（胃脘痈附）
胃脘当心下，主吸受饮食，若烦劳冷热，致气血痰食停瘀作痛，或肝气犯胃，及肾寒厥逆，皆能致之。
症与心痛相似，但胃脘痛必见胃经本病，如胀满、呕逆、不食、便难、面浮、肢倦，与心痛专在包络者自别。
治法须分新久，初痛在经，久痛入络，经主气，络主血也。初痛宜温散以行气，久痛则血络亦痹，必辛通以
和营，未可概以香燥例治也。其因胃阳衰而脘痛者，食入不运，当辛甘理阳。香砂六君子汤加桂枝、良姜。
因肝乘胃而脘痛者，气冲胁胀，当辛酸制木。吴萸、白芍、青皮、木瓜、浓朴、延胡、金橘。因肾寒厥逆而
脘痛者，吐沫呕涎，当辛温泄浊。吴茱萸汤。因烦劳伤气而脘痛者，得食稍缓，当甘温和中。小建中汤。因客
寒犯膈而猝痛者，呕逆不食，当温中散寒。大建中汤加白蔻仁。积寒致痛，绵绵不绝，无增无减，当辛热通
阳。术附汤加浓朴、草蔻。火郁致痛，发则连日，脉必弦数，当苦辛泄热。姜汁炒黄连、山栀泻火为君，香
附、川芎、陈皮、枳壳开郁为臣，反佐炮姜，从治为使。痰积脘痛必呕恶，清中汤加海石、南星、香附。停饮
脘痛必吞酸，胃苓汤、左金丸。食滞脘痛必嗳腐，香砂枳术丸加半夏曲。气郁脘痛，必攻刺胀满，沉香降气
散。伤力脘痛，必瘀血停留，郁金、归尾、桃仁、苏木，或手拈散。怒气脘痛，必呃逆胸痞，半夏泻心汤。
蛔动脘痛，必有休止，安蛔丸。痛久不愈，必入血络，归须、桃仁、延胡、紫降香，或失笑散，效。若痛而
肢冷，脉微欲绝，桂心煎服甚效。凡痛有虚实，按之痛止者为虚，按之痛反甚者为实。虚者，参术散。实者，
栀黄丸。痛甚者脉或伏，用药不宜守补，参、 、术、地之属。以痛则不通，通则不痛故也。若膈间肿痛，
不能进食，但喜水饮，或咽肿，人迎盛而气口紧者，当作胃脘痈治。
〔胃脘痈〕由热毒攻聚胃口而发。《灵枢经》曰∶中脘穴属胃，隐隐痛者，胃脘痈也。《圣济总录》曰∶
胃脘痈，不比肺痈之可认，苟不呕脓血，未免他误矣。其症气逆于胃，脉必沉细，或阳气为风寒所遏，不得上
升，人迎必盛。人迎者，胃脉也，盛则热矣。
诊得此脉，即胃脘痈之候。其人必寒热如疟，身皮甲错，咳呕脓血，若脉洪数，则脓已成，急宜排脓。如脉
迟紧，乃属血瘀，急当议下，否则毒瓦斯内攻，肠胃并腐。如初起寒热如疟，咳吐脓血，射干汤。若风热固结，
唇口 动，薏苡仁汤。积热不散，清胃散、芍药汤。毒成未溃，内消沃雪汤。未溃毒盛，东垣托里散。胸乳
间疼，吐脓腥臭，牡丹散。若在膈下，脓出大便，排脓汤。脓稀，太乙膏。虚者，八珍汤加黄 、忍冬、
连翘。
胃经穴人迎，在结喉两旁，动脉应手，其脉见于左手。人迎盛，则热聚胃口为痈，肺痈咳脓如米粥。
胃痈但呕脓，以其结聚胃脘，从湿化也。凡舌苔经久不退，色黑垢腻，口甜气秽，即胃脘发痈之候。用凉膈
散加石斛、连翘。下尽宿垢，再以保元汤加苓、橘。调理可安。
（附：胃脘痈）
胃脘位于心窝下方，主要功能是受纳和消化饮食。如果因烦劳过度或饮食冷热不当，导致气、血、痰、食停滞瘀阻而引发疼痛；或者是肝气侵犯胃腑，以及肾寒之气厥逆上冲，都能导致此病。
其症状与心痛相似，但胃脘痛必然伴有胃经的本证表现，如胀满、呕吐逆气、不能进食、大便困难、面部浮肿、肢体疲倦，这与真心痛专在膻中包络部位者自然不同。
治疗法则必须区分新病与久病。初起之痛在气分（经），久病之痛则深入血分（络）。气分主司气的运行，血分主司血的流通。初起之痛宜用温散法以行气；久病之痛则血络也会痹阻，必须用辛味药通络以调和营血，不可一概用香燥药物治疗。
如果是因胃阳衰弱而导致脘痛的，食物入胃后无法运化，应当用辛甘药物调理阳气。可用香砂六君子汤加桂枝、高良姜。
如果是因肝气乘袭胃腑而导致脘痛的，表现为气冲两胁、胁部胀满，应当用酸辛药物制约肝木。可用吴茱萸、白芍、青皮、木瓜、厚朴、延胡索、金橘。
如果是因肾寒厥逆而导致脘痛的，表现为吐沫、呕吐涎水，应当用辛温药物泄除浊阴。可用吴茱萸汤。
