凡痘子，腹中常宜宽舒，为里无邪，若腹胀满，须审其伤食否，及大小便何如，
如曾伤食，微满不痛者，木香大安丸。胀满腹痛甚者，丁香脾积丸（俱伤食）。小便不通，百祥丸（黑陷）。大便不通者，
宣风散（发热）主之。此上诸证，皆实胀者也，故宜利之。若自利腹胀，乃虚胀也，陈氏木香散（泄利）主之。
腹胀分虚实寒热 钱氏云∶身热烦躁，腹满而喘，大小便涩，面赤闷乱，大吐者当利小便，不瘥者，宣风散下
之。此实热治例也。陈文中木香散治痘疮腹胀渴泻。此虚寒治例也。薛氏《撮要》云∶腹胀泻渴，脾胃虚寒也，用大
异功散（出不快）
参内托散（即十补散出不快）治之。若前证而兼气促体倦，乃脾气虚也，用白术散（渴）加木香，煎送四神丸（泄泻
）。如腹胀作喘，大便利，小便秘，手足并冷，乃脾气虚也，先用葶苈木香散（喘），次用小异功散（吐泻）一二剂
自愈。此平补例也。
初热时腹胀痛者，由毒瓦斯与外邪相搏，欲出而不得出也，用参苏饮加缩砂、陈皮，去参苓服之（挟有表证者、宜
此）。身热脉数，大便秘而腹胀，此热毒壅遏也，当微下之，或疮半未出而喘息腹胀，其人大便不通，烦躁作渴，谵语
不安者，当急下之，俱用紫草承气汤（挟有里证者、宜此）。〔丹溪〕用桔梗枳壳汤、二陈加枳壳汤。若虚弱自
利，四肢厥冷，腹胀发哕者，里气虚也，姜附、理中辈急救之。
紫草承气汤
浓朴（二两） 大黄（四两） 枳实（一两） 紫草（一两）
上为粗末。每服五钱，水半盏，煎二三分，温服。以利为度，如未利加芒硝一字。
桔梗枳壳汤
枳壳 桔梗（各二两） 甘草（五钱）
上锉。每服三钱，姜二片，水煎服。
二陈加枳壳汤
枳壳 半夏 茯苓 甘草 陈皮（各等分）
上锉。每用三钱，姜二片，水煎服。
若疮既出而腹胀者有二证，一则阴阳不和，或因作热烦渴，饮冷过多，或误投凉剂，热为冷所激，欲出不能，
毒不能发越，故令腹胀。其人必不能食，二便利，腹中虚鸣，甚者气喘发厥，疮白无血色者多致不救。急当
以温中药疏逐冷气，不可又用宣泻之药，以重其困，如小异功散（吐泻）木香散（痘泻）俱可用。王中阳云∶木香散性
温平，能和表里，治腹胀泻渴，有如神之效。一则毒瓦斯陷伏入里，必有他证相杂，或烦躁大渴，或大小便秘，或啼
哭不止，但用温平解毒快气之剂，如人齿散（黑陷）活血散（出不快）之类。又有小便赤涩，而心腹胀满，别无他
证者，此伏热在胃，则中有所隔，上为心气不降，故小便涩少而赤。下为阴气不升，故腹中胀满。董氏用四圣散
（出不快）以发出其毒，则胃热自散矣。若出太盛而面黄，大便黑，烦躁，喘渴腹胀者，此有瘀血在里也，治法见渴
条。若出太盛，至当结脓窠痂 而不结，能食而喘，腹胀谵语不大便者，及靥后腹胀喘渴，大便利小便涩者，治法
俱见喘条。
痘疮起发而腹胀者二证，同前阴阳不和者，疮痘正发，热毒方盛，必生烦渴，宜以葛根解毒汤、人参麦门冬散、
人参白术散（并见痘渴）之类与之。不知此理，或饮冷过多，或误投凉剂，热为冷所激，欲出而不能，冷热相搏，
毒不发起，故令腹胀。且伤于冷者，急当以温中药疏逐冷气，冷气散，则腹胀自消，益黄散（脾）去甘草，加
姜制浓朴。甚者气喘发厥，疮白而无血色，多致不救。陈氏木香散（泄利）圣方也，昧者反用峻下之药，致令重困
而死。其毒瓦斯陷伏入里者，但用温平解毒快气之剂紫草饮子主之（起发）。若腹胀而目闭，口中如烂肉臭者，其证为大恶。
〔丹〕勉奴痘后渴，肚急，小便少，发热。
芍药 白术 陈皮（各五分） 川芎 干葛（各三分） 甘草（炙，一钱半） 木通（二分）
上，用水煎服。
寄子五岁，痘后肚急。
白术（一钱） 陈皮 木通（各五分） 犀角 川芎 白芷（各七分） 甘草（炙，三分）
上，水煎服。
加味透肌散
人参 黄 白术 芍药 川芎 甘草 茯苓 木通 陈皮 糯米 浓朴 大腹皮
等分，为粗散。姜枣煎服。
紫草浓朴汤 治痘疮烦闷痞满，或坚急，或结聚不散。
紫草茸（一钱二分） 枳实 黄芩 黄连 浓朴（各一钱一分） 露蜂房 白茯苓 山豆根
麦门冬 桃仁 石膏 旋复花（各二钱） 蝉蜕 升麻（各八分） 白术（五分）
上锉散。每服四五钱，水煎，食远温服。
温平，能和表里，治腹胀泻渴，有如神之效。一则毒瓦斯陷伏入里，必有他证相杂，或烦躁不渴，或大小便秘，或啼
哭不
止，但用温平解毒快气之剂，如人齿散（黑陷）活血散（出不快）之类。又有小便赤涩。而心腹胀满，别无他证者，此
伏热在胃，则中有所隔，上为心气不降，故小便涩少而赤。若出太盛而面黄，大便黑，烦躁，顺喝腹胀者，此有瘀血在
里也，治法见渴条。若出太盛，至当结脓窠痂 而不结，能食而喘，腹胀谵语不大便者，及靥后腹胀喘渴，大便利小便
涩者，治法俱见喘条。
痘疮起发而腹胀者二证，同前阴阳不和者，疮痘正发，热毒方盛，必生烦渴，宜以葛根解毒汤、人参麦门冬、人参
