足太阳之筋，为目上纲。足阳明之筋，为目下纲。热则筋纵，目不开。（全文见筋 条。）
（ 胃者目睛斜倒不正小儿谓之通睛）
〔《甲》〕 目者，水沟主之。
〔《集》〕直视者，视物而目睛不转动者是也。若目睛动者，非直视也。伤寒直视者，邪气壅盛，冒其正
气，使神气不慧，脏腑之气不上荣于目，则目为之直视。伤寒至于直视，为邪气已极，证候已逆，多难治。经
曰∶衄家不可发汗，发汗则额上陷脉紧急，直视不能 ，不能眠。以肝受血而能视，亡血家，肝气已虚，目气
已弱，又发汗亡阳，则阴阳俱虚所致也。此虽错逆，其未甚也。逮狂言反目直视，又为肾绝，直视摇头，又为
心绝，皆脏腑气脱绝也。直视谵语，喘满者死，下痢者亦死。又剧者发狂则不识人，循衣摸床，惕而不安，微
喘直视，脉弦涩者死。皆邪气盛而正气脱也。
少阳终者，其百节纵，目HT 绝系。（全文见诊生死条。目系绝，故目不动而直视。王注云∶HT 谓
直视如惊貌。HT 音琼。）
瞳子高者，太阳不足。戴眼者，太阳已绝。（全文见诊生死。戴眼者，目直视不能转动也。）
太阳之脉，其终也戴眼反折螈 。
针灸目上视，见中风上。
〔丹〕肝木气实，肝火盛而胁痛者，当归龙荟丸，为泻肝火要药。胁痛甚者，用生姜自然汁，吞下龙荟丸，
以肝火盛也。（龙荟丸方见治法门肝实条。）
经云∶肝气实则怒。又云∶肝痛者，两胁下痛引少腹，善怒。龙荟丸治肝实胁痛，其人气收者，善怒是也。
甚则用姜汁吞下。经云∶风木淫胜，治以辛凉是也。
寿四郎右胁痛，小便赤少，脉少弦不数，此内有陈久积痰饮，因外感风寒所遏，不能宣散，所以作痛。
与龙荟丸三十五粒，保和丸三十粒，细嚼姜片，以热汤下，服后胁痛已安，小便尚赤少，再与∶
白术（三钱） 陈皮 芍药（各二钱） 木通（一钱半） 条芩（一钱） 甘草（五分）
上姜三片，煎热饮之。
一妇人脾疼，带胁痛，口微干，问已多年。时尚秋，用二陈汤加川芎、干葛、青皮、木通，下芦荟丸二十粒。
章宅张郎气痛，自右胁时作时止，脉沉而弦，小便时有赤色，吞酸，喜呕，出食，此湿痰在脾肺间，所以
肝善乘之。小柴胡汤去黄芩，加川芎、白术、木通、芍药、滑石、生姜煎汤，下保和丸三十五粒。
一妇人气晕，两胁胸背皆痛，口干。
青皮 半夏（五钱） 白术 黄芩 川芎（三钱） 木通（二钱半） 陈皮（二钱） 桔梗（二钱）
甘草（炙，五分）
上分六帖，煎热服。又∶胁下有食积一条扛起，加吴茱萸、炒黄连。
〔《本》〕治因惊伤肝，胁骨里疼痛不已，桂枝散。
枳壳（一两，小者） 桂枝（半两）
上为细末，每服二钱，姜枣汤调下。
〔洁〕匀气散 专治胁痛。
山栀 熟地 茯苓 细辛 桂心 川芎（各等分）
上研为末，加羊脂煎服。
〔《本》〕治胁下疼痛不可忍，兼治肺弱，芎葛汤。
川芎 干葛 桂枝 细辛 枳壳 人参 芍药 麻黄 防风（各半两） 甘草（二钱）
上为粗末，每服五钱，水二盏，生姜三片，同煎至七分，去渣，温服。日三服。有汗避风。
治胁下风气作块寒疝，发则连小腹痛凑心。其积属肝，在右胁下，故病发，则右胁手足头面
昏痛，不思饮食。
干葛（一两） 麻黄（二分） 附子（一个） 川芎 防风 当归 枳实 芍药 桂枝 羌活
甘草（各四钱）
上为粗末，每服四钱，水一盏半。生姜三片，同煎至七分，去渣服，日三。有汗避风。
治胁痛如前。兼去手足枯悴，薏苡仁丸
薏苡仁（一两） 石斛（用细者，二钱） 附子（半两） 牛膝 生地黄（各三钱） 细辛 人
参枳壳 柏子仁 川芎 当归（各半两） 甘草 桃仁（各一两）
上为细末，炼蜜丸如桐子大。每服三四十丸，酒吞下，食前，日三服。丸子食前，煮散食后，相兼服为佳。
治悲哀烦恼伤肝气，至两胁骨疼，筋脉紧，腰脚重滞，两股筋急，两胁牵痛，四肢不能举，渐至脊膂挛急。此
药大治胁痛，枳壳煮散。
枳壳（四两，先煎） 细辛 桔梗 防风 川芎（各二两） 葛根（一两半） 甘草
上为粗末，每服四钱，水一盏半，姜枣同煎至七分，去渣，空心食前温服。
右肝虚胁痛，经所谓木不及，病中清， 胁痛是也。中清，谓中有寒也。热实胁痛，当归龙荟丸是也。
〔仲〕胁下偏痛，发热，其脉弦紧，此寒也，以温药下之，宜大黄附子汤。
大黄（三钱） 附子（二枚，炮） 细辛（二两）
上三味，以水五升，煮取二升，分温三服。若强人煮取二升半，分温三服。服后如人行四五里，更进一服。
〔垣〕神保丸 治心膈痛，腹痛血痛，肾气胁下痛，大便不通，气噎，宿食不消。
木香（二钱半） 胡椒（二钱半） 巴豆（十枚，去皮心膜，研） 干蝎（七枚）
上四味共为末，汤浸蒸饼为丸如麻子大，亦用朱砂为衣。每服五丸。心膈痛，柿蒂灯心汤下。腹痛，柿蒂
煨姜汤下。血痛，炒姜醋汤下。肾气胁下痛，茴香酒下。大便不通，蜜汤调槟榔末一钱下。气噎，木香汤下。
