钱氏云∶热痛亦啼叫不止，夜发面赤唇焦，小便赤黄，与三黄丸（里热），人参汤下。
《婴孺》治小儿腹痛，夭纠不能哺乳。茯苓丸方
茯苓 黄连（各一两）
上为末，用蜜为丸，如大豆大。饮下，量加。
〔钱〕积痛，口中气温，面黄白，目无精光，或白睛多，及多睡畏食，或大便酸
臭者，当磨积，宜消积丸，甚者白饼子下之，后和胃，用白术散。（消积丸白饼子方见癖白术散方见消渴）
〔曾〕积痛，腹中阴阴而痛，面黄不食，儿大者口吐酸馊气，先治积滞，后调脾胃，其痛自止，仍辨
虚实和解，治法见后癖积条中。
汤氏三棱散 治积气肚痛。
砂仁 甘草 益智（炒，去壳） 三棱 蓬术 青皮（炒。各等分）
上为末。白汤点下。
丹溪云食积腹痛，必用紫苏、莱菔子之类。初虞世治小儿好吃粽，成肚痛，用黄连、白酒药等分为丸服。
虫痛面 白，心腹痛，口中沫及清水出，发痛有时。田氏云∶虫痛啼哭俯仰，坐卧不安，自按心腹，时时
大叫，面无正色，或青或黄，唇白，又目无精色，口吐涎沫，此为虫痛。钱氏云∶积痛、食痛、虚痛，大同小
异，惟虫痛者当口淡而沫自出，治之随其证用药。虫与痫相似，小儿本怯，故胃虚冷则虫动而心痛，与痫略相
似，但目不斜，手不搐也，安虫散主之。曾氏云∶蛔虫动痛，口吐清水涎沫，或吐出虫，痛不堪忍，其疾因食甘
肥荤腥太早而得，故胃寒虫动作痛，其虫吐来或生或死，儿小者，此痛苦甚，亦致危难，先以理中汤（吐泻）
加乌梅水煎服，使胃暖不逆，次芦荟丸（疳）、使君子丸、化虫饮主之。有儿大者，面 白而间黄色，肉食倍进，肌
体消瘦，腹中时复作痛，此有血鳖、蛔虫杂乎其间，以二圣丸下之。又有胃受极寒极热，亦令虫动，或微痛，或
不痛，遽然吐出，法当安虫为上。若以治虫，及伤胃气，固不可也。因寒而动者用理中汤加乌梅水煎服。因热而
动者用 咀五苓散，亦加乌梅水姜煎投。辛氏女子五岁，病虫痛。诸医以巴豆、干漆、 砂之属治之，不
效。至五日外，多哭而俯仰，睡卧不安，自按心腹，时大叫，面无正色，或青或黄，或白或黑，目无光而慢，唇
白吐沫，至六日，胸高而卧转不安。召钱至，钱详视之，用芜荑散三服，见目不除青色，大惊曰，此病大困，若
更加泻，则为逆矣。至次日，辛见钱曰夜来三更果泻，钱于泻盆中看，如药汁，以杖搅之，见有丸药，钱曰，此
子肌浓，当气实，今证反虚，不可治也。辛日何以然？钱曰脾虚胃冷则虫动，而今反目青，此肝乘脾，又
更加泻，知其气极虚也，而丸药随粪下，即脾胃已脱，兼形
病不相应，故知死病。后五日昏笃，七日而死。
钱氏安虫散 治小儿虫痛。
胡粉（炒黄） 鹤虱（炒黄） 川楝子（去皮核） 白矾（枯，二钱半）
上为细末。每服一字，大者五分，米饮调下。痛时服。
治虫动，痛极不可忍，用干漆半两，槟榔一枚生用，窑老一块再 细研，三件一处为末。空心热酒调，
良久取下虫，立愈，验。（窑老恐窑中 过泥物也。）
又方用干漆一两，捣碎，炒令烟尽出，用新汲水入生麻油，空心调下。
钱氏安虫丸 治上中二焦虚，或胃寒虫动，及痛。
干漆（炒烟尽，二分） 雄黄（一分） 巴豆霜（一钱）
上为细末，糊丸如黍米大。量儿大小服之，取东引石榴根煎汤下，或苦楝根，或芜荑汤下五七丸至
二三十丸，发时服。
芜荑散 主治同前。凡小儿痛时便高声啼叫，人中上鼻头唇口一时黑色，脉法当沉
弱而弦，今反脉大，是虫证也。
白芜荑 干漆（炒。各等分）
上为细末。每服一字或五分或一钱，米饮调下，发时服。
使君子丸 治腹内诸虫作痛，口吐清水。
使君肉（薄切，屋瓦焙干） 槟榔 酸石榴根皮（东向者佳，净洗，锉焙） 大黄（半生半炮。各七钱半）
上，除槟榔锉晒不过火，余三味再焙，同槟榔为末，沙糖水煮面糊丸，麻仁大。
每服三十丸至五十丸，淡猪肉汁空心下，或鸡肉汁亦好。
化虫饮 消化虫毒在腹作痛。
槟榔 酸石榴根皮（净洗，焙干。各一两） 红丹（ 过） 雷丸 贯众（如鸡头者佳） 使君子肉（薄切，
焙。各二钱半） 甘草（炙） 枳壳（去瓤，麸炒微黄） 大黄（各五钱）
