春温一证，由冬令收藏未固，昔人以冬寒内伏，藏于少阴，入春发于少阳，以春木内应肝胆也。寒邪深伏，已经化
热，昔贤以黄芩汤为主方，苦寒直清里热，热伏于阴，苦味坚阴，乃正治也。知温邪忌散，不与暴感门同法。若因外邪
先受，引动在里伏热。必先辛凉以解新邪，自注∶葱豉汤。继进苦寒以清里热。况热乃无形之气，时医多用消滞，攻治
有形，胃汁先涸，阴液劫尽者多矣。
雄按∶新邪引动伏邪者，初起微有恶寒之表证。
徐洄溪曰∶皆正论也。
章虚谷曰∶或云∶人身受邪，无不即病，未有久伏过时而发者，其说甚似有理，浅陋者莫不遵信为然，不知其悖经
义，又从而和之。夫人身五内腑，外营卫，于中十二经、十五络、三百六十五孙络、六百五十七穴，细微幽奥，曲折难
明。今以一郡一邑之地，匪类伏匿，犹且不能觉察。况人身经穴之渊邃隐微，而邪气如烟之渐熏，水之渐积，故如《内
经》论诸痛诸积，皆由初感外邪，伏而不觉，以致渐侵入内所成者也。安可必谓其随感即病，而无伏邪者乎？又如人之
痘毒，其未发时，全然不觉，何以又能伏耶？由是言之，则《素问》所言冬伤寒，春病温，非谰语矣。
雄按∶藏于精者，春不病温，小儿之多温病何耶？良以冬暖而失闭藏耳！夫冬岂年年皆暖欤？因父母以姑息为心，
惟恐其冻，往往衣被过浓，甚则戕之以裘帛（富家儿多夭者，半由此也），虽天令潜藏，而真气已暗为发泄矣。温病之多，
不亦宜乎。此理不但幼科不知，即先贤亦从未道及也。汪按∶惟洄溪尝略论及之耳。
风温者，春月受风，其气已温。
雄按∶此言其常也，冬月天暖，所感亦是风温，春月过冷，亦有风寒也。经谓春病
在头，治在上焦。肺位最高，邪必先伤，此手太阴气分先病，失治则入手厥阴心包络，血分亦伤。盖足经顺传，如太阳
传阳明，人皆知之。肺病失治，逆传心包络，人多不知者。俗医见身热咳喘，不知肺病在上之旨，妄投荆、防、柴、葛，
加入枳、朴、杏、苏、菔子、楂、麦、橘皮之属，辄云解肌消食。有见痰喘，便用大黄礞石滚痰丸，大便数行，上热愈
结。幼稚谷少胃薄，表里苦辛化燥，胃汁已伤，复用大黄大苦沉降丸药，致脾胃阳和伤极，陡变惊痫，莫救者多矣。
自注风温肺病，治在上焦。夫春温忌汗，初病投剂，宜用辛凉。若杂入消导发散，徐云∶须对证亦可用。不但与肺
病无涉，劫尽胃汁，肺乏津液上供。头目清窍，徒为热气熏蒸，鼻干如煤，目瞑或上窜无泪，或热深肢厥，狂躁溺涩，
胸高气促，皆是肺气不宣化之征。斯时若以肺药少加一味清降，使药力不致直趋肠中。
雄按∶所谓非轻不举也，重药则
直过病所矣。而上痹可开，诸窍自爽，无如市医佥云结胸，皆用连、蒌、柴、枳，苦寒直降，致闭塞愈甚，告毙者多。
又∶此证初因发热喘嗽，首用辛凉清肃上焦，徐云∶正论。如薄荷、连翘、牛蒡、象贝、桑叶、沙参、栀皮、姜皮、
花粉。若色苍热胜烦渴，用石膏、竹叶辛寒清散，痧疹亦当宗此。若日数渐多，邪不得解，芩、连、凉膈亦可用。至热
邪逆传膻中，神昏目瞑，鼻窍无涕 ，诸窍欲闭，其势危急，必用至宝丹或牛黄清心丸。徐云∶急救非此不可。病减后
余热，只甘寒清养胃阴足矣。
春月暴暖忽冷，先受温邪，继为冷束，咳嗽痰喘最多，辛解凉温，只用一剂，大忌绝谷。若甚者宜昼夜竖抱勿倒，
三四日。徐云∶秘诀。夫轻为咳，重为喘，喘急则鼻掀胸挺。
自注春温皆冬季伏邪，详于大方诸书，幼科亦有伏邪。
雄按∶人有大小，感受则一也。治从大方。
雄按∶感受既一，
治法亦无殊，奈大方明于治温者罕矣，况幼科乎。然暴感为多，如头痛恶寒，发热喘促，鼻塞声重，脉浮无汗，原可表
散。春令温舒，辛温宜少用，阳经表药，最忌混乱。至若身热咳喘有痰之证，只宜肺药清解，泻白散加前胡、牛蒡、薄
荷之属，消食药只宜一二味。
雄按∶此为有食者言也。若二便俱通者，消食少用，须辨表、里、上、中、下，何者为急
施治。又春季温暖，风温极多，温变热最速，若发散风寒消食，劫伤津液，变证尤速。
雄按∶沈尧封云∶温，亦火之气
也。盖火之微者曰温，火之甚者曰热，三时皆有。惟暑为天上之火，独盛于夏令耳。
初起咳嗽喘促，通行用∶薄荷（汗多不用）连翘 象贝 牛蒡 花粉 桔梗 沙参 木通 枳壳 橘红
表解热不清用∶黄芩 连翘 桑皮 花粉 地骨皮 川贝 知母 山栀
备用方∶黄芩汤 葱豉汤 凉膈散 清心凉膈散 苇茎汤 泻白散 葶苈大枣
汤白虎汤 至宝丹 牛黄清心丸 竹叶石膏汤 喻氏清燥救肺汤
里热不清，朝上凉，晚暮热，即当清解血分，久则滋
清养阴。若热陷神昏，痰升喘促，急用牛黄丸、至宝丹之属。
风温乃肺先受邪，遂逆传心包，治在上焦，不与清胃攻下
同法。幼科不知，初投发散消食，不应。改用∶柴、芩、栝蒌、枳实、黄连，再下夺，不应。多致危殆，皆因不明手经
之病耳。
雄按∶婆心苦口，再四丁宁，舌敝耳聋，可为太息。
若寒痰阻闭，亦有喘急胸高，不可与前法。用三白吐之，或妙香丸。
夏为热病，然夏至以前，时令未为大热，经以先夏至病温，后夏至病暑。温邪前已申明。暑热一证。
雄按∶《阴阳大
论》云∶春气温和，夏气暑热，是暑即热也。原为一证，故夏月中暑。仲景标曰∶中热也。昔人以动静分为暑热二证，
盖未知暑为何气耳。医者易眩，夏暑发自阳明，古人以白虎汤为主方。后贤刘河间创议，迥出诸家，谓“温热时邪，当
分三焦投药，以苦辛寒为主，若拘六经分证，仍是伤寒治法，致误多矣。”徐云∶能分六经者亦鲜矣。盖伤寒外受之寒，
必先从汗解。辛温散邪是已。口鼻吸入之寒，即为中寒阴病，徐云∶亦不尽然。治当温里，分三阴见证施治。若夫暑病，
专方甚少，皆因前人略于暑，详于寒耳。考古如《金匮》暑 痉之因，而洁古以动静分中暑、中热，各具至理。
雄按∶
虽有至理，而强分暑热，名已不正矣。兹不概述。论幼科病暑热，夹杂别病有诸，而时下不外发散消导，加入香薷一味，
或六一散一服。考《本草》∶香薷辛温发汗，能泄宿水。夏热气闭无汗，渴饮停水，香薷必佐杏仁，以杏仁苦降泄气，大
顺散取义若此。徐云∶大顺散非治暑之方，乃治暑月伤冷之方也，何得连类及之，夹杂矣。
雄按∶上言香薷治渴饮停水，
佐杏仁以降泄，故曰大顺散之义，亦若此也。长夏湿令，暑必兼湿。
雄按∶此言长夏湿旺之令，暑以蒸之，所谓土润溽
暑，故暑湿易于兼病，犹之冬月风寒，每相兼感。暑伤气分，湿亦伤气，汗则耗气伤阳，胃汁大受劫烁，变病由此甚多，
发泄司令，里真自虚。张凤逵云∶暑病首用辛凉，继用甘寒，再用酸泄酸敛，不必用下。可称要言不烦矣。然幼科因暑
热蔓延，变生他病。
雄按∶大方何独不然，学人宜知隅反。兹摘其概。
暑邪必挟湿。
雄按∶暑令湿盛，必多兼感，故曰挟。犹之寒邪挟食，湿证兼风，俱是二病相兼，非谓暑中必有湿也。
故论暑者，须知为天上烈日之炎威，不可误以湿热二气并作一气，始为暑也。而治暑者，须知其挟湿为多焉。状如外感
