小儿疮疹候偏多,咳嗽痰涎作久 ;热候心神如怕物,惊时羊眼白翻波。认目看灯睛有
焰,吐来气逆入相磨。十岁梦中如发搐,唇红脸赤疏交罗。汤水心烦头满热,耳冷脚冷发无
过;舌上有如粟米样,定知三日发交瘥。此病未来宜早疗,莫将凉药与伊芳摩;细辨形证为妙
用,只将平药以调和。
刘氏云∶初虞世所着《必用方》,大有益于世。惟疮疹去当转下,误人甚多。缘方宜不
同,所禀虚实有异故也。盖小儿疮疹转泻则内虚,毒瓦斯不能运出,复攻于里,陷伏多致夭伤
。张氏论用药, 疮疹服惺惺散,次服人参羌活散等。如壮热未退,切不可通利大便,及温
热药,恐令疮疹不出。二人之论,与初虞世之论,皆未可执,须在临时可温则温,可下则下
,皆有可温可下证,别具详之矣,学人宜通变用之可也。
发热证候多般,疮疹亦发热也。其体热则同,所得之由不同,须引证而辨明之则各异。
发热如疟状,热作有时者,名潮热;发热饮食不减者,名风热;发热而头热肚热,右额有纹
者,名食热;发热而多渴,渴则泻者,名疳热;发热唇上下汗出,唇中间起一白 子,及耳
阴皆冷者,名变蒸;发热而额正中发际有青纹,下至眉心则发惊者,名惊热,发热而皮肤或
赤色热痛,时时啼叫者,名丹热;发热目闭面赤色者,名胎热;发热而面赤汗出,而鼻流清
涕,左额有青筋纹者,名伤风热,发热而面色青惨,耳鼻冷,恶寒无汗,亦左额有青筋,手
足厥冷者,此名伤寒热也。又有变蒸之中,偶有时行寒疫者,则耳与阴反热。若疮疹发热则
不同,然呵欠顿闷,时发惊悸,乍凉乍热,手足时冷,面目腮颊赤嗽嚏者,此皆疮疹之热证
也。
小儿患疮疹的征候偏多,咳嗽且痰涎增多持续时间较长;热象明显时心神不安,仿佛害怕异物,惊厥发作时眼球上翻,露出眼白如羊眼状。观察眼睛看灯时瞳孔中有火焰般的光焰,呕吐时气逆向上相互冲撞磨激。十岁左右的孩子在睡梦中如同发生抽搐,嘴唇红润、脸颊赤红,脉络交错分布。喝汤水时心烦意乱,头部胀满发热,耳朵和脚部发冷,发热没有规律可循;舌面上出现像粟米大小的颗粒,断定三天后病情就会好转痊愈。此病尚未发作时应尽早治疗,不要将寒凉药物涂抹其身;仔细辨别形体证候为妙用,只使用平和的药物来调和身体。
刘氏说:初虞世所著的《必用方》,对世人大有益处。只有疮疹应当通过攻下法去除邪气,这种观点误人甚多。因为方剂适宜与否不同,孩子先天禀赋的虚实情况有差异的缘故。大概小儿疮疹如果转为腹泻则体内虚弱,毒瓦斯不能排出体外,反而攻冲于体内,陷入伏匿,多导致夭折伤亡。张氏论述用药,认为疮疹服用惺惺散,接着服用人参羌活散等。如果壮热未退,切不可通利大便,以及使用温热药,恐怕导致疮疹发不出来。这两人的论述,与初虞世的论述,都不可固执拘泥,必须在临证时该温补就温补,该攻下就攻下,都有可温可下的证候,另外详细阐述过了,学习的人应该灵活变通地使用即可。
发热证候多种多样,疮疹也会发热。其身体发热的表现相同,但得病的原因不同,必须结合其他证候来辨析明确,则各不相同。发热像疟疾一样,定时发作的,名叫潮热;发热而饮食不减少的,名叫风热;发热而头部和腹部发热,右额角有纹路的,名叫食热;发热而口渴严重,口渴则腹泻的,名叫疳热;发热而嘴唇上下出汗,嘴唇中间起一个白点,以及耳道内部都发冷的,名叫变蒸;发热而额头正中发际处有青色纹路,下行至眉心则引发惊悸的,名叫惊热;发热而皮肤或呈红色且热痛,时时啼叫的,名叫丹热;发热而眼睛闭合、面色赤红的,名叫胎热;发热而面色赤红出汗,且鼻流清涕,左额角有青色筋纹的,名叫伤风热;发热而面色青惨,耳鼻发冷,恶寒无汗,也左额角有青色筋脉,手脚冰冷的,这名叫伤寒热。又有在变蒸期间,偶尔遇到时行寒疫的,则耳朵和阴部反而发热。若疮疹发热则不同,然而呵欠连天、神情困顿闷乱,时常发生惊悸,忽冷忽热,手脚时而冰冷,面目腮颊发红、咳嗽打喷嚏的,这些都是疮疹的热证表现。
Pediatric variola (smallpox) and rashes present with numerous signs, including prolonged coughing and increased phlegm; when heat patterns are prominent, the mind and spirit are restless as if fearing objects, and during convulsions, the eyes roll upward revealing the whites like those of a sheep. Observing the eyes while looking at a lamp reveals flame-like glints in the pupils; vomiting is accompanied by rebellious Qi clashing internally. Around ten years of age, children may experience seizures during sleep; lips are red, cheeks are crimson, and meridians are interlaced. Drinking soup or water causes mental restlessness and head fullness with heat; ears and feet are cold, and fever occurs without regularity; granules resembling millet seeds appear on the tongue, indicating that recovery will occur within three days. Before this disease manifests, early treatment is advisable; do not apply cooling medicines to the child. It is best to carefully distinguish the physical signs and symptoms, using only mild medicines to harmonize the body.
