张涣等方有中风方论,今见小儿绝无患者,而用药多犯香燥,恐血热生风、类
中风证,误用之,则为害不浅,故一切削而不载。薛氏云∶中风之证,西北方有之,
东南气温,腠理疏泄,人患之者皆类中风也。况小儿元气未充,皮毛不固,易虚易
实,外邪乘之,则壮热抽掣,气粗涎涌,甚至昏愦口噤,即似中风,误以续命等汤
投之,多至不救,大人且无真中,况小儿乎。凡有前证,当辨其因,若阳明经气虚,
风邪所乘,筋脉拘急者为外因。足厥阴肝火炽盛,筋脉偏急者为内因。脾肺虚弱,
腠理不密,外邪乘入,或惊风过服金石之剂,耗损肝血,或吐泻后内亡津液,不能
养肝,致口眼 斜者,皆肝血不足,肝火生风之类中风之类证也。
〔钱〕肝有风,甚则身反张强直,不搐,心不受热,当补肾治肝。补肾,地黄丸,
治肝,泻青丸。丹溪云∶痉比痫为虚,宜带补,多是气虚有火兼痰,用人参竹沥
治之,不用兼风药。此论实发前人所未发,汤氏虽云痉候十无一生,盖未尝有此法
施于人也。〔薛〕钱仲阳曰角弓反张者,由风邪客于太阳经也,经曰∶风从上受。
足太阳主周身之气,其脉起于目内 而行于背,肝属木主风,所以风邪易侵也。夫
小儿肌肤未密,外邪易伤,肝为相火,其怒易发,若身反张强直,发热不搐者,风
伤太阳也,宜用人参羌活散、小续命汤。若因暴怒而击动其肝火者,宜用泻青丸。
若饮前剂,其证益甚者,此邪气已去而脾气亏也,宜用异功散加芎、归补之。若
因肝经虚热,或因克伐真气,虚热生风者,宜用异功散、地黄丸补之。若因下而
脾气困惫,腹肚膨胀者,此中气损也,宜用白术散补之。若气血素弱,或服攻伐之
剂,而手寻衣领,切牙呵欠者,肝经虚甚也,急用地黄丸以补之,仍与肝脏参览。
一小儿忽腰背反张,目上视,面青赤。曰青属肝主风,赤属心主火,此风火相搏。用
柴胡栀子散倍加钓藤钩顿安,而痰如旧,又用抱龙丸而愈。一小儿忽腰背反张,
服治惊之药后不时举发,面色黄白,肢体甚倦。余用五味异功散十余剂而愈。后因
惊兼饮食不节,不时举发,随用前药即愈。遂日以参术末每服五七分,炮姜、大枣
煎汤调下,服至二两而不发。以上二证,元气虚而病气实也,若用攻邪之药,皆误
矣。一小儿素患前证痰盛,面色素白而兼青。余谓肺气不能平肝,肝气乘脾,脾
气虚而生痰耳。先用抱龙丸二服以平肝,随用六君子汤以补脾肺,月余而痊。半载
之后复发,谓非逐痰不能全愈,遂用下剂,痰涎甚多,而咽喉如锯声。余曰乃脾不
能摄涎也,咽间鸣,乃肺气虚甚也,遂用人参五钱、炮姜三分,水煎服而醒,至第
四剂后,加枣二枚,人参服数两而愈。后每发,非独参汤不应,若执常方,鲜有不
误者。
人参羌活散(方见惊搐) 小续命汤(方见杂病中风) 泻青丸(方见肝脏) 异功散(方
见吐泻) 柴胡栀子散(方见积热) 抱龙丸(方见惊搐) 六君子汤(方见吐泻)
张涣等人的医方中有关于治疗中风的论述,如今我发现小儿极少患此病,而用药多犯香燥之弊,恐怕血热生风、类中风证,误用这些药物,则危害不浅,所以一切削去而不收录。薛己说:中风的病症,西北地区有之,东南地区气温较高,腠理疏泄,人患此病的都是类中风。况且小儿元气未充,皮毛不固,易虚易实,外邪乘虚而入,则壮热抽掣,气粗涎涌,甚至昏愦口噤,即似中风,误以续命等汤剂投之,多至不救,大人且无真中(真中风),何况小儿呢。凡有前证,当辨其因,若阳明经气虚,风邪所乘,筋脉拘急者为外因。足厥阴肝火炽盛,筋脉偏急者为内因。脾肺虚弱,腠理不密,外邪乘入,或惊风过服金石之剂,耗损肝血,或吐泻后内亡津液,不能养肝,致口眼歪斜者,皆肝血不足,肝火生风之类中风之类证也。
〔钱乙〕肝有风,甚则身反张强直,不搐,心不受热,当补肾治肝。补肾,地黄丸,治肝,泻青丸。丹溪说:痉比痫为虚,宜带补,多是气虚有火兼痰,用人参竹沥治之,不用兼风药。此论实发前人所未发,汤氏虽云痉候十无一生,盖未尝有此法施于人也。〔薛己〕钱仲阳说角弓反张者,由风邪客于太阳经也,经曰:风从上受。足太阳主周身之气,其脉起于目内眦而行于背,肝属木主风,所以风邪易侵也。夫小儿肌肤未密,外邪易伤,肝为相火,其怒易发,若身反张强直,发热不搐者,风伤太阳也,宜用人参羌活散、小续命汤。若因暴怒而击动其肝火者,宜用泻青丸。若饮前剂,其证益甚者,此邪气已去而脾气亏也,宜用异功散加芎、归补之。若因肝经虚热,或因克伐真气,虚热生风者,宜用异功散、地黄丸补之。若因下利而脾气困惫,腹肚膨胀者,此中气损也,宜用白术散补之。若气血素弱,或服攻伐之剂,而手寻衣领,切牙呵欠者,肝经虚甚也,急用地黄丸以补之,仍与肝脏参览。一小儿忽腰背反张,目上视,面青赤。曰青属肝主风,赤属心主火,此风火相搏。用柴胡栀子散倍加钓藤钩顿安,而痰如旧,又用抱龙丸而愈。一小儿忽腰背反张,服治惊之药后不时举发,面色黄白,肢体甚倦。余用五味异功散十余剂而愈。后因惊兼饮食不节,不时举发,随用前药即愈。遂日以参术末每服五七分,炮姜、大枣煎汤调下,服至二两而不发。以上二证,元气虚而病气实也,若用攻邪之药,皆误矣。一小儿素患前证痰盛,面色素白而兼青。余谓肺气不能平肝,肝气乘脾,脾气虚而生痰耳。先用抱龙丸二服以平肝,随用六君子汤以补脾肺,月余而痊。半载之后复发,谓非逐痰不能全愈,遂用下剂,痰涎甚多,而咽喉如锯声。余曰乃脾不能摄涎也,咽间鸣,乃肺气虚甚也,遂用人参五钱、炮姜三分,水煎服而醒,至第四剂后,加枣二枚,人参服数两而愈。后每发,非独参汤不应,若执常方,鲜有不误者。
