钱氏云∶热痛亦啼叫不止，夜发面赤唇焦，小便赤黄，与三黄丸（里热），人参汤下。
《婴孺》治小儿腹痛，夭纠不能哺乳。茯苓丸方
茯苓 黄连（各一两）
上为末，用蜜为丸，如大豆大。饮下，量加。
〔钱〕积痛，口中气温，面黄白，目无精光，或白睛多，及多睡畏食，或大便酸
臭者，当磨积，宜消积丸，甚者白饼子下之，后和胃，用白术散。（消积丸白饼子方见癖白术散方见消渴）
〔曾〕积痛，腹中阴阴而痛，面黄不食，儿大者口吐酸馊气，先治积滞，后调脾胃，其痛自止，仍辨
虚实和解，治法见后癖积条中。
汤氏三棱散 治积气肚痛。
砂仁 甘草 益智（炒，去壳） 三棱 蓬术 青皮（炒。各等分）
上为末。白汤点下。
丹溪云食积腹痛，必用紫苏、莱菔子之类。初虞世治小儿好吃粽，成肚痛，用黄连、白酒药等分为丸服。
虫痛面 白，心腹痛，口中沫及清水出，发痛有时。田氏云∶虫痛啼哭俯仰，坐卧不安，自按心腹，时时
大叫，面无正色，或青或黄，唇白，又目无精色，口吐涎沫，此为虫痛。钱氏云∶积痛、食痛、虚痛，大同小
异，惟虫痛者当口淡而沫自出，治之随其证用药。虫与痫相似，小儿本怯，故胃虚冷则虫动而心痛，与痫略相
似，但目不斜，手不搐也，安虫散主之。曾氏云∶蛔虫动痛，口吐清水涎沫，或吐出虫，痛不堪忍，其疾因食甘
肥荤腥太早而得，故胃寒虫动作痛，其虫吐来或生或死，儿小者，此痛苦甚，亦致危难，先以理中汤（吐泻）
加乌梅水煎服，使胃暖不逆，次芦荟丸（疳）、使君子丸、化虫饮主之。有儿大者，面 白而间黄色，肉食倍进，肌
体消瘦，腹中时复作痛，此有血鳖、蛔虫杂乎其间，以二圣丸下之。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。若以治虫，及伤胃气，固不可也。因寒而动者用理中汤加乌梅水煎服。因热而
动者用 咀五苓散，亦加乌梅水姜煎投。辛氏女子五岁，病虫痛。诸医以巴豆、干漆、 砂之属治之，不
效。至五日外，多哭而俯仰，睡卧不安，自按心腹，时大叫，面无正色，或青或黄，或白或黑，目无光而慢，唇
白吐沫，至六日，胸高而卧转不安。召钱至，钱详视之，用芜荑散三服，见目不除青色，大惊曰，此病大困，若
更加泻，则为逆矣。至次日，辛见钱曰夜来三更果泻，钱于泻盆中看，如药汁，以杖搅之，见有丸药，钱曰，此
子肌浓，当气实，今证反虚，不可治也。辛日何以然？钱曰脾虚胃冷则虫动，而今反目青，此肝乘脾，又
更加泻，知其气极虚也，而丸药随粪下，即脾胃已脱，兼形
病不相应，故知死病。后五日昏笃，七日而死。
钱氏安虫散 治小儿虫痛。
胡粉（炒黄） 鹤虱（炒黄） 川楝子（去皮核） 白矾（枯，二钱半）
上为细末。每服一字，大者五分，米饮调下。痛时服。
治虫动，痛极不可忍，用干漆半两，槟榔一枚生用，窑老一块再 细研，三件一处为末。空心热酒调，
良久取下虫，立愈，验。（窑老恐窑中 过泥物也。）
又方用干漆一两，捣碎，炒令烟尽出，用新汲水入生麻油，空心调下。
钱氏安虫丸 治上中二焦虚，或胃寒虫动，及痛。
干漆（炒烟尽，二分） 雄黄（一分） 巴豆霜（一钱）
上为细末，糊丸如黍米大。量儿大小服之，取东引石榴根煎汤下，或苦楝根，或芜荑汤下五七丸至
二三十丸，发时服。
芜荑散 主治同前。凡小儿痛时便高声啼叫，人中上鼻头唇口一时黑色，脉法当沉
弱而弦，今反脉大，是虫证也。
白芜荑 干漆（炒。各等分）
上为细末。每服一字或五分或一钱，米饮调下，发时服。
使君子丸 治腹内诸虫作痛，口吐清水。
使君肉（薄切，屋瓦焙干） 槟榔 酸石榴根皮（东向者佳，净洗，锉焙） 大黄（半生半炮。各七钱半）
上，除槟榔锉晒不过火，余三味再焙，同槟榔为末，沙糖水煮面糊丸，麻仁大。
每服三十丸至五十丸，淡猪肉汁空心下，或鸡肉汁亦好。
化虫饮 消化虫毒在腹作痛。
槟榔 酸石榴根皮（净洗，焙干。各一两） 红丹（ 过） 雷丸 贯众（如鸡头者佳） 使君子肉（薄切，
焙。各二钱半） 甘草（炙） 枳壳（去瓤，麸炒微黄） 大黄（各五钱）
