Abdominal pain in children refers to the pain occurring below the epigastrium,
around the umbilicus and above the pubis. Acute abdominal pain is not included
in this section, and the abdominal pain occurring in dysentery, intestinal
parasitosis and hernia will be discussed in the relevant sections later.
Etiology and Pathogenesis
Abdominal pain may be caused by cold, dyspepsia, asthenia-cold of the zang-fu
organs or stagnation of qi and blood. Its pathogenesis is the disturbance of
visceral functions, the dysfunction of meridians and the obstruction of qi and
Syndrome Differentiation and Therapeutic Principles
A. Syndrome differentiation
(a) The special manifestations of abdominal pain in infants and children: Sudden
and paroxysmal crying, restlessness, sweating, pallor, listlessness and lying
doubled over in pain.
(b) Differentiation of the involved organ: Pain in the upper abdomen indicates
the involvement of spleen, stomach and large or small intestine. Pain in the
middle of the lower abdomen suggests a disorder of the large intestine or
urinary bladder, while that occurring on both sides of the lower abdomen may be
attributed to a disorder of the liver meridian of Jueyin, appendicitis or
hernia. A periumbilical pain usually indicates a disorder of the large or small
(c) Differentiation of the character of pain: Abdominal pain caused by retention
of food, blood stasis, or parasitic infestation manifests itself as localized
pain, persistent abdominal distention and a visible mass, while that of cold,
heat or asthenic origin as wandering pain with occasional distension and without
visible mass. In general, the pain of asthenic type is marked by a prolonged
course and a dull character which is relievable by pressure and diet, and that
of sthenic type by a sudden onset, marked distension, adverseness of qi
tenderness and refusal of food intake.
B. Therapeutic principles
Regulating the activity of qi and relieving obstruction are the general
principles for this disorder. The therapies for warming meridians and expelling
cold, relieving dyspepsia, activating qi and blood circulation, warming
middle-jiao and tonifying asthenia-syndrome should be employed correspondingly.
Classification and Treatment
A. Cold in the middle-jiao
Manifestations: Sudden onset of abdominal colicky pain which can be relieved by
warmth and aggravated by cold, pale complexion, sweating, coldness of limbs,
cyanotic lips, desire for hot drink, clear urine, diarrhea, white and thin or
moist tongue coating and deep, tense or wiry pulse.
Therapeutic principles: Warm the middle-jiao, expel cold, and promote qi.
Prescription: The Modified Powder of Zhengqi Tianxiang
Radix Linderae 6 g
Remarks: For cases with severe abdominal pain, add Radix Aucklandiae (3 g) and
Fructus Amomi (3 g).
Fructus Perillae 6 g
Rhizoma Zingiberis 3 g
Rhizoma Perillae 6 g
Pericarpium Citri Reticulatae 6 g
B. Retention of food
Manifestations: Abdominal distention, pain and tenderness, halitosis, poor
appetite, eructation, acid regurgitation or vomiting, constipation or desire for
defecation upon abdominal pain which is relieved by discharge of foul stool
containing undigested food, restlessness during sleep, thick, greasy tongue
coating and wiry and smooth pulse.
Therapeutic principles: Relieve dyspepsia, promote circulation, and arrest pain.
Prescription: The Modified Pill of Aucklandiae and Arecae
Radix Aucklandiae 3 g
Semen Arecae 6 g
Pericarpium Citri Reticulatae Viride 6 g
Rhizoma Coptidis 3 g
Rhizoma Cyperi 6 g
Fructus Aurantii 6 g
Massa Fermentata Medicinalis (fried) 10 g
Fructus Hordei Germinatus (fried) 10 g
Fructus Grataegi (fried) 10 g
Remarks: Add Fructus Toosendan (10 g) and Rhizoma Corydalis (10 g) for cases
with severe pain, and add Rhizoma Pinelliae (6 g) for cases with vomiting.
C. Abdominal pain of asthenia-cold type
Manifestations: Dull pain relievable by pressure, warmth and food intake, pale
complexion, thin body physique, listlessness, coldness of limbs, poor appetite
or abdominal distention after eating, diarrhea, pale tongue with white coating
and thready and deep pulse
Therapeutic principles: Tonify middle-jiao with drugs of sweet taste and warm
nature, expel cold, and arrest pain.
Prescription: The Modified Decoction for Mildly Warming the Middle- Jiao
Ramulus Cinnamomi 6 g
Flos Chrysanthemi 15 g
Radix Glycyrrhizae Praeparata 3 g
Rhizoma Zing iberis Recens 3 pcs
Fructus Jujubae 3 pcs
Radix Codonopsis Pilosulae 10 g
Rhizoma Atractylodis Macrocephalae 10 g
Saccharum Granorum (mixed with decoction) 30 g
D. Abdominal pain caused by blood stasis
Manifestations: Localized stabbing pain and tenderness or a palpable fixed mass,
dull lips, dark purplish tongue with petechiae and thready and unsmooth or wiry
Therapeutic principles: Activate blood circulation, remove blood stasis, promote
qi circulation, and arrest pain.
Prescription: The Modified Decoction for Removing Blood Stasis in the Lower
Radix Angelicae Sinensis 10 g
Rhizoma Chuanxiong 3 g
Radix Paeoniae Rubra 6 g
Pollen Typhae 6 g
Faeces Trogopterori 5 g
Myrrha 3 g
Rhizoma Corydalis 10 g
Rhizoma Cyperi 6 g
Remarks: Add Fructus Toosendan (10 g) and Fructus Aurantii (6 g) for cases with
severe abdominal pain. Add Semen Persicae (6 g) and Flos Carthami (6 g) for
cases due to blood stasis after trauma.
A. Endothelium Corneum Gigeriae Galli (9 g) and Fructus Aurantii Immaturus (9
g) prepared as decoction; applicable to abdominal pain due to retention of food.
B. Equal amounts of Rhizoma Zingiberis, Flos Caryophylli and Pericarpium
Zanthoxyli; prepared as powder; taken 1 gram at a time; applicable to abdominal
pain of asthenia-cold type.
C. Take Sal (salt) or Fructus Evodiae (fried and heated and wrapped in a
piece of cloth); applied as a hot compress on the abdomen; applicable to cases
with cold in the abdomen.
Copyright 1995 Hopkins Technology