《圣惠》坐儿稍早，为客风吹脊，风气达髓，使背高如龟，虽有药方，多成痼疾，
以灸法为要。〔钱〕儿生下客风入脊，逐于骨髓，即成龟背，治之以龟尿点节骨。
取尿之法，当安龟在莲叶上，后用镜照之，其尿自出，以物盛之。〔张〕婴儿生后
一百八十日，始 骨成，方能独坐，若强令儿坐之太早，即客风寒吹着儿背及脊至
骨，传入于髓，使背高如龟之状，以松药丹疗之。
〔张〕松药丹 治龟背病。
松花（洗，焙干） 枳壳（去瓤，麸炒） 独活 防风（去芦叉。各一两） 川大黄（炮） 前胡 麻黄（去根节）
桂心（各半两）
上为细末，炼蜜和如黍米大。每服十粒，粥饮下，量儿大小加减。《圣惠》
麻黄丸、多芍药，少前胡。一方，多槟榔、诃皮。一方，无松花，有当归，
煮面糊丸，名枳壳防风丸。
《圣惠》灸法 当灸第三椎骨节下两旁各一寸半肺俞穴，又第五椎骨节下两旁各一寸
半心俞穴，又第七椎骨节下两旁各一寸半膈俞穴，以小儿中指节为一寸，艾炷如
小麦大，三五壮即止。此法累用，十有一二得效，亦无全效之功。（《颅囟经》云∶符殿直
之孙绍熙，辛亥春，灸即效。）
〔世〕龟背在百日内不治。
〔曾〕肺与大肠为表里，肛者大肠之门，肺实热，则闭结不通，肺虚寒，则肠头
出露，有因痢久里急后重，努力肛开，为外风所吹，或伏暑作泻，肠滑不禁，或禀
赋怯弱，易于感冷，亦致大肠虚脱。凡小儿所患泻痢，皆因暑湿风热乘脾胃虚而得，
盖风属木，木胜则制土，土主脾胃，虚而受制，又湿喜伤脾，因虚受湿，不能分别
清浊，水谷交杂，则为洞泄，洞泄既久，大肠亦虚，大肠乃手阳明燥金，而土虚不
能生金，金气既虚，则传送之道亦虚，又为风冷所袭，故肛门脱而不收。法宜补脾
温胃，使金得受母之益而气实，宜藿香饮（不乳食）、匀气散（疝）、平胃散（不乳食）主之，次则
内投固肠之剂，用健脾饮（不乳食）养脏汤（痢）服饵，外以敷贴之法，用伏龙肝散敷之，及
萆麻膏贴囟门，使引气上，令其自收，如收尽，仍以水洗去其膏。及有邪热积滞
于大肠，未经疏涤，亦成此疾，其肛门色红而软，肺脉浮数，右手指纹紫见，身微
有热，时或烦躁，先投清肺饮（嗽）疏解，次用薄荷散、蟠龙散为治，间服万安饮亦
佳。〔薛〕巢氏云∶实热则大便秘结，虚寒则肛门脱出，此多因吐泻脾气虚，肺无
所养，故大肠之气虚，脱而下陷也，用补中益气、或四君子为主。若脱出绯赤，
或作痛者，血虚而有热也，用补中益气汤佐以四物、牡丹皮，微者或作痛者，气虚
而有热也，佐以四君、牡丹皮。大凡手足指热者属胃气热，手足指寒者属胃气寒。
汤氏方治脱肛大肠自粪门出，宜用葱汤熏洗令软，款款送上。此因泻利得之者，亦
可服泻利之药，然后用槐花等药。又有用一味五倍子煎汤，入朴硝熏洗而缩者。又
有用真蒲黄碾极细，以猪脂拌匀，敷肛门上而入者。
《全婴方》用涩肠散，兼有痔证肿痛者，用黄丹、滑石等分，井水调涂即消，并用
铅白霜半钱，片脑半字，好酒调敷肿处，甚佳。黄连解毒汤亦可服。用苦参汤洗亦
效。亦有密陀僧、白矾、脑子末之敷上，更用荆芥、防风等项洗之。用生栝蒌根者效。
【内服】
张涣芜荑丹 治小儿久痢频并，大肠虚冷，肛门脱出。
白芜荑（微炒） 鳖甲（涂酥炙黄，去裙 ） 蜗牛皮（炙令焦黄） 磁石（烧，醋蘸七遍，细研水飞。各一两） 蚺
蛇胆 黄连（去须，微炒。各半两）
上件捣，罗为末，用软饭和丸，如黍米大。每服十粒，粥饮下，量儿大小加减，乳食前。
妙应散
莨菪子（淘去浮者，炒令黑色） 天台乌药（各半两。以上捣罗为细末，次入） 白面（一分） 龙脑（半钱）
上件都拌匀。每服一字，蜜汤调下，乳食前。
〔曾氏〕薄荷散 治阳证脱肛。
薄荷（和梗） 骨碎补（去毛。各半两） 金罂刺根（七钱半） 甘草（二钱半）
上锉碎。每服二钱，水一盏，入无灰酒大匙，煎七分，空心温服，或无时。
《聚宝方》象豆丸 治诸痢脱肛。
HT 藤子（一名象豆，出广南山林间，如通草藤，紫黑）
上一味为末，每服二钱。血痢，热酒调下，三服必效。白痢，倾打破取仁子碎
碾，银器中慢火炒黄褐色，碾细，罗一两遍后，若带白时再炒褐色，为末，宿蒸
饼汤浸，却握干和丸豌豆大，略焙干。每服十五丸至二十丸，仓米饮温下，空心，
食前服，痢瘥即止。虫毒五痔、小儿脱肛，并可为末，酒调下，立愈。
〔茅先生〕方用破故纸一两，于瓦上焙干为末，每服一字或半钱，米饮调下。吴茱萸末亦可。
《婴孺》用黄连、黄柏，二味为末，蜜丸桐子大。饮下三丸，日三四服。
〔庄氏〕用干莲蓬焙干为末。米饮调下一二钱。
〔汤氏〕治大肠虚弱，肛门脱下方
龙骨 诃子（煨，去核。各一两） 没石子（大者，二枚） 罂粟壳（去核，醋涂炙，二钱）
上，为末，白汤点服。仍用葱汤熏洗令软，款款以手托入，用新砖瓦烧红，以
醋浇之，气上，即用脚布叠数重压定，使热气上透，不可过热，令病者以臀坐于