宿食不消，茶酒任下。
许学士云∶沈存中《良方》载∶顷在建阳，医者王琪言，诸气唯膀胱胁下痛，最难治，谓神保丸能治之。
熙宁中病项筋骨痛，诸医皆作风治之，数月不瘥，乃流入于背膂，又臂挛痛甚苦，忆琪语有证，乃合服之，一
服而瘥，再发又一服，立效。
〔洁〕煮黄丸 治胁下 癖痛，如神。（方见内伤饮食。）
〔丹〕控涎丹 治一身气痛及胁走痛。痰挟死血，加桃仁泥。凡胁痛有痰流注，二陈加南星、川芎、苍术。
实者，控涎丹下之。
〔《本》〕治男子两胁疼痛。枳实散。
枳实（一两） 白芍药（炒） 雀脑芎 人参（各半两）
上细末，姜枣汤调二钱，酒亦得，食前，日三服。
〔东〕调中顺气丸 治三焦痞滞，水饮停积，胁下虚满，或时刺痛。
木香 白豆蔻（去壳） 青皮（炮） 京三棱（炮。各一两） 陈皮 大附子（各二两） 半夏（汤炮七
次，一两） 缩砂（去壳） 槟榔 沉香（各半两）
上为末，煮面糊为丸，如桐子大。每服三十丸，渐加六十丸，食后，陈皮汤送下。
沉香导气散 治一切气不升降，胁肋痞塞。
沉香（二钱半） 人参（五钱） 槟榔（二钱半） 白术 乌药 麦 （炒） 神曲（炒） 紫苏叶
大腹皮（炒） 浓朴（制。各一两） 诃子皮（炮，半两） 香附（炮，一两半） 姜黄 橘红 甘草（各四两）
京三棱（二两） 广术（炮，四两） 益智（二两） 红花（四两）
上为细末，每服二钱，食前沸汤点服。
丹溪云∶胁痛有死血者，桃仁、红花、川芎之类是也。若跌扑胁痛者，亦为污血流归胁下而痛，东垣复元
活血汤之类是也。治法见 扑伤损门。
运气胁痛者，乡境皆病胁痛也，其证有二∶
其一，风木助肝气实而痛。经云∶厥阴所至为胁痛。又云∶厥阴在泉，风淫所胜，民病两胁，里急支满。
又云∶少阳司天之政，初之气，风胜乃摇，候乃大温，其病胁痛，治以凉剂得痊也。
其二，燥金攻肝虚而痛。经云∶少阳所至为胁痛。又云∶阳明司天，燥气下临，肝气上从胁痛。又云∶少
阴司天，地乃燥，凄沧数至胁痛，善太息。又云∶岁木不及，燥乃大行，民病中清， 胁痛，治以温剂得痊也。
〔丹〕咳嗽胁痛方。二陈汤加南星，多香附、青皮、青黛、姜汁。
《内经》灸刺胁痛有三法∶
其一取肝。经云∶肝病者，两胁下痛引小腹，善怒，取其经，厥阴与少阳。又云∶邪在肝，则两胁中痛，
寒中，恶血在内，行善掣节，时脚肿，取之行间以引胁下，补三里以温胃中，取血脉以散恶血，取耳间青脉以
去其掣是也。
其二取胆络。经云∶邪客足少阳之络，令人胁痛，不得息，咳而汗，刺足小指次指爪甲上与肉交者各一 ，
不得息立已，汗出立止。咳者，温衣饮食一日已。左刺右，右刺左。其病不已，复刺如法是也。
其三取心。经云∶心手少阴脉所生病者，目黄胁痛，视虚实热寒陷下，施补泻疾留灸之法也。
〔《集》〕胁痛∶悬钟 窍阴（此二穴，左取右，右取左，窍阴出血妙。） 外关 三里（此一穴正取。）
又法∶支沟 章门 中封 阳陵泉（治闪挫。） 行间（泻肝怒气。） 期门（治伤寒后胁痛。）
治胁并胸痛不可忍∶期门（四分。） 章门（六分，灸七壮至七七壮。） 行间 丘墟 涌泉
〔东〕胸胁痛∶期门（沿皮三寸。） 支沟 胆俞（沿皮半寸。） 胸胁胀满痛∶公孙 三里 太冲
三阴交 腰胁痛 环跳 至阴 太白 阳辅
〔《撮》〕胁肋痛∶支沟（透间使，泻之，灸。） 外关（透内关，如取支沟，不必再取外关。）
〔《通》〕胁痛∶阳陵泉
〔《甲》〕胁下支满，呕吐逆，阳陵泉主之。腹中气胀，嗑嗑不嗜食，胁下痛，阴陵泉主之。
〔仲〕寸口脉弦者，即胁下拘急而痛，其人啬啬恶寒也。
〔《灵》〕合腋张胁者肺下，肺下则居贲迫肺，善胁下痛。青色粗理者肝大，肝大则逼胃迫咽，则苦膈中，
且胁下痛。
凡胁骨偏举者肝偏倾，肝偏倾则胁下痛。揭唇者脾高，脾高则 引季胁而痛。（俱见本藏篇。）脾满
气逆。（见喘条。）
足太阳经的筋，构成眼睑的上缘。足阳明经的筋，构成眼睑的下缘。若受热邪则筋脉松弛，导致眼睛无法睁开。（全文详见“筋”条。）
（胃气异常导致眼球斜视、倒转、位置不正，在小儿中称为“通睛”。）
〔《甲乙经》〕 目疾，由水沟穴主治。
〔《针灸大成》〕 直视，是指注视物体时眼球不转动。如果眼球能转动，就不是直视。伤寒病出现直视，是因为邪气壅盛，蒙蔽正气，使神气昏昧，脏腑之气不能上荣于目，从而导致眼睛直视。伤寒发展到直视阶段，说明邪气已至极点，证候已逆乱，大多难以治疗。经文说：经常流鼻血的人不可发汗，若误用发汗法，会导致额部凹陷、脉象紧急、眼睛直视不能闭目、无法入睡。因为肝受血而能视，亡血之人肝气已虚，目气已弱，再发汗导致亡阳，这是阴阳俱虚所致。这种情况虽然错逆，但尚不算严重。等到胡言乱语、反目直视，又是肾气绝的表现；直视且摇头，又是心气绝的表现，这都是脏腑之气脱绝的现象。直视伴谵语、喘满者死，下痢者亦死。病情更重的发狂不识人，循衣摸床，惊恐不安，微喘直视，脉弦涩者死。这些都是邪气盛而正气脱绝的表现。
