钱乙曰。慢惊。因大病后。或吐泻。或只吐不泻。变成脾胃虚损。遍身冷。口鼻气出亦冷。手足时螈 。昏睡露睛。
此无阳也。宜栝蒌汤主之。
张元素曰。慢惊者。阴症也。俱脏受病。
曾氏曰。治慢惊者。考之古书。亦无所据。惟载阴痫而已。盖慢惊属阴。阴主静而搐缓。故曰慢。其候皆因外感风
寒。内作吐泻。或得于大病之后。或传误转之候。目慢神昏。手足偏动。口角流涎。身微温。眼上视。或斜转。或两手
握拳而搐。或兼两足动掣。各辨男左女右搐者为顺。反此为逆。口气冷缓。或囟门陷。此虚热也。脉沉无力。睡则扬睛。
谓两目半开半合。此真阳衰耗。而阴邪独盛。阴盛生寒。寒为水化。水生肝木。木为风化。木克脾土。胃为脾之腑。故
胃中有风。螈 渐生。其螈 状。两肩微耸。两手垂下。时复动摇不已者。名曰慢惊。宜以青州白丸子、苏合丸入姜汁
杵匀。米饮调下。虚极者。加金液丹。
虞抟曰。慢惊者。因吐泻日久。中气大虚而得。盖脾虚则生风。风盛则筋急。宜用温白丸。
鳌按。脾虚则生风者。非风自脾生。以脾虚则肝木必强。乃风生于肝也。故风盛则筋急。以肝主筋故耳。观
温白丸中僵蚕全蝎白附天麻等。皆治肝药可见。
李 曰。阴症慢惊。自阳症急惊传来。才经吐泻。便是慢惊。男子以泻得之为重。女子以吐得之为重。慢惊因吐泻
得者。宜醒脾散、加味术附汤。虚风痰多者。宜八仙散。慢惊纯阴症。宜乌蝎散。或阳症尚在。宜蝉蝎散。若有急惊方
传慢候。而尚有阳症。八候尚在。不必回阳。但与截风调胃。用蝉蝎散、醒脾散。若手足冰冷。方可回阳。用硫
黄、附子。泻滑青者。宜防慢惊。盖泻青色乃夹惊。木克土也。
李杲曰。小儿慢惊。或吐利不止。变成虚风搐搦者。非风也。胃气欲绝也。用来复丹五粒研碎。米饮调下。即效。
史演山曰。慢惊之候。盖由急惊过用寒凉。或转太骤。传变成之。又有吐利不止而成者。有气虚暴吐泻而成者。有
夏月脾胃伏热。大吐泻。当解暑热。不可专曰固阳。有脏虚洞泻成者。有得之久嗽作痫者。有得之发痫不已者。有得之
虫
积冲心者。惟吐泻积痢成虚致之。则症变甚速。凡才经吐泻。便是慢惊。须用温中扶里。或搐来紧急。乃慢惊初传。尚
有阳症。不可误作急惊。世言搐慢为慢惊。非也。若泥此。往往指慢脾为慢惊矣。凡慢惊。男子以泻得之为重。女子以
吐得之为重。又吐有五症。泻有五症。各明所因主治。古云。病家怕惊不怕泻。医家怕泻不怕惊。如因泄泻不止。且先
治泻。若更治风。则惊风愈甚。如因他症。则当循原施治也。其慢惊候。若从急惊传来。只可截风调胃。均平阴阳。不
可全用阳药。使阳归阳。复作急惊之症。
张涣曰。急惊以关窍不通。略用冰麝开通。定其搐搦尚可。慢惊阴重阳亏。诸经已虚。不宜开通。又凉其脏。易作
慢脾风。致不易疗。
闻人 曰。慢惊危急。如眼睛昏定。定而砭。虽砭不左右顾。或窜视。四肢厥冷。汗出如流。口面黪暗。指甲黑。
四体垂。至重。慢惊症。眼半开半合。似睡不睡是也。其脉或浮或沉。身或热或凉。或吐或泻。或不吐不泻。或食乳。
或阻乳。名半阴半阳合病。即如伤寒半表半里也。
叶桂曰。慢惊古称阴痫。其治法。急培脾胃。理中汤为主方。有痰呕吐。用南星、白附子、六君子汤。声音不出。
开窍。加竹沥、姜汁、菖蒲根、郁金之属。是病。皆他病致变。其因非一。有过饥。禁食气伤。有峻药强灌伤胃。有暴
吐暴泻。脾胃两败。其症面青 白。身无热。虽热不甚。短气骨软。昏倦如寐。皆温补治之。惟呕逆不受乳食。温补反
佐姜连。连理汤、钱氏益黄散、钱氏异功散。
钱乙说：慢惊风，是因为大病之后，或者呕吐腹泻，或者只呕吐不腹泻，导致脾胃虚损。全身发冷，口鼻呼出的气也是冷的，手足不时抽搐，昏睡且眼睛半开半合露出眼白。
这是阳气衰竭的表现。适宜用栝蒌汤主治。
曾氏说：治疗慢惊风，查阅古书，也没有确切的依据。只有记载了阴痫而已。大概慢惊风属于阴证，阴主静而抽搐缓慢，所以叫“慢”。其症状都是因为外感风寒，内伤导致吐泻，或者是得于大病之后，或者是误治传变而来的候证。眼神呆滞昏沉，手足偏侧抽动，口角流涎，身体微温，眼睛上视，或者斜转，或者两手握拳而抽搐，或者兼有双脚跳动掣动。分别辨别男左女右抽搐的为顺证，反之则为逆证。口气冷缓，或者囟门凹陷，这是虚热。脉象沉而无力，睡觉时眼睛半开半合（称为“扬睛”）。这是真阳衰耗，而阴邪独盛。阴盛则生寒，寒为水化，水生肝木，木为风化，木克脾土。胃是脾的腑，所以胃中有风，抽搐逐渐产生。其抽搐的状态是：两肩微微耸起，两手垂下，时不时动摇不停，名叫慢惊风。适宜用青州白丸子、苏合丸加入姜汁杵匀，米汤调服。虚极者，加金液丹。
