半、生甘草三分、鲜石斛二钱、天冬钱半、鸭梨汁一瓢、淡竹沥一瓢、鲜石菖蒲汁一匙、先用青铅一斤化烊、
倾入水盆内捞起、再烊再倾三次、取此清水、煎鲜生地等五味、滚百余沸、滤清、再将梨汁竹沥、滚十余沸、
出、冲入鲜菖蒲汁、乘热即服。）或用龙牡潜镇汤。（青龙齿、珍珠母、左牡蛎、生白芍、海蛤壳、东白
薇。）髓热者。黄柏猪脊髓汤。（生川柏、猪脊髓、木通、石决明、鲜生地、生甘梢、冰片少许、童便冲入。）
（2）热痉 因∶其因有五。一因胎热。二因痫热。三因丹毒。四因胎毒。五因积热。皆能使热极生风。刺激神
经而发痉。证∶其证面色深红。口中气热。目赤唇紫。便闭溺少。呵欠顿闷。手足螈 。此因于胎热致痉。即
钱仲阳所谓热盛生风。时发惊搐也。若猝然仆倒。项强螈 。眼翻不转。口噤痰鸣。或作畜声。或吐涎沫。此因
痫热致痉。即孙真人所谓小儿痫热甚。亦发痉也。若身热如火。赤若丹砂。形似锦纹。其痛非常。项背反张。手
足螈 。此因于丹毒致痉。即孙真人所谓丹毒皆风热恶毒所为。入腹则杀人也。若面赤目闭。浑身壮热。小溲
红黄。大便闭结。口鼻气粗。手足螈 。此因于胎毒致痉。即万密斋所谓半岁之真搐。乃胎毒至酷至烈者也。
若壮热惊啼。面红目赤。上视 齿。便闭溺涩。角弓反张。手足螈 。此因积热致痉。即陈无择所谓小儿积
热者。表里俱热也。脉∶胎热发痉。脉多沉数。舌多深红。指纹多青。痫热发痉者。脉多弦滑。舌多灰滑。指
纹青紫。丹毒发痉者。脉多浮数。舌多鲜红。指纹紫青。胎热发痉者。脉多洪数。舌多紫红。纹亦青紫。积热
发痉者。脉多数实。舌多焦黄。指纹紫滞。已上五症。若指纹三关纯黑。推之不动者。症皆不治。治∶胎热发
痉。宜四顺清凉饮。（鲜生地、当归、生锦纹、生甘草。）调下秘授珍珠丸。（西黄五分、琥珀三钱、珠粉一
钱、雷丸、天竺黄、胡连各五钱、银胡、广木香、陈胆星各三钱、鸡内金一两、槟榔七钱、赤金箔五十张
为末、神曲糊为丸、如芥子大、金箔为衣。）每服五七丸。专治小儿急惊风。痰迷心窍。抽搐昏晕。牙关紧
闭。口不能啼。命在须臾。急用此丸。立可回生。痫热发痉。初用羚角钩藤汤。（羚羊角、双钩藤、九制胆
星、天竺黄、嫩桑芽、鲜竹叶心。）调下猴马二宝散。（真猴枣一分、真马宝一分、共为末。）药汤调下。或
用菊花天麻汤。（真滁菊、明天麻、白知母、生玳瑁、石决明、蜣螂虫。）调下痫症镇心丹。（真珠粉、真马
宝、羚羊角各五分、川贝母二钱、为末糊丸、如绿豆大。）每次一二丸。药汤调下。丹毒发痉。初用银翘浮萍
汤。（金银花、连翘、牛蒡子、生甘草、苦桔梗、鲜竹叶、水芦根、紫背浮萍草。）药汤调下五福化毒丸。或
用五味化毒汤。（金银花、野菊花、紫花地丁草、蒲公英、紫背天葵草。）调下犀角解毒丸。胎毒发痉。初用
胡连甘草汤。（胡黄连、生甘草、淡竹叶、鲜生地、木通。）调下解毒延龄丹。（收儿脐带寸许、焙研末五
分、小川连二分半、飞辰砂一分、蜜和为丸。）三分。药汤下。以逐毒定痉。或用三豆银翘汤。（生扁豆、生
绿豆、黑料豆、银花、连翘、生甘草。）调下生熟解毒丸。（生炒子芩、生炒川柏、生炒胡连各一钱、生炙甘
草各八分、上擂水为丸、如小米大、辰砂雄黄为衣、每服十丸。）积热发痉。便闭者。凉膈加羚羊汤。（薄
荷、连翘、生锦纹、焦山栀、青子芩、生甘草、羚羊角、元明粉、淡竹叶、白蜜。）便通者。四物镇痉汤。
（羚羊角、浙茯苓、生石膏、淡竹沥。）善后之法。或用鞠通五汁饮。（鸭梨汁、麦冬汁、荸荠汁、生藕汁、
鲜芦根汁、或用蔗浆。）和匀凉服。重汤炖温。
（四）暑痉 暑兼湿热后。有湿痉一条。此则偏于热多湿少之病。《经》谓后夏至为病暑者是也。按俗名小儿急惊
风者。惟暑月最多。而兼证最杂。非心如澄潭。目如珠智。笔如分水犀者。未易辨此。盖小儿肤薄神怯。经络
脏腑较小。不耐暑气发泄。邪之来也。势如奔马。其传变也。急如掣电。岂粗疏者所能当此任哉。如暑月小儿
身热头痛。项强无汗。此暑兼风寒者也。宜新加香薷饮。有汗。则仍用银翘散。重加桑叶。咳嗽。则用桑菊饮。
汗多。则用白虎汤。脉芤而喘。则用人参白虎汤。身重汗少。则用苍术白虎汤。脉芤面赤。多言喘喝欲脱者。
即用生脉散。神识不清者。即用清营汤。加钩藤、丹皮、羚羊角。神昏者。兼用紫雪丹、牛黄丸等。病势轻微
者。如清络饮之类。方法悉载上焦篇。学人当与前三焦篇、暑门中细心求之。（荣斋按∶此下系何先生语。）
余按婴儿头脊两部脑筋最灵。凡猝然伤暑。即风翔火炽。藉乳酿痰。激动脑筋。发痉而似惊者。夏月最多。其
因有二。一为猝冒暑风。一为骤中暑秽。世俗通称急惊。皆不查病因。见形取名。以欺病家。盖暑风初起。其
症有二。一头痛壮热。项强无汗。角弓反张。咳痰惊啼。吴鞠通所谓暑兼风寒者也。二面红灼热。目赤自汗。
脊强肢螈。此张寿甫所谓热动肝风而脑筋妄行者也。暑秽初起。壮热面红。目赤上视。 齿弄舌。手足螈 。
神识昏迷。四肢厥逆。二便不通。或泻不爽。此叶天士所谓热气闭塞。孔窍昏迷若惊。是为暑厥也。凡暑兼风
寒者。苔白微黄。脉左浮紧。右浮滑。指纹浮红带青。或兼淡紫。无汗。宜用加味香薷饮。（西香薷、制川
朴、羌活、扁豆衣、秦艽、钩藤。）或用新加香薷饮。（香薷、制川朴、金银花、扁豆花。连翘、竹叶。）有
汗则用加减凉膈散。（牛蒡子、滁菊花、明天麻、连翘、天水散、荷叶包、鲜竹叶、桑芽、灯心。）暑重。加
西瓜翠衣。兼咳。则用桑菊饮。暑动肝风者。舌黄或赤。脉多弦数。甚或弦滑。指纹青紫窜出气关。热渴汗多
者。古方竹叶石膏汤主之（方见前）。或新加白虎汤。（生石膏、益元散、知母、西洋参、竹叶、荷花露。）
营热昏痉者。暑陷营分。舌必绛赤。痉而且厥。再挟乳汁酿痰。蒙蔽心包。堵其神气出入之清窍。不论暑风、
暑温、暑痉、暑厥。皆宜羚羊清营汤。（羚羊角、金银花、生山栀、鲜生地、青连翘、淡竹沥。）调下紫雪丹
三分。面赤多言。喘喝欲脱。急用生脉散（太子参、麦冬、五味子。）救之。暑秽闭窍者。舌多黄赤浊腻。脉
多沉伏。指纹紫赤不鲜。若脉芤而喘。大汗息促。指纹青黑。直出命关者。此内闭外脱之危候。治宜清芬宣窍
为主。舌苔垢腻者。清芬辟疫汤。（苏薄荷、佩兰叶、活水芦根、青蒿脑、鲜石菖蒲、鲜茅根。）调下玉枢丹
二粒。或至宝丹一颗。舌上无苔者。石氏犀角地黄汤。（犀角尖、银花、鲜生地、连翘、活水芦根、鲜石菖
蒲、广郁金、梨汁、竹沥、姜汁少许。）调下瓜霜紫雪丹二分。或用陆氏犀羚镇痉汤。（犀角、羚羊角、鲜生
地、元参、银花、连翘、人中黄、竹沥。）调下至宝丹一颗。痉定神苏以后。或用清肺轻剂。清络饮（鲜荷叶
边、鲜银花、西瓜翠衣、鲜扁豆花、鲜丝瓜皮、鲜竹叶。）主之。或用清凉血分。四汁二心汤（鲜生地汁、雪
梨汁、西瓜汁、生藕汁、先用卷心竹叶五十支、用水两碗、煎取清汤、将四汁和入、约煎二十余沸、冲入莲子
心二十支、时时灌饮。）主之。
（五）湿痉 按此一条。螈 兼有。其因于寒湿者。则兼太阳之气。其泄泻太甚。下多亡阴者。木气来乘则螈
矣。按中湿即痉者少。盖湿性柔而下行。不似风刚而上升也。其间有兼风之痉。《名医类案》中有一条云。小儿吐
