小圃先生从小儿机体「肉脆、血少，气弱」的生理特点出发，认为「阴属稚阴，阳为稚阳」，而决非「阳常有余，阴常不足」的「纯阳之体」，所以他在立论上特别强调阳气在人体中的重要性。他非常欣赏《素问·生气通天论》中的「阳气者，若天与日，失其所，则折寿而不彰」的论述，以及张介宾在《类经附翼·求正录·大宝论》中提出的「阳化气，阴成形」、「凡通体之温者，阳气也，一生之活者，阳气也」、「热为阳，寒为阴……热能生物」、「得阳则生，失阳则死」的观点。对这些观点，他通过长期的临床实践，作了进一步的阐明。他认为：阳气在生理状态下是全身的动力，在病理状态下又是抗病的主力，而在儿科中尤为重要。在治疗方法上，他推崇陈复正「圣人则扶阳抑阴」之论，主张治小儿疾病必须处处顾及阳气，并且善于在明辨的基础上识别真寒假热。所以，他在临床上善用辛温解表、扶正达邪、温培脾肾之阳，以及潜阳育阴等治则；在用药配伍中，灵活全面，尤擅于各法之间和各药之间的联系，对于温与清的结合、剂量轻重尺度等，莫不丝丝入扣，恰到好处。
例如他对桂枝的应用，解肌透表必加生姜，有汗发热均伍芍药，无汗表实伍麻黄，项强伍葛根，太少合病用柴胡，清心泻火合黄连，烦渴除热加石膏，肺热，肠热合黄芩，里实腹痛合大黄，与附同用以温阳，与参、芪同用以益气，与甘、枣同用以补心脾，与饴糖同用以建中，与苓、术同用以利水，与五味于同用以纳气，与龙骨、牡蛎同用以潜阳镇惊。且常喜与磁石共投，加强其潜阳宁心的协同作用。他还常使用羌活与桂枝合伍，对风寒入络，头身体痛之寒痹证，效果卓著。
他对麻黄的应用尤多，凡有肺经见证者多用之。认为麻黄作用在于开肺气之闭郁，故喘咳之属实者，佐杏仁以化痰，虽无表证，均可用之，反之，表实无汗而无喘咳者，却并不采用麻黄，因麻黄之发汗解表，需赖桂枝之行血和营，若徒恃麻黄之发汗解表则无益也。以小青龙汤为例，外感风寒、内挟水气者固必用，虽无表证而见喘咳者亦常用，随证加减，尤为灵活。如无汗表实者，用生麻黄去芍药，表虚有汗者用水炙麻黄，但喘咳不发热者用蜜炙麻黄，并去桂枝、芍药；表解但咳不喘者并去麻黄、桂枝。治咳嗽时用五味子，取其五味俱备，非只酸收纳气而已。新咳、暴咳喜用干姜散寒，不宜见咳治咳;久咳不止，则重用五味子;若咳不畅快者，乃邪恋肺经，五味于则在禁用之列。痰多加白芥子;顽痰喘咳，历久不化者加竹节、白附。
小圃先生在临证之暇，常谆谆教诲我们：药不论寒温，要在审辨证情，正确掌握辨证论治的精神实质。桂、麻、附于等虽性温力猛，易以化热助火，亡阴劫液，但使用确当，能收奇效。不然，即桑、菊、荆、防亦足偾事。关键在于用之得当与否，世无明知温热偏胜而妄施温药者。若确系风寒表证，因其壮热而不敢及时投以辛温发散，反以轻清宣透或苦寒抑热，则难免贻误病情。殊不知发热者乃正邪相争之反映，邪气盛，正气尚旺，则发热愈壮，如能及时应用麻、桂，使寒邪得以外拗，不使病邪由表及里，由阳及阴，祛其邪，亦即扶其正也。徐老的教导对我们过去畏麻、桂等辛温药如蛇蝎的疑窦，豁然如释。
诊病全神贯注，一丝不苟
先生诊察小儿疾病时，有个最大的特点，即从进入诊室到诊病完毕，整整一天(除中间略事休息外)一直是站立不坐的。他边问病情，边望神志，详细切脉，切腹，听啼哭、咳嗽，气喘声。尤其令人敬佩的是，他在诊病时能注意到许多候诊患儿的特殊咳嗽和异常的啼哭声音，一经发现，即不按挂号次序的前后，随即提早叫入诊室，得到优先的照顾处理。
有一次，我正在写方，开药未及一半时，先生突令暂停，并令工作人员速将外面候诊的咳嗽患儿带进来先看(徐氏诊所大厅内的候诊室非常宽敞，有一百数十人的座位，是一般病的候诊室，在诊察室的外边有一间小候诊室，可容十来个病号，都是病情较重，或者是挂的「拔号」。候诊室有服务人员照料叫号，诊察室内亦有专人负责。病儿按次叫入，诊治后从诊察室后门出去，秩序井然。)当时，我很觉突然。原来，先生听到室外特殊的犬吠样咳嗽后发觉了一个白喉患儿，他凭声识病，对类似病儿立即予以处理，不致延误病情或传染给其它病儿。这件事我至今仍切切怀记，并对我的医疗态度一直起着积极的影响。他常对我们说：「小儿科医生，一定要具备几个基本功，一是看得准，二是听得清，三是问得明，四是摸(切)得细，缺一不可。那种认为诊治小儿疾病，以望为主，脉无可诊的说法，是把四诊割裂了。单凭脉诊，固然不足以全面识病，但亦须同样重视。」他还风趣地说；「做小儿科医生，要有眼观四处，耳听八方的本领，但这还只做到了一半；还有更重要的，是要有『幼吾幼，以及人之幼』的一颗赤子之心」。徐老教导语重心长，实为后学者之楷范。
先生对望诊，确有独特之处。对婴幼儿呼吸道疾病，凡属啼哭无涕泪而鼻翼扇动者，为肺气闭郁，应首先开宣肺气。同时注意口唇舌苔之润燥，并结合其它各项症候，以辨别其寒热之真假，然后决定治疗决策。例如肺闭证，咳不扬声，呼吸气促，面呈晃白，舌苔淡黄质润，脉细数少力，四肢欠温者，有汗用炙麻黄，无汗生麻黄与桂枝同用，并加紫菀、款冬、天浆壳佐利肺气，附子、龙骨、牡蛎、磁石温阳潜阳，防其阳气之暴脱。使用这一开闭救逆之法则，确实收到良好的效果。我经常运用此法治疗先后天不足的重症肺炎，特别在某些病例中出现心力衰竭或早期心衰的患儿，尤感满意。用药后如能听到咳声爽利，啼哭时有眼泪流出者，表示肺气已宣，病情可望由重转轻，转危为安。
过去在徐老处实习时，冬春季节所见麻疹合并肺类者最多，求诊者皆为后期危重患儿。很多病儿除持续发热并常兼有气喘痰鸣、喘息抬肩外，舌苔黄腻或灰黑，舌质淡红有刺，口唇干燥皲裂，饮水则呛咳作恶的一系列毒热炽盛之化火症侯，清热解毒，保津护阴，固在所必须。但徐老只要诊得脉来细软，扪得舌苔尚有潮润，四肢末端欠温者，则以清温并用，祛邪扶正之法为治，用药如黄连、石膏、鲜生地、大黄、天竺黄、乌附块、龙骨、牡蛎，磁石等。徐老认为麻疹为阳毒，化火最速，清热解毒，养阴护津，固属温毒证的治疗常法；热乃火化，炼液成痰，阻于气道，导致肺闭，关键在于「火」之作祟，故虽肺闭，必佐大黄，通达腑气，导火下行。此时如用一般宣肺定喘等法，已非所宜。盖肺与大肠为表里，泻利大肠，乃「上病下取」之意，所谓「扬汤止沸」不及「釜底抽薪」。乌附块性温而不燥，龙、牡、磁石扶正潜阳，证虽属实热，而舌唇尚润，脉呈细软，肢末欠温，按小儿病理特点，易虚易实，最易出现厥脱。夫阴之所生，必赖阳气之旋运，故少佐温阳者，取其阳生则阴长之意。方虽复杂，但主次分明，配伍灵活，对麻疹肺炎毒重正气将溃的重症病例，颇能见功。我在以后临证中，对某些麻疹肺炎兼金黄色葡萄球菌感染者，常用此法加重生大黄之量，常取得比较满意的效果。说明徐老之使用温阳药和清温并用之法，确是胸有成竹的。
