致肢体逆冷，口鼻气微，手足螈 ，昏睡露睛。此脾虚生风，无阳之证也。亦有急惊日久，脾损阴消，致变慢
惊者。娄全善所谓∶木虚则搐而无力，火虚则身寒气冷，土虚则吐泻露睛。若土虚不能生金，金虚不能平木，
木来侮土而致者。宜异功散加归、芍、钩藤，以补土平木。若脾土虚寒者，宜六君汤加乌头、蝎尾；泄泻加炮
姜、木香；不应，急加附子以回阳气。此乃脏腑传变已极，总归于虚，无风可逐，无惊可疗。若不审其因，泛
用祛风化痰之剂，反促其危。（薛立斋）
慢惊，证见眼睛昏定者重，窜视者重，四肢厥冷者重，汗出如流者亦重，口面忽作惨黯色者至重。眼目半
开半合，乃阴盛传入脏间，阳气亏乏。脾为至阴，次第入脾，故称慢脾风候。○古云∶病家怕惊不怕泻，医家
怕泻不怕惊。如泄泻不止，且先治泻。若更治风，则惊愈甚矣。（《仁斋直指》）
问∶慢惊言脾而不言胃者，何也？盖胃为腑属阳，脾为脏属阴。小儿纯阳之体，病传在腑，多自愈；在脏，
多难治。故以在腑为顺，在脏为逆。古人所以言脾不言胃也。（《证治合参》）
凡治慢惊，若尚有阳证，未可骤行回阳，但与截风调胃，如蝉蝎散、醒脾散。若手足冰冷，即与回阳，用
乌蝎散。其脑、麝、银、粉、巴、硝等药，一切禁断。（《医学入门》）
俗称慢惊风者，不知起于何代，遗祸婴孩，不啻万亿。就其所指之病而论，如吐泻兼作，气祛神倦，虚烦
搐搦，痰喘不食，脉虚无力，睡则露睛等证，与病名毫不相关。究其所指之病，是或由外感未清，或由诸病误
治，或由饮食失调，或由病后而成，以致吐则伤胃，泻则伤脾，土衰不能生金，中虚木必乘克，是皆内伤之病。
治宜急顾本原，扶土生金，安胃和肝，温养肾阳，犹虑弗及。若执慢惊风之名，概用镇坠之药，或散风清火，
豁痰破气，其祸可胜言哉！盖是证始因中土已虚，风木已动，延久见出似惊之状，实非因惊而起。奈何竟以慢
惊风名之，岂非指鹿为马
乎？要之，慢字若以急、慢而论，则凡病之缓者，皆可称慢，惟惊乃属急证，不可以慢字加之，更当参东垣、
立斋、景岳诸法，治无遗蕴矣。（《临证指南》）
世人动曰慢惊，予独曰慢证。慢字虽对急字而言，然所以成此证者，亦由父母怠慢之故。或有汗多不止者
听之，吐泻不止者听之，以致汗多亡阳，吐久伤胃，泻久绝脾而成。此危殆之候，何惊之有？庸医见儿眼翻手
搐，形状似惊，而作惊治，是犹儿已落井，而复下之以石也。（夏禹铸）
暑风惊
真暑风，实证也。暑喜伤心，风喜伤肝。余制暑风饮子，以羌活、防风治风，黄连、石膏治暑，以余药治
兼证，酌而行之，十生八九。若暑伤脾胃，或吐或泻而后发搐者，谓之暑风慢惊，虚证也。治之不当，十死八、
九。○吐泻二者，易成慢惊，然吐更甚于泻。止泻之法，可用温补，能受补则生。吐则胃气伤，胃气伤则不能宣
布津液，是以诸药杂投，多无应验。余思养胃之法，非寒非热，必得生机活泼，方转灵轴，因制黄土稻花汤，
取效甚多，时人未之识也。○暑与心合，故喜伤心。暑风惊，有直中者，有由胃热、肝胆热传入者。由渐传入，
可缓缓用药清之。直中之惊，一发即死，不可不知。○惊搐方作，视其额热、肢热、脉大而微数者，易解；若
额热、肢冷，而脉细数之极者，皆暴脱之证也。○暑邪入心，认证的确，即用清心之剂，黄连有用至五七日者，
不可一二日不愈便思改辙。书云∶脏者藏也。病虽难入，亦复难出，故治法宜守。○暑风惊搐，额热、肢热者，
可用黄连泻心收功；额热、肢冷者，不可用。何也？黄连泻心，实泻脾也。实则泻其子，子既亏，如何泻得？
○暑风有缠绵日久，人事不省，目斜目窜，切牙涎涌者，为痰阻心包，仍用牛黄、胆星、竹沥、姜汁、菖蒲等
透窍之药，兼以清心。若人事清爽，声音明亮，能食便调者，是脏证已罢。但手足强直，或反张，或拳曲蹙缩者，
是大筋为热所伤，血不营经，不必用利痰及入脏药，只宜重养阴血，兼以舒筋之味，久久自回。○强直证，用
养阴药，愈者多；缓弛证，宜兼健脾，苡仁、扁豆，为清暑湿之余药。○养阴药，用生地、丹皮、当归、白芍、
麦冬，加桑寄生、羚羊角、秦艽、钩藤以舒筋。○暑风惊，大概胎气壮，脾土不亏，能受清凉者可治；若吐泻
并作，额热肢冷，搐不甚者，是为暑风慢惊，清补两难，六君加黄连，应药者生，不应者死。（《橡村治验》）
睡中惊惕
小儿睡中惊惕，多由心肾不足所致。盖小儿脏腑脆弱，易为惊恐，且人之神气，寤则行于目，寐则栖于肾，
今心肾既虚，则神气不能摄摄，故睡中惊惕。治宜补心汤，清心安神。有因惊吓而作者，惊则动肝，故神魂不
安，治宜抱龙丸，豁痰镇惊。若因食郁生痰而致者，治宜健脾化痰，加山栀、柴胡以清热。（《张氏医通》）
痫
痫与惊相类。但痫发时，仆地作声，醒则吐涎沫；惊则不作声，不吐涎沫。（娄全善）
小儿之痫有三∶风痫、惊痫、食痫是也。风痫缘衣暖汗出，风因袭入。初时，屈指如数物乃作。惊痫起于
惊怖，大啼乃作。食痫其先不哺乳，吐而变热后发。惊痫按图灸之；风痫治以猪心汤；食痫当下乃愈，紫霜丸
佳。（《千金方》）
痫，小儿之恶候也。盖小儿血脉未敛，骨气未聚，或为风邪所触，或因乳哺失节，停结癖积而得之。其候∶
神气怫郁，瞪眼直视，两目牵引，口噤涎流，腹肚胀膨，手足搐掣，或叫或哑，或项背反张，腰脊强直，但四
体柔弱、发而时醒者为痫。若一身强硬，终日不醒，则为痉矣。（杨仁斋）
痫病，小儿常有之。诸书皆言积惊成痫，故有惊风三发便为痫之语。大概肝主惊风，初作不为疏解，便投
金石丸散，使邪留于心包、肝、胆，久而不除，生痰生热，触着便发，或目直喊叫，
摇头手掣，口吐白沫，或卒然昏仆，或作猪、羊、鸡、犬、牛吼之声。世有五痫之名，阴阳之别，多方杂出，
愈治愈深。予治此证，惟以肝主惊风为本。得之未久，体质旺者，用钱氏泻青丸去龙胆加橘、半，以疏豁之；
病久体弱者，用逍遥散加橘、半以疏达之；搐鼻散不时嚏之；兼以调和胃气，久久自除。（《怡堂散记》）
此皆元气不足之证，治以紫河车丸为主，而以补药佐之。设若泛行克伐，复伤元气，则必不时举发，久而
变危。（薛立斋）
选案
一儿七岁发痫，每作先君令饮人乳，后发渐疏而轻；至十四岁复发，服人乳不应。余用紫河车研烂，乳调
如泥，日二、三次，服至数具而愈。后常用加减八味丸。至二十三岁发而手足厥冷，仍用前法，佐以十全大补
汤而痊。（薛立斋）
客忤
客忤者，小儿神气软弱，忽有非常之物，或未经识见之人触之，与儿神气相忤而发病。吐、下腹痛，面变五
色，其状似痫，但眼不上插耳。其脉弦急而数，失时不治，久则难疗。（《巢氏病源》）
物触
物触者，因小儿所爱之物，而强夺之，致令怒生，神随物散，不食不言，神昏如醉，四肢垂 有若诸恶证
候，莫知其故。须询其父母，遂其所欲，以药调理，神自安矣。（《冯氏锦囊》）
啼哭
小儿有惊啼、有夜啼、有 啼。惊啼者，由于风邪乘心，脏腑生热，热则精神不定，睡卧不安，故令儿惊
啼。夜啼者，脏冷也，夜则阴盛，阴气相感，故令儿夜啼；一云有犯触禁忌，亦令儿夜啼。 啼者，由于腹中
痛甚，儿身 张，气蹙而啼也；又有胎寒而啼者，此儿在胎时已受病也，其状肠胃虚冷，不消乳哺，
腹胀下利，颜色青白，而时啼叫是也。（《万全方》）
小儿夜啼有四证∶一曰寒；二曰热；三曰重舌、口疮；四曰客忤。腹痛面青，口有冷气，曲腰而啼者，寒
也。心躁面赤，小便赤，口热腹暖，仰身而啼者，热也。吮乳不得，口到乳上即啼，急取灯照口，若无疮，舌
必重也。客忤者，见生人忤犯而啼也。各随证治之。（《三因方》）
夜啼有二∶一曰脾寒；一曰心热。夜属阴，胜则脾之寒益盛。脾为至阴，喜温而恶寒，寒则腹中作痛，故
曲腰而啼，得灯火，其啼便止。其候面色青白，手足俱冷，不思乳食，治宜益黄散加钩藤。若见灯愈啼者，此
心热也。心属火，见灯则烦热内生，两阳相搏，故仰身而啼。其候面赤手足俱暖，口中气热，治宜导赤散加黄
连、麦冬。若面色白，黑睛少，此属肾气不足。至夜阴虚而啼者治宜六味丸；因惊者，参客忤惊啼治之。（《张氏医通》）
夜啼者，脾脏冷而痛也。当与温中药。或花火膏主之。（《小儿直诀》）
小儿肝气未充，胆气最怯。凡耳闻骤声，目视骤色，怖其神魂，醒时受怖，则惊惕，或振动不定，或忽尔
啼叫，皆神怯不安之证，总宜安神养气为主。（张景岳）
初生月内多啼者，吉。胎热、胎毒、胎惊，皆从此散。（《医学入门》）
选案
叶时可先生，治一儿丧母忧啼，心烦不安，令服秘旨安神丸，以其母所着未浣里衣覆其身，是夕神安而愈。
余治一儿，堕池惊骇，发热啼吵。用清心安神之剂，命汲池中水，煎药服之而愈。虽曰以意治病，亦取其气相
感耳。（许宣治）
疳
一、眼青揉痒是肝疳。二、齿焦是骨疳。三、毛落鼻干是肺疳。四、皮干肉裂是筋疳。五、发焦黄是血
疳。六、舌上生疮是心疳。七、爱吃泥土是脾疳。（《颅囟经》）
五脏疳伤，大抵然尔。析而论之∶曰五疳，出虫曰蛔疳，曰瘠疳，曰脑疳，曰干疳，曰疳渴，曰疳泻，曰
疳痢，曰疳肿胀，曰疳劳，曰无辜疳，曰丁奚，曰哺露，证状不一。（杨仁斋）
小儿丁奚、哺露、客忤、无辜，四异病也；大人阳易、阴易、百合、狐惑，四奇病也。（王好古）
幼科疳疾，有丁奚、哺露之名，虽系俗称，却有意义。丁奚者，言奚童枯瘦如丁也，主手足枯细言之，
病在肉，脾疳也。哺露者，言愈哺之而骨愈露也。主解颅言之，病在骨，肾疳也。（《医参》）
疳者，干也。小儿肠胃柔嫩，若乳食失调，肥甘不节，运化不及，停积发热，热久津干，此因积成疳者。
或五脏偏热，或因病后，或医药误下，致亡津液，脾不输化，积滞不行，此因干致积者也。故五疳不离乎脾胃。
治法∶胃滞当消，脾弱宜补。热者用苦寒清火，冷者宜辛温健运。有虫者，兼用杀虫之品。虚者各随本脏，补
益其母。总宜丸剂缓调，不能速功。或用鸡肝，纳入治疳药炖食，最为有效。（《临证指南》）
凡疳在内者，则目肿腹胀，泻痢青白，体渐瘦弱；疳在外者，则鼻下赤烂，频揉鼻耳，肢体生疮。大抵
其证虽多，要不出于五脏，而五脏之疳不同，当各分辨治之。（钱仲阳）