风寒，忌用柴、葛、羌、防。如肌表热无汗，辛凉轻剂无误。香薷辛温气升，热服易吐，佐苦降，如杏仁、黄连、黄芩
则不吐。宣通上焦，如杏仁、连翘、薄荷、竹叶。暑热深入，伏热烦渴，白虎汤、六一散。
雄按∶无湿者白虎汤，挟湿
者六一散，须别。暑病头胀如蒙，皆热盛上炽，白虎、竹叶；酒湿食滞者，加辛温通里。
夏令受热，昏迷若惊，此为暑厥。
雄按∶受热而迷，名曰暑厥。譬如受冷而仆，名寒厥也。人皆知寒之即为冷矣，
何以不知暑之为热乎。即热气闭塞孔窍所致。其邪入络，与中络同法，牛黄丸、至宝丹芳香利窍可效。徐云∶妙法。雄
按∶紫雪亦可酌用。神苏以后，用清凉血分，如连翘心、竹叶心、玄参、细生地、鲜生地、二冬之属。
雄按∶暑是火邪，
心为火脏，邪易入之。故治中暑者，必以清心之药为君。此证初起，大忌风药。
雄按∶火邪得风药而更炽矣。初病暑热
伤气。
雄按∶所谓壮火食气也。竹叶石膏汤，或清肺轻剂。
雄按∶火邪克金，必先侵肺矣。大凡热深厥深，四肢逆冷，
魏柳洲曰∶火极似水，乃物极必反之候。凡患此，为燥热温补所杀者多矣，哀哉！盖内真寒而外假热，诸家尝论之矣。
内真热而外假寒，论及者罕也。
雄按∶道光甲辰六月初一日至初四日，连日酷热异常，如此死者，道路相接，余以神犀
丹、紫雪二方救之，极效。但看面垢齿燥，二便不通，或泻不爽，为是，大忌误认伤寒也。
雄按∶尤忌误以暑为阴邪，
或指暑中有湿，而妄投温燥渗利之药也。上暑厥。
雄按∶王节斋云∶夏至后病为暑，相火令行，感之自口齿入，伤心包
络经，甚则火热制金，不能平木，而为暑风。张兼善云∶清邪中上，浊邪中下，其风寒湿皆地之气，所以俱中足经，惟
暑乃天之气，系清邪，所以中手少阴心经。
幼儿断乳纳食，值夏月脾胃主气，易于肚膨泄泻，足心热，形体日瘦，或烦渴喜食，渐成五疳积聚。当审体之强弱，
病之新久，有余者疏胃清热。食入粪色白，或不化，健脾佐消导清热。若湿热内郁，虫积腹痛，徐云∶此证最多。导滞
驱虫微下之。缓调用肥儿丸之属。
上热疳。
夏季秋热，小儿泄泻，或初愈未愈，满口皆生疳蚀，尝有阻塞咽喉致危者，此皆在里湿盛生热，热气蒸灼，津液不
生，湿热偏伤气分，治在上焦，或佐淡渗。徐云∶须用外治。世俗常刮西瓜翠衣治疳，徐云∶合度。取其轻扬渗利也。
上口疳。
夏季湿热郁蒸，脾胃气弱，水谷之气不运，湿着内蕴为热，渐至浮肿腹胀，小水不利，治之非法，水湿久渍，逆行
犯肺，必生咳嗽喘促，甚则坐不得卧，俯不得仰，危期速矣。大凡喘必生胀，胀必生喘。方书以先喘后胀，治在肺；先
胀后喘，治在脾，亦定论也。《金匮》有风水、皮水、石水、正水、黄汗，以分表里之治。河间有三焦分消。子和有磨积
逐水。皆有奥义，学人不可不潜心体认，难以概述。阅近代世俗，论水湿喘胀之证，以《内经》开鬼门取汗为表治，分
利小便洁净府为里治。经旨《病能篇》谓“诸湿肿满，皆属于脾”，以健脾燥湿为稳治。治之不效，技穷束手矣。不知凡
病皆本乎阴阳，通表利小便，乃宣经气，利腑气，是阳病治法；暖水脏、温脾胃、补土以驱水，是阴病治法。治肺痹，
以轻开上；治脾，必佐温通。若阴阳表里乖违，脏真日漓，阴阳不运，亦必作胀，治以通阳，乃可奏绩，如《局方》禹
余粮丸，甚至三焦交阻，必用分消，肠胃窒塞，必用下夺。然不得与伤寒实热同例，擅投硝、黄、枳、朴、扰动阴血。
若太阴脾脏，饮湿阻气，温之、补之不应，欲用下法，少少甘遂为丸可也。徐云∶亦太峻。其治实证，选用方法备采。
雄按∶叶氏《景岳发挥》有“因喘而肿，当以清肺为要”之论，宜参。若水湿侵脾，发肿致喘，治当补土驱水，设
水气
上凌心包，变呃更危。陈远公云∶用苡仁、茯神各一两，白术、苍术各三钱，半夏、陈皮各一钱，丁香五分，吴萸三分，
名止呃汤。二剂可安。
喘胀备用方徐云∶太猛厉者，不可轻用。
葶苈 大枣汤 泻白散 大顺散 牡蛎 泽泻散 五苓散 越脾汤 甘遂 半夏汤 控涎丹 五子五皮汤 子和桂
苓汤 禹功丸 茯苓防己汤 中满分消汤 小青龙汤 木防己汤
吐泻一证，幼儿脾胃受伤，陡变惊搐最多。徐云∶此证多是痰湿。若是不正秽气触入，或口食生冷，应用正气散、
六和汤、五积散之类。正气受伤，肢冷呃忒，呕吐自利，即用钱氏益黄散。有痰用星附六君子汤、理中汤等。倘热气深
伏，烦渴引饮，呕逆者连香饮，黄连竹茹橘皮半夏汤。热闭神昏，用至宝丹。寒闭，用来复丹。
稚年夏月食瓜果，水寒之湿，着于脾胃，令人泄泻，其寒湿积聚，未能遽化热气，必用辛温香窜之气，古方中消瓜
果之积，以丁香、肉桂或用麝香，今七香饼治泻，亦祖此意。其平胃散、胃苓汤亦可用。
雄按∶此非温热为病，何必采入。缘夏月此等证候甚多，因畏热贪凉而反生寒湿之病，乃夏月之伤寒也。虽在暑令，
实非暑证。昔人以阴暑名之，谬矣。譬如避火而溺于水，拯者但可云出之于水，不可云出之于阴火也。
疟之为病，因暑而发者居多。
雄按∶可谓一言扼要，奈世俗惟知小柴胡汤为治，误人多矣。方书虽有痰、食、寒、
热、瘴、疠之互异。幼稚之疟，多因脾胃受病。
雄按∶因暑而发者，虽大人之疟，无不病于脾胃，以暑多兼湿，脾为土
春温这一病证，是由于冬季人体封藏功能不固所致。古人认为，冬寒之邪内伏，藏于少阴肾经，到了春季发作时传于少阳胆经，这是因为春季的木气在体内对应肝胆的缘故。寒邪深伏体内，已经化热，所以前代贤人将黄芩汤作为主要方剂，用苦寒之药直接清泄里热；既然热邪伏于阴分，苦味药物能够坚阴（巩固阴液），这是正治之法。要知道温邪忌用辛温发散，其治法与突发的外感病不同。如果是先感受了外邪，引动了体内的伏热，那么必须先使用辛凉药物来解除新感之外邪，自注：葱豉汤。随后再进服苦寒药物以清泄里热。况且热是无形的邪气，当时的医生多用消食导滞的方法，去攻治有形的积滞，导致胃中津液先被耗竭，阴液被劫夺殆尽的情况很多。
王士雄按语：新感外邪引动体内伏邪者，初起时有轻微的恶寒表证。
徐灵胎说：这些都是正确的论述。
章虚谷说：有人说：人身受到邪气，没有不立即发病的，从来没有久伏体内过时而发的情况，这种说法似乎很有道理，浅薄无知的人无不遵从相信为正确，却不知道这违背了《内经》的义理，反而附和它。人的五脏六腑，体表的营卫之气，以及其中的十二经脉、十五络脉、三百六十五孙络、六百五十七个穴位，细微幽深奥妙，曲折难明。如今对于一郡一邑之地，匪类潜伏隐匿，尚且不能察觉，何况人身经络穴位的渊深隐微，而邪气像烟一样逐渐熏蒸，像水一样逐渐积聚，所以如《内经》论述各种疼痛和积聚，都是由最初感受外邪，潜伏而未觉察，以致逐渐侵入内部所形成的。怎么可以必定说它是随感即病，而没有伏邪呢？又如人的痘毒，在未发作时，完全感觉不到，为什么又能潜伏呢？由此而言，那么《素问》所说的冬天受寒，春天发温病，就不是胡言乱语了。
