小儿温热症,悉与大人同,惟时见痉厥,类于惊风,误治多死,兹特先论其症治。
一、风温致痉 皆由医者不明风寒、风热,见儿头痛发热,不问何邪,概曰风寒夹食,辄与辛燥升散,
杂以苦温消导,往往阴液被伤,肝风内动,鼓痰上升,血不荣筋,筋急拘挛,致成痉螈。一见痉螈,便称惊风,
乱投冰、麝、金石,苦寒 悍毒药,以为开窍镇惊,清热祛风,家传秘法,家藏丸丹,多系如此。又或将惊字
误作筋字之讹,挑筋刺血,强推强拿,其在富贵之家,酿祸尤速。治法∶先以辛凉开肺,继以甘寒化热,佐以
润剂降痰,尤必辨其轻重。轻者用辛凉轻剂,桑菊饮加钩藤、桑枝、竹沥、竺黄、鲜石菖蒲之类;重者用甘
寒复咸寒法,如白虎汤加天麻、羚角、栝蒌、川贝之类,取效最捷,昏厥不语者,速加瓜霜紫雪丹开之;阴液
亏极者,必兼色瘁窍干,无涕无泪等症,再加梨汁、蔗汁、鲜生地、鲜石斛,甘凉以润之。
二、暑热致痉 症必面赤齿燥,四肢厥冷,手足抽搐,神昏若惊。轻则吴氏清络饮加菊花、钩藤;重则
犀羚镇痉汤加瓜霜紫雪丹。神清以后,用竹叶地黄汤,清凉血分,以善其后。
三、燥火致痉 皆由温热化燥,液涸动风。症必鼻窍无涕,目干无泪,面色枯憔,神昏痉厥,势最危急。
速用犀羚白虎汤,加瓜霜紫雪丹挽救之∶或竹叶石膏汤去半夏,重加川贝、竹沥、竹黄、安宫牛黄丸等,亦多
获效,病减后余热,或用叶氏养胃汤清养胃阴,或用竹叶地黄汤清凉血分。此皆似惊非惊,为小儿温热症中之
最重者也。
小儿温热病,其病情与成人基本相同,只是时常出现抽搐和昏厥症状,类似于惊风,若误治往往导致死亡,因此这里特别先论述其症状和治疗。
一、风温导致的抽搐:都是由医生不明白风寒和风热的区别,看到孩子头痛发热,不问是什么邪气,一概说是风寒夹带食积,就立即使用辛温燥烈、升散的药物,混杂苦温消导药,往往导致阴液受损,肝风内动,鼓动痰液上升,血液不能滋养筋脉,筋脉紧急拘挛,从而形成抽搐。一见抽搐,就称为惊风,乱投冰片、麝香、金石类药物,以及苦寒悍烈的毒药,以为是开窍镇惊、清热祛风的家传秘法或家藏丸丹,大多如此。又有人将“惊”字误作“筋”字的讹误,进行挑筋刺血,强行推拿,这在富贵人家,酿成的祸患尤其迅速。治疗方法:先用辛凉药物宣开肺气,继用甘寒药物化解热邪,佐以润剂降化痰浊,尤其必须辨别病情的轻重。轻症用辛凉轻剂,如桑菊饮加钩藤、桑枝、竹沥、竺黄、鲜石菖蒲等;重症用甘寒兼咸寒的方法,如白虎汤加天麻、羚羊角、瓜蒌、川贝母等,取效最快;出现昏迷不语者,迅速加入瓜霜紫雪丹以开窍;阴液亏损极度的,必然兼见面色憔悴、口窍干燥、无涕无泪等症状,再加梨汁、蔗汁、鲜生地黄、鲜石斛,用甘凉药物滋润之。
二、暑热导致的抽搐:症状必定面红齿燥,四肢厥冷,手足抽搐,神志昏迷如同受惊。轻症用吴氏清络饮加菊花、钩藤;重症用犀羚镇痉汤加瓜霜紫雪丹。神志清醒后,用竹叶地黄汤,清凉血分,以善后调理。
三、燥火导致的抽搐:都是因为温热病转化为燥邪,津液枯竭而动风。症状必定鼻窍无涕,眼睛干涩无泪,面色枯槁憔悴,神志昏迷抽搐,形势最为危急。迅速使用犀羚白虎汤,加瓜霜紫雪丹来挽救;或者用竹叶石膏汤去掉半夏,重加川贝母、竹沥、竹黄、安宫牛黄丸等,也大多能获效,病势减退后的余热,或用叶氏养胃汤清养胃阴,或用竹叶地黄汤清凉血分。这些都属于似惊非惊,是小儿温热病中最严重的类型。
Pediatric warm-heat diseases are essentially the same as those in adults, except that convulsions and syncope (spasms and fainting) often occur, resembling wind-stroke (Jing Feng). Misdiagnosis and mistreatment frequently lead to death; therefore, this section specifically discusses their symptoms and treatment first.
