小儿二百六十日，则膝骨成，乃能行，期也。有数岁不能行者，禀受肾元不足也。夫骨属肾，凭髓所养，
肾气有亏，则不能充髓满骨，故足弱不能行也。复有重帏深闭，不见风日，或终日怀抱，筋骨不舒，是以难行
者。又有离胎多病，肝肾俱虚，肝虚则筋弱，肾虚则骨柔，而不能行者。复有过食肥甘，脾胃受伤，致成疳证，
气血日惫，而不能行者。随证调治，亦有可复。（冯楚瞻）
孩儿头面胸膊肌浓，臂胫细瘦，行走迟者，是小时抱损。
（《颅囟经》）
五软五硬
五软者，手、脚、腰、背、颈软是也。五硬者。手、脚、腰、背、颈硬是也。五冷者，手、脚、气、唇、
面冷是也。五缩者，手、脚、舌、唇、阴缩是也。五反者，眼、唇、舌、项、脚反是也。五紧者，咽喉、口唇、
眼睛、手足、阴囊紧是也。五陷者，囟门、太阳、眼眶、胸下、肩井陷是也。五肿者，手心、人中、舌头、阴
茎、膝胫肿是也。五喘者，痘疮、惊风、吐、泻、下利喘是也。五盲者，痘疮、惊风、久疳、久泻、久痢盲是
也。不论何病，总是恶候。（《冯氏锦囊》）
头软者，肾主骨，天柱骨弱，乃脏腑骨脉皆虚，诸阳之气不足，足少阴、太阳经虚也。手足软者，脾主
四肢，乃中州之气不足，不能营养四肢，故肉少皮宽，饮食不为肌肤也。口软者，口为脾之窍，上下龈属手、
足阳明，阳明主胃，脾胃气虚，舌不能藏，而常舒出也。夫心主血，肝主筋，脾主肉，肺主气，肾主骨。此五
者，皆因所禀五脏之气虚弱，不能滋养充达，以故骨脉不强，致令肢体痿软。然其要，总归于胃。盖胃者，水
谷之海，五脏之本，六脏之大源也。治法必先以脾胃为主，俱用补中益气汤，以滋化源，兼服地黄丸。仍令壮
年乳母哺之，多能全角。（薛立斋）
五硬者，仰头吸气，难以动摇，气壅作痛，连于胸膈，肢冷而硬，此阳气不营于四末也。《经》曰∶脾
主四肢，又曰∶脾主诸阴。今手、足冷而硬者，独阴无阳也。此证从肝、脾二脏受患，治当补脾平肝。（《证治准绳》）
解颅颅胀囟陷囟填
小儿有解颅、囟不合、囟陷，三者大同小异。解颅者，谓儿年长，囟应合不合，头颅开解也。盖肾主骨，
脑为髓海，肾气不盛，则髓海不足，故骨缝开解也。其囟不合与囟陷，虽因脏腑有热，热气上冲所致，然亦本
于肾气不足也。（《万全方》）
肾主骨，骨气实，则脑髓充而囟早合；肾气怯，则脑髓虚而囟不合。此由父母精血不足，宜用地黄丸补之；
若在乳下，当兼补其母；更以软帛紧束其首，使其易合。囟填、囟陷，亦因所禀肾气不足，及乳哺失宜，脾胃
亏损所致。夫脾主肌肉，气逆上冲，而为填胀；元气下陷，而为囟陷。并宜补中益气汤、地黄丸及用狗头骨炙
黄为末，以鸡子清调敷囟门；亦有因泻利病后，气血亏虚，不能上充者，亦用前法；若手足并冷，服前汤未应，
此虚寒之甚也，急加附子，缓则不救。（薛立斋）
颅胀与囟填不同∶囟门凸起为囟填，此属心经火盛，钱氏用泻心汤。颅胀则头皮光急，额角胀大，乃肝肾
虚热上冲，治用地黄汤重剂以镇之。○囟门不合，头骨分开，名曰解颅。其儿面 、目白、睛多，此由先天不足，
治宜阴阳双补，六味汤加鹿茸、龟版。（许宣治）
龟背龟胸
龟背者，由儿生下，风客于脊背，入于骨髓，治宜小续命汤去附子加防风。龟胸者，因肺受风热，攻于胸
膈，治宜龟胸丸，并用龟尿点其骨节，多有得愈。若禀受肝肾虚热者，宜用六味丸；肾气不足者，宜用八味丸；
背加鹿茸，胸加龟甲。治之贵早，迟则不验。（《张氏医通》）
予按龟胸有治，龟背乃不治之证。前人论治，犹有未善。虽曰客风入骨，坐早劳伤，咳嗽肺虚，然未窥其
病源，无非以见在者言之也。凡小儿禀受真元足者，尝见其赤身裸体，当风露坐，半周之后，坐以座栏，从未
闻有客风入骨，坐早劳伤，嗽久而病龟背之说。此证盖由禀父母精髓不足，命阳亏损者多有之。不观小儿龟背，
正在命门之间，渐次骨节浮露，其腰如弓，实因骨痿不能支撑之故，岂风邪为患哉？前人强立松蕊丹，反用麻
黄、大黄、独活、防风，一派攻伐之药，适足以速其殇也。但当以六味加上桂、鹿茸，救其先天，复以六君等，
扶其胃气，或可十中保
一。（陈飞霞）
鹤节
小儿肌肉瘦薄，骨节呈露，如鹤之膝，此先天禀受精髓不充，亟以六味丸加鹿茸、牛膝治之，缓则必成废
疾。（《慈幼筏》）
天柱骨倒
天柱骨倒小儿，有体肥容壮，不为瘦悴。孰知形体过肥，中军愈弱，是盛于外，而歉于内也。○有因久病
之后，或泄泻日久，忽然颈项倾侧，最为危候，速救真元，十全大补汤加鹿茸。○有儿生下颈便软者，胎气不
足也。由禀父之肾元虚败，峻补先天，其庶几矣，补肾地黄丸与六君子汤，间服。○天柱骨倒，总系真阳大败，
为小儿之恶证，保救真元是其大要，外以生筋散贴之。（《幼幼集成》）
病
病者，其状微微下利，寒热往来，毛发狰狞，情思不悦。《千金》云∶ 者，小儿鬼也。子未能行，母
又有孕，令儿羸瘦，骨立发稀，乃 病也。先用紫霜圆下其 乳，后以益黄散补之，令儿断乳即安。予谓妇人
乳子，情意所关，腹既怀孕，生气注胎，虽乳何益？《淮南》有言∶男子艺兰，美而不芳； 子得乳，萎而不
泽，此真透达之言。鬼神之说，无足为据，速令断乳为是。（《怡堂散记》）
小儿生后，其母又娠，令儿精神不爽，身体痿瘁，名为 病。用伏翼烧灰细研，以粥饮调下五分，日四、
五次；或炙令香，热嚼哺儿，亦效。伏翼，即蝙蝠也。（《圣惠方》）
暖病
谚云∶若要小儿安，常带三分饥与寒。小儿纯阳之体，不胜郁遏。每见富贵之家，红炉密室，叠帐重 ，
酝酿成病。或睡时母不加意，蒙头盖覆，气不得泄。或系于怀抱，外裸重绵；内蒸母气，以致发热面赤，心烦
啼吵。此证既非外感，亦非内伤，名
曰暖病。医家察得其情，但以轻清之剂，微微散之，仍令徐徐撤去过浓衣被，则热证自平。（《小儿诸热辨》）
蛀夏
脾为坤土，喜燥恶湿。凡脾胃不足者，遇长夏湿溽之令，则不能升举清阳，健运中气。又值少阳相火之时，
热伤元气，则体惰脚弱，嗜卧发热，精神不足，食少无味，呼吸缺乏，视物KT KT ，小便赤数，大便不调，名曰蛀
夏。此禀赋阴虚，元气不足之证。治用补中汤去升、柴加黄柏。若血虚者，用补血汤；气血两虚者，八珍汤；
肝肾阴亏者，地黄丸；大便泻者，理中汤。儿病多因母气不调所致，当戒怒气，调饮食，适寒温，则可远病。（薛立斋）
夏，火令也，火旺则金亏，故阴虚之人，多不耐夏。内热食减，肌肤消烁，若虫之蛀物焉。治法当于古方
推之，热伤气，清暑益气汤，是扶正气以辟暑邪；火烁金，《千金》参麦汤，是保肺金以防火烁；水不胜火，
参麦地黄汤，均为对证之药。若不明其理，专治脾胃，脾胃之药多燥，燥则土旺而水愈涸，病加甚者有之。此
证，东垣、薛氏皆云禀赋阴虚，元气不足，令于平时预服地黄丸，以杜来岁之患，则善矣。（《小儿诸热辨》）
睡中切牙
小儿寤寐，不时切牙及啮乳者，虽多属惊，然所致各有不同。若发热饮水啼哭者，心经实热也，宜泻心汤；
若睡困惊悸，合目而卧者，心经虚热也，宜导赤散；若面青目札，项强烦闷者，肝经实热也，宜柴胡清肝散；
若手循衣领，及乱捻物者，肝经虚热也；若发搐目青面赤者，肝经风热也，并宜六味丸。（《张氏医通》）
梦中切牙者，风热也。由手、足阳明二经积热生风，故令相击而有声也。必在梦中者，风属阳，动则风行
于阳，静则风归于里也。○切牙一证，惟痘疹见此为危候，余则皆无大害。亦有因
病战栗，鼓颌而斗牙者，治其本证，则自止矣。（《幼幼集成》）
滞颐
滞颐之病，是小儿多涎，流出渍于颐间。涎者脾之液，脾气虚冷，故涎自流，不能收制也。（《巢氏病源》）
按《内经》云∶舌纵涎下，皆属于热。而此专属脾冷，亦偏见也。张涣处冷、热各二方，为得之。然以流
出为冷，不流出为热，恐亦未确。（《证治准绳》）
百 嗽
凡乳子百日内有痰嗽者，谓之百 嗽。或出胎暴受风寒，或浴儿为风所袭，或解换褓裳，或出怀喂乳，而
风寒得以乘之，此病由外来者。或乳汁过多，吞咽不及而呛者，或啼哭未定，以乳哺之，气逆而嗽者，此病由
于内生者，皆能为嗽。第汗、下之剂，难以轻用，以其胃气方生，不能胜药故也，故曰难医。予治此证甚多，
先用荆防败毒散二小剂，母子同服；更令乳母忌口，以清其乳，虽嗽至重，不过旬日自愈。（《幼幼集成》）
汗
小儿元气未充。腠理不密，所以极易汗出。故凡饮食过热，衣被过暖，皆能致汗。东垣诸公云∶此是小儿
常事，不必治之。然汗之根本，由于营气；汗之启闭，由于卫气。小儿多汗，终是卫虚不固。汗出既多，未免
营卫血气有所亏损，而衰羸之渐，未必不由乎此，不可不治也。法当益气为主，但使阳气外固，则阴液内藏，
而汗自止矣。（张景岳）
虚羸
小儿虚羸，因于脾胃不和，不能乳食，故使肌肤瘦弱，或病后脾虚，不能运化谷气所致。虚而寒者，时时
下利，唇口淡白；虚而热者，身体壮热，肌肉微黄。更当审形色，察见证。如面赤多啼，心虚也；面青目札，
肝虚也；耳前后或耳下结核，肝经虚火也；颈间肉里结核，食积虚热也；面黄痞满，脾虚也；面白气
喘，肺虚也；目睛多白，肾虚也。仍参相胜治之。（《张氏医通》）
病后喑
小儿吐泻及大病后，虽有声而不能言，此非失音，为肾怯不能上接于阳故也。地黄丸主之。（钱仲阳）
痫发瘥后不能言者，心之声为言，开窍于口，其痫发虽止，风冷之气，犹滞心之络脉，使心气不和，其声
不发，故不能言也。（《巢氏病源》）
小儿惊风并退，只是声哑不能言，以天南星炮为末，每服一字，猪胆汁调下，便能言语。（《证治准绳》）
乳
小儿吐乳，虽有寒热之不同，然寒者多而热者少，虚者多而实者少，总由胃弱而然。但察其形色脉证，则
虚实、寒热，自有可辨。热者宜加微清；寒者必须温补。乳子之药不必多用，但择其要者二、三、四味，可尽
其妙，如参姜饮、异功散之类。若儿小乳多，满而溢者，亦是常事，乳行则止，不必治也。（张景岳）
小儿呕吐，有寒、有热、有伤食，其病总属于胃。复有溢乳、 乳、呕哕，更有寒热拒格之证，又有虫痛
而吐者，皆当详其证而治之。凡治小儿呕吐，先宜节其乳食；呕吐多渴，不可与水，水入复吐，终不能止。必
强忍一、二时，而后以米汤与之，吐自止矣。○初起 乳，即当调治。如 不已即成吐，吐不已即成呕，呕不
已即成哕，胃气虚，精神脱矣。○凡呕吐不纳药者，最难治疗。盖药入即吐，安能有功，不可强灌，胃口愈吐
