(二十）小儿白血病王某，男，5岁，病历号：82477。一年前患急性淋巴性白血病，住某院治疗后缓解。两周胱又复加重，持续发烧38．2℃左右，肢倦身乏，项颈有串珠状肿物，腹有痞块，化验白细胞4，450／立方毫米，中性粒细胞10％，淋巴球85％，原始淋巴细胞4％，前期淋巴细胞：％。舌苔黄厚，脉弦数，诊为急性淋巴性白血病。辨证：毒热内潜，营阴受损。治法：清营解毒退热。方药：广犀角2.4克粉丹皮6克大生地10克丹参6克连翘10克胡连1．5克银花10克桃仁5克青蒿6克焦麦芽10至柴胡6克鲜霍香10克服上方3剂，体温正常，但仍肢体关节疼痛，舌苔已退，脉沉数。继予清营解毒和中之剂。大生地12克丹参6克连翘10克银花10克浙贝10克桃仁3克柴胡5克青蒿10克苏叶3克赤芍5克焦楂榔各6克调治月余，体温平稳，血象有改进，白细胞6，200／立方毫米，中性粒细胞42％，淋巴球58％，尚感精神疲倦，面色苍黄，唇淡苔白，脉细无力，气血虚弱。继予中药调理，嘱其药后继续调治。当归10克黄芪10克丹参6克甘草5克麦冬10克丹皮3至枸杞子6克山萸肉10克淮山药10克阿胶6克
(《赵心波儿科临床经验选编》）
【评按】白血病症势重，威胁幼儿生命健康。此例毒热潜伏，营阴受损，其治法邪扶正必当兼顾。疏方既须析其毒热，又须补其营阴气血，使邪毒得化，血枯得荣，精气得复而效。此案辨证既确，立方自然入彀。
(二十一）过敏性紫癜
例一王××，男，11岁。1957年5月、15日初诊。三年前周身发现紫红色斑疹，服中药治愈。去年又复发一次。近来四肢又出现紫色斑疹，已经二月，西医诊断为过敏紫癜。有时发热，小便短黄，大使色黑，法宜清解。丹皮3至赤芍6克生地6克山栀皮6克黄芩6克银花6克连翘6克荆芥穗6克藕节6克蝉蜕3克甘草3至鲜芦根9克车前草6克清宁丸6克
(分二次兑药冲服）。。二诊：服前方后，疹毒消退，周后又时隐时现，伴有牙痛，此温毒未尽，血热上泛所致，拟以平肝清热之剂。生地6克云苓6克泽泻6克丹皮6克茜草6克骨碎补6克刺蒺藜6克地骨皮6克甘草梢4．5克淮牛膝6克车前草6克三诊：诸证悉减，唯精神倦怠，面色青黄，由于肝盛克脾，饮食懒进，苔黄白相间，脉息平平。本治肝实脾之义，以六君子汤调理之。沙参6克白术6克云苓6克法夏6克广皮6克霍香6克砂仁1．5克炙甘草1．5克四诊：饮食增进，余无所苦，四肢疹痕犹有未尽，改用养阴活血佐以清解之剂为治。生地6克丹皮6克赤芍6至豆卷9克稻芽9克云苓6克荆芥4．5克防风4．5克白茅根6克银花6克连翘6克蝉蜕3克甘草1．5克前方服3剂，疹痕全消，神情活泼。中间偶因饮食失检，发现便溏，用霍香正气丸及香砂六君子丸间日轮服6克，经旬而愈。此证虽属阳证，法当清解，但因历时过久，肝脾受损，虚实互见，故本扶正法邪、标本兼治之意，使气血调和而伏邪自去。小儿易虚易实，用药必须权衡轻重缓急，末期用丸药调理，亦久病缓治勿使过剂之意。
(尚古愚等整理：王朴诚医案，《中医杂志》6：405，1958）
例二叶××，女，14岁。初诊：1971年10月12日。全身紫癜已一月半，四肢突发紫癜，两上下肢不等丘疹样出血点，诊为“过敏性紫癜”。给服强的松稍好转，减至每日20毫克，全身紫癜大发。症见：全身发疹，点点斑斑，色泽鲜红，以下肢为甚。脉弦细带数，苔薄尖红。生地黄12克败龟板12克川黄柏9克肥知母9克金狗脊12克菟丝子12克女贞子12克旱莲草30克鲜藕节30克乌梅4．5克谷麦芽各9克大红枣6枚。以上方为基础，或加当归、白芍以养血，或加紫草、仙鹤草以止血。在服用中药的过程中，逐渐减强的松用量，于1971年12月12日，完全停服激素，未再发。再以八珍散加减善其后。
(张羹梅《临证偶拾》）
例三益林马德荫药号之子，年约十三、四，患斑疫，就余治。其子体材不串，周身斑点，碎小者多，其如指甲豆瓣大者，约三分之一，下部脚面为尤多，惟无苦楚烦热等现象。询其大便：两日前曾微解燥粪，余时已悟得阳症见阴之理，仍从阳治，惟现阴象者，想属气虚、当清其血中之毒，兼益其气，然过分苦寒亦当戒慎。遂以新订之消症活命饮，酒炒大黄仅用4．5克、西洋参2．4克，令服两剂，而大便带黑，小溲宛若盐卤、斑迹渐稀，饮食亦进。其后去大黄，参减三分之一，又服3剂，而斑竟消清，乃获全愈。新订消斑活命饮：川大黄黄芩
(以上二味均用酒炒）连翘甘草山栀(炒黑）苏荷板蓝根青黛、西洋参(隔汤饨）当归(酒洗）大生地(炒）广郁金紫背浮萍紫菊花(如无花则用根）(余奉仙《医方经验汇编》）
【评按】过敏性紫癜，祖国医学多将其列入温热、温疫类病范畴。侧一诊为温毒发斑，紫癜由温毒郁滞、热邪入里所致，故治以清解为大法，但由于患儿久病肝脾受损，虚实互见，在治疗过程中，应注意扶正法邪、标本兼顾；医者当随其主症、兼症的变化以斟酌治法。
例二辨证以阴虚血热为主要矛盾，治以养阴清热止血法。方用大补阴丸为基本方，将原方熟地改为生地，配藕节以凉血止血；知、柏泻火；龟板配合二至九(《医方集解》方）以增强滋阴之效。又方中用乌梅。据近代药埋研究有抗蛋白过敏的作用。
例三原案名为“葡萄疫”，其临床表现比较符合过敏性紫癜，余氏治此证经验丰富，他认为斑色红紫者皆可治，如色紫如葡萄或萝卜，秽气逼人者预后较差。新订消斑活命饮能清血中之毒、益血中之气，俾气能领血、气行毒化。其立方遣药层层俱到。但在《医方经验汇编》所载述的葡萄疫诸案，有的发病急暴、症势凶险，当属暴发型紫癜中之华-弗(WaterhouseFrideri一chsen）氏综合征，故“葡萄疫”与过敏性紫癜又不能等同。
(二十二）血友病杨某，男，2岁半。1965年11月18日初诊。患儿自半岁起，皮肤、粘膜常有紫红色斑块，此起彼消，关节周围也常见，关节肿胀发硬、发热、活动障碍。伴有低热、烦躁、哭闹等。两三个月发作一次。春夏尤重。身体轻微碰伤即出血不止，需经多次输新鲜血方能止。辨证：阴虚火盛，脾失统摄(西医院诊为血友病）。治法：滋补肝肾，健脾益气，清热凉血，佐以益阴养血，活血行瘀。方药：(1）胡萝卜于500克小麦1000克小米500克共磨细粉，蒸馒头吃。(2）紫荆花(去蒂）40克，加面粉少许调糊，油煎成饼，加白糖食之。
