人有两胁作痛，终年累月而不愈者，或时而少愈，时而作痛，病来之时，身发寒热，不
思饮食，人以为此肝经之病也。然肝经之所以成病，尚未知其故，大约得之气恼者为多。因
一时拂抑，欲怒而不敢，一种不平之气，未得畅泄，肝气郁而胆气亦郁，不能取决于心中，
而心中作热，外反变寒，寒热交蒸，则肝经之血停住于两胁而作痛矣。倘境遇顺适，则肝气
少舒，其痛不甚。及夫听恶声，值逆境，又触动其从前之怒气，则前病顿兴，而痛更重矣
。治法必须解其怒气，要在平肝。方用遣怒丹∶
白芍（二两） 柴胡（一钱） 甘草（一钱） 乳香末（一钱） 广木香末（一钱） 白芥子（三钱） 桃仁
（十粒
水煎服。一剂痛轻，四剂痛止，十剂病除。
夫平肝之药，舍白芍实无第二味可代，世人不知其功效，不敢多用。孰知白芍必多用而
后能取胜，用至二两，则其力倍于寻常，自能遍舒其肝气。况助以柴胡之疏泄，甘草之调剂
，桃仁、白芥以攻其败瘀，乳香、广木以止其痛疼，安得不直捣中坚以解散其敌垒哉。
此症亦可用宣郁定痛汤∶
白芍（一两） 川芎 当归 丹皮（各三钱） 柴胡（二钱） 甘草 白芥子 大黄 牛膝 炒栀子
（各一钱）
水煎服。二剂即安。
人有横逆骤加，一时大怒，叫号骂詈，致两胁大痛而声哑者，人以为怒气伤肝矣。然而
其人必素有火性者，此等肝脉必洪大而无伦次，眼珠必红，口必大渴呼水，舌必干燥而开裂
，当急用平肝泻火之药，方能舒其暴怒之气，倘少迟药饵，或药饵不中其病，必触动其气，
有吐血倾盆之患矣。急用平怒汤∶
白芍（三两） 丹皮（一两） 当归（一两） 炒栀子（五钱） 荆芥（炒黑，五钱） 天花粉（三
钱） 甘草（一
水煎服。一剂而气少舒，二剂而气大平，三剂痛如失，不必四剂也
。
盖肝性最急，怒则其气不平，用芍药平其气也，甘草缓其急也。肝气既平而且缓，而后
可散其气而泻其火矣。当归辛以散之也，荆芥引而散之也，栀子、丹皮凉以泻之也。然而徒
散其火，而火为痰气所结，则散火而未能遽散，故又加香附以通其气，加花粉以消其痰。君
臣佐使，无非解纷之妙药，怒气虽甚，有不自知其解而解者矣。或疑药剂太重，凉药过多，
讵知其人，素系有火，又加大怒，则五脏无非热气，苟不用大剂凉药，何以平其怒而解其火
哉。
此症用平怒散亦妙。
白芍（一两） 丹皮（一两） 当归（五钱） 炒栀子 牛膝（各三钱） 甘草 柴胡 广木香（各一钱）
枳壳（八分）
水煎服。一剂轻，二剂愈。
人有跌扑之后，两胁胀痛，手不可按，人以为瘀血之作祟也，用小柴胡汤加草龙胆、青
皮等药而愈。次年而左胁复痛，仍以前药治之，不能取效。盖瘀血存于其中，积而不散，久
而成痛也。夫小柴胡乃半表半里之药，最能入肝以舒木，而胁正肝之部位，宜乎取效而不效
者，以小柴胡止能消有形之活血，而不能散有形之死血也。血活易于流动，行气而瘀滞可通
，血死难于推移，行气而沉积不化，必用败血之药以下死血，而痛可除也。方用抵当丸，以
水蛭、虻虫有形之毒物，庶易下有形之死血耳。服一剂，必便黑血而愈，愈后乃用四物汤加
减而调理之。
熟地（一两） 白芍（一两） 丹皮（三钱） 川芎（一钱） 当归（五钱） 三七根末（三钱）
水煎服。
四物汤补血之剂也，既下死血，何以又补其血乎?不知血死既久，在肝经则肝血已无生
气，若不补其血，则肝舍空虚，未必不因虚而成痛，惟补其血，则死血方去，而新血即生，
肝气快乐，何至有再痛之虞乎。然则补血可也，又加三七
根以止血者何居?恐水蛭、虻虫过于下血，万一死血行而活血随之而下，不徒补无益乎。所
以于补中止之，得补之益，而无下之失，始奏万全之功也。
此症亦可用散瘀汤∶
水蛭（炒黑色，为末，一钱） 当归（五钱） 丹皮 红花（各五钱） 甘草（一钱） 生地（三钱）
水煎服。一剂即愈。
人有右胁大痛，肿起如覆杯，手不可按，按之痛益甚，人以为肝经之火也，谁知是脾火
内伏、瘀血存注而不散乎?夫胁虽为肝位，而肝必克脾，脾受肝克，则脾亦能随肝而作痛。
然而无形之痛，治肝而痛可止，有形之痛，治脾而痛始消。今痛而作肿，正有形之痛也，乃
瘀血积于脾中，郁而不舒，乘肝部之隙，因外肿于右胁耳。治法必须通脾中伏热，而下其瘀
血，则痛可立除也。方用败瘀止痛汤∶
大黄（三钱） 桃仁（十四粒） 当归（三钱） 白芍（一两） 柴胡（一钱） 黄连（一钱） 浓朴（二钱） 甘
草
水煎服。一剂而瘀血下，二剂而痛除，肿亦尽消。
此方大黄、柴胡、黄连同用，能扫瘀去陈，开郁逐火，迅速而无留滞之苦。然非多用白
芍，则肝气难平，而脾中之热受制于肝，正不易散，是病在脾，而治仍在肝也
。
此症用木土两平汤亦效。
石膏 茯苓 苍术 炒栀子（各三钱） 白芍（五钱） 甘草（一钱）
水煎服。一剂轻，二剂愈。
人有贪色房劳，又兼恼怒，因而风府胀闷，两胁作痛，人以为色欲损肾，怒气伤肝，理
