禹铸曰。在汤头中更换药味。有宜不宜。犹文本上更换字眼。有妥不妥。一般更换字眼。有慧思鄙见之殊。更换药
味。亦有鄙见慧思之别。如范希文作子陵祠堂记。有歌曰。先生之德。时李太伯在座。以风字易德字。洵是慧思。李太
白诗。人烟寒橘柚。而黄鲁直以家园字易烟寒字。便是鄙见。至于医家用四物汤以补血。内有熟地。若心有火而血热。
以生地易熟地。却是慧思。若心无火。血不热。而亦以生地易熟地。便是鄙见。此等学问。只可与知者道。难与不知者
言也。业医道者。当留心焉。
禹铸曰。凡小儿病有百端。逃不去五脏六腑气血。症虽多怪。怪不去虚实寒热风痰。病纵难知。瞒不过颜色苗窍。
症即难辨。莫忽略青白红黄。面上之颜色苗窍。乃脏腑气血发出来的。颜色之红黄青白。乃寒热虚实献出来的。业医者。
能于此处做工夫。便得吾家之秘诀。
\r面各穴图\p03-b28a1.bmp\r
推法。用葱姜煎汁浸染医人大指。先从眉心向额上。推至二十四数。
次从眉心分推。至太阳太阴九数。
再自天庭至承浆各穴。掐一下。以代针法。
再于大阳太阴。或发汗。或止汗。
再将两耳下垂尖捻而揉之。
又将两手捧头面摇之。以视其气。
再看寒热。向手推三关六腑及运八卦。
随分推胸口。及揉脐。推委中毕。再揉肩井。至于别穴看症。再加揉法。
\r掌面推三关退六腑运八卦图\p03-b28a2.bmp\r
推三关。退六腑。运八卦。男女俱在左手。人以男右手为女之左手。独不思右掌无八卦。若亦有八卦。则震居西。
兑居东。艮居干。而坤居巽。岂后天八卦之定理。而为女子之推拿。遂变其位置耶。况男女心肝肾脉。俱在左手。
若女以右手为左。则心肝诸脉。可在右手否。
\r掌面水底捞月引水上天河图\p03-b28a3.bmp\r
推法。以两手围握儿手。将两大指在总筋中分推。各往侧边。
儿眼翻上者。将大指甲在小天心向掌心下掐。即平。
儿眼翻下者。将大指甲在小天心向总筋上掐。即平。
夏禹铸曰。大指面属脾。画家画手掌。不把大指画正面。乃画家之正法。前人只得以脾土字。写在侧边。后
人误认。以讹传讹。遂以大指之侧边为脾。余故将前掌图。大指移作正面。此因脾土画图之权宜。又因口诀有曰。
脾土曲补直为推。见有曲字。便把儿指一曲着。则侧面居正。故愈以侧面为脾。那晓得曲补之说。曲者旋也。于
指正面。旋推为补。直推至指甲为泻。此前人一字之讹。遂成流弊莫救。今人推之不效。皆由穴之不真。前人传之已误。
后人幸勿再误。
\r手背面推上三关揉五指节图\p03-b28a4.bmp\r
少商穴∶两大指背挨甲处各灯火一 专治脐风
外劳∶将见小指曲着重揉外劳宫祛脏腑之寒风
后溪∶推往下补肾 推往上是清肾利小便
夏禹铸曰。五指梢尖俱属下。前人作上。误矣。譬诸草木。根是本。梢为末。末。下也。不辨可知。前人又
每以左足为右足。独不想到人在堂居中朝上坐。却是西边为左边。如此明白显易的道理。胡为乎还错了。若女则
右足为左足。地道尚右也。
男左手直骨背面为三关。属气分。推上。气行阳动。故为热为补。
男左手直骨正面为六腑。乃血分。退下。则血行阴动。故为寒为泻。其两边侧里。属阳气阴血交界之地。以
此处作三关六腑之气血。无所适从。补泻何可合用。
五脏阳也。何女以推上为寒为凉。所谓阳极阴生是也。女阴道。故从阴生处推之。
六腑阴也。何女以退下为热为补。所谓阴极生阳是也。故女从阳生处推之。
诀曰。肾水一纹与后溪。推上为清下补之。小便闭赤清之妙。肾虚便少补为宜。
禹铸曰。四脏俱推上为补。下为泻。何肾与四脏相反。盖四脏居一身之上。而肾居下。肾虚则推四脏之气。
往下以滋肾。故曰下补。肾水混浊。则小便闭赤。若再往下推。则闭愈甚。一往上提。疏通水道。而小便自清。
故曰推上为清。此上下清补有异。若不发明上下之理。恐人疑推肾之上下。两字有讹。则遗害不浅。故识之。
\r虎口合骨穴图\p03-b28a5.bmp\r
合骨穴∶乃两骨合缝处用元宵火两手各一
看侧骨之两边明明是正面后人多错看了奈何奈何
老龙穴∶于惊死时在精威二穴拿不醒再于此穴一掐知痛者生不知痛者死可向肺俞穴里揉以探之
夏禹铸曰。前人因合骨穴。故画侧手图。只能画一面。不能画三面。故以三关六腑。写在两边。按图虽在两边。
而推画图之情。两边原是正面。后人不体其情。以侧手图之侧边。遂执为儿手正面之侧边作三关六腑。不大可怪哉。
古人画图绘穴。想无不真。多因粗心者。皆不能揣情度理。一错看过。以讹传讹。相习不察。余力辟前谬。非故示
异也。由几番折肱体认得来的。后之君子。当毋以妄诞目我。
