总括
心藏神,心病主惊,肝属木,肝病故主风也。凡小儿心热肝盛,一触惊受风,则风火相搏,必作急惊之证。若素禀
既虚,或因急惊用药过峻,暴伤元气,每变成慢惊之症。更有因吐泻既久,中气大虚,脾土衰弱,肝木乘虚,而内生惊
风者,名曰慢脾风。三者致病之因不同,而所见之证亦各异。急惊属阳证,必有阳热有余等实象;慢脾属阴证,必有阴
冷不足虚形也。至于慢惊初得之时,阴阳尚未过损,或因急惊传变而成,其中尚有夹痰夹热等证,故属半阴半阳之证,
不比慢脾纯阴之病也。治者当分寒热虚实,要详明也。
惊风八侯
惊风八候者,乃搐、搦、掣、颤、反、引、窜、视之名是也。如肘臂伸缩,名之为搐。十指开合,搦状已成。势若
肩头相扑,谓之掣。颤则头首四肢动摇如铃,反则身仰头向后,引者两手若开弓,窜候则目直常似怒形,视则睹物不转,
睛露。其搐以男子左手,女右手,女大指在内,男大指在外,为顺,反是为逆。须识急惊慢惊之证,所见皆同,此候虚
实,无所异焉。
通关急救法
惊风搐搦,必神气昏愦,皆由痰壅气塞在胸中所致,急用通关散吹入鼻内,无嚏则死,有嚏者则生也。审其表里虚
实治之。
急惊风
急惊一证,因目触异物,耳闻异声,心惊有热,神散气乱而生者。或由心肝火盛,外为风寒郁闭,不得宣通,而火
生风者。有因痰盛热极,而内动风者。然证多暴发,壮热烦急,面赤唇红,痰壅气促,牙关噤急不开,二便秘涩,脉数
而洪,皆主阳热也。触异致惊者,用清热镇惊汤、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,导赤散共凉惊丸主之。
急惊后调理法
急惊多用寒凉,亦急则治标之法。但痰火稍退,即当调理脾胃。若过用寒凉,必致转成慢惊等证。故惊邪一退之后,
尚有痰热未清,当用琥珀抱龙丸最灵。若神气虚弱,痰兼热者,用清心涤痰汤,大有功效也。
慢惊风
慢惊一证,多缘禀赋虚弱,土虚木盛者有之;或因急惊过用峻利之药,以致损而成此证者有之。发时缓缓搐搦,时
作时止,面色淡黄,或清白相兼,身则温和,昏睡眼合,睛则或露,脉来迟缓,神气惨惨,大便青色。此乃脾胃虚弱,
治宜培补元气为主。气虚夹痰者,用醒脾汤最效。脾虚肝旺者,用缓肝理脾汤最灵。
慢惊夹热夹痰
慢惊之证,本无热可言。但脾虚,虚热内生,热生痰,故有夹热或夹痰。其证身热心烦,口溢痰涎,咽喉气粗。如
痰热相兼者,宜用清心涤痰汤治之。如脾虚肝旺痰盛者,用青州白丸子、柴芍六君子汤煎服。
慢脾风
慢脾一证,多因吐泻既久,以致脾虚不能生金,金必弱,不能制木,肝木强盛,以克脾土,故曰脾风。其症摇头闭
目,面唇青暗,额汗昏眼,四肢身体如冰,声哑舌短,频呕清水也。此乃纯阴无阳之证,惟宜大补脾土为真,生胃回阳
为主。如吐泻亡阳者,温中补脾汤为主治。大病后成者,固真汤。四肢厥冷者,理中汤从用。
总括
心主藏神,心病则易受惊;肝属木,肝病则易生风。凡是小儿心火偏盛、肝气旺盛,一旦受到惊吓或感受风邪,就会风火相搏,必然引发急惊风的证候。如果小儿先天禀赋虚弱,或者因为治疗急惊风时用药过于峻猛,突然损伤了元气,往往转变为慢惊风的病症。更有因呕吐腹泻日久,中气大虚,脾土衰弱,肝木乘虚而入,从而内生惊风的,称为慢脾风。这三种病因不同,所表现的证候也各异。急惊属于阳证,必定有阳热有余等实证表现;慢脾风属于阴证,必定有阴寒不足等虚象。至于慢惊风在初起之时,阴阳尚未严重受损,或者是由急惊风传变而来,其中还有夹痰、夹热等证候,所以属于半阴半阳的证候,不像慢脾风那样是纯阴的病证。治疗者应当分辨寒热虚实,务必详细明确。
惊风八侯
惊风八侯,指的是搐、搦、掣、颤、反、引、窜、视这八种症状名称。比如肘部和手臂伸缩,称为搐。十个手指开合,呈现搦的状态。势态像肩膀互相撞击,称为掣。颤则是头部和四肢动摇像铃铛一样,反则是身体后仰头向后倒,引是两手张开像拉弓一样,窜候则是眼睛直视常带怒容,视则是看东西不转动,眼球外露。对于搐的症状,以男子左手、女子右手,女子大拇指在内侧、男子大拇指在外侧为顺证,反之则为逆证。必须识别急惊风和慢惊风的证候,所见症状虽然相同,但此处的侯(症状)在虚实判断上并无差异。
通关急救法
惊风发作出现抽搐痉挛时,必然导致神志昏沉迷糊,这都是由痰浊壅塞、气机阻滞在胸中所致,急需使用通关散吹入鼻内,如果不打喷嚏则会死亡,能打喷嚏则有生机。审察其表里虚实进行救治。
急惊风
