〔娄〕痘腹痛，多是痘毒，当临证消息。〔万〕《内经》腹痛皆属于寒，惟有一证为热，疮疹腹痛，皆属毒
热也。诀云∶发热肚中痛， 疮腹内攻，发多防不透，发少更防痈。是已。或有兼食积者。〔翁〕痘疹腹痛者，
由毒郁于三阴，脐以上属太阴，当脐属少阴，小腹属厥阴，须分别之。腹胀者，毒聚于肠胃也，治法俱当升
发解利痘毒，兼分利小便，使毒瓦斯上下分消，则痛与胀自止，故曰∶痛随利减，胀以利消。俗医以浓朴行滞气而
不知升发解利，非其治矣。亦有乳食停滞不消化而腹胀者，当以升发解利药中，加消食之剂，所伤之物，当审其寒热。
又有数日大便者，大便行而痛胀自止，亦未可骤用硝黄也。
定痛散 伤寒肚痛，及冷气痛。
神曲 香附（各一钱） 山楂（二钱） 良姜 当归 甘草（各五分）
上，用姜三片，枣二枚，水煎服。手足逆冷，加大附子二分。
桂枝芍药汤 治腹痛。
桂枝 炙甘草（各一钱） 白芍药（酒炒，二钱）
生姜三片，枣二枚，水煎服。
黄连汤 治热毒在胃腹痛，时或欲吐。此药能升降阴阳。
黄连 炙甘草 干姜 桂枝（各二钱） 半夏 人参（各八分）
枣二枚，水煎服。
一味异功散 治小儿诸般钓证，角弓反张，胸膈脐凸，以透明没药为末，姜汤调下。
《绍定论》云∶病有似是而非，若同而异者。盖肢体厥冷而腹痛者，此毒瓦斯在里也，若不审谛，必作极冷治之，
反与热药，为害愈深。未冷极者不问有无寒热，肢冷腹痛，必大便自利，蜷卧恶寒，今身热肢冷，腹痛大便不通，
乃热毒在里，热甚则发厥，仲景所谓热深厥亦深也。伏热深而疮疹不出者，宜以蝉蜕末水煎服之，已
出者亦可服，毒瓦斯得泄，则四肢温暖，腹痛自止矣。前人论腹痛有虚实，肠鸣自利而腹痛者为虚痛，是冷也。腹
满而不大便者为实痛，是热也。今腹中痛而不大便、又身热，耳尖冷，脚冷，为疮疹证明矣。又有疮疹始发，腹中
有宿块而痛者，医不能辨，误作食积下之，多夭横矣。〔薛〕前证，痘未出而发热烦躁，或作渴饮冷，大便坚实，此
热毒壅滞也，用疏利之药。
〔万〕凡发热腹中便痛者，此毒瓦斯内攻也，急宜发表疏里，桂枝大黄汤主之。亦有外邪与毒相并，致未尽出而腹疼
胀满者，宜参苏饮去参、苓、加缩砂、陈皮，温而出之。若原无腹痛发热，二三日后大便不通而痛者，此燥屎与毒相并
而痛也，三黄丸（热）、七物升麻丸（初热）、宣风散（痘发热）择而用之。有谵妄狂乱者，三乙承气汤主之（便秘）。
原无腹痛，或因饮冷水而痛者，此冷痛也，理中汤（吐利）加桂心。或因多食而痛者，此食积痛也，微则木香大安丸
（伤食），甚则备急丸（伤食），丁香脾积丸（伤食）、原物汤下。原无腹痛，自利后痛者，此虚痛也，黄 建中汤
加木香、青皮。发热自利，又腹痛者，此亦毒也，黄芩汤（吐利）加木香、青皮，或化毒汤主之。如疮乍出乍隐，此
伏也，七物升麻丸。疮出尽者，
再以紫草饮（出不快）大发之。疮不出者，勿治。〔张〕痘未出，有先作腹疼或腹中有块者，乃腹中先出也，不可投疏利
之药，以戕贼胃气，但与和平匀气兼发散药，如升麻汤、参苏饮之类。
蝉蜕一物汤
用蝉蜕二十一个，洗去泥，为末，水一盏，慢火煎至半盏，去滓，量儿大小温
服之。如觉疮疹已出，便根据前服三五次，不是疮疹，亦无害。小儿疮疹欲发出，加甘草一钱五分，煎一盏，旋旋
与服，累效。小儿伏所蕴积热毒，蝉蜕味咸寒可以制，况有暴感风作热，客于表者，蝉蜕亦治，风毒充于皮肤，
瘙痒不止，惊痫夜啼，癫疾，寒热惊悸，皆宜服之。
桂枝大黄汤
桂枝 白芍药（各二钱半） 甘草（五分） 大黄（一钱半）
上锉碎。加生姜一片，水一盏半，煎至一盏，去滓温服，食前。
桂枝芍药汤
桂枝 白芍药 防风 黄 （炙） 甘草（各等分）
上锉细。加枣子二枚，水一盏，煎七分，去滓温服。
黄 建中汤
黄 人参 桂枝 白芍药 甘草（各等分）
上锉细。加生姜三片，枣二枚，水一盏，煎五分，去滓温服。
化毒汤
肉桂（五分） 白芍药 甘草（各一钱） 青皮 木香 枳壳（各七分） 山楂肉 连翘（各五分）
上锉细。水一盏，煎七分，去滓温服，不拘时。
（汪）一女伤寒，但腹痛甚，日夜啼哭，手足厥冷，渐至危殆。此时天时痘灾，
吾疑或者痘症，遂取生猪血，急用脑麝和灌，一服得睡，须臾痘出而安，若非此方，则夭横矣。
〔万〕痘已出而腹痛，亦是毒在里未曾出透，亦宜桂枝大黄汤。起发不透腹痛者，陷伏也，亦宜三乙承气汤（便
秘）及宣风散（痘发热）。〔薛〕痘已出，而不热躁，不饮冷，大便不实，此元气虚弱也，用白术散之类补之。
〔张〕出不快而腹痛者，活血散（即一味白芍药，见出不快）以姜汤调下。若毒瓦斯弥蔓，阳毒入胃，便血日夜无度，
腹痛啼哭者，牛黄散主之。又有一等将成内溃之证而腹痛者，当预防之，七日前内溃，盖因风寒所中，腠理固密，阴
阳二分，壅塞不通，其毒内攻，脏腑之间毒火炮炽，以致胃烂溃而成脓，口舌皆白，是其验也。此证极为惨毒，识者
知痘毒未出之时，或有风寒阻隔，气粗热甚，身必战动，腹吐急疼者，是欲成内溃也，急以和解汤、升麻汤（初热）逐
散寒邪，开泄腠理，纵毒而出，庶无此证，若证已成，而治之亦无及矣。
