久热也，疳热亦久，但兼面黄、吃炭土、鼻下烂也。《三因》小儿积热者，表
里俱热，遍身皆热，颊赤口干，小便赤，大便焦黄。先以四顺清凉饮子利动脏腑则
热去，既去复热者，内热已解、而表热未解也，当用惺惺散、红绵散、加麻黄微发
汗，表热乃去，表热去后又发热者何也。世医到此，尽不能晓，或再用凉药，或再
解表，或以谓不可医，误致夭伤者甚多。此表里俱虚，气不归元，而阳浮于外，所
以再发热，非热证也，只用六神散入粳米煎，和其胃气，则收阳归内，身体便凉，
热重者，用银白散。〔曾〕积热，眼胞浮肿，面黄足冷，发热从头，至肚愈甚，或
闻饮食之气，恶心及肠疼呕吐。治法，详载伤积论中。
按∶曾氏所谓积热，乃指腹中有癖而热，与久积之积不同，不妨并存之。
清凉饮子（里热） 惺惺散（痘疹）
红绵散
白僵蚕（炒，二两） 天麻（生用，一两） 南星（切薄片，油浸黄，二两） 苏木节
（另研，二两半）
上为末。每服一钱，水一小盏，入红绵少许，同煎至六分，温服。凡小儿风热，
头目不清，并宜服之。若伤寒有表证发热者，每服入去节麻黄末五分。有里热心
燥渴者，入滑石末半钱，同煎服之。
六神散
人参 白茯苓 干山药 白术 白扁豆 甘草（炙。各等分）
上为末。每服一大钱，水一小盏，枣一枚，姜二片，同煎至五分，服。此药用
处甚多，治胃冷，加附子。治风证，加天麻。治痢。加莺粟壳。
银白散
干山药 白术 白茯苓（各半两） 人参 白扁豆 知母 甘草（炙） 升麻（各等分）
上为末。每服一大钱，水一小盏，枣一枚，生姜二片，同煎，温服，不拘时候。
桃枝丸 疏取积热及结胸。又名桃符丸。
巴豆霜 大黄 黄柏（各一钱） 轻粉 砂（各半钱）
上细末，面糊丸，粟米大。煎桃枝汤下。一 儿五七丸，五七岁二三十丸。未
儿二三丸，临卧服。
栀豉饮子 治小儿畜热在中，身热狂躁，昏迷不食。
栀子仁（七枚） 豆豉（半两）
上用水三盏，煎至二盏，看多少服之，无时。或吐不吐，立效。
栀子汤 治小儿积热心脏，小便赤肿，口内生疮。
栀子仁 木通 当归尾 白芷（各二钱） 防风 甘草（各一钱）
上为细末。麦门冬煎汤送下。
三黄丸（里热）
〔曾〕玉露饮 治颊赤咽干，心烦躁，睡不稳，身热头痛。兼中暑发渴昏闷，小便不
通，惊气入肾，梦中切牙，加金珠散，薄荷汤、空心调服。
寒水石（中有细纹手可碎者） 石膏（洁白坚硬而有墙壁者。各一两） 甘草（三钱，晒干，
天阴火焙）
上，除前二味外，甘草锉晒或焙，同为细末。每服半钱至一钱，温汤，无时调
服。或麦门熟水。
益元散 解暑毒，利小便，理烦渴，除惊悸。
滑石（六两） 粉草（一两，细锉）
上二味，或晒或焙，研为细末。每服一钱至二钱，温热水，无时调服。凉水
亦可。
万安饮 推陈致新，除邪辅正，和益脾胃，宣通气血，调顺饮食，疏解风寒，宁心
化痰，去烦理热，不拘证在表里，并宜可投。常服，百病不生，真元益固，补养
诸虚，亦有奇验。此与《宣明论》当归饮相类不远，治法最多，其药品之外惟加枳壳、半夏。
人参（去芦） 当归（酒洗） 大黄（生用） 柴胡（去芦） 枳壳（去瓤炒） 半夏（炮裂）
芍药（洗净） 黄芩 防风（去芦） 甘草（十味各一两） 滑石末（六两）
上锉。除滑石末临入和匀。每服二钱，水一盏，姜二片，煎七分，无时温服。或加枣一枚同煎。
调胃散 桃枝丸取积热后服之。
人参（三钱） 白术（二钱半） 甘草（炙） 白茯苓 莺粟子（各一钱） 白附子（半分）
藿香 丁香（各半钱）
上为末。紫苏汤下半钱或一钱。
这是指长期的发热，疳积引起的发热也是长期的，但兼见面色发黄、吃炭土、鼻孔下方溃烂等症状。《三因方》中记载的小儿积热证，表现为表里俱热，全身发热，脸颊发红，口干，小便颜色深红，大便焦黄。先用四顺清凉饮子通利脏腑以去除热邪，如果热退后又复发，说明内热已解而表热未解，应当使用惺惺散、红绵散，加入麻黄轻微发汗，表热才能去除。表热去除后再次发热是什么原因呢？世间的医生到了这一步，全都不能理解，有的再用凉药，有的再解表，或者认为无法医治，导致许多患儿夭折或受伤的很多。这是因为此时表里俱虚，气不归元，阳气浮越于外，所以再次发热，这并不是热证，只需用六神散加入粳米煎煮，调和胃气，使阳气回归体内，身体就会凉爽；热势重的，用银白散。〔曾氏〕所说的积热，表现为眼睑浮肿，面色发黄，脚冷，发热从头开始，到腹部更加严重，或者闻到饮食的气味就恶心，以及肠痛呕吐。治疗方法，详细记载在伤积论中。
按语：曾氏所说的积热，是指腹中有癖块（积聚）而发热，与长期积滞的积不同，不妨并存这两种说法。
清凉饮子（用于里热） 惺惺散（用于痘疹）
红绵散
白僵蚕（炒制，二两） 天麻（生用，一两） 南星（切薄片，油浸至黄色，二两） 苏木节（另研细，二两半）
以上药物研为末。每次服用一钱，水一小盏，加入少许红绵，同煎至六分，温服。凡是小儿风热，头目不清爽，都适宜服用。如果有伤寒且有表证发热的，每次服用时加入去节麻黄末五分。有里热心燥口渴的，加入滑石末半钱，同煎服用。
六神散
人参 白茯苓 干山药 白术 白扁豆 甘草（炙。各等分）
以上药物研为末。每次服用一大钱，水一小盏，枣一枚，姜二片，同煎至五分，服用。此药用途很多，治疗胃冷，加附子。治疗风证，加天麻。治疗痢疾，加罂粟壳。
银白散
干山药 白术 白茯苓（各半两） 人参 白扁豆 知母 甘草（炙） 升麻（各等分）
以上药物研为末。每次服用一大钱，水一小盏，枣一枚，生姜二片，同煎，温服，不限时候。
桃枝丸 疏泄积聚之热及结胸。又名桃符丸。
巴豆霜 大黄 黄柏（各一钱） 轻粉 砂（各半钱）
以上研为细末，面糊为丸，如粟米大。用桃枝汤送下。未满月婴儿五七丸，五七岁儿童二三十丸。未满周岁婴儿二三丸，临睡前服用。
栀豉饮子 治疗小儿蓄热在中焦，身体发热狂躁，昏迷不食。
栀子仁（七枚） 豆豉（半两）
以上用水三盏，煎至二盏，根据病情多少服用，不限时候。无论是否吐出，立即见效。
栀子汤 治疗小儿积热在心经，小便赤肿，口内生疮。
