(2)剑突下胀痛，时而胸痛，心悸，舌苔薄白，脉弦涩或兼结象等脾阳虚，痰湿不化者．温通阳气，化痰散结，枳实薤白桂枝汤加减：枳实9克，薤白9克，桂枝9克，半夏9克，白芍9克，陈皮9克，瓜蒌15克。
(3)剑突下疼痛，胸胁下半部亦胀痛。口不干，手指冷，舌苔薄白，脉弦紧等心脾虚寒者，温中散寒，枳实理中汤：枳实9克，党参9克，白术9克，干姜9克，甘草9克，附子9克，肉桂9克。
食后胀痛加重，有压痛等寒实结滞者，加大黄4．5克，厚朴9克。
2．胃脘部疼痛常见的有脾胃虚寒，瘀血阻滞，胃阴不足．寒邪直中，寒滞不化，食滞不化，痰食阻滞，肝胃不和等几种情况。
(1)寒邪直中：多见于急性腹痛。天气寒冷，又吃冷食，突然剛烈腹痛，拒按，手足冷，脉沉迟或弦紧等寒邪人中，饮食停滞者，温中攻下，用中成药“一把抓”，一次1袋。或用大黄附子细辛汤加味：大黄3克，细辛3克，附子9克，干姜9克，川椒9克。并配合灸中脘、神阙，针足三里、中脘、梁门，不效配刺十二井穴。
夏季饮食不当，内受寒湿，突然剧烈疼痛，呕吐泄泻，舌苔白。脉弦紧或沉伏等寒暑之证者。温中化暑。射雄丸，一次1包，或紫金锭，一次2块，研化服。曲泽、委中放血，或十宣放血。
吃冷食或着凉后，突然胃脘及脐腹部剧烈疼痛，腹泻或不泄泻，喜按，脉弦紧或沉迟。脾胃虚寒者，温中散寒。附子理中汤：附子9克，干姜9克，党参9克，白术9克，甘草9克；不泄泻，而有暖气或轻微呕吐者，丁蔻理中汤。
(2)脾胃虚寒：多见于慢性的胃脘疼痛。
这类证候总的特点是慢性持久发作性的胃脘疼痛，秋冬天气变冷后发作较频繁，遇冷或吃冷食后疼痛发作，其中常见的有三种情况：
①胃脘冷痛，痞满，手足冷，脉沉迟或弦紧等脾胃虚寒肴，温中健脾，附桂理中汤：附子9克，肉桂9克，党参9克，白术9克，干姜9克，甘草9克；嗳气，胃脘满胀较重首，加丁香9克，砂仁9克，木香9克，陈皮9克；有烧心．泛酸等嘈杂证者，加吴萸9克，川椒9克。
②胃脘疼痛，饥饿时发作，少吃东西后好转，吃冷食后往往疼痛加重，肩背沉重，下肢偶有轻度浮肿或无浮肿，手心热而肢冷，舌苔白或薄黄，脉弦涩不调或右脉弦左脉沉，右尺大于左等脾胃虚寒，而木邪乘土者，健脾温中而抑木，黄芪建中汤加味：黄芪15克，白芍15克，桂枝9克，生姜3片，大枣7个。当归9克。
若夜间疼痛经常发作者，加丹参15克，灵脂9克，蒲黄9克；兼胀满者，加檀香9克，砂仁9克；胃脘满胀，有轻微压痛，大便干者，加瓜蒌30克。
③胃脘冷痛，反复发作，饥饿或劳累或思考问题过久疼痛往往发作，疲乏无力，心悸，气短，怯冷，夜间五心烦热，手足时冷，口干，面色萎黄，脉沉细弦等脾胃虚寒，气血俱虚者，益气养血，健脾温中，十四味建中汤：黄芪15克，党参9克，白术9克，茯苓9克，甘草9克，当归9克，白芍9克，川芎9克，生地9克，附子9克，半夏9克，麦冬9克，肉苁蓉15克，生姜3片，大枣3个。
(3)痰血阻滞：这类证候的主要特点是固定不变的疼痛，夜间疼痛，除其他证候中兼有瘀血者外，以瘀血为主者，常见的有两种情况：
①夜间疼痛，无痞满及嘈杂感，舌苔白，脉沉涩或弦涩不调等瘀血兼寒者，活血散寒，少腹逐瘀汤：小茴香9克，干姜9克，元胡9克，灵脂9克，没药9克，川芎9克，蒲黄9克，当归9克，官桂9克，赤芍9克。
②夜间疼痛，脘痞，口干，舌质微红，脉弦等瘀血兼热者，丹参饮：丹参30克，檀香9克，砂仁9克。
(4)寒热结滞：本类证候的特点是腹胀痛，有明显压痛，舌苔白，脉弦紧或沉迟结等，常见的有两种情况：
①胃脘剧烈疼痛，拒按，食后疼痛加重，口不干，舌苔白或薄黄而润，脉弦紧等寒实结滞者，散寒温中导滞，大黄附子汤加味：大黄9克，附子3克，细辛3克，干姜3克，枳实3克，厚朴3克。
②胃脘疼痛较久，大便时干时稀，满胀拒按，手冷，舌苔．白，脉沉紧或沉等脾胃虚寒为本，寒实结滞为标者，健脾温中以培本，消导攻下以祛其实，附子理中汤合小承气汤：附子9克，干姜9克，党参9克，白术9克，甘草9克，枳实9克，厚朴9克，大黄4．5克。
(5)痰饮阻滞：本类证候的特点是胃脘痞满，饮食后痞满疼痛加重，或呕吐痰涎。常见的有五种情况：
①胃脘疼痛，痞满，食欲不振，口淡乏味，疲乏无力，舌苔薄白，脉濡缓等脾虚为主者，健脾化痰，香砂六君子汤：木香9克，陈皮9克，砂仁9克，半夏．9克，茯苓9克，甘草9克，党参9克，白术9克。
若吐痰者，加苏子9克，莱菔子9克，杏仁9克。
②胃脘疼痛，反复呕吐，呕吐物为食物粘涎，面色呈黧黑状，或比较消瘦，大便秘结，舌苔白，脉弦大等气阴两虚，痰滞不化者，大半夏汤：半夏15克，人参9克，蜂蜜30一60克，生姜9克。
舌质红，手心热者加麦冬12克。
③胃脘胀痛，饮水后胀痛加重，小便少时痞满较重，小便多吋痞满较轻，舌苔白，脉弦滑等寒饮不化者，燥湿化饮，胃苓汤加减：苍术9克，白术9克，肉桂9克，泽泻9克，猪苓9克，茯苓9克，陈皮9克，厚朴9克，甘草6克。
④胃脘胀痛，食后腹痛加重，食欲不振，口粘不爽，舌苔白，脉弦滑等痰湿较盛者，燥湿化痰，乎胃散加味：苍术15克，厚朴9克，陈皮9克，焦三仙各9克，莱菔子9克。
若咳嗽吐痰者，加苏子9克，杏仁9克；口干苦，舌苔黄腻者，加黄连6克，有压痛者加大黄3克，干姜1．5克。
⑤胃脘胀痛，呕吐粘涎，大便干，口干，腰困痛，舌苔白或薄黄，脉弦滑而大等痰滞不化，气阴两虚者，金水六君煎加减：半夏12克，陈皮9克，茯苓9克，生地9克，当归9克：生姜9克，党参9克，蜂蜜30克。
(6)脾胃阴虚：本类证候的主要特点是胃脘疼痛，夜间口渴，舌质嫩红或白苔，中间无苔。常见的有两种情况：
①胃脘疼痛有灼热感，夜间口渴，舌苔净或苔薄白，舌质嫩红，脉沉弦细等胃阴不足者，滋养胃阴，一贯煎加减：生地15克，沙参9克，枸杞9克，麦冬9克，白芍9克，丹参15克，川楝子9克。
②胃脘疼痛，呕吐时作，夜间口渴，舌苔净或薄白，脉弦滑等阴虛兼痰热者，麦门冬汤加味：麦冬15克，沙参9克：党参9克，半夏9克，白芍9克，生姜9克。
(7)肝气郁结：本类证候的特点是除胃脘胀痛外，并具心烦，胸胁苦满，喜叹气等，临床常见的有四种情况：
①胃脘胀痛，有压痛，食后胃脘胀痛加重，心烦，胸胁苦满，食欲不振，口苦，头晕，舌苔白或黄腻，脉弦滑等肝胃不和，痰食郁积者，疏肝和胃，燥湿导滞。柴平汤加减：柴胡6克，半夏9克，黄芩9克，党参9克，厚朴9克，苍术9克，陈皮9克，干姜1．5克，大黄3克，莱菔子9克．
②胃脘疼痛，头晕，心悸，心烦，手心热，舌苔薄白，脉弦等肝脾不和者，疏肝养血助脾，逍遥散加味：柴胡9克，当归9克，白芍15克，白术9克，茯苓9克，甘草9克，檀香9克，砂仁9克，干姜3克，薄荷3克，丹参15克。
