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The presentation of slow convulsion (Man Jing) involves symptoms such as intermittent vomiting or diarrhea, phlegm rales in the throat with slight panting, eyes open but spirit sluggish, sleeping with eyelids unable to close (exposing the eyeballs), sudden jumping and spasms alternating with periods of calm. Some present with body heat, others with body coldness; some have hot limbs, while others exhale cold air from the mouth and nose. The complexion is pale white or pale cyan, with the area between the eyebrows and lips sometimes appearing cyan or dark. The pulse is deep, slow, scattered, or slack. This condition often arises from the excessive use of cold-cooling herbs in the treatment of rapid convulsion (Ji Jing), or from a too-rapid transformation and transmission of the disease. It may also result from persistent vomiting and diarrhea, sudden severe vomiting and diarrhea due to Qi deficiency, or summer-heat and dampness causing severe vomiting and diarrhea where resolving summer-heat is required rather than solely securing Yang. It can be caused by visceral deficiency leading to profuse diarrhea, prolonged dysentery resulting in Qi collapse, excessive purgation for accumulated stagnation, hematemesis or hematochezia, transmission of Cold Damage (Shang Han) into Yin syndromes, chronic cough evolving into epilepsy, unceasing epileptic seizures, intestinal parasites rushing to the heart, or conditions like testicular swelling, hernia, and abdominal pain. Additionally, excessive sweating leading to Spleen fatigue, irritability, thirst, limb edema, and obstruction of urination and defecation, progressing to "running horse acute malnutrition" (Zou Ma Ji Gan) and then to slow convulsion, are possible causes. When caused by deficiency from vomiting, diarrhea, and accumulated dysentery, the syndrome changes very rapidly. Any case immediately following vomiting and diarrhea should be considered slow convulsion and treated with warming the middle and supporting the interior. If spasms occur urgently, it indicates the initial transmission of slow convulsion, still retaining Yang signs, and must not be mistaken for rapid convulsion requiring different medication. The common saying that slow spasms equal slow convulsion is incorrect; adhering to this often leads to misidentifying slow spleen wind (Man Pi Feng) as slow convulsion. In males, slow convulsion acquired through diarrhea is more severe; in females, acquired through vomiting is more severe. There are five types of vomiting and five types of diarrhea, each with specific etiologies and treatments. Ancient texts state: "Patients fear convulsions but not diarrhea; doctors fear diarrhea but not convulsions." If diarrhea persists, treat the diarrhea first; treating wind simultaneously will exacerbate the convulsions. For other syndromes, treat according to the primary cause. If slow convulsion transmits from rapid convulsion, only wind-extinguishing and stomach-regulating methods should be used to balance Yin and Yang; using purely Yang-warming herbs may cause Yang to return excessively, reverting to rapid convulsion signs. Medication should be neither excessive nor insufficient. Rapid convulsion involves blockage of Guan and Ge; using musk and bovine calculus to open orifices and stop spasms is acceptable. Slow convulsion involves excess Yin and deficient Yang with empty meridians; opening orifices and cooling viscera is contraindicated, as it may transform into slow spleen wind. Critical signs of slow convulsion include fixed gaze, blinking without looking around, cold limbs, profuse sweating, dark/blackish complexion and nails, and flaccid limbs, indicating a critical state. The typical eye sign is half-open/half-closed, resembling sleep. The pulse may be floating or deep; the body may be hot or cold; vomiting/diarrhea may or may not occur; feeding may be accepted or refused. This is called Half-Yin Half-Yang combined disease, analogous to the Shaoyang stage in Cold Damage. Treatment requires investigating the source and flow, not merely labeling it slow convulsion. If caused by vomiting/diarrhea, use formulas like Xing Pi San (Wake the Spleen Powder). Since slow convulsion belongs to Yin, assess the depth of Yin/Yang imbalance carefully; avoid overly drying/warming agents.

