小儿虚羸者。由诸病之后。或误行转药。或吐而痢。致脾胃虚弱。不能传化谷气。饮食不入。肌肤消瘦。乃
成虚羸也。有冷者时时下痢。唇口青白。有热者身体温壮。肌肉微黄。此冷热虚羸也。钱乙治冷者木香丸。夏月
不可服。如有证则少服之。治热者胡黄连丸。冬月不可服。如有证则少服之。昔钱乙治齐郎中。其人好收药散
施。有子忽患藏热。齐自取青金膏三服并一服饵之。服毕。至三更泻五行。其子困睡。齐言子睡多生惊。又与一
服。再泻数行。加口干而身热。齐言尚有其热。又欲与青金膏。其妻曰。用药泻十来行未安。莫生他病否。召乙
看之。乙曰。已成虚羸也。先多煎白术散。时时与服。后用香瓜丸。十日愈。乙又治朱监簿子五岁发热。腮赤唇
红。烦躁引饮。前医曰。此心热也。遂用牛黄丸。及以一物泻心汤下之。来日加无力而不能食。又下之。乃便利
黄沫。召乙看之。乙曰。此心经虚而有留热在内。必被凉药下之。致此虚羸也。乙先用白术散生胃中津液，以
生犀散治之。朱曰。大便黄沫何如。乙曰。胃气正即泻自止。此虚热也。朱曰。医用泻心汤何如。乙曰。泻心汤
黄连一物耳。性寒。多服则利。能寒脾胃也。坐久。前医至。曰实热。乙曰虚热。若实热何以泻心
汤下之不愈。又加面黄颊赤。五心烦热。不食而引饮。前医曰。既虚热。何大便黄沫。乙笑曰。便黄沫者。服
泻心汤多故也。乙复与胡黄连丸。愈。乙又治一子夜发热。晓即如故。前医作热治。以凉药解之。
不愈。其候多涎而喜睡。医又以铁粉丸下之。其病益甚。至五日大渴引饮。唇白不食。召乙看之。乙曰。此肺怯
有热。不可下之。若下之。
则损脾胃。致虚羸也。乃用白术散。更以术一两。煎药汁三升。使任意取足服。朱曰。饮多不作泻否。乙曰。无
生水不作泻。纵泻亦不作怪也。但不可下耳。朱曰。先治何病。乙曰。止泻治涎。退热清神。皆此药也。至晚服
尽。乙看曰。更可服之，又作三升。服尽稍愈。第三日又作三升与服。其子不渴无涎。遂投阿胶散二服而安。以
上三证。皆因误行转下之药。亡耗津液。致胃虚发渴不食。而成虚羸。钱乙并先煎白术散与服。以生胃中津液。
得胃气正。然后根据本病为治也。如齐郎中子藏热。与香瓜丸。朱监簿子心虚热。与生犀散胡黄连丸。次子
肺怯。与阿胶散。并皆安愈。故阎孝忠云。转下过多。泄泻等诸病烦渴者。皆津液内
耗也。不问阴阳。煎钱乙白术散。使满意取足饮之。弥多弥好。今特为详而论之。使学人法矣。钱乙所用方。本
集载之外。治虚羸诸方。具于后。
丁香黄 散
治脾胃虚弱不能食。渐致肌瘦虚羸。
丁香 绵黄 （锉） 人参（去芦） 白术 当归（去芦） 鳖甲（涂酥炙焦去裙 各一两） 胡黄连 甘
草（炙各半两）
上为细末。每服一钱。水一小盏。生姜二片。枣一个。煎至五分。去渣温服。食前。
集香煎
治如前。
丁香 沉香 木香 藿香（去土） 浓朴（去粗皮姜制各一两） 白术 白茯苓 白豆蔻（各半两）
上为细末。入研细麝香一钱拌匀。以水一升。蜜半斤。大枣三十枚。生姜二十片。于银器中慢火熬成膏。去
姜枣不用。搅匀。顿当风处阴干。每用皂角子大。米饮化下。乳食前。
国老丸
治瘦瘠虚羸。 少气。以甘草炙焦黄。杵末。炼蜜和丸绿豆大。每服五丸。温水下。日三服。一岁儿五
丸。以上者七八丸。以意加减。无时。
小儿出现虚羸（身体极度消瘦虚弱）的症状，是由于经过各种疾病之后，或者错误地使用了攻下药物，或者发生呕吐和腹泻，导致脾胃虚弱，不能运化吸收水谷精微之气。饮食无法进入体内，肌肤日渐消瘦，从而形成虚羸证。其中属于寒证的，时常出现腹泻，嘴唇和口色青白；属于热证的，身体发热壮盛，肌肉呈现微黄色，这被称为冷热两种类型的虚羸。钱乙治疗寒证使用木香丸，夏季不宜服用，如果有相应症状则少量服用。治疗热证使用胡黄连丸，冬季不宜服用，如果有相应症状则少量服用。
从前钱乙治疗齐郎中的儿子，此人喜欢收集药散施舍给人。他的儿子忽然患内脏有热的病，齐郎中自行取用青金膏，连续三次服用并一次喂服。服药完毕后，到了三更天孩子腹泻了五次。孩子昏沉嗜睡，齐郎中说孩子睡觉多容易受惊，又给孩子喂了一服。再次腹泻数次后，出现口干且身体发热的症状。齐郎中说还有余热，又想给青金膏。孩子的妻子说：“用药泻了十来次还没好，会不会生出其他毛病？”于是召请钱乙来看诊。钱乙说：“已经形成虚羸了。先大量煎煮白术散，经常给孩子服用，之后再使用香瓜丸，十天痊愈。”
钱乙又治疗朱监簿的儿子，五岁，发热，两腮红赤，嘴唇红润，烦躁不安且想喝水。之前的医生说这是心经有热，于是使用牛黄丸，并用一物泻心汤送服。第二天孩子更加无力且不能进食，医生又用了泻下药，结果大便排出黄色泡沫状物质。召请钱乙看诊，钱乙说：“这是心经气虚而在内有残留的热邪，必定是因为被凉性泻下药攻伐，导致这种虚羸。”钱乙先用白术散来滋生胃中的津液，再用生犀散进行治疗。朱监簿问：“大便排出的黄色泡沫状物质怎么办？”钱乙说：“胃气恢复正常，腹泻自然停止，这是虚热。”朱监簿问：“医生使用泻心汤怎么样？”钱乙说：“泻心汤只是黄连一味药，性质寒凉，多服会导致腹泻，能损伤脾胃。”坐了一会儿，前一位医生来了，说是实热。钱乙说是虚热。如果是实热，为什么用泻心汤攻下后不愈，反而加上面色黄、两颊红、五心烦热（手心、脚心和心口烦热）、不吃东西且想喝水？前医生说：“既然是虚热，为什么大便会排出黄色泡沫？”钱乙笑着说：“大便出黄沫，是因为服用泻心汤过多的缘故。”钱乙又给予胡黄连丸，病愈。
