仁斋曰∶小儿尿白，久则成疳，此因心膈伏热，或乳哺失节伤脾，使清浊不分故也。《全婴
方》云∶小便初溺微赤，良久白浊者，乃热疳之症也。初溺黄白，良久白浊者，冷疳之症也
。冷者，益黄散；热者，牛黄丸；冷热相兼者，芦荟丸。纯下白浊者，君朴丸。诸失津液，
欲成疳而小便白者，茯苓散。小便如泔，或良久变白，亦有脾虚食积湿热下注者，先用茯苓散
五七服，次用四味肥儿丸。若乳食少思，或腹肚胀大，小便频数，此脾虚元气下陷也，朝用
五味异功散，夕用四味肥儿丸。若肥体色黄，小便不调，发黄脱落，鼻下疮痍，嗜土少食，
大便青褐者，用栀子茯苓汤。仍审其乳母饮食七情治之。
治验
一小儿发热懒食，小便良久变白，余用四味肥儿丸即愈。或误以为积热，用清凉祛逐之剂，
形体顿弱，虚症悉至，小便如疳，用补中益气汤及四味肥儿丸而愈。
一小儿面色痿黄，眼胞微肿，作渴腹胀，饮食少思，小便澄白，大便不实，此脾疳之症也，
用四君子加山栀、芜荑，兼用四味肥儿丸而愈。
一女子小便或青或白，后前阴作痒出水，此肝经湿热，先用龙胆泻肝汤一剂，又以加味逍遥
散加龙胆草而愈。
一小儿两耳后脑下各结一核，小便白浊，面色痿黄，体倦口干，大便不调，用芦荟丸而愈。
后鼻外生疮作痒，小便仍白，视物不明，用四味肥儿丸而愈。
一小儿白浊，两耳内耳外生疮，脓水淋漓，先用大芦荟丸而愈。后遍身如疥，肌体消瘦，发
热作渴，大便酸臭，小便白浊，用九味芦荟丸、五味异功散而愈。
一小儿白浊，形气甚虚，发热作渴，余谓肝肾虚羸也。用大芦荟丸、地黄丸而愈。毕姻后，
小便仍白，唾痰发热，形气益虚，用大剂益气汤、六味丸，各五十余剂而愈。
一小儿白浊，发热口干，体瘦骨立。余谓肾经虚羸，朝用补中益气汤，夕用六味地黄丸而愈
。后两目或生白翳，面黄浮肿，小便仍白，此变肝脾疳症，用四味肥儿丸，月余渐瘥。
君朴丸 治小儿小便白浊，久则黄瘦，不长肌肉。
使君子（煨） 浓朴（制） 黄连（各一两） 木香（三钱）
上为末，蒸饼糊丸，桐子大。每服一二十丸，米汤下。
茯苓散 治乳食伤脾，或心经伏热，小便白浊。
三棱（煨） 蓬术（煨） 砂仁 赤茯苓（各半两） 青皮 陈皮 滑石 甘草（各一钱五分）
上为末，每服一钱，灯心汤调下。
三棱散 治小儿尿白，久则成疳，宜补脾消食化积。
三棱 蓬术（各一两，炒） 益智仁 甘草 神曲（炒） 麦芽 橘皮（各半两）
上为末，每服一钱，白汤送下。
厘清饮 治小便余沥，并赤白浊。
益智仁 川萆 石菖蒲（盐炒） 乌药 茯苓 白芍药（各三分）
上入灯心水煎。
清心莲子饮 治发热口干，小便白浊，夜则安静，昼则发热。
黄芩 麦门冬 地骨皮 车前子 甘草（各三钱半） 石莲肉 茯苓 黄 柴胡 人参（各二钱五分）
上每服二钱，水煎服。
栀子茯苓汤（即大芜荑汤，方见诸疳症）
大安丸（即保和丸加白术）
补中益气汤（二方见虚羸）
龙胆泻肝汤（方见疝气）
加味逍遥散
异功散
四君子汤（三方见内钓）
益黄散（方见脾脏）
牛黄丸（方见惊痫）
芦荟丸（方见疳症）
仁斋说：小儿尿液发白，时间久了会发展成疳积病，这是因为心膈间有潜伏的热邪，或者哺乳喂养不当损伤了脾胃，导致清浊之气不能正常分离的缘故。《全婴方》记载：小便刚开始排尿时颜色微红，过一会儿变浑浊发白的，是热疳的症状；刚开始排尿时黄白相间，过一会儿变浑浊发白的，是冷疳的症状。属于冷疳的，用益黄散治疗；属于热疳的，用牛黄丸治疗；冷热夹杂的，用芦荟丸治疗。纯粹排出白色浑浊物的，用君朴丸治疗。凡是津液亏损，快要形成疳积且小便发白的，用茯苓散治疗。小便像米泔水一样，或者放置久了变白的，也有因脾虚、食积、湿热下注引起的，先用茯苓散服用五到七次，接着用四味肥儿丸治疗。如果吃奶吃饭没胃口，或者肚子胀大，小便频繁，这是脾虚导致元气下陷，早上用五味异功散，晚上用四味肥儿丸。如果身体肥胖但面色发黄，小便不调，头发发黄脱落，鼻子下面生疮，喜欢吃泥土且食欲减退，大便呈青褐色的，用栀子茯苓汤治疗。同时还要审视乳母的饮食和情绪变化来进行调理。
治验案例：
有一个小孩发热、不想吃东西，小便过一会儿变白，我用四味肥儿丸治疗后痊愈。有人误以为是积热，用了清凉攻逐的药物，导致孩子形体顿时虚弱，各种虚症都出现了，小便像疳积那样浑浊，后来用补中益气汤配合四味肥儿丸才治愈。
有一个小孩面色萎黄，眼睑微微肿胀，口渴腹胀，饮食减少，小便清澈发白，大便不成形，这是脾疳的症状，我用四君子汤加上山栀、芜荑，同时配合四味肥儿丸治疗而痊愈。
有一个女孩小便有时青色有时白色，随后前阴瘙痒并流出液体，这是肝经湿热所致，先用龙胆泻肝汤一剂，又用加味逍遥散加入龙胆草治疗而痊愈。
