《圣惠》∶凡断乳婴孩、童子患疹痘疾候,初觉多似伤寒。面色与四肢俱赤,壮热头痛,腰背疼,足多厥冷,
眼睛黄色。脉息但多洪数、绝大不定,小便赤少,大便多秘。才觉四肢色候及脉息虽是疹痘疾,未攻皮毛穴出
者,便可以服饵。匀和脏腑,疏利遂下。若疹已结在皮毛穴处微微似出,即不可疏泄也。或疹出太盛、痘穴脓
水者,却可疏利也。
《王氏手集》∶世之论疮疹者,莫不以古书之说,才觉便与疏利为非。以钱氏之说,治以温凉之药,不可妄
下为是。遂以谓近世小儿疮疹之出得无横夭者,皆钱氏之功也。盖小儿肠胃娇嫩,若妄取转,便见内虚,热气反
入,必能杀人。故以疮疹倒 而死者,皆取转之罪也。此说诚是。然而不考其言,遂失其意。殊不知古书所谓
疏利者,乃云先和节阴阳,调治荣卫,方利脏腑,即热气渐解。又曰∶婴儿之性,自然阳胜而阴微也。脏腑
阴阳气逆,大小便多秘不通也。才觉是此疾,即可便与疏利,即轻患也。若疹痘已出,即不可疏利,又曷尝使
人疮疹之出,便即取转耶?况疏利与取转相去辽远。疏利者必以轻凉之药,微利动之,如青黛、黄连之类是也;
取转者,以峻快之药极转下之,如巴豆、芒硝之类是也;不可同日而语。愚医不详古意,辄以疏利便为取转,
得不误耶?况取转之际,曾先和节阴阳,调治荣卫乎?小儿已大小便不通乎?才觉之说,即是疮疹未见。医者
取转之时,知疮疹之已出未出乎?又曾知疹痘出,即不可疏转之语乎?盖庸医往往见是疮疹便与取转,云使疮
疹出快,所以多误也。钱氏之说云此天行之病,唯用温凉药治之,不可妄下及妄攻发。亦曷尝有此证不得疏利
之语乎?妄下非疏利之比。至如初虞世犹具误解其意,乃以疮疹比伤寒,至阳明亦用利药,殊不知伤寒至阳明
则宜下。既庸医不晓古意,又使善医者以此印证其说不疑为非,故特为辨。其疮疹之初,果有此证,则宜与疏
利,特不可取转耳。
《圣惠》治小儿热毒盛,发疹痘疮,初发早觉者,宜服此方。
上用黄连一两,去须,捣、筛为散。每服一钱,以水一小盏,煎至五分,去滓。不计时候,量儿大小分减温服。
《圣惠》又方
上用波斯青黛如枣核大,以水调服之。(《疹痘论》同,用温磨刀水调下。)
《疹痘论》当归散方
川当归(一两) 甘草(一分)
上为细末。每服二钱,水一中盏,豆豉十粒,同煎至六分,去滓。量儿大小服,以利动为度,逐日冷吃甘
草汁。三岁以下一岁以上加减服。
《疹痘论》∶如疮候未作脓,心膈燥,睡不安者方。
上用黑豆煮汁温,徐徐服之亦解。
《疹痘论》又∶凡有时气天行疮痘者,则急预之豆汤。
小豆 黑豆 绿豆(各半升) 甘草(一两,炙)
上用水九升煮,候豆熟为度。逐日空心,任意饮。七日后,疮必发快。
《圣惠方》:凡是断奶的婴儿和儿童患疹痘疾病,初起时多类似伤寒。面色和四肢都发红,高热头痛,腰背疼痛,脚部大多厥冷,眼睛发黄。脉象大多洪大数急、极其盛大且不稳定,小便赤红量少,大便多秘结。刚察觉四肢色泽及脉象虽属疹痘疾,但邪气尚未攻入皮毛穴位发出者,就可以服药。调和脏腑,疏通利导使邪气下行。如果疹子已经在皮毛穴位处微微似要发出,就不可再疏通泄下。或者疹出太盛、痘穴有脓水者,却可以疏通利导。
《王氏手集》:世间讨论疮疹的人,没有不以古书的说法为准,认为刚发觉就用疏利法是错误的。以钱乙(钱氏)的说法,用温凉药物治疗,不可妄用泻下法才是正确的。于是认为近代小儿疮疹能顺利发出而无横死夭折的,都是钱乙的功劳。大概小儿肠胃娇嫩,如果妄用泻下法,就会见到内部虚弱,热气反而内陷,必定能致人死亡。所以因疮疹内陷倒伏而死的,都是泻下法的罪过。这种说法确实正确。然而如果不考察其言论的本意,就失去了它的真意。殊不知古书所说的“疏利”,是说先调和阴阳,调理营卫,然后才利导脏腑,这样热气逐渐解除。又说:婴儿的天性,自然是阳气胜而阴气微弱。脏腑阴阳之气逆乱,大小便多秘结不通。刚察觉是此病,就可以立即给予疏利,这样就是轻症。如果疹痘已经发出,就不可疏利,这又何曾让人疮疹发出时就使用泻下法呢?况且疏利与泻下相去甚远。疏利是用轻凉的药,轻微地利导它,如青黛、黄连之类的药物;泻下是用峻猛快速的药极力转泻下行,如巴豆、芒硝之类的药物;不可相提并论。