世为虚弱人及幼孩治实证，往往当克伐之药而不敢用，即用亦必踌躇再四，不敢重其分
量，
药不胜病，同于未用，自以为谨慎，此大误也。不知虚弱人当初病时，其正气尚可支持，不
于此时用重药以直攻其病之所在，而一二剂荡平之，以急挽其垂尽之元气，而徐养其将耗
之精神，乃优柔不断，养痈成患，甚至借寇兵而资盗粮，坐令正气大亏，攻之不可，补之不
能，束手无策，岂非谨慎之误，更甚于鲁莽乎？至于幼孩，或寒或热，或风或痰，或积滞，
有不能不用大寒、大温、大散、大消之品者，愈宜早，愈宜重。盖小儿脏腑未充，气体柔嫩
，病易实，亦易虚。初病多实，久病多虚，实病不攻，待其虚而攻之，已无及矣。况小儿不
肯服药，十有八九；即服，亦不得多，非大剂浓煎，必不胜病。姑息养奸，需为事贼，眼明
手快，是在医者，尤在病家，若孤疑不决，首鼠两端，以昏愦为老成，以观望为持重，庸臣
误国，亦正类是，岂独时医也哉？
小儿气体结实，感受风寒，因而发热，热盛生风，风盛生痰，忽然痉厥，不省人事，此
谓急
惊，外治用针用刮，用推用拿；内治用清用泻，用消用开，即能清醒。如阵云四合，雷雨大
作，霹雳一声，云开雨止，转瞬睛明，其来也忽，其去也突。故治急惊者，似难而实易。所
难治者，厥惟四焉。一曰慢惊。或因先天肾水不充，或因后天脾土不足，脏腑空虚，腠理不
密
，风寒易感，时寒时热，谷食少进，大便溏泄；或因断乳太早杂食伤脾，或痘后疹后痧后疟
后痢后，及一切大病久病之后，正气大亏，皆能成慢惊。而又莫速于大吐大泻之后，竟有一
日即成慢惊者，不可不知也。治法与急惊正大相反，莫善于庄在田之《福幼编》，惟温惟补
，大剂连进，乃可挽回。稍有迟疑，必不可救。而医家、病家，皆以为奇闻，此其所以难也
。二曰痧子。痧子一症，轻者避风，不药能愈；重者辛散，亦可透发。体虚者扶正以达邪，
火盛者滋阴以助汗，幼科书在，本不难治。自夫人误认痧子之喉痛为喉证，不用辛散，专用
寒凉以治其内，珠黄以治其外，使痧毒不能外达于皮毛，则必上攻于咽喉，竟成不治之症，
而难治矣。（详见前麻证喉痛说。）
炳按∶小儿之病，亦难言也。余十五年前，治朱姓子，半夜来请，小儿五岁，面赤身热
，脉
数大汗，舌亦红，有白虎证见象。但余在外房拟方，（连余一日内七医诊视，六用清凉。）问
药曾吃过否？曰∶拣两方已各吃一帖矣，无效也。而片刻泻七次矣。余乃定人参、附子、炒
干姜、于术、炙草、茯苓、煨木香为主药。余回家已四鼓后，是方一剂，热退汗止泻定而愈
。
三曰痘证。近年牛痘盛行，痘科专家，几同绝响。一二种痘之人，大都粗工，下苗以外
，茫
无所知。适或痘不稳顺，及时行天花，急而求方，彼惟以犀、羚、连、芩等一派寒凉之品投
之，使血凝气滞，痘浆冰搁，塌陷而死，其变甚速。治法始终当以补气血扶阳气为要义，用
药以温补少加发散为首务。庄在田《遂生编》，实为痘科圣书，非他家所能及也。四曰脐风
。此症因产时受风，有生下即成者，有迟至百日者，七日内最易犯此，尤宜时刻留心。但见
眉心有一点黄色，便是脐风，脐上必现青筋，即速施治，不治则黄至鼻端，不治则黄至嘴唇
，不治则鸦声撮口，哭不成声，咀乳无力。急治之，犹或十能活一。治法莫妙于《幼科铁镜
》之灯火十三 ，与《广生编》之四等 法。治之得法，顷刻可愈。余尝亲手试之，非臆度
也。以上四症治法，皆详见余所辑《保赤要言》中。今复表而出之，欲使病家知四症虽难治
，要皆有可治之法，勿视为难而竟不治也。总之，治得其法，则难者亦易；治不得法，则易
者亦难。难易之别，亦视其治之如何耳!
