小儿属热之症。脉必洪数而实。色赤作渴。烦躁饮冷。声音雄壮。二便秘结。然其中有
属虚
经实热。宜泻心散以清心火。若色微赤。困卧惊悸。热渴饮汤。则属心经虚热。宜秘旨安神
丸以生心血肝热。则左脸青赤。项强顿闷。目札螈 。此属肝经风热。宜柴胡清肝散主之
若色微赤。倏热切牙。则属肝经虚热。宜地黄丸主之。肺热。则右脸赤。或主风邪。气粗
咳
便不利。乃脾肺燥热。不能化生肾水。宜黄芩清肺饮主之。若哽气出气。唇白气短。则属肺
经虚热。宜五味异功散主之。脾热。则鼻赤身热。饮水。乳食如常。属脾胃实热。宜泻黄散
热理脾。若色微赤。身凉饮汤。乳食少思。则属脾经虚热。宜五味异功散补中健脾。肾热。
则颏间色赤。足不欲覆。若肾与膀胱。气滞热结而小便不通者。宜五苓散主之。若色微赤。
则属膀胱阳虚。阴无所化。宜六味地黄丸主之。至若吐泻二症。间有因于热者。亦宜详辨。
假如吐乳色黄。不能受纳。此属胃经有热。宜先用泻黄散。次用人参安胃散。然当验其手指
热。则属胃热。若手指冷。则属胃寒矣。宜兼详寒论。至如因热而泻者。则必大便。黄赤
有沫。小便赤少。口干烦躁。宜四苓散主之。如更兼右腮色赤。饮冷者。属胃经实热。宜泻
黄散主之。若右腮微赤。喜热恶冷。则属胃经虚热矣。宜白术散主之。若右腮及额间俱赤。
属心脾翕热。宜泻黄散加炒黑黄连。若左颊右腮俱赤。属肝火乘脾。宜四君子汤加柴胡。大
抵泻症最伤元气。若热泻过甚。必变虚寒。宜兼参寒论。盖始病而热者。邪气胜则实也。终
变为寒者。真气夺则虚也。久病而热者。内真寒而外假热也。久泻元气虚寒。急宜温补
。不得误执热论。再如阳虚发躁。内实真寒。而外似热症者。如目赤作渴。身热恶衣。扬手掷足
。欲投于水。但诊其脉。洪数无伦。重按无力。是为假热。宜急投参附之剂。引火归元。若
误进清凉。入口必死。症之疑似。有如此者。医者可不慎欤。此外。如胎毒火丹。口疮重
舌。衄血便血。以及疳热等症。虽亦云属热。然皆各有虚实之不同。是亦不可不明察之也。
Pediatric conditions characterized as heat typically present with a pulse that is surging (Hong), rapid (Shu), and full (Shi). The complexion is red, accompanied by thirst, irritability, and a preference for cold drinks. The voice is robust, and both bowel movements and urination are constipated or difficult. However, among these, there are also cases belonging to deficiency patterns.
If it is excess heat of the Heart meridian, Xixin San (Heart-Draining Powder) should be used to clear Heart fire. If the complexion is slightly red, with lethargy, sleepiness, palpitations, and a desire for hot drinks despite feeling hot and thirsty, this belongs to deficient heat of the Heart meridian. Mizhi Anshen Wan (Secret Prescription Calming Spirit Pill) should be used to nourish Heart blood.
If there is Liver heat, the left cheek appears greenish-red, the neck is stiff, sudden chest oppression occurs, and the eyes twitch. This belongs to wind-heat of the Liver meridian, and Chaihu Qinggan San (Bupleurum Liver-Clearing Powder) is indicated. If the complexion is slightly red, with sudden fever and teeth grinding, this belongs to deficient heat of the Liver meridian, and Dihuang Wan (Rehmannia Pill) is indicated.
