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There are causes originating from external factors. For instance, when fever arises from contracting wind-cold or warm-damp pathogens, one should immediately employ dispersing and harmonizing methods to eliminate the heat. If neglected and untreated, severe heat may trigger convulsions; this is a disease caused by external factors. It is appropriate to treat with Daochi San (Coptis Decoction) and Xieqing Wan (Drain the Liver Pill).

There are causes originating from internal factors. For example, when fever results from dietary injury, one should immediately employ digestion-promoting and purgative methods, such as Baohe Wan (Preserve Harmony Pill) or Sanhuang Zhizhu Wan (Three-Yellow Atractylodes and Immature Bitter Orange Pill), to eliminate the heat. If neglected and untreated, severe heat may trigger convulsions; this is a disease caused by internal factors. One must observe the condition of urination and defecation. If stool is obstructed, first remove the retained food stagnation using Muxiang Binglang Wan (Costus and Areca Nut Pill) or bile enema method. If stool is moistened, treat with Chensha Wuling San (Cinnabar Five-Ingredient Powder) or Hupo Baolong Wan (Amber Protect Dragon Pill).

There are causes neither purely internal nor external. These arise from fright or shock, or from "Ke Wu" (alien influence) and "Zhong E" (sudden evil invasion). The Heart stores the Shen (Spirit); fright injures the Shen. The Kidney stores the Zhi (Will) and Jing (Essence); fear injures the Jing. The Classics state: "That which accompanies the Spirit and goes forth and returns is called Hun (Ethereal Soul); that which enters and exits with the Essence is called Po (Corporeal Soul)." Therefore, if the Shen is injured, the Hun scatters; if the Jing is injured, the Po dissipates. Children have weak Shen and Zhi; sudden fright causes mental chaos, flying Hun and Po, rebellious Qi, and phlegm accumulation, leading to convulsions. Ke Wu and Zhong E occur unexpectedly; even adults are startled, let alone children. One should first resolve the phlegm using Chensha Gao (Cinnabar Paste), then calm the Shen using Hupo Baolong Wan. If there is heat, use Dongyuan Anshen Wan (Dongyuan's Spirit-Calming Pill). Be cautious not to use heavy-calming or purgative drugs like Qingfen (Calomel) or Badou (Croton Seed), lest they damage Yuan Qi (Primal Qi) and harm the Spleen and Stomach, potentially killing the child.

Qian's Baolong Wan: Treats pediatric wind-phlegm, lethargy due to severe heat, and acute convulsions.
Xionghuang (Calcined Realgar, 4 qian), Tianzhuhuang (Heavenly Bamboo Slime, 4 qian), Danning (Fried Phlegm-resolving Star, 8 qian), Zhusha (Water-triturated Cinnabar, 4 qian), Shexiang (Musk, 3 fen). Grind into powder, mix with licorice paste to form pills the size of an euryale seed. Administer dissolved in mint decoction.

Chensha Gao: Used to unblock Heart Qi.
Zhusha (Calcined Cinnabar, 1 qian), Yaxiao (Saltpeter, 2.5 qian), Xionghuang (Calcined Realgar, 2.5 qian), Shexiang (Musk, 1 zi), Jinbo (Gold Leaf, 15 pieces), Yinbo (Silver Leaf, 15 pieces), Baifuzi (Aconitum heterophyllum, 3 qian), Zhike (Stir-fried Aurantium, 3 qian), Chuanxiong (Ligusticum, 4 qian), Baifuling (Poria, 4 qian), Renshen (Ginseng, 2 qian), Huanglian (Coptis, 2 qian), Yuanzhi (Polygala, 2 qian). The first six ingredients are separately ground; the latter seven are mixed into powder. Form honey pills the size of an euryale seed. Take one pill per dose, dissolved in Ophiopogon decoction. This is a modification of Zhusha Gao.