\r脚各穴图\p03-b28a6.bmp\r
涌泉穴。男左转揉之。吐即止。右转揉之。泻即止。左转不揉。主吐。右转不揉。主泻。女反是。
惊来若急。大墩穴拿之。或鞋带穴对拿。如婴儿弱极。在大墩穴按之无脉。又在解溪穴再按又无脉。弱到十二分地
位。不必医。如两处有脉。即用人参一二分服之自转。不可多用。恐弱不能受。反加一死。医者知之。
惊时。若身往前扑。即将委中穴向下掐住。身便直。若身后仰。即将膝上鬼眼穴向下掐住。身即正。
\r身面用灯火图\p03-b28a7.bmp\r
定惊元宵灯火。囟门。眉心。脐心脐轮。合骨。鞋带。各穴共十五 。
脐风灯火。囟门。眉心。人中。承浆。两手大指少商。脐心脐轮。共十三 。
\r背面肺俞各穴图\p03-b28a8.bmp\r
夏禹铸说：在汤剂中更换药味，有适宜与不适宜之分，就像在文章中更换字词，有妥当与不妥当之别。同样是更换字词，有高明的见解与浅陋的见识之差异；更换药味，也有浅陋与高明之区别。例如范仲淹撰写严子陵祠堂记，其中有诗句：“先生之德”，当时李泰伯在场，将“德”字改为“风”字，这确实是高明的见解。李白诗云：“人烟寒橘柚”，而黄庭坚用“家园”二字替换“烟寒”二字，这便是浅陋的见解。至于医家使用四物汤来补血，方中有熟地黄，如果患者心火旺且血热，用生地黄替换熟地黄，这是高明的见解；如果心无火、血不热，却仍然用生地黄替换熟地黄，这就是浅陋的见解。这类学问，只能与懂行的人谈论，难以与不懂的人说清。从事医学的人，应当留心于此。
夏禹铸说：凡是小儿的疾病种类繁多，逃不出五脏六腑和气血的范围；症状虽然千奇百怪，但离不开虚、实、寒、热、风、痰这些病机。病情纵然难以知晓，也瞒不过面色和苗窍（指眼、耳、鼻、口等五官及指纹等外在征象）。病症即使难以辨别，也不要忽略青、白、红、黄等面部颜色。面部的颜色和苗窍，是脏腑气血反映出来的；颜色的红黄青白，是寒热虚实表现出来的。医生能在这方面下功夫，就得到了我们家的秘诀。
[插图：面部各穴位图]
推法：用葱、姜煎汁浸湿医生的大拇指，先从眉心向额头上方推，推二十四次。
接着从眉心向两侧分推，至太阳穴、太阴穴各九次。
再从天庭穴到承浆穴，每个穴位掐一下，以代替针刺的方法。
再在大阳、太阴部位，根据情况或发汗、或止汗。
然后将两耳垂尖捏住揉搓。
再用双手捧住孩子的头面部摇动，以观察其气息。
再看寒热情况，向手上推三关、退六腑以及运八卦。
随后分推胸口，揉脐部，推委中穴完毕，再揉肩井穴。至于其他穴位，则根据病症再加揉法。
[插图：掌面推三关、退六腑、运八卦图]
推三关、退六腑、运八卦，男女都在左手进行。人们认为男孩的右手相当于女孩的左手，却不曾想右掌没有八卦图。如果右掌也有八卦，那么震卦居西，兑卦居东，艮卦居西北，坤卦居西南，这难道改变了后天八卦的定例，使得女子的推拿位置发生变化吗？况且男女的心、肝、肾脉象均在左手，如果女孩以右手为左手，那么心、肝诸脉岂不在右手了吗？
[插图：掌面水底捞月、引水上天河图]
推法：用双手围握住孩子的手，将两个大拇指在总筋处向两侧分推。
如果孩子眼睛上翻，将大拇指指甲在小天心穴向掌心下方掐按，即可平复。
如果孩子眼睛下翻，将大拇指指甲在小天心穴向总筋上方掐按，即可平复。
夏禹铸说：大拇指正面属脾。画家画手掌时，不把大拇指画在正面，这是画家的正统画法。前人只好把“脾土”二字写在侧面，后人误以为真，以讹传讹，于是把大拇指的侧面当作脾经所在。所以我以前掌图中，将大拇指移作正面，这是绘制脾土图的权宜之计。又因为口诀中说：“脾土曲补直为推”，见到“曲”字，就把孩子的手指弯曲，这样侧面就居于正位，因此更加误认侧面为脾。哪里知道“曲补”之说，“曲”是指旋转，在手指正面旋推为补，直推至指甲为泻。这是前人一个字造成的错误，导致流弊无法挽救。现在人推拿无效，都是因为穴位不准确。前人传错了，后人希望不要再错。
[插图：手背面推上三关、揉五指节图]
少商穴：位于两大指背侧靠近指甲处，各灸一壮。专门治疗脐风。
外劳宫穴：将小指弯曲，重揉外劳宫穴，以祛除脏腑中的寒风。
后溪穴：向下推可补肾，向上推可清肾利小便。
夏禹铸说：五指梢尖都属于下部，前人说是上部，是错误的。譬如草木，根是本，梢是末，末就是下，这一点不难分辨。前人又常常把左脚当作右脚，难道没想到人在厅堂居中朝上坐时，西边才是左边吗？如此明白显易的道理，为何还会错呢？如果是女孩，则以右脚为左脚，因为地道尚右。