欲作痫者。五苓散最妙。本论湿温上焦篇。有三仁汤一法。邪入心包。用清宫汤。去莲心、麦冬。加银花、
赤小豆皮一法。用紫雪丹一法。银翘马勃散一法。《千金》苇茎汤加滑石、杏仁一法。而寒湿例中。有形似伤
寒。舌白不渴。经络拘急。桂枝姜附汤一法。凡此非必皆现痉病而后治。盖既感外邪。久则致痉。于其未痉之先。知
系感受何邪。当以何法治之。而痉病之源绝矣。岂不愈于见痉治痉哉。廉按中湿即痉者少。其间必有兼证。约
有二因。一因湿滞兼风。外袭太阳经。发汗太多。致项脊强而痉挛者。但痉不搐。一因湿热动风。直窜脑神
经。致脑膜炎而发痉螈者。痉厥兼搐。古时皆称柔痉。惟方吴二家则名湿痉。盖风湿过汗而发痉挛者。必身热
自汗。肌肉烦疼。项强口噤。四肢拘急。角弓反张。手足微冷。此《内经》所谓诸痉项强皆属于湿是也。亦即
《金匮要略》所谓太阳病发热汗出。而不恶寒者。名曰柔痉也。湿热动风而发痉螈者。卒然口噤。角弓反张。壮热自
汗。口燥渴饮。手足螈 。目瞪昏厥。此《内经》所谓诸热瞀螈。皆属于火是也。陈平伯所谓湿热化火。火动则风
生。风煽则火炽。外窜督脉则成痉。上窜脑中则为厥。正《素问》所谓血之与气并走于上。则为大厥。厥则暴死是
也。凡痉挛脉多浮眩。甚或弦急。舌多白滑。或白而糙。首当活络舒筋为君。佐以熄风化湿。古方观音散加
减。（生苡仁、生明乳香、川桂枝、竹茹、生没药、茯苓、天麻、桑枝。）时方陈氏熄风胜湿汤。（羚羊角、
竹茹、秦艽、钩藤、丝瓜络、飞滑石、梗通草、鲜桑枝。）痉螈脉多弦数。甚则弦劲。舌多黄腻。甚或焦黄。
指纹色多青紫而显明。若天庭青黯。目瞪直视。脉细劲。或伏坚。纹则粗硬如露青筋。推之血不流利。昏厥过
二十四小时不醒者。则必其气不复返而死矣。初起时。首当熄风定螈为君。佐以豁痰泄热。古方竹叶石膏汤加
减（方见前）。时方羚麻白虎汤加减（方见前）。善后之法。总以濡血养筋为君。佐以健胃。加减四物汤。（细
生地、生白芍、黄草石斛、当归、炙甘草、桑枝。）尚有余热者。仍佐清热。见有气虚者。当佐益气。如见关
节处微肿且疼。不能屈伸者。则用茅根桑枝煎。（鲜茅根、嫩桑枝各五钱、阿斯必林片一片冲。）退筋节之
炎。以定挛痛。
（六）燥痉 燥气化火。消烁津液。亦能致痉。其治略似风温。学人当于本论前三焦篇秋燥门中求之。但正秋
之时。有伏暑内发。新凉外加之证。燥者。宜辛凉甘润。有伏暑则兼湿矣。轻则苦辛淡。甚则苦辛寒矣。不可
不细加察。如燥气化寒。胁痛呕吐。法用苦温。佐以甘辛。廉按燥痉其因有二。一因五气化火。火必就燥。液
涸动风。每致痉螈。一因秋燥时。伏暑内发。新凉外搏。燥热动风。亦多发痉螈。液涸动风者。舌绛且干。口
干齿燥。手指蠕动。继则目窜斜视。手足螈 。或厥或呃。却无痰涎。脉左细劲。右浮大。指纹淡红带青。或
兼淡紫。此胡在兹所谓阴虚阳亢。肝风上翔。猝发痉厥也。初用阿胶鸡子黄汤。（陈阿胶、生白芍、生牡蛎、
鲜生地、女贞子、黄甘菊、鸡子黄。）并治妇女血虚生风。见有头晕心悸。耳鸣躁扰。或发痉。或猝厥者。屡
投辄效。或小定风珠。（陈阿胶、生龟版、淡菜、鸡子黄、童便。）或鸡子黄煎。（鸡子黄十枚、乱发一团、沸
汤洗净、二味入铜锅内、以炭火缓缓拌熬、令同化如水、即置地上出火气、频频灌之。）并治胎毒丹毒火疮。
涂之亦效。若肝络尚有伏热者。用加减阿胶黄连汤。（陈阿胶、小川连、生白芍、羚羊角、鸡子黄、童便冲。）
肺经有粘痰者。用青铅镇冲汤（方见前）。加竹沥、梨汁。终用五汁饮以善后。燥热动风者。舌干苔焦。唇焦
齿干。头痛身热。继则脊强肢螈。气升痰壅。或喘或厥。神烦惊啼。脉左弦数。右滑搏。指纹青紫。直窜命
关。此吴鞠通所谓燥气化火。消烁津液。亦能致痉也。便通者。用清离定巽汤。（青连翘、冬桑叶、鲜生地、
鲜竹叶、滁菊花、元参、木瓜、钩藤。）便闭者。用元蜜煎。（元明粉四分、白蜜四钱泡汤。）调下瓜霜紫雪
丹二分。终用四汁二心汤（方见前）以善后。不论虚燥实燥。若津液未能回复。指纹或淡或紫。透关射甲者。
症多不治。惟虚燥尤为危险。
（七）内伤饮食痉（俗名慢脾风）按此证必先由于吐泻。有脾胃两伤者。有专伤脾阳者。有专伤胃阳者。有
伤及肾阳者。参苓白术散、四君。六君、异功、补中益气、理中等汤。皆可选用。虚寒甚者。理中加丁香、
肉桂、肉果、诃子之类。因他病伤寒凉药者。亦同此例。《叶案》中有阴风入脾络一条。方在小儿痫痉厥门中。
其小儿吐泻门中。言此证最为详细。案后华岫云驳俗论最妙。学人不可不静心体察焉。再参之钱仲阳、薛立斋
李东垣、张景岳诸家。可无余蕴矣。再按此证最险最为难治。世之讹传妄治已久。四海同风。历有年所。方中
行驳之于前。诸君子畅论于后。至今日而其伪风不息。是所望于后之强有力者。悉取其伪书而焚耳。细观《叶案》
治法之妙。全在见吐泻时。先防其痉。非于既痉而后设法也。
（八）客忤痉（俗谓惊吓）按小儿神怯气弱。或见非常之物。听非常之响。或失足落空跌仆之类。百证中或
(3) Heat Spasm Etiology: There are five causes. One is fetal heat, two is epileptic heat, three is erysipelas, four is fetal toxin, and five is accumulated heat. All of these can cause extreme heat to generate wind, stimulating the nerves and causing spasms. Symptoms: The complexion is deep red, breath from the mouth is hot, eyes are red and lips are purple, stool is constipated and urine is scanty, yawning occurs accompanied by sudden irritability, and hands and feet twitch. This is spasm caused by fetal heat, which is what Qian Zhongyang referred to as "heat excess generating wind," characterized by frequent convulsions and twitching. If one suddenly falls down, with neck stiffness and twitching, eyes rolling upward and unable to turn, jaw clenched with phlegm rattle, or making sounds like livestock, or vomiting saliva, this