腹中水鸣而痛，亦有因于火，因于郁者。丹溪曰∶腹中水鸣，乃火击动其水也。
盖水欲下，火欲上相触而然，二陈汤加芩连栀子，亦有脏寒而水声汨汨者，宜分三阴部
分而治。中脘太阴，当脐少阴，小腹厥阴，各从其宜温之。又有胁下有水气，上弱不能
制水，故腹中雷鸣下利，谓之协热利者。又有肠胃空虚而鸣者，宜参术之类补之。《经》
云∶脾胃虚则肠鸣腹满。又云∶中气不足，肠为之苦鸣。
腹中畏寒者，不惟中气阳气太虚，由于命门真火，亦甚亏损之。
腹中窄狭，须用苍术。若肥人自觉腹中窄狭，乃是湿痰流灌脏腑，气不升降，燥饮
用苍术，行气用香附。如瘦人自觉腹中窄狭，乃是热气熏蒸脏腑，宜黄连、苍术。
小腹痛者有二。凡尺脉洪大者，为阴不足，宜六味汤；尺脉沉微者，为阳不足，宜
八味汤。在妇人多属瘕症，亦宜温补肝肾；在伤寒家蓄血在下焦，宜抵当、桃仁承气之
类。若因气郁而痛，青皮主之。寒者，桂枝吴茱萸温之。若因疝奔豚瘕聚者，当按本门
施治。凡脐下痛而人中黑者，多死。
治五种噎疾，丸种心痛、 癖、气块冷气攻刺，丈夫疝气，妇人血气。
茴香（炒） 青皮（去白） 甘草（炒） 陈皮（去白） 蓬莪术 川芎（各一
两） 生姜（四两，切片，盐半两，腌一宿） 胡椒 白芷 肉桂（去皮） 缩砂 小茴香
（炒，各五钱） 阿魏（酒浸一宿，同面为糊，各一钱五分） 为末，阿魏和面糊丸，芡实
大，每药一斤，用朱砂七钱为衣，每服三五粒。丈夫气痛，炒姜盐汤下。妇人血气痛，
醋汤下。
腹中水鸣且伴有疼痛，也有因火邪、因气郁所致者。朱丹溪说：腹中水鸣，是火邪击动体内水液所致。
大概是因为水气欲下行，火气欲上行，二者相互接触冲撞而发出声响。对于此类情况，可用二陈汤加黄芩、黄连、栀子治疗；也有因脏腑虚寒导致水声汨汨作响的，应当根据三阴经的部位分别进行治疗。中脘穴属太阴经，肚脐处属少阴经，小腹处属厥阴经，各自根据其适宜的情况进行温补。又有胁下有水气停留，上焦虚弱不能制约水气，从而导致腹中雷鸣般作响并伴腹泻的情况，这被称为“协热利”。又有因肠胃空虚而发出鸣响的，宜用人参、白术等药物进行补益。《黄帝内经》说：脾胃虚弱则会出现肠鸣和腹部胀满。又说：中气不足，肠道就会痛苦地鸣响。
腹中感觉畏寒，不仅是因为中气和阳气过于虚弱，也由于命门真火严重亏损所致。
腹中感觉狭窄紧迫，必须使用苍术。如果肥胖的人自觉腹中狭窄，这是湿痰流注于脏腑，导致气机升降失常，燥湿化痰应用苍术，行气解郁应用香附。如果消瘦的人自觉腹中狭窄，这是热气熏蒸脏腑所致，宜用黄连、苍术。
小腹痛有两种情况。凡是尺脉洪大的，属于阴精不足，宜用六味地黄汤；尺脉沉微的，属于阳气不足，宜用八味丸（金匮肾气丸）。在妇女身上多属于瘕聚病症，也宜温补肝肾；在伤寒病患者中，若瘀血蓄积在下焦，宜用抵当汤、桃仁承气汤之类。若是因气机郁滞而疼痛，以青皮为主药。若是寒邪所致，用桂枝、吴茱萸温散寒邪。若是因疝气、奔豚、瘕聚等疾病引起的，应当按照本章节的相关内容进行施治。凡是脐下疼痛且人中部位发黑的，大多预后不良，难以治愈。
治疗五种噎膈疾病，丸剂可治疗心痛、癖块、气块冷气攻刺作痛，男子疝气，妇人血气疼痛。
配方如下：茴香（炒制）、青皮（去白瓤）、甘草（炒制）、陈皮（去白瓤）、蓬莪术、川芎（各一两）；生姜（四两，切片，加半两盐，腌制一夜）；胡椒、白芷、肉桂（去皮）、缩砂仁、小茴香（炒制，各五钱）；阿魏（酒浸泡一夜，同面粉制成糊状，各一钱五分）。将上述药物研为细末，用阿魏面糊制作成丸药，大小如芡实。每药一斤，用朱砂七钱作为包衣。每次服用三五粒。男子气痛，用炒姜盐汤送服。妇人血气痛，用醋汤送服。
Abdominal borborygmus accompanied by pain may also be caused by fire pathogen or qi stagnation. Zhu Danxi stated: Abdominal borborygmus is the result of fire agitating the water within the body.
