大凡治病,药用根据时,方随病制;寒热温凉,性各不一;宣通补泻,贵乎得宜。恒存济人、博爱之心,乐人之乐,
忧人之忧,则药无不效灵矣。谨附凡例九则∶
一、辨风土
如北方凛冽,药宜辛热;两广烟瘴,解毒为先;云贵高暖,清凉取胜,江南亦然;江北则地卑多湿,辛温是主。推
之九州风气而用药,罔不效者。
一、按时令
春季则以升阳散火,加以辛温;夏则清暑益气,济以清凉;秋当肃杀之时,清金去燥;冬则闭藏之候,药宜辛热。
故曰∶必先岁气,毋伐天和,此之谓也。
一、守经
幼科诸症,治惊最难。大率琥珀抱龙丸、紫金锭、睡惊丸、利惊丸、利惊丹,俱皆良剂。痰甚,玉芝丸、白玉饼、
牛黄八宝散、牛黄丸、蝎梢饼,皆治惊之要药也。审症而投,无有不效。非经验者不赘。
一、用权
凡用药当从王道之剂,即有偶尔不效,不至伤人。若附子、蜈蚣、全蝎诸有毒之药,不可浪用。药不投症,害儿不
浅。如慢惊,诸药不效,不得已而用之,亦当斟酌,中病则已。如金石之药,取以镇惊安神,多服令儿痴呆。麝香、冰
片,用以通窍,多服返泄真元。巴豆有定祸乱而致太平之功,非制得法,返受其害矣,举此为例,则诸毒药之可知。凡
用毒剂,以甘草煎引佐之则善矣。
一、芽儿当下即下
儿初生落地取迟,口吃恶秽内蓄,腹胀不乳,亦似脐风;或乳少以食哺儿,或乳多,又将饼食哺儿;又有将柿饼黑
枣哺儿者,芽儿无知,任彼喂之,开口便纳。幼年之妇,见儿肯吃,喜而喂之不已。余目击种种,庶不知芽儿初生,肠
胃脆薄,此物日积,何能克化,以致肚腹膨胀,呕吐发热,诸疾生矣。病家昧而不言,医者不知,苟不察而用诸惊之药,
大谬之甚,欲求病愈可乎!宜感应丸如菜子大七八丸和平胃丸少许,生姜紫苏甘草汤下。出月者加五六丸。凡遇此症宜
即下,食消而病愈。此良法也。况小儿纯阳之体,即下未必便虚,失下迟延,日久病日甚,痞块内作,多致不救。
禁挑筋论
一、夫小儿两手虎口风、气、命三关,即大人两手寸关尺之脉也。左辩心肝之理,右察脾肺之情。有诸内,故形见
于纹,视形察色,以验病症,以决死生,非细故也。余郡原无此术,祸于罗平野。古有小儿推拿法,村落无医,用此法
援一时之急耳。以姜葱擦印堂虎口,摩擦肚腹上,藉葱姜之力,开通毛孔,取微汗即愈。平野术且不精,儿罗害多矣。
平野死,但在通郡教书者俱云∶平暴投授,又变而为挑筋之说,真胡说可笑之极。若虎口三关筋可挑,必有传授之书可
据,出于黄帝素问乎?出于历代明医乎?出何经典乎?病家昧而不知,恣行无惮,视儿为奇货,反构索谢仪,所为惑世
巫民,深为可恨。小儿疾三间虎口筋可挑,则大人有疾,寸关尺之筋亦可挑乎?凡针灸必看人神所在,挑筋者谅不知此,
岂顾人神所在乎!如值之,儿受祸岂浅浅耶。筋有大络小络,各有定数,容易可挑断耶。此术不禁,则流漫不已,俟道
中高明正之。筋断纹绝,儿有疾何凭治之?