布上，如觉布温，逐旋减之，以常得温热为度。并常服前药。
〔洁古〕五倍子散 治小儿脱肛。
五倍子 地榆（各等分）
上，为细末。每服半钱或一钱，空心米饮调下。
【外治】
钱氏赤石脂散 治小儿因痢后努 气下，推出肛门不入。（ ，于建反，用力努腹也）
真赤石脂 伏龙肝（各等分）
上，为细末。每用五分，敷肛头上，频用按入。
〔曾氏〕蟠龙散 治阳证脱肛。
干地龙蟠（如钱样者佳，略去土，一两） 风化朴硝（二钱）
上锉、焙，研为细末，仍和匀朴硝。每以二钱至三钱，肛门湿润干涂，或干燥
用清油调涂。先以见毒消、荆芥、生葱煮水，候温浴洗，轻与拭干，然后敷药。
伏龙肝散 治阴证脱肛。
伏龙肝（一两） 鳖头骨（一具） 百药煎（二钱半）
上三味，焙研为末。每用一钱至三钱，浓煎紫苏汤候温，和清油调涂患处，并
如前法浴洗拭干，方上药。
治小儿脱肛用五倍子为末，量多少掺患处，以物衬手揉入，切忌食发风毒物。
脱肛治法，用蒲黄一两，猪脂二两，炼猪脂和蒲黄成膏，涂肠头上，即缩入。
水圣散 治小儿脱肛不收，用浮萍草不以多少，杵为细末，干贴患处。
涩肠散 治小儿久痢，大肠头脱出不收
诃子（炮） 赤石脂 龙骨（各等分）
上为末。腊茶少许，和药掺肠头上，绢帛揉入。又治痢，米汤调。又方，治脱
肛，五倍子焙为末，入茶，根据前方用。
胜雪膏 治随肠、番花、鼠奶等痔，热痛不可忍，或已成疮者，并皆治之。
片脑 风化硝
上件，各半字，用好酒少许，研成膏子涂之。随手辄愈。
治大人小儿脱肛不收方 连翘不以多少，洗净，为细末。先以盐水洗，后用药末时
时干敷脱肛上，立瘥。
蓖麻膏 治暴患脱肛。
蓖麻子（一两）
上件，烂杵为膏，捻作饼子，两指宽大，贴囟上。如阴证脱肛，加生附子末，
葱蒜同研作膏，根据前法贴之。
《朱氏家传》治小儿脱肛方
上用磁母石，以石碾为末，面糊为丸，如绿豆大。熟水下五七丸。后以磨刀水
洗脱肛处，立效。
脱肛用东北方陈壁泥土，汤泡，先洗下，后熏上。
《保生信效》治久病肠风痔漏，肠出不收，至有出数寸者，苦楚良极。小儿久泻痢，亦名此疾。
上，先用五倍子四两，以水五升，煎汤一两沸，投入朴硝四两，通手淋洗，至
水冷即止。若觉热痛，即津唾调熊胆涂之，痛即止，当渐收，甚者不过淋洗三五
次收尽。窃详此药朴硝能软，五倍子能收，二物相须以为用也，或更以干蜘蛛末
掺之，乘热以软帛 入，尤妙。（掺蜘蛛者与葛氏方同）
《九 卫生》疗小儿脱肛方
香附子 荆芥穗（各等分）
上，同为粗末。每用三匙，水一大碗，煎十数沸，淋渫。
苦参汤 治脱肛并痔。
枳壳 黄连 大黄 甘草 荆芥 苦参 赤芍药 黄芩（各等分）
上锉散。每用五钱，以车前子、茅草同煎，熏洗。
小儿脱肛泻血，秋深不痊。灸龟尾一壮，炷如小麦大，脊端穷骨也。小儿脱肛者，
灸脐中三壮。小儿脱肛久不瘥，及风痫中风，角弓反张，多哭言语不择，发无
时节，盛即吐沫者，取百会一穴，灸七壮，在鼻直入发际五寸顶中央旋毛中，可容豆，炷如小麦大。
《圣惠方》认为，让婴儿过早坐立，容易受到外来风寒侵袭脊柱，风气深入骨髓，导致背部隆起像乌龟一样。虽然也有药方，但多形成顽固难治的疾病，因此以灸法为主要治疗手段。〔钱乙〕认为，婴儿出生后，客风侵入脊柱，逐入骨髓，即形成龟背，治疗可用龟尿点涂节骨处。取龟尿的方法是，将龟放在莲叶上，然后用镜子照射它，它的尿液就会自然流出，用容器接住即可。〔张涣〕指出，婴儿出生后一百八十天，骨骼才发育成形，才能独自坐立，如果强行让婴儿过早坐立，外来的风寒吹袭婴儿的背部及脊柱直至骨头，传入骨髓，使背部隆起像乌龟的形状，可用松药丹来治疗。
〔张涣〕松药丹：治疗龟背病。
配方：松花（清洗，焙干）一两，枳壳（去除瓤，麸皮炒）一两，独活一两，防风（去芦头叉枝）一两，川大黄（炮制）半两，前胡半两，麻黄（去根和节）半两，桂心半两。
以上药物研成细末，用炼蜜调和，制成如黍米大小的丸剂。每次服用十粒，用粥饮送下，根据患儿年龄大小酌情增减剂量。《圣惠方》中的麻黄丸，芍药用量较多，前胡用量较少。另一方的配方中，槟榔和诃子皮用量较多。还有一方没有松花，但有当归，煮面糊为丸，名为枳壳防风丸。
《圣惠方》灸法：应当灸第三椎骨节下两旁各一寸半处的肺俞穴，第五椎骨节下两旁各一寸半处的心俞穴，以及第七椎骨节下两旁各一寸半处的膈俞穴。以小儿中指中间一节为一寸的标准，艾炷大小如小麦粒，每穴灸三至五壮即可停止。此法多次使用，十分之一二的病例能见效，也没有完全治愈的功效。（《颅囟经》记载：符殿直的孙子绍熙，在辛亥年春天，经过灸治后即见效。）
〔世医观点〕龟背如果在百日内不治疗，则难以治愈。
