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Qian Yi stated: Heat pain is characterized by incessant crying, with red face and scorched lips during nocturnal attacks, and dark yellow urine. It should be treated with Sanhuang Wan (Three-Yellow Pill for Interior Heat) administered with Ginseng Decoction.

The *Yingru Shu* records the treatment for pediatric abdominal pain where the infant cannot breastfeed due to severe pain. The formula for Poria Pill is as follows:
Poria (*Fuling*), Coptis Rhizome (*Huanglian*) (each 1 liang).
Grind the above herbs into fine powder, form pills the size of soybeans using honey. Administer with warm water, adjusting the dose according to the child's condition.

Qian Yi noted: Accumulation pain presents with warm breath, a sallow-white complexion, dull eyes, or excessive whites in the eyes, lethargy, anorexia, or sour-smelling stools. One should eliminate accumulation; Xiaojie Wan (Accumulation-Resolving Pill) is appropriate. For severe cases, Baixing Zi (White Cake Pill) should be used to purge, followed by harmonizing the stomach with Baizhu San (Atractylodes Macrocephala Powder). (Formulas for Xiaojie Wan and Baixing Zi are found in the *Pi Ji* section; the formula for Baizhu San is found in the *Xiao Ke* section.)

Zeng Shirong stated: Accumulation pain manifests as aching in the abdomen, sallow complexion, and anorexia. Older children may exhale a sour, rancid odor. First treat the accumulation, then regulate the spleen and stomach, after which the pain will cease. Differentiate between deficiency and excess for harmonizing treatment; see the *Pi Ji* section below for methods.

Tang's Sanleng San: Treats abdominal pain caused by qi stagnation from accumulation.
Amomum Fruit (*Sharen*), Licorice Root (*Gancao*), Alpinia Oxyphylla Fruit (*Yizhi*), Burreed Tuber (*Sanleng*), Curcuma Wenyujin Rhizome (*Pengzhu*), Green Tangerine Peel (*Qingpi*) (stir-fried, equal parts).
Grind into fine powder. Take with boiling water.

Zhu Danxi stated: Abdominal pain due to food accumulation requires herbs such as Perilla Leaf (*Zisu*) and Radish Seed (*Laifuzi*). Chu Yushi treated a child who developed abdominal pain from eating zongzi by administering pills made of equal parts Coptis Rhizome (*Huanglian*) and Fermented Rice Wine Medicament (*Jiubi Yao*).

Worm pain presents with a pale face, epigastric and abdominal pain, salivation and clear fluid discharge, and periodic pain attacks. Tian Shi stated: Worm pain causes crying, rolling, restlessness, self-palpation of the heart and abdomen, frequent loud cries, variable facial color (blue, yellow), white lips, dull eyes, and spitting of saliva. This is worm pain. Qian Yi stated: Accumulation pain, food pain, and deficiency pain are largely similar, but worm pain is distinguished by a bland taste and spontaneous salivation. Treatment should follow the symptoms. Worm pain resembles epilepsy; because children are inherently timid, cold deficiency in the stomach causes worms to move and induce heart pain, resembling epilepsy slightly, but without eye deviation or hand convulsions. An Chong San (Worm-Anchoring Powder) is the primary prescription. Zeng Shi stated: Pinworm movement pain involves spitting clear fluid and saliva, or expelling worms, with unbearable pain. This disease results from consuming sweet, fatty, and meaty foods too early, causing stomach cold and worm movement. Expelled worms may be alive or dead. In young infants, this suffering is severe and life-threatening. First administer Lizhong Tang (Regulate the Middle Decoction for vomiting and diarrhea) with Smoked Plum (*Wumei*) water decoction to warm the stomach and prevent rebellion. Subsequently, use Lushui Wan (Rhubarb Pill for Infantile Malnutrition), Shijunzi Wan (Quince Seed Pill), or Huachong Yin (Worm-Dissolving Drink). In older children, a pale face mixed with yellow, increased meat consumption, emaciation, and intermittent abdominal pain indicate the presence of blood flukes and pinworms. Ersheng Wan (Two-Sage Pill) should be used to purge them. Additionally, extreme cold or heat in the stomach can cause worm movement, resulting in mild or no pain, followed by sudden expulsion of worms. The method should prioritize anchoring worms. Using harsh vermifuges damages stomach qi and is inadvisable. For movement due to cold, use Lizhong Tang with Smoked Plum water decoction. For movement due to heat, use Jiaowu Ling San (Modified Wu Ling Powder) with Smoked Plum and ginger water decoction.

Case of Ms. Xin’s daughter: At five years old, she suffered from worm pain. Various physicians treated her with Croton Seed (*Badou*), Resina Drymopteridis (*Ganqi*), and Natrii Sulfas (*Naoshan*) without effect. By the fifth day, she cried frequently, rolled her body, slept restlessly, pressed her heart and abdomen, cried loudly intermittently, had variable facial colors (blue, yellow, white, black), dull and slow eyes, white lips, and spittle. On the sixth day, her chest was distended upward, and lying down caused greater unrest. Qian Yi was summoned. After careful examination, he prescribed Wuyi San (Meliosma Powder) for three doses. Seeing that the blue hue in her eyes remained, he exclaimed in alarm, "This illness is critical. If diarrhea occurs, it will be a reversal sign." The next day, Ms. Xin reported, "At the third watch last night, she indeed had diarrhea." Qian Yi examined the basin, noting the stool resembled medicinal juice. Stirring it with a stick revealed pill fragments. Qian Yi said, "This child has thick flesh and should have robust qi, yet the syndrome indicates deficiency. It is incurable." Ms. Xin asked why. Qian Yi replied, "Spleen deficiency and stomach cold cause worm movement. The current blue eyes indicate Liver wood overacting on Spleen earth. Combined with diarrhea, her qi is extremely depleted. The passage of pills with feces indicates the collapse of Stomach and Spleen qi. Since the physical state does not match the pathology, I know this is a fatal case." Five days later, she became comatose and died on the seventh day.

