钱乙曰。慢惊。因大病后。或吐泻。或只吐不泻。变成脾胃虚损。遍身冷。口鼻气出亦冷。手足时螈 。昏睡露睛。
此无阳也。宜栝蒌汤主之。
张元素曰。慢惊者。阴症也。俱脏受病。
曾氏曰。治慢惊者。考之古书。亦无所据。惟载阴痫而已。盖慢惊属阴。阴主静而搐缓。故曰慢。其候皆因外感风
寒。内作吐泻。或得于大病之后。或传误转之候。目慢神昏。手足偏动。口角流涎。身微温。眼上视。或斜转。或两手
握拳而搐。或兼两足动掣。各辨男左女右搐者为顺。反此为逆。口气冷缓。或囟门陷。此虚热也。脉沉无力。睡则扬睛。
谓两目半开半合。此真阳衰耗。而阴邪独盛。阴盛生寒。寒为水化。水生肝木。木为风化。木克脾土。胃为脾之腑。故
胃中有风。螈 渐生。其螈 状。两肩微耸。两手垂下。时复动摇不已者。名曰慢惊。宜以青州白丸子、苏合丸入姜汁
杵匀。米饮调下。虚极者。加金液丹。
虞抟曰。慢惊者。因吐泻日久。中气大虚而得。盖脾虚则生风。风盛则筋急。宜用温白丸。
鳌按。脾虚则生风者。非风自脾生。以脾虚则肝木必强。乃风生于肝也。故风盛则筋急。以肝主筋故耳。观
温白丸中僵蚕全蝎白附天麻等。皆治肝药可见。
李 曰。阴症慢惊。自阳症急惊传来。才经吐泻。便是慢惊。男子以泻得之为重。女子以吐得之为重。慢惊因吐泻
得者。宜醒脾散、加味术附汤。虚风痰多者。宜八仙散。慢惊纯阴症。宜乌蝎散。或阳症尚在。宜蝉蝎散。若有急惊方
传慢候。而尚有阳症。八候尚在。不必回阳。但与截风调胃。用蝉蝎散、醒脾散。若手足冰冷。方可回阳。用硫
黄、附子。泻滑青者。宜防慢惊。盖泻青色乃夹惊。木克土也。
李杲曰。小儿慢惊。或吐利不止。变成虚风搐搦者。非风也。胃气欲绝也。用来复丹五粒研碎。米饮调下。即效。
史演山曰。慢惊之候。盖由急惊过用寒凉。或转太骤。传变成之。又有吐利不止而成者。有气虚暴吐泻而成者。有
夏月脾胃伏热。大吐泻。当解暑热。不可专曰固阳。有脏虚洞泻成者。有得之久嗽作痫者。有得之发痫不已者。有得之
虫
积冲心者。惟吐泻积痢成虚致之。则症变甚速。凡才经吐泻。便是慢惊。须用温中扶里。或搐来紧急。乃慢惊初传。尚
有阳症。不可误作急惊。世言搐慢为慢惊。非也。若泥此。往往指慢脾为慢惊矣。凡慢惊。男子以泻得之为重。女子以
吐得之为重。又吐有五症。泻有五症。各明所因主治。古云。病家怕惊不怕泻。医家怕泻不怕惊。如因泄泻不止。且先
治泻。若更治风。则惊风愈甚。如因他症。则当循原施治也。其慢惊候。若从急惊传来。只可截风调胃。均平阴阳。不
可全用阳药。使阳归阳。复作急惊之症。
张涣曰。急惊以关窍不通。略用冰麝开通。定其搐搦尚可。慢惊阴重阳亏。诸经已虚。不宜开通。又凉其脏。易作
慢脾风。致不易疗。
闻人 曰。慢惊危急。如眼睛昏定。定而砭。虽砭不左右顾。或窜视。四肢厥冷。汗出如流。口面黪暗。指甲黑。
四体垂。至重。慢惊症。眼半开半合。似睡不睡是也。其脉或浮或沉。身或热或凉。或吐或泻。或不吐不泻。或食乳。
或阻乳。名半阴半阳合病。即如伤寒半表半里也。
叶桂曰。慢惊古称阴痫。其治法。急培脾胃。理中汤为主方。有痰呕吐。用南星、白附子、六君子汤。声音不出。
开窍。加竹沥、姜汁、菖蒲根、郁金之属。是病。皆他病致变。其因非一。有过饥。禁食气伤。有峻药强灌伤胃。有暴
吐暴泻。脾胃两败。其症面青 白。身无热。虽热不甚。短气骨软。昏倦如寐。皆温补治之。惟呕逆不受乳食。温补反
佐姜连。连理汤、钱氏益黄散、钱氏异功散。
Qian Yi stated: Slow convulsion (Man Jing Feng) occurs after a severe illness, or following vomiting and diarrhea, or only vomiting without diarrhea, resulting in deficiency and damage of the Spleen and Stomach. The whole body becomes cold, the breath from the mouth and nose is also cold, and the limbs occasionally experience clonic spasms (Rong Zhu). The patient sleeps deeply with eyes half-open, revealing the whites.
