凡治五痫,皆随脏治之,每脏各有一兽并,五色丸治其病也。
犬痫∶反折,上窜,犬叫,肝也。
羊痫∶目证,吐舌,羊叫,心也。
牛痫∶目直视,腹满,牛叫,脾也。
鸡痫∶惊跳,反折,手纵,鸡叫,肺也。
猪痫∶如尸,吐沫,猪叫,肾也。
五痫重者死,病后甚者亦死。
面燥腮赤,目胞亦赤,呵欠顿闷,乍凉乍热,咳嗽嚏喷,手足梢冷,夜卧惊悸多睡,并
疮疹证,此天行之病也。惟用温凉药治之,不可妄下及妄攻发、受风冷。
五脏各有一证∶肝脏水 ;肺脏脓 ;心脏斑;脾脏疹;归肾变黑。
惟斑疹病后,或发痫,余疮难发。痫矣,木胜脾,木归心故也。若凉惊,用凉惊丸;
温惊,用粉红丸。
小儿在胎十月,食五脏血秽,生下则其毒当出。故疮疹之状,皆五脏之液。肝主泪,肺
主涕,心主血,脾为裹血。其疮出有五名,肝为水 ,以泪出如水,其色青小。肺为脓 ,如涕
稠浊,色白而大。心为斑,主心血,色赤而小,次于水 。脾为疹,小次斑疮,其主裹血,
故赤色黄浅也。涕、泪出多,故脓 、水 皆大;血营于内,所出不多,故斑疹皆小也。病
者,涕泪俱少,譬胞中容水,水去则瘦故也。
始发潮热三日以上,热运入皮肤,即发疮疹,而不甚多者,热留肤腠之间故也。潮热随
脏出,如早食潮热不已,为水 之类也。
疮疹始发之时,五脏证见,惟肾无候,但见平证耳,KT 凉、耳凉是也。KT 、耳俱属于
肾,
者,死病也。
凡疮疹若出,辨视轻重。若一发便出尽者,必重也;疮夹疹者,半轻半重也;出稀者轻
,里
陷,昏睡,汗出不止,烦躁热渴,腹胀,啼喘,大小便不通者困也。凡疮疹当乳母慎口,不
可令饥及受风冷。必归肾而变黑,难治也。
有大热者,当利小便;有小热者,宜解毒。若黑紫干陷者,百祥丸下之;不黑者慎勿下
。更看时月轻重∶大抵疮疹属阳,出则为顺,故春夏病为顺,秋冬病为逆。冬月肾旺又盛寒,病
多归肾变黑。又当辨春脓 ,夏黑陷,秋斑子,冬疹子,亦不顺也,虽重病犹十活四五。黑
者无问何时,十难救一。其候或寒战噤牙,或身黄肿紫,宜急以百祥丸下之。复恶寒不已
,身冷出汗,耳KT 反热者,死病也。何以然?肾气大旺,脾虚不能制故也。下后身热气温,
欲饮水者可治,以脾土胜肾,寒去而温热也。治之宜解毒,不可妄下,妄下则内虚多归于肾
。若能食而痂头焦起,或未黑而喘实者,可下之。身热,烦渴,腹满而喘,大小便涩,面赤
,闷乱,大吐,此当利小便;不差者,宜宣风散下之。若五七日痂不焦,是内发热,热气蒸
于皮中,故疮不得焦痂也。宜宣风散导之,用生犀磨汁解之,使热不生,必着痂矣。
疮疹由内相胜也,惟斑疹能作搐。疹为脾所生,脾虚而肝旺乘之。木来胜土,热气相击
,动于心神,心喜为热,神气不安,因搐成痫。斑子为心所生,心生热,热则生风,风属于肝,
二脏相搏,风火相争,故发搐也。治之当泻心肝补其母,栝蒌汤主之。
疮黑而急泻,便脓血并痂皮者顺,水谷不消者逆。何以然?且疮黑属肾,脾气本强,或
旧服补脾药,脾气得实,肾虽用事,脾可制之。今疮入腹为脓血及连痂皮得出,是脾强肾退,
即病出而安也。米谷及泻乳不化者,是脾虚不能制肾,故自泄也,此必难治。
凡是治疗五种痫病,都要根据所属脏腑进行辨证施治,每一脏对应一种动物形象,并用五色丸来治疗相应的病症。
犬痫:表现为身体反折向后仰,头部向上窜动,发出像狗一样的叫声,病位在肝。
羊痫:表现为眼睛异常(如直视或上翻),吐出舌头,发出像羊一样的叫声,病位在心。
牛痫:表现为两眼直视,腹部胀满,发出像牛一样的叫声,病位在于脾。
鸡痫:表现为受惊跳跃,身体反折,双手松弛无力,发出像鸡一样的叫声,病位在肺。
猪痫:表现为像死尸一样静止不动,口吐白沫,发出像猪一样的叫声,病位在肾。
五种痫病如果病情严重会致死,病后症状依然严重的也会致死。
面部干燥、两腮发红,眼睑也发红,频繁打哈欠且感到头昏沉重,忽冷忽热,咳嗽打喷嚏,手脚指尖发凉,夜间睡眠时惊悸多梦且嗜睡,这些都是疮疹的证候,属于天行时气致病。对此只能用温和清凉的药物进行治疗,不可随意使用泻下法以及错误的发汗攻邪法,以免遭受风邪寒冷侵袭。
五脏各有其对应的疮疹表现:肝脏对应水疱;肺脏对应脓疱;心脏对应斑;脾脏对应疹;归入肾脏则变为黑色。
只有在斑疹病愈之后,或者发作痫病时,其余部位的疮疹才难以发出。这是因为痫病发作时,肝木之气过盛克制脾土,且肝木之气归于心中所致。如果是凉惊,使用凉惊丸;如果是温惊,使用粉红丸。
小儿在母胎中十月,摄入了五脏的血秽之物,出生后这些毒素应当排出体外。所以疮疹的形态,都是五脏津液的外现。肝主泪,肺主鼻涕,心主血,脾统摄血液。疮疹发出的形态有五种名称:肝对应的水疱,因为泪水流出如水,颜色青而小;肺对应的脓疱,如同鼻涕稠浊,颜色白而大;心对应的斑,主心血,颜色赤红而小,大小次于水疱;脾对应的疹,比斑更小,它主裹血,所以颜色是赤中带黄且浅淡。由于涕、泪排出较多,所以脓疱和水疱都较大;血液营行于体内,排出不多,所以斑和疹都比较小。患病时,如果涕泪俱少,就像胞宫中容纳的水被排空后变得消瘦一样。
刚开始出现潮热三天以上,热气运行到皮肤,就会发出疮疹,如果发得不多的话,是因为热气停留在肤腠之间。潮热随脏腑而出,比如早晨进食后潮热不止,属于水疱一类的情况。
