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In epidemic febrile diseases, fullness and pain in the lower abdomen indicate that pathogenic heat is knotting in the Lower Jiao (Lower Burner). The Lower Jiao comprises the large intestine, bladder, and the domain of the Jueyin (Liver/Pericardium) meridians; it differs from the Middle Jiao. Manifestations vary: some present with fullness without pain, pain without fullness, or both fullness and pain simultaneously.

If fullness appears without pain at the onset, it is due to dampness prevailing and qi stagnation. Areca seed (Binglang), Magnolia bark (Houpo), and Atractylodes rhizome (Cangzhu) are the essential herbs.

If pain appears without fullness, the area is intolerant to touch (refusal of pressure), indicating that heat has injured the blood level of the Jueyin meridian. Scutellaria root (Huangqin) clears heat; Red peony root (Chishao) and the tail end of Angelica sinensis root (Guiwei) invigorate blood; Bupleurum root (Chaihu) raises the qi of the Jueyin meridian. If the pain radiates to the genitalia and the creases between the thighs, adding Gentian macrophylla root (Qinjiao) will lead to recovery.

When fullness and pain occur together, regardless of whether it is at the beginning or end of the disease, one must observe the urination and defecation. If urination is difficult, it indicates water retention; formulas such as Siling San (Four-Ingredient Powder for Leaching Out Dampness), Zhuling San, or Yiyuan San may be selected. If defecation is difficult, it indicates dry stool accumulation; the Three Chengqi Decoctions (San Chengqi Tangs) may be selected. If urination is free but the stool is black, it indicates blood stasis (accumulated blood); Didang Tang or Taoren Chengqi Tang may be selected. While distinguishing based on the patency or obstruction of urination and defecation is correct, one must also carefully examine the nature of the fullness and pain: if there are hard masses that cannot be pressed, it belongs to dry stool; if the abdomen is drum-like and tender but without hard masses, it belongs to urine retention in the bladder; if it is tender and soft upon pressure, it belongs to blood stasis. By applying this differentiation, the condition becomes clear.

Furthermore, in the late stage of epidemic febrile diseases, cases may present with fullness without pain or pain without fullness, where the patient prefers warmth and pressure. These are deficiency syndromes, and a detailed inquiry into the disease history is necessary. If previous treatments involved excessive use of clearing heat and purging methods, one should consider warming and tonifying methods to nourish yin and yang. One must not rigidly adhere to the notion that epidemic diseases are always excess-heat patterns without flexibility. However, such cases are rare, occurring perhaps once in ten.

The aforementioned syndromes of lower abdominal fullness and pain constitute the major aspect of interior syndromes in epidemic febrile diseases, generally belonging to the internal collapse of heat pathogens. In categories such as wind, cold, summerheat, and dampness, cold, heat, deficiency, and excess patterns all exist. In epidemic febrile diseases, these symptoms typically appear after transmission has occurred and following obvious signs of irritability, thirst, and dry heat. Such heat syndromes are easy to differentiate. However, if they appear before transmission occurs, it indicates epidemic toxins are constrained and not yet manifesting; patients often lack thirst and fever, and may even have cold extremities (Jue). Treating according to wind-cold requires warming methods; treating according to epidemic febrile diseases requires clearing methods. A difference of a hair's breadth leads to a thousand miles of error; life and death can turn in the flip of a hand. Therefore, one must carefully observe and detail the complexion, spirit, pulse, and tongue coating to make a precise differentiation.