小儿腹痛体瘦。面色 白。目无精光。手足指寒。口中气冷。不思饮食。或呕利撮口。此脾
土虚而寒水所侮也。益黄散。或理中丸去参加茯苓。若口中气温。手足心热。面色黄白。目无精
光。或多睡恶食。或大便酸臭。此积痛也。消积丸。甚者。白饼子下之。后以白术散调补脾胃。
若腹胀而闷乱喘满者。白饼子。若不闷乱喘满者脾虚也。白术散调补之。误下而致目胞腮面四肢
浮肿。肚腹愈胀。脾虚欲发惊痫者。塌气丸温理之。若腹中有癖不食。饮乳则吐。按之则啼。当
暂用白饼子下之。盖小儿病此。良由乳食不消。伏于腹中。乍冷乍热。饮水过多。脾胃虚弱。不
能传化水谷。以致四肢羸瘦。肚腹渐大而成疳矣。六君子加干蟾。若痛连两胁。肝木乘脾也。四
君子加柴胡、芍药。若腹痛重坠。脾气下陷也。补中益气汤加枳实。若手足指冷。或呃逆泄泻。
寒水侮土也。六君子加炮姜、肉桂。不应。急加附子。若服克削之药。致腹作痛。按之痛止者。
脾气复伤也。五味异功散。至于腹胀喘满。亦皆脾虚邪乘所致。东垣所谓寒胀多而热胀少。热
者。六君子加芩、连、枳、朴。寒者。六君子加姜、桂、吴茱萸。亦有寒热错杂者。泻心汤。芩、
连、炮姜并用。若治实胀。用二陈加枳、朴、木香。有热。加芩。连可也。
小儿出现腹痛、身体消瘦，面色苍白，眼神缺乏神采，手足指尖发凉，口中呼出气息寒冷，不想进食，或者呕吐、腹泻、撮口（口唇收缩如撮状）。这是脾土虚弱，被寒水之气反侮所致。可用益黄散，或在理中丸中加入茯苓。如果口中气息温暖，手心发热，面色黄白相间，眼神无神，嗜睡且厌恶进食，或者大便气味酸臭，这是积滞引起的疼痛。可用消积丸；病情严重的，用白饼子攻下，之后用白术散调理补益脾胃。
如果腹部胀满且伴有烦闷扰乱、气喘胸满的症状，用白饼子；如果不烦闷扰乱、不气喘胸满的，属于脾虚，用白术散调理补益。若因误用攻下法导致眼睑、腮部及四肢浮肿，肚腹更加胀大，脾气虚弱即将引发惊痫的，用塌气丸温理治疗。如果腹中有癖块（积聚），不吃东西，喝奶就吐，按压腹部就啼哭，应当暂时使用白饼子攻下。大概小儿患此病，大多是因为乳食不消化，潜伏在腹中，忽冷忽热，饮水过多，脾胃虚弱，不能运化传导水谷，导致四肢瘦弱，肚腹逐渐变大而形成疳积。可用六君子汤加入干蟾。
如果疼痛牵连两胁，是肝木乘克脾土所致，用四君子汤加入柴胡、芍药。如果腹痛沉重下坠感明显，是脾气下陷所致，用补中益气汤加入枳实。如果手足指尖发冷，或者呃逆、泄泻，是寒水反侮脾土所致，用六君子汤加入炮姜、肉桂；若无效，紧急加入附子。如果服用克伐削弱的药物，导致腹部作痛，按压后疼痛停止的，是脾气再次受损，用五味异功散。至于腹胀气喘胸满，也都是脾虚邪气乘袭所致。李东垣所说寒胀多而热胀少。属热的，用六君子汤加入黄芩、黄连、枳实、厚朴；属寒的，用六君子汤加入干姜、肉桂、吴茱萸。也有寒热错杂的情况，用泻心汤，黄芩、黄连与炮姜并用。如果治疗实证胀满，用二陈汤加入枳实、厚朴、木香；如果有热象，加入黄芩、黄连即可。
Pediatric abdominal pain with emaciation, pale complexion, lack of luster in the eyes, coldness of the fingertips, cold breath from the mouth, anorexia, or vomiting and diarrhea, and mouth puckering (suo kou). This is due to deficiency-cold of Spleen Earth being invaded by Cold Water. Yi Huang San (Benefit Yellow Powder) may be used, or Lizhong Wan (Regulate the Middle Pill) with additional Poria (Fuling). If the breath is warm, palms are hot, complexion is yellowish-white, eyes lack luster, there is hypersomnia and food aversion, or stool has a sour odor, this is pain caused by food accumulation. Xiao Ji Wan (Eliminate Accumulation Pill) may be used; for severe cases, Bai Bing Zi (White Cake Pill) to purge, followed by Tuzhu San (Atractylodes Powder) to regulate and tonify the Spleen and Stomach.
