议曰∶调理婴孩伤寒体热，头目昏沉，不思饮食，夹惊夹食，寒热，大小便闭涩不通，烦躁作渴，冷汗妄流，夹积
伤滞，膈满胀急，青黄体瘦，日夜大热，及疗伤风、伤暑、惊痫、客忤、肾脏疳气等热，并宜脱甲散主之。亦可服大连
翘汤加大黄神芎，治小儿惊风积热，大小便涩滞，其效尤速。又掩脐法，用连根葱一根，不洗带泥，生姜一片，豆豉二
十一粒，盐二匙，同研烂捏饼，烘热掩脐中，以绵扎定，良久气透自通，不然另换一剂。小便不通、亦可前二问通用。
脱甲散 见第五十三问。
大连翘汤 见第三问大连翘饮子。
神芎丸 见第二十问。
掩脐法 治大小便不通。
海蛳（四十九粒） 葱根（带土、七个） 黑豆（七个） 盐（少许）
上同研烂，捏成一饼，烘热放脐上，以帛扎定，久则自通。
巢氏云∶小儿诸淋者、肾与膀胱热也，膀胱与肾为表里，俱主水，水入小肠，下于胞，行于阴、为小便也，膀胱热，
则津液内溢，水道不通，停积于胞，肾气热则涩，故令水道不利，小便淋沥，故谓之淋。其状小便出少而数，其小腹急
痛引脐是也，又有石淋、气淋、热淋、血淋、寒淋，五淋形症，各有说焉。其石淋者、淋而出砂石也，肾为热所乘，则
化为石，小便茎中痛，尿不能卒出，时自痛引膀胱里急，砂石从小便道出也。其气淋者，肾与膀胱受肺之热气则胀，气
为热所乘，故流入膀胱，则气壅不散，小腹气满，水不宣利，故小便涩而成淋也。其热淋者，三焦有热气传于肾与膀胱，
故热气流入于胞而成淋也。其血淋者，是热之盛，甚则尿血，谓之血淋。心主血、其热甚者，血则散漫失其常经，渗溢
入胞而成血淋矣。若热淋者、其病状先寒战然后尿是也。小儿取冷过度，下焦受之，冷气入胞与正气交争，寒气正气相
胜则战，寒气解，故得小便也。治淋之法，金沙散立效，五苓散、木通散等剂，机变用药，必可求痊，导赤散亦效，
与大方脉相参用药，不亦可乎。
金沙散 治小儿小便淋沥不通。
郁金 海金沙 滑石 甘草（各等分）
上为末，三岁儿一钱，煎落帚汤调下，灯心木通汤亦可。冬瓜。最治小儿小便不通，淋沥并渴。
立效散 治小儿诸淋不通，茎中疼痛。
木通 甘草 白孩儿花（一名王不留行） 胡荽 滑石 海金沙 山栀 槟榔（各等分）
上锉散，每服二钱，水半盏，煎三分，去滓服。
木通散 见第七十四问。
按语说：调理婴幼儿伤寒引起的身体发热、头目昏沉、不想进食，兼有惊风或食积，忽冷忽热，大小便闭塞不通，烦躁口渴，冷汗不止，以及因积滞损伤导致的胸膈胀满急迫、面色青黄、身体消瘦、日夜高热，还有治疗伤风、伤暑、惊痫、客忤（外邪侵袭）、肾脏疳气等热证，都适宜用脱甲散作为主方。也可以服用大连翘汤加大黄、神芎丸，用来治疗小儿惊风积热导致的大小便涩滞不通，疗效尤其迅速。另外采用掩脐法，取一根带根的葱（不洗，带着泥土），一片生姜，二十一粒豆豉，两匙盐，一起捣烂捏成饼状，加热后敷在肚脐上，用棉布扎紧固定，过一段时间后气机通畅自然就能排便排尿，如果不行再换一剂。小便不通的情况，也可以参考前两个问题的通用方法。脱甲散见第五十三问。大连翘汤见第三问的大连翘饮子。神芎丸见第二十问。掩脐法用于治疗大小便不通。海蛳（四十九粒）、葱根（带土七个）、黑豆（七个）、盐（少许）。以上药物一起捣烂，捏成一个饼，加热后放在肚脐上，用布帛扎紧固定，时间久了自然会通畅。
巢元方说：小儿的各种淋证，是肾与膀胱有热所致。膀胱与肾互为表里，都主管水液代谢。水进入小肠后，下行进入胞（此处指尿胞/膀胱），通过阴部排出成为小便。如果膀胱有热，津液就会内溢，水道不通畅，停滞积聚在胞中；肾气有热则会导致尿道涩滞，所以使水道不利，小便淋漓不尽，因此称为“淋”。其症状是小便量少且次数频繁，小腹部急痛牵引到肚脐。此外还有石淋、气淋、热淋、血淋、寒淋五种淋证，它们的形态和症状各有不同。所谓石淋，就是排尿时伴有砂石排出。肾被热邪侵犯，尿液中的杂质化为结石，小便茎中疼痛，尿液不能突然排出，时常疼痛牵引至膀胱内部感到急迫，砂石从小便道排出。所谓气淋，是肾与膀胱受到肺的热气影响而胀满，气被热邪所乘，流入膀胱后气机壅塞不散，小腹胀满，水液不能宣通利下，所以小便涩滞而成淋。所谓热淋，是三焦有热气传导给肾与膀胱，热气流入胞中形成淋证。所谓血淋，是热势极盛，严重时会尿血，称为血淋。心主血脉，如果热势极盛，血液就会散漫失去正常的运行轨道，渗漏溢出进入胞中形成血淋。如果是热淋，其病症表现是先出现寒战然后才排尿。小儿如果过度贪凉，下焦受寒，寒气侵入胞中与正气交争，寒气与正气相胜则发生寒战，寒气消散后，才能排出小便。治疗淋证的方法，金沙散立竿见影，五苓散、木通散等方剂，根据病情灵活用药，必定可以痊愈，导赤散也有效，与大儿科（大方脉）的用药原则相互参照，不也是很好的吗？
金沙散：治疗小儿小便淋漓不通。郁金、海金沙、滑石、甘草（各等分）。以上药物研成粉末，三岁的幼儿服用一钱，用落帚汤调服，灯心草、木通汤也可以。冬瓜最能治疗小儿小便不通、淋沥并伴有口渴。
