小儿多有痞块者，总由口腹无节，见食必啖，食上加食，脾胃化之不及，则胃络所出之道，未
免渐有留滞，留滞不已，则日以益大，因成痞矣。或以感寒发热之后，胃气未清，此时最宜择食节
食，若不知慎，则食以邪留，最易成痞，此实人所不知也。第痞块既成，必在肠胃之外，膜膈之间
，故作可以消伐之剂推逐而去者。若但知攻痞，则胃气益弱，运化失权，不惟不能消痞，且致脾土
亏损，则痞邪益横而变百出矣。故治此者，当酌其缓急，专以调补胃气为主，外则用膏用灸，以拔
其结络之根，庶为万全之策。
一、凡调理脾胃之法，若痞邪未甚，宜芍药枳实丸加减用之为善，或大健脾丸及杨氏启脾丸，皆
可择用。若脾胃气虚，食少体瘦，宜五味异功散。若脾胃虚寒者，宜调中丸、温胃饮、五君子煎。
若兼胃脘停积，食滞作胀者，宜保和丸、消食丸，或大、小和中饮。苦胀急坚实，形气尚强，不得
不泻者，宜赤金豆、白饼子。若痞久成热，致动阳明之火，而牙口溃烂成疳者，宜芦荟丸、胡黄连
丸或蟾蜍丸。此外，如贴痞膏及炙治之法，俱详载积聚门。
钱仲阳曰∶小儿发痫，因血气未充，神气未实，或为风邪所伤，或为惊怪所触，亦有因妊娠时
七情惊怖所致。若眼直目牵，口噤涎流，肚膨发搐，项背反张，腰脊强劲，形如死状，终日不醒，
则为 矣。凡治五痫，皆随脏治之，每脏各有一兽之形，通用五色丸为主，仍参以各经之药。发而
重者死，病甚者亦死，如面赤目瞪，吐舌啮唇，心烦气短，其声如羊者曰心痫。血虚者用养心汤；
发热饮冷为实热，用虎睛丸；发热饮汤为虚热，用辰砂妙香丸。面青唇青，两眼上窜，手足挛掣反
折，其声如犬者曰肝滴。肝之虚者，用地黄丸；抽搐有力为实邪，用柴胡清肝散；大便不通，用泻
青丸。面黑目振，吐涎沫，形体如尸，其声如猪者曰肾痫，用地黄丸、紫河车丸之类。肾无泻法，
故径从虚治之。面如枯骨，目白反视，惊跳反折，摇头吐沫，其声如鸡者曰肺痫。
肺气虚者，用补肺散∶面色萎黄者，土不能生也，用五味异功散；面色亦者，阴火上冲于肺也
，用地黄丸。面色萎黄，目直腹满，自利，四肢不收，其声如牛者曰脾痫，用五味异功散；若面青
泻利，饮食少思，用六君子加木香、柴胡。若发热抽掣仰卧，面色光泽，脉浮者，病在腑，为阳证
，易治；身冷不搐覆卧，面色黯黑，脉沉者，病在脏，为阴证，难治。凡有此证，先宜看耳后高骨
间，若有青脉纹，先抓破出血，可免其患。此皆元气不足之证也，须以紫河车丸为主，而以补药佐
之。设若泛行克伐，复伤元气，则必不时举发，久而变危，多致不救。又有惊痫、风痫、食痫三种
。治惊痫，宜比金丸、茯神丸、钱氏养心汤、辰砂妙香散、清神汤、虎睛
丸之类主之。风痫用钱氏牛黄丸、消风丸、星苏散之类主之。食痫用妙圣丹主之。
薛立斋曰∶妊娠若遇惊恐，则必内应于胎，故一月足厥阴脉养，惊则肝有病；二月足少阳脉养
，惊则胆受病；三月手少阴脉养，惊则心受病；四月名为离经；五月足太阴脉养，惊则脾受病；六
月足阳明脉养，惊则胃受病；七月手太阴脉养，惊则肺受病；八月手阳明脉养，惊则大肠受病；九
月足少阴脉养，惊则肾受病。是脏腑纳气于丹田，自肝至肾，十经滋养而生，此则胎中所致也。若
既生之后，或惊怪所触，或乳哺失节，或乳母饮食起居，六淫七情，脏气不平，亦致是证。须察见
证属于何经，更别阴阳，以调补脾胃为主，否则不时举发，甚至不救。
Pediatric patients often present with *pi* masses (abdominal masses formed by qi and blood stagnation), which generally result from unregulated diet. They consume food indiscriminately, leading to excessive intake that exceeds the transformative capacity of the Spleen and Stomach. Consequently, the pathways of the Stomach collaterals inevitably experience gradual stagnation. If this stagnation persists, the mass enlarges daily, eventually forming a *pi* condition. In some cases, after contracting cold and fever, the Stomach Qi remains turbid. At this stage, it is crucial to select appropriate foods and regulate dietary intake; if caution is not exercised, food combined with pathogenic factors will linger, easily resulting in *pi* formation—a fact often overlooked. Once a *pi* mass has formed, it is located outside the intestines and stomach, within the membrane diaphragm. Therefore, some believe it can be expelled using draining and attacking decoctions. However, if one only focuses on attacking the mass, Stomach Qi becomes further weakened, and transformation and transportation lose their authority. Not only will the *pi* fail to dissipate, but Spleen Earth will also be depleted, causing the pathogenic factor of *pi* to become more rampant and generate various complications. Thus, treatment should assess urgency and prioritize regulating and tonifying Stomach Qi. Externally, applying plasters or moxibustion can extract the root of the knotted collaterals, offering a comprehensive strategy.
