〔娄〕痘腹痛，多是痘毒，当临证消息。〔万〕《内经》腹痛皆属于寒，惟有一证为热，疮疹腹痛，皆属毒
热也。诀云∶发热肚中痛， 疮腹内攻，发多防不透，发少更防痈。是已。或有兼食积者。〔翁〕痘疹腹痛者，
由毒郁于三阴，脐以上属太阴，当脐属少阴，小腹属厥阴，须分别之。腹胀者，毒聚于肠胃也，治法俱当升
发解利痘毒，兼分利小便，使毒瓦斯上下分消，则痛与胀自止，故曰∶痛随利减，胀以利消。俗医以浓朴行滞气而
不知升发解利，非其治矣。亦有乳食停滞不消化而腹胀者，当以升发解利药中，加消食之剂，所伤之物，当审其寒热。
又有数日大便者，大便行而痛胀自止，亦未可骤用硝黄也。
定痛散 伤寒肚痛，及冷气痛。
神曲 香附（各一钱） 山楂（二钱） 良姜 当归 甘草（各五分）
上，用姜三片，枣二枚，水煎服。手足逆冷，加大附子二分。
桂枝芍药汤 治腹痛。
桂枝 炙甘草（各一钱） 白芍药（酒炒，二钱）
生姜三片，枣二枚，水煎服。
黄连汤 治热毒在胃腹痛，时或欲吐。此药能升降阴阳。
黄连 炙甘草 干姜 桂枝（各二钱） 半夏 人参（各八分）
枣二枚，水煎服。
一味异功散 治小儿诸般钓证，角弓反张，胸膈脐凸，以透明没药为末，姜汤调下。
《绍定论》云∶病有似是而非，若同而异者。盖肢体厥冷而腹痛者，此毒瓦斯在里也，若不审谛，必作极冷治之，
反与热药，为害愈深。未冷极者不问有无寒热，肢冷腹痛，必大便自利，蜷卧恶寒，今身热肢冷，腹痛大便不通，
乃热毒在里，热甚则发厥，仲景所谓热深厥亦深也。伏热深而疮疹不出者，宜以蝉蜕末水煎服之，已
出者亦可服，毒瓦斯得泄，则四肢温暖，腹痛自止矣。前人论腹痛有虚实，肠鸣自利而腹痛者为虚痛，是冷也。腹
满而不大便者为实痛，是热也。今腹中痛而不大便、又身热，耳尖冷，脚冷，为疮疹证明矣。又有疮疹始发，腹中
有宿块而痛者，医不能辨，误作食积下之，多夭横矣。〔薛〕前证，痘未出而发热烦躁，或作渴饮冷，大便坚实，此
热毒壅滞也，用疏利之药。
〔万〕凡发热腹中便痛者，此毒瓦斯内攻也，急宜发表疏里，桂枝大黄汤主之。亦有外邪与毒相并，致未尽出而腹疼
胀满者，宜参苏饮去参、苓、加缩砂、陈皮，温而出之。若原无腹痛发热，二三日后大便不通而痛者，此燥屎与毒相并
而痛也，三黄丸（热）、七物升麻丸（初热）、宣风散（痘发热）择而用之。有谵妄狂乱者，三乙承气汤主之（便秘）。
原无腹痛，或因饮冷水而痛者，此冷痛也，理中汤（吐利）加桂心。或因多食而痛者，此食积痛也，微则木香大安丸
（伤食），甚则备急丸（伤食），丁香脾积丸（伤食）、原物汤下。原无腹痛，自利后痛者，此虚痛也，黄 建中汤
加木香、青皮。发热自利，又腹痛者，此亦毒也，黄芩汤（吐利）加木香、青皮，或化毒汤主之。如疮乍出乍隐，此
伏也，七物升麻丸。疮出尽者，
再以紫草饮（出不快）大发之。疮不出者，勿治。〔张〕痘未出，有先作腹疼或腹中有块者，乃腹中先出也，不可投疏利
之药，以戕贼胃气，但与和平匀气兼发散药，如升麻汤、参苏饮之类。
蝉蜕一物汤
用蝉蜕二十一个，洗去泥，为末，水一盏，慢火煎至半盏，去滓，量儿大小温
服之。如觉疮疹已出，便根据前服三五次，不是疮疹，亦无害。小儿疮疹欲发出，加甘草一钱五分，煎一盏，旋旋
与服，累效。小儿伏所蕴积热毒，蝉蜕味咸寒可以制，况有暴感风作热，客于表者，蝉蜕亦治，风毒充于皮肤，
瘙痒不止，惊痫夜啼，癫疾，寒热惊悸，皆宜服之。
桂枝大黄汤
桂枝 白芍药（各二钱半） 甘草（五分） 大黄（一钱半）
上锉碎。加生姜一片，水一盏半，煎至一盏，去滓温服，食前。
桂枝芍药汤
桂枝 白芍药 防风 黄 （炙） 甘草（各等分）
上锉细。加枣子二枚，水一盏，煎七分，去滓温服。
黄 建中汤
黄 人参 桂枝 白芍药 甘草（各等分）
上锉细。加生姜三片，枣二枚，水一盏，煎五分，去滓温服。
化毒汤
肉桂（五分） 白芍药 甘草（各一钱） 青皮 木香 枳壳（各七分） 山楂肉 连翘（各五分）
上锉细。水一盏，煎七分，去滓温服，不拘时。
（汪）一女伤寒，但腹痛甚，日夜啼哭，手足厥冷，渐至危殆。此时天时痘灾，
吾疑或者痘症，遂取生猪血，急用脑麝和灌，一服得睡，须臾痘出而安，若非此方，则夭横矣。
〔万〕痘已出而腹痛，亦是毒在里未曾出透，亦宜桂枝大黄汤。起发不透腹痛者，陷伏也，亦宜三乙承气汤（便
秘）及宣风散（痘发热）。〔薛〕痘已出，而不热躁，不饮冷，大便不实，此元气虚弱也，用白术散之类补之。
〔张〕出不快而腹痛者，活血散（即一味白芍药，见出不快）以姜汤调下。若毒瓦斯弥蔓，阳毒入胃，便血日夜无度，
腹痛啼哭者，牛黄散主之。又有一等将成内溃之证而腹痛者，当预防之，七日前内溃，盖因风寒所中，腠理固密，阴
阳二分，壅塞不通，其毒内攻，脏腑之间毒火炮炽，以致胃烂溃而成脓，口舌皆白，是其验也。此证极为惨毒，识者