白术
散（并见痘渴）之类与之。不知此理，或饮冷过多，或误投凉剂，热为冷所激，欲出而不能，冷热相搏，毒不发起，故
令腹胀。且伤于冷者，急当以温中药疏逐冷气，冷气散，则腹胀自消，益黄散（脾）去甘草，加姜制浓朴，甚者气喘发
厥，疮白而无血色，多致不救。陈氏木香散（泄利）圣方也，昧者反用峻下之药，致冷重因而死。其毒瓦斯陷伏入里者，
但用温平解毒快气之剂紫草饮子主之（起发）。若腹胀而目闭，口中如烂肉臭者，其证为大恶。
〔丹〕 勉奴痘后渴，肚急，小便少，发热。
芍药 白术 陈皮（各五分） 川芎 干葛（各三分） 甘草（炙，一钱半） 木通（二分）
上，用水煎服。
寄子五岁，痘后肚急。
白术（一钱） 陈皮 木通（各五分） 犀角 川芎 白芷（各七分） 甘草（炙，三分）
上，水煎服。
加味透肌散
人参 黄 白术 芍药 川芎 甘草 茯苓 木通 陈皮 糯米 浓朴 大腹皮
等分，为粗散。姜枣煎服。
紫草浓朴汤 治痘疮烦闷痞满，或坚急，或结聚不散。
紫草茸（一钱二分） 枳实 黄芩 黄连 浓朴（各一钱一分） 露蜂房 白茯苓 山豆根 麦门冬 桃仁 石膏
旋复花（各二钱） 蝉蜕 升麻（各八分） 白术（五分）
上锉散。每服四五钱。水煎，食远温服。
紫草枳实汤 治痘疮腹胀，或热毒，或因伤冷所致。
紫草茸 鼠粘子（各一钱二分） 浓朴 苦参（各一钱一分） 白芍药 贝母 枳实 诃子 肉
豆蔻（各一钱） 蝉蜕 桔梗 白术（各八分） 升麻（七分） 甘草（六分）
上锉散。每服四五钱，水煎，食远服。
葶苈木香散（喘）
木通芍药汤 治痘疮作渴腹胀，小便不利。
木通 芍药 白术（各五分） 川芎 陈皮 干葛（各三分） 甘草（二分）
上，水煎服。
姜附汤 治疮疹半出而半不出，或出盛时却下利支厥，呕逆腹胀吃噫，须急与理中丸、四逆、姜附汤之类不
须疑，已试之验也。大便自利腹胀者，是热毒被冷所搐不能出，冷甚则为下利，其毒小得出，则为腹胀，当此
以理中丸、四逆、姜附汤等服之，里复温，则利止，热毒得复出，则腹胀自消，疮疹亦自出矣。又有疮疹
半出半未出，或出盛时却大便不通，小便赤涩，喘粗腹胀，而唇齿干，口燥渴引饮，谵语者，当急下之，此
证是毒瓦斯壅瘀，欲出而出不辨，故腹胀，下之热毒散，
荣卫伸则里胀消，外疮出，合温合下，皆得其宜，不可不述之。若下脓血而腹胀
者，又非此证，宜服南金散、乳香猪血膏、理中丸、姜附汤。
For children suffering from smallpox (Variola), the abdomen should generally remain loose and comfortable, indicating that there is no pathogenic factor in the interior. If abdominal distension and fullness occur, one must carefully examine whether it is due to food stagnation (Food Stagnation) and assess the condition of urination and defecation.
If there was a history of food stagnation, presenting as slight fullness without pain, use Muxiang Da'an Wan (Wood Fragrance Great Peace Pill). If fullness is severe accompanied by abdominal pain, use Dingxiang Pi Ji Wan (Clove Spleen Accumulation Pill) (both cases are due to Food Stagnation). If urination is obstructed, use Baixiang Wan (Hundred Auspicious Pills) (for dark, depressed lesions). If defecation is obstructed, use Xuanfeng San (Dispel Wind Powder) as the primary treatment (for cases with fever). All the aforementioned conditions represent excess-type abdominal