小儿忽然惊搐目直者,皆肝之风热也。若肝虚生风则目连札而不搐,及多欠、切牙。若肝经
风实,则目直大叫,呵欠项急顿闷。若肝经有热,则目直视不搐,得心热则搐,气热则外生
,气温则内生,其症手寻衣领及乱捻物。宜用泻青丸。壮热饮水喘闷,宜用泻白散。凡病之
新久,皆能引肝风,风内动则上入于目,故目为之连札。若热入于目牵其筋脉,两 俱紧,
不能转视,故目直也。亦有饮食停滞中焦,致清阳不升,浊阴不降,肝木生发之气不得升致
生虚风者,须详审之。若胸满腹痛,呕吐恶食,轻则消导化痰,重则探吐滞积,更须审其所
伤寒物热物。亦有因感冒吐泻,致使土败木侮而生虚风者,不可遽服惊药,宜用六君子加芍
药、木香、柴胡,制肝补脾。若因脾土虚而自病者,用五味异功散。凡饮食停滞,痰涎壅满
而见惊症者,实因脾土虚弱,不能生金,金虚不能平木,故木邪妄动也,宜健脾消食,其症
自愈。若辄用惊风之药,反成其风而益其病也。况脏腑脆嫩,不可投以竣厉之剂,治者慎之。
治验
姚仪部子每停食则身发赤晕,此饮食内停不消,郁热发外,用清中解郁汤而愈。后患摇头咬
牙,痰盛发搐,吐出酸味,伺其吐尽,翌日少以七味白术散,调理脾胃,遂不复患。
一小儿停食,服通利之剂作呕腹胀,此脾胃复伤也。用补中益气汤而愈。
一小儿两目动札,手足发搐,数服天麻防风丸之类,前症不愈,其痰益甚,得饮食稍愈。视
其准头及左颊色青黄。余曰∶脾主涎,此肝木克脾土,不能统摄其涎,非痰盛也。遂用六君
、升麻、柴胡、钩藤二剂,饮食渐进,诸症渐愈;又用补中益气汤而安。
九味养脾汤 治小儿大病后,面黄肌瘦,目动切牙发少,未能强步。因误服解表泻利伤克诸
药而致者,宜长缓调理,全复胃气。
白术(一钱二分) 白芍药(酒炒) 白茯苓(各八分) 人参 陈皮 川芎(各六分) 甘草(炙) 黄
(蜜炙)
上用姜、枣水煎服。
六君子汤
五味异功散(二方见天钓)
清中解郁汤(方见丹毒)
七味白术散(方见积痛)
补中益气汤
参苓白术散(二方见虚羸)
天麻防风丸(方见伤风咳嗽)
小儿突然发生惊厥抽搐、两眼直视的,都是肝经风热所致。如果肝虚生风,则眼球颤动而不抽搐,并伴有频繁打哈欠、咬牙齿的症状。如果肝经风邪实证,则表现为两眼直视、大声呼叫、打哈欠、颈部僵硬、突然感到烦闷。如果肝经有热,则两眼直视但不抽搐;若兼有心热则出现抽搐,气分有热则症状表现于外,气温(指阳气郁滞)则症状表现于内,其症状包括手去摸索衣领以及胡乱捻弄物品。适宜使用泻青丸。若出现高热、口渴饮水、气喘胸闷,适宜使用泻白散。凡是疾病的新久,都能引动肝风,风邪在内扰动则向上进入眼部,所以眼睛会颤动。如果热邪侵入眼部牵拉筋脉,导致两眼拘紧,不能转动视物,所以出现两眼直视的情况。也有因饮食停滞在中焦,导致清阳之气不升、浊阴之气不降,肝木生发之气不得上升从而产生虚风的,必须详细审察。如果出现胸满腹痛、呕吐、厌恶食物,轻症用消食导滞化痰的方法,重症用探吐法排出积滞,更须仔细审查所伤的是寒性食物还是热性食物。也有因感冒引起呕吐腹泻,致使脾土败坏、肝木反侮(乘克)而产生虚风的,不可立即服用镇惊药物,适宜使用六君子汤加芍药、木香、柴胡,以制约肝气、补益脾气。如果是因为脾土虚弱而自病的,使用五味异功散。凡是饮食停滞,痰涎壅盛满溢而出现惊症表现的,实际上是脾土虚弱,不能生肺金,肺金虚弱不能平抑肝木,所以肝木邪气妄动,适宜健脾消食,其症状自然痊愈。如果随意使用治惊风的药物,反而助长风邪而加重病情。况且脏腑脆嫩,不可投用峻猛激烈的药剂,治疗者务必谨慎。
医案记录:
姚仪部的儿子每次停食(消化不良)时身体就会发出红色晕斑,这是饮食内停不消化,郁热发于体表所致,使用清中解郁汤而痊愈。后来出现摇头、咬牙齿、痰多、发作抽搐,吐出酸味物质,等到他吐尽之后,第二天少量给予七味白术散,调理脾胃,于是就不再患病。
另一个小儿停食后,服用通利泻下的药物导致呕吐、腹胀,这是脾胃再次受伤的表现。使用补中益气汤而痊愈。
另一个小儿两眼颤动,手足抽搐,多次服用天麻防风丸之类的药物,前面的症状没有痊愈,痰湿反而更加严重,得到饮食后稍有好转。观察他的鼻准头及左脸颊颜色青黄。我说:脾主涎,这是肝木克制脾土,不能统摄津液,并非痰盛。于是使用六君子汤加升麻、柴胡、钩藤,两剂后饮食逐渐增加,各种症状逐渐痊愈;又使用补中益气汤而安定。
九味养脾汤 治疗小儿大病之后,面色萎黄、肌肉消瘦,眼睛跳动、咬牙齿、头发稀少,不能勉强行走。因误服解表、泻利等损伤克伐的药物而导致此症的,宜长期缓慢调理,完全恢复胃气。
白术(一钱二分)、白芍药(酒炒)、白茯苓(各八分)、人参、陈皮、川芎(各六分)、甘草(炙)、黄芪(蜜炙)。
以上药物用生姜、大枣水煎服。
六君子汤
五味异功散(两个方剂见“天钓”章节)
清中解郁汤(方剂见“丹毒”章节)
七味白术散(方剂见“积痛”章节)
补中益气汤
参苓白术散(两个方剂见“虚羸”章节)
天麻防风丸(方剂见“伤风咳嗽”章节)
Infants and children who suddenly experience convulsions, twitching, and fixed staring of the eyes are suffering from Wind-Heat in the Liver channel. If Liver deficiency generates internal Wind, the eyes will tremble without convulsions, accompanied by frequent yawning and teeth grinding. If there is Excess Wind in the Liver channel, symptoms include fixed staring, loud crying, yawning, neck stiffness, and sudden oppression. If there is Heat in the Liver channel, the eyes