滑氏云∶小儿三岁以内，看男左女右，手虎口三关。纹色紫热红伤寒，青惊风，白疳病，黄色淡红，乃平
常小恙。其筋文宜藏，不宜暴露。若见黑色，则为危险。再脉纹见下截风关为轻，中截气关为重，上截命关尤
重耳，直透三关为大危。
叶天士曰∶婴儿肌肉柔脆，不耐风寒，六腑五脏气弱，乳汁难化，内外二因之病自多。然有非风寒，竟敢
外感，不停滞，已属内伤，其故何与？尝思人在气交之中，春夏地气之升，秋冬天令之降，呼去吸入，当时消
息。间有秽浊吸入，即是三焦受邪，过暮原直行中道，必发热烦躁。倘幼医但执前药，消导表散，清火通便，
病轻或有幸成，病重必然颠覆。钱仲阳云∶粪履不可近襁褓小儿，余言非无据矣。四十年来，治效颇多，略述
其概云。
春温一症，由冬令收藏未固。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，昔贤以黄芩汤为主方，苦寒直寝里热，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，幼医多用消
滞，攻治有形，胃汁先涸，阴液劫尽者多矣。
备用方∶黄芩汤、凉膈散、葱豉汤。新邪引动伏邪，清心凉膈散，服之亦愈。
风者，春月受风，其气已温。经谓春气病在头，治在上焦。肺位最高，邪必先伤，此手太阴气分先病，失
治则入手厥阴心包络，血分亦伤。盖足经顺传，如太阳传阳明，人皆知之。肺病先治，逆传心包络，幼科多不
知者。俗医见身热咳喘，不知肺病在上之旨矣，妄用大黄大苦沉降丸药，致脾胃阳和伤极，陡变惊痫，莫救者
多矣。
风温肺病，治在上焦。夫风温春温忌汗，初病投剂，宜用辛凉。若杂入消导发散，不但与肺病无涉，劫尽
胃汁，肺乏津液，上供头目，清窍徒为热气熏蒸，鼻干如煤，目瞑，或上窜无泪，或热深肢厥，或狂躁溺涩，
胸高气促，皆是肺气不宣化之征。斯时若以肺药，少加一味清降，使药力不致直趋肠中，而上痹可开，诸窍自
爽。无如城市庸医，佥云结胸，皆用连、蒌、柴、枳苦寒直降，致闭塞愈甚。若此症初因发热喘嗽，首用辛
凉清通上焦，如薄荷、连翘、牛蒡、象贝、桑叶、沙参、栀皮、蒌皮、花粉。若色苍热胜烦渴，用石膏、竹叶，
辛寒清散，疹症亦当宗此。若日数渐多，邪不得解，芩、连凉膈，亦可选用。至热邪逆入膻中，神昏目瞑，鼻
窍无涕泪，诸窍欲闭，其势危急，必用至宝丹，或牛黄清心丸。病减后余热，只甘寒清养胃阴足矣。
春日暴暖急冷，先受温邪，继为冷束，咳嗽痰喘最多。辛解燥湿只用一剂，大忌绝谷。若甚者，昼夜竖
抱勿倒三四日。夫轻为咳，重为喘，喘急则鼻掀胸挺。
备用方∶苇茎汤、凉心凉膈散、凉膈散、泻白散、葶苈大枣汤、白虎汤、至宝丹、清心牛黄丸、竹叶石
膏汤、喻氏清燥救肺汤。
夏为热病，然夏至以前，时令未为大热，故经以先夏至为病温，后夏至为病暑。二热之病，幼医易眩。夏
暑发自阳明，古人以白虎汤为主方。后贤刘河间创议迥出诸家，谓温热时邪，当分三焦投药，以苦辛寒为主。
长夏湿令，暑必兼湿，暑伤气分，湿亦伤气，汗则耗气伤阳，胃汁大受劫烁，变病由此甚多。发泄司令，里真
甚虚，张用逵云∶暑病首用辛凉，继用甘寒，再用酸泄酸敛，不必用下，可称要言不烦矣。
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、至宝丹，芳香利
窍可效。神苏以后，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，大忌误认伤寒也。
秋深初凉，稚年发热咳嗽证，与春月风温异。但温乃渐热之称，凉即渐冷之意。春月为病，犹冬藏固闭
之余，秋令感伤，恰值夏月发泄之后，（徐灵胎曰∶通人之言。）其体质之虚实不同，但温自上受，燥自上伤，
理亦相等，均是肺气受病。世人误认暴感寒，混投三阳发散津之属，仅一二剂亦可。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。当以清凉甘润之方，气燥自平而愈，慎勿用苦燥劫烁胃汁。
秋燥一症，气分先受，治肺为急。若延绵数十日之久，病必入血分，又非轻浮肺药可医。须审体质症端，
古谓治病当活泼泼地为盘走珠耳。
翁姓子方数月，秋燥潮热，咳嗽如疟，幼科用发散药，二日不效。忙令禁乳，（徐灵胎曰∶不禁可。）更医
用泻白散加芩、连。二日，昼夜烦热，喘而不咳，下痢粘腻，药后竟痢药水，延余诊之。余曰∶稚年以乳食为
命，饿则胃虚气馁，肺气更不爽矣。与玉竹、甘草、炒广皮、竹叶心，一剂热缓。继与粳米、南枣、广皮、甘
草、沙参，二剂与乳少进，令夜抱勿倒，三日痊愈。
