变蒸
小儿变蒸，古无是说，至晋王叔和始言之。继自隋唐巢氏以来，日相传演，其说益繁。然以余观之，则似
有未必然者。何也？盖儿胎月足离怀，气质虽未成实，而脏腑已皆完备。既生之后，凡长养之机，则如月如苗，
一息不容有间，百骸齐到，自当时异而日不同，岂复有此先彼后，一变生肾，二变生膀胱，及每变必三十二日
之理乎？又小儿生病与不病，所见所治，盖亦不少。凡属违和，不因外感，必以内伤，初未闻有无因而病者。
又见保护得宜，自生至长，毫无疾病，虽有暗变之说，亦不能信。余恐临证者，有执迷之误，故道其愚昧若此。（张景岳）
热
小儿之病，惟热居多。夫热有潮热、惊热、夜热、余热、食热、疳热、壮热、烦热、积热、风热、虚热、
客热、痰热、寒热、血热、疮疹热十六者，大同小异。热之始发，必有所因，潮热发歇有时，惊热颠叫恍惚，
夜热夕发旦止，余热寒邪未尽，食热肚
腹先发，疳热骨蒸盗汗，壮热一向不止，烦热心躁不安，积热颊赤口疮，风热汗出身热，虚热因倦少力，客热
来去不定，痰热涎嗽饮水，寒热发如疟状，血热辰已发热，疮疹热耳鼻尖冷，诸证各有所归，其间或有三、两
证交互者，随其轻重而治之。（杨仁斋）
小儿纯阳之体，不独火之一字生热为患，即风、暑、燥、湿，皆从火化，故清凉之剂，活幼者多用之而不
疑。一见壮热、面赤、不恶风、无涕泪，即是火证。火郁当发，今火既发，何可更散？速以凉药济之。但当视
其在何脏腑经络，气分血分，参辨兼证。又当视其儿质之虚实，而用甘寒、苦寒以降之，则热无不退矣。辨其
热在气分，即泻火以保元气；热在血分，即泻火以保阴血。每见病家，视苦寒若砒鸩，以致火甚之儿，气血枯
焦，顷成不救。更有久热阴烁之证，医家不知以水济火，习用消散之药，致令元气益伤，变成慢惊者，不可胜
纪。予用养阴益气，十中犹救五、六。至于风化为火，火静则风熄；暑化为火，火退则暑平。若专事疏解，则
火势愈盛，而惊作矣。○身热饮水者，热在内；身热不饮者，热在外。饮多饮冷者，为实热；饮热而微者，为
虚热。○烦热者，热在膈间。表邪初入于里故烦，里实上干心胸亦烦，烦之甚则躁。或发表、或通里、或泻心、
或养阴，四者酌而行之。○潮热自内而发，如水之潮，应时而至，多属阴虚。与内伤发热时热时止者同类。虽有
外邪，亦必由虚而入。《经》所谓邪之所凑，其气必虚者是也。故治潮热，不得妄行表散，虽当和解，亦以阴
血为主。用药之法，须于补中益气、秦艽扶羸、柴胡鳖甲数方，酌而用之。○潮热，与阴虚生内热之热相似而
又不同。阴虚生内热，是人身之阴阳不相济，只宜养阴；此则为六淫之邪内陷，必提出六淫之邪而后已。○壮
热之壮字，即《内经》壮火食气之壮字。若不急治，则气血受其煎熬，害人最速，故用药如救焚。○壮热无虚，
皆实证也。六淫之邪，惟湿无壮热证。○壮热无补法。辨证的确，泻邪以存元气，便是补。在表者汗之。体
若燔炭，汗出而散是矣。在里者下之，急下存阴是矣。如谵言、汗、渴之有赖于白虎，斑、狂、失血之有赖于
犀角地黄，皆刻不容缓者也。○书云∶壮热者，一向热而不已。非也。热之甚者为壮，不甚者为温。温热亦有虚
实。虚者，正气虚也，不能为壮。实者，邪气实也。邪气温温不去，体泽者属湿，体枯者属燥。燥火不甚，亦
温温也。在夏令秋初多属湿；秋暮冬初多属燥。燥湿之辨，不可混也。○一向热而不已，有疳积之热，有阴虚
之热。有当补脾，有当养阴，须分辨施治。○阳邪陷入阴分，其热自阴分而达于阳分，与疟热相似而实不同。
疟为阴阳交争，此为阳陷于阴，故但热不寒。若独用表散药，则药力从阳分而泄，与陷入阴分之邪，不相会面，
何由相引而出？考孙真人治风劳，有柴前梅连散一方最妙。柴、前，升散药也，只能走表，不能入里。梅、
连摄之使入阴分，阴分之邪，得与柴、前会面。柴、前本升散之性，自应复出之阳，阴分之邪，得以相引而出。
是梅、连为柴、前之向导，梅、连亦发散药也。○骨蒸者，骨里蒸蒸然热出，阴虚也。治宜秦艽鳖甲散。鳖甲
骨属，用以治骨。○胎热者，得之在母腹中，生下便有热证。轻轻一散，托出胎疹，是从外而解也，吉。若不
发疹，喉舌上 ，或生疮肿，不能舐乳，是热蕴于内，当从内泄，少与生大黄。金石药杀儿甚速。○初生有小热，
不可服药。天之生人、生物，皆赖此火。无此火，何能生？更何能长？故初生曰赤子。此火一泻，生机败矣。
惟火甚者当泻，不泻则能作病。（《小儿诸热辨》）
小儿发热，其要有四∶一则外感；二则疮毒；三则痘疹；四则疳积。四者之外，如饮食、惊风、阴虚、变
蒸之类，虽亦有之，然各有其说，均当详辨。○小儿发热，若热随汗退者，外感证也；若汗出热不退，别无痈肿，
耳后红筋烁然，及眼泪指冷，脉紧数者，是痘疹也。○小儿饮食内伤，本无发热之证。盖饮食伤脏，则胀痛吐泻，
本非肌表之病，焉得发热？今人但见小儿发热，
多言伤食，妄行消导，谬亦甚矣！其或饮食内伤，风寒外感，表里兼病而发热者，亦常有之。然当察其食之有
无，非可混行消耗也。○小儿疳积发热，此诚饮食内伤所致，然必成痞、成疳。阳明郁积既久，所以内外俱热，
非暴伤饮食者之比，亦非肌表发热者之比。○小儿有阴虚发热之证，名为童子劳，当于虚损门求法治之。○内热
与外热不同。内热以五内之火，热由内生，病在阴分，故内热者宜清凉，不宜升散；升散则内火愈炽，火空则
发也。外热以肤腠之邪，风寒外袭，病在阳分；故外热者宜解散，不宜清降；清降则表热愈留，外内合邪也。
此外热、内热之治，其不同者有如此。欲分内、外之辨，则外热者其至必骤，内热者其来必缓。但察其绝无表
证，而热在脏腑、七窍、三焦、二阴、筋骨、肌肉之间者，皆是内热。但内热之证，亦有虚实。实者宜从正治，
虚者当从反治。反正之间，冰炭之异。○凡婴儿诸热，有因别证而作者，当从所重者而治之。（张景岳）
选案
小儿百病，先从热起。有感风热者，则恶风头痛，脉浮嗽嚏。有伤食热者，则手心热甚，嗳气吐食。有癖
积热者，则颊赤口疮。有痘疹热者，则耳鼻尖冷，两目含泪，耳纹现，中指冷。有惊热者，则面青心悸，啼叫
恍惚。有疳热者，则形瘦多渴，骨蒸盗汗，泄泻肚大。种种不同，随证治之。然疑似之间，有古人未传者。张
季明云∶一儿外感寒热，用发表药，汗出热退。过日复热便秘，里未解也；服四顺饮，利行热退。隔日又热，小
便短赤，服导赤饮，热退。过三日又热，庸劣无措。诊脉已和，既发汗、又利便，其儿已虚，阳无所归，所以
发热。以六神散和其胃气，加乌梅酸收，阳气归内自愈。又一儿，表里俱热，颊赤口干，小便赤，大便黄，用
四顺饮，利动脏腑，热去复热，里解而表未解也。发散微汗热去，隔日又热，此无他，表里俱虚，气不归元，
而阳浮于外也，以六神散入粳米煎，和其胃气，阳气归
内，身体自凉。此等处最易误人，特揭出以补千古之缺。（《慈幼筏》）
惊风证治总论
惊有四证八候。四证者，惊、风、痰、热是也。小儿热盛生痰，痰盛生惊，惊甚发搐，搐甚则牙关紧
急而八候生焉。肝主风，脾主痰，肺作热，心发惊。四证相临，重者先发。○八候者，一搐、二搦、三掣、四
颤、五反、六引、七窜、八视是也。搐者，两手伸缩；搦者，十指开合；掣者，肩膊搐掣；颤者，四体颤动；
反者，身仰向后；引者，臂若开弓；窜者，目直似怒；视者，睛露不活。（《仁斋直指》）
惊搐，一也，而有晨夕之分，表里之异。身热力大者为急惊；身冷力小者为慢惊；仆地作声、醒时吐沫
者为痫；头目仰视者为天吊；角弓反张者为 。治各不同。○搐频者，风在表，易治，宜发散；搐稀者，风在脏，
难治，宜补脾。（娄全善）
小儿惊搐，目札、目直者，乃肝经风热所致。凡病之新久，皆能引动肝风。肝风内动，则上入于目，故
目札；若热入于目，牵其筋脉，两 俱紧，不能转视，故目直也。亦有因饮食停滞中焦，清阳不升，浊阴不降，
肝木生发之气，遏而不升，致生风者。亦有因吐泻，土败木侮致生风者。皆不可服惊药。（《张氏医通》）
若口中气热，搐而有力，属形病俱实，宜大青膏以散风邪。若口气不热，搐而无力，属形病俱虚，宜异
功散以补脾土，六味丸以滋肝木，钩藤饮以清肝火。若因风邪郁热而变诸证，当清散风热；若外邪既解，而诸