牛黄散 治疮疹阳毒入胃，便血日夜无度，腹痛啼哭。
牛黄（一分） 郁金（一两）
上为细末。每服半钱，以浆水半盏，煎至三分，和滓温服。量儿大小以此增减，日二服。
和解汤 三日前后用。
升麻 芍药 葛根 人参 川芎 甘草 防风 羌活（各四分）
上，用水一钟半，生姜三片，煎至五分，温服。
〔丹〕吴店子出痘疮腹痛。
丁香（二枚） 官桂 芍药（各一钱） 白术 当归（各五分）
上，作一帖服。
如身不甚热，或时发寒，或呕吐，六脉虚细，四肢逆冷而腹痛者，陈氏木香散主之（痘泻利）。腹痛面青，
而手足冷者，脾胃虚寒证也，宜益黄、理中辈主之。理中汤加白芍药、桂。
上三条，以温药治寒痛例。作渴饮汤，手足并冷者，宜之。
〔娄〕尝治痘始出腹痛，或身痛，脉洪数者，解表凉药加芍药、甘草渐安。
按∶解表凉药，即升麻汤、连翘升麻汤、双解散之类，加者倍而用之也。
上一条，以凉药治热痛例。作渴饮冷，手足并热者，宜之。
如疮已出，至收靥时原无腹痛，忽然作痛，此必有饮食也，消息审问，曾因饮冷水者，五苓散主之，或用黄 建中
汤加白术、干姜、人参。曾伤食者，问伤何食，丁香脾积丸主之，用原物汤送下。〔张〕伤食腹痛，不可用巴豆、
大黄辈，只宜平胃助气之剂，如平胃散、小异功散、橘皮汤（吐逆）皆可。〔薛〕嗳腐吞酸，大便秽臭，
乳食停滞也，用保和丸消之（伤食）。
若靥后伤食，食蒸发搐而呕吐腹痛者，治法见惊搐条。靥后热多，大便实，粪黑，腹痛者，蓄血也，犀角地黄
汤主之。
如发热时心腹绞痛，烦闷叫呼，或疮陷伏，胀满疼痛，喘促者，此毒恶之气，攻刺肠胃，燔灼脏腑，必不可治。
[Lou] Abdominal pain in variola (smallpox) is mostly caused by the variola toxin; clinical judgment should be exercised. [Wan] According to *Huangdi Neijing* (The Yellow Emperor's Classic of Internal Medicine), abdominal pain generally belongs to Cold, with only one pattern belonging to Heat. However, abdominal pain in exanthematous diseases (such as smallpox and measles) all belongs to Toxin-Heat. The medical aphorism states: "Fever accompanied by abdominal pain indicates the toxin attacking within the abdomen; if the eruption is profuse, prevent incomplete resolution; if sparse, further fear abscess formation." This is correct. There may also be concurrent food stagnation. [Weng] Abdominal pain in exanthematous diseases arises from toxin depression in the Three Yin channels: above the umbilicus belongs to Taiyin Spleen channel, directly at the umbilicus belongs to Shaoyin Kidney channel, and the lower abdomen belongs to Jueyin Liver channel; these must be distinguished. Abdominal distension indicates toxin accumulation in the intestines and stomach. The treatment method for both should involve raising and venting to resolve the toxin, combined with promoting urination to allow the toxic qi to dissipate upward and downward, thereby stopping pain and distension naturally. Hence it is said: "Pain decreases with purgation/diuresis, distension dissipates with