小儿之热，有心肝脾肺肾五脏之不同。虚实温壮，四者之不一。及表里血气、阴阳浮陷，与
夫风湿痰食，各当详之。心热者额上先赤，心烦心痛，掌中热而哕，或壮热饮水，已午时益
甚。肝热者左颊先赤，便难转筋，寻衣捻物，多怒多惊，四肢困倦，寅卯时益甚。脾热者鼻
上先赤，怠惰嗜卧，身热饮水，遇夜益甚。肺热者右颊先赤，手掐眉目，喘咳寒热饮水，日
西热甚。肾热者颏下先赤，两足热甚，骨苏苏如虫蚀，热甚不能起于床，夜间益甚。仍当辨
其虚实，实则面赤气粗，口燥唇肿，作渴饮冷，大小便难，或掀衣露体，烦啼暴叫，伸体而
卧，睡不露睛，手足指热，宜用表下。虚则面色青白，恍惚神缓，口中虚冷，嘘气软弱，喜
热恶寒，泄泻多尿，或乍凉乍温，怫郁惊惕，上盛下泄，夜则虚汗，屈体而卧，睡露睛，手
足指冷，宜用调补。壮热者肢体大热，热不已则发惊痫。温热者手体微热，热不已则发惊搐
。阴虚则内热，阳盛则外热。以手轻扪之则热重，按之不热，此皮毛血脉之热，热在表也。
重按之筋骨之分则热，轻手则不热，此筋骨之热，热在里也。不轻不重，按之而热，此肌肉
之热，热在表里之间也。以虚实分属表里而言之，壮热恶风寒，为元气不充，表之虚热也。
壮热不恶风寒，为外邪所客，表之实热也。壮热饮汤，为津液短少，里之虚热也。壮热饮水
，为内火销烁，里之实热也。若夫内外皆热，则喘而渴，齿干烦冤腹满，四肢热，逢风寒，
如炙于火，能冬不能夏，是皆阳盛阴虚也。脉尺寸俱满为重实，尺寸俱弱为重虚，脉洪大，
或缓而滑，或数而鼓，此热盛拒阴，虽形症似寒，实非寒也。热而脉数，按之不鼓，此寒盛
格阳，虽形症似热，实非热也。发热恶热，大渴不止，烦躁肌热，不欲近衣，其脉洪大，按
之无力，或兼目痛鼻干者，此血虚发躁也，当补其血。如不能食而热，自汗者，气虚也，当
补其气。仲景论内外不足发热自汗之症，禁不可发汗。加饮食劳役，虽病发热，误发其汗，
则表必虚也。身热而汗出者，风也。发热身疼而身重黄者，湿也。增寒发热，恶风自汗，脉
浮胸痞者，痰也。发热头痛，脉数者，食也。寸口脉微为阳不足，阴气上入阳中则恶寒；尺
脉弱为阴不足，阳气下入阴中则发热，阴阳不归其分，则寒热交争也。昼则安静，夜则发热
烦躁，是阳气下陷入阴中也；昼则发热烦躁，夜则安静，是重阳无阴也，当急泻其阳，峻补
其阴。至若身热脉弦数，战栗而不恶寒者，瘅疟也。发热恶寒，脉浮数者，温病也。若四肢
发热，口舌咽干，是火热乘土位，湿热相合，故烦躁闷乱也。若身体沉重，走注疼痛，乃湿
热相搏，风热郁而不得伸也。心热则用泻心汤、导赤散、安神丸。肝热则用泻青丸、柴胡饮
子。脾热则用泻黄散。肺热轻则用泻白散；重则用凉膈散及地骨皮散。肾热则用滋肾丸。实热
则宜疏下，虚热则宜调补。壮热者导赤散。温热者泻黄散。若肢体热轻，则用惺惺散，重则
用羌活散之类。大便秘者，二黄犀角散。余热不退者，地骨皮散。骨节疼痛者，栀子仁汤。
宿滞内作者，紫霜丸。肝火内热者，龙胆草汤。阴盛隔阳而热者，人参理中汤。肝经血虚生
风而搐者，用四物、天麻、钩藤钩。若热蕴便秘者，四顺清凉饮。热而二便调和，风邪蕴结
于表而发者，用惺惺散加麻黄汗之。汗后血虚而热益甚者，六神散加粳米。汗后气虚而恶寒
发热者，补中益气汤。汗后阴虚，阳无所附而热者，用四物汤加参 。汗后阳虚，阴无所附
而热者，用四君汤加芎、归。婴儿诸热，其因别症而作者，当从所重而治之。或乳母七情浓味，饮食
停积，遗热于儿；或见嗜食甘肥，衣衾过暖；或频浴热汤，积热于内为患者，各当详之。盖
小儿脏腑脆弱，元气易虚，补泄宜用轻和之剂，庶无变症。若乳下婴儿，当兼治其母，仍参
诸热症治之。
治验
一小儿夜间发热，天明如故，或小腹作痛，饮食少思，面色痿黄，热时面赤，不时饮食，此
食积所致，用下积丸，治之而消。又用白术散，调理而安。
一小儿饮食停滞，腹痛作呕，用大安丸而愈，饮食虽进，其腹仍痛，用六君、山楂、神曲，
痛少止。余以为脾气伤，而饮食难化，乃去前二味，服六君子四剂而愈。后又伤食，仍服前
药，痛止而至暮发热，用六君、柴胡、升麻而痊，此由脾虚下陷，不能升发，故至暮发热也
。
一小儿发热，饮食少思，大便不实，常服芦荟等丸，视其鼻赤，此寒凉之剂，复伤脾土而虚
热也，用五味异功散，数剂而愈。
