虚极者，心虚、气短、头眩、多汗，须于前方加沙参、枣仁、熟地、玉竹养之，再参童便，
导瘀下行，亦妙。其有寒热交作者，亦由血虚不能荣养百体所致，宜用前方大剂养血，切勿
作外感治。《金匮》论新产妇人有三病∶一曰痉，二曰郁冒，三曰大便难。血不养肝，肝风
内动，则痉，此筋病也；血虚肝阳上越，则郁冒、头眩、目瞀、呕不能食、但头汗出，此神
病也；血虚不能濡肠，则大便难，此液病也。总之，皆阴虚血燥见证，当大剂养阴养血，如
复脉等汤，最忌辛温耗散，即有外风，亦忌风药升举其阳，致汗脱血晕而毙。春山先生云∶
治风先养血，血充风自灭。易一“养”字“充”字，较古歌尤胜。又有产后随卧，败血乘虚
上攻，或心下满闷，或痰涎壅盛，甚则神昏、口噤，更有败血冲心，喜笑怒骂，逾墙上屋者
，多致不救。此证不论虚实，急用热童便灌之。实证必有腹痛拒按情形，轻者用生化汤，重
者用回生丹最妙。若产后六气外邪为病，当汗、当清、当下，随证治之，速去其邪，兼护其
虚。无粮之师，贵在速战，又不可拘于产后宜温不宜凉之说。《内经》有故无殒，不专指胎
前言之也。女科大要如此，学人以意参之，随所指而进步焉，当不歧于路矣！
小儿，春令也，木德也，花之苞，果之萼，稚阳未充，稚阴未长者也。稚阳未充，则肌
肤疏薄，易于感触；稚阴未长，则脏腑柔嫩，易于传变，易于伤阴。故小儿病较大人尤重，
尤当以存阴为第一义。夫存阴，非补阴之谓。凡辛燥升散，温燥苦涩、消导，皆是耗伤阴液
之药；往往阴液被伤，肝风内动，鼓痰上升，血不荣筋，筋急拘挛，致成痉 。稚阳未充，
忌用苦寒，以苦寒善伐生生之气，且苦能化燥，化燥则又伤阴，不独伐生生之气已也。金石
之品，善定神智，令人发呆，冰、麝香燥走窜，最耗心液。经曰∶石药发癫，芳草发狂。不
可不知！
昔钱仲阳为小儿制六味丸，取酸甘化阴之义。酸，水味也；甘，土味也。木非水不生，
非土不载。木实初结多酸，犹禀木之本味；成熟则纯甘，甲乙合而化土，全得土之正味。五
味惟甘为无毒，甘润得水土气足，故能滋液。仲阳允为小儿之司命者哉！乃世俗未推六气致
病之理，未推六气最易化燥之理，并未推小儿稚阳未充、稚阴未长，尤易化燥之理；见儿发
热，不知何邪，概曰风寒，辄与辛燥升散，杂以苦温、苦涩消导。吾乡尤误于薄荷、荆芥辛
凉之说，下笔辄用。不知荆芥质燥气香，上升巅顶；薄荷质燥，辛辣异常，稍用三五分参于
辛润剂中，以和格拒犹可，若独用、多用、频用，即薄荷一味，实足耗液，致成痉 ，乃见
儿痉 ，便称惊风，乱投冰、麝、金石苦寒 悍毒药，以为开窍、镇惊、清热、祛风，家传
秘法，家藏丸丹，多系如此，误治甚多，殊堪悯恻！又或将“惊”字误作“筋”字之讹，挑
筋刺血，强推强拿，其在富贵之家，酿祸犹速。尝见荐医荐方，接踵而至，此医用热，彼医
用寒，一日之间，七方十剂遍尝，刀针金石全施，又或送鬼叫魂，此摇彼唤，使儿无片刻之
安，重棉浓絮，炉火壶汤，使儿在热 之内。花之苞也，果之萼也，其堪如此伤残也乎
？嗟乎！是谁误之也？父母误之也。假使延一明理之医，对证施治，何能至于此极乎？
吾乡鞠通先生，悯儿之疾苦，作《解儿难》一册。其中分寒痉、风温痉、温热痉、暑痉
、湿痉、燥痉六条，为六气致痉；分内伤饮食痉、本脏自病痉二条，为内伤痉；客忤痉一条
，为惊痉。又谓先感后痉者，即俗所谓惊风是也；病久致痉者，即俗所谓慢惊是也。又引《
素问》太阳所致为痉，痉者，强直之谓，后人所谓角弓反张是也；少阳所致为 ， 者，蠕
动引缩之谓，后人所谓抽掣、搐搦是也。愚细玩诸条，不外燥、湿二字，又终归于燥之一字
。然则六气最易化燥，小儿尤易化燥之说，此岂余之私见哉？
请析言之。寒与燥同源。风寒乃天地干结之气，干则化燥最速，故经谓伤寒为热病之类
。风与热皆属阳邪、风温、温热为温燥之气。暑有热有湿，为燥中夹湿之气。湿与燥相反，
湿不能作痉，故湿痉一条，本论亦曰湿性阴柔，不能致强，初起之湿痉，必兼风而成。兼风
寒者，主寒燥搏湿治；兼风热者，主风燥搏湿治。燥乃正秋之时，金风骤起，草木黄落，为
凉燥搏束之气，比伤寒较轻。又有暑湿内伏，凉燥外来，又为燥邪搏湿之气。所谓六气之邪
，不外燥湿，而燥为尤重者此也。内伤饮食痉，由儿之父母，爱惜过甚，不能为儿节制饮食
；饮食不节，则脾郁不舒；脾困则不能为胃行其津液，而湿渐停矣。湿停则泄泻，泄泻久则
伤脾，脾伤则血无生化之源，化源既薄，血液日虚，肝失所养，肝阳鼓动，内风辄发，木来
乘土，蠕动引缩。此由湿化燥之病，即俗所谓慢惊、慢脾风是也。慢脾风者，因脾慢而致生
肝风者也。本脏自病痉，由于儿之先天薄弱，父母又爱惜过甚，恐儿之寒，着以浓衣，覆以
浓被，冬月设以围炉，致儿每日出汗，汗多则亡血，血燥则生风；又或因儿常啼去泪，泪为
肝液，液去阴伤，肝阳鼓动，内风辄发，见蠕动引缩之象。然本脏自病，又为六气致痉之根
，一感外邪，内风随动，即成痉 。此内伤二痉，不外燥、湿，而又终于化燥者也。古语云
∶欲得小儿安，常带三分饥与寒。此为惜儿秘诀。盖饥非饿也，饮食清淡有节耳！寒非冻也
，不宜浓絮重绵 成热病耳！客忤一痉，瑟庵先生云∶世俗妄传惊风之证，惟此乃副其
名。此由儿之心胆血虚神怯，偶有所惊，即以致痉。所谓风者，非外风也，乃内动之肝风为
病耳。见证或有汗，或无汗，面色时青时赤，畏见异言异服，梦中呓语，手足搐搦，与六气
致痉，神气昏愦者不同，此更为血燥生风之证。余谓小儿诸病，不外燥湿，而又终归于燥者
，固实有明征也。
至于看法，以色诊为第一。凡神充色泽者，天真必浓，易养而少病；神怯神瞪，面色惨
淡枯瘁，唇红不泽者，禀赋必薄，难养而多病。再看其先后天气质。如先天亏者，必囟门难
合，或齿迟、语迟、行迟，或项软、发穗、青络常露之类是也；后天亏者，必食少化迟，腹
膨，泄泻，面色唇舌淡白之类是也。又有看虎口纹法，起于滑氏伯仁。歌曰∶小儿三岁下，
虎口看三关，紫热红伤寒，青惊白是疳，淡红淡黄者，斯为无病看。又谓纹见下节风关为轻
，纹见中节气关为重，纹见上节命关为危，直透三关为大危。世俗推拿一科，从之为法。但
滑氏及幼科诸书，均未推原其故。愚按∶《灵枢经》云∶经脉者，常不可见也。其虚实也，以
气口知之。脉之见者，皆络脉也。凡诊络脉∶色青则寒且痛；赤则有热；胃中寒，鱼际络多
青；胃中热，鱼际络红∶其暴黑者，留久痹也；其有赤有黑有青者，寒热气也；其青短者，
少气也。诊虎口之说，盖本乎此。但《内经》指百病而言，不专指小儿一科。彼滑氏男左女
右之说，未免拘执；且红为伤寒之说，显与经背。至以络脉所见之长短，审病之浅深，固属
法程，而风、气、命三字，又未免杜撰。夏禹铸谓小儿亦以四诊为法，望色、望苗窍为第一
。此说于理甚足。盖病之传变不常，即《内经》以色诊络之说，亦不可拘，惟手络不宜暴露