疳疾不必分冷、热，惟辨其泻不泻耳。不泻者，积热无所发泄，故胸腹发热特甚；泻者，积热有所发泄，
故胸腹不甚热。然其疾总由积热而成，方书有冷疳之名，谬矣。（《慈幼筏》）
小儿五疳，即大人五劳。然既云干、云劳，岂非精血败竭之证乎？察前人诸法，俱从热治，多用清凉。
虽此证真热者固多，而元气虽败，则假热者尤多也。其或血气俱损，有非大补不可者；阴虚假热，脾败肾亏，
又有非温补不可者。贵在临证酌宜，仍当以虚损治法参用，庶得尽善。（《景岳全书》）
无辜疳证，脑后有核如弹丸，若不速去，当损其命。此核初生，软而不痛，中有虫如米粉，得热气日渐
长大，虫随血气流
散，所有停蓄，子母相生，侵蚀脏腑，肌肉作疮，或大便脓血，致令儿渐黄瘦，头大发竖，手足细弱，从兹夭
折也。（《圣惠方》）
无辜，鸟名，啼时两颔煽动，如瘰 之项，小儿肝热目暗，颈核累累，其状相类，因以为名。后人穿凿，
谓儿衣夜露不收，为无辜鸟羽所落，感而成病，荒唐之甚。余用逍遥散加减，缓缓调理，愈者甚多。（《怡堂散记》）
五迟
五迟者，立迟、行迟、齿迟、发迟、语迟是也。盖肾主骨，齿者骨之余，发者肾之荣，若齿久不生，生而
不固，发久不生，生而不黑，皆胎弱也。良由父母精血不足，肾气虚弱，不能荣养而然。若长不能立，立而骨
软；大不能行，行则筋软，皆肝肾气血不充，筋骨痿弱之故。有肝血虚，筋不荣膝，膝盖不成，而手足拳挛者；
有肾气虚，髓不满骨，骨不能用，而足胫无力者。并用地黄丸为主，齿迟加骨碎补、补骨脂；发迟加龟版、
鹿茸、何首乌；立迟加鹿茸、桂、附；行迟加牛膝、鹿茸、五加皮。语迟之因不一，有因妊母卒然惊恐，邪乘
儿心而不能言者；有禀父肾气不足而言迟者；有乳母五火遗热，闭塞气道者；有病后津液内亡，会厌干涸者；
亦有脾胃虚弱，清气不升而言迟者。邪乘儿心，菖蒲丸；肾气不足，地黄丸加远志；闭塞气道，加味逍遥散；
津液内亡，七味白术散；脾胃虚弱，补中益气汤。若病久或五疳所致者，但补养脾胃为主。（《张氏医通》）
导致肢体逆冷，口鼻气息微弱，手足抽搐，昏睡且眼睛半开半合露出眼白。这是脾虚生风、阳气衰微的证候。也有急惊风日久，损伤脾土，阴液消减，从而转变为慢惊风的。娄全善所说：肝木虚弱则抽搐而无力，心火虚弱则身体寒冷四肢发凉，脾土虚弱则呕吐腹泻、眼睛半开半合露睛。如果脾土虚弱不能生肺金，肺金虚弱不能制约肝木，肝木反过来克制脾土而导致的。适宜用异功散加当归、白芍、钩藤，以补益脾土、平抑肝木。如果是脾土虚寒的，适宜用六君子汤加乌头、蝎尾；伴有泄泻的加炮姜、木香；服药无效，紧急加入附子以回阳救逆。这已经是脏腑传变到了极点，总归于虚证，没有风可驱散，没有惊可治疗。如果不审察病因，泛泛使用祛风化痰的药物，反而加速其危重。（薛立斋）
慢惊风，症状表现为眼神昏定者病情重，眼球窜视者病情重，四肢厥冷者病情重，汗出如流水者病情也重，口面部突然呈现惨暗颜色者最为严重。眼睛半开半合，是阴气盛传入内脏之间，阳气亏乏。脾为至阴之脏，病邪次第传入脾脏，所以称为慢脾风候。○古语说：病人家属害怕惊风而不害怕泄泻，医生害怕泄泻而不害怕惊风。如果泄泻不止，应当先治疗泄泻。如果再去治疗惊风，那么惊风会更加严重。（《仁斋直指》）
问：治疗慢惊风只说脾而不说胃，为什么呢？因为胃属于腑，属性为阳；脾属于脏，属性为阴。小儿是纯阳之体，病邪传在腑，多能自愈；传在脏，多难治愈。所以认为在腑为顺证，在脏为逆证。古人之所以只说脾而不说胃，就是这个原因。（《证治合参》）
凡是治疗慢惊风，如果还有阳证表现，不可骤然使用回阳药物，只需用截风调胃的方法，如蝉蝎散、醒脾散。如果手足冰冷，就给予回阳治疗，使用乌蝎散。像脑麝（牛黄、麝香）、银粉（水银制剂）、巴豆、芒硝等药物，一律禁止使用。（《医学入门》）
俗称的“慢惊风”，不知道起源于哪个朝代，祸害婴幼儿，数量多达万亿。就其所指的疾病而言，如吐泻并作，气短神疲，虚烦抽搐，痰喘不食，脉虚无力，睡觉时露睛等症状，与“惊风”的病名毫不相关。究其所指的疾病，有的是由外感未清，有的是由其他疾病误治，有的是由饮食失调，有的是由病后形成，以致于呕吐伤胃，泄泻伤脾，土衰不能生金，中焦虚弱肝木必然乘克，这些都是内伤疾病。治疗应当急切顾护本源，扶土生金，安胃和肝，温养肾阳，还担心做得不够周全。如果执着于“慢惊风”这个名称，一概使用镇坠的药物，或者疏散风邪、清泻火热、豁痰破气，这种祸害能说尽吗？因为这个证候开始是因为中焦脾胃已虚，肝风已动，拖延久了出现类似惊风的状貌，实际上并非因受惊而起。为何竟然称之为“慢惊风”，岂不是指鹿为马吗？总之，“慢”字如果按急、慢来论，那么所有病程缓慢的疾病，都可以称为慢，只有惊风属于急证，不可以用“慢”字加上，更应当参考李东垣、薛立斋、张景岳等人的方法，治疗就没有遗漏了。（《临证指南》）
世人动不动就说“慢惊”，我独自称之为“慢证”。“慢”字虽然是对“急”字而言，然而造成这个证候的原因，也是由于父母怠慢疏忽的缘故。有的出汗过多不止听之任之，吐泻不止听之任之，以致于汗多亡阳，久吐伤胃，久泻绝脾而形成的。这是危急的征候，有什么惊呢？庸医看见孩子翻白眼、手抽搐，形状像惊风，就当作惊风来治，这就像孩子已经掉进井里，又往下扔石头一样。（夏禹铸）
暑风惊
真正的暑风惊，是实证。暑邪喜欢伤心，风邪喜欢伤肝。我制定暑风饮子，用羌活、防风治疗风邪，黄连、石膏治疗暑热，用其他药物治疗兼夹证，斟酌施行，十人能救活八九人。如果暑邪损伤脾胃，或吐或泻之后才发生抽搐的，称为暑风慢惊，是虚证。治疗不当，十人有八、九人死亡。○呕吐和泄泻，容易形成慢惊风，然而呕吐比泄泻更严重。止泻的方法，可以用温补，如果能接受补益就能生存。呕吐则损伤胃气，胃气损伤就不能宣发布散津液，因此各种药物杂投，大多没有疗效。我思考养胃的方法，既非寒也非热，必须得到生机活泼，才能转动灵枢，因此制定黄土稻花汤，取得效果很多，当时的人没有认识到这一点。○暑邪与心相合，所以喜欢伤心。暑风惊，有直中的，有由胃热、肝胆热传入的。逐渐传入的，可以缓缓用药清解。直中的惊风，一发作就会死亡，不可不知道。○惊搐刚开始发作时，看额头热、肢体热、脉大且微数的，容易解除；如果额头热、肢体冷，而脉细数到极点的，都是暴脱的证候。○暑邪入心，辨证确切，就立即使用清心的药剂，黄连有用到五七天的，不可一二天不好就想着换方子。书说：脏就是藏的意思。病邪虽然难侵入，但也难排出，所以治法应当坚守。○暑风惊搐，额头热、肢体热的，可以用黄连泻心收功；额头热、肢体冷的，不可用。为什么呢？黄连泻心，实际上是泻脾。实则泻其子，子脏既然亏损，如何还能泻得？○暑风缠绵日久，人事不省，目斜目窜，咬牙涎涌的，为痰阻心包，仍用牛黄、胆星、竹沥、姜汁、石菖蒲等透窍的药物，兼以清心。如果人事清爽，声音明亮，能进食大便正常的，是脏证已罢。只是手足强直，或反张，或拳曲蹙缩的，是大筋被热邪所伤，血液不能濡养经脉，不必使用利痰及入脏的药物，只宜重用养阴血的药物，兼以舒筋的药物，时间久了自然恢复。○强直证，使用养阴药，痊愈的多；缓弛证，宜兼健脾，薏苡仁、扁豆，是清暑湿的余药。○养阴药，用地黄、丹皮、当归、白芍、麦冬，加桑寄生、羚羊角、秦艽、钩藤以舒筋。○暑风惊，大概胎气壮实，脾土不亏，能承受清凉药物的可以治疗；如果吐泻并作，额头热肢体冷，抽搐不严重的，是为暑风慢惊，清补两难，六君子汤加黄连，应药的能生，不应药的会死。（《橡村治验》）
睡中惊惕
小儿睡觉中惊惕，多由心肾不足所致。因为小儿脏腑脆弱，易受惊恐，而且人的神气，醒时行于目，睡时栖于肾，现在心肾既虚，则神气不能摄持，所以睡觉中惊惕。治疗适宜用补心汤，清心安神。有因惊吓引起的，惊则动肝，所以神魂不安，治疗适宜用抱龙丸，豁痰镇惊。如果因食积郁滞生痰而导致的，治疗适宜健脾化痰，加山栀、柴胡以清热。（《张氏医通》）
痫
痫病与惊风相似。但痫病发作时，仆倒在地发出声音，醒来则吐涎沫；惊风则不发出声音，也不吐涎沫。（娄全善）
小儿的痫病有三种：风痫、惊痫、食痫。风痫是因为衣服太暖出汗，风邪趁机袭入。开始时，手指屈伸像数东西那样才开始发作。惊痫起于惊吓恐怖，大哭后才发作。食痫是先不哺乳，呕吐后变热再发作。惊痫按图灸治；风痫用猪心汤治疗；食痫应当攻下才能痊愈，紫霜丸较好。（《千金方》）
痫病，是小儿的恶候。因为小儿血脉未收敛，骨气未聚集，或被风邪所触，或因乳哺失节，停结癖积而得的。其症状：神气郁结，瞪眼直视，两眼牵引，口噤流涎，腹部胀膨，手足抽搐，或叫或哑，或项背反张，腰脊强直，只要四肢柔弱、发作时能醒过来的就是痫病。如果一身强硬，整天不醒，那就是痉病了。（杨仁斋）
痫病，小儿常有的。各书都说积惊成痫，所以有惊风三发便为痫的说法。大概肝主惊风，初作不为疏解，就投用金石丸散，使邪气留于心包、肝、胆，久而不除，生痰生热，触动就发作，或目直喊叫，摇头手掣，口吐白沫，或突然昏倒，或发出猪、羊、鸡、犬、牛吼的声音。世间有五痫之名，阴阳之别，多方杂出，愈治愈深。我治疗这个证候，只以肝主惊风为本。得病不久，体质旺盛的，用钱氏泻青丸去龙胆草加橘红、半夏，以疏豁之；病久体质虚弱的，用逍遥散加橘红、半夏以疏达之；搐鼻散不时使其打喷嚏；兼以调和胃气，时间久了自然消除。（《怡堂散记》）
这都是元气不足的证候，治疗以紫河车丸为主，而以补药辅助。如果泛泛使用克伐药物，再次损伤元气，则必定不时发作，久而久之变得危险。（薛立斋）
选案
一个七岁儿童患痫病，每次发作前父亲让他喝人乳，后来发作逐渐稀疏且轻微；到十四岁复发，服人乳无效。我用紫河车研烂，用乳汁调成泥状，每天二三次，服用几具后痊愈。后来常用加减八味丸。到二十三岁发作且手足厥冷，仍用前法，佐以十全大补汤而痊愈。（薛立斋）
客忤
