《劝行医说》又有论乳吹一条，语亦详尽，并录于此。凡妇人乳吹初起，切勿先延医治，每
见医家治乳，用黄色敷药调菊花叶涂之，内服皂角甲末等味，速其成脓，待至红未熟，即用
铍针开入寸许，复以手硬出毒，其痛每至昏晕，而血多脓少，既难内消，复使其痛苦多时，
不能收口，日久成漏，腐烂缠绵，致病者求生不能，求死不得，而待哺之儿，亦将失乳毙命
，罪恶之重，擢发难数。在医者本意只求多次相延，博取财物，或冀症久求愈，重索药资而
已，亦知地狱中早虚左以待乎？故乳吹、乳痈等症，初起只须内服逍遥散，及六神丸、莲房
灰末，福橘酒送，外煎紫苏、橘核、丝瓜络、川楝子、当归、红花、川乌、香附、官桂等水
，用手巾两方，绞热替换暖乳，轻者乳散乳通，如再不通，须病患忍痛，命一大婴孩重吮下
积乳，随即吐去，吮三五次无不爽利，无庸延医诊视。至于乳疽、乳岩、乳癖，症情不一，
治法各殊，是在名家息心体认，以煎剂为主，尤非疡科所能奏功矣。
小儿解颅者，因肾气幼弱，脑髓不实，不能收敛，而颅为之大也，宜急服地黄丸补之。
斋《幼科发挥》云∶一儿头缝四破，皮光而急，两眼甚小，万曰∶脑者，髓之海也。肾主骨
髓，中有伏火，故髓热而头破，额颅大而眼楞小也，宜服地黄丸。其父母不信，至十四岁而
死。余族一侄孙，幼时解颅头大，而面甚小，至十六岁竟死。余按∶龟板治小儿囟不合，加
入地黄中煎服，似尤应验。
治小儿惊风，砂雪丸，用朱砂、轻粉各一钱，僵蚕十个，蝎三个，以青蒿节中虫捣和为丸，
研细，人乳调服，相传其方甚神。余按“轻粉辛燥有毒，治之不得其法，则毒瓦斯窜入经络，
变成他疾，为害非浅。不若用青蒿虫末和灯草灰调入人乳服之，或饲小儿，睡时以铜管吹青
蒿虫末和灯草灰入其口中，法尤简妙，屡屡获效，不可忽视。
喻嘉言《温证朗照》云∶凡小儿发热呕吐者，倘未布痘，即须审谛，不可误用温胃之药。里
中一宋侯，高年一子，恣啖不禁，每服香砂平胃散极效，一夕痘发作呕，误服前药，满头红
筋错出，斑点密攒筋露，所谓瓜藤斑也。上饶相公一侄，髫龄选贡，赴宴返寓，痘发作呕，
乃父投以藿香正气丸，一夕，舌上生三黑疔，如尖栗形，舌下生四黄疔，如牛奶形，盖痘邪
正出，阻截其路，凶变若此，当以为戒。余按∶小儿患病，挟热者多，温燥之药，皆宜慎用
，不特痘症宜防也。忆在杭州时，有府胥张某子十岁，夏月触暑，发热恶寒不食，医投以藿
香正气丸，遂至热盛神昏，唇舌焦干，口鼻出血而殒。聂久可《活幼心法》云∶小儿多吐之
后，胃气大虚，气不归元，阳浮于外，反有面赤头热，身热作渴，而似热症者，俗医误认为
热，投以凉药，杀人如反掌，故治吐泻而
药不中病者，与其失之寒凉，宁失之温补。失之温补，犹可救疗，失之寒凉，其祸甚速，不
及救也。余按∶此说与前条喻氏所论绝相反，参观焉而各有至理，惟在审症之的而已。盖凡
症之初起，发热作渴而吐者，挟热居多，吐后复发热作渴者，往往有属虚寒者矣。司命者其
吾邑孔雅六学博宪采，长女初生，啼哭一声，后竟默不作声，查方书捉猫一只，以袱包
之，持向女耳边隔袱咬猫耳，猫大嗥一声，女即应声而啼，后遂无他，今已出嫁生子矣。此即古
之所谓禁方，其理莫能测也。《医学入门》云∶初生月内多啼者，凡胎热、胎毒、胎惊，皆
从此而散，且无奇症、沈芊绿甚韪其说，因谓儿啼只宜轻手扶抱，任其自哭自止，切不可勉
强按住，或令吮乳止之，若无他病，不必服药。余谓是固然矣，然有因他故而啼者，杭州乐
怀谷女方襁褓，忽啼不止，拍之则愈啼，解衣视背，见绣针微露其绪，而针已全没，医治之
杂以药敷，肉溃而针终不出，延至百余日，卖酒家传一方，以银杏仁去衣心杵烂，菜油浸良
久，取油滴疮孔中，移时针透疮口，而针则已弯盖强拍入之也。又曾世荣于船中治王千户子
，头疼额赤，诸治不效，动即大哭，细审知为船蓬小篾刺入囟上皮肉，镊去即愈。然则小儿
啼哭，苟有异于寻常，即当细心审察，固不必一概投药，亦不得任其自啼自止也。
《劝行医说》中又有关于“乳吹”的论述，言辞详尽，一并录于此。凡是妇女患乳吹初起时，千万不要先请医生治疗。我常常见到医生治疗乳房疾病，用黄色敷药调和菊花叶涂抹患处，内服皂角刺末等药物，加速脓液形成。等到乳房红肿但尚未化脓成熟时，就用铍针刺入约一寸深，再用手强行挤出毒物，其疼痛往往导致患者昏厥，且出血多而脓液少。既然难以从内部消散，又让患者遭受长时间痛苦，伤口难以愈合，日久形成瘘管，腐烂缠绵不断，致使病人求生不能、求死不得，而需要哺乳的婴儿也将因失去乳汁而死亡，这种罪恶之重，拔尽头发也难以数清。医生的本意只是希望多次被延请，以博取财物，或者指望病情拖延以便重新索取高额药费罢了，难道不知道地狱中早已空出位置等待他们吗？因此，对于乳吹、乳痈（急性乳腺炎）等病症，初起时只需内服逍遥散（疏肝健脾方剂），以及六神丸（清热解毒方剂）、莲房灰末，用福橘酒送服；外煎紫苏、橘核、丝瓜络、川楝子、当归、红花、川乌、香附、官桂等药材的水，用两块手巾绞热后交替热敷乳房。轻症者乳汁即可疏散通畅，如果仍然不通，必须让患者忍受疼痛，找一个大男孩用力吸出积存的乳汁，随即吐出，吸吮三五次后无不顺畅，无需再请医生诊治。至于乳疽（乳房深部脓肿）、乳岩（乳腺癌）、乳癖（乳腺增生或结节），病情各不相同，治疗方法也各异，这需要名医静心体察认识，以汤剂为主，这绝不是外科医生所能奏效的。