〔曾氏〕肺与大肠互为表里，肛门是大肠的门户。肺有实热，则大便闭结不通；肺虚寒，则直肠脱出露在外面。有的因为痢疾日久，里急后重，用力努挣导致肛门脱开，被外风吹袭；或者因伏暑引起腹泻，肠道滑脱不能控制；或者先天禀赋怯弱，容易感受寒冷，也导致大肠虚脱。凡是小儿患的泻痢，都是因为暑湿风热乘脾胃虚弱而致病。风属木，木盛则克制土，土主脾胃，脾胃虚弱受克，加上湿气容易伤脾，因虚受湿，不能分别清浊，水谷混杂，就形成洞泄。洞泄久了，大肠也会虚弱。大肠属手阳明燥金，土虚不能生金，金气既虚，传导功能也随之虚弱，再加上被风冷侵袭，所以肛门脱出而不能收回。治疗方法宜补脾温胃，使金得到母脏（脾土）的滋养而气实，宜用藿香饮（适用于食欲不振）、匀气散（适用于疝气）、平胃散（适用于食欲不振）为主治疗，其次内服固肠的药物，用健脾饮（适用于食欲不振）、养脏汤（适用于痢疾）服用，外用敷贴的方法，用伏龙肝散敷贴，以及蓖麻膏贴敷囟门，引导气机上行，使其自行收回，如果完全收回，仍用水洗去药膏。如果有邪热积滞在大肠，未经过疏涤清理，也会形成此病，其肛门颜色红而软，肺脉浮数，右手指纹紫色显现，身体微热，时而烦躁，先投清肺饮（适用于咳嗽）疏解，其次用薄荷散、蟠龙散治疗，间服万安饮也很好。
〔薛己〕巢元方说：实热则大便秘结，虚寒则肛门脱出，这多因吐泻导致脾气虚，肺无所养，故大肠之气虚，脱出而下陷。治疗用补中益气汤或四君子汤为主。如果脱出的部分绯红色，或者疼痛，是血虚而有热，用补中益气汤佐以四物汤、牡丹皮；症状轻微且疼痛的，是气虚而有热，佐以四君子汤、牡丹皮。大凡手足指头热的属于胃气热，手足指头冷的属于胃气寒。
汤氏方治疗脱肛，大肠自粪门脱出，宜用葱汤熏洗使其变软，慢慢送回。这是因泻利引起的，也可以服用治疗泻利的药物，然后用槐花等药。又有用一味五倍子煎汤，加入朴硝熏洗而使肛门缩回的。又有用真蒲黄碾成极细粉，用猪脂拌匀，敷在肛门上使其纳入。
《全婴方》用涩肠散，兼有痔疮肿痛者，用黄丹、滑石等分，井水调涂即可消除，并用铅白霜半钱，片脑半字，好酒调敷肿处，效果很好。黄连解毒汤也可服用。用苦参汤清洗也有效。也有用密陀僧、白矾、脑子末敷上的，更用荆芥、防风等项清洗。用生栝蒌根也有效。
【内服】
张涣芜荑丹：治疗小儿久痢频发，大肠虚冷，肛门脱出。
配方：白芜荑（微炒）一两，鳖甲（涂酥炙黄，去裙襕）一两，蜗牛皮（炙令焦黄）一两，磁石（烧，醋蘸七遍，细研水飞）一两，蚺蛇胆半两，黄连（去须，微炒）半两。
以上捣碎，过筛为末，用软饭和丸，如黍米大小。每次服用十粒，粥饮送下，根据患儿大小加减，在吃奶吃饭前服用。
妙应散：
配方：莨菪子（淘去浮者，炒令黑色）半两，天台乌药半两。以上捣罗为细末，次入白面一分，龙脑半钱。
以上都拌匀。每次服用一字，蜜汤调下，在吃奶吃饭前服用。
〔曾氏〕薄荷散：治疗阳证脱肛。
配方：薄荷（带梗）半两，骨碎补（去毛）半两，金罂刺根七钱半，甘草二钱半。
以上锉碎。每次服用二钱，水一盏，加入无灰酒一大匙，煎至七分，空腹温服，或不定时服用。
《聚宝方》象豆丸：治疗各种痢疾脱肛。
配方：HT藤子（一名象豆，出产于广南山林间，像通草藤，紫黑色）。
以上一味药为末，每次服用二钱。血痢，用热酒调下，三次必效。白痢，倾出打破取仁子碎碾，在银器中慢火炒至黄褐色，碾细，过筛一两遍后，如果带白色再炒至褐色，为末，用宿蒸饼汤浸湿，握干和丸如豌豆大，略焙干。每次服用十五丸至二十丸，仓米饮温下，空腹，食前服用，痢疾痊愈即停。虫毒五痔、小儿脱肛，均可研为末，酒调下，立即痊愈。
〔茅先生〕方用破故纸一两，在瓦上焙干为末，每次服用一字或半钱，米饮调下。吴茱萸末也可以。
《婴孺集》用黄连、黄柏，二味为末，蜜丸如桐子大。饮水送下三丸，每天三四次。
〔庄氏〕用干莲蓬焙干为末。米饮调下一二钱。
〔汤氏〕治疗大肠虚弱，肛门脱下方：
配方：龙骨一两，诃子（煨，去核）一两，没石子（大的两枚），罂粟壳（去核，醋涂炙）二钱。
以上为末，白开水冲服。仍用葱汤熏洗使其变软，慢慢用手托入，用新砖瓦烧红，浇醋，热气上升，即用脚布叠数层压定，使热气上透，不可过热，令患者臀部坐在布上，如果觉得布温，逐渐减少层数，以常得温热为度。并常服前面的药物。
〔洁古〕五倍子散：治疗小儿脱肛。
配方：五倍子、地榆（各等分）。
以上为细末。每次服用半钱或一钱，空腹米饮调下。
【外治】
钱氏赤石脂散：治疗小儿因痢后用力努气下坠，推出肛门不入。（“努”，音同“建”的反切，意为用力努腹。）
配方：真赤石脂、伏龙肝（各等分）。
以上为细末。每次用五分，敷在肛头上，频繁使用并按入。
〔曾氏〕蟠龙散：治疗阳证脱肛。
配方：干地龙蟠（如铜钱样为佳，略去泥土，一两），风化朴硝二钱。
以上锉、焙，研为细末，仍和匀朴硝。每次取二钱至三钱，肛门湿润时干涂，或干燥时用清油调涂。先用见毒消、荆芥、生葱煮水，候温浴洗，轻轻拭干，然后敷药。
伏龙肝散：治疗阴证脱肛。