钱乙又治疗一个男孩，夜间发热，天亮后就像正常人一样。前一位医生当作热证治疗，用凉药解表清热，但没治好。其症状表现为多涎唾且喜欢睡觉，医生又用铁粉丸攻下，病情更加严重。到第五天，孩子极度口渴想喝水，嘴唇发白且不进食。召请钱乙看诊，钱乙说：“这是肺气怯弱而有热，不可攻下。如果攻下，就会损伤脾胃，导致虚羸。”于是使用白术散，另外加白术一两，煎药汁三升，让孩子随意喝够量。朱监簿问：“喝多了不会腹泻吗？”钱乙说：“没有生水就不会腹泻，即使腹泻也不会出怪事。只是不可攻下罢了。”朱监簿问：“先治疗什么病？”钱乙说：“止泻、治涎、退热、清神，都是这个药的作用。”到了晚上药喝完，钱乙查看说：“可以继续服用，再煎三升。喝完稍微好转。第三天又煎三升给他喝，孩子就不渴也没有涎唾了，于是投予阿胶散两服而安定。以上三个病例，都是因为错误地使用了攻下药物，耗亡津液，导致胃虚引发口渴、不进食，从而形成虚羸。钱乙都先煎白术散给孩子服用，以滋生胃中津液，待胃气恢复正常，然后根据本病进行治疗。如齐郎中之子的脏热，给予香瓜丸；朱监簿之子的心虚热，给予生犀散和胡黄连丸；第三个孩子的肺怯，给予阿胶散，都平安痊愈。所以阎孝忠说：攻下过多，导致泄泻等诸病伴有烦渴的，都是津液在内消耗所致。不论阴阳属性，都煎煮钱乙的白术散，让孩子满意地喝足，越多越好。现在特别详细地论述它，使学习的人有所效法。钱乙所用的方剂，原本收录在集中，此外治疗虚羸的各种方剂，列在后面。
丁香黄芪散
治疗脾胃虚弱不能进食，逐渐导致肌肉消瘦、身体虚羸。
丁香、绵黄芪（锉碎）、人参（去芦头）、白术、当归（去芦头）、鳖甲（涂酥炙焦，去裙边，各一两）、胡黄连、甘草（炙，各半两）。
以上药材研为细末。每次服用一钱，用水一小盏，生姜两片，大枣一个，煎至五分，去渣温服，饭前服用。
集香煎
治疗同上。
丁香、沉香、木香、藿香（去土）、浓朴（去粗皮，姜制，各一两）、白术、白茯苓、白豆蔻（各半两）。
以上药材研为细末，加入研细的麝香一钱拌匀。用水一升，蜂蜜半斤，大枣三十枚，生姜二十片，在银器中用慢火熬成膏状，去掉姜枣不用，搅匀，放在通风处阴干。每次用皂角子大小的量，用米饮化开服用，乳食之前服用。
国老丸
治疗瘦弱虚羸，少气。将甘草炙至焦黄，捣成粉末，用炼蜜调和做成绿豆大小的丸药。每次服用五丸，温水送下，每天三次。一岁的儿童服用五丸，一岁以上的服用七八丸，根据情况加减，不拘时间服用。
Pediatric Xu Lei (extreme emaciation and weakness) arises after various diseases, or due to the erroneous administration of purgative medicines, or following vomiting and diarrhea, resulting in Spleen-Stomach deficiency. This impairs the transformation and transportation of Gu Qi (Grain Qi), preventing food intake and causing muscle wasting, thereby forming Xu Lei. In cases of Cold Xu Lei, there is frequent diarrhea with bluish-white lips and mouth; in cases of Heat Xu Lei, the body is hot and feverish with slightly yellowish muscles. These are referred to as Cold and Heat types of Xu Lei. Qian Yi treated the Cold type with Muxiang Wan (Musk Pill) and the Heat type with Huhuanglian Wan (Coptis Decoction Pill). The former should not be taken in summer, but if symptoms arise, a small dose may be used; the latter should not be taken in winter, but if symptoms arise, a small dose may be used.
