(服法如前）。五诊：神识更见清楚，已能安睡，因风邪痰气结实于肺胃之间，其势虽减，余焰未尽，致口舌溃破，影响吞咽，此乃病邪外透之象，已无大碍，本随证清下之法为治：川贝母4．5克花粉6克栀壳6克麦冬6克云苓6克法夏3克广皮3克化红6克清宁丸6克
(分三次兑药化开冲服）。鲜梨汁一杯(分次兑服）。服前方两剂，诸证悉减，喘定风息，眠睡安稳，口疮亦已平复，吞咽无碍,中间饮食过度,微热不安，有瘥后食复之象，曾以栀豉汤投之而愈。继以调理脾胃之剂以善其后。从发病至康复，历时二十天。
(尚古愚等整理：王朴诚医案，《中医杂志》6：406，1958）
例四梅××，男，1岁。时当褥暑，起病寒热咳嗽吐乳。前医投发表、和解、消导等剂，症转日哺身热增高，手足抽搐，汗出口渴，喉中痰鸣，大便溏泻，小瘦短赤，沉睡露睛，精神困乏。诊视指纹红细直贯命关，舌质红且干，身虽汗泄不止而大便不实，口虽渴而唇不焦，身虽热而汗则冷。“夏月伏阴在内”，外现假热，内是虚寒，脾肾之阳俱虚。法应温养脾肾，合右归、异功二方加减图治。熟地7克萸肉、枸杞、归身、山药、路党参、土炒於术、云苓、酒炒杭芍各3克熟附片之克上油桂1克丹皮、陈皮、炙甘草各2克复诊：热退汗收，沉睡乃醒，喉中痰鸣减少，虚阳敛摄，原方去丹皮、附片，加西砂仁1克。三诊：痰嗽俱清，惟疲倦少气，吮乳觉累，脾元待复，洽以甘温。按复诊方去熟地黄、山萸肉、当归、白芍、砂仁、油桂，加北黄芪(米炒）3克。《李聪甫医案》）
例五速××，男，3月乳儿。因发热一周，腹泻三天，于1959年3月27日入院。入院后经液体疗法，抗感染等治疗八天，病情改善不大。请中医会诊，证见：发热泄泻10余日，体温尤高，蛋花样便，日七、八次，呕吐不思乳食，咳逆，口唇干燥，精神疲惫，面色青滞。辨证：儿体稚弱，伤寒久泻，脾阳衰微，化源欲绝而有慢脾风之象。治法：助阳解表，温化寒湿。方药：附片15克，炮姜6克白术10克桂枝6克公丁香10粒砂仁3克茯苓10克法半夏6克全蝎1个扁豆10克复诊：发热较减，泄泻呕逆，呵欠无神，睡卧露睛，掐之不啼，面色无华，舌质淡红。阳虚阴盛，寒湿不化，治以回阳救逆。处方：附片15克炮姜6克公了香10粒白术10克桂枝5克茯苓10克法半夏6克全蝎1个葱白2寸。三诊：泄泻仍著，色绿褐,腹痛，烦躁不安，啼哭无涕泪，脾肾阳虚，阴寒极盛,宜大剂回阳救脱，通阳逐寒。方药。川附片24克上肉桂1．5克炮姜6克茯苓12克法半夏6克细辛1．5克葱白2寸麦芽10克药后泄泻较减，仍微发热，继以附子理中汤加桂枝，沙仁、半夏等回阳温中，健脾止泻，数剂后发热泄泻全止，康复出院。
(《廖溶泉儿科医案》
【评按】惊风为儿科四大证之一，以肢体频搐，意识不清为其主症。临床以外感风寒，风热等时邪，或肝盛，脾虚等为惊风的主要发病因素。其病理多有内蕴痰热，风痰窜络，或现邪陷心包、蒙蔽清窍之征。急惊多实证，以急性传染性热病最为常见；慢惊多虚证，多见于吐下后或久病患儿。当分析不同的病因、病理予以辨证治疗。
例一急惊而有阳明经腑实热，董氏先用大承气汤以急下存阴：次用白虎汤加味以透阳明热邪。前后均配合紫雪丹，功能清解热毒。经治后患者腑气通行，热势顿解，神志即清，胃气得苏。此案复诊宗法余师愚，余氏指出“石膏性寒，大清胃热，味淡而薄，能表肌解热；体沉而降，能泄其实热；热疫投之，无不获效”，诚属经验之谈。
例二急惊，西医诊为结核性脑膜炎，中医辨证为湿热壅滞肠内，卫气不宣，外邪乘虚内陷，内外风火交煽。由于因循失治，病邪入营并上犯心包，致使肝风内动，神志不清，反复抽搐，故以清热熄风、豁痰醒神为主要治法。此案在选方用药方面，有其独到之处，颇不同于传统常规治法。
例三为痰热惊风
(西医诊断为大叶性肺炎），兼有积滞化热。治当清热导滞；由于服药后患儿有虚风、肝木乘土见症，故复诊改用柔肝熄风、滋水和血之剂，方用六味地黄丸加减，后又参入定风法痰通滞、清燥润肺定喘及清下之法。立方既有层次，又县法度，在治法的灵动方面,给人以启发。
例四、
例五原案均名“慢脾风”，按此病名出自《小儿卫生总微论方》实亦属慢惊范畴。《医宗金鉴》谓，“慢脾风一证，多缘吐泻既久，脾气大伤，以致土虚不能生金，金弱不能制木，肝木强盛，惟脾是克，故曰脾风”。
例四亦属脾肾虚寒，真阳外越，临床表现为假实热，真虚寒，其中冷汗、便溏、唇凉、露晴和纹红是虚寒的实质反映。李氏右归、异功二方加减以温阳益肾、健中敛汗，调和营卫而诸症自平，后以甘温扶脾元而愈。案明方妥。
例五为脾阳衰微(西医诊断为单纯性消化不良并脱水），法当助阳解表，温化寒湿。治疗的重点是通过温其中而回其阳。患儿临床虽见烦躁，实为阴躁，不可误为阳热。如辨证不细，误投寒凉将祸不旋踵。
(十三）疳积
例一陆××，断乳之后，饮食无节，脾胃渐伤。便泄完谷，腹部膨大，形瘦骨立，每至午后，时带烦躁，贪食不厌，苔中垢，脉细带弦。积阻中州未化。仍宜消健并进。土炒白术4．5克、土炒淮山药4．5克炙五谷虫6克炒扁豆衣4．5克大腹皮9克烧螂虫1个谷麦芽各9克陈米蛀屑12克橹豆衣4．5克使君子肉9克三诊：腹膨较消，大使稍稠，面渐转华，神志安宁，苔垢已化，脉仍细弦。内积渐消，脾气将复。再守原意，以善其后。原方去蜣螂虫，加陈秫米9克。另服和儿丸每日三次，每次20粒，饭后服。
(徐惠之整理：单养和先生儿科临床经验简介，《上海中医药杂志》3：5，1963）
例二戚幼，2岁。初诊
(4月13日）：断乳太早，胃实脾虚，喜食香甘之品，以致腹膨且硬，青筋暴露，形神羸瘦，大便时溏时坚，尿若米泔，腹痛作止无定。盖小儿脏腑娇嫩，精气未充，耗伤脾胃，已成疳积，治宜健脾和胃，导滞化虫。炙蟾皮4．5克槟榔9克枳实4．5克使君子9克雷丸6克川朴2．4克、焦山楂9克炙鸡内金4。5克砂仁1．5克沙于术4．5至广青皮各4.5克3帖。复诊：投以导滞和化，药后大解酱粪，胶固而稠腻不堪，秽臭异常，腹膨渐松，按之已软，是佳兆也。为今之计，仍当调和脾胃，稍佐扶正。太子参9克炒枳壳4．5克半夏4．5克广皮3克云苓9克淮山药9至焦山楂9至炙鸡内金4．5克香谷芽12克春砂仁1．5克此症先天充沛，后天失调而已。即作脾胃论治，用先攻后补之法。
(奚泳裳治验，奚伯初整理，奚氏儿科经验简介，：《上海中医药杂志》巧，1962）
【评论】疳积为儿科四大证之一。多因乳食不节，喂养不当，营养失调，或感染寄生虫等因素造成脾胃虚损，真元怯弱、气衰血虚的病理。疳证多有积滞，《幼幼集成》所谓“食久成积：积久成疳……其证头皮光急，毛发焦稀、腮缩鼻干，口馋唇自，两眼昏烂，揉眉擦鼻，脊纵体黄，斗牙咬甲，焦渴自汗，尿白泻酸，肚胀肠鸣，痛结潮热，酷嗜瓜果咸炭水泥者……”治疗当根据不同的病情，选用消积、理中、扶脾、养胃、驱虫等法。
例一为断乳后饮食所伤，脾虚有积滞内热，故治以健脾和中，清热除烦法，热退烦去，复用消积健脾并进而效。此案用蜣螂配合使君子以消虫积，五谷虫一治小儿疳胀”
(见《本草蒙筌》），《医林纂要》谓其“健脾化食，去热消疳”，可备临床参考。
例二胃实脾虚有虫，采用先攻后补治法。初投健脾和胃、导滞化虫之剂，后专用扶脾调胃以收功。初诊方中用蟾皮者，以其消疳积腹胀之效，为奚氏治疳积所常用的经验用药之一。
(十四）小儿吐泻
例一方某之子，2岁、1936年秋患吐利，9月13日晋城夕、夤夜挽余诊治，前曾发热吐利，脾阴骤夺，后与香燥苦寒消导，重竭其津，稚体弱龄，易克当此。现脉浮虚、指纹沉青晦，困睡眼塌、唇燥露睛，渴饮、苔黄腻，拒乳，大便如黑水，身热溲清，服药吐出白痰，须防脾土将崩，肝风欲动。乃与党参4．5克，苡仁3克，肉果6克，故纸6克，丝瓜络9克，橘络4．5克，广木香1．5克，甘草1．5克，另用甘草煎汤代茶频灌，一日2剂。14日复诊：昨服药后未泻，哺乳能受。今小溲两次、色淡黄，渴减，舌淡苔黄滑腻，目角生脂，眼药后吐出白涎。前方去二神(即肉果，故纸），加缩砂2．4克。增津液须远壅滞之药，运脾阳无取燥烈之品。切忌惶乱，镇定调护，庶可转机。15日复诊：昨日上午大使一次，下午饮乳。今晨大便一次，色转黄褐，嚏而出涕，微咳，此津液复生之征，非伤风之候。前方去苡仁，加广皮2。4克，桔梗1．5克，茯神6克。16日复诊，昨夜颇能吮乳，舌苔灰腻，大便中有如丝状；神情大佳，鼻润，胃气已苏，脾运未健。改与生扁豆9至，生鸡内金3具，广木香1．5至，佩兰3克，丝瓜络9至，橘络4．5克，甘草1。5至，一剂。17日复诊，脉纹俱平，苔退，惟大便时脱肛，此脾虚中气下陷也。投以参苓白术散以竟一贯。
