孕妇时疫，设应用三承气汤，须随证施治，切不可过虑，慎毋惑于参、术安胎之说。病家见用
承气，先自惊疑，或更左右嘈杂，必致医家掣肘，为子母大不祥。若应下之证，反用补剂
，
邪火壅郁，热毒愈炽，胎愈不安，转气传血，胞胎何赖？是以古人有悬钟之喻，梁腐而钟未
有不落者，惟用承气，逐去其邪，火毒消散，炎
顿为清凉，气回而胎自固
。当此证候，反见大黄为安胎之圣药，历治历当，子母俱安。若腹痛如锥，腰痛如折，此时
未堕欲堕之候，服药亦无及矣，虽投承气但可愈疾而全母。昧者以为胎堕，必反咎于医也。
或诘余曰∶孕妇而投承气，设邪未逐，先损其胎，当如之何？余曰∶结粪瘀热，肠胃间事也，胎附于脊，
肠胃之外，子宫内事也，药先到胃，瘀
热才通，胎气便得舒养，是以兴利除害于顷刻之间，何虑之有？但毒药治病，衰去七八，余
邪自愈，慎勿过剂耳。
凡孕娠时疫，万一有四损者，不可正治，当从其损而调之，产后同法。非其损而误补，必死
。（四损详见前应补诸证条后。）
凡小儿感冒风寒疟痢等证，人所易知，一染时疫，人所难窥，所以耽误者良多。何也？盖
由幼科专于痘
、疹、吐、泻、惊、疳并诸杂证，在伤寒时疫甚略之，一也；古人称幼科为哑科
，盖不能尽罄所苦以告师，师又安能悉乎问切之义？所以但知其身热，不知其头疼身痛也，但
知不思乳食、心胸膨胀，疑其内伤乳食，安知其疫邪传胃也？但见呕吐恶心口渴下利，以
小
儿吐泻为常事，又安知其协热下痢也？凡此，何暇致思为时疫，二也。小儿神气娇怯，筋骨
柔脆，一染时疫，延挨失治，即便二目上吊、不时惊搐、肢体发痉、十指钩曲、甚则角弓反
张，必延幼科，正合渠平日学习见闻之证，是多误认为慢惊风，遂投抱龙丸，安神丸，竭尽惊风之剂，
转治转剧，因见不啼不语，又将神门眉心乱灸，艾火虽微，内攻甚急，两阳相拂，如火加油
，红炉添炭，死者不可胜记，深为痛悯。今凡遇疫毒流行，大人可染，小儿岂独不可染耶？但所受之邪则一，因
其气血筋骨柔脆，故所现之症为异耳，务宜求邪以治，故用药与大人仿佛。凡五六岁以上者
，药当减半，二三岁往来者，四分之一可也。又肠胃柔脆，少有差误，为祸更速，临证尤宜加慎
。
小儿太极丸
天竺黄（五钱） 胆星（五钱） 大黄（三钱） 麝香（三分） 冰片（三分） 僵蚕（三钱）
上为细末，端午日午时修合，糯米饭杵为丸，如芡实大，朱砂为衣。凡遇疫证，姜汤化下一丸
，神效。
孕妇感染时疫，如果应当使用三承气汤治疗，必须根据具体证候灵活施治，切不可过度担忧，务必不要受“人参、白术安胎”说法的迷惑。病人家属看到医生使用承气汤，往往先自惊疑，或者旁听者议论纷纷，必然导致医生束手束脚，这对母子都是极大的不吉利。如果是应当攻下的证候，反而使用补剂，会导致邪火壅滞郁结，热毒更加炽盛，胎儿更加不安，病邪由气分传入血分，胞胎还能依靠什么？所以古人有悬挂钟磬的比喻，房梁腐烂了，钟磬没有不坠落的道理。只有使用承气汤，驱逐去除体内的邪气，火毒消散，炎症顿时转为清凉，气机恢复而胎儿自然稳固。在这种证候下，反而将大黄视为安胎的圣药，每次治疗都恰当有效，母子都能平安。如果出现腹痛如针刺，腰痛如折断，这是胎儿即将坠落或已经欲坠的征候，此时服药也已经来不及了，虽然投用承气汤只能治愈疾病保全母亲。愚昧的人认为这是导致堕胎，必定反过来责怪医生。
有人责问我道：“孕妇服用承气汤，假如邪气没有被驱逐，反而先损伤了胎儿，该怎么办呢？”我回答说：“燥结的粪便和瘀积的热邪，是肠胃之间的事情；胎儿附着于脊柱，在肠胃之外，属于子宫内部的事情。药物首先到达胃部，瘀热才得以疏通，胎气随即得到舒缓滋养，因此在顷刻之间兴利除害，有什么可担忧的呢？只是毒药治病，当病势衰退七八分时，剩余的邪气自然会痊愈，务必谨慎不要过量用药罢了。”
凡是妊娠期间感染时疫，万一出现“四损”（指正气极度虚弱等四种危重情况），不可进行常规的正治法，应当顺从其虚损的情况进行调理，产后也采用同样的方法。如果不是虚损却误用补法，必然导致死亡。（关于“四损”的详细内容详见前文“应补诸证”条目的后面。）
凡是小儿感冒风寒、疟疾、痢疾等病症，人们容易知晓；一旦感染了时疫，人们就难以洞察，因此耽误病情的很多。为什么呢？这是因为儿科专门专注于痘疮、麻疹、呕吐、腹泻、惊风、疳积以及各种杂症的治疗，对于伤寒和时疫的研究非常简略，这是一点；古人称儿科为“哑科”，因为患儿不能详尽地把痛苦告诉老师，老师又怎么能完全了解切脉问诊的意义呢？所以只知道孩子身体发热，不知道他头疼身痛；只知道孩子不想吃奶吃饭、心胸胀满，怀疑是内伤乳食，怎么知道是疫邪传入胃腑呢？只见到呕吐恶心、口渴、下利，把小兒吐泻当作常事，又怎么知道这是协热下痢呢？凡此种种，哪里还有心思去考虑是否为时疫，这是第二点。小儿神气娇嫩怯弱，筋骨柔脆，一旦感染时疫，拖延失治，立刻会出现两眼上吊、不时惊厥抽搐、肢体痉挛、十指钩曲，甚至角弓反张。必定延请儿科医生，这正符合他们平日学习和见识过的病症，因此多被误认为是慢惊风，于是投用抱龙丸、安神丸等竭尽惊风治疗的药剂，病情反而加重。因为见孩子不哭不语，又将神门穴、眉心乱灸，艾火虽然微弱，但内攻非常急迫，两阳相激，如同火上浇油、红炉添炭，死去的不可胜数，深表痛惜怜悯。如今凡是遇到疫毒流行，大人可以感染，小儿难道唯独不可以感染吗？只是所受的邪气是一样的，因为他们的气血筋骨柔脆，所以表现出的症状不同而已。务必寻求病因以治疗，所以用药与成人相似。凡是五岁以上的儿童，药量应当减半；两三岁的儿童，取四分之一剂量即可。又因为小儿肠胃柔脆，稍有差错，祸患发生更快，临证尤其应当谨慎。