立效散：治疗小儿各种淋证不通，尿道疼痛。木通、甘草、白孩儿花（一名王不留行）、胡荽、滑石、海金沙、山栀、槟榔（各等分）。以上药物切碎，每次服用二钱，用水半盏，煎煮至三分之一，去渣服用。
木通散见第七十四问。
Commentary states: To regulate infantile typhoid fever causing body heat, dizziness and heaviness of the head and eyes, loss of appetite, conditions complicated by fright or food stagnation, alternating chills and fever, obstruction and difficulty in urination and defecation, irritability and thirst, profuse cold sweating, as well as chest and diaphragm fullness and urgency caused by food retention injury and stagnation, greenish-yellow complexion with emaciation, high fever day and night, and also to treat heat syndromes such as wind-cold injury, summerheat injury, fright convulsion, external pathogenic invasion (Ke Wu), and kidney-type malnutrition syndrome (Gan Qi), all are suitable to be primarily treated with Tuojia San (Shell-Removing Powder). Alternatively, Dalianqiao Tang (Great Lonicera Decoction) combined with Dahuang (Rhubarb Rhizome) and Shenxiong Wan (Divine Xiong Pill) can be taken to treat infantile fright wind and accumulated heat causing sluggish urination and defecation, which yields particularly rapid effects. Another method is the Navel-Covering Method (Yan Qi Fa): take one scallion with roots (unwashed, with soil attached), one slice of fresh ginger, twenty-one fermented soybeans (Douchi), and two spoonfuls of salt; grind them together into a paste, shape into a cake, warm it, and apply it to the umbilicus, securing it firmly with cotton cloth. After a while, if qi circulation penetrates through, bowel movement and urination will naturally resume; otherwise, prepare another dose. For urinary obstruction, the general methods from the previous two questions can also be applied. Tuojia San is described in Question 53. Dalianqiao Tang is described in Question 3 under Dalianqiao Yinzi (Great Lonicera Drink). Shenxiong Wan is described in Question 20. Yan Qi Fa (Navel-Covering Method) treats urinary and fecal obstruction.