1. Regarding methods for regulating the Spleen and Stomach: If the *pi* pathogen is not severe, it is advisable to use Shaoyao Zhishi Wan (Peony and Immature Bitter Orange Pill) with modifications, or alternatively, Dajian Pi Wan (Great Spleen-Tonifying Pill) or Yangshi Qipi Wan (Yang’s Spleen-Enlightening Pill). For Spleen and Stomach Qi deficiency manifesting as poor appetite and emaciation, Wuyi Yigong San (Five-Agent Extraordinary Skill Powder) is suitable. For Spleen and Stomach deficiency-cold, Tiaozhong Wan (Regulate Middle Pill), Wenwei Yin (Warm Stomach Decoction), or Wu Junzi Jian (Five Gentlemen Decoction) are appropriate. If accompanied by accumulation in the epigastrium and distension due to food stagnation, Baohe Wan (Harmony-Preserving Pill), Xiaoshi Wan (Food-Digesting Pill), or Da/Xiao Hezhong Yin (Great/Small Harmonize-Middle Decoctions) may be used. If distension is urgent and hard, yet the patient’s constitution and Qi are still strong, requiring purgation, Chijin Dou (Golden Bean) or Baibingzi (White Cake Pill) are indicated. If the *pi* lingers and transforms into heat, stirring up the Fire of the Yangming channel and causing oral ulcers or infantile malnutrition (*gan*), Lushui Wan (Aloe Pill), Huhuanglian Wan (Coptis Pill), or Chanchu Wan (Toad Pill) are suitable. Additionally, plaster applications and moxibustion therapies are detailed in the Accumulation and Mass section.
Qian Zhongyang stated: Pediatric epilepsy arises because Blood and Qi are not yet full, and Spirit Qi is not yet solid. It may be caused by Wind pathogen invasion, shock from strange sights/sounds, or maternal fright during pregnancy. Symptoms include eyes staring straight or deviating, jaw locking with salivation, abdominal distension with convulsions, opisthotonos (neck/back arching), stiff waist and spine, resembling death, and prolonged unconsciousness. This constitutes epilepsy. Treatment of the five types of epilepsy follows the Zang organs, each associated with an animal form, primarily using Wuse Wan (Five-Color Pill) supplemented by channel-specific herbs. Severe or recurrent attacks lead to death; extreme severity also leads to death.
