小儿发热,有表里虚实之异。何谓表热?外感寒邪,脉浮紧,苔微白,头疼,发热,身
痛,
无汗,恶风,恶寒者是也;何谓里热?小儿肥甘过度,致生内热,面赤,唇焦舌燥,小溲赤
涩,脉实有力者是也;何谓虚热?小儿气质虚弱,营卫不和,其证神倦气乏,又有阴盛格阳
,外浮发热者,其面色虽赤,烦躁不宁,然小溲必清白,四肢必厥逆,方为真寒假热;何谓
实热?小儿午后潮热,蒸蒸有汗,肚腹胀满,面唇红赤,口舌干燥,溲赤,便难,烦渴不止
,啼哭不已,脉洪数有力者是也。辨证确,则施治不难矣。
胎热 儿生旬日间,目赤,身热,溲黄,啼哭,惊烦,由母受胎后,过食五辛,以致热
蕴于
内,熏蒸胎气而生,名曰胎热。久则有鹅口、重舌、木舌、赤紫丹瘤等证,不可不予防也。
分阴阳,(二百遍。)推三关,(一百遍。)退六腑,(一百遍。)推三焦,(三十六遍。)
清天河水,(五十遍。)揉外劳宫,(一百遍。)运内八卦,(一百遍,自坤至坎,宜多二次。)
掐肾水,(三十六遍。)掐十王穴,(三十六遍。)运斗肘,(三十六遍。)水底捞明月。(三十
六遍。)凡推用葱水。 法, 虎口曲池,(见卷二,三十页。)
惊热 小儿见异物则惧,或闻声而心骇,心既受凉,气则不顺,身发微热,梦寐不安,
脉数烦躁,与急惊相似。
分阴阳,(二百遍。)推三关,(一百遍。)退六腑,(一百遍。)清心经,(一百遍。)推二
扇门,
(一百遍。)推肺经,(一百遍。)掐中指巅,(五十遍。)掐合谷,(五十遍。)掐总经,(五十
遍。)清天河水,(三十六遍。)掐揉威灵,(五十遍。)运斗肘,(五十遍。)捞明月。(三十六
遍。)凡推用葱汤。
疳热 小儿食积于中,郁久生热,自脾经失治,传之各脏,致成五疳之疾,若脾病去则
余脏皆安矣。
分阴阳,(二百遍。)推三关,(一百遍。)退六腑,(一百遍。)推补脾土,(二百遍。)天
门入
虎口,(一百遍。)推大小肠,(一百遍。)运内八卦,(一百遍。)掐揉总经,(五十遍。)运斗
肘,(五十遍。)摩运肚脐左右旋转,(各二、三百遍。)分胸腹阴阳。(二百遍。)凡推用葱姜
水。
按∶诸病属热者多。病机十九条,大半皆言热,此热证所宜辨也。其中真热假寒,真寒
假热
,一经差误,生死攸关。然必辨之于平时,而施之于当境。庸工不读书,不辨证,即至病者
就诊,既无主见,有何把握,随意疏方,草菅人命,良可慨也。噫!病者不死于病而死于
医,并不死于医而死于病家之延医者。(惕厉子)
小儿发热,有表热、里热、虚热、实热的区别。什么是表热?外感寒邪,脉象浮紧,舌苔微白,头痛,发热,身体疼痛,无汗,怕风,怕冷,这就是表热;什么是里热?小儿饮食肥甘厚味过度,导致体内产生内热,面色红赤,嘴唇干焦,舌头干燥,小便短赤涩痛,脉象实而有力,这就是里热;什么是虚热?小儿体质虚弱,营卫不和,症状表现为精神疲倦、气力不足,又有阴盛格阳(阴寒内盛,逼迫阳气浮越于外),体表出现发热,虽然面色红赤,烦躁不安,但小便必定清长色白,四肢必定厥冷逆寒,这才是真寒假热;什么是实热?小儿午后定时发热如潮水般起伏,蒸蒸发热且有汗,腹部胀满,面唇红赤,口舌干燥,小便黄赤,大便困难,烦渴不止,啼哭不停,脉象洪大数急且有力,这就是实热。辨证准确了,施治就不难了。
胎热:婴儿出生十几天内,眼睛红赤,身体发热,小便黄,啼哭,惊恐烦躁,这是由于母亲在怀孕期间,过食五辛(葱、蒜、韭、薤、兴渠等五种辛辣食物),导致热蕴积在内,熏蒸胎气而生,名叫胎热。时间久了会有鹅口疮、重舌、木舌、赤紫丹瘤等病症,不可不预先防范。
推拿手法:分阴阳(二百遍)。推三关(一百遍)。退六腑(一百遍)。推三焦(三十六遍)。清天河水(五十遍)。揉外劳宫(一百遍)。运内八卦(一百遍,从坤位推至坎位,宜多推两次)。掐肾水(三十六遍)。掐十王穴(三十六遍)。运斗肘(三十六遍)。水底捞明月(三十六遍)。凡是推拿都用葱水。方法:虎口曲池(见卷二,三十页)。
惊热:小儿见到异物就恐惧,或听到声音就心惊,心既受惊吓受凉,气机就不顺畅,身体发出微热,睡眠不安稳,脉数且烦躁,与急惊风相似。
推拿手法:分阴阳(二百遍)。推三关(一百遍)。退六腑(一百遍)。清心经(一百遍)。推二扇门(一百遍)。推肺经(一百遍)。掐中指巅(五十遍)。掐合谷(五十遍)。掐总经(五十遍)。清天河水(三十六遍)。掐揉威灵(五十遍)。运斗肘(五十遍)。捞明月(三十六遍)。凡是推拿都用葱汤。
疳热:小儿饮食积滞在中焦,郁久生热,如果脾经失治,病邪传变至各脏腑,导致形成五疳之疾,如果脾病去除了,其余脏腑也就安定了。