王士雄按语：精气充盛的人，春天不易患温病，为什么小儿多患温病呢？实在是因为冬季天气温暖而失去了闭藏的功能啊！难道冬天年年都温暖吗？因为父母出于姑息之心，惟恐孩子冻着，往往给孩子穿衣盖被过厚，甚至用皮裘丝绸包裹（富贵人家的孩子多夭折，一半因此原因），虽然天时要求潜藏，但真气已经暗中发泄了。温病多发，不也是理所当然的吗。这个道理不仅儿科医生不知道，就连前代贤人也从未提及。汪氏按：只有徐灵胎曾经略微论述过这一点。
风温病，是在春季感受风邪，此时气候已经转温。
王士雄按语：这是说通常情况，冬季天气温暖，所感的也是风温，春季如果过冷，也有风寒。经文说春季病在头部，治疗应针对上焦。肺的位置最高，邪气必先伤害它，这是手太阴肺经的气分先发病，如果失治则传入手厥阴心包络，血分也会受伤。足经的顺传，比如太阳经传阳明经，人们都知道。肺病失治，逆传心包络，人们大多不知道。世俗医生见到身热咳喘，不知道肺病在上焦的道理，妄投荆芥、防风、柴胡、葛根，加入枳实、厚朴、杏仁、苏叶、莱菔子、山楂、麦芽、橘皮之类，就说是解肌消食。有的见到痰喘，就用大黄、礞石滚痰丸，大便数次后，上部的热邪更加结聚。幼儿脾胃薄弱，表里苦辛药物化燥，胃汁已伤，再用大黄等大苦大降的丸药，导致脾胃阳气受损极重，突然变成惊痫，无法救治的情况很多。
自注：风温肺病，治疗在上焦。春温忌用发汗，初病投药，宜用辛凉。如果杂入消导发散药物，徐灵胎云：必须对证也可以使用。不但与肺病无关，反而劫尽胃汁，肺缺乏津液上供。头目清窍，徒然被热气熏蒸，鼻干如煤，眼睛闭合或向上窜视无泪，或者热深肢厥，狂躁尿涩，胸高气促，都是肺气不宣化的征象。此时如果在肺药中少加一味清降药，使药力不至于直趋肠道。
王士雄按语：这就是所谓“非轻不举”，重药则会直接越过病所。而上部闭塞可开，诸窍自然清爽，无奈市井医生都说这是结胸，都用黄连、瓜蒌、柴胡、枳实，苦寒直降，导致闭塞更严重，告死者很多。
又：此证初因发热喘嗽，首选辛凉清肃上焦，徐灵胎云：正确论述。如薄荷、连翘、牛蒡子、象贝母、桑叶、沙参、栀子皮、姜皮、天花粉。如果面色苍老、热盛烦渴，用石膏、竹叶辛寒清散，痧疹也应当遵循此法。如果日数渐多，邪气不得解，黄芩、黄连、凉膈散也可以使用。直到热邪逆传膻中，神昏眼闭，鼻窍无涕，诸窍欲闭，形势危急，必须用至宝丹或牛黄清心丸。徐灵胎云：急救非此不可。病减后余热，只用甘寒清养胃阴即可。
春季天气暴暖忽冷，先受温邪，继为寒气束缚，咳嗽痰喘最多，辛凉解表只用一剂，绝对禁止绝食。如果严重的，宜昼夜竖抱不要倒置，三四天。徐灵胎云：秘诀。轻的为咳，重的为喘，喘急则鼻孔煽动胸部挺起。
自注：春温都是冬季伏邪，详细记载于大方书籍中，儿科也有伏邪。
王士雄按语：人有大小，感受邪气是一样的。治疗遵循大方原则。
王士雄按语：感受既相同，治法也没有区别，无奈精通治疗温病的大方医生很少，何况儿科呢。然而暴感较多，如头痛恶寒，发热喘促，鼻塞声重，脉浮无汗，原本可以表散。春季气候温和，辛温药宜少用，阳经表药，最忌混乱。至于身热咳喘有痰的证候，只宜用肺药清解，泻白散加前胡、牛蒡子、薄荷之类，消食药只宜一二味。
王士雄按语：这是说有食积的情况。如果二便通畅，消食药少用，必须辨别表、里、上、中、下，何者为急施治。另外春季温暖，风温极多，温变热最快，如果发散风寒消食，劫伤津液，变证尤其迅速。
王士雄按语：沈尧封说：温，也是火的气。大概火的微弱者叫温，火的猛烈者叫热，三时都有。只有暑是天上的火，独盛于夏季罢了。
初起咳嗽喘促，通用方：薄荷（汗多不用）、连翘、象贝母、牛蒡子、天花粉、桔梗、沙参、木通、枳壳、橘红。
表解热不清用：黄芩、连翘、桑白皮、天花粉、地骨皮、川贝母、知母、山栀。
备用方：黄芩汤、葱豉汤、凉膈散、清心凉膈散、苇茎汤、泻白散、葶苈大枣汤、白虎汤、至宝丹、牛黄清心丸、竹叶石膏汤、喻氏清燥救肺汤。
里热不清，早晨凉晚上热，就应当清解血分，久了则滋阴养阴。如果热陷神昏，痰升喘促，急用牛黄丸、至宝丹之类。
风温是肺先受邪，于是逆传心包，治疗在上焦，不与清胃攻下同法。儿科医生不懂，初投发散消食，无效。改用柴胡、黄芩、瓜蒌、枳实、黄连，再下夺，无效。多导致危殆，都是因为不明白手经的病。
如果寒痰阻闭，也有喘急胸高，不可与前法。用三白吐之，或妙香丸。
夏季是热病，然而夏至以前，时令未为大热，经文说先夏至病温，后夏至病暑。温邪前面已经申明。暑热这一证候。
王士雄按语：《阴阳大论》说：春气温和，夏气暑热，所以暑就是热。原为一证，所以夏月中暑。张仲景标为：中热。古人以动静分为暑热二证，大概不知道暑是什么气。医者容易迷惑，夏暑发自阳明，古人以白虎汤为主方。后贤刘河间创议，迥出诸家，说：“温热时邪，当分三焦投药，以苦辛寒为主，如果拘泥六经分证，仍是伤寒治法，致误很多。”徐灵胎云：能分六经的人也很少。大概伤寒外受的寒，必先从汗解。辛温散邪是对的。口鼻吸入的寒，即为中寒阴病，徐灵胎云：也不尽然。治疗应当温里，分三阴见证施治。至于暑病，专方很少，都是因为前人略于暑，详于寒。考古如《金匮》论述暑痉的原因，而洁古以动静分中暑、中热，各具至理。
王士雄按语：虽有至理，而强分暑热，名已不正了。这里不概述。论儿科病暑热，夹杂别病有吗，而时下不外发散消导，加入香薷一味，或六一散一服。考《本草》：香薷辛温发汗，能泄宿水。夏热气闭无汗，渴饮停水，香薷必佐杏仁，以杏仁苦降泄气，大顺散取义若此。徐灵胎云：大顺散不是治暑的方，是治暑月伤冷的方，怎么能连类及之，夹杂了。
王士雄按语：上面说香薷治渴饮停水，佐杏仁以降泄，所以说大顺散的意义，也是如此。长夏湿令，暑必兼湿。
王士雄按语：这是说长夏湿旺的时令，暑以蒸之，所谓土润溽暑，所以暑湿易于兼病，就像冬季风寒，每相兼感。暑伤气分，湿也伤气，汗则耗气伤阳，胃汁大受劫烁，变病由此很多，发泄司令，里真自虚。张凤逵说：暑病首用辛凉，继用甘寒，再用酸泄酸敛，不必用下。可称要言不烦了。然而儿科因暑热蔓延，变生他病。
王士雄按语：大方何独不然，学人应该知道举一反三。这里摘取其概要。
暑邪必挟湿。
王士雄按语：暑令湿盛，必多兼感，所以说挟。就像寒邪挟食，湿证兼风，俱是二病相兼，不是说暑中必有湿。所以论暑的人，须知是天上烈日之炎威，不可误以湿热二气并作一气，始为暑。而治暑的人，须知其挟湿为多焉。状如外感风寒，忌用柴胡、葛根、羌活、防风。如肌表热无汗，辛凉轻剂无误。香薷辛温气升，热服易吐，佐苦降，如杏仁、黄连、黄芩则不吐。宣通上焦，如杏仁、连翘、薄荷、竹叶。暑热深入，伏热烦渴，白虎汤、六一散。
王士雄按语：无湿者白虎汤，挟湿者六一散，须区别。暑病头胀如蒙，皆热盛上炽，白虎、竹叶；酒湿食滞者，加辛温通里。