证不愈者，当实脾土、补肺金。若竟治其风，恐脾气复伤，诸证蜂起矣。（薛立斋）
小儿惊痫，一从虚邪客热相搏，而生其候，当补养安和即愈。加以生冷及消伐太过，即死。（《颅囟经》）
童幼，肌肉、筋骨、脏腑、血脉俱未充长，阳则有余，阴则不足，不比七尺之躯，阴阳交盛也。惟阴不
足、阳有余，故易生热；热盛则生痰、生风、生惊，亦所恒有。设当日直以热、痰、
风、惊四字立名，则后人不眩，乃节去二字，以惊字领头，风字煞尾。后人不解，遂以为奇特之病。又以其头
摇手劲，而立抽掣之名；以其口噤脚挛急，而立搐搦之名；以其脊强背反，而立角弓反张之名。不知小儿之肌
腠未密，易于感冒风寒。风寒中人，必先中于太阳经，太阳之脉，起目内 ，上额交巅入脑，还出别下项，夹
脊抵腰中，是以病则筋脉牵强，因生出种种不通名目。而用金石药镇坠，外邪深入脏腑，千中千死。间有体坚
证轻得愈者，又诧为再造奇功。遂至各守颛门，虽日杀数儿，不自知其罪矣。如方书云∶小儿八岁以前无伤寒。
不知小儿易于外感，易于发热，伤寒独多。初传太阳一经，早已身强多汗，筋脉牵动，人事昏沉，汤药乱投，
死亡接踵，何由见其传经解散耶？又刚痉无汗，柔痉有汗。小儿刚痉少，柔痉多。世医见其汗出不止，神昏
不醒，往往以慢惊为名，而用参、 、术、附等药，闭其腠理，热邪不得外越，亦为大害，但比金石药为差减
耳。所以凡治小儿之热，但当彻其出表，不当固其入里。仲景原有桂枝法，若舍而不用，从事东垣内伤为治，
毫厘千里，最宜详细。要知吾辟惊风之说，非谓绝无惊病也。小儿气怯神弱，凡遇异形异声，骤然跌仆，皆生
惊怖。其候∶面青、粪青、多烦、多哭，不比热邪塞窍，神识昏迷，对面撞钟放铳，全然不闻者。细详勘验，
自识惊风凿空之谬。（喻嘉言）
小儿痉病，俗谓惊风。身体柔脆，易感风邪，固矣。然小儿纯阳之体，易生内热，使腠理开张，风邪乘隙
而入，则又所以易感风邪之由也。世医遽投脑、麝、金石，若百服百死，竟为鸩毒，岂有尚流传其方者乎？亦
必有用之收功者，所以世医不复顾虑也。不知用之而当者，乃小儿中实热之证；用之不当者，系小儿中虚热之
证。苟不察其虚实而概与之，所以同于鸩毒耳。然小儿风热在表，亦自有驱风散热治法，即邪热壅盛于内，急
为宣通，亦自有大承气汤可与，何必以脑、麝散其真气，以金石坠其真阳，
致起他变乎？此世医言惊风传方之所以多夭折生命也。苟不为明其故，而但訾议之，何以服世医之谈惊风、称
传方者哉！（魏荔彤）
幼科惊证，自喻氏以热、痰、惊、风四字立名，大剖从前之讹，实为确论。叶香岩亦宗之，然更有未尽者，
近多冬暖失藏，入春寒温间杂，小儿吸受其邪，先伤肺经，起自寒热气粗，延绵失治，渐从包络内传上部，虽有
微汗，而痰多鼻煽、烦躁神蒙、病家惶惧，辄云变为惊证，动用香开，妄投金石，以致阴液消亡，热势愈张，
正不敌邪，肝风陡动，渐见肢牵目窜，痉闭发厥，势多倾败。若于病未猖獗之前，先以辛凉开肺，继以甘寒化
热，佐以润剂降痰，两候自痊。此盖温邪陷入，阴液内耗，而动肝风，实非惊恐致病也。若误以惊药治之，恐
幼稚之衔冤不少，故为之一辨。（《吴医汇讲》）
惊风二字，千古疑域，嘉言欲打破人鬼关，其实未易能也。盖因婴儿伤寒病痉，每有反张搐搦之态，钱仲
阳偶立惊风之名，门人继述不善，遂以惊字为惊吓之惊，风字即惊字之变文，以致幼科书中，凡青为风者，皆曰
青为惊。谬谓小儿之病，悉由惊而生风。误以伤寒无汗之证为急惊，以伤风自汗之证为慢惊，以脾败胃伤之证
为慢脾。妄立诸惊名色，眩惑后人。是仲阳偶以一字之乖讹，而后世受祸如此其烈也！至于见证立名，更为舛
谬。如小儿伤寒病痉，外证有头项强、背反张、目上窜，此《金匮》所谓能仰不能俯者，属太阳，则称天吊惊；
眼目下视，即《金匮》之项背KT KT 、海藏之低头下视者，属二阳合病，则称看地惊。更有诸多不通名目，莫能
Bian Zheng (Growth and Transformation)
The theory of "Bian Zheng" in infants was not mentioned in ancient texts; it was first proposed by Wang Shuhe of the Jin Dynasty. From the Sui and Tang Dynasties onwards, with figures like Chao Yuanfang, the theory was passed down and evolved, becoming increasingly complex. However, in my opinion, this seems not necessarily correct. Why? Because when an infant is born full-term, although the constitution is not yet fully mature, the zang-fu organs are already complete. After birth, the mechanism of growth and development, like the waxing and waning of the moon or the growth of seedlings, allows for no interruption for a moment. The entire body develops simultaneously, naturally changing from day to day. How could there be a sequence where one transformation generates the Kidney, the next generates the Bladder, and each transformation takes exactly thirty-two days? Furthermore, regarding infants getting sick or staying healthy, there are many cases seen and treated. Any discomfort, if not caused by external pathogens, must be due to internal injury (such as diet). I have never heard of illness occurring without cause. Moreover, seeing children who are well-protected grow up from birth to adulthood without any disease, even the theory of "hidden Bian Zheng" cannot be believed. I fear that clinicians may fall into the error of blind adherence, so I state my humble views thusly. (Zhang Jingyue)
Heat