- Heart Epilepsy: Red face, staring eyes, protruding tongue, biting lips, restlessness, shortness of breath, bleating like a sheep. For Blood deficiency, use Yangxin Tang (Nourish Heart Decoction); for excess heat (fever craving cold drinks), use Huqing Wan (Tiger Eye Pill); for deficient heat (fever craving hot drinks), use Chensha Miaoxiang Wan (Cinnabar Wonderful Fragrance Pill).
- Liver Epilepsy: Blue/green face and lips, eyes rolling upward, limb spasms and hyperextension, barking like a dog. For Liver deficiency, use Dihuang Wan (Rehmannia Pill); for excess pathogen (strong convulsions), use Chaihu Qinggan San (Bupleurum Clear Liver Powder); for constipation, use Xieqing Wan (Drain Green Pill).
- Kidney Epilepsy: Black face, trembling eyes, frothy saliva, corpse-like posture, grunting like a pig. Use Dihuang Wan or Ziheche Wan (Placenta Pill). The Kidney has no purgative method, so treat directly for deficiency.
- Lung Epilepsy: Face like dry bone, white sclera showing, jumping/arching, head shaking with foam, crowing like a chicken. For Lung Qi deficiency, use Bufei San (Tonify Lung Powder); for sallow complexion (Earth failing to generate Metal), use Wuyi Yigong San; for dull complexion (Yin fire rushing to Lung), use Dihuang Wan.
- Spleen Epilepsy: Sallow complexion, staring eyes, abdominal fullness, spontaneous diarrhea, flaccid limbs, lowing like a cow. Use Wuyi Yigong San; for green face with diarrhea and poor appetite, use Liujunzi Tang (Six Gentlemen Decoction) plus Muxiang and Chaihu.
If fever with convulsions and supine posture, glossy face, and floating pulse occur, the disease is in the Fu organs (Yang pattern), easy to treat. If body cold, no convulsions, prone posture, dark face, and deep pulse occur, the disease is in the Zang organs (Yin pattern), difficult to treat. For these signs, first check the area behind the ear above the high bone; if blue vein patterns appear, scratch them to bleed to prevent disaster. These are all signs of insufficient Yuan Qi (Original Qi). Primary treatment must be Ziheche Wan, assisted by tonics. If harsh purgatives are used indiscriminately, damaging Yuan Qi, attacks will recur frequently, becoming critical and often untreatable.
There are also three types: Fright Epilepsy, Wind Epilepsy, and Food Epilepsy.
- Fright Epilepsy: Bijin Wan, Fushen Wan, Qianshi Yangxin Tang, Chensha Miaoxiang San, Qingshen Tang, Huqing Wan.
- Wind Epilepsy: Qianshi Niuhuang Wan, Xiaofeng Wan, Xingsu San.
- Food Epilepsy: Miaosheng Dan.
Xue Lizhai stated: During pregnancy, fright affects the fetus internally.
- Month 1: Foot Jueyin Liver channel nourishes; fright injures Liver.
- Month 2: Foot Shaoyang Gallbladder channel nourishes; fright injures Gallbladder.
- Month 3: Hand Shaoyin Heart channel nourishes; fright injures Heart.
- Month 4: Known as "Li Jing" (Departing from Normal).
- Month 5: Foot Taiyin Spleen channel nourishes; fright injures Spleen.
- Month 6: Foot Yangming Stomach channel nourishes; fright injures Stomach.
- Month 7: Hand Taiyin Lung channel nourishes; fright injures Lung.
- Month 8: Hand Yangming Large Intestine channel nourishes; fright injures Large Intestine.
- Month 9: Foot Shaoyin Kidney channel nourishes; fright injures Kidney.
This reflects the ten channels nourishing the fetus via Qi stored in the Dantian, from Liver to Kidney. Post-birth, epilepsy may result from fright, irregular feeding, or the wet-nurse’s diet/lifestyle affecting her Zang Qi through Six Evils or Seven Emotions. One must identify the affected channel, differentiate Yin/Yang, and prioritize regulating/tonifying Spleen and Stomach. Otherwise, attacks will recur, potentially becoming fatal.