is spasm caused by epileptic heat, which is what Sun Simiao said about severe pediatric epileptic heat also causing spasms. If the body is hot as fire, skin is crimson like cinnabar, the body exhibits patterns resembling brocade, pain is extremely severe, neck and back arch backward (opisthotonos), and hands and feet twitch, this is spasm caused by erysipelas, which is what Sun Simiao said erysipelas is caused by evil wind-heat toxins; if it enters the abdomen, it is fatal. If the face is red and eyes closed, whole body high fever, urine is red and yellow, stool is constipated, breathing through mouth and nose is coarse, and hands and feet twitch, this is spasm caused by fetal toxin, which is what Wan Mizhai said is the true convulsion of a half-year-old infant, caused by extremely fierce fetal toxin. If there is high fever with startled crying, red face and red eyes, upward gaze with teeth grinding, constipation and dysuria, opisthotonos, and hand-foot twitching, this is spasm caused by accumulated heat, which is what Chen Wuze said refers to pediatric accumulated heat where both exterior and interior are hot. Pulse: For fetal heat spasm, the pulse is mostly sinking and rapid, tongue is mostly deep red, and fingerprint is mostly green. For epileptic heat spasm, the pulse is mostly wiry and slippery, tongue is mostly gray and slippery, and fingerprint is green-purple. For erysipelas spasm, the pulse is mostly floating and rapid, tongue is mostly fresh red, and fingerprint is purple-green. For fetal toxin spasm, the pulse is mostly surging and rapid, tongue is mostly purple-red, and fingerprint is also green-purple. For accumulated heat spasm, the pulse is mostly rapid and solid, tongue is mostly scorched yellow, and fingerprint is purple and stagnant. Among the above five conditions, if the fingerprint is purely black across the three sections and immobile upon pushing, all conditions are untreatable. Treatment: For fetal heat spasm, use Sishun Qingliang Yin (Fresh Rehmanniae Radix, Angelicae Sinensis Radix, Rheum Palmatum Radix, Glycyrrhizae Radix et Rhizoma) to take Mishou Zhenzhu Wan (Musk, Amber, Pearl Powder, Oryzoctopus, Tianshu Huang, Coptidis Rhizoma each 5 qian, Silver Hu, Costi Rhizome, Arisaema Cum Bile each 3 qian, Chicken Gizzard Lining 1 liang, Areca Seed 7 qian, Red Gold Leaf 50 sheets powdered, pillified with Schisandra paste to size of mustard seed, coated with gold leaf). Take 5-7 pills per dose. Specifically treats pediatric acute convulsive disease, phlegm confusing the heart orifice, convulsions, coma, clenched jaw, inability to cry, life in imminent danger; urgently use this pill for immediate recovery. For epileptic heat spasm, initially use Lingjiao Gouteng Tang (Antelope Horn, Uncaria Ramulus cum Uncis, Processed Arisaema, Tianshu Huang, Tender Mulberry Sprouts, Fresh Bamboo Leaf Heart) to