小儿惊搐之症必有痰，或因惊而痰聚，或因痰而
致惊。古人治惊方中，俱兼痰药，必须先治其痰，然后泻火清神。若痰壅塞胸膈不去，则泻火、清神之药，
无所施其功也，二陈汤加竹沥，入少姜汁，最稳；痰重者，滚痰丸、白饼子、利惊丸下之。滚痰丸下热痰，
白饼子、利惊丸下痰积。在上者宜吐之，重则用药吐，轻则探吐之。若不必吐下，以二陈为主，脾虚有热
痰，加白术、芩、连；风痰稠结，加南星、贝母、枳实；胃虚生痰，加白术、麦芽、竹沥。
愚按前症若因心肝二经风热炽盛，两目连札，四肢抽搐，宜治肝清心；若因心经蕴热，叫呼战栗，宜
清热安神；若因肺感风邪，气急喘促，宜治痰理肺；若因饮食停滞，嗳吐，困睡，宜消导健脾；若因脾肺
虚弱而风痰壅盛，以致前症，但宜补中益气为主。若执用祛风、治痰、理气之剂，则气散阴消，而促其危
矣。
大尹刘应昌子，患瘰 ，恪用化痰之剂，虚症悉至，殊类惊风。又服祛风至宝丹，小便频数，肢体抽
搐，或两目连札，切牙，呵欠，或作呕懒食，大便重坠，或泄泻，此土伤而木胜也。用补中益气汤、六味
地黄丸而痊。
冬官朱小溪子，项间结核，面色痿黄，肌体消瘦，切牙，抽搐，头摇，目札，此肝木克脾土也。用六君
子汤、九味芦荟丸而愈。
宪幕顾斐斋玄孙，二周，项结核，两臂反张，索败毒之药。余意其症属风热伤肝，血燥筋挛，未敢敷
药。翌早请治，果系前症，遂与六味丸一服，侵晨灌之，午后肢体如常。
儒者王文远子，患瘰 ，痰盛发搐，服金石香燥之剂，手足筋挛，此肝血复伤而致急惊风也。遂用加
味小柴胡加钩藤、山栀、芎、归一剂，又以六味丸料加五味、麦门煎服而安。
小儿忽然惊搐，目上视，摇头，切牙，症候怪异，世俗多作肝经有余之症，投以惊药，岂知饮食停滞，
痰涎壅积，亦多类惊者。便须审察有无伤积，腹痛，胸满，呕吐，恶食，轻则消滞化痰，重则探吐滞积，
而后调之。又有因感冒、吐泻而发热，气血虚为热所迫，虽见惊症，不可即服惊药，但调治吐泻、感冒，
则气自定、热自退，而惊自除矣。
愚按前症若因肝木侮脾土，用六君子加芍药、木香、柴胡；若因脾土虚而自病，用五味异功散。大凡
饮食停滞，痰积壅满，而见惊症，实因脾土虚弱，不能运化所致，但健脾胃，则食自消、痰自化。若轻用
惊药、风药，反所以成其风而重其病也。况脆嫩脏腑，安能受峻厉之剂耶？若专治其病则误矣。
姚仪部子，每停食身发赤晕，用清中解郁汤而愈，后患摇头，切牙，痰盛，发搐，吐出酸味。待其吐尽，
翌日少以七味白术散，后日以参苓白术散调理脾胃，遂不复患。大抵吐后儿安，不必更服药也。
一小儿，停食，服通利之剂作呕、腹胀，此脾胃复伤也。用补中益气汤而愈。
一小儿，两目动札，手足发搐，数服天麻防风丸之类，以祛风化痰，前症不愈，其痰益甚，得饮食诸
症稍愈，视其准头及左颊，色青黄。余曰∶脾主涎，此肝木制脾土，不能统摄其涎，非痰盛也。遂用六君
子汤加升麻、柴胡、钩藤，二剂，饮食渐进，诸症渐愈，又用补中益气而安。
The syndrome of infantile convulsion and tremor (Jing Chu) is invariably associated with phlegm. It may be caused by phlegm accumulation due to fright, or by fright induced by excessive phlegm. In ancient formulas for treating fright, herbs resolving phlegm were always included; one must first treat the phlegm, then clear heat and calm the spirit. If phlegm turbidity obstructs the chest and diaphragm and is not removed, the efficacy of herbs that purge fire and clear the spirit will be nullified. For this, Er Chen Tang (Two-Cured Decoction) added with Bamboo Sap (Zhuli) and a small amount of Ginger Juice is most stable; for severe phlegm, Gun Tan Wan (Rolling Phlegm Pill), Bai Bing Zi (White Cake Pill), or Li Jing Wan (Relieving Fright Pill) are used to purge downward. Gun Tan Wan purges hot phlegm, while Bai Bing Zi and Li Jing Wan purge phlegm accumulations. When the pathogen is located in the upper jiao, emesis is indicated: for severe cases, medicinal emetics are used; for mild cases, throat-probing emesis is employed. If emesis and purgation are not necessary, Er Chen Tang serves as the main formula: for spleen deficiency with hot phlegm, add Atractylodis Macrocephalae Rhizoma (Baizhu), Scutellariae Radix (Huangqin), and Coptidis Rhizoma (Huanglian); for wind-phlegm that is thick and congealed, add Pinelliae Tuber (Nanxing), Fritillariae Bulbus (Beimu), and Aurantii Fructus Immaturus (Zhishi); for stomach deficiency generating phlegm, add Atractylodis Macrocephalae Rhizoma (Baizhu), Malto (Maiya), and Bamboo Sap (Zhuli).
