胡 腹中雷鸣切痛，痛甚则胀及两腰，呕吐酸苦水。此水寒之气侮脾，乃中土阳气不足也。温而通之。
附子理中汤去草，加川椒、吴茱萸、水红花子。
又 脾脏虚寒，宿积痰水阻滞，腹中时痛，痛甚则呕。仿许学士法。
附子理中汤加当归、茯苓、吴茱萸、枳实、大黄。
渊按∶温下之法甚善，惜以后易辄耳。
又 腹痛，下午则胀，脉沉弦。此属虚寒挟积。前用温下，痛势稍减。今以温中化积。
川熟附 党参 干姜 花槟榔 茯苓 当归 青皮 陈皮 乌药
又 腹痛三年，时作时止，寒在中焦，当与温化无疑。然脉小弦滑，必有宿积。前用温下、温通两法，
病虽减而未定。据云
每交午月其痛倍甚，则兼湿热，故脉浮小而沉大，按之有力，此为阴中伏阳也。当利少阴之枢，温厥阴之气，
运太阴之滞，更参滑以去着法。
柴胡 白芍 枳实 甘草 吴茱萸 茯苓 木香 白术
另∶用黄鳝三段，取中七寸，炙脆，共研末，分三服。
渊按∶既知宿积，何不再进温下？三年之病，谅非久虚。脉浮小沉大，乃积伏下焦。盖痛则气聚于下，
故脉见沉大。此论似是而非。
又 腹痛，左脉弦，木克土也。仲景云∶腹痛脉弦者，小建中汤主之。若不止者，小柴胡汤。所以疏土
中之木也。余前用四逆散，即是此意。然三年腹痛，痛时得食稍安，究属中虚，而漉
漉有声，或兼水饮。今拟建中法加椒目，去其水饮，再观动静。
老桂木 白芍 干姜 炙甘草 党参 川椒目
渊按∶此寒而有积，为虚中实证，与建中甘温不合，故服之痛反上攻，以甘能满中，胃气转失顺下也。
又 用建中法，痛势上攻及胃脘，连于心下，左脉独弦滑，是肝邪乘胃也。姑拟疏肝。
金铃子 延胡索 吴茱萸 香附 高良姜 木香 白檀香
沈 肝胃气痛，发则呕吐酸水。治以温通。
二陈汤去草，加栝蒌皮、吴茱萸、白胡椒、当归、香附、川楝子。
时 脘痛不时发作，曾经吐蛔，兼见鼻血。女年二七，天癸未通。想由胃中有寒，肝家有火。
金铃子散加五灵脂、香附、干姜、川连、使君子肉、乌药、乌梅、茯苓。
又 肝胃不和，脘胁痛，得食乃安，中气虚。拟泄肝和胃。
二陈汤去草，加川连、六神曲、乌药、高良姜、香附、砂仁。
殷 呕而不食，病在胃也。食而腹痛，病在脾也。痛连胸胁，肝亦病矣。气弱血枯，病已深矣。和
胃养血，生津益气为治。
淡苁蓉 枸杞子 归身 火麻仁 大麦仁 茯苓 半夏 陈皮 沉香 砂仁
谭 脘痛欲呕，甚则防厥。
党参 陈皮 茯苓 川椒 吴茱萸 蔻仁 生姜
冯 脾胃阳衰，浊阴僭逆。每至下午腹左有块，上攻则心嘈，嘈则脘痛，黄昏乃止，大便常艰。
拟通胃阳而化浊阴，和养血液以悦脾气。
淡苁蓉 陈皮 吴茱萸 茯苓 柏子仁 郁李仁 沙苑子 乌梅 川椒 制半夏
又 脘痛呕酸，腹中亦痛。非用辛温，何能散寒蠲饮。
二陈汤去草，加淡苁蓉、当归、干姜、吴茱萸、乌药、砂仁。
又 温肾通阳以散沉寒之气。久服腹痛自已。
前方去当归，加川熟附、葫芦巴。
顾 当脐硬痛，不食不便，外似恶寒，里无大热，渴不多饮。寒食风热互结于脾胃中，用《局方》
五积散合通圣散，分头解治。
五积合通圣，共为末。朝暮各用开水调服三钱。
又 用五积合通圣温通散寒，便通而痛未止。脉迟，喜食甜味，痛在当脐，后连及腰，身常懔懔恶寒。
此中虚阳弱，寒积内停。拟通阳以破其沉寒，益火以消其阴翳。
四君去草，加肉桂、制附子、木香、元明粉、乌药、苁蓉。
又 温脏散寒，腹痛已止。今当温补。
淡苁蓉 杞子 熟地 当归 茯苓 陈皮 吴茱萸 制附子 乌药 砂仁
渊按∶尚嫌腻滞。仍从四君加减为妙。
袁 三四年来腹痛常发，发则极甚，必数日而平。此脾脏有寒积，肝经有湿热，故痛则腹中觉热。拟温脾兼以凉肝。
金铃子散加陈皮、茯苓、干姜、白术、川朴、白芍、神曲、砂仁。
又 腹中寒积错杂而痛，古今越桃散最妙，变散为丸可耳。
淡吴萸 干姜 黑山栀 白芍 炙甘草。
神曲末一两，煮糊为丸。每朝服三钱，开水送下。
夫越桃散惟姜、栀二味。吴萸、白芍者，复以戊己法。加甘草取其调和也。
某 中气不足，溲便为之变。腹中结瘕，亦气之不运也。
二陈汤去草，加白术、沙苑子、焦神曲、苡仁、泽泻、砂仁、通草。
又 肝胃不和，脘腹作痛，呕吐酸水痰涎，经来则腹痛。先与泄肝和胃。
川连 半夏 陈皮 茯苓 栝蒌皮 薤白头 干姜 蔻仁 猩绛 旋复花
又 腹中久有癖块，今因冷食伤中，腹痛泄泻，呕吐不止，心中觉热。拟苦辛通降，先止其呕。
二陈汤去草，加黄芩、川连、川朴、苏梗、藿梗、蔻仁、泽泻。改方加神曲。
某 自咸丰四年秋季，饱食睡卧起病，今已五载。过投消积破气之药，中气伤戕。脘间窒痛，得食则安，
不能嗳气，亦不易转矢气，脉迟弦。肝胃不和，阳虚寒聚于中。拟通阳泄木法。
苓桂术甘汤加陈皮、白芍、吴茱萸、干姜、大枣。
又 胸背相引而痛，症属胸痹。
二陈汤去草，加栝蒌仁、制附子、桂枝、干姜、吴茱萸、蔻仁、竹茹。
孙 中虚土不制水，下焦阴气上逆于胃。胃脘作痛，呕吐清水，得食则痛缓。拟温中固下，佐以镇逆。
四君子汤去草，加干姜、乌药、白芍、熟地、紫石英、代赭石、橘饼。
渊按∶土虚水盛，用熟地未合。若欲扶土，不去草可也。
秦 悬饮居于胁下，疼痛，呕吐清水。用仲景法。
芫花 大戟 甘遂 白芥子 吴茱萸（各三钱） 大枣（二十枚）
将河水两大碗，上药五味，煎至浓汁一大碗，去滓，然后入大枣煮烂，候干。每日清晨食枣二枚。
渊按∶此十枣汤变法也。以吴萸易葶苈，颇有心思。
某 寒气凝聚，少腹结瘕，时或上攻作痛。法以温通。
小茴香 吴茱萸 木香 青皮 乌药 延胡索 三棱 砂仁 香附
钱 脉微细，阴之象也。少腹有块，上攻及脘，自脘至嗌一条气塞，发作则块攻大痛欲厥，头汗如雨。
用方大法，温通无疑。惟舌黄腻浊苔，便泄臭秽，必兼湿热；而块痛得按稍减，又属虚象。