unblocking." Empirical physicians merely use Houpo (Magnolia Bark) to move stagnant Qi without understanding the need to raise and vent to resolve the toxin; this is incorrect treatment. There are also cases of abdominal distension due to milk or food stagnation and indigestion; in such cases, digestive-resolving agents should be added to the raising-and-venting formulas. The ingested food must be assessed for Cold or Heat. In cases of constipation for several days, once bowel movement resumes, pain and distension cease spontaneously; one should not abruptly use Xiaoshi (Mirabilite) or Dahuang (Rhubarb).
Dingtong San (Pain-Calming Powder) treats abdominal pain from Taiyang Cold Damage and cold-Qi pain.
Shenqu (Massa Medicata Fermentata), Xiangfu (Cyperus Rhizome) (each 1 qian); Shanzha (Crataegus Fruit) (2 qian); Liangjiang (Galangal Rhizome), Danggui (Angelica Sinensis Root), Gancao (Licorice Root) (each 5 fen).
Take the above ingredients, add 3 slices of Shengjiang (Fresh Ginger) and 2 dates, decoct in water, and take warm. If extremities are cold, add Fuzi (Aconite Lateral Root) 2 fen.
Guizhi Shaoyao Tang (Cinnamon Twig and Peony Decoction) treats abdominal pain.
Guizhi (Cinnamon Twig), Zhigancao (Prepared Licorice Root) (each 1 qian); Baishaoyao (White Peony Root) (wine-fried, 2 qian).
Add 3 slices of Shengjiang (Fresh Ginger) and 2 dates, decoct in water, and take.
Huanglian Tang (Coptis Decoction) treats abdominal pain caused by Heat-Toxin in the Stomach, sometimes with nausea. This formula regulates the ascending and descending of Yin and Yang.
Huanglian (Coptis Rhizome), Zhigancao (Prepared Licorice Root), Ganjiang (Dried Ginger), Guizhi (Cinnamon Twig) (each 2 qian); Banxia (Pinellia Tuber), Renshen (Ginseng Root) (each 8 fen).
Add 2 dates, decoct in water, and take.
Yiwei Yigong San (Single-Ingredient Yi Gong Powder) treats various types of convulsive disorders in children, such as opisthotonos and protrusion of the chest, diaphragm, and umbilicus. Use transparent Moyao (Myrrh) ground into powder, taken with Ginger Water.
