《婴童宝鉴》云∶凡修合药饵,切要分别州土,深晓好恶,明辨真伪。然后精细洁净,炮、 炙、
爆,一一都了。乃根据方分两,仔细秤定,始可合和。又合和之际,当须用不津器盛药,勿令尝嗅。(《太平圣惠方》
云∶不可众鼻嗅之,众口尝之,恐损药精气,用之无灵效耳。)又不可全用古方,恐分两差误。今之与古,风俗
尚乃不同,岂得更
用古方之分两也。今时医人,修合小儿药物,惟少是妙,故别立圭则,以表今时。凡古用一刀圭者,即今用一
钱匕。(一钱匕者,以钱满抄一钱末也。)或云∶一钱重者,是等秤之一钱也。明此二说,更无疑焉。夫秤二钱半
为一分,四分为一两,但根据此修合,必无差误。(为小儿脏腑与大人不同,故立此一篇耳。)
《万全方》论小儿用药法∶经言∶六岁以下为小儿。然小儿与大人异疗者,以有撮口,急、慢惊忤,疳、痫
等候,当须别为方论。余病与大人不殊。诸方散在卷中,亦可兼取,详而用之。(如吐泻、伤风、伤寒之类
,受病一同大人,并
取同用之。)然小儿纯阳,病则热多冷少,其药宜少冷于大人为得。其有用温药处,当以意减损之;(如水泻、
白痢、胃冷之
类,亦用温药也。)若丸散用之,亦在医者裁酌。一月以内可与百日同,周岁可与二岁同,三岁可与四岁同,五岁可与
六岁同。同者谓同其多少为一服,虽然大约如此,更详其疾之轻重而增减之。孙思邈言龙胆、调中二汤云∶儿
生一日至七日,取一合分三服。生八日至十五日,取一合半分三服。生十六日至二十日,取二合分三服。生二
十日至三十日,取三合分三服。生三十日至四十日,以五合分三服。恐五合未得,自斟酌。上此二方,准一日
以上,四十日以来儿方法具此,后欲处方者,宜一准此为率,乃至五、六岁,皆节次加减之,不烦重述。
《婴童宝鉴》说:凡是配制药物,必须严格区分药材产地的不同,深入了解药性的偏嗜与禁忌,明确辨别药材的真伪。然后进行精细、洁净的处理,如炮制、炙烤、爆炒等工序,都要逐一完成。接着依据处方的分量,仔细称量确定,才可以进行混合调和。另外,在调和的时候,应当使用不接触口水的器具盛放药物,不要让他人品尝或嗅闻。(《太平圣惠方》说:不可让众人用鼻子嗅它,让众人用嘴尝它,恐怕会损伤药物的精气,使用后就没有灵验的效果了。)又不可以完全照搬古方的剂量,恐怕分两(重量单位)会有差错。现在的时代与古代不同,风俗习惯也有差异,怎么能再使用古方的分两呢?现在的医生,配制小儿药物,以用量少为妙,所以另立标准,以表明当今的用法。凡是古方中用“一刀圭”的,现在就用“一钱匕”。(所谓一钱匕,是用钱币边缘舀满一钱的药末。)有人说:一钱重的,就是相当于秤上的一钱。明白这两种说法,就再也没有疑惑了。大凡秤二钱半为一分,四分为一两,只要根据这个标准来配制,必定不会有差错。(因为小儿的脏腑与成人不同,所以设立这一篇。)
《万全方》论述小儿用药的方法:经书说:六岁以下称为小儿。然而小儿的治疗与成人不同,是因为有撮口风、急惊风、慢惊风、客忤、疳积、癫痫等病症,应当单独制定方论。其他疾病与成人没有区别。各方散见于卷中,也可以兼取参考,详细地加以运用。(例如吐泻、伤风、伤寒等疾病,受病原因与成人相同,都采取同样的方法使用。)然而小儿属于纯阳之体,生病时热证多而寒证少,其用药宜比成人稍凉一些才合适。其中有用到温药的地方,应当凭医者的心意酌情减少;(如水泻、白痢、胃寒等情况,也使用温药。)如果是丸剂或散剂使用,也在医者斟酌决定。一个月以内的婴儿可与百日的婴儿同法,周岁的幼儿可与两岁的幼儿同法,三岁的幼儿可与四岁的幼儿同法,五岁的幼儿可与六岁的幼儿同法。所谓同法,是指服药量的多少作为一服的标准,虽然大致如此,更要详细考察疾病的轻重程度来增减药量。孙思邈在龙胆汤和调中汤中说:出生一天至七天,取一合药量分三次服用。出生八天至十五天,取一合半药量分三次服用。出生十六天至二十天,取二合药量分三次服用。出生二十天至三十天,取三合药量分三次服用。出生三十天至四十天,取五合药量分三次服用。如果五合药量还不足以见效,可自行斟酌调整。以上两个方子,适用于出生一天以上、四十天以下的婴儿,方法都在这里,后来想要开处方的医生,应该一律以此为准则,直到五岁、六岁,也都按次序加减药量,不需要重复叙述。
The *Yingtong Baojian* states: Whenever compounding medicines, one must strictly distinguish the origin of the herbs, deeply understand their preferences and aversions, and clearly differentiate between genuine and fake materials. Then, perform fine and clean processing; procedures such as pao (processing), zhi (roasting with honey or other media), and bao (stir-frying until popping) must be completed one by one. Only then, according to the prescription's dosages, carefully weigh and determine them before mixing and blending. Furthermore, during the mixing process, use vessels that have not touched saliva to hold the medicine, and do not allow tasting or smelling. (The *Taiping Shenghui Fang* states: Do not let many people smell it with their noses or taste it with their mouths, for fear of damaging the vital energy of the medicine, rendering it ineffective when used.) Also, do not completely rely on ancient prescriptions, as there may be errors in the dosage units (fen liang). Customs and practices differ between the present and antiquity; how can one still use the dosages from ancient prescriptions? Current physicians compounding pediatric medicines find that less is better; thus, new standards are established to reflect contemporary