一小儿十三岁，内热晡热，形体倦怠，食少作渴，此禀赋怯弱之虚热也。用地黄丸、异功散
，补之不越月而痊。
一小儿十四岁，而近女色，发热吐痰，至有室，两目羞明，头觉胀大，用地黄丸料加五味子
、当归、黄 ，煎服，及补中益气汤，得慎疾而瘥。
一小儿十四岁，肢体倦怠，发热晡热，口干作渴，吐痰如涌，小便淋漓，或面目赤色，身不
欲衣，此禀肾不足而虚热也，用补中益气汤、六味地黄丸寻愈。
一小儿五岁，发热作渴，右腮鼻准微赤，或与冷水凉药，实时呕吐。余曰∶右腮微赤，肺经
虚热也；鼻准微赤，胃经虚热也。先用四君、升麻一剂吐止，又用白术散二剂而不渴，更用
四君子汤四剂而安。
一小儿九岁，发热作渴，用泻黄散。大便重坠，口角流涎，彼欲泻火。余曰∶鼻准青白，脾
胃虚寒，肝木所侮也；口角流涎，脾气不能摄也；大便重坠，胃气不能升也。不信，竟服凉
药，眉唇微动，四肢微搐，复求治。余曰∶此虚极而变慢脾风矣。用六君、炮姜、当归、木
香、钩藤钩二剂，益甚。欲求更剂。余曰∶药力未及耳，又加炮附子一片即安。后去附子二
剂而愈。
一小儿四岁，停滞腹痛发热，用大安丸，而饮食进。又用六君、山楂、神曲四剂，而痛止。
后伤食，至暮复热，用六君、柴胡、山栀、升麻而痊。此脾虚兼肝火之治法也。
一小儿发热体瘦，夜间遗尿，日间频数，此禀脾肾不足，用补中益气汤加补骨脂，及地黄丸
加鹿茸治之而痊。毕姻后，小便频数，作渴发热，服补阴丸等药，发热尤甚，小便如淋，用补中益气汤
、六味地黄丸而愈。
一小儿体瘦腹大，发热嗜卧，作渴引饮，先用白术散为主，佐以四味肥儿丸，诸症渐愈，又
用异功散、六味丸而愈。
一小儿十四岁，伤食发热，服消食丸，胸腹膨胀，发热作渴，此脾气复伤也。先用四君、升
麻、柴胡，饮食渐进；用补中益气汤而愈。后因劳心，发热少食，用四君、升麻、柴胡而愈
。
一小儿伤风咳嗽，服参苏饮，加痰盛喘急，腹胀不食，此脾肺虚而复伤也，用六君、柴胡、
桔梗一剂，诸症顿息，用六君子汤而痊。
一女子十四岁，发热，至夜益甚，久不愈，左关脉弦数，右关脉微，按之亦弦，此肝火血热
，脾胃虚弱，先用四物二连汤加柴胡、山栀、牡丹皮二剂，热稍退；又二剂，热顿退。再用
加味逍遥散加白术三钱，数剂而痊。
嘉靖癸丑闰三月，渠下第北归。大子麟孙方病泻不食，遍体如焚，胸满腹冷痛，日夜不成寝
。或投以山楂、枳壳，中气愈弱，泻愈甚。不食至累月，日进米饮一半瓯，或糕饵枣栗少许
。稍过节度，则肢体热益壮，腹痛不解，奄奄喘息，旦暮不保矣。立斋先生枉视之，则曰∶
“此胃虚不能纳，脾湿不能运，病在戊巳，深且久，兼木气所乘脱，服攻治之药，则殆矣。
”亟用补中益气汤数，里热稍退，泻不食如初。先生复曰∶此勿亟，惟胃气渐复，湿渐除，
当自得效耳。改用六君兼补中汤，仍服八味丸生命门火，以滋脾土。如是三月，诸症悉退，纳谷倍常
日。惟稍遇形役，或记诵心劳，则潮热遄发，先生复授以归脾方加栀、柴二种，热寻止，形
气日充。甲寅七月，偶触暑饮冷，前症复作，间发疟疾，热昼夜不止。先生曰∶此虚寒 阳
，法当舍时从症。用补中汤多加炮姜，益以生姜二两，及口而疟止，面色青黄相错，更患痢
。或谓∶参、 、炮姜不宜。先生哂之，且曰∶此固虚弱自利耳。往尝谓戊巳受病，木气乘
之，此青黄二色，非正形耶！仍用补中益气多加柴胡、参、术，数日而痢止，余症亦渐解脱
。惟吾儿襁褓失母，渠每姑息之故，其性外温而中易怒。渠少孤，遭家多难，藜藿恒不充，
儿幼多病失调养，故形怯而胃弱，致疾之原，其所由来者渐矣。先生洞微烛幽，知其病深且
久，而坚持独见，以祛攻治之惑，吾儿再造之慈，何幸得此于先生哉！先生之曾大父与先廷
评公为中表兄弟，先君与先生，同宦游京师。末年尤敦泉石之雅。先生盛德，及于犬子，能
使先人后嗣永存，区区志感，诚不能尽万分之一也。是岁冬十月望，眷晚生张慕渠顿首顿首
。
嘉靖甲寅，敬臣之女，年十二，患脾胃素弱，自夏入秋，时泻时止，小腹微痛，至八九月间
，遂成疳积之症，发热凡二十余日不止，汗泄热解，汗已复热，自中脘至小腹膨胀坚直，大
便溏，气喘咳嗽作嗳，俱昼轻夜重，彻夜烦躁不睡，鼻塞眼暗谵语，其母以为必死矣。立斋
先生诊之曰∶脉浮大而无根，此大虚证也，非独参汤不可。乃用参一两，加熟附三分，煨生
姜三片，日进二剂。仍并渣服之，大下疳积，其气甚惺，腹渐宽，热渐减，脉渐敛，然手犹
