男发左搐。或手大指屈外。或目左视无声者顺也。若发右搐。或手大指屈内。或目右视有声者逆也。女发右
搐。或手大指屈内。或目右视无声者顺也。若发左搐。或手大指屈外。或目左视有声者逆也。顺者相胜也。左肝
为木。右肺为金。一负一胜,故无声也。逆者战也。二脏俱实。木金相击。故有声也。顺者易治。逆者难治。
男逆稍易。女逆极难。更当参其发时。以补泻为治。昔钱乙治李寺丞子三岁。发搐自卯至巳。目右视。大叫哭。
乙见曰。逆也。男为阳。本发左视无声则顺。右视有声则逆。所以然者。左肝木也。右肺金也。逆则二脏相战。
金木相击。而有声也。治乃泻强补弱。假令女发搐。目左视。是肺来
胜肝。肝不能任。故叫哭也。当泻其肺。后治其心。续治其肝。若病在秋。(日西时同)肺兼旺位。当大泻其
肺。若病在春。(早晨时同)此肝旺之时。尚不能胜肺。是肺强而肝大弱也。当补其肝肾。大泻其肺。若男发搐目
右视。是肝来胜肺而叫哭。当泻其肝心。若病在春夏。(早晨日中时同)肝心旺时。当大泻其肝。若病在秋。
(日晡时同)
此肺旺之时。尚不能胜肝。是肝强而肺极虚也。当补其肺。大泻其肝。所以言目反视者。乃肝主目也。凡搐则是
风热相搏于内。风属肝。故引见于目也。今此病男反女。故稍易治于女也。先泻其肺。不闷乱。以知肺病退也。
后补其肾。续治其肝心。五日而愈。乙又治徐氏子三岁。每日西发搐。身微热。目微斜露睛。四肢冷而喘。大便
微黄。请乙与一李医同治。乙问李曰。病搐何如。以何药治之。李对不当。乙曰。搐者心肝实也。身微热者。日
西肺用事之时。肺主身温。今且热者。肺虚也。目微斜露睛者。肝肺相乘胜也。四肢冷者。脾虚也。肺若虚甚。
则脾母亦弱。木气乘之。四肢即冷。治当先补脾肺。得脾虚证退。然后治其心肝。九日乃愈。此亦逆搐。肝肺相
乘。目斜者必当右视也。今举此以明逆顺为治之法尔。
男孩出现左侧抽搐,或者大拇指向外观屈,或者眼睛向左看且没有声音的,属于顺证。如果男孩出现右侧抽搐,或者大拇指向内观屈,或者眼睛向右看且有声音的,属于逆证。女孩出现右侧抽搐,或者大拇指向内观屈,或者眼睛向右看且没有声音的,属于顺证。如果女孩出现左侧抽搐,或者大拇指向外观屈,或者眼睛向左看且有声音的,属于逆证。所谓“顺”,是指五行相克中的胜复关系。左侧属肝为木,右侧属肺为金,一负一胜,所以没有声音。所谓“逆”,是指两脏相互争斗。肝肺二脏都实盛,金木相互搏击,所以有声音。顺证容易治疗,逆证难以治疗。男孩的逆证相对稍易治疗,女孩的逆证极难治疗。此外还应当参考发病的时间,以补虚泻实作为治疗原则。
从前钱乙治疗李寺丞的儿子,三岁,抽搐从卯时持续到巳时,眼睛向右看,大声哭叫。钱乙见到后说:“这是逆证。”男孩属阳,本来应该左视无声才为顺,右视有声则为逆。之所以这样,是因为左边属肝木,右边属肺金。如果是逆证,则两脏相互交战,金木相互搏击,从而发出声音。治疗应当泻其强盛之脏,补其虚弱之脏。
假如女孩发生抽搐,眼睛向左看,这是肺气来克制肝木,肝木不能承受,所以大声哭叫。应当先泻肺,然后治心,接着治肝。如果病发在秋季(傍晚时分同理),此时肺兼旺位,应当大泻其肺。如果病发在春季(早晨时分同理),这是肝气旺盛的时候,尚且不能胜过肺,说明肺强而肝非常弱,应当补肝肾,大泻其肺。
如果男孩发生抽搐,眼睛向右看,这是肝气来克制肺金并导致哭叫,应当泻肝和心。如果病发在春夏季(早晨、日中时分同理),肝心气旺之时,应当大泻其肝。如果病发在秋季(日晡时分同理),这是肺气旺盛的时候,尚且不能胜过肝,说明肝强而肺极度虚弱,应当补肺,大泻其肝。之所以说眼睛反视,是因为肝主目。凡是抽搐,都是风热在内相搏结,风属于肝,所以反映在眼睛上。现在这个病例男女表现相反,所以比女孩的病情稍易治疗。先泻肺,如果不出现烦闷混乱,就知道肺病已退。然后补肾,接着治肝心,五天痊愈。
钱乙又治疗徐氏的儿子,三岁,每天傍晚发作抽搐,身体微热,眼睛微斜且露睛,四肢冰冷且气喘,大便微黄。请钱乙与李医生共同诊治。钱乙问李医生:“这抽搐病怎么样?用什么药治疗?”李医生回答不当。钱乙说:“抽搐是心肝实证。身体微热,是因为傍晚时分肺当令,肺主管身体的温度,现在却发热,说明肺虚。眼睛微斜且露睛,是肝肺相互乘克。四肢冰冷,是脾虚。如果肺虚得很严重,那么脾母也会虚弱,木气乘虚而入,四肢就会冰冷。治疗应当先补脾肺,等到脾虚的症状消退,然后再治心肝,九天才痊愈。”这也是逆证抽搐,肝肺相互乘克,眼睛斜视必然向右看。举此案例是为了阐明根据逆顺进行治疗的方法罢了。
In boys, convulsions occurring on the left side, or with the thumb flexed outward, or with the eyes looking to the left and no sound, are considered favorable (Shun). If convulsions occur on the right side, or with the thumb flexed inward, or with the eyes looking to the right accompanied by sound, they are considered unfavorable (Ni). In girls, convulsions occurring on the right side, or with the thumb flexed inward, or with the eyes looking to the right and no sound, are considered favorable. If convulsions occur on the left side, or with the thumb flexed outward, or with the eyes looking to the left accompanied by sound, they are considered unfavorable. "Favorable" refers to the relationship of overcoming in Five Elements theory. The left corresponds to Liver Wood, and the right corresponds to Lung Metal. One is defeated and one overcomes, hence there is no sound. "Unfavorable" refers to struggle between the two Zang organs. Both Liver and Lung are excess; Metal and Wood strike each other, hence there is sound. Favorable cases are easy to treat; unfavorable cases are difficult to treat. Unfavorable cases in boys are slightly easier to treat, while unfavorable cases in girls are extremely difficult. Furthermore, one must consider the time of onset and employ tonification and purgation as treatment principles.
