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When treating excess syndromes in individuals with weak constitutions and young children, people often hesitate to use purgative (pathogen-expelling) medicines when they are indicated. Even if used, there is usually much deliberation, and the dosage is not increased sufficiently. Consequently, the medicinal strength fails to overcome the disease, rendering the treatment equivalent to none. They consider this caution, but it is a grave error. One fails to realize that when a person of weak constitution first falls ill, their righteous qi (vital energy) can still support them. If one does not use heavy medicines at this time to directly attack the site of the disease and resolve it within one or two doses, thereby urgently rescuing the nearly exhausted yuan qi (primordial energy) and gradually nourishing the dissipating spirit, but instead remains indecisive, it is like nurturing a boil until it becomes a disaster, or even lending weapons to the enemy and providing grain to robbers. This allows righteous qi to be severely depleted, making it impossible to purge pathogens later and impossible to tonify deficiency, leaving one helpless. Is this not an error caused by excessive caution, which is even worse than recklessness? As for young children, whether suffering from cold, heat, wind, phlegm, or food stagnation, there are situations where strong cold, strong warm, strong dispersing, or strong resolving agents must be used. In such cases, early treatment and heavier dosages are even more appropriate. This is because children’s zang-fu organs are not yet fully developed, and their qi and blood are tender; their conditions easily become excess and also easily become deficiency. Early-stage diseases are mostly excess, while chronic diseases are mostly deficiency. If an excess condition is not attacked, waiting until it becomes deficiency to treat it will be too late. Moreover, nine out of ten children refuse to take medicine; even those who do cannot consume large amounts. Without large doses and concentrated decoctions, the medicine will inevitably fail to overcome the disease. Indulgence fosters evil, and delay aids the thief. The physician must have clear eyes and quick hands, and so must the patient's family. If they are indecisive, wavering between options, mistaking confusion for maturity, and viewing hesitation as prudence, it is akin to incompetent ministers ruining the state. This is not limited to contemporary physicians.

Children have solid qi and blood; upon contracting wind-cold, they develop fever. Excessive heat generates wind, and excessive wind generates phlegm, leading suddenly to spasms, convulsions, and loss of consciousness, known as "Acute Convulsion" (Ji Jing). External treatments include acupuncture, scraping, pushing, and grasping techniques; internal treatments involve clearing heat, purging, resolving stagnation, and opening orifices, which can restore consciousness. It is like dark clouds gathering, thunderstorms breaking forth, followed by a clap of thunder, after which the clouds disperse and rain stops, revealing bright skies instantly. Its arrival is sudden, and its departure is abrupt. Therefore, treating acute convulsion seems difficult but is actually easy. The truly difficult conditions are only four. The first is "Chronic Convulsion" (Man Jing). It may arise from congenital insufficiency of Kidney Water or acquired deficiency of Spleen Earth, resulting in empty zang-fu organs and loose interstices (cou li), making the body susceptible to wind-cold, presenting with alternating chills and fever, poor appetite, and loose stools. It may also result from weaning too early or improper diet damaging the spleen, or following smallpox, measles, scarlet fever, malaria, or dysentery, and after any major or chronic illness where righteous qi is severely depleted. None is faster to develop into chronic convulsion than after severe vomiting and diarrhea; this must be known. The treatment principle is exactly opposite to that of acute convulsion. The best method is found in Zhuang Zaitian’s *Fu You Bian*, advocating solely warming and tonifying methods with large doses administered continuously to reverse the condition. Any hesitation makes recovery impossible. Yet physicians and families regard this as strange news, which is why it is difficult. The second is "Sha Zi" (Measles/Rash). For mild cases, avoiding wind allows cure without medication; for severe cases, acrid-dispersing herbs can facilitate eruption. For those with weak constitutions, supporting righteous qi expels pathogens; for those with excessive fire, nourishing yin assists sweating. Pediatric texts provide guidance, making it inherently not difficult to treat. However, since people mistakenly identify throat pain associated with Sha Zi as ordinary throat disorders, they avoid acrid-dispersing herbs and instead use cold-cooling herbs internally and Pearl-Yellow preparations externally. This prevents Sha toxin from reaching the skin surface, causing it to attack upward to the throat, resulting in an incurable condition, thus becoming difficult to treat. (See previous discussion on throat pain in measles.)

Bing notes: Children's diseases are also hard to discuss. Fifteen years ago, I treated a five-year-old son of the Zhu family, summoned in the middle of the night. The child had a red face, fever, rapid pulse with profuse sweating, and a red tongue, showing signs of the Baihu Tang syndrome. I was drafting the prescription in the outer room (including myself, seven doctors had examined him that day, six using cooling methods). I asked if he had taken any medicine. He replied, "I selected two prescriptions and took one dose of each, but to no effect." Within moments, he had seven episodes of diarrhea. I then determined the main ingredients to be Ginseng Radix et Rhizoma (Renshen), Aconiti Lateralis Radica Praeparata (Fuzi), dried Ginger processed with stir-braising (Chao Ganjiang), Atractylodis Macrocephalae Rhizoma (Baizhu), Licorice Root processed with honey (Zhi Cao), Poria (Fuling), and Areca Seed processed with baking (Wei Muxiang). I returned home after the fourth watch of the night. After one dose of this prescription, the fever subsided, sweating stopped, and diarrhea ceased, leading to recovery.

The third is "Dou Zheng" (Smallpox). In recent years, cowpox vaccination has become prevalent, and experts in smallpox treatment seem to have vanished. Those administering the vaccine are mostly unskilled workers who know little beyond inoculation. If the eruption is irregular or during epidemic smallpox, urgent requests for prescriptions are met with formulas containing Rhinoceros Horn (Xijiao), Antelope Horn (Lingyang), Coptis Rhizome (Lian), and Scutellaria Root (Qin)—a batch of cold-cooling substances. This causes blood coagulation and qi stagnation, freezing the pustule fluid, leading to collapse and death with rapid progression. The treatment should always prioritize tonifying qi and blood and supporting yang qi. Medications should primarily be warming and tonifying, with slight dispersing agents added. Zhuang Zaitian’s *Sui Sheng Bian* is truly the sacred text of smallpox treatment, unmatched by other works. The fourth is "Qi Feng" (Neonatal Tetanus). This condition results from wind invasion during birth, manifesting immediately after birth or up to 100 days later. It is most common within seven days and requires constant vigilance. If a yellow spot appears on the glabella, it is Qi Feng, accompanied by blue veins above the umbilicus. Immediate treatment is required; otherwise, the yellow color spreads to the nose tip, then to the lips, followed by a crow-like voice, puckered mouth, inability to cry properly, and weakness in sucking milk. Urgent treatment might save one in ten. The best treatments are the thirteen-point moxibustion method from *You Ke Tie Jing* and the four-level method from *Guang Sheng Bian*. With proper treatment, recovery can occur instantly. I have personally tested these methods; they are not mere speculation. The treatment methods for these four conditions are detailed in my compiled work *Bao Chi Yao Yan*. I repeat them here to inform families that although these four conditions are difficult, they are treatable, and should not be abandoned due to perceived difficulty. In short, with correct treatment, difficult cases become easy; with incorrect treatment, easy cases become difficult. The distinction lies in how one treats them.