，是为要诀，以过露为血燥生风候也。
推拿一法，即《内经》按摩法。小儿惟内伤饮食一证，轻摩其腹，取其转运，可冀小效
，若他病用之，则非徒无益，而又害之矣。针灸法为《灵枢经》所重，但从无挑手络之理。
惟霍乱一证，因气闭以致血闭，其络色青黑者，即《内经》其暴黑者留久痹也之说，当针尺
泽（膀弯）、曲池（腿弯）二穴，以通气血，立时有效。此外非深于针法者，皆不可妄针，致伤
脉络。
至于认证，总以燥湿二气为提纲，以因风因寒因暑为机括，以化火未化火为传变，以伤
阴之轻重为用药之浅深。春山先生谓痘疹为燥火之甚者也，其次当以痉病为重。痉病，多由
燥热化风，虽名曰风，实是肝阳为病耳！筋失滋养，故致强急，今现燥象。
治法与大人无异，不必另立法门。试举其大略言之。风、寒、燥邪初起，发热、无汗，
无论痉与不痉，治以辛润，如杏仁、牛蒡、桔梗之类。寒重者加以温润，如葱白、豆豉、鲜
生姜之类。风温、温热，治以辛凉，于前辛润法中，酌加微苦之品，如桑叶、蒌皮、栀皮、
连翘、蔗皮、梨皮、南沙参之类。热重酌加凉润轻品，如银花、菊花、知母、羚羊角片、竹
叶、芦根、梨汁、蔗汁之类。客邪鼓动内风，痰涎上蒙清窍，厥时冒不知人，或发痉发 ，
前法必佐辛润以开内闭，如芥子、鲜石菖蒲、姜汁之类。痰涎闭窍∶热痰加贝母、天竹黄、
花粉、蒌仁、胆星、竹沥、姜汁之类；湿痰加半夏、蜜炙橘红之类。燥火甚者，清燥救肺汤
在所必用。夹暑夹湿者，加以辛淡，如蔻皮、蔻仁、通草、赤苓、淡竹叶、滑石、鲜荷叶、
扁豆花之类；夹湿热者，加姜汁炒木通、姜汁炒黄连之类，苦辛开化。阴液亏极者，色瘁窍
干，无涕无泪，口痉不能言语，宜速救液，如生地、麦冬、元参、鲜首乌、阿胶、鸡子黄、
鲜石斛、玉竹、女贞子、龟板、牡蛎、决明、燕菜之类。液虚燥甚者，必多进方回，切勿中
途易法，致之不救。其有液虚燥极，又有痰热闭窍，暑湿内伏者，不妨于养液剂中，参以辛
润开窍豁痰，辛润又能行水去湿。医不执方，合宜而且，病纯药纯，病杂药杂。细玩汉人方
法，活活泼泼，如珠走盘，其神妙有不可测者。凡此皆治六气致病之大略也。
若本脏自痉病，亦不外救液润燥一法。内伤饮食痉，在湿未化燥时，即须预防后来变痉
，及早节制饮食，健运脾阳，如参苓白术散、八仙糕、一味鸡金散之类；若已化燥，又须参
以甘平微润，如制首乌、山药、扁豆、沙苑子、枸杞、菟丝、枣仁、阿胶、龟板、淡菜、燕
菜之类。但此病阴阳两伤，燥湿并病，多不能救。客忤痉由血虚神怯而起，审其实有所因，
别无他病，用复脉去参、桂、枣、姜，加枣仁、牡蛎。汗多神不宁，时有恐惧者，加 龙骨
、整琥珀、整块朱砂，取其气，不取其质，自无流弊。
疳积一证，鞠通先生谓疳者干也，干生于湿，与内伤饮食痉同一病因。夫干生于湿，病
之所由起也，而湿已成干，病之所至极也。在湿未成干时，用资生、枳术等丸，疏补中焦，
颇为合拍，仿古人以乐侑食之义，食后击鼓，鼓动脾阳，使之运化，又以意治病之法。其有
因肥甘浓味太过，酿生湿热疳虫者，宜加苦寒辛酸，如连、梅、川椒、史君之类。若湿已成
疳，则不独苦寒杀虫，重伤脾胃，不宜误用，即资生等丸，亦嫌刚燥耗液，惟都中相传一方
，温润补脾，辛润通络，一通一补，相需成功，最为妙法。都中方以全蝎三钱，去毒，烘干
为末，每用精牛肉四两，作肉团数枚，加蝎末少许，蒸熟令儿逐日食之，以蝎末完为度。夫
蝎色青属木，善窜而疏土，其性阴，兼通阴络，疏脾郁之久病在络者最良。然其性 悍，不
宜独用。牛肉甘温，最善补土。牛肉得全蝎而愈健，全蝎得牛肉而不悍，补脾之体，运脾之
用，所以治疳积有殊功。一味鸡金散亦最妙。又华阴李孝廉方，用大枣百十枚，去核，象核
之大小，实以生军，面裹煨熟，捣为丸，如枣核大，每服七丸，日再服，神效。此亦一通一
补，润而不燥者也。按∶此二方，不独治疳积有功，凡类于疳积者，旁通触类，实开无限法
门。西学谓小儿疳积，乃吸液管受病。吸液管者，吸 食物之精液管也，千支百派，散布
大肠夹膜之间，食后少顷，内有精液，始见如白丝然，夹膜有小核甚多，即吸管叠积而成，
一切吸管，附近脊处，乃合为一，名曰精液总管，附脊骨而上，至颈骨第七节即屈转而下，
左入颈手回血会管，直达于心。小儿疳积，乃液管凝大闭塞不通，故多食犹瘠。按∶此与鞠
通
推而行之存乎通，神而明之存乎其人也。
凡是虚损到了极点的情况，会出现心气虚弱、气短、头晕目眩、多汗等症状，应当在前方（指前文提到的方剂）中加入沙参、酸枣仁、熟地黄、玉竹来滋养阴血，再配合童便使用，引导瘀血下行，效果也很好。那些出现寒热交替发作的，也是由于血虚不能荣养全身肢体所致，适宜用前方大剂量养血，千万不要当作外感病来治疗。《金匮要略》论述新产后的妇女有三种病：一是痉病，二是郁冒，三是大便难。血液不能滋养肝脏，肝风内动，就会发生痉病，这是筋脉的病变；血虚导致肝阳上越，就会出现郁冒、头晕目眩、视物模糊、呕吐不能进食、仅头部出汗，这是神志的病变；血虚不能濡润肠道，就会导致大便困难，这是津液的病变。总之，这些都是阴虚血燥的表现，应当大剂量滋阴养血，如复脉汤等方剂，最忌讳使用辛温发散的药物，即使有外风侵袭，也忌用升举阳气的风药，以免导致汗出过多、血脱晕厥而死亡。春山先生说：治疗风证首先要养血，血充足了风邪自然熄灭。将古歌中的“充”字改为“养”字，比古歌更为精妙。又有产后败血随着体位改变乘虚上攻，或者感到心下满闷，或者痰涎壅盛，甚至神志昏迷、牙关紧闭，更有败血冲心，表现为喜笑怒骂、爬高上屋等情况，大多难以救治。这种病症不论虚实，急用热童便灌服。实证必然伴有腹痛且拒绝按压的症状，轻症用生化汤，重症用回生丹最为巧妙。如果是产后因六淫外邪致病，应当根据情况采用发汗、清热或攻下的方法，随证治疗，迅速祛除邪气，同时兼顾保护正气。没有粮草的军队，贵在速战速决，也不可拘泥于产后宜温不宜凉的学说。《内经》说“有故无殒”，并不专指产前而言。妇科的大要就是这样，学者用心参悟，顺着所指的方向进步，就不会走偏了！
小儿，对应春季，属木德，像花蕾和果萼，是稚阳未充实、稚阴未生长的阶段。稚阳未充实，则肌肤疏薄，容易感受外邪；稚阴未生长，则脏腑柔嫩，病情容易传变，容易损伤阴液。所以小儿的疾病比成人更严重，尤其应当以保存阴液为第一要义。所谓存阴，并不是补阴的意思。凡是辛燥升散、温燥苦涩、消导类的药物，都是耗伤阴液的；往往阴液被损伤后，肝风内动，鼓动痰浊上升，血液不能荣养筋脉，导致筋脉紧急拘挛，形成痉病。稚阳未充实，忌讳使用苦寒药物，因为苦寒容易损伤生生之气，而且苦能化燥，化燥又会进一步伤阴，不仅损伤生生之气罢了。金石类药物善于安定神智，但令人发呆；冰片、麝香性燥而走窜，最耗伤心液。经书说：“石药发癫，芳草发狂。”不可不知道！