一、儿初落地,稳婆即将砭针割舌下筋,致血淋漓,以墨涂之,因而口害,畏痛不乳。余甚不忍,问之何意?彼云∶
不割,儿长大舌强语言不利。生此孟浪之言,未割者多未常见语言不利,乡村之间,那得稳婆?执此可破,不该刀刺明
矣。
落地受惊论
一、儿初生,稳婆将儿地上滚转数遍。彼言∶如此儿胆大不惧惊吓。愚人听从行之。殊不知儿初脱胞,从暧处来,
芽儿落地,便知惊吓,随时变惊者有之,脐风撮口者有之。夏月犹可,冬月冒寒。肺主皮毛,喜温恶寒,致儿咳嗽喘急
者有之。寒伤肾,肾先着之,偏坠疝气者有之,寒气入腹,皮鳞骨瘠、腹中冷痛者有之。种种他症,如胶入漆牢不可解。
好好芽儿无辜受害,啮脐何及。
小儿禁洗浴
一、儿初生,将猪胆汁洗浴,令肤细腻,且无疮疥。如无,用软绢轻轻洗之,其白垢自退。每见稳婆将肥皂洗儿头
面,抹入眼中,致目日久不开,因害成瞽有之;且令皮肤粗涩,亦不可频洗,泄儿元气或伤脐带,脐疮终身痼疾矣。
大凡治病,用药要根据时令气候,方剂要随病症制定;药物的寒热温凉性质各不相同,宣通、补泻等治法贵在运用得当。常怀救世济人、博爱众生的心,以他人的快乐为快乐,以他人的忧愁为忧愁,那么药物就没有不灵验的。谨附上九条凡例:
一、辨别风土差异
如北方气候凛冽寒冷,用药宜用辛热之品;两广地区烟雾瘴气重,以解毒为先;云贵地区高亢温暖,以清凉取胜,江南地区也是如此;江北地区地势低洼多湿,以辛温为主。推究九州各地的气候风气而用药,没有不有效的。
二、顺应时令变化
春季应当升发阳气、疏散郁火,配合辛温药物;夏季应当清解暑热、益气生津,辅以清凉药物;秋季处于肃杀之时,应清肺金、去燥邪;冬季处于闭藏之时,用药宜辛热。所以说:必须首先了解当年的岁气,不要损伤人体的自然生机,说的就是这个道理。
三、坚守经典理论
儿科各种病症中,治疗惊风最难。大致而言,琥珀抱龙丸、紫金锭、睡惊丸、利惊丸、利惊丹,都是良方。痰湿很重的,玉芝丸、白玉饼、牛黄八宝散、牛黄丸、蝎梢饼,都是治疗惊风的要药。仔细审察病症后投药,没有不生效的。不是经验之谈就不赘述了。
四、懂得权变灵活
凡是用药应当遵循“王道”平和的方剂,即使偶尔不效,也不会伤害人体。像附子、蜈蚣、全蝎这些有毒的药物,不可随意滥用。药不对症,对婴儿的伤害不小。如果是慢惊风,诸药无效,不得已才使用,也应当斟酌,病愈就停止。像金石类药物,用来镇惊安神,多服会让婴儿痴呆。麝香、冰片,用来开窍,多服反而耗泄真元。巴豆有平定祸乱、致太平的功效,如果不是炮制得法,反而会受其害。举此为例,其他毒药的情况也就知道了。凡是使用毒剂,用甘草煎汤作为引经佐使之药,效果就好。
五、婴儿积滞当下即下
婴儿刚出生落地时取用(指处理或喂养)迟缓,口中吞入污秽之物蓄积在内,导致腹胀不吃奶,也像是脐风;或者母乳少用食物哺喂婴儿,或者母乳多,又将饼食哺喂婴儿;又有将柿饼、黑枣哺喂婴儿的,婴儿无知,任由大人喂食,一开口就吞咽。年幼的母亲,见孩子肯吃,高兴而不停地喂。我亲眼目睹种种情况,实在不知道婴儿初生,肠胃脆薄,这些东西日积月累,怎么能消化得了,以致肚腹膨胀,呕吐发热,各种疾病就产生了。病人家属愚昧不说,医生不了解,如果不仔细考察而用治惊的药物,错误极大,想要病愈怎么可能!适宜用感应丸如菜籽大小七八丸和平胃丸少许,生姜紫苏甘草汤送下。满月后的婴儿加五六丸。凡是遇到这种情况应当立即通便,食消则病愈。这是好方法。何况小儿是纯阳之体,即使通便未必就会虚弱,如果延误时机,日久病势加重,痞块在体内形成,多导致无法救治。
禁挑筋论
一、小儿两手虎口的风、气、命三关,就是大人两手寸、关、尺三部脉象。左手可以辨析心肝的道理,右手可以察知脾肺的情况。内部有病,所以表现在纹路颜色上,观察形态色泽,来验证病症,决断生死,这不是小事。我所在郡县原本没有这种技术,祸患始于罗平野。古代有小儿推拿法,村落无医,用这种方法缓解一时之急罢了。用姜葱擦拭印堂和虎口,摩擦肚腹,借助葱姜的力量,开通毛孔,出微汗就好了。罗平野的技术并不精湛,害了不少孩子。罗平野死后,只是在通郡教书的人都声称:罗平野突然传授,又演变为挑筋的说法,真是胡说可笑至极。如果虎口三关的筋可以挑断,必定有传授的书本依据,出自《黄帝素问》吗?出自历代名医吗?出自哪部经典呢?病人家属愚昧不知,肆意施行无所忌惮,把婴儿当作奇货可居,反而索取谢礼,这种行为惑世巫民,深为可恨。小儿疾病如果在虎口三关挑筋,那么大人有病,寸关尺的筋也可以挑吗?凡是针灸必看“人神”所在之处,挑筋的人想必不知道这个,难道不顾“人神”所在吗!如果遇到禁忌部位,婴儿遭受的祸害岂止轻微。筋有大络小络,各有固定数量,容易挑断吗?这种技术不禁止,就会流布蔓延不止,等待道中高明之士纠正。筋断纹绝,婴儿有病靠什么来诊治?