Mr. Liu stated: Chu Yushi's *Bi Yong Fang* (Must-Have Prescriptions) is highly beneficial to the world. However, his assertion that rashes should be treated by purging downward has misled many. This is because the appropriateness of prescriptions varies, and children's innate constitution differs in terms of deficiency and excess. Generally, if pediatric rashes lead to diarrhea, the interior becomes deficient, preventing toxic factors from being expelled outward; instead, they attack the interior, becoming trapped and latent, often resulting in premature death. Mr. Zhang discussed medication, stating that for rashes, one should administer Xingxing San (Stupefying Powder), followed by Renshen Qianghuo San (Ginseng and Notopterygium Decoction). If high fever persists, one must absolutely avoid purgatives and warm-hot medicines, lest they prevent the rash from erupting. Neither Zhang's nor Chu Yushi's theories should be rigidly adhered to; rather, one must apply warming or purging methods according to the specific indications present at the time of diagnosis, which have been detailed elsewhere. Practitioners should apply these principles flexibly.
Fever presents in various forms, and rashes also cause fever. While the bodily heat is similar, the etiology differs; thus, one must analyze accompanying signs to differentiate them accurately. Fever resembling malaria with periodic onset is called tidal fever (Chao Re); fever where appetite remains unchanged is called wind-heat (Feng Re); fever accompanied by heat in the head and abdomen, with lines on the right forehead, is called food-heat (Shi Re); fever with excessive thirst leading to diarrhea is called gan-heat (Gan Re); fever with sweating around the upper and lower lips, a white spot appearing in the center of the lips, and coldness in the ear canals is called bianzheng (developmental fever); fever with blue lines at the hairline on the center of the forehead extending to the glabella, triggering palpitations, is called fright-heat (Jing Re); fever with reddish, painful skin and frequent crying is called dan-re (erysipelas-heat); fever with closed eyes and a red face is called fetal-heat (Tai Re); fever with a red face, sweating, clear nasal discharge, and blue veins on the left forehead is called wind-cold-heat (Shang Feng Re); fever with a sallow-green complexion, cold nose and ears, aversion to cold, absence of sweat, blue veins on the left forehead, and cold extremities is called shaoyang-cold-heat (Shang Han Re). Additionally, during bianzheng, if an epidemic cold pathogen is encountered, the ears and genitals may become hot. In contrast, rash-related fever presents differently: yawning, lethargy, occasional palpitations, alternating chills and fever, intermittent cold extremities, redness of the face and cheeks, coughing, and sneezing are all characteristic heat signs of rashes.