小儿大便不利,多由饮食热物风热结于便,以保和丸加枳壳、大黄微利之。若是血虚,
平素难便者,宜服润肠丸。
保和丸 治饮食停滞,胸膈痞闷,腹胀等症。
神曲 广皮 法夏 云苓 山楂 连翘 莱菔子,为末炼蜜为丸。
润肠丸 治老人、虚人、小儿、男、妇人大便闭结。
火麻仁(八钱) 杏仁 郁李仁(各四钱) 当归(一两) 枳壳 金井胶家苏子 莱菔子(各三钱)
上为末,炼蜜为丸,每一二钱,量人加减,白汤送下。
《难经》云∶出者为虚。肛门之脱,非虚如何。况大肠与肺为表里,肺脏蕴热则闭,虚
则脱。须用补中益气汤为主,升举与补之,不可用坠气之药。
补中益气汤 方见咳嗽门。
脱肛,不红不痛,是气血两虚,本方加粟壳、伏龙肝各一钱。
脱肛赤肿有痛,宜凉血去风,本方加羌活、防风、白芍。
脱肛里急后重,有脓血者,本方加木香、乌梅。
脱肛大肠热甚,肛门赤痛,宜服∶
升麻汤
升麻 白芍 甘草 羌活 黄芩 黄连 西风
肛门作痒,腹中有虫,内服花椒、乌梅、使君子、槟榔等药,葱白为引,外朴硝煎汤洗
之。
脱肛,以鳖头烧灰研细,以麻油调匀涂之,外用尿泡桐叶托进。
小儿脱肛,用陈壁土、地瓜根煎水温洗,用菜叶抬手托进,帕子兜起,大裹脚从屁凹勒
住,负于大人背上;外用蓖麻叶捣烂,包小儿囟门,一时即收。内服∶
黄芩 连翘 升麻 西风 桔梗 甘草(各一钱) 车前为引。
大便粪前见血者为近血,盖自大便出也,宜服∶
黄连解毒汤
黄连(五分) 黄柏 条芩 栀仁(各一钱) 灯芯为引,水煎热服。
粪后见血者为远血,从胃脘小肠出也。清胃汤止之,久不止者,补中益气汤加黄连。
清胃汤
黑栀子 生地 丹皮 当归(各一钱) 川连(五分) 水煎服。
补中益气汤 方见咳嗽门。
泻血 用乱头发、鸡冠花、侧柏叶,俱烧灰存性,为末,酒冲服一钱。
又方霜后干丝瓜烧灰为末,空心酒服一钱。
小儿大便不通畅,多因饮食积滞、热邪或风热之邪结聚于肠道所致,可用保和丸(调和脾胃、消食导滞的方剂)加入枳壳和大黄,轻微通下。如果是血虚体质,平时就排便困难者,适宜服用润肠丸(滋润肠道、通便的方剂)。
保和丸:治疗饮食停滞引起的胸膈痞闷、腹胀等症状。
组成:神曲、广陈皮、法半夏、云茯苓、山楂、连翘、莱菔子,研成细末,用蜂蜜炼制成丸剂。
润肠丸:治疗老人、体虚者、小儿及男女成人出现的大便闭结不通。
组成:火麻仁(八钱)、杏仁、郁李仁(各四钱)、当归(一两)、枳壳、金井阿胶、紫苏子、莱菔子(各三钱)。
制法与用法:以上药材研成细末,用蜂蜜炼制成丸剂,每次服用一两钱,根据患者具体情况增减用量,用温开水送服。
《难经》说:“排出物多为虚证。”肛门脱出,如果不是虚证又是什么呢?况且大肠与肺互为表里,肺脏蕴藏热邪则导致便秘,肺气虚弱则导致脱肛。必须使用补中益气汤(补益中气、升阳举陷的方剂)为主方,以升提举陷并补益正气,不可使用耗气下坠的药物。
补中益气汤:方剂见“咳嗽门”章节。
若脱肛症状表现为不红不痛,属于气血两虚,可在本方基础上加粟壳、伏龙肝各一钱。
若脱肛伴有红肿疼痛,宜凉血祛风,可在本方基础上加羌活、防风、白芍。
若脱肛伴有里急后重感,且有脓血,可在本方基础上加木香、乌梅。
若脱肛伴有大肠热盛,肛门赤痛,适宜服用:
升麻汤
组成:升麻、白芍、甘草、羌活、黄芩、黄连、西风(此处疑为笔误或特定地方用药,暂保留原名)。
若肛门瘙痒,腹中有虫,内服花椒、乌梅、使君子、槟榔等药物,以葱白为引药,外用朴硝煎汤清洗肛门。
治疗脱肛,可将鳖头烧成灰,研成细末,用麻油调匀涂抹患处,外用尿液浸泡过的桐叶托回肛门内。
小儿脱肛,用陈年墙壁土、地瓜根煎水清洗,用菜叶用手托回肛门,用帕子兜住,用宽布带在臀部凹陷处勒紧,背负在成年人背上;外用时将蓖麻叶捣烂,敷贴在小儿囟门上,片刻即可收回。内服方:
组成:黄芩、连翘、升麻、西风、桔梗、甘草(各一钱),以车前草为引药。
大便前出血称为“近血”,血液直接从大便排出,适宜服用:
黄连解毒汤
组成:黄连(五分)、黄柏、条芩、栀仁(各一钱),以灯芯草为引药,水煎热服。
大便后出血称为“远血”,血液来自胃脘或小肠。用清胃汤止血,久治不愈者,用补中益气汤加黄连。
清胃汤
组成:黑栀子、生地、丹皮、当归(各一钱)、川连(五分),水煎服。
补中益气汤:方剂见“咳嗽门”章节。
泻血(便血):用乱头发、鸡冠花、侧柏叶,全部烧成灰但保留药性,研成细末,用酒冲服一钱。
另一方法:霜降后的干丝瓜烧成灰研末,空腹时酒服一钱。