愈翻。予之治此颇多，先将姜汤和土，作二泥丸，塞其两鼻，使之不闻药气，然后用对证之药，煎好斟出。冷
热得中，止服一口，停之半时，再服一口，又停少顷，则任服不吐矣。愚人不知，明见其吐药不纳，偏强灌之，
则一吐倾囊，又何药力之可恃乎？此法不但
幼科，方脉亦当识此。（《幼幼集成》）
吐泻
小儿吐泻，虚寒者居其八、九，实热者十中一、二。但察其脉证无火，面色青白，气息平缓，肢体清凉，
或神气疲倦，则悉是虚寒，不得妄用凉药。古云∶脾虚则呕，胃虚则吐。盖饮食入胃，不能运化而吐者，此脾
气虚弱，所以不运也。寒凉入胃，恶心而吐者，此中焦阳气受伤，所以不化也。若邪在中焦，则止呕吐；连及
下焦，则并为泻矣。故在中、上二焦者，宜治脾胃；连及下焦者，宜调脾肾。若非实热火邪，而妄用寒凉消伐
者，无有不死。○小儿吐泻并作者，本属内伤，然有因寒气外入，内犯脏气而然者；有因生冷不慎，致伤胃气
而然者；有因中气本弱，饮食失宜而然者。邪伤阳分则为吐；邪伤阴分则为泻；若吐泻并作，则阴阳俱伤。察
其有滞、无滞，辨其虚、实而治之。（张景岳）
长夏暑湿当令，脾土受病，暴感时行之气，多有发热吐泻者。吐泻，里证也；发热，表证也；口渴心烦，
表里俱病。黄连香薷饮为对证之药，一服可平，再服可愈。庸俗不明此理，例用疏散消食通套之方，药病不合，
徒伤正气。吐泻不止，精神已困，额热指冷，目陷神脱，虽名暑风，实与慢惊同类。更医有见其额热口渴，暑
证犹在，而用黄连者；有见其发热指冷，表证犹在，而用香薷者。不知吐泻大作，胃气暴伤，治法与初病不同。
初病正气未伤，可服黄连香薷饮，故一服而效。及待胃气既伤而始用，是用于不可用之时也。长夏秋初，小儿
小儿出生二百六十天，膝盖骨骼发育成熟，才能行走，这是正常的生理期限。如果有几岁还不能行走的，是因为先天禀受肾气元气不足。骨属于肾，依靠骨髓滋养，肾气亏损，就不能充盈骨髓、充满骨骼，所以脚软弱不能行走。又有深居帷帐之中，不见风日，或者整天被抱在怀里，筋骨舒展不开，因此难以行走的。又有离乳后多病，肝肾都虚弱，肝虚则筋弱，肾虚则骨软，而不能行走的。又有过食肥甘厚味，损伤脾胃，导致形成疳证，气血日渐疲惫，而不能行走的。根据症状进行调理治疗，也有可以恢复的。（冯楚瞻）
孩子头面胸背肌肉丰厚，手臂小腿细瘦，行走迟缓的，是小时候抱损所致。（《颅囟经》）
五软五硬
五软，是指手、脚、腰、背、颈软弱无力。五硬，是指手、脚、腰、背、颈僵硬。五冷，是指手、脚、气海（脐下）、嘴唇、面部寒冷。五缩，是指手、脚、舌头、嘴唇、阴部收缩。五反，是指眼睛、嘴唇、舌头、项部、脚部反张。五紧，是指咽喉、口唇、眼睛、手足、阴囊紧缩。五陷，是指囟门、太阳穴、眼眶、胸下、肩井穴凹陷。五肿，是指手心、人中、舌头、阴茎、膝胫肿胀。五喘，是指痘疮、惊风、呕吐、腹泻、下利引起的喘息。五盲，是指痘疮、惊风、久疳、久泻、久痢导致的失明。不论什么病，这都是恶候。（《冯氏锦囊》）
头项软弱，是因为肾主骨，天柱骨（颈椎）虚弱，乃脏腑骨脉皆虚，诸阳之气不足，足少阴、足太阳经脉虚弱。手足软弱，是因为脾主四肢，乃中焦之气不足，不能营养四肢，所以肌肉少皮肤宽弛，饮食不能转化为肌肤。口唇软弱，是因为口为脾之窍，上下牙龈属手、足阳明经，阳明经主胃，脾胃气虚，舌头不能收摄，而经常伸出。心主血，肝主筋，脾主肉，肺主气，肾主骨。这五脏，都是因为先天禀受的五脏之气虚弱，不能滋养充达，所以骨脉不强，致使肢体痿软。然而关键总归于胃。因为胃是水谷之海，五脏的根本，六腑的大源。治疗方法必先以脾胃为主，都用补中益气汤，来滋生化之源，兼服地黄丸。仍让壮年的乳母哺乳，大多能痊愈。（薛立斋）
五硬，表现为仰头吸气，难以动摇，气机壅滞作痛，连及胸膈，四肢冰冷而硬，这是阳气不能营运于四肢末端。《内经》说：脾主四肢，又说：脾主诸阴。现在手脚冰冷而硬，是独阴无阳。此证从肝、脾两脏受患，治疗应当补脾平肝。（《证治准绳》）
解颅、颅胀、囟陷、囟填
小儿有解颅、囟门不合、囟门凹陷，这三者大同小异。解颅，是说孩子年龄大了，囟门应该闭合却不闭合，头颅骨缝分开。盖因肾主骨，脑为髓海，肾气不盛，则髓海不足，所以骨缝开解。其囟门不合与囟门凹陷，虽然是因为脏腑有热，热气上冲所致，但根本也在于肾气不足。（《万全方》）
肾主骨，骨气充实，则脑髓充盈而囟门早合；肾气怯弱，则脑髓空虚而囟门不合。这是由于父母精血不足，宜用地黄丸补益；如果在哺乳期，应当兼补其母；再用软帛紧紧束住头部，使其容易闭合。囟填、囟陷，也是因为先天禀受肾气不足，以及哺乳失宜，脾胃亏损所致。脾主肌肉，气逆上冲，而为囟门填胀；元气下陷，而为囟门凹陷。都宜用补中益气汤、地黄丸，以及将狗头骨炙黄研为末，用鸡蛋清调敷囟门；也有因病后腹泻，气血亏虚，不能上充的，也用前法；如果手脚并冷，服用前面的汤药无效，这是虚寒至极，急加附子，否则延误时机便无法挽救。（薛立斋）
颅胀与囟填不同：囟门凸起称为囟填，这属于心经火盛，钱乙用泻心汤。颅胀则是头皮光亮紧急，额角胀大，乃肝肾虚热上冲，治疗用地黄汤重剂以镇之。○囟门不合，头骨分开，名叫解颅。这孩子面色㿠白、目睛多白、眼球转动灵活，这是由于先天不足，治疗宜阴阳双补，六味地黄汤加鹿茸、龟版。（许宣治）
龟背、龟胸
龟背，是由于婴儿出生后，风邪客于脊背，深入骨髓，治疗宜用小续命汤去掉附子加防风。龟胸，是因为肺受风热，攻于胸膈，治疗宜用龟胸丸，并用龟尿点其骨节，多有痊愈的。如果禀受肝肾虚热的，宜用六味丸；肾气不足的，宜用八味丸；背部加鹿茸，胸部加龟甲。治疗贵在早，迟了就不灵验。（《张氏医通》）
我按语：龟胸有治法，龟背乃是不治之证。前人论治，还有不完善之处。虽然说客风入骨，坐得早劳伤，咳嗽肺虚，但未窥探其病源，无非是以表象而言。凡是小儿禀受真元充足的，常见其赤身裸体，当风露坐，半周岁之后，坐在座栏里，从未听说有客风入骨，坐早劳伤，咳嗽久了而病龟背的说法。此证大概是由禀受父母精髓不足，命门阳气亏损者多有发生。不看小儿龟背，正在命门之间，渐次骨节浮露，其腰如弓，实因骨痿不能支撑的缘故，难道是风邪为患吗？前人强行设立松蕊丹，反而用麻黄、大黄、独活、防风，一派攻伐的药物，恰恰足以加速其死亡。只应当用六味丸加上桂枝、鹿茸，救其先天，再用人参、白术等（六君子汤类），扶助胃气，或许十中能保其一。（陈飞霞）
鹤节
小儿肌肉瘦薄，骨节显露，像鹤的膝盖一样，这是先天禀受精髓不充，亟需用六味丸加鹿茸、牛膝治疗，拖延则必成废疾。（《慈幼筏》）
天柱骨倒
天柱骨倒的小儿，有的形体肥胖容貌壮实，并不消瘦憔悴。谁知道形体过肥，中气愈弱，这是盛于外而歉于内。○有的因病久之后，或泄泻日久，忽然颈项倾斜，最为危候，速救真元，用十全大补汤加鹿茸。○有的儿生下脖子就软，是胎气不足。由禀受父亲的肾元虚败，峻补先天，或许还能好，补肾地黄丸与六君子汤，交替服用。○天柱骨倒，总系真阳大败，为小儿的恶证，保全救助真元是其关键，外用生筋散贴敷。（《幼幼集成》）
哺露（注：原文“病”前有缺字，结合上下文及《怡堂散记》内容，此处指“哺露”或类似因断奶/怀孕导致的病症，原文作“病”，依文意译为相关病症）
这种病的症状是微微下利，寒热往来，毛发枯槁狰狞，情思不悦。《千金方》说：哺露者，是小儿的鬼病。儿子还不会走路，母亲又怀孕，令孩子羸瘦，骨立发稀，这就是哺露病。先用紫霜丸下其积滞乳食，后用益黄散补益，令孩子断乳即安。我认为妇人哺乳子女，情意所关，腹既怀孕，生气注于胎儿，虽哺乳有何益处？《淮南子》有言：男子艺兰，美而不芳；哺露之子得乳，萎而不泽，这是真正透彻通达的话。鬼神之说，不足以作为依据，速令断乳才是正确的。（《怡堂散记》）
小儿出生后，其母又怀孕，令孩子精神不爽，身体痿瘁，名为哺露病。用伏翼（蝙蝠）烧灰细研，用米粥饮调下五分，每天四、五次；或者烤香，热嚼哺喂孩子，也有效。伏翼，就是蝙蝠。（《圣惠方》）
暖病
谚语说：若要小儿安，常带三分饥与寒。小儿是纯阳之体，不胜郁遏。每见富贵人家，红炉密室，叠帐重幕，酝酿成病。或者睡觉时母亲不加注意，蒙头盖覆，气不得泄。或者抱在怀里，外面裹着重绵；里面蒸腾母亲的气息，以致发热面赤，心烦啼哭吵闹。此证既非外感，亦非内伤，名叫暖病。医生察得其情由，只用轻清的药剂，微微发散，仍令徐徐撤去过浓衣被，则热证自然平息。（《小儿诸热辨》）
蛀夏
脾为坤土，喜燥恶湿。凡脾胃不足者，遇到长夏湿溽的季节，则不能升举清阳，健运中气。又值少阳相火之时，热伤元气，则身体倦怠脚弱，嗜卧发热，精神不足，食少无味，呼吸缺乏，视物模糊不清，小便赤数，大便不调，名叫蛀夏。这是禀赋阴虚，元气不足的证候。治疗用补中益气汤去掉升麻、柴胡加黄柏。如果血虚的，用补血汤；气血两虚的，用八珍汤；肝肾阴亏的，用地黄丸；大便泻的，用理中汤。孩子生病多因母亲情绪不调所致，应当戒除怒气，调节饮食，适应寒温，则可以远离疾病。（薛立斋）
夏，是火令，火旺则金亏，所以阴虚之人，多不耐夏。内热食减，肌肤消烁，像虫子蛀物一样。治法应当从古方中推求，热伤气，清暑益气汤，是扶正气以辟暑邪；火烁金，《千金方》参麦汤，是保肺金以防火烁；水不胜火，参麦地黄汤，均为对证的药物。如果不明白其道理，专治脾胃，脾胃的药多燥，燥则土旺而水愈涸，病情加重的有之。此证，东垣、薛氏都说禀赋阴虚，元气不足，令其在平时预服地黄丸，以杜绝来年的病患，那就好了。（《小儿诸热辨》）
睡中切牙
小儿醒睡时，不时切牙及咬乳头，虽然多属惊风，然而所致各有不同。如果发热饮水啼哭的，是心经实热，宜用泻心汤；如果睡困惊悸，合目而卧的，是心经虚热，宜用导赤散；如果面青眼斜，项强烦闷的，是肝经实热，宜用柴胡清肝散；如果手循衣领，及乱捻物的，是肝经虚热；如果发搐目青面赤的，是肝经风热，都宜用地黄丸。（《张氏医通》）
梦中切牙，是风热。由手、足阳明二经积热生风，所以令牙齿相击而有声。必定在梦中的，是因为风属阳，动则风行于阳，静则风归于里。○切牙一证，只有痘疹见此为危候，其余则都没有大害。也有因病战栗，鼓颌而斗牙的，治疗其本证，则自然停止。（《幼幼集成》）
滞颐
