《巢氏病源》小儿卒死候∶小儿卒死者,是三虚而遇贼风,故无病仓卒而死也。三虚者∶乘年之衰一也,逢
月之空二也,失时之和三也。有人因此三虚,复为贼风所伤。使阴气偏竭于内,阳气阻隔于外,而气壅闭,阴
阳不通,故暴绝而死也。若腑脏未竭,良久乃苏,亦有兼挟鬼神气者,皆须邪退乃生也。此中客忤及中恶,卒
死而邪气不尽,停滞心腹久乃发动,多变成疰也。
茅先生∶卒死候,眼合哜齿,遍身如绵软,面青黑,口鼻冷。此候因本生下而遍身热,或因有驾患,医人
一向退热,不曾下得惊积及奶积,遂积聚被邪气至此候。
上前件三个候都来,一般只是要辨元初受患根源。所治者,急下夺命散与吐下风涎,(方见急慢惊风门中)。醒后便
下匀气散(方见胃气不和门中)二服补。除后,下朱砂膏、(方见惊积门中)。镇心丸与服。(方见一切惊门中)。如有伏
热
来时,即下大附子散,与调理三、五日安乐。(方见慢惊风门中。)前件三个形候,只是此一般调理。上件疾见鸦声上啼、
偏搐、汗如珠、不得睡、眼障泪出,死候不治。
《婴童宝鉴》小儿三虚歌∶
乘年之衰兮逢月之空,失时之和兮五虚之中。卒中贼风兮成卒死,兼挟鬼气兮候亦同。脏腑未绝兮须再活,
急令医治兮莫忽忽
《金匮要略》救小儿卒死而吐利不知是何病方。
上以马屎一团绞取汁灌之。无湿者,水煮,干者取汁。
《葛氏肘后》救卒死而壮热者。
上用矾石半斤,水一升半煮消,以渍脚,令没踝。
《葛氏肘后》又方 救卒死而目闭者。
上用骑牛临面捣薤汁,灌之耳中。
《葛氏肘后》又方 救卒死而四肢不收,屎便者。
上取牛洞一升,温酒灌口中。洞者,稀粪也。
《千金》卒死,无脉、无他形候,阴阳俱竭故也。治之方。
上用牵牛临鼻上二百息,牛舐必瘥。牛不肯舐,着盐汁涂面上,即牛肯舐。
《千金》又方
上灸,熨斗熨两胁下。(《备急方》云∶及治尸厥。)
《千金》治魇死不自觉者方。
上用慎灯火,勿令人手动,牵牛临其上即觉。若卒不能语,取东门上鸡头末之,以酒服。
《千金》治卒魇死方。
上捣韭汁灌鼻孔中。剧者灌两耳(张仲景云∶灌口中。)
《千金》治鬼魇不悟方。
上末伏龙肝吹鼻中。
《千金》又方
上末皂荚如大豆许,吹鼻中,嚏则气通,起死人。(《集验方》治中恶。)
《圣惠》治小儿卒死方。
上取女青末半钱,用牛乳汁调服之。
《圣惠》又方
上烧 猪粪,水解取汁服之。
《圣惠》又方
上以苦参醋煮汁少许,内口中即苏。水煮亦得。又酒煮烂棺木板取汁,服少许。
《圣惠》又方
上煎盐汤令极咸,以物拗口开灌之,令入腹即活。
《圣惠》又方
上以热汤和灰,浓壅身上,逡巡即苏。
《婴孺》治小儿不知所病便所绝方。
上取雄鸡冠临儿口上割血,滴入口下即活。
《葛氏肘后》灸法∶卒死而四肢不收、屎便者,灸心下一寸、脐上三寸、脐下四寸各一百壮。儿小者随年。
《千金》治卒死,针间使各百余息。
《千金》灸鼻下人中。一名鬼客厅。(《肘后》方云∶又治尸厥。)
《诸病源候论》中关于小儿猝死的证候:小儿猝死,是因为处于“三虚”状态时又遭遇了贼风(指不正之气或外感邪气),所以没有明显疾病却突然死亡。所谓的“三虚”是指:一是正值岁运衰退之年,二是正值月缺无光之时,三是违背了四时气候的调和规律。有人因为具备这三种虚弱状态,再加上受到贼风的侵袭,导致阴气在内偏枯衰竭,阳气在外被阻隔不通,从而气机壅滞闭塞,阴阳之气不相贯通,因此暴然断绝而死。如果脏腑精气尚未完全枯竭,经过较长时间可能苏醒;也有兼夹鬼神邪气的情况,都必须等到邪气退去才能生还。这类情况中的客忤(因惊吓或外来邪气引起的病症)和中恶(突受秽浊邪气而发病),猝死之后若邪气未尽,停滞在心腹部位,日久发动,多会转变为疰病(一种具有传染性、病程迁延的慢性消耗性疾病)。
茅先生论述猝死证候:表现为眼睑闭合、牙齿咬紧、全身肌肉松弛如绵软无力、面色青黑、口鼻发冷。此证候是因为患儿出生后即遍身发热,或者患有惊风等疾患,医生一味地退热治疗,未曾使用下法清除惊积和奶积,导致积聚之物被邪气所困,进而发展为这种猝死证候。
针对上述三种证候,总体原则都是要辨别最初受病的根源。治疗时,应紧急使用夺命散进行攻下,并催吐以排出风涎(方剂见急慢惊风门中)。患者苏醒后,再服用两剂匀气散以调理(方剂见胃气不和门中)。病情稳定后,再服用朱砂膏(方剂见惊积门中)和镇心丸(方剂见一切惊门中)以巩固疗效。如果有伏热发作,则使用大附子散,并调理三至五日使其安宁(方剂见慢惊风门中)。前文所述的三种形证,均按此一般原则调理。若出现鸦叫声上啼、半身抽搐、汗出如珠、无法入睡、眼睑遮蔽流泪等症状,属于死证,难以救治。
《婴童宝鉴》小儿三虚歌诀:
正值岁运衰退又逢月缺无光,违背四时调和陷入五虚之中。
突然遭受贼风侵袭而成猝死,兼夹鬼气邪祟症状也相同。
脏腑精气未绝尚有生机可救,急忙请医治疗切勿疏忽大意。
《金匮要略》救治小儿猝死且伴有呕吐腹泻,不知是何病的方剂。
取马粪一团,绞取汁液灌入患儿口中。若无湿粪,则用水煮,干粪则取汁液。
《葛氏肘后方》救治猝死且身体壮热的患者。
取矾石半斤,加水一升半煮至溶解,用此药液浸泡双脚,使药液没过脚踝。
《葛氏肘后方》另一首方剂,救治猝死且双眼紧闭的患者。
取骑牛草(一种草药)的面部捣烂取汁,滴灌入耳中。
《葛氏肘后方》又一首方剂,救治猝死且四肢弛缓不收、大小便失禁的患者。
取牛洞(即稀粪)一升,用温酒调和后灌入口中。所谓“洞”,指的是稀粪。