客忤，是小儿神气软弱，忽然有非常之物，或未经识见之人触碰，与儿的神气相抵触而发病。呕吐、腹泻腹痛，面色变幻五色，其状似痫病，但眼球不上翻。其脉弦急而数，不及时治疗，久了则难疗。（《巢氏病源》）
物触
物触，是因为小儿喜爱的物品，强行夺走，致使怒气产生，神气随物散失，不食不言，神昏如醉，四肢下垂，有如各种恶证候，不知其原因。须询问其父母，满足其欲望，用药物调理，神气自然安定。（《冯氏锦囊》）
啼哭
小儿有惊啼、有夜啼、有腹痛啼。惊啼，是由于风邪乘心，脏腑生热，热则精神不定，睡卧不安，所以令小儿惊啼。夜啼，是脏冷，夜间阴气盛，阴气相感，所以令小儿夜啼；一说有触犯禁忌，也令小儿夜啼。腹痛啼，是由于腹中痛甚，小儿身体伸展，气促而啼；又有胎寒而啼的，这是小儿在胎时就已受病，其状肠胃虚冷，不能消化乳食，腹胀下利，颜色青白，时而啼叫。（《万全方》）
小儿夜啼有四证：一是寒；二是热；三是重舌、口疮；四是客忤。腹痛面青，口有冷气，弯腰而啼的，是寒证。心躁面赤，小便赤，口热腹暖，仰身而啼的，是热证。吮乳不得，口碰到乳头就啼，急忙取灯照口，如果没有疮，舌头一定是重舌。客忤，是见到生人触犯而啼。各随证治疗。（《三因方》）
夜啼有二：一是脾寒；一是心热。夜属阴，胜则脾之寒益盛。脾为至阴，喜温而恶寒，寒则腹中作痛，所以弯腰而啼，见到灯火，啼声就停止。其候面色青白，手足俱冷，不思乳食，治疗适宜用益黄散加钩藤。如果见到灯火啼哭更厉害的，这是心热。心属火，见到灯火则烦热内生，两阳相搏，所以仰身而啼。其候面赤手足俱暖，口中气热，治疗适宜用导赤散加黄连、麦冬。如果面色白，黑睛少，这属于肾气不足。到了夜间阴虚而啼的治疗适宜用六味丸；因惊的，参考客忤惊啼治疗。（《张氏医通》）
夜啼，是脾脏冷而痛。应当给予温中药。或用花火膏主治。（《小儿直诀》）
小儿肝气未充，胆气最怯。凡耳闻骤声，目视骤色，怖其神魂，醒时受怖，则惊惕，或振动不定，或忽尔啼叫，都是神怯不安的证候，总宜安神养气为主。（张景岳）
初生月内多啼的，吉利。胎热、胎毒、胎惊，都从此散发。（《医学入门》）
选案
叶时可先生，治疗一个因丧母忧啼的小儿，心烦不安，让他服用秘旨安神丸，并用其母亲穿过的未洗的内衣覆盖其身，当晚神安而愈。我治疗一个因堕池惊骇、发热啼吵的小儿。用清心安神的药剂，命汲取池中的水煎药服用而愈。虽说是以意治病，也是取其气相感罢了。（许宣治）
疳
一、眼睛青且揉痒的是肝疳。二、牙齿焦枯的是骨疳。三、毛发脱落鼻干的是肺疳。四、皮肤干燥肌肉裂开的是筋疳。五、头发焦黄的是血疳。六、舌上生疮的是心疳。七、爱吃泥土的是脾疳。（《颅囟经》）
五脏疳伤，大体如此。分析而论：曰五疳，出虫曰蛔疳，曰瘠疳，曰脑疳，曰干疳，曰疳渴，曰疳泻，曰疳痢，曰疳肿胀，曰疳劳，曰无辜疳，曰丁奚，曰哺露，症状不一。（杨仁斋）
小儿丁奚、哺露、客忤、无辜，是四种不同的病；大人阳易、阴易、百合、狐惑，是四种奇特的病。（王好古）
儿科疳疾，有丁奚、哺露的名称，虽然是俗称，却有意义。丁奚，是说奚童枯瘦如丁，主要从手足枯细来说，病在肉，是脾疳。哺露，是说越喂养骨头越显露，主要解释解颅来说，病在骨，是肾疳。（《医参》）
疳，就是干的意思。小儿肠胃柔嫩，如果乳食失调，肥甘不节，运化不及，停积发热，热久津干，这是因积成疳。或者五脏偏热，或者因病后，或者医药误下，导致亡津液，脾不输化，积滞不行，这是因干致积。所以五疳不离乎脾胃。治法：胃滞当消，脾弱宜补。热者用苦寒清火，冷者宜辛温健运。有虫者，兼用杀虫之品。虚者各随本脏，补益其母。总宜丸剂缓调，不能速效。或用鸡肝，纳入治疳药炖食，最为有效。（《临证指南》）
凡是疳在内者的，则目肿腹胀，泻痢青白，身体逐渐瘦弱；疳在外者的，则鼻下赤烂，频繁揉鼻耳，肢体生疮。大体上其证虽多，要不出于五脏，而五脏之疳不同，应当各分辨治疗。（钱仲阳）
疳疾不必分冷、热，只辨别其泻不泻而已。不泻者，积热无处发泄，所以胸腹发热特别厉害；泻者，积热有所发泄，所以胸腹不甚热。然而其疾总由积热而成，方书有冷疳之名，是错误的。（《慈幼筏》）
小儿五疳，即大人的五劳。既然说是干、说是劳，难道不是精血败竭的证候吗？考察前人诸法，都从热治，多用清凉。虽然此证真热者固多，而元气虽败，则假热者尤多也。其或血气俱损，有大补不可的；阴虚假热，脾败肾亏，又有非温补不可的。贵在临证酌宜，仍当以虚损治法参用，庶得尽善。（《景岳全书》）
无辜疳证，脑后有核如弹丸，如果不快速去除，会损害性命。此核初生，软而不痛，中有虫如米粉，得热气日渐长大，虫随血气流散，所有停蓄，子母相生，侵蚀脏腑，肌肉作疮，或大便脓血，致使小儿逐渐黄瘦，头大发竖，手足细弱，从此夭折。（《圣惠方》）
无辜，是鸟名，啼叫时两颔煽动，像瘰疬的颈部，小儿肝热目暗，颈核累累，其状相类，因此以此命名。后人穿凿附会，说小儿衣服夜晚露水不收，为无辜鸟羽所落，感而成病，荒唐得很。我用逍遥散加减，缓缓调理，痊愈的很多。（《怡堂散记》）
五迟
五迟，是指立迟、行迟、齿迟、发迟、语迟。肾主骨，齿是骨的余气，发是肾的外荣，如果牙齿很久不生，生了而不坚固，头发很久不生，生了而不黑，都是胎弱。良由父母精血不足，肾气虚弱，不能荣养而然。如果长到不能站立，站立而骨软；大到不能行走，行走则筋软，都是肝肾气血不充，筋骨痿弱的缘故。有肝血虚，筋不荣膝，膝盖不成，而手足拳挛的；有肾气虚，髓不满骨，骨不能用，而足胫无力的。并用地黄丸为主，齿迟加骨碎补、补骨脂；发迟加龟版、鹿茸、何首乌；立迟加鹿茸、桂枝、附子；行迟加牛膝、鹿茸、五加皮。语迟的原因不一，有因怀孕母亲突然惊恐，邪气乘儿心而不能说话的；有禀受父亲肾气不足而说话迟的；有乳母五火遗热，闭塞气道的；有病后津液内亡，会厌干涸的；也有脾胃虚弱，清气不升而说话迟的。邪乘儿心，用菖蒲丸；肾气不足，地黄丸加远志；闭塞气道，加味逍遥散；津液内亡，七味白术散；脾胃虚弱，补中益气汤。如果病久或五疳导致的，只补养脾胃为主。（《张氏医通》）
Causing cold limbs, faint breath from the mouth and nose, convulsions of the hands and feet, lethargy with eyes half-open showing the whites. This is a syndrome of wind generated by Spleen deficiency and Yang collapse. There are also cases where acute fright-convulsion lasts for a long time, damaging the Spleen and consuming Yin, transforming into slow fright-convulsion. Lou Quanshan said: When Liver Wood is deficient, convulsions occur but are weak; when Heart Fire is deficient, the body is cold and limbs are chilly; when Spleen Earth is deficient, vomiting, diarrhea, and eyes half-open occur. If Spleen Earth deficiency fails to generate Lung Metal, and Lung Metal deficiency fails to control Liver Wood, causing Liver Wood to overact on Spleen Earth, Yi Gong San (Isolated Efficacy Powder) added with Dang Gui (Angelicae Sinensis Radix), Bai Shao (Paeoniae Radix Alba), and Gou Teng (Uncariae Ramulus cum Uncis) should be used to tonify Earth and pacify Wood. For Spleen Earth deficiency-cold, Liu Jun Tang (Six Gentlemen Decoction) added with Wu Tou (Aconiti Lateralis Radix Preparata) and Xie Wei (Scorpio) is suitable; for diarrhea, add Pao Jiang (Zingiberis Rhizoma Preparatum) and Mu Xiang (Aucklandiae Radix); if ineffective, urgently add Fu Zi (Aconiti Lateralis Radix Preparata) to restore Yang Qi. This represents extreme transmission among Zang-Fu organs, ultimately returning to deficiency, with no wind to dispel and no fright to treat. If the cause is not examined and wind-dispelling and phlegm-resolving agents are indiscriminately used, it will instead hasten the critical condition. (Xue Lizhai)
