病由不得隐曲，以致脏真内伤，经期阻闭，女科不察病原，佥用清热安胎，愈医愈剧。
考金
匮虽有 虫丸治虚痨血痹之法，顾此羸躯，恐难胜任。即水土金俱病，古人亦无笼统治理。
议以早用四阴煎，育阴保金，晚仿周慎斋前辈，淡养胃气，甘益脾阴。盖土为物母，脾乃至
阴，其他退热止嗽之药，皆置不用。叶氏云∶勿见热而投凉，勿因咳而理肺，诚哉是言也。
形瘦阴亏，脉虚近数，证见咳嗽侧，卧汗多食少，经停九月，失红三次。据述曩因腹中微动
，疑是妊娠。经云∶妇入手少阴脉动甚者，孕子也。又云∶身有病而无邪脉也。今脉证如此
，谅非孕征。果真有孕，不过气血之虚，胎不长养，虽费调理，尚在可为，无孕则血海干枯
，
势走怯途，殊难着手。且妇人重身，即有病端，但去其病而胎自安。漫究妊娠之是否，惟
论疗治之何知。君以育阴保金，佐以调养胃气，夏至一阴能复，差可保守。
安波按∶女子以血为主，首重在乎冲任。治冲任之法，首重养血，胃为冲脉本，故阳
明气旺，则月事行。先生以育阴调胃，良由斯乎。
一热即搐，幼科呼为急惊。经云∶东方青色，入通于肝。其病发惊骇，昨日惊作，至今
热发
不退，神识昏迷，哭不出声，唇干鼻燥，舌苔中黄尖绛。虽属时感燥邪，然必挟有伏暑，两
邪相合，致病势暴如此，叫喊作努，头仰肢搐，肝风动摇，亟亟清解。守过一候，邪净热退
，庶可安稳。夏暑伏邪，秋时感发，病起三日，热甚作惊，新旧两邪，内犯心肝二脏，入心
则昏迷，入肝则抽掣。观其撮唇弄舌，尖绛苔黄，伏邪化热显著。夫邪在皮毛，疏散可解，
伏热内蕴，非清不除。病来势暴，未可因循，亟当清解伏邪，舍此别无法想。两服清解，热
退七八，惊势虽定，神犹未清，舌仍干黄，唇红目赤，伏邪未尽故也。口中生疮，火寻窍出
，心热外解之征。清药仍不可少。虑其热盛伤阴，参以养阴亦可。九朝惊定复作，余烬复燃
，肝风熄而复动，幸病不由吐泻而来，证属急惊，犹可无妨，热蕴在里，外反不热，肢反厥
冷，所谓热深厥亦深也。若谓热盛伤阴，理则有之。若直指为虚寒，思投温补，断乎不可。
仍当涤邪清热，平肝熄风。病逾两旬，惊犹未定，神迷齿 ，肢掣头摇。证由夏伏暑邪。兼
感秋燥之气，两邪相并，一热即惊。邪传手足，厥阴深伏于里，所谓脏者藏也。邪难入亦复
难出，故治法宜守。更有国中末三法，病初邪热炽甚，治宜清解，急驱其邪，不使陷伏。中
治则和阳熄风，末治惟有养阴存津，缓肝之急而已。若云初起热甚，惊作之时，当服桂枝汤
，岂不抱薪救火，而犯桂枝下咽，阳盛则毙之戒乎。是病纠缠至今，尚有生机可图者。幸能
纳谷。胃气未散。倘一投桂附温补。阳遇阳则为焦枯。胃气消亡殆尽矣。病势溃裂若此，恐
难扭转机关。伏暑至秋而发，邪陷手足厥阴，证经五十余日，肝风虽定，神躁未安。舌绛唇
红，鼻疮便结，虽属病久阴亏，而心肝伏邪，总未涤净。今岁少阴君火司天，阳明燥金在泉
，故多热燥之证。治病须明运气也。缓肝之急以熄风，滋肾之液以驱热。服药数日，躁定寐
安，时或仍有强直之状。经云∶诸暴强直，皆属于风。许宣治前辈，书称暑风惊后，强直者
，属阴虚，治当养阴舒筋，僭仿其旨。
安波按∶案内直犯心肝之句，似欠融化，盖暑邪最喜犯心，其故由肺逆传，肺病则肝
无所
制，故手足制动矣。下句有五十余日之久，其邪深入下焦阴分，故前辈以甘露复脉等方，虽
不治肝，而已治肝。下言肝风两字，日久者少似。盖肝居位不及心肺之高，岂邪一中即直赴
至阴之地乎。
安波按∶小儿惊症一候，历来惟喻氏前辈，驳之甚详，自斯泾渭析矣。其立名曰风热惊
痰四
字，愚尝溯之。盖孩提气血未充，腑脏未实，每招微感，邪留皮毛，上注于肺，失治则蔓沿
于心包络，是以视识溷蒙，目睛上吊。肺失治节之司，聚液成痰，而肝失胜己之制，得以鸱
张上逆，为抽为搐。速当辛凉开肺，甘寒退热。肺开则痰行，热清而昏定，昏定而抽搐螈
之势亦平矣。若陡用芳香全石之剂，使阴液愈亡，肺炽愈横，其祸不可待而言也。余诚怆恻