If there is Lung heat, the right cheek is red, or due to wind-pathogen invasion, breathing is coarse, coughing occurs, and defecation is difficult. This is caused by dryness-heat in the Spleen and Lung, failing to generate Kidney water. Huangqin Qingfei Yin (Scutellaria Lung-Clearing Decoction) is indicated. If there is belching, shortness of breath, and white lips, this belongs to deficient heat of the Lung meridian, and Wuyi Yigong San (Five-Agent Extraordinary Merit Powder) is indicated.
If there is Spleen heat, the nose is red, the body is hot, drinking water occurs, but milk and food intake remain normal. This belongs to excess heat of the Spleen and Stomach. Xiehuang San (Drain Yellow Powder) is indicated to clear heat and regulate the Spleen. If the complexion is slightly red, the body is cool yet desires hot drinks, and appetite is poor, this belongs to deficient heat of the Spleen meridian. Wuyi Yigong San is indicated to tonify the Middle and strengthen the Spleen.
If there is Kidney heat, the chin area is red, and the feet do not wish to be covered. If Qi stagnation and heat binding in the Kidney and Bladder cause urinary retention, Wuling San (Five-Ingredient Powder with Poria) is indicated. If the complexion is slightly red, this belongs to Yang deficiency of the Bladder, where Yin fluids cannot be transformed. Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) is indicated.
Regarding vomiting and diarrhea, occasionally these are caused by heat, requiring detailed differentiation. For instance, if vomited milk is yellow and cannot be retained, this indicates heat in the Stomach meridian. Xiehuang San should be used first, followed by Renshen Anwei San (Ginseng Stomach-Calming Powder). One must check the temperature of the fingers: if warm, it is Stomach heat; if cold, it is Stomach cold, and one should refer to the discussion on Cold syndromes.
If diarrhea is caused by heat, stools will be yellow-red with foam, urine will be scanty and red, with dry mouth and irritability. Siling San (Four-Ingredient Powder) is indicated. If accompanied by a red right cheek and a preference for cold drinks, this is excess heat of the Stomach meridian, and Xiehuang San is indicated. If the right cheek is slightly red, with a preference for heat and aversion to cold, this is deficient heat of the Stomach meridian, and Baizhu San (Atractylodes Macrocephala Powder) is indicated. If both the right cheek and forehead are red, this indicates combined heat of the Heart and Spleen. Xiehuang San added with stir-fried black Coptis Chinensis Rhizome (Huanglian) is indicated. If both the left cheek and right cheek are red, this indicates Liver fire invading the Spleen. Sijunzi Tang (Four Gentlemen Decoction) added with Bupleurum Root (Chaihu) is indicated.
Generally, diarrhea most severely damages Yuan Qi (Original Qi). If heat-type diarrhea is excessive, it inevitably transforms into a deficiency-cold syndrome, so one should refer to the discussion on Cold syndromes. Initial heat indicates an excess pattern due to pathogenic dominance; final transformation into cold indicates a deficiency pattern due to depletion of True Qi. Heat in chronic illness often represents true internal cold with false external heat. Chronic diarrhea leading to Yuan Qi deficiency and cold requires urgent warming and tonification; one must not erroneously adhere to heat-pattern theories.
Furthermore, restlessness caused by Yang deficiency, where the interior is truly cold but the exterior mimics heat—such as red eyes, thirst, body heat, aversion to clothing, tossing limbs, and desire to enter water—if the pulse is surging and rapid without limit but weak upon deep pressure, this is false heat. Shenfu preparations (Ginseng and Aconite preparations) should be urgently administered to guide fire back to its source. Misusing cooling agents will result in death upon ingestion. Such ambiguous symptoms require extreme caution from physicians.
Additionally, conditions such as fetal toxin, erysipelas-like rashes (Huodan), mouth ulcers, double tongue (Zhongshe), epistaxis, hematochezia, and malnutrition fever (Ganre), although classified as heat, each have distinct excess or deficiency characteristics, which must be clearly discerned.