小儿属实之症。惟表里食积。三者而已。盖表邪实者。必头项体痛。腰痛背强。壮热无
汗。脉象浮紧有力。宜从表散。如在冬月。宜羌活冲和汤主之。若在春夏秋三时。则宜易简参
苏饮。或惺惺散之类主之。若兼倦怠昏睡。则属正不胜邪。宜四柴胡饮。或五柴胡饮之类主之
。里邪实者。必舌胎黄浓。口燥唇疮。作渴喜饮。大小便秘。腹痛拒按。声音洪壮。伸体而
卧。睡不露睛。手足指热。脉象沉数有力。宜从攻下。如调胃承气汤。或四顺清凉饮之类主
之。若汗后身热不退。脉象弦洪数实。大便坚秘者。柴胡饮子。夫所谓实者
。邪气实耳。非元气有余之谓也。医者临症之际。果属实邪。于应表应下之药。皆当作小剂
。少少与之。要在中病即止。不可过剂。务宜顾定元气。斯无孟浪偾事之非。至于饮食停积
。必寸口脉浮大。按之反涩。腹皮热。大便 臭。然必由脾虚不运而致。于消导药中。慎毋
损及中气。宜多温中健脾之品。俾得自强不息之妙。如消乳丸。香橘饼。理中汤之类主之。
若伤食甚而或兼浓味积热者。宜大安丸。少少与之。俟食积稍消。仍当以五味异功散调补之
。此外如目直大叫。项急烦闷。肝之实也。泻青丸。抑肝散主之。若筋急血燥。抽搐劲强。
斜视目瞪。则属肝之虚矣。地黄丸主之。叫哭发热。饮水而搐。心之实也。导赤散。泻心汤
主之。若惊惕不安。则属心之虚矣。秘旨安神丸主之。困睡身热。饮水。脾之
实也。泻黄散主之。若呕吐泄泻。不食痞满。倦卧。牙紧流涎。手足牵动。则属脾之虚矣。
益黄
散。或六君子加炮姜木香主之。闷乱喘促。饮水。肺之实也。泻白散主之。若气促多汗。则
属肺之虚矣。四君子汤。或五味异功散主之。肾无实。惟痘疮黑陷。为邪气实而肾则虚也。
地黄丸主之。若二便不禁。津液枯槁。声喑目戴。肢体厥逆。肾虚极也。补中益气汤。兼六
味地黄丸主之。大抵小儿实症无多。若禀赋素虚。或病患已久。或过服克伐之剂。皆当作虚
症施治。不得概以为实也。慎之慎之。
小儿的实证，只有表实、里实和食积这三类罢了。所谓表邪实证，必然出现头项身体疼痛、腰痛背部僵硬、高热无汗、脉象浮紧有力的症状。治疗应当从解表发散入手。如果在冬季，适宜用羌活冲和汤主治。若在春、夏、秋三个季节，则适宜改用易简参苏饮，或者惺惺散之类的方剂主治。如果兼有倦怠昏睡的症状，则属于正气不能战胜邪气，适宜用四柴胡饮，或五柴胡饮之类的方剂主治。
所谓里邪实证，必然出现舌苔黄厚腻、口干燥唇部生疮、口渴喜欢饮水、大小便闭塞不通、腹部疼痛且拒绝按压、声音洪亮壮盛、伸展身体而卧、睡眠时眼睛不睁开、手足指尖发热、脉象沉数有力的症状。治疗应当从攻下泻实入手。如调胃承气汤，或四顺清凉饮之类的方剂主治。如果在发汗之后身热仍然不退，脉象弦洪数实，大便坚硬秘结的，用柴胡饮子主治。
所谓的“实”，是指邪气盛实而已，并不是指元气有余。医生在临症之际，如果确属实邪，对于应当使用解表或攻下的药物，都应当作为小剂量，少量给予。关键在于中病即止，不可过量用药。务必注意顾护元气，这样才不会犯轻率误事的错误。
至于饮食停滞积聚，必然出现寸口脉浮大，重按反而涩滞，腹皮发热，大便臭秽等症状。但这必定是由脾虚不能运化所导致。在使用消导药时，千万不要损伤中气，适宜多用温中健脾的药物，以达到自强不息的妙用。如消乳丸、香橘饼、理中汤之类的方剂主治。如果伤食严重并且兼有浓味积热的，适宜用大安丸，少量给予。等到食积稍微消除后，仍应当用五味异功散进行调理补益。
此外，如两眼直视大叫、颈部拘急烦闷，这是肝的实证，用泻青丸、抑肝散主治。如果筋脉拘急血燥、抽搐强直、斜视目瞪，则属于肝的虚证，用地黄丸主治。叫哭发热、饮水并伴有抽搐，这是心的实证，用导赤散、泻心汤主治。如果惊惕不安，则属于心的虚证，用秘旨安神丸主治。困倦嗜睡身热、饮水，这是脾的实证，用泻黄散主治。如果呕吐泄泻、不思饮食痞满、疲倦卧床、牙关紧闭流涎、手足牵动，则属于脾的虚证，用益黄散，或六君子汤加炮姜、木香主治。
烦乱喘促、饮水，这是肺的实证，用泻白散主治。如果气促多汗，则属于肺的虚证，用四君子汤，或五味异功散主治。肾没有实证，只有痘疮黑陷，是邪气实而肾则虚的表现，用地黄丸主治。如果二便失禁、津液枯槁、声音嘶哑目睛上视、肢体厥冷逆乱，这是肾虚到了极点，用补中益气汤，兼用六味地黄丸主治。
大抵小儿的实证不多。如果禀赋素来虚弱，或者患病时间已久，或者过度服用克伐（攻伐）的药物，都应当按照虚证来施治，不能一概认为是实证。千万谨慎，千万谨慎。
Pediatric excess syndromes are limited to three categories: exterior excess, interior excess, and food accumulation. Exterior excess caused by pathogenic factors is characterized by pain in the head, neck, and body, lower back pain with stiffness of the back, high fever without sweating, and a floating, tight, and forceful pulse (Pulse Floating-Tight). Treatment should focus on releasing the exterior through diaphoresis. In winter, Qianghuo Chonghe Tang (Notopterygium Decoction for Harmonizing) is indicated. In spring, summer, and autumn, Yijian Rensu Yin (Easy-to-Prepare Ginseng and Perilla Decoction) or Xingxing San (Xingxing Powder) may be used. If accompanied by fatigue and drowsiness, it indicates that healthy Qi cannot overcome the pathogen; Sicha Hu Yin (Four-Chaihu Drink) or Wucha Hu Yin (Five-Chaihu Drink) is appropriate.
