（腹中窄狭附）
人身背为阳，腹为阴。中脘属太阴，小腹左右属厥阴，脐腹正中属少阴、冲任。经论寒痛十一条，热痛
一条，寒热痛二条，血虚痛一条，此泛言猝痛，而腹痛该之矣。其症有暴痛久痛，实痛虚痛，有痛在气分血分，
在腑在脏，在经络之辨。凡暴痛非热，久痛非寒；虚痛喜按，实痛拒按。痛在气分者，攻注不定；在血分者，
刺痛不移。痛在腑者，脉多弦滑；在脏者，脉多沉微。初痛邪在经，久痛必入络。经主气，络主血也。感寒腹
痛者，气滞阳衰，喜热手按，脉沉迟，治在温中。香砂理中汤去白术。感寒
呕痛者，气虚兼痰，脉弦滑，治在健运。香砂六君子汤去白术。气滞兼食者，腹中有一条扛起，利后痛减，
脉沉滑，治在消导。香砂枳术汤加神曲、麦芽，或保和丸。寒气滞痛，兼胀满者，治在温通。排气饮加砂仁，
去泽泻。胃虚肝乘，吐酸浊者，治在辛泄。吴茱萸汤。伤寒腹急痛，阳脉涩，阴脉弦，治在甘缓。小建中汤。
太阴寒痛，自利脉沉，理中汤。厥阴寒痛，肢厥脉细，当归四逆汤。少阴寒痛，四肢沉重，咳呕下利，脉沉细，
真武汤。外感兼宿食，或中暑霍乱吐泻，藿香正气散、六和汤。胸腹绞痛，上不得吐，下不得泻，名干霍乱，
脉沉伏，急以烧盐汤探吐，再服藿香正气散。火郁痛，时作时止，热手按而不减，脉洪疾，清中汤，或二陈
汤加栀、苍、连、芍、郁金。热厥痛，时作时止，金铃子散。七情气郁，攻冲作痛，三因七气汤、五磨饮。
理气不应，脉芤涩，痛如芒刺，为血郁，手拈散。血虚腹痛，饥劳必甚，芍药甘草汤加桂、枣、当归。气
血虚寒，腹痛脉微，按之温之必稍缓，大营煎、理阴煎。当脐 痛，审系肝脾络血痧结，失笑散加归须、桃仁、
韭汁。若肾虚任脉为病，六味丸加龟板。凡痛久必入血络，非香燥可劫，治宜宣络。旋复花汤加归须、桃仁、
生鹿角。死血痛，由血络阻痹，桃仁承气汤加苏木、红花。积聚痛，由宿有 瘕，木香槟榔丸去大黄、牵牛，
加郁金。有热，阿魏丸，跌伤痛，由血瘀胁腹，复元活血汤。酒积痛，由湿热阻滞，曲 丸。小腹满痛，由经
闭血滞，玉烛散去硝黄，加延胡索、香附。思伤脾气， 结悸痛，归脾汤去白术。怒伤肝火，痞结刺痛，柴
胡疏肝散，或左金丸。虫痛时作时止，有块梗起，口吐清水，唇有红点，脉乍大乍小，理中安蛔散、乌梅丸
加减。疝气痛，必引睾丸，香橘散、立效散。肠痈痛，身皮甲错，小便如淋，腹皮急，按之濡右左，足屈者大
小，肠痈。牡丹皮饮、十味排脓散。中恶腹痛，霍乱吐利，苏合香丸。大抵腹痛，寒淫为多，热淫为少，以阴
寒尤易阻塞阳气也。腹痛气滞者多，血滞者少，理气滞不宜动血，理血滞则必兼行气也。古谓痛则不通，通则
不痛，故治痛大法，不外温散辛通，而其要则初用通腑，久必通络，尤宜审虚实而施治者矣。
〔腹中窄狭〕《医通》云∶肥人乃是湿痰留滞，气不升降，当行气燥湿。越鞠丸、平胃散为主。瘦人乃
是阴虚火旺，熏蒸脏腑，当降火开郁。逍遥散、左金丸为主。肥人腹中辘辘有声，须作痰治，二术二陈汤。
气虚者，加人参。
(Attached: Sensation of Narrowness in the Abdomen)
The human back belongs to Yang, and the abdomen belongs to Yin. The region of Zhongwan (CV12) is associated with the Taiyin meridian; the left and right sides of the lower abdomen are associated with the Jueyin meridian; the center of the umbilical and abdominal region is associated with the Shaoyin meridian, as well as the Chong and Ren vessels. Medical classics discuss eleven types of cold-induced abdominal pain, one type of heat-induced abdominal pain, two types of alternating cold-heat abdominal pain, and one type of blood-deficiency abdominal pain. These generally refer to sudden-onset pain, thereby encompassing all abdominal pain conditions. Symptoms include acute versus chronic pain, excess versus deficiency pain, and distinctions regarding whether the pain is located in the Qi level or Blood level, in the Fu organs or Zang organs, or in the meridians and collaterals. Generally, acute pain is not due to heat, while chronic pain is not due to cold; deficiency pain is relieved by pressure, whereas excess pain rejects pressure. Pain at the Qi level is migratory and indefinite; pain at the Blood level is stabbing and fixed in location. Pain in the Fu organs typically presents with a wiry and slippery pulse; pain in the Zang organs typically presents with a deep and faint pulse. Initial pain indicates pathogenic factors in the meridians, while chronic pain inevitably enters the collaterals, because meridians govern Qi and collaterals govern Blood. For abdominal pain caused by cold invasion, characterized by Qi stagnation and Yang decline, preference for warm hand pressure, and a deep, slow pulse, treatment should focus on warming the middle. Use Xiangsha Lizhong Tang (Amomum and Aucklandia Decoction for Regulating the Middle), removing Baizhu (Atractylodis Macrocephalae Rhizoma). For abdominal pain with vomiting caused by cold invasion, characterized by Qi deficiency combined with phlegm and a wiry, slippery pulse, treatment should focus on strengthening and transforming. Use Xiangsha Liujunzi Tang (Amomum and Aucklandia Decoction for Strengthening the Six Upright Principles), removing Baizhu. For Qi stagnation combined with food retention, characterized by a band-like elevation in the abdomen, pain relief after defecation, and a deep, slippery pulse, treatment should focus on promoting digestion and guiding out stagnation. Use