(伤寒门中杂症惟此小儿多犯而与大人异治)
夹惊者,因邪热乘心,热极生风,是以手足为之动摇,精神为之恍惚,咬乳面红,
痰壅气喘,喉有锯声,口噤目窜而变惊候也。如痰热皆在上焦横扰者,可即吐之。若
三焦俱客者,可即下之,热中病即止,不可尽剂,盖吐则伤气,气虚者悸,下则亡血。
血虚者惊,故有过剂之后,而变慢惊者多矣。
夹食者,有病先病时病后而得,如食后外感停滞,胸次既病,而为胀满,大便酸
臭,腹痛气急者,此即病先所得是也。如胃气衰微,邪热入伏,以致消谷引食。若胃气
未虚,必与邪气相争而吐者,易治。如胃弱而既不能化,又不能争,以致热结胸膈者,
此脾胃虚弱,即病时所得是也。如病少痊,志食无度,以致停滞发热者,此为食复,即
病后所得是也。宜随症虚实施治,实者,消导为先,虚者,佐以养胃。
斑有温毒,有热毒,有胃烂。温毒者,即冬受寒,至春阳与阴气相搏而发是也。热
毒者,是暑气伏胃,因遇寒而发是也。胃烂者,或误下而热乘虚入胃,或失下而热不得
外泄,毒瓦斯入胃深极也。故斑者,毒也。毒者,乖戾失常,偏阴偏阳之至也。外因六气
相感,胃有热毒熏蒸,胃主肌肉,热甚伤血,里实表虚,故令周匝遍体,状如咬啮,
红赤者,生,紫黑者,死。以热极而胃烂也。舌苔唇裂者,不治。治宜解毒清凉,不
可表药取汗,盖表虚里实,发汗则益令开
泄,更增斑烂矣。其阴症发斑者,或因汗吐下后,中气虚乏,或因欲事耗损真阳,或因
过服凉药,遂成阴症,寒伏于下,逼其无根失守之火,上熏肺胃,而发斑点,其色淡
红,隐隐见于肌表,与阳症发斑,色紫赤者不同。此胃气极虚,若服寒药立见危殆,吴
鹤皋曰∶以参 桂附,而治斑法之变也。医不达权,安足语此?若因风热挟痰,而作搔
痒成块者,此轻症也。当与解毒辛散则愈。
内伤斑者,乃内伤元气不足之病,因气血两虚,亦身痛心烦作热,但脉虚大,懒于
言动,倦怠自汗为异耳。若妄作外感有余治,立见倾危,速进补中益气汤,熟眠热止
而愈。丹溪曰∶内伤发斑者,胃气极虚,一身之火游行于外,宜补以降之,大健中汤最
佳,内用参、 、归、芍、炙草、半夏、桂、附,以姜枣水煎服。若内有伏阴,误服
凉药,逼其虚阳,浮散于外,而为阴斑,脉虽洪大,按之无力,或手足逆冷过肘膝者,
先用炮姜理中汤,以复其阳,次随症治,不应加附子。
(In the category of Cold Damage, among various miscellaneous diseases, only children are prone to these conditions, and their treatment differs from that of adults.)
The syndrome of "夾惊" (Concomitant Fright) arises when pathogenic heat invades the Heart. Extreme heat generates wind, causing trembling of the hands and feet, mental confusion, redness of the face while suckling milk, phlegm obstruction with wheezing, a sawing sound in the throat, locked jaws, and upward deviation of the eyes, thereby transforming into a fright condition. If phlegm-heat accumulates in the Upper Jiao and disrupts horizontally, emesis may be employed immediately. If pathogens occupy all three Jiaos, purgation may be employed immediately. Treatment should cease once heat subsides and the disease resolves; the full dose should not necessarily be consumed. This is because emesis damages Qi, and Qi deficiency leads to palpitations; purgation depletes Blood, and Blood deficiency leads to fright. Therefore, many cases transform into Slow Fright after excessive medication.
