〔钱〕五脏所主∶心主惊，实则叫哭发热，饮水而搐；虚则困卧，悸动不安。肝主风，实则目直视，
大叫呵欠，项急烦闷；虚则切牙多欠；气热则外生风；气温则内生风。脾主困，实则困睡，身热饮水；
虚则吐泻生风。肺主喘，实则闷乱喘促，有饮水者，有不饮水者；虚则哽气长，出气短。肾主虚，无
实也，惟疮疹肾实则黑陷。
更当别虚实证∶如肺病，又见肝证，切牙多呵欠者易治，肝虚不能胜肺故也。若目直视大叫哭
项急烦闷者难治，盖肺病久则虚冷，肝强实而反胜肺也。宜视病之新久虚实，虚则补母，实则泻子。
肝病，哭叫目直视，呵欠，烦闷，项急。心病，多叫哭，惊悸，手足动摇，发热饮水。脾病，困睡
泄泻，不思饮食。肺病，闷乱，哽气长，出气短，气喘急。肾病，目无精光，畏明，体骨重。
肺藏怯，唇白色，当补肺，阿胶散主之。若闷乱气粗，喘促哽气者难治，肺虚损故也。脾肺病久则
虚而唇白，脾者肺之母也，母子皆虚，不能相营，故名曰怯。肺主唇，唇白而光泽者吉，白如枯骨
者死。（此以唇诊肺之法也。唇白色者肺藏怯也，阿胶散主之。若手寻衣领及乱捻物者，肝热也，宜
泻青丸。手掐眉目鼻面者，肺热也，宜甘桔汤之类是也。）
心实 心气实，则气上下行涩，若合面卧，则气不得通，故喜仰卧，使气得上下通也，泻心汤主
之。（心气热则合面卧，实则仰卧也。）
肾虚 儿本虚怯，由胎气不成，则神气不足，目中白睛多，颅解囟开，面色 白者，皆为难养，虽
长不过八八之数。若恣色欲，不及四旬而亡。或有因病而致肾虚者，非也。又肾不足则下窜，盖骨重
惟欲坠下而身缩也。肾者阴也，肾气虚则畏明，皆宜补肾，地黄丸主之。（心气热则上窜，宜导赤散。
肾气虚则下窜，宜地黄丸是也。）
肝病胜肺 肝病秋见，（一作“日晡”。）肝胜肺也。肺怯不能胜肝，当补脾治肝。益脾者，母令子实
故也。补脾，益黄散；治肝，泻青丸主之。
肺病胜肝肺病春见，（一作“早辰”。）肺胜肝也。肝怯故受病，当补肝肾、治肺。补肝肾，地黄丸；
治肺，泻白散主之。
五脏相胜轻重∶肝病见秋，木旺，肝胜肺也，宜补肺泻肝。轻者肝病退，重者唇白而死。肺病见春，
金旺肺胜肝也，当泻肺。轻者肺病退，重者目淡青，必发惊，更有赤者当搐。（海藏云∶为肝怯故目淡
青也。）心病见冬，火旺心胜肾也，当补肾治心。轻者心病退．重者下窜不语，肾怯虚也。肾病见夏，
水胜火，肾胜心也，当泻肾。轻者肾病退，重者悸动当搐。脾病见四旁，皆仿此治之。顺者易治，逆者
难治。脾怯当面赤目黄，五脏相反，随证治之。
上五脏相胜，病随时令，乃钱氏扩充《内经》藏气法时论之旨，实发前人所未发者也。假如肝病见于春
及早晨，乃肝自病于本位也，今反见于秋及日哺、肺之位，知肺虚极，肝往胜之，故当补脾肺、泻
肝也。余仿此。
凡病先虚，或已经下，有合下者，必先实其母，后泻其子也。假令肺虚而痰实，此可下之症，先当
益脾，后方泻肺也。
泻青丸（又名泻肝丸。） 导赤散（海藏云∶泻丙小肠。）泻心汤（海藏云∶泻丁心。） 安神丸（钱
氏治心虚疳热，神思恍惚。） 益黄散（又名补脾散。海藏云∶此剂补脾以燥湿。东垣云∶钱氏益黄散治
胃中寒湿，呕吐腹痛，泻利清白之圣药也。） 泻黄散（又名泻脾散。海藏云∶泻脾热。） 阿胶散（又名补
肺散。海藏云∶杏仁本泻肺，非若人参、天门冬、麦门冬之类也。） 泻白散（又名泻肺散。海藏云∶治
肺热骨蒸自汗，用此直泻之，栀子、黄芩亦泻肺，当以气血分之。以上八方并见脏腑部治虚实法。） 地
黄丸（海藏云∶治肾虚解颅即魃病也。治脉毛而虚。方见劳瘵。）
〔洁〕热则从心，寒则从肾，嗽而气上从肺，风从肝，泻从脾。假令泻兼嗽，又气上，乃脾肺病也。
宜泻白、益黄散合而服之。脾苦湿，肺苦燥，气上逆也。其症见泻，又兼面色黄，肠鸣呦呦者。宜
服理中汤；泻而
呕者，宜服茯苓半夏汤；如泻而渴热多者，宜服黄芩浓朴汤；不渴而热少者，宜服白术浓朴汤。其他五脏若有
兼症，皆如此类推之，更详后论四时推移用药。
心主热，自病或大热，泻心汤主之。实则烦热，黄连泻心汤主之。虚则惊悸，生犀散主之。肺乘心微邪，
喘而壮热，泻白散主之。肝乘心虚邪，风热，煎大羌活汤下大青丸主之。脾乘心实邪，泄泻身热，泻黄散主之。
肾乘心贼邪，恐怖恶寒，安神丸主之。
肺主燥，自病则喘嗽，燥则润之。实则喘而气盛，泻白散主之。虚则喘而少气，先益黄散，后阿胶散主之。
心乘肺，贼邪，热而喘嗽，先地黄丸，中导赤散，后阿胶散主之。肝乘肺，微邪，恶风，眩冒昏愦，嗽，
羌活膏主之。肾乘肺，实邪，憎寒嗽，清利，百部丸主之。脾乘肺，虚邪，体重，吐痰泄泻，嗽，
人参白术散主之。
肝主风，自病则风搐拘急，肝苦急，急食甘以缓之，佐以酸苦，以辛散之。实则风搐力大，泻青丸主之。
虚则风搐力小，地黄丸主之。心乘肝，实邪，壮热而搐，利惊丸、凉惊丸主之。肺乘肝，贼邪，气盛则前伸呵欠，
微搐，法当泻肺，先补本脏。补肝，地黄丸主之，泻肺，泻白散主之。脾乘肝，微邪，多睡，体重而搐，先当定
搐，泻青丸主之。搐止再见后症，则别立法治之。肾乘肝虚邪，憎寒，呵欠而搐，羌活膏主之。
脾主湿，自病则泄泻多睡，体重昏倦。脾苦湿，急食苦以燥之。实则泄泻赤黄，睡不露睛，泻黄散主之。
