或问腹痛何由而生？曰邪正相搏，是以作痛。夫经脉者，乃天真流行出入，脏腑之道路也。所以
水谷之精悍为荣卫，行于脉之内外，而统大其用，是故行六气，运五行，调和五脏，洒陈六腑，法四
时升降浮沉之气，以生长化收藏。其正经之别脉，络在内者，分守脏腑部位，各司其属，与之出纳气
血。凡是荣卫之妙用者，皆
天真也。故经曰∶血气，人之神，不可不谨养，养之则邪弗能伤矣。失之则荣气散解，而诸邪皆得从
其脏腑所虚之舍而入客焉。入客则气停液聚，为积为痰，血凝不行，或瘀或蓄，脉络皆满，邪正相搏，
真气迫促，故作痛也。脾胃内舍心腹，心肺内舍胸膺、两胁，肝内舍 胁、小腹，肾内舍小腹、腰脊，
大小肠、冲任皆在小腹，此脏腑所通之部位也。曰举痛论叙腹痛一十四条，属热者止一条，余皆属寒。
后世方论，因尽作风冷客之攻击而作痛。今子乃云诸邪何哉？曰方论不会通诸篇之旨，因不解篇末，
复谓百病皆生于气，列九气之状，其间虽不言痛，必亦为或有作痛者故也。不然，何乃出于诸痛篇之
末耶。试以《灵枢》百病始生篇观之，其旨则显然矣。所论邪有三部，风雨伤于上，清湿伤于下，伤
于上者，病从外入内，从上下也。次第传入，舍于输之时，六经不通，或着络脉，或着经脉，或着输
脉，或着伏冲之脉，或着肠胃之膜原，皆得成积而痛。伤于下者，病起于足，故积之始生，得寒乃生，
厥乃成积。厥气生足 ， 生胫寒，胫寒则血脉凝涩，血脉凝涩则寒气上入于肠胃，入于肠胃则 胀，
肠外之汁沫迫聚不得散，日以成积。伤于脏者，病起于阴，故卒然多食饮，则肠满，起居不节，用力
过度，则络脉伤、阳络伤则血外溢，血外
溢则衄血。阴络伤则血内溢，血内溢则后血。肠胃之络伤，则血溢于肠外，肠外有寒，汁沫与血相搏，
则并合凝聚不得散而积成矣。卒然外中于寒，若内伤于忧怒，则气上逆，气上逆则六输不通，温气不
行，凝血蕴裹而不散，津液涩渗，着而不去，而积皆成矣。自今观之，此篇所谓成积作
痛，未至于 瘕结块之积，乃汁沫聚而不散之积也。与举痛论所谓血气稽留不得行而成积同也。岂七
情叙于篇末者之不同然于作痛乎。然推原二篇之意，百病始生篇在乎三部之邪会而为痛，故相连而为
言。举痛论在乎其邪各自为病，所以独引寒淫一者，亦为寒邪之能闭塞阳气最甚故也。用是为例，其
他则可自此而推之矣。至如七情之气逆，即伤其荣卫而不行，荣卫不行则液聚血凝，及饮食用力过度
者亦然，皆不待与寒相会，始成积作痛也。且如诸篇有言，胃气实而血虚，其脉软散者，当病食痹，
谓食则痛也；有言岁土太过，湿淫所胜，大腹、小腹痛者；有言冲脉之病，其气溢于大肠，而
着于膏肓之原，在脐下，故环脐而痛；有言脾传之肾，少腹冤热而痛；有言肝热病者，
腹痛身热；有言肾虚者，亦大腹、小腹痛；有言厥阴之厥，小腹肿胀；太阴厥逆，心痛引背；有言六
气司上下之胜之复等邪，各随其所入之部分而痛，岂非诸邪各有自径入作痛，初无与寒相关者耶。
《难经》云∶脐上牢若痛，心内证也。脐下牢若痛，肾内证也。脐右牢若痛，肺内证也。脐左牢若痛，
肝内证也。方论之未备者，不独此而已。至若厥心痛，五邪相乘者，亦不能推及四脏，与之无异，岂
五五二十五阳之相移，独心而已哉。更于五脏之疝，不干涉于睾丸，止在腹中痛者，犹未明也。止知
诸脉急者为疝，未知脉滑微有热者，亦病疝也。其详备见疝条。且刘河间尝解急脉之意，急脉固是寒
之象，然寒脉当短小而迟，非急数而洪也。由紧脉主痛，急而为痛甚，所以痛而脉有紧急者，脉为心
之所养也。凡六气为病，则心神不宁，而紧急不得舒缓，故脉亦从之而见也。欲知何气之为病者，适
其紧急相兼之脉而可知也。如紧急洪数，则为热痛之类也。此论可谓善推脉理病情者也。曰诸邪之作
痛则闻命矣，然其邪之博也，奈何以治？将亦有所守要约之方乎。曰自博而求约，何患约之无其道，
不自博而从事于约，约必失其道，失其道，宁无实实虚虚、诛伐无过之患乎。然其道要在于审经脉气
血之虚实，辨六淫五邪之有无兼气，于是择至真
大要诸治法中，并五郁者之所当施，而后选其经，分祛邪补正，适所宜之药，配君臣佐使以为方。夫
如是而约之，则犹约囊也，不切中其病矣。东垣云∶夫心胃痛及腹中诸痛，皆因劳力过甚，饮食失节，
中气不足，寒邪乘虚而入客之，故卒然而作大痛。经言得炅则止，炅者，热也。以热治寒，治之正也。
然腹痛有部分，脏腑有高下，治之者亦宜分之。如厥心痛者，乃寒邪客于心包络也，前人以良姜、菖
蒲大辛热之味，末之，酒调服，其痛立止，此直折之耳。真心痛者，寒邪伤其君也，手足青至节，甚
则旦发夕死，夕发旦死。中脘痛者、太阴也，理中、建中、草豆蔻丸之类主之。脐腹痛者、少阴也，
四逆姜附、御寒汤之类主之。少腹痛者、厥阴也，正阳散、回阳丹、当归四逆汤之类主之。杂证而痛
者，苦楝汤、酒煮当归丸、丁香楝实丸之类主之。是随高下治之也。更循各脏部分穴俞而灸刺之，如
厥心痛者，痛如针刺其心，甚者，脾之痛也。取之然谷、太溪，余脏皆然。如腹中不和而痛者，甘草
芍药汤主之。如伤寒误下，传太阴腹满而痛者，桂枝加芍药汤主之。痛甚者，桂枝加大黄汤主之。夏
月肌热恶热，脉洪疾而痛者，黄芩芍药汤主之。又有诸虫痛者，如心腹懊 ，作痛聚往来上下行，痛
有休止，腹热善渴涎出，面色乍青乍白乍
赤，呕吐水者，蛔咬也。以手紧按而坚持之，无令得脱，以针刺之，久持之，虫不动，乃出针也。或
《局方》化虫丸，及诸虫之药，量虚实用之，不可一例治也。海藏云∶秋腹痛，肌寒恶寒，脉沉微，
足太阴、足少阴主之，桂枝芍药汤。中脘痛、太阴也，理中、建中、黄 汤之类。脐腹痛、少阴也，
四逆、真武、附子汤之类。小腹痛、厥阴也，重则正阳散、回阳丹之类，轻则当归四逆汤之类。太阴
传少阴痛甚者，当变下利而止。夏腹痛，肌热恶热，脉洪疾，手太阴、足阳明主之，芍药黄芩汤，治
腹痛脉洪数。肚腹痛者，芍药甘草汤主之。稼穑作甘，甘者己也。曲直作酸，酸者甲也。甲己化土，
