房叔 胃脘痛，脉细涩，服香砂六君子汤去白术，加煨姜、益智。痛定后，遇劳复发，食盐炒蚕豆，时止
时痛。予谓昔人以诸豆皆闭气，而蚕豆之香能开脾，盐之咸能走血，痛或时止，知必血分气滞，乃用失笑散，
一服痛除。
巢氏 素有胃气，或用温胃之剂，不效，延至痛引背胁，脉
短涩。予谓短为宿食，涩为气中血滞，宜 痛无已也。用延胡、五灵脂（酒炒）、当归、红曲、降真香末，
痛止。
史 脘痛日久，血络亦痹，理用辛通。当归须、延胡索、橘络、香附、枳壳、降香、郁金汁，服效。
张 操劳伤阳，脉迟小，胃口隐痛，绵绵不已，治用辛温理气。制半夏、良姜、金橘皮、茯苓、檀香、
归须、韭子（炒研），一啜痛止。
薛 痛久热郁，口干内烦，不宜香燥劫液，询得食痛缓，知病在脾之大络受伤，由忍饥得之。甘可缓痛，
仿当归建中汤法。炒白芍（二钱半）、当归（钱半）、炙草（一钱）、豆豉（炒，钱半）、橘白（八分）、
糯稻根须（五钱）、饴糖（熬，三钱冲），数剂痛定。常时食炒粳米粥，嗣后更与调养胃阴。杏仁、麦冬、
白芍、当归、蒌仁、半夏（青盐炒），南枣。数服痛除。
肝脉布胁，胆脉循胁。肩下曰膊，膊下曰 ， 对腋，腋下曰 ， 下曰胁，胁后曰肋，肋下曰季肋，
俗名肋稍，季肋下为腰。故胁痛皆肝胆为病，而胆附于肝。凡气血食痰风寒之滞于肝者，皆足致痛。气郁者，
大怒气逆，或谋虑不遂，皆令肝火动甚。清肝汤、小龙荟丸。血瘀者，跌扑闪挫，恶血停留，按之痛甚。
复元活血汤。痰痛者，痰饮流注其经，嗽则气急。控涎丹，以二陈汤下，或白芥子汤。食积者，食滞胁下，
有一条扛起。消食丸。风寒者，外感之邪，留着胁下，小柴胡汤加桔梗、枳壳。左痛多留血，右痛为肝邪入肺，
为气，痰食亦在右。风寒则不论左右，胁痛多实，不可轻用补肝，致令肝胀。亦有虚痛者，补肝散。怒伤者，
香附汤。郁伤者，逍遥散。初痛在经，久必入络。经主气，络主血，有营络虚寒，得食痛缓者。辛温通络，
甘缓补虚。当归桂枝汤。有肝阴虚者，热痛嗌干，宜凉润滋液。三才汤加柏子仁、白芍。有液虚风动者，胁
气动跃，宜滋液熄风。复脉汤去桂、姜。有郁热胀痛者，宜苦辛泄降。川楝子、黄连、山栀、郁金、降香
末。有因怒劳，致气血皆伤，肝络瘀痹者，宜辛温通络。旋复花
汤加归须，小茴、新绛、延胡、青葱管。有痞积攻痛者，宜辛散通瘀。桃仁、鲮鲤甲、乳香、没药、丹皮、
归须、牡蛎粉、泽兰。有气逆呕涎，由胁攻胃者，用酸泄和肝。木瓜、白芍、金橘皮、枣仁、橘叶、代赭石。
按《内经》治肝，不外甘缓、辛散、酸泻三法。凡胁痛，药忌刚燥，以肝为刚脏，必以柔济之，乃安也。
丹溪曰∶肝苦急，是木气有余，急食辛以散之。用川芎、青皮、醋炒。又曰，肝火盛，两胁痛，不得伸
舒。先以琥珀膏贴患处，以姜汤下当归龙荟丸，最妙。咳引胁痛，宜舒肝气。用青皮、枳壳、香附、白芥子之
类。两胁走痛，控涎丹。
《正传》曰∶凡胁痛，皆肝木有余。小柴胡汤加川芎、青皮、芍药、龙胆草，甚者加青黛、麝香。凡
性急多怒之人，常患腹胁痛。小柴胡汤加川芎、青皮、白芍，下龙荟丸甚效。
《入门》曰∶肝热郁，则胁必痛，发寒热，胁痛似有积块，必是饮食太饱，劳力所致。当归龙荟丸。
肝气实，胁痛者，烦燥不安卧，小柴胡汤加川芎、白芍、当归、青皮、龙胆草。肝气虚，胁痛者，悠悠不止，
耳目KT KT 善恐，四物汤加柴胡、青皮。
《医鉴》曰∶胁痛必用青皮醋炒，煎服，末服并效。以青皮乃肝胆二经药，多怒，胁有郁积，宜此