先生应用附子的指征是；精神萎靡，面色晃白，四肢末端不温，脉息细而软弱，或大便见溏泻，小便清等，只需抓住其一、二主证，即可放手应用。特别出现小便清长者，常重用附子，如小便少者，则改用肉桂。他指出：阳气者，人身之大宝也，无阳则阴无以生。在临证时，如阳虚证端倪初露，即须及时注意，若必待气阳虚衰，阴证毕具而后用之，往往贻噬脐莫及之悔矣！介绍几个常用治则的例案
昔日先生诊病，医案均有留底，余亦积累颇多，惜在日军侵华时，散佚大半，所存者又经十年浩劫，残留无几，因此无法整理其全貌。幸仲才学兄曾在先生逝世后一年，撰有《徐小圃儿科经验简介》一文，以资参考。这里，结合我的回忆，略述梗概，以飨后学。
(一)解表擅用辛温外感风邪者，邪客于肺，导致肺气闭塞。证见壮热无汗，咳不扬声，胸高气急，鼻翼扇动，喉间痰声漉漉，神识欠慧，啼哭无泪，舌苔白，脉紧而浮，治从辛温开泄。药用：生麻黄，川桂枝，大杏仁、白芥子，制南星，像贝母、竹半夏、橘红、远志、生姜汁(冲)，苏合香丸(研细)，用鲜石菖蒲煎汤化服。
本证虽由外感风邪所引起，但已成「肺风痰喘」之重症。痰阻气道，肺气闭塞，痰随气逆，则喉间漉漉鸣响，肺开窍于鼻，肺闭则鼻翼扇动，咳不畅利；身虽壮热，但无汗泄，苔白、脉紧而浮，病机为风寒郁于肌表，痰湿内阻肺络。因病在初起，正气尚盛，所以使用麻，桂辛温发散以开肺气，使邪从外撤，南星，半夏，姜汁温化痰湿；苏合香丸、菖蒲温开泄浊。以上防治结合，祛其邪实，亦即保其正气。若因其壮热而用清凉，徒滋邪机充斥，变证迭起，坐失良机，乃医之过也。
此证多见于冬春季节的婴幼儿，体质肥胖，病来急暴，以喘咳痰鸣、发热为主证，临床多见者为毛细支气管肺炎。如其有上述症侯者，均可参考斟酌使用。
(二)重视扶正达邪麻疹初透患儿，鼻准未显，透而即隐，壮热有汗，咳呛不畅，涕泪俱无，鼻扇气急，面呈青灰，精神萎靡，作恶便溏，肢凉不温，小便不黄，辄见痉厥，苔白不黄，口干不多饮，脉虽数而软，药用水炙麻黄、白杏仁、黄厚附块、活磁石，青龙齿、蝎尾，二味黑锚丹、鲜石菖蒲。
其病机为正气不支，邪陷肺闭，内风蠢动，属麻疹之变证。夫一般麻疹因毒热内闭者固多见，而因正气不足，气阳式微而致疹难透达者亦复不少。此证面色青灰，便溏、溺色清，脉软肢冷，虽有壮热，而见有汗，痧子见而即隐，且频见抽搐，与毒热内陷生风者显属不同。故先生以温阳扶正同宣透并用，止痉不用羚羊而参以潜阳；气喘、汗出不温，当非实邪之喘，所以用二味黑锚丹以温阳镇纳，不用葶苈泻肺以免犯虚虚之戒。且黑锡丹能温纳肾气，凡真阳欲脱之虚喘，先生最善用之。在透疹剂中加用附子以温阳，发中有补，确能达到扶正却邪之目的。
此外，先生对麻疹之出透与否，不以全身四肢密布为凭，而以鼻准有无为标志。因此，他诊视麻疹患儿，必细察鼻准处有无布露，虽周身痧子密布，鼻准未见者，仍以透为主，若鼻准部已有三、五点粒，全身稀疏不多者，即表示痧子已透达向外，无需再用透发。余验之临床，确如其言。附此，以记先生诊视麻疹之卓见。
(三)及时温培脾肾久泻婴儿，屡经治疗，仍泄泻不止，粪色淡黄，挟有粘液乳瓣，小便清长，吮乳作恶，神情萎软，刚匡凹陷，面色萎黄，四肢欠温，寐则露睛，舌净少苔，脉濡细，呼吸浅促。处方用黄厚附块、上安肉桂、茯苓、淮山药，煨肉果、煨益智、破故纸、青龙齿、活磁石。
此为久泻伤脾，脾伤及肾，乃脾肾两伤之证，气阳不足之征毕露，故放手使用温培脾肾之阳，即助火生土之意。
小儿泄泻，夏秋季尤多，湿热泻固属多见，而婴幼儿时期的脾虚泻亦常见及。先生常以钱氏七味白朮散为主方，中寒者加炮姜，阳虚者加附子，对脾伤及肾者常用四神。对泄泻病中具有舌干口渴者，必详辨其伤阴与伤阳之别。伤阴当见舌光色绛，甚则口舌生糜，伤阳舌苔虽净而不干或糙而质润，且多伴小便清长，口虽干而不多饮，饮则作恶(此非阴伤，而是脾不健运，液不上承之故)。肾阳不振，气失摄纳，所以小便虽多，而泻仍不止也。此类病儿临床极为多见，若不及时投以温培脾肾之阳，则必土败木乘，可致虚风暗动，导致慢脾风危候。婴幼儿泄泻之死亡于此者，比比皆是。我在治疗婴幼儿久泻不止，进食进水即泻的脾寒泻时，亦常喜用附子理中汤加生白芍，炙诃子温中安肠，鼓舞脾阳，使之清阳上升，阴霾自散。这与补中益气之升提法具有不同的含义。
(四)潜阳兼顾育阴幼儿在夏秋之交，发热缠绵已将一月，热来起伏，身有微汗，口渴喜饮，尿多色清。近来烦躁不宁，彻夜不寐，咬啮手指，时伴惊搐，面色有时潮红，两足清冷，舌光无苔，脉细数而软。处方为黄厚附片、上川连、磁石、青龙齿、天花粉、蛤粉、覆盆子，莲子心、阿胶、鸡子黄(冲)。
本证已显气阴两虚，属于各种温病范围的后期病症，乃温病之坏证。余对「流行性乙型脑炎」的恢复期，伏暑、湿温病的后期，凡出现此类症候，均宗先生施以潜阳育阴之法治之。
Mr. Xiaopu started from the physiological characteristics of infants and young children, whose bodies are characterized by "fragile flesh, scarce blood, and weak Qi," to argue that their constitution is one where "Yin is tender Yin, and Yang is tender Yang," rather than the so-called "pure Yang body" which is often described as having "excess Yang and insufficient Yin." Therefore, in his theoretical discussions, he particularly emphasized the importance of Yang Qi in the human body. He highly appreciated the discussion in *Suwen: Shengqi Tongtian Lun* (Plain Questions: Treatise on the Connection between Vital Energy and Heaven) stating that "Yang Qi is like the sky and the sun; if it loses its proper function, lifespan will be shortened and vitality obscured," as well as Zhang Jiebin's propositions in *Lijing Fuyi: Qiuzhenglu: Daobao Lun* (Supplement to the Classified