凡痘子，腹中常宜宽舒，为里无邪，若腹胀满，须审其伤食否，及大小便何如，
如曾伤食，微满不痛者，木香大安丸。胀满腹痛甚者，丁香脾积丸（俱伤食）。小便不通，百祥丸（黑陷）。大便不通者，
宣风散（发热）主之。此上诸证，皆实胀者也，故宜利之。若自利腹胀，乃虚胀也，陈氏木香散（泄利）主之。
腹胀分虚实寒热 钱氏云∶身热烦躁，腹满而喘，大小便涩，面赤闷乱，大吐者当利小便，不瘥者，宣风散下
之。此实热治例也。陈文中木香散治痘疮腹胀渴泻。此虚寒治例也。薛氏《撮要》云∶腹胀泻渴，脾胃虚寒也，用大
异功散（出不快）
参内托散（即十补散出不快）治之。若前证而兼气促体倦，乃脾气虚也，用白术散（渴）加木香，煎送四神丸（泄泻
）。如腹胀作喘，大便利，小便秘，手足并冷，乃脾气虚也，先用葶苈木香散（喘），次用小异功散（吐泻）一二剂
自愈。此平补例也。
初热时腹胀痛者，由毒瓦斯与外邪相搏，欲出而不得出也，用参苏饮加缩砂、陈皮，去参苓服之（挟有表证者、宜
此）。身热脉数，大便秘而腹胀，此热毒壅遏也，当微下之，或疮半未出而喘息腹胀，其人大便不通，烦躁作渴，谵语
不安者，当急下之，俱用紫草承气汤（挟有里证者、宜此）。〔丹溪〕用桔梗枳壳汤、二陈加枳壳汤。若虚弱自
利，四肢厥冷，腹胀发哕者，里气虚也，姜附、理中辈急救之。
紫草承气汤
浓朴（二两） 大黄（四两） 枳实（一两） 紫草（一两）
上为粗末。每服五钱，水半盏，煎二三分，温服。以利为度，如未利加芒硝一字。
桔梗枳壳汤
枳壳 桔梗（各二两） 甘草（五钱）
上锉。每服三钱，姜二片，水煎服。
二陈加枳壳汤
枳壳 半夏 茯苓 甘草 陈皮（各等分）
上锉。每用三钱，姜二片，水煎服。
若疮既出而腹胀者有二证，一则阴阳不和，或因作热烦渴，饮冷过多，或误投凉剂，热为冷所激，欲出不能，
毒不能发越，故令腹胀。其人必不能食，二便利，腹中虚鸣，甚者气喘发厥，疮白无血色者多致不救。急当
以温中药疏逐冷气，不可又用宣泻之药，以重其困，如小异功散（吐泻）木香散（痘泻）俱可用。王中阳云∶木香散性
温平，能和表里，治腹胀泻渴，有如神之效。一则毒瓦斯陷伏入里，必有他证相杂，或烦躁大渴，或大小便秘，或啼
哭不止，但用温平解毒快气之剂，如人齿散（黑陷）活血散（出不快）之类。又有小便赤涩，而心腹胀满，别无他
证者，此伏热在胃，则中有所隔，上为心气不降，故小便涩少而赤。下为阴气不升，故腹中胀满。董氏用四圣散
（出不快）以发出其毒，则胃热自散矣。若出太盛而面黄，大便黑，烦躁，喘渴腹胀者，此有瘀血在里也，治法见渴
条。若出太盛，至当结脓窠痂 而不结，能食而喘，腹胀谵语不大便者，及靥后腹胀喘渴，大便利小便涩者，治法
俱见喘条。
痘疮起发而腹胀者二证，同前阴阳不和者，疮痘正发，热毒方盛，必生烦渴，宜以葛根解毒汤、人参麦门冬散、
人参白术散（并见痘渴）之类与之。不知此理，或饮冷过多，或误投凉剂，热为冷所激，欲出而不能，冷热相搏，
毒不发起，故令腹胀。且伤于冷者，急当以温中药疏逐冷气，冷气散，则腹胀自消，益黄散（脾）去甘草，加
姜制浓朴。甚者气喘发厥，疮白而无血色，多致不救。陈氏木香散（泄利）圣方也，昧者反用峻下之药，致令重困
而死。其毒瓦斯陷伏入里者，但用温平解毒快气之剂紫草饮子主之（起发）。若腹胀而目闭，口中如烂肉臭者，其证为大恶。
〔丹〕勉奴痘后渴，肚急，小便少，发热。
芍药 白术 陈皮（各五分） 川芎 干葛（各三分） 甘草（炙，一钱半） 木通（二分）
