夫初生小儿藉乳为命,其哺乳之法,不可不慎。(批∶不特乳要慎,而小儿乳母亦要留心,凡乳母禀赋之浓薄,性
情之缓急,骨相之坚脆,德性之善恶,儿能连背,大为关系,不知渐染,既久识性不问,犹如接木之造化然也,故亦不
可不择信哉。)盖乳者,荣血之所化也,故乳母尤宜谨节,饮食下咽,乳汁便通,情欲动中,乳汁便应,病气到乳汁必
凝滞,儿得此乳,疾病立至。不吐则泻,不疮则疖,或为口糜,或为惊搐,或为夜啼,或为腹痛。病之初来,其溺必甚
少,便须询问端的,随症调治,母安则子安,可消患于未形也。故乳母夏不欲热,热则致吐逆;冬不欲寒,寒则致咳痢;
母不欲怒,怒则上气癫狂;母不欲醉,醉则令身热腹痛。母方吐下而乳,则致虚羸。母有积热而乳,则变黄不能食。新
房而乳,则瘦脊交颈不能行。新浴而乳,则发吐 神困。伤热乳则泻黄,伤冷乳则泻青。冷热不调停积胸膈,结为痰饮,
遂成壮热。壮热不已,乃成惊痫。儿啼未定,遽以乳哺,气逆不消,因成乳癖。怀妊而乳,至令黄瘦、腹大、脚弱,名
曰病。大抵哺乳不可太饱,故俗云∶若要小儿安,须带三分饥与寒是也。
巢氏曰∶小儿初生肌肤未实,宜用旧絮护其背,不可太暖,更宜数见风日,则血气刚强,肌肉致密。若藏于重帏
密室,或浓衣过暖,则筋骨软脆,不任风寒,多易致病。衣服当随寒热加减,但令背暖为佳,亦勿令出汗,恐表虚风邪
易伤。哺乳亦不宜过饱,若宿滞不化,用消乳丸治之。陈氏所谓忍三分寒,吃七分饱,频揉肚,少洗浴,要肚暖、头凉,
皆至论也。须令乳母预慎七情六淫、浓味炙 ,则乳汁清宁,儿不致疾,否则阴阳偏胜,气血沸腾,乳汁败坏,必生诸
症。若屡用药饵,则脏腑阴损,多变败症,可不慎欤。大抵保婴之法,未病则调治乳母,既病则审治孩儿,亦必兼治其
母为善。
〔附方〕
消乳丸 见初生诸症内。
初生的婴儿依靠乳汁维持生命,因此哺乳的方法不可不谨慎。(批注:不仅乳汁要慎重选择,而且对小儿的乳母也要留心关注。凡是乳母体质的浓烈或薄弱、性情的急躁或温和、骨骼相体的坚固或脆弱、品德的善良或邪恶,婴儿都能通过背部接触感知到,这有着重大的关系。如果不知道这种潜移默化的影响,久而久之就会改变孩子的性格,就像嫁接树木一样自然形成,所以也不能不慎重地选择乳母啊。)
乳汁是由荣血转化而来的,所以乳母尤其应当谨慎节制。饮食咽下后,乳汁便随之通畅;情欲在心中萌动时,乳汁便会相应变化;病气侵入体内,乳汁必然凝滞。婴儿得到这样的乳汁,疾病就会立刻发生。不是呕吐就是腹泻,不是生疮就是长疖子,或者成为口糜,或者出现惊厥抽搐,或者夜间啼哭,或者腹痛。疾病刚发生时,婴儿的小便一定很少,这时必须询问清楚病因,根据症状进行调治。母亲平安则孩子平安,可以在疾病未显现之前消除隐患。
所以,乳母夏天不宜过热,过热会导致呕吐逆气;冬天不宜过寒,过寒会导致咳嗽和痢疾;母亲不宜发怒,发怒会导致气机上逆甚至癫狂;母亲不宜醉酒,醉酒会导致身体发热和腹痛。母亲正在呕吐或腹泻时喂奶,会导致婴儿虚弱消瘦。母亲有积热时喂奶,会导致婴儿面色发黄且不能进食。母亲刚进入新房(新婚)时喂奶,会导致婴儿脊背瘦弱、颈部僵硬无法行走。母亲刚洗完澡时喂奶,会导致婴儿呕吐、精神困倦。受热的乳汁会导致婴儿泻出黄色粪便,受冷的乳汁会导致婴儿泻出青色粪便。冷热不调停蓄积在胸膈,凝结成痰饮,最终形成高热。高热不止,就会发展成惊痫。婴儿啼哭未定,就急于喂奶,导致气逆不消,因而形成乳癖(乳房肿块)。母亲怀孕时喂奶,会导致婴儿后来面色黄瘦、腹部胀大、脚部无力,这被称为“病”(此处指因哺乳期不当导致的特定病症)。
大体上哺乳不可让婴儿吃得太饱,所以俗语说:“若要小儿安,须带三分饥与寒。”
巢元方说:婴儿初生时肌肤尚未结实,应用旧棉絮保护其背部,不可太暖,更应经常接触风和阳光,这样气血才能刚强,肌肉才能致密。如果藏在厚重的帷幔密室中,或者衣服过厚导致过热,就会导致筋骨软弱脆弱,不能抵御风寒,容易生病。衣服应当随着寒热情况增减,只要保持背部温暖即可,也不要让婴儿出汗,恐怕表虚导致风邪容易侵袭。哺乳也不宜过饱,如果有宿食停滞不化,用消乳丸治疗。陈氏所说的“忍受三分寒冷,吃七分饱,频繁揉肚子,少洗澡,要肚子暖、头凉”,都是至理名言。必须让乳母预先谨慎对待七情六淫和浓味炙烤的食物,这样乳汁才会清静安宁,婴儿才不会致病,否则阴阳偏胜,气血沸腾,乳汁败坏,必定产生各种病症。如果屡次用药饵治疗,则会损伤脏腑阴气,多变生败症,能不谨慎吗?大体上保婴的方法,未病时调理乳母,既病时审察治疗孩儿,也一定要兼治其母才是最好的。
〔附方〕
消乳丸 见初生诸症内。
Newborn infants rely on milk for life, therefore the method of nursing must not be treated lightly. (Commentary: It is not only the milk that requires caution, but also the nursemaid of the infant must be carefully selected. One must pay attention to the nursemaid's constitution [thick or thin], temperament [hasty or gentle], skeletal structure [firm or fragile], and moral character [good or evil]. The infant can perceive these through back-to-back contact, which has a significant relationship. If one is unaware of this gradual influence, over time it will shape the child's nature, just as grafting trees works naturally; thus, selection cannot be neglected.) Milk is transformed from Ying Blood (Nutritive Blood), so the nursemaid should exercise particular restraint. Once food is swallowed, the milk flow responds; when desires stir within, the milk reacts accordingly; when pathogenic qi enters, the milk becomes stagnant. If the infant receives such milk, disease will arise immediately. There will be either vomiting or diarrhea, sores or boils, aphthous ulcers in the mouth, convulsions, night crying, or abdominal pain. At the onset of illness, the infant's urine output will be very low; one must inquire into the exact cause and treat according to symptoms. If the mother is safe, the child is safe; this prevents disaster before it manifests.
