八正散 方见卷四二便门。
承气汤 方见卷二伤寒门。
木香槟榔丸 方见卷三伤食门。
保和丸 方见卷三伤食门。
润肠丸 治老人虚人,小儿产妇,大便闭结。
火麻仁(去壳) 光杏仁(去皮) 光桃仁(去皮) 当归尾(酒润) 陈枳壳(以上各七钱五分) 金
井胶(炒) 萝卜子(炒) 家苏叶(以上各三钱)
共为细末,炼蜜为丸。每服一二钱,量人加减,白汤送下。
蜜导法 方见卷四二便门。
经曰∶头痛耳鸣,九窍不利,肠胃之所生也。小儿头囟之证,多由脾胃而得。又头为六阳所会,七窍居焉,
故小儿之头,四时宜凉,但见头热,即有病生,宜预防之。
解颅者,谓头缝开解而颅不合也。是由禀气不足,先天肾元大亏。肾主脑髓,肾亏则脑髓不足,故颅为之开
解。然人无脑髓,犹树无根,不过千日,则成废人。其候多愁少喜,目白睛多,而 白色。若成于病后者,尤
凶。宜久服地黄丸,外用封囟法。
囟肿者,囟门肿起也。脾主肌肉,若乳哺不常,饥饱无度,或寒或热,乘于脾家,致使脏腑不调,其气上冲,
为之填胀,囟突而高,如物堆垛,毛发短黄,骨蒸自汗。然亦有寒气冲上而肿者,则牢韧坚硬;热气冲上而肿者,则
柔软红色。然寒肿者十之一,热肿者十之九,更有因包裹严密,盖覆过浓,阳气不得外出,亦令赤肿,皆用封
囟法。热肿者泻青丸,寒肿者参苏饮。
囟陷者,有因泄泻久而气血虚弱,不能上充髓脑,故下陷如坑,此乃胃虚脾弱之极,宜急扶元气。若与枕骨
同陷者,百无一救。此中有禀受父精不足,母血虚羸而陷者,有因久病而陷者。然枕陷尤甚于囟陷,二者皆肾
元败绝之证也,俱参苓白术散或八味地黄丸。
天柱骨倒。小儿有色肥壮,不为瘦悴。孰知形体过肥,中气愈弱,是盛于外而歉于内也。忽然项软倾倒者,
此肝经风热也,小柴胡加粉葛、当归、白芍。
有因久病之后,或泄泻日久,忽然颈项倾侧,名天柱骨倒,最为危候。速救真元,大全大补汤加鹿茸。
有小儿生下颈便软者,胎气不足也。由禀父之肾元虚败,峻补先天,其庶几矣,补肾地黄丸与六君汤间服。
天柱骨倒之证,虽则三条,总系真阳大
败之候,为小儿之恶证。保救真元,是其大要,外以生筋等药贴之可也。
八正散:方剂见卷四“二便门”。
承气汤:方剂见卷二“伤寒门”。
木香槟榔丸:方剂见卷三“伤食门”。
保和丸:方剂见卷三“伤食门”。
润肠丸:用于治疗老年人、体虚者、小儿及产妇的大便闭结不通。
药材组成:火麻仁(去壳)、光杏仁(去皮)、光桃仁(去皮)、当归尾(用酒润湿)、陈枳壳(以上各七钱五分);金井胶(炒制)、萝卜子(炒制)、家苏叶(以上各三钱)。
制法与用法:将上述药材共研为细末,用炼蜜制成丸药。每次服用一二钱,根据患者具体情况增减剂量,用白开水送服。
蜜导法:方法见卷四“二便门”。
《内经》说:“头痛耳鸣,九窍不利,这是由肠胃功能失调所产生的。”小儿头囟部的病证,多因脾胃受损而引发。另外,头部是六条阳经汇聚之处,七窍位于头部,所以小儿的头部在四季中都宜保持清凉,只要发现头部发热,就说明有病邪产生,应当提前预防。
解颅:是指头骨缝裂开而头颅不能闭合。这是由于先天禀赋不足,肾元严重亏损所致。肾主司脑髓,肾亏则脑髓不足,因此颅骨会裂开。人如果没有脑髓,就像树木没有根一样,活不过一千天就会成为废人。其症状表现为多愁少喜,眼白部分较多,且面色㿠白。如果是因病后出现的解颅,病情尤为凶险。适宜长期服用地黄丸,并配合外用封囟法。
囟肿:是指囟门肿胀突起。脾主肌肉,如果哺乳不规律,饥饱无度,或寒热之邪侵袭脾脏,导致脏腑功能不调,气机上冲,致使囟门填胀突起,像物体堆叠一样高起,伴有毛发短黄、骨蒸潮热、自汗等症状。然而也有因寒气上冲而导致肿胀的,此时囟门坚硬牢固;有因热气上冲而导致肿胀的,此时囟门柔软发红。其中寒性肿胀占十分之一,热性肿胀占十分之九。此外,还有因为包裹过严、覆盖过厚,导致阳气无法外散,也会引起赤肿,这些情况都使用封囟法治疗。热性肿胀用泻青丸,寒性肿胀用参苏饮。
