袁仲卿乃郎。入水捉 蜞为戏。偶仆水中。家人救出。少顷大热呻吟。诸小儿医以镇惊清热合成丸散与
服二日。遂至昏迷不醒。胸高三寸。颈软头往侧倒。气已垂绝。万无生理。再四
求余往视。诊其脉。止似蛛丝。过指全无。以汤二茶匙。滴入口中。微有吞意。谓之曰。吾从来不惧外症
之重。但脉已无根。不可救矣。一赵姓医曰。鼻如烟煤。肺气已绝。纵有神丹。不可复活。余曰。此儿受症。
何至此极。主人及客俱请稍远。待吾一人独坐。静筹其故。良久曰。得之矣。其父且惊且喜。医者愿闻其
说。余曰。惊风一症。乃前人凿空妄谭。后之小儿受其害者。不知几千百亿兆。昔与余乡幼科争论。殊无
证据。后见方中行先生伤寒条辨后。附痉书一册。颛言其事。始知昔贤先得我心。于道为不孤。如此症因惊
而得。其实跌仆水中。感冷湿之气。为外感发热之病。其食物在胃中者。因而不化。当比夹食伤寒例。用
五积散治之。医者不明。以金石寒冷药。镇坠外邪。深入脏腑。神识因而不清。其食停胃中者。得寒凉而
不运。所进之药。皆在胃口之上。不能透入。转积转多。以致胸高而突。宜以理中药。运转前药。倘得症减脉
出。然后从伤寒门用药。尚有生理。医者曰。鼻如烟煤。肺气已绝。而用理中。得毋重其绝乎。余曰。所以
独坐沉思者。正为此耳。盖烟煤不过大肠燥结之征。若果肺绝。当汗出大喘。何得身热无汗。又何得胸高而
气不逼。且鼻准有微润耶。此余之所以望其有生也。于是煎理中汤一盏与服。灌入喉中。大啖一口。果然从前
二日所受之药。一齐俱出。胸突顿平。颈亦稍硬。但脉仍不出。人亦不苏。余曰。其事已验。即是转
机。此为食之未动。关窍堵塞之故。再灌前药些少。热已渐退。症复降序。乃从伤寒下例。以玄明粉一味化
水。连灌三次。以开其大肠之燥结。是夜下黑粪甚多。次早忽言一声云。我要酒吃。
此后尚不知人事。以生津药频灌。一日而苏。
胡卣臣先生曰。惊风一症。小儿生死大关。孰知其为外感耶。习幼科者。才虚心领会此案。便可免乎殃咎。
若骇为异说。则造孽无极矣。
门人问曰。惊风一证。虽不见于古典。然相传几千百年。吾
师虽辟其谬。顽钝辈尚不能无疑。请明辨之。以开聋 。答曰。
此问亦不可少。吾为子辈大破其惑。因以破天下后世之惑。盖小儿初生。以及童幼。肌肉筋骨。脏腑血脉。俱
未充长。阳则有余。阴则不足。不比七尺之躯。阴阳交盛也。惟阴不足阳有余。故身内易至于生热。热盛则
生痰生风生惊。亦所恒有。设当日直以四字立名曰热痰风惊。则后人不炫。因四字不便立名。乃
节去二字。以惊字领头。风字煞尾。后人不解。遂以为奇特之病也。且谓此病有八候。以其头摇手劲也。而
立抽掣之名。以其卒口噤脚挛急也。而立目邪心乱搐搦之名。以其脊强背反也。而立角弓反张之名。相传既
久。不知其妄造。遇见此等证出。无不以为奇特。而不知小儿之腠理未密。易于感冒风寒。风寒中人。
必先中入太阳经。太阳之脉。起于目内 。上额交巅入脑。还出。别下项。挟脊抵腰中。是以病则筋脉牵强。
因筋脉牵强。生出抽掣搐搦。角弓反张。种种不通名目。而用金石药。镇坠外邪。深入脏腑。千中千死。万
中万死。间有体坚证轻得愈者。又诧为再造奇功。遂至各守颛门。虽日杀数儿。不自知其罪矣。百
年之内。千里之远。出一二明哲。终不能一一尽剖疑关。如方书中有云。小儿八岁以前无伤寒。此等胡言。
竟出自高明。偏足为惊风之说树帜。曾不思小儿不耐伤寒。初传太阳一经。早已身强汗多。筋脉牵动。人事
昏沉。势已极于本经。汤药乱投。死亡接踵。何繇见其传经解散耶。此所以误言小儿无伤寒也。不知
小儿易于外感。易于发热。伤寒为独多。世所妄称为惊风者。即是也。小儿伤寒。要在三日内即愈为贵。若
待经尽方解。必不能耐矣。又刚痉无汗。柔痉有汗。小儿刚痉少。柔痉多。世医见其汗出不止。神昏不醒。
往往以慢惊风为名。而用参 术附等药。闭其腠理。热邪不得外越。亦为大害。但比金石药为差减耳。所
以凡治小儿之热。但当彻其出表。不当固其入里也。仲景原有桂枝法。若舍而不用。从事东垣内伤为治。
毫厘千里。最宜详细。又新产妇人去血过多。阴虚阳盛。其感冒发热。原与小儿无
别。医者相传称为产后惊风。尤堪笑破口颊。要知吾辟惊风之说。非谓无惊病也。小儿气怯神弱。凡遇异形
异声。骤然跌仆。皆生惊怖。其候面青粪青。多烦多哭。尝过于分别。不比热邪塞窍。神识昏迷。对面撞钟放
铳。全然不闻者。细详勘验。自识惊风凿空之谬。子辈既游吾门。日引光明胜义。洗濯肺肠。忽然灵
悟顿开。便与饮上池无二。若但于言下索解。则不能尽传者多矣。门人又问曰。伤寒原有一表一里之法。
今谓热邪当从表出。不当令其深入。则里药全在所摈矣。岂于古法有未合欤。答曰。此问亦不可少。古法
甚明。但后人卤莽不悟耳。盖人身一个壳子。包着脏腑在内。从壳子上论。即骨亦表。而从近壳子处论。
即膀胱尾闾之间。亦出表之路也。在外以皮毛为表之表。在内以大小孔道为里之表。总驱热邪从外出也。惟有
五脏之间。精神魂魄。意之所居。乃真谓之里。而不可令外邪深入耳。如盗至人家。近大门则驱从大门出。
近后门则驱从后门出。正不使其深入而得窥寝室耳。若盗未至后门。必欲驱至。及已至后门。必
欲驱从大门出。皆非自全之道也。试观心肺脾肝肾之内。并无血脉皮毛肌肉筋骨也。而所主者。乃在外之血
脉皮毛肌肉筋骨。则安得以在外者。即名为表耶。所以伤寒之邪入内。有传腑传脏之不同。而传腑复有浅
深之不同。胃之腑外主肌肉而近大门。故可施解肌之法。内通大小肠而近后门。故间有可下之法。至
胆之腑。则深藏肝叶。乃寝室之内。去前后门俱远。故汗下两有不宜。但从和解而已。若传至三阴。则已舍
大门而逼近寝室。设无他证牵制。惟有大开后门。极力攻之。使从大便出耳。今之治伤寒者。误以包脏腑之壳
子分表里。故动辄乖错。诚知五脏深藏于壳内。而分主在外之血脉皮毛肌肉筋骨也。胸中了然矣。
门人又问曰。获闻躯壳包乎五脏。奉之为主之诲。心地顿开。但尚有一疑。不识人身之头。奉何脏为主耶。答
曰。头为一身之元首。穹然居上。乃主脏而不奉藏者也。虽目通肝。耳通肾。鼻通
肺。口通脾。舌通心。不过借之为户牖。不得而主之也。其所主之脏。则以头之外壳包藏脑髓。脑为髓之海。
主统一身骨中之精髓。以故老人髓减。即头倾视深也。内经原有九脏之说。五脏加脑髓骨脉胆女子胞。神
脏五。形脏四。共合为九。岂非脑之自为一脏之主耶。吾谓脑之中虽不藏神。而脑之上为天门。身中
万神集会之所。泥丸一宫。所谓上八景也。惟致虚之极者。始能冥漠上通。子辈奈何妄问所主耶。凡伤寒显
头痛之证者。用轻清药彻其邪从上出。所谓表也。用搐鼻药搐去脑中黄水。所谓里也。若热已平复。当虑热邪
未尽。用下药时。大黄必须酒浸。藉酒力以上达。所谓鸟巢高巅。射而取之之法也。今世治大头
瘟一证。皆从身之躯壳分表里。不从头之躯壳分表里。是以死亡莫救。诚知脑之自为一脏。而颛力以攻之。思过半矣
