(汗多亡阳津液枯而 筋肉失养故筋惕惕而跳肉 而动也)
脉微弱。汗出恶风。误服大青龙汤。则厥逆。筋惕肉 。(真武汤)太阳病已汗仍发热。
头眩。身 振。(真武汤或人参养荣汤)吐下后复发汗。虚烦。脉微。心痞。胁痛。气冲眩冒。动
惕。久而成痿。(桂枝苓术甘草汤)
大抵此症。因于汗者。十有七八。不因于汗。素禀血虚。邪热搏血。亦见此症。又有未
尝发汗。七八日筋惕而肉不 。潮热。大便闭。小便涩。脐旁硬痛。此燥屎也。大柴胡下之。一
虚一实。治法相悬。临症者。可以不详察乎。
(螈者筋脉急而缩纵者筋脉缓而申一申一缩手足牵引搐搦风主动摇故也)
汗下后。日久螈 。(此虚极生风小续命汤加减)不因汗下螈 。(羌防芩连天麻四物之
类)汗出露风。汗不流通。手足搐搦。(牛蒡根散)风温。被火劫。发微黄色。螈 (葳蕤汤)
肝为风木之脏而主筋风火搏 。多患螈 。当平肝降火。佐以和血。有痰者。二陈竹沥
为主。属虚者。补中益气为先。如应用小续命者。有汗去麻黄。无汗去黄芩。此常法也。若戴眼
上视。汗出如珠。凝而不流太阳绝也。又有四肢HT HT 。动而不已。似螈 而无力抽搐者。肝
绝也。汗下过度。日久变出者。多不可治。
(汗出过多导致亡阳,津液枯竭,筋肉失去滋养,所以出现筋惕惕跳动、肌肉跳动的症状。)
脉象微弱,出汗且怕风。如果误服大青龙汤,则会出现四肢厥冷、筋惕肉瞤的症状。(治疗用真武汤)太阳病已经发过汗,仍然发热,头晕目眩,身体振颤动摇。(治疗用真武汤或人参养荣汤)呕吐或泻下之后又再次发汗,导致虚烦,脉象微细,心下痞塞,胁肋疼痛,气逆上冲,头晕眼花,身体动惕不安,时间久了会形成痿证。(治疗用桂枝苓术甘草汤)
大抵这类病症,因发汗不当引起的,占十之七八。如果不是因为发汗,而是素体血虚,邪热与血相搏结,也会出现这种症状。又有未曾发汗,经过七八天,出现筋惕而肌肉不跳动,伴有潮热,大便闭塞,小便涩滞,脐旁硬痛,这是燥屎内结。应当用大柴胡汤攻下。一虚一实,治疗方法相差悬殊,临症诊治时,能不详细考察吗?
(抽搐是指筋脉紧急收缩,瘛疭是指筋脉舒缓伸展,一伸一缩,手足牵引抽动,这是因为风主动摇的缘故。)
发汗或泻下之后,日久出现抽搐。(这是由于极度虚弱而生风,用小续命汤加减治疗)不是因为发汗或泻下而出现抽搐。(用羌活、防风、黄芩、黄连、天麻配合四物汤之类治疗)出汗后受风吹袭,汗液运行不畅,导致手足抽搐。(用牛蒡根散治疗)风温病,被火法劫迫,发出微黄色,出现抽搐(用葳蕤汤治疗)。
肝是风木之脏,主管筋脉,风火相搏结,多患抽搐。应当平肝降火,佐以和血。有痰的,以二陈汤加竹沥为主;属于虚证的,以补中益气汤为先。如应用小续命汤时,有汗去掉麻黄,无汗去掉黄芩,这是常规治法。如果出现戴眼(眼球固定上视),汗出如珠,凝滞而不流动,这是太阳经气绝的表现。又有四肢震颤抖动,动个不停,类似抽搐但无力抽搐的,这是肝气绝的表现。汗法和下法过度,日久变出的这些症状,大多不可治愈。
(Sweating excessively leads to the loss of Yang Qi, depletion of Body Fluids, and failure of the sinews and muscles to receive nourishment; thus, there is trembling of the sinews [Jin Ti] and twitching of the muscles [Rou Yu].)