男孩子的左手直骨背面为三关，属于气分，向上推，气行于阳而动，所以表现为热，属于补法。
男孩子的左手直骨正面为六腑，属于血分，向下退，血行于阴而动，所以表现为寒，属于泻法。其两边侧里，是阳气与阴血交界之地，以此处作为三关六腑的气血，无所适从，补法和泻法怎么可以混用呢？
五脏属阳，为什么女孩向上推被认为是寒、凉呢？这是因为阳极阴生的道理。女孩属阴，所以从阴生之处推之。
六腑属阴，为什么女孩向下退被认为是热、补呢？这是因为阴极生阳的道理。所以女孩从阳生之处推之。
口诀说：肾水纹与后溪穴，向上推为清，向下推为补。小便闭塞色赤，向上推清利效果奇妙；肾虚尿少，向下推补为宜。
夏禹铸说：其余四脏都向上推为补，向下推为泻。为什么肾脏与四脏相反？因为四脏居于身体上部，而肾居于下部。肾虚时，推四脏之气往下以滋补肾，所以说向下推是补。肾水浑浊，则小便闭塞色赤，如果再向下推，则闭塞更严重。只要往上提，疏通水道，小便自然清利，所以说向上推是清。这种上下清补的差异，如果不阐明其中的道理，恐怕人们会怀疑推肾的“上”、“下”两个字有误，从而造成不小的危害，所以记录下来。
[插图：虎口合骨穴图]
合谷穴：在两骨结合缝隙处，用元宵灯火灸两手各一壮。
看侧骨的两边明明是正面，后人大多看错了，真是无可奈何啊！
老龙穴：当孩子惊厥死亡时，如果在精威二穴拿掐不醒，再在此穴掐一下，知痛的为生，不知痛的为死。可以向肺俞穴里揉以试探。
夏禹铸说：前人因为合谷穴，所以画了侧手图，只能画一面，不能画三面，所以把三关、六腑写在两边。虽然图上在两边，但推画图的情理，两边原本都是正面。后人不明此意，拿着侧手图的侧面，就执认为是孩子手正面的侧面作为三关六腑，这不是很奇怪吗？古人画图绘穴，想必没有不准确的，大多是因为粗心的人，不能揣测情理，一看就错，以讹传讹，相沿成习而不察觉。我极力批判前人的谬误，并非故意标新立异，而是经过多次实践体悟得来的。后来的君子，请不要把我看作狂妄荒诞之人。
[插图：脚各穴位图]
涌泉穴：男孩向左转揉，呕吐即止；向右转揉，泄泻即止。左转不揉，主呕吐；右转不揉，主泄泻。女孩则相反。
受惊来得急骤，拿大敦穴。或者对拿鞋带穴。如果婴儿极度虚弱，在大敦穴按摸没有脉搏，又在解溪穴再按也没有脉搏，虚弱到了十二分的程度，不必医治。如果两处都有脉搏，立即用人参一二分服用，自然会好转。不可多用，恐怕身体虚弱承受不住，反而加重致死。医生要知道这一点。
受惊时，如果身体向前扑倒，即将委中穴向下掐住，身体就会挺直。如果身体向后仰倒，即将膝上的鬼眼穴向下掐住，身体就会端正。
[插图：身面用灯火图]
定惊元宵灯火灸：囟门、眉心、脐心、脐轮、合谷、鞋带等各穴，共十五壮。
脐风灯火灸：囟门、眉心、人中、承浆、两手大指少商、脐心、脐轮，共十三壮。
[插图：背面肺俞各穴位图]
Xia Yuzhu said: The substitution of herbs in decoctions has its appropriateness and inappropriateness, just as the substitution of words in texts has its propriety and impropriety. In the same way that there is a difference between insightful views and shallow opinions when changing words, there is also a distinction between shallow and insightful approaches when substituting herbs. For instance, Fan Zhongyan wrote the "Record of Yan Ziling's Shrine," containing the verse: "The virtue (De) of the Master." At that time, Li Taibo was present and changed the character "De" (virtue) to "Feng" (wind/style), which was indeed an insightful modification. Li Bai's