云岐子云。钱氏用宣风散三味。俱无治风之药。惟有治风之名。合加防风一味。譬如用军先锋。辨
证以大便飧泄为热。大便散中有结。以宣风散下太过为寒。各认其寒热而再详合用药耳。泻白散三
味。亦无泻肺之理。合加黄连一味为泻肺是也。内经云。肺苦气上逆。急食苦以泻之。由是钱氏自
言兼煎入脏君臣药。是包藏其法而言之也。
【夺命散】治肺胀喘满。胸高气急。两胁扇动。陷下作坑。两鼻窍张。闷乱嗽渴。声嗄不
鸣。痰涎潮塞。若不急治。死在旦夕。
川大黄 白牵牛 黑牵牛(各一两。半生半熟)
大槟榔(一个)
上为末。三岁儿服二钱。冷浆水调下。涎多加腻粉少许。利下涎为度。出杨氏极济方。
【无价散】治风热喘促。闷乱不安。
辰砂(二钱半) 轻粉(半钱) 甘遂(一钱半。面裹。微煮焙)
上为末。每服一字。温水少许。滴下小油一点。抄药在上。沉下去脚。以浆水灌之。立效如神。
小儿急慢惊风者古无之。惟曰阴阳痫。所谓急慢惊者。后世名之耳。正如赤白痢之类是也。阳
动而速。故
阳病曰急惊。阴静而缓。故阴病曰慢惊。此阴阳虚实寒热之别。治之不可误也。急惊由有热。热即
生风。又或因惊而发。则目为连札。潮涎搐搦。身体与口中气皆热。及其发定或睡起。即了了如故
。此急惊证也。当其搐势渐减时。与镇心治热之剂一二服。候惊势已定须臾。以药下其痰热。利下
痰热。心神安宁。即愈。慢惊得于大病之余。吐泻之后。或误取转。致脾胃虚损。风邪乘之。似搐
而不甚搐。此名螈 。似睡而精神慢。四肢与口中气皆冷。睡中露睛。或胃痛而啼哭如鸦声。此证
已危。盖脾胃虚损故也。
云岐子说:钱乙(钱氏)使用的宣风散只有三味药,其中都没有治疗风邪的药物,只是拥有治疗风病的名称。应当合加防风一味药,这就像是用军队的先锋官一样。辨证时,如果大便呈完谷不化的泄泻,属于热证;如果大便稀溏中夹杂有结块,是因为使用宣风散攻下太过导致寒证。各自认清其寒热属性后再详细斟酌用药。泻白散也只有三味药,也没有清泻肺热的道理,合加黄连一味药才是正确的清泻肺热之法。《内经》说:“肺脏厌恶气机上逆,急切地食用苦味药物以泻除它。”因此钱乙自己说兼煎入脏的君臣药,这是含蓄地表达他的治法。
【夺命散】治疗肺胀引起的喘满。症状包括胸部高耸、气息急促、两胁像扇子一样扇动、肋间凹陷成坑、两个鼻孔张开、烦闷混乱、咳嗽口渴、声音嘶哑不能发声、痰涎如潮水般壅塞。如果不紧急治疗,死亡就在旦夕之间。
川大黄、白牵牛、黑牵牛(各一两,一半生用一半熟用)、大槟榔(一个)。
以上药物研为细末。三岁儿童服用二钱,用冷浆水调服。如果痰涎多,加入少许腻粉,以利下痰涎为度。此方出自杨氏的极济方。
【无价散】治疗风热引起的喘促、烦闷不安。
辰砂(二钱半)、轻粉(半钱)、甘遂(一钱半,用面粉包裹,微煮后焙干)。
以上药物研为细末。每次服用“一字”的量,用少量温水,滴入一点小油,将药粉抄在油上,使其沉入杯底,然后用浆水灌服。效果立竿见影,神妙无比。
小儿急惊风和慢惊风在古代是没有这种说法的,只称为“阴阳痫”。所谓急惊和慢惊,是后世命名的。这正如赤痢和白痢的区别一样。阳气主动且迅速,所以阳病称为急惊;阴气主静且缓慢,所以阴病称为慢惊。这是阴阳、虚实、寒热的区别,治疗时不可出错。急惊是由于体内有热,热极生风,或者因为受惊而发作,表现为眼睛连眨、流潮涎、抽搐痉挛,身体和口中的气息都发热。等到发作停止或睡醒后,立刻清醒如常。这就是急惊的证候。当抽搐之势逐渐减弱时,给予镇心清热的一两剂药,等惊势安定片刻后,再用药物攻下痰热,利下痰热,心神安宁,即可痊愈。慢惊得于大病之后、吐泻之后,或者误用催吐攻下之法,导致脾胃虚损,风邪乘虚而入。表现为类似抽搐但抽搐不严重,名为“螈”(手足徐徐抽动),似睡非睡且精神萎靡,四肢和口中的气息都发冷,睡觉时眼睛露出瞳孔,或者胃痛而啼哭声音像乌鸦叫。这个证候已经危险了,这是因为脾胃虚损的缘故。
Yun Qizi stated: Qian Yi (Qian Shi) used Xuanfeng San (Disperse Wind Powder), which consists of three ingredients, none of which are herbs for treating wind pathogens; it merely bears the name of treating wind diseases. One should add Fangfeng (Saposhnikoviae Radix) as a single ingredient, akin to employing a vanguard in an army. In syndrome differentiation, if loose stools with undigested food occur, it indicates heat; if loose stools contain hardened masses, it is due to excessive purgation by Xuanfeng San causing cold. Each must recognize its cold or heat nature before carefully selecting medications. Xiexie Bai San (Drain White Powder) also lacks the rationale for draining lung heat. Adding Huanglian (Coptidis Rhizoma) makes it correct for draining lung heat. The *Neijing* states: "The Lung dislikes rebellious Qi; urgently consume bitter substances to drain it." Thus, Qian Yi himself mentioned decocting together the sovereign and minister herbs entering the zang organs, implying he was concealing his method within this statement.
