〔娄〕惊痫,即急慢之证,但惊痫发时仆地作声,醒时吐沫,急慢惊则不作声,
不吐沫也。仁斋曰∶痫,小儿之恶候也,盖小儿血脉不敛,气骨不聚,为风邪所触,
为乳哺失节,停结癖积而得之。其候,神气怫郁,瞪眼直视,面目牵引,口噤涎流,
腹肚胀膨,手足搐掣,似死似生,或声或哑,或项背反张,或腰脊强直,但四体柔
弱,发而时醒者为痫,若一身强硬,终日不醒,则为痉证矣。
阳痫初作时,病先身热螈 ,惊啼叫啖而后发,脉浮者为阳痫,乃急惊也,
内在六腑,外在皮肤,为易治。若病先身冷,不惊 ,不啼呼,而作脉沉者
为阴痫,乃慢惊也,此病内在五脏,外在骨髓,剧者难治。〔曾〕阳痫者,因
感惊风三次发搐,不与去风下痰则再发,然三次者,非一日三次也,或一月、或
一季、一发惊搐,必经三度,故曰三次,所谓惊风三发便为痫,即此义也。其病,
主身热自汗,两目上视,嚼沫切牙,手足制搦,面色红紫,六脉浮数,以百解散加
五和汤、水煎疏解,次下痰,用水晶丹或半夏丸。阴痫者,因慢惊后去痰不尽,
痰入心包而得,四肢逆冷,吐舌摇头,口嚼白沫,牙关紧闭,但不甚惊搐作啼,面色
或白或青,脉息沉微,故《婴孩宝书》云,睡中吐舌更摇头。正此之谓,治以固真
汤加曰生汤同煎,调宽气饮和解。
【娄氏观点】惊痫,就是急惊风和慢惊风这类证候。但惊痫发作时,患儿会仆倒在地并发出声音,清醒后吐出涎沫;而急惊和慢惊发作时不发出声音,也不吐涎沫。
仁斋说:痫病是小儿的一种危重证候。大概是因为小儿血脉未固敛,气骨未充实,受到风邪触动,或因哺乳喂养不当,导致痰食停结、癖积内蕴而发病。其症状表现为:神气郁滞不畅,瞪眼直视,面部肌肉牵引抽动,牙关紧闭、口角流涎,腹部胀大膨隆,手足抽搐掣动,状似死亡又似存活,有时发声有时失声,有时颈项背部向后反张,有时腰脊强直僵硬。但只要四肢尚柔软,发作后能暂时清醒的,属于痫病;如果全身强硬,整天不能清醒的,则属于痉病。
阳痫在初发时,病症先表现为身体发热、肢体抽搐(螈),伴有惊恐啼哭、呼叫啖咬等症状而后发作。脉象浮数的属于阳痫,即急惊风。此病位在内属六腑,在外属皮肤,比较容易治疗。若病症先表现为身体发冷,没有惊恐表现,不啼哭呼叫,脉象沉细的属于阴痫,即慢惊风。此病位在内属五脏,在外属骨髓,病情严重的难以治疗。
【曾氏观点】阳痫,是因为感受惊风之邪,经过三次发作抽搐,如果不及时祛除风邪、降下痰浊,就会再次发作。这里说的“三次”,并非指一天之内发作三次,而是指或一个月、或一个季度,只要发生一次惊搐,累计必须经过三次,所以称为“三次”。所谓“惊风三发便为痫”,就是这个意思。其病症主要表现为:身体发热、自汗,两眼上视,口中嚼碎涎沫、切咬牙齿,手足拘挛握固,面色红紫,六脉浮数。治疗可用百解散加五和汤,用水煎服以疏风解表,随后再使用化痰药,可选用水晶丹或半夏丸。
阴痫,是因为慢惊风之后痰浊未能清除干净,痰邪侵入心包络而致病。症状表现为四肢逆冷,吐舌摇头,口中咀嚼白沫,牙关紧闭,但不怎么出现惊恐抽搐和啼哭,面色或苍白或青暗,脉息沉微。所以《婴孩宝书》中说:“睡梦中吐舌且摇头的”,正是指的这种情况。治疗可用固真汤加曰生汤同煎,并配合调宽气饮进行和解调理。
[Lou's View] Jingxian (Startle Epilepsy) refers to syndromes such as Ji Jing (Acute Startle) and Man Jing (Chronic Startle). However, when Jingxian attacks, the child falls to the ground making sounds, and upon waking, spits out froth; whereas in Ji Jing and Man Jing, there is no sound made during the attack, nor is froth spit out.
Ren Zhai stated: Xian (Epilepsy) is a malignant condition in children. This is because children's blood vessels are not yet consolidated, and their Qi and bones are not fully gathered. They are susceptible to wind pathogens, or it arises from irregular nursing and feeding, leading to the retention and accumulation of phlegm and food stagnation. The manifestations include: depression of spiritual energy, staring with wide eyes, traction and twitching of the face and eyes, lockjaw with drooling, abdominal distension, convulsions of the hands and feet, appearing as if dead yet alive, sometimes vocalizing and sometimes mute, sometimes opisthotonos (backward arching of the neck and back), or rigidity of the waist and spine. If the four limbs remain soft and the child regains consciousness after an episode, it is classified as Xian (Epilepsy); if the whole body is rigid and the child remains unconscious for the entire day, it is classified as Jing Syndrome (Spasm Disorder).
When Yang Xian (Yang Epilepsy) first occurs, the disease initially presents with fever, clonic spasms (Rong Ru), followed by startled crying, shouting, and biting. A floating pulse indicates Yang Xian, which corresponds to Ji Jing (Acute Startle). The pathology lies internally within the Six Fu Organs and externally in the skin, making it relatively easy to treat. Conversely, if the disease initially presents with coldness of the body, without signs of fright, without crying or shouting, and with a deep pulse, it is Yin Xian (Yin Epilepsy), corresponding to Man Jing (Chronic Startle). The pathology lies internally within the Five Zang Organs and externally in the bone marrow; severe cases are difficult to treat.
[Zeng's View] Yang Xian results from contracting wind-stroke due to startle, where convulsions have occurred three times. If wind-pathogens are not expelled and phlegm is not purged, relapses will occur. The term "three times" does not mean three times in one day, but rather that whether over a month or a season, once a startle-convulsion occurs, it must happen cumulatively three times. Hence the saying "Three episodes of wind-stroke lead to epilepsy," which conveys this meaning. The main symptoms include: fever with spontaneous sweating, upward deviation of the eyes, chewing of froth and grinding of teeth, flexion and grasping of the hands and feet, red-purple complexion, and floating-rapid pulses throughout all six positions. Treatment involves using Baijie San (Hundred-Rescue Powder) combined with Wuhe Tang (Five-Harmony Decoction) decocted in water to disperse and resolve the exterior, followed by phlegm-purging agents such as Shuijing Dan (Crystal Pill) or Banxia Wan (Pinellia Pill).
Yin Xian arises because phlegm was not completely cleared after Man Jing (Chronic Startle), allowing phlegm to enter the Pericardium. Symptoms include cold extremities, protrusion of the tongue and shaking of the head, chewing of white froth, and lockjaw, but with less severe startle, convulsions, or crying. The complexion may be pale or cyanotic, and the pulse is deep and faint. Therefore, *Ying'er Bao Shu* (Treasured Book for Infants and Children) states: "Protruding the tongue and shaking the head while sleeping" precisely describes this condition. Treatment involves decocting Guzhen Tang (Solidify the True Decoction) together with Yuesheng Tang (Generate Life Decoction), and administering Kuanqi Yin (Broaden Qi Drink) to harmonize.