陈紫山曰∶保婴一术,号日哑科。口不能言,脉无可视,惟形色以为凭,竭心思以施治。故业擅于专门,以补
化工不及。欲知有病,必观乎色。左颊青龙属肝,右颊白虎属肺。天庭高而离阳心火,地阁低而坎阴肾水。鼻在面中,
脾应唇际。观乎色之所现,知其病之所起。舌乃心之苗,目乃肝之系。胃流注于两颐,肾通窍于两耳。爪则筋系,而
脾为之运,发乃血余,而肾为之主。脾司手足,肾运牙齿。苟本脏之或衰,即所属之失败。能观乎外,可知其内。红
光见而热痰壅盛,青色露而凉痫怔悸。
如煤之黑兮,中恶传逆;似橘之黄兮,土脾吐痢。白乃疳痨,紫为热炽。青遮口角难医,黑掩太阳莫治。年寿赤光,
多生脓血;山根青黑,频见灾危。朱雀见于双瞳,火入水乡;青龙绕于口角,肝乘脾部。泻痢而面赤者宜防,咳嗽
而色青者可畏。面青而唇口撮,疼痛方殷;面赤而目窜视,惊搐将至。火光焰焰,外感风寒;金气浮浮,中藏积滞。
乍黄乍白,疳热连绵;又青又赤,风邪紧急。气乏兮,囟陷成坑;血衰兮,头毛作穗。脾冷则口角流涎,肝热则目生
眵泪。面目虚浮,定腹胀而气喘;眉毛频蹙,必腹痛而多啼。风气二池如黄土,则为不宜,左右两颊似青黛,即或客
忤。风门黑主疝,而青主惊。方广昏凶,而光滑吉。手如数物兮,肝风将发;面若涂朱兮,心火实炎。伸缩就冷,阳
热无疑;坐卧爱暖,阴寒可必。肚大脚细,脾欲困而成疳;目瞪口张,势已危而必毙。察之若精,必得其理。鸦声鱼
口,枉费神思。肉脱皮干,劳神无益。蛔虫兮,脾胃皆败;唇冷兮脾脏先亏。然五体以头为尊,一面惟神可恃。况乎
声有轻重之不同,啼有干湿之顿异。病之初作,必先呵欠;火之将发,忽作惊啼。重舌木舌,积热心脾;哽气喘气,
火伤肝肺。齿龈宣露牙疳,丁奚哺露食积。心热欲卧而不能,脾热好睡而不歇。咳嗽失音者肺痿,病后失音者肾怯。
腹痛而口流清水者虫多,泻痢而大便酸臭者食积。口频撮而脾虚,舌长伸而心热。烦热在心,恶见灯光;疳热在脾,
爱吃泥土。鸡胸兮,肺火胀于胸膈,龟背兮,肾风入于骨髓。鼻干黑燥,金受火刑,肚大青筋,土遭木克。吁瘤疮
疥,皆 毒之流连;五疳泻痢,总食积之停滞。腹痛寒侵,口疮热症。脐风忌乎一腊,蒸变防于周年。惊自热来,
痫由痰至。惊本心生,风从肝使。急惊属热,宜乎清凉;慢惊属虚,宜于补治。痘曰天疮,疹日麻子。痘属五脏,疹
属六腑。疹宜清凉,痘
宜温补。先明阴阳,次识脏腑,补泻得宜,治有何误?贵临机之通变,勿执一以成模。
涂蔚生曰∶此篇有难解之处,如丁奚哺露与鸡胸是也。有解未妥之处,如腹痛寒侵,惊自热来,痘宜温补是也。
盖必腹痛而具有面白唇青之状,始可断为寒侵也。惊是一症,风又是一症,而惊之与风,亦未必俱自热来。痘症亦
多有内部实热,未必尽宜温补也。至其所谓疹曰麻子,亦宜有别。因吾乡之所谓疹子,多是细粒如粟米状,亦有谓其
痧子者,因其细粒又如砂子也。麻子则其形体颇大,较痘为剧,系痘症中之最危险者也。此解是否有当,尚希高明指正。
陈紫山说:儿科护理这一技术,被称为“哑科”。因为患儿口不能言,脉象难以诊察,只能以面色和形体作为依据,竭尽心思来实施治疗。所以专门从事此业的人,可以弥补自然造化(医生)不及之处。想要知道是否有病,必须观察面色。左颊属青龙,对应肝脏;右颊属白虎,对应肺脏。天庭高耸对应离卦阳火之心,地阁低陷对应坎卦阴水之肾。鼻子位于面部中央,脾脏对应唇部周围。通过观察面色的显现,可以知道疾病的起因。舌是心的苗窍,眼睛是肝的系联。胃经流注于两腮,肾脏通窍于双耳。指甲由筋所系,而由脾脏运化滋养;头发是血的余绪,而由肾脏主宰。脾脏主管手足,肾脏运化牙齿。如果本脏功能衰退,那么其所对应的部位就会失败。能够观察外部表现,就可以了解内部状况。红光出现且热痰壅盛,青色显露且有凉痫、怔悸。
像煤一样黑,是中恶邪气传逆;像橘子一样黄,是脾胃土虚导致的呕吐痢疾。白色主疳积痨病,紫色主热势炽盛。青色遮盖口角难治,黑色掩盖太阳穴不可治。年寿部位(鼻准下方)发红,多生脓血;山根部位(两眼之间鼻梁处)青黑,频繁见到灾危。朱雀出现在双瞳,是火入水乡(心火亢盛);青龙环绕口角,是肝木乘克脾土。腹泻痢疾而面色赤红的应当预防,咳嗽而面色青黑的令人畏惧。面色青而嘴唇口角收缩,疼痛正剧烈;面色赤而眼球窜视,惊风抽搐将至。火光焰焰,是外感风寒;金气浮浮,是体内有积滞。忽黄忽白,是疳热连绵;又青又赤,是风邪紧急。气虚则囟门凹陷成坑;血衰则头毛结成穗状。脾冷则口角流涎,肝热则眼睛生出眵泪。面目虚浮,必定腹胀气喘;眉毛频繁皱起,必定腹痛多啼。风气二池(指眼周或特定区域,此处指代异常色泽)如黄土色,则为不宜;左右两颊似青黛色,即是客忤(小儿受惊吓或异气所伤)。风门发黑主疝气,发青主惊风。方广昏凶,光滑吉。手像数东西一样,是肝风将发;面色像涂了朱砂一样红,是心火实炎。身体伸缩喜欢冷,阳气热无疑;坐卧喜欢暖,阴寒可确定。肚子大脚细,是脾欲困顿而成疳积;目瞪口张,形势已危必死。观察得精细,一定能得到道理。鸦声鱼口(形容濒死前的声音和形态),枉费神思。肉脱皮干,劳神无益。蛔虫,说明脾胃都已败坏;嘴唇冷,说明脾脏先亏损。