口噤、角弓反张,痉病也。但口噤而兼反张者,是已成痉也,小续命汤。口噤而不反张
者,是未成痉也,大秦艽汤。其痉病俱见前伤寒兼证中,宜细加查核。
不语有心、脾、肾三经之异,又有风寒客于会厌,卒然无音者。大法,若因痰迷心窍,
当清心火,牛黄丸,神仙解语丹。若因风痰聚于脾经,当导痰涎,二陈汤加竹沥、姜汁,并
用解语丹。若因肾经虚火上炎,当壮水之主,六味汤加远志、石菖蒲。若因肾经虚寒厥逆,
当益火之源,刘河间地黄饮子,或用虎骨胶丸加鹿茸。若风寒客于会厌,声音不扬者,用甘
桔汤加疏散药。
遗尿谓之肾绝,多难救,然反目遗尿者,为肾绝,若不反目,但遗尿者,多属气虚,重
用参、 等药,补之则愈。
桂枝汤、葛根汤、小柴胡汤 (俱见伤寒)
治一切中证,不醒人事,用此吹鼻中,有嚏者生,无嚏者难治。
细辛(去叶) 皂角(去皮弦,各一两) 半夏(生用,五钱)
为极细末,瓷瓶收贮,勿泄气,临用吹一、二分入鼻孔中取嚏。
治中风痰火闭结,或螈 瘫痪,语言謇涩,恍惚眩晕,精神昏愦,不省人事,
或喘嗽痰壅,烦心等症。
牛黄(六钱) 麝香 龙脑(以上三味另研) 羚羊角 当归(酒洗) 防风 黄芩 柴胡 白
术麦冬(去心) 白芍(各七钱五分) 桔梗 白茯苓 杏仁(去皮尖) 川芎 大豆黄卷 阿胶
(各八钱五分) 蒲黄 人参(去芦) 神曲(各一两二钱五分) 雄黄(另研,四钱) 甘草(二两五钱)
白蔹 肉桂(去皮) 干姜(各三钱七分) 犀角(镑,一两) 干山药(三两五钱) 大枣(五十枚,蒸烂
去皮核) 金箔(六百五十片,内存二百片为衣)
为细末,炼蜜同枣膏丸,每两作十丸,用金箔为衣,每服一丸,温水化下。
口噤(牙关紧闭)、角弓反张(身体向后弯曲如弓),属于痉病。如果口噤同时伴有身体反张,说明已经形成痉病,使用小续命汤。如果口噤但不伴有身体反张,说明尚未形成痉病,使用大秦艽汤。关于痉病的详细论述在前面“伤寒兼证”部分已有记载,应当仔细查阅核对。
不语(不能说话)有心、脾、肾三经病变的差异,也有因风寒邪气客居会厌部位,导致突然失音的情况。治疗的大法如下:如果是因痰浊迷蔽心窍所致,应当清泻心火,使用牛黄丸或神仙解语丹;如果是因风痰积聚于脾经所致,应当疏导痰涎,使用二陈汤加竹沥、姜汁,并配合使用解语丹;如果是因肾经虚火上炎所致,应当滋补肾阴(壮水之主以制阳光),使用六味地黄汤加远志、石菖蒲;如果是因肾经虚寒导致厥逆,应当温补元阳(益火之源以消阴翳),使用刘河间的地黄饮子,或者使用虎骨胶丸加鹿茸;如果是风寒邪气客居会厌,导致声音不扬,使用甘桔汤加入疏散风邪的药物。
遗尿被称为肾绝证,大多难以救治。但是,如果眼睛上翻且遗尿,这是肾绝的表现;如果不眼睛上翻,仅仅遗尿,多属于气虚,重用参类(如人参)等药物进行补益,即可痊愈。
桂枝汤、葛根汤、小柴胡汤 (均见于《伤寒论》相关章节)
治疗一切中脏腑之证,患者神志昏迷不醒,将此药吹入鼻中,能打喷嚏的有生机,不能打喷嚏的难治。
细辛(去除叶片) 皂角(去除外皮和筋膜,各一两) 半夏(生用,五钱)
研磨成极细粉末,用瓷瓶密封保存,不要漏气,临用时取一、二分吹入鼻孔中,以诱发喷嚏。
治疗中风引起的痰火闭结,或出现抽搐、瘫痪,语言謇涩(说话不清),恍惚眩晕,精神昏沉困倦,不省人事,或者气喘咳嗽、痰液壅盛,心烦等症状。
牛黄(六钱) 麝香 龙脑(以上三味单独研磨) 羚羊角 当归(酒洗) 防风 黄芩 柴胡 白术 麦冬(去除心) 白芍(各七钱五分) 桔梗 白茯苓 杏仁(去除皮尖) 川芎 大豆黄卷 阿胶(各八钱五分) 蒲黄 人参(去除芦头) 神曲(各一两二钱五分) 雄黄(单独研磨,四钱) 甘草(二两五钱) 白蔹 肉桂(去除外皮) 干姜(各三钱七分) 犀角(镑成片,一两) 干山药(三两五钱) 大枣(五十枚,蒸烂后去皮核) 金箔(六百五十片,其中二百片用于包衣)
研磨成细末,用炼蜜同枣膏制成丸剂,每两药粉做成十丸,用金箔作为外衣,每次服用一丸,用温水送服化开。
Jaw lock (trismus) and opisthotonos (arching of the back like a bow) constitute Jing disease (spasm disorder). If jaw lock is accompanied by opisthotonos, it indicates that Jing disease has fully developed; treat with Xiao Xuming Tang (Minor Continuation of Life Decoction). If jaw lock occurs without opisthotonos, it indicates that Jing disease has not yet fully developed; treat with Da Qin Jiao Tang (Major Gentian Root Decoction). The detailed discussion on Jing disease can be found in the section on "Complications of Cold Damage" mentioned earlier; please consult it carefully.