Infants and children with difficult defecation are mostly caused by food stagnation, heat pathogens, or wind-heat pathogens accumulating in the intestines. Baohe Wan (Harmonizing Stomach Pill) can be used with Zhiqiao (Aurantii Fructus) and Dahuang (Rhei Radix et Rhizoma) to induce mild purgation. If it is due to blood deficiency, and the patient has difficulty defecating normally, Runchang Wan (Moistening Intestine Pill) is suitable.
Baohe Wan: Treats symptoms such as chest and diaphragm fullness and abdominal distension caused by food stagnation.
Ingredients: Shenqu (Medicated Leaven), Guangpi (Tangerine Peel), Faxia (Prepared Pinellia), Yunling (Poria), Shanzha (Crataegi Fructus), Lianqiao (Forsythiae Fructus), Laifuzi (Radish Seed). Grind into powder, refine honey to make pills.
Runchang Wan: Treats constipation in the elderly, debilitated individuals, infants, children, men, and women.
Ingredients: Huomaren (Hemp Seed) (8 qian), Xingren (Apricot Seed), Yuliren (Bush Cherry Seed) (each 4 qian), Danggui (Angelicae Sinensis Radix) (1 liang), Zhiqiao (Aurantii Fructus), Jinjing Jiaojia (Donkey-hide Gelatin from Jingjing), Suzi (Perilla Seed), Laifuzi (Radish Seed) (each 3 qian).
Preparation and Administration: Grind the above ingredients into powder, refine honey to make pills. Take 1-2 qian per dose, adjusting according to the patient's condition, taken with warm water.
The *Nan Jing* (Classic of Difficult Issues) states: "Discharge indicates deficiency." Anal prolapse is certainly not a case other than deficiency. Moreover, the Large Intestine and Lung are exterior-interior related; if the Lung contains heat, it leads to constipation, and if deficient, it leads to prolapse. One must primarily use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) to lift and tonify. Do not use herbs that drain Qi downwards.