小儿解颅（囟门迟闭，头颅增大）的症状，是因为肾气幼弱，脑髓不充实，无法收敛，从而导致头颅变大，应当急服地黄丸（补肾填精方剂）来补益。斋氏在《幼科发挥》中说：有一个孩子头缝四裂，皮肤光亮紧绷，两眼很小。万全曰：脑是髓海。肾主骨骼和骨髓，若其中有伏火，就会导致髓热而头骨开裂，额颅大而眼眶小，适宜服用地黄丸。孩子的父母不信此言，结果孩子十四岁时死去。我的一个族侄孙，幼年时解颅头大，而脸面很小，到十六岁竟然死了。我按语认为：龟板治疗小儿囟门不合，加入地黄中煎服，似乎更加灵验。
治疗小儿惊风（抽搐痉挛），砂雪丸使用朱砂、轻粉各一钱，僵蚕十个，蝎子三个，用青蒿节中的虫捣碎混合制成丸剂，研细，用人乳调服，相传此方非常神奇。我按语认为：“轻粉辛燥有毒，如果治疗不得法，毒气会窜入经络，变成其他疾病，危害非浅。不如用青蒿虫末混合灯草灰调入人乳服用，或者喂给小儿，在孩子睡觉时用铜管将青蒿虫末和灯草灰吹入口中，方法尤其简便奇妙，屡屡获得疗效，不可忽视。
喻嘉言在《温证朗照》中说：凡是小儿发热呕吐的，如果尚未出痘疹，就必须仔细审察，不可误用温胃的药物。邻里有一位宋侯，是一位高龄得子的父亲，放纵饮食不加节制，每次服用香砂平胃散（燥湿运脾方剂）极有效。一天晚上痘疹发作并呕吐，误服了前面的药物，满头红筋交错出现，斑点密集聚集，筋脉显露，这就是所谓的瓜藤斑。上饶的一位宰相侄子，年幼时被选为贡生，赴宴返回住所后，痘疹发作呕吐，他的父亲给他投喂藿香正气丸（解表化湿方剂）。一天夜里，舌头上生出三个黑色疔疮，形状像尖栗子，舌头下面生出四个黄色疔疮，形状像牛奶滴，这是因为痘邪正要发出，被药物阻截了出路，凶险变化如此，应当以此为戒。我按语认为：小儿患病，挟带热邪的居多，温燥性质的药物都应当慎用，不仅仅是痘疹病症需要注意。回忆我在杭州时，有一位府衙胥吏张某的儿子十岁，夏天触犯暑气，发热恶寒不想进食，医生投以藿香正气丸，于是导致热势亢盛、神志昏迷，嘴唇舌头焦干，口鼻出血而死。聂久可在《活幼心法》中说：小儿多在呕吐之后，胃气大虚，气不归元，阳气浮越于外，反而出现面赤头热、身体发热口渴，看起来像热证的情况，庸医误认为是热证，投以凉药，杀人就像翻手掌一样容易，所以治疗吐泻而用药不对症的，与其失误于寒凉，宁可失误于温补。失误于温补，还可以救治，失误于寒凉，祸害非常快，来不及救治。我按语认为：这种说法与前一条喻氏所论述的截然相反，参考阅读可以发现各有至理，关键在于准确辨证。大概凡是在病症初起时，发热口渴且呕吐的，大多挟有热邪；呕吐后又发热口渴的，往往属于虚寒证了。掌管生命的人，是我们县里的孔雅六学博宪采，他的长女刚出生，啼哭一声后，竟然沉默不再发声，查阅方书捉来一只猫，用布包起来，拿着靠近女孩耳边隔着布咬猫耳朵，猫大声嚎叫一声，女孩随即应声啼哭，后来就没有其他问题了，现在已经出嫁生子了。这就是古代所谓的禁方，其中的道理无法测度。《医学入门》说：初生一个月内的婴儿多啼哭，凡是胎热、胎毒、胎惊，都会由此散发出去，而且没有奇症。沈芊绿很赞同这个说法，因此认为婴儿啼哭只宜轻轻扶抱，任其自哭自止，切不可勉强按住，或令其吸吮乳汁来停止哭泣，如果没有其他疾病，不必服药。我认为这是对的，但是也有因为其他原因而啼哭的。杭州乐怀谷家的女儿还在襁褓中，忽然啼哭不止，拍打她则哭得更厉害，解开衣服看背部，看见绣针微微露出线头，而针身已经完全没入肉里，医生治疗时混杂用药敷，肌肉溃烂而针始终不出，拖延到一百多天，卖酒人家传来一方，用银杏仁去掉衣和心后捣烂，用菜油浸泡很久，取油滴入疮口中，移动时针透出了疮口，而针已经弯曲，原来是强行拍入导致的。又曾世荣在船上治疗王千户的儿子，头疼额头红，各种治疗无效，一动就大哭，仔细审察知道是船篷的小竹刺扎入了囟门上部的皮肉中，镊子取出后即痊愈。既然如此，那么小儿啼哭，如果有异于寻常，就应当细心审察，固然不必一概投药，也不得任由其自啼自止。
In "Advice on Practicing Medicine," there is another discussion regarding "Ru Chui" (Breast Blow/Blocked Milk Duct), with detailed explanations, which is recorded here. Whenever a woman first develops Ru Chui, she must not seek medical treatment immediately. I often see doctors treating breast diseases by applying yellow poultices mixed with chrysanthemum leaves to the affected area, and internally administering powder of Gleditsia Sinensis Spina (Zao Jiao Jia) and