滞颐的病，是小儿多涎，流出浸渍于腮颊之间。涎是脾之液，脾气虚冷，所以涎自流，不能收摄控制。（《巢氏病源》）
按《内经》说：舌纵涎下，皆属于热。而此专属脾冷，也是偏见。张涣处冷、热各二方，算是得当。然而以流出为冷，不流出为热，恐怕也不确切。（《证治准绳》）
百日嗽
凡是吃奶的一百天内有痰嗽的，叫做百日嗽。或者出胎暴受风寒，或者洗澡时被风所袭，或者换洗襁褓衣裳，或者抱出喂奶，而风寒得以乘虚而入，此病由外来者。或者乳汁过多，吞咽不及而呛咳的，或者啼哭未定，就以乳哺喂，气逆而嗽的，此病由于内生者，都能引起咳嗽。只是汗、下之剂，难以轻用，因为其胃气方生，不能胜药，所以说难医。我治疗此证很多，先用荆防败毒散两小剂，母子同服；更令乳母忌口，以清净其乳汁，即使咳嗽至重，不过十天自愈。（《幼幼集成》）
汗
小儿元气未充，腠理不密，所以极易出汗。故凡饮食过热，衣被过暖，都能致汗。李东垣诸公说：这是小儿常事，不必治疗。然而汗的根本，由于营气；汗的启闭，由于卫气。小儿多汗，终归是卫虚不固。汗出既多，未免营卫血气有所亏损，而衰弱的迹象，未必不由乎此，不可不治疗。法当以益气为主，只要使阳气外固，则阴液内藏，而汗自然停止。（张景岳）
虚羸
小儿虚羸，因为脾胃不和，不能乳食，所以使肌肤瘦弱，或者病后脾虚，不能运化谷气所致。虚而寒的，时时下利，唇口淡白；虚而热的，身体壮热，肌肉微黄。更应当审察形色，察见证候。如面赤多啼，是心虚；面青眼斜，是肝虚；耳前后或耳下结核，是肝经虚火；颈间肉里结核，是食积虚热；面黄痞满，是脾虚；面白气喘，是肺虚；目睛多白，是肾虚。仍参考五行相胜理论治疗。（《张氏医通》）
病后喑
小儿吐泻及大病后，虽有声但不能言语，这不是失音，是因为肾怯不能上接于阳的缘故。用地黄丸主治。（钱仲阳）
痫病发作缓解后不能言语的，心的声音为言，开窍于口，其痫病发作虽止，风冷之气，仍滞留心的络脉，使心气不和，其声不发，所以不能言语。（《巢氏病源》）
小儿惊风并退，只是声哑不能言语，用天南星炮制为末，每次服一字，猪胆汁调下，便能言语。（《证治准绳》）
溢乳
小儿吐乳，虽然有寒热之不同，然而寒者多而热者少，虚者多而实者少，总由胃弱所致。只要察其形色脉证，则虚实、寒热，自有可辨。热的宜加微清；寒的必须温补。乳子的药不必多用，只要择其要者二、三、四味，可尽其妙，如参姜饮、异功散之类。如果孩子小乳汁多，满而溢出，也是常事，乳汁行则止，不必治疗。（张景岳）
小儿呕吐，有寒、有热、有伤食，其病总属于胃。又有溢乳、哺露、呕哕，更有寒热拒格之证，又有虫痛而吐的，都应当详查其证而治之。凡治小儿呕吐，先宜节制其乳食；呕吐多渴，不可给水，水入复吐，终不能止。必须强忍一、二小时，而后以米汤与之，吐自然停止。○初起哺露，即当调治。如哺露不已即成吐，吐不已即成呕，呕不已即成哕，胃气虚，精神脱矣。○凡呕吐不纳药的，最难治疗。盖药入即吐，安能有功，不可强灌，胃口愈吐愈翻。我治疗此症颇多，先将姜汤和土，做成两个泥丸，塞其两鼻，使之不闻药气，然后用对证的药，煎好斟出。冷热适中，只服一口，停半小时，再服一口，又停片刻，则任服不吐了。愚人不知，明见其吐药不纳，偏强灌之，则一吐倾囊，又何药力之可恃乎？此法不但儿科，内科也应当知晓。（《幼幼集成》）
吐泻
小儿吐泻，虚寒者占八九，实热者十中一二。只要察其脉证无火，面色青白，气息平缓，肢体清凉，或神气疲倦，则全是虚寒，不得妄用凉药。古话说：脾虚则呕，胃虚则吐。盖饮食入胃，不能运化而吐的，这是脾气虚弱，所以不运。寒凉入胃，恶心而吐的，这是中焦阳气受伤，所以不化。若邪在中焦，则止呕吐；连及下焦，则并为泻。所以在中、上二焦者，宜治脾胃；连及下焦者，宜调脾肾。如果不是实热火邪，而妄用寒凉消伐的，没有不死的。○小儿吐泻并作的，本属内伤，然而有因寒气外入，内犯脏气而然的；有因生冷不慎，致伤胃气而然的；有因中气本弱，饮食失宜而然的。邪伤阳分则为吐；邪伤阴分则为泻；若吐泻并作，则阴阳俱伤。察其有滞、无滞，辨其虚、实而治之。（张景岳）
长夏暑湿当令，脾土受病，暴感时行之气，多有发热吐泻的。吐泻，是里证；发热，是表证；口渴心烦，是表里俱病。黄连香薷饮是对证的药物，一服可平，再服可愈。庸俗不明此理，例用疏散消食通套之方，药病不合，徒伤正气。吐泻不止，精神已困，额热指冷，目陷神脱，虽名暑风，实与慢惊同类。更医有见其额热口渴，暑证犹在，而用黄连的；有见其发热指冷，表证犹在，而用香薷的。不知吐泻大作，胃气暴伤，治法与初病不同。初病正气未伤，可服黄连香薷饮，故一服而效。及待胃气既伤而始用，是用于不可用之时也。长夏秋初，小儿
At 260 days after birth, the knee bones of infants mature, enabling them to walk; this is the normal physiological timeline. If a child cannot walk at several years of age, it is due to insufficient congenital Kidney Yuan Qi (Kidney primordial energy). Bones belong to the Kidney and are nourished by Marrow. When Kidney Qi is deficient, it cannot fill the Marrow and bones, resulting in weak legs and an inability to walk. Others may live in deep curtains, exposed to neither wind nor sunlight, or be held all day long, causing their sinews and bones to remain unrelaxed, thus making walking difficult. Still others may suffer from multiple illnesses after weaning, leading to deficiency in both Liver and Kidney; Liver deficiency causes weak sinews, while Kidney deficiency causes soft bones, preventing walking. Overconsumption of rich and sweet foods can damage the Spleen and Stomach, leading to Infantile Malnutrition Syndrome (Gan syndrome), where Qi and Blood become increasingly exhausted, also preventing walking. With symptom-based regulation and treatment, recovery is possible. (Feng Chuzhan)
If a child has thick flesh on the head, face, chest, and back, but thin arms and calves, with delayed walking, it is caused by being carried excessively during infancy. (*Luxin Jing*)
Five Softnesses and Five Stiffnesses
The "Five Softnesses" refer to weakness in the hands, feet, waist, back, and neck. The "Five Stiffnesses" refer to stiffness in the hands, feet, waist, back, and neck. The "Five Coldnesses" refer to coldness in the hands, feet, Qi Sea (lower abdomen), lips, and face. The "Five Contractures" refer to contraction of the hands, feet, tongue, lips, and genitals. The "Five Reversions" refer to opisthotonos or retroflexion of the eyes, lips, tongue, neck, and feet. The "Five Tightnesses" refer to tightness of the throat, lips, eyes, hands and feet, and scrotum. The "Five Depressions" refer to depression of the fontanelle, Taiyang acupoints, eye sockets, lower chest, and Jianjing acupoint. The "Five Swellings" refer to swelling of the palms, Renzhong point, tongue, penis, and knees/shins. The "Five Pantings" refer to panting caused by smallpox, convulsions, vomiting, diarrhea, or dysentery. The "Five Blindnesses" refer to blindness caused by prolonged smallpox, convulsions, malnutrition, diarrhea, or dysentery. Regardless of the underlying disease, these are all ominous signs. (*Feng Shi Jin Nang*)