王士雄按语：受热而迷，名叫暑厥。譬如受冷而仆，名叫寒厥。人皆知寒即为冷了，为什么不知暑为热呢。就是热气闭塞孔窍所致。其邪入络，与中络同法，牛黄丸、至宝丹芳香利窍可效。徐灵胎云：妙法。王士雄按：紫雪也可酌情使用。神苏以后，用清凉血分，如连翘心、竹叶心、玄参、细生地、鲜生地、二冬之类。
王士雄按语：暑是火邪，心为火脏，邪易入之。所以治中暑者，必以清心之药为君。此证初起，大忌风药。
王士雄按语：火邪得风药而更炽矣。初病暑热伤气。
魏柳洲说：火极似水，乃物极必反之候。凡患此，为燥热温补所杀者多了，哀哉！大概内真寒而外假热，诸家曾经论述过了。内真热而外假寒，论述到的很少。
王士雄按语：道光甲辰年六月初一日至初四日，连日酷热异常，如此死者，道路相接，我用神犀丹、紫雪二方救之，极效。但看面垢齿燥，二便不通，或泻不爽，为此，大忌误认伤寒。
王士雄按语：尤忌误以暑为阴邪，或指暑中有湿，而妄投温燥渗利之药也。上面是暑厥。
王士雄按语：王节斋说：夏至后病为暑，相火令行，感之自口齿入，伤心包络经，甚则火热制金，不能平木，而为暑风。张兼善说：清邪中上，浊邪中下，其风寒湿皆地之气，所以俱中足经，惟暑乃天之气，系清邪，所以中手少阴心经。
幼儿断乳纳食，值夏月脾胃主气，易于肚膨泄泻，足心热，形体日瘦，或烦渴喜食，渐成五疳积聚。当审体之强弱，病之新久，有余者疏胃清热。食入粪色白，或不化，健脾佐消导清热。如果湿热内郁，虫积腹痛，徐灵胎云：此证最多。导滞驱虫微下之。缓调用肥儿丸之类。
上面是热疳。
夏季秋热，小儿泄泻，或初愈未愈，满口皆生疳蚀，尝有阻塞咽喉致危者，此皆在里湿盛生热，热气蒸灼，津液不生，湿热偏伤气分，治在上焦，或佐淡渗。徐灵胎云：须用外治。世俗常刮西瓜翠衣治疳，徐灵胎云：合度。取其轻扬渗利也。
上面是口疳。
夏季湿热郁蒸，脾胃气弱，水谷之气不运，湿着内蕴为热，渐至浮肿腹胀，小水不利，治之非法，水湿久渍，逆行犯肺，必生咳嗽喘促，甚则坐不得卧，俯不得仰，危期速矣。大凡喘必生胀，胀必生喘。方书以先喘后胀，治在肺；先胀后喘，治在脾，也是定论。《金匮》有风水、皮水、石水、正水、黄汗，以分表里之治。河间有三焦分消。子和有磨积逐水。皆有奥义，学人不可不潜心体认，难以概述。阅近代世俗，论水湿喘胀之证，以《内经》开鬼门取汗为表治，分利小便洁净府为里治。经旨《病能篇》谓“诸湿肿满，皆属于脾”，以健脾燥湿为稳治。治之不效，技穷束手了。不知道凡病皆本乎阴阳，通表利小便，乃宣经气，利腑气，是阳病治法；暖水脏、温脾胃、补土以驱水，是阴病治法。治肺痹，以轻开上；治脾，必佐温通。如果阴阳表里乖违，脏真日漓，阴阳不运，也必作胀，治以通阳，才可奏绩，如《局方》禹余粮丸，甚至三焦交阻，必用分消，肠胃窒塞，必用下夺。然而不得与伤寒实热同例，擅投硝、黄、枳、朴、扰动阴血。如果太阴脾脏，饮湿阻气，温之、补之不应，欲用下法，少少甘遂为丸可也。徐灵胎云：也太峻。其治实证，选用方法备采。
王士雄按语：叶氏《景岳发挥》有“因喘而肿，当以清肺为要”之论，宜参。如果水湿侵脾，发肿致喘，治当补土驱水，设水气上凌心包，变呃更危。陈远公说：用苡仁、茯神各一两，白术、苍术各三钱，半夏、陈皮各一钱，丁香五分，吴萸三分，名止呃汤。二剂可安。
喘胀备用方徐灵胎云：太猛厉者，不可轻用。
葶苈大枣汤、泻白散、大顺散、牡蛎泽泻散、五苓散、越婢汤、甘遂半夏汤、控涎丹、五子五皮汤、子和桂苓汤、禹功丸、茯苓防己汤、中满分消汤、小青龙汤、木防己汤。
吐泻一证，幼儿脾胃受伤，陡变惊搐最多。徐灵胎云：此证多是痰湿。如果不正秽气触入，或口食生冷，应用正气散、六和汤、五积散之类。正气受伤，肢冷呃忒，呕吐自利，即用钱氏益黄散。有痰用星附六君子汤、理中汤等。倘热气深伏，烦渴引饮，呕逆者连香饮，黄连竹茹橘皮半夏汤。热闭神昏，用至宝丹。寒闭，用来复丹。
稚年夏月食瓜果，水寒之湿，着于脾胃，令人泄泻，其寒湿积聚，未能遽化热气，必用辛温香窜之气，古方中消瓜果之积，以丁香、肉桂或用麝香，今七香饼治泻，亦祖此意。其平胃散、胃苓汤也可用。
王士雄按语：这不是温热为病，何必采入。缘夏月此等证候甚多，因畏热贪凉而反生寒湿之病，乃夏月之伤寒。虽在暑令，实非暑证。昔人以阴暑名之，谬矣。譬如避火而溺于水，拯者但可云出之于水，不可云出之于阴火也。
疟之为病，因暑而发者居多。
王士雄按语：可谓一言扼要，奈世俗惟知小柴胡汤为治，误人多矣。方书虽有痰、食、寒、热、瘴、疠之互异。幼稚之疟，多因脾胃受病。
Chunwen (Spring Warmth) is a syndrome caused by the failure of the body's storage function during winter. Ancient scholars believed that cold pathogenic factors from winter lie latent within, hidden in Shaoyin (the Kidney meridian), and emerge in spring to affect Shaoyang (the Gallbladder meridian), because the Wood energy of spring corresponds internally to the Liver and Gallbladder. The cold pathogen lies deep and has transformed into heat; therefore, former sages used Huangqin Tang (Scutellaria Decoction) as the primary formula, employing bitter-cold herbs to directly clear interior heat. Since heat lies in the Yin aspect, bitter flavors can firm the Yin (consolidate Yin fluids), which constitutes the correct treatment principle. It must be known that warm pathogens contraindicate acrid-warm dispersing methods; their treatment differs from sudden