（脾热附）
《巢氏病源》小儿胃中有热候∶小儿血气俱盛者，则脏腑皆实，故胃中生热。其状大便则黄，四肢温壮，翕
然体热。
钱乙论∶弄舌者，脾脏微热，令舌络微紧，时时舒舌。治之勿用冷药及下之，当少与泻黄散渐服之（方见本门。）
亦或饮水，医疑为热，必冷药下之者，非也。饮水者，脾胃虚，津液少也。又加面黄肌瘦，五心烦热，即为疳
瘦，宜胡黄连丸辈（胡黄连丸方见病后虚羸门中。）大病未已，用药弄舌者凶。
《婴童宝鉴》小儿胃热歌∶
胃热皆因气血强，四肢温壮小便黄，表里热时烦躁甚，渴多身体恰如汤。
《圣惠》治小儿胃中热，心腹烦闷，不欲乳食。麦门冬散方
麦门冬（去心，焙） 赤茯苓 黄芩 茅根（锉） 甘草（炙微赤，锉。以上各
半两） 芦根（二分，锉） 犀角（屑，一分）
上件药捣，粗罗为散。每服一钱，以水一小盏，入竹叶七片，煎至五分，去滓。不计时候，量儿大小，分减
温服。
《圣惠》治小儿胃中热，烦闷，不欲乳食，身体黄，多渴。栝蒌散方
栝蒌 芦根（锉） 柴胡（去苗） 黄芩（各三分） 川大黄（炒） 甘
草（炙） 川芒硝 麦门冬（去心，焙） 石膏（各半两）
上件药捣，粗罗为散。每服一钱，以水一小盏煎至五分，去滓温服。更量儿大小以意加减。
《圣惠》治小儿胃中热，烦闷不食。芦根散方
芦根（锉） 茅根 赤茯苓 黄芩 麦门冬（去心，焙） 甘草（炙微赤，锉。以上各半两）
上件药捣，粗罗为散。每服一钱，以水一小盏，入小麦五十粒、糯米五十粒、生姜少许，煎至五分，去滓。
量儿大小以意加减，温服。
《圣惠》治小儿胃中热，日渐肌瘦。栀子仁散方
栀子仁 甘草（炙） 黄连（去须） 黄芩（以上各半两）
上件药捣，粗罗为散。每服一钱，以水一小盏，煎至五分，去滓。量儿大小以意加减，温服。
《圣惠》又方
甘草（炙微赤，锉） 川大黄（锉，微炒。各半两） 栝蒌根（三分）
上件药捣，粗罗为散。每服一钱，以水一小盏，煎至五分，去滓温服。量儿大小以意加减。
《婴孺》治小儿胃中热，便利赤黄而难，或四、五日乃便利，此为胃中热故也。
大黄（四两） 甘草（一两，炙） 栝蒌（二两） 枣（二个）
上以酒、水各一升，煮一升。服一鸡子许，日进三服。
钱乙论泻黄散 又名泻脾散
藿香叶（七钱） 山栀子仁（一两） 石膏（半两） 甘草（三两） 防风（去芦，切，焙，四两）
上锉，同蜜酒微炒香，为细末。每服一钱至二钱，水一盏，同煎至五分，温服清汁，无时。南方多以寒水
石为石膏，以石膏为寒水石，正与京师相反，乃大误也。盖石膏洁白坚硬，有墙壁；而寒水石则软烂，以手
可碎，外微青黑，中有细纹。方书中寒水石则火 用之，石膏则坚硬不可入火。如白虎汤用石膏，则能解肌
热，破痰，治头痛，若用寒水石则误矣。又有一等坚白全类石膏而方，敲之亦皆成方者，名方解石也，代石
膏用之。南人有不信此说者，孝忠尝相与同就京师大药肆中，买石膏、寒水石、方解石三种，又同诣惠民和剂局，
及访诸国医询证之，皆合此说，乃信服。孝忠顷编《保生信效方》已为辨论，恐小儿尤不可误，故复见于此。
钱乙藿香散 治脾胃虚有热，面赤，呕哕涎嗽及转过度者。
藿香（一分，用叶） 半夏（曲炒） 甘草（炙） 麦门冬（去心，焙干秤） 石膏（各半两）
上同为末。每服半钱至一钱，水一中盏，煎至七分，食前温服。
《活人书》甘露饮子 治胃中客热，口臭，不思饮食，或饥烦不欲食，齿龈肿疼，脓血，舌口咽中有疮，赤眼，
目睑重不欲开，疮疹已发未发并宜服。
熟干地黄 生干地黄 天门冬、麦门冬（各去心，焙） 枇杷叶（去毛） 枳壳（麸炒，
去瓤） 黄芩 石斛（去苗） 山茵陈 甘草（炙。各等分）
上为细末。每服二钱，水一盏，煎至六分，去滓温服，食后临卧。
《聚宝方》四倍散 治小儿胃热，咽喉不利，发歇如疟、喘。
真珠（末，四钱） 生犀（末，二钱） 香附子（一钱） 龙脑（半钱）
上四味为细末。一服一字，煎桃仁汤调下。乳母忌生冷。
《孔氏家传》治小儿脏腑不调，脾胃有热。大便黄色。
灯心（一把） 扁竹（一钱） 槐花（一钱） 甘草（炙，二钱）
上水三盏，同煎至一盏，去滓，温冷细服。
（脾热附）
《巢氏病源》中关于小儿胃中有热的证候：小儿如果血气旺盛，那么脏腑功能都充实，因此胃中会产生热邪。其症状表现为大便颜色发黄，四肢温暖且壮实，全身发热如同被覆盖般温热。
