钱乙曰。惊痫发搐。男发搐。目左视无声。右视有声。女发搐。目右视无声。左视有声。相胜故也。男反右视。女
反左视。亦皆有声。
李杲曰。男为木。故左视木位无声。右视金位。相击则有声。女为金。故右视金位无声。左视木位相击亦有声。
钱乙曰。急惊本因热生于心。身热面赤引饮。口中热气出。二便黄赤。剧则发搐。盖热盛则生风属肝。此阴盛阳虚
也。利惊丸主之。以除热痰。不可用巴豆及温药大下之。恐搐虚。热不消也。小儿热痰客于心胃。因闻大声非常。则动
而惊搐矣。若热极虽不闻声及惊。亦自发搐。
张元素曰。急惊者。阳症也。俱腑受病。热痰客于心肺。是少阳相火旺。经云。热则生风。因闻人声而作。若谓东
方震卦。得火气而发搐。火本不动。焰得风而动。当用利惊丸、导赤散、泻青丸。搐止。宜服安神丸。
危亦林曰。惊风形症不明。若言阴症。则浑身又温。若作阳症。则又不大搐。乃阴阳不和。宜用防风温胆汤下大惊
丸、小惊丸。
杨士瀛曰。急惊先当定搐。搐由风也。风由热也。搐已定。方可下热退惊。热若不退。惊亦不散。急惊。截风定搐
为要。风搐既定。次与下热。热去则无风。风散则不搐。
朱震亨曰。老医常言小儿惊搐。多是热症。若先便用惊风药。若白附子全蝎僵蚕川乌之类。便成坏症。后有医幼科
者。只用导赤散加地黄防风进三服。导去心经邪热。其搐便止。次服宁神膏。神效。
曾氏曰。急惊之论。前代书所不载。惟曰阳痫。大概失所爱护。或抱于当风。或近于热地。昼则食多辛辣。夜则衾
盖太浓。郁蒸邪热。积于心。传于肝。再受人物惊触。或跌扑叫呼。雷声鼓乐。鸡鸣犬吠。一切所惊。未发之时。夜卧
不稳。睡中或哭或笑。切牙咬乳。鼻额有汗。气喘痰喘。忽尔闷绝。目直上视。牙关紧急。口噤不开。手足搐掣。此热
甚而然。况兼面红脉数可辨。盖心有热而肝有风。二脏乃阳中之阳。心火也。肝风也。风火阳物也。风主乎动。火得风
则烟焰起。此五行之造化。二阳相鼓。风火相搏。肝藏魂。心藏神。热则神魂易动。故发惊也。心主乎神。独不受触。
遇有惊则发热。热极生风。故能成搐。名曰急惊。治之之法。先发表。次通心气。疏涤肝经。安魂退热。惊风既除。与
之去痰。免成痴疾。但不可用大寒凉药。
李仲南曰。大要急惊用药。有次第。有轻重。开关以后。且与截风定搐。风搐既定。却下痰热。理为至当。若患在
痰热。未有惊风。只可退热化痰。不可妄投惊风药。盖药中多用寒凉。恐引痰热入经络。凡病在热不可妄治痰。止当解
表。病在惊不可妄治风。盖惊由痰热。只可退热化痰。而惊自止。病在痰不可便治惊。急须退热化痰。病在风不可便治
搐。盖风由惊作。只可利惊化痰。其风自散。若惊亦有搐。须用截风散。至妙之道。若治惊而痰不化。热亦不退。惊安
得自止。化其痰。热若不退。风亦不散。痰安得去。是知不治之治。所以治之也。急惊初传。风搐得定。而痰热一泄。
又须急与和胃定心之剂。若搐定而痰热无多。则但用轻药消痰除热可也。然急惊虽当下。切不可过用寒凉。致成慢惊。
且如只下痰热。不必太骤。但斟酌处。只用大黄一味足矣。且急惊症。原在于去肝风。降心火。幼幼书以为至要之说也。
薛己曰。急惊之候。牙关紧急。壮热涎涌。窜视反张。搐搦颤动。口中气热。颊赤唇红。脉浮洪数者。此肝经血虚。
火动生风。盖风生则阴血愈散。阴火愈炽。火动则肺金愈亏。肝木愈旺。宜滋肝血养脾气。
王肯堂曰。急惊由内挟实热。外感风邪。心家受热积惊。肝家生风发搐。肝风心火。二脏交争。风气壅盛。无可发
泄。故暴烈也。又有搐搦反张斜视。而牙关不紧。口无痰涎而气热。未可直指为惊风。恐是伤风伤寒夹食夹惊疹痘等症。
此即钱氏假搐之说。又各根据本症施治。又急惊搐搦。不可把捉。但扶持之。否则风痰逆入经络。遂使手足拘挛。或成废
疾。小儿急慢惊风。古谓阴阳痫。急者属阳。阳盛而阴亏。慢者属阴。阴盛而阳亏。阳动而躁疾。阴静而迟缓。