附沙宅小儿治验 卫庠沙无翼。门人王生之表兄也。得子甚迟。然纵啖生硬冷物。一夕吐食暴僵。不醒
人事。医以惊风药治之。浑身壮热。面若装朱。眼吊唇掀。下利不计其数。满床皆污。至寓长跽请救。诊毕。
谓曰。此慢脾风候也。脾气素伤。更以金石药重伤。今已将绝。故显若干危症。本有法可救。但须七日
方醒。恐信不笃而更医。无识反得诿罪生谤。王生坚请监督其家。且以代劳。且以壮胆。于是用乌蝎四君
子汤。每日灌一大剂。每剂用人参一钱。其家虽暗慌。然见面赤退而色转明润。便泻止而动移轻活。似有
欲言不言之意。亦自隐忍。至第六晚忽觉手足不宁。揭去衣被。喜吞汤水。始极诋人参之害。王生先自
张皇。竟不来寓告明。任其转请他医。才用牛黄少许。从前危症复出。面上一团死气。但大便不泻耳。重
服理脾药。又五日方苏。
是役也。王生于袁仲卿一案若罔见。而平日提命。凡治阴病。得其转为阳病。则不药自愈。纵不愈。
用阴分药一剂。或四物二连汤。或六味地黄汤。以济其偏。则无不愈。亦若罔闻。姑
为鸣鼓之攻。以明不屑之诲。
袁仲卿的公子。下水捉蟛蜞玩耍。偶然跌倒在水中。家人将他救起。过了一会儿，身体发高热并呻吟。各位儿科医生用镇惊清热的成药丸散给他服用两天。于是导致昏迷不醒。胸部隆起高三寸。颈部软弱头部向侧面倾倒。气息已经微弱到了极点。完全没有生机。经过多次恳求，请我去诊治。诊察他的脉搏，细弱得像蛛丝一样。手指划过脉位完全感觉不到。用汤药两茶匙，滴入口中。有轻微的吞咽动作。我对他说。我从来不怕外症严重。只是脉象已经没有根基。无法救治了。一位赵姓医生说。鼻孔像烟煤一样黑。肺气已经断绝。即使有神丹妙药。也不能复活。我说。这孩子得的病。怎么会到这种地步。主人和客人都请稍微退远一些。让我一个人独自坐着。冷静地思考其中的缘故。过了很久说。我明白了。他的父亲又惊又喜。医生们希望听我的说法。我说。惊风这一病症。是前人凭空捏造妄加谈论。后世的小儿受其害的。不知有多少亿兆。以前我和同乡的儿科医生争论。毫无证据。后来看到方中行先生的《伤寒条辨》后面。附有一册《痉书》。专门论述这件事。才知道以前的贤人先得到了我的心意。在道理上并不孤单。像这样的病症因为惊吓而得。其实是跌仆水中。感受冷湿之气。属于外感发热之病。食物在胃中的。因此不能消化。应当比照夹食伤寒的例子。用五积散治疗。医生不明白。用金石寒凉药物。镇压外邪。深入脏腑。神识因此不清。食物停滞在胃中。遇到寒凉就不能运化。所服的药。都在胃口之上。不能透入体内。越积越多。以致胸部高突。应该用理中汤。运转前面的药物。如果症状减轻脉象出现。然后从伤寒门用药。还有生机。医生说。鼻孔像烟煤一样黑。肺气已经断绝。却用理中汤。难道不是加重他的断绝吗。我说。所以我独自坐着沉思。正是为此事。因为烟煤不过是肠道燥结的迹象。如果真的肺绝。应当大汗出且大喘。怎么能身热无汗。又怎么能胸部高突而气不急促。而且鼻准头有微微湿润呢。这就是我期望他有生的原因。于是煎理中汤一盏给他服用。灌入喉中。大口喝了一口。果然从前两天所受的药。全部吐出。胸突顿时平复。颈部也稍微变硬。但脉象仍然不出。人也未苏醒。我说。此事已经验证。就是转机。这是因为食物未动。关窍堵塞的缘故。再灌前药少许。热势逐渐减退。症状恢复次序。于是从伤寒下法的例子。用玄明粉一味化水。连续灌三次。以开通大肠的燥结。这天夜里排出很多黑便。第二天早上忽然喊一声说。我要喝酒吃。此后还不知人事。用生津药频繁灌服。一天后苏醒。
胡卣臣先生说。惊风这一病症。是小儿生死的关键大关。谁知道它是外感呢。学习儿科的人。只要虚心领会此案。就可以避免灾祸。如果惊骇认为是异说。那就造孽无穷了。
门人问道。惊风这一证候。虽然不见于古典。然而相传几千百年。老师虽然批判它的谬误。愚钝之辈还不能没有疑问。请明确辨析它。以开启聋聩。回答说。
这个问题也不可缺少。我为你们大大破除迷惑。借此破除天下后世的迷惑。大概小儿刚出生。以及儿童幼年。肌肉筋骨。脏腑血脉。都未充实生长。阳气则有余。阴气则不足。不像七尺之躯。阴阳交盛。只有阴不足阳有余。所以体内容易生热。热盛则生痰生风生惊。也是常有的事。假如当时直接用四个字命名曰热痰风惊。那么后人不会炫耀。因为四字不便立名。于是节去二字。以惊字领头。风字煞尾。后人不懂。就以为是奇特的病。并且说此病有八候。因为它头摇手劲。而立抽掣之名。因为它突然口噤脚挛急。而立目邪心乱搐搦之名。因为它脊强背反。而立角弓反张之名。相传既久。不知道是妄造。遇见这些证候出现。无不以为奇特。而不知道小儿的腠理不致密。易于感冒风寒。风寒中人。必先中入太阳经。太阳经脉。起于目内眦。上额交巅入脑。还出。别下项。挟脊抵腰中。所以生病则筋脉牵强。因为筋脉牵强。生出抽掣搐搦。角弓反张。种种不通的名目。而用金石药。镇压外邪。深入脏腑。千中千死。万中万死。间或有体质坚固证候轻的痊愈者。又诧为再造奇功。遂至各守专门。虽然每天杀死几个孩子。不知道自己罪过。百年之内。千里之远。出一两个明智的人。终究不能一一尽剖疑关。如医书中有云。小儿八岁以前无伤寒。这种胡说。竟然出自高明之人。偏偏足以为惊风之说树旗帜。曾不想小儿不耐伤寒。初传太阳一经。早已身强汗多。筋脉牵动。人事昏沉。势头已极于本经。汤药乱投。死亡接踵。从哪里见到它传经解散呢。这就是所以误言小儿无伤寒的原因。不知道小儿易于外感。易于发热。伤寒为独多。世人妄称为惊风的。就是它。小儿伤寒。要在三日内即愈为贵。如果等到经尽才解。必定不能耐受。又刚痉无汗。柔痉有汗。小儿刚痉少。柔痉多。世医见其汗出不止。神昏不醒。往往以慢惊风为名。而用人参白术附子等药。闭塞腠理。热邪不得外越。也是大害。但比金石药稍好罢了。所以凡是治疗小儿的热。只应当彻底让它出表。不应当固护让它入里。仲景原有桂枝法。如果舍弃不用。从事东垣内伤为治。毫厘千里。最宜详细。又新产妇人去血过多。阴虚阳盛。她感冒发热。原本与小儿无别。医生相传称为产后惊风。尤其可笑破口颊。要知道我批判惊风之说。不是说没有惊病。小儿气怯神弱。凡遇异形异声。骤然跌仆。都会产生惊恐。它的征候面青粪青。多烦多哭。常常过于分别。不比热邪塞窍。神识昏迷。对面撞钟放铳。全然听不见。仔细详查勘验。自然识别惊风凭空捏造的谬误。你们既然游历在我的门下。每日引导光明胜义。洗濯肺肠。忽然灵悟顿开。就和饮上池水无二。如果只在言语下索解。那么不能尽传的有很多了。门人又问道。伤寒原有一表一里的方法。现在说热邪当从表出。不应当令其深入。那么里药全在所摒弃了。难道与古法有不合之处吗。回答说。这个问题也不可缺少。古法很明白。只是后人卤莽不悟。大概人身一个壳子。包着脏腑在内。从壳子上论。就是骨头也是表。而从靠近壳子处论。就是膀胱尾闾之间。也是出表的路径。在外以皮毛为表之表。在内以大小孔道为里之表。总驱热邪从外出。惟有五脏之间。精神魂魄。意之所居。才真谓之里。而不可令外邪深入。比如盗贼来到人家。靠近大门则驱从大门出。靠近后门则驱从后门出。正不使其深入而得以窥视寝室。如果盗贼未到后门。必欲驱至。及已到后门。必欲驱从大门出。都不是自保之道。试看心肺脾肝肾之内。并无血脉皮毛肌肉筋骨。而所主的。乃是在外的血脉皮毛肌肉筋骨。那么怎么可以把在外的。就命名为表呢。所以伤寒的邪气入内。有传腑传脏的不同。而传腑又有浅深的不同。胃的腑外主肌肉而近大门。所以可施解肌之法。内通大小肠而近后门。所以间有可下的法。至于胆的腑。则深藏肝叶。乃是寝室的内部。离前后门都远。所以汗下两有不宜。只从和解而已。若传至三阴。则已舍大门而逼近寝室。假设没有其他证候牵制。只有大开后门。极力攻之。使从大便出。现在的治伤寒者。误把包脏腑的壳子分表里。所以动辄乖错。诚知五脏深藏在壳内。而分主在外的血脉皮毛肌肉筋骨。心中了然了。