钱乙论述：弄舌（伸吐舌头玩耍），是脾脏有轻微热邪，导致舌部脉络轻微拘紧，不时地伸出舌头。治疗时不要使用寒凉药物或泻下法，应当少量给予泻黄散逐渐服用（方剂见本门）。
也有因饮水多，医生误认为是热证，必定用寒凉药泻下的，这是错误的。饮水多是因为脾胃虚弱，津液不足所致。如果再出现面色萎黄、肌肉消瘦、五心烦热（手心、脚心及心胸烦热），这就变成了疳瘦病，适宜使用胡黄连丸之类的方剂（胡黄连丸方见病后虚羸门中）。如果大病未愈，因用药不当导致弄舌的，预后凶险。
《婴童宝鉴》小儿胃热歌诀：
胃热皆因气血强盛，四肢温暖壮实小便发黄，表里俱热时烦躁严重，口渴多饮身体感觉像泡在热水中一样。
《圣惠方》治疗小儿胃中热，心腹烦闷，不想吃奶进食。麦门冬散方
麦门冬（去除心，焙干） 赤茯苓 黄芩 茅根（切碎） 甘草（炙至微红，切碎。以上各半两） 芦根（二分，切碎） 犀角（锉成屑，一分）
将上述药材捣碎，粗筛为散剂。每次服用一钱，用水一小盏，加入竹叶七片，煎煮至五分量，去渣。不限时候，根据孩子大小，酌情减量温服。
《圣惠方》治疗小儿胃中热，烦闷，不想吃奶进食，身体发黄，多口渴。栝蒌散方
栝蒌 芦根（切碎） 柴胡（去苗） 黄芩（各三分） 川大黄（炒） 甘草（炙） 川芒硝 麦门冬（去心，焙干） 石膏（各半两）
将上述药材捣碎，粗筛为散剂。每次服用一钱，用水一小盏煎煮至五分量，去渣温服。再根据孩子大小酌情加减。
《圣惠方》治疗小儿胃中热，烦闷不食。芦根散方
芦根（切碎） 茅根 赤茯苓 黄芩 麦门冬（去心，焙干） 甘草（炙至微红，切碎。以上各半两）
将上述药材捣碎，粗筛为散剂。每次服用一钱，用水一小盏，加入小麦五十粒、糯米五十粒、少许生姜，煎煮至五分量，去渣。根据孩子大小酌情加减，温服。
《圣惠方》治疗小儿胃中热，日渐肌肉消瘦。栀子仁散方
栀子仁 甘草（炙） 黄连（去须） 黄芩（以上各半两）
将上述药材捣碎，粗筛为散剂。每次服用一钱，用水一小盏，煎煮至五分量，去渣。根据孩子大小酌情加减，温服。
《圣惠方》又一方
甘草（炙至微红，切碎） 川大黄（切碎，微炒。各半两） 栝蒌根（三分）
将上述药材捣碎，粗筛为散剂。每次服用一钱，用水一小盏，煎煮至五分量，去渣温服。根据孩子大小酌情加减。
《婴孺方》治疗小儿胃中热，大便色赤黄且困难，或者四、五天才排便，这是因为胃中有热的原因。
大黄（四两） 甘草（一两，炙） 栝蒌（二两） 枣（二个）
以上用酒、水各一升，煮取一升。服用约鸡蛋大小的量，每日进三服。
钱乙论述泻黄散，又名泻脾散
藿香叶（七钱） 山栀子仁（一两） 石膏（半两） 甘草（三两） 防风（去芦头，切，焙干，四两）
切碎，同蜜酒微炒至香，研为细末。每次服用一钱至二钱，用水一盏，同煎至五分量，温服清汁，不拘时候。南方人多用寒水石代替石膏，把石膏当作寒水石，这与京师的做法正好相反，是大错误。因为石膏洁白坚硬，像墙壁一样；而寒水石则软烂，用手可碎，外表微青黑，中间有细纹。方书中说寒水石可以火煅用，石膏则坚硬不可入火。如白虎汤用石膏，能解肌热，破痰，治头痛，若用寒水石就错了。还有一类坚白色全像石膏，敲击也成方块的，名叫方解石，用来代替石膏使用。南方有人不信此说，孝忠曾与他们一同去京师大药肆中，购买石膏、寒水石、方解石三种，又一同前往惠民和剂局，并访问各位国医求证，结果都符合此说，于是信服。孝忠先前编撰《保生信效方》时已为此辩论过，恐怕对小儿尤其不能误用，所以再次见于此处。
钱乙藿香散，治疗脾胃虚而有热，面赤，呕哕涎嗽以及转筋过度者。
藿香（一分，用叶） 半夏（曲炒） 甘草（炙） 麦门冬（去心，焙干秤） 石膏（各半两）
同为细末。每次服用半钱至一钱，用水一中盏，煎至七分，食前温服。
《活人书》甘露饮子，治疗胃中客热，口臭，不思饮食，或饥烦不欲食，齿龈肿疼，脓血，舌口咽中有疮，赤眼，目睑重不欲开，疮疹已发未发并宜服。
熟干地黄 生干地黄 天门冬、麦门冬（各去心，焙干） 枇杷叶（去毛） 枳壳（麸炒，去瓤） 黄芩 石斛（去苗） 山茵陈 甘草（炙。各等分）
研为细末。每次服用二钱，用水一盏，煎至六分，去渣温服，食后临卧时服用。
《聚宝方》四倍散，治疗小儿胃热，咽喉不利，发作间歇如疟疾、气喘。