皆因脏腑虚而得之。虚能发热。热则生风。是以风生于肝。痰生于脾。惊出于心。热发于肝。而心亦热。以惊风痰热。
合为四症。搐搦掣颤。反引窜视。为八候。凡眨眼摇头。张口出舌。唇红睑赤。面眼唇青。及泻皆青。发际印堂青筋。
三关虎口纹红紫或青者。皆惊风候也。大抵肝风心火。二者交争。必挟心热而后发始于搐。故热必论虚实。症先分顺逆。
治则有后先。盖实热为急惊。虚热为慢惊。慢惊当无热。其发热者虚也。急惊属阳。用药以寒。慢惊属阴。用药以温。
然又必明浅深轻重进退疾徐之机。故曰热必论虚实。男搐左视左。女搐右视右。男眼上窜。女眼下窜。男握拇指出外。
女握拇指入里。男引手挽左直右曲。女引手挽右直左曲。凡此皆顺。反之则逆。亦有先搐左而后双搐者。但搐则无声。
搐逆则有声。其指纹弯弓入里者顺。反外者逆。出入相半者难痊。故曰症必分顺逆。阳病阴脉。阴病阳脉。亦为反。
热甚生痰。痰甚生惊。惊甚生风。风甚发搐。治搐先于截风。治风先于利惊。治惊先于豁痰。治痰先于解热。其若四症
俱有。又当兼施并理。一或有遗。必生他症。故曰治有先后。纲领如此。若分三者言之。暴烈者为急惊。沉重者为慢惊。
至重者肝风木之克脾土。为慢脾风。丹溪云。忽惊用降火下痰丸。养血药作汤下之。慢惊当补脾。兼用朱砂安神丸。清
米汤
下。更于血药中求之。如四物四君东垣黄 益黄散之类。世以一药通治。甚妄。薛氏于急慢惊痫之外。又出惊风一症。
其候虚惕。怔忡。气怯。神散。痰涎来去。泄泻色青。盖惊之轻而虚者也。若惊入心。则面赤夜啼。用栀子清肝汤加黄
连。若入肝则面青眼窜。用柴胡清肝汤。若入脾。则面黄呕吐。虚汗嗜卧。用六君子汤加柴胡、山栀。若入肺。则面白
喘急。用异功散加柴胡、桔梗。若入肾。则面黑啮乳切牙。用六味地黄丸。
叶桂曰。小儿仓猝骤然惊搐。古曰阳痫。从热症治。古人用凉膈散为主方。按急惊属阳热病。用凉膈以清膈间无形
之热。膈上邪热。逼近膻中。络闭则危殆矣。此宣通乃一定之法。然必询病因察时候治之。幼科以痰热风惊四治。犹可
说也。吾乡有专科。立方钩藤、连翘、木通、薄荷、前胡、枳壳、桔梗加入表散消食。多不效验。惊为七情。内应乎肝。
肝病发惊骇。木强火炽。其病动不能静。且火内寄肝胆。火病来必迅速。后世龙荟芩连。必加冰麝硝黄。取其苦寒直降。
咸苦走下。辛香通里窍之闭也。如牛黄丸、至宝丹、紫雪皆可选用。凡热邪塞窍。神迷昏愦者仿此。钩藤、丹皮之属。
仅泄少阳胆热。与急惊暴热内闭之症。无益。若火热劫烁血液。苦寒咸寒。不中与也。宜犀角地黄汤之属。方书有镇坠
金石之药。有攻风劫痰之药。虽非常用。要不可不考。惊与厥。皆逆乱之象。仲景云。蛔厥都从惊恐得之。凡吐蛔腹痛
呕恶。
明是肝木犯胃。幼医乱治。束手告毙。余宗仲景法。每效。
Qian Yi stated: When convulsive epilepsy manifests with spasms, in males, looking to the left is silent while looking to the right produces sound; in females, looking to the right is silent while looking to the left produces sound. This is due to the mutual overcoming (of Wood and Metal). If males look to the right or females look to the left (counter to their nature), sound will also be produced.
