凡黄病者,不可一概而论。标本不同,证治亦异。故《婴孩宝书》云∶黄病皆因胃热
所为。由是观之,乃脾胃气虚,感受湿热,郁于腠理,淫于皮肤,蕴积成黄,熏发于外,故
有此证。或脾胃虚弱,内因症癖攻之而成。然疳泻亦主皮黄发竖,肚大青筋,肌肉消瘦,外
无色泽,身必发黄,此又本于疳病而作,致有是证,治法若感湿热而得,身黄如烟熏之
色,以 咀五苓散加麻黄,水姜煎投,汗之即愈。或用茵陈蒿汤调下五苓散亦好。若
得于疳癖者,其形如黄土相类,以醒脾散、化癖丸,醒脾快胃,磨积理疳。胃气既和,饮
食倍进,运化精微,荣养百骸,灌溉脏腑,五色各见于本部,精华乃形于面貌,其黄自除。
有婴孩生下,便见遍体俱黄,惟两目弦浓如金色,身发壮热,名为胎黄。皆因未产之前,
母受极热而传于胎,故有其证。乳母宜服生地黄汤,使药入于乳,令儿饮之,必获安矣。
小儿九道出血,何为而然?盖人之所有者,血与气也。心者血之主,肺者气之主,气
主之,血主濡之,荣养百骸,灌溉孙脉,升降上下,荣卫谐和,自然顺适。一或不调,疾
由生矣。或外为六淫所侵,内因七情所汨,气乃留而不行,血乃壅而不濡。内外抑郁,不
能流注,以荣于身,必有妄动之患。叔和以芤脉为失血之义,在七表属阳故也。阳明主
乎多气多血,未有不因热而得。盖气血俱热,毒郁内逼,失其常度,是以妄行。有在襁褓
患此证者,因非七情所伤,皆因乳母执着,不自宽释,及淡辛辣之味,流于乳络,儿饮之
后,停滞不散,郁蒸于内,亦能动血。又或居重帏暖阁,火气熏逼不令常见风日,积温
成热,或极则涌泄,或吐或衄,或大小府亦多血来者。有气出而邪热乘之,则血不得循
流故道,渗于诸经,亦生走失之证。其面 白,脉沉微,血淡紫,口气缓是也。又况婴
孩脆弱,易虚易实,因热内攻,血随气行,或壅而上逆,或下而妄返,遂有吐血、衄血、泻
血、溺血之证。然而血不自动,因气使之,风不自生,因热而起。由是而论,可以类推。治
法先明虚实,审得病源,随经施治。药饵无差,则不失其机要。实则小柴胡汤加生地黄、
丝茅根或苦参亦好,并用水煎服,或 咀五苓散,合五和汤,亦加丝茅根、苦参,水煎,
及投消毒饮,次用《局方》鸡苏丸、三黄丸。间服。虚则理中汤,及人参芎归汤,皆可服。
间有医者,见其血盛,以为热极,过投凉剂,遂使血寒不能归源而妄流,其色紫黯而凝滞,
或成小片,当服姜、附之剂以温之,自然流畅,毋致妄行为佳。
凡患黄病(黄疸)的患儿,不可一概而论。其病因标本不同,证候与治疗也各异。因此《婴孩宝书》说:黄病都是因胃热所致。由此看来,这是脾胃气虚,感受湿热之邪,郁结于腠理(皮肤肌肉间的间隙),浸淫于皮肤,蕴积而成黄疸,熏蒸发越于体表,所以出现这种证候。也有因脾胃虚弱,内因症癖(腹内结块、疳积等病)攻冲而形成的。然而疳泻(疳积兼腹泻)也主要表现为皮肤发黄、毛发竖起、腹部胀大且青筋暴露、肌肉消瘦、外表无光泽、身体必然发黄,这又是基于疳病而发作,导致出现这些证候。治疗方法若属感受湿热而得的,身体黄色如烟熏之色,可用咀碎的五苓散加麻黄,用水和生姜煎煮后服用,发汗后即可痊愈。或者用茵陈蒿汤调服五苓散也很好。若是因疳癖所得的,其颜色像黄土相似,可用醒脾散、化癖丸,以醒脾快胃、磨积理疳。胃气既已调和,饮食加倍增进,运化精微物质,荣养全身骨骼脏腑,灌溉五脏六腑,五色各自显现于相应的部位,精华自然形于面貌,其黄色自然消除。
有的婴儿出生时,就看见遍体发黄,只有两目巩膜浓如金色,身体发出壮热,名为胎黄(新生儿黄疸)。这都是因为未出生之前,母亲受到极热之邪而传于胎儿,所以有此证候。乳母宜服用生地黄汤,使药力进入乳汁,令婴儿饮用,必定能获得安宁。
小儿九道出血,为什么会这样呢?大概人拥有的主要是血与气。心是血的主宰,肺是气的主宰,气主推动,血主濡润,荣养全身骨骼脏腑,灌溉孙脉(细小的脉络),升降上下,营卫谐和,自然顺适。一旦不调和,疾病就会产生。或者外受六淫(风、寒、暑、湿、燥、火六种外感病邪)侵袭,内因七情(喜、怒、忧、思、悲、恐、惊七种情志变化)扰乱,气便停留而不运行,血便壅滞而不能濡润。内外抑郁,不能流注以荣养身体,必然有妄动出血的祸患。叔和认为芤脉(浮大中空,如按葱管)是失血的脉象,因为它在七表脉中属于阳脉的缘故。阳明经主乎多气多血,没有不因热邪而导致的。大概气血俱热,毒邪郁结内逼,失去常度,所以妄行出血。有的在襁褓之中患此证候的,因为不是七情所伤,都是因为乳母执着情志,不能自我宽解,以及食用淡味辛辣之物,流于乳络,婴儿饮乳之后,停滞不散,郁蒸于体内,也能动血。又或者居住在厚重的帷帐暖阁之中,火气熏逼,不令常见风日,积温成热,或者极盛则涌泄,或呕吐,或鼻衄,或大小便也多见出血者。有气出而邪热乘之,则血不得循流故道,渗于诸经,也产生走失之证。其面色㿠白,脉沉微,血色淡紫,口气缓弱是也。况且婴儿脆弱,易虚易实,因热邪内攻,血随气行,或壅滞而上逆,或下走而妄返,遂有吐血、衄血、泻血、溺血之证。然而血不自动,因气使之;风不自生,因热而起。由此而论,可以类推。治疗方法先明虚实,审得病源,随经施治。药饵无差错,则不失其机要。实证用小柴胡汤加生地黄、丝茅根或苦参也很好,并用水煎服,或者咀碎五苓散,合五和汤,也加丝茅根、苦参,水煎,及投消毒饮,次用《局方》鸡苏丸、三黄丸。间服。虚证则用理中汤,及人参芎归汤,皆可服用。间或有医者,见其血盛,以为热极,过投凉剂,遂使血寒不能归源而妄流,其色紫黯而凝滞,或成小片,当服姜、附之剂以温之,自然流畅,毋致妄行为佳。