Among pediatric diseases, heat syndromes are the most common. Heat can be categorized into sixteen types: tidal heat, fright heat, night heat, residual heat, food heat, malnutrition heat, severe heat, vexatious heat, accumulation heat, wind-heat, deficiency heat, guest heat, phlegm-heat, alternating chills and fever, blood heat, and rash heat. These are largely similar with minor differences. The initial onset of heat must have a cause: Tidal heat occurs and ceases at specific times; Fright heat presents with screaming and trance-like states; Night heat starts in the evening and stops in the morning; Residual heat indicates incomplete elimination of cold pathogens; Food heat initially manifests as abdominal discomfort; Malnutrition heat presents with bone-steaming and night sweats; Severe heat persists continuously; Vexatious heat involves mental restlessness and anxiety; Accumulation heat shows red cheeks and mouth ulcers; Wind-heat presents with sweating and body heat; Deficiency heat involves fatigue and weakness; Guest heat comes and goes unpredictably; Phlegm-heat involves excessive saliva, coughing, and thirst; Alternating chills and fever resemble malaria; Blood heat occurs during the Chen and Si hours (7 AM–11 PM); Rash heat presents with cold ears and nose tips. Each syndrome has its specific attribution. Sometimes two or three syndromes may interact; treatment should be based on severity. (Yang Renzhai)
Infants possess a "Pure Yang" constitution. Not only does "Fire" generate heat pathology, but Wind, Summerheat, Dryness, and Dampness also tend to transform into Fire. Therefore, cooling agents are frequently used by pediatricians without hesitation. Upon observing severe heat, red face, aversion to wind absent, and absence of nasal discharge or tears, one identifies a Fire syndrome. If Fire is constrained, it should be dispersed; however, since the Fire is already manifesting, further dispersal is contraindicated. One should swiftly use cooling medicines to assist. However, one must observe which Zang-Fu organ or meridian is affected, whether the Qi level or Blood level is involved, and analyze accompanying symptoms. One must also assess the infant's constitution for deficiency or excess, using Sweet-Cold or Bitter-Cold herbs to descend the heat, ensuring the heat subsides. If heat is in the Qi level, clear Fire to preserve Original Qi; if in the Blood level, clear Fire to preserve Yin Blood. It is common to see families fearing Bitter-Cold herbs as if they were arsenic or poison, leading to infants with intense Fire suffering from dried-up Qi and Blood, becoming incurable in moments. In cases of prolonged heat consuming Yin, doctors who fail to use Water (Yin) to balance Fire and instead habitually use dispersing and reducing drugs cause further damage to Original Qi, transforming the condition into Slow Convulsion (Man Jing Feng), which is countless. Using methods to nourish Yin and tonify Qi, I can save five or six out of ten. When Wind transforms into Fire, calming the Fire extinguishes the Wind; when Summerheat transforms into Fire, dissipating the Fire calms the Summerheat. Specializing solely in dispersal causes Fire to intensify and triggers convulsions. ○ Body heat with thirst indicates Heat inside; body heat without thirst indicates Heat outside. Drinking large amounts of cold liquids suggests Excess Heat; drinking warm liquids in small amounts suggests Deficiency Heat. ○ Vexatious heat implies Heat in the Diaphragm. Initial exterior pathogens entering the interior cause vexation; interior excess affecting the