Slow fright-convulsion: symptoms include heavy daze in the eyes (severe), wandering gaze (severe), cold extremities (severe), profuse sweating like flowing water (severe), and sudden pale/dark complexion of the mouth and face (most severe). Eyes half-open and half-closed indicate excess Yin transmitting to the interior organs and deficiency of Yang Qi. The Spleen is the organ of extreme Yin; as pathogens enter sequentially, they reach the Spleen, hence termed "Slow Spleen Wind." ○ Ancient saying: Patients fear convulsions more than diarrhea, while doctors fear diarrhea more than convulsions. If diarrhea persists, treat the diarrhea first. Treating the convulsion further will worsen the fright. (Ren Zhi Zhi Fang)
Q: Why does the discussion of slow fright-convulsion mention the Spleen but not the Stomach? A: The Stomach belongs to the Fu organs and is Yang; the Spleen belongs to the Zang organs and is Yin. Children are bodies of pure Yang. Diseases transmitted to the Fu organs often resolve spontaneously; those transmitted to the Zang organs are difficult to treat. Thus, involvement of the Fu is considered favorable, while involvement of the Zang is unfavorable. This is why ancients spoke of the Spleen rather than the Stomach. (Zheng Zhi He Can)
In treating slow fright-convulsion, if Yang syndromes are still present, do not abruptly use Yang-restoring methods. Instead, use wind-interrupting and Stomach-regulating methods, such as Chan Xie San (Cicada and Scorpion Powder) or Xing Pi San (Awaken Spleen Powder). If hands and feet are cold, apply Yang-restoring treatment using Wu Xie San (Aspic and Scorpion Powder). Drugs like Niu Huang (Calculus Bovis), She Xiang (Moschus), Yin Fen (Mercurii Bichloridum), Ba Dou (Crotonis Fructus), and Xiao Ming Fan (Natrii Sulfas) are strictly prohibited. (Yi Xue Ru Men)
The common term "slow fright-convulsion," originating from an unknown era, has harmed countless infants. Analyzing the diseases referred to by this term—such as simultaneous vomiting and diarrhea, shortness of breath and spirit fatigue, empty irritability and convulsions, phlegm-wheezing and anorexia, weak pulse, and sleeping with eyes open—are irrelevant to the name "fright-convulsion." Upon investigation, these diseases arise from unresolved external pathogens, mismanagement of other illnesses, dietary irregularities, or post-illness conditions, leading to vomiting injuring the Stomach and diarrhea injuring the Spleen. Earth deficiency fails to generate Metal; Middle Jiao deficiency allows Liver Wood to invade. These are all internal injury diseases. Treatment should urgently protect the root, support Earth to generate Metal, calm the Stomach and harmonize the Liver, and warm-nourish Kidney Yang, yet still worry about insufficient effort. Clinging to the name "slow fright-convulsion" and generally using sedative/heavy-settling drugs, or dispersing wind, clearing fire, resolving phlegm, and breaking Qi, leads to disastrous consequences. This syndrome begins with Middle Jiao Earth already deficient and Liver Wind already moving; prolonged duration manifests as apparent convulsions, but it actually does not originate from fright. Why call it "slow fright-convulsion"? Is this not confusing horse for deer? In summary, if "slow" refers to speed, any chronic disease can be called slow; only fright-convulsion is an acute syndrome and cannot be prefixed with "slow." One should refer to the methods of Li Dongyuan, Xue Lizhai, and Zhang Jingyue, leaving no therapeutic gap. (Lin Zheng Zhi Nan)
People casually say "slow fright-convulsion"; I alone call it "slow syndrome." Although "slow" contrasts with "fast," the cause of this syndrome is often parental negligence. Some allow excessive sweating to continue, some allow persistent vomiting and diarrhea to continue, leading to Yang loss from sweat, Stomach injury from prolonged vomiting, and Spleen exhaustion from prolonged diarrhea. This is a critical state; what fright is there? Quack doctors see children rolling their eyes and twitching hands, mistaking the appearance for fright, and treat it as such. This is like throwing a stone at a child who has already fallen into a well. (Xia Yuzhu)
