〔大〕夫妇人两胁胀痛者，由脏腑虚弱，气血不调，风冷之气，客于肠胃，伤于胞络
之间，与血气相搏，壅寒不宣，邪正交争冲击，故令两胁胀痛也。
〔薛〕东垣先生云∶胸胁作痛，口苦舌干，寒热往来，发呕发吐，四肢满闷，淋溲
便难，腹中急痛，此肝木之妄行也。窃谓前证若暴怒伤血，用小柴胡、芎、归、山栀。气
虚用四物、参、术、柴、栀。若久怒伤气，用六君、芎，归、山栀。若气血俱虚，用六味
地黄丸。若经行腹痛，寒热晡热，或月经不调，发热痰咳，少食嗜卧，体痛，用八珍、柴
胡、丹皮。若胁胀发热，口渴唾痰，或小便淋沥，颈项结核，或盗汗，便血，诸血失音，
用六味丸。若两胁作胀，视物不明，或筋脉拘急，面色青，小腹痛，或小便不调，用补
肝散。若概用香燥之剂，反伤清和之气，则血无所生，诸证作焉。丹溪先生云∶右胁痛
用推气散、小龙荟丸、当归龙荟丸、控涎丹、抑青丸，十枣汤，皆病气元气俱实之剂，用
者审之。一妇人性急，吐血发热、两胁胀痛，日晡益甚，此怒气伤肝，气血俱虚也。朝
用逍遥散倍加炒黑山栀、黄柏、贝母、桔梗、麦门冬，夕以归脾汤送地黄丸而愈。 一孀
妇内热晡热，肢体酸麻，不时吐痰，或用清气化痰药，喉间不利，白带腹胀；用行气散
血药，胸痛不利，肢体时麻。此郁怒伤肝脾而药益甚也。予则朝用归脾汤以解脾郁，生
脾气，夕用加味逍遥散以清肝火，生肝血，百余剂而愈。后因怒，饮食日少，肢体时麻，此
乃肝火侮土，用补中益气加山栀、茯苓，半夏而痊。又饮食失调，兼有怒气，肢体麻甚，
月经如注，脉浮洪而数，此脾受肝伤，不能统血则致崩，肝气亏损阴血而脉大，继用六
君加芎、归、炮姜而血崩止，又用补中益气加炮姜、茯苓、半夏而元气复，更用归脾汤、
逍遥散调理而康。
灵宝散 治妇人血气攻刺，痛引两胁。
丁香 木香 乳香 玄胡索 当归 白芍药（各等分）
上为细末，每服二钱，食前温酒调下。
草豆蔻散 治妇人脾胃虚，气攻两胁胀痛。
草豆蔻 诃子肉（各一两） 桂心 苦梗 浓朴（各三分） 甘草（一分） 川芎 当归
干姜 槟榔（各半两）
上为粗末，每服四钱，水一盏，煎七分，去滓食前热服。
子散 治妇人脏腑虚冷，宿冷气攻，两胁胀痛，坐卧不安。
子 延胡索 桃仁 琥珀 当归 桂心（各一两） 赤芍药 木香 没药（各半两）
上为末，每服二钱，温酒调下。
人参紫金丸 治妇人荣卫不和，心腹刺痛，胸膈胀满，不进饮食。
紫金皮 苍术 石菖蒲（各一两） 香附子（二两） 人参（半两） 木香（三钱）
上为末，米糊丸如梧子大。食后姜汤吞下三十丸。
气针丸 治久积风壅，疏利气滞，空胸膈，止刺痛。
木香 青皮（去白） 大黄（炮） 槟榔 凰撇÷觯 镏 保 绞秩缁穑 源酥 涫低
也，众问如何治疗？仆曰大凡心腹刺痛，不可便作虚冷治之。有二医答曰∶非冷即何？热
即生风，冷生气是也。予曰∶不然。《难经》云∶虚则痒，实则痛。又仲景云∶腹痛者桂
枝加芍药汤，痛甚者，桂枝加大黄汤。提干曰∶荆布素弱。予曰∶有可辨处，遇痛时使
一婢按之，若痛止是虚寒证也。按之转甚，手不可近，此实痛也。即令婢按之，手不可近，
叫呼异常。予曰∶此实热无可疑者。当用大柴胡汤治之。众不从，予责状而投之，八服