金铃子散加人参、乌梅、乌药、泽泻、补故纸、吴茱萸、木香、肉桂、枸杞子、五味子、茯苓、肉果。
又 水饮痰涎与下焦浊阴之气，盘踞于中。中脘腹胁有块，攻撑作痛，痛甚发厥。昨用温通，痛势稍减。
但脉仍微细，泄仍臭秽，谷食厌纳，中气大虚，阴气凝结，当脐硬痛，恐属脏结。攻之不可，补之亦难，仍为棘手。
前方去人参、五味、乌药、故纸、肉果，加白芍、干姜、萱
花、橘饼。
某 腹中有寒，疼痛不止，法当温通。
金铃子散加干姜、吴茱萸、当归、枸杞子、官桂、木香、乌药、紫石英。
张 寒气稽留，气机不利。胸背引痛，脘胁气攻有块。宜辛温通达。
二陈汤去草，加栝蒌皮、薤白头、干姜、吴茱萸、延胡索、九香虫。
某 肝胃不和，腰胁胸背相引而痛。舌光无苔，营阴内亏。大便溏薄，脾气亦弱，并无呕吐痰涎酸水等
症。宜辛温通阳，酸甘化阴。
陈皮 茯苓 苏梗 吴茱萸 沙苑子 枸杞子 薤白头 白芍 橘饼
渊按∶脾肾虚寒宜甘温，营阴内虚宜柔缓，故不用姜、附刚燥之药。
某 饮停中脘，脘腹鸣响，攻撑作痛。大便坚结如栗，但能嗳气而无矢气，是胃失下行而气但上逆也。
和胃降逆，逐水蠲饮治之。
二陈汤去草，加代赭石、旋复花、神曲、干姜、白芍、川椒、甘遂、泽泻。
某 丹田有寒，胸中有热，中焦不运，湿甚生虫。与黄连汤。
川连 肉桂 吴茱萸 干姜 砂仁 使君子 半夏 青皮 乌药 花槟榔
又 虫痛，面黄吐涎。拟苦辛法。
川连 桂枝 川椒 蔻仁 乌梅 芜荑 焦六曲 香附 合金铃子散
张 脘痛两载，近发更勤。得温稍松，过劳则甚。块居中脘，患处皮冷，法以温通。
二陈汤去草，加炮姜、吴茱萸、木香、川朴、归身、神曲、泽泻、生熟谷芽。
又 腹痛有块，肝脾不和，食少面黄。治以疏和。
丹参 白芍 怀山药 茯苓 茯神 冬术 神曲 香附 砂仁
仁渊曰∶脘痛属胃，腹痛属脾。吞酸呕苦，俗名肝气，乃积饮病也。或得之喜餐生冷，或忧思郁结。夫肝
胆属木而喜升达，寄根于土。今脾胃为生冷忧思伤其阳和之气，布化转运失职，肝
胆无温润升达之机，郁久而肆其横逆，侮其所胜，脾胃受克，气机与痰饮凝滞于中脘，故作痛耳。其吞酸呕苦
者，脾寒不化，胃中之水饮停积，如食物置器中不动，其味变焉。稼穑味甘，今胃
不能化，木乘其胜，而齐木之味，化而为酸，齐胆火之味，化而为苦。木气冲逆，泛呕不已，久久积饮成囊，
亦生癖块。由餐凉而起者，尚可治；由七情而起者，每成噎膈。盖忧思既久，中阳
受伤，呕多胃汁槁枯，始则阳气伤，继则阴津竭，营卫少生化之源，胃管干瘪，肠液不充矣。徒恃医药无益，
须怡神静养。治法喻氏进退黄连汤，最有深意，辛以化胃，苦以降逆，所谓能变胃而不受胃变也。罗谦甫治中
汤亦合，用金以制木。若南阳之栝蒌薤白等，或辛或苦，或通或润，皆可用，务在通中焦阳气，使脾
胃之阴凝开，肝木之郁结达，其痛自已。若腹痛须分部位，当脐太阴，脐旁少阴，少腹厥阴。尤宜辨寒热虚
实，大抵寒多热少，虚多实少，热者多实，虚者多寒。《内经·举痛论》∶寒者八九，热者一二，须从脉证
细辨焉。湿郁之年，亦多是证，亦脾胃为寒湿所郁，阳气不得宣化耳。
胡某：腹中肠鸣如雷，剧烈疼痛，痛势严重时胀气波及两侧腰部，呕吐酸苦水。这是水寒之气侵犯脾脏，属于中焦脾胃阳气不足。治疗宜温补并通阳散寒。
附子理中汤去掉甘草，加川椒、吴茱萸、水红花子。
又诊：脾脏虚寒，宿积的痰湿水饮阻滞气机，腹部时常疼痛，痛甚则呕吐。仿照许学士的方法治疗。
附子理中汤加当归、茯苓、吴茱萸、枳实、大黄。
渊按：温下法（温里攻下）非常好，可惜后来医生轻易改变了治法。
又诊：腹痛，下午时腹胀加重，脉象沉弦。这属于虚寒夹杂积滞。之前用温下法，痛势稍减。现在改用温中化积法。
川熟附子 党参 干姜 花槟榔 茯苓 当归 青皮 陈皮 乌药
又诊：腹痛三年，时发时止，寒邪在中焦，应当用温化法无疑。然而脉象小弦滑，必然有宿积存在。之前用温下、温通两种方法，病虽减轻但未稳定。据患者说，每逢农历五月疼痛加倍严重，这说明兼夹湿热，所以脉象浮小而沉取有力，此为阴证中伏藏阳气。治疗当疏利少阴枢机，温养厥阴之气，运化太阴之滞涩，再参考“滑以去着”（用滑利药物去除胶结之邪）的方法。
柴胡 白芍 枳实 甘草 吴茱萸 茯苓 木香 白术
另法：取黄鳝三段，取中间七寸部分，烤脆后研成粉末，分三次服用。
渊按：既然知道有宿积，为何不再进用温下法？三年的病，想必不是单纯的久虚。脉象浮小沉大，乃是积滞伏于下焦。因为疼痛时气聚于下，所以脉见沉大。这种论述看似有理实则错误。
又诊：腹痛，左脉弦，是肝木克伐脾土的表现。张仲景说：腹痛脉弦者，用小建中汤主治。如果无效，用小柴胡汤。这是为了疏解土中的木郁。我之前用四逆散，就是此意。然而三年腹痛，发作时进食后稍安，终究属于中焦虚损，且肠鸣漉漉有声，可能兼有水饮。现在建议采用建中法加椒目，以祛除水饮，再观察病情变化。
老桂木 白芍 干姜 炙甘草 党参 川椒目
渊按：此证为寒而有积，属虚中实证，与建中汤甘温补益之法不合，所以服药后疼痛反而上攻，因为甘味药能壅滞中焦，导致胃气不能顺降。
又诊：使用建中法后，痛势上攻至胃脘，连及心下，唯独左脉弦滑，这是肝邪乘袭胃腑。暂拟疏肝法。
金铃子 延胡索 吴茱萸 香附 高良姜 木香 白檀香
沈某：肝胃气痛，发作时呕吐酸水。治疗以温通为主。
二陈汤去掉甘草，加栝蒌皮、吴茱萸、白胡椒、当归、香附、川楝子。
时某：胃脘痛不时发作，曾经吐蛔虫，兼见鼻出血。女子十四岁，月经尚未通畅。推测是由胃中有寒，肝家有火所致。
金铃子散加五灵脂、香附、干姜、川黄连、使君子肉、乌药、乌梅、茯苓。
又诊：肝胃不和，胃脘及胁肋疼痛，进食后缓解，中气虚弱。拟泄肝和胃法。
二陈汤去掉甘草，加川黄连、六神曲、乌药、高良姜、香附、砂仁。
