痘疮腹痛者。皆毒郁三阴。如腹痛面青手足冷。此脾胃虚寒。理中汤、益黄散选用。若腹痛
痞满气滞。手足厥逆。而大便不通者。此毒壅不透也。桂枝大黄汤。合表里而开泄之。若腹痛面
赤作渴手足热。此脾胃实热。消毒饮加山楂、枳
壳、黄芩、木通。若气粗身发颤动而痛。口臭唇舌白胎者。此毒攻脏腑。肠胃内溃。不治。楼全
善云。腹痛多是热毒为患。当临证消息之。薛氏云。若痘未出而发热烦躁。作渴饮冷。大便坚实
而痛。此热毒壅滞也。急调元明粉通利之。若痘不出而烦热。渴不能饮冷。大便不实。此元气虚
也。白术散温补之。若嗳腐吞酸。大便秽臭。乳食停滞也。保和丸消导之。凡腹痛作渴饮冷。手
足并热者。属实热。若作渴饮汤。手足并冷者。属虚寒也。翁仲仁云。痘疹腹痛。当升发以解利
痘毒。兼分利小便。使上下分消。则痛随利减。俗医恒用浓朴以行滞气。不行升发解利者。非其
治矣。亦有乳食停滞而腹胀痛者。当于升发解利药中加消导之剂。兼审所伤何物而为之清理。又
有数日不大便者。大便行而痛自止。亦未可骤用硝、黄也。然有实邪固结。按之硬满而痛。又须
峻攻。不可胶于上说耳。
痘出腹胀。皆毒郁肠胃所致。若胃中伏热。心气不降。小便赤涩而腹胀者。导赤散加滑石、
紫草。若痘干紫而腹胀。不大便者。为血热毒盛。紫草承气汤。若瘀血在里。面黄烦躁。小便利
。大便黑。犀角地黄汤加穿山甲。若气促体倦。大便利。小便秘。手足冷者。脾虚也。五苓散加
木通、木香。若腹胀肠鸣。气喘厥逆。疮白躁渴者。急用陈氏木香散救之。迟则陷伏难治矣。若
语便秘。躁渴疮紫焦者。此内实热。小承气汤。若长发时。倒 腹胀者。不治。
痘疮引起的腹痛，都是毒邪郁结在三阴经所致。如果腹痛且面色青、手脚发冷，这是脾胃虚寒，可选用理中汤或益黄散。如果腹痛伴有痞闷胀满、气机阻滞、手脚厥冷，并且大便不通畅的，这是毒邪壅滞不透达，可用桂枝大黄汤，表里双解以开泄毒邪。如果腹痛且面色红赤、口渴、手脚发热，这是脾胃实热，可用消毒饮加山楂、枳壳、黄芩、木通。如果呼吸粗重、身体颤抖且疼痛，口臭、唇舌上有白色苔垢的，这是毒邪攻冲脏腑，导致肠胃内部溃败，属于不治之症。楼全善说：腹痛多是由热毒引起，应当根据临床具体情况仔细斟酌。薛氏说：如果痘疹尚未发出而发热烦躁、口渴想喝冷水、大便干结且疼痛，这是热毒壅滞，急需调服元明粉以通利二便。如果痘疹不出而烦热、口渴但不能喝冷水、大便稀溏不成形，这是元气虚弱，用白术散温补。如果有嗳气腐臭、吞酸、大便气味秽臭，这是乳食停滞，用保和丸消食导滞。凡是腹痛、口渴想喝冷水、手脚都发热的，属实热证；如果口渴想喝热水、手脚都发冷的，属虚寒证。翁仲仁说：痘疹腹痛，应当用升发透疹的方法来解除痘毒，兼用分利小便的方法，使毒邪从上、下分消，那么疼痛就会随着二便通畅而减轻。庸医常常使用厚朴来行气滞，而不采用升发透解的方法，这不是正确的治法。也有因乳食停滞而导致腹胀痛的，应当在升发透解的药中加入消导的药物，并审查是伤了什么食物而进行清理。又有几天不大便的，大便通畅后疼痛自然停止，也不可贸然使用芒硝、大黄等峻下药。然而，如果有实邪固结，按压时腹部硬满且疼痛的，又必须用峻猛攻下的方法，不可拘泥于上述说法。
痘疹发出后出现腹胀，都是毒邪郁结在肠胃所致。如果胃中有伏热，心气不降，小便赤涩且腹胀的，用导赤散加滑石、紫草。如果痘疹干枯呈紫色且腹胀、不大便的，这是血热毒盛，用紫草承气汤。如果瘀血在体内，面色发黄、烦躁、小便通畅、大便色黑，用犀角地黄汤加穿山甲。如果气短体倦、大便通畅、小便不通、手脚发冷的，这是脾虚，用五苓散加木通、木香。如果腹胀肠鸣、气喘、四肢厥逆、痘疮色白且烦躁口渴的，急用陈氏木香散救治，迟了就会内陷伏匿难以治疗。如果出现谵语、便秘、烦躁口渴、痘疮紫黑焦枯的，这是内里实热，用小承气汤。如果在头发期（指痘疹灌浆收靥阶段）出现倒陷并腹胀的，属于不治之症。
Abdominal pain caused by smallpox (Xiaochuan) is due to toxin (Du, 毒邪) stagnation in the Three Yin meridians. If abdominal pain is accompanied by a greenish complexion and cold hands and feet, this indicates Spleen-Stomach deficiency-cold; Lizhong Tang (Regulate the Middle Decoction) or Yihuang San (Yellow-Protecting Powder) should be selected. If abdominal pain is associated with epigastric fullness, Qi stagnation, cold extremities, and constipation, this indicates that the toxin is obstructed and not penetrating outward; Guizhi Dahuang Tang (Cinnamon Twig and Rhubarb Decoction) should be used to release both the exterior and interior. If abdominal pain is accompanied by a red face, thirst, and hot hands and feet, this indicates Spleen-Stomach excess-heat; Xiaodu Yin (Toxin-Clearing Drink) added with Shanzha (Crataegi Fructus), Zhike (Aurantii Fructus), Huangqin (Scutellariae Radix), and Mutong (Akebiae Caulis) should be used. If breathing is coarse, the body trembles, and there is pain, along with bad breath and a white coating on the lips and tongue, this indicates the toxin attacking the Zang-Fu organs and causing internal ulceration of the intestines and stomach; this is incurable. Lou Quanshan stated: Abdominal pain is mostly caused by heat-toxin; one must examine the clinical presentation carefully. Xue stated: If fever and irritability occur before the eruption of smallpox, with thirst for cold drinks, hard stools, and pain, this indicates heat-toxin stagnation; Yuanning Fen (Sodium Sulfate) should be urgently administered to promote bowel movement. If smallpox fails to erupt accompanied by irritability and heat, thirst but inability to drink