仲阳云∶慢惊病后,或吐泻胃虚,或气弱因惊,眼白如淡墨,下粪青黄,此泻合温补,至圣保命丹、钓
藤饮(夜啼)主之。或乳随粪下,消乳丸(吐)进食丸(痞)主之。或微渴,心脾喘燥狂热,此泻尤难治,辰砂五苓散
(惊)主之。冷者,定命饮子治之,后与温惊朱君散,睡惊太乙丹。〔薛〕小儿惊泻者,肝主惊,肝木也,盛
则必传克于脾,脾
土既衰,则乳食不化,水道不调,故泄泻色青,或兼发搐者,盖青乃肝之色,搐乃肝之证也。亦有因乳母脾
虚受惊,及怒动肝火而致者,经曰∶怒则气逆,甚则呕血及飧泄。法当平肝补脾,慎勿用峻攻之药,脾气益
虚,肝邪弥甚,甚至抽搐反张者,亦肝火炽盛,中州亏损之变证也。凡见惊证,即宜用四君、六君、异功
散等方加白附子定风,柴胡平肝引经以杜渐,则必不至泻搐而自安矣,今已见泻吐惊搐,尚不知补脾平肝,
以保命、抱龙、镇惊等药治之,其亦去生远矣。
至圣保命丹 治小儿胎惊内钓,腹肚紧硬,眠睡不安,夜多啼哭。及治急慢惊风眼
目上视,手足抽掣,不省人事,悉皆主之,冷证用此。
金蝎(十四个,去毒) 防风 僵蚕(炒,去丝嘴) 南星(炮) 天麻(各二钱) 白附子 麝香(五
分) 金箔(十片) 蝉蜕(洗) 朱砂(各一钱) 有热证加牛黄、脑子、硼砂。
上为末,粳米糊丸,每两作四十丸。常服镇心安神化痰,除一切惊风诸证,汤临时换。一方,加人参、
白茯苓二钱。
定命饮子 治慢惊,吐泻困重,欲传慢脾,通用。
半夏(生,拣圆白者) 茯苓 木香 老生姜(切片,干。各二钱) 白术 甘草(炙。各一钱) 天麻
(二钱半)
上锉散。每服二钱,姜枣汤调下。
朱君散 治吐泻后有此证,并粪青者,宜服之。
人参 白术 茯苓 甘草 辰砂 麝香 灯心 钓藤
上为末。每服一钱,用白汤调下。
睡惊太乙丹 常服安神镇惊,止夜啼粪青。
桔梗(一两,炒) 藿香叶 白扁豆(炒。各半两) 白芷(三钱) 川芎(二钱半)
上为末,炼蜜丸,如芡实大,辰砂、麝香为衣。每服半丸,薄荷汤磨下。正粪色,枣汤下。夜啼,灯
心、钓藤汤磨下。加白术、茯苓、白芍药尤妙。
四神丸 治脾虚胃弱,大便不实,饮食不思,或泄痢腹痛。
肉豆蔻 五味子(各二两) 补骨脂(四两) 吴茱萸(一两)
上为细末。用红枣六十五枚,生姜六两,用水二钟煮干,取枣肉和丸,如桐子大。每服五六十丸,
白汤送下,或化服。
二神丸
补骨脂(四两) 肉豆蔻(二两,生用)
上为末。用红枣四十九枚,生姜四两,用水一钟煮干,取枣肉和丸,如桐子大。每服二三十丸,白滚汤下。
王肯堂引用钱乙(字仲阳)的观点说:慢惊风发生在疾病之后,或者是因为吐泻导致胃气虚弱,或者是因体质气弱而受到惊吓。症状表现为眼白部分呈现淡墨色,排出的粪便颜色青黄相间。这种泄泻应当采用温补疗法,主要使用至圣保命丹和钓藤饮(用于治疗夜啼)。如果乳汁随粪便一起排出,则使用消乳丸(用于治疗呕吐)、进食丸(用于治疗痞块)来治疗。如果出现轻微口渴、心脾部位气喘烦躁、发热狂躁等症状,这种泄泻尤其难以治疗,主要使用辰砂五苓散(用于治疗惊证)来治疗。属于寒证的,用定命饮子治疗,随后服用温惊朱君散,以及睡惊太乙丹以安神镇惊。
薛己认为:小儿惊泻的病因在于肝主惊,肝在五行中属木。当肝气过盛时,必然会乘克脾土;脾土既已衰弱,则乳食无法消化,水道调节失常,因此出现泄泻且粪便色青,有时兼有抽搐症状。这是因为青色是肝的本色,抽搐是肝风的征象。也有因为乳母脾气虚弱受惊,或因愤怒引动肝火而导致小儿发病的情况。《黄帝内经》说:“怒则气逆,甚则呕血及飧泄。”治疗方法应当平抑肝木、补益脾土,千万不要使用峻猛的攻伐药物,否则脾气会更加虚弱,肝邪更加猖獗,甚至出现抽搐、角弓反张等危重症状,这也是肝火炽盛、中焦脾胃亏损所导致的变证。凡是见到惊证表现,就应当立即使用四君子汤、六君子汤、异功散等方剂,加入白附子以定风,柴胡以平肝并作为引经药,从而杜绝病情发展,这样必然不会发生泄泻和抽搐,患儿就能平安。如果已经出现泄泻、呕吐、惊厥抽搐,却还不知道补脾平肝,而是使用保命丹、抱龙丸、镇惊丸等药物治疗,那就离康复越来越远了。
至圣保命丹:治疗小儿胎惊内钓(腹部拘急疼痛),腹部紧绷坚硬,睡眠不安,夜间多啼哭。也治疗急惊风和慢惊风引起的眼睛上视,手足抽搐,不省人事,无论寒证均适用此方。
定命饮子:治疗慢惊风,吐泻严重困倦,病情可能向慢脾风传变,通用此方。
朱君散:治疗吐泻后出现的上述证候,以及粪便发青者,适宜服用。
二神丸:(原文未详述主治,仅列方药,通常用于肾泄/五更泻,此处依原文提取实体即可,不额外补充主治以免臆测,但根据上下文语境,此处列出方名及组成)
Wenkang cited Qian Yi (courtesy name Zhongyang) stating: In cases of slow convulsion following an illness, or due to stomach deficiency from vomiting and diarrhea, or qi weakness triggered by fright, the whites of the eyes appear like pale ink, and stools are greenish-yellow. This type of diarrhea requires warming and tonification, primarily treated with Zhi Sheng Bao Ming Dan (Supreme Holy Life-Preserving Pill) and Gouteng Yin (Uncaria Decoction). If milk passes down with the stool, Xiaoru Wan (Digest Milk Pill), Jinshi Wan (Advance Food Pill) should be used. If there is slight thirst, panting and irritability in the heart and spleen, along with fever and mania, this diarrhea is particularly difficult to treat; Chen Sha Wu Ling San (Cinnabar Five-Ingredient Poria Decoction) is indicated. For cold patterns, Dingming Yinzi (Life-Determining Infusion) is used, followed by Wenjing Zhu Jun San (Warming Fright Master's Powder) and Shuijing Taiyi Dan (Sleeping Fright Supreme One Pill) to calm the spirit and subdue fright.
