凡厥逆卒暴,即与苏合丸,姜汤浓调灌之。通其关窍,苏醒后,却辨寒热阴阳厥证,补
泻治之,是为至要。若阴阳稍差,则促死甚易。热深阳厥,不可作阴厥,用热药治之,则精绝
而死矣。急宜大、小承气汤,随其轻重治之。
沉寒阴厥,急以四逆汤、理中汤之属治之。甚者,仍灸关元、神阙百壮,方得回阳。
气虚者,四君子汤为主。身冷,从八味顺气散、调元散。兼有痰者,四七导痰汤。
血虚以四物汤为主。血因气滞,以白薇汤。产后瘀血,加桂附主之。
痰厥以二陈汤为主。甚者,加姜汁、竹沥。寒痰、湿痰、卒闷壅急者,星香姜附汤斟酌
用之。
蛔厥为胃寒所生。经曰∶蛔者,长虫。胃寒即吐蛔。理中汤加川椒五粒、槟榔五分,
吞乌梅丸,效。蛔见
椒则头伏故也。
苏合丸(方见中风门)治卒暴厥不知人。未辨寒热风痰,先与此药,化姜阳灌之。醒后,
辨脉证,用药分治。
瓜蒂散(方见风门)治诸厥禁,先用搐鼻。
(手足俱热。)
大承气汤 治积热发厥,阳极似阴,亦下之。
小承气汤 白虎汤(二方见伤寒门。)
(手足俱寒。)
理中汤 治沉寒阴厥,四肢逆冷,唇青自利,脉微迟。
四逆汤 姜附汤(并见伤寒门。)
(有外忤邪气,有郁痰火盛,挟痰火者,从痰厥治。)
仲景云∶尸厥脉动而无气,气闭不通,故静而死也。
调气平胃散 治卒暴尸厥。触犯邪气,昏晕卒倒无所知。
白豆蔻 丁香 檀香 木香(各二钱) 藿香 砂仁(各四钱) 甘草(六钱)
上为末,每服二钱,入盐少许,点沸汤调服。
平胃散
苍术(米泔浸,一斤) 浓朴(姜汁炒) 陈皮(各十两) 甘草(炒,五两)
上为细末,每服五钱,姜三片、枣一枚,煎汤入盐炒少许,调服。
(《三因》)追瑰汤 治卒厥暴死,及客忤鬼击,飞尸奄忽,气绝口噤。
麻黄(三钱,去节) 杏仁(二十五粒,去皮尖) 甘草(炙,一钱)
上水盏半煎。口噤斡开灌之。若不下,分病患头发,左右提之,引肩臂,药下即苏。
凡是遇到突然发生的四肢厥冷、猝然昏倒的急症,应立即给予苏合丸,用浓姜汤调匀后灌服。以此开通闭塞的关窍,待患者苏醒后,再辨别是寒证、热证还是阴厥、阳厥,分别采用补法或泻法进行治疗,这是最为关键的要领。如果阴阳辨证稍有差错,则极易导致死亡。对于热邪深重导致的阳厥,不可误认为是阴厥而使用热性药物治疗,否则会导致精气耗尽而死。此时应当紧急使用大承气汤或小承气汤,根据病情的轻重来治疗。
对于沉寒痼冷导致的阴厥,应紧急使用四逆汤、理中汤等方剂治疗。病情严重的,仍需用艾炷灸关元穴、神阙穴各一百壮,才能使阳气回复。
属于气虚的,以四君子汤为主方。若伴有身体寒冷,可选用八味顺气散、调元散。兼有痰湿的,使用四七导痰汤。
属于血虚的,以四物汤为主方。若因气机阻滞导致血行不畅,使用白薇汤。产后若有瘀血,加肉桂、附子为主治疗。
痰厥以二陈汤为主方。病情严重的,加入姜汁、竹沥。若是寒痰、湿痰,或者突然胸闷壅塞急迫者,酌情使用星香姜附汤。
蛔厥是由胃寒引起的。医经说:“蛔虫,就是长虫。”胃寒就会吐出蛔虫。使用理中汤加川椒五粒、槟榔五分,同时吞服乌梅丸,效果显著。这是因为蛔虫见到花椒头部就会伏下的缘故。
苏合丸(方剂见中风门)治疗猝然昏厥不省人事。在未辨别是风、热、痰、哪种因素之前,先给予此药,化开姜汁和阳后灌服。醒后再辨别脉象和症状,用药分别治疗。
(手足都发热的情况。)
大承气汤 治疗积热引发的厥证,阳极似阴的情况,也适用下法。
小承气汤 白虎汤(两个方剂见伤寒门)。
(手足都发冷的情况。)
理中汤 治疗沉寒阴厥,四肢逆冷,嘴唇青紫,自发性腹泻,脉象微弱迟缓。
四逆汤 姜附汤(均见伤寒门)。
(有外感邪气,或有郁结的痰火旺盛,挟带痰火的,从痰厥治疗。)
张仲景说:尸厥脉象跳动但没有气息,气机闭塞不通,所以表现为静止状态如同死亡。
调气平胃散 治疗猝然发作的尸厥。触犯邪气,昏晕猝倒,不知人事。
白豆蔻 丁香 檀香 木香(各二钱) 藿香 砂仁(各四钱) 甘草(六钱)
以上研为细末,每次服用二钱,加入少许盐,用沸水调服。
平胃散
苍术(米泔水浸泡,一斤) 厚朴(姜汁炒) 陈皮(各十两) 甘草(炒,五两)
以上研为细末,每次服用五钱,加生姜三片、大枣一枚,煎汤并加入少许炒盐,调服。
(出自《三因极一病证方论》)追瑰汤 治疗猝然昏厥暴死,以及客忤鬼击、飞尸奄忽,气绝口噤不开。
麻黄(三钱,去节) 杏仁(二十五粒,去皮尖) 甘草(炙,一钱)