(3）丹皮25克当归30克红花22克生地25克仙鹤草22克生白术37至鸡内金(炙）25克赤芍22克砂仁19克玄参25克黄精25克何首鸟25克天门冬22克银柴胡22克远志22克琥珀22克天竺黄15克地骨皮22克骨碎补22克炒神曲19克水牛角25克共研细末，以钩藤62克薄荷37克茵陈31克旱莲草46克煎水取汁，打小丸，每服3克每日三次，服药一周，停药一天。1973克8月20日：来人述及，得处方后即服药，每年(1）方服月余：(2）方每春服7～10天，(3）方每年配1～2料，约服3～4个月。出血重时配合维生素K，维生素C。数年来坚持用药，并常服生花生米，病情明显好转，已能坚持上学。止血时间与正常人相近，未再到医院输血以止血。嘱继服(1）、(2）方，(3）方加熟地46克，威灵仙50克，没药50克，血竭37克，三七31克，茜草根62克，续断77克，菟丝子93克，桑螵蛸62克，白羊角尖46克，胎盘一具，配丸药继服。1974年11月21日随访，症状明显减轻，至今一年余，全身未再发现出血斑块，偶尔表皮擦破，也无出血不止情况。
(《刘惠民医案》）
【评按】血友病为先天性凝血障碍中最常见的一种出血性疾病，患儿易见皮下、肌肉及关节出血。此案辨证属阴虚火盛，脾失统摄。刘氏治以滋补肝肾、健脾益气，清热凉血为主，属虚实互治之法。处方(1）为食疗方，其中胡萝卜下气补中，利胸膈肠胃，安五脏；处方(2）所用紫荆花，李时珍《本草纲目》称其“活血行气，消肿解毒”，亦属经验方，处方3则以温、清、补结合活血行瘀法，能针对主症、兼症，发挥较好的综合疗能。
(二十三）解颅张某某，男，生后34天，1975年2月11日初诊。患儿于生后两天即开始头颅增大，到满月前后更为明显，前囟宽大，饱满隆起，颅缝分离，头皮静脉怒张，精神差，嗜睡，厌食，吐乳，大便可，两目垂视，心肺正常，舌质红，稍淡，指纹淡滞，脉细无力。辨证：肾气不足，脑髓不充，病属解颅(西医诊断：先天性脑积水）。治法：补肾益髓治本，行水化湿治标。方药：地黄丸加味。熟地6克山药3克鹿角胶9至牛膝3克茯苓9克净萸肉、当归各3克猪苓9克茺蔚子3克丹皮3克车前子9克水煎服，每日1剂。自服上药起，每日尿量较多，精神、吃奶均好，不吐。上药连服两周后，头围开始逐渐缩小，两目已不垂视。服至第三周后，头围基本正常。前囟已平，颅缝缩小。
(《何世英儿科医案》
【评按】解颅即小儿脑积水。多由肾气不足，脑髓不充所致。故此案治以补肾益髓、行水化湿，为“上病下取”治法。方用济生肾气丸去泽泻、桂、附；加鹿角胶、当归、猪苓、茺蔚子。补肾而避用桂、附壮阳，兼以利水调肝，较之古法单用补肾者，效验有所提高。
(二十四）小儿癫痈
例一王××，男，11岁，病历号：199884。患儿在八年前患癫痫至今未愈。现每年发作一至三次，多在晚间发作，发作时口吐痰沫，牙关紧闭，不省人事。近日发作较勤，抽搐时间较长，服苯妥英钠或注射镇静药后方解。发作后感到头痛，睡眠不安，时有烦急；曾在各医院治疗不效，故来门诊。辨证：痰痫。痰热内伏，复受惊恐，扰及厥阴所致。治法：清热化痰，镇惊定搐，活血熄风。方药：生侧柏10克天竺黄6克胆草6克地龙6克青礞石10克橘红6克磁石10克红花3克桃仁5克钩藤5克全蝎3克焦楂10克。化风锭1丸，日二次。上方加减共进36剂，症状平稳，惟痰多，纳差，舌无苔，脉弦缓，再拟前法化裁。钩藤5克青礞石12克法夏5克桃仁5克红花6克磁石10克全蝎3克地龙10克化橘红6克胆草6克神曲10克炒麦芽10克化风锭1丸，每日二次。上方又进16剂，合化风锭20丸后，三周来门诊，诉服药后再未发作抽搐，继续治疗四个月后，用礞石滚痰丸和医痫无双丸交替服用，巩固疗效。一年来门诊，痈搐基本全愈。
(《赵心波儿科临床经验选编》
例二刘某，女，2岁。初诊(1975年4月5日）：患儿平素健康，发病前一月在玩耍中曾惊叫一次。此后两周，夜寐中经常哭闹，须哄拍方能入睡。又半个多月，一天下午突然抽搐，为时数秒钟即止。此后抽搐发作渐频，少者每日二、三次，多则十余次，尤其在感冒发热时，发作更频。抽搐时面色苍白，口唇青紫，牙关咬紧，两目上翻、直视，两手紧握，颈项强直，全身抽动，不知人事。约一、二分钟后、痉挛缓解，逐渐清醒，清醒后精神萎软，无他不适。诊其脉象弦细，舌苔薄白。病因惊恐损伤心肝，肝风内动，上扰心神，而致癫痈频发。治拟搜风解痉，平肝潜阳，镇惊媳风，宁心安神。全蝎3克蜈蚣1．8克天麻3克乌梢蛇肉3克
(共研细末，和匀，分三次吞服，一天服完）磁石60克(先煎）白芍15克珍珠母3Q克夜交藤30克生龙齿30克(先煎）钩藤12克(后入）麻仁12克(打）北秫米30克(包）煅龙壮各30克炙甘草9克淮小麦30克2剂。上方1剂煎四汁，和匀，在两天中分次服完，共服四天。药后抽搐即被控制，其家长自行将原方续服四个多月后停药。1976年8月2日随访，癫痫年余未发，神情活泼，智力发育正常。《上海老中医经验选编》王玉润医案）
【评按】癫痫是一种发作性神志异常的疾病。多因惊恐、清志、饮食劳倦等因素所致，《素问·大奇论》并指出此证在发病方面的遗传因素，《诸病源候论》认为：“十岁以上为癫，十岁以下为痫”。此病发作与风痰密切相关，故其治大多以豁痰宣窍、熄风定痫为主，赵氏除用豁痰法痰类药物外，配生侧柏、红花、桃仁以通经活血；胆草、钩藤，磁石、全蝎等以镇静定搐、平肝熄风。在治疗过程中所配合的成药，均注意到癫痫病因、病理中的风和痰的主要矛盾，方治颇具特色。
例二由惊恐损伤心肝，肝风内动、上扰心神而发。王氏治以搜风解痉、平肝镇惊，熄风宁神法，处方中又以蛇虫类搜风镇惊及重镇平肝诸品为主，兼以柔肝扶正，诸法并用而治重肝经，其效着而巩固。五、外科、皮肤科病类医案
（二十）小儿白血病
王某，男性，5岁，病历号：82477。一年前患急性淋巴性白血病，在某医院治疗后病情缓解。两周后病情再次加重，持续发烧约38.2℃，四肢倦怠乏力，颈部有串珠状肿物，腹部有痞块（肿块）。化验显示白细胞4,450/立方毫米，中性粒细胞10%，淋巴细胞85%，原始淋巴细胞4%，前期淋巴细胞百分比不详。舌苔黄厚，脉象弦数。诊断为急性淋巴性白血病。辨证为毒热内伏，营阴受损。治法为清营解毒退热。方药：广犀角2.4克，粉丹皮6克，大生地10克，丹参6克，连翘10克，胡黄连1.5克，银花10克，桃仁5克，青蒿6克，焦麦芽10克，柴胡6克，鲜霍香10克。服用上方3剂后，体温恢复正常，但仍感肢体关节疼痛，舌苔已退，脉象沉数。继续给予清营解毒、调和脾胃的方剂。大生地12克，丹参6克，连翘10克，银花10克，浙贝母10克，桃仁3克，柴胡5克，青蒿10克，苏叶3克，赤芍5克，焦山楂和焦槟榔各6克。调治月余，体温平稳，血象有所改善，白细胞6,200/立方毫米，中性粒细胞42%，淋巴细胞58%。患者仍感精神疲倦，面色苍黄，唇色淡白，舌苔白，脉细无力，属气血虚弱。继续予以中药调理，嘱咐其服药后继续调治。当归10克，黄芪10克，丹参6克，甘草5克，麦冬10克，丹皮3克，枸杞子6克，山萸肉10克，淮山药10克，阿胶6克。
