惊风八候搐搦掣,颤反引窜视之名,肘臂伸缩名为搐,十指开合搦状成,势若相扑谓之掣,颤则头肢动摇铃,反张
身仰头向后,引状两手若开弓,窜则目直常似怒,视则睹物不转睛,内外左右分顺逆,须识急慢证皆同。
【注】八候,谓搐、搦、掣、颤、反,引、窜、视是也。搐谓肘臂伸缩,搦谓十指开合,
掣谓肩头相扑,颤谓手足动摇,反者身仰向后,引者手若开弓,窜则目直而似怒,视则
睛露而不活。其搐以男左手女右手,男大指在外、女大指在内为顺,反是为逆,此候急
惊、慢惊同皆见之,虚实无所异焉,治者宜切记之。
惊风搐搦神昏愦,痰壅气塞在心胸,急用通关吹入鼻,无嚏则死有嚏生。
【注】惊风搐搦,必神气昏愦,皆由痰壅气塞,壅结胸中而致。急用通关散吹入鼻内,
无嚏者不治;有嚏者,审其表里、虚实随证治之。
通关散
半夏(生) 皂角 细辛 薄荷(各等分)
共为细末,用笔管吹入鼻内少许。
急惊触异心惊热,或由风郁火生风,暴发痰盛或热极,壮热烦急面唇红,痰壅气促牙关噤,二便秘涩脉数洪,惊用
镇惊风至宝,牛黄攻痰凉膈清,平治羌活泻青
等,化痰导赤共凉惊。
【注】急惊风一证,有因目触异物,耳闻异声,神散气乱而生者;有因心肝火盛,外
为风寒郁闭,不得宣通而生者;有因痰盛热极而内动风者。然证多暴发壮热,烦急,面
红,唇赤,痰壅气促,牙关噤急,二便秘涩。噤急者,齿紧急不能开也。二便秘涩者,大
便秘结而小便涩难也。脉洪数者,主阳热也。触异致惊者,清热镇惊汤。安神镇惊丸主之;
火郁生风者,至宝丹主之;痰盛生惊者,牛黄丸攻下之;热极生风者,凉膈散清解之;病
不甚者,则用平治之法。风热者,羌活散主之;肝热者,泻青丸主之;痰兼热者,清热
化痰汤主之;心经热者,导赤散、凉惊丸主之。惟在临证者审而用之。
清热镇惊汤
柴胡 薄荷 麦冬(去心) 栀子 龙胆草 川黄连 茯神 钓藤钩 甘草(生) 木通
引用灯心、竹叶,调朱砂末服。
【方歌】清热镇惊治外惊,柴胡薄荷麦门冬,栀子黄连龙胆草,茯神钩藤草木通。
安神镇惊丸
天竺黄 茯神(各五钱) 胆星 枣仁(炒) 麦冬(去心) 赤芍 当归(各三钱) 薄荷叶 黄
连辰砂 牛黄 栀子 木通 龙骨( ,各三钱) 青黛(一钱)
上为细末,炼蜜丸如绿豆大,赤金铂为衣,量儿大小与之,淡姜汤化下。
至宝丹
麻黄 防风 荆芥 薄荷 当归 赤芍 大黄 芒硝 川芎 黄芩 桔梗 连翘(去心) 白术(土
炒) 栀子 石膏( ) 甘草(生) 滑石 全蝎(去毒) 细辛 天麻 白附子 羌活 僵蚕(炒) 川连 独活 黄
柏(各等分)
上共为细末,炼蜜为丸,每丸重五分,量儿大小与之,姜汤化下。
牛黄丸
黑牵牛 白牵牛(各七钱半) 胆星 枳实(麸炒) 半夏(姜制,各五钱) 牙皂(去皮弦,二钱)
大黄(一两半)
研极细末,炼白蜜为丸,重五分,量儿大小与之,姜汤化下。
凉膈散
黄芩 大黄 连翘(去心) 芒硝 甘草(生) 栀子 薄荷
引用竹叶、生蜜,煎服,无汗者加防风、羌活。
【方歌】凉膈散治膈热盛,栀翘芩薄芒硝黄,便秘硝黄加倍用,无汗更加羌活防。
羌活散
羌活 防风 川芎 薄荷 天麻 僵蚕(炒) 甘草(生) 川黄连 柴胡 前胡 枳壳(麸炒) 桔
梗
引用生姜,水煎服。
【方歌】羌活散风兼清热,羌防川芎薄荷叶,天麻僵蚕草黄连,柴胡前胡枳壳桔。
泻青丸
龙胆草(焙) 栀子 大黄(煨) 羌活 防风(各一钱) 川芎(钱半)
上研末,炼蜜为丸,如梧桐子大,竹叶薄荷汤调下。
清热化痰汤
橘红 麦冬(去心) 半夏(姜制) 赤苓 黄芩 竹茹 甘草(生) 川连 枳壳(麸炒) 桔
梗胆星
引用生姜、灯心,水煎服。
【方歌】清热化痰有橘红,麦冬半夏赤茯苓,黄芩竹茹生甘草,川连枳桔胆南星。
泻心导赤汤(方见木舌)
凉惊丸
