〔大〕夫妇人两胁胀痛者，由脏腑虚弱，气血不调，风冷之气，客于肠胃，伤于胞络
之间，与血气相搏，壅寒不宣，邪正交争冲击，故令两胁胀痛也。
〔薛〕东垣先生云∶胸胁作痛，口苦舌干，寒热往来，发呕发吐，四肢满闷，淋溲
便难，腹中急痛，此肝木之妄行也。窃谓前证若暴怒伤血，用小柴胡、芎、归、山栀。气
虚用四物、参、术、柴、栀。若久怒伤气，用六君、芎，归、山栀。若气血俱虚，用六味
地黄丸。若经行腹痛，寒热晡热，或月经不调，发热痰咳，少食嗜卧，体痛，用八珍、柴
胡、丹皮。若胁胀发热，口渴唾痰，或小便淋沥，颈项结核，或盗汗，便血，诸血失音，
用六味丸。若两胁作胀，视物不明，或筋脉拘急，面色青，小腹痛，或小便不调，用补
肝散。若概用香燥之剂，反伤清和之气，则血无所生，诸证作焉。丹溪先生云∶右胁痛
用推气散、小龙荟丸、当归龙荟丸、控涎丹、抑青丸，十枣汤，皆病气元气俱实之剂，用
者审之。一妇人性急，吐血发热、两胁胀痛，日晡益甚，此怒气伤肝，气血俱虚也。朝
用逍遥散倍加炒黑山栀、黄柏、贝母、桔梗、麦门冬，夕以归脾汤送地黄丸而愈。 一孀
妇内热晡热，肢体酸麻，不时吐痰，或用清气化痰药，喉间不利，白带腹胀；用行气散
血药，胸痛不利，肢体时麻。此郁怒伤肝脾而药益甚也。予则朝用归脾汤以解脾郁，生
脾气，夕用加味逍遥散以清肝火，生肝血，百余剂而愈。后因怒，饮食日少，肢体时麻，此
乃肝火侮土，用补中益气加山栀、茯苓，半夏而痊。又饮食失调，兼有怒气，肢体麻甚，
月经如注，脉浮洪而数，此脾受肝伤，不能统血则致崩，肝气亏损阴血而脉大，继用六
君加芎、归、炮姜而血崩止，又用补中益气加炮姜、茯苓、半夏而元气复，更用归脾汤、
逍遥散调理而康。
灵宝散 治妇人血气攻刺，痛引两胁。
丁香 木香 乳香 玄胡索 当归 白芍药（各等分）
上为细末，每服二钱，食前温酒调下。
草豆蔻散 治妇人脾胃虚，气攻两胁胀痛。
草豆蔻 诃子肉（各一两） 桂心 苦梗 浓朴（各三分） 甘草（一分） 川芎 当归
干姜 槟榔（各半两）
上为粗末，每服四钱，水一盏，煎七分，去滓食前热服。
子散 治妇人脏腑虚冷，宿冷气攻，两胁胀痛，坐卧不安。
子 延胡索 桃仁 琥珀 当归 桂心（各一两） 赤芍药 木香 没药（各半两）
上为末，每服二钱，温酒调下。
人参紫金丸 治妇人荣卫不和，心腹刺痛，胸膈胀满，不进饮食。
紫金皮 苍术 石菖蒲（各一两） 香附子（二两） 人参（半两） 木香（三钱）
上为末，米糊丸如梧子大。食后姜汤吞下三十丸。
气针丸 治久积风壅，疏利气滞，空胸膈，止刺痛。
木香 青皮（去白） 大黄（炮） 槟榔（各一两） 黑牵牛（二两，半生半炒）
上为末，炼蜜丸如梧子大，温水下三十丸。
邓安人年五十，忽然气痛，投神保丸愈。不一二日再痛，再服神保丸六七十粒，大腑
不通，其疾转甚。亦有要用沉香、木香、姜、桂，芍药而未敢投，痛甚则筑心、筑背、筑
之两胁，似有两柴十字插定心胁，叫声彻天。
召予诊之，六脉沉伏，乍来乍去。众问何如？予曰∶夫九痛之脉，不可准也，但以证辨
用药。观其人质肥伟，问其大腑数日不通。余曰∶实痛也，其不必胀，但以人按之痛甚，手
不可向迩，此大实也。经云∶大满大实者可下之，用气针丸五六百粒，是晚愈。又己未
在金陵，有家提干巽内人病心胁胀痛，众医投木香、沉香、槟榔、大腹、芍药、姜、桂
之类益甚。召予诊之，六脉弦紧而和，不似病脉，但诊之时，两手如火，以此知其实痛
也，众问如何治疗？仆曰∶大凡心腹刺痛，不可便作虚冷治之。有二医答曰∶非冷即何？热
即生风，冷生气是也。予曰∶不然。《难经》云∶虚则痒，实则痛。又仲景云∶腹痛者桂
枝加芍药汤，痛甚者，桂枝加大黄汤。提干曰∶荆布素弱。予曰∶有可辨处，遇痛时使