Xiangsha Zhizhu Tang (Amomum and Aucklandia Decoction for Regulating the Spleen), adding Shenqu (Massa Medicata Fermentata) and Maiya (Hordei Fructus Germinatus), or use Baohe Wan (Preserve Harmony Pill). For pain due to cold-Qi stagnation combined with distension, treatment should focus on warming and unblocking. Use Paqi Yin (Qi-Expelling Drink), adding Sharen (Amomi Fructus), removing Zexie (Alismatis Rhizoma). For stomach deficiency with Liver overacting, characterized by vomiting of sour turbid fluids, treatment should focus on acrid dispersal and draining. Use Wuzhuyu Tang (Evodiae Fructus Decoction). For abdominal urgent pain due to Cold Damage, with a choppy Yang pulse and wiry Yin pulse, treatment should focus on sweet moderation. Use Xiaojianzhong Tang (Minor Construct the Middle Decoction). For Taiyin cold pain with spontaneous diarrhea and a deep pulse, use Lizhong Tang (Regulate the Middle Decoction). For Jueyin cold pain with cold limbs and a fine pulse, use Danggui Sini Tang (Angelica Sinensis Decoction for Reversing Cold). For Shaoyin cold pain with heavy limbs, cough, vomiting, diarrhea, and a deep, fine pulse, use Zhenwu Tang (True Warrior Decoction). For external contraction combined with retained food, or summerheat Huoluan (Food Poisoning/Cholera) with vomiting and diarrhea, use Huoxiang Zhengqi San (Agastache Powder for Rectifying Qi) or Liuhe Tang (Six Harmonies Decoction). For severe chest and abdominal cramping pain, inability to vomit or defecate, known as Gan Huoluan (Dry Cholera), with a deep, hidden pulse, urgently induce vomiting using Shaoyan Tang (Burned Salt Soup), then administer Huoxiang Zhengqi San. For pain due to Fire Stagnation, occurring intermittently, not relieved by warm pressure, with a surging and rapid pulse, use Qingzhong Tang (Clear the Middle Decoction), or Erchen Tang (Two-Cured Decoction) plus Zhizi (Gardeniae Fructus), Cangzhu (Atractylodis Rhizoma), Lianqiao (Coptidis Rhizoma - *Note: Text says Lian, usually Huanglian*), Baishao (Paeoniae Radix Alba), and Yujin (Curcumae Radix). For pain due to Heat Jue (Reversal), occurring intermittently, use Jinlingzi San (Melia Toosendan Powder). For pain due to emotional Qi stagnation attacking and causing pain, use Sanyin Qi Qi Tang (Three Causes Seven Qi Decoction) or Wumo Yin (Five Grinds Drink). If regulating Qi is ineffective, with a knotted and choppy pulse, and pain like thorns, this is Blood Stagnation; use Shou Nian San (Hand-Picking Powder). For blood-deficiency abdominal pain, worsening with hunger and labor, use Shaoyao Gancao Tang (Peony and Licorice Decoction) plus Guizhi (Cinnamomi Ramulus), Dazao (Ziziphi Jujubae Fructus), and Danggui (Angelicae Sinensis Radix). For Qi and Blood deficiency with cold, abdominal pain with a faint pulse, slightly relieved by pressing and warming, use Daying Jian (Great Camp Decoction) or Liyin Jian (Nourishing Yin Decoction). For pain at the umbilicus, if confirmed as Liver-Spleen collateral blood stasis and Sha (sand/stasis) knotting, use Shixiao San (Instant Relief Powder) plus Danggui Xu (Angelicae Sinensis Radix Caulis), Taoren (Persicae Semen), and Jiuji (Allii Tuberosi Juice). If it is Kidney deficiency affecting the Ren vessel, use Liuwei Wan (Six-Ingredient Pill) plus Guiban (Testudinis Carapax et Plastrum). Generally, chronic pain inevitably enters the blood collaterals; it cannot be forcibly attacked with aromatic-dry herbs. Treatment should focus on unblocking the collaterals. Use Xuanfuhua Tang (Inula Flower Decoction) plus Danggui Xu, Taoren, and Sheng Lujiao (Cervi Cornu Pantotrichum). For death-blood pain caused