从前钱仲阳为小儿配制六味丸，取酸甘化阴的含义。酸，是水之味；甘，是土之味。木无水不生，无土不载。果实初结时多酸，如同禀受木的本味；成熟后纯甘，甲乙相合化为土，完全得到土的纯正味道。五味中只有甘味无毒，甘润得水土之气充足，所以能滋润津液。仲阳真可以说是小儿生命的守护者啊！然而世俗之人没有推究六气致病的道理，没有推究六气最容易化燥的道理，也没有推究小儿稚阳未充、稚阴未长，特别容易化燥的道理；看见孩子发热，不知道是什么邪气，一概说是风寒，就给予辛燥升散的药物，混杂苦温、苦涩消导的药。我家乡的人错误地认为薄荷、荆芥是辛凉药，下笔就用。不知道荆芥质地燥气味香，上行至头顶；薄荷质地燥，辛辣异常，稍微用三五分配合在辛润剂中调和格拒还可以，如果单独使用、多用、频用，即使是薄荷一味，也足以耗伤津液，导致成痉。等到看到孩子痉挛，就称为惊风，乱投冰片、麝香、金石等苦寒悍毒的药物，以为可以开窍、镇惊、清热、祛风，家传秘法，家藏丸丹，大多如此，误治很多，实在令人怜悯！又有人将“惊”字误作“筋”字的讹误，挑筋刺血，强行推拿。在富贵人家，酿成的祸患更快。曾见荐医荐方的人接踵而至，这个医生用热药，那个医生用寒药，一天之内，七方十剂全部尝遍，刀针金石全部施用，或者送鬼叫魂，这里摇那里唤，使孩子没有片刻安宁，厚棉浓絮，炉火壶汤，使孩子在热气之中。花之苞，果之萼，怎么能承受这样的伤残呢？唉！是谁误害了他们？是父母误害的。假使请一位明理的医生，对证施治，怎么会到这种地步呢？
我家乡的鞠通先生，怜悯儿童的疾苦，写了《解儿难》一书。其中分为寒痉、风温痉、温热痉、暑痉、湿痉、燥痉六条，属于六气致痉；分为内伤饮食痉、本脏自病痉二条，属于内伤痉；客忤痉一条，属于惊痉。又说先感邪后发痉的，就是俗话所说的惊风；病久导致发痉的，就是俗话所说的慢惊。又引用《素问》太阳所致为痉，痉的意思是强直，后人所说的角弓反张就是；少阳所致为瘛疭，瘛疭的意思是蠕动引缩，后人所说的抽掣、搐搦就是。我仔细玩味这些条目，不外乎燥、湿两个字，最终归结于燥这一个字。那么六气最容易化燥，小儿特别容易化燥的说法，这难道是我个人的私见吗？
请详细分析。寒与燥同源。风寒是天地干燥凝结之气，干燥则化燥最快，所以经书说伤寒属于热病一类。风与热都属阳邪，风温、温热是温燥之气。暑有热有湿，是燥中夹湿之气。湿与燥相反，湿不能导致痉病，所以湿痉一条，本论也说湿性阴柔，不能导致强直，初起的湿痉，必定兼有风而成。兼风寒的，主治寒燥搏湿；兼风热的，主治风燥搏湿。燥是正秋之时，金风骤起，草木黄落，是凉燥搏束之气，比伤寒较轻。又有暑湿内伏，凉燥外来，又是燥邪搏湿之气。所谓的六气之邪，不外乎燥湿，而燥尤为重要的原因就在这里。内伤饮食痉，是由于孩子的父母爱惜过度，不能为孩子节制饮食；饮食不节制，则脾郁不舒；脾困顿则不能为胃行使其津液，湿气逐渐停聚。湿停聚则泄泻，泄泻久了则伤脾，脾受伤则血液没有生化之源，化源既薄弱，血液日渐虚弱，肝失所养，肝阳鼓动，内风辄发，木来乘土，出现蠕动引缩。这是由湿化燥的病，即俗话所说的慢惊、慢脾风。慢脾风，是因为脾慢而导致生肝风的。本脏自病痉，由于孩子的先天薄弱，父母又爱惜过度，怕孩子冷，穿厚衣，盖厚被，冬天设围炉，导致孩子每天出汗，汗多则亡血，血燥则生风；又或因孩子常啼哭流泪，泪为肝液，液去阴伤，肝阳鼓动，内风辄发，出现蠕动引缩的现象。然而本脏自病，又是六气致痉的根本，一旦感受外邪，内风随之而动，即成痉病。这内伤两种痉病，不外乎燥、湿，而又最终归于化燥。古语说：要想小儿安，常带三分饥与寒。这是爱惜孩子的秘诀。饥饿不是饿肚子，而是饮食清淡有节制！寒冷不是冻着，而是不宜用浓絮重绵造成热病！客忤一痉，瑟庵先生说：世俗妄传的惊风证，只有这个才符合其名。这是由于孩子的心胆血虚神怯，偶然受到惊吓，就导致发痉。所谓的风，不是外风，而是内动的肝风致病。见证或有汗，或无汗，面色时青时赤，害怕见到异言异服，梦中呓语，手足搐搦，与六气致痉、神气昏愦的不同，这更是血燥生风的证候。我认为小儿诸病，不外乎燥湿，而又最终归于燥，确实有明确的证据。
至于诊察方法，以色诊为第一。凡是神气充沛色泽好的，天真必浓厚，容易养育而少病；神气怯弱眼神呆滞，面色惨淡枯槁，唇红而无光泽的，禀赋必薄弱，难养育而多病。再看其先后天体质。如先天亏虚的，必定囟门难合，或者牙齿长得晚、说话晚、走路晚，或者项软、发穗、青色脉络常露等；后天亏虚的，必定吃得少消化慢，腹部膨隆，泄泻，面色唇舌淡白等。又有看虎口纹的方法，起源于滑氏伯仁。歌诀说：小儿三岁下，虎口看三关，紫热红伤寒，青惊白是疳，淡红淡黄者，斯为无病看。又说纹见下节风关为轻，纹见中节气关为重，纹见上节命关为危，直透三关为大危。世俗推拿一科，遵循此法。但滑氏及幼科诸书，都没有推究其根本原因。我认为：《灵枢经》说：经脉通常看不见。其虚实，通过气口知道。脉可见的，都是络脉。凡诊察络脉：色青则寒且痛；赤则有热；胃中寒，鱼际络多青；胃中热，鱼际络红；突然变黑的，是留久痹也；有赤有黑有青的，是寒热气也；青而短的，是少气也。诊虎口之说，大概基于此。但《内经》指百病而言，不专指小儿一科。那滑氏男左女右的说法，未免拘执；且红为伤寒的说法，显然与经背道而驰。至于以络脉所见之长短，审病之浅深，固然是法则，而风、气、命三个字，又未免杜撰。夏禹铸说小儿也以四诊为法，望色、望苗窍为第一。此说于理很充分。因为病的传变无常，即《内经》以色诊络的说法，也不可拘泥，只有手络不宜暴露，是要诀，因为过露是血燥生风的征候。
推拿一法，即《内经》按摩法。小儿只有内伤饮食一证，轻摩其腹，取其转运，可冀小效，若其他病用之，则非徒无益，而又害之矣。针灸法为《灵枢经》所重视，但从无挑手络的道理。只有霍乱一证，因气闭以致血闭，其络色青黑的，即《内经》其暴黑者留久痹也的说法，当针尺泽（膀弯）、曲池（腿弯）二穴，以通气血，立时有效。此外非深于针法者，皆不可妄针，致伤脉络。
至于辨证，总以燥湿二气为提纲，以因风因寒因暑为机括，以化火未化火为传变，以伤阴之轻重为用药之浅深。春山先生说痘疹为燥火之甚者也，其次当以痉病为重。痉病，多由燥热化风，虽名曰风，实是肝阳为病耳！筋失滋养，故致强急，今现燥象。