[Qian Yi] Slow convulsion occurs after severe illness, vomiting, or diarrhea, transforming into Spleen-Stomach deficiency. Symptoms include whole-body coldness, cold breath from mouth/nose, occasional spasms (Rong), lethargy, and exposed eyeballs during sleep, indicating absence of Yang. Gualua Tang (Trichosanthes Decoction) is indicated. A child of Mr. Wang in Dongdu suffered vomiting and diarrhea; physicians used purgatives causing extreme deficiency, leading to slow convulsion with lethargy, exposed eyes, spasms, and cold body. Qian diagnosed slow convulsion and prescribed Gualua Tang. Upon recovery of Stomach Qi, the child opened his eyes and warmed up. The father suspected urinary/fecal retention and requested diuretics/purgatives. Physicians used Bazheng San (Eight Corrects Powder) without effect, worsening coldness. Qian advised against diuresis, predicting further coldness, which occurred. He explained that diuresis would exhaust Spleen/Stomach Qi, leading to death, but fetal Qi was strong. Using Yihuang San (Benefit Yellow Powder) and Shijunzi Wan (Quince Pill) four times allowed slight intake of food. By noon, eating resumed. Diuresis damages Spleen/Stomach cold-deficiency; tonification is needed, not attack. Later, aphonia developed; physicians treated for loss of voice. Qian questioned how one could eat and open eyes if truly aphonic, noting no jaw clenching. Using Dihuang Wan (Rehmannia Pill) to tonify Kidney was deemed incorrect by Qian, who attributed the issue to cold-diuretics damaging Spleen/Kidney. With Spleen recovered but Kidney still weak, Kidney tonification ensured recovery. Speech returned in half a month; full recovery in one month.

[Zhang Yuansu] Slow convulsion presents with complete Yin signs and visceral pathology. Prolonged vomiting/diarrhea in children damages Spleen/Stomach; untreated, it becomes slow convulsion, termed Rong (spasmodic twitching), resembling convulsion but less intense. Due to Spleen deficiency causing loose stools, remove wind from the Spleen using Xuan Feng San (Disperse Wind Powder) first, then stabilize with Yihuang San and Shijunzi Wan to stop diarrhea. If neglected, Spleen/Stomach deficiency allows Liver Wood to overact on Earth, constituting slow convulsion, treated with warming tonification via Qianghuo Gao (Notopterygium Ointment).

[Li Dongyuan] Yan Xiaozhong’s compilation of Qian’s formulas incorrectly identifies Yihuang San as a method to tonify Earth. The formula contains Dingxiang (Clove), acrid-hot and fire-assisting; when Fire is strong, Earth becomes weaker. Qingjupi (Green Tangerine Peel) drains Lung Metal; Dingxiang strongly drains Lung and Large Intestine. While excess Spleen may require draining the Son (Metal), deficiency requires avoiding this to prevent further weakening Earth. In cases of hyperactive Wind Wood with a surging Right Guan pulse, palm/abdominal heat, such fire-assisting/metal-draining herbs are inappropriate. However, for Cold Water attacking Spleen Earth presenting with vomiting, abdominal pain, and green/white dysentery, Yihuang San is a sacred remedy. I propose a new formula: Huangqi (Astragali Radix) 2 qian, Renshen (Ginseng Radix) 1 qian, Zhigancao (Prepared Licorice Root) 0.5 qian, Baishao (White Peony Root) 1 qian. These four sweet-warm herbs tonify Yuan Qi; sweetness clears Heat. As per Neijing: "For Heat rampant within, use sweetness to drain, acidity to gather." Baishao is sour-cold; cold drains Heat, acidity drains Liver and tonifies Lung Metal. This strengthens Metal and Earth positions; strong Metal and weak Fire prevent Wind Wood from attacking Earth, allowing subsequent dispersal of Wind pathogen. Yihuang San, Lizhong Wan, and Yangshen Dan treat severe Cold-Damp in Spleen/Stomach. They are harmful for latent Fire, fatigue-induced deficiency, or slow convulsion from Stomach deficiency after consuming hot drugs like Bidao (Croton Seed). Slow convulsion arises from prolonged diarrhea damaging Spleen/Stomach; Qian’s use of Qianghuo Gao is erroneous. Spleen deficiency involves Fire pathogen attacking Earth ("following evil" from posterior); strong Fire strengthens Wood, which attacks Earth. Tonify Earth source via Heart meridian with sweet-warm herbs, drain Fire in Spleen with sweet-cold herbs, and tonify Metal in Spleen with sour-cool herbs. This strengthens Metal, weakens Fire, and empties Wind Wood.

[Liu Wansu] For crying with spasms and unstable sleep, use Sijunzi Tang (Four Gentlemen Decoction) plus Quanxie (Scorpion, tail tip removed and fried), Gouteng (Uncariae Ramulus cum Uncis), and Baifuzi (Aconiti Kusnezoffii Rhizoma, fried) in equal parts, decocted together. For Spleen/Stomach weakness generating wind and fatigue, use Sijunzi Tang plus Chao Banxia Qu (Fried Pinellia Paste) and Meishi Zi (Hematitum) in equal parts, powdered, with winter melon seeds, decocted.

