《活人书》论伤寒小儿、大人治法∶一般但小分剂,药性差凉耳。问∶喘者,何也?伤寒喘只有太阳、阳明二证。
太阳病,头疼发热,身疼恶风,无汗而喘者,宜汗,属麻黄汤(桂枝证医反下之,利遂不止,脉促者,表未解也。喘
而汗出者,葛根黄芩黄连汤也。太阳病下之,微喘者,表未解故也,桂枝加浓朴杏子汤也。发汗后不可更行桂枝汤,汗
出而喘,无大热者可,与麻黄杏子甘草石膏汤。)阳明病汗出不恶寒,腹满而喘有潮热者,宜下属承气汤。(然阳明病脉浮,
无汗而喘,发汗则愈,宜麻黄汤。)太阳与阳明合病,喘而胸满者,不可下,宜麻黄汤。又有发汗后饮水多,咳而微喘者,
以水停心下,肾气乘心,故喘也。小青龙去麻黄加杏仁也。小腹满者去麻黄加茯苓也。(又问麻黄主喘,何故去之,失
治,心下有水而喘,不当汗也。小便不利,小腹满,故去麻黄加茯苓也。)
《小儿形证论》四十八候治热传伤寒歌∶
身热皆因积热生,至令潮热变伤寒。先除积热方成路,便作伤寒事转难。夹食夹惊须下积,办佗虚实与重看。喘虚
草下热当下,更与调荣患乃安。
此疾先潮热,后作伤寒,加喘气急,失调理,成惊难治也。先用南星丸(方见伤寒变疹门中)。或白丁香膏(方未
见),少使退潮热。如下尽热方调气,或虚惊,却与 丸一、二服(方见一切痫门中)。须用意调理而安。
《圣惠》治小儿伤寒,心胸烦闷,喘促。人参散方
人参(去芦头) 麻黄(去根节) 甘草(炙微赤,锉。各半两) 贝母(煨微黄) 杏仁(汤浸,去皮尖、双仁,
麸炒微黄。各一分)
上件药捣,粗罗为散。每服一钱,以水一小盏,煎至五分,去滓。不计时候,量儿大小分减温服。
《活人书》仲景麻黄汤方
麻黄(一两半,去节) 桂枝(一两) 甘草(半两,炙) 杏仁(三十五个,去皮尖)
上锉如麻豆大。每服抄五钱匕,水一盏半,煮至八分,去滓温服,覆取微汗,不须 粥。加减法∶伤寒热
病药性须凉,不可太温。夏至后,麻黄汤须加知母半两,石膏一两,黄芩一分。盖麻黄汤性热,夏月服之,
有发黄斑出之失,唯冬及春与病患;素虚寒者,乃用正方,不再加减。
《活人书》仲景葛根黄芩黄连汤
葛根(四两) 黄芩 黄连(各一两半) 甘草(炙,一两)
上锉如麻豆大。每服抄五钱匕,水一盏半,煮至八分,去滓温服。日二、三服。
《活人书》仲景桂枝加浓朴杏子汤
桂枝(去皮) 芍药(各一两) 甘草(六分三字) 杏仁(去皮尖,十七个) 浓朴(去皮,姜汁炙,六分三字)
上锉如麻豆大。每服抄五钱匕,生姜四片,枣子一个,煎至八分,去滓温服,覆取微汗。
《活人书》仲景麻黄杏子甘草石膏汤
麻黄(二两) 杏仁(二十五个,去皮尖) 石膏(四两,碎,绵裹) 甘草(一两,炙)
上锉如麻豆大。每服抄五钱匕,水一盏半,煮至八分,去滓温服。
《活人书》仲景大承气汤
大黄(二两,锦纹者去皮生用,酒洗过) 枳实(二枚半,炒,去瓤) 芒硝(一合半) 浓朴(四两,去皮,姜
汁炙)
上锉如麻豆大。每服抄五钱匕,以水二盏,煎至八分,去滓,然后入芒硝,更再煎一、二沸,放温服,以
利为度。未利,再作与服。
《活人书》仲景小青龙汤 方见伤寒咳嗽门中。
《活人书》论述伤寒在小儿和成人中的治法:大体相同,只是剂量较小,药性偏凉罢了。问:喘证是怎么回事?伤寒引起的喘只有太阳病和阳明病两种证型。
太阳病,出现头痛、发热、身体疼痛、恶风、无汗而喘的症状,适宜用发汗法治疗,属于麻黄汤证。(如果是桂枝汤证误用下法,导致腹泻不止,脉象急促的,说明表证未解;如果喘且出汗的,是葛根黄芩黄连汤证。太阳病误用下法后,轻微气喘的,是因为表证未解,应用桂枝加厚朴杏子汤。发汗后不可再用桂枝汤,如果汗出而喘,体内没有大热的,可用麻黄杏仁甘草石膏汤。)阳明病,出汗且不恶寒,腹部胀满而喘,伴有潮热的,适宜用攻下法治疗,属于承气汤证。(然而阳明病若脉浮,无汗而喘,发汗即可痊愈,宜用麻黄汤。)太阳与阳明合病,出现气喘且胸部胀满的,不可用攻下法,宜用麻黄汤。又有发汗后饮水过多,咳嗽且轻微气喘的,是因为水饮停聚在心下(胃脘部),肾气上乘于心,所以引起气喘。此时用小青龙汤去掉麻黄,加入杏仁。如果小腹胀满的,去掉麻黄,加入茯苓。(又问:麻黄主治喘证,为何要去掉它?这是因为失治导致心下有停水而喘,不应当发汗。因为小便不利,小腹胀满,所以去掉麻黄加入茯苓。)