虞抟说：慢惊风，是因为吐泻日久，中气大虚而得的。大概脾虚则生风，风盛则筋脉拘急。适宜用温白丸。
我（沈金鳌）按语：说脾虚则生风，并非风从脾脏生出，而是因为脾虚则肝木必然亢盛，风其实是生于肝脏的。所以风盛则筋脉拘急，因为肝主筋的缘故。看温白丸中的僵蚕、全蝎、白附子、天麻等药，都是治疗肝脏的药物，由此可见。
李曰：阴证慢惊风，是从阳证急惊风传变而来。才经过吐泻，就是慢惊风。男子以腹泻为重，女子以呕吐为重。慢惊风因吐泻而得的，适宜用醒脾散、加味术附汤。虚风痰多者，适宜用八仙散。慢惊风纯阴证，适宜用乌蝎散。如果还有阳证尚在，适宜用蝉蝎散。如果有急惊方传变为慢惊候，但还有阳证，八候（指慢惊风的八种征象）尚在，不必回阳。只需截风调胃，用蝉蝎散、醒脾散。如果手足冰冷，才可以回阳，用硫黄、附子。大便滑泄青色者，宜防慢惊风。因为泻青色乃是夹惊，是木克土的表现。
李杲说：小儿慢惊风，或者吐利不止，变成虚风抽搐的，不是风邪，而是胃气欲绝。用来复丹五粒研碎，米汤调服，立即见效。
史演山说：慢惊风的候证，大概是由于急惊风过用寒凉药物，或者转变太骤，传变而成。又有吐利不止而成的，有气虚暴吐泻而成的，有夏季脾胃伏热，大吐泻，应当解暑热，不可专一固护阳气。有脏虚洞泻而成的，有得之久咳发作成痫的，有得之癫痫不已的，有得之虫积冲心的。只有吐泻积痢成虚导致的，则病症变化很快。凡是才经过吐泻，就是慢惊风。须用温中扶里。如果抽搐来得紧急，乃是慢惊初传，还有阳证，不可误作急惊风。世人说抽搐慢就是慢惊风，是不对的。如果拘泥于此，往往把慢脾风指认为慢惊风了。凡是慢惊风，男子以腹泻为重，女子以呕吐为重。另外呕吐有五症，腹泻有五症，各自明确病因主治。古话说：病家怕惊不怕泻，医家怕泻不怕惊。如果因泄泻不止，且先治泻。如果再去治风，则惊风会更严重。如果因其他病症，则应当遵循原发病施治。其慢惊风候证，如果从急惊风传来，只可截风调胃，均平阴阳，不可全用阳药，使阳气归位，又发作成急惊风的病症。
张涣说：急惊风因为关窍不通，略用冰片、麝香开通，定其抽搐尚可。慢惊风阴重阳亏，诸经已虚，不宜开通。又凉其脏腑，容易变成慢脾风，导致不易治疗。
闻人某说：慢惊风危急，如眼睛昏定，定而砭刺，虽然砭刺但不左右顾盼，或者窜视，四肢厥冷，汗出如流，口面颜色黪暗，指甲黑，四体下垂，至重。慢惊风症，眼睛半开半合，似睡非睡。其脉象或浮或沉，身体或热或凉，或吐或泻，或不吐不泻，或食乳，或拒乳，名叫半阴半阳合病，就像伤寒的半表半里证一样。
叶桂说：慢惊风古称阴痫。其治法，急培脾胃，理中汤为主方。有痰呕吐，用南星、白附子、六君子汤。声音不出，开窍，加竹沥、姜汁、菖蒲根、郁金之类。这个病，都是他病致变，其原因不一。有过饥、禁食气伤的，有峻药强灌伤胃的，有暴吐暴泻，脾胃两败的。其症见面青唇白，身无热，即使有热也不甚，短气骨软，昏倦如寐，都用温补治疗。只有呕逆不受乳食，温补反佐黄连、干姜，用连理汤、钱氏益黄散、钱氏异功散。
Qian Yi stated: Slow convulsion (Man Jing Feng) occurs after a severe illness, or following vomiting and diarrhea, or only vomiting without diarrhea, resulting in deficiency and damage of the Spleen and Stomach. The whole body becomes cold, the breath from the mouth and nose is also cold, and the limbs occasionally experience clonic spasms (Rong Zhu). The patient sleeps deeply with eyes half-open, revealing the whites.