，不愧赘言。若见斯症，辄投惊药，其幼稚之衔冤无胜数矣。
许氏妇人因内心郁结不畅，导致脏腑真气内伤，月经闭止。妇科医生未能查明病因，一概使用清热安胎的药物，结果病情越治越重。
查阅《金匮要略》，虽然有鳖甲煎丸等治疗虚劳血痹的方法，但考虑到患者身体极度虚弱，恐怕难以承受攻伐之药。即使肺、脾、肾三脏均受病，古人也没有笼统统一的治疗方法。
建议早晨服用四阴煎，以滋养阴液、保护肺气；晚上效仿周慎斋前辈的做法，用清淡饮食调养胃气，用甘味药物补益脾阴。因为脾胃为后天之本，脾属至阴之脏，至于其他退热止咳的药物，全部不用。叶天士说：“不要见到发热就投用寒凉药，不要因为咳嗽就单纯调理肺部”，这话说得确实正确。
患者形体消瘦，阴液亏损，脉象虚弱接近数脉，症状表现为咳嗽时侧卧出汗多、进食少，月经停闭九个月，期间有过三次阴道出血。据患者叙述，此前因腹部有轻微跳动，怀疑是怀孕。《内经》说：“妇女手少阴心经脉搏动明显的，是怀孕的征象。”又说：“身体虽有病状，但脉象没有邪气。”如今脉证如此，推测并非怀孕征兆。如果真的有孕，不过是气血虚弱，胎儿得不到滋养，虽然需要调理，尚在可救治范围内；如果没有怀孕，则是血海干枯，病情趋向于虚损怯弱，很难着手治疗。况且妇女怀孕后，即使有病端，只要去除疾病，胎儿自然安定。不必盲目探究是否妊娠，只需讨论如何治疗即可。君主张用育阴保肺的方法，辅以调养胃气，等到夏至一阴生之时，阴气能够恢复，尚可保守治疗。
安波按语：女子以血为主，首要重视冲任二脉。治疗冲任的方法，首要在于养血，胃是冲脉的根本，所以阳明胃气旺盛，月经就能正常来潮。先生采用育阴调胃的方法，正是基于这一原理。
一发热就出现抽搐，儿科称之为急惊风。《内经》说：“东方青色，通应于肝。”其病症表现为惊恐骇怕。昨日惊厥发作，至今发热不退，神识昏迷，哭不出声音，嘴唇干燥，鼻孔燥热，舌苔中部黄而舌尖红绛。虽然属于感受时令燥邪，但必然夹杂有伏藏的暑邪，两种邪气相合，导致病势凶猛如此，叫喊用力，头向后仰，四肢抽搐，这是肝风动摇的表现，亟需紧急清解邪热。坚守治疗一个候（五天），待邪气净尽、热退之后，才可以安稳下来。夏日的暑邪潜伏体内，到秋季感发出来，病起三天，高热引发惊厥，新旧两股邪气，内犯心、肝两脏，邪入心则昏迷，邪入肝则抽搐掣动。观察其撮唇弄舌，舌苔尖部红绛中部黄，说明伏邪化热非常明显。邪气在皮毛，通过疏散可以解除；伏热蕴结在内，不清除就不能根除。病势来得迅猛，不可拖延，应当紧急清解伏邪，除此之外别无他法。服用两剂清解药后，热退了七八成，惊厥之势虽已平定，但神志仍未清醒，舌头仍然干黄，嘴唇红眼睛赤，这是因为伏邪未尽的缘故。口中生疮，是火热之邪寻找孔窍外泄的表现，也是心热向外解除的征象。清热药仍不可少。担心热盛损伤阴液，参入养阴药物也可以。九天之后，惊厥停止又复发，余烬复燃，肝风熄灭后又重新发动，幸好病不是由呕吐腹泻引起的，证属急惊风，还可以无妨，热邪蕴结在体内，体表反而不热，四肢反而厥冷，这就是所谓的“热深厥亦深”。如果说热盛伤阴，道理上是有的。但如果直接认定为虚寒，想要投用温补药物，绝对不可以。仍然应当涤除邪气、清热，平抑肝风、熄风。病程超过二十天，惊厥仍未平定，神志迷乱，牙齿咬紧，四肢抽搐，头部摇动。证因夏季伏藏的暑邪，兼感秋季燥气，两邪相并，一发热就惊厥。邪气传入手足经脉，厥阴肝经深伏于里，所谓“脏者藏也”，邪气难入也难出，所以治法宜守。更有国医界的初、中、末三种治法，病初邪热炽盛，治宜清解，急驱邪气，不让其陷伏。中期则调和阳气、熄风，末期只有养阴存津，舒缓肝之急迫而已。如果说初起热甚，惊厥发作时，应当服用桂枝汤，岂不是抱薪救火，犯了“桂枝下咽，阳盛则毙”的戒律吗？这个病纠缠至今，尚有生机可图，幸亏还能进食，胃气未散。