仲阳云∶壮热者，一向热而不已，甚则发惊痫也。温壮者，但温而不热也。巢氏云∶小儿壮热者，是热气盛熏发于
外，故令身体壮然。其发于渐，大体与温热相似，少有异者，热加甚也。此候宜服轻药，惺惺散羌活散皆可，甚则黄芩、
柴胡、干葛、之剂散之。夫温壮者，由小儿脏腑不调，内有伏热，或挟宿寒，皆抟于胃气，故令不和，气行壅涩故积体
热，名曰温壮。大便黄而臭者，内有伏热、其大便白而臭酸者，则挟宿寒故也，宜温之，服理中、四君子辈加桂治之。
伏热宜五苓散、并白虎汤，二药俱效。其腹中有伏热温壮，柴苓散主之。其心神不安，大腑秘热，二黄犀角散主之。温
壮常热不止，牛黄散主之。凡解后余热不退，可服地骨皮散、黄龙汤、牛黄膏。亦治壮热。直指羚羊角汤治诸惊壮热。
治下后热不退，身壮热百骨节疼，栀子仁汤、大连翘饮、六物黄芩汤、五物人参饮、对症选用之。古法去伏热则用龙胆
汤，去宿滞则用紫霜丸，当效其法而治之。圣济经用升麻芍药等剂治之。
理中汤 见第五十三问。
四君子汤 见第十六问。
五苓散 见第五十二问。
白虎汤 治伤寒大汗出，表症已解，心胸大烦，渴欲饮水。及吐或下后七八日、邪毒不解，热结在里，表里俱
热，时时恶风，大渴、舌上干燥而烦，欲饮数升者宜服。又治夏月中暑、汗出，恶热，身热而渴。
知母（三两） 甘草（一两炙） 石膏（八两、另研） 粳米（二合）
上 咀，每服三钱，水一盏，煎六分，米熟为度，去滓温服。圣惠方加干葛。
柴苓散 治小儿腹中有伏热，温壮未去。
柴胡（七钱半、去苗） 麦门冬（去心） 人参 赤茯苓 甘草（各半两） 黄芩（一两）
上锉散，每服二钱，水一盏，入小麦一撮，竹叶一片，煎五分，去滓温服，量大小加减与之。
三黄犀角散 治小儿身体温壮，心神不安，大腑秘热。
犀角屑 大黄（酒浸、蒸） 钩藤 栀子仁 甘草 黄芩（各五钱）
上为末，每服五分，量大小加减，热汤调下。
牛黄散 治小儿温壮，身体常热不止。
牛黄（研） 甘草（各五分） 柴胡（去苗） 栀子（炒） 龙胆草 黄芩（各二钱半）
上为末，每服五分，以金银汤调下无时。
地骨皮散 见第五十七问。
黄龙汤 治伤寒身热不退。
柴胡（五钱） 黄芩 甘草（各二钱） 赤芍药（三钱）
上 咀，每服二钱，姜一片，枣一枚，水一盏，煎至五分，去滓温服无时。
牛黄膏 治小儿天吊惊风，手足搐搦，面唇红赤，咽喉痰响，浑身头额壮热，唤问不知，不醒人事。或只左手
右脚偏搐，或只右手左脚偏搐，或只唇口眼鼻颤搐。此疾多则腹肚紧胀，热极，胸膈久积惊涎，忽被风邪所触，故作此
候也。此患大忌，不得针灸，若针灸乃误矣，凡中此疾，须辨认有前项形证，宜急服此剂。
蝎尾（四十九枚） 巴豆（去壳、一枚半、不去油） 梅花脑（半字） 辰砂（研、二钱） 郁金（三钱、以皂角
水煮过） 牛黄（少许） 麝香（一字）
上六味为末，每遇小儿中、前项形证，周岁半字，三四岁一字，仍观孩儿身体肥瘦，脏腑虚实，及病势轻重，则加
减药，用蜜热水一二分调匀灌下，或薄荷汤亦可。服药后良久，压下痰涎，疏去风气，当宣泻两三行，其泻出如鸡子白
是应效，或胸膈痰涎壅盛痞满，服此药当吐风痰，亦为美也。下药后，或吐或泻，手足搐搦稍定，喉咙不响，头额腹肚
渐凉，眼目不倒，记得人事，面红赤色，但时时有少温壮，惊潮风热来未退，便续下保寿散三两，服金粉散一二服，早
晨更可下均气补虚进乳哺白术散一日。早晨与一服，或服此数件药后，或只觉得肚腹至夜微热，不进乳食，宜空心与进
一服宽热散，微微通去腹中余热风涎。或有是疾，服药稍退，忌两日不可见风。一方加粉霜二钱，名朱砂膏。
羚羊角汤 治诸惊壮热。
羚羊角 蝉蜕 茯神（去木） 麦门冬（去心） 柴胡 地骨皮（各一钱） 黄芩 甘草（各五分、炒）
上锉散，每服二钱，姜枣煎服。
栀子仁汤 治阳毒伤寒壮热，百节疼痛，下后热不退者。
栀子仁 赤芍药 大青 知母（各一两） 川升麻 黄芩 石膏（各二两） 柴胡（一两、去苗） 甘草（半两）
杏仁（二两，去皮尖、及双仁者、麸炒微黄色）
上锉散，每服三钱，水一盏，生姜三片，煎六分，去滓不拘时温服。
大连翘饮子 见第三问。
六物黄芩汤 治小儿天行壮热，少腹大、短气、热有进退、饮食不化。
黄芩 大青 甘草 麦门冬（去心） 石膏（各半两） 肉桂（三钱）
上锉散，每服三钱，白水煎，去滓温服。
五物人参饮 治天行壮热，咳嗽心胀满。
人参 甘草（各半两） 麦门冬（去心） 生地黄（各一两半） 茅根（半握）
上锉散，每服三钱，白水煎服。
龙胆汤 见第三问千金龙胆汤。
紫霜丸 见第三问。