Ingredients for Navel-Covering Method: Haishi (Terebralia palustris Shell, 49 grains), Congen (Scallion Root with soil, 7 stalks), Heidou (Black Soybean, 7 grains), Yanshao (Salt, a little). Grind all ingredients together into a paste, shape into a cake, warm it, place on the umbilicus, and secure tightly with cloth. After a long time, it will naturally become unobstructed.
Chao Yuanfang stated: Various types of Lin syndrome (strangury) in children are caused by heat in the Kidney and Bladder. The Bladder and Kidney are interior-exteriorly related and both govern water metabolism. Water enters the Small Intestine, descends into the Bao (uterus/bladder), travels through the yin organs, and is excreted as urine. If there is heat in the Bladder, body fluids overflow internally, the water passages become obstructed, and fluid stagnates and accumulates in the Bao. If Kidney qi is hot, it causes涩 (astringency/sluggishness), leading to impaired water passage and dribbling urine, hence termed "Lin". The symptoms include small amounts of frequent urination, acute pain in the lower abdomen radiating to the umbilicus. There are also five types of Lin: Shi Lin (Stone Strangury), Qi Lin (Qi Strangury), Re Lin (Heat Strangury), Xue Lin (Blood Strangury), and Han Lin (Cold Strangury), each with distinct manifestations.
Shi Lin (Stone Strangury) involves passing sand or stones during urination. When the Kidney is invaded by heat, impurities in urine transform into stones. This causes pain in the urethral meatus, inability to pass urine suddenly, frequent pain radiating to the interior of the Bladder with a sense of urgency, and the passage of sand/stones via the urinary tract.
Qi Lin (Qi Strangury) occurs when the Kidney and Bladder are affected by heat qi from the Lung, causing distension. Qi, overwhelmed by heat, flows into the Bladder, where it becomes congested and fails to disperse, resulting in lower abdominal fullness. Since water cannot be freely promoted and drained, urination becomes sluggish, forming Lin syndrome.
Re Lin (Heat Strangury) arises when heat qi from the Triple Burner transmits to the Kidney and Bladder, flowing into the Bao and forming Lin syndrome.
Xue Lin (Blood Strangury) results from excessive heat; when severe, it causes hematuria. The Heart governs blood; when heat is extreme, blood scatters and deviates from its normal channels,渗溢 (oozing and overflowing) into the Bao, forming Blood Strangury.
If it is Re Lin, the initial symptom is chills/shivering followed by urination. If children consume too much cold, the Lower Jiao is affected, cold qi enters the Bao and contends with healthy qi. The struggle between cold qi and healthy qi causes shivering; once the cold qi dissipates, urination can proceed.
The treatment principle for Lin syndrome is that Jinsha San (Golden Sand Powder) acts immediately. Formulas such as Wuling San (Five-Ingredient Powder with Poria) and Mutong San (Akebia Decoction) can be used with flexible adjustments to ensure recovery. Daochi San (Guide Out Red Powder) is also effective. Referencing these with the principles of adult medicine (Da Fang Mai) for medication selection is advisable.
Jinsha San: Treats infantile dribbling and obstruction of urine. Ingredients: Yujin (Curcuma Radix), Haijinsha (Lygodium Spore), Huashi (Talcum), Gancao (Licorice Root) in equal parts. Grind into powder. For a three-year-old child, administer one qian, mixed with Luoshu Tang (Broom Tea) or Dengxin/Mutong Tang (Juncus/Akebia Decoction). Winter Melon (Donggua) is most effective for treating infantile urinary obstruction, dribbling, and thirst.
Lixiao San: Treats various types of infantile Lin syndrome obstruction and pain in the urethra. Ingredients: Mutong (Akebia Caulis), Gancao (Licorice Root), Baihaierhua (Vincetoxicum officinale root/Vitex fruit, also known as Wangbuliuxing), Huisu (Coriander), Huashi (Talcum), Haijinsha (Lygodium Spore), Shanzhi (Gardenia Fruit), Binglang (Areca Seed) in equal parts. Cut into pieces. Take two qian per dose, add half zhan of water, decoct until one-third remains, strain, and drink.
Mutong San is described in Question 74.