夏禹铸曰。前辈云。动而得之为中热。静而得之为中暑。此言甚是。然中暑与中热。病形无异。中暑作渴。
中热亦作渴。中热说诡话。中暑亦说诡话。若不细审形色。虽得动静二字。究何益也。如探中暑说诡话。乃低声
平平而说。中热发狂雄壮而说。此犹恐不得其真。只于口中一看。舌色惨白。唇无血色。口气微弱而冷。便是中
暑。宜用清暑益气汤。立愈。若唇舌皆红。气出如焚。小便赤涩。定是心经中热。宜用木通、薄荷煎汤。再以犀
角磨水一杯。羚羊角磨水半杯。入煎药和服。即解。
己亥之岁。余从伯一孙。方四岁。患病。初、伯与先君交恶已久。伯母呼予往治。举室阻挠。且畏之曰。彼
孙一死。祸来匪轻。余曰。具有两眼。不烦过虑。视之。口气微微。面色惨极。唇舌白淡。口道诞话。知为中暑。
用清暑益气汤。一服愈。
穿山郡庠方绍文。仅一子。乃余婿。十七岁抱疾。以余只知幼科。延两方脉共治。彼见口说诡话。便作热治。
用尽犀角、连翘、芩、膏凉剂。疾益加甚。急闻于余。余往见。直卧如尸。口气冰冷。唇舌皆白。乃中暑之症。
误作中热。大可怪也。用清暑益气汤。一服立愈。此大方脉切脉。不如小儿科望色辨窍为妙之一证也。
夜啼有六。
一、面深红多泪。无灯则啼稍息。见灯则啼愈甚。此心热也。遇火两阳相搏。故见灯而啼甚也。其候手腹必
热。小便赤。推用水底捞月。引水上天河。退下六腑及运八卦。推坎入艮。药用导赤散加栀仁、薄荷、天麻。
一、哭多睡少。天明则已。面色青白。便亦青白。治宜温下焦。用备急方。
一、为异物所侵。目有所视。口不能言。但睡中惊悸。抱母大哭。面色紫黑。治宜陈皮、生姜、茯神、远志、
甘草。
一、有脾胃两虚。吐泻少食而啼者。治宜用六君子汤加炮姜、木香。
一、有心血不足而啼者。其候睡浓忽悸。舌色淡白。而色不重。宜用安神汤。
一、有脏寒肠痛而啼者。以手按其腹即不啼。起手又啼。此候面必青。手必冷。口不吮乳。治用当归、白芍、
人参、甘草、桔梗、橘皮。等分服之。
外此而啼者。必非病也。或夜醒时为戏灯所惯。无灯而啼者有之。或乳母缺乳而啼者有之。
夏禹铸说:前辈曾讲,因活动而得病的是中热,因静止而得病的是中暑。这种说法非常正确。然而,中暑和中热的病症表现没有区别,中暑会口渴,中热也会口渴;中热患者会说胡话,中暑患者也会说胡话。如果不仔细审视患者的神色形态,即使知道了是动还是静,究竟有什么益处呢?比如,中暑患者说胡话时,声音低微、平淡;而中热患者说胡话时,声音发狂、雄壮有力。但这还恐怕不能确定真伪,只需看口中情况:如果舌色惨白,嘴唇没有血色,口气微弱且冷,这就是中暑。适宜使用清暑益气汤,立刻痊愈。如果嘴唇和舌头都红,呼出的气像火一样烫,小便赤红涩痛,这一定是心经中热。适宜用木通、薄荷煎汤,再用犀角磨水一杯,羚羊角磨水半杯,加入煎好的药液中一起服用,即可解除病邪。
己亥年,我伯父的一个孙子,才四岁,患病。起初,伯父与我父亲交恶已久,伯母叫我前去诊治,全家都阻挠,并且害怕地说:“他孙子一死,祸事就不轻了。”我说:“我有双眼看着,不必过分忧虑。”查看病人,口气微微,面色极其惨淡,嘴唇和舌头白淡,嘴里说着痴话,知道是中暑。用了清暑益气汤,服一次就痊愈了。
穿山郡庠生方绍文,只有一个儿子,是我的女婿,十七岁生病。因为我只懂儿科,他们请了两名内科医生共同治疗。那些医生见他口说胡话,便当作热证治疗。用尽了犀角、连翘、黄芩、石膏等凉性药物,病情反而更加严重。急忙通知我,我去看望,见病人直挺挺地躺着像尸体一样,口气冰冷,嘴唇和舌头都白,这是中暑的症状,却被误认为是中热,太奇怪了。用了清暑益气汤,服一次立刻痊愈。这也是内科医生切脉,不如小儿科通过望色和辨别孔窍来诊断精妙的一个证明啊。
夜啼有六种情况。
第一,面部深红多流泪,没有灯光时啼哭稍停,见到灯光时啼哭更厉害。这是心热所致。遇到火与两阳相搏,所以见到灯光就啼哭加剧。其症状表现为手脚和腹部必然发热,小便赤红。推拿手法用水底捞月、引水上天河、退下六腑及运八卦、推坎入艮。药用导赤散加栀子仁、薄荷、天麻。
第二,哭声多睡眠少,天亮后停止。面色青白,大便也青白。治疗宜温补下焦。用备急方。
第三,被异物惊吓。眼睛看着某处,口不能言,只是在睡中惊悸,抱着母亲大哭。面色紫黑。治疗宜用陈皮、生姜、茯神、远志、甘草。
第四,脾胃两虚,伴有呕吐腹泻、食欲不振而啼哭的。治疗宜用六君子汤加炮姜、木香。
第五,心血不足而啼哭的。其症状为熟睡中忽然惊悸,舌色淡白,面色不重(指面色无明显异常或苍白)。宜用安神汤。
第六,有脏寒肠痛而啼哭的。用手按压腹部就不啼哭,手抬起又啼哭。此症状面色必青,手脚必冷,口不吮吸乳汁。治疗用当归、白芍、人参、甘草、桔梗、橘皮,等分服用。
除此之外啼哭的,一定不是疾病。或者是夜间醒来时被玩灯的习惯所惯坏,没有灯就啼哭的情况有之。或者是乳母缺奶而啼哭的情况有之。
