万密斋治楚臬之子，九月发热，恐是痘疹。召万往，视之非痘，乃变蒸也。曰∶何以辨之？万曰∶以日计
之，当有变蒸之期，以症察之，亦无痘疹之候。曰∶痘症云何？万曰∶痘者，五脏之液毒也，故每脏各见一症。
呵欠惊悸，心也；项急烦闷，肝也；咳嗽喷嚏，肺也；吐泻昏睡，脾也；身体皆凉，肾也。今公子无之，知非
痘，乃变蒸将退也。次日果安。
叶天士曰∶夏季秋热，小儿泄泻，或初愈未愈，满口皆生疳蚀，阻塞咽喉致危者，此皆在里湿盛生热，热
气蒸灼，津液不升，湿热偏伤气分，治在上焦，或佐淡渗。世俗常刮西瓜翠衣治疳，取其轻扬渗利也。
吴孚先治一小儿，咽喉忽肿胀，痛甚。米饮汤水不下，危甚。吴曰∶此名锁喉风。以银针刺少商、然谷二
穴出血，其喉即宽。与之茶，即下咽无苦，饮食遂进。
一小儿不时舌出，以清凉药治之不愈。吴曰∶此名弄舌，与吐舌不同。薛新甫曰∶吐舌者，脾经实热，而
舌长出也；弄舌者，脾经虚热，时舒时敛也。照新甫成方，用异功散加钩藤而愈。（四君子加陈皮谓之异功。）
巢氏云∶小儿滞颐者，涎流出而渍必于颐间也，此由脾冷涎多故也。脾之液为涎，脾胃虚冷，不能收制其
津液，故出于颐也，张氏温脾丹主之。一法百药煎含咽，其涎自不出，亦截法也。黄散亦治此症，温脾散亦可。
（《东垣十书》。）
万密斋外孙，满口生疮，咽喉唇舌皆是。为制方∶用柏连一钱，朱砂、白矾五分，鼠妇焙干三分，共研
细，敷之立效。乃奇方也。
一儿患口舌生疮，所搽所服，皆芩、连、知、柏之类，无效。曰∶心热所致，苦入心，反助其热，
宜无效。乃作洗心散与之，一服而安。大黄、麻黄、白术、当归、白芍、荆芥、薄荷、甘草等分，水煎服，更
用柏连散搽之。（仍用苦矣。）
一儿舌上生疮，口唇破裂，吮乳不得，日夜啼哭，求治。用洗心散，入竹叶煎服，以解其里热，外用柏连
散搽之效。
蒋仲芳治一小儿，初患舌碎，既而遍身发热。或谓伤风停食，与发散消导。曰∶无益也。服后果热愈，而
汤水难入。乃以黄连五钱，（疑是分。）煎汤徐徐与之，终剂而愈。问故。曰∶若先身热而后舌碎，则因风食发
热所致。今先舌碎，知其心火亢甚，加之身热，是内热极而火外行耳。
万密斋诊治楚臬（官职名）的儿子，孩子九个月大时出现发热症状，家人担心是痘疹（天花或麻疹类疾病）。万密斋被请来诊视，观察后认为不是痘疹，而是变蒸（小儿生长发育过程中的一种生理现象，伴有轻微发热等症）。有人问：如何辨别？万密斋说：按日龄推算，应当处于变蒸的时期；从症状观察，也没有痘疹的征候。那人又问：痘症有什么表现？万密斋说：痘毒是五脏的液毒，所以每脏各表现出一种症状。呵欠、惊悸，是心的症状；项部僵硬、烦闷，是肝的症状；咳嗽、喷嚏，是肺的症状；呕吐、腹泻、昏睡，是脾的症状；全身发凉，是肾的症状。现在公子没有这些症状，可知不是痘疹，而是变蒸即将消退。第二天果然痊愈。
叶天士说：夏季和秋季天气炎热，小儿发生泄泻，或者病初愈尚未完全康复，满口都生出疳蚀（口腔黏膜溃烂），阻塞咽喉导致危重情况的，这都是因为体内湿气盛而生热，热气蒸灼，津液不能上升，湿热偏伤气分所致。治疗应着眼于上焦，或者佐以淡渗利湿之法。世俗常用刮下的西瓜翠衣（西瓜皮外层绿色部分）治疗疳症，是取其轻扬渗利的功效。
吴孚先诊治一个小孩，咽喉突然肿胀，疼痛剧烈。连米汤和水都无法咽下，情况非常危急。吴孚先说：这名叫锁喉风（急性咽喉肿痛导致呼吸困难）。用银针刺少商穴、然谷穴出血，喉咙随即宽松。给他喝茶，就能顺利咽下且无痛苦，饮食随后也能进食。
另一个小孩不时伸出舌头，用清凉药物治疗无效。吴孚先说：这名叫弄舌（伸舌即缩，玩弄状），与吐舌不同。薛新甫说：吐舌，是脾经实热，舌头长出后不收回；弄舌，是脾经虚热，舌头时而伸出时而收缩。按照薛新甫的成方，使用异功散加钩藤而痊愈。（四君子汤加陈皮称为异功散。）
巢元方说：小儿滞颐（流口水），是指涎水流出并浸渍在面颊下巴部位，这是由于脾冷涎多造成的。脾的液为涎，脾胃虚寒，不能收摄控制津液，所以涎水流出到面颊。张氏温脾丹主治此症。另一种方法是含服百药煎，其涎自然不再流出，这也是一种截断疗法。黄散也治疗此症，温脾散也可以。（出自《东垣十书》。）
万密斋的外孙，满口生疮，咽喉、嘴唇、舌头都有。为他制定方剂：用黄连一钱，朱砂、白矾五分，鼠妇（潮虫）焙干三分，共同研成细末，外敷患处立即见效。这是一个奇特的方子。
一个小孩患口舌生疮，所涂抹和服用的药物，都是黄芩、黄连、知母、黄柏这类苦寒药，但无效。我说：这是心热所致，苦味入心，反而助长其热，所以应该无效。于是制作洗心散给他服用，一次服药就安稳了。大黄、麻黄、白术、当归、白芍、荆芥、薄荷、甘草等量，水煎服，另外再用柏连散外搽。（这里仍然使用了苦寒药。）
一个小孩舌头上生疮，口唇破裂，无法吸吮乳汁，日夜啼哭，求治。使用洗心散，加入竹叶煎服，以解除体内的热邪，外用柏连散外搽，效果显著。