上为细末。用清油煎鸡子一枚如春饼样，候冷，抄药末一钱于上，摊匀，空心卷而食之。儿小者，用糯
米粉水煮糊丸，粟谷大。每服十五粒至三十丸，以淡猪肉汁空心下，鸡肉汁亦好。
二圣丸 治腹内诸虫，及消谷逐水，下气去风。
槟榔（一两） 巴豆（十五粒、去壳膜心、大好者，存油）
上，槟榔锉晒为末，巴豆碎切，在乳钵内极细杵，仍入槟榔末同再杵匀，面糊
丸，绿豆大。每服七十七丸至九十九丸，用温茶清，五更初空心，止一投药，见虫下尽，进以稀粥自安。
钱乙说：热痛表现为啼哭不止，夜间发作时面色发红、嘴唇焦干，小便颜色深黄，可用三黄丸（治疗里热证）配合人参汤送服。
《婴孺书》记载治疗小儿腹痛，因疼痛剧烈导致无法哺乳的情况。茯苓丸方如下：
茯苓、黄连（各一两）。
将上述药材研为细末，用蜂蜜制成如大豆大小的丸剂。用温水送服，根据患儿情况酌情增减剂量。
钱乙认为：积滞引起的腹痛，口中气息温热，面色黄白相间，眼神无光彩，或者眼白部分较多，嗜睡且厌恶进食，或者大便气味酸臭的，应当消除积滞，适宜使用消积丸；病情严重的，用白饼子攻下，之后再调和胃气，使用白术散。（消积丸和白饼子的方剂见癖积篇，白术散的方剂见消渴篇）
曾世荣认为：积滞引起的腹痛，腹部隐隐作痛，面色发黄且不思饮食，年龄较大的儿童口中吐出酸腐气味。先治疗积滞，再调理脾胃，疼痛自然停止，同时需辨别虚实进行和解治疗，具体治法见后文癖积条中。
汤氏三棱散：治疗积气导致的肚痛。
砂仁、甘草、益智仁（炒制，去壳）、三棱、蓬术、青皮（炒制，各等分）。
将上述药材研为细末。用沸水冲服。
朱丹溪说：食积引起的腹痛，必须使用紫苏、莱菔子之类的药物。初虞世治疗小儿喜欢吃粽子导致肚子痛，使用黄连和白酒药等分制成丸剂服用。
虫痛表现为面色苍白，心腹疼痛，口中流出唾液及清水，疼痛发作有定时。田氏说：虫痛时患儿啼哭翻滚，坐卧不安，自己按压心腹部，不时大声呼叫，面色无常，或青或黄，嘴唇发白，而且眼神无光彩，口吐涎沫，这是虫痛。钱乙说：积痛、食痛、虚痛大同小异，只有虫痛的特点是口淡而口水自出，治疗时应根据症状用药。虫痛与痫证相似，小儿本身体质怯弱，所以胃虚寒则虫动引起心痛，与痫证略微相似，但眼睛不斜视，手脚不抽搐，主用安虫散治疗。曾氏说：蛔虫活动引起的疼痛，口吐清水涎沫，或者吐出虫子，疼痛难以忍受，这种病是因为过早食用甘甜、肥腻、荤腥食物所致，因此胃寒导致虫动而作痛，吐出的虫子或生或死，年幼的患儿痛苦甚重，甚至危及生命。先用理中汤（治疗呕吐腹泻）加乌梅水煎服，使胃暖而不逆乱，再用芦荟丸（治疗疳积）、使君子丸、化虫饮主治。年龄较大的患儿，面色苍白间杂黄色，肉食摄入量倍增，身体消瘦，腹部时常疼痛，这是因为体内有血鳖、蛔虫混杂其中，用二圣丸攻下。又有因胃受极寒或极热刺激，也会导致虫动，有时轻微疼痛，有时不痛，突然吐出虫子，治疗方法应当以安虫为主。如果用猛烈的方法杀虫，会损伤胃气，这是不可取的。因寒而动者用理中汤加乌梅水煎服。因热而动者用咀五苓散，也加乌梅、生姜水煎后服用。辛氏的女儿五岁时患虫痛。众医生用巴豆、干漆、硇砂等药物治疗，无效。到了第五天以后，患儿多哭且身体俯仰扭动，睡卧不安，自己按压心腹部，不时大叫，面色无常，或青或黄，或白或黑，眼神无光且迟缓，嘴唇发白吐沫，到了第六天，胸部高耸，躺卧更加不安。请钱乙诊治，钱乙仔细查看后，开具芜荑散，服用三剂后，发现患儿眼中青色未除，大惊说：“这病非常危重，如果再发生腹泻，就是逆证了。”到了第二天，辛氏对钱乙说：“昨晚三更果然发生了腹泻。”钱乙在泻盆中查看，粪便像药汁一样，用棍棒搅拌，看见有丸药，钱乙说：“这个孩子肌肉丰厚，应当是气实之体，现在证候反而虚弱，无法治愈了。”辛氏问：“为什么这样说？”钱乙说：“脾虚胃冷则虫动，而现在反而出现目青，这是肝木乘克脾土，再加上腹泻，可知其元气极度虚弱，而丸药随粪便排出，说明脾胃之气已脱失，兼形体与病证不相符合，所以知道是死症。”五天后病情昏迷加重，七天后死亡。
