医云阳痫也手足搐搦涎潮大热医家下之其所用药往往利以经粉或水银巴豆皆
等既已苏省之后精神由尚昏沉未KT 乳食者或有余热其候欲得安痊和平只可用平稳药调胃气
不可直便与服燥热药若与服之其候复作何可怪耶
议曰小见惊风之后胃气多虚不食沉沉默默或泻尚不止只可助胃生气须以截风药移在(平
(观音散)中谓用全蝎天麻僵蚕白附防风羌活之类生姜枣子同煎自然胃壮泻止诸风不作虽则惊
搐搦皆去其精神未爽不可便谓无事若用补药助虚干姜豆蔻硫黄附子之类则热复来其候又发非
病不除医者妄谬病家无见亦不可不告凡治急惊之候正谓医疗岂可据云调理之说用药乃在一时
之久若也宽缓症候转加深重医者既知当下即可量其轻重如病五六分只下三四分许随通且利热
去痰消则病与症次第徐徐而减瘥若不揣度一概并荡下之大过伤害脏腑疾传阴症乃作慢惊风
候岂可临时生胃回阳诚为枉究既是医工莫不知之矣
医云阴痫也良由急惊用寒凉之药太过转动深重乃传作慢惊或因吐利不止而成
或因澡浴感风不解而作慢惊或因风食二痫不治而变成慢惊或因咳嗽下痰转虚而成慢惊因由甚
众概而举之病家怕惊不怕泻良医怕泻不怕惊其泻不止则惊风愈盛若与治惊更用寒凉之药且
泻转多病加进重矣
议曰小儿脾胃虚怯方作吐泻其症有五有热吐冷吐虚吐痰吐食吐所言热吐者谓母饮酒吃肥
炙爆
腌藏或冒风伤暑致热儿吻乳入胃遂成热吐冷吐者谓儿胃冷加以宿冷之物与食即吐虚吐者其儿
肌弱神困疳积未消胃堂久虚即吐痰吐者其儿胃气本虚复感寒邪生痰作热留滞胸膈故吐食吐者
其儿胃弱饮食不节强食伤脾作热袖困吐后即逆病家但知其吐不明其所以吐且吐兼泻共作名曰
霍乱其吐候又推轻重有五初则乳自流出谓之 之不已即谓之吐吐之不也即作呕呕之不已即
传逆逆之不已即作哕(于月反)自呕逆哕皆有出声动气呕者口开而作逆者心胸上下气逆郁筑哕
者无物可出即膈虚胃寒引气哕哕作声此等候恶须更症变即慢脾风热吐者先去风痰冷吐虚吐与
生胃气痰吐下却其痰次与(正气)食吐宜与(塌气)岂可一概理之吐泻不止脾虚风生眼开慢惊眼
合慢
脾治之不当更下惊药死不旋踵岂可得而救疗儿分长幼病察虚实有吐泻三五日发风者有一日半
日而发者大抵女孩以吐为急男以泻为速若气虚暴泻暴吐才作便得之惟有疳泻不成风候水则患
无辜症终于虚乏矣但滞肠止泻为良吐即生胃为正截风之药加而用之凡惊药及寒凉之药切不可
用亦不可用大热药其候乃属阴症医者裁之勿佞为幸
医生诊断为阳痫,症状表现为手足抽搐、涎液上涌、高热。医家采用攻下法治疗,所用药物往往是含有轻粉或水银、巴豆等成分的泻药。
在患者神志稍醒之后,精神仍然昏沉,不愿吃奶进食。如果体内还有余热,想要使其平安痊愈、恢复平和,只能使用性质平稳的药物来调理胃气。不可直接服用燥热性质的药物。如果服用了这类药物,病情就会复发,这有什么可奇怪的呢?
