巢元方曰。诸筋会于阴器。邪客于厥阴、少阴之经。与冷气相搏。则阴囊肿痛而引缩。经中虽
分四症。曰肠 、气 、水 、卵 。然小儿患此。若治之不早。则成痼疾。如腰曲腹痛。冷汗自出。
而阴囊二子吊缩入腹。痛止方出。名曰内吊。用匀气散及金铃散。
曾氏曰。有阴茎全缩不见。有阴囊光肿不痛。此因肝肾气虚也。宜金铃散、匀气散。盖筋遇寒
则引缩。遇热则弛张。故三因用法。以宽小肠气疏风为治。然小儿此症。多因坐阴冷之处。及感风
湿而得。用当归散加槟榔、苍术。水姜煎服。有外肾无故而肤囊肿大。不燥不痛。光亮如吹。此
气虚所致。宜三因家韭子丸、匀气散。一症外肾肤囊赤肿通明。及女儿阴户肿胀。乃心热之所
传。皆以木通散、导赤散为治。间有啼叫怒气闭系于下。结聚不散。加以水窦不行。以致阴肿核
肿者。宜桃仁丸。小儿狐疝。气偏有大小。时时上下者。此名偏坠。以蜘蛛十四个炒焦。桂枝五
钱。共为末。每服八分。日再。酒调下。蜜丸亦可。外敷黑散。
钱乙曰。溺血者盖心主血。与小肠相合。血之流行。周遍经络。循环脏腑。若热聚膀胱。血渗
入脬。故小便血出也。
薛己曰。热入大肠。则大便下血。热入小肠。则小便出血。小儿多因胎中变热。或乳母六淫七
情。浓味积热。或儿自食甘肥积热。或六淫外侵而成。小便出血者。实热。清心莲子饮。虚热。六味
地黄丸。
巢元方说:所有的筋脉汇聚于生殖器部位。邪气侵袭足厥阴肝经和足少阴肾经,与体内的冷气相互搏结,就会导致阴囊肿痛并牵引睾丸收缩。虽然经络理论中将此病分为四种症状,即肠疝、气疝、水疝和卵疝,但是小儿患此病,如果治疗不及时,就会变成顽固性疾病。例如出现腰部弯曲、腹痛、冷汗自出,以及双侧睾丸收缩进入腹腔,疼痛停止后睾丸才出来,这种情况叫做“内吊”。治疗使用匀气散和金铃散。
曾氏说:有的患儿阴茎完全缩回看不见,有的阴囊光亮肿胀但不疼痛,这是由于肝肾之气虚弱所致。适宜使用金铃散、匀气散。因为筋脉遇到寒冷就会收缩牵引,遇到热就会松弛张开。所以根据三因学说,治疗方法应以宽理小肠气机、疏风为主。然而小儿这种病症,多是因为坐在阴冷之处,以及感受风湿之邪而得病。可以使用当归散加槟榔、苍术,用水和生姜煎服。有的外生殖器皮肤囊肿大,不干燥也不疼痛,光亮如同吹起的气球,这是气虚所致。适宜使用三因家的韭子丸、匀气散。还有一种情况是外生殖器皮肤红肿透亮,以及女童外阴肿胀,这是心热传变所致,都以木通散、导赤散为治疗方法。间或有因啼哭叫骂、怒气郁结于下焦,导致气血结聚不散,加上水道不通,从而引起阴囊肿核肿大的,适宜使用桃仁丸。小儿狐疝,表现为两侧大小不一,时时上下移动,这叫做偏坠。用十四个炒焦的蜘蛛,配伍五钱桂枝,共同研为细末,每次服用八分,每日两次,用酒调服,制成蜜丸也可以。外用黑散敷贴。
钱乙说:尿血的原因在于心主血脉,与小肠相表里。血液在体内流行,周遍经络,循环脏腑。如果热邪聚集在膀胱,血液渗入膀胱(脬),就会导致小便出血。
薛己说:热邪侵入大肠,则大便下血;热邪侵入小肠,则小便出血。小儿多因胎中受热,或者乳母受到六淫邪气侵袭或七情内伤,饮食浓味积热,或者小儿自己食用甘肥食物积热,或者被六淫外邪侵袭而成病。小便出血属于实热的,用清心莲子饮;属于虚热的,用六味地黄丸。
Chao Yuanfang stated: All sinews converge at the genitalia. When pathogenic factors invade the Jueyin (Liver) and Shaoyin (Kidney) meridians and contend with cold qi, it results in swelling and pain of the scrotum with retraction of the testes. Although the classics divide this condition into four types—namely Chang hernia (intestinal hernia), Qi hernia (gas hernia), Shui hernia (water hernia), and Luan hernia (testicular hernia)—if pediatric cases are not treated promptly, they may become chronic stubborn diseases. For instance, symptoms such as curved waist, abdominal pain, spontaneous cold sweating, and both testes retracting into the abdomen until the pain subsides and they emerge, is named "Nei Diao" (Internal Retraction). It is treated with Yunqi San (Uniform Qi Powder) and Jinling San (Golden Bell Powder).
Zeng stated: Some infants present with complete retraction of the penis where it is invisible, or a shiny swollen scrotum without pain; this is due to deficiency of Liver and Kidney qi. Jinling San and Yunqi San are appropriate. This is because sinews contract and retract when exposed to cold, but relax and extend when exposed to heat. Therefore, according to the Three Causes theory, treatment should focus on relaxing the Small Intestine qi and dispersing wind. However, this condition in children often arises from sitting in cold, damp places or contracting wind-dampness. Danggui San (Angelica Decoction) combined with Areca Seed (Binglang) and Atractylodes Rhizome (Cangzhu), decocted with water and fresh ginger, is suitable. In cases where the external genitalia skin swells greatly without dryness or pain, appearing shiny like an inflated balloon, this is caused by qi deficiency. Jiuzi Wan (Leek Seed Pill) from the Three Causes school and Yunqi San are indicated. Another presentation involves reddish, transparent swelling of the external genitalia skin, or swelling of the vulva in female infants, which is transmitted from Heart heat; these are treated with Mutong San (Akebia Decoction) and Daochi San (Guide Out Redness Powder). Occasionally, crying, shouting, and anger cause stagnation in the lower jiao, leading to accumulation that does not dissipate, combined with obstruction of the urinary orifice, resulting in scrotal or testicular swelling; Taoren Wan (Peach Kernel Pill) is appropriate. Pediatric Hu hernia (fox hernia), characterized by asymmetry in size and frequent movement up and down, is called Pian Zhui (Lateral Drooping). Ten-four roasted spiders and five qian of Cinnamon Twig (Guizhi) are ground into powder. Each dose is 8 fen, taken twice daily, mixed with wine. Honey pills are also acceptable. External application of Hei San (Black Powder) is used.
Qian Yi stated: The cause of hematuria lies in the fact that the Heart governs blood and has a interior-exterior relationship with the Small Intestine. Blood circulates throughout the meridians and organs. If heat accumulates in the Bladder, blood渗 (seeps) into the bladder (pao), causing blood to appear in the urine.
Xue Ji stated: Heat entering the Large Intestine causes hematochezia (blood in stool); heat entering the Small Intestine causes hematuria (blood in urine). In children, this is often due to heat acquired in the womb, or the nursing mother suffering from invasion by the Six Exogenous Pathogens or Seven Emotions, or accumulating heat from rich and heavy foods, or the child consuming sweet and fatty foods leading to heat accumulation, or being invaded by exogenous pathogens. For hematuria due to excess heat, Qingxin Lianzi Yin (Clear the Heart Lotus Seed Decoction) is used; for deficiency heat, Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) is used.