患此者，岁岁皆然。予前有参连饮之论，又有黄土稻花汤之论，皆属后起之功，点破机关，莫若黄连香薷饮，
劈头一服之为愈也。（《怡堂散记》）
选案
余仲儿，生于五月，本年初秋，感寒发热，脉微紧。素知其脏气属阴，不敢清解，与苏、羌、芷、辛、生
姜之属，冀散其寒。一剂下咽，不惟发热不退，反加大泻，愈泻愈喘。斯时谓其寒气
盛耶，何以用温药而反泻？谓其火刑金耶，岂以清泻连日而尚堪寒凉？谓其表邪未除耶，何以不利于疏散？束
手无策，且见其表里俱剧，大喘垂危，又岂轻剂所能挽回？乃用人参二钱，生姜五片，煎汁半盏，未敢骤进，
挑与二、三匙。怀之，旋走室中，察其呼吸进退，喘虽未减，而亦不增。又与三、四匙，少顷，鼻息少舒。遂
与半钟，更觉有应。复以人参二钱，如前煎汤，服完气息遂平， 大睡，泻止，热亦退矣。所以然者，观其
因泻反喘，岂非中虚？设有实邪，自当喘随泻减。纪此，以见温中散寒之功，妙有如此。○余季子，生甫半周，
余见新凉日至，虞 褥之薄，恐为寒侵，切嘱眷属保护。不以为意，数日后，吐泻大作。用温胃、和脾、理中
等剂，不效。加人参三钱及姜、桂、吴萸、肉蔻，亦不效。至四、五日，则随乳随吐，乃用人参五、六钱，附
子、姜、桂等各一、二钱，下咽即吐。所下之乳，白洁无气，斯时形气危矣。默测其故，且度其寒气犯胃，而
吐泻不止，若舍参、姜、桂附，尚有何术？思其胃虚已极，药之气味，略有不投，则胃不受，附子味咸，亦能
致呕，必其故也，须得甘辣可口，庶胃气可安。乃用胡椒三钱，煨姜一两，人参二两，分煎听用。凡用参汤之
十，椒、姜汤之一，味微甘辣，正得可口。徐与经时，皆咽不吐，乳药皆安，但泻仍未止。参尽后，忽躁扰呻
吟，家人皆怨，谓婴儿娇嫩脏腑，何堪此等热药？是必烧断肚肠也。余虽疑之，而不为乱，思此药若果难堪，
何午前相安而遽变若此？其必数日不食，胃气新复，仓廪空虚，饥甚则然也。旁有预备之粥，与一小盏，辄鲸
吞虎噬，又望其余，复与半碗犹然不足，又与半碗，遂寂然安卧。次日，复加制附，泻止全愈。○钱旭阳长郎，
年两周。季夏间，生冷伤脾，先泻后痢。旭阳善医，知其伤于生冷，与参、术、姜、桂等药，泻痢不愈，渐至
唇口生疮。谋之余曰∶此儿明为生冷所伤，今不利温药，奈何？余曰∶此因泻伤阴，兼之辛辣遽入，而虚火上
炎耳！非易附子，不能使
火归原。因用二剂，口疮咽肿倍甚，见于头面。又谋之余曰∶用药不投，岂真因湿生热耶？余诊之，曰∶上之
脉息，下之所出，皆非真热，温之不效，虽属可疑，然究其所归，寒之则死，意者药犹未及耳！旭阳曰∶尚有
一证，似属真寒，今其所饮，必欲极热。余等不能入口，彼则安然吞之，即其喉口肿痛，所罔顾也。余曰∶是
矣。复增附子及姜、桂、肉果、人参、熟地之属，其泻渐止，喉口等证，不日全收。疑似之间，难辨如此，非
有确见，万无一生。（张景岳）
惊痢
每见惊与痢齐作者，竟不能救。间有惊定热退，而后痢作者，又在可治之例。又有痢后作惊者，此脾土败
坏，肝木生风，亦不治之证。（《怡堂散记》）
选案
一儿三岁，秋杪，惊后患痢，日夜百度，发热，米粒不进，此噤口也。况在惊后，势不可为，不得已，用
木别子合脐法。超时，稍能食粥，方用参、术、苓、草、归、芍、香、连，服药二剂，痢减食加。再以石连、
石脂、白头翁等味出入，去参则食少，去连则痢多，二物竟不能除，守服旬日而愈。予所治惊后痢，皆不得起，
不意此子竟得成功。虽赖参力，亦由惊定而后痢作，稍有不同。（许宣治）
食积
小儿食积，多因脾虚，乳食不化，久而成积。其证夜热朝凉，或寒热并作，腹痛呕酸，喜睡神昏，大便酸
臭。盖脾为至阴之脏，故凡脾病者，至夜必热，热而兼寒，则又见所胜者侮所不胜矣。食未消者消之，食既消
者补之，若手足冷，喜热饮者，此中州虚寒也，宜温之。大便欲去不去者，脾气下陷也，宜升之。若夜间或晨
泻者，脾肾俱虚也，四神丸主之。若手足热，作渴饮水者，脾胃实热也，泻黄散主之。（《张氏医通》）
伤风
小儿伤风，鼻塞发热，多因乳母鼻吹囟门所致。治宜内服惺惺散，外用葱头七茎，生姜一片，细切擂烂，
摊于纸上，掌中合温，贴于囟门，其邪即解。乃去其葱，另用绢缎寸余，涂以面糊，仍贴囟门，永可杜患。（《张氏医通》）
风痰
风痰一证，乳儿最多，四时皆有。大概冬春之交宜温散，荆、防、甘、桔、橘、半、生姜、杏仁、苏子
之类。夏令宜清散，杏仁、牛蒡、栀子之类。秋令宜清润，枳壳、栝蒌之类。冬令严寒，有用麻黄汤而解者。
患为娇脏，总宜疏解，不得妄投丸散。○肺虽喜润，然胃中湿痰宜燥。小儿乳腻生痰，外证有鼻水多涕泪，二
陈汤为治痰总剂，合之前胡、桔梗、荆、防、苏子、枳壳、麦芽、杏仁之类，或加生姜、葱白。结者散之，保
赤之善也。（许宣治）
结胸
结胸一证，幼科本无是名，由仲景《伤寒论》中，有下早表邪入里则为结胸；亦有热已入里，失下而成
结胸者。病在脐之上，满而拒按，此阳明胃腑证也。结有轻、重，故有大、小结胸之辨。若近世幼科之所谓结
胸者，乃肺中痰热结聚，非胃腑之病也。盖肺为五脏华盖，上通于鼻，外合皮毛，其儿本有痰热，复感风寒，
肺气外不得通，内何由化？以致发热咳嗽，痰鸣喘筑，甚至鼻煽口张，面青目直，此皆表气未开故也。予治冬
令严寒，有用麻黄汤而解者，有用姜苏饮而散者，三时则用畅肺饮加减，一切金石之品，概置不用。故于结之
未甚者，十保十全。若已经庸手，及服过金药化痰丸等，则解散为艰。胃气强者，尚能旋转五、六。惟肺为降
利之药所逼，镇坠之性所压，提之不动，胶固不开，肺既填实，金顽不灵，肝木无制，而惊风作矣。医又不知
从肺治，更用镇惊之剂，愈远愈离，从无一活。是皆医家未究结
胸之原，由于肺气之壅闭。妇女见儿痰甚，视丸散为至宝，甘受其误而不悟，良可扼腕！（许宣治）
风温
风温者，春月受风，其气已温。《经》谓∶春气者，病在头，治在上焦。肺位最高，邪必先伤。此手太阴
气分先病，失治则入手厥阴心包络，血分亦伤。幼科见其身热咳嗽，不知肺病在上之旨，妄投荆、防、柴、葛，
加入积、朴、杏、苏、卜子、楂、麦、广皮之属，辄云解肌消食。有见痰喘，便用滚痰丸，大便数行，上热愈
结。幼稚谷少胃薄，表里苦辛化燥，胃汁已伤，复用苦降丸药，以致脾胃阳和伤极，陡变惊痫莫救。○按风温
肺病，治在上焦。夫风温忌汗，初病宜用辛凉，若杂入消导发散，不但与肺病无涉，且劫尽胃汁，肺乏津液上
供，头目清窍为热气熏蒸，鼻干目瞑，上窜无泪；或热深肢厥，狂躁溺涩，胸高气促，皆是肺气不宣化之征。
斯时若以肺药少加清降，使药力不致直趋肠中，则上痹可开，诸窍自爽。无如庸医佥云结胸，杂用连、蒌、柴、
枳，苦寒直降，致闭塞愈甚，告毙甚多。○按此证初时发热喘嗽，首用辛凉，清肃上焦，如薄荷、连翘、牛蒡、
象贝、桑叶、沙参、栀仁、蒌皮、花粉之属。若色苍热甚烦渴，用石膏、竹叶辛寒清散。若日数渐多，邪不得
解，芩、连、凉膈亦可选用。倘热邪逆传膻中，神昏目瞑，全无涕泪，诸窍欲闭，其势危急，必用至宝丹或牛
黄丸。若病后余热，只宜甘寒清养胃阴足矣。（《临证指南》）
夏热
暑热一证，古人以白虎汤为主方，后贤刘河间谓温热时邪，当分三焦投药，以苦辛寒为主，若拘六经分证，
仍是伤寒治法，致误多矣。盖伤寒外受之寒，治从汗解；口鼻吸入之寒，治当温里。论幼稚病暑热，时下不外
发散消导，加入香薷或六一散。但暑必兼湿，暑伤气分，湿亦伤气，汗则耗气伤阳，胃汁受劫，变
病甚多。发泄司令，里真自虚。张凤逵云∶暑病首用辛凉，继用甘寒，再用酸泄酸敛，不必用下。可称要言不
烦。（《临证指南》）
秋燥
秋深初凉，稚年发热咳嗽，证似春月风温。但温乃渐热之称，凉即渐冷之意。春令为病，犹是冬藏固密之
余；秋令感伤，恰值夏热发泄之后。然虽体质虚实不同，而温自上受，燥自上伤，理亦相等，均是肺气受病。
世人误认暴感风寒，混投三阳发散，津劫燥甚，喘急告危。若果暴凉外束，身热痰嗽，宜葱豉汤，或苏梗、前
胡、杏仁、枳、桔，投一、二剂亦可。粗工亦知燥热为病，与泻白散加芩、连之属，不知苦愈助燥，必增他变。
当以辛凉甘润，燥气自平。○秋燥一证，气分先受，治肺为急。若延缠日久，病入血分，又非轻浮肺药可医。
须审体质证端，古谓治病须活泼泼地，如盘走珠耳。（《临证指南》）
选案
翁姓子，生数月，证患秋燥，潮热咳嗽如疟。幼科发散不效，忙令禁乳。更医用泻白散加芩、连，昼夜烦
热，喘而不咳，下利粘腻，药后竟利药水。余曰∶稚年以乳食为命，饿则胃虚气馁，肺更不爽。乃与玉竹、甘
草、广皮，竹叶心，一剂热缓。与粳米、南枣、甘草、沙参二剂，与乳并进，令其竖抱勿倒，三日全愈。（《临证指南》）
冬寒
深秋入冬暴冷，折伤外感，发热，头痛，身痛，呕恶，治从太阳。风伤卫，用桂枝法；寒伤营，用麻黄法。
小儿肌疏易汗，难任麻、桂重表，轻则紫苏、防风，身痛用羌活，然不过一剂。伤风亦肺病为多，前、杏、枳、
桔之属，辛胜即是汗药。其葱豉汤，乃通用要方。若肢冷寒战，呕吐自利，或身无热，即从中寒里证，治分三
阴。但小儿太阴中寒证多，厥阴间有。若冬令应寒，气候温暖，当藏反泄致病，名曰冬温。温为欲热之渐，非寒
证得汗可解。若涉表邪一、二，里热必兼七、八。是瘾疹、丹痧，非徒风寒一途。或外受之邪，与里邪相薄，
亦令郁于经络；或饮醇浓味，里热炽烈，而卫不与营和；或不正之气内侵，即有腹痛下利诸证。治法以里证为
主。稍兼清散，设用辛温，祸不旋踵。（《临证指南》）
附方
柴胡梅连散 柴胡、前胡各三钱，胡黄连、乌梅各一钱。上 咀，每一钱，童便一盏，猪KT 一枚，猪脊
髓一条，韭根白半钱，同煎，不拘时温服。
暑风饮子 治暑风急惊。防风、柴胡、香薷、连翘、赤苓、半夏、钩藤钩、石膏、扁荚叶、甘草。风胜加
羌活；热胜，舌如杨梅加黄连；小便不利加木通；人事昏迷加鲜菖蒲。
大青膏 治伤风吐泻。青黛、天麻各一钱，朱砂、干蝎、白附子各五分，天竺黄、乌梢蛇肉各二钱，麝香
二分。各为细末，蜜和成膏，薄荷汤化服，每一小豆许。
钩藤饮 人参、犀角各五分，全蝎、天麻各二分，甘草一分，钩藤一钱。
蝉蝎散 慢惊，阳证尚在，宜用此方。蝉蜕二十一个，全蝎七个，南星一个，甘草二分半，为末，每用一
钱，姜枣水煎服。
醒脾散 治脾困昏沉，吐泻不止，渐成慢惊。人参、白术、茯苓、甘草、白附子、天麻、僵蚕、木香各五
分，全蝎二分半。上为粗末，每用二钱，姜枣水煎服。
乌蝎散 治慢惊纯阴证，吐泻不止。人参、白术、茯苓、炙甘草、南星、川乌、全蝎，同锉粗末，姜枣水煎服。
黄土稻花汤 治暑风吐泻，将成慢惊。黄土一两，稻花一合，人参五分，陈皮四分，半夏五分，茯苓七分，
甘草二分，乌梅肉五分。新汲水，搅黄土，澄清煎药；汤熟，入稻花，再煎数沸，温服。如无稻花，以生谷芽代之。
蒿虫丸 治急惊神效。朱砂、轻粉各一钱。上为细末，取青蒿节内虫，同研，丸如麻子大，晒干，瓷罐
收贮。一岁一丸，人乳化服。（蒿虫须七月初旬取，迟则生翅飞去。）
紫霜丸 治惊积。代赭石二钱，杏仁二十一个，巴豆二十一粒。为末，饭丸粟米大，每服五、七丸，煎
皂角仁汤下。
猪心汤 治小儿痫证。用甘遂末一钱，猪心一个，批作两片，入甘遂末药在内，线缚，湿纸包裹，文武
火煨熟，取药细研，入辰砂末一钱，和匀，分作四丸。每服一丸，猪心汤化下，神效。
紫河车丸 治先天不足，痫证频发。紫河车（即小儿胞衣）肥浓者一个，洗净，重汤蒸烂，研入人参、
当归末，和匀为丸，如芡实大。每服五、六丸，乳汁化下。
摩药 治小儿客忤。用豆豉数合，水拌令湿，捣熟，丸如鸡子大。先摩儿囟顶、足心各五、六遍；再摩
心口及脐。摩之食顷，破视丸中有细毛为验，掷丸道中，痛即止。
花火膏 治夜啼。灯花一颗。涂乳上，命儿吮之。
蝉花散 用蝉退下半截为末，一字，薄荷汤入酒少许调下，其啼即止。若用上截，即复啼。
布袋丸 治小儿丁奚、哺露、无辜疳。人参、白术、茯苓、甘草、芦荟各五钱，夜明砂、使君子、芜荑
那些患此病的人，每年都是如此。我之前有关于参连饮的论述，也有关于黄土稻花汤的论述，这些都属于后来补充的功效，要点破其中的关键机关，不如用黄连香薷饮，当头一服就能痊愈。（《怡堂散记》）
选录医案
