小儿中风者,以其血气未定,寒温失调,内则盛热蕴蓄,外则腠理开虚,故风邪乘其外虚而暴中之,其状昏不知人,
壮热狂躁,搐掣气粗,口噤涎潮是也。心中风则偃卧不能倾侧,发热失音,其舌焦赤,若汗流唇赤者可治,灸心俞,或
唇间白黑青黄,乃心坏为水,或面目青黑,时时竦动者并不治。肝中风则踞坐不得低头,左胁疼痛,诸筋挛急,头目转
动,上视多怒,其目青,若绕两目连额微青,唇青面黄者可治,灸肝俞;大段青黑,其目一黄一白不治。肾中风则踞坐
面浮,腰脊痛引小腹,其耳黑,若两胁未有黄色起者可治,灸肾俞;或胁间如黄土,发直而齿黄赤者不治。肺中风则偃
卧胸满、喘息咳嗽、躁闷汗出,其鼻白,若目下至鼻四围,及唇口皆白色可治,灸肺俞;或色带黄,乃肺坏为血不治。
脾中风则踞坐腹满,皮肉 动,四肢不收,其唇黄,若一身通黄,口吐咸涎者可治,灸脾俞;或手足青而厥冷者不治。
凡人为风邪所中,皆自背上五脏俞而入,风入于颔颊之间,则口 而牙噤。风塞于咽喉声音之间,则语不出而失音。风
与气搏,气与痰隔,则喉间如鼾 之声响。是风也,始入于肤腠,次达于经络而搏于经脉,筋得寒则拘急挛痛,得热则
缓弛不随,风挟寒邪,即挛急也,风挟热气,即缓弛也,拘挛脉必浮紧,缓弛脉必浮洪,寒者小续命汤,热者追风毒锉
散之类。脉浮者病在表,脉实者病在里,脉促者病在上,在表者散之,在里者利之,在上者涌之,若虚而寒者,则乌附
之类又不可缺,古人治法,虽以灼艾之类为本,亦当消息权度而投剂焉。虽然风寒暑湿,皆能中人,况又有因气而中风
者,人之骤病,莫急于中风,仓卒之际,若未能精审,且与下气豁痰。盖中风皆因痰郁气滞而作,先用通关散以疏之,
急以南星、生姜、木香煎汤,调苏合香丸灌下,牙紧者,南星、细辛末,入麝香、乌梅肉点擦牙自开,进药之后,痰消
气下,病势稍苏,即详审五脏外症而调理之,宜省风汤、羌活散,势甚者防风通圣散、化风丹、牛黄散、钩藤散、至宝
丹等剂,可选用之。
通关散 治卒暴中风,昏塞不省人事,牙关紧急,药不得咽下。
细辛 薄荷 牙硝 雄黄(各等分)
上为末,每用少许,吹入鼻中,候喷嚏,然后进药,或用白梅擦牙,更以菖蒲末着舌下,牙关即开,仓卒可用。
小续命汤 见第二十七问。
追风毒锉散 治中风内外皆热。
大黄(二钱) 郁李仁(炒、二钱) 桑白皮(炒半两) 槟榔(半两) 防风(半两) 羌活(一两)
上锉散,每服二钱,黑豆三十粒同煎,乳食后服。
省风汤 见第十四问。
防风通圣散 治小儿热甚惊风,或斑疹出不快者,更热剧黑陷将欲死者,或风热疮疥久不愈者,诸般风热。
防风(去芦、半两) 荆芥(二钱半) 川芎(半两) 锦纹大黄(半两) 当归(半两) 薄荷叶(半两) 芍
药(半两) 麻黄(去根节、半两) 芒硝(半两) 石膏(细纹者、方解者非、一两) 黄芩(一两) 桔梗(一两)
滑石(六两) 甘草(二两) 白术(二钱半) 山栀子(用小者、大者非、二钱半)
上粗末,每服二钱,姜二片,水一盏,煎七分,去滓不拘时服,或卒中久不语,或暴喑不语皆治。
化风丹 见第十九问。
钩藤散 见第十六问。
至宝丹 见第二十问。
小儿中风,是因为其气血尚未定型,寒温调节失调。在内则盛热蕴积蓄留,在外则腠理(皮肤毛孔)开泄虚弱,所以风邪趁着体表虚弱而突然侵袭中伤人体。其症状表现为昏迷不省人事、高热狂躁、抽搐掣动、呼吸气粗、牙关紧闭、口角流涎等。
心中风,则表现为仰卧不能翻身侧卧,发热失音,舌苔焦黑发红。如果汗出淋漓且嘴唇红润的还可以治疗,可灸心俞穴;如果嘴唇间出现白、黑、青、黄等杂色,这是心气败坏导致水气泛滥之象;或者面目呈现青黑色,时时惊恐跳动的,均属于不治之症。
肝中风,则表现为蹲坐时无法低头,左胁部疼痛,全身筋脉拘挛紧急,头目转动,眼球上翻,易怒,眼睛发青。如果环绕双眼及额头微现青色,嘴唇青而面色黄的还可以治疗,可灸肝俞穴;如果青色深重呈黑青色,且一只眼睛发黄一只眼睛发白的,属于不治之症。
肾中风,则表现为蹲坐时面部浮肿,腰脊疼痛牵引至小腹,耳朵发黑。如果两胁下还没有黄色斑块出现的还可以治疗,可灸肾俞穴;如果胁间肤色如黄土,头发直立且牙齿黄赤的,属于不治之症。
肺中风,则表现为仰卧时胸部胀满、喘息咳嗽、烦躁闷乱、出汗,鼻子颜色发白。如果眼下至鼻周四围,以及嘴唇口角皆呈白色的还可以治疗,可灸肺俞穴;如果面色带黄,这是肺气败坏导致血瘀之象,属于不治之症。