usage. Where ancient texts specify "one dao gui" (a unit of measure using a knife-edge scoop), use "one qian bi" today. (One qian bi refers to filling a coin with powdered medicine equivalent to one qian.) Some say: One qian weight is equal to one qian on the scale. Understanding these two explanations removes all doubt. Generally, two and a half qian constitute one fen, and four fen constitute one liang. Compounding according to this standard ensures no errors. (This section was established because infants' internal organs differ from adults'.)
The *Wanquan Fang* discusses methods for prescribing medicine for children: The classics state: Those under six years old are called children. However, treating children differs from adults because they suffer from specific conditions such as mouth-tightening syndrome (cuokou), acute convulsions (ji jing), chronic convulsions (man jing), fright attacks (wu), malnutrition syndromes (gan), and epilepsy (xian); therefore, separate formulas and discussions are required. Other diseases are not significantly different from those in adults. Various formulas scattered throughout the volumes can also be consulted and applied after detailed examination. (For example, vomiting and diarrhea, wind-cold, and cold damage diseases are contracted similarly to adults, so the same treatments are adopted.) However, children possess pure yang qi; when ill, heat patterns predominate over cold patterns. Therefore, medications should be slightly cooler than those prescribed for adults. In cases where warm medicines are used, the dosage should be reduced at the physician's discretion; (for instance, water-like diarrhea, white dysentery, and stomach coldness also require warm medicines.) Whether using pills or powders, the decision rests with the physician's judgment. Infants within one month can be treated similarly to those at 100 days; one-year-olds similarly to two-year-olds; three-year-olds similarly to four-year-olds; five-year-olds similarly to six-year-olds. "Similarly" means the volume per dose is the same. Although this is the general rule, the dosage must be increased or decreased based on the severity of the illness. Sun Simiao stated regarding Longdan Tang (Gentian Decoction) and Tiaozhong Tang (Regulate the Middle Decoction): For infants aged one to seven days, take one he (a unit of volume) divided into three doses. For eight to fifteen days, take one and a half he divided into three doses. For sixteen to twenty days, take two he divided into three doses. For twenty to thirty days, take three he divided into three doses. For thirty to forty days, take five he divided into three doses. If five he is insufficient, adjust accordingly. These two formulas apply to infants from one day to forty days old; the methods are fully detailed here. Physicians prescribing later should follow this as the standard. Even for children up to five or six years old, dosages should be adjusted sequentially without need for repetition.