鲁伯嗣说：壮热，是指持续发热而不停止，严重时甚至引发惊痫。温壮，只是体温微温而不算高热。巢元方说：小儿壮热，是因为体内热气旺盛，熏蒸发散于体表，所以导致身体发烫。这种病起病较缓，大体上与温热病相似，只有少许不同之处，就是热度更加严重。遇到这种情况适宜服用药性轻清的方剂，惺惺散、羌活散都可以使用；如果病情严重，则可用黄芩、柴胡、干葛等药物组成的方剂来疏散邪热。至于温壮，是由于小儿脏腑功能不调，体内有伏热，或者夹杂宿寒，这些邪气都搏结在胃气中，导致脾胃不和，气机运行壅滞涩慢，从而积聚成身体发热，称为温壮。大便颜色黄且气味臭秽的，说明体内有伏热；大便颜色白且气味酸臭的，则是夹杂宿寒所致，适宜用温法治疗，可服用理中汤、四君子汤之类，并加入桂枝进行治疗。对于伏热，适宜服用五苓散和白虎汤，这两种药都有效。如果是腹中有伏热导致的温壮，以柴苓散为主治方。如果心神不安，大肠秘结且有热象，以三黄犀角散为主治方。温壮导致长期发热不退，以牛黄散为主治方。凡是经过发汗或攻下治疗后余热仍不退的，可以服用地骨皮散、黄龙汤、牛黄膏。这些方剂也能治疗壮热。《直指方》中的羚羊角汤可以治疗各种惊风引起的壮热。如果是攻下之后热势仍不退，身体壮热且全身骨节疼痛，应选用栀子仁汤、大连翘饮、六物黄芩汤、五物人参饮，根据具体症状对症选用。古法中去除伏热用龙胆汤，去除宿食积滞用紫霜丸，应当效法这些方法进行治疗。《圣济经》用升麻、芍药等方剂来治疗。
理中汤 参见第五十三问。
四君子汤 参见第十六问。
五苓散 参见第五十二问。
白虎汤 治疗伤寒大汗出后，表证已解，心胸极度烦闷，口渴想喝水的情况。以及呕吐或攻下后七八天，邪毒未解，热邪结聚在体内，表里俱热，时常怕风，极度口渴，舌面干燥而烦躁，想要喝几升水的人适宜服用。又治疗夏季中暑，出汗，怕热，身体发热且口渴。
知母（三两） 甘草（一两，炙） 石膏（八两，另研） 粳米（二合）
以上药材切碎，每次服用三钱，用水一盏，煎至六分，米粒熟透为度，去渣温服。《圣惠方》中加入干葛。
柴苓散 治疗小儿腹中有伏热，温壮之症未去。
柴胡（七钱半，去苗） 麦门冬（去心） 人参 赤茯苓 甘草（各半两） 黄芩（一两）
以上药材锉碎成散剂，每次服用二钱，用水一盏，加入一小撮小麦、一片竹叶，煎至五分，去渣温服，根据患儿年龄大小增减剂量给予服用。
三黄犀角散 治疗小儿身体温壮，心神不安，大肠秘结且有热象。
犀角屑 大黄（酒浸，蒸） 钩藤 栀子仁 甘草 黄芩（各五钱）
以上药材研为末，每次服用五分，根据患儿年龄大小增减剂量，用热开水调服。
牛黄散 治疗小儿温壮，身体持续发热不退。
牛黄（研细） 甘草（各五分） 柴胡（去苗） 栀子（炒） 龙胆草 黄芩（各二钱半）
以上药材研为末，每次服用五分，随时用金银花煎汤调服。
地骨皮散 参见第五十七问。
黄龙汤 治疗伤寒身热不退。
柴胡（五钱） 黄芩 甘草（各二钱） 赤芍药（三钱）
以上药材切碎，每次服用二钱，加生姜一片、大枣一枚，用水一盏，煎至五分，去渣随时温服。
牛黄膏 治疗小儿天吊惊风，手足抽搐，面唇红赤，咽喉痰鸣，浑身头额壮热，呼唤不答，不醒人事。或者仅左手右脚偏侧抽搐，或者仅右手左脚偏侧抽搐，或者仅口唇眼鼻颤动抽搐。此病多因腹部紧胀，热极，胸膈久积惊涎，忽然被风邪触动，故而出现此症。此患大忌针灸，若进行针灸乃是误治。凡患此疾，必须辨认具备上述形证，宜急服此方。
蝎尾（四十九枚） 巴豆（去壳，一枚半，不去油） 梅花脑（半字） 辰砂（研细，二钱） 郁金（三钱，用皂角水煮过） 牛黄（少许） 麝香（一字）
以上六味药材研为末，每当小儿出现前述形证时，周岁服用半字，三四岁服用一字，同时观察孩子身体肥瘦、脏腑虚实及病情轻重，则加减药量，用蜂蜜热水一二分调匀灌服，或用薄荷汤亦可。服药后良久，压下痰涎，疏去风气，应当排便两三行，泻出物如鸡蛋清样即为见效。或者胸膈痰涎壅盛痞满，服此药当吐出风痰，也是好事。下药后，或吐或泻，手足抽搐稍定，喉咙不响，头额腹肚渐凉，眼睛不翻白，记得人事，面色红赤，但时时仍有轻微温壮，惊潮风热尚未退去，便继续服用保寿散三两，服用金粉散一至二服，早晨更可服用均气补虚进乳哺白术散一日。早晨给一服，或者服用这几件药后，只觉得肚腹至夜微热，不进乳食，宜空腹给进一服宽热散，微微通去腹中余热风涎。如果有此疾，服药稍退，忌两天不可见风。另一方加入粉霜二钱，名为朱砂膏。
羚羊角汤 治疗各种惊风壮热。
羚羊角 蝉蜕 茯神（去木） 麦门冬（去心） 柴胡 地骨皮（各一钱） 黄芩 甘草（各五分，炒）
以上药材锉碎成散剂，每次服用二钱，加姜枣煎服。
栀子仁汤 治疗阳毒伤寒壮热，百节疼痛，攻下后热不退者。
栀子仁 赤芍药 大青 知母（各一两） 川升麻 黄芩 石膏（各二两） 柴胡（一两，去苗） 甘草（半两） 杏仁（二两，去皮尖，及双仁者，麸炒微黄色）
以上药材锉碎成散剂，每次服用三钱，用水一盏，生姜三片，煎至六分，去渣不拘时温服。
大连翘饮子 参见第三问。
六物黄芩汤 治疗小儿天行壮热，少腹胀大、短气、热势有进退、饮食不化。
黄芩 大青 甘草 麦门冬（去心） 石膏（各半两） 肉桂（三钱）
以上药材锉碎成散剂，每次服用三钱，白水煎，去渣温服。
五物人参饮 治疗天行壮热，咳嗽心胀满。
人参 甘草（各半两） 麦门冬（去心） 生地黄（各一两半） 茅根（半握）
以上药材锉碎成散剂，每次服用三钱，白水煎服。