当兼治，而不知兼治之中尤当治肾也。盖肝为肾之子，肾足而肝气易平，肾亏而肝血多燥，
肝恶急，补血以制其急，不若补水以安其急也。况肝血易生，而肾水
难生，所以肝血不足，轻补肝而木得其养矣。肾水不足，非大用补肾之味，则水不能生。然
则房劳之后胁痛，其亏于精者更多，乌可重治肝而轻治肾哉。方用填精益血汤∶
熟地（一两） 山茱萸（五钱） 白芍（五钱） 当归（三钱） 柴胡（一钱） 丹皮（二钱） 沙参（
三钱） 茯苓
水煎服。一剂而肝气平，二剂而胁痛止，连服十剂全愈。
此方重于补肾以填精，轻于舒肝以益血，治肝肾之中而复去通腰脐之气。腰脐气利，而
两胁之气有不同利者乎。故精血生而痛亦止耳。
此症亦可用水木两滋汤∶
熟地（一两） 山茱萸 山药（各四钱） 白芍 当归（各五钱） 甘草（一钱）
水煎服。
There are cases where a person suffers from pain in both hypochondriac regions, lasting for years without cure. Sometimes it improves slightly, then recurs. When the disease strikes, the body experiences alternating chills and fever (alternating chills and fever), loss of appetite, and people assume this is a disease of the Liver Meridian (Liver Channel). However, the cause of the Liver Meridian becoming diseased is not fully understood; it is mostly due to anger and frustration. Because of a momentary suppression, wanting to be angry but daring not to, an unbalanced Qi fails to vent smoothly. This causes Liver Qi to stagnate, and Gallbladder Qi also stagnates. Unable to make decisions from the Heart, heat arises within the Heart, while the exterior becomes cold. The steaming interaction of cold and heat causes Blood in the Liver Meridian to stagnate in the hypochondriac regions, resulting in pain. If circumstances are favorable, Liver Qi relaxes slightly, and the pain is not severe. But when hearing foul words or encountering adverse situations, previous anger is triggered again, causing the old illness to flare up suddenly with more intense pain. The treatment method must resolve the anger, focusing on calming the Liver. Use the Formula to Disperse Anger (Qiannu Dan):
Radix Paeoniae Alba (Bai Shao) (2 liang), Radix Bupleuri (Chai Hu) (1 qian), Radix Glycyrrhizae Preparata (Gan Cao) (1 qian), Resina Frankincense Pulverized (Ruxiang Mo) (1 qian), Fructus Tsaoko Pulverized (Guang Muxiang Mo) (1 qian), Semen Mustardae (Bai Jie Zi) (3 qian), Semen Persicae (Tao Ren) (10 grains).