小儿太极丸
天竺黄（五钱） 胆南星（五钱） 大黄（三钱） 麝香（三分） 冰片（三分） 僵蚕（三钱）
以上药材研为细末，在端午节午时制作，用糯米饭捣烂作为丸剂，大小如芡实，用朱砂做衣。凡是遇到疫病证候，用姜汤化开一丸服用，效果神奇。
When a pregnant woman contracts an epidemic disease, if the San Chengqi Decoction (Three Purging Formulas) is indicated, treatment must be administered flexibly according to the specific syndrome. One must not worry excessively and should strictly avoid being misled by the notion that Ginseng Radix et Rhizoma (Renshen) and Atractylodis Macrocephalae Rhizoma (Baizhu) are used to stabilize the fetus. When the family sees the use of Chengqi formulas, they often become alarmed and suspicious, or bystanders may create confusion, inevitably hampering the physician's actions, which brings great misfortune to both mother and child. If a case requires purgation but tonics are instead used, pathogenic fire will become congested and stagnant, heat toxicity will intensify, and the fetus will become increasingly unstable. The pathogen may transmit from the Qi level to the Blood level, leaving the fetal sac without support. Therefore, ancients used the metaphor of a hanging bell: when the beam rots, the bell inevitably falls. Only by using Chengqi Decoction to expel the pathogen can the fire and toxicity dissipate, inflammation turn cool, Qi mechanism recover, and the fetus naturally stabilize. In such syndromes, Dahuang (Rhei Radix et Rhizoma) is regarded as a sacred herb for stabilizing the fetus; every application has been effective, ensuring safety for both mother and child. However, if abdominal pain feels like piercing and lower back pain feels like breaking, these are signs that the fetus is about to miscarry or is in the process of miscarriage. At this stage, medication is futile. Even if Chengqi Decoction is administered, it can only cure the disease and preserve the mother. Ignorant people attribute the miscarriage to the doctor and blame them accordingly.
