小儿惊痫发搐。有切牙不休。及未发、发过时亦常切牙者。予在行朝。有李统制一子。病证如是。遂请众医
询治。有言是惊入于肾者。此乃乔岳汉东王先生歌中睡里切牙惊入肾之句。其意谓牙为骨。骨入肾。故以言之。
此常流无据语也。古书无有。亦无惊入肾之理。果用药无验。今详校其证。特为明之。乃足阳明之病也。足阳明
为胃之经。起鼻交额。循鼻外。入上齿中。还出侠口。环唇。下交承浆。过颐后。出大迎。循颊车。且发搐为
风。风属木。胃属土。木能刑土。是以牙齿受风则痒。颊车邪干则紧。故使切牙不休。以缓颊车之急。以解牙齿
之痒也。(治当去胃中风)
暗痫其病似惊痫。又似中风 病。遇其发时。则暗地急。至令人僵仆。心神昏塞。志意迷闷。气乱不省。手
足弹拨。战掉搐搦。喉中涎响。或吐痰沫。或作吼叫。其脉三部阴阳俱盛。每发远则终日或半日。近则一两时
辰。发过便起。却如不病之人。俗呼谓之痫病。稍轻者谓之暗风。古人又云。小者发则为惊。大者发则为痫。小
者气血怯嫩。发即难当而伤多。大者气血壮盛。发即易任而失少。
小儿惊痫搐搦。至发定之后。有诸余证不退者。虽大势已罢。而病本尚在。或服冷热药过多。或汗下之失
宜。故痫搐难退。而有余证也。
小儿惊痫发作时出现抽搐,伴有牙齿咬合不止的情况;以及在未发作或发作过后,也常常出现牙齿咬合的现象。我在京城任职期间,有一位李统制的儿子,患病症状正是如此。于是请众多医生询问治疗方案。有人说这是“惊邪入肾”,这其实是引用乔岳汉东王先生歌诀中“睡里切牙惊入肾”这一句。其意思是说牙齿属于骨,骨归属于肾,所以这样说。这是通常流传的没有根据的说法,古书中并无记载,也没有惊邪入肾的道理。果然用药无效。如今详细考证其证候,特意阐明其理,这实际上是足阳明胃经的病证。足阳明胃经,起于鼻翼旁交于额部,沿鼻外侧下行,进入上齿中,复出环绕口唇,向下交会于承浆穴,经过下颌后部,出于大迎穴,沿颊车穴上行。而且抽搐属于风邪,风在五行中属木,胃属土,木能克土(刑伤脾土),因此牙齿受风邪侵袭则发痒,颊车部位受邪气干扰则拘紧,从而导致牙齿咬合不止。治疗应当去除胃经中的风邪,以缓解颊车的紧急状态,解除牙齿的瘙痒。(治当去胃中风)
暗痫这种病看起来像惊痫,又有点像中风病。等到发作的时候,患者会突然昏倒在地上,甚至令人僵直仆倒,心神昏乱闭塞,意志迷闷,气机紊乱而不省人事,手足弹动拨弄,颤抖抽搐,喉中有痰鸣声,或者吐出痰沫,或者发出吼叫声。其脉象三部阴阳俱盛。每次发作间隔远的则整天或半天,近的则一两个时辰,发作过后便苏醒起来,却像没病的人一样。俗称为痫病,病情稍轻的称为暗风。古人又说:小儿发病称为惊,成人发病称为痫。小儿气血怯弱稚嫩,发病时难以承受而损伤较多;成人气血壮盛,发病时容易承受而损失较少。
小儿惊痫抽搐,到了发作停止之后,仍有其他余证不退的情况。虽然大势已平息,但病根尚存。或者是服用冷药、热药过多,或者是汗法、下法使用不当,导致痫证抽搐难以消退,从而留下余证。
Pediatric convulsive epilepsy presents with twitching accompanied by unceasing teeth grinding. Even when not in an attack or after the attack has passed, teeth grinding often persists. While serving in the capital, I encountered a case where the son of Commander Li suffered from these exact symptoms. Consequently, many physicians were consulted for treatment advice. Some claimed this was "fright invading the Kidney," citing a line from Mr. Wang's song: "Teeth grinding in sleep indicates fright invading the Kidney." The reasoning is that teeth are considered bone, and bone belongs to the Kidney; hence the statement. This is a common but unfounded rumor. It appears in no ancient texts, nor is there any pathological basis for "fright invading the Kidney." Indeed, the medication proved ineffective. Upon detailed examination of the syndrome, it is clarified here that this is actually a disease of the Foot-Yangming Stomach Meridian. The Foot-Yangming Stomach Meridian originates at the side of the nose, crosses the forehead, runs along the lateral aspect of the nose, enters the upper gums, emerges to encircle the lips, descends to intersect at Chengjiang (CV24), passes behind the chin, emerges at Daying (ST5), and follows the Jiache (ST6) region. Furthermore, twitching is attributed to Wind pathogen. In the Five Elements theory, Wind corresponds to Wood, while the Stomach corresponds to Earth. Wood controls (or penalizes) Earth. Therefore, when teeth are affected by Wind, they feel itchy; when the Jiache area is disturbed by evil Qi, it becomes tight. This causes unceasing teeth grinding. Treatment should aim to eliminate Wind from the Stomach meridian, thereby relieving the tension in Jiache and resolving the itching in the teeth. (Treatment should remove Wind from the Stomach)
An-Xian (Dark Epilepsy) resembles Convulsive Epilepsy and also mimics Stroke. During an attack, the patient suddenly collapses into darkness, sometimes falling stiffly. The mind and spirit become confused and blocked, consciousness is lost, qi mechanism is chaotic, and limbs may flicker or tremble with spasms. There is phlegm-rattle in the throat, possibly with expectoration of frothy sputum or roaring sounds. The pulse is vigorous in all three positions (Cun, Guan, Chi) with both Yin and Yang aspects appearing excess. The interval between attacks varies: distant intervals last half a day to a full day, while close intervals last one to two shichen (two to four hours). After the attack subsides, the patient recovers immediately, appearing as if healthy. Commonly called Epilepsy (Xian-Bing), milder cases are referred to as An-Feng (Dark Wind). Ancient texts state: pediatric onset is termed Jing (Fright/Convulsion), while adult onset is termed Xian (Epilepsy). Children have weak and tender Qi and Blood; thus, attacks are hard to endure and cause significant damage. Adults have robust Qi and Blood; thus, attacks are easier to bear and result in less loss.
After pediatric convulsive epilepsy ceases, various residual symptoms may persist. Although the major crisis has subsided, the root pathology remains. This can be due to excessive administration of cold or hot medicines, or improper use of sweating (Han) or purging (Xia) methods, leading to difficulty in resolving the epilepsy and twitching, leaving behind residual syndromes.