《千金方》救治猝死,无脉搏、无其他形证,因阴阳之气俱竭所致者。治疗方剂如下:
将牵牛子置于患儿鼻端,令其闻嗅二百次,若有牛来舔舐患儿,必能痊愈。若牛不肯舔舐,可将盐汁涂在患儿脸上,牛便会前来舔舐。
《千金方》另一首方剂
采用艾灸疗法,用熨斗熨烫两侧胁下部位。(《备急方》记载:也可用于治疗尸厥。)
《千金方》治疗魇死(梦中惊死或鬼压床致死)而不自知的方剂。
注意谨慎灯火,不要让人随意移动患儿手脚,让牵牛子在患儿上方即可唤醒。若突然不能言语,取东门上的鸡头(鸡冠)研末,用酒送服。
《千金方》治疗突然魇死的方剂。
捣取韭菜汁,灌入鼻孔中。病情严重者,灌入双耳中。(张仲景说:灌入口中。)
《千金方》治疗鬼魇不醒的方剂。
将伏龙肝(灶心土)研成细末,吹入鼻中。
《千金方》另一首方剂
将皂荚研成如大豆大小的颗粒,吹入鼻中,引发喷嚏则气机通畅,可使死人复活。(《集验方》用于治疗中恶。)
《太平圣惠方》治疗小儿猝死的方剂。
取女青粉末半钱,用牛乳汁调匀后服用。
《太平圣惠方》另一首方剂
烧猪粪,用水化解后取汁液服用。
《太平圣惠方》又一首方剂
用苦参加醋煮取少量汁液,纳入口中即可苏醒。用水煮也可以。或者用酒煮烂棺材木板取汁,服用少许。
《太平圣惠方》又一首方剂
煎煮盐水至极咸,用器具撬开嘴巴灌入,药液进入腹部即可活过来。
《太平圣惠方》又一首方剂
用热水调和草木灰,浓稠地敷裹在身上,片刻后即可苏醒。
《婴孺书》治疗小儿不知患病突然断气的方剂。
取雄鸡冠,置于患儿口上割破放血,滴入口中即可立即复活。
《葛氏肘后方》灸法:对于猝死且四肢弛缓不收、大小便失禁者,灸心下一寸、脐上三寸、脐下四寸各一百壮。幼儿则根据年龄酌情减少壮数。
According to *Zhu Bing Yuan Hou Lun* (General Treatise on the Pathogenesis and Manifestations of All Diseases) regarding the syndrome of sudden death in infants: Sudden death in infants occurs when they are in a state of "Three Deficiencies" and encounter thief-wind (pathogenic wind). Thus, they die suddenly without prior obvious illness. The "Three Deficiencies" refer to: first, encountering a year of declining annual fortune; second, meeting a time of moonless darkness; third, failing to harmonize with the seasonal climate changes. Individuals possessing these three deficiencies, upon being injured by thief-wind, cause Yin Qi to be excessively depleted internally and Yang Qi to be blocked externally. This leads to Qi stagnation and closure, with the interruption of communication between Yin and Yang, resulting in sudden cessation of life. If the Zang-Fu organs have not completely exhausted their essence, revival may occur after a long period. There are also cases involving the interference of ghostly or evil Qi, where survival depends on the retreat of the pathogenic factors. In conditions such as Ke Wu (sudden fright or external pathogenic invasion) and Zhong E (sudden illness due to foul pathogenic qi), if the pathogenic factors remain incomplete after sudden death and stagnate in the heart and abdomen for a long time before manifesting, they often transform into Zhu disease (a chronic, contagious wasting disease).
