小儿肛痒，或嗜甘肥，大肠湿热壅滞，或湿毒生虫，而蚀肛门。若因湿热壅滞，用四味肥儿
丸。大便秘结者，用清凉饮。虫食肛门，先用化虫丸，后用四味肥儿丸，外以雄黄散纳肛内
。若因病不食，虫无所养，而食脏食肛者，其齿龈无色，舌上尽白，四肢倦怠，其上唇内有疮
，唾血如粟，心内懊 ，此虫在上食脏。若下唇内有疮，此虫在下蚀肛门。若蚀肛透内者，
不治。诸虫惟上半月头向上，可用药追之。望后头向下，令患者闻烹食香味，虫头即向上矣
，后用药追之。
治验
一小儿嗜膏粱甘味，患疥疮，余谓当禁其浓味，急用清胃之药，以治其积热。不从，乃用敷
药以治其外，更肛门作痒发热，疮益甚，肌体骨立，饮食少思，遂用九味芦荟丸，五味异功
散加柴胡、升麻寻愈。
一小儿肛门作痒，耳前后结小核如贯珠，隐于肌肉之间，小便不调，面色青，此禀母之肝火
为患，用九味芦荟丸为主，佐以五味异功散加山栀、柴胡，又以加味逍遥散加漏芦与母服之
而愈。
一小儿十三岁，肛门作痒，或脱出，或大便血，遍身生疮，发热作渴，腹大青筋，用大芦荟
丸、五味异功散，其疮渐愈；佐以补中益气汤，热渴渐止，肛门悉愈；又用异功散为主，佐
以补中益气汤加吴茱萸所制黄连治之而血愈。
一小儿十五岁，两目白翳，遍身似疥非疥，肛门作痒，晡热作渴，形体骨立，余以为肝疳之
症也，用六味地黄丸而痊。后阴茎作痒，小便澄白，服蟠葱散，肛门肿痛，服大黄等药，肛
门脱出，作痒不可忍，杂用降火之药，不应，下唇内生小白疮，余以为虫蚀肛门，用九味芦
荟丸而愈。
一小儿肛门作痒，误以为痔，服槐角丸等药，肢体消瘦，鼻下湿烂，下唇内生疮，此虫食下
部也，先用化虫丸二服，乃用五味异功散四剂，却用大芜荑汤、四味肥儿丸而痊。
一小儿七岁，饮食过多即作泻，面色青黄，服峻利克剂，余谓当节饮食健脾胃为善。不信，
后牙龈赤烂，肛门作痒，服清热之剂，腹痛膨胀。复请欲用前剂，余曰∶此元气亏损，虚火
上炎也。仍不信，后腮间黑腐，余曰∶此脾气大虚，肉死而不知痛也明矣。后虽信余，已不
救矣。若初用五味异功散，健脾胃为主，佐以大芦荟丸、四味肥儿丸，清脾湿热，岂有不治
之理哉！后之患者审之。
一小儿肛门作痒，属大肠经风热，用槐角丸而愈。
一小儿肛门连阴囊痒，出水漓淋，属肝经湿热也，用龙胆泻肝汤、九味芦荟丸治之并愈。
一小儿嗜甘肥，肛门作痒，发热作渴，杂用清热之剂，腹胀少食，鼻下生疮，余谓脾胃湿热
生虫也。不信，后下唇内生疮，先用四味肥儿丸，诸症渐愈，又用大芜荑汤治之而痊。
小儿肛门瘙痒，有的因为嗜好甘甜油腻食物，导致大肠湿热壅滞；有的因为湿毒生虫，侵蚀肛门。如果是由于湿热壅滞引起的，使用四味肥儿丸。大便秘结的，使用清凉饮。如果是虫类侵蚀肛门，先用化虫丸，再用四味肥儿丸，外用雄黄散纳入肛门内。如果是因为生病不想吃东西，虫类没有食物可吃，转而吃内脏和肛门的，其齿龈颜色淡白无血色，舌面上全部发白，四肢倦怠无力，上唇内部有疮疡，吐出的唾液中有如粟米大小的血点，心中烦闷懊恼，这是虫在上部吃内脏的表现。如果下唇内部有疮疡，这是虫在下部侵蚀肛门。如果虫蚀穿透肛门内部，属于不治之症。各种虫类只有在上半月头部向上，可以用药物驱赶它们。下半月（望后）头部向下，让患者闻烹饪食物的香味，虫头就会向上，然后再用药驱赶。
治验案例：
一个小孩嗜好膏粱甘味，患有疥疮，我告诉他应当禁止食用浓烈滋味的食物，急忙用清胃的药物来治疗他的积热。他不听从，反而只用外敷药治疗体表症状，结果更加肛门瘙痒发热，疮疡更加严重，身体消瘦如柴，饮食减少思虑不足，于是我用九味芦荟丸、五味异功散加柴胡、升麻，不久就好了。
一个小孩肛门瘙痒，耳前后结成小核如串珠状，隐藏在肌肉之间，小便不调，面色青，这是因为禀受母亲的肝火为患，我用九味芦荟丸为主药，佐以五味异功散加山栀、柴胡，又让母亲服用加味逍遥散加漏芦，母子同治而痊愈。
一个十三岁的小孩，肛门瘙痒，有时脱出，有时大便出血，遍身生疮，发热口渴，腹部胀大且有青筋暴露，我用大芦荟丸、五味异功散，他的疮疡逐渐愈合；佐以补中益气汤，热渴逐渐停止，肛门完全愈合；后来又用异功散为主药，佐以补中益气汤加吴茱萸炮制的黄连来治疗，便血痊愈。
一个十五岁的小孩，两目出现白翳，遍身似疥非疥，肛门瘙痒，傍晚发热口渴，身体消瘦如柴，我认为这是肝疳的症状，用六味地黄丸治愈。后来阴茎瘙痒，小便浑浊色白，服用蟠葱散后，肛门肿痛，服用大黄等药，导致肛门脱出，瘙痒难忍，杂用降火的药物，没有效果，下唇内生小白疮，我认为这是虫蚀肛门，用九味芦荟丸治愈。
一个小孩肛门瘙痒，误以为是痔疮，服用槐角丸等药，肢体消瘦，鼻下湿烂，下唇内生疮，这是虫食下部所致，先用化虫丸服两次，再用五味异功散服四剂，随后用大芜荑汤、四味肥儿丸而痊愈。
