阳水身热脉沈数,小便赤涩大便难,热盛烦渴浚川散,湿盛胀满神佑丸,
量儿大小斟酌用,应变而施勿一偏。
[注]
阳水者,小儿湿热内郁,水道阻塞,外攻肌表,以致外肿内胀,
发热口渴心烦,小便短赤,大便秘结,法当泄水,不可少缓,
热盛烦渴者,以大圣浚川散攻之,
湿盛胀满者,舟车神佑丸攻之,
须量儿大小,视病轻重,合宜而用,勿执一偏过于峻攻,徒伤正气也。
(大圣浚川散) 川大黄煨 牵牛取头末 郁李仁各一两 木香三钱
芒硝三钱 甘遂五分 以上为细末,姜汤调下,量儿大小用之。
(舟车神佑丸) 方见风湿肿。
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水肿门
阴水便利不烦热,须服实脾肾气丸,若服温补俱无验,攻补兼施病始痊。
[注]
阴水者,因脾肾虚弱也,脾虚不能制水,肾虚不能主水,
以致外泛作肿内停作胀,
若二便不实,身不热心不烦者,宜用实脾散,金匮肾气丸,
若服温补之药而无效验者,则是虚中有实也,欲投攻下之剂,恐小儿难堪,
若不攻之,又岂可坐以待毙,须攻补兼施,或一补一攻,或三补一攻,
或九补一攻,审其进退,俟有可攻之机,以意消息,药与元气相当,
始能逐邪而不伤正也,必须忌盐酱百日,方可收功。
(实脾散) 草果仁研 大腹皮 木瓜 木香研 厚朴姜炒 干姜 附子制
白术土炒 茯苓甘草炙 以上引用枣二枚,水煎服。
(方歌)
实脾散治阴水肿,草叶大腹木瓜香,厚朴姜附术苓草,虚者仍兼肾气方。
(金匮肾气丸)熟地黄一两 山药八钱炒 山茱萸八钱 牡丹皮五钱
茯苓一两 泽泻五钱 肉桂五钱 淡附子五钱 车前子五钱 牛膝八钱
以上为细末,炼蜜为丸,如梧桐子大,每服钱半,白滚水送下。
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阳水表现为身体发热、脉象沉而数,小便颜色红赤且排尿涩痛不畅,大便干结困难。若热邪炽盛导致烦躁口渴,应使用浚川散;若湿邪偏盛导致腹部胀满,应使用神佑丸。需根据患儿年龄大小斟酌剂量,灵活施治,不可偏向一方。
[注]
所谓阳水,是由于小儿体内湿热郁结,水道阻塞,病邪向外攻袭肌表,从而导致体表浮肿、体内胀满。症状包括发热、口渴、心烦,小便短少色赤,大便秘结。治疗法则应当泻下利水,不可稍有迟缓。
对于热盛且烦躁口渴者,用大圣浚川散来攻逐邪气;
对于湿盛且腹部胀满者,用舟车神佑丸来攻逐邪气;
必须衡量患儿的年龄大小,观察病情的轻重,选择合适的方药使用,不要固执于单一方法而过度峻猛攻伐,以免徒然损伤正气。
(大圣浚川散)组成:煨制的大黄一两、取头末的牵牛子一两、郁李仁一两、木香三钱、芒硝三钱、甘遂五分。以上药物研为细末,用姜汤调服,根据患儿年龄大小决定用量。
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水肿门
阴水表现为二便通利、无烦躁和发热感,应当服用实脾散或肾气丸。如果只服用温补药物都没有疗效,则需要攻补兼施,病情才能痊愈。
[注]
所谓阴水,是因为脾肾虚弱所致。脾虚不能制约水液,肾虚不能主持水液代谢,从而导致水液外泛引起浮肿,内停引起胀满。
如果大小便不实(指可能伴有泄泻或失禁),身体不发热、心中不烦躁者,适宜使用实脾散和金匮肾气丸。
如果服用温补药物而没有疗效,说明是虚中夹实的情况。想要投用攻下之剂,又担心小儿难以承受;如果不进行攻逐,难道只能坐以待毙吗?因此必须攻补兼施,或者一补一攻,或者三补一攻,或者九补一攻,审慎判断病势的进退,等待可以攻邪的时机,根据具体情况调整用药比例,使药力与元气相当,这样才能驱逐邪气而不损伤正气。必须忌食盐和酱类一百天,才能取得疗效。
(实脾散)组成:草果仁(研碎)、大腹皮、木瓜、木香(研碎)、厚朴(姜炒)、干姜、附子(制)、白术(土炒)、茯苓、甘草(炙)。以上药材引用红枣两枚,加水煎服。
(方歌)
实脾散治疗阴水引起的浮肿,含有草果、白术、大腹皮、木瓜、木香,以及厚朴、生姜、附子、白术、茯苓、甘草,体虚者仍可配合肾气丸使用。
(金匮肾气丸)熟地黄一两、山药八钱(炒)、山茱萸八钱、牡丹皮五钱、茯苓一两、泽泻五钱、肉桂五钱、淡附子五钱、车前子五钱、牛膝八钱。以上药物研为细末,用炼蜜制成丸药,如梧桐子大小,每次服用一钱半,用白开水送服。
Yang edema presents with fever, a deep and rapid pulse, dark and scanty urine with dysuria, and difficult defecation. If heat is excessive causing irritability and thirst, use Jun Chuan San (Jun Chuan Powder); if dampness is excessive causing abdominal distension, use Shen You Wan (Shen You Pill). Dosage must be adjusted according to the child's age, treatment should be flexible, and one must avoid bias towards a single approach.