解之。若二经气血不足，当先补血，少用青皮。
房姓患者，胃脘部疼痛，脉象细涩。服用香砂六君子汤（由木香、砂仁、人参、白术、茯苓、甘草、陈皮、半夏组成）并去掉白术，加入煨姜和益智仁。疼痛缓解后，一遇劳累便复发，食用食盐炒制的蚕豆，疼痛时止时作。我认为古人说各种豆类都容易阻滞气机，而蚕豆的香气能疏通脾气，盐的咸味能入血分，疼痛有时停止，可知必然是血分中气机阻滞所致，于是使用失笑散（由蒲黄、五灵脂组成），服用一次后疼痛消除。
巢姓患者，平素就有胃气不和的症状，曾使用温胃的药物，但无效，病情拖延至疼痛牵引背部和胁肋，脉象短而涩。我认为脉短表示有宿食停滞，脉涩表示气滞导致血行不畅，这种疼痛恐怕不会自行停止。使用延胡索、五灵脂（用酒炒制）、当归、红曲、降真香末，疼痛停止。
史姓患者，胃脘疼痛日久，血络也发生痹阻，治疗应当使用辛味药物以通络。使用当归须、延胡索、橘络、香附、枳壳、降香、郁金汁，服用后见效。
张姓患者，因操劳损伤阳气，脉象迟而小，胃口处隐隐作痛，连绵不断，治疗应当使用辛温药物调理气机。使用制半夏、良姜、金橘皮、茯苓、檀香、当归须、韭菜子（炒后研碎），喝一次后疼痛停止。
薛姓患者，疼痛日久导致热邪郁结，口干且内心烦躁，不宜使用香燥药物劫伤津液，询问得知进食后疼痛缓解，知道病位在脾之大络受伤，是由忍饥挨饿引起的。甘味药可以缓急止痛，仿照当归建中汤的方法。使用炒白芍（二钱半）、当归（一钱半）、炙甘草（一钱）、豆豉（炒，一钱半）、橘白（八分）、糯稻根须（五钱）、饴糖（熬化，三钱冲服），服用数剂后疼痛安定。平时常食用炒粳米粥，随后再给予调养胃阴的药物。使用杏仁、麦冬、白芍、当归、瓜蒌仁、半夏（青盐炒制）、南枣。服用数次后疼痛消除。
肝经的脉气布散于胁肋，胆经的脉气循行于胁肋。肩膀下方称为膊，膊下称为[此处原文缺字，通常指腋下或侧胸]，与腋相对，腋下称为[此处原文缺字]，其下称为胁，胁后称为肋，肋下称为季肋，俗称肋稍，季肋以下为腰。所以胁痛都是肝胆的疾病，而胆附属于肝。凡是气血、食积、痰饮、风寒等邪气滞留于肝者，都足以导致疼痛。气郁的情况，多因大怒导致气逆，或者谋虑不能遂心，都会使肝火剧烈发动。可用清肝汤、小龙荟丸。血瘀的情况，多因跌打损伤或闪挫，恶血停留，按压时疼痛加剧。可用复元活血汤。痰痛的情况，是痰饮流注于经络，咳嗽时气急。可用控涎丹，用二陈汤送服，或者用白芥子汤。食积的情况，是食物停滞在胁下，感觉有一条筋扛起。可用消食丸。风寒的情况，是外感邪气留着在胁下，可用小柴胡汤加桔梗、枳壳。左侧疼痛多为留血，右侧疼痛为肝邪传入肺，属于气分病变，痰食积滞也多在右侧。风寒则不论左右，胁痛多属实证，不可轻易使用补肝药，以免导致肝胀。也有虚性疼痛的，可用补肝散。因怒致伤的，可用香附汤。因郁致伤的，可用逍遥散。初起疼痛在经脉，久病必然进入络脉。经脉主气，络脉主血，有营络虚寒，进食后疼痛缓解的情况。应用辛温通络，甘缓补虚的方法。可用当归桂枝汤。有肝阴虚的情况，表现为热痛、咽喉干燥，宜用凉润滋液的方法。可用三才汤加柏子仁、白芍。有津液亏虚导致风动的情况，表现为胁部肌肉跳动，宜滋液熄风。可用复脉汤去掉桂枝、生姜。有郁热胀痛的情况，宜用苦辛泄降的方法。可用川楝子、黄连、山栀、郁金、降香末。有因愤怒和劳累，导致气血皆伤，肝络瘀痹的情况，宜用辛温通络的方法。可用旋复花汤加当归须、小茴香、新绛、延胡索、青葱管。有痞块积聚攻痛的情况，宜用辛散通瘀的方法。可用桃仁、鲮鲤甲、乳香、没药、丹皮、当归须、牡蛎粉、泽兰。有气逆呕吐涎沫，由胁肋攻及胃部的情况，用酸味泄降以调和肝脏。可用木瓜、白芍、金橘皮、枣仁、橘叶、代赭石。
