伤寒蕴要曰凡小儿伤寒则怕寒拘急发热合为一然在表昼夜不止直待汗出方解其恶寒必偎
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引衣鼻塞多涕是为表证宜微汗之解肌汤萧氏青龙汤败毒散之类恶寒而内实者必出头露面扬手
掷足掀衣气粗是为里证宜疏利之大柴胡汤四顺饮洗心散之类若头额冷手足凉口气冷面色黯淡
泻利青白是谓阴证宜与温之五积散理中汤之类重者四逆汤主之夹惊者因惊之时而又感寒邪或
因伤寒发热以致热极生风是热乘于心心主血脉心神易动为热所乘故发搐也慎勿与治惊之剂宜
疏解之王氏薄荷散人参羌和散之类甚者抱龙丸主之夹食者或先伤于寒后伤于食或先伤于食后
伤于寒以致发热气粗口中嗳气肚热腹胀上热下冷或大便酸 并宜解散次与消导甚则推荡之先
用败毒散后用藿香正气散加神曲麦芽棠球子砂仁香附之类内实者加枳实青皮不解者加软苗柴
胡芩连之类如不愈以大柴汤下之其疮疹发热又与正受伤寒不同但见腮赤烦躁多嚏呵欠烦闷悸
动昏倦耳鼻尖冷手足俱冷者是也其伤寒发热自表达里疮疹发热从里出外宜行温平之剂有大热
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解毒葛根汤参苏饮之类汤氏曰大凡小儿伤寒治法周岁以前热轻者服惺惺散周岁以后急须解表
微汗为妙须在一昼夜得热退方保无虞今之医士多不表汗致令五六日不除入于经络搏于血气传
变多证或生惊风渐至危笃伤生害命可不慎乎
《伤寒蕴要》说：凡是小儿患伤寒，怕冷、肢体拘急、发热这三种症状通常同时出现。然而，病邪在表时，恶寒昼夜不止，直到出汗后才会解除。其恶寒的表现一定是依偎在人身边、蜷缩身体、拉紧衣服、鼻塞且多鼻涕，这属于表证，适宜用微汗法治疗，可选用解肌汤、萧氏青龙汤、败毒散之类的方剂。如果恶寒且体内有实邪（里实证），一定表现为头露在外面、手扬脚踢、掀开衣服、呼吸粗重，这属于里证，适宜用疏泄通下的方法治疗，可选用大柴胡汤、四顺饮、洗心散之类的方剂。如果头额发冷、手脚冰凉、口气冷、面色黯淡无光、腹泻且大便青白色，这称为阴证，适宜用温法治疗，可选用五积散、理中汤之类的方剂；病情严重的，以四逆汤为主治方。
夹惊者，是因为受惊的同时又感受了寒邪，或者因为伤寒发热导致热极生风，这是热邪侵犯心脏，心主血脉，心神容易受扰动，被热邪乘袭所以发生抽搐。千万不要给予治疗惊风的药剂，适宜用疏解的方法，可选用王氏薄荷散、人参羌活散之类的方剂；病情严重的，以抱龙丸为主治方。
夹食者，或者是先伤于寒后伤于食，或者先伤于食后伤于寒，导致发热、呼吸粗重、口中嗳气、肚子发热、腹胀、上身热下身冷，或者大便酸臭，都适宜先用解散表邪的方法，随后再用消食导滞的方法；病情严重的则用推荡攻下的方法。先用败毒散，后用藿香正气散加入神曲、麦芽、棠球子、砂仁、香附之类的药物；体内有实邪的加入枳实、青皮；不解表的加入软苗柴胡、黄芩、黄连之类的药物；如果还不愈，用大柴胡汤攻下它。
至于疮疹发热，又与普通的伤寒不同。只要见到腮部发红、烦躁、多打喷嚏、呵欠、烦闷、心悸、昏倦、耳鼻尖冷、手脚都冷的，就是疮疹发热。伤寒发热是从体表传入体内，疮疹发热是从体内透发到体表，适宜使用温和平和的药剂。如果有大热，适宜用解毒的方法，可选用葛根汤、参苏饮之类的方剂。
汤氏说：大凡小儿伤寒的治疗方法，一周岁以前热势轻的服用惺惺散；一周岁以后急需解表，微汗为妙，必须在一昼夜内热退，才能保全无忧。现在的医生大多不进行解表发汗，导致五六天病邪不除，进入经络，搏结于血气，传变出多种证候，或者产生惊风，逐渐发展到危重地步，伤害生命，怎么能不谨慎呢？
*Shanghan Yunyao* (Summary of Cold Damage) states: In pediatric cases of cold damage, aversion to cold, limb stiffness/tension, and fever typically occur together. However, when the pathogen is in the exterior, aversion to cold persists day and night until sweating occurs, at which point it resolves. The manifestation of aversion to cold involves cuddling close to others, curling up the body, pulling clothes tight, nasal congestion, and excessive runny nose; this constitutes an exterior syndrome. It is appropriate to treat with mild diaphoresis using formulas such as Jieji Tang (Muscle-Relieving Decoction), Xiao Shi Qinglong Tang (Xiao's Green Dragon Decoction), or Baidu San (Poison-Detoxifying Powder). If there is aversion to cold accompanied by interior excess, the patient will likely expose their head and face, wave hands and kick feet, throw off clothes, and exhibit coarse breathing; this constitutes an interior syndrome. It is appropriate to treat with purgation and drainage using formulas such as Daxiehu Tang (Major Bupleurum Decoction), Sishun Yin (Four-Compliance Drink), or Xixin San (Washing Heart Powder). If the forehead is cold, hands and feet are cold, breath is cold, complexion is dull and dark, and diarrhea presents with greenish-white stool, this is termed a Yin syndrome. It is appropriate to treat with warming methods using formulas such as Wuji San (Five Accumulations Powder) or Lizhong Tang (Regulate the Middle Decoction); for severe cases, Sini Tang (Frigid Extremities Decoction) is the primary treatment.
