，黄连（半斤）为末，蒸饼糊丸服。
当归龙荟丸。（方见《骨蒸》中。）
Pain subsides slightly; if moxibustion heat is excessive, pain recurs. At nine moxa cones, body yang recovers; at fifteen moxa cones, hot sweat is discharged and the disease is cured. Alas! Cold pathogen invades the human body deeply. Even when using hot herbs such as Shengjiang (Zingiberis Rhizoma) and Fuzi (Aconiti Lateralis Radix Praeparata), rapid efficacy is not seen. The merit of moxa fire is truly miraculous. (*Xinghai*)
Abdominal pain caused by catching cold after sexual intercourse can be treated by moxibustion on Shenque (CV 8), Qihai (CV 6), and other acupoints, or by applying fried Shengjiang (Zingiberis Rhizoma) and Congbai (Allii Fistulosi Bulbus) to the affected area. (*Yiquan*)
**Pulse Diagnosis:** Pulse is wiry and tight, accompanied by hypochondriac pain, indicating organ injury with blood stasis (or alternatively, cold-blood). (*Maijing*)
Cunkou pulse is wiry and slippery. Wiry indicates pain; slippery indicates excess. Pain implies urgency; excess implies surging. When pain and surging contend, there is pulling and tension in the chest and hypochondrium. (Ibid.) [Note: *Zhoubing Yuanhou Lun* reads "yue" for "yong", and "xian-hua" for "tong-yong"; "pain" is added after "qiang-ji".]
Diagnosing a wiry and urgent pulse, with stabbing pain under the hypochondrium resembling "Feishi" (Flying Corpse disease); though extremely distressed, death does not ensue. A large pulse on the left hand and a small pulse on the right hand indicate pain under the right hypochondrium. A double-wiry Cunkou pulse indicates tension under the hypochondrium, with the patient feeling chilly and shivering. (*Zhoubing Yuanhou Lun*)
A wiry and choppy pulse is favorable; a flooding and large pulse is unfavorable. (*Qixiao Liangfang*)
Double-wiry pulse indicates Liver Qi excess, causing pain in both hypochondria. (*Yixue Zhengchuan*) [Note: *Yitong* states: Double-wiry means both hands have a wiry pulse.]
A fine, tight, or wiry pulse indicates anger. (*Yitong*)
A deep and choppy pulse indicates stagnation. (*Yixue Zhunsheng*) [Note: *Zhunsheng* follows Zhu Danxi.]
**Disease Location Involves Gallbladder, Liver, and Kidney Meridians:** Pathogenic factors lodging in the Foot-Shaoyang collateral cause hypochondriac pain, cough, and sweating. Yin energy striking the Liver, and Cold pathogen lodging in the vessels, causes blood to congeal and vessels to contract, pulling on the hypochondrium and lower abdomen. (*Zhoubing Yuanhou Lun*)
Chest and hypochondriac pain arises from deficiency in the branch meridians of the Gallbladder, Liver, and Kidney, which are invaded by Cold pathogen. The branch meridians of these three channels all circulate through the chest and hypochondrium. Pathogenic factors invading the chest and hypochondrium damage the meridians. The contention between pathogenic factors and healthy Qi causes pulling and urgent pain in the chest and hypochondrium. (Ibid.)
