夫大笑不止者,心病也。喘急大息者,肺病也。怒而骂詈者,肝病也。气不足以息
者,脾病也,欲言不言,语轻多畏者,肾病也。啼而不哭者,是声直无泪,主乎盘肠气
,腹痛几绝也。哭而不啼者,是连声多泪,主惊入心也,吱煎不安者是烦,主热在
心经,精神恍惚。若吱 不足者是躁,主风邪在心,为搐为视。言而微,终日乃复言
者,此夺气也。声响,如瓮中语者,是伤风也。声如从室中言者,是中气之湿也。语言
无力,难布息者,内伤。言而不厌者,外感声清而轻者,气清弱也。重浊者,痛也,风
也。高喊者,热狂也。声急者,神惊也。声塞者,痰也。声战者,寒也。声噎者,气不
顺也。喘者气促气短,有虚有实也。喷嚏者,知其风。呵欠者,知其倦而生风,阴阳
上下相离,或脾困而病机将发也。衣被不敛,善恶随口不避亲疏者,神明之乱也。妄
言错乱,目见异物者,邪热归心也。喉中有声,谓之肺鸣,是火乘金位不得其平而故
鸣。此三者坏症也。至若五脏已夺,神明不守,而声嘶者死,视直沫多,渐至音哑者死。
夫医专司命之重,学习可不精祥,故毋论方脉、幼科、女科、外科,不可不广博群
书,究心切脉,由博及约,则认病无差。理路既明,用药自当,即外科徒验外见之症,
而不察脉候之微,则何以审气血之盛衰,阴阳之偏胜而明脏腑之所属?以得疗治之无误
也。至于幼科,尤宜参看方脉诸书。盖儿科谓之哑科,疾病痛苦,勿能告人,全赖治者
细心详察。奈幼科诸书,理浅言略,难明病源。惟以小儿不节饮食为执见,最重消磨,
更以纯阳之子为定论,恣投寒苦,孰知易停滞者,脾气必虚。若图见小效于目前,则便
遗大害于日后。况芽儿易虚易实,言虚者正气易于虚也。言实者邪气易于实也。然邪凑
之实,必乘正气之虚,罔顾正气之虚,惟逐邪气之实,其有不败者几希!如寒伤荣也。
温养荣阴;风伤卫也。辛调卫气,惟调荣卫和平而宣行,客邪不攻而自退,使正气自行
逐贼,则邪退而正气安然,如浮云一过,天日昭明也。若投与气血无情之猛剂,则客邪
虽散,正气亦伤,乘虚之邪,接踵可至。要知正气不至空虚,邪必不能凑而为实。至于
云纯阳者,以无阴而谓,乃稚阳耳。其阳几何?阴气未全而复败,其阳将何所而望其生
长耶?况天地之气化日薄,男女之情性日嚣,幼稚之禀受日弱。有禀父之阳气不足
者,多犯气虚中满∶有禀母之阴血不足者,多犯阴虚发热;患痘则多犯肾虚内溃之症,
此皆先天不足所致,近来比比皆然。若徒效上古克削寒凉,如肥儿丸芦荟丸之类,则千
中千死。即使火之有余,实因水之不足,壮水以制阳光,先贤之至论。服寒凉者,百不
一生,古哲之格言。以不生之药,投欲生之儿,心何忍哉!至于脾胃自能消谷,偶有停
滞者,缘消谷之脾胃病也。只助其能调其病而自已,故有助脾消化,推扬谷气者。有禀
命门火衰,则补火生土者,有一消一补者,有纯以补为消者,盖恐宽一分,更耗一分元
气也。人之有生唯一气耳,易亏难复,可轻耗哉!况天地之气既薄,父母之气既衰,幼
稚之禀既亏,可不根究先天之阴虚阳虚,而徒方脉诸书,水源探本为治,靡不附应合
宜,既能挽回此代赤子元气于后天,便是培值后代赤子元气于先天,诚为寿世无疆矣。
若徒宗上古幼科浅略方论,则犹灌溉树木者,罔顾根本而惟润饰枝叶,则欲望其生
长,未之有也。况更加戕贼者乎!张所以有大小合参之集,幸高明鉴诸。
大笑不止,是心病。
呼吸急促且频繁叹气,是肺病。
发怒并骂人,是肝病。
气息不足以支撑呼吸,是脾病。
想说话却不说,声音轻微且多畏惧,是肾病。
