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This condition is more severe than Ke Wu (Guest Intrusion, a disease caused by sudden exposure to strange or hostile energies). Ke Wu involves merely the improper qi of outsiders or animals, whereas Zhong E (Sudden Poisoning by Evil Qi) involves poisoning by toxic evil qi. For instance, old coffins, abandoned graves, illicit shrines, ancient trees, desolate temples, dry wells, ruined houses, and dark ditches all harbor toxic evil qi. When children encounter these, the pathogen enters through the nose; the Lung (Zang organ governing respiration and qi) is affected first, blocking the clear orifices and filling the chest. This results in sudden collapse, cold limbs (Jue Ni), clenched fists, and rapid, labored breathing.

Additionally, there are cases where one contracts the disease by ingesting toxic substances, also termed Zhong E. Examples include poisonous mushrooms, grass toxins, pufferfish, cattle or horses that died from plague, livestock that died naturally, as well as water frogs, shrimp, and clams. The pathogen enters through the mouth, affecting the Stomach and Intestines. Consequently, the patient experiences stabbing pain in the heart and abdomen, bluish-black discoloration of the abdominal skin, and extreme restlessness bordering on death. For both the preceding case (inhalation of evil qi) and this case (ingestion of toxic matter), Pi Li San (Thunderbolt Powder) should be applied to the nostrils to induce sneezing, thereby expelling the toxic vapors. Only after this should medicinal treatment proceed. For death caused by inhaling toxic vapors, Fan Hun Tang (Resurrection Decoction) is used; for death caused by ingesting toxic substances, Xiong Huang Jie Du Wan (Realgar Detoxification Pill) is used to purge the toxin.

Pi Li San (Thunderbolt Powder): Treats sudden death from Zhong E and all sudden, acute conditions.
Zhu Ya Zao (Gleditsiae Sinensis Fructus Spina, 3 fen), Bei Xi Xin (Asari Radix et Rhizoma, 5 fen), Da Chuan Xiong (Ligusticum Chuanxiong Rhizoma, 5 fen, aromatic variety), Bai Zhi (Angelicae Dahuricae Radix, 5 fen), Zhi Zhu Hua (Daphne Genkwa Flower, 0.5 fen), Ming Xiong Huang (Realgar, 2 fen), Zhen She Xiang (Moschus, 0.5 fen).
Grind all ingredients into an extremely fine powder. Use a small amount, dip a three-cun long lamp wick into the powder, and apply it inside the nostrils. Induction of sneezing indicates efficacy.

Fan Hun Tang (Resurrection Decoction): Treats sudden death from Zhong E; this formula serves as the primary treatment. It is essentially Zhang Zhongjing's Ma Huang Tang (Ephedra Decoction). Since toxic vapors block the lung orifices, this formula is used to open them.
Jing Ma Huang (Ephedrae Herba, de-stemmed, 2 qian), Guang Xing Ren (Armeniacae Semen Amarum, peeled, 7 seeds), Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Preparata, 1 qian), Cong Bai (Allii Fistulosi Bulbus, 3 cun).
Boil one cup of water until half remains. Administer in divided doses.

Xiong Huang Jie Du Wan (Realgar Detoxification Pill): See Volume II, under the section for convulsive sores and ulcers.

Another category is "Fei Chu" (Non-Convulsion), which refers to Man Jing Feng (Slow Convulsion Wind) and Man Pi Feng (Slow Spleen Wind) in pediatrics.
Note: Pediatric texts state, "Acute Convulsion transmits to Slow Convulsion; Slow Convulsion develops into Slow Spleen." Slow Spleen is a syndrome of pure Yin deficiency. However, Slow Convulsion may also present with deficient heat, often accompanied by constipation, phlegm obstruction, and qi stagnation, leading to misdiagnosis as excess heat. Practitioners may recklessly use Ba Dou (Crotonis Fructus) and Da Huang (Rhei Radix et Rhizoma) to purge phlegm and stool, or mistakenly administer Nao Bing (Borneolum Syntheticum) and She Xiang (Moschus) to open orifices and cool the viscera. This exacerbates Yin and weakens Yang further. If the child survives, they develop this condition. Another name for this is "Xu Feng" (Deficient Wind), caused by prolonged vomiting and diarrhea allowing wind pathogens to enter the intestines, resulting in fecal incontinence, sallow complexion, exhaustion of Spleen Qi, depletion of True Yuan (Original Qi), followed by fever. This constitutes Slow Spleen Wind. This does not necessarily result from the transmission of Acute Convulsion; in males, it is more severe when acquired via diarrhea, and in females, via vomiting. Symptoms include a cyanotic face, short tongue, head drooping, eyes closed, protruding tongue, teeth grinding, low voice, head shaking during sleep, slight twitching of limbs, coldness without retraction, alternating body temperature, stagnant saliva, coma, and excessive sleepiness. At this stage, dispelling wind finds no wind to dispel, and treating convulsion finds no convulsion to treat. These are critical signs; only one or two out of ten may survive. The general treatment principle is: nourish the Stomach and Spleen, restore Yang and benefit will, calm the Heart and stabilize the spirit, resolve phlegm and regulate qi. If the eyes are half-open/half-closed, hands and feet are not cold, and urination/defecation are difficult, there are still signs of Yang; mild methods to resolve phlegm and regulate qi should be used, avoiding immediate restoration of Yang. However, cooling herbs should not be used simply because Yang signs appear. This is merely fluctuating deficient fire mimicking Yang excess. Such is the pediatric discourse.