Regarding hypochondriac pain, medical classics state: The two hypochondria are the manifestation of the Liver. It also states: Patients with Liver disease suffer pain under both hypochondria. This is often due to extreme fatigue, anger, sorrow, worry, or fright, injuring the Liver. Once injured, accumulated Qi attacks and flows; accumulating on the left causes left-sided pain, on the right causes right-sided pain, and moving to both sides causes bilateral pain. If unresolved for a long time, it flows into the sinews, causing heavy legs and feet, tense thigh sinews, or inability to move limbs, gradually leading to spinal muscle spasms and pain. If Qi encounters Wind, masses form under the hypochondrium; if Qi encounters Cold, rib pain occurs, connecting downward to the lower abdomen and upward to the heart region. (*Jisheng Xu Fang*)
**Left and Right Blood and Qi** (Refer to Treatment Examples in *Yaojue*): The left and right hypochondria are the pathways of Yin and Yang. Thus, Liver Qi originates on the left, and Lung Qi resides on the right. The left belongs to the Liver and stores Blood; Liver is Yang, Blood is Yin, representing Outer Yang and Inner Yin. The right belongs to the Lung and governs Qi; Lung is Yin, Qi is Yang, representing Outer Yin and Inner Yang. Some say Liver Blood accumulates in the left hypochondrium, forming a mass and pain, called Liver Accumulation, named "Feiqi" (Fat Qi). Liver Qi stagnates in the right hypochondrium, causing distension, hardness, pain, cough, and asthma, called Lung Accumulation, named "Xiben" (Breathful Gasping). The Spleen is associated with the right; its channel has dominant Dampness, so Phlegm-Fluid-Dampness transforms and flows into the right via the channel. Left hypochondriac pain is mostly due to retained Blood. Right hypochondriac pain is entirely due to Phlegm-Qi. How can bilateral hypochondriac pain be discussed uniformly? Discussing etiology, one must distinguish external Six Excesses and internal Five Evils. Sudden anger, sorrowful Qi knotting, overeating, imbalance of cold/heat, or traumatic injury can cause Phlegm accumulation flowing to the right, contending with Blood, all resulting in pain. Zhang Zhongjing discusses Shaoyang deafness and severe hypochondriac pain in Cold Damage, attributing it to stagnation of Liver-Gallbladder Qi. Moreover, various classics discuss hypochondriac pain in detail. (*Qixiao Liangfang*)
External Six Excesses, internal Seven Emotions, labor, and dietary irregularities are sufficient to cause diseases of Phlegm-Qi and accumulated Blood. Although Phlegm-Qi can flow to the left, it must contend with Blood to cause pain, unlike right-sided pain which is unrelated to Blood. (*Yixue Zhunsheng*)
There is a distinction between left/right Blood/Qi in hypochondriac pain. Some schools claim the Liver is on the left storing Blood, and the Lung is on the right storing Qi, so left-sided disease is Blood Accumulation and right-sided is Qi Stagnation. Spleen Qi is also on the right, so Damp-Phlegm flows to the right. If one adheres to this view, how can there be no Qi on the left or Blood on the right? Can Food Stagnation and Phlegm-Fluid not involve the left? This theory did not exist in ancient times; it is a later fallacy and unreliable. So how to distinguish Qi from Blood? Observe whether it is tangible or intangible. Blood accumulation is tangible and fixed, hard and refusing pressure; Qi pain migrates without trace, appearing and disappearing suddenly. Food stagnation and Phlegm-Fluid are tangible syndromes; careful examination of etiology allows identification. Furthermore, all tangible syndromes stem from Qi stagnation; once Qi moves, aggregation disperses. Therefore, treatment for any case, whether Blood or Phlegm, must prioritize regulating Qi, followed by appropriate adjuvants. This is the key method for success. (*Jingyue Quanshu*)
Hypochondriac pain, although primarily governed by the Liver and Gallbladder, texts mention differences involving Heart, Liver, Taiyang, and Shaoyang, as well as dietary, sexual, labor, and transmission syndromes. Although predecessors established theories based on reasoning, distinguishing left/right by Damp-Phlegm, Dead Blood, and Qi Deficiency merely clarifies the Left-Liver/Right-Lung locations. However, both sides are Liver-Gallbladder meridians; one should not be rigid. Moreover, pain may enter the diaphragm from the hypochondrium, shift to the hypochondrium from the chest/abdomen, ascend to the head from the hypochondrium, or descend to the knees from the hypochondrium. Symptoms vary but always relate to Liver-Gallbladder meridians. One must not treat solely based on Liver-Gallbladder but must establish methods according to specific etiologies. Only when hidden pain in the hypochondrium feels like tearing upon coughing, and the patient wants to cough but cannot due to severe pain, is it actually Lung Pathogen consolidation, mostly seen on the right. If seen on the left, it remains in the Liver. (*Yiji*)
**Sources from *Zhoubing Yuanhou Lun*:** Hypochondriac pain involves Liver Fire excess, Wood Qi solidity, Dead Blood, Phlegm flow, and Liver urgency. (*Danxi Xinfa*)
Liver Fire excess and Wood Qi solidity causing hypochondriac pain may result from excessive anger, severe Liver Qi stagnation, indecisiveness, or Wind attacking the Liver, all making Wood Qi vigorous and Fire excessive, leading to Liver urgency. Classics state: "The Liver suffers from urgency; eat pungent flavors to disperse it." Use Xufu (Chuanxiong), Cangzhu (Atractylodis Rhizoma) [Note: *Xinfa* adds Qingpi and Danggui], or Xiaochaihu Tang. Dead Blood, Stasis Blood, and Evil Blood lingering in the Liver gather under the hypochondrium causing pain, with spontaneous sweating and increased pain on pressure; use blood-breaking and Qi-moving methods. For Qi-deficient patients with hypochondriac pain, wiry/tight/small pulse, often due to labor and anger, use Bawu Tang plus Muxiang and Qingpi, or Guigui. (*Yitong* citing Danxi) (See blood-moving formulas for Dead Blood syndrome.)