此仲景妙方也。脉缓伤水，加桂枝、生姜。脉洪伤金，加黄芩、大枣。脉涩伤血，加当归。脉弦伤气，
加芍药。脉迟伤火，加干姜。丹溪云∶有寒、有热、有食积、有湿痰、有死血。绵绵痛而无增减，欲
得热手按，及喜热食，其脉迟者，寒也。当用香砂理中汤，或治中汤、小建中汤、五积散等药。若
冷痛用温药不效，痛愈甚，大便不甚通，当微利之，用藿香正气散，每服加官桂、木香、枳壳各半钱，
吞下来复丹，或用苏感丸，不利，则量虚实用神保丸。时痛时止，热手按而不散，其脉洪大而数者，
热也。宜二陈平胃、炒芩、连，或四顺清凉
饮、黄连解毒汤、神芎丸、金花丸之类。若腹中常觉有热而痛，此为积热，宜调胃承气汤。感暑而痛，
或泄利并作，其脉必虚豁，宜十味香薷饮、六和汤。感湿而痛，小便不利，大便溏泄，其脉必细，宜
胃苓汤。痰积作痛，或时眩晕，或呕冷涎，或下白积，或小便不利，或得辛辣热汤则暂止，其脉必滑，
宜二陈加行气之剂，及星半安中汤。食积作痛，痛甚欲大便，利后痛减，其脉必弦，或沉滑，宜二陈
平胃加山楂、神曲、麦芽、砂仁、草果，温中丸、枳术丸、保和丸、木香槟榔丸之类。酒积腹痛，用
三棱、蓬术、香附、官桂、苍术、浓朴、陈皮、甘草、茯苓、木香、槟榔主之。多年败田螺壳， 存
性，加三倍于木香槟榔丸中，更加山茵陈等分，其效甚速。气滞作痛，痛则腹胀，其脉必沉，宜木香
顺气散。死血作痛，痛有常处而不移，其脉必涩或芤，宜桃仁承气汤。虚者加归、地蜜丸服，以缓除
之。或用牡丹皮、江西红曲、麦芽、香附、川通草、穿山甲、番降香、红花、苏木、山楂、玄胡索、
桃仁泥，酒、童便各一钟，煎至一钟，入韭汁服。七情内结，或寒气外攻，积聚坚牢如杯，心腹绞痛，
不能饮食，时发时止，发即欲死，宜七气汤。腹痛有作止者，有块耕起往来者，吐清水者，皆是虫痛。
或以鸡汁吞万应丸下之，或以椒汤吞乌梅
丸安之。《金匮要略》问曰∶病腹痛有虫，其脉何以别之？师曰∶腹中痛，其脉当沉，若弦，反洪大，
故有蛔虫。关上脉紧而滑者，蛔毒。脉沉而滑者，寸白。肘后粗以下三四寸热者，肠中有虫。脾胃虚
而心火乘之，不能滋荣上焦元气，遇冬肾与膀胱之寒水旺时，子能令母实，致肺金大肠相辅而来克心
乘脾胃，此大复其雠也。经曰∶大胜必大复，故皮毛血脉分肉之间，元气已绝于外，又大寒大燥二气
并乘之，则苦恶风寒，耳鸣，及腰背相引胸中而痛，鼻息不通，不闻香臭，额寒脑痛，目时眩，目不
欲开，腹中为寒水反乘，痰唾涎沫，食入反出，腹中常痛，及心胃痛，胁下急缩，有时而痛，腹不能
努，大便多泻而少秘，下气不绝或肠鸣，此脾胃虚之极也。胸中气乱，心烦不安，而为霍乱之渐，膈
咽不通，噎塞极则有声喘喝闭塞，或日阳中，或暖房内稍缓，口吸风寒则复作，四肢厥冷，身体沉重，
不能转侧，不可回顾，小便溲而时燥，以草豆蔻丸主之。此主秋冬寒凉大复气之药也。复气乘冬足太
阳寒气、足少阴肾水之旺，子能令母实。手太阴肺实，反来侮土，火木受邪，腰背胸膈闭塞疼痛，善
嚏，口中涎，目中泣，鼻中流浊涕不止，或有 肉，不闻香臭，咳嗽痰沫，上热如火，下寒如水，头
作阵痛，目中流火，视物KT KT ，耳鸣耳聋，头
并口鼻或恶风寒喜日阳，夜卧不安。常觉痰塞膈咽不通，口无滋味，两胁缩急而痛。牙齿动摇，不能
嚼物，腰脐间及尻臀膝足寒冷，阴汗，前阴冷，行步欹侧，起居艰难，掌中寒，风痹麻木，小便数而
昼多，夜频而少。气短喘喝，少气不足以息，卒遗失无度。妇人白带，阴户中大痛，牵心而痛，黧黑
失色。男子控睾牵心，阴阴而痛，面如赭色，食少，大小便不调。烦心霍乱，逆气里急，而腹皮色白，
后出余气，腹不能努或肠鸣，膝下筋急，肩胛大痛。此皆寒水来复火土之雠也。以神圣复气汤主之。
季秋心腹中大痛，烦躁，冷汗自出，宜益智和中丸。季秋客寒犯胃，心胃大痛不可忍者，麻黄草豆蔻
丸。脾胃虚寒心腹满，及秋冬客寒犯胃，时作疼痛，宜浓朴汤。为戊火已衰，不能运化，又加客气聚
为满痛，散以辛热，佐以苦甘温，以淡泄之，扶持胃气，以期平也。腹痛或大便利，或用手重按痛处
不痛者为虚，宜于以上治寒痛方中选用之。无寒者，芍药甘草汤。仲景云∶虚劳，里急腹中痛，小建
中汤主之。此补例也，温例也。痛而秘者，浓朴三物汤主之。此泻例也，寒例也。三阴受邪，于心脐
少三腹疼痛气风等证，当归丸主之。失笑散，治心腹痛效。心痛门有刘寄奴玄胡索方，亦治腹痛，皆
通理气血之剂也。有全不喜食，其人本体素怯弱，
而又加以腹冷疼者，养胃汤，以人参、白术、苍术，仍加桂、茱萸各半钱，木香三分，应腹冷痛，或
心脾疼者，加生姜，均治之。诸寒作痛，得炅则止者，熨之。用熟艾半斤，以白纸一张，铺于腹上，
纸上摊艾令匀，又以憨葱数枝，批作两半片，铺于艾上，再用白纸一张覆之，以慢火熨斗熨之，冷则
易之，觉腹中热、腹皮暖不禁，以帛三搭多缝带系之，待冷方解。一法用盐炒，布裹熨痛处，神效。
腹痛证治，上条列之详矣。但有因别病而致痛者，不可不明。且如疝致腹痛，必是睾丸肿疼牵引而痛，
或边有一条冲腹而痛。霍乱腹痛，必吐利兼作，甚有不呕不利，四肢厥冷痛极者，名干霍乱，又名搅
肠沙。急用樟木煎汤大吐之；或用白矾末一钱，清汤调服探吐之；或用台芎为末，每一钱许入姜汁半
盏，热汤调服。甚者面青昏倒不省人事，急以鼠矢一合，研为细末，滚汤调，澄清，通口服之。或刺
委中并十指出血。肠内生痈，亦常腹痛，但小便数似淋，脉滑数，身甲错，腹皮急，按之濡，如肿状，
或绕脐生疮，治法见本门。凡此数证，要当审辨，随其所因而施治，毋苟且而误人也。
【少腹痛】
伤寒蓄血在下焦，宜抵当丸、桃仁承气之类。若因气郁而痛，以青皮主之。寒
者，以桂枝、吴茱萸温之。（苦练丸、酒煮当归丸。）若因疝、奔豚、症聚者，更检本门施治。若身
甲错，腹皮急，按之濡，如肿状，或绕脐生疮者，小肠痈也。急宜下之，或以云母膏、太乙膏作丸服。
【诊】脉多细小紧急。滑为痰。弦为食。阴弦或紧，或尺紧而实，或伏者，可下。细小迟者生。