Cases complicated by fright arise because the child was frightened while simultaneously contracting cold pathogens, or because high fever from cold damage leads to extreme heat generating wind. This represents heat invading the Heart; since the Heart governs blood vessels and the Shen (Spirit) is easily disturbed, the invasion of heat causes convulsions. One must not administer medications intended for treating fright directly; instead, dispersing and resolving methods are appropriate, using formulas such as Wangshi Bohe San (Wang's Mint Powder) or Renshen Qianghuo San (Ginseng and Notopterygium Powder); for severe cases, Baolong Wan (Embracing Dragon Pill) is the primary treatment.
Cases complicated by food stagnation may result from cold injury followed by food injury, or food injury followed by cold injury, leading to fever, coarse breathing, belching, abdominal heat, abdominal distension, upper body heat with lower body coldness, or sour-smelling stools. These should initially be treated with dispersing methods, followed by digestion-promoting and stagnation-resolving methods; for severe cases, pushing-down purgative methods are used. Initially use Baidu San (Poison-Detoxifying Powder), followed by Huoxiang Zhengqi San (Agarweed Harmonizing Qi Powder) added with Shenqu (Medicated Leaven), Maiya (Sprouted Barley), Tangqiuzi (Crataegus Fruit), Sharen (Amomum Fruit), and Xiangfu (Cyperus Rhizome); if interior excess exists, add Zhishi (Immature Bitter Orange) and Qingpi (Aged Tangerine Peel); if the exterior is not resolved, add Ruanmiao Chaihu (Soft-stemmed Bupleurum), Huangqin (Scutellaria Root), and Huanglian (Coptis Rhizome); if still unresolved, purge with Daxiehu Tang (Major Bupleurum Decoction).
Regarding fever from chancres/rashes, it differs from ordinary cold damage. Signs include red cheeks, irritability, frequent sneezing, yawning, mental restlessness, palpitations, drowsiness, coldness at the tips of the ears and nose, and coldness in both hands and feet. Fever from cold damage transmits from the exterior to the interior, whereas fever from chancres/rashes emerges from the interior to the exterior. Therefore, mild and neutral agents are appropriate. For high fever, detoxification is appropriate, using formulas such as Gegen Tang (Kudzu Decoction) or Shensu Yin (Ginseng and Perilla Drink).
Dr. Tang states: Generally, the treatment method for pediatric cold damage is as follows: for children under one year old with mild heat, Xingxing San (Awakening Spirit Powder) is administered; for those over one year old, immediate exterior resolution with mild sweating is ideal. Heat must subside within one day and night to ensure safety. Many contemporary physicians fail to induce sweating, allowing the pathogen to persist for five to six days, enter the meridians, contend with blood and qi, transform into various syndromes, or generate wind-stroke, gradually progressing to critical conditions and endangering life. How can one not be cautious?