小儿实热者，头昏颊赤，口内热，小便赤涩，状如豆汁，大便坚硬，或秘涩不
通，腹急，宜四顺饮子、大黄朴硝汤、八珍散，略挨动脏腑，即安。〔杨〕实则面
赤浓黄，气粗口热，燥渴唇肿，大小便难，掀揭露衣，烦啼暴叫，宜四顺清凉饮加
柴胡。薛氏又有伸体而卧，睡不露睛，手足指热等证。
按∶实中宜分表里，表实宜汗，里实宜下，半表半里宜和解，今一以利下为
主，非通论也。治法并方，更于后表里条内求之。云岐云∶小儿实热在内者，四
顺饮之类，在上者，吐之。丹溪云∶小儿热病，六一散妙药也。
〔茅先生〕三解牛黄散 治实热，潮热。
白僵蚕 全蝎（炙） 防风 白附子 桔梗 川大黄 甘草（炙） 白茯苓 川黄芩 人
参川郁金（皂角水煮）
等分，未服半钱一钱，薄荷蜜汤调。
牛黄凉膈丸 治风壅痰实，蕴积不散，头痛面赤，心烦潮热，痰涎壅塞，咽膈不利，
精神恍忽，睡卧不安，口干多渴，唇焦咽痛，颔颊赤肿，口舌生疮。
牛黄（一两一分） 甘草（ ，十两） 寒水石 牙硝（枯） 石膏（各二十两） 紫石英（飞）
脑麝（各五两） 胆星（柒两半）
末之，蜜丸，每两作三十丸。温薄荷人参汤、嚼一丸，食后服。常服，半丸。
治急惊，并薄荷水化。
小儿实热证，表现为头部昏沉、两颊潮红、口腔内发热、小便短赤且排尿涩痛，尿液浑浊状如豆汁，大便干结坚硬，或便秘不通，腹部拘急疼痛。治疗适宜使用四顺饮子、大黄朴硝汤、八珍散，稍通导脏腑积滞，即可安宁。〔杨氏〕认为：实证见面色深红兼黄浊，呼吸粗重，口中有热气，烦躁口渴，嘴唇肿胀，大小便困难，掀开衣物，烦躁啼哭甚至暴怒大叫。适宜用四顺清凉饮加柴胡。薛氏又有身体伸展而卧，睡眠时眼睛不睁开（露睛），手足指尖发热等证候。
按语：实证中应当区分表里，表实证适宜发汗解表，里实证适宜攻下通便，半表半里证适宜和解少阳。如今一概以通利攻下为主，并非通论。治法及方剂，可于后文“表里”条中查找。云岐说：小儿实热在体内的，用四顺饮之类；实热在上焦的，用吐法。丹溪说：小儿热病，六一散是妙药。
〔茅先生〕三解牛黄散，治疗实热、潮热。
药材：白僵蚕、全蝎（炙）、防风、白附子、桔梗、川大黄、甘草（炙）、白茯苓、川黄芩、人参、川郁金（用皂角水煮）。
以上药材等分，未服用前每次服半钱至一钱，用薄荷蜜汤调服。
牛黄凉膈丸，治疗风壅痰实，蕴积不散，头痛面赤，心烦潮热，痰涎壅塞，咽喉膈部不利，精神恍惚，睡卧不安，口干多渴，唇焦咽痛，下颌脸颊赤肿，口舌生疮。
药材：牛黄（一两一分）、甘草（十两）、寒水石、牙硝（枯）、石膏（各二十两）、紫石英（飞研）、脑麝（各五两）、胆星（七两半）。
研为细末，蜂蜜炼丸，每两药粉作三十丸。饭后温薄荷人参汤送服一丸，嚼碎更佳。常服者，服半丸。治疗急惊风，并用薄荷水化开服用。
For pediatric excess-heat syndromes, manifestations include dizziness (tou hun), flushed cheeks (jia chi), heat in the mouth (kou nei re), dark and scanty urine with dysuria (xiao bian chi se), urine turbid like bean juice (zhuang ru dou zhi), hard or constipated stools (da bian jian ying), abdominal urgency (fu ji). Treatment is suitable with Sishun Yinzi (Four-Obedience Decoction), Dahuang Puxiao Tang (Rhubarb and Niter Decoction), Bazhen San (Eight-Treasure Powder); slightly moving the accumulation in the Zang-Fu organs will bring relief. [Yang] states: Excess syndromes present with deep red and yellowish complexion (mian chi nong huang), coarse breathing (qi cu), oral heat (kou re), dryness and thirst (zao ke), swollen lips (chun zhong), difficulty in urination and defecation (da xiao bian nan), uncovering clothes due to heat (xian lou jie yi), irritability, crying, and sudden shouting (fan ti bao jiao). Treatment is suitable with Sishun Qingliang Yin (Four-Obedience Cooling Decoction) added with Chaihu (Bupleuri Radix). Xue also describes symptoms such as lying with body extended (shen ti er wo), eyes not opening during sleep (shui bu lu jing), and heat in the fingertips of hands and feet (shou zu zhi re).
