议曰慢脾风候即是慢惊风所传元由吐泻脾虚惊与风传入故曰脾风谓其脾家受风者更逐风
无风
可逐若也逐惊无惊可疗但有疗涎虚热来去儿病至此所以难医盖由症与候惊与风传经已极总归
虚
处惟脾所受何故不曰胃风胃属阳其病即传阴脏故无胃候儿既尚有胃气可以一向生胃兼与回阳
即渐苏省若更一向攻击惊风脾亦不受而又传散诸经不可得而加药若见眼合即是脾风宜服下
项药
议治慢脾风乃是不得已而设其疾危如灯无油渐见昏灭钱氏所用全液丹又青州白丸子各半
细研
和匀饭饮薄荷汤下一两半两许此乃截风回阳又一方以四君子汤加黑附子末四分之二脚手冰冷
者用和对半生姜枣子煎与服此万古人用之岂不同常所较下项良方亦尽世之善也
议治慢惊慢脾须禁脑麝腻粉水银粉霜之项及寒凉动脏脂等或以燥热俱不可用只宜回阳醒
脾汤使与服
议慢脾风候十个孩儿有个以艾灸之须当斟酌病候有已来脉绝之理若也一脏绝即不可用药
谓如眼无光指甲黑四肢垂 五体俱冷并不可勉强下药
议慢惊风候至于痰涎在膈之时诸脏皆虚喉中声如拽锯一二日之间不散但只闭目此乃虚之
盛也只是虚痰饱养其气未有所知之者直便下去痰涎其儿随时化去宜用下项妙沙丹服之乃良
议婴孩所患急惊慢惊脾三者皆由风痰所作以渐传及未有初得病而便慢脾或急惊传来或即
吐泻
而得久痢其气虚脱而得伤寒表里俱虚传入阴症亦成慢候久嗽成痫亦传慢候霍乱吐利亦传慢候
脾困久睡亦作慢候吐血亦传慢候虫积冲心亦传慢候肝风筋惫亦传慢候大小便闭亦作慢候心虚
烦躁亦作慢候烦渴引饮亦传慢候腹肚 痛亦传慢候睡里切牙亦传慢候般日夜汗出亦传慢候走
马疳急亦传慢候诸丹毒亦传慢候龙带缠腰亦传慢候膀胱吊疝卵肿茎曲亦传慢候(茎曲阴茎勾
曲)四体浮肿亦传慢候以上小儿所患诸疾皆能传作慢惊风候由慢惊乃传作慢脾脾气既绝胃气
已尽无可得而治疗故也
议婴孩五脏易冷易热易虚易实医方并不治脐受病曰脾不病耳曰非也小儿在腑有疾自愈者
有之
在脏不可不治脏者阴属腑者阳属谓小儿先阴而后阳又曰小儿乃纯阳之气在腑则顺在脏则逆故
前贤皆理其脏未言治腑也又肾一脏常主虚不可攻疗若有肾脏患但清心肺绿心与肾即既济也肺
与肾乃子母也无与肾药及诸补药若治肾脏即他病发生故戒上不可疗
议婴孩慢候皆由脏虚阳亏阴盛应小儿所患脏病阳虚阴盛者无不入慢候而毙惟吐与泻痢与积
致入慢
候其症速也虚又速也宜用良方治法循其次第无不获安然其慢惊脾无令速愈顿瘳之理既和且平
更用调脾养胃万万不可过剂用冷热汤药若失之即吁哉
议曰:慢脾风候,即是慢惊风所传变而来。其根本原因在于吐泻导致脾虚,惊与风邪传入,故称为“脾风”,意指脾脏受风邪侵袭。若再逐风,则无风可逐;若再治惊,则无惊可疗。唯有治疗涎多、虚热往来。患儿病至此阶段,所以难以医治。盖因症状与证候中,惊与风已传经至极,总归归于虚处,唯脾脏受累。为何不称“胃风”?因为胃属阳,其病即传至阴脏,故无“胃候”。小儿既然尚有胃气,便有一线生机,兼用回阳之法,即可逐渐苏醒。若再继续攻伐惊风,脾亦不能承受,且病邪会传散至诸经,此时不可再加药。若见眼睑闭合,即是脾风之象,宜服用下列药物。
议:治疗慢脾风,乃是不得已而设的治法。其病情危重如灯油将尽,渐渐昏灭。钱乙(钱氏)所用的全蝎丸(注:原文作“全液丹”,据《活幼口议》及后世考证,此处指代含全蝎等熄风药方,或为笔误,依原文译作全液丹,但按中医常识常指全蝎类方,此处严格依原文翻译为全液丹),又青州白丸子,各取一半,细研和匀,以饭饮或薄荷汤送服一两半至二两许。此乃截断风邪、回阳救逆之法。另一方案是用四君子汤加入黑附子末四分之二,若手足冰冷者,用附子与药粉对半,加生姜、大枣煎服。这是万代古人使用的方法,难道不同于平常吗?所比较的下述良方,也是世间极好的方剂。
议:治疗慢惊、慢脾,必须禁用脑麝、腻粉、水银、粉霜之类,以及寒凉动脏的脂类等,或以燥热之品,都不可使用。只宜服用回阳醒脾汤使其服用。
议:慢脾风候,十个孩子中有一个,需用艾灸治疗。须当斟酌病情,若有脉绝之理,若某一脏气绝,则不可用药。例如:眼睛无光、指甲发黑、四肢下垂、五体俱冷,均不可勉强下药。
议:慢惊风候,至于痰涎停留在膈部之时,诸脏皆虚,喉中声音如拉锯,一二日之间不散,只是闭目。这是虚盛之象,也只是虚痰。饱养其气,未有所知者,直接下去痰涎,患儿随即死亡。宜用下述妙沙丹服用,乃是良方。
议:婴孩所患急惊、慢惊、脾风三者,皆由风痰所作,逐渐传变而来。未有初得病便是慢脾风,或是从急惊传来,或是因吐泻而得,久痢导致气虚脱而得,伤寒表里俱虚传入阴症亦成慢候,久嗽成痫亦传慢候,霍乱吐利亦传慢候,脾困久睡亦作慢候,吐血亦传慢候,虫积冲心亦传慢候,肝风筋惫亦传慢候,大小便闭亦作慢候,心虚烦躁亦作慢候,烦渴引饮亦传慢候,腹肚疼痛亦传慢候,睡里切牙亦传慢候,昼夜汗出亦传慢候,走马疳急亦传慢候,诸丹毒亦传慢候,龙带缠腰亦传慢候,膀胱吊疝卵肿茎曲亦传慢候(茎曲指阴茎勾曲),四体浮肿亦传慢候。以上小儿所患诸疾,皆能传作慢惊风候。由慢惊乃传作慢脾,脾气既绝,胃气已尽,无可得而治疗,故也。
议:婴孩五脏易冷易热、易虚易实。医方并不治脐受病,说“脾不病耳”,我说“非也”。小儿在腑有疾自愈者有之,在脏不可不治。脏者阴属,腑者阳属。谓小儿先阴而后阳。又曰小儿乃纯阳之气,在腑则顺,在脏则逆。故前贤皆理其脏,未言治腑也。又肾一脏常主虚,不可攻疗。若有肾脏患,但清心肺,心与肾即既济也。肺与肾乃子母也,无与肾药及诸补药。若治肾脏,即他病发生,故戒上不可疗。
议:婴孩慢候皆由脏虚、阳亏、阴盛所致。应小儿所患脏病阳虚阴盛者,无不入慢候而毙。惟吐与泻、痢与积致入慢候,其症速也,虚又速也。宜用良方治法,循其次第,无不获安然。其慢惊脾无令速愈顿瘳之理,既和且平,更用调脾养胃,万万不可过剂用冷热汤药。若失之,即吁哉。
Translation:
It is discussed that the syndrome of Slow Spleen Wind (Man Pi Feng) is a progression from Slow Convulsion (Man Jing Feng). Its root cause lies in vomiting and diarrhea leading to Spleen deficiency, with惊 (Jing/Fright) and Wind pathogens invading. Hence it is called "Spleen Wind," indicating the Spleen organ is affected by Wind. If one attempts to expel Wind, there is no Wind to expel; if one attempts to treat Fright, there is no Fright to treat. One can only treat excessive saliva and alternating deficiency heat. When a child's illness reaches this stage, it is difficult to cure. This is because the symptoms and signs indicate that Fright and Wind have transmitted through the meridians to the extreme, ultimately returning to a state of deficiency, specifically affecting the Spleen. Why is it not called "Stomach Wind"? Because the Stomach belongs to Yang; its disease immediately transmits to Yin organs, thus there is no "Stomach Syndrome." Since the child still possesses Stomach Qi, there is a chance for life. By simultaneously using methods to restore Yang, the child may gradually regain consciousness. However, if one continues to attack the Fright and Wind, the Spleen cannot withstand it, and the pathogen will scatter to various meridians, at which point further medication should not be added. If the eyelids are seen closing, this is the sign of Spleen Wind, and the following medicines should be administered.
Discussion: The treatment of Slow Spleen Wind is a measure of last resort. The condition is critical, like a lamp running out of oil, gradually dimming and extinguishing. The Quan Ye Dan (Full Liquid Pill) used by Qian Yi (Qian Shi), along with Qingzhou Bai Wan Zi (White Pills of Qingzhou), each taken in half portions, are finely ground and mixed evenly. They are administered with rice water or Bohe Tang (Mint Decoction), in doses of 1.5 to 2 liang. This method aims to intercept Wind and restore Yang. Another prescription uses Si Jun Zi Tang (Four Gentlemen Decoction) added with 2/4 parts of Hei Fu Zi Mo (Black Aconite Powder). For those with cold hands and feet, equal parts of Aconite and powder are used, decocted with Sheng Jiang (Fresh Ginger) and Zao (Jujube). This has been the method used by sages across generations; is it not consistent with common practice? The superior formulas listed below are also among the best in the world.
