Library

Observe the physical form and facial complexion to distinguish the etiology: when Yin is weak and Yang is strong, the body may exhibit stiffness or flaccidity; if it is Taiyang disease (disease of the Taiyang channel), the feet will be cold, and to determine if there is heat, one must examine the abdomen. A cold nose indicates variola or smallpox eruptions; cold ears indicate wind-heat syndrome; general body heat indicates Taiyang disease; upper body heat with lower body coldness indicates heat injury.

Cold fingertips suggest convulsions that are difficult to control; warmth in the middle finger indicates Taiyang disease; coldness isolated to the middle finger suggests measles or smallpox; for females, observe the right hand, and for males, the left hand, examining clearly and carefully.

A red face indicates wind-heat; a green face allows for detailed diagnosis of convulsions; symptoms of the Heart and Liver manifest here, distinguished by pulse and symptom patterns as warm or cold syndromes. Spleen deficiency presents with jaundice, infantile malnutrition (Gan syndrome), and abdominal distension due to deficiency-cold. The appearance of black qi indicates Kidney failure and impending death.

For children under three years old with illness, inspect the Three Passages on the Tiger's Mouth of the male left or female right hand. Viewing from the side of the second finger, the first segment is the Wind Passage, the second is the Qi Passage, and the third is the Life Passage. Distinguish the color of the veins: purple indicates heat, red indicates cold, green indicates convulsions, white indicates Gan syndrome, black indicates evil invasion, and yellow indicates Spleen distress. Appearance at the Wind Passage signifies mild condition; at the Qi Passage, severe condition; extending beyond the Life Passage indicates a difficult-to-treat case.

Purple, black, and red indicate Taiyang disease; green indicates convulsions; white indicates Gan syndrome; black results from evil invasion; yellow indicates Spleen distress.
Furthermore: Green curves of varying sizes indicate human fright with four-limb convulsions; red curves indicate attacks by water/fire birds; purple curves indicate food injury from rice, flour, meat, or fish; black curves indicate slight spasms from Spleen wind.

(Attachment: Slow Spleen Wind)
Summary: Sudden facial redness, whole-body heat, black lips, jaw clenching with breath nearly ceased; eyes rolling up, convulsions with throat sounds; this is acute convulsion, easy to diagnose.
Furthermore: In deep diseases of Yin deficiency and Yang excess, after vomiting and diarrhea, sleep is accompanied by upward eye deviation; unconsciousness, slow convulsions, and profuse salivation clearly indicate slow convulsion.
Pulse Method: Floating, rapid, full, and tight pulses indicate acute convulsion; sinking, slow, scattered, and relaxed pulses indicate slow convulsion. Green-purple veins on the Tiger's Mouth indicate convulsion; veins curving inward are favorable (Shun), while those curving outward are unfavorable (Ni).
The *Medical Outline* states: Convulsion is one symptom, but differs by morning/evening and interior/exterior. Body heat with strong force indicates acute convulsion; body coldness with weak force indicates slow convulsion. Falling with sound and foaming upon waking indicates epilepsy; head and eyes looking upward indicates "Heavenly Hanging" (Tian Diao); opisthotonos indicates spasm, each treated differently.

Inspecting the vein morphology: Blue-black like a hanging needle at the Wind Passage indicates Water Fright, easy to treat; red like a hanging needle at the Qi Passage indicates Gan syndrome with Lung heat accumulation, still treatable; any such vein at the Life Passage, regardless of color, indicates a critical condition. If all three passages show a vein like a hanging needle, it indicates slow convulsion, difficult to treat; blue like a fish spine at the Wind Passage is easy to treat, indicating initial fright; black is difficult to treat; blue like a fish spine at the Qi Passage indicates Gan consumption with body heat, easy to treat; blue like a fish spine at the Life Passage indicates deficient wind transmitting to the Spleen, difficult to treat. Blue across all three passages indicates Four-Limb Fright; red indicates Water Fright; black indicates Human Fright.