虚则泄泻色白，睡露睛，白术散主之。肝乘脾，贼邪，风泻而呕，茯苓半夏汤主之。心乘脾，虚邪，壮热，体重而
泻，羌活黄芩苍术甘草汤主之。肺乘脾，实邪，能食，不大便而呕吐，嗽，煎槟榔大黄汤下葶苈丸。肾乘脾，
微邪，恶寒，泄泻，理中丸之类主之。
肾主寒，自病则足胫寒而逆。人之五脏，惟肾无实。小儿疮疹变黑陷，则是肾实水克退心火。心乘肾，
微邪，内热，不恶寒，桂枝汤主之。肺乘肾，虚邪，喘嗽，皮涩寒，百部丸主之。肝乘肾，实邪，拘急，气搐
身寒，理中丸主之。脾乘肾，贼邪，体重，泄泻身寒，理中丸主之。
凡五脏虚弱，是自己正令不行，乃鬼贼之所克害，当补本脏之正气。假令肺病喘嗽，时于初春见之，法当
补肾；见于夏，救肺；见于秋，泻肺；见于冬，补心、泻本脏，又名寒嗽。大抵五脏各至本位，即气
盛，不可更补；到所克位，不可更泻。（洁古云∶五脏子母虚实，鬼贼微正，若不达旨意，不易得
而入焉。在前者为实邪，在后者为虚邪，妻来乘夫为微邪，夫来乘妻为贼邪，本藏自病为正邪。）
〔洁〕肝病面白，肺病面赤，脾病面青，肾病面黄，心病面黑。若肝病惊搐，而又加面白，痰涎喘急之类，
此皆难治。余仿此推之。假令春分前风寒也，宜用地黄、羌活、防风，或地黄丸及泻青丸相间服之。春分后风
热也，宜用羌活、防风、黄芩，或泻青丸、导赤散下之。立夏后热也，宜用三黄丸、导赤散。夏至
后湿热也，宜用导赤散、泻黄散合而服之，或黄芩、人参、木香之类。秋分后，用泻白散。立冬后，用地
黄丸主之。谓肾不受泻也。
〔海〕补肝丸，四物汤内加防风、羌活等分，为细末，炼蜜丸是也。镇肝丸，泻青丸去栀子、大黄，
治肝虚。泻肾丸，治脉洪而实，前熟地改生地，去山茱萸是也，此治左手本部脉。若右尺洪实，以凤
髓丹泻之，此地黄丸，即仲景八味丸去桂、附。若加五味子，肾气丸也，此益肺之源，以生肾水焉。
〔丹〕慈幼论人生十六岁以前，血气俱盛，如日方升，如月将圆，惟阴长不足，肠胃尚脆而窄。
养之之道，不可不谨。童子不衣裘帛，前哲格言，具在人耳。裳，下体之服。帛，温暖甚于布者也，裘，
皮服温软甚于帛者也。盖下体主阴，得寒凉则阴易长，得温暖则阴暗消，是以下体不与绵绢夹浓温暖
之服，恐妨阴气，实为确论。血气俱盛，食物异消，故食无时。然肠胃尚脆而窄，若稠粘干硬，酸
咸甜辣，一切鱼肉水果湿面，烧炙煨炒，俱是发热难化之物，皆宜禁绝。只与熟菜白粥，非惟无病，
且不纵口，可以养德。此外生栗味咸，干柿性凉，可为长阴之助，然栗太补，柿太涩，俱为难化，亦宜少
与。妇人无知，惟务姑息，畏其啼哭，无所不与，积成痼疾，虽悔何及。所以富贵骄养，有子多病，
迨至成人，筋骨柔弱，有食则不能忌口以自养，居丧则不能食素以尽礼，小节不谨，大义亦亏，可不
慎欤。至于乳母，尤宜谨节，饮食下咽，乳汁便通，情欲中动，乳脉便应，病气到乳，汁必凝滞，儿
得此乳，疾病立至，不吐则泻，不疮则热，或为口糜，或为惊搐，或为夜啼，或为腹
痛。病之初来，其溺必少，便须询问，随证治母，母安亦安，可消患于未形也。夫饮食之择，犹是小可，乳母
禀受之浓薄，性情之缓急，骨相之坚脆，德行之善恶，儿能速肖，尤为关系。古之胎教，具在方册，愚奚多赘。
若夫胎孕致疾，事起茫昧，人多玩忽，医所不知。儿之在胎，与母同体，得热俱热，得寒俱寒，病则俱病，安
则俱安。母之饮食起居，尤当慎密，不可不知也。
〔田〕大凡小儿过暖生热，热极生风，提抱生痈，喂饲生癖，最宜慎之。
〔钱〕大喜后食乳食，多成惊痫；大哭后食乳食，多成吐泻。
〔丹〕乳下小儿，常多湿热食积痰热，乃是伤乳为病。小儿易怒，肝病与脾病最多。
〔钱〕脉乱（不治，） 弦急（气不和，） 沉缓（伤食，） 促急（虚惊，） 浮（风，） 沉细（冷。）
〔《本》〕候儿脉，当以大指按三部，一息六七至为平和，八九至为发热，五至为内寒。脉弦为风痫，沉缓
为伤食，促急为虚惊，弦急为气不和，沉细为冷，浮为风，大小不匀为恶候、为鬼祟，浮大数为风为热，伏结
为物聚，单细为疳劳。凡腹痛，多喘呕而脉洪者，为有虫。沉而迟，潮热者，胃寒也，温之则愈。诀曰∶小儿
脉紧风痫候，沉缓食伤多呕吐，弦急因知气不和，急促急惊神不守，冷则沉细风则浮，牢实大便应秘久，腹痛
之候紧而弦，脉乱不治安可救，变蒸之时脉必乱，不治自然无过缪，单细疳劳洪有虫，大小不匀为恶候，
脉沉而迟有潮热，此必胃寒来内寇，泻利脉大不可医，仔细酌量宜审究。（云岐子云∶未及五岁，不可视听者，
未可别脉。五岁以上，方可以脉别浮沉迟数。按钱氏论，又不拘五岁上下也。）
婴儿未可方脉者，俗医多看虎口中纹颜色，与四肢冷热取之，亦有可验。予作二歌纪之，曰∶紫风红伤寒，
青惊白色疳，黑时因中恶，黄即困脾端。又，冷热症歌曰∶鼻冷定知是疮疹，耳冷因知风热证，通身皆热是伤
寒，上热下冷伤食病。若能以色脉参伍验之，所得亦过半矣。
〔世〕百日内不治症∶发斑，脐风撮口，马脾风，龟背。
〔钱〕不治症∶目赤脉贯瞳人，胸肿及陷，鼻干黑，鱼口气急，吐虫不定，泻不定，精神不好，大渴不定，止
之又渴，吹鼻不喷，病重口干不睡，时气唇上青黑点，颊深赤如涂胭脂，鼻孔开张，喘急不定。