distension (Excess Distension); therefore, purgative or draining methods are appropriate. If spontaneous diarrhea accompanies abdominal distension, it indicates deficiency-type abdominal distension (Deficiency Distension); use Chen's Muxiang San (Chen's Wood Fragrance Powder) as the primary treatment (for diarrhea).
Regarding the differentiation of abdominal distension into excess/deficiency and cold/heat: Qian Yi stated that if the body is hot and restless, the abdomen is full and distended with wheezing, urination and defecation are涩 (astringent/difficult), the face is red with chest oppression and confusion, and there is severe vomiting, one should first promote urination. If ineffective, use Xuanfeng San to purge downwards. This is an example of treating excess-heat patterns. Chen Wenzhong used Muxiang San to treat abdominal distension, thirst, and diarrhea caused by smallpox. This is an example of treating deficiency-cold patterns. Xue Ji, in *Cuoyao*, stated that abdominal distension, diarrhea, and thirst are due to spleen-stomach deficiency-cold; use Dacigong San (Great Miracle Worker Powder) (for slow eruption) and Renshen Naituo San (Ginseng Internal Support Powder) (also known as Shibu San, for slow eruption) for treatment. If these symptoms are accompanied by shortness of breath and fatigue, it indicates spleen-qi deficiency; use Baizhu San (Atractylodes Macrocephala Powder) (for thirst) added with Muxiang, decocted and taken with Sishen Wan (Four Spirits Pill) (for diarrhea). If abdominal distension occurs with wheezing, normal bowel movements but obstructed urination, and cold hands and feet, this is also spleen-qi deficiency; first use Tingli Muxiang San (Descurainia Wood Fragrance Powder) (for wheezing), followed by Xiaogong San (Minor Miracle Worker Powder) (for vomiting and diarrhea) for one or two doses, and the condition will resolve spontaneously. This is an example of mild tonification.