（《赵心波儿科临床经验选编》）
【评按】白血病症势沉重，威胁幼儿的生命健康。此例毒热潜伏，营阴受损，治疗时扶正与祛邪必须兼顾。处方既要辨析并清除毒热，又要补益营阴气血，使邪毒得以化解，血液枯竭得到滋养，精气得以恢复，从而取得疗效。此案辨证准确，处方自然合乎法度。
（二十一）过敏性紫癜
病例一 王××，男性，11岁。1957年5月15日初诊。三年前周身发现紫红色斑疹，服用中药治愈。去年复发一次。近来四肢又出现紫色斑疹，已持续两个月，西医诊断为过敏性紫癜。有时发热，小便短少色黄，大便色黑。治法宜清解。丹皮3克，赤芍6克，生地6克，山栀皮6克，黄芩6克，银花6克，连翘6克，荆芥穗6克，藕节6克，蝉蜕3克，甘草3克，鲜芦根9克，车前草6克，清宁丸6克（分二次兑药冲服）。二诊：服用前方后，疹毒消退，但一周后又时隐时现，伴有牙痛，此为温毒未尽，血热上泛所致，拟用平肝清热之剂。生地6克，云苓6克，泽泻6克，丹皮6克，茜草6克，骨碎补6克，刺蒺藜6克，地骨皮6克，甘草梢4.5克，淮牛膝6克，车前草6克。三诊：诸证悉减，唯精神倦怠，面色青黄，由于肝气过盛克制脾土，饮食懒进，苔黄白相间，脉息平平。本着治肝实脾的意义，以六君子汤调理。沙参6克，白术6克，云苓6克，法半夏6克，广陈皮6克，霍香6克，砂仁1.5克，炙甘草1.5克。四诊：饮食增进，其余无不适，四肢疹痕犹有未尽，改用养阴活血佐以清解之剂治疗。生地6克，丹皮6克，赤芍6克，豆卷9克，稻芽9克，云苓6克，荆芥4.5克，防风4.5克，白茅根6克，银花6克，连翘6克，蝉蜕3克，甘草1.5克。前方服用3剂，疹痕全消，神情活泼。中间偶因饮食不节制，发现便溏，用霍香正气丸及香砂六君子丸间日轮流服用6克，经旬而愈。此证虽属阳证，法当清解，但因历时过久，肝脾受损，虚实互见，故本扶正祛邪、标本兼治之意，使气血调和而伏邪自去。小儿易虚易实，用药必须权衡轻重缓急，末期用丸药调理，亦久病缓治勿使过剂之意。
（尚古愚等整理：王朴诚医案，《中医杂志》6：405，1958）
病例二 叶××，女性，14岁。初诊：1971年10月12日。全身紫癜已一月半，四肢突发紫癜，两上下肢不等丘疹样出血点，诊为“过敏性紫癜”。给服强的松稍好转，减至每日20毫克，全身紫癜大发。症见：全身发疹，点点斑斑，色泽鲜红，以下肢为甚。脉弦细带数，苔薄尖红。生地黄12克，败龟板12克，川黄柏9克，肥知母9克，金狗脊12克，菟丝子12克，女贞子12克，旱莲草30克，鲜藕节30克，乌梅4.5克，谷麦芽各9克，大红枣6枚。以上方为基础，或加当归、白芍以养血，或加紫草、仙鹤草以止血。在服用中药的过程中，逐渐减强的松用量，于1971年12月12日，完全停服激素，未再发。再以八珍散加减善其后。
（张羹梅《临证偶拾》）
病例三 益林马德荫药号之子，年龄约十三、四岁，患斑疫，求我诊治。其子体形不强壮，周身斑点，碎小的多，如指甲豆瓣大小的，约占三分之一，下部脚面尤为多，惟无痛苦烦热等现象。询问其大便：两日前曾微解燥粪，其余时间已悟得阳症见阴之理，仍从阳治，惟现阴象者，想属气虚，当清其血中之毒，兼益其气，然过分苦寒亦当戒慎。遂以新订之消斑活命饮，酒炒大黄仅用4.5克、西洋参2.4克，令服两剂，而大便带黑，小溲宛若盐卤、斑迹渐稀，饮食亦进。其后去大黄，参减三分之一，又服3剂，而斑竟消清，乃获全愈。新订消斑活命饮：川大黄、黄芩（以上二味均用酒炒）、连翘、甘草、山栀（炒黑）、苏荷、板蓝根、青黛、西洋参（隔汤炖）、当归（酒洗）、大生地（炒）、广郁金、紫背浮萍、紫菊花（如无花则用根）。
（余奉仙《医方经验汇编》）
【评按】过敏性紫癜，祖国医学多将其列入温热、温疫类病范畴。病例一诊为温毒发斑，紫癜由温毒郁滞、热邪入里所致，故治以清解为大法，但由于患儿久病肝脾受损，虚实互见，在治疗过程中，应注意扶正祛邪、标本兼顾；医者当随其主症、兼症的变化以斟酌治法。
病例二辨证以阴虚血热为主要矛盾，治以养阴清热止血法。方用大补阴丸为基本方，将原方熟地改为生地，配藕节以凉血止血；知母、黄柏泻火；龟板配合二至丸（《医方集解》方）以增强滋阴之效。又方中用乌梅，据近代药理研究有抗蛋白过敏的作用。
病例三原案名为“葡萄疫”，其临床表现比较符合过敏性紫癜，余氏治此证经验丰富，他认为斑色红紫者皆可治，如色紫如葡萄或萝卜，秽气逼人者预后较差。新订消斑活命饮能清血中之毒、益血中之气，俾气能领血、气行毒化。其立方遣药层层俱到。但在《医方经验汇编》所载述的葡萄疫诸案，有的发病急暴、症势凶险，当属暴发型紫癜中之华-弗（Waterhouse-Friderichsen）氏综合征，故“葡萄疫”与过敏性紫癜又不能等同。
（二十二）血友病
杨某，男性，2岁半。1965年11月18日初诊。患儿自半岁起，皮肤、粘膜常有紫红色斑块，此起彼消，关节周围也常见，关节肿胀发硬、发热、活动障碍。伴有低热、烦躁、哭闹等。两三个月发作一次。春夏尤重。身体轻微碰伤即出血不止，需经多次输新鲜血方能止。辨证：阴虚火盛，脾失统摄（西医院诊为血友病）。治法：滋补肝肾，健脾益气，清热凉血，佐以益阴养血，活血行瘀。方药：(1)胡萝卜干500克，小麦1000克，小米500克共磨细粉，蒸馒头吃。(2)紫荆花（去蒂）40克，加面粉少许调糊，油煎成饼，加白糖食之。(3)丹皮25克，当归30克，红花22克，生地25克，仙鹤草22克，生白术37克，鸡内金（炙）25克，赤芍22克，砂仁19克，玄参25克，黄精25克，何首乌25克，天门冬22克，银柴胡22克，远志22克，琥珀22克，天竺黄15克，地骨皮22克，骨碎补22克，炒神曲19克，水牛角25克，共研细末，以钩藤62克，薄荷37克，茵陈31克，旱莲草46克煎水取汁，打小丸，每服3克，每日三次，服药一周，停药一天。1973年8月20日：来人述及，得处方后即服药，每年(1)方服月余；(2)方每春服7～10天，(3)方每年配1～2料，约服3～4个月。出血重时配合维生素K，维生素C。数年来坚持用药，并常服生花生米，病情明显好转，已能坚持上学。止血时间与正常人相近，未再到医院输血以止血。嘱继服(1)、(2)方，(3)方加熟地46克，威灵仙50克，没药50克，血竭37克，三七31克，茜草根62克，续断77克，菟丝子93克，桑螵蛸62克，白羊角尖46克，胎盘一具，配丸药继服。1974年11月21日随访，症状明显减轻，至今一年余，全身未再发现出血斑块，偶尔表皮擦破，也无出血不止情况。
