小儿病 多伤寒 喻嘉言曰∶方书谓小儿八岁以前无伤寒，此胡言也。小儿不耐伤寒，
初传太阳一经，早已身强、多汗、筋脉牵动、人事昏沉，势已极于本经，误药即死，无由见
其传经，所以谓其无伤寒也。俗云惊风皆是。
稚阳体 邪易干 时医以稚阳为纯阳，生死关头，开手便错。
凡发热 太阳观 太阳主身之表，小儿腠理未密，最易受邪。其症头痛、项强、发热、
恶寒等小儿不能自明，唯发热一扪可见。
热未已 变多端 喻嘉言曰∶以其头摇手动也，而立抽掣之名；以其卒口噤、脚挛急也
，而立目斜、心乱、搐搦之名；以其脊强背反也，而立角弓反张之名；造出种种不通名目，
谓为惊风。而用攻痰、镇惊、清热之药，投之立死矣。不知太阳之脉起于目内 、上额交巅
入脑、还出别下项、夹脊抵腰中，是以见上诸症。当时若以桂枝汤照法服之，则无余事矣。
过此失治，则变为痉症。无汗用桂枝加葛根汤，有汗用桂枝加栝蒌根汤，此太阳而兼阳明之
治也。抑或寒热往来，多呕，以桂枝汤合小柴胡汤或单用小柴胡汤，此太阳而兼少阳之治也。
太阳外 仔细看 喻嘉言云∶三日即愈为贵，若待经尽方解，必不能耐矣。然亦有耐得
去而传他经者，亦有实时见他经之症者，宜细认之。
遵法治 危而安 遵六经提纲之法而求之，详于《伤寒论》。
若吐泻 求太阴 太阴病以吐食、自利、不渴、手足自温、腹时痛为提纲，以理中汤主之。
吐泻甚 变风淫 吐泻不止，则土虚而木邪乘之。《左传》云∶风淫末疾。末，四肢之
末也。即抽掣挛急之象。
慢脾说 即此寻 世谓慢脾风多死，而不知即太阴伤寒也。有初时即伤于太阴者，有渐
次传入太阴者，有误用神曲、麦芽、山楂、萝卜子、枳壳、葶苈、大黄、栝蒌、胆南星等药
陷入太阴者。既入太阴，其治同也。如吐泻后，冷汗不止，手足厥逆，理中汤加入附子，或
通脉四逆汤、白通汤佐之，此太阴而兼少阴之治也。如吐泻手足厥冷、烦躁欲死、不吐食而
吐涎沫，服理中汤不应，宜吴茱萸汤佐之，此太阴而兼厥阴之治也。若三阴热化之证，如太
阴腹时痛时止，用桂枝加芍药汤。大便实而痛，用桂枝加大黄汤。少阴之咳而呕渴，心烦不
得眠，宜猪苓汤。心中烦、不得卧，宜黄连阿胶汤。厥阴之消渴、气冲、吐蛔、下利，宜乌
梅丸。下利后重、喜饮水，用白头翁汤等症亦间有之。熟《伤寒论》者自知，而提纲不在此也。
阴阳证 二太擒 三阳独取太阳，三阴独取太阴，擒贼先擒王之手段也。太阳阳明少阳
为三阳，太阴少阴厥阴为三阴。
千古秘 理蕴深 喻嘉言通禅理，后得异人所授，独得千古之秘。胡卣臣曰∶习幼科者
，能虚心领会，便可免乎殃咎，若骇为异说，则造孽无极矣。
即痘疹 此传心 痘为先天之毒，伏于命门，因感外邪而发。初起时用桂枝汤等，从太
阳以化其气，气化则毒不留，自无一切郁热诸症，何用服连翘、紫草、牛蒡、生地、犀角、
石膏、芩、连诸药，以致寒中变症乎?及报点已齐后，冀其浆满，易于结痂而愈，当求之太
阴，用理中汤等补中宫土气，以为成浆脱痂之本，亦不赖保元汤及鹿茸、人乳、糯米、桂圆
之力也。若用毒药取浆，先损中宫土气，浆何由成?误人不少!此古今痘书所未言，唯张隐庵
《侣山堂类辩》微露其机于言外，殆重其道而不敢轻泄欤?疹症视痘症稍轻，亦须知此法。
高士宗《医学真传》有桂枝汤加金银花、紫草法。
谁同志 度金针
小儿的疾病，大多属于伤寒范畴。喻嘉言说：医书中称八岁以下儿童没有伤寒，这是胡说。小儿不耐受伤寒邪气，病邪初传至太阳经时，就已经出现身体僵硬、多汗、筋脉抽搐牵引、神志昏沉等症状，病情在本经已发展到极点，误用药物就会死亡，根本没有机会看到病邪传入其他经络，所以人们才说小儿没有伤寒。民间所说的惊风，其实都是这种情况。
小儿体质稚阳，外邪容易侵犯。当时的医生认为小儿是“纯阳”之体，在生死攸关的关头，治疗一开始就错了。
凡是遇到发热症状，应从太阳经的角度观察。太阳经主管人体体表，小儿腠理（皮肤纹理及毛孔）不致密，最容易受到邪气侵袭。其症状如头痛、项背强直、发热、恶寒等，小儿无法自行表达，只有发热这一项可以通过触摸感知到。
如果发热未止，变化多种多样。喻嘉言说：因为看到患儿头摇手动，就创立了“抽掣”的名称；因为看到突然口噤、脚部痉挛拘急，就创立了“目斜”、“心乱”、“搐搦”的名称；因为看到脊背强直反折，就创立了“角弓反张”的名称。造出种种不通顺的名目，称之为惊风。并使用攻逐痰涎、镇惊、清热的药物，投药后患儿立刻死亡。他们不知道太阳经脉起于目内眦，上行额部交会于头顶，入络脑，复出别下行项后，夹脊柱抵腰中，因此会出现上述各种症状。当时如果按照法度服用桂枝汤，就没有其他问题了。错过这个时机失治，就会转变为痉症。无汗的用桂枝加葛根汤，有汗的用桂枝加栝蒌根汤，这是太阳经兼治阳明经的方法。或者出现寒热往来、频繁呕吐，用桂枝汤合小柴胡汤，或者单用小柴胡汤，这是太阳经兼治少阳经的方法。
太阳经受邪，要仔细诊察。喻嘉言说：三天内痊愈最为可贵，如果等到经络之气尽时才解除，小儿一定承受不了。然而也有能耐受而病邪传入其他经络的，也有立即出现其他经络症状的，应当仔细辨认。
遵循治疗方法，就能使危重转为平安。遵循六经提纲证的方法去求索，详细记载在《伤寒论》中。
如果出现呕吐腹泻，要寻求太阴经的病机。太阴病的提纲证是呕吐食物、自发性腹泻、口不渴、手足自然温暖、腹部时常疼痛，以理中汤为主治方剂。
如果吐泻严重，会变为风邪淫溢之症。吐泻不止，则脾土虚弱而肝木邪气乘虚而入。《左传》说：风淫末疾。“末”指四肢末端。即表现为抽搐挛急的征象。
关于慢脾风的说法，由此可以探寻。世人认为慢脾风大多致死，却不知道这就是太阴伤寒。有的起初就伤于太阴，有的逐渐传入太阴，有的误用神曲、麦芽、山楂、萝卜子、枳壳、葶苈、大黄、栝蒌、胆南星等药物，导致病邪陷入太阴。既然进入太阴，治疗方法相同。如在吐泻之后，冷汗不止，手足厥冷，理中汤中加入附子，或者配合通脉四逆汤、白通汤，这是太阴经兼治少阴经的方法。如吐泻导致手足厥冷、烦躁欲死、不呕吐食物而呕吐涎沫，服用理中汤无效，宜用吴茱萸汤配合治疗，这是太阴经兼治厥阴经的方法。如果是三阴经的热化证，如太阴经腹部时而疼痛时而停止，用桂枝加芍药汤。大便干结且疼痛，用桂枝加大黄汤。少阴经咳嗽而呕吐口渴，心烦不得睡眠，宜用猪苓汤。心中烦闷、不能安卧，宜用黄连阿胶汤。厥阴经消渴、气上冲心、吐蛔虫、下利，宜用乌梅丸。下利后里急后重、喜欢喝水，用白头翁汤等病症也间或有之。熟读《伤寒论》的人自然知道，而提纲证并不在此处列举。
