初虞世曰。脾家微热。冷舌。络微紧。时时舒舌。微露即收。名弄舌。宜泻黄散。其欲饮水。脾胃
液少也。勿用冷药。反下舌肿硬。渐粗大满口。名木舌。由风热盛也。不急治。即塞杀人。宜当归散、
泻黄散、玉露饮。以消黄散擦舌上。有小舌附舌下近舌根处。名重舌。用苦竹沥浸黄柏末点舌上。
不效。真蒲黄敷之。不过三次愈。内服当归连翘汤。外点绿袍散亦可。盖舌者心之苗。心热则生疮
破裂。肝壅则血出如涌。脾闭则白苔如雪。总宜凉散上焦及心肝脾三经邪热。疏风化痰为主。
王汉东曰。肾主骨。齿者。骨之余也。小儿初生。肾气不足。则齿生迟缓。若肾经有热。上蒸于
齿。亦能令齿肿。以肾为胃关。故肾热易移于胃也。其由脾胃实火。作渴。口舌生疮。齿龈溃烂。
痛连头面。或恶寒发热。宜清胃散。若因脾胃气虚。寒凉克伐。或虚热上行。口舌生疮。弄舌发热。
或呕吐困倦。大便不实。流涎龈烂者。五味异功散。
谭殊圣曰。咽喉者。一身之总要。与胃气相接。呼吸之所从出也。凡小儿热毒蕴积于胸膈之
间。壅滞不散。发为咽喉之病。如单蛾、双蛾、重舌、木舌、 腮、悬痈。皆其属也。(宜参杂病源流中
咽喉症法治之)大法先洗去口中舌上白苔。其次扫去风痰。然后根据所见症治之。
薛己曰。小儿喉痹。因膏粱积热。或禀赋有热。或乳母七情之火。饮食之毒。当分其邪蓄表
里。与症之轻重经之所主而治之。若左腮色青赤。肝胆风热也。柴胡栀子散。右腮色赤。肺经热
也。泻白散。额间色赤。心小肠热也。导赤散。兼青色。风热相搏也。加味逍遥散。鼻间色黄。脾胃
热也。泻黄散。兼青。木乘土位也。加味逍遥散。兼赤。心传土位也。柴胡栀子散。颏间色赤。肾热
也。地黄丸。凡此积热内蕴。二便不通。疏利之。风邪外客而发寒热。发散之。乳食膏粱积热。清胃
散。阴虚。地黄丸。大概当用轻和之剂。以治其本。切不可用峻利之药。以伤真气。其或感风热。但
肿痛咳嗽者。为轻症。宜甘桔汤、牛蒡汤、化毒汤、牛蒡子汤、拔萃桔梗汤。若至气塞不通。则非
吹喉散、立效散不可。
初虞世说:脾脏有轻微热邪,导致舌体发凉,舌下脉络微微紧绷,孩子不时伸出舌头,刚露出一点就迅速收回,这叫做“弄舌”。适宜使用泻黄散治疗。如果孩子想喝水,是因为脾胃津液不足,不要使用寒凉药物,否则反而会导致舌体肿胀僵硬,逐渐变粗大并充满口腔,这叫做“木舌”,是由风热炽盛引起的。如果不及时治疗,就会堵塞气道致死。适宜使用当归散、泻黄散、玉露饮,并用消黄散擦拭舌面。在舌下靠近舌根处有一个小舌,叫做“重舌”。用苦竹沥浸泡的黄柏末点涂在舌上;如果无效,用真蒲黄敷贴,不超过三次即可痊愈。内服当归连翘汤,外用绿袍散点涂也可以。因为舌是心的外候,心热则生疮破裂,肝气壅滞则出血如涌,脾气闭塞则舌苔白如雪。总体适宜疏散上焦及心、肝、脾三经的邪热,以疏风化痰为主要治法。
王汉东说:肾主骨,牙齿是骨的余气。小儿刚出生时,肾气不足,所以牙齿生长迟缓。如果肾经有热,向上熏蒸于牙齿,也能导致牙齿肿胀。因为肾是胃的关隘,所以肾热容易转移到胃。如果是由于脾胃实火,导致口渴、口舌生疮、齿龈溃烂,疼痛牵连头面部,或者伴有恶寒发热,适宜使用清胃散。如果是由于脾胃气虚,被寒凉药物攻伐,或者虚热上行,导致口舌生疮、弄舌发热,或者呕吐困倦、大便不成形、流口水且牙龈腐烂,适宜使用五味异功散。
谭殊圣说:咽喉是人体一身的关键要道,与胃气相接,是呼吸之气出入的通道。凡是小儿的热毒蕴积在胸膈之间,壅滞不散,就会引发咽喉疾病。如单蛾、双蛾、重舌、木舌、腮部肿胀、悬痈,都属于此类。(应当参考杂病源流中的咽喉症治方法)。大法则是先洗去口中舌上的白苔,其次扫除风痰,然后根据所见的症状进行治疗。
薛己说:小儿喉痹,是由于膏粱厚味积热,或者先天禀赋有热,或者乳母七情之火、饮食之毒所致。应当分辨邪气蓄积在表还是里,以及症状的轻重和所属经络来治疗。如果左腮颜色青赤,是肝胆风热,用柴胡栀子散;右腮颜色红赤,是肺经热,用泻白散;额头中间颜色红赤,是心和小肠热,用导赤散;兼有青色,是风热相搏,用加味逍遥散;鼻间颜色黄,是脾胃热,用泻黄散;兼有青色,是肝木乘克脾土,用加味逍遥散;兼有红色,是心火传至脾土,用柴胡栀子散;下巴中间颜色红赤,是肾热,用地黄丸。凡此种种,都是积热内蕴,二便不通的,用疏利之法;风邪外袭而引发寒热的,用发散之法;乳食膏粱积热的,用清胃散;阴虚的,用地黄丸。大概应当使用轻平和的药物来治本,切不可使用峻猛通利的药物来损伤真气。如果感受风热,只是肿痛咳嗽的,属于轻症,适宜用甘桔汤、牛蒡汤、化毒汤、牛蒡子汤、拔萃桔梗汤。如果发展到气塞不通,则非吹喉散、立效散不可。