门人又问道。听闻躯壳包乎五脏。奉之为主要的教诲。心地顿开。但尚有一个疑问。不知人身的头。奉何脏为主。回答说。头是一身的元首。高高居上。是主脏而不奉藏者的。虽然目通肝。耳通肾。鼻通肺。口通脾。舌通心。不过借它们为门户窗户。不能由它们来主。它所主的脏。则以头的外壳包藏脑髓。脑为髓之海。主统一身骨中之精髓。所以老人髓减。就头倾视深。内经原有九脏的说法。五脏加脑髓骨脉胆女子胞。神脏五。形脏四。共合为九。难道不是脑自为一脏之主吗。我认为脑之中虽不藏神。而脑之上为天门。身中万神集会之所。泥丸一宫。所谓上八景。只有致虚之极的人。才能冥漠上通。你们为什么妄问所主呢。凡伤寒显头痛之证的。用轻清药彻其邪从上出。所谓表。用搐鼻药搐去脑中黄水。所谓里。如果热已平复。当虑热邪未尽。用下药时。大黄必须酒浸。藉酒力以上达。所谓鸟巢高巅。射而取之的方法。现在世医治大头瘟一证。都从身的躯壳分表里。不从头的躯壳分表里。所以死亡莫救。诚知脑自为一脏。而专心力以攻之。思过半矣
附沙宅小儿治验 卫庠沙无翼。门人王生的表兄。得子很晚。然而放纵吃生冷硬物。一晚吐食暴僵。不醒人事。医生用惊风药治疗。浑身壮热。面若装朱。眼吊唇掀。下利不计其数。满床皆污。到寓所长跪请求救命。诊毕。说。这是慢脾风候。脾气素伤。又以金石药重伤。现在已经将绝。所以显现若干危症。本来有法可救。但须七日才醒。恐怕信心不笃而换医生。无知反而推诿罪过生诽谤。王生坚决请求监督他家。并且代为劳苦。并且壮胆。于是用乌蝎四君子汤。每天灌一大剂。每剂用人参一钱。他家虽然暗中惊慌。然而见面赤退而色转明润。便泻止而动移轻活。似有欲言不言之意。也自己隐忍。到第六晚忽然觉得手足不宁。揭去衣被。喜欢吞汤水。开始极力诋毁人参的危害。王生先自张皇。竟不来寓告明。任其转请他医。才用牛黄少许。从前危症复出。面上一团死气。只是大便不泻。重服理脾药。又五日才苏。
这次诊疗。王生在袁仲卿一案好像没看见。而平日提命。凡是治阴病。得到它转为阳病。就不药自愈。纵然不愈。用阴分药一剂。或四物二连汤。或六味地黄汤。以济其偏。就没有不愈的。也像没听见。姑且鸣鼓攻击。以表明不屑的教诲。
The son of Yuan Zhongqing. Went into the water to catch small crabs for play. Accidentally fell into the water. Family members rescued him. After a short while, high fever and groaning appeared. Various pediatric physicians administered pills and powders combining calming fright and clearing heat for two days. Consequently, he fell into a coma. The chest protruded three cun high. The neck was soft with the head tilting to the side. Qi was on the verge of extinction. There was absolutely no hope of survival. After repeated entreaties, they asked me to examine him. I palpated his pulse; it was fine and weak like a spider's thread. Passing over the pulse position yielded no sensation. I dripped two tea spoons of decoction into his mouth. He showed a slight swallowing reflex. I said to them, "I have never feared severe external syndromes. However, the pulse has lost its root; it is incurable." A physician surnamed Zhao said, "The nostrils are black like soot; Lung Qi has already perished. Even with divine medicine, he cannot be revived." I said, "How did this child's condition reach such an extreme?" I asked the host and guests to step back slightly, allowing me to sit alone and calmly ponder the cause. After a long time, I said, "I have figured it out." His father was both surprised and delighted. The physicians wished to hear my explanation. I said, "Fright Wind (Jing Feng) is a syndrome fabricated by predecessors without basis. Countless children in