配方：伏龙肝一两，鳖头骨一具，百药煎二钱半。
以上三味，焙研为末。每次用一钱至三钱，浓煎紫苏汤候温，和清油调涂患处，并如前法浴洗拭干，方上药。
治疗小儿脱肛用五倍子为末，量多少掺患处，以物衬手揉入，切忌食用发风毒物。
脱肛治法，用蒲黄一两，猪脂二两，炼猪脂和蒲黄成膏，涂肠头上，即缩入。
水圣散：治疗小儿脱肛不收，用浮萍草不限多少，杵为细末，干贴患处。
涩肠散：治疗小儿久痢，大肠头脱出不收。
配方：诃子（炮）、赤石脂、龙骨（各等分）。
以上为末。腊茶少许，和药掺肠头上，绢帛揉入。又治痢，米汤调。又方，治脱肛，五倍子焙为末，入茶，根据前方用。
胜雪膏：治疗随肠、番花、鼠奶等痔疮，热痛不可忍，或已成疮者，皆治之。
配方：片脑、风化硝（各半字）。
以上各半字，用好酒少许，研成膏子涂之。随手辄愈。
治大人小儿脱肛不收方：连翘不限多少，洗净，为细末。先以盐水洗，后用药末时时干敷脱肛上，立瘥。
蓖麻膏：治疗暴患脱肛。
配方：蓖麻子一两。
以上烂杵为膏，捻作饼子，两指宽大，贴囟上。如阴证脱肛，加生附子末，葱蒜同研作膏，根据前法贴之。
《朱氏家传》治小儿脱肛方：
上用磁母石，以石碾为末，面糊为丸，如绿豆大。熟水下五七丸。后以磨刀水洗脱肛处，立效。
脱肛用东北方陈壁泥土，汤泡，先洗下，后熏上。
《保生信效》治久病肠风痔漏，肠出不收，至有出数寸者，苦楚良极。小儿久泻痢，亦名此疾。
以上，先用五倍子四两，以水五升，煎汤一两沸，投入朴硝四两，通手淋洗，至水冷即止。若觉热痛，即津唾调熊胆涂之，痛即止，当渐收，甚者不过淋洗三五次收尽。窃详此药朴硝能软，五倍子能收，二物相须以为用也，或更以干蜘蛛末掺之，乘热以软帛 入，尤妙。（掺蜘蛛者与葛氏方同）
《九 卫生》疗小儿脱肛方：
配方：香附子、荆芥穗（各等分）。
以上同为粗末。每次用三匙，水一大碗，煎十数沸，淋渫。
苦参汤：治疗脱肛并痔。
配方：枳壳、黄连、大黄、甘草、荆芥、苦参、赤芍药、黄芩（各等分）。
以上锉散。每次用五钱，以车前子、茅草同煎，熏洗。
小儿脱肛泻血，秋深不痊。灸龟尾一壮，炷如小麦大，脊端穷骨也。小儿脱肛者，灸脐中三壮。小儿脱肛久不瘥，及风痫中风，角弓反张，多哭言语不择，发无时节，盛即吐沫者，取百会一穴，灸七壮，在鼻直入发际五寸顶中央旋毛中，可容豆，炷如小麦大。
*Shenghui Fang* (Supreme Benefit Formulas) suggests that allowing infants to sit too early exposes the spine to external wind-cold. Wind-pathogen enters the marrow, causing the back to protrude like a turtle shell. Although medicinal formulas exist, they often fail to cure chronic conditions; therefore, moxibustion is the primary treatment. [Qian Yi] states that if postnatal "guest wind" invades the spine and penetrates the bone marrow, it results in turtle-back deformity. Treatment involves applying turtle urine to the joint bones. To collect the urine, place the turtle on a lotus leaf and shine a mirror upon it; the urine will excrete naturally and can be collected with a vessel. [Zhang Huan] notes that an infant's bones are not fully formed until 180 days after birth, at which point they can sit independently. Forcing an infant to sit too early allows external wind-cold to strike the back and spine, penetrating the bones and marrow, resulting in a humpback resembling a turtle. This should be treated with *Songyao Dan* (Pine Medicine Pill).