愈。
论胁肋痛服木通散。（亦可治男子。）
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
小腹痛，诸书并有效方，而胁肋下痛，鲜获治法。
木通散 治胁肋苦痛偏效，并心下胁肋，并少腹牵引痛者，皆主之。
木通（去皮节） 青皮（去白） 川楝子（去皮核，各一两。以上三味，用巴豆半两，炒黄，
去巴豆不用） 萝卜子（炒） 舶上 香（一两，炒） 莪术 木香 滑石（各半两）
上为细末，煎葱白酒调三钱，一服愈。甚者不过再服。
三腕散 治中焦虚痞，两胁气痛，面目手足浮肿，大便秘涩，兼治香港脚。
大腹皮 紫苏 沉香 干木瓜 独活（各一两） 白术 川芎 木香 甘草 陈皮 槟
榔（各三分）
上 咀，每服三钱，水一盏，煎至七分，去滓空心热服，日中再服。戊午秋在京城，
有一妇人，中焦虚痞，腹膨胀痛，大便秘结，六脉虚弱，诸医服药无效。予投此药，不终
剂而愈。
《补遗》∶《局方》青木香丸、沉香降气汤、小乌沉汤、四磨汤皆可用。
〔薛〕左金丸 （一名四金丸） 治肝火胸胁胀痛，或发寒热，或头目作痛，或大便不实，
或小便淋秘，或小腹疼痛，及一切肝火之证。
黄连（炒，六两） 吴茱萸（一两，汤煮片时用）
上为末，粥丸，白术、陈皮汤下。
当归龙荟丸 治肝经实火，胸胁胀痛，或大便秘结，小便涩滞。凡属肝经实火，皆宜
用之。
当归 龙胆草（炒焦） 栀子仁（炒） 黄连（炒） 黄芩（炒，各一两） 大黄（炒）
芦荟 青黛（各五钱） 木香（二钱半） 麝香（另研，五分）
上为末，用神曲糊丸桐子大。每服二十丸，姜汤下。
补肝散 治肝肾二经气血亏损，胁胀作痛，或胁胀头晕，寒热发热，或遍身作痛，经
候不调。
山茱萸肉 当归 五味子（炒，杵） 山药 黄 （炒） 川芎 木瓜（各半两）
熟地黄（自制） 白术（炒，各一钱） 独活 酸枣仁（炒，各四两）
上为末，每服五钱，枣水煎服。
[Da] When women experience distending pain in both hypochondria, it is caused by weakness of the zang-fu organs and disharmony of qi and blood. The pathogenic factor of wind-cold invades the intestines and stomach, damaging the Bao Luo (uterine collaterals). It clashes with qi and blood, leading to stagnation and cold coagulation without free circulation. The struggle between pathogenic factors and healthy qi causes impact and shock, resulting in distending pain in both hypochondria.
