小儿疟疾。不外乎风痰与食。无食不发热。无风不作寒。而痰食风之所成也。外感风寒
。则
则伤脾也。肺气不清。则生痰。脾土受伤。则裹痰。故痰者风食之所成也。无痰则不成疟。
故寒热作焉。要而言之。风虽属肺。食虽属脾。而风食之所藏。又近于胆经。故作寒热。盖
胆经为足之少阳。其位在半表半里。是以寒热往来也。大率寒多则为风。热多则为食。寒热
相半。则风食俱多。治此病者。惟消食疏风化痰而已。然消食必兼疏风。
疏风必兼消食。而消食疏风必兼化痰。盖三者不全。则不能成疟。故宜兼用。但量其所属轻
重可也。
疏脾饮 治小儿因风成疟。
紫苏 柴胡 半夏(各一钱) 防风 青皮 浓朴 川芎(各五分) 生姜三
片。不拘时热服。槟陈饮治小儿因食成疟。
山楂 青皮 草果(各八分) 槟榔 枳实 半夏 柴胡 麦芽(各六分) 生姜三片。空
心煎服。
平妥饮 治小儿痰疟。来时作呕。
半夏 贝母 橘红 柴胡(各七分) 黄芩 草果 白术 枳壳(各五分) 生姜三片。不
拘时热服。鳖甲饮 治小儿久疟不住。
何首乌 鳖甲(酒炙) 当归 白术 人参 黄芩(各八分) 黑枣三枚。空心煎服。
凡泻在脾。而痢在肾。故先泻而后痢者。则曰脾传肾。为贼邪。其病难愈。先痢而泻者
。则曰肾传脾。为微邪。其病易愈。此前人之说也。以愚论之。泻为在脾不暇言矣。而后谓痢为在
肾。不能无议焉。泻固多由于饮食。而痢独非饮食之所伤乎。饮食停积。因湿热而化遂为稠
浊胶固于肠胃之中。欲下不下。是以有里急后重之苦。明是脾经之病矣。而顾以痢属于肾者
。何所谓欤。吾未闻饮食之人。不由于脾。而反由于肾也。大概谓之肾病矣。然治痢之药。
悉用苍术浓朴黄连。木香白术陈皮之类。并未有用杜仲黄柏牛膝地黄补肾等药。治肾之疾。
而乃用脾家之剂。必其非肾病故也。要之先痢后泻而易愈者。以其积滞已尽。而脾尚虚也。
岂肾传脾之谓耶。先泻后痢而难愈者。以脾土已坏。而积滞方壅也。岂脾传肾之谓耶。肾能
藏精。不能藏饮食。若以痢属于肾。则饮食皆藏于肾矣。岂理也哉。大约治痢之法。与大人
无异。但下痢纯血者。在
大人则为难治。在小儿则为食积。而无所妨。而治小儿之痢。又宜多以消积为主。其详具大
人痢疾门。不复细赘耳。
小儿疟疾,不外乎风痰与食积两种原因。没有食积就不会发热,没有风邪就不会发冷,而痰和食积正是由风邪引起的。外感风寒会损伤脾脏。肺气不清爽就会生痰,脾土受伤就会裹挟痰湿。所以痰是由风和食积所形成的。没有痰就不会形成疟疾,因此会出现寒热交替的症状。总而言之,风邪虽然归属于肺,食积虽然归属于脾,但风和食积的藏匿之处,又接近胆经,所以会出现寒热往来的症状。因为胆经属于足少阳经,其位置在半表半里之间,所以表现为寒热往来。大致来说,寒多则为风邪重,热多则为食积重,寒热各半,则风邪和食积都较多。治疗这种病的方法,只有消食、疏风、化痰而已。然而消食必须兼用疏风,疏风必须兼用消食,而消食疏风必须兼用化痰。因为这三者不全备,就不能形成疟疾,所以应当同时使用,只需根据所属病因的轻重来权衡即可。
疏脾饮:治疗小儿因风邪引起的疟疾。
紫苏、柴胡、半夏(各一钱),防风、青皮、浓朴、川芎(各五分),生姜三片。不拘时间,趁热服用。
槟陈饮:治疗小儿因食积引起的疟疾。
山楂、青皮、草果(各八分),槟榔、枳实、半夏、柴胡、麦芽(各六分),生姜三片。空腹煎服。
平妥饮:治疗小儿痰疟,发作时伴有呕吐。
半夏、贝母、橘红、柴胡(各七分),黄芩、草果、白术、枳壳(各五分),生姜三片。不拘时间,趁热服用。
鳖甲饮:治疗小儿久疟不愈。
何首乌、鳖甲(酒炙)、当归、白术、人参、黄芩(各八分),黑枣三枚。空腹煎服。
凡是泄泻在脾,而痢疾在肾。所以先泄泻而后患痢疾的,称为“脾传肾”,属于贼邪,病情难以痊愈;先患痢疾而后泄泻的,称为“肾传脾”,属于微邪,病情容易痊愈。这是前人的说法。依我看来,泄泻确实多在脾,这不必多说,但说痢疾在肾,我不能没有异议。泄泻固然多由于饮食不当,但痢疾难道不是也受饮食伤害吗?饮食停积体内,因湿热转化,于是变得稠浊胶固于肠胃之中,想下又下不出来,因此有里急后重的痛苦,这明明是脾经的疾病,却为什么说痢疾属于肾呢?我没听说过饮食进入人体,不是通过脾而是通过肾的道理。大概说是肾病吧,然而治疗痢疾的药物,全部使用苍术、浓朴、黄连、木香、白术、陈皮之类,并没有使用杜仲、黄柏、牛膝、地黄等补肾的药物。治疗肾脏的疾病,却使用调理脾胃的方剂,必定是因为它不是肾病的原因。总之,先痢后泻且容易痊愈的,是因为积滞已经排尽,而脾脏尚且虚弱罢了,哪里是肾传脾的说法呢?先泻后痢且难以痊愈的,是因为脾土已经败坏,而积滞正壅塞在内,哪里是脾传肾的说法呢?肾能藏精,不能藏饮食。如果把痢疾归属于肾,那么饮食都藏在肾里了,这合乎道理吗?大约治疗痢疾的方法,与成人没有不同。只是对于纯血痢,在成人则难治,在小儿则是食积所致,没有什么妨碍。治疗小儿痢疾,又宜多以消除积滞为主,详细内容见成人痢疾门,不再细述。