Any infant suffering from jaundice (Huang Bing) should not be treated uniformly. The root and branch causes differ, so the syndromes and treatments also vary. Therefore, *Yinghan Baoshu* states: Jaundice is caused by stomach heat. From this perspective, it results from deficiency of spleen and stomach qi, contraction of damp-heat pathogens, stagnation in the couli (interstices of skin and muscle), infiltration into the skin, accumulation to form jaundice, steaming outward, thus presenting this syndrome. Alternatively, it may arise from spleen and stomach weakness combined with internal attack by zhengpi (abdominal masses and malnutrition). However, ganxia (malnutrition with diarrhea) also primarily manifests as yellowish skin, erect hair, distended abdomen with visible veins, emaciation, lack luster externally, and inevitable body yellowing; this originates from gan disease, leading to these signs. If the treatment is for cases contracted via damp-heat, where the body yellow resembles smoke-stained color, use Wu Ling San (Five-Ingredient Poria Pill) crushed and added with Ephedrae Herba (Mahuang, 麻黄), decocted with water and ginger, administered orally; inducing sweating will lead to recovery. Alternatively, using Yinchen Hao Tang (Artemisia Capillaris Decoction) to regulate Wu Ling San is also good. If obtained due to ganpi, the appearance resembles yellow earth; use Xingpi San (Spleen-Awakening Powder) and Huapi Wan (Mass-Dissolving Pill) to awaken the spleen, invigorate the stomach, grind away accumulations, and manage gan. Once stomach qi harmonizes, food intake doubles, refining and transporting essence, nourishing all bones and viscera, irrigating the zang-fu organs, with the five colors appearing in their respective regions, essence manifesting in the face, and the yellow naturally eliminating.
