洁 伤寒表里攻发有表证恶风恶寒者当发表(海藏云恶风者白术散恶寒者神术汤)如气盛能食不大便无表证者
可攻
里春主温属木身温当发汗(海藏云神术汤)夏主长属火身热而烦躁合大发散(海藏云神术加黄 汤)长夏主化属土及居
四季同当调其饮食(海藏云四君子汤)秋主收属金身凉内温合微下(海藏云通膈丸金花丸)冬主脏属水身热而恶寒是热
在外而寒在内身寒而恶热是热在内而寒在外(海藏云热在内者调胃承气汤寒在内者调中汤丸)
洁 凡伤寒宜根据四时阴阳升降逆顺刚柔而施治法气升浮则顺发之收藏则下之有汗发热恶风脉浮缓者风伤卫桂枝
汤
无汗发热恶寒不当风而自憎寒脉浮紧者寒伤荣麻黄汤有汗发热恶风脉浮紧无汗发热恶寒脉浮缓谓之荣卫俱伤青龙桂枝
麻黄各半汤无汗发热不恶风寒脉沉洪者可下之更详认其厥与不厥量寒热浅深而治之有汗四肢厥脉沉微者名阴厥四逆汤
无汗四肢厥脉沉微者名阳厥大承气汤加腻粉如四肢不厥身热内外皆阳不动三焦宜凉药三五服下之黄芩甘草汤黄芩白术
汤黄芩苍术汤黄芩栀子汤连翘饮子小柴胡汤八正散凉膈散白虎汤五黄散此上中下三焦药宜选用之中暑脉虚背恶寒自汗
而渴者白虎汤身凉脉紧热在内者急下之口燥咽干不大便是也无汗身大热者可发汗升麻汤大青膏天麻膏有汗身大热者桂
枝汤惺惺散解肌汤小柴胡汤白术防风汤可选用之发汗者量四时暄暑燥湿风寒各宜春凉夏寒秋温冬热而发之
钱 伤风贪睡口中气热呵欠烦闷当发散与大青膏表证也(洁古补遗云小儿外感于风寒拘急呵欠烦闷皮毛涩口中
气热
者当发散秋冬用温热药春夏用凉寒药)
大青膏方
天麻 青黛(研各一钱) 白附子(生一钱半) 蝎尾(去毒生半钱) 朱砂(研) 天竺黄(研) 麝香(各一
字匕) 乌梢蛇内(酒浸焙干取末半两)上同研细生蜜和成膏每服半皂子或一皂子大月中儿粳米大同牛黄膏薄荷水化一
处服之五岁以上同甘露散服
雄黄膏 治伤风温壮热引饮
雄黄(小枣大研萝卜根水并醋一大盏煮尽) 甘草末 川甜梢(各三钱) 寒水石(研细五钱匕) 脑子(一字匕)
朱砂(五分)上研匀炼蜜成膏薄荷汤化下半皂子大上此及前方发散贪睡口气热呵欠烦闷表证者盖为三岁以下小儿未能言
者设也
活 寻常风壅发热鼻涕痰嗽烦渴惺惺散主之
惺惺散 治小儿风热及伤寒时气或疮疹发热
桔梗 细辛 人参 白术 甘草 栝蒌根 白茯苓 川芎(各等分)上为末每服二钱姜二片薄荷二叶煎服三岁以下
作四五服凡小儿不问伤风伤寒风热与此即愈
海 伤寒时气风热痰壅咳嗽及气不和者四君子加细辛栝蒌桔梗各一分生姜薄荷煎或加防风川芎各一分分内有寒
及
遇天寒欲发散者则去栝蒌加桔梗多虚汗夜啼者加麦门冬伤风身热头痛气促者四君子加川芎防风等分细辛羌活减半同煎
活 咽喉不利痰实咳嗽鼠粘子汤
云 人参羌活散 治小儿寒邪及瘟气时疫疮疹头痛体痛壮热多眠不语潮湿烦渴痰实咳嗽
羌活 独活 柴胡 人参 芎 枳壳(炒) 甘草(炙) 白茯苓(去皮各二两) 前胡 桔梗 天麻(酒浸炒)
地骨皮(各半两)上为散每服二钱水一盏入薄荷少许同煎去渣温服不拘时候
七宝散 治时气头昏体热小儿同乳母服大人亦可
紫苏叶 香附(炒各三两) 陈皮 甘草 桔梗 白芷 川芎(各一两) 上 咀姜枣煎服
海 麻黄黄芩汤 治小儿伤寒无汗头痛身热恶寒
麻黄 赤芍药 黄芩(各半两) 甘草(炙) 桂枝(各二钱半)上为粗末水煎服
升麻黄芩汤 治伤风有汗头疼发热恶风
升麻 葛根 黄芩 芍药(各五钱半) 甘草(一钱半)上 咀每服二钱水煎温服上惺惺散等药发散头痛发热恶风
寒表证者盖为三岁以上小儿能言者设也能言故头疼恶风寒可问而知也前五方通治有汗无汗恶风恶寒第五方治无汗恶寒
第六方治有汗恶风
钱 与大青膏不解散有下证当下大黄丸主之大热饮水不止而善食者可微下余不可下也(此里证也洁古补遗云大
热饮
水能食不大便用大黄丸作散子与服之如清便自调慎不可妄下恐外热逐于内而变结胸危证多矣)
大黄丸 治风热里实口中气热大小便秘赤饮水不止有下证者宜服之
川芎(半两) 黑牵牛(半两半生半熟炒) 大黄(酒蒸一两) 甘草(炙二钱半)上为细末稀糊和丸麻子大二岁
每服十丸温蜜水下乳后服以溏利为度未利加丸数
活 头额痛身体发热大便黄赤腹中有热四顺散连翘饮三黄丸主之(三方并见幼科准绳痘疹门)身体潮热头目昏
痛心
神烦躁小便赤大便秘此热剧也洗心散调胃承气汤主之(洗心散见痘门)
头额身体温热大便白而酸臭者胃中有食积双圣丸主之(方见科幼食癖门)
洁 如身表无大热而小便不利是有湿热结膀胱仍用胜湿药白术白茯苓之类利小便则其热自退
云 小儿伤寒烦热小便赤涩大便褐色面赤热者导赤散
钱 伤风兼藏兼心则惊悸兼肺则闷乱喘息哽气长出气嗽兼肾则畏明各随补母脏虚故也
伤风手足冷脾脏怯也当先和脾后发散和脾益黄散发散大青膏主之(此治阴厥有汗脉沉微者若阳厥无汗脉沉滑者不宜
此法宜大承气汤而加腻粉)伤风自利脾脏虚怯也当补脾后发散补脾益黄散发散大青膏主之未瘥调中丸主之有下证大黄丸
下之后服温惊丸
伤风腹胀脾脏虚也当补肺必不喘后发散仍补脾也去胀塌气丸主之发散大青膏主之
伤风吐泻(治见幼科准绳吐泻门泻门益黄散白术散发散用大青膏)
汤 治夹惊伤寒热极生风薄荷散
薄荷叶(半两) 羌活 全蝎 麻黄(去根节) 甘草(各一钱二分半) 天竺黄 僵蚕 白附子(炮各二钱半)
为细末每服一钱水半盏煎至三分加竹沥少许妙
云 小儿表伤寒则皮肤闭而为热盛即生风欲为惊搐血气未实不能胜邪故发搐也大小便根据度口中气热当发之宜大
