痈疽证治已详疡医准绳，其在小儿，虽肌体柔脆，而天真未凿，鲜五发之毒，
亦无五善七恶之诊，初生周 前后，遍体生疮，俗忌疗治，其他小小痈疖，自可敷
贴而消，若憎寒壮热，沉困躁扰，为心腹之害，又当求其本而治之，乳下婴儿，母
子俱服，是在医师神而明之，无按图索骥之理，薛氏乃掇大科痈疽证治，赘附《保
婴》，近于骈拇枝指矣，若夫溯流穷源，明经络，分表里，审顺逆，则无大小之异，
有专科书在，又何赘焉。今第以小儿所专者集为是编，以至危且急，杀人顷刻，莫
如丹毒，故首列之，且独加详焉。
〔郑〕夫疮疡，皆因脏腑不调，经络壅滞而得，或由胎毒，或者风化为虫，或则
热气有盛，或者惊入皮肤，其大者是滞于血脉而横出于皮肤之间，若节其气血则易
破，若或风缠，则生瘾轸，或者外邪所入，即多KT 痒而不定，其食毒则滞死其血气，
久则化为脓也。或作惊疮者，惊本无物，亦蹉其血气，在脏而为积，在腑故出皮肤
为疮，发遍身而四肢难较。风疮，亦发遍身，其形甚小，世呼为疥热毒疮，发
处不定，节滞其血，故作疮虫窠，疮常发于胫后作其窠，窠内有虫如虮子，盖因腹
中蛲虫随气而化，其疮即较而再发，或片子如癣相似，甚有死血痒，若以药敷较，
只是归腹中，须是取却虫方瘥，及与杀虫药。
〔曾〕《内经》曰∶诸痛痒疮疡，皆属心火。火郁内发，致有斯疾，盖心主乎血，
血热生风，热郁内甚，递相传袭，故火能生土，血注阳明主肌肉，风热与血热相搏，
发见皮肤，其名不一，有黄脓而白者，土生金，母归子也，始生微痒而热轻，肿痛
溃烂为热极，血凝化水，气滞成脓，甚至寒热作而饮食减，尤为可虑，宜宣泄风毒，
凉心经，解胃热，用当归散加黄连、升麻、干葛，水姜葱灯心煎服，及三解散、牛
蒡汤、木通散，虽服，涂以四黄散、一抹金。
当归散（潮热） 三解散（惊） 牛蒡汤（咽喉） 木通散（淋）
四黄散 治小儿身上一切热毒疮疾燥痒，抓破有汁不干。
净黄连 黄柏 黄芩 大黄 滑石（五味各半两） 五倍子（去虫屑，二钱半）
上锉、晒，为末。用清油和调二钱至三钱，涂搽患处。仍服四顺散、消毒饮。
一抹金 治小儿遍身生疮，溃烂如糜梨，燥痛，脓汁不干。
藜芦（净洗，焙） 蛇床子（去埃土） 红丹（水飞过。三味各五钱） 硫黄 赤石脂 明白矾（火飞过）
五倍子（去虫屑） 黄柏（去粗皮。五味二钱半） 轻粉（五十帖）
上，前八味或晒或焙，为末，仍同轻粉在乳钵再杵匀，用生肥猪膏碎切，以瓦
钵和药末烂杵。涂抹患处，或清油调搽亦可。
〔汤〕小儿血气凝滞，而有热毒之气乘之，故结聚成痈疖肿毒也，未结之先，微见
有红头 子、隐起作疼者，急用不语唾、夜半频频涂之（饮酒了不可用）即消散。若已结成，
当用天乌散贴方。若内显躁热不宁等证，即须内服漏芦散，真良方也，热甚者用青
解毒丸，四顺清凉饮加防风、连翘，玄参剂亦可服，五福化毒丹尤良，连翘汤可服，
青露散掩之留小孔，后用惊毒掩子收疮口。热甚者凉膈散亦可服。（方类列于后）
【背景信息】
书名：证治准绳·幼科 作者：王肯堂 朝代：明 章节：疮疡 类别：综合
痈疽（一种严重的化脓性感染）的证治已在《疡医准绳》中详细记载。对于小儿而言，虽然肌肤柔嫩脆弱，但先天真气未受凿破，极少发生“五发”之毒，也没有“五善七恶”的诊断指征。在出生前后，若遍体生疮，世俗忌讳治疗；其他轻微的痈疖（小脓肿），自然可以通过敷贴消除。如果出现憎寒壮热、沉困躁扰等症状，这是心腹内部的危害，应当探究其根本原因进行治疗。对于哺乳期的婴儿，母子需共同服药，这在于医师能够神妙地明辨病机，不能机械地按图索骥。薛氏（薛己）只是摘录了成人科书中关于痈疽的证治，附加在《保婴撮要》中，这就像多余的脚趾和树枝一样累赘。至于追溯源头、明了经络、分辨表里、审察顺逆，则没有大小之分，已有专科书籍存在，又何必赘述呢？现在仅将小儿特有的内容汇编成此编，其中最危险且紧急、顷刻杀人的，莫过于丹毒（一种急性感染性皮肤病），所以首先列出，并且单独加以详述。
〔郑〕夫疮疡，皆因脏腑不调，经络壅滞而得，或由胎毒，或者风化为虫，或则热气有盛，或者惊入皮肤，其大者是滞于血脉而横出于皮肤之间，若节其气血则易破，若或风缠，则生瘾轸，或者外邪所入，即多KT 痒而不定，其食毒则滞死其血气，久则化为脓也。或作惊疮者，惊本无物，亦蹉其血气，在脏而为积，在腑故出皮肤为疮，发遍身而四肢难较。风疮，亦发遍身，其形甚小，世呼为疥热毒疮，发处不定，节滞其血，故作疮虫窠，疮常发于胫后作其窠，窠内有虫如虮子，盖因腹中蛲虫随气而化，其疮即较而再发，或片子如癣相似，甚有死血痒，若以药敷较，只是归腹中，须是取却虫方瘥，及与杀虫药。
〔曾〕《内经》曰∶诸痛痒疮疡，皆属心火。火郁内发，致有斯疾，盖心主乎血，血热生风，热郁内甚，递相传袭，故火能生土，血注阳明主肌肉，风热与血热相搏，发见皮肤，其名不一，有黄脓而白者，土生金，母归子也，始生微痒而热轻，肿痛溃烂为热极，血凝化水，气滞成脓，甚至寒热作而饮食减，尤为可虑，宜宣泄风毒，凉心经，解胃热，用当归散加黄连、升麻、干葛，水姜葱灯心煎服，及三解散、牛蒡汤、木通散，虽服，涂以四黄散、一抹金。
当归散（潮热） 三解散（惊） 牛蒡汤（咽喉） 木通散（淋）
四黄散 治小儿身上一切热毒疮疾燥痒，抓破有汁不干。
净黄连 黄柏 黄芩 大黄 滑石（五味各半两） 五倍子（去虫屑，二钱半）
上锉、晒，为末。用清油和调二钱至三钱，涂搽患处。仍服四顺散、消毒饮。