take Houma Erbao San (Real Monkey Date, Real Horse Treasure, powdered together). Administer with medicinal decoction. Or use Juhua Tianma Tang (Real Chuzhou Chrysanthemum, Clear Sky Gastrodia, White Anemarrhena, Raw Trionyx Carapax, Argopecten irradians Shell, Dung Beetle), to take Xianzheng Zhenxin Dan (Pearl Powder, Real Horse Treasure, Antelope Horn each 5 fen, Fritillariae Bulbus 2 qian, powdered and pillified with paste to size of mung bean). Take 1-2 pills per time, administered with medicinal decoction. For erysipelas spasm, initially use Yinqiao Fuping Tang (Honeysuckle Flower, Forsythiae Fructus, Arctii Fructus, Raw Licorice Root, Bitter Platycodon Root, Fresh Bamboo Leaf, Water Reed Rhizome, Purple-backed Floating Fern Herb) to take Wufu Huadu Wan. Or use Wuwei Huadu Tang (Honeysuckle Flower, Wild Chrysanthemum Flower, Violet Perilla Herb, Dandelion, Purple-backed Tiande Herb) to take Xijiao Jiedu Wan. For fetal toxin spasm, initially use Hulian Gancao Tang (Coptidis Rhizoma, Raw Licorice Root, Light Bamboo Leaf, Fresh Rehmanniae Radix, Akebia Caulis) to take Jiedu Yanling Dan (Collect infant umbilical cord approx. 1 cun, dry and powder 5 fen, Small Coptis 2.5 fen, Calcined Cinnabar 1 fen, honey-pilled). Take 3 fen with medicinal decoction to expel toxin and stabilize spasm. Or use Sandou Yinqiao Tang (Raw Soybean, Raw Green Bean, Black Soybean, Honeysuckle, Forsythia, Raw Licorice) to take Shengshu Jiedu Wan (Raw/Stir-fried Scutellaria Root, Raw/Stir-fried Phellodendron Bark, Raw/Stir-fried Coptis each 1 qian, Raw/Roasted Licorice each 8 fen, pounded with water into pills the size of millet seeds, coated with Cinnabar and Realgar, take 10 pills per dose). For accumulated heat spasm, if stool is constipated, use Liangge Jia Lingyang Tang (Mint, Forsythia, Raw Rhubarb, Scorched Gardenia, Young Scutellaria Root, Raw Licorice, Antelope Horn, Mirabilite, Light Bamboo Leaf, White Honey). If stool is unblocked, use Siwu Zhenjing Tang (Antelope Horn, Zhejiang Poria, Raw Gypsum, Light Bamboo Juice). For aftercare, use Juzhong Wuzhi Yin (Duck Pear Juice, Ophiopogon Juice, Arrowroot Juice, Raw Lotus Root Juice, Fresh Reed Rhizome Juice, or Sugarcane Juice), mix evenly and take cool, warm in double boiler.
(4) Summerheat Spasm After summerheat combines with dampness, there is a damp spasm condition; this text discusses the pathology biased towards more heat and less dampness. The Classic states that diseases occurring after the Summer Solstice are summerheat. According to common names, pediatric acute convulsive disease occurs most frequently in summer months and has the most complex accompanying symptoms. It is not easy to distinguish clearly without a mind clear as a still pool, eyes wise as pearls, and pen sharp as a dividing rhino horn. Generally, infants have thin skin and timid spirit, their meridians and zang-fu