少阳经气终绝时，全身关节松弛，目系断绝。（全文详见诊生死条。目系断绝，所以眼睛不动而直视。王冰注解说：HT（此处原文为异体字或讹字，指瞪眼貌）是指直视如受惊的样子。HT音琼。）
瞳子高（眼球上视），是太阳经气不足。戴眼（眼球固定向上凝视），是太阳经气已绝。（全文详见诊生死。戴眼，是指眼睛直视不能转动。）
太阳经脉气终绝时，会出现戴眼、角弓反张、抽搐。
针灸治疗目上视，参见中风篇。
〔朱丹溪〕肝木气实，肝火旺盛导致的胁痛，用当归龙荟丸，这是泻肝火的要药。胁痛严重的，用生姜自然汁送服龙荟丸，这是因为肝火太盛。（龙荟丸方见治法门肝实条。）
经文说：肝气实则易怒。又说：肝痛表现为两胁下痛牵引少腹，易怒。龙荟丸治疗肝实引起的胁痛，这类人气机收敛，容易发怒。严重时可用姜汁送服。经文说：风木淫胜，治以辛凉，正是此理。
寿四郎右胁痛，小便赤少，脉象稍弦但不数，这是体内有陈久的积痰饮，因外感风寒遏制，不能宣散，所以作痛。给予龙荟丸三十五粒，保和丸三十粒，细嚼姜片，用热汤送下，服后胁痛已缓解，但小便仍赤少，再给予：
白术（三钱） 陈皮 芍药（各二钱） 木通（一钱半） 黄芩（一钱） 甘草（五分）
加生姜三片，煎煮后热饮。
一位妇人脾疼，伴有胁痛，口微干，病程已多年。当时还是秋季，用二陈汤加川芎、干葛、青皮、木通，送服芦荟丸二十粒。
章宅张郎气痛，自右胁时作时止，脉沉而弦，小便时有赤色，吞酸，喜呕，吐出食物，这是湿痰在脾肺之间，所以肝木容易乘袭脾土。用小柴胡汤去黄芩，加川芎、白术、木通、芍药、滑石、生姜煎汤，送服保和丸三十五粒。
一位妇人气晕，两胁胸背皆痛，口干。
青皮 半夏（五钱） 白术 黄芩 川芎（三钱） 木通（二钱半） 陈皮（二钱） 桔梗（二钱）
甘草（炙，五分）
以上分六帖，煎煮后热服。另外：胁下有食积形成一条硬块隆起，加吴茱萸、炒黄连。
〔《本草纲目》引方〕治疗因惊吓伤肝，胁骨内疼痛不止，用桂枝散。
枳壳（一两，小的） 桂枝（半两）
以上研为细末，每次服二钱，用姜枣汤调下。
〔李东垣〕匀气散 专门治疗胁痛。
山栀 熟地 茯苓 细辛 桂心 川芎（各等分）
以上研为末，加羊脂煎服。
〔《本草纲目》引方〕治疗胁下疼痛不可忍受，兼治肺弱，用芎葛汤。
川芎 干葛 桂枝 细辛 枳壳 人参 芍药 麻黄 防风（各半两） 甘草（二钱）
以上为粗末，每次服五钱，水二盏，生姜三片，同煎至七分，去渣，温服。每日三次。服药后有汗需避风。
治疗胁下风气结块寒疝，发作时连及小腹痛凑心胸。其积滞属肝，位于右胁下，故发病时，右胁手足头面昏痛，不思饮食。
干葛（一两） 麻黄（二分） 附子（一个） 川芎 防风 当归 枳实 芍药 桂枝 羌活
甘草（各四钱）
以上为粗末，每次服四钱，水一盏半。生姜三片，同煎至七分，去渣服，每日三次。服药后有汗需避风。
治疗胁痛如前所述。兼治手足枯瘦憔悴，用薏苡仁丸。
薏苡仁（一两） 石斛（用细者，二钱） 附子（半两） 牛膝 生地黄（各三钱） 细辛 人参 枳壳 柏子仁 川芎 当归（各半两） 甘草 桃仁（各一两）
以上为细末，炼蜜丸如梧桐子大。每次服三四十丸，酒送下，饭前服，每日三次。丸子饭前服，煮散剂饭后服，配合服用为佳。
治疗悲哀烦恼伤肝气，导致两胁骨疼，筋脉紧绷，腰脚重滞，两股筋急，两胁牵痛，四肢不能抬起，逐渐至脊背挛急。此药大治胁痛，用枳壳煮散。
枳壳（四两，先煎） 细辛 桔梗 防风 川芎（各二两） 葛根（一两半） 甘草
以上为粗末，每次服四钱，水一盏半，姜枣同煎至七分，去渣，空腹饭前温服。
右侧肝虚胁痛，即经文所说的木不及，病中生清冷感，胁痛即是。中清，谓中有寒。热实胁痛，用当归龙荟丸。
〔张仲景〕胁下偏痛，发热，脉弦紧，这是寒证，应用温下药下之，宜用大黄附子汤。
大黄（三钱） 附子（二枚，炮制） 细辛（二两）
以上三味，用水五升，煮取二升，分三次温服。若体质强壮者，煮取二升半，分三次温服。服药后如人行走四五里的时间，再进一服。
〔李杲〕神保丸 治疗心膈痛，腹痛血痛，肾气胁下痛，大便不通，气噎，宿食不消。
木香（二钱半） 胡椒（二钱半） 巴豆（十枚，去皮心膜，研） 干蝎（七枚）
以上四味共为末，汤浸蒸饼为丸如麻子大，也可用朱砂为衣。每次服五丸。心膈痛，柿蒂灯心汤送下。腹痛，柿蒂煨姜汤送下。血痛，炒姜醋汤送下。肾气胁下痛，茴香酒送下。大便不通，蜜汤调槟榔末一钱送下。气噎，木香汤送下。宿食不消，茶酒任送。
