無聲透露了他內在的天翻地覆
Silently revealed the upheaval in his heart
𓍼
非中風後遺症之失語症，可能來自頭部外傷、腦瘤、腦炎、癲癇，或暫時性腦缺血等因素，造成大腦的語言區受損（大多數人的大腦語言區位於左側，但這並非絕對），導致語言的「理解」或「表達」出現障礙，或是理解和表達能力都受損。另外，嚴重的心理壓力或創傷，也會引起暫時性的言語困難，而有失語症的表現。
Non-CVA-related aphasia can result from head trauma, brain tumour, encephalitis, epilepsy, or transient ischemic attack, which can damage the language area of the brain (in most people, this area is located on the left side, but this is not always the case), leading to impairments in language comprehension, expression, or both. Furthermore, severe psychological stress or trauma can cause temporary speech difficulties, which can manifest as aphasia.
๋࣭𓈒𓂂 𓈒⭑𓍯𓂃 ֶָ֢˖ ࣪⊹
這是發生在一位我非常親近的家人的故事。我最近一次很認真的跟這位家人談，才意外發現她疑似有失語的症狀，我認為可能因此導致她的一些行為舉止改變。
This is a story about a family member I'm very close to. During a recent serious conversation with this family member, I unexpectedly discovered that she might be experiencing aphasia, which I believe may be contributing to some of her behavioural changes.
說到失語症，在常規醫療上首先要排除腦中風、認知功能障礙、藥物副作用等因素，除了會做腦部影像學檢查之外，還需要神經專科醫生或語言治療師做檢查，以判斷是屬於哪一種失語症，診斷上有其難度。不過，最主要還是患者自身的病識感可能不強、患者和最常互動的身邊的人可能對失語症的認識也不深，更別說是察覺到異樣了。
Before diagnosing aphasia, conventional medical treatment first has to rule out factors such as stroke, cognitive impairment, and medication side effects. In addition to brain imaging, a neurologist or speech therapist will give the patient a thorough examination to determine the specific type of aphasia, making diagnosis challenging. However, the main issue is that the patient may lack insight, and the people they interact with most often know nothing about the disease, let alone be aware of it.
而且失語症患者外觀與常人無異，只是溝通上容易碰壁，對患者本人來說會不方便，但忍耐之下通常可以維持日常生活，不是一種足以讓人去到醫院求診的病。可以理解我問了一圈同業朋友，都沒有這類患者的治療經驗。但我認為疾病這種東西是這樣的：不常看到不代表很少，很常看到不代表很多。
Furthermore, patients with aphasia appear no different from normal people, though communication can be challenging, which can be inconvenient for the patient. However, they can usually maintain daily life with tolerance, and it's not a condition that warrants a visit to the hospital. Understandably, I asked around among my colleagues, and none of them had experience treating patients with sucha disease. But I believe that with illnesses, the uncommon presence doesn't mean it's rare, and the common presence doesn't mean it's common.
而我會發現這位家人的異樣，有一定程度是天時人和。要不是那天我認真跟她聊，我可能不會想到失語症。我都以為那是她個性和習慣問題，情緒性的故意用奇怪的方式表達，只為了挑釁之類的，原來不是。我本來也想說，她有點右耳重聽，才越講越大聲，原來也不單純是這樣。
My discovery of this family member's unusual behaviour was partly due to timing and luck. If I hadn't spoken to her seriously that day, I might not have considered aphasia. I'd assumed it was a personality quirk, a deliberate expression of emotion in strange ways, just to provoke, or something. But it wasn't. I'd also considered suggesting she was slightly hard of hearing in her right ear, which was why she kept talking louder, but it wasn't simply that.
尤其當她緊張還是急的時候，常常用吼的，或有點像不會說，就用情緒演出，或不斷重複同一段詞，而那段詞和要表達的事情也有落差，常常造成誤會和爭辯。她自己這時也才緩緩的說，她懷疑自己說話有問題，但太害怕又不知道怎麼講這件事。
Especially when she's nervous or anxious, she often yells, or seems unable to speak, acting out her emotions, or repeating the same words over and over, which often doesn't reflect what she's trying to say, often leading to misunderstandings and arguments. Only then did she slowly admit that she suspected she had a speech problem, but she was too scared and didn't know how to address it.