脾中风,则表现为蹲坐时腹部胀满,皮肉跳动,四肢无力收摄,嘴唇发黄。如果全身通黄,口吐咸味涎水的还可以治疗,可灸脾俞穴;如果手足青紫且厥冷逆冷的,属于不治之症。
大凡人被风邪所中,风邪都是从背部的五脏俞穴进入体内。风邪侵入下颌脸颊之间,就会导致口眼歪斜且牙关紧闭。风邪阻滞于咽喉声音之处,就会导致言语不出且失音。风邪与正气相搏结,气机与痰浊相互阻隔,就会导致喉间发出如打鼾般的声响。这种风邪,起初侵入皮肤腠理,随后通达经络并搏结于经脉之中。筋脉遇到寒邪就会拘急挛痛,遇到热邪就会松弛无力不能随意运动。风挟带寒邪,就会导致筋脉拘急;风挟带热气,就会导致筋脉松弛。筋脉拘急时脉象必浮紧,筋脉松弛时脉象必浮洪。属寒证的用小续命汤,属热证的用追风毒锉散之类的方剂。脉浮表示病在表,脉实表示病在里,脉促表示病在上部。在表的用发散法,在里的用通利法,在上的用涌吐法。如果是虚证兼寒证,那么乌头、附子之类的药物也不可缺少。古人治法,虽然以艾灸等方法为本,但也应当斟酌权衡病情后投药。虽然风寒暑湿都能中人,况且又有因情绪气机紊乱而中风的。人突然患病,没有比中风更急迫的了。在仓促之际,如果未能精确审察病情,暂且先用降气豁痰的方法。因为中风多因痰郁气滞而引起,先用通关散来疏通窍道,紧急时用天南星、生姜、木香煎汤,调服苏合香丸灌下。牙关紧闭的,用天南星、细辛粉末,加入麝香、乌梅肉点擦牙齿,牙关自然张开。进药之后,痰消气顺,病势稍缓苏醒,再详细审察五脏的外在症状进行调理。适宜选用省风汤、羌活散;病情严重的可选用防风通圣散、化风丹、牛黄散、钩藤散、至宝丹等方剂。
通关散:治疗突然暴发的中风,昏塞不省人事,牙关紧急,药物无法咽下。
配方:细辛、薄荷、牙硝、雄黄(各等分)。
制法用法:以上研为细末,每次取少许,吹入鼻中,等待患者打喷嚏后,然后再进药。或者用白梅擦牙,再用石菖蒲粉末置于舌下,牙关即可张开,仓促之时可用。
小续命汤:见第二十七问。
追风毒锉散:治疗中风内外皆热证。
配方:大黄(二钱)、郁李仁(炒、二钱)、桑白皮(炒半两)、槟榔(半两)、防风(半两)、羌活(一两)。
制法用法:以上锉成散剂,每次服用二钱,与三十粒黑豆同煎,乳食后服用。
省风汤:见第十四问。
防风通圣散:治疗小儿热甚引起的惊风,或者斑疹出不畅快的,甚至热势剧烈、疹色黑陷即将死亡的,或者风热疮疥久不愈的,以及各种风热证。
配方:防风(去芦头、半两)、荆芥(二钱半)、川芎(半两)、锦纹大黄(半两)、当归(半两)、薄荷叶(半两)、芍药(半两)、麻黄(去根节、半两)、芒硝(半两)、石膏(有细纹理者佳,方解石非、一两)、黄芩(一两)、桔梗(一两)、滑石(六两)、甘草(二两)、白术(二钱半)、山栀子(用小者佳,大者非、二钱半)。
制法用法:以上捣成粗末,每次服用二钱,加生姜两片,水一盏,煎至七分,去渣滓,不拘时候服用。或者卒中后长时间不语,或者突然失音不语的皆可治疗。
化风丹:见第十九问。
钩藤散:见第十六问。
至宝丹:见第二十问。
Pediatric wind-stroke occurs because the child's qi and blood are not yet stabilized, and the regulation of cold and warmth is disordered. Internally, excessive heat accumulates and stagnates; externally, the couli (skin pores) are open and deficient. Thus, wind pathogens take advantage of this external deficiency to suddenly strike and injure the body. The manifestations include coma with loss of consciousness, high fever with mania and restlessness, convulsions and twitching, coarse breathing, locked jaw, and salivary overflow.
