大意
腹痛有三部。大腹痛者。属太阴脾。当脐痛者。属少阴肾。小腹痛者。属厥阴肝及冲任大小肠。各有五贼之
变。七情之发。六气之害。五运之邪。（必读）
内因
大腹痛。多食积寒邪。脐腹痛。多积热痰火。小腹痛。多瘀血及溺涩。（入门）
外候
腹痛乃脾家受病。或受有形而痛。或受无形而痛。盖暴伤饮食。则胃脘先痛而后入腹。暴触怒气。则两胁
先痛而后入腹。血积上焦。脾火熏蒸。则痛从腹而攻上。血积下部。胃气下陷。则痛从腹而下坠。伤于寒者。
痛无间断。得热则缓。伤于热者。痛作有时。得寒则减。因饥而痛者。过饥即痛。得食则止。因食而痛者。多食
则痛。得便乃安。吞酸腹痛。为痰郁中焦。痞闷腹痛。为气搏中州。火痛肠内雷鸣。冲斥无定。痛处觉热。心烦
口渴。虫痛肚大青筋。饥即咬啮。痛必吐水。痛定能食。气虚痛者。痛必喜按。呼吸短浅。血虚痛者。痛如芒刺。
牵引不宁。（汇补）
腹痛分辨
痛而胀闷者多实。痛不胀闷者多虚。拒按者为实。可按者为虚。喜寒者多实。爱热者多虚。饱则甚者多实。
饥即闷者多虚。脉强气粗者多实。脉虚气少者多虚。新病年壮者多实。久病年高者多虚。补而不效者多
实。攻而愈剧者多虚。病在经者脉多弦。大病在脏者脉多沉微。（必读）
死候
脐下忽大痛。人中黑色者死。（丹溪）此中恶客忤也。（入门）
腹痛别症
肠痈痛者。腹重而痛。身皮甲错。绕脐生疮。小便如淋。疝气痛者。大腹胀。小腹急。下引睾丸。上冲而痛。痧症
痛者。或大吐。或大泻。上下绞痛。厥冷转筋。阴毒痛者。爪甲青。面唇黑。厥逆呕吐。身冷欲绝。积聚痛者。有形
可按。痢疾痛者。后重逼迫。至于妇人腹痛。多有关于经水胎孕者。宜先审之。（汇补）
治法
凡痛多属血涩气滞。宜甘以缓之。寒宜辛温消散。热宜苦寒清解。虚宜甘温调理。实宜辛寒推荡。在上者
吐之。在下者利之。随其乘侮胜复。俱以开胃调脾为主。（汇补）
补法宜审
表虚痛者。阳不足也。非温经不可。里虚痛者。阴不足也。非养荣不可。上虚痛者。脾胃伤也。非调补中州不
可。下虚痛者。肝肾败也。非温补命门不可。临症之顷。最宜审谛。（汇补）
急救法
或用炒盐。或姜渣。或麸皮炒热。绢包熨痛处。冷则再炒再熨。以愈为度。或用吐法亦可。
用药
主以二陈汤。加香附、苏梗等。寒加肉桂、木香。热加黄连、芍药。痰加枳实、苍术。食加山楂、麦芽。血瘀加归
尾、玄胡索、桃仁、红花。气滞加浓朴、枳壳。虫加槟榔、使君子。气虚加人参、白术，大实大满者。以大黄、槟榔下
之。大寒大虚者。以理中建中温之。血虚痛者。炮姜、芍药和之。
【附腹中窄狭】
腹属坤土。位居中央。升心肺之阳。降肾肝之阴。情志不药。湿热交旺。腹中自觉窄狭。神昏性躁。饮食减少。
乃湿热痰火横格中州。以致升降失常者。比比然也。（汇补）
肥人多湿痰。宜二陈汤加苍术、香附。瘦人多湿火。宜二陈汤加黄连、苍术。虚人气血虚弱。宜六君子汤加芎、归。
【附小腹痛】
小腹为至阴之位。厥阴所属。有沉寒下虚。有积热内郁。或忿怒所至。或房劳损伤。俾中上二焦清纯之气。
下陷于至极之地。郁久不舒。痛连阴器。久则元气愈虚。不能归复本位。所以痛无止耳。然肝主疏泄。不利
峻补。总宜调和血气为主。（汇补）
气滞用四磨汤。血瘀用手拈散。寒郁以二陈汤。加干姜、吴萸、苍术、浓朴。热郁以四逆散。加黄连、山栀、香
附、黄芩。沉寒以理中汤。加附子、肉桂、吴茱、茴香。气陷以二陈汤。加升麻、柴胡、干姜、当归。若醉饱行房。小
腹胀痛。用当归、芍药、川芎、柴胡、青皮、吴萸、甘草之类。
腹痛选方
二陈汤 统治腹痛诸症。（方见痰症）
大承气汤 治实满腹痛。（方见发热）
理中汤 治虚寒腹痛。（方见中寒）
建中汤 治腹痛喜按。（方见血症）
六君子汤 治腹痛泄利。（方见中风）
四逆散 治热郁腹痛。
柴胡 枳壳 芍药（等分） 甘草（减半）
水煎服。
顺气散 治气郁腹痛。
香附（上） 木香（下） 槟榔（下） 青皮（中） 陈皮（中） 浓朴（中）
苍术（上） 枳壳（中） 砂仁（上） 甘草（下）
生姜。水煎服。
加味平胃散 治酒积腹痛。以宽气为主。
即平胃散加干葛、香附、木香、槟榔。
加味枳术丸（正传） 治清痰食积酒积茶积肉积在胃脘。当心作痛。及痞满恶心。嘈杂嗳气。吞酸呕吐。脾
疼等症。
白术（三两土炒） 枳实（麸炒） 苍术（米汁浸三宿炒） 猪苓（去黑皮） 麦芽曲（炒黄） 神曲（炒黄）
半夏（各一两） 泽泻（去毛） 赤茯苓 川芎 黄连（土炒） 白螺壳（ 七钱）
砂仁 炒豆蔻 黄芩（土炒） 青皮 莱菔子 干生姜（各五钱）
陈皮 香附 栝篓仁 浓朴（姜炒） 槟榔（各二钱） 木香
甘草（各二钱） 吞酸。加吴萸。（汤泡寒月五钱热月二钱半） 久病虚者。加人参、扁豆、石莲肉各五钱。时常口吐
清水。加滑石一两牡蛎五钱。
上为末。青荷叶泡汤。浸晚粳米。研粉作糊丸桐子大。每服五十丸。米清饮下。
[General Principles]
Abdominal pain is divided into three regions. Pain in the upper/middle abdomen (Da Fu) belongs to the Taiyin Spleen meridian; pain around the umbilicus belongs to the Shaoyin Kidney meridian; pain in the lower abdomen (Xiao Fu) belongs to the Jueyin Liver meridian, as well as the Chong and Ren vessels, and the Large and Small Intestines. Each region is subject to variations caused by the Five Elements' destructive cycles (Wu Zei), the Seven Emotions, the Six Exogenous Pathogens (Liu Qi), and pathogenic factors from the Five Movements and Six Qi. (From *Bi Du*)
[Etiology: Internal Factors]
Pain in the upper/middle abdomen is mostly due to food stagnation and cold pathogens; pain around the umbilicus is mostly due to accumulated heat, phlegm, and fire; pain in the lower abdomen is mostly due to blood stasis and dysuria. (From *Ru Men*)
[External Manifestations]
