麻疹腹痛者。由食滞凝结。毒瓦斯不得宣发于外。故不时曲腰啼叫。两眉频蹙。须以加味平胃
散治之。滞消毒解。而痛自除矣。
加味平胃散
防风 升麻 枳壳 葛根 苍术
陈皮 浓朴 山楂 麦芽 甘草
廉按。袁某之女。年十四。出疹即没。喉痛腹胀。接余看视。面色黧黯。鼻黑。唇裂口渴。
舌赤如朱。并无点胎喉痛难咽。心如火烧。腹胀而冷。手足亦厥。此热极反寒之象。观其前
方。川连。黄芩。射干。元参。石膏。升麻。大黄。卜子。知母。犀角等药。已服三四剂矣
。且重用石膏。大黄。每药下咽。则胀满愈甚。四围匍匐而走。略下清水。则口渴。喉痛。
胸满。益甚。昼夜不安。眼不合缝。诸医无策。坐以待毙。余按其脉。脾脉独宏大坚实。腹
中拒按更甚。此由食积于中。胃火上冲。以致喉痛诸症也。时医拘定枳壳。山楂。浓朴。酸
涩。麦芽消疹之论。不敢用以消食。而惟用凉药以清其火。大黄以硬通之。不知愈凉则愈滞
。大黄直走。不能消化。所以腹中冰冷。火毒聚于上焦。每服药而胀满欲死也。余用枳壳、
浓朴。山楂。麦芽。神曲。粉葛。槟榔。七味。诸医以为人已干燥。用此燥烈之药。当无不
死。且枳壳山楂等酸收之性。麻隐何能复发。其父谓女已垂危。死生惟命。排众议而服之。
药方下咽。即已睡去。酣眠半日而醒。诸症顿减。舌胎极浓而黄。余复以前方饮之。酣睡一
夜。次日原方加大黄六钱而愈。又有毒盛作痛者。余用蝉蜕二两。桔梗三钱。一剂而愈。
Abdominal pain during the eruption of measles is caused by food stagnation and concretion, which prevents the toxic factors from being vented outward. Consequently, the patient frequently bends their waist and cries out, with eyebrows often furrowed. It is necessary to treat this with Jiawei Pingwei San (Modified Pingwei Decoction). Once the stagnation is resolved and the toxins are dispersed, the pain will naturally cease.
Jiawei Pingwei San (Modified Pingwei Decoction)
Fangfeng (Saposhnikovia Root), Shengma (Cimicifugae Rhizoma), Zhike (Aurantii Fructus Immaturus), Gegen (Puerariae Lobatae Radix), Cangzhu (Atractylodis Rhizoma), Chenpi (Citri Reticulatae Pericarpium), Houpo (Magnoliae Officinalis Cortex), Shanzha (Crataegi Fructus), Maiya (Hordei Fructus Germinatus), Gancao (Glycyrrhizae Radix et Rhizoma).
Commentary by Lian: The daughter of Mr. Yuan, aged fourteen, had her measles rash suddenly disappear after appearing, accompanied by sore throat and abdominal distension. Upon my examination, her complexion was dark and dull, her nose was black, her lips were cracked and dry, and she felt thirsty. Her tongue was red like cinnabar without coating, her sore throat was severe making swallowing difficult, her heart felt as if burning, her abdomen was distended yet cold to the touch, and her hands and feet were cold. This is a manifestation of extreme heat generating cold (false cold signs). Reviewing her previous prescription, it contained Huanglian (Coptidis Rhizoma), Huangqin (Scutellariae Radix), Shegan (Belamcandae Rhizoma), Xuanshen (Scrophulariae Radix), Shigao (Gypsum Fibrosum), Shengma (Cimicifugae Rhizoma), Dahuang (Rhei Radix et Rhizoma), Bobzi (Raphani Fructus), Zhimu (Anemarrhenae Rhizoma), and Xijiao (Rhino-ceris Cornu). She had taken three or four doses. Moreover, heavy doses of Shigao and Dahuang were used; each time she swallowed the medicine, her abdominal distension worsened. She crawled around in distress, occasionally passing clear fluid, after which her thirst, sore throat, and chest fullness intensified. She was restless day and night, unable to close her eyes. All physicians were at a loss, sitting and waiting for death. I palpated her pulse and found that only the Spleen pulse was large, expansive, firm, and solid. Her abdomen was extremely tender to pressure. This condition resulted from food accumulation in the middle jiao, with Stomach fire rushing upward, causing the sore throat and other symptoms. Contemporary physicians adhered rigidly to the theory that Zhike, Shanzha, Houpo, sour/astringent herbs, and Maiya hinder the eruption of measles, so they dared not use them to digest food. Instead, they only used cooling herbs to clear fire and Dahuang to force bowel movements. They did not realize that excessive cooling increases stagnation; although Dahuang has a purgative effect, it cannot digest accumulated food, leading to a cold abdomen and fire-toxin gathering in the upper jiao. Thus, every dose of medicine caused unbearable abdominal distension. I prescribed seven herbs: Zhike, Houpo, Shanzha, Maiya, Shenqu (Massa Medicata Fermentata), Fenge (Puerariae Radix), and Binglang (Arecae Semen). Other physicians argued that since the patient was already dry, using such drying and acrid-hot herbs would certainly cause death. Furthermore, they believed the astringent nature of Zhike and Shanzha would prevent the measles from re-emerging. The father stated his daughter was critically ill and left her life and death to fate. He disregarded the objections and administered the medicine. Immediately after swallowing the decoction, she fell asleep. After sleeping soundly for half a day, she woke up, and all symptoms significantly decreased. At this point, her tongue coating became very thick and yellow. I continued administering the original formula, and she slept soundly through the night. On the second day, adding six qian of Dahuang to the original formula cured her. In another case where severe toxin accumulation caused pain, I used Chanui (Cicadae Periostracum, 2 liang) and Jiegeng (Platycodonis Radix, 3 qian), which cured the patient in one dose.