Question: Severe heat generates phlegm; severe phlegm triggers convulsions. Qian Yi used Lijing Wan to purge phlegm, and Chen Shi used Xiongxie San to induce vomiting for phlegm. Are these acceptable?
Answer: Medicinal formulas are not rigid; they are applied according to appropriateness. For robust children, emetic and purgative methods may be used until the illness ceases. For weak and timid children, do not act rashly, lest you damage Yuan Qi. Generally, if phlegm obstructs the throat, preventing food and medicine intake, emesis is indicated. This follows the principle of "treating disorders above by inducing vomiting." Use equal parts of Jiangcan (Bombyx Batryticatus) and Yazao (Gleditsia Sinensis, roasted) ground into powder. Take a small amount, administer natural juice of Tu Niuxi (Achyranthes root) to induce vomiting. After vomiting, administer phlegm-purging drugs such as Wuse Sanhuang Wan (Five-Color Three-Yellow Pill), Mengshi Gun Tan Wan (Mengshi Rolling Phlegm Pill), or Chensha Gao.

Chensha Gao: Excellent for purging phlegm.
Fei Chensha (Calcined Cinnabar, 3 qian), Pengsha (Borax, 1.5 qian), Mayaxiao (Saltpeter, 1.5 qian), Xuanmingfen (Mirabilite, 2 qian), Quanxie (Scorpion, de-toxicated, 1 qian), Zhenzhu (Pearl, 1 qian), Shexiang (Musk, 1 zi). Mix into powder, wrap in oiled paper to naturally form a paste. Use about one grain per dose. For general convulsions, take with mint decoction; for fetal convulsions, mix with breast milk and jujube decoction.

When I first studied medicine, I treated a two-year-old child who died of convulsions. The family summoned me, weeping bitterly. I stopped them and told the father: "The child's complexion has not changed, and hands and feet are not cold. This is Qi stagnation and phlegm obstruction causing syncope, not true death." I moxa small cones on the Zhongchong points (PC 9) of both hands. As soon as the fire touched the skin, the child woke up and cried loudly. The parents were delighted. I then used a family-prescribed formula for calming convulsions: fifteen pills of Xionghuang Jiedu Wan (Realgar Detoxification Pill) to drain phlegm, and twenty-five pills of Liangjing Wan (Cool Convulsions Pill) to clear heat, taken together with mint decoction. Shortly after, yellow sputum was purged, and convulsions ceased. Upon my return, the father asked what medicine produced such rapid effect. I explained everything. The father said to his wife: "I have my son back."

A child suffered from convulsions and phlegm obstruction. A physician used Baibingzi (White Cake Pill) to purge, but it failed. After three purgations, the condition worsened: eyes closed, lethargic, no crying or suckling, barking breath, upper body panting, and occasional fecal incontinence. I said: "The Qi of the five Zang organs is exhausted; the disease is incurable. This resulted from excessive purgation." The physician replied: "Baibingzi is Qian Yi's divine formula for draining phlegm." I said: "To believe books entirely is worse than having no books. Qian Yi's pediatric theories were largely fabricated by his disciples. Phlegm in humans is like sap in trees. In extreme heat, plants exude sap; thus, phlegm arises from heat. This is evident. Phlegm is like water, moving with Qi. Flowing through the nose or accumulating in mountains is not its nature but forced by agitation. Now phlegm rises with fire. Instead of descending fire, you purged downward, damaging Stomach Qi. Once Stomach Qi fails, all five Zang organs are damaged. Closed eyes indicate Liver exhaustion; lethargy and refusal to suckle indicate Spleen exhaustion; inability to cry indicates Heart exhaustion; panting and rattling phlegm indicate Lung exhaustion; incontinence indicates Kidney exhaustion." The child indeed died.

A scholar-physician in the county had unique prescriptions but was too stubborn and inflexible. When a child presented with convulsions, I diagnosed acute wind-stroke and prescribed cooling and purging methods, specifically Daochi San and Xieqing Wan. He argued that wind-stroke results from constrained Liver Fire and prescribed Xiao Xuming Tang (Minor Continuation of Life Decoction) to disperse constraint. People could not decide. Both treatments were attempted. My patient recovered in one day; his patient died. He regretted not believing me, but it was too late.

A child had convulsions, which stopped after massage therapy. Later, the condition became critical. I said: "Massage is a remnant of acupuncture and moxibustion techniques. The Classics state: 'Do not needle those with extreme deficiency.' Massage for convulsions is suitable only for robust children. For weak children, Qi does not flow freely; massage induces sweating and damages Yuan Qi." The family ignored my advice. I predicted: "If not dead, he will develop epilepsy." Half a month later, he died.