坚大疾者，数而紧者，浮大而长者死。痛而喘，脐下或大痛，人中黑色者，不治。
问：腹痛是如何产生的？答：是邪气与正气相互搏结，因而产生疼痛。经脉，是先天真气流行出入的通道，也是脏腑之间的通路。因此，水谷精微中强盛的部分化为营卫之气，运行于脉内和脉外，统摄并扩大其作用，从而运行六气，运化五行，调和五脏，布散六腑，效法四季之气升降浮沉的规律，以完成生长化收藏的过程。其正经的别络，联络在体内的部分，分别守护脏腑的部位，各自管辖所属区域，负责气血的出纳。凡是营卫奇妙的作用，都是先天的真气。所以经文说：血气，是人的神机所在，不可不谨慎养护，养护好它，邪气就不能伤害人体了。如果失于养护，荣气就会涣散解离，各种邪气都能顺着脏腑虚弱的部位侵入并停留。邪气侵入停留后，导致气停液聚，形成积滞或痰饮，血液凝滞不行，或者瘀阻或者蓄积，脉络都充满邪气，邪正相互搏结，真气受到逼迫而急促，所以产生疼痛。
脾胃内部对应心腹，心肺内部对应胸膺、两胁，肝脏内部对应胁肋、小腹，肾脏内部对应小腹、腰脊，大小肠、冲脉、任脉都在小腹，这是脏腑所对应的部位。《黄帝内经·举痛论》叙述了十四条腹痛，属于热证的只有一条，其余都属于寒证。后世的方书论述，因此全都当作风冷客邪攻击身体而导致的疼痛。现在您却说各种邪气是怎么回事呢？回答说：后世方书的论述没有融会贯通各篇的宗旨，因为不理解篇末的意思，又认为百病都生于气，列举了九种气病的状况，其中虽然没直接说疼痛，但必定也有因此产生疼痛的情况吧。不然的话，为什么这些内容会出现在诸痛篇的末尾呢？试着参考《灵枢经·百病始生篇》来看，其中的宗旨就显而易见了。该篇论述邪气有三部，风雨之邪伤于上部，清湿之邪伤于下部。伤于上部的，病邪从外入内，从上往下传变。依次传入，停留在输穴时，六经不通，或者附着在络脉，或者附着在经脉，或者附着在输脉，或者附着在伏冲之脉，或者附着在肠胃的膜原，都能形成积滞而疼痛。伤于下部的，病起于足部，所以积滞的产生，得到寒气才生成，厥逆之气才形成积滞。厥逆之气生于足部，导致小腿寒冷，小腿寒冷则血脉凝涩，血脉凝涩则寒气向上进入肠胃，进入肠胃则腹部胀满，肠外的汁沫被迫聚集不能消散，一天天形成积滞。伤于脏的，病起于阴分，所以突然多吃饮食，就会肠满；起居不节制，用力过度，就会损伤络脉。阳络受伤则血液外溢，血液外溢则出现鼻衄。阴络受伤则血液内溢，血液内溢则出现便血。肠胃的络脉受伤，则血液溢出到肠外，肠外有寒气，汁沫与血液相互搏结，于是合并凝聚不能消散而形成积滞。突然外部受寒，或者内部因忧怒而受伤，就会导致气机上逆，气机上逆则六输不通，温煦之气不行，凝血蕴裹不散，津液涩滞渗泄，附着不去，积滞就形成了。从当今的观点看，这篇所说的形成积滞产生疼痛，还没有达到瘕块结块的严重程度，乃是汁沫聚集不散形成的积滞。这与《举痛论》所说的血气稽留不行而形成积滞是一样的。难道七情叙在篇末的原因不是导致疼痛的不同吗？然而推究这两篇的本意，《百病始生篇》在于三部的邪气汇聚而成疼痛，所以连在一起说。《举痛论》在于各种邪气各自成为疾病，所以单独引用寒淫这一条，也是因为寒邪闭塞阳气最为严重的原因。用这个作为例子，其他情况就可以由此推知了。至于像七情之气逆乱，就会损伤营卫而不运行，营卫不运行则液聚血凝，以及饮食过量、用力过度的情况也是如此，都不必等待与寒气相会合，就开始形成积滞产生疼痛了。况且如各篇中有说法，胃气实而血虚，脉象软散的，应当患食痹，即进食则疼痛；有说法称岁土太过，湿气淫胜，会导致大腹、小腹疼痛；有说法称冲脉的病，其气溢于大肠，附着于膏肓之原，在脐下，所以环绕脐部疼痛；有说法称脾病传肾，少腹冤热而痛；有说法称肝热病，腹痛身热；有说法称肾虚者，也见大腹、小腹疼痛；有说法称厥阴之厥，小腹肿胀；太阴厥逆，心痛牵引背部；有说法称六气司天在泉的胜复等邪气，各自随着它们进入的部位而疼痛，这难道不是各种邪气各有自己的途径进入而导致疼痛，起初并没有与寒相关吗？
《难经》说：脐上坚硬且疼痛，是心的内证。脐下坚硬且疼痛，是肾的内证。脐右坚硬且疼痛，是肺的内证。脐左坚硬且疼痛，是肝的内证。方书的论述不完备，不仅仅在此而已。至于厥心痛，由五邪相乘引起的，也不能推及四脏，与之没有区别，难道五五二十五阳气的相互移易，唯独心脏受影响吗？更对于五脏的疝气，如果不涉及睾丸，只在腹中疼痛的，还未能阐明。只知道诸脉紧急者为疝，不知道脉滑微有热的，也是病疝。详细情况见疝气条目。况且刘河间曾经解释急脉的意思，急脉固然是寒的征象，然而寒脉应当短小而迟，而不是急数而洪大的。由于紧脉主痛，急而致痛甚，所以疼痛而脉象有紧急的，脉是由心所养的。凡六气致病，心神就不安宁，而紧急不得舒缓，所以脉象也随之显现。想知道是何气致病，观察其紧急兼见的脉象就可以知道了。如紧急洪数，就是热痛之类。这种论述可以说是善于推演脉理和病情的人。问：各种邪气造成的疼痛我已经听明白了，然而邪气繁多，如何治疗？是否有所坚守的要约方剂呢？回答说：从博杂中寻求简约，何必担心简约没有其道？如果不从博杂出发而直接从事于简约，简约必然会失去其道，失去其道，难道不会有实实虚虚、诛伐无辜的祸患吗？然而道的关键在于审察经脉气血的虚实，辨别六淫五邪是否有兼夹之气，于是选择至真大要诸治法中，以及五郁应当施用的方法，然后选取经络，分清祛邪补正，选用适宜的药物，配伍君臣佐使组成方剂。像这样来简约，就像扎口袋一样，就能切中病症了。李东垣说：心胃痛及腹中各种疼痛，都是因为劳力过度，饮食不节，中气不足，寒邪乘虚而入停留，所以突然发作剧烈疼痛。经文说得热则停止，炅就是热。用热治寒，是正确的治法。然而腹痛有部位之分，脏腑有高下之别，治疗者也应当区分对待。如厥心痛，是寒邪客于心包络，前人用良姜、石菖蒲等大辛大热的药，研末，酒调服，疼痛立即停止，这是直折其势的方法。