阴阳证候，关键在于把握太阴和太阳。三阳经独取太阳，三阴经独取太阴，这是擒贼先擒王的策略。太阳、阳明、少阳为三阳，太阴、少阴、厥阴为三阴。
这是千古秘密，道理蕴含深远。喻嘉言通晓禅理，后来得到异人传授，独自获得了千古秘传。胡卣臣说：学习儿科的医生，如果能虚心领会，就可以避免灾祸，如果惊骇地认为是异端学说，那就造孽无穷了。
即使是痘疹病症，也传承此心法。痘毒是先天之毒，潜伏在命门，因感受外邪而发作。初起时用桂枝汤等，从太阳经来化解其气，气化则毒邪不留存，自然没有一切郁热诸症，何须服用连翘、紫草、牛蒡、生地、犀角、石膏、黄芩、黄连等药物，以致损伤中焦阳气变生他症呢？等到痘点发出齐备后，希望浆液饱满，易于结痂而愈，应当求之于太阴，用理中汤等补益中宫脾胃之气，作为成浆脱痂的根本，也不依赖保元汤以及鹿茸、人乳、糯米、桂圆的力量。如果使用毒药强行取浆，先损伤中宫脾胃之气，浆液从何而来？误人不浅！这是古今痘科书籍所未曾言说的，只有张隐庵在《侣山堂类辩》中在言外微微透露其机理，大概是重视其道而不敢轻易泄露吧？疹症比痘症稍轻，但也需要知晓这种方法。高士宗在《医学真传》中有桂枝汤加金银花、紫草的方法。
谁有志同道合者，我愿传授这金针度人的秘诀。
Diseases in children are mostly of the nature of Shanghan (Cold Damage). Yu Jiayan stated: Medical texts claim that children under eight years old do not suffer from Shanghan; this is nonsense. Children cannot tolerate Shanghan pathogens. When the pathogen initially transmits to the Taiyang channel (Taiyang channel disease), symptoms such as body stiffness, excessive sweating, tendon and vessel spasms, and mental confusion already appear. The condition reaches its extreme within the primary channel. If treated with incorrect medication, death ensues immediately, leaving no opportunity to observe transmission to other channels. Hence, it is said that children do not have Shanghan. What is commonly referred to as "Jingfeng" (Convulsive Disease) in folklore is actually all of this.
Children possess a "Zhiyang" (Tender Yang) constitution, making them susceptible to external pathogens. Contemporary physicians mistakenly consider tender yang to be "Pure Yang." This error occurs right at the critical juncture of life and death.
Whenever fever occurs, one should examine the Taiyang channel. The Taiyang channel governs the exterior of the body. Children's couli (pores and skin texture) are not dense, making them most prone to pathogenic invasion. Symptoms such as headache, neck stiffness, fever, and aversion to cold cannot be self-reported by children; only fever can be detected by palpation.
If the fever persists, variations are numerous. Yu Jiayan stated: Because head shaking and hand movements are observed, the term "Chouche" (Spasmodic Twitching) was coined; because sudden jaw locking and leg cramps are seen, terms like "Muxie" (Eye Deviation), "Xinluan" (Heart Confusion), and "Chunuo" (Jerking) were established; because spinal rigidity and opisthotonos are present, the term "Jiaogong