Xia Yuzhu said: Predecessors stated that illness acquired through activity is "Zhongre" (Heatstroke due to exertion), while illness acquired through stillness is "Zhongshu" (Summerheat stroke due to rest). This statement is very correct. However, the clinical manifestations of Zhongshu and Zhongre are indistinguishable; both Zhongshu and Zhongre present with thirst. Both Zhongre and Zhongshu patients may speak deliriously. If one does not carefully examine the patient's complexion and physical appearance, knowing merely whether it was caused by movement or stillness is of what benefit? For instance, when a Zhongshu patient speaks deliriously, their voice is low and flat; whereas a Zhongre patient speaks deliriously with a frantic and robust tone. Yet, this alone may still fail to reveal the truth. One need only inspect the mouth: if the tongue color is pale white, the lips lack blood color, and the breath is weak and cold, it is Zhongshu. It is appropriate to use Qingshu Yiqi Tang (Clear Summerheat and Boost Qi Decoction), which will bring about an immediate cure. If the lips and tongue are both red, the exhaled breath feels like fire, and urination is dark and scanty/difficult, it is definitely Heart Meridian Zhongre. It is appropriate to decoct Tongcao (Akebiae Caulis) and Bohe (Menthae Haplocalycis Herba) in water, then mix in one cup of water prepared by grinding Jiaojiao (Rhinocerotis Cornu) and half a cup of water prepared by Lingyangjiao (Saigae Tataricae Cornu), and administer together with the decoction to resolve the condition.
In the year Ji Hai, my uncle's grandson, aged four, fell ill. Initially, my uncle had been at odds with my father for a long time. My aunt asked me to go treat him, but the whole household obstructed me, fearing and saying, "If his grandson dies, the disaster will be severe." I said, "I have eyes to see; there is no need for excessive worry." Upon examination, the child's breath was faint, complexion extremely pale, lips and tongue pale white, and he was speaking nonsensical words. I identified it as Zhongshu. I administered Qingshu Yiqi Tang (Clear Summerheat and Boost Qi Decoction), and he recovered after one dose.