许学士说：沈存中《良方》记载：以前在建阳，医生王琪说，诸气中唯膀胱胁下痛最难治，称神保丸能治此症。熙宁年间患项筋骨痛，众医皆按风邪治疗，数月不愈，于是流入背膂，又臂挛痛甚苦，想起王琪的话有对应证候，于是合服神保丸，一服而愈，复发又一服，立竿见影。
〔李东垣〕煮黄丸 治疗胁下癖痛，效果如神。（方见内伤饮食。）
〔朱丹溪〕控涎丹 治疗一身气痛及胁肋走窜痛。痰挟死血，加桃仁泥。凡胁痛有痰流注，二陈汤加南星、川芎、苍术。实证，用控涎丹攻下。
〔《本草纲目》引方〕治疗男子两胁疼痛。枳实散。
枳实（一两） 白芍药（炒） 雀脑芎 人参（各半两）
以上细末，姜枣汤调二钱，酒亦可，饭前服，每日三次。
〔张元素〕调中顺气丸 治疗三焦痞滞，水饮停积，胁下虚满，或时刺痛。
木香 白豆蔻（去壳） 青皮（炮） 京三棱（炮。各一两） 陈皮 大附子（各二两） 半夏（汤炮七次，一两） 缩砂（去壳） 槟榔 沉香（各半两）
以上为末，煮面糊为丸，如梧桐子大。每次服三十丸，渐加六十丸，食后，陈皮汤送下。
沉香导气散 治疗一切气不升降，胁肋痞塞。
沉香（二钱半） 人参（五钱） 槟榔（二钱半） 白术 乌药 麦 （炒） 神曲（炒） 紫苏叶
大腹皮（炒） 浓朴（制。各一两） 诃子皮（炮，半两） 香附（炮，一两半） 姜黄 橘红 甘草（各四两）
京三棱（二两） 广术（炮，四两） 益智（二两） 红花（四两）
以上为细末，每次服二钱，食前沸汤点服。
丹溪说：胁痛有死血者，用桃仁、红花、川芎之类。若跌扑致胁痛者，也是污血流归胁下而痛，用东垣复元活血汤之类。治法见跌扑伤损门。
运气胁痛者，乡境皆病胁痛也，其证有二：
其一，风木助肝气实而痛。经文说：厥阴所至为胁痛。又说：厥阴在泉，风淫所胜，民病两胁，里急支满。又说：少阳司天之政，初之气，风胜乃摇，候乃大温，其病胁痛，治以凉剂得痊也。
其二，燥金攻肝虚而痛。经文说：少阳所至为胁痛。又说：阳明司天，燥气下临，肝气上从胁痛。又说：少阴司天，地乃燥，凄沧数至胁痛，善太息。又说：岁木不及，燥乃大行，民病中清，胁痛，治以温剂得痊也。
〔朱丹溪〕咳嗽胁痛方。二陈汤加南星，多香附、青皮、青黛、姜汁。
《内经》灸刺胁痛有三法：
其一取肝。经文说：肝病者，两胁下痛引小腹，善怒，取其经，厥阴与少阳。又说：邪在肝，则两胁中痛，寒中，恶血在内，行善掣节，时脚肿，取之行间以引胁下，补三里以温胃中，取血脉以散恶血，取耳间青脉以去其掣是也。
其二取胆络。经文说：邪客足少阳之络，令人胁痛，不得息，咳而汗，刺足小指次指爪甲上与肉交者各一 ，不得息立已，汗出立止。咳者，温衣饮食一日已。左刺右，右刺左。其病不已，复刺如法是也。
其三取心。经文说：心手少阴脉所生病者，目黄胁痛，视虚实热寒陷下，施补泻疾留灸之法也。
〔《针灸大成》〕胁痛：悬钟 窍阴（此二穴，左取右，右取左，窍阴出血妙。） 外关 三里（此一穴正取。）
又法：支沟 章门 中封 阳陵泉（治闪挫。） 行间（泻肝怒气。） 期门（治伤寒后胁痛。）
治疗胁并胸痛不可忍：期门（四分。） 章门（六分，灸七壮至七七壮。） 行间 丘墟 涌泉
〔张元素〕胸胁痛：期门（沿皮三寸。） 支沟 胆俞（沿皮半寸。） 胸胁胀满痛：公孙 三里 太冲
三阴交 腰胁痛 环跳 至阴 太白 阳辅
〔《针灸聚英》〕胁肋痛：支沟（透间使，泻之，灸。） 外关（透内关，如取支沟，不必再取外关。）
〔《针灸通玄》〕胁痛：阳陵泉
〔《甲乙经》〕胁下支满，呕吐逆，阳陵泉主之。腹中气胀，嗑嗑不嗜食，胁下痛，阴陵泉主之。
〔张仲景〕寸口脉弦者，即胁下拘急而痛，其人啬啬恶寒也。
〔《灵枢》〕合腋张胁者肺下，肺下则居贲迫肺，善胁下痛。青色粗理者肝大，肝大则逼胃迫咽，则苦膈中，且胁下痛。
凡胁骨偏举者肝偏倾，肝偏倾则胁下痛。揭唇者脾高，脾高则 引季胁而痛。（俱见本藏篇。）脾满气逆。（见喘条。）
The sinews of the Foot-Taiyang (Bladder) meridian form the upper eyelid margin. The sinews of the Foot-Yangming (Stomach) meridian form the lower eyelid margin. Heat causes the sinews to relax, resulting in the inability to open the eyes. (See full text under "Sinew" section.)
