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The hypochondriac region is traversed by the Liver Meridian of Foot-Jueyin and the Gallbladder Meridian of Foot-Shaoyang, hence pain in the hypochondriac region is often related to liver and gallbladder disorders. Lingshu．Chapter on Five Pathogens states: "When evil is in the liver, there is pain in both hypochondriac regions." Suwen．Mouci Lun says: "When Xieke affects the collaterals of the Foot-Shaoyang meridian, it causes hypochondriac pain and inability to rest."

Jingui Yaolue．Chapter on Pulse Patterns and Treatment of Wind-Cold Abdominal Mass in the Five Zang-Organs mentions "pain below the ribs." The "Dantai Yu'an" refers to it as "hypochondrium pain," and Zabing Guangyao calls it "pain in the lateral hypochondriac region," all of which fall within the category of hypochondriac pain.

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1. Pathogenic Factors in the Shaoyang Meridian︰hypochondriac pain, alternating chills and fever, fullness and discomfort in chest and hypochondrium, bitter taste in mouth, dry throat, dizzy vision, deafness, poor appetite, vexation and vomiting, white and slippery tongue coating, wiry pulse. There are two causes of the disease: one is the direct invasion of the meridian by wind-cold pathogens, and the other is the transmission from the greater yang to the shaoyang. The shaoyang meridian spreads across both flanks, and when cold pathogens attack externally, the qi of the shaoyang meridian becomes obstructed, causing the pathogens to reside between the exterior and interior. "Treatise on Cold Damage Diseases, Discussion on the Pulse and Symptoms of Taiyang Disease and Its Treatment, Chapter Six": "Five or six days after cold damage, apoplexy, alternating chills and fever, fullness and discomfort in chest and hypochondrium, silent anorexia, vexation and vomiting, or chest vexation without vomiting, or thirst, or abdominal pain, or stuffiness and hardness below the ribs..." The key diagnostic points are hypochondriac pain, fullness and discomfort in chest and hypochondrium, and alternating chills and fever. The treatment should focus on harmonizing the shaoyang, and the prescription of choice is Minor Bupleurum Decoction with modifications.
2. Internal Retention of Water and Fluid︰pleural fluid retention, distending pain in the chest and ribs, aggravated pain during coughing, spitting, turning, or breathing, shortness of breath, white tongue coating, deep and wiry or deep and slippery pulse. This condition is often caused by inherent deficiency of middle yang, compounded by external contraction of cold-dampness, or due to dietary overexertion, leading to impaired lung regulation, dysfunctional spleen transportation, and kidney's failure in transformative steaming. These three factors interact, causing fluid retention to stagnate, multiple abscesses between the ribs, and disrupted qi movement, resulting in chest and hypochondriac pain. Jingui Yaolue·"Pulse and Symptom Treatment of Phlegm-Fluid Retention Cough Disease" states: "After drinking, fluid flows and accumulates below the hypochondrium, causing referred pain during coughing and spitting, which is called pleural fluid retention." Hypochondriac pain is one of the main symptoms of pleural fluid retention. Key diagnostic points include hypochondriac pain, shortness of breath, and aggravated pain during coughing, spitting, turning, or breathing. Treatment should focus on expelling water by purgation, with prescriptions such as Pepperweed and Jujube Lung-Draining Decoction or Cyperus Inula Flower Decoction. For robust individuals, Ten Jujubes Decoction may be used.
3. Liver Qi Depression︰The hypochondriac pain is mainly characterized by distending pain and migratory pain, with the pain fluctuating according to emotional changes. Symptoms include chest tightness, frequent sighing, epigastric distension and fullness, reduced appetite, thin tongue coating, and wiry pulse. This condition arises from emotional distress or sudden anger damaging the liver, leading to liver qi stagnation due to impaired free flow and failure in dispersion. Zhengzhi Huibu states in the chapter on hypochondriac pain: "It is caused by sudden rage injuring the liver or grief causing qi stagnation." The liver is located below the hypochondrium, and its meridians spread across both flanks. When qi movement stagnates and obstructs the hypochondriac collaterals, it results in distending pain in the hypochondriac region, which varies with emotional changes. The pain is predominantly distending in nature, wandering and shifting unpredictably. It may also manifest as chest tightness, frequent sighing, and emotional depression—symptoms of liver qi stagnation. Treatment focuses on soothing the liver and regulating qi to resolve stagnation, primarily using Bupleurum Liver-Soothing Powder with modifications. For severe hypochondriac pain, green tangerine peel, white mustard seed, and Curcuma Root can be added.
4. Static Blood︰The hypochondriac pain is stabbing, fixed in location, and worsens at night. There may be a mass below the hypochondriac region, the tongue texture is purplish-dark or with ecchymosis, and the pulse is choppy. It is mostly caused by habitual constraining of liver qi or liver qi depression, which over time affects the collaterals, leading to impeded blood flow and static blood stagnation. Linzheng Zhinan Yi'an states in the chapter on "hypochondriac pain": "The channels dominate qi, the collaterals dominate blood, and prolonged illness results in blood stasis." Obstruction of the hypochondriac collaterals causes stabbing pain in the chest and hypochondrium that is fixed and unrelenting. Therefore, these two patterns can be clinically differentiated based on whether the disease is in qi or blood, the nature of the pain, and its location. The pain is mostly stabbing, fixed in location, and may present with masses, a purplish-dark tongue texture with ecchymosis, and other symptoms of static blood. The treatment primarily focuses on invigorating blood and resolving stasis to unblock the collaterals. The recommended formulas are Infradiaphragmatic Stasis-Expelling Decoction or Origin-Restoring Blood-Invigorating Decoction.
5. Liver-gallbladder Dampness-heat︰Hypochondriac pain and distension, bitter taste in the mouth, irritability, chest tightness, anorexia, nausea and vomiting, red eyes or jaundice, dark yellow urine, wiry and slippery pulse, yellow and greasy tongue coating. This is an excess heat pattern, often caused by external invasion of dampness-heat or dietary irregularities, leading to dysfunction of the spleen in transportation, which generates internal dampness. The dampness transforms into heat, invades the liver and gallbladder, and causes the liver and gallbladder to lose their function of free coursing and discharge, resulting in hypochondriac pain. Zabing Yuanliu Xizhu states: "Pain in the hypochondriac region is a disease of the liver channel, as the liver and gallbladder channels traverse the hypochondriac region. When liver fire is exuberant and wood qi is replete, it flows into the hypochondriac region and causes pain." Clinically, it often manifests as severe hypochondriac pain, chest tightness, anorexia, dark urine, yellow and greasy tongue coating, wiry and slippery or wiry and rapid pulse. The treatment mainly focuses on clearing heat and draining dampness, commonly using Gentian Liver-Draining Decoction.
6. Liver Yin Deficiency︰Hypochondriac region pain, which is lingering and unceasing, accompanied by dry mouth and throat, vexing heat in the heart, dizziness and blurred vision, or dim eyesight, a red tongue with scant coating, and a wiry, thin, and rapid pulse. It may be caused by liver depression transforming into fire and damaging yin, or by kidney yin deficiency affecting liver yin, or by blood deficiency failing to nourish the liver. Liver yin deficiency leads to malnutrition of the liver collaterals, resulting in dull hypochondriac pain. Jingyue Quanshu states in the chapter "Hypochondriac Pain": "Internal damage and deficiency-consumption, hypochondriac pain—those who overindulge in sexual activity and suffer from kidney deficiency and weakness often experience dull pain in the chest and hypochondriac region. This is due to deficiency of liver and kidney essence." Key points for diagnosis: dull hypochondriac pain, lingering and unceasing, a red tongue with scant coating, and a wiry, thin, and rapid pulse. Symptoms may also include yin deficiency with internal heat or yin deficiency with yang hyperactivity (dry mouth and throat, flushed face, malar redness, vexing heat in the heart, dizziness, tinnitus, and dim vision). The treatment method is to enrich yin and emolliate the liver, with the main prescription being All-Along Decoction.

