唐·孙真人《玉关要诀》
风盛之脉须与解之。惊热之脉须与利之。伤冷之脉须与温之。积聚之脉(一云积热)。须与下之。或虚中有积热,
先与利热,后与治虚。热里有虚,先与补虚,然后退热,次调胃气,即无误矣。
《惠眼观证》论治病∶
夫惊啼者,皆因滞,风热在心,恐生其涎,必当取下。夫惊热,但治脾惊,化心下涎,必自安也。夫疳热
者,皆伤脾胃,受积传邪心肾,必先解邪热,次服疳药。夫惊泻者,必当匀气。夫伤寒者,微微用汤解表里。
夫疳有五种,在意消息。
若麻痘已出,不可冷药过多,或成泻痢,或使毒瓦斯不出,杀人。若麻痘未出,则宜解之。若霍乱,皆因胃
气不顺。若三岁,目忽然而闭,乃成肝疳,煮肝散子服之。
凡小儿取积药,便下匀气汤随之,乃不损小儿。
《惠眼观证》又云∶调治小儿之法,当须慎护肾胃气也。缘小儿未有天癸之旺而常根据四时也。胃气一虚,病
皆滋长,轻者至重,重者必死,此决然之理也。观令医者,不深念虑,而云小儿纯阳之气。凡有疾病须当疏下,
是以世之为医者执此而妄资疏泄,因此而死毙者不可胜纪,良可叹也。虽然疏下在乎审谛而不可过,调理小儿
之要也。今夫五脏生病自有阴阳,在脏为阴,在腑为阳。为阴者,为阴邪所中,慢惊、吐泻、疟、痢之病是也。
为阳者,为阳邪所中,急风、伤寒、疹痘之病是也。然阴阳之气相感而动,以阳感阳,以阴感阴。阳或未动,
待阴而动。阴或未动,待阳而动者有之矣。冬末春初,多患伤寒疹痘,是其阳病感阳而动也。夏末秋初,多患
吐泻、疟痢,是其阴病感阴而动也。误或冬末春初,患一惊候,与之化涎,未与之下,迁延至秋,其发则慢,
是阳病积之为阴,是感阴而动也。秋末冬初,患一惊候,不与下涎,至春气之盛激触而发,是其阴病待阳而动
也。由此推之,调理小儿在乎壮阴阳,识虚实。凡有一病,知之于未然之前,能审知实则生风,虚则气怯,乃善矣。
《联珠》论小儿五虚不治(谓病久而虚,五者或肿也∶)
手心肿、脐中肿、脚心肿、肾阴肿、舌头肿。
小儿五硬不治∶
心硬(啼无泪)、头硬、手硬、脚硬、背硬。
小儿五软不治∶
手软、项软、脚软、腰软、背软。
又歌曰∶小儿不与大人同,得病多由惊热风。先治心神次除热,脉宜紧数及浮洪。
长沙医者毛彬集入室生死候∶
有候小儿定脉部,左臂为肝上为肺。对面为心并晓然,脾病只看见勾睡。肾病夜间不发作,急死之候将口
约。忽然吐出冷顽涎,如此徒劳下良药。声细声嘶气血里,昏昏不语大难医。狂言不认人形状,气满
胸中也可悲。久患唇红不可医,惊来眼满勿相窥。睛青颊赤耳花黑,发直鸦声怕乱啼。手若无纹舌须黑,
鼻头浑黑口双垂。昏昏只睡不开眼,便是神仙难救之。
唐代孙思邈《玉关要诀》指出:风邪盛盛的脉象,必须用疏散风邪的方法治疗。惊热(因受惊引起的发热)的脉象,必须用通利的方法治疗。伤冷(感受寒邪)的脉象,必须用温补的方法治疗。积聚(体内有包块或积滞)的脉象(一说为积热),必须用泻下的方法治疗。如果是虚证中夹杂积热,应先清利热邪,然后再治疗虚证。如果热证中夹杂虚证,应先补益虚损,然后退热,接着调理胃气,这样就不会出错了。
《惠眼观证》论述治病方法:
凡是小儿惊啼(受惊啼哭),都是因为体内有积滞,风热在心,导致生涎(产生痰涎),必须采用泻下法。凡是惊热,只需治疗脾惊,化解心下的痰涎,自然就会安宁。凡是疳热(疳积发热),都是损伤了脾胃,病邪传变至心肾,必须先解除邪热,再服用治疗疳积的药物。凡是惊泻(因惊引起的腹泻),必须调和气机。凡是伤寒,应轻微地用汤药解表里之邪。疳积有五种,需根据具体情况斟酌处理。
如果麻疹、天花已经发出,不可过多使用寒凉药物,否则可能导致腹泻痢疾,或者使毒邪不能排出,从而致死。如果麻疹、天花尚未发出,则应当予以透发。霍乱,都是因为胃气不顺所致。如果三岁小儿眼睛突然闭合,这是形成了肝疳,应煮服肝散子。
凡是给小儿服用消积药物后,紧接着服用匀气汤,才不会损伤小儿的身体。
《惠眼观证》又说:调治小儿的方法,必须谨慎保护肾气和胃气。因为小儿还没有天癸(指肾中精气充盈后产生的促进性发育的物质)旺盛的阶段,所以常顺应四季变化。胃气一旦虚弱,疾病都会滋生增长,轻的会变重,重的必死,这是确定的道理。观察现在的医生,不深入思考,就说小儿是“纯阳”之气。凡是有疾病都必须疏泄泻下,因此世间的医生执着于此而妄加疏泄,因此导致死亡的人不计其数,实在令人叹息。虽然疏泄泻下需要审慎仔细而不能过度,但调理小儿的关键在于此。如今五脏生病自有阴阳之分,在脏属阴,在腑属阳。属于阴证的,是被阴邪所中,如慢惊、吐泻、疟疾、痢疾等疾病。属于阳证的,是被阳邪所中,如急风、伤寒、疹痘等疾病。然而阴阳之气相互感应而动,以阳感阳,以阴感阴。有的情况是阳未动,等待阴来触动;阴未动,等待阳来触动的。冬末春初,多患伤寒、疹痘,这是阳病感阳而动。夏末秋初,多患吐泻、疟痢,这是阴病感阴而动。误诊或延误,如在冬末春初患惊候,给予化涎药,未予泻下,拖延到秋天发作,病情变得缓慢,这是阳病积久转为阴,是感阴而动。秋末冬初,患惊候,不给以泻下化痰,等到春天阳气旺盛时激发触动而发作,这是阴病等待阳来触动。由此推断,调理小儿关键在于壮实阴阳,识别虚实。对于每一种病,要在未发生之前知晓,能审慎知道实证会生风,虚证则气怯,这才是高明的。
