总括 脾经不睦胃家虚，邪正交争气不舒；热痛面红并尿赤，冷知青白口唇黧。
脉法 阴弦则腹痛，弦急则小腹痛，尺脉紧则脐小腹痛，尺脉伏则小腹痛。
瘕疝痛心腹痛，痛不息，脉细小迟者生，紧实大者死；腹痛脉反大而长者死；脐下大痛、人中黑者死。
《内经》曰∶寒气入经则稽迟，涩而不行，客于脉外则血少，客于脉中则气郁，故卒然而痛云。
按《内经》言，寒邪外客而痛者，甚为详悉，未能尽述，后学自宜检阅。
《原病式》曰∶热郁于内则腹满坚结而痛，不可例言为寒也。
丹溪曰∶如腹痛欲以物按住者属虚寒；如手不可按者，属实热。痛类不同详列于后∶
有锁肠痛者，一月后，婴儿忽乳不下咽，肚硬如石，面赤如朱，撮口而哭，面青，唇黑，手足口气俱冷是也，始因
断脐时不紧系，故为风冷所乘，症亦危急，以白芍药汤、乌梅散投之，日久则难愈。更参考脐风症内，论 瘕痛，乃积
久所致，亦能成疳，此皆荣卫俱虚，外则感受风寒，内则过伤乳食，停滞既久，不能克化。邪并于阴为 ，阴则专静凝
而不移；邪并于阳为瘕，假物象形，动而不息。此二症若久而不治，亦成脾疳积，或两胁间有块如石，按之则痛，不按
则轻，或面黄肌瘦肚硬而胀，及有青筋，昼凉夜热，蒸热无时，乳食减少，爱吃土泥，或大便酸泻，痛则身冷如冰。法
当调脾养胃，用醒脾散；磨积理疳，用化癖丸；治 泻，没石子丸。然此积滞之疾，非七剂可疗，必须次第调理，日久
自然平复矣。
痛者，始则腹内一小长块，其硬如臂，从腰缠转，或左或右，良久痛甚，则见于皮下，不思乳食。其症先因有痰，
表解未尽，遽尔下之太过，气虚寒搏，郁结而成，法宜益气。脾虚用参苓白术散、沉香槟榔丸。为治蛔虫动痛，口吐清
水涎沫，或时吐虫，痛不堪忍，其疾因食肥甘荤腥太早，故胃寒虫动作痛，其虫吐出，或生或死。儿小者此痛若甚，亦
致危难，先以理中汤加乌梅煎服，使胃暖不逆，次使君子丸。有儿大者，面 白色而带黄，肉食倍进，肌体消瘦，腹中
时痛，此有血鳖蛔虫集乎其间，以二圣丸下之可也。
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，若治虫反伤胃气，固不可也。因寒而
动者，用理中汤加乌梅煎。因热而动者，用五苓散加乌梅，水姜煎服。
积痛者腹中隐隐而痛，面黄不食，儿大吐酸溲气，先治积滞，后调脾胃，其痛自止，仍辨虚实。和解治法详伤积论。
癖痛者 瘕 癖，四症大同小异，总名积聚。详见积聚论中。
脏寒痛附胎寒论内。
盘肠内吊痛在夜啼论内。
吊肾偏坠痛，当理肾和气，论在阴囊肿内。
寒疝痛详在疝症内。
〔附方〕
白芍药汤 芍药 泽泻 薄桂 甘草
乌梅散 钩藤 乳香 元胡 没药 乌梅肉 粉草
醒脾散 人参 砂仁 黄芩 藿香 白术 丁香 南星 甘草
化癖丸 见积聚症内。
没石子丸 没药 赤石脂 诃子
参苓白术散 见霍乱症内。
沉香槟榔丸 沉香 槟榔 木香 丁香 三棱 莪术 神曲 浓朴 苍术 青皮 陈皮 砂仁 益智 枳壳
良姜 香附 谷芽 使君子
理中汤 见惊风症内。
使君子丸 槟榔 大黄 使君子 酸石榴皮
二圣丸 槟榔（一两） 巴豆（十五粒，去壳膜心，略去油） 入槟榔木杵丸，如绿豆大，服后虫下，饮稀粥
自安，或用黑丑亦可。
五苓散 见惊风症内。
总括：脾经不和，胃气虚弱，邪气与正气相互交争，导致气机不畅。热性腹痛表现为面色红赤、小便短赤；冷性腹痛表现为面色青白、口唇发黑。
脉法：脉象阴弦主腹痛，脉象弦急主小腹痛，尺部脉紧主脐下及小腹痛，尺部脉伏主小腹痛。
瘕疝痛（腹部结块疼痛）和心腹痛，如果疼痛不止，脉象细小迟缓者预后良好，脉象紧实大者预后不良；腹痛而脉象反而大而长者预后不良；脐下剧烈疼痛且人中部位发黑者预后不良。
《黄帝内经》说：寒气侵入经脉则运行迟滞，涩而不行，若客于脉外则血液亏少，客于脉中则气机郁滞，所以会突然发生疼痛。
按照《黄帝内经》的说法，寒邪外侵导致的疼痛论述非常详尽，此处无法全部列举，后学者应当自行查阅。
《原病式》说：热邪郁结在体内会导致腹部胀满、坚硬结聚而疼痛，不能一概而论说是寒证。
