小儿偏风者,属少阳厥阴肝胆二经症也。噤者筋急,由风木太甚而乘于脾以胜水湿,则筋太
燥。然燥金主于收敛劲切故也。又曰∶风之为病,善行而数变,或左或右,其因一也。治须
审而药之。若足阳明胃经气虚,风邪所乘,其筋脉偏急者属外因。若足厥阴肝经风热乘脾,
筋脉偏急者属内因。若脾肺虚弱,腠理不密,外邪所乘,或服金石之剂耗损肝血,或吐泻后
内亡津液不能养肝,致口眼歪斜,或半身不遂,诸症皆属肝血不足,肝火生风,宜滋肾水养
肝血壮脾土。治法∶脾胃虚而动风者,异功散加柴胡、钩藤钩。脾肺虚而外邪所乘者,用钩
藤饮。肝火血燥者,用六味地黄丸。津液不足者,用白术散。若兼目紧上视,寒热往来,小
便淋沥,面色青洁,两胁胀痛之类,皆肝经之本病也。或唇口歪斜,腹痛少食,目胞浮肿,
面色青黄,肢体倦怠之类,皆肝木乘脾之症也,当审五脏相胜而主之。设执其见症概投风药
,反成坏症者有矣。
治验
一小儿口眼 斜,面色或青或赤,此肝心风火乘脾也。朝用柴胡清肝散,夕用异功散加钩藤
钩而愈。其时有患前症,服祛风导痰之药者,皆不能起。
一小儿痢后患前症发搐。面色痿黄,肢体倦怠,此元气虚克伐多矣。余用补中益气汤加钩藤
钩子服而渐愈。后因乳母七情饮食失宜,或儿乳食过多,前症仍作。服补中益气汤、五味异
功散而应。
钱氏全蝎散 治惊风口眼歪斜,言语不正,手足偏废不举。
全蝎(去毒,炒) 僵蚕(直者,炒) 川芎 黄芩 甘草 桂枝 赤芍 麻黄(去节。各二钱) 天麻
(六钱) 天南星(去脐,二钱)
上为末,每服二三钱,姜五片,水煎服。
胃风汤 治风冷乘虚入客肠胃,水谷不化,泄泻注下,及肠胃湿毒,下如豆汁或瘀血,日夜
人参 白茯苓 芎 桂 当归 白芍 白术(各等分)
上散每服二钱,入粟米数粒同煎,食前服。
异功散(方见天钓)
六味丸(方见肾脏)
白术散(方见积痛)
柴胡清肝散(方见诸热)
补中益气汤(方见虚羸)
小儿偏风病,属于少阳经和厥阴经(肝胆二经受邪)的病症。口噤是指筋脉拘急,这是由于风木之气过盛而克制脾土,进而克制水湿,导致筋脉过于干燥。然而,燥金之气主收敛且劲切,故有此表现。又说:风邪致病,善于游走且变化迅速,症状可能出现在身体左侧或右侧,其病因本质是一样的。治疗必须审慎辨证后用药。如果是足阳明胃经气虚,风邪乘虚而入,导致一侧筋脉拘急,这属于外因所致。如果是足厥阴肝经的风热之邪侵犯脾土,导致一侧筋脉拘急,这属于内因所致。如果是脾肺虚弱,腠理(皮肤毛孔及肌肉间隙)不致密,外邪乘虚而入;或者服用金石类药物耗损了肝血;或者在呕吐腹泻之后,体内津液亡失不能滋养肝木,从而导致口眼歪斜,或者半身不遂,这些症状都属于肝血不足、肝火生风所致,适宜采用滋补肾水、滋养肝血、壮实脾土的方法治疗。
治疗方法:脾胃虚弱而动风者,使用异功散加柴胡、钩藤钩。脾肺虚弱而受外邪侵袭者,使用钩藤饮。肝火旺盛、血液枯燥者,使用六味地黄丸。津液不足者,使用白术散。如果兼有眼睛紧闭上视、寒热往来、小便淋漓不畅、面色青白、两胁胀痛等症状,这都是肝经的本脏病变。如果出现嘴唇口角歪斜、腹痛、食欲不振、眼睑浮肿、面色青黄、肢体倦怠等症状,这都是肝木克制脾土的病症,应当审察五脏之间的相克关系来主治。如果固执于表面症状,一概投用祛风药物,反而会造成坏证的情况是有的。
治验案例:
有一个小儿出现口眼歪斜,面色有时发青有时发红,这是肝心风火之邪侵犯脾土所致。早晨服用柴胡清肝散,晚上服用异功散加钩藤钩,从而痊愈。当时有患同样病症的人,服用祛风导痰的药物,都不能治愈。
另一个小儿在痢疾后出现上述病症并发搐搦。面色萎黄,肢体倦怠,这是元气虚弱且被攻伐过多所致。我使用补中益气汤加钩藤钩子服用,逐渐痊愈。后来因为乳母七情饮食调理不当,或者小儿乳食过多,前症再次发作。服用补中益气汤、五味异功散后见效。
钱乙的全蝎散,治疗惊风引起的口眼歪斜,言语不正,手足偏废不能举起。
全蝎(去毒,炒制)、僵蚕(直者,炒制)、川芎、黄芩、甘草、桂枝、赤芍、麻黄(去节,各二钱)、天麻(六钱)、天南星(去脐,二钱)。
以上药物研为细末,每次服用二三钱,加生姜五片,用水煎服。
胃风汤,治疗风冷乘虚侵入肠胃,导致水谷不消化,泄泻如水注下,以及肠胃湿毒,大便像豆汁或瘀血一样,日夜不停。
人参、白茯苓、川芎、桂枝、当归、白芍、白术(各等分)。
以上药散每次服用二钱,加入粟米数粒同煎,饭前服用。
异功散(方剂见“天钓”章节)
六味丸(方剂见“肾脏”章节)
白术散(方剂见“积痛”章节)
柴胡清肝散(方剂见“诸热”章节)
补中益气汤(方剂见“虚羸”章节)
Pediatric hemiplegia with facial deviation (Pian Feng) belongs to the syndromes of the Shaoyang and Jueyin meridians (pathogens affecting the Liver and Gallbladder channels). Trismus (Jin) refers to tendon tension, caused by excessive Wind-Wood qi overacting on Spleen-Earth, thereby overcoming Water-Dampness, resulting in excessive dryness of the tendons. However, Dryness-Metal governs contraction and rigidity, hence this manifestation. It is also said: Wind pathogens are prone to migration and rapid changes; symptoms may appear on the left or right side, yet the underlying etiology remains the same. Treatment requires careful differentiation before administering medication. If Qi deficiency in the Foot-Yangming Stomach channel allows Wind pathogens to invade, causing unilateral tendon tension, it is classified as an external cause. If Wind-Heat from the Foot-Jueyin Liver channel invades the Spleen, causing unilateral tendon tension, it is classified as an internal cause. If Spleen and Lung Qi are deficient, and the Couli (pores and interstitial spaces) are not dense, allowing external pathogens to invade; or if mineral drugs have consumed Liver Blood; or if post-emetic/diarrheal fluid loss fails to nourish the Liver Wood, leading to facial deviation or hemiplegia, these symptoms all belong to insufficient Liver Blood and Wind generated by Liver Fire. The appropriate treatment is to nourish Kidney Water, tonify Liver Blood, and strengthen Spleen Earth.
