阳水身热脉沉数,小便赤涩大便难,热盛烦渴浚川散,湿盛胀满神 丸,量儿大小斟酌
用,应变而施勿一偏。
【注】阳水者,小儿湿热内郁,水道阻塞,外攻肌表,以致外肿内胀,发热口渴,心烦,
小便短赤,大便秘结。法当泄水,不可少缓。热盛烦渴者,以大圣浚川散攻之;湿盛胀满
者,舟车神 丸攻之。须量儿大小,视病轻重,合宜而用,勿执一偏过于峻攻,徒伤正气也。
大圣浚川散
川大黄(煨) 牵牛(取头末) 郁李仁(各一两) 木香(三钱) 芒硝(三钱) 甘遂(五
分)
共为细末,姜汤调下,量儿大小用之。
舟车神 丸(方见风湿肿)
阴水便利不烦热,须服实脾肾气丸,若服温补俱无验,攻补兼施病始痊。
【注】阴水者,因脾肾虚弱也。脾虚不能制水,肾虚不能主水,以致外泛作肿,内停
作胀,若二便不实,身不热,心不烦者,宜用实脾散、金匮肾气丸。若服温补之药而无
效验者,则是虚中有实也。欲投攻下之剂,恐小儿难堪;若不攻之,又岂可坐以待毙。须
攻补兼施,或一补一攻,或二补一攻,或九补一攻,审其进退,俟有可攻之机,以意消
息。药与元气相当,始能逐邪而不伤正也。必须忌盐酱百日,方可收功。
实脾散
草果仁(研) 大腹皮 木瓜 茯苓 木香(研) 浓朴(姜炒) 干姜 附子(制) 白术(土炒)
甘草(炙)
引用枣二枚,水煎服。
【方歌】实脾散治阴水肿,草果大腹木瓜香,浓朴姜附术苓草,虚者仍兼肾气方。
金匮肾气丸
熟地黄(一两) 山药(炒八钱) 山茱萸(八钱) 牡丹皮(五钱) 茯苓(一两) 泽泻(五
钱) 肉桂(五钱) 淡附子(五钱) 车前子(五钱) 牛膝(八钱)
共为细末,炼蜜为丸,如梧桐子大,每服钱半,白滚水送下。
阳水证表现为身体发热、脉象沉而数,小便赤红涩痛、大便困难。若热邪炽盛导致烦躁口渴,宜用大圣浚川散;若湿邪盛导致腹部胀满,宜用舟车神祐丸。需根据患儿年龄大小斟酌用量,灵活施治,不可偏执一端。
【注】所谓阳水,是指小儿体内湿热郁结,水道阻塞,邪气外攻肌表,从而导致体表浮肿、内部胀满,伴有发热、口渴、心烦、小便短赤、大便秘结等症状。治疗法则应当泄除水湿,不可稍有迟缓。对于热盛且烦躁口渴者,使用大圣浚川散进行攻逐;对于湿盛且腹部胀满者,使用舟车神祐丸进行攻逐。必须衡量患儿的年龄大小,观察病情的轻重,选择合适的药物使用,不要固执于单一方法而过度峻猛攻伐,以免徒然损伤正气。
大圣浚川散
药材包括:煨制的大黄、取头末的牵牛子、郁李仁(各一两)、木香(三钱)、芒硝(三钱)、甘遂(五分)。
将上述药材共研为细末,用姜汤调服,根据患儿年龄大小决定用量。
阴水证表现为二便通利、无烦躁和发热症状,须服用实脾散或金匮肾气丸。如果单纯服用温补药物没有疗效,则需采用攻补兼施的方法,疾病才能痊愈。
【注】所谓阴水,是由于脾肾虚弱所致。脾虚不能制约水液,肾虚不能主司水液代谢,从而导致水液外泛引起浮肿,内停引起胀满。如果患者二便不实(此处指非秘结之实证,结合语境指无明显实热闭结之象,或指二便情况与阳水不同),身体不发热,心中不烦躁,适宜使用实脾散和金匮肾气丸。如果服用温补药物却无效,说明是虚中夹实。此时若想投用攻下之剂,担心小儿难以承受;若不攻逐邪气,又岂能坐以待毙。因此必须攻补兼施,或者一补一攻,或者二补一攻,或者九补一攻,审慎判断病势进退,等待可以攻邪的时机,根据具体情况灵活调整。药力与元气相当,才能驱逐邪气而不损伤正气。必须忌食盐和酱类一百天,才能取得疗效。
实脾散
药材包括:草果仁(研碎)、大腹皮、木瓜、茯苓、木香(研碎)、浓朴(姜炒)、干姜、附子(制)、白术(土炒)、甘草(炙)。
引用大枣两枚,加水煎服。
【方歌】实脾散治疗阴水肿,含有草果、大腹皮、木瓜、木香,以及浓朴、干姜、附子、白术、茯苓、甘草,体虚者仍应配合肾气丸使用。
金匮肾气丸
药材包括:熟地黄(一两)、山药(炒八钱)、山茱萸(八钱)、牡丹皮(五钱)、茯苓(一两)、泽泻(五钱)、肉桂(五钱)、淡附子(五钱)、车前子(五钱)、牛膝(八钱)。
将上述药材共研为细末,用炼蜜制成丸药,大小如梧桐子,每次服用半钱至一钱半,用白开水送服。
Yang Water presents with fever, a deep and rapid pulse, red and scanty urine with dysuria, and difficult defecation. If heat is excessive causing restlessness and thirst, Dasheng Xuan Chuan San (Great Sage Purging River Powder) should be used; if dampness is excessive causing abdominal distension, Zhou Che Shen You Wan (Boat-Traveling Divine佑 Pill) should be used. The dosage must be adjusted according to the child's age, and treatment should be flexible without bias.
