王海藏云夫 之为病皆由子在母腹中时浸渍食母血秽蕴而成毒皆太阴湿土壅滞君相二火
之所
作也因小儿真气既盛正气又旺邪无所容或因天寒伤表或伤里 由是而生焉治当外者外治内者
内治中外皆和其 自出至于恶寒者发之表大热者夺之渴者清之秘者通利之惊者安之泄者分之
不可执一大抵伤寒同治随经用药最为高论假如五日以里诸病与 疹不能别辨者不可疑似必须
发之但各从其所伤应见治之皆不妨 出若强发之其变不可胜数矣前人言首尾俱不可下者何也
曰首不可下者为 未显于表下则邪气不得伸越此脉证有表而无里故禁首不可下也尾不可下者
为毒已显于外内无根蒂大便不实无一切里证下之则 气逆陷故禁尾不可下也又言温暖不令
通风 若已出身热天暄何必盖覆不使之通风乎后人执此二句不知天令人事通变致误者多大
抵以脉为主浮中沉之诊平举按之候察其虚实定其中外则可以万全矣
外伤升麻汤 内伤枳实丸 大便KT 者枳术丸 伤冷者温之神应丸 恶寒者发之防风苍术
汤
表大热者夺之此表者通言三阳也夫阳盛则气必上行言夺者治之不令上行也 大便秘结者下之
桃仁承气四顺饮柴胡饮选用察其在气在血 渴者清之大渴者白虎汤小渴者凉膈散 小便不通
者利之导赤散八正散之类当求上下三焦何经而用药惊者分轻重安之 泄者察寒热分之
已显 证所用之药
出不快化毒汤 出太多犀角地黄汤 地骨皮鼠粘子汤 咽不利桔梗甘草粘子汤 烦者桔
梗甘草栀子汤
肺不利紫草甘草枳壳汤
太阳出不快荆芥甘草防风汤
阳明出不快升麻加紫草汤
少阳出不快速翘防风汤
四肢出不快防风芍药甘草汤
王海藏说:疹这种病,都是由胎儿在母腹中时,浸淫吸收母亲经血中的秽浊之气,蕴结而成毒邪。这主要是由于太阴湿土壅滞,加上君火与相二火的熏蒸作用所致。因为小儿真气旺盛,正气充足,邪气无处容身;或者因天气寒冷损伤体表,或损伤体内,由此而发病。治疗应当根据病位在外则从外治,在内则从内治,内外调和,疹毒自然透出。至于恶寒的,用发散法解表;大热的,用攻夺法清热;口渴的,用清法除渴;便秘的,用通利法通便;惊悸的,用安神法定惊;泄泻的,用分消法止泻。不可固执于一种治法,大致说来,伤寒与疹的治疗原则相通,随经络辨证用药是最高的理论。假如发病五日内,各种病症与疹难以辨别者,不可犹豫疑似,必须采用发散法。但应各自根据其受邪情况,对应见到症状进行治疗,都不妨碍疹毒透出。如果强行使用发散法,其变证将不可胜数。前人说初起和末期都不可用下法,为什么呢?回答说:初期不可下,是因为疹毒尚未显露于体表,若用下法,邪气就不能向外透发,此脉证表现为有表证而无里证,所以禁止初期使用下法。末期不可下,是因为毒邪已显露于外部,内部没有根基,大便不实,没有任何里证,若用下法,会导致疹气逆陷,所以禁止末期使用下法。又有人说要保暖不让受风,但如果疹已发出且身热,天气又暖和,何必还要覆盖被子不使之通风呢?后人拘执这两句话,不知顺应天时人事进行变通,导致失误的人很多。大致应以脉象为主,通过浮、中、沉三部诊法,平举、轻按、重按来候察虚实,确定病位的内外,这样就可以万无一失了。
外伤升麻汤 内伤枳实丸 大便不通者用枳术丸 伤冷者用温神应丸 恶寒者用发散法防风苍术汤
表证大热者用攻夺法(此处“表”泛指三阳经)。阳气盛则气必上行,所谓“夺”,是指治疗时不让气机上逆。大便秘结者用下法,选用桃仁承气汤、四顺饮、柴胡饮等,需察辨病在气分还是血分。口渴的用清法,大渴者用白虎汤,小渴者用凉膈散。小便不通的用利法,如导赤散、八正散之类,应求之于上下三焦何经病变而用药。惊悸的分轻重用安神法。泄泻的察辨寒热用分消法。
已显证所用之药
出疹不快用化毒汤 出疹太多用犀角地黄汤、地骨皮鼠粘子汤 咽部不利用桔梗甘草粘子汤 烦躁用桔梗甘草栀子汤
肺气不利用紫草甘草枳壳汤
太阳经出疹不快用荆芥甘草防风汤
阳明经出疹不快用升麻加紫草汤
少阳经出疹不快用速翘防风汤
四肢出疹不快用防风芍药甘草汤
Wang Haicang stated: The disease of macules (Zhen) arises from the fetus in the womb being immersed in and absorbing the turbid essence of the mother's blood, which accumulates into toxic heat. This is primarily due to the stagnation of Taiyin Dampness-Earth, combined with the steaming action of the Ministerial Fire and Sovereign Fire. Since the infant's true Qi is vigorous and righteous Qi is abundant, there is no room for pathogenic factors; or it may be caused by cold weather injuring the exterior or the interior, thereby giving rise to the disease. Treatment should follow the principle: if the pathology is external, treat externally; if internal, treat internally. When both interior and exterior are harmonized, the macular toxin will naturally emerge. For those with aversion to cold, use dispersing methods to release the exterior; for high fever, use draining methods to clear heat; for thirst, use clearing methods to quench thirst; for constipation, use purgative methods to promote bowel movement; for fright, use calming methods to settle the spirit; for diarrhea, use separating methods to resolve dampness. One must not adhere rigidly to a single treatment method. Generally speaking, the treatment principles for Cold Damage (Shanghan) and macules are similar; prescribing herbs according to the affected meridians is considered the highest theory. If within five days of onset, various diseases cannot be distinguished from macules, one must not hesitate or doubt; dispersing methods must be employed. However, treatment should correspond to the specific injury and manifested symptoms, which will not hinder the emergence of the macules. If dispersing methods are forced inappropriately, the resulting complications would be countless.