上为细末。用清油煎鸡子一枚如春饼样，候冷，抄药末一钱于上，摊匀，空心卷而食之。儿小者，用糯
米粉水煮糊丸，粟谷大。每服十五粒至三十丸，以淡猪肉汁空心下，鸡肉汁亦好。
二圣丸 治腹内诸虫，及消谷逐水，下气去风。
槟榔（一两） 巴豆（十五粒、去壳膜心、大好者，存油）
上，槟榔锉晒为末，巴豆碎切，在乳钵内极细杵，仍入槟榔末同再杵匀，面糊
丸，绿豆大。每服七十七丸至九十九丸，用温茶清，五更初空心，止一投药，见虫下尽，进以稀粥自安。
钱乙说：热痛表现为哭闹不止，夜间发作时面色发红、嘴唇焦干，小便颜色深黄，应给予三黄丸（清泻里热），用人参汤送服。
《婴孺》治疗小儿腹痛，因疼痛剧烈而无法哺乳。茯苓丸方：
茯苓、黄连（各一两）
以上药物研为细末，用蜂蜜制成丸剂，大小如大豆。温水送下，根据患儿情况调整剂量。
钱乙说：积滞引起的腹痛，口中气息温热，面色黄白相间，眼神无光彩，或者眼白部分较多，嗜睡且厌恶进食，或者大便有酸臭味，应当消除积滞，适宜使用消积丸，病情严重的用白饼子攻下，之后调和胃气，使用白术散。（消积丸、白饼子的方剂见癖积条；白术散的方剂见消渴条）
曾世荣说：积滞引起的腹痛，腹部隐隐作痛，面色发黄、不想吃东西，年龄较大的儿童口中吐出酸腐气味，先治疗积滞，后调理脾胃，疼痛自然停止，仍需辨别虚实进行和解治疗，治疗方法见后文癖积条中。
汤氏三棱散：治疗积气引起的肚痛。
砂仁、甘草、益智仁（炒，去壳）、三棱、蓬术、青皮（炒，各等分）
以上药物研为细末。用开水冲服。
朱丹溪说：食积引起的腹痛，必须使用紫苏、莱菔子之类的药物。初虞世治疗小儿喜欢吃粽子导致肚子痛，用黄连、白酒药等分制成丸剂服用。
虫痛表现为面色苍白，心腹疼痛，口中流出唾液及清水，疼痛发作有定时。田氏说：虫痛时啼哭翻滚，坐卧不安，自己按压心腹部，不时大声呼叫，面色不正常，或青或黄，嘴唇发白，而且眼神无光彩，口吐涎沫，这是虫痛。钱乙说：积痛、食痛、虚痛大同小异，只有虫痛的特点是口淡而口水自行流出，治疗时应根据具体证候用药。虫痛与痫证相似，小儿本来体质怯弱，所以胃虚冷则虫动引起心痛，与痫证略微相似，但眼睛不斜视，手脚不抽搐，主用安虫散治疗。曾氏说：蛔虫活动引起的疼痛，口吐清水涎沫，或者吐出虫子，疼痛难以忍受，此病是因为过早食用甘甜、肥腻、荤腥食物所致，因此胃寒导致虫动产生疼痛，吐出的虫子有的生有的死，年幼的患儿痛苦很深，也会导致危险，先用理中汤（治疗呕吐腹泻）加乌梅水煎服，使胃温暖而不逆乱，再用芦荟丸（治疗疳积）、使君子丸、化虫饮主治。年龄较大的患儿，面色白而间杂黄色，肉食摄入倍增，身体消瘦，腹部时常疼痛，这是体内有血鳖、蛔虫混杂其中，用二圣丸攻下。又有因为胃受极寒或极热刺激，也令虫动，有时轻微疼痛，有时不痛，突然吐出，治法应当以安虫为上策。如果用猛烈的方法治虫，会损伤胃气，这是不可取的。因寒而动的用理中汤加乌梅水煎服。因热而动的用咀五苓散，也加乌梅、生姜水煎服。辛氏的女儿五岁，患虫痛。众医生用巴豆、干漆、硇砂之类的药物治疗，无效。到了第五天以后，孩子多哭且翻滚，睡卧不安，自己按压心腹部，不时大声呼叫，面色不正常，或青或黄，或白或黑，眼神无光且迟缓，嘴唇白并吐沫，到了第六天，胸部高耸，躺卧更加不安。请钱乙来诊治，钱乙仔细查看后，用了三服芜荑散，发现孩子眼中青色未除，大惊说：“这个病非常危重，如果再发生腹泻，就是逆证了。”到了第二天，辛氏对钱乙说：“昨晚三更果然腹泻了。”钱乙在泻盆中观察，粪便像药汁一样，用棍棒搅拌，看见有丸药，钱乙说：“这孩子肌肉厚实，本该是实证，现在证候反而表现为虚，无法治愈了。”辛氏问：“为什么这样说？”钱乙说：“脾虚胃冷则虫动，而现在眼睛发青，这是肝木乘克脾土，再加上腹泻，知道其元气极度虚弱，而且丸药随粪便排出，说明脾胃之气已脱失，加上形体与病证不相符合，所以知道是死症。”五天后病情加重昏迷，七天后死亡。
钱乙安虫散：治疗小儿虫痛。