深秋入冬，暴冷折阳，外感发热，头痛身痛，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，寒伤荣，用麻黄法。小儿肌疏易汗，难任麻、桂辛温，表邪太阳，治
用轻则紫苏、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，其葱豉汤，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。但小儿科
太阴中寒最多，厥阴间有。若冬令应寒，气候温暖，当藏反泄，即能致病，名曰冬温。温为欲热之渐，非比
寒症得汗而解。若涉表邪一二，里热必由七八。生瘾疹丹痧，非徒风寒。或外受之邪与里邪相搏，亦令入于经
络，或饮醇浓味，里热炽烈，而卫气不与荣分相和，或不正直入内侵，即有腹痛下痢诸症，其治法、按症，必
以里症为主。稍由清散，误用辛温，祸不旋踵矣。
钱氏《直诀》云∶心主惊，实则叫哭发热，饮水而搐。虚则卧而悸动不安。又视其睡，口中气昏，或合
面睡，及上窜切牙，皆心热也。若心气实，则喜仰卧。
肝主风，实则目直，大叫呵欠，项急烦闷。虚则切牙呵欠。肝热则手寻衣领及乱捻物，肚热，饮水喘闷，
目赤发搐。肝有风则目连札，得心热则发搐，或筋脉牵系而直视。风甚则身反张强直。不搐，心不受热也，
当补肾治肝。
脾主困，实则困睡，身热饮水。虚则吐泻生风，面白腹痛，口中气冷，不思饮食，或吐清水。或呵欠多睡
者，脾气虚而欲发惊也。
肺主喘，实则闷乱喘促，有饮水者，有不饮水者。虚则哽气，长出气。肺热则手掐眉目鼻面。肺盛复
感风寒，则胸满气急，喘嗽上气。肺脏怯，则唇白闷乱，气粗喘促。哽气者难治，肺虚甚也。
肾主虚，无实也，惟疮疹肾实则变黑陷。兹胎禀虚怯，神气不足，目无睛光，面白颅解，此皆难育不寿。
或更加色欲，变症百出，愈难救疗。或目畏明下窜者，盖骨重而身缩也。切牙者，肾水虚而不能制心火也。（以
上辨五脏虚实寒热。）
喜汗者，浓衣卧，而额汗出也。盗汗者，肌肉虚，而睡中汗出也。胃虚汗者，上至项，下至脐也。六阳虚
汗者，上至头，下至项，难治。
夜啼者，小儿筋骨血脉未成而多哭，脾脏冷而痛也。当与温中药，或花大膏主之。若虚怯为冷所乘则唇青。
惊啼者，邪气乘心也，当以安神丸主之。
若浴后拭脐不干，风入作疮，令儿撮口甚者，是脾虚也。若频撮口，是气不和也。并舌热者，胃脏微热。
令舌络牵紧，时时舒热，或饮水者，脾胃虚而津液少也。黄面、惯肌瘦、五心烦热者，疳积也。大便未已而
弄舌者凶。
解颅者，生下囟门不合也。长必多愁少笑，目白睛多，面色 白，或体消瘦，皆肾虚。胎肥者，生下丰浓，
目睛粉红，大便干难，时出涎水。
胎热者，生下有血色，时叫哭，身热淡黄，目睛多赤，大便色黄，急欲食乳，并用浴体法主之。
胎怯者，生下面白，肌肉瘦弱，大便白水，身无血色，哽气多哕，亦用浴体法。
急欲乳不能食者，此风邪由脐而蕴热心脾，致舌浓唇燥，不能吮乳也。
龟胸龟背者，由儿初生下，风客于脊，入于骨髓，致成龟背。若肺热胀满，攻于胸膈，即成龟胸。并用龟
尿点其骨节，自愈。（取尿法，用青莲叶，安龟在上，用镜照之，其尿自出。）
失音吐泻，或大便后，虽有声而不能言，又能咽物者，非失音，此肾怯不能上接于阳也。凡口噤不止，则
失音语迟。
长大不行，行则脚软，齿久不生，生则不固，发久不生，生则不黑，皆胎弱。（以上五脏杂症主治。）
徐灵胎曰∶幼科古人谓之哑科，以其不能言，而不知病之所在也，此特其一端耳。幼科之病，如变蒸胎惊
之类，与成人异者，不可胜举。非兹妇人之与男子异者，止经产数端也。古人所以另立专科，其说精详明备。
自初生以致成童，其病名不啻以百计，其治法立方，种种各别。又妇人之与男子病相同者，治亦相同。兹小儿
之与成人，即病相同者，治亦迥异。如伤食之症，反有用巴豆、硼砂者，其余诸症，皆用金石峻厉之药，特分
两极少耳，此古人真传也。后世不敢用，而以草木和平之药治之，往往迁延而死，此医者失传之故。至于调摄
之法，病家能知之者，千不得一。盖小儿纯阳之体，最宜清凉。今人非太暖，即太饱，而其尤害者，则在于有
病之后，而数与之乳。乳之为物，得热则坚，纫为绵絮。况儿有病，则食乳甚稀，乳久不食，则愈充满，一与
之吮，则迅疾踊出，较平日之下咽更多。前乳未消，新乳复充，填积胃口，化为顽痰，痰火相结，诸脉皆闭而
死矣。譬如常人，平日食饭几何，当病危之时，其食与平日不减，安有不死者哉？然嘱病家云∶乳不可食。则
寻相诟曰∶乳犹水也，食之何害？况儿虚如此，全赖乳养，兹复禁乳，则饿死矣。不但不肯信，反将医者诟骂。