按照《内经》治疗肝病的原则，不外乎甘缓、辛散、酸泻三种方法。凡是胁痛，用药忌讳刚燥，因为肝是刚脏，必须用柔润的药物来济助它，才能安宁。朱丹溪说：肝苦急，这是木气有余，应紧急食用辛味药以疏散它。使用川芎、青皮，醋炒。又说，肝火旺盛，两胁疼痛，身体不得舒展。先用琥珀膏贴敷患处，再用姜汤送服当归龙荟丸，效果最好。咳嗽牵引胁痛，宜舒肝气。使用青皮、枳壳、香附、白芥子之类的药物。两胁游走性疼痛，用控涎丹。
《正传》说：凡是胁痛，都是肝木有余。用小柴胡汤加川芎、青皮、芍药、龙胆草，严重的加青黛、麝香。凡是性格急躁易怒的人，常患腹部和胁肋疼痛。用小柴胡汤加川芎、青皮、白芍，再服用龙荟丸非常有效。
《入门》说：肝热郁结，则胁必痛，伴有发冷发热，胁痛好像有积块，必定是饮食过饱、劳力过度所致。可用当归龙荟丸。肝气实盛，胁痛者，烦躁不安卧，可用小柴胡汤加川芎、白芍、当归、青皮、龙胆草。肝气虚弱，胁痛者，疼痛悠悠不止，耳目昏花，容易恐惧，可用四物汤加柴胡、青皮。
《医鉴》说：胁痛必须使用青皮醋炒，煎服或末服都有效。因为青皮是肝胆二经的药物，对于多怒、胁下有郁积的情况，适宜用它来解郁。如果这两经的气血不足，应当先补血，少用青皮。
Patient Fang suffered from epigastric pain with a fine and choppy pulse. He took Xiangsha Liujunzi Tang (Cinnamon Twig, Amomum, Ginseng, Atractylodes Macrocephala, Poria, Licorice, Tangerine Peel, Pinellia Decoction) with Atractylodes Macrocephala removed, adding baked ginger and Alpinia Oxyphylla. After the pain subsided, it recurred upon exertion; eating salt-fried broad beans temporarily relieved the intermittent pain. I reasoned that while most legumes tend to obstruct Qi, the fragrance of broad beans can open the Spleen, and the salty taste enters the Blood level. Since the pain ceased intermittently, it indicated Qi stagnation in the Blood aspect. Thus, Shixiao San (Pollen Typhae and Trogopterus Dung Powder) was prescribed, which eliminated the pain after one dose.