This indicates the exhaustion of Yang Qi. It is appropriate to treat with Gualou Tang (Trichosanthes Decoction).
Zhang Yuansu stated: Slow convulsion belongs to Yin syndromes. All involve disease affecting the Zang organs.
Zeng Shi stated: Regarding the treatment of slow convulsion, ancient texts provide little basis, recording only Yin epilepsy. Generally, slow convulsion belongs to Yin; Yin governs stillness, hence the spasms are slow, thus named "slow." Its symptoms arise from external contraction of Wind-Cold, internal dysfunction causing vomiting and diarrhea, or occurring after a severe illness, or as a result of misdiagnosis and improper transmission. The gaze is dull and confused, limbs move asymmetrically, saliva flows from the corners of the mouth, the body is slightly warm, eyes roll upward or deviate sideways, hands may be clenched in spasms, or feet may jerk. Differentiate based on whether the male's left side or female's right side spasms first; this is considered favorable (Shun). The opposite is unfavorable (Ni). The breath is cold and slow, or the fontanelle is sunken, indicating deficient heat. The pulse is deep and powerless. During sleep, the eyes are half-open and half-closed, termed "Yang Jing" (raising eyes). This signifies the depletion of True Yang and the predominance of Yin pathogenic factors. Excess Yin generates Cold; Cold transforms into Water; Water generates Liver Wood; Wood generates Wind; Wood overacts on Spleen Earth. Since the Stomach is the Fu organ of the Spleen, Wind exists in the Stomach, leading to gradual onset of spasms. The manifestation of these spasms includes slight elevation of both shoulders, hanging down of both hands, and continuous intermittent trembling, named Slow Convulsion. It is appropriate to use Qingzhou Bai Wan (White Pills of Qingzhou) and Suhé Wan (Styrax Pill), mixed with ginger juice, and taken with rice water. For extreme deficiency, add Jin Ye Dan (Golden Pellet).
Yu Tun stated: Slow convulsion results from prolonged vomiting and diarrhea causing significant deficiency of Middle Qi. Deficiency of the Spleen generates Wind; excess Wind causes tendon tension. It is appropriate to use Wenbai Wan (Warm White Pill).
I (Shen Jin'ao) note: Saying "Spleen deficiency generates Wind" does not mean Wind originates from the Spleen. Rather, Spleen deficiency leads to hyperactivity of Liver Wood, so Wind actually originates from the Liver. Thus, excess Wind causes tendon tension because the Liver governs the tendons. This is evident from the ingredients of Wenbai Wan, such as Jiangcan (Bombyx Batryticatus), Quanxie (Scorpio), Baifuzi (Aconitum Kusnezoffii Rhizome), and Tianma (Gastrodiae Rhizoma), all of which are herbs treating the Liver.
Li stated: Yin syndrome slow convulsion transmits from Yang syndrome acute convulsion (Ji Jing Feng). Once vomiting and diarrhea occur, it becomes slow convulsion. In males, diarrhea is more severe; in females, vomiting is more severe. For slow convulsion caused by vomiting and diarrhea, Xingpi San (Spleen-Awakening Powder) or Jiawei Shu Fu Tang (Modified Atractylodes and Aconite Decoction) is appropriate. For deficient Wind with much phlegm, Baxian San (Eight Immortals Powder) is appropriate. For pure Yin syndrome slow convulsion, Wuxie San (Scorpion Powder) is appropriate. If Yang syndrome signs persist, Chanxie San (Cicada and Scorpion Powder) is appropriate. If acute convulsion has transmitted to slow convulsion signs but Yang syndrome remains and the eight signs of slow convulsion are present, there is no need to restore Yang. Instead, stop Wind and regulate the Stomach using Chanxie San and Xingpi San. Only if the hands and feet are cold should one restore Yang using Liuhuang (Sulfur) and Fuzi (Prepared Aconite Root). For slippery green stools, prevent slow convulsion. Green stool indicates夹杂惊 (mixed with fright), representing Wood overacting on Earth.
