\x发作不常治疗不一方论不等该载不尽轻重斟酌随宜设方
议曰疳者甘也疳因脾家有积虚而所致其积不下后食粘腻甘甜生冷炙爆之物故得名曰疳初
作为
疾名曰疳气皆由饮食不节生冷相投积伤久滞不化而得之久则疳气传于五脏传是名疳极候又反
传名疳逆候虽食不生肌肉作渴烦躁名疳虚候时发潮热盗汗常有名疳劳候腹大喉细手足无肉者
名丁奚候自丁奚翻食吐虫虚热来去名曰哺露十岁以下名曰疳十岁以上名曰劳
治劳之理悉不用
疳药盖疾作传足非常治疳之法理其气虚其血弱调令脉壮消其虫子散去疳热和顺三焦详而后已
无用急力攻治亦无勉强投柏只可循候而设不得过剂若冷药易动脏腑燥药易损三焦审察端的
丸散随其轻重故无得失之叹矣
药疗理法度惟有咳嗽一症究莫能尽月内牙儿难医百日婴孩亦难
有乎得失学人当知之
议曰所言牙儿及婴儿咳嗽难治之者盖为初生血气微弱五脏未充肌体未固应变蒸未周之儿
所感
寒邪攻及腠理表里相干邪正相胜阴阳未和不可强生攻治妄吐妄下妄汗妄补皆令儿疾转盛不惟
无益甚有伤害幼幼咳嗽乳母之过丸散野狼虎医人之罪岂特牙儿及婴儿难为调理隐小儿有患咳嗽
未敢轻许一二服药便见安乐虽伤寒伤风症候已归平复且咳嗽尚作大抵究竟小儿咳嗽先有有
无热与痰有热在表无热传过或者未传（近则未传远则传过）痰桐热盛痰壅即吐宜服补肺散人参
茯苓麻黄白术杏仁甘草阿胶蚵子地骨皮桑白皮桔梗有痰加半夏风热加防风天麻服之自然痰化
热散咳嗽渐愈未可直用粗涩药白矾南星石膏雄朱砒粉之类宜先滋润脾肺次用王氏（金华散）少
少
时时与服或以白丸子如雄朱脑子随大小作丸凡儿患嗽须究表里未可一向攻嗽若用金石药直入
胃脘乃成提脾风候手足勾曲又何所益巴豆轻粉砒霜药下之肠胃不禁须更成风亦何所宜只用温
平
与表顺助其气滋润肺经和顺三焦其痰渐化其热自退不必攻击所谓理嗽宜且补气化痰益肺生胃胃
开气壮即嗽渐减胃正即痰不生肺滋即嗽不有在乳毋当忌食稍长父用安存避风回滋忌毒慎冷然
小
儿气弱其嗽作热与夫大人一同且用药调理实不同耳又有时气咳嗽谓其天时冷热不调幼幼虚怯
受
患者众其嗽日夜不辍或吐或喘痰热壅盛至重者利之即愈谓用大黄朴硝枳实陈皮半夏人参浓朴
柴胡心神烦闷胸膈不快方宜与服无热与痰亦不可下伏请鉴辨毋致得失
发作没有固定规律，治疗方法不一，方论各异，无法全部记载。需根据病情的轻重进行斟酌，随宜设立处方。
议曰：“疳”字意为“甘”，疳疾是因为脾脏有积滞、虚弱所致。由于积滞不能消除，又食用了粘腻、甘甜、生冷以及炙烤爆炒的食物，所以得名叫做“疳”。起初作为疾病名称叫做“疳气”，这都是因为饮食不节制，摄入生冷之物，积滞损伤日久，停滞不化而形成的。时间久了，“疳气”会传变到五脏，这种传变称为“疳极候”；如果反过来传变则称为“疳逆候”。虽然进食但肌肉不生，口渴烦躁，这叫做“疳虚候”；时常发生潮热、盗汗，这叫做“疳劳候”；腹部胀大、喉咙细瘦、手足无肉，这叫做“丁奚候”；从“丁奚”翻食、吐虫、虚热往来，这叫做“哺露候”。十岁以下称为“疳”，十岁以上称为“劳”。
治疗“劳”的道理，完全不用治疳的药物。大概因为疾病发作传变迅速，非常规。治疗疳法，道理在于调理其气虚，调和其血弱，使脉象强壮，消除寄生虫，散去疳热，调和顺畅三焦，详细诊察后停止。不要用急迫猛烈的力量去攻治，也不要勉强投药。只能遵循证候来设立方剂，不得过量。如果使用寒凉药物容易扰动脏腑，使用燥性药物容易损伤三焦。审察确切后，制成丸散，根据病情轻重给药，因此不会有得失的叹息。
用药疗理的法度，唯有咳嗽这一症状，探究起来难以穷尽。一个月内的婴儿难医，百日的婴孩也难治。其中有得有失，学医者应当知晓。
议曰：所说的牙儿（乳齿未出之婴儿）及婴儿咳嗽难治的原因，是因为初生时血气微弱，五脏未充盈，肌体未坚固，应变蒸周期未周全的幼儿，感受寒邪，攻及腠理，表里相互干扰，邪正相争，阴阳未和。不可强行攻治，妄用吐法、下法、汗法、补法，都会让小儿疾病加重，不仅无益，反而造成伤害。幼幼咳嗽是乳母的过错，丸散乱用是庸医人的罪过。岂止是牙儿及婴儿难调理？隐忧在于小儿患有咳嗽，不敢轻易许诺服药一两次就能见安乐。即使是伤寒伤风症候已经平复，只要咳嗽还在发作。大抵究其究竟，小儿咳嗽先是有还是没有热与痰？有热在表，无热则传变过去，或者尚未传变（近处则未传，远处则传过）。痰多热盛，痰壅塞即呕吐，适宜服用补肺散（人参、茯苓、麻黄、白术、杏仁、甘草、阿胶、蚵子、地骨皮、桑白皮、桔梗）。有痰加半夏，风热加防风、天麻。服用之后自然痰化热散，咳嗽逐渐痊愈。不可直接使用粗涩的药物如白矾、南星、石膏、雄黄、朱砂、砒粉之类。