〔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。如果是因湿热壅滞所致，使用四味肥儿丸（治疗疳积），大便秘结的则使用清凉饮（治疗里热）。如果是虫蚀肛门，先用化虫丸，后用四味肥儿丸，外用雄黄散纳入肛内。如果因病导致食欲不振，虫无所养，转而吃内脏或侵蚀肛门，表现为齿龈无色，舌上全白，四肢倦怠。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，这是虫在上部侵蚀内脏；如果下唇内有疮疡，这是虫在下部侵蚀肛门；如果虫蚀肛门并穿透体内，则属不治之症。各种寄生虫在农历上半月头部向上，可用药物驱虫；下半月头部向下，让患者闻到烹煮食物的香味，虫头就会向上，然后再用药驱虫。有一个孩子嗜好膏粱甘味，患有疥疮。我认为应当禁止其食用浓腻厚味的食物，急用清胃的药物以治疗其积热。他不听从，反而用外敷药治疗体表症状，随后肛门作痒发热，疮疡更加严重，身体消瘦如骨立，饮食减少且不想进食。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，寻得痊愈。有一个孩子肛门作痒，耳前后结成小核如串珠状，隐于肌肉之间，小便不调，面色发青。这是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（治疗虚热）加漏芦，母子同治而愈。有一个十三岁的孩子，肛门作痒，有时脱出，或者大便出血，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，其疮渐愈，佐以补中益气汤，热渴渐止，肛门完全愈合，后又以异功散为主，佐以补中益气汤（治疗虚热）加吴茱萸所制的黄连来治疗，便血痊愈。有一个十五岁的孩子，两目有白翳，遍身似疥非疥，肛门作痒，傍晚发热口渴，形体消瘦如骨立。我认为这是肝疳的证候。用六味地黄丸而痊愈。后来阴茎作痒、小便浑浊色白，服用蟠葱散后，肛门肿痛，服用大黄等药后，肛门脱出，瘙痒难忍，杂用降火的药物无效，下唇内生小白疮，我认为这是虫蚀肛门，用九味芦荟丸而愈。一个小男孩肛门作痒，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。这是虫侵蚀下部。先用化虫丸二服，再用五味异功散四剂，最后用大芜荑汤（治疗疳积）、四味肥儿丸而痊愈。有一个七岁的孩子，饮食过多即腹泻，面呈青黄色，服用峻猛利下的药物。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，肛门作痒，服用清热药剂，腹痛腹胀，再次请求使用之前的药剂。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，但已无法救治了。如果初起时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，哪有不能治愈的道理呢？后来的患者请仔细审察。一个小男孩肛门作痒，属于大肠经风热，用槐角丸而愈。一个小男孩肛门连阴囊痒，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，肛门作痒，发热口渴，杂用清热药剂，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，诸证渐愈，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，用猪胆汁浸蒸糕丸，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 arise from a preference for sweet and fatty foods, leading to damp-heat stagnation in the Large Intestine; or it may result from damp-toxins generating parasites that erode the anus. If caused by damp-heat stagnation, Siwei Fei'er Wan (Four-Ingredient Child-Nourishing Pill) is used for malnutrition syndromes; 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) should be administered first, followed by Siwei Fei'er Wan externally applied as Xionghuang San (Realgar Powder) inserted into the anus. If the illness causes anorexia such that parasites lack nourishment and turn to eating internal organs or eroding the anus, symptoms include colorless gums, a completely white tongue, and limb fatigue. Ulcers inside the upper lip with saliva containing blood spots like millet grains, and mental restlessness (ao'nan), indicate parasites eroding the upper organs; ulcers inside the lower lip indicate parasites eroding the lower anus; if the erosion penetrates inward, it is incurable. For all parasites, during the first half of the lunar month, their heads face upward, so medication can be given to expel them; during the second half, their heads face downward. Let the patient smell the aroma of cooking food to make the parasite heads turn upward, then administer expulsion medication. 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 did not comply, instead using topical treatments for external lesions. Subsequently, his anus became itchy and feverish, the sores worsened, he became emaciated ("bone-standing"), and had little appetite. I then prescribed Jiwei Luluhuan (Nine-Ingredient Aloe Pill) for malnutrition and Wuyi Yigong San (Five-Ingredient Yi-Gong Powder) for vomiting and diarrhea, added with Chaihu (Bupleuri Radix) and Shengma (Cimicifugae Rhizoma), resulting in recovery. Another child presented with anal pruritus, small nodules behind and in front of the ears like beads hidden in the muscles, irregular urination, and a bluish complexion. This was attributed to inheriting Liver Fire from the mother. I used Jiwei Luluhuan as the principal formula, assisted by Wuyi Yigong San added with Zhizi (Gardeniae Fructus) and Chaihu, and had the mother take Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) for deficiency heat with Loulu (Euphorbiae Humifusae Herba); both mother and child recovered. A thirteen-year-old child suffered from anal pruritus, occasional prolapse, hematochezia, generalized sores, fever with thirst, abdominal