神庭(一穴入发际五分。)
百会(一穴在顶心。)
囟会(一穴在上星后一寸。)
长强(一穴在尾 端。)
上随意会相宜,灸炷如麦大,灸三壮即愈。
《类萃》云∶小儿伤寒与大人无异,所以异者,兼有夹食而已,其或有二证,某证
某方皆无越张、朱格例,特不过大小之分,剂中病则止。按仲景《伤寒论》云∶春气温和,夏
气暑热,秋气清凉,冬气冷冽,此四时正气之序也。惟冬时严寒,去寒就温,不致于伤。
偶然触冒,名为伤耳。若冬冒寒,伏藏于肌肤,而未即病,至春而发者,为之温病,至夏而
发者,为之热病。至此则冬伏寒随春夏之气改变,为病既久之后,不得复言其寒也。故曰∶
温病不恶寒者,其理可见矣。如春应暖而反寒,夏应热而反冷,秋应凉而反热,冬应寒而反温,
非其时而有其气,此四时乖戾之气也。偶即中伤,谓之时气,又与伤寒不同。若小儿在襁
褓中,或长成而禀赋怯弱,多因乳母解脱衣服不避风寒所致也。然小儿患此,口不能言其致病
之由,脉不能诊其必然之理,但只烦啼发热而已,故不可不尽心焉。初得之时,婴幼则以虎
口三关脉纹红色验之。长而童稚,则以一指按其三部,据左手脉之紧盛而断之,其喘急憎寒
心气热,呵欠顿闷项急者,是也。其恶寒恶风必畏入藏身,引衣密隐,是为表证。恶热内实
者,必出头露面,扬手踯足,烦渴燥粪,掀衣气粗,是为里证。至若头额冷汗,手足凉,口冷
气,面色黑暗淡,大便泻青,此为阴证,视其小便或赤或白,可以知里热之有无,或清或浊,
可以知里之轻重。举是观之,则汗下清温之法可类推矣。
神庭穴(位于前发际正中直上五分处。)
百会穴(位于头顶正中央。)
囟会穴(位于上星穴后方一寸处。)
长强穴(位于尾骨端。)
施灸时应顺应病情取穴,艾炷大小如麦粒,每穴灸三壮即可痊愈。
《类萃》记载:小儿患伤寒与成人没有本质区别,不同之处在于小儿常兼夹食积。若出现两种证候,无论何种证型、使用何方,都不超出张仲景、朱丹溪的规范法则,仅仅只是剂量大小的差异,药力中病即止。根据张仲景《伤寒论》所述:春季气候温和,夏季气候暑热,秋季气候清凉,冬季气候寒冷刺骨,这是四季正常的气候顺序。只有在冬季严寒时,人们远离寒冷、趋向温暖,就不会导致疾病。若是偶然受风寒侵袭,才称为“伤”。如果在冬季感受寒邪,寒气潜伏在肌肤之间,当时并未发病,到了春季发作的,称为温病;到了夏季发作的,称为热病。到了这个时候,冬季潜伏的寒邪随着春夏季节的气候变化而转化,患病时间既久之后,就不能再称之为寒病了。所以说:温病患者不恶寒,其道理就在这里。如果春天本该温暖却反而寒冷,夏天本该炎热却反而凉爽,秋天本该凉快却反而炎热,冬天本该寒冷却反而温暖,这种非其时而有其气的现象,称为四时乖戾之气。偶然受到这种邪气侵袭,称为时气,这与伤寒又有所不同。如果小儿在襁褓之中,或者长大后禀赋虚弱,多是因为乳母解开衣物时不注意避风寒所导致的。然而小儿患病,口不能说出致病的原因,脉象也不能完全诊断出其必然的道理,只是表现为烦躁啼哭和发热而已,所以医生不可不尽心诊治。刚患病时,对于婴幼儿通过观察虎口三关脉纹的颜色为红色来验证。对于稍长的儿童,用一根手指按压寸、关、尺三部脉,依据左手脉象紧盛来判断,伴有气喘急促、憎恨寒冷、心气热、打哈欠、突然胸闷、颈部僵硬等症状的,就是伤寒。那些厌恶寒冷、厌恶风邪,必定害怕进入室内身体蜷缩,拉紧衣服严密遮盖的,属于表证。厌恶炎热、体内实热的,必定喜欢把头脸伸出被外,挥手踢脚,烦躁口渴,大便干燥,掀开衣服呼吸粗重,属于里证。至于额头出冷汗,手脚冰凉,口中呼出冷气,面色晦暗淡白,大便泻下青色稀便,这属于阴证。观察小便颜色或红或白,可以知道体内是否有热;观察小便清亮或浑浊,可以知道里证的轻重程度。通过以上观察,那么发汗、攻下、清热、温中等治疗方法就可以类推了。
Shenting (EX-HN2, located 0.5 cun above the anterior hairline on the midline.)