The syndrome of "夾食" (Concomitant Food Stagnation) occurs before, during, or after the onset of illness. For instance, if one contracts an external pathogen after eating, leading to stagnation, chest discomfort, abdominal distension, sour-smelling stools, abdominal pain, and rapid breathing, this results from food intake prior to the onset of illness. If Stomach Qi is weak and pathogenic heat lies dormant, causing increased appetite; or if Stomach Qi is not yet deficient and struggles against the pathogen, resulting in vomiting, this case is easy to treat. If the Spleen and Stomach are weak, unable to digest food nor struggle against the pathogen, leading to heat binding in the chest and diaphragm, this results from dietary indiscretion during the onset of illness due to Spleen-Stomach deficiency. If, after slight recovery, one eats without restraint, leading to stagnation and fever, this is called "Food Relapse," resulting from dietary indiscretion after the illness. Treatment should follow the pattern of excess or deficiency: for excess patterns, resolving stagnation is primary; for deficiency patterns, nourishing the Stomach is assisted.
Rashes (Ban) arise from Warm Toxin, Heat Toxin, or Rotting Stomach. Warm Toxin refers to cold contracted in winter, which erupts in spring when Yang Qi contends with Yin Qi. Heat Toxin refers to summer-heat latent in the Stomach, which erupts upon exposure to cold. Rotting Stomach occurs either from erroneous purgation allowing heat to enter the Stomach via deficiency, or from failure to purge, preventing heat from venting externally, so that toxic vapors penetrate deeply into the Stomach. Thus, rashes represent toxin. Toxin is a state of aberrancy, extreme deviation of Yin or Yang. Externally caused by the interaction of the Six Qi, internal heat-toxin steams within the Stomach. Since the Stomach governs muscles, extreme heat injures Blood, creating interior excess and exterior deficiency. Consequently, spots resembling bites appear all over the body. Red and bright spots indicate survival; purple-black spots indicate death, due to extreme heat causing rotting of the Stomach. Dry tongue coating and cracked lips indicate incurability. Treatment should focus on clearing heat and detoxifying. Exterior-releasing drugs for sweating must not be used, as exterior deficiency with interior excess means sweating will further open the pores, worsening the rash. In cases of Yin-pattern rash, it may result from Qi deficiency of the Middle Jiao after sweating, vomiting, or purging; or from depletion of True Yang due to sexual activity; or from excessive use of cold medicines, forming a Yin pattern where cold lurks below, forcing rootless, unanchored fire to ascend and steam the Lungs and Stomach, producing pale-red spots faintly visible under the skin. This differs from Yang-pattern rashes, which are purple-red. This indicates extreme Stomach Qi deficiency; administering cold medicines would lead to immediate danger. Wu Hegao stated: Using Ginseng, Cinnamon Twig, and Aconite to treat rashes is a variation in therapeutic method. Physicians who do not understand flexibility cannot discuss this. If itching and plaques form due to Wind-Heat carrying Phlegm, this is a mild case, curable with detoxifying and acrid-dispersing herbs.
Internal Injury Rash arises from insufficiency of Original Qi due to internal injury. Due to dual deficiency of Qi and Blood, patients also experience body pain, irritability, and fever, but differ in having a large and empty pulse, reluctance to speak or move, fatigue, and spontaneous sweating. Treating this erroneously as an exterior excess condition leads to immediate peril. Rapid administration of Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) allows for deep sleep, cessation of fever, and recovery. Zhu Danxi said: Internal injury rash indicates extreme Stomach Qi deficiency, with Fire roaming outside the body. It should be treated by tonification to descend the Fire. Dajianzhong Tang (Greatly Build the Middle Decoction) is best, containing Ren Shen (Ginseng), [missing character, likely Bai Zhu], Dang Gui (Angelica Sinensis), Bai Shao (White Peony Root), Zhi Gan Cao (Prepared Licorice), Ban Xia (Pinellia), Gui Zhi (Cinnamon Twig), and Fu Zi (Aconite), decocted with Ginger and Jujube. If latent Yin exists internally and cold medicines are mistakenly taken, forcing deficient Yang to float outward, forming Yin Rash, the pulse may be surging and large but empty upon pressure, or extremities may be cold beyond elbows and knees. First, use Pao Jiang Lizhong Tang (Baked Ginger Regulate the Middle Decoction) to restore Yang, then treat according to symptoms. If ineffective, add Fu Zi (Aconite).