小儿诸热辨例∶
伤寒热∶手足梢冷,发热恶寒而无汗,面色青惨而不舒,左额有青纹。
伤风热∶手足梢微温,自汗,面赤而光。
伤食热∶目泡肿,右额有青纹,身热而头额、腹肚尤甚,夜热昼凉,面黄,或吐痢腹疼。
惊风热∶面色青红,额正中有青纹,手心有汗,时作惊惕,手脉络微动而发热。
风热∶身热,倍能食,唇红颊赤,大小便秘。
潮热∶如水之潮,根据时而至。
变蒸热∶身体上下而蒸热,上气虚惊,耳热微汗,唇上下有白泡,状如珠子。重者,身热脉乱、腹痛啼叫、
不能乳食、或吐 。周岁以后,无此症也。
潮热,发渴有时;惊热,颠叫恍惚;夜热;夕发且止;余热,寒邪未尽;食热,肚背先热;疳热,骨蒸盗
汗;背热,一向不止;烦热,心躁不安;积热,颊赤口疮;风热,汗出身热;虚热,困倦少力;客热,来去不
定;癖热,涎嗽饮水;寒热,发如疟状;血热,辰巳时发;疹热,耳鼻尖冷。诸热得之,各有所归,其间有三
两症交互者,宜随其轻重而治之。
诸热为病者,宜清热也。
大连翘饮 治小儿伤风感冒,发热。痰壅、风热、丹毒肿痛、颈项有核、腮赤痈疖、眼目赤肿、口舌
生疮、咽喉疼痛、小便淋沥、胎毒痘疹余毒、一切热毒并治。
连翘 瞿麦 滑石 车前子 牛蒡子 赤芍 栀子 木通 当归 防风(各四分) 柴胡 黄芩 荆芥
(各一钱二分) 蝉蜕(五
分) 甘草(一钱六分)
上锉,竹叶十个、灯芯十茎,水煎,不拘时温服。风痰热变蒸加麦冬;实热、丹热加大黄;胎热、疮疹余
毒加薄荷叶;痈疖热毒加大黄、芒硝。
五福化毒丹 治小儿壅积热毒,唇口肿破生疮、牙根出血、口臭颊赤、咽干烦躁、或痘疹余毒未解、
或头目身体多生疮疖。
犀角 桔梗(去芦) 生地黄(酒洗) 赤茯苓(去皮) 牛蒡子(微炒。各五钱) 朴硝 连翘 玄
参(黑者) 粉草(各六钱) 青黛(二钱,研极细)
上为末,炼蜜丸,如龙眼大。每服一丸,薄荷汤化下。兼有惊,加朱砂为衣。
小儿各种热证的辨证示例:
伤寒热:手足末端发冷,发热且怕冷,无汗,面色青暗而不舒展,左侧额头有青色纹路。
伤风热:手足末端微温,自发出汗,面部发红且有光泽。
伤食热:眼睑浮肿,右侧额头有青色纹路,身体发热而头部、额头及腹部尤为严重,夜间发热白天凉爽,面色发黄,或伴有呕吐、腹泻及腹痛。
惊风热:面色青红相间,额头正中有青色纹路,手心出汗,时常出现惊恐警惕的表现,手背脉络轻微跳动并伴有发热。
潮热:像潮水一样,按时到来。
变蒸热:全身上下蒸腾发热,上气虚怯易受惊吓,耳朵发热微汗,嘴唇上下有白色水泡,形状像珠子。病情重的,身体发热脉象紊乱、腹痛啼哭、不能哺乳进食、或呕吐。周岁以后,就没有这种病症了。
潮热,发作口渴有时;惊热,头顶叫喊神情恍惚;夜热,傍晚发作清晨停止;余热,寒邪尚未清除;食热,肚子和背部先热;疳热,骨蒸盗汗;背热,一直不停止;烦热,心中烦躁不安;积热,两颊赤红口舌生疮;风热,出汗后身体发热;虚热,困倦乏力;客热,来去不定;癖热,流涎咳嗽饮水;寒热,发作像疟疾状;血热,辰时巳时(上午7点至11点)发作;疹热,耳朵和鼻子尖端发冷。各种热证得之,各有归属,其中有两三种症状交互出现的,应当根据病情的轻重进行治疗。
各种热证致病,适宜采用清热法治疗。
大连翘饮:治疗小儿伤风感冒,发热。痰液壅盛、风热、丹毒肿痛、颈项有肿块、腮部红肿痈疖、眼睛红肿、口舌生疮、咽喉疼痛、小便淋漓不尽、胎毒痘疹余毒,一切热毒均能治疗。
连翘、瞿麦、滑石、车前子、牛蒡子、赤芍、栀子、木通、当归、防风(各四分)、柴胡、黄芩、荆芥(各一钱二分)、蝉蜕(五分)、甘草(一钱六分)。
以上药物切碎,用竹叶十片、灯芯草十茎,加水煎煮,不拘时间温服。若有风痰热、变蒸热,加麦冬;若是实热、丹热,加大黄;若是胎热、疮疹余毒,加薄荷叶;若是痈疖热毒,加大黄、芒硝。
五福化毒丹:治疗小儿壅积热毒,嘴唇口腔肿胀破裂生疮、牙根出血、口臭脸颊赤红、咽干烦躁、或是痘疹余毒未解、或是头目身体多生疮疖。
犀角、桔梗(去芦头)、生地黄(酒洗)、赤茯苓(去皮)、牛蒡子(微炒,各五钱)、朴硝、连翘、玄参(黑色的)、粉草(各六钱)、青黛(二钱,研成极细粉末)。
以上药物制成粉末,用炼蜜做成丸药,大小如龙眼核。每次服用一丸,用薄荷汤送服化下。兼有惊风的,加朱砂作为外衣。
Examples of Differentiating Various Febrile Conditions in Children:
Heat from Cold Damage (Shanghan): Coldness at the extremities of hands and feet, fever with aversion to cold, absence of sweating, a bluish-dark complexion that appears constrained, and a blueish line on the left forehead.