Someone might question me: "If a pregnant woman takes Chengqi Decoction and the pathogen is not expelled, but the fetus is damaged first, what should be done?" I reply: "The accumulation of dry feces and stasis-heat belongs to the intestines and stomach. The fetus attaches to the spine, outside the intestines and stomach, residing within the uterus. The medicine reaches the stomach first; once the stasis-heat is cleared, the fetal Qi immediately receives nourishment and relief. Thus, benefit is promoted and harm removed in an instant. What is there to fear? However, when using toxic herbs to treat disease, once the illness has receded by seventy or eighty percent, the remaining pathogens will resolve themselves. One must be cautious not to overdose."
In all cases of epidemic disease during pregnancy, if one of the "Four Damages" (severe deficiencies) occurs, standard curative methods should not be applied. Instead, treatment should follow the principle of regulating the deficiency. The same method applies postpartum. If non-deficiency conditions are mistakenly treated with tonics, death is inevitable. (Details on the "Four Damages" are found later in the section on "Syndromes Requiring Tonification".)
Regarding pediatric cases of wind-cold invasion, malaria, dysentery, etc., these are well-known. However, when children contract epidemic diseases, they are difficult to diagnose, leading to many delays. Why? First, pediatrics focuses primarily on smallpox, measles, vomiting, diarrhea, convulsions, malnutrition (Gan syndrome), and miscellaneous disorders, while knowledge of Shanghan (Cold Damage) and epidemic diseases is scant. Second, ancient texts refer to pediatrics as the "Mute Department" because infants cannot fully articulate their suffering, making it difficult for physicians to accurately apply pulse diagnosis and inquiry. Physicians may observe fever but miss headache and body pain; they may see loss of appetite and chest distension, suspecting food stagnation, rather than recognizing the transmission of epidemic pathogens to the Stomach. They may observe vomiting, nausea, thirst, and diarrhea, dismissing them as common infant issues, rather than identifying heat-coupled dysentery. Under such circumstances, how can one consider the possibility of an epidemic disease? This constitutes the second reason. Children have delicate Shen (Spirit) and Qi, and soft bones and tendons. Once infected with an epidemic, delayed or incorrect treatment can lead to upward deviation of the eyes, frequent convulsions, limb spasms, hooking of the fingers, and even opisthotonos. Physicians often misdiagnose these as slow convulsive wind (Man Jing Feng) based on familiar symptoms, administering pills such as Baolong Wan (Dragon-Holding Pill) or Anshen Wan (Spirit-Calming Pill), exhausting all treatments for convulsions. The condition worsens. Seeing the child silent and unresponsive, practitioners may indiscriminately moxa points such as Shenmen and Meixin. Although the moxa fire is slight, its internal attack is urgent. The interaction of two Yangs is like adding oil to fire or charcoal to a red-hot furnace. Many deaths have occurred, causing deep sorrow. Today, when epidemic toxins prevail, adults can be infected; why should children be exempt? The pathogen received is the same, but due to the delicacy of their Qi, Blood, bones, and tendons, the symptoms manifest differently. Treatment must seek the pathogen, so the herbal prescriptions are similar to those for adults. For children aged five and above, the dosage should be halved; for those aged two to three, one-quarter of the adult dose is appropriate. Furthermore, children's intestines and stomachs are delicate; any error leads to rapid disaster, so clinical caution is paramount.
Xiao'er Taiji Wan (Children's Supreme Ultimate Pill)
Tianzhuhuang (Calamiform Beech Pollen, 5 qian)
Danning (Arisaema cum Bile, 5 qian)
Dahuang (Rhei Radix et Rhizoma, 3 qian)
Shexiang (Moschus, 3 fen)
Bingpian (Borneolum Syntheticum, 3 fen)
Jiangcan (Bombyx Batryticatus, 3 qian)
Grind the above ingredients into a fine powder. Prepare on the noon hour of the Dragon Boat Festival (Duanwu). Pounded with glutinous rice paste into pills the size of a water caltrop. Coat with Cinnabar (Zhusha). For any epidemic syndrome, dissolve one pill in Ginger Decoction (Jiang Tang) and administer. It yields miraculous effects.