龙胆草 防风 青黛(各三钱) 钓藤钩(二钱) 黄连(五钱) 牛黄(一钱)
上为细末,面糊为丸,如粟米大,量儿大小与之,金器煎汤化下。
惊风八候是指搐、搦、掣、颤、反、引、窜、视这八种症状名称。肘臂伸缩的动作称为“搐”,十指开合的状态称为“搦”,势态如同相扑般的动作称为“掣”,头部和肢体像摇铃一样抖动的状态称为“颤”,身体后仰头向后仰的姿态称为“反”,双手张开如同拉弓的姿态称为“引”,眼睛直视常似愤怒的状态称为“窜”,注视物体时眼球不转动的状态称为“视”。内外左右分为顺证和逆证,必须识别急惊风和慢惊风的证候表现是相同的。
【注】八候,指的是搐、搦、掣、颤、反、引、窜、视。搐是指肘臂的伸缩,搦是指十指的开合,掣是指肩头相互扑击(形容肢体抽动),颤是指手足的动摇,反是指身体后仰向后,引是指手像拉开弓一样,窜是指眼睛直视且似愤怒,视是指眼珠暴露且不灵活。对于搐症,以男左手女右手为大指在外、女大指在内为顺证,相反则为逆证。此候在急惊风和慢惊风中都会出现,虚实没有差异,治疗者应当牢记。
惊风发作时出现抽搐痉挛、神志昏迷,痰液壅塞、气机阻滞在心胸部位。紧急情况下使用通关散吹入鼻中,如果不打喷嚏则死亡,如果打喷嚏则有生机。
【注】惊风引起的抽搐痉挛,必然导致神气昏愦,这都是由于痰浊壅塞、气机阻滞,郁结在胸中而导致的。紧急时使用通关散吹入鼻内,不打喷嚏的无法救治;有喷嚏的,需审查其表里、虚实的状况,随证进行治疗。
通关散
半夏(生用) 皂角 细辛 薄荷(各等分)
共研为细末,用笔管吹入鼻内少许。
急惊风因接触异物受惊吓而心惊发热,有的由风邪郁闭化火生风引起,有的暴发时痰盛或热极所致。表现为壮热、烦躁急迫、面唇红赤,痰壅气促、牙关紧闭,大小便秘涩、脉象数而洪大。惊证使用镇惊风至宝丹,牛黄丸攻逐痰浊并清利膈热,平治法配合羌活散、泻青丸等,化痰导赤散共同起到凉惊的作用。
【注】急惊风这一病证,有因眼睛接触异物、耳朵听到异声,导致神气散乱、气机紊乱而发生的;有因心肝火盛,外被风寒郁闭,不得宣通而发生的;有因痰盛热极而在内部动风引起的。然而证候多表现为突然发作的壮热、烦躁急迫、面红、唇赤、痰壅气促、牙关紧闭、大小便秘涩。牙关紧闭,是指牙齿紧急不能张开。大小便秘涩,是指大便秘结而小便涩滞困难。脉象洪数的,主阳热证。因接触异物致惊的,用清热镇惊汤、安神镇惊丸主治;火郁生风的,用至宝丹主治;痰盛生惊的,用牛黄丸攻下治疗;热极生风的,用凉膈散清解治疗;病情不严重的,则使用平治之法。风热的,用羌活散主治;肝热的,用泻青丸主治;痰兼热的,用清热化痰汤主治;心经热的,用导赤散、凉惊丸主治。关键在于临证医生仔细审察后使用。
清热镇惊汤
柴胡 薄荷 麦冬(去心) 栀子 龙胆草 川黄连 茯神 钓藤钩 甘草(生) 木通
引用灯心草、竹叶,调服朱砂末。
【方歌】清热镇惊治外惊,柴胡薄荷麦门冬,栀子黄连龙胆草,茯神钩藤草木通。
安神镇惊丸
天竺黄 茯神(各五钱) 胆星 枣仁(炒) 麦冬(去心) 赤芍 当归(各三钱) 薄荷叶 黄连 辰砂 牛黄 栀子 木通 龙骨(煅,各三钱) 青黛(一钱)
以上研为细末,炼蜜制成如绿豆大的丸药,用赤金箔为衣,根据患儿大小给予剂量,用淡姜汤送服化下。
至宝丹
麻黄 防风 荆芥 薄荷 当归 赤芍 大黄 芒硝 川芎 黄芩 桔梗 连翘(去心) 白术(土炒) 栀子 石膏(煅) 甘草(生) 滑石 全蝎(去毒) 细辛 天麻 白附子 羌活 僵蚕(炒) 川连 独活 黄柏(各等分)
以上共研为细末,炼蜜为丸,每丸重五分,根据患儿大小给予剂量,用姜汤送服化下。
牛黄丸
黑牵牛 白牵牛(各七钱半) 胆星 枳实(麸炒) 半夏(姜制,各五钱) 牙皂(去皮弦,二钱) 大黄(一两半)
