小儿初生之时,肠胃绵脆,易饥易饱,易虚易实,易寒易热,方书旧说,天下皆
知之矣。然《礼记》曲礼及玉符潜诀论所云∶天下皆不知《曲礼》云∶童子不衣裘
裳,《说》云∶裘
大温,消阴气。且人十五岁成童,尚不许衣裘。今之人养稚子,当正夏时,以绵夹裹腹,日
不下怀,人气相蒸;见天稍寒,即封闭密室,睡毡下幕,暖炕红炉,使微寒不入,大暖不泄
。虽衰老之人,尚犹不可,况纯阳之小儿乎?然君子当居密室,亦不当如是之暖也。玉符潜
诀论云∶婴儿之病,伤于饱也。今人养稚子,不察肠胃所容几何,但闻一声哭,将谓饥号
,急以潼乳纳之儿口,岂复知量,不吐不已。及稍能食,应口辄与。夫小儿初生,别无伎俩,
惟善号泣为强良耳。此二者,乃百病之源也。
小儿除胎生病外有四种∶曰惊,曰疳,曰吐,
曰泻。其病之源止有二∶曰饱,曰暖。惊者,火乘肝之风木也;疳者,热乘脾之湿土也;吐
者,火乘胃膈,甚则上行也;泻者,火乘肝与大肠而泻者也。夫乳者,血从金化而大寒,小
儿食之,肌肉充实。然其体为水,故伤乳过多,反从湿化。湿热相兼,吐痢之病作矣。
医者
不明其本,辄以紫霜进食比金白饼之属,其中皆巴豆杏仁。其巴豆大热有大毒。杏仁小热有
小毒,小儿阳热,复以热毒之药,留毒在内,久必变生。故刘河间先生,以通圣、凉膈、神
芎、益元治之,皆无毒之药。或曰∶此大人所服之药,非小儿所宜也。余闻笑曰∶大人小儿,虽年
壮不同,其五脏六腑,岂复殊耶?大人服多,小儿服少,其实一也。故不可下者宜解毒,可
下者宜调胃、泻心。然有逐湿为之方者,故余尝以牵牛、大黄、木通三味,末之为丸,以治
小儿诸病皆效。盖食乳小儿,多湿热相兼故也。今之医者,多以此药谤予。彼既不明造化,难与力
辩,故予书此方,以俟来世知道者。然善治小儿者,当察其贫富贵贱治之。
盖富贵之家,衣
食有余,生子常夭;贫贱之家,衣食不足,生子常坚。贫家之子,不得纵其欲,虽不如意而
不敢怒,怒少则肝病少;富家之子,得纵其欲,稍不如意则怒多,怒多则肝病多矣。夫肝者
木也,甚则乘脾矣。又况贫家无财少药,故死少;富家有财多药,故死多。故贫家之育子,
虽薄于富家,其成全小儿,反出于富家之右。其暗合育子之理者有四焉∶薄衣淡食,少欲
怒,一也;无财少药,其病自痊,不为庸医热药所攻,二也;在母腹中,其母作劳,气血动
用,形得充实,三也;母既作劳,多易生产,四也。此四者,与富家相反也。
俚谚曰∶“儿哭
即儿歌,不哭不偻HT 。”此言虽鄙,切中其病。世俗岂知
号哭者,乃小儿所以泄气之热也?老子曰∶终日号而不嗄。余常授人以养子之法;儿未坐时
,卧以赤地,及天寒时不与浓衣,布而不绵;及能坐时,以铁铃、木壶、杂戏之物,连以细
绳,置之水盆中,使一浮一沉,弄之有声;当炎暑之时,令坐其旁,掬水弄铃,以散诸热。《内
经》曰∶四肢者,诸阳之本也。手得寒水,阴气达于心中,乃不药之药也。余尝告于陈敬之∶若
小儿病缓急无药,不如不用庸医。但恐妻外家怪其不医,宜汤浸蒸饼令软,丸作白丸,给其妻
外家,以为真药,使儿服之,以听天命,最为上药。忽岁在丙戌,群儿皆病泄泻,但用药者皆
死,盖医者不达湿热之理,以温燥行之,故皆死。惟陈敬之不与药,用余之言,病儿独存。
噫!呜呼!班固真良史,尝曰∶有病不治得中医。除暴得大疾病服药者,当谨熟阴阳,无与
众谋,若未病之前,从予奉养之法,亦复不生病。纵有微疾,虽不服药可也。
小儿刚出生时,肠胃细嫩脆弱,容易饥饿也容易饱食,容易出现虚证也容易出现实证,容易受寒也容易受热,这些在医书旧说中,天下人都知道了。然而《礼记·曲礼》及《玉符潜诀论》所说的内容,天下人却不知道。《曲礼》说:儿童不穿皮衣和裙裳,《说》解释:皮衣太温暖,会消耗阴气。况且人到十五岁成为成童,还不允许穿皮衣。现在的人养育幼儿,正当盛夏时节,用绵夹包裹腹部,白天从不离怀,人气相互蒸腾;见到天气稍冷,就封闭密室,睡在毡下帷幕中,使用暖炕红炉,使微寒不入体内,大暖不致外泄。即使是衰老之人,尚且不可这样,何况是纯阳之体的小儿呢?然而君子居住在密室中,也不应当如此温暖。《玉符潜诀论》说:婴儿的疾病,是由于过饱造成的。现在的人养育幼儿,不考察肠胃能容纳多少食物,只要听到一声哭,就认为是饥饿的号叫,急忙将乳汁喂入婴儿口中,哪里还会知道分量,不吐出来就不停止。等到稍微能进食时,只要是入口的食物就给吃。小儿刚出生,别无本事,只有善于啼哭来显示强壮罢了。这两种情况(过饱、过暖),乃是百病的根源。
小儿除了胎生病之外有四种病:分别是惊风、疳积、呕吐、腹泻。其疾病的根源只有两个:分别是过饱、过暖。惊风,是火邪乘袭肝之风木所致;疳积,是热邪乘袭脾之湿土所致;呕吐,是火邪乘袭胃膈,严重时向上逆行;腹泻,是火邪乘袭肝与大肠导致的泻下。乳汁,是由血转化而来,性质大寒,小儿食用后肌肉充实。然而小儿的身体属水,所以如果伤乳过多,反而会从湿而化。湿热相兼,呕吐和痢疾的病就发作了。
