（腋下为 ， 下为胁，胁下为肋，肋下为季胁，季胁下为 。）
肝胆脉布胁，而心包络筋脉亦挟胁。肝脉布肋，而脾筋亦结肋。胆筋脉乘季胁，
而肺筋亦抵季胁。胆脉乘 ，是胁肋痛未必尽由肝胆，而肝胆为多。大概分气血食
痰四种，而怒气瘀血居多，治者须分左右，审虚实。左痛多留血，或肋下有块，
右痛多气郁，气郁则痰亦停，然左血右气，亦难泥定。大抵瘀血按之痛，不按亦痛，
痛无时息，而不膨胀。气痛则时止而膨，得嗳即宽，以此辨之。胁痛火实者，忌陈
皮、生姜、细辛，能令肝胀。（火盛忌热药，三者性热，而味又辛散，火得风而益炽也，故忌之。）
龙荟丸，柴胡、青皮必用。肝火郁甚，用黄连、龙胆草等苦寒直折，火愈郁愈烈。
用大栝蒌一枚，连皮捣烂，加粉草二钱，妙，栝蒌甘寒润滑，于郁不逆，又如油之
洗物，未尝不洁也。详《准绳》。气实痛，枳壳、青皮、姜黄、香附、甘草，有
痰加苍术、半夏、白芥子。枳壳乃治胁痛的剂，必用。死血阻滞，必日轻夜重，午后
发热，脉短涩，桃仁承气汤（见血）加鳖甲、青皮、芎、归之属。痰饮痛，脉沉弦滑，
导痰汤（见痰）。食痛，凡痛有一条扛起者是也。煮黄丸（见心痛）治胁下 癖痛，如神。悲哀
伤肝，气引两胁疼痛，枳壳煮散。房劳伤肾，气虚血滞，胸胁多有隐隐作痛，宜补
肾，加芎、归之类和血。酒色太过，胁下一点痛不止，名干胁痛，甚危，惟大补气
血而已。虚冷作痛，不宜疏散，须辛热补剂。肝虚，视物不明，筋脉拘急，面青爪
甲枯，胁引小腹痛，补肝汤。凡痛而胁骨偏举者，肝偏倾也。
（腋下为腋，腋下为胁，胁下为肋，肋下为季胁，季胁下为脊。）
肝胆的经脉分布于胁部，而心包络的筋脉也夹行于胁部。肝的经脉分布于肋部，而脾的筋脉也结聚于肋部。胆的筋脉覆盖季胁，而肺的筋脉也抵达季胁。胆的经脉经过腋部，所以胁肋疼痛未必全由肝胆引起，但多数情况确实源于肝胆。大体上分为气、血、食积、痰饮四种类型，其中因怒气导致的瘀血最为常见。治疗时必须区分左右，审察虚实。左侧疼痛多为瘀血停留，或者胁下有肿块；右侧疼痛多为气机郁滞，气机郁滞则痰饮也会停滞，然而左血右气的规律也不能死板拘泥。大抵瘀血疼痛的特点是按压时痛，不按压时也痛，疼痛没有间歇，且腹部不膨胀。气痛则是时断时续并伴有胀满，打嗝后感到舒缓，据此可以辨别。胁痛属于火邪实证者，忌用陈皮、生姜、细辛，因为这些药能使肝脏胀大。（火盛时忌讳热性药物，这三者药性温热，且味道辛散，火势遇风会更加猛烈，因此禁忌使用。）龙荟丸中，柴胡、青皮是必用的。肝火郁结严重，可用黄连、龙胆草等苦寒药物直接折降火势，但如果火愈郁结反而更烈。此时用大栝蒌一枚，连皮捣烂，加入粉甘草二钱，效果奇妙，栝蒌甘寒润滑，对于郁结没有抵触，就像油清洗物品一样，未尝不能洗净。详见《医学准绳六要》。气实引起的疼痛，用枳壳、青皮、姜黄、香附、甘草，有痰加苍术、半夏、白芥子。枳壳是治疗胁痛的药剂，必须使用。死血阻滞，必然表现为白天轻晚上重，午后发热，脉象短涩，用桃仁承气汤（见血证篇）加鳖甲、青皮、川芎、当归之类。痰饮引起的疼痛，脉象沉弦滑，用导痰汤（见痰证篇）。食积引起的疼痛，凡是疼痛有一条像扛物感的是这种情况。煮黄丸（见心痛篇）治疗胁下的癖积疼痛，如神效。悲哀损伤肝脏，气机牵引两胁疼痛，用枳壳煮散。房劳过度损伤肾脏，气虚血滞，胸胁多有隐隐作痛，宜补肾，加川芎、当归之类调和血液。酒色过度，胁下一点疼痛不止，名为干胁痛，非常危险，只有大补气血这一种办法。虚冷引起的疼痛，不宜疏散，需用辛热补剂。肝虚，视物不明，筋脉拘急，面色青，爪甲枯槁，胁部牵引小腹痛，用补肝汤。凡是疼痛且胁骨偏斜高举的，是肝脏位置偏倾。
(The area under the armpit is the axilla, below the axilla is the hypochondrium, below the hypochondrium is the rib, below the rib is the costal margin, and below the costal margin is the spine.)