Lu Bosi stated: Zhuangre (Intense Fever) refers to continuous fever without cessation, which may even lead to Jingxian (Convulsions and Epilepsy) in severe cases. Wenzhuang (Mild Persistent Fever) refers to a state where the body is merely warm but not hot. Chao Yuanfang stated: In children, Zhuangre occurs because excessive internal heat steams and diffuses outward, causing the body to feel intensely hot. This condition develops gradually and is largely similar to Wenre (Warm Heat disease), with the only difference being that the heat is more severe. For this syndrome, it is appropriate to administer mild medications; Xingxing San (Stimulating Powder) or Qianghuo San (Notopterygium Powder) can be used. If the condition is severe, formulas containing Huangqin (Scutellariae Radix), Chaihu (Bupleuri Radix), and Gange (Puerariae Radix) should be used to disperse the heat. As for Wenzhuang, it arises from disharmony of the Zang-Fu organs in children, where latent heat resides internally, or is combined with retained cold. These pathogens congregate in the Stomach Qi, leading to dysfunction. The stagnation and sluggishness of Qi flow result in accumulated body heat, termed Wenzhuang. If the stool is yellow and foul-smelling, it indicates latent heat inside; if the stool is white and sour-smelling, it indicates retained cold. Such cases should be treated with warming methods, using Lizhong Tang (Regulate the Middle Decoction) or Sijunzi Tang (Four Gentlemen Decoction) with added Guizhi (Cinnamon Twig). For latent heat, Wuling San (Five-Ingredient Powder with Poria) and Baihu Tang (White Tiger Decoction) are suitable, both being effective. If there is latent heat in the abdomen causing Wenzhuang, Chailing San (Bupleurum and Pinellia Powder) is the primary treatment. If there is mental restlessness and constipation with heat in the Large Intestine, Sanhuang Xijiao San (Three-Yellow and Rhinoceros Horn Powder) is indicated. For persistent fever due to Wenzhuang, Niuhuang San (Calculus Bovis Powder) is used. If residual