Heart and Chest also causes vexation; severe vexation leads to agitation. Treatment may involve releasing the exterior, purging the interior, draining the Heart, or nourishing Yin, chosen appropriately. ○ Tidal heat originates internally, like water tides arriving on time, mostly belonging to Yin Deficiency. It is similar to internal injury fever that comes and goes. Even if exterior pathogens exist, they enter through deficiency. As the *Classic* states, "Where pathogenic factors gather, Qi must be deficient." Therefore, treating tidal heat requires avoiding reckless exterior release; even if harmonization is needed, it must prioritize nourishing Yin Blood. Medication should be selected from formulas such as Bu Zhong Yi Qi Tang, Qin Jiao Fu Lei Tang, or Chai Hu Bie Jia Tang. ○ Tidal heat is similar to but distinct from Heat generated by Yin Deficiency. Yin Deficiency heat arises from disharmony between Yin and Yang, requiring only Yin nourishment; here, it is the invasion of Six Excess Pathogens into the interior, requiring their expulsion. ○ The character "Zhuang" (Severe) in Zhuang Re refers to "Zhuang Huo Shi Qi" (Strong Fire consumes Qi) in the *Nei Jing*. If not treated urgently, Qi and Blood suffer boiling, causing rapid harm; thus, medication is like fighting a fire. ○ Severe heat has no deficiency patterns; all are Excess patterns. Among the Six Excess Pathogens, only Dampness does not present with severe heat. ○ Severe heat has no tonification method. Accurate differentiation and expelling pathogens to preserve Original Qi constitutes tonification. For exterior patterns, induce sweating; for interior patterns, purge urgently to preserve Yin. For delirium, sweating, and thirst, Bai Hu Tang is essential; for macules, mania, and bleeding, Xi Jiao Di Huang Tang is crucial; both are urgent. ○ Books say: Severe heat is continuous. This is incorrect. Intense heat is called Severe; mild heat is called Warm. Both Warm and Heat have Excess and Deficiency. Deficiency refers to weak Zheng Qi, which cannot manifest as Severe Heat. Excess refers to strong Xie Qi. Persistent mild heat with moist skin belongs to Dampness; dry skin belongs to Dryness. Mild Dryness-Fire is also mild. In summer and early autumn, it is mostly Dampness; in late autumn and early winter, it is mostly Dryness. Differentiating Dryness and Dampness is critical. ○ Continuous heat may stem from Malnutrition/Accumulation or Yin Deficiency. Some require Spleen tonification, others Yin nourishment; differentiation is key. ○ Yang pathogens sinking into the Yin level cause heat to rise from Yin to Yang, resembling Malaria heat but differing essentially. Malaria involves Yin-Yang conflict; this is Yang sinking into Yin, presenting as heat without chills. Using only exterior-releasing drugs causes the medicinal force to exit via the Yang level, missing the pathogens in the Yin level, preventing their extraction. Sun Simiao’s formula Chai Qian Mei Lian San is excellent for Wind-Lao. Chai Hu and Qian Hu are ascending/dispersing herbs that act on the exterior but not the interior. She Gan and Lian Qiao guide them into the Yin level. Once the pathogens meet the ascending herbs in the Yin level, the natural ascending nature of Chai Hu and Qian Hu brings the pathogens back out to the Yang level. Thus, She