寻捻不已，鼻孔出血。先生曰∶此肝证也。煎六味丸料与之一服，如脱，乃昼服独参姜附汤
，夜服六味丸料，脉渐有根，诸症渐退。先此手足恒热，至是乃始觉寒。先生喜曰∶此病邪
尽退，而真气见矣。然犹饮食不进，乃单用六君子汤加炮姜，遂能食；咳嗽独甚，与补中益
气汤嗽遂止，夜始有睡。凡弱女之得生，皆先生力也，向非先生卓有定见，专治其本，而其末自愈，
则奄奄一息之躯，岂堪杂剂之攻击哉！其为丘中之骨，盖必然矣。敬臣感激之余，无由以报
，敬书施疗之颠末，以附医录，庶不泯先生之功，且以告同患此者，幸无所误。亦推展先生
一念之仁于万一云尔！孟冬望日，眷晚生王敬臣顿首拜书。
败毒散 治伤风瘟疫风湿，头目昏眩，四肢作痛，增寒壮热，项强睛疼，或恶寒咳嗽，鼻塞
声重。
柴胡 前胡 川芎 枳壳（炒） 羌活 独活 茯苓 桔梗 人参（各一两） 甘草（半两）
上每服二钱，生姜、薄荷水煎。
滋肾丸 治肾热。
黄柏（酒拌炒焦，三钱） 知母（二钱） 肉桂（五分）
上为末，熟水丸，桐子大。每服二十丸至三十丸，食前百沸汤下。
四顺清凉饮 治小儿血脉壅实，脏腑蓄热，颊赤作渴，五心烦热，睡卧不安，四肢擎掣。及
因乳哺不时，寒温失度，令儿血气不顺，肠胃不调，大小便涩，欲发惊痫。或风热结核，头
面生疮，目赤咽痛，疮疹余毒，一切壅滞挟热。泄泻不止，加木香，煨大黄。
赤芍药 当归 甘草 大黄（各等分）
上每服一钱，水煎作两服。
消风散 治小儿解脱，致令风邪客于皮毛，入于脏腑，则令恶风发热，胸膈痰涎，目涩多睡
。（方见惊痫胎症）
小柴胡汤 治伤寒温热，身热恶风，头痛项强，四肢烦疼，往来寒热，胁痛耳聋，呕哕痰实
，中暑疟疾并服之。（方见天钓）
愚按∶前方若肝胆经风热，肝火瘰 ，寒热往来，日晡发热潮热，不欲饮食，或怒火口苦耳
聋咳嗽，或胁痛 满，小便不利，或泄泻吐酸苦水，或肢体搐动，唇目抽掣，及乳母有前症
，致儿为患者，并宜服之。
抑肝散 治肝经虚热发搐，或发热切牙，或惊悸寒热，或木乘土而呕吐痰涎，腹胀少食，睡
眠不安。（方见肝脏）
栀子清肝散（一名柴胡栀子散） 治三焦及足少阳经风热发热，耳内作痒生疮，或出水疼痛，或
胸乳间作痛，寒热往来。
柴胡 栀子（炒） 牡丹皮（各一钱） 茯苓 川芎 芍药 当归 牛蒡子（炒。各七分） 甘草（三分）
上水煎服。
柴胡清肝散 治肝胆三焦风热怒火，或乍寒乍热，往来寒热发热，或头发疮毒等症。
柴胡（一钱半） 黄芩（炒） 人参 川芎（各一钱） 山栀（炒，一钱半） 连翘 甘草（各五分） 桔梗（八
分）
上水煎服。
柴胡饮子 解肌热、蒸热、积热，或汗后余热，脉洪实弦数，大便坚实。
黄芩（七分） 甘草（四分） 大黄（八分） 芍药（七分） 柴胡 人参（各五分） 当归（一钱）
上每服一钱，姜水煎。
当归补血汤 治肌热躁热，目赤面红烦渴，昼夜不息，其脉洪大而虚，重按全无，此脉虚血
虚也。若误服白虎汤必死，宜此主之。
黄 当归（各等分）
上水煎服。
三黄丸 治三焦积热，眼目赤肿，头项肿痛，口舌生疮，心膈烦躁，不美饮食，大小便秘涩
，五脏实热，或下鲜血，疮节热症。
黄连 黄芩 大黄（煨。各等分）
上为末，炼蜜丸，桐子大。每服三十丸，白滚汤下，量大小加减服。
The fever in children varies according to the five zang organs: Heart, Liver, Spleen, Lung, and Kidney. The conditions of deficiency (Xu), excess (Shi), warm pathogen (Wen), and severe heat (Zhuang) are distinct among these four categories. Furthermore, the floating and sinking of exterior-interior, blood and qi, yin and yang, as well as wind-dampness, phlegm, and food retention, must all be carefully differentiated.