〔《灵》〕婴儿病，其头毛皆逆上者，必死。（论疾诊尺篇）
〔《脉》〕小儿病困，汗出如珠，着身不流者死。小儿病而胸陷，口唇枯干，目直视，口中气冷，
足与头相抵，卧不举身，手足四肢垂，其卧正直如缚，掌中冷，皆死，至十日不可复治之。
〔钱〕病重，面有五色不常不泽者，死。
【钱乙】五脏所主：心主惊，实证表现为叫哭、发热、饮水时抽搐；虚证表现为嗜睡困倦、心悸不安。肝主风，实证表现为目睛直视、大声呼叫呵欠、项部拘急烦闷；虚证表现为磨牙多呵欠；气热则外生风；气温则内生风。脾主困，实证表现为嗜睡、身热、想喝水；虚证表现为呕吐腹泻并生风。肺主喘，实证表现为胸闷烦躁、呼吸急促，有的想喝水，有的不想喝水；虚证表现为叹气长、呼气短。肾主虚，没有实证，只有疮疹若肾实则出现黑陷。
更应当辨别虚证实证：例如肺病，又见肝证，若出现磨牙多呵欠的容易治疗，这是因为肝虚不能克制肺的缘故。如果出现目睛直视、大叫哭、项部拘急烦闷的难治，因为肺病日久则虚冷，肝强实反而克制肺。应当视病的新久虚实，虚证则补母脏，实证则泻子脏。
肝病症状：哭叫、目睛直视、呵欠、烦闷、项部拘急。心病症状：多叫哭、惊悸、手足动摇、发热、想喝水。脾病症状：嗜睡泄泻、不思饮食。肺病症状：胸闷烦躁、叹气长、呼气短、气喘急促。肾病症状：目中无神光、畏光、身体骨骼沉重。
肺藏怯（肺气虚弱），唇色白，应当补肺，用阿胶散主治。（如果胸闷烦躁、气粗、气喘急促、叹气的难治，这是肺虚损的缘故。）脾肺病日久则虚而唇白，脾是肺的母脏，母子皆虚，不能相互滋养，所以名叫“怯”。肺主唇，唇白而有光泽者吉，唇白如枯骨者死。（这是通过诊察嘴唇来诊断肺的方法。唇白色的是肺藏怯，用阿胶散主治。如果手抓衣领及乱捻东西的，是肝热，宜用泻青丸。手掐眉目鼻面的，是肺热，宜用甘桔汤之类。）
心实：心气实，则气上下运行涩滞，如果趴着睡，则气不得通畅，所以喜欢仰卧，使气能上下通畅，用泻心汤主治。（心气热则趴着睡，实证则仰卧。）
肾虚：小儿本身体质虚怯，由于胎气不成，则神气不足，眼中白睛多，囟门未闭或头骨缝开解，面色㿠白的，都难养育，即使长大也不超过八八六十四岁的寿命。如果恣意纵欲，不到四十岁就死亡。或者有因病导致肾虚的，不是这种情况。另外肾不足则下肢向下窜缩，因为骨重只想坠下而身体蜷缩。肾属阴，肾气虚则畏光，都宜补肾，用地黄丸主治。（心气热则向上窜，宜用导赤散。肾气虚则向下窜，宜用地黄丸。）
肝病胜肺：肝病在秋季出现，（一作“日晡”，即申时。）这是肝胜肺。肺怯不能胜肝，应当补脾治肝。补脾，是因为母令子实的缘故。补脾用益黄散；治肝用泻青丸主治。
肺病胜肝：肺病在春季出现，（一作“早辰”。）这是肺胜肝。肝怯故受病，应当补肝肾、治肺。补肝肾用地黄丸；治肺用泻白散主治。
五脏相胜轻重：肝病见于秋，木旺，肝胜肺，宜补肺泻肝。轻者肝病退，重者唇白而死。肺病见于春，金旺肺胜肝，当泻肺。轻者肺病退，重者目淡青，必发惊，更有红赤者当抽搐。（海藏云：因为肝怯所以目淡青。）心病见于冬，火旺心胜肾，当补肾治心。轻者心病退，重者下肢窜缩不语，肾怯虚也。肾病见于夏，水胜火，肾胜心，当泻肾。轻者肾病退，重者心悸动当抽搐。脾病见于四旁（四季之末月），都仿此法治疗。顺者易治，逆者难治。脾怯见面赤目黄，五脏相反，随证治疗。
以上五脏相胜，病随时令，是钱氏扩充《内经》藏气法时论的宗旨，实为发前人所未发。假如肝病见于春及早晨，乃肝自病于本位，今反见于秋及日哺、肺之位，知肺虚极，肝往胜之，故当补脾肺、泻肝。其余仿此。
凡病先虚，或者已经攻下，有合下者，必须先实其母脏，后泻其子脏。假令肺虚而痰实，这是可下的症候，先当益脾，后方泻肺。
泻青丸（又名泻肝丸。） 导赤散（海藏云：泻丙小肠。） 泻心汤（海藏云：泻丁心。） 安神丸（钱氏治心虚疳热，神思恍惚。） 益黄散（又名补脾散。海藏云：此剂补脾以燥湿。东垣云：钱氏益黄散治胃中寒湿，呕吐腹痛，泻利清白之圣药也。） 泻黄散（又名泻脾散。海藏云：泻脾热。） 阿胶散（又名补肺散。海藏云：杏仁本泻肺，非若人参、天门冬、麦门冬之类也。） 泻白散（又名泻肺散。海藏云：治肺热骨蒸自汗，用此直泻之，栀子、黄芩亦泻肺，当以气血分之。以上八方并见脏腑部治虚实法。） 地黄丸（海藏云：治肾虚解颅即魃病也。治脉毛而虚。方见劳瘵。）
【李杲】热则从心，寒则从肾，嗽而气上从肺，风从肝，泻从脾。假令泻兼嗽，又气上，乃脾肺病也。宜泻白、益黄散合而服之。脾苦湿，肺苦燥，气上逆也。其症见泻，又兼面色黄，肠鸣呦呦的。宜服理中汤；泻而呕的，宜服茯苓半夏汤；如泻而渴热多的，宜服黄芩浓朴汤；不渴而热少的，宜服白术浓朴汤。其他五脏若有兼症，都如此类推，更详后论四时推移用药。
心主热，自病或大热，用泻心汤主治。实证烦热，用黄连泻心汤主治。虚证惊悸，用生犀散主治。肺乘心微邪，喘而壮热，用泻白散主治。肝乘心虚邪，风热，煎大羌活汤送服大青丸主治。脾乘心实邪，泄泻身热，用泻黄散主治。肾乘心贼邪，恐怖恶寒，用安神丸主治。