heat remains after sweating or purging, Digupi San (Lycium Bark Powder), Huanglong Tang (Yellow Dragon Decoction), or Niuhuang Gao (Calculus Bovis Paste) can be taken. These also treat Zhuangre. The Lingyangjiao Tang (Antelope Horn Decoction) from *Zhizhi Fang* treats various types of convulsive intense fever. If fever persists after purging, accompanied by intense fever and pain in all joints, one should select Zhizi Ren Tang (Gardeniae Semen Decoction), Dalianqiao Yin (Large Lonicera Drink), Liuwu Huangqin Tang (Six-Ingredient Scutellaria Decoction), or Wuwu Renshen Yin (Five-Ingredient Ginseng Drink) according to specific symptoms. Ancient methods use Longdan Tang (Gentian Decoction) to remove latent heat, and Zishuang Wan (Purple Frost Pill) to remove food retention; these methods should be followed. *Shengji Jing* uses Shengma (Cimicifugae Rhizoma) and Shaoyao (Paeoniae Radix) preparations for treatment.
Lizhong Tang See Question 53.
Sijunzi Tang See Question 16.
Wuling San See Question 52.
Baihu Tang (White Tiger Decoction) treats cases of Shanghan (Cold Damage) with profuse sweating where the exterior syndrome has resolved, resulting in extreme vexation in the chest and heart, and thirst for water. It is also indicated for cases seven to eight days after vomiting or purging where pathogenic toxins remain unresolved, heat binds internally, presenting with simultaneous interior and exterior heat, occasional aversion to wind, extreme thirst, dry tongue, vexation, and desire to drink several liters of water. It also treats Summerheat-Toxin (Zhongshu) in summer, characterized by sweating, aversion to heat, fever, and thirst.
Zhimu (Anemarrhenae Rhizoma) (3 liang) Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried) (1 liang) Shigao (Gypsum Fibrosum, ground separately) (8 liang) Jingsmi (Oryza Sativa, rice) (2 he)
Crush the ingredients. Take 3 qian per dose, decoct in 1 zhen of water until reduced to 0.6 zhen, cooking until the rice is soft. Strain and take warm. *Shenghui Fang* adds Gange (Puerariae Radix).