庸医不详细探究古人的本意,辄然将疏利当作泻下,难道不会出错吗?况且在使用泻下之际,曾先调和阴阳,调理营卫吗?小儿已大小便不通了吗?“刚发觉”的说法,即是疮疹未见之时。医者在使用泻下之时,知道疮疹已发出还是未发出吗?又曾知道“疹痘发出,就不可疏利”的话吗?大概庸医往往看见是疮疹就给泻下,说能使疮疹发出得快,所以多有误治。钱乙的说法说这是天行疫病,只用温凉药治疗,不可妄用泻下及妄用攻发。又何曾有这种证候不得疏利的言语呢?妄用泻下与疏利不可同日而语。至于像初虞世仍然误解其意,乃将疮疹比作伤寒,到了阳明经也用利药,殊不知伤寒到了阳明经则适宜用下法。既然庸医不懂古人的本意,又让善于医术的人以此印证他们的说法而不怀疑其为非,所以我特意为此辩明。在疮疹之初,果真有这些证候,就适宜给予疏利,只是不可使用泻下罢了。
《圣惠方》治疗小儿热毒旺盛,发疹痘疮,初发早觉的,适宜服用此方。
用上等黄连一两,去掉须根,捣碎、筛成散剂。每次服用一钱,用水一小盏,煎至五分,去渣。不分时候,根据孩子的大小减量温热服用。
《圣惠方》又一方
用上等波斯青黛如枣核大小,用水调服。(《疹痘论》相同,用温热的磨刀水调下。)
《疹痘论》当归散方
川当归(一两) 甘草(一分)
以上研为细末。每次服用二钱,水一中盏,豆豉十粒,同煎至六分,去渣。根据孩子的大小服用,以利动为度,每天冷吃甘草汁。三岁以下一岁以上加减服用。
《疹痘论》:如果疮候未化脓,心膈干燥,睡不安稳的方子。
用上等黑豆煮汁温热,徐徐服用也能缓解。
《疹痘论》又:凡是有时气天行疮痘的,就要紧急预先准备豆汤。
小豆 黑豆 绿豆(各半升) 甘草(一两,炙)
以上用水九升煮,等到豆子煮熟为止。每天空腹,任意饮用。七日后,疮疹必定发出顺畅。
*Shenghui Fang*: For weaned infants and children suffering from rash and smallpox diseases, the initial stage often resembles Taiyang disease (a syndrome caused by pathogenic factors affecting the Taiyang meridian). The complexion and limbs are both red, with high fever, headache, pain in the waist and back, coldness in the feet, and yellow eyes. The pulse is mostly surging and rapid, extremely large and irregular; urine is dark red and scanty, and stool is mostly constipated. As soon as the color of the limbs and the pulse indicate a rash or smallpox disease, but the pathogen has not yet attacked the skin pores to emerge, medication can be administered. Harmonize the Zang-Fu organs, and use methods to unblock and guide downward. If the rash has already formed at the skin pores and seems slightly ready to emerge, do not use unblocking and purging methods. However, if the rash is too abundant or the pustules contain pus and fluid, unblocking and guiding downward may be used.