蒋仲芳诊治一个小孩，起初舌头碎裂，随后全身发热。有人说是伤风停食，给予发散消导的药物。蒋仲芳说：这样没有益处。服药后果然热势更甚，而且汤水难以下咽。于是用黄连五钱（怀疑是分两之误，应为更少），煎汤慢慢喂服，服完一剂后痊愈。询问原因。蒋仲芳说：如果先有身热而后舌头碎裂，那是因风邪和食积发热所致。现在是先舌头碎裂，可知心火亢盛至极，加上身热，这是内热极盛而火热向外发散的表现。
Wan Mizhai treated the son of a Chu provincial judge (Chuo Nie). At nine months old, the child developed fever, and the family feared it was variola (smallpox) or rubeola (measles). Wan Mizhai was summoned and examined the child, determining it was not variola/rubeola but bianzheng (a physiological developmental phase in infants characterized by mild fever and other symptoms). When asked how to differentiate them, Wan said: "By calculating the days, the timing corresponds to bianzheng; by observing the symptoms, there are no signs of variola/rubeola." The questioner then asked about the manifestations of variola. Wan replied: "Variola toxins are fluids from the five zang organs, so each organ manifests one specific symptom. Yawning and palpitations indicate the Heart; neck stiffness and irritability indicate the Liver; coughing and sneezing indicate the Lungs; vomiting, diarrhea, and lethargy indicate the Spleen; and a cool body indicates the Kidney. Since the young master lacks these symptoms, we know it is not variola, but rather that the bianzheng phase is subsiding." The next day, the child indeed recovered.
Ye Tianshi stated: "In summer and autumn, when children suffer from diarrhea, or have recently recovered but are not fully healed, and develop gan erosion (oral mucosal ulceration) all over the mouth, obstructing the throat and causing critical conditions, this is due to excessive dampness in the interior generating heat. The heat steams and scorches, preventing fluids from ascending, and damp-heat disproportionately injures the qi level. Treatment should focus on the upper jiao, possibly assisted by light diuretic methods. Common practice involves scraping watermelon rind (xigua cui yi) to treat gan, utilizing its light and dispersing diuretic properties."
