阎孝忠曰∶慢惊得于大病之后,吐泻之余,或误取,转致脾胃虚损,风邪乘之,似搐而不
甚搐,名曰螈 。似睡而精神慢,四肢冷而口中气皆冷。睡中露睛,或胃痛而啼哭如鸦声,
此证已危,盖脾胃虚损故也。洁古曰∶慢惊,阴证也,俱脏受病耳。盖小儿泄泻,病久脾胃
虚损,若不早治,则成慢惊,名曰螈 ,似搐而不甚搐也。脾肺俱虚,肝木所乘,是为慢惊也,
常用温补羌活膏主之。
医慢惊不可急攻。急惊,阳证,稍易理;慢惊,阴证,最难治。服药已愈而尚虚乏,
未待三五日之间者有之,俗谓过街候,发为定论,不可轻易妄剂投之,攻急则前功俱废。
慢惊所治之理,须究问原由。所发若是急惊传阴为慢惊者,乃阳痫所作阴痫也。当察阳证未
纯,其阴证,用药斟酌。如因泄泻而作慢惊者,男儿为重。如因吐逆而作慢惊者,女子为重,
即阳脱而阴盛。小儿有长幼之别,脏腑有虚实之分。有泻三五次,便成风候,乃由虚之盛也。
或有二三日泄,方成风候,或有五七
日泻不止,而成风候。暴泻成风,犹可速治。盖回阳调中,补气之谓易。若久泻渐传成风
候者,为虚乏,故难理疗。
慢惊不治证
四肢厥冷,吐泻咳嗽,面黯神惨,鸦声胃痛,两胁动气,口生白疮,发直摇头,睛不
转,涎鸣喘嗌,头软,大小便不禁,手足一边牵引者,皆为不治。唇脸青紫者不治。
一身不管百节,似瘫者不治。
阎孝忠说:慢惊风是在大病之后,或者呕吐腹泻之后,又因误用攻下法,导致脾胃虚损,风邪趁机侵袭,出现类似抽搐但不是很剧烈的症状,称为“螈”(手足蠕动)。患儿似睡非睡且精神萎靡,四肢发冷,口中呼出的气也是冷的。睡觉时眼睛半睁露出眼珠,或者胃痛而啼哭声音像乌鸦叫,这种证候已经非常危险,这是因为脾胃严重虚损的缘故。
张元素(洁古)说:慢惊风属于阴证,都是脏腑受病所致。小儿泄泻如果病程长久,导致脾胃虚损,如果不及时治疗,就会发展成慢惊风,表现为“螈”,即类似抽搐但并不剧烈。脾肺两脏都虚弱,肝木之气乘虚克制脾土,这就是慢惊风,常用温补羌活膏来主治。
治疗慢惊风不可急于攻伐。急惊风是阳证,相对容易调理;慢惊风是阴证,最难治疗。服药后虽然病情好转但仍感虚弱乏力的情况,有的甚至需要等待三五天才能恢复,俗称“过街候”,这已成为定论,不能轻易乱投药物,如果攻伐太急,之前的治疗效果都会白费。
治疗慢惊风的道理,必须探究其起因。如果是急惊风传入阴分转化为慢惊风的,那就是阳痫转为阴痫。应当观察阳证是否未完全消退,针对阴证斟酌用药。如果是因泄泻而引发慢惊风的,男孩病情较重;如果是因呕吐逆乱而引发慢惊风的,女孩病情较重,这是阳气外脱而阴寒内盛的表现。小儿有年龄长幼的区别,脏腑有虚实之分。有的腹泻三五次,就形成风候,这是由于正气虚弱导致的邪气亢盛。有的腹泻二三天,才形成风候;有的腹泻五七天不止,才形成风候。暴发性腹泻引发的风候,还可以快速治疗,因为回阳调中、补气的方法比较容易见效。如果是久泻逐渐传变为风候的,由于身体极度虚弱,所以难以调理治疗。
慢惊风的不治之症:
四肢厥冷,呕吐腹泻兼咳嗽,面色暗黑神情凄惨,哭声如鸦鸣且胃痛,两胁部位有动气现象,口腔生白疮,头发竖起并摇头,眼球不转动,喉间痰鸣气喘,头部软弱无力,大小便失禁,手足向一侧牵引抽搐的,都属于不治之症。嘴唇和脸颊呈现青紫色的,也不治。全身瘫软无法控制关节,类似瘫痪状态的,也不治。
Yan Xiaozhong stated: Slow convulsion (Man Jing Feng) arises after a severe illness, or following prolonged vomiting and diarrhea. It may also result from the erroneous use of purgatives, which further damages the Spleen and Stomach, allowing Wind pathogen to invade. The symptoms resemble convulsions but are not severe, termed "Rou" (muscle twitching/crepitation). The child appears drowsy with lethargic spirit, cold limbs, and cold breath. During sleep, the eyes may remain partially open (sleeping with eyes open), or there may be stomach pain accompanied by crying sounds resembling a crow's croak. This condition is critical due to the severe deficiency of the Spleen and Stomach.
Zhang Yuansu (Jiegu) stated: Slow convulsion belongs to Yin syndromes, involving disease in the Zang organs. Prolonged diarrhea in children damages the Spleen and Stomach; if not treated early, it develops into slow convulsion, characterized by "Rou," where movements resemble convulsions but are mild. When both the Spleen and Lung are deficient, Liver Wood overacts upon Earth (Spleen), resulting in slow convulsion. The commonly used formula is Wenbu Qianghuo Gao (Warming and Tonifying Qianghuo Paste).
In treating slow convulsion, one must not attack aggressively. Fast convulsion (Ji Jing Feng) is a Yang syndrome and is relatively easier to manage; slow convulsion is a Yin syndrome and is the most difficult to treat. Even after medication has alleviated the acute symptoms, the patient may remain weak and deficient. Recovery may take three to five days, a period colloquially known as "Guojie Hou" (Crossing-the-Street Period). This is a established rule; one should not prescribe medications rashly. Aggressive treatment will negate previous efforts.
The principle of treating slow convulsion requires investigating the etiology. If slow convulsion results from fast convulsion transmitting into the Yin level, it represents the transformation of Yang epilepsy into Yin epilepsy. One must observe whether residual Yang signs persist and carefully adjust medication for the Yin syndrome. If slow convulsion arises from diarrhea, it tends to be more severe in males; if it arises from vomiting and reflux, it tends to be more severe in females, indicating Yang collapse and excess Yin cold. Children vary in age, and their Zang-Fu organs differ in deficiency or excess. Some cases develop wind manifestations after only three or five episodes of diarrhea, representing an excess pattern arising from deficiency. Others may develop wind manifestations after two or three days of diarrhea, or after five to seven days of unceasing diarrhea. Wind caused by sudden, severe diarrhea can still be treated rapidly because restoring Yang, regulating the Middle Jiao, and tonifying Qi are relatively straightforward. However, wind developing gradually from chronic diarrhea involves severe deficiency and is difficult to manage.
Incurable Signs of Slow Convulsion:
Cold extremities (Jue Leng), vomiting and diarrhea accompanied by cough, dark complexion with a miserable expression, crow-like crying with stomach pain, qi movement in the hypochondrium, white sores in the mouth, erect hair with head shaking, fixed gaze without eye movement, phlegm-rattling and wheezing, soft neck, incontinence of urine and stool, and unilateral traction of hands and feet are all considered incurable. Cyanosis of the lips and face is incurable. Generalized flaccidity with loss of joint control, resembling paralysis, is incurable.