[Xue] Master Dongyuan stated: Pain in the chest and hypochondria, bitter taste in the mouth, dry tongue, alternating chills and fever, nausea and vomiting, fullness and oppression in the four limbs, dribbling urination or difficult defecation, and acute abdominal pain are manifestations of the reckless movement of Liver Wood. I believe that if these symptoms are caused by sudden anger injuring blood, Xiao Chai Hu Tang (Minor Bupleurum Decoction) combined with Chuanxiong Rhizoma, Danggui Radix, and Gardeniae Fructus should be used. If there is qi deficiency, Si Wu Tang (Four Substances Decoction) combined with Renshen Ginseng Radix et Rhizoma, Baizhu Atractylodis Macrocephalae Rhizoma, Chaihu Bupleuri Radix, and Gardeniae Fructus should be used. If chronic anger injures qi, Liu Jun Zi Tang (Six Gentlemen Decoction) combined with Chuanxiong Rhizoma, Danggui Radix, and Gardeniae Fructus should be used. If both qi and blood are deficient, Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) should be used. If there is abdominal pain during menstruation accompanied by chills/fever or afternoon fever, irregular menstruation, fever with phlegm cough, poor appetite with drowsiness, and body pain, Ba Zhen Tang (Eight Treasures Decoction) combined with Chaihu Bupleuri Radix and Mudanpi Moutan Cortex should be used. If there is hypochondriac distension with fever, thirst with expectoration, dribbling urination, cervical lymphadenopathy, night sweats, hematochezia, various bleeding disorders with aphonia, Liu Wei Di Huang Wan should be used. If there is distension in both hypochondria, blurred vision, tendon spasm, bluish complexion, lower abdominal pain, or urinary dysfunction, Bu Gan San (Liver-Nourishing Powder) should be used. If aromatic-drying agents are indiscriminately used, they will damage the clear and harmonious qi, preventing blood generation and causing various syndromes to arise. Master Danxi stated: For right-sided hypochondriac pain, Tui Qi San, Xiao Long Hui Wan, Danggui Longhui Wan, Kong Xian Dan, Yi Qing Wan, and Shi Zao Tang can be used; these are formulas for conditions where both pathogenic qi and healthy qi are excess. Users must exercise caution. One woman with a quick temper experienced hematemesis, fever, and distending pain in both hypochondria, worsening in the late afternoon. This was due to anger injuring the Liver and deficiency of both qi and blood. In the morning, she took Xiao Yao San (Free and Easy Wanderer Powder) with added fried black Gardeniae Fructus, Phellodendri Cortex, Fritillariae Bulbus, Platycodonis Radix, and Ophiopogonis Radix. In the evening, she took Di Huang Wan (Rehmannia Pill) delivered by Gui Pi Tang (Restore the Spleen Decoction), and she recovered. Another widow suffered from internal heat, afternoon fever, soreness and numbness in the limbs, and frequent expectoration. Someone used Qing Qi Hua Tan drugs, leading to throat discomfort, leukorrhea, and abdominal distension; then someone used Qi Xing San Xue drugs, leading to chest pain and discomfort, and intermittent limb numbness. This was due to depression and anger injuring the Liver and Spleen, worsened by medication. I treated her by using Gui Pi Tang in the morning to resolve Spleen depression and generate Spleen qi, and Jiawei Xiao Yao San (Modified Free and Easy Wanderer Powder) in the evening to clear Liver fire and generate Liver blood. After more than a hundred doses, she recovered. Later, due to anger, her food intake decreased daily, and her limbs became numb. This was Liver Fire insulting Earth (Liver Wood overacting on Spleen Earth). She recovered after taking Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) with added Gardeniae Fructus, Poria, and Pinelliae Rhizoma. Again, due to dietary irregularity and anger, her limb numbness became severe, and menstruation flowed profusely. Her pulse was floating, surging, and rapid. This indicated the Spleen was injured by the Liver and failed to control blood, causing Bing (metrorrhagia). The Liver qi was deficient, and yin blood was depleted, resulting in a large pulse. Subsequently, Liu Jun Tang combined with Chuanxiong Rhizoma, Danggui Radix, and prepared Zingiberis Rhizoma stopped the bleeding. Then, Bu Zhong Yi Qi Tang with prepared Zingiberis Rhizoma, Poria, and Pinelliae Rhizoma restored healthy qi. Finally, Gui Pi Tang and Xiao Yao San were used for regulation, and she recovered.
Ling Bao San treats women with blood and qi attacking and stabbing, with pain radiating to both hypochondria.
Dingxiang Caryophylli Flos, Muxiang Aucklandiae Radix, Ruxiang Boswelliae Resina, Xuanshusuo Corydalis Rhizoma, Danggui Radix, Baishao Paoniae Radix Alba (equal parts).
Grind into fine powder. Take two qian each time, mixed with warm wine before meals.
Caodou Kou San treats women with Spleen and Stomach deficiency, with qi attacking both hypochondria causing distending pain.