Wu Fuxian treated a child whose throat suddenly swelled with severe pain. Rice broth and water could not be swallowed, creating a critical situation. Wu said: "This is called suo hou feng (locking throat wind). By pricking the Shaoshang (LU11) and Ran Gu (KI2) acupoints with silver needles to bleed, the throat immediately relaxed. After giving him tea, he could swallow without discomfort, and food intake resumed."
Another child frequently protruded his tongue. Cooling medications failed to cure him. Wu said: "This is called nong she (playing with the tongue), which differs from tu she (protruding tongue)." Xue Xinpu explained: "Tu she results from excess heat in the Spleen channel, where the tongue extends and stays out; nong she results from deficient heat in the Spleen channel, where the tongue intermittently extends and retracts." Following Xue Xinpu's established formula, Yi Gong San (Extraordinary Power Powder) combined with Gouteng (Uncaria rhynchophylla) cured the condition. (Yi Gong Si Jun Zi Tang is Si Jun Zi Tang plus Chen Pi.)
Chao Yuanfang noted: "Zhi yi (drooling) in children refers to saliva flowing out and soaking the cheeks/chin area. This is caused by cold spleen and excessive saliva. The fluid of the Spleen is saliva; when the Spleen and Stomach are deficient and cold, they fail to control the fluids, causing them to flow onto the cheeks. Zhang Shi Wen Pi Dan is indicated for this condition. Another method is to hold Bai Yao Jian (Galla Chinensis) in the mouth to swallow, which stops salivation naturally; this is also a blocking method. Huang San and Wen Pi San are also effective for this condition." (From *Dong Yuan Shi Shu*).
Wan Mizhai’s grandson had ulcers all over his mouth, affecting the throat, lips, and tongue. Wan prescribed: Huang Lian (Coptidis Rhizoma) 1 qian, Zhu Sha (Cinnabaris) and Bai Fan (Alumen) 5 fen, Shu Fu (Stableia/Oniscus asellus) dried and roasted 3 fen. These were ground into fine powder and applied topically, yielding immediate effect. It was an unusual prescription.
A child suffered from oral and lingual ulcers. Treatments using Huang Qin (Scutellariae Radix), Huang Lian, Zhi Mu (Anemarrhenae Rhizoma), and Huang Bo (Phellodendri Cortex)—all bitter-cold herbs—were ineffective. I reasoned: "This is caused by Heart heat. Bitter flavors enter the Heart and may exacerbate the heat, hence the ineffectiveness." I prepared Xi Xin San (Wash the Heart Powder) for him, which brought relief after one dose. The formula contained equal parts of Da Huang (Rhei Radix et Rhizoma), Ma Huang (Ephedrae Herba), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Dang Gui (Angelicae Sinensis Radix), Bai Shao (Paeoniae Radix Alba), Jing Jie (Schizonepetae Spica), Bo He (Menthae Haplocalycis Herba), and Gan Cao (Glycyrrhizae Radix et Rhizoma), decocted in water. Additionally, Bai Lian San was applied topically. (Note: This still utilizes bitter-cold herbs.)
Another child had ulcers on the tongue and cracked lips, unable to suck milk, crying day and night. Seeking treatment, I used Xi Xin San decocted with Zhu Ye (Phyllostachdis Folium) to clear internal heat, and applied Bai Lian San externally, which proved effective.
Jiang Zhongfang treated a child who initially presented with a fragmented tongue, followed by generalized fever. Some attributed it to wind invasion and food stagnation, prescribing diaphoretic and digestive-promoting herbs. Jiang said: "This will be of no benefit." Indeed, after administration, the fever worsened, and liquids became difficult to ingest. Jiang then administered Huang Lian (Coptidis Rhizoma) 5 qian (likely a typo for a smaller dose), decocted in water, given slowly. The course of treatment cured the child. When asked for the rationale, Jiang explained: "If fever precedes the tongue fragmentation, it is due to wind and food stagnation generating heat. Here, the tongue fragmentation preceded the fever, indicating extreme hyperactivity of Heart fire. Combined with the subsequent fever, this signifies extreme internal heat with fire manifesting outwardly."