③胃脘及胸胁胀痛，吃冷食及生气后诸证加重，胸满心烦，食欲不振，舌苔薄白，脉沉弦等肝气郁结者，疏肝理气，柴胡疏肝散加减：柴胡6克，枳壳9克，白芍9克，桂枝9克，陈皮9克，木香9克，乌药9克，川芎9克，甘草6克。食后胀痛加重者加莱菔子9克。
④胃脘胀痛，胸胁苦满，心烦，口苦，胸胁及全身窜痛，疲乏无力，下肢偶有浮肿，舌苔薄白或薄黄，脉虚而弦等中气不足，肝气郁结者，益气补中，疏肝理气，升阳益胃汤加减：苗苠15克，党参9克，白术9克，黄连9克，半夏9克，陈皮9克，甘草3克，茯苓9克，泽泻9克，防风9克，羌活9克，独活9克，柴胡9克，白芍9克，生姜3片，大枣3个。
(8)实滞不化：本类证候的特点是胃脘胀痛不能俯仰，拒按，舌苔黄厚，口苦口干，脉滑数或沉实等。临床常见的有四种情况：
①腹胀痛，拒按，舌苔黄厚干燥，脉沉实或沉而滑等实热阻滞者，攻下实热，大承气汤加味：枳实12克，厚朴12克，大黄12克，莱菔子12克，芒硝9克。
大便干较轻者，去芒硝、大黄，加二丑粉6克(冲)。
②腹胀痛，有压痛，食后胀痛加重，大便不畅，舌苔薄黄，脉沉滑等痰食阻滞者，木香槟榔丸：木香9克，槟榔9克，青皮9克，陈皮9克，枳壳9克，酒黄柏9克，黄连9克，三棱9克，莪术9克，酒军3—6克，香附9克。
③腹胀痛剧烈，拒按，舌苔白，或过去不能吃冷食，脉沉弦等寒实结滞者，宜温下祛实。方用：槟榔9克，木香9克，厚朴9克，附子9克，二丑9克，党参6克，枳实9克。
④寒热往来，恶心，心烦，腹胀痛，拒按，大便秘结，舌苔黄，脉弦等少阳阳明合病，和解攻里，大柴胡汤加减：柴胡9克，半夏9克，大黄9克，枳实15克，黄芩15克，白芍15克，莱菔子15克，白芥子9克。
(9)脾肾阳虚：胃脘冷痛，腰困腰痛，手足冷，舌苔薄白，脉弦紧或沉细等脾肾虚寒者，温补脾肾，附子理中汤加味：附子9克，干姜9克，肉桂9克，党参9克，白术9克，甘草9克，生地9克，山药9克，肉苁蓉9克，茯苓9克，泽泻9克，丹皮9克．
(10)寒热夹杂证：本类证候的主要特点是胃脘冷痛，痞满，口苦干等。常见的有三种情况：
①胃脘痞满疼痛，食欲不振，口苦口干，大便稀溏或正常，舌苔白或薄黄而腻，脉滑等寒热夹杂，热多于寒者，半夏泻心汤加减：半夏9克，黄连9克，黄芩9克，干姜9克，党参9克，甘草6克，枳壳9克，神曲9克。
胃脘有压痛者，开胸顺气丸，一次1丸，或平胃散加减：苍术12克，厚朴9克，陈皮9克，甘草6克，焦三仙各9克，莱菔子9克，干姜1．5克，大黄4．5克。
②胃脘疼痛嘈杂，不能吃冷食，食欲差，口苦，苔白，脉弦等寒热夹杂，寒多热少者，黄连汤：黄连9克，半夏9克，干姜9克，肉桂9克，党参9克，甘草6克。
手足厥冷者，附子理中汤加味：附子9克，党参9克，白术9克，干姜9克，黄连9克。
胃脘有压痛者，附子理中汤合小承气汤：附子9克，党参9克，白术9克，干姜9克，甘草9克，枳实9克，厚朴9克，大黄3克。
③胃脘疼痛，不能吃冷食，口干，夜间口干加重，手冷而手心热等寒热夹杂，苦辛酸法，乌梅丸：乌梅15—30克，细辛4.5克，肉桂9克，附子9克，川椒9克，干姜9克，黄连9克，黄柏9克，当归9克，党参9克。
3．胁下疼痛常见的有肝气郁结，肝胆湿热，肝寒，肝肾阴虚，瘀血阻滞等几种情况：
(1)肝气郁结：本类证候的特点是胸胁苦满窜痛，喜出长气，心烦，胁下满痛，常见的有两种情况：
①胁下满痛，心烦，喜出长气，舌苔白，脉沉等肝气郁结者，疏肝理气，柴胡疏肝散：柴胡6克，枳壳9克，白芍9克，木香9克，川芎9克，乌药9克，香附9克，甘草6克，陈皮12克，山楂12克。脉沉而结者，加桂枝9克。⑨胁下满痛，心烦，心悸，背困，五心烦热，时头晕痛，舌苔薄白，脉沉弦等肝郁血虚者，疏肝养血，逍遥散加减：丹疼9克，栀子9克，当归9克，白芍9克，白术9克，茯苓9克，丹参9克，木香6克，生姜3片，薄荷3克。
(2)肝脾虚寒：胁下痛胀，午后满胀加重，不能吃冷食，腰有时酸困，舌苔白或黄润，脉弦等肝脾虚寒者，补肝温脾，暖肝煎加减：枸杞子12克，生地9克，当归9克，小茴香3克，肉桂3克，香附6克，巴戟天9克。
(3)肝肾阴虚：本类证候的特点是胁下及胃脘一侧疼痛，腰困，口干，常见的有两种类型：
①腰及胁下疼痛，劳累时加重，口干，手心热，脉弦尺大等肝肾阴虚者，滋养肝肾，一贯煎加减：生地12克，枸杞子12克，麦冬12克，沙参12克，当归9克，白芍9克，川棟子9克，乌梅9克，木瓜9克。
②腰及胁下疼痛，食欲不振，胸满，心烦，口苦干，头晕，喜叹气，脉沉弦等肝肾俱虚，气郁化火者，滋补肝肾，疏肝泻火，滋水清肝饮加减：生地15克，山药9克，山萸肉9克，枸杞子9克，茯苓9克，泽泻9克，丹皮9克，栀子9克，当归9克，白芍9克，炒枣仁9克，柴胡6克，薄荷3克。
(4)肝胆湿热：本类证候胁下疼痛，黄疸，胃脘满胀，食欲不振，口苦干而粘，舌苔黄白腻，脉弦滑等。常见的有四种情况：
①胁下剧烈疼痛，胃脘胀痛，有明显压痛，口苦干，寒热往来，恶心，大便秘结或正常，脉弦数等肝胆湿热者，和解攻里，大柴胡汤加减：柴胡9克，半夏12克，枳实15克，白芍15克，木香9克，大黄9克。
②肝区疼痛，尿赤黄，口苦干，黄疸，舌苔黄腻，脉弦等肝胆湿热者，清肝利胆祛湿。方用：枳壳15克，茵陈15克，鸡内金15克，郁金15克，瞿麦15克，大黄9克，焦楂30克，金钱草60克。
(2) 剑突下出现胀痛，有时伴有胸痛、心悸，舌苔薄白，脉象弦涩或兼有结象等，属于脾阳虚衰、痰湿无法运化的证候。治法为温通阳气、化痰散结，方用枳实薤白桂枝汤加减：枳实9克，薤白9克，桂枝9克，半夏9克，白芍9克，陈皮9克，瓜蒌15克。
(3) 剑突下疼痛，胸胁下半部也感到胀痛。口不干，手指发冷，舌苔薄白，脉象弦紧等，属于心脾虚寒的证候。治法为温中散寒，方用枳实理中汤：枳实9克，党参9克，白术9克，干姜9克，甘草9克，附子9克，肉桂9克。
若食后胀痛加重，且有压痛等属于寒实结滞者，加大黄4.5克，厚朴9克。
2. 胃脘部疼痛常见的有脾胃虚寒、瘀血阻滞、胃阴不足、寒邪直中、寒滞不化、食滞不化、痰食阻滞、肝胃不和等几种情况。
(1) 寒邪直中：多见于急性腹痛。因天气寒冷，又进食生冷食物，突然发生剧烈腹痛，拒按，手足冰冷，脉象沉迟或弦紧等，属于寒邪入侵、饮食停滞的证候。治法为温中攻下，使用中成药“一把抓”，一次1袋。或者使用大黄附子细辛汤加味：大黄3克，细辛3克，附子9克，干姜9克，川椒9克。并配合艾灸中脘穴、神阙穴，针刺足三里穴、中脘穴、梁门穴；若无效，配合刺十二井穴放血。
夏季饮食不当，内受寒湿，突然剧烈疼痛，呕吐泄泻，舌苔白，脉象弦紧或沉伏等，属于寒暑夹杂的证候。治法为温中化暑，服用射雄丸，一次1包，或者紫金锭，一次2块，研碎化服。曲泽穴、委中穴放血，或者十宣穴放血。