Baihui (GV20, located at the apex of the head.)
Xinhui (GV22, located 1 cun posterior to Shangxing GV23.)
Changqiang (GV1, located at the tip of the coccyx.)
Moxibustion should be applied according to appropriate acupoint selection; use moxa cones the size of a wheat grain, three moxa cones per acupoint will result in cure.
*Leicui* states: Pediatric Shanghan (Cold Damage) is no different from that in adults; the only difference lies in the frequent co-occurrence of food stagnation. Regardless of whether one or two syndromes are present, neither the syndrome differentiation nor the prescription exceeds the principles established by Zhang Zhongjing and Zhu Danxi; the distinction is merely in dosage magnitude. Treatment should cease once the medicine targets the pathogen. According to Zhang Zhongjing's *Shanghan Lun*: The Qi of spring is mild and harmonious; the Qi of summer is hot and sultry; the Qi of autumn is cool and clear; the Qi of winter is cold and piercing. This constitutes the normal sequence of the four seasons. Only during the severe cold of winter, if one avoids cold and seeks warmth, will illness not occur. If one accidentally contracts wind-cold, it is termed "Shang" (Injury). If cold is contracted in winter but latent in the skin and muscles without immediate onset, and manifests in spring, it is called Wenbing (Warm Disease); if it manifests in summer, it is called Rebing (Heat Disease). By this time, the winter-latent cold has transformed with the Qi of spring and summer; after the disease has persisted for some time, it can no longer be referred to as cold. Thus, it is said: Patients with Warm Disease do not exhibit aversion to cold, which clarifies the rationale. If spring should be warm but is instead cold; summer should be hot but is instead cool; autumn should be cool but is instead hot; winter should be cold but is instead warm—this phenomenon where the season does not match the climate is termed the chaotic Qi of the four seasons. Accidental contraction of this pathogen is termed Shiqi (Seasonal Pathogen), which differs from Shanghan. If infants in swaddling clothes, or older children with congenital weakness, contract this due to their wet nurses exposing themselves to wind and cold without protection, it occurs. However, when children suffer from this, they cannot verbally describe the cause of illness, and pulse diagnosis alone cannot fully reveal the inevitable pathology; they simply manifest irritability, crying, and fever. Therefore, physicians must exert utmost care. Upon initial onset, for infants, redness of the pulse pattern at the Three Passages of the Tiger's Mouth is used for verification. For older toddlers, palpating the Cun, Guan, and Chi positions with one finger, judging based on the tight and vigorous pulse on the left hand, accompanied by panting, aversion to cold, heart Qi heat, yawning, sudden chest stuffiness, and neck stiffness, indicates the condition. Those who fear cold and wind, preferring to hide indoors, curl up, and tightly cover themselves with clothes, present a Biao Syndrome (Exterior Syndrome). Those who fear heat and have interior excess, preferring to expose their heads and faces, wave hands and kick feet, feel irritable and thirsty, have dry stools, push away covers, and breathe heavily, present a Li Syndrome (Interior Syndrome). Regarding cases with cold sweat on the forehead and temples, cold limbs, cold breath, dark and pale complexion, and green watery diarrhea, these constitute Yin Syndromes. Observing whether urine is red or white reveals the presence or absence of interior heat; observing whether urine is clear or turbid reveals the severity of the interior condition. From these observations, methods such as sweating, purging, clearing heat, and warming can be inferred by analogy.