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Zhenfeng Tang (Wind-Extinguishing Decoction)

Treats infantile acute convulsion (Ji Jing Feng). This pathogenic wind is acquired suddenly, with symptoms manifesting as spasms and twitching of the four limbs, rigidity of the body and neck, coma, and facial heat. Alternatively, there may be upward deviation of the eyeballs, accumulation of phlegm and saliva obstructing the airway, lockjaw, or profuse sweating due to heat.

Gouteng Hook (Uncariae Ramulus cum Uncis) - 3 qian
Lingyangjiao (Saiga Antelope Horn) - 1 qian, stewed separately and mixed into the decoction
Longdancao (Gentianae Radix) - 2 qian
Qingdai (Indigo Naturalis) - 2 qian
Qing Banxia (Pinelliae Rhizoma Preparatum) - 2 qian
Sheng Zheshi (Hematitum) - 2 qian, finely crushed
Fushen (Poria with Hostwood) - 2 qian
Jiangcan (Bombyx Batryticatus) - 2 qian
Boheye (Menthae Haplocalycis Herba) - 1 qian
Zhusha (Cinnabaris) - 2 fen, finely ground and taken with water

Decoct the herbs in concentrated rust water from raw iron.

Infants suffering from this syndrome do not necessarily contract it due to fright. Some cases arise from external heat pathogens transmitting to the Yangming channel; in such instances, Sheng Shigao (Gypsum Fibrosum) should be added to the formula. Others arise from heat malaria; in these cases, Sheng Shigao (Gypsum Fibrosum) and Chaihu (Bupleuri Radix) should be added.

Besides acute convulsion, there is what is called chronic convulsion (Man Jing Feng). The pathology of chronic convulsion is rooted in cold, which stands in stark contrast to the heat-based pathology of acute convulsion, much like ice and charcoal. Medical texts often use a single formula to treat both acute and chronic convulsions, which is fundamentally erroneous. Zhuang Zaitian’s *Fu You Bian* (Compilation for Nourishing Infants) offers the most precise differentiation of chronic convulsion and employs the most exquisite formulas. His differentiation of chronic convulsion comprises fourteen points:
1. Chronic convulsion accompanied by vomiting and diarrhea indicates deficiency-cold of the Spleen and Stomach.
2. Coldness of the body in chronic convulsion results from the suppression of Yang Qi, preventing its outward distribution.
3. Flaring of the nostrils in chronic convulsion signifies the loss of control over True Yin, with deficient fire scorching the Lungs.
4. Greenish-yellow or pale complexion in chronic convulsion indicates deficiency of both Qi and Blood.
5. Cold breath from the mouth and nose in chronic convulsion denotes middle-jiao cold.
6. Clear and colorless urine and stool in chronic convulsion indicate a complete lack of Fire in the Kidneys and Large Intestine.
7. Coma with eyes half-open in chronic convulsion reflects insufficiency of Shen Qi (Spiritual Qi).
8. Twitching and jerking of the limbs in chronic convulsion occurs because Blood fails to circulate to the extremities.
9. Opisthotonos in chronic convulsion is caused by Blood deficiency leading to tendon tension.
10. Alternating chills and fever in chronic convulsion results from insufficient Yin-Blood and disorder of Yin and Yang.
11. Sweating profusely in chronic convulsion indicates Yin deficiency and insecure exterior defense.
12. Tremors and writhing of the limbs in chronic convulsion occur because Blood deficiency fails to nourish the tendons.
13. Sunken fontanelle in chronic convulsion signifies extreme deficiency.
14. Although the body may be feverish with cracked, bleeding lips that do not desire cold drinks, administering cold-natured medicines worsens the critical condition. Furthermore, undigested milk in vomitus and undigested matter in stool reveal the absence of Fire in the Spleen and Stomach. Blackened, cracked lips clearly demonstrate insufficiency of True Yin.

Spleen Wind (Pi Feng) is also a syndrome of spasms in infants, known in medical texts as chronic convulsion. Because the term "chronic convulsion" is somewhat obscure, modern texts have renamed it "Chronic Spleen Wind" or simply "Spleen Wind." Comparing the two terms, "Spleen Wind" seems more appropriate, as the origin of the syndrome lies in deficiency-cold of the Spleen and Stomach. Although infants are considered to possess a Shaoyang constitution, Shaoyang is actually tender Yang, akin to the sprout of grass and trees—delicate and fearing cold. Therefore, if an infant’s diet or daily activities involve exposure to cold, or if they take excessive cold-natured medicines during illness, or suffer from prolonged malaria or dysentery (even without taking cold medicines), deficiency-generated cold can gradually develop into Spleen Wind. Initially, due to deficiency of Spleen-Stomach Yang, cold fluids condense and stagnate at the cardia, blocking food from descending; even if it descends, it cannot be digested, resulting in vomiting and diarrhea. Over time, True Yin becomes damaged, potentially generating burning sensations; alternatively, abundant cold fluids force the body's Yang Qi to float outward, also creating a burning sensation. This progresses to Liver deficiency with internal wind stirring, affecting the brain nerves, ultimately leading to spasms and limb twitching. Zhuang Zaitian discusses this syndrome in detail in *Fu You Bian*, proposing two excellent formulas: Zhuhan Dangjing Tang (Cold-Expelling Convulsion-Shaking Decoction) and Jiawei Lizhong Dihuang Tang (Modified Regulate the Middle and Rehmannia Decoction). First, administer Zhuhan Dangjing Tang, a strongly acrid-hot preparation, to resolve cold-phlegm in the chest, allowing the patient to tolerate medication without vomiting. Then, follow up with Jiawei Lizhong Dihuang Tang, and all symptoms will naturally resolve. I have used his formulas to save many lives, but by adapting them to specific conditions, I achieve immediate efficacy.