钱乙安虫散：治疗小儿虫痛。
胡粉（炒至黄色）、鹤虱（炒黄）、川楝子（去皮核）、白矾（枯矾，二钱半）。
将上述药材研为细末。每次服用“一字”量，年龄大者五分，用米汤调服。疼痛时服用。
治疗虫动，疼痛剧烈无法忍受，用干漆半两，槟榔一枚生用，窑老一块再次研磨成细末，将三味药一处混合研末。空腹时用热酒调服，过一段时间后虫子排出，立即痊愈，有效。（注：窑老恐怕是窑中烧过的泥物。）
又一方：用干漆一两，捣碎，炒至烟尽冒出，用新汲井水加入生麻油，空腹调服。
钱乙安虫丸：治疗上中二焦虚损，或胃寒虫动以及疼痛。
干漆（炒至烟尽，二分）、雄黄（一分）、巴豆霜（一钱）。
将上述药材研为细末，用糊制成如黍米大小的丸剂。根据患儿大小给药，用东引石榴根煎汤送服，或用苦楝根汤，或用芜荑汤送服五七丸至二三十丸，疼痛发作时服用。
芜荑散：主治同前。凡是小儿腹痛时便高声啼叫，人中、鼻头、嘴唇一时变黑，脉法应当沉弱而弦，现在反而脉大，这是虫证的表现。
白芜荑、干漆（炒制，各等分）。
将上述药材研为细末。每次服用“一字”或五分或一钱，用米汤调服，疼痛发作时服用。
使君子丸：治疗腹内各种寄生虫作痛，口吐清水。
使君子肉（薄切，在屋瓦上焙干）、槟榔、酸石榴根皮（向东生长的为佳，洗净，锉碎焙干）、大黄（一半生用，一半炮制，各七钱半）。
以上药材，除了槟榔锉碎晾晒不过火外，其余三味药再次焙干，与槟榔一起研为细末，用沙糖水煮面糊制成丸剂，大小如麻仁。
每次服用三十丸至五十丸，空腹时用淡猪肉汁送服，或用鸡肉汁送服也可以。
化虫饮：消化腹中的虫毒引起的疼痛。
槟榔、酸石榴根皮（洗净，焙干，各一两）、红丹（煅过）、雷丸、贯众（如鸡头状者佳）、使君子肉（薄切，焙干，各二钱半）、甘草（炙制）、枳壳（去瓤，麸炒微黄）、大黄（各五钱）。
将上述药材研为细末。用清油煎一个鸡蛋如春饼样，待冷却后，取药末一钱放在上面，摊匀，空腹卷起来吃。幼儿小的，用糯米粉水煮成糊丸，大小如粟谷。每次服用十五粒至三十丸，空腹时用淡猪肉汁送服，或用鸡肉汁送服也可以。
二圣丸：治疗腹内各种寄生虫，以及消谷逐水，下气祛风。
槟榔（一两）、巴豆（十五粒，去壳膜心，选大的，保留油脂）。
以上药材，将槟榔锉碎晾晒研为细末，巴豆切碎，在乳钵内极细研磨，仍加入槟榔末一同再研磨均匀，用面糊制成丸剂，大小如绿豆。每次服用七十七丸至九十九丸，用温茶清，在五更初空腹时，只投一次药，见到虫子排尽后，进稀粥以安养身体。
Qian Yi stated: Heat pain is characterized by incessant crying, with red face and scorched lips during nocturnal attacks, and dark yellow urine. It should be treated with Sanhuang Wan (Three-Yellow Pill for Interior Heat) administered with Ginseng Decoction.
The *Yingru Shu* records the treatment for pediatric abdominal pain where the infant cannot breastfeed due to severe pain. The formula for Poria Pill is as follows:
Poria (*Fuling*), Coptis Rhizome (*Huanglian*) (each 1 liang).
Grind the above herbs into fine powder, form pills the size of soybeans using honey. Administer with warm water, adjusting the dose according to the child's condition.