《小儿形证论》中关于四十八候治疗热传伤寒的歌诀:
身体的发热都因积热而生,到了后来潮热变成了伤寒。先清除积热才走上正轨,若当作伤寒处理事情就难办了。夹带食积或惊风的必须攻下积滞,辨别其他虚实并仔细查看。喘证属虚者慎用攻下,热盛当下则当下,再调和营卫患体才能安宁。
此病先出现潮热,后转为伤寒,加上气喘气急,若调理不当,会形成惊风,难以治愈。先用南星丸(方剂见伤寒变疹门中)。或者白丁香膏(方剂未见记载),少量服用以退去潮热。如果热邪已尽则调理气机,若是虚惊,则给予某丸一两次服用(方剂见一切痫门中)。必须用心调理才能使患儿平安。
《圣惠方》治疗小儿伤寒,心胸烦闷,气喘急促的人参散方:
人参(去除芦头) 麻黄(去除根节) 甘草(炙至微红,锉碎。各半两) 贝母(煨至微黄) 杏仁(热水浸泡,去皮尖及双仁,麸炒至微黄。各一分)
以上药材捣碎,粗筛为散。每次服用一钱,用水一小盏,煎至五分,去渣。不分时候,根据患儿大小酌情减量,温服。
《活人书》仲景麻黄汤方:
麻黄(一两半,去节) 桂枝(一两) 甘草(半两,炙) 杏仁(三十五个,去皮尖)
以上药材锉如麻豆大小。每次取五钱匕,水一盏半,煮至八分,去渣温服,覆盖衣被取微汗,不需要喝粥助汗。加减法:伤寒热病的药性须偏凉,不可太温。夏至之后,麻黄汤须加知母半两,石膏一两,黄芩一分。因为麻黄汤性热,夏季服用,有导致发黄、出斑疹的过失,只有冬季及春季给病患使用;素体虚寒者,才使用原方,不再加减。
《活人书》仲景葛根黄芩黄连汤:
葛根(四两) 黄芩 黄连(各一两半) 甘草(炙,一两)
以上药材锉如麻豆大小。每次取五钱匕,水一盏半,煮至八分,去渣温服。每日二至三次服用。
《活人书》仲景桂枝加厚朴杏子汤:
桂枝(去皮) 芍药(各一两) 甘草(六分三字) 杏仁(去皮尖,十七个) 厚朴(去皮,姜汁炙,六分三字)
以上药材锉如麻豆大小。每次取五钱匕,生姜四片,枣子一个,煎至八分,去渣温服,覆盖衣被取微汗。
《活人书》仲景麻黄杏仁甘草石膏汤:
麻黄(二两) 杏仁(二十五个,去皮尖) 石膏(四两,捣碎,用绵布包裹) 甘草(一两,炙)
以上药材锉如麻豆大小。每次取五钱匕,水一盏半,煮至八分,去渣温服。
《活人书》仲景大承气汤:
大黄(二两,选用锦纹者,去皮生用,酒洗过) 枳实(二枚半,炒,去瓤) 芒硝(一合半) 厚朴(四两,去皮,姜汁炙)
以上药材锉如麻豆大小。每次取五钱匕,用水二盏,煎至八分,去渣,然后加入芒硝,再煎一二沸,放温服,以利下为度。若未通利,再次制作服用。
The *Huoren Shu* (Book of Vitality) discusses the treatment of Shanghan (Cold Damage) in both children and adults: generally the same, but with smaller dosages and cooler medicinal properties. Question: What is panting? Panting caused by Shanghan only presents as two syndromes: Taiyang (Greater Yang) syndrome and Yangming (Yang Brightness) syndrome.