以上用水一盏半煎煮。若口噤不开,撬开嘴巴灌服。如果药液不下,分开患者的头发,左右提拉其肩臂,引导气血,药液下去后即苏醒。
In cases of sudden cold extremities and abrupt syncope, administer Suheli Wan (Suheli Pill) immediately, mixed with strong ginger decoction for forced feeding. This opens the blocked orifices. After the patient regains consciousness, differentiate between Cold, Heat, Yin Jue (Cold Extremity Syndrome), and Yang Jue (Heat Extremity Syndrome), and treat accordingly using tonification or purgation methods; this is the most crucial principle. A slight error in differentiating Yin and Yang can easily lead to death. In cases of deep heat causing Yang Jue, do not mistake it for Yin Jue and treat with hot-natured medicines, as this will deplete essence and cause death. Urgently use Dachengqi Tang (Major Order the Qi Decoction) or Xiaochengqi Tang (Minor Order the Qi Decoction), treating according to the severity of the condition.
For Yin Jue caused by deep-seated cold, urgently treat with Sini Tang (Frigid Extremities Decoction), Lizhong Tang (Regulate the Middle Decoction), and similar formulas. For severe cases, moxibustion at Guanyuan (CV-4) and Shenque (CV-8) with one hundred moxa cones each is necessary to restore Yang Qi.
For deficiency of Qi, Si Junzi Tang (Four Gentlemen Decoction) is the primary formula. If accompanied by cold body temperature, Bawei Shunqi San (Eight-Flavor Regulating Qi Powder) or Tiaoyuan San (Regulate Origin Powder) may be used. If phlegm is also present, Sizhi Daotan Tang (Four Seven Phlegm-Resolving Decoction) is indicated.
For deficiency of Blood, Siwu Tang (Four Substances Decoction) is the primary formula. If blood stasis is due to Qi stagnation, Baiwei Tang (Baiwei Decoction) is used. For postpartum blood stasis, add Rougui (Cortex Cinnamomi) and Fuzi (Radix Aconiti Lateralis Preparata) as main ingredients.
