病之最难治者莫如小儿小儿口不能言古人谓之哑科凡一切疾痛 痒莫由达之医人医
者以意消
息其表里虚实则诚有难然者也然最易治者亦莫如小儿小儿脏腑虽脆弱固易受病却是一片天真
之气全无七情六欲其中病也必先见于形色观色之晦明即可知其寒热又必发于声音审其声之宏
细即可知其虚实又水镜诀有三关脉辨色以验五脏医者心诚求之果能得其虚实取效甚速此又治
之易易也钱仲阳小儿脉诀云弦急气不和沉缓为伤食促急是虚惊风浮冷沉细消息得其端脉乱者
不治又全幼心鉴有按眉端法介宾以强弱缓急四脉验小儿病最为得要思其难以图其易则难者不
难视为易不识其难则易者不易常见世俗时医执守数方以为的将小儿之病以作射的之矢其中我
力也不中尔命也嗟乎何其轻尝浅试忍心夭折一至于此吴中叶氏有讽切之言谓近时俗医所用药
饵不分气血阴阳初则疏散继为清解未从消导尽此不效别无方法托言服药已疲且缓药数日待其
自愈倘有变症希企掩饰而已更有病家延集多医以为合谋商酌必然稳安不知筑室道旁杂无成见
内有稍通道者主立一方众医传视佥曰正合吾意或加一味或减一味虚应在事之情迨药不中病
群相推诿或侥幸成功各夸己能并不识在经在络汤药乱投即病家亦不知谁咎谁功妄加毁誉此等
风气
开自庸医富室而医事几为若辈坏矣予亦有医愿数则附录于后以明医道实为躯命所关丝毫不可
率略而小儿尤必加谨焉
一惊风有急慢二症急惊之候壮
热痰壅窜视反张搐搦颤动牙关紧急口中气热颊赤唇红饮冷便结脉浮洪数此肝邪有余而风
生热
热生痰痰热客于心膈间则风火相搏故其形症急暴阳症也实症也当先治其标后治其本慢惊之候
多
由吐泻因致气微神缓昏睡露睛痰鸣气促惊跳搐搦或乍发乍静或身凉身热或肢体逆冷或眉唇
青赤面色淡白但其脉迟缓或见细数此脾肺气虚肝邪无制因而侮脾生风故其形气病气俱不足阴
症也虚症也当专顾脾胃以救元气若慢脾之症由慢惊之后吐泻损脾面赤额汗舌短头低眼合不开
睡中摇头吐舌频呕腥臭噤口切牙床手足微搐或身冷或身温或四肢冷脉沉微此病传已极总归虚
处惟脾所受若逐风无风可逐疗惊无惊可疗于此不审其因泛用祛风化痰之剂则促其危矣又撮口
脐风由胎中受热或初生不慎风寒遂致聚唇撮口眼闭口噤啼声如鸦或声不能出或舌上如粟或口
吐白沫或痰鸣气喘甚者舌强面青腹胀青筋吊肠牵痛七日内
病者百无一生百日内病甚者亦多不治若因风动入
脐或冷气传于脾络以致前症者口内
有小泡急掐破去其毒水以艾灸脐中亦有得生者治法多端无如灸法神妙
一龟背者因小儿初生客风吹脊入于骨髓小儿元气未充腠理不密易为风邪所乘或痰饮
蕴结风热
交攻亦致此症鸡胸者由肺热胀满攻于胸膈或乳母多食五辛热物及儿食宿乳而成钱仲阳云肺主
气实则闷乱壅迫干胸间乃成鸡胸之症
一小儿羸瘦肚大多属疳症如手足极细项小骨高尻削体痿腹大脐突号哭胸陷是为丁奚
如虚热
往
来头骨分开翻食吐虫烦渴呕哕是为哺露又脑后项边有如弹丸按之转动软而不痛其内有虫不速
针出则内食脏腑肢体痈疽便利脓血壮热羸瘦头露骨高是为无辜疳若见白膜遮睛或泻血而瘦此
为肝疳又名筋疳亦名风疳钱仲阳云小儿诸疳皆因脾胃亏损内亡津液虚火妄动或乳母六淫七情
饮食起居失宜致儿为患又因食积腹大多缘脾胃阳气不足虚寒作胀东垣云寒胀多热胀少若脾胃
不虚则运化以时何致腹膨胀大此崇本之论非一家言也
一泄泻霍乱由于六淫外侵调护失常乳食不节有冷有热有食积三者之不同也冷者脾胃
虚寒水谷
不化小便白而大便青或如糟粕手足厥冷或兼外感风寒内伤生冷身体乍
凉乍热面黑气喘者不治热者脾胃有湿大便黄而小便赤口干烦渴四肢温暖亦有兼暑受热而
作吐
泻者若唇深红内热大甚不退者不治食积者因伤食过度脾胃积滞腹胀发热吐如酸醋气泻如败卵
臭此其候也总之吐泻不止脏气日衰多成慢惊之症可不慎乎若霍乱与吐泻又稍有不同霍乱之来
暴而疾吐泻之症徐而缓或以寒凉伤胃或犯时气阴湿或因饮食失宜皆能致之医者当此紧要关头
不可无定见
一小儿夜啼有脾寒有心热如夜属阴阴胜则脾藏之寒愈威脾为至阴喜温而恶寒寒则腹
中作痛故
曲腰而啼其候面青白手腹俱冷不思乳食是为脾寒亦曰胎寒若见灯愈啼者心热也心属火见灯则
烦热内生两阳相搏故仰身而啼其候面赤手腹俱暖口中气热是也究其所自多由心气之不足或触
犯禁忌状若鬼崇者亦有之
一小儿心脾有热舌下有形如小舌者名曰重舌舌肿硬不柔和者名木舌若舌下有紫脉牵
绊不语啼
哭名绊舌用布针刺脉上数针即愈
一小儿语迟钱氏云心之声为言小儿数岁不语由妊母卒有惊动邪乘儿心致心气不足故
不能言也
有禀父肾气不足者有乳母五火遗热闭塞气道者有病后津液内亡会厌干涸者亦有脾胃虚弱
清气不升而言迟者宜随经用治
一小儿口转屎气经云受谷者浊受气者清清者注阴浊者注阳清者上出于肺浊者下出于
胃清浊
相
干命曰乱气故宜上者反下宜下者反上此不独小儿为然凡肺胃伤冷阴阳淆乱者多致此病小儿
脏腑脆弱宜温而不宜寒若乳母喜食寒凉寒气流入乳中小儿吮食不得下化并胃中积浊转逆而作
屎气非若胃热口臭之冲人鼻也
一阴肿疝气多由寒邪所郁阴囊偏坠肿痛不可忍或小腹痛引腰脊挛曲身不能直卒然肿
痛或坐地
多时或邪气外袭亦有为虫蚁吹者皆得以致此
一癫痫病钱仲阳云小儿发痫因血气未充神气未实或为风邪所伤或为惊怪所触亦有娠
妊七情惊
怖所致如面赤目瞪吐舌啮唇心烦气短其声如羊者曰心痫面青唇青两目上窜手足挛掣反折其声
如犬者曰肝痫面黑目振吐涎沫形体如尸其声如猪者曰肾痫面如枯骨目白反视惊跳反折摇头吐
沫其声如鸡者曰肺痫面色痿黄目直腹满自利四肢不收其声如牛者曰脾痫凡有此症先宜看耳后
高骨间先有青脉纹抓破出血可免其患此皆元气不足之症也又有