研成极细末,炼白蜜为丸,重五分,根据患儿大小给予剂量,用姜汤送服化下。
凉膈散
黄芩 大黄 连翘(去心) 芒硝 甘草(生) 栀子 薄荷
引用竹叶、生蜜,煎服,无汗者加防风、羌活。
【方歌】凉膈散治膈热盛,栀翘芩薄芒硝黄,便秘硝黄加倍用,无汗更加羌活防。
羌活散
羌活 防风 川芎 薄荷 天麻 僵蚕(炒) 甘草(生) 川黄连 柴胡 前胡 枳壳(麸炒) 桔梗
引用生姜,水煎服。
【方歌】羌活散风兼清热,羌防川芎薄荷叶,天麻僵蚕草黄连,柴胡前胡枳壳桔。
泻青丸
龙胆草(焙) 栀子 大黄(煨) 羌活 防风(各一钱) 川芎(钱半)
以上研末,炼蜜为丸,如梧桐子大,用竹叶薄荷汤调服。
清热化痰汤
橘红 麦冬(去心) 半夏(姜制) 赤苓 黄芩 竹茹 甘草(生) 川连 枳壳(麸炒) 桔梗 胆南星
引用生姜、灯心草,水煎服。
【方歌】清热化痰有橘红,麦冬半夏赤茯苓,黄芩竹茹生甘草,川连枳桔胆南星。
凉惊丸
龙胆草 防风 青黛(各三钱) 钓藤钩(二钱) 黄连(五钱) 牛黄(一钱)
以上研为细末,面糊为丸,如粟米大,根据患儿大小给予剂量,用金器煎汤送服化下。
The eight manifestations (Ba Hou) of convulsion are twitching (Chu), grasping (Nuo), jerking (Che), trembling (Chan), opisthotonos (Fan), drawing (Yin), staring (Cuan), and gazing (Shi). The extension and flexion of the elbow and arm is called "twitching" (Chu); the opening and closing of the ten fingers forms the state of "grasping" (Nuo); a movement resembling wrestling is called "jerking" (Che); trembling of the head and limbs like a shaking bell is called "trembling" (Chan); the posture of the body arching backward with the head thrown back is called "opisthotonos" (Fan); the posture of both hands opening as if drawing a bow is called "drawing" (Yin); eyes staring straight ahead as if in anger is called "staring" (Cuan); gazing at objects without moving the eyeballs is called "gazing" (Shi). These are divided into favorable (Shun) and unfavorable (Ni) patterns based on internal/external and left/right directions; one must recognize that the clinical presentations of acute convulsion (Ji Jing Feng) and chronic convulsion are identical.