Convulsion has four syndromes and eight signs. The four syndromes are: Fright, Wind, Phlegm, Heat. The eight signs are: Twitching (Chu), Grasping (Nuo), Jerking (Che), Trembling (Chan), Reversal (Fan), Drawing/Stretching (Yin), Staring (Cuan), and Gazing (Shi). Twitching refers to extension and flexion of hands; Grasping refers to opening and closing of fingers; Jerking resembles wrestling; Trembling refers to head tilting; Reversal refers to hands bending backward; Drawing refers to arms like a drawn bow; Staring refers to fixed, angry gaze; Gazing refers to exposed, unresponsive eyeballs. When the four syndromes exist, the eight signs arise. Without the four syndromes, how can the eight signs exist?

Acute convulsion with three or two loud cries indicates Heart Qi exhaustion, difficult to treat. Acute convulsion with flaccid limbs is untreatable; acute convulsion with nasal bleeding indicates dispersing heat, easy to treat; oral bleeding is difficult to treat. Constipation is easy to treat; enuresis/incontinence is difficult to treat; straight black lines at the junction indicate death.

Limb coldness and incontinence of urine/feces are treated with formulas to warm the Stomach and restore Yang. If treatment fails, it is deemed untreatable. I have treated such cases successfully; do not declare them untreatable solely based on these symptoms.
The *Inner Canon* states: All wind-induced tremors and dizziness belong to Liver Wood. Children are pure Yang bodies; their True Water is not yet robust, while Heart Fire flares. Lung Metal is constrained and cannot pacify Liver Wood, so Liver Wood is often in excess, and Spleen Earth is often deficient. Parents may neglect care, exposing children to wind or heat, or allowing excessive spicy food and thick clothing, causing pathogenic heat to stagnate in the Heart, transmit to the Liver, and be triggered by external fright. Before onset, sleep is restless, with laughing/crying during sleep, teeth grinding, sweating on nose/forehead, rapid breathing, and phlegm rattle. Suddenly, they become unconscious, eyes roll up, jaws clamp shut, and limbs convulse. This is due to extreme heat, distinguishable by red face and rapid pulse. Heart heat and Liver wind interact; wind moves, fire spreads with wind, two Yangs stimulate each other, wind and fire collide. Liver stores Hun (Ethereal Soul), Heart stores Shen (Spirit); heat agitates Hun and Shen, causing fright. Heart governs Shen and is not easily disturbed, but fright causes heat, which generates wind, leading to convulsions, named Acute Convulsion. Treat primarily with Kuanqi Yin (Broad Qi Decoction) and Sandie San (Three-Dispersing Powder) removing Ren Shen. For sudden onset without distinguishing Yin/Yang or Deficiency/Excess, first use Wuling San combined with Kuanqi Yin and a little Kuanre Yin, mixed and administered with ginger juice and boiling water. Generally, treating convulsions by broading Qi is optimal; smooth Qi stops convulsions, a natural law. I lament that many physicians, seeing convulsions, fail to distinguish root and branch, mixing them into one syndrome, and hastily using large doses of cold herbs like minerals, borneol, musk, centipede, silkworm, snake, and scorpion to search out wind. This depletes true Qi and worsens symptoms, often leading to death. They do not know that Fright arises from Heart, Wind from Liver, and Convulsion begins with Qi. These are three distinct aspects. Fright and Wind were detailed earlier. Convulsion begins with Qi: when Wind, Cold, Summer-heat, Dampness, Dryness, or Fire becomes disordered, it accumulates in the throat/pharynx, clashes with Heart/Lung, transmits to Liver Meridian. Qi cannot ascend or descend, fluids stagnate, phlegm-saliva obstructs, causing convulsions. Treat with Kuanqi Yin.