我的二儿子，生于五月，本年初秋时，感受寒邪而发热，脉象微紧。我素知他脏腑之气属阴（体质偏寒），不敢使用清热解表法，给予苏叶、羌活、白芷、细辛、生姜等药物，希望发散其寒邪。一剂药喝下去后，不仅发热不退，反而出现严重腹泻，泻得越厉害，气喘就越严重。这时我想：难道是因为寒气盛吗？为什么用了温药反而导致腹泻？难道是因为火克金（肺热）吗？难道经过几天的清热泻下治疗后，还能耐受寒凉药物吗？难道是因为表邪未除吗？为什么疏散表邪的方法不利呢？束手无策，且见其表里病情都加重，大喘气濒临危险，这难道是轻剂所能挽回的吗？于是用人参二钱，生姜五片，煎取半盏汁液，不敢贸然进服，先挑两、三匙喂给他。含在嘴里，随即在室内走动，观察他的呼吸进退，气喘虽然没有减少，但也没有增加。又喂了三、四匙，过了一会儿，鼻息稍微舒缓。于是喂了半钟，感觉更有反应。再用二钱人参，像前面那样煎汤，服完后气息就平稳了，沉沉睡去，腹泻停止，热也退了。之所以这样，观察他因为腹泻反而气喘，难道不是中焦虚损吗？如果有实邪，自然应当随着腹泻而气喘减轻。记录此案，以显示温中散寒的功效，竟然精妙到如此地步。○我的小儿子，出生刚满周岁，我看到新凉天气到来，担心被褥太薄，恐怕受寒侵袭，特意嘱咐家属保护。他们不以为意，几天后，呕吐和腹泻大作。使用温胃、和脾、理中等方剂，没有效果。加入人参三钱以及干姜、肉桂、吴茱萸、肉豆蔻，也没有效果。到了第四、五天，吃奶就吐，于是用人参五、六钱，附子、干姜、肉桂等各一、二钱，药一下咽就吐出来。所吐出的乳汁，洁白无气味，此时形体和气机都很危险了。暗自推测其原因，并且揣度是寒气犯胃，而呕吐腹泻不止，如果舍弃人参、干姜、肉桂、附子，还有什么办法呢？想到他胃虚已经到了极点，药物的气味，稍微有一点不合，胃就不能接受，附子味咸，也能导致呕吐，这一定是原因所在，必须得到甘辣可口的药物，才能使胃气安宁。于是用胡椒三钱，煨姜一两，人参二两，分开煎煮备用。凡是十份参汤中，配一份椒、姜汤，味道微甘辣，正合口味。慢慢地喂了一个时辰，都能咽下不吐，吃奶吃药都安稳，但是腹泻仍然没有停止。人参用完后，忽然烦躁不安呻吟，家人们都埋怨，说婴儿娇嫩脏腑，怎么能承受这种热药？这一定是烧断肚肠了。我虽然怀疑这一点，但不为所乱，想这药如果真的难以忍受，为什么午前相安无事而突然变成这样？这一定是因为几天没吃东西，胃气刚刚恢复，仓库空虚，饥饿得很就会这样。旁边有预备好的粥，给了一小盏，他就狼吞虎咽，还望着剩下的，又给了半碗还不够，又给了半碗，于是安静地躺下了。第二天，再加制附子，腹泻停止完全痊愈。○钱旭阳的大儿子，两岁。季夏期间，因生冷伤了脾胃，先腹泻后痢疾。钱旭阳擅长医术，知道他是伤于生冷，给予人参、白术、干姜、肉桂等药，腹泻痢疾不好，逐渐发展到唇口生疮。来问我道：“这孩子明明是生冷所伤，现在不能用温药，怎么办？”我说：“这是因为腹泻伤了阴，加上辛辣药突然进入，导致虚火上炎耳！非易附子，不能使火归原。”因此用了两剂，口疮咽肿加倍严重，出现在头面部。又来问我道：“用药不投，难道真的是因湿生热吗？”我诊察后说：“上面的脉象，下面所排出的，都不是真热，温补无效，虽然属于可疑，然而究其归宿，寒凉则死，猜想是药力还没到位吧！”旭阳说：“还有一个症状，似乎属于真寒，现在他所喝的，一定要极热的。我们都不能入口，他却安然吞下，即使喉口肿痛，也不顾惜。”我说：“对了。”再增加附子以及干姜、肉桂、肉果、人参、熟地黄等药，他的腹泻渐渐停止，喉口等症状，不久全部消退。疑似之间，难辨如此，如果没有确切的见解，万无一生的可能。（张景岳）
惊痫伴痢疾
经常见到惊风与痢疾同时发作的，竟然不能救治。偶尔有惊风定住热退之后，才发作痢疾的，又在可治的范围内。又有痢疾之后发作惊风的，这是脾土败坏，肝木生风，也是不治之证。（《怡堂散记》）
选录医案
一个三岁儿童，秋末，惊风后患痢疾，日夜上百次，发热，米粒不进，这是噤口痢。况且在惊风之后，形势不可为，不得已，用木别子合脐法。过了时辰，稍微能吃粥，方药用党参、白术、茯苓、甘草、当归、白芍、木香、黄连，服药两剂，痢疾减轻食欲增加。再用石莲子、赤石脂、白头翁等药加减，去掉党参则食少，去掉黄连则痢多，这两味药竟然不能去除，坚持服用十天而痊愈。我所治疗的惊风后痢疾，都没有救起，没想到这个孩子竟然成功。虽然依赖人参的力量，也是因为惊定而后痢作，稍有不同。（许宣治）
食积
小儿食积，多因脾虚，乳食不化，久而成积。其症状是夜间发热早晨凉爽，或寒热并作，腹痛呕酸，喜欢睡觉神志昏沉，大便酸臭。盖脾为至阴之脏，所以凡是脾病的人，到了晚上必然发热，发热兼有寒邪，则是所见到的胜者侮所不胜（五行相乘侮）。食物未消化的要消导它，食物已经消化的要补益它，如果手脚冷，喜欢热饮的，这是中焦虚寒，宜温补。大便想拉拉不出来的，是脾气下陷，宜升提。如果夜间或早晨腹泻的，是脾肾俱虚，主用四神丸。如果手脚热，口渴饮水的，是脾胃实热，主用泻黄散。（《张氏医通》）
伤风
小儿伤风，鼻塞发热，多因乳母对着囟门吹气所致。治疗宜内服惺惺散，外用葱头七茎，生姜一片，细细切碎捣烂，摊在纸上，手掌中合温，贴在囟门上，邪气即解。然后去掉葱，另用绢缎一寸多，涂上面糊，仍贴在囟门上，永远可以杜绝病患。（《张氏医通》）
风痰
风痰这一证候，哺乳婴儿最多，四季都有。大概冬春之交宜温散，用荆芥、防风、甘草、桔梗、橘红、半夏、生姜、杏仁、苏子之类。夏令宜清散，用杏仁、牛蒡子、栀子之类。秋令宜清润，用枳壳、瓜蒌之类。冬令严寒，有用麻黄汤而解的。患儿脏腑娇嫩，总宜疏解，不得妄投丸散。○肺虽喜润，然而胃中湿痰宜燥。小儿乳腻生痰，外证有鼻水多涕泪，二陈汤为治痰总剂，配合前胡、桔梗、荆芥、防风、苏子、枳壳、麦芽、杏仁之类，或加生姜、葱白。结聚的要消散它，这是保赤丹的善法。（许宣治）
结胸
结胸这一证候，儿科本来没有这个名字，由仲景《伤寒论》中，有下早表邪入里则为结胸；也有热已入里，失下而成结胸者。病在脐之上，胀满而拒按，这是阳明胃腑证。结胸有轻、重，故有大、小结胸之辨。若近世儿科所谓的结胸者，乃是肺中痰热结聚，不是胃腑的病。盖肺为五脏华盖，上通于鼻，外合皮毛，那孩子本有痰热，又感受风寒，肺气外不得通，内何由化？以致发热咳嗽，痰鸣喘促，甚至鼻翼煽动口张，面青目直，这都是表气未开的原因。我治疗冬令严寒，有用麻黄汤而解的，有用姜苏饮而散的，三时则用畅肺饮加减，一切金石之品，一概不用。所以对于结胸未严重的，十个保全十个。如果已经被庸手治疗，及服用过金药化痰丸等，则解散为难。胃气强的，尚能旋转五、六。惟独肺被降利之药所逼，镇坠之性所压，提之不动，胶固不开，肺既填实，金顽不灵，肝木无制，而惊风发作了。医生又不知道从肺治，更用镇惊之剂，愈远愈离，从无一活。这都是医家未研究结胸的原由，由于肺气之壅闭。妇女见儿痰甚，视丸散为至宝，甘愿受其误而不悟，实在令人扼腕！（许宣治）
风温
风温者，春季受风，其气已温。《内经》谓：春气者，病在头，治在上焦。肺位最高，邪必先伤。这是手太阴气分先病，失治则入手厥阴心包络，血分亦伤。儿科见到其身热咳嗽，不知肺病在上之旨，妄投荆芥、防风、柴胡、葛根，加入枳实、厚朴、杏仁、苏子、莱菔子、山楂、麦芽、陈皮之类，辄云解肌消食。有见到痰喘，便用滚痰丸，大便数行，上热愈结。幼稚谷少胃薄，表里苦辛化燥，胃汁已伤，复用苦降丸药，以致脾胃阳和伤极，陡变惊痫莫救。○按风温肺病，治在上焦。夫风温忌汗，初病宜用辛凉，若杂入消导发散，不但与肺病无涉，且劫尽胃汁，肺乏津液上供，头目清窍为热气熏蒸，鼻干目瞑，上窜无泪；或热深肢厥，狂躁溺涩，胸高气促，皆是肺气不宣化之征。斯时若以肺药少加清降，使药力不致直趋肠中，则上痹可开，诸窍自爽。无如庸医佥云结胸，杂用连翘、瓜蒌、柴胡、枳实，苦寒直降，致闭塞愈甚，告毙甚多。○按此证初时发热喘嗽，首用辛凉，清肃上焦，如薄荷、连翘、牛蒡子、象贝母、桑叶、沙参、栀仁、瓜蒌皮、花粉之类。若面色苍老热甚烦渴，用石膏、竹叶辛寒清散。若日数渐多，邪不得解，黄芩、黄连、凉膈散亦可选用。倘热邪逆传膻中，神昏目瞑，全无涕泪，诸窍欲闭，其势危急，必用至宝丹或牛黄丸。若病后余热，只宜甘寒清养胃阴足矣。（《临证指南》）
夏热
暑热这一证候，古人以白虎汤为主方，后贤刘河间谓温热时邪，当分三焦投药，以苦辛寒为主，若拘泥六经分证，仍是伤寒治法，致误多矣。盖伤寒外受之寒，治从汗解；口鼻吸入之寒，治当温里。论幼稚病暑热，时下不外发散消导，加入香薷或六一散。但暑必兼湿，暑伤气分，湿亦伤气，汗则耗气伤阳，胃汁受劫，变病甚多。发泄司令，里真自虚。张凤逵云：暑病首用辛凉，继用甘寒，再用酸泄酸敛，不必用下。可称要言不烦。（《临证指南》）
秋燥
秋深初凉，稚年发热咳嗽，证似春月风温。但温乃渐热之称，凉即渐冷之意。春令为病，犹是冬藏固密之余；秋令感伤，恰值夏热发泄之后。然虽体质虚实不同，而温自上受，燥自上伤，理亦相等，均是肺气受病。世人误认暴感风寒，混投三阳发散，津劫燥甚，喘急告危。若果暴凉外束，身热痰嗽，宜葱豉汤，或苏梗、前胡、杏仁、枳壳、桔梗，投一、二剂亦可。粗工亦知燥热为病，与泻白散加黄芩、黄连之类，不知苦愈助燥，必增他变。当以辛凉甘润，燥气自平。○秋燥一证，气分先受，治肺为急。若延缠日久，病入血分，又非轻浮肺药可医。须审体质证端，古谓治病须活泼泼地，如盘走珠耳。（《临证指南》）
选录医案
姓翁的孩子，出生数月，证患秋燥，潮热咳嗽如疟。儿科发散不效，忙令禁乳。更医用泻白散加黄芩、黄连，昼夜烦热，喘而不咳，下利粘腻，药后竟利药水。我说：稚年以乳食为命，饿则胃虚气馁，肺更不爽。于是给予玉竹、甘草、陈皮，竹叶心，一剂热缓。给予粳米、南枣、甘草、沙参二剂，与乳并进，令其竖抱勿倒，三日全愈。（《临证指南》）
冬寒
深秋入冬暴冷，折伤外感，发热，头痛，身痛，呕恶，治从太阳经。风伤卫，用桂枝法；寒伤营，用麻黄法。小儿肌疏易汗，难任麻黄、桂枝重表，轻则紫苏、防风，身痛用羌活，然不过一剂。伤风亦肺病为多，前胡、杏仁、枳壳、桔梗之类，辛胜即是汗药。其葱豉汤，乃通用要方。若肢冷寒战，呕吐自利，或身无热，即从中寒里证，治分三阴。但小儿太阴中寒证多，厥阴间有。若冬令应寒，气候温暖，当藏反泄致病，名曰冬温。温为欲热之渐，非寒证得汗可解。若涉表邪一、二，里热必兼七、八。是瘾疹、丹痧，非徒风寒一途。或外受之邪，与里邪相薄，亦令郁于经络；或饮醇浓味，里热炽烈，而卫不与营和；或不正之气内侵，即有腹痛下利诸证。治法以里证为主。稍兼清散，设用辛温，祸不旋踵。（《临证指南》）
附方
柴胡梅连散 柴胡、前胡各三钱，胡黄连、乌梅各一钱。上药捣碎，每一钱，童便一盏，猪膏一枚，猪脊髓一条，韭根白半钱，同煎，不拘时温服。
暑风饮子 治暑风急惊。防风、柴胡、香薷、连翘、赤茯苓、半夏、钩藤钩、石膏、扁豆叶、甘草。风胜加羌活；热胜，舌如杨梅加黄连；小便不利加木通；人事昏迷加鲜石菖蒲。
大青膏 治伤风吐泻。青黛、天麻各一钱，朱砂、干蝎、白附子各五分，天竺黄、乌梢蛇肉各二钱，麝香二分。各为细末，蜜和成膏，薄荷汤化服，每一小豆许。
钩藤饮 人参、犀角各五分，全蝎、天麻各二分，甘草一分，钩藤一钱。
蝉蝎散 慢惊，阳证尚在，宜用此方。蝉蜕二十一个，全蝎七个，南星一个，甘草二分半，为末，每用一钱，姜枣水煎服。
醒脾散 治脾困昏沉，吐泻不止，渐成慢惊。人参、白术、茯苓、甘草、白附子、天麻、僵蚕、木香各五分，全蝎二分半。上为粗末，每用二钱，姜枣水煎服。
乌蝎散 治慢惊纯阴证，吐泻不止。人参、白术、茯苓、炙甘草、南星、川乌、全蝎，同锉粗末，姜枣水煎服。
黄土稻花汤 治暑风吐泻，将成慢惊。黄土一两，稻花一合，人参五分，陈皮四分，半夏五分，茯苓七分，甘草二分，乌梅肉五分。新汲水，搅黄土，澄清煎药；汤熟，入稻花，再煎数沸，温服。如无稻花，以生谷芽代之。
蒿虫丸 治急惊神效。朱砂、轻粉各一钱。上为细末，取青蒿节内虫，同研，丸如麻子大，晒干，瓷罐收贮。一岁一丸，人乳化服。（蒿虫须七月初旬取，迟则生翅飞去。）
紫霜丸 治惊积。代赭石二钱，杏仁二十一个，巴豆二十一粒。为末，饭丸粟米大，每服五、七丸，煎皂角仁汤下。
猪心汤 治小儿痫证。用甘遂末一钱，猪心一个，批作两片，入甘遂末药在内，线缚，湿纸包裹，文武火煨熟，取药细研，入辰砂末一钱，和匀，分作四丸。每服一丸，猪心汤化下，神效。
紫河车丸 治先天不足，痫证频发。紫河车（即小儿胞衣）肥浓者一个，洗净，重汤蒸烂，研入人参、当归末，和匀为丸，如芡实大。每服五、六丸，乳汁化下。
