（第八）
小儿腹痛之病，诚为急切。凡初生二、三个月及一周之内，多有腹痛之患，无故啼哭
不已，或夜间啼哭之甚，多是腹痛之故，大都不外寒热二因∶夫因于寒者，面白唇青，或泻痢
清白，以热绵裹腹而啼少止即是寒也；因于热者，面赤唇红，得暖啼甚即是热也。一周之外，
能吃饮食，则有伤食腹痛，或泻、或不泻，口渴而臭，面黄身热，即是积痛。久而不愈，必
至成疳。除此三因之外，则如《内经·举痛论篇》云∶五脏卒痛，寒邪客经，其机不可不察
也。若《类萃》、《小儿》等方概言寒邪而不及热与积，是则以管窥豹，未见其全斑也。
小儿脾胃脉弦，食积痛；脉迟微，为寒痛；阴弦则腹痛，弦急小腹痛；尺脉紧，脐下
痛。心腹痛不得息，脉细小迟者生；坚实大者死。腹痛脉大而长者死。
腹痛乃邪正交攻，相击而作也。挟热痛者，以面赤或壮热，四肢烦，手心热见之；挟
冷者，以面色青白见之，冷甚则变证，唇口黑，爪甲青矣。热证黄芩芍药汤、四顺清凉饮；
冷证理中汤、指迷七气汤加桂，煎调苏合丸。钱氏云∶小儿积痛，面黄，目白无精光，多睡
畏食，大便酸臭者，当用消积丸；甚者白饼子下之，后和胃。凡虫痛多在心腹，口吐清水，
安虫散主之。
理中汤 治小儿受寒腹痛。
人参 白术 炙甘草 炮干姜
上等分，每服三钱，水一盏煎五分，热服。
七气汤 治七气伤脾，结聚，大腹痛，不能乳食。
半夏（制一两） 人参（二钱） 甘草（炙） 桂心（各一钱）
上咀，每服二钱，姜、枣煎，食前服。
指迷七气汤 治阴阳不升降，气滞作痛。
青皮 陈皮 桔梗 莪术（炮） 肉桂 藿香 益智仁 香附子（制） 半夏（制）
甘草（各等分）
每服二钱，姜、枣煎。
桔梗枳壳汤 治诸气痞闷，心腹疼痛。
桔梗 枳壳（各等分） 甘草（减半）
每服二钱，姜煎服。
芍药甘草汤 治热腹痛，小便不通，及治痘疹肚痛。
芍药（一钱） 甘草（五分）
白水煎。加黄芩，名黄芩芍药汤。
四顺清凉饮 治小儿血脉壅实，脏腑生热，颊赤多渴，五心烦躁，睡不宁，四肢惊掣，及因
乳哺不时，寒温
失度，令儿血气不顺，脾胃不调，或湿吐连滞，欲成伏热，或壮热不饮，欲发惊痫。又治
风热结核，头面疮疡，目赤咽痛，余毒，一切壅滞，并宜服之。
芍药 当归 甘草 大黄（各等分）
上咀，三岁儿服一钱，水半盏煎服。胃风邪加去节麻黄；中风体强，目上视加独活。
平胃保和汤即平胃加山楂、麦芽。
（第八）
小儿腹痛这一病症，确实非常紧急。凡是出生两三个月以及一周以内的婴儿，多有腹痛的病患，无故啼哭不止，或者夜间啼哭特别厉害，大多都是腹痛的缘故，大体上不外乎寒、热两种病因：因于寒邪的，面色白而嘴唇青，或者泻下痢疾颜色清白，用热绵包裹腹部后啼哭稍微停止，这就是寒证；因于热邪的，面色红赤而嘴唇红，遇到温暖环境啼哭反而加剧，这就是热证。满一周之后，能够进食饮食，那么就有伤食引起的腹痛，或者腹泻、或者不腹泻，口渴且口气臭秽，面色黄身体发热，这就是积滞痛。如果久治不愈，必然发展成疳积病。除了这三种病因之外，就像《内经·举痛论篇》所说：五脏突然疼痛，是寒邪客居经脉所致，其中的机理不可不仔细考察。如果像《类萃》、《小儿》等医书一概只说寒邪而不提及热邪与积滞，那就是以管窥豹，未能看到其全貌。
小儿脾胃脉象弦，是食积痛；脉象迟而微弱，是寒痛；阴部脉弦则腹痛，弦急则小腹痛；尺脉紧，脐下疼痛。心腹疼痛导致呼吸急促困难，脉象细小迟缓的预后良好（生）；脉象坚实大的预后不良（死）。腹痛脉象大而长的预后不良（死）。
腹痛乃是邪气与正气相互交攻，相互搏击而产生的。挟带热邪的疼痛，通过面色红赤或高热，四肢烦躁，手心发热来识别；挟带冷邪的疼痛，通过面色青白来识别，寒冷严重则出现变证，嘴唇口角发黑，指甲青紫。热证使用黄芩芍药汤、四顺清凉饮；冷证使用理中汤、指迷七气汤加肉桂，煎煮后调服苏合丸。钱乙（钱氏）说：小儿积滞痛，面色黄，眼白无精光，多睡且畏食，大便酸臭的，应当使用消积丸；严重的用白饼子攻下，之后调和胃气。凡是虫痛多在心腹部位，口吐清水，用安虫散主治。
理中汤 治疗小儿受寒腹痛。
人参 白术 炙甘草 炮干姜
以上药材上等分，每次服用三钱，用水一盏煎至五分，热服。
七气汤 治疗七气损伤脾脏，气结聚，大腹痛，不能吃奶和食物。
半夏（制一两） 人参（二钱） 甘草（炙） 桂心（各一钱）
以上切碎，每次服用二钱，加生姜、大枣煎煮，饭前服用。
指迷七气汤 治疗阴阳之气不升降，气机阻滞引起疼痛。
青皮 陈皮 桔梗 莪术（炮） 肉桂 藿香 益智仁 香附子（制） 半夏（制）
甘草（各等分）
每次服用二钱，加生姜、大枣煎煮。
桔梗枳壳汤 治疗各种气机痞闷，心腹疼痛。
桔梗 枳壳（各等分） 甘草（减半）
每次服用二钱，加生姜煎服。
芍药甘草汤 治疗热性腹痛，小便不通，以及治疗痘疹引起的肚痛。
芍药（一钱） 甘草（五分）
用清水煎煮。加入黄芩，名为黄芩芍药汤。
四顺清凉饮 治疗小儿血脉壅实，脏腑产生热邪，脸颊红赤多口渴，五心烦躁，睡眠不安，四肢惊厥抽搐，以及因为哺乳不定时，寒温失度，导致孩子血气不顺，脾胃不调，或者湿吐连绵不断，想要形成伏热，或者高热不饮水，想要引发惊痫。又治疗风热结核，头面疮疡，眼睛红赤咽喉疼痛，余毒，一切壅滞，都适宜服用。
