一 一妇耳内外肿痛，胸胁不利，寒热往来，小便不调。立斋曰∶此肝火伤血所致。先用龙胆泻肝
汤四剂，诸症顿退，又用加味逍遥散而愈。
二 一人耳内不时作痛，痛极欲死，痛止如故。立斋诊之，六脉皆安，意其有虫误入，令急取猫
尿〔生姜擦鼻、即出〕滴耳，果出臭虫而安。
三 一小儿患耳聋，经年服药不效，殊不知此肾疳也，用六味丸加桑螵蛸，服之而愈。
胃脘痛，俗呼心痛。盖胃之上口名贲门，与心相近，故经亦言胃脘当心而痛，若真心痛必死。经
曰∶心者五脏六腑之大主也，精神之所舍也，其脏坚固，邪不能客也，客之则心伤，心伤则神去，神去
则死矣。故诸邪之在心者，皆在于心之包络，其心痛之与包络痛别者，包络之痛，在两乳中间；其与胃
脘痛别者，心痛在岐骨陷处，胃脘痛在心之下；其与胸痛别者，胸痛在心之上。横满胸间也。但胸痛
宜分属肺属心、属肝，辩之既明，治之自效。而胃痛之因亦异，有因气郁，因血瘀。有因食积，因痰
饮，因寒，因火，因虫，因虚之不同。宜分别而治之。包络之痛，皆因思虑伤神，涸血所致，须参胃痛
之条分治，但无食耳。按丹溪云∶治胃痛宜分新久，若明知身受寒气，口食寒物，于初病之时，当用温
散温利之剂。若稍久则郁蒸成热，再用温剂，宁不助火添痛乎？故古方多用山栀为君，稍加温热，为之
向导，则邪易伏，病易起。腹痛之因，亦同胃痛分治，但有应下一法。又须辩其因食积，因瘀血，因痰
饮之异。更有内痈作痛，最宜审慎。如胃脘生痈，亦在中脘，手不可按，或寒热作渴。肠痈则小腹硬
痛，频数如淋。丹溪言∶
内痈症，因饮食之毒，七情之火，相郁而成。故初起时，急宜清热解毒，凉血破瘀之剂下之，须参外科
诸书治之则善。按景岳云∶近治痛，有以诸痛为实，痛无补法者，有以通则不痛，痛则不通者，有以痛
随利减者，皆为不易之法。不知形实病实 秘不通者，乃为相宜；若形弱脉弱，食少便泄者，岂容混治。
须知拒按者为实，可按者为虚；疼痛而胀闭者多实，不胀不闭者多虚；喜寒者多按实，爱热者多虚；
饱则甚者多实，饥则甚者多虚；脉实气粗多实，脉虚气少者多虚，新病年壮者多实，久病年老者多者虚；
补而不效者多实，攻而愈剧者多虚。必以望、闻、问、切，四者详辩，则虚实自明。仲景云∶阳明中
土，万物所归。故世人之患胃痛腹痛者甚多，而其治病之因，亦难以悉数，临症之际，当潜心会通各
门，参究施治，庶不致误。
芍甘汤 胃脘心腹诸痛，主此随症加减。
白芍〔制肝补脾，活血止痛。酒炒。三、四钱。〕木香 豆蔻〔快气，各五、七分。〕
香附〔制，各二、三钱。〕甘草〔和中缓痛。炙钱许〕。可加枳壳、橘红、玄胡、郁金〔行瘀
各一、二钱。〕苏子〔炒研。〕茯苓〔消痰。〕山楂 麦芽〔化食。各二、三钱。〕如挟
热。〔时作时止，得热更甚〕。本方采加芩、连、山栀、川楝〔泻火则痛自止。〕羚羊角〔能疗腹病
热满。〕如挟寒〔痛无增减，得热则止。〕本方采加桂、附、干姜、沉香〔温中则痛自停。〕吴茱萸〔能除
腹痛冷服。〕挟虚〔重按之则痛缓。〕本方采加参、术、当
归。〔气旺脾健血充，虚痛自止。〕
此方以芍甘汤为主，乃健脾最胜之剂，能治血虚腹痛。夫邪之所凑，其气必虚，故须此二味。又、
凡痛定因气滞，气滞则血为之凝，痰为之结，食亦为不消。以上加入诸药，皆快气行瘀，消食化痰之
品，常用颇效，至若挟寒、挟热、挟虚，各随其所宜，加药以治之。
四磨汤 胃脘胸腹因气郁不舒，痞结胀满，攻刺而痛者宜之。
木香 真沉香〔调气开郁。〕枳实 尖槟榔、降气破结〕。加乌药名五磨饮，白
汤磨服。
此一派调气降气之剂，气实者宜之。
聚宝丹 凡一切因气滞血凝作痛者，用俱神效。
木香、沉香、砂仁〔各三钱。〕麝香〔快气，八分。〕玄胡、乳香、没药〔各三
钱。〕真血竭〔活血，一钱五分。〕〔另研入药。若同药研，即化作尘〕。
〔为细末，糯米糊丸如弹子，朱砂为衣，或酒或随症用汤化服〕。
此快气活血之剂，昔人谓其能治胃脘寒痰结阻，致反胃呕吐，饮食不进者，亦甚神验。乃痰随
气降之义。
失笑散〔治胃脘胸腹，因瘀血停留，满痛拒按。〕
蒲黄〔凉血活血。〕五灵脂〔散血活血。〕何氏加玄胡、山楂、赤芍、没药、姜黄〔
行瘀血。〕尖槟榔〔破滞气。〕木通〔通血脉。〕临服入盐卤。〔入血软坚，二、三匙。〕
可加犀角〔辛寒破蓄血。〕羚羊角〔咸寒祛恶血。〕如可下者，宜桃仁承气加减下之。
此系何氏秘方，称其能治九种心疼，诸药不应者。盖以
痛久气滞血凝，用此得效者，血行则气和而痛止也。
保和丸〔见泄泻。〕治伤食胃脘腹痛，〔如食在上，胸膈饱闷，嗳腐吞酸。如食在中，腹
满硬痛拒按。如食在下，绕脐硬病拒按。〕主此加减。〔外用陈糟炒热，加盐、麝香熨之，内已热甚者
忌之。〕如可下者，宜承气之属下之。
二陈汤〔见中风。〕治胃脘胸腹因停痰留饮作痛，或吐清涎，或发眩晕，主此加减。如可下者，
礞石丸微利之。
黄芩汤 竹叶石膏汤〔俱见伤寒。〕治胃脘胸腹，因火热痛甚者，选而用之。
香苏散〔见伤寒。〕治外感寒，内食冷，胃脘心腹作痛。
宜加草豆蔻 生姜〔寒散温中。〕香砂〔利气止痛。〕甚者加桂心、吴茱萸等。〔
治心腹冷痛。〕
盏落汤〔言盏落痛即止。〕治胃脘心腹，因虚寒痛者。
胡桃肉〔益命门火，则寒可除；利三焦气，则痛自止。三枚。〕大枣〔同胡桃肉，补脾胃
而兼温，同生姜，调荣卫而兼散。三枚，去核，夹桃肉，纸裹煨熟。〕生姜〔三片。煎汤，细嚼送下，
永不再发。〕可加沉砂。如果虚寒甚者，可选用理中汤、参附汤之属。
槟黄丸 胃脘心腹因虫作痛，痛有休止，面生白斑，或吐清水，淡食而饥则痛，浓味而饱则安，宜
于上半月服之。〔虫头向上故也。下半月则虫头向下，先食鸡肉汁，或蜜或糖，引之向上，随后服药。〕
鸡心槟榔、雄黄、制绿矾〔皆主杀虫。等分为末，饭丸米大，空心每服一钱至三钱，量人虚
实用之。〕
万应丸 下虫积如神。
雷丸〔醋煮。〕槟榔〔杀虫。〕黑丑〔下虫积之迅药。〕大黄〔攻积滞之要品。各
六两。〕木香〔一两。〕沉香〔气芳引虫食，气利使积行。五钱。〕
〔共为末，用皂荚、苦楝根各四两，煎汤泛为丸，绿豆大，外用二香末为衣。每服一钱至三
钱，五更时砂糖汤下。〕
异功散〔见中风。〕
归脾汤〔见虚劳。〕胃脘心腹因虚而痛者，宜主此加减治之。
此数方或因食、因痰、因热、因寒、因虫、因虚，宜各审明而采用之。
《金匮》大黄丹皮汤 治肠痈小腹坚肿如掌而热，〔痈势已成。〕疼痛拒按，肉色如故。〔痈
不在躯壳也。〕或 赤微肿，小便频，〔火逼下行之故。〕汗出憎寒，〔因卫气为热毒壅遏，不行于表，
