小儿腹胀腹痛，多因食积，或寒凉伤脾而然。《内经》曰∶病痛者阴也。又曰∶痛者，寒气多
也，有寒故痛也。束垣曰∶寒胀多，热胀少，皆主于脾胃。故凡小儿肚腹或胀或痛，虽曰多由积滞
，然脾胃不虚，则运化以时，何致作胀？是胀必由于虚也。若胃气无伤而腹中和暖，则必无留滞作
痛，是痛多由乎寒也。故治痛治胀者，必当以健脾暖胃为主。若无火证，不得妄用凉药。若无拒按
坚实等证，不得妄用攻药。
一、治法∶凡小儿肚腹膨胀，或时常作痛，黄瘦，常用调理之法，惟芍药枳实丸加减用之为宜，
且善止腹痛。或大健脾丸、杨氏启脾丸、和中丸之类，皆可酌用。若偶尔伤脾，气促困倦，外见腹
胀而内不胀者，此脾气虚也，宜五味异功散，或六味异功煎。若脾胃阳气不足，虚寒作胀，或畏寒
，或手足冷，或兼呕泻者，宜五君子煎、养中煎、温胃饮、六君子汤，或调中丸。若兼脾肾阳虚，
或水泛为痰，成喘促、痛胀、泄泻，宜理阴煎加减主之。若脾胃气虚而痛滞吐泻者，宜六味异功煎
，或六君子汤加木香，或调中汤。若胃口偶有留滞，大痛而胀者，宜排气饮，或益黄散。若宿食偶
有不消而暂为胀满者，宜大、小和中饮，或保和丸、消食丸。若有坚积停滞，胀痛拒按，形气俱实
者，宜赤金豆、白饼子、紫霜丸之类攻下之。凡诸未尽，当于腹痛肿胀二门，参酌为治。
余初年在京，治一五岁邻女，适经药铺，见有晒晾巴豆，其父误以为松仁，以一粒与食之，嚼
而味辣，即忙吐出，而已半粒下咽矣。少顷，大泻十余次，泻后次日，即致肚腹通身悉皆肿胀，绝
口不食，因求治于余。或谓宜黄连、绿豆以解毒；或谓宜四苓、五皮以利水。余曰∶大攻之后，岂
非大虚之证乎？能再堪苦寒以败脾否？大泻之后，又尚有何水之可利？遂单用独参汤及温胃饮以培
脾气，不数剂而复元如初。夫既以大泻，而何以反胀若是？因此一证，乃知大虚大寒而致成肿胀者
，类多如此。（新按）
小儿出现腹胀和腹痛，大多是因为饮食积滞，或者因寒凉损伤了脾脏所致。《黄帝内经》说：病痛属于阴证。又说：疼痛，多由寒气引起，因为有寒所以会痛。束垣说：寒性胀满多见，热性胀满少见，这些情况都主要与脾胃有关。因此，凡是小儿腹部出现胀或痛的情况，虽然大多是由积滞引起的，但如果脾胃不虚损，就能按时进行运化功能，怎么会导致胀满呢？所以胀满必定是由于虚损造成的。如果胃气没有受伤且腹部温暖中和，就一定不会有留滞导致的疼痛，所以疼痛大多是由于寒邪造成的。因此，治疗疼痛和胀满，必须以健脾暖胃为主要原则。如果没有火（热）的证候，不得随意使用寒凉药物。如果没有拒按、腹部坚实等实证表现，不得随意使用攻下药物。
一、治疗方法：凡是小儿腹部膨胀，或经常疼痛，身体发黄消瘦，常用的调理方法，适宜用芍药枳实丸加减来服用，并且它能很好地停止腹痛。或者大健脾丸、杨氏启脾丸、和中丸这类方剂，都可以酌情使用。如果是偶尔伤及脾脏，气息急促、困倦乏力，外表看腹部胀但内部并不胀的，这是脾气虚，适宜用五味异功散，或者六味异功煎。如果是脾胃阳气不足，因虚寒导致胀满，或者怕冷，或者手脚冰凉，或者兼有呕吐腹泻的，适宜用五君子煎、养中煎、温胃饮、六君子汤，或者调中丸。如果兼有脾肾阳虚，或者水湿泛滥变成痰饮，形成气喘急促、疼痛胀满、泄泻的，适宜用理阴煎加减为主治疗。如果是脾胃气虚导致疼痛、气滞、呕吐腹泻的，适宜用六味异功煎，或者六君子汤加木香，或者调中汤。如果是胃口偶尔有食物留滞，剧烈疼痛且胀满的，适宜用排气饮，或者益黄散。如果是宿食偶尔不消化而暂时造成胀满的，适宜用大、小和中饮，或者保和丸、消食丸。如果有坚硬的积滞停聚，疼痛胀满且拒绝按压，形体和气机都表现为实证的，适宜用赤金豆、白饼子、紫霜丸这类药物来攻下。以上各种未尽的情况，应当在腹痛和肿胀两个门类中，参考斟酌进行治疗。
我早年在京城时，治疗过一个五岁的邻居女孩，刚好经过药店，看见有人在晾晒巴豆，她的父亲误以为是松子仁，给小孩吃了一颗，孩子嚼起来味道辛辣，急忙吐了出来，但已经有半颗吞下去了。过了一会儿，剧烈腹泻十几次，泻后第二天，导致肚子和全身都肿胀起来，完全不肯进食，于是来找我治疗。有人说适宜用黄连、绿豆来解毒；有人说适宜用四苓散、五皮饮来利水。我说：在大面积攻下之后，难道不是大虚的证候吗？还能再承受苦寒药物来败坏脾脏吗？在剧烈腹泻之后，又还有什么水湿可以利掉呢？于是单独使用独参汤以及温胃饮来培补脾气，没过几剂药就恢复健康如初了。既然已经发生了大泻，为什么反而胀满如此严重呢？通过这个病例，才知道大虚和大寒导致形成肿胀的，大多都是这样。（新按）
Abdominal distension and pain in children are mostly caused by food accumulation or spleen injury due to cold and coolness. The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: Painful conditions belong to Yin. It also states: Pain is mostly due to cold qi; because there is cold, there is pain. Shu Yuan stated: Cold-type distension is common, while heat-type distension is rare; all these cases are primarily governed by the Spleen and Stomach. Therefore, whenever a child's abdomen is distended or painful, although it is mostly due to stagnation, if the Spleen and Stomach are not deficient, they will transform and transport nutrients on time, so how could distension occur? Thus, distension must result from deficiency. If the Stomach Qi is uninjured and the abdominal center is warm and harmonious, there will definitely be no stagnation causing pain; thus, pain is mostly due to cold. Therefore, when treating pain and distension, one must prioritize strengthening the Spleen and warming the Stomach. In the absence of Fire (Heat) syndromes, cooling medicines should not be used recklessly. In the absence of signs such as refusal to press and firmness, purgative medicines should not be used recklessly.