真珠（末，四钱） 生犀（末，二钱） 香附子（一钱） 龙脑（半钱）
以上四味研为细末。一次服用一字量，用桃仁汤调下。乳母忌食生冷。
《孔氏家传》治疗小儿脏腑不调，脾胃有热。大便黄色。
灯心草（一把） 扁竹（一钱） 槐花（一钱） 甘草（炙，二钱）
用水三盏，同煎至一盏，去渣，温冷后细细服用。
(Attached to Spleen Heat)
From *Chao Shi Bing Yuan* (Source of Diseases by Chao Yuanfang), regarding the condition of heat in the stomach of children: When a child's blood and qi are abundant, the zang-fu organs are all solid/excess, thus heat arises in the stomach. The presentation includes yellow stool, warm and robust limbs, and a generalized body heat that feels like being covered.
Qian Yi discusses: "Tongue-playing" (frequently protruding the tongue) is caused by slight heat in the spleen, making the tongue meridians slightly tight, causing the tongue to be extended occasionally. Treatment should not use cold medicines or purgatives; instead, give Xie Huang San (Drain Yellow Powder) gradually in small amounts (formula see this section).
Sometimes, excessive drinking of water occurs. Physicians may suspect heat and inevitably use cold purgatives, which is incorrect. Excessive drinking is due to deficiency of the spleen and stomach and scanty fluids. If accompanied by sallow complexion, emaciation, and five-palm heat (heat in palms, soles, and chest), it becomes Gan Emaciation (Infantile Malnutrition), suitable for Hu Huang Lian Wan (Coptis and Picrorhiza Pill) type formulas (Hu Huang Lian Wan formula see section on Post-illness Debility). If serious illness persists and medication induces tongue-playing, the prognosis is ominous.
From *Ying Tong Bao Jian*, Song on Infant Stomach Heat:
Stomach heat stems from strong blood and qi;
Limbs are warm and robust, urine is yellow.
When exterior and interior heat prevail, irritability is severe;
Thirst is great, body feels as if soaked in hot soup.
