仲阳云∶小儿虚羸，因脾胃不和，不能乳食，使肌体瘦弱，或大病后脾气尚弱，不能传化谷
气所致。若冷者时时下利，唇口清白；热者身温壮热，肌体微黄。更当审其形色，察其见证
。如面赤多啼，心之虚羸也；面青目札，肝之虚羸也；耳前后或耳下结核，肝经虚火也；颈
间肉里结核，食积虚热也；面黄痞满，脾之虚羸也；面白气喘，肺之虚羸也；目睛多白，肾
之虚羸也；仍审相胜而药之。又寒热二症，不可不辨。若腹痛泻利清白，不渴喜热，此属寒
症，虽在夏月，宜木香丸。身热烦躁，泻利焦黄，作渴喜冷，此属热症，虽在冬月，宜胡黄
连丸。皆舍时从症之治法也。
治验
一小儿十三岁，面赤惊悸发热，形体羸瘦，不时面白，嗳气下气，时常停食，服保和丸及清
热等药。余曰∶面赤惊悸，心神怯也；面白嗳气，心火虚也；大便下气，脾气虚也。此皆禀
心火虚，不能生脾土之危症，前药在所当禁者。不信，又服枳术丸、镇惊等药，而诸症益甚
，大便频数，小腹重坠，脱肛痰涎，饮食日少，余先用六君子汤为主，佐以补心丸，月余饮
食少进，痰涎少止，又用补中益气汤送四神而愈。毕姻后，病复作坠，时至仲冬，面白或黧
色，手足冷，喜食胡椒、姜物，腹中不热，脉浮按之微细，两尺微甚，乃用八味丸，元气复而形气渐
充。年至二十，苦畏风寒，面目赤色，发热吐痰，唇舌赤裂，食椒姜之物唇口即破，痰热愈
甚，腹中却不热，诊其脉或如无，或欲绝，此寒气逼阳于外，内真寒而外假热也，仍用八味
丸而诸症顿愈。
一小儿八岁，面常青色，或时色赤，日间目札，夜睡切牙，二年余矣，服清肝降火之药益甚
，形气日羸。余考绩到京，求治于余，曰∶肝主五色，入心则赤，自入则青，盖肝属木而生
风，故肝气为阳为火，肝血为阴为水，此禀肝肾精血不足，虚火内动，阴血益虚，虚而生风
，风自火出，故变面赤目札等症耳，非外风也。遂用地黄丸以滋肾水生肝木，两月目札切牙
悉止，又三月许诸症寻愈，而元气亦充矣。凡肝木之症，若肝木实热生风而自病，或肺金实
热而克木者，宜用清肝降火之剂，以泻其邪气。若肝经风热而目直等症，用柴胡栀子散以清
肝火；加味四物汤，以养肝血。若肾虚而切牙诸症，用六君子汤以健脾土；六味地黄丸以滋
肾水则愈。
一小儿脾气虚弱，饮食停滞，发热作渴，服泻黄散，不时下痢，余先用保和丸二服而愈；但
不食恶心，面青手冷，又用六君、柴胡、升麻四剂，面色痿黄，食进手温；惟形体羸甚，倦
怠发热，小腹重坠，肛门脱出，用补中益气汤加半夏、肉豆蔻二剂而安。凡脾胃之症，若发
热作渴，饮食喜冷，或泄泻色黄，睡不露睛者，属形病俱实，宜用泻黄散疏导之。若发热口干恶冷，
或泄泻色白，睡而露睛者，属形病俱虚，宜用异功散调补之。若脾气下陷者，补中益气汤。
寒水侮土者，益黄散。肝木克脾者，六君加柴胡。若目睛微动，潮热抽搐，吐泻不食，宜用秘旨保脾
汤。凡小儿诸病，先当调补脾胃，使根本坚固，则诸病自退，非药所能尽祛也。
一小儿五岁，形气虚羸，睡中切牙，夜间遗尿，日间频数，余以为禀肾气不足，用补中益气
汤加补骨脂、地黄丸加鹿茸，以补脾肾而痊。毕姻后，小便频数，作渴发热，日晡益甚，恪服黄柏、
知母等药，以滋阴降火。后患肾痿，卧床年许，余因考绩北上，仍用前药，喜其慎疾，半载
而痊。
一小儿年十一岁，面白或赤，足软不能久行，用地黄丸加鹿茸年许而瘥。毕姻后，两目羞明
，两足仍软，用前丸及补中益气汤而痊。后病复发，增口渴足热，头囟觉开，视物觉大，此
肾虚瞳人散
不能荣养，宜用地黄丸补之，有至七八岁，或十四五岁，气血既盛而自合。若纵盗色欲，戕
贼真阴，亦不尽其寿矣。
一小儿体素虚弱，患咳嗽痰涎，服化痰药而痰益甚，余以为脾虚食积，先用六君、神曲、山
楂渐愈。后伤风咳嗽，腹胀不食，泄泻酸臭，此食滞伤脾，而肺气虚也，用六君、桔梗而愈
。又饮食停滞，呕吐痰涎，喘嗽面白，余谓脾虚不能消化饮食而为痰，肺虚不能摄气归源而
作喘，仍用六君子汤而愈。大凡腠理不密，外邪所感而肺病者，因脾胃气虚不能相生，必用
六君子汤。若脾胃气实，大肠不利而肺病者，用泻黄散。若心火炎烁肺金而喘嗽者，用地黄
丸。
一小儿形瘦，不时咳嗽，自用参苏散一剂，更加喘急惊搐，面白或黄。余谓此禀脾肺不足，
而形气虚羸，因前剂峻利，外邪虽去而肺气益虚。肺虚则宜补脾，先用异功散加桔梗、钩藤
钩一剂，痰喘顿定；乃去桔梗，加半夏、当归，再剂惊搐亦去，又加酸枣仁治之而安。年十
五岁，发热痰盛，作渴面赤，形体羸瘦，用地黄丸加五味子及补中益气汤，各百余剂，而形
气渐壮。若认为阴火，用黄柏、知母等药，复伤生化之源，其亦不治者矣。
一小儿五岁，尚饮乳，耳前后颈间至缺盆，以手推寻，其筋结小核如贯珠，隐于肌肉之间，