惊痫心神恍惚或语言鬼神喜笑不休有风痫怵惕怔忡痰涎泄泻有食痫脾土虚弱饮食停滞夜
多漩溺
若眼直目牵口噤涎流肚膨筋搐背项反张腰脊强劲形如死状终日不醒则为瘥矣
一痞气在肠胃之外膈膜之间非可以消伐推荡而去总由饮食不节脾胃传化不及则胃络
所出之道
渐有留滞日以益大因成痞矣或感寒发热热后胃气未清不自知戒口腹则食以邪留最易成痞治
此者不识从胃气推求则痞未消而元气已惫矣
者筋脉拘急 者筋脉张纵也素问云心脉急甚者螈 脾脉急甚者亦为螈 灵枢云心
脉满大痫
筋挛肝脉小急亦痫 筋挛有风热有虚寒经云肝主筋而藏血血亏阳火炽盛筋无所养多致此病
营分因寒伤筋为拘急小儿吐泻后脾胃亏损与夫阳气脱陷者亦多患之人有忽得痴呆者失志之病
也忧思过甚志不能转移心神因之失守心胞之络气结痰凝故冥顽不灵又有梦魇鬼击者由于心志
不交心藏神肾藏志人寐纳气于肾肾有所恐则精却却则上焦闭闭则肝之魂肺之魄化变百出而为
邪魇鬼击气不得升呼不得出甚则一夜数发虚人小儿多有之灵枢淫邪发梦篇可参考焉
一癫狂风痫五痉螈 各有不同难经曰重阴者颠重阳者狂狂为痰火实甚颠为心血不足
脉经曰阴
附阳则狂阳附阴则颠颠者或狂或愚或歌或笑或悲或泣如醉如痴言语有头无尾秽洁不知积年累
月不愈俗呼心风此志愿高硕而不遂所欲者多有之狂者病发之时猖狂刚暴如伤寒阳明大实发狂
骂詈不避亲疏甚者登高而歌弃衣而走逾垣上屋非力所能或与人语所未常见之事如有邪根据附者
是也风痫者由热甚而风燥发则昏不知人眩仆倒地不省高下甚而螈 抽掣目上视或口目 邪或
口作六畜之声时发时止与痉病相似然痉病身强直反张如弓不如痫之身软也夫痉者即后人误为
病也仲景云身热足寒颈项强急恶寒时头热面赤目赤独头动摇卒口噤背反张者
是也太阳病发热无汗反恶寒者名曰刚痉太阳病发
热汗出名曰柔痉所谓刚痉者为中风发热重感于寒而得之所谓柔痉者为太阳发热重感于湿
而得之后
人方论乃以无汗为表实有汗为表虚不思湿胜者自
多汗出治者误为表虚而行温补能不重增大筋之热欤
一雀盲昼视通明夜视罔见因禀阳气衰弱遇夜阴盛则阳愈衰故不能见物也
一口噤不吮乳因初生试口不净恶秽入腹则令腹满气短不能吮乳或为风寒所侵眼闭口
噤啼声渐
小或不能出声或口吐白沫或唇紧撮口或吼气喘急喉痰潮响甚者舌强面青腹胀青筋吊肠牵痛
百日内病甚者多不治
一小儿脱肛泻血巢氏云实热则大便闭结虚寒则肛门脱出多因吐泻脾气虚肺无所养故
大肠之气
虚脱而下陷又脾胃有伤营卫虚弱诸经之血行失常道故下为泻血若脏腑撮痛亦主于脾胃经云痛
者阴也又曰痛者寒气多也虽谓多由积滞然脾胃不虚则运化以时何有积滞若胃气无伤而腹中和
暖则必无留滞作痛是痛者多由乎虚寒也
最难治疗的疾病，没有比得上小儿疾病的了。因为小儿口不能言，古人称之为“哑科”。凡是所有的病痛、瘙痒，都无法表达出来，医生只能凭心意去揣测表里的虚实，这确实是非常困难的事情。然而，最容易治疗的疾病，也没有比得上小儿疾病的了。虽然小儿脏腑虽然脆弱，固而易受病邪侵袭，但他们是一片天真之气，完全没有七情六欲的干扰。其中生病，必定先表现在面色和形态上，观察面色的晦暗或明亮，就可以知道是寒证还是热证；又必定表现在声音上，审察声音的宏大或细微，就可以知道是虚证还是实证。《水镜诀》中有通过三关脉象、辨色来验证五脏的方法，医者只要诚心求治，果能掌握其虚实，取效非常迅速，这又是治疗起来非常容易的地方。钱仲阳在《小儿脉诀》中说：脉弦急表示气机不和，沉缓表示伤食，促急表示虚惊风，浮而冷，沉而细，仔细推敲就能得其要领；脉乱者难以治愈。《全幼心鉴》中有按眉端的方法，介宾用强弱、缓急四种脉象来检验小儿疾病，最为关键。考虑到难治的一面以图易治的一面，那么难的就不难了；如果视为容易而不识其难，那么容易的也就不容易了。常见世俗的时医，固执地守着几个方子作为标准，将小儿的疾病当作射箭的目标，箭中与否全凭运气，不中则孩子丧命。唉！怎么如此轻率尝试，忍心让孩子夭折到这种地步呢？吴中的叶氏有讽刺切中要害的话，说近时的庸医所用药饵，不分气血阴阳，起初只是疏散，接着就是清解，没有从消导入手，如果不效，便别无方法，托言服药已疲乏，且暂缓药数日，等待其自愈。倘若出现变症，也只是希望掩饰而已。更有病家延请多位医生，以为合谋商酌必然稳妥安全，却不知道像路旁建房一样杂乱无成见。里面稍微懂医的人主立一方，众医传看，都说正合我意，有的加一味药，有的减一味药，虚应在事之情，等到药不对症，大家互相推诿，或者侥幸成功，各自夸耀自己的能力，并不认识病在经还是在络，汤药乱投，即使病家也不知道是谁的过错谁的功劳，妄加毁誉。这种风气开自庸医和富室，而医事几乎被这些人败坏了。我也有几条行医愿望附录在后面，以阐明医道实为躯命所关，丝毫不可轻率，而小儿尤其必须谨慎。
一、惊风有急惊和慢惊两种病症。急惊的表现是壮热、痰壅、目睛上视、角弓反张、抽搐颤动、牙关紧急、口中气热、脸颊红、嘴唇红、想喝冷水、大便干结、脉浮洪数。这是肝邪有余而生风，热生痰，痰热客居在心膈之间，所以风火相搏，因此症状急暴，属于阳证、实证。应当先治其标，后治其本。慢惊的表现多由吐泻导致，致使气息微弱、精神倦怠、昏睡、眼睛露白、痰鸣、气促、惊跳抽搐，或者时而发作时而安静，或者身凉身热，或者四肢逆冷，或者眉唇青赤、面色淡白，但是脉迟缓或者见细数。这是脾肺气虚，肝邪无制因而侮脾生风，所以形气病气都不足，属于阴证、虚证。应当专门顾护脾胃以救元气。如果是慢脾风症，由慢惊之后，吐泻损伤脾气，面赤额汗、舌短头低、眼合不开、睡中摇头吐舌、频繁呕吐腥臭、噤口切牙床、手足微搐，或者身冷或身温，或者四肢冷、脉沉微。这是病传已极，总归虚处，只有脾受病。如果逐风无风可逐，疗惊无惊可疗，在此不审其因，泛用祛风化痰之剂，则会加速其危殆。还有撮口、脐风，由于胎中受热或初生不慎风寒，遂致聚唇撮口、眼闭口噤、啼声如鸦或声不能出，或者舌上如粟米状，或者口吐白沫，或者痰鸣气喘，甚者舌强面青、腹胀、青筋吊肠牵痛。七日内病者百无一活，百日内病重的也多不治。若因风动入脐或冷气传于脾络以致前症者，口内有小泡，急掐破去其毒水，以艾灸脐中，也有得生的。治疗方法很多，不如灸法神妙。
