伤寒腹痛，寒、热、血、积四条，大节目也。有太阳症，失散表，误用承气下早，阳邪内陷
阳明，身反不热，脉沉而紧，自胸至腹皆痛，名大小结胸症，用大小陷胸汤。不比误下，阳
邪内陷太阴腹痛，脉沉而细，用桂枝芍药大黄汤者。若太阳症失于散表，误用承气下早，不
成上部结胸，阳邪内陷太阴，成腹满腹痛之症，脉必沉细而数，用桂枝芍药大黄汤。不比阳
邪内陷阳明，脉大汗出，而用大陷胸汤者。又有太阳症，误用承气下早，阳邪不结心下，不
结太阴，内陷大肠与燥屎食积结聚，小腹作痛，汗出心烦，脉沉数，此阳明大肠腹痛，用不
得桂枝、大黄，而用承气再下者。又有不因误下，热邪自传入里，下结大便，唇焦口燥，满
腹作痛，脉见沉数，潮热自汗，用三承气正下者。又有热邪传里，时或下利，腹痛频并，此
有热无结，三阳协热下痢等症，宜黄连枳壳汤。若腹痛大便结，寒热未除，尚带三阳表邪
者，即有下症，未可攻下，止以大柴胡汤双解表里。若小便不利，小腹硬痛，此为溺涩，八
正散等利小便。若小便自利，腹脐硬痛，漱水不欲下咽，或如狂喜忘，此蓄血腹痛也，桃仁
承气汤下之。若初起本是阳症，或寒凉抑遏，寒凝太阴脾经腹痛，脉必沉迟，宜理中汤，建
中汤。若本是阳症，或多食生冷，寒凝阳明肠胃腹痛，脉必沉大，宜大顺饮或平胃散，用生
姜汤调服。更有初起不发热，脉沉迟，二便清利，腹微痛，口不渴，此三阴经阴症腹痛也，
轻则理中，重则四逆汤。
伤寒胸中有热，胃中有邪气，腹中痛，欲呕吐者，黄连汤主之。
胸中热，上焦热也。胃中邪气，中焦热邪也。腹中痛，下焦热也。三焦皆热而呕吐，故用黄连汤。
伤寒病四逆，其人或咳，或悸，或小便不利，腹中痛，或泄利下重者，四逆散主之。
此条虽见四肢冷，然小便不利，腹中痛，泄利下重，乃是热痛，故用四逆散先治四逆。
伤寒阳脉涩，阴脉弦，腹中急痛，法当先与小建中汤。不瘥，与小柴胡加芍药。
阳脉涩，阴脉弦，腹中急痛，似三阴腹痛，故先与小建中。设不瘥，乃是少阳郁火未伸，
故脉弦涩，用小柴胡清少阳，加芍药和弦涩之脉。
少阴病，二三日不已，至四五日腹痛，四肢沉重疼痛，自下利者，此为水气，其人或咳，或
呕，或下利，或小便利，真武汤主之。
此少阴经寒湿，传变太阴腹痛，用真武汤，补土中之火，以制水气下利。
厥阴伤寒四五日，腹中痛，若转气下趋小腹者，此欲下利也。
阳邪传里，有燥屎，转矢气，下趋肛门，阴寒在里，欲下利，转气下趋小腹。盖热气欲
出，直从肛门而出。阴寒欲出，则下趋小腹而止。
大陷胸汤 见结胸、痞满。
桂枝芍药大黄汤
桂枝 白芍药 大黄 甘草
承气汤，下阳明腹痛者，桂枝大黄汤，治太阴腹痛也。大肠热结，不用桂枝、大黄；脾家
秽腐，不用承气汤。
三乙承气汤 见大便结。
三黄枳壳汤
黄柏 黄连 黄芩 枳壳 木通
腹痛大便秘结者，用承气汤。协热下利而腹痛，当用三黄汤。腹痛皆气结，故用枳壳、木
通，分利两便。
大柴胡汤 见寒热。
桃仁承气汤
桃仁 大黄 枳壳
误下表邪，心胸痛连小腹，大陷胸汤。邪陷太阴腹痛，桂枝、大黄汤。太阳秘结腹痛，承
气汤。挟热下利腹痛，三黄枳壳汤。腹痛表症未解，大柴胡汤。今以蓄血腹痛，用此方。
理中汤
人参 白术 干姜 甘草