From *Sheng Hui Fang*, treating infant stomach heat with heart/abdominal vexation, aversion to milk/food. Mai Men Dong San (Ophiopogon Decoction):
Mai Men Dong (Ophiopogonis Radix, remove heart, roast) Chi Fu Ling (Poria Cocos with Red Bark) Huang Qin (Scutellariae Radix) Mao Gen (Imperatae Rhizoma, chop) Gan Cao (Glycyrrhizae Radix et Rhizoma, honey-fried until slightly red, chop. Each half liang above) Lu Gen (Phragmitis Rhizoma, two fen, chop) Xi Jiao (Rhinocerotis Cornu, shaved, one fen)
Crush the above herbs, sift coarsely into powder. Take one qian per dose, with one small cup of water, add seven leaves of Zhu Ye (Bambusae Folium), decoct to half a cup, strain. Take at any time, adjust amount according to child's size, take warm.
From *Sheng Hui Fang*, treating infant stomach heat with vexation, aversion to milk/food, yellowish body, excessive thirst. Gua Lou San (Trichosanthis Fructus Powder):
Gua Lou (Trichosanthis Fructus) Lu Gen (Phragmitis Rhizoma, chop) Chai Hu (Bupleuri Radix, remove sprout) Huang Qin (Scutellariae Radix) Chuan Da Huang (Rhei Radix et Rhizoma, stir-fried) Gan Cao (Glycyrrhizae Radix et Rhizoma, honey-fried) Chuan Mang Xiao (Natrii Sulfas) Mai Men Dong (Ophiopogonis Radix, remove heart, roast) Shi Gao (Gypsum Fibrosum. Each half liang)
Crush the above herbs, sift coarsely into powder. Take one qian per dose, with one small cup of water, decoct to half a cup, strain, take warm. Adjust dosage according to child's size.
From *Sheng Hui Fang*, treating infant stomach heat with vexation and anorexia. Lu Gen San (Phragmitis Rhizoma Powder):
Lu Gen (Phragmitis Rhizoma, chop) Mao Gen (Imperatae Rhizoma) Chi Fu Ling (Poria Cocos with Red Bark) Huang Qin (Scutellariae Radix) Mai Men Dong (Ophiopogonis Radix, remove heart, roast) Gan Cao (Glycyrrhizae Radix et Rhizoma, honey-fried until slightly red, chop. Each half liang above)
Crush the above herbs, sift coarsely into powder. Take one qian per dose, with one small cup of water, add fifty grains of Xiao Mai (Tritici Fructus), fifty grains of Nuo Mi (Oryza Sativa Glutinosa), and a little Sheng Jiang (Zingiberis Rhizoma Recens), decoct to half a cup, strain. Adjust dosage according to child's size, take warm.
From *Sheng Hui Fang*, treating infant stomach heat with gradual emaciation. Zhi Zi Ren San (Gardeniae Semen Powder):
Zhi Zi Ren (Gardeniae Fructus) Gan Cao (Glycyrrhizae Radix et Rhizoma, honey-fried) Huang Lian (Coptidis Rhizoma, remove roots) Huang Qin (Scutellariae Radix. Each half liang above)
Crush the above herbs, sift coarsely into powder. Take one qian per dose, with one small cup of water, decoct to half a cup, strain. Adjust dosage according to child's size, take warm.
From *Sheng Hui Fang*, another prescription:
Gan Cao (Glycyrrhizae Radix et Rhizoma, honey-fried until slightly red, chop) Chuan Da Huang (Rhei Radix et Rhizoma, chop, lightly stir-fried. Each half liang) Gua Lou Gen (Trichosanthis Radix, three fen)
Crush the above herbs, sift coarsely into powder. Take one qian per dose, with one small cup of water, decoct to half a cup, strain, take warm. Adjust dosage according to child's size.
From *Ying Ru Fang*, treating infant stomach heat where stool is reddish-yellow and difficult, or defecation occurs only after four or five days, due to stomach heat.
Da Huang (Rhei Radix et Rhizoma, four liang) Gan Cao (Glycyrrhizae Radix et Rhizoma, honey-fried, one liang) Gua Lou (Trichosanthis Fructus, two liang) Zao (Jujubae Fructus, two pieces)
Boil the above with one sheng of wine and one sheng of water until reduced to one sheng. Take an amount equivalent to a chicken egg, three times a day.
