经云∶肺朝百脉之气，肝统诸经之血。又云∶气主 之，血主濡之。盖荣血为水谷之精气，
灌溉五脏六腑、四肢百骸。若脾胃有伤，荣卫虚弱，行失常道，故上为衄血、吐血，下为尿
血、便血。若外感风邪则血鲜，为肠风。内伤则血浊，为脏毒。又热入大肠，则大便下血。
热入小肠，则小便出血。然小儿多因胎中受热，或乳母六淫七情浓味积热，或儿自食甘肥积
热、六淫外侵而成。若因母食浓味者，加味清胃散。怒动肝火者，加味小柴胡汤。忧思郁怒
者，加味归脾汤。禀父肾燥者，六味地黄丸。儿有积热，小便出血者，实热用清心莲子饮，
虚热用六味地黄丸。大便出血者，犀角地黄汤。风邪外侵者，仓廪散。病后元气下陷者，补
中益气汤。
粪前见血者，四君加黄连制吴茱萸。粪后见血者，四君加吴茱萸制黄连。若婴儿以治母为主
。余当临症制宜。
治验
一小儿七岁，食菱、芡过多，腹胀发热，大便不通，小便下血，先用消积丸，大便即通，小
便血止，又用保和丸及异功散而愈。
一小儿因乳母饮酒，小便出血，用八正散去大黄加干葛、山栀、漏芦，母子服之并愈。
一小儿小便见血，或咳血、衄血，此脾肺虚热，食后用圣济犀角地黄汤，食前用六味地黄丸
顿愈。后因食浓味，用清胃散及六味地黄丸而愈。
一小儿禀父气不足，不时便血，用六味地黄丸、补中益气汤而愈。后因母饮酒炙 ，复致前
症，母服加味清胃散，子服六味地黄丸而愈。
一小儿便血，手足发热，齿龈溃臭，朝用六味地黄丸，暮用异功散加芜荑，月余渐愈，乃佐
以补中益气汤而愈。
一小儿禀父肾虚，便血作渴，足热形瘦，用六味丸寻愈。后出痘第四日，两足发热，作渴饮
冷，以前丸料煎与恣饮，三剂后足凉渴止，其痘安然而靥。
一小儿便血，面青胁痛，小便频数，此肝木侮脾土而不能统摄也，用异功散加柴胡、炒黑龙
胆草，二剂肝症顿退；仍用异功散而血止。
一小儿便血发热，作渴饮冷，用黄连解毒汤一剂热服，诸症顿愈。后因饮食过伤，下血甚多
，发热倦怠，饮食少思，先用补中益气汤，元气复而饮食增，又用四君加升麻而愈。
一小儿便血，作渴少食，先用七味白术散，渴止食进，又用补中益气汤而瘥。后食生冷，腹
胀便秘，用保和丸，二便下血，或时发搐，此脾气伤而肝火动也，用异功散加钩藤钩、柴胡而搐止，
又加升麻、木香而血止。
一小儿食生冷果品，腹胀作痛，大便不利，小便尿血，用茯苓散加黄连，二剂大便通而尿血
愈。
一小儿尿血，两足发热，用六味地黄丸而愈。后患痢久不愈，复尿血，作渴饮冷，以前丸料
煎服，兼用补中益气汤而痊。
一小儿尿血，面青胁痛，小便频数，用五味异功散加柴胡、炒黑龙胆草，次用地黄丸而愈。
一小儿久患便血，属脾胃虚热也，诸药不应，用人参二两、炒黑黄连、吴茱萸各半两为末，
米糊作丸，佐以补中益气汤顿痊。
一小儿便血，面黄腹胀，用四味肥儿丸，及补中益气汤加吴茱萸制黄连、木香、芜荑，三十
余剂而愈。至夏间患血痢，发热晡热，手足浮肿，仍用前药而痊。
一小儿八岁，腹胀脐凸，大便下血如痢，小便色赤似血，面目皆黄，两腮色赤，此食积所伤
，而肝侮之也，盖脾病则肺虚不能生肾，故有是症，当先消导积滞，遂用越鞠丸加三棱、蓬
术、姜汤下四服，二便通利；又用大安丸二服，下血亦止。后复伤食，发热腹胀，小便下血
，服保和丸四服而愈。
一小儿十一岁，因劳发热尿血，小便不利，先用清心莲子饮二剂，后用补中益气汤加山栀而
痊。
一小儿便血，服寒凉药过多，腹胀小便不利，其血益甚，余朝用补中益气汤，夕用金匮加减
肾气丸而痊。
甘露饮 治小儿胃中客热，齿龈溃烂，时出脓血，及目赤肿痛，口疮喉肿，或身面皆黄，大
便不调，小便黄涩。
熟地黄 麦门冬（去心，焙） 枳壳（炒） 茵陈 甘草（炙） 枇杷叶 石斛 黄芩（炒） 生地黄 天门
冬（去心炒。各等分）
上为末，每服二钱，水煎服。
聚金丸 治大便下血，发热烦躁，腹中热痛，作渴妄言，舌涩目昏，其脉弦数。
黄连（一两水侵晒干，一两炒，一两灰火煨，一两生用） 黄芩 防风（各一两）
上为末，每服二钱，水煎服。
愚按∶前方若肝脾积热，吐血衄血便血，发热作渴，大便秘，小便赤者，宜用之。若热已退
，而作渴下血未止，或日晡益甚者，阴血虚也，用四物、参、术主之。若热既退，饮食少思
，肢体倦怠，脾气虚也，用四君子、当归主之。若概用前方，则误多矣。
济生犀角地黄汤 治伤寒温病失于表汗，致内有瘀血吐血，面色黄，大便黑，及疮痘出，多
以此解之。
犀角 牡丹皮（各一两） 生地黄（八钱） 赤芍药（七钱）
上每服二钱，水煎服。
千金地黄丸 治小肠积热，脏毒去血。
黄连（四两） 生地黄（半斤，捣取汁连滓拌匀晒干）
上为末，炼蜜丸桐子大。每服一二十丸，食后麦门冬汤下，量儿加减。
制黄连吴茱萸法
上以黄连、吴茱萸各等分，熟水拌湿入瓷器内，炖汤中良久，俟气味相和取出晒干，炒黄，
各拣出听用。
清心莲子饮（方见白浊）
小柴胡汤（方见痉症）
加味归脾汤
越鞠丸
四君子汤
清胃散
异功散（五方见内钓）
补中益气汤
保和丸
大安丸（三方见虚羸，即保和丸加白术）
加减肾气丸（方见腹胀）
八正散（方见小便不通）
六味丸（方见肾脏）
茯苓散（方见尿白）
下积丸
白术散（二方见积痛）
四味肥儿丸（方见寒吐）
