受湿肿 伤寒虚气入腹 食毒瓦斯肿 泻痢虚气入腹
议曰此四种所患病不相同皆由虚盛而得之受湿谓脾胃受湿冷久不克化气浮四肢头面皆肿食
毒瓦斯由脾胃伤之冷积毒瓦斯停留胃脘致虚入腹作
种伤寒由下之大早乘虚入腹作肿泻痢之久脾气亦虚是以致肿以上宜平调胃气补脏充实方可去
肿先服四味理中丸减半干姜加白术桑白皮同煎伤寒虚肿加枳实作喘加淡豆泻痢虚肿服正气
调胃胃气既壮以救生丹利之其肿即退再调补脏腑用观音散良益固平复矣
气虚肿(亦名气蛊) 血虚肿(亦名血蛊) 荣卫俱虚肿(亦名气血蛊)
议曰小儿所患肿胀一门最为要急前人少有究竟然肿胀已作皆由荣卫不顺脏腑怯弱壅滞
流注百脉表里俱虚邪正相乱所以致受四大浮盛腹肚膨满多由食毒得之饮食得之症伤得之饥饱得
积久不化诸虚所入故成斯病病由虚得或则妄乱通下因虚致虚根不能去疾加已盛是谓坏证危候
者怯而为辞庸者暴以攻击二医不同诚属难治原夫智者商之谓商量斟酌轻重良者审之虽曰良工
由宜审其可否之意疑者塌之疑其病盛不可利只宜与塌其气明者起之明其虚实已定良方起活谨
遵其理始可调治药用至真对症克效即无恙矣
以上先与服荣卫饮子次服分气饮子
调补婴孩气血俱虚荣卫不顺四肢头面手足俱浮睡以至喘急者并宜服荣卫饮子良方
川当归 熟干地黄(净洗) 人参 白茯苓 川芎 白术 甘草(炙) 白芍药 枳壳(研,
别制) 黄 (蜜炙) 陈皮
上等分 咀每服二钱匕水小盏煎至半去滓通口不拘时候
议曰荣者血温流行于脉卫者气顺调和于络是故荣行脉中卫行脉外阴阳相安循环无正自幼
不离呼吸无少滞碍其脉方调其气乃顺呼吸之间脉不应息气有违滞流注经络隐伏脏腑虚热则发痈
疽背部实热则患疮痍 疥况其荣与卫阴及阳偏枯有作易感寒邪亦易致虚百病皆由兹始此方最
良虽儿幼小并可与脉以肚其根血荣气卫顺且和矣腑寒脏虚温且壮矣盈亏自然而平法弱自然而
正阴阳调均气脉充实乃曰妙工
【受湿肿】伤寒导致虚气侵入腹部,饮食中毒瓦斯(指食物腐败产生的毒气)引起肿胀,腹泻痢疾导致虚气侵入腹部。
讨论说:这四种疾病虽然表现不同,但都是由正气虚弱或邪气盛实而引发的。“受湿”是指脾胃受到湿冷之邪侵袭,长久不能运化,导致气机浮越于四肢、头面,从而出现全身浮肿;“食毒瓦斯”是由于脾胃受损,冷积与毒瓦斯停滞在胃脘,致使虚邪入腹形成肿胀;“伤寒”是因为攻下过早,乘虚而入腹部导致肿胀;“泻痢”日久,脾气亦虚弱,因此导致肿胀。以上情况,应当先平调胃气,补益脏腑使其充实,然后才能消除肿胀。先服用四味理中丸,将干姜用量减半,加入白术、桑白皮共同煎煮。若是伤寒引起的虚肿,加枳实;若伴有气喘,加淡豆豉。若是泻痢引起的虚肿,服用正气调胃汤。待胃气壮实后,再用救生丹利水消肿,其肿胀即可消退。随后再调理补益脏腑,使用观音散,效果良好且稳固,身体自然恢复平静。
【气虚肿(又称气蛊)】【血虚肿(又称血蛊)】【荣卫俱虚肿(又称气血蛊)】
讨论说:小儿所患的肿胀一类疾病最为紧急重要,前人对此少有详尽论述。然而肿胀一旦发作,皆因荣卫运行不顺、脏腑怯弱、气机壅滞,流注于百脉,导致表里俱虚,邪气与正气相乱,从而致病。腹部膨满多由饮食中毒所致,或因饮食不当、症伤(指某种特定的损伤或病症)、饥饱不均、积久不化以及诸种虚损所致,故而成此病。疾病由虚损引起,如果胡乱使用通下法,会导致因虚更虚,病根不能去除,反而加重病情,这被称为坏证、危候。医生若怯懦则不敢治疗,庸医则猛烈攻击,这两种做法都难以治愈。原本明智者会斟酌权衡轻重,良医则会审慎判断。虽然说是良工,也应当审察治疗的可行性;对于怀疑邪气盛实不可利水的情况,只宜用“塌”法来平息其气;对于明辨虚实已定者,用良方使其起死回生。只要谨遵医理,用药至真对症,就能取得疗效,患者便无大碍了。
【调补婴孩气血俱虚、荣卫不顺】若四肢、头面、手足均浮肿,甚至发展到气喘急促者,都适宜服用荣卫饮子这一良方。
药物组成:川当归、熟干地黄(洗净)、人参、白茯苓、川芎、白术、甘草(炙)、白芍药、枳壳(研碎,另处理)、黄耆(蜜炙)、陈皮。
以上各药等分,切碎。每次服用二钱匕,用水一小盏,煎至一半,去渣滓,不拘时候,通口服下。
讨论说:荣是血,温和流行于脉管之中;卫是气,顺调和畅于络脉之外。因此荣行于脉内,卫行于脉外,阴阳相互安宁,循环无端,自幼至今不离呼吸,没有丝毫滞碍,这样脉象才调和,气机才顺畅。如果在呼吸之间,脉搏不应息而动,说明气有违逆滞涩,流注经络,隐伏脏腑。虚热则会引发痈疽,背部实热则会患疮痍疥癣。况且荣与卫若阴及阳偏枯,就会容易感受寒邪,也容易致虚,百病皆由此开始。此方最为优良,即使幼儿幼小也可服用,以固护其根本,使血荣气卫顺和。腑寒脏虚得以温壮,盈亏自然平衡,柔弱自然端正,阴阳调均,气脉充实,这才称为妙手良工。