胡粉（炒至黄）、鹤虱（炒黄）、川楝子（去皮核）、白矾（枯，二钱半）
以上研为细末。每次服用一字，大一点的孩子服用五分，米汤调下。疼痛时服用。
治疗虫动，疼痛剧烈无法忍受，用干漆半两，槟榔一枚生用，窑老一块再研磨成细末，将这三样东西一处研为细末。空腹时用热酒调服，过一会儿虫子排出，立刻痊愈，有效。（窑老恐怕是窑中烧过的泥物。）
又一方：用干漆一两，捣碎，炒至烟尽冒出，用新汲井水加入生麻油，空腹调服。
钱乙安虫丸：治疗上中二焦虚损，或胃寒虫动，以及疼痛。
干漆（炒至烟尽，二分）、雄黄（一分）、巴豆霜（一钱）
以上研为细末，用糊制作成丸剂，大小如黍米。根据孩子的大小给药，用东引石榴根煎汤送服，或者苦楝根，或者芜荑汤送服，每次五七丸到二三十丸，发作时服用。
芜荑散：主治同前。凡是小儿疼痛时便高声啼叫，人中、鼻头、嘴唇同时变黑，脉法应当沉弱而弦，现在反而脉大，这是虫证。
白芜荑、干漆（炒，各等分）
以上研为细末。每次服用一字或五分或一钱，米汤调下，发作时服用。
使君子丸：治疗腹内各种寄生虫引起的疼痛，口吐清水。
使君子肉（薄切，在屋瓦上焙干）、槟榔、酸石榴根皮（向东生长的为佳，洗净，锉碎焙干）、大黄（半生半炮，各七钱半）
以上，除了槟榔锉碎晒干不过火，其余三味再次焙干，同槟榔一起研为细末，用砂糖水煮面糊制丸，大小如麻仁。
每次服用三十丸至五十丸，空腹用淡猪肉汁送服，或者鸡肉汁也可以。
化虫饮：消化腹中的虫毒引起的疼痛。
槟榔、酸石榴根皮（洗净，焙干，各一两）、红丹（煅过）、雷丸、贯众（如鸡头者佳）、使君子肉（薄切，焙，各二钱半）、甘草（炙）、枳壳（去瓤，麸炒微黄）、大黄（各五钱）
以上研为细末。用清油煎一个鸡蛋如春饼状，待冷却后，取药末一钱放在上面，摊匀，空腹卷起来吃。孩子小的，用糯米粉水煮成糊丸，大小如粟谷。每次服用十五粒至三十丸，空腹用淡猪肉汁送服，鸡肉汁也可以。
二圣丸：治疗腹内各种寄生虫，以及消谷逐水，下气祛风。
槟榔（一两）、巴豆（十五粒，去壳膜心，选大的，保留油脂）
以上，槟榔锉碎晒干为末，巴豆切碎，在乳钵内极细杵碎，仍加入槟榔末一同再杵均匀，用面糊制丸，大小如绿豆。每次服用七十七丸至九十九丸，用温茶清，五更初空腹，只投一次药，见到虫子排尽，进稀粥自安。
Qian Yi stated: Heat pain is characterized by incessant crying, with red face and scorched lips during nocturnal episodes, and dark yellow urine. It should be treated with Sanhuang Wan (Three-Yellow Pill [clearing interior heat]), administered with Renshen Tang (Ginseng Decoction).
The *Yingru* text treats infantile abdominal pain where the child cannot breastfeed due to severe pain. Formula for Fuling Wan (Poria Pill):
Fuling (Poria) and Huanglian (Coptidis Rhizoma), each 1 liang.
Grind into powder, form pills the size of soybeans using honey. Administer with water, adjusting dosage according to the child's condition.