治疗方法与大人无异，不必另立法门。试举其大略言之。风、寒、燥邪初起，发热、无汗，无论痉与不痉，治以辛润，如杏仁、牛蒡、桔梗之类。寒重者加以温润，如葱白、豆豉、鲜生姜之类。风温、温热，治以辛凉，于前辛润法中，酌加微苦之品，如桑叶、蒌皮、栀皮、连翘、蔗皮、梨皮、南沙参之类。热重酌加凉润轻品，如银花、菊花、知母、羚羊角片、竹叶、芦根、梨汁、蔗汁之类。客邪鼓动内风，痰涎上蒙清窍，厥时冒不知人，或发痉发瘛疭，前法必佐辛润以开内闭，如芥子、鲜石菖蒲、姜汁之类。痰涎闭窍：热痰加贝母、天竹黄、花粉、蒌仁、胆星、竹沥、姜汁之类；湿痰加半夏、蜜炙橘红之类。燥火甚者，清燥救肺汤在所必用。夹暑夹湿者，加以辛淡，如蔻皮、蔻仁、通草、赤苓、淡竹叶、滑石、鲜荷叶、扁豆花之类；夹湿热者，加姜汁炒木通、姜汁炒黄连之类，苦辛开化。阴液亏极者，色瘁窍干，无涕无泪，口痉不能言语，宜速救液，如生地、麦冬、元参、鲜首乌、阿胶、鸡子黄、鲜石斛、玉竹、女贞子、龟板、牡蛎、决明、燕菜之类。液虚燥甚者，必多进方回，切勿中途易法，致之不救。其有液虚燥极，又有痰热闭窍，暑湿内伏者，不妨于养液剂中，参以辛润开窍豁痰，辛润又能行水去湿。医不执方，合宜而且，病纯药纯，病杂药杂。细玩汉人方法，活活泼泼，如珠走盘，其神妙有不可测者。凡此皆治六气致病之大略也。
若本脏自痉病，亦不外救液润燥一法。内伤饮食痉，在湿未化燥时，即须预防后来变痉，及早节制饮食，健运脾阳，如参苓白术散、八仙糕、一味鸡金散之类；若已化燥，又须参以甘平微润，如制首乌、山药、扁豆、沙苑子、枸杞、菟丝、枣仁、阿胶、龟板、淡菜、燕菜之类。但此病阴阳两伤，燥湿并病，多不能救。客忤痉由血虚神怯而起，审其实有所因，别无他病，用复脉去参、桂、枣、姜，加枣仁、牡蛎。汗多神不宁，时有恐惧者，加龙骨、整琥珀、整块朱砂，取其气，不取其质，自无流弊。
疳积一证，鞠通先生谓疳者干也，干生于湿，与内伤饮食痉同一病因。夫干生于湿，病之所由起也，而湿已成干，病之所至极也。在湿未成干时，用资生、枳术等丸，疏补中焦，颇为合拍，仿古人以乐侑食之义，食后击鼓，鼓动脾阳，使之运化，又以意治病之法。其有因肥甘浓味太过，酿生湿热疳虫者，宜加苦寒辛酸，如连、梅、川椒、史君之类。若湿已成疳，则不独苦寒杀虫，重伤脾胃，不宜误用，即资生等丸，亦嫌刚燥耗液，惟都中相传一方，温润补脾，辛润通络，一通一补，相需成功，最为妙法。都中方以全蝎三钱，去毒，烘干为末，每用精牛肉四两，作肉团数枚，加蝎末少许，蒸熟令儿逐日食之，以蝎末完为度。夫蝎色青属木，善窜而疏土，其性阴，兼通阴络，疏脾郁之久病在络者最良。然其性悍，不宜独用。牛肉甘温，最善补土。牛肉得全蝎而愈健，全蝎得牛肉而不悍，补脾之体，运脾之用，所以治疳积有殊功。一味鸡金散亦最妙。又华阴李孝廉方，用大枣百十枚，去核，象核之大小，实以生军，面裹煨熟，捣为丸，如枣核大，每服七丸，日再服，神效。此亦一通一补，润而不燥者也。按：此二方，不独治疳积有功，凡类于疳积者，旁通触类，实开无限法门。西学谓小儿疳积，乃吸液管受病。吸液管者，吸食物之精液管也，千支百派，散布大肠夹膜之间，食后少顷，内有精液，始见如白丝然，夹膜有小核甚多，即吸管叠积而成，一切吸管，附近脊处，乃合为一，名曰精液总管，附脊骨而上，至颈骨第七节即屈转而下，左入颈手回血会管，直达于心。小儿疳积，乃液管凝大闭塞不通，故多食犹瘠。按：此与鞠通推而行之存乎通，神而明之存乎其人也。
In cases of extreme deficiency, symptoms such as heart deficiency (deficiency of the Heart organ and its functions), shortness of breath, dizziness, and excessive sweating occur. One should add Glehniae Radix (Shashen), Ziziphi Spinosae Semen (Zaoren), Rehmanniae Radix Praeparata (Shudi), and Polygonati Odorati Rhizoma (Yuzhu) to the previous formula to nourish the body. Additionally, incorporating human urine (Tongbian) can guide blood stasis downward, which is also effective. Cases with alternating chills and fever are also caused by blood deficiency failing to nourish the entire body; it is appropriate to use a large dose of the previous formula to nourish blood, and one must not treat it as an exterior contraction. The *Jingui Yaolue* discusses three diseases in postpartum women: first, spasm (Jing); second, depression and vertigo (Yumao); third, difficulty in defecation. When blood fails to nourish the Liver, internal stirring of Wind occurs, leading to spasm; this is a disease of the sinews. When blood deficiency causes Liver Yang to ascend, depression, vertigo, blurred vision, vomiting with inability to eat, and sweating only on the head occur; this is a disease of the Spirit. When blood deficiency fails to moisten the intestines, difficulty in defecation occurs; this is a disease of fluids. In summary, these are all manifestations of Yin deficiency and blood dryness. Large doses of Yin-nourishing and blood-nourishing formulas, such as Fumai Tang (Decoction for Reviving the Pulse), should be used. It is strictly forbidden to use acrid-warm