要說分型的話，我覺得有點混合（各位知道現實世界的疾病並不會長得跟課本一樣吧？），但表達型比較明顯，也有錯語、命名困難。
If I were to categorise it, I think it's a bit mixed (you know that diseases in the real world don't look the same as in textbooks, right?), but the expressive type is more obvious, and there are also paraphasias and naming difficulties.
這個故事才剛開始，我知道要找到更清楚的證據和線索還有很長的路要走，也知道即使證實是失語症，治療也只有語言復健。但也因為這件事，讓我對「中醫如何治療『非中風後遺症』的失語症」這個主題產生興趣，因為我還有很多治療方法和工具可以使用，往後我都會試試看，希望能做成記錄。這只是個開始而已。
This story is just beginning. I know there's still a long way to go to find clearer evidence and clues. I also know that even if aphasia is confirmed, the only treatment is language rehabilitation. However, this incident has sparked my interest in "How Traditional Chinese Medicine treats aphasia that isn't a sequelae of stroke." I have many treatments and tools at my disposal, and I'll continue to try. I hope to document them in a way that will be useful to others. This is just the beginning.
《百病辨證錄》中並沒有「失語症」的篇章，但匯集我所有對這個病例的了解，包括生活作息、飲食習慣、脾氣，臨床表現，長期和近期病史，先有了初步證型和症狀，在三個不同章節能找到一些可參考的資料，可以和我的治則和想開的處方做比較。節錄書中內容於下：
There's no chapter on aphasia in the TCM classic: A Record of Differentiation of Symptoms and Symptoms of All Diseases, but by gathering all my knowledge of this case, including lifestyle, dietary habits, temperament, clinical manifestations, and long-term and recent medical history, I've developed a preliminary understanding of her syndrome and symptoms. Three different chapters offer some reference material that I can compare with my treatment principles and proposed prescriptions. Excerpts from the book are below:
𓍼
有人對人說話，隨說隨忘，其他人複述他說過的話，他自己卻杳無記憶，好像自己從來並不道及。這和他的心與腎有關，中醫認為，人的心腎交而智慧生，心腎離而智慧失；人的聰明並非生於心腎，而是生於心腎之交。腎水滋養著心，則智慧生生不息，心火滋養於腎，則智慧亦生生無窮。心火過度亢盛，或是腎水枯竭，皆會導致心腎兩不相交，這勢必導致人健忘，難以記住事情。
Some people forget what they say as soon as they speak. When others recount what they said, they themselves have no recollection, as if they had never mentioned it. This is caused by disharmony between their heart and kidneys. Traditional Chinese Medicine believes that wisdom arises from the interaction between the heart and kidneys, and wisdom is lost when the heart and kidneys separate. A person's intelligence is not born from the heart and kidneys, but from the interaction between the heart and kidneys. Kidney water nourishes the heart, fostering endless wisdom; heart fire nourishes the kidneys, fostering endless wisdom as well. But when there’s exuberant heart fire, or when kidney water dries up, the interaction between the heart and the kidney is disrupted, which inevitably leads to forgetfulness and difficulty remembering.
治療方法必須補養心腎，使相離者恢復相親，那自然能記得說過的話，想起怎麼說話。
此方為神交湯：人參一兩，麥冬一兩，巴戟天一兩，柏子仁五錢，山藥一兩，芡實五錢，玄參一兩，丹參三錢，茯神三錢，菟絲子一兩，水煎服，連續服十劑後，健忘能改善。服用一個月，可以鞏固療效。
To treat this disease, you must nourish the heart and kidneys so that the separated can reconnect. Then the patient will naturally remember what they said and how to speak.
◌𓈒𓐍𓂃 Remedy components 𓂃𓈒𓂂 (1 tael = 1 liang ≒ 37.5 grams = 10 mace)
Ginseng (Panax ginseng): 1 tael
Ophiopogon japonicus: 1 tael
Morinda officinalis: 1 tael
Platycladi Seed: 5 mace
Chinese yam: 1 tael
Euryale Seed: 5 mace
Figwort Root (Scrophulariae radix): 1 tael
Danshen Root (Salvia miltiorrhiza): 3 mace
Wolfiporia extensa (poria): 3 mace
Dodder Seed: 1 tael
Boil the ingredients in water to make a decoction. Forgetfulness will improve after ten consecutive doses. Continue taking the medicine for a month to consolidate the therapeutic effects.