摩药 治小儿客忤。用豆豉数合，水拌令湿，捣熟，丸如鸡子大。先摩儿囟顶、足心各五、六遍；再摩心口及脐。摩之食顷，破视丸中有细毛为验，掷丸道中，痛即止。
花火膏 治夜啼。灯花一颗。涂乳上，命儿吮之。
蝉花散 用蝉退下半截为末，一字，薄荷汤入酒少许调下，其啼即止。若用上截，即复啼。
布袋丸 治小儿丁奚、哺露、无辜疳。人参、白术、茯苓、甘草、芦荟各五钱，夜明砂、使君子、芜荑
Those who suffer from this condition experience it every year. I previously had discussions on Shenlian Yin (Ginseng and Coptis Decoction) and Huangtu Daohua Tang (Yellow Earth and Rice Flower Decoction), which all belong to later-added efficacies. To break through the key mechanism, nothing is better than using Huanglian Xiangru Yin (Coptis and Elsholtzia Decoction); a single dose administered at the onset can bring about recovery. (From *Yitang Sanji*)
Selected Cases
My second son was born in the fifth lunar month. In early autumn of that year, he contracted cold pathogenic factors and developed fever, with a pulse that was slightly tight. Knowing his organ qi belonged to Yin (cold constitution), I dared not use clearing-heat and resolving-exterior methods. Instead, I prescribed herbs such as Suz Ye (Perilla Leaf), Qiang Huo (Notopterygium Rhizome), Bai Zhi (Angelica Dahurica Root), Xi Xin (Asarum Root), and Sheng Jiang (Fresh Ginger), hoping to disperse the cold. After one dose was swallowed, not only did the fever not subside, but severe diarrhea ensued; the more he diahrreased, the worse his wheezing became. At that time, I wondered: Was it because cold pathogenic factors were abundant? Why did the use of warming herbs cause diarrhea instead? Was it because Fire was attacking Metal (Lung heat)? Could he still tolerate cold-cooling herbs after days of clearing-heat and purging? Was it because exterior pathogenic factors remained? Why were dispersing methods ineffective? I was at a loss. Seeing that both interior and exterior conditions were severe, with critical wheezing, how could mild formulas reverse this? Therefore, I used Ren Shen (Ginseng Root) 2 qian and Sheng Jiang (Fresh Ginger) 5 slices, decocted to half a cup. Daring not to administer it rapidly, I offered two or three spoonfuls. He held it in his mouth, walked around the room, and I observed his breathing. Although the wheezing did not decrease, it did not increase either. I then gave three or four more spoonfuls. After a short while, his nasal breathing relaxed slightly. I then gave half a cup, and felt a positive response. I again decocted 2 qian of Ren Shen (Ginseng Root) as before. After finishing the dose, his breath stabilized, he fell into a deep sleep, the diarrhea stopped, and the fever subsided. The reason for this: observing that he wheezed due to diarrhea, was this not deficiency of the Middle Jiao? If there were excess pathogenic factors, the wheezing should naturally decrease with the diarrhea. I recorded this case to demonstrate the marvelous efficacy of warming the middle and dispersing cold. ○ My youngest son was just turning one year old. When I noticed the arrival of cool weather, fearing the bedding was too thin and he might be invaded by cold, I specifically instructed family members to protect him. They paid no attention. Several days later, severe vomiting and diarrhea occurred. I used formulas to warm the stomach, harmonize the spleen, and regulate the middle (such as Lizhong Wan), but they were ineffective. I added 3 qian of Ren Shen (Ginseng Root) along with Gan Jiang (Dried Ginger), Rou Gui (Cinnamon Bark), Wu Zhu Yu (Evodia Fruit), and Rou Dou Kou (Nutmeg), but these were also ineffective. By the fourth or fifth day, he vomited immediately after breastfeeding. I then used 5-6 qian of Ren Shen (Ginseng Root), and 1-2 qian each of Fu Zi (Aconite Lateral Root), Gan Jiang (Dried Ginger), and Rou Gui (Cinnamon Bark). However, he vomited immediately upon swallowing. The vomited milk was white, clear, and odorless. At this moment, his form and qi were critical. Silently analyzing the cause, and estimating that cold pathogenic factors had attacked the stomach causing persistent vomiting and diarrhea, if I abandoned Ren Shen (Ginseng Root), Gan Jiang (Dried Ginger), Rou Gui (Cinnamon Bark), and Fu Zi (Aconite Lateral Root), what other method was there? Considering his stomach deficiency was extreme, any slight mismatch in the flavor and aroma of the medicine would cause rejection by the stomach. Fu Zi (Aconite Lateral Root) has a salty taste, which can also induce vomiting; this must be the reason. We needed something sweet and spicy and palatable to stabilize the Stomach Qi. Therefore, I used Hu Jiao (Black Pepper) 3 qian, Wei Jiang (Baked Ginger) 1 liang, and Ren Shen (Ginseng Root) 2 liang, decocted separately for use. For every ten parts of Ginseng Decoction, one part of Pepper and Ginger Decoction was mixed, resulting in a slightly sweet and spicy taste, which was indeed palatable. Administered slowly over an hour, he swallowed everything without vomiting, tolerating both milk and medicine, although the diarrhea persisted. After the Ren Shen (Ginseng Root) was exhausted, he suddenly became restless and moaned. His family complained, saying, "The infant's delicate organs cannot withstand such hot medicines; surely this will burn