dispersing agents. Even if there is external Wind, wind-dispersing drugs that raise Yang should be avoided to prevent death from collapse due to excessive sweating and blood loss. Mr. Chunshan stated: "To treat Wind, first nourish the Blood; when Blood is sufficient, Wind extinguishes itself." Changing the character "chong" (fill) to "yang" (nourish) in ancient songs is superior. Another condition is postpartum blood stasis attacking upward due to weakness, causing fullness and oppression in the epigastrium or excessive phlegm-saliva, even leading to coma and lockjaw. More severely, blood stasis rushing to the Heart may cause laughter, cursing, climbing walls, and roofs, often resulting in untreatable conditions. Regardless of excess or deficiency, hot human urine should be administered immediately. Excess patterns will necessarily present with abdominal pain and tenderness upon pressure; mild cases should use Shenghua Tang (Decoction for Generating New Blood), while severe cases should use Huisheng Dan (Elixir for Reviving Life). If postpartum illness is caused by the Six Qi (Six Pathogenic Factors) exterior pathogens, treatment should follow sweating, clearing, or purging methods according to the syndrome, rapidly eliminating the pathogen while protecting the deficiency. An army without provisions relies on swift battle; one must not be bound by the saying that postpartum conditions require warmth rather than cooling. The *Neijing* states "if there is a cause, there is no injury," which does not refer exclusively to pregnancy. These are the main principles of gynecology; scholars should contemplate them and progress accordingly, avoiding deviation.
Children correspond to Spring, possess Wood Virtue, and are like flower buds and fruit calyces. They have immature Yang that is not yet full and immature Yin that is not yet grown. Because immature Yang is not full, their skin and muscles are thin and susceptible to external pathogens; because immature Yin is not grown, their Zang-Fu organs are tender, prone to rapid transmission of disease, and easily damaged in terms of Yin. Therefore, pediatric diseases are more serious than adult diseases, and preserving Yin must be the primary principle. Preserving Yin does not mean tonifying Yin. All acrid-dry ascending and dispersing, warm-dry bitter-astringent, and digestive-promoting drugs consume Yin fluids. Often, when Yin fluids are damaged, Liver Wind stirs internally, driving Phlegm upward, and Blood fails to nourish the sinews, causing spasms and convulsions. With immature Yang, bitter-cold drugs should be avoided because they damage the vital energy of life, and bitterness can transform into dryness, further injuring Yin. Mineral drugs stabilize the Spirit but cause dullness; Borneolum Syntheticum (Bingpian) and Moschus (Shexiang) are drying and penetrating, consuming Heart fluids most severely. The Classics state: "Mineral drugs cause mania, aromatic herbs cause madness." This must be known!