如果是因烦劳伤气而导致脘痛的，进食后疼痛稍缓解，应当用甘温药物调和脾胃。可用小建中汤。
如果是因外感客寒侵犯膈间而突然剧痛的，表现为呕吐逆气、不能进食，应当用温中散寒法。可用大建中汤加白豆蔻仁。
如果是因积寒导致疼痛，疼痛绵绵不绝，无增减变化，应当用辛热药物通阳。可用术附汤加厚朴、草豆蔻。
如果是因火郁导致疼痛，发作时连续多日，脉象必定弦数，应当用苦辛药物泄热。以姜汁炒黄连、山栀泻火为君药，香附、川芎、陈皮、枳壳开郁为臣药，反佐炮姜，从治为使药。
如果是因痰积导致脘痛的，必然伴有恶心呕吐，可用清中汤加海浮石、胆南星、香附。
如果是因食滞导致脘痛的，必然伴有嗳出腐臭气味，可用香砂枳术丸加半夏曲。
如果是因气郁导致脘痛的，必然有攻撑刺痛、胀满感，可用沉香降气散。
如果是因用力过度导致脘痛的，必然有瘀血停留，可用郁金、当归尾、桃仁、苏木，或者手拈散。
如果是因怒气导致脘痛的，必然伴有呃逆、胸中痞闷，可用半夏泻心汤。
如果是因蛔虫扰动导致脘痛的，必然有疼痛休止的特点，可用安蛔丸。
如果疼痛日久不愈，必然深入血络，可用归须、桃仁、延胡索、紫降香，或者失笑散，疗效显著。
如果疼痛伴随四肢冰冷，脉微细欲绝，用桂心煎服非常有效。
凡是疼痛有虚实的区别，按压后疼痛停止的是虚证，按压后疼痛反而加剧的是实证。虚证用参术散。实证用栀黄丸。
疼痛剧烈时脉象可能伏匿，用药不宜单纯守补，如人参、白术、地黄之类。因为“痛则不通，通则不痛”的缘故。
如果膈间肿痛，不能进食，只喜欢喝水，或者咽喉肿痛，人迎脉盛大而气口脉紧的，应当当作胃脘痈来治疗。
〔胃脘痈〕是由热毒攻聚于胃口而引发的。《灵枢经》说：中脘穴属于胃，隐隐作痛的，是胃脘痈。《圣济总录》说：胃脘痈不像肺痈那样容易辨认，如果不出现呕脓血的症状，难免会被误诊。其症状是气逆于胃，脉象必定沉细，或者是阳气被风寒所遏制，不能上升，人迎脉必定盛大。人迎脉是反映胃气的脉象，盛大则表示有热。
诊察到这种脉象，就是胃脘痈的征候。病人必定像疟疾一样寒热往来，皮肤干枯如鳞甲，咳嗽呕吐脓血，如果脉象洪数，说明脓已经形成，急需排脓。如果脉象迟紧，属于血瘀，急需考虑攻下，否则毒瓦斯内攻，肠胃都会腐烂。如果初起时寒热如疟，咳嗽吐脓血，用射干汤。如果风热固结，嘴唇口角跳动，用薏苡仁汤。积热不散，用清胃散、芍药汤。毒成但未溃破，用内消沃雪汤内消。未溃破且毒盛，用东垣托里散。胸乳间疼痛，吐出腥臭脓液，用牡丹散。如果在膈下，脓从大便排出，用排脓汤。脓液稀薄，外用太乙膏。体虚者，用八珍汤加黄芪、忍冬藤、连翘。
胃经穴位人迎，位于结喉两旁，动脉应手，其脉象见于左手。人迎脉盛大，则热聚于胃口形成痈肿，肺痈咳出的脓像米粥一样。胃痈只是呕吐脓液，因为邪气结聚在胃脘，随湿邪转化所致。凡是舌苔经久不退，颜色黑垢腻，口甜气秽，就是胃脘发痈的征候。用凉膈散加石斛、连翘。待宿垢排尽后，再用保元汤加茯苓、陈皮。调理后可痊愈。
(Attached: Gastric Abscess)
The epigastrium (Wei Wan), located below the heart pit, is primarily responsible for receiving and digesting food and drink. If excessive fatigue or improper dietary temperature leads to the stagnation and stasis of Qi, Blood, Phlegm, and Food, pain may result. Alternatively, Liver Qi invading the Stomach or Cold from the Kidney counterflowing upward can also cause this condition.