有一个小孩两耳后脑勺下方各结了一个肿块，小便白浊，面色萎黄，身体疲倦口干，大便不调，用芦荟丸治疗而痊愈。后来鼻外生疮瘙痒，小便仍然发白，视物不清，用四味肥儿丸治疗而痊愈。
有一个小孩患白浊，两耳内耳外生疮，脓水淋漓，先用大芦荟丸治疗而痊愈。后来全身像疥疮一样，肌肉消瘦，发热口渴，大便酸臭，小便白浊，用九味芦荟丸、五味异功散治疗而痊愈。
有一个小孩患白浊，形体气息非常虚弱，发热口渴，我认为这是肝肾虚损。用大芦荟丸、地黄丸治疗而痊愈。结婚后，小便仍然发白，吐痰发热，气息更加虚弱，用大剂量的益气汤、六味丸，各服用五十多剂才痊愈。
有一个小孩患白浊，发热口干，身体瘦弱骨骼突出。我认为这是肾经虚损，早上用补中益气汤，晚上用六味地黄丸治疗而痊愈。后来两眼有时生白翳，面黄浮肿，小便仍然发白，这变成了肝脾疳症，用四味肥儿丸，一个多月逐渐好转。
君朴丸 治疗小儿小便白浊，时间久了身体黄瘦，不长肌肉。
使君子（煨制） 浓朴（炮制） 黄连（各一两） 木香（三钱）
以上研为细末，用蒸饼糊做成丸药，如梧桐子大小。每次服用一二十丸，米汤送服。
茯苓散 治疗乳食损伤脾胃，或心经潜伏热邪，导致小便白浊。
三棱（煨制） 蓬术（煨制） 砂仁 赤茯苓（各半两） 青皮 陈皮 滑石 甘草（各一钱五分）
以上研为细末，每次服用一钱，灯心草汤调服。
三棱散 治疗小儿尿白，时间久了形成疳积，应当补脾消食化积。
三棱 蓬术（各一两，炒制） 益智仁 甘草 神曲（炒制） 麦芽 橘皮（各半两）
以上研为细末，每次服用一钱，白开水送服。
厘清饮 治疗小便余沥不尽，以及赤白浊。
益智仁 川萆薢 石菖蒲（盐炒） 乌药 茯苓 白芍药（各三分）
以上加入灯心草和水煎煮。
清心莲子饮 治疗发热口干，小便白浊，夜间安静，白天发热。
黄芩 麦门冬 地骨皮 车前子 甘草（各三钱半） 石莲肉 茯苓 黄芪 柴胡 人参（各二钱五分）
以上每次服用二钱，水煎服。
栀子茯苓汤（即大芜荑汤，方剂见诸疳症章节）
大安丸（即保和丸加白术）
补中益气汤（两个方剂见虚羸章节）
龙胆泻肝汤（方剂见疝气章节）
加味逍遥散
异功散
四君子汤（三个方剂见内钓章节）
益黄散（方剂见脾脏章节）
牛黄丸（方剂见惊痫章节）
芦荟丸（方剂见疳症章节）
Ren Zhai stated: When an infant's urine is white, if left untreated for a long time, it may develop into *Gan* syndrome (a chronic malnutrition and digestive disorder in children). This is caused by latent heat in the heart and diaphragm, or by improper breastfeeding and feeding that damages the spleen, resulting in the failure to separate clear from turbid qi. The *Quan Ying Fang* records: If the urine is slightly reddish at the beginning of urination and becomes turbid and white after a while, it is a symptom of Heat *Gan*. If the urine is yellowish-white initially and becomes turbid and white after a while, it is a symptom of Cold *Gan*. For Cold cases, use Yihuang San; for Heat cases, use Niuhuang Wan; for mixed cold-heat cases, use Lushui Wan. For pure white turbidity, use Junpu Wan. For cases where body fluids are depleted and *Gan* syndrome is impending with white urine, use Fuling San. If the urine