poem reads: "Human smoke chills the kumquats and pomelos," while Huang Tingjian replaced "Yan Han" (smoke chills) with "Jia Yuan" (homeland), which was a shallow alteration. As for physicians using Siwu Tang (Four Substances Decoction) to nourish blood, which contains Shudi Huang (Prepared Rehmanniae Radix), if the patient has heart fire and hot blood, replacing Shudi Huang with Shengdi Huang (Raw Rehmanniae Radix) is an insightful approach; however, if there is no heart fire and the blood is not hot, yet one still replaces Shudi Huang with Shengdi Huang, this is a shallow approach. Such knowledge can only be discussed with those who understand; it is difficult to explain to those who do not. Practitioners of medicine should pay attention to this.
Xia Yuzhu said: Pediatric diseases are numerous, but they cannot escape the scope of the five zang organs, six fu organs, qi, and blood. Although symptoms may appear bizarre, they ultimately stem from deficiency, excess, cold, heat, wind, or phlegm. Even if the disease is hard to discern, it cannot hide from the complexion and miao qiao (external signs such as facial color, eyes, ears, nose, mouth, and fingernail beds). Although symptoms are difficult to differentiate, one must not ignore the colors green, white, red, and yellow on the face. The facial complexion and miao qiao reflect the state of the zang-fu organs and the qi-blood. The colors red, yellow, green, and white manifest the conditions of cold, heat, deficiency, and excess. If a physician can exert effort in observing these aspects, they will have acquired our family's secret method.
[Image: Diagram of Facial Acupoints]
Pushing technique: Use a decoction of scallion and ginger to moisten the doctor's thumb. First, push from the center of the eyebrows upward to the forehead, repeating twenty-four times.
