小儿腹痛。属食积者多。食积之痛。属寒者多。盖天地之化。热则发散而流通。寒
聚而壅塞。饮食下咽之后。肠胃之阳。不能行其变化转输之令。使谷肉果菜之物。留恋肠胃
之中。故随其所在之处。而作痛也。
如在胃中犹是完物。在当心而痛。宜吐之。所谓高者越之也。瓜蒂散主之。
其在小肠中。虽变化犹是糟粕。其痛在心之下脐之上。宜辛温之药利下之。宜丁香脾积
丸主之。
一儿周岁。食肉太早。自此成积，日渐羸瘦。不思乳食。其父沙溪告予。请医治之。予
脾去积丸。先服三日。后用脾积丸。鸡肉汤下。取下鸡肉一片。犹未化也。再服养脾丸调理
而愈。
其在大肠者。水谷已分。传送广肠为疾也。其痛在脐之上。宜苦寒之药下之。木香槟榔
丸主之。
如可吐者。不如盐汤探吐之法尤妙。如饮食之后更有胃口痛者。此宜吐之。如因旧日之
积作痛者。不可吐之。恐伤胃气。宜小陷胸丸主之。
枳实（麸炒二钱） 半夏 黄连（姜汁炒各二钱） 草豆蔻（炒五分） 上为末。神曲糊丸。
麻子大。姜汤下。
王小亭一日胃腕当心而痛。请予治之。七日不止。予以手摸其胸腹。问在何处。惟心之
手不可近。予曰。吾差矣。何怪其药之不效也。凡腹痛手可按者。虚痛也。手不可按者。实
痛也。实痛。非积则痰。故不可按也。乃立一方。于枳实导滞丸控涎丹二方内。择取枳实黄
连半夏各二钱。木香黑牵牛头末白芥子炒甘草等分。捣罗为末。用生姜自然汁和神曲作丸。
麻子大。以沉香木香槟榔磨水下。或姜汤亦可。初服二十一丸。少顷痛移下中脘。又服七丸
。至脐下。又服五丸。利下清水而止。乃知是脾痛也。复作枳术丸加青皮陈皮木香砂仁神曲
麦芽山楂。调理而安。治痛者。其可忽诸。
凡腹中积痛者。只在肠胃之中。盖肠胃为市。物之聚也。脾主腐化。而无所受故也。非
客所犯必不为痛。如有脾痛者。宜祖传三圣散主之。
苍术（盐炒） 香附子（盐炒） 良姜（清油炒） 上为细末。热酒调下。
小儿腹痛，大多属于食积所致。食积引起的疼痛，多因寒邪引起。这是因为天地自然的规律是：热则发散而流通，寒则凝聚而壅塞。饮食咽下之后，肠胃的阳气不能行使变化转输的功能，使得谷物、肉类、水果和蔬菜等食物滞留于肠胃之中，因此随着食物停留的部位不同而产生疼痛。
如果食物还在胃中，形态尚完整，疼痛位于心窝部，适宜采用催吐法治疗，即所谓“病位高者，用涌吐法使其从上而出”。方用瓜蒂散主治。
如果食物在小肠中，虽然经过初步消化但仍属糟粕，疼痛位于心窝之下、肚脐之上，适宜用辛温性质的药物通利下行。方用丁香脾积丸主治。
有一个患儿刚满周岁，吃肉过早，从此形成积滞，日渐消瘦，不想吃奶和食物。他的父亲沙溪来找我，请我医治。我先让他服用去积丸三天，随后改用脾积丸，用鸡肉汤送服。结果排出一块鸡肉，尚未完全消化。之后再服用养脾丸进行调理，病就好了。
如果积滞在大肠，水谷已经分离，传导至广肠成为疾病。疼痛位于肚脐之上，适宜用苦寒性质的药物攻下。方用木香槟榔丸主治。
如果可以催吐，不如用盐汤探吐的方法更为巧妙。如果在饮食之后出现胃口疼痛，这适宜用催吐法。如果是由于旧有的积滞引发疼痛，则不可催吐，恐怕会损伤胃气，适宜用小陷胸丸主治。
药材组成：枳实（麸炒二钱）、半夏、黄连（姜汁炒各二钱）、草豆蔻（炒五分）。以上药物研为细末，用神曲糊制成丸药，大小如麻子，用姜汤送服。
王小亭有一天胃脘当心部位疼痛，请我诊治。疼痛持续七天不止。我用手触摸他的胸腹，询问疼痛的具体位置，发现只有心窝处的手无法靠近（拒按）。我说：“是我诊断失误了，难怪药效不好。”凡是腹痛可以按压的，是虚痛；手不可按压的，是实痛。实痛，不是积滞就是痰饮，所以不可按压。于是立即拟定一方，在枳实导滞丸和控涎丹两个方剂中选取枳实、黄连、半夏各二钱，木香、黑牵牛头末、白芥子（炒）、甘草等量，捣碎过筛为细末，用生姜自然汁调和神曲制成丸药，大小如麻子。用沉香、木香、槟榔磨成的水送服，或者用姜汤也可以。初次服用二十一丸，过了一会儿疼痛转移至中脘部，又服用七丸，疼痛移至脐下，再服用五丸，排出清水后疼痛停止。这才知道是脾痛。随后又制作枳术丸，加入青皮、陈皮、木香、砂仁、神曲、麦芽、山楂，进行调理而痊愈。治疗疼痛，怎么可以忽视呢？
凡是腹中积滞疼痛，只在肠胃之中。因为肠胃如同集市，是万物聚集的地方，脾主腐熟消化，但本身没有受纳功能，所以如果不是外邪侵犯或内伤饮食，就不会发生疼痛。如果有脾痛的情况，适宜用祖传的三圣散主治。
Abdominal pain in children is mostly caused by food stagnation (Food Stagnation). The pain due to food stagnation is mostly attributed to cold (Cold). This is because the transformation of heaven and earth follows the principle that heat causes dispersion and free flow, while cold causes condensation and obstruction. After food is swallowed, the yang qi of the stomach and intestines fails to perform its functions of transformation and transportation, causing grains, meats, fruits, and vegetables to linger within the gastrointestinal tract. Consequently, pain arises depending on the location where the food remains.