推拿手法:分阴阳(二百遍)。推三关(一百遍)。退六腑(一百遍)。推补脾土(二百遍)。天门入虎口(一百遍)。推大小肠(一百遍)。运内八卦(一百遍)。掐揉总经(五十遍)。运斗肘(五十遍)。摩运肚脐左右旋转(各二、三百遍)。分胸腹阴阳(二百遍)。凡是推拿都用葱姜水。
按语:各种疾病属于热证的很多。《素问·至真要大论》中的病机十九条,大半都在论述热证,这就是热证应当辨析的原因。其中的真热假寒、真寒假热,一旦辨错,关乎生死。然而必须在平时就加以辨析,而在发病时才能正确施治。庸医不读书,不辨证,等到病人就诊时,既没有主见,有什么把握,随意开方,草菅人命,实在令人感慨叹息!唉!病人不是死于疾病,而是死于医生,甚至不是死于医生,而是死于病家聘请医生的不当。(惕厉子)
Pediatric fever presents with distinctions between exterior heat, interior heat, deficiency heat, and excess heat. What is exterior heat? It refers to cases where external cold pathogens invade, characterized by a floating and tight pulse, slightly white tongue coating, headache, fever, body pain, absence of sweating, aversion to wind, and aversion to cold. What is interior heat? It results from excessive consumption of rich and sweet foods by the child, leading to internal heat accumulation, manifested as a red face, dry and cracked lips, dry tongue, scanty and painful urination, and a solid and forceful pulse. What is deficiency heat? It occurs in children with weak constitutions and disharmony between Ying (Nutrient) and Wei (Defensive) Qi. Symptoms include mental fatigue and lack of energy. Additionally, there is Yin excess repelling Yang (Yin Sheng Ge Yang), where Yin-cold accumulates internally and forces Yang to float outward, causing surface fever. Although the face may be red and the child restless, the urine must be clear and copious, and the limbs must be cold and inverted; this constitutes true cold with false heat. What is excess heat? It is characterized by tidal fever in the afternoon, steaming fever with sweating, abdominal distension, red face and lips, dry mouth and tongue, dark urine, difficult defecation, incessant thirst and irritability, continuous crying, and a surging, rapid, and forceful pulse. Once the syndrome differentiation is accurate, treatment becomes straightforward.