According to the classics: The Lung organ gathers the Qi of all meridians, and the Liver controls the Blood of all meridians. It is also said: Qi primarily promotes blood circulation, while Blood primarily nourishes the body tissues. Ying Blood (Nutritive Blood) is the essence derived from food and water, responsible for irrigating the Zang-Fu organs and the limbs and bones. If the Spleen and Stomach are damaged, leading to weakness of Ying and Wei (Defensive) Qi, and blood circulation loses its normal course, it may manifest upward as epistaxis or hematemesis, and downward as hematuria or hematochezia. If caused by external Wind pathogen, the blood is bright red, termed Chang Feng (Intestinal Wind). If caused by internal injury, the blood is turbid, termed Zang Du (Visceral Toxin). Furthermore, Heat entering the Large Intestine causes blood in the stool; Heat entering the Small Intestine causes blood in the urine. However, children often suffer from this due to heat accumulated in the womb, or because the nursing mother has accumulated heat from Six Excesses (Wind, Cold, Summerheat, Dampness, Dryness, Fire), Seven Emotions (Joy, Anger, Worry, Pensiveness, Sadness, Fear, Fright), or rich flavors, or because the child themselves consumes sweet and fatty foods causing accumulated heat, or suffers from invasion by Six Excesses externally. If caused by the mother consuming rich flavors, use Jiawei Qingwei San (Modified Stomach-Clearing Powder). If caused by anger stirring up Liver Fire, use Jiawei Xiaochaihu Tang (Modified Minor Bupleurum Decoction). If caused by sorrow, pensiveness, depression, and anger, use Jiawei Guipi Tang (Modified Spleen-Restoring Decoction). If due to inheriting insufficient Kidney Yin from the father, use Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill). For children with accumulated heat and hematuria, use Qingxin Lianzi Yin (Heart-Clearing Lotus Seed Decoction) for Excess Heat, and Liuwei Dihuang Wan for Deficiency Heat. For hematochezia, use Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction). For external Wind pathogen invasion, use Canglin San (Granary Dispelling Powder). For post-illness sinking of Yuan Qi (Primal Qi), use Buzhong Yiqi Tang (Middle-Warming and Qi-Supplementing Decoction).