Classic: Record of Seeking Truth: Treatise on the Precious Treasure) that "Yang transforms into functional energy, Yin forms physical structure," "The warmth of the whole body depends on Yang Qi, the vitality of life depends on Yang Qi," "Heat belongs to Yang, Cold belongs to Yin... Heat can generate things," and "With Yang there is life, without Yang there is death." Through long-term clinical practice, he further elucidated these viewpoints. He believed that under physiological conditions, Yang Qi is the driving force of the whole body, while under pathological conditions, it is the main force against disease, a role that is especially crucial in pediatrics. In terms of treatment principles, he advocated Chen Fuzheng's theory that "the way of the sage is to support Yang and suppress Yin," asserting that treating pediatric diseases must always consider protecting Yang Qi, and one must be adept at identifying true cold with false heat based on clear differentiation. Consequently, in clinical practice, he skillfully employed treatment principles such as releasing the exterior with acrid-warm herbs, supporting healthy Qi to expel pathogens, warming and tonifying the Yang of the Spleen and Kidney, and anchoring Yang while nourishing Yin. In herbal compatibility, he was flexible and comprehensive, particularly skilled at connecting various treatment methods and herbs. The combination of warming and clearing methods, as well as the scale of dosage, were all handled with meticulous precision and appropriateness.
For example, regarding his application of *Guizhi Tang* (Cinnamon Twig Decoction): when releasing the muscle layer and penetrating the exterior, he would invariably add *Shengjiang* (Fresh Ginger); for sweating and fever, he would combine it with *Shaoyao* (Peony Root); for no sweating and excess exterior syndrome, he would combine it with *Mahuang* (Ephedra Herb); for stiffness of the neck and back, he would combine it with *Gegen* (Kudzu Root); for concurrent Taiyang and Shaoyang syndromes, he would use *Chaihu* (Bupleurum Root); for clearing Heart heat and purging fire, he would combine it with *Huanglian* (Coptis Rhizome); for irritability, thirst, and removing heat, he would add *Shigao* (Gypsum Fibrosum); for Lung heat and Intestine heat, he would combine it with *Huangqin* (Scutellaria Root); for interior excess and abdominal pain, he would combine it with *Dahuang* (Rhubarb Root); combined with *Fuzi* (Aconite Lateralis Radix Preparata) to warm Yang; combined with *Renshen* (Ginseng Radix) and *Huangqi* (Astragalus Membranaceus Radix) to benefit Qi; combined with *Gancao* (Licorice Root) and *Dazao* (Jujube Fruit) to tonify the Heart and Spleen; combined with *Yitang* (Maltose) to establish the Middle Jiao; combined with *Fuling* (Poria) and *Baizhu* (Atractylodes Macrocephala Rhizome) to promote urination; combined with *Wuweizi* (Schisandra Berry) to grasp Qi; combined with *Longgu* (Fossilized Mammal Bones) and *Muli* (Oyster Shell) to anchor Yang and calm fright. Moreover, he often liked to administer it together with *Cishi* (Magnetite) to strengthen the synergistic effect of anchoring Yang and calming the Heart. He also frequently combined *Qianghuo* (Notopterygium Rhizome et Radix) with *Guizhi* (Cinnamon Twig), achieving remarkable effects for cold-bi syndromes caused by wind-cold invading the collaterals, resulting in headache and body pain.
He used *Mahuang* (Ephedra Herb) even more frequently, employing it whenever there were manifestations of the Lung meridian. He believed that the action of *Mahuang* lies in opening the closure and depression of Lung Qi. Therefore, for wheezing and coughing due to excess patterns, he would assist with *Xingren* (Apricot Seed) to resolve phlegm, and could use it even without an exterior syndrome. Conversely, for exterior excess with no sweating but without wheezing or coughing, he did not use *Mahuang*, because the sweating and exterior-releasing effect of *Mahuang* relies on the blood-moving and nutritive-regulating action of *Guizhi* (Cinnamon Twig). Relying solely on *Mahuang* for sweating and exterior release would be of no benefit. Taking *Xiao Qinglong Tang* (Minor Green Dragon Decoction) as an example, it is certainly necessary for external wind-cold with internal retained fluid, but it is also commonly used for wheezing and coughing even without an exterior syndrome, with modifications according to symptoms, demonstrating great flexibility. For no sweating and exterior excess, he used raw *Mahuang* (Ephedrae Herba) and removed *Shaoyao* (Paeoniae Radix Alba); for exterior deficiency with sweating, he used water-processed *Mahuang*; for wheezing and coughing without fever, he used honey-processed *Mahuang* and removed *Guizhi* and *Shaoyao*; for resolved exterior but only coughing without wheezing, he removed both *Mahuang* and *Guizhi*. When treating cough, he used *Wuweizi* (Schisandrae Chinensis Fructus) because it possesses all five flavors, not merely for its sour taste to grasp Qi. For new-onset or sudden cough, he preferred *Ganjiang* (Zingiberis Rhizoma) to dispel cold, avoiding the mistake of treating only the cough; for persistent chronic cough, he heavily used *Wuweizi*; if the cough was not smooth, it indicated pathogenic factors lingering in the Lung meridian, and *Wuweizi* was then contraindicated. For excessive phlegm, he added *Baijiezi* (Sinapis Semen); for stubborn phlegm with wheezing and cough that persisted for a long time, he added *Zhujie* (Bambusa Takahei Chiku Nan) and *Baifu* (Aconiti Kusnezoffii Radix).