小便不调，面色青黄，形气羸瘦，此禀母之肝火为患，用九味芦荟丸、五味异功散加山栀、
柴胡，与儿饮之；又以加味逍遥散，与母服之寻愈。
一小儿患虚羸，耳出秽水，左手尺关，洪数而无力，余为清肝补肾，耳中虽愈，脉未全敛。
毕姻后，患瘵症，误服黄柏、知母之类，复伤元气，不胜寒暑劳役，无日不病，几至危殆，
余大补脾肾，滋养元气而愈。
一小儿患症如前，肢体消瘦，面色痿黄，大便酸臭，此脾虚食积，用四味肥儿丸、五味异功
散，治之而愈。
一小儿体瘦腹大，寒热嗜卧，作渴引饮，以白术散为主，佐以四味肥儿丸，诸症渐愈，乃以
异功散、六味丸，月余而安。
一小儿患前症，身热如炙，此肝疳之症也，朝用异功散，夕用四味肥儿丸，诸症稍愈；佐以
蚵蟆丸，数服而痊。
一小儿停食发热，服芩、连、三棱等剂，饮食日少，胸腹膨胀，肢体羸瘦，余谓脾虚饮食停
滞元气复伤，先用补中益气汤加木香、钩藤钩，数剂渐愈；又用六君、炮姜，调理而安。
一小儿虚羸昏倦，咳嗽惊悸，自用参苏散一剂，更加喘急，此脾肺气虚而妄发表也，用惺惺
散微解外邪，调和胃气，诸症顿愈；但手足逆冷，又用六君子汤，调补元气而安。
一小儿九岁，吞酸恶食，肌体消瘦，腹中作痛，余谓食积虚羸也，用保和丸而愈。后腹中数
痛，皆服保和丸，余曰∶此因脾胃虚而饮食所伤也，当调补脾土，以杜后患。不信，后腹痛
喜按，余用五味异功散二剂，因未应，自用平胃散等药，腹胀作痛，余仍以异功散加木香四
剂而愈。若屡用攻伐之剂，阴损元气，多致虚羸，深可慎也。
参苓白术散 治脾胃虚弱，饮食少思，中满痞噎，心忪气喘，呕吐泄泻。
白扁豆（二两半，姜汁浸，去皮微炒） 人参 白茯苓 白术 甘草（炒） 山药（各三两半） 莲肉
桔梗（炒黄色） 薏苡仁 宿砂仁（各二两）
上为末，每服一钱，枣汤调下。
地黄丸（加肉桂一两，名加减八味丸） 治小儿肝经虚热血燥，或风客淫气，而患瘰 结核。或
四肢发搐，眠目抽动，痰涎上涌。又治肾疳，脑热消瘦，手足如冷，寒热往来，滑泻腹胀，口
鼻干渴，齿龈溃烂，爪黑面黧，遍身两耳生疮，或两耳出水，或发热自汗盗汗，便血诸血失
喑等症，其功不可尽述。（即六味地黄丸，方见肾脏）
补中益气汤 治中气虚弱，体疲食少，或发热烦渴等症。
人参 黄 （各八分） 白术 甘草 陈皮（各五分） 升麻 柴胡（各二分） 当归（一钱）
上姜枣水煎，空心午前服。
愚按∶前方若因药克伐，元气虚损，恶寒发热，肢体倦怠，饮食少思，或兼饮食劳倦，头痛
身热，烦躁作渴，脉洪大弦虚，或微细软弱，或寸关独甚者，宜用之。凡久病，或过服克伐
之剂，亏损元气，而虚症悉具者，最宜前汤。若母有脾胃不足之症，或阴虚内热，致儿为患
者，尤宜用之。
钱氏异功散 治脾胃饮食少思，吐泻不食，凡虚冷症，先与数服，以正胃气。（即五味异功散
见内钓）
愚按∶前方治脾胃虚弱，吐泻不食，或惊搐痰盛，或睡而露睛，手足指冷，或脾肺虚弱，咳
嗽吐痰，或虚热上攻，口舌生疮，弄舌流涎。若母脾胃虚，儿患此症，亦当服之。
四君子汤 治脾气虚损，吐泻少食，肌肉羸瘦。（方见内钓）
保和丸 治饮食停滞，胸膈痞满，嗳气吞酸，或吐泻腹痛。（加白术一两，即大安丸）
神曲（炒） 山楂 半夏 茯苓（各一两） 陈皮 连翘 萝卜子（炒，五钱）
上为末，粥丸，桐子大。每服三十丸，白汤送下。
愚按∶前方行气克滞之剂，若元气无亏，暴停乳食，而致斯症者，宜用此消导之。若元气虚
弱，而乳食所伤者，必调补胃气为主，而佐以消导。若乳食已消而作呕者，乃胃气被伤，当
用异功散补之，不宜仍用前药，重损胃气，治者审之。
肥儿丸 治肝疳食积，肢体消瘦，二便不调。
黄连 神曲 木香（各一两五钱） 槟榔（二十个） 肉豆蔻（二两煨） 使君子（酒浸去皮） 麦芽（各四两
上为末，神曲糊丸麻子大。每服二三十丸，米饮下。
愚按∶前方若食积五疳，发热口干，大便不调，小便不清，或颈项结核，发稀成穗，寒热作
渴，宜用之。若脾胃稍虚者，用五味异功散兼服。虚甚者，异功散为主，佐以前药。
枳术丸（方见癖块）
六君子汤（方见内钓）
四神丸（方见脱肛）
八味丸（方见肾脏）
柴胡栀子散
四物汤（二方见急惊）
九味芦荟丸（方见疳症）
加味逍遥散（方见内钓）
白术散（方见积滞）
虾蟆丸（方见疳症）