When Year Wood is excessive, Liver Qi is vigorous, causing fullness in both hypochondria, inability to vent, distension and pain, urgent and unbearable; this is due to excessive Liver Fire. Old Phlegm flows into both hypochondria, or one side, causing lingering dull pain, intermittent. Nausea triggers pulling pain; long-term results in swelling, redness, and immobility. Treating as abscess worsens it; this is Phlegm-Qi knotting. Heart generates Blood, Liver stores Blood; Liver Heat causes reckless bleeding, flowing to hypochondrium causing pain, purple-black color, or masses. Upper body uses Didang Tang, middle body uses Tao Ren Chengqi Tang, both effective; this is Filthy Blood accumulation. When Year Metal is severe, suppressing Wood excessively, Liver Qi stagnates, causing persistent bilateral hypochondriac pain; suppress Metal, support Wood, drain excess, tonify deficiency to balance Qi, stopping pain; this is Liver depression. [Note: Differentiation based on annual Qi is rigid, but distinguishing Liver Excess vs. Depression has merit.] Dietary blockage in Taiyin compresses Liver Qi; however, Liver is the General, fierce nature, resisting compression. Upward rushing causes epigastric pain; horizontal spreading causes bilateral hypochondriac pain. Digest food, smooth Qi, add mild warming/dispersing agents; once food digests, Liver Qi relaxes, pain stops. Some doctors say a raised bar under the hypochondrium indicates Food Stagnation. Food enters the stomach; how can it emerge to the hypochondrium as a bar? It must be Food Stagnation shifting to one side near the hypochondrium. Doctors say so, but believe only in reason. Trauma or falls causing Qi stagnation or Blood accumulation also cause hypochondriac pain; cooling herbs worsen pain. Use blood-moving and Qi-regulating herbs with warming dispersants for efficacy. Yang Deficiency and Yin Deficiency are insufficiencies, not treated as excess. (*Siming*)
Dead Blood: Lighter by day, heavier by night, or afternoon fever, short/choppy or knotted pulse. Use Tao Ren Chengqi Tang plus Biejia (Tartaricae Testa), Qingpi, Chaihu, Chuanxiong, Danggui. [Note: *Yisheng Weilun* records left hypochondriac pain treated with Tao Ren Chengqi Tang plus Ganqi; refer.] Traumatic hypochondriac pain is also Dead Blood; use Fuyuan Huoxue Tang or Poxue San Yu Tang (Dongyuan's formula: Qianghuo, Fangfeng, Guizhi, Lianqiao, Danggui, Chaihu, Shizhe, Shexiang, Sumu). Anger-induced: wiry/excess/forceful pulse; large dose of Xiangfu combined with Chuanxiong and Danggui. Phlegm-Fluid retention: deep/wiry/slippery pulse; Daotan Tang plus Baijiezi. Excessive sexual activity, Kidney Deficiency weakness: dull pain in chest/diaphragm due to Kidney failing to control Qi and Qi failing to generate Blood. Qi and Blood are like water; abundant flows, scarce stagnates. Deficiency leads to stagnation and pain. Use Boguzhi to tonify Kidney, Chuanxiong and Danggui to harmonize Blood. Treating as ordinary hypochondriac pain is dangerous. (*Yixue Zhunsheng*)
Bilateral hypochondriac migration with sound: Phlegm-Fluid. Left hypochondriac mass with fixed pain: Dead Blood. Right hypochondriac mass with pain and fullness: Food Stagnation. Cough,急促 breathing, fever: Phlegm-Knot pain; untreated becomes Lung Abscess. Labor-injury fever and hypochondriac pain: pulse must be deficient. (*Dingbu Zhizhang*)
Hypochondriac-Rib pain is a Liver Channel disease. Liver and Gallbladder meridians distribute to hypochondriac-ribs. Liver Fire excess, Wood Qi solid, flows to hypochondriac-ribs causing pain. Anatomy: Shoulder below is Bo, Bo below is Nao, Nao opposite Ye, Ye below is Xie, Xie posterior is Lei, Lei below is Jilei (rib tip), Jilei below is Yao. Current hypochondriac-rib pain stems from Liver Channel Excess. Liver Pathogens do not exceed Qi, Blood, Food, Phlegm, Wind-Cold.