[Note] The eight manifestations refer to twitching, grasping, jerking, trembling, opisthotonos, drawing, staring, and gazing. Twitching refers to the extension and flexion of elbows and arms; grasping refers to the opening and closing of the ten fingers; jerking refers to the shoulder heads moving as if wrestling; trembling refers to the shaking of hands and feet; opisthotonos refers to the body arching backward; drawing refers to the hands resembling a drawn bow; staring refers to the eyes being straight and appearing angry; gazing refers to the eyeballs being exposed and inflexible. For the twitching manifestation, in males, the left hand is primary, and in females, the right hand is primary; having the thumb outside is favorable, while having the thumb inside is unfavorable. This manifestation appears in both acute and chronic convulsions, regardless of deficiency or excess patterns. Practitioners should keep this firmly in mind.
Convulsions and spasms due to fright-convulsion lead to confusion and coma, with phlegm obstructing and qi stagnating in the chest and heart. Urgently use Tongguan San (Pass-the-Gate Powder) blown into the nose; absence of sneezing indicates death, while presence of sneezing indicates survival.
[Note] Convulsions and spasms caused by fright-convulsion inevitably result in mental confusion, all due to phlegm obstruction and qi stagnation knotting in the chest. Urgently blow Tongguan San into the nasal cavity; those who do not sneeze are incurable; those who sneeze require examination of exterior/interior and deficiency/excess conditions for symptomatic treatment.
Tongguan San (Pass-the-Gate Powder)
Raw Pinelliae Rhizoma (Banxia), Gleditsiae Sinensis Spina (Zaojiao), Asari Radix (Xixin), Menthae Haplocalycis Herba (Bohe) (equal parts)
Grind into fine powder, blow a small amount into the nasal cavity using a quill tube.
Acute fright-convulsion arises from startle fever upon encountering strange objects, or from wind constraint transforming into fire generating wind, or from sudden onset of abundant phlegm or extreme heat. Symptoms include high fever, restlessness, redness of face and lips, phlegm obstruction, rapid breathing, locked jaw, constipation and difficult urination, and a rapid, surging pulse. For startle-induced conditions, use Zhenjing Fengzhibao Dan (Calming Fright and Treasuring Preciousness Pill); Niuhuang Wan (Calculus Bovis Pill) attacks phlegm and clears the diaphragm; Pingzhi Fa (Neutralizing Method) combined with Qianghuo San (Notopterygii Root Powder) and Xieqing Wan (Draining Green Pill) together with Huatan Daochi Tang (Phlegm-Resolving and Heart-Clearing Decoction) serve to cool and calm the fright.
[Note] Acute fright-convulsion may arise from visual contact with strange objects or auditory exposure to strange sounds, causing spirit dispersion and qi disorder; it may arise from excessive heart and liver fire constrained externally by wind-cold, preventing free flow; or it may arise from internal wind stirring due to abundant phlegm and extreme heat. Typically, symptoms present suddenly with high fever, restlessness, red face, red lips, phlegm obstruction, rapid breathing, locked jaw, and constipation with difficult urination. Locked jaw means teeth are tight and cannot open. Constipation and difficult urination mean feces are dry and hard, and urine is scanty and difficult to pass. A surging and rapid pulse indicates yang-heat. For startle due to strange objects, Qingre Zhenjing Tang (Heat-Clearing and Fright-Calming Decoction) and Anshen Zhenjing Wan (Spirit-Calming and Fright-Calming Pill) are indicated; for wind generated by fire constraint, Zhibao Dan (Precious Treasure Pill) is indicated; for fright generated by abundant phlegm, Niuhuang Wan (Calculus Bovis Pill) is used for purgation; for wind generated by extreme heat, Liangge San (Cool Diaphragm Powder) is used for clearing and resolving; for mild cases, the neutralizing method is used. For wind-heat, Qianghuo San (Notopterygii Root Powder) is indicated; for liver heat, Xieqing Wan (Draining Green Pill) is indicated; for phlegm combined with heat, Qingre Huatan Tang (Heat-Clearing and Phlegm-Resolving Decoction) is indicated; for heart meridian heat, Daochi San (Guide Out Red Powder) and Liangjing Wan (Cool Fright Pill) are indicated. It depends on the clinician's careful assessment and application.