During his spare time from clinical duties, Mr. Xiaopu often earnestly taught us: It does not matter whether herbs are cold or warm; the key lies in examining and differentiating the condition, correctly grasping the essence of pattern differentiation and treatment. Although *Guizhi* (Cinnamomi Ramulus), *Mahuang* (Ephedrae Herba), and *Fuzi* (Aconiti Lateralis Radix Preparata) are warm and potent, easily transforming into heat and aiding fire, causing loss of Yin and depletion of fluids, if used appropriately, they can achieve miraculous effects. Otherwise, even mild herbs like *Sangye* (Mulberry Leaf), *Juhua* (Chrysanthemi Flos), *Jingjie* (Schizonepetae Spica), and *Fangfeng* (Saposhnikoviae Radix) can cause harm. The crux lies in whether they are used properly. There are no wise physicians who recklessly apply warming herbs knowing clearly that heat and warmth predominate. If it is indeed a wind-cold exterior syndrome, and one dares not timely administer acrid-warm dispersing agents due to high fever, instead using light-clearing ventilating or bitter-cold suppressing heat methods, one will inevitably delay the condition. Little do they know that fever is a reflection of the struggle between healthy Qi and pathogenic factors. When pathogens are strong and healthy Qi is still robust, the higher the fever, the better. If *Mahuang* and *Guizhi* are applied timely to allow cold pathogens to be expelled outward, preventing the pathogen from moving from the exterior to the interior, or from Yang to Yin, expelling the pathogen is equivalent to supporting healthy Qi. Mr. Xu's teachings dissipated our past suspicions and fears of acrid-warm herbs like *Mahuang* and *Guizhi* as if they were snakes and scorpions.
Attentive and Meticulous in Diagnosis
When examining pediatric patients, Mr. had one greatest characteristic: from entering the consultation room until finishing the diagnosis, throughout the entire day (except for brief rest intervals), he remained standing and never sat. While asking about the illness, he observed the spirit/mind, meticulously felt the pulse, palpated the abdomen, and listened to crying, coughing, and wheezing sounds. What was particularly admirable was that during consultations, he could notice special coughs and abnormal crying sounds among many waiting children. Once discovered, he would immediately call them into the consultation room ahead of their registration order, giving them priority care.
Once, while I was writing a prescription, before half the medicine was listed, Mr. suddenly ordered a pause and instructed staff to quickly bring in a coughing child waiting outside for immediate examination (The waiting room in the hall of the Xu Clinic was very spacious, with seats for over a hundred people, serving as the general waiting area outside the consultation room. There was a small waiting room outside the consultation room accommodating about ten patients, mostly those with severe conditions or special appointments. Service personnel managed the calling queue in the waiting room, and dedicated staff were inside the consultation room. Children were called in turn, examined, and exited through the back door of the consultation room in an orderly manner.) At that moment, I felt quite surprised. It turned out that upon hearing a special barking-like cough from outside, Mr. identified a diphtheria patient. By recognizing the disease through sound, he immediately treated similar cases, preventing delay or transmission to other children. I still deeply cherish this event, and it has positively influenced my medical attitude ever since. He often told us: "Pediatricians must possess several basic skills: first, accurate observation; second, clear hearing; third, clear questioning; fourth, detailed palpation/pulse-taking. None can be lacking. The notion that diagnosing pediatric diseases relies mainly on inspection and that pulse diagnosis is useless splits the Four Diagnostic Methods apart. Relying solely on pulse diagnosis is indeed insufficient for comprehensive disease identification, but it must also be equally valued." He also humorously said: "Being a pediatrician requires the ability to see everywhere and hear everything, but this only accomplishes half the task; what is more important is having the heart of a pure child, 'treating others' children as one treats one's own'." Mr. Xu's teachings were profound and sincere, serving as a model for later learners.