医生不明白疾病的根本,就用紫霜丸、进金白饼之类的药物,其中都含有巴豆和杏仁。巴豆大热且有剧毒,杏仁小热且有小毒,小儿本身阳气偏盛、内热较多,再用这种热毒的药物,导致毒素留在体内,时间久了必然变生他病。所以刘河间先生,用防风通圣散、凉膈散、神芎丸、益元散来治疗这些疾病,这些都是无毒的药物。有人说:这是大人服用的药,不适合小儿服用。我听了笑着说:大人和小孩,虽然年岁壮实程度不同,他们的五脏六腑,难道有区别吗?大人服用剂量多,小儿服用剂量少,其实道理是一样的。所以不能攻下的适宜解毒,可以攻下的适宜调胃、泻心。然而有驱逐湿气的方剂,所以我曾经用牵牛子、大黄、木通三味药,研末制成丸药,用来治疗小儿各种疾病都有效。大概是因为吃乳的小儿,多是湿热相兼的缘故。现在的医生,大多因此诽谤我。他们既然不明白造化之理,难以与他们力争辩驳,所以我写下这个方子,以等待后世懂道理的人。然而善于治疗小儿疾病的,应当观察患儿的贫富贵贱来治疗。
大概富贵之家,衣食有余,生子常常夭折;贫贱之家,衣食不足,生子常常健壮。贫家的孩子,不能放纵欲望,即使不如意也不敢发怒,发怒少则肝病少;富家的孩子,能够放纵欲望,稍不如意就发怒多,发怒多则肝病多。肝属木,严重时就会乘袭脾土。更何况贫家没有钱财和药物,所以死亡少;富家有钱财和药物,所以死亡多。所以贫家养育子女,虽然在物质上比富家微薄,但成全保全小儿的生命,反而超过富家。这暗中符合养育子女的道理有四点:穿衣单薄饮食清淡,欲望少发怒少,这是一点;没有钱财和药物,疾病自然痊愈,不被庸医的热药攻击,这是第二点;在母腹中时,母亲从事劳作,气血动用,胎儿形体得到充实,这是第三点;母亲既从事劳作,大多容易生产,这是第四点。这四点,与富家相反。
俗语说:“儿哭即儿歌,不哭不偻。”这话虽然粗俗,却切中病症要害。世俗之人哪里知道啼哭,是小儿宣泄体内热气的方法呢?老子说:整天啼哭嗓子却不哑。我曾经传授给人养育子女的方法:婴儿还不会坐的时候,让他在地上卧着,到了天冷时不给穿厚衣服,穿布衣而不穿棉衣;等到能坐的时候,用铁铃、木壶、各种玩具,连上细绳,放在水盆里,使其一浮一沉,弄出声音;当炎热酷暑之时,让他坐在旁边,捧水玩铃,以散发体内的热气。《内经》说:四肢是诸阳之本。手接触寒冷的生水,阴气通达心中,这就是不用药的药方。我曾经告诉陈敬之:如果小儿病情缓急而没有药,不如不用庸医。只是恐怕妻子娘家责怪他不治病,应用汤浸泡蒸饼使其变软,做成白色丸药,欺骗妻子的娘家,说是真药,让小儿服用,以此听从天命,这才是最好的药。忽然某年丙戌年,群儿都患病腹泻,凡是用药治疗的都死了,大概是因为医生不通晓湿热的道理,用温燥的方法治疗,所以都死了。只有陈敬之不给药,采用我的话,患病的孩子唯独存活下来。唉!呜呼!班固真是优秀的史官,曾说:有病不治,得到中等水平的医疗。除了突发重大疾病服药者,应当谨慎熟悉阴阳,不要与众人商量,如果在未病之前,遵循我的奉养方法,也不会生病。纵然有轻微疾病,虽然不服药也可以。
When infants are first born, their intestines and stomachs are delicate and brittle; they are prone to hunger and satiety, deficiency and excess, cold and heat. These points have long been known by everyone in the world according to old medical texts. However, what is stated in *The Rites of Zhou* (Zhou Li) and *Qu Li*, as well as in the *Yufu Qianjue Lun*, remains unknown to the general public. *Qu Li* states: "Children do not wear fur coats or skirts." The commentary explains: "Fur coats are too warm and consume Yin Qi." Moreover, even when a person reaches fifteen years of age and becomes a 