青膏
肺盛复有风冷则胸满短气气急喘嗽上气当先散肺后发散风冷散肺泻白散散风大青膏主之若止伤寒(则不胸满)肾虚
则畏明宜补肾地黄丸(有表者间用地黄膏发散之)
伤风下后虚热以药下之太过胃中虚热饮水无力当生胃中津液多服白术散小儿结热于内口干而渴身黄体重者宜白术
散
汤 伤寒发渴宜白虎汤
洁 大热饮水能食不大便用大黄丸作散服之
上三方白术散治虚渴为下后而食少胃虚者设也白虎汤大黄丸治实渴为未经下而能食不大便者设也
洁 伤寒咳嗽吐清水哽气长出气是肺之不足也合用阿胶散面白如枯骨者死不治身热咳喘吐痰者当用褊银丸(方
见幼科咳嗽门)
上二方治咳嗽阿胶散治虚嗽为哽气长出气者设也褊银丸治实嗽为痰盛喘满者设也若有表证恶风寒而嗽者当用惺惺
散加减四君子汤鼠粘子汤之类
阴厥阳厥(见)
洁 身大热吐逆不止者茯苓半夏汤(即小半夏加茯苓汤方见呕门)
汤 伤寒呕者枳壳半夏汤
枳壳 半夏(各半两) 上水一碗姜十片煎至半碗十岁以下作五服
藿香正气散 治伤寒发呕
藿香叶 浓朴(制) 半夏(制) 甘草(炙) 陈皮 苍术(米泔浸各等分)上 咀每服二钱水半盏姜三片枣一
枚煎至二分去滓温服
洁 大吐者当下之白饼子珍珠丸消积丸(三方俱见幼科食癖门)潮热有时胸满短气呕吐者桃枝丸(方见幼科积
热门)上七方治伤寒呕吐前二方治痰饮而吐中一方治有表而吐后四方治有里而吐其桃枝丸治里热而吐余二方治表寒而吐
也
汤 伤寒自汗当补虚和阴阳小建中汤减桂加黄 人参地黄
黄 (一两) 白芍药(三两) 甘草 人参 熟地黄(各半两)上 咀每二钱水半盏煎至三分去渣服
小儿伤寒形证 头痛 体痛鼻塞或流涕 喉内喘息 两手脉洪数 颊赤眼涩 身上寒毛起 口鼻出水 眼赤黄
口干涩 咳嗽 山根青色 喷嚏
活 头目疼痛而畏人恶寒者此伤寒证也
云 设令小儿卒暴身壮热恶寒四肢冷或耳尻冷鼻气热为斑疹也与伤寒表证相似此胎气始发自当作斑疹治之内之
外若与伤寒表证同治者误也
吴 小儿伤寒六经治例皆同但有胎热惊热血热客热寒热潮热痰热食热变蒸发热痘疹发热伤风发热一皆发作状似
伤寒要在明辨之耳况肌体嫩弱血气未定脉法不同药剂轻小之别故略其节要另开录于下以便览焉
凡小儿察面色为先要宜详察色要略也
凡小儿视虎口脉纹者以男左女右手食指第一节为初关二节为中关三节为末关即寅卯辰三位也
凡脉纹见初关者轻中关者重末关者病危也以紫脉为惊热红脉为伤寒为热白主疳热少血青主惊主风主寒主腹中痛主
搐搦黄主伤乳食脾虚黑主冷气主中恶主病沉困也凡紫赤青黑脉纹直透末关者死
凡小儿四五岁以一指按其三部脉六七岁以二指按切三部脉十岁以上当密排三指而切之宜详脉诀要略也脉经曰四五
岁以上者呼吸七八至细数者吉九至为热十至为困五至为寒四至困也十岁左右者五六至为平也凡胎热惊热客热血热痰热
寒热潮热等治法并见幼科准绳宜详玩之兹不具录
凡食热伤乳者则吐 乳瓣不消口中醋气伤食则心下满硬嗳气作酸恶食右手气口脉盛手心热手背不热发热则肚背先
热以此别之
凡治伤食发热必以六君子汤为主或加神曲麦芽棠求子砂仁香附子之类如内实者加枳实青皮热不解者加软苗柴胡炒
黄连或黄芩之类以解如无热宜服香砂保和丸
凡变蒸发热者以长气血也夫变者气上蒸体热也轻者发热虚惊耳冷微汗唇中有白泡如珠子三日而愈重者寒热脉乱腹
疼啼叫不食凡乳食辄吐 五日愈也
凡伤风发热则贪睡脾涩呵欠顿闷鼻塞喷嚏或鼻流清涕口中气热或咳嗽声重或自汗怕风也宜人参羌活散加减主之其
余治例宜伤风表证之例要在详辨而治之尔
凡伤寒则怕寒拘急发热翕翕然在表昼夜不止直待汗出方解钱氏曰男子则面黄体重女子则面赤喘急憎寒口中气热呵
欠顿闷项急也大抵伤寒则手背热手心不热左手人迎脉紧盛也其余六经为病详见六经发热例同但药剂宜轻小也亦有失惊
失食伤寒要在审辨而已
凡痘疹发热钱氏曰腮赤多躁喷嚏眼涩呵欠顿闷时发惊悸身重发热耳尖鼻尖手足稍冷乍凉乍热睡中惊惕起卧不安者
乃其候也切不可认作伤寒辄用发汗或重被盖覆取汗则大误矣须仔细辨之
凡壮热痘疹欲出未出者宜用升麻葛根汤主之胃弱食少者必加人参白术白茯苓主之若欲透斑更加紫草茸为妙丹溪言
但见红点便忌葛根诚恐发得表虚疮出烂熳也钱氏治斑疮未透者以四君子汤加糯米煎先助胃气也一方更加升麻紫草茸以
透斑出凡痘疮三日至足谓之出齐若小大不等根窠红活者不必服药至五日当灌浆若浆来肥满光泽者不必服药若五六日浆
不来盒饭救之以人参黄 当归三味为君佐以白术陈皮白芷川芎白芍药防风炙甘草之类必须加肉桂三分或五分能引药入
血分化脓为妙若气逆满闷出不快者少加木香二三分主之如恶心呕逆不食者须加丁香三粒以透胃气升发痘毒外出然此皆
秘传之法用之累验者也若有痒塌寒战切牙手足冷或呕或喘或大便下利者此表里之气俱虚也宜加肉豆蔻诃子各五分熟附
子二分或五分主之或十宣内托散加此三味亦佳凡欲靥未靥头温足冷或泻渴或气促四肢冷闷乱不宁卧则哽气寒战切牙无
热证者宜陈氏十二味异功散主之凡青干紫陷有热者不可用此宜八珍汤加黄 升麻紫草茸生地黄之类主之其余详见幼科
准绳痘疹门宜详玩而用焉一方治痘疮未透浆不至者以乌骨白雄鸡冠上取血和白酒浆温与之最效凡有痒塌抓损宜房中常
烧乳香尤妙宜多用 归等汤大抵痘疮变黑或青干或紫陷浆不来昏沉汗出不止烦躁热渴腹胀啼哭声嗄大小便不通者皆难
救也凡疮外黑里赤者重外白里黑者极重疮端里黑点如针孔者难治惟里外肥红者最吉若一发并出及一发如针头密者皆难