薛己（字新甫，号立斋，明代著名医家，此处“余”指薛己）说：小儿虚羸，是因为脾胃不和，不能消化乳食，导致肌体瘦弱；或者大病之后脾气尚且虚弱，不能运化水谷精微之气所致。如果属于寒证，则时常腹泻，嘴唇和口色清白；如果属于热证，则身体温热或壮热，肌体微微发黄。更应当审察其面色形态，观察其见证表现。例如：面赤多啼哭，是心的虚羸；面青、眼睛眨动频繁，是肝的虚羸；耳前耳后或耳下出现结核肿块，是肝经虚火所致；颈部肌肉间出现结核肿块，是食积引起的虚热；面黄且痞满胀闷，是脾的虚羸；面白且气喘，是肺的虚羸；眼白多黑睛少，是肾的虚羸。仍然要审察五行相克的关系来进行药物治疗。另外，寒证和热证两种症状，不可不加以辨别。如果腹痛、腹泻清稀、口不渴且喜欢热饮，这属于寒证，即使在夏季，也适宜用木香丸。如果身热烦躁、腹泻焦黄、口渴且喜欢冷饮，这属于热证，即使在冬季，也适宜用胡黄连丸。这都是舍弃季节因素而顺从病症表现的治法。
【治疗验案】
有一个十三岁的小儿，面赤、惊悸、发热，形体消瘦，不时面色发白，嗳气、排气，时常停食，服用保和丸及清热等药物。我说：面赤惊悸，是心神怯弱；面白嗳气，是心火虚衰；大便排气，是脾气虚弱。这些都是禀赋中心火虚衰，不能生助脾土的危重证候，前面的药物是在所禁忌的。患者不信，又服用枳术丸、镇惊等药物，结果各种症状更加严重，大便频数，小腹沉重下坠，脱肛、痰涎增多，饮食日渐减少。我首先用六君子汤为主方，佐以补心丸，一个月后饮食稍微增加，痰涎稍微停止；接着用补中益气汤送服四神丸，病愈。结婚后，病情复发并再次出现下坠感，时值仲冬，面色苍白或黧黑，手足冰冷，喜欢吃胡椒、姜类食物，腹中不觉热，脉象浮取微弱，沉取微细，两尺脉尤其微弱。于是用八味丸，元气恢复，形体气息逐渐充盈。到了二十岁，苦于畏惧风寒，面目赤色，发热吐痰，嘴唇舌头赤裂，吃椒姜类食物后唇口即破溃，痰热更加严重，但腹中却不热。诊其脉象有时如无，有时欲绝，这是寒气逼迫阳气外越，内里是真寒而外表是假热，仍然用八味丸，各种症状立刻痊愈。
有一个八岁的小儿，面色常呈青色，有时发红，白天眼睛眨动频繁，夜间睡觉磨牙，两年多了，服用清肝降火的药物后症状加重，形体气息日益消瘦。我到京城任职，求治于我。我说：肝主五色，入心则赤，自入则青。肝属木而生风，所以肝气为阳为火，肝血为阴为水。这是禀赋肝肾精血不足，虚火内动，阴血更加虚弱，因虚而生风，风自火出，所以出现面赤、目札等症状，并非外风所致。于是用地黄丸来滋补肾水生养肝木，两个月后目札、切牙全部停止，又过了三个月左右各种症状相继痊愈，元气也充盛了。凡是肝木的病证，如果是肝木实热生风而自病，或者肺金实热克制肝木者，适宜用清肝降火的药剂，以泻除邪气。如果是肝经风热导致眼睛直视等症状，用柴胡栀子散来清肝火；用加味四物汤来养肝血。如果是肾虚导致切牙等症状，用六君子汤来健脾土；用六味地黄丸来滋肾水，即可痊愈。
有一个小儿脾气虚弱，饮食停滞，发热作渴，服用泻黄散后，不时下痢。我首先用保和丸两服而愈；但不进食、恶心、面青手冷，又用六君子汤、柴胡、升麻四剂，面色转为萎黄，进食增加、手部转温；只是形体非常消瘦，倦怠发热，小腹沉重下坠，肛门脱出，用补中益气汤加半夏、肉豆蔻二剂而安定。凡是脾胃的病证，如果发热作渴，饮食喜冷，或者泄泻颜色黄，睡觉不露眼睛的，属于形病俱实，适宜用泻黄散疏导。如果发热口干恶冷，或者泄泻颜色白，睡觉露眼睛的，属于形病俱虚，适宜用异功散调补。如果是脾气下陷者，用补中益气汤。寒水侮土者，用益黄散。肝木克制脾土者，用六君子汤加柴胡。如果眼睛轻微转动，潮热抽搐，吐泻不食，适宜用秘旨保脾汤。凡是小儿各种疾病，首先应当调补脾胃，使根本坚固，那么各种疾病自然消退，不是单靠药物所能完全祛除的。
有一个五岁的小儿，形体气息虚羸，睡中磨牙，夜间遗尿，日间尿频。我认为这是禀赋肾气不足，用补中益气汤加补骨脂、地黄丸加鹿茸，以补脾肾而痊愈。结婚后，小便频数，作渴发热，傍晚时分更加严重，严格服用黄柏、知母等药物，以滋阴降火。后来患肾痿，卧床一年多。我因考绩北上，仍然用前面的药物，庆幸他谨慎对待疾病，半年后痊愈。
有一个十一岁的小儿，面色白或红，脚软不能久行，用地黄丸加鹿茸一年左右而病愈。结婚后，两眼羞明，双脚仍然软弱，用前面的药丸及补中益气汤而痊愈。后来病情复发，增加口渴足热，头囟感觉张开，视物觉得变大，这是肾虚瞳人散大，不能荣养所致，适宜用地黄丸补之，有的到七八岁，或者十四五岁，气血既盛而自然愈合。如果放纵盗色欲，戕害真阴，也不能尽其天年了。
有一个小儿体质素来虚弱，患咳嗽痰涎，服用化痰药后痰反而更多。我认为这是脾虚食积，先用六君子汤、神曲、山楂逐渐治愈。后来伤风咳嗽，腹胀不食，泄泻酸臭，这是食滞伤脾，而肺气虚，用六君子汤、桔梗而愈。又有饮食停滞，呕吐痰涎，喘嗽面白，我认为这是脾虚不能消化饮食而为痰，肺虚不能摄气归源而作喘，仍然用六君子汤而愈。大凡腠理不密，外邪所感而致肺病者，因为脾胃气虚不能相生，必须用六君子汤。如果脾胃气实，大肠不利而致肺病者，用泻黄散。如果心火炎烁肺金而喘嗽者，用地黄丸。