殷某：呕吐但不进食，病在胃。进食后腹痛，病在脾。疼痛牵连胸胁，肝也病了。气弱血枯，病已深入。治疗以和胃养血、生津益气为主。
淡苁蓉 枸杞子 归身 火麻仁 大麦仁 茯苓 半夏 陈皮 沉香 砂仁
谭某：胃脘痛欲呕，严重时防止出现四肢厥冷。
党参 陈皮 茯苓 川椒 吴茱萸 蔻仁 生姜
冯某：脾胃阳气衰微，浊阴之气僭越逆行。每到下午左侧腹部有块状物，上攻则心中嘈杂，嘈杂则胃脘痛，黄昏时才停止，大便常艰涩难行。
拟通胃阳而化浊阴，和养血液以悦脾气。
淡苁蓉 陈皮 吴茱萸 茯苓 柏子仁 郁李仁 沙苑子 乌梅 川椒 制半夏
又诊：胃脘痛呕吐酸水，腹部也痛。不用辛温药，怎能散寒蠲饮？
二陈汤去掉甘草，加淡苁蓉、当归、干姜、吴茱萸、乌药、砂仁。
又诊：温肾通阳以散沉寒之气。久服后腹痛自然痊愈。
前方去掉当归，加川熟附子、葫芦巴。
顾某：肚脐周围硬痛，不进食不便秘，外表似恶寒，体内无大热，口渴但饮水不多。寒食风热互结于脾胃中，用《局方》五积散合通圣散，分头解表治里。
五积合通圣，共为末。早晚各用开水调服三钱。
又诊：用五积合通圣温通散寒，大便通了但疼痛未止。脉迟，喜食甜味，痛在肚脐，向后连及腰部，身体常常凛凛恶寒。这是中焦虚阳弱，寒积内停。拟通阳以破其沉寒，益火以消其阴翳。
四君子汤去掉甘草，加肉桂、制附子、木香、元明粉、乌药、苁蓉。
又诊：温脏散寒，腹痛已止。现在应当温补。
淡苁蓉 杞子 熟地 当归 茯苓 陈皮 吴茱萸 制附子 乌药 砂仁
袁某：三四年来腹痛常发，发作时极剧，必须数日才能平息。这是脾脏有寒积，肝经有湿热，所以痛时腹中觉热。拟温脾兼以凉肝。
金铃子散加陈皮、茯苓、干姜、白术、川朴、白芍、神曲、砂仁。
又诊：腹中寒积错杂而痛，古今越桃散最妙，将散剂改为丸剂即可。
淡吴茱萸 干姜 黑山栀 白芍 炙甘草。
神曲末一两，煮糊为丸。每晨服三钱，开水送下。
越桃散只有姜、栀两味。加吴茱萸、白芍，是复用戊己法。加甘草取其调和之意。
某：中气不足，大小便为之改变。腹中结瘕，也是气机不运所致。
二陈汤去掉甘草，加白术、沙苑子、焦神曲、薏苡仁、泽泻、砂仁、通草。
又诊：肝胃不和，脘腹作痛，呕吐酸水痰涎，经期则腹痛。先予泄肝和胃。
川黄连 半夏 陈皮 茯苓 栝蒌皮 薤白头 干姜 蔻仁 猩绛 旋复花
又诊：腹中久有癖块，今因冷食伤中，腹痛泄泻，呕吐不止，心中觉热。拟苦辛通降法，先止其呕吐。
二陈汤去掉甘草，加黄芩、川黄连、川朴、苏梗、藿梗、蔻仁、泽泻。改方加神曲。
某：自咸丰四年秋季，饱食睡卧起病，至今五年。过投消积破气之药，中气受伤戕害。脘间窒塞疼痛，得食则安，不能嗳气，也不易转矢气，脉迟弦。肝胃不和，阳虚寒聚于中。拟通阳泄木法。
苓桂术甘汤加陈皮、白芍、吴茱萸、干姜、大枣。
又诊：胸背相互牵引而痛，症属胸痹。
二陈汤去掉甘草，加栝蒌仁、制附子、桂枝、干姜、吴茱萸、蔻仁、竹茹。
孙某：中虚土不制水，下焦阴气上逆于胃。胃脘作痛，呕吐清水，得食则痛缓。拟温中固下，佐以镇逆。
四君子汤去掉甘草，加干姜、乌药、白芍、熟地、紫石英、代赭石、橘饼。
秦某：悬饮居于胁下，疼痛，呕吐清水。用张仲景法。
芫花 大戟 甘遂 白芥子 吴茱萸（各三钱） 大枣（二十枚）
将河水两大碗，上药五味，煎至浓汁一大碗，去滓，然后入大枣煮烂，候干。每日清晨食枣二枚。
某：寒气凝聚，少腹结瘕，时而上攻作痛。治法以温通为主。
小茴香 吴茱萸 木香 青皮 乌药 延胡索 三棱 砂仁 香附
钱某：脉微细，是阴证的象。少腹有块，上攻至胃脘，自胃脘至咽喉一条气塞，发作时块攻大痛欲厥，头汗如雨。
用方大法，温通无疑。惟舌苔黄腻浊，便泄臭秽，必兼湿热；而块痛得按稍减，又属虚象。
金铃子散加人参、乌梅、乌药、泽泻、补故纸（补骨脂）、吴茱萸、木香、肉桂、枸杞子、五味子、茯苓、肉果。
又诊：水饮痰涎与下焦浊阴之气，盘踞于中。中脘腹胁有块，攻撑作痛，痛甚发厥。昨天用温通法，痛势稍减。
但脉仍微细，泄仍臭秽，谷食厌纳，中气大虚，阴气凝结，当脐硬痛，恐属脏结。攻之不可，补之亦难，仍为棘手。
前方去人参、五味、乌药、故纸、肉果，加白芍、干姜、萱花、橘饼。
某：腹中有寒，疼痛不止，治法当温通。
金铃子散加干姜、吴茱萸、当归、枸杞子、官桂、木香、乌药、紫石英。
张某：寒气稽留，气机不利。胸背引痛，脘胁气攻有块。宜辛温通达。
二陈汤去掉甘草，加栝蒌皮、薤白头、干姜、吴茱萸、延胡索、九香虫。
某：肝胃不和，腰胁胸背相引而痛。舌光无苔，营阴内亏。大便溏薄，脾气亦弱，并无呕吐痰涎酸水等症。宜辛温通阳，酸甘化阴。
陈皮 茯苓 苏梗 吴茱萸 沙苑子 枸杞子 薤白头 白芍 橘饼
渊按：脾肾虚寒宜甘温，营阴内虚宜柔缓，故不用姜、附刚燥之药。
某：饮停中脘，脘腹鸣响，攻撑作痛。大便坚结如栗，但能嗳气而无矢气，是胃失下行而气但上逆也。
和胃降逆，逐水蠲饮治之。
二陈汤去掉甘草，加代赭石、旋复花、神曲、干姜、白芍、川椒、甘遂、泽泻。
某：丹田有寒，胸中有热，中焦不运，湿甚生虫。给予黄连汤。
川黄连 肉桂 吴茱萸 干姜 砂仁 使君子 半夏 青皮 乌药 花槟榔
又诊：虫痛，面黄吐涎。拟苦辛法。
川黄连 桂枝 川椒 蔻仁 乌梅 芜荑 焦六曲 香附 合金铃子散
张某：胃脘痛两年，近期发作更频繁。得温稍松，过劳则甚。块居中脘，患处皮冷，治法以温通为主。
二陈汤去掉甘草，加炮姜、吴茱萸、木香、川朴、归身、神曲、泽泻、生熟谷芽。
又诊：腹痛有块，肝脾不和，食少面黄。治以疏和。
丹参 白芍 怀山药 茯苓 茯神 冬术 神曲 香附 砂仁
