典藏书目

Qian Yi stated: Cough is caused by the Lung being affected by slight cold. In the eighth and ninth lunar months, Lung Qi is vigorous; thus, when cough occurs, the condition is necessarily excess (Shi) rather than a chronic illness. The symptoms include red face, profuse phlegm, and fever. The treatment method should be to purge using Tingli Wan (Descurainia Seed Pill). If it is a chronic cough, purging is contraindicated. Cough occurring in the eleventh and twelfth lunar months is due to wind-cold injury. The pathogenic wind enters through Feishu (BL13), an acupoint located at the third thoracic vertebra on the back. The treatment method should be to induce sweating using Ma Huang Tang (Ephedra Decoction). If there are heat signs, such as red face, desire for water, hot and sticky saliva, and throat discomfort, Gan Jie Tang (Licorice and Platycodon Decoction) should be used concurrently. If within five to seven days the symptoms are fever, profuse phlegm, and sticky sputum, Pian Yin Wan should be used to purge. If there is Lung Excess (Lung Qi stagnation), characterized by cough followed by wheezing, facial edema, desire or non-desire for water accompanied by body heat, Xie Bai San (Bai Pi San) should be used to clear and drain Lung heat. For wind-cold induced cough without heat signs within five to seven days, only coughing present, Tingli Wan is the primary treatment, followed by phlegm-resolving herbs. If there is Lung Deficiency, characterized by cough with choking sensations, frequent deep sighs, and sounds in the throat, this is a chronic condition treated with E Jiao San (Donkey-hide Gelatin Powder) to tonify. If phlegm is profuse, the Spleen should first be strengthened, then Pian Yin Wan used to mildly purge; after the phlegm subsides, the Lung should be tonified according to the above method. If cough is accompanied by vomiting clear water or green-blue water, Baixiang Wan should be used to purge. If cough is accompanied by vomiting phlegm-saliva and undigested milk/food, Baibing Zi (White Pill) should be used to purge. If cough is accompanied by expectoration of pus and blood, this indicates Lung Heat; Gan Jie Tang should be taken after meals. For chronic cough leading to depletion of Lung fluids, E Jiao San is used to tonify. For cough with solid phlegm but mild wheezing, red face, and frequent desire for water, Pian Yin Wan can be used to purge. The general principle for treating cough is: treat excess conditions by purging, and chronic conditions by tonifying, adjusting further based on deficiency and excess.

Note: This discussion on pediatric cough distinguishes between external pathogens and internal causes, as well as excess and deficiency patterns. Treatment methods should also refer to other formulas in the Cough category for comprehensive application.

Qian Yi stated: Vomiting milk with yellow stool indicates injury from hot milk; vomiting milk with green stool indicates injury from cold milk. In infants aged three days to eleven days, if vomiting, diarrhea, high fever, anorexia, and undigested milk or white stools occur, this is food retention requiring purgation, followed by harmonizing the Stomach using Baibing Zi. Alternatively, if milk is not digested, the body temperature is normal or cool, there is no desire for milk, and stools are green or white, this is Upper Excess and Lower Deficiency. There are also combined syndromes: vomiting and diarrhea caused by wind-cold, with fluctuating body temperature, lethargy, coarse breathing, yellow-white stools, vomiting of undigested milk/food, and occasional cough. There are also five-Zang combined syndromes; one should decoct the "Zang-Entry Minister-Monarch" herbs, starting with Da Qing Gao, followed by Yi Huang San. If purgation has already been performed or there are no indications for purgation, it must not be done again. This is because the Spleen and Lung are affected by cold, failing to transform food. Wind-cold induced vomiting and diarrhea with fever, lethargy, ability to suckle, excessive thirst, vomiting of phlegm, and yellow watery stools indicate Stomach deficiency-heat causing thirst and vomiting/diarrhea. One should generate stomach fluids to stop thirst, then use dispersing herbs once thirst stops; Baid Zhu San may be taken frequently for dispersal, or Da Qing Gao used. Wind-cold induced vomiting and diarrhea with cool body temperature, salivation, green-white loose stools, restlessness, choking sensations, deep sighs, sleeping with eyes partially open, and white lips indicate mild wind-cold leading to vomiting/diarrhea; the Spleen should be tonified first, then dispersed. These two conditions often occur in spring and winter. Vomiting and diarrhea occurring after May 25th with high fever indicate heat. Children have nine parts heat to one part cold in their Zang-Fu organs. If caused by injury from hot milk/food, with undigested milk vomiting and deep yellow diarrhea, Yulu San is the primary treatment. After June 15th, vomiting and diarrhea with warm body temperature resembling heat indicate six parts heat to four parts cold in the Zang-Fu. With vomiting of undigested milk/food, white-yellow diarrhea, apparent thirst or variable feeding, take small amounts of Yi Huang San before meals and large amounts of Yulu San after meals. After July 7th, vomiting and diarrhea with cool body temperature indicate three parts heat to seven parts cold. Inability to suckle, lethargy, restlessness, choking, deep sighs, sleeping with eyes open, white lips, frequent hiccups, urge to defecate without thirst, require large amounts of Yi Huang San before meals and small amounts of Yulu San after meals. After August 15th, vomiting and diarrhea with cold body and absence of Yang Qi, inability to suckle, dry hiccups, and green-brown watery diarrhea require Spleen tonification with Yi Huang San; purgation is contraindicated. Weakness and emaciation due to Spleen-Stomach disharmony and inability to suckle, resulting in muscle wasting, often follow severe illness or prolonged vomiting/diarrhea where Spleen-Stomach transformation is weak. Cold types presenting with frequent diarrhea and blue-white lips/mouth are treated with Muxiang Wan; avoid in summer, use sparingly if indicated. Heat types presenting with low-grade fever, body heat, and slightly yellow skin are cold-heat deficiency-emaciation, treated with Huhuanglian Wan; avoid in winter, use sparingly if indicated.