表失其固护也。〕或发热，〔经言热盛于中，故热遍于身。〕或肌肤甲错如鳞，〔血瘀成痈，不充肌肤之
故。〕脉数者，宜此方急下之。
大黄 芒硝〔均能荡热，散结，逐血。各钱许，量加。〕丹皮〔凉血，二钱。〕桃
仁〔破瘀。〕栝蒌仁〔利肠胃，消痈肿，各二钱。〕冬瓜仁〔散瘀毒，治肠痈。五钱。〕加
宜犀角〔散邪清热，凉血解毒，五钱。〕猪悬蹄甲〔祛腹中伏热，能治肠痈。酒炙研末三
钱。〕苡仁〔利肠胃，消毒肿。〕鲜金银藤〔数两。〕煎汤煎药。〔再加紫花地丁一、二
两同煎更佳。〕
此方虽为下药，实内消药也，故稍有脓则从下去，未成脓，即下出瘀热毒血而肿消矣。按立斋
云∶如脉洪数，以手掩肿上热极者，血已成脓，下恐伤肠胃之气，宜苡仁汤排之，即本方去硝、黄加苡仁。
会脓汤 治腹中肿毒。
大黄〔泻血分之热极。二两。〕乳香 没药〔通血气之壅滞。〕五灵脂〔散血化
瘀。〕穿山甲〔破血逐瘀。〕僵蚕〔化痰散结。〕白芷〔散肿排脓。各五钱。〕
〔为末，每服五钱，酒下。脓从大便出，幼者服三钱。〕
《金匮》排脓散 诸疮痈毒皆可宗用。
生鸡子〔解热毒。〕枳壳〔破结气为君。〕赤芍〔行瘀血为臣。〕桔梗〔开提
肺气，〕宜加桑皮。〔清利肺气。盖肺主周身之气，气利血行，则脓成毒化。〕
立斋云∶余治胃脘痈，每用前方加清胃药亦效。若吐脓血，饮食少思，则壮胃气为主，而佐以前
药，不可专治其痈。又言肠痈不可惊之，惊则肠断而死。故坐卧转侧，务宜徐缓，时少饮薄粥，及服固元
气药，静养调理，庶可得生。
痛甚者脉多伏，伏脉有因火者，有因气郁、血瘀、食滞、痰滞，亦有因寒者。〔阴气盛，阳气衰
故也。〕促脉因火亢，亦有因气血食痰停滞，阻其营运之机，皆致歇止。如止数渐稀，则为病瘥；止数渐
增，则为病剧。代脉痛家不忌。滑伯仁曰∶无病而瘦羸脉代者危候也。暴病而气血乍损，只为病脉。
大痛而喘，人中黑者死。真心痛手足寒至节，心痛甚，
旦发夕死，夕发旦死。
一、一位妇女耳内外肿痛，胸胁部气机不畅，寒热交替发作，小便失调。薛立斋说：这是肝火损伤血液所致。先用龙胆泻肝汤（清泻肝胆实火的方剂）服用四剂，各种症状立刻消退，接着用加味逍遥散（在逍遥散基础上加减的方剂）而痊愈。
二、一个人耳内不时疼痛，痛到极点想要死去，痛止后如常人一样。薛立斋诊察发现六脉平和，推测是有虫子误入，命令紧急取猫尿滴入耳中（或用生姜擦鼻，虫子就会出来），果然排出臭虫而安宁。
三、一个小孩患耳聋，常年服药无效，却不知道这是肾疳（因肾虚导致的疳积类疾病），用六味丸（滋补肾阴的经典方剂）加桑螵蛸（固精缩尿药材），服用后痊愈。
胃脘痛，俗称心痛。因为胃的上口叫贲门，与心脏相近，所以医经也说胃脘当心而痛，如果是真心痛（心脏本体受邪的重症）必死无疑。医经说：心是五脏六腑的大主，精神居住的地方，它的脏器坚固，外邪不能侵犯；如果邪气侵入则心受伤，心伤则神去，神去则死亡。所以凡是邪气在心部的，都在于心包络（保护心脏的外围组织）。心痛与心包络痛的区别在于：心包络的痛在两乳中间；它与胃脘痛的区别在于：心痛在歧骨（剑突）凹陷处，胃脘痛在心的下方；它与胸痛的区别在于：胸痛在心的上方，横满于胸间。但胸痛应当分辨属于肺、属于心、还是属于肝，辨证清楚后，治疗自然有效。而胃痛的原因也各不相同，有因气郁、因血瘀、因食积、因痰饮、因寒、因火、因虫、因虚等不同情况。应当分别治疗。心包络的痛，都是因为思虑过度损伤心神，导致血液枯竭所致，需要参考胃痛条目分别治疗，只是没有食积罢了。按朱丹溪所说：治疗胃痛应当区分新病和久病。如果明确知道身体受了寒气，口中吃了寒凉食物，在初病之时，应当使用温散、温利的药剂。如果时间稍长，则郁结蒸腾化为热，再用温热药剂，难道不是助火添痛吗？所以古方多用山栀（栀子）作为君药，稍微加入温热药物作为向导，那么邪气容易伏藏，病容易起效。腹痛的原因，也与胃痛类似需要分治，只是多有一种攻下的方法。又必须辨别是因食积、因瘀血、因痰饮的不同。更有内痈（体内脏腑发生的化脓性炎症）作痛，最宜审慎。比如胃脘生痈，也在中脘穴附近，手不可按压，或者伴有寒热口渴。肠痈则是小腹硬痛，尿频急像淋证一样。朱丹溪说：内痈症，是因为饮食之毒和七情之火，相互郁结而成。所以在初起时，急宜使用清热解毒、凉血破瘀的药剂攻下，必须参考外科各书的治法才能妥善。按张景岳所说：近代治疗疼痛，有的认为诸痛为实证，痛无补法；有的认为通则不痛，痛则不通；有的认为痛随利减，这些都是不易之法。不知道形体壮实、病势属实、便秘不通者，才适宜用攻下法；如果形体虚弱、脉象虚弱、食少便泄者，岂能混同治疗。须知拒按的是实证，可按的是虚证；疼痛且胀闭的多为实证，不胀不闭的多为虚证；喜冷的多为实证，爱热的多为虚证；饱食后加重的是实证，饥饿时加重的是虚证；脉实气粗的多为实证，脉虚气少的多为虚证；新病年轻的多为实证，久病年老的多为虚证；补益无效的多为实证，攻伐后病情加剧的多为虚证。必须以望、闻、问、切四诊详细辨别，那么虚实自然明了。仲景说：阳明中土，是万物所归之处。所以世人患胃痛腹痛的很多，而其治病的原因，也难以全部列举，临症之际，应当潜心融会贯通各科知识，参究施治，才不会致误。
芍甘汤：主治胃脘及心腹各种疼痛，根据症状加减使用。
白芍（制肝补脾，活血止痛。酒炒。三至四钱。）木香 豆蔻（快气，各五至七分。）
香附（制，各二至三钱。）甘草（和中缓痛。炙，约一钱。）可加枳壳、橘红、玄胡索、郁金（行瘀，各一至二钱。）苏子（炒研。）茯苓（消痰。）山楂 麦芽（化食。各二至三钱。）如果挟热（时作时止，得热更甚），本方采加黄芩、黄连、山栀、川楝子（泻火则痛自止。）羚羊角（能疗腹病热满。）如果挟寒（痛无增减，得热则止），本方采加桂枝、附子、干姜、沉香（温中则痛自停。）吴茱萸（能除腹痛冷服。）挟虚（重按之则痛缓），本方采加人参、白术、当归。（气旺脾健血充，虚痛自止。）
此方以芍甘汤为主，乃是健脾最胜的药剂，能治血虚腹痛。因为邪气聚集的地方，正气必然虚弱，所以需要这两味药。另外，凡疼痛多因气滞，气滞则血为之凝，痰为之结，食亦不消。以上加入的各种药物，都是快气行瘀、消食化痰的品种，常用颇有效验。至于挟寒、挟热、挟虚，各自随其适宜情况，加药以治疗。
四磨汤：主治胃脘胸腹因气郁不舒，痞结胀满，攻刺而痛者适宜。
木香 真沉香（调气开郁。）枳实 尖槟榔（降气破结。）加乌药名为五磨饮，用白开水磨服。
这是一派调气降气的药剂，气实者适宜。