1. **Qi Stagnation:** From great anger or indecision, stirring Liver Fire, causing hypochondriac-rib pain. (Use Zhike Zhusan, Zhike San, Guizhi Tang, Xiao Longhui Wan.)
2. **Dead Blood:** Evil blood lingers in Liver, under hypochondrium, causing pain worse on pressure. (Use Xiaochaihu Tang combined with Siwu Tang, plus Taoren, Honghua, Ruxiang, Moyao; or Tao Ren Chengqi Tang, Fuyuan Huoxue Tang.)
3. **Phlegm-Fluid:** Flows into Jueyin channel, causing pain with cough/shortness of breath. (Use Kongyan Dan.)
4. **Food Stagnation:** Food stops under hypochondrium, raised bar, causing pain. (Use Shenbao Wan swallowed with Zhishi Tang; or Danggui Longhui Wan.)
5. **Wind-Cold:** External pathogen lodges under hypochondrium, causing pain. (Use Xiong Ge Tang, Xiaochaihu Tang plus Zhike, Jiegeng.)
These five cause pain, mostly Anger and Blood Stasis. Locations are close; pain need not be subdivided. (*Zunsheng Shu*)
Liver Blood deficiency, lingering pain: Siwu Tang plus Chaishao. Single point pain under hypochondrium unceasing, due to excessive wine/sex, named Gan Xietong (Dry Hypochondriac Pain), difficult to treat. (*Zhizhang*)
Blood Stasis pain: Pain without distension, painful on and off pressure, constant pain. Anger pain: Pain with distension, relieved by belching, recurring, intermittent pain. Is this not the difference between Blood and Qi? (*Yu An*)
Liver Deficiency: Liver Channel deficiency, Yin deficiency causes vessel contraction. Liver meridian passes diaphragm to hypochondriac-ribs; Yin deficiency/Blood dryness causes vessel malnourishment and pain. Symptoms: Tense sinews under hypochondrium, inability to deep breathe, blurry vision, brittle green nails, worsening with labor or hunger. (*Jinkui Yi*)
**Jilei (Rib Tip) Pain:** Located at rib tips, below Liver, position of Gallbladder. Severe pain connecting to lower abdomen is Dead Blood; mild pain localized to one spot is Phlegm. (*Yu An*)
Jilei pain is invariably due to Kidney Deficiency. Select Jiajian Bawei Wan (Bawei Wan minus Fuzi plus Wuweizi) or Shenqi Wan. (*Yixue Rumen*)
**Treatment Examples:** Hypochondriac-rib pain: Mutong San (also for men, *Mingli Fang*). Epigastric, hypochondriac, lower abdominal pain due to chronic cold: Wenwan Tang San; severe cases use warming purgatives. Epigastric/lower abdominal pain has many formulas; hypochondriac pain lacks standard treatments. (*Furen Liangfang*)
Yin-Yang Qi stagnation, residual pathogen: Wuji San minus Mahuang, plus Huixiang, Qingmuxiang, Taoren, Juye; Xiaochaihu Tang, Ben Shi Xiong Ge Tang, Zhike San. Dietary Qi stagnation radiating to breast pain: Chenxiang Tang (single herb decoction) with Hong Wan Zi. Pain radiating to lower abdomen, agonizing: Xin Fuyuan Tongqi San, Shenbao Wan with Scallion Decoction. With swelling: Ershi Siwei Liuqi Yin with Shenbao Wan. (*Yonglei Qianfang*) (Excerpt.)