食用冷食或受凉后，突然胃脘及脐腹部剧烈疼痛，腹泻或不腹泻，喜欢按压，脉象弦紧或沉迟，属于脾胃虚寒的证候。治法为温中散寒，方用附子理中汤：附子9克，干姜9克，党参9克，白术9克，甘草9克；若不腹泻，而有嗳气或轻微呕吐者，用丁蔻理中汤。
(2) 脾胃虚寒：多见于慢性的胃脘疼痛。
这类证候的总体特点是慢性、持久、发作性的胃脘疼痛，秋冬天气变冷后发作较频繁，遇冷或吃冷食后疼痛发作，其中常见的有三种情况：
① 胃脘冷痛，痞满（感觉堵塞不通），手足冷，脉象沉迟或弦紧等，属于脾胃虚寒的证候。治法为温中健脾，方用附桂理中汤：附子9克，肉桂9克，党参9克，白术9克，干姜9克，甘草9克；若有嗳气，胃脘满胀较重者，加丁香9克，砂仁9克，木香9克，陈皮9克；若有烧心、泛酸等嘈杂感者，加吴茱萸9克，川椒9克。
② 胃脘疼痛，饥饿时发作，少吃东西后好转，吃冷食后往往疼痛加重，肩背沉重，下肢偶有轻度浮肿或无浮肿，手心热而四肢冷，舌苔白或薄黄，脉象弦涩不调或右脉弦左脉沉，右尺脉大于左脉等，属于脾胃虚寒，且肝木邪气乘袭脾土的证候。治法为健脾温中而抑制肝木，方用黄芪建中汤加味：黄芪15克，白芍15克，桂枝9克，生姜3片，大枣7个，当归9克。
若夜间疼痛经常发作者，加丹参15克，五灵脂9克，蒲黄9克；兼有胀满者，加檀香9克，砂仁9克；胃脘满胀，有轻微压痛，大便干结者，加瓜蒌30克。
③ 胃脘冷痛，反复发作，饥饿或劳累或思考问题过久疼痛往往发作，疲乏无力，心悸，气短，怕冷，夜间五心烦热，手足时而发冷，口干，面色萎黄，脉象沉细弦等，属于脾胃虚寒，气血俱虚的证候。治法为益气养血，健脾温中，方用十四味建中汤：黄芪15克，党参9克，白术9克，茯苓9克，甘草9克，当归9克，白芍9克，川芎9克，生地9克，附子9克，半夏9克，麦冬9克，肉苁蓉15克，生姜3片，大枣3个。
(3) 瘀血阻滞：这类证候的主要特点是固定不变的疼痛，夜间疼痛加重，除其他证候中兼有瘀血者外，以瘀血为主者，常见的有两种情况：
① 夜间疼痛，无痞满及嘈杂感，舌苔白，脉象沉涩或弦涩不调等，属于瘀血兼寒的证候。治法为活血散寒，方用少腹逐瘀汤：小茴香9克，干姜9克，元胡9克，五灵脂9克，没药9克，川芎9克，蒲黄9克，当归9克，官桂9克，赤芍9克。
② 夜间疼痛，脘部痞闷，口干，舌质微红，脉象弦等，属于瘀血兼热的证候。治法为活血化瘀清热，方用丹参饮：丹参30克，檀香9克，砂仁9克。
(4) 寒热结滞：本类证候的特点是腹胀痛，有明显压痛，舌苔白，脉象弦紧或沉迟结等，常见的有两种情况：
① 胃脘剧烈疼痛，拒按，食后疼痛加重，口不干，舌苔白或薄黄而润，脉象弦紧等，属于寒实结滞的证候。治法为散寒温中导滞，方用大黄附子汤加味：大黄9克，附子3克，细辛3克，干姜3克，枳实3克，厚朴3克。
② 胃脘疼痛时间较长，大便时干时稀，满胀拒按，手冷，舌苔白，脉象沉紧或沉等，属于脾胃虚寒为本，寒实结滞为标的证候。治法为健脾温中以培补根本，消导攻下以祛除实邪，方用附子理中汤合小承气汤：附子9克，干姜9克，党参9克，白术9克，甘草9克，枳实9克，厚朴9克，大黄4.5克。
(5) 痰饮阻滞：本类证候的特点是胃脘痞满，饮食后痞满疼痛加重，或呕吐痰涎。常见的有五种情况：
① 胃脘疼痛，痞满，食欲不振，口淡乏味，疲乏无力，舌苔薄白，脉象濡缓等，属于以脾虚为主的证候。治法为健脾化痰，方用香砂六君子汤：木香9克，陈皮9克，砂仁9克，半夏9克，茯苓9克，甘草9克，党参9克，白术9克。
若吐痰者，加苏子9克，莱菔子9克，杏仁9克。
② 胃脘疼痛，反复呕吐，呕吐物为食物粘涎，面色呈黧黑状，或比较消瘦，大便秘结，舌苔白，脉象弦大等，属于气阴两虚，痰滞不化的证候。治法为补气养阴、降逆化痰，方用大半夏汤：半夏15克，人参9克，蜂蜜30-60克，生姜9克。
若舌质红，手心热者，加麦冬12克。
③ 胃脘胀痛，饮水后胀痛加重，小便少时痞满较重，小便多时痞满较轻，舌苔白，脉象弦滑等，属于寒饮不化的证候。治法为燥湿化饮，方用胃苓汤加减：苍术9克，白术9克，肉桂9克，泽泻9克，猪苓9克，茯苓9克，陈皮9克，厚朴9克，甘草6克。
④ 胃脘胀痛，食后腹痛加重，食欲不振，口粘不爽，舌苔白，脉象弦滑等，属于痰湿较盛的证候。治法为燥湿化痰，方用平胃散加味：苍术15克，厚朴9克，陈皮9克，焦三仙各9克，莱菔子9克。
若咳嗽吐痰者，加苏子9克，杏仁9克；口干苦，舌苔黄腻者，加黄连6克；有压痛者加大黄3克，干姜1.5克。
⑤ 胃脘胀痛，呕吐粘涎，大便干，口干，腰困痛，舌苔白或薄黄，脉象弦滑而大等，属于痰滞不化，气阴两虚的证候。治法为燥湿化痰、益气养阴，方用金水六君煎加减：半夏12克，陈皮9克，茯苓9克，生地9克，当归9克，生姜9克，党参9克，蜂蜜30克。
(6) 脾胃阴虚：本类证候的主要特点是胃脘疼痛，夜间口渴，舌质嫩红或白苔，中间无苔。常见的有两种情况：
① 胃脘疼痛有灼热感，夜间口渴，舌苔净或苔薄白，舌质嫩红，脉象沉弦细等，属于胃阴不足的证候。治法为滋养胃阴，方用一贯煎加减：生地15克，沙参9克，枸杞9克，麦冬9克，白芍9克，丹参15克，川楝子9克。
② 胃脘疼痛，呕吐时作，夜间口渴，舌苔净或薄白，脉象弦滑等，属于阴虚兼痰热的证候。治法为滋阴降逆，方用麦门冬汤加味：麦冬15克，沙参9克，党参9克，半夏9克，白芍9克，生姜9克。
(7) 肝气郁结：本类证候的特点是除胃脘胀痛外，并具心烦，胸胁苦满，喜叹气等，临床常见的有四种情况：
① 胃脘胀痛，有压痛，食后胃脘胀痛加重，心烦，胸胁苦满，食欲不振，口苦，头晕，舌苔白或黄腻，脉象弦滑等，属于肝胃不和，痰食郁积的证候。治法为疏肝和胃，燥湿导滞，方用柴平汤加减：柴胡6克，半夏9克，黄芩9克，党参9克，厚朴9克，苍术9克，陈皮9克，干姜1.5克，大黄3克，莱菔子9克。
② 胃脘疼痛，头晕，心悸，心烦，手心热，舌苔薄白，脉象弦等，属于肝脾不和的证候。治法为疏肝养血助脾，方用逍遥散加味：柴胡9克，当归9克，白芍15克，白术9克，茯苓9克，甘草9克，檀香9克，砂仁9克，干姜3克，薄荷3克，丹参15克。
③ 胃脘及胸胁胀痛，吃冷食及生气后诸证加重，胸满心烦，食欲不振，舌苔薄白，脉象沉弦等，属于肝气郁结的证候。治法为疏肝理气，方用柴胡疏肝散加减：柴胡6克，枳壳9克，白芍9克，桂枝9克，陈皮9克，木香9克，乌药9克，川芎9克，甘草6克。食后胀痛加重者加莱菔子9克。
④ 胃脘胀痛，胸胁苦满，心烦，口苦，胸胁及全身窜痛，疲乏无力，下肢偶有浮肿，舌苔薄白或薄黄，脉象虚而弦等，属于中气不足，肝气郁结的证候。治法为益气补中，疏肝理气，方用升阳益胃汤加减：黄芪15克，党参9克，白术9克，黄连9克，半夏9克，陈皮9克，甘草3克，茯苓9克，泽泻9克，防风9克，羌活9克，独活9克，柴胡9克，白芍9克，生姜3片，大枣3个。