阳症腹痛，当用清热；阴症腹痛，则用此方。
四逆汤 见身痛。
建中汤
白芍药 桂枝 甘草
中气虚而腹痛，用理中汤；真阳不足而腹痛，用四逆汤。肝脾血分虚寒，故以戊己汤加
桂枝。
大顺饮
缩砂 草豆蔻 浓朴 青皮
阳症腹痛，当用清热；阴症腹痛，则用温经。今本是阳症，因过服寒凉，以致腹痛，故用辛散疏利。
黄连汤
黄连 桂枝 干姜 半夏 人参 甘草 大枣
误用寒药，痰饮热邪，痞塞中焦，故用泻心汤，寒热各半散之。今加参、枣，化泻心汤为
和中散邪之剂。
四逆散
柴胡 白芍药 枳壳 甘草
阴症腹痛厥冷，用四逆汤；阳症腹痛厥冷，用凉膈散。今以阴经阳症腹痛厥冷，不可骤用
寒凉，故先疏通肝胆血脉，调和胃家中气，四肢温暖，然后清热。
真武汤
茯苓 白术 白芍药 附子
阳邪腹痛，肠胃居多，阴寒腹痛，乃脾寒，故用真武汤。
通脉四逆汤
附子 干姜 广皮 甘草 葱白头
阴症腹痛，下利厥冷，脉伏，真阳脱矣，故用通脉四逆。
如果患者有太阳病的症状，因未能及时发散表邪，过早误用承气汤攻下，导致阳热之邪内陷进入阳明经，身体反而不发热，脉象沉而紧，疼痛从胸部一直延伸到腹部，这称为大结胸证或小陷胸证，应使用大陷胸汤或小陷胸汤治疗。这与没有误下，而是阳热之邪内陷太阴经导致的腹痛不同；后者脉象沉而细，应使用桂枝芍药大黄汤。如果是太阳病失于发散表邪，过早误用承气汤攻下，未形成上部的结胸证，而是阳热之邪内陷太阴经，形成了腹满腹痛的症状，脉象必定沉细而数，应使用桂枝芍药大黄汤。这与阳热之邪内陷阳明经，出现大汗出等症状，从而使用大陷胸汤的情况不同。
又有太阳病，过早误用承气汤攻下，阳热之邪并未在心下（胃脘部）结聚，也未陷入太阴经，而是内陷大肠，与燥屎和食积结聚在一起，导致小腹疼痛，伴有出汗、心烦，脉象沉数，这是阳明大肠的腹痛，此时不得使用桂枝和大黄，而应继续使用承气汤进行攻下。
又有并非因为误下，而是热邪自行传入体内，向下结聚于大便，出现嘴唇焦枯、口舌干燥，全腹疼痛，脉象沉数，伴有潮热和自汗，应使用三承气汤正治攻下。
又有热邪传入体内，时而出现腹泻，腹痛频繁发作，这是有热而无实邪结聚，属于三阳经协同热邪导致的痢疾等病症，适宜使用黄连枳壳汤。
如果腹痛且大便秘结，但寒热症状尚未消除，仍然带有三阳经的表邪，即使有可下的里证，也不可立即攻下，只宜使用大柴胡汤双解表里。
如果小便不通利，小腹硬痛，这是溺涩（排尿困难），应用八正散等方剂通利小便。
如果小便自利，肚脐周围硬痛，想喝水却不想咽下，或者出现如发狂、健忘等症状，这是蓄血导致的腹痛，应用桃仁承气汤攻下瘀血。
如果起初本是阳证，或因过用寒凉药物抑制遏阻，导致寒凝滞于太阴脾经引起腹痛，脉象必定沉迟，适宜使用理中汤或建中汤。
如果本是阳证，但因多吃生冷食物，导致寒凝滞于阳明肠胃引起腹痛，脉象必定沉大，适宜使用大顺饮或平胃散，并用生姜汤调服。
更有起初不发热，脉象沉迟，大小便清长通畅，腹部轻微疼痛，口不渴，这是三阴经的阴证腹痛，轻症用理中汤，重症用四逆汤。
伤寒病，胸中有热，胃中有邪气，腹中疼痛，想要呕吐的，以黄连汤为主治方。
胸中热，是指上焦有热。胃中邪气，是指中焦有热邪。腹中痛，是指下焦有热。三焦都有热并且伴有呕吐，所以使用黄连汤。
