经云∶热生风。因时火盛而作(不知此火,何由而盛)。盖东方之震木,得火气而发搐(此处不言肝风心火作
搐,硬说为少阳相火作搐,但闻雷得火而丰,未闻震得火而搐。杜撰)。
有曰∶身热脉浮,精神恍惚,或吐泻不思乳食,发搐,即半阴半阳合病(身热脉浮,外感风寒也;吐泻兼
作,内伤饮食也。但曰外感内伤足矣,何必曰半阴半阳?原其意,不过以身热脉浮属太阳,吐泻属阳明太阴。
凡幼科所言者,无非心肝脾之脏病,若曰外感内伤,则惊风痰热之证,何处安顿,岂不自呈败露乎)。身热脉
沉,精神倦怠,或吐不泻,又有乳食发搐,亦半阴半阳合病(身热脉沉属太阴,但吐不泻属阳明,明是阳明伤
食,太阴受寒,显然夹食伤寒,偏不明言。悲哉)。
有曰∶亦有急惊,凉泻而不愈,或与吐下药太过,变为慢惊者(此等之言,益见背谬。诸书以急惊为阳,
为实热,既是急惊,则用凉泻无疑,何以不愈?盖因误以伤寒表证
为急惊,所以不愈也。既凉泻不愈,则认证不确,自应愧悔,何昧焉不察,而更用吐下之药乎?凉泻一误,吐
下再误,而不变为坏证者,未之有也。非病之能变,由医变之也);又有慢惊补温而不愈,变为急惊者(幼科
疏忽,于此数语,尽见底里。既以脾虚阴寒为慢惊,则用温补,适为恰当。今不特不愈,反加变证,盖误以伤
风自汗为慢惊,不知此证本有风邪在表,正宜解肌,今误用温补而致变,偏不言错认病源,误用反药,而曰病
变急惊,即至于死,亦曰病变于死,与医何涉?可谓善为说辞者矣)。
有曰∶病有阴阳,急惊风属热,病在心肝二脏,谓之阳痫;慢惊风属虚寒,病在脾肺二脏,谓之阴痫,此
以寒热分阴阳也(以寒热分阴阳,虽曰牵强,犹可混赖;以心肝二脏主阳痫,不通)。五脏属阴,六腑属阳,
急惊发于六腑为易治,慢惊发于五脏为难治。此以脏腑分阴阳也(上节言急惊属实热,病在心肝二脏;慢惊属
虚寒,病在脾肺二脏。此以急慢二惊,皆属五脏也明矣,与六腑无涉。下节即云急惊发于六腑,慢惊发于五脏,
是又以脏腑均有惊风也。夫六腑者,膀胱、胃、胆、小肠、大肠、三焦,六经是也。其六经证治,轻重不等,
理应指明急惊发于何腑。五脏者,心、肝、脾、肺、肾,五经是也。其五经证治,贵贱不同,理应指明慢惊
发于何脏,后人始有实据。今竟不指明,第泛言急惊发六腑,慢惊发五脏。岂急惊之来,六腑齐病,应用六经
之药治之乎;慢惊之至,五脏均伤,应用五经之药治之乎?必无是理。若以上节心肝脾肺之言为是,则与下节
六腑五脏不相侔矣;若以下节六腑五脏之言为是,则与上节心肝阳痫,脾肺阴痫,相矛盾矣。盖腑脏关乎表里,
岂容混称!如腑为表,脏为里,表病不可治里,里病不可治表,不易之规,以其阴阳不同,内外自别,不可误
治者也。今详前说,既惊风之属脏属腑者,已无定论,而临证之治表治里者,安有成规?吾
恐其李帽张戴,势所不免。如前诸家之论,非但脏腑混淆,表里不辨,而反多增名色,眩人心目,曰风、曰痰、
曰惊、曰吓、曰火、曰热、曰血虚、曰木急、曰相火、曰阴火、曰外感、曰内伤、曰喜怒、曰乳哺、曰阳盛、
曰阴虚、曰属腑、曰属脏,究于惊风二字,毫无着落。其论证如此支离,治疗何能不误,不为规正,其害岂胜
言哉)。
诸家之说,已见于前,种种不经,殊难尽述。夫古哲立言,自有定理。如仲景伤寒六经,表里汗下和温,井
然不乱,孰敢妄赞一辞!独此惊风之说,纷纭鼎沸,莫可究诘。医事动关生命,岂容混乱经常,不特来学无归,
练达者难言不惑。予因不辞狂悖,易去惊风字样,庶知病各有名,治无致误,在医者俾不致入海求蟾,病者亦可
以鉴车易辙矣。
《黄帝内经》说:“热极生风。”这是因时令之火过盛而引发的(却不探究这火究竟是如何过盛的)。大概东方震卦属木,得到火气就会发生抽搐(这里不提肝风和心火导致抽搐,硬说是少阳相火导致抽搐,只听说打雷得火气而丰盛,没听说过震卦得火气就抽搐。纯属杜撰)。
有人说:“身体发热、脉象浮,精神恍惚,或者呕吐腹泻、不想吃奶进食,出现抽搐,这就是半阴半阳的合病(身体发热、脉象浮,是外感风寒;呕吐腹泻同时发生,是内伤饮食。只要说外感和内伤就够了,何必说是半阴半阳?推究其本意,不过是把身热脉浮归为太阳病,吐泻归为阳明和太阴病。凡是儿科所说的,无非是心、肝、脾三脏的病,如果说只是外感和内伤,那么惊风、痰热这些证候该放在哪里呢?岂不是自露破绽吗)。”又说:“身体发热、脉象沉,精神倦怠,或者只吐不泻,又有吃奶后引发抽搐,也是半阴半阳的合病(身热脉沉属于太阴病,但只吐不泻属于阳明病,明明是阳明伤食、太阴受寒,显然是夹食伤寒,偏偏不明说。可悲啊)。”
有人说:“也有急惊风,用凉泻法治疗却不愈,或者因为使用吐下法太过,转变为慢惊风的(这种说法,更加显得荒谬背理。各种医书将急惊风定为阳证、实热证,既然是急惊风,那么用凉泻法毫无疑问是正确的,为什么治不好?这是因为误把伤寒表证当作急惊风,所以治不好。既然凉泻法无效,说明辨证不准确,医生本该感到羞愧后悔,为何还昏昧不清,反而继续使用吐下药物呢?凉泻是一误,吐下又是再误,如果不变成坏证,是没有这样的事。不是病自己变化,而是医生把它治变了);又有慢惊风,用温补法治疗却不愈,转变为急惊风的(儿科医生疏忽大意,从这几句话就能看出他们的底细。既然认为脾虚阴寒是慢惊风,那么用温补法,正合适。现在不仅没好,反而增加变证,这是因为误把伤风自汗当作慢惊风,不知道这个证候本来有风邪在体表,正应该解肌发表,现在误用温补而导致变化,偏偏不说错认病源、误用反药,而说是病变成了急惊风,即使因此死亡,也说是病自然演变致死,与医生有什么关系?真可以说是善于狡辩的人了)。”