栀子仁 木通 当归尾 白芷（各二钱） 防风 甘草（各一钱）
以上研为细末。用麦门冬煎汤送下。
三黄丸（用于里热）
〔曾氏〕玉露饮 治疗脸颊发红咽干，心烦急躁，睡眠不安，身体发热头痛。兼治中暑引起口渴昏闷，小便不通，惊气入肾，梦中磨牙，配合金珠散，薄荷汤空腹调服。
寒水石（中间有细纹用手可碎的） 石膏（洁白坚硬且有层理的。各一两） 甘草（三钱，晒干，阴天用火焙干）
以上，除前两种药物外，甘草锉碎晒干或焙干，一起研为细末。每次服用半钱至一钱，温开水，不限时候调服。也可以用麦门冬熟水。
益元散 解暑毒，利小便，理烦渴，除惊悸。
滑石（六两） 粉草（一两，细锉）
以上两种药物，或晒或焙，研为细末。每次服用一钱至二钱，温热水，不限时候调服。凉水也可以。
万安饮 推陈致新，除邪辅正，和益脾胃，宣通气血，调顺饮食，疏解风寒，宁心化痰，去烦理热，不拘证在表里，都适宜投用。常服，百病不生，真元益固，补养诸虚，也有奇效。这与《宣明论》中的当归饮相差不远，治疗方法最多，其药品之外只加了枳壳、半夏。
人参（去芦） 当归（酒洗） 大黄（生用） 柴胡（去芦） 枳壳（去瓤炒） 半夏（炮裂）
芍药（洗净） 黄芩 防风（去芦） 甘草（十味各一两） 滑石末（六两）
以上锉碎。除滑石末临用时加入和匀。每次服用二钱，水一盏，姜二片，煎至七分，不限时候温服。或者加枣一枚同煎。
调胃散 桃枝丸取积热后服用。
人参（三钱） 白术（二钱半） 甘草（炙） 白茯苓 罂粟子（各一钱） 白附子（半分）
藿香 丁香（各半钱）
以上研为末。紫苏汤送下半钱或一钱。
This refers to prolonged fever. Fever caused by gan accumulation (nutritional disorder due to chronic indigestion) is also prolonged, but it is accompanied by yellowish complexion, pica for charcoal or soil, and erosion under the nose. According to *San Yin Fang*, pediatric ji re (accumulated heat) syndrome presents with heat in both exterior and interior, generalized body heat, flushed cheeks, dry mouth, dark red urine, and scorched yellow stool. Initially, use Sishun Qingliang Yinzi (Four-Obedience Cooling Decoction) to purge the viscera and eliminate heat. If fever recurs after subsiding, it indicates that internal heat has resolved but external heat remains; one should use Xingxing San (Wonderful Powder), Hongmian San (Red Cotton Powder), add Mahuang (Ephedrae Herba) to induce slight sweating, so that external heat may be eliminated. Why does fever recur after external heat is gone? Physicians of the world often fail to comprehend this stage. Some administer cooling medicines again, some attempt to release the exterior again, or declare it incurable, leading to many cases of premature death or injury. This occurs because both exterior and interior are deficient, Qi fails to return to its origin, and Yang floats outward. Thus, recurrent fever is not a heat syndrome. One should only use Liushen San (Six-God Powder) with Jingmi (Oryzae Semen Japonicum) decocted to harmonize Stomach Qi, causing Yang to return inward, thereby cooling the body. For severe heat, use Yinbai San (Silver-White Powder). [Zeng] described ji re as presenting with swollen eyelids, yellowish face, cold feet, fever starting from the head and worsening towards the abdomen, nausea upon smelling food, intestinal pain, and vomiting. Treatment methods are detailed in the chapter on Injury Accumulation.