out his intestines." Although I doubted this, I remained calm. I reasoned: If the medicine were truly unbearable, why was he stable in the morning and suddenly changed like this? It must be because he had not eaten for several days, his Stomach Qi had just recovered, his granary was empty, and extreme hunger caused this reaction. There was prepared porridge nearby; I gave him a small cup, which he devoured greedily, asking for more. I gave another half bowl, which was still insufficient, and yet another half bowl, after which he lay quietly and peacefully. The next day, I added processed Fu Zi (Aconite Lateral Root), and the diarrhea stopped completely. ○ Mr. Qian Xuyang’s eldest son was two years old. In late summer, damage from raw and cold foods injured the Spleen, leading first to diarrhea and then to dysentery. Mr. Qian, being skilled in medicine, knew the injury was from raw/cold foods and prescribed Ren Shen (Ginseng Root), Bai Zhu (Atractylodes Macrocephala Rhizome), Gan Jiang (Dried Ginger), and Rou Gui (Cinnamon Bark). The diarrhea and dysentery did not improve, and ulcers gradually appeared on his lips and mouth. He asked me: "This child is clearly injured by raw/cold foods, yet warming herbs are not effective now. What should we do?" I said: "This is because the diarrhea injured Yin, and the sudden introduction of pungent-spicy herbs caused deficient fire to flare upward! Only by using Fu Zi (Aconite Lateral Root) can the fire return to its source." Consequently, two doses were given, but the oral ulcers and swollen throat worsened significantly, appearing on the head and face. He came to me again: "The medication is not matching the syndrome; could it truly be dampness generating heat?" I examined him and said: "The pulse above and the discharge below are not true heat. Although warming treatment was ineffective, which is suspicious, ultimately, cold-cooling would lead to death. I suspect the medicinal force has not yet reached the target!" Mr. Qian said: "There is one more symptom that seems to indicate true cold: whatever he drinks must be extremely hot. We cannot even swallow it, yet he swallows it calmly, disregarding his sore throat and mouth swelling." I said: "Exactly." I further increased the dosage of Fu Zi (Aconite Lateral Root) along with Gan Jiang (Dried Ginger), Rou Gui (Cinnamon Bark), Rou Dou Kou (Nutmeg), Ren Shen (Ginseng Root), and Shu Di Huang (Prepared Rehmannia Root). His diarrhea gradually stopped, and the throat/mouth symptoms resolved within a few days. Between doubt and similarity, differentiation is so difficult. Without firm insight, survival is impossible. (Zhang Jingyue)
Startling Dysentery
I often see cases where startling convulsions and dysentery occur simultaneously, which are incurable. Occasionally, when the startling subsides and heat recedes, followed by dysentery, it falls into the category of treatable cases. There are also cases where startling occurs after dysentery; this indicates the failure of Spleen Earth and the generation of Wind by Liver Wood, which is also an incurable syndrome. (From *Yitang Sanji*)
Selected Cases
A three-year-old child, at the end of autumn, developed dysentery after a startling episode. He had over a hundred bowel movements per day, fever, and could not eat rice grains; this is Jin Kou Li (Jin Kou Dysentery/Anorexic Dysentery). Given that it occurred after startling, the situation seemed hopeless. Reluctantly, I used Mu Bie Zi (Melon Seed) applied to the umbilicus. After some time, he could eat a little congee. The formula used contained Dang Shen (Codonopsis Root), Bai Zhu (Atractylodes Macrocephala Rhizome), Fu Ling (Poria), Gan Cao (Licorice Root), Dang Gui (Angelica Sinensis Root), Bai Shao (White Peony Root), Mu Xiang (Aucklandia Root), and Huang Lian (Coptis Rhizome). After two doses, the dysentery decreased and appetite increased. Subsequently, Shi Lian Zi (Stone Lotus Seed), Chi Shi Zhi (Halloysitum Rubrum), and Bai Tou Weng (Pulsatilla Root) were used in variations. Removing Dang Shen (Codonopsis Root) led to poor appetite; removing Huang Lian (Coptis Rhizome) led to increased dysentery. These two herbs could not be omitted. He continued taking the medicine for ten days and recovered. All the post-startling dysentery cases I treated failed to recover, so I did not expect this child to succeed. Although it relied on the power of Ren Shen (Ginseng Root), it was also because the dysentery started after the startling subsided, which was slightly different. (Xu Xuanzhi)
Food Stagnation