然而五体以头部为尊,一面之中只有神气可依靠。况且声音有轻重不同,啼哭有干湿顿异。疾病初起,必先呵欠;火证将发,忽然惊啼。重舌木舌,是积热心脾;哽气喘气,是火伤肝肺。齿龈宣露牙疳,丁奚哺露(形容极度消瘦的病态)是食积。心热想睡而不能,脾热好睡而不歇。咳嗽失音的是肺痿,病后失音的是肾怯。腹痛而口流清水的是虫多,泻痢而大便酸臭的是食积。口频繁撮动是脾虚,舌头长长伸出是心热。烦热在心,厌恶见灯光;疳热在脾,爱吃泥土。鸡胸,是肺火胀于胸膈;龟背,是肾风入于骨髓。鼻干黑燥,是金受火刑;肚大青筋,是土遭木克。吁瘤疮疥,都是毒邪流连;五疳泻痢,总归是食积停滞。腹痛是寒邪侵袭,口疮是热症。脐风忌乎出生一个月以内,蒸变(一种小儿病症)防备于一周年之内。惊风自热而来,痫证由痰所致。惊本心生,风从肝使。急惊属于热证,宜用清凉法;慢惊属于虚证,宜用补法治。痘称为天疮,疹称为麻子。痘属于五脏,疹属于六腑。疹宜清凉,痘宜温补。先明阴阳,次识脏腑,补泻得当,治疗有何错误?贵在临机通变,不要固执一成不变的模式。
涂蔚生说:这篇中有难解的地方,比如丁奚哺露与鸡胸。有解释不妥当的地方,比如腹痛寒侵,惊自热来,痘宜温补。大概必须腹痛且具有面白唇青的症状,才可以断定为寒侵。惊是一症,风又是一症,而惊与风,也未必都自热来。痘症也多有内部实热,未必全都适宜温补。至于所谓疹叫麻子,也应该有别。因为我家乡所说的疹子,多是细粒如粟米状,也有称之为痧子的,因为其细粒又像砂子。麻子则其形体颇大,较痘更严重,是痘症中最危险的一种。这个解释是否恰当,还希望高明之士指正。
Chen Zishan said: Pediatric care is known as the "Mute Department" (Ya Ke). Since infants cannot speak and pulse diagnosis is difficult, one must rely on complexion and physical form, exhausting one's mind to administer treatment. Thus, specialists in this field can supplement what nature (or innate medical ability) cannot fully achieve. To know if there is disease, one must observe the complexion. The left cheek corresponds to the Azure Dragon (Qinglong) and the Liver; the right cheek corresponds to the White Tiger (Baihu) and the Lung. The high forehead corresponds to the Li Trigram, Yang Fire, and the Heart; the low chin corresponds to the Kan Trigram, Yin Water, and the Kidney. The nose is in the center of the face, corresponding to the Spleen and the lips. By observing the manifestations of color, one can know the origin of the disease. The tongue is the sprout of the Heart; the eyes are the connection of the Liver. The Stomach meridian flows into the cheeks; the Kidneys open into the ears. Nails are connected to tendons, governed by the Spleen's transportation; hair is the surplus of blood, governed by the Kidneys. The Spleen governs the hands and feet; the Kidneys govern the teeth. If the zang organ declines, its corresponding parts will fail. Observing the exterior allows knowledge of the interior. Red luster indicates heat-phlegm congestion; cyan hue indicates cold epilepsy or palpitations.