Li Gao stated: Males belong to Wood. Thus, looking to the left (Wood position) is silent, while looking to the right (Metal position) involves Metal striking Wood, producing sound. Females belong to Metal. Thus, looking to the right (Metal position) is silent, while looking to the left (Wood position) involves Metal striking Wood, also producing sound.
Qian Yi stated: Ji Jing Feng (Urgent Convulsive Wind) originates from Heat generating in the Heart. Symptoms include fever, flushed face, thirst, hot breath, and yellow-red urine and stool. In severe cases, spasms occur. Since excessive Heat generates Wind, it belongs to the Liver. This represents Excess Yin and Deficient Yang. The primary formula is Lijing Wan (Relieve Convulsion Pill) to clear Heat-Phlegm. Bitter-cold purgatives like Radix Euphorbiae Pekingensis (Badou) and warming herbs should not be used for aggressive purging, lest spasms persist and Heat fail to dissipate. In children, Heat-Phlegm lodges in the Heart and Stomach. Hearing loud, unusual noises can trigger agitation and convulsions. Even without external stimuli, extreme Heat alone can cause spontaneous spasms.
Zhang Yuansu stated: Ji Jing Feng is a Yang syndrome involving the Fu organs. Heat-Phlegm lodges in the Heart and Lungs, indicating hyperactivity of Shaoyang Ministerial Fire. The Classics state: "Heat generates Wind." It is triggered by hearing voices. Referring to the East Zhen Trigram, receiving Fire Qi causes spasms. Fire does not move on its own; flames move when stirred by wind. One should use Lijing Wan, Daochi San (Guide Out Red Powder), and Xieqing Wan (Drain Green Pill). After spasms cease, Anshen Wan (Calm Spirit Pill) is appropriate.
Wei Yilin stated: The manifestations of Jing Feng (Convulsive Wind) are unclear. If considered a Yin syndrome, the body is warm; if considered a Yang syndrome, spasms are not severe. This indicates disharmony between Yin and Yang. Fangfeng Wendan Tang (Saposhnikovia Decoction to Warm the Gallbladder) administered with Dajing Wan (Great Calming Convulsion Pill) and Xiaojing Wan (Small Calming Convulsion Pill) is suitable.
Yang Shiyin stated: In Ji Jing Feng, stopping spasms is the priority. Spasms arise from Wind, and Wind arises from Heat. Only after spasms are controlled can one clear Heat and calm fright. If Heat remains, Fright will not disperse. The key to treating Ji Jing Feng is intercepting Wind and stabilizing spasms. Once Wind and spasms are controlled, clearing Heat follows. Removing Heat eliminates Wind; dispersing Wind stops spasms.
Zhu Zhenheng stated: Old physicians often said that pediatric convulsions are mostly Heat syndromes. Using typical anti-convulsant herbs like Rhizoma Typhonii (Baifuzi), Full Scorpion (Quanxie), Bombyx Batryticatus (Jiangcan), or Radix Aconiti Lateralis Preparata (Chuanwu) prematurely leads to complicated conditions. Later pediatricians used Daochi San (Guide Out Red Powder) added with Radix Rehmanniae Preparata (Dihuang) and Radix Saposhnikoviae (Fangfeng). Three doses guided out Evil Heat from the Heart Meridian, stopping spasms. Subsequently, Ningshen Gao (Spirit-Calming Paste) was given with miraculous effect.
Zeng Shi stated: Discussions on Ji Jing Feng were not recorded in ancient texts, only referred to as Yang Xian (Yang Epilepsy). It generally results from neglect, such as exposing the child to drafts or heat sources. Eating spicy foods during the day and overdressing at night causes stagnant Evil Heat to accumulate in the Heart and transmit to the Liver. Further stimulation by startling events—such as falls, shouting, thunder, drums, or animal cries—triggers the condition. Before onset, sleep is restless, with crying or laughing during sleep, grinding teeth, biting the nipple, sweating on the nose and forehead, panting, and phlegm-rattling. Suddenly, the child may become unconscious, stare upward rigidly, have a locked jaw, open mouth tightly, and experience limb spasms. This is due to extreme Heat. Facial redness and rapid pulse confirm this. The Heart has Heat, and the Liver has Wind; both are Yang within Yang. Heart governs Fire, Liver governs Wind; both are Yang entities. Wind governs movement; Fire with Wind creates flames. This is the transformation of the Five Elements. Two Yangs drum each other, Wind and Fire clash. The Liver stores Hun (Ethereal Soul), the Heart stores Shen (Spirit). Heat agitates Hun and Shen, causing Fright. The Heart governs Shen and is not easily touched by external fright; however, upon being startled, it generates Heat. Extreme Heat generates Wind, causing spasms, named Ji Jing Feng. Treatment involves first releasing the exterior, then unblocking Heart Qi, draining the Liver Meridian, calming the soul, and reducing Heat. After the convulsion subsides, Phlegm-resolving herbs prevent intellectual disability. Large bitter-cold herbs must be avoided.