聚宝丹：凡是所有因气滞血凝作痛的，使用都神效。
木香、沉香、砂仁（各三钱。）麝香（快气，八分。）玄胡索、乳香、没药（各三钱。）真血竭（活血，一钱五分。）〔另研入药。若同药研，即化作尘〕。
〔为细末，糯米糊丸如弹子大小，朱砂为衣，或酒或随症用汤化服〕。
这是快气活血的药剂，古人称它能治胃脘寒痰结阻，导致反胃呕吐，饮食不进者，也非常神验。这是痰随气降的道理。
失笑散〔治胃脘胸腹，因瘀血停留，满痛拒按。〕
蒲黄〔凉血活血。〕五灵脂〔散血活血。〕何氏加玄胡索、山楂、赤芍、没药、姜黄〔行瘀血。〕尖槟榔〔破滞气。〕木通〔通血脉。〕临服入盐卤。〔入血软坚，二至三匙。〕
可加犀角〔辛寒破蓄血。〕羚羊角〔咸寒祛恶血。〕如果可以攻下者，宜桃仁承气汤加减下之。
这是何氏秘方，称其能治九种心疼，诸药不应者。大概因为痛久气滞血凝，用此得效者，血行则气和而痛止也。
保和丸〔见泄泻篇。〕治伤食胃脘腹痛，〔如食在上，胸膈饱闷，嗳腐吞酸。如食在中，腹满硬痛拒按。如食在下，绕脐硬痛拒按。〕主此加减。〔外用陈糟炒热，加盐、麝香熨之，内已热甚者忌之。〕如果可以攻下者，宜承气汤属下之。
二陈汤〔见中风篇。〕治胃脘胸腹因停痰留饮作痛，或吐清涎，或发眩晕，主此加减。如果可以攻下者，礞石丸微利之。
黄芩汤 竹叶石膏汤〔俱见伤寒篇。〕治胃脘胸腹，因火热痛甚者，选而用之。
香苏散〔见伤寒篇。〕治外感寒，内食冷，胃脘心腹作痛。
宜加草豆蔻 生姜〔寒散温中。〕香砂〔利气止痛。〕甚者加桂心、吴茱萸等。〔治心腹冷痛。〕
盏落汤〔言盏落痛即止。〕治胃脘心腹，因虚寒痛者。
胡桃肉〔益命门火，则寒可除；利三焦气，则痛自止。三枚。〕大枣〔同胡桃肉，补脾胃而兼温，同生姜，调荣卫而兼散。三枚，去核，夹桃肉，纸裹煨熟。〕生姜〔三片。煎汤，细嚼送下，永不再发。〕可加沉砂。如果虚寒甚者，可选用理中汤、参附汤之属。
槟黄丸：胃脘心腹因虫作痛，痛有休止，面生白斑，或吐清水，淡食而饥则痛，浓味而饱则安，宜于上半月服之。〔虫头向上故也。下半月则虫头向下，先食鸡肉汁，或蜜或糖，引之向上，随后服药。〕
鸡心槟榔、雄黄、制绿矾〔皆主杀虫。等分为末，饭丸米大，空心每服一钱至三钱，量人虚实用之。〕
万应丸：下虫积如神。
雷丸〔醋煮。〕槟榔〔杀虫。〕黑丑〔下虫积之迅药。〕大黄〔攻积滞之要品。各六两。〕木香〔一两。〕沉香〔气芳引虫食，气利使积行。五钱。〕
〔共为末，用皂荚、苦楝根各四两，煎汤泛为丸，绿豆大，外用二香末为衣。每服一钱至三钱，五更时砂糖汤下。〕
异功散〔见中风篇。〕
归脾汤〔见虚劳篇。〕胃脘心腹因虚而痛者，宜主此加减治之。
这几方或因食、因痰、因热、因寒、因虫、因虚，宜各审明而采用之。
《金匮》大黄丹皮汤：治肠痈小腹坚肿如掌而热，〔痈势已成。〕疼痛拒按，肉色如故。〔痈不在躯壳也。〕或 赤微肿，小便频，〔火逼下行之故。〕汗出憎寒，〔因卫气为热毒壅遏，不行于表，表失其固护也。〕或发热，〔经言热盛于中，故热遍于身。〕或肌肤甲错如鳞，〔血瘀成痈，不充肌肤之故。〕脉数者，宜此方急下之。
大黄 芒硝〔均能荡热，散结，逐血。各钱许，量加。〕丹皮〔凉血，二钱。〕桃仁〔破瘀。〕栝蒌仁〔利肠胃，消痈肿，各二钱。〕冬瓜仁〔散瘀毒，治肠痈。五钱。〕加宜犀角〔散邪清热，凉血解毒，五钱。〕猪悬蹄甲〔祛腹中伏热，能治肠痈。酒炙研末三钱。〕苡仁〔利肠胃，消毒肿。〕鲜金银藤〔数两。〕煎汤煎药。〔再加紫花地丁一、二两同煎更佳。〕
此方虽为下药，实内消药也，故稍有脓则从下去，未成脓，即下出瘀热毒血而肿消矣。按薛立斋说：如脉洪数，以手掩肿上热极者，血已成脓，下恐伤肠胃之气，宜苡仁汤排之，即本方去硝、黄加苡仁。
会脓汤：治腹中肿毒。
大黄〔泻血分之热极。二两。〕乳香 没药〔通血气之壅滞。〕五灵脂〔散血化瘀。〕穿山甲〔破血逐瘀。〕僵蚕〔化痰散结。〕白芷〔散肿排脓。各五钱。〕
〔为末，每服五钱，酒下。脓从大便出，幼者服三钱。〕
《金匮》排脓散：诸疮痈毒皆可宗用。
生鸡子〔解热毒。〕枳壳〔破结气为君。〕赤芍〔行瘀血为臣。〕桔梗〔开提肺气，〕宜加桑皮。〔清利肺气。盖肺主周身之气，气利血行，则脓成毒化。〕
薛立斋说：我治胃脘痈，每用前方加清胃药亦效。若吐脓血，饮食少思，则壮胃气为主，而佐以前药，不可专治其痈。又说肠痈不可惊之，惊则肠断而死。故坐卧转侧，务宜徐缓，时少饮薄粥，及服固元气药，静养调理，庶可得生。
痛甚者脉多伏，伏脉有因火者，有因气郁、血瘀、食滞、痰滞，亦有因寒者。〔阴气盛，阳气衰故也。〕促脉因火亢，亦有因气血食痰停滞，阻其营运之机，皆致歇止。如止数渐稀，则为病瘥；止数渐增，则为病剧。代脉痛家不忌。滑伯仁说：无病而瘦羸脉代者危候也。暴病而气血乍损，只为病脉。
大痛而喘，人中黑者死。真心痛手足寒至节，心痛甚，旦发夕死，夕发旦死。
1. A woman suffered from swelling and pain inside and outside her ears, discomfort in the chest and hypochondrium, alternating chills and fever, and irregular urination. Xue Lizhai said: This is caused by Liver Fire damaging the Blood. First, administer Longdan Xiegan Tang (Gentian Liver-Draining Decoction) for four doses, after which all symptoms subsided suddenly. Then, use Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) to achieve a cure.