Patient Chao had a history of Stomach Qi disharmony. Previous warming treatments for the Stomach were ineffective, and the condition progressed to pain radiating to the back and hypochondrium, with a short and choppy pulse. I diagnosed the short pulse as indicating retained food and the choppy pulse as Qi stagnation causing Blood stasis, predicting the pain would not cease spontaneously. Yanhusuo, Trogopterus Dung (stir-fried with wine), Angelica Sinensis, Red Yeast Rice, and Dalbergia Odorifera powder were used, stopping the pain.
Patient Shi suffered from chronic epigastric pain with obstruction in the collateral vessels. Treatment required acrid substances to unblock collaterals. Radix Angelicae Sinensis tips, Corydalis Rhizome, Citrus reticulata white mesh, Cyperus Rotundus, Aurantium Fructus, Aquilaria Lignum Resinatum, and Curcuma Aromatica juice were administered with effect.
Patient Zhang injured Yang through overwork, presenting with a slow and small pulse and dull, continuous pain in the stomach region. Treatment employed acrid-warm substances to regulate Qi. Processed Pinellia Rhizome, Alpinia Katsumadai Rhizome, Citrus reticulata peel, Poria, Santalum Album Wood, Radix Angelicae Sinensis tips, and fried Chinese Chive Seed were given; one sip stopped the pain.
Patient Xue suffered from long-standing pain leading to heat constraint, dry mouth, and internal irritability. Acrid-dry herbs that consume fluids were contraindicated. Upon inquiry, relief upon eating indicated injury to the Great Luo of the Spleen caused by fasting. Sweet substances can relieve urgency and pain. Following the method of Danggui Jianzhong Tang: stir-fried White Peony Root (2.5 qian), Angelica Sinensis (1.5 qian), roasted Licorice (1 qian), stir-fried Fermented Soybean (1.5 qian), Citrus reticulata white pith (0.8 fen), Glutinous Rice Rootlets (5 qian), and Malt Sugar (3 qian, dissolved). Several doses stabilized the pain. The patient commonly ate stir-fried japonica rice porridge, followed by treatment to nourish Stomach Yin: Apricot Seed, Ophiopogon Root, White Peony Root, Angelica Sinensis, Trichosanthes Seed, Processed Pinellia Rhizome (stir-fried with green salt), and Jujube. Several doses eliminated the pain.
The Liver meridian distributes along the hypochondrium, and the Gallbladder meridian follows the hypochondrium. Below the shoulder is the arm side; below that is the axilla area opposite the armpit; below the armpit is the lateral chest; behind the lateral chest are the ribs; below the ribs are the lower costal margins, commonly called the "rib tip"; below the lower costal margin is the waist. Therefore, hypochondriac pain is always a disease of the Liver and Gallbladder, with the Gallbladder attached to the Liver. Any stagnation of Qi, Blood, Food, Phlegm, Wind, or Cold in the Liver can cause pain. Qi depression, often due to great anger causing Qi reversal or unfulfilled plans, causes severe Liver Fire. Qinggan Tang or Xiaolonghui Wan may be used. Blood stasis, often from trauma or sprains with retained evil blood, worsens on pressure. Fuyuan Huoxue Tang is indicated. Phlegm pain involves phlegm-fluids flowing into the meridians, causing shortness of breath on coughing. Kongxian Dan, taken with Erchen Tang, or Baijiezi Tang may be used. Food retention involves food stagnating under the hypochondrium, feeling like a raised cord. Xiaoshi Wan is used. Wind-Cold involves external pathogens lingering in the hypochondrium. Xiaochaihu Tang with Platycodon Root and Aurantium Fructus is appropriate. Left-sided pain often indicates retained Blood; right-sided pain suggests Liver pathogen entering the Lung, involving Qi, Phlegm, and Food, mostly on the right. Wind-Cold affects both sides. Hypochondriac pain is mostly excess; tonifying the Liver lightly should be avoided to prevent Liver distension. There are also deficiency pains, treated with Bu Gan San. Injury from anger is treated with Xiangfu Tang. Injury