一婢按之，若痛止是虚寒证也。按之转甚，手不可近，此实痛也。即令婢按之，手不可近，
叫呼异常。予曰∶此实热无可疑者。当用大柴胡汤治之。众不从，予责状而投之，八服
愈。
论胁肋痛服木通散。（亦可治男子。）
心下胁肋少腹疼痛，皆素有积寒，而温暖汤散亦可主治，甚者以温药下之。心下与
小腹痛，诸书并有效方，而胁肋下痛，鲜获治法。
木通散 治胁肋苦痛偏效，并心下胁肋，并少腹牵引痛者，皆主之。
木通（去皮节） 青皮（去白） 川楝子（去皮核，各一两。以上三味，用巴豆半两，炒黄，
去巴豆不用） 萝卜子（炒） 舶上 香（一两，炒） 莪术 木香 滑石（各半两）
上为细末，煎葱白酒调三钱，一服愈。甚者不过再服。
三腕散 治中焦虚痞，两胁气痛，面目手足浮肿，大便秘涩，兼治香港脚。
大腹皮 紫苏 沉香 干木瓜 独活（各一两） 白术 川芎 木香 甘草 陈皮 槟
榔（各三分）
上 咀，每服三钱，水一盏，煎至七分，去滓空心热服，日中再服。戊午秋在京城，
有一妇人，中焦虚痞，腹膨胀痛，大便秘结，六脉虚弱，诸医服药无效。予投此药，不终
剂而愈。
《补遗》∶《局方》青木香丸、沉香降气汤、小乌沉汤、四磨汤皆可用。
〔薛〕左金丸 （一名四金丸） 治肝火胸胁胀痛，或发寒热，或头目作痛，或大便不实，
或小便淋秘，或小腹疼痛，及一切肝火之证。
黄连（炒，六两） 吴茱萸（一两，汤煮片时用）
上为末，粥丸，白术、陈皮汤下。
当归龙荟丸 治肝经实火，胸胁胀痛，或大便秘结，小便涩滞。凡属肝经实火，皆宜
用之。
当归 龙胆草（炒焦） 栀子仁（炒） 黄连（炒） 黄芩（炒，各一两） 大黄（炒）
芦荟 青黛（各五钱） 木香（二钱半） 麝香（另研，五分）
上为末，用神曲糊丸桐子大。每服二十丸，姜汤下。
补肝散 治肝肾二经气血亏损，胁胀作痛，或胁胀头晕，寒热发热，或遍身作痛，经
候不调。
山茱萸肉 当归 五味子（炒，杵） 山药 黄 （炒） 川芎 木瓜（各半两）
熟地黄（自制） 白术（炒，各一钱） 独活 酸枣仁（炒，各四两）
上为末，每服五钱，枣水煎服。
【大】妇女出现两胁胀痛的症状，是由于脏腑虚弱，气血不调，风冷之邪侵入肠胃，并伤及胞络之间，与气血相互搏结，导致壅滞寒凝、宣通不畅，邪气与正气交争冲击，从而引起两胁胀痛。
【薛】东垣先生曾说：胸胁疼痛，口苦舌干，寒热往来，恶心呕吐，四肢胀满闷塞，小便淋漓或排便困难，腹部拘急疼痛，这是肝木之气妄行所致。我认为上述症状若因暴怒伤血引起，可用小柴胡汤（Xiao Chai Hu Tang, Minor Decoction of Bupleurum）加川芎、当归、山栀；若属气虚，可用四物汤（Si Wu Tang, Four Substances Decoction）加人参、白术、柴胡、山栀；若因久怒伤气，可用六君子汤（Liu Jun Zi Tang, Six Gentlemen Decoction）加川芎、当归、山栀；若气血俱虚，可用六味地黄丸（Liu Wei Di Huang Wan, Six-Ingredient Rehmannia Pill）；若经期腹痛，伴有寒热或午后发热，或月经不调，发热伴痰咳，食欲减退嗜睡，身体疼痛，可用八珍汤（Ba Zhen Tang, Eight Treasures Decoction）加柴胡、丹皮；若胁部胀满发热，口渴唾痰，或小便淋漓不尽，颈项有结核肿块，或盗汗，便血，各种失血症，可用六味地黄丸；若两胁作胀，视物模糊，或筋脉拘挛紧急，面色发青，小腹痛，或小便不调，可用补肝散（Bu Gan San, Liver-Nourishing Powder）。如果一概使用香燥的药物，反而会损伤清和之气，导致血液无法化生，诸种病症由此产生。