Formerly, Qian Zhongyang formulated Liuwei Wan (Six-Ingredient Pill with Rehmannia) for children, based on the principle of sour and sweet transforming into Yin. Sour is the flavor of Water; Sweet is the flavor of Earth. Wood cannot grow without Water, nor be supported without Earth. Young fruits are often sour, inheriting the original flavor of Wood; mature fruits are purely sweet, where Jia and Yi combine to transform into Earth, obtaining the true flavor of Earth. Among the five flavors, only Sweet is non-toxic. Sweet and moistening, benefiting from sufficient Water and Earth Qi, can nourish fluids. Zhongyang truly deserves to be called the guardian of children's lives! However, common people fail to deduce the principles of Six Qi causing disease, the principle that Six Qi easily transforms into dryness, and the principle that children with immature Yang and Yin are especially prone to dryness. Seeing fever in children, they do not identify the pathogen, generally calling it Wind-Cold, and immediately administer acrid-dry ascending drugs mixed with bitter-warm and bitter-dry digestive agents. In my hometown, there is a misconception that Bohe (Menthae Haplocalycis Herba) and Jingjie (Schizonepetae Herba) are acrid-cool, so they are used indiscriminately. Jingjie is drying and aromatic, ascending to the vertex; Bohe is drying and extremely pungent. Using 3-5 fen in an acrid-moist formula to harmonize rejection is acceptable, but using it alone, in large doses, or frequently will consume fluids and cause spasms. Once spasms occur, it is labeled as "Jing Feng" (Wind-Stirring), and Borneolum, Moschus, and mineral bitter-cold toxic drugs are recklessly thrown in under the guise of opening orifices, calming fright, clearing heat, and dispelling wind. Family secret recipes and pills often contain such ingredients, causing much misdiagnosis and harm, which is pitiable. Some mistake "Jing" (Fright) for "Jin" (Sinew), performing tendon-piercing and bloodletting, or forceful manipulation. In wealthy families, this causes rapid disaster. I have seen doctors and prescriptions arriving in succession; one doctor uses hot drugs, another cold, trying dozens of prescriptions and needles/minerals in a day, or summoning spirits, disturbing the child's peace, wrapping them in thick cotton near fires, subjecting them to intense heat. Can flower buds and fruit calyces endure such mutilation? Alas! Who errs? The parents err. If a knowledgeable doctor were consulted to treat according to the syndrome, how could it reach such extremes?
