《百问》小儿大便秘，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（热）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（伤寒）汗之，解后
大便秘，或肚疼者，以清凉饮、大柴胡汤、承气汤（并热）皆可下之。积热者，神芎丸尤
妙。〔薛〕因乳母或儿膏粱积热，及六淫七情郁火，传儿为患者，用清邪解郁之剂。
禀赋怯弱，早近色欲，大便难而小便牵痛者，用滋补肺肾之剂。《褚氏遗书》云∶男
子精未满而御女以通其精，则四体有不满之处，异日有难状之疾，老人阴已痿而思
色以降其精，则精不出而内败。精已耗而复竭之，则大小便牵痛如淋。今童子即有
此患，益见今人所禀，与古人大径庭矣。人之气血浓薄既殊，而医之用药疗法，又
岂可泥执古方，而无加减之变乎。一小儿食粽停滞，大便不通，痛不可忍，手足发
搐。用大柴胡汤调酒曲末一钱，下滞秽甚多，作呕不食，用五味异功散加升麻、柴
胡、而愈。一小儿大便不通。审乳母饮食浓味所致。用清胃散以治母热，儿间饮以
一二匙而愈。后乳母感寒腹痛，食姜酒之物，儿大便秘结兼便血，仍用清胃散每日
数匙而愈。一小儿因乳母暴怒，大便不通，儿亦患之，兼用加味小柴胡汤，先用保
和丸二服，后用五味异功散加升麻、柴胡，儿日饮数匙，并愈。
《圣惠》芎黄散 治小儿大便不通，腹胁妨闷。
芎 （半两） 川大黄（锉，微炒） 郁李仁（汤浸，去皮，微炒。各三分）
上件药捣，细罗为散。每服一钱，以温水半盏调服，量儿大小，以意分减，以
利为度。张涣兼治大小便不通。
张锐《鸡峰方》用麻子以水研汁饮之。
《百问》指出，小儿大便秘结，是由于肺家有热邪在里，流入大肠，导致秘结不通，这属于实热证，应当使用四顺清凉饮（清热剂）加入柴胡。如果热势严重，加入山栀、黄芩以增强清热之力，并配合具有通利作用的药物。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，应先解表，用柴胡散（伤寒方剂）发汗；表解之后，若仍大便秘结，或伴有腹痛者，可以使用清凉饮、大柴胡汤、承气汤（均为清热泻下剂）进行攻下治疗。若有积热者，使用神芎丸尤为巧妙。〔薛己〕认为，因乳母或患儿食用膏粱厚味导致积热，以及六淫七情郁火，传变给患儿致病者，应使用清解邪气、疏解郁火的药剂。若禀赋怯弱，过早接触色欲（此处指先天肾精亏虚），导致大便困难且小便牵拉疼痛者，应使用滋补肺肾的药剂。《褚氏遗书》说：男子精气未满却御女泄精，则身体会有不完满之处，日后会有难以名状的疾病；老人阴痿已甚却思色欲泄精，则精液不出而在体内败坏。精气已耗损却又进一步竭尽，则大小便牵拉疼痛如同淋证。如今童子也有此患，更可见今人禀受之气，与古人相差甚远。人的气血浓薄既然不同，医生用药疗法，又怎能拘泥执守古方，而没有加减变化呢？有一个小儿吃粽子停滞，大便不通，疼痛难忍，手足抽搐。用大柴胡汤调服酒曲末一钱，排出很多积滞秽物，出现呕吐不食，后用五味异功散加升麻、柴胡，痊愈。另一个小儿大便不通，经审察是乳母饮食浓味所致。用清胃散治疗母亲的热证，让婴儿间接受药一二匙而愈。后来乳母感受寒邪腹痛，食用姜酒之物，导致婴儿大便秘结兼便血，仍用清胃散每日数匙而愈。还有一个小儿因乳母暴怒，导致大便不通，婴儿也患病，兼用加味小柴胡汤，先用保和丸二服，后用五味异功散加升麻、柴胡，婴儿每日饮用数匙，一并痊愈。
《圣惠方》中的芎黄散，治疗小儿大便不通，腹胁胀闷不适。
川芎（半两） 川大黄（锉碎，微炒） 郁李仁（温水浸泡，去皮，微炒。各三分）
以上药材捣碎，过细罗成为散剂。每次服用一钱，用温水半盏调服，根据患儿大小，酌情减量，以利为度。张涣还兼治大小便不通。
张锐《鸡峰方》用水研磨麻子取汁饮用。
The *Baiwen* states that constipation in infants and children is caused by heat in the Lung organ remaining internally, flowing into the Large Intestine, resulting in blockage and difficulty in passage. This is a case of Excess Heat (Shi Re), and one should administer Sishun Qingliang Yin (Four-Obedience Cooling Decoction) with added Chai Hu (Bupleurum Root). If the heat is severe, add Shan Zhi (Gardenia Fruit) and Huang Qin (Scutellaria Root) to clear heat and promote smoothness. In cases where both exterior and interior are hot, manifesting as a sallow complexion with red cheeks, dry lips, dry mouth, dark and scanty urine, and scorched yellow stools, if there is no sweat, the exterior should first be resolved using Chai Hu San (Bupleurum Powder) to induce sweating. After the exterior is resolved, if constipation persists or abdominal pain occurs, Qingliang Yin, Da Chai Hu Tang (Major Bupleurum Decoction), or Cheng Qi Tang (Purgative Decoctions) can all be used for purgation. For cases of accumulated heat, Shen Xiong Wan (Divine Xion Pill) is particularly effective. [Xue Ji] posits that when heat accumulates from rich foods consumed by the wet nurse or the child, or when fire stagnates due to the six climatic factors and seven emotions and transmits to the child, agents that clear pathogenic factors and resolve stagnation should be used. For those with weak constitution and early depletion of essence (metaphorically referring to congenital kidney deficiency), leading to difficult defecation