急惊这一证候,是因为眼睛看到异物,耳朵听到异声,心惊且体内有热,神气涣散、气机紊乱而发生的。或者由于心肝火盛,外部被风寒郁闭,不得宣通,从而火生风。也有因痰盛热极,从而内部动风的。然而此证多突然暴发,高热烦躁急迫,面色红赤嘴唇红,痰多气促,牙关紧闭不开,大小便不通畅,脉象数而洪大,都主阳热之证。因接触异物导致受惊的,用清热镇惊汤、安神镇惊丸主治;因火郁生风的,用至宝丹主治;因痰盛生惊的,用牛黄丸攻下治疗;因热极生风的,用凉膈散清解治疗。病情不严重的,则用平治的方法。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,用导赤散配合凉惊丸主治。
急惊后调理法
急惊风多用寒凉药物,这也是“急则治标”的方法。但痰火稍微退去之后,就应当调理脾胃。如果过度使用寒凉药物,必然会导致转变成慢惊风等证候。所以惊邪退去之后,如果还有痰热未清,当用琥珀抱龙丸最为灵验。如果神气虚弱,痰兼热的,用清心涤痰汤,大有功效。
慢惊风
慢惊这一证候,多缘于先天禀赋虚弱,土虚木盛的有之;或者因为急惊风时过度使用峻烈通利之药,以致损伤正气而形成此证的有之。发作时缓缓抽搐痉挛,时作时止,面色淡黄,或清白相间,身体温和,昏睡眼合,眼球有时外露,脉来迟缓,神情惨淡,大便呈青色。这是脾胃虚弱,治疗应以培补元气为主。气虚夹痰的,用醒脾汤最有效;脾虚肝旺的,用缓肝理脾汤最灵验。
慢惊夹热夹痰
慢惊风本无实热可言。但因为脾虚,虚热内生,热生痰,所以有夹热或夹痰的情况。其证候表现为身热心烦,口溢痰涎,咽喉呼吸气粗。如痰热相兼的,宜用清心涤痰汤治疗。如脾虚肝旺痰盛的,用青州白丸子、柴芍六君子汤煎服。
慢脾风
慢脾风这一证候,多因呕吐腹泻日久,以致脾虚不能生肺金,肺金必弱,不能制约肝木,肝木强盛,克制脾土,所以称为脾风。其症状为摇头闭目,面唇青暗,额头出汗眼神昏蒙,四肢身体冰冷,声音嘶哑舌头短缩,频繁呕吐清水。这是纯阴无阳的证候,唯有大补脾土才是正道,以生胃回阳为主。如因吐泻亡阳的,温中补脾汤为主治;大病后形成的,用固真汤;四肢厥冷的,理中汤从症选用。
General Overview
The Heart stores the Shen (Spirit), and Heart disease primarily manifests as fright; the Liver belongs to Wood, and Liver disease primarily generates wind. Whenever a child has excessive Heart heat and flourishing Liver qi, upon encountering fright or contracting wind pathogens, wind and fire will contend with each other, inevitably resulting in acute convulsions (Ji Jing). If the child has innate deficiency, or if overly harsh medications were used to treat acute convulsions, suddenly damaging the Yuan Qi (Original Qi), it often transforms into chronic convulsions (Man Jing). Furthermore, prolonged vomiting and diarrhea can lead to severe deficiency of Middle Qi, weakening of Spleen Earth, allowing Liver Wood to invade due to emptiness, thereby generating internal wind, known as Slow Spleen Wind (Man Pi Feng). Although the causes of these three conditions differ, their manifested symptoms are also distinct. Acute convulsions belong to Yang syndromes, necessarily presenting with excess signs such as surplus Yang-heat; Slow Spleen Wind belongs to Yin syndromes, necessarily presenting with deficiency signs such as insufficiency of Yin-cold. As for early-stage chronic