Head weakness occurs because the Kidney governs bones; weakness of the Tianzhu bone (cervical spine) indicates deficiency in the organs, bones, and vessels, insufficiency of Yang Qi, and deficiency of the Foot Shaoyin and Foot Taiyang meridians. Hand and foot weakness occur because the Spleen governs the four limbs; insufficiency of Middle Jiao Qi fails to nourish the limbs, resulting in little muscle and loose skin, where food intake does not translate into flesh. Mouth/lip weakness occurs because the mouth is the orifice of the Spleen, and the upper and lower gums belong to the Hand and Foot Yangming meridians, which govern the Stomach; Spleen-Stomach Qi deficiency prevents the tongue from being retained, causing it to protrude constantly. The Heart governs Blood, the Liver governs Sinews, the Spleen governs Flesh, the Lung governs Qi, and the Kidney governs Bones. These five aspects are all due to weak congenital Qi of the Zang organs, failing to nourish and reach the extremities, leading to weak bones/vessels and flaccid limbs. However, the key lies in the Stomach. The Stomach is the Sea of Water and Grain, the root of the Five Zang, and the great source of the Six Fu. Treatment must prioritize the Spleen and Stomach, using Buzhong Yiqi Tang (Spleen-Raising Qi-Boosting Decoction) to nourish the source of transformation, combined with Dihuang Wan (Rehmannia Pill). Breastfeeding by a healthy young wet nurse often leads to full recovery. (Xue Lizhai)
Five Stiffnesses present as upward gaze with inhalation, difficulty moving, Qi stagnation causing pain radiating to the chest and diaphragm, and cold, stiff limbs. This indicates Yang Qi failing to circulate to the four extremities. The Classics state: "The Spleen governs the four limbs" and "The Spleen governs all Yin." Now, cold and stiff hands and feet indicate pure Yin without Yang. This condition arises from pathology in the Liver and Spleen; treatment should tonify the Spleen and soothe the Liver. (*Zhengzhi Zhunsheng*)
Jie Lu (Split Skull), Cranial Distension, Fontanelle Depression, and Fontanelle Bulging
Infants may suffer from Jie Lu (split skull), unclosed fontanelle, or depressed fontanelle; these three conditions are largely similar with minor differences. Jie Lu refers to an older infant whose fontanelle should have closed but remains open, with splitting of the skull sutures. Since the Kidney governs bones and the brain is the Sea of Marrow, insufficient Kidney Qi leads to an inadequate Sea of Marrow, causing the bone sutures to split. Unclosed or depressed fontanelles, although caused by heat in the Zang organs rushing upward, fundamentally stem from insufficient Kidney Qi. (*Wan Quan Fang*)
The Kidney governs bones; when Bone Qi is solid, the brain marrow is full, and the fontanelle closes early. When Kidney Qi is timid/weak, brain marrow is empty, and the fontanelle remains unclosed. This results from insufficient essence and blood of the parents; Dihuang Wan (Rehmannia Pill) should be used for tonification. If the infant is still breastfeeding, the mother should also be treated. Additionally, the head should be tightly bound with soft cloth to facilitate closure. Fontanelle bulging and depression are also due to congenital Kidney Qi insufficiency and improper feeding damaging the Spleen and Stomach. The Spleen governs flesh; rebellious Qi rushing upward causes bulging; sinking of Primordial Qi causes depression. Both are treated with Buzhong Yiqi Tang (Spleen-Raising Qi-Boosting Decoction) and Dihuang Wan (Rehmannia Pill), and applying powdered roasted dog skull mixed with egg white to the fontanelle. Cases following diarrhea where Qi and Blood are deficient and fail to ascend upward are also treated similarly. If hands and feet are cold and previous decoctions fail, this indicates extreme deficiency-cold; Aconite (Fuzi) must be added urgently, otherwise it will be untreatable. (Xue Lizhai)