If the food is still in the stomach and retains its original form, with pain located at the epigastrium, emesis (Emesis) is indicated, following the principle "where the pathogen is high, use vomiting to expel it." Guadi San (Melon Pedicle Powder) is the primary formula.
If the food has reached the small intestine, although partially digested, it remains as dregs, with pain located below the epigastrium and above the umbilicus. Acrid-warm herbs that promote purgation are indicated. Dingxiang Pi Ji Wan (Clove Spleen Accumulation Pill) is the primary formula.
A one-year-old child began eating meat too early, leading to chronic accumulation, progressive emaciation, and anorexia for milk and food. His father, Sha Xi, sought my treatment. I prescribed Qu Ji Wan (Remove Accumulation Pill) for three days first, followed by Pi Ji Wan (Spleen Accumulation Pill), administered with chicken broth. A piece of undigested chicken was expelled. Subsequently, Yang Pi Wan (Nourish Spleen Pill) was used for regulation, resulting in recovery.
If the accumulation is in the large intestine, where water and grain have separated and transmission to the broad intestine is impaired, pain occurs above the umbilicus. Bitter-cold herbs for purgation are indicated. Muxiang Binglang Wan (Aucklandia and Betel Nut Pill) is the primary formula.
If emesis is suitable, the method of inducing vomiting with salt water probe is particularly effective. If pain occurs in the stomach region after eating, emesis is indicated. However, if pain is caused by old accumulations, emesis should be avoided to prevent damaging stomach qi. Xiaoxianxiong Wan (Small Chest-Piercing Pill) is indicated.
Ingredients: Zhishi (Bran-fried Fried Immature Bitter Orange, 2 qian), Banxia (Pinelliae Rhizoma, 2 qian), Huanglian (Ginger-juice fried Coptidis Rhizoma, 2 qian), Caodoukou (Fried Cardamom Seed, 0.5 qian). Grind into powder, make pills with Shenqu paste, size of hemp seeds, administer with ginger decoction.
Wang Xiaoting suffered from epigastric pain at the heart center for seven days without relief. Upon palpating his chest and abdomen and asking for the precise location, I found that the area over the heart was tender to touch (refusal to press). I admitted, "My diagnosis was flawed; no wonder the previous medicine failed." Generally, abdominal pain that can be pressed indicates deficiency pain (Deficiency Pain); pain that cannot be pressed indicates excess pain (Excess Pain). Excess pain is due to either stagnation or phlegm-fluid, hence tenderness. I immediately formulated a prescription combining elements from Zhishi Daozhi Wan (Immature Bitter Orange Regulating Stagnation Pill) and Kongxian Dan (Draining Fluids Pill): Zhishi (2 qian), Huanglian (2 qian), Banxia (2 qian), Muxiang (Aucklandiae Radix), Toumo Heiqianniu (Black Morning Glory Seed), Baizijie (Stir-fried White Mustard Seed), and Gancao (Licorice Root) in equal parts. These were ground into powder, mixed with fresh ginger juice and Shenqu to form pills the size of hemp seeds. Administered with water infused with Chenxiang (Aquilariae Lignum Resinatum), Muxiang, and Binglang (Arecae Semen). Initial dose: 21 pills. Shortly after, pain shifted to the Zhongwan point. Second dose: 7 pills. Pain moved to below the umbilicus. Third dose: 5 pills. Clear fluid stool ensued, and pain ceased. It was then determined to be spleen pain. Zhizhu Wan (Atractylodes and Citrus Pill) was compounded with Qingpi (Green Tangerine Peel), Chenpi (Aged Tangerine Peel), Muxiang, Sharen (Amomi Fructus), Shenqu, Maiya (Hordei Fructus Germinatus), and Shanzha (Crataegi Fructus) for regulation, leading to stability. One must not neglect the treatment of pain.
Accumulative pain in the abdomen is confined to the stomach and intestines. The stomach and intestines are like a market, gathering substances. The spleen governs rotting and ripening but does not receive directly; thus, without external invasion or internal injury, pain does not occur. For spleen pain, the ancestral San Sheng San (Three Saints Powder) is indicated.
Ingredients: Cangzhu (Salt-stir-fried Atractylodis Rhizoma), Xiangfuzi (Salt-stir-fried Cyperi Rhizoma), Liangjiang (Clear-oil stir-fried Galangal Rhizome). Grind into fine powder, take with hot wine.