'cheng tong' (a youth), they are still not allowed to wear fur. Nowadays, people raising young children wrap their bellies with cotton layers during midsummer, never taking them off during the day, causing body heat to steam together; upon seeing slightly cold weather, they seal the room tightly, sleep under felt curtains, use heated kang beds and red stoves, preventing even slight cold from entering and retaining excessive warmth. Even for elderly people, this is inadvisable, let alone for infants who possess pure Yang constitution. Indeed, even gentlemen residing in sealed rooms should not keep them so warm. The *Yufu Qianjue Lun* states: "Infants' illnesses stem from overfeeding." People raising infants today do not consider how much their digestive systems can hold; hearing a cry, they assume it is hunger and hastily feed milk into the infant's mouth without measuring quantity, continuing until vomiting occurs. As they grow slightly older and able to eat, any food offered is given. Infants have no other skills; crying loudly is their way of showing strength. These two factors—overfeeding and overheating—are the sources of all diseases.
Apart from congenital diseases, there are four types of pediatric conditions: Jing (startle/wind syndrome), Gan (malnutrition syndrome), vomiting, and diarrhea. Their root causes lie in only two aspects: overfeeding and overheating. Jing arises when Fire pathogen attacks the Liver's Wood element; Gan occurs when Heat pathogen attacks the Spleen's Damp-Soil element; vomiting results from Fire attacking the Stomach and Diaphragm, ascending severely; diarrhea is caused by Fire attacking the Liver and Large Intestine. Milk transforms from blood and is extremely cold; while it builds muscle mass in infants, the infant's body is Water-based. Therefore, excessive milk consumption leads to transformation into Dampness. When Damp-Heat combines, vomiting and dysentery arise.