上，用水煎服。
寄子五岁，痘后肚急。
白术（一钱） 陈皮 木通（各五分） 犀角 川芎 白芷（各七分） 甘草（炙，三分）
上，水煎服。
加味透肌散
人参 黄 白术 芍药 川芎 甘草 茯苓 木通 陈皮 糯米 浓朴 大腹皮
等分，为粗散。姜枣煎服。
紫草浓朴汤 治痘疮烦闷痞满，或坚急，或结聚不散。
紫草茸（一钱二分） 枳实 黄芩 黄连 浓朴（各一钱一分） 露蜂房 白茯苓 山豆根
麦门冬 桃仁 石膏 旋复花（各二钱） 蝉蜕 升麻（各八分） 白术（五分）
上锉散。每服四五钱，水煎，食远温服。
温平，能和表里，治腹胀泻渴，有如神之效。一则毒瓦斯陷伏入里，必有他证相杂，或烦躁不渴，或大小便秘，或啼
哭不
止，但用温平解毒快气之剂，如人齿散（黑陷）活血散（出不快）之类。又有小便赤涩。而心腹胀满，别无他证者，此
伏热在胃，则中有所隔，上为心气不降，故小便涩少而赤。若出太盛而面黄，大便黑，烦躁，顺喝腹胀者，此有瘀血在
里也，治法见渴条。若出太盛，至当结脓窠痂 而不结，能食而喘，腹胀谵语不大便者，及靥后腹胀喘渴，大便利小便
涩者，治法俱见喘条。
痘疮起发而腹胀者二证，同前阴阳不和者，疮痘正发，热毒方盛，必生烦渴，宜以葛根解毒汤、人参麦门冬、人参
白术
散（并见痘渴）之类与之。不知此理，或饮冷过多，或误投凉剂，热为冷所激，欲出而不能，冷热相搏，毒不发起，故
令腹胀。且伤于冷者，急当以温中药疏逐冷气，冷气散，则腹胀自消，益黄散（脾）去甘草，加姜制浓朴，甚者气喘发
厥，疮白而无血色，多致不救。陈氏木香散（泄利）圣方也，昧者反用峻下之药，致冷重因而死。其毒瓦斯陷伏入里者，
但用温平解毒快气之剂紫草饮子主之（起发）。若腹胀而目闭，口中如烂肉臭者，其证为大恶。
〔丹〕 勉奴痘后渴，肚急，小便少，发热。
芍药 白术 陈皮（各五分） 川芎 干葛（各三分） 甘草（炙，一钱半） 木通（二分）
上，用水煎服。
寄子五岁，痘后肚急。
白术（一钱） 陈皮 木通（各五分） 犀角 川芎 白芷（各七分） 甘草（炙，三分）
上，水煎服。
加味透肌散
人参 黄 白术 芍药 川芎 甘草 茯苓 木通 陈皮 糯米 浓朴 大腹皮
等分，为粗散。姜枣煎服。
紫草浓朴汤 治痘疮烦闷痞满，或坚急，或结聚不散。
紫草茸（一钱二分） 枳实 黄芩 黄连 浓朴（各一钱一分） 露蜂房 白茯苓 山豆根 麦门冬 桃仁 石膏
旋复花（各二钱） 蝉蜕 升麻（各八分） 白术（五分）
上锉散。每服四五钱。水煎，食远温服。
紫草枳实汤 治痘疮腹胀，或热毒，或因伤冷所致。
紫草茸 鼠粘子（各一钱二分） 浓朴 苦参（各一钱一分） 白芍药 贝母 枳实 诃子 肉
豆蔻（各一钱） 蝉蜕 桔梗 白术（各八分） 升麻（七分） 甘草（六分）
上锉散。每服四五钱，水煎，食远服。
葶苈木香散（喘）
木通芍药汤 治痘疮作渴腹胀，小便不利。
木通 芍药 白术（各五分） 川芎 陈皮 干葛（各三分） 甘草（二分）
上，水煎服。
姜附汤 治疮疹半出而半不出，或出盛时却下利支厥，呕逆腹胀吃噫，须急与理中丸、四逆、姜附汤之类不
须疑，已试之验也。大便自利腹胀者，是热毒被冷所搐不能出，冷甚则为下利，其毒小得出，则为腹胀，当此
以理中丸、四逆、姜附汤等服之，里复温，则利止，热毒得复出，则腹胀自消，疮疹亦自出矣。又有疮疹
半出半未出，或出盛时却大便不通，小便赤涩，喘粗腹胀，而唇齿干，口燥渴引饮，谵语者，当急下之，此