distension with visible subcutaneous veins. I used Da Luluhuan (Large Aloe Pill) and Wuyi Yigong San; the sores gradually healed. I assisted with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction); fever and thirst ceased, and the anus fully healed. Later, I used Yigong San as the principal formula, assisted by Buzhong Yiqi Tang for deficiency heat, combined with Coptidis Rhizoma processed with Evodiae Fructus, which cured the bleeding. A fifteen-year-old child had leukocoria, generalized skin resembling but not being scabies, anal pruritus, afternoon fever with thirst, and emaciation. I diagnosed this as Liver Malnutrition Syndrome (Gan Gan). The child recovered after taking Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill). Later, penile pruritus and cloudy white urine occurred; after taking Pancong San, the anus became swollen and painful. After taking Dahuang (Rhei Radix et Rhizoma) and other drugs, the anus prolapsed, and the itching became unbearable. Various fire-descending medications were ineffective. Small white ulcers appeared inside the lower lip; I diagnosed parasitic erosion of the anus and treated with Jiwei Luluhuan, resulting in recovery. A young boy with anal pruritus was misdiagnosed with hemorrhoids and took Huaijiao Wan (Sophorae Flos Pill) and other drugs, leading to emaciation, moist rot under the nose, and ulcers inside the lower lip. This indicated parasites eroding the lower region. I first gave two doses of Huachong Wan, then four doses of Wuyi Yigong San, and finally Da Wutui Tang (Large Trogopteri Dung Decoction) and Siwei Fei'er Wan, resulting in recovery. A seven-year-old child experienced 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 gums became red and ulcerated, and his anus itched. After taking heat-clearing agents, he suffered from abdominal pain and distension, and requested the previous prescription again. I stated this was Yuanqi (Primordial Qi) deficiency with deflected deficient fire rising. 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 later believed me, it was too late to save him. If initially treated with Wuyi Yigong San to strengthen the Spleen and Stomach, assisted by Da Luluhuan, Siwei Fei'er Wan, and herbs to clear Spleen damp-heat, why would it not be curable? Future patients should examine this carefully. A young boy with anal pruritus due to Wind-Heat in the Large Intestine Meridian recovered with Huaijiao Wan. A young boy with anal and scrotal pruritus with dripping discharge, attributed to Damp-Heat in the Liver Meridian, recovered with Longdan Xiegan Tang (Gentian Liver-Draining Decoction) and Jiwei Luluhuan. A young boy who indulged in sweet and fatty foods had anal pruritus, fever with thirst, and after taking various heat-clearing agents, developed abdominal distension, poor appetite, and sores under the nose. I diagnosed Spleen-Stomach damp-heat generating parasites. He did not believe me. Later, ulcers appeared inside the lower lip. I first used Siwei Fei'er Wan; symptoms gradually improved. Then I treated with Da Wutui Tang, resulting in recovery.
Huachong Wan: Treats various malnutrition syndromes with parasites, frequent crying, vomiting of clear fluid, abdominal distension and pain, purple-black lips and mouth, and moist erosion of the rectum.
Ingredients: Wutui (Trogopteri Dung), Qingdai (Indigo Naturalis), Luluhuan (Aloe), Xama (Toad, calcined to ash), Chuanxiong (Ligustici Chuanxiong Rhizoma), Baizhi (Angelicae Dahuricae Radix), Huhuanglian (Coptidis Rhizoma). All in equal parts.
Preparation: Grind each ingredient separately into powder. Soak in pig bile to form pills the size of hemp seeds. Dosage: 10-20 pills per administration, taken after meals and before bed, washed down with Apricot Seed Decoction.
Xionghuang San: Treats Zouma Gan (Running Horse Malnutrition) and痘毒 (Smallpox toxin) parasites eroding the anus.
Ingredients: Xionghuang (Realgar), Tonglv (Chalcitis). Each 2 qian.
Preparation: Grind into powder and sprinkle onto the sores.