Qian Yi's An Chong San: Treats pediatric worm pain.
Lead White (*Hufen*) (stir-fried until yellow), Chrysanthemum Seed (*Heshi*) (stir-fried until yellow), Toosendan Fruit (*Chuanlianzi*) (peeled and seeded), Alum (*Baifan*) (calcined, 2 qian 5 fen).
Grind into fine powder. Each dose is one "zi" (approx. 0.3g); for older children, 5 fen. Mix with rice drink and take. Administer during pain.

For severe pain due to worm movement, use 0.5 liang of Resina Drymopteridis (*Ganqi*), one raw Areca Nut (*Binglang*), and one piece of Yaolao (kiln mud residue), ground finely together. Mix into powder. Take with hot wine on an empty stomach. After some time, worms will be expelled, and recovery will be immediate. (Note: Yaolao is likely kiln-burnt mud.)

Another formula: Use 1 liang of Resina Drymopteridis (*Ganqi*), crushed and stir-fried until smoke ceases. Mix with fresh well water and raw Sesame Oil (*Mahu You*). Take on an empty stomach.

Qian Yi's An Chong Wan: Treats deficiency in the Upper and Middle Jiao, or stomach cold causing worm movement and pain.
Resina Drymopteridis (*Ganqi*) (stir-fried until smoke ceases, 2 fen), Realgar (*Xionghuang*) (1 fen), Croton Seed Frost (*Badoushuang*) (1 qian).
Grind into fine powder, make pills the size of millet seeds using paste. Dose according to age. Take with decoction of pomegranate root from an east-facing tree, or Sophora Root (*Kulian Gen*), or Meliosma Decoction. Take 5-7 pills up to 20-30 pills during pain attacks.

Wuyi San: Indications same as above. Whenever a child cries loudly during pain, and the philtrum, nose tip, and lips turn black, the pulse should be deep, weak, and wiry. If the pulse is large instead, it indicates worm syndrome.
White Meliosma Fruit (*Bai Wuyi*), Resina Drymopteridis (*Ganqi*) (stir-fried, equal parts).
Grind into fine powder. Each dose is one "zi", 5 fen, or 1 qian. Mix with rice drink. Take during pain attacks.

Shijunzi Wan: Treats abdominal pain caused by various internal parasites and spitting of clear fluid.
Quinoa Seed Meat (*Shijunrou*) (thinly sliced, baked on roof tiles), Areca Nut (*Binglang*), Acid Pomegranate Root Bark (*Suan Shiliu Genpi*) (preferably from east-facing trees, washed clean, cut, and baked), Rhubarb (*Dahuang*) (half raw, half processed, each 7 qian 5 fen).
Prepare all except Areca Nut (cut and sun-dried without burning). Bake the other three ingredients again, grind together with Areca Nut into powder. Make pills using sugar-water wheat paste, size of hemp seeds.
Take 30-50 pills on an empty stomach with lean pork broth. Chicken broth is also acceptable.

Huachong Yin: Dissolves worm toxins causing abdominal pain.
Areca Nut (*Binglang*), Acid Pomegranate Root Bark (*Suan Shiliu Genpi*) (washed clean, dried, each 1 liang), Red Lead (*Hongdan*) (calcined), Polyporus Umbellatus (*Leiwuan*), Millettia Speciosa Root (*Guanzhong*) (chicken-head shape preferred), Quinoa Seed Meat (*Shijunrou*) (thinly sliced, baked, each 2 qian 5 fen), Licorice Root (*Gancao*) (honey-fried), Aurantium Fructus (*Zhike*) (pith removed, bran-fried until light yellow), Rhubarb (*Dahuang*) (each 5 qian).
Grind into fine powder. Fry one egg in clear oil like a crepe. When cool, place 1 qian of powder on top, spread evenly, and roll up. Eat on an empty stomach. For small children, make pills with glutinous rice flour paste, size of millet grains. Take 15-30 pills on an empty stomach with lean pork broth. Chicken broth is also acceptable.

Ersheng Wan: Treats various internal parasites, promotes digestion and water metabolism, directs qi downward, and dispels wind.
Areca Nut (*Binglang*) (1 liang), Croton Seed (*Badou*) (15 seeds, peeled, de-seeded, select large ones retaining oil).
Cut Areca Nut, sun-dry, and grind into powder. Crush Croton Seed finely in a mortar, mix with Areca Nut powder, and grind uniformly. Make pills with wheat paste, size of mung beans. Take 77-99 pills with warm tea water at dawn on an empty stomach. A single dose is sufficient. Once worms are fully expelled, consume thin congee to restore health.