During the initial heat stage, if abdominal distension and pain occur, it is because toxic factors (Toxic Factors) are struggling with external pathogens, attempting to erupt but failing. Use Shen Su Yin (Ginseng and Perilla Decoction) added with Suisha (Amomum Villosum) and Chenpi (Citrus Reticulata Peel), removing Renshen (Ginseng) and Fuling (Poria), and take it (suitable for cases with exterior syndromes). If the body is hot, pulse is rapid, stool is constipated, and the abdomen is distended, this is heat-toxin obstruction; mild purgation is indicated. Or, if half the lesions have erupted while half have not, accompanied by wheezing and abdominal distension, where the patient has constipation, restlessness, thirst, delirium, and unrest, urgent purgation is required; use Zicao Chengqi Tang (Arnebia Rhubarb Decoction) (suitable for cases with interior syndromes). [Zhu Danxi] advocated using Jiegeng Zhike Tang (Platycodon and Aurantium Decoction) and Erchen Tang (Two-Aged Decoction) added with Zhike (Aurantium). If the patient is weak with spontaneous diarrhea, cold limbs, abdominal distension, and hiccups, this indicates interior qi deficiency; rescue urgently with Ganjiang (Dried Ginger), Fuzi (Aconite), Lizhong Tang (Regulate the Middle Decoction), etc.
[Formula] Zicao Chengqi Tang
Houpo (Magnolia Bark, 2 liang) Dahuang (Rhubarb Root and Rhizome, 4 liang) Zhishi (Immature Bitter Orange, 1 liang) Zicao (Arnebia Root, 1 liang)
Grind into coarse powder. Take 5 qian per dose, add half zhan of water, decoct until reduced to two or three parts, and take warm. Stop when bowel movement is achieved; if not achieved, add Mangxiao (Mirabilite) one zi amount.
[Formula] Jiegeng Zhike Tang
Zhike (Aurantium Fructus Immaturus, 2 liang) Jiegeng (Platycodon Root, 2 liang) Gancao (Licorice Root, 5 qian)
Cut into pieces. Take 3 qian per dose, add two slices of ginger, decoct in water, and take.
[Formula] Erchen Tang Added with Zhike
Zhike (Aurantium Fructus Immaturus) Banxia (Pinellia Tuber) Fuling (Poria) Gancao (Licorice Root) Chenpi (Citrus Reticulata Peel) (equal parts)
Cut into pieces. Take 3 qian per dose, add two slices of ginger, decoct in water, and take.
If abdominal distension occurs after lesions have erupted, there are two patterns. The first is yin-yang disharmony, possibly due to fever, restlessness, and thirst, excessive drinking of cold fluids, or misapplication of cooling agents. The heat is激itated by cold, preventing eruption and dispersion of toxins, leading to abdominal distension. Such patients definitely cannot eat, have normal urination and defecation, and have borborygmus in the abdomen. Severe cases may present with wheezing, syncope, and pale, bloodless lesions, which often lead to death. Urgently use warming medicines to disperse and drive out cold qi. Do not use purgative drugs again to avoid worsening the condition. Xiaogong San (for vomiting and diarrhea) and Muxiang San (for smallpox diarrhea) can be used. Wang Zhongyang said: Muxiang San has a warm and balanced nature, harmonizes the exterior and interior, and treats abdominal distension, diarrhea, and thirst with miraculous effect. The second pattern is toxic factors sinking and hiding in the interior, necessarily mixed with other symptoms, such as restlessness and extreme thirst, or constipation of urine and stool, or incessant crying. Only use warm, balanced, detoxifying, and qi-moving agents, such as Renci San (Human Tooth Powder) (for black depression) and Huoxue San (Blood Activating Powder) (for slow eruption). Additionally, if there is red, astringent urination with heart and abdominal distension but no other symptoms, this is latent heat in the stomach causing middle jiao obstruction. Upper heart qi fails to descend, causing scanty red urination; lower yin qi fails to ascend, causing abdominal distension. Dong Shi used Sisheng San (Four Sages Powder) (for slow eruption) to vent the toxin, thereby dissipating stomach heat. If eruptions are too profuse with yellow face, black stool, restlessness, wheezing, thirst, and abdominal distension, this indicates blood stasis in the interior; see the "Thirst" section for treatment. If eruptions are too profuse, failing to form pustule crusts when they should, able to eat but wheezing, with abdominal distension, delirium, and constipation, or post-crusting abdominal distension, wheezing, thirst, normal stool but astringent urination, see the "Wheezing" section for treatment.