The pulse is faint and weak, with sweating and aversion to wind. If Da Qing Long Tang (Major Green Dragon Decoction) is mistakenly administered, it will result in cold extremities [Jue Ni] and tremors of sinews with twitching of muscles [Jin Ti Rou Yu]. (Treat with Zhen Wu Tang [True Warrior Decoction]). In Taiyang disease [Taiyang Bing], if fever persists after sweating, accompanied by dizziness [Xuan Yun] and bodily tremulousness [Zhen Dong], (treat with Zhen Wu Tang [True Warrior Decoction] or Ren Shen Yang Rong Tang [Ginseng Nourishing Nutrient Decoction]). After vomiting or purging, if sweating is induced again, it causes empty irritability [Xu Fan], a faint pulse, epigastric fullness [Xin Pi], hypochondriac pain, rebellious Qi causing dizziness and vertigo [Xuan Mao], bodily tremulousness [Dong Ti], which over time may develop into flaccidity syndrome [Wei Zheng]. (Treat with Gui Zhi Ling Zhu Gan Cao Tang [Cinnamon Twig, Poria, Atractodes, and Licorice Decoction]).
Generally speaking, this type of syndrome arises from improper sweating in seven or eight out of ten cases. If not caused by sweating, but due to inherent Blood deficiency where pathogenic heat contends with Blood, this syndrome also appears. There are also cases where no sweating was induced, yet after seven or eight days, there is trembling of sinews without muscle twitching, tidal fever [Chao Re], constipation [Da Bian Bi], dysuria [Xiao Bian Se], and hardness and pain around the umbilicus; this is dry stool [Zao Shi]. It should be purged with Da Chai Hu Tang (Major Bupleurum Decoction). One is deficiency, the other is excess; the treatment methods are vastly different. Clinicians must examine carefully.
(Chou Chu [convulsions] refers to the urgency and contraction of sinews and vessels; Chi Zong [clonic spasms] refers to the relaxation and extension of sinews and vessels. Alternating extension and contraction cause traction and jerking of the hands and feet because Wind governs movement and shaking.)
After sweating or purging, convulsions appear after a long duration. (This is Wind generated by extreme deficiency; treat with modified Xiao Xu Ming Tang [Minor Continuation of Brightness Decoction]). Convulsions appearing not due to sweating or purging. (Treat with Qiang Huo, Fang Feng, Huang Qin, Huang Lian, Tian Ma combined with Si Wu Tang [Four Substances Decoction] etc.). Sweating followed by exposure to wind, with unsmooth flow of sweat, leading to jerking of hands and feet. (Treat with Niu Bang Gen San [Arctium Root Powder]). In Wind-Warmth disease [Feng Wen Bing], if forced by fire therapy, resulting in a slightly yellow complexion and convulsions, (treat with Wei Rui Tang [Polygonatum Decoction]).
The Liver is the organ of Wind and Wood, governing the sinews. When Wind and Fire contend, convulsions are common. One should soothe the Liver and descend Fire, assisted by harmonizing the Blood. If Phlegm is present, Er Chen Tang [Two Old Decoction] with Zhu Li [Bamboo Sap] is primary. If it belongs to deficiency, Bu Zhong Yi Qi Tang [Tonify the Middle and Augment the Qi Decoction] takes precedence. When applying Xiao Xu Ming Tang [Minor Continuation of Brightness Decoction], remove Ma Huang [Ephedrae Herba] if there is sweating, and remove Huang Qin [Scutellariae Radix] if there is no sweating; this is the standard method. If Dai Yan [fixed upward gaze] occurs, with sweat like pearls that coagulate and do not flow, this indicates the exhaustion of the Taiyang channel [Taiyang Jue Ye]. Furthermore, if the four limbs tremble continuously [HT HT - representing tremors], moving incessantly, resembling convulsions but lacking strength for strong jerking, this indicates the exhaustion of the Liver [Gan Jue Ye]. Excessive sweating and purging leading to these changes over a long period are mostly incurable.