Fang Shaowen, a county scholar from Chuanshan, had only one son, who was my son-in-law. At seventeen years old, he fell ill. Because I specialized only in pediatrics, they invited two internal medicine physicians to treat him jointly. Seeing the patient speaking deliriously, those physicians treated it as a heat syndrome. They used copious amounts of cooling agents such as Jiaojiao (Rhinocerotis Cornu), Lianqiao (Forsythiae Fructus), Huangqin (Scutellariae Radix), and Shigao (Gypsum Fibrosum). The illness worsened significantly. They urgently notified me. Upon visiting, I found the patient lying stiffly like a corpse, with cold breath, and white lips and tongue. This was a symptom of Zhongshu, yet it was mistakenly diagnosed as Zhongre, which is truly strange. I used Qingshu Yiqi Tang (Clear Summerheat and Boost Qi Decoction), and he recovered immediately after one dose. This serves as proof that internal medicine physicians relying on pulse diagnosis are not as effective as pediatricians relying on observing complexion and distinguishing orifices.
There are six types of night crying.
First, the face is deep red with many tears; crying ceases slightly without light, but intensifies upon seeing light. This is due to Heart Heat. When encountering fire, the interaction of two Yangs causes intensified crying upon seeing light. The signs include heat in the hands, abdomen, and feet, and dark urine. Tuina techniques should include Water Bottom Moon Retrieval (Shuidi Laoyue), Drawing Water Up to Heavenly River (Yinshui Shang Tianhe), Clearing the Six Fu Organs (Tui Xia Liufu), and Moving Eight Trigrams (Yun Bagua), pushing Kan into Gen. Medicinally, use Daochi San (Guide Out Red Powder) plus Zhiren (Gardeniae Semen), Bohe (Menthae Haplocalycis Herba), and Tianma (Gastrodiae Rhizoma).
Second, there is much crying and little sleep, which stops at dawn. The complexion is greenish-white, and stools are also greenish-white. Treatment should warm the Lower Jiao (Lower Burner). Use Beijifang (Emergency Formula).
Third, fright caused by foreign objects. The eyes gaze at something, the mouth cannot speak, but the child is startled and palpitations occur during sleep, crying loudly while holding the mother. The complexion is purple-black. Treatment should use Chenpi (Citri Reticulatae Pericarpium), Shengjiang (Zingiberis Rhizoma Recens), Fushen (Poria cum Ramo Pini), Yuanzhi (Polygalae Radix), and Gancao (Glycyrrhizae Radix et Rhizoma).
Fourth, crying due to deficiency of both Spleen and Stomach, accompanied by vomiting, diarrhea, and poor appetite. Treatment should use Liujunzi Tang (Six Gentlemen Decoction) plus Paojiang (Zingiberis Rhizoma Preparatum) and Muxiang (Aucklandiae Radix).
Fifth, crying due to insufficiency of Heart Blood. The signs include sudden palpitations during deep sleep, pale white tongue, and a complexion that is not notably abnormal (or pale). It is appropriate to use Anshen Tang (Calm Spirit Decoction).
Sixth, crying due to Cold Viscera and intestinal pain. Crying ceases when the abdomen is pressed with hand, but resumes when the hand is removed. The signs include a greenish face, cold hands, and refusal to suckle milk. Treatment uses Danggui (Angelicae Sinensis Radix), Baishao (Paeoniae Radix Alba), Renshen (Ginseng Radix), Gancao (Glycyrrhizae Radix et Rhizoma), Jiegeng (Platycodonis Radix), and Juapi (Citri Reticulatae Pericarpium), taken in equal parts.
Night crying outside these categories is certainly not a disease. It may be that the child has become accustomed to playing with lights upon waking at night, thus crying when there is no light. Or it may be crying because the wet nurse lacks milk.