伤寒病出现四肢厥逆，其人或有咳嗽，或有惊悸，或小便不利，或腹中痛，或泄泻且肛门重坠感的，以四逆散为主治方。
这一条虽然见到四肢冷，但小便不利、腹中痛、泄泻且肛门重坠，乃是热性疼痛，所以使用四逆散先治疗四肢厥逆。
伤寒病，阳脉涩，阴脉弦，腹中急痛，依法应当先给予小建中汤。如果不愈，再给予小柴胡汤加芍药。
阳脉涩，阴脉弦，腹中急痛，看似三阴经腹痛，所以先给予小建中汤。假设不愈，那是少阳郁火未能舒展，所以脉象弦涩，使用小柴胡汤清解少阳，加芍药调和弦涩之脉。
少阴病，两三天未愈，到了四五日出现腹痛，四肢沉重疼痛，自发腹泻的，这是水气病，其人或有咳嗽，或有呕吐，或腹泻，或小便通利，以真武汤为主治方。
这是少阴经寒湿，传变至太阴引起腹痛，使用真武汤，补益脾土中的阳气（火），以制约水气导致的腹泻。
厥阴伤寒四五日，腹中疼痛，如果有气体转动并向下趋向小腹的，这是将要发生腹泻的表现。
阳热之邪传入体内，有燥屎，转矢气（放屁），气体向下趋向肛门；阴寒在体内，欲发生腹泻，气体转动向下趋向小腹。大概是因为热气欲出，直接从肛门而出；阴寒欲出，则向下趋向小腹而止。
桂枝芍药大黄汤
组成：桂枝、白芍药、大黄、甘草。
承气汤，是治疗阳明腹痛的；桂枝大黄汤（即桂枝芍药大黄汤），是治疗太阴腹痛的。大肠热结，不用桂枝、大黄；脾家秽腐，不用承气汤。
三黄枳壳汤
组成：黄柏、黄连、黄芩、枳壳、木通。
腹痛伴大便秘结者，用承气汤。协热下利而腹痛，当用三黄汤。腹痛皆因气结，故用枳壳、木通，分利大小二便。
桃仁承气汤
组成：桃仁、大黄、枳壳。
误下后表邪未解，心胸痛连及小腹，用大陷胸汤。邪陷太阴腹痛，用桂枝大黄汤。太阳腑实秘结腹痛，用承气汤。挟热下利腹痛，用三黄枳壳汤。腹痛表症未解，用大柴胡汤。如今是蓄血腹痛，用此方（桃仁承气汤）。
理中汤
组成：人参、白术、干姜、甘草。
阳证腹痛，应当用清热法；阴证腹痛，则用此方（理中汤）。
四逆汤：见“身痛”章节。
建中汤
组成：白芍药、桂枝、甘草。
中气虚而腹痛，用理中汤；真阳不足而腹痛，用四逆汤。肝脾血分虚寒，故以戊己汤加桂枝（此处指代建中汤之意或相关变方）。
大顺饮
组成：缩砂、草豆蔻、浓朴、青皮。
阳证腹痛，应当用清热法；阴证腹痛，则用温经法。如今本是阳证，因过服寒凉，以致腹痛，故用辛散疏利之法。
黄连汤
组成：黄连、桂枝、干姜、半夏、人参、甘草、大枣。
误用寒药，导致痰饮热邪痞塞中焦，故用泻心汤类方，寒热各半以散之。如今加入参、枣，将泻心汤化为和中散邪的剂型。
四逆散
组成：柴胡、白芍药、枳壳、甘草。
阴证腹痛厥冷，用四逆汤；阳证腹痛厥冷，用凉膈散。如今是阴经阳证腹痛厥冷，不可骤用寒凉，故先疏通肝胆血脉，调和胃家中气，待四肢温暖后，再清热。
Abdominal pain caused by Shanghan (Cold Damage) is primarily categorized into four main principles: Cold, Heat, Blood stasis, and Accumulation.