朱丹溪说：如果腹痛想要用东西按住的是虚寒证；如果手不能触碰按压的是实热证。各类疼痛的具体表现详细列述如下：
有一种锁肠痛，发病一个月后，婴儿突然乳汁无法咽下，肚子硬如石头，面色红如朱砂，撮口而哭，面色发青，嘴唇发黑，手足及口气都冰冷。这起初是因为断脐时绑缚不紧，导致风冷乘虚而入，症状也很危急，可用白芍药汤、乌梅散治疗，若拖延日久则难以治愈。另外参考脐风症中的论述，瘕痛是由于积滞日久所致，也能形成疳积，这都是因为营卫两虚，外感风寒，内伤乳食，停滞时间过长，无法消化。邪气并入阴分形成“”，阴分特性是专静凝滞而不移动；邪气并入阳分形成“瘕”，假借物象成形，动而不停。这两种病症如果长期不治疗，也会变成脾疳积，或者在两胁间有像石头一样的肿块，按压则痛，不按则轻，或者面色黄、肌肉消瘦、肚子硬而胀，以及出现青筋，白天凉晚上热，蒸热无定时，吃奶减少，爱吃泥土，或者大便酸臭泄泻，疼痛时身体冷如冰。治疗方法应当调理脾胃，使用醒脾散；磨积消疳，使用化癖丸；治疗“”泻，使用没石子丸。然而这种积滞的疾病，不是七剂药就能治愈的，必须按次序调理，日久自然平复。
“”痛，开始时腹内有一个长条形的硬块，硬度如手臂，从腰部缠绕转动，或左或右，许久后疼痛加剧，则在皮下显现，不思饮食。这种病症起初是因为有痰，表证未解尽，就急于攻下太过，导致气虚寒搏结，郁结而成，治法宜益气。脾虚者使用参苓白术散、沉香槟榔丸。
这是治疗蛔虫引起的动痛，口中吐出清水涎沫，有时吐出虫子，疼痛难忍。此病是因为过早食用肥甘厚味及荤腥食物，导致胃寒虫动而作痛，虫子吐出，或生或死。幼儿若此痛严重，也会导致危难，先用理中汤加乌梅煎服，使胃暖且不逆乱，再用使君子丸。年龄较大的儿童，面色㿠白而带黄，肉食摄入加倍，身体消瘦，腹中时常疼痛，这是因为有血鳖蛔虫聚集在其中，可以用二圣丸攻下。
又有因胃受极寒或极热，也会导致虫动，或微痛，或不痛，突然呕吐出来，治法应当以安虫为上策，如果只治虫反而损伤胃气，也是不可取的。因寒而动者，用理中汤加乌梅煎服。因热而动者，用五苓散加乌梅，用水和生姜煎服。
积痛表现为腹中隐隐作痛，面色黄，不想吃东西，年龄较大的儿童吐酸水、放屁，先治疗积滞，后调理脾胃，疼痛自然会停止，仍需辨别虚实。和解治法详见伤积论。
癖痛即“”、“瘕”、“癖”，这四种症状大同小异，总称为积聚。详见积聚论中。
盘肠内吊痛在夜啼论内。
寒疝痛详细记载在疝症内。
〔附方〕
白芍药汤：芍药、泽泻、薄桂、甘草。
乌梅散：钩藤、乳香、元胡、没药、乌梅肉、粉草。
醒脾散：人参、砂仁、黄芩、藿香、白术、丁香、南星、甘草。
化癖丸：见积聚症内。
没石子丸：没药、赤石脂、诃子。
参苓白术散：见霍乱症内。
沉香槟榔丸：沉香、槟榔、木香、丁香、三棱、莪术、神曲、浓朴、苍术、青皮、陈皮、砂仁、益智、枳壳、良姜、香附、谷芽、使君子。
理中汤：见惊风症内。
使君子丸：槟榔、大黄、使君子、酸石榴皮。
二圣丸：槟榔（一两）、巴豆（十五粒，去壳膜心，略去油），将巴豆与槟榔用木杵捣烂制成丸药，大小如绿豆，服药后虫子排出，喝稀粥即可自安，或者也可以用黑丑。
五苓散：见惊风症内。
General Overview: Disharmony of the Spleen Meridian and deficiency of the Stomach lead to contention between pathogenic factors and healthy Qi, resulting in stagnant Qi flow. Heat-type abdominal pain presents with a red face and dark urine; cold-type abdominal pain presents with a cyan-white complexion and black lips.