其余之不当食而食，与当食而反不与之食，种种失宜，不可枚举。医者岂能坐守之，使事之合节耶？况明理之
医，能知调养之法者，亦百不得一，故小儿之所以难治，非尽不能言之故也。
保婴汤，治小儿诸病。陈米、（清胃。）黄土、（养脾。）嫩竹叶、（清热。）莱菔子、（化积。）薄荷
叶、（去风。）灯心、（降火。）麦芽。（运食。）上七味，随证所主者多用，其余次之。每服不过三钱，
袋盛煮汤，任意喝饮。如便燥者，调入白
蜜少许。小儿之病，多起于乳食不节，此汤调养脾胃，故可随症损益，以应诸病。若夏月泄泻，尤为妙方。即
痘疹后调理，亦宜准此，不可以平淡而忽之，而从事温补，致酿别症也。
雄按∶小儿以脾胃为后天根本，乳食不节，脾胃渐伤，吐泻乃作。久则脾土虚弱，肝木乘之，粪色渐青，
面部萎白带青，手足微搐无力，神气恹恹不振，而慢脾成矣。江笔花《医镜》云∶时俗所谓慢惊风，即木
侮土是也。初起宜异功散，甚者加木香、玉桂。若肢冷唇白，息微，元微欲脱也，急用附子理中汤，尚可
挽回。然变之速者，用药稍缓，即不济事，未可概视为慢也。雄按∶《福幼编》专论此症，若果系此证，
应用此药，乃谓执一方，而可通治泄泻，其祸可胜言哉。
天一丸，治小儿百病。灯心十斤，以米粉浆染，晒干研末，入水澄之，浮者为灯心，取出晒干，入药用二
两五钱，沉者为末，米粉不用。赤白茯苓去皮苗用，茯神各五两，滑石水飞五两，猪苓去皮二两，泽泻去芦
三两，五味各为细末。以潞参熬膏和丸，龙眼大，辰砂为衣，金箔包裹。每服一丸，随证用引调服。韩天爵云∶
小儿生理向上，本天一生水之妙，故治病以小水通利为快捷方式也。
程世光治宪王诞长子初生胎，不吮乳。程曰∶此明难产，儿伤气也。持人参煎汤灌半匙即吮。（《江西通志》。）
一舟工生子，脆而无皮，程令取土数升糁其体，即成肌。（同上文。）
太原王相公始生，冷无气，母惊，谓已死。有邻妪徐氏者，反复谛视良久，笑曰∶此俗名卧胞生，吾能
治之，当活，活则当贵，但不免多病，累阿母耳。趣使治之，其法用左手掬儿，右手掴其背，余时嚏下而醒。
后六岁中痘，公母尝下楼谒巫，见一白衣人，长丈许，闭立凝视，若有所言，母惊仆楼下，以为不详，然竟无
恙。（《眉公见闻录》。）
儿生堕地不啼，击水瓢迫猫令叫即啼。又俗称不啼儿为闷寂生，旁人呼其父名，父应，儿即啼。（《物理小识》。）
有舟人生子，身无全肤，人莫能晓。适吴门葛可久出，医众告之。可久就岸令作一坎，置儿其中，以细土
隔衾覆之，且戒勿动。久之，可久回，启衾视之，已生肤矣。盖母怀娠舟中，日久不登岸，失受土气故也。
按∶危《得效方》云∶宜速用白早米粉干扑，候生皮方止。
Hua Shou stated: For children under three years old, observe the three sections (Wind Gate, Qi Gate, Life Gate) on the tiger's mouth of the hand, left for boys and right for girls. A purple finger vein indicates heat, red indicates cold damage (Shanghan), green indicates convulsive disease (Jingfeng), white indicates malnutrition disease (Ganbing), while yellow or pale red indicates minor common ailments. The texture of the finger veins should be hidden rather than exposed. If black is seen, the condition is dangerous. Furthermore, if the vein appears in the lower section (Wind Gate), the illness is mild; in the middle section (Qi Gate), it is severe; in the upper section (Life Gate), it is particularly serious; and if it penetrates all three sections directly, it is extremely critical.