Summer-Wind Fright-Convulsion
True summer-wind fright-convulsion is an Excess syndrome. Summer-heat favors injuring the Heart; wind favors injuring the Liver. I formulated Shu Feng Yin Zi (Summer-Wind Drink), using Qiang Huo (Notopterygii Rhizoma et Radix) and Fang Feng (Saposhnikoviae Radix) to treat wind, Huang Lian (Coptidis Rhizoma) and Shi Gao (Gypsum Fibrosum) to treat summer-heat, and other herbs for concurrent symptoms. Practiced judiciously, 80-90% survive. If summer-heat injures the Spleen and Stomach, followed by convulsions after vomiting or diarrhea, it is called Summer-Wind Slow Fright-Convulsion, a Deficiency syndrome. Improper treatment results in 80-90% mortality. ○ Vomiting and diarrhea easily lead to slow fright-convulsion, but vomiting is worse than diarrhea. To stop diarrhea, warm-tonification can be used; survival depends on tolerance to tonification. Vomiting injures Stomach Qi; injured Stomach Qi cannot distribute fluids, so mixed medications often fail. I reasoned that nourishing the Stomach requires neither cold nor heat but must activate vital energy to turn the pivot. Thus, I formulated Huang Tu Dao Hua Tang (Yellow Earth and Rice Flower Decoction), achieving many successes, though contemporaries did not recognize it. ○ Summer-heat combines with the Heart, favoring Heart injury. Summer-wind fright-convulsion can strike directly or transmit from Stomach/Liver/Gallbladder heat. Gradual transmission allows slow clearing with medication. Direct striking causes immediate death upon onset; this must be known. ○ When convulsions begin, check forehead and limb temperature and pulse. Forehead/limb heat with large, slightly rapid pulse indicates easy resolution. Forehead heat with cold limbs and extremely fine, rapid pulse indicates sudden collapse. ○ Once summer-heat enters the Heart and diagnosis is confirmed, immediately use Heart-clearing formulas. Huang Lian may be used for 5-7 days; do not change prescription if no improvement in 1-2 days. Texts say: Zang organs store essence. Pathogens are hard to enter but also hard to exit; thus, treatment strategy must be maintained. ○ For summer-wind convulsions with forehead/limb heat, Huang Lian to drain Heart can conclude treatment. With forehead heat and cold limbs, do not use. Why? Huang Lian drains Heart, which effectively drains Spleen (Earth). According to "Excess drains its son," if the son (Metal) is already deficient, how can one drain? ○ For lingering summer-wind with unconsciousness, strabismus, grinding teeth, and salivation due to phlegm obstructing the Pericardium, use Qiao Tong (opening orifices) drugs like Niu Huang (Calculus Bovis), Dan Xing (Armeniacae Amarum Semens Preparatum), Zhu Li (Bambusa Sap), Jiang Zhi (Zingiberis Juice), and Shi Chang Pu (Acori Tatarinowii Rhizoma), combined with Heart-clearing. If consciousness clears, voice is bright, appetite returns, and stool normalizes, Zang pathology has ceased. Only stiff/extending limbs or curling fists indicate Heat damaging tendons and Blood failing to nourish meridians. Do not use phlegm-draining or Zang-penetrating drugs; instead, heavily nourish Yin and Blood, combine with tendon-relaxing herbs, and recovery will occur slowly. ○ For stiffness, Yin-nourishing drugs yield more cures; for flaccidity, combine Spleen-fortifying herbs like Yi Yi Ren (Coicis Semen) and Bian Dou (Dolichoris Lablab Semen) for residual summer-dampness. ○ Yin-nourishing formula: Di Huang (Rehmanniae Radix), Mu Dan Pi (Moutan Cortex), Dang Gui (Angelicae Sinensis Radix), Bai Shao (Paeoniae Radix Alba), Mai Dong (Ophiopogonis Tuber), plus Sang Ji Sheng (Taxilli Caulis), Ling Yang Jiao (Capricornis Cornu), Qin Jiao (Gentianae Macrophyllae Radix), and Gou Teng (Uncariae Ramulus cum Uncis) to relax tendons. ○ Summer-wind fright-convulsion is treatable if fetal Qi is strong and Spleen Earth is intact, tolerating cooling drugs. If vomiting/diarrhea coexist, forehead heat/cold limbs, and mild convulsions, it is Summer-Wind Slow Fright-Convulsion, difficult to clear or tonify. Liu Jun Tang added with Huang Lian works for survivors; failure indicates death. (Xiang Cun Zhi Yan)