囟陷:有的因长期泄泻导致气血虚弱,不能向上充养髓脑,因此囟门下陷如坑,这是胃虚脾弱到了极点,应当紧急扶助元气。如果囟门与枕骨同时下陷,则百无一救。这种情况中,有的是因禀受父亲精气不足、母亲血液虚羸导致的下陷;有的是因久病导致的下陷。然而枕骨下陷比囟门下陷更为严重,两者都是肾元败绝的证候,均使用参苓白术散或八味地黄丸治疗。
天柱骨倒:有些小儿虽然形体肥壮,并不消瘦憔悴。殊不知形体过分肥胖,中气反而更加虚弱,这是外表盛实而内部亏虚的表现。忽然出现颈项软弱倾倒的,这是肝经风热所致,用小柴胡汤加粉葛、当归、白芍。
有的因久病之后,或长期泄泻,忽然出现颈项倾斜侧倒,称为天柱骨倒,这是最为危重的证候。需迅速挽救真元,使用大全大补汤加鹿茸。
有的小儿出生时颈项就软弱,这是胎气不足所致。由于禀受父亲的肾元虚败,需要峻补先天之本,这样或许还能救治,可间服补肾地黄丸与六君汤。
天柱骨倒的证候,虽然分为上述三种情况,但总归是真阳大败的征象,属于小儿的恶证。保全救助真元是其关键要点,外用生筋等药物贴敷也可以辅助治疗。
Ba Zheng San (Eight-Right Decoction): See the formula in Volume 4, Section on Disorders of Urination and Defecation.
Cheng Qi Tang (Purgative Decoction): See the formula in Volume 2, Section on Cold Damage.
Mu Lan Xing Lang Wan (Buddlea and Areca Pill): See the formula in Volume 3, Section on Food Stagnation.
Bao He Wan (Preserve Harmony Pill): See the formula in Volume 3, Section on Food Stagnation.
Run Chang Wan (Moisten Intestines Pill): Treats constipation in the elderly, debilitated individuals, children, and postpartum women.
Ingredients: Huomaren (Cannabis Seed), Guang Xingren (Apricot Kernel), Guang Taoren (Peach Kernel), Dangguiwei (Tail of Angelica Sinensis Root) moistened with wine; Chen Zhiqiao (Aged Aurantium Fructus) (all above at 7.5 qian); Jinjingjiao (Colla Corii Asini processed with specific water method), Luobozhongzi (Radish Seed), Jiayezhu (Perilla Leaf) (all above at 3 qian).
Preparation and Administration: Grind all ingredients into a fine powder, mix with refined honey to form pills. Take 1–2 qian per dose, adjusting according to the patient's condition, washed down with warm water.
Mi Dao Fa (Honey Suppository Method): See the method in Volume 4, Section on Disorders of Urination and Defecation.
