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Pediatric Xu Lei (extreme emaciation and weakness) arises after various diseases, or due to the erroneous administration of purgative medicines, or following vomiting and diarrhea, resulting in Spleen-Stomach deficiency. This impairs the transformation and transportation of Gu Qi (Grain Qi), preventing food intake and causing muscle wasting, thereby forming Xu Lei. In cases of Cold Xu Lei, there is frequent diarrhea with bluish-white lips and mouth; in cases of Heat Xu Lei, the body is hot and feverish with slightly yellowish muscles. These are referred to as Cold and Heat types of Xu Lei. Qian Yi treated the Cold type with Muxiang Wan (Musk Pill) and the Heat type with Huhuanglian Wan (Coptis Decoction Pill). The former should not be taken in summer, but if symptoms arise, a small dose may be used; the latter should not be taken in winter, but if symptoms arise, a small dose may be used.

Previously, Qian Yi treated the son of Langzhong Qi, who liked to collect and distribute medicinal powders. His son suddenly suffered from internal Zang heat. Langzhong Qi self-administered Qingjin Gao (Blue Gold Ointment), giving three doses at once. After finishing the medication, by the third watch (midnight), the child had five episodes of diarrhea. The child was lethargic and sleepy. Langzhong Qi noted that excessive sleep might lead to fright and administered another dose. This resulted in several more diarrheal episodes, accompanied by dry mouth and fever. Langzhong Qi, perceiving residual heat, intended to give more Qingjin Gao. The wife objected, stating that ten-plus purgations had not brought relief and fearing adverse effects. They summoned Qian Yi. Qian Yi diagnosed it as having progressed to Xu Lei. He prescribed large quantities of Baizhu San (Atractylodes Powder) to be given frequently, followed by Xigua Wan (Melon Pill), resulting in recovery within ten days.

Qian Yi also treated the five-year-old son of Jianbu Zhu, who presented with fever, red cheeks, red lips, irritability, and polydipsia. The previous physician diagnosed Heart Heat and administered Niuhuang Wan (Calculus Bovis Pill) along with Yiwu Xiexin Tang (One-Ingredient Bitter Gallbladder-Draining Decoction). The next day, the child became weaker and anorexic. The physician purged again, leading to the passage of yellow frothy stool. Upon consultation, Qian Yi stated this was Heart Meridian deficiency with lingering internal heat, caused by the damaging effect of cold purgatives leading to Xu Lei. Qian Yi first used Baizhu San to generate Stomach fluids, then treated with Shengxi San (Raw Rhinoceros Horn Powder). When asked about the yellow frothy stool, Qian Yi replied that the diarrhea would stop naturally once Stomach Qi recovered, identifying it as Deficiency Heat. Regarding the use of Xiexin Tang, Qian Yi explained it contains only Huanglian (Coptidis Rhizoma), which is cold in nature; excessive use causes diarrhea and damages the Spleen and Stomach. Later, the previous physician arrived, insisting on Excess Heat. Qian Yi countered with Deficiency Heat, asking why Excess Heat did not respond to purgation and instead developed yellow complexion, red malar flush, Five-Center Heat (heat in palms, soles, and chest), anorexia, and polydipsia. When asked why Deficiency Heat produced yellow frothy stool, Qian Yi smiled and attributed it to the overuse of Xiexin Tang. He subsequently prescribed Huhuanglian Wan, leading to recovery.

Qian Yi also treated a boy who had fever at night but returned to normal by morning. The previous physician treated it as Heat using cooling herbs without success. The symptoms included excessive salivation and somnolence. The physician further purged with Tiefen Wan (Iron Powder Pill), worsening the condition. By the fifth day, the child had extreme thirst, white lips, and anorexia. Qian Yi diagnosed Lung Qi deficiency with heat, advising against purgation as it would damage the Spleen and Stomach, causing Xu Lei. He prescribed Baizhu San, adding one liang of Baizhu, decocted in three sheng of water for free consumption. When asked if excessive drinking would cause diarrhea, Qian Yi replied that without raw water, diarrhea would not occur, and even if it did, it would not be severe. The key was avoiding purgation. When asked about the treatment priority, Qian Yi listed stopping diarrhea, resolving phlegm/saliva, reducing fever, and calming the spirit, all achieved by this medicine. After finishing the dose by evening, Qian Yi advised continuing with another three sheng. After completion, the condition improved slightly. On the third day, another three sheng were given; the child no longer had thirst or salivation. Two doses of Ejiao San (Donkey-Hide Gelatin Powder) were then administered to stabilize the case.

These three cases illustrate how excessive purgation consumes Jin-Ye (Body Fluids), leading to Stomach deficiency, thirst, anorexia, and Xu Lei. Qian Yi consistently used Baizhu San first to restore Stomach fluids and Qi before treating the specific disease: Xigua Wan for the internal heat of Langzhong Qi's son; Shengxi San and Huhuanglian Wan for the Heart Deficiency Heat of Jianbu Zhu's son; and Ejiao San for the Lung deficiency of the third child. Yan Xiaozhong stated that excessive purgation leading to diarrhea and thirst indicates internal depletion of Jin-Ye. Regardless of Yin or Yang patterns, decocting sufficient Qian Yi's Baizhu San is beneficial, with more being better. This detailed exposition aims to guide students. Other formulas by Qian Yi for Xu Lei are listed below.

Dingxi Huangqi San (Clove and Astragalus Powder)
Treats Spleen-Stomach deficiency with anorexia, gradually leading to emaciation and Xu Lei.
Ingredients: Dingxi (Clove), Mian Huangqi (Astragali Radix, sliced), Renshen (Ginseng Radix et Rhizoma, de-gorged), Baizhu (Atractylodis Macrocephalae Rhizoma), Danggui (Angelicae Sinensis Radix, de-gorged), Biejia (Testudinis Carapax et Plastrum, coated with butter, roasted until scorched, skirt removed, each 1 liang), Huhuanglian (Coptidis Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried, each 0.5 liang).
Preparation: Grind into fine powder. Take 1 qian per dose. Decoct with 1 small cup of water, 2 slices of Shengjiang (Zingiberis Rhizoma Recens), and 1 Dazao (Jujubae Fructus) until reduced to 0.5 portion. Strain and take warm before meals.

Jixiang Jian (Collected Aromatics Decoction/Paste)
Treats as above.
Ingredients: Dingxiang (Clove), Chenxiang (Aquilariae Lignum Resinatum), Muxiang (Vladimiriae Radix), Huoxiang (Pogostemonis Herba, cleaned), Houpo (Magnoliae Officinalis Cortex, stripped of rough bark, ginger-processed, each 1 liang), Baizhu (Atractylodis Macrocephalae Rhizoma), Baifuling (Poria, white), Baixiudoukou (Amomi Fructus Rotundus, each 0.5 liang).
Preparation: Grind into fine powder, mix with 1 qian of finely ground Shexiang (Moschus). Add 1 sheng of water, 0.5 jin of Honey, 30 Dazao, and 20 slices of Shengjiang. Slowly simmer in a silver vessel into a paste. Remove ginger and dates. Stir well and dry in the shade in a ventilated place. Take an amount the size of a Gengjiao Zi (Gleditsiae Spina) dissolved in Rice Drink before milk or food.

Guolao Wan (Elder Pill)
Treats emaciation, Xu Lei, and shortness of breath.
Ingredients: Gancao (Licorice Root), roasted until golden brown, pounded into powder, mixed with refined honey to form pills the size of mung beans.
Dosage: Take 5 pills with warm water, three times daily. For one-year-olds, 5 pills; for older children, 7-8 pills. Adjust according to circumstances. Take at any time.