(朱不远整理：朱颜医案医话选，《中医杂志》1：15，1980）
例二庞，女，4个半月。于1970年7月1日入院。住院号：10749，、发热、腹泻、呕吐十余日，近五天病清加重。入院五天来仍发热，腹泻也未减轻人昨日达22次，有时呕吐，口不渴。自昨日禁食十二小时。要求中医会诊，在止泻方面积极发挥中药作用。7月6日中医会诊所见：精神弱，面色暗，前囟及眼窝凹陷。腹部胀满，肠鸣音弱。大便呈淡黄色稀便，量多，尿少，舌质红，舌苔白腻而粘；脉象濡而数。体温39℃。辨证，暑湿夹食作泻
(西医诊为中毒性消化不良，有脱水征）。治法，清暑解毒，利湿止泻。方药：六一散12克霍香、葛根各4．5克云苓、大腹皮、炒扁豆各6克姜厚朴、苏叶各3克7月7日复诊：今日热退，身有微汗，未呕吐，腹胀减轻，尿渐增多。大便每日十次
(禁食下），色质略有好转3口润，舌已不粘腻。证属暑湿渐化，脾虚益显，拟集中药力，健脾止泻。方药：党参、云苓。炒白术、炒泽泻、广陈皮、白扁豆、莲子肉各9克炙甘草3克炒山药12克六一散9克大腹皮6克苍术4．5克7月9日复诊：精神好，纳可，腹胀消失。昨日大便十次，夜半至今晨大便二次，水分已少，尿量增多。脱水征(+），已停止静滴。方药：党参、云芩、炒泽泻、补骨脂、炒白术、炒薏米各9克炙甘草3至每日一剂。7月13日复诊：一般情况好，面色红润，精神好。大便日二至三次，色质正常。通知出院，
(《何世英儿科医案》）
【评按】小儿吐泻属消化系常见病证，多由饮食
(或乳食）不节或不洁，脾胃虚弱或感受外邪所致。由于小儿体质孱弱，脾胃易虚易实，如吐泻严重，较易产生变逆请证，当予急治，并须加意顾护脾胃之阴。
例一身热吐利，脾阴骤夺，前医失治，重竭其津，为防止中气败、肝风动。先治以调和脾胃，补益脾肾之法。见效后，复以健脾和中等法收功。方治运筹殊当，
例二为中毒性消化不良，已见脱水。中医辨证为暑湿夹食。先当治其标。用清暑解表、利湿止泻法，以六一散合霍香正气散加减，后以健脾止泻法治其本。先表后里，层次井然，方药合度。
(十五）小儿黄疸
例一刘××，女，初生19天，因颜面头部多发性小脓疱疹三天，于1961年3月15日入院。患儿皮肤。巩膜软腭黄染，黄疸指数90单位，胆红质10毫克％，凡登白直接(+++）、间接(+++），麝香草酚浊度3单位，尿三胆及胆红质(-）。诊断：(1）新生儿败血症，(2）脓疱病，(3）生理性发黄。经用抗生素及输血，脓疱已瘥，惟黄疸日渐加重，大便色白，外科排除先天性胆道梗阻。会诊时患儿面目皮肤发黄已一月，有时呕吐，脘部胀气，小便短赤，筋纹青，舌淡红。辨证：胎毒内蕴，湿热不尽，肝脾郁滞，发为胎黄。治法：疏肝化湿。方药。茵陈6克白术10克枳壳5克桂枝3克茯苓12克法半夏5克鸡内金1枚炮姜3至2付。复诊：黄疸减退，因更换乳食致腹泻七次。此系脾胃娇弱，运化失调：治以温中健脾利湿。茵陈6克白术10克茯苓10克桂枝3克苍术6克炮姜3克苡仁10克砂仁3克法半夏5克麦芽10克鸡内金1枚2剂。三诊：腹泻已止，乳食佳，黄疸渐退，大便色黄，继以扶脾化湿之六君汤加茵陈退黄为主，乳食积滞加曲、麦；鹅口疮加白寇仁、厚朴、通草等调理善后。
(《廖溶泉儿科医案》）
（服用方法同前）。第五次诊疗：神志更加清醒，已经能够安稳入睡。由于风邪与痰气结实于肺胃之间，虽然病势已减，但余火未尽，导致口舌溃破，影响吞咽，这是病邪向外透发的迹象，已无大碍。因此遵循随证清下的治法进行治疗：川贝母4.5克、天花粉6克、栀子壳6克、麦冬6克、云茯苓6克、法半夏3克、广陈皮3克、化红6克、清宁丸6克。（分三次兑入药汁化开冲服）。鲜梨汁一杯（分次兑入服用）。服用前方两剂后，所有症状明显减轻，喘息平息，风息止住，睡眠安稳，口疮也已平复，吞咽无障碍。中间因饮食过度，出现轻微发热不安，有病愈后因饮食不当而复发的迹象，曾用栀豉汤投喂而痊愈。随后以调理脾胃的方剂善后。从发病到康复，历时二十天。
（尚古愚等整理：王朴诚医案，《中医杂志》6：406，1958）
第四例 梅××，男，1岁。正值暑湿季节，起病时寒热咳嗽、吐乳。前医给予发表、和解、消导等药剂，症状转为每日傍晚身热增高，手足抽搐，出汗且口渴，喉中有痰鸣声，大便溏泻，小便短赤，沉睡且眼睛睁开露睛，精神困乏。诊视指纹红细直贯命关，舌质红且干燥，身体虽汗泄不止但大便不实，口虽渴但嘴唇不焦，身体虽热但汗水发冷。“夏季体内伏藏阴寒”，外现假热，内里是虚寒，脾肾之阳俱虚。治法应当温养脾肾，合用右归丸、异功散二方加减治疗。熟地黄7克、山茱萸、枸杞、当归身、山药、潞党参、土炒白术、云茯苓、酒炒杭白芍各3克、熟附片3克、上油桂1克、牡丹皮、陈皮、炙甘草各2克。复诊：热退汗止，沉睡苏醒，喉中痰鸣减少，虚阳收敛摄纳，原方去掉牡丹皮、附片，加西砂仁1克。三诊：痰嗽全部清除，只是疲倦少气，吸吮乳汁觉得劳累，脾元待恢复，治以甘温之法。按复诊方去掉熟地黄、山茱萸、当归、白芍、砂仁、油桂，加北黄芪（米炒）3克。（李聪甫医案）
第五例 速××，男，3个月婴儿。因发热一周，腹泻三天，于1959年3月27日入院。入院后经液体疗法、抗感染等治疗八天，病情改善不大。请中医会诊，证见：发热泄泻10余日，体温尤其高，大便呈蛋花样，每天七、八次，呕吐不想吃奶，咳逆，口唇干燥，精神疲惫，面色青滞。辨证：幼儿体质稚弱，伤寒久泻，脾阳衰微，化源欲绝而有慢脾风的迹象。治法：助阳解表，温化寒湿。方药：附片15克，炮姜6克，白术10克，桂枝6克，公丁香10粒，砂仁3克，茯苓10克，法半夏6克，全蝎1个，扁豆10克。复诊：发热较减，泄泻呕逆，呵欠无神，睡卧露睛，掐之不啼，面色无华，舌质淡红。阳虚阴盛，寒湿不化，治以回阳救逆。处方：附片15克，炮姜6克，公丁香10粒，白术10克，桂枝5克，茯苓10克，法半夏6克，全蝎1个，葱白2寸。三诊：泄泻仍然严重，色绿褐，腹痛，烦躁不安，啼哭无涕泪，脾肾阳虚，阴寒极盛，宜大剂回阳救脱，通阳逐寒。方药：川附片24克，上肉桂1.5克，炮姜6克，茯苓12克，法半夏6克，细辛1.5克，葱白2寸，麦芽10克。药后泄泻较减，仍微发热，继以附子理中汤加桂枝、砂仁、半夏等回阳温中，健脾止泻，数剂后发热泄泻全止，康复出院。
（《廖溶泉儿科医案》）
【评按】惊风为儿科四大证之一，以肢体频繁抽搐，意识不清为其主症。临床以外感风寒、风热等时邪，或肝盛、脾虚等为惊风的主要发病因素。其病理多有内蕴痰热，风痰窜络，或现邪陷心包、蒙蔽清窍之征。急惊多实证，以急性传染性热病最为常见；慢惊多虚证，多见于吐下后或久病患儿。当分析不同的病因、病理予以辨证治疗。
第一例 急惊而有阳明经腑实热，董氏先用大承气汤以急下存阴：次用白虎汤加味以透阳明热邪。前后均配合紫雪丹，功能清解热毒。经治后患者腑气通行，热势顿解，神志即清，胃气得苏。此案复诊宗法余师愚，余氏指出“石膏性寒，大清胃热，味淡而薄，能表肌解热；体沉而降，能泄其实热；热疫投之，无不获效”，诚属经验之谈。
第二例 急惊，西医诊为结核性脑膜炎，中医辨证为湿热壅滞肠内，卫气不宣，外邪乘虚内陷，内外风火交煽。由于因循失治，病邪入营并上犯心包，致使肝风内动，神志不清，反复抽搐，故以清热熄风、豁痰醒神为主要治法。此案在选方用药方面，有其独到之处，颇不同于传统常规治法。
第三例 为痰热惊风（西医诊断为大叶性肺炎），兼有积滞化热。治当清热导滞；由于服药后患儿有虚风、肝木乘土见症，故复诊改用柔肝熄风、滋水和血之剂，方用六味地黄丸加减，后又参入定风化痰通滞、清燥润肺定喘及清下之法。立方既有层次，又有法度，在治法的灵动方面，给人以启发。