organs are smaller, and they cannot tolerate the venting of summerheat qi. When pathogenic factors arrive, the momentum is like a galloping horse; their transmission is as rapid as lightning. How could rough and careless practitioners handle this? For example, in summer months, if an infant has body heat, headache, neck stiffness, and no sweat, this is summerheat combined with wind-cold, suitable for Xinjia Xiangru Yin. With sweat, continue using Yinqiao San, adding heavy Cassiae Folium. For cough, use Sangju Yin. For excessive sweating, use Baihu Tang. For Kou pulse and panting, use Renshen Baihu Tang. For heavy body and little sweat, use Cangzhu Baihu Tang. For Kou pulse, red face, excessive talking, panting and drinking, desire to collapse, immediately use Shengmai San. For unclear consciousness, use Qingying Tang, adding Uncaria, Moutan Cortex, Antelope Horn. For coma, additionally use Zixue Dan, Niuhuang Wan, etc. For mild disease severity, use formulas like Qingluo Yin; methods are fully recorded in the Upper Jiao Chapter. Students should seek them carefully in the first three Jiao chapters and the Summerheat section. (Rongzhai notes: The following is Mr. He's words.) I note: The brain and spinal cord in the head and spine of infants are most sensitive. Whenever sudden summerheat injury occurs, wind flies and fire blazes, milk ferments into phlegm, agitating the brain and causing spasms resembling convulsions, which is most common in summer. There are two causes: one is sudden exposure to summerwind, the other is sudden inhalation of summer foulness. The secular world generally calls it acute convulsion, without investigating the cause, naming based on appearance to deceive the sick family. Initially, summerwind presents with two symptoms: one is headache, high fever, neck stiffness, no sweat, opisthotonos, coughing phlegm, and startled crying, which Wu Jutong called summerheat combined with wind-cold. The other is red burning face, red eyes with spontaneous sweat, stiff spine and limb twitching, which Zhang Shoufu called heat moving liver wind and brain nerves acting wildly. Initially, summer foulness presents with high fever, red face, red eyes, upward gaze, teeth grinding, tongue playing, hand-foot twitching, unconsciousness, cold limbs, blockage of both bowels and bladder, or unsatisfactory diarrhea. This is Ye Tianshi called heat qi blocking orifices, confusion resembling convulsion, known as summer syncope. For summerheat combined with wind-cold, coating is white slightly yellow, left pulse floating tight, right pulse floating slippery, fingerprint floating red with green, or mixed light purple, no sweat, suitable for Jiawei Xiangru Yin (Western Xiangru, Processed Magnolia Bark, Notopterygium Root, Legume Coat, Gentian Macrophylla Root, Uncaria). Or Xinjia Xiangru Yin (Xiangru, Processed Magnolia