Ye Tianshi said: Infants have soft and fragile muscles that cannot withstand wind and cold. Their Qi in the six fu organs and five zang organs is weak, and milk is difficult to digest, so diseases caused by both internal and external factors are naturally frequent. However, some cases are not caused by wind and cold, yet they dare to contract external pathogens without stagnation, already constituting internal injury. What is the reason? I ponder that humans exist within the intersection of heaven and earth qi. In spring and summer, earth qi rises; in autumn and winter, heaven qi descends. With exhalation and inhalation, qi fluctuates accordingly. Occasionally inhaling turbid air means the San Jiao (Triple Burner) is invaded by pathogens. After passing through the evening, the pathogen originally travels straight along the central pathway, inevitably causing fever and irritability. If pediatric doctors only adhere to previous prescriptions, using methods of promoting digestion and resolving stagnation, releasing the exterior, clearing fire, and unblocking bowels, mild illnesses may recover by chance, but severe illnesses will inevitably worsen. Qian Zhongyang said: Feces should not be near infants in swaddling clothes. My words are not without basis. In forty years, many treatments have been effective; I briefly describe the general principles.
Spring-warmth (Chunwen) is caused by insufficient storage during winter. Ancients believed that winter cold hides internally in the Shaoyin channel, and emerges in spring in the Shaoyang channel, because spring wood corresponds internally to the liver and gallbladder. Cold pathogens hide deeply and have transformed into heat. Former sages used Huangqin Tang (Scutellaria Decoction) as the main formula, using bitter-cold herbs to directly quell interior heat. Heat hiding in the yin aspect, bitter taste strengthens yin, which is the correct treatment. One must know that warmth pathogens contraindicate dispersing methods, differing from sudden contraction categories. If a new external pathogen is contracted 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 formless qi. Pediatric doctors often use methods to eliminate stagnation and treat formful accumulations, leading to premature depletion of stomach fluids and exhaustion of yin fluids.
Alternative formulas: Huangqin Tang (Scutellaria Decoction), Liangge San (Cooling the Chest Powder), Congchi Tang (Scallion and Fermented Soybean Decoction). If new pathogens trigger latent pathogens, Qingxin Liangge San (Clear Heart Cooling Chest Powder) can also be effective.
Wind, contracted in spring, has already become warm. The classics state that spring diseases affect the head, and treatment focuses on the Upper Jiao (Upper Burner). The lung position is highest, so pathogens first injure it. This is a disease of the Hand-Taiyin Lung meridian qi level. If untreated, it transmits to the Hand-Jueyin Pericardium, injuring the blood level. The smooth transmission of foot meridians, such as Taiyang transmitting to Yangming, is well known. However, lung disease transmitting inversely to the Pericardium is unknown to many pediatricians. Empirical doctors seeing fever, cough, and asthma do not understand the principle that lung disease is located superiorly. They recklessly use Da Huang (Rhubarb Rhizome) and other bitter, heavy, sinking pills, severely damaging spleen and stomach yang harmony, suddenly transforming into convulsions and epilepsy, often incurable.
