周岁女婴，病经两月，消散多剂，脾元内伤，面青目定，肢掣指冷，证属慢惊。势颇危
殆。
无风可逐，无惊可疗。治惟温补脾阳，百中冀图一二。病缘脾元大亏，木横土困，变生慢惊
，屡进六君温补脾元，已臻小效。日来停药，神形复疲，小儿脏腑柔脆，初生萌芽，非苍枝
老干可比。根蒂伤伐，恐难图效，尽人工以邀天眷耳。
安波按∶惊风一途，初感即发为急惊慢惊，总缘食积伤脾，脾伤则木恣其所侮，宜培
土之中，兼以抑木。虽圣人复起，不易吾言矣。丁酉仲春志。
本证风痱，近加受暑，脉虚身热，倦怠口渴。经云∶脉虚身热，得之伤暑，暑伤气是以
倦怠
。夫暑乃六淫标邪，虽无大害，特恐质亏不胜病耳。商仿清暑益气汤大意，以俟消息。脉仍
虚急，热甚心烦，夜不安寐，方内酌除 术，加以玉竹，本草言其用代参 ，不寒不燥，且
能治风淫湿毒，寒热 疟，大便五日未圊，小溲数热，肺与大肠相表里，又与膀胱通气化
。
古人治暑证，每用生脉散者，以其有保肺清金之能也。病躯加受暑邪，恙经六日，两进清暑
益气，辅正涤邪，形倦肤干，热仍 ，心烦口渴，溲数便闭。张介宾云∶干锅赤裂，润自
何来，但加以水，则郁蒸畅然，而气化四达。宗玉女煎。早服玉女煎，薄暮复视，病势依然
。暑邪留着，原难急驱。今日已服药两渣，末便再进，暂与荷蜜煎代茶。便通肤泽，往日早
晨热缓，交午复甚，心内如焚，今午热势平和，无焦烦辗转之状，病躯治标，亦不得已。兹
既势平，自当斟酌，无使过也。前药退松，昨午其热复甚，溲数口渴，心如煎熬，质虚恙重
，况加反复，切虚更改。揣诸病情，得无心营胃液，为热灼伤，以致焦烦嘈杂者欤。宗阿胶
鸡子黄汤法。
安波按∶方议均佳。
【背景信息】
书名：程杏轩医案 作者：程杏轩 朝代：清 章节：方女慢惊 / 某妪本病风痱加感暑邪 类别：医论
【待处理原文】
周岁女婴，病经两月，消散多剂，脾元内伤，面青目定，肢掣指冷，证属慢惊。势颇危殆。
翻译：
一名周岁大的女婴，患病两个月，经过多次使用消食导滞、疏散外邪的药物治疗后，导致脾胃元气内部受损，出现面色发青、目光呆滞固定、四肢抽搐、手指冰冷等症状，此证属于慢惊风（小儿慢性惊厥）。病情相当危险。
无风可逐，无惊可疗。治惟温补脾阳，百中冀图一二。病缘脾元大亏，木横土困，变生慢惊，屡进六君温补脾元，已臻小效。日来停药，神形复疲，小儿脏腑柔脆，初生萌芽，非苍枝老干可比。根蒂伤伐，恐难图效，尽人工以邀天眷耳。
翻译：
此时体内没有实风可以驱散，也没有急惊可以治疗。治疗方法唯有温补脾阳，在百次尝试中希望有一两次能奏效。病因是脾胃元气严重亏损，肝木之气横逆克制脾土，导致脾土困顿，从而变化生成慢惊风。此前多次使用六君子汤（由人参、白术、茯苓、甘草、陈皮、半夏组成，具有益气健脾、燥湿化痰功效的方剂）来温补脾胃元气，已经取得了微小的疗效。近日停止服药后，精神形体再次疲惫。小儿的脏腑柔弱脆弱，如同刚萌发的幼苗，不能与苍劲的老树干相比。根基受到损伤和砍伐，恐怕难以再求得疗效，只能尽力运用人为医疗手段以求得天意的眷顾罢了。
安波按∶惊风一途，初感即发为急惊慢惊，总缘食积伤脾，脾伤则木恣其所侮，宜培土之中，兼以抑木。虽圣人复起，不易吾言矣。丁酉仲春志。
翻译：
程安波按语：惊风这一类疾病，初次感受病邪随即发作的，分为急惊风和慢惊风，总归是因为饮食积滞损伤了脾胃。脾胃受伤，则肝木之气就会肆意地欺侮脾土（五行中木克土，脾虚则肝乘之），适宜在培补脾土的同时，兼顾抑制肝木。即使是圣人复活，也不会改变我的这番言论。记录于丁酉年仲春。
本证风痱，近加受暑，脉虚身热，倦怠口渴。经云∶脉虚身热，得之伤暑，暑伤气是以倦怠。夫暑乃六淫标邪，虽无大害，特恐质亏不胜病耳。商仿清暑益气汤大意，以俟消息。
翻译：
这位患者原本患有风痱（一种以肢体痿废不用为主要表现的病症），近期又加上感受暑邪，出现脉象虚弱、身体发热、疲倦乏力、口渴的症状。《黄帝内经》说：脉象虚弱且身体发热，是由于感受暑邪所致，暑邪损伤人体正气，所以会导致疲倦乏力。暑邪属于六淫（风、寒、暑、湿、燥、火六种外感病邪）中的标邪，虽然本身没有太大危害，但特别担心患者体质虚弱，无法承受病邪的侵害。商量着模仿清暑益气汤（李东垣方，具有清暑益气、养阴生津功效的方剂）的大致思路，以此等待病情的变化。
脉仍虚急，热甚心烦，夜不安寐，方内酌除 术，加以玉竹，本草言其用代参 ，不寒不燥，且能治风淫湿毒，寒热 疟，大便五日未圊，小溲数热，肺与大肠相表里，又与膀胱通气化。
