〔薛〕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（疳），大便秘结者用清凉饮（里热）。虫蚀肛门，先用化 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。一儿嗜膏粱
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（疳）、五味
异功散（吐泻）加柴胡、升麻寻愈。一儿肛门作痒，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，佐以五味异功加
山栀、柴胡，又以加味逍遥散（虚热）加漏芦，与母服而愈。一儿十三岁，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（虚热）加吴茱萸所制黄连治之，而血愈。一儿十五岁，两目白翳，遍身似疥非疥，
肛门作痒，晡热口渴，形体骨立。余以为肝疳之证也。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 丸二服，乃用五味异功散四剂，却用大芜荑汤（疳）四味肥儿丸而痊。
一儿七岁，饮食过多即作泻，面青黄色，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。余曰此脾气太虚，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，出水淋漓，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，诸证渐愈，又用大芜荑汤治之而痊。
化 丸 治诸疳生虫，不时啼哭，呕吐清水，肚腹胀痛，唇口紫黑，肠头湿 。
芜荑 青黛 芦荟 虾蟆（烧灰） 川芎 白芷 胡黄连（各等分）
上，各另为末，猪胆浸糕丸，如麻子大。每服一二十丸，食后并临卧，杏仁汤下。
雄黄散 治走马疳，并痘毒疳虫蚀肛门。
雄黄 铜绿（各二钱）
上为末，掺疮上。
【薛己】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；有的因为湿毒生虫而侵蚀肛门。如果是由于湿热壅滞引起的，使用四味肥儿丸（治疗疳积），大便秘结的使用清凉饮（治疗里热）。如果是虫蚀肛门，先用化虫丸，后用四味肥儿丸，外用雄黄散纳入肛门内。如果因为生病不想吃东西，虫子没有食物可吃，转而啃食内脏和肛门，那么患者齿龈颜色淡白，舌面全白，四肢倦怠无力。其上唇内有疮疡，吐出的唾液中有如粟米大小的血点，心中烦闷懊恼，这是虫子在上部啃食内脏；如果下唇内有疮疡，这是虫子在下部侵蚀肛门；如果虫子侵蚀肛门并穿透体内脏腑的，属于不治之症。各种虫子在农历上半月头朝上，可以用药驱赶它们；下半月亮相过后头朝下，让患者闻到烹煮食物的香味，虫头就会向上，然后再用药驱赶。有一个孩子嗜好膏粱甘味，患了疥疮。我认为应当禁止他食用浓味食物，急用清胃的药物来治疗他的积热。他不听从，只用外敷药治疗体表症状，结果肛门更加瘙痒发热，疮疡更严重，身体消瘦如柴，饮食减少思虑不足。于是我用九味芦荟丸（治疗疳积）、五味异功散（治疗呕吐腹泻）加入柴胡、升麻，不久痊愈。有一个孩子肛门瘙痒，耳前后结成小核如串珠状，隐藏在肌肉之间，小便不调，面色发青。这是因为禀受母亲的肝火所致。我用九味芦荟丸为主药，辅以五味异功散加入山栀、柴胡，又给母亲服用加味逍遥散（治疗虚热）加入漏芦，母子同治而痊愈。有一个十三岁的孩子，肛门瘙痒，有时脱出，或者大便出血，全身生疮，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，其疮疡逐渐愈合，辅以补中益气汤，热渴逐渐停止，肛门完全痊愈，后又以异功散为主，辅以补中益气汤（治疗虚热）加入由吴茱萸炮制的黄连来治疗，便血得以治愈。有一个十五岁的孩子，两眼出现白翳，全身似疥非疥，肛门瘙痒，傍晚发热口渴，形体消瘦如柴。我认为这是肝疳的症状。服用六味地黄丸后痊愈。后来阴茎瘙痒、小便浑浊色白，服用蟠葱散，肛门肿痛，服用大黄等药物，导致肛门脱出，瘙痒难忍，杂用降火药物无效，下唇内生小白疮，我认为这是虫蚀肛门，服用九味芦荟丸而愈。一个小男孩肛门瘙痒，误以为是痔疮，服用槐角丸等药物，肢体消瘦，鼻下湿烂，下唇内生疮。这是虫子啃食下部。先用化虫丸两服，再用五味异功散四剂，随后用大芜荑汤（治疗疳积）、四味肥儿丸而痊愈。一个七岁的孩子，饮食过多就腹泻，面色青黄，服用峻烈的泻利药物。我认为应当节制饮食，健运脾胃为好。他不相信，后来牙龈赤烂，肛门瘙痒，服用清热药物，腹痛腹胀，再次请求使用之前的泻利药物。我说这是元气亏损，虚火上炎。他仍不相信，后来腮间出现黑色腐烂。我说这是脾气太虚，肌肉坏死而不知疼痛，这很明显了。后来虽然相信我的话，但已经无法救治了。如果在初起时用五味异功散健运脾胃为主，辅以大芦荟丸、四味肥儿丸，清除脾经湿热，哪有治不好的道理呢？后来的患者请仔细审察。一个小男孩肛门瘙痒，属于大肠经风热，用槐角丸而愈。一个小男孩肛门连阴囊瘙痒，出水淋漓，属于肝经湿热。用龙胆泻肝汤、九味芦荟丸治疗，一并痊愈。一个小男孩嗜好甘甜油腻食物，肛门瘙痒，发热口渴，杂用清热药物，导致腹胀少食，鼻下生疮。我认为这是脾胃湿热生虫。他不相信，后来下唇内生疮，先用四味肥儿丸，诸证逐渐痊愈，又用大芜荑汤治疗而痊愈。
化虫丸 治疗各种疳积生虫，不时啼哭，呕吐清水，肚腹胀痛，唇口紫黑，肠头湿润糜烂。
芜荑 青黛 芦荟 虾蟆（烧成灰） 川芎 白芷 胡黄连（各等分）
以上药物，分别研为细末，用猪胆汁浸透米粉制成丸药，如麻子大小。每次服用一二十丸，饭后及临睡前，用杏仁汤送服。
