《百问》小儿大便秘，乃是肺家有热在里，流入大肠，以致秘结不通，乃实热
也，当以四顺清凉饮（热）加柴胡。热甚者，加山栀、黄芩、流利之。其表里俱热者，
面黄颊赤，唇燥口干，小便赤涩，大便焦黄，无汗者先解表，以柴胡散（伤寒）汗之，解后
大便秘，或肚疼者，以清凉饮、大柴胡汤、承气汤（并热）皆可下之。积热者，神芎丸尤
妙。〔薛〕因乳母或儿膏粱积热，及六淫七情郁火，传儿为患者，用清邪解郁之剂。
禀赋怯弱，早近色欲，大便难而小便牵痛者，用滋补肺肾之剂。《褚氏遗书》云∶男
子精未满而御女以通其精，则四体有不满之处，异日有难状之疾，老人阴已痿而思
色以降其精，则精不出而内败。精已耗而复竭之，则大小便牵痛如淋。今童子即有
此患，益见今人所禀，与古人大径庭矣。人之气血浓薄既殊，而医之用药疗法，又
岂可泥执古方，而无加减之变乎。一小儿食粽停滞，大便不通，痛不可忍，手足发
搐。用大柴胡汤调酒曲末一钱，下滞秽甚多，作呕不食，用五味异功散加升麻、柴
胡、而愈。一小儿大便不通。审乳母饮食浓味所致。用清胃散以治母热，儿间饮以
一二匙而愈。后乳母感寒腹痛，食姜酒之物，儿大便秘结兼便血，仍用清胃散每日
数匙而愈。一小儿因乳母暴怒，大便不通，儿亦患之，兼用加味小柴胡汤，先用保
和丸二服，后用五味异功散加升麻、柴胡，儿日饮数匙，并愈。
《圣惠》芎黄散 治小儿大便不通，腹胁妨闷。
芎 （半两） 川大黄（锉，微炒） 郁李仁（汤浸，去皮，微炒。各三分）
上件药捣，细罗为散。每服一钱，以温水半盏调服，量儿大小，以意分减，以
利为度。张涣兼治大小便不通。
张锐《鸡峰方》用麻子以水研汁饮之。
The *Baiwen* states that constipation in infants and children is caused by heat in the Lung organ remaining internally, flowing into the Large Intestine, resulting in blockage and difficulty in passage. This is a case of Excess Heat (Shi Re), and one should administer Sishun Qingliang Yin (Four-Obedience Cooling Decoction) with added Chai Hu (Bupleurum Root). If the heat is severe, add Shan Zhi (Gardenia Fruit) and Huang Qin (Scutellaria Root) to clear heat and promote smoothness. In cases where both exterior and interior are hot, manifesting as a sallow complexion with red cheeks, dry lips, dry mouth, dark and scanty urine, and scorched yellow stools, if there is no sweat, the exterior should first be resolved using Chai Hu San (Bupleurum Powder) to induce sweating. After the exterior is resolved, if constipation persists or abdominal pain occurs, Qingliang Yin, Da Chai Hu Tang (Major Bupleurum Decoction), or Cheng Qi Tang (Purgative Decoctions) can all be used for purgation. For cases of accumulated heat, Shen Xiong Wan (Divine Xion Pill) is particularly effective. [Xue Ji] posits that when heat accumulates from rich foods consumed by the wet nurse or the child, or when fire stagnates due to the six climatic factors and seven emotions and transmits to the child, agents that clear pathogenic factors and resolve stagnation should be used. For those with weak constitution and early depletion of essence (metaphorically referring to congenital kidney deficiency), leading to difficult defecation and pulling pain in urination, agents tonifying the Lung and Kidney should be employed. The *Chu Shi Yi Shu* states: "If a man whose essence is not yet full engages in intercourse to drain his essence, his body will have deficiencies, and later he will suffer from inexplicable diseases. If an old man, whose yin energy is already atrophied, desires sexual activity to drain his essence, the essence will not exit but will rot internally. If essence has already been depleted and is further exhausted, it causes pulling pain in defecation and urination resembling strangury." That young boys now suffer from this condition further demonstrates that the innate endowment of people today differs greatly from that of the ancients. Since the density and thinness of qi and blood vary among individuals, how can physicians rigidly adhere to ancient prescriptions without making modifications? One infant suffered from food stagnation after eating zongzi, resulting in constipation, unbearable pain, and convulsions of the hands and feet. Da Chai Hu Tang was administered with one qian of fermented Qu powder mixed in wine; after passing a large amount of stagnant waste, the infant vomited and refused food. Subsequently, Wuwei Yigong San (Five-Ingredient Benefit-the-Spleen Powder) with added Sheng Ma (Cimicifuga Rhizome) and Chai Hu cured the condition. Another infant had constipation, which was determined to be caused by the wet nurse's consumption of rich flavors. Qing Wei San (Clear the Stomach Powder) was used to treat the mother's heat, and the infant received a few spoonfuls intermittently, resulting in recovery. Later, the wet nurse contracted cold and suffered abdominal pain after consuming ginger and wine, causing the infant to develop severe constipation accompanied by bloody stools. Qing Wei San was again administered in small doses daily, curing the infant. A third infant suffered from constipation due to the wet nurse's sudden anger, affecting the infant as well. Jiamiao Xiao Chai Hu Tang (Modified Minor Bupleurum Decoction) was used concurrently. First, Baohe Wan (Preserve Harmony Pill) was given twice, followed by Wuwei Yigong San with added Sheng Ma and Chai Hu, taken in small daily doses by the infant, leading to recovery.
Xiong Huang San (Sichuan Lovage and Scutellaria Powder) from the *Shenghui Fang* treats infantile constipation accompanied by abdominal and hypochondriac fullness and oppression.
Xiong (Ligusticum Chuanxiong Rhizome) (half liang)
Chuan Da Huang (Rheum Palmatum Rhizome, crushed, slightly stir-fried)
Yu Li Ren (Prunus japonica Seed, soaked in water, skin removed, slightly stir-fried. Each three qian)
Crush the above ingredients and sift them through a fine sieve to make a powder. Take one qian per dose, mix with half a zhan of warm water, and adjust the dosage according to the child's age and size, stopping when bowel movement is facilitated. Zhang Huan also treated cases of both constipation and urinary retention.
Zhang Rui's *Jifeng Fang* recommends grinding hemp seeds (Cannabis Sativa Seeds) in water and drinking the juice.