Predecessors stated that purgatives should not be used at either the beginning or the end of the disease. Why? It is said that at the beginning, purgatives are forbidden because the toxin has not yet manifested on the surface; using purgatives prevents the pathogenic factor from extending outward. In this stage, the pulse and symptoms indicate an exterior pattern without interior involvement, hence the prohibition. At the end, purgatives are forbidden because the toxin has already manifested externally, there is no internal root, the stool is loose, and there are no interior patterns; using purgatives would cause the macular Qi to sink inward, hence the prohibition. Some also suggested keeping warm and avoiding wind. However, if the macules have emerged and the body is hot, and the weather is warm, why cover up and prevent ventilation? Many people in later generations adhered rigidly to these two sentences, failing to adapt to seasonal changes and human circumstances, leading to many errors. Generally, diagnosis should focus on the pulse. Through superficial, middle, and deep palpation—using light, moderate, and heavy pressure—one can assess deficiency and excess, determine the location (interior/exterior), and ensure a perfect outcome.
For external injury: Shengma Decoction (Cimicifugae Decoction).
For internal injury: Zhishi Pill (Immature Bitter Orange Pill).
For constipation: Zhizhu Pill (Atractylodes and Immature Bitter Orange Pill).
For cold injury: Wenshen Pill (Spirit-Calming Pill).
For aversion to cold: Dispersing method with Fangfeng Cangzhu Tang (Saposhnikovia and Atractylodes Decoction).
For severe exterior heat: Draining method (Here "exterior" refers generally to the Three Yang meridians). When Yang is excessive, Qi tends to ascend; "draining" here means treating so as to prevent Qi from ascending upward.
For severe constipation: Purgative method, selecting Tao Ren Chengqi Tang (Peach Kernel and Cinnamon Twig Decoction), Sishun Yin (Four-Compliance Drink), or Chaihu Yin (Bupleurum Drink), depending on whether the pathology is in the Qi level or Blood level.
For thirst: Clearing method. For severe thirst: Baihu Tang (White Tiger Decoction); for mild thirst: Liangge San (Cooling Chest Powder).
For urinary obstruction: Promoting urination method, such as Daochi San (Guiding Out Red Powder) or Bazheng San (Eight-Righteous Powder), choosing herbs based on the affected meridian of the Upper, Middle, or Lower Jiao.
For fright: Calming method, graded by severity.
For diarrhea: Separating method, differentiated by cold and heat.
Herbs for Manifested Patterns:
For slow emergence: Huadu Tang (Toxin-Resolving Decoction).
For excessive emergence: Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) or Digupi Shuniuzi Tang (Cortex Lycii and Arctii Decoction).
For throat discomfort: Jiegeng Gancao Zhizi Tang (Platycodon and Licorice Decoction with Arctii seeds).
For irritability: Jiegeng Gancao Zhizi Tang (Platycodon and Licorice Decoction with Gardenia).
For Lung Qi obstruction: Zicao Gancao Zhike Tang (Arnebia, Licorice, and Aurantium Decoction).
For slow emergence in the Taiyang channel: Jingjie Gancao Fangfeng Tang (Schizonepeta, Licorice, and Saposhnikovia Decoction).
For slow emergence in the Yangming channel: Shengma plus Zicao Tang (Cimicifuga and Arnebia Decoction).
For slow emergence in the Shaoyang channel: Suqiao Fangfeng Tang (Scutellaria and Saposhnikovia Decoction).
For slow emergence in the four limbs: Fangfeng Shaoyao Gancao Tang (Saposhnikovia, Peony, and Licorice Decoction).