Pediatric malaria is not beyond the scope of wind-phlegm and food stagnation. Without food stagnation, there is no fever; without wind, there is no chills. Phlegm and food are formed by wind. External contraction of wind-cold damages the Spleen. If Lung Qi is not clear, phlegm is generated; if Spleen Earth is injured, it wraps phlegm. Thus, phlegm is formed by wind and food. Without phlegm, malaria cannot form, hence alternating chills and fever occur. In summary, although wind belongs to the Lung and food belongs to the Spleen, the storage site of wind and food is close to the Gallbladder Meridian, thus causing alternating chills and fever. The Gallbladder Meridian is the Foot Shaoyang, located at the half-exterior and half-interior level, which is why chills and fever alternate. Generally, more chills indicate heavier wind, more fever indicates heavier food, and equal chills and fever indicate both wind and food are abundant. To treat this disease, one must only resolve food stagnation, disperse wind, and transform phlegm. However, resolving food stagnation must be combined with dispersing wind; dispersing wind must be combined with resolving food; and resolving food and dispersing wind must be combined with transforming phlegm. Because if these three are not complete, malaria cannot form, so they should be used together, weighing their respective lightness or heaviness.
Shu Pi Yin (Spleen-Dispersing Decoction): Treats pediatric malaria caused by wind.
Perilla Leaf (Zi Su Ye), Bupleurum Root (Chai Hu), Pinellia Tuber (Ban Xia) (each 1 qian); Saposhnikovia Root (Fang Feng), Tangerine Peel (Qing Pi), Magnolia Bark (Nong Po), Ligusticum Rhizome (Chuan Xiong) (each 0.5 qian); Fresh Ginger (Sheng Jiang) 3 slices. Take warm at any time.