啼哭却没有眼泪,这是哭声直而无泪,主病为盘肠气(一种以剧烈腹痛为主的儿科病症),腹痛剧烈近乎昏厥。
哭泣而没有啼声,这是连续发声且多泪,主病为惊邪入心。
吱吱作响且不安稳,这是烦躁,主病为热在心经,导致精神恍惚。
若叫声微弱不足,这是躁动,主病为风邪在心,表现为抽搐和眼球上翻。
说话声音低微,整天才说几句话,这是夺气(正气严重耗损)。
声音响亮,像从瓮中发出的声音,这是伤风。
声音沉闷,像在室内说话的声音,这是中气湿阻。
语言无力,难以顺畅呼吸,这是内伤。
说话不停歇,这是外感。
声音清亮而轻浮,是清气虚弱。
声音重浊,是疼痛或风邪所致。
高声喊叫,是热盛狂乱。
声音急促,是神志受惊。
声音堵塞不畅,是有痰。
声音颤抖,是有寒。
声音哽咽,是气机不顺。
喘促,是气短急促,有虚证也有实证。
打喷嚏,可知是风邪侵袭。
打哈欠,可知是疲倦而生风,或是阴阳上下分离,或者是脾困顿而病机即将发作。
穿衣盖被不整齐,好坏言语随口而出,不分亲疏远近,这是神明混乱。
胡言乱语错乱,看见异物,这是邪热归于心。
喉中有声音,称为肺鸣,这是火邪乘袭肺金之位,致使肺气不得平复而发出声响。
这三种情况属于坏症(危重之症)。
至于五脏精气已极度亏损,神明不能守舍,而声音嘶哑的,预后不良致死;眼睛直视、口水多,逐渐发展到声音嘶哑的,也致死。
医生专门掌管人的生死重任,学习怎能不精详?所以不论方脉(内科)、幼科(儿科)、女科(妇科)、外科,都不能不广泛博览群书,用心钻研切脉,由博返约,这样诊断疾病就不会出差错。
病理思路既然明确,用药自然得当。
即使是外科只验证外在可见的症状,而不察脉候的微妙变化,那么凭什么来审察气血的盛衰、阴阳的偏胜,从而明确脏腑所属?以此来确保治疗无误呢?
至于儿科,尤其应该参考方脉(内科)诸书。
因为儿科被称为“哑科”,疾病痛苦,患儿无法告知他人,全赖医者细心详细观察。
无奈儿科诸书,理论浅显言辞简略,难以明了病源。
往往只把小儿饮食不节制作为执见,最重视消食导滞,又认为小儿是“纯阳之子”而定论,肆意投用寒凉苦燥药物。
谁知道容易停滞的,是因为脾气必然虚弱。
如果贪图眼前的小效,就会留下日后的巨大危害。
况且幼儿体质易虚易实,所谓“虚”,是指正气易于虚弱;所谓“实”,是指邪气易于壅实。
然而邪气凑集而成的实证,必定是趁着正气的虚弱,如果不顾正气的虚弱,只去驱逐邪气的实证,有不败亡的极少!
比如寒邪伤及营阴,应当温养荣阴;风邪伤及卫气,应当辛散调和卫气。
只有调和平顺营卫并宣通运行,客邪不攻自退,让正气自行驱逐贼邪,那么邪气退去而正气安然无恙,就像浮云一过,天日昭明一样。
如果投用针对气血无情的猛剂,那么客邪虽然散去,正气也会受伤,趁虚而入的邪气,接踵而至。
要知道正气不至于空虚,邪气就不能凑集而形成实证。
至于所说的“纯阳”,是因为没有阴而言,其实是稚阳。
其阳气有多少呢?阴气未完全成熟而又受损败,其阳气将依靠什么来期望生长呢?
况且天地之气化日益薄弱,男女的情性日益喧嚣,幼稚的禀赋日益虚弱。
有禀受父亲阳气不足的,多犯气虚中满之症;有禀受母亲阴血不足的,多犯阴虚发热之症;患痘疹则多犯肾虚内溃之症,这都是先天不足所致,近来比比皆是。
如果徒然效仿上古时期克削寒凉的疗法,如肥儿丸、芦荟丸之类,则是千中千死。
即使火有余,其实是因为水不足,壮水之主以制阳光,是先贤的至理名言。
服用寒凉药物者,百无一活,这是古哲的格言。
用不能让人生存的药,投给想要生存的婴儿,于心何忍呢!