知痘毒未出之时，或有风寒阻隔，气粗热甚，身必战动，腹吐急疼者，是欲成内溃也，急以和解汤、升麻汤（初热）逐
散寒邪，开泄腠理，纵毒而出，庶无此证，若证已成，而治之亦无及矣。
牛黄散 治疮疹阳毒入胃，便血日夜无度，腹痛啼哭。
牛黄（一分） 郁金（一两）
上为细末。每服半钱，以浆水半盏，煎至三分，和滓温服。量儿大小以此增减，日二服。
和解汤 三日前后用。
升麻 芍药 葛根 人参 川芎 甘草 防风 羌活（各四分）
上，用水一钟半，生姜三片，煎至五分，温服。
〔丹〕吴店子出痘疮腹痛。
丁香（二枚） 官桂 芍药（各一钱） 白术 当归（各五分）
上，作一帖服。
如身不甚热，或时发寒，或呕吐，六脉虚细，四肢逆冷而腹痛者，陈氏木香散主之（痘泻利）。腹痛面青，
而手足冷者，脾胃虚寒证也，宜益黄、理中辈主之。理中汤加白芍药、桂。
上三条，以温药治寒痛例。作渴饮汤，手足并冷者，宜之。
〔娄〕尝治痘始出腹痛，或身痛，脉洪数者，解表凉药加芍药、甘草渐安。
按∶解表凉药，即升麻汤、连翘升麻汤、双解散之类，加者倍而用之也。
上一条，以凉药治热痛例。作渴饮冷，手足并热者，宜之。
如疮已出，至收靥时原无腹痛，忽然作痛，此必有饮食也，消息审问，曾因饮冷水者，五苓散主之，或用黄 建中
汤加白术、干姜、人参。曾伤食者，问伤何食，丁香脾积丸主之，用原物汤送下。〔张〕伤食腹痛，不可用巴豆、
大黄辈，只宜平胃助气之剂，如平胃散、小异功散、橘皮汤（吐逆）皆可。〔薛〕嗳腐吞酸，大便秽臭，
乳食停滞也，用保和丸消之（伤食）。
若靥后伤食，食蒸发搐而呕吐腹痛者，治法见惊搐条。靥后热多，大便实，粪黑，腹痛者，蓄血也，犀角地黄
汤主之。
如发热时心腹绞痛，烦闷叫呼，或疮陷伏，胀满疼痛，喘促者，此毒恶之气，攻刺肠胃，燔灼脏腑，必不可治。
[Lou] Abdominal pain in smallpox is mostly due to the smallpox toxin; clinical judgment should be exercised. [Wan] According to the *Neijing*, abdominal pain generally belongs to cold, with only one pattern belonging to heat. However, abdominal pain caused by rash diseases (exanthems) all belongs to toxic heat. The aphorism states: "Fever accompanied by abdominal pain indicates internal attack by the rash toxin; if the eruption is profuse, prevent incomplete penetration; if sparse, fear abscess formation." This is correct. Some cases are complicated by food stagnation. [Weng] Abdominal pain in smallpox/rash arises from toxin stagnation in the Three Yin channels: above the umbilicus belongs to Taiyin (Spleen), at the umbilicus belongs to Shaoyin (Kidney), and the lower abdomen belongs to Jueyin (Liver); these must be distinguished. Abdominal distension results from toxin accumulation in the intestines and stomach. The treatment method for both should involve raising and venting to resolve the smallpox toxin, combined with promoting urination to allow the toxin to dissipate upward and downward. Thus it is said: "Pain diminishes with purgation/urination, distension resolves