(When stomach qi is abnormal, causing the eyeballs to deviate, invert, or be misaligned, it is called "Tong Jing" [strabismus] in children.)
[From *Jia Yi Jing*] Eye disorders are treated by Shuigou (GV26).
[From *Zhen Jiu Da Cheng*] "Direct gaze" (Zhi Shi) refers to staring at objects without eye movement. If the eyes can move, it is not direct gaze. In Shanghan (Cold Damage), direct gaze occurs because pathogenic factors are abundant and obstruct righteous qi, clouding the spirit. Qi from the Zang-Fu organs fails to nourish the eyes, leading to fixed staring. When Shanghan progresses to direct gaze, it indicates that pathogenic factors have reached their extreme and the syndrome has become inverted; it is mostly difficult to treat. The classic states: Patients with frequent epistaxis should not undergo sweating therapy. If sweating is mistakenly induced, it leads to depression of the forehead, tightness of the vessels, direct gaze with inability to close the eyes, and insomnia. Since the Liver stores blood to enable vision, patients who have lost blood already have deficient Liver qi and weak eye qi. Inducing sweating further depletes Yang, resulting in deficiency of both Yin and Yang. Although this condition is inverted, it is not yet severe. However, when accompanied by delirium, reversed gaze, and direct staring, it indicates Kidney Qi exhaustion; direct gaze with head shaking indicates Heart Qi exhaustion. These are all signs of exhaustion and depletion of Zang-Fu Qi. Direct gaze with delirium, wheezing, and chest fullness results in death; diarrhea also results in death. In more severe cases, madness with loss of recognition, grasping at clothes and bedrails, restlessness, slight wheezing, direct gaze, and a wiry and choppy pulse indicate death. All these are due to excess of pathogenic factors and depletion of righteous qi.
When Shaoyang (Gallbladder) Qi terminates, the joints of the body become flaccid, and the eye system severs. (See full text under "Diagnosing Death" section. Because the eye system severs, the eyes do not move but stare directly. Wang Bing's commentary notes: HT refers to a staring look as if startled. HT sounds like 'Qiong'.)
High position of the pupil indicates insufficiency of Taiyang. Upward deviation of the eyes (Dai Yan) indicates exhaustion of Taiyang. (See full text under "Diagnosing Death". Dai Yan means the eyes stare straight up and cannot rotate.)
When the meridians of Taiyang terminate, symptoms include Dai Yan (upward fixed gaze), opisthotonos (arching back), and convulsions.
For acupuncture treatment of upward-gazing eyes, see the Stroke section.
[Zhu Danxi] For hypochondriac pain caused by excess Liver Wood Qi and flourishing Liver Fire, use Danggui Longhui Wan (Angelica Dahurica and Gardenia Pill), which is an essential medicine for purging Liver Fire. For severe hypochondriac pain, swallow Longhui Wan with fresh ginger juice, due to excessive Liver Fire. (Formula for Longhui Wan is found in the Treatment Methods section under Liver Excess.)
The classics state: Excess Liver Qi leads to anger. It also states: Liver pain manifests as pain in the lower hypochondrium radiating to the lower abdomen, accompanied by irritability. Longhui Wan treats hypochondriac pain due to Liver Excess; such individuals have constrained Qi and are prone to anger. In severe cases, it can be taken with ginger juice. The classics state: When Wind-Wood is excessive, treat with pungent-cool methods, which aligns with this principle.
Shou Sijiang suffered from right-sided hypochondriac pain, scanty dark urine, and a slightly wiry but not rapid pulse. This was due to old phlegm-fluid retention inside, constrained by external Wind-Cold, preventing dispersion, thus causing pain. He was given 35 pills of Longhui Wan and 30 pills of Baohe Wan, chewed finely with ginger slices, and swallowed with hot water. After taking, the hypochondriac pain subsided, but the urine remained scanty and dark. Then he was prescribed:
Baizhu (Atractylodis Rhizoma, 3 qian) Chenpi (Citri Reticulatae Pericarpium) Shaoyao (Paeoniae Radix Alba, each 2 qian) Mutong (Akebiae Caulis, 1.5 qian) Huangqin (Scutellariae Radix, 1 qian) Gancao (Glycyrrhizae Radix et Rhizoma, 0.5 qian)
Add three slices of ginger, decoct, and drink warm.