For Phlegm Jue, Erchen Tang (Two-Aged Decoction) is the primary formula. For severe cases, add Jiangzhi (Zingiberis Rhizoma Juice) and Zhuli (Bambusae Caulis in Taenia). For Cold Phlegm or Damp Phlegm, or cases of sudden chest oppression and urgency, Xingxiang Jiangfu Tang (Arisaema, Amber, Ginger, and Aconite Decoction) should be used with discretion.
Hui Jue (Roundworm Jue) is generated by Stomach Cold. The Classics state: "Roundworms are long parasites." Stomach cold causes vomiting of roundworms. Lizhong Tang added with five grains of Chuanjiao (Zanthoxyli Pericarpium) and two grams of Binglang (Arecae Semen), taken together with Wumei Wan (Mume Pill), is effective. This is because roundworms lower their heads when they see pepper.
Suheli Wan (Formula seen in Stroke Section) treats abrupt syncope with loss of consciousness. Before differentiating Wind, Heat, Phlegm, or Fire, first administer this medicine, dissolved in ginger juice and Yang-restoring agents for feeding. After waking, differentiate pulse and symptoms, and treat with specific medications.
Gudisan (Melon Seed Powder) (Formula seen in Wind Section) treats contraindications in various Jue syndromes; first induce sneezing by insufflating into the nose.
(When both hands and feet are hot.)
Dachengqi Tang (Major Order the Qi Decoction) treats Jue caused by accumulated heat and extreme Yang resembling Yin; purgation is also applicable.
Xiaochengqi Tang (Minor Order the Qi Decoction) Bahtu Tang (White Tiger Decoction) (Both formulas seen in Cold Damage Section).
(When both hands and feet are cold.)
Lizhong Tang (Regulate the Middle Decoction) treats deep-cold Yin Jue, with cold extremities, cyanotic lips, spontaneous diarrhea, and a faint, slow pulse.
Sini Tang (Frigid Extremities Decoction) Jiangfu Tang (Ginger and Aconite Decoction) (Both seen in Cold Damage Section).
(If there is external invasion by evil qi, or excessive stagnant phlegm-fire, involving phlegm-fire, treat from Phlegm Jue.)
Zhang Zhongjing said: "In Shi Jue (Corpse Jue), the pulse moves but there is no breath; Qi is blocked and cannot flow, hence the patient appears still and dead."
Tiaoqi Pingwei San (Regulate Qi and Calm Stomach Powder) treats abrupt onset of Shi Jue. Caused by touching evil qi, resulting in dizziness, abrupt collapse, and loss of consciousness.
Baidoukou (Amomi Fructus Rotundus) Dingxiang (Flos Caryophylli) Tanxiang (Santalum Album Lignum) Muxiang (Aucklandiae Radix) (each 6 g) Huoxiang (Agastaches Herba) Sharen (Amomi Fructus) (each 12 g) Gancao (Glycyrrhizae Radix et Rhizoma) (18 g)
Grind all into powder. Take 6 g per dose, add a little salt, and mix with boiling water for administration.
Pingwei San (Calm the Stomach Powder)
Cangzhu (Imperatae Rhizoma) soaked in rice wash water (500 g) Houpo (Magnoliae Officinalis Cortex) stir-fried with ginger juice Chenpi (Citri Reticulatae Pericarpium) (each 300 g) Gancao (Glycyrrhizae Radix et Rhizoma) stir-fried (150 g)
Grind into fine powder. Take 15 g per dose, with three slices of ginger and one jujube, decocted in water with a little stir-fried salt, mixed for administration.
(Zhui Gui Tang from *San Yin Fang*) Treats sudden syncope and apparent death, as well as Ke Wu (Guest Malevolence), Gui Ji (Ghost Strike), Fei Shi (Flying Corpse) occurring suddenly, with cessation of breath and locked jaw.
Mahuang (Ephedrae Herba) (9 g, remove joints) Xingren (Armeniacae Semen Amarum) (25 seeds, remove skin and tips) Gancao (Glycyrrhizae Radix et Rhizoma) honey-fried (3 g)
Decoct in one and a half cups of water. If the jaw is locked, pry it open and feed. If the medicine does not go down, part the patient's hair, pull the shoulders and arms left and right to guide the Qi; once the medicine enters, the patient will revive.