芍药 当归 甘草 大黄（各等分）
以上切碎，三岁儿童服用一钱，用水半盏煎服。胃中风邪加去节麻黄；中风身体强直，眼睛向上视加独活。
平胃保和汤 即平胃散加上山楂、麦芽。
(8)
Abdominal pain in infants and young children is indeed an urgent condition. Infants aged two to three months up to one week often suffer from abdominal pain, crying incessantly without cause, or crying severely at night; this is mostly due to abdominal pain. Generally, it does not exceed two causes: cold and heat. When caused by cold, the complexion is pale with blue lips, or there is diarrhea with clear and white stool; if wrapping the abdomen with a warm cloth stops the crying slightly, it indicates a cold syndrome. When caused by heat, the complexion is red with red lips, and crying worsens when warmed, indicating a heat syndrome. After one week of age, when they can eat and drink, abdominal pain may be caused by food stagnation, presenting as either diarrhea or no diarrhea, thirst with foul breath, yellowish complexion, and body heat, which is known as accumulation pain (Ji Tong). If left untreated for a long time, it will inevitably develop into infantile malnutrition (Gan disease). Besides these three causes, as stated in the *Neijing · Ju Tong Lun* chapter: sudden pain of the five zang organs is caused by cold pathogen lodging in the meridians; the mechanism must be carefully observed. If texts like *Lei Cui* and *Xiao Er* generally mention only cold pathogen without referring to heat and accumulation, it is like looking at a leopard through a tube, failing to see its full pattern.
In infants and young children, a wiry pulse of the spleen and stomach indicates pain from food stagnation; a slow and faint pulse indicates cold pain; a wiry pulse at the yin position indicates abdominal pain, and a wiry and rapid pulse at this position indicates lower abdominal pain; a tight pulse at the cun position (chi pulse) indicates pain below the umbilicus. For heart and abdominal pain causing difficulty in breathing, a fine, small, and slow pulse indicates survival; a firm, large pulse indicates death. A large and long pulse in abdominal pain indicates death.