此藥方看起來似乎著重於治心，而輕於治腎，這是因為治療此病症必須使心先交於腎。而且此配方中的藥，全都是心腎同治之藥。
At first glance, this recipe may appear to prioritise treating the heart over the kidneys, but treating this condition requires the heart to reconnect to the kidneys first. Furthermore, all the herbs in this recipe are chosen because they treat both the heart and kidneys., all the herbs in this recipe are chosen because they treat both the heart and kidneys.
此症用天絲飲亦有效：
巴戟天一兩，菟絲子一兩，水煎服十劑，即不忘。
Another effective remedy for this condition is as follows:
Morinda officinalis: 1 tael
Dodder Seed: 1 tael
Boil the ingredients in water to make a decoction. Forgetfulness will improve after ten consecutive doses.
𓍼
接下來的例子適用於先天胃虛，有胃陰虛夾邪火/邪熱（口臭、牙齦腫爛、口渴欲食西瓜、果汁口味汽水之類）症狀，又容易覺得胃部冷冷的，特別喜歡吃熱湯，並且有痰、腦神經相關症狀，以及勞神勞心勞累者。
The next example can be useful in cases having stomach qi and/or stomach yin deficiency, with pathological stomach fire/heat (bad breath, swollen gums, thirsty and craving for watermelon, juice and soda), often feel cold in the stomach, especially like to eat hot soup, and also have phlegm and central nerve system symptoms, emotional drained and general fatigue.
人有一時呆病發作，是由於起居失節，胃氣受傷而導致痰迷心竅。中醫臟象中，胃屬土，五行理論是火生土。然而火能生土，亦能害土；火不足則土了無生氣，火過多則使土焦灼而死。怎麼會原本生土的元素反而傷害了土呢？這是因為這裡的火是來自於外來不良影響所生之火。人體自然存在的火是能滋養胃土的，使胃能消化食物並供給能量，不正常的火卻傷害胃氣，使得食物不能正常消化，反而生痰（病理產物），痰形成了又更傷胃土，而火邪也會傷害心，使神智不清明，輕則成呆，重則暈厥。這都是起居失節，胃有所勞傷，導致吃進的食物不產生能量，而是生痰。
Sometimes a person may experience an acute “space out.” It’s the result of unhealthy lifestyle habits that damage the stomach qi, leading to phlegm clouding the mind. In Traditional Chinese Medicine, the stomach belongs to the element of earth. According to the five-element theory, fire generates earth. While fire can generate earth, it can also harm it. Insufficient fire renders the earth lifeless, while intense fire scorches and kills earth. How can an element that generates earth harm it instead?
How can an element that generates earth harm it instead? The reason is the fire here is pathological, arising from negative external influences. The heart fire naturally occurs from the body nourishes the stomach earth, supporting digestion and provide energy. However, pathological fire damages stomach qi, disrupt digestion and instead producing phlegm (a pathological product). The phlegm further damages the stomach earth. The pathological fire also harms the heart, causing mental confusion, leading to forgetfulness at best and fainting at worst. This is all due to a disordered lifestyle that strains the stomach, causing the intake (food) to produce phlegm instead of energy.
治療是使胃氣恢復，並佐以消痰之品。只要痰解開了，神智就能恢復。此方為啟心救胃湯：人參一兩，茯苓一兩，白芥子三錢，菖蒲一錢，神麴三錢，半夏二錢，南星二錢，黃連一錢，甘草一錢，枳殼五分，水煎服，一劑而痰解，再劑而神清，三劑而呆病消失。
The best treatment is to restore stomach qi and administer phlegm-removing herbs. Once the phlegm is cleared, mental clarity can be restored.
◌𓈒𓐍𓂃 Remedy components 𓂃𓈒𓂂 (1 tael = 1 liang ≒ 37.5 grams = 10 mace = 100 candareen)
Ginseng (Panax ginseng): 1 tael
Wolfiporia extensa (poria): 1 tael
white mustard seeds: 3 mace
Rhizoma Acori tatarinowii: 1 mace
Shenqu (Massa medicata fermentata): 3 mace
Ternate Pinellia (Pinelliae Rhizoma): 2 mace
Arisaematis Rhizoma: 2 mace
Coptis chinensis: 1 mace
Glycyrrhiza uralensis (Chinese liquorice): 1 mace
Submature bitter orange peel: 5 candareen
Boil the ingredients in water to make a decoction. After taking the first dose, the phlegm is removed, and regains clear mind after the second dose. The third dose will eliminate the illness.