Chu Yushi stated: When the Spleen organ has slight heat, causing the tongue to feel cold, with the sublingual collaterals slightly tense, and the child frequently extending the tongue only to retract it immediately upon partial exposure, this is named "playing tongue" (Nong She). It is suitable to use Xiehuang San (Drain the Yellow Powder). If the child desires to drink water, it is due to a deficiency of fluids in the Spleen and Stomach; do not use cold medicines, as this will instead cause the tongue to swell and become stiff, gradually enlarging until it fills the mouth, which is named "wooden tongue" (Mu She), caused by exuberant wind-heat. If not treated urgently, it will block the airway and cause death. Suitable treatments include Danggui San (Angelica Decoction), Xiehuang San (Drain the Yellow Powder), and Yulu Yin (Jade Dew Drink), applied externally by wiping the tongue surface with Xiaohuang San (Eliminate Yellow Powder). There is a small tongue attached under the main tongue near the root, named "double tongue" (Chong She). Apply Huangbai end (Phellodendron Bark powder) soaked in Kuzhuli (Bitter Bamboo Sap) onto the tongue. If ineffective, apply Zhen Puhuang (Real Cattail Pollen); recovery occurs within three applications. Internally administer Danggui Lianqiao Tang (Angelica and Forsythia Decoction); externally applying Lvpaos San (Green Robe Powder) is also effective. The tongue is the sprout of the Heart; Heart heat causes sores and rupture, Liver stagnation causes bleeding like a gush, and Spleen closure results in white coating like snow. Generally, it is suitable to dissipate pathogenic heat from the Upper Jiao and the Heart, Liver, and Spleen meridians, with dispelling wind and resolving phlegm as the primary method.