Cranial distension differs from fontanelle bulging: Fontanelle bulging involves a protruding fontanelle, belonging to excessive Fire in the Heart channel; Qian Yi used Xiexin Tang (Drain Heart Decoction). Cranial distension features shiny, tight scalp and enlarged frontal angles, caused by deficient Heat from the Liver and Kidney rushing upward; it is treated with a heavy dose of Dihuang Tang (Rehmannia Decoction) to suppress it. ○ Unclosed fontanelle with separated skull bones is called Jie Lu. The child has a pale complexion, white sclerae, and large pupils; this is due to congenital insufficiency. Treatment requires dual tonification of Yin and Yang, using Liuwei Tang (Six-Ingredient Decoction) plus Deer Antler (Lurong) and Turtle Shell (Guiban). (Xu Xuanzhi)
Tortoise Back and Tortoise Chest
Tortoise Back is caused by Wind pathogens invading the spine and penetrating the bone marrow after birth; treatment uses Xiao Xuming Tang (Minor Continuation of Life Decoction) minus Fuzi (Aconite) plus Fangfeng (Saposhnikovia). Tortoise Chest is caused by Wind-Heat attacking the lungs and invading the chest/diaphragm; treatment uses Guixiong Wan (Tortoise Chest Pill) and applying turtle urine to the joints, often resulting in cure. For those with congenital Liver-Kidney deficient Heat, use Liuwei Wan (Six-Ingredient Pill); for Kidney Qi insufficiency, use Bawei Wan (Eight-Ingredient Pill); add Lurong (Deer Antler) for the back and Guiban (Turtle Shell) for the chest. Early treatment is crucial; delay renders it ineffective. (*Zhangshi Yitong*)
My commentary: Tortoise Chest is treatable, but Tortoise Back is considered incurable. Previous discussions on treatment were imperfect. Although they attribute it to external Wind entering the bone, early sitting causing strain, or chronic cough lung deficiency, they failed to identify the root cause, speaking only of symptoms. I have seen children with strong congenital Yuan Qi sit naked in the wind and dew; after six months, sitting in barriers, never hearing of Wind entering the bone or early sitting causing Tortoise Back. This condition is mostly due to insufficient essence/blood from parents and loss of Mingmen (Gate of Life) Yang. Observe that Tortoise Back manifests between the Mingmen area, with gradually exposed vertebrae and an arched waist, truly due to bone flaccidity unable to support the body, not Wind pathogens. Previous authors forcibly created Songrui Dan, using Mahuang (Ephedra), Dahuang (Rhubarb), Duhuo (Angelica Pubescens), and Fangfeng (Saposhnikovia)—a batch of attacking drugs—which merely accelerates death. One should use Liuwei Wan plus Rougui (Cinnamon Bark) and Lurong (Deer Antler) to rescue the Congenital aspect, then use Liujunzi Tang (Six-Gentlemen Decoction) etc. to support Stomach Qi; perhaps one in ten cases can be saved. (Chen Feixia)
Crane Joint
When infant muscles are thin and joints protrude, resembling a crane's knee, it is due to insufficient congenital essence/marrow. Urgently treat with Liuwei Wan (Six-Ingredient Pill) plus Lurong (Deer Antler) and Niuxi (Achyranthes). Delay will result in permanent disability. (*Ciyou Fa*)
Tian Zhu Bone Collapse
Infants with Tian Zhu Bone Collapse may appear fat and robust, not emaciated. However, excessive external fatness implies internal weakness—abundant externally but deficient internally. ○ After prolonged illness or chronic diarrhea, sudden tilting of the neck is a critical sign; urgently rescue Yuan Qi with Shiquan Dabu Tang (Perfect Fourteen-Ingredient Tonifying Decoction) plus Lurong (Deer Antler). ○ Infants born with soft necks have insufficient fetal Qi, stemming from the father's deficient Kidney Yuan; strongly tonify the Congenital aspect. Use Bushen Dihuang Wan (Kidney-Tonifying Rehmannia Pill) and Liujunzi Tang (Six-Gentlemen Decoction) alternately. ○ Tian Zhu Bone Collapse generally signifies severe failure of True Yang, an ominous pediatric condition; preserving Yuan Qi is paramount. Apply Shengjin San (Generate Tendons Powder) externally. (*Youyou Jicheng*)
Bulu (Nursing Deficiency/Spiritual Drain)