此配方看起來都在救心，卻能救胃氣，是因為胃土為心火之子，心氣既清，則胃氣也能恢復平安。
This remedy appears to focus on relieving the heart, but it can restore stomach qi as well. This is because stomach earth is the child of heart fire (according to the five-element theory). Clearing heart fire can also restore stomach qi.
真正的呆病是經年累月形成的，不會突然發生，所以若一時呆病發作，並非真的呆病。
True dementia develops over years and does not occur suddenly. Therefore, a temporary dementia-like manifestation is not real dementia.
久病適合以溫熱之藥補胃以消痰，突然發作的病症則是要用寒涼的藥物清胃，才能達到補胃氣和消除痰的效果，兩者不一樣。
Long-term illness requires warm/hot medicine to nourish the stomach and eliminate phlegm. For acute onset illness, use cool/cold medicine to clear the stomach heat so you can nourish stomach qi and eliminate phlegm. The two are different.
𓍼
人有遭受他人強橫所害而受辱，憤懣不平，於是發病如狂。人們可能認為這人胃火亢盛，但病人可能已經胃土衰敗。當胃土衰敗卻呈現胃火亢盛的症狀，表示此病態的心火已經傷及胃（後天之根）。狂症皆是熱，臟腑實熱可以涼折，虛熱就必須溫引。
When someone is bullied and humiliated by others, they become filled with resentment and may go mad. The patient might seem to be suffering from intense stomach fire, but actually they are suffering from stomach earth depletion. When stomach earth depletion manifests as intense stomach fire, it indicates that this pathological heart fire has already affected the stomach (the root of the acquired constitution). Mania is always caused by pathological heat. While intense heat in the internal organs can be treated by cooling and calming, deficient heat must be guided by introducing warmth.
然而胃的虛熱又不可全用溫引，需要以溫中之藥，佐之微寒之品。因為這類的病屬於內傷，是因憤懣而生熱，和外邪入侵的生熱不同，必須清楚分辨。
However, deficient heat in the stomach meridian cannot be treated solely with warming. Warming herbs, supplemented with mildly cooling herbs, are needed. This is because the illness originates from within; the pathological heat generated by resentment is different from heat generated by external pathogens, and this distinction must be made.
方用平熱湯：人參五錢，黃耆一兩，甘草一錢，麥冬一兩，黃芩一錢，青皮五分，竹瀝一合，白芍五錢，茯苓三錢，棗仁三錢，炒梔子五分，天花粉三錢，柴胡五分，水煎服，二劑而狂輕，四劑而狂定，服一月而安然熟臥矣。
◌𓈒𓐍𓂃 Remedy components 𓂃𓈒𓂂 (1 tael = 1 liang ≒ 37.5 grams = 10 mace = 100 candareen)
Ginseng (Panax ginseng): 5 mace
Astragalus: 1 tael
Glycyrrhiza uralensis (Chinese liquorice): 1 mace
Ophiopogon japonicus: 1 tael
Baikal Skullcap (Scutellaria baicalensis): 1 mace
Green Tangerine Peel: 5 candareen
Succus Bambusae: 1 portion
White Peony Root: 5 mace
Wolfiporia extensa (poria): 3 mace
Spine Date Seed: 3 mace
stir-fried Gardenia fruit: 5 candareen
Trichosanthis Radix: 3 mace
Bupleurum Root: 5 candareen
Boil the ingredients in water to make a decoction. After taking two doses, the mania will be relieved; after taking four doses, the mania will be settled; after taking it for one month, the patient will sleep soundly and peacefully.
此證用舒憤湯亦有效：
白芍二兩，炒梔子五錢，玄參一兩，天花粉三錢，柴胡一錢，水煎服，一劑狂定，再劑癒，三劑痊癒。
Another effective remedy for this condition is as follows:
White Peony Root: 2 tael
stir-fried Gardenia fruit: 5 candareen
Scrophularia Root: 1 tael
Trichosanthis Radix: 3 mace
Bupleurum Root: 1 mace
Boil the ingredients in water to make a decoction. One dose will calm the mind, two doses will cure the disease, and three doses will recover completely.
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