《全婴方》小儿每早食后发热,夜则凉,世医多谓虚劳,或为疳热,不知此血热
证也,宜龙胆丸、地黄膏、之类,时时与服节瘥。
接∶《全婴方》所云血热者,巳午发热,遇夜则凉,与东垣所谓夜则发热,昼
则明了,不同,然东垣所云血热者,指阴虚而生内热也,夜则发热,昼则明了,
取其昼阳夜阴也,郑氏所云血热者,指小儿血盛实而言也,盖谓巳午者,心火用
事之时也,心主血,血气行至巳午,则阳气盛,阳气与正气相搏,故至期而发热,
非其时者,非血热也。
〔薛〕一小儿寅卯时发热,或兼搐有痰。服抱龙、泻青、二丸而愈。后复患,服
前药兼咳嗽气喘,不时发搐,面赤色,或青黄,或浮肿,或流涎。予谓咳嗽气喘脾
肺气虚也,不时发搐肝木乘脾也,面青黄肝入心脾也,浮肿流涎脾气虚也。用益智
丸以养心血,补中益气汤以补脾气而愈。一小儿巳午时发热惊悸,发时形气倦怠,
面黄懒食,流涎饮汤。予谓心气不足所致。不信,反服凉心之药,更加吐泻,睡而
露睛,手足并冷,几至慢脾风。先用六君姜桂汤佐以地黄丸而愈。一小儿申酉时发
热面赤,腹中作痛,或用峻利之剂下之,致发搐吐痰,作渴腹痛,按之即止。此脾
胃伤而变证也。用七味白术散、补中益气汤顿安。
龙胆丸 治小儿食后多发热,或夜则凉,此血热证。疳热皆可治。
宣黄连(去毛) 赤芍药(各半两) 草龙胆(去苗) 青皮(去穣。各二钱半) 槟榔(一个大者)
麝香(少许)
上为末。猪胆汁少入面糊为丸,萝卜子大。每三、二十丸,米饮,空心服。
六合汤 治小儿血热,每日巳午间发热,遇夜则凉。
当归 大黄 川芎 熟地黄
上为末。三岁一钱,水半盏,煎至三分,无时服。
猪胆丸 治小儿每日早饭后发热,夜则身凉,此血热也。
胡黄连(二钱半) 宣黄连 赤芍药(各半两)
上为末,猪胆汁和成剂,入在胆中悬,用浆水煮熟,取出,饭为丸,如豆大。
三岁三十丸,米汤送下,日三服,无时。
《全婴方》记载:小儿每天早晨进食后出现发热,到了夜晚则体温恢复正常(凉爽),世俗医生大多将其诊断为虚劳,或者认为是疳积发热,却不知道这实际上是血热证,适宜服用龙胆丸、地黄膏等药物,经常给予服用以逐渐痊愈。
按语:《全婴方》所说的血热证,表现为巳时、午时(上午9点至下午3点)发热,遇到夜晚则凉爽,这与李东垣所说的“夜间发热,白天神志清醒”不同。然而,李东垣所说的血热证,指的是阴虚而生内热,即夜间发热、白天清醒,这是取法于昼为阳、夜为阴的理论;郑氏所说的血热证,指的是小儿气血充盛且实邪内蕴而言。大概因为巳时、午时是心火当令的时候,心主血脉,气血运行至巳午之时,阳气旺盛,阳气与正气相互搏结,所以到这个时候就会发热,如果不是这个时辰发热,就不是血热证。
〔薛己〕有一个小儿在寅时、卯时(凌晨3点至上午7点)发热,有时兼有抽搐和痰多。服用抱龙丸、泻青丸两种药丸后痊愈。后来再次患病,服用前药并伴有咳嗽气喘,不时发生抽搐,面色红赤,或呈青色、黄色,或面部浮肿,或流口水。我认为咳嗽气喘是由于脾肺气虚所致,不时抽搐是肝木乘克脾土,面色青黄是肝气传入心和脾,浮肿流涎是脾气虚弱。于是使用益智丸来滋养心血,用补中益气汤来补益脾气,从而痊愈。另一个小儿在巳时、午时发热并惊悸,发作时形体和气力倦怠,面色发黄,懒于进食,流口水,想喝热汤。我认为这是心气不足所致。家属不信,反而服用清心凉药,导致更加严重的呕吐腹泻,睡觉时眼睛半睁(露睛),手脚都冰冷,几乎发展成慢脾风。先用六君姜桂汤辅助以地黄丸而痊愈。还有一个小儿在申时、酉时(下午3点至晚上7点)发热面红,腹部疼痛,有人用峻猛的泻下剂攻下,导致发生抽搐、吐痰、口渴腹痛,按压腹部疼痛就停止。这是脾胃受伤而产生的变证。使用七味白术散、补中益气汤顿服而安。
龙胆丸:治疗小儿进食后容易发热,或者夜间身体凉爽,这是血热证。疳积发热也可以治疗。
宣黄连(去毛)、赤芍药(各半两)、草龙胆(去苗)、青皮(去瓤,各二钱半)、槟榔(一个大者)、麝香(少许)。
以上药材研为细末。加入少量猪胆汁和面糊制成丸药,大小如萝卜子。每次服用三二十丸,米汤送服,空腹服用。
六合汤:治疗小儿血热,每天巳时、午间发热,遇到夜晚则凉爽。
当归、大黄、川芎、熟地黄。
以上药材研为细末。三岁儿童服用一钱,用水半盏,煎至三分量,随时服用。
猪胆丸:治疗小儿每天早饭后发热,夜间身体凉爽,这是血热证。
胡黄连(二钱半)、宣黄连、赤芍药(各半两)。
以上药材研为细末,用猪胆汁调和成剂状,放入猪胆中悬挂起来,用浆水煮熟,取出,用米饭做丸,大小如豆粒。三岁儿童服用三十丸,米汤送下,每日三次,随时服用。
Quan Ying Fang records: When infants experience fever after eating in the morning every day, and their body temperature returns to normal (cool) at night, worldly physicians mostly diagnose it as deficiency consumption (Xu Lao), or consider it to be heat from malnutrition (Gan Re). They fail to realize that this is actually a syndrome of blood heat. It is appropriate to administer Long Dan Wan (Gentian Pill) and Di Huang Gao (Rehmannia Paste), giving them frequently until gradual recovery occurs.