Qingre Zhenjing Tang (Heat-Clearing and Fright-Calming Decoction)
Bupleuri Radix (Chaihu), Menthae Haplocalycis Herba (Bohe), Ophiopogonis Radix (Maidong, dehearted), Gardeniae Fructus (Zhizi), Gentianae Radix (Longdancao), Coptidis Rhizoma (Chuanlianhua), Poria (Fushen), Uncariae Ramulus cum Uncis (Gouteng), Glycyrrhizae Radix et Rhizoma (Gancao, raw), Akebiae Caulis (Mutong).
Decoct with Jiedaxin (Centella asiatica herb/stem) and Zhu Ye (Bamboo leaves), take with suspended Cinnabar powder (Zhusha mo).
[Formula Song] Heat-clearing and fright-calming treats external fright, Chaihu, Bohe, Maidong, Zhizi, Huanglian, Longdancao, Fushen, Gouteng, Mutong.
Anshen Zhenjing Wan (Spirit-Calming and Fright-Calming Pill)
Tianzhuhuang (Calculus Budhis), Poria (Fushen) (each 5 qian), Arisaematis Cum Bile Rhizoma (Danning), Ziziphi Spinosae Semen (Suanzaoren, stir-fried), Ophiopogonis Radix (Maidong, dehearted), Rubia Cordifolia Radix et Rhizoma (Chishao), Angelicae Sinensis Radix (Danggui) (each 3 qian), Menthae Haplocalycis Folium (Bohoye), Coptidis Rhizoma (Huanglian), Cinnabaris (Chensha), Calculus Bovis (Niuhuang), Gardeniae Fructus (Zhizi), Akebiae Caulis (Mutong), Ostreae Concha (Longgu, calcined) (each 3 qian), Indigo Naturalis (Qingdai) (1 qian).
Grind into fine powder, make pills with refined honey the size of mung beans, coat with Gold Leaf (Chijinbo), administer according to child's age, dissolve and take with light ginger soup.
Zhibao Dan (Precious Treasure Pill)
Ephedrae Herba (Mahuang), Saposhnikoviae Radix (Fangfeng), Schizonepetae Spica (Jingjie), Menthae Haplocalycis Herba (Bohe), Angelicae Sinensis Radix (Danggui), Rubia Cordifolia Radix et Rhizoma (Chishao), Rheum Palmatum Radix et Rhizoma (Dahuang), Natrii Sulfas (Mangxiao), Ligustici Chuanxiong Rhizoma (Chuanxiong), Scutellariae Radix (Huangqin), Platycodonis Radix (Jiegeng), Forsythiae Fructus (Lianqiao, dehearted), Atractylodis Macrocephalae Rhizoma (Baizhu, earth-fried), Gardeniae Fructus (Zhizi), Gypsum Fibrosum (Shigao, calcined), Glycyrrhizae Radix et Rhizoma (Gancao, raw), Talcum (Huashi), Scorpio (Quanxie, detoxified), Asari Radix (Xixin), Gastrodiae Rhizoma (Tianma), Typhonii Rhizoma (Baifuzi), Notopterygii Rhizoma et Radix (Qianghuo), Bombyx Batryticatus (Jiangcan, stir-fried), Coptidis Rhizoma (Chuanlian), Angelicae Pubescentis Radix (Duohuo), Phellodendri Chinensis Cortex (Huangbai) (equal parts).
Grind into fine powder, make pills with refined honey, each pill weighs 5 fen, administer according to child's age, dissolve and take with ginger soup.
Niuhuang Wan (Calculus Bovis Pill)
Semen Kochiae (Heiqianniu), Semen Kochiae (Baiqianniu) (each 7.5 qian), Arisaematis Cum Bile Rhizoma (Danning), Aurantii Fructus Immaturus (Zhishi, bran-fried), Pinelliae Rhizoma (Banxia, ginger-processed) (each 5 qian), Gleditsiae Sinensis Fructus (Ya'ao, skin and strings removed) (2 qian), Rheum Palmatum Radix et Rhizoma (Dahuang) (1.5 liang).
Grind into extremely fine powder, make pills with refined white honey, each pill weighs 5 fen, administer according to child's age, dissolve and take with ginger soup.