with drainage." Vulgar physicians know only to use Houpo (Magnolia Bark) to move stagnant Qi but fail to understand raising and venting to resolve toxins; this is incorrect treatment. There are also cases of abdominal distension due to milk or food stagnation and indigestion; in such cases, digestive-resolving agents should be added to the raising-and-venting formulas. The ingested food must be assessed for cold or heat nature. In cases of constipation for several days, once bowel movements resume, pain and distension cease naturally; sudden use of Xiaoshi (Mangosteen Pericarp/Xia Kuding Cha? Context implies Cathartics like Mangxiao/Magnolia Fructus contextually often grouped with Dahuang, here likely referring to harsh cathartics like Mangxiao) and Dahuang (Rhubarb) should be avoided.
Dingtong San (Definitive Pain Powder) treats abdominal pain from Cold Damage (Shanghan) and cold qi pain.
Shenqu (Massa Medicata Fermentata), Xiangfu (Cyperus Rhizome) (each 1 qian), Shanzha (Crataegus Fruit) (2 qian), Liangjiang (Alpinia Officinarum Rhizome), Danggui (Angelica Sinensis Root), Gancao (Licorice Root) (each 5 fen).
Decoct with 3 slices of Shengjiang (Fresh Ginger) and 2 dates (Zao) in water. If extremities are cold, add Fuzi (Aconite Lateral Root) 2 fen.
Guizhi Shaoyao Tang (Cinnamon Twig and Peony Decoction) treats abdominal pain.
Guizhi (Cinnamon Twig), Zhigancao (Honey-fried Licorice Root) (each 1 qian), Baishaoyao (White Peony Root) (wine-fried, 2 qian).
Decoct with 3 slices of Shengjiang (Fresh Ginger) and 2 dates (Zao) in water.
Huanglian Tang (Coptis Decoction) treats abdominal pain caused by heat toxin in the stomach, sometimes accompanied by nausea/vomiting. This formula regulates the ascending and descending of Yin and Yang.
Huanglian (Coptis Rhizome), Zhigancao (Honey-fried Licorice Root), Ganjiang (Dried Ginger), Guizhi (Cinnamon Twig) (each 2 qian), Banxia (Pinellia Tuber), Renshen (Ginseng Root) (each 8 fen).