Bark, Honeysuckle, Legume Flower, Forsythia, Bamboo Leaf). With sweat, use Jiajian Liange San (Arctii Fructus, Chuzhou Chrysanthemum, Clear Sky Gastrodia, Forsythia, Tianshui San wrapped in Lotus Leaf, Fresh Bamboo Leaf, Mulberry Sprouts, Juncus Effusus). For heavy summerheat, add Watermelon Albedo. With cough, use Sangju Yin. For summerheat moving liver wind, tongue is yellow or red, pulse is mostly wiry and rapid, even wiry and slippery, fingerprint green-purple窜ming out of Qi Guan. For heat thirst and excessive sweating, ancient formula Zhuye Shigao Tang governs (formula seen before). Or Xinjia Baihu Tang (Raw Gypsum, Yi Yuan San, Anemarrhena, American Ginseng, Bamboo Leaf, Lotus Flower Dew). For Ying heat coma spasm, summerheat sinks into Ying level, tongue must be crimson red, spasm with syncope, further mixing milk fermenting phlegm, covering Heart Protector, blocking clear orifices for spirit qi entry and exit. Regardless of summerwind, summerwarmth, summer spasm, or summer syncope, all should use Lingyang Qingying Tang (Antelope Horn, Honeysuckle, Raw Gardenia, Fresh Rehmannia, Green Forsythia, Light Bamboo Juice) to take Zixue Dan 3 fen. For red face, excessive talking, panting/drinking, desire to collapse, urgently use Shengmai San (Pseudostellaria Root, Ophiopogon, Schisandra) to rescue. For summer foulness closing orifices, tongue is mostly yellow-red turbid greasy, pulse is mostly sunken and hidden, fingerprint purple-red not fresh. If pulse is Kou and panting, massive sweat, rapid breathing, fingerprint green-black straight out to Ming Guan, this is critical condition of internal closure and external collapse. Treatment should focus on clearing fragrance and opening orifices. For greasy tongue coating, Qingfen Biyi Tang (Peppermint, Eupatorium Leaf, Living Water Reed Rhizome, Artemisia Brain, Fresh Acorus, Fresh Imperata Rhizome) to take Yushu Dan 2 pills. Or Zhibao Dan 1 pill. For tongue without coating, Shi's Xijiao Dihuang Tang (Xijiao tip, Honeysuckle, Fresh Rehmannia, Forsythia, Living Water Reed Rhizome, Fresh Acorus, Curcuma Aromatica Root, Pear Juice, Bamboo Juice, small amount Ginger Juice) to take Guashuang Zixue Dan 2 fen. Or Lu's Xiling Zhenjing Tang (Xijiao, Antelope Horn, Fresh Rehmannia, Scrophularia Root, Honeysuckle, Forsythia, Human Middle Yellow, Bamboo Juice) to take Zhibao Dan 1 pill. After spasm settles and spirit revives, use light lung-clearing agent, Qingluo Yin (Fresh Lotus Leaf Edge, Fresh Honeysuckle, Watermelon Albedo, Fresh Legume Flower, Fresh Luffa Peel, Fresh Bamboo Leaf) governs. Or use cooling blood level, Sizhi Erxin Tang (Fresh Rehmannia Juice, Snow Pear Juice, Watermelon Juice, Raw Lotus Root Juice, first boil 50 curled heart bamboo leaves in 2 bowls water, extract clear soup, mix four juices, boil approx 20 boils, add 20 lotus hearts, administer frequently) governs.