A child had convulsions, temporarily controlled by massage. One month later, it recurred. Massage was repeated. Frequency varied from once to twice a month. I said: "This has become epilepsy. Massage releases the exterior. Phlegm is集聚 in the Heart and cannot exit. Early-stage epilepsy is treatable; chronic cases are incurable lifelong ailments." I formulated Sese Duanxian Wan (Four-Color Epilepsy-Cutting Pill):
Huanglian (Coptis, 5 qian), Fei Zhusha (Calcined Cinnabar, 2.5 qian), Danning (Phlegm-resolving Star, 1 qian), Baigansui (White Kansui, 3 fen). Grind into powder, bind with millet paste and pig heart blood. Form pills the size of an euryale seed. Take one pill per dose, dissolved in Jiedicao (Plantago) decoction. Take three times at night, once during the day. The child recovered.

In the second month of Guihai year, the former magistrate of Yingshan County, Mr. Wu, had a son with convulsions. His doctor used Erchen Tang (Two-Aged Decoction) with ginger juice and bamboo sap, without effect. Mr. Wu had previously met me in Luotian. An official messenger invited me. I examined the child: blue veins visible on the three gates, red cheeks, fixed gaze, fingers moving as if picking something. I said: "This is due to external pathogenic factors not being dispersed, allowing heat to enter the interior. Qian Yi stated: Heat in the Liver causes fixed gaze; Heat in the Heart causes convulsions. Red cheeks and fixed gaze predict wind-stroke. Children often have excess Liver Wood, especially during peak Wood seasons. We must drain the Liver. Erchen Tang contains Chenpi, Banxia, and Shengjiang, which are acrid and assist the Liver. The Classics say: 'Acid nourishes, but acrid tonifies [Liver].' Hence, it was ineffective." I prescribed Xieqing Wan to drain excess Liver Qi and Daochi San to drain Heart Fire. One dose stopped the convulsions. Mr. Wu joyfully told his subordinates: "Different views yield different effects. You were right to trust him; truly a good physician. I felt confident when you arrived, and now I am relieved." Observing his congenital weakness and weak Spleen/Stomach, fearing future convulsions turning into epilepsy, I prescribed Hupo Wan (Amber Pill) for long-term maintenance.

Xu Shudao from Shayang, Qishui, had a son with wind-stroke. He first sought treatment from a Dr. Zhang, with no improvement over several days. I was summoned. The child had urgent phlegm-wheezing and convulsions. I treated the phlegm first, then the convulsions, resolving the issue sequentially. However, body heat remained high. Dr. Zhang wanted to use Jiedu Tang, Zhuye Tang, or Xiao Chaihu Tang. I refused, stating: "Children often have excess Liver and deficient Spleen. Disease originates in the Liver; Wind-Wood is too vigorous, injuring Spleen-Earth. This is deficiency heat. Do not use cold-cooling herbs that damage Middle Qi." I prescribed Sijunzi Tang (Four Gentlemen Decoction) plus Zhi Huangqi (Prepared Astragalus) and Chao Hei Ganjiang (Stir-fried Black Ginger). One dose brought peace.

A five-year-old child cried in fear in dreams, clinging to his mother. This was caused by fright. I formulated a prescription: Renshen (Ginseng), Maidong (Ophiopogon), Baifuben (likely Poria, text error for Baifuling?), Huanglian (Coptis), Suanzaoren (Ziziphus Seed), Baiziren (Biota Seed), Zhi Gancao (Prepared Licorice), Zhusha (Cinnabar), all in equal parts. Half decocted in water; half mixed with Dihuang (Rehmannia) and Zhi Gancao into powder, bound with Yam flour into pills the size of millet seeds. Take 25 pills per dose with Plantago decoction. The child recovered before finishing the course.

A one-year-old child had fever and convulsions. Xieqing Wan was ineffective. I asked about the convulsion characteristics. The mother said: "After convulsions, the child sleeps well. Drinks milk if offered, refuses if not. When awake, makes cat-like sounds, smiles at people. Without convulsions, appears normal." I said: "Physicians must recognize patterns and match medicines. No wonder previous medicines failed." I prescribed Daochi San. One dose cured the child. The father asked why. I said: "The Heart belongs to Fire, and its sound is laughter. Fire is born in Yin, associated with the Tiger. Cats are related to tigers. Cat sounds and laughter indicate Heart pathology, not Liver. Thus, I drained Heart Fire with Daochi San." Listeners were convinced.