经曰。神有余则笑不休。又曰。在脏为心。在声为笑。在志为喜。又火太过为赫曦。赫曦之
纪。其病笑谑狂妄。又云。少阴所主为喜笑。又云。精气并于心则喜。此数者皆言属心火也。先
用泻心汤治其心火。次与六味丸滋其肾水。太仆所谓壮水之主。以制阳光也。扁鹊云。其人唇口
赤色者可治。青黑者死。若肾水亏涸。不胜心火。而喜笑不休。寻作不安之态者。六味地黄丸。
肝木过盛。上挟心火。而喜笑不休者。柴胡清肝散。余兼别证各从其类而参治之。
循衣撮空。皆由肝热筋脉血枯而风引之。故手指为之撮敛也。宜确服六味丸。间有回生之功。
亦有脾虚肝乘者。六君子加钩藤、蝎梢。若肝经实热。泻青丸。盖循衣撮空。皆病之败证。求其
实热。十无一二。许叔微云。循衣撮空。皆神虚无主。非大剂独参、保元。不能挽回。虚寒。则
十全大补、人参养荣、大建中温补之。然亦有心包热极所致者。王海藏治血脱。循衣撮空摸床。
扬手摇头。错语失神。脉弦浮而虚。血脱内燥。热之极也。气粗鼻干。此为难治。生地黄黄连汤。
孙真人曰。儿初生。叫声连延相属者寿。声绝而复扬急者不寿。啼声散。不成人。啼声深。
不成人。脐中无血者好。脐小者。不成人。通身软弱如无骨者不寿。鲜白长大者寿。生下目自开
者。不成人。目视不正数动者。大非佳。汗血者。多危不寿。汗不流。不成人。小便凝如脂膏。
不成人。头四破。不成人。常摇手足者。不成人。额上有旋毛者早贵。妨父母。儿生枕骨不成者。
能言而死。尻骨不成者。能踞而死。掌骨不成者。能匐匍而死。踵骨不成者。能行而死。膑骨不
成者。能立而死。身不收者死。鱼目者死。股间无生肉者死。颐下破者死。阴不起者死。阴囊下
白者死。赤者死。卵缝通达黑者寿。儿小时。识悟通敏过人者。多夭。大则项橐颜回之流也。小
儿骨法。成就威仪。回转迟舒。稍费人精神雕琢者寿。其预知人意。回旋敏速者夭。大则杨修孔
融之徒也。
张介宾曰。小儿之寿夭。其因有二。一则由于禀赋。一则由于抚养。夫禀赋为胎元之本。精
气之受于父母者也。抚养为居处寒温。饮食饥饱之得失者也。凡少年之子多有羸弱。欲勤精薄也。
老年之子多强壮者。欲少精全也。多饮者
子多不育。盖以酒湿乱精。则精半非真而湿热胜也。多欲者子多不育。以孕后不节。则泄母阴。
夺养胎之气也。此外如饥饱劳逸。五情六气。无不各有所关。是皆所谓禀赋也。至于抚养之法。
则俗传有云。若要儿安。须带饥寒。此言殊为未审。夫欲其带饥者。恐饮食之过耳。过则伤脾而
病生。宁使略饥。其犹庶几。至若寒之一字。则大有关系。小儿以未成之血气。嫩薄之肌肤。较
之大人。相去百倍。顾可令其带寒耶。尝见新产之儿。多生惊搐。此为稳婆不慎。则风寒袭之。
多致不救者此也。及其稍长。每多发热。轻则为鼻塞咳嗽。重则为小儿伤寒。幼科不识。一概呼
为变蒸。投药致毙者此也。或寒气伤脏。则为吐泻。或因寒生热。则为惊为疳。种种变生。多由
外感。虽禀体强盛不畏风寒者。亦所常有。但强者三之一。弱者三之二。伤热者十之三。伤寒者
十之七。况膏粱贫贱。气质本是不同。医家不能察。但知见热攻热。婴儿不能言。病家不能辨。
徒付之命。诚可叹也。又有谓小儿纯阳之体。故多宜清凉治之。此说尤为误人。而王节斋又曰。
小儿无补肾。谓男至十六而肾始充满。既满之后。妄用亏损。则可用药补之。若受胎之时。禀之
不足。则无可补。禀之原足。又何待补。呜呼。此何说耶。夫小儿谓纯阳者。以其阴气未成。即
肾虚也。或父母多欲而所禀水亏。亦肾虚也。阴既不足。而不知补之。阴绝则孤阳亦绝矣。何谓
无可补耶。殊不知钱氏六味地黄丸。专治小儿肾虚解颅。以其纯阳无阴。故取崔氏八味丸。裁去
桂、附。以独补肾水也。此义惟薛立斋得之。惜乎世医。多所未悟也。
《黄帝内经》说：神气有余就会笑个不停。又说：在五脏中对应心，在五声（呼、笑、歌、哭、呻）中对应笑，在五志（怒、喜、思、忧、恐）中对应喜。又说：火气太过称为“赫曦”（形容火势盛大炽热）。赫纪之年，其病症表现为谈笑戏谑、狂妄失常。又说：少阴经所主的是喜笑。又说：精气汇聚于心则产生喜悦之情。以上几种说法，都是指病证归属于心火。治疗时先用泻心汤来清泻心火，再用六味丸来滋补肾水。这正是太仆（王冰）所说的“壮水之主，以制阳光”的道理。扁鹊说：如果患者嘴唇和口角呈赤色，说明尚有生机，可以治愈；若呈青黑色，则为死证。如果是肾水枯竭，无法制约心火，而导致喜笑不休，并逐渐出现心神不安神态的，应用六味地黄丸。若是肝木过盛，向上挟持心火，导致喜笑不休的，用柴胡清肝散。其余兼夹其他证候的，分别根据其所属类别配合治疗。
循衣摸空（手指无意识地抓摸衣被或虚空），都是由肝热、筋脉失养、血液枯涸而引动内风所致，所以手指会出现撮敛的动作。适宜坚持服用六味地黄丸，偶尔有起死回生的功效。也有因脾虚导致肝木乘克脾土的，用六君子汤加钩藤、全蝎梢。若是肝经实热，用泻青丸。大概循衣摸空，都是病情败坏的重症，其中属于实热的，十人中不到一两个。许叔微说：循衣摸空，都是神气虚无、没有主宰的表现，不用大剂量的独参汤或保元汤，不能挽回生机。若是虚寒证，则用十全大补汤、人参养荣汤、大建中汤等温补方剂。然而也有因心包热极导致的。王海藏曾治疗一例血脱患者，出现循衣摸空、抚摸床铺、扬手摇头、言语错乱、神识丧失等症状，脉象弦浮而虚，这是血脱导致体内燥热，热势到了极点，伴有呼吸粗重、鼻干，这属于难治之症，用生地黄黄连汤。