有一个小儿形体消瘦，不时咳嗽，自用参苏散一剂，更加喘急惊搐，面白或黄。我认为这是禀赋脾肺不足，而形气虚羸，因为前面的药剂峻利，外邪虽去而肺气更加虚弱。肺虚则宜补脾，先用异功散加桔梗、钩藤一剂，痰喘立刻安定；然后去掉桔梗，加半夏、当归，再剂后惊搐也去除，又加酸枣仁治疗而安定。十五岁时，发热痰盛，作渴面赤，形体消瘦，用地黄丸加五味子及补中益气汤，各百余剂，而形气逐渐强壮。如果认为是阴火，用黄柏、知母等药物，会再次损伤生化之源，那就不可治了。
有一个五岁的小儿，还在吃奶，耳前后颈间至缺盆，用手推寻，筋结小核如串珠，隐于肌肉之间，小便不调，面色青黄，形气消瘦，这是禀受母亲的肝火为患，用九味芦荟丸、五味异功散加山栀、柴胡，给小儿饮用；又以加味逍遥散，给母亲服用，很快痊愈。
有一个小儿患虚羸，耳出秽水，左手尺关脉洪数而无力，我为其清肝补肾，耳中虽然痊愈，脉象未全收敛。结婚后，患瘵症（肺结核），误服黄柏、知母之类，再次损伤元气，不胜寒暑劳役，无日不病，几乎至危殆，我大补脾肾，滋养元气而愈。
有一个小儿患症如前，肢体消瘦，面色萎黄，大便酸臭，这是脾虚食积，用四味肥儿丸、五味异功散，治疗而愈。
有一个小儿体瘦腹大，寒热嗜卧，作渴引饮，以白术散为主，佐以四味肥儿丸，各种症状逐渐痊愈，乃以异功散、六味地黄丸，一个月左右而安定。
有一个小儿患前症，身热如炙，这是肝疳的病证，早晨用异功散，晚上用四味肥儿丸，各种症状稍愈；佐以蚵蟆丸，几次服用而痊愈。
有一个小儿停食发热，服用黄芩、黄连、三棱等药剂，饮食日渐减少，胸腹膨胀，肢体消瘦。我认为这是脾虚饮食停滞，元气复伤，先用补中益气汤加木香、钩藤，几剂后逐渐痊愈；又用六君子汤、炮姜，调理而安。
有一个小儿虚羸昏倦，咳嗽惊悸，自用参苏散一剂，更加喘急，这是脾肺气虚而妄用发表药，用惺惺散微解外邪，调和胃气，各种症状立刻痊愈；但手足逆冷，又用六君子汤，调补元气而安。
有一个九岁的小儿，吞酸恶食，肌体消瘦，腹中作痛，我认为这是食积虚羸，用保和丸而愈。后来腹中多次疼痛，都服用保和丸。我说：这是因为脾胃虚而饮食所伤，应当调补脾土，以杜绝后患。患者不信，后来腹痛喜按，我用五味异功散二剂，因为未见效，自用平胃散等药，腹胀作痛，我仍以异功散加木香四剂而愈。如果屡用攻伐的药物，阴损元气，多导致虚羸，深可慎重啊。
参苓白术散：治疗脾胃虚弱，饮食少思，中满痞噎，心忪气喘，呕吐泄泻。
配方：白扁豆（二两半，姜汁浸，去皮微炒）、人参、白茯苓、白术、甘草（炒）、山药（各三两半）、莲肉、桔梗（炒黄色）、薏苡仁、缩砂仁（各二两）。
用法：以上研为末，每服一钱，枣汤调下。
地黄丸（加肉桂一两，名加减八味丸）：治疗小儿肝经虚热血燥，或风客淫气，而患瘰疬结核。或四肢发搐，眠目抽动，痰涎上涌。又治肾疳，脑热消瘦，手足如冷，寒热往来，滑泻腹胀，口鼻干渴，齿龈溃烂，爪黑面黧，遍身两耳生疮，或两耳出水，或发热自汗盗汗，便血诸血失喑等症，其功效不可尽述。（即六味地黄丸，方见肾脏）
补中益气汤：治疗中气虚弱，体疲食少，或发热烦渴等症。
配方：人参、黄芪（各八分）、白术、甘草、陈皮（各五分）、升麻、柴胡（各二分）、当归（一钱）。
用法：以上用姜枣水煎，空心午前服。
按语：前方如果是因为药物克伐，元气虚损，恶寒发热，肢体倦怠，饮食少思，或兼饮食劳倦，头痛身热，烦躁作渴，脉洪大弦虚，或微细软弱，或寸关独甚者，适宜使用。凡是久病，或过服克伐之剂，亏损元气，而虚症悉具者，最适宜前方。如果母亲有脾胃不足之症，或阴虚内热，导致儿子患病者，尤其适宜使用。
钱氏异功散：治疗脾胃饮食少思，吐泻不食，凡虚冷症，先与数服，以正胃气。（即五味异功散，见内钓）
按语：前方治疗脾胃虚弱，吐泻不食，或惊搐痰盛，或睡而露睛，手足指冷，或脾肺虚弱，咳嗽吐痰，或虚热上攻，口舌生疮，弄舌流涎。如果母亲脾胃虚，儿子患此症，也应当服用。
保和丸：治疗饮食停滞，胸膈痞满，嗳气吞酸，或吐泻腹痛。（加白术一两，即大安丸）
配方：神曲（炒）、山楂、半夏、茯苓（各一两）、陈皮、连翘、萝卜子（炒，五钱）。
用法：以上研为末，粥丸，桐子大。每服三十丸，白汤送下。
按语：前方是行气克滞的药剂，如果元气无亏，暴停乳食，而导致此症者，适宜用此消导。如果元气虚弱，而乳食所伤者，必须调补胃气为主，而佐以消导。如果乳食已消而作呕者，乃是胃气被伤，应当用异功散补之，不宜仍用前药，重损胃气，医者审慎。
肥儿丸：治疗肝疳食积，肢体消瘦，二便不调。
配方：黄连、神曲、木香（各一两五钱）、槟榔（二十个）、肉豆蔻（二两煨）、使君子（酒浸去皮）、麦芽（各四两）。