[Note] Yang Water refers to internal stagnation of damp-heat in children, blocking the water passages, with pathogenic factors attacking the muscle layer externally, resulting in external edema and internal distension, accompanied by fever, thirst, restlessness, short and red urine, and constipation. The therapeutic principle is to drain water, allowing no delay. For cases with excessive heat and restlessness/thirst, Dasheng Xuan Chuan San is used for purgation; for cases with excessive dampness and distension, Zhou Che Shen You Wan is used for purgation. One must consider the child's age and the severity of the illness, using appropriate remedies cautiously. Do not adhere rigidly to one method or use overly harsh purgatives, which would merely damage the healthy Qi.
Dasheng Xuan Chuan San (Great Sage Purging River Powder)
Ingredients: Rhizoma et Radix Rhei Preparata (prepared Rhubarb), Semen Trichosanthis (Tian Hua Fen - *Note: Text says Qian Niu, usually Semen Pharbitidis*, but strictly translating text: Semen Pharbitidis [Qian Niu], Fructus Pruni Armeniacae Amarum (Yu Li Ren) (each 1 liang), Lignum Aucklandiae (Mu Xiang) (3 qian), Natrii Sulfas (Mang Xiao) (3 qian), Radix Kansui (Gan Sui) (5 fen).
Grind all ingredients into fine powder. Take with ginger decoction, adjusting dosage according to the child's age.
Zhou Che Shen You Wan (Boat-Traveling Divine佑 Pill) (See formula under "Wind-Damp Edema")
Yin Water presents with normal bowel movements and urination, absence of restlessness and fever. Shipi San (Realize the Spleen Powder) or Jin Gui Shen Qi Wan (Golden Cabinet Kidney Qi Pill) should be administered. If warm tonification yields no effect, simultaneous attack and tonification are required for recovery.
[Note] Yin Water is caused by deficiency of the Spleen and Kidney. Spleen deficiency fails to control water, and Kidney deficiency fails to govern water metabolism, leading to external edema and internal distension. If there is no constipation/obstruction in bowels/bladder, no body heat, and no mental restlessness, Shipi San and Jin Gui Shen Qi Wan are suitable. If warm tonifying herbs prove ineffective, it indicates deficiency mixed with excess. While administering purgative agents may be difficult for a child to tolerate, failing to purge leaves no choice but to wait passively for death. Therefore, simultaneous attack and tonification are necessary: perhaps one part tonification to one part attack, two parts tonification to one part attack, or nine parts tonification to one part attack. Carefully assess the progression and regression of the disease, waiting for the opportune moment to attack, adjusting based on clinical signs. When the medicinal strength matches the Healthy Qi, pathogens can be expelled without damaging the Healthy Qi. Salt and soy sauce must be avoided for 100 days to achieve success.
Shipi San (Realize the Spleen Powder)
Ingredients: Fructus Tsaoko (Cao Guo Ren), Pericarpium Citri Reticulatae Viride (Da Fu Pi), Fructus Chaenomelis (Mu Gua), Poria (Fu Ling), Lignum Aucklandiae (Mu Xiang), Cortex Magnoliae Officinalis (Nong Po), Rhizoma Zingiberis Recens (Gan Jiang), Radix Aconiti Lateralis Preparata (Fu Zi), Rhizoma Atractylodis Macrocephalae (Bai Zhu), Radix Glycyrrhizae Preparata (Gan Cao).
Add two Jujubes (Da Zao), decoct in water, and take orally.
[Formula Song] Shipi San treats Yin Water edema, containing Caoguo, Dafupi, Mu Gua, Muxiang, Nongpo, Ganjiang, Fuzi, Baizhu, Fuling, and Gancao; for deficient cases, still combine with Shenqi Fang.
Jin Gui Shen Qi Wan (Golden Cabinet Kidney Qi Pill)
Ingredients: Radix Rehmanniae Preparata (Shu Dihuang), Rhizoma Dioscoreae (Shanyao), Fructus Corni (Shanzhuyu), Cortex Moutan (Mudanpi), Poria (Fuling), Radix Alismatis (Zexie), Ramulus Cinnamomi (Rougui), Radix Aconiti Lateralis Preparata (Dan Fuzi), Semen Plantaginis (Cheqianzi), Radix Achyranthis Bidentatae (Niuxi).
Grind all ingredients into fine powder, mix with refined honey to make pills the size of Sophora japonica seeds. Take 1.5 qian per dose, washed down with plain boiled water.