The symptoms resemble Heart Pain (Xin Tong), but Epigastric Pain must present with primary Stomach Meridian manifestations, such as distension and fullness, vomiting and reflux, inability to eat, difficulty in defecation, facial edema, and limb fatigue. This naturally differs from True Heart Pain, which is localized specifically to the Pericardium area.
Treatment principles must distinguish between new-onset and chronic conditions. Initial pain resides in the Meridians (Qi level), while chronic pain penetrates into the Collaterals (Blood level). The Meridians govern Qi, and the Collaterals govern Blood. Initial pain should be treated with warming and dispersing methods to move Qi. In chronic cases, blood collaterals become obstructed, requiring pungent herbs to unblock and harmonize Ying (Nutritive) Blood; one cannot generally treat it with aromatic and drying herbs alone.
If epigastric pain is caused by deficiency of Stomach Yang, where food enters but fails to transform, warm and sweet herbs should be used to regulate Yang. Use Xiangsha Liujunzi Tang (Aucklandia and Amomum Six Gentlemen Decoction) plus Guizhi (Cinnamon Twig) and Liangjiang (Galangal Rhizome).
If epigastric pain is caused by Liver overacting on the Stomach, characterized by Qi rushing to the flanks and flank distension, sour and pungent herbs should be used to subdue Wood. Use Wu Zhu Yu (Evodia Fruit), Bai Shao (White Peony Root), Qing Pi (Tangerine Peel), Mu Gua (Chaenomeles Fruit), Hou Po (Magnolia Bark), Yan Hu Suo (Corydalis Rhizome), and Jin Ju (Kumquat).
If epigastric pain is caused by Kidney Cold and counterflow, characterized by spitting saliva and vomiting phlegm-water, warm and pungent herbs should be used to drain turbidity. Use Wu Zhu Yu Tang (Evodia Decoction).
If epigastric pain is caused by fatigue injuring Qi, where eating provides slight relief, sweet and warm herbs should be used to harmonize the Middle Jiao. Use Xiao Jianzhong Tang (Minor Construct the Middle Decoction).
If sudden severe pain is caused by exogenous Cold invading the Diaphragm, characterized by vomiting, reflux, and inability to eat, warming the Middle and dispersing Cold is indicated. Use Da Jianzhong Tang (Major Construct the Middle Decoction) plus Bai Kou Ren (Cardamom Seed).
If pain is caused by accumulated Cold, continuous without increase or decrease, hot and pungent herbs should be used to unblock Yang. Use Shu Fu Tang (Atractylodes and Aconite Decoction) plus Hou Po (Magnolia Bark) and Cao Kou (Round Cardamom).
If pain is caused by Fire depression, occurring continuously for days with a wiry and rapid pulse, bitter and pungent herbs should be used to drain Heat. Use Huang Lian (Coptis Rhizome) stir-fried with Ginger Juice and Shan Zhi (Gardenia Fruit) as Sovereign to drain fire; Xiang Fu (Cyperus Rhizome), Chuan Xiong (Ligusticum Rhizome), Chen Pi (Aged Tangerine Peel), and Zhi Ke (Bitter Orange Fruit) as Ministers to open depression; and Pao Jiang (Prepared Ginger) as Assistant to counteract, following the principle of treating contrary to appearance.
If epigastric pain is caused by Phlegm accumulation, inevitably accompanied by nausea and vomiting, use Qing Zhong Tang (Clear the Middle Decoction) plus Hai Shi (Halloysitum Rubrum), Nan Xing (Arisaema Cum Bile), and Xiang Fu (Cyperus Rhizome).
If epigastric pain is caused by retained fluid, inevitably accompanied by acid regurgitation, use Weiling Tang (Stomach and Five Herbs Decoction) or Zuojin Wan (Left Metal Pill).
If epigastric pain is caused by food stagnation, inevitably accompanied by belching with rotten odors, use Xiangsha Zhizhu Wan (Aucklandia and Amomum Immature Bitter Orange Pill) plus Banxia Qu (Pinellia Fermented Paste).
If epigastric pain is caused by Qi depression, inevitably accompanied by stabbing pain and distension, use Chenxiang Jiangqi San (Aquilaria Descending Qi Powder).
If epigastric pain is caused by physical strain, inevitably accompanied by blood stasis, use Yujin (Curcuma Radix), Gui Wei (Angelica Sinensis Tail), Tao Ren (Peach Kernel), and Sumu (Sappan Wood), or Shou Nian San (Hand-Picking Powder).