exogenous infections. If an external pathogen is contracted first, triggering latent interior heat, one must first use acrid-cool herbs to resolve the new external pathogen, [Self-note: Congchi Tang (Scallion and Fermented Soybean Decoction)]. Subsequently, bitter-cold herbs should be administered to clear interior heat. Moreover, heat is a formless pathogen; contemporary physicians often employ digestive-resolving methods to treat有形 (formful) accumulations, leading to premature depletion of stomach fluids and frequent exhaustion of Yin fluids.
Wang Shixiong’s Note: When new external pathogens trigger latent pathogens, there are initially mild exterior symptoms of aversion to cold.
Xu Lingtai stated: These are all correct discussions.
Zhang Xugu said: Some argue that when the human body receives pathogens, illness invariably follows immediately; there have never been cases where pathogens lay latent for a long time and emerged later. This argument seems reasonable, and shallow-minded individuals universally accept it as true, unaware that it contradicts the principles of the *Neijing* and further supports this error. The internal organs, external Ying-Wei (Nutritive and Defensive Qi), twelve meridians, fifteen collaterals, 365 Sun collaterals, and 657 acupoints are subtle, profound, and difficult to comprehend. Even in a small region, we cannot detect hidden bandits; how much more so the profound and hidden nature of meridians and acupoints, where pathogens accumulate like smoke or water? Thus, as discussed in the *Neijing*, various pains and accumulations result from initial external pathogen contraction lying latent unnoticed, gradually invading inward. How can we insist that illness always follows immediate contraction without latent pathogens? Consider chickenpox toxins; they are imperceptible before eruption, yet they can lie latent. Therefore, the statement in *Suwen* that winter cold leads to spring warmth is not nonsense.
Wang Shixiong’s Note: Those who store essence well do not suffer from spring warmth; why do children frequently suffer from warm diseases? It is precisely because winter warmth causes a loss of closure and storage! Does winter warm every year? Parents, acting out of indulgence and fear of cold, often overdress children, even wrapping them in fur and silk (many wealthy children die young, partly due to this). Although the seasonal command requires storage, the True Qi is secretly leaked. Is it not appropriate that warm diseases are common? This principle is unknown not only to pediatricians but also rarely mentioned by former sages. Wang’s Note: Only Xu Lingtai briefly discussed this.
Fengwen (Wind Warmth) occurs when wind is contracted in spring, when the climate is already warm.