有人说:“疾病有阴有阳,急惊风属于热证,病在心、肝两脏,称为阳痫;慢惊风属于虚寒证,病在脾、肺两脏,称为阴痫,这是以寒热来分阴阳的(以寒热分阴阳,虽然说是牵强附会,还可以勉强混过去;但说心肝两脏主掌阳痫,就不通了)。”“五脏属阴,六腑属阳,急惊风发于六腑容易治疗,慢惊风发于五脏难以治疗。这是以脏腑来分阴阳的(上一节说急惊属实热,病在心肝两脏;慢惊属虚寒,病在脾肺两脏。这说明急惊和慢惊都归属于五脏,与六腑无关。下一节却说急惊发于六腑,慢惊发于五脏,这又意味着脏腑都有惊风。所谓六腑,是指膀胱、胃、胆、小肠、大肠、三焦,也就是六经。它们的六经证治,轻重不等,理应指明急惊发于哪一个腑。所谓五脏,是指心、肝、脾、肺、肾,也就是五经。它们的五经证治,贵贱不同,理应指明慢惊发于哪一个脏,后人要有确凿证据才能这样说。现在竟然不指明,只是泛泛地说急惊发于六腑,慢惊发于五脏。难道急惊发作时,六腑全部生病,要应用六经的药物来治疗吗?慢惊到来时,五脏都受伤,要应用五经的药物来治疗吗?必定没有这个道理。如果以上一节中心、肝、脾、肺的说法是对的,那就与下一节的六腑、五脏不相符合;如果以下一节六腑、五脏的说法是对的,那就与上一节的心肝阳痫、脾肺阴痫相矛盾。大概腑与脏关乎表与里,怎么可以混淆称呼!如果腑代表表,脏代表里,表病不可治里,里病不可治表,这是不可改变的原则,因为它们阴阳不同,内外自然有别,不能误治。现在详细考察前面的说法,既然惊风属于脏还是属于腑已经没有定论,那么临证时治疗表还是治疗里,又怎么会有固定的规矩?我恐怕他们这种李戴张冠的情况,是势所难免的。像前面各位医家的论述,不仅脏腑混淆,表里不辨,反而增添许多名目,迷惑人的视线,说什么风、痰、惊、吓、火、热、血虚、木急、相火、阴火、外感、内伤、喜怒、乳哺、阳盛、阴虚、属腑、属脏,最终对于‘惊风’这两个字,毫无着落。他们的论证如此支离破碎,治疗怎么可能不误人子弟?如果不加以纠正,其危害岂能说得完呢)。”
各位医家的说法,前面已经提到,种种不经之谈,很难一一叙述。古代圣贤确立言论,自有定理。比如张仲景的伤寒六经理论,表、里、汗、下、和、温,井然有序不乱,谁敢随意增减一个字!唯独这惊风的说法,纷纭鼎沸,无法追究到底。医事关系生命,怎么容许混乱常规,这不仅让初学者无所适从,即使是经验丰富的医生也难以做到不被迷惑。我不辞狂妄悖逆,去掉‘惊风’这个字样,希望知道疾病各有名称,治疗才不会出错,使医生不至于入海求蟾蜍(比喻徒劳无功或方向错误),病人也可以鉴前车之覆,改换车道了。
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: "Heat generates wind." This occurs due to the excessive fire of the season (without inquiring how this fire becomes excessive). It is said that the Zhen Wood of the East, receiving fire energy, causes convulsions (here, it does not mention liver wind or heart fire causing convulsions, but insists on Shaoyang ministerial fire causing convulsions; one hears of thunder bringing abundance with fire, but never of the Zhen trigram causing convulsions with fire. Pure fabrication).
Some say: "Body heat and floating pulse, mental confusion, or vomiting and diarrhea with loss of appetite for milk and food, accompanied by convulsions, constitute a combined disease of half-Yin and half-Yang (body heat and floating pulse indicate external contraction of wind-cold; simultaneous vomiting and diarrhea indicate internal injury from diet. It suffices to say external contraction and internal injury; why call it half-Yin and half-Yang? Investigating the intent, it merely attributes body heat and floating pulse to Taiyang disease, and vomiting/diarrhea to Yangming and Taiyin diseases. Everything pediatrics discusses pertains only to diseases of the Heart, Liver, and Spleen organs. If one says it is merely