Decoct with 2 dates (Zao) in water.
Yiwei Yigong San (Single-Ingredient Yi Gong Powder) treats various types of convulsions in children, including opisthotonos and protrusion of the chest/diaphragm and umbilicus. Use transparent Moyao (Myrrh) as powder, taken with Ginger Water.
*Shaoding Lun* states: Diseases may appear similar yet differ essentially. Limb coldness with abdominal pain indicates toxin in the interior. Without careful examination, treating this as extreme cold and administering hot herbs will deepen the harm. If not extremely cold, regardless of presence of cold/heat signs, limb coldness with abdominal pain implies spontaneous diarrhea, curling up, and aversion to cold. However, current symptoms of fever, limb coldness, abdominal pain, and constipation indicate heat toxin in the interior. Extreme heat causes jue (cold limbs), as Zhongjing stated: "The deeper the heat, the deeper the jue." For latent deep heat preventing rash eruption, decoct Chanui (Cicada Slough) powder in water and administer; it can also be used after eruption. Once the toxin is released, limbs warm and abdominal pain stops. Predecessors discussed deficiency and excess in abdominal pain: borborygmus with spontaneous diarrhea and abdominal pain is deficiency pain (cold). Abdominal fullness with constipation is excess pain (heat). Current symptoms of abdominal pain, constipation, fever, cold ear tips, and cold feet clearly indicate rash disease. Another case involves a pre-existing mass in the abdomen causing pain when the rash first appears; misdiagnosis as food stagnation and purging often leads to premature death. [Xue] In the preceding condition, fever and irritability before eruption, thirst for cold drinks, and firm stool indicate heat toxin obstruction; use draining/resolving medicines.
[Wan] Fever with immediate abdominal pain indicates internal attack by toxin; urgently release the exterior and drain the interior using Guizhi Dahuang Tang (Cinnamon Twig and Rhubarb Decoction). If external pathogen combines with toxin, preventing complete eruption and causing abdominal pain/distension, use Shenqi Yin (Ginseng Qi Drink) removing Renshen (Ginseng) and Fuling (Poria), adding Suansha (Amomum Fruit) and Chenpi (Tangerine Peel), administered warm to vent the toxin. If there was originally no abdominal pain/fever, but constipation and pain arise after 2-3 days, this is dry feces combining with toxin; choose among Sanhuang Wan (Three Yellows Pill - Heat), Qi Wu Shengma Wan (Seven-Ingredient Cimicifuga Pill - Initial Heat), or Xuanfeng San (Dispel Wind Powder - Smallpox Fever) as appropriate. For delirium and mania, use Sanyi Chengqi Tang (Three-Yi Da-Cheng-Qi Decoction) for constipation. Originally no abdominal pain, but pain after drinking cold water indicates cold pain; use Lizhong Tang (Regulate the Middle Decoction) + Guixin (Cinnamon Bark). Pain after overeating indicates food stagnation pain; mild cases use Muxiang Da'an Wan (Costus Great Peace Pill), severe cases use Beiji Wan (Emergency Pill) or Dingxiang Pi Ji Wan (Clove Spleen Accumulation Pill), taken with the soup of the ingested substance. Originally no abdominal pain, but pain after spontaneous diarrhea indicates deficiency pain; use Huangqi Jianzhong Tang (Astragalus Build-the-Middle Decoction) + Muxiang (Costus Root), Qingpi (Green Tangerine Peel). Fever with spontaneous diarrhea plus abdominal pain indicates toxin; use Huangqin Tang (Scutellaria Decoction) + Muxiang, Qingpi, or Huadu Tang (Resolve Toxin Decoction). If eruptions appear and disappear, this is latent toxin; use Qi Wu Shengma Wan. If eruptions are complete, use Zicao Yin (Arnebia Drink) to vigorously promote eruption. If eruptions do not appear, do not treat. [Zhang] Before smallpox eruption, abdominal pain or masses indicate early eruption in the abdomen; do not use draining medicines to damage Stomach Qi. Use harmonizing Qi and dispersing formulas like Shengma Tang (Cimicifuga Decoction) or Shenqi Yin.