Note: Zeng's concept of ji re refers to heat arising from abdominal masses (pi accumulation), which differs from long-term stagnation accumulation; both descriptions can coexist.
Qingliang Yinzi (for Interior Heat) Xingxing San (for Smallpox/Measles)
Hongmian San
Baijiangcan (Stir-fried Bombyx Batryticatus, 2 liang) Tianma (Raw Gastrodiae Rhizoma, 1 liang) Nanting (Sliced, oil-soaked until yellow, Arisaematis Tuber, 2 liang) Sumujie (Separately ground, Su Mu Node, 2.5 liang)
Grind into powder. Take 1 qian per dose, decoct with 1 small cup of water and a little red cotton until reduced to 6 fen, take warm. Suitable for pediatric wind-heat causing unclear head and eyes. For Taiyang disease with exterior syndrome and fever, add 5 fen of Mahuang without nodes per dose. For interior heat with dryness and thirst, add 0.5 qian of Huashi (Talcum) powder per dose, decoct and take together.
Liushen San
Renshen (Ginseng Radix et Rhizoma) Baifuling (Poria, dried) Ganshanyao (Dioscoreae Rhizoma, dried) Baizhu (Atractylodis Macrocephalae Rhizoma) Baibiandou (Lablab Album Seed) Gancao (Licorice Root, honey-fried). Equal parts.
Grind into powder. Take 1 large qian per dose, decoct with 1 small cup of water, 1 jujube, and 2 slices of ginger until reduced to 5 fen, take. This medicine has many uses: for Cold Stomach, add Fuzi (Aconiti Lateralis Radix Preparata); for Wind syndromes, add Tianma (Gastrodiae Rhizoma); for dysentery, add Ying Sushe (Papaveris Pericarpium).
Yinbai San
Ganshanyao (Dioscoreae Rhizoma, dried) Baizhu (Atractylodis Macrocephalae Rhizoma) Baifuling (Poria). Each 0.5 liang. Renshen (Ginseng Radix et Rhizoma) Baibiandou (Lablab Album Seed) Zhimu (Anemarrhenae Rhizoma) Gancao (Licorice Root, honey-fried) Shengma (Cimicifugae Rhizoma). Equal parts.
Grind into powder. Take 1 large qian per dose, decoct with 1 small cup of water, 1 jujube, and 2 slices of fresh ginger, take warm, at any time.
Taozhi Wan (Peach Twig Pill) Disperses accumulated heat and Jie Xiong (chest binding). Also known as Taofu Wan.
Badoushuang (Crotonis Fructus Pulvis) Dahuang (Rhei Radix et Rhizoma) Huangbai (Phellodendri Cortex). Each 1 qian. Qingfen (Calomelas) Sha (Arsenicum Rubrum). Each 0.5 qian.
Grind into fine powder, make pills with wheat paste, size of millet seeds. Take with Taozhi Tang (Peach Twig Decoction). Infants under one month: 5-7 pills; children aged 5-7 years: 20-30 pills; infants under one year: 2-3 pills. Take before bed.