stare fixedly without convulsions; if Heart Heat is present, convulsions occur; if Qi Heat is present, symptoms manifest externally; if Qi stagnation (warmth) is present, symptoms manifest internally. The symptoms include the hands groping for clothing collars and randomly twisting objects. Xie Qing Wan (Drain the Blue Pill) should be used. For cases with high fever, thirst with drinking, wheezing, and chest oppression, Xie Bai San (Drain the White Powder) is appropriate. Whether a disease is new or chronic, it can induce Liver Wind. When Wind moves internally and ascends to the eyes, the eyes tremble. If Heat enters the eyes and pulls on the sinews, causing both eyes to become tight and unable to turn, fixed staring results. There are also cases where food stagnation in the Middle Jiao prevents Clear Yang from ascending and Turbid Yin from descending, causing the ascending energy of Liver Wood to fail, thereby generating Deficiency Wind; these must be carefully examined. If chest fullness, abdominal pain, vomiting, and aversion to food occur, mild cases are treated with methods to resolve stagnation and transform phlegm, while severe cases require emesis to expel accumulated matter. One must further examine whether the ingested food was cold or hot in nature. Cases caused by wind-cold invasion leading to vomiting and diarrhea may result in Spleen Earth failure and Liver Wood overacting (rebellious attack), generating Deficiency Wind; in such cases, one must not hastily administer anti-convulsant medicines. Instead, Liu Jun Zi Tang (Six Gentlemen Decoction) modified with Bai Shao Yao (White Peony Root), Mu Xiang (Aucklandia Root), and Chai Hu (Bupleurum Root) should be used to subdue the Liver and tonify the Spleen. If the condition arises solely from Spleen Earth deficiency, Wu Wei Yi Gong San (Five-Ingredient Powder for Extraordinary Merit) is indicated. Whenever food stagnation and excessive phlegm-fluids lead to symptoms resembling convulsions, the root cause is actually Spleen Earth weakness failing to generate Lung Metal; Lung Metal deficiency fails to control Liver Wood, causing Liver Wood pathogenicity to move recklessly. Tonifying the Spleen and resolving food stagnation will allow the symptoms to heal spontaneously. Indiscriminate use of anti-convulsant medicines will instead exacerbate the Wind and worsen the disease. Furthermore, the Zang-Fu organs are delicate and tender; harsh and drastic agents must not be administered. Practitioners must exercise caution.