[Zhang Huan] *Songyao Dan*: Treats turtle-back deformity.
Ingredients: *Pinus massoniana* flower heads (washed, dried by baking) 1 liang, *Aurantii Fructus* (pulp removed, stir-fried with bran) 1 liang, *Angelicae Pubescentis Radix* 1 liang, *Saposhnikoviae Radix* (rhizome and forked roots removed) 1 liang, *Rhei Radix et Rhizoma* (processed) 0.5 liang, *Peucedani Radix* 0.5 liang, *Ephedrae Herba* (roots and nodes removed) 0.5 liang, *Cinnamomi Cortex* 0.5 liang.
Grind all ingredients into a fine powder. Mix with refined honey to form pills the size of millet seeds. Administer 10 pills per dose, washed down with gruel beverage, adjusting the dosage according to the child's age and size. In *Shenghui Fang*'s *Mahuang Wan*, the dosage of *Paeoniae Radix Alba* is increased while *Peucedani Radix* is decreased. Another variation increases *Arecae Semen* and *Terminalia Chebula Retusa*. A third variant omits pine flowers but adds *Angelicae Sinensis Radix*, formed into pills with boiled wheat paste, named *Zhike Fangfeng Wan*.
*Shenghui Fang* Moxibustion Method: Moxibustion should be applied to the *Feishu* (BL13) acupoint, located 1.5 cun lateral to the spinous process of the third thoracic vertebra; the *Xinshu* (BL15) acupoint, located 1.5 cun lateral to the fifth thoracic vertebra; and the *Geshu* (BL17) acupoint, located 1.5 cun lateral to the seventh thoracic vertebra. Use the middle segment of the child's middle finger as the standard for 1 cun. The moxa cone should be the size of a wheat grain. Apply 3 to 5 cones per acupoint. This method has been used repeatedly with success in only one or two out of ten cases, and rarely achieves complete cure. (*Lunxin Jing* records: Shaoxi, grandson of Fu Dianzhi, was cured after moxibustion in the spring of the Xinhai year.)
[General Medical Consensus] Turtle-back deformity is incurable if not treated within the first hundred days.