[Zhu Zhenheng] For frequent vomiting/diarrhea impending slow convulsion, use Qian’s Baizhu San (Atractylodis Macrocephalae Powder) plus Shanyao (Dioscoreae Rhizoma), Bian Dou (Lablab Semen Album, fried), and Rou Doukou (Myristicae Semen, flour-roasted), 1 qian each, with ginger slice, decocted. If slow convulsion has manifested, add Xixin (Asari Radix et Rhizoma), Tianma (Gastrodiae Rhizoma), 1 qian each; Quanxie (Scorpion), 3 pieces (tip removed); Baifuzi, 0.8 fen (flour-roasted). For convulsion with diarrhea, use Renshen (Ginseng Radix), Fuling (Poria), Shaoyao (Paeoniae Radix, wine-fried), Baizhu (Atractylodis Macrocephalae Rhizoma), decocted with ginger; add Huanglian (Coptidis Rhizoma), Gancao (Licorice Root), Zhuye (Bambusae Folium) in summer.

[Zeng Shirong] Ancient texts lack basis for treating slow convulsion, recording only Yin Epilepsy. Slow convulsion belongs to Yin, characterized by stillness and slow spasms. Etiologies include external Wind-Cold, internal vomiting/diarrhea, post-severe illness, or iatrogenic transmission. Signs include sluggish spirit, asymmetric limb movement, drooling, slight warmth, upward/sideways eye deviation, clenched fist spasms, or leg movements. Male left-side/spasm-on-left is favorable; reverse is unfavorable. Cold breath or depressed fontanelle indicates extreme deficiency; pulse is deep and forceless; sleeping with eyes half-open indicates true Yang exhaustion and dominant Yin pathogen. Yin excess generates Cold (Water), which generates Liver Wood (Wind), which attacks Spleen Earth. Since Stomach is the Stomach-Fu of Spleen, Wind in Stomach causes spasms. Spasm signs include shoulder shrugging, hanging arms, continuous trembling. Treat with Qingzhou Baiwanzi (Qingzhou White Pills) and Suhexiang Wan (Styrax Pills) pounded with ginger juice, taken with rice water. For extreme deficiency, add Jin Ye Dan (Golden Pellet). Subsequently use Chonghe Yin (Harmonizing Drink) with Qibao San (Seven Treasures Powder) and roasted ginger. To resolve vomiting/diarrhea, alternate with Weiling Tang (Stomach and Five Ling Decoction) for exterior-interior rescue. For persistent vomiting, Tingtu Yin (Stop Vomiting Drink); for persistent diarrhea, Liuzhu San (Six Pillars Powder) or Sheng Tang (Life Decoction) to remove Stomach Wind, stabilize spasms, and clear spirit. Wuling San (Five Ling Powder) guides rebellion, harmonizes Ying-Wei and Yin-Yang. For excessive phlegm, white lips, ice-cold limbs, unconsciousness (extreme deficiency-slow), administer Guzhen Tang (Secure True Decoction) quickly to restore Stomach Qi. Once restored, use Xingpi San and Chenxiang Yin for regulation.

[Xue Ji] Slow convulsion presents with vomiting, diarrhea, phlegm rales, wheezing, open eyes with sluggish spirit, lethargy with exposed eyeballs, jumping/spasms alternating with calm, body heat/cold alternation, pale cyan-white face or cyan-red lips/brows, and slow-deep-slack pulse. Causes include congenital insufficiency, chronic Spleen deficiency, or frequent use of attacking/draining drugs. If Earth deficiency fails to generate Metal, and Metal fails to control Wood, allowing Wood to insult Earth, treat with Wuwei Yigong San (Five-Ingredient Extraordinary Merit Powder) plus Danggui (Angelicae Sinensis Radix) and Suanzaoren (Ziziphi Spinosae Semen), assisted by Gouteng Yinzi (Uncaria Infusion) to tonify Earth and level Wood. For Spleen Earth deficiency-cold, use Liujunzi Tang (Six Gentlemen Decoction) plus Paojiang (Prepared Ginger) and Muxiang (Aucklandiae Radix); if ineffective, urgently add Fuzi (Aconiti Lateralis Radix Praeparata) to recover Yang. Yin-blood is born from Spleen Earth; use Sijunzi Tang, Danggui, and Suanzaoren. For Yuan Qi depletion leading to coma, moxa Baihui (GV20) urgently; delaying until phlegm removal fails results in irreversible Qi collapse.