真心痛，是寒邪伤了君主之官（心），手足青紫至关节，严重的早晨发病晚上死，晚上发病早晨死。中脘痛，属太阴，用理中汤、建中汤、草豆蔻丸等主治。脐腹痛，属少阴，用四逆汤、姜附汤、御寒汤等主治。少腹痛，属厥阴，用正阳散、回阳丹、当归四逆汤等主治。杂证疼痛，用苦楝汤、酒煮当归丸、丁香楝实丸等主治。这是根据高下部位进行治疗。再沿着各脏部分的穴位进行灸刺，如厥心痛，痛如针刺其心，严重的，是脾之痛。取然谷、太溪穴，其他脏腑都类似。如腹中不和而疼痛，用甘草芍药汤主治。如伤寒误用下法，传入太阴腹满而痛的，用桂枝加芍药汤主治。疼痛剧烈的，用桂枝加大黄汤主治。夏季肌肤发热恶热，脉洪疾而痛的，用黄芩芍药汤主治。又有各种虫痛，如心腹烦闷懊恼，作痛聚散往来上下行，疼痛有休止，腹部发热口渴流涎，面色乍青乍白乍赤，呕吐清水的，是蛔虫咬噬。用手紧紧按住并保持住，不让虫子逃脱，用针刺入，久持针，虫子不动，才拔出针。或者用《局方》的化虫丸，以及治虫的药，根据虚实用量使用，不能一概而论。张元素（海藏）说：秋季腹痛，肌肤寒冷恶寒，脉沉微，由足太阴、足少阴主治，用桂枝芍药汤。中脘痛，属太阴，用理中、建中、黄芪汤等。脐腹痛，属少阴，用四逆、真武、附子汤等。小腹痛，属厥阴，重的用正阳散、回阳丹等，轻的用当归四逆汤等。太阴传少阴疼痛剧烈的，应当变为下利而停止。夏季腹痛，肌肤发热恶热，脉洪疾，由手太阴、足阳明主治，用芍药黄芩汤，治疗腹痛脉洪数。肚腹痛，用芍药甘草汤主治。稼穑作甘，甘味对应己土。曲直作酸，酸味对应甲木。甲己化土，这是张仲景的妙方。脉缓伤水，加桂枝、生姜。脉洪伤金，加黄芩、大枣。脉涩伤血，加当归。脉弦伤气，加芍药。脉迟伤火，加干姜。朱丹溪说：有寒、有热、有食积、有湿痰、有死血。绵绵作痛而无增减，喜欢热手按压，以及喜热食，脉迟的，是寒证。应当用香砂理中汤，或治中汤、小建中汤、五积散等药。如果用温药治冷痛无效，疼痛更甚，大便不甚通畅，应当轻微通利，用藿香正气散，每服加官桂、木香、枳壳各半钱，吞服下来复丹，或用苏感丸，不利，则根据虚实用量用神保丸。时痛时止，热手按而不散，脉洪大而数的，是热证。宜用二陈平胃散、炒黄芩、黄连，或四顺清凉饮、黄连解毒汤、神芎丸、金花丸等。如果腹中常觉有热而痛，这是积热，宜用调胃承气汤。感受暑邪而痛，或泄利并作，脉必虚豁，宜用十味香薷饮、六和汤。感受湿邪而痛，小便不利，大便溏泄，脉必细，宜用胃苓汤。痰积作痛，或时而眩晕，或呕吐冷涎，或下白积，或小便不利，或得辛辣热汤则暂时停止，脉必滑，宜用二陈汤加行气之剂，及星半安中汤。食积作痛，痛甚想大便，泻后痛减，脉必弦，或沉滑，宜用二陈平胃散加山楂、神曲、麦芽、砂仁、草果，温中丸、枳术丸、保和丸、木香槟榔丸等。酒积腹痛，用三棱、莪术、香附、官桂、苍术、厚朴、陈皮、甘草、茯苓、木香、槟榔主治。多年的败田螺壳，存性，加三倍量于木香槟榔丸中，再加山茵陈等分，效果很快。气滞作痛，痛则腹胀，脉必沉，宜用木香顺气散。死血作痛，痛有固定处而不移动，脉必涩或芤，宜用桃仁承气汤。虚者加当归、地黄蜜丸服用，以缓和消除。或者用牡丹皮、江西红曲、麦芽、香附、川通草、穿山甲、番降香、红花、苏木、山楂、玄胡索、桃仁泥，酒、童便各一钟，煎至一钟，加入韭汁服用。七情内结，或寒气外攻，积聚坚牢如杯，心腹绞痛，不能饮食，时发时止，发作即欲死，宜用七气汤。腹痛有发作停止的，有块状起伏往来的，吐清水的，都是虫痛。或者用鸡汁吞服万应丸下之，或者用椒汤吞服乌梅丸安之。《金匮要略》问：病腹痛有虫，脉象如何辨别？老师说：腹中痛，脉应当沉，如果反见洪大，所以有蛔虫。关上脉紧而滑的，是蛔毒。脉沉而滑的，是寸白虫。肘后粗以下三四寸处发热的，肠中有虫。脾胃虚弱而心火乘之，不能滋荣上焦元气，遇到冬季肾与膀胱寒水旺盛之时，子能令母实，导致肺金大肠相辅而来克制心、乘袭脾胃，这是大复其雠（报复）。经文说：大胜必大复，所以皮毛血脉分肉之间，元气已绝于外，又大寒大燥二气并乘之，则苦于恶风寒，耳鸣，以及腰背牵引胸中疼痛，鼻息不通，不闻香臭，额头寒冷脑痛，眼睛时常眩晕，不想睁开，腹中为寒水反乘，痰唾涎沫，食物吃进去反出来，腹中常痛，以及心胃痛，胁下急缩，有时疼痛，腹部不能努责，大便多泻而少秘，下气不绝或肠鸣，这是脾胃虚极的表现。胸中气乱，心烦不安，而为霍乱的征兆，膈咽不通，噎塞极则有声喘喝闭塞，或者白天在阳处稍缓，或者在暖房内稍缓，口吸风寒则复发，四肢厥冷，身体沉重，不能转侧，不可回顾，小便溲而时常干燥，用草豆蔻丸主治。这是主治秋冬寒凉大复气的药物。复气乘冬季足太阳寒气、足少阴肾水旺盛，子能令母实。手太阴肺实，反过来侮土，火木受邪，腰背胸膈闭塞疼痛，善嚏，口中流涎，眼中流泪，鼻中流浊涕不止，或者有息肉，不闻香臭，咳嗽痰沫，上热如火，下寒如水，头部阵痛，眼中流火，视物模糊不清，耳鸣耳聋，头并口鼻或恶风寒喜日阳，夜卧不安。常觉痰塞膈咽不通，口无滋味，两胁缩急而痛。牙齿动摇，不能嚼物，腰脐间及尻臀膝足寒冷，阴汗，前阴冷，行走倾斜，起居艰难，掌中寒，风痹麻木，小便数而白天多，夜间频而少。气短喘喝，少气不足以息，突然遗失无度。妇人白带，阴户中大痛，牵连心而痛，面色黧黑失色。男子控睾牵心，隐隐作痛，面如赭色，食少，大小便不调。烦心霍乱，逆气里急，而腹皮色白，后出余气，腹部不能努责或肠鸣，膝下筋急，肩胛大痛。这都是寒水来复火土之雠。用神圣复气汤主治。季秋心腹中大痛，烦躁，冷汗自出，宜用益智和中丸。季秋客寒犯胃，心胃大痛不可忍者，用麻黄草豆蔻丸。脾胃虚寒心腹满，及秋冬客寒犯胃，时作疼痛，宜用浓朴汤。为戊火已衰，不能运化，又加客气聚为满痛，散以辛热，佐以苦甘温，以淡泄之，扶持胃气，以期平衡。腹痛或大便利，或用手重按痛处不痛的为虚证，宜在上述治寒痛方中选用。无寒者，用芍药甘草汤。