易简参苏饮 感感冒发热头痛。与因痰饮凝积。发而为热。并宜服之。亦治中脘痞闷。
呕逆恶心。小儿室女。尤宜服之。
前胡 人参(如无以好党参代之) 紫苏 干葛 半夏 茯苓(各三分) 枳壳 陈皮 甘草 桔梗 木香(各二
分)
上 咀。每服四钱。水一盏。生姜七片。枣一枚。煎至六分。去渣服。
惺惺散 治小儿伤寒
人参 白术(炒) 茯苓 甘草 北细辛 川芎 桔梗(炒各等分)
上为末。每服二钱。入薄荷五叶。水煎服(一方有防风天花粉。)
凡治小儿里症。亦惟宜忌二字而已。要在辨之明而见之确耳。夫小儿元气无多。脏腑脆
若夫当下而不下。则津液消烂。所谓急下以救胃中津液是也。不当下而下。则里气受伤。邪
反乘虚内陷。其祸更甚。今将宜忌诸形症。辨晰于左。如禀气素实。汗不解。发热谵语。舌
苔黄浓。渴而引饮。大便秘。小便赤。腹满拒按。手足心热。脉沉而实此为阳邪入里。宜下
之。虽二三日。若见上项诸症。亦宜下之。如调胃承气汤。四顺清凉饮之类。少少与之。贵
在与
病相值。恐多下亡阴也。不可拘于庸医下不厌迟之说。谬称稳当。必待至七日之后始下也。
如太阳证。表未罢。脉浮大恶寒者。此邪在表。虽十余日。亦不宜下。呕多者不可下。太阳
阳明合病。喘而胸满者。不可下。恶水者。不可下。禀赋虚者。不可下。逆厥者。不可下。
仲景先生云。日数虽多。但有表证而脉浮者。犹宜发汗。日数虽少。若有里证而脉沉者。即
宜
下之。此不可不知也。此外有因气虚阳脱而谵语者。乃大虚之症。当用参附之剂。不得认为
实症。而误下之也。慎之慎之。至于伤食停积。小儿虽间亦有之。然皆必由脾虚不运而致。
经所谓邪之所凑。其气必虚者是矣。每见庸医肆行克伐。或遇表证。亦云有里。以致小儿外
邪未解。里气已伤。往往变症蜂起而不可救。受此害者。不知凡几。殊堪痛恨。曾不知下者
。下其邪耳。非饮食积滞之谓也。世人阴受此害者比比矣。故特表而出之。兼详实论。
易简参苏饮:适用于感冒引起的发热、头痛。也适用于因痰饮凝聚积聚,进而引发发热的情况,这两种情况都适宜服用。此外,还能治疗中脘部痞塞闷胀、呕吐逆气、恶心等症状。小儿和未婚女子尤其适宜服用此方。
药材组成:前胡、人参(若无人参,可用优质的党参代替)、紫苏、干葛、半夏、茯苓(以上各三分);枳壳、陈皮、甘草、桔梗、木香(以上各二分)。
制法与用法:将上述药材切碎(咀)。每次服用四钱,加水一盏,生姜七片,大枣一枚,煎煮至剩余六分药液,滤去药渣后服用。
药材组成:人参、白术(炒制)、茯苓、甘草、北细辛、川芎、桔梗(炒制,以上各等分)。
制法与用法:将上述药材研为细末。每次服用二钱,加入薄荷五叶,加水煎煮后服用(另一版本配方中含有防风、天花粉)。
大凡治疗小儿的里证(病位在脏腑内部的病症),关键在于“宜”与“忌”两个字。重点在于辨证要明晰,判断要准确。因为小儿元气不多,脏腑娇嫩脆弱。如果应当使用下法(泻下通便)而没有及时使用,就会导致津液消亡枯竭,这就是所说的“急下以救胃中津液”。如果不应当使用下法却使用了,就会损伤体内的正气,邪气反而乘虚内陷,其祸害更加严重。现在将适宜和下法禁忌的各种症状表现,辨析如下:
如果患儿先天禀赋体质充实,发汗后热不退,出现发热、说胡话(谵语)、舌苔黄厚浓腻、口渴想喝水、大便秘结、小便颜色深红、腹部胀满且拒绝按压、手心脚心发热、脉象沉而有力。这是阳邪进入体内(入里),适宜使用下法。即使发病仅两三天,只要见到上述各项症状,也适宜使用下法。例如调胃承气汤、四顺清凉饮之类的方剂,少量给予。贵在药力与病邪相当,担心过度泻下会导致阴液亡失。不可拘泥于庸医所谓“下法不嫌迟”的说法,谬称这样稳妥,一定要等到七天以后才使用下法。
如果是太阳病(外感风寒表证)的症状,表证尚未解除,脉象浮大且恶寒的,这是邪气在体表,即使患病十余日,也不适宜使用下法。呕吐频繁的,不可使用下法。太阳经与阳明经合病,出现气喘且胸部胀满的,不可使用下法。厌恶饮水的,不可使用下法。先天禀赋虚弱的,不可使用下法。四肢逆冷的,不可使用下法。
张仲景先生曾说:虽然患病天数较多,但只要还有表证且脉象浮的,仍然适宜发汗;虽然患病天数较少,但如果有里证且脉象沉的,就适宜使用下法。这一点是不可不知道的。
此外,有因气虚阳气脱失而导致说胡话的情况,这属于极度虚弱的病症,应当使用人参、附子类的温补药剂,不能误认为是实证而错误地使用下法。务必谨慎再谨慎。至于伤食停滞积滞,小儿虽然偶尔也有这种情况,但必然都是由脾虚运化无力所导致。正如经典所说:“邪气之所以聚集,是因为正气必然虚弱。”我常常见到庸医肆意使用攻伐药物,或者遇到表证,也声称有里证,导致小儿体外的邪气未解,体内的正气已受伤,往往变生各种危急病症而无法挽救。遭受这种害处的,不知有多少。实在令人痛恨。这些人根本不知道,“下法”是用来祛除邪气的,并非指饮食积滞。世上暗中受此害处的人比比皆是。因此特意指出并阐明,兼详细论述。
Yijian Rensu Yin (Easy-to-Use Ginseng and Perilla Decoction): Indicated for fever and headache caused by common cold. It is also suitable for cases where heat is triggered by the accumulation of phlegm-fluids (Tan-Yin). Both conditions are appropriate for its use. It additionally treats epigastric fullness and oppression, vomiting with reflux, and nausea. It is particularly suitable for infants, children, and unmarried young women.