曾世荣评议说:小儿在惊风发作后,胃气大多虚弱,不思饮食,神情萎靡沉默,或者腹泻不止。此时只能帮助胃气恢复生机,必须将熄风止痉的药物配合(观音散)一起使用。所谓配合,是指使用全蝎、天麻、僵蚕、白附子、防风、羌活等药物,加生姜、大枣同煎。这样自然能使胃气壮实、腹泻停止,各种风证不再发作。虽然惊风抽搐的症状都消失了,但精神尚未完全清爽,不能就认为没事了。如果使用补药,如干姜、豆蔻、硫黄、附子之类,则热气会再次袭来,病情又会发作。这不是病除,而是医者妄谬,病家见识短浅,这也是不得不告知的。凡是治疗急惊风的候症,正在于医疗手段的运用,岂可依据“调理”的说法?用药往往需要持续一段时间。如果宽缓拖延,症候就会转而加深加重。医者既然知道应当攻下,就可以根据病情的轻重,比如病势有五六分重,只攻下三四分量的药,使大便通畅,热去痰消,那么疾病和症状就会次第逐渐减轻直至痊愈。如果不揣度病情,一概用峻猛药物荡涤攻下,就会造成过度伤害,损伤脏腑,疾传为阴症,从而形成慢惊风的候症。到那时再想临时生胃回阳,确实为时已晚且徒劳无功。既然是医生,没有不知道这些道理的。
医生诊断为阴痫,这大多是因为急惊风使用了过多的寒凉药物,导致病情转深加重,从而传变为慢惊风;或者因为呕吐腹泻不止而成为慢惊风;或者因为洗澡沐浴后感冒风寒未解而引发慢惊风;或者因为风痫、食痫两种痫证未能治愈而变成慢惊风;或者因为咳嗽排痰导致体质转虚而成为慢惊风。原因很多,概括起来列举如下。病家害怕惊风发作,不怕腹泻;良医害怕腹泻不止,不怕惊风发作。如果腹泻不止,惊风就会更加严重。如果对惊风进行治疗,又使用寒凉药物,那么腹泻就会更多,病情会更加加重。
曾世荣评议说:小儿脾胃虚弱怯懦,刚开始出现呕吐腹泻,其症状有五种:热吐、冷吐、虚吐、痰吐、食吐。所说的热吐,是指母亲饮酒,食用肥腻、炙烤、油炸、腌制储藏的食物,或者感受风邪、伤于暑气,导致热气进入婴儿口中,吸入胃中遂成热吐。冷吐,是指婴儿胃寒,加上喂食生冷之物即吐。虚吐,是指婴儿肌肉瘦弱、精神困倦,疳积未消,胃腑长期虚弱即吐。痰吐,是指婴儿胃气本虚,又感受寒邪,生痰化热,留滞胸膈故吐。食吐,是指婴儿胃弱,饮食不节制,强行进食损伤脾脏,产生热气,身体困倦,吐后即逆。病家只知道呕吐,不明白呕吐的原因。而且呕吐兼腹泻共同发作,名为霍乱。对于呕吐的候症,又推究轻重分为五种:初起乳汁自然流出,称为溢乳;溢乳不止,称为吐;吐不停止,即作呕;呕不停止,即传变为逆;逆不停止,即作哕(yuè,打嗝)。从呕、逆、哕都有出声动气。呕者口张开而发声;逆者心胸上下气机逆乱郁结;哕者无物可出,是膈虚胃寒引气致哕,发出声音。这种候症凶险,须臾之间症候变化,就会转为慢脾风。热吐者先去风痰;冷吐、虚吐与生胃气;痰吐者下却其痰,其次给予(正气散);食吐宜给予(塌气丸)。岂可一概而论进行治理?呕吐腹泻不止,脾虚风生,眼睛睁开为慢惊风,眼睛闭合为慢脾风。治疗不当,再用惊风药攻下,死亡就在眨眼之间,怎么能够救疗呢?婴儿分长幼,病症察虚实。有呕吐腹泻三五日后发风的,有一日半日就发的。大体上女孩以呕吐为急,男孩以腹泻为速。如果是气虚暴泻、暴吐,刚发作就得之。惟有疳泻不成风候。若是水泻,则患无辜症,最终死于虚乏。但是,滞留肠道止泻为良策,呕吐则生胃气为正治。截风之药加入使用。凡惊药及寒凉之药切不可用,也不可用大热药。其候症属于阴症,医者裁断,不要迷信偏方,算是幸运了。
The physician diagnosed it as Yang Epilepsy (Yang Xian), characterized by spasms and convulsions of the hands and feet, flooding of saliva, and high fever. The physician employed purgation therapy, often using medicines containing Calomel (Qingfen) or Mercury (Shuiyin), and Croton Seed (Badou).
After the patient regained consciousness, the spirit remained lethargic, with a reluctance to suckle or eat. If there is residual heat, to ensure a peaceful recovery and restoration of harmony, only mild and stable medicines should be used to regulate Stomach Qi (Wei Qi). One must not directly administer drying and heating medicines. If such medicines are taken, the condition will recur; what is surprising about this?
Zeng Shirong commented: After an attack of Wind-convulsion (Jing Feng), the Stomach Qi is mostly deficient. The infant does not desire food, appears listless and silent, or suffers from persistent diarrhea. At this time, one can only assist in generating Stomach Qi. It is necessary to incorporate wind-extinguishing herbs into Guanyin San (Guanyin Powder). This refers to using Scorpion (Quanxie), Gastrodia Rhizome (Tianma), Bombyx Batryticatus (Jiangcan), Aconitum Carmandii Rhizome Preparatum (Baifu), Saposhnikovia Root (Fangfeng), and Notopterygium Root (Qianghuo), decocted together with Fresh Ginger (Shengjiang) and Jujube (Zao). Naturally, the Stomach Qi will strengthen, diarrhea will cease, and various wind syndromes will not arise. Although the symptoms of wind-convulsion have subsided, if the spirit has not fully recovered, one cannot assume that everything is fine. If tonifying medicines such as Dried Ginger (Ganjiang), Cardamom (Doukou), Sulfur (Huang), and Prepared Aconite Root (Fuzi) are used, the heat will return, and the condition will relapse. This is not curing the disease but rather medical error due to the physician's recklessness and the family's lack of insight. This is something that must be communicated. When treating the syndrome of Acute Wind-convulsion (Ji Jing), the focus lies on medical intervention. How can one rely merely on "conditioning" theories? Medication administration often requires sustained effort. If treatment is delayed or lenient, the symptoms will deepen and worsen. Since the physician knows that purgation is indicated, they should assess the severity. For instance, if the illness is five or six parts severe, purging three or four parts may suffice. Once the bowels are unblocked, heat is eliminated, and phlegm dissipates, the disease and symptoms will gradually diminish step by step until recovery. If one fails to estimate the condition and indiscriminately uses harsh purgatives, it causes excessive damage, injuring the Zang-Fu organs. The disease may transmit to Yin syndromes, manifesting as Chronic Wind-convulsion (Man Jing Feng). At that point, attempting to temporarily generate Stomach Qi and restore Yang is indeed futile and late. Any competent physician should know this.