Abdominal pain is a disease of the Spleen. It may be caused by tangible pathogens or intangible pathogens. If suddenly injured by diet, epigastric pain occurs first, then spreads to the abdomen; if suddenly provoked by anger, hypochondriac pain occurs first, then spreads to the abdomen. If blood accumulation is in the Upper Jiao, Spleen fire steams upward, causing pain to attack upwards from the abdomen; if blood accumulation is in the Lower Jiao, Stomach Qi sinks downward, causing pain to drag downwards from the abdomen. Cold injury causes continuous pain that relieves with heat; heat injury causes intermittent pain that relieves with cold. Hunger-induced pain occurs when overly hungry and stops after eating; food-induced pain occurs after overeating and resolves after defecation. Abdominal pain with acid regurgitation indicates Phlegm-Dampness stagnating in the Middle Jiao; abdominal pain with stuffiness and oppression indicates Qi collision in the Middle State (Spleen/Stomach). Fire-induced pain features borborygmus (intestinal rumbling), erratic gas movement, a hot sensation at the painful site, irritability, and thirst. Parasitic pain features a distended abdomen with visible blue veins, biting sensations when hungry, vomiting of clear fluid during pain, and ability to eat when pain subsides. Qi-deficiency pain is relieved by pressure and accompanied by shortness of breath; Blood-deficiency pain feels like thorn pricks and causes restless pulling sensations. (From *Hui Bu*)
[Differentiation of Abdominal Pain]
Pain with distension and oppression is mostly Excess; pain without distension/oppression is mostly Deficiency. Rejection of pressure indicates Excess; acceptance of pressure indicates Deficiency. Preference for cold indicates Excess; preference for warmth indicates Deficiency. Worsening after fullness indicates Excess; oppression upon hunger indicates Deficiency. Strong pulse and coarse breathing indicate Excess; weak pulse and faint breathing indicate Deficiency. New onset in young adults indicates Excess; chronic condition in elderly indicates Deficiency. Ineffectiveness of tonification suggests Excess; aggravation by purgation suggests Deficiency. Disease in the meridians often presents with a wiry pulse; severe disease in the Zang organs often presents with a deep and faint pulse. (From *Bi Du*)
[Mortal Signs]
Sudden severe pain below the umbilicus combined with black discoloration of the philtrum indicates a fatal prognosis. (From Zhu Danxi) This is caused by Zhong E (sudden evil invasion) or Ke Wu (hostile spirit intrusion). (From *Ru Men*)
[Other Symptoms of Abdominal Pain]
Intestinal abscess (Chang Yong) pain features heavy abdominal pain, rough skin resembling fish scales, sores around the umbilicus, and dysuria-like urination. Hernia (Shan Qi) pain features abdominal distension, lower abdominal urgency, pain radiating down to the testicles, and upward rushing pain. Sha Syndrome pain features severe vomiting or diarrhea, severe cramping pain above and below, cold limbs, and muscle spasms. Yin Toxic pain features cyanotic nails, black face and lips, cold limbs with vomiting, and extreme body coldness. Accumulation/Mass pain features palpable masses. Dysentery pain features tenesmus (urgent feeling of incomplete defecation). For women, abdominal pain is often related to menstruation or pregnancy and should be examined first. (From *Hui Bu*)