用法：以上研为末，神曲糊丸麻子大。每服二三十丸，米饮下。
按语：前方如果食积五疳，发热口干，大便不调，小便不清，或颈项结核，发稀成穗，寒热作渴，适宜使用。如果脾胃稍虚者，用五味异功散兼服。虚甚者，异功散为主，佐以前药。
枳术丸（方见癖块）
六君子汤（方见内钓）
四神丸（方见脱肛）
八味丸（方见肾脏）
柴胡栀子散
四物汤（二方见急惊）
九味芦荟丸（方见疳症）
加味逍遥散（方见内钓）
白术散（方见积滞）
虾蟆丸（方见疳症）
Xue Ji (a famous Ming Dynasty physician, here referred to as "I") stated: Pediatric Xu Lei (deficiency and emaciation) is caused by disharmony of the Spleen and Stomach, leading to an inability to digest milk and food, resulting in a weak body; or it occurs after a severe illness when the Spleen Qi is still weak and unable to transform grain qi. If it belongs to Cold patterns, there is frequent diarrhea with clear lips and mouth color; if it belongs to Heat patterns, there is warm or high fever with slightly yellowish skin. One must further examine the facial appearance and observe the manifestations. For instance: red face with frequent crying indicates Heart Xu Lei; blue face with frequent blinking of eyes indicates Liver Xu Lei; tubercles behind or below the ears indicate deficient fire of the Liver channel; tubercles in the neck muscles indicate deficiency heat from food stagnation; yellow face with fullness and distension indicates Spleen Xu Lei; pale face with asthma indicates Lung Xu Lei; eyes with excessive white sclera indicate Kidney Xu Lei. Treatment should still be guided by the principles of mutual overcoming among the Five Elements. Furthermore, one must distinguish between Cold and Heat patterns. If there is abdominal pain, clear diarrhea, no thirst, and preference for hot drinks, this belongs to Cold patterns; even in summer, Muxiang Wan (Aucklandia Pill) is appropriate. If there is fever, irritability, dark yellow diarrhea, thirst, and preference for cold drinks, this belongs to Heat patterns; even in winter, Huhuanglian Wan (Picrorhiza Pill) is appropriate. These are treatment methods that set aside seasonal factors to follow the symptoms.