[Edema due to Dampness] Taiyang disease (disease of the Taiyang channel) leads to deficient Qi invading the abdomen; food poisoning/toxic vapors cause swelling; diarrhea and dysentery lead to deficient Qi invading the abdomen.
Discussion: Although these four conditions manifest differently, they all arise from either deficiency or excess. "Dampness invasion" refers to the Spleen and Stomach being affected by cold-dampness for a long time, failing to transform and transport fluids, causing Qi to float to the limbs, head, and face, resulting in generalized edema. "Food toxic vapor" occurs when the Spleen and Stomach are damaged, leading to cold accumulation and toxic vapors stagnating in the epigastrium, allowing deficient pathogens to enter the abdomen and cause swelling. "Taiyang disease" causes swelling due to premature purgation, allowing pathogens to invade the abdomen while the body is deficient. Prolonged diarrhea and dysentery weaken the Spleen Qi, thereby causing edema. For the above conditions, one should first harmonize the Stomach Qi and tonify the Zang organs to make them substantial before eliminating the edema. First, administer Siwei Lizhong Wan (Four-Ingredient Regulating Middle Pill), reducing the dosage of Shengjiang (Prepared Ginger), and decocting together with Baizhu (Atractylodis Macrocephalae Rhizoma) and Sangbaipi (Mori Cortex). If it is edema due to Taiyang disease, add Zhishi (Aurantii Fructus); if accompanied by wheezing, add Dansh dou (Sojae Semen Praeparatum). If it is edema due to diarrhea/dysentery, administer Zhengqi Tiaowei Tang (Righteous Qi Regulating Stomach Decoction). Once the Stomach Qi is strengthened, use Jiusheng Dan (Life-Saving Pill) to promote urination and reduce edema, which will then subside. Subsequently, regulate and tonify the Zang-Fu organs using Guanyin San (Guanyin Powder), which yields good and stable results, leading to natural recovery.