肺主燥，自病则喘嗽，燥则润之。实证喘而气盛，用泻白散主治。虚证喘而少气，先用益黄散，后用阿胶散主治。心乘肺，贼邪，热而喘嗽，先用地黄丸，中用导赤散，后用阿胶散主治。肝乘肺，微邪，恶风，眩冒昏愦，嗽，用羌活膏主治。肾乘肺，实邪，憎寒嗽，清利，用百部丸主治。脾乘肺，虚邪，体重，吐痰泄泻，嗽，用人参白术散主治。
肝主风，自病则风搐拘急，肝苦急，急食甘以缓之，佐以酸苦，以辛散之。实证风搐力大，用泻青丸主治。虚证风搐力小，用地黄丸主治。心乘肝，实邪，壮热而搐，用利惊丸、凉惊丸主治。肺乘肝，贼邪，气盛则前伸呵欠，微搐，法当泻肺，先补本脏。补肝用地黄丸主治，泻肺用泻白散主治。脾乘肝，微邪，多睡，体重而搐，先当定搐，用泻青丸主治。搐止再见后症，则别立法治之。肾乘肝虚邪，憎寒，呵欠而搐，用羌活膏主治。
脾主湿，自病则泄泻多睡，体重昏倦。脾苦湿，急食苦以燥之。实证泄泻赤黄，睡不露睛，用泻黄散主治。虚证泄泻色白，睡露睛，用白术散主治。肝乘脾，贼邪，风泻而呕，用茯苓半夏汤主治。心乘脾，虚邪，壮热，体重而泻，用羌活黄芩苍术甘草汤主治。肺乘脾，实邪，能食，不大便而呕吐，嗽，煎槟榔大黄汤送服葶苈丸。肾乘脾，微邪，恶寒，泄泻，用理中丸之类主治。
肾主寒，自病则足胫寒而逆。人之五脏，惟肾无实。小儿疮疹变黑陷，则是肾实水克退心火。心乘肾，微邪，内热，不恶寒，用桂枝汤主治。肺乘肾，虚邪，喘嗽，皮涩寒，用百部丸主治。肝乘肾，实邪，拘急，气搐身寒，用理中丸主治。脾乘肾，贼邪，体重，泄泻身寒，用理中丸主治。
凡五脏虚弱，是自己正令不行，乃鬼贼之所克害，当补本脏之正气。假令肺病喘嗽，时于初春见之，法当补肾；见于夏，救肺；见于秋，泻肺；见于冬，补心、泻本脏，又名寒嗽。大抵五脏各至本位，即气盛，不可更补；到所克位，不可更泻。（洁古云：五脏子母虚实，鬼贼微正，若不达旨意，不易得而入焉。在前者为实邪，在后者为虚邪，妻来乘夫为微邪，夫来乘妻为贼邪，本藏自病为正邪。）
【李杲】肝病面白，肺病面赤，脾病面青，肾病面黄，心病面黑。若肝病惊搐，而又加面白，痰涎喘急之类，此皆难治。余仿此推之。假令春分前风寒也，宜用地黄、羌活、防风，或地黄丸及泻青丸相间服之。春分后风热也，宜用羌活、防风、黄芩，或泻青丸、导赤散下之。立夏后热也，宜用三黄丸、导赤散。夏至后湿热也，宜用导赤散、泻黄散合而服之，或黄芩、人参、木香之类。秋分后，用泻白散。立冬后，用地黄丸主治。谓肾不受泻也。
【王海藏】补肝丸，四物汤内加防风、羌活等分，为细末，炼蜜丸是也。镇肝丸，泻青丸去栀子、大黄，治肝虚。泻肾丸，治脉洪而实，前熟地改生地，去山茱萸是也，此治左手本部脉。若右尺洪实，以凤髓丹泻之，此地黄丸，即仲景八味丸去桂、附。若加五味子，肾气丸也，此益肺之源，以生肾水焉。
【朱震亨】慈幼论人生十六岁以前，血气俱盛，如日方升，如月将圆，惟阴长不足，肠胃尚脆而窄。养之之道，不可不谨。童子不衣裘帛，前哲格言，具在人耳。裳，下体之服。帛，温暖甚于布者也，裘，皮服温软甚于帛者也。盖下体主阴，得寒凉则阴易长，得温暖则阴暗消，是以下体不与绵绢夹浓温暖之服，恐妨阴气，实为确论。血气俱盛，食物异消，故食无时。然肠胃尚脆而窄，若稠粘干硬，酸甜咸辣，一切鱼肉水果湿面，烧炙煨炒，俱是发热难化之物，皆宜禁绝。只与熟菜白粥，非惟无病，且不纵口，可以养德。此外生栗味咸，干柿性凉，可为长阴之助，然栗太补，柿太涩，俱为难化，亦宜少与。妇人无知，惟务姑息，畏其啼哭，无所不与，积成痼疾，虽悔何及。所以富贵骄养，有子多病，迨至成人，筋骨柔弱，有食则不能忌口以自养，居丧则不能食素以尽礼，小节不谨，大义亦亏，可不慎欤。至于乳母，尤宜谨节，饮食下咽，乳汁便通，情欲中动，乳脉便应，病气到乳，汁必凝滞，儿得此乳，疾病立至，不吐则泻，不疮则热，或为口糜，或为惊搐，或为夜啼，或为腹痛。病之初来，其溺必少，便须询问，随证治母，母安亦安，可消患于未形也。夫饮食之择，犹是小可，乳母禀受之浓薄，性情之缓急，骨相之坚脆，德行之善恶，儿能速肖，尤为关系。古之胎教，具在方册，愚奚多赘。若夫胎孕致疾，事起茫昧，人多玩忽，医所不知。儿之在胎，与母同体，得热俱热，得寒俱寒，病则俱病，安则俱安。母之饮食起居，尤当慎密，不可不知也。
【田氏】大凡小儿过暖生热，热极生风，提抱生痈，喂饲生癖，最宜慎之。
【钱乙】大喜后食乳食，多成惊痫；大哭后食乳食，多成吐泻。
【朱震亨】乳下小儿，常多湿热食积痰热，乃是伤乳为病。小儿易怒，肝病与脾病最多。
【钱乙】脉乱（不治，） 弦急（气不和，） 沉缓（伤食，） 促急（虚惊，） 浮（风，） 沉细（冷。）
【《本草》】候儿脉，当以大指按三部，一息六七至为平和，八九至为发热，五至为内寒。脉弦为风痫，沉缓为伤食，促急为虚惊，弦急为气不和，沉细为冷，浮为风，大小不匀为恶候、为鬼祟，浮大数为风为热，伏结为物聚，单细为疳劳。凡腹痛，多喘呕而脉洪者，为有虫。沉而迟，潮热者，胃寒也，温之则愈。诀曰∶小儿脉紧风痫候，沉缓食伤多呕吐，弦急因知气不和，急促急惊神不守，冷则沉细风则浮，牢实大便应秘久，腹痛之候紧而弦，脉乱不治安可救，变蒸之时脉必乱，不治自然无过缪，单细疳劳洪有虫，大小不匀为恶候，脉沉而迟有潮热，此必胃寒来内寇，泻利脉大不可医，仔细酌量宜审究。（云岐子云∶未及五岁，不可视听者，未可别脉。五岁以上，方可以脉别浮沉迟数。按钱氏论，又不拘五岁上下也。）
