小儿痫证类痉惊,发时昏倒搐涎声,食顷即苏如无病,阴阳惊热痰食风。
【注】痫证类乎惊风、痉风者,谓发时昏倒抽搐,痰涎壅盛,气促作声,与惊、痉二
证相似也。但四体柔软,一食之顷即醒,依然如无病之人,非若痉风一身强硬,终日不
醒也。阴者,阴痫也,见脏阴证。阳者,阳痫也,见腑阳证。惊痫因惊热,痰痫因痰,食
痫因食,风痫因风。其证不一,治亦不同,临证宜详辨之。
阴痫属脏肢厥冷,偃卧拘急面白青,吐沫声微脉沉细,醒脾固真定痫灵。
【注】阴痫属阴,脏寒之病也。多因慢惊之后,痰入心包而得。发时手足厥冷,僵卧
拘急,面色青白,口吐涎沫,声音微小,脉来沉细。轻者醒脾汤,甚者固真汤。病退调
理,用定痫丹主之。
醒脾汤(方见慢惊风)
固真汤(方见慢脾风)
定痫丹
人参(三钱) 当归(三钱) 白芍(炒,三钱) 茯神 枣仁(炒,各五钱) 远志(去心,三钱)
琥珀(三钱) 天竺黄(四钱) 白术(土炒,五钱) 橘红 半夏(姜制) 天麻(各三钱) 钓藤钩(四钱) 甘
草(炙,二钱)
共为细末,炼蜜丸如榛子大,每服一丸,淡姜汤化服。
阳痫属腑身热汗,仰卧面赤脉数洪,噤急啼叫吐涎沫,龙胆泻青与抱龙。
【注】阳痫属阳,腑热之病也。多因急惊去风下痰不净,久而致成此证。发时身热自
汗,仰卧面赤,脉象洪数,牙关噤急,或啼叫不已,口吐涎沫。如风兼热者,用龙胆汤;
肝经热者,用泻青丸;痰涎壅盛者,用四制抱龙丸主之。
龙胆汤(方见噤口)
泻青丸(方见急惊风)
四制抱龙丸
天竺黄(五钱) 辰砂(二钱) 胆星(一两) 雄黄(二钱) 麝香(一分半)
上为极细末,另用麻黄、款冬花、甘草各五钱,煎汤去滓,慢火熬成膏,合药末为丸,如芡实大,每服一丸,薄荷
汤化下。
小儿痫证的表现类似惊风和痉风,发作时出现昏倒、抽搐、流涎及发出声响,经过一顿饭的时间即可苏醒,如同没有生病一样,其病因分为阴痫、阳痫,由惊、热、痰、食、风引起。
【注】痫证之所以类似惊风和痉风,是因为发作时会出现昏倒、抽搐,痰涎壅盛,呼吸急促并伴有声响,这与惊风和痉风两种病证相似。但不同的是,患儿四肢柔软,一顿饭的功夫就能醒来,依然像没病的人一样,不像痉风那样全身僵硬,整天不醒。所谓“阴”,是指阴痫,表现为脏器的阴寒证候;所谓“阳”,是指阳痫,表现为腑器的阳热证候。因惊吓和热邪引起的称为惊痫,因痰浊引起的称为痰痫,因饮食积滞引起的称为食痫,因风邪引起的称为风痫。这些证候各不相同,治疗方法也不同,临证时需要仔细辨别。
阴痫属于脏病,表现为四肢厥冷,身体仰卧且拘急,面色苍白或发青,口吐白沫,声音微弱,脉象沉细,治疗宜用醒脾汤、固真汤以定痫灵效。
【注】阴痫属于阴证,是脏器虚寒的疾病。多因慢惊风之后,痰浊进入心包所致。发作时手足冰冷,僵卧且肢体拘急,面色青白,口吐涎沫,声音微小,脉象沉细。轻症用醒脾汤,重症用固真汤。病情退去后调理,主要使用定痫丹。
醒脾汤(方剂见慢惊风章节)
固真汤(方剂见慢脾风章节)
定痫丹
人参(三钱) 当归(三钱) 白芍(炒制,三钱) 茯神 枣仁(炒制,各五钱) 远志(去心,三钱)
琥珀(三钱) 天竺黄(四钱) 白术(土炒,五钱) 橘红 半夏(姜汁制) 天麻(各三钱) 钩藤(四钱) 甘草(炙制,二钱)
以上药材共研为细末,用炼蜜制成如榛子大小的丸药,每次服用一丸,用淡姜汤送服化开。
阳痫属于腑病,表现为身体发热、出汗,身体仰卧且面部发红,脉象数而洪大,牙关紧闭拘急、啼叫不止、口吐涎沫,治疗宜用龙胆泻青丸与抱龙丸。
【注】阳痫属于阳证,是腑器有热的疾病。多因急惊风时祛风化痰不彻底,日久导致此证。发作时身体发热、自然出汗,仰卧且面部发红,脉象洪大且快,牙关紧闭拘急,或者啼叫不停,口吐涎沫。如果兼有风邪和热邪,使用龙胆汤;如果是肝经有热,使用泻青丸;如果痰涎壅盛,主要使用四制抱龙丸。
龙胆汤(方剂见噤口章节)
泻青丸(方剂见急惊风章节)
四制抱龙丸
天竺黄(五钱) 辰砂(二钱) 胆南星(一两) 雄黄(二钱) 麝香(一分半)
以上药材研成极细粉末,另外取麻黄、款冬花、甘草各五钱,煎煮汤液去渣,用慢火熬成膏状,混合药末制成丸药,如芡实大小,每次服用一丸,用薄荷汤送服化下。
Pediatric epilepsy presents similarly to convulsive disorders and tetany. During an attack, the child falls unconscious, experiences convulsions, salivation, and abnormal sounds. After a short while (the time it takes to eat a meal), the child recovers as if healthy. The etiology involves Yin epilepsy and Yang epilepsy, caused by fright, heat, phlegm, food stagnation, and wind.