Mr. Ju Tong of my hometown, pitying the suffering of children, wrote *Jie Er Nan* (Resolving Pediatric Difficulties). It categorizes Cold Spasm, Wind-Warm Spasm, Warm-Thermal Spasm, Summer-Heat Spasm, Dampness Spasm, and Dryness Spasm as Six Qi causing spasm; Internal Injury from Diet Spasm and Primary Organ Self-Disease Spasm as Internal Injury spasms; and Ke Wu Spasm as Fright Spasm. It states that spasm following initial infection is the popular "Jing Feng"; spasm after prolonged illness is "Man Jing" (Slow Convulsion). Citing the *Suwen*, Taiyang causes spasm (rigidity/opisthotonos); Shaoyang causes chi-zong (twitching/clonic movements). Studying these categories reveals they revolve around Dryness and Dampness, ultimately归结ing to Dryness. Thus, the theory that Six Qi easily transforms into dryness, and children are especially prone to dryness, is not merely my private view.
Let us analyze this. Cold and Dryness share a source. Wind-Cold is the dry-condensing Qi of Heaven and Earth; dryness transforms quickly, hence the Classic says Cold Damage is a type of Heat Disease. Wind and Heat are Yang pathogens; Wind-Warm and Warm-Thermal are Warm-Dry Qi. Summer-Heat has both Heat and Dampness, being Dryness intermixed with Dampness. Dampness opposes Dryness and cannot cause spasm; thus, Dampness Spasm involves Wind. Combined with Wind-Cold, treat Cold-Dry binding Dampness; combined with Wind-Heat, treat Wind-Dry binding Dampness. Dryness occurs in mid-Autumn with Metal Wind, yellowing leaves, representing Cool-Dry binding, milder than Cold Damage. Summer-Dampness lurking internally with external Cool-Damp creates Dryness binding Dampness. Thus, among Six Qi pathogens, Dryness and Dampness are key, with Dryness being heavier. Internal Injury Spasm from diet arises from parents overprotecting and failing to regulate diet; irregular eating causes Spleen stagnation; Spleen dysfunction fails to transport fluids, leading to Dampness retention. Prolonged diarrhea damages the Spleen, depleting the source of Blood generation. Blood deficiency fails to nourish the Liver, causing Liver Yang to stir and Internal Wind to arise, with Wood overacting on Earth, causing twitching. This is Wet transforming into Dry, known as Slow Convulsion or Slow Spleen Wind. Slow Spleen Wind is Liver Wind generated by Spleen sluggishness. Primary Organ Self-Disease Spasm stems from congenital weakness and parental overprotection (overclothing/heating), causing sweating, blood loss, blood dryness, and Internal Wind. Or, frequent crying depletes tears (Liver fluid), injuring Yin, stirring Liver Yang and Internal Wind. This primary organ disease is the root of Six Qi-induced spasm; once external pathogens enter, Internal Wind moves, causing spasm. These two internal injuries involve Dryness and Dampness, ultimately transforming into Dryness. The proverb "Keep a child safe with slight hunger and cold" means moderate diet and avoiding overheating. Ke Wu Spasm, per Mr. Se'an, is the only true "Fright" syndrome. It arises from Heart/Gallbladder Blood deficiency and Spirit timidity; sudden fright triggers spasm. The "Wind" here is not external but Internal Liver Wind. Symptoms include sweating or none, fluctuating complexion, fear of strange sights/sounds, sleep-talking, and limb twitching, differing from Six Qi spasm with clouded Spirit. This confirms Blood Dryness generating Wind.
Regarding diagnosis, color observation is primary. Abundant Spirit and good luster indicate strong constitution and health; timid Spirit, dull eyes, pale/withered complexion, and red lips without luster indicate weak constitution and susceptibility to disease. Assess congenital and acquired constitution. Congenital deficiency presents as delayed fontanelle closure, late teething/speaking/walking, weak neck, sparse hair, or visible blue veins. Acquired deficiency presents as poor appetite, slow digestion, distended abdomen, diarrhea, and pale face/lips/tongue. Observing the Tiger’s Mouth (thenar eminence) lines originates from Master Hua. The rhyme states: For children under three, check three gates on the Tiger’s Mouth; Purple indicates Heat, Red indicates Wind-Cold, Green indicates Fright, White indicates Malnutrition; Pale Red/Yellow indicates health. Lower gate (Wind) is mild, middle gate (Qi) is heavy, upper gate (Life) is critical; penetrating all three is very critical. Tuina follows this, but origins are unclear. The *Lingshu* states meridians are invisible; their deficiency/excess is known via the radial pulse. Visible vessels are collateral vessels. Blue collaterals indicate Cold/Pain; Red indicates Heat; Blue at Yuji indicates Stomach Cold; Red at Yuji indicates Stomach Heat; Black indicates chronic Bi; Mixed colors indicate Cold/Heat; Short Blue indicates Qi deficiency. Tiger’s Mouth diagnosis derives from this. However, *Neijing* applies to all diseases, not just pediatrics. Hua’s left-male/right-female rule is rigid; Red indicating Wind-Cold contradicts the Classic. Using collateral length to judge depth is valid, but naming gates Wind/Qi/Life is fabricated. Xia Yuzhu emphasizes Four Diagnostic Methods, prioritizing Color and Miao Qiao (Orifices). This is logical. Disease transmission varies; even *Neijing*’s color diagnosis shouldn't be rigid. Hand collaterals should not be exposed, as exposure indicates Blood Dryness generating Wind.