治也要在详辨而已
洁古:伤寒表证与里证的攻发,若有表证表现为恶风、恶寒的,应当使用发表法(海藏云:恶风的用白术散,恶寒的用神术汤)。如果气盛、能进食且不大便,没有表证的,可以使用攻下法。
春季主温,属木,身体温热时应当发汗(海藏云:用神术汤);夏季主长,属火,身体发热且烦躁时,应当大发散(海藏云:用神术加黄芩汤);长夏主化,属土,以及处于四季交替之时,都应当调理饮食(海藏云:用四君子汤);秋季主收,属金,身体凉爽而内部温暖时,应当轻微通下(海藏云:用通膈丸、金花丸);冬季主脏,属水,身体发热而恶寒,这是热在外而寒在内;身体寒冷而恶热,这是热在内而寒在外(海藏云:热在内部的用调胃承气汤,寒在内部的用调中汤丸)。
洁古:凡是伤寒,应当根据四时阴阳升降的逆顺、刚柔来施治法。气机升浮则顺应其势发散之,收藏则下行导之。有汗、发热、恶风、脉浮缓的,是风伤卫分,用桂枝汤;无汗、发热、恶寒、不当风却自感憎寒、脉浮紧的,是寒伤营分,用麻黄汤;有汗、发热、恶风、脉浮紧,或无汗、发热、恶寒、脉浮缓的,称为荣卫俱伤,用青龙汤、桂枝麻黄各半汤;无汗、发热、不恶风寒、脉沉洪的,可以攻下,更需详细辨认是否有厥逆,衡量寒热的浅深来治疗。有汗、四肢厥冷、脉沉微的,名叫阴厥,用四逆汤;无汗、四肢厥冷、脉沉微的,名叫阳厥,用大承气汤加腻粉。如果四肢不厥冷,身体发热,内外皆属阳,三焦气机未动,宜用凉药三五服以下之,可选用黄芩甘草汤、黄芩白术汤、黄芩苍术汤、黄芩栀子汤、连翘饮子、小柴胡汤、八正散、凉膈散、白虎汤、五黄散。以上为上、中、下三焦的药物,宜选用其中。中暑脉虚、背部恶寒、自汗且口渴的,用白虎汤;身体凉爽、脉紧、热在内部的,急当攻下;口燥咽干、不大便的是(适用症);无汗、身体大热的,可以发汗,用升麻汤、大青膏、天麻膏;有汗、身体大热的,用桂枝汤、惺惺散、解肌汤、小柴胡汤、白术防风汤,可选用其中。发汗者,要量四时暄暑、燥湿、风寒,各依春凉、夏寒、秋温、冬热而发之。
钱乙:伤风贪睡、口中气热、呵欠、烦闷的,应当发散,给予大青膏,此为表证(洁古补遗云:小儿外感风寒,拘急、呵欠、烦闷、皮毛涩、口中气热的,应当发散,秋冬用温热药,春夏用凉寒药)。
大青膏方:天麻、青黛(研细,各一钱)、白附子(生用,一钱半)、蝎尾(去毒,生用,半钱)、朱砂(研细)、天竺黄(研细)、麝香(各一字匕)、乌梢蛇肉(酒浸焙干取末,半两)。以上同研细,用生蜜和成膏。每服半皂子大或一皂子大,月中儿用粳米大同牛黄膏,薄荷水化开一处服之。五岁以上同甘露散服。
雄黄膏:治伤风温壮热、引饮。雄黄(如小枣大,研细,用萝卜根水并醋一大盏煮尽)、甘草末、川甜梢(各三钱)、寒水石(研细,五钱匕)、脑子(一字匕)、朱砂(五分)。以上研匀,炼蜜成膏。薄荷汤化开,下半皂子大。上述及前方,用于发散贪睡、口气热、呵欠、烦闷等表证者,是为三岁以下小儿未能言语者设立的。
惺惺散:治小儿风热及伤寒时气,或疮疹发热。桔梗、细辛、人参、白术、甘草、栝蒌根、白茯苓、川芎(各等分)。以上为末,每服二钱,姜二片、薄荷二叶,煎服。三岁以下作四五服。凡小儿不问伤风、伤风、风热,与此方即愈。
海藏:伤寒时气、风热、痰壅、咳嗽及气不和的,用四君子汤加细辛、栝蒌、桔梗各一分,生姜、薄荷煎服;或加防风、川芎各一分。分内有寒及遇天寒欲发散者,则去栝蒌加桔梗。多虚汗、夜啼的,加麦门冬。伤风身热、头痛、气促的,用四君子汤加川芎、防风等分,细辛、羌活减半,同煎。
活人:咽喉不利、痰实、咳嗽的,用鼠粘子汤。
云岐子:人参羌活散:治小儿寒邪及瘟气时疫、疮疹、头痛、体痛、壮热、多眠不语、潮湿、烦渴、痰实、咳嗽。羌活、独活、柴胡、人参、川芎、枳壳(炒)、甘草(炙)、白茯苓(去皮,各二两)、前胡、桔梗、天麻(酒浸炒)、地骨皮(各半两)。以上为散,每服二钱,水一盏,入薄荷少许,同煎去渣,温服,不拘时候。
七宝散:治时气头昏、体热,小儿同乳母服,大人亦可。紫苏叶、香附(炒,各三两)、陈皮、甘草、桔梗、白芷、川芎(各一两)。以上㕮咀,姜枣煎服。
海藏:麻黄黄芩汤:治小儿伤寒无汗、头痛、身热、恶寒。麻黄、赤芍药、黄芩(各半两)、甘草(炙)、桂枝(各二钱半)。以上为粗末,水煎服。
升麻黄芩汤:治伤风有汗、头疼、发热、恶风。升麻、葛根、黄芩、芍药(各五钱半)、甘草(一钱半)。以上㕮咀,每服二钱,水煎温服。上述惺惺散等药,用于发散头痛、发热、恶风寒等表证者,盖为三岁以上小儿能言语者设立。能言故头疼、恶风寒可问而知也。前五方通治有汗、无汗、恶风、恶寒。第五方治无汗恶寒,第六方治有汗恶风。
钱乙:与大青膏不解散,有下证当下,大黄丸主之。大热、饮水不止而善食者可微下,余不可下也(此里证也。洁古补遗云:大热、饮水、能食、不大便,用大黄丸作散子与服之。如清便自调,慎不可妄下,恐外热逐于内而变结胸危证多矣)。
大黄丸:治风热里实、口中气热、大小便秘赤、饮水不止、有下证者宜服之。川芎(半两)、黑牵牛(半两,半生半熟炒)、大黄(酒蒸一两)、甘草(炙,二钱半)。以上为细末,稀糊和丸,麻子大二岁,每服十丸,温蜜水下,乳后服,以溏利为度,未利加丸数。
活人:头额痛、身体发热、大便黄赤、腹中有热的,四顺散、连翘饮、三黄丸主之(三方并见幼科准绳痘疹门)。身体潮热、头目昏沉、心神烦躁、小便赤、大便秘的,此热剧也,洗心散、调胃承气汤主之(洗心散见痘门)。