世人在为体质虚弱的人和幼童治疗实证时，往往遇到应当使用攻伐（祛除病邪）药物的情况却不敢使用，即使使用了也必定犹豫再三，不敢加大药量。结果药力不足以战胜疾病，效果等同于没有用药，自认为这是谨慎，这却是极大的错误。不知道体质虚弱的人刚患病时，其正气尚且还能支撑，如果不在此时用重药直接攻击病灶所在，用一两剂药就能平定病情，从而急切挽回即将耗尽的元气，并慢慢调养将要耗散的精神，反而优柔寡断，如同养痈成患，甚至等于借武器给敌人、送粮食给盗贼，坐视正气大亏，此时再想攻邪已不可行，想补虚又无法承受，束手无策，这难道不是因过度谨慎而造成的错误吗？这种错误甚至比鲁莽更为严重！至于幼童，无论是受寒、受热、受风还是痰积、食积，都有不能不用大寒、大温、大发散、大消导药物的情况，更宜早治，更宜重用。因为小儿脏腑尚未充盈，气血形体柔嫩，病证容易转为实证，也容易转为虚证。初起多为实证，久病多为虚证，实证若不攻逐，等到它转为虚证再去攻治，就已经来不及了。况且小儿不肯服药的情况十有八九；即使肯服，也不能喝太多，如果不是大剂量浓煎，必然药不胜病。姑息纵容如同养奸，拖延时间如同助长贼势，这需要医生眼明手快，更需要病家配合，如果犹豫不决、首鼠两端，把昏聩糊涂当作老成持重，把观望等待当作稳重，庸医误国的情形与此类似，哪里只是当今的医生如此呢？
小儿气血结实，感受风寒，因而发热，热盛则生风，风盛则生痰，突然发生痉挛厥逆，不省人事，这称为“急惊”。外治法可用针刺、刮痧、推拿、拿法等；内治法可用清热、泻下、消导、开窍等法，通常能使患儿清醒。这就好比乌云四合，雷雨大作，一声霹雳之后，云开雨止，转瞬之间天色晴朗，它的来势迅猛，去势也突然。所以治疗急惊症，看似困难实则容易。真正难以治疗的病症只有四种。第一种叫“慢惊”。有的因为先天肾水不足，有的因为后天脾土虚弱，导致脏腑空虚，腠理不致密，风寒容易侵袭，出现时冷时热，饮食减少，大便溏泄；有的因为断奶太早或杂食损伤脾胃，有的在出痘、出疹、出痧、患疟疾、患痢疾后，以及一切大病久病之后，正气大亏，都能形成慢惊。其中没有比在大吐大泻之后更快形成慢惊的了，这一点必须知晓。治疗方法与急惊症完全相反，最好的方法是庄在田的《福幼编》，主张只用温补之法，大剂量连续服用，才能挽回生机。稍有迟疑，就必不可救。然而医生和病家都认为是奇闻怪谈，这就是它难治的原因。第二种叫“痧子”（麻疹）。痧子这一病症，轻者避风，不吃药也能痊愈；重者用辛散药物，也可以透发出来。体质虚弱的扶持正气以驱除邪气，火气旺盛的滋阴以助汗液排出，儿科书籍中有记载，本来不难治疗。自从人们误认痧子的喉痛为普通的喉科疾病，不用辛散药物，专门用寒凉药物治疗内部，用珠黄类药物治疗外部，使得痧毒不能向外透达于皮毛，就一定会向上攻冲咽喉，最终成为不治之症，因而变得难治。（详见前文关于麻证喉痛的论述。）
炳按：小儿的疾病，也很难言说。我十五年前，治疗一位朱姓人家的儿子，半夜来人请诊，小儿五岁，面色红赤，身体发热，脉象数且大汗淋漓，舌质也红，呈现出白虎汤证的征象。但我当时在外间房拟定处方，（连同我在内一天看了七个医生，六个用了清凉药物。）我问药曾吃过没有？回答说：“挑了两个方子已经各吃了一帖，无效。”而且片刻之间腹泻七次。于是我确定以人参、附子、炒干姜、白术、炙甘草、茯苓、煨木香为主药。我回家时已是深夜四鼓之后，这一剂药下去，热退、汗止、泻停而痊愈。
第三种叫“痘证”（天花）。近年来牛痘盛行，专攻痘科的专家几乎绝迹。接种一二种痘的人，大多是粗通医术的工匠，除了下苗之外，茫然无知。如果遇到痘出不稳顺，或是流行性天花，急忙求方，他们只用犀角、羚羊角、黄连、黄芩等一派寒凉药物投喂，使血液凝滞、气机阻滞，痘浆冻结搁置，塌陷而死，变化非常迅速。治疗方法应始终以补气血、扶阳气为要义，用药以温补为主，稍加发散为首要任务。庄在田的《遂生编》，实在是痘科的圣书，其他医家的著作达不到这个水平。第四种叫“脐风”。此症因分娩时受风引起，有的生下即发作，有的迟至一百天发作，七日内最容易犯此病，尤其需要时刻留心。只要见到眉心有一点黄色，便是脐风，脐部必现青筋，应立即施治，若不治疗，黄色蔓延至鼻端，再不治疗则蔓延至嘴唇，再不治疗则声音如乌鸦般嘶哑、口唇撮缩，哭声不成声，吮乳无力。紧急治疗的话，或许十分中能救活一分。治疗方法莫过于《幼科铁镜》中的灯火灸十三穴法，以及《广生编》中的四等法。治疗得法，顷刻即可痊愈。我曾亲手尝试过，并非凭空推测。以上四种病症的治疗方法，都详细记载在我编纂的《保赤要言》中。现在再次列举出来，是想让病家知道这四种病症虽然难治，但确实都有可治的方法，不要因为觉得难治就不去治疗。总之，治疗得法，难的也会变易；治疗不得法，易的也会变难。难易的区别，也在于如何治疗罢了！