[Case Records]
A thirteen-year-old boy presented with a red face, palpitations, fever, emaciation, occasional pallor, belching, flatus, and frequent food stagnation. He had taken Baohe Wan (Harmonize the Stomach Pill) and heat-clearing medicines. I said: Red face and palpitations indicate timidity of the Heart Spirit; pallor and belching indicate deficiency of Heart Fire; flatus indicates deficiency of Spleen Qi. These are critical conditions due to congenital deficiency of Heart Fire failing to generate Spleen Earth. The previous medications were contraindicated. The patient did not believe me and took Zhizhu Wan (Immature Bitter Orange and Atractylodes Pill) and calming medicines, causing all symptoms to worsen: frequent stools, heavy sensation in the lower abdomen, rectal prolapse, increased phlegm-saliva, and decreased appetite. I first used Liujunzi Tang (Six Gentlemen Decoction) as the main formula, assisted by Buxin Wan (Tonify the Heart Pill). After one month, appetite slightly improved, and phlegm-saliva decreased. Then, using Buzhong Yiqi Tang (Decoction to Supplement the Middle and Augment the Qi) administered with Sishen Wan (Four Spirits Pill), he recovered. After marriage, the disease relapsed with prolapse again. It was mid-winter; his face was pale or dark, hands and feet were cold, he preferred pepper and ginger, felt no heat in the abdomen, and his pulse was floating and faint on superficial pressure, fine and weak on deep pressure, especially at the Chi positions. I then used Bawei Wan (Eight-Ingredient Pill). His Yuan Qi (Original Qi) recovered, and his physical constitution gradually filled up. At age twenty, he suffered from aversion to wind and cold, red face and eyes, fever with expectoration, cracked red lips and tongue, and lip/mouth sores after eating spicy foods. Phlegm-heat was severe, but the abdomen felt cool. His pulse was sometimes imperceptible or nearly absent. This indicated cold forcing Yang outward, true cold inside and false heat outside. Using Bawei Wan again, all symptoms resolved immediately.
An eight-year-old boy had a persistently blue face, occasionally red, frequent eye blinking during the day, and teeth grinding at night, lasting over two years. Taking liver-clearing and fire-draining medicines worsened his condition, leading to daily decline in form and Qi. Seeking my treatment in Beijing, I said: The Liver governs the five colors; entering the Heart makes it red; its own color is blue. The Liver belongs to Wood and generates Wind. Thus, Liver Qi is Yang/Fire, and Liver Blood is Yin/Water. This case resulted from congenital insufficiency of Liver-Kidney essence and blood, causing internal movement of deficient fire, further depleting Yin blood. Deficiency generates wind, and wind arises from fire, hence the red face and eye blinking, not external wind. I used Dihuang Wan (Rehmannia Pill) to nourish Kidney Water to generate Liver Wood. After two months, eye blinking and teeth grinding stopped. After another three months, all symptoms resolved, and Yuan Qi became robust. For Liver Wood disorders, if caused by excess heat generating wind internally, or by excess heat of Lung Metal overcoming Wood, use liver-clearing and fire-draining agents to drain pathogenic factors. For Liver channel wind-heat causing staring eyes, use Chaihu Zhizi San (Bupleurum and Gardenia Powder) to clear Liver fire; Jiawei Siwu Tang (Modified Four Substances Decoction) to nourish Liver blood. For Kidney deficiency causing teeth grinding, use Liujunzi Tang to strengthen Spleen Earth; Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) to nourish Kidney Water.
A boy with weak Spleen Qi, food stagnation, fever, and thirst took Xiehuang San (Drain the Yellow Powder) and developed intermittent dysentery. I first cured him with two doses of Baohe Wan. However, due to anorexia, nausea, blue face, and cold hands, I prescribed six doses of Liujunzi Tang, Chai Hu (Bupleuri Radix), and Sheng Ma (Cimicifugae Rhizoma). His complexion turned sallow, appetite increased, and hands warmed. Due to severe emaciation, fatigue, fever, heavy lower abdomen, and rectal prolapse, I used Buzhong Yiqi Tang with Banxia (Pinelliae Rhizoma) and Roudoukou (Myristicae Semen) for two doses, bringing stability. For Spleen-Stomach disorders: fever/thirst preferring cold, yellow diarrhea, eyes closed during sleep indicate excess form and disease; use Xiehuang San to guide out stagnation. Fever/dry mouth/aversion to cold, white diarrhea, eyes open during sleep indicate deficiency form and disease; use Yigong San (Yi Gong Powder) to regulate and tonify. For sinking of Spleen Qi, use Buzhong Yiqi Tang. For Cold Water insulting Earth, use Yihuang San. For Liver Wood insulting Spleen, use Liujunzi Tang plus Chai Hu. For slight eye movements, tidal fever, convulsions, vomiting/diarrhea/anorexia, use Mizhi Baopi Tang. Generally, pediatric diseases require first regulating and tonifying the Spleen and Stomach to solidify the root; then diseases recede naturally, not solely by drugs.
A five-year-old boy with weak form and Qi, teeth grinding in sleep, nocturnal enuresis, and daytime frequency was diagnosed with congenital Kidney Qi deficiency. I used Buzhong Yiqi Tang plus Buguzhi (Evodiae Fructus) and Dihuang Wan plus Lurong (Cervi Cornu Colla) to tonify Spleen and Kidney, leading to recovery. After marriage, he had frequent urination, thirst, fever (worse in afternoon), and strictly took Huangbai (Phellodendri Cortex) and Zhimu (Anemarrhenae Rhizoma) to nourish Yin and drain fire. Later, he developed Kidney Wei (impotence/wasting), bedridden for a year. I used the previous prescriptions while traveling north; he was cautious with his illness, recovering in half a year.
