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。
麻疹期间出现腹痛，是由于饮食停滞凝结，导致毒邪之气不能向外宣发透达，因此患儿不时弯腰啼哭，双眉频繁皱起。必须使用加味平胃散来治疗，待积滞消除、毒邪解散，疼痛自然就会停止。
加味平胃散
防风、升麻、枳壳、葛根、苍术、陈皮、厚朴、山楂、麦芽、甘草。
廉按（廉泉按语）：袁先生的女儿，十四岁，出疹后随即隐没，伴有喉痛和腹胀。请我诊治时，见她面色黧黑晦暗，鼻部发黑，嘴唇干裂口渴，舌头红得像朱砂一样，没有舌苔，喉痛严重难以吞咽，心中感觉像火烧一样，腹部胀满但触之发冷，手脚也冰凉。这是热极生寒的假象。观察她之前服用的方剂，包含黄连、黄芩、射干、玄参、石膏、升麻、大黄、莱菔子、知母、犀角等药物，已经服用了三四剂。而且重用石膏和大黄，每喝下一口药，腹胀反而更加严重，她在周围爬着走动，偶尔排出一些清水，随后口渴、喉痛、胸闷等症状更加加剧，昼夜不得安宁，眼睛无法闭合，各位医生都没有办法，只能坐着等待死亡。我诊察她的脉象，唯独脾脉宏大坚实，腹部拒按（按压时疼痛加剧）更为明显。这是由于食积停滞在中焦，胃火上冲，导致了喉痛等各种症状。当时的医生拘泥于“枳壳、山楂、厚朴、酸涩、麦芽会阻碍疹毒发散”的理论，不敢使用这些药物来消食导滞，而只用凉药来清火，用大黄来强行通便。他们不知道越用凉药，积滞就越严重；大黄虽然具有泻下作用，但不能消化积食，所以导致腹中冰冷，火毒聚集在上焦，每次服药都感到腹胀欲死。我使用了枳壳、厚朴、山楂、麦芽、神曲、粉葛、槟榔这七味药，其他医生认为病人已经身体干燥，使用这种燥烈性质的药物，肯定会导致死亡。而且他们认为枳壳、山楂等具有酸收的性质，会使麻疹隐伏不能再次发出。孩子的父亲说女儿已经垂危，生死听凭命运安排，于是排除众人的异议让她服用了此药。药方咽下后，孩子立即入睡，酣睡半天后醒来，各种症状顿时减轻。此时舌苔变得极厚且发黄，我继续给予原方服用，她又酣睡了一夜。第二天在原方基础上加大黄六钱，病就好了。又有因毒邪炽盛引起疼痛的情况，我使用蝉蜕二两、桔梗三钱，一剂药就治愈了。
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.