external contraction and internal injury, where do conditions like fright-wind, phlegm-heat belong? Would they not expose their own flaws?). Another says: 'Body heat and deep pulse, mental fatigue, or vomiting without diarrhea, and convulsions triggered by feeding, are also combined diseases of half-Yin and half-Yang (body heat with deep pulse belongs to Taiyin; vomiting without diarrhea belongs to Yangming. Clearly, this is Yangming food retention complicated by Taiyin cold, obviously wind-cold with food retention, yet deliberately left unspoken. How sad).'
Some say: "There are cases of Ji Jing (Acute Fright-Wind/Convulsion) that do not improve with cooling purgatives, or transform into Man Jing (Chronic Fright-Wind/Convulsion) due to excessive use of emetic and purgative drugs (Such statements further reveal absurdity. Medical texts classify Ji Jing as Yang and excess-heat. Since it is Ji Jing, cooling purgatives are undoubtedly correct; why would it fail? This is because the exterior syndrome of Shanghan (Cold Damage) was mistaken for Ji Jing, hence the failure. Since cooling purgatives failed, indicating inaccurate diagnosis, the physician should feel ashamed and repent. Why remain ignorant and continue using emetics and purgatives? A mistake with cooling purgatives followed by another with emetics/purgatives inevitably leads to a deteriorated condition (Huai Zheng). It is not the disease that changes, but the doctor who changes it); there are also cases of Man Jing that do not improve with warming tonification, transforming into Ji Jing (Pediatricians' negligence is fully exposed in these few sentences. If Spleen deficiency and Yin-cold are considered Man Jing, then warming tonification is appropriate. Now, not only does it fail, but complications arise. This is because wind-cold with spontaneous sweating was mistaken for Man Jing. Ignoring that wind-pathogen remains at the exterior, which requires releasing the muscle layer, the erroneous use of warming tonification caused transformation. Yet, instead of admitting misidentifying the disease source and using contrary remedies, they claim the disease transformed into Ji Jing. Even if death results, they attribute it to natural disease progression, absolving the doctor. Truly skilled at making excuses)."