Master Mao describes the signs of sudden death: eyelids closed, teeth clenched, body flaccid like cotton, face cyanotic and dark, mouth and nose cold. This syndrome arises because the infant had generalized heat since birth, or suffered from convulsions, and physicians only focused on reducing fever without using purgative methods to clear convulsive accumulation or milk accumulation. Consequently, the accumulated pathogens were trapped by evil Qi, leading to this critical condition.
For the aforementioned three syndromes, the general principle is to identify the root cause of the initial pathology. Treatment should urgently employ Duoming San (Life-Saving Powder) to purge, and induce vomiting to expel wind-phlegm (see section on Acute and Chronic Convulsions). After regaining consciousness, administer two doses of Yunqi San (Qi-Balancing Powder) to regulate (see section on Stomach Qi Disharmony). Subsequently, administer Zhusha Gao (Cinnabar Paste) (see section on Convulsion Accumulation) and Zhenxin Wan (Heart-Calming Pill) (see section on All Convulsions) to consolidate recovery. If latent heat arises, use Da Fuzi San (Great Aconite Powder) and provide conditioning care for three to five days for peace (see section on Chronic Convulsions). The three forms described above are managed according to this general principle. However, if symptoms such as crow-like crying, hemiconvulsions, sweat beading like pearls, insomnia, and eyes covered with tears appear, it indicates a fatal prognosis that is untreatable.
*Yingtong Baojian* (Precious Mirror for Infants and Children) Song on the Three Deficiencies of Infants:
When annual fortune declines and the moon is empty,
And seasonal harmony is lost amidst the Five Deficiencies.
Sudden strike by thief-wind leads to sudden death,
Accompanied by ghostly qi, the signs are similar.
If Zang-Fu essence is not yet severed, life can be restored,
Seek medical aid urgently, do not be negligent.
*Jin Gui Yao Lue* (Essential Prescriptions from the Golden Cabinet) formula for saving infants who die suddenly with vomiting, diarrhea, and unknown etiology:
Take a clump of horse manure, wring out the juice, and instill it into the mouth. If fresh manure is unavailable, boil dry manure in water and take the juice.