Diseases may appear similar but differ essentially, as I have experienced. Recently, a child had body heat, then fell stiff and unconscious, eyes upturned, lips twitching, resembling convulsion with continuous jerking. A physician treated for convulsion, but the child woke and convulsed repeatedly. Upon examination, I asked about fever history. The family reported intermittent fever previously, resolved by evening, normal yesterday, but fever returned this afternoon leading to convulsion. I diagnosed this as Malaria caused by retained food and stubborn phlegm obstructing the center, blocking Ying and Wei, with Evil and Righteous Qi attacking each other. Using mineral-based calming drugs would only aid fire. I advised withholding medication to avoid drug toxicity exacerbating the condition. By afternoon, symptoms lessened. I prescribed Erchen Tang plus Hawthorn, Maidong, Qingpi, Areca Nut, Pueraria, and Saposhnikovia. By next day, malaria manifested and other symptoms receded. After taking phlegm-resolving and exterior-releasing medicines for four doses, the child recovered.

One must understand the cause of illness. If the issue is Fright caused by Phlegm-Heat, only clear heat and resolve phlegm, and Fright will cease. If the issue is Wind caused by Fright, only benefit Fright and resolve phlegm, and Wind will disperse. If the issue is Phlegm-Saliva, urgently clear heat and resolve phlegm; if convulsions occur, use wind-interrupting and fright-calming methods, though this is often untreatable.
Dongyuan stated: For children with diarrhea and fright, first tonify Earth, then drain Wood. Signs of hyperactive Wind-Wood include a large, flooding pulse at the Right Guan position, heat in palms, and heat in the abdominal wall. I now prescribe Huang Yi Huang San. Ren Shen, Gan Cao, and Huang Qi in equal parts warm and tonify Spleen Earth, boost Yuan Qi, and Sweet flavor drains fire. The *Inner Canon* says: For heat rampant within, use Sweet to drain and Sour to astringe. Bai Shao is Sour-Cold, draining fire and Liver Wood while tonifying Lung Metal. This balances Metal and Wood; when Earth is robust, Fire becomes deficient. How does Wind-Wood attack Earth? First drain the pathogen. Excessive Fire strengthens Wood, causing Wood to attack Earth. Tonify the source of Earth with Sweet-Warm in the Heart Meridian; drain Fire with Sweet-Cold in Spleen Earth; tonify Metal with Sour-Cool. Thus, Metal becomes robust and Fire declines in Spleen Earth, making Wind-Wood naturally deficient.

Convulsions following Wind-Cold injury, with hot breath, yawning, irritability, and limb trembling, result from insufficient Qi and Blood unable to cope. Treat by releasing the exterior first, using Da Qing Gao.
Convulsions following Food Injury, with warm body, lethargy, vomiting, and anorexia, result from food stagnation causing Qi stagnation. First stop convulsions, add Qiang Huo and Fang Feng, administer Xie Qing Wan, then use Bai Bing Zi to purge food, followed by Yigong San to nourish Qi gradually.
Convulsions preceding Measles/Smallpox eruption, with warm body, lethargy, vomiting, and aversion to food, result from Heat affecting Heart, with Heart Fire flaming upward, causing eyes to roll up. Symptoms include cold earlobes, nose tip, and fingertips, sneezing, gritty eyes, and startle during sleep, differing only by lack of phlegm. Treat by pacifying Liver Wood and promoting urination. Pacifying Liver removes Wind; urination clears Heart Heat. Once Wind-Heat subsides, eruptions appear and convulsions cease. Use Dao Chi San plus Bai Shao, Fang Feng, and Jing Jie.
Convulsions after Smallpox result from Qi/Blood deficiency compounded by Wind-Cold-Heat-Toxin stagnation. Since exterior-releasing and clearing-draining methods are contraindicated, many are untreatable.
Children who jerk upon hearing sounds have insufficient Liver and Lung, with unsettled Hun and Po, leading to unstable Spirit, not necessarily Fright. Administer Xi Jiao Di Huang Wan.
Children with deficient Heart Qi and unsettled Spirit, accompanied by jerking, can take Si Jun Zi Tang with a little Chen Sha (Cinnabar).
Summer-Wind Syndrome, caused by severe Wind-Heat contraction in summer, presenting with dirty face, red lips, sinking-thin-rapid pulse, sudden convulsions, and unconsciousness, is treated with Xiao Shu Qing Xin Yin, Chen Sha Wuling San, and Bao Long Wan.