Wang Shixiong’s Note: This describes the general rule. In winter, if the weather is warm, the contracted pathogen is also Fengwen; in spring, if the weather is too cold, there may be Wind-Cold. The classics state that spring diseases affect the head, and treatment should target the Upper Jiao. The Lung is located highest, so pathogens injure it first; this is an initial disease of the Hand Taiyin Qi level. If untreated, it enters the Hand Jueyin Pericardium, injuring the Blood level. The sequential transmission of Foot meridians, such as Taiyang transmitting to Yangming, is well known. However, few know that Lung disease, if untreated, can transmit reversely to the Pericardium. Common physicians seeing fever, cough, and wheezing fail to understand that Lung disease resides in the upper part; they recklessly prescribe Jingjie (Schizonepeta), Fangfeng (Saposhnikovia), Chaihu (Bupleurum), and Gegen (Pueraria), adding Zhishi (Immature Bitter Orange), Houpo (Magnolia Bark), Xingren (Apricot Seed), Suzye (Perilla Leaf), Lapsus (Radish Seed), Shanzha (Hawthorn), Maoya (Barley Sprout), and Chenpi (Tangerine Peel), claiming to release the muscle layer and digest food. Seeing phlegm and wheezing, they use Dahuang (Rhubarb) and Mengshi (Magnetite) Rolling Phlegm Pills; after several bowel movements, upper heat becomes more consolidated. Children have thin stomachs and little grain intake; acrid-warm and bitter-dry herbs desiccate fluids, damaging stomach juices. Using harsh, sinking Dahuang pills further damages Spleen-Stomach Yang harmony, suddenly causing convulsions and epilepsy, often incurable.
[Self-note]: Fengwen Lung disease is treated in the Upper Jiao. Chunwen contraindicates sweating; initial prescriptions should use acrid-cool herbs. If mixed with digestive and dispersing herbs, Xu noted: "They can be used if symptomatic." This does not address Lung disease, exhausts stomach juices, deprives the Lung of fluid supply, and allows heat to steam the clear orifices of the head and eyes, causing dry nose like coal, closed eyes or upward staring without tears, deep heat with cold limbs, mania, irritability, and difficult urination—all signs of Lung Qi failing to diffuse and transform. At this time, adding a single clearing-descending herb to Lung formulas prevents the medicinal force from rushing directly to the intestines.
Wang Shixiong’s Note: This is what is meant by "non-light agents cannot achieve the effect"; heavy drugs will bypass the disease site. Upper obstruction opens, and orifices refresh themselves. Unfortunately, city doctors all diagnose "Jie Xiong" (Chest Binding) and use Lianqiao (Forsythia), Gualou (Trichosanthes), Chaihu, and Zhishi, using bitter-cold descending methods, worsening obstruction, leading to many deaths.
Furthermore: For this syndrome starting with fever, cough, and wheezing, first use acrid-cool herbs to clear and purify the Upper Jiao, Xu noted: "Correct discussion." Examples include Bohe (Mint), Lianqiao (Forsythia), Niubangzi (Arctium Seed), Xiangbei (Fritillaria Thunbergii), Sangye (Mulberry Leaf), Shashen (Glehnia), Zhipi (Gardenia Peel), Jiangpi (Ginger Peel), and Huafen (Trichosanthes Root). If the complexion is dark with severe heat and thirst, use Shigao (Gypsum) and Zhuye (Bamboo Leaf) for acrid-cold clearing and dispersing; this applies to measles as well. If days pass and the pathogen is not resolved, Huangqin (Scutellaria), Huanglian (Coptis), and Liangge San (Cooling the Chest Powder) can be used. If heat pathogen transmits reversely to Danzhong (Conception Vessel area), causing coma, closed eyes, no nasal discharge, and closing orifices, the situation is critical; Zhibao Dan (Precious Treasure Pill) or Niuhuang Qingxin Wan (Calculus Bovis Clear Heart Pill) must be used. Xu noted: "Emergency rescue requires these." After improvement, residual heat requires only sweet-cold herbs to clear and nourish Stomach Yin.
In spring, sudden warmth followed by cold contracts warm pathogens, then binds with cold, causing most coughs and phlegm-wheezing. Acrid-releasing and cool-warming treatments work with one dose; fasting is strictly prohibited. Severe cases require holding the child upright day and night for three to four days. Xu noted: "Secret method." Mild cases cause cough; severe cases cause wheezing; urgent wheezing involves flaring nostrils and protruding chest.
[Self-note]: Chunwen all stems from winter latent pathogens, detailed in major texts; pediatrics also recognizes latent pathogens.
Wang Shixiong’s Note: Humans vary in size, but pathogen reception is the same. Treatment follows major texts.
Wang Shixiong’s Note: Reception being the same, treatment is no different, yet few masters clearly treat warmth, let alone pediatricians. However, sudden infections are common: headache, aversion to cold, fever, wheezing, nasal congestion, floating pulse without sweat—originally suitable for releasing the exterior. Spring warmth favors acrid-warm herbs sparingly; Yang meridian exterior drugs must not be confused. For fever, cough, wheezing with phlegm, only Lung-clearing herbs are suitable, such as Xiebai San (Drain White Powder) plus Qianhu (Peucedanum), Niubangzi, and Bohe. Digestive herbs should be limited to one or two types.
Wang Shixiong’s Note: This refers to cases with food stagnation. If bowels and urine are unobstructed, use digestive herbs sparingly; one must distinguish whether the urgency lies in Exterior, Interior, Upper, Middle, or Lower levels to apply treatment. Additionally, spring warmth brings much Fengwen; warmth transforms to heat rapidly. Dispersing wind-cold and resolving food depletes Jin-Ye (Body Fluids), accelerating transformation syndromes.
Wang Shixiong’s Note: Shen Yaofeng said: Warmth is also the Qi of Fire. What is weak fire is called Warmth; what is intense fire is called Heat; these exist in all three seasons. Only Summerheat is heavenly fire, peaking in summer.
Initial cough and wheezing commonly use: Bohe (avoid if sweating profusely), Lianqiao, Xiangbei, Niubangzi, Huafen, Jiegeng (Platycodon), Shashen, Mutong (Akebia), Zhike (Immature Bitter Orange), Juhong (Tangerine Pith).
If exterior resolves but heat persists: Huangqin, Lianqiao, Sangpi (Mulberry Bark), Huafen, Digupi (Groundcherry Bark), Chuanbei (Fritillaria Cirrhosa), Zhimu (Anemarrhena), Shanzhi (Gardenia).
Backup formulas: Huangqin Tang, Congchi Tang, Liangge San, Qingxin Liangge San, Weijing Tang (Reed Rhizome Decoction), Xiebai San, Tingli Dazao Tang (Semen Lepidii et Jujubae Decoction), Baihu Tang (White Tiger Decoction), Zhibao Dan, Niuhuang Qingxin Wan, Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction), Yu Shi Qingzao Jiufei Tang (Mr. Yu’s Dryness-Rescuing Lung-Decoction).
If interior heat persists, cool in morning and hot at night, clear and resolve the Blood level; prolonged cases require nourishing Yin. If heat traps causing coma and rising phlegm with wheezing, urgently use Niuhuang Wan or Zhibao Dan.
Fengwen begins with Lung pathogen invasion, reversely transmitting to the Pericardium; treatment targets the Upper Jiao, differing from Stomach-clearing and purgative methods. Pediatricians, ignorant of this, first use dispersing and digestive herbs; when ineffective, they switch to Chaihu, Huangqin, Gualou, Zhishi, and Huanglian, then purge again; this often leads to danger due to misunderstanding Hand Meridian diseases.