Gan and Lian Qiao act as guides for Chai Hu and Qian Hu; they are also dispersing herbs. ○ Bone-steaming refers to heat radiating from within the bones, indicating Yin Deficiency. Treatment should use Qin Jiao Bie Jia San. Bie Jia (Turtle Shell) corresponds to bones and treats bone conditions. ○ Fetal Heat is acquired in the womb, presenting with heat symptoms after birth. A gentle dispersal can push out fetal rashes, resolving from the exterior, which is auspicious. If no rash appears, but ulcers/swelling occur on the throat/tongue preventing breastfeeding, Heat is trapped internally and must be drained internally with a small amount of Sheng Da Huang (Raw Rhizoma Rheomi Palmatae). Mineral/Metallic drugs kill infants rapidly. ○ Mild heat in newborns requires no medication. Heaven’s generation of life relies on this Fire. Without it, survival and growth are impossible; hence, newborns are called "Chi Zi" (Red Children). If this Fire is purged, vitality fails. Only extreme Fire requires purging; otherwise, it causes disease. (*Xiao Er Zhu Re Bian*)
Pediatric fever has four main categories: 1. Exterior contraction; 2. Toxin from sores; 3. Smallpox/Rash; 4. Malnutrition/Accumulation. Outside these, such as diet, Fright Wind, Yin Deficiency, and Bian Zheng, while existing, have distinct theories and require detailed differentiation. ○ If fever subsides with sweating, it is an exterior contraction; if sweating does not reduce fever, accompanied by prominent red veins behind the ears, tears, cold fingers/toes, and tight/rapid pulse, it is Smallpox/Rash. ○ Dietary internal injury in infants typically does not cause fever. Injury to Zang-Fu causes distension, pain, vomiting, and diarrhea, which are not surface diseases and thus do not cause fever. Modern practitioners often attribute fever to food stagnation and wrongly use digestive aids, a serious error. However, simultaneous dietary injury and exterior wind-cold causing table-interior dual pathology with fever does occur. One must check for food retention before using reducing methods. ○ Fever from Pediatric Malnutrition/Accumulation is indeed caused by dietary injury but progresses to Pi masses and Kan syndrome. Long-standing Stomach channel stagnation causes internal and external heat, unlike acute dietary injury or surface fever. ○ Pediatric Yin Deficiency fever, named Tong Zi Lao (Youth Consumption), should be treated according to the Deficiency category. ○ Internal Heat differs from External Heat. Internal Heat stems from Fire within the Five Zang, originating internally, affecting the Yin level; thus, it requires cooling, not ascending/dispersing, as dispersal intensifies internal Fire ("Fire rises when empty"). External Heat stems from pathogens in skin/collaterals, wind-cold attacking externally, affecting the Yang level; thus, it requires dispersion, not clearing/descending, as clearing leaves exterior heat and combines exterior/internal pathogens. To distinguish: External Heat arrives suddenly; Internal Heat arrives slowly. If there are absolutely no exterior signs, and heat is in Zang-Fu, orifices, San Jiao, Yin/Anus, sinews/bones, or muscles, it is Internal Heat. Internal Heat also has Excess and Deficiency. Excess requires standard treatment; Deficiency requires contrary treatment. The difference is like ice and charcoal. ○ For all infant fevers caused by other syndromes, treat the primary aspect. (Zhang Jingyue)
