积热生虫蚀脊膂，手击其背若鼓鸣，羸瘦脊骨锯齿状，身热下利烦渴增，十指皆疮啮爪甲，此名脊疳病热凶，芦荟
丸同金蟾散，急急调治莫从容。
【注】脊疳者，因积热生虫，上蚀脊臂也。以手击其背，必空若鼓鸣，脊骨羸瘦，状若
锯齿，始为脊疳外证。亦身体发热，下利烦渴，十指皆疮，频啮爪甲，其证最为可畏。须
先以芦荟丸杀其虫，继用金蟾散消其疳，随时调治，或可愈也。
芦荟丸
生芦荟 青黛 朱砂 熊胆 胡黄连 贯众 地龙（微炒） 川黄连 蝉蜕（去足） 雷丸（各五钱）
麝香（一钱） 虾蟆（酥涂炙焦，一个）
上为细末，用蜗角肉研和，丸如麻子大，每服五丸，粥饮下，量儿大小与之。
金蟾散
蟾（酥涂炙焦，一枚） 夜明砂（炒） 桃白皮 樗根白皮 地榆 黄柏 诃黎勒（皮煨） 百合 人
参大黄 白芜荑（炒） 胡粉（各三钱） 槟榔（一钱） 丁香（三十七粒）
上为细末，每服五分，粥饮调下。
过食腻冷并肥甘，湿热生蛔腹内缠，时烦多啼时腹痛，口唇色变溢清涎，腹胀青筋肛湿痒，使君散
治莫迟延，不愈下虫丸极效，蛔退补脾肥儿丸。
【注】蛔疳者，因过食生冷、油腻、肥甘之物，以致湿热生蛔，腹中扰动，故有时烦
躁多啼，有时肚腹搅痛，口唇或红或白，口溢清涎，腹胀青筋，肛门湿痒也。先用使君
子散治之；不愈，下虫丸主之。若蛔退，又当调补其脾，肥儿丸主之。
使君子散
使君子（瓦上炒为末，十个） 苦楝子（泡去核，五个） 白芜荑 甘草（胆汁浸一宿，各一钱）
上为末，每服一钱，水调服。
下虫丸
苦楝根皮（新白者佳酒浸焙） 木香 桃仁（浸去皮尖） 绿包贯众 芜荑（焙） 鸡心槟榔（各二
钱） 轻粉（五分） 鹤虱（炒，一钱） 干虾蟆（炒黑，三钱） 使君子（取肉煨，三钱）
上为末，面糊成丸，如麻子大，每服二十丸，滚白水下。
肥儿丸（方见脾疳）
Accumulated heat generates parasites that erode the spine and back; striking the back with the hand produces a sound like drumming. The body is emaciated, and the spinal bones appear serrated. Fever, diarrhea, irritability, and increased thirst ensue. Sores appear on all ten fingers, and the child gnaws their nails. This condition is named Ji Gan (Spinal Malnutrition), characterized by severe heat and ominous prognosis. Use Lushui Wan (Aloe Pill) together with Jinchan San (Golden Toad Powder); immediate treatment is required without delay.
[Note] Ji Gan (Spinal Malnutrition) arises from accumulated heat generating parasites that ascend to erode the spine and arms. Striking the back with the hand yields an empty, drum-like resonance. The spinal bones are emaciated and resemble a sawtooth edge, which constitutes the external signs of Ji Gan. Additionally, there is fever, diarrhea, irritability, and thirst. Sores appear on all ten fingers, and the child frequently gnaws their nails. This presentation is most formidable. One must first use Lushui Wan (Aloe Pill) to eliminate the parasites, followed by Jinchan San (Golden Toad Powder) to resolve the malnutrition. Timely adjustment of treatment may lead to recovery.