疮疹刚开始发出时,五脏的证候都会显现,只有肾脏没有特定的外候,只见到平和的征象,即尻冷、耳廓发凉就是这种情况。尻部和耳朵都属于肾,如果尻部发热,是死证。
凡是疮疹发出,要辨别视诊轻重。如果一发出来就出尽的,病情必然重;疮与疹夹杂出现的,病情半轻半重;发出稀疏的为轻症;如果疮疹内陷,伴有昏睡、出汗不止、烦躁、发热口渴、腹胀、啼哭喘息、大小便不通的,则为危重症。凡是疮疹期间,乳母必须谨慎饮食,不可让患儿饥饿,也不可让其遭受风冷。如果疮疹最终归入肾脏变为黑色,就很难治疗了。
如果有大热的,应当通利小便;如果有小热的,适宜解毒。如果疮疹呈现黑紫色且干枯内陷的,用百祥丸泻下;如果不黑的,千万不要泻下。还要结合季节判断轻重:大抵疮疹属阳,发出为顺证,所以春夏发病为顺,秋冬发病为逆。冬季肾脏旺盛又寒气盛大,病情多归入肾脏变为黑色。还应当辨别春季多发脓疱,夏季多发黑陷,秋季多发斑子,冬季多发疹子,这些都不顺,虽然病情重,但还有四五成存活率。如果变为黑色的,无论何时发生,十难救一。其症状或有寒战咬牙,或身体发黄肿胀发紫,应当紧急用百祥丸泻下。如果泻下后仍然恶寒不止,身体冰冷出汗,耳廓和尻部反而发热的,是死证。为什么会这样?因为肾气大旺,脾虚不能制约的缘故。泻下后如果身体发热、体温温和、想喝水的,可以治愈,这是脾土胜肾,寒气去除而转为温热的缘故。治疗宜解毒,不可妄用泻下,妄用泻下会导致内虚,病邪多归于肾。如果能进食且痂皮焦起,或者尚未变黑但气喘实证的,可以泻下。如果身体发热,烦渴,腹部胀满而喘,大小便涩滞,面红,闷乱,大吐,这应当通利小便;不好的话,宜用宣风散泻下。如果五七天后痂皮不焦,是内部发热,热气蒸腾于皮肤之中,所以疮疹不能形成焦痂。宜用宣风散导滞,用生犀角磨汁解毒,使热气不生,必定能结痂。
疮疹是由内脏相互克制产生的,只有斑疹能引起抽搐。疹由脾所生,脾虚则肝旺乘之。木来克土,热气相击,扰动心神,心喜热,神气不安,因而抽搐形成痫病。斑由心所生,心生热,热则生风,风归属于肝,两脏相搏,风火相争,所以发生抽搐。治疗应当泻心肝、补其母脏,以栝蒌汤为主方。
疮疹变黑而急泻,排出脓血并连带痂皮的为顺证,排出米谷及未消化的乳汁的为逆证。为什么这样说?况且疮疹变黑属肾,脾气本来强盛,或者以前服用过补脾药,脾气得实,即使肾气当令,脾也能制约它。现在疮疹入腹化为脓血并连着痂皮排出,这是脾强肾退,病邪外出而安宁。如果米谷及泻下的乳汁不消化,这是脾虚不能制约肾,所以自泄,这种情况一定难治。
Whenever treating the five types of epilepsy (Xian Bing), treatment should follow the affected Zang organ. Each Zang corresponds to a specific animal, and the Five-Color Pills (Wu Se Wan) are used to treat the respective condition.
Canine Epilepsy (Gou Xian): Characterized by opisthotonos (body arching backward), upward head movement, and barking sounds; the pathology is in the Liver.
Ovine Epilepsy (Yang Xian): Characterized by eye abnormalities (such as staring or rolling up), tongue protrusion, and bleating sounds; the pathology is in the Heart.
Bovine Epileshi (Niu Xian): Characterized by fixed staring, abdominal distension, and mooing sounds; the pathology is in the Spleen.
Gallus Epilepsy (Ji Xian): Characterized by startle jumps, opisthotonos, flaccid hands, and crowing sounds; the pathology is in the Lung.
Porcine Epilepsy (Zhu Xian): Characterized by a corpse-like stillness, foaming at the mouth, and grunting sounds; the pathology is in the Kidney.
Severe cases of the five epilepsies result in death, as do cases where symptoms remain severe after the illness has passed.
