Library

Pediatric acute and chronic convulsions (Ji Man Jing Feng) were historically referred to as Yin epilepsy (Yin Xian) and Yang epilepsy (Yang Xian). Acute convulsions belong to the Yang category, characterized by excess Yang and deficiency of Yin. Chronic convulsions belong to the Yin category, characterized by excess Yin and deficiency of Yang. Yang is active and restless, while Yin is still and slow. Both conditions arise from the deficiency of Zang-Fu organs. Deficiency can generate fever; fever generates wind. Thus, wind originates in the Liver, phlegm in the Spleen, fright in the Heart, and heat in the Liver (with the Heart also affected). The combination of Fright, Wind, Phlegm, and Heat constitutes the "Four Syndromes" (Si Zheng); Convulsion (Chu), Finger Flexion/Extension (Nuo), Tugging (Che), Trembling (Chan), Opisthotonos (Fan), Arm Pulling (Yin), Gazing Upward (Cuan), and Strabismus (Shi) constitute the "Eight Signs" (Ba Hou). Any manifestation such as blinking and shaking the head, opening the mouth and protruding the tongue, red lips and flushed face, cyanosis of the face, eyes, and lips, greenish stool, visible blue veins at the hairline and Yintang point, or red-purple/blue nail bed patterns at the Three Passages Tiger's Mouth are all signs of convulsions.

Generally, Liver Wind and Heart Fire contend with each other, inevitably accompanied by Heart Heat before onset, starting with convulsions. Therefore, one must distinguish between Excess and Deficiency heat, and first determine whether the syndrome is Favorable (Shun) or Unfavorable (Ni), which dictates the sequence of treatment. Excess heat leads to Acute Convulsions, while deficiency heat leads to Chronic Convulsions. Chronic convulsions should theoretically be without heat; if heat is present, it is due to deficiency. Acute convulsions belong to Yang, treated with cold-natured herbs; chronic convulsions belong to Yin, treated with warm-natured herbs. However, one must also understand the mechanisms of depth, severity, progression, and speed. Hence, the statement "distinguishing heat by excess or deficiency" refers to this principle. In boys, convulsions involve looking to the left; in girls, to the right. Boys' eyes gaze upward; girls' eyes gaze downward. Boys' thumbs extend outward when clenched; girls' thumbs tuck inward. When pulling the arms, boys have the left arm straight and right curved; girls have the right arm straight and left curved. These are all Favorable signs; the reverse indicates Unfavorable signs. There are cases where convulsions start on the left and then affect both sides. If the convulsion pattern is Favorable, there is no sound; if Unfavorable, there is sound. Nail bed patterns curving inward are Favorable; outward are Unfavorable. Patterns showing equal inward and outward movement indicate a difficult prognosis for recovery. Hence, "distinguishing favorable and unfavorable signs" refers to this. Yang disease presenting with Yin pulse, or Yin disease presenting with Yang pulse, are also considered Unfavorable (reverse).

When heat is excessive, it generates phlegm; when phlegm is excessive, it generates fright; when fright is excessive, it generates wind; when wind is excessive, it causes convulsions. To treat convulsions, one must first intercept the wind; to treat wind, one must alleviate fright; to treat fright, one must resolve phlegm; to treat phlegm, one must clear heat. If all four syndromes are present, they must be treated simultaneously. Neglecting any aspect will lead to other complications. Hence, "treatment has a sequence" refers to this. The general principles being thus, if divided into three categories: violent cases are Acute Convulsions; heavy/profound cases are Chronic Convulsions; the most severe cases, where Liver Wind (Wood) overacts on Spleen Earth, become Chronic Spleen Wind (Man Pi Feng).

[Lou] Acute convulsions belong to Excess syndromes of Wood, Fire, and Earth. Wood excess results in forceful convulsions, upward eye deviation or blinking, known as "Wood excess leads to growth," manifesting as tremors, vertigo, and epilepsy. Fire excess results in body fever and flushed face. Earth excess results in no vomiting or diarrhea, and closed eyes during sleep. Therefore, the treatment method should employ cooling and purging, using formulas such as Liang Jing Wan (Cooling Convulsion Pill) or Li Jing Wan (Alleviating Convulsion Pill).

Chronic convulsions belong to Deficiency syndromes of Wood, Fire, and Earth. Wood deficiency results in weak convulsions, appearing as slight trembling, described in classics as "Wood deficiency is called Wei He," manifesting as trembling, diarrhea, and fear—specifically hand-foot convulsions, abdominal diarrhea, and cardiac palpitations with fear. Fire deficiency results in cold body and cold breath; Earth deficiency results in vomiting and diarrhea, and open eyes during sleep. Therefore, the treatment method should employ warming and tonifying, using Qiang Huo Gao (Qianghuo Paste) or Yi Huang San (Yellow Protecting Powder). If heat is present, use Dongyuan Huang Qi Yi Huang San (Dongyuan Astragalus Yellow Protecting Powder)—note that this is not Qian Shi's Qiang Huo Gao. Treating chronic convulsions involves recognizing that if Earth deficiency causes diarrhea, it is attacked by Fire and Wood, presenting with heat in palms and abdomen. If Fire, Wood, and Earth are all deficient, presenting with trembling, fear, diarrhea, and cold hands/abdomen, only Qiang Huo Gao can treat it.

[Dan] Pediatric convulsions have two types: Acute convulsions belong to Phlegm-Heat, suitable for cooling and purging; Chronic convulsions are governed by Spleen Deficiency, often fatal, suitable for warming and tonifying. For acute convulsions, use Jiang Huo Xia Tan Wan (Fire-Reducing Phlegm-Lowering Pill), administered with decoctions of blood-nourishing herbs. For chronic convulsions, tonify the Spleen and concurrently use Zhu Sha An Shen Wan (Cinnabar Calming Spirit Pill), taken with clear rice soup. Further, seek remedies within blood-nourishing formulas (such as Si Wu Tang [Four Substances Decoction], Si Jun Zi Tang [Four Gentlemen Decoction], Dongyuan Huang Qi Yi Huang San [Dongyuan Astragalus Yellow Protecting Powder]). It is highly absurd for people to use a single formula to treat all convulsions universally.