Wind-stroke affecting the Heart presents as lying supine unable to turn sideways, fever, and aphonia, with a scorched red tongue. If sweating is profuse and lips are reddish, it is treatable; moxa can be applied to Xinshu (BL15). If the lips show mixed colors of white, black, green, or yellow, this indicates heart failure leading to water flooding; if the face and eyes appear green-black with frequent startles, these are intractable cases.
Wind-stroke affecting the Liver presents as sitting in a squatting position unable to bow the head, pain in the left hypochondrium, spasms and tightness of all sinews, turning of the head and eyes, upward gaze, irritability, and greenish eyes. If there is slight greenish discoloration around both eyes extending to the forehead, with green lips and yellow complexion, it is treatable; moxa can be applied to Ganshu (BL18). If the color is deeply green-black, or one eye is yellow and the other white, it is intractable.
Wind-stroke affecting the Kidney presents as squatting with facial edema, lower back and spine pain radiating to the lower abdomen, and black ears. If no yellow patches have appeared in the hypochondriac region, it is treatable; moxa can be applied to Shenshu (BL23). If the skin between the ribs resembles yellow earth, with stiff hair and yellow-red teeth, it is intractable.
Wind-stroke affecting the Lung presents as supine posture with chest fullness, panting, coughing, restlessness, sweating, and a white nose. If the area from below the eyes to around the nose, as well as the lips and mouth, are all white, it is treatable; moxa can be applied to Feishu (BL13). If the complexion carries a yellow hue, this indicates lung failure leading to blood stasis, which is intractable.
Wind-stroke affecting the Spleen presents as squatting with abdominal fullness, twitching of skin and flesh, inability to control the four limbs, and yellow lips. If the whole body is jaundiced and the patient spits out salty saliva, it is treatable; moxa can be applied to Pishu (BL20). If the hands and feet are cyanotic and cold (jue), it is intractable.
Generally, when humans are struck by wind pathogens, the pathogen enters through the Five Zang Shu points on the back. If wind enters the mandible and cheek areas, it causes facial deviation and locked jaw. If wind obstructs the throat and vocal cords, it results in inability to speak and aphonia. When wind struggles with qi, and qi is blocked by phlegm, a snoring sound is heard in the throat. This wind pathogen initially invades the skin and couli, then reaches the meridians and collaterals, struggling within the main meridians. Sinews subjected to cold become contracted, painful, and spasmodic; those subjected to heat become relaxed and weak. Wind combined with cold causes spasms; wind combined with heat causes relaxation. Spasmodic conditions present with floating and tight pulses; relaxed conditions present with floating and surging pulses. Cold patterns are treated with Xiao Xuming Tang (Minor Continuation Life Decoction); heat patterns are treated with formulas like Zhuifeng Du Cuo San (Wind-Chasing Poison Powder). Floating pulse indicates disease in the exterior; excess pulse indicates disease in the interior; rapid/intermittent pulse indicates disease in the upper jiao. Exterior diseases are dispersed; interior diseases are purged; upper jiao diseases are induced to vomit. For deficiency-cold patterns, Aconite (Fuzi) and Asarum (Wutou) types are indispensable. Ancient treatments prioritized moxibustion but also required careful assessment before prescribing. Although wind, cold, summer-heat, and dampness can all invade the