丹溪先生曾说：右胁痛可用推气散、小龙荟丸、当归龙荟丸、控涎丹、抑青丸、十枣汤，这些都是针对病气和元气都充实的实证所用的方剂，使用者需谨慎辨别。有一位女性性格急躁，吐血发热、两胁胀痛，下午加重，这是怒气伤肝，导致气血俱虚。早晨服用逍遥散（Xiao Yao San, Free and Easy Wanderer Powder），加倍加入炒黑山栀、黄柏、贝母、桔梗、麦门冬；晚上用归脾汤（Gui Pi Tang, Restore the Spleen Decoction）送服地黄丸而痊愈。又有一位寡妇内热、午后发热，肢体酸麻，不时吐痰，有人用清气化痰药，导致喉间不利，白带增多腹胀；有人用行气散血药，导致胸痛不利，肢体时常麻木。这是郁怒伤及肝脾，用药反而使病情加重。我则早晨用归脾汤以解除脾郁，生发脾气；晚上用加味逍遥散以清肝火，生养肝血，服用百余剂后痊愈。后来因生气，饮食日渐减少，肢体时常麻木，这是肝火侮犯脾土，用补中益气汤（Bu Zhong Yi Qi Tang, Tonify the Middle and Augment the Qi Decoction）加山栀、茯苓、半夏而痊愈。又因饮食失调，兼有怒气，肢体麻木严重，月经如注，脉象浮洪而数，这是脾受肝伤，不能统摄血液而导致崩漏，肝气亏损阴血而脉大，继用六君子汤加川芎、当归、炮姜而血崩止住，又用补中益气汤加炮姜、茯苓、半夏而元气恢复，再用归脾汤、逍遥散调理而康复。
灵宝散：治疗妇人血气攻刺，疼痛牵引至两胁。
丁香、木香、乳香、玄胡索、当归、白芍药（各等分）。
以上研为细末，每次服用二钱，饭前用温酒调服。
草豆蔻散：治疗妇人脾胃虚弱，气攻两胁胀痛。
草豆蔻、诃子肉（各一两）、桂心、苦梗、浓朴（各三分）、甘草（一分）、川芎、当归、干姜、槟榔（各半两）。
以上研为粗末，每次服用四钱，用水一盏，煎至七分，去渣，饭前热服。
[此处原文缺字，推测为“红蓝花”或类似活血药，依原文“子散”处理] 散：治疗妇人脏腑虚冷，宿冷气攻，两胁胀痛，坐卧不安。
[子]、延胡索、桃仁、琥珀、当归、桂心（各一两）、赤芍药、木香、没药（各半两）。
以上研为末，每次服用二钱，温酒调服。
人参紫金丸：治疗妇人营卫不和，心腹刺痛，胸膈胀满，不进饮食。
紫金皮、苍术、石菖蒲（各一两）、香附子（二两）、人参（半两）、木香（三钱）。
以上研为末，用米糊制成梧桐子大小的丸药。饭后用姜汤吞服三十丸。
气针丸：治疗久积风壅，疏利气滞，空胸膈，止刺痛。
木香、青皮（去白）、大黄（炮制）、槟榔（各一两）、黑牵牛（二两，半生半炒）。
以上研为末，炼蜜制成梧桐子大小的丸药，温水送服三十丸。
邓安人五十岁时，忽然气痛，服用神保丸后痊愈。不到一两天再次疼痛，又服用神保丸六七十粒，导致大便不通，疾病反而加重。也有需要用沉香、木香、姜、桂，以及芍药却不敢投用的情况。疼痛剧烈时，感觉像有东西撞击心脏、背部和两胁，好像有两根柴火十字交叉插定心胁，叫声震天。
召请我为其诊治，六脉沉伏，忽来忽去。众人问如何？我说：九痛的脉象不可作为唯一标准，应根据证候辨别用药。观察其人形体肥伟，询问其大便数日不通。我说：这是实痛，虽然不一定胀满，但按压时疼痛剧烈，手不可触碰，这是大实证。经书说：大满大实者可下之。于是用气针丸五六百粒，当晚即愈。又在己未年在金陵时，有家提干巽的内人患心胁胀痛，众医投用木香、沉香、槟榔、大腹、芍药、姜、桂之类，病情反而加重。召请我为其诊治，六脉弦紧而和缓，不像病脉，但在诊察时，两手如火烫，以此判断是实痛。众人问如何治疗？我说：凡是心腹刺痛，不可立即当作虚寒证治疗。有两个医生回答说：不是冷就是什么？热则生风，冷则生气，说的就是这个道理。我说：不对。《难经》说：虚则痒，实则痛。又说仲景云：腹痛者用桂枝加芍药汤，痛甚者，用桂枝加大黄汤。提干说：荆布素来体弱。我说：这里有可辨别之处，遇痛时让一婢女按压患处，若疼痛停止则是虚寒证；若按压后疼痛加剧，手不可靠近，这是实痛。随即令婢女按压，手不可靠近，病人叫呼异常。我说：这是实热证，无可怀疑。应当用大柴胡汤（Da Chai Hu Tang, Major Bupleurum Decoction）治疗。众人不听从，我让他们写下保证书后投药，服用八剂后痊愈。