Pulse Diagnosis: A Yin-chord (Xian) pulse indicates abdominal pain; a tense-urgent (Xian-Ji) pulse indicates lower abdominal pain; a tight pulse at the Chi position indicates periumbilical and lower abdominal pain; a deep-hidden (Fu) pulse at the Chi position indicates lower abdominal pain.
Abdominal masses and hernia pains (Jia-Shan Tong), heart and abdominal pain that do not cease: if the pulse is fine, small, and slow, survival is likely; if the pulse is tight, solid, and large, death is likely; if abdominal pain presents with a pulse that is unexpectedly large and long, death is likely; severe pain below the umbilicus accompanied by blackening of the Renzhong area indicates death.
The Huangdi Neijing states: When cold pathogen enters the meridians, its movement becomes sluggish and obstructed. If it lodges outside the vessels, blood volume decreases; if it lodges inside the vessels, Qi stagnates. Thus, sudden pain occurs.
According to the Huangdi Neijing, the discussion on pain caused by external invasion of cold pathogen is very detailed and cannot be fully recounted here; later students should consult the original text themselves.
The Yuanbing Shi states: Heat stagnating internally causes abdominal fullness, hardness, and pain; this cannot be indiscriminately diagnosed as a cold syndrome.
Zhu Danxi stated: Abdominal pain relieved by pressure belongs to deficiency-cold; abdominal pain intolerable to touch belongs to excess-heat. The various types of pain are listed in detail below:
There is a condition called Suochang Tong (Locking Intestine Pain). About a month after birth, an infant suddenly fails to swallow milk, the abdomen becomes hard as stone, the face is red like cinnabar, the mouth puckers while crying, the complexion turns cyan, lips turn black, and the hands, feet, and breath become cold. This initially occurs because the umbilical cord was not tied tightly during severance, allowing wind-cold to invade. The symptoms are critical. Treat with Baishaoyao Tang (White Peony Decoction) or Wumei San (Mume Powder). If left untreated for a long time, it becomes difficult to cure. Refer also to the discussion on Umbilical Wind Syndrome. Jia Tong (Mass Pain) results from long-standing accumulation and can develop into Gan Syndrome (Infantile Malnutrition). These conditions arise from dual deficiency of Ying (Nutritive) and Wei (Defensive) Qi, external contraction of wind-cold, and internal overconsumption of milk and food leading to stagnation and inability to digest. Pathogenic factors merging into Yin result in "Yi" (fixed mass), which is quiet, coagulated, and immobile; pathogenic factors merging into Yang result in "Jia" (mobile mass), which takes shape from objects and moves incessantly. If these two conditions are not treated for a long time, they may become Pi Gan Ji (Spleen Malnutrition Accumulation), or lumps like stones may appear between the hypochondrium, painful upon pressure but light when untouched, or the face may be yellow, muscles emaciated, abdomen hard and distended, with visible blue veins, coolness by day and heat by night, intermittent steaming fever, reduced milk intake, craving for dirt/clay, or sour diarrhea. During pain, the body feels cold as ice. The treatment method should regulate the Spleen and nourish the Stomach using Xingpi San (Awaken Spleen Powder); grind accumulations and treat Gan using Huapi Wan (Eliminate Mass Pill); treat Yi diarrhea using Moshizi Wan (Myrobalan Pill). However, such accumulation diseases cannot be cured in seven doses; sequential regulation is required, and recovery will occur naturally over time.
"Yi" pain begins with a small, elongated, hard lump inside the abdomen, hard as an arm, winding around from the waist, either left or right. After a while, pain intensifies and becomes visible subcutaneously, accompanied by loss of appetite. This condition initially arises from phlegm, where the exterior syndrome is not fully resolved, followed by excessive purgation, leading to Qi deficiency, cold condensation, and stagnation. The treatment method should tonify Qi. For Spleen deficiency, use Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) or Chenxiang Binglang Wan (Aquilaria and Areca Nut Pill).
This section addresses pain caused by moving roundworms, characterized by spitting clear saliva, occasional vomiting of worms, and unbearable pain. The disease results from early consumption of rich, sweet, greasy, and fishy foods, causing Stomach cold and worm agitation. The vomited worms may be alive or dead. In young children, severe pain of this type can lead to danger. First, administer Lizhong Tang (Regulate the Middle Decoction) with Wumei (Mume Fruit) to warm the Stomach and prevent rebellion, followed by Shijunzi Wan (Quince Seed Pill). In older children presenting with a sallow-white complexion tinged with yellow, increased meat consumption, emaciation, and intermittent abdominal pain, blood flukes or roundworms may be aggregating within. Treat with Ersheng Wan (Two Sages Pill) to purge them.