Decoct in water and take orally. After one dose, pain lightens; after four doses, pain stops; after ten doses, the disease is eliminated.
Among herbs that calm the Liver, besides Radix Paeoniae Alba (Bai Shao), there is truly no second herb that can replace it. People do not know its efficacy and dare not use large doses. Who knows that Radix Paeoniae Alba (Bai Shao) must be used in large doses to achieve victory? Using two liang makes its power several times greater than usual, naturally able to comprehensively soothe Liver Qi. Moreover, assisted by the dispersing action of Radix Bupleuri (Chai Hu), the harmonizing action of Radix Glycyrrhizae Preparata (Gan Cao), the attacking action of Semen Persicae (Tao Ren) and Semen Mustardae (Bai Jie Zi) against stagnant blood, and the pain-relieving actions of Resina Frankincense (Ruxiang) and Fructus Tsaoko (Guang Muxiang), how could it not strike directly at the core to disperse the enemy's fortress?
This condition can also be treated with the Formula to Disperse Stagnation and Stop Pain (Xuanyu Ding Tong Tang):
Radix Paeoniae Alba (Bai Shao) (1 liang), Radix Chuanxiong (Chuan Xiong), Radix Angelicae Sinensis (Dang Gui), Cortex Moutan (Dan Pi) (each 3 qian), Radix Bupleuri (Chai Hu) (2 qian), Radix Glycyrrhizae Preparata (Gan Cao), Semen Mustardae (Bai Jie Zi), Rhizoma Rhei (Da Huang), Radix Achyranthis Bidentatae (Niu Xi), Fructus Gardeniae Praeparatus (Chao Zhizi) (each 1 qian).
Decoct in water and take orally. Peace is achieved in two doses.
There are cases where someone suffers sudden adversity, flies into a rage, shouting and cursing, leading to severe pain in both hypochondriac regions and hoarseness. People think this is anger injuring the Liver. However, such a person must inherently possess Fire nature. The Liver pulse here must be surging and chaotic, eyes red, mouth extremely thirsty calling for water, tongue dry and cracked. One must urgently use herbs to calm the Liver and drain Fire to soothe the violent anger. If medication is delayed even slightly, or if the medication does not match the pathology, it will surely agitate the Qi, leading to the danger of profuse hematemesis (vomiting blood like a basin). Urgently use the Formula to Calm Anger (Pingnu Tang):
Radix Paeoniae Alba (Bai Shao) (3 liang), Cortex Moutan (Dan Pi) (1 liang), Radix Angelicae Sinensis (Dang Gui) (1 liang), Fructus Gardeniae Praeparatus (Chao Zhizi) (5 qian), Herba Schizonepetae Praeparated (Jingjie - charred black, 5 qian), Radix Trichosanthis (Tian Hua Fen) (3 qian), Radix Glycyrrhizae Preparata (Gan Cao) (1 qian).
Decoct in water and take orally. After one dose, Qi relaxes slightly; after two doses, Qi calms significantly; after three doses, pain disappears as if lost; four doses are unnecessary.
The nature of the Liver is most urgent; anger makes its Qi uneven. Using Radix Paeoniae Alba (Shao Yao) calms its Qi, and Radix Glycyrrhizae Preparata (Gan Cao) relieves urgency. Once Liver Qi is calm and relaxed, one can then disperse its Qi and drain its Fire. Radix Angelicae Sinensis (Dang Gui) disperses via pungency, Herba Schizonepetae (Jingjie) guides dispersion, Fructus Gardeniae (Zhizi) and Cortex Moutan (Dan Pi) cool and drain. However, merely dispersing Fire is insufficient if Fire is knotted by Phlegm and Qi; thus, adding Rhizoma Cyperi (Xiang Fu) to unblock Qi and Radix Trichosanthis (Hua Fen) to resolve Phlegm is necessary. The Sovereign, Minister, Assistant, and Courier herbs are all wonderful remedies for resolving conflicts. Even with severe anger, it may dissolve unknowingly. Some may suspect the prescription is too heavy and cooling herbs too numerous. But knowing the person inherently has Fire and has just suffered great anger, the Five Viscera are full of hot Qi. Without large doses of cooling herbs, how can one calm anger and resolve fire?
Using the Powder to Calm Anger (Pingnu San) for this condition is also excellent.