Qian Yi noted: Accumulation pain presents with warm breath, a sallow-white complexion, dull eyes, or excessive whites in the eyes, lethargy, anorexia, or sour-smelling stools. One should eliminate accumulation; Xiaojie Wan (Accumulation-Resolving Pill) is appropriate. For severe cases, Baixing Zi (White Cake Pill) should be used to purge, followed by harmonizing the stomach with Baizhu San (Atractylodes Macrocephala Powder). (Formulas for Xiaojie Wan and Baixing Zi are found in the *Pi Ji* section; the formula for Baizhu San is found in the *Xiao Ke* section.)
Zeng Shirong stated: Accumulation pain manifests as aching in the abdomen, sallow complexion, and anorexia. Older children may exhale a sour, rancid odor. First treat the accumulation, then regulate the spleen and stomach, after which the pain will cease. Differentiate between deficiency and excess for harmonizing treatment; see the *Pi Ji* section below for methods.
Tang's Sanleng San: Treats abdominal pain caused by qi stagnation from accumulation.
Amomum Fruit (*Sharen*), Licorice Root (*Gancao*), Alpinia Oxyphylla Fruit (*Yizhi*), Burreed Tuber (*Sanleng*), Curcuma Wenyujin Rhizome (*Pengzhu*), Green Tangerine Peel (*Qingpi*) (stir-fried, equal parts).
Grind into fine powder. Take with boiling water.
Zhu Danxi stated: Abdominal pain due to food accumulation requires herbs such as Perilla Leaf (*Zisu*) and Radish Seed (*Laifuzi*). Chu Yushi treated a child who developed abdominal pain from eating zongzi by administering pills made of equal parts Coptis Rhizome (*Huanglian*) and Fermented Rice Wine Medicament (*Jiubi Yao*).
