甲、概况
小儿二便下血，宜分虚实。凡大便下血，初起多为肥甘积热，蕴蓄于肠，传化失职，以致便血。无论色紫
色鲜，当从实治。下血日久，或粪前先下，或粪后淋出，爽而不痛者，当从虚治。粪中杂有赤白似冻者，则
为痢疾。凡便血之类，不论先后，血是血粪是粪者，此为大肠之血，虽多无碍，若有血点血丝混于
粪内者，当防其为小肠之血，最为难治。放下血之轻重，不能遽以多少断也。凡小便溲血，初起多为心经有
热，由小肠传导而下，当从实治。肾亏而下者，血液全混于小便之中，当从虚治。然小儿二便下血，非习见
之病，或由跌仆伤其腰腑，或由玩弄伤其尿道，亦间有之。凡此外来之因，一时未能诊得，故治病之
始，当先问其源，庶几着手较易也。
乙、治法
大便下血，初起宜用槐花、银花各三钱，神曲、山楂炒炭各二钱，加五倍子，以凉血清热，消食化积，
多者加黑荆芥、侧柏炭以止之。便血日久者宜四君子汤加川连，或用补中益气汤以升提之。赤白似冻，当从
痢治（参看第八章）。小便溲血，初起宜清心经之热，用导赤散或清心莲子饮。肾亏而下，病后所致者，
宜用黄 、旱莲草、枸杞子、补骨脂之类以固之。若虚而有热者，用六味地黄丸。因损伤溲血者，腰腑受
伤，宜用杜仲、川断之类，佐以和血养血之剂。尿道受伤，宜用大豆、甘草、 蓄
草、赤芍、生地、车前子以和养清利；伤于外部者，则以大豆甘草汤洗之。
附方
（一）四君子汤 见第三章第五节。
（二）补中益气汤 见第四章第四节。
（三）导赤散 见第四章第一节。
（四）清心莲子饮 治上盛下虚，心火炎上，口苦咽干，心烦发渴，及膀胱气虚湿热，阴茎肿痛，
或茎窍涩滞，小便赤或白浊。亦治妇人积热血崩，白浊带下。
石莲肉（去心） 白茯苓 黄 （蜜炙） 人参（各七分五厘） 黄芩 麦
冬（去心） 地骨皮 车前子（炒） 甘草（炙。各一钱）
清水煎服。
（五）六味地黄丸 见第三章第五节。
（六）大豆甘草汤 外用。止痒消疼，解毒。治各种疳疮。
黑豆（一合） 生甘草（一两） 赤皮葱（三茎） 槐条（六十寸）
清水煎汤，候温洗之。
甲、概况
小儿大小便出血，应当区分虚证和实证。凡是排便时出血，初起大多是因为过食肥甘厚味导致积热，蕴结在肠道，致使传化功能失职，从而引起便血。无论血色紫暗还是鲜红，都应当按照实证来治疗。如果下血时间较长，或者在大便之前先出血，或者在大便之后淋漓流出，且通畅无痛感，就应当按照虚证来治疗。粪便中混杂有像冻胶一样的赤白物质，这就是痢疾。凡是便血之类的情况，不论出血先后，只要血是血、粪是粪，互不混合的，这是大肠出血，即使量多也无大碍；如果有血点或血丝混在粪便里面的，应当防备是小肠出血，这种最为难治。判断便血的轻重，不能仅仅根据出血量的多少来断定。凡是小便带血，初起大多是因为心经有热，通过小肠传导而下，应当从实证治疗。如果是肾虚导致的下血，血液会完全混入小便之中，应当从虚证治疗。然而小儿大小便出血并不是常见的疾病，有的可能是因为跌打损伤腰部脏腑，有的是因为玩弄损伤尿道，也有偶尔发生的。凡是有这些外来致病因素，一时未能诊断清楚，所以在治病之初，应当先询问病因源头，这样着手治疗才比较容易。
乙、治法
大便下血，初起宜用槐花、金银花各三钱，神曲、山楂炒炭各二钱，加入五倍子，以凉血清热，消食化积，血量多的加黑荆芥、侧柏炭以止血。便血日久者宜用四君子汤加黄连，或者用补中益气汤以升提阳气。粪便中赤白相兼像冻胶一样，应当按痢疾治疗（参看第八章）。小便带血，初起宜清心经之热，用导赤散或清心莲子饮。因肾虚而下血，或者是病后导致的，宜用黄耆、旱莲草、枸杞子、补骨脂之类以固摄。如果虚证兼有热象，用六味地黄丸。因损伤导致小便出血的，腰部脏腑受伤，宜用杜仲、川断之类，佐以和血养血的药剂。尿道受伤，宜用大豆、甘草、萹蓄草、赤芍、生地、车前子以调和滋养并清利湿热；外部受伤，则用大豆甘草汤清洗。
附方
（一）四君子汤 见第三章第五节。
（二）补中益气汤 见第四章第四节。
（三）导赤散 见第四章第一节。
（四）清心莲子饮 治疗上盛下虚，心火炎上，口苦咽干，心烦发渴，以及膀胱气虚湿热，阴茎肿痛，或者尿道涩滞，小便赤色或白浊。也治疗妇人积热血崩，白浊带下。
石莲肉（去心） 白茯苓 黄耆（蜜炙） 人参（各七分五厘） 黄芩 麦冬（去心） 地骨皮 车前子（炒） 甘草（炙。各一钱）
清水煎服。
（五）六味地黄丸 见第三章第五节。
（六）大豆甘草汤 外用。止痒消痛，解毒。治疗各种疳疮。
黑豆（一合） 生甘草（一两） 赤皮葱（三茎） 槐条（六十寸）
清水煎汤，候温洗之。
A. Overview
Hematochezia and hematuria in children should be differentiated into deficiency (Xu) and excess (Shi) patterns. Hematochezia at the onset is mostly caused by heat accumulation from overconsumption of rich and sweet foods, which stagnates in the intestines, impairing their transportation and transformation functions, thereby leading to bleeding. Regardless of whether the blood color is dark purple or bright red, it should be treated as an excess pattern. If bleeding persists for a long time, or occurs before defecation, or drips after defecation with a smooth flow and no pain, it should be treated as a deficiency pattern. If the stool contains red and white substances resembling jelly, it is dysentery. Regarding hematochezia, if the blood and stool are separate regardless of the order of occurrence, this indicates large intestine bleeding; even if the volume is large, it is generally not dangerous. However, if blood spots or threads are mixed within the stool, one must guard against small intestine bleeding, which is the most difficult to treat. The severity of hematochezia cannot be judged solely by the amount of blood. Hematuria at the onset is mostly due to heat in the Heart Meridian, transmitted downward via the Small Intestine, and should be treated as an excess pattern. If caused by Kidney deficiency, the blood mixes completely with urine, and should be treated as a deficiency pattern. However, hematochezia and hematuria in children are not common diseases. They may result from falls injuring the waist and viscera, or from playing causing urethral injury, though such cases are occasional. When external causes cannot be immediately diagnosed, it is essential to inquire about the origin of the disease at the beginning of treatment to facilitate easier intervention.
