〔薛〕小儿惊后目微动切牙者,皆病后亡津液,不能荣其筋脉也,亦有肝经虚热
而生风者,当审其气血有余不足而治之。其日中发热饮冷而动者,气有余也,用泻
青丸。夜间盗汗及睡不宁而动者,血不足也,用地黄丸。或因肝经风邪传于脾肾
者,亦令切牙,先用柴胡清肝散,次用五味异功散、六味地黄丸。若因脾胃虚热,
用补中益气汤加芍药、山栀。实热用泻黄散。盖牙床属手足阳明故也。若肝肾热,
用六味地黄丸。
〔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
肝补肺,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。
蝉蜕钓藤饮 治肚疼惊啼。
钓藤钩 天麻 茯苓 川芎 白芍药(各三钱) 甘草 蝉蜕(各一两)
上,入灯心,水煎服。
阎氏云∶惊风或泄泻等证烦渴者,皆津液内耗也,不问阴阳,宜煎钱氏白术散,
使满意取足饮之,弥多弥好。
清心丸 治惊热烦躁。
人参 茯神 防风 朱砂 柴胡(各三钱) 金箔(三十片)
上为末,炼蜜丸,如桐子大。每服一二丸,竹沥调下。
神芎丸 治风热壅滞,头目昏眩,口舌生疮,牙齿疳蚀,或遍身疮疥,切牙惊惕怔
忡,烦躁作渴,或大便涩滞,或积热腹满,惊风潮搐等证。
大黄(生) 黄芩(各二两) 生牵牛末(一两) 滑石(四两) 黄连 薄荷叶 川芎(各半两)
上为末,水糊丸桐子大。每服三四丸,温热水下。
【薛己】小儿在受惊之后,出现眼睛微动、咬紧牙齿的症状,都是因为病后津液耗损,无法滋养筋脉所致;也有因肝经虚热而生风的情况,应当审查其气血是有余还是不足,然后进行治疗。如果在白天发热、想喝冷饮且伴有症状发作的,属于气有余,使用泻青丸。如果在夜间盗汗、睡眠不安且伴有症状发作的,属于血不足,使用地黄丸。如果是由于肝经的风邪传变到脾肾引起的,也会导致咬紧牙齿,先用柴胡清肝散,接着用五味异功散、六味地黄丸。如果是因为脾胃虚热,使用补中益气汤加芍药、山栀。如果是实热,使用泻黄散。这是因为牙床归属于手足阳明经的缘故。如果是肝肾有热,使用六味地黄丸。
【薛己】小儿患惊泻证,肝主惊,肝属木,肝气旺盛时必然会乘克脾土,脾土既已衰弱,则乳食不能消化,水道运行不调,所以出现泄泻,大便颜色发青或兼有抽搐的症状,因为青色是肝的本色,抽搐是肝的病证表现。也有因乳母脾虚受惊,以及愤怒导致肝火上升而引发的。医经说:愤怒会导致气机逆乱,严重时会出现呕血和完谷不化的泄泻,治法应当平抑肝木、补益肺气,千万不要使用猛烈攻下的药物,否则脾气会更加虚弱,肝邪更加严重,甚至出现抽搐、角弓反张等症状,这也是肝火炽盛、中焦脾胃亏损的变证。凡是见到惊证,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,患儿自然能安稳。如今已经出现泄吐、惊搐症状,却不知道补脾平肝,反而使用保命丹、抱龙丸、镇惊丸等药物治疗,这就离康复越来越远了。
蝉蜕钓藤饮:治疗肚子痛、受惊啼哭。
钓藤钩、天麻、茯苓、川芎、白芍药(各三钱),甘草、蝉蜕(各一两)。
以上药材,加入灯心草,用水煎服。
阎氏说:惊风或泄泻等病症中出现烦渴症状的,都是体内津液消耗所致,不分阴阳属性,适宜煎煮钱乙的白术散,让患儿满意地足量饮用,越多越好。
清心丸:治疗惊热烦躁。
人参、茯神、防风、朱砂、柴胡(各三钱),金箔(三十片)。
以上药材研为细末,用炼蜜制成丸子,大小如梧桐子。每次服用一到二丸,用竹沥送服。
神芎丸:治疗风热壅滞,头目昏眩,口舌生疮,牙齿疳蚀,或者全身疮疥,咬紧牙齿、受惊警惕、心悸怔忡,烦躁口渴,或者大便秘结不畅,或者积热导致腹部胀满,惊风潮搐等病症。
大黄(生)、黄芩(各二两),生牵牛子末(一两),滑石(四两),黄连、薄荷叶、川芎(各半两)。
以上药材研为细末,用水糊制作成丸子,大小如梧桐子。每次服用三到四丸,用温热水送服。
[Xue Ji] When a child exhibits slight eye movements and teeth grinding after being startled, it is generally due to the depletion of body fluids (Jin-Ye) following an illness, which fails to nourish the sinews and vessels. There are also cases where deficiency-heat in the Liver channel generates wind. One should examine whether Qi and Blood are in excess or deficiency before treating. If fever occurs during the day, with a desire for cold drinks and symptom exacerbation, it indicates Qi excess; use Xie Qing Wan (Drain the Green Pill). If night sweats occur and restlessness during sleep accompanies the movements, it indicates Blood deficiency; use Di Huang Wan (Rehmannia Pill). If caused by Wind-Evil in the Liver channel transmitting to the Spleen and Kidney, causing teeth grinding, first use Chai Hu Qing Gan San (Bupleurum Liver-Clearing Powder), followed by Wu Wei Yi Gong San (Five-Ingredient Spleen-Enriching Powder) and Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill). If due to deficiency-heat in the Spleen and Stomach, use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) with added Bai Shao Yao (White Peony Root) and Shan Zhi (Gardenia Fruit). For excess heat, use Xie Huang San (Drain the Yellow Powder). This is because the gums belong to the Hand and Foot Yangming channels. If there is heat in the Liver and Kidney, use Liu Wei Di Huang Wan.