Pediatric food stagnation is mostly due to Spleen deficiency, where milk and food fail to transform, eventually forming stagnation. Symptoms include night fever and morning coolness, alternating chills and fever, abdominal pain and sour regurgitation, preference for sleeping and mental confusion, and sour-smelling stools. The Spleen is the organ of Extreme Yin; therefore, in Spleen diseases, fever inevitably occurs at night. Fever combined with chills indicates that the conquered element insults the conqueror (Five Elements theory). For undigested food, use digestion-promoting methods; for digested food, use tonification. If hands and feet are cold and the patient prefers hot drinks, this is Middle Jiao deficiency-cold, requiring warming. If there is a sensation of stool but inability to defecate, this is Spleen Qi sinking, requiring lifting. If diarrhea occurs at night or in the morning, this is dual deficiency of Spleen and Kidney, primarily treated with Si Shen Wan (Four Spirits Pill). If hands and feet are hot, with thirst and desire to drink water, this is Spleen-Stomach excess-heat, primarily treated with Xie Huang San (Drain Yellow Powder). (From *Zhangshi Yitong*)
Wind-Cold Injury
Pediatric wind-cold injury, characterized by nasal congestion and fever, is often caused by the mother blowing air onto the fontanelle. Treatment should involve internal administration of Xingxing San (Xingxing Powder) and external application of seven scallion heads and one slice of fresh ginger, finely chopped and mashed, spread on paper, warmed in the palm, and applied to the fontanelle. The pathogenic factor will then resolve. Remove the scallion, apply a piece of silk cloth coated with flour paste to the fontanelle, which can permanently prevent recurrence. (From *Zhangshi Yitong*)
Wind-Phlegm
The syndrome of Wind-Phlegm is most common in nursing infants and occurs in all seasons. Generally, during the transition from winter to spring, warming dispersion is suitable, using herbs such as Jing Jie (Schizonepeta Spike), Fang Feng (Saposhnikovia Root), Gan Cao (Licorice Root), Jie Geng (Platycodon Root), Ju Hong (Tangerine Peel), Ban Xia (Pinellia Tuber), Sheng Jiang (Fresh Ginger), Xing Ren (Apricot Seed), and Su Zi (Perilla Fruit). In summer, cooling dispersion is suitable, using Xing Ren (Apricot Seed), Niu Bang Zi (Arctium Fruit), and Zhi Zi (Gardenia Fruit). In autumn, cooling and moistening are suitable, using Zhi Ke (Aurantium Fruit) and Gua Lou (Trichosanthes Fruit). In the severe cold of winter, Ma Huang Tang (Ephedra Decoction) may be used for resolution. Since children have delicate organs, total relief and dispersion are always preferred; pills and powders should never be recklessly administered. ○ Although the Lung prefers moisture, damp-phlegm in the Stomach requires drying. Phlegm generated from rich milk in children presents externally with excessive nasal discharge and tearing. Er Chen Tang (Two-Aged Decoction) is the general formula for treating phlegm. Combined with Qian Hu (Peucedanum Root), Jie Geng (Platycodon Root), Jing Jie (Schizonepeta Spike), Fang Feng (Saposhnikovia Root), Su Zi (Perilla Fruit), Zhi Ke (Aurantium Fruit), Mai Ya (Barley Sprout), and Xing Ren (Apricot Seed), or adding Sheng Jiang (Fresh Ginger) and Cong Bai (Scallion White). For accumulation, use dispersing methods; this is the virtue of Baochi Dan (Infant Protection Pill). (Xu Xuanzhi)
Jie Xiong (Glomus Formation)
The syndrome of Jie Xiong (Glomus Formation) does not originally exist in pediatrics. In Zhang Zhongjing’s *Shanghan Lun* (Treatise on Cold Damage), if purgatives are used too early, exterior pathogenic factors enter the interior, resulting in Jie Xiong; or if heat has entered the interior and purgatives are missed, Jie Xiong forms. The disease is located above the navel, presenting with fullness and tenderness upon pressure, indicating a Yangming Stomach-Fu syndrome. Jie Xiong has light and heavy degrees, hence the distinction between Large and Small Jie Xiong. However, what modern pediatricians call Jie Xiong is actually the aggregation of phlegm-heat in the Lung, not a disease of the Stomach-Fu. The Lung is the canopy of the five zang organs, connects to the nose above, and governs the skin and hair externally. If the child already has phlegm-heat and contracts wind-cold, Lung Qi cannot circulate outward, nor transform internally. This leads to fever, cough, phlegm-rattling, and panting, even to the point of nasal flaring, mouth opening, cyanosis, and staring eyes. All these are due to unopened exterior Qi. In my treatment of severe winter cold, I have used Ma Huang Tang (Ephedra Decoction) for resolution, or Jiang Su Yin (Ginger and Perilla Drink) for dispersion. During the other three seasons, Chang Fei Yin (Lung-Unblocking Drink) with modifications is used. All mineral-based substances are generally excluded. Thus, for mild Jie Xiong, ten cases yield ten cures. If treated by incompetent physicians or after administering metallic/phlegm-resolving pills, dispersion becomes difficult. Those with strong Stomach Qi may recover after five or six adjustments. However, if the Lung is forced by descending-draining drugs and suppressed by sedative-heavy properties, it cannot be lifted, remains stuck and unopened. Once the Lung is filled and solid, Metal becomes stubborn and dull, Liver Wood loses control, and Startling Wind develops. Doctors, failing to treat from the Lung, further use calming-startling agents, moving further away from the root, with zero survivors. This is because doctors have not investigated the origin of Jie Xiong, which lies in the obstruction of Lung Qi. Women seeing excessive phlegm in children regard pills and powders as treasures, willingly suffering errors without realization, which is truly heartbreaking! (Xu Xuanzhi)