If a patient presents with Taiyang syndrome symptoms, and due to failure to release the exterior in time, Chengqi Tang (Cassia Twig Decoction) is mistakenly used for purging too early, causing Yang pathogenic heat to sink inward into the Yangming channel. The body may actually not feel hot, the pulse is deep and tight, and pain extends from the chest to the abdomen. This is called Da Jie Xiong Syndrome (Major Chest Binding Syndrome) or Xiao Jie Xiong Syndrome (Minor Chest Binding Syndrome), and should be treated with Da Xian Xiong Tang (Major Sinking Chest Decoction) or Xiao Xian Xiong Tang (Minor Sinking Chest Decoction). This differs from abdominal pain caused by Yang pathogenic heat sinking inward into the Taiyin channel without prior mistaken purging; in that case, the pulse is deep and fine, and Guizhi Shaoyao Dahuang Tang (Cinnamon Twig, Peony, and Rhubarb Decoction) should be used. If Taiyang syndrome fails to release the exterior, and Chengqi Tang is mistakenly used for purging too early, failing to form an upper Jue Xiong (Chest Binding) but instead causing Yang pathogenic heat to sink into the Taiyin channel, resulting in abdominal fullness and pain, the pulse must be deep, fine, and rapid. In this case, Guizhi Shaoyao Dahuang Tang should be used. This is distinct from Yang pathogenic heat sinking into the Yangming channel, which presents with profuse sweating and requires Da Xian Xiong Tang.
In another scenario, following premature mistaken purging of Taiyang syndrome with Chengqi Tang, the Yang pathogenic heat does not bind at the Xin Xia (epigastrium) nor sink into the Taiyin channel, but instead sinks into the Large Intestine, binding with dry stool and food accumulation. This causes lower abdominal pain, accompanied by sweating, restlessness, and a deep, rapid pulse. This is abdominal pain of the Yangming Large Intestine. At this stage, Guizhi (Cinnamon Twig) and Dahuang (Rhubarb) should not be used; instead, Chengqi Tang should be continued for purging.
In yet another case, not due to mistaken purging, but because heat pathogen transmits inward on its own, binding downward in the stool, presenting with cracked lips, dry mouth and tongue, generalized abdominal pain, deep and rapid pulse, tidal fever, and spontaneous sweating, San Chengqi Zheng Xia (Three Chengqi Decoctions for Proper Purging) should be used.
If heat pathogen transmits inward, occasionally causing diarrhea, with frequent abdominal pain, this indicates heat without solid accumulation, belonging to syndromes such as dysentery where the Three Yang channels cooperate with heat. Huanglian Zhike Tang (Coptis and Aurantium Decoction) is appropriate.
If there is abdominal pain with constipation, but chills and fever have not resolved, indicating residual exterior pathogen in the Three Yang channels, even if interior excess signs exist, immediate purging is contraindicated. Instead, Da Chaihu Tang (Major Bupleurum Decoction) should be used to resolve both exterior and interior simultaneously.
If urination is difficult and the lower abdomen is hard and painful, this is Niao Se (difficulty in urination), and Bazheng San (Eight Correct Powders) or similar formulas should be used to promote urination.
If urination is normal, the area around the umbilicus is hard and painful, there is a desire to rinse the mouth but no desire to swallow water, or symptoms like mania-like behavior and forgetfulness occur, this is abdominal pain due to Blood Stasis (Xu Xue). Taoren Chengqi Tang (Peach Kernel and Cassia Twig Decoction) should be used to purge the stasis.
If the initial presentation was a Yang syndrome, but due to excessive use of cold/cooling herbs suppressing the pathogen, cold congeals in the Taiyin Spleen meridian causing abdominal pain, the pulse will be deep and slow. Lizhong Tang (Regulate the Middle Decoction) or Jianzhong Tang (Establish the Middle Decoction) are suitable.
If it was originally a Yang syndrome, but abdominal pain occurred due to overconsumption of raw/cold foods causing cold to congeal in the Yangming Stomach and Intestines, the pulse will be deep and large. Dashun Yin (Great Smooth Drink) or Pingwei San (Peace the Stomach Powder) should be used, taken with Ginger Decoction.
Furthermore, if there is no initial fever, the pulse is deep and slow, urination and defecation are clear and free, there is slight abdominal pain, and no thirst, this is Yin syndrome abdominal pain of the Three Yin channels. For mild cases, Lizhong Tang is used; for severe cases, Sini Tang (Frigid Extremities Decoction) is used.