二、龟背，是因为小儿初生时客风吹脊入于骨髓，小儿元气未充，腠理不密，易为风邪所乘，或者痰饮蕴结、风热交攻，也导致此症。鸡胸，是由肺热胀满，攻于胸膈，或者乳母多食五辛热物及儿食宿乳而成。钱仲阳说：肺主气，实则闷乱壅迫干胸间，乃成鸡胸之症。
三、小儿羸瘦肚大，大多属疳症。如手足极细、项小骨高、尻削体痿、腹大脐突、号哭胸陷，是为丁奚疳。如虚热往来、头骨分开、翻食吐虫、烦渴呕哕，是为哺露疳。又脑后项边有如弹丸，按之转动软而不痛，其内有虫，不速针出则内食脏腑肢体痈疽便利脓血壮热羸瘦头露骨高，是为无辜疳。若见白膜遮睛或泻血而瘦，此为肝疳，又名筋疳，亦名风疳。钱仲阳说：小儿诸疳皆因脾胃亏损，内亡津液，虚火妄动，或者乳母六淫七情饮食起居失宜致儿为患。又因食积腹大，多缘脾胃阳气不足，虚寒作胀。东垣说：寒胀多热胀少。若脾胃不虚则运化以时，何致腹膨胀大？这是崇本之论，非一家之言也。
四、泄泻霍乱，由于六淫外侵、调护失常、乳食不节，有冷、有热、有食积三者之不同。冷者，脾胃虚寒，水谷不化，小便白而大便青，或如糟粕，手足厥冷，或兼外感风寒内伤生冷，身体乍凉乍热，面黑气喘者不治。热者，脾胃有湿，大便黄而小便赤，口干烦渴，四肢温暖，亦有兼暑受热而作吐泻者，若唇深红内热大甚不退者不治。食积者，因伤食过度，脾胃积滞，腹胀发热，吐如酸醋，气泻如败卵臭，此其候也。总之吐泻不止，脏气日衰，多成慢惊之症，可不慎乎？若霍乱与吐泻又稍有不同，霍乱之来暴而疾，吐泻之症徐而缓。或以寒凉伤胃，或犯时气阴湿，或因饮食失宜，皆能致之。医者当此紧要关头，不可无定见。
五、小儿夜啼，有脾寒有心热。如夜属阴，阴胜则脾藏之寒愈威，脾为至阴喜温而恶寒，寒则腹中作痛，故曲腰而啼。其候面青白，手腹俱冷，不思乳食，是为脾寒，亦曰胎寒。若见灯愈啼者，心热也。心属火，见灯则烦热内生，两阳相搏，故仰身而啼。其候面赤，手腹俱暖，口中气热是也。究其所自，多由心气之不足，或触犯禁忌，状若鬼祟者亦有之。
六、小儿心脾有热，舌下有形如小舌者，名曰重舌。舌肿硬不柔和者，名木舌。若舌下有紫脉牵绊不语啼哭，名绊舌。用布针刺脉上数针即愈。
七、小儿语迟，钱氏说：心之声为言。小儿数岁不语，由妊母卒有惊动，邪乘儿心，致心气不足，故不能言也。有禀父肾气不足者，有乳母五火遗热闭塞气道者，有病后津液内亡会厌干涸者，亦有脾胃虚弱清气不升而言迟者。宜随经用治。
八、小儿口转屎气，《经》云：受谷者浊，受气者清，清者注阴，浊者注阳，清者上出于肺，浊者下出于胃，清浊相干，命曰乱气。故宜上者反下，宜下者反上。此不独小儿为然，凡肺胃伤冷，阴阳淆乱者多致此病。小儿脏腑脆弱，宜温而不宜寒。若乳母喜食寒凉，寒气流入乳中，小儿吮食不得下化，并胃中积浊转逆而作屎气，非若胃热口臭之冲人鼻也。
九、阴肿疝气，多由寒邪所郁，阴囊偏坠肿痛不可忍，或小腹痛引腰脊挛曲身不能直，卒然肿痛，或坐地多时，或邪气外袭，亦有为虫蚁吹者，皆得以致此。
十、癫痫病，钱仲阳说：小儿发痫，因血气未充，神气未实，或为风邪所伤，或为惊怪所触，亦有妊娠七情惊怖所致。如面赤目瞪吐舌啮唇心烦气短，其声如羊者，曰心痫。面青唇青两目上窜手足挛掣反折，其声如犬者，曰肝痫。面黑目振吐涎沫形体如尸，其声如猪者，曰肾痫。面如枯骨目白反视惊跳反折摇头吐沫，其声如鸡者，曰肺痫。面色痿黄目直腹满自利四肢不收，其声如牛者，曰脾痫。凡有此症，先宜看耳后高骨间，先有青脉纹抓破出血，可免其患。此皆元气不足之症也。又有惊痫，心神恍惚，或语言鬼神，喜笑不休。有风痫，怵惕怔忡，痰涎泄泻。有食痫，脾土虚弱，饮食停滞，夜多漩溺。若眼直目牵口噤涎流肚膨筋搐背项反张腰脊强劲，形如死状，终日不醒，则为瘥矣。
十一、痞气，在肠胃之外，膈膜之间，非可以消伐推荡而去。总由饮食不节，脾胃传化不及，则胃络所出之道渐有留滞，日以益大，因成痞矣。或感寒发热，热后胃气未清，不自知戒口腹，则食以邪留，最易成痞。治此者不识从胃气推求，则痞未消而元气已惫矣。
十二、螈（抽搐）、（筋脉拘急）、（筋脉张纵）。《素问》云：心脉急甚者螈，脾脉急甚者亦为螈。《灵枢》云：心脉满大，痫筋挛；肝脉小急，亦痫筋挛。有风热，有虚寒。《经》云：肝主筋而藏血，血亏阳火炽盛，筋无所养，多致此病。营分因寒伤筋为拘急，小儿吐泻后脾胃亏损，与夫阳气脱陷者亦多患。人有忽得痴呆者，失志之病也。忧思过甚，志不能转移，心神因之失守，心胞之络气结痰凝，故冥顽不灵。又有梦魇鬼击者，由于心志不交，心藏神，肾藏志，人寐纳气于肾，肾有所恐则精却，却则上焦闭，闭则肝之魂肺之魄化变百出而为邪魇鬼击，气不得升呼不得出，甚则一夜数发，虚人小儿多有之。《灵枢·淫邪发梦》篇可参考焉。
