腹痛腹胀。病属中宫。脏气相击。邪正交攻。挟寒挟热。症见不同。曰食曰积。壅滞于胸。有虚有实。其故难穷。
二病之因。各以类从。先详腹痛。势若攻中。脾虚气冷。胃虚呕HT 。虚热面黄。实热面红。食积便臭。蛊积沫 。肝
木乘脾。两胁恫恫。寒水侮土。泻利重重。脾气下陷。重坠如钟。脾来克肾。少腹如舂。盘肠内吊。腰曲犹弓。啼干唇
黑。由于肝风。
亦有锁肚。硬如石HT 。撮口面青。初生屯蒙。此二症者。患之实凶。以上种种。务通其中。次详腹胀。痞气填衷。
闷乱喘满。下则倥侗。不喘虚痞。误下疲癃。土虚及肺。金气销熔。目胞腮肿。内及喉咙。或缘病后。脉细朦胧。或缘
痰食。膈满肚壅。（叶平声）或缘热结。壮热若烘。或缘寒积。肢冷涎之。丁奚哺露。无辜病丛。头小腹大。黄瘦其躬。
乃
胀之重。病气日充。审其根原。毋俾病隆。为补为泻。当可病松。莫作等闲。用拯幼童。
钱乙曰。小儿积痛、食痛、虚痛、虫痛。大同小异。惟虫痛当口淡而沫自出。治之随其症用药。虫与痫相似。小儿
本怯。故胃虚冷。则虫动而心痛。与痫略相似。但目不斜。手不搐也。宜安虫散。又有胃受极寒极热。亦令虫病。或微
痛。或不痛。遽然吐虫。法当安虫为主。若因治虫。反伤胃气。固不可。因寒而动者。理中汤加乌梅、川椒。因热而动
者。五苓散加乌梅。
曾氏曰。虫痛。小儿多有之。其症心腹痛。叫哭。倒身扑手。呕吐清水涎沫。面青黄。时作时止。口唇紫黑色者。
是蛔厥也。宜安虫散、安虫丸。
谭殊圣曰。小儿腹痛。多因邪正交攻。与脏气相击而作。桔梗枳壳汤加青皮、陈皮、木香、当归为妙。挟热而痛。
必面赤壮热。四肢烦。手足心热。四顺清凉饮加青皮、枳壳。挟冷而痛者。必面色或白或青。手足冷。七气汤加桂。调
苏合丸。冷甚变症。则面黯。唇口俱黑。爪甲皆青矣。若内吊痛。则钩藤散。其余则芍药甘草汤。皆要药也。
Abdominal pain and abdominal distension. The disease belongs to the Middle Jiao (Central Palace, referring to the Spleen and Stomach). Visceral Qi strikes each other; pathogenic factors and healthy Qi attack mutually. Accompanied by cold or heat, symptoms present differently. It is said to be food stagnation or accumulation, obstructing in the chest. There are deficiency and excess patterns, their causes are difficult to exhaust.
The causes of these two diseases follow their respective categories. First, detail abdominal pain: the momentum seems to attack the center. Spleen deficiency leads to Qi cold; Stomach deficiency leads to vomiting. Deficiency-heat presents with a yellow complexion; Excess-heat presents with a red complexion. Food stagnation presents with foul-smelling stool; Gu accumulation (parasitic accumulation) presents with foaming from the mouth. Liver Wood overacting on Spleen Earth causes dull pain in both hypochondria. Cold Water insulting Spleen Earth causes severe diarrhea and dysentery. Spleen Qi sinking causes a heavy, dragging sensation like a bell. Spley attacking Kidney causes the lower abdomen to feel as if being pounded. Intestinal colic (internal hanging intestines) with the waist curved like a bow. Crying without tears and black lips are due to Liver Wind.
There is also "Lock Belly" (failure to pass meconium), where the abdomen is hard as stone. "Mouth pinching" (tightening of the lips/mouth) with a cyan complexion. In newborns, these two conditions are truly ominous. For all the above situations, it is essential to unblock the middle Jiao. Next, detail abdominal distension: Pi Qi (stagnant Qi) fills the chest and heart. Chest oppression, confusion, wheezing, and fullness. If purged incorrectly, it leads to weakness and urinary retention. Earth deficiency affecting Lung Metal causes Metal Qi to melt. Eyelids and cheeks swell, internally involving the throat. Or due to post-illness, the pulse is fine and hazy. Or due to phlegm and food, the diaphragm is full and the belly is obstructed. Or due to heat binding, high fever like roasting. Or due to cold accumulation, cold limbs and salivation. Ding Xi, Bu Lu, and Wu Gu diseases cluster together; small head, large belly, yellow and emaciated body. This is a severe stage of distension, with pathogenic Qi filling daily. Examine the root cause, do not allow the disease to flourish. Whether tonifying or purging, the disease should relax. Do not treat it lightly; use this to save the child.
Qian Yi said: Children's Ji pain (accumulation pain), Shi pain (food pain), Xu pain (deficiency pain), and Chong pain (worm pain) are largely similar with minor differences. Only worm pain presents with a bland taste and spontaneous foaming. Treatment depends on the symptoms. Worm pain resembles epilepsy. Children are naturally timid; thus, when the Stomach is deficient and cold, worms move causing heart pain, slightly resembling epilepsy. However, the eyes do not deviate, and hands/feet do not convulse. An Chong San (Worm-Calming Powder) is suitable. Also, extreme cold or heat affecting the Stomach can cause worm disease. Sometimes mild pain, sometimes no pain, suddenly vomiting worms. The method should focus on calming worms. If treating worms damages Stomach Qi, it is inadvisable. For movement due to cold, Li Zhong Tang (Regulate the Middle Decoction) plus Wumei (Mume Fruit) and Chuanjiao (Sichuan Pepper). For movement due to heat, Wu Ling San (Five-Ingredient Powder with Poria) plus Wumei.
Zeng said: Worm pain is common in children. Symptoms include heart and abdominal pain, crying, throwing the body and hitting hands, vomiting clear water and foam, greenish-yellow complexion, intermittent onset and cessation. Those with purple-black lips have Hui Jue (Roundworm Jue). An Chong San (Worm-Calming Powder) and An Chong Wan (Worm-Calming Pill) are suitable.
Tan Shusheng said: Children's abdominal pain is often caused by the mutual attack of pathogenic and healthy Qi, striking visceral Qi. Jiegeng Zhike Tang (Platycodon and Bitter Orange Decoction) added with Qingpi (Green Tangerine Peel), Chenpi (Aged Tangerine Peel), Muxiang (Costus Root), and Danggui (Angelica Sinensis) is excellent. Pain with heat binding必然 (necessarily) presents with red face, high fever, restless limbs, and hot palms/soles. Sishun Qingliang Yin (Four-Smooth Cooling Decoction) added with Qingpi and Zhike (Bitter Orange). Pain with cold binding necessarily presents with white or cyan face and cold extremities. Qi Qi Tang (Seven-Qi Decoction) added with Guizhi (Cinnamon Twig), mixed with Suhe Wan (Styrax Pill). If cold becomes severe and changes symptoms, the face darkens, lips and mouth turn black, and nails become cyan. For internal hanging pain, Gouteng San (Uncaria Powder) is used. For others, Shaoyao Gancao Tang (Peony and Licorice Decoction) is used; these are all important formulas.