婴儿未可方脉者，俗医多看虎口中纹颜色，与四肢冷热取之，亦有可验。予作二歌纪之，曰∶紫风红伤寒，青惊白色疳，黑时因中恶，黄即困脾端。又，冷热症歌曰∶鼻冷定知是疮疹，耳冷因知风热证，通身皆热是伤寒，上热下冷伤食病。若能以色脉参伍验之，所得亦过半矣。
【世传】百日内不治症∶发斑，脐风撮口，马脾风，龟背。
【钱乙】不治症∶目赤脉贯瞳人，胸肿及陷，鼻干黑，鱼口气急，吐虫不定，泻不定，精神不好，大渴不定，止之又渴，吹鼻不喷，病重口干不睡，时气唇上青黑点，颊深赤如涂胭脂，鼻孔开张，喘急不定。
【《灵枢》】婴儿病，其头毛皆逆上者，必死。（论疾诊尺篇）
【《脉经》】小儿病困，汗出如珠，着身不流者死。小儿病而胸陷，口唇枯干，目直视，口中气冷，足与头相抵，卧不举身，手足四肢垂，其卧正直如缚，掌中冷，皆死，至十日不可复治之。
【钱乙】病重，面有五色不常不泽者，死。
[Qian Yi] The Five Zang Organs and Their Dominances: The Heart governs fright. In excess, there is crying and weeping, fever, and convulsions when drinking water; in deficiency, there is lethargy, palpitations, and restlessness. The Liver governs wind. In excess, there is staring eyes, loud crying with yawning, neck stiffness, and irritability; in deficiency, there is teeth grinding and frequent yawning; heat in the Qi generates external wind; warmth in the Qi generates internal wind. The Spleen governs lethargy. In excess, there is drowsiness, body heat, and desire for water; in deficiency, there is vomiting, diarrhea, and generation of wind. The Lung governs panting. In excess, there is chest oppression, confusion, and rapid breathing, with some desiring water and others not; in deficiency, there are long sighs and short exhalations. The Kidney governs deficiency and has no excess condition, except that in smallpox/variolae, if the Kidney is in excess, the lesions turn black and sink inward.
One must further distinguish between deficiency and excess syndromes. For example, in Lung disease presenting with Liver symptoms, if there is teeth grinding and frequent yawning, it is easy to treat because Liver deficiency fails to overcome the Lung. If there is staring eyes, loud crying, neck stiffness, and irritability, it is difficult to treat because prolonged Lung disease leads to deficiency-cold, while strong Liver-excess overcomes the Lung. One should assess the newness or chronicity and deficiency or excess of the disease; in deficiency, tonify the Mother organ; in excess, drain the Child organ.