B. Treatment Methods
For initial hematochezia, use Huaihua (Sophorae Flos) and Yinhua (Lonicerae Japonicae Flos), each 3 qian, Shenqu (Medicated Leaven) and Shanzha (Crataegi Fructus) stir-fried to charcoal, each 2 qian, plus Wubeizi (Galae Chinensis), to cool the blood and clear heat, digest food and resolve accumulation. For heavy bleeding, add Hei Jingjie (Schizonepetae Herba Carbonisata) and Cebaiye Tan (Platycladi Cacumen Carbonisatum) to stop bleeding. For chronic hematochezia, use Sijunzi Tang (Four Gentlemen Decoction) with Chuanlian (Coptidis Rhizoma), or Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) to raise the Qi. For stool resembling red and white jelly, treat as dysentery (see Chapter 8). For initial hematuria, clear Heat from the Heart Meridian using Daochi San (Guide Out the Red Powder) or Qingxin Lianzi Yin (Clear the Heart Lotus Seed Decoction). For bleeding due to Kidney deficiency or post-illness, use Huangqi (Astragali Radix), Hanliancao (Ecliptae Herba), Gouqizi (Lycii Fructus), and Buguzhi (Psoraleae Fructus) to consolidate. For deficiency patterns with heat, use Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia). For hematuria due to trauma involving injury to the waist and viscera, use Duzhong (Eucommiae Cortex) and Chuanduan (Dipsaci Radix), assisted by formulas that harmonize and nourish the blood. For urethral injury, use Dadou (Sojae Semen Nigrum), Gancao (Glycyrrhizae Radix et Rhizoma), Pianxucao (Polygoni Avicularis Herba), Chishao (Paeoniae Radix Rubra), Shengdi (Rehmanniae Radix), and Cheqianzi (Plantaginis Semen) to harmonize, nourish, and promote urination to clear damp-heat. For external injuries, wash with Dadou Gancao Tang (Soybean and Licorice Decoction).
Appendix Formulas
(1) Sijunzi Tang (Four Gentlemen Decoction): See Chapter 3, Section 5.
(2) Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction): See Chapter 4, Section 4.
(3) Daochi San (Guide Out the Red Powder): See Chapter 4, Section 1.
(4) Qingxin Lianzi Yin (Clear the Heart Lotus Seed Decoction): Treats upper excess and lower deficiency, flaming Heart Fire manifesting as bitter taste and dry throat, irritability, thirst, and Bladder Qi deficiency with damp-heat causing penile swelling and pain, or urinary obstruction, red urine, or cloudy urine. Also treats women with accumulated heat causing metrorrhagia, leukorrhea, and cloudy discharge.
Shilianrou (Nelumbinis Plumula, heart removed) Baifuling (Poria), Huangqi (Astragali Radix, honey-fried), Renshen (Ginseng Radix et Rhizoma) (each 7.5 li), Huangqin (Scutellariae Radix), Maidong (Ophiopogonis Radix, heart removed), Digupi (Lycii Cortex), Cheqianzi (Plantaginis Semen, stir-fried), Gancao (Glycyrrhizae Radix et Rhizoma, roasted) (each 1 qian).
Decoct in clear water and take orally.
(5) Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia): See Chapter 3, Section 5.
(6) Dadou Gancao Tang (Soybean and Licorice Decoction): For external use. Relieves itching and pain, detoxifies. Treats various gan sores.
Heidou (Sojae Semen Nigrum, 1 he), Sheng Gancao (Raw Glycyrrhizae Radix et Rhizoma, 1 liang), Chipicong (Allium fistulosum with red skin, 3 stalks), Huaitiao (Catalpae Ramulus, 60 cun).
Decoct in clear water, wait until warm, and wash.