证是毒瓦斯壅瘀，欲出而出不辨，故腹胀，下之热毒散，
荣卫伸则里胀消，外疮出，合温合下，皆得其宜，不可不述之。若下脓血而腹胀
者，又非此证，宜服南金散、乳香猪血膏、理中丸、姜附汤。
凡是出痘的孩子，腹部应当保持宽舒通畅，这是因为体内没有邪气干扰。如果出现腹胀满的症状，必须仔细审查是否因饮食积滞引起，以及大小便的情况如何。
如果确实伤食，表现为轻微胀满但不疼痛的，用木香大安丸治疗。如果胀满且腹痛严重的，用丁香脾积丸治疗（这两种情况都属于伤食）。如果小便不通畅，用百祥丸治疗（适用于痘色黑陷的情况）。如果大便不通畅，用宣风散治疗（适用于伴有发热的情况）。以上这些证候，都属于实性腹胀，所以适宜采用通利的方法治疗。如果是腹泻后出现的腹胀，则属于虚性腹胀，用陈氏木香散治疗（适用于泄泻情况）。
关于腹胀分为虚、实、寒、热四种类型：钱乙说，身体发热烦躁，腹部胀满且气喘，大小便涩滞不畅，面色红赤且闷乱，剧烈呕吐的，应当先通利小便；如果无效，再用宣风散攻下。这是实热证的治法示例。陈文中用木香散治疗痘疮引起的腹胀、口渴和泄泻。这是虚寒证的治法示例。薛己在《撮要》中说：腹胀、泄泻和口渴，是由于脾胃虚寒所致，应用大异功散治疗（适用于痘疹出不顺畅的情况）；参内托散（即十补散，用于痘疹出不顺畅的情况）也可用来治疗。如果上述症状兼有气短急促、身体疲倦，则是脾气虚弱，用白术散（适用于口渴情况）加木香，煎汤送服四神丸（适用于泄泻情况）。如果腹胀并伴有气喘，大便通畅但小便不通，手脚冰冷，这也是脾气虚弱，先用葶苈木香散治疗气喘，接着用小异功散治疗吐泻，服用一两次后即可自愈。这是平和补益的治法示例。
在初热阶段出现腹胀痛的，是因为毒气与外邪相互搏结，想要透发出来却不得出，用参苏饮加缩砂仁、陈皮，去掉人参和茯苓服用（适用于兼有表证的情况）。如果身体发热、脉象数急，大便秘结且腹胀，这是热毒壅塞阻滞，应当轻微攻下；或者痘疮一半发出、一半未发出，同时出现喘息、腹胀，病人大便不通，烦躁作渴，胡言乱语、心神不安的，应当紧急攻下，这些都使用紫草承气汤治疗（适用于兼有里证的情况）。〔朱丹溪〕主张用桔梗枳壳汤、二陈汤加枳壳汤。如果体质虚弱且自发性腹泻，四肢厥冷，腹胀并伴有呃逆，这是里气虚弱，需用干姜、附子、理中汤等药物急救。
紫草承气汤
方药组成：浓朴（二两）、大黄（四两）、枳实（一两）、紫草（一两）。
制法用法：将上述药材捣成粗末。每次服用五钱，加水半盏，煎煮至剩余二三分量，温服。以大便通畅为度，如果仍未通畅，增加芒硝一字。
桔梗枳壳汤
方药组成：枳壳、桔梗（各二两）、甘草（五钱）。
制法用法：将药材切碎。每次服用三钱，加生姜两片，水煎服。
二陈加枳壳汤
方药组成：枳壳、半夏、茯苓、甘草、陈皮（各等分）。
制法用法：将药材切碎。每次取三钱，加生姜两片，水煎服。
如果痘疮已经发出但仍出现腹胀，有两种证型。第一种是阴阳不和，可能因为发热烦躁口渴，饮水过多，或者误用了寒凉药剂，导致热气被寒气激荡，痘毒想要发出却无法发出，毒气不能发散，从而导致腹胀。这类病人一定食欲不振，大小便正常，腹中有虚鸣声，严重的会出现气喘、昏厥，痘色苍白无血色，大多难以救治。此时应当紧急用温中药来疏解驱逐冷气，不可再用宣泻的药物，以免加重病情，如小异功散（适用于吐泻情况）、木香散（适用于痘泻情况）都可以使用。王中阳说：木香散性质温和平稳，能调和表里，治疗腹胀、泄泻和口渴，效果神奇。