经曰∶太阳中热, 是也。其证初起,面垢身热自汗,烦躁不安,唇舌皆赤,气出如
火,小便赤涩,口中大渴。此证常见夏秋。
按∶此条在藜藿之儿多有之,以其坐卧烈日之中,澡浴寒涧之内,以致暑气入里,内热外寒,故见以前诸证。
医者见其身热自汗,口渴烦躁,疑为惊风,妄用风药,反燥其血,以致心中噎闷,昏不知人,甚则反张搐搦,
皆由血不荣筋,烦热过甚之故也。若膏粱之儿,不涉长途,不经酷日,暑证尚少,何有暑风?若谓高堂广厦,口
餐生冷,身纳风凉而得之者,即伤寒之类,又何暑之可称?
古人谓暑伤心,其实心不可伤,伤之必死。盖心为君主之官,虚灵湛寂,神性居之,邪不易犯。止因六气
之中,以暑配君火,故曰暑伤心,然所犯者心包络耳。包络为心之宫阙,捍蔽外邪,不容轻侮,惟由暑热摇撼
外郭,故神志为之昏惑。但泻其太阳丙火,则少阴君主神志自宁矣。宜却暑丹。
却暑丹 治小儿伤暑,误用风药,致心神昏闷,烦躁不安,甚则搐搦。
漂白术(五钱) 白茯苓(五钱) 洁猪苓(五钱) 宣泽泻(五钱) 青化桂(二钱) 片黄芩(五钱)
正川连(三钱) 镜辰砂(二钱) 炙甘草(五钱)
上为细末,炼蜜为丸,如芡实大。每服二三丸,量儿大小加减,麦冬汤化服。或十中取一,煎服亦可。
《黄帝内经》说:太阳经受中热邪气,就是暑病。其症状在初起时,表现为面色垢浊、身体发热、自然出汗、烦躁不安、嘴唇和舌头都发红、呼出的气息像火一样烫、小便颜色深且排尿涩痛、口中极度口渴。这种病症常见于夏季和秋季。
按语:这一条所述的情况,在平民百姓家的孩子身上多有发生,因为他们坐在烈日之下,或在寒冷的溪涧中洗澡,导致暑气侵入体内,形成内热外寒的病理状态,所以出现上述各种症状。
医生看到患儿身体发热、自然出汗、口渴烦躁,便怀疑是惊风(小儿惊厥),胡乱使用祛风药物,反而使血液干燥,导致心中噎塞闷痛、昏迷不省人事,甚至出现角弓反张、抽搐痉挛等症状,这都是因为血液不能濡养筋脉,以及烦热过甚的缘故。如果是富贵人家的孩子,不经历长途跋涉,不经过酷日暴晒,患暑病的还很少,哪里会有“暑风”呢?如果说是在高大宽敞的厅堂里,饮食生冷,身体感受风寒凉气而得病的,这属于伤寒之类的疾病,又怎么能称为暑病呢?
古人说暑邪伤害心脏,其实心脏不会被直接伤害,一旦受伤必然死亡。因为心是君主之官,空虚灵明、清澈寂静,神志居住在其中,邪气不容易侵犯。只是因为六气(风、寒、暑、湿、燥、火)之中,将暑与君火相配,所以说“暑伤心”,但实际上受侵犯的是心包络(保护心脏的外围组织)。心包络是心的宫阙,抵御并遮蔽外邪,不容轻视侮辱,只是由于暑热摇撼了外围屏障,所以神志因此变得昏乱迷惑。只要清泻太阳经的丙火(小肠之火/实火),那么少阴经的君主之神志自然就能安宁了。适宜使用却暑丹。
却暑丹:治疗小儿伤暑,误用祛风药,导致心神昏闷、烦躁不安,甚至出现抽搐痉挛。
漂白术(五钱) 白茯苓(五钱) 洁猪苓(五钱) 宣泽泻(五钱) 青化桂(二钱) 片黄芩(五钱) 正川连(三钱) 镜辰砂(二钱) 炙甘草(五钱)
以上药材研成细末,用炼蜜制成丸药,大小如芡实。每次服用二三丸,根据患儿年龄大小增减用量,用麦冬汤送服化开。或者取其中一两味药煎汤服用也可以。
The *Yellow Emperor's Inner Classic* states: "Taiyang (Bladder/Governing Vessel channel) suffering from heat evil" refers to this condition. The initial symptoms include a greasy appearance of the face, fever, spontaneous sweating, restlessness and irritability, redness of the lips and tongue, breath that feels like fire, dark and scanty or painful urination, and extreme thirst in the mouth. This syndrome is commonly seen in summer and autumn.
Commentary: This description applies frequently to children from commoner families, as they sit under the scorching sun or bathe in cold streams, causing summer-heat to penetrate inward. This results in internal heat with external cold, manifesting as the aforementioned symptoms.
When physicians observe fever, spontaneous sweating, thirst, and irritability, they may suspect infantile convulsion (Jing Feng) and recklessly administer wind-dispelling herbs. This inadvertently dries up the blood, leading to chest oppression, coma, and even opisthotonos (back arching) and spasms. These complications arise because the blood fails to nourish the sinews due to excessive irritant heat. For children of wealthy families who do not endure long journeys or exposure to intense sun, summer-heat syndromes are rare; thus, where would "summer-heat wind" come from? If one claims that illness arises from living in spacious halls, consuming raw/cold foods, and being exposed to wind and cool air, such cases belong to Cold Damage (Shang Han) categories, and should not be termed summer-heat.
Ancients stated that summer-heat damages the Heart. In reality, the Heart itself cannot be damaged; if it were, death would ensue. The Heart is the Sovereign Official, characterized by emptiness, spirituality, clarity, and tranquility, housing the Shen (Spirit), making it resistant to pathogenic invasion. However, since summer-heat is paired with Ministerial Fire among the Six Qi (Wind, Cold, Summer-Heat, Dampness, Dryness, Fire), it is said that "summer-heat damages the Heart." Actually, what is invaded is the Pericardium (Xin Bao Luo). The Pericardium serves as the palace wall of the Heart, defending against external evils. It is not easily violated. Only when summer-heat shakes the outer defenses does the Shen become confused and disoriented. By clearing the Bing Fire of the Taiyang (Small Intestine channel), the Shen of the Shaoyin (Heart/Kidney channel) Sovereign will naturally calm. Que Shu Dan (Summer-Heat Repelling Pill) is indicated.
Que Shu Dan (Summer-Heat Repelling Pill): Treats pediatric summer-heat injury caused by the mistaken use of wind-dispelling herbs, resulting in mental confusion, chest oppression, restlessness, and potentially spasms.
Bai Zhu (Atractylodis Rhizoma, processed with bran) - 5 qian
Bai Fu Ling (Poria) - 5 qian
Zhu Ling (Polyporus) - 5 qian
Ze Xie (Alisma Rhizome) - 5 qian
Gui Zhi (Cinnamomi Ramulus) - 2 qian
Huang Qin (Scutellariae Radix) - 5 qian
Chuan Lian Zi / Huang Lian (Coptidis Rhizome) - 3 qian
Chen Sha (Cinnabar) - 2 qian
Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma, honey-fried) - 5 qian
Grind all ingredients into a fine powder. Form pills using refined honey, sized like Euryale seed (Qian Shi). Administer 2-3 pills per dose, adjusting according to the child's age and size, dissolved and taken with Mai Dong Tang (Ophiopogon Decoction). Alternatively, selecting one or two herbs from the formula for decoction is also acceptable.