Previously, Qian Yi treated the son of Langzhong Qi, who liked to collect and distribute medicinal powders. His son suddenly suffered from internal Zang heat. Langzhong Qi self-administered Qingjin Gao (Blue Gold Ointment), giving three doses at once. After finishing the medication, by the third watch (midnight), the child had five episodes of diarrhea. The child was lethargic and sleepy. Langzhong Qi noted that excessive sleep might lead to fright and administered another dose. This resulted in several more diarrheal episodes, accompanied by dry mouth and fever. Langzhong Qi, perceiving residual heat, intended to give more Qingjin Gao. The wife objected, stating that ten-plus purgations had not brought relief and fearing adverse effects. They summoned Qian Yi. Qian Yi diagnosed it as having progressed to Xu Lei. He prescribed large quantities of Baizhu San (Atractylodes Powder) to be given frequently, followed by Xigua Wan (Melon Pill), resulting in recovery within ten days.
Qian Yi also treated the five-year-old son of Jianbu Zhu, who presented with fever, red cheeks, red lips, irritability, and polydipsia. The previous physician diagnosed Heart Heat and administered Niuhuang Wan (Calculus Bovis Pill) along with Yiwu Xiexin Tang (One-Ingredient Bitter Gallbladder-Draining Decoction). The next day, the child became weaker and anorexic. The physician purged again, leading to the passage of yellow frothy stool. Upon consultation, Qian Yi stated this was Heart Meridian deficiency with lingering internal heat, caused by the damaging effect of cold purgatives leading to Xu Lei. Qian Yi first used Baizhu San to generate Stomach fluids, then treated with Shengxi San (Raw Rhinoceros Horn Powder). When asked about the yellow frothy stool, Qian Yi replied that the diarrhea would stop naturally once Stomach Qi recovered, identifying it as Deficiency Heat. Regarding the use of Xiexin Tang, Qian Yi explained it contains only Huanglian (Coptidis Rhizoma), which is cold in nature; excessive use causes diarrhea and damages the Spleen and Stomach. Later, the previous physician arrived, insisting on Excess Heat. Qian Yi countered with Deficiency Heat, asking why Excess Heat did not respond to purgation and instead developed yellow complexion, red malar flush, Five-Center Heat (heat in palms, soles, and chest), anorexia, and polydipsia. When asked why Deficiency Heat produced yellow frothy stool, Qian Yi smiled and attributed it to the overuse of Xiexin Tang. He subsequently prescribed Huhuanglian Wan, leading to recovery.