Selected Cases
Pediatric diseases mostly start with Heat. Wind-Heat contraction causes aversion to wind, headache, floating pulse, cough, and sneezing. Food-Stagnation Heat causes hot palms, belching, and vomiting. Mass-Accumulation Heat causes red cheeks and mouth ulcers. Rash Heat causes cold ear/nose tips, watery eyes, visible ear lines, and cold middle finger. Fright Heat causes blue face, palpitations, crying, and trance. Malnutrition Heat causes emaciation, polydipsia, bone-steaming, night sweats, diarrhea, and distended abdomen. Treat according to symptoms. However, some ambiguous cases were unrecorded by ancients. Zhang Jiming reported: An infant with exterior cold-heat was treated with exterior-releasing herbs; sweat occurred, fever subsided. Next day, fever and constipation returned (interior unresolved); Si Shun Yin was given, bowels moved, fever subsided. Two days later, fever returned with scanty dark urine; Dao Chi Yin was given, fever subsided. Three days later, fever returned again; the mediocre doctor was helpless. Pulse was harmonious. Having been sweated and purged, the child was now deficient, with Yang having no root, causing fever. Liu Shen San was used to harmonize Stomach Qi, plus W Mei (Mume Fructus) for astringency; Yang returned inward, and health recovered. Another infant had table-interior heat, red cheeks, dry mouth, dark urine, yellow stool. Si Shun Yin was used, moving viscera, heat left then returned. Interior resolved, exterior remained. Mild sweating dispersed heat, but fever returned two days later. This was due to table-interior deficiency, Qi failing to return to its source, with Yang floating outward. Liu Shen San with Jing Mi (Oryza Sativa) was used to harmonize Stomach Qi; Yang returned inward, body cooled. These cases are easily misdiagnosed; I highlight them to fill a historical gap. (*Ci You Fa*)
General Discussion on Fright Wind Syndrome
Fright has Four Syndromes and Eight Signs. The Four Syndromes are Fright, Wind, Phlegm, and Heat. Infant Heat excess generates Phlegm; Phlegm excess generates Fright; severe Fright triggers spasms; severe spasms cause jaw locking and the Eight Signs. Liver governs Wind, Spleen governs Phlegm, Lung generates Heat, Heart generates Fright. When Four Syndromes overlap, the heavier one appears first. ○ The Eight Signs are: 1. Chu (Spasm), 2. Nuo (Grasping), 3. Che (Twitching), 4. Chan (Trembling), 5. Fan (Reversion), 6. Yin (Drawing), 7. Cuan (Darting), 8. Shi (Staring). Chu: Hands extending/flexing. Nuo: Fingers opening/closing. Che: Shoulder/arm twitching. Chan: Limb trembling. Fan: Body arching backward. Yin: Arms like drawing a bow. Cuan: Eyes staring straight in anger. Shi: Pupils exposed and immobile. (*Ren Zhi Zhi Fang*)
Fright Spasms are one condition but differ by time (morning/evening) and location (table/interior). Body heat with strong force indicates Acute Fright; body cold with weak force indicates Chronic Fright. Falling with sound and foaming upon waking indicates Epilepsy; head/eyes looking up indicates Tian Diao (Heaven-Hanging); opisthotonos indicates Jing (Spasm). Treatments differ. ○ Frequent spasms indicate Wind in the Exterior, easy to treat, suitable for dispersal. Rare spasms indicate Wind in the Zang, difficult to treat, suitable for Spleen tonification. (Lou Quanshan)