[Zeng Zhixi] The Lung and Large Intestine are exterior-interior paired organs. The anus is the gate of the Large Intestine. Lung excess-heat causes constipation; Lung deficiency-cold causes rectal prolapse. Prolapse may result from prolonged dysentery with tenesmus and straining, exposing the anus to external wind; or from summer-heat diarrhea causing intestinal slippage and incontinence; or from congenital weakness making the child susceptible to cold, leading to Large Intestine deficiency collapse. Pediatric diarrhea and dysentery generally arise when summer-dampness, wind, and heat exploit Spleen-Stomach deficiency. Wind belongs to Wood; excessive Wood controls Earth. Earth governs the Spleen and Stomach; when deficient and controlled, combined with dampness injuring the Spleen due to deficiency, the body fails to separate clear from turbid. Water and food mix, causing profuse watery diarrhea. Prolonged watery diarrhea weakens the Large Intestine. The Large Intestine corresponds to Hand-Yangming Dryness-Metal. Spleen-earth deficiency fails to generate Metal; thus, Metal qi becomes deficient, weakening the transmission pathway. Attack by wind-cold then causes anal prolapse that cannot retract. The treatment principle is to tonify the Spleen and warm the Stomach, allowing Metal to receive nourishment from its mother (Earth) and strengthen its qi. Primary formulas include *Huoxiang Yin* (for poor appetite), *Yunqi San* (for hernia), and *Pingwei San* (for poor appetite). Subsequently, administer internal bowel-consolidating agents such as *Jianpi Yin* (for poor appetite) and *Yangzang Tang* (for dysentery). Externally, apply *Fulonggan San* (Dragon Bone Powder) or castor oil plaster to the anterior fontanelle to guide qi upward, allowing spontaneous retraction. Once retracted, wash off the plaster with water. If pathogenic heat and stagnation accumulate in the Large Intestine without prior resolution, this condition also arises. Signs include red, soft anus, floating-rapid Lung pulse, purple appearance of the distal phalanx fingerprint on the right hand, slight fever, and occasional irritability. Initially administer *Qingfei Yin* (for cough) to disperse and resolve, followed by *Bohe San* and *Panlong San*. Intermittent administration of *Wan'an Yin* is also beneficial.
[Xue Ji] Chao Yuanfang stated: Excess-heat causes constipation; deficiency-cold causes anal prolapse. This is often due to vomiting and diarrhea causing Spleen qi deficiency, leaving the Lung un-nourished, resulting in Large Intestine qi deficiency, leading to prolapse and sinking. Treat primarily with *Buzhong Yiqi Tang* (Tonify the Middle and Augment the Qi Decoction) or *Sijunzi Tang* (Four Gentlemen Decoction). If the prolapsed tissue is crimson or painful, it indicates blood deficiency with heat; treat with *Buzhong Yiqi Tang* supplemented by *Siwu Tang* (Four Substances Decoction) and *Mudanpi* (Tree Peony Bark). If symptoms are mild with pain, it indicates qi deficiency with heat; supplement *Sijunzi Tang* with *Mudanpi*. Generally, hot fingertips indicate Stomach qi heat; cold fingertips indicate Stomach qi cold.
[Tang Shi's Formula] For rectal prolapse where the Large Intestine exits the anus, fumigate and wash with scallion decoction to soften, then gently reduce it manually. For cases caused by diarrhea/dysentery, administer anti-diarrheal/dysentery medicines first, followed by herbs such as *Chrysanthemi Flos* (Flower of Chrysanthemum). Another method uses a decoction of single-ingredient *Galla Chinensis* (Chinese Gall) with *Natrii Sulfas* (Mirabilite) for fumigation and washing to induce retraction. Another method uses finely powdered *Pollen Typhae* (Cat-tail Pollen) mixed with lard, applied to the anus to facilitate reduction.
*Quanying Fang* uses *Secchang San* (Intestine-Astringing Powder). For cases with hemorrhoid swelling and pain, mix equal parts of *Minium* (Lead Monoxide) and *Talcum* (Talc), apply with well water to resolve swelling. Also apply half a qian of *Plumbi Subcarbonas* (White Lead Frost) and half a zi of *Borneolum Syntheticum* (Borneol) mixed with good wine to the swollen area for excellent results. *Huanglian Jiedu Tang* (Coptis Decoction to Relieve Toxicity) is also suitable. Washing with *Sophorae Flavescentis Radix* (Kushen) decoction is effective. Other options include applying powders of *Argenti Nitras* (Litharge), *Alumen* (Alum), and *Borneolum* (Camphor), followed by washing with *Schizonepetae Herba* (Schizonepeta) and *Saposhnikoviae Radix* (Fangfeng). Using fresh *Trichosanthis Radix* (Gualou Gen) is also effective.
[Internal Administration]
Zhang Huan's *Wuyi Dan* (Melia Pill): Treats pediatric chronic frequent dysentery, Large Intestine deficiency-cold, and anal prolapse.
Ingredients: *Meliae Semen* (lightly stir-fried) 1 liang, *Testudinis Carapax et Plastrum* (coated with butter, roasted yellow, remove skirt) 1 liang, *Viperis Corpus* (roasted until scorched yellow) 1 liang, *Magnetitum* (calcined, dipped in vinegar seven times, finely ground and levigated) 1 liang, *Bungarus Caeruleus Bile* 0.5 liang, *Coptidis Rhizoma* (remove whiskers, lightly stir-fried) 0.5 liang.