（《刘惠民医案》）
【评按】血友病为先天性凝血障碍中最常见的一种出血性疾病，患儿易见皮下、肌肉及关节出血。此案辨证属阴虚火盛，脾失统摄。刘氏治以滋补肝肾、健脾益气，清热凉血为主，属虚实互治之法。处方(1)为食疗方，其中胡萝卜下气补中，利胸膈肠胃，安五脏；处方(2)所用紫荆花，李时珍《本草纲目》称其“活血行气，消肿解毒”，亦属经验方，处方3则以温、清、补结合活血行瘀法，能针对主症、兼症，发挥较好的综合疗能。
（二十三）解颅
张某某，男性，生后34天，1975年2月11日初诊。患儿于生后两天即开始头颅增大，到满月前后更为明显，前囟宽大，饱满隆起，颅缝分离，头皮静脉怒张，精神差，嗜睡，厌食，吐乳，大便可，两目垂视，心肺正常，舌质红，稍淡，指纹淡滞，脉细无力。辨证：肾气不足，脑髓不充，病属解颅（西医诊断：先天性脑积水）。治法：补肾益髓治本，行水化湿治标。方药：地黄丸加味。熟地6克，山药3克，鹿角胶9克，牛膝3克，茯苓9克，净萸肉、当归各3克，猪苓9克，茺蔚子3克，丹皮3克，车前子9克，水煎服，每日1剂。自服上药起，每日尿量较多，精神、吃奶均好，不吐。上药连服两周后，头围开始逐渐缩小，两目已不垂视。服至第三周后，头围基本正常。前囟已平，颅缝缩小。
（《何世英儿科医案》）
【评按】解颅即小儿脑积水。多由肾气不足，脑髓不充所致。故此案治以补肾益髓、行水化湿，为“上病下取”治法。方用济生肾气丸去泽泻、桂、附；加鹿角胶、当归、猪苓、茺蔚子。补肾而避用桂、附壮阳，兼以利水调肝，较之古法单用补肾者，效验有所提高。
（二十四）小儿癫痫
病例一 王××，男性，11岁，病历号：199884。患儿在八年前患癫痫至今未愈。现每年发作一至三次，多在晚间发作，发作时口吐痰沫，牙关紧闭，不省人事。近日发作较勤，抽搐时间较长，服苯妥英钠或注射镇静药后方解。发作后感到头痛，睡眠不安，时有烦急；曾在各医院治疗不效，故来门诊。辨证：痰痫。痰热内伏，复受惊恐，扰及厥阴所致。治法：清热化痰，镇惊定搐，活血熄风。方药：生侧柏10克，天竺黄6克，胆草6克，地龙6克，青礞石10克，橘红6克，磁石10克，红花3克，桃仁5克，钩藤5克，全蝎3克，焦楂10克。化风锭1丸，日二次。上方加减共进36剂，症状平稳，惟痰多，纳差，舌无苔，脉弦缓，再拟前法化裁。钩藤5克，青礞石12克，法夏5克，桃仁5克，红花6克，磁石10克，全蝎3克，地龙10克，化橘红6克，胆草6克，神曲10克，炒麦芽10克，化风锭1丸，每日二次。上方又进16剂，合化风锭20丸后，三周来门诊，诉服药后再未发作抽搐，继续治疗四个月后，用礞石滚痰丸和医痫无双丸交替服用，巩固疗效。一年来门诊，痈搐基本全愈。
（《赵心波儿科临床经验选编》）
病例二 刘某，女性，2岁。初诊(1975年4月5日)：患儿平素健康，发病前一月在玩耍中曾惊叫一次。此后两周，夜寐中经常哭闹，须哄拍方能入睡。又半个多月，一天下午突然抽搐，为时数秒钟即止。此后抽搐发作渐频，少者每日二、三次，多则十余次，尤其在感冒发热时，发作更频。抽搐时面色苍白，口唇青紫，牙关咬紧，两目上翻、直视，两手紧握，颈项强直，全身抽动，不知人事。约一、二分钟后、痉挛缓解，逐渐清醒，清醒后精神萎软，无他不适。诊其脉象弦细，舌苔薄白。病因惊恐损伤心肝，肝风内动，上扰心神，而致癫痫频发。治拟搜风解痉，平肝潜阳，镇惊熄风，宁心安神。全蝎3克，蜈蚣1.8克，天麻3克，乌梢蛇肉3克（共研细末，和匀，分三次吞服，一天服完），磁石60克（先煎），白芍15克，珍珠母30克，夜交藤30克，生龙齿30克（先煎），钩藤12克（后入），麻仁12克（打），北秫米30克（包），煅龙骨、牡蛎各30克，炙甘草9克，淮小麦30克，2剂。上方1剂煎四汁，和匀，在两天中分次服完，共服四天。药后抽搐即被控制，其家长自行将原方续服四个多月后停药。1976年8月2日随访，癫痫年余未发，神情活泼，智力发育正常。（《上海老中医经验选编》王玉润医案）
【评按】癫痫是一种发作性神志异常的疾病。多因惊恐、情志、饮食劳倦等因素所致，《素问·大奇论》并指出此证在发病方面的遗传因素，《诸病源候论》认为：“十岁以上为癫，十岁以下为痫”。此病发作与风痰密切相关，故其治大多以豁痰宣窍、熄风定痫为主，赵氏除用豁痰法痰类药物外，配生侧柏、红花、桃仁以通经活血；胆草、钩藤，磁石、全蝎等以镇静定搐、平肝熄风。在治疗过程中所配合的成药，均注意到癫痫病因、病理中的风和痰的主要矛盾，方治颇具特色。
病例二由惊恐损伤心肝，肝风内动、上扰心神而发。王氏治以搜风解痉、平肝镇惊，熄风宁神法，处方中又以蛇虫类搜风镇惊及重镇平肝诸品为主，兼以柔肝扶正，诸法并用而治重肝经，其效着而巩固。
五、外科、皮肤科病类医案
(20) Pediatric Leukemia
Wang Mou, male, 5 years old, Medical Record No.: 82477. One year ago, he suffered from acute lymphocytic leukemia and achieved remission after treatment at a certain hospital. Two weeks later, the condition worsened again, with persistent fever around 38.2°C, fatigue in the limbs and body, beaded masses on the neck, and abdominal masses (痞块). Laboratory tests showed white blood cells 4,450/cubic millimeter, neutrophils 10%, lymphocytes 85%, blast cells 4%, and early precursor lymphocytes percentage unspecified. The tongue coating was yellow