A woman suffered from Spleen pain with accompanying hypochondriac pain and slight dry mouth, having had the condition for many years. It was still autumn, so Erchen Tang (Two-Aged Decoction) was used with added Chuanxiong (Ligustici Chuanxiong Rhizoma), Gegen (Puerariae Lobatae Radix), Qingpi (Citri Reticulatae Pericarpium Viride), and Mutong, followed by 20 pills of Lushui Wan (Aloe Pill).
Mr. Zhang of the Zhang residence suffered from Qi pain, intermittent in the right hypochondrium, with a deep and wiry pulse, occasional dark urine, acid regurgitation, desire to vomit, and vomiting of food. This was damp-phlegm between the Spleen and Lung, allowing Liver Wood to overact on Earth. Xiaochaihu Tang (Minor Bupleurum Decoction) was used minus Huangqin, with added Chuanxiong, Baizhu, Mutong, Shaoyao, Huashi (Talcum), and ginger decocted, followed by 35 pills of Baohe Wan.
A woman suffered from Qi dizziness, pain in both hypochondria, chest, and back, and dry mouth.
Qingpi (Citri Reticulatae Pericarpium Viride) Banxia (Pinelliae Rhizoma, 5 qian) Baizhu Huangqin Chuanxiong (each 3 qian) Mutong (2.5 qian) Chenpi (2 qian) Jiegeng (Platycodonis Radix, 2 qian)
Gancao (Honey-fried Glycyrrhizae Radix et Rhizoma, 0.5 qian)
Divide into six doses, decoct, and take warm. Additionally: If there is a food stagnation lump rising in the hypochondrium, add Wuzhuyu (Evodiae Fructus) and stir-fried Huanglian (Coptidis Rhizoma).
[From *Ben Cao Gang Mu* citing formulas] To treat persistent pain inside the rib cage due to fright injuring the Liver, use Guizhi San (Cinnamon Twig Powder).
Zhike (Aurantii Fructus Immaturus, 1 liang, small ones) Guizhi (Cinnamomi Ramulus, 0.5 liang)
Grind into fine powder. Take 2 qian per dose, mixed with Ginger-Jujube Decoction.
[Li Dongyuan] Yunqi San (Qi-Balancing Powder) specifically treats hypochondriac pain.
Zhizi (Gardeniae Fructus) Shudi (Rehmanniae Radix Preparata) Fuling (Poria) Xixin (Asari Radix et Rhizoma) Guixin (Cinnamomi Cortex) Chuanxiong (each equal parts)
Grind into powder, add sheep fat, decoct, and take.
[From *Ben Cao Gang Mu* citing formulas] To treat unbearable pain in the hypochondrium, also treating weak Lung, use Xiongge Tang (Ligusticum and Kudzu Decoction).
Chuanxiong Ge Gen (Puerariae Lobatae Radix) Guizhi Xixin Zhike Ren Shen Shaoyao Mahuang (Ephedrae Herba) Fangfeng (each 0.5 liang) Gancao (2 qian)
Make into coarse powder. Take 5 qian per dose with two cups of water, three slices of ginger. Decoct to one part remaining, strain, and take warm. Three times daily. Avoid wind if sweating occurs.
To treat cold hernia caused by Wind-Qi accumulation in the hypochondrium, which radiates to the lower abdomen and heart upon attack. The accumulation belongs to the Liver, located in the right hypochondrium. Upon onset, there is dull pain in the right hypochondrium, limbs, head, and face, and loss of appetite.
Ge Gen (1 liang) Mahuang (2 fen) Fuzi (Aconiti Lateralis Radix Preparata, one piece) Chuanxiong Fangfeng Danggui (Angelicae Sinensis Radix) Zhishi (Aurantii Fructus) Shaoyao Guizhi Qianghuo (Notopterygii Rhizoma et Radix)
Gancao (each 4 qian)
Make into coarse powder. Take 4 qian per dose with one and a half cups of water, three slices of ginger. Decoct to one part remaining, strain, and take. Three times daily. Avoid wind if sweating occurs.
To treat hypochondriac pain as described above, also treating emaciation of limbs, use Yiyiren Wan (Coix Seed Pill).
Yiyiren (Coicis Semen) Shihu (Dendrobii Caulis, use thin ones, 2 qian) Fuzi (0.5 liang) Niuxi (Achyranthis Bidentatae Radix) Shengdihuang (Rehmanniae Radix, each 3 qian) Xixin Ren Shen (Ginseng Radix et Rhizoma) Zhike Baoren (Platycodi Radix) Baiziren (Biotae Semen) Chuanxiong Danggui (each 0.5 liang) Gancao Tao Ren (Persicae Semen, each 1 liang)
Make into fine powder, refine honey, and make pills the size of tung seeds. Take 30-40 pills per dose, swallowed with wine, before meals, three times daily. Pills taken before meals, decoctions taken after meals; combining them is best.
To treat Liver Qi injury from sorrow and worry, causing pain in both hypochondrial bones, tight sinews, heavy waist and legs, tight tendons in both thighs, pulling pain in both hypochondria, inability to lift limbs, gradually progressing to spinal spasms. This medicine greatly treats hypochondriac pain, using Zhike Decoction.
Zhike (4 liang, decoct first) Xixin Jiegeng Fangfeng Chuanxiong (each 2 liang) Gegen (1.5 liang) Gancao
Make into coarse powder. Take 4 qian per dose with one and a half cups of water, ginger and jujube. Decoct to one part remaining, strain, and take warm on an empty stomach before meals.