第二种是毒气陷入潜伏于体内，必然夹杂其他证候，如烦躁大渴，或大小便不通，或啼哭不止，只需用温和平稳、解毒理气的药剂，如人齿散（适用于黑陷情况）、活血散（适用于出不顺畅情况）之类。又有小便颜色红赤涩痛，而心腹胀满，没有其他证候的，这是伏热在胃，导致中焦阻隔，上部心气不降，所以小便涩少且红赤；下部阴气不升，所以腹中胀满。董氏用四圣散（适用于出不顺畅情况）来透发毒气，胃热自然消散。如果痘疮发出过于旺盛而面色发黄，大便黑色，烦躁，气喘口渴腹胀的，这是里有瘀血，治法参见“渴”条。如果痘疮发出过于旺盛，到了该结成脓疱痂皮的时候却不结，能进食但气喘，腹胀、胡言乱语、不大便的，以及痘疹收靥后出现腹胀、气喘、口渴，大便通畅但小便涩滞的，治法都参见“喘”条。
痘疮起发阶段出现腹胀的，有两种证型。同前所述的阴阳不和者，痘疮正在发出，热毒正盛，必然产生烦躁口渴，宜用葛根解毒汤、人参麦门冬散、人参白术散（均见于“痘渴”条）等给予治疗。如果不明白这个道理，或者冷饮过多，或者误投寒凉药剂，热气被寒气激荡，想要发出而不能，冷热相互搏结，毒气无法发起，从而导致腹胀。而且受寒伤的，应当紧急用温中药疏解驱逐冷气，冷气散去，腹胀自然消除，可用益黄散（针对脾虚）去掉甘草，加姜制的浓朴。严重的出现气喘、昏厥，痘色苍白无血色，大多难以救治。陈氏木香散（适用于泄利）是圣方，愚昧的人反而用峻猛攻下的药物，导致病情加重而死。其毒气陷入潜伏于体内的，只用温和平稳、解毒理气的药剂紫草饮子主治（适用于起发阶段）。如果腹胀且眼睛闭合，口中像烂肉一样的臭味，这个证候非常凶险。
〔朱丹溪〕记载：勉奴出痘后口渴，肚子紧迫，小便少，发热。
处方：芍药、白术、陈皮（各五分）、川芎、干葛（各三分）、甘草（炙，一钱半）、木通（二分）。
制法用法：用水煎服。
寄子五岁，出痘后肚子紧迫。
处方：白术（一钱）、陈皮、木通（各五分）、犀角、川芎、白芷（各七分）、甘草（炙，三分）。
制法用法：用水煎服。
加味透肌散
方药组成：人参、黄芪、白术、芍药、川芎、甘草、茯苓、木通、陈皮、糯米、浓朴、大腹皮。
制法用法：等分，研为粗散。加生姜、大枣煎服。
紫草浓朴汤 治疗痘疮烦闷痞满，或者坚硬紧急，或者结聚不散。
方药组成：紫草茸（一钱二分）、枳实、黄芩、黄连、浓朴（各一钱一分）、露蜂房、白茯苓、山豆根、麦门冬、桃仁、石膏、旋复花（各二钱）、蝉蜕、升麻（各八分）、白术（五分）。
制法用法：切碎成散剂。每次服用四五钱，水煎，饭后稍久温服。
（注：原文此处有重复段落，内容与前文相同，略去重复部分，直接翻译后续新内容）
紫草枳实汤 治疗痘疮腹胀，或因热毒，或因受寒所致。
方药组成：紫草茸、鼠粘子（各一钱二分）、浓朴、苦参（各一钱一分）、白芍药、贝母、枳实、诃子、肉豆蔻（各一钱）、蝉蜕、桔梗、白术（各八分）、升麻（七分）、甘草（六分）。
制法用法：切碎成散剂。每次服用四五钱，水煎，饭后稍久服。
葶苈木香散（治疗气喘）
木通芍药汤 治疗痘疮作渴腹胀，小便不利。
方药组成：木通、芍药、白术（各五分）、川芎、陈皮、干葛（各三分）、甘草（二分）。
制法用法：用水煎服。