*Wangshi Shouji*: Those who discuss sores and rashes generally rely on ancient texts, considering it incorrect to use unblocking and guiding methods immediately upon detection. They cite Qian Yi's theory that treating with warm and cool medicines without reckless purging is correct. Thus, they believe that the reason modern children with sores and rashes survive without sudden death is due to Qian Yi's merit. Since children's intestines and stomachs are delicate, reckless purging leads to internal deficiency, causing heat pathogens to retreat inward, which can be fatal. Therefore, deaths caused by the inversion of sores and rashes are attributed to the fault of purging. This view is indeed correct. However, failing to examine the words leads to losing their true meaning. It is unknown that what ancient texts call "unblocking and guiding" means first harmonizing Yin and Yang, regulating Ying and Wei (nutritive and defensive Qi), and then benefiting the Zang-Fu organs, so that heat pathogens gradually resolve. It also states: Infants naturally have excess Yang and deficient Yin. When the Qi of Zang-Fu organs and Yin-Yang becomes rebellious, bowel movements and urination are often blocked. Upon detecting this disease, one should immediately apply unblocking and guiding, resulting in a mild condition. Once the rash or smallpox has emerged, unblocking and guiding should not be used. Does this ever imply using purging when the rash emerges? Moreover, there is a vast difference between unblocking/guiding and purging. Unblocking and guiding uses light and cool herbs to gently promote drainage, such as Qingdai (Indigo Naturalis) and Huanglian (Coptidis Rhizoma); purging uses harsh and fast-acting drugs to forcefully drain downward, such as Badou (Crotonis Fructus) and Mangxiao (Natrii Sulfas); they cannot be compared. Ignorant physicians fail to understand the ancient intent and confuse unblocking/guiding with purging, leading to errors. Did they harmonize Yin and Yang and regulate Ying and Wei before purging? Was the child suffering from blocked urination and defecation? The phrase "upon detection" refers to the time when sores and rashes have not yet appeared. When physicians purge, do they know whether the sores and rashes have emerged or not? Do they know the saying "once the rash emerges, do not unblock or guide"? Often, ignorant physicians see sores and rashes and administer purging, claiming it helps them emerge quickly, thus causing many errors. Qian Yi stated that this is an epidemic disease, treatable only with warm and cool medicines, avoiding reckless purging and attacking/dispersing. Did he ever say such conditions should not be unblocked or guided? Reckless purging is not equivalent to unblocking and guiding. Even Chu Yushi misunderstood the intent, comparing sores and rashes to Taiyang disease and using draining medicines when reaching the Yangming stage, not realizing that for Taiyang disease reaching Yangming, purging is appropriate. Since ignorant physicians do not understand the ancient intent, and even skilled physicians verify these statements without doubting their correctness, I specifically clarify this. At the beginning of sores and rashes, if these symptoms exist, unblocking and guiding are suitable, but purging must be avoided.
*Shenghui Fang* treats children with excessive heat toxicity causing rash and smallpox, detected early in onset. This formula is suitable.
Take Huanglian (Coptidis Rhizoma) one liang, remove roots, crush, and sieve into powder. Take one qian per dose, decoct with one small cup of water until reduced to half a cup, remove dregs. Administer warm, adjusted according to the child's age and size, at any time.
Another formula from *Shenghui Fang*:
Take Boshi Qingdai (Persian Indigo Naturalis) the size of a date pit, mix with water and take orally. (Same as in *Zhen Dou Lun*, mixed with warm knife-sharpening water.)
*Danggui San* from *Zhen Dou Lun*:
Chuan Danggui (Angelicae Sinensis Radix) (one liang), Gancao (Glycyrrhizae Radix et Rhizoma) (one fen).
Grind into fine powder. Take two qian per dose, decoct with one medium cup of water and ten grains of Douchi (Fermented Soybean) until reduced to six-tenths, remove dregs. Dosage depends on the child's age. Stop when gentle drainage occurs. Drink Gancao juice (Licorice Juice) cold daily. Adjust dosage for children aged one to three years.
*Zhen Dou Lun*: For cases where sores have not yet suppurated, with dryness in the heart and diaphragm and restlessness during sleep.
Decoct Heidou (Sojae Semen Nigrum) in water, warm, and drink slowly to relieve symptoms.
*Zhen Dou Lun* again: For epidemic sores and rashes, urgently prepare Dou Tang (Bean Decoction) in advance.
Xiaodou (Adzuki Bean), Heidou (Black Bean), Lüdou (Mung Bean) (each half sheng), Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried) (one liang).
Decoct with nine sheng of water until beans are cooked. Drink freely on an empty stomach daily. After seven days, the sores and rashes will likely emerge smoothly.