2. A man experienced intermittent ear pain, so severe he wished to die, but returned to normal when the pain ceased. Xue Lizhai examined his pulse and found all six pulses peaceful. He surmised that an insect had entered accidentally, and ordered cat urine to be dripped into the ear urgently (or rub the nose with fresh ginger root, and the insect will come out). Indeed, a stinking insect was expelled, and he was relieved.
3. A child suffered from deafness. After years of medication with no effect, it was unknown that this was Kidney Gan (a type of deficiency syndrome related to the Kidneys). Use Liuwei Wan (Six-Ingredient Pill with Rehmannia) plus Sangpiaoxiao (Mantis Egg Case), and he recovered upon taking it.
Stomach Epigastrium Pain, commonly called Heart Pain. Because the upper opening of the stomach is named the Cardiac Orifice (Bumen), which is close to the Heart, the classics also state that stomach epigastrium pain feels like it is at the heart. If it is True Heart Pain, death is inevitable. The classics say: The Heart is the great master of the five zang and six fu organs, the residence of the Spirit. Its organ is solid, and evil qi cannot invade it; if evil qi invades, the Heart is injured, the Spirit departs, and death ensues. Therefore, any evil qi affecting the Heart region actually affects the Pericardium (the protective membrane surrounding the Heart). The distinction between Heart Pain and Pericardium Pain is that Pericardium pain is located between the two breasts. The distinction between it and Stomach Epigastrium Pain is that Heart pain is at the depression of the xiphoid process, while Stomach Epigastrium Pain is below the Heart. The distinction from Chest Pain is that Chest Pain is above the Heart, filling the chest horizontally. However, Chest Pain should be differentiated as belonging to the Lung, Heart, or Liver; once clearly distinguished, treatment will naturally be effective. The causes of Stomach Pain also vary: there are those due to Qi Stagnation, Blood Stasis, Food Retention, Phlegm-Fluid retention, Cold, Heat, Parasites, and Deficiency. They must be treated differently. Pericardium pain is caused by excessive worry injuring the Spirit and depleting the Blood; it requires reference to the Stomach Pain section for differentiated treatment, except without food retention. According to Zhu Danxi: Treating Stomach Pain requires distinguishing between new and chronic conditions. If one knows clearly that the body has been exposed to Cold or ingested cold foods, during the initial stage of illness, warm-dispersing and warm-promoting agents should be used. If it persists for a while, stagnation steams and transforms into Heat; using warm agents then would only aid Fire and increase pain. Therefore, ancient formulas often use Gardenia (Shanzhi) as the sovereign herb, adding