In Taiyang syndrome, symptoms include headache, fever, body pain, aversion to wind, absence of sweating, and panting; it is appropriate to induce sweating, belonging to the Mahuang Tang (Ephedra Decoction) pattern. (If a Guizhi Tang (Cinnamon Twig Decoction) pattern is mistakenly treated with purgation, leading to persistent diarrhea and a rapid pulse, the exterior pathogen remains unresolved; if there is panting with sweating, it is the Gegen Huangqin Huanglian Tang (Kudzu, Scutellaria, and Coptis Decoction) pattern. If mild panting occurs after mistaken purgation in Taiyang syndrome, it is because the exterior is not resolved, so Guizhi Jia Houpo Xingzi Tang (Cinnamon Twig Decoction plus Magnolia Bark and Apricot Kernel) should be used. After inducing sweating, Guizhi Tang should not be administered again; if there is sweating with panting and no significant heat, Mahuang Xingzi Gancao Shigao Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction) may be given.) In Yangming syndrome, there is sweating without aversion to cold, abdominal fullness with panting, and tidal fever; purgation is appropriate, belonging to the Chengqi Tang (Purgative Decoction) pattern. (However, if Yangming syndrome presents with a floating pulse, absence of sweating, and panting, inducing sweating will lead to recovery, so Mahuang Tang is suitable.) When Taiyang and Yangming syndromes combine, presenting with panting and chest fullness, purgation is contraindicated, and Mahuang Tang is suitable. Additionally, if excessive water intake follows sweating, causing coughing and slight panting, this is due to fluid retention in the epigastrium (heart region), where Kidney Qi attacks the Heart, causing panting. Xiao Qinglong Tang (Minor Blue Dragon Decoction) should have Mahuang removed and Xingzi added. If there is lower abdominal fullness, remove Mahuang and add Fuling (Poria). (Another question: Since Mahuang treats panting, why remove it? This is because improper treatment led to fluid retention in the epigastrium causing panting, which should not be treated with sweating. Due to difficult urination and lower abdominal fullness, Mahuang is removed and Fuling is added.)
The song from *Xiao'er Xingzheng Lun* (Treatise on Infant Forms and Syndromes) regarding the treatment of forty-eight manifestations of heat transmitting into Shanghan:
Body heat arises from accumulated heat, eventually becoming tidal fever that transforms into Shanghan. First clear the accumulated heat to find the right path; treating it directly as Shanghan makes matters difficult. For cases complicated by food stagnation or fright, purge the stagnation; carefully distinguish other excess and deficiency patterns. For panting due to deficiency, avoid harsh purgation; for heat requiring purgation, purge it; then harmonize Ying (Nutritive) and Wei (Defensive) Qi, and the patient will be safe.
This disease first presents with tidal fever, then transforms into Shanghan, accompanied by panting and rapid breathing. If mishandled, it may develop into fright convulsions, which are difficult to treat. Initially use Nanxing Wan (Arisaema Pill) (formula seen in the Shanghan transforming into rash section). Or use Baidingxiang Gao (White Civet Cat Excrement Ointment) (formula not found), administered in small amounts to reduce tidal fever. Once the heat is exhausted, regulate Qi; if it is deficiency-fright, administer certain pills one or two doses (formula seen in the section on all types of epilepsy). Careful regulation is required for the patient to recover.