论胁肋痛服木通散。（也可治疗男子。）
心下、胁肋、少腹疼痛，都是素有积寒，温暖汤散亦可主治，严重者用温药下之。心下与小腹痛，各书均有有效方剂，而胁肋下痛，很少见到治法。
木通散：治疗胁肋苦痛偏效，并治心下胁肋、少腹牵引痛者，皆主之。
木通（去皮节）、青皮（去白）、川楝子（去皮核，各一两。以上三味，用巴豆半两，炒黄，去巴豆不用）、萝卜子（炒）、舶上[沉香]（一两，炒）、莪术、木香、滑石（各半两）。
以上研为细末，煎葱白酒调服三钱，一服即愈。严重者不过再服。
三腕散：治疗中焦虚痞，两胁气痛，面目手足浮肿，大便秘涩，兼治香港脚（脚气）。
大腹皮、紫苏、沉香、干木瓜、独活（各一两）、白术、川芎、木香、甘草、陈皮、槟榔（各三分）。
以上切碎，每次服用三钱，用水一盏，煎至七分，去渣，空腹热服，中午再服一次。戊午年秋天在京城，有一位妇人，中焦虚痞，腹膨胀痛，大便秘结，六脉虚弱，诸医服药无效。我投以此药，未服完一剂即愈。
《补遗》：《局方》中的青木香丸、沉香降气汤、小乌沉汤、四磨汤皆可用。
【薛】左金丸（一名四金丸）：治疗肝火胸胁胀痛，或发寒热，或头目作痛，或大便不实，或小便淋秘，或小腹疼痛，及一切肝火之证。
黄连（炒，六两）、吴茱萸（一两，汤煮片时用）。
以上研为末，用粥做成丸药，用白术、陈皮汤送服。
当归龙荟丸：治疗肝经实火，胸胁胀痛，或大便秘结，小便涩滞。凡属肝经实火，皆宜用之。
当归、龙胆草（炒焦）、栀子仁（炒）、黄连（炒）、黄芩（炒，各一两）、大黄（炒）、芦荟、青黛（各五钱）、木香（二钱半）、麝香（另研，五分）。
以上研为末，用神曲糊制成梧桐子大小的丸药。每次服用二十丸，姜汤送服。
补肝散：治疗肝肾二经气血亏损，胁胀作痛，或胁胀头晕，寒热发热，或遍身作痛，经候不调。
山茱萸肉、当归、五味子（炒，杵）、山药、黄芪（炒）、川芎、木瓜（各半两）、熟地黄（自制）、白术（炒，各一钱）、独活、酸枣仁（炒，各四两）。
以上研为末，每次服用五钱，用枣水煎服。
[Da] When women experience distending pain in both hypochondria, it is caused by deficiency and weakness of the zang-fu organs, disharmony of qi and blood, and invasion of wind-cold pathogens into the intestines and stomach. The pathogenic factors affect the uterine collaterals, where they contend with qi and blood, leading to stagnation, cold accumulation, and failure of free flow. The struggle between evil and righteous qi causes impact and shock, resulting in distending pain in both hypochondria.
