钱氏曰小儿变蒸乃骨之余气自胸分入龈中作三十二齿而齿牙不及三十二数者由变不足其
常
也或二十八日即至长二十八齿又云小儿变蒸蜕齿者如花之易苗所谓不及三十二齿由变之不及
齿当与变日相合也年壮观齿方明齿生迟者乃禀受肾气不足即髓不强盖骨之所络而为髓不足故
不能充于齿所以齿生迟也故初生儿有重龈重 者由其血气不收敛成肉故颊里上有物如芦HT
盛
水状肿者名重 有着齿龈者名重龈治法当以绵缠长针留两处如粟米大以刺之令泄出血汁先用
淡盐汤洗拭次用一字散即愈
夫舌者心之候脾之脉络于舌者也脏腑壅滞心脾积热热气上冲故令舌肿渐渐胀大塞满口中
是为
木舌若不急疗必至害人宜用紫雪竹沥调服即愈重舌者亦心脾有热也盖心候于舌所主者血脾之
络脉出于舌下若心脾有热则血气俱盛附舌根而重生一物形如舌而短小也谓之重舌以真蒲黄和
黄柏末点之或牙硝亦可钱氏云脾脏微热令舌络微紧时时舒舌治勿用冷药及下之当少以泻黄散
渐服之亦或饮水者医疑为热必以冷药下之非也饮水者脾胃虚津液少也又加面黄肌瘦五心烦热
即为疳瘦宜加胡黄连丸辈大病者已用药弄舌者凶
化毒汤 治小儿解风热上攻咽喉肿痛乳食不便
桔梗(去芦炒五钱) 薄荷叶(二钱半) 荆芥穗 甘草(各二钱半) 山豆根(一钱半) 牙
硝(二钱) 硼砂(二钱) 朴硝(一钱) 雄黄(水飞) 朱砂(水飞各二钱)
上为极细末敷或温汤调不拘时候服少与含咽
甘桔汤 治小儿感冒风热火气熏逼痘疮蕴毒上攻咽喉肿胀痰气不顺咳嗽失音
人参(去芦五钱) 桔梗(蜜浸炒一两) 甘草(半生半炙五钱)
上锉散用水煎不拘时候
立效散 治小儿咽喉痹痛不能吞咽
硼砂 龙脑 雄黄 朴硝(各半钱)
上为极细末干掺
吹喉散 治小儿咽喉肿痛气塞不通
甘草(生二钱半) 朴硝(一两)
上为细末干掺咽喉中如肿甚者用小竹管吹入喉内
钱乙说:小儿的“变蒸”是骨骼之余气,从胸部分布进入牙龈中,形成三十二颗牙齿。如果牙齿数量不足三十二颗,是因为“变”的过程不足,属于常态。有的小儿在二十八天时就会长出二十八颗牙齿。又说小儿“变蒸”期间换牙,就像花更换幼苗一样。所谓牙齿不足三十二颗,是由于“变”的过程不够,牙齿的生长应当与“变蒸”的天数相吻合。等到年岁大、体格壮实之后,牙齿才完全长齐且清晰。牙齿生长迟缓,是因为禀受的肾气不足,导致骨髓不充盈。因为骨由髓所滋养,髓不足所以不能充实于牙齿,因此牙齿生长迟缓。
刚出生的婴儿如果有“重龈”或“重舌”,是因为其血气不能收敛形成肌肉,所以在脸颊内部上方有物体像芦管盛水那样肿胀,这种叫“重舌”;如果长在齿龈上的,叫“重龈”。治疗方法应当用绵丝缠绕长针,留出两处如粟米大小的位置进行刺破,放出血液和汁液。先用淡盐水清洗擦拭,然后使用一字散,即可痊愈。
舌是心的外候,脾的脉络联系于舌。如果脏腑壅滞,心脾积热,热气上冲,就会导致舌头肿胀,逐渐胀大塞满口腔,这叫做“木舌”。如果不紧急治疗,必定会危害生命。适宜用紫雪和竹沥调服,即可痊愈。“重舌”也是心脾有热所致。因为心对应于舌,主司血液;脾的络脉出于舌下。如果心脾有热,则气血都旺盛,附着在舌根处重新生出一个物体,形状像舌头但短小,这叫做“重舌”。可以用真蒲黄和黄柏末点涂患处,或者使用牙硝也可以。钱乙说:脾脏微热会导致舌络轻微紧绷,时时伸出舌头。治疗时不要用寒凉药及泻下药,应当少量服用泻黄散,逐渐调理。也有因饮水而致病的,医生误以为是热证,必然用寒凉药攻下,这是错误的。饮水者是因为脾胃虚弱,津液少。如果再加上面色发黄、肌肉消瘦、五心烦热,就是疳瘦病,适宜加用胡黄连丸之类的药物。大病中出现弄舌现象的,预后凶险。
化毒汤:治疗小儿感受风热,热气上攻咽喉,导致咽喉肿痛,乳食不便。
桔梗(去芦头,炒,五钱) 薄荷叶(二钱半) 荆芥穗 甘草(各二钱半) 山豆根(一钱半) 牙硝(二钱) 硼砂(二钱) 朴硝(一钱) 雄黄(水飞法处理) 朱砂(水飞法处理,各二钱)
以上药材研成极细末,外敷患处,或用温水调匀不拘时候服用,也可少量含咽。
甘桔汤:治疗小儿感冒风热,火气熏逼痘疮蕴毒上攻咽喉,导致咽喉肿胀,痰气不顺,咳嗽失音。
人参(去芦头,五钱) 桔梗(蜜浸后炒,一两) 甘草(一半生用,一半炙用,五钱)
以上切碎,用水煎煮,不拘时候服用。
立效散:治疗小儿咽喉痹痛,不能吞咽。
硼砂 龙脑 雄黄 朴硝(各半钱)
以上研成极细末,干掺患处。
吹喉散:治疗小儿咽喉肿痛,气塞不通。
甘草(生用,二钱半) 朴硝(一两)
以上研成细末,干掺咽喉中。如果肿胀严重,用小竹管将药粉吹入喉内。
Qian Yi stated: The "Bian Zheng" (periodic growth and transformation) in infants is the residual Qi of bones, which enters the gums from the chest region to form thirty-two teeth. If the number of teeth does not reach thirty-two, it is due to insufficient "Bian" (transformation), which is a normal variation. Some infants may grow twenty-eight teeth at twenty-eight days of age. It is also said that infants shed teeth during "Bian Zheng," similar to flowers replacing seedlings. The reason for having fewer than thirty-two teeth is that the process of "Bian" was inadequate; tooth eruption should correspond with the days of "Bian Zheng." Only when the child grows older and physically robust will the teeth fully erupt and become distinct. Delayed tooth eruption is caused by insufficient congenital Kidney Qi, leading to weak Marrow. Since bones are connected to Marrow, insufficient Marrow cannot nourish the teeth, resulting in delayed eruption.