Ingredients: Qianhu (Peucedani Radix), Renshen (Ginseng Radix et Rhizoma; if unavailable, high-quality Dangshen [Codonopsis Radix] may be substituted), Zisu (Perillae Folium), Gange (Puerariae Radix), Banxia (Pinelliae Rhizoma Preparatum), Fuling (Poria); each 3 fen. Zhike (Aurantii Fructus Immaturus), Chenpi (Citri Reticulatae Pericarpium), Gancao (Glycyrrhizae Radix et Rhizoma), Jiegeng (Platycodonis Radix), Muxiang (Aucklandiae Radix); each 2 fen.
Preparation and Administration: Coarsely crush the herbs. For each dose, take 4 qian, add one cup of water, seven slices of fresh ginger, and one jujube. Decoct until six-tenths of the liquid remains, strain, and administer.
Xingxing San (Awakening Powder): Treats pediatric Shanghan (Cold Damage).
Ingredients: Renshen (Ginseng Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma, stir-fried), Fuling (Poria), Gancao (Glycyrrhizae Radix et Rhizoma), Beixixin (Asari Radix et Rhizoma), Chuanxiong (Ligustici Chuanxiong Rhizoma), Jiegeng (Platycodonis Radix, stir-fried); all in equal proportions.
Preparation and Administration: Grind into a fine powder. For each dose, take 2 qian, add five leaves of Bohe (Menthae Haplocalycis Herba), decoct in water, and administer. (Another version includes Fangfeng [Saposhnikoviae Radix] and Tianhuafen [Trichosanthis Radix].)
In general, treating interior syndromes (Bing Wei Zang Fu Nei Bu De Bing Zheng) in children hinges on the principles of "appropriateness" (Yi) and "contraindication" (Ji). The key lies in clear differentiation and accurate judgment. Since children have limited primordial qi (Yuan Qi) and fragile zang-fu organs, failing to apply purgation (Xia Fa) when indicated leads to the depletion of body fluids (Jin Ye), which is referred to as "urgent purgation to save the stomach's fluids." Conversely, applying purgation when not indicated injures the interior qi, allowing pathogenic factors to sink inward due to deficiency, causing even more severe harm. The following symptoms are analyzed to distinguish indications and contraindications for purgation:
If a child has a constitutionally robust nature, sweating fails to resolve the condition, and symptoms include fever, delirium (Shan Yu), thick yellow tongue coating, thirst with desire to drink, constipation, dark red urine, abdominal distension with tenderness upon pressure, heat in the palms and soles, and a deep, forceful pulse. This indicates yang pathogens entering the interior (Yang Xie Ru Li), and purgation is indicated. Even if only two or three days have passed since onset, if these symptoms are present, purgation is appropriate. Formulas such as Tiaowei Chengqi Tang (Regulate the Stomach Order Qi Decoction) or Sishun Qingliang Yin (Four-Smooth Clearing and Cooling Decoction) should be administered in small amounts. The goal is to match the medicinal strength with the pathogen, avoiding excessive purgation that could lead to the loss of yin. One must not adhere to the fallacy of quacks who claim "purgation is never too late," falsely calling it safe, and delaying treatment until after seven days.
If Taiyang syndrome (Tai Yang Bing - exterior cold damage syndrome) signs persist, the exterior pathogen has not been resolved, the pulse is floating and large, and there is aversion to cold, the pathogen remains at the exterior. Even if ten or more days have passed, purgation is inappropriate. Frequent vomiting is a contraindication for purgation. In combined Taiyang and Yangming disease presenting with wheezing and chest fullness, purgation is contraindicated. Aversion to drinking water is a contraindication. Constitutional deficiency is a contraindication. Cold extremities (Ni Jue) are a contraindication.
Master Zhang Zhongjing stated: Although many days have passed, if exterior signs remain and the pulse is floating, diaphoresis (Fa Han) is still appropriate. Although few days have passed, if interior signs exist and the pulse is deep, purgation is appropriate. This principle must be understood.
Furthermore, delirium caused by qi deficiency and yang collapse represents a severe deficiency syndrome. Tonifying formulas containing Renshen (Ginseng) and Fuzi (Aconiti Lateralis Radix Preparata) should be used. It must not be mistaken for an excess syndrome and erroneously treated with purgation. Exercise extreme caution. Regarding food stagnation, while occasional in children, it invariably stems from spleen deficiency and impaired transportation. As the classics state: "Where pathogenic factors gather, qi is necessarily deficient." I often observe quacks recklessly using harsh draining methods, or misidentifying exterior syndromes as having interior components, leading to unresolved exterior pathogens and injured interior qi. This frequently results in unpredictable complications that are incurable. Many suffer this harm, which is truly lamentable. These practitioners fail to realize that "purgation" refers to expelling pathogens, not merely clearing food stagnation. Countless people secretly suffer from this error. Therefore, I specifically highlight and elaborate on this point.