Worm pain presents with a pale face, epigastric and abdominal pain, salivation and clear fluid discharge, and periodic pain attacks. Tian Shi stated: Worm pain causes crying, rolling, restlessness, self-palpation of the heart and abdomen, frequent loud cries, variable facial color (blue, yellow), white lips, dull eyes, and spitting of saliva. This is worm pain. Qian Yi stated: Accumulation pain, food pain, and deficiency pain are largely similar, but worm pain is distinguished by a bland taste and spontaneous salivation. Treatment should follow the symptoms. Worm pain resembles epilepsy; because children are inherently timid, cold deficiency in the stomach causes worms to move and induce heart pain, resembling epilepsy slightly, but without eye deviation or hand convulsions. An Chong San (Worm-Anchoring Powder) is the primary prescription. Zeng Shi stated: Pinworm movement pain involves spitting clear fluid and saliva, or expelling worms, with unbearable pain. This disease results from consuming sweet, fatty, and meaty foods too early, causing stomach cold and worm movement. Expelled worms may be alive or dead. In young infants, this suffering is severe and life-threatening. First administer Lizhong Tang (Regulate the Middle Decoction for vomiting and diarrhea) with Smoked Plum (*Wumei*) water decoction to warm the stomach and prevent rebellion. Subsequently, use Lushui Wan (Rhubarb Pill for Infantile Malnutrition), Shijunzi Wan (Quince Seed Pill), or Huachong Yin (Worm-Dissolving Drink). In older children, a pale face mixed with yellow, increased meat consumption, emaciation, and intermittent abdominal pain indicate the presence of blood flukes and pinworms. Ersheng Wan (Two-Sage Pill) should be used to purge them. Additionally, extreme cold or heat in the stomach can cause worm movement, resulting in mild or no pain, followed by sudden expulsion of worms. The method should prioritize anchoring worms. Using harsh vermifuges damages stomach qi and is inadvisable. For movement due to cold, use Lizhong Tang with Smoked Plum water decoction. For movement due to heat, use Jiaowu Ling San (Modified Wu Ling Powder) with Smoked Plum and ginger water decoction.
Case of Ms. Xin’s daughter: At five years old, she suffered from worm pain. Various physicians treated her with Croton Seed (*Badou*), Resina Drymopteridis (*Ganqi*), and Natrii Sulfas (*Naoshan*) without effect. By the fifth day, she cried frequently, rolled her body, slept restlessly, pressed her heart and abdomen, cried loudly intermittently, had variable facial colors (blue, yellow, white, black), dull and slow eyes, white lips, and spittle. On the sixth day, her chest was distended upward, and lying down caused greater unrest. Qian Yi was summoned. After careful examination, he prescribed Wuyi San (Meliosma Powder) for three doses. Seeing that the blue hue in her eyes remained, he exclaimed in alarm, "This illness is critical. If diarrhea occurs, it will be a reversal sign." The next day, Ms. Xin reported, "At the third watch last night, she indeed had diarrhea." Qian Yi examined the basin, noting the stool resembled medicinal juice. Stirring it with a stick revealed pill fragments. Qian Yi said, "This child has thick flesh and should have robust qi, yet the syndrome indicates deficiency. It is incurable." Ms. Xin asked why. Qian Yi replied, "Spleen deficiency and stomach cold cause worm movement. The current blue eyes indicate Liver wood overacting on Spleen earth. Combined with diarrhea, her qi is extremely depleted. The passage of pills with feces indicates the collapse of Stomach and Spleen qi. Since the physical state does not match the pathology, I know this is a fatal case." Five days later, she became comatose and died on the seventh day.
Qian Yi's An Chong San: Treats pediatric worm pain.
Lead White (*Hufen*) (stir-fried until yellow), Chrysanthemum Seed (*Heshi*) (stir-fried until yellow), Toosendan Fruit (*Chuanlianzi*) (peeled and seeded), Alum (*Baifan*) (calcined, 2 qian 5 fen).
Grind into fine powder. Each dose is one "zi" (approx. 0.3g); for older children, 5 fen. Mix with rice drink and take. Administer during pain.