a slight amount of warm herbs as guides, so that evil can be subdued and the disease easily resolved. The causes of Abdominal Pain are similar to Stomach Pain and require differentiated treatment, with the addition of purgative methods. One must distinguish whether it is due to Food Retention, Blood Stasis, or Phlegm-Fluid retention. Furthermore, internal abscesses causing pain require utmost caution. For example, a gastric abscess occurs near the Zhongwan point, is intolerant to pressure, and may present with chills, fever, and thirst. An intestinal abscess presents as hardness and pain in the lower abdomen, with frequent urination resembling strangury. Zhu Danxi said: Internal abscesses are formed by the interaction of dietary toxins and emotional fire stagnation. Therefore, at the onset, urgent use of heat-clearing, detoxifying, blood-cooling, and blood-breaking purgatives is required; one must refer to surgical texts for proper treatment. According to Zhang Jingyue: In recent times regarding pain treatment, some believe all pains are excess patterns and that pain has no tonification method; others believe "unblocked means no pain, blocked means pain"; others believe pain decreases with purgation. These are unchangeable principles. However, one must not know that only when the physique is strong, the disease is excess, and constipation prevents flow, is purgation suitable; if the physique is weak, the pulse is weak, appetite is poor, and stools are loose, how can mixed treatment be tolerated? Know that tenderness to rejection indicates Excess, while tenderness to pressure indicates Deficiency; pain with distension and blockage is mostly Excess, without distension or blockage is mostly Deficiency; preference for cold indicates Excess, love for warmth indicates Deficiency; worsening after fullness indicates Excess, worsening on hunger indicates Deficiency; full pulse and rough breath indicate Excess, weak pulse and little breath indicate Deficiency; new illness in young people indicates Excess, chronic illness in old people indicates Deficiency; ineffectiveness of tonification indicates Excess, aggravation after attack indicates Deficiency. One must carefully differentiate using Inspection, Auscultation/Olfaction, Inquiry, and Palpation, so that Excess and Deficiency become clear. Zhongjing said: Yangming Central Earth is where all things return. Thus, many people suffer from stomach and abdominal pain, and their causes are hard to list completely. At the time of clinical practice, one must deeply understand and integrate various disciplines to investigate and treat, lest errors occur.
