议曰∶小儿大肠热，乃是肺家有热在里，流入大肠，以致秘结不通，乃实热也。当以四顺清凉饮加柴胡，热甚者、
加山栀、黄芩流利之。其表里俱热者，面黄颊赤，唇燥口干，小便赤涩，大便焦黄。无汗者，先解表，以柴胡散汗之，
解后大便秘，或肚疼者，以清凉饮，大柴胡汤、承气汤皆可下之。积热者，神芎丸尤妙。
四顺清凉饮 见第四十四问。
柴胡散 见第五十问。
大柴胡汤 见第二十九问。
大承气汤 见第二十九问。
神芎丸 见第二十问。
轻号散 治小儿初生，大便不通。
轻粉（一分） 蜜（少许）
上以热汤调开，蜜糊轻粉，点儿口即通。与一、二次，再不可与。
汤氏云∶凡小儿小便不通，皆因心经不顺，或伏热，或惊起，心火上攻，不能降济，肾水不能上升，故使心经 热，
而小肠与心合，所以小便不通。木通散主之，甚者八正散。又小便不通，脐腹胀闷，心神烦热，栀子仁散主之。积热者，
神芎丸效。
木通散 治小便不通，小腹疼痛。
木通 滑石（各一两） 黑牵牛（炒、半两）
上为粗末，灯心葱白煎，去滓、大小以意加减服。
八正散 治小儿心经邪热，一切蕴毒，咽干口燥，大渴引饮，心忪面热，烦躁不宁，目赤睛疼，唇焦鼻衄，口
舌生疮，咽喉肿痛。及治小便赤涩不通，热淋、血淋之症。
车前子 瞿麦 滑石 大黄（湿纸裹煨） 小栀 蓄 木通 甘草
上锉散，每二钱，水一盏，入灯心，煎至七分、去滓温服，食后、临卧，小儿量力，少少与服。
葱号散 见第三问。
栀子仁散 治小儿小便不通，脐腹胀闷，心神烦热。
栀子仁（五枚） 茅根（锉） 冬葵子（各半两） 甘草（二钱半）
上锉散，每服二钱，水一小盏，煎五分，去滓不拘时侯，大小加减温服。
神芎丸 见第二十问。
按语说：小儿大肠有热，是因为肺脏内部有热邪，传入大肠，导致大便干结不通，这属于实热证。应当使用四顺清凉饮加入柴胡；如果热势严重，加入山栀、黄芩以通利清热。若表里俱热，表现为面色黄而两颊红赤，嘴唇干燥，口干，小便短赤涩痛，大便焦黄。无汗者，先解表，用柴胡散发汗；表解之后若大便秘结或腹痛，可用清凉饮、大柴胡汤、承气汤等攻下。若是积热所致，神芎丸效果尤佳。
四顺清凉饮 见第四十四问。
柴胡散 见第五十问。
大柴胡汤 见第二十九问。
大承气汤 见第二十九问。
神芎丸 见第二十问。
轻号散 治疗新生儿大便不通。
轻粉（一分） 蜂蜜（少许）
以上药物用热水调开，将蜂蜜制成糊状调和轻粉，点入患儿口中即可通便。给予一两次后，不可再给。
汤氏说：凡是小儿小便不通，都是因为心经气机不顺，或有伏热，或因受惊引起，导致心火上炎，不能下行济助肾水，肾水也不能上升，从而导致心经有热。因为小肠与心相表里，所以出现小便不通。主方用木通散，病情严重的用八正散。另外，若小便不通，伴有脐腹部胀闷，心神烦热，主方用栀子仁散。若是积热所致，神芎丸有效。
木通散 治疗小便不通，小腹疼痛。
木通 滑石（各一两） 黑牵牛（炒制，半两）
以上药物捣成粗末，用灯心草和葱白煎煮，去渣，根据患者年龄大小酌情加减服用。
八正散 治疗小儿心经邪热，各种蕴毒，咽干口燥，大渴引饮，心悸面热，烦躁不宁，眼睛红肿疼痛，嘴唇焦裂，鼻出血，口腔舌头生疮，咽喉肿痛。以及治疗小便短赤涩痛不通，热淋、血淋等症状。
车前子 瞿麦 滑石 大黄（湿纸包裹煨制） 小栀子 蓄草 木通 甘草
以上药物切碎，每次取二钱，加水一盏，放入灯心草，煎至七分，去渣温服，饭后、临睡前服用，小儿根据量力原则少量多次服用。
葱号散 见第三问。
栀子仁散 治疗小儿小便不通，脐腹部胀闷，心神烦热。
栀子仁（五枚） 白茅根（切碎） 冬葵子（各半两） 甘草（二钱半）
以上药物切碎，每次服用二钱，加水一小盏，煎至五分，去渣不拘时间，根据患者年龄大小酌情加减温服。
神芎丸 见第二十问。
Commentary states: Intestinal heat in children arises from heat in the Lung organ that penetrates inward into the Large Intestine, resulting in constipation and blockage; this is a case of Excess Heat (Shi Re). The treatment should employ Sishun Qingliang Yin (Four-Oriented Cooling Decoction) with added Chai Hu (Bupleurum Root); if the heat is severe, add Shan Zhi (Gardenia Fruit) and Huang Qin (Scutellaria Root) to promote free flow. In cases where both exterior and interior are hot, presenting with a sallow complexion but red cheeks, dry lips, dry mouth, dark and scanty urine, and dry yellow stools, if there is no sweating, first release the exterior using Chai Hu San (Bupleurum Powder) to induce sweating. After the exterior is resolved, if constipation or abdominal pain persists, Qingliang Yin (Cooling Decoction), Da Chai Hu Tang (Major Bupleurum Decoction), or Cheng Qi Tang (Purgative Decoction) may be used for purgation. For accumulated heat, Shen Xiong Wan (Divine Ligusticum Pill) is particularly effective.