Caodoukou Alpiniae Katsumadai Semen, Hezirun Terminaliae Chebulae Fructus (each 1 liang); Guixin Cinnamomi Cortex, Kugeng Platycodonis Radix, Nongpu Magnoliae Officinalis Cortex (each 3 fen); Gancao Glycyrrhizae Radix et Rhizoma (1 fen); Chuanxiong Rhizoma, Danggui Radix, Ganjiang Zingiberis Rhizoma, Binglang Arecae Semen (each 0.5 liang).
Grind into coarse powder. Take 4 qian each time, decocted in one sheng of water until reduced to 0.7 sheng. Strain and take hot before meals.
[Zi] San treats women with cold deficiency of the zang-fu organs, with old cold qi attacking, causing distending pain in both hypochondria and restlessness in sitting or lying.
[Zi] Zi (seed name missing in text), Yanhusuo Corydalis Rhizoma, Taoren Pruni Semen, Hupo Succinum, Danggui Radix, Guixin Cinnamomi Cortex (each 1 liang); Chishaoyao Paoniae Radix Rubra, Muxiang Aucklandiae Radix, Moyao Myrrhae Resina (each 0.5 liang).
Grind into powder. Take 2 qian each time, mixed with warm wine.
Renshen Zijin Wan treats women with disharmony of Ying and Wei, stabbing pain in the heart and abdomen, fullness in the chest and diaphragm, and loss of appetite.
Zijinpi (bark name unclear), Cangzhu Atractylodis Rhizoma, Shichangpu Acori Tatarinowii Rhizoma (each 1 liang); Xiangfuzi Cyperi Rhizoma (2 liang); Renshen Ginseng Radix et Rhizoma (0.5 liang); Muxiang Aucklandiae Radix (3 qian).
Grind into powder, make pills with rice paste size of wutong seeds. Swallow 30 pills with ginger soup after meals.
Qi Zhen Wan treats long-standing accumulation of wind obstruction, promoting qi flow and resolving stagnation, emptying the chest and diaphragm, and stopping stabbing pain.
Muxiang Aucklandiae Radix, Qingpi Citri Reticulatae Pericarpium Viride (peeled), Dahuang Rheum Radix et Rhizoma (prepared), Binglang Arecae Semen... [Text garbled here].
They asked how to treat it. I said generally, stabbing pain in the heart and abdomen should not immediately be treated as deficiency-cold. Two doctors answered: If not cold, what else? Heat generates wind, cold generates qi stagnation. I said: Not so. The Nan Jing states: Deficiency causes itching, excess causes pain. Also, Zhang Zhongjing stated: For abdominal pain, use Guizhi Jia Shaoyao Tang (Cinnamon Twig Decoction Plus Peony Root); for severe pain, use Guizhi Jia Dahuang Tang (Cinnamon Twig Decoction Plus Rhubarb). Ti Gan said: Jing Bu was originally weak. I said: There are distinguishable signs. When pain occurs, have a maid press the area. If the pain stops, it is deficiency-cold. If pressing makes it worse and the hand cannot approach, it is excess pain. I had the maid press, and she could not approach, with abnormal crying and shouting. I said: This is clearly excess-heat. Da Chai Hu Tang (Major Bupleurum Decoction) should be used. The crowd did not agree, but I made them sign a statement and administered it. After eight doses, she recovered.
Discussion on treating hypochondriac pain with Mutong San (also effective for men).
Pain in the epigastrium, hypochondria, and lower abdomen is usually due to accumulated cold. Warm decoctions and powders can primarily treat this; for severe cases, warm purgatives should be used. Books have effective formulas for epigastric and lower abdominal pain, but few methods exist for hypochondriac pain.
Mutong San is particularly effective for painful hypochondria, and also treats pain radiating from the epigastrium/hypochondria to the lower abdomen.
Mutong Lonicerae Japonicae Caulis (remove nodes), Qingpi Citri Reticulatae Pericarpium Viride (peeled), Chuanlianzi Toosendan Fructus (remove skin and seeds, each 1 liang). These three ingredients are stir-fried with 0.5 liang of Badous Semen (Crotonis Fructus) until yellow, then discard the Badous. Luobozio Raphani Semen (stir-fried), Bo Shang Xiang (Agarwood) (1 liang, stir-fried), Ezhu Curcumae Rhizoma, Muxiang Aucklandiae Radix, Huashi Talcum (each 0.5 liang).