Commentary: The "blood heat" mentioned in Quan Ying Fang refers to fever during Si and Wu hours (9:00 AM - 3:00 PM), with coolness at night. This differs from Li Dongyuan's description of "fever at night and clarity during the day." However, Li Dongyuan's concept of blood heat refers to internal heat generated by Yin deficiency, where fever occurs at night and clarity prevails during the day, aligning with the theory that day is Yang and night is Yin. Zheng's concept of blood heat refers to infants having abundant Qi and Blood with excess pathogenic factors. Specifically, Si and Wu hours are when Heart Fire is dominant. Since the Heart governs Blood, when Qi and Blood circulate to these hours, Yang Qi becomes vigorous. The struggle between Yang Qi and Healthy Qi causes fever at this specific time. Fever occurring outside these hours is not due to blood heat.
[Xue Ji] An infant experienced fever during Yin and Mao hours (3:00 AM - 7:00 AM), sometimes accompanied by convulsions and phlegm. After administering Bao Long Wan (Dragon-Holding Pill) and Xie Qing Wan (Drain Green Pill), the condition resolved. Later, the illness recurred. After taking the previous medicines, the infant developed cough and wheezing, frequent convulsions, red face, or faces turning cyan, yellow, or puffy, and drooling. I reasoned that cough and wheezing resulted from Spleen and Lung Qi deficiency; frequent convulsions indicated Liver Wood overacting on Spleen Earth; cyan-yellow complexion suggested Liver Qi affecting Heart and Spleen; puffiness and drooling indicated Spleen Qi deficiency. Thus, I used Yi Zhi Wan (Wisdom Pill) to nourish Heart Blood, and Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) to tonify Spleen Qi, resulting in recovery.
Another infant experienced fever and palpitations during Si and Wu hours. During episodes, the infant showed physical fatigue, sallow complexion, anorexia, drooling, and a desire for hot drinks. I attributed this to insufficient Heart Qi. The family disagreed and administered Heart-cooling medicines instead, worsening vomiting and diarrhea. The infant slept with eyes partially open (exposing the pupils), and extremities became cold, nearly developing into Slow Spleen Wind (Man Pi Feng). I first treated with Liu Jun Jiang Gui Tang (Six-Ingredient Decoction with Ginger and Cinnamon) assisted by Di Huang Wan (Rehmannia Pill), leading to recovery.
A third infant experienced fever and facial flushing during Shen and You hours (3:00 PM - 7:00 PM), with abdominal pain. Someone used harsh purgatives to drain the bowels, causing convulsions, phlegm expectoration, thirst, and abdominal pain that ceased upon pressure. This was a complication arising from damaged Spleen and Stomach. Administering Qi Wei Bai Zhu San (Seven-Ingredient Atractylodes Macrocephala Powder) and Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) provided immediate relief.
Long Dan Wan (Gentian Pill): Treats infants prone to fever after meals or feeling cool at night, indicating a blood heat syndrome. It also treats Gan heat (malnutrition heat).
Xuan Huang Lian (Scutellariae Radix, de-haired), Chi Shao Yao (Paeoniae Radix Rubra) (each 1.5 liang); Cao Long Dan (Gentianae Radix, de-rooted); Qing Pi (Citri Reticulatae Pericarpium Viride, de-albedo) (each 2.5 qian); Bing Lang (Arecae Semen, one large fruit); She Xiang (Moschus) (a small amount).
Grind all ingredients into fine powder. Add a small amount of Porcis Bile (Zhu Dan Zhi) and wheat paste to form pills, sized like radish seeds. Take 30-20 pills each time, washed down with rice drink, on an empty stomach.
Liu He Tang (Six-Harmony Decoction): Treats infant blood heat, characterized by fever during Si and Wu hours daily, with coolness at night.
Dang Gui (Angelicae Sinensis Radix); Da Huang (Rhei Radix et Rhizoma); Chuan Xiong (Chuanxiong Rhizoma); Shu Di Huang (Rehmanniae Radix Praeparata).
Grind into powder. For a three-year-old, take 1 qian, decoct with half a cup of water until reduced to one-third volume. Take at any time.
Zhu Dan Wan (Porcine Bile Pill): Treats infants who develop fever after breakfast and feel cool at night, indicating blood heat.
Hu Huang Lian (Coptidis Rhizoma or Scutellariae Radix variant, 2.5 qian); Xuan Huang Lian (Scutellariae Radix); Chi Shao Yao (Paeoniae Radix Rubra) (each 1.5 liang).
Grind into powder. Mix with Porcine Bile (Zhu Dan Zhi) to form a paste. Hang inside a pig gallbladder, cook thoroughly using fermented grain water (Jiang Shui), then remove. Form pills using rice flour, sized like beans. For a three-year-old, take 30 pills, washed down with rice gruel, three times daily, at any time.