Tuina is the massage method of *Neijing*. Only for internal dietary injury, gentle abdominal massage aids transformation. For other diseases, it is harmful. Acupuncture is valued in *Lingshu*, but pricking hand collaterals is not standard. Except for Cholera (Huo Luan) where Qi blockage causes Blood blockage with blue-black collaterals (chronic Bi), puncturing Chize (Cubital fossa) and Quchi (Elbow crease) opens Qi/Blood effectively. Others should not needle blindly to avoid damaging collaterals.
Syndrome differentiation focuses on Dryness/Dampness as the outline, Wind/Cold/Summer-Heat as mechanisms, Fire transformation as progression, and Yin damage severity as medication depth. Mr. Chunshan states Varicella is extreme Dryness-Fire, followed by Spasm. Spasm is mostly Dryness-Heat transforming into Wind, actually a Liver Yang disorder. Sinews lose nourishment, causing rigidity and Dryness signs.
Treatment mirrors adults. For initial Wind/Cold/Dryness with fever/no sweat, use Acrid-Moist (Almond, Bullace Seed, Platycodon). For severe Cold, add Warm-Moist (Scallion, Fermented Soybean, Fresh Ginger). For Wind-Warm/Warm-Thermal, use Acrid-Cool (Mulberry Leaf, Trichosanthes Peel, Gardenia Peel, Forsythia, Sugarcane Peel, Pear Peel, Glehnia). For severe Heat, add Cool-Moist (Chrysanthemum, Honeysuckle, Anemarrhena, Antelope Horn, Bamboo Leaf, Reed Rhizome, Pear Juice, Sugarcane Juice). If pathogenic factors stir Internal Wind and Phlegm obscures clear orifices, causing coma or spasm, add Acrid-Moist to open internal closure (Mustard Seed, Fresh Acorus, Ginger Juice). For Phlegm blocking orifices: Hot Phlegm adds Fritillaria, Talcum, Glehnia, Trichosanthes Seed, Areca Seed, Bamboo Sap, Ginger Juice; Damp Phlegm adds Pinellia, Honey-fried Tangerine Peel. For severe Dryness-Fire, Qingzao Jiufei Tang is essential. For Summer-Heat/Dampness, add Acrid-Light (Cardamom Peel/Seed, Akebia, Polyporus, Smilax, Lotus Leaf, Bean Flower); for Damp-Heat, add Ginger-fried Akebia and Coptis for Bitter-Acid opening. For extreme Yin fluid depletion (withered complexion, dry orifices, no tears/saliva, locked jaw), urgently rescue fluids with Rehmannia, Ophiopogon, Scrophularia, Polygonatum, Donkey-hide Gelatin, Egg Yolk, Dendrobium, Polygonatum, Ligustrum, Turtle Shell, Oyster Shell, Cassia Seed, Swallow Nest. For severe fluid deficiency/dryness, continue the same formula; do not change midway. If fluid deficiency/dryness coexists with Phlegm-Heat blocking orifices and Summer-Dampness, add Acrid-Moist to open orifices and resolve Phlegm within fluid-nourishing formulas; Acrid-Moist also moves water and removes dampness. Doctors should not stick rigidly to formulas; match pure diseases with pure medicines. Han dynasty methods are flexible and profound. These are general principles for Six Qi diseases.
For Primary Organ Spasm, the method is rescuing fluids and moistening dryness. For Internal Dietary Spasm, before Dampness transforms to Dryness, regulate diet and strengthen Spleen Yang (Shenling Baizhu San, Eight Immortals Cake, Single Herb Chicken Gizzard Membrane Powder). If already transformed to Dryness, add Sweet-P neutral-Moist (Prepared Fleeceflower, Yam, Dolichos, Astragalus complanatus, Goji, Dodder, Jujube Seed, Donkey-hide Gelatin, Turtle Shell, Mussel, Swallow Nest). This condition involves both Yin/Yang injury and Dryness/Dampness, often untreatable. Ke Wu Spasm arises from Blood/Spirit deficiency; if confirmed without other causes, use Fumai Tang minus Ginseng, Cinnamon, Jujube, Ginger, adding Jujube Seed and Oyster Shell. For sweating/restlessness/fear, add Dragon Bone, Amber, Cinnabar (using their Qi, not substance).
Malnutrition (Gan Ji) is "Dryness born from Dampness," same cause as Internal Dietary Spasm. Dryness born from Dampness is the origin; Dampness becoming Dryness is the extremity. Before Dampness becomes Dryness, use Zisheng or Zhizhu Pills to soothe/tonify Middle Jiao, mimicking ancient music-to-aid-eating rituals to stimulate Spleen Yang. For Greasy/Sweet excess causing Damp-Heat Parasites, add Bitter-Cold/Acrid-Sour (Coptis, Plum, Sichuan Pepper, Croton). If Dampness has become Gan, Bitter-Cold parasites killers hurt Spleen/Stomach; Zisheng pills are too drying. Use a Beijing formula: Scorpion (Quelled toxicity, dried powder) with Beef. Scorpion (Green/Wood) penetrates and soothes Earth; Beef (Sweet/Warm) tonifies Earth. Scorpion + Beef balances movement and tonification, treating Gan Ji excellently. Single Herb Chicken Gizzard Membrane Powder is also excellent. Li Xiaolian’s Huayin formula: Dates stuffed with Rheum, baked, pill-sized, highly effective. Both formulas are Tonifying/Moving, Moistening/Non-drying. Western medicine attributes Gan Ji to lacteal vessel obstruction. Lacteals absorb nutrients, branching in intestinal mesentery, merging into the thoracic duct near the spine, entering the heart. Gan Ji is blockage of these vessels, causing emaciation despite eating. This aligns with Ju Tong’s theory: Application depends on flexibility; enlightenment depends on the practitioner.