Therefore, in summer, the nursemaid should not be too hot, as heat leads to vomiting and reflux; in winter, she should not be too cold, as cold leads to cough and dysentery; the mother should not be angry, as anger causes Qi to rise upward leading to mania; the mother should not be drunk, as drunkenness causes body heat and abdominal pain. Nursing while the mother is vomiting or purging leads to emaciation. Nursing while the mother has accumulated heat results in jaundice and anorexia. Nursing after the mother's new marriage leads to a lean spine and stiff neck preventing walking. Nursing after the mother has taken a bath causes vomiting and mental fatigue. Milk affected by heat causes yellow diarrhea; milk affected by cold causes green diarrhea. Improper regulation of cold and heat accumulates in the chest and diaphragm, condensing into Phlegm-Fluids, eventually forming high fever. Unrelenting high fever develops into Convulsive Epilepsy. Feeding an infant who has not yet stopped crying causes Qi reversal and stagnation, resulting in Breast Masses (Ru Pi). Nursing while pregnant leads to later jaundice, leanness, abdominal distension, and weak legs, termed "Bing" (Disease). Generally, nursing should not make the infant too full; hence the proverb: "If you want the infant to be peaceful, keep them slightly hungry and cool."
Chao Yuanfang stated: Newborns have unconsolidated skin and flesh; old cotton wadding should be used to protect their backs, avoiding excessive warmth. They should frequently be exposed to wind and sunlight so that Blood and Qi become strong and muscles dense. If kept in heavy curtains and sealed rooms, or dressed too warmly, bones and tendons become soft and fragile, unable to resist Wind-Cold, making them prone to disease. Clothing should be adjusted with temperature changes, keeping the back warm is best, but avoid sweating, lest Wei Qi deficiency allow Wind Pathogens to invade easily. Nursing should not be excessive; if there is retained undigested food, Xiao Ru Wan (Milk-Dissolving Pill) should be used. Chen's saying, "Endure three parts cold, eat seven parts full, frequently rub the belly, bathe less, keep the belly warm and head cool," are all profound truths. The nursemaid must prudently avoid the Seven Emotions, Six Exogenous Pathogens, and rich/fried foods, so that the milk remains clear and tranquil, preventing disease in the child. Otherwise, Yin and Yang become imbalanced, Blood and Qi boil, the milk spoils, and various syndromes arise. Frequent use of medicinal herbs damages Zang-Fu Yin, leading to complex refractory syndromes; how can one not be cautious? Generally, the method of protecting infants involves regulating the nursemaid before illness occurs, and treating the child after illness arises, but it is best to treat the mother concurrently.
[Attached Formula]
Xiao Ru Wan (Milk-Dissolving Pill) See under Various Syndromes of Newborns.