The *Neijing* states: "Headache, tinnitus, and dysfunction of the nine orifices are generated by disorders of the stomach and intestines." Disorders of the fontanelle in children often arise from spleen and stomach pathology. Furthermore, the head is the convergence point of the six Yang meridians, where the seven orifices reside. Therefore, the child's head should remain cool throughout the four seasons; any sign of head heat indicates the presence of pathogenic factors, necessitating preventive measures.
Jie Lu (Splitting Skull): Refers to the separation of cranial sutures with failure of the skull to close. This results from congenital insufficiency and severe depletion of Kidney Yuan (Primordial Qi). The Kidney governs brain marrow; when the Kidney is deficient, brain marrow becomes insufficient, causing the skull to split open. Without brain marrow, a person is like a tree without roots, likely becoming disabled within a thousand days. Symptoms include melancholy, lack of joy, prominent whites of the eyes, and pale complexion. If occurring after an illness, it is particularly ominous. Long-term administration of Di Huang Wan (Rehmannia Pill) is indicated, combined with external application for sealing the fontanelle.
Xiong Zhong (Fontanelle Swelling): Refers to the swelling and protrusion of the anterior fontanelle. The Spleen governs muscles; irregular feeding, excessive hunger or fullness, or invasion of cold/heat pathogens into the Spleen can cause disharmony of the zang-fu organs. Qi rushes upward, filling and distending the fontanelle, making it protrude high like stacked objects, accompanied by short yellow hair, bone-steaming fever, and spontaneous sweating. However, swelling caused by cold qi rushing upward feels firm and hard; swelling caused by hot qi rushing upward feels soft and red. Cold-type swelling accounts for one-tenth, while hot-type swelling accounts for nine-tenths. Additionally, tight wrapping or excessive covering may trap Yang Qi, preventing its dispersion and causing redness and swelling. All these conditions are treated with methods to seal the fontanelle. Hot-type swelling is treated with Xie Qing Wan (Drain Green Pill); cold-type swelling is treated with Shen Su Yin (Ginseng and Perilla Decoction).
Xiong Xian (Fontanelle Depression): Some cases result from prolonged diarrhea leading to Qi and Blood deficiency, failing to nourish the brain marrow, causing the fontanelle to sink like a pit. This represents extreme deficiency of the Stomach and weakness of the Spleen, requiring urgent support of Yuan Qi. If both the fontanelle and the occiput are depressed, there is little hope of recovery. Causes include insufficient paternal essence and maternal blood deficiency, or prolonged illness. Depression of the occiput is more severe than that of the fontanelle; both indicate exhaustion of Kidney Yuan. Treatment involves Shen Ling Bai Zhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) or Ba Wei Di Huang Wan (Eight-Ingredient Rehmannia Pill).
Tian Zhu Gu Dao (Collapse of the Heavenly Pillar Bone): Some children appear robust and not emaciated. However, excessive corpulence indicates weaker Middle Qi, representing excess externally but deficiency internally. Sudden softness and collapse of the neck indicate Wind-Heat in the Liver Meridian, treated with Xiao Chai Hu Tang (Minor Bupleurum Decoction) plus Ge Gen (Kudzu Root), Dang Gui (Angelica Sinensis), and Bai Shao (White Peony Root).
In cases following prolonged illness or chronic diarrhea, sudden tilting of the neck is called Tian Zhu Gu Dao, a critical condition. Immediate rescue of True Yuan is required using Da Quan Da Bu Tang (Great Total Tonifying Decoction) plus Rong (Deer Antler).
Some infants have soft necks at birth due to insufficient fetal Qi, resulting from deficient and failing paternal Kidney Yuan. Severe tonification of the Congenital Foundation is needed for potential recovery; administer Bu Shen Di Huang Wan (Kidney-Tonifying Rehmannia Pill) and Liu Jun Tang (Six-Gentlemen Decoction) alternately.
Although Tian Zhu Gu Dao presents in three variations, it fundamentally signifies severe failure of True Yang and is a malignant syndrome in children. Preserving and rescuing True Yuan is paramount. External application of herbs such as Sheng Jin (Generate Tendons) may also be used.