[Attached Formulas]

(1) Zhuhan Dangjing Tang (Cold-Expelling Convulsion-Shaking Decoction)

Hu jiao (Piperis Longi Fructus), Pao Jiang (Zingiberis Rhizoma Preparatum), Rougui (Cinnamomi Cortex) each 1 qian; Dingxiang (Caryophylli Flos) 10 grains. Pound together into fine dregs. Boil Zaoxintu (Caulis Arundinis Taedia) 3 liang in water, clarify the liquid, and decoct the herbs until only half a teacup remains. (The herbs must be crushed; do not decoct for too long, especially Rougui, which should only boil three or four times). Administer frequently by force-feeding. Follow with Jiawei Lizhong Dihuang Tang for miraculous effects.

Note: Hu jiao (Piperis Longi Fructus) should be the sovereign herb in this decoction. In severe cases of cold-phlegm binding the chest, use 2 qian. However, aged Hu jiao is unsuitable. My clan nephew XX, at age six, suffered from this syndrome. Food swallowed was rejected in the chest and diaphragm, vomiting immediately. This persisted for several days, accompanied by coma, eyes half-open, and gradual fever. I administered the original Zhuhan Dangjing Tang; after finishing the dose, there was no vomiting. When attempting to follow up with Jiawei Lizhong Dihuang Tang, vomiting recurred. I realized then that the medicine was purchased from a rural pharmacy, where the Hu jiao was likely aged. Moreover, using only 1 qian provided insufficient potency. I subsequently bought 2 qian of fresh Hu jiao from a spice shop, kept the other ingredients according to the original formula, and administered one dose. The cold-phlegm dispersed, and eating became possible. Following with Jiawei Lizhong Dihuang Tang cured him in one dose.

The Zaoxintu (Caulis Arundinis Taedia) used in the formula requires substitution. Plant materials generally contain alkaline flavors. Upon combustion, these alkaline residues accumulate in the hearth soil. Using this soil to decoct soup yields a strong alkaline taste, which is difficult to ingest and detrimental to the Spleen and Stomach. Instead, use the red-soot-stained soil from the surrounding walls of the stove pit, which lacks alkalinity and far surpasses standard hearth soil in efficacy.

(2) Jiawei Lizhong Dihuang Tang (Modified Regulate the Middle and Rehmannia Decoction)

Shudi (Rehmanniae Radix Preparata) 5 qian; Jiao Baizhu (Atractylodis Macrocephalae Rhizoma Carbonisatum) 3 qian; Danggui (Angelicae Sinensis Radix), Dangshen (Codonopsis Radix), Zhi Huangqi (Astragali Radix Preparated), Guzhi (Psoraleae Fructus, stir-fried and crushed), Zaoren (Ziziphi Spinosae Semen, stir-fried and crushed), Gouqi (Lycii Fructus) each 2 qian; Pao Jiang (Zingiberis Rhizoma Preparatum), Yurou (Corni Fructus, pits removed completely), Zhi Cao (Glycyrrhizae Radix et Rhizoma Preparatum), Rougui (Cinnamomi Cortex) each 1 qian; Shengjiang (Zingiberis Rhizoma Recens) 3 slices; Hongzao (Jujubae Fructus) 3 pieces (split); Hutao 2 pieces (kernel only, crushed) as guide drugs. Use Zaoxintu (substituted with stove-pit soil) 2 liang to boil water for decocting the herbs. Extract one teacup of concentrated juice, add Fuzi (Aconiti Lateralis Radix Preparata) 5 fen, decoct in water, and mix in. Administer based on the child's age, divided into several doses.