头额、身体温热、大便白而酸臭的,胃中有食积,双圣丸主之(方见科幼食癖门)。
洁古:如身表无大热而小便不利,是有湿热结膀胱,仍用胜湿药白术、白茯苓之类,利小便则其热自退。
云岐子:小儿伤寒烦热、小便赤涩、大便褐色、面赤热的,导赤散。
钱乙:伤风兼脏、兼心则惊悸,兼肺则闷乱、喘息、哽气长出气、嗽,兼肾则畏明,各随补母脏虚故也。
伤风手足冷,脾脏怯也,当先和脾后发散。和脾益黄散发散,大青膏主之(此治阴厥有汗、脉沉微者。若阳厥无汗、脉沉滑者,不宜此法,宜大承气汤而加腻粉)。伤风自利,脾脏虚怯也,当补脾后发散。补脾益黄散发散,大青膏主之。未瘥,调中丸主之。有下证,大黄丸下。之后服温惊丸。
伤风腹胀,脾脏虚也,当补肺必不喘后发散,仍补脾也。去胀塌气丸主之。发散,大青膏主之。
伤风吐泻(治见幼科准绳吐泻门。泻门益黄散、白术散发散用大青膏)。
汤氏:治夹惊伤寒热极生风,薄荷散。薄荷叶(半两)、羌活、全蝎、麻黄(去根节)、甘草(各一钱二分半)、天竺黄、僵蚕、白附子(炮,各二钱半)。为细末,每服一钱,水半盏,煎至三分,加竹沥少许,妙。
云岐子:小儿表伤寒则皮肤闭而为热盛,即生风欲为惊搐。血气未实,不能胜邪,故发搐也。大小便根据度,口中气热,当发之,宜大青膏。
肺盛复有风冷则胸满、短气、气急、喘嗽、上气,当先散肺后发散风冷。散肺,泻白散;散风,大青膏主之。若止伤寒(则不胸满),肾虚则畏明,宜补肾地黄丸(有表者间用地黄膏发散之)。
伤风下后虚热,以药下之太过,胃中虚热,饮水无力,当生胃中津液,多服白术散。小儿结热于内,口干而渴,身黄体重者,宜白术散。
上述三方,白术散治虚渴,为下后而食少、胃虚者设也。白虎汤、大黄丸治实渴,为未经下而能食、不大便者设也。
洁古:伤寒咳嗽、吐清水、哽气、长出气,是肺之不足也,合用阿胶散。面白如枯骨者,死不治。身热、咳喘、吐痰者,当用褊银丸(方见幼科咳嗽门)。
上述二方治咳嗽。阿胶散治虚嗽,为哽气、长出气者设也。褊银丸治实嗽,为痰盛、喘满者设也。若有表证、恶风寒而嗽者,当用惺惺散、加减四君子汤、鼠粘子汤之类。
洁古:身大热、吐逆不止的,茯苓半夏汤(即小半夏加茯苓汤,方见呕门)。
汤氏:伤寒呕者,枳壳半夏汤。枳壳、半夏(各半两)。以上水一碗,姜十片,煎至半碗,十岁以下作五服。
藿香正气散:治伤寒发呕。藿香叶、浓朴(制)、半夏(制)、甘草(炙)、陈皮、苍术(米泔浸,各等分)。以上㕮咀,每服二钱,水半盏,姜三片、枣一枚,煎至二分,去滓温服。
洁古:大吐者当下之,白饼子、珍珠丸、消积丸(三方俱见幼科食癖门)。潮热有时、胸满、短气、呕吐的,桃枝丸(方见幼科积热门)。上述七方治伤寒呕吐。前二方治痰饮而吐,中一方治有表而吐,后四方治有里而吐。其桃枝丸治里热而吐,余二方治表寒而吐也。
汤氏:伤寒自汗,当补虚和阴阳,小建中汤减桂加黄芪、人参、地黄。黄芪(一两)、白芍药(三两)、甘草、人参、熟地黄(各半两)。以上㕮咀,每二钱,水半盏,煎至三分,去渣服。
小儿伤寒形证:头痛、体痛、鼻塞或流涕、喉内喘息、两手脉洪数、颊赤眼涩、身上寒毛起、口鼻出水、眼赤黄、口干涩、咳嗽、山根青色、喷嚏。
云岐子:设令小儿卒暴身壮热、恶寒、四肢冷,或耳尻冷、鼻气热,为斑疹也与伤寒表证相似。此胎气始发,自当作斑疹治之内之外。若与伤寒表证同治者,误也。
吴氏:小儿伤寒六经治例皆同,但有胎热、惊热、血热、客热、寒热、潮热、痰热、食热、变蒸发热、痘疹发热、伤风发热,一皆发作状似伤寒,要在明辨之耳。况肌体嫩弱,血气未定,脉法不同,药剂轻小之别,故略其节要,另开录于下,以便览焉。
凡小儿察面色为先,要宜详察色,要略也。
凡小儿视虎口脉纹者,以男左女右手食指第一节为初关,二节为中关,三节为末关,即寅卯辰三位也。
凡脉纹见初关者轻,中关者重,末关者病危也。以紫脉为惊热,红脉为伤寒为热,白主疳热少血,青主惊主风主寒主腹中痛主搐搦,黄主伤乳食脾虚,黑主冷气主中恶主病沉困也。凡紫赤青黑脉纹直透末关者死。
凡小儿四五岁以一指按其三部脉,六七岁以二指按切三部脉,十岁以上当密排三指而切之。宜详脉诀要略也。脉经曰:四五岁以上者呼吸七八至,细数者吉,九至为热,十至为困,五至为寒,四至困也。十岁左右者五六至为平也。凡胎热、惊热、客热、血热、痰热、寒热、潮热等治法并见幼科准绳,宜详玩之,兹不具录。
凡食热伤乳者则吐,乳瓣不消,口中醋气。伤食则心下满硬,嗳气作酸,恶食,右手气口脉盛,手心热,手背不热,发热则肚背先热,以此别之。
凡治伤食发热,必以六君子汤为主,或加神曲、麦芽、棠求子、砂仁、香附子之类。如内实者加枳实、青皮,热不解者加软苗柴胡、炒黄连或黄芩之类以解之。如无热,宜服香砂保和丸。
凡变蒸发热者,以长气血也。夫变者,气上蒸体热也。轻者发热、虚惊、耳冷、微汗、唇中有白泡如珠子,三日而愈。重者寒热、脉乱、腹痛、啼叫、不食,凡乳食辄吐,五日愈也。
凡伤风发热则贪睡,脾涩,呵欠,顿闷,鼻塞,喷嚏,或鼻流清涕,口中气热,或咳嗽声重,或自汗怕风也。宜人参羌活散加减主之。其余治例宜伤风表证之例,要在详辨而治之尔。
