慢惊夹热或夹痰,身热心烦口溢涎,宜以清心涤痰治,白丸柴芍六君煎。
【注】慢惊之证,本无热可言,但脾虚虚热内生,故痰涎上泛,咽喉气粗、身热心烦,
所谓虚夹痰热是也。痰热相兼者,清心涤痰汤主之;脾虚肝旺痰盛者,青州白丸子、柴
芍六君汤主之。
清心涤痰汤(方见急惊后调理法)
青州白丸子
生川乌(去皮脐,五钱) 生半夏(七两) 南星(生,三两) 白附子(生,二两)
上为末,盛生绢袋内,用井华水摆出粉,未尽再摆,以粉尽为度,置瓷盆内,日晒夜露,每早撇去旧水,别用新水
搅,春五日,夏三日,秋七日,冬十日,去水晒干,研为细末,用糯米粉煎粥清丸绿豆大,每服三五丸,薄荷汤送下。
柴芍六君子汤
人参 白术(土炒) 茯苓 陈皮 半夏(姜制) 甘草(炙) 柴胡 白芍(炒) 钓藤钩
引用姜、枣,水煎服。
【方歌】脾虚木旺风痰盛,四君人参术草苓,痰盛陈半因加入,肝风更用柴芍藤。
肝盛脾衰金气弱,金失承制木生风,每因吐泻伤脾胃,闭目摇头面唇青,额汗昏睡身肢冷,舌短声哑呕澄清,温中
补脾为主剂,固真理中随证从。
【注】慢脾风一证,多缘吐泻既久,脾气大伤,以致土虚不能生金,金弱不能制木,肝
木强盛,惟脾是克,故曰脾风。闭目摇头,面唇青黯,额汗昏睡,四肢厥冷,舌短声哑,频
呕清水,此乃纯阴无阳之证。逐风则无风可逐,治惊则无惊可治,惟宜大补脾士,生胃
回阳为主。吐泻亡阳者,温中补脾汤主之;大
病后成者,固真汤主之;四肢厥冷者,理中汤加附子主之。
温中补脾汤
人参 黄 (蜜炙) 白术(土炒) 干姜 陈皮 半夏(姜制) 附子(制) 茯苓 砂仁 肉
桂(去粗皮研) 白芍(炒焦) 甘草(炙) 丁香
引用煨姜,水煎服。
【方歌】慢脾温中补脾汤,参 白术共干姜,陈半附苓缩砂桂,白芍甘草共丁香。
固真汤
人参 白术(土炒) 肉桂(去粗皮) 白茯苓 山药(炒) 黄 (蜜炙) 甘草(湿纸裹煨透) 附
子(去皮脐汤泡浸)
引用姜、枣,水煎服。
【方歌】固真汤治慢脾风,人参白术桂茯苓,山药黄 煨甘草,附子浸泡最宜精。
理中汤(方见不乳)
慢惊风夹有热邪或夹有痰浊,表现为身体发热、心中烦躁、口中溢出涎沫,治疗应当采用清心火、涤除痰浊的方法,方剂选用青州白丸子、柴胡芍药六君子汤。
【注】慢惊风的证候,本来没有实热可言,但因为脾气虚弱导致虚热内生,所以痰涎向上泛溢,出现咽喉气息粗重、身体发热、心中烦躁的症状,这就是所谓的“虚证夹杂痰热”。如果是痰与热相互兼杂的,以清心涤痰汤为主治方;如果是脾虚肝旺且痰湿盛行的,以青州白丸子、柴芍六君汤为主治方。
青州白丸子
生川乌(去除皮和脐,五钱) 生半夏(七两) 南星(生用,三两) 白附子(生用,二两)
将上述药材研成粉末,装入生的丝绢袋中,用清晨汲取的井水反复漂洗出淀粉,直到淀粉完全洗出为止。将剩下的药渣放入瓷盆中,白天日晒、夜晚露置,每天早晨撇去旧水,换用新水搅拌。春季五日,夏季三日,秋季七日,冬季十日,去掉水分晒干后,研为细末。用糯米粉煮成的稀粥作为粘合剂,制成如绿豆大小的丸药。每次服用三到五丸,用薄荷汤送服。
柴芍六君子汤
人参 白术(土炒制) 茯苓 陈皮 半夏(姜汁制) 甘草(炙烤) 柴胡 白芍(炒制) 钩藤
引用生姜、大枣,加水煎煮后服用。
【方歌】脾虚木旺风痰盛,四君人参术草苓,痰盛陈半因加入,肝风更用柴芍藤。
肝气过盛而脾气衰弱,肺金之气虚弱,肺金失去对肝木的制约作用,导致肝木化风。这往往是因为呕吐腹泻损伤了脾胃,症状表现为闭目摇头、面色嘴唇青暗、额头出汗、昏睡、四肢发冷、舌体短缩、声音嘶哑、频繁呕吐清稀液体。治疗应以温中补脾为主要法则,根据具体证候灵活选用固真汤或理中汤。
【注】慢脾风这一证候,多是因为长期的呕吐腹泻,导致脾气严重受损,致使土(脾)虚不能生金(肺),金弱不能制约木(肝)。肝木强盛,专门克制脾土,所以称为“脾风”。闭目摇头、面色嘴唇青暗、额头出汗、昏睡、四肢厥冷、舌短声哑、频繁呕吐清水,这是纯阴无阳的证候。此时驱逐风邪则无风可逐,治疗惊风则无惊可治,只宜大补脾土,以生胃气、回阳气为主要治疗原则。因吐泻导致亡阳的,以温中补脾汤为主治方;大病之后形成的,以固真汤为主治方;四肢厥冷的,以理中汤加附子为主治方。
温中补脾汤
人参 黄芪(蜂蜜炙烤) 白术(土炒制) 干姜 陈皮 半夏(姜汁制) 附子(制过) 茯苓 砂仁 肉桂(去除粗皮研碎) 白芍(炒焦) 甘草(炙烤) 丁香
引用煨姜,加水煎煮后服用。
【方歌】慢脾温中补脾汤,参 白术共干姜,陈半附苓缩砂桂,白芍甘草共丁香。
固真汤
人参 白术(土炒制) 肉桂(去除粗皮) 白茯苓 山药(炒制) 黄芪(蜂蜜炙烤) 甘草(湿纸包裹煨透) 附子(去除皮和脐,用水浸泡)
引用生姜、大枣,加水煎煮后服用。
【方歌】固真汤治慢脾风,人参白术桂茯苓,山药黄 煨甘草,附子浸泡最宜精。
理中汤(方剂见不乳章节)