[Therapeutic Methods]
Most pain is due to sluggish blood flow and stagnant Qi; sweet flavors should be used to relieve urgency. Cold patterns require acrid-warm dispersants; Heat patterns require bitter-cold clarifiers; Deficiency patterns require sweet-warm regulators; Excess patterns require acrid-cold pushers/purgatives. Diseases in the upper part are treated with emesis; diseases in the lower part are treated with purgation. Treatment follows the principles of overcoming and being overcome among the Zang-Fu, always prioritizing opening the stomach and regulating the Spleen. (From *Hui Bu*)
[Caution in Tonification]
Exterior Deficiency pain is due to Yang insufficiency and requires warming the meridians; Interior Deficiency pain is due to Yin insufficiency and requires nourishing Ying (Nutritive) Blood; Upper Deficiency pain is due to Spleen/Stomach injury and requires regulating and tonifying the Middle State; Lower Deficiency pain is due to Liver/Kidney failure and requires warming and tonifying the Gate of Vitality (Ming Men). Careful examination is crucial during clinical practice. (From *Hui Bu*)
[Emergency Rescue Methods]
One may use fried salt, ginger residue, or wheat bran fried hot, wrapped in silk cloth, and applied as a compress to the painful area. Re-fry and re-apply when cool until healed. Alternatively, emetic methods may be used.
[Medication]
The main formula is Er Chen Tang (Two-Cured Decoction), added with Xiang Fu (Cyperus Rhizome) and Su Geng (Perilla Stem). For Cold, add Rou Gui (Cinnamon Bark) and Mu Xiang (Aucklandiae Root); for Heat, add Huang Lian (Coptidis Rhizome) and Shao Yao (Peony Root); for Phlegm, add Zhi Shi (Immature Bitter Orange) and Cang Zhu (Atractylodis Rhizoma); for Food Stagnation, add Shan Zha (Crataegi Fructus) and Mai Ya (Hordei Fructus Germinatus); for Blood Stasis, add Gui Wei (Angelicae Sinensis Radix Tail), Yuan Hu Suo (Corydalis Rhizoma), Tao Ren (Persicae Semen), and Hong Hua (Carthami Flos); for Qi Stagnation, add Hou Po (Magnoliae Officinalis Cortex) and Zhi Qiao (Aurantii Fructus); for Parasites, add Bing Lang (Arecae Semen) and Shi Jun Zi (Quisqualis Fructus); for Qi Deficiency, add Ren Shen (Ginseng Radix) and Bai Zhu (Atractylodis Macrocephalae Rhizoma); for severe Excess and fullness, use Da Huang (Rhei Radix et Rhizoma) and Bing Lang for purgation; for severe Cold and Deficiency, use Li Zhong Tang (Regulate the Middle Decoction) and Jian Zhong Tang (Establish the Middle Decoction) for warming; for Blood Deficiency pain, use Pao Jiang (Prepared Ginger) and Shao Yao to harmonize.