张仲景说：虚劳，里急腹中痛，用小建中汤主治。这是补例，也是温例。痛而便秘者，用浓朴三物汤主治。这是泻例，也是寒例。三阴受邪，于心脐少三腹疼痛气风等证，用当归丸主治。失笑散，治疗心腹痛有效。心痛门有刘寄奴玄胡索方，也治腹痛，都是通理气血的药剂。有全不喜欢吃东西，其人本体素来怯弱，而又加上腹冷疼的，用养胃汤，以人参、白术、苍术，仍加桂枝、吴茱萸各半钱，木香三分，应对腹冷痛，或者心脾疼的，加生姜，均治之。各种寒作痛，得热则停止的，用熨法。用熟艾半斤，以白纸一张，铺于腹上，纸上摊开艾绒令均匀，又以大葱数枝，劈成两半片，铺于艾上，再用白纸一张覆盖，用慢火熨斗熨之，冷了则更换，觉得腹中热、腹皮暖不禁受，用帛三搭多缝带系之，待冷才解开。一种方法用盐炒，布裹熨痛处，神效。腹痛证治，上面条款列得很详细了。但有因其他病而导致疼痛的，不可不明白。比如疝致腹痛，必定是睾丸肿疼牵引而痛，或者边有一条冲腹而痛。霍乱腹痛，必定吐利兼作，甚至有不呕不利，四肢厥冷痛极的，名叫干霍乱，又名搅肠沙。急用樟木煎汤大吐之；或者用白矾末一钱，清汤调服探吐之；或者用台芎为末，每一钱许入姜汁半盏，热汤调服。严重的面青昏倒不省人事，急以鼠矢一合，研为细末，滚汤调，澄清，通口服之。或者刺委中并十指出血。肠内生痈，也常腹痛，但小便数似淋，脉滑数，身甲错，腹皮急，按之濡，如肿状，或绕脐生疮，治法见本门。凡此数证，要当审辨，随其所因而施治，不要苟且而误人。
【少腹痛】
伤寒蓄血在下焦，宜用抵当丸、桃仁承气汤等。若因气郁而痛，以青皮主治。寒者，以桂枝、吴茱萸温之。（苦练丸、酒煮当归丸。）若因疝、奔豚、症聚者，更检本门施治。若身甲错，腹皮急，按之濡，如肿状，或绕脐生疮的，是小肠痈。急宜下之，或者用云母膏、太乙膏作丸服。
【诊】
脉多细小紧急。滑为痰。弦为食。阴弦或紧，或尺紧而实，或伏者，可下。细小迟者生。坚大疾者，数而紧者，浮大而长者死。痛而喘，脐下或大痛，人中黑色者，不治。
Question: How is abdominal pain generated? Answer: It arises from the struggle between pathogenic factors and healthy qi. The meridians are the pathways through which innate true qi flows in and out, serving as the routes connecting the zang-fu organs. Therefore, the robust essence of food and drink transforms into Ying (Nutritive) and Wei (Defensive) qi, circulating inside and outside the vessels, governing and expanding their functions. They circulate the Six Qi, operate the Five Phases, harmonize the Five Zang organs, distribute to the Six Fu organs, and follow the ascending, descending, floating, and sinking patterns of the Four Seasons to facilitate growth, transformation, and storage. The collateral branches of the regular meridians connect internally, separately guarding the regions of the zang-fu organs, each managing its own jurisdiction, responsible for the influx and efflux of qi and blood. All the wondrous functions of Ying and Wei qi are manifestations of innate true qi. Thus, the classics state: "Qi and blood are the spirit of humans; they must be carefully nourished." If properly nourished, pathogenic factors cannot harm the body. If neglected, Ying qi scatters and dissipates, allowing various pathogens to enter and lodge in the deficient areas of the zang-fu organs. Once lodged, qi stagnates and fluids accumulate, forming accumulations or phlegm; blood coagulates and fails to circulate, resulting in stasis or retention. The collaterals become full, pathogenic factors and healthy qi contend, true qi is pressured and hurried, thus causing pain.