Heat in the Heart manifests first with redness on the forehead, mental restlessness and heart pain, heat in the palms, and hiccups; or high fever with thirst for water, worsening during the Si and Wu hours (11 am–1 pm).
Heat in the Liver manifests first with redness on the left cheek, difficulty in defecation with tendon twitching, picking at clothes and objects, irritability and fright, limb fatigue, worsening during the Yin and Mao hours (3 am–7 am).
Heat in the Spleen manifests first with redness on the nose bridge, lethargy and desire to sleep, body heat with thirst for water, worsening at night.
Heat in the Lung manifests first with redness on the right cheek, rubbing eyes and eyebrows with hands, asthma and cough with alternating cold and heat and thirst, worsening in the late afternoon.
Heat in the Kidney manifests first with redness under the chin, severe heat in both feet, aching bones feeling like insect erosion, inability to rise from bed due to severe heat, worsening at night.
One must also differentiate between deficiency and excess. Excess patterns present with red face, coarse breathing, dry mouth and swollen lips, thirst preferring cold drinks, difficulty in urination and defecation, throwing off clothes to expose the body, irritability, crying out loudly, lying stretched out, sleeping with eyes closed, and hot fingertips; treatment should employ releasing the exterior or purging methods. Deficiency patterns present with blue-white complexion, absent-mindedness and sluggish spirit, feeling of cold in the mouth, weak sighing, preference for warmth and aversion to cold, diarrhea and frequent urination, alternating cold and heat, depression and fright, upper excess with lower diarrhea, night sweats, lying curled up, sleeping with eyes partially open, and cold fingertips; treatment should employ regulating and tonifying methods.
Severe heat (Zhuang Re) refers to very hot limbs; if unchecked, it leads to convulsive diseases (Jing Xian). Warm heat (Wen Re) refers to slightly hot hands and body; if unchecked, it leads to convulsions (Jing Chu).
Yin deficiency generates internal heat; Yang excess generates external heat.
Light palpation reveals heat on the skin but no heat upon deep pressure indicates heat in the skin and blood vessels, located in the Exterior.
Deep pressure reveals heat in the sinews and bones but no heat upon light touch indicates heat in the sinews and bones, located in the Interior.
Moderate pressure reveals heat indicates heat in the muscles, located between the Exterior and Interior.
Differentiating by deficiency/excess combined with exterior/interior: Severe heat with aversion to wind and cold indicates insufficient Yuan Qi, representing deficient heat in the Exterior. Severe heat without aversion to wind and cold indicates invasion by external pathogens, representing excess heat in the Exterior. Severe heat with desire for hot soup indicates shortness of fluids, representing deficient heat in the Interior. Severe heat with desire for cold water indicates consumption by internal fire, representing excess heat in the Interior.
If both interior and exterior are hot, there is asthma and thirst, dry teeth, mental distress and abdominal fullness, hot limbs, feeling like being roasted by fire when encountering wind and cold, ability to endure winter but not summer; this is all Yang excess and Yin deficiency.
Pulses at Cun and Chi positions both full indicate heavy excess; both weak indicate heavy deficiency. Pulses that are surging (Hong Da), or slow and slippery, or rapid and forceful, indicate heat盛 rejecting Yin; although symptoms resemble cold, it is actually not cold.
Fever with rapid pulse, but non-forceful upon pressure, indicates cold盛 rejecting Yang; although symptoms resemble heat, it is actually not heat.
Fever with aversion to heat, unquenchable thirst, irritability, hot skin, unwillingness to wear clothes, surging pulse that is empty upon pressure, or accompanied by eye pain and dry nose, indicates irritability caused by Blood deficiency; one should tonify Blood.
Inability to eat with fever and spontaneous sweating indicates Qi deficiency; one should tonify Qi.
Zhang Zhongjing discussed symptoms of fever and spontaneous sweating due to interior and exterior insufficiency, prohibiting diaphoresis. If compounded by dietary injury or overwork, even if fever is present, mistaken diaphoresis will further weaken the Exterior.
Body heat with sweating indicates Wind. Fever with body ache and heaviness/yellowing indicates Dampness. Increased chills and fever, aversion to wind, spontaneous sweating, floating pulse, and chest stuffiness indicate Phlegm. Fever with headache and rapid pulse indicates Food retention.
A faint pulse at Cun indicates Yang insufficiency; Yin Qi entering Yang causes aversion to cold. A weak pulse at Chi indicates Yin insufficiency; Yang Qi descending into Yin causes fever. When Yin and Yang do not remain in their respective divisions, cold and heat contend.
Calm during the day, feverish and irritable at night, indicates Yang Qi sinking into Yin. Feverish and irritable during the day, calm at night, indicates excessive Yang without Yin; one should urgently drain Yang and vigorously tonify Yin.
Regarding body heat with wiry-rapid pulse, shivering but no aversion to cold, this is Dan Malaria (Dan Nue).
Fever with aversion to cold, floating-rapid pulse, this is Warm Disease (Wen Bing).
If limbs are hot, mouth, tongue, and throat dry, this is Fire-Heat attacking the Earth position (Spleen/Stomach), with Damp-Heat combining, causing irritability and confusion.