The meridians of the Liver and Gallbladder distribute to the hypochondrium, while the sinews and vessels of the Pericardium also flank the hypochondrium. The meridian of the Liver distributes to the ribs, while the sinews of the Spleen also knot at the ribs. The sinews of the Gallbladder cover the costal margin, while the sinews of the Lung also reach the costal margin. The meridian of the Gallbladder passes through the axilla; therefore, pain in the hypochondrium and ribs is not necessarily entirely caused by the Liver and Gallbladder, but mostly originates from them. Generally, it is divided into four categories: Qi, Blood, Food Stagnation, and Phlegm-Fluids, among which Blood Stasis due to anger is most common. Treatment must distinguish between left and right, and examine deficiency and excess. Pain on the left is mostly due to retained Blood, or there may be a mass under the hypochondrium; pain on the right is mostly due to Qi stagnation. When Qi stagnates, Phlegm-Fluids also tend to accumulate. However, the rule of "left for Blood, right for Qi" cannot be rigidly adhered to. Generally, pain from Blood Stasis is painful upon pressing and also when not pressing, with no cessation of pain, and without abdominal distension. Pain from Qi is intermittent accompanied by distension, relieved by belching, which serves as a method of differentiation. For hypochondriac pain due to Excess Fire, Chenpi (Tangerine Peel), Shengjiang (Fresh Ginger), and Xixin (Asarum) are contraindicated as they can cause Liver distension. (When Fire is excessive, hot medicines are contraindicated; these three substances are hot in nature and pungent-dispersing in flavor. Fire fueled by wind becomes more intense, hence they are contraindicated.) In Longhui Wan (Dragon Ascent Pill), Chaihu (Bupleurum Root) and Qingpi (Aged Tangerine Peel) are essential. For severe depression of Liver Fire, bitter-cold herbs such as Huanglian (Coptis Rhizome) and Longdancao (Gentian Root) can be used to directly subdue the fire; however, if the fire is too depressed, it may become even fiercer. In such cases, use one large Gualou (Trichosanthes Fruit), crushed with the peel, added with 2 qian of Fengancao (Licorice Root). This is effective because Gualou is sweet, cold, moistening, and lubricating, opposing depression without conflict, much like oil cleaning objects, ensuring cleanliness. See *Zhunsheng* for details. For pain due to Excess Qi, use Zhike (Aurantii Fructus), Qingpi, Jianghuang (Turmeric Rhizome), Xiangfu (Cyperi Rhizome), and Gancao (Licorice Root). If there is Phlegm, add Cangzhu (Atractylodis Rhizoma), Banxia (Pinellia Tuber), and Baijiezi (Sinapis Semen). Zhike is an agent for treating hypochondriac pain and must be used. For obstruction by Dead Blood, symptoms typically worsen at night and improve during the day, with afternoon fever and a short, choppy pulse. Use Taoren Chengqi Tang (Peach Kernel Decoction to Order the Qi) [see Blood Disorders] plus Biejia (Testudinis Carapax et Plastrum), Qingpi, Xiong (Ligusticum Rhizome), and Danggui (Angelicae Sinensis Radix). For pain due to Phlegm-Fluids, the pulse is deep, wiry, and slippery; use Daotan Tang (Great Phlegm-Resolving Decoction) [see Phlegm Disorders]. For pain due to Food Stagnation, it is characterized by a sensation of a band-like pressure across the abdomen. Zhu Huang Wan (Boiled Yellow Pill) [see Heart Pain] treats pain from accumulation under the hypochondrium with miraculous effect. Sorrow injures the Liver, causing Qi to draw pain to both hypochondria; use Zhike decoction powder. Sexual exhaustion injures the Kidney, leading to Qi deficiency and Blood stasis, often resulting in dull pain in the chest and hypochondrium; tonify the Kidney and add Xiong and Danggui to harmonize the Blood. Excessive alcohol and sexual activity cause unceasing pinpoint pain under the hypochondrium, named Gan Xie Tong (Dry Hypochondriac Pain), which is critical; only massive tonification of Qi and Blood will suffice. Pain due to Deficiency-Cold should not be treated with dispersing methods but requires pungent-hot tonic formulas. For Liver Deficiency, with unclear vision, tendon and vessel spasm, bluish complexion, withered nails, and hypochondriac pain radiating to the lower abdomen, use Bu Gan Tang (Liver-Tonifying Decoction). Whenever pain is accompanied by the protrusion of the hypochondrial bone, it indicates the Liver is displaced.