Wang Shixiong’s Note: With heartfelt earnestness, repeated warnings, speaking until tongue wears and ears deafen, one can only sigh.
If cold-phlegm obstruction causes urgent wheezing and high chest, do not use previous methods. Use Sanbai (Three Whites) to induce vomiting, or Miaoxiang Wan.
Summer is characterized by heat diseases, but before Summer Solstice, the season is not yet intensely hot. Classics state: pre-Solstice illnesses are Warmth; post-Solstice illnesses are Summerheat. Warmth was clarified earlier. Regarding Summerheat:
Wang Shixiong’s Note: *Yinyang Dalun* states: Spring Qi is mild/harmonious, Summer Qi is hot/stifling; thus Summerheat is Heat. Originally one syndrome, hence midsummer heatstroke. Zhang Zhongjing labeled it "Zhong Re" (Heat Stroke). Former scholars divided Summerheat into two based on activity/rest, likely not understanding what Summerheat Qi truly is. Physicians are easily confused. Summerheat originates from Yangming; ancients used Baihu Tang as the main formula. Later scholar Liu Hejian proposed distinctively: "Warm-heat seasonal pathogens should be treated by dividing the Three Jiaos, primarily using bitter-acrid-cold herbs. If constrained by Six Meridian differentiation, it remains Cold Damage treatment, causing many errors." Xu noted: "Few can differentiate Six Meridians." Cold damage from external cold must be resolved via sweating; acrid-warm dispersal is correct. Cold inhaled through mouth/nose is Cold Damage Yin disease, Xu noted: "Not entirely so." Treatment should warm the interior, treating according to Three Yin manifestations. Summerheat diseases have few specific formulas because predecessors neglected Summerheat while detailing Cold Damage. Ancient texts like *Jingui* discuss Summerheat and Spasm; Jiegu divided midsummer heat and midsummer warmth based on activity/rest, each having merit.
Wang Shixiong’s Note: Though meritorious, forcibly dividing Summerheat makes the name inaccurate. Not summarized here. Discussing pediatric Summerheat complicated by other diseases: currently, treatment is merely dispersing and digesting, adding Xiangru (Mosla) or Yiliu San (Six-One Powder). *Bencao* states: Xiangru is acrid-warm, induces sweating, drains old water. In summer heat with closed pores, no sweat, thirst, and retained water, Xiangru must be paired with Xingren (Apricot Seed); Xingren’s bitter descent drains Qi, which is the rationale for Dashun San. Xu noted: "Dashun San treats cold injury in summer, not Summerheat; why mix them?"
Wang Shixiong’s Note: Above, Xiangru treats thirst/retained water, assisted by Xingren for descent, hence the meaning of Dashun San. Long Summer damp command means Summerheat must combine with Dampness.
Wang Shixiong’s Note: This refers to the Long Summer damp peak; Summerheat steams it, described as "earth moistens, stifling heat," so Summerheat-Dampness easily combines, like Winter Wind-Cold combining. Summerheat injures Qi level; Dampness also injures Qi. Sweating consumes Qi and damages Yang, severely robbing stomach fluids, causing many transformations. Expelling command leads to interior deficiency. Zhang Fengkui said: "Summerheat treatment starts with acrid-cool, continues with sweet-cold, then sour-astringent/sour-draining; purgatives are unnecessary." This is concise and essential. However, pediatric Summerheat spreads, transforming into other diseases.
Wang Shixiong’s Note: Major texts are no different; students should infer analogies. Here is a summary.
Summerheat pathogen must carry Dampness.
Wang Shixiong’s Note: Summer season dampness is abundant, so combination is frequent, hence "carrying." Like Cold carrying Food, or Dampness carrying Wind, these are combined diseases, not implying Summerheat inherently contains Dampness. Thus, discussing Summerheat requires knowing it is the scorching intensity of heavenly sun; do not mistake combined Damp-Heat as one Qi constituting Summerheat. Treating Summerheat requires knowing it often carries Dampness. Symptoms resemble Wind-Cold exterior; avoid Chaihu, Gegen, Qianghuo, Fangfeng. If skin surface is hot with no sweat, acrid-cool light agents are correct. Xiangru is acrid-warm and ascending; taken hot, it may cause vomiting. Paired with bitter-descending herbs like Xingren, Huanglian, or Huangqin, it prevents vomiting. To ventilate Upper Jiao, use Xingren, Lianqiao, Bohe, Zhuye. If Summerheat penetrates deeply with latent heat, vexation, and thirst, use Baihu Tang or Yiliu San.
Wang Shixiong’s Note: No Dampness use Baihu Tang; with Dampness use Yiliu San; must distinguish. Summerheat causing head distension like wrapped cotton indicates excessive heat blazing upward; use Baihu Tang or Zhuye. For alcohol-dampness and food stagnation, add acrid-warm interior-unblocking herbs.
Summer heat exposure causing coma resembling fright is Summerheat Jue (Syncope).
Wang Shixiong’s Note: Coma from heat is named Summerheat Jue. Like collapse from cold is Cold Jue. Everyone knows cold is cold; why not know Summerheat is heat? It results from heat blocking orifices. Pathogen enters collaterals, treated same as Collateral Invasion; Niuhuang Wan or Zhibao Dan with aromatic orifice-opening properties are effective. Xu noted: "Excellent method." Wang’s Note: Zixue (Purple Frost) can also be considered. After consciousness returns, use cooling Blood-level herbs like Lianqiaoxin (Forsythia Heart), Zhuyexin (Bamboo Leaf Heart), Xuanshen (Scrophularia), Xishengdi (Small Rehmannia), Xianshengdi (Fresh Rehmannia), and Er Dong (Asparagus and Ophiopogon).
Wang Shixiong’s Note: Summerheat is Fire pathogen; Heart is Fire organ; pathogen easily enters. Thus, treating Summerheat must prioritize Heart-clearing herbs as sovereign. Initial stage strictly forbids Wind herbs.
Wang Shixiong’s Note: Fire pathogen intensifies with Wind herbs. Initial Summerheat injures Qi.
Wang Shixiong’s Note: As stated, "Excessive Fire consumes Qi." Zhuye Shigao Tang or light Lung-clearing agents.
Wang Shixiong’s Note: Fire pathogen overcomes Metal, invading Lung first. Generally, deep heat causes deep Jue (cold limbs).
Wei Liuzhou said: Extreme Fire resembles Water, a sign of reversal at extremes. Many die from dry-heat and warm-tonics! Alas! Internal True Cold with External False Heat has been discussed by many. Internal True Heat with External False Cold is rarely discussed.
Wang Shixiong’s Note: From June 1st to 4th in Jiachen year of Daoguang era, extreme heat persisted; bodies lined the roads. I saved them effectively with Shenxi Dan and Zixue. Look for dirty face, dry teeth, obstructed bowels/urine, or incomplete diarrhea. Strictly forbid misdiagnosing as Cold Damage.
Wang Shixiong’s Note: Especially forbid mistaking Summerheat for Yin pathogen or pointing to Dampness in Summerheat and recklessly prescribing warm-dry diuretics. Above is Summerheat Jue.