Wind-warmth lung disease is treated in the Upper Jiao. Wind-warmth and spring-warmth contraindicate sweating. Initial medication should use acrid-cool agents. If mixed with digestive and dispersing drugs, it not only fails to address lung disease but also exhausts stomach fluids, leaving lungs lacking in moisture to nourish the head and eyes. Clear orifices are merely steamed by hot qi, resulting in dry nose like coal, closed eyes, upward staring without tears, deep heat with cold limbs, mania, or dysuria. These are signs of lung qi failing to diffuse and transform. At this time, if lung herbs are used with just one clearing and descending agent, preventing the medicinal force from rushing directly to the intestines, upper obstruction can open, and orifices will refresh. Unfortunately, urban quacks all claim it is Jie Xiong (Chest Binding) and use Lian Qiao (Forsythia Fruit), Gua Lou (Trichosanthes Fruit), Chai Hu (Bupleurum Root), Zhi Shi (Immature Bitter Orange) to descend bitterly and coldly, worsening the blockage. If the initial symptoms are fever, wheezing, and coughing, start with acrid-cool agents to clear and unblock the Upper Jiao, such as Bo He (Mint Herb), Lian Qiao (Forsythia Fruit), Niu Bang Zi (Arctium Seed), Xiang Bei Mu (Fritillaria Bulb), Sang Ye (Mulberry Leaf), Sha Shen (Glehnia Root), Zhi Pi (Gardenia Peel), Lou Pi (Trichosanthes Peel), Hua Fen (Tien-Hua-Kin Root). If the complexion is dark, heat is intense, and thirst is烦渴 (irritable thirst), use Shi Gao (Gypsum Fibrosum) and Zhu Ye (Bamboo Leaf) for acrid-cold clearing and dispersing. Rash conditions should follow this method. If days pass and pathogens are not resolved, Qin Lian Liangge San (Scutellaria and Gardenia Cooling Chest Powder) can be selected. When heat pathogens reverse into the Dan Zhong (Chest Center), causing coma, closed eyes, no nasal discharge or tears, and closing orifices, the situation is critical. Zhibao Dan (Treasure Pill) or Niuhuang Qingxin Wan (Calculus Bovis Clearing Heart Pill) must be used. For residual heat after improvement, sweet-cold herbs to clear and nourish stomach yin are sufficient.
Sudden warmth followed by rapid cold in spring leads to wind pathogens contracted first, then bound by cold, causing most coughs and phlegm-wheezing. Acrid-releasing and drying-dampness methods should be used for only one dose. Starvation is strictly forbidden. If severe, hold the child upright day and night for three to four days without laying them down. Mild cases involve coughing, severe cases involve wheezing. Wheezing urgently causes nasal flaring and chest protrusion.
Alternative formulas: Weijing Tang (Reed Shoot Decoction), Liangxin Liangge San (Cool Heart Cooling Chest Powder), Liangge San (Cooling the Chest Powder), Xiebai San (Draining White Powder), Tingli Dazao Tang (Descurainia Seed and Jujube Decoction), Baihu Tang (White Tiger Decoction), Zhibao Dan (Treasure Pill), Qingxin Niuhuang Wan (Clear Heart Calculus Bovis Pill), Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction), Yu Shi Qingzao Jiufei Tang (Mr. Yu’s Dryness-Rescuing Lung-Decoction).
Summer is the season of heat diseases. However, before Summer Solstice, the climate is not yet intensely hot. Thus, the classics say diseases before Summer Solstice are Wen (Warmth), and after are Shu (Heat). These two heat diseases confuse pediatric doctors. Summer heat originates from the Yangming channel. Ancients used Baihu Tang (White Tiger Decoction) as the main formula. Later sages like Liu Hejian proposed distinct views, stating that warm-heat seasonal pathogens should be treated by differentiating the Three Jiao, primarily using bitter-acrid-cold herbs. In late summer, dampness commands, so heat must combine with dampness. Heat injures the qi level, and dampness also injures qi. Sweating consumes qi and damages yang, greatly roasting stomach fluids, leading to many complications. During the season of venting, true interior qi is very deficient. Zhang Yongkui said: Treat summer heat initially with acrid-cool, then sweet-cold, then sour-astringent and sour-dispersing. Purgatives are unnecessary. This is concise and essential.
Contracting heat in summer, coma resembling convulsions, is called Shu Jue (Summer Heat Syncope), caused by hot qi blocking orifices. The pathogen enters collaterals, treated similarly to Collateral Invasion. Niuhuang (Calculus Bovis) and Zhibao Dan (Treasure Pill), aromatic and orifice-opening, can be effective. After consciousness returns, use cooling blood-level herbs like Lianqiao Xin (Forsythia Heart), Zhuye Xin (Bamboo Leaf Heart), Xuanshen (Scrophularia Root), Xi Shengdi (Fine Rehmannia Root), Xian Shengdi (Fresh Rehmannia Root), Dong Gen (Asparagus Root) and Oudong (Ophiopogon Root). Initially, wind herbs are strictly contraindicated. Early summer heat injuring qi uses Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction) or light lung-clearing agents. Generally, deep heat causes deep cold limbs. Look for dirty face, dry teeth, blocked urination/defecation, or unsatisfactory diarrhea. This is correct; strictly avoid mistaking it for Cold Damage (Shanghan).
