钱乙曰。贪睡。口中气热。呵欠。烦闷者。伤风症也。头目疼痛。而畏人畏寒者。伤寒症也。
张元素曰。小儿外感风寒。拘急。呵欠。皮毛涩。口中气热者。当发散。秋冬用温热。春夏用凉寒。
谭殊圣曰。小儿头疼体痛。鼻塞流涕。咳嗽喷嚏。颊赤眼涩。山根青色。皆伤风寒也。宜大青膏。
初虞世曰。感冒风寒。通用人参羌活汤、惺惺散、参苏饮。
万全曰。有风热兼伤者。或先伤风而后受热。或先受热而后伤风。一时齐发。贵审轻重而治之。宜桔梗汤、热郁汤。
若久不愈。此儿必虚。不得仍用表散。
李 曰。伤风则涕流鼻塞声重。伤风症。属肺者多。宜辛温辛凉散之。戴氏曰。新咳嗽鼻塞声重是也。有汗而恶风。
此真感风症也。
王履曰。小儿春日温病。未满三日。先用惺惺散二帖。后四五日不解。烦渴呕吐。白术散。自汗口燥。用制白虎汤。
六七日。大便燥结。四顺饮子下之。心腹大实大满。牛黄通肠丸下之。初起。疑是疮疹。只用葛根升麻汤解肌。
叶桂曰。春温。伏气症也。昔人以冬寒内伏。藏于少阴。入春发于少阳。以春木内应肝胆也。寒邪深伏。已经化热。
昔人以黄芩汤为主方。苦寒直清里热。热伏于阴。苦味坚阴。乃正治也。知温邪忌散。不与暴感门同法。若因外邪先受。
引动在里伏热。必先辛凉以解新邪。继进苦寒。以清里热。况热乃无形之气。幼医用消滞攻治有形。胃汁先涸。阴液劫
尽者多矣。拟春温备用方。黄芩汤、凉膈散、清心凉膈散。若新邪引动伏邪。葱豉汤。春温。为冬季伏邪。幼科亦有之。
治从大方。然暴感为多。如头痛恶寒发热。喘促鼻塞。身重。脉浮无汗。原可表散。春令温舒。辛温宜少用。阳经表药。
最忌混乱。至若身热咳嗽。有痰之症。只宜肺药辛解。泻白散加前胡、牛蒡、薄荷之属。消食药。只宜一二味。风温。
乃肺先受邪。遂逆传心包。治在上焦。不与清胃攻下同法。幼科不明手经之病。多致危殆。若寒痰阻闭。亦有喘急胸高。
不可与前法。用三白吐之。春季温暖。风温极多。温变热最速。若发散风寒消食。劫伤津液。变症尤速。拟风温备用方。
凉膈散、清心凉膈散、泻白散、白虎汤、至宝丹、清心牛黄丸、喻氏清燥救肺汤。先夏至为病温。后夏至为病热。热者。
暑热也。暑必兼湿。暑伤气分。湿亦伤气。汗则耗气伤阳。胃汁大受劫烁。病变由此甚多。张凤逵云。暑病首用辛凉。
继用甘寒。再用酸泄收敛。不必用下。可称要言不烦。夏令受热。昏迷若惊。此为暑厥。即热气闭塞孔窍所致。其邪入
络与中络同法。牛黄丸、至宝丹。芳香利窍。可效。苏后用清凉血分。如连翘心、竹叶心、元参、细生地、鲜生地、二
冬之属。此症初起。大忌风药。初病暑热伤气。竹叶石膏汤。或清肺轻剂。大凡热深厥深。四肢逆冷。但看面垢齿燥。
二便不通。或泻不爽为是。大忌误认伤寒。秋深初凉。稚年发热咳嗽。与春月风温相似。而温自上受。燥自
上伤。理亦相等。均是肺气受病。世人误认暴感风寒。混投三阳发散津劫燥甚。喘急告危。若果暴凉外束。身热痰嗽。
只宜葱豉汤。或苏梗、前胡、杏仁、枳桔之属。仅一二帖亦可。更有粗工。亦知热病与泻白散加芩连之属。不知愈苦助
燥。
必增他变。当以辛凉甘润之方。气燥自平而愈。慎勿用苦燥劫烁胃液。秋燥一症。气分先受。治肺为急。若延数十日。
病必入血分。又非轻浮肺药可治。须审体症端。深秋入冬。暴冷折阳。外感发热。头疼身痛。呕恶。必从太阳。若渴能
饮水者。里热见症。即非纯以表散。伤寒每以风伤卫用桂枝法。寒伤营用麻黄法。小儿肌疏易汗。难任麻桂。辛温表邪。
太阳治法。轻则紫苏、防风一二味。身痛用羌活。然不过一剂。伤风症亦肺病为多。前、杏、枳、桔之属。辛胜即是汗
药。葱豉汤乃通用要方。若肢冷寒战。呕吐自利。或身无热。即从中寒里症。三阴须分。但小儿太阴中寒最多。厥阴间
有。若冬令应寒。气候温暖。当藏反泄。即能病。名曰冬温。温为欲热之渐。非寒症得汗即解。若涉表邪一二。里热必
兼七八。是瘾疹丹痧。非徒风寒。或外受之邪。与里邪相搏。亦令郁于经络。或饮醇浓味。里热炽烈。而卫气不与营气
相和。或不正直入内侵。即有腹痛下痢诸症。其治法必以里症为主。稍兼清散。设用辛温。祸不旋踵。至于痧痘时疠。
须分四气也。
Qian Yi said: Lethargy, hot breath from the mouth, yawning, and irritability indicate Wind-Cold Injury syndrome (Shang Feng Zheng). Head and eye pain accompanied by fear of people and aversion to cold indicates Cold Damage syndrome (Shang Han Zheng).
