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[Xue Ji] In children, anal pruritus may arise from a preference for sweet and fatty foods, leading to damp-heat stagnation in the Large Intestine; or it may result from damp-toxins generating parasites that erode the anus. If caused by damp-heat stagnation, Siwei Fei'er Wan (Four-Ingredient Child-Nourishing Pill) is used for malnutrition syndromes; if accompanied by constipation, Qingliang Yin (Cooling Drink) is used for interior heat. If caused by parasites eroding the anus, Huachong Wan (Parasite-Destroying Pill) should be administered first, followed by Siwei Fei'er Wan externally applied as Xionghuang San (Realgar Powder) inserted into the anus. If the illness causes anorexia such that parasites lack nourishment and turn to eating internal organs or eroding the anus, symptoms include colorless gums, a completely white tongue, and limb fatigue. Ulcers inside the upper lip with saliva containing blood spots like millet grains, and mental restlessness (ao'nan), indicate parasites eroding the upper organs; ulcers inside the lower lip indicate parasites eroding the lower anus; if the erosion penetrates inward, it is incurable. For all parasites, during the first half of the lunar month, their heads face upward, so medication can be given to expel them; during the second half, their heads face downward. Let the patient smell the aroma of cooking food to make the parasite heads turn upward, then administer expulsion medication. One child who indulged in rich and sweet foods developed scabies. I advised restricting rich foods and urgently using Stomach-Clearing herbs to treat accumulated heat. He did not comply, instead using topical treatments for external lesions. Subsequently, his anus became itchy and feverish, the sores worsened, he became emaciated ("bone-standing"), and had little appetite. I then prescribed Jiwei Luluhuan (Nine-Ingredient Aloe Pill) for malnutrition and Wuyi Yigong San (Five-Ingredient Yi-Gong Powder) for vomiting and diarrhea, added with Chaihu (Bupleuri Radix) and Shengma (Cimicifugae Rhizoma), resulting in recovery. Another child presented with anal pruritus, small nodules behind and in front of the ears like beads hidden in the muscles, irregular urination, and a bluish complexion. This was attributed to inheriting Liver Fire from the mother. I used Jiwei Luluhuan as the principal formula, assisted by Wuyi Yigong San added with Zhizi (Gardeniae Fructus) and Chaihu, and had the mother take Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) for deficiency heat with Loulu (Euphorbiae Humifusae Herba); both mother and child recovered. A thirteen-year-old child suffered from anal pruritus, occasional prolapse, hematochezia, generalized sores, fever with thirst, abdominal distension with visible subcutaneous veins. I used Da Luluhuan (Large Aloe Pill) and Wuyi Yigong San; the sores gradually healed. I assisted with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction); fever and thirst ceased, and the anus fully healed. Later, I used Yigong San as the principal formula, assisted by Buzhong Yiqi Tang for deficiency heat, combined with Coptidis Rhizoma processed with Evodiae Fructus, which cured the bleeding. A fifteen-year-old child had leukocoria, generalized skin resembling but not being scabies, anal pruritus, afternoon fever with thirst, and emaciation. I diagnosed this as Liver Malnutrition Syndrome (Gan Gan). The child recovered after taking Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill). Later, penile pruritus and cloudy white urine occurred; after taking Pancong San, the anus became swollen and painful. After taking Dahuang (Rhei Radix et Rhizoma) and other drugs, the anus prolapsed, and the itching became unbearable. Various fire-descending medications were ineffective. Small white ulcers appeared inside the lower lip; I diagnosed parasitic erosion of the anus and treated with Jiwei Luluhuan, resulting in recovery. A young boy with anal pruritus was misdiagnosed with hemorrhoids and took Huaijiao Wan (Sophorae Flos Pill) and other drugs, leading to emaciation, moist rot under the nose, and ulcers inside the lower lip. This indicated parasites eroding the lower region. I first gave two doses of Huachong Wan, then four doses of Wuyi Yigong San, and finally Da Wutui Tang (Large Trogopteri Dung Decoction) and Siwei Fei'er Wan, resulting in recovery. A seven-year-old child experienced diarrhea after overeating, with a yellowish-blue complexion, and was treated with harsh purgatives. I advised dietary moderation and strengthening the Spleen and Stomach. He did not believe me. Later, his gums became red and ulcerated, and his anus itched. After taking heat-clearing agents, he suffered from abdominal pain and distension, and requested the previous prescription again. I stated this was Yuanqi (Primordial Qi) deficiency with deflected deficient fire rising. He still did not believe me. Later, black necrosis appeared on his cheeks. I said this was extreme Spleen Qi deficiency causing muscle death without pain sensation. Although he later believed me, it was too late to save him. If initially treated with Wuyi Yigong San to strengthen the Spleen and Stomach, assisted by Da Luluhuan, Siwei Fei'er Wan, and herbs to clear Spleen damp-heat, why would it not be curable? Future patients should examine this carefully. A young boy with anal pruritus due to Wind-Heat in the Large Intestine Meridian recovered with Huaijiao Wan. A young boy with anal and scrotal pruritus with dripping discharge, attributed to Damp-Heat in the Liver Meridian, recovered with Longdan Xiegan Tang (Gentian Liver-Draining Decoction) and Jiwei Luluhuan. A young boy who indulged in sweet and fatty foods had anal pruritus, fever with thirst, and after taking various heat-clearing agents, developed abdominal distension, poor appetite, and sores under the nose. I diagnosed Spleen-Stomach damp-heat generating parasites. He did not believe me. Later, ulcers appeared inside the lower lip. I first used Siwei Fei'er Wan; symptoms gradually improved. Then I treated with Da Wutui Tang, resulting in recovery.

Huachong Wan: Treats various malnutrition syndromes with parasites, frequent crying, vomiting of clear fluid, abdominal distension and pain, purple-black lips and mouth, and moist erosion of the rectum.
Ingredients: Wutui (Trogopteri Dung), Qingdai (Indigo Naturalis), Luluhuan (Aloe), Xama (Toad, calcined to ash), Chuanxiong (Ligustici Chuanxiong Rhizoma), Baizhi (Angelicae Dahuricae Radix), Huhuanglian (Coptidis Rhizoma). All in equal parts.
Preparation: Grind each ingredient separately into powder. Soak in pig bile to form pills the size of hemp seeds. Dosage: 10-20 pills per administration, taken after meals and before bed, washed down with Apricot Seed Decoction.

Xionghuang San: Treats Zouma Gan (Running Horse Malnutrition) and痘毒 (Smallpox toxin) parasites eroding the anus.
Ingredients: Xionghuang (Realgar), Tonglv (Chalcitis). Each 2 qian.
Preparation: Grind into powder and sprinkle onto the sores.