cold fluids, and loose stools, this indicates deficiency of Yuanqi (Original Qi); Baizhu San (Atractylodes Macrocephala Powder) should be used for warming and tonifying. If belching with a rotten smell, acid regurgitation, and foul-smelling stools occur, this indicates food stagnation; Baohe Wan (Harmony-Preserving Pill) should be used to digest and guide out the stagnation. Whenever abdominal pain is accompanied by thirst for cold drinks and hot hands and feet, it belongs to excess-heat. If thirst is accompanied by a desire for warm drinks and cold hands and feet, it belongs to deficiency-cold. Weng Zhongren stated: For abdominal pain in rashes, one should use methods to raise and vent to resolve the rash toxin, combined with promoting urination to allow the toxin to dissipate from above and below; thus, pain will decrease as the bowels and bladder are cleared. Empirical physicians often use Houpo (Magnoliae Officinalis Cortex) to move stagnant Qi without employing raising and venting methods; this is incorrect treatment. There are also cases of abdominal distension and pain due to food stagnation; in such cases, digestive agents should be added to the raising and venting formulas, and the specific ingested substance should be identified for targeted clearance. In cases of several days without a bowel movement, once the stool passes, the pain naturally ceases; one should not hastily use Mangxiao (Natrii Sulfas) or Dahuang (Rhei Radix et Rhizoma). However, if solid pathogenic factors are firmly bound, resulting in hardness, fullness, and pain upon palpation, harsh purgatives are required; one must not rigidly adhere to the aforementioned principles.
Abdominal distension after the eruption of smallpox is caused by toxin stagnation in the intestines and stomach. If latent heat in the Stomach prevents Heart Qi from descending, leading to dark, scanty urine and abdominal distension, Daochi San (Guide Out the Red Powder) added with Huashi (Talcum) and Zicao (Arnebiae Radix seu Cortex) should be used. If the pustules are dry and purple with abdominal distension and constipation, this indicates blood-heat and abundant toxin; Zicao Chengqi Tang (Arnebiae and Magnolia Bark Decoction) should be used. If blood stasis is retained internally, presenting with a yellowish complexion, irritability, free urination, and black stools, Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) added with Chuanshanjia (Manis Squama) should be used. If there is shortness of breath, fatigue, free bowel movements, urinary retention, and cold extremities, this indicates Spleen deficiency; Wuling San (Five-Ingredient Poria Powder) added with Mutong and Muxiang (Aucklandiae Radix) should be used. If abdominal distension is accompanied by borborygmus, panting, cold extremities, and pale, irritable, thirsty lesions, Chen’s Muxiang San (Aucklandiae Powder) should be urgently administered; delay will lead to collapse and difficult treatment. If delirium, constipation, irritability, thirst, and purple-black scorched lesions occur, this indicates internal excess-heat; Xiao Chengqi Tang (Minor Order the Qi Decoction) should be used. If during the hair stage (eruption phase) the lesions invert inward accompanied by abdominal distension, it is incurable.