[Xue] Master Dongyuan stated: Pain in the chest and hypochondria, bitter taste in the mouth, dry tongue, alternating chills and fever, nausea and vomiting, fullness and oppression in the four limbs, dribbling urination or difficult defecation, and acute abdominal pain are due to the reckless movement of Liver Wood qi. I believe that if the aforementioned symptoms are caused by sudden anger injuring blood, Xiao Chai Hu Tang (Minor Decoction of Bupleurum) combined with Chuanxiong Rhizoma (Chuanxiong), Radix Angelicae Sinensis (Danggui), and Gardeniae Fructus (Shanzhi) should be used. If there is qi deficiency, Si Wu Tang (Four Substances Decoction) combined with Ginseng Radix et Rhizoma (Renshen), Atractylodis Macrocephalae Rhizoma (Baizhu), Bupleuri Radix (Chaihu), and Gardeniae Fructus (Shanzhi) should be used. If chronic anger injures qi, Liu Jun Zi Tang (Six Gentlemen Decoction) combined with Chuanxiong Rhizoma (Chuanxiong), Radix Angelicae Sinensis (Danggui), and Gardeniae Fructus (Shanzhi) should be used. If both qi and blood are deficient, Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) should be used. If there is abdominal pain during menstruation accompanied by chills/fever or afternoon fever, or irregular menstruation, fever with phlegm and cough, poor appetite, lethargy, and body pain, Ba Zhen Tang (Eight Treasures Decoction) combined with Bupleuri Radix (Chaihu) and Moutan Cortex (Danpi) should be used. If there is hypochondriac distension with fever, thirst with expectoration of phlegm, or dribbling urination, cervical lymphadenopathy, night sweats, hematochezia, and various bleeding disorders, Liu Wei Di Huang Wan should be used. If there is distension in both hypochondria, blurred vision, tendon spasm, greenish complexion, lower abdominal pain, or urinary dysfunction, Bu Gan San (Liver-Nourishing Powder) should be used. If aromatic and drying agents are indiscriminately used, they will damage the clear and harmonious qi, preventing blood generation and causing various syndromes. Master Danxi stated: For right-sided hypochondriac pain, Tui Qi San, Xiao Long Hui Wan, Dang Gui Long Hui Wan, Kong Xian Dan, Yi Qing Wan, and Shi Zao Tang may be used. These are formulas for conditions where both disease qi and healthy qi are excess; users must exercise caution. One woman with a quick temper experienced hematemesis, fever, and distending pain in both hypochondria, worsening in the late afternoon. This was due to anger injuring the Liver and causing deficiency of both qi and blood. In the morning, she took Xiao Yao San (Free and Easy Wanderer Powder) with added fried black Gardeniae Fructus (Shanzhi), Phellodendri Cortex (Huangbai), Fritillariae Bulbus (Beimu), Platycodonis Radix (Jiegeng), and Ophiopogonis Radix (Maidong); in the evening, she took Di Huang Wan (Rehmannia Pill) delivered by Gui Pi Tang (Restore the Spleen Decoction), and was cured. Another widow experienced internal heat, afternoon fever, soreness and numbness of the limbs, and frequent expectoration of phlegm. Some physicians used formulas to clear heat and transform phlegm, leading to throat discomfort, leukorrhea, and abdominal distension; others used formulas to move qi and dispel blood stasis, leading to chest pain and discomfort, and intermittent limb numbness. This was due to depression and anger injuring the Liver and Spleen, exacerbated by inappropriate medication. I treated her by