倘若一旦投用附子、肉桂等温补药物，阳遇阳则如同焦枯，胃气将消亡殆尽。病势溃败若此，恐怕难以扭转局面。伏暑到秋季发作，邪气陷入手足厥阴经，病程经过五十多天，肝风虽已平定，但神志躁动未安。舌质红绛，嘴唇红，鼻生疮疡，大便干结，虽然属于病久阴亏，但心肝伏邪，始终未彻底清除。今年岁运是少阴君火司天，阳明燥金在泉，所以多有热燥之证。治病必须明了运气学说。舒缓肝之急迫以熄风，滋补肾之阴液以驱热。服药数日后，躁动平定，睡眠安宁，偶尔仍有肢体强直的现象。《内经》说：“所有暴发的强直症状，都归属于风。”许宣治前辈记载，暑风惊厥之后，出现强直的，属于阴虚，治疗应当养阴舒筋，我冒昧仿效他的旨意。
安波按语：案文中提到“直犯心肝”，似乎不够圆融，因为暑邪最喜欢侵犯心脏，其原因是由肺逆传而来，肺病则肝失去制约，所以手足运动受限了。下文提到五十多天的时间，邪气深入下焦阴分，所以前辈使用甘露饮、复脉汤等方剂，虽然名义上不治肝，但实际上已经治了肝。下面提到的“肝风”二字，对于日久病来说似乎不太恰当。因为肝的位置不及心肺高，难道邪气一侵入就直接奔赴至阴之地了吗？
安波按语：关于小儿惊症的一个候（五天）的说法，历来只有喻嘉言前辈驳斥得非常详细，从此是非分明。他立名为“风、热、惊、痰”四个字，我曾追溯其源。因为幼儿气血未充，脏腑未实，容易招致轻微外感，邪气留滞在皮毛，向上注于肺，失治则蔓延于心包络，因此视物认识模糊，眼球上吊。肺失去治理调节的功能，聚液成痰，而肝失去克制自己的制约，得以嚣张上逆，造成抽风抽搐。应当迅速使用辛凉药物开宣肺气，甘寒药物退热。肺气开宣则痰行，热清则昏蒙定，昏蒙定则抽搐的趋势也就平息了。如果突然使用芳香开窍和金石重镇的药物，会使阴液更加亡失，肺热更加横行，其祸患不堪设想。我实在感到悲怆，不惜多说几句。如果见到这种症状，就投用惊风药，那么幼儿的冤屈不知有多少了。
Xu's wife, due to internal emotional depression and inability to express her feelings, suffered internal injury to the Zhen Qi (True Qi) of the viscera, resulting in amenorrhea. The gynecologists failed to identify the root cause and uniformly prescribed heat-clearing and fetal-calming herbs, causing the condition to worsen with each treatment.
Consulting the *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet), although there are methods using pills like Biejia Jian Wan (Turtle Shell Decoction) for treating consumptive diseases and blood bi, given this emaciated body, it is feared that such strong purgative or resolving treatments would be too harsh. Even if the Lung, Spleen, and Kidney are all diseased, ancient physicians did not employ a generalized, uniform treatment approach.