一抹金 治小儿遍身生疮，溃烂如糜梨，燥痛，脓汁不干。
藜芦（净洗，焙） 蛇床子（去埃土） 红丹（水飞过。三味各五钱） 硫黄 赤石脂 明白矾（火飞过）
五倍子（去虫屑） 黄柏（去粗皮。五味二钱半） 轻粉（五十帖）
上，前八味或晒或焙，为末，仍同轻粉在乳钵再杵匀，用生肥猪膏碎切，以瓦钵和药末烂杵。涂抹患处，或清油调搽亦可。
〔汤〕小儿血气凝滞，而有热毒之气乘之，故结聚成痈疖肿毒也，未结之先，微见有红头 子、隐起作疼者，急用不语唾、夜半频频涂之（饮酒了不可用）即消散。若已结成，当用天乌散贴方。若内显躁热不宁等证，即须内服漏芦散，真良方也，热甚者用青解毒丸，四顺清凉饮加防风、连翘，玄参剂亦可服，五福化毒丹尤良，连翘汤可服，青露散掩之留小孔，后用惊毒掩子收疮口。热甚者凉膈散亦可服。（方类列于后）
[Background Information]
Book: Zhengzhi Zhunsheng · Pediatrics; Author: Wang Kentang; Dynasty: Ming; Chapter: Sores and Ulcers; Category: Comprehensive
The syndrome differentiation and treatment of carbuncles and sores (severe purulent infections) have been detailed in *Yangyi Zhunsheng*. For children, although their skin and muscles are tender and fragile, their innate true qi remains intact, and they rarely suffer from the "Five Emergences" toxins, nor do they present with the diagnostic signs of "Five Auspicious and Seven Inauspicious" conditions. Around the time of birth, if sores appear all over the body, folk custom forbids treatment; other minor boils (small abscesses) can naturally be resolved through external applications. However, if symptoms such as aversion to cold with high fever, lethargy, and restlessness occur, these indicate internal harm to the heart and abdomen, requiring treatment based on the root cause. For nursing infants, both mother and child must take medicine together; this requires the physician to discern the pathology with divine clarity, rather than mechanically following diagrams. Xue Shi (Xue Ji) merely excerpted the syndrome differentiation and treatment of carbuncles and sores from adult medical texts and appended them to *Baoying*, which is like adding superfluous toes or branches. As for tracing the source, understanding meridians, distinguishing exterior and interior, and assessing favorable and unfavorable trajectories, there is no difference between adults and children, and specialized books already exist, so why add more? Now, only the content specific to children is compiled into this volume. Among these, the most dangerous and urgent condition that can kill within moments is erysipelas (an acute infectious skin disease); therefore, it is listed first and described in detail.
