《孫真人備急千金要方》Vol. 8

Sun Simiao, Essential Prescriptions Worth a Thousand Gold for Emergencies, Scroll Eight, Part Three

(Edited by Lin Yi and others, Court Gentleman for Attending Affairs, Acting Junior Director of the Court of Imperial Sacrifices, and Proofreader of the Secret Pavilion)

Prescriptions for Infants and Young Children, Part One

Preface and General Remarks, First Section (Prescriptions)

Discussion: Raising young children is a major concern in people’s lives. If children are not cared for from an early age, they will find it difficult to develop their abilities as they grow up. The Classic of Changes says that great things are accomplished by accumulating small ones; the Classic of Poetry also speaks of the beginning of human life. The Zuo Tradition records that Shengzi gave birth to Duke Yin. All these passages describe how the small becomes significant and the young grow to maturity. Everyone can understand this principle; there is no need to have studied the classics and histories to grasp it. That is why this book discusses women and children first, and adults and the elderly afterward: it is a way of honoring what comes first.

Yet children are physically frail and small, and it is often very difficult for physicians to treat them attentively and achieve good results. Most people who study medicine today do not take this matter seriously. Perhaps they think that babies are still wrapped in swaddling clothes and smell of milk. Physicians who pride themselves on their skill are even unwilling to look at them. On calm reflection, this is truly lamentable.

The Small Prescriptions says: at six years of age, a person is considered a child; at sixteen, a youth. (The Treatise on the Origins and Symptoms of Diseases and the Arcane Essentials from the Imperial Library say that a person is considered a youth at eighteen.) At thirty, a person is considered to be in their prime. (The Treatise on the Origins and Symptoms of Diseases and the Arcane Essentials from the Imperial Library say that a person is considered to be in their prime from the age of twenty onward.) At fifty, a person is considered old. Medical classics do not discuss children under six, so illnesses in infants are often difficult to treat because there is little guidance to follow.

In ancient times, a man named Wu Fang (called “Wu Fang” in the Treatise on the Origins and Symptoms of Diseases) compiled the Classic of the Infant’s Skull and Fontanelle, which was used to assess children’s longevity, illnesses, and prospects of life or death. “Skull and fontanelle” refers to the part of an infant’s crown that has not yet closed. This book was passed down from generation to generation, and only then did prescriptions for children’s medicine come into being. During the Jin and Song dynasties, people in the Jiangnan region valued the Su family’s inherited prescriptions for treating children and considered them quite effective, so they spread among the people. Under the Qi dynasty, a Prince Xu also compiled three scrolls of prescriptions for children. Thus, physicians today can already learn some of this tradition.

However, Prince Xu held a high rank; how could he have devoted himself to thoroughly investigating prescriptions for children? On close examination, his prescriptions are not particularly detailed. Only a few are worth keeping, and they are not especially precious. I have now gathered prescriptions from many sources and included methods that I have personally tried and found effective, compiling them into this section. Everyone who manages a household should understand how to care for children, so that they can prevent a child from dying prematurely for no reason.

It is also said: illnesses in children are not fundamentally different from illnesses in adults; the only difference is the amount of medicine to use …

The remaining sections, on childhood convulsions, sudden illness brought on by fright or external stimuli, delayed closure of an infant’s fontanel, and inability to walk, comprise another eight or nine chapters, compiled here.

Other prescriptions in this volume for illnesses such as diarrhea are scattered throughout the chapters and can be found by consulting them.

In general, sixty days after birth, an infant’s pupils have matured, and the child can cough, laugh, and respond to others. At one hundred days, the Ren meridian, one of the body’s meridians, has matured, and the child can turn over unaided. At one hundred and eighty days, the bones of the lower back and sacrum have formed, and the child can sit alone. At two hundred and ten days, the bones of the palms have formed, and the child can crawl. At three hundred days, the kneecaps have formed, and the child can stand alone. At three hundred and sixty days, the knee bones have formed, and the child can walk. These are the general stages of development. If a child does not reach them on time, something must be wrong.