(5) Damp Spasm According to this item, twitching is present. Those caused by cold-damp combine with Taiyang qi. Those with excessive diarrhea leading to yin loss, Wood qi attacks causing twitching. Note that dampness turning into spasm is rare. Damp nature is soft and descends, unlike wind which is rigid and ascends. Among them, there is spasm combining wind. "Famous Medical Cases" has one case: Infant vomiting wanting to become epilepsy, Wuling San is best. This treatise's Damp-Warmth Upper Jiao chapter has Sanren Tang method. Pathogen entering Heart Protector, use Qinggong Tang, remove Nelumbo Plumule and Ophiopogon, add Honeysuckle and Vigna Angularis Skin method. Use Zixue Dan method. Yinqiao Mabo San method. "Qianjin" Weijing Tang plus Slipperseed and Apricot Kernel method. In Cold-Damp examples, shape resembles cold damage, white tongue without thirst, meridian constriction, Guizhi Jiangfu Tang method. None of these necessarily require waiting for spasm symptoms to treat. Once external pathogen is felt, long-term leads to spasm. Before spasm occurs, know which pathogen was felt and how to treat it, thus cutting off the source of spasm. Is this not better than treating spasm after it appears? Lian notes dampness turning into spasm is rare, there must be accompanying symptoms, roughly two causes. One is damp stagnation combining with wind, externally attacking Taiyang meridian, excessive sweating causing neck/spine stiffness and spasm, but only spasm without twitching. One is damp-heat moving wind, directly rushing to brain nerves, causing meningitis and spasm/twitching, spasm/syncope with twitching. Ancient times called all Rou Jing. Only Fang and Wu named it Shi Jing. Wind-damp from excessive sweating causing spasm must have body heat, spontaneous sweat, muscle irritation/pain, neck stiffness, jaw clenching, limb rigidity, opisthotonos, slight cold hands/feet. This is "Neijing" saying all spasms with neck stiffness belong to damp. Also "Jingui Yaolue" saying Taiyang disease with fever and sweat but no aversion to cold is named Rou Jing. Damp-heat moving wind causing spasm/twitching: sudden jaw clenching, opisthotonos, high fever with spontaneous sweat, dry mouth/thirst for drink, hand-foot twitching, staring eyes/coma. This is "Neijing" saying all heat dizziness/twitching belongs to fire. Chen Pingbo said damp-heat transforms to fire, fire moves then wind generates, wind fans then fire blazes, externally rushing Du meridian becomes spasm, upwards rushing brain becomes syncope. Exactly "Suwen" saying blood and qi running up together becomes Great Syncope, syncope means sudden death. For spasm, pulse is mostly floating/dizzy, even wiry/tight, tongue mostly white slippery or white rough. First activate collaterals and relax sinews as sovereign, assist with extinguishing wind and resolving dampness. Ancient formula Guanyin San modified (Coix Seed, Raw Milk Frankincense, Cinnamon Twig, Bamboo Sheath, Raw Myrrh, Poria, Gastrodia, Mulberry Branch). Contemporary formula Chen's Xifeng Shengshi Tang (Antelope Horn, Bamboo Sheath, Gentian Macrophylla, Uncaria, Luffa Loop, Calcined Talc, Passerstalk Akebia, Fresh Mulberry Branch). Spasm/twitching pulse mostly wiry/rapid, even wiry/firm, tongue mostly yellow greasy, even scorched yellow, fingerprint color mostly green-purple and bright. If forehead is dark cyan, staring eyes fixed, pulse fine/firm or sunken/hard, fingerprint thick/hard like exposed blue vein, pushing blood does not flow smoothly, coma over 24 hours not waking, then qi will not return and death is certain. At onset, first extinguish wind and stop twitching as sovereign, assist with resolving phlegm and draining heat. Ancient formula Zhuye Shigao Tang modified (formula seen before). Contemporary formula Lingma Baihu Tang modified (formula seen before). Aftercare method always nourishes blood and tonifies sinews as sovereign, assists with strengthening stomach. Jiajian Siwu Tang (Fine Rehmannia, Raw White Peony, Dendrobium, Angelica, Roasted Licorice, Mulberry Branch). If residual heat remains, still assist with clearing heat. If qi deficiency seen, assist with tonifying qi. If joints slightly swollen and painful, unable to flex/extend, use Maogen Sangzhi Decoction (Fresh Imperata Rhizome, Tender Mulberry Branch each 5 qian, Aspirin tablet 1 piece dissolved) to reduce joint inflammation and settle cramping pain.