人参羌活散(方见惊搐) 小续命汤(方见杂病中风) 泻青丸(方见肝脏) 异功散(方见吐泻) 柴胡栀子散(方见积热) 抱龙丸(方见惊搐) 六君子汤(方见吐泻)
Zhang Huan and others' medical formulas contain discussions on treating stroke (Zhong Feng). However, I have observed that children rarely suffer from this disease. The medications used often violate the principle of avoiding aromatic and drying substances. It is feared that blood heat generating wind (Xue Re Sheng Feng) or stroke-like syndromes (Lei Zhong Feng) may occur; misusing these drugs would cause significant harm. Therefore, all such content has been omitted and not recorded. Xue Ji stated: Stroke syndromes exist in the northwest regions. In the southeast, where the climate is warmer, pores are open and sweat is easily discharged. Those who suffer from it generally have stroke-like syndromes rather than true stroke. Moreover, children's primordial qi (Yuan Qi) is not yet fully developed, their skin and hair follicles are not solid, and they are prone to both deficiency and excess conditions. When external pathogens take advantage of this, it results in high fever, convulsions, coarse breathing, and excessive salivation. In severe cases, it leads to coma, locked jaw, resembling stroke. Misusing decoctions like Xu Ming Tang (Minor Life-Sustaining Decoction) can often lead to death. Even adults rarely suffer from true stroke (Zhen Zhong), let alone children. For any of the aforementioned symptoms, one must differentiate the cause. If there is qi deficiency in the Yangming channel, with wind pathogen invading and causing tendon vessel spasm, it is an external cause. If liver fire in the Foot Jueyin Liver channel is blazing, causing unilateral tendon vessel tension, it is an internal cause. If Spleen and Lung are weak, pores are not tight, and external pathogens invade, or if convulsive diseases are over-treated with mineral medicines, depleting Liver Blood, or if vomiting and diarrhea lead to internal loss of body fluids, failing to nourish the Liver, resulting in deviation of the mouth and eyes, these are all stroke-like syndromes caused by insufficient Liver Blood and Liver Fire generating wind.