Fanzhang" (Opisthotonos) was created. These illogical names were fabricated and labeled as Jingfeng. Medications for expelling phlegm, calming fright, and clearing heat are administered, leading to immediate death. They fail to realize that the Taiyang meridian originates from the inner canthus, ascends to the forehead, intersects at the vertex, enters the brain, emerges again to descend along the nape, runs alongside the spine to the loins. Thus, the aforementioned symptoms arise. At that time, if Guizhi Tang (Cinnamon Twig Decoction) had been administered according to protocol, there would have been no further issues. Missing this window of treatment leads to transformation into Jingzheng (Stiffness Syndrome). For cases without sweat, Guizhi Jia Gegen Tang (Guizhi Tang plus Pueraria Decoction) is used; for cases with sweat, Guizhi Jia Gualougen Tang (Guizhi Tang plus Trichosanthes Root Decoction) is used. This represents the treatment for Taiyang combined with Yangming. Alternatively, if there are alternating chills and fever with frequent vomiting, Guizhi Tang combined with Xiaochaihu Tang (Minor Bupleurum Decoction), or Xiaochaihu Tang alone, is used. This represents the treatment for Taiyang combined with Shaoyang.
When the Taiyang exterior is affected, careful examination is required. Yu Jiayan noted: Recovery within three days is ideal. If one waits until the channel cycle completes for resolution, the child certainly could not endure it. However, some withstand it and transmit to other channels, while others immediately show symptoms of other channels; these must be carefully distinguished.
Following the correct treatment methods transforms danger into safety. One should seek guidance based on the outline patterns of the Six Channels, as detailed in the *Shanghan Lun* (Treatise on Cold Damage).
If vomiting and diarrhea occur, one should investigate the Taiyin channel. The outline pattern of Taiyin disease includes vomiting food, spontaneous diarrhea, absence of thirst, naturally warm hands and feet, and intermittent abdominal pain. Lizhong Tang (Regulate the Middle Decoction) is the primary formula.
Severe vomiting and diarrhea may transform into wind-pathogen excess conditions. Persistent vomiting and diarrhea lead to Spleen Earth deficiency, allowing Liver Wood pathogenic factors to invade. As stated in the *Zuo Zhuan*: "Wind excess causes diseases of the extremities." "Extremities" refer to the limbs. This manifests as spasms and cramps.