After birth, an infant undergoes a “change” every thirty-two days. At sixty-four days, the second change occurs, accompanied by a “steaming.” At ninety-six days comes the third change; at one hundred and twenty-eight days, the fourth change, accompanied by a steaming. At one hundred and sixty days comes the fifth change; at one hundred and ninety-two days, the sixth change, accompanied by a steaming. At two hundred and twenty-four days comes the seventh change; at two hundred and fifty-six days, the eighth change, accompanied by a steaming. At two hundred and eighty-eight days comes the ninth change; at three hundred and twenty days, the tenth change, accompanied by a steaming. After a total of three hundred and twenty days, the minor steamings are complete. Sixty-four days later, a major steaming occurs; another sixty-four days later, a second major steaming occurs; and after a further one hundred and twenty-eight days, a third major steaming occurs.

In general, an infant undergoes one change every thirty-two days, and two changes make one steaming. Of the ten changes, five are accompanied by minor steamings, followed by three major steamings. After a total of five hundred and seventy-six days, both the minor and major steamings are complete, and the child is considered grown.

The term “change and steaming” in children refers to the process by which the child’s blood and meridians become abundant and the five viscera develop and transform. After each change, the child’s appearance and condition often differ somewhat.

During change and steaming, Qi rises during a change, while the body becomes hot during a steaming. The reaction may be mild or severe. In a mild case, the body is warm, the child is slightly restless, the ears and buttocks are cool, and small white blisters appear on the upper lip or head, resembling fish eyes, with slight sweating. In a more severe case, the body is very hot and the pulse irregular; the child may or may not sweat, has no appetite, and vomits after eating. The whites of the eyes are slightly red, while the dark parts are slightly pale. Another account holds that pale whites of the eyes indicate a more severe case, while red whites and darkened irises indicate a milder one. Once the change and steaming are over, the child’s eyes become bright and clear. These are the corresponding signs.

When a change occurs without a steaming, the symptoms are mild; when change and steaming occur together, the symptoms are more severe. In an uncomplicated course, the symptoms ease after five days; in a longer one, they ease after ten days. Thus, the process begins five days early and ends five days late, lasting ten days in all.

After the fever associated with the bianzheng (developmental transformation) subsides, the ears will cool as well. A baby undergoes the first bianzheng on the thirty-second day after birth; the fever may begin as early as the twenty-ninth day.

If the fever appears early, treat it by the appropriate method. The bianzheng process is not considered complete until the thirty-sixth or thirty-seventh day. Since some may not know this, let me explain again: during bianzheng, do not disturb the child or let a crowd gather nearby. A child’s bianzheng may come early or late, and does not always follow the commonly stated schedule exactly.

During the first bianzheng, some children develop a severe fever that persists beyond the expected number of days. If careful checking confirms that the child is indeed due for bianzheng, and the fever is mild with only slight agitation, do not give medicine, use acupuncture, or apply moxibustion. Simply keep the child quiet and observe. If the fever continues for a long time, give a small amount of Purple Pill, a medicine used at the time to relieve constipation and draw heat downward. Once a slight bowel movement occurs and the fever subsides, stop the medicine.

If an epidemic warm disease occurs during bianzheng, or the child contracts one at another time, the symptoms of the two conditions can look very similar. The signs described here as bianzheng are present only when the ears and the area around the buttocks are both hot, and there are no white blisters on the roof of the mouth. In such a case, first give Black Powder, a formula used here to induce sweating, and make the child sweat. Afterward, dust the body with warming powder; the fever will usually subside and the child’s condition improve. If the fever does not fully abate, give Purple Pill to promote a bowel movement.

If a child is exposed to cold during bianzheng, cold and heat may contend, causing cramping pain in the abdomen and lower back and unceasing crying. Warming the body with a heated compress can improve the symptoms. The method is described in the next chapter; the text refers to applying warmed mugwort and cotton batting.

The signs of bianzheng resemble those of warm disease, high fever, and cold damage. If it is not bianzheng but the child has a fever, hot ears, and heat around the buttocks, then another illness is present and should be treated accordingly. If it is confirmed to be bianzheng, do not treat it as another disease.