My commentary: Regarding the aforementioned syndromes, if they result from blazing wind-heat in the Heart and Liver meridians, manifesting as frequent blinking of both eyes and limb convulsions, treatment should focus on soothing the Liver and clearing the Heart. If caused by latent heat in the Heart meridian, manifesting as crying out and trembling, treatment should clear heat and calm the spirit. If caused by Wind pathogen affecting the Lung, manifesting as rapid breathing and panting, treatment should resolve phlegm and regulate the Lung. If caused by food stagnation, manifesting as belching, vomiting, drowsiness, and lethargy, treatment should promote digestion and strengthen the Spleen. If caused by Spleen and Lung deficiency leading to abundant wind-phlegm causing these symptoms, treatment should primarily tonify the Middle and boost Qi (Bu Zhong Yi Qi). Adhering rigidly to agents that dispel wind, resolve phlegm, or regulate Qi will scatter Qi and consume Yin, thereby hastening critical danger.
The son of Dayin Liu Yingchang suffered from scrofula (Luo Li). He strictly used phlegm-resolving agents, which led to the manifestation of all deficiency syndromes, closely resembling infantile convulsion. He then took Qu Feng Zhi Bao Dan (Wind-Dispelling Precious Pill), resulting in frequent urination, limb convulsions, occasional frequent blinking of both eyes, teeth grinding, yawning, occasional nausea and poor appetite, a sensation of heaviness in defecation, or diarrhea. This indicates injury to Earth (Spleen) allowing Wood (Liver) to flourish. He recovered after using Bu Zhong Yi Qi Tang (Tonify the Middle and Boost Qi Decoction) and Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia).
The son of Dongguan Zhu Xiaoxi had neck lymph node swellings, sallow complexion, emaciation, teeth grinding, convulsions, head shaking, and eye blinking. This represents Liver Wood overacting on Spleen Earth. He was cured using Liu Jun Zi Tang (Six-Gentleman Decoction) and Jiu Wei Lu Hui Wan (Nine-Ingredient Aloe Pill).
The great-grandson of Xianmu Gu Feizhai, aged two weeks, had neck lymph node swellings and opisthotonos (arms hyperextended backward). He requested detoxifying medicines. I reasoned that the syndrome belonged to wind-heat injuring the Liver, causing blood dryness and tendon spasms, so I dared not apply external medicine. The next morning, upon request for treatment, it proved to be the aforementioned syndrome. I administered one dose of Liu Wei Wan (Six-Ingredient Pill), given early in the morning; by afternoon, his limbs returned to normal.
