久热也，疳热亦久，但兼面黄、吃炭土、鼻下烂也。《三因》小儿积热者，表
里俱热，遍身皆热，颊赤口干，小便赤，大便焦黄。先以四顺清凉饮子利动脏腑则
热去，既去复热者，内热已解、而表热未解也，当用惺惺散、红绵散、加麻黄微发
汗，表热乃去，表热去后又发热者何也。世医到此，尽不能晓，或再用凉药，或再
解表，或以谓不可医，误致夭伤者甚多。此表里俱虚，气不归元，而阳浮于外，所
以再发热，非热证也，只用六神散入粳米煎，和其胃气，则收阳归内，身体便凉，
热重者，用银白散。〔曾〕积热，眼胞浮肿，面黄足冷，发热从头，至肚愈甚，或
闻饮食之气，恶心及肠疼呕吐。治法，详载伤积论中。
按∶曾氏所谓积热，乃指腹中有癖而热，与久积之积不同，不妨并存之。
清凉饮子（里热） 惺惺散（痘疹）
红绵散
白僵蚕（炒，二两） 天麻（生用，一两） 南星（切薄片，油浸黄，二两） 苏木节
（另研，二两半）
上为末。每服一钱，水一小盏，入红绵少许，同煎至六分，温服。凡小儿风热，
头目不清，并宜服之。若伤寒有表证发热者，每服入去节麻黄末五分。有里热心
燥渴者，入滑石末半钱，同煎服之。
六神散
人参 白茯苓 干山药 白术 白扁豆 甘草（炙。各等分）
上为末。每服一大钱，水一小盏，枣一枚，姜二片，同煎至五分，服。此药用
处甚多，治胃冷，加附子。治风证，加天麻。治痢。加莺粟壳。
银白散
干山药 白术 白茯苓（各半两） 人参 白扁豆 知母 甘草（炙） 升麻（各等分）
上为末。每服一大钱，水一小盏，枣一枚，生姜二片，同煎，温服，不拘时候。
桃枝丸 疏取积热及结胸。又名桃符丸。
巴豆霜 大黄 黄柏（各一钱） 轻粉 砂（各半钱）
上细末，面糊丸，粟米大。煎桃枝汤下。一 儿五七丸，五七岁二三十丸。未
儿二三丸，临卧服。
栀豉饮子 治小儿畜热在中，身热狂躁，昏迷不食。
栀子仁（七枚） 豆豉（半两）
上用水三盏，煎至二盏，看多少服之，无时。或吐不吐，立效。
栀子汤 治小儿积热心脏，小便赤肿，口内生疮。
栀子仁 木通 当归尾 白芷（各二钱） 防风 甘草（各一钱）
上为细末。麦门冬煎汤送下。
三黄丸（里热）
〔曾〕玉露饮 治颊赤咽干，心烦躁，睡不稳，身热头痛。兼中暑发渴昏闷，小便不
通，惊气入肾，梦中切牙，加金珠散，薄荷汤、空心调服。
寒水石（中有细纹手可碎者） 石膏（洁白坚硬而有墙壁者。各一两） 甘草（三钱，晒干，
天阴火焙）
上，除前二味外，甘草锉晒或焙，同为细末。每服半钱至一钱，温汤，无时调
服。或麦门熟水。
益元散 解暑毒，利小便，理烦渴，除惊悸。
滑石（六两） 粉草（一两，细锉）
上二味，或晒或焙，研为细末。每服一钱至二钱，温热水，无时调服。凉水
亦可。
万安饮 推陈致新，除邪辅正，和益脾胃，宣通气血，调顺饮食，疏解风寒，宁心
化痰，去烦理热，不拘证在表里，并宜可投。常服，百病不生，真元益固，补养
诸虚，亦有奇验。此与《宣明论》当归饮相类不远，治法最多，其药品之外惟加枳壳、半夏。
人参（去芦） 当归（酒洗） 大黄（生用） 柴胡（去芦） 枳壳（去瓤炒） 半夏（炮裂）
芍药（洗净） 黄芩 防风（去芦） 甘草（十味各一两） 滑石末（六两）
上锉。除滑石末临入和匀。每服二钱，水一盏，姜二片，煎七分，无时温服。或加枣一枚同煎。
调胃散 桃枝丸取积热后服之。
人参（三钱） 白术（二钱半） 甘草（炙） 白茯苓 莺粟子（各一钱） 白附子（半分）
藿香 丁香（各半钱）
上为末。紫苏汤下半钱或一钱。
长期的发热，疳积引起的发热也是长期的，但兼见面色发黄、吃炭土、鼻孔下方溃烂。《三因方》中记载的小儿积热证，表现为表里俱热，全身发热，两颊发红，口干，小便颜色深红，大便焦黄。先用四顺清凉饮子通利脏腑以祛除热邪，如果热邪去除后又复发，说明内热已解而表热未解，应当使用惺惺散、红绵散，加入麻黄轻微发汗，表热才能去除。表热去除后又再次发热是什么原因呢？世间的医生到了这一步，全都不能理解，有的再用凉药，有的再解表，或者认为无法医治，导致误事夭折的非常多。这是因为表里都虚，气不归根，阳气浮越于外，所以再次发热，这并不是热证，只用六神散加入粳米煎煮，调和胃气，就能使阳气回归体内，身体自然凉爽；热势重的，用银白散。〔曾氏〕所说的积热，眼胞浮肿，面色黄，脚冷，发热从头开始，到腹部更严重，或者闻到饮食的气味就恶心，肠痛呕吐。治疗方法，详细记载在伤积论中。
按语：曾氏所说的积热，是指腹中有癖块而发热，与长期积滞引起的积不同，不妨并存这两种说法。
红绵散
白僵蚕（炒，二两） 天麻（生用，一两） 南星（切薄片，油浸至黄色，二两） 苏木节（另研，二两半）
以上研为细末。每次服用一钱，水一小盏，加入少许红绵，同煎至六分，温服。凡是小儿风热，头目不清爽，都适宜服用。如果有伤寒表证发热者，每次服用时加入去节麻黄末五分。有里热心燥口渴者，加入滑石末半钱，同煎服用。
六神散
人参 白茯苓 干山药 白术 白扁豆 甘草（炙。各等分）
以上研为细末。每次服用一大钱，水一小盏，枣一枚，姜二片，同煎至五分，服用。此药用途很多，治胃冷，加附子。治风证，加天麻。治痢疾，加罂粟壳。
银白散
干山药 白术 白茯苓（各半两） 人参 白扁豆 知母 甘草（炙） 升麻（各等分）
以上研为细末。每次服用一大钱，水一小盏，枣一枚，生姜二片，同煎，温服，不限时候。
桃枝丸 疏泄积聚之热及结胸。又名桃符丸。
巴豆霜 大黄 黄柏（各一钱） 轻粉 砂（各半钱）
以上研为细末，面糊做丸，如粟米大。用桃枝汤送下。一岁五七丸，五七岁二三十丸。未满周岁的婴儿二三丸，临睡前服用。
栀豉饮子 治疗小儿蓄热在中，身热狂躁，昏迷不食。
栀子仁（七枚） 豆豉（半两）
以上用水三盏，煎至二盏，看情况多少服用，不限时候。或吐或不吐，立即见效。
栀子汤 治疗小儿积热心脏，小便赤肿，口内生疮。