Deep autumn and early coolness, childhood fever and cough differ from spring wind-warmth. Warmth implies gradual heating; coolness implies gradual cooling. Spring illnesses are remnants of winter storage closure. Autumn injuries occur after summer venting. (Xu Lingtai said: Words of a wise person.) Constitution varies in deficiency and excess. Warmth enters from above, dryness injures from above; the logic is equal, both affecting lung qi. People mistakenly identify sudden cold contraction and indiscriminately use Three-Yang dispersing fluids. One or two doses may suffice. Crude doctors know it is heat but use Xiebai San (Draining White Powder) plus Huangqin (Scutellaria Root) and Lianqiao (Forsythia Fruit), not knowing bitterness aids dryness, causing further changes. Use cool-sweet-moistening formulas; qi dryness will flatten and heal. Do not use bitter-dry agents to scorch stomach fluids.
Autumn dryness affects the qi level first; treating the lung is urgent. If lingering for dozens of days, the disease enters the blood level, unmanageable by light lung herbs. Must assess constitution and symptoms. Ancients said treating disease should be lively, like a pearl rolling on a plate.
A child surnamed Weng, only months old, had autumn dryness tidal fever and malaria-like cough. Pediatricians used dispersing herbs for two days without effect. Urgently stopped breastfeeding. (Xu Lingtai noted: Not stopping would be fine too.) Another doctor used Xiebai San (Draining White Powder) plus Huangqin (Scutellaria Root) and Lianqiao (Forsythia Fruit). Two days later, day-night irritability and fever, wheezing without cough, sticky dysentery, even expelling medicine water after dosing. I examined him. I said: Infants rely on milk and food for life. Hunger causes stomach deficiency and qi collapse, making lung qi even more obstructed. Prescribed Yuzhu (Polygonatum Rhizome), Gancao (Licorice Root), Chao Guangpi (Stir-fried Tangerine Peel), Zhuyexin (Bamboo Leaf Heart). After one dose, fever eased. Then used Jingmi (Rice Grain), Nanzao (Southern Jujube), Guangpi (Tangerine Peel), Gancao (Licorice Root), Shashen (Glehnia Root). After two doses, small amounts of milk were taken. Held upright at night without laying down. Cured in three days.
Late autumn to winter, sudden cold breaks yang. External contraction causes fever, headache, body pain, vomiting, and nausea, starting from Taiyang. If thirsty and able to drink, interior heat signs appear; pure exterior release is not applicable. Cold damage often uses Guizhi Fa (Cinnamon Twig Method) for wind injuring Wei (Defensive) and Mahuang Fa (Ephedra Method) for cold injuring Ying (Nutritive). Children have loose skin, sweat easily, and cannot tolerate the acrid-warmth of Mahuang (Ephedra Herba) and Guizhi (Cinnamon Twig). For Taiyang exterior pathogens, use light Zisu (Perilla Leaf) and Fangfeng (Saposhnikovia Root), one or two doses. For body pain, use Qianghuo (Notopterygium Rhizome), but no more than one dose. Wind-cold often involves lung disease, using Qianhu (Peucedanum Root), Xingren (Apricot Seed), Zhike (Immature Bitter Orange), Jiegeng (Platycodon Root). Acrid-potent acts as sweating agent. Congchi Tang (Scallion and Fermented Soybean Decoction) is a universal key formula. If limbs are cold, shivering, vomiting, spontaneous diarrhea, or no fever, it is Middle-Cold interior syndrome; differentiate the Three Yin. Pediatric cases mostly involve Taiyin Middle-Cold, occasionally Jueyin. If winter should be cold but climate is warm, storing instead of venting causes disease, named Winter-Warmth. Warmth is the gradual onset of heat, unlike cold resolving with sweat. If involving one or two parts exterior, seven or eight parts interior heat exists. Erythema and scarlet fever are not solely wind-cold. External pathogens battling interior pathogens enter collaterals. Or drinking rich flavors causes intense interior heat, where Wei (Defensive) qi does not harmonize with Ying (Nutritive) qi. Or invading internally causes abdominal pain and dysentery. Treatment must focus on interior symptoms based on presentation. Slight clearing and dispersing, mistaken use of acrid-warmth brings immediate disaster.
Qian Yi's *Zhi Jue* states: Heart governs fright. Excess manifests as crying, fever, drinking, and convulsions. Deficiency manifests as lying down with palpitations and unrest. Observe sleep: foul breath, sleeping face down, upward staring, and grinding teeth indicate Heart Heat. If Heart Qi is excess, the child prefers supine position.
Liver governs wind. Excess manifests as staring straight, loud crying, yawning, neck stiffness, and irritability. Deficiency manifests as grinding teeth and yawning. Liver heat manifests as grasping collar, fidgeting, belly heat, drinking, wheezing, red eyes, and convulsions. Liver wind manifests as blinking eyes; combined with Heart heat, convulsions occur, or tendon pulling with staring. Severe wind causes opisthotonos and rigidity. No convulsions means Heart is not affected by heat; tonify Kidney and treat Liver.