Fetal Heat: Within ten days after birth, the infant exhibits red eyes, body fever, yellow urine, crying, and frightful restlessness. This arises because the mother consumed excessive amounts of Five Pungent Spices during pregnancy, causing heat to accumulate internally and steam the fetal Qi, named Fetal Heat. If prolonged, it may lead to conditions such as Thrush (E Kou), Double Tongue (Chong She), Wooden Tongue (Mu She), and Red-Purple Dan Liu (a type of skin lesion), which must be prevented in advance.
Massage Techniques: Divide Yin and Yang (200 repetitions). Push San Guan (100 repetitions). Retreat Liu Fu (100 repetitions). Push San Jiao (36 repetitions). Clear Tian He Shui (50 repetitions). Rub Wai Lao Gong (100 repetitions). Rotate Nei Ba Gua (100 repetitions, from Kun to Kan position, preferably two additional times). Pinch Shen Shui (36 repetitions). Pinch Shi Wang Acupoint (36 repetitions). Rotate Dou Zhou (36 repetitions). Retrieve the Bright Moon from the Bottom of the Water (36 repetitions). For all pushing techniques, use scallion water. Method: Hu Kou Qu Chi (see Volume 2, page 30).
Fright Heat: The child fears strange objects or is startled by sounds. Since the Heart is affected by fright and cold, Qi flow becomes obstructed, resulting in slight body fever, restless sleep, rapid pulse, and irritability, resembling Ji Jing Feng (Acute Convulsion).
Massage Techniques: Divide Yin and Yang (200 repetitions). Push San Guan (100 repetitions). Retreat Liu Fu (100 repetitions). Clear Xin Jing (Heart Meridian) (100 repetitions). Push Er Men Shan (100 repetitions). Push Fei Jing (Lung Meridian) (100 repetitions). Pinch the tip of the middle finger (50 repetitions). Pinch He Gu (50 repetitions). Pinch Zong Jing (50 repetitions). Clear Tian He Shui (36 repetitions). Pinch and rub Wei Ling (50 repetitions). Rotate Dou Zhou (50 repetitions). Retrieve the Bright Moon (36 repetitions). For all pushing techniques, use scallion soup.
Gan Heat: Food stagnation in the middle jiao leads to heat generation over time. If the Pi Jing (Spleen Meridian) is not treated properly, the pathogen transmits to other zang-fu organs, resulting in the five types of Gan diseases. If the Spleen pathology is resolved, the other organs will be stabilized.
Massage Techniques: Divide Yin and Yang (200 repetitions). Push San Guan (100 repetitions). Retreat Liu Fu (100 repetitions). Push and Tonify Pi Tu (Spleen Earth) (200 repetitions). Tian Men Ru Hu Kou (100 repetitions). Push Da Xiao Chang (Large and Small Intestines) (100 repetitions). Rotate Nei Ba Gua (100 repetitions). Pinch and rub Zong Jing (50 repetitions). Rotate Dou Zhou (50 repetitions). Massage and rotate the umbilicus clockwise and counterclockwise (200-300 repetitions each). Divide Chest and Abdomen Yin and Yang (200 repetitions). For all pushing techniques, use scallion and ginger water.
Commentary: Many diseases belong to the category of heat. In the Nineteen Pathogenesis Mechanisms (Bing Ji Shi Jiu Tiao) from the *Su Wen*, most clauses discuss heat, which is why heat syndromes require careful differentiation. True heat with false cold, and true cold with false heat, if misdiagnosed, can be fatal. However, differentiation must be established during normal times so that appropriate treatment can be applied when the condition arises. Incompetent physicians who do not study classics or differentiate syndromes lack judgment and assurance when treating patients, prescribing arbitrarily and disregarding human life, which is truly lamentable. Alas! Patients do not die from their disease, but from their doctors; or rather, they do not even die from their doctors, but from the improper selection of doctors by the patient's family. (Ti Li Zi)