至于脾胃本就能消化谷物,偶尔有停滞的,是因为负责消化的脾胃生病了。
只需帮助它能调理好病,自己就好了,所以有的助脾消化,推扬谷气;有的禀受命门火衰,则补火生土;有的有一消一补的,有纯以补为消的,大概是恐怕宽缓一分,更消耗一分元气啊。
人的生存只靠这一口气罢了,容易亏损难以恢复,岂可轻易耗损呢!
况且天地之气既已薄弱,父母之气既已衰弱,幼稚的禀赋既已亏损,可不根究先天的阴虚阳虚,而仅仅依据方脉诸书,从水源探本进行治理,无不顺应合宜。
既能挽回这一代赤子的元气于后天,便是培植后代赤子的元气于先天,这真是长寿于世无疆了。
如果徒然尊崇上古儿科浅略的方论,那就如同灌溉树木的人,不顾根本而只润饰枝叶,那样希望它生长,是没有的事。
何况更加残害它呢!
所以我才有大小合参(内科与儿科互相参考)的编纂,希望高明之士鉴察。
Unremitting laughter indicates Heart disease.
Rapid breathing with frequent sighing indicates Lung disease.
Anger accompanied by cursing indicates Liver disease.
Insufficient breath to support respiration indicates Spleen disease.
Desiring to speak but not doing so, with a soft voice and much fear, indicates Kidney disease.
Crying without wailing (tearless crying) is characterized by straight sounds without tears, primarily indicating Pan Chang Qi (intestinal colic), where abdominal pain is severe enough to cause near-syncope.
Wailing without crying (continuous vocalization with tears) primarily indicates fright entering the Heart.
Restless whimpering indicates irritability, primarily indicating Heat in the Heart Meridian, leading to mental confusion.
If the sound is weak and insufficient, it indicates restlessness, primarily indicating Wind pathogen in the Heart, manifesting as convulsions and upward deviation of the eyes.
Speaking in a low voice, only speaking once after a whole day, indicates Devastation of Qi (severe depletion of healthy Qi).
A loud voice, sounding as if from within a jar, indicates Wind-Cold injury (Shang Feng).
A muffled voice, sounding as if from within a room, indicates Dampness obstructing Middle Qi.
Weak speech with difficulty in smooth breathing indicates Internal Injury.
Incessant talking indicates External Contraction.
A clear and light voice indicates deficiency of Clear Qi.
A heavy and turbid voice indicates Pain or Wind pathogen.
Loud shouting indicates Excessive Heat and mania.
An urgent voice indicates Shock to the Spirit.
A blocked voice indicates Phlegm.
A trembling voice indicates Cold.
A choking voice indicates Disharmony of Qi mechanism.
Panting (Chuan) refers to rapid and short breathing, which can be either Deficiency or Excess syndrome.
Sneezing indicates the presence of Wind pathogen.
Yawning indicates fatigue generating Wind, or separation of Yin and Yang above and below, or Spleen stagnation with impending pathogenesis.
Disheveled clothing and bedding, speaking indiscriminately about good and bad without avoiding kin or strangers, indicates Chaos of the Spirit (Shen Ming).
Delirious and confused speech, seeing imaginary objects, indicates Evil Heat returning to the Heart.
Sound in the throat is called Lung Ming (Lung Resonance), indicating Fire pathogen attacking the Metal position, causing Lung Qi to lose its balance and produce sound.
These three conditions are considered Huai Zheng (critical/ruinous syndromes).
As for cases where the essence of the Five Zang organs is exhausted, the Spirit cannot hold fast, and the voice becomes hoarse, death ensues. Similarly, staring straight ahead with excessive saliva, gradually progressing to hoarseness, also leads to death.
Physicians bear the heavy responsibility of life and death; how can their study not be precise and detailed? Therefore, regardless of internal medicine (Fang Mai), pediatrics (You Ke), gynecology (Nv Ke), or surgery (Wai Ke), one must extensively read various books and devote oneself to pulse diagnosis. By broadening knowledge to reach simplicity, disease recognition will be error-free.
Once the pathological logic is clear, medication will naturally be appropriate.