Zhichi Yinzi (Gardenia and Fermented Soybean Decoction) Treats pediatric heat retained in the Middle Jiao, manifesting as body heat, mania/restlessness, coma, and anorexia.
Zhizi Ren (Gardeniae Fructus Seed, 7 pieces) Douchi (Sojae Seminis Preparatum, 0.5 liang)
Decoct with 3 cups of water until reduced to 2 cups. Take appropriate amount based on condition, at any time. Effective whether vomiting occurs or not.
Zhizi Tang (Gardenia Decoction) Treats pediatric accumulated heat in the Heart meridian, manifesting as dark red and swollen urine, and oral ulcers.
Zhizi Ren (Gardeniae Fructus Seed) Mutong (Akebiae Caulis) Dangguiwei (Angelicae Sinensis Radix Tail) Baizhi (Angelicae Dahuricae Radix). Each 2 qian. Fangfeng (Saposhnikoviae Radix) Gancao (Licorice Root). Each 1 qian.
Grind into fine powder. Take with Maidong Tang (Ophiopogonis Decoction).
Sanhuang Wan (Three-Yellow Pill) (for Interior Heat)
[Zeng] Yulu Yin (Jade Dew Decoction) Treats flushed cheeks, dry throat, irritability, restless sleep, body heat, and headache. Also treats summerheat causing thirst, dizziness, and confusion, urinary retention, fright qi entering the Kidney, and teeth grinding in dreams. Combine with Jinzhu San (Gold Pearl Powder), take with Bohe Tang (Mentha Decoction) on an empty stomach.
Hanshuishi (Halloysitum Rubrum) (select those with fine lines that break easily by hand) Shigao (Gypsum Fibrosum) (select pure white, hard, and layered ones). Each 1 liang. Gancao (Licorice Root) (3 qian, sun-dried, or baked if cloudy).
Except for the first two herbs, process Gancao by chopping, sun-drying, or baking. Grind all into fine powder. Take 0.5 to 1 qian per dose, mixed with warm water, at any time. Or use Maidong Shui (Ophiopogonis Water).
Yiyuan San (Beneficial Origin Powder) Resolves summerheat toxicity, promotes urination, relieves烦渴 (restless thirst), and eliminates palpitations/fright.
Huashi (Talcum) (6 liang) Fengcao (Licorice Root, finely chopped) (1 liang)
Sun-dry or bake the two ingredients, grind into fine powder. Take 1 to 2 qian per dose, mixed with warm hot water, at any time. Cool water is also acceptable.
Wan'an Yin (Ten-Thousand Peace Decoction) Pushes out the old and generates the new, dispels evil and supports righteousness, harmonizes and benefits Spleen and Stomach, unblocks Qi and Blood, regulates diet, disperses wind-cold, calms the mind and resolves phlegm, removes vexation and clears heat. Suitable regardless of whether the syndrome is in the exterior or interior. Regular use prevents myriad diseases, consolidates True Yuan, and tonifies various deficiencies with remarkable efficacy. This is similar to Danggui Yin (Angelica Decoction) in *Xuanming Lun*. It has the most treatment variations; besides the standard herbs, it adds Zhike (Aurantii Fructus) and Banxia (Pinelliae Rhizoma).
Renshen (Ginseng Radix et Rhizoma, remove rhizome) Danggui (Angelicae Sinensis Radix, wine-washed) Dahuang (Rhei Radix et Rhizoma, raw) Chaihu (Bupleuri Radix, remove rhizome) Zhike (Aurantii Fructus, remove pulp and stir-fry) Banxia (Pinelliae Rhizoma, processed until cracked) Shaoyao (Paeoniae Radix, washed) Huangqin (Scutellariae Radix) Fangfeng (Saposhnikoviae Radix, remove rhizome) Gancao (Licorice Root). Ten ingredients, each 1 liang. Huashi Mo (Talcum Powder) (6 liang)
Chop the solid ingredients. Add Huashi Mo just before use and mix evenly. Take 2 qian per dose, decoct with 1 cup of water and 2 slices of ginger until reduced to 7 fen, take warm at any time. Alternatively, add 1 jujube and decoct together.
Tiaowei San (Regulate Stomach Powder) Taken after Taozhi Wan has cleared accumulated heat.
Renshen (Ginseng Radix et Rhizoma) (3 qian) Baizhu (Atractylodis Macrocephalae Rhizoma) (2.5 qian) Gancao (Licorice Root, honey-fried) Baifuling (Poria) Yingsuzi (Papaveris Semen). Each 1 qian. Baifuzi (Typhonii Rhizoma) (0.5 fen) Huoxiang (Agastaches Herba) Dingxiang (Caryophylli Flos). Each 0.5 qian.
Grind into powder. Take 0.5 or 1 qian, taken with Zisu Tang (Perillae Decoction).