using Gui Pi Tang (Restore the Spleen Decoction) in the morning to resolve Spleen depression and generate Spleen qi, and Jia Wei Xiao Yao San (Modified Free and Easy Wanderer Powder) in the evening to clear Liver fire and generate Liver blood. After more than one hundred doses, she was cured. Later, due to anger, her food intake decreased daily, and her limbs became intermittently numb. This was Liver fire insulting the Earth (Spleen). She was cured using Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) with added Gardeniae Fructus (Shanzhi), Poria (Fuling), and Pinelliae Rhizoma (Banxia). Again, due to dietary irregularity and anger, her limb numbness worsened, and menstruation flowed profusely. Her pulse was floating, surging, and rapid. This indicated that the Spleen was injured by the Liver and failed to control blood, leading to metrorrhagia. The Liver qi was deficient, and yin blood was depleted, resulting in a large pulse. Subsequently, Liu Jun Zi Tang (Six Gentlemen Decoction) with added Chuanxiong Rhizoma (Chuanxiong), Radix Angelicae Sinensis (Danggui), and Prepared Zingiberis Rhizoma (Paojiang) stopped the bleeding. Then, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) with added Prepared Zingiberis Rhizoma (Paojiang), Poria (Fuling), and Pinelliae Rhizoma (Banxia) restored the yuan qi. Finally, she was recovered through regulation with Gui Pi Tang (Restore the Spleen Decoction) and Xiao Yao San (Free and Easy Wanderer Powder).
Ling Bao San: Treats women with blood and qi attacking and stabbing, with pain radiating to both hypochondria.
Cardamomum (Dingxiang), Costus Root (Muxiang), Frankincense (Ruxiang), Corydalis Rhizoma (Yanhusuo), Radix Angelicae Sinensis (Danggui), White Peony Root (Baishaoyao) (equal parts).
Grind into fine powder. Take two qian each time, mixed with warm wine before meals.
Caodoukou San: Treats women with Spleen-Stomach deficiency, with qi attacking both hypochondria causing distending pain.
Areca Seed (Caodoukou), Chebula Fruit Flesh (Hezi Rou) (each 1 liang), Cinnamon Twig (Guixin), Platycodonis Radix (Kugeng), Magnolia Bark (Nongpu) (each 3 fen), Licorice Root (Gancao) (1 fen), Chuanxiong Rhizoma (Chuanxiong), Radix Angelicae Sinensis (Danggui), Dried Ginger (Ganjiang), Areca Nut (Binglang) (each 0.5 liang).
Grind into coarse powder. Take 4 qian each time, decocted in one sheng of water until reduced to 0.7 sheng. Strain and take hot before meals.
[Zi] San: Treats women with deficiency-cold of the zang-fu organs, with old cold qi attacking, causing distending pain in both hypochondria and restlessness in sitting and lying.
[Zi], Corydalis Rhizoma (Yanhusuo), Peach Kernel (Taoren), Amber (Hupo), Radix Angelicae Sinensis (Danggui), Cinnamon Twig (Guixin) (each 1 liang), Red Peony Root (Chishaoyao), Costus Root (Muxiang), Myrrh (Moyao) (each 0.5 liang).
Grind into powder. Take 2 qian each time, mixed with warm wine.
Ren Shen Zi Jin Wan: Treats women with disharmony of Ying and Wei, stabbing pain in the heart and abdomen, fullness and oppression in the chest and diaphragm, and loss of appetite.
Zijin Pi, Atractylodis Rhizoma (Cangzhu), Acori Tatarinowii Rhizoma (Shichangpu) (each 1 liang), Cyperi Rhizoma (Xiangfuzi) (2 liang), Ginseng Radix et Rhizoma (Renshen) (0.5 liang), Costus Root (Muxiang) (3 qian).
Grind into powder, make pills with rice paste the size of wutong seeds. Swallow 30 pills with ginger soup after meals.