Bing Chen Yin: Treats pediatric malaria caused by food stagnation.
Hawthorn Fruit (Shan Zha), Tangerine Peel (Qing Pi), Tsaoko Cardamom (Cao Guo) (each 0.8 fen); Areca Seed (Bing Lang), Immature Bitter Orange (Zhi Shi), Pinellia Tuber (Ban Xia), Bupleurum Root (Chai Hu), Malt (Mai Ya) (each 0.6 fen); Fresh Ginger (Sheng Jiang) 3 slices. Decoct and take on an empty stomach.
Ping Tuo Yin: Treats pediatric phlegm-malaria, accompanied by vomiting upon onset.
Pinellia Tuber (Ban Xia), Fritillaria Bulb (Bei Mu), Aged Tangerine Peel (Ju Hong), Bupleurum Root (Chai Hu) (each 0.7 fen); Scutellaria Root (Huang Qin), Tsaoko Cardamom (Cao Guo), Atractylodes Rhizome (Bai Zhu), Aurantium Fruit (Zhi Ke) (each 0.5 fen); Fresh Ginger (Sheng Jiang) 3 slices. Take warm at any time.
Bie Jia Yin: Treats persistent pediatric malaria.
Polygonum Multiflorum Root (He Shou Wu), Turtle Shell (Bie Jia) (prepared with wine), Angelica Sinensis Root (Dang Gui), Atractylodes Rhizome (Bai Zhu), Ginseng Root (Ren Shen), Scutellaria Root (Huang Qin) (each 0.8 fen); Black Date (Hei Zao) 3 pieces. Decoct and take on an empty stomach.
Generally, diarrhea resides in the Spleen, while dysentery resides in the Kidney. Therefore, diarrhea preceding dysentery is called "Spleen transmitting to Kidney," constituting a destructive pathogen (Ze Xie), making the disease difficult to cure. Dysentery preceding diarrhea is called "Kidney transmitting to Spleen," constituting a mild pathogen (Wei Xie), making the disease easy to cure. This is the view of predecessors. In my opinion, while diarrhea indeed mostly involves the Spleen, I have reservations about stating that dysentery resides in the Kidney. Diarrhea is indeed often due to dietary irregularities, but is dysentery not also injured by diet? Food stagnation transforms due to damp-heat, becoming thick, turbid, and sticky within the intestines and stomach. It desires to pass but cannot, resulting in the suffering of tenesmus. This is clearly a disease of the Spleen Meridian. Why then attribute dysentery to the Kidney? I have never heard that food entering the body bypasses the Spleen to go directly to the Kidney. Even if called a Kidney disease, the herbs for treating dysentery all use Atractylodes Rhizome (Cang Zhu), Magnolia Bark (Nong Po), Scutellaria Root (Huang Lian), Aucklandia Root (Mu Xiang), Atractylodes Rhizome (Bai Zhu), and Tangerine Peel (Chen Pi). None use Eucommia Bark (Du Zhong), Phellodendron Bark (Huang Bo), Achyranthes Root (Niu Xi), or Rehmannia Root (Di Huang) to tonify the Kidney. Treating a Kidney disease with Spleen formulas implies it is not a Kidney disease. Ultimately, dysentery followed by diarrhea being easy to cure is because stagnation has cleared and the Spleen is still deficient, not because of "Kidney transmitting to Spleen." Diarrhea followed by dysentery being difficult to cure is because Spleen Earth is damaged and stagnation is just accumulating, not because of "Spleen transmitting to Kidney." The Kidney stores essence but does not store food. If dysentery belonged to the Kidney, food would be stored in the Kidney, which is illogical. Generally, the method for treating dysentery in children is no different from adults. However, pure blood dysentery is difficult to treat in adults, whereas in children it is due to food stagnation and poses no major hindrance. Treatment for pediatric dysentery should focus mainly on resolving stagnation. Details are provided in the Adult Dysentery section, so no further elaboration is needed here.