If blood appears before defecation, use Sijunzi Tang (Four Gentlemen Decoction) added with Huanglian (Coptis Rhizome) processed with Wuzhuyu (Evodia Fruit). If blood appears after defecation, use Sijunzi Tang added with Wuzhuyu processed with Huanglian. If the patient is an infant, treatment should focus on regulating the nursing mother. Other cases should be managed flexibly according to clinical presentation.
Clinical Cases:
A seven-year-old child consumed too many water chestnuts and Chinese lotus seeds, resulting in abdominal distension, fever, constipation, and hematuria. First, Xiaoji Wan (Accumulation-Dissolving Pill) was administered; upon passage of stool, hematuria ceased. Subsequently, Baohe Wan (Harmonize the Stomach Pill) and Yigong San (Extraordinary Efficacy Powder) were used, leading to recovery.
A child developed hematuria because the nursing mother drank alcohol. Bazheng San (Eight Upright Powder) without Dahuang (Rhubarb Root), plus Gan Ge (Kudzu Root), Shanzhi (Gardenia Fruit), and Loulu (Leuzea Rhizome) were prescribed for both mother and child, resulting in recovery.
A child presented with hematuria, occasional hemoptysis, and epistaxis, attributed to Deficient Heat of the Spleen and Lung. Shengji Xijiao Dihuang Tang (Shengji Rhino Horn and Rehmannia Decoction) was taken after meals, and Liuwei Dihuang Wan before meals, leading to immediate recovery. Later, due to consumption of rich flavors, the condition recurred; Qingwei San and Liuwei Dihuang Wan were used for recovery.
A child inherited insufficient Kidney Qi from the father, suffering from intermittent hematochezia. Liuwei Dihuang Wan and Buzhong Yiqi Tang were used for recovery. Later, due to the mother drinking alcohol and eating roasted foods, the previous symptoms returned. The mother took Jiawei Qingwei San, and the child took Liuwei Dihuang Wan, leading to recovery.
A child with hematochezia had hot hands and feet, and foul-smelling, ulcerated gums. Liuwei Dihuang Wan was taken in the morning, and Yigong San added with Wuyi (Melia Azedarach Fruit) in the evening. After more than a month, gradual improvement occurred, followed by supplementation with Buzhong Yiqi Tang for full recovery.
A child inherited Kidney Deficiency from the father, presenting with hematochezia, thirst, hot feet, and emaciation. Liuwei Dihuang Wan was used, leading to quick recovery. On the fourth day of smallpox eruption, the child had hot feet and thirst for cold drinks. The previously mentioned pill ingredients were decocted and allowed to drink freely. After three doses, foot temperature normalized, thirst ceased, and the smallpox resolved safely.
A child with hematochezia had a blueish complexion, hypochondriac pain, and frequent urination. This indicated Liver Wood overacting on Spleen Earth, failing to control blood. Yigong San added with Chaihu (Bupleurum Root) and Chaohei Longdancao (Charred Gentian Root) was used; Liver symptoms subsided after two doses. Yigong San alone was then used to stop bleeding.
A child with hematochezia and fever had thirst for cold drinks. Huanglian Jiedu Tang (Coptis Detoxification Decoction) was taken hot in one dose, resolving all symptoms. Later, due to dietary excess, severe bleeding occurred with fever, fatigue, and poor appetite. Buzhong Yiqi Tang was used first; after Yuan Qi recovered and appetite increased, Sijunzi Tang added with Shengma (Cimicifuga Rhizome) was used for recovery.