Pediatric fright spasms with blinking or fixed gaze are caused by Liver Channel Wind-Heat. New or chronic illnesses can stir Liver Wind. Liver Wind moving internally ascends to the eyes, causing blinking; if Heat enters the eyes, pulling sinews, both eyes tighten, preventing movement, causing fixed gaze. It may also result from food stagnation in the Middle Jiao, blocking Clear Yang ascent and Turbid Yin descent, suppressing Liver Wood’s rising Qi, generating Wind. Or from vomiting/diarrhea causing Earth failure and Wood rebellion, generating Wind. None of these should be treated with "Fright Medicine." (*Zhang Shi Yi Tong*)
If breath is hot and spasms are strong, it is Form and Disease both Excess; use Da Qing Gao to disperse Wind. If breath is not hot and spasms are weak, it is Form and Disease both Deficient; use Yi Gong San to tonify Spleen Earth, Liu Wei Wan to nourish Liver Wood, and Gou Teng Yin to clear Liver Fire. If symptoms change due to Wind-Heat constraint, clear and disperse Wind-Heat. If exterior pathogens are resolved but symptoms persist, strengthen Spleen Earth and tonify Lung Metal. Treating only Wind may re-injure Spleen Qi and trigger more symptoms. (Xue Lizhai)
Pediatric Fright-Epilepsy arises from the interaction of Deficient Pathogens and Guest Heat. Tonification and harmonization lead to recovery. Adding raw/cold foods or excessive reducing/draining drugs leads to death. (*Lu Xin Jing*)
Children’s muscles, sinews, bones, Zang-Fu, and vessels are undeveloped. Yang is in excess, Yin is deficient, unlike adults where Yin and Yang are balanced. Due to Yin deficiency and Yang excess, Heat easily generates; Heat excess generates Phlegm, Wind, and Fright, which are common. If originally named simply Heat, Phlegm, Wind, Fright, later generations would not be confused. Instead, two characters were removed, starting with Fright and ending with Wind. Later generations misunderstood, thinking it a unique disease. Based on head-shaking/hand-tensing, "Chou Che" (Spasm) was named; based on jaw-locking/leg-curling, "Chu Nuo" was named; based on stiff spine/back-arching, "Jiao Gong Fan Zhang" (Opisthotonos) was named. They did not know children’s pores are loose, easily contracting Wind-Cold. Wind-Cold enters the Taiyang Channel first. Taiyang meridians start at inner eye corners, go over forehead to vertex, enter brain, exit down neck, along spine to waist. Illness causes sinus tension, creating various obscure names. Using mineral/metallic sedatives drives exterior pathogens deep into Zang-Fu, killing thousands. Rare survivors with strong constitutions are hailed as miracles. Doctors guard their schools, killing children unknowingly. Books say: No Taiyang Cold Damage in children under eight. Ignoring that children easily contract exterior pathogens and fever, especially Taiyang Cold Damage. Initial transmission to Taiyang causes stiffness, sweating, sinus movement, confusion. Random medication leads to death; how can one see transmission resolution? Gang Jing (Rigid Spasm) has no sweat; Rou Jing (Soft Spasm) has sweat. Children have less Gang Jing, more Rou Jing. Doctors seeing profuse sweating