[Qian Yi] When the Liver has wind, it may severely manifest as opisthotonos (Jiao Gong Fan Zhang) and rigidity without tremors. If the Heart does not receive heat, one should tonify the Kidney and treat the Liver. To tonify the Kidney, use Dihuang Wan (Rehmannia Pill); to treat the Liver, use Xie Qing Wan (Drain the Green Pill). Danxi stated: Spasms (Jing) are more deficient than epilepsy (Xian) and should be treated with tonification. They are mostly due to qi deficiency with fire and phlegm. Treat with Ren Shen Zhu Li (Ginseng and Bamboo Juice), avoiding wind-dispelling herbs. This theory truly reveals what predecessors had not expressed. Although Tang Shi claimed that ten out of ten spasmodic cases die, this method was never applied to people. [Xue Ji] Qian Zhongyang stated that opisthotonos is caused by wind pathogen lodging in the Taiyang channel. The classics say: Wind enters from above. The Foot Taiyang governs the qi of the whole body; its meridian starts at the inner canthus and runs along the back. Since the Liver belongs to Wood and governs wind, wind pathogen easily invades. Children's skin and flesh are not dense, making them susceptible to external pathogens. The Liver acts as ministerial fire, and its anger is easily aroused. If there is opisthotonos and rigidity with fever but no tremors, it is wind injuring the Taiyang channel. Use Renshen Qiang Huo San (Ginseng and Notopterygium Powder) or Xiao Xu Ming Tang (Minor Life-Sustaining Decoction). If triggered by sudden rage stirring up Liver Fire, use Xie Qing Wan (Drain the Green Pill). If drinking the previous prescriptions worsens the condition, this indicates the pathogen has left but Spleen qi is deficient. Use Yigong San (Benefit the Work Powder) plus Chuanxiong and Danggui to tonify. If due to deficiency-heat in the Liver channel, or if attacking treatments damage true qi leading to deficiency-heat generating wind, use Yigong San (Benefit the Work Powder) and Dihuang Wan (Rehmannia Pill) to tonify. If due to purgation causing Spleen qi exhaustion and abdominal distension, this is damage to central qi. Use Baizhu San (Atractylodes Powder) to tonify. If blood and qi are inherently weak, or after taking attacking/depleting agents, if the child seeks the collar with hands, grinds teeth, and yawns, the Liver channel is extremely deficient. Urgently use Dihuang Wan (Rehmannia Pill) to tonify, and refer to the Liver chapter for reference. A child suddenly presented with opisthotonos, upward staring eyes, and a cyan-red face. Cyan corresponds to the Liver governing wind; red corresponds to the Heart governing fire. This is wind and fire clashing. Use Chai Hu Zhi Zi San (Bupleurum and Gardenia Powder) with doubled Gou Teng Gou (Uncaria Hook) for immediate calmness. Phlegm remained unchanged, so Bao Long Wan (Embracing Dragon Pill) was used, leading to recovery. Another child suddenly presented with opisthotonos. After taking anti-convulsant medicines, it recurred intermittently. The face was yellow-white, limbs very fatigued. I used Wu Wei Yi Gong San (Five-Ingredient Benefit the Work Powder) for over ten doses, leading to recovery. Later, due to fright combined with irregular diet, it recurred intermittently. Using the previous medicine cured it immediately. Thus, daily administration of Ginseng and Atractylodes powder, five to seven fen per dose, mixed with decocted Pao Jiang (Roasted Ginger) and Da Zao (Jujube), taken until two liang were consumed, prevented recurrence. The above two cases showed deficient primordial qi and excess pathogenic qi. Using pathogen-attacking medicines would be erroneous. A child suffering from the aforementioned condition with abundant phlegm, pale white face with cyan tinge. I stated that Lung qi cannot level the Liver, Liver qi attacks the Spleen, and Spleen qi deficiency generates phlegm. First, use two doses of Bao Long Wan (Embracing Dragon Pill) to level the Liver, followed by Liu Jun Zi Tang (Six Gentlemen Decoction) to tonify Spleen and Lung, recovering after a month and a half. Half a year later, it recurred. I stated that only by expelling phlegm could full recovery be achieved. Thus, using a purgative agent resulted in much phlegm-saliva, and sawing sounds in the throat. I said this is because the Spleen cannot control saliva, and the sound in the throat indicates extreme Lung qi deficiency. Thus, use five qian of Ren Shen (Ginseng) and three fen of Pao Jiang (Roasted Ginger), decocted in water and administered, leading to awakening. After the fourth dose, add two jujubes. Consuming several liang of Ginseng led to recovery. Later, upon each recurrence, Du Shen Tang (Single Ginseng Decoction) was required; sticking to standard formulas rarely avoids error.
Renshen Qiang Huo San (Formula seen in Convulsions) Xiao Xu Ming Tang (Formula seen in Miscellaneous Diseases - Stroke) Xie Qing Wan (Formula seen in Liver Chapter) Yigong San (Formula seen in Vomiting and Diarrhea) Chai Hu Zhi Zi San (Formula seen in Accumulated Heat) Bao Long Wan (Formula seen in Convulsions) Liu Jun Zi Tang (Formula seen in Vomiting and Diarrhea)