resembles rice water or turns white after standing, it may also be due to spleen deficiency, food stagnation, and damp-heat pouring downward. Initially, administer Fuling San five to seven times, followed by Simei Fei'er Wan. If there is poor appetite for milk and food, abdominal distension, and frequent urination, this indicates spleen deficiency with sinking of primordial qi. Use Wumei Yigong San in the morning and Simei Fei'er Wan in the evening. If the child is obese but has a sallow complexion, irregular urination, yellowing and loss of hair, sores under the nose, pica (craving earth), reduced appetite, and dark green-brown stools, use Zhizi Fuling Tang. Additionally, examine the wet nurse's diet and emotional state for treatment.
Clinical Cases:
One infant presented with fever and anorexia, and his urine turned white after a while. I treated him with Simei Fei'er Wan, and he recovered. Someone mistakenly attributed this to accumulated heat and used cooling purgatives, causing the child's physique to weaken instantly and various deficiency symptoms to appear, with urine becoming turbid like in *Gan* syndrome. He was subsequently cured using Buzhong Yiqi Tang combined with Simei Fei'er Wan.
One infant presented with a sallow complexion, slightly swollen eyelids, thirst, abdominal distension, reduced appetite, clear white urine, and loose stools. This was diagnosed as Spleen *Gan* syndrome. I treated him with Sizijunzi Tang added with Gardenia (*Shanzhi*) and Coir Fruit (*Wuyi*), along with Simei Fei'er Wan, and he recovered.
One girl presented with urine that was sometimes blue-green and sometimes white, followed by itching and discharge from the anterior yin. This was diagnosed as damp-heat in the Liver channel. She was first treated with one dose of Longdan Xiegan Tang, and then cured with Jiawei Xiaoyao San added with Gentian Root (*Longdancao*).