第四例、第五例 原案均名“慢脾风”，按此病名出自《小儿卫生总微论方》，实亦属慢惊范畴。《医宗金鉴》谓，“慢脾风一证，多缘吐泻既久，脾气大伤，以致土虚不能生金，金弱不能制木，肝木强盛，惟脾是克，故曰脾风”。
第四例 亦属脾肾虚寒，真阳外越，临床表现为假实热，真虚寒，其中冷汗、便溏、唇凉、露晴和纹红是虚寒的实质反映。李氏右归、异功二方加减以温阳益肾、健中敛汗，调和营卫而诸症自平，后以甘温扶脾元而愈。案明方妥。
第五例 为脾阳衰微（西医诊断为单纯性消化不良并脱水），法当助阳解表，温化寒湿。治疗的重点是通过温其中而回其阳。患儿临床虽见烦躁，实为阴躁，不可误为阳热。如辨证不细，误投寒凉将祸不旋踵。
（十三）疳积
第一例 陆××，断乳之后，饮食无节，脾胃渐伤。便泄完谷，腹部膨大，形瘦骨立，每至午后，时带烦躁，贪食不厌，苔中垢，脉细带弦。积阻中州未化。仍宜消健并进。土炒白术4.5克、土炒淮山药4.5克、炙五谷虫6克、炒扁豆衣4.5克、大腹皮9克、烧螂虫1个、谷麦芽各9克、陈米蛀屑12克、橹豆衣4.5克、使君子肉9克。三诊：腹膨较消，大便稍稠，面渐转华，神志安宁，苔垢已化，脉仍细弦。内积渐消，脾气将复。再守原意，以善其后。原方去蜣螂虫，加陈秫米9克。另服和儿丸每日三次，每次20粒，饭后服。
（徐惠之整理：单养和先生儿科临床经验简介，《上海中医药杂志》3：5，1963）
第二例 戚幼，2岁。初诊（4月13日）：断乳太早，胃实脾虚，喜食香甘之品，以致腹膨且硬，青筋暴露，形神羸瘦，大便时溏时坚，尿若米泔，腹痛作止无定。盖小儿脏腑娇嫩，精气未充，耗伤脾胃，已成疳积，治宜健脾和胃，导滞化虫。炙蟾皮4.5克、槟榔9克、枳实4.5克、使君子9克、雷丸6克、川朴2.4克、焦山楂9克、炙鸡内金4.5克、砂仁1.5克、沙参于术4.5至广青皮各4.5克，3帖。复诊：投以导滞和化，药后大解酱粪，胶固而稠腻不堪，秽臭异常，腹膨渐松，按之已软，是佳兆也。为今之计，仍当调和脾胃，稍佐扶正。太子参9克、炒枳壳4.5克、半夏4.5克、广陈皮3克、云茯苓9克、淮山药9克、焦山楂9克、炙鸡内金4.5克、香谷芽12克、春砂仁1.5克。此症先天充沛，后天失调而已。即作脾胃论治，用先攻后补之法。
（奚泳裳治验，奚伯初整理，奚氏儿科经验简介，《上海中医药杂志》15，1962）
【评论】疳积为儿科四大证之一。多因乳食不节，喂养不当，营养失调，或感染寄生虫等因素造成脾胃虚损，真元怯弱、气衰血虚的病理。疳证多有积滞，《幼幼集成》所谓“食久成积：积久成疳……其证头皮光急，毛发焦稀、腮缩鼻干，口馋唇白，两眼昏烂，揉眉擦鼻，脊纵体黄，斗牙咬甲，焦渴自汗，尿白泻酸，肚胀肠鸣，痛结潮热，酷嗜瓜果咸炭水泥者……”治疗当根据不同的病情，选用消积、理中、扶脾、养胃、驱虫等法。
第一例 为断乳后饮食所伤，脾虚有积滞内热，故治以健脾和中，清热除烦法，热退烦去，复用消积健脾并进而效。此案用蜣螂配合使君子以消虫积，五谷虫一治小儿疳胀”（见《本草蒙筌》），《医林纂要》谓其“健脾化食，去热消疳”，可备临床参考。
第二例 胃实脾虚有虫，采用先攻后补治法。初投健脾和胃、导滞化虫之剂，后专用扶脾调胃以收功。初诊方中用蟾皮者，以其消疳积腹胀之效，为奚氏治疳积所常用的经验用药之一。
（十四）小儿吐泻
第一例 方某之子，2岁，1936年秋患吐利，9月13日晋城夕、夤夜挽余诊治，前曾发热吐利，脾阴骤夺，后与香燥苦寒消导，重竭其津，稚体弱龄，易克当此。现脉浮虚、指纹沉青晦，困睡眼塌、唇燥露睛，渴饮、苔黄腻，拒乳，大便如黑水，身热溲清，服药吐出白痰，须防脾土将崩，肝风欲动。乃与党参4.5克，苡仁3克，肉果6克，故纸6克，丝瓜络9克，橘络4.5克，广木香1.5克，甘草1.5克，另用甘草煎汤代茶频灌，一日2剂。14日复诊：昨服药后未泻，哺乳能受。今小溲两次、色淡黄，渴减，舌淡苔黄滑腻，目角生脂，眼药后吐出白涎。前方去二神（即肉果，故纸），加缩砂2.4克。增津液须远壅滞之药，运脾阳无取燥烈之品。切忌惶乱，镇定调护，庶可转机。15日复诊：昨日上午大便一次，下午饮乳。今晨大便一次，色转黄褐，嚏而出涕，微咳，此津液复生之征，非伤风之候。前方去苡仁，加广陈皮2.4克，桔梗1.5克，茯神6克。16日复诊，昨夜颇能吮乳，舌苔灰腻，大便中有如丝状；神情大佳，鼻润，胃气已苏，脾运未健。改与生扁豆9克，生鸡内金3具，广木香1.5克，佩兰3克，丝瓜络9克，橘络4.5克，甘草1.5克，一剂。17日复诊，脉纹俱平，苔退，惟大便时脱肛，此脾虚中气下陷也。投以参苓白术散以竟一贯。
（朱不远整理：朱颜医案医话选，《中医杂志》1：15，1980）
第二例 庞，女，4个半月。于1970年7月1日入院。住院号：10749，发热、腹泻、呕吐十余日，近五天病情加重。入院五天来仍发热，腹泻也未减轻，昨日达22次，有时呕吐，口不渴。自昨日禁食十二小时。要求中医会诊，在止泻方面积极发挥中药作用。7月6日中医会诊所见：精神弱，面色暗，前囟及眼窝凹陷。腹部胀满，肠鸣音弱。大便呈淡黄色稀便，量多，尿少，舌质红，舌苔白腻而粘；脉象濡而数。体温39℃。辨证：暑湿夹食作泻（西医诊为中毒性消化不良，有脱水征）。治法：清暑解毒，利湿止泻。方药：六一散12克、藿香、葛根各4.5克、云茯苓、大腹皮、炒扁豆各6克、姜厚朴、苏叶各3克。7月7日复诊：今日热退，身有微汗，未呕吐，腹胀减轻，尿渐增多。大便每日十次（禁食下），色质略有好转，口润，舌已不粘腻。证属暑湿渐化，脾虚益显，拟集中药力，健脾止泻。方药：党参、云茯苓、炒白术、炒泽泻、广陈皮、白扁豆、莲子肉各9克、炙甘草3克、炒山药12克、六一散9克、大腹皮6克、苍术4.5克。7月9日复诊：精神好，纳可，腹胀消失。昨日大便十次，夜半至今晨大便二次，水分已少，尿量增多。脱水征（+），已停止静滴。方药：党参、云茯苓、炒泽泻、补骨脂、炒白术、炒薏米各9克、炙甘草3克，每日一剂。7月13日复诊：一般情况好，面色红润，精神好。大便日二至三次，色质正常。通知出院。
（《何世英儿科医案》）
【评按】小儿吐泻属消化系常见病证，多由饮食（或乳食）不节或不洁，脾胃虚弱或感受外邪所致。由于小儿体质孱弱，脾胃易虚易实，如吐泻严重，较易产生变逆请证，当予急治，并须加意顾护脾胃之阴。
第一例 身热吐利，脾阴骤夺，前医失治，重竭其津，为防止中气败、肝风动。先治以调和脾胃，补益脾肾之法。见效后，复以健脾和中等法收功。方治运筹殊当。
第二例 为中毒性消化不良，已见脱水。中医辨证为暑湿夹食。先当治其标。用清暑解表、利湿止泻法，以六一散合藿香正气散加减，后以健脾止泻法治其本。先表后里，层次井然，方药合度。
（十五）小儿黄疸
第一例 刘××，女，初生19天，因颜面头部多发性小脓疱疹三天，于1961年3月15日入院。患儿皮肤、巩膜、软腭黄染，黄疸指数90单位，胆红质10毫克％，凡登白直接（+++）、间接（+++），麝香草酚浊度3单位，尿三胆及胆红质（-）。诊断：（1）新生儿败血症，（2）脓疱病，（3）生理性发黄。经用抗生素及输血，脓疱已瘥，惟黄疸日渐加重，大便色白，外科排除先天性胆道梗阻。会诊时患儿面目皮肤发黄已一月，有时呕吐，脘部胀气，小便短赤，筋纹青，舌淡红。辨证：胎毒内蕴，湿热不尽，肝脾郁滞，发为胎黄。治法：疏肝化湿。方药：茵陈6克、白术10克、枳壳5克、桂枝3克、茯苓12克、法半夏5克、鸡内金1枚、炮姜3克，2付。复诊：黄疸减退，因更换乳食致腹泻七次。此系脾胃娇弱，运化失调：治以温中健脾利湿。茵陈6克、白术10克、茯苓10克、桂枝3克、苍术6克、炮姜3克、苡仁10克、砂仁3克、法半夏5克、麦芽10克、鸡内金1枚，2剂。三诊：腹泻已止，乳食佳，黄疸渐退，大便色黄，继以扶脾化湿之六君汤加茵陈退黄为主，乳食积滞加曲、麦；鹅口疮加白蔻仁、厚朴、通草等调理善后。
（《廖溶泉儿科医案》）