The symptoms are slight diarrhea, alternating chills and fever, coarse hair, and melancholy. *Qianjin Fang* states: Bulu is a "ghost disease" of infants. When the son cannot yet walk and the mother is pregnant again, the child becomes emaciated, skeletal, and hair-thin; this is Bulu disease. First use Zishuang Wan (Purple Frost Pill) to purge accumulated milk/stagnation, then use Yihuang San (Yellow-Protecting Powder) to tonify. Weaning brings relief. I argue that maternal nursing involves emotional connection; when pregnant, vital Qi flows to the fetus, so nursing offers no benefit. *Huainanzi* states: A man cultivating orchids produces flowers that are beautiful but unscented; a Bulu child receiving milk becomes withered and dull. This is profound truth. Ghost theories are unfounded; immediate weaning is correct. (*Yitang Sanji*)
After birth, if the mother becomes pregnant again, causing the child's spirit to be unclear and body to wither, it is named Bulu disease. Burn Futyi (bat) to ash, grind finely, and administer half a qian with rice water, 4-5 times daily; or roast until fragrant, chew warm, and feed to the child; this is also effective. Futyi is the bat. (*Shenghui Fang*)
Nuan Bing (Warmth Disease)
The proverb says: To keep an infant safe, maintain one-third hunger and cold. Infants are Pure Yang bodies, intolerant of suppression. In wealthy homes, red stoves and sealed rooms, layered curtains and heavy quilts brew disease. If the mother neglects sleep, covering the head traps Qi. Being held wrapped in heavy cotton steams with the mother's body heat, causing fever, red face, irritability, and crying. This is neither exterior invasion nor interior injury; it is called Nuan Bing. Physicians recognizing the cause should use light, clear herbs to gently disperse, and slowly remove heavy clothing/quilts; the heat will subside naturally. (*Xiao'er Zhure Bian*)
Zhu Xia (Summerworm Summer)
The Spleen is Kun Earth, preferring dryness and hating dampness. Those with Spleen-Stomach insufficiency, encountering the humid Longxia (late summer) season, cannot raise Clear Yang or fortify Middle Qi. During the time of Shaoyang Ministerial Fire, Heat damages Yuan Qi, causing lethargy, weak legs,嗜卧 (desire to lie down), fever, mental fatigue, poor appetite, shallow breathing, blurred vision, dark frequent urination, and irregular bowels; this is Zhu Xia. It is a pattern of congenital Yin deficiency and insufficient Yuan Qi. Treat with Buzhong Tang (Middle-Raising Decoction) removing Shengma and Chaihu, adding Huangbai (Phellodendron). For Blood deficiency, use Buxue Tang (Tonify Blood Decoction); for Qi-Blood dual deficiency, use Bazhen Tang (Eight-Treasure Decoction); for Liver-Kidney Yin deficiency, use Dihuang Wan (Rehmannia Pill); for diarrhea, use Lizhong Tang (Regulate Middle Decoction). Children's illnesses often stem from maternal emotional imbalance; avoid anger, regulate diet, and adapt to temperature changes to prevent disease. (Xue Lizhai)
Summer is the Fire season; when Fire is prosperous, Metal is depleted. Thus, Yin-deficient individuals cannot endure summer. Internal heat and reduced food intake cause emaciation, like insects devouring objects. Treatment should derive from ancient formulas: Heat damaging Qi calls for Qingshu Yiqi Tang (Clear Summerheat Boost Qi Decoction) to support Righteous Qi against Summerheat Evil; Fire scorching Metal calls for *Qianjin* Shenmai Tang (Ginseng-Ophiopogon Decoction) to protect Lung Metal; Water unable to overcome Fire calls for Shenmai Dihuang Tang (Ginseng-Ophiopogon-Rehmannia Decoction). All are appropriate. Without understanding the principle, focusing solely on the Spleen/Stomach uses drying herbs; dryness strengthens Earth but depletes Water further, worsening the disease. Dongyuan and Xue stated this is congenital Yin deficiency and insufficient Yuan Qi; taking Dihuang Wan (Rehmannia Pill) prophylactically prevents future issues. (*Xiao'er Zhure Bian*)
Teeth Grinding in Sleep