Chailing San Treats latent heat in the abdomen of children, where Wenzhuang has not subsided.
Chaihu (Bupleuri Radix, removed sprouts) (7.5 qian) Maimendong (Ophiopogonis Radix, removed heart) Renshen (Ginseng Radix et Rhizoma) Chifuling (Polypori Cum Ramis Pini Rubri) Gancao (Glycyrrhizae Radix et Rhizoma) (each 0.5 liang) Huangqin (Scutellariae Radix) (1 liang)
Cut into pieces and make into powder. Take 2 qian per dose, decoct in 1 zhen of water with a pinch of Wheat (Triticum aestivum) and one leaf of Bamboo (Phyllostachys nigra var. henonis), reduce to 0.5 zhen. Strain and take warm. Adjust dosage according to age.
Sanhuang Xijiao San Treats Wenzhuang in children, mental restlessness, and constipation with heat in the Large Intestine.
Xijiaoxie (Rhinocerotis Cornu, shaved) Dahuang (Rhei Radix et Rhizoma, soaked in wine, steamed) Gouteng (Uncariae Ramulus cum Uncis) Zhiziren (Gardeniae Semen) Gancao (Glycyrrhizae Radix et Rhizoma) Huangqin (Scutellariae Radix) (each 5 qian)
Grind into powder. Take 0.5 qian per dose, adjust according to age, mix with hot water and swallow.
Niuhuang San Treats Wenzhuang in children, with continuous unceasing body heat.
Niuhuang (Calculus Bovis, ground) Gancao (Glycyrrhizae Radix et Rhizoma) (each 0.5 qian) Chaihu (Bupleuri Radix, removed sprouts) Zhizi (Gardeniae Fructus, stir-fried) Longdancao (Gentianae Radix) Huangqin (Scutellariae Radix) (each 2.5 qian)
Grind into powder. Take 0.5 qian per dose, mix with Jin-yin-hua (Lonicerae Japonicae Flos) decoction and take at any time.
Digupi San See Question 57.
Huanglong Tang Treats persistent fever in Shanghan.
Chaihu (Bupleuri Radix) (5 qian) Huangqin (Scutellariae Radix) Gancao (Glycyrrhizae Radix et Rhizoma) (each 2 qian) Chishaoyao (Paeoniae Radix Rubra) (3 qian)
Crush the ingredients. Take 2 qian per dose, add one slice of Ginger (Zingiberis Rhizoma Recens) and one date (Jujubae Fructus), decoct in 1 zhen of water until reduced to 0.5 zhen. Strain and take warm at any time.
Niuhuang Gao (Calculus Bovis Paste) Treats Tiandiao Convulsion (a type of infantile convulsion), spasms of hands and feet, red face and lips, phlegm-rattle in the throat, intense fever on the whole body, head, and forehead, unresponsiveness to calls, and unconsciousness. Or unilateral spasms of left hand/right foot, or right hand/left foot, or tremors of lips, eyes, and nose. This disease often involves tight abdominal distension, extreme heat, and long-standing accumulation of phlegm-saliva in the chest and diaphragm, suddenly triggered by Wind-pathogen. Acupuncture and moxibustion are strictly contraindicated; using them would be a mistake. One must confirm the aforementioned symptoms before urgently administering this formula.