Commentary: Excess syndromes should be differentiated into exterior and interior. Exterior excess requires sweating (han), interior excess requires purgation (xia), and half-exterior half-interior requires harmonization (he jie). To treat all with purgation as the primary method is not a universal principle. For treatment methods and formulas, refer to the "Exterior and Interior" section later. Yun Qi said: For pediatric excess-heat located internally, use decoctions like Sishun Yin; for excess-heat located superiorly, use emesis (tu). Dan Xi said: For pediatric heat diseases, Liuyi San (Six-Ingredient Powder) is an excellent remedy.
[Mao Xiansheng] Sanjie Niuhuang San (Three-Resolving Calculus Bezoar Powder), treating excess-heat and tidal fever (chao re).
Herbs: Bai Jiangcan (Bombyx Batryticatus), Quanxie (Scorpio), Fangfeng (Saposhnikoviae Radix), Baifuzi (Aconiti Kusnezoffii Rhizoma), Jiegeng (Platycodonis Radix), Chuan Dahuang (Rhei Radix et Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma, prepared), Baifuling (Poria), Chuan Huangqin (Scutellariae Radix), Renshen (Ginseng Radix), Chuan Yujin (Curcumae Radix, boiled with Gleditsiae Sinensis Fructus water).
Equal parts. Before administration, take 0.5 qian to 1 qian per dose, mixed with honey water infused with Bohe (Menthae Haplocalycis Herba).
Niuhuang Liangge Wan (Bezoar Cooling Diaphragm Pill), treating wind-phlegm obstruction and phlegm-excess, accumulation failing to disperse, headache (tou tong) and flushed face (mian chi), mental restlessness (xin fan) and tidal fever (chao re), phlegm-saliva obstruction (tan xian yong sai), throat and diaphragm discomfort (yan ge bu li), vague spirit (jing shen huang hu), restless sleep (shui wo bu an), dry mouth and excessive thirst (kou gan duo ke), scorched lips and sore throat (chun jiao yan tong), swollen red mandible and cheeks (han jia chi zhong), sores on mouth and tongue (kou she sheng chuang).
Ingredients: Niuhuang (Calculus Bovis, 1 liang 1 fen), Gancao (Glycyrrhizae Radix et Rhizoma, 10 liang), Hanshuishi (Aqua Stibitum), Yaxiao (Natrii Sulfas, calcined), Shigao (Gypsum Fibrosum, each 20 liang), Zhi Shiyuan (Quartzum Roseum, refined), Naoshe (Camphora and Moschus, each 5 liang), Danning (Arisaematis Cum Bile, 7.5 liang).
Grind into powder, make pills with honey. Each liang of powder makes 30 pills. Take one pill after meals, chewed, with warm Bohe and Renshen tea. For regular maintenance, take half a pill. For acute convulsions (ji jing), dissolve in Bohe water.