Slow convulsion complicated by heat or phlegm presents with fever, irritability, and salivation. Treatment should focus on clearing the Heart and eliminating phlegm, using Qingzhou Baiwanzi (Qingzhou White Pill) and Chai Shao Liu Jun Decoction.
[Note] The syndrome of slow convulsion originally lacks excess heat; however, spleen deficiency generates internal deficient heat, causing phlegm-saliva to rise upward. This results in coarse breath in the throat, fever, and irritability, known as "deficiency complicated by phlegm-heat." For cases where phlegm and heat are combined, Qingxin Ditan Tang (Clear the Heart and Eliminate Phlegm Decoction) is the primary formula. For cases involving spleen deficiency with liver hyperactivity and abundant phlegm, Qingzhou Baiwanzi (Qingzhou White Pill) and Chai Shao Liu Jun Tang (Bupleurum and Peony Six Gentlemen Decoction) are used.
Qingxin Ditan Tang (See the section on post-treatment regulation for acute convulsion).
Qingzhou Baiwanzi (Qingzhou White Pill)
Raw Chuanwu (Aconiti Lateralis Radix Preparata, peeled and core removed, 5 qian), Raw Banxia (Pinelliae Rhizoma, 7 liang), Nanxing (Arisaematis Rhizoma, raw, 3 liang), Baifuzi (Typhonii Rhizoma, raw, 2 liang).
Grind the above into powder, place in a raw silk bag, and wash repeatedly with well water drawn at dawn until the starch is fully extracted. Place the residue in a porcelain basin, expose to sun during the day and dew at night. Each morning, discard the old water and stir with fresh water. Spring: 5 days; Summer: 3 days; Autumn: 7 days; Winter: 10 days. Drain the water, dry, and grind into fine powder. Use rice gruel made from glutinous rice to bind the powder into pills the size of mung beans. Take 3–5 pills per dose, washed down with mint tea.
Chai Shao Liu Jun Zi Tang (Bupleurum and Peony Six Gentlemen Decoction)
Renshen (Ginseng Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma, stir-fried with soil), Fuling (Poria), Chenpi (Citri Reticulatae Pericarpium), Banxia (Pinelliae Rhizoma, processed with ginger juice), Gancao (Licorice Radix et Rhizoma, honey-fried), Chaihu (Bupleuri Radix), Baishao (Paeoniae Radix Alba, stir-fried), Gouteng (Uncariae Ramulus cum Uncis).
