Library

*Neijing: Ju Tong Lun* (Treatise on Pain in the Yellow Emperor's Inner Canon) records: What qi causes sudden pain in the five zang organs? Qibo answered: The qi and blood in the meridians circulate endlessly, revolving around the body without rest. When cold pathogen enters the meridians, it causes stagnation and sluggishness (pronounced "se"), preventing smooth flow, thus resulting in sudden pain. Generally speaking, pediatric abdominal pain includes cold-viscera pain (*Zang Han Tong*), locked-belly pain (*Suo Du Tong*), coiled-intestine internal-hanging pain (*Pan Chang Nei Diao Tong*), accumulation pain (*Ji Tong*), *jia* mass pain (*Jia Tong*), *xuan* cord-like pain (*Xuan Tong*), *pi* lump pain (*Pi Tong*), hanging-kidney pain (*Diao Shen Tong*), unilateral scrotal swelling qi (*Pian Zhui Qi*), cold hernia pain (*Han Shan Tong*), and roundworm agitation pain (*Hui Chong Dong Tong*). These pains differ from one another, and their names are also distinct; therefore, they cannot be generalized.

The discussion on cold-viscera pain is attached after the treatise on fetal cold. Locked-belly pain refers to infants within one month of age who suddenly fail to swallow milk, have an abdomen hard as stone, skin red as cinnabar, mouth puckering while crying, cyanotic complexion with black lips, and cold extremities and breath. This is caused initially by umbilical cord ligation not being tight enough, allowing wind-cold pathogen to invade. The condition is critical and can be treated with *Baishao Yao Tang* (White Peony Decoction), *Wumei San* (Mume Powder), or *Yizi Jin*. If left for a long time, it becomes difficult to cure; further reference should be made to the discussions on neonatal tetanus (*Qi Feng*). The discussion on coiled-intestine internal-hanging pain is found in the treatise on night crying.

Accumulation pain presents as dull pain in the abdomen, yellowish complexion, and anorexia. Older children may vomit sour-smelling gas. Treatment should first focus on resolving food stagnation, followed by regulating the spleen and stomach, after which the pain will cease naturally. One must distinguish between deficiency and excess and apply harmonizing methods, as detailed in the previous treatise on injury and accumulation.

*Jia* mass pain results from long-standing accumulation and can develop into infantile malnutrition (*Gan Ji*). This occurs when both Ying (nutritive) and Wei (defensive) qi are deficient, external wind-cold pathogens are contracted, and internal damage to milk and food intake leads to prolonged stagnation and indigestion. Consequently, pathogenic factors merge into the Yin aspect to form *Zheng* masses (fixed, non-moving lumps); Yin governs stillness, so these remain stationary. Pathogens merging into the Yang aspect form *Jia* masses (migratory lumps). Named after resembling objects, these masses move incessantly. If these two conditions are untreated for a long time, they may become spleen-related *Gan* accumulation, or present as stone-hard lumps between the hypochondrium that hurt upon pressure but feel light otherwise, accompanied by sallow complexion, emaciation, distended and hard abdomen, visible blue veins, daytime coolness with nighttime fever, irregular tidal fever, reduced milk intake, pica (eating dirt), or loose stools. During pain episodes, the body feels cold as ice. The treatment method should regulate the spleen and nourish the stomach using *Xing Pi San* (Awaken Spleen Powder) and *Shen Ling Bai Zhu San* (Ginseng, Poria, and Atractylodes Macrocephala Powder). To grind down accumulations and resolve *Gan*, use *Hua Pi Wan* (Resolve Lumps Pill), *San Leng San* (Curcuma Zedoaria Powder), or *Muxiang Ezhu Wan* (Aucklandia and Curcuma Pill). For loose stools, use *Mei Shi Zi Wan* (Myrobalan Pill) or *Chenxiang Binglang Wan* (Agarwood and Areca Seed Pill). However, such accumulation diseases cannot be cured with just a few doses; sequential regulation is required, and recovery will occur naturally over time.

*Xuan* pain begins with a small, elongated, arm-hard lump inside the abdomen, wrapping around the waist, shifting left or right. After a while, pain intensifies, and the lump becomes visible subcutaneously, without affecting feeding. This condition arises because, after an initial illness where exterior pathogens were not fully resolved, excessive purgation was applied too hastily, leading to qi deficiency, cold pathogen binding, and郁结 (stagnant knotting). The appropriate method is to tonify qi and address deficiency, using *Shen Ling Bai Zhu San*, *Chenxiang Binglang Wan*, and *Muxiang Ezhu Wan*. Alternatively, administer *Baishao Yao Tang* intermittently, adding *Renshen* (Ginseng) and *Fuling* (Poria), decocted with water and ginger.

*Pi* pain belongs to the four syndromes of *Xuan*, *Jia*, and *Pi*, which are largely similar with minor differences, each having specific treatments. The detailed discussion on *Pi* syndrome is provided earlier.

Hanging-kidney unilateral scrotal swelling pain is discussed under the treatise on scrotal swelling syndromes; treatment should regulate the kidney and harmonize qi. Cold hernia pain is detailed in the hernia treatise.

Roundworm agitation pain presents with vomiting clear saliva or worms, unbearable pain. This disease results from consuming sweet, fatty, and meaty foods too early, causing stomach cold and worm agitation. The expelled worms may be alive or dead. In young infants, this causes severe suffering and danger. Initially, use *Lizhong Tang* (Regulate the Middle Decoction) with added *Wumei* (Mume Fruit), decocted in water, to warm the stomach and prevent rebellion. Subsequently, use *Lushui Wan* (Aloe Pill) or *Shijunzi Wan* (Quisqualis Pill) combined with *Huachong Yin* (Expel Worm Drink) as the main treatment. For older children presenting with pale complexion interspersed with yellow, increased meat consumption, emaciation, and recurrent abdominal pain, this indicates mixed blood flukes and roundworms; treat with *Ersheng Wan* (Two Sages Pill) to purge them. Additionally, extreme cold or heat in the stomach can cause worm agitation, resulting in mild or no pain, followed by sudden vomiting. The treatment principle should prioritize calming the worms. Using vermifuges directly would damage stomach qi, which is inadvisable. For cases triggered by cold, use *Lizhong Tang* with *Wumei*, decocted in water. For cases triggered by heat, use *Wu Ling San* (Five-Ingredient Powder with Poria) with *Wumei*, decocted with water and ginger.