later generations have suffered from it. Previously, I debated with pediatricians in my hometown but lacked evidence. Later, after seeing Mr. Fang Zhongxing's *Shanghan Tiaobian* (Delineation of Cold Damage), which included a volume on Spasm (Jing), specifically discussing this matter, I realized that ancient sages had anticipated my thoughts. I am not lonely in this understanding. This case, attributed to fright, actually resulted from falling into water and contracting cold-dampness, constituting an external contraction fever syndrome. Food in the stomach failed to digest due to this. It should be treated according to the example of Cold Damage with food retention, using Wuji San (Five Accumulations Powder). The physicians did not understand this. They used heavy, cold minerals and herbs to suppress the external pathogen, driving it deep into the Zang-Fu organs, thereby clouding the Shen (Spirit). The food stagnating in the stomach could not transform when encountering cold-cooling agents. The administered medicines remained above the gastric opening, unable to penetrate inward. Accumulation increased, causing the chest to bulge. One should use Lizhong Tang (Regulate the Middle Decoction) to mobilize the previous medications. If symptoms subside and the pulse emerges, then one can proceed with treatments for Cold Damage, and there would still be a chance of survival." The physician said, "The nostrils are black like soot, indicating Lung Qi has perished. Using Lizhong Tang would only hasten his death." I said, "This is precisely why I sat in deep contemplation. Soot-like nostrils are merely a sign of dryness and constipation in the Large Intestine. If Lung Qi were truly perished, there would be profuse sweating and severe panting. How could there be body heat without sweat? Furthermore, how could the chest be elevated without rapid breathing? Moreover, the tip of the nose shows slight moisture. This is why I hoped for his survival." Thus, I decocted a cup of Lizhong Tang (Regulate the Middle Decoction) for him to drink. It was poured down his throat. He took a large gulp. Indeed, all the medication ingested over the previous two days was vomited out. The chest protrusion flattened instantly, and the neck became slightly firmer. However, the pulse still did not emerge, and he remained unconscious. I said, "This confirms the treatment; it is a turning point. This is because the food has not moved, blocking the orifices." I administered a small amount of the previous medicine again. The heat gradually subsided, and the symptoms returned to their proper sequence. Then, following the purgative method for Cold Damage, I dissolved Xuanming Fen (Mirabilite) in water and administered it three times continuously to open the dryness and constipation of the Large Intestine. That night, he passed a large amount of black stool. The next morning, he suddenly cried out, "I want to drink wine." Afterwards, he remained unconscious. I frequently administered fluids-generating medicines. After one day, he regained consciousness.