[Xue Ji] In pediatric "Startled Diarrhea," the Liver governs fright, and the Liver corresponds to Wood. When Liver Qi is excessive, it inevitably overacts upon the Spleen (Earth). Once Spleen Earth is weakened, milk and food fail to digest, and the water passages become disordered, resulting in diarrhea with green stool or accompanied by convulsions. Green is the color of the Liver, and convulsions are manifestations of Liver pathology. Some cases arise from the nursing mother having Spleen deficiency and being startled, or anger stirring up Liver Fire. The Classics state: "Anger causes Qi to rebel; severely, it leads to vomiting blood and undigested diarrhea." The treatment method should be to calm the Liver and tonify the Lung. Do not use harsh purgatives, as this will further weaken the Spleen Qi and intensify Liver pathogenic factors, potentially leading to convulsions and opisthotonos. These are variations caused by blazing Liver Fire and deficiency of the Middle Jiao. Whenever signs of fright are seen, one should immediately use formulas such as Si Jun Zi Tang (Four Gentlemen Decoction), Liu Jun Zi Tang (Six Gentlemen Decoction), or Yi Gong San, adding Bai Fu Zi (Typhonii Rhizoma) to stabilize wind, and Chai Hu (Bupleuri Radix) to calm the Liver and guide the medicine, thereby preventing progression. This ensures no diarrhea or convulsions will occur, and the child will recover. Now that diarrhea, vomiting, fright, and convulsions have already appeared, failing to tonify the Spleen and calm the Liver, and instead using Bao Ming Dan, Bao Long Wan, or Zhen Jing Wan, moves the patient further away from life.
Chan Tui Diao Teng Yin (Cicada Slough and Uncaria Decoction): Treats abdominal pain and frightened crying.
Diao Teng Gou (Uncariae Ramulus cum Uncis), Tian Ma (Gastrodiae Rhizoma), Fu Ling (Poria), Chuan Xiong (Chuanxiong Rhizome), Bai Shao Yao (Radix Paeoniae Alba) (each 3 qian); Gan Cao (Glycyrrhizae Radix et Rhizoma), Chan Tui (Cicadae Periostracum) (each 1 liang).
Add Deng Xin Cao (Junci Medullia) to the above, decoct in water, and take orally.
Yan Shi stated: In conditions such as Fright-Wind or diarrhea, if irritability and thirst are present, it indicates internal consumption of body fluids. Regardless of Yin or Yang patterns, it is appropriate to decoct Qian's Bai Zhu San (Atractylodis Macrocephalae Powder) and allow the patient to drink sufficient amounts to satisfaction; the more, the better.
Qing Xin Wan (Clear the Heart Pill): Treats fright-heat and irritability.
Ren Shen (Ginseng Radix), Fu Shen (Poria with Hostwood), Fang Feng (Saposhnikoviae Radix), Zhu Sha (Cinnabar), Chai Hu (Bupleuri Radix) (each 3 qian); Jin Bo (Folium Aureum) (30 pieces).
Grind into powder, mix with refined honey to form pills the size of paulownia seeds. Take 1–2 pills per dose, administered with Zhu Li (Bambusae Succus).
Shen Xiong Wan (Divine Ligusticum Pill): Treats stagnation of Wind-Heat, dizziness and vertigo of the head and eyes, sores in the mouth and tongue, dental caries (Gu erosion), or sores and scabies all over the body; teeth grinding, fright, vigilance, palpitations, irritability, and thirst; constipation or accumulation of heat causing abdominal fullness; and symptoms such as Fright-Wind tidal convulsions.
Da Huang (Rhei Radix et Rhizoma, raw), Huang Qin (Scutellariae Radix) (each 2 liang); Sheng Qian Niu Mo (Semen Phaseoli Volubilis, raw powder) (1 liang); Hua Shi (Talcum) (4 liang); Huang Lian (Coptidis Rhizoma), Bo He Ye (Menthae Haplocalycis Folium), Chuan Xiong (Chuanxiong Rhizome) (each half liang).
Grind into powder, bind with water paste to form pills the size of paulownia seeds. Take 3–4 pills per dose, washed down with warm water.