议曰小儿有热热盛生痰痰盛生惊惊盛作风风盛发搐又盛牙关紧急又盛反张上窜痰涎拥牙
关紧
风热极闭经络即作搐搦涎壅胃口闷乱不省才入中脘手足挛是诸关窍不通百脉凝滞有退热而愈
者
有治惊而愈者有截风而愈者有化痰通关而愈者皆是根据症用药不可不究竟其所以受病凡病在热
不可妄治痰病在惊不可妄治风病在痰不可便治惊病在风不可便治搐凡治小儿病在惊惊由痰热
得
只可退热化痰其惊自止病在风风由惊作只可利惊化痰其风自散病在痰涎急须退热化痰若也有
搐须用截风散惊此乃谓医工至妙之道若以意急虽治惊痰不化热亦不退惊如何自止化其痰热若
不退风亦不散痰如何去是知不治之治所以治之之谓欤学人深可留心操志于此一端究竟无至得
失乃谓之醇全通道而已矣
议曰小儿脏寒腑冷大肠不禁总谓之泻分别轻重究竟缓速有溏有泄有滑有利有洞五者不同
岂可
一概而理之溏者糟粕不聚由其尚浓似泻非泻泄者无时而作或出不知利者直射溅溜气从中脱滑
者谷食直过肠胃不化洞者顿然下之如桶散溃余更不留即知其儿脏寒腑冷泻之作疾其来缓速
轻重可知凡儿泻粪出青色者盖脾受肝经所制肝属乙木能克己土所胜之功故现本质由其脏之虚
寒非谓惊也又泻初黄良久变青色乃脏寒之微又泻药物直过尤为寒滑凡虚滑三五次即困乏若不
急与温其脏调其胃平顺三焦和正荣卫不尔即慢惊症候传变如此之急欲以止泻药次第理之往往
不及惟务温其脏腑脏腑既温寒何能留于肠胃之间或以热药顿止则热反为它疾须先投 肠药然
后生胃正气与服切不可意急过剂投之热药稍或脏腑至虚寒孩童困之四肢厥冷者是谓逆症当
用黑附
子白术干姜即量轻重而用凡投热药泻止即痢作无疑理泻良方已着在后请意度之为得即妙矣
议曰：小儿体内有热，热势亢盛则生痰；痰势壅盛则引发惊风；惊风之势极盛则化为内风；内风炽盛则出现抽搐；若再加重，则牙关紧闭；若更甚，则身体角弓反张、双目上视；此时痰涎涌塞于牙关之间。
风热之邪极盛，闭塞经络，随即发生抽搐痉挛；痰涎壅滞于胃口（胃脘部），导致神志昏乱、不省人事；病邪初入中脘穴所在区域，手足便出现挛急。以上种种情况，皆因诸窍闭塞不通，百脉气血凝滞所致。有的通过清热而痊愈，有的通过镇惊而痊愈，有的通过息风而痊愈，有的通过化痰通窍而痊愈。这都是根据症状用药的结果，不可不深入探究其致病原因。
凡是病在热者，不可妄治；病在痰者，不可妄治；病在惊者，不可妄治；病在风者，不可便治惊；病在风者，不可便治搐。大凡治疗小儿疾病，若病在惊，惊由痰热引起，只可退热化痰，惊症自然停止；若病在风，风由惊动引起，只可利惊化痰，风邪自然消散；若病在痰涎，急须退热化痰；如果伴有抽搐，必须使用息风散惊之法。这可以说是医家至高妙的道理。如果凭主观意念急躁行事，虽然治疗了惊症，但痰不化、热不退，惊如何能自止？若不化解痰热，风亦不能消散，痰又如何能去除？因此，所谓“不治之治”，正是为了达到“治之”的目的。学者对此应深加留心，专心钻研这一环节，彻底探究得失，才能称为掌握了圆满通达的医术之道。
议曰：小儿脏腑虚寒，大肠固摄无力，统称为泻痢。需分辨轻重，探究缓急。大便溏薄、泄泻、滑脱、利下、洞泄，这五种情况各不相同，岂能一概而论进行治疗？
所谓“溏”，是指糟粕不能聚结，因其质地尚浓稠，似泻非泻；所谓“泄”，是指无定时发作，或排出时不知控制；所谓“利”，是指直接喷射溅流，气从中脱失；所谓“滑”，是指谷物食物直过肠胃，无法消化；所谓“洞”，是指突然大量排出，如桶壁溃散，余沥不留。由此可知，这是小儿脏腑虚寒所致。泻疾的发生，其来势缓急、病情轻重是可以推断的。
凡是小儿泻痢，粪便呈青色者，是因为脾脏受到肝经的制约。肝属乙木，能克制己土（脾土）。由于胜复之功显现本质，故现青色，这是由于脏腑虚寒所致，并非惊风。另外，泻下初为黄色，良久变为青色，乃是脏寒较轻的表现；若是服用药物后原样排出，尤为寒滑之象。凡是虚滑之证，三五次即会导致困乏。若不急于温补脏腑、调理脾胃、平顺三焦、调和营卫，病情就会迅速传变为慢惊风证候。如此急迫，若想依次使用止泻药来治理，往往来不及见效。务必先温补脏腑，脏腑既已温暖，寒气怎能留存在肠胃之间？若用热药强行顿止，热气反而可能引发其他疾病。应当先投予涩肠之药，然后滋生胃中正气并服用。切不可凭主观意念急躁而过量投予热药。稍有不慎，若脏腑极度虚寒，孩童被困厄，四肢厥冷，这就称为逆症。此时当用黑附子、白术、干姜，并根据病情轻重斟酌用量。凡是投用热药后，泻止却转为痢疾，这是无疑的。关于理泻的良好方剂已在后文列出，请用心揣摩，便可得其妙处。
Translation:
It is discussed that when a child has heat, excessive heat generates phlegm; excessive phlegm generates fright (Jing); excessive fright generates wind; excessive wind causes convulsions; if it worsens further, the jaw becomes rigid; if even more severe, opisthotonos and upward gaze occur; at this point, phlegm-saliva obstructs the jaw.