[Duoming San] Treats lung distension with wheezing and fullness. Symptoms include high chest, rapid breathing, flapping of the two hypochondria like fans, sunken intercostal spaces forming pits, dilated nostrils, mental confusion, coughing with thirst, hoarseness or loss of voice, and tidal accumulation of phlegm and saliva. If not treated urgently, death may occur at dawn or dusk.
Chuan Dahuang (Rhei Radix et Rhizoma), Baidianqiu (Bunge's Morning Glory Seed), Heidianqiu (Black Morning Glory Seed) (each 1 liang, half raw and half processed); Da Binglang (Arecae Semen) (one fruit).
Grind the above into powder. For a three-year-old child, administer 2 qian, mixed with cold Jiangshui (fermented grain water). If there is excessive phlegm, add a small amount of Nifen (Calomel). Continue until phlegm is discharged. This formula originates from Yang Shi's Ji Ji Fang.
[Wujia San] Treats wheezing and restlessness caused by wind-heat.
Chensha (Cinnabar) (2.5 qian), Qingfen (Calomel) (0.5 qian), Gansui (Kansui Root) (1.5 qian, wrapped in flour, slightly boiled then dried).
Grind the above into powder. Take one "yi zi" dose each time. Use a small amount of warm water, drip a drop of oil into it. Place the medicine on top of the oil so that it sinks to the bottom. Administer with Jiangshui (fermented grain water). The effect is immediate and miraculous.
Pediatric acute and chronic convulsions did not exist in ancient times; they were only called Yin-Yang Epilepsy (Yin Yang Xian). The terms acute and chronic convulsions were named by later generations, similar to the distinction between red and white dysentery. Yang moves quickly, so Yang disease is called Acute Convulsion (Ji Jing). Yin is still and slow, so Yin disease is called Chronic Convulsion (Man Jing). These are distinctions of Yin/Yang, Deficiency/Excess, and Cold/Heat; treatment must not be mistaken. Acute convulsion arises from internal heat; extreme heat generates wind, or it may be triggered by fright. Symptoms include blinking eyes, tidal salivation, spasms, and heat in the body and breath. When the attack subsides or upon waking, the child returns to normal consciousness. This is the syndrome of acute convulsion. When the spasm gradually decreases, administer one or two doses of heart-calming and heat-clearing agents. After the convulsive state stabilizes, use medication to purge phlegm-heat. Once phlegm-heat is purged and the mind settles, recovery occurs. Chronic convulsion occurs after severe illness, vomiting, or diarrhea, or due to erroneous use of emetics or purgatives, leading to Spleen-Stomach deficiency and damage, allowing wind pathogens to invade. Symptoms resemble spasms but are mild, termed "You Ku" (slow twitching). The child appears sleepy but lethargic, with cold limbs and breath. Eyes may remain open during sleep, or stomach pain may cause crying with a crow-like sound. This condition is critical due to Spleen-Stomach deficiency.