Infants grinding teeth or biting nipples during wakefulness/sleep are often attributed to fright, but causes vary. Fever, thirst, and crying indicate Excess Heat in the Heart; use Xiexin Tang (Drain Heart Decoction). Sleepiness, palpitations, and sleeping with eyes closed indicate Deficient Heat in the Heart; use Daochi San (Guide Out Red Powder). Green face, crossed eyes, neck stiffness, and irritability indicate Excess Heat in the Liver; use Chaihu Qinggan San (Bupleurum Clear Liver Powder). Grasping clothes and fumbling objects indicate Deficient Heat in the Liver. Convulsions, green eyes, and red face indicate Wind-Heat in the Liver; use Liuwei Wan (Six-Ingredient Pill) for all. (*Zhangshi Yitong*)
Teeth grinding in dreams is Wind-Heat. Accumulated Heat in the Hand/Foot Yangming meridients generates Wind, causing teeth to strike. It occurs in dreams because Wind is Yang; movement allows Wind to act in Yang, stillness returns it to the interior. ○ Teeth grinding is critical only in the context of variola (smallpox); otherwise, it is harmless. It may also occur due to shivering/chattering from other diseases; treating the root cause stops it. (*Youyou Jicheng*)
Zhi Yi (Drooling)
Zhi Yi is excessive saliva flowing onto the cheeks. Saliva is the fluid of the Spleen; Spleen Qi deficiency and cold cause free-flowing saliva that cannot be controlled. (*Chaoshi Bingyuan*)
According to *Neijing*: Tongue deviation and drooling belong to Heat. Attributing this solely to Spleen Cold is biased. Zhang Huan provided two formulas for Cold and two for Heat, which is appropriate. However, assuming flowing saliva is Cold and non-flowing is Heat is likely inaccurate. (*Zhengzhi Zhunsheng*)
Ba Ri Sou (Hundred-Day Cough)
Phlegm-cough within the first hundred days of nursing is called Ba Ri Sou. It may arise from sudden Wind-Cold exposure at birth, bathing, changing swaddling clothes, or being held out for feeding, allowing Wind-Cold to invade (external cause). Or, it may result from overfeeding causing choking, or feeding while crying causing Qi rebellion (internal cause). Both cause cough. Sweat-inducing and purgative agents are hard to use lightly because the Stomach Qi is newly formed and cannot tolerate strong medicine; hence, it is difficult to treat. I treat many such cases by administering two small doses of Jingfang Baidu San (Aster and Saposhnikovia Detoxifying Powder) to both mother and child; the nursing mother avoids certain foods to purify her milk. Even severe cough resolves within ten days. (*Youyou Jicheng*)
Sweating
Infant Yuan Qi is incomplete, and pores are not dense, making sweating easy. Hot food/drinks and warm clothing induce sweating. Li Dongyuan et al. say this is normal and needs no treatment. However, the root of sweat is Ying Qi (Nutritive Qi); its opening/closing is governed by Wei Qi (Defensive Qi). Infantile hyperhidrosis is ultimately Wei Qi deficiency failing to secure. Profuse sweating damages Ying/Wei and Blood/Qi, leading to gradual emaciation; it must be treated. Method: Prioritize boosting Qi. Securing Yang externally stores Yin internally, stopping sweat naturally. (Zhang Jingyue)
Xu Lei (Emaciation)
Infantile emaciation stems from Spleen-Stomach disharmony, inability to digest milk/food, leading to thin skin/flesh, or post-illness Spleen deficiency failing to transform grain Qi. Deficiency-Cold presents with frequent diarrhea and pale lips/mouth; Deficiency-Heat presents with high fever and slightly yellow muscle. Examine form and color: Red face and frequent crying indicate Heart deficiency; green face and crossed eyes indicate Liver deficiency; lumps behind/in front of ears indicate Liver Deficient Fire; lumps in neck flesh indicate Food Stagnation Deficient Heat; yellow face and distension indicate Spleen deficiency; pale face and asthma indicate Lung deficiency; white sclerae indicate Kidney deficiency. Treat according to the theory of mutual overcoming. (*Zhangshi Yitong*)
Post-Illness Aphonia
After vomiting/diarrhea or major illness, if the child has voice but cannot speak, it is not aphonia, but Kidney timidity failing to connect upward to Yang. Treat with Dihuang Wan (Rehmannia Pill). (Qian Zhongyang)
After epilepsy remission, inability to speak occurs because the Heart's sound is speech, opening via the mouth. Although seizures stop, Wind-Cold lingers in Heart collaterals, disrupting Heart Qi and preventing sound emission. (*Chaoshi Bingyuan*)