Radix Paeoniae Alba (Bai Shao) (1 liang), Cortex Moutan (Dan Pi) (1 liang), Radix Angelicae Sinensis (Dang Gui) (5 qian), Fructus Gardeniae Praeparatus (Chao Zhizi), Radix Achyranthis Bidentatae (Niu Xi) (each 3 qian), Radix Glycyrrhizae Preparata (Gan Cao), Radix Bupleuri (Chai Hu), Fructus Tsaoko (Guang Muxiang) (each 1 qian), Pericarpium Citri Reticulatae Viride (Zhi Qiao) (8 fen).
Decoct in water and take orally. One dose brings relief, two doses cure.
After a fall or blow, a person suffers distending pain in both hypochondriac regions, intolerable to touch. People attribute this to stagnant Blood acting up, and it heals using Minor Bupleurum Decoction (Xiao Chai Hu Tang) plus Caulis Longdancao (Caolongdan) and Exocarpium Citri Reticulatae Viride (Qing Pi). The following year, left hypochondriac pain returns, but treating with the same formula yields no effect. This is because stagnant Blood remains inside, accumulating without dissipating, eventually causing pain over time. Minor Bupleurum Decoction (Xiao Chai Hu Tang) is a formula for the half-exterior half-interior stage, best at entering the Liver to soothe Wood, and the hypochondrium is indeed the domain of the Liver. It should have worked. The reason it failed is that Minor Bupleurum Decoction (Xiao Chai Hu Tang) can only eliminate active/stagnant Blood (Huoxue) but cannot scatter dead/stagnant Blood (Sixue). Active Blood flows easily; moving Qi can clear stasis. Dead Blood is hard to move; moving Qi cannot resolve deposits. One must use blood-breaking herbs to purge dead Blood downward to remove pain. Use the Pill for Attending to Blood (Didang Wan), utilizing leeches (Shuizhi) and horseflies (Mengchong), these有形 (tangible) toxic substances, to facilitate the purging of tangible dead Blood. After one dose, black Blood will be passed in stool, and the patient will heal. Afterwards, use Four Substances Decoction (Siwu Tang) modified to regulate.
Radix Rehmanniae Preparata (Shudi), Radix Paeoniae Alba (Baishao) (each 1 liang), Cortex Moutan (Dan Pi) (3 qian), Radix Chuanxiong (Chuanxiong) (1 qian), Radix Angelicae Sinensis (Danggui) (5 qian), Radix Notoginseng Pulverized (Sanqi Gen Mo) (3 qian).
Decoct in water and take orally.
Four Substances Decoction (Siwu Tang) is a blood-nourishing formula. Since dead Blood has been purged, why nourish Blood again? It is unknown that if Blood has been dead for a long time, the Liver Blood loses its vital energy. If Blood is not nourished, the Liver residence becomes empty, potentially causing pain due to deficiency. Only by nourishing Blood can dead Blood go and new Blood be born. With joyful Liver Qi, why worry about recurrent pain? Then, nourishing Blood is fine, but why add Radix Notoginseng (Sanqi Gen) to stop bleeding? It is feared that leeches and horseflies are too aggressive in purging Blood; if dead Blood moves, active Blood might follow and be purged, rendering the nourishment useless. Therefore, stopping bleeding within the nourishing strategy gains the benefit of nourishment without the loss of purging, achieving perfect efficacy.
This condition can also use the Formula to Scatter Stasis (Sanyu Tang):
Leech (Shuizhi - charred black, pulverized, 1 qian), Radix Angelicae Sinensis (Danggui) (5 qian), Cortex Moutan (Danpi), Flos Carthami Tinctorii (Honghua) (each 5 qian), Radix Glycyrrhizae Preparata (Gancao) (1 qian), Radix Rehmanniae Recens (Shengdi) (3 qian).
Decoct in water and take orally. One dose cures.