convulsions, when Yin and Yang have not yet been severely damaged, or when transmitted from acute convulsions, there may still be syndromes involving phlegm accumulation or heat, thus belonging to half-Yin half-Yang syndromes, unlike Slow Spleen Wind which is a pure Yin disease. Practitioners must differentiate cold and heat, deficiency and excess, and be thorough and clear.
Eight Signs of Convulsions
The Eight Signs of Convulsions refer to the names: Chu (Tremor/Spasm), Nuo (Gripping), Che (Pulling), Chan (Shaking), Fan (Reversal), Yin (Drawing), Cuan (Staring), and Shi (Gazing). For example, extension and flexion of elbows and arms is called Chu. Opening and closing of the ten fingers constitutes the state of Nuo. A posture resembling shoulder-to-shoulder wrestling is called Che. Chan refers to the head and four limbs shaking like a bell. Fan refers to the body arching backward with the head tilted back. Yin refers to both hands opening as if drawing a bow. The Cuan sign involves eyes staring straight ahead with an angry expression. The Shi sign involves fixed gaze without turning, with eyeballs exposed. Regarding the Chu sign, for males, the left hand is favorable; for females, the right hand is favorable. For females, the thumb inside is favorable; for males, the thumb outside is favorable. These are considered Shun (favorable); the reverse is Ni (unfavorable). One must recognize that while the manifestations of acute and chronic convulsions appear similar, the assessment of deficiency and excess in these signs remains consistent.
Emergency Method for Unblocking Orifices
When convulsions occur, spirit and qi become confused and dull, caused by phlegm obstruction and qi stagnation in the chest. Immediately use Tong Guan San (Pass Through Powder) blown into the nostrils. If sneezing does not occur, death ensues; if sneezing occurs, life is preserved. Treat based on an examination of exterior/interior, deficiency/excess.