Buzhong Yiqi Tang: See the "Cough" section for the formula.
If anal prolapse presents without redness or pain, it is due to dual deficiency of Qi and Blood. Add Suké (Poppy Shell) and Fulonggan (Vermilion Dragon Liver) each 1 qian to this formula.
If anal prolapse is accompanied by redness, swelling, and pain, cool the blood and dispel wind. Add Qianghuo (Notopterygii Rhizoma et Radix), Fangfeng (Saposhnikoviae Radix), and Baishao (Paeoniae Radix Alba) to this formula.
If anal prolapse is accompanied by tenesmus and pus/blood, add Muxiang (Aucklandiae Radix) and Wumei (Mume Fructus) to this formula.
If anal prolapse is accompanied by excessive heat in the Large Intestine and red/painful anus, take:
Shengma Tang (Cimicifugae Decoction)
Ingredients: Shengma (Cimicifugae Rhizoma), Baishao (Paeoniae Radix Alba), Gancao (Glycyrrhizae Radix et Rhizoma), Qianghuo (Notopterygii Rhizoma et Radix), Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Xifeng.
If the anus itches and there are parasites in the abdomen, internally take Huajiao (Zanthoxyli Pericarpium), Wumei (Mume Fructus), Shijunzi (Quisqualis Fructus), Binglang (Arecae Semen), etc., using Congbai (Scallion White) as a guiding drug. Externally wash with Puxiao (Natrii Sulfas) decoction.
For anal prolapse, burn turtle head to ash, grind finely, mix with Sesame Oil, apply topically, and externally support the prolapsed rectum back with Tongye (Paulownia Leaf) soaked in urine.
For infantile anal prolapse, wash with warm decoction of Chenbitu (Old Wall Soil) and Digegen (Ipomoea Batatas Root). Push back with vegetable leaves, secure with a cloth, bind tightly around the buttocks with a wide bandage, and carry on an adult's back. Externally, crush Biyanye (Ricinus Leaf) and apply to the infant's fontanelle; it will retract immediately. Internally take:
Ingredients: Huangqin (Scutellariae Radix), Lianqiao (Forsythiae Fructus), Shengma (Cimicifugae Rhizoma), Xifeng, Jiegeng (Platycodonis Radix), Gancao (Glycyrrhizae Radix et Rhizoma) (each 1 qian), with Cheqian (Plantaginis Semen/Herba) as a guiding drug.
Blood appearing before stool is called "Near Blood," coming directly from the large intestine. Take:
Huanglian Jiedu Tang (Coptis Decoction for Resolving Toxicity)
Ingredients: Huanglian (Coptidis Rhizoma) (5 fen), Huangbai (Phellodendri Cortex), Tiaoxin (Scutellariae Radix), Zhiren (Gardeniae Fructus) (each 1 qian), with Dengxin (Junci Medulla) as a guiding drug. Decoct in water and take hot.
Blood appearing after stool is called "Far Blood," originating from the stomach or small intestine. Stop it with Qingwei Tang (Clear the Stomach Decoction); if persistent, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) plus Huanglian (Coptidis Rhizoma).
Qingwei Tang (Clear the Stomach Decoction)
Ingredients: Heizhizi (Black Gardeniae Fructus), Shengdi (Rehmanniae Radix Preparata), Danpi (Moutan Cortex), Danggui (Angelicae Sinensis Radix) (each 1 qian), Chuanlian (Coptidis Rhizoma) (5 fen). Decoct in water and take.
Buzhong Yiqi Tang: See the "Cough" section for the formula.
Hematochezia: Use tangled hair, Chicken Comb Flower, and Cebaiye (Biota Tops), all burned to ash while retaining their properties, ground into powder, taken with wine, 1 qian per dose.
Another method: Burn dried loofah after frost to ash, take 1 qian with wine on an empty stomach.