Mr. Hu Youchen stated, "Fright Wind is a critical juncture for the life and death of children. Who knew it was an external contraction? Those practicing pediatrics who sincerely comprehend this case can avoid disaster. If they regard it as a heterodox theory, they commit boundless sin."
A disciple asked, "Although Fright Wind is not found in classical texts, it has been transmitted for thousands of years. Although you refute its fallacy, dull minds still harbor doubts. Please clarify it to dispel ignorance." I replied, "This question is necessary. I will greatly dispel your confusion and thereby dispel the confusion of the world and future generations. Generally, newborns and young children have muscles, bones, tendons, Zang-Fu organs, blood, and vessels that are not yet fully developed. Yang is in excess, and Yin is insufficient. This differs from adults whose Yin and Yang are balanced. Because Yin is insufficient and Yang is in excess, internal heat easily generates. When heat is excessive, it produces phlegm, wind, and fright, which is common. If we had simply named it 'Heat-Phlegm-Wind-Fright,' later generations might not have exaggerated it. Since four characters were inconvenient for naming, two were removed, leaving 'Fright' at the beginning and 'Wind' at the end. Later generations misunderstood, regarding it as a unique disease. They claimed this disease has eight manifestations: due to head shaking and stiff hands, they named it 'Twitching'; due to sudden jaw clenching and leg cramping, they named it 'Eye deviation, heart chaos, convulsions'; due to spinal rigidity and opisthotonos, they named it 'Opisthotonos.' Long transmission led to unawareness of its fabrication. Upon seeing these symptoms, everyone regarded them as peculiar, failing to realize that children's couli (pores/skin texture) are not dense, making them prone to Wind-Cold invasion. Wind-Cold entering the human body first invades the Taiyang Meridian. The Taiyang meridian originates from the inner canthus, crosses the vertex, enters the brain, emerges, descends behind the neck, and runs along the spine to the waist. Therefore, illness causes tendon and vessel tension. Due to this tension, twitching, convulsions, and opisthotonos arise—various nonsensical terms. Physicians then used mineral drugs to suppress external pathogens, driving them deep into the Zang-Fu organs. Thousands treated, thousands died; ten thousand treated, ten thousand died. Occasionally, those with strong