肝火盛而胁痛者，肝气实也。其人气收善怒。经云∶肝病者，两胁下痛引少腹，善怒，
又云
∶肝气实则怒是也，其脉当弦急数实，其口当苦酸，其痛必甚，或烦热，或渴，或二便热涩
不通。
龙荟丸方 丹溪云∶治肝火胁痛要药。
龙胆草 当归（并酒洗） 栀子 黄连 黄柏 黄芩（各一两） 大黄（酒浸） 青黛 芦荟
（各五钱） 木香（二钱半） 麝香（五分）
蜜丸小豆大，姜汤下二三十丸。
《元珠》云∶一人性躁，夏月受热，忽左胁间痛，皮肤红如碗大，发水 疮三五点，脉弦数
，医作肝经郁火治之，用黄连、青皮、香附、川芎、柴胡之类，进一剂痛益甚，且增热，皮
红大如盘，水泡疮又加至三十余粒。医以水调白郁金末敷，于前剂加青黛、龙胆进之，夜痛
益甚，胁中如钩摘之状。次早视之，红已及半身矣，立泡又增至百数。后询黄古潭乃以大栝
蒌一枚，连皮捣烂，加粉草二钱，红花五分，药进而痛止。盖前药苦寒，益资其燥，栝蒌之
为物，柔而润滑，于郁不逆，甘缓润下，故奏效捷也。
污血胁痛者，凡跌仆损伤，污血必归胁下故也。其症昼轻夜重，或午后发热，脉短涩或
搏
，其人喘逆。经云∶肝脉搏坚而长，色不青，当病坠若搏，因血在胁下，令人喘逆是也。
东垣复元活血汤
柴胡（半两） 栝蒌根 当归（各三钱） 红花 甘草 穿山甲（炮，各二钱） 大黄（酒浸
，一钱半） 桃仁（去皮尖，研如泥，五十枚）
上除桃仁外，锉如麻豆大，每服半两，水盏半，酒半盏，同煎至七分，去渣，大温服之
，以利为度。
《针经》云∶有所堕坠，恶血留内，若有所大怒，气上而不下，积于胁下，则伤肝。肝
胆之
经俱行于胁下，经属厥阴少阳，宜以柴胡为君，以当归和血脉。又痛者急也，甘草缓其急，
亦能生新为臣。穿山甲、栝蒌根、桃仁、红花破血润血为佐，大黄酒制以荡涤败血为使，气
味和合，气血有所归，痛自定矣。
芍药散 治妇人胁痛。
白芍药 延胡索 肉桂（各一两） 香附（二两，醋一升，盐半两，同煮干）
上为细末，每服二钱，不拘时白汤下。
肝火旺盛导致的胁痛，是由于肝气实证所致。这类患者性格收敛且容易发怒。《内经》说：肝病的人，两侧胁下疼痛并牵引至小腹，容易发怒；又说：肝气实就会发怒。其脉象应当是弦、急、数、实，口中应当感觉酸苦，疼痛必然剧烈，或者伴有烦热，或者口渴，或者大小便热涩不通。
龙荟丸方剂。朱丹溪说：这是治疗肝火胁痛的要药。
配方：龙胆草、当归（均用酒洗）、栀子、黄连、黄柏、黄芩（各一两），大黄（用酒浸泡）、青黛、芦荟（各五钱），木香（二钱半），麝香（五分）。
制成蜜丸，大小如小豆，用姜汤送服二十至三十丸。
《元珠》记载：有一人性情急躁，夏季受热后，突然左胁间疼痛，皮肤红肿如碗大，发出三五点水疱疮，脉象弦数。医生将其诊断为肝经郁火进行治疗，使用了黄连、青皮、香附、川芎、柴胡等药物，服用一剂后疼痛更加剧烈，并且增加了发热，皮肤红肿扩大如盘，水泡疮又增加到三十多粒。医生用水调和白郁金粉末外敷，并在前一方剂中加入青黛、龙胆草内服，夜间疼痛更加剧烈，胁中疼痛如同被钩摘一般。第二天早上查看，红肿已蔓延至半身，新起的泡增至上百个。后来咨询黄古潭，他用一枚大栝蒌，连皮捣烂，加入粉甘草二钱、红花五分，服药后疼痛停止。这是因为前面的药物过于苦寒，反而助长了燥性；而栝蒌这种药物，性质柔润光滑，对于郁结之气不违背，具有甘缓润下的作用，所以见效迅速。
污血（瘀血）导致的胁痛，是因为凡是跌打损伤，瘀血必然会积聚在胁下。其症状表现为白天轻晚上重，或者午后发热，脉象短涩或搏动有力，患者出现气喘逆乱。《内经》说：肝脉搏动坚实而长，面色不发青，应当是遭受坠落或打击所致，因为血液停留在胁下，导致人气喘逆乱，说的就是这种情况。
东垣的复元活血汤方剂。
配方：柴胡（半两），栝蒌根、当归（各三钱），红花、甘草、穿山甲（炮制，各二钱），大黄（用酒浸泡，一钱半），桃仁（去皮尖，研成泥状，五十枚）。
以上除桃仁外，锉碎如麻豆大小，每次服用半两，用水一盏半、酒半盏，共同煎煮至七分，去渣，趁大温热服，以大便通畅为度。
《针经》说：如果有坠落受伤，恶血留在体内，如果又有大怒，气机上逆而不能下行，积聚在胁下，就会伤及肝脏。肝胆的经脉都行走在胁下，经脉分别属于厥阴经和少阳经，适宜以柴胡为君药，以当归调和血脉。另外，痛症即是急症，甘草可以缓解急迫，也能促进新血生成，作为臣药。穿山甲、栝蒌根、桃仁、红花破血润血，作为佐药；大黄经酒制以荡涤败血，作为使药。气味调和，气血有所归依，疼痛自然安定。
芍药散，治疗妇女胁痛。
配方：白芍药、延胡索、肉桂（各一两），香附（二两，用醋一升、盐半两，同煮至干）。
以上研为细末，每次服用二钱，不拘时间，用白开水送服。
Liver fire causing hypochondriac pain is due to Liver Qi excess (Liver Qi Excess). Such individuals have a reserved nature and are prone to anger. The Classics state: "In Liver diseases, there is pain in both hypochondria radiating to the lower abdomen, and irritability." It also states: "Excess of Liver Qi leads to anger." The pulse should be wiry (Xian), rapid (Shu), forceful (Shi), and tense (Ji). The mouth may taste sour and bitter. The pain must be severe, possibly accompanied by vexation and heat, thirst, or hot and obstructed urination and defecation.