1. Convulsions caused by Wind-Warmth: These arise because physicians fail to distinguish between Cold-Wind and Wind-Heat. Upon observing headache and fever in children, without determining the pathogenic factor, they generally attribute it to "Cold-Wind combined with food stagnation." They immediately administer acrid-warm, drying, ascending, and dispersing herbs, mixed with bitter-warm digestive agents. This often damages Yin fluids, causing Liver Wind to stir internally, driving phlegm upward. Since blood fails to nourish the sinews, the sinews become tight and cramped, resulting in convulsions. Once convulsions appear, it is indiscriminately labeled as "Wind-Stroke" (Jing Feng), leading to the reckless use of Borneol (Bingpian), Musk (Shexiang), mineral substances, and harsh bitter-cold toxic drugs under the guise of opening orifices, calming fright, clearing heat, and dispelling wind—often touted as family secret recipes or stored pills. Furthermore, some confuse the character for "Fright" (Jing) with "Sinew" (Jin), performing tendon-piercing and bloodletting, or forcing vigorous massage. In wealthy families, such errors cause disaster even more rapidly. Treatment method: First, use acrid-cool herbs to ventilate the Lung Qi; subsequently, use sweet-cool herbs to resolve heat; assist with moistening agents to descend phlegm. It is crucial to differentiate severity. For mild cases, use light acrid-cool formulas, such as Sang Ju Yin (Mulberry Leaf and Chrysanthemum Decoction) added with Gouteng (Uncaria Rhynchophylla), Sangzhi (Morus Twig), Zhuli (Bamboo Sap), Zhuhuang (Processed Bamboo Bezoar), and Xian Shichangpu (Fresh Acorus Tatarinowii). For severe cases, employ a combination of sweet-cool and salty-cool methods, such as Baihu Tang (White Tiger Decoction) added with Tianma (Gastrodia Rhizome), Lingjiao (Antelope Horn), Gualou (Trichosanthes Fruit), and Chuanbeimu (Fritillaria Cirrhosa Bulb), which yield rapid results. For patients with coma and inability to speak, quickly add Guashuang Zixue Dan (Melon Frost Purple Snow Pill) to open the orifices. For those with extreme depletion of Yin fluids, who necessarily present with sallow complexion, dry orifices, absence of nasal discharge, and absence of tears, add Pear Juice, Sugarcane Juice, Xian Shengdihuang (Fresh Rehmannia Root), and Xian Shihu (Fresh Dendrobium Stem), using sweet-cool herbs to moisten.
2. Convulsions caused by Summer-Heat: Symptoms must include flushed face, dry teeth, cold extremities, hand and foot spasms, and mental confusion resembling fright. For mild cases, use Wu Shi Qingluo Yin (Wu’s Clear Collateral Decoction) added with Juhua (Chrysanthemum Flower) and Gouteng (Uncaria Rhynchophylla); for severe cases, use Xiling Zhenjing Tang (Rhinoceros Horn and Antelope Horn Convulsion-Calming Decoction) added with Guashuang Zixue Dan (Melon Frost Purple Snow Pill). After mental clarity is restored, use Zhuye Dihuang Tang (Bamboo Leaf and Rehmannia Decoction) to cool the Blood level for convalescence.
3. Convulsions caused by Dryness-Fire: These result from warm-heat transforming into dryness, leading to fluid exhaustion and stirring of Wind. Symptoms must include absence of nasal discharge, dry eyes without tears, sallow and emaciated complexion, mental confusion, and convulsions/syncope, representing the most critical condition. Quickly use Xiling Baihu Tang (Rhinoceros Horn and White Tiger Decoction) added with Guashuang Zixue Dan (Melon Frost Purple Snow Pill) for rescue; alternatively, use Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction) with Banxia (Pinellia Tuber) removed, heavily added with Chuanbeimu (Fritillaria Cirrhosa Bulb), Zhuli (Bamboo Sap), Zhuhuang (Processed Bamboo Bezoar), and Angong Niuhuang Wan (Angong Unicorn Pill), which also often prove effective. For residual heat after the illness subsides, use Ye Shi Yangwei Tang (Ye’s Stomach-Nourishing Decoction) to clear and nourish Stomach Yin, or use Zhuye Dihuang Tang (Bamboo Leaf and Rehmannia Decoction) to cool the Blood level. These conditions resemble fright but are not true fright; they represent the most severe type among pediatric warm-heat diseases.