仁渊曰：脘痛属胃，腹痛属脾。吞酸呕苦，俗名肝气，乃积饮病也。或得之喜餐生冷，或忧思郁结。夫肝胆属木而喜升达，寄根于土。今脾胃为生冷忧思伤其阳和之气，布化转运失职，肝胆无温润升达之机，郁久而肆其横逆，侮其所胜，脾胃受克，气机与痰饮凝滞于中脘，故作痛耳。其吞酸呕苦者，脾寒不化，胃中之水饮停积，如食物置器中不动，其味变焉。稼穑味甘，今胃不能化，木乘其胜，而齐木之味，化而为酸，齐胆火之味，化而为苦。木气冲逆，泛呕不已，久久积饮成囊，亦生癖块。由餐凉而起者，尚可治；由七情而起者，每成噎膈。盖忧思既久，中阳受伤，呕多胃汁槁枯，始则阳气伤，继则阴津竭，营卫少生化之源，胃管干瘪，肠液不充矣。徒恃医药无益，须怡神静养。治法喻氏进退黄连汤，最有深意，辛以化胃，苦以降逆，所谓能变胃而不受胃变也。罗谦甫治中汤亦合，用金以制木。若南阳之栝蒌薤白等，或辛或苦，或通或润，皆可用，务在通中焦阳气，使脾胃之阴凝开，肝木之郁结达，其痛自已。若腹痛须分部位，当脐太阴，脐旁少阴，少腹厥阴。尤宜辨寒热虚实，大抵寒多热少，虚多实少，热者多实，虚者多寒。《内经·举痛论》∶寒者八九，热者一二，须从脉证细辨焉。湿郁之年，亦多是证，亦脾胃为寒湿所郁，阳气不得宣化耳。
Mr. Hu: Borborygmus (intestinal rumbling) in the abdomen with severe cutting pain; when the pain is severe, distension spreads to both flanks of the waist, accompanied by vomiting of sour and bitter fluids. This is due to cold-dampness invading the Spleen, indicating a deficiency of Yang Qi in the Middle Jiao (Middle Burner). Treatment should involve warming and unblocking.
Fuzi Lizhong Tang (Aconite Decoction for Regulating the Middle) minus Licorice Root, plus Sichuan Pepper, Evodia Fruit, and Red Flower Buckwheat Seed.
Re-examination: Deficiency-cold of the Spleen organ, with accumulated phlegm-fluids obstructing the mechanism. Abdominal pain occurs intermittently; severe pain leads to vomiting. Following the method of Scholar Xu.
Fuzi Lizhong Tang (Aconite Decoction for Regulating the Middle) plus Angelica Sinensis Root, Poria, Evodia Fruit, Immature Bitter Orange, and Rhubarb.
Note by Yuan: The method of warming and purging is excellent; it is a pity that subsequent physicians changed the treatment arbitrarily.
Re-examination: Abdominal pain, with distension worsening in the afternoon; pulse is deep and wiry. This belongs to deficiency-cold complicated by accumulation. Previously used warming and purging, which slightly reduced the pain. Now using warming the middle and resolving accumulation.
Prepared Aconite Root, Codonopsis Root, Dried Ginger, Betel Nut, Poria, Angelica Sinensis Root, Green Tangerine Peel, Aged Tangerine Peel, Lindera Root.
Re-examination: Abdominal pain for three years, intermittent, with cold in the Middle Jiao; warming and transforming is undoubtedly correct. However, the pulse is small, wiry, and slippery, indicating the presence of accumulated pathogens. Previous use of warming-purging and warming-unblocking methods reduced the illness but did not stabilize it. The patient reports that pain