other substances to accelerate pus formation. When the breast becomes red but has not yet matured into an abscess, they use a Pi Zhen (Bicheng Needle) to puncture about one cun deep, then forcibly squeeze out the toxic matter with their hands. The pain often causes the patient to faint, resulting in excessive bleeding and little pus. Since internal resolution is difficult, the patient suffers for a long time, the wound fails to heal, and over time it forms a fistula. The rotting and lingering condition makes the patient unable to live or die peacefully, while the nursing infant will also perish from lack of milk. The gravity of this sin is beyond counting. The doctor's original intention is merely to be consulted repeatedly to gain wealth, or hoping the disease lingers so they can demand higher fees. Do they not know that hell has already reserved a seat for them? Therefore, for conditions such as Ru Chui and Ru Yong (Acute Mastitis), at the initial stage, it is sufficient to internally administer Xiao Yao San (Free and Easy Wanderer Powder), Liu Shen Wan (Six Gods Pill), and ash from Nelumbo Nucifera Calyx (Lian Fang Hui), taken with Fu Ju Jiu (Fortune Tangerine Wine). Externally, decoct Perilla Frutescens Folium (Zi Su Ye), Citrus Reticulata Semen (Ju He), Luffa Cylindrica Retinerve (Si Gua Luo), Melia Toosendan Fructus (Chuan Lian Zi), Angelica Sinensis Radix (Dang Gui), Carthamus Tinctorius Flos (Hong Hua), Aconitum Carmichaelii Radix Praeparata (Chuan Wu), Cyperi Rhizoma (Xiang Fu), and Cinnamomum Cassia Cortex (Guan Gui) in water. Use two towels soaked in hot water, wring them out, and apply alternately to warm the breast. In mild cases, the milk will disperse and flow freely. If it remains blocked, the patient must endure the pain and have a large boy forcefully suck out the accumulated milk, spitting it out immediately. After three to five times, relief is invariably achieved, without the need to consult a doctor. As for Ru Ju (Deep Breast Abscess), Ru Yan (Breast Cancer), and Ru Pi (Breast Nodule/Hyperplasia), the symptoms vary, and treatments differ. This requires renowned physicians to calmly observe and understand, relying primarily on decoctions, which are beyond the capability of general surgeons to effect a cure.