and thick, and the pulse was wiry and rapid. Diagnosed as acute lymphocytic leukemia. Syndrome differentiation: latent toxic heat damaging Ying-Yin (nutritive Yin). Treatment method: clear the Ying level, detoxify, and reduce fever. Prescription: Guang Xijiao (Broad Rhinoceros Horn, 2.4g), Fen Danpi (Pink Moutan Cortex, 6g), Da Shengdi (Large Rehmanniae Radix, 10g), Danshen (Salviae Miltiorrhizae Radix et Rhizoma, 6g), Lianqiao (Forsythiae Fructum, 10g), Hulian (Picrorhizae Rhizoma, 1.5g), Yinhua (Lonicerae Japonicae Flos, 10g), Tao Ren (Persicae Semen, 5g), Qinghao (Artemisiae Annuae Herba, 6g), Jiao Maiya (Scorized Hordei Fructus Germinatus, 10g), Chaihu (Bupleuri Radix, 6g), Xian Huoxiang (Fresh Pogostemonis Herba, 10g). After taking three doses of the above prescription, body temperature normalized, but pain in limbs and joints persisted, tongue coating receded, and pulse became deep and rapid. Continued with a formula to clear the Ying level, detoxify, and harmonize the middle jiao (spleen and stomach): Da Shengdi (12g), Danshen (6g), Lianqiao (10g), Yinhua (10g), Zhe Bei (Fritillariae Thunbergii Bulbus, 10g), Tao Ren (3g), Chaihu (5g), Qinghao (10g), Su Ye (Perillae Folium, 3g), Chi Shao (Paeoniae Radix Rubra, 5g), Jiao Zhaliang (Scorized Hawthorn Fruit and Areca Seed, 6g each). After one month of regulation, body temperature stabilized, blood picture improved, white blood cells 6,200/cubic millimeter, neutrophils 42%, lymphocytes 58%. The patient still felt mentally tired, complexion was pale and yellow, lips were pale, tongue coating white, and pulse fine and weak, indicating Qi and Blood deficiency. Continued with Chinese medicine regulation, advising continued treatment after medication: Danggui (Angelicae Sinensis Radix, 10g), Huangqi (Astragali Radix, 10g), Danshen (6g), Gancao (Glycyrrhizae Radix et Rhizoma, 5g), Maidong (Ophiopogonis Radix, 10g), Danpi (3g), Gouqizi (Lycii Fructus, 6g), Shanyurou (Corni Fructus, 10g), Huaishanyao (Dioscoreae Rhizoma, 10g), Ejiao (Asini Corii Colla, 6g).
(From "Selected Clinical Experience of Zhao Xinbo in Pediatrics")
[Commentary] Leukemia is a severe condition threatening the life and health of young children. In this case, toxic heat is latent and Ying-Yin is damaged; therefore, supporting healthy Qi and eliminating pathogenic factors must be balanced. The prescription must analyze and eliminate toxic heat while supplementing Ying-Yin and Qi-Blood, so that pathogenic toxins are resolved, blood depletion is nourished, and essence-Qi is restored, leading to efficacy. The syndrome differentiation in this case was accurate, and the prescription naturally adhered to principles.