一、婴儿刚出生,稳婆就用砭针刺割舌下的筋,导致血流淋漓,用墨汁涂抹,因而口腔疼痛,畏惧疼痛不肯吃奶。我很不忍心,问这是什么意思?她们说:不割,孩子长大后舌头僵硬语言不利。生出这样鲁莽的话,没割的孩子大多也没常见到语言不利,乡村之间,哪里来的稳婆?凭这一点就可以破除迷信,不该用刀刺割是显而易见的。
落地受惊论
一、婴儿刚出生,稳婆将婴儿在地上滚转几遍。她们说:这样做孩子胆大不怕惊吓。愚笨的人听从并实行。却不知道婴儿刚脱离母体,从温暖的地方出来,婴儿落地,就知道惊吓,随时发生惊风的有之,发生脐风撮口的有之。夏季还可以,冬季冒着寒气。肺主皮毛,喜欢温暖厌恶寒冷,导致婴儿咳嗽喘急的有之。寒气伤肾,肾先受邪,发生偏坠疝气的有之,寒气入腹,皮肤鳞屑骨骼消瘦、腹中冷痛的有之。种种其他病症,像胶入漆牢一样不可解脱。好好的婴儿无辜受害,咬破脐带都来不及补救。
小儿禁洗浴
一、婴儿刚出生,用猪胆汁洗浴,使皮肤细腻,且无疮疥。如果没有,用软绢轻轻擦洗,其白垢自然退去。每见稳婆用肥皂洗婴儿头面,抹入眼中,导致眼睛日久不开,因害而成盲的有之;而且令皮肤粗糙干燥,也不可频繁清洗,会泄掉婴儿元气或伤及脐带,导致脐疮成为终身顽疾。
Generally speaking, in treating diseases, the use of medicines must be based on the seasonal climate, and prescriptions should be formulated according to the disease; the properties of cold, heat, warm, and cool are all different, and methods such as dispersing, unblocking, tonifying, and purging are most appropriate when applied correctly. One should always harbor a heart for saving people and universal love, finding joy in others' joy and sorrow in others' sorrow, then there will be no medicine that is not effective. Hereby, nine general rules are attached:
1. Distinguishing Local Environments
For example, in the North where the climate is biting and cold, medicinal herbs should be acrid and hot; in Liangguang (Guangdong and Guangxi) regions with smoky miasma, detoxification comes first; in Yunnan and Guizhou, which are high and warm, cooling agents prevail, and the same applies to Jiangnan; in Jiangbei, where the terrain is low and dampness is prevalent, acrid and warm substances are primary. By inferring the wind and qi of the Nine Provinces to prescribe medication, efficacy is invariably achieved.