Sishun Qingliang Yin (Four-Oriented Cooling Decoction): See Question 44.
Chai Hu San (Bupleurum Powder): See Question 50.
Da Chai Hu Tang (Major Bupleurum Decoction): See Question 29.
Da Cheng Qi Tang (Major Purgative Decoction): See Question 29.
Shen Xiong Wan (Divine Ligusticum Pill): See Question 20.
Qing Hao San (Light Number Powder) treats neonatal constipation.
Qing Fen (Calomel, one fen)
Honey (a small amount)
Mix the above with hot water until dissolved, form a honey paste with the Calomel, and apply a small amount to the infant's mouth to induce bowel movement. Administer only once or twice; do not administer again.
Ms. Tang states: All cases of urinary retention in children are due to disharmony of the Heart Meridian, latent heat, or fright causing Heart Fire to flare upward, preventing it from descending to assist Kidney Water, while Kidney Water fails to ascend. This results in Heat in the Heart Meridian. Since the Small Intestine is internally-externally related to the Heart, urinary retention occurs. The primary formula is Mutong San (Akebia Decoction); for severe cases, use Bazheng San (Eight-Utensils Powder). Additionally, for urinary retention accompanied by umbilical and abdominal distension and fullness, and mental restlessness with heat, Zhizi Ren San (Gardenia Seed Powder) is indicated. For accumulated heat, Shen Xiong Wan (Divine Ligusticum Pill) is effective.
Mutong San (Akebia Decoction) treats urinary retention and lower abdominal pain.
Mutong (Akebia Vine Stem, one liang)
Huashi (Talcum, one liang)
Hei Qianniu (Black Morning Glory Seed, stir-fried, half liang)
Grind the above into coarse powder. Decoct with Deng Xin Cao (Juncus Effusus Stem) and Cong Bai (White Part of Scallion), strain, and adjust dosage according to age and condition.
Bazheng San (Eight-Utensils Powder) treats pathogenic heat in the Heart Meridian in children, all types of accumulated toxins, dry throat and mouth, excessive thirst with desire to drink, palpitations with facial heat, irritability and restlessness, red eyes with eye pain, cracked lips, epistaxis, sores on the oral cavity and tongue, and swollen painful throat. It also treats dark, scanty, difficult, or blocked urination, as well as Heat Lin (Strangury) and Blood Lin (Bloody Strangury).
Che Qian Zi (Plantago Seed)
Qu Mai (Dianthus Herb)
Huashi (Talcum)
Da Huang (Rhubarb Root and Rhizome, wrapped in wet paper and baked)
Xiao Zhi (Gardenia Fruit)
Xu Shu (Polygonum Aviculare Herb)
Mu Tong (Akebia Vine Stem)
Gan Cao (Licorice Root)
Cut the herbs into pieces. Take two qian per dose, add one sheng of water and Deng Xin Cao (Juncus Effusus Stem), decoct until reduced to seven-tenths, strain, and take warm. Administer after meals and before bedtime; for children, give small amounts according to their capacity.
Cong Hao San (Scallion Number Powder): See Question 3.
Zhizi Ren San (Gardenia Seed Powder) treats pediatric urinary retention, umbilical and abdominal distension and fullness, and mental restlessness with heat.
Zhi Zi Ren (Gardenia Seed, five seeds)
Mao Gen (Imperata Rhizome, chopped)
Dong Kui Zi (Abutilon Seed, half liang each)
Gan Cao (Licorice Root, two qian and half)
Cut the herbs into pieces. Take two qian per dose, add a small sheng of water, decoct until reduced to five-tenths, strain, and take warm at any time, adjusting dosage according to age and condition.
Shen Xiong Wan (Divine Ligusticum Pill): See Question 20.