应当先滋润脾肺，其次用王氏（金华散），少量、时时给予服用。或者用白丸子，如雄黄、朱砂、脑子等，根据大小做成丸药。凡是小儿患咳嗽，必须究查表里，不可一味攻嗽。如果使用金石类药物直入胃脘，就会形成提脾风候，导致手足勾曲，又有什么益处？巴豆、轻粉、砒霜等药，如果泻下，肠胃承受不住，须臾之间就会成风，又有什么适宜的呢？只用温平的药物，解表顺助其气，滋润肺经，调和顺畅三焦，其痰逐渐化解，其热自然消退，不必攻击。所谓理嗽，应当暂且补气化痰，益肺生胃。胃开气壮，则咳嗽逐渐减少；胃正，则痰不生；肺滋，则咳嗽不再出现。在哺乳期不要忌讳饮食，稍长一些父亲要用安存之法，避风回滋，忌毒慎冷。然而小儿气弱，其咳嗽发作发热与大人相同，但用药调理确实不同。又有时候气咳嗽，说是天时冷热不调，幼幼虚怯受患者众多，其咳嗽日夜不停，或吐或喘，痰热壅盛，至重者利之即愈。谓用大黄、朴硝、枳实、陈皮、半夏、人参、浓朴、柴胡。心神烦闷、胸膈不快，方宜与服。无热与痰也不可以下法。伏请鉴辨，不要导致得失。
The onset is irregular, treatments vary, and prescriptions differ; they cannot be fully recorded. One must weigh the severity of the condition and formulate prescriptions accordingly.
Discussion: The term "Gan" (Pediatric Malnutrition Syndrome) implies "sweetness." Gan disease arises from accumulation in the Spleen leading to deficiency. Because the accumulation is not resolved, and the child consumes sticky, sweet, cold, raw, roasted, or fried foods, it is named "Gan." Initially, as a disease name, it is called "Gan Qi" (Gan Qi Syndrome). This results from unregulated diet, intake of cold/raw items, long-standing injury from accumulation, stagnation, and failure to transform. Over time, "Gan Qi" transmits to the Five Zang Organs; this transmission is named "Gan Ji Hou" (Critical Stage of Gan). If it transmits in reverse, it is named "Gan Ni Hou" (Rebellious Stage of Gan). Although eating occurs, muscles do not grow, thirst and irritability are present; this is named "Gan Xu Hou" (Deficiency Stage of Gan). Occasional tidal fever and night sweats are named "Gan Lao Hou" (Consumption Stage of Gan). Abdominal distension, thin throat, and fleshless limbs are named "Ding Xi Hou" (Ding Xi Syndrome). Vomiting worms after turning over food, with fluctuating deficiency-heat, is named "Bu Lu Hou" (Feeding Dew Syndrome). Under ten years old is called "Gan"; over ten years old is called "Lao" (Consumption).
