小儿属实之症。惟表里食积。三者而已。盖表邪实者。必头项体痛。腰痛背强。壮热无
汗。脉象浮紧有力。宜从表散。如在冬月。宜羌活冲和汤主之。若在春夏秋三时。则宜易简参
苏饮。或惺惺散之类主之。若兼倦怠昏睡。则属正不胜邪。宜四柴胡饮。或五柴胡饮之类主之
。里邪实者。必舌胎黄浓。口燥唇疮。作渴喜饮。大小便秘。腹痛拒按。声音洪壮。伸体而
卧。睡不露睛。手足指热。脉象沉数有力。宜从攻下。如调胃承气汤。或四顺清凉饮之类主
之。若汗后身热不退。脉象弦洪数实。大便坚秘者。柴胡饮子。夫所谓实者
。邪气实耳。非元气有余之谓也。医者临症之际。果属实邪。于应表应下之药。皆当作小剂
。少少与之。要在中病即止。不可过剂。务宜顾定元气。斯无孟浪偾事之非。至于饮食停积
。必寸口脉浮大。按之反涩。腹皮热。大便 臭。然必由脾虚不运而致。于消导药中。慎毋
损及中气。宜多温中健脾之品。俾得自强不息之妙。如消乳丸。香橘饼。理中汤之类主之。
若伤食甚而或兼浓味积热者。宜大安丸。少少与之。俟食积稍消。仍当以五味异功散调补之
。此外如目直大叫。项急烦闷。肝之实也。泻青丸。抑肝散主之。若筋急血燥。抽搐劲强。
斜视目瞪。则属肝之虚矣。地黄丸主之。叫哭发热。饮水而搐。心之实也。导赤散。泻心汤
主之。若惊惕不安。则属心之虚矣。秘旨安神丸主之。困睡身热。饮水。脾之
实也。泻黄散主之。若呕吐泄泻。不食痞满。倦卧。牙紧流涎。手足牵动。则属脾之虚矣。
益黄
散。或六君子加炮姜木香主之。闷乱喘促。饮水。肺之实也。泻白散主之。若气促多汗。则
属肺之虚矣。四君子汤。或五味异功散主之。肾无实。惟痘疮黑陷。为邪气实而肾则虚也。
地黄丸主之。若二便不禁。津液枯槁。声喑目戴。肢体厥逆。肾虚极也。补中益气汤。兼六
味地黄丸主之。大抵小儿实症无多。若禀赋素虚。或病患已久。或过服克伐之剂。皆当作虚
症施治。不得概以为实也。慎之慎之。
Pediatric excess syndromes are limited to three categories: exterior excess, interior excess, and food accumulation. Exterior excess caused by pathogenic factors is characterized by pain in the head, neck, and body, lower back pain with stiffness of the back, high fever without sweating, and a floating, tight, and forceful pulse (Pulse Floating-Tight). Treatment should focus on releasing the exterior through diaphoresis. In winter, Qianghuo Chonghe Tang (Notopterygium Decoction for Harmonizing) is indicated. In spring, summer, and autumn, Yijian Rensu Yin (Easy-to-Prepare Ginseng and Perilla Decoction) or Xingxing San (Xingxing Powder) may be used. If accompanied by fatigue and drowsiness, it indicates that healthy Qi cannot overcome the pathogen; Sicha Hu Yin (Four-Chaihu Drink) or Wucha Hu Yin (Five-Chaihu Drink) is appropriate.
Interior excess is characterized by a thick, yellow tongue coating, dry mouth with lip sores, thirst with desire to drink, constipation of both stool and urine, abdominal pain with tenderness upon pressure, loud voice, lying with extended limbs, eyes remaining closed during sleep, heat in the fingertips, and a deep, rapid, and forceful pulse (Pulse Deep-Rapid). Treatment should focus on purging and draining. Tiaowei Chengqi Tang (Stomach-Harmonizing Major Order Decoction) or Sishun Qingliang Yin (Four-Compliant Cooling Decoction) may be used. If fever persists after sweating, with a wiry, surging, rapid, and full pulse (Pulse Wiry-Surging-Rapid-Full) and hard, constipated stool, Chaihu Yin (Bupleurum Drink) is indicated.
The term "excess" refers to the abundance of pathogenic factors, not an abundance of Healthy Qi (Zheng Qi). When diagnosing, if an excess pattern is confirmed, formulas for releasing the exterior or purging should be prescribed in small doses and administered gradually. The key is to stop treatment once the disease is addressed, avoiding overdose. It is crucial to protect Healthy Qi to avoid reckless errors.
Food stagnation presents with a floating and large pulse at the Cun position (Inch Position) that feels choppy upon heavy pressure, heat in the abdominal skin, and foul-smelling stools. This is invariably caused by Spleen deficiency leading to failure of transportation and transformation. When using digestive herbs, care must be taken not to damage Middle Qi. Formulas warming the middle and strengthening the Spleen should be prioritized, such as Xiaoru Wan (Milk-Digesting Pill), Xiangju Bing (Fragrant Orange Cake), or Lizhong Tang (Regulate the Middle Decoction). For severe food injury complicated by heat from rich foods, Da'an Wan (Great Peace Pill) may be given in small amounts. Once the stagnation subsides, Wuwei Yigong San (Five-Ingredient Extraordinary Merit Powder) should be used for regulation and tonification.
Other manifestations include staring straight ahead with loud crying, neck stiffness, and irritability, indicating Liver Excess; Xieqing Wan (Drain-Green Pill) or Yi Gan San (Suppress-Liver Powder) are indicated. If there is tendon tension due to blood dryness, convulsions with rigidity, oblique gaze, and fixed eyes, this indicates Liver Deficiency; Dihuang Wan (Rehmannia Pill) is indicated. Crying, fever, drinking water, and convulsions indicate Heart Excess; Daochi San (Guide Out Redness Powder) or Xiexin Tang (Drain-Heart Decoction) are indicated. Restlessness and fright indicate Heart Deficiency; Mizhi Anshen Wan (Secret Manual Calming Spirit Pill) is indicated. Drowsiness, fever, and drinking water indicate Spleen Excess; Xiehuang San (Drain-Yellow Powder) is indicated. Vomiting, diarrhea, anorexia, abdominal distension, lethargy, clenched teeth with salivation, and limb twitching indicate Spleen Deficiency; Yihuang San (Yellow-Protecting Powder) or Liujunzi Tang (Six-Gentlemen Decoction) added with Paojiang (Roasted Ginger) and Muxiang (Aucklandia Root) are indicated.
Restlessness, panting, and drinking water indicate Lung Excess; Xiebai San (Drain-White Powder) is indicated. Panting with excessive sweating indicates Lung Deficiency; Sijunzi Tang (Four-Gentlemen Decoction) or Wuwei Yigong San (Five-Ingredient Extraordinary Merit Powder) are indicated. The Kidney has no excess patterns; black depression of smallpox lesions represents pathogenic excess with underlying Kidney Deficiency, treated with Dihuang Wan (Rehmannia Pill). Incontinence of urine and feces, withered fluids, hoarseness, upward deviation of the eyes, and cold extremities indicate extreme Kidney Deficiency; Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) combined with Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) is indicated.
Generally, pediatric excess patterns are rare. If the child has innate deficiency, has been ill for a long time, or has overused harsh purgatives, treatment should follow the principles for deficiency patterns, not assuming excess. Exercise utmost caution.