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Yang Daye, Hanlin Daizhao (Attendant Physician in the Hanlin Academy), asked: What is the cause of constipation and difficult urination in infants? I replied: This is due to improper feeding of milk and food, leading to an imbalance of the "Four Elements" (a TCM concept referring to the body's physiological balance, metaphorically derived from earth, water, fire, and wind); greed for rich flavors causes disease in the five Zang organs. Sweet foods tend to accumulate undigested food, while salty and sour foods tend to stagnate saliva. Food remains stagnant and knotted in the stomach and intestines; wind pathogen stagnation infiltrates the heart and lungs, causing the Qi and blood vessels to flow irregularly, and water and grain essences cannot be transported normally. Although the pathogenic factor may not reverse upward to the Upper Jiao, it must be blocked and knotted in the lower part of the body. Infants do not understand pain nor can they explain the cause; they only cry frequently with fright, refuse to nurse due to anger and distension. If one does not know that when a child is in piercing pain radiating to the umbilicus, their complexion turns greenish-yellow, and treats solely based on pulse diagnosis and external manifestations without seeking the root cause, how can medication be effective?

The *Baiwen* (Hundred Questions) states: To regulate infantile typhoid fever presenting with body heat, dizziness and heaviness of the head and eyes, loss of appetite, combined with fright and food stagnation causing alternating cold and heat, complete obstruction of stool and urine, irritability, thirst, spontaneous profuse cold sweat, food retention and stagnation, chest fullness and urgency, greenish-yellow emaciated complexion, and persistent high fever day and night. It also treats wind-cold, summerheat injury, fright epilepsy, Ke Wu (sudden illness caused by external evil invasion affecting the spirit), and heat from Kidney Gan Qi (wasting-thirst syndrome related to the Kidney). All these conditions should primarily be treated with Tuojia San (Shedding Armor Powder) (for Typhoid). Alternatively, Dalianqiao Tang (Greater Forsythia Decoction) (for constipation during smallpox/variolae) can be taken with added Dahuang (Rhei Radix et Rhizoma) and Shenxiong Wan (Shenxiong Pill). For treating infantile convulsions due to accumulated heat causing sluggish stool and urine, its effect is particularly rapid.

Another method is the Umbilical Covering Method: Use one stalk of scallion with roots, unwashed and retaining soil; one piece of fresh ginger; twenty-one grains of Dan Dou Chi (Fermented Soybean); two teaspoons of salt. Grind them together into a paste, shape into a cake, warm it, and apply it to the umbilicus. Secure firmly with cotton cloth. After a while, if Qi circulation is restored, defecation will occur naturally. If not, apply another dose.

Shenxiong Wan (Shenxiong Pill): Treats wind-heat stagnation, dizziness and vertigo, sores in the mouth and tongue, dental gan erosion, or sores and scabies all over the body, teeth grinding, fright, palpitations, irritability, excessive thirst, sluggish stool and urine, abdominal fullness due to accumulated heat, and convulsive seizures.
Composition: Dahuang (Raw Rhei Radix et Rhizoma), Huangqin (Scutellariae Radix) (2 liang each), Sheng Qianniu Mo (Ground Raw Pharbitidis Semen) (1 liang), Huashi (Talcum) (4 liang), Huanglian (Coptidis Rhizoma), Bohe Ye (Menthae Haplocalycis Folium), Chuanxiong (Ligustici Chuanxiong Rhizoma) (0.5 liang each).
Preparation and Administration: Grind the above ingredients into fine powder, add water dropwise to make pills the size of wutong seeds. Take 40-50 pills after meals with warm water. Another formula adds Puhuang (Typhae Pollen) for hemostasis.

Qian's Yuliren Wan (Yuliren Pill by Dr. Qian): Treats infants with obstruction of stool and urine, as well as fright-heat, phlegm-stagnation, and excess syndromes where loose stools are desired.
Composition: Yuliren (Prunus japonica Seed, peeled), Chuan Dahuang (Rhei Radix et Rhizoma, coarse skin removed, solid core taken, cut, soaked in wine for half a day, drained, stir-fried, ground into fine powder) (1 liang each), Huashi (Talcum, 0.5 liang, finely ground).
Preparation and Administration: First grind Yuliren into a paste, mix with Dahuang and Huashi, make pills the size of millet seeds. Administer according to age/size, before meals, with breast milk or Bohe Tang (Mint Decoction).