Feng Wen (Wind-Warmth)
Feng Wen (Wind-Warmth) occurs when wind is contracted in spring, when the qi is already warm. The *Classic* states: Spring qi diseases affect the head, and treatment should focus on the Upper Jiao. The Lung is positioned highest, so pathogenic factors must injure it first. This begins as a disease of the Hand-Taiyin Qi level; if untreated, it enters the Hand-Jueyin Pericardium Collateral, injuring the Blood level. Pediatricians seeing fever and cough in children often ignore the principle that Lung disease is in the upper part, recklessly prescribing Jing Jie (Schizonepeta Spike), Fang Feng (Saposhnikovia Root), Chai Hu (Bupleurum Root), and Ge Gen (Kudzu Root), adding Zhi Shi (Immature Bitter Orange), Hou Po (Magnolia Bark), Xing Ren (Apricot Seed), Su Zi (Perilla Fruit), Lai Fu Zi (Radish Seed), Shan Zha (Hawthorn Fruit), Mai Ya (Barley Sprout), and Guang Pi (Tangerine Peel), claiming to release the muscle layer and digest food. Upon seeing phlegm-wheezing, they use Gun Tan Wan (Rolling Phlegm Pill), causing multiple bowel movements, which further knots the upper heat. Children have little grain intake and thin stomachs; bitter-pungent transformations dry them out, injuring stomach fluids. Using bitter-descending pills further damages Spleen-Stomach Yang harmony, suddenly transforming into incurable Startling Epilepsy. ○ Note: Feng Wen Lung disease is treated in the Upper Jiao. Wind-Warmth contraindicates sweating; early treatment should use acrid-cool methods. If mixed with digestive and dispersing agents, not only does it fail to address Lung disease, but it also exhausts stomach fluids. The Lung lacks fluids to supply upwards; head and eye orifices are steamed by heat, causing dry nose, closed eyes, upward staring without tears; or deep heat with cold limbs, mania, restlessness, and difficult urination. Chest fullness and rapid breathing are all signs of Lung Qi failing to disseminate and transform. At this time, if Lung herbs are slightly added with cooling-descending agents, preventing the medicinal force from rushing directly to the intestines, the upper obstruction can open, and orifices will clear. Unfortunately, incompetent doctors all claim Jie Xiong, mixing Qian Hu (Peucedanum Root), Gua Lou (Trichosanthes Fruit), Chai Hu (Bupleurum Root), and Zhi Shi (Immature Bitter Orange), using bitter-cold direct descent, causing greater closure, leading to many deaths. ○ Note: In the initial stage of this syndrome with fever, wheezing, and cough, first use acrid-cool methods to clear and purify the Upper Jiao, such as Bo He (Mint), Lian Qiao (Forsythia Fruit), Niu Bang Zi (Arctium Fruit), Xiang Bei Mu (Fritillaria Thunbergii Bulb), Sang Ye (Mulberry Leaf), Sha Shen (Glehnia Root), Zhi Ren (Gardenia Seed), Gua Lou Pi (Trichosanthes Peel), and Hua Fen (Trichosanthes Root). If the complexion is dark, heat is severe, and thirst is prominent, use Shi Gao (Gypsum) and Zhu Ye (Bamboo Leaf) for acrid-cold dispersion. If days pass and the pathogen is not resolved, Huang Qin (Scutellaria Root), Huang Lian (Coptis Rhizome), or Liang Ge San (Cooling Chest Powder) can be selected. If heat pathogen reversely transmits to the Dan Zhong (Chest Center), causing coma, closed eyes, absence of nasal discharge and tears, and closing of all orifices, the situation is critical, requiring Zhi Bao Dan (Treasure Pill) or Niu Huang Wan (Calculus Bovis Pill). For residual heat after illness, only sweet-cold methods to nourish Stomach Yin are sufficient. (From *Linzheng Zhinan*)
Summer Heat
For the Summer-Heat syndrome, ancients used Bai Hu Tang (White Tiger Decoction) as the main formula. Later scholars like Liu Hejian stated that warm-heat seasonal pathogens should be treated by dividing the Three Jiaos, primarily using bitter-acrid-cold methods. If one rigidly adheres to Six Meridian differentiation, it remains a Shanghan (Cold Damage) treatment method, leading to many errors. Cold contracted externally in Shanghan is treated via sweating; cold inhaled through mouth and nose is treated by warming the interior. Regarding pediatric summer-heat, current practice involves dispersing and digesting, adding Xiang Ru (Elsholtzia Herb) or Liu Yi San (Six-to-One Powder). However, Summer-Heat must combine with Dampness. Summer-Heat injairs Qi level, and Dampness also injairs Qi. Sweating consumes Qi and injairs Yang,劫 (robs) stomach fluids, leading to many complications. With the command of dispersal, the interior True Qi becomes deficient. Zhang Fengku said: Summer-Heat disease first uses acrid-cool, then sweet-cold, then sour-dispersing and sour-astringing; purgatives are unnecessary. This can be called concise and essential. (From *Linzheng Zhinan*)
Autumn Dryness