*Shaoding Lun* states: Diseases can appear similar yet be different. Limb coldness with abdominal pain indicates toxin in the interior. Without careful examination, treating it as extreme Cold and administering Hot medicines will deepen the harm. If not extremely cold, regardless of presence or absence of Cold/Heat signs, limb coldness with abdominal pain implies spontaneous diarrhea, curling up, and aversion to cold. However, current symptoms of fever, limb coldness, abdominal pain, and constipation indicate Heat-Toxin in the interior. Extreme Heat leads to厥 (Jue/cold extremities), as Zhang Zhongjing stated: "The deeper the Heat, the deeper the Jue." When latent Heat is deep and exanthems fail to erupt, Chanui (Cicada Slough) powder decocted in water should be used; it can also be used after eruption. Once the toxic qi is released, limbs become warm, and abdominal pain stops. Predecessors discussed deficiency and excess in abdominal pain: borborygmus with spontaneous diarrhea indicates Deficiency Pain (Cold); abdominal fullness with constipation indicates Excess Pain (Heat). Current symptoms of abdominal pain, constipation, fever, cold ear tips, and cold feet clearly indicate an exanthematous disease. Additionally, when exanthems first appear, abdominal pain with a palpable mass may be misdiagnosed as food stagnation and treated with purgatives, often leading to premature death. [Xue] Regarding the aforementioned conditions, fever and irritability before eruption, thirst with preference for cold drinks, and firm stool indicate Heat-Toxin obstruction; use draining and resolving medicines.
[Wan] Fever accompanied immediately by abdominal pain indicates internal attack by toxic qi; urgently release the exterior and drain the interior using Guizhi Dahuang Tang (Cinnamon Twig and Rhubarb Decoction). If external pathogens combine with toxins, preventing complete eruption and causing abdominal pain and distension, use Shenru Yin (Ginseng and Perilla Drink) removing Renshen (Ginseng) and Fuling (Poria), adding Suansha (Amomum Fruit) and Chenpi (Tangerine Peel), taken warm to vent outward. If there was originally no abdominal pain or fever, but constipation and pain develop after two or three days, this is dry feces combining with toxins; choose from Sanhuang Wan (Three-Yellow Pill - Heat), Qiwu Shengma Wan (Seven-Ingredient Cimicifuga Pill - Initial Heat), or Xuanfeng San (Vent Wind Powder - Varicella Fever). For delirium and mania, use Sanyi Chengqi Tang (Three-Yield Da-Cheng-Qi Decoction - Constipation). Originally no abdominal pain, but pain induced by drinking cold water indicates Cold Pain; use Lizhong Tang (Regulate the Middle Decoction - Vomiting/Diarrhea) plus Guixin (Cinnamon Bark). Pain induced by overeating indicates Food Stagnation Pain; mild cases use Muxiang Da'an Wan (Aucklandia Great Peace Pill - Food Injury), severe cases use Beijie Wan (Emergency Relief Pill - Food Injury) or Dingxiang Pi Ji Wan (Clove Spleen Accumulation Pill - Food Injury), taken with the original food's broth. Originally no abdominal pain, but pain following spontaneous diarrhea indicates Deficiency Pain; use Huangqi Jianzhong Tang (Astragalus Building-the-Middle Decoction) plus Muxiang (Aucklandia Root) and Qingpi (Green Tangerine Peel). Fever with spontaneous diarrhea and abdominal pain also indicates toxin; use Huangqin Tang (Scutellaria Decoction - Vomiting/Diarrhea) plus Muxiang and Qingpi, or Huadu Tang (Resolve Toxin Decoction). If eruptions appear and disappear intermittently, indicating latent toxin, use Qiwu Shengma Wan. If eruptions are complete, use Zicao Yin (Arnebia Drink - Slow Eruption) to vigorously vent. If eruptions do not appear, do not treat. [Zhang] Before eruption, if abdominal pain or a mass appears first, this is "abdominal eruption"; do not use draining medicines to damage Stomach Qi. Instead, use harmonious Qi-regulating and dispersing formulas like Shengma Tang (Cimicifuga Decoction) or Shenru Yin.