This indicates the exhaustion of Yang Qi. It is appropriate to treat with Gualou Tang (Trichosanthes Decoction).
Zhang Yuansu stated: Slow convulsion belongs to Yin syndromes. All involve disease affecting the Zang organs.
Zeng Shi stated: Regarding the treatment of slow convulsion, ancient texts provide little basis, recording only Yin epilepsy. Generally, slow convulsion belongs to Yin; Yin governs stillness, hence the spasms are slow, thus named "slow." Its symptoms arise from external contraction of Wind-Cold, internal dysfunction causing vomiting and diarrhea, or occurring after a severe illness, or as a result of misdiagnosis and improper transmission. The gaze is dull and confused, limbs move asymmetrically, saliva flows from the corners of the mouth, the body is slightly warm, eyes roll upward or deviate sideways, hands may be clenched in spasms, or feet may jerk. Differentiate based on whether the male's left side or female's right side spasms first; this is considered favorable (Shun). The opposite is unfavorable (Ni). The breath is cold and slow, or the fontanelle is sunken, indicating deficient heat. The pulse is deep and powerless. During sleep, the eyes are half-open and half-closed, termed "Yang Jing" (raising eyes). This signifies the depletion of True Yang and the predominance of Yin pathogenic factors. Excess Yin generates Cold; Cold transforms into Water; Water generates Liver Wood; Wood generates Wind; Wood overacts on Spleen Earth. Since the Stomach is the Fu organ of the Spleen, Wind exists in the Stomach, leading to gradual onset of spasms. The manifestation of these spasms includes slight elevation of both shoulders, hanging down of both hands, and continuous intermittent trembling, named Slow Convulsion. It is appropriate to use Qingzhou Bai Wan (White Pills of Qingzhou) and Suhé Wan (Styrax Pill), mixed with ginger juice, and taken with rice water. For extreme deficiency, add Jin Ye Dan (Golden Pellet).
Yu Tun stated: Slow convulsion results from prolonged vomiting and diarrhea causing significant deficiency of Middle Qi. Deficiency of the Spleen generates Wind; excess Wind causes tendon tension. It is appropriate to use Wenbai Wan (Warm White Pill).
I (Shen Jin'ao) note: Saying "Spleen deficiency generates Wind" does not mean Wind originates from the Spleen. Rather, Spleen deficiency leads to hyperactivity of Liver Wood, so Wind actually originates from the Liver. Thus, excess Wind causes tendon tension because the Liver governs the tendons. This is evident from the ingredients of Wenbai Wan, such as Jiangcan (Bombyx Batryticatus), Quanxie (Scorpio), Baifuzi (Aconitum Kusnezoffii Rhizome), and Tianma (Gastrodiae Rhizoma), all of which are herbs treating the Liver.
Li stated: Yin syndrome slow convulsion transmits from Yang syndrome acute convulsion (Ji Jing Feng). Once vomiting and diarrhea occur, it becomes slow convulsion. In males, diarrhea is more severe; in females, vomiting is more severe. For slow convulsion caused by vomiting and diarrhea, Xingpi San (Spleen-Awakening Powder) or Jiawei Shu Fu Tang (Modified Atractylodes and Aconite Decoction) is appropriate. For deficient Wind with much phlegm, Baxian San (Eight Immortals Powder) is appropriate. For pure Yin syndrome slow convulsion, Wuxie San (Scorpion Powder) is appropriate. If Yang syndrome signs persist, Chanxie San (Cicada and Scorpion Powder) is appropriate. If acute convulsion has transmitted to slow convulsion signs but Yang syndrome remains and the eight signs of slow convulsion are present, there is no need to restore Yang. Instead, stop Wind and regulate the Stomach using Chanxie San and Xingpi San. Only if the hands and feet are cold should one restore Yang using Liuhuang (Sulfur) and Fuzi (Prepared Aconite Root). For slippery green stools, prevent slow convulsion. Green stool indicates夹杂惊 (mixed with fright), representing Wood overacting on Earth.