[Note]
Yang edema arises from internal stagnation of damp-heat in children, blocking the water passages, with pathogenic factors attacking the muscle surface externally, resulting in external swelling and internal distension. Symptoms include fever, thirst, irritability, short and dark urine, and constipation. The therapeutic principle is to drain water and purge accumulation; delay is not permissible.
For cases with excessive heat and irritability/thirst, Da Sheng Jun Chuan San (Great Sage Jun Chuan Powder) is used to attack the pathogen.
For cases with excessive dampness and abdominal distension, Zhou Che Shen You Wan (Boat Cart Shen You Pill) is used to attack the pathogen.
One must weigh the child's age and the severity of the illness, using appropriate remedies. Do not adhere rigidly to one method or use overly harsh purgatives, which would merely damage the healthy Qi.
(Da Sheng Jun Chuan San): Prepared Rhizoma Rhei (Da Huang, 大黄), prepared for one tael; Semen Trichosanthis (Qian Niu Zi, 牵牛子), head powder only, for one tael; Fructus Pruni (Yu Li Ren, 郁李仁), for one tael; Radix Aucklandiae (Mu Xiang, 木香), for three qian; Natrii Sulfas (Mang Xiao, 芒硝), for three qian; Radix Kansui (Gan Sui, 甘遂), for five fen. Grind all into fine powder, mix with ginger decoction, and administer according to the child's age.
(Zhou Che Shen You Wan): See the section on Wind-Damp Edema.
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Edema Section
Yin edema presents with free urination and defecation, without irritability or fever. One should administer Shi Pi San (Shi Pi Powder) or Shen Qi Wan (Shen Qi Pill). If warm tonification yields no effect, simultaneous attack and tonification are required for recovery.
[Note]
Yin edema is caused by deficiency of the Spleen and Kidney. Spleen deficiency fails to control water, and Kidney deficiency fails to govern water, leading to water overflowing externally causing swelling and stopping internally causing distension.
If there is laxity of the bowels and bladder, no body heat, and no mental restlessness, Shi Pi San (Shi Pi Powder) and Jin Gui Shen Qi Wan (Jin Gui Shen Qi Pill) are suitable.
If warm tonifying medicines prove ineffective, it indicates a condition of deficiency with excess. While one may wish to administer purgatives, one fears the child cannot tolerate them; yet, failing to purge is tantamount to waiting passively for death. Therefore, simultaneous attack and tonification are necessary: either one part tonify and one part attack, three parts tonify and one part attack, or nine parts tonify and one part attack. Carefully assess the progression and regression of the disease, wait for the opportune moment to attack, and adjust the dosage based on circumstances. When the medicinal strength matches the Healthy Qi, the pathogen can be expelled without damaging the Healthy Qi. Salt and soy sauce must be avoided for one hundred days to achieve success.
(Shi Pi San): Fructus Tsaoko (Cao Guo Ren, 草果仁), crushed; Pericarpium Arecae Catechu (Da Fu Pi, 大腹皮); Exocarpium Citri Grandis (Mu Gua, 木瓜); Radix Aucklandiae (Mu Xiang, 木香), crushed; Cortex Magnoliae Officinalis (Hou Po, 厚朴), stir-fried with ginger; Rhizoma Zingiberis Recens (Gan Jiang, 干姜); Radix Aconiti Lateralis Preparata (Fu Zi, 附子), processed; Rhizoma Atractylodis Macrocephalae (Bai Zhu, 白术), earth-fried; Poria (Fu Ling, 茯苓); Radix Glycyrrhizae Preparata (Gan Cao, 甘草), honey-fried. Add two Jujubae Fructus (Da Zao, 大枣) and decoct in water for oral administration.
(Verse Formula):
Shi Pi San treats Yin edema, containing Caoguo, Bai Zhu, Dafupi, Mugua, Muxiang, Houpo, Ginger, Fuzi, Baizhu, Fuling, and Gancao; for deficient cases, still combine with Shen Qi Fang.
(Jin Gui Shen Qi Wan): Radix Rehmanniae Preparata (Shu Di Huang, 熟地黄), one tael; Rhizoma Dioscoreae (Shan Yao, 山药), eight qian, stir-fried; Fructus Corni (Shan Zhu Yu, 山茱萸), eight qian; Cortex Moutan (Mu Dan Pi, 牡丹皮), five qian; Poria (Fu Ling, 茯苓), one tael; Radix Alismatis (Ze Xie, 泽泻), five qian; Cortex Cinnamomi (Rou Gui, 肉桂), five qian; Radix Aconiti Lateralis Preparata (Dan Fu Zi, 淡附子), five qian; Semen Plantaginis (Che Qian Zi, 车前子), five qian; Radix Achyranthis Bidentatae (Niu Xi, 牛膝), eight qian. Grind all into fine powder, make pills with refined honey, size of Sophora japonica seeds. Take one and a half qian per dose, swallowed with plain boiled water.