If body is heavy with wandering pain, this is Damp-Heat clashing, with Wind-Heat stagnating and unable to extend.
For Heart Heat, use Xi Xin Tang (Heart-Draining Decoction), Dao Chi San (Guide Out Red Powder), and An Shen Wan (Spirit-Calming Pill).
For Liver Heat, use Xie Qing Wan (Drain Green Pill) and Chai Hu Yin Zi (Bupleurum Drink).
For Spleen Heat, use Xie Huang San (Drain Yellow Powder).
For mild Lung Heat, use Xie Bai San (Drain White Powder); for severe cases, use Liang Ge San (Cool Diaphragm Powder) and Di Gu Pi San (Lycium Bark Powder).
For Kidney Heat, use Zi Shen Wan (Nourish Kidney Pill).
Excess heat requires draining and purging; deficient heat requires regulating and tonifying.
For severe heat, use Dao Chi San. For warm heat, use Xie Huang San.
For mild limb heat, use Xing Xing San (Xingxing Powder); for severe cases, use Qiang Huo San (Notopterygium Powder).
For constipation, use Er Huang Xi Jiao San (Two Yellows and Rhinoceros Horn Powder).
For lingering residual heat, use Di Gu Pi San.
For bone and joint pain, use Zhi Zi Ren Tang (Gardenia Seed Decoction).
For retained stagnation acting internally, use Zi Shuang Wan (Purple Frost Pill).
For Liver Fire internal heat, use Long Dan Cao Tang (Gentian Root Decoction).
For heat due to Yin excess repelling Yang, use Ren Shen Li Zhong Tang (Ginseng Regulate Middle Decoction).
For convulsions due to Liver channel Blood deficiency generating Wind, use Si Wu Tang (Four Substances Decoction) plus Tian Ma (Gastrodia) and Gou Teng Hook (Uncaria).
For heat accumulation with constipation, use Si Shun Qing Liang Yin (Four Smooth Clearing Cold Drink).
For fever with normal urination/defecation, where Wind pathogen stagnates in the Exterior, use Xing Xing San plus Ma Huang (Ephedra) to induce sweating.
After sweating, if Blood deficiency causes increased heat, use Liu Shen San (Six Spirits Powder) plus Jing Mi (Rice).
After sweating, if Qi deficiency causes aversion to cold and fever, use Bu Zhong Yi Qi Tang (Supplement the Middle and Augment the Qi Decoction).
After sweating, if Yin deficiency leaves Yang unattached causing heat, use Si Wu Tang plus Ren Shen (Ginseng).
After sweating, if Yang deficiency leaves Yin unattached causing heat, use Si Jun Tang (Four Gentlemen Decoction) plus Chuan Xiong (Ligusticum) and Dang Gui (Angelica).
For infant fevers caused by other specific conditions, treat based on the primary condition.
Causes may include maternal emotional excess or rich diet leading to food stagnation transferring heat to the child; or the child’s preference for sweet/greasy foods, overdressing; or frequent hot baths causing internal heat accumulation. Each case requires detailed differentiation.
Because children’s zang-fu are fragile and Yuan Qi easily depleted, tonification and purgation should use mild and harmonious formulas to avoid transformation of disease.
For nursing infants, treat the mother concurrently and refer to treatments for various heat syndromes.
Case Records:
A child had fever at night, normal at dawn, sometimes lower abdominal pain, poor appetite, sallow complexion, red face during fever, intermittent desire to eat. This was caused by Food Stagnation. Treated with Xia Ji Wan (Downward Accumulation Pill), stagnation cleared. Then treated with Bai Zhu San (Atractylodes Macrocephala Powder) for regulation and recovery.
A child with food stagnation had abdominal pain and vomiting. Cured with Da An Wan (Great Peace Pill). Although eating improved, abdominal pain persisted. Treated with Liu Jun Zi Tang (Six Gentlemen Decoction) plus Shan Zha (Hawthorn) and Shen Qu (Medicated Leaven), pain subsided slightly. I reasoned Spleen Qi was injured, making digestion difficult. Removed previous two herbs, administered Liu Jun Zi Tang for four doses, cured. Later, another food injury occurred; same prescription stopped pain but fever appeared at dusk. Treated with Liu Jun Zi Tang plus Chai Hu (Bupleurum) and Sheng Ma (Cimicifuga), cured. This was due to Spleen deficiency with sinking, failing to ascend, causing dusk fever.
A child with fever, poor appetite, loose stools, frequently taking Lu Hui (Aloe) pills, showed red nose. This indicated cold-cooling agents re-injuring Spleen Earth, causing deficient heat. Treated with Wu Wei Yi Gong San (Five Flavor Extraordinary Ability Powder), cured after several doses.
A thirteen-year-old child had internal heat and afternoon tidal fever, physical fatigue, poor appetite, and thirst. This was deficient heat due to weak constitution. Treated with Di Huang Wan (Rehmannia Pill) and Yi Gong San (Extraordinary Ability Powder), cured within a month via tonification.
A fourteen-year-old child, after sexual activity, had fever and expectoration, went to a brothel, had photophobia, head distension. Treated with Di Huang Wan formula plus Wu Wei Zi (Schisandra), Dang Gui (Angelica), and Huang Qi (Astragalus) decocted, plus Bu Zhong Yi Qi Tang, recovered with careful management.