凡伤寒则怕寒、拘急、发热,翕翕然在表,昼夜不止,直待汗出方解。钱氏曰:男子则面黄、体重,女子则面赤、喘急、憎寒、口中气热、呵欠、顿闷、项急。大抵伤寒则手背热,手心不热,左手人迎脉紧盛也。其余六经为病详见六经发热例同,但药剂宜轻小也。亦有失惊、失食伤寒,要在审辨而已。
凡痘疹发热,钱氏曰:腮赤、多躁、喷嚏、眼涩、呵欠、顿闷、时发惊悸、身重发热、耳尖鼻尖、手足稍冷、乍凉乍热、睡中惊惕、起卧不安者,乃其候也。切不可认作伤寒,辄用发汗或重被盖覆取汗,则大误矣。须仔细辨之。
凡壮热痘疹欲出未出者,宜用升麻葛根汤主之。胃弱食少者,必加人参、白术、白茯苓主之。若欲透斑,更加紫草茸为妙。丹溪言但见红点便忌葛根,诚恐发得表虚,疮出烂熳也。钱氏治斑疮未透者,以四君子汤加糯米煎,先助胃气也。一方更加升麻、紫草茸以透斑出。凡痘疮三日至足谓之出齐,若小大不等,根窠红活者,不必服药。至五日当灌浆,若浆来肥满光泽者,不必服药。若五六日浆不来,盒饭救之以人参、黄芪、当归三味为君,佐以白术、陈皮、白芷、川芎、白芍药、防风、炙甘草之类,必须加肉桂三分或五分,能引药入血分化脓为妙。若气逆满闷出不快者,少加木香二三分主之。如恶心呕逆不食者,须加丁香三粒以透胃气,升发痘毒外出。然此皆秘传之法,用之累验者也。若有痒塌、寒战、切牙、手足冷,或呕或喘,或大便下利者,此表里之气俱虚也,宜加肉豆蔻、诃子各五分,熟附子二分或五分主之。或十宣内托散加此三味亦佳。凡欲靥未靥,头温足冷,或泻渴,或气促,四肢冷,闷乱不宁,卧则哽气,寒战切牙,无热证者,宜陈氏十二味异功散主之。凡青干、紫陷有热者,不可用此,宜八珍汤加黄芪、升麻、紫草茸、生地黄之类主之。其余详见幼科准绳痘疹门,宜详玩而用焉。一方治痘疮未透、浆不至者,以乌骨白雄鸡冠上取血和白酒浆温与之,最效。凡有痒塌抓损,宜房中常烧乳香,尤妙,宜多用归等汤。大抵痘疮变黑,或青干,或紫陷,浆不来,昏沉,汗出不止,烦躁,热渴,腹胀,啼哭声嗄,大小便不通者,皆难救也。凡疮外黑里赤者重,外白里黑者极重,疮端里黑点如针孔者难治,惟里外肥红者最吉。若一发并出及一发如针头密者,皆难治也。要在详辨而已。
Jiegu: For exterior and interior syndromes of Shanghan (Cold Damage), if there are exterior signs such as aversion to wind and cold, exterior-releasing methods should be used (Haizang stated: for aversion to wind, use Baizhu San; for aversion to cold, use Shenzhu Tang). If the patient has robust qi, can eat, suffers from constipation, and lacks exterior signs, purgative methods may be employed.
Spring governs warmth and corresponds to Wood; when the body is warm, sweating should be induced (Haizang: use Shenzhu Tang). Summer governs growth and corresponds to Fire; when the body is hot with irritability, vigorous dispersal is required (Haizang: use Shenzhu Tang plus Huangqin Decoction). Late summer governs transformation and corresponds to Earth; during the transition between seasons, diet should be regulated (Haizang: use Sijunzi Tang). Autumn governs gathering and corresponds to Metal; when the body is cool but internally warm, mild purgation is indicated (Haizang: use Tongge Wan or Jinhua Wan). Winter governs the Zang organs and corresponds to Water; fever with aversion to cold indicates heat on the exterior and cold on the interior; coldness with aversion to heat indicates heat on the interior and cold on the exterior (Haizang: for interior heat, use Tiaowei Chengqi Tang; for interior cold, use Tiaozhong Tang Pills).