The physician diagnosed it as Yin Epilepsy (Yin Xian). This largely results from the excessive use of cold and cooling medicines for Acute Wind-convulsion, causing the condition to deepen and transform into Chronic Wind-convulsion. Or it arises because vomiting and diarrhea persist, leading to Chronic Wind-convulsion. Or it occurs because bathing led to wind-cold invasion that was not resolved, triggering Chronic Wind-convulsion. Or it transforms from untreated Wind-Epilepsy or Food-Epilepsy into Chronic Wind-convulsion. Or it becomes Chronic Wind-convulsion due to deficiency caused by coughing and expectoration. There are many causes, summarized here. Families fear convulsions but not diarrhea; good physicians fear persistent diarrhea but not convulsions. If diarrhea persists, the wind-convulsion intensifies. If one treats the convulsion while using cold and cooling medicines, diarrhea will increase, and the condition will worsen.
Zeng Shirong commented: Children have weak and timid Spleen and Stomach. When vomiting and diarrhea first occur, there are five types of symptoms: Heat Vomiting, Cold Vomiting, Deficiency Vomiting, Phlegm Vomiting, and Food Vomiting. Heat Vomiting refers to when the mother drinks alcohol, eats fatty, roasted, fried, or preserved foods, or contracts wind or summerheat, causing heat to enter the infant's mouth and stomach upon nursing, resulting in Heat Vomiting. Cold Vomiting refers to when the infant's Stomach is cold, and vomiting occurs after consuming cold raw foods. Deficiency Vomiting refers to when the infant is emaciated and spiritually exhausted, with unresolved malnutrition (Gan accumulation) and long-term Stomach deficiency, leading to vomiting. Phlegm Vomiting refers to when the infant's Stomach Qi is originally deficient, contracts cold pathogenic factors, generates phlegm and heat, which stagnate in the chest and diaphragm, causing vomiting. Food Vomiting refers to when the infant has a weak Stomach, lacks dietary discipline, forces food intake damaging the Spleen, generates heat, feels lethargic, and vomits followed by reflux. Families only know of vomiting but do not understand its cause. Furthermore, when vomiting and diarrhea occur together, it is named Cholera-like disorder (Huo Luan). Regarding the severity of vomiting, there are five degrees: initially, milk flows out naturally, called Spillage (Yi); if spilling continues, it is called Vomiting (Tu); if vomiting persists, it becomes Retching (Ou); if retching continues, it transmits to Reflux/Reversal (Ni); if reversal continues, it becomes Hiccups (Yue). From retching, reversal, to hiccups, there is sound and qi movement. Retching involves opening the mouth to make sound; Reversal involves upward counterflow and stagnation of qi in the chest and heart; Hiccups involve no substance to expel, caused by deficiency of the diaphragm and cold of the Stomach drawing qi, producing sound. This syndrome is ominous; within moments, the syndrome changes, transforming into Chronic Spleen Wind (Man Pi Feng). For Heat Vomiting, first eliminate wind-phlegm; for Cold and Deficiency Vomiting, generate Stomach Qi; for Phlegm Vomiting, drain the phlegm, then administer Zhengqi San (Zhengqi Powder); for Food Vomiting, administer Taqi Wan (Taqi Pill). How can they all be treated uniformly? Persistent vomiting and diarrhea lead to Spleen deficiency and generation of wind. Eyes open indicates Chronic Wind-convulsion; eyes closed indicates Chronic Spleen Wind. Inappropriate treatment, especially using convulsion medicines for purgation, leads to death instantly; how can it be saved? Infants vary in age; conditions vary in deficiency or excess. Some develop wind after three to five days of vomiting and diarrhea; some develop it within half a day. Generally, for girls, vomiting is urgent; for boys, diarrhea is rapid. If Qi deficiency leads to sudden profuse diarrhea or vomiting, it occurs immediately. Only Malnutrition Diarrhea (Gan Xie) does not form wind syndromes. Water-like diarrhea leads to Wugu Syndrome (infantile paralysis/wasting), ultimately resulting in death from deficiency and exhaustion. However, stopping diarrhea by resolving intestinal stagnation is good; generating Stomach Qi for vomiting is correct. Wind-extinguishing medicines can be added. Convulsion medicines and cold/cooling medicines must absolutely not be used, nor should strongly heating medicines be used. The syndrome belongs to Yin syndromes. Physicians must exercise judgment; avoiding superstition is fortunate.