《联珠》论述小儿五虚不治(指病程长久且身体虚弱,出现以下五种肿胀之一即难治):
手心肿、肚脐周围肿、脚心肿、生殖器部位肿、舌头肿。
小儿五硬不治:
心硬(啼哭无泪)、头硬、手硬、脚硬、背硬。
小儿五软不治:
手软、颈项软、脚软、腰软、背软。
又有歌诀说:小儿的病不与大人相同,得病多由惊、风、热引起。先治疗心神,其次清除热邪,脉象适宜表现为紧、数、浮、洪。
长沙医生毛彬收集了入室观察的生死征候:
有观察小儿定脉的部位,左臂对应肝,上部对应肺。对面(面部)对应心,也很明显。脾病只看见勾睡(嗜睡)。肾病夜间不发作,将口紧闭是急死之候。忽然吐出冷而粘稠的痰涎,如此即使下良药也徒劳无功。声音细小嘶哑,说明气血已败,昏昏不语,极难医治。胡言乱语不认识人,胸中气满,也可悲悯。久病嘴唇红赤不可医,受惊后眼睛瞪大勿靠近看。眼球青、脸颊红、耳朵黑且花白,头发直竖、声音像乌鸦叫、害怕乱啼。手上没有纹路、舌头必黑,鼻头浑黑、口角双垂。昏昏只想睡觉不开眼,即使是神仙也难救活。
Tang Dynasty Sun Simiao's *Yuguan Yaojue* states: For a pulse indicating excess wind, one must apply methods to dissipate the wind. For a pulse indicating fright-heat (fever caused by fright), one must apply methods to promote drainage and unblocking. For a pulse indicating cold injury (injury from cold pathogens), one must apply warming methods. For a pulse indicating accumulation and mass (pathological masses or stagnation within the body) (alternatively described as accumulated heat), one must apply purgative methods. If there is accumulated heat amidst deficiency, first clear and drain the heat, then treat the deficiency. If there is deficiency amidst heat, first tonify the deficiency, then reduce the heat, followed by regulating stomach qi; this approach ensures no errors.
*Huiyan Guanzheng* discusses treatment principles:
Infantile crying due to fright is always caused by internal stagnation; wind-heat resides in the Heart, generating phlegm-saliva (phlegm-fluids), which necessitates purgation. For fright-heat, treating Spleen-fright and resolving phlegm-saliva below the Heart will naturally bring peace. For malnutrition fever (fever associated with infantile malnutrition syndrome), the Spleen and Stomach are damaged, and pathogenic factors transmit to the Kidney and Heart; one must first resolve pathogenic heat, then administer medicines for malnutrition. For diarrhoea due to fright, one must harmonize qi. For cold damage (Shanghan), use mild decoctions to release both the exterior and interior. There are five types of malnutrition; one must exercise discretion in handling them.