A fourteen-year-old child had limb fatigue, fever and afternoon tidal fever, dry mouth/thirst, profuse expectoration, dribbling urine, red face/eyes, aversion to clothing. This was deficient heat due to congenital Kidney insufficiency. Treated with Bu Zhong Yi Qi Tang and Liu Wei Di Huang Wan (Six Ingredient Rehmannia Pill), quickly recovered.
A five-year-old child had fever and thirst, slight redness on right cheek and nose tip. Given cold water/cooling medicine, immediately vomited. I said: Right cheek redness indicates Lung channel deficient heat; nose tip redness indicates Stomach channel deficient heat. First dose of Si Jun Zi Tang plus Sheng Ma stopped vomiting. Two doses of Bai Zhu San stopped thirst. Four doses of Si Jun Zi Tang brought stability.
A nine-year-old child had fever and thirst, treated with Xie Huang San. Heavy sensation in defecation, drooling at mouth corner. Patient wanted to purge fire. I said: Blue-white nose tip indicates Spleen-Stomach deficiency-cold, insulted by Liver Wood; drooling indicates Spleen Qi failing to control; heavy defecation indicates Stomach Qi failing to ascend. Patient did not believe, took cooling medicine, developed slight eyebrow/lip movement and limb twitching, sought treatment again. I said: This is extreme deficiency transforming into Slow Spleen Wind (Man Pi Feng). Treated with Liu Jun Zi Tang, Pao Jiang (Baked Ginger), Dang Gui, Mu Xiang (Aucklandia), Gou Teng Hook for two doses, worsened. Wanted new prescription. I said: Medicinal power has not yet reached. Added one slice of Pao Fu Zi (Baked Aconite), then stabilized. Removed Fu Zi, two more doses cured.
A four-year-old child had stagnation, abdominal pain, fever. Treated with Da An Wan, diet improved. Four doses of Liu Jun Zi Tang, Shan Zha, Shen Qu stopped pain. Later food injury, dusk fever returned. Treated with Liu Jun Zi Tang, Chai Hu, Zhi Zi (Gardenia), Sheng Ma, cured. This is the treatment method for Spleen deficiency combined with Liver Fire.
A child with fever, emaciation, nocturnal enuresis, frequent daytime urination. Congenital Spleen-Kidney insufficiency. Treated with Bu Zhong Yi Qi Tang plus Gu Zhi (Psoralea), and Di Huang Wan plus Lu Rong (Deer Antler), cured. After marriage, frequent urination, thirst, fever. Took Bu Yin Wan (Nourish Yin Pill), fever worsened, urinary frequency like strangury. Treated with Bu Zhong Yi Qi Tang and Liu Wei Di Huang Wan, cured.
A child with emaciated body, large abdomen, fever, lethargy, thirst drinking much. Primarily used Bai Zhu San, assisted by Si Wei Fei Er Wan (Four Flavor Emaciation-Children Pill), symptoms gradually improved. Then Yi Gong San and Liu Wei Wan cured.
A fourteen-year-old child, food injury fever, took Xiao Shi Wan (Digestive Pills), chest/abdominal distension, fever, thirst. Spleen Qi re-injured. First Si Jun Zi Tang, Sheng Ma, Chai Hu, diet slowly improved; Bu Zhong Yi Qi Tang cured. Later mental labor, fever, poor diet, cured with Si Jun Zi Tang, Sheng Ma, Chai Hu.
A child with wind-cold cough, took Shen Su Yin (Ginseng Perilla Drink),痰增多 wheezing urgency, abdominal distension, anorexia. Spleen-Lung deficiency re-injured. One dose of Liu Jun Zi Tang, Chai Hu, Jie Geng (Platycodon), symptoms ceased; Liu Jun Zi Tang cured.
A fourteen-year-old girl, fever, worse at night, chronic. Left Guan pulse wiry-rapid, Right Guan pulse faint, wiry upon pressure. Liver Fire Blood Heat, Spleen-Stomach weakness. First Si Wu Er Lian Tang (Four Substances Two Lotuses Decoction) plus Chai Hu, Zhi Zi, Mu Dan Pi (Moutan) for two doses, fever slightly receded; two more doses, fever suddenly receded. Then Jia Wei Xiao Yao San (Modified Free Wanderer Powder) plus Bai Zhu 3 qian, several doses cured.