Mr. had unique expertise in inspection. For respiratory diseases in infants and young children, those who cry without tears or nasal discharge and exhibit alar flaring indicate closure and depression of Lung Qi, requiring first to open and ventilate Lung Qi. Simultaneously, attention should be paid to the moisture or dryness of the lips and tongue coating, combined with other symptoms, to distinguish the truth or falsity of cold and heat, thereby determining the treatment strategy. For example, in Lung Closure Syndrome, where coughing is voiceless, breathing is rapid, complexion is pale, tongue coating is pale yellow and moist, pulse is fine, rapid, and weak, and limbs are cool: for sweating, use processed *Mahuang* (Ephedrae Herba); for no sweating, use raw *Mahuang* combined with *Guizhi* (Cinnamomi Ramulus), adding *Ziwan* (Astern Radix), *Kudonghua* (Farfarae Flos), and *Tianjiangke* (Calici Trichosanthis Pericarpium) to assist in benefiting Lung Qi, and *Fuzi* (Aconiti Lateralis Radix Preparata), *Longgu* (Os Draconis), *Muli* (Concha Ostreae), and *Cishi* (Magnetitum) to warm and anchor Yang, preventing sudden collapse of Yang Qi. Using this method of opening closure and rescuing from collapse indeed yielded good results. I frequently used this method to treat severe pneumonia in children with congenital or postnatal insufficiency, especially feeling satisfied with cases showing heart failure or early-stage heart failure. After medication, if one can hear a crisp cough or see tears flowing during crying, it indicates that Lung Qi has been ventilated, and the condition is expected to improve from severe to mild, turning danger into safety.
During my internship with Mr. Xu, winter and spring seasons saw the most cases of measles complicated by pneumonia, and most seekers were critically ill children in the late stages. Many children presented with continuous fever accompanied by wheezing, rattling phlegm, shoulder lifting during respiration, yellow greasy or gray-black tongue coating, pale red tongue body with prickles, dry and cracked lips, and choking/coughing upon drinking—a series of symptoms indicating intense toxic heat transforming into fire. Clearing heat and detoxifying, preserving fluids, and protecting Yin were undoubtedly necessary. However, whenever Mr. diagnosed a fine and soft pulse, felt a moist tongue coating, and noted cool extremities, he employed a method combining clearing and warming, expelling pathogens and supporting healthy Qi, using herbs such as *Huanglian* (Coptidis Rhizoma), *Shigao* (Gypsum Fibrosum), *Xiashengdi* (Rehmanniae Radix Recens), *Dahuang* (Rhei Radix et Rhizoma), *Tianzhuhuang* (Calami Tinosporae), *Wufukuai* (Aconiti Kusnezoffii Radix), *Longgu* (Os Draconis), *Muli* (Concha Ostreae), and *Cishi* (Magnetitum). Mr. considered measles as Yang toxin, which transforms into fire most rapidly. Clearing heat and detoxifying, nourishing Yin and protecting fluids, though standard for warm-toxin syndromes; heat transforms into fire, refining fluids into phlegm, obstructing airways, leading to Lung Closure. The key lies in the mischief of "fire." Thus, even with Lung Closure, he necessarily assisted with *Dahuang* (Rhei Radix et Rhizoma) to unblock the Fu organs and guide fire downward. At this stage, general methods of ventilating the Lung and stabilizing wheezing were inappropriate. Since the Lung and Large Intestine are exterior-interior partners, purging the Large Intestine embodies the principle of "treating upper disorders by lowering," meaning "stirring the soup to stop boiling" is inferior to "removing firewood from under the pot." *Wufukuai* is warm but not drying; *Longgu*, *Muli*, and *Cishi* support healthy Qi and anchor Yang. Although the syndrome appears as excess heat, the tongue and lips remain moist, the pulse is fine and soft, and extremities are cool. According to pediatric pathological characteristics, children are prone to both deficiency and excess, and most easily develop syncope and collapse. The generation of Yin relies on the rotation of Yang Qi; thus, adding a little warming Yang herb follows the intention that "when Yang generates, Yin grows." Although the formula was complex, priorities were clear, and compatibility was flexible, achieving notable success in severe cases of measles pneumonia with heavy toxins and collapsing healthy Qi. In subsequent clinical practice, for certain measles pneumonia cases complicated by *Staphylococcus aureus* infection, I often used this method with increased doses of *Dahuang* (Rhei Radix et Rhizoma), achieving relatively satisfactory results. This demonstrates that Mr. Xu's use of warming Yang herbs and the combined clearing-warming method was indeed confident and well-founded.
The indications for Mr. applying *Fuzi* (Aconiti Lateralis Radix Preparata) were: listlessness, pale complexion, cool extremities, fine and weak pulse, or loose stools and clear urine. Grasping just one or two main symptoms was sufficient to confidently apply it. Particularly when clear and copious urination appeared, he heavily used *Fuzi*; if urine volume was low, he switched to *Rougui* (Cinnamomi Cortex). He pointed out: "Yang Qi is the great treasure of the human body; without Yang, Yin cannot be generated." In clinical practice, if signs of Yang deficiency initially appear, one must pay attention promptly. If one waits until Qi and Yang are severely deficient and all Yin symptoms are present before using it, regret will often come too late! Introducing examples of several common treatment principles
In the past, Mr. kept copies of medical records, and I accumulated many as well. Unfortunately, most were lost during the Japanese invasion, and what remained was largely destroyed during the Ten Years of Turmoil, leaving very few. Thus, it was impossible to organize the complete picture. Fortunately, my fellow student Zhongcai wrote an article titled "Brief Introduction to Mr. Xu Xiaopu's Pediatric Experience" one year after Mr.'s passing, for reference. Here, combining my memories, I briefly outline the gist to nourish later learners.