(21) Allergic Purpura
Case 1 Wang XX, male, 11 years old. First consultation: May 15, 1957. Three years ago, purple-red macules appeared all over the body and were cured by Chinese medicine. It relapsed once last year. Recently, purple macules appeared on the limbs again, lasting for two months, diagnosed by Western medicine as allergic purpura. Occasional fever, short yellow urine, black stool. Treatment method should be clearing and resolving. Danpi (3g), Chi Shao (6g), Shengdi (6g), Shanzhi Pi (Gardeniae Pericarpium, 6g), Huangqin (Scutellariae Radix, 6g), Yinhua (6g), Lianqiao (6g), Jingjie Sui (Schizonepetae Spica, 6g), Oujie (Nelumbinis Node, 6g), Chantui (Cicadae Periostracum, 3g), Gancao (3g), Xian Lugen (Fresh Phragmitis Rhizoma, 9g), Cheqiancao (Plantaginis Herba, 6g), Qingning Wan (6g, taken separately mixed with medicine). Second consultation: After taking the previous prescription, rash toxins subsided, but reappeared intermittently after a week, accompanied by toothache. This indicates residual warm toxin and upward flooding of blood heat. Proposed a formula to calm the liver and clear heat: Shengdi (6g), Yunling (Poria, 6g), Zexie (Alismatis Rhizoma, 6g), Danpi (6g), Qiancao (Rubiae Radix et Rhizoma, 6g), Gusuibu (Drynariae Rhizoma, 6g), Ciji Li (Tribuli Fructus, 6g), Digupi (Lycii Cortex, 6g), Gancao Shao (Glycyrrhizae Radix et Rhizoma tip, 4.5g), Huainiu Xi (Achyranthis Radix, 6g), Cheqiancao (6g). Third consultation: Symptoms largely reduced, only mental fatigue and greenish-yellow complexion remained due to excessive Liver Qi attacking Spleen Earth, leading to poor appetite, yellow-white intermixed tongue coating, and flat pulse. Following the principle of treating the Liver and strengthening the Spleen, regulated with Liu Junzi Tang (Six Gentlemen Decoction): Shashen (Glehniae Radix, 6g), Baizhu (Atractylodis Macrocephalae Rhizoma, 6g), Yunling (6g), Fa Xia (Prepared Pinelliae Tuber, 6g), Guangpi (Citri Reticulatae Pericarpium, 6g), Huoxiang (Agastaches Herba, 6g), Sharen (Amomi Fructus, 1.5g), Zhi Gancao (Honey-fried Glycyrrhizae Radix et Rhizoma, 1.5g). Fourth consultation: Appetite increased, no other discomfort, but limb rashes remained incomplete. Changed to a formula nourishing Yin, invigorating blood, and assisting with clearing and resolving: Shengdi (6g), Danpi (6g), Chi Shao (6g), Doujuan (Sojae Semen Praeparatum, 9g), Daoya (Oryzae Fructus Germinatus, 9g), Yunling (6g), Jingjie (4.5g), Fangfeng (Saposhnikoviae Radix, 4.5g), Baimaogen (Imperatae Rhizoma, 6g), Yinhua (6g), Lianqiao (6g), Chantui (3g), Gancao (1.5g). After three doses of the previous prescription, rashes completely disappeared, and spirit became lively. Occasionally, loose stools occurred due to dietary indiscretion, treated with Huoxiang Zhengqi Wan and Xiangsha Liujunzi Wan alternately every other day (6g each), cured after ten days. Although this syndrome belongs to Yang syndromes and requires clearing and resolving, due to prolonged illness damaging Liver and Spleen, presenting both deficiency and excess, the treatment followed the principle of supporting healthy Qi and eliminating pathogens, addressing both root and branch, harmonizing Qi and Blood so that latent pathogens disappear. Children are prone to deficiency and excess; medication must weigh severity and urgency. Using pill medicine for regulation at the end reflects the principle of slow treatment for chronic illness without overdosing.
(Organized by Shang Guyu et al.: Wang Pucheng's Medical Cases, *Chinese Journal of Traditional Medicine* 6:405, 1958)
Case 2 Ye XX, female, 14 years old. First consultation: October 12, 1971. Generalized purpura had lasted for one and a half months. Sudden onset of purpura on limbs, unequal papule-like hemorrhagic spots on upper and lower limbs, diagnosed as "allergic purpura." Prednisone provided slight improvement, but when reduced to 20 mg daily, generalized purpura flared up. Symptoms: general rash, spotted, bright red color, worse on lower limbs. Pulse wiry, fine, and slightly rapid, thin coating with red tip. Shengdihuang (12g), Baiguiban (Testudinis Carapax et Plastrum, 12g), Chuan Huangbai (Phellodendri Chinensis Cortex, 9g), Fei Zhimu (Anemarrhenae Rhizoma, 9g), Jin Gouji (Drynariae Rhizoma, 12g), Tusizi (Cuscutae Semen, 12g), Nvzhenzi (Ligustri Lucidi Fructus, 12g), Hanliancao (Ecliptae Herba, 30g), Xian Oujie (Fresh Nelumbinis Node, 30g), Wumei (Mume Fructus, 4.5g), Gu Mai Ya (Valerianae Radix and Hordei Fructus Germinatus, 9g each), Da Hongzao (Jujubae Fructus, 6 pieces). Based on this prescription, add Danggui and Baishao to nourish blood, or add Zicao and Xianhexiao to stop bleeding. During the process of taking Chinese medicine, gradually reduced prednisone dosage. On December 12, 1971, completely stopped hormones, with no recurrence. Subsequently used Bajia San (Eight Treasures Powder) modified to consolidate recovery.
(From Zhang Gengmei's *Occasional Picks in Clinical Practice*)
Case 3 Son of Ma Deyin from Yilin Pharmacy, aged about thirteen or fourteen, suffered from ban yi (rash epidemic), sought my treatment. His son was not physically robust, with spots all over the body; most were small, about one-third were as large as fingernails or soybeans, especially numerous on the feet, but without pain or fever. Asked about bowel movements: passed dry stool slightly two days ago, otherwise realized the principle of Yang syndrome showing Yin signs, still treated from Yang perspective, but the Yin signs likely belong to Qi deficiency. Should clear blood toxins and benefit Qi, but caution against excessive bitter-cold herbs. Thus used newly revised Xiao Ban Huo Ming Yin (Eliminate Rash and Save Life Decoction): Jiu Chao Dahuang (Wine-fried Rhei Radix et Rhizoma, only 4.5g), Xiyangshen (American Ginseng, 2.4g), instructed to take two doses. Stool turned black, urine resembled brine, rash marks gradually thinned, and appetite improved. Later removed Dahuang, reduced Xiyangshen by one-third, took another three doses, and rash completely cleared, achieving full recovery. Newly Revised Xiao Ban Huo Ming Yin: Chuan Dahuang, Huangqin (both wine-fried), Lianqiao, Gancao, Shan Zhi (charred black), Su He (Perillae Folium and Menthae Haplocalycis Herba), Banlangen (Isatidis Radix), Qingdai (Indigo Naturalis), Xiyangshen (steamed separately), Danggui (wine-washed), Da Shengdi (stir-fried), Guang Yujin (Curcumae Radix), Zi Bei Fu Ping (Purple-backed Lemna Minoris Herba), Zi Ju Hua (Chrysanthemi Flos, use root if flowers unavailable).