姜附汤 治疗疮疹一半发出、一半未发出，或者发出旺盛时却出现腹泻、四肢厥冷、呕吐逆气、腹胀嗳气，必须紧急给予理中丸、四逆汤、姜附汤等，无需怀疑，这是经过验证有效的。如果大便自利且腹胀，这是热毒被寒气牵引不能透出，寒气严重则导致下利，毒气稍微透出则为腹胀，此时应当服用理中丸、四逆汤、姜附汤等，里气恢复温暖，则下利停止，热毒得以重新透出，则腹胀自然消除，疮疹也会自行发出。又有疮疹一半发出、一半未发出，或者发出旺盛时却大便不通，小便红赤涩痛，呼吸急促粗重、腹胀，嘴唇牙齿干燥，口干渴想喝水，胡言乱语的，应当紧急攻下，这个证候是毒气壅塞瘀滞，想要透出却透出不畅，所以腹胀，攻下后热毒消散，营卫通畅则里胀消除，外部疮疹发出，合用温法和下法，都得其适宜，不可不叙述。如果排出脓血且腹胀的，又不是这个证候，宜服用南金散、乳香猪血膏、理中丸、姜附汤。
For children suffering from smallpox, the abdomen should generally remain loose and comfortable, indicating that there is no pathogenic factor in the interior. If abdominal distension and fullness occur, one must carefully examine whether it is due to food stagnation and assess the condition of urination and defecation.
If there is indeed food stagnation presenting as slight fullness without pain, Muxiang Da'an Wan (Aucklandia Great Peace Pill) should be used. If fullness and abdominal pain are severe, Dingxiang Pi Ji Wan (Clove Spleen Accumulation Pill) should be used (both cases belong to food stagnation). If urination is obstructed, Baixiang Wan (Hundred Auspicious Pill) should be used (applicable to black depressed lesions). If defecation is obstructed, Xuanfeng San (Dispersing Wind Powder) should be used (applicable with fever). All the above conditions represent excess-type abdominal distension; therefore, purgative or draining methods are appropriate. If abdominal distension occurs following diarrhea, it represents deficiency-type abdominal distension, which should be treated with Chen's Muxiang San (Chen Aucklandia Powder) (applicable to diarrhea).