Startle During Sleep
Pediatric startle during sleep is mostly caused by Heart-Kidney insufficiency. Children's Zang-Fu are fragile and prone to fright. Human Shen Qi travels through the eyes when awake and resides in the Kidneys when asleep. With Heart-Kidney deficiency, Shen Qi cannot hold fast, causing startle during sleep. Treatment: Bu Xin Tang (Tonify Heart Decoction) to clear Heart and calm Spirit. If caused by fright, which agitates the Liver, causing unsettled Hun and Po, use Bao Long Wan (Dragon-Holding Pill) to resolve phlegm and settle fright. If caused by food stagnation generating phlegm, strengthen Spleen and resolve phlegm, adding Zhi Zi (Gardeniae Fructus) and Chai Hu (Bupleuri Radix) to clear heat. (Zhang Shi Yi Tong)
Epilepsy
Epilepsy resembles fright-convulsion. However, during epilepsy attacks, the patient falls making sounds and vomits saliva upon waking; fright-convulsion involves no sound and no saliva vomiting. (Lou Quanshan)
Pediatric epilepsy has three types: Wind Epilepsy, Fright Epilepsy, and Food Epilepsy. Wind Epilepsy arises from sweating due to warm clothing, allowing wind invasion. It starts with finger movements resembling counting. Fright Epilepsy originates from terror, starting after loud crying. Food Epilepsy begins with refusal to nurse, vomiting, fever, then convulsions. Fright Epilepsy is treated with acupuncture/moxibustion according to diagrams; Wind Epilepsy with Pig Heart Soup; Food Epilepsy requires purgation, preferably Zi Shuang Wan (Purple Frost Pill). (Qian Jin Fang)
Epilepsy is a malignant condition in children. Their blood vessels are unconsolidated and bone Qi unaggregated. It can be triggered by wind pathogens or irregular nursing, leading to stagnation and accumulation. Symptoms: depressed spirit, staring eyes, eye deviation, locked jaw with drooling, abdominal distension, limb convulsions, screaming or muteness, opisthotonos, spinal rigidity. If limbs are soft and the patient regains consciousness between episodes, it is epilepsy. If the whole body is rigid and unconscious all day, it is tetanus/spasm. (Yang Renzhai)
Epilepsy is common in children. Books state accumulated fright becomes epilepsy, hence "three fright-convulsions become epilepsy." Liver governs fright-convulsion. If initial agitation is not resolved and mineral pills are given, pathogens stay in Pericardium, Liver, and Gallbladder, generating phlegm and heat over time. Triggers cause attacks: staring, screaming, head shaking, hand jerking, foaming at mouth, sudden collapse, or animal-like noises. World has names for Five Epilepsies and Yin/Yang distinctions, with various treatments worsening the condition. My treatment focuses on Liver governing fright. For recent onset with robust constitution, use Qian Shi's Xie Qing Wan (Drain Green Pill) removing Long Dan Cao (Gentianae Radix), adding Ju Hong (Citri Reticulatae Pericarpium) and Ban Xia (Pinelliae Tuber) to disperse. For long-standing weakness, use Xiao Yao San (Free and Easy Wanderer Powder) with Ju Hong and Ban Xia to smooth flow. Use Chu Bi San (Nose-Tickling Powder) intermittently. Harmonize Stomach Qi; self-recovery follows. (Yi Tang San Ji)
These are all Yuan Qi deficiency syndromes. Treat primarily with Zi He Che Wan (Placenta Pill), assisted by tonics. Indiscriminate purging damages Yuan Qi further, causing frequent relapses and eventual danger. (Xue Lizhai)
Case Selection