Qian Yi stated: Accumulation pain presents with warm breath, a sallow-white complexion, dull eyes, or excessive scleral exposure, lethargy, anorexia, or sour-smelling stools. One should eliminate accumulation; Xiaojie Wan (Accumulation-Resolving Pill) is appropriate. For severe cases, Baixiazi (White Cake Pill) may be used to purge, followed by harmonizing the stomach with Baizhu San (Atractylodes Macrocephala Powder). (Formulas for Xiaojie Wan and Baixiazi are found under the "Pi Ji" section; formula for Baizhu San is found under the "Xiao Ke" section.)
Zeng Shirong stated: Accumulation pain involves dull abdominal pain, sallow complexion, and anorexia. Older children may exhale sour, fermented odors from the mouth. First treat the accumulation, then regulate the spleen and stomach; the pain will cease naturally. Differentiation between deficiency and excess is required for harmonizing treatment; see the "Pi Ji" section below for methods.
Tang Shi Sanleng San (Sanleng Powder of Master Tang): Treats abdominal pain caused by qi accumulation.
Sharen (Amomi Fructus), Gancao (Glycyrrhizae Radix et Rhizoma), Yizhi (Alpiniae Oxymelae Fructus, stir-fried, husked), Sanleng (Sparganii Rhizoma), Pengzhu (Curcumae Rhizoma), Qingpi (Citri Reticulatae Pericarpium Viride, stir-fried), in equal proportions.
Grind into powder. Take with boiling water.
Zhu Danxi stated: Food-stagnation abdominal pain requires herbs such as Zisu (Perillae Folium) and Laifuzi (Raphani Semen). Chu Yushi treated a child who developed abdominal pain from eating zongzi (sticky rice dumplings) by administering pills made of equal parts Huanglian (Coptidis Rhizoma) and Baijiu Yao (Fermented Rice Ball).