(Method of administration as before). Fifth consultation: Mental clarity has further improved, and the patient is now able to sleep peacefully. Since wind-pathogen and phlegm-qi are solidified between the Lung and Stomach, although the pathogenic force has diminished, residual heat remains unextinguished, causing ulceration of the mouth and tongue and affecting swallowing. This is a sign of pathogenic factors being expelled outward and poses no major threat. Therefore, treatment follows the principle of clearing and purging according to the syndrome: Chuan Bei Mu (Fritillariae Bulbus) 4.5g, Hua Fen (Trichosanthis Radix) 6g, Zhi Qiao (Gardeniae Fructus pericarpium) 6g, Mai Dong (Ophiopogonis Radix) 6g, Yun Ling (Poria) 6g, Fa Xia (Pinelliae Rhizoma preparatum) 3g, Guang Pi (Citri Reticulatae Pericarpium) 3g, Hua Hong 6g, Qing Ning Wan 6g. (Divided into three doses, dissolved in decoction and taken orally). Fresh Pear Juice one cup (mixed and taken in portions). After taking two doses of the previous prescription, all symptoms significantly decreased; wheezing subsided, wind ceased, sleep was stable, oral ulcers healed, and swallowing was unobstructed. Due to overeating in between, slight fever and restlessness occurred, indicating recurrence due to improper diet after recovery. Zhichi Tang (Gardenia and Soybean Decoction) was administered with success. Subsequently, formulas regulating the Spleen and Stomach were used to conclude treatment. From onset to recovery, it took twenty days.
(Compiled by Shang Guyu et al.: Wang Pucheng's Medical Cases, *Journal of Traditional Chinese Medicine* 6:406, 1958)
Case 4 Mei ××, Male, 1 year old. Occurring during the damp-heat season, the illness began with chills, fever, cough, and vomiting of milk. Previous physicians administered diaphoretic, harmonizing, and digestive agents, leading to increased body heat every afternoon, convulsions of hands and feet, sweating with thirst, phlegm rattle in the throat, loose stools, scanty dark urine, deep sleep with eyes open, and mental fatigue. Examination of the fingerprint showed redness and thinness extending straight to the Life Gate (Ming Guan); the tongue was red and dry. Although sweating profusely, stools remained loose; although thirsty, lips were not scorched; although hot, sweat was cold. "In summer, yin lies hidden within"; external false heat indicates internal deficiency-cold. Both Spleen and Kidney Yang are deficient. The method should be to warm and nourish the Spleen and Kidney, combining modifications of You Gui Wan (Right-Restoring Pill) and Yi Gong San (Extraordinary Efficacy Powder). Shu Di Huang (Prepared Rehmanniae Radix) 7g, Yu Rou (Corni Fructus), Gou Qi (Lycii Fructus), Gui Shen (Angelicae Sinensis Radix caulis), Shan Yao (Dioscoreae Rhizoma), Lu Dang Shen (Codonopsis Radix), Tu Chao Bai Zhu (Atractylodis Macrocephalae Rhizoma stir-fried with soil), Yun Ling (Poria), Jiu Chao Hang Shao (Paeoniae Radix Alba prepared with wine) each 3g, Shu Fu Pian (Aconiti Lateralis Radix Praeparata) 3g, Shang You Gui (Cinnamomi Cortex) 1g, Dan Pi (Moutan Cortex), Chen Pi (Citri Reticulatae Pericarpium), Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma preparatum) each 2g. Second visit: Heat receded, sweating stopped, deep sleep ended, phlegm rattle decreased, floating Yang was contained. Original formula minus Dan Pi and Fu Pian, plus Xi Sha Ren (Amomi Fructus) 1g. Third visit: Phlegm and cough cleared, only fatigue and shortness of breath remained; sucking milk caused tiredness, indicating Spleen Yuan needs restoration. Treatment uses sweet-warm methods. Based on the second visit formula, remove Shu Di Huang, Yu Rou, Dang Gui, Bai Shao, Sha Ren, You Gui; add Bei Huang Qi (Astragali Radix stir-fried with rice flour) 3g. (Li Congfu's Medical Cases)