Add Shengjiang (Zingiberis Rhizoma Recens) and Dazao (Jujubae Fructus), decoct in water, and take orally.
[Formula Song] Spleen deficiency with wood hyperactivity leads to abundant wind-phlegm; Si Jun Zi Tang consists of Ginseng, Atractylodes, Licorice, and Poria. When phlegm is abundant, add Citrus Peel and Pinellia; for liver wind, further add Bupleurum, Peony, and Uncaria.
Liver excess and spleen decline weaken Metal (Lung); Metal fails to control Wood, generating wind. This often arises from vomiting and diarrhea damaging the Spleen and Stomach. Symptoms include closing eyes and shaking head, cyanosis of face and lips, sweating on the forehead, lethargy, cold limbs, short tongue, hoarse voice, and frequent vomiting of clear fluid. The main treatment principle is to warm the middle and tonify the spleen. Depending on the syndrome, Guzhen Tang (Solidify the True Decoction) or Lizhong Tang (Regulate the Middle Decoction) should be selected.
[Note] The syndrome of slow spleen wind usually stems from prolonged vomiting and diarrhea severely injuring the Spleen Qi. Earth deficiency fails to generate Metal, and weak Metal fails to control Wood. Liver Wood becomes strong and exclusively overacts on Spleen Earth, hence called "Spleen Wind." Closing eyes, shaking head, dark cyanotic face and lips, forehead sweating, lethargy, cold limbs, short tongue, hoarse voice, and frequent vomiting of clear water indicate a syndrome of pure Yin without Yang. At this stage, there is no wind to dispel and no convulsion to calm; the only approach is to greatly tonify Spleen Earth, generating Stomach Qi and restoring Yang. For yang collapse due to vomiting and diarrhea, Wenzhong Bupi Tang (Warm the Middle and Tonify the Spleen Decoction) is used. For cases arising after severe illness, Guzhen Tang (Solidify the True Decoction) is used. For cold limbs, Lizhong Tang (Regulate the Middle Decoction) with Fuzi (Prepared Aconite Lateralis Radix) is used.
Wenzhong Bupi Tang (Warm the Middle and Tonify the Spleen Decoction)
Renshen (Ginseng Radix et Rhizoma), Huangqi (Astragali Radix, honey-fried), Baizhu (Atractylodis Macrocephalae Rhizoma, stir-fried with soil), Ganjiang (Zingiberis Rhizoma), Chenpi (Citri Reticulatae Pericarpium), Banxia (Pinelliae Rhizoma, processed with ginger juice), Fuzi (Aconiti Lateralis Radix Preparata), Fuling (Poria), Sharen (Amomi Fructus), Rougui (Cinnamomi Cortex), Baishao (Paeoniae Radix Alba, stir-fried until scorched), Gancao (Licorice Radix et Rhizoma, honey-fried), Dingxiang (Eugeniae Flos).
Add Wei Jiang (Zingiberis Rhizoma Recens, roasted), decoct in water, and take orally.
[Formula Song] Wenzhong Bupi Tang treats slow spleen wind; Ginseng, Atractylodes, and Ginger work together. With Citrus Peel, Pinellia, Aconite, Poria, Amomum, Cinnamon, Peony, Licorice, and Clove combined.
Guzhen Tang (Solidify the True Decoction)
Renshen (Ginseng Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma, stir-fried with soil), Rougui (Cinnamomi Cortex, peeled), Fuling (Poria), Shanyao (Dioscoreae Rhizoma, stir-fried), Huangqi (Astragali Radix, honey-fried), Gancao (Licorice Radix et Rhizoma, wrapped in wet paper and roasted thoroughly), Fuzi (Aconiti Lateralis Radix Preparata, peeled, soaked in water).
Add Shengjiang (Zingiberis Rhizoma Recens) and Dazao (Jujubae Fructus), decoct in water, and take orally.
[Formula Song] Guzhen Tang treats slow spleen wind; Ginseng, Atractylodes, Cinnamon, and Poria. Yam, Astragalus, and roasted Licorice combine; soaking Aconite is most essential.
Lizhong Tang (Regulate the Middle Decoction) (See the section on refusal to nurse).