小儿温壮者,由腑脏不调,内有伏热,或挟宿寒,皆搏于胃气。足阳明为胃之经,主身
之肌肉,其胃不和调,则气行壅涩,故蕴积体热,名为温壮。
候小儿大便,其粪黄而臭,此腹内有伏热,宜将服龙胆汤;若粪白而酢臭,则挟宿寒不
消,当服紫双丸。轻者少服药,令默除之;甚者小增药,令微利。皆当节乳哺数日,令胃气
和调。若不节乳哺,则病易复,复则伤其胃气,令腹满。再、三利尚可,过此则伤小儿矣。
小儿壮热者,是小儿血气盛,五脏生热,熏发于外,故令身体壮热。大体与温壮相似,
而有小异。或挟伏热,或挟宿寒。其挟伏热者,大便黄而臭;挟宿寒者,粪白而有酸气。
此二者,腑脏不调,冷热之气俱乘肠胃。蕴积染渐而发,温温然热不甚盛,是温壮也;
其壮热者,是血气盛,熏发于外,其发无渐,壮热甚,以此为异。若壮热不歇,则变为惊,
极重者,亦变痫也。
小儿惊者,由血气不和,热实在内,心神不定,所以发惊,甚者掣缩变成痫。
又小儿变蒸,亦微惊,所以然者,亦由热气所为。但须微发惊,以长血脉,不欲大
惊。大惊乃灸惊脉,若五六十日灸者,惊复更甚,生百日后灸惊脉,乃善耳。
小儿温壮(低热持续不退),是由于脏腑功能不调,体内有潜伏的热邪,或者夹杂宿存的寒邪,这些病邪都搏结于胃气之中。足阳明经是胃的经脉,主管全身的肌肉,如果胃的功能不调和,那么气机运行就会壅滞涩缓,因此蕴积产生体热,这种病症称为温壮。
观察小儿的大便,如果粪便颜色黄且气味臭秽,这说明腹内有潜伏的热邪,适宜服用龙胆汤;如果粪便颜色白且有酸臭味,则是夹杂宿寒不能消化,应当服用紫双丸。病情轻的,减少服药量,让身体默默自行消除病邪;病情重的,稍微增加药量,使大便轻微通利。都应当节制喂奶和喂食几天,使胃气调和。如果不节制饮食,疾病容易复发,复发则会损伤胃气,导致腹部胀满。反复、多次使用泻下法还可以,超过这个限度就会伤害小儿的身体。
小儿壮热(高热),是因为小儿血气旺盛,五脏产生热邪,熏蒸发散到体表,所以导致身体高热。大体上与温壮相似,但又有细微的区别。有的夹杂伏热,有的夹杂宿寒。其中夹杂伏热的,大便黄且臭;夹杂宿寒的,粪便白且有酸气。这两种情况,都是脏腑不调,冷气和热气同时侵犯肠胃。热邪蕴积并逐渐发展而发作,体温温和地升高但不算特别盛,这就是温壮;而壮热,是因为血气旺盛,熏蒸发散到体外,其发作没有渐进过程,高热严重,以此作为区别。如果壮热不停歇,就会转变为惊风,极严重的,也会变成痫证。
小儿惊风,是由于血气不和,热邪实盛于内,心神不安定,所以发生惊风,严重的会出现肢体抽搐缩紧,进而变成痫证。
另外,小儿在“变蒸”(生长发育过程中的生理现象)期间,也会有轻微的惊悸,之所以这样,也是因为热气的作用。只需要轻微出现惊悸,以利于血脉生长,不想要大惊大恐。如果出现大惊大恐,就应当灸治惊脉穴位;如果在出生后五六十天就灸治,惊风反而会加重;如果在出生一百天后灸治惊脉,才是好的处理方法。
凡是小儿尚未发作痫证,但有即将发作的征兆时,或者表现为温壮症状连绵不断,或者摇头弄舌,或者睡眠中惊悸抽搐,频繁咬牙齿,像这样的情况就是将要发作(痫证)的征兆。
Pediatric *Wenzhuang* (persistent low-grade fever) arises from the disharmony of the zang-fu organs, with latent heat within, or accompanied by retained cold; all these pathogenic factors contend with the Stomach Qi. The Foot-Yangming Meridian is the meridian of the Stomach and governs the muscles of the body. When the Stomach is not harmonious, Qi circulation becomes stagnant and sluggish, leading to the accumulation of internal heat, a condition termed *Wenzhuang*.
Observe the infant's stool: if the feces are yellow and foul-smelling, this indicates latent heat in the abdomen, and *Longdan Tang* (Gentian Decoction) should be administered. If the feces are white and sour-smelling, it indicates retained cold that has not been digested, and *Zishuang Wan* (Purple Double Pill) should be given. For mild cases, reduce the dosage to allow the body to resolve the condition silently; for severe cases, slightly increase the dosage to induce mild purgation. In all cases, breastfeeding and feeding should be restricted for several days to restore harmony to the Stomach Qi. Failure to restrict diet will cause the disease to recur, damaging the Stomach Qi and leading to abdominal distension. Repeated or multiple purgations may be tolerated, but exceeding this limit will harm the infant.
Pediatric *Zhuangre* (high fever) occurs because the infant's Blood and Qi are vigorous, generating heat within the Five Zang Organs, which steams and radiates outward, causing high body temperature. Generally, it resembles *Wenzhuang* but has slight differences. It may involve latent heat or retained cold. Cases involving latent heat present with yellow, foul-smelling stools; those involving retained cold present with white, sour-smelling stools. Both conditions result from zang-fu disharmony, where both cold and heat pathogens invade the intestines and stomach. When heat accumulates and develops gradually, resulting in a gentle rise in temperature that is not intense, it is called *Wenzhuang*. In contrast, *Zhuangre* results from vigorous Blood and Qi steaming outward; its onset is abrupt without gradual progression, characterized by severe high fever, which distinguishes it. If *Zhuangre* persists without abating, it may transform into *Jingfeng* (convulsions); in extreme cases, it may transform into *Xian* (epilepsy).
Pediatric *Jing* (startle/convulsions) arises from the disharmony of Blood and Qi, with excess heat residing internally, causing instability of the Heart Spirit (*Shen*), thus manifesting as startle or convulsions. Severe cases involve limb twitching and contraction, transforming into epilepsy.
Additionally, during the period of "Bianzheng" (physiological growth and development phases in infants), there may be mild startle. This is due to the influence of heat. Mild startle is permissible as it helps nourish the Blood vessels; however, severe startle should be avoided. If severe startle occurs, moxibustion on the *Jingmai* (Startle Vessel) acupoints should be performed. Moxibustion performed at 50-60 days after birth may exacerbate the startle; moxibustion performed after 100 days of age is beneficial.
Regarding the prodromal signs of epilepsy in infants before an actual seizure occurs: if *Wenzhuang* symptoms persist continuously, or if the infant shakes their head and manipulates their tongue, experiences startle and twitching during sleep, or frequently grinds their teeth, these are indications that an episode is about to occur.