2. Adhering to Seasonal Changes
In spring, one should raise yang and disperse fire, adding acrid-warm herbs; in summer, clear summerheat and benefit qi, assisted by cooling herbs; in autumn, during the time of肃杀 (severe/clearing), clear Metal and remove dryness; in winter, during the time of closure and storage, medications should be acrid and hot. Thus it is said: "One must first know the annual qi, and not damage the natural harmony," which refers to this principle.
3. Upholding Classical Theory
Among pediatric syndromes, treating fright (Jing) is the most difficult. Generally speaking, Hupo Baolong Wan (Amber Embracing Dragon Pill), Zijin Ding (Purple Gold Ingot), Shuijing Wan (Sleep Fright Pill), Lijing Wan (Relieve Fright Pill), and Lijing Dan (Relieve Fright Pellet) are all excellent preparations. For severe phlegm, Yuzhi Wan (Jade Fruit Pill), Baiyu Bing (White Jade Cake), Niuhuang Babao San (Calculus Bovis Eight-Treasure Powder), Niuhuang Wan (Calculus Bovis Pill), and Xieshao Bing (Scorpion Tip Cake) are all essential medicines for treating fright. Prescribing after careful syndrome differentiation yields no ineffectiveness. Non-experiential claims are not elaborated upon.
4. Exercising Discretion
Medications should generally follow "Kingly Way" (Wangdao) gentle formulas; even if occasionally ineffective, they do not harm the body. Toxic herbs such as Fuzi (Aconite Lateral Root), Wugong (Scolopendra), and Quanxie (Scorpio) should not be used recklessly. If the medicine does not match the syndrome, the harm to the child is profound. In cases of slow fright (Man Jing) where other medicines fail, if one must use them, discretion is required, and usage should cease once the disease is cured. Minerals and metals used to settle fright and calm the spirit, if taken in excess, cause children to become dull. She Xiang (Musk) and Bing Pian (Borneol), used to open orifices, if taken in excess, deplete true yuan. Radix Crotonis Fructus (Badou, Castor Bean Seed) has the merit of pacifying chaos and bringing peace, but if not processed correctly, it causes harm instead. Taking this as an example, the nature of other toxic drugs can be understood. Whenever using toxic agents, decocting Licorice Root (Gancao, Glycyrrhizae Radix et Rhizoma) as a guide and assistant improves safety.
5. Immediate Purgation for Infant Accumulation
If an infant is delayed in being handled after birth, foul matter accumulates in the mouth, causing abdominal distension and refusal to nurse, resembling Umbilical Wind (Qifeng); or if breast milk is insufficient and food is fed, or if there is excessive milk and cakes are also fed; or if dried persimmon cakes and black dates are fed, infants, lacking knowledge, swallow whatever is offered. Young mothers, seeing the child willing to eat, happily feed incessantly. I have witnessed various situations, unaware that newborns have fragile and thin intestines and stomachs; how can accumulated food be digested day by day? This leads to abdominal distension, vomiting, fever, and the onset of various diseases. Families remain ignorant and silent, and doctors may not realize it. If one fails to investigate and uses anti-fright medicines, the error is extreme; recovery would be impossible. It is suitable to use Yinggan Wan (Response Pill) sized like rapeseed seeds, 7-8 pills, along with a small amount of Pingwei Wan (Calm the Stomach Pill), taken down with a decoction of Fresh Ginger (Shengjiang, Zingiberis Rhizoma Recens), Perilla Leaf (Zisu, Perillae Folium), and Licorice Root (Gancao, Glycyrrhizae Radix et Rhizoma). For infants over one month old, add 5-6 pills. Whenever encountering this syndrome, immediate purgation is recommended; once food digestion occurs, the disease resolves. This is a good method. Moreover, since children possess a "Pure Yang" constitution, purgation does not necessarily cause deficiency; delaying purgation allows the disease to worsen over time, forming masses internally, often leading to untreatable conditions.