Jiegu: In all cases of Shanghan, treatment should be administered according to the ascending and descending, smooth and adverse, rigid and soft dynamics of Yin and Yang across the four seasons. When Qi ascends and floats, disperse it in accordance with its nature; when it stores, guide it downward. Sweating, fever, aversion to wind, and a floating, moderate pulse indicate Wind injuring the Wei (Defensive) level; use Guizhi Tang. No sweating, fever, aversion to cold, spontaneous aversion to cold without exposure to wind, and a floating, tight pulse indicate Cold injuring the Ying (Nutritive) level; use Mahuang Tang. Sweating, fever, aversion to wind, and a floating, tight pulse; or no sweating, fever, aversion to cold, and a floating, moderate pulse indicate simultaneous injury to Ying and Wei; use Qinglong Tang or Guizhi Mahuang Banxia Tang. No sweating, fever, absence of aversion to wind/cold, and a deep, surging pulse allow for purgation; further distinguish the presence or absence of Jue (cold extremities) and treat based on the depth of cold/heat. Sweating, cold extremities, and a deep, faint pulse constitute Yin Jue; use Sini Tang. No sweating, cold extremities, and a deep, faint pulse constitute Yang Jue; use Dachengqi Tang plus Nifen. If extremities are not cold, the body is hot, and both interior and exterior belong to Yang with unactivated Sanjiao (Triple Burner), use cooling medicines for three to five doses. Options include Huangqin Gancao Tang, Huangqin Baizhu Tang, Huangqin Cangzhu Tang, Huangqin Zhizi Tang, Lianqiao Yinzi, Xiaochaihu Tang, Bazheng San, Liangge San, Baihu Tang, and Wuhuang San. These represent upper, middle, and lower Jiao remedies; select appropriately. For Zhongshu (Summerheat) with a deficient pulse, back aversion to cold, spontaneous sweating, and thirst, use Baihu Tang. For a cool body, tight pulse, and interior heat, urgent purgation is needed; dry mouth/throat and constipation are indications. For no sweating and high fever, induce sweating with Shengma Tang, Daqing Gao, or Tianma Gao. For sweating and high fever, use Guizhi Tang, Xingxing San, Jieji Tang, Xiaochaihu Tang, or Baizhu Fangfeng Tang. When inducing sweating, consider seasonal variations (spring cool, summer cold, autumn warm, winter hot) relative to weather conditions.
Qian Yi: For Shangfeng (Wind Strike) with drowsiness, hot breath, yawning, and restlessness, disperse the exterior using Daqing Gao (this is an exterior syndrome). (Jiegu's supplement states: for children externally affected by Wind-Cold with stiffness, yawning, restlessness, rough skin, and hot breath, disperse the exterior; use warming herbs in autumn/winter and cooling herbs in spring/summer.)
Daqing Gao Formula: Tianma, Qingdai (ground, 1 qian each), Baifuzi (raw, 1.5 qian), Xiewei (de-venomed, raw, 0.5 qian), Zhusha (ground), Tianzhuhuang (ground), Shexiang (each 1 zi bi), Wushaoshe meat (soaked in wine, baked dry, powdered, 0.5 liang). Grind finely, mix with raw honey to form a paste. Dosage: half to one soap-bean size. For infants under one month, mix with Jingmi Datong Niuhuang Gao and dissolve in mint water. For children over five years, take with Ganlu San.
Xionghuang Gao: Treats Shangfeng with warm-high fever and excessive drinking. Xionghuang (size of small date, ground, boiled in radish root water and vinegar until dry), Gancao powder, Chuantianshao (each 3 qian), Hanshuishi (ground, 5 qian bi), Naobi (1 zi bi), Zhusha (0.5 fen). Grind uniformly, refine with honey into a paste. Dissolve half a soap-bean size in mint decoction. The above formulas are for dispersing exterior signs like drowsiness, hot breath, yawning, and restlessness, specifically designed for children under three who cannot speak.
Huoren: For common Wind obstruction with fever, nasal discharge, phlegm-cough, and thirst, use Xingxing San.
Xingxing San: Treats pediatric Wind-Heat, Shanghan seasonal pathogens, or fever from sores/rashes. Jiegeng, Xixin, Renshen, Baizhu, Gancao, Gualougen, Baifuling, Chuanxiong (equal parts). Powder. Dosage: 2 qian per dose, decoct with 2 slices of ginger and 2 mint leaves. For children under three, divide into four to five doses. This formula cures pediatric cases regardless of Wind Strike, Cold, or Wind-Heat.
Haizang: For Shanghan seasonal pathogens, Wind-Heat, phlegm obstruction, cough, and Qi disharmony, use Sijunzi Tang plus Xixin, Gualou, and Jiegeng (1 fen each), decocted with Shengjiang and Bohe. Add Fangfeng and Chuanxiong (1 fen each) if needed. If there is internal cold or cold weather requires dispersal, remove Gualou and add more Jiegeng. For excessive deficiency sweating and night crying, add Maidong. For Wind Strike with fever, headache, and rapid breathing, use Sijunzi Tang plus Chuanxiong and Fangfeng (equal parts), reduce Xixin and Qianghuo by half, and decoct together.
Huoren: For throat discomfort, phlegm-solidity, and cough, use Shuniuzi Tang.
Yunqizi: Ren Shen Qiang Huo San: Treats pediatric Cold Evil, plague/epidemic pathogens, sores/rashes, headache, body pain, high fever, lethargy/speechlessness, dampness, thirst, phlegm-solidity, and cough. Qianghuo, Duhuo, Chaihu, Renshen, Chuanxiong, Zhike (stir-fried), Gancao (honey-fried), Baifuling (peeled, 2 liang each), Qianhu, Jiegeng, Tianma (wine-soaked and stir-fried), Digupi (0.5 liang each). Powder. Dosage: 2 qian per dose, decoct with 1 cup water and a little mint, strain, and take warm at any time.
Qibao San: Treats seasonal pathogen causing dizziness and body heat. Children take it with their nursing mothers; adults may also take it. Ziye, Xiangfu (stir-fried, 3 liang each), Chenpi, Gancao, Jiegeng, Baizhi, Chuanxiong (1 liang each). Chew up, decoct with Jiang and Zao.
Haizang: Mahuang Huangqin Tang: Treats pediatric Shanghan with no sweating, headache, body heat, and aversion to cold. Mahuang, Chishaoyao, Huangqin (0.5 liang each), Gancao (honey-fried), Guizhi (2.5 qian each). Coarse powder, decoct in water.
Shengma Huangqin Tang: Treats Wind Strike with sweating, headache, fever, and aversion to wind. Shengma, Gegen, Huangqin, Shaoyao (5.5 qian each), Gancao (1.5 qian). Chew up, dosage 2 qian per dose, decoct in water, take warm. The aforementioned Xingxing San etc. are for dispersing exterior signs like headache, fever, and aversion to cold/wind, designed for children over three who can speak, allowing inquiry about symptoms. The first five formulas treat sweating/no-sweating and aversion to wind/cold generally. Formula 5 treats no-sweating and aversion to cold; Formula 6 treats sweating and aversion to wind.