Generally, this occurs because water qi desires to descend while fire qi desires to ascend, and their collision produces the sound. For such cases, Erchen Tang (Two Aged Decoction) can be used with added Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), and Zhizi (Gardeniae Fructus). There are also cases where visceral cold causes a gurgling water sound; these should be treated according to the divisions of the Three Yin meridians. The Zhongwan point belongs to the Taiyin meridian, the area around the umbilicus belongs to the Shaoyin meridian, and the lower abdomen belongs to the Jueyin meridian; each should be warmed according to its specific indication. Additionally, there is water qi retained under the hypochondrium; due to upper jiao deficiency failing to control the water, borborygmus resembling thunder and diarrhea occur, which is termed "Xiere Li" (Diarrhea accompanying heat). There are also cases of borborygmus due to emptiness of the stomach and intestines, which should be treated with tonics such as Renshen (Ginseng Radix et Rhizoma) and Baizhu (Atractylodis Macrocephalae Rhizoma). The *Classic* states: Spleen and stomach deficiency leads to intestinal borborygmus and abdominal fullness. It also states: Deficiency of middle qi causes painful intestinal borborygmus.
A sensation of cold in the abdomen is not only due to severe deficiency of middle qi and yang qi, but also due to significant depletion of the true fire of the Mingmen gate.
For a sensation of tightness or narrowness in the abdomen, Cangzhu (Atractylodis Rhizoma) must be used. If obese individuals feel a sensation of narrowness in the abdomen, it is due to damp-phlegm flowing into the zang-fu organs, causing obstruction of qi ascent and descent; for drying dampness and resolving phlegm, Cangzhu is used, and for moving qi, Xiangfu (Cyperi Rhizoma) is used. If thin individuals feel a sensation of narrowness in the abdomen, it is due to heat steaming the zang-fu organs, and Huanglian (Coptidis Rhizoma) and Cangzhu (Atractylodis Rhizoma) should be used.
There are two types of lower abdominal pain. Whenever the chi pulse is surging and large, it indicates yin insufficiency, and Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) is appropriate. Whenever the chi pulse is deep and faint, it indicates yang insufficiency, and Bawei Wan (Eight-Ingredient Pill) is appropriate. In women, this often belongs to jia masses (abdominal masses), and warming and tonifying the liver and kidneys is suitable. In patients with Shanghan (Cold Damage), if blood stasis is stored in the lower jiao, Didang Tang (Rescue the Extremities Decoction) or Taoren Chengqi Tang (Peach Kernel and Rhubarb Decoction) are appropriate. If the pain is due to qi stagnation, Qingpi (Citri Reticulatae Pericarpium Viride) is the primary herb. If it is due to cold, Guizhi (Cinnamomi Ramulus) and Wuzhuyu (Evodiae Fructus) are used to warm and disperse. If it is due to hernia, Bentun (Rushing Pig Qi), or jia masses, treatment should follow the protocols in the respective sections. Whenever there is pain below the navel accompanied by blackening of the Renzhong area (philtrum), death is likely.
This formula treats five types of Yeguan (dysphagia/obstruction of food passage) disorders. The pills treat heart pain, pi masses (lumps), qi masses, stabbing pain from cold qi attacking, male hernia, and female blood qi pain.
Ingredients: Huixiang (Foeniculi Fructus, stir-fried), Qingpi (Pericarpium Citri Reticulatae Viride, white pith removed), Gancao (Glycyrrhizae Radix et Rhizoma, stir-fried), Chenpi (Pericarpium Citri Reticulatae, white pith removed), Peng'ezhu (Curcumae Longae Rhizoma), Chuanxiong (Ligustici Chuanxiong Rhizoma) (each 1 liang); Shengjiang (Zingiberis Rhizoma Recens, 4 liang, sliced, pickled overnight with half a liang of salt); Hujiao (Piperis Nigris Fructus), Baizhi (Angelicae Dahuricae Radix), Rougui (Cinnamomi Cortex, bark removed), Suosha (Amomi Fructus Rotundus), Xiaohuixiang (Foeniculi Fructus, stir-fried) (each 5 qian); Awèi (Asafoetidae Resina, soaked in wine overnight, made into paste with flour, each 1.5 qian). Grind all ingredients into powder. Use the Awèi-flour paste to form pills the size of Euryale Seed (Qianshi). For every 1 jin of medicine, coat with 7 qian of Zhusha (Cinnabar). Take 3–5 pills per dose. For male qi pain, swallow with stir-fried ginger and salt water. For female blood qi pain, swallow with vinegar water.