Liver disease symptoms: Crying, staring eyes, yawning, irritability, neck stiffness. Heart disease symptoms: Frequent crying, fright and palpitations, trembling of hands and feet, fever, desire for water. Spleen disease symptoms: Drowsiness, diarrhea, loss of appetite. Lung disease symptoms: Chest oppression, long sighs, short exhalations, rapid panting. Kidney disease symptoms: Lack of spirit in the eyes, photophobia, heaviness of the body and bones.
Lung deficiency (Fei Cang Qie): Pale lips. Tonify the Lung using Ejiao San (Donkey-Hide Gelatin Decoction). If there is chest oppression, coarse breathing, rapid panting, and sighing, it is difficult to treat due to severe Lung deficiency. Chronic Spleen-Lung disease leads to deficiency with pale lips. Since the Spleen is the Mother of the Lung, if both Mother and Child are deficient and cannot nourish each other, it is named "Qie" (Timidity/Weakness). The Lung manifests in the lips; pale but lustrous lips indicate a good prognosis, while pale lips like dry bone indicate death. (This is the method of diagnosing the Lung via the lips. Pale lips indicate Lung deficiency, treated with Ejiao San. Grasping at clothes or picking at objects indicates Liver heat, treated with Xie Qing Wan. Pinching eyebrows, eyes, nose, or face indicates Lung heat, treated with Gan Jie Tang.)
Heart Excess: Excess Heart Qi causes obstructed upward and downward movement of Qi. Lying prone obstructs Qi flow, so the patient prefers supine position to allow free Qi movement. Treat with Xie Xin Tang (Drain the Heart Decoction). (Heat in Heart Qi causes prone sleeping; excess causes supine sleeping.)
Kidney Deficiency: Infants are inherently weak due to incomplete prenatal Qi, resulting in insufficient Shen Qi. Symptoms include excessive white sclera, open fontanelles, and sallow complexion; these are hard to nurture and may not live past sixty-four years. Indulgence in sexual desires may lead to death before forty. Pathological Kidney deficiency is different from this constitutional weakness. Insufficient Kidney Qi causes downward curling of the legs due to heavy bones and desire to collapse. As Yin, Kidney deficiency causes photophobia. Tonify the Kidney using Dihuang Wan (Rehmannia Pill). (Heat in Heart Qi causes upward curling, treated with Dao Chi San. Deficiency in Kidney Qi causes downward curling, treated with Dihuang Wan.)
Liver Overcoming Lung: Liver disease appearing in autumn (or late afternoon) indicates Liver overcoming Lung. Since Lung is weak and cannot overcome Liver, tonify the Spleen and treat the Liver. Tonifying the Spleen follows the principle of "Mother making the Child full." Use Yihuang San (Benefit Yellow Decoction) to tonify the Spleen; use Xie Qing Wan to treat the Liver.
Lung Overcoming Liver: Lung disease appearing in spring (or early morning) indicates Lung overcoming Liver. Liver is weak and thus affected. Tonify the Liver and Kidney, and treat the Lung. Use Dihuang Wan to tonify Liver and Kidney; use Xie Bai San to treat the Lung.
Severity of Five Zang Overcoming: Liver disease in autumn shows Wood prosperity, indicating Liver overcoming Lung. Tonify Lung, drain Liver. Mild cases resolve; severe cases result in pale lips and death. Lung disease in spring shows Metal prosperity, indicating Lung overcoming Liver. Drain the Lung. Mild cases resolve; severe cases show pale blue eyes, leading to fright and convulsions if redness appears. (Haizang notes: Pale blue eyes occur due to Liver weakness.) Heart disease in winter shows Fire prosperity, indicating Heart overcoming Kidney. Tonify Kidney, treat Heart. Mild cases resolve; severe cases show downward curling and muteness due to Kidney weakness. Kidney disease in summer shows Water overcoming Fire, indicating Kidney overcoming Heart. Drain the Kidney. Mild cases resolve; severe cases show palpitations and convulsions. Spleen disease appearing in the four transitional months follows this pattern. Smooth progression is easy to treat; reverse progression is difficult. Spleen weakness presents with red face and yellow eyes; contrary patterns require symptom-based treatment.
The above discussion on Five Zang overcoming according to seasonal timing expands upon the *Neijing*’s principles of Zang Qi and seasonal laws, originating insights previously unexpressed. For instance, Liver disease in spring/morning is self-disease in its proper position. If seen in autumn/late afternoon (Lung's position), it indicates extreme Lung deficiency allowing Liver excess to overcome it; thus, tonify Spleen and Lung, drain Liver. The rest follows this logic.
In cases of initial deficiency or post-purgation, if purgation is indicated, first solidify the Mother organ, then drain the Child organ. For example, Lung deficiency with Phlegm excess requires purgation; first benefit the Spleen, then drain the Lung.
Formulas: Xie Qing Wan (Drain Green Pill, also known as Drain Liver Pill); Dao Chi San (Guide Out Redness Decoction, Haizang: Drains Bing Small Intestine); Xie Xin Tang (Drain Heart Decoction, Haizang: Drains Ding Heart); An Shen Wan (Calm Spirit Pill, Qian’s formula for Heart deficiency with Gu heat and mental confusion); Yihuang San (Benefit Yellow Decoction, also Benefit Spleen Decoction, Haizang: Tonifies Spleen to dry dampness; Dongyuan: Holy medicine for Stomach cold-damp, vomiting, abdominal pain, and clear-white diarrhea); Xie Huang San (Drain Yellow Decoction, also Drain Spleen Decoction, Haizang: Drains Spleen heat); Ejiao San (Donkey-Hide Gelatin Decoction, also Benefit Lung Decoction, Haizang: Apricot kernel drains Lung, unlike Ginseng, Tian Men Dong, Mai Men Dong); Xie Bai San (Drain White Decoction, also Drain Lung Decoction, Haizang: Directly drains Lung heat causing steaming bone disorder and spontaneous sweating; Gardenia and Scutellaria also drain Lung but differ by Qi/Blood aspects. See Zang-Fu section for methods treating deficiency/excess); Dihuang Wan (Rehmannia Pill, Haizang: Treats Kidney deficiency with open skull/bone disease; treats fine/weak pulse. Formula seen in Consumption section).