Qian Yi: If Daqing Gao fails to resolve, and there are interior excess signs requiring purgation, use Dahuang Wan. High fever, incessant drinking, and good appetite allow for mild purgation; otherwise, do not purge (this is an interior syndrome). (Jiegu's supplement: High fever, drinking, eating, and constipation require Dahuang Wan as powder. If stool is normal, strictly avoid purgation to prevent exterior heat driving inward and causing dangerous Jie Xiong syndromes.)
Dahuang Wan: Treats Wind-Heat interior excess, hot breath, constipation/red urine, incessant drinking, and signs requiring purgation. Chuanxiong (0.5 liang), Heiqianniu (0.5 liang, half raw half stir-fried), Dahuang (wine-steamed, 1 liang), Gancao (honey-fried, 2.5 qian). Fine powder, bind with thin paste into pills the size of hemp seeds. Dosage: 10 pills for two-year-olds, taken with warm honey water after milk. Stop when loose stools occur; increase dose if no effect.
Huoren: Head/forehead pain, body fever, yellow-red stool, and abdominal heat are treated with Sishun San, Lianqiao Yin, or Sanhuang Wan (see Youke Zhunsheng Rash section). Body tidal fever, dull head/eyes, restless mind, red urine, and constipation indicate severe heat; treat with Xixin San or Tiaowei Chengqi Tang (Xixin San see Rash section).
Forehead/body warmth, white sour-smelling stool indicates food stagnation in Stomach; treat with Shuangsheng Wan (see Pediatric Food Accumulation section).
Jiegu: If no significant surface heat but difficulty urinating, it is Damp-Heat binding the Bladder; use damp-resolving herbs like Baizhu and Baifuling to promote urination, and the heat will subside.
Yunqizi: Pediatric Shanghan with vexatious heat, red/astringent urination, brown stool, and red-hot face is treated with Daochi San.
Qian Yi: Wind Strike affecting Zang organs causes palpitations; affecting Heart causes fright; affecting Lung causes chest oppression, panting, sighing, and cough; affecting Kidney causes photophobia. This follows the principle of tonifying the mother organ due to deficiency.
For Wind Strike with cold hands, Spleen deficiency is suspected; harmonize Spleen first, then disperse exterior. Use Yihuang San to harmonize Spleen and Daqing Gao to disperse exterior (treats Yin Jue with sweating/faint pulse; for Yang Jue with no sweating/slipping pulse, use Dachengqi Tang plus Nifen). For Wind Strike with spontaneous diarrhea, Spleen deficiency is suspected; tonify Spleen first, then disperse. Use Yihuang San and Daqing Gao. If unresolved, use Tiaozhong Wan. If purgation signs exist, use Dahuang Wan, followed by Wenjing Wan.
For Wind Strike with abdominal distension, Spleen deficiency is suspected; tonify Lung to prevent wheezing, then disperse exterior, and continue tonifying Spleen. Use Quzhang Taqi Wan. Disperse exterior with Daqing Gao.
For Wind Strike with vomiting/diarrhea (see Pediatric Vomiting/Diarrhea section; use Yihuang San, Baizhu San, and Daqing Gao).
Tang Shi: For Shanghan complicated by Fright with extreme heat generating Wind, use Bohe San. Boheye, Qianghuo, Quanxie, Mahuang (remove roots/joints), Gancao (1.25 qian each), Tianzhuhuang, Jiangcan, Baifuzi (processed, 2.5 qian each). Fine powder. Dosage: 1 qian, decoct with half cup water to one-third volume, add a little Zhuli.
Yunqizi: Exterior Cold binding pores causes intense heat, generating Wind and potential convulsions. Due to immature Qi/Blood unable to resist pathogens, convulsions occur. With normal bowel/bladder function and hot breath, disperse exterior using Daqing Gao.
If Lung is excessive with Wind-Cold, causing chest fullness, shortness of breath, asthma, and upward Qi, first disperse Lung (Xiebai San) then disperse Wind-Cold (Daqing Gao). If only Shanghan (no chest fullness) with Kidney deficiency causing photophobia, tonify Kidney with Dihuang Wan (use Dihuang Gao intermittently if exterior signs exist).
Post-purgation deficiency heat from excessive purgation leads to Stomach deficiency heat and weak thirst; promote Stomach fluids with Baizhu San. For pediatric interior heat with dry mouth/thirst, yellow body, and heavy weight, use Baizhu San.
Tang Shi: Shanghan with thirst is treated with Baihu Tang.
Jiegu: High fever, drinking, eating, and constipation are treated with Dahuang Wan as powder.
The above three formulas: Baizhu San treats deficiency-thirst post-purgation with poor appetite/Stomach weakness. Baihu Tang and Dahuang Wan treat excess-thirst pre-purgation with good appetite/constipation.
Jiegu: Shanghan cough with clear water vomiting, sighing, and long exhalations indicates Lung deficiency; use Ejiao San. Pale face like dead bone indicates fatal prognosis. Fever, coughing, wheezing, and phlegm are treated with Pianyin Wan (see Pediatric Cough section).
Ejiao San treats deficiency-cough with sighing/long exhalations. Pianyin Wan treats excess-cough with heavy phlegm/wheezing. For exterior signs with aversion to cold/wind and cough, use Xingxing San, modified Sijunzi Tang, or Shuniuzi Tang.
Yin Jue and Yang Jue (see above).
Jiegu: High fever with incessant vomiting is treated with Fuling Banxia Tang (Xiao Banxia Jia Fuling Tang, see Vomiting section).
Tang Shi: Shanghan with vomiting is treated with Zhike Banxia Tang. Zhike, Banxia (0.5 liang each). Decoct with 1 cup water and 10 ginger slices to half cup. Dosage for under ten years: five doses.
Huoxiang Zhengqi San: Treats Shanghan with vomiting. Huoxiangye, Houpo (processed), Banxia (processed), Gancao (honey-fried), Chenpi, Cangzhu (rice-water soaked, equal parts). Chew up. Dosage: 2 qian, decoct with half cup water, 3 ginger slices, 1 jujube, reduce to two-tenths, strain, take warm.
Jiegu: Severe vomiting requires purgation with Baibingzi, Zhenzhu Wan, or Xiaoji Wan (see Pediatric Food Accumulation section). Periodic tidal fever, chest fullness, shortness of breath, and vomiting are treated with Taozhi Wan (see Pediatric Heat Accumulation section). The seven formulas treat Shanghan vomiting: first two for Phlegm-Fluid, middle one for exterior syndrome, latter four for interior syndrome. Taozhi Wan treats interior heat vomiting; others treat exterior cold vomiting.