Interior excess is characterized by a thick, yellow tongue coating, dry mouth with lip sores, thirst with desire to drink, constipation of both stool and urine, abdominal pain with tenderness upon pressure, loud voice, lying with extended limbs, eyes remaining closed during sleep, heat in the fingertips, and a deep, rapid, and forceful pulse (Pulse Deep-Rapid). Treatment should focus on purging and draining. Tiaowei Chengqi Tang (Stomach-Harmonizing Major Order Decoction) or Sishun Qingliang Yin (Four-Compliant Cooling Decoction) may be used. If fever persists after sweating, with a wiry, surging, rapid, and full pulse (Pulse Wiry-Surging-Rapid-Full) and hard, constipated stool, Chaihu Yin (Bupleurum Drink) is indicated.
The term "excess" refers to the abundance of pathogenic factors, not an abundance of Healthy Qi (Zheng Qi). When diagnosing, if an excess pattern is confirmed, formulas for releasing the exterior or purging should be prescribed in small doses and administered gradually. The key is to stop treatment once the disease is addressed, avoiding overdose. It is crucial to protect Healthy Qi to avoid reckless errors.
Food stagnation presents with a floating and large pulse at the Cun position (Inch Position) that feels choppy upon heavy pressure, heat in the abdominal skin, and foul-smelling stools. This is invariably caused by Spleen deficiency leading to failure of transportation and transformation. When using digestive herbs, care must be taken not to damage Middle Qi. Formulas warming the middle and strengthening the Spleen should be prioritized, such as Xiaoru Wan (Milk-Digesting Pill), Xiangju Bing (Fragrant Orange Cake), or Lizhong Tang (Regulate the Middle Decoction). For severe food injury complicated by heat from rich foods, Da'an Wan (Great Peace Pill) may be given in small amounts. Once the stagnation subsides, Wuwei Yigong San (Five-Ingredient Extraordinary Merit Powder) should be used for regulation and tonification.
Other manifestations include staring straight ahead with loud crying, neck stiffness, and irritability, indicating Liver Excess; Xieqing Wan (Drain-Green Pill) or Yi Gan San (Suppress-Liver Powder) are indicated. If there is tendon tension due to blood dryness, convulsions with rigidity, oblique gaze, and fixed eyes, this indicates Liver Deficiency; Dihuang Wan (Rehmannia Pill) is indicated. Crying, fever, drinking water, and convulsions indicate Heart Excess; Daochi San (Guide Out Redness Powder) or Xiexin Tang (Drain-Heart Decoction) are indicated. Restlessness and fright indicate Heart Deficiency; Mizhi Anshen Wan (Secret Manual Calming Spirit Pill) is indicated. Drowsiness, fever, and drinking water indicate Spleen Excess; Xiehuang San (Drain-Yellow Powder) is indicated. Vomiting, diarrhea, anorexia, abdominal distension, lethargy, clenched teeth with salivation, and limb twitching indicate Spleen Deficiency; Yihuang San (Yellow-Protecting Powder) or Liujunzi Tang (Six-Gentlemen Decoction) added with Paojiang (Roasted Ginger) and Muxiang (Aucklandia Root) are indicated.
Restlessness, panting, and drinking water indicate Lung Excess; Xiebai San (Drain-White Powder) is indicated. Panting with excessive sweating indicates Lung Deficiency; Sijunzi Tang (Four-Gentlemen Decoction) or Wuwei Yigong San (Five-Ingredient Extraordinary Merit Powder) are indicated. The Kidney has no excess patterns; black depression of smallpox lesions represents pathogenic excess with underlying Kidney Deficiency, treated with Dihuang Wan (Rehmannia Pill). Incontinence of urine and feces, withered fluids, hoarseness, upward deviation of the eyes, and cold extremities indicate extreme Kidney Deficiency; Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) combined with Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) is indicated.
Generally, pediatric excess patterns are rare. If the child has innate deficiency, has been ill for a long time, or has overused harsh purgatives, treatment should follow the principles for deficiency patterns, not assuming excess. Exercise utmost caution.