Zhang Yuansu said: When children are externally affected by Wind-Cold, presenting with muscle tension and spasms, yawning, dry and rough skin and hair, and hot breath from the mouth, dispersing methods should be used. In autumn and winter, warm-hot herbs are used; in spring and summer, cool-cold herbs are used.
Tan Shusheng said: Headache, body pain, nasal congestion with runny nose, coughing and sneezing, red cheeks, dry eyes, and a bluish color at the Shan Gen (root of the nose) all indicate injury by Wind-Cold. Da Qing Gao (Great Green Ointment) is suitable.
Chu Yushi said: For common cold due to Wind-Cold, Ren Shen Qiang Huo Tang (Ginseng and Notopterygium Decoction), Xing Xing San (Xing Xing Powder), and Shen Su Yin (Ginseng and Perilla Drink) are commonly used.
Wan Quan said: There are cases where Wind-Heat is involved simultaneously, or Wind is injured first followed by Heat, or Heat is encountered first followed by Wind, occurring simultaneously. It is crucial to assess the severity for treatment. Jie Geng Tang (Platycodon Decoction) and Re Yu Tang (Heat Stagnation Decoction) are suitable.
If it persists without healing, the child must be deficient, and dispersing/superficial-releasing methods must not be continued.
Li said: Wind injury results in runny nose, nasal congestion, and heavy voice. Wind injury syndromes mostly belong to the Lung. Dispersal with acrid-warm or acrid-cool herbs is appropriate. Dai Shi said: New onset of cough, nasal congestion, and heavy voice is this condition. Sweating with aversion to wind indicates true Wind sensation syndrome.
Wang Lü said: For pediatric Spring Warmth disease within three days, start with two doses of Xing Xing San. If unresolved after four to five days, with irritability, thirst, and vomiting, use Bai Zhu San (Atractylodes Macrocephala Powder). Spontaneous sweating and dry mouth require Zhi Bai Hu Tang (Prepared White Tiger Decoction).