In the leap third month of Ji Chou year (Jiajing era), Mr. Qu returned north after failing the imperial exam. His grandson, Tai Zi Lin Sun, suffered from diarrhea and anorexia, body burning like fire, chest fullness, cold abdominal pain, unable to sleep day or night. Someone gave Shan Zha and Zhi Ke (Citrus Aurantium), weakening Middle Qi further, worsening diarrhea. No food for months, only half bowl rice drink daily, or small amounts of cake/dates. Any deviation caused stronger limb heat, unresolved abdominal pain, gasping breath, life hanging by a thread. Mr. Lizhai visited, saying: "Stomach deficiency cannot receive, Spleen dampness cannot transport. Disease in Wu-Ji (Earth), deep and long, compounded by Wood Qi overacting. Administering attacking medicines would be fatal." Urgently used Bu Zhong Yi Qi Tang several doses, interior heat slightly receded, diarrhea/anorexia remained. Mr. said: "Do not rush. As Stomach Qi recovers and dampness removes, effect will come naturally." Changed to Liu Jun Zi Tang combined with Bu Zhong Yi Qi Tang, continued Ba Wei Wan (Eight Ingredient Pill) to warm Ming Men Fire to nourish Spleen Earth. Over three months, all symptoms receded, intake doubled. Only upon physical exertion or mental strain did tidal fever recur. Mr. prescribed Gui Pi Fang (Restore the Spleen Formula) plus Zhi Zi and Chai Hu, fever stopped, physique/qi filled daily. In July of Jia Yin year, accidental summerheat exposure and cold drink caused recurrence, intermittent malaria, fever day and night. Mr. said: "This is deficiency-cold repelling Yang. Method: abandon season, follow syndrome." Used Bu Zhong Tang plus extra Pao Jiang, added 2 liang fresh ginger, administered orally, malaria stopped. Complexion yellow-green mixed, then dysentery. Some said: Ginseng, Astragalus, Pao Jiang inappropriate. Mr. smiled: "This is indeed deficiency-cold self-diarrhea. I once said Wu-Ji disease, Wood overacting; this green-yellow color is exactly the sign!" Continued Bu Zhong Yi Qi Tang plus Chai Hu, Ren Shen, Bai Zhu, dysentery stopped in days, other symptoms resolved. My son lost mother in infancy; he indulged him, resulting in gentle exterior but irritable interior. He was orphaned young, family disasters, poor diet, childhood illness and poor care led to frailty and weak stomach. Origin of disease was gradual. Mr. saw through subtleties, knowing disease was deep/long, insisted on unique view to dispel attacking treatment confusion. Grace of rebirth for my son, how fortunate to receive this from Mr.! Mr.'s great-grandfather and my grandfather were cousins. My father and Mr. served together in capital. Late years shared love for nature. Mr.'s virtue reached my son, allowing ancestors' lineage to continue. My gratitude cannot express one ten-thousandth. On the 15th day of 10th lunar month, junior student Zhang Mu Qu bows repeatedly.
In Jia Yin year (Jiajing era), Jing Chen's daughter, age 12, had weak Spleen-Stomach constitution. From summer to autumn, intermittent diarrhea, slight lower abdominal pain. By Aug/Sept, became Gan Ji (Childhood Malnutrition Syndrome), fever >20 days, sweat-relieved fever but returned, distension/firmness from Zhong Wan to lower abdomen, loose stool, asthma/cough/belching, worse at night, restless insomnia, nasal congestion, dim vision, delirium. Mother thought death certain. Mr. Lizhai diagnosed: Pulse floating-large without root, major deficiency syndrome, only Du Shen Tang (Single Ginseng Decoction) works. Used Ren Shen 1 liang, Shu Fu Zi 3 fen, Wei Sheng Jiang 3 slices, 2 doses/day. Taken with dregs. Passed large amount of Gan Ji, spirit clear, abdomen soft, heat reduced, pulse converging, but hand still picking/twitching, epistaxis. Mr. said: This is Liver syndrome. Decocted Liu Wei Wan formula, one dose felt relief. Day: Du Shen Jiang Fu Tang; Night: Liu Wei Wan formula. Pulse gained root, symptoms receded. Previously hands/feet hot, now felt cold. Mr. rejoiced: Pathogens exhausted, True Qi revealed. Still no appetite, used single Liu Jun Zi Tang plus Pao Jiang, ate; cough severe, gave Bu Zhong Yi Qi Tang, cough stopped, slept at night. Weak girl survived due to Mr.'s effort. Without his firm view to treat root, branches self-resolved, could such a dying body withstand mixed attacks? Would surely become bones in hills. Grateful, Jing Chen wrote treatment details to attach to medical records, preserving Mr.'s merit, warning others, extending Mr.'s benevolence. On 15th day of 1st lunar month, junior student Wang Jing Chen bows and writes.
Bai Du San (Detoxify Decoction) Treats wind-cold, epidemic damp-wind, dizziness, limb pain, increased chills/severe heat, stiff neck/eye pain, aversion to cold/cough, nasal congestion/heavy voice.
Chai Hu (Bupleuri Radix), Qian Hu (Peucedani Radix), Chuan Xiong (Chuanxiong Rhizoma), Zhi Ke (Aurantii Fructus, stir-fried), Qiang Huo (Notopterygii Rhizoma et Radix), Du Huo (Angelicae Pubescentis Radix), Fu Ling (Poria), Jie Geng (Platycodi Radix), Ren Shen (Ginseng Radix) [each 1 liang], Gan Cao (Glycyrrhizae Radix et Rhizoma) [0.5 liang].
Take 2 qian per dose, decoct with Sheng Jiang (Zingiberis Rhizoma Recens) and Bo He (Menthae Haplocalycis Herba).
Zi Shen Wan (Nourish Kidney Pill) Treats Kidney Heat.
Huang Bo (Phellodendri Cortex, wine-mixed, stir-fried until scorched) [3 qian], Zhi Mu (Anemarrhenae Rhizoma) [2 qian], Rou Gui (Cinnamomi Cortex) [0.5 fen].
Grind to powder, make pills with boiled water, size of paulownia seeds. Take 20-30 pills before meals, swallow with boiling water.