Spleen governs fatigue. Excess manifests as drowsiness, fever, and drinking. Deficiency manifests as vomiting/diarrhea generating wind, pale face, abdominal pain, cold breath, anorexia, or vomiting clear fluid. Frequent yawning and sleeping indicate Spleen Qi deficiency predisposing to fright.
Lung governs wheezing. Excess manifests as chest oppression, confusion, and rapid breathing, with or without thirst. Deficiency manifests as choking gasps and long sighs. Lung heat manifests as pinching brows, eyes, nose, and face. Lung excess with wind-cold re-invasion causes chest fullness, urgency, wheezing, coughing, and rebellious qi. Lung deficiency manifests as pale lips, oppression, confusion, coarse breathing, and wheezing. Choking gasps are hard to treat, indicating severe Lung deficiency.
Kidney governs deficiency, having no excess, except when carbuncles/rashes turn black and sunken due to Kidney excess. Here referring to congenital weakness, lack of spirit, dull eyes, pale face, and open fontanelle, all indicating poor prognosis and short life. Adding sexual indulgence causes myriad changes, harder to save. Eyes fearing light and looking down indicate heavy bones and curled body. Grinding teeth indicates Kidney Water deficiency failing to control Heart Fire. (Above distinguishes Five Zang excess/deficiency and cold/heat.)
Spontaneous sweating: wearing thick clothes, sleeping, forehead sweating. Night sweats: muscle deficiency, sweating during sleep. Stomach deficiency sweating: from neck to navel. Six-Yang deficiency sweating: from head to neck, difficult to treat.
Night crying: infant bones/tendons/blood/vessels undeveloped, crying much, Spleen cold causing pain. Treat with warming herbs or Hua Da Gao. If deficiency/cold attacks, lips turn blue. Fright crying: pathogen attacking Heart, treat with Anshen Wan.
If umbilicus not dried after bathing, wind enters causing sores, child puckering mouth severely, indicates Spleen deficiency. Frequent puckering indicates Qi disharmony. Tongue heat indicates slight Stomach heat. Tongue tendons tight, frequently extending tongue, or drinking, indicates Spleen/Stomach deficiency and low fluids. Yellow face, habitual emaciation, five-center heat indicates Ganji (Malnutrition Accumulation). Tongue playing before defecation ends is ominous.
Jie Lu (Split Skull): fontanelle not closed at birth. Will likely be melancholic, little smiling, white sclera, pale face, or emaciated, all Kidney deficiency. Tai Fei (Fetal Fat): born plump, pink eyes, dry stool, salivation.
Tai Re (Fetal Heat): born with bloody discharge, crying, low-grade yellow fever, red eyes, yellow stool, eager to nurse. Treat with bathing methods.
Tai Qie (Fetal Weakness): born pale, emaciated, watery stool, no color, choking gasps, frequent hiccups. Treat with bathing methods.
Eager to nurse but unable: wind pathogen enters umbilicus, accumulating in Heart/Spleen, causing thick tongue and dry lips, unable to suck.
Gui Xiong (Turtle Chest) and Gui Bei (Turtle Back): wind lodges in spine entering marrow at birth, causing Turtle Back. Lung heat/fullness attacking chest/diaphragm causes Turtle Chest. Apply turtle urine to bone joints for self-healing. (Method: place turtle on lotus leaf, shine mirror, urine flows out.)
Loss of voice with vomiting/diarrhea, or after defecation, can make sound but not speak, can swallow: not loss of voice, but Kidney weakness failing to connect to Yang. Jaw locking causes loss of voice and delayed speech.
Delayed walking, weak legs, delayed tooth eruption, unstable teeth, delayed hair growth, black hair not appearing: all fetal weakness. (Above treats miscellaneous Five Zang diseases.)
Xu Lingtai said: Pediatrics was anciently called "Mute Department" because children cannot speak and location of disease is unknown. This is only one aspect. Pediatric diseases like Bian Zheng (Metamorphosis) and Tai Jing (Fetal Fright) differ vastly from adults. Not just gender differences in menstruation/childbirth. Ancients established separate specialty with detailed theories. From infancy to childhood, hundreds of disease names, various formulas. Diseases same as adults treated similarly. But even if diseases are same between child and adult, treatments differ greatly. E.g., Food Injury might use Radix Crotonis (Badou) or Borax. Other diseases use harsh mineral drugs in tiny doses. This is ancient truth. Later generations dared not use, using mild herbal drugs instead, leading to prolonged illness and death. This is lost medical transmission. Care methods known by families are rare. Children are Pure Yang bodies, best suited for cooling. Now people over-warm or over-feed. Most harmful is feeding milk after illness. Milk hardens when hot, tough as cotton. Sick children eat little; milk accumulates. Sucking forces it out faster than usual. Undigested old milk mixes with new, filling stomach, turning to stubborn phlegm. Phlegm-fire binds, meridians close, death ensues. Like adults eating normally while critically ill, how can they survive? Advising families to stop milk leads to abuse: "Milk is like water, what harm?" "Child is weak, relies on milk." "Starving to death." Families refuse belief, curse doctors. Indiscriminate feeding or withholding is endless. Doctors cannot sit and ensure proper rhythm. Even wise doctors knowing care are rare. Thus, pediatrics is difficult not just because of muteness.