Shaogan Tang: Governs various pains in the stomach epigastrium and heart/abdomen, modified according to symptoms.
White Peony Root (Zhibai Shaoyao) [Regulates Liver, tonifies Spleen, invigorates Blood, stops pain. Wine-fried. 3-4 qian.] Mu Xiang (Aucklandiae Radix) Doukou (Amomi Fructus Rotundus) [Promotes Qi movement, each 5-7 fen.]
Xiangfu (Cyperi Rhizoma) [Processed, each 2-3 qian.] Gancao (Licorice Root) [Harmonizes Middle, relieves pain gently. Honey-fried, approx. 1 qian.] Can add Zhiqiao (Aurantii Fructus), Juhong (Citri Reticulatae Pericarpium), Yanhusuo (Corydalis Rhizoma), Yujin (Curcumae Longae Radix) [Invigorate Blood and resolve stasis, each 1-2 qian.] Suzi (Perillae Fructus) [Stir-fried and ground.] Fuling (Poria) [Resolves Phlegm.] Shanzha (Crataegi Fructus) Maiya (Hordei Fructus Germinatus) [Transforms Food, each 2-3 qian.] If complicated by Heat [intermittent, worse with heat], add Huangqin (Scutellariae Radix), Lianlian (Coptidis Rhizoma), Shanzhi (Gardeniae Fructus), Chuanlianzi (Meliae Fructus) [Clearing Fire stops pain naturally.] Lingyangjiao (Saigae Tataricae Cornu) [Treats abdominal heat and fullness.] If complicated by Cold [pain constant, relieved by heat], add Guizhi (Cinnamomi Ramulus), Fuzi (Aconiti Lateralis Radix Preparata), Ganjiang (Zingiberis Rhizoma), Chenxiang (Aquilariae Lignum Resinatum) [Warming the Middle stops pain naturally.] Wuzhuyu (Evodiae Fructus) [Relieves cold abdominal pain.] Complicated by Deficiency [pain relieved by deep pressure], add Renshen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Danggui (Angelicae Sinensis Radix). [When Qi is robust, Spleen healthy, and Blood充盈, deficiency pain stops naturally.]
This formula takes Shaogan Tang as the main base, being the most superior agent for strengthening the Spleen, capable of treating Blood-deficiency abdominal pain. Where evil gathers, Qi must be deficient, hence these two ingredients are needed. Furthermore, pain is generally due to Qi Stagnation; Qi stagnation causes Blood to coagulate, Phlegm to knot, and Food to fail to digest. The added herbs above are all agents that promote Qi movement, resolve Blood stasis, transform Food, and resolve Phlegm, commonly quite effective. As for complications of Cold, Heat, or Deficiency, add herbs according to suitability.
Simopolis Decoction (Simo Tang): Suitable for stomach epigastrium, chest, and abdomen due to Qi stagnation and discomfort,痞结 (plugging and knotting), distension, fullness, stabbing pain.
Mu Xiang (Aucklandiae Radix) Zhen Chenxiang (Aquilariae Lignum Resinatum) [Regulate Qi, open stagnation.] Zhishi (Aurantii Fructus Immaturus) Jian Binglang (Arecae Semen) [Descend Qi, break knots.] Adding Wuyao (Tso-o Wood) makes Wu Mo Yin (Five-Musk Drink), taken with white water prepared by grinding.
This is a category of Qi-regulating and Qi-descending agents, suitable for Qi Excess.
Jubao Dan (Treasure-Gathering Pill): All pains due to Qi stagnation and Blood coagulation respond miraculously.
Mu Xiang, Chenxiang, Sharen (Amomi Fructus) [Each 3 qian.] Shexiang (Moschus) [Promotes Qi movement, 8 fen.] Yanhusuo, Ruxiang (Olibanum), Moyao (Myrrha) [Each 3 qian.] Zhen Xuiejie (Dragon's Blood) [Invigorates Blood, 1.5 qian.] [Grind separately and add to medicine. If ground together, it turns to dust.]