Some say: "Diseases have Yin and Yang aspects. Ji Jing belongs to heat and affects the Heart and Liver, called Yang Xian (Yang Epilepsy); Man Jing belongs to deficiency-cold and affects the Spleen and Lung, called Yin Xian (Yin Epilepsy). This divides Yin/Yang based on cold/heat (Dividing Yin/Yang by cold/heat is forced but passable; claiming Heart/Liver govern Yang Xian is incorrect). The Five Zang organs are Yin, the Six Fu organs are Yang. Ji Jing originating in the Six Fu is easy to treat; Man Jing originating in the Five Zang is difficult to treat. This divides Yin/Yang based on Zang/Fu (The previous section stated Ji Jing is excess-heat affecting Heart/Liver; Man Jing is deficiency-cold affecting Spleen/Lung. Thus, both acute and chronic convulsions belong to the Five Zang, unrelated to the Six Fu. The next section claims Ji Jing originates in the Six Fu and Man Jing in the Five Zang, implying both Zang and Fu suffer from convulsions. The Six Fu are Bladder, Stomach, Gallbladder, Small Intestine, Large Intestine, Sanjiao, corresponding to the Six Channels. Their treatments vary in severity; one should specify which Fu organ is affected by Ji Jing. The Five Zang are Heart, Liver, Spleen, Lung, Kidney, corresponding to the Five Channels. Their treatments vary in importance; one should specify which Zang organ is affected by Man Jing, requiring solid evidence from later scholars. Now, no specification is made, only generalizations that Ji Jing affects the Six Fu and Man Jing the Five Zang. Does Ji Jing imply all Six Fu are diseased, requiring medicines of all Six Channels? Does Man Jing imply all Five Zang are injured, requiring medicines of all Five Channels? Surely not. If the previous statement about Heart/Liver/Spleen/Lung is correct, it contradicts the Six Fu/Five Zang statement below; if the Six Fu/Five Zang statement is correct, it contradicts the Heart/Liver Yang Xian and Spleen/Lung Yin Xian above. Fu and Zang relate to Exterior and Interior; they cannot be confused! If Fu represents Exterior and Zang Interior, treating Interior for Exterior disease, or Exterior for Interior disease, violates immutable rules, as Yin/Yang differ and Interior/Exterior are distinct, preventing mis-treatment. Examining the previous arguments, since there is no fixed conclusion on whether convulsions belong to Zang or Fu, how can there be standard rules for treating Exterior vs. Interior in clinical practice? I fear such confusion of roles (Li Mao Zhang Dai) is inevitable. The aforementioned theories not only confuse Zang/Fu and fail to distinguish Interior/Exterior, but also add numerous terms confusing the mind: Wind, Phlegm, Fright, Shock, Fire, Heat, Blood Deficiency, Wood Urgency, Ministerial Fire, Yin Fire, External Contraction, Internal Injury, Joy/Anger, Feeding, Yang Excess, Yin Deficiency, Belonging to Fu, Belonging to Zang. Ultimately, none of this clarifies the concept of 'Fright-Wind'. Such fragmented reasoning makes treatment bound to err. Without correction, the harm is incalculable)."
The theories of various schools have been mentioned previously; their many baseless claims are hard to recount completely. Ancient sages established doctrines with clear principles. For instance, Zhang Zhongjing’s Six Channels of Shanghan are orderly, distinguishing Exterior, Interior, Sweating, Purging, Harmonizing, and Warming, leaving no room for arbitrary alteration. Yet, the theory of Fright-Wind is chaotic and uproarious, impossible to trace to its root. Medicine concerns life itself; how can norms be allowed to become chaotic? This leaves beginners without guidance and even experienced physicians struggling to remain unconfused. Therefore, disregarding accusations of arrogance, I remove the term "Fright-Wind," hoping that knowing diseases have specific names prevents treatment errors. May physicians avoid futile efforts (seeking toads in the sea), and may patients learn from others' mistakes to change their course.