Another account says that the first bianzheng begins on the thirty-second day after birth; “transformation” (bian) means that the body becomes hot. The second occurs on the sixty-fourth day and involves both “transformation” and “steaming” (zheng); the child lies with a straight posture. The third occurs on the ninety-sixth day and is called “stabilization” (ding); at this time, the appearance of the Dan opening and the discharge of waste can be observed. The fourth occurs on the one hundred and twenty-eighth day, when the child can cough and laugh. The fifth occurs on the one hundred and sixtieth day, as the child’s ability to move gradually develops. The sixth occurs on the one hundred and ninety-second day and also involves both transformation and steaming; the child’s ability to move develops further. The seventh occurs on the two hundred and twenty-fourth day, when the child can crawl. The eighth occurs on the two hundred and fifty-sixth day and also involves both transformation and steaming; the child begins to understand and want to learn to speak. The ninth occurs on the two hundred and eighty-eighth day, when the child can stand upright. By the two hundred and eighty-eighth day after birth, the child has undergone nine transformations and four steamings. Be especially careful on the days when bianzheng occurs, and do not treat the child casually, as this may worsen the condition.

When an infant’s condition changes and fever develops, this is considered “transformation steaming” (bianzheng), a periodic fever that, according to the ancients, occurs as an infant grows and develops. It is also called “welcoming and sending the months.” “Steaming” refers to a high fever accompanied by an irregular pulse and sweating. A recent episode usually subsides in about five days; a more prolonged one may take eight or nine days. During this febrile stage, do not rashly use acupuncture or administer medicines indiscriminately.

Purple Pill: Used to treat fever that does not subside during an infant’s transformation steaming. It is also used when high fever occurs alongside cold damage or warm disease; when the fever persists after sweating; when there is phlegm accumulation in the abdomen, refusal of milk or food, vomiting after nursing, food-related convulsions, or alternating cold and heat.

One liang each of red halloysite and hematite, thirty croton seeds, and fifty apricot kernels.

Grind the four ingredients into a fine powder. Grind the croton seeds and apricot kernels separately into a paste, then combine them with the powder and pound the mixture two thousand times until well blended. If the mixture is too hard, add a little honey while pounding. Store it in a sealed container. For an infant thirty days old, give one pill the size of a hemp seed with a little milk. After about the time it takes to eat a meal, offer a small amount of milk again, but not too much. By noon the infant should have a mild bout of diarrhea, and the fever should subside. If it has not fully subsided, give another pill the next morning. For an infant one hundred days old, give one pill the size of a date pit, adjusting the dose according to the child’s age and size. In summer, when the weather is hot and children are prone to develop rashes, it is best to give a dose every twenty or thirty days. The Purple Pill is said to have broad uses; even if it causes diarrhea, it does not weaken the patient.

Black Powder: Used when an infant has an epidemic warm disease during transformation steaming, or contracts an epidemic warm disease outside that period.

Half a liang each of ephedra and apricot kernels, and six zhu of rhubarb.

First pound the ephedra and rhubarb into powder. Grind the apricot kernels separately into an oily paste, then gradually add it to the powder and continue pounding until evenly mixed. Store the mixture in a sealed container for one month. For an infant thirty days old, give one pill the size of an adzuki bean, mixed with milk, and hold the child so that they sweat. Afterward, dust the body with warming powder and keep the child out of drafts. For an infant one hundred days old, give one pill the size of a date pit, adjusting the dose according to the child’s age and size.

How to Choose a Wet Nurse

A wet nurse’s Qi and blood are transformed into milk; emotions such as joy and anger also arise from Qi and blood. Therefore, while caring for an infant, a wet nurse should carefully regulate her emotions. There are many physical traits considered suitable in a wet nurse, and she need not possess all of them. As long as she does not suffer from body odor, goiter, cough, scabies, leprosy, urinary retention, white scalp ringworm, scrofula, swollen lips, deafness, nasal congestion, epilepsy, or similar conditions, she may nurse an infant. The physician examines her…

Therefore, by examining the scars left by moxibustion, one can learn the underlying cause of a person’s previous illness.

Essential Prescriptions Worth a Thousand in Gold for Emergencies by Master Sun (Sun Zhenren Beiji Qianjin Yaofang), juan 8