Treatment methods: For Wind movement due to Spleen-Stomach deficiency, use Yigong San (Isolated Efficacy Powder) with Chai Hu (Bupleuri Radix) and Gou Teng Gou (Uncariae Ramulus cum Uncis). For Spleen-Lung deficiency with external pathogen invasion, use Gou Teng Yin (Uncaria Decoction). For Liver Fire and blood dryness, use Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill). For fluid insufficiency, use Baizhu San (Atractylodes Powder). If accompanied by eyes tightly closed and looking upward, alternating chills and fever, dribbling urination, pale-green complexion, and distending pain in the hypochondrium, these are primary diseases of the Liver channel. If accompanied by lip and mouth deviation, abdominal pain, poor appetite, eyelid edema, green-yellow complexion, and limb fatigue, these are syndromes of Liver Wood overacting on Spleen Earth; one must examine the mutual overcoming relationships among the Five Zang organs to treat them. If one stubbornly adheres to visible symptoms and indiscriminately administers Wind-dispelling herbs, adverse outcomes may occur.
Clinical Cases:
One pediatric patient presented with facial deviation, with a complexion that was sometimes green and sometimes red. This indicated Liver and Heart Wind-Fire invading the Spleen. In the morning, Chai Hu Qing Gan San (Bupleurum Liver-Clearing Powder) was administered; in the evening, Yigong San with Gou Teng Gou was given, resulting in recovery. At that time, other patients with similar symptoms who took Wind-dispelling and phlegm-resolving medicines failed to recover.
Another pediatric patient developed convulsions following dysentery. The complexion was sallow, and limbs were fatigued, indicating deficient Yuan Qi (Primordial Qi) and excessive depletion. I administered Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with Gou Teng Gou, leading to gradual recovery. Later, due to improper emotional regulation and diet by the wet nurse, or excessive milk/food intake by the infant, the previous symptoms recurred. Administration of Buzhong Yiqi Tang and Wuwei Yigong San proved effective.
Qian's Quanxie San (Scorpion Powder), treating facial deviation, abnormal speech, and hemiplegia caused by Wind-stroke (Jing Feng):
Quan Xie (Scorpio, detoxified and fried), Jiang Can (Bombyx Batryticatus, straight ones, fried), Chuan Xiong (Ligustici Chuanxiong Rhizoma), Huang Qin (Scutellariae Radix), Gan Cao (Glycyrrhizae Radix et Rhizoma), Gui Zhi (Cinnamomi Ramulus), Chi Shao (Paeoniae Radix Rubra), Ma Huang (Ephedrae Herba, nodes removed, each 2 qian), Tian Ma (Gastrodiae Rhizoma, 6 qian), Tian Nan Xing (Arisaematis Rhizoma, umbilicus removed, 2 qian).
Grind into powder. Take 2–3 qian per dose, with 5 slices of fresh ginger, decocted in water.
Weifeng Tang (Stomach Wind Decoction), treating Wind-Cold invading the intestines and stomach due to deficiency, causing undigested food and watery diarrhea, as well as intestinal-rectal damp-toxin manifesting as stool resembling bean curd dregs or blood clots, occurring day and night:
Ren Shen (Ginseng Radix), Baifu Ling (Poria), Xiong (Chuan Xiong), Gui (Gui Zhi), Dang Gui (Angelicae Sinensis Radix), Bai Shao (Paeoniae Radix Alba), Baizhu (Atractylodis Macrocephalae Rhizoma, equal parts).
Take 2 qian of the powder per dose, decocted with a few grains of millet, taken before meals.
Yigong San (See "Tian Diao" chapter for formula)
Liuwei Wan (See "Shen Zang" chapter for formula)
Baizhu San (See "Ji Tong" chapter for formula)
Chai Hu Qing Gan San (See "Zhu Re" chapter for formula)
Buzhong Yiqi Tang (See "Xu Lei" chapter for formula)