Wang Handong stated: The Kidney governs bones, and teeth are the surplus of bones. In infants, insufficient Kidney Qi leads to delayed tooth eruption. If there is heat in the Kidney meridian steaming upwards to the teeth, it can also cause tooth swelling. Since the Kidney acts as the gate for the Stomach, Kidney heat easily transfers to the Stomach. If caused by excess fire in the Spleen and Stomach, leading to thirst, sores in the mouth and tongue, ulceration of the gums, pain radiating to the head and face, or aversion to cold and fever, Qingwei San (Clear the Stomach Powder) is suitable. If caused by deficiency of Qi in the Spleen and Stomach, overuse of cold/clearing drugs, or upward floating of deficient heat, resulting in sores in the mouth and tongue, playing tongue with fever, vomiting, fatigue, loose stools, drooling, and gum erosion, Wuyi Gong San (Five Agents Success Powder) is suitable.
Tan Shusheng stated: The throat and pharynx are the vital thoroughfares of the entire body, connecting with the Stomach Qi and serving as the passage for respiration. Whenever heat-toxins accumulate in the chest and diaphragm of children and fail to disperse, throat diseases arise. These include single tonsillar hypertrophy (Dan E), double tonsillar hypertrophy (Shuang E), double tongue (Chong She), wooden tongue (Mu She), mumps/parotid swelling (Sai), and uvular abscess (Xuan Yong), all belonging to this category. (Refer to the treatment methods for throat symptoms in the sources of miscellaneous diseases). The general principle is first to wash away the white coating on the mouth and tongue, then to sweep away wind-phlegm, and finally to treat according to the observed symptoms.
Xue Ji stated: Pediatric throat obstruction (Hou Bi) is caused by accumulated heat from rich foods, congenital heat predisposition, maternal emotional fire, or dietary toxins. One must differentiate whether the pathogen is stored in the exterior or interior, and treat based on the severity of symptoms and the affected meridian. If the left cheek is cyan-red, it indicates Wind-Heat in the Liver and Gallbladder; use Chaihu Zhizi San (Bupleurum and Gardenia Powder). If the right cheek is red, it indicates Heat in the Lung meridian; use Xiebai San (Drain White Powder). If the forehead is red, it indicates Heat in the Heart and Small Intestine; use Daochi San (Guide Out Redness Powder). If accompanied by cyan color, it indicates Wind-Heat struggling together; use Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder). If the nose area is yellow, it indicates Heat in the Spleen and Stomach; use Xiehuang San (Drain the Yellow Powder). If accompanied by cyan, it indicates Wood overcoming Earth; use Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder). If accompanied by red, it indicates Heart Fire transmitting to Earth; use Chaihu Zhizi San (Bupleurum and Gardenia Powder). If the chin is red, it indicates Kidney Heat; use Dihuang Wan (Rehmannia Pill). For such internal accumulation of heat with blocked urination and defecation, use draining and purging methods. For external wind pathogens causing chills and fever, use dispersing methods. For accumulated heat from milk, food, and rich diets, use Qingwei San (Clear the Stomach Powder). For Yin deficiency, use Dihuang Wan (Rehmannia Pill). Generally, mild and harmonizing formulas should be used to treat the root cause. One must absolutely avoid using harsh purgatives that damage the True Qi. If wind-heat is contracted, causing only swelling, pain, and cough, it is a mild case, suitable for Ganjie Tang (Licorice and Magnolia Bud Decoction), Niubang Tang (Arctium Decoction), Huadu Tang (Resolve Toxin Decoction), Niubangzi Tang (Arctium Seed Decoction), or Bcui Jiegeng Tang (Excellence Extract Platycodon Decoction). If it progresses to airway obstruction, only Chuihou San (Blow Throat Powder) and Li Xiao San (Instant Effect Powder) will suffice.