Some infants are born with whole-body yellowing, only the sclera thick like gold, accompanied by high fever, named Taihuang (Fetal Jaundice). This occurs because before birth, the mother suffered extreme heat transmitted to the fetus, hence this syndrome. The nursing mother should take Shengdi Huang Tang (Rehmannia Root Decoction) so that the medicine enters the milk, allowing the infant to drink it, ensuring safety.
Why does bleeding occur in the nine orifices of children? Essentially, humans possess blood and qi. The Heart is the master of blood, the Lung is the master of qi. Qi governs movement, blood governs moistening, nourishing all bones and viscera, irrigating sunmai (fine collaterals), ascending and descending, harmonizing ying and wei, naturally smooth. Once unharmonious, diseases arise. Either invaded externally by six excesses (Liu Yin, pathogenic factors), or disturbed internally by seven emotions (Qi Qing), qi stagnates and fails to move, blood obstructs and fails to moisten. Internal and external depression prevents flow and nourishment, inevitably causing reckless movement (bleeding). He Hanzhong stated that Kong Mai (Hollow Pulse) signifies blood loss, as it belongs to yang in the seven superficial pulses. The Yangming channel governs abundant qi and blood, never occurring without heat. Generally, both qi and blood become hot, toxins stagnate and force inward, losing normal regulation, thus flowing recklessly. Some infants in swaddling clothes suffer this due to non-emotional causes, but rather because the nursing mother holds grudges, fails to relax, consumes bland spicy foods, which flow into the milk collaterals; after the infant drinks, stagnation persists, steaming internally, moving blood. Or living in heavy curtains and warm rooms, heated by fire, lacking exposure to wind and sun, accumulating warmth into heat, eventually surging and leaking, causing vomiting, epistaxis, or bleeding in bowel/bladder movements. When qi exits and evil heat takes advantage, blood cannot follow its normal channels, seeping into various meridians, producing leakage syndromes. Their faces are pale white, pulse deep and faint, blood light purple, breath slow—this is the presentation. Moreover, infants are fragile, prone to deficiency and excess; internal heat attack causes blood to follow qi, either obstructing and reversing upward, or flowing downward recklessly, resulting in hematemesis, epistaxis, hematochezia, or hematuria. However, blood does not move on its own but is driven by qi; wind does not generate itself but arises from heat. By this reasoning, one can infer others. Treatment first clarifies deficiency and excess, examines the disease source, treats according to the meridian. Medication without error preserves the key mechanism. For excess patterns, Xiao Chai Hu Tang (Minor Bupleurum Decoction) added with Rehmanniae Radix (Shengdi Huang), Imperatae Rhizoma (Simao Gen), or Sophorae Flavescentis Radix (Kushen) is good, decocted in water; or crush Wu Ling San, combine with Wu He Tang (Five-Harmony Decoction), add Imperatae Rhizoma and Sophorae Flavescentis Radix, decoct in water, and administer Xiao Du Yin (Detoxification Drink), followed by intermittent use of Jisu Wan (Chicken Mint Pill) and San Huang Wan (Three-Yellows Pill) from *Ju Fang*. For deficiency patterns, Lizhong Tang (Regulate the Middle Decoction) and Renshen Xiong Gui Tang (Ginseng, Ligusticum and Angelica Decoction) are suitable. Occasionally, physicians see abundant bleeding, assume extreme heat, over-administer cold agents, causing blood to become cold, unable to return to its source, flowing recklessly, appearing dark purple and stagnant, or forming small clots; one should administer Ginger and Aconite preparations to warm, ensuring natural flow and preventing reckless movement.