(8) 实滞不化：本类证候的特点是胃脘胀痛不能俯仰，拒按，舌苔黄厚，口苦口干，脉象滑数或沉实等。临床常见的有四种情况：
① 腹胀痛，拒按，舌苔黄厚干燥，脉象沉实或沉而滑等，属于实热阻滞的证候。治法为攻下实热，方用大承气汤加味：枳实12克，厚朴12克，大黄12克，莱菔子12克，芒硝9克。
大便干结较轻者，去芒硝、大黄，加二丑粉6克（冲服）。
② 腹胀痛，有压痛，食后胀痛加重，大便不畅，舌苔薄黄，脉象沉滑等，属于痰食阻滞的证候。治法为行气导滞，方用木香槟榔丸：木香9克，槟榔9克，青皮9克，陈皮9克，枳壳9克，酒黄柏9克，黄连9克，三棱9克，莪术9克，酒军3-6克，香附9克。
③ 腹胀痛剧烈，拒按，舌苔白，或过去不能吃冷食，脉象沉弦等，属于寒实结滞的证候。宜温下祛实。方用：槟榔9克，木香9克，厚朴9克，附子9克，二丑9克，党参6克，枳实9克。
④ 寒热往来，恶心，心烦，腹胀痛，拒按，大便秘结，舌苔黄，脉象弦等，属于少阳阳明合病的证候。治法为和解攻里，方用大柴胡汤加减：柴胡9克，半夏9克，大黄9克，枳实15克，黄芩15克，白芍15克，莱菔子15克，白芥子9克。
(9) 脾肾阳虚：胃脘冷痛，腰困腰痛，手足冷，舌苔薄白，脉象弦紧或沉细等，属于脾肾虚寒的证候。治法为温补脾肾，方用附子理中汤加味：附子9克，干姜9克，肉桂9克，党参9克，白术9克，甘草9克，生地9克，山药9克，肉苁蓉9克，茯苓9克，泽泻9克，丹皮9克。
(10) 寒热夹杂证：本类证候的主要特点是胃脘冷痛，痞满，口苦干等。常见的有三种情况：
① 胃脘痞满疼痛，食欲不振，口苦口干，大便稀溏或正常，舌苔白或薄黄而腻，脉象滑等，属于寒热夹杂，热多于寒的证候。治法为调和寒热，方用半夏泻心汤加减：半夏9克，黄连9克，黄芩9克，干姜9克，党参9克，甘草6克，枳壳9克，神曲9克。
胃脘有压痛者，服用开胸顺气丸，一次1丸，或者平胃散加减：苍术12克，厚朴9克，陈皮9克，甘草6克，焦三仙各9克，莱菔子9克，干姜1.5克，大黄4.5克。
② 胃脘疼痛嘈杂，不能吃冷食，食欲差，口苦，苔白，脉象弦等，属于寒热夹杂，寒多热少的证候。治法为平调寒热，方用黄连汤：黄连9克，半夏9克，干姜9克，肉桂9克，党参9克，甘草6克。
手足厥冷者，方用附子理中汤加味：附子9克，党参9克，白术9克，干姜9克，黄连9克。
胃脘有压痛者，方用附子理中汤合小承气汤：附子9克，党参9克，白术9克，干姜9克，甘草9克，枳实9克，厚朴9克，大黄3克。
③ 胃脘疼痛，不能吃冷食，口干，夜间口干加重，手冷而手心热等，属于寒热夹杂的证候。治法为苦辛酸法（寒热并用），方用乌梅丸：乌梅15-30克，细辛4.5克，肉桂9克，附子9克，川椒9克，干姜9克，黄连9克，黄柏9克，当归9克，党参9克。
3. 胁下疼痛常见的有肝气郁结、肝胆湿热、肝寒、肝肾阴虚、瘀血阻滞等几种情况：
(1) 肝气郁结：本类证候的特点是胸胁苦满窜痛，喜出长气，心烦，胁下满痛，常见的有两种情况：
① 胁下满痛，心烦，喜出长气，舌苔白，脉象沉等，属于肝气郁结的证候。治法为疏肝理气，方用柴胡疏肝散：柴胡6克，枳壳9克，白芍9克，木香9克，川芎9克，乌药9克，香附9克，甘草6克，陈皮12克，山楂12克。脉象沉而结者，加桂枝9克。
② 胁下满痛，心烦，心悸，背困，五心烦热，时头晕痛，舌苔薄白，脉象沉弦等，属于肝郁血虚的证候。治法为疏肝养血，方用逍遥散加减：丹皮9克，栀子9克，当归9克，白芍9克，白术9克，茯苓9克，丹参9克，木香6克，生姜3片，薄荷3克。
(2) 肝脾虚寒：胁下痛胀，午后满胀加重，不能吃冷食，腰有时酸困，舌苔白或黄润，脉象弦等，属于肝脾虚寒的证候。治法为补肝温脾，方用暖肝煎加减：枸杞子12克，生地9克，当归9克，小茴香3克，肉桂3克，香附6克，巴戟天9克。
(3) 肝肾阴虚：本类证候的特点是胁下及胃脘一侧疼痛，腰困，口干，常见的有两种类型：
① 腰及胁下疼痛，劳累时加重，口干，手心热，脉象弦尺大等，属于肝肾阴虚的证候。治法为滋养肝肾，方用一贯煎加减：生地12克，枸杞子12克，麦冬12克，沙参12克，当归9克，白芍9克，川楝子9克，乌梅9克，木瓜9克。
② 腰及胁下疼痛，食欲不振，胸满，心烦，口苦干，头晕，喜叹气，脉象沉弦等，属于肝肾俱虚，气郁化火的证候。治法为滋补肝肾，疏肝泻火，方用滋水清肝饮加减：生地15克，山药9克，山萸肉9克，枸杞子9克，茯苓9克，泽泻9克，丹皮9克，栀子9克，当归9克，白芍9克，炒枣仁9克，柴胡6克，薄荷3克。
(4) 肝胆湿热：本类证候胁下疼痛，黄疸，胃脘满胀，食欲不振，口苦干而粘，舌苔黄白腻，脉象弦滑等。常见的有四种情况：
① 胁下剧烈疼痛，胃脘胀痛，有明显压痛，口苦干，寒热往来，恶心，大便秘结或正常，脉象弦数等，属于肝胆湿热的证候。治法为和解攻里，方用大柴胡汤加减：柴胡9克，半夏12克，枳实15克，白芍15克，木香9克，大黄9克。
② 肝区疼痛，尿赤黄，口苦干，黄疸，舌苔黄腻，脉象弦等，属于肝胆湿热的证候。治法为清肝利胆祛湿。方用：枳壳15克，茵陈15克，鸡内金15克，郁金15克，瞿麦15克，大黄9克，焦楂30克，金钱草60克。
(2) Distending pain below the xiphoid process, occasionally accompanied by chest pain and palpitations; thin white tongue coating; wiry and choppy pulse or with a knotted quality. This indicates Spleen Yang deficiency with failure to transform phlegm-dampness. The treatment principle is to warm and unblock Yang Qi, resolve phlegm and dissipate nodules. Use Zhishi Xiebai Guizhi Tang (Bitter Orange, Macrostemon, and Cinnamon Twig Decoction) modified: Zhishi (Immature Bitter Orange) 9g, Xiebai (Macrostemon Rhizome) 9g, Guizhi (Cinnamon Twig) 9g, Banxia (Pinellia Tuber) 9g, Baishao (White Peony Root) 9g, Chenpi (Aged Tangerine Peel) 9g, Gualou (Trichosanthes Fruit) 15g.
