甲、概况
小儿二便下血，宜分虚实。凡大便下血，初起多为肥甘积热，蕴蓄于肠，传化失职，以致便血。无论色紫
色鲜，当从实治。下血日久，或粪前先下，或粪后淋出，爽而不痛者，当从虚治。粪中杂有赤白似冻者，则
为痢疾。凡便血之类，不论先后，血是血粪是粪者，此为大肠之血，虽多无碍，若有血点血丝混于
粪内者，当防其为小肠之血，最为难治。放下血之轻重，不能遽以多少断也。凡小便溲血，初起多为心经有
热，由小肠传导而下，当从实治。肾亏而下者，血液全混于小便之中，当从虚治。然小儿二便下血，非习见
之病，或由跌仆伤其腰腑，或由玩弄伤其尿道，亦间有之。凡此外来之因，一时未能诊得，故治病之
始，当先问其源，庶几着手较易也。
乙、治法
大便下血，初起宜用槐花、银花各三钱，神曲、山楂炒炭各二钱，加五倍子，以凉血清热，消食化积，
多者加黑荆芥、侧柏炭以止之。便血日久者宜四君子汤加川连，或用补中益气汤以升提之。赤白似冻，当从
痢治（参看第八章）。小便溲血，初起宜清心经之热，用导赤散或清心莲子饮。肾亏而下，病后所致者，
宜用黄 、旱莲草、枸杞子、补骨脂之类以固之。若虚而有热者，用六味地黄丸。因损伤溲血者，腰腑受
伤，宜用杜仲、川断之类，佐以和血养血之剂。尿道受伤，宜用大豆、甘草、 蓄
草、赤芍、生地、车前子以和养清利；伤于外部者，则以大豆甘草汤洗之。
附方
（一）四君子汤 见第三章第五节。
（二）补中益气汤 见第四章第四节。
（三）导赤散 见第四章第一节。
（四）清心莲子饮 治上盛下虚，心火炎上，口苦咽干，心烦发渴，及膀胱气虚湿热，阴茎肿痛，
或茎窍涩滞，小便赤或白浊。亦治妇人积热血崩，白浊带下。
石莲肉（去心） 白茯苓 黄 （蜜炙） 人参（各七分五厘） 黄芩 麦
冬（去心） 地骨皮 车前子（炒） 甘草（炙。各一钱）
清水煎服。
（五）六味地黄丸 见第三章第五节。
（六）大豆甘草汤 外用。止痒消疼，解毒。治各种疳疮。
黑豆（一合） 生甘草（一两） 赤皮葱（三茎） 槐条（六十寸）
清水煎汤，候温洗之。
A. Overview
Hematochezia and hematuria in children should be differentiated into deficiency (Xu) and excess (Shi) patterns. Hematochezia at the onset is mostly caused by heat accumulation from overconsumption of rich and sweet foods, which stagnates in the intestines, impairing their transportation and transformation functions, thereby leading to bleeding. Regardless of whether the blood color is dark purple or bright red, it should be treated as an excess pattern. If bleeding persists for a long time, or occurs before defecation, or drips after defecation with a smooth flow and no pain, it should be treated as a deficiency pattern. If the stool contains red and white substances resembling jelly, it is dysentery. Regarding hematochezia, if the blood and stool are separate regardless of the order of occurrence, this indicates large intestine bleeding; even if the volume is large, it is generally not dangerous. However, if blood spots or threads are mixed within the stool, one must guard against small intestine bleeding, which is the most difficult to treat. The severity of hematochezia cannot be judged solely by the amount of blood. Hematuria at the onset is mostly due to heat in the Heart Meridian, transmitted downward via the Small Intestine, and should be treated as an excess pattern. If caused by Kidney deficiency, the blood mixes completely with urine, and should be treated as a deficiency pattern. However, hematochezia and hematuria in children are not common diseases. They may result from falls injuring the waist and viscera, or from playing causing urethral injury, though such cases are occasional. When external causes cannot be immediately diagnosed, it is essential to inquire about the origin of the disease at the beginning of treatment to facilitate easier intervention.