A seven-year-old boy had epilepsy. Father made him drink human milk before each attack; attacks became sparse and mild. At fourteen, recurrence occurred; human milk failed. I used Zi He Che (Human Placenta) ground into paste, mixed with milk, taken 2-3 times daily. After several doses, he recovered. Later maintained with Modified Ba Wei Wan (Eight Flavor Pill). At twenty-three, recurrence with cold limbs; same method plus Shi Quan Da Bu Tang (Comprehensive Great Tonifying Decoction) led to cure. (Xue Lizhai)
Ke Wu (External Intrusion)
Ke Wu occurs when a child's weak Shen Qi is suddenly disturbed by unusual objects or unfamiliar people, clashing with the child's spirit. Symptoms: vomiting, diarrhea, abdominal pain, changing facial colors, resembling epilepsy but without upward eye deviation. Pulse is wiry, rapid, and tense. Untimed treatment leads to chronic difficulty. (Chao Shi Bing Yuan)
Wu Chu (Object Contact)
Wu Chu happens when a child's beloved object is forcibly taken, causing anger, scattering Shen Qi. Symptoms: anorexia, mutism, drunken stupor, hanging limbs, resembling various evil syndromes. Ask parents, fulfill desires, medicate to regulate; Shen Qi settles naturally. (Feng Shi Jin Nang)
Crying
Children have fright-crying, night-crying, and abdominal pain-crying. Fright-crying stems from wind invading Heart, generating internal heat, unsettling spirit and sleep. Night-crying is due to Cold Zang; Yin dominates at night, inducing crying. Also attributed to taboo violations. Abdominal pain-crying is due to severe colic, body extension, and gas pressure. Fetal cold-crying originates in utero: intestinal cold, indigestion, bloating, diarrhea, pale/blue complexion, intermittent crying. (Wan Quan Fang)
Four types of pediatric night-crying: 1. Cold; 2. Heat; 3. Double tongue/mouth sores; 4. Ke Wu. Cold: abdominal pain, blue face, cold breath, bending waist. Heat: irritability, red face, dark urine, hot mouth/warm abdomen, extending body. Double tongue: inability to suck, crying upon touching nipple; check mouth with light. Ke Wu: crying upon seeing strangers. Treat according to syndrome. (San Yin Fang)
Two types of night-crying: 1. Spleen Cold; 2. Heart Heat. Night is Yin; dominance increases Spleen Cold. Spleen is Extreme Yin, likes warmth, hates cold. Cold causes abdominal pain, bending waist crying, stopping with lamp light. Signs: pale/blue face, cold limbs, anorexia. Treat with Yi Huang San (Benefit Yellow Powder) + Gou Teng. If crying worsens with lamp, it is Heart Heat. Heart is Fire; lamp aggravates internal heat, two Yangs clash, causing extending body crying. Signs: red face, warm limbs, hot breath. Treat with Dao Chi San (Guide Out Red Powder) + Huang Lian, Mai Dong. Pale face, small black pupils indicate Kidney Qi deficiency. Night crying due to Yin deficiency: Liu Wei Wan (Six Flavor Pill). Fright-related: treat as Ke Wu/Fright Crying. (Zhang Shi Yi Tong)
Night-crying is Spleen Cold causing pain. Give warming medicines. Or use Hua Huo Gao. (Xiao Er Zhi Jue)
Children's Liver Qi is undeveloped, Gallbladder Qi is timid. Sudden sounds/colors frighten Hun and Po. Waking fright causes startle, trembling, or sudden crying—all signs of weak Shen. General treatment: calm Shen and nourish Qi. (Zhang Jingyue)
Excessive crying in the first month is auspicious. Fetal heat, toxicity, and fright dissipate through it. (Yi Xue Ru Men)
Case Selection
Mr. Ye Shi Ke treated a child crying from maternal grief, irritability. Prescribed Mi Zhi An Shen Wan (Secret Instruction Calming Spirit Pill) and wrapped the child in the mother's unwashed inner garment. Spirit calmed and cured that night. I treated a child frightened by falling into a pool, with fever and crying. Used Heart-clearing/calming herbs, boiled pool water for decoction. Cured. Though "treating by intent," it relies on Qi resonance. (Xu Xuanzhi)
Gan Syndrome (Childhood Malnutrition)
1. Blue eyes/rubbing itching: Liver Gan. 2. Scorched teeth: Bone Gan. 3. Hair loss/dry nose: Lung Gan. 4. Dry skin/cracked flesh: Tendon Gan. 5. Yellow/brittle hair: Blood Gan. 6. Mouth sores: Heart Gan. 7. Geophagia (eating dirt): Spleen Gan. (Lu Xin Jing)