(3) Pain below the xiphoid process, with distending pain in the lower half of the chest and hypochondrium; mouth not dry, cold fingers; thin white tongue coating; wiry and tight pulse. This indicates Heart and Spleen deficiency-cold. The treatment principle is to warm the middle and dispel cold. Use Zhishi Lizhong Tang (Bitter Orange and Gastrodia Decoction) [Note: Standard name is Lizhong Tang modified with Zhishi]: Zhishi (Immature Bitter Orange) 9g, Dangshen (Codonopsis Root) 9g, Baizhu (Atractylodes Macrocephala Rhizome) 9g, Ganjiang (Dried Ginger) 9g, Gancao (Licorice Root) 9g, Fuzi (Prepared Aconite Root) 9g, Rougui (Cinnamon Bark) 9g.
If distending pain worsens after eating and there is tenderness on pressure, indicating cold-excess stagnation, add Dahuang (Rhubarb Root) 4.5g and Houpo (Magnolia Bark) 9g.
2. Common causes of epigastric pain include Spleen-Stomach deficiency-cold, blood stasis obstruction, Stomach Yin deficiency, direct invasion of cold pathogen, failure to transform cold stagnation, food stagnation, phlegm-food obstruction, and Liver-Stomach disharmony.
(1) Direct invasion of cold pathogen: Commonly seen in acute abdominal pain. Due to cold weather and consumption of cold foods, sudden severe abdominal pain occurs, which is aggravated by pressure, accompanied by cold hands and feet, and a deep, slow or wiry-tight pulse. This indicates cold pathogen invasion and food stagnation. The treatment principle is to warm the middle and purge accumulation. Use the Chinese patent medicine "Yibazhua" (One-Grab), one bag per dose. Alternatively, use Dahuang Fuzi Xixin Tang (Rhubarb, Aconite, and Asarum Decoction) modified: Dahuang (Rhubarb Root) 3g, Xixin (Asarum) 3g, Fuzi (Prepared Aconite Root) 9g, Ganjiang (Dried Ginger) 9g, Chuanjiao (Sichuan Pepper) 9g. Combine with moxibustion on Zhongwan (CV12) and Shenque (CV8), acupuncture at Zusanli (ST36), Zhongwan (CV12), and Liangmen (ST21); if ineffective, combine with pricking the Twelve Jingwell points for bleeding.
Improper diet in summer leading to internal cold-dampness, sudden severe pain, vomiting, diarrhea, white tongue coating, wiry-tight or deep-hidden pulse indicates cold-summerheat syndrome. The treatment principle is to warm the middle and resolve summerheat. Use Shexiong Wan (She Xiong Pill), one packet per dose, or Zijin Ding (Purple Gold Pellet), two pieces per dose, crushed and taken with water. Bleed Quze (PC3) and Weizhong (BL40), or Shixuan (EX-UE11).
After consuming cold food or catching a chill, sudden severe pain in the epigastrium and umbilical-abdominal region occurs, with diarrhea or no diarrhea, preference for pressure, and wiry-tight or deep-slow pulse. This indicates Spleen-Stomach deficiency-cold. The treatment principle is to warm the middle and dispel cold. Use Fuzi Lizhong Tang (Aconite and Gastrodia Decoction): Fuzi (Prepared Aconite Root) 9g, Ganjiang (Dried Ginger) 9g, Dangshen (Codonopsis Root) 9g, Baizhu (Atractylodes Macrocephala Rhizome) 9g, Gancao (Licorice Root) 9g; if no diarrhea but with belching or mild vomiting, use Dingkou Lizhong Tang (Cloves and Cardamom Gastrodia Decoction).
(2) Spleen-Stomach deficiency-cold: Commonly seen in chronic epigastric pain.
The general characteristic of this syndrome is chronic, persistent, paroxysmal epigastric pain, which occurs more frequently when the weather turns cold in autumn and winter, and is triggered by exposure to cold or consumption of cold foods. There are three common situations:
① Cold pain in the epigastrium, fullness and stuffiness, cold hands and feet, deep-slow or wiry-tight pulse. This indicates Spleen-Stomach deficiency-cold. The treatment principle is to warm the middle and strengthen the Spleen. Use Fugui Lizhong Tang (Aconite and Cinnamon Gastrodia Decoction): Fuzi (Prepared Aconite Root) 9g, Rougui (Cinnamon Bark) 9g, Dangshen (Codonopsis Root) 9g, Baizhu (Atractylodes Macrocephala Rhizome) 9g, Ganjiang (Dried Ginger) 9g, Gancao (Licorice Root) 9g; if belching and severe epigastric distension occur, add Dingxiang (Clove) 9g, Sharen (Amomum Fruit) 9g, Muxiang (Vladimiria Root) 9g, Chenpi (Aged Tangerine Peel) 9g; if burning sensation and acid regurgitation (zao re) occur, add Wuyu (Evodia Fruit) 9g, Chuanjiao (Sichuan Pepper) 9g.
② Epigastric pain occurring during hunger, improving with small meals, worsening with cold food; heavy shoulders and back, occasional mild edema in lower limbs or none; hot palms but cold extremities; white or thin-yellow tongue coating; wiry-choppy irregular pulse, or wiry right pulse and deep left pulse, with right Chi pulse larger than left. This indicates Spleen-Stomach deficiency-cold with Liver Wood overacting on Earth. The treatment principle is to strengthen the Spleen, warm the middle, and suppress the Liver. Use Huangqi Jianzhong Tang (Astragalus and Middle-Nourishing Decoction) modified: Huangqi (Astragalus Root) 15g, Baishao (White Peony Root) 15g, Guizhi (Cinnamon Twig) 9g, Shengjiang (Fresh Ginger) 3 slices, Dazao (Jujube) 7 pieces, Danggui (Angelica Sinensis) 9g.
If night pain is frequent, add Danshen (Salvia Root) 15g, Lingzhi (Trogopterus Dung) 9g, Puhuang (Lygodium Spore) 9g; if accompanied by distension, add Tanxiang (Sandalwood) 9g, Sharen (Amomum Fruit) 9g; if epigastric fullness with mild tenderness and dry stool, add Gualou (Trichosanthes Fruit) 30g.
③ Recurrent cold pain in the epigastrium, often triggered by hunger, fatigue, or prolonged thinking; fatigue, palpitations, shortness of breath, aversion to cold, five-palm heat at night, intermittent cold hands and feet, dry mouth, sallow complexion, deep-thin-wiry pulse. This indicates Spleen-Stomach deficiency-cold with Qi and Blood deficiency. The treatment principle is to tonify Qi and nourish Blood, strengthen the Spleen and warm the middle. Use Shisiwei Jianzhong Tang (Fourteen-Ingredient Middle-Nourishing Decoction): Huangqi (Astragalus Root) 15g, Dangshen (Codonopsis Root) 9g, Baizhu (Atractylodes Macrocephala Rhizome) 9g, Fuling (Poria) 9g, Gancao (Licorice Root) 9g, Danggui (Angelica Sinensis) 9g, Baishao (White Peony Root) 9g, Chuanxiong (Ligusticum Rhizome) 9g, Shengdi (Rehmannia Root) 9g, Fuzi (Prepared Aconite Root) 9g, Banxia (Pinellia Tuber) 9g, Maidong (Ophiopogon Tuber) 9g, Roushouyu (Cistanche Stem) 15g, Shengjiang (Fresh Ginger) 3 slices, Dazao (Jujube) 3 pieces.
(3) Blood stasis obstruction: The main characteristic of this syndrome is fixed pain that worsens at night. Besides cases where blood stasis is concurrent with other syndromes, those primarily due to blood stasis have two common situations:
① Night pain, without fullness or zao re sensation, white tongue coating, deep-choppy or wiry-choppy irregular pulse. This indicates blood stasis combined with cold. The treatment principle is to invigorate blood and dispel cold. Use Shaofu Zhuyu Tang (Lower Abdomen Blood-Stasis Resolving Decoction): Xiaohuixiang (Fennel Fruit) 9g, Ganjiang (Dried Ginger) 9g, Yuanhu (Corydalis Rhizome) 9g, Lingzhi (Trogopterus Dung) 9g, Moyao (Myrrh) 9g, Chuanxiong (Ligusticum Rhizome) 9g, Puhuang (Lygodium Spore) 9g, Danggui (Angelica Sinensis) 9g, Guangui (Cinnamon Bark) 9g, Chishao (Red Peony Root) 9g.