栀子仁 木通 当归尾 白芷（各二钱） 防风 甘草（各一钱）
以上研为细末。用麦门冬煎汤送下。
〔曾氏〕玉露饮 治疗两颊发红咽干，心烦躁，睡不稳，身热头痛。兼中暑发渴昏闷，小便不通，惊气入肾，梦中磨牙，加金珠散，薄荷汤空腹调服。
寒水石（中有细纹手可碎者） 石膏（洁白坚硬而有墙壁者。各一两） 甘草（三钱，晒干，天阴火焙）
以上，除前二味外，甘草锉晒或焙，同为细末。每次服用半钱至一钱，温开水，不限时候调服。或用麦门冬熟水。
益元散 解暑毒，利小便，理烦渴，除惊悸。
滑石（六两） 粉草（一两，细锉）
以上二味，或晒或焙，研为细末。每次服用一钱至二钱，温热水，不限时候调服。凉水也可以。
万安饮 推陈致新，除邪辅正，和益脾胃，宣通气血，调顺饮食，疏解风寒，宁心化痰，去烦理热，不拘证在表里，都适宜投用。常服，百病不生，真元益固，补养诸虚，也有奇效。这与《宣明论》中的当归饮相差不远，治法最多，其药品之外只加了枳壳、半夏。
人参（去芦） 当归（酒洗） 大黄（生用） 柴胡（去芦） 枳壳（去瓤炒） 半夏（炮裂）
芍药（洗净） 黄芩 防风（去芦） 甘草（十味各一两） 滑石末（六两）
以上锉碎。除滑石末临入和匀。每次服用二钱，水一盏，姜二片，煎七分，不限时候温服。或加枣一枚同煎。
调胃散 桃枝丸取积热后服用。
人参（三钱） 白术（二钱半） 甘草（炙） 白茯苓 罂粟子（各一钱） 白附子（半分）
藿香 丁香（各半钱）
以上研为细末。紫苏汤送下半钱或一钱。
Prolonged fever, and the fever caused by gan accumulation (malnutrition syndrome) is also prolonged, but it is accompanied by yellowish complexion, pica for charcoal or soil, and erosion under the nose. According to *San Yin Fang*, pediatric accumulated heat syndrome manifests as heat in both the exterior and interior, generalized body heat, flushed cheeks, dry mouth, dark red urine, and scorched yellow stool. First, use Sishun Qingliang Yinzi (Four-Oriented Cooling Decoction) to promote bowel movement and clear the viscera to eliminate the heat. If the heat recurs after being eliminated, it indicates that the interior heat has been resolved but the exterior heat remains; therefore, Xingxing San (Stimulating Powder), Hongmian San (Red Cotton Powder), along with Ephedrae Herba (Mahuang, 麻黄) to induce mild sweating, should be used to dispel the exterior heat. Why does fever recur after the exterior heat is gone? Physicians of the world often fail to understand this stage; some administer cooling medicines again, others attempt to release the exterior again, or declare it incurable, leading to many mismanaged cases of premature death. This occurs because both the exterior and interior are deficient, Qi fails to return to its origin, and Yang floats outwardly, causing recurrent fever. This is not a heat syndrome. One should only use Liushen San (Six-God Powder) with Oryzae Semen (Jingmi, 粳米) decocted together to harmonize Stomach Qi, thereby drawing Yang back inside, resulting in a cool body. For severe heat, Yinbai San (Silver-White Powder) is used. [Zeng] states that accumulated heat presents with swollen eyelids, yellowish face, cold feet, fever starting from the head and worsening towards the abdomen, nausea upon smelling food, intestinal pain, and vomiting. The treatment methods are detailed in the chapter on Injury Accumulation.