One infant had nodules formed below each ear on the back of the head, white turbid urine, a sallow complexion, fatigue, dry mouth, and irregular stools. He was cured with Lushui Wan. Later, sores appeared outside the nose with itching, the urine remained white, and vision was unclear. He was cured with Simei Fei'er Wan.
One infant with white turbidity had sores inside and outside both ears with dripping pus. He was first cured with Da Lushui Wan. Later, his whole body resembled scabies, he became emaciated, had fever and thirst, sour-smelling stools, and white turbid urine. He was cured with Jiwei Lushui Wan and Wumei Yigong San.
One infant with white turbidity had very deficient form and qi, fever, and thirst. I diagnosed this as deficiency and emaciation of the Liver and Kidney. He was cured with Da Lushui Wan and Dihuang Wan. After marriage, his urine remained white, he expectorated phlegm, had fever, and his qi became even more deficient. He was cured with large doses of Yiqi Tang and Liuwei Wan, taking over fifty doses of each.
One infant with white turbidity had fever, dry mouth, and a thin, skeletal body. I diagnosed this as deficiency of the Kidney channel. He was treated with Buzhong Yiqi Tang in the morning and Liuwei Dihuang Wan in the evening, and he recovered. Later, white films occasionally appeared on his eyes, his face was yellow and edematous, and his urine remained white. This transformed into Liver-Spleen *Gan* syndrome. He was treated with Simei Fei'er Wan and gradually improved over a month.
Junpu Wan: Treats pediatric white turbid urine, which if prolonged leads to sallow emaciation and lack of muscle growth.
Shijunzi (roasted) Houpo (processed) Huanglian (each 1 liang) Muxiang (3 qian)
Grind into powder, make pills with steamed bread paste, size of paulownia seeds. Take 10-20 pills per dose, washed down with rice soup.
Fuling San: Treats spleen injury from milk/food, or latent heat in the Heart channel, causing white turbid urine.
Sanleng (roasted) Pengzhu (roasted) Sharen Chifuling (each 0.5 liang) Qingpi Chenpi Shigao Gancao (each 1.5 qian)
Grind into powder. Take 1 qian per dose, mixed with Dengxincao (Juncus effusus) decoction.
Sanleng San: Treats pediatric white urine, which if prolonged forms *Gan* syndrome. It should tonify the spleen, resolve food, and transform accumulation.
Sanleng Pengzhu (each 1 liang, stir-fried) Yizhiren Gancao Shenqu (stir-fried) Maiya Jupi (each 0.5 liang)
Grind into powder. Take 1 qian per dose, washed down with warm water.
Liqing Yin: Treats dribbling after urination, and red/white turbidity.
Yizhiren Chuanbi Shi Changpu (salt-fried) Wuyao Fuling Baishao (each 3 fen)
Decoct with Dengxincao (Juncus effusus) and water.
Qingxin Lianzi Yin: Treats fever, dry mouth, white turbid urine, quietness at night, and fever during the day.
Huangqin Maidong Digupi Cheqianzi Gancao (each 3.5 qian) Shilianrou Fuling Huangqi Chaihu Renshen (each 2.5 qian)
Take 2 qian per dose, decoct in water and drink.
Zhizi Fuling Tang (Same as Da Wuyi Tang, see chapter on Various *Gan* Syndromes)
Da'an Wan (Same as Baohe Wan plus Atractylodes Macrocephala / Baizhu)
Buzhong Yiqi Tang (See two formulas in Deficiency and Emaciation chapter)
Longdan Xiegan Tang (See formula in Hernia chapter)
Jiawei Xiaoyao San
Yigong San
Sizijunzi Tang (See three formulas in Internal Hook chapter)
Yihuang San (See formula in Spleen Organ chapter)
Niuhuang Wan (See formula in Startled Epilepsy chapter)
Lushui Wan (See formula in *Gan* Syndrome chapter)