② Night pain, epigastric stuffiness, dry mouth, slightly red tongue body, wiry pulse. This indicates blood stasis combined with heat. The treatment principle is to invigorate blood and clear heat. Use Danshen Yin (Salvia Infusion): Danshen (Salvia Root) 30g, Tanxiang (Sandalwood) 9g, Sharen (Amomum Fruit) 9g.
(4) Cold-Heat knotting/stagnation: The characteristic of this syndrome is abdominal distending pain with obvious tenderness, white tongue coating, wiry-tight or deep-slow knotted pulse. There are two common situations:
① Severe epigastric pain, aggravated by pressure, worsening after eating, mouth not dry, white or thin-yellow moist tongue coating, wiry-tight pulse. This indicates cold-excess stagnation. The treatment principle is to scatter cold, warm the middle, and guide out stagnation. Use Dahuang Fuzi Tang (Rhubarb and Aconite Decoction) modified: Dahuang (Rhubarb Root) 9g, Fuzi (Prepared Aconite Root) 3g, Xixin (Asarum) 3g, Ganjiang (Dried Ginger) 3g, Zhishi (Immature Bitter Orange) 3g, Houpo (Magnolia Bark) 3g.
② Long-standing epigastric pain, alternating dry and loose stools, distension with aggravation by pressure, cold hands, white tongue coating, deep-tight or deep pulse. This indicates Spleen-Stomach deficiency-cold as the root and cold-excess stagnation as the branch. The treatment principle is to strengthen the Spleen and warm the middle to support the root, and to digest and purge to remove excess. Use Fuzi Lizhong Tang combined with Xiao Chengqi Tang (Minor Order the Qi Decoction): Fuzi (Prepared Aconite Root) 9g, Ganjiang (Dried Ginger) 9g, Dangshen (Codonopsis Root) 9g, Baizhu (Atractylodes Macrocephala Rhizome) 9g, Gancao (Licorice Root) 9g, Zhishi (Immature Bitter Orange) 9g, Houpo (Magnolia Bark) 9g, Dahuang (Rhubarb Root) 4.5g.
(5) Phlegm-fluid obstruction: The characteristic of this syndrome is epigastric fullness and stuffiness, worsening after eating, or vomiting of phlegm-saliva. There are five common situations:
① Epigastric pain, fullness, poor appetite, bland taste, fatigue, thin-white tongue coating, soggy-slow pulse. This indicates predominance of Spleen deficiency. The treatment principle is to strengthen the Spleen and resolve phlegm. Use Xiangsha Liujunzi Tang (Costus and Amomum Six-Gentlemen Decoction): Muxiang (Vladimiria Root) 9g, Chenpi (Aged Tangerine Peel) 9g, Sharen (Amomum Fruit) 9g, Banxia (Pinellia Tuber) 9g, Fuling (Poria) 9g, Gancao (Licorice Root) 9g, Dangshen (Codonopsis Root) 9g, Baizhu (Atractylodes Macrocephala Rhizome) 9g.
If vomiting phlegm, add Suzi (Perilla Seed) 9g, Laifuzi (Radish Seed) 9g, Xingren (Apricot Seed) 9g.
② Epigastric pain, recurrent vomiting of sticky saliva/food, dark sallow complexion, emaciation, constipation, white tongue coating, large wiry pulse. This indicates Qi and Yin deficiency with phlegm stagnation. The treatment principle is to tonify Qi and nourish Yin, descend rebellion and resolve phlegm. Use Da Banxia Tang (Major Pinellia Decoction): Banxia (Pinellia Tuber) 15g, Ren Shen (Ginseng Root) 9g, Fengmi (Honey) 30-60g, Shengjiang (Fresh Ginger) 9g.
If red tongue body and hot palms, add Maidong (Ophiopogon Tuber) 12g.
③ Epigastric distending pain, worsening after drinking water, heavier fullness when urine output is low, lighter fullness when urine output is high, white tongue coating, wiry-slippery pulse. This indicates failure to transform cold fluids. The treatment principle is to dry dampness and resolve fluids. Use Weiling Tang (Stomach-Calm Decoction) modified: Cangzhu (Atractylodes Lancea Rhizome) 9g, Baizhu (Atractylodes Macrocephala Rhizome) 9g, Rougui (Cinnamon Bark) 9g, Zexie (Alisma Rhizome) 9g, Zhuling (Polyporus) 9g, Fuling (Poria) 9g, Chenpi (Aged Tangerine Peel) 9g, Houpo (Magnolia Bark) 9g, Gancao (Licorice Root) 6g.
④ Epigastric distending pain, worsening abdominal pain after eating, poor appetite, sticky mouth, white tongue coating, wiry-slippery pulse. This indicates excessive phlegm-dampness. The treatment principle is to dry dampness and resolve phlegm. Use Pingwei San (Stomach-Calming Powder) modified: Cangzhu (Atractylodes Lancea Rhizome) 15g, Houpo (Magnolia Bark) 9g, Chenpi (Aged Tangerine Peel) 9g, Jiao Sanxian (Charred Three Immortals: Shan Zha, Shen Qu, Mai Ya) each 9g, Laifuzi (Radish Seed) 9g.
If coughing with phlegm, add Suzi (Perilla Seed) 9g, Xingren (Apricot Seed) 9g; if dry bitter mouth and yellow-greasy tongue coating, add Huanglian (Coptis Rhizome) 6g; if tenderness on pressure, add Dahuang (Rhubarb Root) 3g, Ganjiang (Dried Ginger) 1.5g.
⑤ Epigastric distending pain, vomiting sticky saliva, dry stool, dry mouth, sore and painful lower back, white or thin-yellow tongue coating, wiry-slippery-large pulse. This indicates phlegm stagnation with Qi and Yin deficiency. The treatment principle is to resolve phlegm, tonify Qi and nourish Yin. Use Jinshui Liu Jun Jian (Metal-Water Six-Gentlemen Decoction) modified: Banxia (Pinellia Tuber) 12g, Chenpi (Aged Tangerine Peel) 9g, Fuling (Poria) 9g, Shengdi (Rehmannia Root) 9g, Danggui (Angelica Sinensis) 9g, Shengjiang (Fresh Ginger) 9g, Dangshen (Codonopsis Root) 9g, Fengmi (Honey) 30g.
(6) Spleen-Stomach Yin deficiency: The main characteristic is epigastric pain, thirst at night, tender-red tongue body or white coating with no coating in the center. There are two common situations:
① Burning sensation in epigastric pain, thirst at night, clean or thin-white tongue coating, tender-red tongue body, deep-wiry-thin pulse. This indicates Stomach Yin deficiency. The treatment principle is to nourish Stomach Yin. Use Yiguan Jian (One Glance Decoction) modified: Shengdi (Rehmannia Root) 15g, Shashen (Glehnia Root) 9g, Gouqi (Goji Berry) 9g, Maidong (Ophiopogon Tuber) 9g, Baishao (White Peony Root) 9g, Danshen (Salvia Root) 15g, Chuanlianzi (Szechwan Chinaberry Seed) 9g.
② Epigastric pain, intermittent vomiting, thirst at night, clean or thin-white tongue coating, wiry-slippery pulse. This indicates Yin deficiency combined with phlegm-heat. The treatment principle is to nourish Yin and descend rebellion. Use Maidong Tang (Ophiopogon Decoction) modified: Maidong (Ophiopogon Tuber) 15g, Shashen (Glehnia Root) 9g, Dangshen (Codonopsis Root) 9g, Banxia (Pinellia Tuber) 9g, Baishao (White Peony Root) 9g, Shengjiang (Fresh Ginger) 9g.