B. Treatment Methods
For initial hematochezia, use Huaihua (Sophorae Flos) and Yinhua (Lonicerae Japonicae Flos), each 3 qian, Shenqu (Medicated Leaven) and Shanzha (Crataegi Fructus) stir-fried to charcoal, each 2 qian, plus Wubeizi (Galae Chinensis), to cool the blood and clear heat, digest food and resolve accumulation. For heavy bleeding, add Hei Jingjie (Schizonepetae Herba Carbonisata) and Cebaiye Tan (Platycladi Cacumen Carbonisatum) to stop bleeding. For chronic hematochezia, use Sijunzi Tang (Four Gentlemen Decoction) with Chuanlian (Coptidis Rhizoma), or Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) to raise the Qi. For stool resembling red and white jelly, treat as dysentery (see Chapter 8). For initial hematuria, clear Heat from the Heart Meridian using Daochi San (Guide Out the Red Powder) or Qingxin Lianzi Yin (Clear the Heart Lotus Seed Decoction). For bleeding due to Kidney deficiency or post-illness, use Huangqi (Astragali Radix), Hanliancao (Ecliptae Herba), Gouqizi (Lycii Fructus), and Buguzhi (Psoraleae Fructus) to consolidate. For deficiency patterns with heat, use Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia). For hematuria due to trauma involving injury to the waist and viscera, use Duzhong (Eucommiae Cortex) and Chuanduan (Dipsaci Radix), assisted by formulas that harmonize and nourish the blood. For urethral injury, use Dadou (Sojae Semen Nigrum), Gancao (Glycyrrhizae Radix et Rhizoma), Pianxucao (Polygoni Avicularis Herba), Chishao (Paeoniae Radix Rubra), Shengdi (Rehmanniae Radix), and Cheqianzi (Plantaginis Semen) to harmonize, nourish, and promote urination to clear damp-heat. For external injuries, wash with Dadou Gancao Tang (Soybean and Licorice Decoction).
Appendix Formulas
(1) Sijunzi Tang (Four Gentlemen Decoction): See Chapter 3, Section 5.
(2) Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction): See Chapter 4, Section 4.
(3) Daochi San (Guide Out the Red Powder): See Chapter 4, Section 1.
(4) Qingxin Lianzi Yin (Clear the Heart Lotus Seed Decoction): Treats upper excess and lower deficiency, flaming Heart Fire manifesting as bitter taste and dry throat, irritability, thirst, and Bladder Qi deficiency with damp-heat causing penile swelling and pain, or urinary obstruction, red urine, or cloudy urine. Also treats women with accumulated heat causing metrorrhagia, leukorrhea, and cloudy discharge.
Shilianrou (Nelumbinis Plumula, heart removed) Baifuling (Poria), Huangqi (Astragali Radix, honey-fried), Renshen (Ginseng Radix et Rhizoma) (each 7.5 li), Huangqin (Scutellariae Radix), Maidong (Ophiopogonis Radix, heart removed), Digupi (Lycii Cortex), Cheqianzi (Plantaginis Semen, stir-fried), Gancao (Glycyrrhizae Radix et Rhizoma, roasted) (each 1 qian).
Decoct in clear water and take orally.
(5) Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia): See Chapter 3, Section 5.
(6) Dadou Gancao Tang (Soybean and Licorice Decoction): For external use. Relieves itching and pain, detoxifies. Treats various gan sores.
Heidou (Sojae Semen Nigrum, 1 he), Sheng Gancao (Raw Glycyrrhizae Radix et Rhizoma, 1 liang), Chipicong (Allium fistulosum with red skin, 3 stalks), Huaitiao (Catalpae Ramulus, 60 cun).
Decoct in clear water, wait until warm, and wash.