The Spleen and Stomach correspond internally to the heart and abdomen; the Heart and Lungs correspond to the chest, epigastrium, and hypochondrium; the Liver corresponds to the hypochondrium and lower abdomen; the Kidneys correspond to the lower abdomen and lumbar spine; the Large Intestine, Small Intestine, Chong vessel, and Ren vessel are all located in the lower abdomen. These are the regions corresponding to the zang-fu organs. The *Jutong Lun* (Treatise on Pain) describes fourteen types of abdominal pain; only one belongs to heat, while the rest belong to cold. Later medical texts, therefore, treated them all as pain caused by wind-cold pathogenic factors attacking the body. Now you ask about various pathogens? I reply that later texts failed to integrate the principles of various chapters. Because they did not understand the meaning at the end of the chapter, which states that "all diseases arise from qi," and listed nine types of qi disorders, although pain was not explicitly mentioned, it implies that some may cause pain. Otherwise, why would these appear at the end of the chapter on pains? Consider the *Baibing Shisheng Pian* (Chapter on the Origin of Hundred Diseases) in the *Lingshu*: the principle is clear. Pathogens are described in three parts: wind and rain injure the upper part, and clear dampness injures the lower part. Injuries to the upper part involve pathogens entering from outside to inside, moving downward. Sequentially transmitting, when lodging at the Shu points, the Six Meridians become obstructed. Pathogens may attach to Luo collaterals, Jing meridians, Shu points, Fuchong vessels, or the membrane origins of the intestines and stomach, all capable of forming accumulations and pain. Injuries to the lower part begin in the feet; thus, accumulations originate from cold, and Jue (rebellious/cold extremities) qi forms accumulations. Jue qi originates in the feet, causing cold in the calves. Cold calves lead to congealed and sluggish blood vessels; congealed vessels allow cold qi to ascend into the stomach and intestines. Entering the stomach and intestines causes distension. Juice and foam outside the intestines are forced to gather and cannot disperse, gradually forming accumulations. Injuries to the zang organs begin in the yin aspect. Sudden overeating leads to intestinal fullness; irregular living habits and excessive exertion damage the collaterals. Damage to Yang collaterals causes external bleeding (epistaxis); damage to Yin collaterals causes internal bleeding (hematochezia/hematemesis). Damage to the collaterals of the stomach and intestines causes blood to overflow outside the intestines. With cold present outside the intestines, juice/foam and blood contend, merging and coagulating without dispersing, forming an accumulation. Sudden external exposure to cold, or internal injury from worry and anger, causes qi to rebel upward. Upward rebellion obstructs the Six Shu points, preventing warm qi from circulating. Congealed blood remains wrapped and undispersed, fluids become sluggish and seep, adhering and not leaving, forming accumulations. From a modern perspective, the "accumulation" described here refers to gathered juices and foams, not yet reaching the stage of hard masses (jia/ji). This aligns with the *Jutong Lun*'s description of qi and blood stagnation forming accumulations. Is it not because the discussion of Seven Emotions at the end of the chapter differs in causing pain? However, examining the intent of both chapters: *Baibing Shisheng Pian* focuses on the convergence of pathogens in three parts causing pain, hence linked statements. *Jutong Lun* focuses on each pathogen causing disease independently, so it singles out Cold Yin because cold pathogenic factors most severely obstruct yang qi. Using this as an example, others can be deduced. Regarding rebellious qi from Seven Emotions, it damages Ying and Wei qi, stopping circulation; stagnant fluids and congealed blood form, similar to overeating or excessive exertion. These do not need to wait for cold to combine before forming accumulations and pain. Furthermore, texts mention: if Stomach qi is excess and Blood is deficient, with a soft/scattered pulse, one suffers from Shi Bi (food obstruction), meaning pain upon eating. Another text states: excessive Earth year, overwhelming dampness, causes large and small abdominal pain. Another states: Chong vessel disease, qi overflows into the Large Intestine, attaching to the Gaohuang origin below the umbilicus, causing periumbilical pain. Another states: Spleen transmitting to Kidney causes hot pain in the lower abdomen. Another states: Liver heat disease involves abdominal pain and fever. Another states: Kidney deficiency causes large and small abdominal pain. Another states: Jueyin Jue causes lower abdominal swelling; Taiyin Jueni causes heart pain radiating to the back. Another states: Six Qi winning/losing/rebounding pathogens cause pain according to their entry site. Do these not show that various pathogens have their own paths to cause pain, unrelated to cold initially?