The theory of Manpi Feng (Slow Spleen Wind) can be traced back to this. The world believes Manpi Feng is often fatal, not realizing it is Taiyin Shanghan. Some are injured in Taiyin initially, some gradually transmit to Taiyin, and some fall into Taiyin due to the misuse of herbs such as Shenqu (Medicated Leaven), Maiya (Sprouted Barley), Shanzha (Hawthorn), Luobozhizi (Radish Seed), Zhiqiao (Immature Bitter Orange), Tingli (Descurainia Seed), Dahuang (Rhubarb), Gualou (Trichosanthes Fruit), and Danningxing (Arisaema with Bear Bile). Once entering Taiyin, the treatment is the same. For instance, after vomiting and diarrhea, if cold sweat continues and the four limbs are cold, Fuzi (Aconite Lateralis Radix Preparata) is added to Lizhong Tang, or Tongmai Sini Tang (Pulse-Restoring Four Reversal Decoction) and Baitong Tang (White Decoction) are used as adjuncts. This is the treatment for Taiyin combined with Shaoyin. If vomiting and diarrhea cause cold limbs, severe irritability, retching saliva instead of food, and Lizhong Tang is ineffective, Wuzhuyu Tang (Evodia Decoction) should be used as an adjunct. This is the treatment for Taiyin combined with Jueyin. In cases of heat-transformation syndromes of the Three Yin channels: for Taiyin intermittent abdominal pain, Guizhi Jia Shaoyao Tang (Guizhi Tang plus Peony Decoction) is used. For constipation with pain, Guizhi Jia Dahuang Tang (Guizhi Tang plus Rhubarb Decoction) is used. For Shaoyin cough with vomiting, thirst, irritability, and insomnia, Zhuling Tang (Polyporus Decoction) is indicated. For heart irritability and inability to lie down, Huanglian Ejiao Tang (Coptis and Donkey-Hide Gelatin Decoction) is indicated. For Jueyin thirst, Qi rushing upward, vomiting roundworms, and diarrhea, Wu Mei Wan (Mume Pill) is indicated. After diarrhea, tenesmus and preference for drinking water suggest Bailianweng Tang (Pulsatilla Decoction); such cases also occur occasionally. Those familiar with the *Shanghan Lun* will know this; the outline patterns are not listed here.
Yin and Yang syndromes are grasped through Taiyin and Taiyang. Isolating Taiyang among the Three Yang channels and Taiyin among the Three Yin channels is the strategy of "capturing the ringleader first." Taiyang, Yangming, and Shaoyang constitute the Three Yang; Taiyin, Shaoyin, and Jueyin constitute the Three Yin.
This is a secret passed down through millennia, containing profound principles. Yu Jiayan understood Zen philosophy and later received instruction from an extraordinary person, uniquely acquiring this ancient secret. Hu Youchen stated: Pediatricians who sincerely comprehend this can avoid disaster. If they regard it as heresy, they incur boundless karmic retribution.
Even regarding smallpox and measles, this principle applies. Smallpox toxin is congenital, latent in the Mingmen (Gate of Life), and erupts upon exposure to external pathogens. In the early stage, Guizhi Tang etc. are used to resolve the Qi via the Taiyang channel. When Qi transforms, the toxin does not linger, preventing various stagnation-heat syndromes. Why use Qiaoliao (Forsythia), Zicao (Arnebia), Niubang (Burdock), Shengdi (Rehmannia), Xijiao (Rhinoceros Horn - now prohibited/protected species, historically used), Shigao (Gypsum), Huangqin (Scutellaria), and Huanglian (Coptis), thereby damaging the Middle Jiao and causing adverse transformations? After the rash points are fully erupted, hoping for full pustules and easy scabbing requires focusing on Taiyin. Using Lizhong Tang etc. to tonify the Middle Jiao Earth Qi serves as the foundation for forming pus and shedding scabs. There is no need to rely on Baoyuan Tang (Preserve Origin Decoction), Lurong (Deer Antler), Renru (Human Milk), Nuomi (Glutinous Rice), or Guiyuan (Longan). If toxic drugs are used to force pustule formation, the Middle Jiao Earth Qi is damaged first; how can pus form? Many have been misled! This has not been stated in ancient and modern smallpox texts. Only Zhang Yinan subtly revealed this mechanism in his words in *Lushantang Leibian*. Perhaps he valued the Dao too highly to reveal it lightly? Measles are slightly milder than smallpox but require understanding this method. Gao Shizong’s *Yixue Zhenchuan* mentions a method of adding Jinyinhua (Honeysuckle) and Zicao to Guizhi Tang.
Whoever shares this aspiration, I will impart the golden needle [of wisdom].