Pediatric "Jie Lu" (Delayed Closure of Fontanelle with Enlarged Head) occurs because the kidney qi is weak in childhood, and the brain marrow is insufficient, failing to consolidate, leading to an enlarged head. It is advisable to urgently administer Di Huang Wan (Rehmannia Pill) to tonify. Zhai's "You Ke Fa Hui" states: A child had four split sutures on the head, with tight, shiny skin and very small eyes. Wan Quan said: The brain is the sea of marrow. The Kidneys govern bones and marrow; if latent fire exists within, it causes heat in the marrow, leading to skull splitting, a large forehead, and small eye sockets. Administration of Di Huang Wan is appropriate. The parents did not believe this, and the child died at age fourteen. My clan's grand-nephew suffered from Jie Lu with a large head and small face in childhood, and died at sixteen. My commentary notes: Tortoise Shell (Gui Ban) treats unclosed fontanelles in children; adding it to Di Huang for decoction seems even more effective.
To treat pediatric Jing Feng (Convulsions), Sha Xue Wan uses Cinnabaris (Zhu Sha) and Hydrargyrum Chloridum Corrosivum (Qing Fen) each one qian, Bombyx Batryticatus (Jiang Can) ten pieces, and Scorpio (Quan) three pieces. These are pounded together with insects found in Artemisia Annua nodes (Qing Hao Jie Zhong Chong) and formed into pills, ground fine, and taken with human milk. This prescription is traditionally considered miraculous. My commentary notes: Qing Fen is acrid, dry, and toxic. If treated improperly, its toxicity may invade the meridians, causing other diseases with severe consequences. It is better to use powder of Qing Hao Chong mixed with Equisetum Hiemale Ash (Deng Cao Hui) dissolved in human milk for oral administration, or to feed it to the child. Alternatively, when the child sleeps, blow the mixture of Qing Hao Chong powder and Deng Cao Hui into the mouth using a copper tube. This method is simple and ingenious, yielding frequent success, and should not be ignored.