(From Yu Fengxian's *Compilation of Medical Formula Experience*)
[Commentary] Allergic purpura is mostly categorized under warm heat and warm epidemic diseases in traditional Chinese medicine. Case 1 was diagnosed as warm toxin causing macules, where purpura resulted from warm toxin stagnation and heat entering the interior; thus, clearing and resolving was the main method. However, due to prolonged illness damaging Liver and Spleen, presenting both deficiency and excess, attention should be paid to supporting healthy Qi and eliminating pathogens, addressing both root and branch during treatment; physicians should adjust methods according to changes in chief and accompanying symptoms.
Case 2 syndrome differentiation focused on Yin deficiency and blood heat as the main contradiction, treating with nourishing Yin, clearing heat, and stopping bleeding methods. Used Da Bu Yin Wan (Great Supplement Yin Pill) as the basic formula, replacing original Shudi with Shengdi, paired with Oujie to cool blood and stop bleeding; Zhi Mu and Huang Bai purge fire; Guiban paired with Er Zhi Wan (Two Solitudes Pill from *Collection of Medical Formulas*) to enhance Yin-nourishing effects. Also used Wumei in the formula; modern pharmacological research shows it has anti-protein allergy effects.
Case 3 original case named "Grape Epidemic," its clinical manifestations align closely with allergic purpura. Mr. Yu had rich experience treating this syndrome, believing that red-purple spots are treatable, whereas spots purple like grapes or radishes with foul odor have a poorer prognosis. Newly Revised Xiao Ban Huo Ming Yin can clear blood toxins and benefit blood Qi, allowing Qi to lead blood and Qi movement to transform toxins. Its prescription and herb selection are meticulous. However, some cases of Grape Epidemic recorded in *Compilation of Medical Formula Experience* had sudden onset and dangerous severity, belonging to Waterhouse-Friderichsen syndrome among fulminant purpura types; thus, "Grape Epidemic" cannot be equated with allergic purpura.
(22) Hemophilia
Yang Mou, male, 2.5 years old. First consultation: November 18, 1965. Since six months old, the child often had purple-red patches on skin and mucous membranes, appearing and disappearing, commonly seen around joints, with joint swelling, hardness, fever, and movement障碍 (impairment). Accompanied by low-grade fever, irritability, crying, etc. Episodes occurred every two to three months, worse in spring and summer. Even minor bumps caused uncontrollable bleeding, requiring multiple fresh blood transfusions to stop. Syndrome differentiation: Yin deficiency with hyperactive fire, Spleen failing to control blood (Western diagnosis: hemophilia). Treatment method: tonify Liver and Kidney, strengthen Spleen and benefit Qi, clear heat and cool blood, assisted by benefiting Yin and nourishing blood, invigorating blood and moving stasis. Prescription: (1) Dried carrot 500g, wheat 1000g, millet 500g, ground into fine powder, steamed as buns. (2) Zijinghua (Bauhiniae Flower, remove stalk) 40g, mixed with a little flour into paste, pan-fried into cakes, eaten with white sugar. (3) Danpi 25g, Danggui 30g, Honghua 22g, Shengdi 25g, Xianhexiao 22g, Sheng Baizhu 37g, Ji Neijin (roasted) 25g, Chi Shao 22g, Sharen 19g, Xuanshen 25g, Huangjing 25g, Heshouwu 25g, Tiandong 22g, Yinchaihu 22g, Yuanzhi 22g, Hupo 22g, Tianzhuhuang 15g, Digupi 22g, Gusuibu 22g, Chao Shenqu 19g, Shuiniujiao 25g, all ground into fine powder. Decoct Gouteng (Uncariae Ramulus cum Uncis, 62g), Bohe (Menthae Haplocalycis Herba, 37g), Yichen (Artemisiae Scopariae Herba, 31g), Hanliancao (46g) for juice, make small pills, take 3g each time, three times daily, take medicine for one week, stop for one day. August 20, 1973: Visitors reported taking medicine immediately after receiving the prescription. Formula (1) taken for over a month annually; Formula (2) taken for 7-10 days every spring; Formula (3) prepared 1-2 batches annually, taken for about 3-4 months. Combined with Vitamin K and Vitamin C during heavy bleeding. Persisted in medication for several years, often eating raw peanuts, condition significantly improved, able to attend school. Hemostasis time similar to normal people, no longer needed hospital blood transfusions. Advised continuing Formula (1) and (2); Formula (3) added Shudi 46g, Weilingxian 50g, Moyao 50g, Xuemei 37g, Sanqi 31g, Qiancaogen 62g, Xuduan 77g, Tusizi 93g, Sangpiaoxiao 62g, Baiyangjiaojian 46g, Taipan (Placenta Hominis, 1 unit), prepared as pills for continued use. Follow-up on November 21, 1974: Symptoms significantly reduced, for over a year since then, no bleeding patches found on the whole body, occasional epidermal abrasions did not cause uncontrollable bleeding.
(From "Medical Cases of Liu Huimin")
[Commentary] Hemophilia is the most common bleeding disease among congenital coagulation disorders, with children prone to subcutaneous, muscle, and joint bleeding. This case's syndrome differentiation belongs to Yin deficiency with hyperactive fire and Spleen failing to control blood. Mr. Liu treated it mainly by tonifying Liver and Kidney, strengthening Spleen and benefiting Qi, clearing heat and cooling blood, representing a method of treating both deficiency and excess. Prescription (1) is a food therapy formula; carrots descend Qi and tonify the middle, benefit chest/diaphragm and intestines/stomach, and calm the five viscera. Prescription (2) uses Zijinghua, which Li Shizhen's *Compendium of Materia Medica* describes as "invigorating blood and moving Qi, reducing swelling and detoxifying," also an empirical formula. Prescription (3) combines warming, clearing, and tonifying with invigorating blood and moving stasis, effectively addressing chief and accompanying symptoms with comprehensive therapeutic potential.
