小儿时时好睡，乃脾虚困倦也，不必用温胆汤。睡中惊动不安，是心血虚而火动也。盖心虚则惊动，
宜清心、安神、养血、降痰。又胸膈有痰，亦作惊动；又脾胃有伤，郁滞不清，亦惊动不安。此又脾胃与痰
所致，非由心血也。宜消食、化痰，食去痰除，则补脾胃。
愚按前症若因心脾气虚有痰，宜用参、术、茯苓、五味以补心气；当归、芍药、枣仁以养心血；橘红、半
夏以开痰滞。若脾肺气虚，胸膈有痰，用补中益气汤以补中气；用胆星、天竺黄以化痰涎。若因饮食停滞
而作，用四君子汤以健脾胃；用山楂、神曲以消饮食。若因脾虚而好睡，用五味异功散以补脾气；当归、芍
药以生脾血。若因母饮酒致儿醉好睡者，以甘草、干葛煎汤解之；不应，用四君子汤。
杨永兴子，七岁，停食吐泻后好睡，睡中兼惊，久治不愈。余曰∶好睡是脾气虚困也，善惊是心血虚
怯也。盖心为母，脾为子也，此心火不能生脾土。用补中益气汤及六味丸加鹿茸治之而愈。
小儿若因出痘而生惊搐，不必治惊。若身热、耳冷、 冷，疑似未明，古方服升麻葛根汤；痘已出及
出完，调理气血。只根据丹溪痘疮法，分气血虚实，看红紫淡白、稠密稀疏，及参时令用药。常以脾胃为主，
虚寒用陈文秀温补法，实热用解毒法，全在活法通变。
愚按小儿痘疮，未出则补托之，已出及出完则调理之。更当察色、听声，辨其多寡、表里、虚实而治之，
庶不有误。世皆宗丹溪、钱氏、陈氏三家之论，又必会而通之，与时宜之，不致胶柱而鼓瑟也。窃谓黑陷、
耳冷、切牙、吐泻者，乃脾土虚败，寒水反来侮土归肾之恶候也。用百祥丸泻之，急以四君子、丁香、陈
皮、木香、浓朴、炮姜，以温补脾土，身热饮水，黑陷复起，十救一二。盖此症因脾土虚败，寒水乘侮，故
陈文秀先生云，若治寒水于既侮之后，何不保脾土于未败之先？此发前人之未发，救后世之误妄。况痘疮
发出、成脓、收靥，即痈疽起发、腐溃、生肌，皆脾土元
气使然。若黑陷、寒战、切牙、泄泻、喘嗽，即痈疽阳气脱陷、寒气内淫之阴症，急用异功散，倍参、
、归、术、姜、附温补脾胃，不可泥其日期，而行解毒、托里等法。但见其虚弱，便宜滋补脾胃，以
顾收靥。观丹溪先生治一叟，发热而昏倦，其脉大而似数，与参、 、归、术、陈皮大料，二十剂而痘出，
又二十剂而脓泡成，身无全肤，又六十剂而安，其义可见。
The child frequently desires sleep, which is due to Spleen Qi deficiency and fatigue; there is no need to use Wendan Tang (Phlegm-Resolving Decoction). Restlessness and startle during sleep indicate Heart Blood deficiency with hyperactive Fire. Since Heart Qi deficiency leads to startle, the treatment should focus on clearing Heart heat, calming the Spirit, nourishing Heart Blood, and descending Phlegm. Additionally, Phlegm in the chest and diaphragm can also cause startle; likewise, damage to the Spleen and Stomach with stagnant and unclear Qi mechanism also results in restlessness and startle. This condition is caused by Spleen-Stomach dysfunction and Phlegm, not by Heart Blood deficiency. One should first resolve food stagnation and transform Phlegm; only after the food stagnation is cleared and Phlegm removed should one tonify the Spleen and Stomach.
In my opinion, if the aforementioned symptoms are due to Heart-Spleen Qi deficiency with Phlegm, one should use Ren Shen (Ginseng Radix), Bai Zhu (Atractylodis Rhizoma), Fu Ling (Poria), and Wu Wei Zi (Schisandrae Fructus) to tonify Heart Qi; Dang Gui (Angelicae Sinensis Radix), Bai Shao (Paeoniae Radix Alba), and Suan Zao Ren (Ziziphi Spinosae Semen) to nourish Heart Blood; Ju Hong (Citri Reticulatae Pericarpium Rubrum) and Ban Xia (Pinelliae Rhizoma) to open Phlegm obstruction. If it is Spleen-Lung Qi deficiency with Phlegm in the chest and diaphragm, use Buzhong Yiqi Tang (Middle-Boosting Qi-Rescuing Decoction) to tonify Middle Qi; use Dan Xing (Arisaematis Cum Bile) and Tian Zhu Huang (Bambusae Concretio Silicea) to transform Phlegm-fluids. If caused by food stagnation, use Sijunzi Tang (Four Gentlemen Decoction) to strengthen the Spleen and Stomach; use Shan Zha (Crataegi Fructus) and Shen Qu (Massa Medicata Fermentata) to digest food. If caused by Spleen deficiency leading to hypersomnia, use Wuwei Yigong San (Five-Ingredient Extraordinary Merit Powder) to tonify Spleen Qi; combine with Dang Gui and Bai Shao to generate Spleen Blood. If the infant drinks excessively due to the mother's alcohol consumption, causing drunkenness and sleepiness, decoct Gan Cao (Glycyrrhizae Radix et Rhizoma) and Ge Gen (Puerariae Lobatae Radix) to resolve toxicity; if ineffective, use Sijunzi Tang.