A child with hematochezia had thirst and poor appetite. Qiwei Baizhu San (Seven-Ingredient Atractylodes Macrocephala Powder) was used first; upon cessation of thirst and improvement in appetite, Buzhong Yiqi Tang was used for recovery. Later, consumption of raw/cold foods caused abdominal distension and constipation. Baohe Wan was used, leading to bleeding in both stools and urine, and occasional convulsions. This indicated Spleen Qi damage stirring Liver Fire. Yigong San added with Goutenggou (Uncaria Rhynchophylla) and Chaihu stopped convulsions; adding Shengma and Muxiang (Costus Root) stopped bleeding.
A child who ate raw/cold fruits had abdominal distension and pain, difficult defecation, and hematuria. Fuling San (Poria Powder) added with Huanglian was used; after two doses, defecation normalized and hematuria resolved.
A child with hematuria had hot feet. Liuwei Dihuang Wan was used for recovery. Later, chronic dysentery recurred with hematuria, thirst for cold drinks. The previous pill ingredients were decocted and taken, combined with Buzhong Yiqi Tang, leading to cure.
A child with hematuria had a blueish complexion, hypochondriac pain, and frequent urination. Wuwei Yigong San (Five-Ingredient Extraordinary Efficacy Powder) added with Chaihu and Charred Longdancao was used, followed by Dihuang Wan (Rehmannia Pill) for recovery.
A child suffered from chronic hematochezia due to Deficient Heat of Spleen and Stomach, unresponsive to various medicines. Ren Shen (Ginseng Root) 2 liang, Chaohei Huanglian (Charred Coptis Rhizome) and Wuzhuyu (Evodia Fruit) 0.5 liang each were powdered, formed into pills with rice paste, and supplemented with Buzhong Yiqi Tang for immediate cure.
A child with hematochezia had a yellow face and abdominal distension. Siwei Feier Wan (Four-Ingredient Child-Nourishing Pill) and Buzhong Yiqi Tang added with Wuzhuyu-processed Huanglian, Muxiang, and Wuyi were used for over thirty doses, leading to recovery. In summer, bloody dysentery occurred with fever (worse in late afternoon) and swollen extremities; the previous medicine cured it.
An eight-year-old child had abdominal distension with protruding umbilicus, bloody stool resembling dysentery, dark red urine, jaundice, and red cheeks. This was caused by food accumulation affecting the Liver's overaction on the Spleen. Since Spleen disease leads to Lung deficiency failing to generate Kidney, these symptoms arose. First, accumulation was cleared using Yueju Wan (Resolve Frustration Pill) added with Sanleng (Sparganium Rhizome) and Pengzhu (Curcuma Rhizome), taken four times with Ginger Decoction, resulting in free passage of urine and stool. Then, Da'an Wan (Great Peace Pill) was taken twice, stopping bleeding. Later, recurrent food injury caused fever, distension, and hematuria; Baohe Wan taken four times led to recovery.
An eleven-year-old child had fever and hematuria due to labor, with difficult urination. Qingxin Lianzi Yin was used for two doses, followed by Buzhong Yiqi Tang added with Shanzhi for cure.
A child with hematochezia took too many cold-natured medicines, resulting in abdominal distension, difficult urination, and worsened bleeding. I prescribed Buzhong Yiqi Tang in the morning and Jingui Jiashen Qiwang Wan (Jingui Modified Kidney-Qi Pill) in the evening, leading to recovery.
Ganlu Yin (Sweet Dew Decoction) treats Guest Heat in the Stomach of children, causing gum ulceration, pus and blood discharge, red and swollen painful eyes, mouth sores, throat swelling, generalized jaundice, irregular bowel movements, and yellow, scanty, difficult urination.
Shu Dihuang (Prepared Rehmannia Root), Maidong (Ophiopogon Tuber, heart removed, baked), Zhike (Bitter Orange Fruit, stir-fried), Yinchen (Artemisia Capillaris Herb), Gancao (Licorice Root, honey-fried), Pipaye (Loquat Leaf), Shihu (Dendrobium Stem), Huangqin (Scutellaria Root, stir-fried), Sheng Dihuang (Raw Rehmannia Root), Tiandong (Asparagus Tuber, heart removed, stir-fried). All in equal parts.