It is proposed to use Si Yin Jian (Four Yin Decoction) in the morning to nourish Yin and protect the Lung Metal; in the evening, following the precedent of Senior Zhou Shenzhai, use bland foods to nurture Stomach Qi and sweet herbs to benefit Spleen Yin. Since Earth (Spleen/Stomach) is the mother of all things and the Spleen belongs to extreme Yin, other heat-clearing and cough-stopping medications should be set aside. Ye Tianshi said: "Do not administer cooling medicines just because you see heat; do not treat the Lung just because you see cough." This statement is indeed true.
The patient is thin with Yin deficiency, the pulse is deficient and near-rapid. Symptoms include coughing when lying on the side, excessive sweating, and poor appetite. Menstruation has stopped for nine months, with three episodes of uterine bleeding previously. According to her account, she suspected pregnancy due to slight movement in the abdomen. The *Classic of Difficult Issues* states: "If the pulse at the hand Shaoyin (Heart) channel moves vigorously, it indicates pregnancy." It also says: "The body has disease signs, but the pulse shows no pathogenic factors." Given the current pulse and symptoms, it is presumed not to be a sign of pregnancy. If pregnant, it would merely be Qi and Blood deficiency failing to nourish the fetus; although requiring regulation, it remains treatable. If not pregnant, the Sea of Blood is dry, and the condition trends toward deficiency and timidity, making it difficult to initiate treatment. Moreover, during pregnancy, even if disease arises, removing the disease ensures the fetus remains safe. There is no need to blindly investigate whether pregnancy exists; one should only discuss how to treat. By nourishing Yin and protecting the Lung, assisted by regulating Stomach Qi, by the time of the Summer Solstice (when Yin begins to regenerate), Yin Qi can recover, allowing for conservative management.
An Bo's Note: Women prioritize Blood, focusing primarily on the Chong and Ren vessels. The method for treating the Chong and Ren vessels prioritizes nourishing Blood. The Stomach is the root of the Chong Mai (Penetrating Vessel); thus, when Yangming Stomach Qi is vigorous, menstruation flows. Mr. Cheng's method of nourishing Yin and regulating the Stomach is based on this principle.
Convulsions occurring immediately upon fever are called "Acute Convulsion" (Ji Jing) in pediatrics. The *Classic* states: "The color of the East is green, communicating with the Liver." Its pathology manifests as fright and terror. Yesterday the convulsion started, and today the fever persists without receding. Consciousness is confused, unable to cry out, lips are dry, nostrils are parched, the tongue coating is yellow in the center and crimson at the tip. Although this belongs to seasonal dryness pathogen invasion, it must be complicated by latent summer-heat. The combination of these two pathogens causes such violent disease progression: shouting, straining, head retraction, and limb convulsions indicate Liver Wind stirring. Urgent clearing and resolving are required. Maintain this treatment for one period (five days); once pathogens are cleared and heat subsides, stability can be achieved. Summer-heat pathogens lie latent and manifest in autumn. Within three days of onset, high fever triggered convulsions; both new and old pathogens invaded the Heart and Liver internally. Entering the Heart causes coma; entering the Liver causes spasms. Observing the puckering of lips and playing with the tongue, with a crimson tip and yellow coating, indicates significant transformation of latent pathogens into heat. Pathogens in the skin and hair can be resolved by dispersing; latent heat stored internally cannot be removed without clearing. The disease comes violently; delay is unacceptable. One must urgently clear and resolve latent pathogens; there is no other way. After two doses of clearing and resolving, heat reduced by 70-80%. Although convulsions stabilized, consciousness remained unclear, tongue still dry and yellow, lips red, eyes red, indicating residual latent pathogens. Mouth ulcers indicate fire seeking orifices to exit, a sign of Heart heat resolving externally. Clearing medicines remain indispensable. Worrying about heat damaging Yin, adding Yin-nourishing herbs is acceptable. Nine days later, convulsions stopped then restarted; embers reignited. Liver wind extinguished then stirred again. Fortunately, the disease did not arise from vomiting or diarrhea; being Acute Convulsion, it is manageable. Heat is stored internally, yet the exterior is not hot; limbs are cold—this is what is meant by "the deeper the heat, the deeper the cold extremities." If stated that heat damages Yin, the