Slow Convulsion belongs to Yin; Yin governs stillness, hence slow convulsions. It may follow severe illness or mismanagement. Symptoms include slow eyes, unconsciousness, asymmetric limb movement, drooling, cold breath, sunken fontanelle, upward eye deviation during sleep, or half-open/half-closed eyes. This indicates depletion of True Yang and dominance of Yin-Evil. Yin excess generates Cold; Cold transforms to Water; Water generates Liver Wood; Wood transforms to Wind; Wind attacks Spleen Earth. Stomach is the腑 (Fu) of Spleen, so Wind arises internally, causing gradual spasms, shoulder shrugging, hanging arms, and constant trembling. Cases with sweating are untreatable. Zhongjing said: Yin conditions should not sweat. Yin conditions have no sweat; sweating indicates Yang collapse. Treatment varies. If caused by vomiting/diarrhea, use Lizhong Tang with Mu Xiang to warm the middle, and Wuling San to guide water. If caused by Cold-Fu diarrhea, first use Zhu Fu Tang. If caused by purging accumulated pathogens, first use Tiaoqi Tang to harmonize Spleen/Stomach. If caused by external Wind-Cold, use Guizhi Tang or Gegen Tang. Other cases can be inferred. Although Slow Convulsion is Yin, depending on depth, do not use purely warming or drying agents. Add wind-interrupting and convulsion-calming herbs like Quan Xie, Jiang Can, Bai Fu Zi, Tian Ma, and Nan Xing to formulas that stabilize Stomach Qi. For persistent vomiting, use Ding Tu Yin; for persistent diarrhea, use Liu Zhu San or Wuling San. If phlegm is abundant, lips are white, limbs are ice-cold, and consciousness is lost, restore Yang using Gu Zhen Tang quickly to generate Stomach Qi. Once Stomach Qi returns, use Xing Pi San for gradual regulation.

Signs of Slow Spleen Wind: Green face, forehead sweat, curled tongue, bowed head, closed eyes, shaking head and sticking out tongue during sleepy state, frequent vomiting of foul odor, locked jaw, grinding teeth, slight uncontrollable limb convulsions, cold or hot body, sinking-thin pulse. Following Slow Convulsion, vomiting/diarrhea damages Spleen; disease progresses to extremity, returning to deficiency, specifically affecting Spleen, hence called Slow Spleen. There is no Wind to expel, no Fright to calm; only phlegm-saliva and deficient heat circulate in Spleen. Closed eyes indicate Spleen distress, Qi exhaustion, coma, and phlegm obstruction, considered difficult to treat by the world. The key is generating Stomach Qi and restoring Yang, using Jin Ye Dan or Sheng Fu Si Jun Zi Tang酌情 (discretionarily). As Stomach Qi recovers, continue with Xing Pi San or Yigong San. If all medicines fail, if the Taichong pulse is present, moxa the Baihui acupoint.

Untreatable Acute Convulsion (oral bleeding, non-responsive to stimulation, occasionally some survive): Eyes rolling back, oral bleeding, hand waving, abdominal convulsions, or sluggish spirit touching body/searching clothes, or severe condition with unconsciousness and rapid breathing, inability to swallow medicine, non-responsive to stimulation, heart pain, sudden loud crying—untreatable.
Untreatable Slow Convulsion: Limb coldness, dark face, miserable spirit, crow-like voice, fish-mouth appearance, white ulcers in mouth, straight hair with head shaking, fixed eyes, soft neck/head, incontinence, unilateral limb traction—untreatable.
Untreatable Slow Spleen is the same.
Supplement:
When convulsions occur, allow them to subside naturally; do not restrain tightly, ensuring Qi flows smoothly. Otherwise, paralysis may result.
For Acute Convulsion, first interrupt wind and stop convulsions, then purge heat. Removing heat eliminates wind; removing wind stops convulsions. In Wind-Cold/Taiyang disease, extreme heat may not cause convulsions, only jaw clenching, resembling convulsion.
Children holding fists during convulsion have toxic phlegm in the chest. Observe male left, female right. For males, thumb inside is favorable; crossed fingers indicate bad prognosis. While not definitive, it is valid.