Yang Yongxing’s son, seven years old, suffered from hypersomnia after food stagnation with vomiting and diarrhea, accompanied by startle during sleep, which persisted despite long-term treatment. I said: Hypersomnia indicates Spleen Qi deficiency and exhaustion; frequent startle indicates Heart Blood deficiency and timidity. The Heart is the Mother organ, and the Spleen is the Child organ; this case represents Heart Fire failing to generate Spleen Earth. Treatment with Buzhong Yiqi Tang combined with Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) plus Lu Rong (Cervi Cornu Pantotrichum) resulted in recovery.
If a child experiences convulsions and tremors due to smallpox, there is no need to specifically treat the convulsions. If the body is hot and ears are cold, with ambiguous symptoms, ancient formulas recommend taking Shengma Gegen Tang (Kudzu Root and Cimicifuga Decoction); once the rash has erupted or fully appeared, regulate Qi and Blood. One should strictly follow Danxi’s methods for smallpox, distinguishing between Qi and Blood deficiency and excess, observing whether the rash color is red-purple or pale-white, and whether distribution is dense or sparse, while adjusting medication according to the season. Generally, prioritize regulating the Spleen and Stomach; for deficiency-cold patterns, use Chen Wenxiu’s warming and tonifying method; for excess-heat patterns, use detoxification methods. Flexibility and adaptation are key.
In my view, for pediatric smallpox, before eruption, one should tonify and support the expulsion of toxins; after eruption and completion, one should regulate. Furthermore, one must observe complexion, listen to voice, and differentiate severity, exterior-interior status, and deficiency-excess to treat accordingly, thereby avoiding errors. The world generally reveres the theories of Danxi, Qian Yi, and Chen Zhongwen, but one must integrate them, adapt to seasonal changes, and avoid rigid adherence. I privately believe that black depression of the rash, cold ears, teeth grinding, vomiting, and diarrhea are ominous signs of Spleen Earth deficiency and collapse, where Cold Water counter-attacks Spleen Earth and returns to the Kidney. One should use Baixiang Wan (Hundred-Auspicious Pills) to purge; urgently use Sijunzi Tang plus Ding Xiang (Caryophylli Flos), Chen Pi (Citri Reticulatae Pericarpium), Mu Xiang (Aucklandiae Radix), Hou Po (Magnoliae Officinalis Cortex), and Pao Jiang (Zingiberis Rhizoma Preparatum) to warm and tonify Spleen Earth. If there is body heat and thirst, and the black depression lifts to re-emerge, one or two out of ten may be saved. This pathology arises because Spleen Earth is deficient and collapsed, allowing Cold Water to invade. Thus, Mr. Chen Wenxiu stated: "If one treats Cold Water after it has already invaded, why not protect Spleen Earth before it collapses?" This elucidates insights previously unexpressed by predecessors and saves later generations from erroneous practices. Moreover, the eruption, suppuration, and crusting of smallpox are analogous to the rising, ulceration, and flesh regeneration of carbuncles and sores, all driven by the primal Qi of Spleen Earth. If black depression, chills, teeth grinding, diarrhea, wheezing, and coughing occur, this corresponds to Yang Qi collapse and internal invasion of Cold pathogen in Yin syndromes of carbuncles. Urgently use Yigong San (Extraordinary Merit Powder) with doubled Ren Shen, Bai Zhu, Dang Gui, Huang Qi, Gan Jiang, and Fu Zi to warm and tonify the Spleen and Stomach. Do not adhere to disease timelines and apply detoxification or supporting methods. Whenever weakness is observed, one should promptly tonify and nourish the Spleen and Stomach to safeguard the crusting process. Observing Mr. Danxi’s treatment of an elderly man who had fever, drowsiness, and a large, rapid pulse, he administered a large dose of Ren Shen, Huang Qi, Dang Gui, Bai Zhu, and Chen Pi. After twenty doses, the rash emerged; after another twenty doses, pustules formed, leaving almost no intact skin; after sixty more doses, he recovered. The principle is evident here.