Chanui Yi Wu Tang (Single-Ingredient Cicada Slough Decoction)
Use 21 Chanui (Cicada Slough), wash off mud, grind to powder. Add 1 liang of water, simmer slowly until half remains, strain, and take warm according to child's size. If eruptions have appeared, continue taking 3-5 doses; even if not exanthems, it is harmless. For children whose exanthems desire to erupt, add Gancao (Licorice Root) 1.5 qian, decoct to 1 liang, administer gradually; this has proven effective repeatedly. Chanui is salty and cold, capable of restraining latent heat-toxin accumulation in children. It also treats wind-heat invading the exterior, skin itching due to wind-toxin, night crying from fright/epilepsy, mania, alternating chills/fever, and palpitations.
Guizhi Dahuang Tang (Cinnamon Twig and Rhubarb Decoction)
Guizhi (Cinnamon Twig), Baishaoyao (White Peony Root) (each 2.5 qian); Gancao (Licorice Root) (5 fen); Dahuang (Rhubarb Root) (1.5 qian).
Chop finely. Add 1 slice of Shengjiang (Fresh Ginger), 1.5 liang of water, decoct to 1 liang, strain, and take warm before meals.
Guizhi Shaoyao Tang (Cinnamon Twig and Peony Decoction)
Guizhi (Cinnamon Twig), Baishaoyao (White Peony Root), Fangfeng (Saposhnikovia Root), Huangqi (Astragalus Root - prepared), Gancao (Licorice Root) (equal parts).
Chop finely. Add 2 dates, 1 liang of water, decoct to 0.7 liang, strain, and take warm.
Huangqi Jianzhong Tang (Astragalus Building-the-Middle Decoction)
Huangqi (Astragalus Root), Renshen (Ginseng Root), Guizhi (Cinnamon Twig), Baishaoyao (White Peony Root), Gancao (Licorice Root) (equal parts).
Chop finely. Add 3 slices of Shengjiang (Fresh Ginger), 2 dates, 1 liang of water, decoct to 0.5 liang, strain, and take warm.
Huadu Tang (Resolve Toxin Decoction)
Rougui (Cinnamon Bark) (5 fen); Baishaoyao (White Peony Root), Gancao (Licorice Root) (each 1 qian); Qingpi (Green Tangerine Peel), Muxiang (Aucklandia Root), Zhike (Bitter Orange Fruit) (each 7 fen); Shan zha Rou (Crataegus Flesh), Lianqiao (Forsythia Fruit) (each 5 fen).
Chop finely. Add 1 liang of water, decoct to 0.7 liang, strain, and take warm at any time.
(Wang) A girl suffered from Taiyang Cold Damage with severe abdominal pain, crying day and night, and cold extremities, approaching critical condition. Suspecting varicella due to the epidemic season, I took raw pig blood, mixed with Nao (Brain) and Shexiang (Musk), and administered it urgently. After one dose, she slept; shortly after, eruptions appeared, and she recovered. Without this remedy, she would have died prematurely.
[Wan] Abdominal pain after eruption indicates toxin remaining in the interior without full resolution; Guizhi Dahuang Tang is also appropriate. Pain due to incomplete elevation indicates sinking/latent toxin; use Sanyi Chengqi Tang (Constipation) and Xuanfeng San (Varicella Fever). [Xue] After eruption, if there is no fever/restlessness, no desire for cold drinks, and loose stools, this indicates Yuanqi (Primal Qi) deficiency; tonify with Baizhu San (Atractylodes Powder).
[Zhang] Pain with slow eruption: use Huoxue San (Invigorate Blood Powder, i.e., single ingredient Baishaoyao) taken with Ginger Water. If toxin spreads diffusely, Yang-Toxin enters the Stomach, causing continuous bloody stool day and night with abdominal pain and crying, use Niuhuang San (Calculus Bovis Powder). Another type involves impending internal ulceration with abdominal pain; prevention is key. Internal ulceration usually occurs within seven days due to Wind-Cold invasion, dense pores, and blockage of Yin/Yang Qi, causing internal toxin attack and fierce fire in organs, leading to gastric rot and pus formation, with white coating on mouth/tongue as evidence. This condition is extremely severe. Experienced practitioners know that before eruption, if Wind-Cold blocks, with coarse breathing, high fever, body tremors, and acute abdominal/vomiting pain, internal ulceration is imminent. Urgently use Hejie Tang (Harmonize Decoction) or Shengma Tang (Initial Heat) to scatter Cold, open pores, and vent toxin. If the condition develops, treatment is futile.
