(此证则螈病也)
按此证由于平日儿之父母,恐儿之受寒,复被过多,着衣过浓,或冬日房屋热炕过暖,以致小儿
每日出汗,汗多亡血,亦如产妇亡血致痉一理。肝主血,肝以血为自养,血足则柔,血虚则强,故曰本
脏自病。然此一痉也,又实为六淫致痉之根;盖汗多亡血者,本脏自病,汗多亡卫外之阳,则易感六
淫之邪也。全赖明医参透此理,于平日预先告谕小儿之父母,勿令过暖汗多亡血,暗中少却无穷之病
矣,所谓治未病也。治本脏自病法,一以育阴柔肝为主,即同产后血亡致痉一例,所谓血足风自灭
也。六味丸,复脉汤,三甲复脉三方,大小定风珠二方,专翕膏,皆可选用。专翕膏为痉止后,每日
服四、五钱,分二次,为填阴善后计也。六淫误汗致痉者,亦同此例。救风温、温热误汗者,先与存
阴,不比伤寒误汗者急与护阳也,盖寒病不足在阳,温病不足在阴也。
按小儿易痉之故,一由于肌肤薄弱,脏腑嫩小,传变最速;一由于近世不明六气感人之理,一
见外感无论何邪,即与发表。既痉之后,重用苦寒,虽在壮男壮女,二、三十岁,误汗致痉而死者,
何可胜数!小儿薄弱,则更多矣。余于医学,不敢自信,然留心此证几三十年,自觉洞彻此理,尝谓
六气明而痉必少,敢以质之明贤,共商救世之术也。
按语:此证是由于平日孩子的父母,担心孩子受寒,给孩子穿盖过多,衣着过厚,或者在冬天房屋里的热炕过于温暖,导致小儿每天出汗。汗出过多会耗伤阴血,其道理与产妇因失血而导致痉挛是一样的。肝主藏血,肝以血液作为自身的滋养,血液充足则筋脉柔和,血液亏虚则筋脉强急,所以称为“本脏自病”。然而这一类痉挛,实际上又是六淫(风、寒、暑、湿、燥、火)致痉的根本原因;因为汗多亡血属于本脏自病,而汗多也会耗伤卫外的阳气,从而导致容易感受六淫之邪。这完全依赖明医透彻理解这一原理,在平日里预先告知小儿的父母,不要让孩子过热导致出汗过多而耗伤阴血,从而暗中减少无穷无尽的疾病,这就是所谓的“治未病”(预防疾病)。治疗本脏自病的方法,以滋养阴液、柔润肝脏为主,这与产后失血导致痉挛的治法相同,即所谓“血液充足,内风自然熄灭”。可选用的方剂包括六味地黄丸、复脉汤、三甲复脉汤、大定风珠和小定风珠这两个方子,以及专翕膏。专翕膏用于痉挛停止后,每日服用四到五钱,分两次服用,作为填补阴精、善后调理的措施。由六淫误用发汗法导致痉挛的,也遵循同样的原则。救治因温病、温热病误用发汗法的患者,首先要保存阴液,不像伤寒病误用发汗那样急需保护阳气,这是因为寒性病不足在于阳气,温性病不足在于阴液。
关于小儿容易发生痉挛的原因,一是由于肌肤薄弱,脏腑娇嫩,病情传变速度最快;二是由于近代医生不明白六气(风、寒、暑、湿、燥、火)侵袭人体的原理,一见外感病症,无论何种邪气,就立即使用发表(发汗解表)的药物。一旦引发痉挛之后,又重用苦寒药物。即使是身体强壮的男子或女子,二三十岁的人,因误用发汗法导致痉挛而死亡的,数不胜数!小儿体质薄弱,这种情况就更多了。我在医学上不敢自信,但留心研究此证已有近三十年,自觉对此理透彻明了。曾言:如果明白了六气的致病机理,痉挛症必然会减少。我敢以此向贤明的医生请教,共同商讨拯救世人的医术。
(This syndrome is a case of convulsions and spasms.)
Commentary: This syndrome arises because parents, fearing their children may catch cold, overdress them or cover them too heavily, or keep the heated kang in winter rooms excessively warm. This causes infants to sweat daily. Excessive sweating depletes blood (Yin-blood), following the same principle as postpartum hemorrhage leading to spasms. The Liver governs blood storage; it nourishes itself with blood. When blood is sufficient, tendons are flexible; when blood is deficient, tendons become rigid. Hence, this is termed "self-disease of the Zang organ" (pathology originating within the specific organ system). However, this type of spasm is actually the root cause for spasms induced by the Six Exogenous Pathogens (Wind, Cold, Summerheat, Dampness, Dryness, Fire). Depletion of blood due to sweating constitutes a self-disease of the Zang, while excessive sweating also damages the defensive Yang (Wei Qi) that protects the exterior, making one susceptible to invasion by the Six Exogenous Pathogens. It relies entirely on enlightened physicians to thoroughly understand this principle and advise parents beforehand not to over-warm children to the point of excessive sweating and blood depletion, thereby secretly preventing countless diseases. This is known as "treating disease before it arises" (Preventive Treatment). The method for treating self-disease of the Zang focuses primarily on nourishing Yin and softening the Liver, identical to the treatment for postpartum blood-loss-induced spasms, where "sufficient blood extinguishes internal wind." Selectable formulas include Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill), Maizhong Huoxue Tang (Decoction for Reviving the Pulse), Sanjia Fumai Tang (Pulse-Reviving Decoction with Three Shells), Da Dingfeng Zhu (Great Wind-Calming Pearl) and Xiao Dingfeng Zhu (Small Wind-Calming Pearl), as well as Zhuanxi Gao (Zhuanxi Paste). Zhuanxi Gao is taken after spasms cease, four to five qian daily in two doses, as a measure to tonify Yin and manage recovery. Cases of spasms caused by erroneous sweating due to the Six Exogenous Pathogens follow this same principle. In rescuing patients with Warm Diseases or Warm-Heat Diseases who suffered from erroneous sweating, one must first preserve Yin, unlike in Cold Damage (Shanghan) cases where protecting Yang is urgent. This is because Cold diseases involve deficiency of Yang, whereas Warm diseases involve deficiency of Yin.
Regarding why infants are prone to spasms: First, their skin and muscles are thin, and their Zang-Fu organs are delicate, leading to the fastest progression of disease transmission. Second, contemporary physicians often fail to understand the mechanism by which the Six Qi (Six Exogenous Pathogens) affect humans; upon seeing any external contraction regardless of the pathogen, they immediately administer diaphoretic (sweat-inducing) methods. After spasms occur, they heavily employ bitter-cold herbs. Even among strong men and women aged twenty to thirty, deaths resulting from erroneous sweating leading to spasms are innumerable! Among infants with fragile constitutions, such cases are even more frequent. I dare not claim confidence in my medical skills, but having closely studied this condition for nearly thirty years, I feel I have thoroughly comprehended its principles. I have stated: If the nature of the Six Qi is understood, spasms will surely decrease. I venture to submit this to enlightened scholars for discussion on methods to save the world.