The *Nanjing* states: Hardness and pain above the umbilicus indicate Heart pathology; below the umbilicus, Kidney pathology; right of the umbilicus, Lung pathology; left of the umbilicus, Liver pathology. Textual incompleteness extends beyond this. Regarding Jue Xin Tong (Rebellious Heart Pain) caused by five pathogens interacting, it cannot be distinguished from other organ pains. Does the interaction of the twenty-five Yang meridians affect only the Heart? Also, regarding Five Zang Hernias, if pain is confined to the abdomen without involving the testicles, this is unclear. It is known that urgent/tight pulses indicate hernia, but it is unknown that slippery, slightly hot pulses also indicate hernia. See the Hernia section for details. Liu Hejian explained the urgent pulse: while urgency indicates cold, cold pulses should be short, small, and slow, not urgent, rapid, and surging. Since tight pulses indicate pain, urgency leads to severe pain. Thus, painful conditions with urgent pulses reflect the Heart's nourishment of the pulse. When Six Qi cause disease, the Heart Spirit becomes unsettled, unable to relax, so the pulse reflects this urgency. To identify the pathogenic factor, observe the combined urgent pulse characteristics. Urgent, surging, and rapid indicate heat pain. This demonstrates skillful deduction of pulse-pathology relationships. Question: I understand how various pathogens cause pain, but given their diversity, how should they be treated? Are there essential formulas? Answer: Seeking simplicity from complexity, one must not skip the complex to find simple methods, lest one lose the correct approach and commit errors of tonifying excess or purging deficiency. The key lies in assessing the deficiency/excess of meridian qi and blood, distinguishing the presence of Six Exogenous Factors and Five Pathogens, selecting appropriate treatments from the *Zhenyao Dajiao*, applying methods for Five Stagnations, choosing meridians, differentiating between expelling pathogens and supporting healthy qi, and selecting suitable herbs with Jun-Chen-Zuo-Shi formulation principles. This simplifies treatment like tying a bag, hitting the target accurately. Li Dongyuan stated: Heart/Stomach and abdominal pains often result from excessive labor, irregular diet, middle qi deficiency, and cold pathogens invading due to weakness, causing sudden severe pain. Classics say "heat stops it"; heat treats cold correctly. However, abdominal pain has locations, and organs have high/low positions, requiring differentiated treatment. Jue Xin Tong is cold lodging in the Pericardium; predecessors used dried ginger and Acorus (large acrid-hot), powdered and taken with wine, stopping pain instantly—this is direct suppression. Zhen Xin Tong is cold injuring the Monarch (Heart); hands/feet turn cyan to joints, death occurs morning-to-evening or evening-to-morning. Zhongwan pain belongs to Taiyin; treat with Lizhong Tang, Jianzhong Tang, Caodoukou Wan. Qifu (umbilical) pain belongs to Shaoyin; treat with Sini Tang, Jiangfu Tang, Yuhan Tang. Shaofu (lower) pain belongs to Jueyin; treat with Zhengyang San, Huiyang Dan, Danggui Sini Tang. Miscellaneous pains use Kulian Tang, Jiuzhu Danggui Wan, Dingxiang Lianshi Wan. This treats based on location. Further, moxa/acupuncture at specific points: Jue Xin Tong, stabbing heart pain, severe cases involve Spleen pain; select Ran Gu, Tai Xi. Other organs are similar. Abdominal disharmony pain uses Gancao Shaoyao Tang. Typhoid misused purgatives transmitting to Taiyin with fullness/pain uses Guizhi Jia Shaoyao Tang. Severe pain uses Guizhi Jia Dahuang Tang. Summer muscle-heat, aversion to heat, surging/rapid pulse pain uses Huangqin Shaoyao Tang. Parasite pain: cardiac/abdominal restlessness, wandering pain, intermittent, abdominal heat/thirst/salivation, changing complexion, vomiting water indicates Ascaris. Press firmly, needle deeply, hold until worm stops moving, then remove needle. Or use Jufang Huachong Wan or parasite herbs based on deficiency/excess. Zhang Yuansu (Haizang) stated: Autumn abdominal pain, cold skin/aversion to cold, deep/micro pulse, treated by Foot Taiyin/Shaoyin, Guizhi Shaoyao Tang. Zhongwan pain (Taiyin): Lizhong, Jianzhong, Huangqi Tang. Qifu pain (Shaoyin): Sini, Zhenwu, Fuzi Tang. Xiaofu pain (Jueyin): severe Zhengyang San/Huiyang Dan; mild Danggui Sini Tang. Taiyin transmitting to Shaoyin severe pain turns to diarrhea and stops. Summer abdominal pain, hot skin/aversion to heat, surging/rapid pulse, Hand Taiyin/Foot Yangming, Shaoyao Huangqin Tang for surging/rapid pulse. Umbilical pain: Shaoyao Gancao Tang. Sweet corresponds to Ji Earth; Sour to Jia Wood. Jia-Ji transform to Earth, Zhang Zhongjing's subtle formula. Slow pulse damaging Water adds Guizhi/Shengjiang; Surging pulse damaging Metal adds Huangqin/Dazao; Choppy pulse damaging Blood adds Danggui; Wiry pulse damaging Qi adds Shaoyao; Delayed pulse damaging Fire adds Ganjiang. Zhu Danxi stated: Cold, Heat, Food Stagnation, Damp-Phlegm, Dead Blood. Continuous pain without fluctuation, preferring heat pressure/food, delayed pulse indicates Cold. Use Xiangsha Lizhong Tang, Zhizhong Tang, Xiao Jianzhong Tang, Wuji San. If warm herbs fail for cold pain, worsening with slight constipation, mildly purge with Huoxiang Zhengqi San plus Guizhi, Muxiang, Zhike half qian each, swallow Laifu Dan, or Sugan Wan. If ineffective, Shenbao Wan based on deficiency/excess. Intermittent pain, heat pressure doesn't disperse, surging/rapid pulse indicates Heat. Use Erchen Pingwei San, fried Huangqin/Lian, Sishun Qingliang Yin, Huanglian Jiedu Tang, Shenxiong Wan, Jinhua Wan. Constant heat-pain indicates accumulated heat; use Tiaowei Chengqi Tang. Summerheat pain with diarrhea, vacuous pulse: Shiwei Xiangru Yin, Liuhe Tang. Dampness pain, difficult urination, loose stool, fine pulse: Weiling Tang. Phlegm-stagnation pain, dizziness, cold saliva, white discharge, difficult urination, relieved by spicy/hot drinks, slippery pulse: Erchen Tang with qi-moving agents, Xingban Anzhong Tang. Food-stagnation pain, urge to defecate, relief after stool, wiry/choppy-slippery pulse: Erchen Pingwei San plus Shan Zha, Shen Qu, Maiya, Sharen, Cao Guo, Wenzhong Wan, Zhizhu Wan, Baohe Wan, Muxiang Binglang Wan. Wine-stagnation pain: Sanleng, Ezhu, Xiangfu, Guizhi, Cangzhu, Houpo, Chenpi, Gancao, Fuling, Muxiang, Binglang. Old snail shells calcined, triple amount added to Muxiang Binglang Wan, plus Yinchen equal parts, very effective. Qi-stagnation pain, distension, deep pulse: Muxiang Shunqi