body, wind-stroke caused by emotional qi disturbance also exists. Among sudden illnesses, wind-stroke is the most urgent. In emergencies, if precise diagnosis is difficult, first use methods to descend qi and resolve phlegm. Since wind-stroke often arises from phlegm stagnation and qi obstruction, first use Tongguan San (Pass-the-Gate Powder) to unblock orifices. Urgently decoct Arisaemae Rhizoma (Nanxing), Zingiberis Rhizoma Recens (Shengjiang), and Aucklandiae Radix (Muxiang), mix with Suhexiang Wan (Styrax Pill), and administer. For locked jaw, apply powder of Nanxing and Asari Radix et Rhizoma (Xixin) mixed with Moschus (Shexiang) and Pruni Mume Carpos (Wumei) to rub the teeth until the jaw opens. After medication, when phlegm dissipates and qi descends, and the condition slightly improves, carefully assess the external symptoms of the five zang organs for further regulation. Suitable formulas include Shengfeng Tang (Wind-Prostrating Decoction) and Qianghuo San (Notopterygii Root Powder); for severe cases, Fangfeng Tongsheng San (Saposhnikovia Universal Relief Powder), Huafeng Dan (Wind-Transforming Pill), Niuhuang San (Calculus Bovis Powder), Gouteng San (Uncaria Decoction), and Zhibao Dan (Precious Treasure Pill) may be selected.
Tongguan San: Treats sudden acute wind-stroke with coma, loss of consciousness, locked jaw, and inability to swallow medicine.
Ingredients: Asari Radix et Rhizoma (Xixin), Menthae Haplocalycis Herba (Bohe), Natrii Sulfas (Yaxiao), Realgar (Xionghuang) in equal parts.
Usage: Grind into powder. Use a small amount, insufflate into the nose. Wait for sneezing, then administer oral medicine. Alternatively, rub teeth with Pruni Mume Carpos (Wumei), place Acori Tatarinowii Rhizoma (Changpu) powder under the tongue to open the jaw. Useful in emergencies.
Xiao Xuming Tang: See Question 27.
Zhuifeng Du Cuo San: Treats wind-stroke with internal and external heat.
Ingredients: Rheomi Radix (Dahuang, 2 qian), Prunus humilis seed (Yuliren, stir-fried, 2 qian), Morus alba root bark (Sangbaipi, stir-fried, 0.5 liang), Arecae Semen (Binglang, 0.5 liang), Saposhnikoviae Radix (Fangfeng, 0.5 liang), Notopterygii Rhizoma et Radix (Qianghuo, 1 liang).
Usage: Cut into pieces. Take 2 qian per dose, decoct with 30 black soybeans. Take after milk or food.
Shengfeng Tang: See Question 14.
Fangfeng Tongsheng San: Treats pediatric convulsive wind due to severe heat, or slow eruption of macules and papules, even critical cases with dark, depressed lesions nearing death, or chronic wind-heat sores and scabies, and various wind-heat patterns.
Ingredients: Saposhnikoviae Radix (Fangfeng, remove rhizome, 0.5 liang), Schizonepetae Spica (Jingjie, 2.5 qian), Chuanxiong Rhizoma (Chuanxiong, 0.5 liang), Rheomi Radix (Jinwen Dahuang, 0.5 liang), Angelicae Sinensis Radix (Danggui, 0.5 liang), Menthae Haplocalycis Herba (Boheye, 0.5 liang), Paeoniae Radix (Shaoyao, 0.5 liang), Ephedrae Herba (Mahuang, remove roots and joints, 0.5 liang), Natrii Sulfas (Mangxiao, 0.5 liang), Gypsum Fibrosum (Shigao, fine texture preferred, 1 liang), Scutellariae Radix (Huangqin, 1 liang), Platycodonis Radix (Jiegeng, 1 liang), Talcum (Huashi, 6 liang), Glycyrrhizae Radix et Rhizoma (Gancao, 2 liang), Atractylodis Macrocephalae Rhizoma (Baizhu, 2.5 qian), Gardeniae Fructus (Shanzhizi, small ones preferred, 2.5 qian).
Usage: Coarsely grind. Take 2 qian per dose, add two slices of Zingiberis Rhizoma (Shengjiang), decoct one cup of water to 0.7 portion, strain, and take at any time. Also treats prolonged mutism after stroke or sudden aphonia.
Huafeng Dan: See Question 19.
Gouteng San: See Question 16.
Zhibao Dan: See Question 20.