凡小儿于将见痘疹之时。必先发热。热甚则阴分受伤。或心移热于肝。以致风火相搏。
而见
手足搐搦。口眼歪斜者。亦常有之。经云。诸风掉眩。皆属于肝。又云。诸痛痒疮。皆属于
心。盖心主热。热甚则肺经受克。不能制伏肝木。热则生风。风火相搏。神气不安。故惊惕
而发搐也。苟或妄以惊药治之。则心寒而肌敛。毒必内陷。害可胜言哉。主治之法。当察其
所属而调剂之。如发热无汗。表邪甚而搐者。柴归饮。或惺惺散之类主之。烦渴饮冷。里热
甚而搐者。导赤散。或辰砂六一散之类主之。肝胆热甚。大便秘结。烦躁而搐者。泻青丸主
之热甚见血而搐者。犀角地黄汤主之。风热既退。则痘随出而搐自止矣。然此皆治实之法。
此外有因禀赋素虚。心脾不足而搐者。但当以面色青白。神气怯弱为辨。宜七福饮。或养心
汤。或六气煎。加枣仁主之。
仲景先生云。身热足寒。头项强急。恶寒时头热。面赤。目脉赤。独头面摇。卒口噤。
背反
张者。痉病也。发热无汗。反恶寒者。名刚痉。发热汗出。不恶寒者。名柔痉。又曰。太
阳病。发汗过多。因致痉。小儿肌肤嫩薄。腠理不密。血液未充。易于感冒。往往初传太阳
一
经。便觉身强多汗。筋脉牵动。人事昏沉。是即变痉症也。良由热甚伤阴。汗多伤液。血气
内虚。筋失所养。以致此耳。主治之法。若初病便痉。表邪未解。阴虚无汗身热者。宜人参
羌活散。或三柴胡饮。或四柴胡饮之类主之。若因汗出太多。或过事表散。阳气虚甚者。宜
参附汤。参归汤。人参建中汤之类主之。若汗出兼火。脉见洪滑。证见烦躁。或
痰热甚者。用丹溪人参竹沥之法主之。若身微热。脉不紧数。此表邪已随汗解。不必再用发
散。只宜专顾正气为要。宜五福饮之类主之。若大虚而脉见沉细阴胜者。宜大营煎。大补元
煎。十全大补汤之类主之。其次。有以误下伤阴。或泄泻过度。或湿症误汗。或疮家误汗。
或亡血过多。或妇人产后。或伤暑。或中风之类。种种不一。皆能致痉。奈何世
医不明此理。以小儿太阳初病变痉。而谬名之曰急惊风。以汗下过度。神气微弱。口开眼张
。而名之曰慢惊风。以妇人产后。血虚发痉。而名之曰产后惊风。以损伤亡血过多变痉。
而名之曰破伤风。以暑伤正气。汗多厥逆。而名之曰暑惊风。以及体虚非风之类。不知皆属
极虚之症。动以惊风为名。辄投开关镇坠之品。致使真气益虚。邪反内陷。死亡相继。何生
民之不幸。若此其甚也。业幼科者。毋得以头摇口噤。反张搐搦。便妄作惊风施治。以致误
人不救也。
凡是小儿在痘疹即将发出之前，必定先出现发热。如果热势严重，就会损伤阴分；或者心火移热于肝，导致风与火相互搏结，从而出现手足抽搐、口眼歪斜的症状，这种情况也很常见。《内经》说：“各种风病引起的肢体震颤、眩晕，都归属于肝。”又说：“各种疼痛、瘙痒、疮疡，都归属于心。”因为心主热，热势过盛就会克制肺金，使肺不能制约肝木。热极则生风，风火相搏，神气不安稳，所以会出现惊惕并引发抽搐。如果不加辨证，胡乱使用镇惊药物治疗，会导致心阳受寒而肌表收敛，痘毒必然内陷，其危害怎能说得尽呢？治疗的原则，应当根据病证所属的脏腑经络进行调理。例如：发热无汗，表邪严重且伴有抽搐的，用柴归饮，或惺惺散之类的方剂主治；烦渴喜冷饮，里热严重且伴有抽搐的，用导赤散，或辰砂六一散之类的方剂主治；肝胆热盛，大便秘结，烦躁且伴有抽搐的，用泻青丸主治；热势极盛见出血且伴有抽搐的，用犀角地黄汤主治。待风热退去，痘疹随之发出，抽搐自然停止。然而这些都属于治疗实证的方法。此外，还有因先天禀赋素来虚弱，心脾不足而导致抽搐的，应当以面色青白、神气怯弱作为辨别依据，宜用七福饮，或养心汤，或六气煎加酸枣仁主治。
张仲景先生说：“身体发热，足部发凉，头项强直僵硬，恶寒时头部发热，面色红赤，目睛脉络红赤，只有头部摇动，突然牙关紧闭，背部反折如弓者，这是痉病。”发热无汗，反而恶寒的，称为刚痉；发热汗出，不恶寒的，称为柔痉。又说：“太阳病，发汗过多，因而导致痉病。”小儿肌肤嫩薄，腠理不致密，血液未充盈，容易感受外邪。往往初传太阳经时，就感觉身体强直、多汗，筋脉牵拉抽动，人事昏沉，这就是变生为痉症。这主要是由于热势严重损伤阴液，汗出过多损伤津液，导致气血内部空虚，筋脉失去滋养，从而引起此症。治疗原则是：如果是初病即发生痉症，表邪未解，阴虚无汗且身热的，宜用人参羌活散，或三柴胡饮，或四柴胡饮之类的方剂主治；如果是因出汗太多，或过度使用发散药物，导致阳气极度虚弱的，宜用参附汤，参归汤，人参建中汤之类的方剂主治；如果是汗出兼有火热，脉象洪滑，证见烦躁，或痰热严重的，采用朱丹溪用人参和竹沥的方法主治；如果身体微热，脉象不紧数，这说明表邪已经随汗而解，不必再用发散药，只应专注于顾护正气为宜，宜用五福饮之类的方剂主治。如果极度虚弱且脉象沉细、阴气偏胜的，宜用大营煎，大补元煎，十全大补汤之类的方剂主治。其次，还有因误用攻下法损伤阴液，或泄泻过度，或湿证误用发汗，或疮疡患者误用发汗，或失血过多，或妇女产后，或伤暑，或中风等情况，种种不一，都能导致痉病。无奈世俗医生不明白这个道理，将小儿太阳经初病变生的痉症，错误地命名为急惊风；将因汗下过度、神气微弱、口开眼张的，命名为慢惊风；将妇女产后血虚引发的痉症，命名为产后惊风；将因创伤亡血过多变生的痉症，命名为破伤风；将暑邪损伤正气、汗多厥逆的，命名为暑惊风，以及体虚非风等情况，不知道这些都属于极度虚弱的病症，却动辄以“惊风”为名，立即投用开关、镇坠的药物，致使真气更加虚弱，邪气反而内陷，导致死亡相继发生，百姓如此不幸，情况竟到了这般地步！从事儿科的医生，不要看到头摇、口噤、背反张、抽搐等症状，就妄以为是惊风而进行治疗，以致误人而不救啊。