Regarding the differentiation of abdominal distension into deficiency, excess, cold, and heat: Qian Yi stated that if the body is hot and restless, the abdomen is full and wheezy, urination and defecation are astringent and difficult, the face is red and confused, and there is severe vomiting, one should first promote urination. If ineffective, use Xuanfeng San to purge downward. This is an example of treating excess-heat patterns. Chen Wenzhong used Muxiang San to treat abdominal distension, thirst, and diarrhea caused by smallpox. This is an example of treating deficiency-cold patterns. Xue Ji in *Cuoyao* stated that abdominal distension, diarrhea, and thirst are due to spleen-stomach deficiency-cold; Dayigong San (Great Yi Gong Powder) should be used (for slow eruption); Shen Neituo San (Support Interior Support Pill), also known as Shibu San (Ten Tonics Pill) for slow eruption, can also be used. If the aforementioned symptoms are accompanied by shortness of breath and fatigue, it indicates spleen-qi deficiency; Baizhu San (Atractylodes Macrocephala Powder) (for thirst) with added Muxiang, decocted and taken with Sishen Wan (Four Spirits Pill) (for diarrhea) should be used. If abdominal distension is accompanied by wheezing, free defecation but obstructed urination, and cold hands and feet, this is also spleen-qi deficiency. First, Tingli Muxiang San (Descurainia Aucklandia Powder) should be used for wheezing, followed by Xiaoyigong San (Small Yi Gong Powder) for vomiting and diarrhea; self-healing will occur after one or two doses. This is an example of mild tonification.
During the initial heat stage, if abdominal distension and pain occur, it is because toxic qi clashes with external pathogens, attempting to emerge but failing to do so. Can Su Yin (Ginseng and Perilla Decoction) with Su Sha Ren (Amomum Villosum Fruit) and Chen Pi (Tangerine Peel), removing Renshen (Ginseng) and Fuling (Poria), should be administered (suitable for cases with exterior syndrome). If the body is hot, pulse is rapid, stool is constipated, and the abdomen is distended, this is heat-toxin obstruction; mild purgation should be applied. Or, if half the lesions have erupted while the other half have not, accompanied by wheezing and abdominal distension, where the patient has constipation, restlessness, thirst, delirium, and anxiety, urgent purgation is required. Zicao Chengqi Tang (Arnebia Rhubarb Decoction) should be used in all these cases (suitable for cases with interior syndrome). [Zhu Danxi] advocated using Jiegeng Zhike Tang (Platycodon and Bitter Orange Decoction) or Erchen Tang (Two Aged Things Decoction) with added Zhike (Bitter Orange). If the constitution is weak with spontaneous diarrhea, cold limbs, abdominal distension, and hiccups, this is interior qi deficiency; Ganjiang (Dried Ginger), Fuzi (Aconite Root), Lizhong Tang (Regulate the Middle Decoction), etc., should be used for emergency rescue.
**Zicao Chengqi Tang (Arnebia Rhubarb Decoction)**
Ingredients: Houpo (Magnolia Bark, 2 liang), Dahuang (Rhubarb Root and Rhizome, 4 liang), Zhishi (Immature Bitter Orange, 1 liang), Zicao (Arnebia Root, 1 liang).
Preparation and Administration: Grind into coarse powder. Take 5 qian per dose, add half zhan of water, decoct until reduced to two or three parts, and take warm. Stop when bowel movement occurs; if not, add Mangxiao (Mirabilite) one zi.
**Jiegeng Zhike Tang (Platycodon and Bitter Orange Decoction)**
Ingredients: Zhike (Bitter Orange, 2 liang), Jiegeng (Platycodon Root, 2 liang), Gancao (Licorice Root, 5 qian).
Preparation and Administration: Cut into pieces. Take 3 qian per dose, add two slices of fresh ginger, decoct in water, and take.
**Erchen Tang with Added Zhike (Two Aged Things Decoction with Bitter Orange)**
Ingredients: Zhike (Bitter Orange), Banxia (Pinellia Tuber), Fuling (Poria), Gancao (Licorice Root), Chenpi (Tangerine Peel) in equal proportions.
Preparation and Administration: Cut into pieces. Take 3 qian per dose, add two slices of fresh ginger, decoct in water, and take.
