钱氏曰小儿惊搐因伤风后得之口中气出热呵欠烦闷手足动摇当发散大青膏主之小儿本怯
多此
病也因伤食后得之身体温多睡或吐不思乳食而发搐当先定搐搐退白饼子下之后与安神丸主之
惟疮疹能发搐风火相争故也治当泻心肝补其母
按小儿因伤风而得以上证者同大人伤风寒之类当辨有汗无汗阴阳二证用大青膏仲景小续
命之
类开发则愈因伤食发搐谓不因他病忽然而搐此因饮食过度致损脾胃故见多睡或吐不思乳食脾
胃既虚引肝风则发搐当先定其搐加羌活防风煎下泻青丸后用白饼子下其食渐渐用调中丸异功
散养其气因斑疹而得之者盖疹为脾虚所生脾虚而肝旺乘之木来胜土势气相击动于心神心喜为
热神气不安故也斑为心所生心主热热则生风风属于肝二脏相搏故发搐也宜泻心肝补其母导赤
散地黄丸主之
小儿惊风有二急惊属痰热宜凉泻一云用降火下痰丸养血药作汤下之慢惊属脾虚所主多死
宜温
补一云当养脾用朱砂安神丸清米汤下更于血药中求之世以一药通治之甚妄急惊风发热口疮手
心伏热痰嗽痰喘并用涌法重则用瓜蒂散轻则用赤小豆苦参末须用酸齑汁调服之候少定用通圣
散蜜丸服之间以桑树上桑牛阴干为末调服以平其风又以北薄荷叶寒水石各一两青黛白僵蚕辰
砂各一钱全蝎二枚猪牙皂角槐角各五分为末灯心汤和乳汁灌之角弓反张目直视因惊而致宜南
星半夏入姜汁竹沥灌之更灸印堂频吐泻将成慢惊用钱氏白术散加山药扁豆炒肉豆蔻面煨各
一钱
入姜一片煎服若慢惊已作加细辛天麻各一钱全蝎三个去梢白附八分面煨惊而泻用参苓芍药酒
炒白术姜煎夏月加黄连生甘草竹叶服之
钱乙说:小儿惊搐如果是在伤风之后发生的,表现为口中呼出热气、打呵欠、烦躁闷乱、手足动摇,应当使用发散法治疗,以大青膏为主方。小儿本性怯弱,容易患此病。
如果惊搐是在伤食之后发生的,表现为身体微温、嗜睡,或者呕吐、不想吃奶和食物而引发抽搐,应当先止住抽搐,待抽搐停止后,用白饼子攻下积滞,之后再给予安神丸主治。
只有疮疹(斑疹)引发的惊搐,是因为风火相争所致,治疗应当泻心肝之火,并补益其母脏(肾)。
按语:小儿因伤风而导致上述症状的,与大人感受风寒类似,应当辨别有汗和无汗两种阴阳证候,使用大青膏或张仲景小续命汤之类的方剂来开发腠理,即可痊愈。
因伤食引发惊搐,是指没有其它疾病突然发生抽搐,这是因为饮食过度损伤了脾胃,所以出现多睡、呕吐、不思乳食等症状。脾胃既已虚弱,引动肝风则发为抽搐。应当先用药物止住抽搐,加羌活、防风煎汤送服泻青丸,随后用白饼子攻下积食,逐渐再用调中丸、异功散来调养正气。
因斑疹而引发惊搐的,大概是因为疹子是由脾虚所生,脾虚导致肝气旺盛乘袭脾土,木来克土,气势相击,扰动心神。心主喜,热扰心神则神气不安,所以发病。斑是由心所生,心主热,热极生风,风归属于肝,心肝两脏邪气相搏结,所以发生抽搐。适宜泻心肝之火,补益其母脏,以导赤散、地黄丸为主方。
小儿惊风分为两类:急惊属于痰热,适宜用凉泻法;有一种说法是用降火下痰丸配合养血药煎汤送服。慢惊属于脾虚所致,预后多不良,适宜用温补法;有一种说法是应当养脾,用朱砂安神丸配合米汤送服,更应在养血药中寻求治法。世人用一种药通治这两种病,非常荒谬。
急惊风伴有发热、口疮、手心伏热、痰嗽、痰喘等症状时,应并用涌吐法。重症用瓜蒂散,轻症用赤小豆、苦参末,必须用酸醋汁调服。待病情稍定,用通圣散蜜丸服用。期间可用桑树上的桑牛,阴干研末调服,以平息肝风。又方:取北薄荷叶、寒水石各一两,青黛、白僵蚕、辰砂各一钱,全蝎二枚,猪牙皂角、槐角各五分,研为细末,用灯心草汤调和乳汁灌服。
若出现角弓反张、两眼直视,是因惊风所致,宜用南星、半夏加入姜汁、竹沥灌服。另外可灸印堂穴。
频繁吐泻将转为慢惊时,用钱氏白术散,加山药、扁豆、炒肉豆蔻面煨制各一钱,入生姜一片煎服。
如果慢惊已经发作,加细辛、天麻各一钱,全蝎三个去梢,白附子八分面煨制。因惊而腹泻者,用人参、茯苓、芍药(酒炒)、白术(姜汁炒)煎汤,夏季加黄连、生甘草、竹叶服用。
Qian Yi stated: If pediatric convulsions and tremors (Jing Chu) occur after a wind-cold injury, characterized by hot breath from the mouth, yawning, restlessness and oppression, and trembling of the limbs, dispersing methods should be used, with Da Qing Gao (Great Blue Ointment) as the primary formula. Children are naturally timid and prone to this disease.