Niuhuang San (Calculus Bovis Powder) treats Yang-Toxin entering Stomach in exanthems, continuous bloody stool, abdominal pain, and crying.
Niuhuang (Calculus Bovis) (1 fen); Yujin (Curcuma Tuber) (1 liang).
Grind to fine powder. Take 0.5 qian per dose, decoct with 0.5 liang of Jiangshui (Fermented Rice Water) to 0.3 liang, take warm with dregs. Adjust dosage based on child's size; twice daily.
Hejie Tang (Harmonize Decoction) Used 3 days before and after onset.
Shengma (Cimicifuga Rhizome), Shaoyao (Peony Root), Gegen (Pueraria Root), Renshen (Ginseng Root), Chuanxiong (Ligusticum Rhizome), Gancao (Licorice Root), Fangfeng (Saposhnikovia Root), Qianghuo (Notopterygium Rhizome) (each 4 fen).
Add 1.5 zhong of water, 3 slices of Shengjiang (Fresh Ginger), decoct to 0.5, take warm.
[Dan] Wu Dianzi had varicella with abdominal pain.
Dingxiang (Clove) (2 pieces); Guanyuan Gui (Official Cinnamon), Shaoyao (Peony Root) (each 1 qian); Baizhu (Atractylodes Macrocephala Rhizome), Danggui (Angelica Sinensis Root) (each 5 fen).
Take as one dose.
If body heat is not high, or intermittent chills, vomiting, weak/fine pulse, cold extremities with abdominal pain: Chen's Muxiang San (Varicella Diarrhea). Abdominal pain with blue face and cold hands/feet indicates Spleen/Stomach Deficiency-Cold; use Yihuang San (Yellow-Protecting Powder) or Lizhong Tang (Regulate the Middle). Lizhong Tang plus Baishaoyao (White Peony Root) and Guizhi (Cinnamon Twig).
The above three items are examples of treating Cold Pain with Warm medicines. Suitable for thirst with desire for hot drinks and cold extremities.
[Lou] I once treated abdominal pain or body pain upon initial eruption with a rapid, surging pulse, using Exterior-Resolving Cool medicines plus Shaoyao (Peony) and Gancao (Licorice), resulting in gradual improvement.
Note: Exterior-Resolving Cool medicines refer to Shengma Tang (Cimicifuga Decoction), Lianqiao Shengma Tang (Forsythia and Cimicifuga Decoction), Shuangjie San (Double-Resolution Powder), etc., with doubled dosages of added herbs.
This item is an example of treating Heat Pain with Cool medicines. Suitable for thirst with desire for cold drinks and hot extremities.
If eruptions have reached the crusting stage and were previously painless but suddenly become painful, dietary factors are likely. Investigate carefully: if caused by cold water, use Wuling San (Five-Ingredient Powder) or Huangqi Jianzhong Tang (Astragalus Building-the-Middle Decoction) plus Baizhu (Atractylodes), Ganjiang (Dried Ginger), Renshen (Ginseng). If caused by food injury, identify the food and use Dingxiang Pi Ji Wan (Clove Spleen Accumulation Pill) taken with the original food's broth. [Zhang] For food-stagnation abdominal pain, do not use Baidu (Croton Seed) or Dahuang (Rhubarb); use Pingwei San (Peace the Stomach Powder), Xiao Yigong San (Minor Yi-Gong Powder), or Jupi Tang (Tangerine Peel Decoction - Vomiting). [Xue] Belching with sour regurgitation and foul stool indicates milk/food stagnation; use Baohe Wan (Preserve Harmony Pill) to resolve (Food Injury).
If food injury occurs after crusting, leading to fever-induced convulsions, vomiting, and abdominal pain, see the Convulsion section. Post-crusting heat predominance, hard black stool, and abdominal pain indicate Blood Stasis; use Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction).
If during fever there is heart/abdominal colic, restlessness, screaming, sunken eruptions, distension/pain, or panting, this is malignant toxic Qi attacking intestines/stomach and burning organs; it is incurable.