十三、癫狂、风痫、五痉、螈，各有不同。《难经》曰：重阴者颠，重阳者狂。狂为痰火实甚，颠为心血不足。《脉经》曰：阴附阳则狂，阳附阴则颠。颠者，或狂或愚，或歌或笑，或悲或泣，如醉如痴，言语有头无尾，秽洁不知，积年累月不愈，俗呼心风。此志愿高硕而不遂所欲者多有之。狂者，病发之时，猖狂刚暴，如伤寒阳明大实发狂，骂詈不避亲疏，甚者登高而歌，弃衣而走，逾垣上屋，非力所能，或与人语所未常见之事，如有邪根据附者是也。风痫者，由热甚而风燥，发则昏不知人，眩仆倒地，不省高下，甚而螈抽掣，目上视，或口目斜，或口作六畜之声，时发时止，与痉病相似。然痉病身强直反张如弓，不如痫之身软也。夫痉者，即后人误为病也。仲景云：身热足寒，颈项强急，恶寒时头热面赤目赤，独头动摇，卒口噤背反张者，是也。太阳病发热无汗反恶寒者，名曰刚痉。太阳病发热汗出，名曰柔痉。所谓刚痉者为中风发热重感于寒而得之，所谓柔痉者为太阳发热重感于湿而得之。后人方论乃以无汗为表实，有汗为表虚，不思湿胜者自多汗出，治者误为表虚而行温补，能不重增大筋之热欤？
十四、雀盲，昼视通明，夜视罔见，因禀阳气衰弱，遇夜阴盛则阳愈衰，故不能见物也。
十五、口噤不吮乳，因初生试口不净，恶秽入腹，则令腹满气短，不能吮乳。或为风寒所侵，眼闭口噤，啼声渐小，或不能出声，或口吐白沫，或唇紧撮口，或吼气喘急，喉痰潮响，甚者舌强面青，腹胀青筋吊肠牵痛，百日内病甚者多不治。
十六、小儿脱肛泻血，巢氏云：实热则大便闭结，虚寒则肛门脱出。多因吐泻脾气虚，肺无所养，故大肠之气虚脱而下陷。又脾胃有伤，营卫虚弱，诸经之血行失常道，故下为泻血。若脏腑撮痛，亦主于脾胃。《经》云：痛者阴也，又曰痛者寒气多也。虽谓多由积滞，然脾胃不虚则运化以时，何有积滞？若胃气无伤而腹中和暖，则必无留滞作痛，是痛者多由乎虚寒也。
The most difficult diseases to treat are none other than those in children. Because children cannot speak, ancients called it the "Mute Department" (Ya Ke). For all kinds of pain and itching, they cannot express them; physicians must rely on their intuition to discern the exterior-interior deficiency-excess patterns, which is indeed very difficult. However, the easiest diseases to treat are none other than those in children. Although children's Zang-Fu organs are fragile and susceptible to disease, they possess a pure innocence and lack the interference of the Seven Emotions (Qi Qing) and Six Desires (Liu Yu). When sick, symptoms must first manifest in complexion and form; observing whether the complexion is dull or bright allows one to determine cold or heat patterns. Symptoms must also manifest in voice; examining whether the voice is loud or subtle allows one to determine deficiency or excess patterns. The *Shui Jing Jue* (Water Mirror Manual) describes methods for verifying the five Zang organs through pulse diagnosis at the three gates and color observation. If a physician sincerely seeks to understand the deficiency-excess patterns, efficacy can be achieved very quickly, making treatment relatively easy. Qian Zhongyang stated in the *Xiao Er Mai Jue* (Pediatric Pulse Resolution): "String-tight pulse indicates disharmony of Qi; deep-slow pulse indicates food injury; rapid-urgent pulse indicates deficiency-startled wind; floating-cold and deep-thin pulses require careful deliberation