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(Three Discourses, Thirteen Prescriptions, Twenty-six Moxibustion Methods)

Discourse states: The reason why infants and young children suffer from epilepsy (Xian Bing, 痫病) and tetanus/spasm (Jing Bing, 痉病) is all due to the imbalance of Zang-Fu Qi (Visceral Energy). Epilepsy occurring immediately after birth results from the failure of the Five Zang Organs (Five Viscera) to consolidate, the inability of Blood and Qi to gather, the stagnation of the Five Meridians, and skeletal weakness with incomplete development; such cases often fail to survive to adulthood. Epilepsy occurring between forty days and one year after birth is also caused by improper nursing and rearing, disharmony of Blood and Qi, and invasion of Wind Pathogen (Wind Evil). This condition initially presents with body heat, convulsions, startled crying, and shouting, followed by an epileptic seizure. A floating Pulse (Mai, 脉) indicates Yang Epilepsy (Yang Xian), where the disease resides in the Six Fu Organs (Six Bowels), manifests on the exterior skin and muscles, and is relatively easy to treat. Conversely, if the body is initially cold, without convulsions or crying, but the Pulse becomes deep during the attack, it is Yin Epilepsy (Yin Xian), where the disease resides in the Five Zang Organs, penetrates deeply into the bone marrow, and is extremely difficult to treat. When the body is soft and the child regains consciousness intermittently during an episode, it is called Epilepsy. When the body is rigid, arched backward like a bow, and does not regain consciousness, it is called Tetanus/Spasm. For those presenting with opisthotonos (backward arching of the spine), if the space under the adult's spine can accommodate a hand, or three fingers for a child, the condition is incurable. Generally, floating and deep Pulses are used merely to distinguish whether the disease is in the Yin/Yang or Exterior/Interior. Within these floating and deep categories, there are further variations such as large/small, slippery/choppy, empty/excess, and slow/fast signs; treatment must be tailored according to the specific pulse morphology.

The *Shennong Bencao Jing* (Divine Farmer's Materia Medica) states that there are one hundred and twenty types of infantile startled epilepsy. Their symptoms differ slightly from normal conditions, which constitutes the signs of epilepsy. Upon birth, when blood vessels have not yet consolidated and the Five Zang Organs are undeveloped, any slight impropriety in care will lead to illness. In infants who cannot yet speak or walk, diseases occurring after the meridian "Bian Zheng" (developmental fever stages) generally have mild symptoms, except for Wind Stroke (Zhong Feng, 中风), which is the most acute and sudden. If an infant's limbs are inactive, showing signs of startling and convulsions, with slight abnormalities in breathing, indicating impending epilepsy, or if symptoms persist after the Bian Zheng cycle is complete, Long Dan Tang (Gentian Decoction) is appropriate.

Generally, infantile epilepsy is divided into three types: Wind Epilepsy (Feng Xian), Startled Epilepsy (Jing Xian), and Food Stagnation Epilepsy (Shi Xian). However, Wind and Startled Epilepsies are common, whereas only one or two out of ten children suffer from them. Any case presenting with initial chills followed by fever is classified as Food Stagnation Epilepsy. Startled Epilepsy should be treated with moxibustion according to diagrams; Wind Epilepsy should be treated with Zhu Xin Tang (Pig Heart Decoction); Food Stagnation Epilepsy requires purgation, preferably followed by Zi Wan (Purple Pill). Infantile Wind Epilepsy occurs because excessive clothing causes sweating, allowing Wind Pathogen to enter. Initially, Wind Epilepsy presents with finger flexion resembling counting, followed by an attack. Startled Epilepsy arises from fright, manifesting after loud crying. Mild cases of Startled Epilepsy can be stopped by holding the child urgently and preventing further fright. Cases where the infant refused milk, vomited, developed heat, and then had an epileptic seizure are Food Stagnation Epilepsy; early purgation leads to recovery. Si Wei Zi Wan Zhu Pi Yin (Four-Ingredient Purple Pill for Expelling Accumulation) is most effective, removing disease rapidly without damaging healthy Qi. Chi Wan (Red Pill)—note: originally absent from this text, see the first prescription in the "Accumulation and Distension" chapter; likely identical to the Cinnabar-colored Purple Double Pill—acts quickly and should be used for severe cases.