If measles and smallpox have already erupted, excessive use of cold-natured herbs should be avoided, lest it cause diarrhoea and dysentery, or prevent the expulsion of toxic vapours, leading to death. If measles and smallpox have not yet erupted, they should be promoted for eruption. Cholera-like vomiting and diarrhoea result from disharmony of Stomach qi. If a three-year-old child suddenly closes their eyes, it indicates Liver malnutrition; one should administer boiled Gan San Zi.
When administering anti-stagnation medicines to children, follow immediately with Yunqi Tang to prevent damage to the child.
*Huiyan Guanzheng* further states: The method for regulating children requires careful protection of Kidney and Stomach qi. Since children have not yet reached the peak of Tian Gui (essence of the Kidneys that promotes sexual maturity), they generally follow the four seasons. Once Stomach qi becomes deficient, diseases proliferate; mild cases become severe, and severe cases lead to death. This is an absolute principle. Observing contemporary physicians, who fail to contemplate deeply, claiming that children possess pure Yang qi, and thus insisting on draining and purging for all diseases, many die due to such reckless purgation. This is truly lamentable. Although purgation must be judicious and not excessive, the key to regulating children lies here. The five Zang organs have their own Yin-Yang distinctions; Zang organs belong to Yin, and Fu organs belong to Yang. Yin syndromes are caused by invasion of Yin pathogens, such as slow convulsion, vomiting and diarrhoea, malaria, and dysentery. Yang syndromes are caused by invasion of Yang pathogens, such as acute wind, cold damage, rashes, and smallpox. However, Yin and Yang qi interact and move; Yang responds to Yang, and Yin responds to Yin. There are cases where Yang has not moved, waiting for Yin to trigger it; or Yin has not moved, waiting for Yang to trigger it. At the end of winter and beginning of spring, cold damage and rashes/smallpox are common; this is Yang disease responding to Yang movement. At the end of summer and beginning of autumn, vomiting/diarrhoea and malaria/dysentery are common; this is Yin disease responding to Yin movement. Misdiagnosis or delay, such as encountering a fright syndrome at the end of winter/beginning of spring, treating with phlegm-resolving agents but failing to purge, allowing it to linger until autumn when it manifests slowly, indicates Yang disease accumulating into Yin, responding to Yin movement. Encountering a fright syndrome at the end of autumn/beginning of winter, failing to purge and resolve phlegm, allowing it to erupt when Spring Qi becomes vigorous, indicates Yin disease waiting for Yang movement. From this, we deduce that regulating children depends on strengthening Yin and Yang, and distinguishing deficiency and excess. For every disease, one must anticipate it before it occurs; knowing that excess generates wind and deficiency leads to Qi timidity is excellent.
*Lianzhu* discusses the five untreatable deficiencies in children (referring to prolonged illness with deficiency, manifesting as any of the following five swellings):
Swelling of the palms, swelling of the umbilicus, swelling of the soles, swelling of the genitalia, and swelling of the tongue.
The five untreatable hardenings in children:
Hardness of the Heart (crying without tears), hardness of the head, hardness of the hands, hardness of the feet, and hardness of the back.
The five untreatable softnesses in children:
Softness of the hands, flaccidity of the neck, softness of the feet, flaccidity of the waist, and softness of the back.
Another verse states: Children’s conditions differ from adults’; illnesses often arise from Fright, Wind, and Heat. First treat the Heart Spirit, then eliminate Heat; the pulse should be tight, rapid, floating, and full.
Mao Bin, a physician from Changsha, collected signs observed at the bedside indicating life and death:
Regarding pulse diagnosis locations, the left arm corresponds to the Liver, and the upper area to the Lung. The face corresponds to the Heart, which is obvious. Spleen disease is indicated by lethargy/sleepiness. Kidney disease does not manifest at night; closing the mouth tightly is a sign of imminent death. Sudden expulsion of cold, tenacious phlegm-saliva renders even good medicine useless. Thin and hoarse voice indicates depletion of Qi and Blood; drowsiness and inability to speak indicate extreme difficulty in treatment. Delirium and failure to recognize people, with chest fullness, is pitiable. Chronic red lips are untreatable; wide-open eyes after fright should not be stared at. Blue sclerae, red cheeks, and blackish ears with white spots, straight hair, crow-like voice, and fear of chaotic crying are ominous. Absence of palm lines and black tongue, black nose tip, and drooping corners of the mouth indicate doom. Drowsiness with eyes closed is incurable even by immortals.