doubles during the fifth lunar month, suggesting concurrent damp-heat. Thus, the pulse is floating and small on the surface but forceful when pressed deeply, indicating hidden Yang within Yin. Treatment should regulate the pivot of Shaoyin, warm the Qi of Jueyin, move the stagnation of Taiyin, and refer to the method of "slippery substances to remove adherence."
Bupleurum Root, White Peony Root, Immature Bitter Orange, Licorice Root, Evodia Fruit, Poria, Costus Root, Atractylodes Macrocephala Rhizome.
Separately: Take three segments of eel, use the central seven inches, roast until crisp, grind into powder, divide into three doses.
Note by Yuan: Since accumulated pathogens are known, why not continue with warming-purging? A three-year illness is likely not merely chronic deficiency. A floating-small and deep-forceful pulse indicates accumulation hidden in the Lower Jiao. Pain causes Qi to gather below, hence the deep-forceful pulse. This argument is plausible but incorrect.
Re-examination: Abdominal pain, left pulse is wiry, indicating Liver Wood overacting on Spleen Earth. Zhang Zhongjing stated: For abdominal pain with a wiry pulse, Xiaojianzhong Tang (Minor Construct the Middle Decoction) is indicated. If ineffective, Xiaochaihu Tang (Minor Bupleurum Decoction) is used to vent the Wood within the Earth. My previous use of Sixian San (Four Reversal Powder) followed this intent. However, three years of abdominal pain, relieved somewhat by eating, ultimately points to Middle Jiao deficiency, with borborygmus suggesting concurrent fluid retention. I propose constructing the Middle method with added Pepper Eye to drain fluids, then observe.
Old Cinnamon Twig, White Peony Root, Dried Ginger, Honey-fried Licorice Root, Codonopsis Root, Pepper Eye.
Note by Yuan: This condition involves cold with accumulation, constituting a deficiency-excess syndrome, which does not match the sweet-warm tonification of Jianzhong Tang. Hence, after taking it, pain attacks upward because sweet substances can cause fullness in the middle, causing Stomach Qi to fail to descend smoothly.
Re-examination: After using Jianzhong method, pain attacked upward to the epigastrium and heart region; only the left pulse was wiry and slippery, indicating Liver pathogen attacking the Stomach. Tentatively prescribing liver-soothing method.