and coma diagnose Slow Fright, using Ginseng, Atractylodes, Aconite to close pores, trapping Heat, causing great harm, though better than minerals. Thus, treating pediatric heat should always vent it to the exterior, not consolidate it inward. Zhang Zhongjing’s Gui Zhi method exists; abandoning it for Dong Yuan’s internal injury theory causes huge errors. My refutation of Fright Wind does not deny Fright diseases. Children have weak Qi/Spirit; strange sights/sounds or falls cause fright. Signs: Blue face/stool, irritability, crying. This differs from Heat blocking orifices causing coma/unresponsiveness. Careful examination reveals the absurdity of fabricated Fright Wind theories. (Yu Jiayan)
Pediatric Spasm, commonly called Fright Wind. Soft bodies easily contract Wind, true. But Pure Yang constitutions easily generate Internal Heat, opening pores, allowing Wind entry, explaining susceptibility. Doctors hastily using Realgar, Musk, Minerals kill every time, acting like poison. Yet some succeed, so doctors ignore risks. Correct use applies to Excess Heat; incorrect use applies to Deficiency Heat. Giving indiscriminately is like poison. For exterior Wind-Heat, there are proper dispersing methods. For internal Heat congestion, Da Cheng Qi Tang is appropriate. Why scatter True Qi with Musk/Realgar or sink True Yang with Minerals, causing other changes? This explains why Fright Wind prescriptions cause premature death. Without explaining reasons, mere criticism won’t convince doctors. (Wei Litong)
Pediatric Fright syndromes, since Yu Jiayan named them Heat, Phlegm, Fright, Wind, correcting past errors, is accurate. Ye Tianshi followed this, but incompletely. Recently, warm winters disrupt storage; spring cold/warm mix infects children, injuring Lung first. Starting with cold/warm air breathing, untreated, it spreads from Pericardium to upper parts. With slight sweat, but much phlegm, nasal flaring, vexation, confusion, families panic, calling it Fright, using aromatic opening and minerals, consuming Yin, increasing Heat, defeating Zheng Qi, stirring Liver Wind. Symptoms: limb traction, eye darting, spasm/coma, collapse. Before worsening, use Pungent-Cold to open Lung, then Sweet-Cold to resolve Heat, aided by moistening/phlegm-resolving agents. This is Warm Pathogen sinking, Yin consumption, stirring Liver Wind, NOT Fright disease. Mistreating with Fright drugs wrongs children. Hence this clarification. (*Wu Yi Hui Jiang*)
"Fright Wind" is a千古 (eternal) mystery. Jiayan wanted to break the barrier between life and death, but it is hard. Infants with Taiyang Cold Damage Spasm often show opisthotonos/spasms. Qian Zhongyang accidentally named it Fright Wind. Disciples propagated poorly, interpreting "Fright" as scare and "Wind" as variation, leading to texts saying "Blue is Fright." Erroneously believing all pediatric Wind comes from Fright. Misdiagnosing Taiyang Cold Damage (no sweat) as Acute Fright; Wind Strike (sweat) as Chronic Fright; Spleen/Stomach failure as Slow Spleen Fright. Fabricating names confuses later generations. Qian’s single word error caused massive harm! Naming signs is also wrong. E.g., Taiyang Spasm with stiff neck/back-arching/upward eyes is "Tian Diao Fright"; downward eyes is "Kan Di Fright." Many more nonsensical names exist...