If abdominal distension occurs after the lesions have erupted, there are two syndromes. The first is yin-yang disharmony, possibly due to heat-induced restlessness and thirst, excessive drinking of cold fluids, or misadministration of cold-cooling agents, causing heat to be agitated by cold. The toxins cannot erupt, leading to abdominal distension. These patients definitely cannot eat, have normal urination and defecation, hear borborygmus in the abdomen, and in severe cases experience wheezing and syncope. Lesions are white and bloodless, often resulting in death. Emergency treatment requires warm medicines to disperse and drive out cold qi; do not use purgatives to worsen the condition. Xiaoyigong San (Small Yi Gong Powder) (for vomiting/diarrhea) and Muxiang San (Aucklandia Powder) (for smallpox diarrhea) can be used. Wang Zhongyang said: Muxiang San is warm and balanced, harmonizes the interior and exterior, and treats abdominal distension, diarrhea, and thirst with miraculous effect. The second type is toxic qi sinking and lying dormant in the interior, necessarily mixed with other symptoms such as restlessness and extreme thirst, or constipation of urine and stool, or incessant crying. Only warm, balanced, detoxifying, and qi-moving agents should be used, such as Renci San (Human Tooth Powder) (for black depression) or Huoxue San (Invigorate Blood Powder) (for slow eruption). Additionally, if there is red, astringent urination with heart and abdominal distension but no other symptoms, this is latent heat in the stomach causing middle jiao obstruction. Upper heart qi fails to descend, causing scanty red urine; lower yin qi fails to ascend, causing abdominal distension. Dong Shi used Sisheng San (Four Sages Powder) (for slow eruption) to vent the toxin, thereby dissipating stomach heat. If eruptions are too profuse with yellowish face, black stool, restlessness, wheezing, thirst, and abdominal distension, this indicates blood stasis in the interior; see the "Thirst" section for treatment. If eruptions are too profuse, failing to form pustules and scabs when they should, yet able to eat but wheezing, with abdominal distension, delirium, and constipation, or post-scabbing abdominal distension, wheezing, thirst, free stool but astringent urine, see the "Wheezing" section for treatment.
When abdominal distension occurs during the eruption phase, there are two syndromes. Similar to the previously mentioned yin-yang disharmony, as the lesions erupt and heat-toxin is vigorous, restlessness and thirst inevitably arise. Gegen Jiedu Tang (Kudzu Detoxification Decoction), Renshen Maidong San (Ginseng Ophiopogon Powder), and Renshen Baizhu San (Ginseng Atractylodes Powder) (see "Smallpox Thirst") should be given. Ignoring this principle, excessive cold drinks or misused cooling agents cause heat to be agitated by cold, preventing eruption. Cold and heat clash, toxins fail to rise, causing abdominal distension. For cold injury, urgently use warm medicines to disperse cold qi; once dispersed, distension resolves. Yihuang San (Yellow Benefit Powder) (for spleen) with Gancao removed and Jiangzhi Houpo (Ginger-processed Magnolia Bark) added is suitable. Severe cases with wheezing, syncope, and white bloodless lesions often result in death. Chen's Muxiang San (for diarrhea) is a sacred formula; ignorant practitioners mistakenly use harsh purgatives, leading to death from worsening condition. For toxic qi sinking into the interior, use warm, balanced, detoxifying, and qi-moving agents like Zicao Yinzi (Arnebia Infusion) (for eruption). If abdominal distension is accompanied by closed eyes and a foul odor like rotting meat in the mouth, the prognosis is extremely poor.
[Zhu Danxi] recorded: Mian Nu had thirst, abdominal tightness, scanty urine, and fever after smallpox.
Prescription: Shaoyao (Peony Root), Baizhu (Atractylodes Macrocephala Rhizome), Chenpi (Tangerine Peel) (each 5 fen); Chuanxiong (Sichuan Lovage Rhizome), Gange (Kudzu Root) (each 3 fen); Gancao (Licorice Root, honey-fried, 1.5 qian); Mutong (Akebia Stem, 2 fen).
Administration: Decoct in water and take.
Jizi, aged five, had abdominal tightness after smallpox.
Prescription: Baizhu (1 qian); Chenpi, Mutong (each 5 fen); Xijiao (Rhinoceros Horn), Chuanxiong, Baizhi (Angelica Dahurica Root) (each 7 fen); Gancao (honey-fried, 3 fen).