Golden Bell Fruit, Corydalis Rhizome, Evodia Fruit, Cyperus Rhizome, Galangal Root, Costus Root, Sandalwood.
Mr. Shen: Liver-Stomach Qi pain, vomiting sour water upon attack. Treat with warming and unblocking.
Erchen Tang (Two-Aged Decoction) minus Licorice Root, plus Trichosanthes Peel, Evodia Fruit, White Pepper, Angelica Sinensis Root, Cyperus Rhizome, and Chinaberry Seed.
Ms. Shi: Epigastric pain occurring intermittently, history of vomiting roundworms, accompanied by epistaxis. Female, fourteen years old, menstruation has not yet commenced. Likely due to cold in the Stomach and fire in the Liver.
Jinlingzi San (Golden Bell Powder) plus Trogopterus Dung, Cyperus Rhizome, Dried Ginger, Coptis Rhizome, Quisqualis Fruit Flesh, Lindera Root, Mume Fruit, and Poria.
Re-examination: Liver-Stomach disharmony, epigastric and hypochondriac pain, relieved by eating, indicating Middle Qi deficiency. Prescribing draining Liver and harmonizing Stomach method.
Erchen Tang (Two-Aged Decoction) minus Licorice Root, plus Coptis Rhizome, Medicated Leaven, Lindera Root, Galangal Root, Cyperus Rhizome, and Amomum Fruit.
Mr. Yin: Vomiting without desire to eat, pathology in the Stomach. Eating causes abdominal pain, pathology in the Spleen. Pain radiating to chest and hypochondrium indicates Liver involvement. Qi is weak, Blood is dry, disease is deep. Treatment focuses on harmonizing Stomach, nourishing Blood, generating fluids, and boosting Qi.
Cistanche Stem, Goji Berry, Angelica Sinensis Root, Hemp Seed, Barley Grain, Poria, Pinellia Tuber, Aged Tangerine Peel, Agarwood, Amomum Fruit.
Mr. Tan: Epigastric pain with nausea, severe cases risking cold limbs.
Codonopsis Root, Aged Tangerine Peel, Poria, Sichuan Pepper, Evodia Fruit, Cardamom Seed, Fresh Ginger.
Mr. Feng: Decline of Spleen-Stomach Yang, turbid Yin rising rebelliously. Every afternoon, a mass appears on the left side of the abdomen; when it rises, there is cardiac discomfort (heartburn), leading to epigastric pain, stopping at dusk. Stool is often difficult.
Prescribing to unblock Stomach Yang and transform turbid Yin, harmonize and nourish Blood to please Spleen Qi.
Cistanche Stem, Aged Tangerine Peel, Evodia Fruit, Poria, Biota Seed, Prunus Seed, Astragalus Complanatus Seed, Mume Fruit, Sichuan Pepper, Processed Pinellia Tuber.
Re-examination: Epigastric pain with vomiting acid, abdominal pain as well. Without acrid-warm herbs, how can cold be dispersed and fluids eliminated?
Erchen Tang (Two-Aged Decoction) minus Licorice Root, plus Cistanche Stem, Angelica Sinensis Root, Dried Ginger, Evodia Fruit, Lindera Root, and Amomum Fruit.
Re-examination: Warm Kidney and unblock Yang to disperse lingering cold. Long-term use will naturally resolve abdominal pain.
Previous formula minus Angelica Sinensis Root, plus Prepared Aconite Root and Fenugreek Seed.
Mr. Gu: Hard and painful tenderness around the umbilicus, inability to eat or pass stool, external appearance of aversion to cold, internal absence of significant heat, thirst with little desire to drink. Cold food, wind, and heat mutually knot in the Spleen-Stomach. Use Wuji San (Five Accumulations Powder) from Ju Fang combined with Tongsheng San, treating exterior and interior separately.
Wuji combined with Tongsheng, ground into powder. Mix three qian with boiled water for morning and evening doses.
Re-examination: Used Wuji combined with Tongsheng for warming, unblocking, and dispersing cold. Stool passed but pain persisted. Pulse is slow, preference for sweet taste, pain at umbilicus radiating to lower back, constant shivering aversion to cold. This indicates Middle deficiency and weak Yang, with cold accumulation internally. Prescribing unblocking Yang to break lingering cold, benefiting Fire to dissipate Yin shadows.
Sijunzi Tang (Four Gentlemen Decoction) minus Licorice Root, plus Cinnamon Bark, Processed Aconite Root, Aucklandia Root, Mirabilite, Lindera Root, and Cistanche Stem.
Re-examination: Warming viscera and dispersing cold, abdominal pain has stopped. Now should tonify with warmth.
Cistanche Stem, Goji Berry, Prepared Rehmannia Root, Angelica Sinensis Root, Poria, Aged Tangerine Peel, Evodia Fruit, Processed Aconite Root, Lindera Root, Amomum Fruit.
Note by Yuan: Still feels cloying and stagnant. It would be better to modify Sijunzi Tang.
Mr. Yuan: Abdominal pain frequently occurring for three to four years, extremely severe upon attack, taking several days to subside. This is cold accumulation in the Spleen organ and damp-heat in the Liver meridian, hence feeling heat in the abdomen during pain. Prescribing warming Spleen while cooling Liver.
Jinlingzi San (Golden Bell Powder) plus Aged Tangerine Peel, Poria, Dried Ginger, Atractylodes Macrocephala Rhizome, Magnolia Bark, White Peony Root, Medicated Leaven, and Amomum Fruit.
Re-examination: Abdominal pain due to mixed cold accumulation; Yue Tao San (Persimmon Calyx Powder) is best throughout ancient and modern times. Change powder to pill form.
Mild Evodia Fruit, Dried Ginger, Gardenia Fruit, White Peony Root, Honey-fried Licorice Root.
One liang of Medicated Leaven powder, cooked into paste to form pills. Take three qian every morning with boiled water.