from depression is treated with Xiaoyao San. Initial pain is in the channels; chronic pain enters the collaterals. Channels govern Qi; collaterals govern Blood. In cases of Ying-collateral deficiency-cold with pain relief upon eating, use acrid-warm to unblock collaterals and sweet to relieve urgency and tonify deficiency. Danggui Guizhi Tang is used. For Liver Yin deficiency with hot pain and dry throat, use cool-moisturizing methods. Santiantang with Biota Seed and White Peony Root is suitable. For fluid deficiency causing wind movement with jumping sensations in the hypochondrium, nourish fluids and extinguish wind. Maixuanshen Tang (Fuxmai Tang) without Cinnamon Twig and Ginger is used. For depression-heat with distending pain, use bitter-acrid to drain and descend. Toosendan Fruit, Coptis Rhizome, Gardenia Fruit, Curcuma Aromatica, and Aquilaria Lignum Resinatum powder are used. For Qi and Blood injury from anger and labor causing Liver collateral stasis, use acrid-warm to unblock collaterals. Xuanfuhua Tang with Radix Angelicae Sinensis tips, Fennel, Xinjiang (Safflower silk), Corydalis Rhizome, and Green Onion Tube is used. For mass-related attacking pain, use acrid-dispersing to unblock stasis. Peach Kernel, Manis Pentadactyla Scale, Frankincense, Myrrh, Moutan Cortex, Radix Angelicae Sinensis tips, Oyster Shell Powder, and Agrimonia Pilosa are used. For Qi reversal with vomiting saliva, attacking the Stomach from the hypochondrium, use sour-draining to harmonize the Liver. Quince, White Peony Root, Citrus reticulata peel, Ziziphus Seed, Tangerine Leaf, and Magnetite are used.
According to *Neijing*, treating the Liver involves three methods: sweet-relaxing, acrid-dispersing, and sour-draining. For hypochondriac pain, avoid harsh-dry drugs because the Liver is a rigid organ; it must be assisted with softening agents to achieve peace. Zhu Danxi stated: "The Liver suffers from tension," indicating excess Wood Qi; urgently use acrid substances to disperse it, such as Ligusticum Wallichii Rhizome and Aurantium Fructus, stir-fried with vinegar. He also said: "Excessive Liver Fire causes bilateral hypochondriac pain and inability to stretch." Apply Hupo Gao (Amber Plaster) to the affected area first, then administer Danggui Longhui Wan with Ginger Decoction, which is excellent. Cough pulling the hypochondrium requires soothing Liver Qi using Aurantium Fructus, Aurantium Fructus, Cyperus Rotundus, and White Mustard Seed. Wandering pain in both hypochondria uses Kongxian Dan.
*Zhengchuan* states: All hypochondriac pain results from excess Liver Wood. Xiaochaihu Tang plus Ligusticum Wallichii Rhizome, Aurantium Fructus, White Peony Root, and Gentiana Scabra Root is used; severe cases add Indigo Naturalis and Musk. People with irritable temperaments often suffer abdominal and hypochondriac pain. Xiaochaihu Tang plus Ligusticum Wallichii Rhizome, Aurantium Fructus, and White Peony Root, followed by Longhui Wan, is very effective.
*Rumen* states: Liver heat depression causes hypochondriac pain with chills and fever; pain resembling a mass is caused by overeating and physical strain. Danggui Longhui Wan is used. Excess Liver Qi causing hypochondriac pain presents with restlessness and insomnia; Xiaochaihu Tang plus Ligusticum Wallichii Rhizome, White Peony Root, Angelica Sinensis, Aurantium Fructus, and Gentiana Scabra Root is indicated. Deficiency Liver Qi causing hypochondriac pain presents with lingering pain, blurred vision/hearing, and fear; Siwu Tang plus Bupleurum Root and Aurantium Fructus is used.
*Yijian* states: Hypochondriac pain requires Aurantium Fructus stir-fried with vinegar, effective whether decocted or powdered. Aurantium Fructus is a herb for the Liver and Gallbladder meridians, suitable for resolving depression from anger and accumulation in the hypochondrium. If Qi and Blood of these two meridians are deficient, tonify Blood first and use Aurantium Fructus sparingly.