If cough persists, add Bieke (Papaveris Pericarpium) and Jinyingzi (Rosae Laevigatae Fructus) each 1 qian. If high fever persists, add Sheng Baishao (Paeoniae Radix Alba) 1 qian. If diarrhea persists, remove Danggui and add Dingxiang (Caryophylli Flos) 7 grains. After two or three days, use only 2-3 fen of Fuzi. Since Fuzi is strongly hot, it should be discontinued once the disease is addressed. Excessive use of Fuzi causes constipation and urinary retention. Absence of Fuzi leaves deep cold in the viscera, causing stubborn stagnation. If the infant suffers from extreme deficiency-cold, using 1-2 qian of Fuzi is acceptable. If the infant merely has persistent diarrhea, slight convulsions, and can still take medicine and breastfeed with normal bowel/bladder function, Zhuhan Dangjing Tang is not strictly necessary; one dose of this formula alone will stop the wind and clear the spirit. If the infant has not yet developed full chronic convulsion but exhibits lethargy and fever, or intermittent fever, quietness by day and fever by night, this formula is suitable. For newly ill, robust infants with red eyes and thirst indicating excess fire, temporary clearing and resolving methods may be used. However, true excess fire presents with constipation, robust qi and voice, and a preference for cold water. Vomiting and diarrhea together rule out excess fire. If ineffective after one dose in a state of extreme deficiency, larger doses and repeated administration are advisable. Tian Diao Feng (Heaven-Hanging Wind) and Man Pi Feng (Chronic Spleen Wind) mentioned in texts refer to this syndrome.

Note: Regarding the modification for persistent diarrhea in the original formula, only Dingxiang is added without removing Danggui. However, Danggui promotes intestinal lubrication and is unsuitable for persistent diarrhea. If Danggui is removed, the yin-nourishing capacity decreases; thus, increase Shudi (Rehmanniae Radix Preparata) by 1-2 qian. (If diarrhea persists despite medication, use Gaolishen (Codonopsis Radix Koreanensis) 2 qian, powdered, and administer in divided doses with the decoction; diarrhea will cease.)

Chronic convulsion can be diagnosed not only by physical signs but also by pulse. My clan nephew XX, at age seven or eight, suddenly experienced alternating vomiting and diarrhea after recovering from malaria. Cholera was prevalent at the time, and his family suspected cholera. His pulse was wiry, thin, and slow, with no obstruction in any of the six positions. I stated: This is not cholera. Is there sticky phlegm in the vomit and stool? His family replied it occurred occasionally. I said: This is cold-phlegm binding the chest, rejecting food intake, signaling impending chronic convulsion. One dose each of Zhuhan Dangjing Tang and Jiawei Lizhong Dihuang Tang cured him.

Furthermore, while these two decoctions are highly effective for chronic convulsion, prevention is the complete strategy. An infant of five or six years old consumed fruits and melons excessively as meals during the transition from summer to autumn. By late autumn, his movements were sluggish, often sitting on the ground while walking. I observed this and earnestly warned his family: This is a precursor to chronic convulsion. Infantile chronic convulsion is extremely dangerous, but treatment at this stage is easy; two or three doses of medicine would prevent disaster. The family dismissed my advice. By early winter, the manifestations of chronic convulsion appeared: vomiting prevented food intake, and treatment was delayed. After half a month of procrastination, the condition became critical, and treatment began, but medications failed.

Another case resembled acute convulsion but had an etiology closer to chronic convulsion. An eleven or twelve-year-old boy suffered throat ulceration. A physician applied throat powder, curing it in days. Suddenly, he exhibited body rigidity, limb convulsions, and unconsciousness, waking intermittently several times a day. His pulse was very slow and soggy. He reported no internal cold sensation but feared cold foods. His respiration seemed short. Despite it being midsummer, his fear of cold combined with the pulse and symptoms confirmed cold-phlegm coagulation and meridian blockage. I administered Bainong Tang (White Connecting Decoction) from *Shanghan Lun*, which cured him in one dose.

I treated another five-year-old child who, after taking Zhuhan Dangjing Tang, could eat but suffered severe slippery diarrhea. Subsequent administration of Jiawei Lizhong Dihuang Tang (two doses in one day) failed to stop the diarrhea; even the ingested medicine was expelled. I switched to a large piece of Red Gaolishen (Codonopsis Radix Koreanensis), powdered, and boiled 6 qian of raw Huai Shan Yao (Dioscoreae Hypoglaucae Rhizoma) into porridge, mixing in slightly more than 1 qian of the ginseng powder. Administered three times daily, the diarrhea stopped. The next day, I continued this formula but added 6 fen of the Western enzyme "Bromelain" (Bubusheng) to the porridge to prevent bloating. After three days of this regimen, the illness resolved completely.

I also treated an infant under one year old who vomited immediately upon breastfeeding, expelling all administered medicines. The fontanelle was sunken, and eyes opened during sleep, indicating impending Spleen Wind. I instructed placing a pinch of finely powdered Sheng Liuhuang (Sulfur) in the infant's mouth during each feeding, washed down with breast milk. Vomiting gradually decreased, and full recovery occurred within ten days.