Aphasia (inability to speak) differs depending on whether the Heart, Spleen, or Kidney meridians are involved. There are also cases of sudden loss of voice due to Wind-Cold pathogenic factors lodging in the epiglottis. The general principles of treatment are as follows: If caused by phlegm turbidity confusing the Heart orifice, clear Heart Fire using Niuhuang Wan (Calculus Bovis Pill) or Shenxian Jieyu Dan (Immortal Speech-Resolving Elixir). If caused by Wind-phlegm accumulating in the Spleen meridian, guide out phlegm-fluids using Erchen Tang (Two Aged Substances Decoction) added with Zhuli (Bamboo Juice) and Jiangzhi (Ginger Juice), combined with Shenxian Jieyu Dan. If caused by deficiency-Fire flaming upward from the Kidney meridian, nourish the source of Water (Kidney Yin) using Liuwei Dihuang Tang (Six-Ingredient Rehmannia Pill) added with Yuanzhi (Polygala Root) and Shichangpu (Acorus Rhizome). If caused by deficiency-Cold in the Kidney meridian leading to Jue-ni (reversal cold extremities), tonify the source of Fire (Kidney Yang) using Dihuang Yinzi (Rehmannia Infusion) by Liu Hejian, or use Hugujiao Wan (Tiger Bone Gelatin Pill) added with Lurong (Deer Antler Velvet). If Wind-Cold lodges in the epiglottis causing hoarseness, use Ganjie Tang (Licorice and Platycodon Decoction) added with herbs that disperse pathogens.
Enuresis (involuntary urination) is referred to as Kidney Exhaustion (Shen Jue), which is mostly difficult to save. However, if enuresis is accompanied by retracted eyes (rolling up of the eyes), it signifies Kidney Exhaustion; if the eyes do not retract but only enuresis occurs, it mostly belongs to Qi Deficiency. Use heavy doses of Ren (Ginseng) and similar tonifying herbs to restore health.
Guizhi Tang (Cinnamon Twig Decoction), Gegen Tang (Kudzu Root Decoction), Xiaochaihu Tang (Minor Bupleurum Decoction) (All seen in Treatments of Cold Damage).
To treat all types of Stroke affecting the Zang-Fu organs with unconsciousness, blow this powder into the nose. Survival is indicated if sneezing occurs; difficulty in treatment if no sneeze occurs.
Xixin (Asarum Root, leaves removed) Zaojiao (Gleditsia Sinensis Fruit, skin and strings removed, each 1 liang) Banxia (Pinellia Tuber, raw, 5 qian)
Grind into an extremely fine powder, store in a porcelain bottle tightly sealed to prevent leakage. When used, blow one or two fen into the nostrils to induce sneezing.
To treat Stroke complicated by closure due to Phlegm-Fire, or convulsions and paralysis, dysarthria (slurred speech), dizziness, mental confusion, unconsciousness, panting cough with copious phlegm, vexation, etc.
Niuhuang (Calculus Bovis, 6 qian) Shexiang (Musk, separate grinding) Longnao (Borneol, separate grinding) [The above three ingredients are ground separately] Lingyangjiao (Saiga Antelope Horn) Danggui (Angelica Sinensis Root, wine-washed) Fangfeng (Saposhnikovia Root) Huangqin (Scutellaria Root) Chaihu (Bupleurum Root) Baizhu (Atractylodes Macrocephala Rhizome) Maidong (Ophiopogon Tuber, heart removed) Baishao (White Peony Root, each 7.5 qian) Jiegeng (Platycodon Root) Bai Fuling (Poria Cocos, 7.5 qian) Xingren (Apricot Seed, skin and tips removed) Chuanxiong (Ligusticum Rhizome) Dahuangjuan (Sojae Semen Praeparatum) Ejiao (Donkey-Hide Glue, each 8.5 qian) Puhuang (Typha Pollen) Renshen (Ginseng Root, rhizome removed) Shenqu (Medicated Leaven, each 1.25 liang) Xionghuang (Realgar, separate grinding, 4 qian) Gancao (Licorice Root, 2.5 liang) Bailian (Trollius Chinensis Root) Rougui (Cinnamon Bark, peeled) Ganjiang (Dried Ginger, each 3.7 fen) Xijiao (Rhinoceros Horn, shaved, 1 liang) Ganshanyao (Dioscorea Rhizome, dried, 3.5 liang) Dazao (Jujube, 50 pieces, steamed until soft, skin and pits removed) Jinbo (Gold Foil, 650 pieces, 200 pieces reserved for coating)
Grind into a fine powder. Make pills using refined honey and jujube paste. Each liang of powder makes ten pills. Coat with gold foil. Take one pill per dose, dissolved in warm water.