Dry face with red cheeks and red eyelids, frequent yawning accompanied by drowsiness and heaviness, alternating chills and fever, coughing and sneezing, cold fingertips, night-time restlessness with palpitations and excessive sleepiness—these are all signs of variola/varioliform eruptions (Chuang Zhen). This is a disease caused by epidemic pathogenic factors (Tian Xing). Treatment should only employ mild cooling herbs; one must not recklessly use purgatives or incorrect diaphoretic methods, nor allow exposure to wind and cold.
Each Zang organ has its corresponding eruption manifestation: The Liver manifests as vesicles (Shui Pao); the Lung as pustules (Nong Pao); the Heart as macules (Ban); the Spleen as papules (Zhen); and if it enters the Kidney, it turns black.
Only after the recovery from macular/papular eruptions, or during an epileptic seizure, do other eruptions fail to emerge. This is because during seizures, Wood (Liver) overacts on Earth (Spleen), and Wood Qi returns to the Heart. For cold-type fright, use Liang Jing Wan (Cooling Fright Pill); for warm-type fright, use Fen Hong Wan (Pink Pill).
During the ten months in the womb, the infant consumes the blood impurities of the five Zang organs. After birth, these toxins must be expelled. Thus, the forms of eruptions represent the fluids of the five Zang organs. The Liver governs tears; the Lung governs nasal mucus; the Heart governs blood; the Spleen envelops/controls blood. There are five named eruption types:
1. Liver-related Vesicles (Shui Pao): Like tears flowing like water, small in size and greenish in color.
2. Lung-related Pustules (Nong Pao): Like thick, turbid nasal mucus, large in size and white in color.
3. Heart-related Macules (Ban): Governing heart blood, small in size, reddish in color, smaller than vesicles.
4. Spleen-related Papules (Zhen): Smaller than macules, governing enveloped blood, thus yellowish-red and pale.
Since nasal mucus and tears discharge in larger quantities, pustules and vesicles are larger. Blood circulates internally and discharges less, so macules and papules are smaller. If a patient has little nasal mucus or tears, it is akin to a bladder emptied of water becoming shrunken.