The son of Scholar Wang Wenyuan suffered from scrofula with abundant phlegm triggering convulsions. After taking metallic and aromatic-dry agents, he developed tendon spasms in hands and feet. This resulted from further injury to Liver Blood leading to acute infantile convulsion. I prescribed Jia Wei Xiao Chai Hu Tang (Modified Minor Bupleurum Decoction) added with Uncariae Ramulus cum Uncis (Gouteng), Gardeniae Fructus (Shanzhi), Ligustici Chuanxiong Rhizoma (Xiong), and Angelicae Sinensis Radix (Gui). One dose was given, followed by an infusion of Liu Wei Wan ingredients added with Schisandrae Fructus (Wuweizi) and Ophiopogonis Tuber (Maimen) to stabilize him.
When infants suddenly experience convulsion and tremor, upward gaze, head shaking, and teeth grinding, presenting bizarre symptoms, laypeople often diagnose it as excess in the Liver meridian and administer anticonvulsant drugs. They fail to realize that food stagnation and phlegm-saliva accumulation often mimic convulsion. One must carefully examine for signs of food retention, abdominal pain, chest fullness, vomiting, and food aversion. For mild cases, promote digestion and resolve phlegm; for severe cases, probe for emesis to expel retained food, then regulate. Additionally, fever caused by cold-attack or vomiting/diarrhea, where deficient Qi and Blood are forced by heat, may present with convulsive symptoms. Anticonvulsant drugs should not be taken immediately. Instead, regulating vomiting/diarrhea and cold-attack will naturally settle Qi, reduce heat, and eliminate convulsion.
My commentary: Regarding the aforementioned syndromes, if caused by Liver Wood insulting Spleen Earth, use Liu Jun Zi Tang added with Paeoniae Radix Alba (Shaoyao), Aucklandiae Radix (Muxiang), and Bupleuri Radix (Chaihu). If caused by Spleen Earth deficiency itself, use Wu Wei Yi Gong San (Five-Ingredient Formula for Benefiting Work). Generally, when food stagnation and phlegm accumulation cause convulsive symptoms, it is truly due to Spleen Earth deficiency failing to transform and transport. Strengthening the Spleen and Stomach will naturally digest food and resolve phlegm. Lightly using anticonvulsant or wind-dispelling drugs will instead generate wind and worsen the disease. Moreover, how can delicate organs withstand harsh and fierce agents? Treating only the apparent illness would be a mistake.
The son of Yibu Yao developed red halos on his body whenever food stagnated, cured by Qing Zhong Jie Yu Tang (Clear the Middle and Resolve Depression Decoction). Later, he suffered from head shaking, teeth grinding, abundant phlegm, and convulsions, vomiting sour fluid. After waiting for the vomitus to clear, he was given a small amount of Qi Wei Bai Zhu San (Seven-Ingredient Atractylodes Macrocephala Powder) the next day, followed by Shen Ling Bai Zhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) on subsequent days to regulate the Spleen and Stomach, after which he never suffered again. Generally, once vomiting ceases and the child is calm, no further medication is needed.
An infant with food stagnation developed nausea and abdominal distension after taking purgative/laxative agents, indicating secondary injury to the Spleen and Stomach. He recovered using Bu Zhong Yi Qi Tang.
An infant exhibited eye blinking and limb convulsions. Multiple doses of Tian Ma Fang Feng Wan (Gastrodia and Saposhnikovia Pill) were used to dispel wind and resolve phlegm, but the symptoms persisted and phlegm increased. Symptoms improved slightly after feeding. Observation of the nasal tip and left cheek revealed blue-yellow discoloration. I stated: The Spleen governs saliva/phlegm fluid. This is Liver Wood restraining Spleen Earth, failing to control the secretion of fluids, rather than excessive phlegm. I prescribed Liu Jun Zi Tang added with Cimicifugae Rhizoma (Shengma), Bupleuri Radix (Chaihu), and Uncariae Ramulus cum Uncis (Gouteng). After two doses, food intake gradually increased, and symptoms improved. Finally, Bu Zhong Yi Qi Tang was used to achieve stability.