腹属阴属里。故阳明里症是腹满。三阴俱有腹满。太阳汗后腹满。脾胃不和也。
二陈汤加浓朴和之。阳明潮热腹满。燥矢也。下之。身黄小水不利腹满。湿热也。茵陈蒿汤。
邵评∶腹满有汗后脾胃不和之虚满。有燥矢湿热二症之实满。当分因施治。
太阴腹满。有虚寒。如腹满时痛。食不下。吐利交作是也。理中汤加浓朴。有实热。如
腹满大痛。咽干便秘。或发黄。或暴下赤黄。此脾家实热。为转属阳明。宜承气加减。（合参准绳金鉴）
邵评∶腹满有虚寒。是太阴本症。宜温中。有实热。是太阴转属阳明。宜下之。
邪气入里。与正气相搏。则腹痛。故太阳无腹痛。少阳有胁痛而无腹痛。阳明里症有腹痛。三阴俱有
腹痛。当分部位。中脘痛属脾。脉沉迟者内寒。理中汤。阳脉涩。阴脉弦。小建中汤。
邵评∶三阳惟阳明。有腹痛。三阴俱有腹痛。须分部位。当察其所痛之因。分别施
治。
少腹痛属厥阴界分。四肢逆冷。小便清白。是冷结膀胱。宜当归四逆加吴茱萸生
姜汤温之。如不厥冷。小便自利者。是血蓄膀胱。宜桃仁承气汤。小便不利者。
是水蓄膀胱。五苓散。大小便俱不利者。是水热蓄积。八正散。
邵评∶少腹痛有血蓄、水蓄、水与热俱蓄三因分别。治法甚精。惟桃仁承气之大黄。宜用醋炒。
若大实。小腹满痛。或绕脐攻痛。不大便。脉实者。承气汤。
邵评∶胃腑热实。燥屎作痛。故用下法。
发热口渴。脉弦洪而腹痛者。属脾热。芍药黄芩汤。腹痛欲吐利。烦躁饱闷者。防
痧毒。当刺委中、少商等穴。（合参准绳金鉴）
邵评∶痧秽内滞。气闭作痛。治宜芳香开泄。
按腹痛有虚实。按之痛甚属实。按之痛减属虚。有寒热。自下逆攻而上者。火也。自
上奔迫于下者。寒也。又伤寒腹痛。以凉水试之。其痛稍可者。热也。转甚者。寒也。
邵评∶辨明虚实寒热痛势之不同。甚精。
又评∶试辨寒热之法亦当。
腹部属于阴，归属于里。因此，阳明病的里证表现为腹满。三阴经病也都可能出现腹满。太阳病发汗后出现腹满，是脾胃功能失调所致。可用二陈汤加浓朴来调和。阳明病潮热伴腹满，是燥屎内结所致，应当用下法攻下。身体发黄、小便不利伴腹满，是湿热蕴结所致，可用茵陈蒿汤治疗。
邵评：腹满有发汗后脾胃不和导致的虚性腹满，也有燥屎和湿热两种实证导致的实性腹满，应当根据病因分别施治。
太阴病腹满，有虚寒证，如腹满且时作疼痛，饮食不下，呕吐与腹泻交替发作，这就是虚寒证。可用理中汤加浓朴治疗。也有实热证，如腹满且剧烈疼痛，咽干便秘，或者身黄，或者突然排出赤黄色稀便，这是脾家实热，属于转属阳明病，宜用承气汤加减治疗。（参考《伤寒合参》、《医宗金鉴》）
邵评：腹满有虚寒证，这是太阴病的本证，适宜温中散寒；有实热证，这是太阴病转属阳明病，适宜用下法攻下。
邪气入里，与正气相搏结，就会引起腹痛。因此，太阳病没有腹痛，少阳病只有胁痛而没有腹痛，阳明病的里证会有腹痛，三阴病也都会有腹痛。应当区分疼痛的部位。中脘部疼痛属于脾，脉象沉迟的是内寒，可用理中汤。阳脉涩、阴脉弦的，用小建中汤。
邵评：三阳病中只有阳明病有腹痛，三阴病都有腹痛。必须区分部位，应当考察疼痛的原因，分别施治。
少腹部疼痛属于厥阴经的范围。四肢逆冷，小便清长色白，这是冷结膀胱，宜用当归四逆加吴茱萸生姜汤温通治疗。如果不四肢逆冷，小便自利的，这是瘀血蓄积在膀胱，宜用桃仁承气汤。小便不利的，是水湿蓄积在膀胱，用五苓散。大小便都不利的，是水热蓄积，用八正散。
邵评：少腹痛有瘀血蓄积、水湿蓄积、水与热共同蓄积三种原因，分别论述，治疗方法非常精妙。只是桃仁承气汤中的大黄，宜用醋炒。如果是大实证，小腹胀满疼痛，或者绕脐攻痛，不大便，脉象实的，用承气汤。
发热口渴，脉象弦洪且伴有腹痛的，属于脾热，用芍药黄芩汤。腹痛想吐泻，烦躁饱闷的，要防备痧毒，应当针刺委中、少商等穴位。（参考《伤寒合参》、《医宗金鉴》）
邵评：痧秽之气内滞，气机闭塞导致疼痛，治疗宜用芳香开泄之法。
按之腹痛，有虚有实。按压时疼痛加剧属实证，按压时疼痛减轻属虚证。有寒热之分。疼痛从下部向上冲逆的，是火（热）证；疼痛从上向下奔迫的，是寒证。另外，伤寒腹痛，用凉水试探，如果疼痛稍微缓解的，是热证；如果疼痛反而加重的，是寒证。
又评：用试法辨别寒热的方法也是恰当的。
The abdomen belongs to Yin and is located in the interior. Therefore, interior syndromes of Yangming manifest as abdominal fullness. Abdominal fullness can also occur in all three Yin meridians. Abdominal fullness after sweating therapy in Taiyang syndrome indicates disharmony between the Spleen and Stomach. Erchen Tang (Two Aged Decoction) with Houpo (Magnolia Bark) should be used to harmonize it. In Yangming syndrome, tidal fever accompanied by abdominal fullness indicates dry fecal impaction; purgation should be applied. Jaundice, difficulty in urination, and abdominal fullness indicate damp-heat accumulation; Yinchen Hao Tang (Artemisia Capillaris Decoction) is indicated.