Powdered above. Take 2 qian per dose, decoct in water and drink.
Ju Jin Wan (Gathering Metal Pill) treats hematochezia, fever, irritability, hot pain in the abdomen, thirst, delirious speech, dry tongue, blurred vision, and wiry-rapid pulse.
Huanglian (Coptis Rhizome): 1 liang soaked in water and dried, 1 liang stir-fried, 1 liang baked in ash fire, 1 liang raw. Huangqin (Scutellaria Root) 1 liang. Fangfeng (Saposhnikovia Root) 1 liang.
Powdered above. Take 2 qian per dose, decoct in water and drink.
My Commentary: The aforementioned formulas (such as Ju Jin Wan) are suitable for Liver and Spleen Accumulated Heat presenting with hematemesis, epistaxis, hematochezia, fever, thirst, constipation, and red urine. If Heat has subsided but thirst and bleeding persist, or worsen in the late afternoon, it indicates Yin Blood Deficiency; treat primarily with Siwu Tang (Four Substances Decoction), Renshen (Ginseng), and Baizhu (Atractylodes Macrocephala). If Heat has subsided, appetite is poor, and limbs are fatigued, it indicates Spleen Qi Deficiency; treat primarily with Sijunzi Tang (Four Gentlemen Decoction) and Danggui (Angelica Sinensis). Using the aforementioned formulas indiscriminately would lead to many errors.
Jisheng Xijiao Dihuang Tang (Jisheng Rhino Horn and Rehmannia Decoction) treats Shanghan (Cold Damage) and Wenbing (Warm Diseases) where failure to induce sweating leads to internal Blood stasis, hematemesis, yellow complexion, black stool, and eruptive diseases like sores and smallpox. It is often used to resolve these conditions.
Xijiao (Rhino Horn - *Note: Substitute with Water Buffalo Horn in modern practice*), Mudanpi (Moutan Bark, 1 liang each), Sheng Dihuang (Raw Rehmannia Root, 8 qian), Chi Shaoyao (Red Peony Root, 7 qian).
Take 2 qian per dose, decoct in water and drink.
Qianjin Dihuang Wan (Thousand Gold Rehmannia Pill) treats Small Intestine Accumulated Heat and Zang Du (Visceral Toxin) causing blood loss.
Huanglian (Coptis Rhizome, 4 liang), Sheng Dihuang (Raw Rehmannia Root, half jin, crushed to extract juice, mixed with dregs, blended and dried).
Powdered above, formed into pills the size of tung tree seeds with refined honey. Take 10-20 pills per dose after meals, washed down with Maidong Tang (Ophiopogon Decoction), adjusting dosage according to the child's age.
Method for Processing Huanglian with Wuzhuyu:
Mix equal parts of Huanglian and Wuzhuyu with warm water until moist. Place in a porcelain vessel and steam in boiling water for a long time until the aromas blend. Remove, dry, stir-fry until yellow, and separate for use.
Qingxin Lianzi Yin (See Bai Zhuo/White Turbidity section)
Xiaochaihu Tang (See Jingzheng/Spasm Section)
Jiawei Guipi Tang
Yueju Wan
Sijunzi Tang
Qingwei San
Yigong San (Five formulas see Neidiao/Internal Hook section)
Buzhong Yiqi Tang
Baohe Wan
Da'an Wan (Three formulas see Xu Lei/Emaciation section, i.e., Baohe Wan added with Baizhu)
Jiashen Qiwang Wan (See Fu Zhang/Abdominal Distension section)
Bazheng San (See Xiaobian Butong/Urine Inhibition section)
Liuwei Wan (See Shen Zang/Kidney Organ section)
Fuling San (See Niao Bai/White Urine section)
Xiaji Wan (Accumulation-Lowering Pill)
Baizhu San (Two formulas see Ji Tong/Accumulation Pain section)
Siwei Feier Wan (See Han Tu/Cold Vomiting section)