小儿腹痛体瘦。面色 白。目无精光。手足指寒。口中气冷。不思饮食。或呕利撮口。此脾
土虚而寒水所侮也。益黄散。或理中丸去参加茯苓。若口中气温。手足心热。面色黄白。目无精
光。或多睡恶食。或大便酸臭。此积痛也。消积丸。甚者。白饼子下之。后以白术散调补脾胃。
若腹胀而闷乱喘满者。白饼子。若不闷乱喘满者脾虚也。白术散调补之。误下而致目胞腮面四肢
浮肿。肚腹愈胀。脾虚欲发惊痫者。塌气丸温理之。若腹中有癖不食。饮乳则吐。按之则啼。当
暂用白饼子下之。盖小儿病此。良由乳食不消。伏于腹中。乍冷乍热。饮水过多。脾胃虚弱。不
能传化水谷。以致四肢羸瘦。肚腹渐大而成疳矣。六君子加干蟾。若痛连两胁。肝木乘脾也。四
君子加柴胡、芍药。若腹痛重坠。脾气下陷也。补中益气汤加枳实。若手足指冷。或呃逆泄泻。
寒水侮土也。六君子加炮姜、肉桂。不应。急加附子。若服克削之药。致腹作痛。按之痛止者。
脾气复伤也。五味异功散。至于腹胀喘满。亦皆脾虚邪乘所致。东垣所谓寒胀多而热胀少。热
者。六君子加芩、连、枳、朴。寒者。六君子加姜、桂、吴茱萸。亦有寒热错杂者。泻心汤。芩、
连、炮姜并用。若治实胀。用二陈加枳、朴、木香。有热。加芩。连可也。
Pediatric abdominal pain with emaciation, pale complexion, lack of luster in the eyes, coldness of the fingertips, cold breath from the mouth, anorexia, or vomiting and diarrhea, and mouth puckering (suo kou). This is due to deficiency-cold of Spleen Earth being invaded by Cold Water. Yi Huang San (Benefit Yellow Powder) may be used, or Lizhong Wan (Regulate the Middle Pill) with additional Poria (Fuling). If the breath is warm, palms are hot, complexion is yellowish-white, eyes lack luster, there is hypersomnia and food aversion, or stool has a sour odor, this is pain caused by food accumulation. Xiao Ji Wan (Eliminate Accumulation Pill) may be used; for severe cases, Bai Bing Zi (White Cake Pill) to purge, followed by Tuzhu San (Atractylodes Powder) to regulate and tonify the Spleen and Stomach.
If abdominal distension is accompanied by restlessness and chest fullness with panting, use Bai Bing Zi. If there is no restlessness or panting, it indicates Spleen deficiency, treated with Tuzhu San to regulate and tonify. If improper purging leads to edema of the eyelids, cheeks, and limbs, and increased abdominal distension, with Spleen Qi deficiency predisposing to convulsions and epilepsy, Ta Qi Wan (Collapse Qi Pill) should be used to warm and regulate. If there are masses (pi) in the abdomen, refusal to eat, vomiting after drinking milk, and crying upon palpation, temporarily use Bai Bing Zi to purge. Generally, pediatric disease arises from undigested milk and food lying dormant in the abdomen, alternating cold and heat, excessive water intake, and weak Spleen-Stomach failing to transform and transport water and grain, leading to emaciated limbs and gradually enlarging abdomen, resulting in Gan syndrome (infantile malnutrition). Liu Junzi Tang (Six Gentlemen Decoction) with dried Bufo (Gan Chan) may be used.
If pain radiates to both hypochondria, it is Liver Wood overacting on Spleen Earth; Si Junzi Tang (Four Gentlemen Decoction) with Bupleurum (Chai Hu) and Peony (Shaoyao) may be used. If abdominal pain feels heavy and bearing-down, it is sinking of Spleen Qi; Buzhong Yiqi Tang (Decoction to Supplement the Middle and Augment the Qi) with Immature Bitter Orange (Zhishi) may be used. If fingertips are cold, or there is hiccups and diarrhea, it is Cold Water invading Spleen Earth; Liu Junzi Tang with fried Ginger (Pao Jiang) and Cinnamon Bark (Rou Gui) may be used. If ineffective, add Aconite (Fuzi) urgently. If taking harsh draining medicines causes abdominal pain that ceases upon pressure, it indicates further injury to Spleen Qi; Wuwei Yigong San (Five-Ingredient Extraordinary Skill Powder) may be used. As for abdominal distension with panting and chest fullness, these are also caused by Spleen deficiency allowing pathogenic factors to invade. Li Dongyuan stated that cold distension is more common than heat distension. For heat type, Liu Junzi Tang with Scutellaria (Huang Qin), Phellodendron (Huang Lian), Immature Bitter Orange (Zhishi), and Magnolia Bark (Hou Po) may be used. For cold type, Liu Junzi Tang with Dried Ginger (Sheng Jiang), Cinnamon Bark (Rou Gui), and Evodia (Wu Zhu Yu) may be used. There are also mixed cold-heat patterns, treated with Xi Xin Tang (Heart-Purging Decoction), using Scutellaria, Phellodendron, and fried Ginger together. For treating excess distension, Er Chen Tang (Two-Cured Decoction) with Immature Bitter Orange, Magnolia Bark, and Costus Root (Muxiang) may be used; if heat is present, adding Scutellaria and Phellodendron is appropriate.