Shao's Commentary: Abdominal fullness includes deficiency-type fullness caused by Spleen-Stomach disharmony after sweating, and excess-type fullness caused by dry feces or damp-heat. Treatment must be tailored to the etiology.
In Taoyin syndrome, abdominal fullness may present as deficiency-cold, such as abdominal fullness with intermittent pain, inability to eat, and alternating vomiting and diarrhea. Lizhong Tang (Regulate the Middle Decoction) with Houpo (Magnolia Bark) is indicated. It may also present as excess-heat, such as severe abdominal fullness and pain, dry throat, constipation, jaundice, or sudden passage of red-yellow loose stools. This represents excess-heat in the Spleen system, indicating a transition to Yangming syndrome; Chengqi Tang formulas should be modified accordingly. (Referenced from *Shanghan He Can* and *Yizong Jinjian*)
Shao's Commentary: Deficiency-cold abdominal fullness is the primary syndrome of Taoyin, warranting warming the middle. Excess-heat abdominal fullness indicates a transition from Taoyin to Yangming, warranting purgation.
When pathogenic factors enter the interior and contend with healthy Qi, abdominal pain occurs. Thus, Taiyang syndrome does not present with abdominal pain; Shaoyang syndrome presents with hypochondriac pain but no abdominal pain; Yangming interior syndrome presents with abdominal pain; and all three Yin syndromes may present with abdominal pain. The location of pain must be differentiated. Pain in the Zhongwan region belongs to the Spleen; a deep and slow pulse indicates internal cold, treated with Lizhong Tang (Regulate the Middle Decoction). A choppy pulse on the Yang position and a string-taut pulse on the Yin position indicates treatment with Xiaojianzhong Tang (Minor Construct the Middle Decoction).
Shao's Commentary: Among the Three Yang syndromes, only Yangming presents with abdominal pain, while all Three Yin syndromes may present with it. One must distinguish the location and investigate the cause of the pain to apply appropriate treatment.
Pain in the lower abdomen belongs to the Jueyin meridian. Cold limbs and clear, white urine indicate cold binding in the Bladder, treated with Danggui Sini Jia Wuzhuyu Shengjiang Tang (Angelica Sinensis Decoction Modified with Evodia and Fresh Ginger) to warm the channels. If there are no cold limbs and urination is free, blood stasis is accumulating in the Bladder, treated with Tao Ren Chengqi Tang (Apricot Seed Purgative Decoction). If urination is difficult, water retention is in the Bladder, treated with Wuling San (Five-Ling Powder). If both urination and defecation are difficult, water and heat are accumulated, treated with Bazheng San (Eight-Righteousness Powder).
Shao's Commentary: Lower abdominal pain has three etiologies: blood stasis, water retention, and combined water-heat accumulation. The differentiation and treatment are exquisite. Note that the Dahuang (Rhubarb Root) in Tao Ren Chengqi Tang should be stir-fried with vinegar. In cases of major excess, if the lower abdomen is full and painful, or if there is periumbilical attacking pain with constipation and a forceful pulse, Chengqi Tang is indicated.
Shao's Commentary: Heat-excess in the Stomach-Fu organ causes pain due to dry feces; thus, purgation is used.
Fever, thirst, string-taut and surging pulse, and abdominal pain indicate Spleen-heat, treated with Shaoyao Huangqin Tang (Peony and Scutellaria Decoction). Abdominal pain with urge to vomit or diarrhea, irritability, and distension suggests toxic sha (sand-poison); acupoints Weizhong (BL40) and Shaoshang (LU11) should be pricked. (Referenced from *Shanghan He Can* and *Yizong Jinjian*)
Shao's Commentary: Accumulation of sha-toxicity obstructs Qi mechanism causing pain; treatment requires aromatic opening and draining methods.
Abdominal pain involves deficiency and excess. Tenderness worsening upon pressure indicates excess; tenderness alleviating upon pressure indicates deficiency. There is also a distinction between cold and heat. Pain rushing upward from below indicates Fire (Heat); pain pressing downward from above indicates Cold. Additionally, for abdominal pain in Shanghan, testing with cool water: if pain slightly relieves, it is Heat; if pain worsens, it is Cold.
Shao's Commentary: Differentiating the nature of pain regarding deficiency/excess and cold/heat is very precise.
Further Commentary: The method of testing to differentiate cold and heat is also appropriate.