Qian Yi also treated a boy who had fever at night but returned to normal by morning. The previous physician treated it as Heat using cooling herbs without success. The symptoms included excessive salivation and somnolence. The physician further purged with Tiefen Wan (Iron Powder Pill), worsening the condition. By the fifth day, the child had extreme thirst, white lips, and anorexia. Qian Yi diagnosed Lung Qi deficiency with heat, advising against purgation as it would damage the Spleen and Stomach, causing Xu Lei. He prescribed Baizhu San, adding one liang of Baizhu, decocted in three sheng of water for free consumption. When asked if excessive drinking would cause diarrhea, Qian Yi replied that without raw water, diarrhea would not occur, and even if it did, it would not be severe. The key was avoiding purgation. When asked about the treatment priority, Qian Yi listed stopping diarrhea, resolving phlegm/saliva, reducing fever, and calming the spirit, all achieved by this medicine. After finishing the dose by evening, Qian Yi advised continuing with another three sheng. After completion, the condition improved slightly. On the third day, another three sheng were given; the child no longer had thirst or salivation. Two doses of Ejiao San (Donkey-Hide Gelatin Powder) were then administered to stabilize the case.
These three cases illustrate how excessive purgation consumes Jin-Ye (Body Fluids), leading to Stomach deficiency, thirst, anorexia, and Xu Lei. Qian Yi consistently used Baizhu San first to restore Stomach fluids and Qi before treating the specific disease: Xigua Wan for the internal heat of Langzhong Qi's son; Shengxi San and Huhuanglian Wan for the Heart Deficiency Heat of Jianbu Zhu's son; and Ejiao San for the Lung deficiency of the third child. Yan Xiaozhong stated that excessive purgation leading to diarrhea and thirst indicates internal depletion of Jin-Ye. Regardless of Yin or Yang patterns, decocting sufficient Qian Yi's Baizhu San is beneficial, with more being better. This detailed exposition aims to guide students. Other formulas by Qian Yi for Xu Lei are listed below.
Dingxi Huangqi San (Clove and Astragalus Powder)
Treats Spleen-Stomach deficiency with anorexia, gradually leading to emaciation and Xu Lei.
Ingredients: Dingxi (Clove), Mian Huangqi (Astragali Radix, sliced), Renshen (Ginseng Radix et Rhizoma, de-gorged), Baizhu (Atractylodis Macrocephalae Rhizoma), Danggui (Angelicae Sinensis Radix, de-gorged), Biejia (Testudinis Carapax et Plastrum, coated with butter, roasted until scorched, skirt removed, each 1 liang), Huhuanglian (Coptidis Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried, each 0.5 liang).
Preparation: Grind into fine powder. Take 1 qian per dose. Decoct with 1 small cup of water, 2 slices of Shengjiang (Zingiberis Rhizoma Recens), and 1 Dazao (Jujubae Fructus) until reduced to 0.5 portion. Strain and take warm before meals.
Jixiang Jian (Collected Aromatics Decoction/Paste)
Treats as above.
Ingredients: Dingxiang (Clove), Chenxiang (Aquilariae Lignum Resinatum), Muxiang (Vladimiriae Radix), Huoxiang (Pogostemonis Herba, cleaned), Houpo (Magnoliae Officinalis Cortex, stripped of rough bark, ginger-processed, each 1 liang), Baizhu (Atractylodis Macrocephalae Rhizoma), Baifuling (Poria, white), Baixiudoukou (Amomi Fructus Rotundus, each 0.5 liang).
Preparation: Grind into fine powder, mix with 1 qian of finely ground Shexiang (Moschus). Add 1 sheng of water, 0.5 jin of Honey, 30 Dazao, and 20 slices of Shengjiang. Slowly simmer in a silver vessel into a paste. Remove ginger and dates. Stir well and dry in the shade in a ventilated place. Take an amount the size of a Gengjiao Zi (Gleditsiae Spina) dissolved in Rice Drink before milk or food.
Guolao Wan (Elder Pill)
Treats emaciation, Xu Lei, and shortness of breath.
Ingredients: Gancao (Licorice Root), roasted until golden brown, pounded into powder, mixed with refined honey to form pills the size of mung beans.
Dosage: Take 5 pills with warm water, three times daily. For one-year-olds, 5 pills; for older children, 7-8 pills. Adjust according to circumstances. Take at any time.