小儿湿痰,因过食生冷油腻之物,有伤脾胃,遂致脾土虚湿,不能运化而成。其痰滑而易出,脾虚不运,故
懒食,脾主四肢,故倦怠嗜卧,脾属土,故面色多黄。痰多者,古法主枳桔二陈汤(如枳壳、桔梗、陈皮、半夏、
茯苓、炙甘草,引用姜)加苍术、白术以除湿化痰。
痰饮盛者,古法主桂苓甘术汤(如茯苓、桂枝、生甘草、土炒白术,引用生姜)。
〔真按〕湿痰必清稀色白,絮絮不休,但以化州橘红钱半,半夏曲一钱,土炒白术钱半,米泔浸炒苍术五分,
炒茯苓一钱,白芥子五分,炙甘草三分,引用姜汁炒竹茹一钱。
痰饮盛者,加九转胆南星三分,生姜一片。
血为一身之液,有血则筋骨脏腑皆得其灌溉而成,无血则内失所养,形容无不枯槁。小儿失血之证,阳盛乘
阴,则血为热迫,故犯气分而妄行,不得归入经脉也。若血病伤及于腑者,则血渗入肠胃之浊道,上行于咽,出而
为吐为衄,下从二便而出,为便为溺也。若血病伤及于脏者,则溢出于胸中之清道,上从喉出,而兼咳嗽,下从精
窍而出,为溺血也。夫血藏于脏内,行于脉中,流于躯壳之内,不可得而见也,非损伤不能为病,故损之原因有三。
一曰。热伤阳络,腑病也。热伤阴络,脏病也。宜以清热为主。
二曰努伤,宜以破逐为主。
三曰劳伤,宜以理损为主。
治血须先明此三大原因,始不至误治小儿之失血证。循其名而核其实,因作血解。
小儿湿痰,是由于过量食用生冷、油腻的食物,损伤了脾胃,导致脾土虚弱且湿气内停,无法运化水湿而形成的。这种痰液滑利且容易咳出;因为脾虚不能运化,所以孩子食欲不振;脾主四肢,所以身体倦怠、喜欢躺着;脾在五行中属土,所以面色多呈黄色。痰多的情况,古法主张使用枳桔二陈汤(包含枳壳、桔梗、陈皮、半夏、茯苓、炙甘草,煎药时加入生姜作为引经药),并加用苍术、白术来祛除湿气、化解痰浊。
如果痰饮症状严重,古法主张使用桂苓甘术汤(包含茯苓、桂枝、生甘草、土炒白术,煎药时加入生姜作为引经药)。
〔真按〕(陈守真按语):湿痰必定质地清稀、颜色发白,连绵不断,治疗只需使用化州橘红一钱半,半夏曲一钱,土炒白术一钱半,米泔水浸泡后炒制的苍术五分,炒茯苓一钱,白芥子五分,炙甘草三分,煎药时用姜汁炒过的竹茹一钱作为引经药。
血液是全身津液的重要组成部分,有血液存在,筋骨和脏腑才能得到滋养从而形成形体;如果没有血液,内部就会失去滋养,人的容貌和形体无不枯槁消瘦。小儿出现失血的症状,是因为阳气过盛侵犯阴分,血液被热邪逼迫,因此侵入气分而妄行,不能回归到经脉之中。如果血病损伤了腑,那么血液就会渗入肠胃的浊道,向上从咽喉吐出,表现为吐血或鼻衄;向下从大小便排出,表现为便血或尿血。如果血病损伤了脏,那么血液就会溢出到胸中的清道,向上从喉咙咳出,并伴有咳嗽;向下从尿道排出,表现为尿血。血液藏于脏器之内,运行于脉管之中,流淌在躯体内部,是不可见的,除非受到损伤否则不会致病,所以造成损伤的原因主要有三种。
第一种是热伤阳络,属于腑的病证。热伤阴络,属于脏的病证。治疗应当以清热为主。
第二种是努伤(因用力过度导致的损伤),治疗应当以破血逐瘀为主。
第三种是劳伤(因劳累过度导致的损伤),治疗应当以调理补益为主。
Pediatric damp-phlegm arises from excessive consumption of raw, cold, and greasy foods, which injure the Spleen and Stomach. This leads to deficiency-dampness in Spleen Earth (the Spleen's functional system associated with transformation and transportation), resulting in an inability to transform and transport fluids, thereby forming phlegm. This type of phlegm is slippery and easy to expectorate. Due to Spleen deficiency and impaired transportation, the child exhibits poor appetite. Since the Spleen governs the four limbs, the child feels fatigued and prefers lying down. As the Spleen corresponds to the element of Earth in Five-Phase theory, the complexion is often yellow. For cases with abundant phlegm, ancient methods primarily prescribe Zhijie Erchen Tang (Bitter Orange and Citrus Decoction, containing Zhiqiao [Aurantii Fructus], Jiegeng [Platycodonis Radix], Chenpi [Citri Reticulatae Pericarpium], Banxia [Pinelliae Rhizoma], Fuling [Poria], Zhi Gancao [Prepared Licorice Root], with Shengjiang [Fresh Ginger] as a guide drug), added with Cangzhu [Atractylodis Rhizoma] and Baizhu [Atractylodis Macrocephalae Rhizoma] to dispel dampness and resolve phlegm.