[Appendix: Narrowness in the Abdomen]
The abdomen belongs to Kun Earth and is located centrally, responsible for ascending the Yang of Heart/Lung and descending the Yin of Kidney/Liver. If emotional regulation fails and Damp-Heat flourishes, one may feel narrowness in the abdomen, mental confusion, irritability, and reduced appetite. This is commonly caused by Damp-Heat and Phlegm-Fire obstructing the Middle State, leading to dysfunction of ascending and descending mechanisms. (From *Hui Bu*)
Obese individuals often have Damp-Phlegm; treat with Er Chen Tang plus Cang Zhu and Xiang Fu. Thin individuals often have Damp-Fire; treat with Er Chen Tang plus Huang Lian and Cang Zhu. Individuals with Qi and Blood Deficiency should be treated with Liu Jun Zi Tang (Six-Gentlemen Decoction) plus Chuan Xiong (Ligustici Chuanxiong Rhizoma) and Dang Gui (Angelicae Sinensis Radix).
[Appendix: Lower Abdominal Pain]
The lower abdomen is the position of Extreme Yin and belongs to the Jueyin Liver meridian. Causes include sinking Cold and Lower Deficiency, or accumulated Heat internal depression, or anger, or sexual exhaustion. These cause the pure Qi of the Upper and Middle Jiao to sink to the lowest point, stagnating for a long time without relief, causing pain radiating to the genitalia. Over time, Yuan Qi (Primal Qi) becomes more deficient and cannot return to its original position, resulting in ceaseless pain. Since the Liver governs free flow, harsh tonification is contraindicated; the general principle is to harmonize Blood and Qi. (From *Hui Bu*)
For Qi Stagnation, use Si Mo Tang (Four-Mist Decoction); for Blood Stasis, use Shou Nian San (Hand-Picking Powder); for Cold Depression, use Er Chen Tang plus Gan Jiang (Zingiberis Rhizoma), Wu Zhu Yu (Evodiae Fructus), Cang Zhu, and Hou Po; for Heat Depression, use Si Ni San (Frigid Extremities Powder) plus Huang Lian, Shan Zhi (Gardeniae Fructus), Xiang Fu, and Huang Qin (Scutellariae Radix); for Sinking Cold, use Li Zhong Tang plus Fu Zi (Aconiti Lateralis Radix Praeparata), Rou Gui, Wu Zhu Yu, and Hui Xiang (Foeniculi Fructus); for Qi Sinking, use Er Chen Tang plus Sheng Ma (Cimicifugae Rhizoma), Chai Hu (Bupleuri Radix), Gan Jiang, and Dang Gui. If pain and distension occur after drinking and sexual intercourse, use Dang Gui, Shao Yao, Chuan Xiong, Chai Hu, Qing Pi (Citri Reticulatae Pericarpium Viride), Wu Zhu Yu, and Gan Cao (Glycyrrhizae Radix et Rhizoma).
[Selected Formulas for Abdominal Pain]
Er Chen Tang (Two-Cured Decoction): Treats various symptoms of abdominal pain. (Formula see "Phlegm Syndromes")
Da Cheng Qi Tang (Major Order the Qi Decoction): Treats Excess Fullness abdominal pain. (Formula see "Febrile Diseases")
Li Zhong Tang (Regulate the Middle Decoction): Treats Deficiency-Cold abdominal pain. (Formula see "Middle Cold")
Jian Zhong Tang (Establish the Middle Decoction): Treats abdominal pain relieved by pressure. (Formula see "Blood Syndromes")
Liu Jun Zi Tang (Six-Gentlemen Decoction): Treats abdominal pain with diarrhea. (Formula see "Wind Stroke")
Si Ni San (Frigid Extremities Powder): Treats Heat Depression abdominal pain.
