Jia Liujin, Master of Traditional Chinese Medicine: Eight Essentials of Diagnosis and Treatment of Children's Cold and Fever

Children's viscera are delicate, the shape and qi are not full, the exterior of the guard is not solid, and the fence is not solid, which is the most likely to be evil.

Six evils invade from fur, nose and mouth, invading lung and Wei, resulting in abnormal opening and closing of phlegm and turbid urine, stagnation of Wei Yang, and a series of exogenous symptoms with fever and aversion to cold as the main symptoms, which are the most common disease syndromes in childhood.

Timely and accurate diagnosis and treatment can prevent transmission, change, pinch, relieve symptoms, shorten the course of disease and recover as soon as possible.

According to the clinical needs, eight points of diagnosis and treatment of exogenous fever are summarized, which are obviously simple and easy to master and use.

First of all, this table follows an old adage.

Generally speaking, if there is exterior syndrome, exogenous pathogenic factors and six evils will be eliminated with sweat through the functions of dispersing lung qi, regulating health and resolving phlegm. However, symptoms and signs are often mixed, not simple. In the diagnosis and treatment of exogenous fever, it is necessary to distinguish the order of specimens and determine the treatment principle.

As Su Wen's Biography of Specimen Diseases said, "Those who know the specimen will do anything, but those who don't know the specimen are reckless." Exterior syndrome is characterized by new onset, exogenous pathogenic factors, severe symptoms and acute illness, and belongs to the master in the relationship between master and essence, and treats the master in an emergency.

"Medical Mind Knowledge" warns later scholars that "doctors make mistakes and lose specimens, so we should keep the priorities right, re-mark after serious illness, and learn a few things to the point."

Treatise on Febrile Diseases applies the theory of specimen perfectly. "Taiyang disease, the exterior syndrome is not solved, the pulse is weak, and it is appropriate to sweat" and "sweating at the root" are also the opposite. If you sweat first, you can't take it as the opposite. "Everything is to treat the exterior syndrome first. As long as the exterior evidence exists and has not changed, you should continue to solve the exterior evidence and not attack the interior, otherwise it will violate the principle.

Second, distinguish between cold, wind and heat

Most children have colds, wind-heat syndrome and wind-cold syndrome, while summer pathogenic colds are relatively rare because of their strict seasonality.

The syndrome differentiation of wind-heat syndrome and wind-cold syndrome, although the main syndromes are different, the tongue and pulse are different, which seems simple, but it is actually difficult. For example, the subjective feeling of aversion to cold and wind is very clear to doctors, but it is difficult to understand, so it is necessary to have objective signs as a diagnosis point.

Jia Lao first looked at the oropharynx, and the pharynx was red, with herpes, congestion of the soft palate and erythema, but he could be diagnosed as wind-heat syndrome as soon as he saw the doctor.

The diagnosis points of wind-cold syndrome are that the pharynx is not red, the face is pale, the skin on the cheeks and the outer side of the upper arm is like chicken skin, and the hair is erect, which hinders the hands.

Third, be alert to epidemics and prevent misdiagnosis.

Epidemic febrile disease is a general term for all kinds of acute infectious diseases caused by infectious diseases.

The clinical manifestations of some common acute infectious diseases are usually nonspecific, such as fever, sore throat, fatigue, loss of appetite, headache, general pain, etc. These are very common in many infectious diseases and are very similar to the symptoms of children's colds.

Generally, after 1.3 days, the unique symptoms and signs of infectious diseases, such as measles, chickenpox, scarlet fever, whooping cough and epidemic cerebrospinal meningitis, will be fully revealed. , and should pay attention to the presence of jaundice, hepatosplenomegaly, meningeal irritation, etc. To prevent misdiagnosis and mistreatment.

In the early diagnosis of infectious diseases, we should inquire about the history of vaccination and infectious diseases in detail, and comprehensively analyze and judge according to the unique symptoms and signs in the early stage of the disease, such as Koch's spot of measles, combined with epidemiological data and laboratory examination, so as to achieve early detection, early diagnosis, early isolation and early treatment.

Fourth, the condition is complex and changeable.

Children are prone to illness and change quickly. After catching a cold, they often have complications, including phlegm, stagnation and shock.

In addition, some concurrent certificates are also common.

First, abdominal pain, the abdomen is invaded by external evil, and the guest is between the stomach and intestines, which hinders the qi movement, and the meridians are blocked, resulting in abdominal pain, which is often complicated by acute mesenteric lymphadenitis.

Secondly, the swelling and pain of cervical nucleus is caused by exogenous wind-heat and phlegm-toxin. The symptoms are swelling and pain of the cervical nucleus, which is equivalent to simple cervical lymphadenitis in western medicine.

Thirdly, the ear pain caused by wind-heat invading the exterior can also hurt the orifice, or the existing acute catarrhal otitis media belongs to the category of modern medicine.

Often secondary to acute upper respiratory tract infection, acute rhinitis, adenoid enlargement, inflammation directly affects the eustachian tube, and the lumen mucosa is congested and swollen, which hinders the normal ventilation and drainage of the tympanum.

Young children scratch their ears, pat their heads, cry and be agitated, while older children often complain about earache, tinnitus, ear occlusion or bloating.

Wind-heat cold and earache are common, and the treatment should be based on pungent cooling, clearing away heat and toxic materials, such as Gentiana scabra, Prunella vulgaris and Cortex Moutan.

Five, early fever to prevent convulsions.

In the early stage of cold and fever, it is easy to be accompanied by sudden convulsions, mostly because children feel evil wind and heat, which are depressed on the muscle surface, turn heat into fire, extremely hot wind, wind helps fire, wind and fire fan, leading to liver wind fever, stiff neck, dizziness, convulsions and other symptoms. Western medicine calls it febrile convulsion.