Crush and sieve into powder. Mix with soft rice to form pills the size of millet seeds. Administer 10 pills per dose with gruel beverage, adjusting for age/size, before milk or meals.
*Miaoying San* (Wonderful Efficacy Powder):
Ingredients: *Hyoscyami Semen* (wash away floating ones, roast until black) 0.5 liang, *Linderae Radix* (Tiantai Wuyao) 0.5 liang. Grind these into fine powder, then add *Tritici Farina* (Wheat Flour) 1 fen, *Borneolum* (Borneol) 0.5 qian.
Mix thoroughly. Administer one zi per dose, mixed with honey water, before milk or meals.
[Zeng Shi] *Bohe San* (Mint Powder): Treats Yang-type rectal prolapse.
Ingredients: *Menthae Haplocalycis Herba* (with stem) 0.5 liang, *Drynariae Rhizoma* (remove hairs) 0.5 liang, *Berberidis Radix* (Jinyingsi root) 0.75 liang, *Glycyrrhizae Radix et Rhizoma* 0.25 liang.
Cut into pieces. Administer 2 qian per dose with one cup of water and one large spoon of non-adulterated wine. Decoct to 0.7 cup. Take warm on an empty stomach or as needed.
*Jubao Fang* *Xiangdou Wan* (Elephant Bean Pill): Treats various dysenteries with prolapse.
Ingredient: HT Vine Seeds (also known as Elephant Beans, found in mountains of Guangnan, resembling *Akebia* vine, purple-black).
Grind into powder. Administer 2 qian per dose. For bloody dysentery, take with hot wine; three doses guarantee efficacy. For white dysentery, break open, extract kernels, grind, and slowly roast in a silver vessel until yellow-brown. Grind fine, sieve once or twice. If white remains, roast again until brown. Grind to powder. Soak in steamed cake tea, squeeze dry, and form pills the size of pea seeds. Lightly dry. Administer 15-20 pills per dose with warehouse rice beverage, warm, on an empty stomach before meals. Stop when dysentery resolves. For worm toxins, five types of hemorrhoids, and pediatric prolapse, take powder mixed with wine for immediate cure.
[Mao Xiansheng] Formula: Roast *Psoraleae Fructus* (Buguzhi) 1 liang on a tile until dry, grind to powder. Administer one zi or half a qian, mixed with rice beverage. *Evodiae Fructus* (Wuzhuyu) powder is also acceptable.
*Yingru Ji* uses *Coptidis Rhizoma* (Huanglian) and *Phellodendri Cortex* (Huangbai), ground to powder, honey-pilled to the size of paulownia seeds. Take 3 pills with water, 3-4 times daily.
[Zhuang Shi] Uses dried lotus seed pods, roasted and ground to powder. Take 1-2 qian mixed with rice beverage.
[Tang Shi] Formula for Large Intestine weakness and anal prolapse:
Ingredients: *Longgu* (Fossilized Bones) 1 liang, *Terminalia Chebula Retusa* (Hezi, baked, pitted) 1 liang, *Myrobalans* (large ones, 2 pieces), *Papaveris Pericarpium* (Yangsuke Qiao, pitted, coated with vinegar and roasted) 2 qian.
Grind to powder. Take with plain boiled water. Continue fumigating and washing with scallion water to soften, then gently reduce manually. Heat new brick tiles, pour vinegar to generate steam, stack several layers of foot cloth, press firmly to allow heat penetration (ensure not too hot). Have the patient sit on the cloth. Reduce layers gradually as it cools, maintaining warmth. Continue taking the internal medicine.
[Jiegu] *Wubeizi San* (Five-Gallnut Powder): Treats pediatric rectal prolapse.
Ingredients: *Galla Chinensis* (Wubeizi), *Sanguisorbae Radix* (Diyu) (equal parts).
Grind to fine powder. Take half a qian or one qian, mixed with rice beverage on an empty stomach.
[External Treatment]
Qian Yi's *Chishizhi San* (Red Halloysite Powder): Treats pediatric anal prolapse following dysentery due to straining. ("Nu" means straining the abdomen).
Ingredients: True *Halloysitum Rubrum* (Chishizhi), *Fulonggan* (Dragon's House Soil) (equal parts).
Grind to fine powder. Apply 0.5 fen to the anal head frequently, pressing it in.
[Zeng Shi] *Panlong San* (Coiled Dragon Powder): Treats Yang-type rectal prolapse.
Ingredients: Dried *Pheretima* (Di Long, coiled like a coin is best, remove soil) 1 liang, *Natrii Sulfas Efflorescens* (Fenghua Puxiao) 2 qian.
Cut, bake, and grind to fine powder, mixing evenly with Mirabilite. Apply 2-3 qian directly if the anus is moist, or mix with sesame oil if dry. First, boil *Anemones Radix* (Jianduxiao), *Schizonepetae Herba* (Jingjie), and raw scallion in water. Wash with warm water, gently pat dry, then apply medicine.
*Fulonggan San* (Dragon's House Soil Powder): Treats Yin-type rectal prolapse.
Ingredients: *Fulonggan* (Dragon's House Soil) 1 liang, *Testudinis Cranium* (Bie Tou Gu) 1 piece, *Baiyaojian* (Fermented Medicinal Leaven) 2.5 qian.