Chanui Yi Wu Tang (Single-Ingredient Cicada Slough Decoction)
Use 21 Chanui (Cicada Slough), wash off mud, powder. Decoct in 1 sheng of water over slow fire until half remains. Strain and take warm according to age. If eruptions have appeared, continue taking 3-5 times; even if not rash, it is harmless. For children whose rashes desire to erupt, add Gancao (Licorice) 1.5 qian, decoct to 1 sheng, feed slowly. Highly effective. Chanui is salty and cold, capable of restraining latent heat/toxin accumulation in children. It also treats wind-heat attacking the exterior, skin itching from wind-toxin, convulsions, night crying, epilepsy, chills/fever, and palpitations.
Guizhi Dahuang Tang (Cinnamon Twig and Rhubarb Decoction)
Guizhi (Cinnamon Twig), Baishaoyao (White Peony Root) (each 2.5 qian), Gancao (Licorice Root) (5 fen), Dahuang (Rhubarb Root) (1.5 qian).
Chop coarsely. Add 1 slice of Shengjiang (Fresh Ginger), 1.5 sheng of water, decoct to 1 sheng. Strain and take warm before meals.
Guizhi Shaoyao Tang (Cinnamon Twig and Peony Decoction)
Guizhi (Cinnamon Twig), Baishaoyao (White Peony Root), Fangfeng (Saposhnikovia Root), Huangqi (Astragalus Root) (fried), Gancao (Licorice Root) (equal parts).
Chop finely. Add 2 dates, 1 sheng of water, decoct to 0.7 sheng. Strain and take warm.
Huangqi Jianzhong Tang (Astragalus Build-the-Middle Decoction)
Huangqi (Astragalus Root), Renshen (Ginseng Root), Guizhi (Cinnamon Twig), Baishaoyao (White Peony Root), Gancao (Licorice Root) (equal parts).
Chop finely. Add 3 slices of Shengjiang (Fresh Ginger), 2 dates, 1 sheng of water, decoct to 0.5 sheng. Strain and take warm.
Huadu Tang (Resolve Toxin Decoction)
Rougui (Cinnamon Bark) (5 fen), Baishaoyao (White Peony Root), Gancao (Licorice Root) (each 1 qian), Qingpi (Green Tangerine Peel), Muxiang (Costus Root), Zhike (Bitter Orange Fruit) (each 7 fen), Shanzha Rou (Crataegus Flesh), Lianqiao (Forsythia Fruit) (each 5 fen).
Chop finely. Decoct in 1 sheng of water to 0.7 sheng. Strain and take warm, anytime.
(Wang) A girl with Cold Damage had severe abdominal pain, crying day and night, cold limbs, approaching critical state. During a smallpox epidemic, I suspected smallpox. I took raw pig blood, mixed with Naozhang (Camphor and Musk), and forced it down. One dose led to sleep, followed by eruption and recovery. Without this, she would have died prematurely.
[Wan] Abdominal pain after smallpox eruption indicates toxin still in the interior not fully vented; Guizhi Dahuang Tang is also suitable. Failure to rise/develop with abdominal pain indicates sinking/latent toxin; use Sanyi Chengqi Tang (for constipation) and Xuanfeng San (for smallpox fever). [Xue] After eruption, if there is no fever/restlessness, no desire for cold drinks, and loose stools, this is Yuanqi (Primordial Qi) deficiency; tonify with Baizhu San (Atractylodes Powder).
[Zhang] Slow eruption with abdominal pain: use Huoxue San (Blood Invigorating Powder, i.e., single ingredient Baishaoyao) taken with Ginger Water. If toxin spreads, Yang toxin enters the Stomach, causing continuous bloody stools day and night with abdominal pain and crying, use Niuhuang San (Calculus Bovis Powder). Another type involves impending internal ulceration with abdominal pain; prevention is key. Internal ulceration within 7 days is often due to Wind-Cold blocking the pores, causing stagnation of Yin/Yang, leading to internal attack of toxin, fiery inflammation in organs, rotting of the Stomach forming pus, and white coating on mouth/tongue. This is extremely severe. Those who understand know that before eruption, if Wind-Cold blocks, causing rough breathing, high fever, trembling, and acute abdominal/vomiting pain, it signals impending internal ulceration. Urgently use Hejie Tang (Harmonize Decoction) or Shengma Tang (Initial Heat) to disperse cold, open pores, and vent toxin. If the condition develops, treatment is futile.