(23) Jie Lu (Open Skull / Hydrocephalus)
Zhang XX, male, 34 days old after birth, first consultation: February 11, 1975. The child began to show head enlargement two days after birth, more obvious around one month, with wide anterior fontanelle, full and bulging, separated cranial sutures, distended scalp veins, poor spirit, lethargy, anorexia, vomiting milk, normal stool, downward gaze, normal heart and lungs, red tongue body slightly pale, faint stagnant fingerprint, fine and weak pulse. Syndrome differentiation: insufficient Kidney Qi, unfilling of brain marrow, disease belongs to Jie Lu (Western diagnosis: congenital hydrocephalus). Treatment method: tonify Kidney and benefit marrow to treat the root, move water and transform dampness to treat the branch. Prescription: Dihuang Wan modified. Shudi 6g, Shanyao 3g, Lujiao Jiao (Deer Antler Glue, 9g), Niuxi 3g, Fuling 9g, Jing Yurou and Danggui 3g each, Zhuling 9g, Chongweizi 3g, Danpi 3g, Cheqianzi 9g, decocted in water, one dose daily. From starting the above medicine, daily urine volume increased, spirit and milk intake were good, no vomiting. After two weeks of continuous administration, head circumference began to gradually shrink, eyes no longer gazed downward. By the third week, head circumference was basically normal. Anterior fontanelle flattened, cranial sutures narrowed.
(From "Pediatric Medical Cases of He Shiying")
[Commentary] Jie Lu refers to pediatric hydrocephalus. It is mostly caused by insufficient Kidney Qi and unfilling of brain marrow. Therefore, this case was treated by tonifying Kidney and benefiting marrow, moving water and transforming dampness, employing the "treating upper disease from below" method. Used Jisheng Shenqi Wan removing Zexie, Gui, and Fu; adding Lujiao Jiao, Danggui, Zhuling, Chongweizi. Tonified Kidney while avoiding Gui and Fu for strong yang-tonifying, combined with promoting urination and regulating Liver, improving efficacy compared to ancient methods using only Kidney tonification.
(24) Pediatric Epilepsy
Case 1 Wang XX, male, 11 years old, Medical Record No.: 199884. The child suffered from epilepsy eight years ago and has not been cured until now. Currently attacks occur one to three times a year, mostly at night. During attacks, foaming at mouth, clenched jaw, unconsciousness. Recently attacks are more frequent, convulsions last longer, relieved only after taking phenytoin sodium or injecting sedatives. After attacks, headache, restless sleep, occasional irritability; ineffective treatments at various hospitals led to outpatient visit. Syndrome differentiation: Tan Xian (Phlegm Epilepsy). Latent phlegm-heat, compounded by fright, disturbing Jueyin. Treatment method: clear heat and resolve phlegm, calm fright and stop convulsions, invigorate blood and extinguish wind. Prescription: Sheng Ce Bai 10g, Tianzhuhuang 6g, Dan Cao 6g, Di Long 6g, Qing Meng Shi 10g, Ju Hong 6g, Cishi 10g, Honghua 3g, Tao Ren 5g, Gouteng 5g, Quan Xie 3g, Jiao Zha 10g. Huafeng Ding 1 pill, twice daily. Above prescription modified and taken together for 36 doses, symptoms stabilized, only much phlegm, poor appetite, mossless tongue, wiry-slow pulse. Re-proposed previous method modification: Gouteng 5g, Qing Meng Shi 12g, Fa Xia 5g, Tao Ren 5g, Honghua 6g, Cishi 10g, Quan Xie 3g, Di Long 10g, Hua Ju Hong 6g, Dan Cao 6g, Shenqu 10g, Chao Maiya 10g, Huafeng Ding 1 pill, twice daily. Taken another 16 doses of above prescription, plus 20 pills of Huafeng Ding, visited clinic after three weeks, reported no convulsion attacks since taking medicine, continued treatment for four months, alternated using Mengshi Gun Tan Wan and Yi Xian Wu Shuang Wan to consolidate efficacy. Over one year of outpatient visits, convulsions basically cured.
(From "Selected Clinical Experience of Zhao Xinbo in Pediatrics")
Case 2 Liu Mou, female, 2 years old. First consultation (April 5, 1975): Child usually healthy, screamed once while playing one month before onset. For two weeks thereafter, often cried during sleep, needing coaxing and patting to fall asleep. Another half month later, suddenly convulsed one afternoon, lasting seconds. Thereafter convulsions became more frequent, two to three times a day minimum, up to ten-plus times, especially more frequent during colds and fevers. During convulsions, pale face, cyanotic lips, clenched jaw, eyes rolling up and staring, hands tightly clenched, stiff neck, whole body twitching, unaware of surroundings. About one to two minutes later, spasms relaxed, gradually woke up, weak spirit after waking, no other discomfort. Pulse wiry and fine, thin white tongue coating. Etiology: fright damaging Heart and Liver, internal stirring of Liver Wind, disturbing Heart Spirit, causing frequent epilepsy. Treatment proposed: search for wind and relieve spasms, calm Liver and submerge Yang, calm fright and extinguish wind, soothe Heart and calm Spirit. Quan Xie 3g, Wugong 1.8g, Tianma 3g, Wushao She Rou (Wagler's Pit Viper Meat, 3g) (all ground into fine powder, mixed evenly, divided into three doses, taken in one day), Cishi 60g (decocted first), Baishao 15g, Zhenzhumu 30g, Yejiaoteng 30g, Sheng Longchi 30g (decocted first), Gouteng 12g (added later), Mahren 12g (crushed), Beishumi 30g (wrapped), Duan Longgu and Muli 30g each, Zhi Gancao 9g, Huaixiaomai 30g, 2 doses. Decoct one dose of above prescription into four juices, mix evenly, take in divided doses over two days, total four days. Convulsions controlled after medicine, parents self-continued original prescription for over four months then stopped. Follow-up August 2, 1976: epilepsy did not recur for over a year, lively spirit, normal intellectual development. (From *Selection of Old TCM Doctors' Experiences*, Wang Yurun's Medical Cases)
[Commentary] Epilepsy is a paroxysmal disorder of consciousness. Mostly caused by fright, emotions, diet, and fatigue. *Su Wen · Da Qi Lun* points out genetic factors in onset, while *Zhu Bing Yuan Hou Lun* states: "Over ten years old is Dian, under ten years old is Xian." This disease's attacks are closely related to wind-phlegm, so treatment mostly focuses on expelling phlegm, opening orifices, extinguishing wind, and stabilizing epilepsy. Besides using phlegm-resolving herbs, Mr. Zhao paired Sheng Ce Bai, Honghua, Tao Ren to unblock meridians and invigorate blood; Dan Cao, Gouteng, Cishi, Quan Xie to calm and stop convulsions, calm Liver and extinguish wind. The patent medicines used during treatment noted the main contradictions of wind and phlegm in epilepsy etiology and pathology, making the prescription distinctive.
Case 2 originated from fright damaging Heart and Liver, internal stirring of Liver Wind, and disturbing Heart Spirit. Mr. Wang treated with searching wind, relieving spasms, calming Liver, pacifying fright, extinguishing wind, and soothing spirit methods. The prescription mainly used snake and insect species to search wind and pacify fright, along with heavy-settling herbs to calm Liver and submerge Yang, supplemented by softening Liver and supporting healthy Qi. Multiple methods combined focusing on Liver meridian, yielding significant and consolidated effects.
V. Surgical and Dermatological Disease Cases