An eleven-year-old boy with pale or red face and weak legs unable to walk long distances took Dihuang Wan plus Lurong for a year until recovery. After marriage, photophobia and leg weakness persisted; treated with the previous pill and Buzhong Yiqi Tang until recovery. Relapse brought thirst, hot feet, open fontanelle sensation, and macropsia. This was due to Kidney deficiency causing pupil dilation and failure to nourish. Dihuang Wan was used. Some recover spontaneously around ages 7-8 or 14-15 when Qi and Blood are abundant. Indulgence in sexual activity damages True Yin and shortens lifespan.
A boy with inherent weakness, cough, and phlegm-saliva worsened with expectorants. Diagnosed as Spleen deficiency with food stagnation, I used Liujunzi Tang, Shenqu (Medicated Leaven), and Shanzha (Crataegi Fructus) for gradual improvement. Later, wind-cold cough, abdominal distension, anorexia, and sour-smelling diarrhea indicated food stagnation injuring Spleen and Lung Qi deficiency. Treated with Liujunzi Tang and Jiegeng (Platycodonis Radix) to cure. Another case of food stagnation, vomiting phlegm, asthma, pale face indicated Spleen deficiency failing to digest food into phlegm, and Lung deficiency failing to grasp Qi. Treated with Liujunzi Tang to cure. Generally, for exterior pathogens affecting the Lung due to loose pores, caused by Spleen-Stomach Qi deficiency failing to generate, Liujunzi Tang is essential. For Spleen-Stomach excess with Large Intestine obstruction affecting the Lung, use Xiehuang San. For Heart Fire scorching Lung Metal causing asthma/cough, use Dihuang Wan.
A thin boy with intermittent cough took Sansu San (Ginseng and Perilla Powder) once, worsening with asthma, convulsions, and pale/yellow face. Diagnosed as congenital Spleen-Lung insufficiency and weak form/Qi, exacerbated by the harsh nature of the previous prescription which expelled exterior pathogens but further weakened Lung Qi. Since Lung deficiency requires tonifying Spleen, I first used Yigong San with Jiegeng and Gouteng (Uncariae Ramulus cum Uncis) for one dose, settling phlegm-asthma. Then removed Jiegeng, added Banxia and Danggui (Angelicae Sinensis Radix); after two doses, convulsions ceased. Added Suanzaoren (Ziziphi Spinosae Semen) for stabilization. At age fifteen, fever, profuse phlegm, thirst, red face, and emaciation were treated with Dihuang Wan plus Wuweizi (Schisandrae Fructus) and Buzhong Yiqi Tang, each over a hundred doses, strengthening form and Qi. Mistaking this for Yin fire and using Huangbai/Zhimu would damage the source of transformation and become incurable.
A five-year-old boy still breastfeeding had nodules like beads under the skin behind ears, neck, to clavicle, irregular urination, blue-yellow face, and emaciation. This was attributed to maternal Liver fire transmitted to the child. The child drank Jiwei Lvhui Wan (Nine-Ingredient Aloe Pill) and Wuyi Yigong San (Five-Agent Yi Gong Powder) with Zhizi (Gardeniae Fructus) and Chai Hu. The mother took Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder). Both recovered quickly.
A boy with Xu Lei had foul-smelling ear discharge. Left Chi/Guan pulses were surging, rapid, and empty. I cleared Liver and tonified Kidney. Ears healed, but pulses remained unconsolidated. After marriage, he developed Zhai Syndrome (consumptive disease/tuberculosis), mistakenly taking Huangbai/Zhimu, further damaging Yuan Qi. Unable to withstand cold/heat/work, he was constantly ill, near death. I greatly tonified Spleen and Kidney, nourishing Yuan Qi until recovery.
Another boy with similar symptoms had emaciation, sallow face, and sour-smelling stool. Diagnosed as Spleen deficiency with food stagnation, treated with Siwei Fei'er Wan (Four-Ingredient Fattening Child Pill) and Wuyi Yigong San to cure.
A boy with thin body, large abdomen, alternating chills/fever, lethargy, thirst, and drinking water took Baizhu San (Atractylodes Macrocephala Powder) as main, assisted by Siwei Fei'er Wan. Symptoms gradually improved, then stabilized with Yigong San and Liuwei Dihuang Wan over a month.
A boy with previous symptoms had intense fever, diagnosed as Gan Syndrome of the Liver (Liver Wasting). Morning: Yigong San; Evening: Siwei Fei'er Wan. Symptoms slightly improved. Assisted by Hemawa Wan (Toad Pill), cured after several doses.
A boy with food stagnation fever took Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Sanleng (Sparganii Rhizoma), etc., leading to decreased appetite, chest/abdominal distension, and emaciation. Diagnosed as Spleen deficiency with food stagnation re-injuring Yuan Qi. First used Buzhong Yiqi Tang with Muxiang (Aucklandiae Radix) and Gouteng for several doses until improvement. Then regulated with Liujunzi Tang and Paojiang (Prepared Ginger) to stabilize.
A boy with Xu Lei, drowsiness, cough, palpitations took Sansu San once, worsening with asthma. Diagnosed as Spleen-Lung Qi deficiency with inappropriate sweating method. Used Xingxing San (Stupor-Dispelling Powder) to mildly resolve exterior pathogens and harmonize Stomach Qi; symptoms resolved. But with inverted cold limbs, used Liujunzi Tang to regulate and tonify Yuan Qi to stabilize.