Severe pain, Liver Fire excess: Danggui Longhui Wan with Ginger Decoction (key fire-draining herb per *Bencao Gangmu*). Dead Blood: Taoren, Honghua, Chuanxiong. Phlegm flow: Erchen Tang plus Nanxing, Cangzhu, Chuanxiong. Fire excess: Drain Liver Wood. Qi stagnation with chest/hypochondriac pain, deep/choppy pulse: Treat as Stagnation. Pain preventing extension: Honey-pill Longhui Wan is fastest. Food stagnation bar under hypochondrium: Wuzhuyu, Fried Huanglian. (*Danxi Xinfa*)
Case: Hypochondriac pain radiating to diaphragm, aggravated by Qi-regulating herbs and bowel purgation. Cured by辛热 (pungent-hot) tonic with Heixi Dan. This was deficiency-cold pain; further draining increased deficiency. Hypochondriac pain is Liver/Gallbladder disease; Cold Damage hypochondriac pain is Shaoyang, use Xiaochaihu Tang; if severe constipation, add Zhike. Ordinary hypochondriac pain with slight fever: Zhike Zhusan (*Ben Shi Fang*). Isolated hypochondriac pain, left side: Liver Channel pathogen, use Chuanxiong, Zhike, Gancao; right side: Liver pathogen transferring to Lung, use Pian Jiang Huang, Zhike, Guixin, Gancao. These two formulas from Yan Shi *Jisheng Xu Ji*, modifications depend on practitioner. Gallbladder/Liver Phlegm-Fluid, unilateral pain: Yan Shi Daotan Tang. Phlegm-knot mass: Intermittent Banshu Wan. Zhike is essential for hypochondriac pain. Pan Zixian reported hypochondriac pain cured by Qinglong Tang, with cough relief; pain likely right-sided. Clearly Cold pain: Zhishi Lizhong Tang is suitable. (*Yaojue*)
Treatment should focus on resolving knots, smoothing Qi, transforming Phlegm, harmonizing Blood, calming Liver, and guiding stagnation. All will heal. (*Xuanyao*)
Hypochondriac pain lasting 2-3 years forms masses from Phlegm-Stasis: Liver Feiqi, Lung Xiben, periodic attacks. Though Liver Wood excess, do not attack harshly. Use Zhizhu Wan plus Guigui, Chenpi, Jiegeng, Gancao, honey pills; or Fuyuan Tongqi San. (*Rumen*)
Remove stagnant Qi with Qingpi, a Liver/Gallbladder herb; suitable for angry patients with hypochondriac stagnation. (*Liuyao*)
Do not overuse Qi-descending herbs: Hypochondrium is Liver/Gallbladder zone. Liver is pure Yin, likes free flow, hates stagnation; Gallbladder has no separate opening, likes ascending, hates depression. When Wood stagnates, Qi cannot vent, Fire cannot escape, distension fears pressure, use dispersing/ascending methods. Do not overuse descending herbs, worsening Wood stagnation and pain. (*Huibu*)
**Women's Treatment:** Left hypochondriac pain and epigastric pain are common in women. Due to accumulated sorrow/anger Qi, rising up, blocked by Damp-Phlegm/Dead Blood, unable to flow freely, causing pain. Treat women's pains by regulating Qi and resolving depression primarily, supplemented by blood-breaking and fire-clearing. (*Xinfa Fuyu*)
**Liver-Soothing Formulas:** Treats sorrow/worry injuring Liver Qi, causing bilateral rib pain, tendon tension, heavy legs/thighs, pulling hypochondriac pain, limb paralysis, spinal spasm. Excellent for hypochondriac pain: Zhike Zhusan.
Zhike (de-rind, bran-fried yellow), Xixin (de-leaf), Jiegeng (fried), Fangfeng (de-twig), Chuanxiong (each 4 liang), Gegen (1.5 liang), Gancao (roasted, 2 liang).
Coarse powder. Take 4 qian, water 1.5 sheng, 3 slices ginger, boil to 0.7 sheng, strain. Warm take on empty stomach before meals. (*Ju Fang*)
Da Chaihu Tang: Treats hypochondriac pain, dry mouth/thirst, unbearable pain. (*Yilin Jiyao*)
Cold Damage hypochondriac pain: Xiaochaihu Tang plus Bai Mu Li powder (ground), Zhike (de-rind, sliced), each 0.5 qian, decoct. (*Defang*) Named Jiawei Xiaochaihu Tang in *Qixiao*.
Angry people with frequent abdominal/hypochondriac pain: Xiaochaihu Tang plus Chuanxiong, Shaoyao, Qingpi. Severe pain: swallow Danggui Longhui Wan with decoction. (*Danxi Xinfa*)
Zuojin Wan: Treats Liver Fire, also called Huiling Wan.
Huanglian (6 liang, some say Huangqin), Wuzhuyu (1 liang or 0.5 liang).
Powder, water pills or steamed cake pills. Take 50 pills with warm water. (*Ibid.*) [Note: Based on *Shenghui Fang* Zhuyu Wan for diarrhea.] Also Yiqing Wan: Drains Liver Fire. Huanglian (0.5 jin) powder, steamed cake paste pills.
Danggui Longhui Wan. (Formula see *Guzheng* section.)