logic holds. But directly diagnosing it as Deficiency-Cold and administering warming tonics is absolutely forbidden. One must still purge pathogens, clear heat, calm the Liver, and extinguish wind. After more than twenty days, convulsions remain unstable; consciousness is confused, teeth are clenched, limbs spasm, head shakes. The syndrome stems from summer latent heat combined with autumn dryness. Upon any heat, convulsion occurs. Pathogens transmit to the Hand and Foot Jueyin channels, hiding deeply within—the meaning of "Zang organs store." Pathogens are hard to enter and hard to exit, so the treatment strategy should be steadfast. There are also early, middle, and late stage treatments in our field: Early stage, pathogens are fierce; treat by clearing and resolving, driving out pathogens quickly to prevent entrapment. Middle stage harmonize Yang and extinguish wind. Late stage only nourishes Yin, preserves fluids, and relieves Liver urgency. If one claimed that at the onset of high heat and convulsion, Guizhi Tang (Cinnamon Twig Decoction) should be taken, wouldn't that be adding fuel to the fire, violating the warning "Once Guizhi enters the throat, Yang excess leads to death"? This disease has persisted until now, yet there is still hope for recovery, fortunately, the patient can eat, and Stomach Qi has not scattered. If warming tonics like Fuzi (Aconite) and Roushu (Cinnamon Bark) were administered, Yang meeting Yang would lead to scorching and drying up; Stomach Qi would perish completely. With the disease collapsing like this, it may be hard to reverse the situation. Latent summer heat manifests in autumn; pathogens sink into Hand and Foot Jueyin. The course has lasted over fifty days. Although Liver wind has settled, spirit remains restless. Tongue is crimson, lips red, nasal ulcers, constipation. Although this is long-term Yin deficiency, the latent pathogens in Heart and Liver have not been thoroughly purged. This year, Shaoyin Jun Fire governs the Heaven (upper half of the year), and Yangming Dry Metal governs the Earth (lower half of the year), hence many heat-dry syndromes occur. Treating disease requires understanding the Six Qi and Five Movements (Yunqi). Relieve Liver urgency to extinguish wind; nourish Kidney fluids to drive out heat. After several days of medication, restlessness ceased, sleep was peaceful, though occasional stiffness remained. The *Classic* states: "All sudden stiffness belongs to Wind." Senior Xu Xuanzhi recorded that after summer-heat wind convulsion, stiffness belongs to Yin deficiency; treatment should nourish Yin and relax sinews. I presumptuously imitate his intent.
An Bo's Note: The phrase "directly invading Heart and Liver" in the case seems somewhat rigid. Summer-heat pathogen loves to invade the Heart; the reason is retrograde transmission from the Lung. When the Lung is diseased, the Liver loses its control, so hand and foot movements become restricted. Regarding the mention of "over fifty days," the pathogen has deeply entered the Lower Jiao Yin division. Thus, the senior physician used formulas like Ganlu Yin (Sweet Dew Decoction) and Maixian Tang (Ophiopogon Decoction); although nominally not treating the Liver, they effectively treated it. The term "Liver Wind" mentioned below seems inappropriate for a chronic, long-standing case. Since the Liver is located lower than the Heart and Lung, how could the pathogen, upon invasion, go directly to the most Yin location?
An Bo's Note: Regarding the concept of a "period" (five days) for pediatric convulsions, only Senior Yu Jiayan refuted it in detail historically, clarifying the distinction. He named it "Wind, Heat, Convulsion, Phlegm." I have traced its origin. Infants have unfulfilled Qi and Blood and immature viscera, easily attracting mild external pathogens. Pathogens linger in the skin and hair, ascend to the Lung. If untreated, they spread to the Pericardium collateral, causing confusion and upward deviation of the eyes. The Lung loses its regulatory function, accumulating fluid into phlegm; the Liver loses its controlling mechanism, allowing it to rise aggressively, causing spasms and convulsions. One should promptly use acrid-cool herbs to open the Lung and sweet-cold herbs to reduce heat. Once the Lung opens, phlegm moves; once heat clears, confusion settles; once confusion settles, the trend of convulsions flattens. If aromatic and mineral-heavy sedatives are suddenly used, Yin fluids will further deplete, and Lung heat will rage unchecked, leading to disastrous consequences. I am truly sorrowful and offer these extra words. If one sees such symptoms and indiscriminately administers convulsion medicines, the grievances suffered by infants are countless.