[Li Gao] Heat originates from the Heart; Cold from the Kidney; Cough with upward Qi from the Lung; Wind from the Liver; Diarrhea from the Spleen. If diarrhea accompanies cough and upward Qi, it is Spleen-Lung disease. Combine Xie Bai San and Yihuang San. Spleen suffers from dampness; Lung suffers from dryness and rebellious Qi. Symptoms of diarrhea with yellow complexion and borborygmus: Use Lizhong Tang. Diarrhea with vomiting: Use Fuling Banxia Tang. Diarrhea with thirst and heat: Use Huangqin Houpo Tang. No thirst with mild heat: Use Baizhu Houpo Tang. Other Zang combinations follow this analogy; see later discussions on seasonal medication adjustments.
Heart governs heat. Self-disease with high fever: Xie Xin Tang. Excess with irritability and heat: Huanglian Xie Xin Tang. Deficiency with fright and palpitations: Shengxi San. Lung attacking Heart with slight pathogen: Panting and high fever, Xie Bai San. Liver attacking Heart with deficiency pathogen: Wind-heat, Da Qianghuo Tang with Daqing Wan. Spleen attacking Heart with excess pathogen: Diarrhea and body heat, Xie Huang San. Kidney attacking Heart with thief pathogen: Terror and aversion to cold, An Shen Wan.
Lung governs dryness. Self-disease: Panting and cough; dryness requires moistening. Excess: Panting with abundant Qi, Xie Bai San. Deficiency: Panting with scant Qi, first Yihuang San, then Ejiao San. Heart attacking Lung (thief pathogen): Heat with panting/cough, first Dihuang Wan, then Dao Chi San, then Ejiao San. Liver attacking Lung (slight pathogen): Aversion to wind, dizziness, fainting, cough, Qianghuo Gao. Kidney attacking Lung (excess pathogen): Aversion to cold with cough, clearing/drainage, Bubu Wan. Spleen attacking Lung (deficiency pathogen): Heaviness, phlegm vomiting, diarrhea, cough, Renshen Baizhu San.
Liver governs wind. Self-disease: Wind convulsions and stiffness; Liver suffers urgency, soothe with sweet, assist with sour/bitter, disperse with pungent. Excess: Strong convulsions, Xie Qing Wan. Deficiency: Weak convulsions, Dihuang Wan. Heart attacking Liver (excess pathogen): High fever with convulsions, Lijing Wan, Liangjing Wan. Lung attacking Liver (thief pathogen): Abundant Qi with forward extension/yawning, mild convulsions; drain Lung, first tonify Liver (Dihuang Wan), then drain Lung (Xie Bai San). Spleen attacking Liver (slight pathogen): Drowsiness, heaviness with convulsions; first stop convulsions with Xie Qing Wan. After cessation, treat subsequent symptoms separately. Kidney attacking Liver (deficiency pathogen): Aversion to cold, yawning with convulsions, Qianghuo Gao.
Spleen governs dampness. Self-disease: Diarrhea, drowsiness, heaviness, fatigue. Spleen suffers dampness, dry with bitter. Excess: Red-yellow diarrhea, eyes closed during sleep, Xie Huang San. Deficiency: White diarrhea, eyes open during sleep, Baizhu San. Liver attacking Spleen (thief pathogen): Wind-diarrhea with vomiting, Fuling Banxia Tang. Heart attacking Spleen (deficiency pathogen): High fever, heaviness with diarrhea, Qianghuang Huangqin Cangzhu Gancao Tang. Lung attacking Spleen (excess pathogen): Appetite present, constipation with vomiting/cough, Binglang Dahuang Tang with Tingli Wan. Kidney attacking Spleen (slight pathogen): Aversion to cold, diarrhea, Lizhong Wan.
Kidney governs cold. Self-disease: Cold/reversal of lower legs. Among Zang organs, only Kidney has no excess. In pediatric smallpox, black sinking lesions indicate Kidney excess (Water) overcoming Heart Fire. Heart attacking Kidney (slight pathogen): Internal heat, no aversion to cold, Guizhi Tang. Lung attacking Kidney (deficiency pathogen): Panting/cough, rough skin, cold, Bubu Wan. Liver attacking Kidney (excess pathogen): Stiffness, Qi convulsions, body cold, Lizhong Wan. Spleen attacking Kidney (thief pathogen): Heaviness, diarrhea, body cold, Lizhong Wan.
When all five Zang are weak, their own ruling Qi fails, allowing "Ghost Thief" pathogens to attack; tonify the healthy Qi of the respective Zang. For example, Lung disease with panting/cough: Seen in early spring, tonify Kidney; seen in summer, save Lung; seen in autumn, drain Lung; seen in winter, tonify Heart and drain Lung (also called Cold Cough). Generally, when Zang reaches its proper position, Qi is prosperous and should not be tonified; when reaching the position it overcomes, it should not be drained. (Jiegu notes: Understanding Zang Mother-Child deficiency/excess and Ghost Thief/Slight/Proper distinctions is crucial. Former is excess, latter is deficiency; Wife attacking Husband is slight; Husband attacking Wife is thief; Self-disease is proper.)
[Li Gao] Liver disease: White face; Lung disease: Red face; Spleen disease: Green face; Kidney disease: Yellow face; Heart disease: Black face. Liver disease with convulsions plus white face, phlegm-rapid breathing, etc., are difficult to treat. Follow this logic. Before Spring Equinox (Wind-Cold): Dihuang, Qianghuo, Fangfeng, or alternating Dihuang Wan and Xie Qing Wan. After Spring Equinox (Wind-Heat): Qianghuo, Fangfeng, Huangqin, or Xie Qing Wan/Dao Chi San. After Start of Summer (Heat): Sanhuang Wan, Dao Chi San. After Summer Solstice (Damp-Heat): Dao Chi San combined with Xie Huang San, or Huangqin, Renshen, Muxiang. After Autumn Equinox: Xie Bai San. After Start of Winter: Dihuang Wan (Kidney does not accept draining).