After six to seven days, if stool is dry and constipated, use Si Shun Yin Zi (Four Smooths Drink) to purge. Severe fullness and hardness in the heart and abdomen require Niu Huang Tong Chang Wan (Calculus Bovis Intestine-Purging Pill) to purge. At the onset, if suspected as rash/pox, only Ge Gen Sheng Ma Tang (Pueraria and Cimicifuga Decoction) should be used to release the muscle layer.
Ye Tianshi said: Spring Warmth is a Fu Qi (Lagging Pathogen) syndrome. Ancients believed winter cold hides internally in the Shaoyin channel, emerging in spring into the Shaoyang channel, as spring wood corresponds internally to the Liver and Gallbladder. The cold pathogen is deeply hidden and has transformed into heat.
Ancients used Huang Qin Tang (Scutellaria Decoction) as the main formula, using bitter-cold herbs to directly clear interior heat. Heat hiding in the Yin aspect, bitter taste solidifies Yin; this is the correct treatment. One must know that Warm pathogens contraindicate dispersal; they do not follow the same methods as sudden exposure syndromes. If external pathogen is acquired first,
triggering latent interior heat, one must first use acrid-cool herbs to resolve the new pathogen, then proceed with bitter-cold herbs to clear interior heat. Moreover, heat is a formless qi. Pediatricians who use digestion-promoting and attacking methods for tangible pathogens often cause premature depletion of stomach fluids and exhaustion of yin fluids. Proposed reserve formulas for Spring Warmth: Huang Qin Tang, Liang Ge San (Cooling the Diaphragm Powder), Qing Xin Liang Ge San (Clear Heart Cooling Diaphragm Powder). If new pathogen triggers latent pathogen, use Cong Chi Tang (Scallion and Fermented Soybean Decoction). Spring Warmth stems from winter latent pathogens; pediatrics also encounters this.
Treatment follows general principles, but sudden exposures are more common. Symptoms like headache, aversion to cold, fever, panting, nasal congestion, heaviness of body, floating pulse, and no sweat can originally be treated with superficial release. Spring climate is mild and comfortable; acrid-warm herbs should be used sparingly. Yang meridian superficial-release herbs
are most forbidden from chaotic use. As for fever and cough with phlegm, only lung-targeted acrid-dispersing herbs are suitable. Xie Bai San (Draining White Powder) added with Qian Hu, Niu Bang Zi, Bo He, etc. Digestion-promoting herbs should be limited to one or two types. Wind-Warmth
occurs when the Lung is first affected by pathogen, then counter-transmits to the Pericardium. Treatment focuses on the Upper Jiao, differing from stomach-clearing purgative methods. Pediatricians unfamiliar with Hand Meridian diseases often lead to critical conditions. If cold-phlegm obstruction causes panting urgency and chest elevation,
the previous methods are contraindicated. Use San Bai (Three Whites) to induce vomiting. Spring warmth brings much Wind-Warmth. Warmth transforms to heat very rapidly. Dispersing Wind-Cold and promoting digestion deplete yin fluids, leading to rapid transformation symptoms. Proposed reserve formulas for Wind-Warmth:
Liang Ge San, Qing Xin Liang Ge San, Xie Bai San, Bai Hu Tang, Zhi Bao Dan, Qing Xin Niu Huang Wan, Yu's Qing Zao Jiu Fei Tang (Moistening Dryness Rescuing Lung Decoction by Yu). Disease before Summer Solstice is Wen (Warmth); after Summer Solstice is Re (Heat). Heat
is Shu (Summer Heat). Shu must combine with Dampness. Shu damages Qi aspect; Dampness also damages Qi. Sweating consumes Qi and damages Yang; stomach fluids are severely depleted, causing many variations. Zhang Fengkui said: Shu disease starts with acrid-cool,