Li Zhongnan stated: Medication for Ji Jing Feng must follow a sequence and weight. After opening the jaws, use herbs to intercept Wind and stabilize spasms. Once controlled, purge Phlegm-Heat. This is most appropriate. If the pathology is Phlegm-Heat without convulsions, only clear Heat and resolve Phlegm; do not recklessly use anti-convulsants, as cold herbs may drive Phlegm-Heat into the collaterals. For Heat pathogens, do not treat Phlegm directly; release the exterior. For Fright, do not treat Wind directly, as Fright stems from Phlegm-Heat; clearing Heat and resolving Phlegm stops Fright naturally. For Phlegm, do not treat Fright directly; urgently clear Heat and resolve Phlegm. For Wind, do not treat spasms directly, as Wind stems from Fright; relieving Fright and resolving Phlegm disperses Wind naturally. If Fright includes spasms, Jiefeng San (Wind-Intercepting Powder) is excellent. If treating Fright fails to transform Phlegm or reduce Heat, Fright cannot stop. Transforming Phlegm without reducing Heat means Wind will not disperse, so Phlegm cannot leave. Thus, "non-treatment" is the method of treatment. In early Ji Jing Feng, once Wind and spasms are stabilized and Phlegm-Heat purged, harmonize the Stomach and calm the Heart. If spasms stop and Phlegm-Heat is minimal, use mild herbs to eliminate Phlegm and Heat. Although Ji Jing Feng requires purging, avoid excessive cold herbs to prevent conversion to Man Jing Feng (Slow Convulsive Wind). Purge Phlegm-Heat gently; Rhubarb (Dahuang) alone suffices. The essence of Ji Jing Feng treatment is dispelling Liver Wind and descending Heart Fire, a crucial point in pediatric texts.
Xue Ji stated: Signs of Ji Jing Feng include locked jaws, high fever with salivation, darting eyes, opisthotonos, spasms, tremors, hot breath, flushed cheeks and lips, and a floating, surging, rapid pulse. This indicates Liver Blood deficiency with Fire stirring Wind. As Wind generates, Yin Blood scatters further, and Yin Fire flares. As Fire stirs, Lung Metal weakens, and Liver Wood becomes hyperactive. Nourish Liver Blood and strengthen Spleen Qi.
Weng Kentang stated: Ji Jing Feng involves internal Excess Heat and external Wind pathogen. Heart accumulates Heat and Fright; Liver generates Wind and spasms. Liver Wind and Heart Fire contend, causing turbulent Wind with no outlet, resulting in violent symptoms. Cases with spasms, opisthotonos, and strabismus but without locked jaws or phlegm, yet with hot breath, may not be true Jing Feng. They might be Wind-Cold, Food Retention, or Rashes/Pox mixed with Fright. These are Qian's "false spasms." Treat according to the specific syndrome. Do not restrain Ji Jing Feng spasms forcibly; support the child gently. Otherwise, Wind-Phlegm may reverse into collaterals, causing contracture or disability. Ancient texts call pediatric convulsions Yin-Yang Xian. Urgent belongs to Yang (Excess Yang, Deficient Yin); Slow belongs to Yin (Excess Yin, Deficient Yang). Yang is active and restless; Yin is quiet and slow. All stem from Zang-Fu deficiency. Deficiency generates Heat; Heat generates Wind. Wind arises from Liver, Phlegm from Spleen, Fright from Heart, Heat from Liver (and Heart). These four factors combine. Spasms, tremors, pulling, and darting eyes constitute eight signs. Blinking, head shaking, tongue protrusion, red lips/eyelids, cyanosis around eyes/lips, green stools, cyanotic veins at hairline/glabella, and red/purple/cyanotic finger veins at the Three Passages are all Jing Feng indicators. Generally, Liver Wind and Heart Fire contend, requiring Heart Heat to initiate spasms. Therefore, assess Heat for Deficiency/Excess, distinguish favorable/unfavorable prognoses, and determine treatment order. Excess Heat is Ji Jing Feng; Deficient Heat is Man Jing Feng. Man Jing Feng typically lacks Heat; if present, it is Deficient. Ji Jing Feng is Yang; use Cold herbs. Man Jing Feng is Yin; use Warm herbs. Understand depth, severity, and timing. "Heat must be assessed for