Right-sided Liver Deficiency hypochondriac pain corresponds to the classic saying "Wood Insufficiency," where the disease involves internal cold, manifesting as hypochondriac pain. "Internal Cold" means cold within. Heat-Excess hypochondriac pain is treated with Danggui Longhui Wan.
[Zhang Zhongjing] Hypochondriac pain on one side with fever and a wiry-tight pulse indicates Cold. Treat with warming purgatives; Dahuang Fuzi Tang (Rhubarb and Prepared Aconite Decoction) is appropriate.
Dahuang (Rhei Radix et Rhizoma, 3 qian) Fuzi (Prepared Aconiti Lateralis Radix, 2 pieces, processed) Xixin (2 liang)
Take the three ingredients, add five sheng of water, boil to obtain two sheng, divide into three warm doses. For strong individuals, boil to obtain two and a half sheng, divide into three warm doses. After taking, wait the time it takes to walk four or five li, then take another dose.
[Li Gao] Shenbao Wan (Spirit-Preserving Pill) treats Heart/Epigastric pain, abdominal pain, blood pain, Kidney Qi hypochondriac pain, constipation, Qi obstruction, and undigested food.
Muxiang (Aucklandiae Radix, 2.5 qian) Hujiao (Piperis Longi Fructus, 2.5 qian) Badou (Crotonis Fructus, ten seeds, skin and core removed, ground) Ganxie (Dry Scorpion, seven pieces)
Grind the four ingredients into powder, mix with dough steamed in soup to make pills the size of hemp seeds, optionally coated with Cinnabar. Take five pills per dose. For Heart/Epigastric pain, swallow with Persimmon Calyx and Centella Decoction. For abdominal pain, swallow with Persimmon Calyx and Roasted Ginger Decoction. For blood pain, swallow with Stir-fried Ginger and Vinegar Decoction. For Kidney Qi hypochondriac pain, swallow with Fennel Wine. For constipation, swallow with Honey Water and one qian of Areca Seed Powder. For Qi obstruction, swallow with Aucklandia Decoction. For undigested food, swallow with Tea or Wine as desired.
Xu Xueshi said: Shen Cunzhong's *Liang Fang* records: Previously in Jianyang, Doctor Wang Qi said that among all Qi disorders, only Bladder hypochondriac pain is hardest to treat, stating Shenbao Wan can cure it. During the Xining era, I suffered from neck and bone pain. All doctors treated it as Wind, but it did not heal for months, eventually spreading to the back and spine, with severe arm spasms and pain. Remembering Wang Qi's words regarding the syndrome, I took Shenbao Wan. One dose cured it; upon recurrence, one dose again brought immediate relief.
[Li Dongyuan] Zhu Huang Wan (Boiled Yellow Pill) treats hypochondriac Pi (mass) pain, effective as a god. (Formula seen in Internal Injury/Dietary section.)
[Zhu Danxi] Kongxian Dan (Phlegm-Draining Pellet) treats generalized Qi pain and migrating hypochondriac pain. If Phlegm binds with dead blood, add Peach Kernel Paste. For hypochondriac pain with phlegm migration, use Erchen Tang with added Nanxing (Arisaematis Rhizoma), Chuanxiong, and Cangzhu (Atractylodis Rhizoma). For Excess patterns, use Kongxian Dan to purge.
[From *Ben Cao Gang Mu* citing formulas] To treat bilateral hypochondriac pain in men, use Zhishi San (Immature Bitter Orange Powder).
Zhishi (Aurantii Fructus Immaturus, 1 liang) Baishaoyao (Fried Paeoniae Radix Alba) Que nao Xiong (Sichuan Lovage Rhizome) Ren Shen (each 0.5 liang)
Grind into fine powder. Take 2 qian mixed with Ginger-Jujube Decoction; wine is also acceptable. Take before meals, three times daily.
[Zhang Yuansu] Tiaozhong Shunqi Wan (Regulate Middle and Smooth Qi Pill) treats Sanjiao (Triple Burner) stagnation, fluid retention, distension in the hypochondrium, or stabbing pain.
Muxiang Bai Doukou (Cardamomi Fructus, peeled) Qingpi (Pounded) Jingsanleng (Polygoni Kunmingii Rhizoma, pounded. Each 1 liang) Chenpi Dafuzi (Aconiti Lateralis Radix Preparata, each 2 liang) Banxia (Processed in boiling water seven times, 1 liang) Suosha (Amomi Fructus, peeled) Binglang (Arecae Semen) Chenxiang (Aquilariae Lignum Resinatum, each 0.5 liang)
Make into powder, use boiled flour paste to make pills the size of tung seeds. Take 30 pills per dose, gradually increasing to 60 pills, after meals, with Tangerine Peel Decoction.
Chenxiang Daoqi San (Agarwood Guiding Qi Powder) treats all Qi failing to ascend and descend, with stuffiness in the hypochondrium and ribs.
Chenxiang (2.5 qian) Ren Shen (5 qian) Binglang (2.5 qian) Baizhu Wuyao (Illicii Fructus) Mai (Fried) Shenqu (Fried) Zisu Ye (Perillae Folium)
Dafupi (Arecae Pericarpium, fried) Houpo (Magnoliae Officinalis Cortex, prepared. Each 1 liang) Hezi Pi (Myristicae Semen, pounded, 0.5 liang) Xiangfu (Cyperi Rhizoma, pounded, 1.5 liang) Jianghuang (Curcumae Longae Rhizoma) Juhong (Citri Reticulatae Pericarpium Rubrum) Gancao (each 4 liang)
Jingsanleng (2 liang) Guangzhu (Curcumae Phaeocaulis Rhizoma, pounded, 4 liang) Yizhi (Alpiniae Oxyphyllae Fructus, 2 liang) Honghua (Carthami Flos, 4 liang)
Grind into fine powder. Take 2 qian per dose before meals, mixed with boiling water.