孙真人说：婴儿刚出生时，哭声连绵不断、相互接续的，寿命长；哭声中断后又突然扬起且急促的，寿命短；哭声散乱的，不能成人；哭声深沉的，也不能成人。脐部没有瘀血的为好；脐部小的，不能成人。全身软弱像没有骨头一样的，寿命短；肤色鲜白且身体长大的，寿命长。出生后眼睛自然睁开的，不能成人；眼神不正、频繁眨动的，非常不好。出汗带血的，多危险且寿命短；不出汗的，不能成人。小便凝结像脂膏一样的，不能成人。头部有四道裂纹的，不能成人。经常摇动手脚的，不能成人。额头有旋毛的，早年显贵，但会妨害父母。婴儿出生时枕骨发育不全的，能说话后死亡；骶骨发育不全的，能蹲坐后死亡；掌骨发育不全的，能爬行后死亡；踵骨（脚后跟骨）发育不全的，能行走后死亡；髌骨（膝盖骨）发育不全的，能站立后死亡。身体无法收束控制的死亡；眼睛像鱼眼一样的死亡；大腿内侧没有生肉的死亡；下巴破损的死亡；生殖器不勃起的死亡；阴囊发白的死亡；发红的死亡；睾丸缝通达黑色且透亮的长寿。婴儿小时候，领悟力通晓敏捷超过常人的，大多夭折，长大后就是项橐、颜回这一类人。小儿骨骼形态方面，举止威严庄重，动作回转迟缓舒展，稍微需要耗费精神去雕琢培养的，寿命长；那些预知人意、回旋敏捷迅速的，寿命短，长大后就是杨修、孔融这一类人。
张介宾说：小儿寿夭的原因有两个。一是由于禀赋，二是由于抚养。禀赋是胎元的根本，是从父母那里接受的精气。抚养是指居住环境的寒温调节，以及饮食饥饱是否得当。凡是年轻父母的子女大多羸弱，是因为房事勤而精气稀薄。年老父母的子女大多强壮，是因为房事少而精气保全。饮酒过多者的子女多不育，因为酒湿扰乱精气，使得精气半真半假且湿热偏胜。纵欲过度者的子女多不育，因为怀孕后不知节制，耗泄母体阴精，掠夺了滋养胎儿的气血。此外，如饥饱劳逸、七情六淫，无不各有关系，这些都属于禀赋的范畴。至于抚养的方法，民间俗语说：“若要孩子平安，必须让他受点饥饿和寒冷。”这种说法很不严谨。让孩子受点饥饿，是担心饮食过量，过量会损伤脾胃从而生病，宁可让他略微饥饿，或许还差不多。至于“寒冷”这一点，则关系重大。小儿气血未成，肌肤嫩薄，与大人相比相差百倍，怎么能让他在寒冷中度过呢？我曾见到刚出生的婴儿，多发生惊厥抽搐，这是因为接生婆不慎，导致风寒侵袭，多导致无法救治的。等到稍大一些，常常发热，轻则鼻塞咳嗽，重则成为小儿伤寒，儿科医生不懂，一概称为“变蒸”，投药致死的情况就是这样发生的。或者是寒气伤及脏腑，导致吐泻；或者因寒生热，导致惊风、疳积。种种变化产生，多由外感引起。虽然体质强健不怕风寒的孩子也有，但只占三分之一，体弱的占三分之二。伤于热邪的占十分之三，伤于寒邪的占十分之七。况且富贵与贫贱家庭的孩子，气质本就不同，医生如果不能明察，只知道见热就清热，婴儿不会说话，家属不能辨别，只能听天由命，实在令人叹息。又有说法认为小儿是“纯阳之体”，所以多宜用清凉药物治疗，这种说法更是误人。王节斋又说：小儿不需要补肾，说男子到十六岁肾脏才充满，既满之后，如果妄用药物亏损，才可用药补之。如果在受孕之时，禀受不足，那就无可补；如果禀受原本充足，又何须补呢？唉，这是什么理论呢？所谓小儿为纯阳，是因为其阴气尚未长成，即肾虚。或者是父母纵欲导致所禀受的水液亏虚，也是肾虚。阴既然不足，却不知道补益，阴绝则孤阳也会随之灭绝，怎么能说无可补呢？殊不知钱乙的六味地黄丸，专门治疗小儿肾虚引起的解颅（囟门迟闭），因为其纯阳无阴，所以取崔氏八味丸（金匮肾气丸），裁去桂枝、附子，以单独补肾水。这个义理只有薛立斋领悟到了，可惜世间的医生，大多没有悟透。
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: When Shen spirit (Divine Spirit/Mental Activity) is in excess, laughter will not cease. It further states: In the Zang organs, it corresponds to the Heart; in the Five Sounds (Shouting, Laughing, Singing, Crying, Groaning), it corresponds to Laughter; in the Five Emotions (Anger, Joy, Pensive thought, Sorrow, Fear), it corresponds to Joy. It also states: Excessive Fire is termed "He Xi" (describing the majestic and blazing intensity of fire). In years governed by this phase, diseases manifest as playful chatter, madness, and abnormal behavior. It is also stated that the Shao Yin meridian governs joy and laughter. Furthermore, when Jing essence (Essence) converges in the Heart, joy arises. These statements all indicate that such conditions belong to Heart Fire. Treatment should first employ Xie Xin Tang (Drain the Heart Decoction) to clear Heart Fire, followed by Liu Wei Wan (Six-Ingredient Pill with Rehmannia) to nourish Kidney Water. This aligns with what Taipu (Wang Bing) described as "Strengthening the Master of Water to control the Yang brilliance." Bian Que stated: If the patient's lips and mouth are red, the condition is treatable; if they are cyan or black, it is a death sign. If Kidney Water is depleted and fails to restrain Heart Fire, resulting in incessant laughter and gradually developing signs of mental unrest, Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) should be used. If Liver Wood is excessive and upwardly invades Heart Fire, causing incessant laughter, Chai Hu Qing Gan San (Bupleurum Liver-Clearing Powder) is indicated. For other concurrent syndromes, treatment should be combined according to their respective categories.
Tracing clothes and grasping at empty air (involuntary finger movements grasping at bedding or void space) are caused by Liver Heat, malnourishment of sinews and vessels, blood depletion, and the stirring of internal Wind, leading to the fingers curling and grasping. Persistent administration of Liu Wei Wan is appropriate, occasionally yielding miraculous recovery. There are cases due to Spleen Deficiency with Liver Overacting on the Spleen, treated with Liu Jun Zi Tang (Six Gentlemen Decoction) plus Gou Teng (Uncariae Ramulus cum Uncis) and Quan Xie Shao (Scorpio tail tip). For excess heat in the Liver channel, Xie Qing Wan (Drain the Green Pill) is used. Generally, tracing clothes and grasping at empty air represent a deteriorating stage of disease; true excess heat accounts for less than one in ten cases. Xu Shuwei stated: Tracing clothes and grasping at empty air indicate that Shen spirit is deficient and lacks mastery; without large doses of Du Shen Tang (Single Ginseng Decoction) or Bao Yuan Tang (Protect the Origin Decoction), vitality cannot be restored. For deficiency-cold patterns, Shi Quan Da Bu Tang (Ten Significant Tonifying Decoction), Ren Shen Yang Rong Tang (Ginseng Nourishing Blood Decoction), or Da Jian Zhong Tang (Great Establish the Middle Decoction) are used for warming and tonification. However, some cases are caused by extreme heat in the Pericardium. Wang Haizang treated a case of blood loss where the patient traced clothes, grasped at the bed, waved hands, shook head, spoke confusedly, and lost consciousness. The pulse was wiry, floating, and deficient. This indicated blood loss leading to internal dryness and extreme heat, accompanied by coarse breathing and dry nose, which is difficult to treat. Sheng Di Huang Huang Lian Tang (Rehmannia and Coptis Decoction) was prescribed.