1. Treatment Methods: For children with abdominal distension or frequent pain, accompanied by yellowish complexion and emaciation, the commonly used regulatory method is to appropriately modify Shaoyao Zhishi Wan (Peony and Immature Bitter Orange Pill). This formula is effective in stopping abdominal pain. Alternatively, Dajianpi Wan (Great Spleen-Strengthening Pill), Yangshi Qipi Wan (Yang's Spleen-Initiating Pill), or Hezhong Wan (Middle-Harmonizing Pill) can be used as appropriate. If the Spleen is occasionally injured, leading to shortness of breath, fatigue, and external abdominal distension without internal fullness, this indicates Spleen Qi Deficiency; Wuyi Gong San (Five-Efficacy Powder) or Liuwei Yigong Jian (Six-Ingredient Efficacy Decoction) is suitable. If Spleen and Stomach Yang Qi is insufficient, causing distension due to deficiency-cold, or accompanied by aversion to cold, cold hands and feet, or vomiting and diarrhea, Wu Junzi Jian (Five Gentlemen Decoction), Yangzhong Jian (Nourishing Middle Decoction), Wenwei Yin (Stomach-Warming Drink), Liujunzi Tang (Six-Gentlemen Decoction), or Tiaozhong Wan (Middle-Regulating Pill) are suitable. If there is concurrent Spleen and Kidney Yang Deficiency, or water flooding transforming into phlegm, resulting in panting, painful distension, and diarrhea, Liyin Jian (Yin-Nourishing Decoction) modified is indicated. If Spleen and Stomach Qi Deficiency leads to pain, stagnation, vomiting, and diarrhea, Liuwei Yigong Jian or Liujunzi Tang added with Muxiang (Aucklandiae Radix) or Tiaozhong Tang (Middle-Regulating Decoction) is suitable. If there is occasional food retention at the stomach opening, causing severe pain and distension, Paiqi Yin (Qi-Expelling Drink) or Yihuang San (Yellow-Rescuing Powder) is suitable. If retained food occasionally fails to digest, causing temporary fullness, Da Hezhong Yin and Xiao Hezhong Yin (Large and Small Middle-Harmonizing Drinks), or Baohe Wan (Preserve Harmony Pill) and Xiaoshi Wan (Food-Digesting Pill) are suitable. If there are hard accumulations and stagnation, with painful distension, refusal to pressure, and both physical form and Qi manifesting as Excess, Chijin Dou (Golden Bean), Baibing Zi (White Cake Pill), or Zishuang Wan (Purple Frost Pill) can be used for purgation. For any remaining cases, treatment should be determined by referring to the sections on Abdominal Pain and Swelling.
In my early years in Beijing, I treated a five-year-old neighbor girl. Passing by a pharmacy, she saw dried Crotonis Fructus (Badou, 巴豆) being sun-dried. Her father mistook it for pine nuts and gave her one seed. She chewed it, found the taste spicy, and spat it out immediately, but half had already been swallowed. Shortly after, she suffered severe diarrhea more than ten times. The next day following the diarrhea, her abdomen and entire body became swollen, and she refused all food. Seeking my treatment, some suggested using Coptidis Rhizoma (Huanglian, 黄连) and Phaseoli Semen Mungo (Lvdou, 绿豆) to detoxify; others suggested Siling San (Four-Powder Powder) and Wupi Yin (Five-Skin Drink) to promote urination. I said: After such aggressive purging, is this not a condition of great deficiency? Can she still endure bitter-cold herbs that damage the Spleen? After such severe diarrhea, what fluid retention remains to be drained? Therefore, I used only Duchen Tang (Single Ginseng Decoction) and Wenwei Yin to nourish Spleen Qi. Within a few doses, she recovered completely. Since she had undergone severe purging, why did she become so swollen? From this case, we learn that swelling caused by great deficiency and great cold is often like this. (New Commentary)