Case 5 Su ××, Male, 3-month-old infant. Admitted on March 27, 1959, due to fever for one week and diarrhea for three days. After eight days of intravenous fluid therapy and anti-infection treatment upon admission, condition improved little. TCM consultation requested. Symptoms: Fever and diarrhea for over ten days, especially high temperature, egg-drop soup-like stools, seven to eight times daily, vomiting, refusal of milk/food, coughing upward, dry lips, mental exhaustion, bluish-dull complexion. Syndrome differentiation: Infant constitution is tender and weak; prolonged diarrhea from Cold Damage leads to decline of Spleen Yang, depletion of transformation source, showing signs of Slow Spleen Wind. Treatment method: Assist Yang and release exterior, warm and transform cold-damp. Prescription: Fu Pian (Aconiti Lateralis Radix Praeparata) 15g, Pao Jiang (Zingiberis Rhizoma Preparatum) 6g, Bai Zhu (Atractylodis Macrocephalae Rhizoma) 10g, Gui Zhi (Cinnamomi Ramulus) 6g, Gong Ding Xiang (Eugeniae Flos) 10 grains, Sha Ren (Amomi Fructus) 3g, Fu Ling (Poria) 10g, Fa Ban Xia (Pinelliae Rhizoma preparatum) 6g, Quan Xie (Scorpio) 1 piece, Bian Dou (Dolichoris Semen) 10g. Second visit: Fever reduced, diarrhea and vomiting lessened, yawning without spirit, sleeping with eyes open, does not cry when pinched, lusterless complexion, pale-red tongue. Yang deficiency with Yin excess, cold-damp not transformed. Treatment: Restore Yang and rescue from collapse. Prescription: Fu Pian 15g, Pao Jiang 6g, Gong Ding Xiang 10 grains, Bai Zhu 10g, Gui Zhi 5g, Fu Ling 10g, Fa Ban Xia 6g, Quan Xie 1 piece, Cong Bai (Allii Tuberosi Bulbus) 2 cun. Third visit: Diarrhea still severe, green-brown color, abdominal pain, restlessness, crying without tears or mucus. Spleen-Kidney Yang deficiency, extreme Yin-cold. Large dose required to restore Yang, rescue from collapse, unblock Yang, and expel cold. Prescription: Chuan Fu Pian 24g, Shang Rou Gui (Cinnamomi Cortex) 1.5g, Pao Jiang 6g, Fu Ling 12g, Fa Ban Xia 6g, Xi Xin (Asari Radix et Rhizoma) 1.5g, Cong Bai 2 cun, Mai Ya (Hordei Fructus germinatus) 10g. After medication, diarrhea decreased, slight fever remained. Continued with Fuzi Lizhong Tang (Aconite Decoction to Regulate the Middle) added with Gui Zhi, Sha Ren, Ban Xia to restore Yang, warm the middle, strengthen Spleen, and stop diarrhea. After several doses, fever and diarrhea ceased completely, and the patient was discharged recovered.
(Liao Rongquan's Pediatric Medical Cases)