Newborns who present with "Chong Yin" (double gum) or "Chong She" (double tongue) do so because their Blood and Qi fail to consolidate into muscle tissue. Consequently, there is a swelling inside the cheek resembling a reed tube filled with water, termed "Chong She"; if located on the gums, it is called "Chong Yin." The treatment involves wrapping a long needle with cotton, leaving two puncture points the size of millet grains to pierce the area, allowing blood and fluid to drain. First, cleanse with light salt water, then apply Yizi San (One-Character Powder), which leads to recovery.
The tongue is the external indicator of the Heart, and the Spleen's collaterals connect to the tongue. If Zang-Fu organs are obstructed and Heat accumulates in the Heart and Spleen, rising Heat causes the tongue to swell, gradually enlarging until it fills the mouth. This condition is known as "Mu She" (wooden tongue). Without urgent treatment, it can be fatal. It is appropriate to administer Zixue (Purple Snow) mixed with Zhuli (Bamboo Juice), which results in recovery. "Chong She" (double tongue) is also caused by Heat in the Heart and Spleen. The Heart corresponds to the tongue and governs Blood; the Spleen's collaterals emerge from under the tongue. If Heat exists in the Heart and Spleen, both Blood and Qi become excessive, attaching to the root of the tongue and forming a secondary mass resembling a small tongue, termed "Chong She." One may apply Zhen Puhuang (Real Cattail Pollen) mixed with Huangbai powder (Phellodendron Bark) to the site, or use Yanxiao (Niter) instead. Qian Yi stated: Mild Heat in the Spleen causes slight tightness in the tongue collaterals, leading to frequent protrusion of the tongue. Treatment should avoid cold medicines and purgatives; instead, Xiehuang San (Drain Yellow Powder) should be administered in small amounts gradually. There are cases where infants drink water excessively; physicians mistakenly attribute this to Heat and use cold purgatives, which is incorrect. Excessive drinking indicates deficiency of the Spleen and Stomach and scanty Body Fluids. If accompanied by sallow complexion, emaciation, and five-palm heat, it constitutes Ganshou (Gan syndrome with emaciation), and herbs such as Huhuanglian Wan (Coptis Pill) should be added. In severe illnesses, the appearance of "Nong She" (playing with the tongue) indicates a poor prognosis.
Huadu Tang (Toxin-Detoxifying Decoction): Treats pediatric wind-Heat attacking the throat, causing sore throat and difficulty feeding.
Jiegeng (Platycodon Root, de-lugged and stir-fried, 5 qian); Boheye (Mint Leaf, 2.5 qian); Jingjiesui (Schizonepeta Spike, 2.5 qian); Gancao (Licorice Root, 2.5 qian each); Shandougen (Sophora Tonkinensis Root, 1.5 qian); Yanxiao (Niter, 2 qian); Pengsha (Borax, 2 qian); Puxiao (Mirabilite, 1 qian); Xionghuang (Realgar, processed by water levigation, 2 qian); Zhusha (Cinnabar, processed by water levigation, 2 qian).
Grind all ingredients into an extremely fine powder. Apply externally or mix with warm water for oral administration at any time; alternatively, allow the child to hold and swallow small amounts.
Ganjie Tang (Glycyrrhiza and Platycodon Decoction): Treats pediatric wind-Heat invasion where Fire Qi harasses acne toxins, attacking the throat, causing swelling, phlegm obstruction, cough, and loss of voice.
Renshen (Ginseng Root, de-lugged, 5 qian); Jiegeng (Platycodon Root, honey-steeped and stir-fried, 1 liang); Gancao (Licorice Root, half raw and half honey-roasted, 5 qian).
Cut into pieces, decoct in water, and administer at any time.
Lixiao San (Instant-Efficacy Powder): Treats pediatric throat bi-pain preventing swallowing.
Pengsha (Borax); Longnao (Borneol); Xionghuang (Realgar); Puxiao (Mirabilite) (each 0.5 qian).
Grind into an extremely fine powder and sprinkle dry onto the affected area.
Chuihou San (Throat-Blowing Powder): Treats pediatric sore throat with qi obstruction.
Gancao (Raw Licorice Root, 2.5 qian); Puxiao (Mirabilite, 1 liang).
Grind into a fine powder and sprinkle dry into the throat. If swelling is severe, use a small bamboo tube to blow the powder into the throat.