Qian Yi discusses Xie Huang San (Drain Yellow Powder), also known as Xie Pi San (Drain Spleen Powder):
Huo Xiang Ye (Agastaches Herba, seven qian) Shan Zhi Zi Ren (Gardeniae Fructus, one liang) Shi Gao (Gypsum Fibrosum, half liang) Gan Cao (Glycyrrhizae Radix et Rhizoma, three liang) Fang Feng (Saposhnikoviae Radix, remove radicle, cut, roast, four liang)
Cut, stir-fry lightly with honey and wine until fragrant, grind into fine powder. Take one to two qian per dose, with one cup of water, decoct to half a cup, take the clear liquid warm, at any time. In the south, Han Shui Shi (Natronum) is often used instead of Shi Gao, and Shi Gao is mistaken for Han Shui Shi, which is opposite to the practice in the capital and a major error. Shi Gao is white, hard, and solid like a wall; Han Shui Shi is soft and crumbly, breakable by hand, externally slightly green-black with fine internal veins. Formulary texts state Han Shui Shi can be calcined, while Shi Gao is too hard for fire. For example, Bai Hu Tang (White Tiger Decoction) uses Shi Gao to relieve muscle heat, resolve phlegm, and treat headache; using Han Shui Shi would be erroneous. There is also a stone resembling Shi Gao in hardness and whiteness, breaking into square fragments when struck, called Fang Jie Shi (Calcitum), used to substitute Shi Gao. Some southerners did not believe this; Xiaozhong once went with them to a large pharmacy in the capital to buy Shi Gao, Han Shui Shi, and Fang Jie Shi, then visited the Huimin Heji Bureau and consulted various imperial physicians, all confirming this view, leading to their acceptance. Xiaozhong had previously debated this in *Bao Sheng Xin Xiao Fang*, fearing infants might be misled, hence repeating it here.
Qian Yi's Huo Xiang San (Agastache Powder), treating spleen/stomach deficiency with heat, flushed face, vomiting/regurgitation with saliva/cough, and excessive convulsions/tetany.
Huo Xiang (Agastaches Herba, one fen, use leaf) Ban Xia (Pinelliae Rhizoma, processed with yeast) Gan Cao (Glycyrrhizae Radix et Rhizoma, honey-fried) Mai Men Dong (Ophiopogonis Radix, remove heart, roast dry) Shi Gao (Gypsum Fibrosum. Each half liang)
Grind together into powder. Take half to one qian per dose, with one medium cup of water, decoct to seven-tenths, take warm before meals.
From *Huo Ren Shu*, Gan Lu Yin Zi (Sweet Dew Decoction), treating guest-heat in the stomach, bad breath, loss of appetite, or hunger with vexation but no desire to eat, swollen/painful gums with pus/blood, ulcers in tongue/mouth/throat, red eyes, heavy eyelids unwilling to open. Suitable for both erupted and unerupted rashes.
Shu Di Huang (Prepared Rehmanniae Radix) Sheng Di Huang (Rehmanniae Radix) Tian Men Dong (Asparagi Radix), Mai Men Dong (Ophiopogonis Radix. Each remove heart, roast) Pi Pa Ye (Loquat Leaf, remove hairs) Zhi Ke (Aurantii Fructus, bran-fried, remove pith) Huang Qin (Scutellariae Radix) Shi Hu (Dendrobii Caulis, remove sprout) Shan Yin Chen (Artemisiae Scopariae Herba) Gan Cao (Glycyrrhizae Radix et Rhizoma, honey-fried. Equal parts each)
Grind into fine powder. Take two qian per dose, with one cup of water, decoct to six-tenths, strain, take warm after meals and before bed.
From *Ju Bao Fang*, Si Bei San (Fourfold Powder), treating infant stomach heat, throat obstruction, intermittent symptoms like malaria, asthma.
Zhen Zhu (Pearl, powdered, four qian) Sheng Xi (Fresh Rhinoceros Horn, powdered, two qian) Xiang Fu Zi (Cyperi Rhizoma, one qian) Long Nao (Borneolum Syntheticum, half qian)
Grind the above four ingredients into fine powder. Take one zi (a very small measure) per dose, mixed with Tao Ren Tang (Apricot Seed Decoction). Nursing mothers must avoid raw/cold foods.
From *Kong Shi Jia Chuan*, treating infant organ dysfunction, spleen/stomach heat, yellow stool.
Deng Xin (Junci Medulla, one bundle) Bian Zhu (Smilax Glabra Rhizoma, one qian) Huai Hua (Sophorae Flos, one qian) Gan Cao (Glycyrrhizae Radix et Rhizoma, honey-fried, two qian)
Boil with three cups of water until reduced to one cup, strain, take warm or cool slowly.