Xue Ji stated: In pediatric fright-diarrhea, the Liver governs fright and belongs to Wood in the Five Elements. When Liver Qi is excessive, it inevitably overacts upon Spleen Earth. Once Spleen Earth is weakened, milk and food fail to transform, and water pathways become disordered, resulting in diarrhea with greenish stools, sometimes accompanied by twitching. Green is the color of the Liver, and twitching is a sign of Liver wind. There are also cases caused by the nursing mother suffering from Spleen deficiency and fright, or anger stirring up Liver fire. The Classic states: "Anger causes Qi to rebel; severely, it leads to hematemesis and undigested food diarrhea." The treatment method should focus on soothing the Liver and tonifying the Spleen. One must strictly avoid harsh purgatives, as this will further deplete Spleen Qi and exacerbate Liver pathogenic factors, potentially leading to convulsions and opisthotonos—these are adverse changes due to blazing Liver fire and depletion of the Middle Jiao. Whenever signs of fright are observed, one should immediately use formulas such as Sijunzi Tang (Four Gentlemen Decoction), Liujunzi Tang (Six Gentlemen Decoction), or Yigong San (Extraordinary Skill Powder), adding Baifuzi (Typhonii Rhizoma) to settle wind, and Chaihu (Bupleuri Radix) to soothe the Liver and guide the medicine, thereby preventing progression. This ensures no diarrhea or convulsions occur, and the child recovers. If diarrhea, vomiting, and fright-convulsions have already manifested, yet one fails to tonify the Spleen and soothe the Liver, instead using Baoming Dan, Baolong Wan, or Zhenjing Wan, the patient moves further away from life.
Zhi Sheng Bao Ming Dan: Treats fetal fright and internal drawing pain in infants, characterized by a tight and hard abdomen, restlessness during sleep, and frequent crying at night. It also treats acute and chronic convulsions with upward gazing of the eyes, limb jerking, and loss of consciousness. It is suitable for cold patterns.
Dingming Yinzi: Treats slow convulsions with severe vomiting and diarrhea, indicating potential transmission to slow spleen-wind. It is generally applicable.
Zhu Jun San: Treats the aforementioned symptoms after vomiting and diarrhea, especially when stools are green.
Shuijing Taiyi Dan: Regular use calms the spirit, subdues fright, stops night crying, and resolves greenish stools.
Sishen Wan: Treats Spleen deficiency and Stomach weakness, loose stools, lack of appetite, or dysentery with abdominal pain.
Ershen Wan: (Formula listed without specific indication in the provided text segment, typically associated with kidney-deficiency diarrhea).