Next, push outward from the center of the eyebrows toward the Taiyang (Temple) and Taiyin points, nine times each side.
Then, pinch once at each point from Tian Ting (Forehead Center) down to Cheng Jiang (Chin Groove), acting as a substitute for acupuncture.
Subsequently, at the Dayang and Taiyin areas, induce sweating or stop sweating as indicated.
Then, pinch and rub the tips of both earlobes.
Hold the child's head and face with both hands and shake gently to observe their breath/qi.
Observe cold and heat patterns; push San Guan (Three Gates) and Tui Liu Fu (Retreat Six Bowels) on the hand, and perform Yun Ba Gua (Rotate Eight Trigrams).
Then, fen tui (divide-push) the chest area, rub the umbilicus, finish pushing Wei Zhong, and then rub Jian Jing. For other acupoints, additional rubbing methods are applied based on the specific symptoms.
[Image: Diagram of Palm Pushing San Guan, Retreating Liu Fu, and Rotating Ba Gua]
San Guan, Liu Fu, and Ba Gua manipulations are performed on the left hand for both boys and girls. People often assume the boy's right hand corresponds to the girl's left hand, failing to realize that the right palm lacks the Ba Gua diagram. If the right palm also had Ba Gua, Zhen would be in the west, Dui in the east, Gen in the northwest, and Kun in the southwest. Would this alter the fixed principles of Later Heaven Ba Gua for female pediatric massage? Moreover, the pulse positions for the heart, liver, and kidneys are on the left hand for both genders. If the girl's right hand were treated as the left, would the heart and liver pulses then be on the right hand?
[Image: Diagram of Water Bottom Moon Retrieval and Drawing Water Up to Heavenly River on Palm]
Pushing technique: Grasp the child's hand with both hands. Place both thumbs on Zong Jin (Total Sinew) and push outward to the sides.
If the child's eyes roll upward, press the nail of the thumb at Xiao Tian Xin (Little Heavenly Heart) downward toward the palm center until it settles.
If the child's eyes roll downward, press the nail of the thumb at Xiao Tian Xin upward toward Zong Jin until it settles.
Xia Yuzhu said: The palmar surface of the thumb belongs to the Spleen. Traditional painters did not depict the thumb facing forward, adhering to orthodox painting conventions. Consequently, predecessors wrote "Spleen Earth" on the side. Later generations misunderstood this, spreading the error, and came to regard the lateral side of the thumb as the Spleen meridian. Therefore, in my anterior palm diagram, I positioned the thumb facing frontally. This was a pragmatic adjustment for drawing the Spleen Earth. Additionally, the mnemonic states: "Spleen Earth curved supplementation, straight pushing." Seeing the word "curved," people bent the child's finger so the side faced forward, further cementing the misconception that the side is the Spleen. They failed to realize that "curved" refers to rotation; rotating on the frontal surface constitutes supplementation, while straight pushing toward the nail constitutes purging. This single-character error by predecessors led to incurable deviations. Current ineffectiveness in massage stems from inaccurate acupoint identification. Since predecessors transmitted errors, later practitioners must avoid repeating them.
[Image: Diagram of Back of Hand Pushing Upper San Guan and Rubbing Five Finger Joints]
Shao Shang Acupoint: Located on the dorsal aspect of both thumbs near the nails. Moxibustion with one cone treats Omphalospasm (Umbilical Tetanus).
Wai Lao Gong Acupoint: Bend the little finger and firmly rub Wai Lao Gong to dispel cold wind from the zang-fu organs.
Hou Xi Acupoint: Pushing downward tonifies the Kidney; pushing upward clears the Kidney and promotes urination.
Xia Yuzhu said: The tips of all five fingers belong to the lower part; predecessors claiming they belong to the upper part were mistaken. Just as roots are the base and tips are the extremities, the extremities are lower, which is self-evident. Predecessors also frequently confused the left foot with the right foot. Did they not consider that when a person sits centrally in a hall facing north, the west is on their left? This is a clear and simple principle; why the error? For females, the right foot corresponds to the left, following the principle that earth/yin favors the right.
For males, the dorsal aspect of the straight bone on the left hand is San Guan, belonging to the Qi level. Pushing upward moves Qi into Yang, generating heat, thus constituting a supplementation method.