Bake and grind the three ingredients to powder. Take 1-3 qian, mix with strong decoction of *Perillae Folium* (Zisu Ye) cooled to warm temperature and sesame oil. Apply to the affected area. Wash and dry as described above before application.
For pediatric rectal prolapse, use *Galla Chinensis* powder applied to the lesion, reducing it manually with protection. Strictly avoid foods that trigger wind-toxins.
Treatment for prolapse: Mix 1 liang *Pollen Typhae* with 2 liang lard, refine into ointment, apply to the prolapsed intestine to induce retraction.
*Shuisheng San*: For irreducible pediatric prolapse, use *Lemma Minoris* (Fuping) in any amount, pounded to fine powder, applied dry to the lesion.
*Secchang San*: For chronic pediatric dysentery with irreducible Large Intestine prolapse.
Ingredients: *Terminalia Chebula Retusa* (Hezi, processed), *Halloysitum Rubrum* (Chishizhi), *Longgu* (equal parts).
Grind to powder. Add a little aged tea, mix with powder, apply to the prolapsed intestine, and reduce with silk cloth. Also treats dysentery when mixed with rice soup. Another formula for prolapse: Roast *Galla Chinensis*, grind to powder, add tea, follow previous instructions.
*Xuesnow Ointment*: Treats prolapsed hemorrhoids (Suochang, Fanhua, Shunainai), unbearable heat/pain, or ulcerated hemorrhoids.
Ingredients: *Borneolum Syntheticum* (Bingpian), *Natrii Sulfas Efflorescens* (Fenghua Xiao) (half a zi each).
Mix with a small amount of good wine, grind into ointment, and apply. Cures immediately.
Formula for adult/pediatric irreducible prolapse: *Forsythiae Fructum* (Lianqiao) in any amount, washed and ground to powder. Wash with salt water first, then apply powder dry to the prolapse repeatedly. Cures instantly.
*Bimagan Gao* (Castor Oil Plaster): Treats acute rectal prolapse.
Ingredients: *Ricini Semen* (Bimazi) 1 liang.
Pound into paste, shape into cakes two fingers wide, apply to the anterior fontanelle. For Yin-type prolapse, add *Aconiti Lateralis Radix Praeparata* (Sheng Fuzi) powder, crush with scallion and garlic to make paste, apply as above.
*Zhu Shi Jia Chuan* Formula for pediatric prolapse:
Grind *Ci Mu Shi* (Magnetite) to powder with a stone mill, form pills with wheat paste the size of mung beans. Swallow 5-7 pills with cooked water. Wash the prolapse area with whetstone water for immediate effect.
Northeastern folk remedy for prolapse: Use old wall earth, soak in hot water, wash the lower part first, then fumigate the upper part.
*Bao Sheng Xin Xiao* treats chronic wind-intestinal hemorrhoids/fistulas with irreducible prolapse (sometimes extending several inches), causing extreme suffering. Chronic pediatric diarrhea/dysentery is also called this disease.
Take 4 liang *Galla Chinensis*, boil in 5 sheng water for one boil, add 4 liang *Natrii Sulfas* (Mirabilite). Wash with solution until cool. If burning pain occurs, mix bear bile with saliva and apply to stop pain; retraction follows. Severe cases resolve in 3-5 washes. Mirabilite softens, *Galla Chinensis* astringes; they work synergistically. Alternatively, sprinkle dry spider powder and reduce with warm soft cloth for superior results (same as Ge Shi's formula).
*Jiu Wei Wei Sheng* Formula for pediatric prolapse:
Ingredients: *Cyperi Rhizoma* (Xiangfu), *Schizonepetae Spica* (Jingjie Sui) (equal parts).
Grind to coarse powder. Take 3 spoons, boil in one large bowl of water for several boils, pour over the area.
*Kushen Tang* (Sophora Decoction): Treats prolapse and hemorrhoids.
Ingredients: *Aurantii Fructus* (Zhike), *Coptidis Rhizoma* (Huanglian), *Rhei Radix et Rhizoma* (Dahuang), *Glycyrrhizae Radix et Rhizoma* (Gancao), *Schizonepetae Herba* (Jingjie), *Sophorae Flavescentis Radix* (Kushen), *Paeoniae Radix Rubra* (Chishaoyao), *Scutellariae Radix* (Huangqin) (equal parts).
Cut into pieces. Take 5 qian, decoct with *Plantaginis Semen* (Cheqian Zi) and *Imperatae Rhizoma* (Maogeng), fumigate and wash.
For pediatric prolapse with bloody stool persisting late autumn: Apply one cone of moxibustion to *Guiwei* (Coccyx tip, the end of the spine), cone size of a wheat grain. For pediatric prolapse: Apply three cones to *Qihai* (CV6, center of umbilicus). For chronic pediatric prolapse, wind-stroke epilepsy, opisthotonos, excessive crying, incoherent speech, irregular onset, or foaming at the mouth during attacks: Moxibustion on *Baihui* (GV20), seven cones. Location: 5 cun directly above the nose hairline, in the central whorl of hair on the vertex. Cone size of a wheat grain.