For severe pain due to worm movement, use 0.5 liang of Resina Drymopteridis (*Ganqi*), one raw Areca Nut (*Binglang*), and one piece of Yaolao (kiln mud residue), ground finely together. Mix into powder. Take with hot wine on an empty stomach. After some time, worms will be expelled, and recovery will be immediate. (Note: Yaolao is likely kiln-burnt mud.)
Another formula: Use 1 liang of Resina Drymopteridis (*Ganqi*), crushed and stir-fried until smoke ceases. Mix with fresh well water and raw Sesame Oil (*Mahu You*). Take on an empty stomach.
Qian Yi's An Chong Wan: Treats deficiency in the Upper and Middle Jiao, or stomach cold causing worm movement and pain.
Resina Drymopteridis (*Ganqi*) (stir-fried until smoke ceases, 2 fen), Realgar (*Xionghuang*) (1 fen), Croton Seed Frost (*Badoushuang*) (1 qian).
Grind into fine powder, make pills the size of millet seeds using paste. Dose according to age. Take with decoction of pomegranate root from an east-facing tree, or Sophora Root (*Kulian Gen*), or Meliosma Decoction. Take 5-7 pills up to 20-30 pills during pain attacks.
Wuyi San: Indications same as above. Whenever a child cries loudly during pain, and the philtrum, nose tip, and lips turn black, the pulse should be deep, weak, and wiry. If the pulse is large instead, it indicates worm syndrome.
White Meliosma Fruit (*Bai Wuyi*), Resina Drymopteridis (*Ganqi*) (stir-fried, equal parts).
Grind into fine powder. Each dose is one "zi", 5 fen, or 1 qian. Mix with rice drink. Take during pain attacks.
Shijunzi Wan: Treats abdominal pain caused by various internal parasites and spitting of clear fluid.
Quinoa Seed Meat (*Shijunrou*) (thinly sliced, baked on roof tiles), Areca Nut (*Binglang*), Acid Pomegranate Root Bark (*Suan Shiliu Genpi*) (preferably from east-facing trees, washed clean, cut, and baked), Rhubarb (*Dahuang*) (half raw, half processed, each 7 qian 5 fen).
Prepare all except Areca Nut (cut and sun-dried without burning). Bake the other three ingredients again, grind together with Areca Nut into powder. Make pills using sugar-water wheat paste, size of hemp seeds.
Take 30-50 pills on an empty stomach with lean pork broth. Chicken broth is also acceptable.
Huachong Yin: Dissolves worm toxins causing abdominal pain.
Areca Nut (*Binglang*), Acid Pomegranate Root Bark (*Suan Shiliu Genpi*) (washed clean, dried, each 1 liang), Red Lead (*Hongdan*) (calcined), Polyporus Umbellatus (*Leiwuan*), Millettia Speciosa Root (*Guanzhong*) (chicken-head shape preferred), Quinoa Seed Meat (*Shijunrou*) (thinly sliced, baked, each 2 qian 5 fen), Licorice Root (*Gancao*) (honey-fried), Aurantium Fructus (*Zhike*) (pith removed, bran-fried until light yellow), Rhubarb (*Dahuang*) (each 5 qian).
Grind into fine powder. Fry one egg in clear oil like a crepe. When cool, place 1 qian of powder on top, spread evenly, and roll up. Eat on an empty stomach. For small children, make pills with glutinous rice flour paste, size of millet grains. Take 15-30 pills on an empty stomach with lean pork broth. Chicken broth is also acceptable.
Ersheng Wan: Treats various internal parasites, promotes digestion and water metabolism, directs qi downward, and dispels wind.
Areca Nut (*Binglang*) (1 liang), Croton Seed (*Badou*) (15 seeds, peeled, de-seeded, select large ones retaining oil).
Cut Areca Nut, sun-dry, and grind into powder. Crush Croton Seed finely in a mortar, mix with Areca Nut powder, and grind uniformly. Make pills with wheat paste, size of mung beans. Take 77-99 pills with warm tea water at dawn on an empty stomach. A single dose is sufficient. Once worms are fully expelled, consume thin congee to restore health.