Danxi said: Hypochondriac pain due to dead blood uses Taoren (Peach Kernel), Honghua (Safflower), Chuanxiong, etc. Hypochondriac pain due to trauma is also caused by dirty blood flowing to the hypochondrium; use Li Dongyuan's Fuyuan Huoxue Tang (Restore Flow and Invigorate Blood Decoction), etc. See Trauma section for treatment methods.
Wind-Charge hypochondriac pain affects the whole region, presenting in two syndromes:
First, Wind-Wood assists Liver Qi Excess causing pain. The classic says: What arrives via Jueyin causes hypochondriac pain. Also: When Jueyin governs the interior, Wind excess causes people to suffer from bilateral hypochondriac pain, internal urgency, and flank fullness. Also: When Shaoyang governs Heaven, in the First Qi period, Wind excess causes shaking, the climate becomes very warm, and the disease is hypochondriac pain, cured by cool agents.
Second, Dryness-Metal attacks Liver Deficiency causing pain. The classic says: What arrives via Shaoyang causes hypochondriac pain. Also: When Yangming governs Heaven, Dryness descends, Liver Qi follows upward causing hypochondriac pain. Also: When Shaoyin governs Heaven, the earth becomes dry, chilling winds frequently arrive causing hypochondriac pain and frequent sighing. Also: When Year Wood is insufficient, Dryness prevails, people suffer from internal cold and hypochondriac pain, cured by warm agents.
[Zhu Danxi] Formula for Cough with Hypochondriac Pain. Erchen Tang with added Nanxing, plus more Xiangfu, Qingpi, Qingdai (Indigo Naturalis), and ginger juice.
The *Neijing* describes three acupuncture/moxibustion methods for hypochondriac pain:
First, target the Liver. The classic says: Liver diseases cause pain in the lower hypochondrium radiating to the lower abdomen, with irritability; select the meridians, Jueyin and Shaoyang. Also: Pathogen in the Liver causes pain in the middle of both hypochondria, cold in the middle, evil blood inside, jerking of joints, and occasional leg swelling; select Xingjian (LR2) to guide Qi from the hypochondrium, tonify Zusanli (ST36) to warm the Stomach, select blood vessels to disperse evil blood, and select blue veins behind the ear to remove jerking.
Second, target the Gallbladder collateral. The classic says: Pathogen invading the collateral of Foot-Shaoyang causes hypochondriac pain, difficulty breathing, coughing with sweat; prick the point where the nail meets the flesh on the fourth toe, one prick each side; difficulty breathing stops immediately, sweating stops immediately. For cough, keep warm and eat well for one day. Prick left then right, right then left. If the disease persists, repeat this method.
Third, target the Heart. The classic says: Diseases produced by the Hand-Shaoyin meridian include yellow eyes and hypochondriac pain; assess excess/deficiency, heat/cold, sinking/depression, and apply tonifying/reducing and quick-retention moxibustion methods.
[From *Zhen Jiu Da Cheng*] Hypochondriac pain: Xuanzhong (GB39) Xiaoyin (GB44) (Select these two points cross-wise, left-right, right-left; bleeding Xiaoyin is excellent.) Waiguan (TE5) Zusanli (ST36) (This point is correctly selected.)
Another method: Zhigou (TE6) Zhangmen (LR13) Zhongfeng (LR4) Yanglingquan (GB34) (For sprains.) Xingjian (LR2) (To drain Liver anger.) Qimen (LR14) (For post-Shanghan hypochondriac pain.)
To treat unbearable hypochondriac and chest pain: Qimen (4 cun insertion?) Zhangmen (6 cun insertion, moxa 7 to 49 cones.) Xingjian Qiuxu (GB40) Yongquan (KI1)
[Zhang Yuansu] Chest-Hypochondriac pain: Qimen (Insert along skin 3 cun.) Zhigou Danshu (BL18) (Insert along skin 0.5 cun.) Chest-Hypochondriac Distension/Pain: Gongsun (SP4) Zusanli Taichong (LR3)
Sanyinjiao (SP6) Waist-Hypochondriac pain: Huantiao (GB30) Zhiyin (BL67) Taibai (SP3) Yangfu (GB38)
[From *Zhen Jiu Ju Ying*] Hypochondriac-Rib Pain: Zhigou (Penetrate to Jianshi PC5, reduce, moxa.) Waiguan (Penetrate to Neiguan PC6; if Zhigou is taken, no need to take Waiguan again.)
[From *Zhen Jiu Tong Xuan*] Hypochondriac pain: Yanglingquan (GB34)
[From *Jia Yi Jing*] Fullness and distension below the hypochondrium, vomiting and reflux, Yanglingquan (GB34) governs. Abdominal Qi distension, reluctance to eat, hypochondriac pain, Yinlingquan (SP9) governs.
[Zhang Zhongjing] A wiry pulse at the Cun Kou position indicates tension and pain in the hypochondrium, with aversion to cold.
[From *Ling Shu*] Axillary folding and rib spreading indicates low Lung position; low Lung presses against the diaphragm and Lung, causing frequent hypochondriac pain. Coarse texture with bluish color indicates enlarged Liver; enlarged Liver presses against Stomach and throat, causing epigastric distress and hypochondriac pain.
If the rib cage is tilted, the Liver is displaced; displacement causes hypochondriac pain. Everted lips indicate high Spleen; high Spleen pulls the costal margin causing pain. (All seen in Ben Zang chapter.) Spleen fullness with rebellious Qi. (See Asthma section.)