Ingredients: Chai Hu (Bupleuri Radix), Zhi Qiao (Aurantii Fructus), Shao Yao (Peoniae Radix) in equal parts; Gan Cao (Glycyrrhizae Radix et Rhizoma) halved. Decoct in water and take orally.
Shun Qi San (Smooth Qi Powder): Treats Qi Depression abdominal pain.
Ingredients: Xiang Fu (Cyperus Rhizoma, Grade A), Mu Xiang (Aucklandiae Radix, Grade C), Bing Lang (Arecae Semen, Grade C), Qing Pi (Citri Reticulatae Pericarpium Viride, Grade B), Chen Pi (Citri Reticulatae Pericarpium, Grade B), Hou Po (Magnoliae Officinalis Cortex, Grade B), Cang Zhu (Atractylodis Rhizoma, Grade A), Zhi Qiao (Aurantii Fructus, Grade B), Sha Ren (Amomi Fructus, Grade A), Gan Cao (Glycyrrhizae Radix et Rhizoma, Grade C). Add fresh ginger, decoct in water, and take orally.
Jia Wei Ping Wei San (Modified Level the Stomach Powder): Treats Alcohol Accumulation abdominal pain, primarily to broaden and move Qi.
This is Ping Wei San plus Ge Gen (Puerariae Lobatae Radix), Xiang Fu, Mu Xiang, and Bing Lang.
Jia Wei Zhi Zhu Wan (Modified Immature Bitter Orange and Atractylodes Macrocephala Pill) (From *Zheng Chuan*): Treats Clear Phlegm, Food Accumulation, Alcohol Accumulation, Tea Accumulation, and Meat Accumulation in the epigastrium, causing pain under the heart, stuffiness, nausea, acid reflux, belching, vomiting, and Spleen pain.
Ingredients: Bai Zhu (Atractylodis Macrocephalae Rhizoma, 3 liang, earth-fried), Zhi Shi (Immature Bitter Orange, bran-fried), Cang Zhu (Atractylodis Rhizoma, soaked in rice water for three nights then fried), Zhu Ling (Polyporus), Mai Ya Qu (Hordei Fructus Germinatus yeast, fried yellow), Shen Qu (Massa Medicata Fermentata, fried yellow), Ban Xia (Pinelliae Rhizoma Praeparatum, each 1 liang), Ze Xie (Alismatis Rhizoma, de-husked), Chi Fu Ling (Red Polyporus), Chuan Xiong (Ligustici Chuanxiong Rhizoma), Huang Lian (Coptidis Rhizoma, earth-fried), Bai Luo Ke (Concha Meretricis, 7 qian), Sha Ren (Amomi Fructus), Chao Dou Kou (Cardamomi Fructus Rotundus, fried), Huang Qin (Scutellariae Radix, earth-fried), Qing Pi (Citri Reticulatae Pericarpium Viride), Lai Fu Zi (Radish Seed), Gan Sheng Jiang (Dried Fresh Ginger, each 5 qian), Chen Pi (Citri Reticulatae Pericarpium), Xiang Fu (Cyperus Rhizoma), Gua Lou Ren (Trichosanthis Semen), Hou Po (Magnoliae Officinalis Cortex, ginger-fried), Bing Lang (Arecae Semen, each 2 qian), Mu Xiang (Aucklandiae Radix), Gan Cao (Glycyrrhizae Radix et Rhizoma, each 2 qian). For acid regurgitation, add Wu Zhu Yu (Evodiae Fructus) (soaked in soup: 5 qian in cold months, 2.5 qian in hot months). For chronic deficiency, add Ren Shen (Ginseng Radix), Bian Dou (Vigna Unguiculata Seed), and Shi Lian Rou (Nelumbinis Nuciferae Endocarpium) each 5 qian. For frequent spitting of clear fluid, add Hua Shi (Talcum, 1 liang) and Mu Li (Ostreae Concha, 5 qian).
Grind all ingredients into powder. Soak green lotus leaves in water, soak late-japonica rice in this liquid, grind into paste to form pills the size of paulownia seeds. Take 50 pills per dose, washed down with rice water.