Yu Jiayan in "Wen Zheng Lang Zhao" states: For any child with fever and vomiting, if pox (smallpox/variolae) have not yet erupted, careful examination is required. One must not mistakenly use warming stomach medications. A neighbor, Song Hou, was an elderly father who indulged in food without restraint. He always took Xiang Sha Ping Wei San (Aucklandia and Amomum Powder to Pacify the Stomach) with great effect. One night, pox erupted accompanied by vomiting. He mistakenly took the previous medicine, resulting in red veins crisscrossing his entire head, dense spots clustering with exposed vessels, known as "Melon Vine Spots." The nephew of a Shangrao minister, selected as a tribute student in his youth, returned from a banquet with erupting pox and vomiting. His father administered Huo Xiang Zheng Qi Wan (Patchouli Powder to Rectify the Qi). Within one night, three black ding (carbuncles) appeared on the tongue, shaped like sharp chestnuts, and four yellow ding appeared under the tongue, shaped like milk drops. This occurred because the pox pathogen was trying to emerge but was blocked by the medication, leading to such ominous changes. This serves as a warning. My commentary notes: Children's illnesses often involve heat pathogens; warming and drying medicines should be used with caution, not only for pox cases. Recalling my time in Hangzhou, the son of a clerk surnamed Zhang, aged ten, contracted summerheat in summer, presenting with fever, aversion to cold, and anorexia. The doctor prescribed Huo Xiang Zheng Qi Wan, leading to intense heat, coma, scorched lips and tongue, and hemorrhage from the mouth and nose, resulting in death. Nie Jiu Ke in "Huo You Xin Fa" states: After prolonged vomiting in children, stomach qi is severely deficient, qi fails to return to its origin, and yang floats externally. This presents with red face, hot head, body heat, and thirst, resembling a heat syndrome. Quack doctors mistake this for heat and administer cooling medicines, killing patients as easily as flipping a hand. Therefore, when treating vomiting and diarrhea with ineffective medication, it is better to err on the side of warming and tonifying than cooling. Erring on warming and tonifying allows for potential rescue; erring on cooling brings rapid disaster that cannot be saved. My commentary notes: This view contradicts Yu's previous discussion. Reading both reveals merit in each; the key lies in accurate syndrome differentiation. Generally, early-stage symptoms of fever, thirst, and vomiting usually involve heat pathogens. However, fever and thirst recurring after vomiting often indicate deficiency-cold.
The guardian of life, Kong Yaliu, a learned scholar from our county, had a eldest daughter who cried once upon birth and then fell silent. Consulting medical texts, a cat was caught, wrapped in cloth, and brought near the girl's ear to bite the cat's ear through the cloth. The cat screamed loudly, and the girl cried in response. She recovered fully and later married and had children. This is what ancient texts call a "forbidden prescription," whose mechanism is unfathomable. "Yi Xue Ru Men" states: Infants crying frequently within the first month dissipate fetal heat, fetal toxins, and fetal fright, preventing strange diseases. Shen Qianlü agreed with this view, stating that infant crying should be handled by gently holding the baby, allowing them to cry until they stop naturally. One must not forcibly restrain them or make them suckle to stop crying. If no other illness exists, medication is unnecessary. I agree, but some crying stems from other causes. In Hangzhou, the daughter of Le Huaigu, still in swaddling clothes, cried incessantly. Patting her made her cry harder. Upon undressing her back, a sewing needle was seen slightly protruding with thread, while the rest was embedded in flesh. Doctors treated her with various topical applications, causing tissue ulceration, but the needle remained stuck for over 100 days. A wine seller provided a formula: remove the skin and heart of Ginkgo Biloba seeds (Yin Xing Ren), pound them into a paste, soak in rapeseed oil for a long time, and drip the oil into the wound. The needle eventually emerged through the wound, bent because it had been forced in during patting. Additionally, Zeng Shirong treated the son of Commander Wang on a boat. The child had a headache, red forehead, unresponsive to various treatments, and cried loudly upon movement. Careful examination revealed a small bamboo splinter from the boat canopy pierced into the skin above the fontanelle. Removal with tweezers cured him. Thus, if a child's crying differs from the norm, careful observation is essential. One should not indiscriminately medicate, nor simply ignore the crying.