Heat from Wind Injury (Shangfeng): Slightly warm extremities of hands and feet, spontaneous sweating, a red and lustrous facial appearance.
Heat from Food Retention (Shangshi): Swollen eye bags, a blueish line on the right forehead, body heat especially severe in the head, forehead, and abdomen, night fever with daytime coolness, sallow complexion, or accompanied by vomiting, diarrhea, and abdominal pain.
Heat from Startling Wind (Jingfeng): A complexion alternating between blue and red, a blueish line in the center of the forehead, sweaty palms, frequent episodes of startling and vigilance, slight pulsation of the veins on the dorsum of the hand accompanied by fever.
Wind-Heat: Body heat, increased appetite, red lips and flushed cheeks, constipation of both stool and urine.
Tidal Fever (Chaore): Arriving on schedule like the tide.
Bianzheng Heat: Steaming heat throughout the upper and lower body, deficiency of Qi in the upper jiao leading to fright, hot ears with slight sweating, white blisters on the upper and lower lips resembling beads. In severe cases, body heat with chaotic pulse, abdominal pain, crying, inability to nurse or eat, or vomiting. This condition does not occur after one year of age.
Tidal fever presents with occasional thirst; startling fever involves shouting from the vertex and trance-like states; night fever begins in the evening and stops at dawn; residual heat indicates incomplete elimination of pathogenic cold; food heat manifests as initial heat in the abdomen and back; guan heat involves steaming bone sensation and nocturnal sweating; back heat persists continuously; vexatious heat is characterized by mental restlessness and anxiety; accumulated heat shows flushed cheeks and mouth ulcers; wind heat follows sweating with body heat; deficiency heat presents with fatigue and weakness; exogenous heat comes and goes unpredictably; pi heat involves salivation, coughing, and drinking water; chuan-re (alternating cold and heat) resembles malaria; blood heat occurs during Chen and Si hours (7:00–11:00 AM); rash heat features coldness at the tips of the ears and nose. Each type of heat has its specific attribution. When two or three symptoms interact, treatment should be adjusted according to the severity of the condition.
For diseases caused by various febrile conditions, clearing heat is appropriate.
Da Lianqiao Yin (Great Forsythia Decoction): Treats children’s wind-cold common cold with fever, phlegm obstruction, wind-heat, erysipelas with swelling and pain, neck masses, swollen and painful sores on the cheeks, red and swollen eyes, mouth and tongue ulcers, sore throat, dribbling urination, residual toxins from fetal toxicity and smallpox/rash, and all types of heat toxins.
Forsythiae Fructus (Lianqiao), Dianthi Herba (Qumai), Talcum (Huashi), Plantaginis Semen (Cheqianzi), Arctii Fructus (Niubangzi), Paeoniae Radix Rubra (Chishao), Gardeniae Fructus (Zhizi), Akebiae Caulis (Mutong), Angelicae Sinensis Radix (Danggui), Saposhnikoviae Radix (Fangfeng) (each 4 fen), Bupleuri Radix (Chaihu), Scutellariae Radix (Huangqin), Schizonepetae Spica (Jingjie) (each 1.2 qian), Cicadae Periostracum (Chanui) (5 fen), Glycyrrhizae Radix et Rhizoma (Gancao) (1.6 qian).
Decoct the above ingredients with ten leaves of Bambusa Leaves (Zhuye) and ten stems of Juncus Effusus (Dengxin), take warm decoction at any time. For wind-phlegm heat or Bianzheng heat, add Ophiopogonis Radix (Maidong); for excess heat or Dan heat, add Rheum Palmatum (Dahuang); for fetal heat or residual toxins from rashes, add Menthae Haplocalycis Herba (Boheye); for carbuncle and furuncle heat toxins, add Rheum Palmatum (Dahuang) and Natrii Sulfas (Mangxiao).
Wufu Huadu Dan (Five Blessings Detoxification Pill): Treats children’s accumulation of heat toxins causing swollen and broken lips and mouth with ulcers, bleeding gums, foul breath, flushed cheeks, dry throat and irritability, unresolved residual toxins from smallpox/rash, or multiple carbuncles and furuncles on the head, eyes, and body.
Rhinocerotis Cornu (Xijiao), Platycodonis Radix (Jiegeng, de-rhizome), Rehmanniae Radix Preparata (Shengdihuang, washed with wine), Poria (Chifuling, peeled), Arctii Fructus (Niubangzi, lightly fried) (each 5 qian), Natrii Sulfas (Puxiao), Forsythiae Fructus (Lianqiao), Scrophulariae Radix (Xuanshen, black variety), Glycyrrhizae Radix et Rhizoma (Fengcao) (each 6 qian), Indigo Naturalis (Qingdai, 2 qian, ground to fine powder).
Grind the above into powder, mix with refined honey to make pills the size of a longan fruit. Take one pill per dose, dissolved in Mint Decoction (Bohe Tang). If accompanied by fright, coat with Cinnabar (Zhusha).