to grasp the essence; chaotic pulses are untreatable." The *Quan You Xin Jian* (Complete Young Heart Mirror) mentions pressing the eyebrow ends method; Jie Bin used four pulse qualities—strong-weak, slow-fast—to examine pediatric diseases, which is crucial. Considering the difficult aspects to address the easy ones makes the difficult not difficult; regarding them as easy without recognizing the difficulty makes the easy not easy. Common contemporary physicians often rigidly adhere to a few formulas as standards, treating pediatric diseases like shooting arrows at a target, where success or failure depends on luck, potentially leading to death if missed. Alas! How can they be so reckless and tolerate such infant mortality? Ye Shi from Wuzhong offered sharp criticism, stating that recent quacks prescribe medicines without distinguishing Qi-Blood or Yin-Yang. Initially using dispersing methods, then clearing and resolving, without focusing on digestion. If ineffective, they claim the patient is tired from medication and delay treatment, hoping for spontaneous recovery. If complications arise, they merely attempt to cover up. Furthermore, families inviting multiple doctors for consultation believe this ensures safety, unaware that this is like building a house by the roadside—chaotic and lacking consensus. Slightly knowledgeable doctors propose prescriptions, others copy them, adding or subtracting herbs arbitrarily. When medications fail, they shift blame. If successful by chance, they boast of their own skill, ignoring whether the pathology lies in the meridians or collaterals, administering decoctions recklessly. Families cannot determine credit or blame, engaging in baseless praise or criticism. This trend originates from quacks and wealthy households, ruining medical practice. I append several principles of medical conduct below to clarify that medicine concerns life and death and must not be treated lightly, especially for children.