Black like coal indicates malignant qi reversal; yellow like an orange indicates Spleen Earth deficiency leading to vomiting and dysentery. White indicates malnutrition tuberculosis (Gan Ji); purple indicates intense heat. Cyan covering the mouth corners is difficult to treat; black covering the temples is untreatable. Redness at the Nianshou area (below the nose tip) often produces pus and blood; cyan-black at the Shangen area (bridge of the nose) frequently signals disaster. Vermilion appearing in both pupils indicates Fire entering the Water region (Heart fire excess); Azure Dragon surrounding the mouth corners indicates Liver Wood overacting on Spleen Earth. Diarrhea with red face requires prevention; cough with blue-green face is alarming. Cyan face with puckered lips indicates severe pain; red face with wandering eyes indicates impending convulsions. Flaming fire light indicates external contraction of wind-cold; floating metal energy indicates internal accumulation and stagnation. Alternating yellow and white indicates continuous Gan heat; alternating cyan and red indicates urgent wind pathogen. Qi deficiency causes fontanelle depression; blood deficiency causes hair tufting. Cold Spleen causes drooling; Hot Liver causes eye discharge. Puffy face and eyes indicate abdominal distension and asthma; frequent frowning indicates abdominal pain and crying. Yellow earth-like color in the wind pools is unfavorable; cyan powder-like color on cheeks indicates fright invasion. Black at the Fengmen area indicates hernia; cyan indicates fright. Square and dull are ominous; smooth and bright are auspicious. Hands counting objects indicates impending Liver Wind; face painted with cinnabar indicates full Heart Fire. Stretching towards cold confirms Yang heat; sitting/lying preferring warmth confirms Yin cold. Large belly and thin legs indicate Spleen exhaustion leading to Gan Ji; staring eyes and open mouth indicate critical condition and death. Precise observation yields principles. Crow voice and fish mouth (signs of impending death) waste effort. Emaciation and dry skin make mental exertion useless. Roundworms indicate failure of Spleen and Stomach; cold lips indicate prior Spleen deficiency. Among the five body parts, the head is supreme; among the face, only Shen (Spirit) is reliable. Voices differ in weight; cries differ in wetness/dryness. Disease onset begins with yawning; Fire manifestation starts with sudden frightful crying. Double tongue and wooden tongue indicate accumulated heat in Heart and Spleen; choking and panting indicate Fire injuring Liver and Lung. Exposed gums and dental caries, Ding Xi Bu Lu (emaciation) indicate food retention. Heart heat desires sleep but cannot; Spleen heat loves sleep without rest. Cough with loss of voice indicates Lung Wei (flaccidity); post-illness loss of voice indicates Kidney weakness. Abdominal pain with clear saliva indicates many worms; dysentery with sour-smelling stool indicates food retention. Frequent lip puckering indicates Spleen deficiency; long protruding tongue indicates Heart heat. Heat in the Heart dislikes light; Gan heat in the Spleen craves eating dirt. Chicken breast indicates Lung Fire swelling in chest/diaphragm; Turtle back indicates Kidney Wind entering bone marrow. Dry/black nose indicates Metal punished by Fire; large belly with visible veins indicates Earth overcome by Wood. Tumors, sores, and scabies are lingering toxins; Five Gan types with dysentery are total food stagnation. Abdominal pain is cold invasion; mouth ulcers are heat syndromes. Umbilical wind is contraindicated within one month of birth; Zheng Bian (steam transformation illness) is prevented within one year. Fright comes from heat; Epilepsy arises from phlegm. Fright originates in Heart; Wind is driven by Liver. Acute fright is Heat type, suitable for cooling; Chronic fright is Deficiency type, suitable for tonification. Smallpox is called Heavenly Sore; Measles is called Ma Zi. Smallpox belongs to Five Zang; Measles belongs to Six Fu. Measles suits cooling; Smallpox suits warming and tonifying. First clarify Yin/Yang, then identify Zang/Fu; proper tonification/reduction ensures no error in treatment. Value adaptability; do not stick to rigid patterns.
Tu Weisheng said: This passage has difficult-to-understand parts, such as Ding Xi Bu Lu and Chicken Breast. There are inappropriate explanations, such as abdominal pain from cold invasion, fright from heat, and smallpox suited for warming/tonifying. Generally, abdominal pain must present with pale face and cyan lips to be diagnosed as cold invasion. Fright is one syndrome, Wind is another; fright and wind do not necessarily all come from heat. Smallpox cases also often have internal excess heat, not all suitable for warming/tonifying. Regarding measles being called Ma Zi, distinctions should be made. In my hometown, "measles" are mostly fine grains like millet, sometimes called Sha Zi because they resemble sand. "Ma Zi" (True Measles) are larger and more severe than smallpox, being the most dangerous type of smallpox-related illness. Whether this explanation is appropriate awaits correction from experts.