治腹痛证当以可按拒按，及宜饱宜饥，辨其虚实，不得谓痛无补法，而悉行消伐也。又
当因脉因证，辨其寒热，不得妄用寒凉也。大都寒滞者十居八九，热郁者间或有之，若虚不知
补而寒因寒用，则害莫甚矣。
一、初见发热，痘疮未出，别无寒滞食滞而腹满腹痛者，此必起发不透，痘毒内攻而然，
宜解表疏里，以化毒汤加紫苏、浓朴之类主之，或五积散加木香亦可。若大便不远，腹胀而
作痛者，桂枝大黄汤酌宜用之。
一、寒气犯胃，或食生冷而呕恶吐泻，腹无服满而但有疼痛者，温胃饮、理中汤加肉桂、
木香，或小建中汤，随宜用之。若胃气虚寒作痛而喜按者，黄 建中汤。
一、寒犯中焦，气滞作胀，而腹痛或泄泻者，和胃饮，或抑扶煎加丁香、木香，或陈氏十
一味木香散。
一、脾肾虚寒，下腹作痛，泻利不止者，胃关煎。
一、误饮冷水凉茶，寒湿留中，小水不利而腹痛者，五苓散或加木香，或用小建中汤。
一、饮食停滞，中满作痛者，大、小和中饮，或保和丸加木香、砂仁。若大便不通而痛
甚者，赤金豆或承气汤利之。
一、发热二、三日后，大便不通，燥粪留滞而腹痛者，当归丸，或用猪胆导法。
一、湿热下利，烦热大渴，小水热涩而腹痛者，大、小厘清饮，或黄芩汤加木香、青皮、
砂仁。
一、火毒内攻，谵妄狂乱而烦热腹痛者，退火丹，或朱砂益元散。
In the treatment of abdominal pain, one must distinguish between deficiency and excess syndromes by observing whether the pain is relieved or aggravated upon pressure, and whether it occurs when hungry or after eating. One should not assume that there are no tonifying methods for pain and indiscriminately use resolving and purgative drugs. Furthermore, cold and heat syndromes must be distinguished based on the pulse and symptoms; one must not recklessly use cold-natured cooling herbs. Generally speaking, cases of cold stagnation account for eight or nine out of ten, while those of heat constraint occur occasionally. If a deficiency syndrome is not treated with tonification, but instead cold-coldening herbs are used due to a misdiagnosis of cold, the harm would be unparalleled.
1. When fever appears initially, before the eruption of smallpox/variolous lesions (dou chuang), without external cold stagnation or food retention, yet accompanied by abdominal fullness and pain, this is likely due to incomplete eruption of the rash and internal attack of toxin. The appropriate method is to release the exterior and unblock the interior using Huadu Decoction (Toxin-Resolving Decoction) supplemented with Perilla Leaf (Zisu) and Magnolia Bark (Houpo). Alternatively, Wuji Powder (Five Accumulations Powder) supplemented with Aucklandia Root (Muxiang) may be used. If the stool is normal but abdominal distension and pain occur, Guizhi Dahuang Decoction (Cinnamon Twig and Rhubarb Decoction) should be used judiciously.
2. When cold pathogen invades the stomach, or consumption of raw/cold foods causes nausea, vomiting, and diarrhea, with abdominal pain but no distension, Wenyi Decoction (Stomach-Warming Decoction), Lizhong Decoction (Regulate the Middle Decoction) supplemented with Cinnamon Bark (Rougui) and Aucklandia Root (Muxiang), or Xiaojianzhong Decoction (Minor Construct the Middle Decoction) should be selected according to the situation. If the pain is caused by deficiency-cold of the stomach qi and is relieved by pressure, Huangqi Jianzhong Decoction (Astragalus Construct the Middle Decoction) is indicated.
3. When cold invades the middle jiao, causing qi stagnation, distension, abdominal pain, or diarrhea, Hewei Decoction (Harmonize the Stomach Decoction), Yifu Decoction (Suppress and Support Decoction) supplemented with Clove (Dingxiang) and Aucklandia Root (Muxiang), or Chen’s Eleven-Ingredient Muxiang San (Powder) should be used.
4. For deficiency-cold of the spleen and kidney, with lower abdominal pain and incessant dysentery/diarrhea, Weiguan Decoction (Stomach Gate Decoction) is indicated.
5. If cold water or cool tea is mistakenly ingested, leading to retention of cold-dampness in the middle jiao, difficult urination, and abdominal pain, Wuling San (Five Ling Powder) possibly supplemented with Aucklandia Root (Muxiang), or Xiaojianzhong Decoction (Minor Construct the Middle Decoction) should be used.
6. For food stagnation causing middle jiao fullness and pain, Dahezhong Yin (Major Harmonize the Middle Drink) or Xiaohezhong Yin (Minor Harmonize the Middle Drink), or Baohe Wan (Preserve Harmony Pill) supplemented with Aucklandia Root (Muxiang) and Amomum Fruit (Sharen), should be used. If constipation accompanies severe pain, Chijin Dou (Golden Bean) or Chengqi Tang (Chengqi Decoction) should be used to promote bowel movement.
7. Two or three days after the onset of fever, if constipation persists and dry feces are retained causing abdominal pain, Danggui Wan (Angelica Sinensis Pill) or the Pig Gallbladder Suppository Method (Zhudan Dao Fa) may be employed.
8. For damp-heat dysentery accompanied by irritability, intense thirst, hot and obstructive urination, and abdominal pain, Da Liqing Yin (Major Clearing Decoction) or Xiao Liqing Yin (Minor Clearing Decoction), or Huangqin Tang (Scutellaria Decoction) supplemented with Aucklandia Root (Muxiang), Tangerine Peel (Qingpi), and Amomum Fruit (Sharen), should be used.
9. In cases of internal attack by fire-toxin, manifesting as delirium, mania, irritability, fever, and abdominal pain, Tuohuo Dan (Fire-Removing Elixir) or Zhusha Yiyuan San (Cinnabar Yi Yuan Powder) should be administered.