The condition of hypochondriac pain can be divided into external contraction and internal damage based on the cause of the disease. The symptoms can be distinguished as deficiency and excess, and the location of the disease can be differentiated as qi and blood. Although the pathological changes are in the liver and gallbladder, the mechanism of the disease is mainly attributed to qi and blood. As stated in Jingyue Quanshu．Hypochondriac Pain: "Blood accumulation has form and does not move, or is hard and resists pressure; qi pain flows without trace, or suddenly gathers and disperses; if food accumulation and phlegm-fluid retention are all tangible symptoms, by carefully examining the causes, they can be identified." During treatment, following the principle of "free flow prevents pain," removing pathogenic factors and regulating qi and blood will naturally yield results.

Qi stagnation and blood stasis can coexist simultaneously, as mentioned in Linzheng Zhinan Yi'an．Hypochondriac Pain: "Chronic illness in the collaterals, both qi and blood are obstructed." They can also appear sequentially or have a particular emphasis. If distension is more pronounced than pain, it often leans towards qi depression; if pain is more pronounced than distension, it mostly belongs to blood stasis.

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1. Jingyue Quanshu．Hypochondriac Pain》: "The Bingben of hypochondriac pain pertains to the liver and gallbladder meridians, as both meridians traverse the hypochondriac region. However, the heart, lungs, spleen, stomach, kidneys, and bladder can also manifest hypochondriac pain. This does not mean that all these meridians inherently have this condition, but rather that when pathogenic factors reside in these meridians and qi counterflow persists, it will sequentially transmit and eventually reach the Shaoyin, causing pain in the hypochondriac region. Therefore, hypochondriac pain caused by anxiety and overthinking is transmitted from the heart and lungs; hypochondriac pain caused by dietary overindulgence is transmitted from the spleen and stomach; and hypochondriac pain caused by excessive sexual activity, internal damage, and urinary blockage is transmitted from the kidneys and bladder. When transmitted to the Benjing, it is invariably a liver and gallbladder disorder."
2. Zhengzhi Huibu．Hypochondriac Pain》: "Sudden anger, grief-induced qi stagnation, overeating, external invasion of wind-cold, physical trauma from falls, shouting-induced qi injury, phlegm accumulation, multiple abscesses, or static blood clashing can all cause pain. Additionally, dampness-heat, stagnant fire, overexertion, and excessive sexual activity can also contribute to the condition."
3. Linzheng Zhinan Yi'an．Hypochondriac Pain》: "Miscellaneous hypochondriac pain syndromes are all related to the Jueyin liver meridian, as the liver meridian spreads across the hypochondriac region. Therefore, Zhang Zhongjing's Inula Flower Decoction, Liu Hejian's Toosendan Fruit Powder, and the master's methods of warming and unblocking collaterals, sweet moderation to regulate deficiency, gentle warming to tonify, and acrid dispersion to remove stasis are all treatments for liver stagnation hypochondriac pain. These methods thoroughly address the condition and encompass all necessary approaches. However, the syndrome can be deficient or excess, cold or heat, and should not be generalized. If one can expand upon these principles and refine their diagnosis, clinical practice will have a solid foundation."