*Ge Shi Zhou Hou Fang* (Emergency Prescriptions Kept at the Elbow of Master Ge) for saving those who die suddenly with high fever:
Take half a jin of Alum, boil in one and a half sheng of water until dissolved, and soak the feet, submerging them up to the ankles.
*Ge Shi Zhou Hou Fang*, another formula for saving those who die suddenly with closed eyes:
Crush the herb Qiniu Linmian (likely *Allium tuberosum* or related species used topically) and extract its juice, instilling it into the ears.
*Ge Shi Zhou Hou Fang*, another formula for saving those who die suddenly with flaccid limbs and incontinence:
Take one sheng of Niu Dong (cow dung, specifically loose feces), mix with warm wine, and instill into the mouth.
*Qian Jin Fang* (Prescriptions Worth a Thousand Gold) for sudden death characterized by absence of pulse and other signs, caused by exhaustion of both Yin and Yang Qi:
Place Qian Niu Zi (Pharbitis Seed) near the nose for 200 breaths. If a cow licks the patient, recovery is certain. If the cow refuses, apply salt juice to the face to attract the cow.
*Qian Jin Fang*, another formula:
Apply moxibustion or hot compress (using an iron warmer) to the hypochondriac regions bilaterally. (*Bei Ji Fang* notes this also treats Shi Jue/Corpse-Jue).
*Qian Jin Fang* for treating Yan Si (death by nightmare/supernatural oppression) where the patient is unaware:
Ensure careful management of lamps/fire, avoid moving the patient's limbs, and place Qian Niu Zi above the patient to awaken them. If sudden aphasia occurs, take powder from the rooster comb at the East Gate, and administer with wine.
*Qian Jin Fang* for sudden Yan Si:
Crush Chinese chive (*Jiu Cai*) to extract juice and instill into the nostrils. For severe cases, instill into both ears. (Zhang Zhongjing states: instill into the mouth.)
*Qian Jin Fang* for supernatural oppression causing unconsciousness:
Powder Fu Long Gan (Caosinis Cauda/Fireplace Earth) and blow it into the nostrils.
*Qian Jin Fang*, another formula:
Powder Zao Jia (Gleditsia Sinensis Fruit) to the size of soybeans, blow into the nostrils. Sneezing will restore Qi flow and revive the deceased. (*Ji Yan Fang* uses this for Zhong E).
*Tai Ping Sheng Hui Fang* (Holy惠民 Formulas of the Taiping Era) for pediatric sudden death:
Take half a qian of Nu Qing powder, mix with cow's milk, and administer orally.
*Tai Ping Sheng Hui Fang*, another formula:
Burn pig manure, dissolve in water, and administer the juice.
*Tai Ping Sheng Hui Fang*, another formula:
Boil Ku Shen (Sophora Root) in vinegar to obtain a small amount of juice, place in the mouth for revival. Boiling in water is also acceptable. Alternatively, boil coffin wood boards in wine, take the juice, and administer a small amount.
*Tai Ping Sheng Hui Fang*, another formula:
Prepare extremely salty brine, pry open the mouth with a tool, and instill the liquid. Once it enters the stomach, the patient will live.
*Tai Ping Sheng Hui Fang*, another formula:
Mix hot water with plant ash, apply thickly over the body. Revival will occur shortly.
*Ying Ru Shu* (Book for Infants and Toddlers) for infants dying suddenly from unknown causes:
Cut the comb of a male chicken, hold it above the infant's mouth to collect blood, and drip the blood into the mouth for immediate revival.
*Ge Shi Zhou Hou Fang* Moxibustion Method: For sudden death with flaccid limbs and incontinence, moxa-burn points located one cun below the heart, three cun above the umbilicus, and four cun below the umbilicus, each 100 moxa cones. For smaller children, adjust the number of cones according to age.
*Qian Jin Fang* for sudden death: Needle Jian Shi (PC5) for over 100 breaths.
*Qian Jin Fang* Moxa-burn Ren Zhong (GV26), located below the nose. Also known as Gui Ke Ting (Ghost Guest Hall). (*Zhou Hou Fang* notes this also treats Shi Jue).