If abdominal distension is accompanied by restlessness and chest fullness with panting, use Bai Bing Zi. If there is no restlessness or panting, it indicates Spleen deficiency, treated with Tuzhu San to regulate and tonify. If improper purging leads to edema of the eyelids, cheeks, and limbs, and increased abdominal distension, with Spleen Qi deficiency predisposing to convulsions and epilepsy, Ta Qi Wan (Collapse Qi Pill) should be used to warm and regulate. If there are masses (pi) in the abdomen, refusal to eat, vomiting after drinking milk, and crying upon palpation, temporarily use Bai Bing Zi to purge. Generally, pediatric disease arises from undigested milk and food lying dormant in the abdomen, alternating cold and heat, excessive water intake, and weak Spleen-Stomach failing to transform and transport water and grain, leading to emaciated limbs and gradually enlarging abdomen, resulting in Gan syndrome (infantile malnutrition). Liu Junzi Tang (Six Gentlemen Decoction) with dried Bufo (Gan Chan) may be used.
If pain radiates to both hypochondria, it is Liver Wood overacting on Spleen Earth; Si Junzi Tang (Four Gentlemen Decoction) with Bupleurum (Chai Hu) and Peony (Shaoyao) may be used. If abdominal pain feels heavy and bearing-down, it is sinking of Spleen Qi; Buzhong Yiqi Tang (Decoction to Supplement the Middle and Augment the Qi) with Immature Bitter Orange (Zhishi) may be used. If fingertips are cold, or there is hiccups and diarrhea, it is Cold Water invading Spleen Earth; Liu Junzi Tang with fried Ginger (Pao Jiang) and Cinnamon Bark (Rou Gui) may be used. If ineffective, add Aconite (Fuzi) urgently. If taking harsh draining medicines causes abdominal pain that ceases upon pressure, it indicates further injury to Spleen Qi; Wuwei Yigong San (Five-Ingredient Extraordinary Skill Powder) may be used. As for abdominal distension with panting and chest fullness, these are also caused by Spleen deficiency allowing pathogenic factors to invade. Li Dongyuan stated that cold distension is more common than heat distension. For heat type, Liu Junzi Tang with Scutellaria (Huang Qin), Phellodendron (Huang Lian), Immature Bitter Orange (Zhishi), and Magnolia Bark (Hou Po) may be used. For cold type, Liu Junzi Tang with Dried Ginger (Sheng Jiang), Cinnamon Bark (Rou Gui), and Evodia (Wu Zhu Yu) may be used. There are also mixed cold-heat patterns, treated with Xi Xin Tang (Heart-Purging Decoction), using Scutellaria, Phellodendron, and fried Ginger together. For treating excess distension, Er Chen Tang (Two-Cured Decoction) with Immature Bitter Orange, Magnolia Bark, and Costus Root (Muxiang) may be used; if heat is present, adding Scutellaria and Phellodendron is appropriate.