constitutions and mild symptoms recovered, leading others to marvel at this 'miraculous regeneration.' Consequently, each adhered to their own school. Although killing several children daily, they were unaware of their guilt. Within a century and a thousand miles, one or two wise individuals emerge, but they cannot resolve all doubts. Medical books claim, 'Children under eight do not suffer from Cold Damage.' Such nonsense comes from so-called experts, inadvertently supporting the Fright Wind theory. Did they not consider that children tolerate Cold Damage poorly? Once the pathogen transmits to the Taiyang meridian, the body becomes rigid with profuse sweating, tendon tension, and mental confusion. The condition reaches its peak in the primary meridian. Random prescription leads to successive deaths. How could they observe transmission and resolution? This is why it was erroneously said that children do not suffer from Cold Damage. In reality, children are prone to external contraction and fever, with Cold Damage being most common. What the world falsely calls Fright Wind is exactly this. For pediatric Cold Damage, recovery within three days is precious. If one waits for the meridian cycle to complete before resolution, the child certainly cannot endure. Also, Gang Jing (Stiff Spasm) has no sweat; Rou Jing (Flexible Spasm) has sweat. Children have few cases of Gang Jing and many of Rou Jing. Physicians seeing continuous sweating and unconsciousness often diagnose Slow Fright Wind and use Ginseng, Atractylodes, and Aconite to close the couli, preventing heat pathogens from venting outward, which is also harmful, though less so than mineral drugs. Therefore, treating pediatric heat, one must thoroughly vent it outward, not consolidate it inward. Zhang Zhongjing originally had the Guizhi Tang (Cinnamon Twig Decoction) method. Abandoning it to follow Li Dongyuan's internal injury treatment is a mistake of huge magnitude, requiring careful attention. Similarly, postpartum women losing excessive blood suffer from Yin deficiency and Yang hyperactivity. Their contracted fever is identical to that of children. Physicians call this Postpartum Fright Wind, which is laughable. Know that refuting Fright Wind does not mean denying fright illnesses. Children have timid Qi and weak Shen. Encountering strange sights or sounds, or sudden falls, they generate fear. Symptoms include blue face and stool, irritability, and crying. This is often over-interpreted. It differs from heat pathogens blocking orifices causing Shen coma, where one hears nothing despite loud noises nearby. Careful examination reveals the fabrication of Fright Wind. Since you study under me, daily exposed to bright principles, cleansing your lungs and intestines, sudden enlightenment occurs, akin to drinking from Shangchi Spring. If you only seek understanding in words, much remains untransmitted."