[Commentary] Jing Feng (Convulsive Disease) is one of the four major pediatric syndromes, characterized by frequent limb convulsions and unclear consciousness. Clinically, exogenous wind-cold, wind-heat, and other seasonal pathogens, or Liver excess and Spleen deficiency, are main factors. Pathologically, there is often internal accumulation of phlegm-heat, wind-phlegm invading collaterals, or pathogen sinking into the Pericardium obscuring the clear orifices. Acute Jing Feng is mostly excess syndrome, commonly seen in acute infectious febrile diseases; Chronic Jing Feng is mostly deficiency syndrome, often occurring after vomiting/diarrhea or in long-term illness. Different etiologies and pathologies must be analyzed for syndrome differentiation and treatment.
Case 1: Acute Jing Feng with excess-heat in Yangming Meridian and Fu organs. Dr. Dong first used Da Cheng Qi Tang (Major Order the Qi Decoction) to urgently purge and preserve Yin; then used Bai Hu Tang (White Tiger Decoction) with modifications to vent Yangming heat. Both stages were combined with Zi Xue Dan (Purple Snow Pellet) to clear heat and resolve toxicity. After treatment, bowel qi moved, heat dissipated instantly, consciousness cleared, and Stomach Qi revived. The second visit followed Yu Shiyu's method. Yu stated, "Shi Gao (Gypsum Fibrosum) is cold, greatly clearing Stomach heat; light and thin in flavor, it can release muscle layer and reduce heat; heavy and descending, it can drain real heat; effective for heat epidemics." This is indeed experiential wisdom.
Case 2: Acute Jing Feng, Western diagnosis Tuberculous Meningitis. TCM syndrome: Damp-heat stagnating in intestines, Wei Qi not disseminating, exogenous pathogen sinking inward due to deficiency, internal and external wind-fire stirring together. Due to delayed treatment, pathogen entered Ying level and attacked Pericardium, causing internal Liver wind movement, unconsciousness, and repeated convulsions. Main treatment: Clear heat, extinguish wind, resolve phlegm, awaken spirit. This case shows unique prescription choices, differing from traditional routines.
Case 3: Phlegm-Heat Jing Feng (Western diagnosis: Lobar Pneumonia), complicated by food stagnation transforming into heat. Treatment should clear heat and guide out stagnation. After medication, signs of deficiency wind and Liver Wood attacking Earth appeared. Second visit changed to softening Liver, extinguishing wind, nourishing Water, and harmonizing Blood using Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) modified. Later incorporated methods to calm wind, resolve phlegm, unblock stagnation, clear dryness, moisten Lungs, calm wheezing, and clear/purge. The prescription had layers and rules, inspiring flexible treatment approaches.
Cases 4 & 5: Originally named "Slow Spleen Wind," this term comes from *Xiao'er Weisheng Zongwei Lun Fang*, actually belonging to Chronic Jing Feng. *Yi Zong Jin Jian* states, "Slow Spleen Wind often arises from prolonged vomiting/diarrhea damaging Spleen Qi, causing Earth deficiency unable to generate Metal, Metal weakness unable to control Wood, leading to strong Liver Wood suppressing Spleen, hence called Spleen Wind."
Case 4: Also Spleen-Kidney deficiency-cold, True Yang floating outward. Clinical presentation: False excess-heat, True deficiency-cold. Cold sweat, loose stools, cool lips, exposed eyes, and red fingerprint reflect true deficiency-cold. Li's modification of You Gui and Yi Gong warms Yang, benefits Kidney, strengthens Middle, stops sweating, harmonizes Ying and Wei, resolving symptoms. Later, sweet-warm methods restored Spleen Yuan. Case is clear, prescription appropriate.