Yue Tao San consists only of Ginger and Gardenia. Adding Evodia and White Peony repeats the Wuji method. Adding Licorice aims at harmonization.
Unknown Patient: Insufficiency of Middle Qi leads to changes in urination and defecation. Abdominal masses (jia) are also due to failure of Qi movement.
Erchen Tang (Two-Aged Decoction) minus Licorice Root, plus Atractylodes Macrocephala Rhizome, Astragalus Complanatus Seed, Charred Medicated Leaven, Coix Seed, Alisma Rhizome, Amomum Fruit, and Tongcao.
Re-examination: Liver-Stomach disharmony, epigastric and abdominal pain, vomiting sour water and phlegm, abdominal pain during menstruation. First, drain Liver and harmonize Stomach.
Coptis Rhizome, Pinellia Tuber, Aged Tangerine Peel, Poria, Trichosanthes Peel, Allium Macrostemon Bulb, Dried Ginger, Cardamom Seed, Crimson Silk, Inula Flower.
Re-examination: Long-standing abdominal masses, now aggravated by cold food injuring the Middle, causing abdominal pain, diarrhea, and incessant vomiting, with sensation of heat in the heart. Prescribing bitter-acrid descending method to stop vomiting first.
Erchen Tang (Two-Aged Decoction) minus Licorice Root, plus Scutellaria Root, Coptis Rhizome, Magnolia Bark, Perilla Stem, Agastache Stem, Cardamom Seed, and Alisma Rhizome. Modified formula adds Medicated Leaven.
Unknown Patient: Illness began in autumn of the 4th year of Xianfeng era after overeating and lying down, lasting five years. Overuse of resolving accumulation and breaking Qi medicines injured Middle Qi. Epigastric stuffiness and pain, relieved by eating, inability to belch or pass flatus, pulse slow and wiry. Liver-Stomach disharmony, Yang deficiency with cold gathering in the Middle. Prescribing unblocking Yang and venting Wood method.
Ling Gui Zhu Gan Tang (Poria, Cinnamon, Atractylodes, and Licorice Decoction) plus Aged Tangerine Peel, White Peony Root, Evodia Fruit, Dried Ginger, and Jujube.
Re-examination: Pain radiating between chest and back, syndrome belongs to Chest Bi (Obstruction).
Erchen Tang (Two-Aged Decoction) minus Licorice Root, plus Trichosanthes Seed, Processed Aconite Root, Cinnamon Twig, Dried Ginger, Evodia Fruit, Cardamom Seed, and Bamboo Shavings.
Mr. Sun: Middle deficiency, Earth fails to control Water, Yin Qi from Lower Jiao rebels upward to Stomach. Epigastric pain, vomiting clear water, pain relieved by eating. Prescribing warming Middle and securing Lower, assisted by anchoring rebellion.
Sijunzi Tang (Four Gentlemen Decoction) minus Licorice Root, plus Dried Ginger, Lindera Root, White Peony Root, Prepared Rehmannia Root, Fluorite, Hematite, and Tangerine Rind.
Note by Yuan: Earth deficiency with abundant Water, using Prepared Rehmannia is inappropriate. To support Earth, do not remove Licorice.
Mr. Qin: Hanging fluid residing under the ribs, causing pain and vomiting clear water. Using Zhang Zhongjing's method.
Kansui Root, Genkwa Flower, Kansui, White Mustard Seed, Evodia Fruit (3 qian each), Jujube (20 pieces).
Boil five herbs in two large bowls of river water until concentrated to one large bowl, strain, then add Jujubes and boil until soft and dry. Eat two Jujubes early every morning.
Note by Yuan: This is a modification of Shizao Tang (Ten Jujube Decoction). Replacing Torreya Seed with Evodia shows ingenuity.
Unknown Patient: Cold Qi condensing, forming abdominal masses in Lower Abdomen, occasionally attacking upward causing pain. Method: Warming and unblocking.
Fennel Seed, Evodia Fruit, Aucklandia Root, Green Tangerine Peel, Lindera Root, Corydalis Rhizome, Burreed Tuber, Amomum Fruit, Cyperus Rhizome.
Mr. Qian: Pulse is faint and fine, a sign of Yin. Mass in Lower Abdomen attacking upward to epigastrium, Qi blockage from epigastrium to throat, upon attack mass causes severe pain nearly leading to syncope, profuse sweating on head.
General principle of prescription: Warming and unblocking is certain. However, yellow greasy turbid tongue coating and foul-smelling diarrhea indicate concurrent damp-heat; mass pain relieved by pressure indicates deficiency.
Jinlingzi San (Golden Bell Powder) plus Ginseng Root, Mume Fruit, Lindera Root, Alisma Rhizome, Psoralea Fruit, Evodia Fruit, Aucklandia Root, Cinnamon Bark, Goji Berry, Schisandra Berry, Poria, and Areca Seed.
Re-examination: Water-fluids, phlegm, and turbid Yin Qi from Lower Jiao occupy the Middle. Masses in epigastrium and hypochondrium causing distending pain, severe pain leading to syncope. Yesterday used warming-unblocking, pain slightly reduced.
But pulse remains faint and fine, diarrhea still foul-smelling, aversion to food, severe Middle Qi deficiency, Yin Qi condensing, hard pain at umbilicus, fearing Zang-Jie (Visceral Knotting). Attacking is impossible, tonifying is difficult, still troublesome.
Previous formula minus Ginseng, Schisandra, Lindera, Psoralea, and Areca Seed; add White Peony Root, Dried Ginger, Daylily Flower, and Tangerine Rind.
Unknown Patient: Cold in abdomen, incessant pain, method should be warming and unblocking.
Jinlingzi San (Golden Bell Powder) plus Dried Ginger, Evodia Fruit, Angelica Sinensis Root, Goji Berry, Official Cinnamon, Aucklandia Root, Lindera Root, and Fluorite.