[Make into fine powder, pill with glutinous rice paste to the size of a bullet, coat with Cinnabar, or take with wine or decoction according to symptoms.]
This is an agent that promotes Qi movement and invigorates Blood. Ancients claimed it could treat stomach epigastrium cold-phlegm obstruction leading to regurgitation, vomiting, and inability to eat, which is also very miraculous. This is the meaning of Phlegm descending with Qi.
Shixiao San (Pain-Chasing Powder) [Treats stomach epigastrium and chest/abdomen pain due to Blood Stasis retention, fullness, pain, and rejection to pressure.]
Puhuang (Typhae Pollen) [Cools Blood, invigorates Blood.] Wulingzhi (Trogopterori Faeces) [Scatters Blood, invigorates Blood.] He Shi adds Yanhusuo, Shanzha, Chishao (Paeoniae Radix Rubra), Moyao, Jianghuang (Curcumae Radix) [Move Blood Stasis.] Jian Binglang [Breaks Qi stagnation.] Mutong (Akebiae Caulis) [Unblocks Blood vessels.] Add Salt Brine before administration. [Softens hardness in Blood, 2-3 spoons.]
Can add Xijiao (Rhinocerotis Cornu - note: substitute with Buffalo Horn in modern practice) [Acrid-Cold breaks accumulated Blood.] Lingyangjiao [Salty-Cold expels bad Blood.] If purgation is possible, use Taoren Chengqi Tang modified to purge.
This is He Shi's secret formula, claiming to treat nine types of heartache unresponsive to other drugs. Generally, because long-standing pain leads to Qi stagnation and Blood coagulation, using this brings efficacy; when Blood moves, Qi harmonizes, and pain stops.
Baohe Wan (Preserve Harmony Pill) [See Diarrhea section.] Treats Food-Injury stomach epigastrium and abdominal pain. [If food is upper, chest/diaphragm full/stuffy, belching rotten smell, acid regurgitation. If food is middle, abdominal fullness/hardness/pain/rejection. If food is lower, periumbilical hardness/pain/rejection.] Govern this with modifications. [Externally, stir-fry old grain residue until hot, add salt and Moschus, apply as compress; contraindicated internally if Heat is severe.] If purgation is possible, use Chengqi Tang derivatives to purge.
Erchen Tang [See Stroke section.] Treats stomach epigastrium and chest/abdomen pain due to retained Phlegm and Fluids, or spitting clear saliva, or vertigo. Govern this with modifications. If purgation is possible, use Mengshi Wan to mildly purge.
Huangqin Tang (Scutellaria Decoction) Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction) [Both see Cold Damage section.] Treat stomach epigastrium and chest/abdomen pain caused by severe Fire-Heat; select and use accordingly.
Xiangsu San (Aucklandia and Perilla Powder) [See Cold Damage section.] Treats external Cold contraction and internal ingestion of cold foods causing stomach epigastrium and heart/abdomen pain.
Should add Caodoukou (Alpiniae Katsumadai Fructus) Shengjiang (Zingiberis Rhizoma Recens) [Dispel Cold, warm the Middle.] Xiangsha [Promote Qi movement, stop pain.] Severe cases add Guixin (Cinnamomi Cortex) Wuzhuyu etc. [Treat heart/abdomen cold pain.]
Zhanluo Tang (Said to stop pain when the cup falls) [Name implies immediate cessation of pain.] Treats stomach epigastrium and heart/abdomen pain due to Deficient-Cold.
Hutaorou (Walnut Kernel) [Benefits Mingmen Fire, thus Cold is removed; benefits Sanjiao Qi, thus pain stops. Three pieces.] Dazao (Jujubae Fructus) [With Walnut, tonifies Spleen/Stomach and warms; with Ginger, harmonizes Ying/Wei and disperses. Three pieces, pitted, sandwiched with walnut meat, wrapped in paper and baked.] Shengjiang (Three slices.) [Decoct soup, chew finely and swallow, never recurs.] Can add Chenxiang and Sharen. If Deficient-Cold is severe, select Lizhong Tang or Shenfu Tang categories.
Binghuang Wan: Stomach epigastrium and heart/abdomen pain due to parasites, pain with intervals, white spots on face, or spitting clear water, pain on hunger with bland diet, comfort on fullness with rich diet. Should be taken in the first half of the lunar month. [Because parasite heads face upward. In the second half, heads face downward; first eat chicken broth, honey, or sugar to draw them upward, then take medicine.]
Jixin Binglang (Arecae Semen cum Medulla), Xionghuang (Realgar), Zhi Lvfan (Vitriolum Viride Preparatum) [All primarily kill parasites. Equal parts, make powder, pill with rice paste to rice size. Empty stomach, take 1-3 qian per person, adjusted for deficiency/excess.]
Wanying Wan (Ten-Thousand Response Pill): Expels parasite accumulation miraculously.
Leiwang (Polyporus Umbellatus) [Boil in vinegar.] Binglang (Arecae Semen) [Kills parasites.] Heiqiu (Cassiae Semen) [Rapid drug for expelling parasites.] Dahuang (Rhei Radix et Rhizoma) [Essential product for attacking stagnation. Each 6 liang.] Muxiang (1 liang.) Chenxiang (5 qian.) [Fragrant Qi attracts parasites to eat, promoting Qi movement to move accumulation.]
[Make into powder, use Zaojiao (Gleditsiae Fructus) and Kuligen (Toosendan Radix) 4 liang each, decoct soup to pill, mung bean size, coat externally with the two Musk powders. Take 1-3 qian, down with sugar water at wugeng (3-5 AM).]