Initially, tidal fever lasts for more than three days. When heat travels to the skin, eruptions appear. If few appear, it is because heat remains between the skin and interstices. Tidal fever emerges according to the Zang organ; for instance, persistent tidal fever after morning meals indicates the vesicle type.
At the onset of eruptions, manifestations of the five Zang organs appear, except for the Kidney, which shows no specific external sign but rather a normal state, specifically coldness at the sacrum (Kun) and ears. Both the sacrum and ears belong to the Kidney. If the sacrum becomes hot, it is a fatal sign.
When eruptions appear, assess their severity. If they erupt fully at once, the condition is severe. If eruptions and rashes are mixed, the condition is moderate. Sparse eruptions indicate mildness. Internal sinking of eruptions accompanied by lethargy, profuse sweating, irritability, fever, thirst, abdominal distension, crying, wheezing, and obstruction of urination and defecation indicates critical danger. During eruptions, the nursing mother must control her diet; the infant must not go hungry nor be exposed to wind and cold. If eruptions turn black upon entering the Kidney, they are difficult to treat.
For high fever, promote urination; for low fever, resolve toxicity. If eruptions are dark purple, dry, and sunken, purge with Baixiang Wan (Hundred Auspicious Pills); if not dark, do not purge. Consider the season: Eruptions are Yang in nature; emergence is favorable (Shun). Thus, spring/summer onset is favorable, while autumn/winter onset is unfavorable (Ni). In winter, when Kidney Qi is strong and cold is severe, eruptions often turn black in the Kidney. Differentiate seasonal patterns: spring pustules, summer black sunken eruptions, autumn macules, winter papules—all are unfavorable. Even in severe cases, 40-50% may survive. Black eruptions are fatal regardless of season, with only 1 in 10 surviving. Symptoms may include chills with teeth grinding, yellowish-purple swelling. Urgently purge with Baixiang Wan. If chills persist after purging, body becomes cold with sweating, and ears/sacrum become hot, it is fatal. Why? Because Kidney Qi is excessively strong, and Spleen deficiency fails to control it. If after purging, the body is warm, temperature is mild, and thirst for water exists, it is curable; this indicates Spleen Earth overcoming Kidney Water, removing cold and restoring warmth. Treatment should focus on resolving toxicity, avoiding reckless purging, which causes internal deficiency allowing pathogens to retreat to the Kidney. If the patient can eat and scabs form and crust over, or if not yet black but with excess asthma, purging is appropriate. For fever, irritability, thirst, abdominal distension with asthma, obstructed urination/defecation, red face, confusion, and vomiting, promote urination. If ineffective, use Xuan Feng San (Disperse Wind Powder) to purge. If scabs do not crust over after 5-7 days, it is due to internal heat steaming the skin, preventing crusting. Use Xuan Feng San to guide out stagnation, and apply fresh Rhinoceros Horn Decoction (Xi Jiao) to resolve heat, ensuring heat does not proliferate and scabs form.
Eruptions arise from internal mutual overaction; only macules/papules cause convulsions. Papules are generated by the Spleen; Spleen deficiency allows Liver Wood to invade. Wood overcoming Earth, with heat clashing, disturbs the Heart Spirit. The Heart delights in heat, causing spiritual unrest, leading to convulsions and epilepsy. Macules are generated by the Heart; Heart heat generates wind, which belongs to the Liver. The two Zang organs contend, wind and fire clash, causing convulsions. Treatment requires draining Heart and Liver and tonifying their mothers, primarily using Gualou Tang (Trichosanthes Decoction).
If eruptions turn black and purging results in pus/blood and scabs, it is favorable (Shun). If undigested food/grain is discharged, it is unfavorable (Ni). Why? Black eruptions belong to the Kidney. If Spleen Qi is originally strong, or if spleen-tonifying herbs were previously taken, Spleen Qi is solid. Even if Kidney Qi is active, Spleen can control it. Now, if eruptions enter the abdomen, transform into pus/blood, and exit with scabs, it indicates Spleen strength overcoming Kidney retreat, meaning the pathogen exits and peace is restored. If rice/grain and milk are un-digested in diarrhea, it indicates Spleen deficiency failing to control Kidney, resulting in spontaneous diarrhea; this is difficult to treat.