In cases where phlegm-fluid retention is severe, ancient methods primarily prescribe Guiling Gan Zhu Tang (Cinnamon Twig, Poria, Licorice, and Atractylodes Decoction, containing Fuling [Poria], Guizhi [Cinnamomi Ramulus], Sheng Gancao [Raw Licorice Root], Tu Chao Baizhu [Earth-fried Atractylodis Macrocephalae Rhizoma], with Shengjiang [Fresh Ginger] as a guide drug).
[Commentary by Chen Shouzhen]: Damp-phlegm is invariably clear, thin, white, and continuous. Treatment should focus on using Huazhou Juhong [Exocarpium Citri Grandis] (1.5 qian), Banxia Qu [Pinellia Fermented Paste] (1 qian), Tu Chao Baizhu [Earth-fried Atractylodis Macrocephalae Rhizoma] (1.5 qian), Mi Jiang Jin Chao Cangzhu [Mi Jiang Water-soaked and Stir-fried Atractylodis Rhizoma] (0.5 fen), Chao Fuling [Stir-fried Poria] (1 qian), Baijiezi [Brassicae Semen] (0.5 fen), Zhi Gancao [Prepared Licorice Root] (0.3 fen), with Zhuru [Bambusa Textilis Caulis] stir-fried with Jiangzhi [Ginger Juice] (1 qian) as a guide drug.
If phlegm-fluid retention is severe, add Jiuzhuan Danningxing [Nine-fold Processed Arisaema cum Bile] (0.3 fen) and one slice of Shengjiang [Fresh Ginger].
Blood is the fluid substance of the whole body. With blood, the sinews, bones, zang-organs, and fu-organs are irrigated and nourished to form the physical structure. Without blood, internal nourishment is lost, leading to emaciation and withering of the physique. In pediatric hemorrhagic syndromes, excess Yang invades Yin, causing blood to be forced by heat. Consequently, blood enters the Qi level and moves recklessly, failing to return to the meridians. If the blood disease injures the fu-organs, blood seeps into the turbid pathways of the intestines and stomach, ascending through the throat to emerge as vomiting or epistaxis; descending through the two excretions, it manifests as hematochezia or hematuria. If the blood disease injures the zang-organs, blood overflows into the clear pathways of the chest, ascending through the larynx accompanied by coughing, and descending through the essence aperture (urethra) to manifest as hematuria. Blood resides within the zang-organs, circulates within the vessels, and flows inside the body shell, remaining invisible. It does not cause disease unless injured; thus, there are three main causes of injury:
First, heat injuring the Yang collaterals, which pertains to fu-organ pathology. Heat injuring the Yin collaterals pertains to zang-organ pathology. Treatment should prioritize clearing heat.
Second, strain injury (caused by excessive exertion), for which treatment should prioritize breaking stasis and expelling blood.
Third, fatigue injury (caused by overexertion), for which treatment should prioritize regulating and tonifying deficiency.
To treat hemorrhage, one must first clarify these three major causes to avoid misdiagnosis and mistreatment of pediatric blood-loss syndromes. By examining the name to verify the reality, this section on blood is composed.