Yigong San [See Stroke section.]
Guipi Tang (Restore the Spleen Decoction) [See Consumption section.] Stomach epigastrium and heart/abdomen pain due to Deficiency should be governed by this with modifications.
These few formulas, whether due to Food, Phlegm, Heat, Cold, Parasites, or Deficiency, should be carefully examined and adopted.
Jingui Dahuang Mudan Tang (Rhubarb and Moutan Decoction from Essential Prescriptions of the Golden Cabinet): Treats intestinal abscess with lower abdomen firm/swollen like a palm and hot, [abscess formed.] pain and rejection to pressure, skin color unchanged. [Abscess is not in the body surface.] Or redness/mild swelling, frequent urination, [due to Fire forcing downward.] sweating with aversion to cold, [because Wei Qi is obstructed by Heat-Toxin, failing to circulate on the surface, losing protection.] or fever, [Classics say Heat abundant in center spreads throughout body.] or skin rough like scales, [Blood stasis forming abscess, failing to nourish skin.] rapid pulse, should use this formula to urgently purge.
Dahuang (Rhei Radix et Rhizoma) Mangxiao (Natrii Sulfas) [Both sweep Heat, dissipate knots, drive out Blood. Approx. 1 qian each, adjust.] Danpi (Moutan Cortex) [Cool Blood, 2 qian.] Tao Ren (Persicae Semen) [Break stasis.] Gualouren (Trichosanthis Semen) [Benefit intestines/stomach, eliminate abscess/swelling, each 2 qian.] Dongguaren (Benincasis Semen) [Disperse stasis-toxin, treat intestinal abscess, 5 qian.] Add Xijiao (Rhinocerotis Cornu) [Dispel evil, clear Heat, cool Blood, detoxify, 5 qian.] Zhu Xuantijia (Porci Unguis Preparatus) [Remove latent Heat in abdomen, treat intestinal abscess. Wine-fried, grind powder, 3 qian.] Yiren (Coicis Semen) [Benefit intestines/stomach, disinfect swelling.] Xian Jinyinteng (Lonicerae Japonicae Caulis) [Several liang.] Decoct soup to decoct medicine. [Adding Zijia Dideng (Viola Yedoensis) 1-2 liang is better.]
Although this formula is a purgative, it is actually an internal resolution agent. Thus, if pus forms slightly, it goes down; if not yet formed, purging expels stasis-heat-toxic blood and swelling resolves. According to Xue Lizhai: If pulse is flooding and rapid, and extreme heat under hand covering the swelling, Blood has turned to pus; purging fears damaging Spleen/Stomach Qi. Use Yiren Tang to drain, i.e., this formula minus Mangxiao/Dahuang plus Yiren.
Huinong Tang (Pus-Converging Decoction): Treats abdominal swelling/toxins.
Dahuang [Drains extreme Heat in Blood level, 2 liang.] Ruxiang, Moyao [Unblock Qi/Blood stagnation.] Wulingzhi [Scatter Blood, resolve stasis.] Chuanshanjia (Manis Squama) [Break Blood, drive out stasis.] Jiangcan (Bombyx Batryticatus) [Resolve Phlegm, dissipate knots.] Baizhi (Angelicae Dahuricae Radix) [Disperse swelling, drain pus. Each 5 qian.]
[Make powder, take 5 qian with wine. Pus exits via stool, children take 3 qian.]
Jingui Painong San (Pus-Draining Powder from Essential Prescriptions of the Golden Cabinet): Applicable to all sores and abscess toxins.
Sheng Jizi (Raw Chicken Egg) [Resolve Heat-Toxin.] Zhike (Aurantii Fructus) [Break knot-Qi as Sovereign.] Chishao (Paeoniae Radix Rubra) [Move Blood Stasis as Minister.] Jiegeng (Platycodonis Radix) [Raise Lung Qi,] should add Sangbai (Mori Cortex) [Clear/benefit Lung Qi. Since Lung governs Qi of whole body, benefiting Qi moves Blood, then pus forms and toxin transforms.]
Xue Lizhai said: I treat stomach epigastrium abscess, often using the previous formula plus Stomach-Clearing herbs, also effective. If spitting pus/blood, poor appetite, then strengthen Stomach Qi as primary, assisting with previous herbs, do not focus solely on treating the abscess. Also said intestinal abscess should not startle the patient; startling causes intestinal rupture and death. Therefore, sitting, lying, turning, moving must be slow, drink thin porridge occasionally, take Qi-solidifying medicines, rest and regulate, so life may be saved.
Severe pain usually presents with hidden (Fu) pulse. Hidden pulse can be due to Fire, Qi stagnation, Blood stasis, Food stagnation, Phlegm stagnation, or Cold. [Because Yin Qi is abundant, Yang Qi declines.] Cu pulse (Surging/Intermittent) is due to Fire hyperactivity, or also due to Qi/Blood/Food/Phlegm stagnation blocking circulation mechanism, all causing pauses. If pauses gradually decrease, disease improves; if pauses gradually increase, disease worsens. Dai pulse (Interrupted) is not taboo for pain patients. Hua Borin said: No disease but emaciated with Dai pulse is a critical sign. Acute illness with sudden Qi/Blood damage is merely a disease pulse.
Great pain with panting, blackness of philtrum (RenZhong) indicates death. True Heart Pain: hands/feet cold up to joints, severe heart pain, die morning if onset evening, die evening if onset morning.