(6) Dryness Spasm Dryness qi transforms to fire, consuming fluids, can also cause spasm. Its treatment is similar to Wind-Warmth. Students should seek in the first three Jiao chapters Autumn Dryness section of this treatise. But during mid-autumn, there are cases of latent summerheat internally erupting and new coolness externally adding. For dryness, use pungent-cool sweet-moist. If latent summerheat exists, it combines with dampness. Mildly bitter-pungent light, severely bitter-pungent cold. Must examine carefully. If dryness transforms to cold, hypochondriac pain/vomiting, method uses bitter-warm, assist with sweet-pungent. Lian notes dryness spasm has two causes. One is five qi transforming to fire, fire seeks dryness, fluid depletion moves wind, often causing spasm/twitching. One is autumn dryness time, latent summerheat internally erupts, new coolness externally combats, dryness-heat moves wind, also often causes spasm/twitching. Fluid depletion moving wind: tongue crimson and dry, dry mouth/tooth dry, finger twitching, subsequently eye wandering/slanting gaze, hand-foot twitching, or syncope or hiccups, yet no phlegm-saliva, left pulse fine/firm, right pulse floating/large, fingerprint light red with green, or mixed light purple. This is Hu Zaizi called yin deficiency yang hyperactivity, liver wind flying up, suddenly causing spasm/syncope. Initially use Ejiao Jizihuang Tang (Aged Ejiao, Raw White Peony, Raw Oyster Shell, Fresh Rehmannia, Ligustrum Lucidum Fruit, Yellow Chrysanthemum, Egg Yolk), also treats women blood deficiency generating wind, seeing dizziness/palpitations, tinnitus/restlessness, or spasm or sudden syncope, repeatedly effective. Or Xiaodingfeng Zhu (Aged Ejiao, Raw Turtle Shell, Clam Meat, Egg Yolk, Child Urine). Or Jizihuang Jian (10 Egg Yolks,一团 Hair, washed with boiling water, put two items in copper pot, slowly stir-fry over charcoal fire until melting like water, place on ground to remove fire qi, frequently administer). Also treats fetal toxin/erysipelas/fire sores, applying is also effective. If liver collaterals still have latent heat, use Jiajian Ejiao Huanglian Tang (Aged Ejiao, Small Coptis, Raw White Peony, Antelope Horn, Egg Yolk, child urine flush). If lung meridian has sticky phlegm, use Qingqian Zhenchong Tang (formula seen before), add Bamboo Juice, Pear Juice. Finally use Wuzhi Yin for aftercare. Dryness-heat moving wind: tongue dry coating scorched, lips scorched teeth dry, headache body heat, subsequently spine stiff limb twitching, qi rising phlegm congestion, or panting or syncope, spirit irritable/startled crying, left pulse wiry/rapid, right pulse slippery/beating, fingerprint green-purple, straight rushing to Ming Guan. This is Wu Jutong called dryness qi transforming to fire, consuming fluids, also causing spasm. If stool unblocked, use Qingli Dingxun Tang (Green Forsythia, Winter Mulberry Leaf, Fresh Rehmannia, Fresh Bamboo Leaf, Chuzhou Chrysanthemum, Scrophularia, Quince, Uncaria). If stool blocked, use Yuanmi Jian (Mirabilite 4 fen, White Honey 4 qian soaked in soup) to take Guashuang Zixue Dan 2 fen. Finally use Sizhi Erxin Tang (formula seen before) for aftercare. Regardless of deficiency-dryness or excess-dryness, if fluids do not recover, fingerprint pale or purple, penetrating guan shooting nail, condition mostly untreatable, deficiency-dryness is especially dangerous.
(7) Internal Injury Diet Spasm (Secular name Slow Spleen Wind) According to this condition, it must first result from vomiting/diarrhea. There are spleen/stomach both injured, spleen yang only injured, stomach yang only injured, kidney yang injured. Shenling Baizhu San, Sijunzi, Liu Jun, Yigong, Buzhong Yiqi, Lizhong etc. decoctions can be selected. For severe deficiency-cold, Lizhong added with Clove, Cinnamon, Myristica, Chebula etc. Due to other diseases taking cold medicines for cold damage, same principle applies. "Ye An" has Yin Wind Entering Spleen Collateral item, formula in Pediatric Epilepsy/Spasm/Syncope section. Its Pediatric Vomiting/Diarrhea section discusses this condition most detailed, post-case Hua Xiuyun refuting secular theory is best, students must calmly observe. Further refer to Qian Zhongyang, Xue Lizhai, Li Dongyuan, Zhang Jingyue etc. families, no remaining essence left. Further note this condition is most dangerous and difficult to treat. World error transmission/wrong treatment long established, four seas same wind, passed many years. Fang Zhongxing refuted before, gentlemen discussed freely after, until today fake wind not ceasing, hope for future powerful ones to burn all fake books. Carefully observing "Ye An" treatment subtlety, entirely lies in seeing vomiting/diarrhea, first prevent spasm, not after spasm occurs then devise method.
(8) Guest Startle Spasm (Secular name Fright) According to infant spirit timid qi weak, or seeing unusual objects, hearing unusual sounds, or falling empty/stumbling etc., among hundred conditions or