Niuhuang San (Calculus Bovis Powder) treats Yang toxin entering Stomach from rash, continuous bloody stools, abdominal pain, and crying.
Niuhuang (Calculus Bovis) (1 fen), Yujin (Curcuma Radix) (1 liang).
Powder finely. Take 0.5 qian per dose, decoct in 0.5 sheng of Jiangshui (Fermented Rice Water) to 0.3 sheng. Take warm with dregs. Adjust dosage by age. Twice daily.
Hejie Tang (Harmonize Decoction) Used 3 days before or after.
Shengma (Cimicifuga Rhizome), Shaoyao (Peony Root), Gegen (Pueraria Root), Renshen (Ginseng Root), Chuanxiong (Ligusticum Rhizome), Gancao (Licorice Root), Fangfeng (Saposhnikovia Root), Qianghuo (Notopterygium Rhizome) (each 4 fen).
Decoct in 1.5 zhong of water with 3 slices of Shengjiang (Fresh Ginger) to 0.5 sheng. Take warm.
[Dandan/Wu Dianzi] Smallpox eruption with abdominal pain.
Dingxiang (Clove) (2 pieces), Guanyuan Gui (Official Cinnamon), Shaoyao (Peony Root) (each 1 qian), Baizhu (Atractylodes Macrocephala Rhizome), Danggui (Angelica Sinensis Root) (each 5 fen).
Take as one dose.
If body heat is not high, occasional chills, vomiting, empty/fine pulse, cold limbs with abdominal pain, use Chen's Muxiang San (Costus Powder) (for smallpox diarrhea). Abdominal pain with blue face and cold hands/feet indicates Spleen/Stomach deficiency-cold; use Yihuang San (Yellow Regulating Powder) or Lizhong Tang (Regulate the Middle Decoction). Lizhong Tang + Baishaoyao, Gui (Cinnamon).
These three items illustrate treating cold pain with warm herbs. Indicated for thirst for hot drinks and cold limbs.
[Lou] I treated smallpox initial eruption with abdominal or body pain and surging-rapid pulse using exterior-releasing cooling herbs + Shaoyao, Gancao, resulting in gradual improvement.
Note: Exterior-releasing cooling herbs refer to Shengma Tang, Lianqiao Shengma Tang, Shuangjie San, etc., with doubled dosage of added ingredients.
This item illustrates treating heat pain with cooling herbs. Indicated for thirst for cold drinks and hot limbs.
If eruptions have reached the crusting stage and suddenly develop abdominal pain (previously absent), dietary factors are likely. Investigate carefully. If caused by cold water, use Wuling San (Five-Ingredient Powder with Poria) or Huangqi Jianzhong Tang + Baizhu, Ganjiang, Renshen. If caused by food injury, identify the food; use Dingxiang Pi Ji Wan taken with the soup of the ingested substance. [Zhang] For food-stagnation abdominal pain, do not use Badou (Croton Seed) or Dahuang (Rhubarb); use gentle Qi-moving formulas like Pingwei San (Peace the Stomach Powder), Xiao Yigong San (Minor Yi Gong Powder), or Jupi Tang (Tangerine Peel Decoction). [Xue] Belching with sour regurgitation and foul stool indicates milk/food stagnation; use Baohe Wan (Preserve Harmony Pill).
After crusting, if food stagnation triggers wind stirring and convulsions with vomiting/abdominal pain, see the Convulsions section. After crusting, if heat is prominent, stool is hard/black, and abdominal pain exists, this is Blood Stasis; use Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction).
If during fever there is heart/abdominal colic, restlessness, shouting, or sunken/latent eruptions with distension/pain and panting, this is malignant toxic qi attacking intestines/stomach and burning organs; this is incurable.