一个七岁的小孩，饮食过多就腹泻，面色青黄，服用峻猛利下的药物，我告诉他应当节制饮食、健运脾胃为好。他不相信，后来牙龈赤烂，肛门瘙痒，服用清热药剂，腹痛腹胀。再次请我诊治想用前一种药剂，我说：“这是元气亏损，虚火上炎。”他仍不相信，后来腮间黑腐，我说：“这是脾气大虚，肌肉坏死而不知疼痛，明摆着的事。”后来虽然相信我，已经无法救治了。如果起初用五味异功散，以健脾胃为主，佐以大芦荟丸、四味肥儿丸，清脾湿热，哪有治不好的道理呢！后来的患者要仔细审察。
一个小孩肛门连阴囊瘙痒，出水淋漓，属于肝经湿热，用龙胆泻肝汤、九味芦荟丸治疗并痊愈。
一个小孩嗜好甘肥食物，肛门瘙痒，发热口渴，杂用清热药剂，腹胀少食，鼻下生疮，我认为是脾胃湿热生虫所致。他不相信，后来下唇内生疮，先用四味肥儿丸，诸症逐渐痊愈，又用大芜荑汤治疗而痊愈。
Pediatric anal pruritus may result from a preference for sweet and fatty foods, leading to damp-heat stagnation in the Large Intestine (Da Chang), or from damp-toxicity generating parasites that erode the anus. If caused by damp-heat stagnation, Siwei Fei'er Wan (Four-Ingredient Worm-Expelling Pill) is used. For cases with constipation, Qingliang Yin (Cooling Drink) is prescribed. If parasites are eroding the anus, Huachong Wan (Parasite-Dissolving Pill) is administered first, followed by Siwei Fei'er Wan, with Xionghuang San (Realgar Powder) applied externally into the anus. If the child refuses food due to illness, leaving no other food source for the parasites, they may consume internal organs and the anus. In such cases, the gums appear colorless, the tongue surface is entirely white, the limbs are fatigued, there are sores inside the upper lip, saliva contains blood spots like millet grains, and the heart feels vexed and restless; this indicates parasites feeding on organs in the upper body. If sores appear inside the lower lip, it indicates parasites eroding the anus below. If the erosion penetrates through the anus internally, it is incurable. Parasites generally have their heads pointing upward during the first half of the lunar month, allowing for expulsion via medication. During the second half of the month (after the full moon), their heads point downward; having the patient smell cooking food aromas will cause the parasite heads to turn upward, after which medication can be used for expulsion.