In deep autumn, initial coolness brings fever and cough in children, resembling Spring Wind-Warmth. But Warmth implies gradual heating, while Coolness implies gradual cooling. Diseases in Spring are remnants of Winter storage and consolidation; injuries in Autumn occur exactly after Summer heat dispersal. Although constitutions vary between deficiency and excess, Warmth is received from above, and Dryness injairs from above; the principle is equal, both affecting Lung Qi. People mistakenly recognize sudden wind-cold contraction, indiscriminately administering Three Yang dispersing agents. Fluids are robbed, Dryness becomes severe, leading to critical wheezing. If truly bound by sudden coolness externally, with fever, phlegm, and cough, Cong Chi Tang (Scallion and Fermented Soybean Decoction) or Su Geng (Perilla Stem), Qian Hu (Peucedanum Root), Xing Ren (Apricot Seed), Zhi Ke (Aurantium Fruit), and Jie Geng (Platycodon Root) for one or two doses is acceptable. Crude practitioners know Dryness-Heat causes disease, prescribing Xie Bai San (Drain White Powder) plus Huang Qin (Scutellaria Root) and Huang Lian (Coptis Rhizome), not knowing that bitterness increases Dryness, inevitably increasing other changes. One should use acrid-cool and sweet-moistening methods, and Dryness Qi will naturally level out. ○ Autumn Dryness syndrome affects the Qi level first; treating the Lung is urgent. If lingering for a long time, entering the Blood level, it cannot be treated with light-floating Lung herbs. One must examine constitution and syndrome origins. Ancients said treating diseases must be lively and flexible, like pearls rolling on a plate. (From *Linzheng Zhinan*)
Selected Cases
A child surnamed Weng, aged several months, suffered from Autumn Dryness, tidal fever, and malaria-like cough. Pediatric dispersing methods were ineffective; breastfeeding was hastily forbidden. A subsequent doctor used Xie Bai San (Drain White Powder) plus Huang Qin (Scutellaria Root) and Huang Lian (Coptis Rhizome). Day and night irritability and fever ensued, wheezing without cough, sticky diarrhea, and finally passing only medicinal water after dosing. I said: Infants rely on milk and food for life; hunger leads to empty Stomach and weak Qi, making the Lung even less comfortable. Therefore, I prescribed Yu Zhu (Polygonatum Odoratum Rhizome), Gan Cao (Licorice Root), Guang Pi (Tangerine Peel), and Zhu Ye Xin (Bamboo Leaf Heart). After one dose, heat eased. After two doses of Jing Mi (Rice), Nan Zao (Chinese Date), Gan Cao (Licorice Root), and Sha Shen (Glehnia Root), breastfeeding resumed. Instructed to hold upright and not lie down, he recovered fully in three days. (From *Linzheng Zhinan*)
Winter Cold
Sudden cold from late autumn to winter causes external injury and contraction, with fever, headache, body pain, vomiting, and nausea. Treatment follows the Taiyang Meridian. Wind injuring Wei (Defensive) uses Gui Zhi Fa (Cinnamon Twig Method); Cold injuring Ying (Nutritive) uses Ma Huang Fa (Ephedra Method). Children have loose muscles and sweat easily, unable to bear heavy exterior-releasing agents like Ma Huang (Ephedra) and Gui Zhi (Cinnamon Twig). Lighter agents like Zi Su (Perilla Leaf) and Fang Feng (Saposhnikovia Root) are used; for body pain, Qiang Huo (Notopterygium Rhizome) is used, but usually not exceeding one dose. Wind-cold injury is mostly Lung disease, using Qian Hu (Peucedanum Root), Xing Ren (Apricot Seed), Zhi Ke (Aurantium Fruit), and Jie Geng (Platycodon Root). Acrid superiority acts as a sweating agent. Cong Chi Tang (Scallion and Fermented Soybean Decoction) is a universal important formula. If limbs are cold with shivering, vomiting and spontaneous diarrhea, or no body heat, it is Interior Cold from Middle Cold, treated by dividing the Three Yin. However, pediatric Taiyang Middle Cold cases are common, with occasional Jueyin involvement. If winter should be cold but climate is warm, storing instead of releasing causes disease, named Dong Wen (Winter Warmth). Warmth is the gradual approach to heat, not a cold syndrome solvable by sweating. If involving one or two parts exterior pathogen, interior heat must account for seven or eight parts. This includes rashes and scarlet fever, not merely wind-cold paths. Or external pathogens clash with interior pathogens,郁 (stagnating) in meridians; or drinking rich flavors, interior heat is intense, and Wei does not harmonize with Ying; or improper Qi invades internally, causing abdominal pain and diarrhea. Treatment focuses on interior syndromes. Slightly combining clearing and dispersing; if acrid-warm agents are used, disaster follows immediately. (From *Linzheng Zhinan*)
Attached Formulas
Chai Hu Mei Lian San (Bupleurum, Sour Plum, and Coptis Powder): Chai Hu (Bupleurum Root) and Qian Hu (Peucedanum Root) 3 qian each, Hu Huang Lian (Coptis chinensis var. wenshanensis) and Wu Mei (Mume Fruit) 1 qian each. Crush the herbs. For each qian, decoct with one cup of boy’s urine, one piece of pig fat (Zhu Gao), one pig spinal cord, and half qian of leek root white. Decoct together, take warm at any time.