Additionally, extreme cold or heat affecting the Stomach can cause worm agitation, resulting in slight pain or no pain, followed by sudden vomiting. The treatment priority should be to calm the worms; treating only the worms without protecting the Stomach Qi is inadvisable. For agitation due to cold, use Lizhong Tang with Wumei decocted in water. For agitation due to heat, use Wuling San (Five-Ingredient Polyporus Powder) with Wumei, decocted with water and fresh ginger.
Ji Tong (Accumulation Pain) presents as dull abdominal pain, yellow complexion, and anorexia. In older children, acid regurgitation and flatulence occur. First treat the accumulation, then regulate the Spleen and Stomach; the pain will cease naturally. Differentiate between excess and deficiency. Harmonizing treatment methods are detailed in the Treatise on Food Accumulation.
Pi Tong (Favoritism/Mass Pain) refers to Yi, Jia, and Pi. These four conditions are largely similar with minor differences, collectively termed Ji Ju (Accumulations and Masses). See the Treatise on Accumulations and Masses for details.
Zang Han Tong (Visceral Cold Pain) is attached to the Treatise on Fetal Cold.
Pan Chang Nei Diao Tong (Coiling Intestine Internal Torsion Pain) is discussed in the Treatise on Night Crying.
Diao Shen Pian Zhui Tong (Hanging Kidney Unilateral Hernia Pain) requires regulating the Kidney and harmonizing Qi; see the Treatise on Scrotal Swelling.
Han Shan Tong (Cold Hernia Pain) is detailed in the Treatise on Hernia.
[Attached Formulas]
Baishaoyao Tang (White Peony Decoction): Shaoyao (Paeoniae Radix), Zexie (Alisma Rhizoma), Bo Gui (Cinnamomi Ramulus), Gancao (Glycyrrhizae Radix et Rhizoma).
Wumei San (Mume Powder): Gouteng (Uncariae Ramulus cum Uncis), Ruxiang (Olibanum), Yuanhu (Corydalis Rhizoma), Moyao (Myrrha), Wumei Rou (Fructus Mume), Fugan (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle).
Xingpi San (Awaken Spleen Powder): Renshen (Ginseng Radix), Sharen (Amomi Fructus), Huangqin (Scutellariae Radix), Huoxiang (Agastaches Herba), Baizhu (Atractylodis Macrocephalae Rhizoma), Dingxiang (Caryophylli Flos), Nanxing (Arisaomatis Rhizoma Preparatum), Gancao (Glycyrrhizae Radix et Rhizoma).
Huapi Wan (Eliminate Mass Pill): See Treatise on Accumulations.
Moshizi Wan (Myrobalan Pill): Moyao (Myrrha), Chishizhi (Halloysit Rubra), Hezi (Terminaliae Chebulae Fructus).
Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder): See Treatise on Cholera-like Disease.
Chenxiang Binglang Wan (Aquilaria and Areca Nut Pill): Chenxiang (Aquilariae Lignum Resinatum), Binglang (Arecae Semen), Muxiang (Aucklandiae Radix), Dingxiang (Caryophylli Flos), Sanleng (Sparganii Rhizoma), Ezhu (Curcumae Rhizoma), Shenqu (Massae Fermentatae Medicatae), Nongpo (Magnoliae Officinalis Cortex), Cangzhu (Atractylodis Rhizoma), Qingpi (Citri Reticulatae Pericarpium Viride), Chenpi (Citri Reticulatae Pericarpium), Sharen (Amomi Fructus), Yizhi (Alpiniae Oxyphyllae Fructus), Zhike (Aurantii Fructus Immaturus), Liangjiang (Alpiniae Katsumadai Rhizoma), Xiangfu (Cyperi Rhizoma), Guya (Hordei Fructus Germinatus), Shijunzi (Quisqualis Fructus).
Lizhong Tang (Regulate the Middle Decoction): See Treatise on Convulsions.
Shijunzi Wan (Quince Seed Pill): Binglang (Arecae Semen), Dahuang (Rhei Radix et Rhizoma), Shijunzi (Quisqualis Fructus), Suan Shiliu Pi (Granati Pericarpium).
Ersheng Wan (Two Sages Pill): Binglang (Arecae Semen, 1 liang), Badou (Crotonis Fructus, 15 grains, remove shell, membrane, and heart, slightly press out oil). Pound Badou with Binglang using a wooden mortar to make pills the size of mung beans. After worms are expelled, drink thin rice gruel for comfort. Alternatively, Heiqiu (Strychni Semen) may be used.
Wuling San (Five-Ingredient Polyporus Powder): See Treatise on Convulsions.