San. Dead-blood pain, fixed location, choppy/vacuous pulse: Tao Ren Chengqi Tang. Deficiency add Danggui/Dihuang honey pills. Or Mudan Pi, Hongqu, Maiya, Xiangfu, Tongcao, Shanzhujia, Jiangxiang, Honghua, Sumu, Shan Zha, Yuanhu, Taoren paste, decocted with wine and child's urine, add leek juice. Seven Emotions internal knotting or external cold attack, hard accumulations like cups, cardiac/abdominal colic, inability to eat, intermittent fatal attacks: Qi Qi Tang. Intermittent pain, moving masses, vomiting clear fluid: parasite pain. Swallow Wanying Wan with chicken juice, or Wumei Wan with pepper soup. *Jingui Yaolue* asks: How to distinguish parasitic abdominal pain by pulse? Master says: Abdominal pain usually has deep pulse; if surging/large instead, it indicates Ascaris. Tight-slipper pulse at Guan indicates Ascaris toxin. Deep-slippery pulse indicates Tapeworm. Heat 3-4 cun below elbow coarse line indicates intestinal worms. Spleen/Stomach deficiency with Heart fire attacking fails to nourish Upper Jiao yuan qi. In winter, Kidney/Bladder cold water prospers; "Child makes Mother full," Lung/Large Intestine assist to overcome Heart/Spleen-Stomach, representing great rebound. Classics: "Great victory brings great rebound." Yuan qi exhausted externally; Great Cold/Dryness attack together. Suffer wind/cold aversion, tinnitus, waist/back pulling chest pain, nasal congestion, loss of smell, forehead cold/headache, vertigo, eyes unwilling to open. Abdomen invaded by cold water, phlegm/saliva, regurgitation, constant abdominal/cardiac pain, hypochondriac contraction/pain, inability to strain, frequent diarrhea/infrequent constipation, continuous flatulence/borborygmus. Extreme Spleen/Stomach deficiency. Chest qi chaos, irritability, precursor to Huoluan. Diaphragm/throat blockage, choking sounds, breathing difficulty. Relieved by sun/warm rooms; worsened by wind/cold. Limb coldness, heavy body, immobility, inability to look back, frequent dry urination. Treat with Caodoukou Wan. This treats autumn/winter cold rebound. Rebound qi in winter with Foot Taiyin/Shaoyin prosperity, Child makes Mother full. Hand Taiyin Lung excess insults Earth, Fire/Wood suffer. Waist/back/chest blockage/pain, sneezing, salivation, tearing, turbid nasal discharge, polyps, anosmia, cough/phlegm, upper heat/fire, lower cold/water, paroxysmal headache, eye burning, blurred vision, tinnitus/deafness. Head/nose/facial wind/cold aversion or preference for sun, restless sleep. Phlegm blocking diaphragm/throat, tastelessness, hypochondriac contraction/pain. Loose teeth, inability to chew, cold waist/navel/gluteal/knee/foot, genital sweating/cold, walking unsteady, difficult movement, cold palms, wind-bi numbness, frequent day urination/frequent night low volume. Shortness of breath, insufficient qi, sudden incontinence. Women: leukorrhea, severe vaginal pain pulling to heart, dark complexion. Men: testicular pain pulling to heart, dull pain, ruddy face, poor appetite, bowel/bladder dysfunction. Irritability, Huoluan, rebellious qi, abdominal tension, pale abdominal skin, residual gas, inability to strain, borborygmus, knee tendon tension, shoulder blade pain. All represent Cold Water rebelling against Fire/Earth. Treat with Shensheng Fuqi Tang. Late autumn cardiac/abdominal severe pain, irritability, cold sweat: Yizhi Hezhong Wan. Late autumn external cold invading Stomach, unbearable cardiac/stomach pain: Mahuang Caodoukou Wan. Spleen/Stomach deficiency-cold fullness, autumn/winter external cold invading Stomach, intermittent pain: Houpo Tang. Wu Fire declining, failing to transform, guest qi gathering causes fullness/pain. Disperse with acrid-hot, assist with bitter-sweet-warm, drain with bland, support Stomach qi, aim for balance. Abdominal pain with free stool or pain relief upon heavy pressure indicates deficiency; select from above cold-pain formulas. No cold: Shaoyao Gancao Tang. Zhongjing: Consumption, interior tension/abdominal pain, Xiao Jianzhong Tang. Tonification method, warming method. Pain with constipation: Houpo Sanwu Tang. Purging method, cold method. Three Yin pathogens, cardiac/umbilical/lower abdominal pain/qi/wind syndromes: Danggui Wan. Shixiao San effective for cardiac/abdominal pain. Xin Tong section mentions Liu Jinu/Yuanhu formula for abdominal pain, both regulating qi/blood. Total anorexia, weak constitution, cold abdominal pain: Yangwei Tang with Renshen, Baizhu, Cangzhu, plus Guizhi/Zhuyu half qian, Muxiang 3 fen. For cardiac/Spleen pain, add Shengjiang. All cold pains relieved by heat: moxibustion/ironing. Half jin cooked mugwort, paper on abdomen, spread mugwort evenly, green onion split, place on mugwort, cover with paper, iron with slow fire. Replace when cool. When abdomen feels hot/skin warm, bind with cloth strips. Wait to cool before removing. Alternative: salt stir-fried, cloth-wrapped ironing, miraculous effect. Abdominal pain treatments detailed above. But pain caused by other diseases must be clarified. Hernia-induced pain: testicular swelling/pain radiating, or band-like pain rushing to abdomen. Huoluan abdominal pain: vomiting/diarrhea together. Even non-vomiting/non-diarrhea, limb coldness/extreme pain is Dry Huoluan (Intestine-Twisting Sand). Urgently vomit using Camphor wood decoction; or Alum powder 1 qian with clear water to induce vomiting; or Xiong powder 1 qian with ginger juice/hot water. Severe cyanosis/coma: Rat feces 1 he, powder, hot water, clarify, drink orally. Or prick Weizhong and ten fingertips to bleed. Intestinal abscess causes abdominal pain, frequent urination resembling strangury, slippery-rapid pulse, rough skin, tense abdomen, soft on pressure, swollen appearance, or periumbilical sores. Treatment in this section. All these syndromes require differentiation and treatment according to cause, avoiding negligence.
[Lower Abdominal Pain]
Typhoid blood stasis in Lower Jiao: Didang Wan, Tao Ren Chengqi Tang. Qi-stagnation pain: Qingpi. Cold: Guizhi, Wuzhuyu to warm. (Kulian Wan, Jiuzhu Danggui Wan.) Hernia, Ben Tun, mass accumulation: see respective sections. Rough skin, tense abdomen, soft on pressure, swollen appearance, periumbilical sores: Small Intestine Abscess. Urgently purge. Yunmu Gao, Taiyi Gao pills.
[Diagnosis]
Pulse mostly small, thin, urgent. Slippery indicates Phlegm. Wiry indicates Food. Yin-wiry, tight, Chi-tight-solid, or hidden: purgative indicated. Small-thin-delayed: survival. Firm-large-rapid, rapid-tight, floating-large-long: death. Pain with panting, lower abdominal severe pain, black nasolabial fold: incurable.