If epigastric pain is caused by anger, inevitably accompanied by hiccups and chest stuffiness, use Banxia Xiexin Tang (Pinellia Decoction to Drain the Epigastrium).
If epigastric pain is caused by Ascaris movement, inevitably characterized by intermittent pain, use An Hui Wan (Calming Parasites Pill).
If pain persists for a long time, it inevitably enters the blood collaterals. Use Gui Xu (Angelica Sinensis Whiskers), Tao Ren (Peach Kernel), Yan Hu Suo (Corydalis Rhizome), and Zi Jiang Xiang (Dalbergia Odorifera Lignum), or Shixiao San (Disappointing Pain Powder), which is effective.
If pain is accompanied by cold limbs and a faint pulse nearly imperceptible, Gui Xin (Cinnabar Core/Cinnamon Heart) decocted and taken orally is very effective.
Generally, pain has deficiency and excess patterns. Pressing stops the pain indicates deficiency; pressing exacerbates the pain indicates excess. Deficiency is treated with Shen Zhu San (Ginseng and Atractylodes Powder). Excess is treated with Zhi Huang Wan (Gardenia and Rhubarb Pill).
When pain is severe, the pulse may be hidden. Medications should not rely solely on tonification, such as Ginseng, Atractylodes, or Rehmannia. This is because "pain results from obstruction, and freedom from pain results from flow."
If there is swelling and pain in the diaphragm, inability to eat, preference for water drinks, or swollen throat, with a flourishing Renying pulse and tight Qikou pulse, it should be treated as Gastric Abscess.
[Gastric Abscess] arises from heat-toxin attacking and gathering at the stomach opening. The *Ling Shu Jing* states: The Zhongwan acupoint belongs to the Stomach; dull pain here indicates Gastric Abscess. The *Sheng Ji Zong Lu* states: Gastric Abscess is not as easily recognizable as Lung Abscess; if pus and blood are not vomited, misdiagnosis is inevitable. Its symptoms include Qi counterflow in the Stomach, a sunken and fine pulse, or Yang Qi being suppressed by Wind-Cold and unable to ascend, causing the Renying pulse to flourish. Renying is the pulse reflecting Stomach Qi; flourishing indicates Heat.
Diagnosing this pulse indicates Gastric Abscess. The patient will likely experience chills and fever like malaria, dry and scaly skin, coughing and vomiting pus and blood. If the pulse is flooding and rapid, pus has formed, and urgent drainage is required. If the pulse is slow and tight, it belongs to blood stasis, and purgation should be considered urgently; otherwise, toxic vapors will attack internally, rotting the intestines and stomach. If initially presenting with chills and fever like malaria, coughing and vomiting pus and blood, use Shegan Tang (Belamcanda Decoction). If Wind-Heat is consolidated, with twitching of the lips and mouth, use Yiyi Ren Tang (Coix Seed Decoction). If accumulated Heat does not dissipate, use Qingwei San (Clear the Stomach Powder) or Shaoyao Tang (Peony Decoction). If toxin forms but has not ulcerated, use Neixiao Woxue Tang (Internal Dissolving Snow-Draining Decoction). If not ulcerated and toxin is abundant, use Dongyuan Tuoli San (Dongyuan Supporting Interior Powder). If pain is in the chest and breasts, with foul-smelling pus vomited, use Mudan San (Moutan Powder). If located below the diaphragm, with pus discharged via stool, use Paion Tang (Drain Pus Decoction). If pus is thin, apply Taiyi Gao (Supreme Ointment). For deficiency, use Bazhen Tang (Eight Treasures Decoction) plus Huang Qi (Astragalus Root), Rendong Teng (Honeysuckle Stem), and Lianqiao (Forsythia Fruit).
The Renying acupoint of the Stomach Meridian is located on both sides of the laryngeal prominence, where the artery is palpable, and its pulse appears on the left hand. Flourishing Renying pulse indicates Heat gathering at the stomach opening forming an abscess; Lung Abscess causes coughing up of pus resembling congee. Gastric Abscess merely causes vomiting of pus because the pathogen gathers in the epigastrium and transforms according to Dampness. Whenever tongue coating persists for a long time, appearing black, greasy, and dirty, with a sweet taste and foul breath, it is a sign of Gastric Abscess. Use Liangge San (Cool the Diaphragm Powder) plus Shihu (Dendrobium Stem) and Lianqiao (Forsythia Fruit). After old fecal matter is completely expelled, use Baoyuan Tang (Preserve Origin Decoction) plus Fuling (Poria) and Chenpi (Aged Tangerine Peel). Regulation can lead to recovery.