(I) Proficiency in Acrid-Warm Exterior Release
When external wind-cold pathogens invade the Lung, causing Lung Qi closure. Symptoms include high fever, no sweating, voiceless cough, chest distension with rapid breathing, alar flaring, rattling phlegm in the throat, dull consciousness, crying without tears, white tongue coating, and tight floating pulse. Treatment follows acrid-warm opening and draining. Medicines used: Raw *Mahuang* (Ephedrae Herba), *Guizhi* (Cinnamomi Ramulus), large *Xingren* (Armeniacae Semen Amarum), *Baijiezi* (Sinapis Semen), prepared *Nanxing* (Arisaematis Rhizoma Preparatum), *Xiangbeimu* (Fritillariae Thunbergii Bulbus), *Zhubanxia* (Pinelliae Rhizoma Preparatum), *Juhong* (Citri Reticulatae Pericarpium Rubrum), *Yuanzhi* (Polygalae Radix), *Shengjiangzhi* (Zingiberis Recens Juice - mixed in), *Suhexiang Wan* (Styrax Pill - ground fine), administered dissolved in decoction of fresh *Shichangpu* (Acori Tatarinowii Rhizoma).
Although this syndrome is caused by external wind-cold, it has become a severe case of "Wind-Phlegm Wheezing." Phlegm obstructs the airway, Lung Qi closes, phlegm rises with rebellious Qi, causing rattling sounds in the throat. The Lung opens to the nose; Lung closure causes alar flaring and ineffective coughing. Despite high fever, there is no sweating; white coating and tight floating pulse indicate the pathology is wind-cold stagnating in the muscle layer and damp-phlegm obstructing the Lung collaterals internally. Since the disease is in its initial stage and healthy Qi is still robust, *Mahuang* and *Guizhi* are used for acrid-warm dispersing to open Lung Qi, allowing pathogens to retreat outward; *Nanxing*, *Banxia*, and ginger juice warm and transform damp-phlegm; *Suhexiang Wan* and *Shichangpu* warm and open turbidity. Combining prevention and treatment, expelling pathogenic excess preserves healthy Qi. If one uses cooling herbs due to high fever, it merely aids pathogenic proliferation, leads to successive complications, misses the opportunity, and constitutes a medical error.
This syndrome is common in infants and young children during winter and spring, characterized by obesity, acute onset, with wheezing, rattling phlegm, and fever as main symptoms. Clinically, it is often seen as bronchiolitis. Cases with the above symptoms can refer to and carefully consider this approach.
(II) Emphasis on Supporting Healthy Qi to Expel Pathogens
In children with early measles eruption, the tip of the nose is not yet visible, eruptions appear and then vanish, high fever with sweating, ineffective coughing, absence of nasal discharge and tears, alar flaring with rapid breathing, bluish-gray complexion, listlessness, aversion to food and loose stools, cool limbs, non-yellow urine, frequent spasms and convulsions, white non-yellow tongue coating, dry mouth but little desire to drink, rapid but soft pulse. Medicines used: Water-processed *Mahuang* (Ephedrae Herba), white *Xingren* (Armeniacae Semen Amarum), thick yellow *Fuzi* (Aconiti Lateralis Radix Preparata), live *Cishi* (Magnetitum), *Qinglongchi* (Os Longorum), scorpion tail, *Erwei Heixi Dan* (Two-Ingredient Black Tin Pill), fresh *Shichangpu* (Acori Tatarinowii Rhizoma).
Its pathology is healthy Qi unable to support itself, pathogens sinking into Lung closure, stirring internal wind, belonging to variant measles syndromes. Generally, measles due to internal closure of toxic heat is common, but those due to insufficient healthy Qi and declining Qi-Yang making eruption difficult are also numerous. This syndrome presents with bluish-gray complexion, loose stools, clear urine, soft pulse, and cold limbs. Despite high fever, there is sweating, eruptions appear and vanish, and frequent convulsions occur, clearly different from toxic heat sinking and generating wind. Therefore, Mr. combined warming Yang and supporting healthy Qi with venting and penetrating methods. For stopping spasms, he did not use *Lingyangjiao* (Capricornus Bubali Cornu) but incorporated anchoring Yang; for wheezing, sweating, and lack of warmth, it was not real pathogenic wheezing, so he used *Erwei Heixi Dan* to warm Yang and stabilize/grasp Qi, avoiding *Tinglizi* (Semen Lepidii seu Descurainiae) to purge the Lung to prevent violating the prohibition against weakening the deficient. Furthermore, *Heixi Dan* can warm and grasp Kidney Qi. For deficiency wheezing due to impending collapse of True Yang, Mr. was most skilled in using it. Adding *Fuzi* (Aconiti Lateralis Radix Preparata) to erupt-measle formulas warms Yang; releasing with tonification truly achieves the purpose of supporting healthy Qi and repelling pathogens.