Abdominal pain arises from the conflict and mutual striking between pathogenic factors and righteous qi. Pain accompanied by heat is identified by a red complexion, high fever, irritability of the four limbs, and heat in the palms. Pain accompanied by cold is identified by a bluish-white complexion; if the cold is severe, transformation symptoms occur, such as black lips and mouth, and cyanotic nails. For heat syndromes, use Huangqin Shaoyao Tang (Scutellaria and Peony Decoction) and Sishun Qingliang Yin (Four-Compliant Cooling Clearing Drink); for cold syndromes, use Lizhong Tang (Regulate the Middle Decoction) or Zhimi Qiqi Tang (Seven-Qi Decoction for Pointing Out the Maze) added with Rougui (Cinnamon Bark), decocted and taken with Suhewan (Styrax Pill). Qian Yi (Qian Shi) said: For infantile accumulation pain, characterized by a yellow complexion, lackluster whites of the eyes, excessive sleepiness, aversion to eating, and sour-smelling stool, Xiaoji Wan (Accumulation-Dissolving Pill) should be used; for severe cases, Baixiazi (White Cake Pill) is used to purge, followed by harmonizing the stomach. Worm pain usually occurs in the heart and abdomen, with spitting of clear saliva, treated primarily with Anzhong San (Worm-Calming Powder).
Lizhong Tang treats abdominal pain in infants caused by cold invasion.
Renshen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Zhi Gancao (Prepared Licorice Root), Pao Ganjiang (Prepared Dried Ginger).
Equal parts of the above ingredients. Take three qian per dose, decoct with one sheng of water until reduced to half a sheng, and take hot.
Qiqi Tang treats damage to the spleen by the seven emotions, qi knotting and aggregation, causing great abdominal pain and inability to suckle or eat.
Banxia (Pinelliae Tuber, processed, 1 liang), Renshen (Ginseng Radix, 2 qian), Gancao (Licorice Root, prepared), Guixin (Cinnamomi Cortex, 1 qian each).
Chop the above ingredients. Take two qian per dose, decoct with ginger and jujube, and take before meals.
Zhimi Qiqi Tang treats pain caused by qi stagnation due to failure of yin and yang qi to ascend and descend.
Qingpi (Citri Reticulatae Pericarpium Viride), Chenpi (Citri Reticulatae Pericarpium), Jiegeng (Platycodonis Radix), Ezhu (Curcumae Rhizoma, processed), Rougui (Cinnamomi Cortex), Huoxiang (Agastaches Herba), Yizhiren (Alpiniae Oxyphyllae Fructus), Xiangfuzi (Cyperi Rhizoma, processed), Banxia (Pinelliae Tuber, processed), Gancao (Licorice Root). Equal parts.
Take two qian per dose, decoct with ginger and jujube.
Jiegeng Zhike Tang treats various types of qi obstruction and fullness, and heart and abdominal pain.
Jiegeng (Platycodonis Radix), Zhike (Aurantii Fructus Immaturus). Equal parts. Gancao (Licorice Root), halved.
Take two qian per dose, decoct with ginger and take.
Shaoyao Gancao Tang treats heat-type abdominal pain, urinary retention, and also treats abdominal pain caused by chickenpox and smallpox rashes.
Shaoyao (Paeoniae Radix Alba, 1 qian), Gancao (Licorice Root, 0.5 qian).
Decoct with plain water. Adding Huangqin (Scutellariae Radix) makes it Huangqin Shaoyao Tang (Scutellaria and Peony Decoction).
Sishun Qingliang Yin treats blood vessel congestion and excess in infants, heat generated in the viscera, red cheeks, excessive thirst, vexation in the five centers, restless sleep, convulsions of the four limbs, and conditions caused by irregular feeding, improper temperature regulation leading to disharmony of blood and qi and spleen and stomach, continuous damp vomiting, impending latent heat, high fever with refusal to drink, or impending convulsive epilepsy. It also treats wind-heat nodules, sores and ulcers on the head and face, red eyes, sore throat, residual toxins, and all types of congestion and stagnation.
Shaoyao (Paeoniae Radix), Danggui (Angelicae Sinensis Radix), Gancao (Licorice Root), Dahuang (Rhei Radix et Rhizoma). Equal parts.
Chop the above ingredients. For a three-year-old child, take one qian, decoct with half a sheng of water and take. Add Mahuang (Ephedrae Herba, stems removed) for wind-cold invading the stomach; add Duhuo (Angelicae Pubescentis Radix) for wind-stroke with stiff body and upward gaze.
Pingwei Baohe Tang is Pingwei San plus Shanzha (Crataegi Fructus) and Maiya (Hordei Fructus Germinatus).