Another disciple asked, "Cold Damage originally has exterior and interior methods. Now you say heat pathogens should exit via the exterior and not deepen inward. Are interior-resolving drugs entirely excluded? Does this contradict ancient methods?" I replied, "This question is also necessary. Ancient methods are clear, but later generations were rash and ignorant. The human body is a shell containing the Zang-Fu organs. From the perspective of the shell, even bones are exterior. From the perspective near the shell, areas between the bladder and the coccyx are also pathways for exiting the exterior. Externally, skin and hair constitute the 'exterior of the exterior.' Internally, the large and small orifices constitute the 'interior of the exterior.' The goal is to drive heat pathogens out. Only between the five Zang organs, where Spirit, Soul, Ethereal Soul, Corporeal Soul, and Intent reside, is it truly called 'Interior,' and external pathogens must not enter deeply. Like thieves entering a house, if near the front door, drive them out the front; if near the back door, drive them out the back. Do not let them enter deeply to peek into the bedroom. If thieves haven't reached the back door, forcing them there is wrong; if they are at the back door, forcing them out the front is also wrong. Both fail to ensure self-preservation. Observe inside the Heart, Lungs, Spleen, Liver, and Kidneys; there are no blood vessels, skin, hair, muscles, or bones. What they govern are the blood vessels, skin, hair, muscles, and bones outside. Thus, how can what is outside be named 'Exterior'? Therefore, Cold Damage pathogens entering inward differ in transmitting to Fu or Zang organs, and transmission to Fu organs varies in depth. The Stomach's Fu organ governs muscles externally (near the front door), so muscle-releasing methods apply. Internally connecting to the Large and Small Intestines (near the back door), purgative methods occasionally apply. The Gallbladder's Fu organ is hidden deep within the liver lobes (inside the bedroom), far from both doors, so neither sweating nor purging is suitable; only harmonizing applies. If transmitting to the Three Yin meridians, the pathogen has abandoned the front door and approaches the bedroom. Assuming no other constraints, one must open the back door wide and attack vigorously to expel via the stool. Current practitioners mistakenly divide the shell surrounding the Zang-Fu organs into exterior and interior, leading to frequent errors. Truly knowing that the five Zang organs are deeply hidden within the shell and govern the external blood vessels, skin, hair, muscles, and bones brings clarity."