Prohibition of Tendon Cutting Theory
1. The Wind, Qi, and Life three gates at the tiger's mouth of both hands in children correspond to the Cun, Guan, and Chi pulses of adults. The left side discerns the principles of Heart and Liver, while the right side observes the condition of Spleen and Lung. Internal pathology manifests externally in the lines; observing form and color verifies syndromes and determines life or death, which is no trivial matter. My jurisdiction originally had no such technique; the disaster began with Luo Pingye. Anciently, there was a pediatric massage method used in villages without doctors to relieve temporary emergencies. Rubbing forehead (Yintang, Ex-HN14) and tiger's mouth with ginger and scallion, and rubbing the abdomen, utilizes the power of ginger and scallion to open pores and induce slight sweating for cure. Luo Pingye's skills were not refined, causing much harm to children. After Luo Pingye's death, teachers in Tong Commandery claimed he suddenly transmitted the method, which evolved into the tendon-cutting theory. This is truly absurd and laughable. If the tendons of the three gates at the tiger's mouth can be cut, there must be a transmitted book as evidence. Does it come from the Huangdi Suwen (Yellow Emperor's Inner Canon)? From famous doctors of past dynasties? From which classic? Families are ignorant and act recklessly, treating children as commodities and demanding fees. Such bewitchment of the world and deception of people is detestable. If tendons at the tiger's mouth can be cut for pediatric diseases, can the tendons at Cun, Guan, and Chi be cut for adult diseases? Acupuncture requires knowing the location of "Ren Shen" (Human Spirit/Taboo Points); those cutting tendons likely do not know this, ignoring the location of Ren Shen! If encountered, the disaster suffered by the child would not be slight. Tendons have major and minor collaterals with fixed numbers; are they easily cut? If this technique is not banned, it will spread endlessly, awaiting correction by superior experts in the Dao. If tendons are cut and lines destroyed, how can childhood diseases be treated?
1. When infants are born, midwives use Bianzhen (stone needles) to cut the tendons under the tongue, causing bleeding, and apply ink. This results in oral pain and fear of nursing due to pain. I could not bear this and asked for the reason. They said: "If not cut, the child will have a stiff tongue and speech difficulties when grown." Such reckless statements are baseless; most uncuted children do not show speech difficulties. Where do midwives come from in rural areas? This alone refutes the practice; knife incision is clearly inappropriate.
Theory of Shock Upon Birth
1. When infants are born, midwives roll them on the ground several times, claiming this makes the child brave and fearless of fright. Foolish people obey and practice this. They do not know that infants just leaving the womb come from a warm environment; touching the ground causes fright, leading to sudden fright syndromes or Umbilical Wind with mouth contraction. Summer is tolerable, but winter exposes them to cold. The Lung governs skin and hair, preferring warmth and hating cold, leading to cough and wheezing. Cold injures the Kidney, which is affected first, causing hernia and testicular swelling. Cold qi entering the abdomen causes scaly skin, emaciation, and cold abdominal pain. Various other syndromes become inseparable like glue in lacquer. Innocent infants suffer harm undeservedly; it is too late to bite the umbilicus to remedy it.
Prohibition of Bathing for Children
1. Upon birth, infants are bathed with pig bile to make skin delicate and free from sores. If unavailable, gently wash with soft silk cloth, and white residue will naturally fade. I often see midwives washing infants' heads and faces with soap, getting it into the eyes, causing eyes to remain closed for days, resulting in blindness; it also makes skin rough and dry. Frequent bathing should be avoided as it leaks the child's Yuan Qi or damages the umbilical cord, leading to umbilical ulcers becoming lifelong chronic diseases.