In Shanghan disease, if there is heat in the chest, pathogenic qi in the stomach, abdominal pain, and a desire to vomit, Huanglian Tang (Coptis Decoction) is the primary treatment.
"Heat in the chest" refers to heat in the Upper Jiao. "Pathogenic qi in the stomach" refers to heat pathogen in the Middle Jiao. "Abdominal pain" refers to heat in the Lower Jiao. With heat in all three Jiaos accompanied by vomiting, Huanglian Tang is used.
In Shanghan disease presenting with Sini (Frigid Extremities), if the patient also has cough, palpitations, difficulty urinating, abdominal pain, or diarrhea with a sensation of heaviness in the rectum, Sini San (Frigid Extremities Powder) is the primary treatment.
Although this section mentions cold extremities, the presence of difficulty urinating, abdominal pain, and diarrhea with rectal heaviness indicates heat-type pain. Therefore, Sini San is used first to treat the frigid extremities.
In Shanghan disease, if the Yang pulse is choppy (Se) and the Yin pulse is taut (Xian), with acute abdominal pain, according to the method, one should first administer Xiao Jianzhong Tang (Minor Establish the Middle Decoction). If it does not improve, Xiao Chaihu Tang (Minor Bupleurum Decoction) with added Shaoyao (Peony) should be given.
A choppy Yang pulse and taut Yin pulse with acute abdominal pain resemble Three Yin abdominal pain, so Xiao Jianzhong Tang is administered first. If it does not improve, it indicates that Shaoyang stagnant fire has not been released, hence the taut and choppy pulse. Xiao Chaihu Tang is used to clear the Shaoyang, and adding Shaoyao harmonizes the taut and choppy pulse.
In Shaoyin disease, if after two to three days the condition persists, and by the fourth or fifth day abdominal pain, heavy and painful limbs, and spontaneous diarrhea occur, this is Water Qi (fluid retention). If the patient also has cough, vomiting, diarrhea, or normal urination, Zhenwu Tang (True Warrior Decoction) is the primary treatment.
This represents Cold-Dampness of the Shaoyin channel transmitting to the Taiyin, causing abdominal pain. Zhenwu Tang is used to tonify the Fire within Earth (Spleen Yang) to control the Water Qi causing diarrhea.
In Jueyin Shanghan, after four to five days, if there is abdominal pain and gas moves downward toward the lower abdomen, this indicates impending diarrhea.
When Yang pathogenic heat transmits inward with dry stool, passing flatus (Zhuan Shi Qi) downward toward the anus; whereas when Yin-Cold is internal and diarrhea is impending, gas moves downward toward the lower abdomen. Generally, heat desires to exit directly through the anus, while Yin-Cold desires to exit but stops by moving downward toward the lower abdomen.
Da Xian Xiong Tang: See "Jie Xiong" (Chest Binding) and "Pi Man" (Stagnant Fullness).
Guizhi Shaoyao Dahuang Tang (Cinnamon Twig, Peony, and Rhubarb Decoction)
Ingredients: Guizhi (Cinnamon Twig), Baishao Yao (White Peony Root), Dahuang (Rhubarb), Gancao (Licorice).
Chengqi Tang treats Yangming abdominal pain; Guizhi Dahuang Tang (Guizhi Shaoyao Dahuang Tang) treats Taiyin abdominal pain. For Large Intestine heat binding, Guizhi and Dahuang are not used; for Spleen deficiency with turbid decay, Chengqi Tang is not used.
San Yi Chengqi Tang: See "Da Bian Jie" (Constipation).
San Huang Zhike Tang (Three Yellows and Aurantium Decoction)
Ingredients: Huangbai (Phellodendron Bark), Huanglian (Coptis Rhizome), Huangqin (Scutellaria Root), Zhike (Aurantium Fruit), Mutong (Akebia Stem).
For abdominal pain with constipation, use Chengqi Tang. For diarrhea cooperating with heat accompanied by abdominal pain, use San Huang Tang. Abdominal pain is generally due to Qi stagnation, so Zhike and Mutong are used to separate and drain both urine and stool.
Da Chaihu Tang: See "Han Re" (Chills and Fever).