Sun Simiao said: When an infant is born, if the crying sound is continuous and uninterrupted, longevity is indicated. If the sound ceases and then rises abruptly and urgently, life is short. Scattered crying indicates failure to mature. Deep crying also indicates failure to mature. Absence of blood in the umbilicus is good. A small umbilicus indicates failure to mature. A body soft as if boneless indicates short life. Bright white skin and large size indicate longevity. Eyes naturally open at birth indicate failure to mature. Eyes looking askance with frequent movement are very unfavorable. Sweating blood indicates danger and short life. Absence of sweating indicates failure to mature. Urine congealing like paste indicates failure to mature. Four cracks on the head indicate failure to mature. Constant shaking of hands and feet indicates failure to mature. Whorls on the forehead indicate early nobility but harm to parents. Incomplete occipital bone development leads to death after speech. Incomplete sacral bone development leads to death after squatting. Incomplete palmar bone development leads to death after crawling. Incomplete calcaneal bone development leads to death after walking. Incomplete patellar bone development leads to death after standing. Inability to control the body results in death. Fish-like eyes result in death. Lack of flesh between the thighs results in death. Broken chin results in death. Non-erect genitals result in death. White scrotum results in death. Red scrotum results in death. Testicular seams reaching black and transparency indicate longevity. Infants who are unusually perceptive and agile in childhood often die young, becoming figures like Xiang Tuo or Yan Hui in adulthood. Regarding pediatric skeletal morphology, those with dignified demeanor, slow and graceful movements, requiring considerable effort to cultivate, live long. Those who anticipate others' thoughts and move quickly die young, becoming figures like Yang Xiu or Kong Rong.