Another disciple asked, "Having heard that the shell encloses the five Zang organs, revered as the master, my mind is opened. But I have one doubt: Which Zang organ governs the head?" I replied, "The head is the chief of the body, situated high above. It is governed by a Zang organ but does not house one. Although the eyes connect to the Liver, ears to the Kidney, nose to the Lung, mouth to the Spleen, and tongue to the Heart, these serve merely as windows and doors, not as governors. The governing Zang organ is the one whose outer shell encloses the Brain Marrow. The Brain is the Sea of Marrow, governing the essence and marrow of all bones. Hence, when elders lose marrow, their heads droop and vision sinks. The *Neijing* mentions Nine Zang organs: the Five Zang plus Brain Marrow, Bones, Vessels, Gallbladder, and Uterus. Five Spiritual Zang and Four Form Zang, totaling nine. Is this not proof that the Brain is a master Zang itself? I believe although the Brain does not house the Shen, the top of the Brain is the Heavenly Gate, the gathering place of ten thousand spirits in the body, the Niwan Palace, known as the Upper Eight Views. Only those achieving extreme emptiness can communicate spiritually upward. Why do you ask about governance? For Cold Damage presenting with headache, use light and clear medicines to vent pathogens from above (Exterior). Use nasal insufflation medicines to remove yellow fluid from the brain (Interior). If heat subsides but residual heat remains, when using purgatives, Rhubarb must be soaked in wine to ascend via the wine's power, following the method of 'shooting from below to hit the nest high up.' Today, treating Big Head Plague, physicians divide exterior/interior based on the body's shell, not the head's shell, leading to untreatable deaths. Truly knowing the Brain is a Zang organ and attacking it directly covers half the understanding."
[Appendix: Case of Pediatric Treatment at the Sha Residence]
Sha Wuyi, a student of the Imperial Academy and cousin of my disciple Wang, had a son late in life. Allowing indulgence in raw, hard, and cold foods, one night he vomited, became rigid, and lost consciousness. Physicians treated with Fright Wind medicines. He developed high fever, flushed face like rouge, retracted eyes, and everted lips. Diarrhea was countless, soiling the bed. He knelt long at my residence begging for help. After diagnosis, I said, "This is the pattern of Slow Spleen Wind. Spleen Qi has been chronically damaged, further severely injured by mineral drugs. It is now nearly extinct, hence the critical signs. There is a cure, but it requires seven days for awakening. Doubt may lead to changing doctors, and ignorance may result in blame and slander." Wang insisted on supervising at home, assisting, and bolstering courage. Thus, I prescribed Wuxie Sijunzi Tang (Black Scorpion and Four Gentlemen Decoction), administering one large dose daily, with one qian of Ren Shen (Ginseng Root) per dose. Although secretly panicked, they saw the red flush recede, complexion become bright and moist, diarrhea stop, and movement become lighter. There seemed to be a desire to speak but silence. They endured silently. On the sixth night, he suddenly felt restless limbs, kicked off blankets, and eagerly swallowed medicine. Previously, he had strongly condemned the harm of Ginseng. Wang initially panicked and did not inform me, allowing them to consult another physician. Upon using a small amount of Niu Huang (Calculus Bovis), the critical symptoms returned. The face showed a mass of deathly qi, except for the cessation of diarrhea. Re-administering Spleen-regulating medicines, he awakened after five more days.
In this case, Wang seemed oblivious to the Yuan Zhongqing case and ignored my usual instructions: for Yin diseases, if they transform into Yang diseases, they heal spontaneously without medicine; if not, a single dose of Yin-nourishing medicine, such as Siwu Erlian Tang (Four Substances and Two Lotus Herbs Decoction) or Liuwei Dihuang Tang (Six Ingredient Pill with Rehmannia), to correct the imbalance, ensures recovery. He acted as if he hadn't heard, serving as a drumbeat warning to demonstrate the teaching of disdain for the unworthy.