Deficiency/Excess." Male spasms look left; female spasms look right. Male eyes roll up; female eyes roll down. Male thumbs extend outward; female thumbs tuck inward. Male arms pull left straight/right curved; female arms pull right straight/left curved. These are favorable (Shun). Reverse patterns are unfavorable (Ni). Also, spasms without sound are favorable; with sound are unfavorable. Finger vein curves inward are favorable; outward are unfavorable. Half-in/half-out indicate difficult recovery. "Prognosis must distinguish Shun/Ni." Yang disease with Yin pulse, or Yin disease with Yang pulse, are reversals. Extreme Heat generates Phlegm; extreme Phlegm generates Fright; extreme Fright generates Wind; extreme Wind causes spasms. Treat spasms by intercepting Wind; intercept Wind by relieving Fright; relieve Fright by resolving Phlegm; resolve Phlegm by clearing Heat. If all four exist, treat simultaneously. Neglect leads to other symptoms. "Treatment has sequence." Violent cases are Ji Jing Feng; heavy cases are Man Jing Feng; most severe, where Liver Wood overacts on Spleen Earth, is Man Pi Feng (Slow Spleen Wind). Danxi advised using Jianghuo Xiutan Wan (Descend Fire Resolve Phlegm Pill) with blood-nourishing decoction for sudden Fright. For Man Jing Feng, tonify Spleen and use Zhusha Anshen Wan (Cinnabar Spirit-Calming Pill) with rice water. Seek blood-tonifying formulas like Si Wu Tang, Si Jun Zi Tang, or Dongyuan Huangqi Yihuang San. Treating all with one formula is absurd. Xue added "Jing Feng" outside Ji/Man Xian, characterized by timidity, palpitations, qi deficiency, scattered spirit, wandering phlegm, and green diarrhea. This is mild, deficient Fright. If Fright enters Heart: red face, night crying; use Zhizi Qinggan Tang plus Coptidis Rhizoma (Huanglian). If entering Liver: blue face, darting eyes; use Chaihu Qinggan Tang. If entering Spleen: yellow face, vomiting, spontaneous sweat, lethargy; use Liujunzi Tang plus Chaihu and Gardenia (Shanzhi). If entering Lung: pale face, wheezing; use Yigong San plus Chaihu and Platycodon (Jiegeng). If entering Kidney: black face, gnawing teeth; use Liuwei Dihuang Wan.
Ye Gui stated: Sudden pediatric convulsions were called Yang Xian in antiquity and treated as Heat syndromes. Ancients used Liangge San (Cool the Diaphragm Powder) as the main formula. Ji Jing Feng is a Yang-Heat disease; Liangge San clears formless Heat in the diaphragm. If Evil Heat nears the Chest Center (Shanzhong), collateral blockage leads to danger. Promoting circulation is a fixed method. However, etiology and timing must be considered. Pediatric treatments focusing on Phlegm, Wind, Heat, and Fright are acceptable. Local specialists using Gouteng, Forsythia, Akebia, Mint, Peucedanum, Aurantium, and Platycodon for exterior release and digestion often fail. Fright is one of the Seven Emotions, corresponding to the Liver. Liver disease causes fright; Wood strength and Fire blazing make the patient restless. Fire resides in Liver/Gallbladder; Fire diseases progress rapidly. Later generations used Longdan Xiegan Tang variants with Borneol, Musk, Nitre, and Rhubarb for bitter-cold descent, salty-bitter downward action, and pungent-aromatic opening of interior orifices. Niuhuang Wan, Zhibao Dan, and Zixue are options. For Heat blocking orifices with confusion, follow this. Gouteng and Moutan Cortex only drain Shaoyang Gallbladder Heat, ineffective for acute Ji Jing Feng with internal closure. If Fire scorches Blood, bitter/salty-cold herbs are contraindicated; use Jiaojiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) variants. Formulas contain mineral sedatives and Wind-dispelling/Phlegm-resolving drugs; though not routine, they must be studied. Fright and Jue (syncope) are images of reversal. Zhang Zhongjing stated: Ascariasis syncope stems from fright. Vomiting worms, abdominal pain, and nausea indicate Liver Wood invading Stomach. Pediatricians mishandling this lead to death. I follow Zhongjing's methods with success.