Tang Shi: Shanghan with spontaneous sweating requires tonifying deficiency and harmonizing Yin/Yang. Use Xiaojianzhong Tang minus Guizhi, plus Huangqi, Renshen, and Dihuang. Huangqi (1 liang), Baishaoyao (3 liang), Gancao, Renshen, Shudihuang (0.5 liang each). Chew up. Dosage: 2 qian, decoct with half cup water to one-third volume, strain, take.
Pediatric Shanghan Signs: Headache, body pain, nasal congestion/runny nose, throat wheezing, surging-rapid pulses, red cheeks/dry eyes, goosebumps, fluid from mouth/nose, red/yellow eyes, dry mouth, cough, blue mountain root, sneezing.
Huoren: Head/eye pain, fear of people, and aversion to cold indicate Shanghan.
Yunqizi: Sudden high fever, aversion to cold, cold limbs, cold ears/buttocks, and hot nasal breath in children resemble Shanghan exterior signs but may be early rash eruption (Taiqi). Treat as rash, not Shanghan. Treating as Shanghan exterior is an error.
Wu Shi: Six Meridian treatments for pediatric Shanghan are similar, but must distinguish from Tai Re, Jing Re, Xue Re, Ke Re, Han Re, Chao Re, Tan Re, Shi Re, Bianfa Fever, Douzhen Fever, and Shangfeng Fever, which all mimic Shanghan. Due to tender bodies, unsettled Qi/Blood, different pulse methods, and lighter/smaller dosages, key points are listed below.
Observe facial color first. Examine Tiger Mouth Pulse Veins: Index finger segments 1, 2, 3 correspond to Chu Guan, Zhong Guan, Mo Guan (Yin/Mao/Chen positions). Male left, female right. Vein at Chu Guan is mild; Zhong Guan is severe; Mo Guan is critical. Purple indicates Fright-Heat; Red indicates Shanghan-Heat; White indicates Gan-Heat/Blood Deficiency; Green indicates Fright/Wind/Cold/Abdominal Pain/Convulsions; Yellow indicates Milk/Food Injury/Spleen Deficiency; Black indicates Cold/Evil/Deep Disease. Purple/Red/Green/Black penetrating to Mo Guan indicates death.
Pulse diagnosis: Ages 4-5 use one finger; 6-7 use two fingers; over 10 use three fingers. Normal respiration for 4-5 years is 7-8 beats (fine-rapid is auspicious); 9 beats is Heat; 10 is Exhaustion; 5 is Cold; 4 is Critical. Age 10 is normal at 5-6 beats. Methods for various fevers are in Youke Zhunsheng.
Food/Milk Heat causes vomiting, undigested milk, sour breath. Food Injury causes epigastric hardness, belching, acid regurgitation, anorexia, strong Qi Kou pulse, hot palms, cool backs, and dorsal-back heat onset. Treat food-injury fever with Liu Junzi Tang base, adding Shenqu, Maiya, etc. For interior excess, add Zhishi, Qingpi. For unresolved heat, add Chaihu, Huanglian, or Huangqin. Without heat, use Xiangsha Baohe Wan.
Bianfa Fever grows Qi/Blood. Mild: fever, fright, cold ears, slight sweat, white bubbles on lips, resolves in 3 days. Severe: alternating chills/fever, chaotic pulse, abdominal pain, crying, anorexia, vomiting milk, resolves in 5 days.
Shangfeng Fever causes drowsiness, stiff Spleen, yawning, stuffiness, nasal congestion/sneezing, clear runny nose, hot breath, heavy cough, spontaneous sweating, wind-aversion. Use modified Renshen Qianghuo San. Differentiate carefully.
Shanghan causes cold-aversion, stiffness, fever (surface-level, day/night), resolving only with sweat. Qian Yi: Males have yellow face/heavy body; females have red face/panting/cold-aversion/hot breath/yawning/stiff neck. Generally, Shanghan shows hot backs, cool palms, and tight Shouren pulse on left. Other meridian diseases follow Six Meridian Fever examples with lighter dosages. Distinguish from Fright/Food Injury Shanghan.
Douzhen Fever: Red cheeks, irritability, sneezing, dry eyes, yawning, fright, heavy body, ear/nose/hand/foot coldness, alternating temp, sleep startles. Do not mistake for Shanghan or force sweat with heavy blankets.
High fever before rash eruption: Use Shengma Gegen Tang. Add Renshen, Baizhu, Baifuling for weak Stomach/poor appetite. Add Zicao Rong to penetrate spots. Danxi warns against Gegen if red spots appear to avoid superficial deficiency and spreading sores. Qian Yi uses Sijunzi Tang plus glutinous rice to boost Stomach Qi. Add Shengma/Zicao Rong to help eruption. Day 3 marks full eruption; if roots are red/vital, no medicine needed. Day 5 expects pus; if plump/shiny, no medicine needed. If no pus by day 5-6, rescue with Renshen, Huangqi, Danggui as chief, plus Baizhu, Chenpi, Baizhi, Chuanxiong, Baishaoyao, Fangfeng, Zhi Gancao. Add Rougui (0.3-0.5 fen) to guide blood and transform pus. For Qi reversal/fullness, add Muxiang (0.2-0.3 fen). For nausea/anorexia, add Dingxiang (3 grains) to open Stomach and raise toxin. These are secret effective methods. For itching/collapse/chills/grinding teeth/cold limbs/vomiting/diarrhea (exterior-interior deficiency), add Roudoukou, Hesui (0.5 fen each), Shufuzi (0.2-0.5 fen). Or use Shixuan Neituo San with these. For pre-scabbing with warm head/cold feet/diarrhea/thirst/panting/cold limbs/restlessness/sighing/chills/no heat, use Chenshi Shiwei Yigong San. For green-dry/purple-depressed with heat, use Bazhen Tang plus Huangqi, Shengma, Zicao Rong, Shengdihuang. See Youke Zhunsheng Rash section. Another method: chicken comb blood mixed with wine for non-erupting/non-pus cases. Burn frankincense in room for itching/scratching. Use Gui-class decoctions. Black/green-dry/purple-depressed/no pus/coma/excessive sweat/irritability/thirst/distension/hoarse cry/constipation are difficult to save. Outer black/inner red is severe; outer white/inner black is very severe; needle-hole black dots are hard to treat. Inner/outer fat-red is best. Simultaneous eruption or dense pinhead eruptions are hard to treat. Careful differentiation is essential.