by collateral obstruction, use Taoren Chengqi Tang (Peach Kernel and Cathartic Decoction) plus Sumu (Sappan Lignum) and Honghua (Carthami Flos). For accumulation pain caused by existing masses, use Muxiang Binglang Wan (Costus and Areca Nut Pill), removing Dahuang (Rhei Radix et Rhizoma) and Qianniu (Pharbitidis Semen), adding Yujin. If there is heat, useawei Wan (Styrax Pill). For trauma pain caused by blood stasis in the hypochondrium and abdomen, use Fuyuan Huoxue Tang (Restore Origin Invigorating Blood Decoction). For alcohol accumulation pain caused by damp-heat obstruction, use Qu Wan (*Text implies a pill containing yeast/enzyme, likely referring to a specific formulation*). For lower abdominal fullness and pain caused by amenorrhea and blood stasis, use Yuzhu San (Jade Candle Powder), removing Xiaoshi (Natrii Sulfas) and Dahuang, adding Yanhusuo (Corydalis Rhizoma) and Xiangfu (Cyperi Rhizoma). For spleen Qi injury from overthinking, resulting in heart-spleen palpitation and pain, use Guipi Tang (Restore the Spleen Decoction), removing Baizhu. For liver fire injury from anger, resulting in epigastric fullness and stabbing pain, use Chaihu Shugan San (Bupleurum Powder for Soothing the Liver) or Zuojin Wan (Left Metal Pill). For worm pain occurring intermittently, with blockages rising, spitting clear water, red spots on lips, and fluctuating pulses, use Lizhong Anhui San (Regulate the Middle and Pacify Worms Powder) or Wumei Wan (Mume Pill) with modifications. For hernia pain, which necessarily radiates to the testicles, use Xiangju San (Aromatic Orange Powder) or Lixiao San (Immediate Effect Powder). For intestinal abscess pain, characterized by rough skin like fish scales, urinary symptoms resembling strangury, tense abdominal wall, soft upon pressure, and flexion of legs on either side indicating large or small intestine abscess, use Mudanpi Yin (Moutan Decoction) or Shiwei Paimon San (Ten-Ingredient Pus-Discharging Powder). For evil qi attack causing abdominal pain with Huoluan vomiting and diarrhea, use Suhexiang Wan (Styrax Pill). Generally, abdominal pain is mostly due to cold pathogens and rarely due to heat, because Yin-cold easily obstructs Yang Qi. Abdominal pain due to Qi stagnation is common, while that due to Blood stagnation is rare. When treating Qi stagnation, one should avoid disturbing the Blood; when treating Blood stagnation, one must simultaneously move Qi. Ancients said, "Pain indicates obstruction; freedom from pain indicates flow." Therefore, the general principle for treating pain is not beyond warming and dispersing, and acridly unblocking. The key lies in initially using methods to unblock the Fu organs, and for chronic cases, inevitably using methods to unblock the collaterals. It is especially important to examine deficiency and excess before applying treatment.
[Regarding Sensation of Narrowness in the Abdomen]: *Yitong* states: In obese individuals, this is due to damp-phlegm retention and impaired Qi ascent and descent; treatment should promote Qi movement and dry dampness. Yueju Wan (Resolve Frustration Pill) and Pingwei San (Calm the Stomach Powder) are primary formulas. In thin individuals, this is due to Yin deficiency with hyperactive fire steaming the Zang-Fu organs; treatment should descend fire and open depression. Xiaoyao San (Wandering Powder) and Zuojin Wan (Left Metal Pill) are primary formulas. Obese individuals with rumbling sounds in the abdomen should be treated as phlegm disorders, using Eryue Erchen Tang (Two Atractylodes and Two-Cured Decoction). For Qi deficiency, add Renshen (Ginseng Radix et Rhizoma).