1. **Jing Feng (Wind Tremors)** has acute and chronic types. Acute Jing Feng presents with high fever, phlegm obstruction, upward staring eyes, opisthotonos, convulsions, tremors, locked jaw, hot breath, red cheeks and lips, desire for cold drinks, constipation, and floating-rapid-full pulse. This is due to Liver pathogen excess generating Wind, Heat generating Phlegm, and Phlegm-Heat lodging between the Heart and Diaphragm, causing Wind-Fire conflict. It is an Yang pattern and Excess pattern. Treat the branch (symptoms) first, then the root (cause). Chronic Jing Feng often results from vomiting and diarrhea, leading to weak Qi, lethargy, drowsiness, exposed eyes, phlegm rattle, shortness of breath, startled jumps, and convulsions. It may alternate between发作 and quiet states, body temperature fluctuations, cold limbs, or blue-red eyebrows/lips with pale complexion. Pulses are slow-slow or fine-rapid. This is Spleen-Lung Qi deficiency, uncontrolled Liver pathogen invading the Spleen generating Wind. It is a Yin pattern and Deficiency pattern. Focus on protecting the Spleen and Stomach to save Yuan Qi. If it progresses to Man Pi Feng (Chronic Spleen Wind), following chronic Jing Feng, vomiting/diarrhea damages Spleen Qi, causing red face, forehead sweating, short tongue, head drooping, closed eyes, head shaking, tongue protrusion during sleep, frequent vomiting of foul odor, locked mouth, grinding teeth, slight limb convulsions, cold/warm body, cold limbs, and deep-micro pulse. The disease has reached extremity, returning to deficiency, primarily affecting the Spleen. If Wind is chased but no Wind exists, or Jing is treated but no Jing exists, failing to identify the cause and blindly using Wind-dispelling and Phlegm-resolving agents will accelerate danger. Also include Cuo Kou (Pinched Mouth) and Qi Feng (Umbilical Wind), caused by fetal heat or exposure to Wind-Cold after birth, leading to puckered lips, closed eyes, locked mouth, crow-like crying or silence, millet-like spots on tongue, white foam from mouth, phlegm rattle, severe cases showing stiff tongue, cyan face, abdominal distension, visible veins, and intestinal pain. Mortality within seven days is nearly 100%; within 100 days, severe cases are mostly untreatable. If caused by Wind entering the umbilicus or Cold Qi transmitting to Spleen collaterals, small blisters appear in the mouth; prick them to drain toxic fluid and moxa the umbilicus for potential survival. Moxibustion is superior among treatments.