When smallpox is in the rising phase and abdominal distension occurs, there are two patterns. Similar to the previously mentioned yin-yang disharmony, as lesions are rising and heat-toxin is vigorous, restlessness and thirst inevitably arise. Use Gegen Jiedu Tang (Kudzu Detoxification Decoction), Renshen Maidong San (Ginseng Ophiopogon Powder), and Renshen Baizhu San (Ginseng Atractylodes Powder) (see "Smallpox Thirst") to treat. Ignoring this principle, excessive drinking of cold fluids or misapplication of cooling agents causes heat to be激itated by cold, preventing eruption. Cold and heat struggle, toxins fail to rise, causing abdominal distension. For those injured by cold, urgently use warming medicines to disperse cold qi; once dispersed, distension resolves. Yihuang San (Benefit Yellow Powder - Spleen) minus Gancao, added with Jiangzhi Houpo (Ginger-processed Magnolia Bark). Severe cases with wheezing, syncope, and pale, bloodless lesions often result in death. Chen's Muxiang San (for diarrhea) is a sacred formula; ignorant practitioners mistakenly use harsh purgatives, leading to death from aggravated condition. For toxic factors sinking into the interior, use warm, balanced, detoxifying, and qi-moving Zicao Yin (Arnebia Infusion) as the primary treatment (for rising phase). If abdominal distension is accompanied by closed eyes and a foul odor like rotting meat in the mouth, the prognosis is extremely poor.
[Zhu Danxi Case] Mian Nu had thirst, urgent abdomen, scanty urination, and fever after smallpox.
Shaoyao (Peony Root) Baizhu (Atractylodes Macrocephala Rhizome) Chenpi (Citrus Reticulata Peel) (each 5 fen) Chuanxiong (Ligusticum Chuanxiong Rhizome) Gange (Kudzu Root) (each 3 fen) Gancao (Licorice Root, honey-fried, 1.5 qian) Mutong (Akebia Stem, 2 fen)
Decoct in water and take.
Jizi, aged five, had urgent abdomen after smallpox.
Baizhu (Atractylodes Macrocephala Rhizome, 1 qian) Chenpi (Citrus Reticulata Peel) Mutong (Akebia Stem) (each 5 fen) Xijiao (Rhinoceros Horn) Chuanxiong (Ligusticum Chuanxiong Rhizome) Baizhi (Angelica Dahurica Root) (each 7 fen) Gancao (Licorice Root, honey-fried, 3 fen)
Decoct in water and take.
[Formula] Jiawei Touji San (Modified Skin-Penetrating Powder)
Renshen (Ginseng Root) Huangqi (Astragalus Root) Baizhu (Atractylodes Macrocephala Rhizome) Shaoyao (Peony Root) Chuanxiong (Ligusticum Chuanxiong Rhizome) Gancao (Licorice Root) Fuling (Poria) Mutong (Akebia Stem) Chenpi (Citrus Reticulata Peel) Nuomi (Glutinous Rice) Houpo (Magnolia Bark) Dafupi (Areca Peel)
Equal parts, grind into coarse powder. Decoct with ginger and jujube and take.
[Formula] Zicao Houpo Tang (Arnebia Magnolia Bark Decoction) Treats smallpox with vexation, stuffiness, fullness, hardness, urgency, or aggregation that does not disperse.