Xiewei (Scorpio Tail) (49 pieces) Badou (Crotonis Fructus, shelled, 1.5 pieces, oil not removed) Meihuanao (Borneolum Syntheticum) (0.5 zi) Chencha (Cinnabaris) (ground, 2 qian) Yujin (Curcumae Radix) (3 qian, boiled in Saposhnikoviae Radix decoction) Niuhuang (Calculus Bovis) (a little) Shexiang (Moschus) (1 zi)
Grind the six ingredients into powder. When the child exhibits the aforementioned symptoms, infants (1 year old) take 0.5 zi, children aged 3-4 take 1 zi. Observe the child's body fat/thinness, deficiency/excess of Zang-Fu, and severity of illness to adjust the dose. Mix with honey and warm water (1-2 fen) and administer. Mint decoction is also acceptable. After some time, the phlegm-saliva will be suppressed, Wind dispersed, and the child should have 2-3 bowel movements. Stool resembling egg white indicates efficacy. Alternatively, if there is phlegm-fullness in the chest/diaphragm, vomiting of Wind-phlegm is expected. After administration, if vomiting or diarrhea occurs, spasms subside, throat noise stops, head/abdomen cool down, eyes do not roll back, consciousness returns, and face becomes less red, but slight Wenzhuang and Wind-Heat persist, continue with Baoshou San (Longevity Powder) 3 liang, then Jinfen San (Gold Dust Powder) 1-2 doses. In the morning, administer Junqi Buxu Jinru Bu Baizhu San (Harmonize Qi, Tonify Deficiency, Promote Milk, Atractylodes Macrocephala Powder) once daily. If after taking these medicines the abdomen feels slightly hot at night and milk intake decreases, give Kuanre San (Relieve Heat Powder) on an empty stomach to gently clear residual heat and Wind-phlegma. If the disease improves after medication, avoid wind exposure for two days. Another variant adds Fen-shuang (Tin Oxide) 2 qian, named Zhusha Gao (Cinnabar Paste).
Lingyangjiao Tang (Antelope Horn Decoction) Treats various convulsive intense fevers.
Lingyangjiao (Saigae Tataricae Cornu) Chantui (Cicadae Periostracum) Fushen (Poria with Pine Root, removed wood) Maimendong (Ophiopogonis Radix, removed heart) Chaihu (Bupleuri Radix) Digupi (Lycii Cortex) (each 1 qian) Huangqin (Scutellariae Radix) Gancao (Glycyrrhizae Radix et Rhizoma) (each 0.5 qian, stir-fried)
Cut into pieces and make into powder. Take 2 qian per dose, decoct with Ginger and Date.
Zhizi Ren Tang (Gardeniae Semen Decoction) Treats Yangdu Shanghan (Yang-toxin Cold Damage) with intense fever, pain in all joints, and persistent fever after purging.
Zhiziren (Gardeniae Semen) Chishaoyao (Paeoniae Radix Rubra) Daqing (Isatidis Folium) Zhimu (Anemarrhenae Rhizoma) (each 1 liang) Chuanshengma (Cimicifugae Rhizoma) Huangqin (Scutellariae Radix) Shigao (Gypsum Fibrosum) (each 2 liang) Chaihu (Bupleuri Radix, removed sprouts) (1 liang) Gancao (Glycyrrhizae Radix et Rhizoma) (0.5 liang) Xingren (Pruni Semen, peeled, double-kernel removed, stir-browned) (2 liang)
Cut into pieces and make into powder. Take 3 qian per dose, decoct in 1 zhen of water with three slices of Ginger until reduced to 0.6 zhen. Strain and take warm at any time.
Dalianqiao Yinzi (Large Lonicera Drink) See Question 3.
Liawu Huangqin Tang (Six-Ingredient Scutellaria Decoction) Treats Tianxing Zhuangre (Epidemic Intense Fever) in children, with lower abdominal distension, shortness of breath, fluctuating fever, and indigestion.
Huangqin (Scutellariae Radix) Daqing (Isatidis Folium) Gancao (Glycyrrhizae Radix et Rhizoma) Maimendong (Ophiopogonis Radix, removed heart) Shigao (Gypsum Fibrosum) (each 0.5 liang) Rougui (Cinnamomi Cortex) (3 qian)
Cut into pieces and make into powder. Take 3 qian per dose, decoct in plain water. Strain and take warm.
Wuwu Renshen Yin (Five-Ingredient Ginseng Drink) Treats Tianxing Zhuangre (Epidemic Intense Fever), cough, and chest fullness.
Renshen (Ginseng Radix et Rhizoma) Gancao (Glycyrrhizae Radix et Rhizoma) (each 0.5 liang) Maimendong (Ophiopogonis Radix, removed heart) Shengdihuang (Rehmanniae Radix) (each 1.5 liang) Maogen (Imperatae Rhizoma) (half handful)
Cut into pieces and make into powder. Take 3 qian per dose, decoct in plain water.
Longdan Tang (Gentian Decoction) See Question 3 Qianjin Longdan Tang.
Zishuang Wan (Purple Frost Pill) See Question 3.