Xijiao Wan (Rhinoceros Horn Pill): Treats infantile wind-heat, phlegm-excess with red face, constipation and difficult urination, pathogenic heat in the Three Jiao, toxicity accumulation in fu-zang organs. Its guiding and draining action is very stable.
Composition: Sheng Xi Jiao Mo (Ground Raw Cornu Rhinocerotis - *Note: Modern substitution often uses Sheng Shui Niu Jiao/Cornu Bubali*, 1 fen), Ren Shen (Ginseng Radix et Rhizoma, whiskers removed, sliced), Zhishi (Aurantii Fructus Immaturus, pith removed, stir-fried), Binglang (Arecae Semen) (0.5 liang each), Huanglian (Coptidis Rhizoma) (1 liang), Dahuang (Rhei Radix et Rhizoma) (2 liang, sliced after wine soaking, place 100 peeled Badou seeds against the Dahuang slices, wrap in paper, steam over rice three times, slice, stir-fry until yellow-brown, discard Badou).
Preparation and Administration: Grind into fine powder, mix with refined honey to make pills the size of hemp seeds. Take 10-20 pills before sleep with cooked water. Increase dosage if bowel movement does not occur. Also treats adults; safe for pregnant women.

*Huiyan* Shaoyao San (Shaoyao Powder from *Huiyan*): Treats cases where stool and urine remain obstructed even after taking purgatives.
Composition: Shaoyao (Paeoniae Radix), Dahuang (Rhei Radix et Rhizoma), Gancao (Licorice Root, stir-fried), Danggui (Angelicae Sinensis Radix), Puxiao (Natrii Sulfas) (1 fen each).
Preparation and Administration: Grind into powder. Take one large qian per dose, decoct in one cup of water in a clay vessel until half remains, strain, and drink. Stool and urine will pass immediately.

[Dr. Ji's] Formula for Obstruction of Stool and Urine:
Composition: Gancao Jie (Licorice Root Nodes, processed), Huaihua (Sophorae Flos, washed) (1 liang each).
Preparation and Administration: Grind into powder. Take one qian per dose, mixed with half a qian of tea, taken with hot water.

Another Formula:
Composition: Huashi (Talcum) (one large qian), Dengxin (Junci Medulla) (one handful).
Preparation and Administration: Decoct in two bowls of water until one bowl remains, take warm.

*Zimu Milu* records: Burn Fengfang (Vespa Nidus) to ash, take one qian with wine, twice daily.

Umbilical Covering Method (Alternative):
Composition: Haisi (Siliqua/Volva shells) (49 pieces), Conggen (Allii Fistulosi Rhizoma, with soil) (7 pieces), Heidou (Sojae Semen Nigrum) (7 pieces), Yan (Salt) (a little).

Woxuan Wan (Woxuan Pill): Treats infantile dry fecal impaction, or abdominal bloating and confusion caused by astringent medicines, where life is at stake. This pill can be used; within a short time, stool and urine will pass naturally.
Composition: Badou (Crotonis Fructus) (1.5 qian), Liuhuang (Sulfur), Liangjiang (Alpiniae Officinarum Rhizoma), Fuzi (Aconiti Lateralis Radix Praeparata), Binglang (Arecae Semen), Gansui (Kansui Radix) (equal parts).
Preparation and Administration: Grind into fine powder, mix with millet rice paste to make pills the size of mung beans. Wash the infant's hand (left for males, right for females) with pepper water, have them hold the pill, wrap securely with cotton. Observe how many steps they walk, then wash off the medicine. Stop when no longer needed.

*Qianjin* Moxibustion Method: For infantile obstruction of stool and urine, moxa moxibustion one Zhuang at each corner of the mouth.