Physicians who fail to understand the root cause often prescribe medicines like Zishuang Wan (Purple Frost Pill) or Jinbai Bing (Gold White Cake), which contain Radix Euphorbiae Humifusae (Badou, 巴豆) and Semen Armeniacae Amarum (Xingren, 杏仁). Badou is extremely hot and highly toxic; Xingren is mildly hot and slightly toxic. Since infants naturally have strong Yang and internal heat, administering such hot and toxic drugs retains toxins within, eventually leading to further complications. Thus, Liu Hejian used Fangfeng Tongsheng San (Wind-Barrier Universal Rescue Decoction), Liangge San (Cooling the Chest Powder), Shenxiong Wan (Divine Achyranthes Pill), and Yiyuan San (Benefit Origin Powder)—all non-toxic formulas—to treat these conditions. Some argue that these adult medications are unsuitable for children. I laughed and replied: Although adults and children differ in physical maturity, their Zang-Fu organs are fundamentally the same. Adults take larger doses, children smaller ones, but the principle is identical. For cases where purging is contraindicated, detoxification is appropriate; for cases requiring purging, regulating the Stomach or draining Heart heat is suitable. There are also formulas to expel Dampness. I once used Qian Niu Zi (Seed of Morning Glory), Dahuang (Rhubarb Root and Rhizome), and Mutong (Akebia Stem) ground into powder and made into pills, which proved effective for various pediatric ailments. This is likely because nursing infants often suffer from combined Damp-Heat. Contemporary physicians slander me for this. Since they do not comprehend natural transformations, debate is futile. I record this formula for future generations who understand these principles. However, skilled pediatricians must treat based on the family's socioeconomic status.
Wealthy families, having abundant food and clothing, often see their children die young; poor families, lacking resources, often see their children survive robustly. Poor children cannot indulge their desires; even if dissatisfied, they dare not anger, resulting in less Liver pathology. Wealthy children indulge freely; minor dissatisfaction leads to frequent anger, increasing Liver disease. The Liver corresponds to Wood and, when severe, overacts upon the Spleen. Furthermore, the poor lack money and medicine, so fewer die; the rich have money and medicine, so more die. Thus, although poor families provide less materially than wealthy ones, they better preserve their children's lives. Four hidden principles align with proper child-rearing: wearing thin clothes and eating bland food with few desires and little anger (1); lacking wealth and medicine allows self-healing without attack by quacks using hot drugs (2); maternal labor in utero stimulates Qi and Blood, ensuring fetal physical fullness (3); maternal labor facilitates easier childbirth (4). These four aspects contrast with those of wealthy families.
A folk saying goes: "Crying is like singing for a child; silence leads to deformity." Though vulgar, this hits the mark. How does society know that crying is a method for infants to vent internal heat? Laozi said: "One can cry all day without losing one's voice." I have taught others methods of nurturing children: before an infant can sit, let them lie on bare ground; in cold weather, dress them in cloth rather than thick cotton. Once they can sit, place toys like iron bells, wooden pots, and other items tied with strings in a water basin, making them float and sink with sound. During summer heat, let them sit nearby, splashing water and playing with bells to dissipate heat. The *Neijing* states: "The four limbs are the root of all Yang meridians." Cold water touching the hands allows Yin Qi to reach the heart; this is the "medicine without medication." I once told Chen Jingzhi: If a child falls ill and no medicine is available, it is better to avoid quack doctors. Fearing criticism from his wife's relatives for not treating him, he could soak steamed dough cakes until soft, shape them into white pills, deceive the relatives into thinking they are real medicine, administer them to the child, and leave the outcome to Heaven's will. This is the best approach. In the year Bingxu, many children suffered diarrhea; those treated with medicine died, likely because physicians misunderstood Damp-Heat principles and applied warming-drying methods. Only Chen Jingzhi, following my advice and withholding medicine, saved his child. Alas! Ban Gu was indeed a fine historian, stating: "Not treating illness yields medium-level medical care." For sudden severe diseases requiring medication, one must carefully study Yin-Yang and consult wisely. Before illness strikes, following my nurturing methods prevents disease. Even with minor ailments, abstaining from medicine is acceptable.