翻译：
脉象仍然虚弱而急促，发热严重导致心中烦躁，夜晚不能安稳入睡。在处方中酌情去除白术（或苍术，具燥湿健脾功效），加入玉竹（一种滋阴润燥的药材）。本草书籍记载其作用可以代替人参，药性不寒不燥，而且能够治疗风邪淫溢、湿毒以及寒热往来的疟疾。患者大便五天没有排便，小便频数且灼热。肺与大肠互为表里，（玉竹又能）协助膀胱进行气化功能。
古人治暑证，每用生脉散者，以其有保肺清金之能也。病躯加受暑邪，恙经六日，两进清暑益气，辅正涤邪，形倦肤干，热仍 ，心烦口渴，溲数便闭。张介宾云∶干锅赤裂，润自何来，但加以水，则郁蒸畅然，而气化四达。宗玉女煎。
翻译：
古代医生治疗暑证，经常使用生脉散（由人参、麦冬、五味子组成，具有益气复脉、养阴生津功效的方剂），是因为它具有保护肺气、清肃肺金（肺属金）的能力。患者病体之上又感受暑邪，病程经过六天，两次服用清暑益气汤，辅助正气、涤除邪气，但形体依然疲倦、皮肤干燥，发热仍然存在，心中烦躁口渴，小便频数、大便闭塞。张介宾（明代医家）说：就像干烧的铁锅红热开裂，滋润从何而来？只要加上水，那么郁结蒸腾之气就能通畅，气化功能就能通达四方。遵循玉女煎（由石膏、熟地黄、麦冬、知母、牛膝组成，具有清胃热、滋肾阴功效的方剂）的思路。
早服玉女煎，薄暮复视，病势依然。暑邪留着，原难急驱。今日已服药两渣，末便再进，暂与荷蜜煎代茶。便通肤泽，往日早晨热缓，交午复甚，心内如焚，今午热势平和，无焦烦辗转之状，病躯治标，亦不得已。兹既势平，自当斟酌，无使过也。前药退松，昨午其热复甚，溲数口渴，心如煎熬，质虚恙重，况加反复，切虚更改。揣诸病情，得无心营胃液，为热灼伤，以致焦烦嘈杂者欤。宗阿胶鸡子黄汤法。
翻译：
早上服用玉女煎，傍晚再次诊视，病情势头依然如故。暑邪留滞体内，本来就很难迅速驱除。今天已经服用了两副药的药渣（意指两剂药），不便再继续进服，暂时给予荷叶蜂蜜煎剂代替茶饮。后来大便通畅、皮肤润泽，以往早晨热度稍缓，到了中午又加重，内心像被焚烧一样难受，今天中午热势变得平和，没有焦躁烦恼、翻来覆去的状态。对于病体来说，治疗标症也是不得已而为之。现在既然势头平稳，自然应当斟酌调整，不要过度治疗。之前的药物效力减退松弛，昨天中午热度再次加重，小便频数、口渴，内心像受煎熬一样，体质虚弱、疾病沉重，况且病情反复，必须谨慎更改方案。推测各种病情，难道是心的营血和胃的津液，被热邪灼伤，从而导致焦躁烦恼、胃中嘈杂不适吗？遵循阿胶鸡子黄汤（由阿胶、鸡子黄、生地、白芍、甘草、茯神组成，具有滋阴养血、熄风止痉功效的方剂）的方法。
安波按∶方议均佳。
翻译：
程安波按语：处方的议论都非常好。
[Background Information]
Book: Cheng Xingxuan's Medical Cases; Author: Cheng Xingxuan; Dynasty: Qing; Chapter: Fang Girl's Slow Convulsion / Certain Matron's Original Disease of Wind Paralysis Complicated by Summerheat Pathogen; Category: Medical Discussion
[Original Text Processing]
A one-year-old female infant has been ill for two months. After multiple doses of digestive and dispersing prescriptions, the Spleen Yuan (fundamental energy of the Spleen) was internally damaged. She presents with a bluish complexion, fixed gaze, limb convulsions, and cold fingers. The syndrome belongs to Slow Convulsion (chronic pediatric convulsion). The condition is quite critical.