Si Shun Qing Liang Yin (Four Smooth Clearing Cold Drink) Treats pediatric blood vessel congestion, organ heat accumulation, red cheeks/thirst, five-palm heat, restless sleep, limb spasms. Also for irregular feeding, temperature imbalance causing adverse blood/qi, gastrointestinal disorder, difficult urination/defecation, impending convulsions. Or wind-heat nodules, facial sores, red eyes/sore throat, post-varicella toxicity, all stagnation with heat. For persistent diarrhea, add Mu Xiang (Aucklandiae Radix), Wei Da Huang (Rhei Radix et Rhizoma, baked).
Chi Shao Yao (Paeoniae Radix Rubra), Dang Gui (Angelicae Sinensis Radix), Gan Cao (Glycyrrhizae Radix et Rhizoma), Da Huang (Rhei Radix et Rhizoma) [equal parts].
Take 1 qian per dose, decoct in water, divide into two doses.
Xiao Feng San (Eliminate Wind Powder) Treats pediatric rectal prolapse, allowing wind pathogen to lodge in skin/hair, enter organs, causing aversion to wind/fever, chest/phlegm, dry eyes/sleepiness. (Formula see Convulsion/Fetal Syndromes).
Xiao Chai Hu Tang (Minor Bupleurum Decoction) Treats Shang Han/Warm diseases, fever/aversion to wind, headache/stiff neck, limb pain, alternating chills/fever, hypochondriac pain/deafness, vomiting/phlegm, heatstroke/malaria. Take together. (Formula see Heavenly Hook Syndrome).
Commentary: The above formula is suitable for Wind-Heat in Liver/Gallbladder channels, Liver Fire scrofula, alternating chills/fever, afternoon tidal fever, anorexia, anger-induced bitter taste/deafness/cough, hypochondriac distension, difficult urination, diarrhea/vomiting sour-bitter water, limb tremors, lip/eye twitching, and maternal symptoms affecting the child. All should take it.
Yi Gan San (Suppress Liver Powder) Treats Liver channel deficient heat with convulsions, fever/grinding teeth, fright/palpitations/chills-fever, Wood overacting Earth with vomiting/phlegm, abdominal distension/poor diet, restless sleep. (Formula see Liver Channel).
Zhi Zi Qing Gan San (Gardenia Clear Liver Powder, aka Chai Hu Zhi Zi San) Treats San Jiao and Foot-Shaoyang channel Wind-Heat fever, ear itching/sores/discharge/pain, chest/breast pain, alternating chills/fever.
Chai Hu (Bupleuri Radix), Zhi Zi (Gardeniae Fructus, stir-fried), Mu Dan Pi (Moutan Cortex) [each 1 qian], Fu Ling (Poria), Chuan Xiong (Chuanxiong Rhizoma), Shao Yao (Paeoniae Radix), Dang Gui (Angelicae Sinensis Radix), Niu Bang Zi (Arctii Fructus, stir-fried) [each 0.7 qian], Gan Cao (Glycyrrhizae Radix et Rhizoma) [0.3 fen].
Decoct in water and take.
Chai Hu Qing Gan San (Bupleurum Clear Liver Powder) Treats Liver/Gallbladder/San Jiao Wind-Heat/Anger, alternating cold/heat, fever, hair sores/toxins.
Chai Hu (Bupleuri Radix) [1.5 qian], Huang Qin (Scutellariae Radix, stir-fried), Ren Shen (Ginseng Radix), Chuan Xiong (Chuanxiong Rhizoma) [each 1 qian], Shan Zhi (Gardeniae Fructus, stir-fried) [1.5 qian], Lian Qiao (Forsythiae Fructus), Gan Cao (Glycyrrhizae Radix et Rhizoma) [each 0.5 fen], Jie Geng (Platycodi Radix) [0.8 fen].
Decoct in water and take.
Chai Hu Yin Zi (Bupleurum Drink) Resolves muscle heat, steaming heat, accumulated heat, or residual heat after sweating, with surging-excess-wiry-rapid pulse, hard stool.
Huang Qin (Scutellariae Radix) [0.7 qian], Gan Cao (Glycyrrhizae Radix et Rhizoma) [0.4 qian], Da Huang (Rhei Radix et Rhizoma) [0.8 qian], Shao Yao (Paeoniae Radix) [0.7 qian], Chai Hu (Bupleuri Radix), Ren Shen (Ginseng Radix) [each 0.5 qian], Dang Gui (Angelicae Sinensis Radix) [1 qian].
Take 1 qian per dose, decoct with Ginger Water.
Dang Gui Bu Xue Tang (Angelica Tonify Blood Decoction) Treats skin heat/restlessness, red eyes/face/thirst, day/night incessant, pulse surging-large but empty, completely void upon heavy pressure. This is pulse/Blood deficiency. Mistaken use of Bai Hu Tang (White Tiger Decoction) will cause death; this formula is indicated.
Huang Qi (Astragali Radix), Dang Gui (Angelicae Sinensis Radix) [equal parts].
Decoct in water and take.
San Huang Wan (Three Yellows Pill) Treats San Jiao accumulated heat, red/swollen eyes, head/neck swelling/pain, mouth/tongue sores, chest irritability, poor appetite, constipation, five-zang excess heat, lower bright blood, sores/joint heat syndromes.
Huang Lian (Coptidis Rhizoma), Huang Qin (Scutellariae Radix), Da Huang (Rhei Radix et Rhizoma, baked) [equal parts].
Grind to powder, make pills with refined honey, size of paulownia seeds. Take 30 pills with plain boiled water, adjust dosage by age/size.