[Qi Deficiency Edema (also known as Qi Gu)] [Blood Deficiency Edema (also known as Blood Gu)] [Ying-Wei Dual Deficiency Edema (also known as Qi-Blood Gu)]
Discussion: Among pediatric diseases, edema/swelling is among the most critical. Predecessors have rarely provided exhaustive discussions on this. However, once swelling manifests, it is invariably due to disordered Ying and Wei circulation, weak Zang-Fu organs, qi stagnation, and flow into the hundred vessels, resulting in exterior-interior deficiency and chaotic interaction between pathogenic factors and healthy Qi. Abdominal distension is mostly caused by food toxicity, improper diet, specific injuries/illnesses, irregular eating habits, long-standing accumulation not transforming, and various deficiencies. The disease originates from deficiency. If indiscriminate purgatives are used, it leads to further deficiency upon existing deficiency, the root cannot be removed, and the condition worsens; this is termed a "ruined syndrome" or critical prognosis. A timid physician may hesitate to treat, while a mediocre physician may attack aggressively; both approaches are difficult to manage successfully. Wise physicians deliberate on the severity, and good physicians examine carefully. Even skilled practitioners must assess the appropriateness of treatment. For cases where pathogenic excess is suspected and diuresis is contraindicated, only the "Ta" method (settling/subduing Qi) should be used to calm the Qi. For cases where deficiency and excess are clearly distinguished, good prescriptions can revive the patient. By strictly adhering to medical principles and using precise, symptomatic medications, efficacy is achieved, and the patient remains safe.
For the above conditions, first administer Yingwei Yinzi (Ying-Wei Decoction), followed by Fenqi Yinzi (Separating Qi Decoction).
[Regulating and Tonifying Infant Qi and Blood, Resolving Disordered Ying-Wei] If there is generalized edema of the limbs, head, face, hands, and feet, progressing to wheezing and urgency, Yingwei Yinzi (Ying-Wei Decoction) is suitable.
Ingredients: Chuan Danggui (Angelicae Sinensis Radix), Shu Dihuang (Rehmanniae Radix Preparata), Renshen (Ginseng Radix), Baifuling (Poria), Chuanxiong (Ligusticum Chuanxiong Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma - Honey-fried), Baishaoyao (Paeoniae Radix Alba), Zhike (Aurantii Fructus - ground, processed separately), Huangqi (Astragali Radix - honey-fried), Chenpi (Citri Reticulatae Pericarpium).
Equal parts of the above ingredients, coarsely crushed. Take two qianbi (approx. 6-9g) per dose, decoct with one small cup of water until half remains, strain, and drink orally at any time.
Discussion: Ying refers to Blood, which flows warmly within the vessels; Wei refers to Qi, which harmonizes smoothly within the collaterals. Thus, Ying circulates inside the vessels, and Wei circulates outside the vessels. Yin and Yang remain peaceful, cycling endlessly without interruption since childhood, synchronized with respiration without any lag. Only then are the pulses harmonious and Qi smooth. If during respiration the pulse does not correspond to the breath, it indicates Qi deviation and stagnation, flowing into meridians and hiding in Zang-Fu organs. Deficient heat may cause carbuncles and sores; Excess heat in the back may cause ulcers and scabies. Moreover, if Ying and Wei suffer from Yin-Yang imbalance or hemiplegia-like weakness, the body easily contracts cold pathogens and becomes deficient. All diseases originate from here. This prescription is excellent; even for young children, it can be administered to secure the root, making Blood Ying and Qi Wei smooth and harmonious. Cold in Fu organs and deficiency in Zang organs are warmed and strengthened. Balance and correction occur naturally. When Yin-Yang are balanced and Qi-Pulses are substantial, this is called the work of a master physician.