Li Dongyuan stated: In children, slow convulsion, or persistent vomiting and diarrhea transforming into deficient Wind spasms, is not due to Wind, but rather the impending exhaustion of Stomach Qi. Using Laifu Dan (Revival Pellet), five pills crushed and taken with rice water, yields immediate effect.
Shi Yanshan stated: The presentation of slow convulsion generally arises from the excessive use of cold-cooling medicines for acute convulsion, or overly rapid transformation. It can also result from persistent vomiting and diarrhea, sudden vomiting and diarrhea due to Qi deficiency, summer-heat and dampness stagnating in the Spleen and Stomach causing severe vomiting and diarrhea (requiring resolution of summer-heat rather than solely securing Yang), deficiency of Zang organs causing profuse watery diarrhea, chronic cough evolving into epilepsy, unceasing epilepsy, or intestinal parasites rushing to the Heart. Only when vomiting, diarrhea, dysentery, and accumulation transform into deficiency do the symptoms change rapidly. As soon as vomiting and diarrhea occur, it is considered slow convulsion. One must use warming the Middle and supporting the Interior. If spasms come urgently, it is the initial transmission of slow convulsion, still retaining Yang signs; do not mistake it for acute convulsion. The common saying that "slow spasms equal slow convulsion" is incorrect. Adhering to this often leads to misidentifying Man Pi Feng (Slow Spleen Wind) as slow convulsion. In slow convulsion, diarrhea is heavier in males, vomiting in females. There are five types of vomiting and five types of diarrhea, each requiring specific etiological and therapeutic differentiation. Ancient wisdom states: Patients fear convulsion more than diarrhea; physicians fear diarrhea more than convulsion. If diarrhea persists, treat the diarrhea first. Treating Wind concurrently will exacerbate the convulsion. If due to other diseases, treat according to the original cause. If slow convulsion transmits from acute convulsion, only stop Wind and regulate the Stomach to balance Yin and Yang. Do not use exclusively Yang-warming medicines, lest Yang returns excessively and reverts to acute convulsion symptoms.
Zhang Huan stated: Acute convulsion involves blocked orifices; slight use of Bingpian (Borneol) and Shexiang (Musk) to open them can stabilize spasms. Slow convulsion features Yin excess and Yang deficiency, with all meridians already depleted; opening is inappropriate. Cooling the Zang organs easily leads to Man Pi Feng (Slow Spleen Wind), making it difficult to treat.
Renren Mou stated: Slow convulsion is critical. If the eyes are fixed and dull, even after bloodletting (Bian), they do not look around or dart. Limbs are cold, sweat flows like water, face and mouth are dark, nails are black, and limbs hang limp—this is extremely severe. Slow convulsion presents with eyes half-open and half-closed, appearing asleep but not quite. The pulse may be floating or deep; the body may be hot or cool; there may be vomiting or diarrhea, or neither; feeding may be accepted or refused. This is called Half-Yin Half-Yang Combined Disease, similar to the Shaoyang stage in Shanghan (Cold Damage).
Ye Tianshi stated: Slow convulsion was anciently called Yin Epilepsy. The treatment method urgently tonifies the Spleen and Stomach, using Lizhong Tang (Regulate the Middle Decoction) as the primary formula. With phlegm and vomiting, use Nanxing (Arisaematis Rhizoma), Baifuzi, and Liujunzi Tang (Six Gentlemen Decoction). For loss of voice, open the orifices by adding Zhuli (Bamboo Sap), Jiangzhi (Ginger Juice), Changpu Gen (Acori Tatarinowii Rhizoma), and Yujin (Curcumae Radix). This disease results from transformations of other illnesses with various causes: starvation or fasting damaging Qi, harsh drugs forcibly administered damaging the Stomach, violent vomiting and diarrhea causing dual failure of Spleen and Stomach. Symptoms include blue complexion and white lips, absence of fever (or mild fever), shortness of breath, soft bones, drowsiness resembling sleep—all treated with warming and tonification. Only if there is vomiting and refusal of milk/food should warming tonification be counterbalanced with Huanglian (Coptidis Rhizoma) and Ganjiang (Zingiberis Rhizoma), using Lianli Tang (Coptis and Poria Decoction), Qian Shi Yihuang San (Master Qian's Yellow Fortifying Powder), or Qian Shi Yigong San (Master Qian's Meritorious Service Powder).