(7) Liver Qi stagnation: In addition to epigastric distending pain, characteristics include irritability, fullness and discomfort in the chest and hypochondrium, and sighing. There are four common clinical situations:
① Epigastric distending pain with tenderness, worsening after eating, irritability, chest-hypochondriac fullness, poor appetite, bitter taste, dizziness, white or yellow-greasy tongue coating, wiry-slippery pulse. This indicates Liver-Stomach disharmony with phlegm-food depression. The treatment principle is to soothe the Liver and harmonize the Stomach, dry dampness and guide out stagnation. Use Chaiping Tang (Bupleurum and Pinellia Decoction) modified: Chaihu (Bupleurum Root) 6g, Banxia (Pinellia Tuber) 9g, Huangqin (Scutellaria Root) 9g, Dangshen (Codonopsis Root) 9g, Houpo (Magnolia Bark) 9g, Cangzhu (Atractylodes Lancea Rhizome) 9g, Chenpi (Aged Tangerine Peel) 9g, Ganjiang (Dried Ginger) 1.5g, Dahuang (Rhubarb Root) 3g, Laifuzi (Radish Seed) 9g.
② Epigastric pain, dizziness, palpitations, irritability, hot palms, thin-white tongue coating, wiry pulse. This indicates Liver-Spleen disharmony. The treatment principle is to soothe the Liver, nourish Blood and assist the Spleen. Use Xiaoyao San (Free and Easy Wanderer Powder) modified: Chaihu (Bupleurum Root) 9g, Danggui (Angelica Sinensis) 9g, Baishao (White Peony Root) 15g, Baizhu (Atractylodes Macrocephala Rhizome) 9g, Fuling (Poria) 9g, Gancao (Licorice Root) 9g, Tanxiang (Sandalwood) 9g, Sharen (Amomum Fruit) 9g, Ganjiang (Dried Ginger) 3g, Bohe (Mint) 3g, Danshen (Salvia Root) 15g.
③ Epigastric and hypochondriac distending pain, worsening with cold food and anger, chest fullness and irritability, poor appetite, thin-white tongue coating, deep-wiry pulse. This indicates Liver Qi stagnation. The treatment principle is to soothe the Liver and regulate Qi. Use Chaihu Shugan San (Bupleurum Powder to Soothe the Liver) modified: Chaihu (Bupleurum Root) 6g, Zhike (Bitter Orange Fruit) 9g, Baishao (White Peony Root) 9g, Guizhi (Cinnamon Twig) 9g, Chenpi (Aged Tangerine Peel) 9g, Muxiang (Vladimiria Root) 9g, Wuyao (Lindera Root) 9g, Chuanxiong (Ligusticum Rhizome) 9g, Gancao (Licorice Root) 6g. If distending pain worsens after eating, add Laifuzi (Radish Seed) 9g.
④ Epigastric distending pain, chest-hypochondriac fullness, irritability, bitter taste, wandering pain in chest-hypochondrium and whole body, fatigue, occasional lower limb edema, thin-white or thin-yellow tongue coating, deficient-wiry pulse. This indicates Middle Qi deficiency with Liver Qi stagnation. The treatment principle is to tonify Qi and supplement the middle, soothe the Liver and regulate Qi. Use Shengyang Yiwei Tang (Raise Yang and Benefit Stomach Decoction) modified: Huangqi (Astragalus Root) 15g, Dangshen (Codonopsis Root) 9g, Baizhu (Atractylodes Macrocephala Rhizome) 9g, Huanglian (Coptis Rhizome) 9g, Banxia (Pinellia Tuber) 9g, Chenpi (Aged Tangerine Peel) 9g, Gancao (Licorice Root) 3g, Fuling (Poria) 9g, Zexie (Alisma Rhizome) 9g, Fangfeng (Saposhnikovia Root) 9g, Qianghuo (Notopterygium Rhizome) 9g, Duhuo (Angelica Pubescens Root) 9g, Chaihu (Bupleurum Root) 9g, Baishao (White Peony Root) 9g, Shengjiang (Fresh Ginger) 3 slices, Dazao (Jujube) 3 pieces.
(8) Excess stagnation failing to transform: The characteristic is epigastric distending pain preventing bending forward or backward, aggravation by pressure, thick-yellow tongue coating, bitter and dry mouth, slippery-rapid or deep-solid pulse. There are four common clinical situations:
① Abdominal distending pain, aggravation by pressure, thick-dry yellow tongue coating, deep-solid or deep-slippery pulse. This indicates excess-heat obstruction. The treatment principle is to purge excess heat. Use Dachengqi Tang (Major Order the Qi Decoction) modified: Zhishi (Immature Bitter Orange) 12g, Houpo (Magnolia Bark) 12g, Dahuang (Rhubarb Root) 12g, Laifuzi (Radish Seed) 12g, Mangxiao (Mirabilite) 9g.
For mild dry stool, remove Mangxiao and Dahuang, add Erchou Fen (Croton and Morning Glory Seeds Powder) 6g (taken with water).
② Abdominal distending pain with tenderness, worsening after eating, difficult defecation, thin-yellow tongue coating, deep-slippery pulse. This indicates phlegm-food obstruction. The treatment principle is to move Qi and lead out stagnation. Use Muxiang Binglang Wan (Costus and Areca Nut Pill): Muxiang (Vladimiria Root) 9g, Binglang (Areca Seed) 9g, Qingpi (Green Tangerine Peel) 9g, Chenpi (Aged Tangerine Peel) 9g, Zhike (Bitter Orange Fruit) 9g, Jiu Huangbai (Wine-processed Phellodendron Bark) 9g, Huanglian (Coptis Rhizome) 9g, Sanleng (Sparganium Rhizome) 9g, Ezhu (Curcuma Rhizome) 9g, Jiu Jun (Wine-processed Rhubarb) 3-6g, Xiangfu (Cyperus Rhizome) 9g.
③ Severe abdominal distending pain, aggravation by pressure, white tongue coating, history of inability to eat cold food, deep-wiry pulse. This indicates cold-excess stagnation. The treatment principle is to warm and purge to remove excess. Formula: Binglang (Areca Seed) 9g, Muxiang (Vladimiria Root) 9g, Houpo (Magnolia Bark) 9g, Fuzi (Prepared Aconite Root) 9g, Erchou 9g, Dangshen (Codonopsis Root) 6g, Zhishi (Immature Bitter Orange) 9g.
④ Alternating chills and fever, nausea, irritability, abdominal distending pain, aggravation by pressure, constipation, yellow tongue coating, wiry pulse. This indicates Shaoyang-Yangming combined disease. The treatment principle is to harmonize and purge the interior. Use Da Chaihu Tang (Major Bupleurum Decoction) modified: Chaihu (Bupleurum Root) 9g, Banxia (Pinellia Tuber) 9g, Dahuang (Rhubarb Root) 9g, Zhishi (Immature Bitter Orange) 15g, Huangqin (Scutellaria Root) 15g, Baishao (White Peony Root) 15g, Laifuzi (Radish Seed) 15g, Baijiezi (White Mustard Seed) 9g.
(9) Spleen-Kidney Yang deficiency: Cold pain in the epigastrium, sore and painful lower back, cold hands and feet, thin-white tongue coating, wiry-tight or deep-thin pulse. This indicates Spleen-Kidney deficiency-cold. The treatment principle is to warm and tonify Spleen and Kidney. Use Fuzi Lizhong Tang modified: Fuzi (Prepared Aconite Root) 9g, Ganjiang (Dried Ginger) 9g, Rougui (Cinnamon Bark) 9g, Dangshen (Codonopsis Root) 9g, Baizhu (Atractylodes Macrocephala Rhizome) 9g, Gancao (Licorice Root) 9g, Shengdi (Rehmannia Root) 9g, Shanyao (Chinese Yam) 9g, Roushouyu (Cistanche Stem) 9g, Fuling (Poria) 9g, Zexie (Alisma Rhizome) 9g, Danpi (Moutan Bark) 9g.
(10) Mixed cold-heat syndrome: The main characteristic is cold pain in the epigastrium, fullness, bitter and dry mouth. There are three common situations:
① Epigastric fullness and pain, poor appetite, bitter and dry mouth, loose or normal stools, white or thin-yellow greasy tongue coating, slippery pulse. This indicates mixed cold-heat with heat predominating. The treatment principle is to harmonize cold and heat. Use Banxia Xiexin Tang (Pinellia Decocting the Heart Decoction) modified: Banxia (Pinellia Tuber) 9g, Huanglian (Coptis Rhizome) 9g, Huangqin (Scutellaria Root) 9g, Ganjiang (Dried Ginger) 9g, Dangshen (Codonopsis Root) 9g, Gancao (Licorice Root) 6g, Zhike (Bitter Orange Fruit) 9g, Shenqu (Medicated Leaven) 9g.