A nine-year-old boy with acid regurgitation, anorexia, emaciation, and abdominal pain was diagnosed with food stagnation Xu Lei. Cured with Baohe Wan. Later recurrent abdominal pain treated repeatedly with Baohe Wan. I said this was due to Spleen-Stomach deficiency injured by food; should tonify Spleen Earth to prevent recurrence. Patient refused. Later, pain relieved by pressure; I used Wuyi Yigong San for two doses. No effect. Patient self-medicated with Pingwei San, causing distension/pain. I used Yigong San with Muxiang for four doses to cure. Frequent use of attacking/draining agents damages Yin and Yuan Qi, often leading to Xu Lei; caution is advised.
Shenling Baizhu San: Treats Spleen-Stomach weakness, poor appetite, epigastric fullness/blockage, palpitations/asthma, vomiting/diarrhea.
Ingredients: Bai Biandou (2.5 liang, soaked in ginger juice, peeled, lightly stir-fried), Renshen, Baifuling, Baizhu, Gancao (stir-fried), Shanyao (3.5 liang each), Lianrou, Jiegeng (stir-fried to yellow), Yiyiren, Suosharen (2 liang each).
Usage: Powdered. Take 1 qian per dose, mixed with jujube decoction.
Dihuang Wan (add Rougui 1 liang, named Jiajian Bawei Wan): Treats pediatric Liver channel deficiency-heat and dry blood, or wind invading with excessive qi, causing Scrofula/Tubercles. Or limb convulsions, eye twitching, rising phlegm-saliva. Also treats Kidney Gan, brain heat/emaciation, cold-like hands/feet, alternating chills/fever, slippery diarrhea/abdominal distension, dry mouth/nose/thirst, gum ulceration, black nails/dark face, sores on body/ears, ear discharge, fever/sweating (spontaneous/night), hematochezia/hematuria, aphonia. Effects are too numerous to list. (i.e., Liuwei Dihuang Wan, see Kidney section).
Buzhong Yiqi Tang: Treats Middle Qi deficiency, fatigue, poor appetite, or fever/irritability/thirst.
Ingredients: Renshen, Huangqi (0.8 fen each), Baizhu, Gancao, Chenpi (0.5 fen each), Shengma, Chaihu (0.2 fen each), Danggui (1 qian).
Usage: Decoct with ginger and jujube. Take on an empty stomach before noon.
Commentary: Use this formula if Yuan Qi is damaged by harsh drugs, presenting with aversion to cold/fever, limb fatigue, poor appetite, or combined with diet/labor exhaustion, headache/body heat, irritability/thirst, pulsations that are surging/string-taut/empty, or fine/weak/soft, or prominent only at Cun/Guan. Most suitable for chronic illnesses or overuse of draining agents causing Yuan Qi loss and full deficiency symptoms. Especially suitable if the mother has Spleen-Stomach insufficiency or Yin deficiency with internal heat affecting the child.
Qian's Yigong San: Treats Spleen-Stomach poor appetite, vomiting/diarrhea/anorexia. For any deficiency-cold pattern, give several doses first to rectify Stomach Qi. (i.e., Wuyi Yigong San, see Neidiao).
Commentary: Treats Spleen-Stomach weakness, vomiting/diarrhea/anorexia, or convulsions/profuse phlegm, eyes open during sleep, cold finger/toes, or Spleen-Lung weakness, cough/phlegm, or deficiency heat attacking upper body, mouth/tongue sores, tongue playing/drooling. If mother has Spleen-Stomach deficiency and child suffers these symptoms, she should also take it.
Sijunzi Tang: Treats Spleen Qi damage, vomiting/diarrhea/poor appetite, emaciated muscles. (See Neidiao).
Baohe Wan: Treats food stagnation, chest/diaphragm fullness, belching/acid regurgitation, or vomiting/diarrhea/abdominal pain. (Add Baizhu 1 liang = Da'an Wan).
Ingredients: Shenqu (stir-fried), Shanzha, Banxia, Fuling (1 liang each), Chenpi, Lianqiao, Luobozhongzi (stir-fried, 0.5 liang).
Usage: Powdered, pill with congee, size of paulownia seeds. Take 30 pills per dose, washed down with plain water.
Commentary: This is a Qi-moving and stagnation-resolving agent. Suitable for acute food/milk stagnation with intact Yuan Qi. If Yuan Qi is weak and injured by food/milk, tonifying Stomach Qi is primary, assisting with digestion. If vomiting occurs after food digestion, Stomach Qi is injured; use Yigong San to tonify. Do not continue previous drugs to avoid further damage. Physicians must be careful.
Fei'er Wan: Treats Liver Gan with food stagnation, emaciation, irregular bowel/bladder movements.
Ingredients: Huanglian, Shenqu, Muxiang (1.5 liang each), Binglang (20 pieces), Roudoukou (2 liang, baked), Shijunzi (soaked in wine, peeled), Maiya (4 liang each).
Usage: Powdered, pill with Shenqu paste, size of hemp seeds. Take 20-30 pills per dose, washed down with rice drink.
Commentary: Suitable for Food Stagnation Five Gans with fever/dry mouth, irregular bowels/urine, neck tubercles, sparse hair tufts, alternating chills/fever/thirst. If Spleen-Stomach is slightly weak, take Wuyi Yigong San concurrently. If severely weak, make Yigong San primary, assisting with previous drug.
Zhizhu Wan (See Pixie section).
Liujunzi Tang (See Neidiao section).
Sishen Wan (See Tuogang section).
Bawei Wan (See Kidney section).
Chaihu Zhizi San.
Siwu Tang (Two formulas see Jijing section).
Jiwei Lvhui Wan (See Gansheng section).
Jiawei Xiaoyao San (See Neidiao section).
Baizhu San (See Jizhi section).
Hamawa Wan (See Gansheng section).