Note: Zeng's "accumulated heat" refers to heat arising from abdominal masses (pi), which differs from long-standing accumulation; thus, both concepts can coexist.
Qingliang Yinzi (for Interior Heat) Xingxing San (for Smallpox/Measles)
Hongmian San (Red Cotton Powder)
Bombyx Batryticatus (Chao, fried, 2 liang) Gastrodiae Rhizoma (Raw, 1 liang) Pinelliae Tuber (Sliced thinly, oil-soaked until yellow, 2 liang) Paeonia Lactiflora Root (Su Mu Jie, separate grinding, 2.5 liang)
Grind into fine powder. Take 1 qian per dose, decoct with 1 small cup of water and a little red cotton until reduced to 0.6 parts, take warm. Suitable for pediatric wind-heat causing unclear head and eyes. For exogenous cold with exterior syndrome and fever, add 0.5 qian of Ephedrae Herba (Mahuang, 麻黄) without stems. For interior heat with dryness and thirst, add 0.5 qian of Talcum (Huashi, 滑石).
Liushen San (Six-God Powder)
Ginseng Radix et Rhizoma Baicalensis Scutellariae Radix Dried Dioscoreae Rhizoma Atractylodis Macrocephalae Rhizoma Puerariae Lobatae Radix Glycyrrhizae Radix et Rhizoma (Roasted. Equal parts)
Grind into fine powder. Take 1 large qian per dose, decoct with 1 small cup of water, 1 jujube, and 2 slices of ginger until reduced to 0.5 parts, take. This medicine has many uses: for cold stomach, add Aconiti Lateralis Radix Praeparata (Fuzi, 附子); for wind syndromes, add Gastrodiae Rhizoma; for dysentery, add Papaveris Pericarpium (Yingsuqiao, 罂粟壳).
Yinbai San (Silver-White Powder)
Dried Dioscoreae Rhizoma Atractylodis Macrocephalae Rhizoma Baicalensis Scutellariae Radix Ginseng Radix et Rhizoma Puerariae Lobatae Radix Anemarrhenae Rhizoma Glycyrrhizae Radix et Rhizoma (Roasted) Cimicifugae Rhizoma (Equal parts)
Grind into fine powder. Take 1 large qian per dose, decoct with 1 small cup of water, 1 jujube, and 2 slices of fresh ginger, take warm, at any time.
Taozhi Wan (Peach Twig Pill) Disperses accumulated heat and chest binding. Also known as Taofu Wan.
Crotonis Fructus Frost (Badou Shuang, 巴豆霜) Rheii Radix et Rhizoma Phellodendri Chinensis Cortex Calomel Sand (Each 1 qian)
Grind into fine powder, make pills with wheat paste, size of millet seeds. Administer with Peach Twig Decoction. Age 1 year: 5-7 pills; age 5-7 years: 20-30 pills. Infants under 1 year: 2-3 pills, taken before bed.