Mr. Zhang: Cold Qi lingering, Qi mechanism unfavorable. Radiating pain in chest and back, Qi attacking in epigastrium and hypochondrium with masses. Suitable for acrid-warm unblocking.
Erchen Tang (Two-Aged Decoction) minus Licorice Root, plus Trichosanthes Peel, Allium Macrostemon Bulb, Dried Ginger, Evodia Fruit, Corydalis Rhizome, and Aspongopus.
Unknown Patient: Liver-Stomach disharmony, radiating pain in waist, hypochondrium, chest, and back. Tongue bare without coating, Ying-Yin internally deficient. Loose stools, Spleen Qi also weak, no vomiting of phlegm or sour water. Suitable for acrid-warm unblocking Yang, sour-sweet generating Yin.
Aged Tangerine Peel, Poria, Perilla Stem, Evodia Fruit, Astragalus Complanatus Seed, Goji Berry, Allium Macrostemon Bulb, White Peony Root, Tangerine Rind.
Note by Yuan: Spleen-Kidney deficiency-cold suits sweet-warm; Ying-Yin internal deficiency suits softening and slowing; thus avoiding acrid-hot drying herbs like Ginger and Aconite.
Unknown Patient: Fluid retention in Middle Epigastrium, borborygmus in epigastrium and abdomen, distending pain. Stool hard as chestnut, able to belch but not pass flatus, indicating Stomach failing to descend and Qi rebelling upward.
Harmonize Stomach and direct rebellion downward, expel water and eliminate fluids.
Erchen Tang (Two-Aged Decoction) minus Licorice Root, plus Hematite, Inula Flower, Medicated Leaven, Dried Ginger, White Peony Root, Sichuan Pepper, Kansui, and Alisma Rhizome.
Unknown Patient: Cold in Dantian, heat in Chest, Middle Jiao fails to transport, excessive dampness generates parasites. Give Huanglian Tang (Coptis Decoction).
Coptis Rhizome, Cinnamon Bark, Evodia Fruit, Dried Ginger, Amomum Fruit, Quisqualis Fruit, Pinellia Tuber, Green Tangerine Peel, Lindera Root, Betel Nut.
Re-examination: Parasitic pain, yellow face, vomiting saliva. Prescribe bitter-acrid method.
Coptis Rhizome, Cinnamon Twig, Sichuan Pepper, Cardamom Seed, Mume Fruit, Wormseed, Charred Medicated Leaven, Cyperus Rhizome, combined with Jinlingzi San.
Mr. Zhang: Epigastric pain for two years, recent attacks more frequent. Relieved by warmth, worsened by overwork. Mass in Middle Epigastrium, skin at lesion is cold, method is warming and unblocking.
Erchen Tang (Two-Aged Decoction) minus Licorice Root, plus Roasted Ginger, Evodia Fruit, Aucklandia Root, Magnolia Bark, Angelica Sinensis Root, Medicated Leaven, Alisma Rhizome, and Raw/Cooked Barley Sprouts.
Re-examination: Abdominal pain with mass, Liver-Spleen disharmony, poor appetite, yellow complexion. Treat with soothing and harmonizing.
Salvia Root, White Peony Root, Chinese Yam, Poria, Poria cocos (with wood), Winter Atractylodes, Medicated Leaven, Cyperus Rhizome, Amomum Fruit.
Ren Yuan said: Epigastric pain belongs to Stomach, abdominal pain belongs to Spleen. Acid regurgitation and vomiting bitter fluid, commonly called Liver Qi, is actually a disease of accumulated fluids. It may result from fondness for raw/cold food or worry/thought depression. Liver and Gallbladder belong to Wood and prefer ascending and spreading, rooted in Earth. Now Spleen-Stomach Yang-heating Qi is injured by raw/cold food and worry/thought, failing in distribution and transportation. Liver-Gallbladder lose their moist-warm ascending mechanism, become depressed and act violently, insulting what they overcome, causing Spleen-Stomach to be suppressed. Qi mechanism and phlegm-fluids stagnate in Middle Epigastrium, causing pain. Those with acid regurgitation and bitter vomiting have Spleen cold failing to transform, Stomach fluids accumulating; like food left in a vessel, its taste changes. Sweet taste belongs to Earth (Grain); now Stomach cannot transform, Wood overacts on its conquered element, changing Wood's taste to sour, and Gallbladder Fire's taste to bitter. Wood Qi rebels, causing incessant vomiting; long-term fluid accumulation forms sacs and masses. Caused by cold food, it is treatable; caused by emotions, it often becomes dysphagia. Prolonged worry injures Middle Yang, frequent vomiting dries Stomach juices; initially Yang is injured, then Yin fluids exhausted, Ying-Wei lack source of generation, stomach tube shrinks, intestinal fluids deplete. Relying solely on medicine is useless; must calm spirit and rest quietly. Yu Shi's method of advancing/retreating Huanglian Tang has deep meaning: Acrid transforms Stomach, Bitter directs rebellion downward, "changing the Stomach without being changed by it." Luo Qianfu's Zhizhong Tang also fits, using Metal to control Wood. Zhang Zhongjing's Trichosanthes and Allium formulas, whether acrid or bitter, unblocking or moistening, are all usable, aiming to unblock Middle Jiao Yang, allowing Spleen-Stomach Yin coagulation to open and Liver Wood depression to spread, pain resolves itself. Abdominal pain must be differentiated by location: Umbilicus is Taiyin, beside umbilicus is Shaoyin, Lower Abdomen is Jueyin. Especially differentiate cold-heat deficiency-excess; generally cold is more than heat, deficiency more than excess, heat mostly excess, deficiency mostly cold. Neijing · Ju Tong Lun states: Eight or nine parts cold, one or two parts heat; must carefully distinguish via pulse and symptoms. In years of damp depression, many such cases occur, also due to Spleen-Stomach depressed by cold-damp, Yang Qi unable to diffuse and transform.