周岁女婴，病经两月，消散多剂，脾元内伤，面青目定，肢掣指冷，证属慢惊。势颇危
殆。
无风可逐，无惊可疗。治惟温补脾阳，百中冀图一二。病缘脾元大亏，木横土困，变生慢惊
，屡进六君温补脾元，已臻小效。日来停药，神形复疲，小儿脏腑柔脆，初生萌芽，非苍枝
老干可比。根蒂伤伐，恐难图效，尽人工以邀天眷耳。
安波按∶惊风一途，初感即发为急惊慢惊，总缘食积伤脾，脾伤则木恣其所侮，宜培
土之中，兼以抑木。虽圣人复起，不易吾言矣。丁酉仲春志。
本证风痱，近加受暑，脉虚身热，倦怠口渴。经云∶脉虚身热，得之伤暑，暑伤气是以
倦怠
。夫暑乃六淫标邪，虽无大害，特恐质亏不胜病耳。商仿清暑益气汤大意，以俟消息。脉仍
虚急，热甚心烦，夜不安寐，方内酌除 术，加以玉竹，本草言其用代参 ，不寒不燥，且
能治风淫湿毒，寒热 疟，大便五日未圊，小溲数热，肺与大肠相表里，又与膀胱通气化
。
古人治暑证，每用生脉散者，以其有保肺清金之能也。病躯加受暑邪，恙经六日，两进清暑
益气，辅正涤邪，形倦肤干，热仍 ，心烦口渴，溲数便闭。张介宾云∶干锅赤裂，润自
何来，但加以水，则郁蒸畅然，而气化四达。宗玉女煎。早服玉女煎，薄暮复视，病势依然
。暑邪留着，原难急驱。今日已服药两渣，末便再进，暂与荷蜜煎代茶。便通肤泽，往日早
晨热缓，交午复甚，心内如焚，今午热势平和，无焦烦辗转之状，病躯治标，亦不得已。兹
既势平，自当斟酌，无使过也。前药退松，昨午其热复甚，溲数口渴，心如煎熬，质虚恙重
，况加反复，切虚更改。揣诸病情，得无心营胃液，为热灼伤，以致焦烦嘈杂者欤。宗阿胶
鸡子黄汤法。
安波按∶方议均佳。
[Background Information]
Book: Cheng Xingxuan's Medical Cases; Author: Cheng Xingxuan; Dynasty: Qing; Chapter: Fang Girl's Slow Convulsion / Certain Matron's Original Disease of Wind Paralysis Complicated by Summerheat Pathogen; Category: Medical Discussion
[Original Text Processing]
A one-year-old female infant has been ill for two months. After multiple doses of digestive and dispersing prescriptions, the Spleen Yuan (fundamental energy of the Spleen) was internally damaged. She presents with a bluish complexion, fixed gaze, limb convulsions, and cold fingers. The syndrome belongs to Slow Convulsion (chronic pediatric convulsion). The condition is quite critical.
There is no wind to dispel, nor is there acute fright to treat. The treatment lies solely in warming and tonifying the Spleen Yang, hoping for success in one or two out of a hundred attempts. The disease originates from a severe deficiency of Spleen Yuan, where Liver Wood overacts upon Earth, causing Earth to be constrained, thereby transforming into Slow Convulsion. Repeated administration of Liu Jun Zi Tang (Six Gentlemen Decoction, a formula for tonifying Qi and strengthening the Spleen) to warm and tonify Spleen Yuan had already achieved slight efficacy. However, after stopping medication recently, her spirit and physical form have become fatigued again. Children's Zang-Fu organs are tender and fragile, like newly sprouted seedlings, not comparable to old, tough tree trunks. If the root and foundation are damaged, it is feared that efficacy will be hard to achieve; we can only exert human effort to seek heavenly favor.
Cheng Anbo’s Commentary: Regarding the category of Fright Wind, whether it manifests as Acute Fright Wind or Slow Fright Wind upon initial pathogenic invasion, it generally stems from food retention injuring the Spleen. When the Spleen is injured, Liver Wood freely insults it. Therefore, one should cultivate Earth while simultaneously suppressing Wood. Even if the Sages were to rise again, they would not change my words. Recorded in mid-spring of the Dingyou year.
This case involves original Wind Paralysis (a condition characterized by flaccid paralysis of limbs), recently complicated by summerheat invasion. The pulse is deficient, the body is hot, accompanied by fatigue and thirst. The Classics state: "Deficient pulse and body heat result from summerheat injury; summerheat injures Qi, hence fatigue." Summerheat is a superficial pathogen among the Six Excesses (Wind, Cold, Summerheat, Dampness, Dryness, Fire). Although it causes little direct harm, one must fear that the patient's deficient constitution cannot withstand the disease. We propose imitating the general principle of Qing Shu Yi Qi Tang (Clear Summerheat and Benefit Qi Decoction) to await developments.
The pulse remains deficient and rapid; severe heat causes mental restlessness and insomnia at night. In the prescription, Atractylodes (Bai Zhu or Cang Zhu) is酌情 removed, and Polygonatum Odoratum (Yuzhu) is added. Materia Medica states its use can substitute for Ginseng; it is neither cold nor drying, and can treat wind excess, damp toxins, and alternating chills and fever malaria. The bowels have not moved for five days; urination is frequent and hot. The Lung and Large Intestine are exterior-interior related, and [the herb also assists] the Bladder in Qi transformation.
Ancient physicians often used Sheng Mai San (Generate the Pulse Powder) to treat summerheat syndromes because of its ability to protect the Lung and clear Metal (Lung). On a diseased body further invaded by summerheat, after six days of illness, having taken Qing Shu Yi Qi Tang twice to support healthy Qi and eliminate pathogens, the form is still tired, skin dry, heat persists, mental restlessness and thirst continue, urination is frequent, and defecation is obstructed. Zhang Jiebin said: "Like a dry pot cracking from red heat, where does moisture come from? Only by adding water can the stagnant steaming dissipate smoothly, allowing Qi transformation to reach all directions." Following the method of Yu Nu Jian (Jade Woman Decoction).
Taking Yu Nu Jian in the morning, re-examined at dusk, the disease trend remained unchanged. Summerheat lingering in the body is originally difficult to drive out quickly. Today, two doses of decoction residue have been consumed; it is inconvenient to continue immediately. Temporarily provide Lotus Leaf and Honey Decoction as tea. Later, bowel movement became smooth, skin lustrous. Previously, heat eased in the morning but intensified at noon, with internal burning sensation. At noon today, the heat trend is peaceful, without anxious tossing and turning. Treating the branch symptoms for a debilitated body is also a necessity. Now that the trend is stable, one must deliberate carefully, avoiding excess. As the previous medicine's effect waned, yesterday at noon the heat intensified again, with frequent urination, thirst, and internal torment. With a deficient constitution and heavy disease, compounded by recurrence, changes must be made cautiously. Speculating on the condition, could it be that the Heart Ying (Nutritive Level) and Stomach fluids are scorched by heat, leading to anxiety and gastric discomfort? Following the method of E Jiao Ji Zi Huang Tang (Donkey-Hide Gelatin and Egg Yolk Decoction).
Cheng Anbo’s Commentary: The prescription discussions are all excellent.