胁痛须分左右，治左属血虚，右属气，左缘肝火木气充，右必痰流兼所滞，左疾加减四
物汤，芍药芎归熟地黄，白术陈皮甘草茯，玄胡枳壳木香当，但痛不移淤作祟，红花苏木桂
桃姜。小柴胡汤治右痛，半茯柴芩甘壳共，木香大腹与青皮，白术香附煎可送。
复元通圣散 复元通圣穿山甲，青陈甘草栝蒌屑，每用热酒下一钱，诸痛诸疮和血气。
当归龙荟丸 治内有湿热，两胁痛甚者，此乃泻肝火之要药。
当归 龙胆草 山栀 黄连 大黄（酒炒） 芦荟 青黛各五钱 木香二钱五分 麝香
五分（另研） 加青皮 柴胡五分神曲丸如梧子，姜汤下三十丸。
香桂散
治妇人胁痛。
香附四两（醋一碗，盐一两煮干） 肉桂 白芍 玄胡（炒）各二两。
每服三钱，空心滚汤调下。
单方
治胁间刺痛，属气者。枳壳（面炒黄）二两半，甘草（炙）七钱。每服二钱，浓煎，葱
白汤下。
余论
胁痛，肝火盛者居多，间有瘀血痛甚。而元气实者，用桃仁承气下之（方见伤寒），或
因癖痛者，煮黄主之（方见心痛）。凡胁痛用青皮，必须醋煮过。
辨证
臂有风寒痛，有湿气痛，有痰饮痛。因睡露肩，偶然痛者，风寒也，宜五积散。原素受
湿，雨天甚者，湿气也，宜蠲痹汤加苍术、防己。两手软痹，肩背酸痛者，痰饮也，宜导汤
加木香、姜黄。
五积散（见中寒） 蠲痹汤（见痹） 导痰汤（见痰饮）
单方
漏肩风痛，向外坐门限上，用木棰烘热，赶痛处，七次即愈。
Pain in the hypochondrium must be distinguished by left and right sides. Treatment for the left side pertains to Blood Deficiency (Xue Xu), while treatment for the right side pertains to Qi Stagnation (Qi Zhi). Pain on the left is often due to Liver Fire (Gan Huo) flourishing and Wood Qi (Mu Qi) being excessive; pain on the right is necessarily caused by Phlegm-Dampness (Tan Shi) flowing and accompanied by Qi stagnation. For left-sided pain, Jiajian Siwu Tang (Modified Four Substance Decoction) may be used, containing Shaoyao (Radix Paeoniae Alba/Rubra), Xiong (Rhizoma Chuanxiong), Gui (Radix Angelicae Sinensis), Shudi Huang (Prepared Rhizoma Dioscoreae Hypoglaucae), Baizhu (Rhizoma Atractylodis Macrocephalae), Chenpi (Pericarpium Citri Reticulatae), Gancao (Radix Glycyrrhizae), Fuling (Sclerotium Poriae), Yanhusuo (Rhizoma Corydalis), Zhike (Fructus Aurantii), Muxiang (Radix Aucklandiae), Danggui (Radix Angelicae Sinensis - repeated in text), Honghua (Flos Carthami), Sumu (Lignum Sappan), Guizhi (Ramulus Cinnamomi), Taoren (Semen Persicae), and Jiang (Rhizoma Zingiberis Recens) if the pain is fixed in one location, indicating Blood Stasis (Yu Xue). For right-sided pain, Xiaochaihu Tang (Minor Bupleurum Decoction) is used, containing Banxia (Rhizoma Pinelliae Preparatum), Fuling (Sclerotium Poriae), Chaihu (Radix Bupleuri), Qin (Radix Scutellariae), Gancao (Radix Glycyrrhizae), Zhike (Fructus Aurantii), Muxiang (Radix Aucklandiae), Dafupi (Pericarpium Benincasae), Qingpi (Pericarpium Citri Reticulatae Viride), Baizhu (Rhizoma Atractylodis Macrocephalae), and Xiangfu (Rhizoma Cyperi). It can be decocted and taken.