If tenderness in the epigastrium, use Kaixiong Shunqi Wan (Open Chest and Regulate Qi Pill), one pill per dose, or Pingwei San modified: Cangzhu (Atractylodes Lancea Rhizome) 12g, Houpo (Magnolia Bark) 9g, Chenpi (Aged Tangerine Peel) 9g, Gancao (Licorice Root) 6g, Jiao Sanxian (Charred Three Immortals) each 9g, Laifuzi (Radish Seed) 9g, Ganjiang (Dried Ginger) 1.5g, Dahuang (Rhubarb Root) 4.5g.
② Epigastric pain with zao re sensation, inability to eat cold food, poor appetite, bitter taste, white coating, wiry pulse. This indicates mixed cold-heat with cold predominating. The treatment principle is to balance cold and heat. Use Huanglian Tang (Coptis Decoction): Huanglian (Coptis Rhizome) 9g, Banxia (Pinellia Tuber) 9g, Ganjiang (Dried Ginger) 9g, Rougui (Cinnamon Bark) 9g, Dangshen (Codonopsis Root) 9g, Gancao (Licorice Root) 6g.
If cold hands and feet, use Fuzi Lizhong Tang modified: Fuzi (Prepared Aconite Root) 9g, Dangshen (Codonopsis Root) 9g, Baizhu (Atractylodes Macrocephala Rhizome) 9g, Ganjiang (Dried Ginger) 9g, Huanglian (Coptis Rhizome) 9g.
If tenderness in the epigastrium, use Fuzi Lizhong Tang combined with Xiao Chengqi Tang: Fuzi (Prepared Aconite Root) 9g, Dangshen (Codonopsis Root) 9g, Baizhu (Atractylodes Macrocephala Rhizome) 9g, Ganjiang (Dried Ginger) 9g, Gancao (Licorice Root) 9g, Zhishi (Immature Bitter Orange) 9g, Houpo (Magnolia Bark) 9g, Dahuang (Rhubarb Root) 3g.
③ Epigastric pain, inability to eat cold food, dry mouth, worsening dry mouth at night, cold hands but hot palms. This indicates mixed cold-heat. The treatment principle is the Sour-Bitter-Acrid method (using mixed cold and heat herbs). Use Wu Mei Wan (Mume Pill): Wu Mei (Mume Fruit) 15-30g, Xixin (Asarum) 4.5g, Rougui (Cinnamon Bark) 9g, Fuzi (Prepared Aconite Root) 9g, Chuanjiao (Sichuan Pepper) 9g, Ganjiang (Dried Ginger) 9g, Huanglian (Coptis Rhizome) 9g, Huangbai (Phellodendron Bark) 9g, Danggui (Angelica Sinensis) 9g, Dangshen (Codonopsis Root) 9g.
3. Hypochondriac pain commonly includes Liver Qi stagnation, Liver-Gallbladder damp-heat, Liver cold, Liver-Kidney Yin deficiency, and blood stasis obstruction.
(1) Liver Qi stagnation: The characteristic is fullness, wandering pain in the chest and hypochondrium, desire for long sighs, irritability, and fullness/pain in the hypochondrium. There are two common situations:
① Fullness and pain in the hypochondrium, irritability, desire for long sighs, white tongue coating, deep pulse. This indicates Liver Qi stagnation. The treatment principle is to soothe the Liver and regulate Qi. Use Chaihu Shugan San (Bupleurum Powder to Soothe the Liver): Chaihu (Bupleurum Root) 6g, Zhike (Bitter Orange Fruit) 9g, Baishao (White Peony Root) 9g, Muxiang (Vladimiria Root) 9g, Chuanxiong (Ligusticum Rhizome) 9g, Wuyao (Lindera Root) 9g, Xiangfu (Cyperus Rhizome) 9g, Gancao (Licorice Root) 6g, Chenpi (Aged Tangerine Peel) 12g, Shanzha (Hawthorn Fruit) 12g. If the pulse is deep and knotted, add Guizhi (Cinnamon Twig) 9g.
② Fullness and pain in the hypochondrium, irritability, palpitations, back heaviness, five-palm heat, occasional dizziness and headache, thin-white tongue coating, deep-wiry pulse. This indicates Liver depression with Blood deficiency. The treatment principle is to soothe the Liver and nourish Blood. Use Xiaoyao San modified: Danpi (Moutan Bark) 9g, Zhizi (Gardenia Fruit) 9g, Danggui (Angelica Sinensis) 9g, Baishao (White Peony Root) 9g, Baizhu (Atractylodes Macrocephala Rhizome) 9g, Fuling (Poria) 9g, Danshen (Salvia Root) 9g, Muxiang (Vladimiria Root) 6g, Shengjiang (Fresh Ginger) 3 slices, Bohe (Mint) 3g.
(2) Liver-Spleen deficiency-cold: Hypochondriac pain and distension, worsening fullness in the afternoon, inability to eat cold food, occasional sore and heavy lower back, white or yellow-moist tongue coating, wiry pulse. This indicates Liver-Spleen deficiency-cold. The treatment principle is to tonify the Liver and warm the Spleen. Use Nuan Gan Jian (Warm the Liver Decoction) modified: Gouqizi (Goji Berry) 12g, Shengdi (Rehmannia Root) 9g, Danggui (Angelica Sinensis) 9g, Xiaohuixiang (Fennel Fruit) 3g, Rougui (Cinnamon Bark) 3g, Xiangfu (Cyperus Rhizome) 6g, Bajitian (Morinda Root) 9g.
(3) Liver-Kidney Yin deficiency: The characteristic is pain on one side of the hypochondrium and epigastrium, sore lower back, and dry mouth. There are two common types:
① Pain in the lower back and hypochondrium, worsening with fatigue, dry mouth, hot palms, wiry pulse with large Chi position. This indicates Liver-Kidney Yin deficiency. The treatment principle is to nourish Liver and Kidney. Use Yiguan Jian modified: Shengdi (Rehmannia Root) 12g, Gouqizi (Goji Berry) 12g, Maidong (Ophiopogon Tuber) 12g, Shashen (Glehnia Root) 12g, Danggui (Angelica Sinensis) 9g, Baishao (White Peony Root) 9g, Chuanlianzi (Szechwan Chinaberry Seed) 9g, Wu Mei (Mume Fruit) 9g, Mugua (Chaenomeles Fruit) 9g.
② Pain in the lower back and hypochondrium, poor appetite, chest fullness, irritability, bitter and dry mouth, dizziness, desire for sighs, deep-wiry pulse. This indicates Liver-Kidney dual deficiency with Qi stagnation transforming into fire. The treatment principle is to tonify Liver and Kidney, soothe the Liver and drain fire. Use Zishui Qinggan Yin (Nourish Water and Clear Liver Decoction) modified: Shengdi (Rehmannia Root) 15g, Shanyao (Chinese Yam) 9g, Shanzhuyu (Cornus Fruit) 9g, Gouqizi (Goji Berry) 9g, Fuling (Poria) 9g, Zexie (Alisma Rhizome) 9g, Danpi (Moutan Bark) 9g, Zhizi (Gardenia Fruit) 9g, Danggui (Angelica Sinensis) 9g, Baishao (White Peony Root) 9g, Chao Zaoren (Fried Ziziphus Seed) 9g, Chaihu (Bupleurum Root) 6g, Bohe (Mint) 3g.
(4) Liver-Gallbladder damp-heat: Hypochondriac pain, jaundice, epigastric fullness, poor appetite, bitter and sticky dry mouth, yellow-white greasy tongue coating, wiry-slippery pulse. There are four common situations:
① Severe hypochondriac pain, epigastric distending pain, obvious tenderness, bitter dry mouth, alternating chills and fever, nausea, constipation or normal stools, wiry-rapid pulse. This indicates Liver-Gallbladder damp-heat. The treatment principle is to harmonize and purge the interior. Use Da Chaihu Tang modified: Chaihu (Bupleurum Root) 9g, Banxia (Pinellia Tuber) 12g, Zhishi (Immature Bitter Orange) 15g, Baishao (White Peony Root) 15g, Muxiang (Vladimiria Root) 9g, Dahuang (Rhubarb Root) 9g.
② Liver area pain, dark yellow urine, bitter dry mouth, jaundice, yellow-greasy tongue coating, wiry pulse. This indicates Liver-Gallbladder damp-heat. The treatment principle is to clear the Liver, benefit the Gallbladder, and dispel dampness. Formula: Zhike (Bitter Orange Fruit) 15g, Yinchen (Artemisia Capillaris) 15g, Jineijin (Chicken Gizzard Lining) 15g, Yujin (Turmeric Tuber) 15g, Qumai (Dianthus Herb) 15g, Dahuang (Rhubarb Root) 9g, Jiao Zha (Charred Hawthorn) 30g, Jinqiancao (Lysimachia Herb) 60g.