and pulling pain in urination, agents tonifying the Lung and Kidney should be employed. The *Chu Shi Yi Shu* states: "If a man whose essence is not yet full engages in intercourse to drain his essence, his body will have deficiencies, and later he will suffer from inexplicable diseases. If an old man, whose yin energy is already atrophied, desires sexual activity to drain his essence, the essence will not exit but will rot internally. If essence has already been depleted and is further exhausted, it causes pulling pain in defecation and urination resembling strangury." That young boys now suffer from this condition further demonstrates that the innate endowment of people today differs greatly from that of the ancients. Since the density and thinness of qi and blood vary among individuals, how can physicians rigidly adhere to ancient prescriptions without making modifications? One infant suffered from food stagnation after eating zongzi, resulting in constipation, unbearable pain, and convulsions of the hands and feet. Da Chai Hu Tang was administered with one qian of fermented Qu powder mixed in wine; after passing a large amount of stagnant waste, the infant vomited and refused food. Subsequently, Wuwei Yigong San (Five-Ingredient Benefit-the-Spleen Powder) with added Sheng Ma (Cimicifuga Rhizome) and Chai Hu cured the condition. Another infant had constipation, which was determined to be caused by the wet nurse's consumption of rich flavors. Qing Wei San (Clear the Stomach Powder) was used to treat the mother's heat, and the infant received a few spoonfuls intermittently, resulting in recovery. Later, the wet nurse contracted cold and suffered abdominal pain after consuming ginger and wine, causing the infant to develop severe constipation accompanied by bloody stools. Qing Wei San was again administered in small doses daily, curing the infant. A third infant suffered from constipation due to the wet nurse's sudden anger, affecting the infant as well. Jiamiao Xiao Chai Hu Tang (Modified Minor Bupleurum Decoction) was used concurrently. First, Baohe Wan (Preserve Harmony Pill) was given twice, followed by Wuwei Yigong San with added Sheng Ma and Chai Hu, taken in small daily doses by the infant, leading to recovery.
Xiong Huang San (Sichuan Lovage and Scutellaria Powder) from the *Shenghui Fang* treats infantile constipation accompanied by abdominal and hypochondriac fullness and oppression.
Xiong (Ligusticum Chuanxiong Rhizome) (half liang)
Chuan Da Huang (Rheum Palmatum Rhizome, crushed, slightly stir-fried)
Yu Li Ren (Prunus japonica Seed, soaked in water, skin removed, slightly stir-fried. Each three qian)
Crush the above ingredients and sift them through a fine sieve to make a powder. Take one qian per dose, mix with half a zhan of warm water, and adjust the dosage according to the child's age and size, stopping when bowel movement is facilitated. Zhang Huan also treated cases of both constipation and urinary retention.
Zhang Rui's *Jifeng Fang* recommends grinding hemp seeds (Cannabis Sativa Seeds) in water and drinking the juice.