2. **Gui Bei (Turtle Back/Back Deformity)** occurs when external Wind strikes the spine and enters the bone marrow in newborns whose Yuan Qi is insufficient and pores are loose, allowing Wind pathogens to invade, or due to Phlegm-Fluid accumulation and Wind-Heat attack. **Ji Xiong (Chicken Breast)** results from Lung Heat causing fullness attacking the chest and diaphragm, or from the nursing mother consuming excessive pungent-hot foods or the child swallowing residual milk. Qian Zhongyang stated: "The Lung governs Qi; excess causes stifling and pressure in the chest, forming Chicken Breast."
3. **Gan Syndrome** in emaciated children with large abdomens includes Ding Xi Gan (characterized by thin limbs, small neck, prominent bones, flat buttocks, stiff body, large abdomen, protruding navel, crying with sunken chest), Bu Lu Gan (intermittent deficiency fever, separated skull bones, regurgitation, worm vomiting, thirst, retching), Wu Gu Gan (lump behind the ear moving softly without pain, containing parasites that eat internal organs, causing abscesses, bloody stool, high fever, emaciation, prominent head bones), and Gan Gan (Liver Gan, also known as Jin Gan or Feng Gan, characterized by white membrane covering eyes or bloody diarrhea). Qian Zhongyang noted: "All Gan syndromes stem from Spleen-Stomach damage, loss of body fluids, and erratic deficiency Fire, or maternal exposure to Six Evils, Seven Emotions, improper diet/lifestyle." Food stagnation causing abdominal distension is due to Spleen-Stomach Yang deficiency and Cold distension. Dong Yuan stated: "Cold distension is more common than Heat distension." If Spleen-Stomach is not deficient, transformation occurs timely, preventing distension. This is a fundamental theory.
4. **Xie Xie (Diarrhea) and Huo Luan (Cholera)** result from Six Evils invasion, improper care, or irregular feeding, categorized into Cold, Heat, and Food Stagnation. Cold type: Spleen-Stomach deficiency-cold, undigested food/water, white urine, green stool, cold limbs, possibly with external Wind-Cold/internal Cold injury, alternating chills/fever, black face, panting (untreatable). Heat type: Dampness in Spleen-Stomach, yellow stool, red urine, dry mouth/thirst, warm limbs, possibly Summerheat-induced vomiting/diarrhea (deep red lips, intense internal heat, non-resolving = untreatable). Food Stagnation type: Overeating, Spleen-Stomach stagnation, abdominal distension, fever, sour vomit, rotten egg-smelling diarrhea. Persistent vomiting/diarrhea depletes organ Qi, leading to Chronic Jing Feng. Huo Luan differs from simple diarrhea/vomiting by its sudden onset and rapid progression. Causes include Cold-Cool damaging Stomach, seasonal dampness, or improper diet. Physicians must remain decisive.
5. **Ye Ti (Night Crying)** involves Spleen Cold or Heart Heat. Night is Yin; Yin excess exacerbates Spleen Cold. Spleen is extreme Yin, preferring warmth and hating cold. Cold causes abdominal pain, leading to curled-back crying. Signs: pale-blue face, cold hands/abdomen, refusal to feed (Spleen Cold/Fetal Cold). Crying worse near lamps indicates Heart Heat. Heart is Fire; lamp light generates internal heat, Yang conflicts with Yang, causing back-arching crying. Signs: red face, warm hands/abdomen, hot breath. Root causes include Heart Qi deficiency or taboo violations resembling spirit possession.
6. **Chong She (Double Tongue)** is a small tongue-like shape under the tongue due to Heart-Spleen Heat. **Mu She (Wood Tongue)** is swollen/stiff tongue. **Ban She (Tied Tongue)** involves purple vessels under the tongue preventing speech/crying; pricking with cloth-wrapped needle heals it.
7. **Yu Chi (Delayed Speech)**: Qian stated "Heart sound is speech." Delayed speech in toddlers results from maternal shock affecting the child's Heart Qi, or paternal Kidney Qi deficiency, maternal Five Fires heat blocking airways, post-illness fluid depletion drying the epiglottis, or Spleen-Stomach weakness failing to ascend clear Qi. Treat according to meridians.
8. **Kou Zhuan Shi Qi (Fecal Breath Odor)**: Classics state grain produces turbid Qi, breath produces clear Qi. Clear Qi goes to Yin, Turbid to Yang. Clear exits via Lung, Turbid via Stomach. Interference causes "Chaotic Qi." Upper should descend, lower should ascend. Caused by Lung-Stomach Cold and Yin-Yang confusion. Children's fragile Zang-Fu prefer warmth over cold. Maternal cold food intake transmits cold via milk, causing stomach turbidity to reverse and create fecal odor, distinct from Stomach Heat halitosis.
9. **Yin Zhong Shan Qi (Scrotal Swelling/Hernia)**: Often due to Cold pathogen constraint, causing unilateral scrotal swelling/pain, lower abdominal pain radiating to waist/spine, inability to straighten, sudden swelling, prolonged sitting, external evil invasion, or insect bites.