Additionally, Mr. judged whether measles had fully erupted not by dense distribution on the whole body and limbs, but by the presence on the tip of the nose. Therefore, when examining measles patients, he strictly inspected whether the tip of the nose showed eruption. Even if the whole body was densely covered, if the nose tip was not visible, he still focused on eruption. If three to five spots appeared on the nose tip, even if the rest of the body was sparse, it indicated the rash had fully erupted outward, and no further erupting agents were needed. My clinical verification confirmed his words. I record this here to note Mr.'s outstanding insight into measles diagnosis.
(III) Timely Warming and Tonifying Spleen and Kidney
Infants with chronic diarrhea, repeatedly treated but still suffering from incessant diarrhea, pale yellow stool mixed with mucus and milk curds, clear and copious urine, aversion to sucking milk, limp demeanor, depressed fontanelle, sallow complexion, cool limbs, eyes opening during sleep, clean tongue with little coating, soggy fine pulse, and shallow rapid breathing. Prescription: Thick yellow *Fuzi* (Aconiti Lateralis Radix Preparata), top-grade *Rougui* (Cinnamomi Cortex), *Fuling* (Poria), *Huai Shanyao* (Dioscoreae Hypoglaucae Rhizoma), baked *Rouguo* (Myristicae Semen), baked *Yizhi* (Alpiniae Oxyphyllae Fructus), *Po Gu Zhi* (Psoraleae Fructus), *Qinglongchi* (Os Longorum), live *Cishi* (Magnetitum).
This is chronic diarrhea injuring the Spleen, which then injures the Kidney, a syndrome of dual Spleen-Kidney injury, manifesting full signs of Qi-Yang deficiency. Thus, boldly using warming and tonifying Spleen-Kidney Yang, embodying the idea of assisting Fire to generate Earth.
Pediatric diarrhea is especially common in summer and autumn. While damp-heat diarrhea is prevalent, Spleen-deficiency diarrhea in infancy is also common. Mr. often used Qian's *Qiwei Baizhu San* (Seven-Ingredient Powder for Invigorating the Spleen) as the main formula, adding roasted *Jiang* (Zingiberis Rhizoma Preparatum) for middle-jiao cold, adding *Fuzi* (Aconiti Lateralis Radix Preparata) for Yang deficiency, and commonly using *Sishen Wan* (Four-Spirit Pill) for Spleen injury affecting the Kidney. For diarrhea patients with dry tongue and thirst, one must carefully differentiate between Yin injury and Yang injury. Yin injury shows a glossy crimson tongue, even ulceration of mouth and tongue; Yang injury shows a clean but not dry tongue coating, or rough but moist texture, often accompanied by clear copious urine, dry mouth but little desire to drink, and aversion to drinking (this is not Yin injury, but Spleen failing to transport fluids upward). Kidney Yang failing to rise and Qi losing its grasping power means that although urine is frequent, diarrhea persists. Such children are extremely common clinically. If warming and tonifying Spleen-Kidney Yang is not administered timely, Earth will fail and Wood will overcome, potentially causing latent empty wind, leading to the critical condition of Slow Spleen Wind. Deaths from infant diarrhea due to this are commonplace. In treating infant chronic diarrhea where eating or drinking immediately triggers diarrhea (Spleen-Cold Diarrhea), I also often prefer using *Fuzi Lizhong Tang* (Aconite Regulate the Middle Decoction) plus raw *Baishao* (Paeoniae Radix Alba), processed *Hezi* (Terminaliae Chebulae Fructus) to warm the middle and stabilize the intestines, inspiring Spleen Yang so that clear Yang rises and yin turbidity dissipates. This differs in meaning from the lifting method of *Buzhong Yiqi Tang* (Tonify the Middle and Augment the Qi Decoction).
(IV) Anchoring Yang while Nourishing Yin
Toddlers at the transition of summer and autumn have suffered lingering fever for nearly a month, with fluctuating heat, slight sweating, thirst with desire to drink, and frequent clear urine. Recently, irritability, insomnia all night, biting fingers, occasional convulsions, sometimes flushed complexion, cold feet, glossy tongue without coating, and fine, rapid, soft pulse. Prescription: Thick yellow *Fupian* (Aconiti Lateralis Radix Preparata Slice), top-grade *Chuanlian* (Coptidis Rhizoma), *Cishi* (Magnetitum), *Qinglongchi* (Os Longorum), *Tianhuafen* (Trichosanthis Radix), *Ge Fen* (Concha Meretricis et Cyclinae), *Fupenzi* (Rubiae Fructus), *Lianzixin* (Nelumbinis Plumula), *Ejiao* (Colla Corii Asini), *Jizihuang* (Yolli Galli - mixed in).
This syndrome already manifests Qi and Yin dual deficiency, belonging to the late stage of various warm diseases, representing a deteriorated state of warm disease. For the recovery phase of "Japanese Encephalitis B," and the late stages of latent summerheat and damp-warm diseases, whenever such symptoms appear, I follow Mr.'s method of anchoring Yang and nourishing Yin.