For infants unable to nurse, Zi Wan should be administered to purge. Newborns possess vigorous Sheng Qi (Vital Energy); even minor discomfort warrants purgation, causing no harm and yielding profound benefits upon recovery. Failure to purge promptly may lead to serious illness, which becomes difficult to treat once established. Among purgatives, Si Wei Zi Wan is superior; it removes disease without injuring the body. If Si Wei Zi Wan is unavailable, use Chi Wan. If ineffective, double the dosage. If residual heat remains after purgation, administer Long Dan Tang in small amounts according to the formula, and apply Chi Gao (Red Ointment) (see end of this chapter). Wind Epilepsy also requires purgation, specifically using Zhu Xin Tang. Startled Epilepsy requires only moxibustion per diagrams and application of Sheng Gao (Life Ointment) (see end of this chapter); strong purgation is contraindicated. Why? Because Startled Epilepsy involves unstable Heart Qi; purgation causes internal deficiency, exacerbating the condition. Severe Startled Epilepsy is particularly difficult to treat. Therefore, when raising children, one must guard against fright, avoid loud noises, and handle them gently to prevent terror. During thunderstorms, plug the child's ears and make soft noises to mask the sound.

In raising children, slight fright helps develop blood vessels, but severe fright must be avoided. If severe fright occurs, moxa should be applied to the Jing Mai (Startle Meridian/Vessels). Applying moxa at 50-60 days may worsen the startle response; it is beneficial only after 100 days of age. If a child has heat, refuses nursing, sleeps restlessly, and is frequently startled, this is the onset of epilepsy; Zi Wan will cure it, and should be repeated if necessary. If a child startles slightly while sleeping once a month, administer Zi Wan to reduce excess Qi and prevent epilepsy.

If a child falls ill after the Start of Summer (Li Xia), treatment must avoid arbitrary moxibustion and emetic/purgative methods. Instead, bathe with Chu Re Tang (Heat-Removing Decoction), dust with Chu Re San (Heat-Removing Powder) (see Shang Han section below), massage with Chu Re Chi Gao (Heat-Removing Red Ointment), and apply ointment to the umbilicus. Keep the child in a cool place, do not restrict water intake, and frequently offer fresh water.

If a child wears thin clothing, milk and food in the abdomen will not digest. Undigested food causes sour-smelling stools, indicating the beginning of Pi Ji (Accumulation/Mass). Immediately use Zi Wan for mild digestion aid. Administer starting with a small dose, maintaining loose stools without strong purgation. Gradually reduce the dose as stools become less loose; stop medication when stools no longer smell sour.

Infants falling ill in winter months are easier to manage than those in summer, but purgation is still necessary when indicated. Post-purgation abdominal distension is expected; thus, nursing should be moderated for several days. Avoid arbitrary purgation. Feeding amounts should follow a standard, increasing gradually as the child grows. If intake decreases, it indicates mild abdominal disharmony; administer mild medication and withhold solid food, offering only milk. For severe cases, withhold food for over ten days; for mild cases, five to six days. Normal feeding will resume. If the child refuses all food and desires only milk, it indicates significant Pi Ji requiring urgent purgation. Failure to purge may lead to alternating chills and fever, vomiting with epilepsy, or dysentery. These outcomes result from delaying treatment in severe cases, making them difficult to cure. Early intervention prevents depletion and ensures rapid recovery.

Yellow, foul-smelling stools indicate latent heat in the abdomen; mildly administer Long Dan Tang. White, sour-smelling stools indicate retained undigested food; administer Zi Wan. For mild cases, give a small dose to resolve internally; for severe cases, slightly increase the dose for mild purgation. Moderately restrict nursing for several days to restore Stomach Qi harmony. Failure to moderate nursing leads to recurrence; subsequent purgation damages Stomach Qi, causing abdominal distension. Repeated purgation is tolerable up to a point, but excess causes injury.

If an infant has Pi Ji and the Pulse is large, epilepsy will likely ensue; this is Food Stagnation Epilepsy, cured by purgation. Carefully examine the palm and three-finger pulses; they should not rise. Failure to purge promptly leading to epilepsy makes treatment difficult. Early purgation prevents the pulse from rising. If the pulse is confined to the palm, early treatment is viable; if it extends to the fingertips, the disease has worsened.

When pathological factors arise in the infant's abdomen, alternating chills and fever occur. This agitates the blood vessels, destabilizing Heart Qi. Unstable Heart Qi leads to susceptibility to fright, which triggers rapid onset of epilepsy.