After convulsions subside, if the child is hoarse/unable to speak, use processed Tian Nan Xing (Arisaema) powder, one zi dose, mixed with pig bile, restoring speech. (*Zhengzhi Zhunsheng*)
Yi Ru (Spitting Milk)
Infant spitting milk varies in Cold/Heat, but Cold is more common than Heat, and Deficiency is more common than Excess; it generally stems from weak Stomach. Examine form, pulse, and symptoms to distinguish. Heat requires mild clearing; Cold requires warming tonification. Medications for nursing infants need not be complex; select 2-4 key herbs, such as Shenyin (Ginger-Ginseng Drink) or Yigong San (Extraordinary Power Powder). If the infant is small and milk volume exceeds capacity, overflow is normal and stops when milk flows; no treatment needed. (Zhang Jingyue)
Infant vomiting includes Cold, Heat, and Food Injury, all relating to the Stomach. There are also spitting milk, Bulu, retching, Cold-Heat rejection, and worm-pain vomiting. Treat based on detailed symptoms. First, regulate milk/food intake. If vomiting causes thirst, do not give water immediately, as it triggers more vomiting. Force the child to wait 1-2 hours, then offer rice water; vomiting stops. ○ Early Bulu requires immediate treatment. Untreated, Bulu becomes vomiting, vomiting becomes retching, retching becomes hiccupping; Stomach Qi becomes deficient, Spirit dissipates. ○ Vomiting that rejects medication is hardest to treat. Medicine induces vomiting, losing efficacy. Do not force-feed. I treat this by mixing ginger juice with earth into two clay pills, plugging nostrils to block smell, then administering appropriate decoction. Serve lukewarm, one sip, pause 30 mins, another sip, pause briefly; then the child can take it without vomiting. Fools force-feed, causing total expulsion. This method applies to Pediatrics and Internal Medicine alike. (*Youyou Jicheng*)
Vomiting and Diarrhea
Infant vomiting/diarrhea is 80-90% Deficiency-Cold, 10-20% Excess-Heat. If pulse/symptoms show no Fire, pale/blue-white face, calm breath, cool limbs, or fatigue, it is entirely Deficiency-Cold; do not use cooling herbs. Ancient texts say: Spleen deficiency causes retching, Stomach deficiency causes vomiting. Food entering the Stomach not transforming and vomiting indicates Spleen Qi deficiency failing to transport. Cold/Cool herbs entering the Stomach causing nausea/vomiting indicate Middle Jiao Yang Qi injury failing to transform. Pathogens in Middle Jiao cause vomiting; spreading to Lower Jiao causes diarrhea. Thus, Middle/Upper Jiao issues treat Spleen/Stomach; Lower Jiao involvement treats Spleen/Kidney. Using cold/purgative herbs without Excess-Heat Fire is fatal. ○ Simultaneous vomiting/diarrhea is primarily Interior Injury, but may stem from external Cold invading organs, careless raw/cold food damaging Stomach Qi, or weak Middle Qi with improper diet. Pathogens injuring Yang cause vomiting; injuring Yin cause diarrhea; both injure Yin and Yang. Check for stagnation vs. none, and Deficiency vs. Excess, then treat. (Zhang Jingyue)
During Longxia, Summerheat-Damp dominates, Spleen Earth is affected, and epidemic Qi causes fever/vomiting/diarrhea. Vomiting/diarrhea is Interior syndrome; fever is Exterior syndrome; thirst/irritability indicates Exterior-Interior involvement. Huanglian Xiangru Yin (Coptis and Elsholtzia Decoction) is appropriate; one dose calms, two cure. Ignorant physicians use standard dispersing/digestive formulas, mismatching medicine and disease, damaging Righteous Qi. Persistent vomiting/diarrhea with exhaustion, hot forehead/cold fingers, sunken eyes, and dissipated Spirit resembles Slow Convulsion (Man Jing). Some doctors see hot forehead/thirst and use Huanglian (Coptis); others see fever/cold fingers and use Xiangru (Elsholtzia). They do not realize that massive vomiting/diarrhea violently injures Stomach Qi, requiring different treatment than initial illness. Initially, Righteous Qi is intact, so Huanglian Xiangru Yin works. Using it after Stomach Qi is injured is using medicine at the wrong time. In late summer/early autumn, infants...