When treating excess syndromes in individuals with weak constitutions and young children, people often hesitate to use purgative (pathogen-expelling) medicines when they are indicated. Even if used, there is usually much deliberation, and the dosage is not increased sufficiently. Consequently, the medicinal strength fails to overcome the disease, rendering the treatment equivalent to none. They consider this caution, but it is a grave error. One fails to realize that when a person of weak constitution first falls ill, their righteous qi (vital energy) can still support them. If one does not use heavy medicines at this time to directly attack the site of the disease and resolve it within one or two doses, thereby urgently rescuing the nearly exhausted yuan qi (primordial energy) and gradually nourishing the dissipating spirit, but instead remains indecisive, it is like nurturing a boil until it becomes a disaster, or even lending weapons to the enemy and providing grain to robbers. This allows righteous qi to be severely depleted, making it impossible to purge pathogens later and impossible to tonify deficiency, leaving one helpless. Is this not an error caused by excessive caution, which is even worse than recklessness? As for young children, whether suffering from cold, heat, wind, phlegm, or food stagnation, there are situations where strong cold, strong warm, strong dispersing, or strong resolving agents must be used. In such cases, early treatment and heavier dosages are even more appropriate. This is because children’s zang-fu organs are not yet fully developed, and their qi and blood are tender; their conditions easily become excess and also easily become deficiency. Early-stage diseases are mostly excess, while chronic diseases are mostly deficiency. If an excess condition is not attacked, waiting until it becomes deficiency to treat it will be too late. Moreover, nine out of ten children refuse to take medicine; even those who do cannot consume large amounts. Without large doses and concentrated decoctions, the medicine will inevitably fail to overcome the disease. Indulgence fosters evil, and delay aids the thief. The physician must have clear eyes and quick hands, and so must the patient's family. If they are indecisive, wavering between options, mistaking confusion for maturity, and viewing hesitation as prudence, it is akin to incompetent ministers ruining the state. This is not limited to contemporary physicians.