[Zheng] Sores and ulcers arise from disharmony of the zang-fu organs and stagnation of the meridians. They may result from fetal toxicity, wind transforming into parasites, excessive heat, or fright entering the skin. The larger ones stagnate in the blood vessels and protrude horizontally between the skin and flesh. If the flow of qi and blood is regulated, they break easily; if entangled by wind, urticaria (hives) develops. If external pathogens invade, itching occurs but is unstable. Food toxicity stagnates and kills the qi and blood, eventually turning into pus. Some cases are called "fright sores"; fright itself has no physical substance but disrupts qi and blood. When located in the zang organs, it forms accumulations; when in the fu organs, it emerges on the skin as sores, spreading over the whole body but difficult to compare with limb lesions. Wind sores also spread over the whole body, appearing very small, commonly known as scabies. Heat-toxin sores appear at unpredictable locations, stagnating blood and forming "parasite nests." These sores often form behind the calves, containing parasites like lice eggs inside the nest, likely due to pinworms in the abdomen transforming with the qi. The sores heal and recur, sometimes resembling tinea patches. Severe cases involve stagnant blood and itching. Applying medication externally only drives the pathogen back to the abdomen; one must remove the parasites and administer vermifuges to achieve a cure.
[Zeng] The *Neijing* states: "All pain, itching, sores, and ulcers belong to Heart Fire." Internal depression of fire leads to this disease. Since the Heart governs blood, blood heat generates wind. With severe internal heat depression transmitted sequentially, fire generates earth. Blood flows to the Yangming channel, which governs the muscles. Wind-heat and blood heat contend, manifesting on the skin under various names. Some present with yellow pus and white discharge, representing earth generating metal (mother returning to son). Initially, there is slight itching and mild heat; swelling, pain, ulceration, and rotting indicate extreme heat. Blood coagulates and transforms into water; qi stagnation forms pus. Even chills and fever occur with reduced appetite, which is particularly concerning. One should vent wind toxins, cool the Heart meridian, and resolve stomach heat. Use Danggui San (Angelica Decoction) added with Huanglian (Coptis Rhizome), Shengma (Cimicifugae Rhizome), and Gan Ge (Puerariae Radix), decocted with water, ginger, green onion, and Jixin (Centipedae Herba). Also use Sanjie San (Three-Unbinding Powder), Niubang Tang (Arctii Decoction), and Mutong San (Akebia Decoction). Externally apply Sihuang San (Four-Yellows Powder) and Yimojin (One Stroke of Gold).
Danggui San (for tidal fever) Sanjie San (for fright) Niubang Tang (for throat issues) Mutong San (for strangury)
Sihuang San treats all heat-toxin sores and dry itching on children's bodies; scratching breaks the skin with non-drying exudate.
Pure Huanglian (Coptidis Rhizome), Huangbai (Phellodendri Cortex), Huangqin (Scutellariae Radix), Dahuang (Rhei Radix et Rhizoma), Huashi (Talcum) (each half liang), Wubeizi (Galla Chinensis) (free of insect debris, two qian half).
Crush and sun-dry, then powder. Mix with pure sesame oil, two to three qian, and apply to the affected area. Continue taking Sishun San (Four-Regulating Powder) and Xiaodu Yin (Detoxifying Drink).
Yimojin treats sores all over the body in children, ulcerating like rotting pears, with dry pain and non-drying pus.
Lilu (Veratrum Nigrum Rhizome) (cleanly washed and baked), Shechuangzi (Cnidii Fructus) (free of dust), Hongdan (Minium) (water-washed; these three each five qian), Liuhuang (Sulfur), Chishizhi (Halloysit Rubrum), Mingfan (Alumen) (fire-washed), Wubeizi (Galla Chinensis) (free of insect debris), Huangbai (Phellodendri Cortex) (free of rough bark; these five each two qian half), Qingfen (Calomelas) (for fifty patches).
The first eight ingredients are either sun-dried or baked, then powdered. Mix thoroughly with Calomelas in a mortar. Chop fresh fat pork lard finely, mix with the powder in a clay mortar until smooth. Apply to the affected area, or mix with pure sesame oil for application.
[Tang] Children's qi and blood stagnate, and heat-toxin qi takes advantage of this, leading to the formation of carbuncles, boils, and swellings. Before consolidation, if a red head appears slightly raised and painful, immediately apply saliva frequently at midnight (do not use if the patient has drunk alcohol) to dissipate it. If already consolidated, apply Tianwu San (Heavenly Black Powder) patch formula. If internal restlessness and heat are evident, internally administer Loulu San (Euphorbiae Fissuratae Root Powder), a truly excellent prescription. For severe heat, use Qingjie Du Wan (Green Detoxification Pill), Sishun Qingliang Yin (Four-Regulating Cooling Drink) added with Fangfeng (Saposhnikoviae Radix) and Lianqiao (Forsythiae Fructus), or Xuanshen Ji (Scrophulariae Radix Preparation) can be taken. Wufu Huadu Dan (Five-Fortunes Detoxification Pill) is especially good; Lianqiao Tang (Forsythia Decoction) can be taken. Cover with Qinglu San (Green Dew Powder), leaving a small hole, and later use Jingdu Yanzi (Fright-Toxin Covering Seed) to close the sore. For severe heat, Liange San (Cooling Diaphragm Powder) can also be taken. (Formulas are listed below.)