[Note] Epilepsy resembles convulsive disorders and tetany because during an attack, there is unconsciousness, convulsions, abundant phlegm and saliva, rapid breathing with sounds, which are similar to convulsive disorders and tetany. However, the limbs remain soft, and the child wakes up after a short while, appearing as if healthy, unlike tetany where the body becomes rigid and the child remains unconscious for a long time. "Yin" refers to Yin epilepsy, characterized by Yin-cold syndromes of the Zang organs. "Yang" refers to Yang epilepsy, characterized by Yang-heat syndromes of the Fu organs. Fright-induced epilepsy is due to fright and heat; Phlegm-induced epilepsy is due to phlegm; Food-induced epilepsy is due to food stagnation; Wind-induced epilepsy is due to wind. These syndromes vary, and treatments differ accordingly; careful differentiation is required in clinical practice.
Yin epilepsy belongs to Zang organ pathology, presenting with cold extremities, supine posture with stiffness, pale or bluish complexion, foaming at the mouth, faint voice, and deep, fine pulse. Treatment should focus on awakening the Spleen, securing the True Qi, and calming epilepsy.
[Note] Yin epilepsy is a Yin syndrome, a disease of cold in the Zang organs. It often arises after slow convulsive disorder, when phlegm enters the Pericardium. During an attack, the hands and feet are cold, the body lies stiffly with stiffness, the complexion is blue-white, there is foaming at the mouth, the voice is faint, and the pulse is deep and fine. For mild cases, Xingpi Tang (Spleen-Awakening Decoction) is used; for severe cases, Guzhen Tang (True-Qi-Securing Decoction) is used. After the illness subsides, for regulation, Dingxian Dan (Epilepsy-Calming Pill) is primarily used.
Xingpi Tang (See formula under Slow Convulsive Disorder)
Guzhen Tang (See formula under Slow Spleen Wind)
Dingxian Dan (Epilepsy-Calming Pill)
Ren Shen (Ginseng Radix et Rhizoma, 3 qian) Dang Gui (Angelicae Sinensis Radix, 3 qian) Bai Shao (Paeoniae Radix Alba, stir-fried, 3 qian) Fu Shen (Poria with Hostwood, 5 qian) Zao Ren (Ziziphi Spinosae Semen, stir-fried, 5 qian) Yuan Zhi (Polygalae Radix, heart removed, 3 qian)
Hu Po (Amber, 3 qian) Tian Zhu Huang (Bambusae Concretio Silicea, 4 qian) Bai Zhu (Atractylodis Macrocephalae Rhizoma, soil-stir-fried, 5 qian) Ju Hong (Citri Reticulatae Pericarpium Rubrum, 3 qian) Ban Xia (Pinelliae Tuberum, ginger-processed, 3 qian) Tian Ma (Gastrodiae Rhizoma, 3 qian) Gou Teng Uncariae Ramulus cum Uncis (4 qian) Gan Cao (Glycyrrhizae Radix et Rhizoma, honey-fried, 2 qian)
Grind all ingredients into a fine powder. Mix with refined honey to form pills the size of hazelnuts. Take one pill per dose, dissolved in light ginger decoction.
Yang epilepsy belongs to Fu organ pathology, presenting with fever, sweating, supine posture with red face, rapid and surging pulse, locked jaw with stiffness, crying out, and foaming at the mouth. Treatment should use Longdan Xieqing Wan (Gentian Liver-Draining Pill) and Baolong Wan (Dragon-Holding Pill).
[Note] Yang epilepsy is a Yang syndrome, a disease of heat in the Fu organs. It often results from incomplete expulsion of wind and resolution of phlegm during acute convulsive disorder, leading to this condition over time. During an attack, there is fever, spontaneous sweating, supine posture with red face, surging and rapid pulse, locked jaw with stiffness, incessant crying, and foaming at the mouth. If wind and heat are combined, use Longdan Tang (Gentian Decoction); if there is heat in the Liver meridian, use Xieqing Wan (Liver-Draining Pill); if phlegm and saliva are abundant, use Sizhi Baolong Wan (Four-Processed Dragon-Holding Pill).
Longdan Tang (See formula under Jin Kou/Throat Lock)
Xieqing Wan (See formula under Acute Convulsive Disorder)
Sizhi Baolong Wan (Four-Processed Dragon-Holding Pill)
Tian Zhu Huang (Bambusae Concretio Silicea, 5 qian) Chen Sha (Cinnabaris, 2 qian) Dan Xing (Arisaridis Cum Bile, 1 liang) Xiong Huang (Realgar, 2 qian) She Xiang (Moschus, 1.5 fen)
Grind the above ingredients into an extremely fine powder. Separately, decoct Ma Huang (Ephedrae Herba), Kuan Dong Hua (Fritillariae Thunbergii Bulbus), and Gan Cao (Glycyrrhizae Radix et Rhizoma), each 5 qian, in water. Remove the dregs, and simmer slowly to form a paste. Mix the paste with the powder to form pills the size of Euryale Seed. Take one pill per dose, dissolved in mint decoction.