Clinical Records:
The son of Yi Bu (Official Yao) developed red rashes on his body whenever he suffered from food stagnation. This was due to undigested food retaining internally and generating stagnant Heat that manifested externally. He was cured using Qing Zhong Jie Yu Tang (Clear the Middle and Resolve Stagnation Decoction). Later, he suffered from head shaking, teeth grinding, profuse phlegm, and convulsions, vomiting sour fluid. After he vomited completely, a small amount of Qi Wei Bai Zhu San (Seven-Ingredient Atractylodes Macrocephala Powder) was given the next day to regulate the Spleen and Stomach, after which he did not suffer recurrence.
Another infant, after taking purgative/diuretic agents for food stagnation, developed vomiting and abdominal distension, indicating further injury to the Spleen and Stomach. He was cured using Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction).
Another infant presented with trembling eyes and convulsions of the hands and feet. After several doses of Tian Ma Fang Feng Wan (Gastrodia and Saposhnikovia Pills), the previous symptoms persisted, and phlegm increased. Symptoms improved slightly with food intake. Observation of the nasal tip and left cheek revealed blue-yellow discoloration. I stated: The Spleen governs saliva/fluids. This is Liver Wood overacting on Spleen Earth, failing to control the fluids, rather than an excess of phlegm. Therefore, Liu Jun Zi Tang (Six Gentlemen Decoction) combined with Sheng Ma (Cimicifuga Rhizome), Chai Hu (Bupleurum Root), and Gou Teng (Uncaria Ramulus cum Uncis) was prescribed for two doses. Food intake gradually increased, and all symptoms gradually resolved; subsequently, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) was used to stabilize the condition.
Jiu Wei Yang Pi Tang (Nine-Ingredient Spleen-Nourishing Decoction) treats infants after severe illness who present with sallow complexion, emaciation, eye movements, teeth grinding, sparse hair, and inability to walk strongly. These conditions result from the mistaken use of exterior-releasing and purgative drugs that damaged and depleted the body. Long-term, gradual regulation is required to fully restore Stomach Qi.
Bai Zhu (Atractodis Macrocephalae Rhizoma) (1 qian 2 fen), Bai Shao Yao (Paeoniae Radix Alba, stir-fried with wine), Bai Fu Ling (Poria) (each 8 fen), Ren Shen (Ginseng Radix), Chen Pi (Citri Reticulatae Pericarpium), Chuan Xiong (Ligusticum Chuanxiong Rhizoma) (each 6 fen), Gan Cao (Licorice Radix et Rhizoma, honey-roasted), Huang Qi (Astragali Radix, honey-roasted).
Decoct the above ingredients with fresh ginger and jujube in water.
Liu Jun Zi Tang (Six Gentlemen Decoction)
Wu Wei Yi Gong San (Five-Ingredient Powder for Extraordinary Merit) [See "Tian Diao" chapter]
Qing Zhong Jie Yu Tang (Clear the Middle and Resolve Stagnation Decoction) [See "Dan Du" chapter]
Qi Wei Bai Zhu San (Seven-Ingredient Atractylodes Macrocephala Powder) [See "Ji Tong" chapter]
Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction)
Shen Ling Bai Zhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) [See "Xu Lei" chapter]
Tian Ma Fang Feng Wan (Gastrodia and Saposhnikovia Pills) [See "Shang Feng Ke Sou" chapter]