Qi Zhen Wan: Treats long-standing accumulation of wind obstruction, unblocking qi stagnation, emptying the chest and diaphragm, and stopping stabbing pain.
Costus Root (Muxiang), Green Tangerine Peel (Qingpi) (remove white pith), Rhubarb (Dahuang) (processed), Areca Nut (Binglang) (each 1 liang), Black Morning Glory Seed (Heiqianniu) (2 liang, half raw, half fried).
Grind into powder, make pills with refined honey the size of wutong seeds. Take 30 pills with warm water.
Madam Deng, aged fifty, suddenly experienced qi pain and was cured by Shen Bao Wan. Within one or two days, the pain recurred. She took another 60-70 pills of Shen Bao Wan, resulting in constipation and worsening of the condition. There were cases where Chenxiang (Aquilaria Lignum), Muxiang (Costus Root), Jiang (Ginger), Guixin (Cinnamon Twig), and Shaoyao (Peony Root) were needed but not dared to be administered. The pain was severe, feeling like impacts on the heart, back, and both hypochondria, as if two pieces of firewood crossed and pinned the heart and hypochondria, with cries reaching the sky.
I was summoned to diagnose her. The six pulses were deep and hidden, appearing and disappearing intermittently. Everyone asked what to do. I said: The pulses of the nine pains are not reliable standards; treatment should be based on syndrome differentiation. Observing that she had a robust and plump physique, and asking about her bowel movements, I found she had not defecated for several days. I said: This is excess pain. Although there may not be distension, pressing causes severe pain and cannot be tolerated by touch, indicating a major excess syndrome. The Classics state: For major fullness and excess, purgatives can be used. Thus, I administered 500-600 pills of Qi Zhen Wan, and she was cured that evening. Later, in the year Jiwei in Jinling, the wife of a family official named Xun suffered from heart and hypochondriac distending pain. Various physicians administered Muxiang (Costus Root), Chenxiang (Aquilaria Lignum), Binglang (Areca Nut), Dafufu (Areca Peel), Shaoyao (Peony Root), Jiang (Ginger), and Guixin (Cinnamon Twig), which worsened the condition. I was summoned to diagnose her. The six pulses were wiry, tight, yet harmonious, unlike typical pathological pulses. However, during diagnosis, both hands felt hot like fire, indicating excess pain. Everyone asked how to treat it. I said: Generally, stabbing pain in the heart and abdomen should not be immediately treated as deficiency-cold. Two doctors replied: If it is not cold, what is it? Heat generates wind, and cold generates qi [stagnation]. I said: Not so. The Nan Jing states: Deficiency causes itching, excess causes pain. Also, Zhang Zhongjing stated: For abdominal pain, use Guizhi Jia Shaoyao Tang (Cinnamon Twig Decoction plus Peony Root); for severe pain, use Guizhi Jia Dahuang Tang (Cinnamon Twig Decoction plus Rhubarb). The official said: She has always been frail. I said: There is a way to distinguish. When the pain occurs, have a maid press the area. If the pain stops, it is deficiency-cold. If pressing increases the pain and makes it intolerable to touch, it is excess pain. I ordered the maid to press, and she could not tolerate it, crying out excessively. I said: This is clearly excess-heat. Da Chai Hu Tang (Major Bupleurum Decoction) should be used. The others did not agree. I had them sign a statement of responsibility and administered the formula. After eight doses, she was cured.
Discussion on Hypochondriac Pain and Administration of Mutong San (also effective for men):
Pain in the epigastrium, hypochondria, and lower abdomen is usually due to accumulated cold. Warm decoctions and powders can primarily treat this; for severe cases, warm purgatives should be used. Epigastric and lower abdominal pain have effective prescriptions in various books, but methods for treating hypochondriac pain are rare.
Mutong San: Highly effective for hypochondriac pain, and also treats pain in the epigastrium, hypochondria, and radiating lower abdomen.
Akebia Caulis (Mutong) (remove nodes), Green Tangerine Peel (Qingpi) (remove white pith), Toosendan Fructus (Chuanlianzi) (remove skin and seeds, each 1 liang. For these three ingredients, use 0.5 liang of Croton Seed (Badou), stir-fry until yellow, remove Badou), Rapeseed (Luobozhong) (fried), Agarwood (Bo Shang Xiang) (1 liang, fried), Curcuma Zedoaria (Ezhu), Costus Root (Muxiang), Talcum (Huashi) (each 0.5 liang).