Taoren Chengqi Tang (Peach Kernel and Cassia Twig Decoction)
Ingredients: Taoren (Peach Kernel), Dahuang (Rhubarb), Zhike (Aurantium Fruit).
If exterior pathogen remains after mistaken purging, with heart/chest pain radiating to the lower abdomen, use Da Xian Xiong Tang. For pathogen sinking into Taiyin causing abdominal pain, use Guizhi Dahuang Tang. For Taiyang organ obstruction causing abdominal pain, use Chengqi Tang. For diarrhea with heat causing abdominal pain, use San Huang Zhike Tang. For abdominal pain with unresolved exterior syndrome, use Da Chaihu Tang. For current Blood Stasis abdominal pain, use this formula (Taoren Chengqi Tang).
Lizhong Tang (Regulate the Middle Decoction)
Ingredients: Renshen (Ginseng), Baizhu (Atractylodes Macrocephala), Ganjiang (Dried Ginger), Gancao (Licorice).
For Yang syndrome abdominal pain, clearing heat is indicated; for Yin syndrome abdominal pain, this formula is used.
Sini Tang: See "Shen Tong" (Body Pain).
Jianzhong Tang (Establish the Middle Decoction)
Ingredients: Baishao Yao (White Peony Root), Guizhi (Cinnamon Twig), Gancao (Licorice).
For abdominal pain due to Middle Qi deficiency, use Lizhong Tang; for abdominal pain due to True Yang insufficiency, use Sini Tang. For Liver-Spleen blood deficiency and cold, Wuji Tang (Five Earths Decoction) with added Guizhi is used.
Dashun Yin (Great Smooth Drink)
Ingredients: Suosha (Amomum Villosum), Caodoukou (Cardamom Seed), Nongpo (Magnolia Bark), Qingpi (Green Tangerine Peel).
For Yang syndrome abdominal pain, clearing heat is indicated; for Yin syndrome abdominal pain, warming the meridians is indicated. Since this was originally a Yang syndrome but abdominal pain resulted from excessive intake of cold/cool substances, acrid-dispersing and draining methods are used.
Huanglian Tang (Coptis Decoction)
Ingredients: Huanglian (Coptis Rhizome), Guizhi (Cinnamon Twig), Ganjiang (Dried Ginger), Banxia (Pinellia Tuber), Renshen (Ginseng), Gancao (Licorice), Dazao (Jujube).
Mistaken use of cold herbs leads to Phlegm-Fluid and Heat Pathogen obstructing the Middle Jiao. Thus, Xiexin Tang (Drain the Epigastrium Decoction) type formulas are used, balancing cold and heat to dissipate them. Now, adding Renshen and Dazhao transforms the Xiexin Tang into a formula that harmonizes the middle and disperses pathogen.
Sini San (Frigid Extremities Powder)
Ingredients: Chaihu (Bupleurum Root), Baishao Yao (White Peony Root), Zhike (Aurantium Fruit), Gancao (Licorice).
For Yin syndrome abdominal pain with cold extremities, use Sini Tang; for Yang syndrome abdominal pain with cold extremities, use Liangge San (Cool the Diaphragm Powder). For Yin channel Yang syndrome abdominal pain with cold extremities, sudden use of cold/cool herbs is contraindicated. Therefore, first unblock the Liver-Gallbladder blood vessels and harmonize the Stomach's Middle Qi. Once the limbs warm up, then clear the heat.
Zhenwu Tang (True Warrior Decoction)
Ingredients: Fuling (Poria), Baizhu (Atractylodes Macrocephala), Baishao Yao (White Peony Root), Fuzi (Aconite Lateral Root).
Yang pathogen abdominal pain mostly involves the Stomach and Intestines; Yin-Cold abdominal pain involves Spleen cold, so Zhenwu Tang is used.
Tongmai Sini Tang (Pulse-Restoring Frigid Extremities Decoction)
Ingredients: Fuzi (Aconite Lateral Root), Ganjiang (Dried Ginger), Guangpi (Tangerine Peel), Gancao (Licorice), Congbaitou (Scallion White).
For Yin syndrome abdominal pain with diarrhea and cold extremities, with a hidden pulse, indicating collapse of True Yang, Tongmai Sini Tang is used.