Worm pain presents with a pale face, epigastric and abdominal pain, drooling and clear fluid from the mouth, and periodic pain attacks. Tian Shi stated: Worm pain manifests as crying, rolling over, restlessness, self-palpation of the heart and abdomen, frequent loud screaming, abnormal facial coloration (blue, yellow, white), lackluster eyes, and salivation. This is worm pain. Qian Yi stated: Accumulation pain, food-stagnation pain, and deficiency pain are largely similar, except that worm pain is characterized by a bland taste and spontaneous salivation. Treatment should follow the specific syndrome. Worm pain resembles epilepsy (Xian Zheng); infants are inherently timid, so coldness and deficiency in the stomach cause worms to move, inducing heart pain, which slightly resembles epilepsy but differs by the absence of eye deviation and hand convulsions. An Chong San (Calming Worms Powder) is the primary formula. Zeng Shi stated: Ascaris-induced pain presents with spitting of clear fluid and saliva, or expulsion of worms, with unbearable pain. This disease results from early consumption of sweet, fatty, and meaty foods, causing stomach coldness that activates worms. The expelled worms may be alive or dead. In young children, this causes severe suffering and danger. Initially, Lizhong Tang (Regulate the Middle Decoction [for vomiting and diarrhea]) with Wumei (Mume Fructus) decocted in water should be given to warm the stomach and prevent rebellion. Subsequently, Lushui Wan (Aloe Pill [for malnutrition]), Shijunzi Wan (Quinine Seed Pill), or Huachong Yin (Worm-Dissolving Drink) may be used. In older children presenting with a pale-yellow complexion, increased meat consumption, emaciation, and intermittent abdominal pain, blood flukes and ascarides may be mixed within. Ersheng Wan (Two-Sage Pill) should be used to purge them. Extreme cold or heat affecting the stomach can also activate worms, causing mild or no pain, followed by sudden expulsion. The method should prioritize calming the worms. Aggressive worm-expelling methods damage stomach qi and are inadvisable. For activation due to cold, use Lizhong Tang with Wumei decocted in water. For activation due to heat, use Juzai Wuling San (Modified Five-Ingredient Poria Powder) with Wumei and Shengjiang (Zingiberis Rhizoma Recens) decocted in water.
Case: A five-year-old girl of the Xin family suffered from worm pain. Various physicians treated her with Badou (Crotonis Fructus), Ganqi (Dammar Resina), and Naosha (Natrii Sulfas) without effect. By the fifth day, she cried frequently, rolled over, was restless in sleep, pressed her heart and abdomen, screamed loudly, displayed fluctuating facial colors (blue, yellow, white, black), had dull eyes, pale lips, and salivated. On the sixth day, her chest was elevated, and lying down became increasingly uncomfortable. Qian Yi was summoned. After careful examination, he prescribed three doses of Wuyi San (Meliosma Powder). Seeing that the blue hue in her eyes persisted, he exclaimed in alarm, "This illness is critical. If diarrhea ensues, it will be a adverse sign." The next day, Mrs. Xin told Qian Yi, "Indeed, she had diarrhea at the third watch last night." Qian Yi examined the stool basin, noting the feces resembled medicinal juice. Stirring it with a stick, he saw pill fragments. Qian Yi said, "This child has thick muscles and should present with excess patterns, but now the signs indicate deficiency; it is untreatable." Mrs. Xin asked why. Qian Yi replied, "Spleen deficiency and stomach cold activate worms. Now the eyes are blue, indicating Liver wood overacting on Spleen earth. Coupled with diarrhea, we know her qi is extremely depleted. The pills passing with the stool indicate the collapse of Stomach and Spleen qi. Furthermore, the physical state does not match the disease pattern; thus, I know it is a fatal case." Five days later, she fell into deep coma, and died seven days after onset.
Qian Yi An Chong San (Calming Worms Powder): Treats infantile worm pain.
Hufen (Cerussita, stir-fried until yellow), Leshe (Chrysanthemi Indici Flos, stir-fried), Chuanlianzi (Toosendan Fructus, peeled and seeded), Baifan (Alumen, calcined, 2 qian 5 fen).
Grind into fine powder. Each dose: one zi (approx. 0.3g); for older children, 5 fen. Mix with rice drink and take. Administer during pain episodes.