Liangge San (Cool Diaphragm Powder)
Scutellariae Radix (Huangqin), Rheum Palmatum Radix et Rhizoma (Dahuang), Forsythiae Fructus (Lianqiao, dehearted), Natrii Sulfas (Mangxiao), Glycyrrhizae Radix et Rhizoma (Gancao, raw), Gardeniae Fructus (Zhizi), Menthae Haplocalycis Herba (Bohe).
Decoct with Zhu Ye (Bamboo leaves) and raw honey, take orally; add Fangfeng (Saposhnikoviae Radix) and Qianghuo (Notopterygii Rhizoma et Radix) if there is no sweating.
[Formula Song] Liangge San treats excessive diaphragmatic heat, Zhizi, Lianqiao, Huangqin, Bohe, Mangxiao, Dahuang; double the dose of Mangxiao and Dahuang for constipation; add Qianghuo and Fangfeng if no sweat.
Qianghuo San (Notopterygii Root Powder)
Notopterygii Rhizoma et Radix (Qianghuo), Saposhnikoviae Radix (Fangfeng), Ligustici Chuanxiong Rhizoma (Chuanxiong), Menthae Haplocalycis Herba (Bohe), Gastrodiae Rhizoma (Tianma), Bombyx Batryticatus (Jiangcan, stir-fried), Glycyrrhizae Radix et Rhizoma (Gancao, raw), Coptidis Rhizoma (Chuanlianhua), Bupleuri Radix (Chaihu), Peucedani Radix (Qianhu), Aurantii Fructus Immaturus (Zhike, bran-fried), Platycodonis Radix (Jiegeng).
Decoct with Shengjiang (Fresh Ginger) in water, take orally.
[Formula Song] Qianghuo San disperses wind and clears heat, Qianghuo, Fangfeng, Chuanxiong, Bohoye, Tianma, Jiangcan, Gancao, Huanglian, Chaihu, Qianhu, Zhike, Jiegeng.
Xieqing Wan (Draining Green Pill)
Gentianae Radix (Longdancao, roasted), Gardeniae Fructus (Zhizi), Rheum Palmatum Radix et Rhizoma (Dahuang, baked), Notopterygii Rhizoma et Radix (Qianghuo), Saposhnikoviae Radix (Fangfeng) (each 1 qian), Ligustici Chuanxiong Rhizoma (Chuanxiong, 1.5 qian).
Grind into powder, make pills with refined honey the size of paulownia seeds, take with Zhu Ye (Bamboo leaves) and Bohe (Mint) decoction.
Qingre Huatan Tang (Heat-Clearing and Phlegm-Resolving Decoction)
Citri Reticulatae Pericarpium (Juhong), Ophiopogonis Radix (Maidong, dehearted), Pinelliae Rhizoma (Banxia, ginger-processed), Poria (Chiling), Scutellariae Radix (Huangqin), Bambusae Medulla (Zhuru), Glycyrrhizae Radix et Rhizoma (Gancao, raw), Coptidis Rhizoma (Chuanlian), Aurantii Fructus Immaturus (Zhike, bran-fried), Platycodonis Radix (Jiegeng), Arisaematis Cum Bile Rhizoma (Danning).
Decoct with Shengjiang (Fresh Ginger) and Jiedaxin (Centella asiatica herb/stem) in water, take orally.
[Formula Song] Heat-clearing and phlegm-resolving uses Juhong, Maidong, Banxia, Chiling, Huangqin, Zhuru, Gancao, Chuanlian, Zhike, Jiegeng, Danning.
Xiexin Daochi Tang (Heart-Purging and Guide-Out Red Decoction) (See chapter on Wooden Tongue)
Liangjing Wan (Cool Fright Pill)
Gentianae Radix (Longdancao), Saposhnikoviae Radix (Fangfeng), Indigo Naturalis (Qingdai) (each 3 qian), Uncariae Ramulus cum Uncis (Gouteng, 2 qian), Coptidis Rhizoma (Huanglian, 5 qian), Calculus Bovis (Niuhuang, 1 qian).
Grind into fine powder, make pills with wheat paste the size of millet grains, administer according to child's age, dissolve and take with decoction boiled with gold vessels.