Li Dongyuan stated: In children, slow convulsion, or persistent vomiting and diarrhea transforming into deficient Wind spasms, is not due to Wind, but rather the impending exhaustion of Stomach Qi. Using Laifu Dan (Revival Pellet), five pills crushed and taken with rice water, yields immediate effect.
Shi Yanshan stated: The presentation of slow convulsion generally arises from the excessive use of cold-cooling medicines for acute convulsion, or overly rapid transformation. It can also result from persistent vomiting and diarrhea, sudden vomiting and diarrhea due to Qi deficiency, summer-heat and dampness stagnating in the Spleen and Stomach causing severe vomiting and diarrhea (requiring resolution of summer-heat rather than solely securing Yang), deficiency of Zang organs causing profuse watery diarrhea, chronic cough evolving into epilepsy, unceasing epilepsy, or intestinal parasites rushing to the Heart. Only when vomiting, diarrhea, dysentery, and accumulation transform into deficiency do the symptoms change rapidly. As soon as vomiting and diarrhea occur, it is considered slow convulsion. One must use warming the Middle and supporting the Interior. If spasms come urgently, it is the initial transmission of slow convulsion, still retaining Yang signs; do not mistake it for acute convulsion. The common saying that "slow spasms equal slow convulsion" is incorrect. Adhering to this often leads to misidentifying Man Pi Feng (Slow Spleen Wind) as slow convulsion. In slow convulsion, diarrhea is heavier in males, vomiting in females. There are five types of vomiting and five types of diarrhea, each requiring specific etiological and therapeutic differentiation. Ancient wisdom states: Patients fear convulsion more than diarrhea; physicians fear diarrhea more than convulsion. If diarrhea persists, treat the diarrhea first. Treating Wind concurrently will exacerbate the convulsion. If due to other diseases, treat according to the original cause. If slow convulsion transmits from acute convulsion, only stop Wind and regulate the Stomach to balance Yin and Yang. Do not use exclusively Yang-warming medicines, lest Yang returns excessively and reverts to acute convulsion symptoms.
Zhang Huan stated: Acute convulsion involves blocked orifices; slight use of Bingpian (Borneol) and Shexiang (Musk) to open them can stabilize spasms. Slow convulsion features Yin excess and Yang deficiency, with all meridians already depleted; opening is inappropriate. Cooling the Zang organs easily leads to Man Pi Feng (Slow Spleen Wind), making it difficult to treat.
Renren Mou stated: Slow convulsion is critical. If the eyes are fixed and dull, even after bloodletting (Bian), they do not look around or dart. Limbs are cold, sweat flows like water, face and mouth are dark, nails are black, and limbs hang limp—this is extremely severe. Slow convulsion presents with eyes half-open and half-closed, appearing asleep but not quite. The pulse may be floating or deep; the body may be hot or cool; there may be vomiting or diarrhea, or neither; feeding may be accepted or refused. This is called Half-Yin Half-Yang Combined Disease, similar to the Shaoyang stage in Shanghan (Cold Damage).
Ye Tianshi stated: Slow convulsion was anciently called Yin Epilepsy. The treatment method urgently tonifies the Spleen and Stomach, using Lizhong Tang (Regulate the Middle Decoction) as the primary formula. With phlegm and vomiting, use Nanxing (Arisaematis Rhizoma), Baifuzi, and Liujunzi Tang (Six Gentlemen Decoction). For loss of voice, open the orifices by adding Zhuli (Bamboo Sap), Jiangzhi (Ginger Juice), Changpu Gen (Acori Tatarinowii Rhizoma), and Yujin (Curcumae Radix). This disease results from transformations of other illnesses with various causes: starvation or fasting damaging Qi, harsh drugs forcibly administered damaging the Stomach, violent vomiting and diarrhea causing dual failure of Spleen and Stomach. Symptoms include blue complexion and white lips, absence of fever (or mild fever), shortness of breath, soft bones, drowsiness resembling sleep—all treated with warming and tonification. Only if there is vomiting and refusal of milk/food should warming tonification be counterbalanced with Huanglian (Coptidis Rhizoma) and Ganjiang (Zingiberis Rhizoma), using Lianli Tang (Coptis and Poria Decoction), Qian Shi Yihuang San (Master Qian's Yellow Fortifying Powder), or Qian Shi Yigong San (Master Qian's Meritorious Service Powder).