follows with sweet-cold, then sour-astringent convergence; purgatives are unnecessary. This is concise and essential. Summer heat exposure causing coma resembling convulsions is called Shu Jue (Summer Heat Syncope), caused by heat closing orifices. Its entry into collaterals follows the same method as Zhong Luo (Stroke of Collaterals). Niu Huang Wan, Zhi Bao Dan, aromatic orifice-opening agents are effective. Su uses cooling blood-aspect herbs like Lian Qiao Xin, Zhu Ye Xin, Xuan Shen, Xi Sheng Di, Xian Sheng Di, Dong Er (Tian Dong and Mai Dong). At onset,
wind herbs are strictly contraindicated. Initial Shu-heat damages Qi; use Zhu Ye Shi Gao Tang (Schizonepeta and Gypsum Decoction) or light lung-clearing agents. Generally, deep heat leads to deep jue (cold limbs). Look for greasy face, dry teeth,
obstruction of urination and defecation, or unsatisfactory diarrhea to confirm. Strictly avoid misdiagnosing as Shang Han. Late autumn early cooling, children with fever and cough resemble Spring Wind-Warmth, but Warmth enters from above, Dryness injures from above; the principle is similar. Both involve Lung Qi pathology. People mistakenly diagnose sudden Wind-Cold exposure, indiscriminately administering Three Yang dispersing herbs,劫 (plundering) fluids, causing severe dryness, urgent panting. If truly bound by sudden cold with fever and phlegm-cough,
Cong Chi Tang is suitable. Or Su Geng, Qian Hu, Xing Ren, Zhi Ke, Jie Geng, etc. One or two doses suffice. Crude physicians know to use Xie Bai San with Huang Qin and Huang Lian for heat diseases, not realizing bitterness increases
dryness,
leading to other transformations. Acrid-cool and sweet-moist formulas should be used; qi-dryness will naturally level and heal. Never use bitter-dry herbs to scorch stomach fluids. Autumn Dryness syndrome affects the Qi aspect first; treating the Lung is urgent. If delayed for dozens of days,
pathogen enters Blood aspect, unmanageable by light-floating lung herbs. Constitution and symptoms must be carefully assessed. Late autumn to winter, sudden cold damages Yang, external contraction causes fever, headache, body pain, vomiting, nausea, starting from Taiyang. If thirsty and able to drink, interior heat signs appear; pure superficial release is not applicable. Shang Han uses Gui Zhi method for Wind damaging Wei, Ma Huang method for Cold damaging Ying. Children have loose skin and sweat easily, unable to tolerate Ma Huang and Gui Zhi. Acrid-warm superficial release,
Taiyang treatment: mild cases use Zi Su, Fang Feng one or two herbs. Body pain uses Qiang Huo. However, not exceeding one dose. Wind injury syndromes also mostly affect the Lung. Qian Hu, Xing Ren, Zhi Ke, Jie Geng, etc. Acrid superiority acts as sweating agent. Cong Chi Tang is a universal key formula. If cold limbs and chills, vomiting and spontaneous diarrhea, or no fever, it involves Middle Cold interior syndrome. Three Yin meridians must be distinguished. But children most frequently suffer Taiyin Middle Cold, occasionally Jueyin. If winter should be cold but climate is warm, storage turns to leakage,
illness occurs. Named Winter Warmth. Warmth is the gradual approach to heat, not resolved by sweating like cold syndromes. If exterior pathogen is minor (1-2 parts), interior heat is major (7-8 parts). This includes Erythema and Scarlet Fever, not merely Wind-Cold. External pathogens clashing with interior pathogens
may stagnate in collaterals. Rich flavors may cause intense interior heat, disrupting harmony between Wei and Ying qi, or upright qi failing to enter internally, resulting in abdominal pain and dysentery. Treatment must focus on interior syndrome, slightly combining clearing and dispersing. Using acrid-warm herbs would bring immediate disaster. Regarding scarlet fever, smallpox, and seasonal epidemics,
the Four Qi must be distinguished.