Lushui Wan (Aloe Pill)
Raw Aloe (Sheng Lushui), Indigo Naturalis (Qingdai), Cinnabar (Zhusha), Bear Bile (Xiongdan), Picrorhizae Rhizoma (Huhuanglian), Agastache Rhizoma (Guanzhong), Earthworm (Dilong, lightly fried), Coptidis Rhizoma (Chuan Huanglian), Cicada Slough (Chantui, feet removed), each 5 qian; Musk (Shexiang) 1 qian; Toad (Xiamu, coated with butter and roasted until scorched) 1 piece.
Grind into fine powder. Mix with snail meat using a mortar. Form pills the size of hemp seeds. Administer 5 pills per dose, taken down with rice gruel beverage, adjusted according to the child's age and size.
Jinchan San (Golden Toad Powder)
Toad (Chan, coated with butter and roasted until scorched) 1 piece, Night soil (Yeming Sha, fried), Peach Inner Bark (Taobai Pi), Chinese Chinaberry Root Bark (Chugen Baipi), Sanguisorbae Radix (Diyu), Phellodendri Cortex (Huangbai), Terminalia Chebula Retz. (Helile, skin roasted), Lilii Bulbus (Baihe), Ginseng Radix et Rhizoma (Renshen), Rheum Palmatum (Dahuang), White Melia Seed (Bai Wuyi, fried), Lead Carbonate (Hufen), each 3 qian; Areca Seed (Binglang) 1 qian; Clove (Dingxiang) 37 grains.
Grind into fine powder. Administer 0.5 fen per dose, mixed with rice gruel beverage.
Excessive consumption of greasy, cold, and rich foods leads to damp-heat generating roundworms that entangle within the abdomen. Intermittent irritability, excessive crying, and abdominal pain occur. The lips change color, and clear saliva overflows. Abdominal distension with visible veins and wetness/itching at the anus arise. Use Shijunzi San (Quinine Powder) without delay. If ineffective, Xia Chong Wan (Worm-Expelling Pill) is highly effective. Once the roundworms are expelled, tonify the Spleen with Fei'er Wan (Child-Nourishing Pill).
[Note] Hui Gan (Roundworm Malnutrition) results from excessive intake of raw, cold, greasy, and sweet/rich foods, causing damp-heat to generate roundworms that disturb the abdomen. Thus, there is intermittent irritability and excessive crying, or twisting abdominal pain. The lips may be red or white, with overflow of clear saliva. Abdominal distension presents with visible veins, and the anus is wet and itchy. First, treat with Shijunzi San (Quinine Powder). If ineffective, administer Xia Chong Wan (Worm-Expelling Pill). After the roundworms are expelled, one should regulate and tonify the Spleen, using Fei'er Wan (Child-Nourishing Pill).
Shijunzi San (Quinine Powder)
Quinoa Fruit (Shijunzi, fried on tile into powder, 10 fruits), Melia Azedarach Seed (Kulianzi, soaked and pitted, 5 seeds), White Melia Seed (Bai Wuyi), Licorice Root (Gancao, soaked in bile overnight), each 1 qian.
Grind into powder. Administer 1 qian per dose, mixed with water.
Xia Chong Wan (Worm-Expelling Pill)
Melia Root Bark (Kulian Genpi, fresh white bark is best, soaked in wine and dried), Costus Root (Muxiang), Peach Kernel (Taoren, soaked, skin and tip removed), Green-wrapped Agastache Rhizoma (Lvbao Guanzhong), Melia Seed (Wuyi, roasted), Heart-shaped Areca Seed (Jixin Binglang), each 2 qian; Calomel (Qingfen) 0.5 fen; Dandelion Root? No, *Pyrethri Flos* (Heshi, fried) 1 qian; Dried Toad (Gan Xiamu, roasted black) 3 qian; Quinoa Fruit Meat (Shijunzi, flesh roasted) 3 qian.
Grind into powder. Bind with wheat paste to form pills the size of hemp seeds. Administer 20 pills per dose, taken down with boiling plain water.
Fei'er Wan (Child-Nourishing Pill) (Formula see Pi Gan)