Wang Shixiong’s Note: Wang Jiezhai said: Illness after Summer Solstice is Summerheat; Ministerial Fire commands, entering via mouth/teeth, injuring Pericardium meridian. Severe cases: Fire controls Metal, failing to calm Wood, causing Summerheat Wind. Zhang Jianshan said: Clear pathogens attack Upper; turbid pathogens attack Lower. Wind/Cold/Damp are Earth Qi, attacking Foot meridians. Summerheat is Heaven Qi, a Clear pathogen, attacking Hand Shaoyin Heart meridian.
Toddlers weaning and eating, during Summer when Spleen/Stomach dominate, easily develop abdominal distension, diarrhea, hot soles, emaciation, vexation/thirst, craving food, gradually forming Five Worms and Accumulations. Assess constitution strength and disease duration. Excess conditions: drain Stomach and clear heat. If stool is white or undigested after eating: strengthen Spleen, assist digestion, clear heat. If Damp-Heat internal depression causes worm-colic pain, Xu noted: "This case is very common." Guide stagnation, expel worms, slight purgation. For slow regulation, use Fei’er Wan.
Above is Heat Worms.
Summer/Autumn heat, pediatric diarrhea, or unresolved recovery, with mouth ulcers covering the whole mouth, sometimes blocking throat dangerously. This is interior Dampness generating heat, steaming fluids, preventing generation, Damp-Heat biasing Qi level. Treat Upper Jiao, or assist with bland-leaching. Xu noted: "External treatment required." Secular practice scrapes Watermelon Rind (Xigua Cuiyi) for worms, Xu noted: "Appropriate." Taking its light-floating leaching property.
Above is Mouth Worms.
Summer Damp-Heat oppression, weak Spleen/Stomach Qi, failing to transport Grain Qi, Dampness accumulating internally generating heat, gradually causing edema and abdominal distension, difficult urination. Illegal treatment leads to long-term Damp-Water soaking, reversing to invade Lung, causing cough/wheezing, unable to sit or lie flat, rapid death. Generally, wheezing causes distension; distension causes wheezing. Formulas state: Wheezing first, treat Lung; Distension first, treat Spleen—a fixed theory. *Jingui* distinguishes Fengshui, Pishui, Shishui, Zhengshui, Huanghan for exterior/interior treatment. Hejian uses Three Jiao separation. Hezi uses grinding accumulations and driving water. All have profound meanings; students must study carefully, hard to summarize. Reading modern secular views on Water-Damp wheezing/distension: using *Neijing* "Open Ghost Gate" (sweating) for exterior, separating urine for interior. Classic *Bingneng Pian* says "All Damp swelling/fullness belongs to Spleen," advocating Spleen-strengthening and Damp-drying as stable treatment. If ineffective, skills exhausted. Ignoring that all diseases root in Yin/Yang. Unblocking exterior and promoting urine宣经气 (ventilates Meridian Qi) and 利腑气 (benefits Fu Qi)—Yang disease treatment. Warming Water Organ, warming Spleen/Stomach, tonifying Earth to drive water—Yin disease treatment. Treating Lung Bi, lightly open Upper; treating Spleen, must assist with warm-unblocking. If Yin/Yang exterior/interior discord, Zhen Qi daily depletes, Yin/Yang fails to move, causing distension; treat by unblocking Yang to succeed, e.g., *Ju Fang* Yuyuliang Wan. Even if Three Jiao block, must separate; if Intestines/Stomach blocked, must purge. However, cannot equate with Cold Damage Excess Heat; recklessly using Xiaoshi (Mirabilite), Dahuang (Rhubarb), Zhishi, Houpo disturbs Yin Blood. If Taiyin Spleen has Drink/Damp blocking Qi, and warming/tonifying fails, attempting purgation, use small amounts of Gansui pills. Xu noted: "Too harsh." Select methods for excess patterns prepared.
Wang Shixiong’s Note: Ye Tianshi’s *Jingyue Fahui* has "Swelling due to wheezing requires Lung clearing as key"; refer to it. If Water-Damp invades Spleen, causing swelling/wheezing, treat by tonifying Earth driving water. If Water Qi attacks Pericardium, changing to hiccups is more critical. Chen Yuan Gong said: Use Yiren (Coix Seed) and Fushen (Poria with Hostwood) 1 liang each, Baizhu (Atractylodes Macrocephala) and Cangzhu (Atractylodes Lancea) 3 qian each, Banxia (Pinellia) and Chenpi (Tangerine Peel) 1 qian each, Dingxiang (Clove) 0.5 qian, Wuyu (Evodia) 0.3 qian, named Zhi’e Tang. Two doses bring peace.
Backup formulas for Wheezing/Distension Xu noted: Too fierce, do not use lightly.
Tingli Dazao Tang, Xiebai San, Dashun San, Muli Zexie San (Oyster and Alisma Powder), Wuling San, Yuebi Tang, Gansui Banxia Tang, Kongyan Dan, Wuzi Wupi Tang, Hezi Guiling Tang, Yugong Wan, Fuling Fangji Tang, Zhongman Fenxiao Tang, Xiao Qinglong Tang, Mugufangji Tang.
Vomiting/Diarrhea syndrome: Toddler Spleen/Stomach injured, suddenly transforming into convulsions most frequently. Xu noted: "This case is mostly Phlegm-Damp." If foul秽气 (filthy Qi) intrudes, or raw/cold food eaten, use Zhengqi San, Liuhe Tang, Wuji San. If Righteous Qi injured, cold limbs, hiccups, vomiting, spontaneous diarrhea, use Qian Shi Yihuang San. With Phlegm, use Xingfu Liujunzi Tang or Lizhong Tang. If heat lies deep, vexation/thirst drinking, vomiting/reversal, use Lianxiang Yin or Huanglian Zhuru Jupi Banxia Tang. Heat closing coma, use Zhibao Dan. Cold closing, use Laifu Dan.
Children eating melons/fruits in summer: Water-cold dampness adheres to Spleen/Stomach, causing diarrhea. Cold-Damp accumulation fails to quickly transform to heat; must use acrid-warm aromatic penetrating Qi. Ancient formulas for dissolving melon/fruit accumulation use Dingxiang (Clove), Rougui (Cinnamon Bark), or Shexiang (Musk). Modern Qixiang Bing (Seven-Aromatic Cake) for diarrhea follows this intent. Pingwei San and Weiling Tang are also usable.
Wang Shixiong’s Note: This is not a Warm-Heat disease; why include it? Because such cases are numerous in summer; fearing heat and seeking coolness generates Cold-Damp disease, i.e., Summer Cold Damage. Though in Summerheat season, it is not Summerheat syndrome. Former scholars named it "Yin Summerheat," which is erroneous. Like avoiding fire but drowning in water, rescuers say "saved from water," not "saved from Yin Fire."
Malaria disease mostly originates from Summerheat.
Wang Shixiong’s Note: A concise summary, yet secular world only knows Xiaochaihu Tang for treatment, misleading many. Formulas differ for Phlegm, Food, Cold, Heat, Miasma, Pestilence. Pediatric malaria mostly stems from Spleen/Stomach disease.
Wang Shixiong’s Note: Originating from Summerheat, even adult malaria affects Spleen/Stomach, as Summerheat often carries Dampness, and Spleen is Earth...