The principle for treating "Lao" completely avoids using Gan medicines. Generally, because the disease progresses rapidly and abnormally, the method for treating Gan involves regulating Qi deficiency, harmonizing Blood weakness, strengthening the pulse, eliminating parasites, dissipating Gan heat, and smoothly harmonizing the San Jiao (Triple Burner), stopping only after detailed examination. Do not use urgent, forceful attack methods, nor forcibly administer drugs. One should follow the syndrome patterns to set prescriptions and must not exceed the dosage. Cold medicines easily disturb the Zang-Fu organs; dry medicines easily damage the San Jiao. After examining the exact situation, prepare pills and powders according to severity, thus avoiding regret over errors.
In the methodology of medicinal treatment, only the symptom of coughing is difficult to exhaustively explore. Infants within one month are difficult to treat; infants at one hundred days are also difficult. There are gains and losses; students of medicine should know this.
Discussion: The reason why coughing in infants ("Ya Er") and babies is difficult to treat is that upon birth, their Qi and Blood are weak, the Five Zang Organs are not full, the body is not solid, and the physiological changes of "Ying Zheng" (growth and development cycles) are not complete. When such children contract Cold Evil, it attacks the Cou Li (interstitial spaces), causing internal and external interference, struggle between Pathogenic and Righteous factors, and disharmony of Yin and Yang. One must not forcefully attack; rash use of emetic, purgative, diaphoretic, or tonifying methods will cause the child's illness to worsen, doing no good and causing harm. Coughing in young children is the fault of the wet nurse; reckless use of pills and powders is the sin of quack doctors. Is it only infants and babies that are hard to regulate? The hidden worry is that when a child has coughing, one dare not lightly promise that taking one or two doses of medicine will bring peace and health. Even if symptoms of Taiyang Shang Han (Cold Damage) or Shang Feng (Wind Strike) have subsided, if coughing persists, it remains an issue. Generally, investigating the root, does pediatric coughing involve heat and phlegm initially? If heat is on the Exterior, without heat it may transmit inward, or it may not have transmitted yet (nearby then not transmitted, distant then transmitted). With excessive phlegm and heat, obstruction leads to vomiting; it is suitable to take Bu Fei Tang (Lung-Tonifying Decoction) [Ren Shen, Fu Ling, Ma Huang, Bai Zhu, Xing Ren, Gan Cao, E Jiao, Ke Zi, Di Gu Pi, Sang Bai Pi, Jie Geng]. Add Ban Xia if there is phlegm; add Fang Feng and Tian Ma if there is Wind-Heat. After administration, phlegm naturally transforms, heat dissipates, and cough gradually heals. Do not directly use coarse, astringent medicines like Bai Fan, Nan Xing, Shi Gao, Xiong Huang, Zhu Sha, or Pi Fen. First, moisten the Spleen and Lungs; second, use Wang Shi Jin Hua San (Wang's Golden Flower Powder), administering small amounts frequently. Or use Bai Wan Zi (White Pills) containing Xiong Huang, Zhu Sha, and Nao Zi, made into pills according to size. Whenever a child suffers from coughing, one must investigate the Interior and Exterior; do not solely attack the cough. If metal and stone medicines enter the Stomach directly, they may form Ti Pi Feng Hou (Splee-Raising Wind Syndrome), causing flexion of hands and feet, which benefits nothing. Ba Dou, Qing Fen, and Pi Shuang, if used as purgatives, will overwhelm the intestines and stomach, leading to wind convulsions shortly thereafter; what benefit is there? Use only warm and neutral medicines to release the Exterior, assist Qi, moisten the Lung Meridian, and harmonize the San Jiao. Phlegm will gradually resolve, and heat will recede without need for aggressive attack. Regarding managing coughing, one should temporarily tonify Qi, transform phlegm, benefit the Lung, and generate the Stomach. When the Stomach opens and Qi strengthens, cough decreases; when the Stomach is correct, phlegm is not produced; when the Lung is moistened, cough ceases. During breastfeeding, dietary taboos are not strictly necessary; as they grow older, fathers should use preservation methods, avoid wind, nourish, avoid toxins, and be cautious with cold. However, children have weak Qi; their coughs generating heat are similar to adults, but the medication regulation is truly different. There is also seasonal epidemic coughing, attributed to improper temperature fluctuations in the weather, affecting many vulnerable children. Their coughing continues day and night, with vomiting or wheezing, severe phlegm-heat obstruction. In critical cases, purging brings cure. This refers to using Da Huang, Pu Xiao, Zhi Shi, Chen Pi, Ban Xia, Ren Shen, Hou Po, and Chai Hu. If there is mental restlessness and chest/epigastric discomfort, this formula is suitable. If there is no heat or phlegm, purgation is not appropriate. Please examine and distinguish carefully to avoid errors.