Grind into fine powder. Mix 3 qian with decocted green onion and white wine. One dose cures. Severe cases may require no more than two doses.
San Wan San treats deficiency and fullness in the middle jiao, qi pain in both hypochondria, edema of face/eyes/hands/feet, constipation, and also treats Hong Jiao Jiao (Beriberi/Foot Qi).
Dafupi Arecae Pericarpium, Zisu Perillae Folium, Chenxiang Aquilariae Lignum, Ganmugua Chaenomelis Fructus, Duhuo Angelicae Pubescentis Radix (each 1 liang); Baizhu Atractylodis Macrocephalae Rhizoma, Chuanxiong Rhizoma, Muxiang Aucklandiae Radix, Gancao Glycyrrhizae Radix et Rhizoma, Chenpi Citri Reticulatae Pericarpium, Binglang Arecae Semen (each 3 fen).
Cut into pieces. Take 3 qian each time, decocted in one sheng of water until reduced to 0.7 sheng. Strain and take hot on an empty stomach, and again at noon. In autumn of the Wuwu year in the capital, a woman suffered from middle jiao deficiency and fullness, abdominal distension and pain, constipation, and weak pulses in all six positions. Medications from other doctors were ineffective. I administered this formula, and she recovered before finishing one dose.
"Supplement": Qingmuxiang Wan (Blue Sandalwood Pill), Chenxiang Jiangqi Tang (Agarwood Descending Qi Decoction), Xiao Wuchen Tang (Minor Black and Dark Decoction), and Si Mo Tang (Four Steaming Decoction) from Ju Fang can all be used.
[Xue] Zuo Jin Wan (also known as Si Jin Wan) treats Liver Fire causing chest and hypochondriac distending pain, or alternating chills/fever, headache/eye pain, loose stools, difficult urination, lower abdominal pain, and all syndromes of Liver Fire.
Huanglian Coptidis Rhizoma (stir-fried, 6 liang); Wuzhuyu Evodiae Fructus (1 liang, boiled in water for slices).
Grind into powder, make pills with congee. Take with Baizhu Atractylodis Macrocephalae Rhizoma and Chenpi Citri Reticulatae Pericarpium decoction.
Danggui Longhui Wan treats excess fire of the Liver channel, chest and hypochondriac distending pain, or constipation, and scanty/difficult urination. It is suitable for all cases of excess fire in the Liver channel.
Danggui Radix, Longdancao Gentianae Radix et Rhizoma (stir-fried until scorched), Zhiziren Gardeniae Fructus (stir-fried), Huanglian Coptidis Rhizoma (stir-fried), Huangqin Scutellariae Radix (stir-fried, each 1 liang), Dahuang Rheum Radix et Rhizoma (stir-fried), Lvhui Aloe, Qingdai Indigo Naturalis (each 5 qian), Muxiang Aucklandiae Radix (2.5 qian), Shexiang Moschus (separately ground, 5 fen).
Grind into powder, make pills with Shenqu paste size of tung seeds. Take 20 pills each time with ginger soup.
Bu Gan San treats deficiency of qi and blood in the Liver and Kidney channels, causing hypochondriac distension and pain, or hypochondriac distension with dizziness, chills/fever, body-wide pain, and irregular menstruation.
Shanzhuyu Corni Fructus, Danggui Radix, Wuweizi Schisandrae Chinensis Fructus (stir-fried, pounded), Shanyao Dioscoreae Rhizoma, Huangqi Astragali Radix (stir-fried), Chuanxiong Rhizoma, Mugua Chaenomelis Fructus (each 0.5 liang); Shudigu Prepared Rehmanniae Radix (homemade), Baizhu Atractylodis Macrocephalae Rhizoma (stir-fried, each 1 qian), Duhuo Angelicae Pubescentis Radix, Suanzaoren Ziziphi Spinosae Semen (stir-fried, each 4 liang).
Grind into powder. Take 5 qian each time, decocted with jujube water.