I find these discussions verbose yet self-contradictory and riddled with errors, leaving me only to sigh deeply. I never expected pediatric medicine to be so inferior! If Slow Spleen is recognized as a pure Yin syndrome, how can one mistake the deficient heat of Slow Convulsion for excess heat, wrongly purging phlegm and opening orifices, thus causing Slow Spleen? Furthermore, in cases of prolonged vomiting/diarrhea with wind entering the gut, fecal incontinence, sallow face, exhausted Spleen Qi, depleted True Yuan, and subsequent fever—clearly Slow Spleen—one should urgently rescue True Yuan and sustain impending collapse. How can one claim Yang signs exist based on half-open eyes, warm limbs, and difficult excretion, thereby refusing immediate Yang restoration? Alas, such basic principles remain unclear, yet practitioners wish to leave writings for posterity! Half-open eyes signify "Hun Shui Lu Jing" (Sleeping with Exposed Eyes), indicating severe damage to both Spleen and Stomach, a sign of extreme depletion, not excess. Limbs are the root of Yang; they should always be kept warm. Warm limbs indicate a faint thread of Yang remaining, preventing full Jue Ni (cold extremities); this is not a Yang excess syndrome. Difficult excretion here results from damaged Qi and Blood, withered Large Intestine, and lack of lubrication, unlike excess internal constipation. With proper treatment, these conditions can be reversed. Yet, labeling them as Yang excess and treating with qi-regulating and phlegm-resolving herbs implies that half-open eyes, warm limbs, and difficult excretion are truly signs of Yang heat excess? Or are they due to phlegm stagnation? If so, what is the purpose of resolving phlegm and regulating qi? Alas, pediatric knowledge is so shallow as to be irredeemable! Whenever children have heat, whether exterior or interior, deficient or excess, floating Yang causing heat, or extreme Yin causing restlessness, it is indiscriminately labeled as Yang Fire. In Slow Spleen, the heat stems from a pure Yin syndrome where True Yang is forced outward, floating on the surface and dissipating without return. Death is imminent. Urgent consolidation and gathering of Yang is required, yet it is mistaken for Yang excess. Must one wait for cessation of breath, closed eyes, ice-cold limbs, and uncontrolled excretion to recognize Yin? Practitioners with such views ensure their successors follow suit. Therefore, I name these conditions "Fei Chu" (Non-Convulsion), urging practitioners to focus solely on rescue without speculation or detailed differentiation. I cite Xia Yuzhu to clarify these errors, proving my words are not baseless.

Xia Yuzhu states: People often speak of "Slow Convulsion," but I call it "Slow Syndrome." This condition usually arises after severe illness. Quack doctors, seeing recovery, neglect post-recovery care. Initial errors in sweating or purging, combined with prolonged vomiting/diarrhea causing extreme Spleen/Stomach deficiency, lead to Slow Syndrome. Although "Slow" contrasts with "Fast," the cause often lies in parental negligence. Allowing profuse sweating, persistent vomiting, or chronic diarrhea leads to loss of Yang from sweat, loss of Stomach Qi from vomiting, and exhaustion of Spleen from diarrhea, creating incurable conditions. Hence, "Slow Syndrome." Where is the "Convulsion"? Labeling it "Convulsion" occurs because quacks see eye-rolling, hand twitching, and fist-clenching, resembling convulsions. Treating it as such—via massage or moxibustion—is like pushing a child down a well and dropping stones. Slow Syndrome is Spleen Deficiency. Eyelids belong to the Spleen; Spleen failure prevents tight closure, causing exposed eyes during sleep. Deficiency causes loss of Spleen Yuan Qi, leading to dull, wandering eyes. Spleen failure loses control over fluids, causing stagnant saliva to obstruct the throat with a rattling sound. Limbs are governed by Spleen/Stomach; their failure causes cold extremities. Deficiency generates cold, leading to green stools and clear urine. These confirm Slow Spleen. Treating for convulsion finds none; dispelling wind finds none; resolving phlegm finds none; clearing heat finds none. Only dry phlegm and deficient heat fluctuate in the Spleen. Treatment may involve Liu Jun Zi Tang (Six Gentlemen Decoction) with Pao Jiang (Prepared Zingiberis Rhizoma), or Li Zhong Tang (Regulate the Middle Decoction) with Fu Zi (Aconiti Lateralis Radix Preparata).

Xia’s insight surpasses common practice. He clarifies that Slow Convulsion and Slow Spleen are syndromes of exhaustion, rendering treatments for convulsion, wind, phlegm, and heat entirely inappropriate. This aligns with my own views. Here, I place Xia’s description of Spleen failure from vomiting/diarrhea first, followed by Zhang Jingyue’s account of sudden fright, under the "Fei Chu" category. This demonstrates that these conditions are not wind-convulsions, hopefully preventing futile cranial treatments and unnecessary harm. The above treatments strictly follow the original formulas of Xia and Zhang; I need not add further commentary.