For severe pain caused by moving worms that is unbearable: Use Ganqi (Dammar Resina) 0.5 liang, Binglang (Arecae Semen) 1 piece (raw), and Yaolao (fired clay from kilns) 1 piece. Grind all three into fine 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 fired mud from kilns.)
Another prescription: Use Ganqi (Dammar Resina) 1 liang, crush it, and stir-fry until smoke ceases. Mix with fresh well water and raw Sesame Oil (Sesami Oleum). Take on an empty stomach.
Qian Yi An Chong Wan (Calming Worms Pill): Treats deficiency in the Upper and Middle Jiao, stomach cold activating worms, and pain.
Ganqi (Dammar Resina, stir-fried until smoke ceases, 2 fen), Xionghuang (Realgar, 1 fen), Badoushuang (Crotonis Fructus Frost, 1 qian).
Grind into fine powder, make pills the size of millet seeds using paste. Dosage depends on the child's age. Take with decoction of Shiliugen (Punica Granati Radix Cortex from eastward-growing trees), or Kuanlien Gen (Meliae Radix Cortex), or Wuyi Tang (Meliosma Decoction). Dose: 5–7 pills up to 20–30 pills. Administer during attacks.
Wuyi San (Meliosma Powder): Indications same as above. Whenever a child cries loudly during pain, and the philtrum, nose tip, and lips turn black simultaneously, the pulse should be deep, weak, and wiry. If the pulse is instead large, it indicates a worm syndrome.
Baiwuyi (Meliosmae Fructus), Ganqi (Dammar Resina, stir-fried), in equal proportions.
Grind into fine powder. Each dose: one zi, 5 fen, or 1 qian. Mix with rice drink. Administer during attacks.
Shijunzi Wan (Quinine Seed Pill): Treats pain caused by various intestinal parasites and spitting of clear fluid.
Shijunrou (Canarii Semen, thinly sliced, dried on roof tiles), Binglang (Arecae Semen), Suan Shiliu Genpi (Punica Granati Radix Cortex, preferably from eastward-growing trees, washed clean, cut, and dried), Dahuang (Rhei Radix et Rhizoma, half raw, half processed), each 7 qian 5 fen.
Process: Cut and dry Binglang without overheating. Roast the other three ingredients again. Grind all together into powder. Make pills using sugar-water wheat paste, size of hemp seeds.
Each dose: 30–50 pills. Take on an empty stomach with lean pork broth; chicken broth is also acceptable.
Huachong Yin (Worm-Dissolving Drink): Dissolves worm toxins causing abdominal pain.
Binglang (Arecae Semen), Suan Shiliu Genpi (Punica Granati Radix Cortex, washed and dried, each 1 liang), Hongdan (Minii Preparatum, calcined), Leiwan (Waniliae Semen), Guanzhong (Cyrtomii Rhizoma, best if shaped like a chicken head), Shijunrou (Canarii Semen, thinly sliced and dried, each 2 qian 5 fen), Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried), Zhike (Aurantii Fructus, pith removed, bran-fried until slightly yellow), Dahuang (Rhei Radix et Rhizoma, each 5 qian).
Grind into fine powder. Fry one egg in clear oil until crisp like a spring pancake. Let cool. Place 1 qian of powder on the egg, spread evenly, and roll up. Eat on an empty stomach. For small children, make pills with glutinous rice flour paste, size of millet grains. Each dose: 15–30 pills. Take on an empty stomach with lean pork broth; chicken broth is also acceptable.
Ersheng Wan (Two-Sage Pill): Treats various intestinal parasites, promotes digestion, expels water, directs qi downward, and dispels wind.
Binglang (Arecae Semen, 1 liang), Badou (Crotonis Fructus, 15 seeds, husked and cored, select large ones retaining oil).
Process: Cut and dry Binglang into powder. Crush Badou finely in a mortar. Mix thoroughly with Binglang powder. Make pills with wheat paste, size of mung beans. Each dose: 77–99 pills. Take with warm tea on an empty stomach at the fifth watch (early morning). Single dose only. Once worms are fully expelled, resume diet with thin congee to restore comfort.