Shu Feng Yin Zi (Summer-Wind Drink): Treats Summer-Wind acute startling. Fang Feng (Saposhnikovia Root), Chai Hu (Bupleurum Root), Xiang Ru (Elsholtzia Herb), Lian Qiao (Forsythia Fruit), Chi Fu Ling (Red Poria), Ban Xia (Pinellia Tuber), Gou Teng Gou (Uncaria Ramulus cum Uncis), Shi Gao (Gypsum), Bian Dou Ye (Lablab Leaf), Gan Cao (Licorice Root). Increase Qiang Huo (Notopterygium Rhizome) if Wind predominates; add Huang Lian (Coptis Rhizome) if Heat predominates and tongue resembles a bayberry; add Mu Tong (Akebia Stem) if urination is difficult; add Xian Chang Pu (Acorus Tatarinowii Rhizome) if consciousness is lost.
Da Qing Gao (Great Blue Ointment): Treats wind-cold with vomiting and diarrhea. Qing Dai (Indigo Naturalis) and Tian Ma (Gastrodia Rhizome) 1 qian each, Zhu Sha (Cinnabar), Gan Xie (Dried Scorpion), and Bai Fu Zi (Typhonium Rhizome) 5 fen each, Tian Zhu Huang (Calculus Budae) and Wu Shao She Rou (Wagler’s Pit Viper Meat) 2 qian each, She Xiang (Musk) 2 fen. Grind each into fine powder, mix with honey to form ointment. Dissolve in Bo He Tang (Mint Decoction), take amount equivalent to a small bean.
Gou Teng Yin (Uncaria Drink): Ren Shen (Ginseng Root) and Xi Jiao (Rhinoceros Horn - *Note: Substitute with Niux Huang or other safe alternatives in modern practice, though text says Xi Jiao*) 5 fen each, Quan Xie (Full Scorpion) and Tian Ma (Gastrodia Rhizome) 2 fen each, Gan Cao (Licorice Root) 1 fen, Gou Teng (Uncaria Ramulus) 1 qian.
Chan Xie San (Cicada and Scorpion Powder): For slow startling, if Yang syndrome persists, use this formula. Chan Tui (Cicada Slough) 21 pieces, Quan Xie (Full Scorpion) 7 pieces, Nan Xing (Arisaema Cum Bile) 1 piece, Gan Cao (Licorice Root) 2.5 fen. Grind into powder. Take 1 qian per dose, decoct with Ginger and Jujube water.
Xing Pi San (Awaken Spleen Powder): Treats Spleen fatigue, drowsiness, continuous vomiting and diarrhea, gradually becoming slow startling. Ren Shen (Ginseng Root), Bai Zhu (Atractylodes Macrocephala Rhizome), Fu Ling (Poria), Gan Cao (Licorice Root), Bai Fu Zi (Typhonium Rhizome), Tian Ma (Gastrodia Rhizome), Jiang Can (Bombyx Batryticatus), and Mu Xiang (Aucklandia Root) 5 fen each, Quan Xie (Full Scorpion) 2.5 fen. Coarsely grind. Take 2 qian per dose, decoct with Ginger and Jujube water.
Wu Xie San (Black Scorpion Powder): Treats pure Yin syndrome of slow startling with continuous vomiting and diarrhea. Ren Shen (Ginseng Root), Bai Zhu (Atractylodes Macrocephala Rhizome), Fu Ling (Poria), Zhi Gan Cao (Honey-fried Licorice Root), Nan Xing (Arisaema Cum Bile), Chuan Wu (Sichuan Aconite), and Quan Xie (Full Scorpion). Coarsely chop and decoct together with Ginger and Jujube water.
Huang Tu Dao Hua Tang (Yellow Earth and Rice Flower Decoction): Treats Summer-Wind vomiting and diarrhea, impending slow startling. Huang Tu (Yellow Earth) 1 liang, Dao Hua (Rice Flower) 1 he, Ren Shen (Ginseng Root) 5 fen, Chen Pi (Tangerine Peel) 4 fen, Ban Xia (Pinellia Tuber) 5 fen, Fu Ling (Poria) 7 fen, Gan Cao (Licorice Root) 2 fen, Wu Mei Rou (Mume Fruit Flesh) 5 fen. Use fresh well water, stir Huang Tu (Yellow Earth), clarify, and decoct herbs. When decoction is ready, add Dao Hua (Rice Flower), boil a few more times, take warm. If Dao Hua (Rice Flower) is unavailable, substitute with Sheng Gu Ya (Raw Barley Sprout).
Hao Chong Wan (Green Worm Pill): Highly effective for acute startling. Zhu Sha (Cinnabar) and Qing Fen (Calomel) 1 qian each. Grind into fine powder. Take worms from inside green mugwort nodes, grind together, form pills the size of sesame seeds, dry in sun, store in porcelain jar. One pill per year of age, dissolve in human breast milk. (Harvest worms in early July; later they grow wings and fly away.)
Zi Shuang Wan (Purple Frost Pill): Treats startling and accumulation. Dai Zhe Shi (Hematitum) 2 qian, Xing Ren (Apricot Seed) 21 pieces, Ba Dou (Croton Seed) 21 kernels. Grind into powder, form pills the size of millet grains using rice paste. Take 5-7 pills per dose, wash down with decoction of Soap Bean Kernel.
Zhu Xin Tang (Pig Heart Decoction): Treats pediatric epilepsy. Use 1 qian of Gan Sui (Kansui Root) powder. One pig heart, sliced into two pieces. Insert Gan Sui powder inside, tie with thread, wrap in wet paper, simmer on low-medium heat until cooked. Take medicine, grind finely, mix with 1 qian of Chen Sha (Vermilion), blend evenly, divide into four pills. Take one pill per dose, dissolve in Pig Heart Decoction. Highly effective.
Zi He Che Wan (Purple River Carriage Pill): Treats congenital insufficiency and frequent epilepsy. One plump Zi He Che (Placenta Humanum), clean thoroughly, steam thoroughly in double boiler, grind, mix with Ren Shen (Ginseng Root) and Dang Gui (Angelica Sinensis Root) powders, blend evenly, form pills the size of Euryale Seed. Take 5-6 pills per dose, dissolve in breast milk.
Mo Yao (Massage Medicine): Treats pediatric Ke Wu (Alien Invasion). Use several he of Dou Chi (Fermented Soybean), mix with water to moisten, mash thoroughly, form pills the size of chicken egg. First massage infant’s fontanelle top and soles 5-6 times each; then massage chest and umbilicus. Massage for a meal’s duration. Break open pill; presence of fine hairs is the sign. Throw pill into the road; pain stops immediately.
Hua Huo Gao (Flame-Oil Ointment): Treats night crying. One lamp wick flower. Apply to nipple, instruct infant to suck.
Chan Hua San (Cicada-Flower Powder): Use lower half of Cicada Slough, grind into powder. Take one zi (approx. 0.5-1g), mix with Mint Decoction and a little wine. Crying stops immediately. If using upper half, crying recurs.
Bu Dai Wan (Cloth Bag Pill): Treats pediatric Ding Xi, Bu Lu, and Wu Gu Gan (Malnutrition syndromes). Ren Shen (Ginseng Root), Bai Zhu (Atractylodes Macrocephala Rhizome), Fu Ling (Poria), Gan Cao (Licorice Root), and Lu Hui (Aloe) 5 qian each, Ye Ming Sha (Silkworm Droppings), Shi Jun Zi (Quisqualis Seed), and Wu Yi (Chukrasia Tabularis Seed)