Five Zang Gan injuries are generally similar. Detailed: Five Gan, Worm Gan, Emaciation Gan, Brain Gan, Dry Gan, Thirst Gan, Diarrhea Gan, Dysentery Gan, Swelling Gan, Consumption Gan, Innocent Gan, Ding Xi, Bu Lu. Various symptoms. (Yang Renzhai)
Pediatric Ding Xi, Bu Lu, Ke Wu, Innocent Gan are four distinct diseases; Adult Yang Yi, Yin Yi, Bai He, Hu Huo are four strange diseases. (Wang Haogu)
Pediatric Gan terms Ding Xi and Bu Lu are colloquial but meaningful. Ding Xi means emaciated like a peg, referring to thin limbs, disease in flesh (Spleen Gan). Bu Lu means bones exposed despite feeding, referring to fontanelle opening, disease in bone (Kidney Gan). (Yi Can)
Gan means dry. Children's intestines/stomach are tender. Irregular diet, rich foods, poor digestion lead to stagnation, heat, fluid depletion, forming Gan from accumulation. Or Zang heat, post-illness, or mistaken purging depletes fluids, Spleen fails to transport, stagnation forms Gan from dryness. Thus, Five Gan centers on Spleen/Stomach. Treatment: Clear Stomach stagnation, tonify Spleen weakness. Heat: bitter-cold clearing. Cold: acrid-warm promoting. Worms: add vermifuges. Deficiency: tonify mother organ. Pills for slow regulation, not quick results. Chicken liver stewed with Gan herbs is effective. (Lin Zheng Zhi Nan)
Internal Gan: swollen eyes, abdominal distension, white/green dysentery, emaciation. External Gan: red/rotten nose, rubbing nose/ears, skin sores. All relate to Five Zang; differentiate and treat accordingly. (Qian Zhongyang)
Gan need not distinguish Cold/Heat, only diarrhea status. No diarrhea: accumulated heat trapped, intense chest/abdominal heat. Diarrhea: heat vented, less chest/abdominal heat. Root is accumulated heat; "Cold Gan" in texts is erroneous. (Ci You Fa)
Pediatric Five Gan equals Adult Five Exhaustion. "Dry" and "Exhaustion" imply essence/blood depletion. Ancients treated heat with cooling. While true heat is common, false heat from defeated Yuan Qi is frequent. Blood/Qi damage requires major tonification. Yin deficiency with false heat, Spleen/Kidney failure requires warm tonification. Clinical judgment is key; reference deficiency treatments for perfection. (Jing Yue Quan Shu)
Innocent Gan: bead-like lump behind ear. If not removed quickly, fatal. Initially soft/painless, contains worm-like rice grains. Heat enlarges them; worms spread via blood/qi, multiplying and eroding Zang-Fu, causing ulcers, bloody stools, jaundice, emaciation, erect hair, thin limbs, early death. (Sheng Hui Fang)
"Innocent" is a bird name, flapping jaws when crying, resembling scrofula necks. Children with Liver heat/dim vision have neck lumps, resembling the bird, hence the name. Later scholars absurdly claimed exposure of clothes to moonlight attracts bird feathers causing disease. I used modified Xiao Yao San for slow regulation, curing many. (Yi Tang San Ji)
Five Delays
Five Delays: standing, walking, teeth, hair, speech. Kidney governs bone; teeth are bone surplus; hair is Kidney bloom. Delayed/unstable teeth/hair indicate fetal weakness. Caused by parents' insufficient Jing/Blood and weak Kidney Qi failing to nourish. Inability to stand/soft bones, inability to walk/weak sinews indicate Liver/Kidney Qi/Blood deficiency and tendon/bone weakness. Liver Blood deficiency: sinews fail to nourish knees, clenched hands/feet. Kidney Qi deficiency: marrow fails to fill bones, weak calves. Main formula: Di Huang Wan (Rehmannia Pill). Teeth delay: add Gu Sui Bu, Bu Gu Zhi. Hair delay: add Gui Ban, Lu Rong, He Shou Wu. Standing delay: add Lu Rong, Gui Zhi, Fu Zi. Walking delay: add Niu Xi, Lu Rong, Wu Jia Pi. Speech delay causes vary: maternal fright invading Heart (Shi Chang Pu Wan); paternal Kidney deficiency (Di Huang Wan + Yuan Zhi); lactating mother's fire blocking airways (Jia Wei Xiao Yao San); post-illness fluid loss drying epiglottis (Qi Wei Bai Zhu San); Spleen/Stomach weakness failing to raise clear Qi (Bu Zhong Yi Qi Tang). Chronic cases or Gan-induced: focus on Spleen/Stomach tonification. (Zhang Shi Yi Tong)