Acute Convulsions
This syndrome arises from seeing strange objects, hearing strange sounds, causing heart fright and internal heat, leading to dispersion of Shen and disorder of qi. It may also result from excessive Fire in the Heart and Liver, externally constrained by Wind-Cold, preventing free circulation, thereby generating Wind from Fire. It can also arise from extreme Phlegm and Heat stirring internal Wind. This syndrome often erupts suddenly with high fever, restlessness, red face and lips, copious phlegm, rapid breathing, locked jaw, constipation and difficult urination, and a rapid, surging pulse, all indicating Yang-Heat. For fright induced by external stimuli, use Qing Re Zhen Jing Tang (Clear Heat and Calm Fright Decoction) or An Shen Zhen Jing Wan (Calm Spirit and Pacify Fright Pill). For Wind generated by constrained Fire, use Zhi Bao Dan (Precious Treasure Pill). For Phlegm-induced fright, use Niu Huang Wan (Calculus Bovis Pill) to purge downwards. For Wind generated by extreme Heat, use Liang Ge San (Cool the Diaphragm Powder) to clear and resolve. For mild cases, use gentle balancing methods. For Wind-Heat, use Qiang Huo San (Notopterygium Powder). For Liver Heat, use Xie Qing Wan (Drain Green Pill). For Phlegm combined with Heat, use Qing Re Hua Tan Tang (Clear Heat and Transform Phlegm Decoction). For Heart Meridian Heat, use Dao Chi San (Direct Red Powder) combined with Liang Jing Wan (Cool Fright Pill).
Post-Acute Convulsion Regulation
Treatment for acute convulsions often employs cold and cooling herbs, which is the method of "treating the branch in emergencies." However, once Phlegm-Fire subsides slightly, regulation of the Spleen and Stomach should begin. Overuse of cold and cooling agents will inevitably transform the condition into chronic convulsions. Therefore, after the pathogenic fright recedes, if Phlegm-Heat remains unclarified, Hu Po Bao Long Wan (Amber Embracing Dragon Pill) is most effective. If Shen-Qi is weak with Phlegm-Heat, Qing Xin Di Tan Tang (Clear Heart and Scour Phlegm Decoction) yields great efficacy.
Chronic Convulsions
This syndrome often stems from innate weakness or Spleen Earth deficiency with Liver Wood flourishing. It may also result from overuse of harsh purgatives during acute convulsions, damaging Zheng Qi. Onset features slow, intermittent spasms, pale yellow complexion or mixed clear-white hues, warm body, lethargy with closed eyes, occasionally exposed eyeballs, slow pulse, listless demeanor, and greenish stool. This indicates Spleen-Stomach weakness; treatment should focus on tonifying Yuan Qi. For Qi deficiency with Phlegm, Xing Pi Tang (Awaken Spleen Decoction) is most effective. For Spleen deficiency with Liver hyperactivity, Huan Gan Li Pi Tang (Soothe Liver and Regulate Spleen Decoction) is most efficacious.
Chronic Convulsions with Accompanying Heat and Phlegm
Chronic convulsions inherently lack excess heat. However, Spleen deficiency generates internal deficient heat, which produces Phlegm, hence the presence of accompanying heat or phlegm. Symptoms include fever, irritability, salivation, and coarse throat respiration. For combined Phlegm-Heat, use Qing Xin Di Tan Tang. For Spleen deficiency, Liver hyperactivity, and abundant Phlegm, use Qing Zhou Bai Wan Zi (Qingzhou White Pills) and Chai Shao Liu Jun Zi Tang (Bupleurum and Peony Six Gentlemen Decoction) decocted for administration.
Slow Spleen Wind
This syndrome often results from prolonged vomiting and diarrhea, causing Spleen deficiency unable to generate Lung Metal. Weak Lung Metal cannot control Liver Wood, allowing Liver Wood to flourish and overcome Spleen Earth, hence named Spleen Wind. Symptoms include head shaking, closed eyes, dark cyan face and lips, forehead sweating with dull eyes, ice-cold limbs and body, hoarse voice, short tongue, and frequent vomiting of clear fluid. This is a pure Yin syndrome devoid of Yang. Treatment must strictly tonify Spleen Earth, focusing on generating Stomach Qi and restoring Yang. For Yang collapse due to vomiting/diarrhea, Wen Zhong Bu Pi Tang (Warm Middle and Tonify Spleen Decoction) is primary. For post-major illness onset, Gu Zhen Tang (Solidify Truth Decoction) is used. For cold extremities, Li Zhong Tang (Regulate the Middle Decoction) is selected.