There is no wind to dispel, nor is there acute fright to treat. The treatment lies solely in warming and tonifying the Spleen Yang, hoping for success in one or two out of a hundred attempts. The disease originates from a severe deficiency of Spleen Yuan, where Liver Wood overacts upon Earth, causing Earth to be constrained, thereby transforming into Slow Convulsion. Repeated administration of Liu Jun Zi Tang (Six Gentlemen Decoction, a formula for tonifying Qi and strengthening the Spleen) to warm and tonify Spleen Yuan had already achieved slight efficacy. However, after stopping medication recently, her spirit and physical form have become fatigued again. Children's Zang-Fu organs are tender and fragile, like newly sprouted seedlings, not comparable to old, tough tree trunks. If the root and foundation are damaged, it is feared that efficacy will be hard to achieve; we can only exert human effort to seek heavenly favor.
Cheng Anbo’s Commentary: Regarding the category of Fright Wind, whether it manifests as Acute Fright Wind or Slow Fright Wind upon initial pathogenic invasion, it generally stems from food retention injuring the Spleen. When the Spleen is injured, Liver Wood freely insults it. Therefore, one should cultivate Earth while simultaneously suppressing Wood. Even if the Sages were to rise again, they would not change my words. Recorded in mid-spring of the Dingyou year.
This case involves original Wind Paralysis (a condition characterized by flaccid paralysis of limbs), recently complicated by summerheat invasion. The pulse is deficient, the body is hot, accompanied by fatigue and thirst. The Classics state: "Deficient pulse and body heat result from summerheat injury; summerheat injures Qi, hence fatigue." Summerheat is a superficial pathogen among the Six Excesses (Wind, Cold, Summerheat, Dampness, Dryness, Fire). Although it causes little direct harm, one must fear that the patient's deficient constitution cannot withstand the disease. We propose imitating the general principle of Qing Shu Yi Qi Tang (Clear Summerheat and Benefit Qi Decoction) to await developments.
The pulse remains deficient and rapid; severe heat causes mental restlessness and insomnia at night. In the prescription, Atractylodes (Bai Zhu or Cang Zhu) is酌情 removed, and Polygonatum Odoratum (Yuzhu) is added. Materia Medica states its use can substitute for Ginseng; it is neither cold nor drying, and can treat wind excess, damp toxins, and alternating chills and fever malaria. The bowels have not moved for five days; urination is frequent and hot. The Lung and Large Intestine are exterior-interior related, and [the herb also assists] the Bladder in Qi transformation.
Ancient physicians often used Sheng Mai San (Generate the Pulse Powder) to treat summerheat syndromes because of its ability to protect the Lung and clear Metal (Lung). On a diseased body further invaded by summerheat, after six days of illness, having taken Qing Shu Yi Qi Tang twice to support healthy Qi and eliminate pathogens, the form is still tired, skin dry, heat persists, mental restlessness and thirst continue, urination is frequent, and defecation is obstructed. Zhang Jiebin said: "Like a dry pot cracking from red heat, where does moisture come from? Only by adding water can the stagnant steaming dissipate smoothly, allowing Qi transformation to reach all directions." Following the method of Yu Nu Jian (Jade Woman Decoction).
Taking Yu Nu Jian in the morning, re-examined at dusk, the disease trend remained unchanged. Summerheat lingering in the body is originally difficult to drive out quickly. Today, two doses of decoction residue have been consumed; it is inconvenient to continue immediately. Temporarily provide Lotus Leaf and Honey Decoction as tea. Later, bowel movement became smooth, skin lustrous. Previously, heat eased in the morning but intensified at noon, with internal burning sensation. At noon today, the heat trend is peaceful, without anxious tossing and turning. Treating the branch symptoms for a debilitated body is also a necessity. Now that the trend is stable, one must deliberate carefully, avoiding excess. As the previous medicine's effect waned, yesterday at noon the heat intensified again, with frequent urination, thirst, and internal torment. With a deficient constitution and heavy disease, compounded by recurrence, changes must be made cautiously. Speculating on the condition, could it be that the Heart Ying (Nutritive Level) and Stomach fluids are scorched by heat, leading to anxiety and gastric discomfort? Following the method of E Jiao Ji Zi Huang Tang (Donkey-Hide Gelatin and Egg Yolk Decoction).
Cheng Anbo’s Commentary: The prescription discussions are all excellent.