小儿腹胀腹痛，多因食积，或寒凉伤脾而然。《内经》曰∶病痛者阴也。又曰∶痛者，寒气多
也，有寒故痛也。束垣曰∶寒胀多，热胀少，皆主于脾胃。故凡小儿肚腹或胀或痛，虽曰多由积滞
，然脾胃不虚，则运化以时，何致作胀？是胀必由于虚也。若胃气无伤而腹中和暖，则必无留滞作
痛，是痛多由乎寒也。故治痛治胀者，必当以健脾暖胃为主。若无火证，不得妄用凉药。若无拒按
坚实等证，不得妄用攻药。
一、治法∶凡小儿肚腹膨胀，或时常作痛，黄瘦，常用调理之法，惟芍药枳实丸加减用之为宜，
且善止腹痛。或大健脾丸、杨氏启脾丸、和中丸之类，皆可酌用。若偶尔伤脾，气促困倦，外见腹
胀而内不胀者，此脾气虚也，宜五味异功散，或六味异功煎。若脾胃阳气不足，虚寒作胀，或畏寒
，或手足冷，或兼呕泻者，宜五君子煎、养中煎、温胃饮、六君子汤，或调中丸。若兼脾肾阳虚，
或水泛为痰，成喘促、痛胀、泄泻，宜理阴煎加减主之。若脾胃气虚而痛滞吐泻者，宜六味异功煎
，或六君子汤加木香，或调中汤。若胃口偶有留滞，大痛而胀者，宜排气饮，或益黄散。若宿食偶
有不消而暂为胀满者，宜大、小和中饮，或保和丸、消食丸。若有坚积停滞，胀痛拒按，形气俱实
者，宜赤金豆、白饼子、紫霜丸之类攻下之。凡诸未尽，当于腹痛肿胀二门，参酌为治。
余初年在京，治一五岁邻女，适经药铺，见有晒晾巴豆，其父误以为松仁，以一粒与食之，嚼
而味辣，即忙吐出，而已半粒下咽矣。少顷，大泻十余次，泻后次日，即致肚腹通身悉皆肿胀，绝
口不食，因求治于余。或谓宜黄连、绿豆以解毒；或谓宜四苓、五皮以利水。余曰∶大攻之后，岂
非大虚之证乎？能再堪苦寒以败脾否？大泻之后，又尚有何水之可利？遂单用独参汤及温胃饮以培
脾气，不数剂而复元如初。夫既以大泻，而何以反胀若是？因此一证，乃知大虚大寒而致成肿胀者
，类多如此。（新按）
Abdominal distension and pain in children are mostly caused by food accumulation or spleen injury due to cold and coolness. The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: Painful conditions belong to Yin. It also states: Pain is mostly due to cold qi; because there is cold, there is pain. Shu Yuan stated: Cold-type distension is common, while heat-type distension is rare; all these cases are primarily governed by the Spleen and Stomach. Therefore, whenever a child's abdomen is distended or painful, although it is mostly due to stagnation, if the Spleen and Stomach are not deficient, they will transform and transport nutrients on time, so how could distension occur? Thus, distension must result from deficiency. If the Stomach Qi is uninjured and the abdominal center is warm and harmonious, there will definitely be no stagnation causing pain; thus, pain is mostly due to cold. Therefore, when treating pain and distension, one must prioritize strengthening the Spleen and warming the Stomach. In the absence of Fire (Heat) syndromes, cooling medicines should not be used recklessly. In the absence of signs such as refusal to press and firmness, purgative medicines should not be used recklessly.
1. Treatment Methods: For children with abdominal distension or frequent pain, accompanied by yellowish complexion and emaciation, the commonly used regulatory method is to appropriately modify Shaoyao Zhishi Wan (Peony and Immature Bitter Orange Pill). This formula is effective in stopping abdominal pain. Alternatively, Dajianpi Wan (Great Spleen-Strengthening Pill), Yangshi Qipi Wan (Yang's Spleen-Initiating Pill), or Hezhong Wan (Middle-Harmonizing Pill) can be used as appropriate. If the Spleen is occasionally injured, leading to shortness of breath, fatigue, and external abdominal distension without internal fullness, this indicates Spleen Qi Deficiency; Wuyi Gong San (Five-Efficacy Powder) or Liuwei Yigong Jian (Six-Ingredient Efficacy Decoction) is suitable. If Spleen and Stomach Yang Qi is insufficient, causing distension due to deficiency-cold, or accompanied by aversion to cold, cold hands and feet, or vomiting and diarrhea, Wu Junzi Jian (Five Gentlemen Decoction), Yangzhong Jian (Nourishing Middle Decoction), Wenwei Yin (Stomach-Warming Drink), Liujunzi Tang (Six-Gentlemen Decoction), or Tiaozhong Wan (Middle-Regulating Pill) are suitable. If there is concurrent Spleen and Kidney Yang Deficiency, or water flooding transforming into phlegm, resulting in panting, painful distension, and diarrhea, Liyin Jian (Yin-Nourishing Decoction) modified is indicated. If Spleen and Stomach Qi Deficiency leads to pain, stagnation, vomiting, and diarrhea, Liuwei Yigong Jian or Liujunzi Tang added with Muxiang (Aucklandiae Radix) or Tiaozhong Tang (Middle-Regulating Decoction) is suitable. If there is occasional food retention at the stomach opening, causing severe pain and distension, Paiqi Yin (Qi-Expelling Drink) or Yihuang San (Yellow-Rescuing Powder) is suitable. If retained food occasionally fails to digest, causing temporary fullness, Da Hezhong Yin and Xiao Hezhong Yin (Large and Small Middle-Harmonizing Drinks), or Baohe Wan (Preserve Harmony Pill) and Xiaoshi Wan (Food-Digesting Pill) are suitable. If there are hard accumulations and stagnation, with painful distension, refusal to pressure, and both physical form and Qi manifesting as Excess, Chijin Dou (Golden Bean), Baibing Zi (White Cake Pill), or Zishuang Wan (Purple Frost Pill) can be used for purgation. For any remaining cases, treatment should be determined by referring to the sections on Abdominal Pain and Swelling.
In my early years in Beijing, I treated a five-year-old neighbor girl. Passing by a pharmacy, she saw dried Crotonis Fructus (Badou, 巴豆) being sun-dried. Her father mistook it for pine nuts and gave her one seed. She chewed it, found the taste spicy, and spat it out immediately, but half had already been swallowed. Shortly after, she suffered severe diarrhea more than ten times. The next day following the diarrhea, her abdomen and entire body became swollen, and she refused all food. Seeking my treatment, some suggested using Coptidis Rhizoma (Huanglian, 黄连) and Phaseoli Semen Mungo (Lvdou, 绿豆) to detoxify; others suggested Siling San (Four-Powder Powder) and Wupi Yin (Five-Skin Drink) to promote urination. I said: After such aggressive purging, is this not a condition of great deficiency? Can she still endure bitter-cold herbs that damage the Spleen? After such severe diarrhea, what fluid retention remains to be drained? Therefore, I used only Duchen Tang (Single Ginseng Decoction) and Wenwei Yin to nourish Spleen Qi. Within a few doses, she recovered completely. Since she had undergone severe purging, why did she become so swollen? From this case, we learn that swelling caused by great deficiency and great cold is often like this. (New Commentary)