Previously, Qian Yi treated the three-year-old son of Official Li. The child suffered from convulsions from Mao hour to Si hour, with eyes looking to the right and loud crying. Upon seeing this, Qian Yi said, "This is an unfavorable case." Boys belong to Yang. Normally, leftward gaze without sound is favorable, while rightward gaze with sound is unfavorable. This is because the left corresponds to Liver Wood and the right to Lung Metal. In unfavorable cases, the two Zang organs battle, Metal and Wood strike each other, producing sound. Treatment should involve purging the excess and tonifying the deficiency.
For example, if a girl suffers convulsions with eyes looking to the left, it indicates that Lung Qi is overcoming Liver Wood, which cannot withstand it, resulting in crying. One should purge the Lung first, then treat the Heart, and subsequently treat the Liver. If the disease occurs in Autumn (similarly at dusk), when Lung is in a prosperous position, one should heavily purge the Lung. If the disease occurs in Spring (similarly in the morning), when Liver is prosperous, yet it still cannot overcome the Lung, it indicates that Lung is strong and Liver is very weak. One should tonify Liver and Kidney, and heavily purge the Lung.
If a boy suffers convulsions with eyes looking to the right, it indicates that Liver Qi is overcoming Lung Metal, causing crying. One should purge Liver and Heart. If the disease occurs in Spring and Summer (similarly in the morning and noon), when Liver and Heart are prosperous, one should heavily purge the Liver. If the disease occurs in Autumn (similarly at dusk), when Lung is prosperous, yet it still cannot overcome the Liver, it indicates that Liver is strong and Lung is extremely deficient. One should tonify Lung and heavily purge the Liver. The reason for retroversion of the eyes is that Liver governs the eyes. All convulsions result from Wind-Heat struggling internally. Wind belongs to Liver, hence it manifests in the eyes. Since this case presents opposite symptoms for males and females, it is slightly easier to treat than in females. Purge Lung first; if there is no distress or confusion, it indicates Lung pathology has receded. Then tonify Kidney, followed by treating Liver and Heart. Recovery occurs in five days.
Qian Yi also treated the three-year-old son of the Xu family. Every day at dusk, he suffered convulsions, slight fever, slightly deviated eyes with eyelids retracted, cold limbs, panting, and slightly yellow stool. He requested both Qian Yi and Physician Li to treat him. Qian Yi asked Physician Li, "How is the convulsion? What medicine do you propose?" Physician Li's response was inappropriate. Qian Yi said, "Convulsions indicate Heart and Liver Excess. Slight fever occurs because at dusk, Lung takes command; Lung governs body warmth. Current heat indicates Lung Deficiency. Slightly deviated eyes with retracted eyelids indicate Liver and Lung mutual overcoming. Cold limbs indicate Spleen Deficiency. If Lung is severely deficient, its mother, Spleen, will also be weak. Wood Qi will take advantage, causing cold limbs. Treatment should first tonify Spleen and Lung. Once Spleen deficiency signs recede, then treat Heart and Liver. Recovery occurs in nine days." This is also an unfavorable convulsion, with Liver and Lung mutual overcoming. Deviated eyes must look to the right. This case is cited to illustrate the method of treatment based on favorable and unfavorable patterns.