Administration: Decoct in water and take.
**Jiawei Touji San (Modified Skin-Penetrating Powder)**
Ingredients: Renshen (Ginseng), Huangqi (Astragalus Root), Baizhu, Shaoyao, Chuanxiong, Gancao, Fuling, Mutong, Chenpi, Nuomi (Glutinous Rice), Houpo, Dafupi (Areca Peel) in equal proportions.
Administration: Grind into coarse powder. Decoct with fresh ginger and dates and take.
**Zicao Houpo Tang (Arnebia Magnolia Bark Decoction)** Treats smallpox-related stifling, fullness, hardness, urgency, or aggregation that does not disperse.
Ingredients: Zicaorong (Arnebia Flower Bud, 1.2 qian); Zhishi, Huangqin (Scutellaria Root), Huanglian (Coptis Rhizome), Houpo (each 1.1 qian); Lufengfang (Beehive), Baifuling (White Poria), Shandougen (Sophora Flavescens Root), Maidong (Ophiopogon Tuber), Taoren (Peach Kernel), Shigao (Gypsum Fibrosum), Xuanjinhua (Inula Flower) (each 2 qian); Chantui (Cicada Slough), Shengma (Cimicifuga Rhizome) (each 8 fen); Baizhu (5 fen).
Administration: Cut into pieces. Take 4-5 qian per dose, decoct in water, and take warm long after meals.
**Zicao Zhishi Tang (Arnebia Immature Bitter Orange Decoction)** Treats smallpox abdominal distension caused by heat-toxin or cold injury.
Ingredients: Zicaorong, Niuzibang (Burdock Fruit) (each 1.2 qian); Houpo, Kushen (Sophora Root) (each 1.1 qian); Baishaoyao (White Peony Root), Beimu (Fritillaria Bulb), Zhishi, Hezi (Chebulic Myrobalan), Roudoukou (Nutmeg) (each 1 qian); Chantui, Jiegeng, Baizhu (each 8 fen); Shengma (7 fen); Gancao (6 fen).
Administration: Cut into pieces. Take 4-5 qian per dose, decoct in water, and take warm long after meals.
**Tingli Muxiang San (Descurainia Aucklandia Powder)** Treats wheezing.
**Mutong Shaoyao Tang (Akebia Peony Decoction)** Treats smallpox-induced thirst, abdominal distension, and difficult urination.
Ingredients: Mutong, Shaoyao, Baizhu (each 5 fen); Chuanxiong, Chenpi, Gange (each 3 fen); Gancao (2 fen).
Administration: Decoct in water and take.
**Jiangfu Tang (Ginger and Aconite Decoction)** Treats rash where half has erupted and half has not, or where profuse eruption is followed by diarrhea, limb coldness, vomiting, abdominal distension, and belching. Urgently administer Lizhong Wan (Regulate the Middle Pill), Sini Tang (Reverse the Extremities Decoction), Jiangfu Tang, etc. There is no need to doubt their efficacy, as they have been tested. If spontaneous diarrhea accompanies abdominal distension, it is because heat-toxin is restrained by cold and cannot exit; severe cold causes diarrhea, while slight toxin exit causes distension. Administer Lizhong Wan, Sini Tang, Jiangfu Tang, etc. When the interior warms, diarrhea stops, heat-toxin re-emerges, distension resolves, and the rash erupts. If half the rash has erupted, or during profuse eruption, there is constipation, red astringent urine, coarse breathing, abdominal distension, dry lips and teeth, dry mouth with thirst seeking drink, and delirium, urgent purgation is required. This syndrome involves congested and stagnant toxic qi attempting to exit but failing, causing distension. Purging disperses heat-toxin, allows Ying and Wei to extend, resolves interior distension, and promotes external eruption. Combining warming and purging methods appropriately is essential and must be recorded. If pus and blood are discharged with abdominal distension, it is not this syndrome; Nanjin San (Southern Gold Powder), Ruxiang Zhuxue Gao (Frankincense Pig Blood Paste), Lizhong Wan, and Jiangfu Tang should be taken.