Zicaorong (Arnebia Rootlet, 1.2 qian) Zhishi (Immature Bitter Orange) Huangqin (Scutellaria Root) Huanglian (Coptis Rhizome) Houpo (Magnolia Bark) (each 1.1 qian) Lufengfang (Beehive) Baifuling (White Poria) Shandougen (Sophora Tonkinensis Root) Maidong (Ophiopogon Tuber) Taoren (Peach Seed) Shigao (Gypsum Fibrosum) Xuanfuhua (Inula Flower) (each 2 qian) Chantui (Cicada Slough) Shengma (Cimicifuga Rhizome) (each 8 fen) Baizhu (Atractylodes Macrocephala Rhizome, 5 fen)
Cut into pieces. Take 4-5 qian per dose, decoct in water, and take warm long after meals.
(Note: The following text repeats previous content regarding Muxiang San, Yihuang San, Zhu Danxi's case, Jiawei Touji San, and Zicao Houpo Tang. The entities within these repetitions are already listed above.)
[Formula] Zicao Zhishi Tang (Arnebia Immature Bitter Orange Decoction) Treats smallpox abdominal distension, caused by heat-toxin or cold injury.
Zicaorong (Arnebia Rootlet) Niubangzi (Arctium Fruit) (each 1.2 qian) Houpo (Magnolia Bark) Kushen (Sophora Flavescens Root) (each 1.1 qian) Baishaoyao (White Peony Root) Beimu (Fritillaria Bulb) Zhishi (Immature Bitter Orange) Hezi (Chebula Fruit) Roudoukou (Myristica Seed) (each 1 qian) Chantui (Cicada Slough) Jiegeng (Platycodon Root) Baizhu (Atractylodes Macrocephala Rhizome) (each 8 fen) Shengma (Cimicifuga Rhizome, 7 fen) Gancao (Licorice Root, 6 fen)
Cut into pieces. Take 4-5 qian per dose, decoct in water, and take warm long after meals.
[Formula] Tingli Muxiang San (Descurainia Wood Fragrance Powder) (for wheezing)
[Formula] Mutong Shaoyao Tang (Akebia Peony Decoction) Treats smallpox with thirst, abdominal distension, and difficult urination.
Mutong (Akebia Stem) Shaoyao (Peony Root) Baizhu (Atractylodes Macrocephala Rhizome) (each 5 fen) Chuanxiong (Ligusticum Chuanxiong Rhizome) Chenpi (Citrus Reticulata Peel) Gange (Kudzu Root) (each 3 fen) Gancao (Licorice Root, 2 fen)
Decoct in water and take.
[Formula] Jiangfu Tang (Ginger and Aconite Decoction) Treats rash where half has erupted and half has not, or during peak eruption presents with diarrhea, limb coldness, vomiting, abdominal distension, and belching. Urgently administer Lizhong Wan (Regulate the Middle Pill), Sini Tang (Reverse the Extremity Decoction), Jiangfu Tang, etc., without hesitation, as this has been proven effective. When spontaneous diarrhea accompanies abdominal distension, it is because heat-toxin is restrained by cold and cannot exit; severe cold causes diarrhea, while slight toxin exit causes distension. In this case, administer Lizhong Wan, Sini Tang, Jiangfu Tang, etc. When the interior warms, diarrhea stops, heat-toxin re-emerges, distension resolves, and the rash erupts. Additionally, if half the rash has erupted and half has not, or during peak eruption there is constipation, red astringent urination, coarse wheezing, abdominal distension, dry lips and teeth, mouth dryness with thirst and desire to drink, urgent purgation is required. This pattern is due to toxic factor obstruction and stasis, wanting to exit but unable to do so clearly, causing distension. Purging dissipates heat-toxin, allows Ying and Wei (Nutritive and Defensive Qi) to extend, reduces interior distension, and promotes external eruption. Both warming and purging methods are applied appropriately; this must be recorded. If pus and blood are discharged with abdominal distension, it is not this pattern; administer Nanjin San, Rushu Xue Gao (Frankincense Pig Blood Paste), Lizhong Wan, Jiangfu Tang.