If convulsions occur after food retention, characterized by slight body warmth, excessive sleepiness, or vomiting and anorexia leading to convulsions, the convulsions should first be arrested. After the convulsions subside, Bai Bing Zi (White Pill) should be administered to purge accumulation, followed by An Shen Wan (Calming the Spirit Pill) for treatment.
Only convulsions caused by macules and papules (Chuang Zhen) result from the struggle between wind and fire; treatment should involve purging the Heart and Liver and tonifying their mother organ (Kidney).
Note: Pediatric cases where the above symptoms arise from wind-cold injury are similar to adults contracting wind-cold. One must distinguish between yin and yang syndromes based on the presence or absence of sweating. Da Qing Gao or formulas similar to Zhang Zhongjing's Xiao Xu Ming Tang (Minor Continuation of Life Decoction) should be used to open the pores, leading to recovery.
Convulsions caused by food retention refer to sudden convulsions without other illnesses, resulting from overeating damaging the Spleen and Stomach. Symptoms include excessive sleepiness, vomiting, and anorexia. Since the Spleen and Stomach are deficient, they draw out Liver Wind, causing convulsions. The convulsions should first be arrested, then Xie Qing Wan (Drain Green Pill) should be taken with a decoction of Qiang Huo (Notopterygii Rhizoma et Radix) and Fang Feng (Saposhnikoviae Radix). Subsequently, Bai Bing Zi should be used to purge food stagnation. Gradually, Tiao Zhong Wan (Regulate the Middle Pill) and Yi Gong San (Extraordinary Efficacy Powder) should be used to nourish Qi.
Convulsions arising from macules and papules generally occur because rashes are generated by Spleen deficiency. Spleen deficiency allows excessive Liver Qi to invade the Earth element; Wood overcoming Earth creates conflicting forces that disturb the Heart Spirit. The Heart governs joy; heat disturbs the spirit, causing spiritual unrest, thus manifesting the disease. Macules are generated by the Heart, which governs heat. Excessive heat generates wind, which belongs to the Liver. The conflict between these two organs causes convulsions. Treatment should involve purging the Heart and Liver and tonifying their mother organ, using Dao Chi San (Direct Out Red Powder) and Di Huang Wan (Rehmannia Pill) as primary formulas.
Pediatric Jing Feng (Startling Wind) is divided into two categories: Ji Jing Feng (Acute Startling Wind) belongs to Phlegm-Heat and is suitable for cooling and purging methods; one school suggests using Jiang Huo Xia Tan Wan (Descend Fire and Resolve Phlegm Pill) combined with blood-nourishing herbs in a decoction. Man Jing Feng (Chronic Startling Wind) is governed by Spleen deficiency, often has a poor prognosis, and is suitable for warming and tonifying methods; another view suggests nourishing the Spleen using Zhu Sha An Shen Wan (Cinnabar Calming Spirit Pill) taken with rice water, seeking remedies within blood-nourishing prescriptions. It is highly erroneous for people to use a single medicine to treat both conditions universally.
For Acute Startling Wind accompanied by fever, mouth ulcers, latent heat in the palms, phlegm cough, and phlegm wheezing, emetic methods should be employed. For severe cases, Gua Di San (Melon Peduncle Powder) is used; for mild cases, a powder of Chi Xiao Dou (Vigna umbellata) and Ku Shen (Sophorae Flavescentis Radix), mixed with sour vinegar juice, is administered. Once the condition stabilizes slightly, Tong Sheng San (Universal Salvation Powder) honey pills are taken. During this period, dried mulberry tree insects (Sang Niu), ground into powder and mixed, can be taken to pacify wind. Another prescription consists of Bei Bo He Ye (Mentha haplocalyx Leaf), Han Shui Shi (Stibnite), each 1 liang; Qing Dai (Indigo Naturalis), Bai Jiang Can (Bombyx Batryticatus), and Chen Sha (Cinnabaris), each 1 qian; Quan Xie (Scorpio) 2 pieces; Zhu Ya Zao Jiao (Gleditsia Sinensis Fructus Spina) and Huai Jiao (Sophorae Tonkinensis Fructus), each 5 fen. These are ground into powder and administered with Deng Xin Tang (Junci Medullae Decoction) mixed with breast milk.
If opisthotonos (rigid arching of the back) and fixed gaze occur due to startling wind, Nan Xing (Arisaema Cum Bile) and Ban Xia (Pinelliae Rhizoma) should be administered with Ginger Juice and Bamboo Sap. Additionally, moxibustion should be applied to Yin Tang (Extracranial Point).
When frequent vomiting and diarrhea are about to transform into Chronic Startling Wind, Qian’s Bai Zhu San (Atractylodis Macrocephalae Powder) should be used, adding Shan Yao (Dioscoreae Rhizoma), Bian Dou (Vigna unguiculata), and roasted Rou Dou Kou (Myristicae Semen) prepared with flour, each 1 qian, with one slice of ginger, decocted and taken.
If Chronic Startling Wind has already manifested, add Xi Xin (Asari Radix et Rhizoma) and Tian Ma (Gastrodiae Rhizoma), each 1 qian; three Quan Xie (Scorpio) with tips removed; and Ba Fu Zi (Fuzi Preparata) 8 fen, roasted with flour. For diarrhea caused by startling, use Ren Shen (Ginseng Radix), Ling Zhu (Poria), Shao Yao (Paeoniae Radix alba) stir-fried with wine, and Bai Zhu (Atractylodis Macrocephalae Rhizoma) stir-fried with ginger juice. In summer, add Huang Lian (Coptidis Rhizoma), Sheng Gan Cao (Glycyrrhizae Radix et Rhizoma), and Zhu Ye (Bambusae Folium).