Zhichi Yinzi (Gardenia and Fermented Soybean Decoction) Treats pediatric retained heat in the middle, body heat, mania/restlessness, coma, and anorexia.
Gardeniae Fructus (7 pieces) Fermented Sojae Semen (Banliang, half liang)
Decoct with 3 cups of water until 2 cups remain. Take according to condition, at any time. Vomiting may occur or not; effect is immediate.
Zhizi Tang (Gardenia Decoction) Treats pediatric accumulated heat affecting the Heart, red/swollen urine, and oral ulcers.
Gardeniae Fructus Thunberg Flos Coptidis Radix Angelicae Sinensis Radix (Tail) Angelicae Dahuricae Radix (Each 2 qian) Saposhnikoviae Radix Glycyrrhizae Radix et Rhizoma (Each 1 qian)
Grind into fine powder. Take with Ophiopogonis Decoction.
Sanhuang Wan (Three-Yellow Pill) (Interior Heat)
[Zeng] Yulu Yin (Jade Dew Decoction) Treats flushed cheeks, dry throat, mental restlessness, poor sleep, body heat, and headache. Also treats summerheat with thirst/coma, urinary obstruction, fright qi entering Kidney, and teeth grinding in dreams. Add Jinzhu San (Gold Pearl Powder), take with Mint Decoction on an empty stomach.
Hypostasis Aquae Frigidus Gypsum Fibrosum (Each 1 liang. Hypostasis Aquae Aquae Frigidus should have fine veins and break easily by hand; Gypsum Fibrosum should be white, hard, and layered.) Glycyrrhizae Radix et Rhizoma (3 qian, sun-dried or baked on cloudy days)
Except for the first two ingredients, process Glycyrrhizae Radix et Rhizoma by cutting, drying, or baking, then grind all into fine powder. Take 0.5-1 qian per dose, mix with warm water, at any time. Or use Ophiopogon boiled water.
Yiyuan San (Benefit Origin Powder) Resolves summerheat toxicity, promotes urination, relieves vexatious thirst, and eliminates palpitations/fright.
Talcum (6 liang) Glycyrrhizae Radix et Rhizoma (1 liang, finely cut)
Dry or bake the two ingredients, grind into fine powder. Take 1-2 qian per dose, mix with warm hot water, at any time. Cold water is also acceptable.
Wan'an Yin (Ten-Thousand Peace Decoction) Eliminates the old and generates the new, expels evil and supports righteousness, harmonizes and benefits Spleen/Stomach, unites Qi/Blood, regulates diet, disperses wind-cold, calms heart and resolves phlegm, removes vexation and clears heat. Suitable regardless of whether the syndrome is in the exterior or interior. Regular use prevents hundred diseases, consolidates true Yuan, and tonifies various deficiencies with remarkable efficacy. This is similar to Danggui Yin in *Xuanming Lun*. It has many treatments; besides the standard herbs, it adds Aurantii Fructus (Zhike, 枳壳) and Pinelliae Rhizoma Preparatum (Banxia, 半夏).
Ginseng Radix et Rhizoma (De-rhizome) Angelicae Sinensis Radix (Wine-washed) Rheii Radix et Rhizoma (Raw) Bupleuri Radix (De-rhizome) Aurantii Fructus (De-pith, stir-fried) Pinelliae Rhizoma Preparatum (Cracked by frying) Paeoniae Radix Alba (Washed) Scutellariae Radix Saposhnikoviae Radix (De-rhizome) Glycyrrhizae Radix et Rhizoma (Ten ingredients, each 1 liang) Talcum Powder (6 liang)
Cut into pieces. Except for Talcum Powder, which is added just before mixing evenly. Take 2 qian per dose, decoct with 1 cup of water and 2 slices of ginger until reduced to 0.7 parts, take warm at any time. Or add 1 jujube and decoct together.
Tiaowei San (Regulate Stomach Powder) Taken after Taozhi Wan clears accumulated heat.
Ginseng Radix et Rhizoma (3 qian) Atractylodis Macrocephalae Rhizoma (2.5 qian) Glycyrrhizae Radix et Rhizoma (Roasted) Baicalensis Scutellariae Radix Papaveris Pericarpium (Each 1 qian) Fuzi (Bai Fuzi, 白附子) (0.5 fen) Agastache Rhizoma Symplocos Fructus (Each 0.5 qian)
Grind into fine powder. Take 0.5-1 qian with Perilla Decoction.