[Wang Haizang] Buchgan Wan: Siwu Tang plus equal parts Fangfeng and Qianghuo, powdered, honey pills. Zhenggan Wan: Xie Qing Wan minus Zhizi and Dahuang, treats Liver deficiency. Xieshen Wan: Treats surging/excess pulse; replace Shudihuang with Shengdihuang, remove Shanzhuyu; treats left hand local pulse. If right Chong pulse is surging/excess, use Fengsui Dan to drain. This Dihuang Wan is Zhang Zhongjing’s Bajun Wan minus Rougui and Fuzi. Adding Wuweizi makes Shenqi Wan, benefiting Lung source to generate Kidney Water.
[Zhu Zhenheng] On Nurturing Children: Before age sixteen, Blood and Qi are vigorous, like the rising sun or nearly full moon, but Yin growth is insufficient; intestines/stomach are fragile and narrow. Nurturing requires caution. Boys should not wear fur or silk (fine fabrics), an ancient maxim. Skirts cover the lower body; silk is warmer than cloth; fur is warmer/softer than silk. Lower body governs Yin; coolness promotes Yin growth, warmth dissipates Yin. Avoid thick warm clothing for lower body to protect Yin Qi—this is correct. With vigorous Blood/Qi, food digests differently, so eating times vary. However, fragile intestines cannot handle sticky/hard foods, sour/sweet/spicy meats/fruits/wet noodles, roasted/fried items which generate heat and are hard to digest. Prohibit these. Offer cooked vegetables and white porridge to prevent illness, control appetite, and cultivate virtue. Raw chestnuts (salty) and dried persimmons (cool) aid Yin growth but are too tonic/astringent and hard to digest; give sparingly. Ignorant women indulge children out of fear of crying, leading to chronic diseases. Rich families spoil children, leading to weak bones/tendons in adulthood, inability to diet or observe mourning rituals. Neglecting details harms major principles. Wet nurses must be disciplined; what they eat enters milk; emotional disturbances affect milk flow. Pathogenic Qi in milk causes stagnation; infant gets sickness immediately: vomiting/diarrhea, sores/heat, mouth ulcers, convulsions, night crying, abdominal pain. Early signs include scant urine; treat the mother based on symptoms. Selecting diet is minor; wet nurse’s constitution, temperament, bone structure, and morality significantly impact the child. Prenatal education is recorded in texts. Pregnancy illness arises from unknown factors often ignored. Fetus shares mother’s body: heat/cold/disease/peace are shared. Mother’s diet/lifestyle must be careful.
[Tian] Over-warming generates heat; extreme heat generates wind; carrying causes abscesses; overfeeding causes accumulations. Be cautious.
[Qian Yi] Eating after great joy often causes fright-seizures; eating after great crying often causes vomiting/diarrhea.
[Zhu Zhenheng] Breastfed infants often have damp-heat, food stagnation, and phlegm-heat due to nursing injuries. Infants are prone to anger; Liver and Spleen diseases are most common.
[Qian Yi] Pulse conditions: Chaotic (incurable); Wiry-tense (Qi disharmony); Deep-slow (Food injury); Rapid-hurried (Deficient fright); Floating (Wind); Deep-fine (Cold).
[Ben Cao] Infant pulse diagnosis: Press three positions with thumb. 6-7 beats per breath: Harmonious; 8-9 beats: Fever; 5 beats: Internal cold. Wiry: Wind-seizure; Deep-slow: Food injury; Rapid-hurried: Deficient fright; Wiry-tense: Qi disharmony; Deep-fine: Cold; Floating: Wind; Irregular size: Bad omen/Ghost influence; Floating-large-rapid: Wind-heat; Hidden/knotted: Mass accumulation; Single-fine: Gu consumption. Abdominal pain with panting/vomiting and surging pulse: Worms. Deep-slow with tidal fever: Stomach cold, warm to cure. Rhyme: Tight pulse indicates wind-seizure; deep-slow indicates food injury/vomiting; wiry-tense indicates Qi disharmony; rapid-hurried indicates urgent fright/unprotected Shen; cold is deep-fine, wind is floating; firm-solid indicates constipation; abdominal pain is tight-wiry; chaotic pulse is incurable; Bianzheng period pulse is chaotic (self-resolving); single-fine is Gu consumption, surging is worms; irregular size is bad omen; deep-slow with tidal fever is stomach cold; large pulse in diarrhea is incurable. Careful analysis is required. (Yunqizi: Under five, pulse differentiation is difficult; over five, distinguish floating/deep/slow/rapid. Qian’s theory applies regardless of age.)
For infants where pulse diagnosis is difficult, folk doctors check tiger-mouth lines and limb temperature. Two songs record this: Purple-Wind, Red-Cold Damage, Green-Fright, White-Gu, Black-Evil Qi, Yellow-Spleen trouble. Another song: Cold nose=Smallpox; Cold ears=Wind-heat; Whole body hot=Cold Damage; Upper hot/Lower cold=Food injury. Color and pulse combined yield half the diagnosis.
[Shichuan] Untreatable within 100 days: Macules, Umbilical wind/gaping mouth, Horse spleen wind, Turtle back.
[Qian Yi] Untreatable signs: Red eyes with vessels crossing pupil, chest swelling/sinking, dry/black nose, fish-mouth gasping, intermittent worm vomiting/diarrhea, poor spirit, unquenchable thirst, no sneeze after blowing nose, severe dry mouth/insomnia, epidemic cyanotic/black spots on lips, deep red cheeks like rouge, dilated nostrils, unsteady rapid panting.
[Lingshu] Infant with hair standing on end: Death.
[Mai Jing] Infant with bead-like sweat not flowing: Death. Sunken chest, dry lips, staring eyes, cold breath, head touching feet, unable to lift body, hanging limbs, straight rigid posture, cold palms: Death, untreatable after ten days.
[Qian Yi] Severe disease with changing/unlustrous five colors on face: Death.