Even in surgery, if one only verifies external visible symptoms without observing the subtleties of pulse indications, how can one assess the prosperity or decline of Qi and Blood, the excess or deficiency of Yin and Yang, and clarify the affiliation of the Zang organs? This is necessary to ensure accurate treatment.
Pediatrics, in particular, should refer to internal medicine texts.
Because pediatrics is known as the "Mute Department," infants cannot communicate their pain and suffering, relying entirely on the physician's careful observation.
Regrettably, many pediatric texts have shallow theories and brief explanations, making it difficult to understand the source of diseases.
They often cling to the view that infant illness stems from dietary indiscretion, prioritizing digestive reduction, and rely on the theory that infants are "Pure Yang" entities, recklessly administering cold and bitter drugs.
Who realizes that easy stagnation occurs because the Spleen Qi is necessarily deficient?
Seeking immediate minor efficacy may cause major harm later.
Moreover, infants' constitutions are prone to both deficiency and excess. "Deficiency" means Healthy Qi is easily depleted; "Excess" means Pathogenic Qi easily accumulates.
However, Excess caused by pathogen accumulation must take advantage of Healthy Qi deficiency. Ignoring Healthy Qi deficiency while solely pursuing Pathogenic Excess rarely ends well.
For example, if Cold damages Ying (Nutritive) Yin, one should warm and nourish Ying Yin; if Wind damages Wei (Defensive) Qi, one should use pungent herbs to harmonize Wei Qi.
Only by harmonizing Ying and Wei and promoting their circulation can the invading pathogen retreat without direct attack, allowing Healthy Qi to expel the evil naturally. The pathogen retreats, and Healthy Qi remains secure, like clouds passing to reveal a bright sky.
If harsh agents that ruthlessly affect Qi and Blood are administered, although the pathogen may scatter, Healthy Qi will also be injured, and opportunistic pathogens will follow.
It must be understood that if Healthy Qi is not empty, Pathogenic Qi cannot accumulate to form Excess.
Regarding the term "Pure Yang," it implies a lack of Yin, referring actually to "Young Yang." How much Yang does an infant possess? If Yin Qi is incomplete and damaged, upon what basis can one expect Yang to grow?
Furthermore, the Qi transformation of Heaven and Earth is becoming thinner, human desires are becoming more turbulent, and the endowment of children is becoming weaker.
Those inheriting insufficient Yang Qi from their fathers often suffer from Qi deficiency and middle fullness; those inheriting insufficient Yin Blood from their mothers often suffer from Yin deficiency with fever; those suffering from smallpox often suffer from Kidney deficiency with internal ulceration. These are all due to congenital insufficiency, which is common nowadays.
Blindly imitating ancient practices of using draining and cooling methods, such as Fei Er Wan (Slimming Pill) or Lu Hui Wan (Aloe Pill), results in death in every case.
Even if there is excess Fire, it is actually due to insufficiency of Water. Strengthening Water to control Solar Fire is the supreme doctrine of sages.
Those who take cold-cooling herbs survive less than one in a hundred; this is the maxim of ancient philosophers.
How can one bear to administer life-destroying drugs to infants seeking life?
The Spleen and Stomach can naturally digest grain; occasional stagnation occurs because the Spleen and Stomach responsible for digestion are diseased.
One need only assist them in regulating the disease for self-recovery. Thus, some treatments aid Spleen digestion and promote Grain Qi; some address declining Fire of the Gate of Vitality (Ming Men) by tonifying Fire to generate Earth; some combine reduction and tonification; some use pure tonification as reduction, fearing that any relaxation would consume more Original Qi.
Human life relies on a single Qi, which is easily depleted and hard to restore; how can it be lightly consumed?
Given that the Qi of Heaven and Earth is thin, the Qi of parents is declining, and the endowment of children is deficient, one must investigate congenital Yin and Yang deficiency. Relying merely on internal medicine texts and treating from the root (Water Source) ensures harmony.
This can recover the Original Qi of current infants in the Post-Heaven phase, thereby cultivating the Original Qi of future generations in the Pre-Heaven phase, truly extending longevity indefinitely.
If one blindly follows the shallow theories of ancient pediatrics, it is like irrigating trees by neglecting the roots and only moistening the branches; expecting growth is impossible.
How much more damaging is it to further injure them!
Therefore, I compiled this work combining internal and pediatric medicine, hoping that experts will appreciate it.