Baoying Tang treats various pediatric diseases. Chen Mi (Aged Rice) clears stomach. Huang Tu (Yellow Earth) nourishes spleen. Nen Zhuye (Tender Bamboo Leaf) clears heat. Laifuzi (Radish Seed) resolves accumulation. Bohe Ye (Mint Leaf) removes wind. Dengxin (Juncus Effusus) descends fire. Maiya (Malt) moves food. Seven herbs, increase dosage based on symptoms, others secondary. Each dose max 3 qian, boil in bag, drink freely. If constipated, add honey. Pediatric diseases often start from irregular milk/food. This formula nourishes spleen/stomach, adaptable to symptoms. Especially good for summer diarrhea. Also suitable for post-smallpox recovery. Do not ignore as bland and use warming tonics, causing other diseases.
Xiong Note: Children rely on spleen/stomach as post-heaven root. Irregular milk/food gradually injures spleen/stomach, causing vomiting/diarrhea. Long-term spleen earth weakness allows liver wood to invade. Stool turns green, face withers with green tint, slight limb twitching, listless spirit, leading to Manpi Feng (Slow Spleen Wind). Jiang Bihua's *Yi Jing* says: Commonly called Slow Convulsion Wind, this is Wood insulting Earth. Start with Yigong San. Severe cases add Muxiang (Costus Root) and Yugui (Cinnamon Bark). If cold limbs, white lips, faint breath, yuan qi about to collapse, urgently use Fuzi Lizhong Tang (Aconite Regulate Middle Decoction) to salvage. Rapid changes require fast action; slow meds fail. Do not view all as slow. Xiong Note: *Fu You Bian* discusses this specifically. If confirmed, use these meds. Claiming one formula cures all diarrhea is disastrous.
Tianyi Wan treats hundred pediatric diseases. Dengxin (Juncus Effusus) 10 jin, dyed with rice flour paste, dried, ground. Wash in water. Floating part is Dengxin, take 2 liang 5 qian, dry for use. Sinking part is waste. Chi/Fu Ling (Poria) peeled, Fushen (Poria with Hostwood) each 5 liang. Huashi (Calcined Halloysite) water-flowered 5 liang. Zhuling (Polyporus) peeled 2 liang. Zexie (Alisma) de-stemmed 3 liang. Grind each finely. Mix with Luparen (Codonopsis) paste into pills, size of longan. Coat with Zhusha (Cinnabar), wrap in Jinbo (Gold Foil). One pill per dose, guide with symptom-specific decoction. Han Tianjue said: Infant physiology looks upward, following Heaven generates Water mystery. Treating via promoting urination is expedient.
Cheng Shiguang treated Prince Xian's eldest son, newborn not nursing. Cheng said: Difficult birth, child injured qi. Gave Ginseng decoction half spoon, immediately nursed. (*Jiangxi Tongzhi*.)
Boat worker's son, fragile without skin. Cheng ordered soil sprinkled on body, skin formed. (Same source.)
Taiyuan Lord Wang born cold, no breath, mother thought dead. Neighbor Xu laughed: Named Wo Bao Sheng (Womb-Birth). I can cure. Will live, be noble, but sickly, burdening mother. Cure: Left hand cupped child, right hand slapped back. Child sneezed and woke. Later age six, contracted smallpox. Parents visited shrine. Saw white-robed figure, ten feet tall, staring silently. Mother fell stairs, feared omen, but recovered. (*Meigong Jianwen Lu*.)
Newborn not crying: Hit gourd to scare cat to cry, baby cries. Also called Men Ji Sheng (Silent Birth). Call father's name, father answers, baby cries. (*Wuli Xiaoshi*.)
Boat man's son, incomplete skin. Wu doctor Ge Kejiu saw. Dug pit, placed child inside, covered with quilt separated by fine soil, warned not to move. Returned later, opened quilt, skin grown. Mother pregnant on boat, long time ashore, lost earth qi reception.
Note: Wei's *Dexiao Fang* says: Quickly use dry white rice flour powder, stop when skin forms.