Case Records:
A child who indulged in rich and sweet foods developed scabies. I advised prohibiting strong-flavored foods and urgently prescribing stomach-clearing herbs to treat accumulated heat. The parents did not comply, opting instead for topical treatments only. Consequently, anal pruritus and fever worsened, the sores intensified, the body became emaciated ("bone-standing"), and appetite decreased. I then prescribed Jiwei Luluhuan (Nine-Ingredient Aloe Pill) and Wuwei Yigong San (Five-Ingredient Yi-Gong Powder) supplemented with Chaihu (Bupleuri Radix) and Shengma (Cimicifugae Rhizoma), resulting in recovery.
Another child presented with anal pruritus, small nodules resembling beads clustered around the ears and temples hidden within the muscles, irregular urination, and a bluish complexion. This was attributed to maternal Liver Fire (Gan Huo) inherited by the child. Treatment centered on Jiwei Luluhuan, assisted by Wuwei Yigong San augmented with Zhizi (Gardeniae Fructus) and Chaihu. The mother simultaneously took Jia Wei Xiaoyao San (Modified Free and Easy Wanderer Powder) with Loulu (Euphorbiae Humifusae Herba), leading to cure.
A thirteen-year-old child suffered from anal pruritus, occasional prolapse, hematochezia, generalized skin sores, fever with thirst, abdominal distension with visible subcutaneous veins. Da Luluhuan (Major Aloe Pill) and Wuwei Yigong San were used, gradually healing the sores. Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) was added, stopping the fever and thirst, and fully healing the anus. Subsequently, Yigong San served as the base, supplemented with Buzhong Yiqi Tang combined with Huanglian (Coptidis Rhizoma) processed with Wuzhuyu (Evodiae Fructus), curing the bleeding.
A fifteen-year-old child exhibited leukoma (white opacities on the cornea), generalized skin lesions resembling but distinct from scabies, anal pruritus, afternoon fever with thirst, and severe emaciation. I diagnosed this as Liver Caloric Disease (Gan Gan). Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) cured the condition. Later, penile pruritus and cloudy white urine occurred. Pancong San was taken, followed by Da Huang (Rhei Radix et Rhizoma), causing anal prolapse and unbearable pruritus. Various fire-draining herbs failed. Small white sores appeared inside the lower lip; diagnosing parasitic erosion, Jiwei Luluhuan cured the case.
Another child with anal pruritus was misdiagnosed with hemorrhoids and treated with Huaijiao Wan (Sophorae Fructus Immaturus Pill). This led to emaciation, moist rot under the nose, and sores inside the lower lip, indicating parasites attacking the lower region. Two doses of Huachong Wan were given first, followed by four doses of Wuwei Yigong San. Finally, Dayuanyi Tang (Major Tso-Woo Decoction) and Siwei Fei'er Wan restored health.
A seven-year-old child experienced diarrhea after overeating, with a greenish-yellow complexion. Harsh purgatives were administered. I advised dietary moderation and strengthening the Spleen and Stomach. Disregarding this, the child developed red and rotting gums and anal pruritus. Heat-clearing agents caused abdominal pain and bloating. Upon re-consultation, when asked to use previous remedies, I stated this was Yuan Qi (Primal Qi) deficiency with deflected Deficient Fire. Again disregarded, black necrosis appeared on the cheeks. I explained this was severe Spleen Qi deficiency with muscle death and loss of sensation. Although belief came later, it was too late to save the child. Had Wuwei Yigong San been used initially to strengthen the Spleen and Stomach, assisted by Da Luluhuan and Siwei Fei'er Wan to clear Spleen damp-heat, recovery would have been certain. Future patients should heed this.
A child with anal pruritus due to Wind-Heat in the Large Intestine Meridian was cured with Huaijiao Wan.
A child with anal and scrotal pruritus with dripping discharge, attributed to Damp-Heat in the Liver Meridian, was cured using Longdan Xiegan Tang (Gentian Decoction to Drain the Liver) and Jiwei Luluhuan.
A child fond of sweet and fatty foods presented with anal pruritus, fever, and thirst. Miscellaneous heat-clearing agents caused abdominal distension, poor appetite, and sores under the nose. I diagnosed Spleen-Stomach Damp-Heat generating parasites. Ignoring this, sores appeared inside the lower lip. Siwei Fei'er Wan was used first, resolving most symptoms, followed by Dayuanyi Tang for complete recovery.