Fuyuan Tongsheng San (Restoring Vitality and Unblocking Supreme Powder) consists of Shanjiajia (Squama Manitis), Qingpi (Pericarpium Citri Reticulatae Viride), Chenpi (Pericarpium Citri Reticulatae), Gancao (Radix Glycyrrhizae), and Gualou Xie (Semen Trichosanthis Pulverized). Take one qian with hot wine each time; it harmonizes Qi and Blood and treats various pains and sores.
Danggui Longhui Wan (Angelica and Gardenia Pill) treats severe pain in both hypochondria caused by internal Damp-Heat (Shi Re); this is a key medicine for purging Liver Fire. Ingredients include Danggui (Radix Angelicae Sinensis), Longdancao (Radix Gentianae), Shanzhi (Fructus Gardeniae), Huanglian (Rhizoma Coptidis), Dahuang (Radix et Rhizoma Rhei, stir-fried with wine), Lvhui (Resina Aloes), Qingdai (Indigo Naturalis), each 5 qian; Muxiang (Radix Aucklandiae) 2.5 qian; Shexiang (Moschus) 0.5 qian (separately ground); add Qingpi (Pericarpium Citri Reticulatae Viride) and Chaihu (Radix Bupleuri), each 0.5 fen; use Shenqu (Massa Medicata Fermentata) to form pills the size of wutong seeds. Take 30 pills with Ginger Decoction (Jiang Tang).
Xianggui San (Cyperi and Cinnamon Powder) treats hypochondriac pain in women. Ingredients include Xiangfu (Rhizoma Cyperi) 4 liang (boiled dry with one bowl of vinegar and 1 liang of salt), Rougui (Cortex Cinnamomi), Baishao (Radix Paeoniae Alba), and Yanhusuo (Rhizoma Corydalis, stir-fried), each 2 liang. Take 3 qian each time, mixed with boiling water on an empty stomach.
Single Prescription: Treats stabbing pain between the ribs, attributed to Qi Stagnation. Ingredients include Zhike (Fructus Aurantii, stir-fried with flour until yellow) 2.5 liang, Gancao (Radix Glycyrrhizae, honey-fried) 7 qian. Take 2 qian each time, decocted strongly, taken with Scallion White Decoction (Congbai Tang).
Additional Remarks: Most cases of hypochondriac pain are due to excessive Liver Fire; occasionally, severe pain is caused by Blood Stasis. For those with sufficient Yuanqi (Primary Qi), Tao Ren Cheng Qi Tang (Peach Kernel and Cathartic Decoction) may be used to purge downward (see Shanghan section); if pain is due to Pi Ji (accumulations), Zhu Huang Zhu Zhi (Boiled Huang Main Treatment) is used (see Xin Tong section). Whenever Qingpi (Pericarpium Citri Reticulatae Viride) is used for hypochondriac pain, it must be boiled with vinegar.
Syndrome Differentiation: Arm pain can be caused by Wind-Cold (Feng Han), Dampness (Shi Qi), or Phlegm-Fluids (Tan Yin). If pain occurs accidentally after sleeping with the shoulder exposed, it is due to Wind-Cold, suitable for Wuji San (Five Accumulations Powder). If originally susceptible to Dampness and worsens on rainy days, it is due to Dampness, suitable for Juanbi Tang (Expel Bi Decoction) added with Cangzhu (Rhizoma Atractylodis Lanceae) and Fangji (Radix Stephaniae Tetrandrae). If both hands are soft and numb, with soreness and pain in the shoulders and back, it is due to Phlegm-Fluids, suitable for Daotan Tang (Great Phlegm-Removing Decoction) added with Muxiang (Radix Aucklandiae) and Jianghuang (Rhizoma Curcumae Longae).
Wuji San (see Zhong Han section), Juanbi Tang (see Bi Zheng section), Daotan Tang (see Tan Yin section).
Single Prescription: For Lou Jian Feng (Leaky Shoulder Wind) pain, sit facing outward on a threshold. Use a wooden mallet heated by baking to beat the painful area seven times, which will result in recovery.