10. **Dian Xian (Epilepsy)**: Qian stated epilepsy arises from insufficient Blood-Qi/Spirit, Wind invasion, fright, or maternal emotional trauma. Heart Epilepsy: red face, staring eyes, tongue protrusion, lip biting, irritability, shortness of breath, sheep-like cry. Liver Epilepsy: blue face/lips, upward eye deviation, limb spasms, dog-like cry. Kidney Epilepsy: black face, trembling eyes, foaming, corpse-like posture, pig-like cry. Lung Epilepsy: sallow face, white eyes, backward staring, jumping, chicken-like cry. Spleen Epilepsy: yellow face, straight eyes, abdominal fullness, diarrhea, flaccid limbs, cow-like cry. Check blue veins behind ears and prick for bleeding to prevent attacks. These are Yuan Qi deficiency patterns. Other types include Startle Epilepsy (spiritual confusion, talking to spirits), Wind Epilepsy (fear, palpitations, phlegm-diarrhea), and Food Epilepsy (Spleen weakness, food stagnation, nocturnal enuresis). Severe cases with stiff neck/back and unconsciousness are critical.
11. **Pi Qi (Mass/Lump)**: Located outside intestines, between diaphragm layers. Cannot be removed by purging. Caused by irregular diet, Spleen-Stomach transmission failure, leading to stagnation in Stomach collaterals, growing daily. Post-fever Stomach Qi不清 combined with poor dietary discipline easily forms Pi. Treatment must seek Stomach Qi; otherwise, Pi remains while Yuan Qi exhausts.
12. **Chou (Convulsion) and Jiang Ji (Muscle Cramp)**: *Su Wen* states Heart pulse urgency causes Chou; Spleen pulse urgency causes Chou. *Ling Shu* states Heart pulse full-large causes Epileptic tendon cramping; Liver pulse small-urgent causes Epileptic tendon cramping. Causes include Wind-Heat or Deficiency-Cold. Liver governs tendons and stores Blood; Blood deficiency with blazing Fire leaves tendons un nourished. Cold damaging Ying level causes cramps. Post-vomiting/diarrhea Spleen-Stomach damage or Yang collapse also causes this. Dementia (Shi Zhi) stems from excessive worry disrupting Heart Spirit and Pericardium Qi condensing Phlegm. Nightmares/Ghost Strikes result from Heart-Kidney disconnect; fear causes Essence retreat, closing Upper Jiao, transforming Liver Soul/Lung Po into evil spirits. Refer to *Ling Shu: Yin Xie Fa Meng*.
13. **Dian Kuang (Mania/Depression), Feng Xian (Wind Epilepsy), Wu Jing (Five Spasms), Chou**: Distinct entities. *Nan Jing*: Heavy Yin is Dian, Heavy Yang is Kuang. Kuang is Phlegm-Fire excess; Dian is Heart Blood deficiency. *Mai Jing*: Yin attaching to Yang is Kuang; Yang attaching to Yin is Dian. Dian involves erratic behavior, singing/laughing/crying, drunk-like state, incoherent speech, lasting years. Kuang involves violent aggression, climbing walls, stripping clothes, speaking nonsense. Feng Xian results from Heat-Wind dryness, sudden unconsciousness, falling, convulsions, upward eye gaze, animal sounds. Different from Jing Disease (Spasm), which features rigid opisthotonos like a bow, whereas Xian involves soft body. Zhang Zhongjing defined Jing: fever, cold feet, stiff neck, aversion to cold, head heat/red face/eyes, head tremor, locked jaw, back arching. Taiyang Fever-no sweat = Gang Jing (Rigid Spasm); Taiyang Fever-sweat = Rou Jing (Soft Spasm). Gang Jing is Wind-Cold; Rou Jing is Wind-Damp. Later theories wrongly classified no-sweat as Exterior Excess and sweat as Exterior Deficiency, leading to erroneous warming tonification for Damp-Heat, worsening tendon heat.
14. **Que Mang (Night Blindness)**: Clear vision by day, blind by night. Due to weak Yang constitution; Night Yin excess further weakens Yang, preventing vision.
15. **Kou Jin (Locked Jaw) Refusing Milk**: Caused by unclean oral cleaning at birth allowing filth into abdomen, causing distension/shortness of breath. Or Wind-Cold invasion causing closed eyes/jaw, weak cry, white foam, puckered lips, wheezing, phlegm rattle, severe cases with stiff tongue/cyan face/distension/veins. Untreatable within 100 days if severe.
16. **Tuo Gang Xie Xue (Rectal Prolapse/Bloody Stool)**: Chao Shi stated Excess-Heat causes constipation; Deficiency-Cold causes prolapse. Often due to vomiting/diarrhea damaging Spleen Qi, Lung losing nourishment, Large Intestine Qi sinking. Spleen-Stomach damage leads to Wei-Qi weakness, blood leaving normal channels, causing bloody stool. Abdominal pain relates to Spleen-Stomach. Classics: Pain is Yin/Cold. Though often due to stagnation, if Spleen-Stomach is strong, transformation is timely, preventing stagnation. Warm abdomen implies no stagnation/pain; thus, pain is mostly due to Deficiency-Cold.