Case 5: Spleen Yang decline (Western diagnosis: Simple Dyspepsia with Dehydration). Method: Assist Yang, release exterior, warm-transform cold-damp. Focus is restoring Yang by warming the Middle. Although irritability appears clinically, it is Yin irritability, not Yang heat. Imprecise differentiation leading to cold-cooling herbs would bring disaster swiftly.
(Thirteen) Gan Ji (Malnutrition)
Case 1 Lu ××, after weaning, irregular diet gradually injured Spleen and Stomach. Stools contain undigested food, abdomen distended, body emaciated, irritability every afternoon, insatiable appetite, greasy coating in center, fine-string pulse. Food stagnation obstructing Middle Jiao unresolved. Continue digestion and strengthening simultaneously. Tu Chao Bai Zhu 4.5g, Tu Chao Huai Shan Yao 4.5g, Zhi Wu Gu Chong 6g, Chao Bian Dou Yi 4.5g, Da Fu Pi 9g, Shao Lang Chong 1 piece, Gu Ya and Mai Ya each 9g, Chen Mi Zhu Xie 12g, Lu Dou Yi 4.5g, Shi Jun Zi Rou 9g. Third visit: Abdominal distension reduced, stool slightly thicker, complexion improving, mind peaceful, greasy coating resolved, pulse still fine-string. Internal stagnation dissipating, Spleen Qi recovering. Maintain original intent to conclude treatment. Remove Lang Chong from original formula, add Chen Xu Mi 9g. Also take He Er Wan three times daily, 20 pills each time, after meals.
(Compiled by Xu Huizhi: Brief Introduction to Mr. Shan Yanghe's Pediatric Clinical Experience, *Shanghai Journal of Traditional Chinese Medicine* 3:5, 1963)
Case 2 Qi, young child, 2 years old. First visit (April 13): Weaned too early, Stomach excess and Spleen deficiency, likes fragrant/sweet foods, leading to hard/distended abdomen, visible blue veins, emaciated form/spirit, alternating loose/hard stools, urine like rice water, intermittent abdominal pain. Children's Zang-Fu are tender, Essence-Qi not full; damaging Spleen/Stomach leads to Gan Ji. Treatment: Strengthen Spleen, harmonize Stomach, guide out stagnation, eliminate parasites. Zhi Chan Pi 4.5g, Bing Lang 9g, Zhi Shi 4.5g, Shi Jun Zi 9g, Lei Wan 6g, Chuan Po 2.4g, Jiao Shan Zha 9g, Zhi Ji Nei Jin 4.5g, Sha Ren 1.5g, Sha Zhu Yu 4.5g to Guang Qing Pi each 4.5g, 3 doses. Second visit: Administered stagnation-guiding and harmonizing medicine; large stool passed was paste-like, sticky/thick, foul-smelling; abdominal distension loosened, soft to touch, good omen. Current plan: Harmonize Spleen/Stomach, slightly assist Righteousness. Tai Zi Shen 9g, Chao Zhi Ke 4.5g, Ban Xia 4.5g, Guang Pi 3g, Yun Ling 9g, Huai Shan Yao 9g, Jiao Shan Zha 9g, Zhi Ji Nei Jin 4.5g, Xiang Gu Ya 12g, Chun Sha Ren 1.5g. This case has sufficient congenital essence but postnatal imbalance. Treat as Spleen/Stomach issue, using attack-first then tonify method.
(Treated by Xi Yongshang, compiled by Xi Bochu, Brief Introduction to Xi Family Pediatric Experience, *Shanghai Journal of Traditional Chinese Medicine* 15, 1962)
[Commentary] Gan Ji is one of the four major pediatric syndromes. Often caused by irregular breastfeeding/diet, improper feeding, nutritional imbalance, or parasitic infection, leading to Spleen-Stomach damage, weak Yuan Essence, Qi/Blood deficiency. Gan syndrome often involves stagnation. *Youyou Jicheng* says, "Food becomes stagnation over time; stagnation becomes Gan... Symptoms include tight shiny scalp, sparse scorched hair, sunken cheeks/dry nose, craving/chapped lips, dim/blind eyes, rubbing brows/nose, straight spine/yellow body, grinding teeth/biting nails, scorched thirst/sweating, white urine/sour diarrhea, bloated belly/bowel sounds, painful clustering/tidal fever, craving fruits/salt/carbon/cement..." Treatment selects methods like eliminating stagnation, regulating Middle, supporting Spleen, nourishing Stomach, expelling parasites based on condition.
Case 1: Dietary injury after weaning, Spleen deficiency with stagnation/internal heat. Treatment: Strengthen Spleen, harmonize Middle, clear heat, relieve irritability. After heat/irritability resolved, continued with eliminating stagnation and strengthening Spleen for effect. Used Biang Lang (Mantidis Ootheca) with Shi Jun Zi to eliminate parasitic stagnation; Wu Gu Chong treats pediatric Gan distension (*Bencao Mengquan*), *Yilin Zuanyao* says it "strengthens Spleen, transforms food, clears heat, eliminates Gan," useful for clinical reference.
Case 2: Stomach excess, Spleen deficiency with parasites. Uses attack-first then tonify method. Initially administers Spleen-strengthening/Stomach-harmonizing/stagnation-guiding/parasite-eliminating agents; later focuses solely on supporting Spleen/harmonizing Stomach to conclude. Chan Pi in first visit formula used for its efficacy in eliminating Gan distension, a common experience herb of Xi family for Gan Ji.
(Fourteen) Pediatric Vomiting and Diarrhea
Case 1 Son of Fang, 2 years old, autumn 1936, suffered vomiting/diarrhea. Invited for treatment late night Sept 13. Previously had fever/vomiting/diarrhea, sudden loss of Spleen Yin, then given aromatic-dry bitter-cold digestive agents, heavily depleting fluids. Tender body/weak age cannot bear this. Now pulse floating-deficient, fingerprint沉-blue-dim, sleepy drooping eyes, dry lips/exposed eyes, thirsty drinking, yellow-greasy coating, refusing milk, stool like black water, body heat/clear urine, vomits white phlegm after medicine. Must prevent Spleen Earth collapsing and Liver Wind moving. Prescribed Dang Shen 4.5g, Yi Ren 3g, Rou Guo 6g, Gu Zhi 6g, Si Gua Luo 9g, Ju Luo 4.5g, Guang Mu Xiang 1.5g, Gan Cao 1.5g. Additionally, Gan Cao decoction as tea frequently灌, 2 doses/day. Sept 14 second visit: No diarrhea after yesterday's medicine, accepts breastfeeding. Two urinations today, pale-yellow, thirst decreased, pale tongue yellow-slippery-greasy coating, grease at eye corners, vomits white saliva after eye drops. Remove Er Shen (Rou Guo, Gu Zhi) from former formula, add Suo Sha 2.4g. To increase fluids, avoid stagnating drugs; to move Spleen Yang, do not use drying-hot items. Avoid panic, calm care may turn situation. Sept 15 third visit: Morning stool once, drank milk afternoon. Morning stool once, color turned yellow-brown, sneezed with mucus, slight cough, sign of fluid regeneration, not wind-cold. Remove Yi Ren from former formula, add Guang Pi 2.4g, Jie Geng 1.5g, Fu Shen 6g. Sept 16 fourth visit: Sucked milk well last night, gray-greasy coating, silk-like strands in stool; spirit greatly improved, moist nose, Stomach Qi revived, Spleen transport not yet healthy. Changed to Sheng Bian Dou 9g, Sheng Ji Nei Jin 3 pieces, Guang Mu Xiang 1.5g, Pei Lan 3g, Si Gua Luo 9g, Ju Luo 4.5g, Gan Cao 1.5g, 1 dose. Sept 17 fifth visit: Pulse/fingerprint flat, coating retreated, only occasional rectal prolapse during stool, Spleen deficiency with Middle Qi sinking. Administer Shen Ling Bai Zhu San to complete treatment.