Its attack is mostly related to the sudden rise of body temperature of epidemic febrile disease, and more than 70% is related to upper respiratory tract infection.

The prevalence rate of children is 3% 4%, and the age of first onset is 6 months to 3 years old, with more boys than girls. It only happens once in the process of a fever disease, and the duration of convulsion does not exceed 10 minute, which belongs to simple febrile convulsion.

If the seizure form is localized or asymmetric, the duration is 15 minutes, and the total number of repeated seizures or recurrences in 24 hours is 5 times, which meets the diagnostic criteria of complex thermal syncope and is one of the risk factors of epilepsy.

As early as 1294, doctors in China Yuan Dynasty had noticed the possibility of epilepsy after shock. In the book "Live a Young Heart", it is said that "the so-called three shocks are epilepsy".

In the prevention and treatment of infantile convulsion, there are many records in ancient medical books, and more than 300 prescriptions about infantile convulsion are collected in Pediatric Syndrome Differentiation and Treatment Standard.

As early as the Tang Dynasty, there were detailed observations on the premonitions of fright. In Qian Jin Fang, Tang Sun Simiao recorded more than 20 premonitions, such as "dark thenar veins of the hand, white flesh, dry nostrils, unfavorable defecation, unclear eyes and sunny eyes".

Wang Qingren also summed up 20 premonitory symptoms of convulsions, such as "the roof of the door sinks, eyes are sleepy, the tongue is shaking in the mouth, you can't cry, you can't cry, but as long as you see one or two symptoms, you will know that you will smoke in the future".

In Wang Qingren's view, telling patients that "the ancient prescription is invalid" has nothing to do with doctors, and it is also a responsibility. "Before you want to twitch, you will see the symptoms of convulsions."

Compared with Sun Simiao's and Wang Qingren's summary of premonitions of convulsions, Shen Qingjin 'ao said in Interpretation of Pediatric Mysteries that "anyone who wants to have convulsions is mentally deficient, afraid of people in a trance, looking up at people, holding his hand and clenching his fist, being depressed and having abnormal emotions, all of which are premonitions of convulsions", which is more in line with clinical practice.

It is also a good measure to keep some drugs at home, such as Angong Niuhuang Pills, Diazepam, Valproate Tablets and Phenobarbital Tablets, in case of emergency. Acupuncture at Renzhong, Hegu, Yongquan and Baihui is effective immediately after onset.

Sixth, you should remember that you are sweating all over.

"Su Wenyin Yang Ying Xiang Da Lun" said that "it is caused by skin sweating". Sweating is a good method to treat exterior syndrome, but it should be used properly. If sweating is not thorough, the cause is unreasonable, the camp and the health are unreasonable, and the disease is terminally ill, which is easy to spread to the meridians; Hyperhidrosis can lead to yin injury and yang injury, and the evil is not solved, and the healthy qi is already deficient. Therefore, in the specific application of sweating method, we should not only follow the statutes, but also find the laws.

Zhang Zhongjing used the sweat method to "hang the beam" for the doctor. The frying method of Guizhi decoction in Treatise on Febrile Diseases tells future generations that "warming for a while seems to make you sweat all over, and you can't make the disease go away."

Sweating all over the body is the best state, which indicates clearing away evil, harmonizing camp and health, and smoothing pulmonary blood vessels, and eliminating evil and six evils with sweat.

As for how to master the "whole body": if there is slight sweat in the lower limbs, especially in the calves, it means that the whole body sweat has been sent out.

Seven, sweating cold pulse needs rest.

The word "vein" comes from Treatise on Febrile Diseases. "Typhoid fever day, the sun, pulse if static, don't pass. If you want to vomit, you will be impatient. If your pulse is fast, you will pass it. " "Quiet" means that the pulse condition is consistent with the syndrome, and the condition has not changed.

Physicians in later generations often use the expression "the pulse is still and the body is cold" to express the solution of internal harmony, and the evil is eliminated and the disease has been cured. The "vein" here should be understood as a normal pulse condition, which should mean tenderness, uniformity and calmness, such as the spring breeze and the image of a willow dancer.

Cold and fever, mostly floating or tight pulse. "Lake Pulse Tactics" says that "the number of strings is tight" and "the number of strings is tight like strings". Tight pulses are included in the number of pulses. With the external pathogen completely solved, the cause of disease was eliminated and the body temperature gradually dropped to normal. At this time, the skin is moist, which usually lasts for several hours to a day or two. The pulse condition changes from tight to soft, refreshing and healing quickly.

Eight. Check the causes of thermal recession and thermal rise in detail.

If the cold and fever are manifested as symptoms, defecation, digestion and clearing away heat, the disease will be cured; If the fever goes down again, it should be carefully identified. For example, sweating is not as good as the law. When the condition is serious, the medication is lighter, and the symptoms of fatigue and lack of food appear repeatedly, which also changes the symptoms of bee rising. Children often see food recovery and symptoms of both.

"Su Wen Re Lun" "Why do you want to ban fever? Qi Bo said that if you are sick with less heat, you should just eat meat, and if you eat too much, you will fall behind. This is forbidden. "

The child's fever has initially gone down and his digestive function has not returned to normal. Overeating meat or eating too much will lead to the recurrence of the disease.

Concurrent syndrome is also common. For example, combined with modern medicine, we should consider the mixed infection of virus and bacteria, and the mixed infection of mycoplasma and EB virus, and we need to treat it according to syndrome differentiation again.

Excerpt from: Jia Liujin Pediatric Experience Collection of Traditional Chinese Medicine/Jia Liujin, edited by Zheng Xue. —— Beijing: People's Health Publishing House.