A person suffers severe right hypochondriac pain, swelling rising like an inverted cup, intolerable to touch, worse upon pressure. People think this is Fire in the Liver Meridian. Who knows it is latent Spleen Fire and stagnant Blood depositing without dissipating? Although the hypochondrium is the Liver's domain, the Liver controls the Spleen. When the Spleen is controlled by the Liver, it can also hurt along with the Liver. However, formless pain is stopped by treating the Liver; tangible pain is resolved by treating the Spleen. Now, pain accompanied by swelling is tangible pain. It is stagnant Blood accumulated in the Spleen, depressed and unable to舒展 (relax), taking advantage of gaps in the Liver region, thus swelling externally on the right hypochondrium. Treatment must clear latent heat in the Spleen and purge stagnant Blood downward to immediately relieve pain. Use the Formula to Break Stasis and Stop Pain (Baiyu Zhitong Tang):
Rhizoma Rhei (Da Huang) (3 qian), Semen Persicae (Tao Ren) (14 grains), Radix Angelicae Sinensis (Dang Gui) (3 qian), Radix Paeoniae Alba (Bai Shao) (1 liang), Radix Bupleuri (Chai Hu) (1 qian), Rhizoma Coptidis (Huang Lian) (1 qian), Cortex Magnoliae Officinalis (Hou Po) (2 qian), Radix Glycyrrhizae Preparata (Gan Cao) (1 qian).
Decoct in water and take orally. One dose passes stagnant Blood, two doses eliminate pain, swelling completely subsides.
This formula uses Rhizoma Rhei (Da Huang), Radix Bupleuri (Chai Hu), and Rhizoma Coptidis (Huang Lian) together to sweep away stasis, remove old accumulation, open depression, and drive out fire, acting swiftly without lingering difficulties. However, without using large doses of Radix Paeoniae Alba (Bai Shao), Liver Qi is hard to calm. Heat in the Spleen, constrained by the Liver, is difficult to dissipate. Thus, although the disease is in the Spleen, treatment still focuses on the Liver.
Using the Formula to Balance Wood and Earth (Mutu Liangping Tang) for this condition is also effective.
Gypsum Fibrosum (Shigao), Poria (Fuling), Rhizoma Atractylodis Macrocephalae (Cang Zhu), Fructus Gardeniae Praeparatus (Chao Zhizi) (each 3 qian), Radix Paeoniae Alba (Bai Shao) (5 qian), Radix Glycyrrhizae Preparata (Gan Cao) (1 qian).
Decoct in water and take orally. One dose brings relief, two doses cure.
A person indulges in sexual activity and suffers from frustration, leading to distension and stuffiness at the Fengfu point (GV16) and pain in both hypochondriac regions. People think excessive sex damages the Kidney and anger injures the Liver, so they should be treated simultaneously. However, they do not know that among simultaneous treatments, treating the Kidney is particularly important. The Liver is the child of the Kidney. When Kidney essence is sufficient, Liver Qi calms easily; when Kidney essence is deficient, Liver Blood becomes dry. The Liver dislikes urgency; nourishing Blood to control urgency is inferior to nourishing Water (Kidney Yin) to calm urgency. Moreover, Liver Blood is easy to generate, while Kidney Water is hard to produce. Thus, for insufficient Liver Blood, lightly tonifying the Liver allows Wood to receive nourishment. For insufficient Kidney Water, unless large doses of Kidney-tonifying herbs are used, Water cannot be generated. Therefore, in hypochondriac pain after sexual fatigue, the deficiency in Essence is greater. How can one heavily treat the Liver and lightly treat the Kidney? Use the Formula to Replenish Essence and Nourish Blood (Tianjing Yixue Tang):
Radix Rehmanniae Preparata (Shudi) (1 liang), Fructus Corni (Shanzhuyu) (5 qian), Radix Paeoniae Alba (Baishao) (5 qian), Radix Angelicae Sinensis (Danggui) (3 qian), Radix Bupleuri (Chaihu) (1 qian), Cortex Moutan (Danpi) (2 qian), Radix Adenophorae (Shashen) (3 qian), Poria (Fuling) (3 qian).
Decoct in water and take orally. One dose calms Liver Qi, two doses stop hypochondriac pain, continuous intake of ten doses leads to complete recovery.
This formula emphasizes tonifying the Kidney to replenish Essence and lightly soothes the Liver to benefit Blood. While treating the Liver and Kidney, it also unblocks Qi in the waist and umbilicus. With free-flowing Qi in the waist and umbilicus, how could Qi in the hypochondrium not flow freely? Thus, when Essence and Blood are generated, pain stops.
This condition can also use the Formula to Nourish Water and Wood (Shuimu Liangzi Tang):
Radix Rehmanniae Preparata (Shudi) (1 liang), Fructus Corni (Shanzhuyu), Rhizoma Dioscoreae Oppositae (Shanyao) (each 4 qian), Radix Paeoniae Alba (Baishao), Radix Angelicae Sinensis (Danggui) (each 5 qian), Radix Glycyrrhizae Preparata (Gancao) (1 qian).
Decoct in water and take orally.