*Shenghui Fang* (Holy Wisdom Formulas) treats infant Shanghan with vexation, oppression in the chest and heart, and panting urgency. Formula for Renshen San (Ginseng Powder):
Renshen (Panax Ginseng Radix et Rhizoma, remove rhizome head) Mahuang (Ephedrae Herba, remove root joints) Gancao (Licorice Root, roasted until slightly red, crushed. Each half tael) Beimu (Fritillariae Bulbus, roasted until slightly yellow) Xingren (Prunus Armeniaca Semen, soaked in hot water, remove skin and tips, discard double kernels, stir-fried with bran until slightly yellow. Each one fen)
Crush the above herbs and sieve coarsely to make a powder. Take one qian per dose, with one small cup of water, decoct to five fen, remove dregs. Take at any time, adjusting the dose according to the child's age and size, warm administration.
*Huoren Shu* Zhongjing's Mahuang Tang formula:
Mahuang (Ephedrae Herba, one and a half taels, remove joints) Guizhi (Cinnamomi Ramulus, one tael) Gancao (Licorice Root, half tael, roasted) Xingren (Prunus Armeniaca Semen, thirty-five kernels, remove skin and tips)
Crush to the size of hemp seeds. Take five qian bi per dose, with one and a half cups of water, boil to eight parts, remove dregs, take warm. Cover to induce slight sweating; porridge is not needed. Modification rules: Medicinal properties for Shanghan heat diseases must be cool, not too warm. After the Summer Solstice, Mahuang Tang must add Zhimu (Anemarrhenae Rhizoma) half a tael, Shigao (Gypsum Fibrosum) one tael, and Huangqin (Scutellariae Radix) one fen. Because Mahuang Tang is hot in nature, taking it in summer can cause jaundice and macular eruptions; it is only used for patients in winter and spring; those with inherent deficiency-cold use the original formula without modifications.
*Huoren Shu* Zhongjing's Gegen Huangqin Huanglian Tang:
Gegen (Puerariae Lobatae Radix) Huangqin (Scutellariae Radix) Huanglian (Coptidis Rhizoma) (Each one and a half taels) Gancao (Licorice Root, roasted, one tael)
Crush to the size of hemp seeds. Take five qian bi per dose, with one and a half cups of water, boil to eight parts, remove dregs, take warm. Take two or three times daily.
*Huoren Shu* Zhongjing's Guizhi Jia Houpo Xingzi Tang:
Guizhi (Cinnamomi Ramulus, remove bark) Shaoyao (Paeoniae Radix Alba) (Each one tael) Gancao (Licorice Root, six fen three zhu) Xingren (Prunus Armeniaca Semen, seventeen kernels, remove skin and tips) Houpo (Magnoliae Officinalis Cortex, remove bark, roast with ginger juice, six fen three zhu)
Crush to the size of hemp seeds. Take five qian bi per dose, with four slices of fresh ginger and one jujube, decoct to eight parts, remove dregs, take warm. Cover to induce slight sweating.
*Huoren Shu* Zhongjing's Mahuang Xingzi Gancao Shigao Tang:
Mahuang (Ephedrae Herba, two taels) Xingren (Prunus Armeniaca Semen, twenty-five kernels, remove skin and tips) Shigao (Gypsum Fibrosum, four taels, crushed, wrapped in silk) Gancao (Licorice Root, one tael, roasted)
Crush to the size of hemp seeds. Take five qian bi per dose, with one and a half cups of water, boil to eight parts, remove dregs, take warm.
*Huoren Shu* Zhongjing's Da Chengqi Tang:
Dahuang (Rhei Radix et Rhizoma, two taels, select those with brocade patterns, remove skin, use raw, washed with wine) Zhishi (Immature Bitter Orange Fruit, two and a half pieces, stir-fried, remove pulp) Mangxiao (Natrii Sulfas, one he and a half) Houpo (Magnoliae Officinalis Cortex, four taels, remove bark, roast with ginger juice)
Crush to the size of hemp seeds. Take five qian bi per dose, with two cups of water, decoct to eight parts, remove dregs, then add Mangxiao, boil for one or two more boils, let cool to warm, take. Stop when bowel movement occurs. If not relieved, prepare another dose.
*Huoren Shu* Zhongjing's Xiao Qinglong Tang (Formula seen in the Shanghan cough section).