Grind into fine powder. Mix with decocted scallion and white wine, take 3 qian. One dose cures. Severe cases require no more than two doses.
San Wan San: Treats middle jiao deficiency and痞 (fullness), qi pain in both hypochondria, edema of face, eyes, hands, and feet, constipation, and also treats Hongjiaojiao (Beriberi/Lower limb swelling).
Areca Peel (Dafupi), Perilla Leaf (Zisu), Aquilaria Lignum (Chenxiang), Dried Quince (Gan Mugua), Angelica Pubescens Root (Duhuo) (each 1 liang), Atractylodis Macrocephalae Rhizoma (Baizhu), Chuanxiong Rhizoma (Chuanxiong), Costus Root (Muxiang), Licorice Root (Gancao), Tangerine Peel (Chenpi), Areca Nut (Binglang) (each 3 fen).
Cut into small pieces. Take 3 qian each time, decoct in one sheng of water until reduced to 0.7 sheng. Strain and take hot on an empty stomach, and again at noon. In autumn of the year Wuwu in the capital, there was a woman with middle jiao deficiency and fullness, abdominal distension and pain, constipation, and weak six pulses. Various physicians' medications were ineffective. I administered this prescription, and she was cured before finishing one dose.
Supplement: Qingmuxiang Wan (Green Aromatic Musk Pill), Chenxiang Jiangqi Tang (Aquilaria Descending Qi Decoction), Xiao Wuchen Tang (Minor Dark Sink Decoction), and Simo Tang (Four Mortars Decoction) from Ju Fang can all be used.
[Xue] Zuo Jin Wan (also known as Si Jin Wan): Treats Liver fire causing chest and hypochondriac distending pain, or alternating chills and fever, headache and eye pain, loose stools, difficult urination, lower abdominal pain, and all syndromes of Liver fire.
Coptis Rhizome (Huanglian) (fried, 6 liang), Evodia Fruit (Wuzhuyu) (1 liang, boiled in water for slices).
Grind into powder, make pills with congee. Take with decoction of Atractylodis Macrocephalae Rhizoma (Baizhu) and Tangerine Peel (Chenpi).
Dang Gui Long Hui Wan: Treats excess fire of the Liver channel, chest and hypochondriac distending pain, or constipation, and scanty/difficult urination. Suitable for all excess fire of the Liver channel.
Radix Angelicae Sinensis (Danggui), Gentian Root (Longdancao) (fried until scorched), Gardeniae Fructus (Zhizi Ren) (fried), Coptis Rhizome (Huanglian) (fried), Scutellaria Root (Huangqin) (fried, each 1 liang), Rhubarb (Dahuang) (fried), Aloe (Lvhui), Indigo Naturalis (Qingdai) (each 5 qian), Costus Root (Muxiang) (2.5 qian), Moschus (Shexiang) (separately ground, 5 fen).
Grind into powder, make pills with Massae Fermentatae Medicinatae (Shenqu) paste the size of wutong seeds. Take 20 pills each time with ginger soup.
Bu Gan San: Treats deficiency of qi and blood in the Liver and Kidney channels, causing hypochondriac distension and pain, or dizziness with hypochondriac distension, chills/fever, generalized body pain, and irregular menstruation.
Cornus Fruit (Shanzhuyu Rou), Radix Angelicae Sinensis (Danggui), Schisandrae Fructus (Wuweizi) (fried, pounded), Dioscorea Rhizome (Shanyao), Astragalus Root (Huangqi) (fried), Chuanxiong Rhizoma (Chuanxiong), Chaenomelis Fructus (Mu Gua) (each 0.5 liang), Prepared Rehmannia Root (Shudihuang) (homemade), Atractylodis Macrocephalae Rhizoma (Baizhu) (fried, each 1 qian), Angelica Pubescens Root (Duhuo), Sour Jujube Seed (Suanzaoren) (fried, each 4 liang).
Grind into powder. Take 5 qian each time, decoct with water infused with dates.