(Compiled by Zhu Buyuan: Selections from Zhu Yan's Medical Cases and Conversations, *Journal of Traditional Chinese Medicine* 1:15, 1980)
Case 2 Pang, Female, 4.5 months. Admitted July 1, 1970. Hospital No. 10749. Fever, diarrhea, vomiting for over ten days, worsening in last five days. Still feverish after five days hospitalization, diarrhea not relieved, reaching 22 times yesterday, occasional vomiting, no thirst. Fasting for 12 hours since yesterday. Requested TCM consultation to actively utilize Chinese herbs for stopping diarrhea. July 6 TCM consultation findings: Weak spirit, dark complexion, depressed anterior fontanelle and eye sockets. Abdominal distension, weak bowel sounds. Pale yellow watery stool, large volume, scanty urine, red tongue, white-greasy-sticky coating, soggy-rapid pulse. Temperature 39°C. Syndrome: Summer-heat-damp mixed with food causing diarrhea (Western diagnosis: Toxic dyspepsia with dehydration signs). Treatment: Clear summer-heat, resolve toxicity, promote dampness, stop diarrhea. Prescription: Liu Yi San 12g, Huo Xiang, Ge Gen each 4.5g, Yun Ling, Da Fu Pi, Chao Bian Dou each 6g, Jiang Hou Po, Su Ye each 3g. July 7 second visit: Heat gone today, slight sweat on body, no vomiting, abdominal distension reduced, urine increasing. Stool 10 times daily (under fasting), color/quality slightly better, moist mouth, tongue no longer sticky. Syndrome: Summer-heat-damp gradually transforming, Spleen deficiency more apparent. Concentrate herbal power to strengthen Spleen, stop diarrhea. Prescription: Dang Shen, Yun Ling, Chao Bai Zhu, Chao Ze Xie, Guang Chen Pi, Bai Bian Dou, Lian Zi Rou each 9g, Zhi Gan Cao 3g, Chao Shan Yao 12g, Liu Yi San 9g, Da Fu Pi 6g, Cang Zhu 4.5g. July 9 third visit: Good spirit, acceptable appetite, abdominal distension disappeared. Ten stools yesterday, two from midnight to morning, less water, increased urine. Dehydration sign (+), IV drip stopped. Prescription: Dang Shen, Yun Ling, Chao Ze Xie, Bu Gu Zhi, Chao Bai Zhu, Chao Yi Mi each 9g, Zhi Gan Cao 3g, one dose daily. July 13 fourth visit: General condition good, ruddy complexion, good spirit. Stool 2-3 times daily, normal color/quality. Discharged.
(He Shiying's Pediatric Medical Cases)
[Commentary] Pediatric vomiting/diarrhea is a common digestive disease, often caused by irregular/unhygienic diet (or milk), Spleen-Stomach weakness, or exogenous pathogens. Due to children's frail constitution, Spleen-Stomach easily become deficient or excess. Severe vomiting/diarrhea easily produces adverse complications requiring urgent treatment, while carefully protecting Spleen-Stomach Yin.
Case 1: Body heat with vomiting/diarrhea, sudden Spleen Yin loss. Previous physician mismanaged, heavily depleting fluids. To prevent Middle Qi failure and Liver Wind movement, first treated with harmonizing Spleen/Stomach, supplementing Spleen/Kidney methods. After effect, concluded with strengthening Spleen/harmonizing Middle. Prescription strategy was very appropriate.
Case 2: Toxic dyspepsia with dehydration. TCM syndrome: Summer-heat-damp mixed with food. Treat branch first. Use clearing summer-heat/releasing exterior/promoting dampness/stopping diarrhea method, modifying Liu Yi San combined with Huo Xiang Zheng Qi San, then treat root with strengthening Spleen/stopping diarrhea method. Exterior first, interior later, orderly layers, appropriate prescriptions.
(Fifteen) Pediatric Jaundice
Case 1 Liu ××, Female, 19 days old. Admitted March 15, 1961, due to multiple small pustules on face/head for three days. Patient's skin, sclera, soft palate jaundiced, jaundice index 90 units, bilirubin 10mg%, Van den Bergh direct (+++), indirect (+++), Thymol turbidity 3 units, urine tri-bilirubin and bilirubin (-). Diagnosis: (1) Neonatal sepsis, (2) Impetigo, (3) Physiological jaundice. After antibiotics and blood transfusion, pustules healed, but jaundice worsened daily, stool white, surgery excluded congenital biliary obstruction. At consultation, facial/skin jaundice present for one month, occasional vomiting, epigastric distension, scanty dark urine, cyanotic tendon marks, pale-red tongue. Syndrome: Fetal toxin internally stored, damp-heat not exhausted, Liver-Spleen stagnation, developing Fetal Jaundice. Treatment: Soothe Liver, transform dampness. Prescription: Yin Chen 6g, Bai Zhu 10g, Zhi Ke 5g, Gui Zhi 3g, Fu Ling 12g, Fa Ban Xia 5g, Ji Nei Jin 1 piece, Pao Jiang 3g, 2 doses. Second visit: Jaundice reduced, diarrhea seven times due to changing milk/food. This is delicate Spleen-Stomach, disorderly transport/transformation. Treatment: Warm Middle, strengthen Spleen, promote dampness. Yin Chen 6g, Bai Zhu 10g, Fu Ling 10g, Gui Zhi 3g, Cang Zhu 6g, Pao Jiang 3g, Yi Ren 10g, Sha Ren 3g, Fa Ban Xia 5g, Mai Ya 10g, Ji Nei Jin 1 piece, 2 doses. Third visit: Diarrhea stopped, good milk/food intake, jaundice gradually receding, stool yellow. Continue with Liu Jun Tang (Six-Gentlemen Decoction) to strengthen Spleen/transform dampness plus Yin Chen for jaundice as mainstay; add Qu/Mai for food stagnation; add Bai Kou Ren, Hou Po, Tong Cao for thrush for conditioning and conclusion.
(Liao Rongquan's Pediatric Medical Cases)