When wind-heat is extreme, it blocks the meridians, immediately causing convulsions and spasms; phlegm-dampness stagnates in the stomach region, leading to mental confusion and unconsciousness; as the pathogen enters the Zhongwan area, the limbs become cramped. All these conditions result from the blockage of orifices and the stagnation of Qi and blood in the hundred vessels. Some recover through clearing heat, some through calming fright, some through extinguishing wind, and some through resolving phlegm and unblocking orifices. These are all outcomes of treating according to symptoms. One must not fail to thoroughly investigate the root cause of the disease.
If the pathology lies in heat, do not treat recklessly; if in phlegm, do not treat recklessly; if in fright, do not treat recklessly; if in wind, do not hastily treat for fright; if in wind, do not hastily treat for convulsions. Generally, when treating pediatric diseases where the issue is fright caused by phlegm-heat, one should only clear heat and resolve phlegm, and the fright will subside naturally. Where the issue is wind caused by agitation of fright, one should only benefit the spirit and resolve phlegm, and the wind will dissipate naturally. Where the issue is phlegm-saliva, one must urgently clear heat and resolve phlegm; if convulsions are present, one must use methods to extinguish wind and calm fright. This is considered the supreme skill of medicine. If one acts rashly based on subjective intent, although treating for fright, if phlegm is not resolved and heat is not cleared, how can the fright stop? If wind is not dispersed because phlegm-heat is not transformed, how can phlegm be removed? Thus, the so-called "non-treatment treatment" is precisely what constitutes "treatment." Students should pay deep attention to this aspect, focusing on investigating gains and losses, thereby achieving a comprehensive and thorough mastery of medical principles.
It is discussed that when a child's Zang organs are cold and Fu organs are cold, with the large intestine failing to maintain control, it is collectively termed diarrhea. One must distinguish severity and investigate the pace. Loose stools, diarrhea, incontinence, purging, and bucket-like discharge are five different types; how can they be treated uniformly?
"Loose stools" refer to waste materials that do not consolidate, appearing thick yet resembling diarrhea but not quite; "diarrhea" refers to episodes occurring without fixed timing, sometimes with loss of awareness during expulsion; "purging" refers to direct spraying and splashing, indicating Qi escaping from within; "incontinence" refers to food passing directly through the intestines without digestion; "bucket-like discharge" refers to sudden massive expulsion, like a barrel collapsing, leaving nothing behind. From this, we know it stems from cold deficiency in the Zang and Fu organs. The onset speed and severity of diarrhea can be inferred.
Whenever a child's stool is green, it is because the Spleen is constrained by the Liver meridian. The Liver belongs to Yi Wood and controls Ji Earth (Spleen). Due to the interaction of overcoming and being overcome, the true nature manifests as green. This is due to Zang-Fu cold deficiency, not Fright. Additionally, if stool starts yellow and turns green after a while, it indicates mild Zang cold; if ingested medicine passes through unchanged, it indicates severe cold and slipperiness. In cases of deficiency-type incontinence, fatigue sets in after just three or five episodes. If one does not urgently warm the Zang organs, regulate the Stomach, smooth the San Jiao, and harmonize Ying and Wei, the condition will rapidly progress to slow Fright syndrome. Given such urgency, attempting to treat sequentially with anti-diarrheal agents is often too late. One must prioritize warming the Zang and Fu organs; once warmed, how can cold remain in the intestines? Using hot herbs to forcibly stop diarrhea may cause heat to trigger other ailments. One should first administer intestinal-astringent herbs, then tonify Stomach Qi. One must not act rashly or overdose with hot herbs. If the Zang-Fu are extremely deficient and cold, causing the child to suffer with cold limbs, this is termed a "Ni" (adverse/rebellious) syndrome. In such cases, Hei Fu Zi (Black Prepared Aconite), Bai Zhu (Atractylodes Macrocephala Rhizome), and Gan Jiang (Dried Ginger) should be used, dosed according to severity. Whenever hot herbs are administered and diarrhea stops but dysentery ensues, this is inevitable. Excellent formulas for managing diarrhea are listed later; please study them carefully to grasp their essence.