🌿 Folk Prescriptions

Abdominal pain is one of the most common symptoms in pediatric clinical practice. Any pain occurring below the xiphoid process, on either side of the umbilicus, or above the pubic bone is termed abdominal pain. One survey found that over one-third of children from early childhood to primary school graduation have experienced abdominal pain. Abdominal pain involves numerous diseases, many internal and surgical conditions can present with abdominal pain, which may be functional or organic. Here, we refer to recurrent abdominal pain localized around the umbilicus, excluding organic lesions. The condition is most common in ages 3–14, with a prevalence rate of 10%–20% among school-aged children. In TCM, this condition is known as "intestinal gas disease," "intestinal pain," or "winding intestinal gas." It is believed to arise from causes such as parasitic infection (e.g., roundworms), improper diet, cold stimulation, spleen and stomach weakness, qi stagnation and blood stasis, and liver qi invading the stomach. Based on different clinical presentations, it can be classified and treated as follows:
1. Worm Infestation Abdominal Pain: Commonly presents with intermittent pain around the umbilicus, sometimes vomiting worms, pain upon eating, and emaciation. Treatment focuses on killing parasites, guiding stagnation, and promoting bowel movements. Use Wu Mei Wan (Plum Pill) with modifications, decocted and taken orally.
2. Food Injury Abdominal Pain: Refers to abdominal pain caused by children consuming excessive oily or fried foods, damaging the spleen and stomach. Symptoms include chest and epigastric fullness, decreased appetite, belching with sour odor, abdominal distension and pain, halitosis, thick tongue coating. Infants may vomit undigested milk clumps or food, or show crying and irritability. Treatment aims to eliminate food stagnation and guide digestion. Use Bao He Wan (Preserve Harmony Pill) with modifications, or use Jiao San Xian (Fried Three Herbs).
3. Cold Constriction Abdominal Pain: Children with weak constitutions are prone to cold invasion when temperatures drop, causing cold congealing and qi stagnation leading to abdominal pain. Symptoms include paroxysmal pain, loose stools, clear urine, pale complexion, acid regurgitation, cold extremities, warmth relieving pain. Treatment should warm the center and dispel cold. Use Xiao Jian Zhong Tang (Minor Constructing Middle Decoction), or modify Wu Zhu Yu Tang (Evodia Decoction).
4. Cold Drink Abdominal Pain: Caused by children consuming excessive raw or cold foods, fruits, damaging the spleen and stomach. Most likely to occur after drinking cold beverages in summer. Presents with paroxysmal pain, commonly around the umbilicus, nausea, vomiting with sour smell and food residue, intestinal rumbling, diarrhea, with normal stool examination. Treatment should warm the center, dispel cold, move qi, and relieve pain. Use Si Ni Tang (Four Reversal Decoction) with modifications. When vomiting and diarrhea coexist, Huo Xiang Zheng Qi Water (Huo Xiang Correcting Qi Water) proves effective.
5. Spleen Deficiency Abdominal Pain: Refers to chronic abdominal pain due to inherent spleen and stomach weakness in children. Manifestations include frail constitution, weakness in limbs, shortness of breath, poor speech, undigested food in stool, or vomiting/diarrhea, and dull abdominal pain. Treatment should strengthen the spleen, tonify qi, harmonize the stomach, and resolve dampness. Use Shen Ling Bai Zhu San (Ginseng, Poria, and White Atractylodes Powder) with modifications.
6. Liver Qi Invading the Stomach Abdominal Pain: Symptoms include epigastric distension, severe pain around the umbilicus, intermittent pain, frequent sighing. Pain eases after passing gas, recurrent episodes triggered by emotional changes. Treatment should soothe the liver, regulate qi, harmonize the stomach, and relieve pain. Use Chai Hu Shu Gan San (Bupleurum Liver-Soothing Powder) with modifications.
7. Qi Stagnation and Blood Stasis Abdominal Pain: Symptoms include discomfort and distension around the umbilicus, painful and tender to touch, stabbing pain with fixed location (around the umbilicus), palpable mass that doesn’t shift, severe pain on pressure, dull complexion, dark red tongue or ecchymotic spots, fine or wiry pulse. Treatment should regulate qi, resolve stasis, dissipate masses, and relieve pain. Use Shao Fu Zhu Yu Tang (Lower Abdominal Stasis-Removing Decoction) with modifications. If qi stagnation is prominent, add Cha Chuan Lian Zi (Toosendan Fruit) and Wu Yao (Lindera Root) for qi regulation and pain relief. If a mass is present, cautiously add San Leng (Sparganium Rhizome), E Zhu (Curcuma Rhizome), and Chuan Shan Jia (Carp's Claw) to break up stasis and relieve pain.
In conclusion, the causes of pediatric abdominal pain are diverse. Careful differential diagnosis based on clinical presentation is essential. Alongside syndrome differentiation and medication, complementary therapies such as acupuncture, massage, and physiotherapy may be applied based on individual conditions. Additionally, preventive measures and daily care are important: maintain regular eating habits, avoid overeating or indulgence in raw, fried, or greasy foods; observe dietary hygiene—wash and cook vegetables thoroughly, peel and wash fruits, avoid raw water, and wash hands before meals and after defecation.