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To treat children with many roundworms (also known as food worms), seed worms (also known as gan worms), and stomach worms (also known as blood worms), it is appropriate to administer the Xiachong Wan (Expel Worms Pill) formula.

Artemisiae Argyi Fructus (Heshi, 鹤虱) (one tael, stir-fried), Guangfen (Guangfen, 光粉) (two taels, stir-fried), Nifen (Nifen, 腻粉) (two large taels), Tsootsao Seed (Shijunzi, 使君子) (one hundred pieces, stir-fried), Areca Seed (Binglang, 槟榔) (one fen, raw), Longyagen (Longyagen, 龙牙根) (one qian), Scrophulariae Radix (Guanzhong, 贯众) (harvested on Zi, Mao, or You days for efficacy; green ones are best, two taels), Gentianae Radix (Longdan Gen, 龙胆根) (two qian), Toosendan Cortex (Kulian Genpi, 苦楝根皮) (wine-processed, two qian).

Grind the above ingredients into a fine powder. Use boiled wheat flour paste as a binder to form pills the size of hemp seeds. Take thirty to fifty pills per dose, before meals on an empty stomach, washed down with Licorice Decoction (Gancao Tang, 甘草汤). Alternatively, taking them with the clear juice soup of Broussonetia fruit (Churou, 褚肉) yields excellent results.

Discussion: Gan accumulation and worm accumulation in children both result from consuming meat too early. The spleen and stomach are inherently weak and unable to digest properly. When pathological damage occurs and digestion fails, eating fatty, greasy, cold, and hard foods further weakens the intestines and stomach.

Meat accumulation tends to generate three types of worms: roundworms, seed worms, and stomach worms. An abundance of roundworms makes children crave flavorful preserved foods, causing abdominal tightness and distension, and fullness in the chest and heart. An abundance of seed worms leads to emaciation, mental fatigue, abdominal distension, visible subcutaneous veins on the abdomen, increasing severity of gan syndrome, borborygmus, foul-smelling diarrhea, and vomiting or hiccups after eating. An abundance of stomach worms makes children desire wine and meat, suppresses hunger, causes frequent lethargy, irritability, flank distension and烦躁 (restlessness), mental confusion, and restless sleep. All these conditions are suitable for this formula, which will naturally resolve the worms. If the condition is severe and purgatives are used, one must still regulate the stomach qi and harmonize the nutritive and defensive energies to assist.

Regarding pediatric typhoid fever (Shanghan, 伤寒) symptoms, only three main types are discussed as standard: Zheng Shanghan (True Typhoid), Jia Jing (Accompanied by Fright), and Jia Shi (Accompanied by Food Stagnation). For the aforementioned typhoid syndromes, Tuojia San (Exfoliating Powder) should be used. Since the disease is divided into these three types, their severity must be thoroughly analyzed. Symptoms include nasal congestion, reddish urine, cough, obstruction of orifices, high fever, red face, headache, heavy body, and heat throughout the whole body including hands and feet.

For treating true typhoid injury in children, as well as injuries from cold pathogens or wind-cold, Renshen Qianghuo San (Ginseng and Notopterygium Powder) is appropriate. If urine is reddish, or if there is mental restlessness indicating the pathogen is between the exterior and interior, or if the condition recurs, Xiaochaihu Tang (Minor Bupleurum Decoction) should be administered for one or two doses.

For pediatric typhoid accompanied by fright, presenting with mental fatigue, dizziness, palpitations, headache, and coarse breathing, Wangshi Dumbohe San (Wang’s Mint and Perilla Powder) and Xiaofeng San (Dispel Wind Powder) are appropriate.

For pediatric typhoid accompanied by food stagnation, first administer mild purgatives, then use Tuojia San or Renshen Qianghuo San to purge downwards. Zishuang Wan (Purple Frost Pill) is the superior choice. The goal is mild purgation. Generally, treating pediatric typhoid requires avoiding excessive diaphoresis (sweating) and excessive purgation, and certainly not combining exterior-releasing and purging methods simultaneously. If the child is currently deficient, fatigued, and heavy, it becomes a "Huai Zheng" (Complicated/Deteriorated Syndrome), which is difficult to treat.

Discussion: Although pediatric typhoid may not present with complex issues, symptoms must be clearly identified. For pure typhoid or wind-injury, only exterior-releasing methods are applicable. Only when accompanied by food stagnation should purgative methods be used. Typhoid accompanied by food stagnation presents with cold-like symptoms resembling accumulation, but this type of typhoid is distinct. One must ascertain the exact cause before administering medicine in sequence. It is crucial to instruct the family to avoid wind and dampness, forbid raw and cold foods, prevent overexertion, and avoid binge eating, lest the stomach qi be damaged. If the illness recurs, the physician must carefully evaluate. Special attention is needed during outbreaks of exanthematous diseases or if neighbors are ill. Even if so, once the exterior is resolved, medication can be given without recklessly administering anti-fright drugs; otherwise, the patient will remain safe. The "Huai Zheng" (Deteriorated Syndrome) generally arises from previous physicians' inappropriate medication, disrupting yin and yang; or from exposure to wind pathogens; or from overexertion and toxic diet; or from damaging meridians with cold/warm medications. Deteriorated syndromes are extremely difficult to cure, and physicians should feel deep remorse. Among pediatric typhoid symptoms, cough is not trivial. If cough is present, Renshen Zhishi Tang (Ginseng and Aurantium Decoction) is appropriate, hoping for some efficacy; do not attack vigorously. A skilled physician who recognizes this is considered excellent.