Zhang Jiebin stated: The causes of longevity or brevity of life in children are twofold: constitution (Bing Fu) and upbringing (Fu Yang). Constitution is the root of the fetal origin, receiving Jing Qi from parents. Upbringing refers to the regulation of cold and warmth in the living environment, and the appropriateness of dietary intake regarding hunger and satiety. Children of young parents are often frail because sexual activity is frequent and essence is sparse. Children of older parents are often robust because sexual activity is infrequent and essence is preserved. Men who drink excessively often have offspring that do not survive, as alcohol dampness disturbs essence, making it impure and prone to damp-heat. Men with excessive desires often have offspring that do not survive, as lack of restraint during pregnancy depletes maternal Yin and steals the Qi nourishing the fetus. Additionally, factors such as hunger/satiety, labor/rest, and the Seven Emotions and Six Evils all play a role; these constitute constitution. Regarding upbringing, folk wisdom says, "To keep a child safe, keep them slightly hungry and cold." This view is imprecise. Allowing slight hunger prevents overeating, which damages the Spleen and causes disease; thus, slight hunger is acceptable. However, "cold" is critical. Children have unformed Qi and Blood and tender skin, differing vastly from adults. How can they endure cold? I have seen newborns suffer convulsions due to midwives' negligence allowing Wind-Cold invasion, often leading to death. As they grow, fever is common; mild cases present as nasal congestion and cough, severe cases as Pediatric Taiyang Disease. Unskilled pediatricians mislabel these as "Bian Zheng" (metamorphic eruption) and administer drugs, causing death. Cold damaging the Zang organs causes vomiting and diarrhea; cold generating heat causes convulsions and Gan syndrome. Most variations stem from external pathogens. Although strong children resist Wind-Cold, they are only one-third; weak children are two-thirds. Thirty percent suffer heat damage; seventy percent suffer cold damage. Moreover, temperament differs between rich and poor families. Physicians who fail to observe and merely attack heat upon seeing fever, while infants cannot speak and families cannot distinguish symptoms, leave fate to chance, which is lamentable. Another erroneous theory claims children are "Pure Yang" bodies and should be treated with cooling agents. Wang Jiezhai argued against kidney tonification in children, stating male kidneys fill only at sixteen; before fullness, tonification is unnecessary, and if congenitally deficient, it cannot be supplemented. This is flawed. "Pure Yang" in children means Yin is undeveloped, indicating Kidney Deficiency. Parental excess desire leads to water deficiency, also Kidney Deficiency. Without supplementing insufficient Yin, Yin extinction leads to the extinction of solitary Yang. How can it be said there is nothing to supplement? Qian Yi's Liu Wei Di Huang Wan specifically treats pediatric Kidney Deficiency manifesting as Jie Lu (delayed closure of fontanelles) due to pure Yang lacking Yin. It derives from Cui Shi Ba Wei Wan (Eight-Ingredient Pill from Cui's Formulas) but removes Gui Zhi (Cinnamon Twig) and Fu Zi (Aconite Root) to solely tonify Kidney Water. Only Xue Li Zhai understood this principle; unfortunately, most contemporary physicians have not realized it.