[Xue Ji] In children, anal pruritus may result from a preference for sweet and greasy foods, leading to damp-heat stagnation in the Large Intestine; or it may arise from damp-toxicity generating parasites that erode the anus. If caused by damp-heat stagnation, Siwei Fei'er Wan (Four-Ingredient Child-Nourishing Pill) is used for gan syndrome (malnutrition syndrome); 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) is administered first, followed by Siwei Fei'er Wan externally applied as Xionghuang San (Realgar Powder) inserted into the anus. If the child refuses food due to illness, leaving no nourishment for the parasites, they turn to devouring internal organs and the anus. The patient will present with colorless gingiva, a white-coated tongue, and four-limb fatigue. Ulcers within the upper lip with saliva containing millet-sized blood spots and mental restlessness indicate parasites feeding on upper organs; ulcers within the lower lip indicate parasites eroding the lower anus. If the erosion penetrates inward to the viscera, it is incurable. Parasites generally have their heads pointing upward during the first half of the lunar month; medication can be given to expel them then. 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 administered. 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 refused, using only topical applications, resulting in worsened anal pruritus and fever, more severe sores, emaciation, and poor appetite. I then prescribed Jiwei Luluo Wan (Nine-Ingredient Aloe Pill) for gan syndrome and Wuyi Yigong San (Five-Ingredient Extraordinary Merit Powder) for vomiting and diarrhea, adding Chaihu (Bupleuri Radix) and Shengma (Cimicifugae Rhizoma), leading to recovery. Another child presented with anal pruritus, small nodules like beads behind the ears hidden in the muscle layer, irregular urination, and a bluish complexion. This was attributed to inheriting the mother's Liver Fire. I used Jiwei Luluo Wan as the principal formula, assisted by Wuyi Yigong San added with Zhizi (Gardeniae Fructus) and Chaihu, while the mother took Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) for deficiency heat with Loulu (Euphorbiae Humifusae Herba), resulting in cure for both. A thirteen-year-old child suffered from anal pruritus, occasional prolapse, hematochezia, generalized sores, fever with thirst, abdominal distension with visible veins. Da Luluo Wan (Major Aloe Pill) and Wuyi Yigong San were used; the sores gradually healed. Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) was added, stopping fever and thirst, and healing the anus completely. Subsequently, Yigong San was used as the main formula, assisted by Buzhong Yiqi Tang added with Huanglian (Coptidis Rhizoma) processed with Wuzhuyu (Evodiae Fructus), curing the bleeding. A fifteen-year-old child had leukoma in both eyes, generalized skin resembling scabies but not quite, anal pruritus, afternoon fever with thirst, and emaciation. I diagnosed this as Liver Gan Syndrome. Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) led to recovery. Later, penile pruritus and cloudy white urine occurred; Pancong San was taken. Anal swelling and pain followed; Dahuang (Rhei Radix et Rhizoma) and other drugs were used, causing anal prolaxis and unbearable pruritus. Various fire-descending medicines failed. Small white ulcers appeared inside the lower lip; I diagnosed parasitic erosion of the anus and treated with Jiwei Luluo Wan, resulting in cure. A young boy with anal pruritus was misdiagnosed with hemorrhoids and took Huaijiao Wan (Sophorae Flos Pill) and others, leading to limb emaciation, moist rot under the nose, and ulcers inside the lower lip. This indicated parasites eating the lower part. Two doses of Huachong Wan were given first, followed by four doses of Wuyi Yigong San, then Da Wutang (Major Wormwood Decoction) and Siwei Fei'er Wan cured him. A seven-year-old child had 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 gingiva became red and ulcerated, and he had anal pruritus. Taking heat-clearing medicines caused abdominal pain and distension. He requested the previous purgatives again. I stated this was Yuanqi (Original Qi) deficiency with defying deficient fire. 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 believed me later, it was too late to save him. If initially Wuyi Yigong San had been used to strengthen the Spleen and Stomach, assisted by Da Luluo Wan and Siwei Fei'er Wan to clear Spleen damp-heat, there would have been no case of non-cure. Patients should reflect on 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, due to Damp-Heat in the Liver meridian, was cured with Longdan Xiegan Tang (Gentian Decoction to Drain the Liver) and Jiwei Luluo Wan. A child who preferred sweet and greasy foods had anal pruritus, fever, and thirst. Miscellaneous heat-clearing medicines caused abdominal distension and poor appetite, with sores under the nose. I diagnosed Spleen-Stomach damp-heat generating parasites. He did not believe me. Later, ulcers appeared inside the lower lip. Siwei Fei'er Wan was used first, resolving symptoms gradually, then Da Wutang cured him.
Huachong Wan: Treats various gan syndromes with parasites, frequent crying, vomiting clear fluid, abdominal distension and pain, purple-black lips and mouth, and moist erosion of the rectum.
Wutang (Macleaya Cordata Stem), Qingdai (Indigo Naturalis), Luluo (Aloe), Xama (Bufo Toad, calcined to ash), Chuanxiong (Ligusticum Chuanxiong Rhizome), Baizhi (Angelicae Dahuricae Radix), Huhuanglian (Coptidis Chinensis Rhizoma). (Equal parts)
Grind each into powder separately. Soak rice paste in pig bile to make pills the size of hemp seeds. Take 10-20 pills after meals and before bed, washed down with Apricot Seed Decoction.
Xionghuang San: Treats Zouma Gan (Rapidly Progressing Gangrenous Mouth Ulcer) and痘毒 (smallpox toxin) gan parasites eroding the anus.
Xionghuang (Realgar), Tonglv (Chrysocolla). (Each 2 qian)
Grind into powder and sprinkle on the sores.