Zhang Yuansu (Jiegu) stated: In summer, Heart Fire is dominant; treat vomiting/diarrhea without warming herbs. In autumn, use warm herbs; in late autumn, use warm-hot herbs. For five-Zang combined syndromes: wind-diarrhea uses Fangfeng and Qianghuo; heat-diarrhea uses Huangqin and Dahuang; cold-diarrhea uses Fuzi; damp-diarrhea uses Baizhu and Fuling; Lung-diarrhea uses Shaoyao, Jingjie, and Renshen; add Binglang and Muxiang if severe. If constipation, add Dahuang. Further distinguish new vs. old disease: new cases stop the pathology; old cases risk intestinal wind, requiring pushing out the old and generating the new, using Xuan Feng San to guide stagnation, and regulating with Zang-Entry Minister-Monarch herbs like Yi Huang San.

For severe diarrhea with intense thirst, regardless of new or old onset, Baizhu San is appropriate; dysentery follows the same principle. Fever, vomiting, diarrhea, and cough indicate Wind-Wood invading Earth (Spleen); since the Mother (Liver/Wood) is deficient, the Child (Spleen/Earth) is also weak. Treat by decocting Binglang and Doukou Tang to administer Da Qing Gao, followed by Yi Huang San. Fever, vomiting, diarrhea, extreme thirst, and scanty stools indicate heat entering the Bladder and fluid depletion, a major reversal indicating Yin-Yang mutual invasion; Wuling San is the primary treatment. Cool body, vomiting, diarrhea, and no thirst indicate cold-diarrhea; tonify by decocting Fuzi and Guizhi Tang to administer Da Qing Gao. Yin-Yang mutual invasion with Liver Qi entering the Stomach causes fever and vomiting; take Baizhu San, then decoct Binglang and Muxiang Tang to administer Da Qing Gao.

Yan Xiaozhong stated: Pediatric vomiting and diarrhea should be treated with warming and tonifying. I commonly use Lizhong Wan to warm the middle, Wuling San to direct rebellious Qi downward, administered repeatedly, combined with Yichong San and other warming herbs for regulation, often resulting in recovery. If already depleted, quickly restore Stomach Qi by administering Siwei Lizhong Wan mixed with Jin Ye Dan powder, diluted in ginger-rice drink. Frequent administration is key until Stomach Qi returns, limbs warm, Yin recedes, and Yang returns. If convulsions persist, reduce Jin Ye Dan by two fen and increase Qingzhou Baizi Wan by one to two fen, combining with Yichong San, Qianghuo Gao, Wenbai Wan, Gouteng Yinzi, etc., for regulation until stability. Following this treatment and frequent porridge intake, even critical cases often survive, saving eight or nine out of ten. Jin Ye Dan is excellent for pediatric vomiting/diarrhea with extreme deficiency. Shen Kuo, in *Liangfang*, regarding Jin Ye Dan: "I personally witnessed several children with severe vomiting/diarrhea and absent pulse revive after taking it. It is not false. High doses are required for efficacy."

Note: Qian’s discussion on these conditions attributes them to milk/food injury, distinguishing cold/heat and wind-cold, identifying combined syndromes, and clarifying cold/heat for treatment, thoroughly exploring the origins. Yan advocates warming the middle and using Jin Ye Dan, suitable for cold-damp patterns and sinking collapse. Jiegu further differentiates by season and comprehensively addresses combined syndromes in medication, leaving little room for improvement. However, while vomiting and diarrhea are discussed together, cases of vomiting without diarrhea or diarrhea without vomiting require separate consideration. Vomiting without diarrhea due to cold should be warmed in the Stomach; diarrhea without vomiting due to cold with a faint pulse should be treated with moxibustion. Distinctions are necessary because the root causes vary.