For males, the volar aspect of the straight bone on the left hand is Liu Fu, belonging to the Blood level. Pushing downward moves Blood into Yin, generating cold, thus constituting a purging method. The lateral sides represent the junction of Yang Qi and Yin Blood. Using this area for San Guan/Liu Fu creates ambiguity regarding Qi and Blood, making it inappropriate to combine supplementation and purging techniques here.
The Five Zang organs are Yang. Why is pushing upward considered cold/cool for females? This follows the principle that extreme Yang generates Yin. Females belong to Yin, so manipulation proceeds from where Yin arises.
The Six Fu organs are Yin. Why is pushing downward considered hot/warming for females? This follows the principle that extreme Yin generates Yang. Thus, females are manipulated from where Yang arises.
Mnemonic: Regarding the Kidney Water line and Hou Xi, pushing upward clears, while pushing downward tonifies. For urinary retention with dark urine, upward pushing clears effectively; for Kidney deficiency with scanty urine, downward pushing is suitable for tonification.
Xia Yuzhu said: The other four Zang organs are supplemented by pushing upward and purged by pushing downward. Why is the Kidney opposite? Because the four Zang reside in the upper body, while the Kidney resides below. In cases of Kidney deficiency, pushing the Qi of the four Zang downward nourishes the Kidney; hence, downward pushing is termed "tonifying." When Kidney water is turbid, causing urinary retention and dark urine, pushing downward exacerbates the blockage. Pushing upward unblocks the water passages, clearing the urine; hence, upward pushing is termed "clearing." The differences in upper/lower clearing and tonifying must be elucidated. Without clarifying this logic, people might suspect errors in the terms "up" and "down" for Kidney manipulation, causing significant harm. Therefore, this is recorded.
[Image: Diagram of Hegu Acupoint]
Hegu Acupoint: Located in the depression between the two bones. Apply one cone of moxibustion on the元宵节 lantern fire to each hand.
Observing the lateral bones clearly shows the frontal view, yet later generations often misinterpret it. How lamentable!
Lao Long Acupoint: In cases of convulsive death, if the child does not revive after pinching Jing Wei, pinch Lao Long. If pain is felt, the child lives; if not, the child dies. One may rub Fei Shu to test responsiveness.
Xia Yuzhu said: Predecessors drew the Hegu acupoint on a side-view hand diagram because they could only depict one side, not three. Thus, they placed San Guan and Liu Fu on the sides. Although depicted on the sides in the diagram, logically, both sides represent the frontal view. Later generations failed to grasp this intent, mistakenly taking the side of the side-view diagram as the lateral side of the child's actual frontal hand to define San Guan and Liu Fu. Is this not strange? Ancient diagrams of acupoints were likely accurate; errors arose from careless individuals who failed to reason through the context, leading to widespread transmission of mistakes. I vigorously critique these past errors not to show off, but from extensive practical experience. Future scholars should not dismiss me as absurd.
[Image: Diagram of Foot Acupoints]
Yongquan Acupoint: For males, rotating left stops vomiting; rotating right stops diarrhea. Left rotation without rubbing indicates vomiting; right rotation without rubbing indicates diarrhea. For females, reverse these directions.
In acute fright, pinch Da Dun. Alternatively, pinch Xie Dai bilaterally. If the infant is extremely weak and no pulse is felt at Da Dun, and none at Jie Xi, the condition is critical (twelfth degree of weakness); medical intervention is futile. If pulses are present at both sites, administer 1-2 fen of Renshen (Ginseng). Do not overdose, as excessive dosage may overwhelm the weak constitution and cause death. Physicians must know this.
During fright, if the body thrusts forward, pinch Weizhong downward to straighten the body. If the body arches backward, pinch Gui Yan above the knee downward to correct the posture.
[Image: Diagram of Body/Face Moxibustion Points]
Calming Fright Moxibustion: Xuan Men, Mei Xin, Qi Xin, Qi Lun, Hegu, Xie Dai, etc., totaling fifteen cones.
Omphalospasm Moxibustion: Xuan Men, Mei Xin, Ren Zhong, Cheng Jiang, Shao Shang on both thumbs, Qi Xin, Qi Lun, totaling thirteen cones.
[Image: Diagram of Back Fei Shu Acupoints]