Discussion: In treating Slow Convulsion and Slow Spleen, one must strictly prohibit the use of Nao She (Camphor and Musk), Ni Fen (Calamine/Powder), Shui Yin Fen (Mercury Powder), Fen Shuang (White Lead Powder), as well as fatty substances that are cold-cooling and disturb the Zang organs, or overly drying and heating agents. None of these should be used. Only Hui Yang Xing Pi Tang (Decoction to Restore Yang and Awaken the Spleen) should be administered.
Discussion: Regarding Slow Spleen Wind, one in ten children requires moxibustion. One must carefully assess the condition. If there is a rationale of pulse disappearance (Mai Jue), meaning one Zang organ's Qi has ceased, medication should not be given. For example, if the eyes lack luster, nails are black, limbs hang limp, and all five bodies are cold, one must not forcibly administer medicine.
Discussion: In the syndrome of Slow Convulsion, when Phlegm-Saliva remains in the Diaphragm region, all Zang organs are deficient. The sound in the throat resembles sawing wood. If it does not dissipate within one or two days, and the child merely keeps their eyes closed, this indicates an extreme state of deficiency, specifically deficiency Phlegm. Nourishing the Qi without understanding this leads to direct expulsion of Phlegm-Saliva, causing the child to perish instantly. One should administer Miao Sha Dan (Wonderful Sand Pill) as listed below, which is a good formula.
Discussion: The acute convulsion, slow convulsion, and spleen wind suffered by infants are all caused by Wind-Phlegm, transmitting gradually. It is rare for a child to present with Slow Spleen Wind immediately upon onset. It may be transmitted from Acute Convulsion, or acquired through vomiting and diarrhea, chronic dysentery leading to Qi collapse, or Taiyang/Taiyin syndromes where exterior and interior are both deficient transmitting into Yin syndromes forming slow conditions. Chronic cough leading to epilepsy also transmits to slow conditions. Cholera with vomiting and diarrhea also transmits to slow conditions. Spleen fatigue with prolonged sleep also becomes a slow condition. Hematemesis also transmits to slow conditions. Intestinal parasites rushing to the heart also transmits to slow conditions. Liver Wind with tendon exhaustion also transmits to slow conditions. Constipation and urinary retention also become slow conditions. Heart deficiency with irritability also becomes a slow condition. Thirst with desire to drink also transmits to slow conditions. Abdominal pain also transmits to slow conditions. Teeth grinding during sleep also transmits to slow conditions. Day and night sweating also transmits to slow conditions. Rapid-progressing gan ulcers (Zou Ma Gan) also transmit to slow conditions. Various toxic rashes also transmit to slow conditions. Snake-like belt sores (Long Dai Chan Yao) also transmit to slow conditions. Bladder hernia with swollen testicles and curved penis (Sheng Qu) also transmit to slow conditions. Generalized edema also transmits to slow conditions. All the aforementioned diseases in children can transmit into Slow Convulsion syndrome. From Slow Convulsion, it transmits to Slow Spleen. Once Spleen Qi is exhausted and Stomach Qi is depleted, there is no way to treat it.
Discussion: The five Zang organs of infants are prone to becoming cold or hot, deficient or excess. Medical texts often state that illnesses affecting the umbilicus do not affect the Spleen, saying "the Spleen is not diseased." I say this is incorrect. Infants may recover spontaneously from diseases in the Fu organs, but diseases in the Zang organs must be treated. Zang organs belong to Yin, Fu organs to Yang. It is said that infants prioritize Yin before Yang. Also, infants possess Pure Yang Qi; diseases in Fu organs follow the natural flow (Shun), while diseases in Zang organs go against it (Ni). Therefore, ancient experts focused on regulating the Zang organs and did not speak of treating Fu organs. Furthermore, the Kidney organ is often associated with deficiency and should not be attacked. If there is a Kidney pathology, one should only clear the Heart and Lung. When Heart and Kidney interact, they achieve mutual intersection (Ji Ji). Lung and Kidney have a mother-child relationship. Do not administer Kidney tonics or other supplement drugs. Treating the Kidneys directly may trigger other diseases; hence, it is warned that upper treatments should not target the Kidneys directly.
Discussion: Infant slow conditions are all caused by Zang deficiency, Yang depletion, and Yin abundance. Any infant suffering from Zang diseases characterized by Yang deficiency and Yin abundance will inevitably enter a slow condition and perish. Only vomiting, diarrhea, dysentery, and accumulation lead rapidly to slow conditions due to their rapid nature and resulting deficiency. One should use excellent formulas and methods, following the proper sequence, to ensure safety. There is no principle of rapid recovery for Slow Convulsion and Slow Spleen; the approach must be harmonious and balanced. Further, use formulas to regulate the Spleen and nourish the Stomach. One must absolutely avoid overdosing with cold or hot decoctions. Failure to adhere to this leads to disaster.