Longhui Wan (Dragon Gallbladder Pill) Formula. Zhu Danxi stated: This is an essential medicine for treating hypochondriac pain caused by liver fire.
Ingredients: Longdan Cao (Gentianae Radix), Danggui (Angelicae Sinensis Radix, both washed with wine), Zhizi (Gardeniae Fructus), Huanglian (Coptidis Rhizoma), Huangbai (Phellodendri Cortex), Huangqin (Scutellariae Radix) (each 1 liang); Dahuang (Rhei Radix et Rhizoma, soaked in wine), Qingdai (Indigo Naturalis), Lushen (Aloe) (each 5 qian); Muxiang (Aucklandiae Radix) (2.5 qian); Shexiang (Moschus) (0.5 fen).
Make into honey pills the size of small beans. Take 20-30 pills with ginger decoction.
Yuanshu records: A person with an irritable temperament suffered heat exposure in summer and suddenly experienced pain in the left hypochondrium. The skin was red like a bowl, with 3-5 water blisters appearing. The pulse was wiry and rapid. The physician diagnosed it as constrained fire in the Liver channel and prescribed herbs such as Huanglian, Qingpi (Citri Reticulatae Pericarpium Viride), Xiangfu (Cyperi Rhizoma), Chuanxiong (Ligustici Chuanxiong Rhizoma), and Chaihu (Bupleuri Radix). After one dose, the pain worsened, fever increased, the redness expanded to the size of a plate, and the blisters increased to over thirty. The physician applied white Yujin (Curcumae Radix) powder mixed with water externally and added Qingdai and Longdan Cao to the internal prescription. At night, the pain became excruciating, feeling like hooks tearing at the hypochondrium. The next morning, redness had spread to half the body, and new blisters numbered over a hundred. Later, consulting Huang Gutan, he used one large Gualou (Trichosanthis Fructus), mashed with the peel, added Fugcao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle) 2 qian, and Honghua (Carthami Flos) 0.5 fen. The pain ceased after taking the medicine. This is because the previous bitter-cold medicines exacerbated dryness; whereas Gualou is soft and lubricating, does not oppose stagnation, and has sweet,緩 (soothing), and descending moistening properties, thus achieving quick results.
Hypochondriac pain caused by stagnant blood (stasis) occurs because traumatic injuries cause blood stasis to accumulate in the hypochondrium. Symptoms include mild pain during the day and severe pain at night, or afternoon fever, a short and choppy (Se) or forceful pulse, and wheezing/asthma. The Classics state: "If the Liver pulse is firm and long, but the complexion is not green, it indicates injury from falling or beating, because blood remains in the hypochondrium, causing wheezing and asthma."
Dongyuan's Fuyuan Huoxue Tang (Revive the Original Blood-Invigorating Decoction) Formula.
Ingredients: Chaihu (Bupleuri Radix) (0.5 liang), Gualougen (Trichosanthis Radix), Danggui (Angelicae Sinensis Radix) (each 3 qian), Honghua (Carthami Flos), Gancao (Glycyrrhizae Radix et Rhizoma), Chuanshanjia (Manis Squama, processed) (each 2 qian), Dahuang (Rhei Radix et Rhizoma, soaked in wine) (1.5 qian), Taoren (Persicae Semen) (skin and tips removed, ground into paste, 50 seeds).
Except for Taoren, chop the other ingredients to the size of hemp seeds. For each dose, take 0.5 liang, add 1.5 cups of water and 0.5 cup of wine. Simmer until 0.7 cup remains, strain, and drink warm. Continue until bowel movement is achieved.
Zhenjing (Needle Classic) states: If there is a fall or injury, evil blood remains inside. If accompanied by great anger, qi rises but does not descend, accumulating in the hypochondrium, the Liver is injured. The Liver and Gallbladder meridians both run through the hypochondrium, belonging to the Jueyin and Shaoyang channels respectively. Therefore, Chaihu should be used as the Sovereign herb to harmonize the blood vessels with Danggui. Pain implies urgency; Gancao soothes urgency and generates new blood, serving as the Minister herb. Chuanshanjia, Gualougen, Taoren, and Honghua break stasis and moisten blood, serving as Assistant herbs. Wine-processed Dahuang sweeps away ruined blood, serving as the Envoy herb. When flavors and effects harmonize, qi and blood find their proper residence, and pain naturally subsides.
Shaoyao San (Peony Powder) treats hypochondriac pain in women.
Ingredients: Baishaoyao (Paeoniae Radix Alba), Yanhusuo (Corydalis Rhizoma), Rougui (Cinnamomi Cortex) (each 1 liang); Xiangfu (Cyperi Rhizoma) (2 liang, boiled dry with 1 sheng of vinegar and 0.5 liang of salt).
Grind into fine powder. Take 2 qian per dose, at any time, with plain warm water.