Children have solid qi and blood; upon contracting wind-cold, they develop fever. Excessive heat generates wind, and excessive wind generates phlegm, leading suddenly to spasms, convulsions, and loss of consciousness, known as "Acute Convulsion" (Ji Jing). External treatments include acupuncture, scraping, pushing, and grasping techniques; internal treatments involve clearing heat, purging, resolving stagnation, and opening orifices, which can restore consciousness. It is like dark clouds gathering, thunderstorms breaking forth, followed by a clap of thunder, after which the clouds disperse and rain stops, revealing bright skies instantly. Its arrival is sudden, and its departure is abrupt. Therefore, treating acute convulsion seems difficult but is actually easy. The truly difficult conditions are only four. The first is "Chronic Convulsion" (Man Jing). It may arise from congenital insufficiency of Kidney Water or acquired deficiency of Spleen Earth, resulting in empty zang-fu organs and loose interstices (cou li), making the body susceptible to wind-cold, presenting with alternating chills and fever, poor appetite, and loose stools. It may also result from weaning too early or improper diet damaging the spleen, or following smallpox, measles, scarlet fever, malaria, or dysentery, and after any major or chronic illness where righteous qi is severely depleted. None is faster to develop into chronic convulsion than after severe vomiting and diarrhea; this must be known. The treatment principle is exactly opposite to that of acute convulsion. The best method is found in Zhuang Zaitian’s *Fu You Bian*, advocating solely warming and tonifying methods with large doses administered continuously to reverse the condition. Any hesitation makes recovery impossible. Yet physicians and families regard this as strange news, which is why it is difficult. The second is "Sha Zi" (Measles/Rash). For mild cases, avoiding wind allows cure without medication; for severe cases, acrid-dispersing herbs can facilitate eruption. For those with weak constitutions, supporting righteous qi expels pathogens; for those with excessive fire, nourishing yin assists sweating. Pediatric texts provide guidance, making it inherently not difficult to treat. However, since people mistakenly identify throat pain associated with Sha Zi as ordinary throat disorders, they avoid acrid-dispersing herbs and instead use cold-cooling herbs internally and Pearl-Yellow preparations externally. This prevents Sha toxin from reaching the skin surface, causing it to attack upward to the throat, resulting in an incurable condition, thus becoming difficult to treat. (See previous discussion on throat pain in measles.)
Bing notes: Children's diseases are also hard to discuss. Fifteen years ago, I treated a five-year-old son of the Zhu family, summoned in the middle of the night. The child had a red face, fever, rapid pulse with profuse sweating, and a red tongue, showing signs of the Baihu Tang syndrome. I was drafting the prescription in the outer room (including myself, seven doctors had examined him that day, six using cooling methods). I asked if he had taken any medicine. He replied, "I selected two prescriptions and took one dose of each, but to no effect." Within moments, he had seven episodes of diarrhea. I then determined the main ingredients to be Ginseng Radix et Rhizoma (Renshen), Aconiti Lateralis Radica Praeparata (Fuzi), dried Ginger processed with stir-braising (Chao Ganjiang), Atractylodis Macrocephalae Rhizoma (Baizhu), Licorice Root processed with honey (Zhi Cao), Poria (Fuling), and Areca Seed processed with baking (Wei Muxiang). I returned home after the fourth watch of the night. After one dose of this prescription, the fever subsided, sweating stopped, and diarrhea ceased, leading to recovery.
The third is "Dou Zheng" (Smallpox). In recent years, cowpox vaccination has become prevalent, and experts in smallpox treatment seem to have vanished. Those administering the vaccine are mostly unskilled workers who know little beyond inoculation. If the eruption is irregular or during epidemic smallpox, urgent requests for prescriptions are met with formulas containing Rhinoceros Horn (Xijiao), Antelope Horn (Lingyang), Coptis Rhizome (Lian), and Scutellaria Root (Qin)—a batch of cold-cooling substances. This causes blood coagulation and qi stagnation, freezing the pustule fluid, leading to collapse and death with rapid progression. The treatment should always prioritize tonifying qi and blood and supporting yang qi. Medications should primarily be warming and tonifying, with slight dispersing agents added. Zhuang Zaitian’s *Sui Sheng Bian* is truly the sacred text of smallpox treatment, unmatched by other works. The fourth is "Qi Feng" (Neonatal Tetanus). This condition results from wind invasion during birth, manifesting immediately after birth or up to 100 days later. It is most common within seven days and requires constant vigilance. If a yellow spot appears on the glabella, it is Qi Feng, accompanied by blue veins above the umbilicus. Immediate treatment is required; otherwise, the yellow color spreads to the nose tip, then to the lips, followed by a crow-like voice, puckered mouth, inability to cry properly, and weakness in sucking milk. Urgent treatment might save one in ten. The best treatments are the thirteen-point moxibustion method from *You Ke Tie Jing* and the four-level method from *Guang Sheng Bian*. With proper treatment, recovery can occur instantly. I have personally tested these methods; they are not mere speculation. The treatment methods for these four conditions are detailed in my compiled work *Bao Chi Yao Yan*. I repeat them here to inform families that although these four conditions are difficult, they are treatable, and should not be abandoned due to perceived difficulty. In short, with correct treatment, difficult cases become easy; with incorrect treatment, easy cases become difficult. The distinction lies in how one treats them.