Whenever a child is about to manifest smallpox or measles, fever must first appear. When the heat is severe, it injures the Yin aspect of the body. Alternatively, Heart Fire may transfer heat to the Liver, causing Wind and Fire to contend with each other. This results in symptoms such as convulsions of the hands and feet, and deviation of the mouth and eyes, which is also common. The *Classic of Difficult Issues* (or *Neijing*) states: "All wind diseases characterized by tremors and dizziness belong to the Liver." It also states: "All pain, itching, sores, and ulcers belong to the Heart." Since the Heart governs Heat, excessive Heat overcomes the Lung Metal, preventing the Lung from restraining Liver Wood. Extreme Heat generates Wind; when Wind and Fire contend, the Spirit (*Shen*) becomes unsettled, leading to fright and convulsions. If one recklessly treats this with anti-convulsant medicines, it will cause Cold in the Heart and contraction of the muscles, forcing the toxin to sink inward. The harm caused would be incalculable. The principle of treatment should be to observe the etiology and adjust accordingly. For example: if there is fever without sweating, indicating severe exterior pathogenic factors accompanied by convulsions, treat with *Chai Gui Yin* (Bupleurum and Angelica Decoction) or *Xing Xing San* (Awakening Powder). If there is irritability, thirst for cold drinks, and severe interior heat accompanied by convulsions, treat with *Dao Chi San* (Guide Out Redness Powder) or *Chen Sha Liu Yi San* (Cinnabar Six-to-One Powder). If Liver and Gallbladder heat are excessive, with constipation, irritability, and convulsions, treat with *Xie Qing Wan* (Drain Green Pill). If heat is extreme, manifested by bleeding and convulsions, treat with *Xi Jiao Di Huang Tang* (Rhinoceros Horn and Rehmannia Decoction). Once the Wind-Heat recedes, the rash will emerge, and the convulsions will cease naturally. However, these are all methods for treating excess syndromes. Additionally, there are cases where convulsions arise due to innate constitutional deficiency and insufficiency of the Heart and Spleen. These should be differentiated by pale bluish-white complexion and timid spirit. Treat with *Qi Fu Yin* (Seven Blessings Decoction), or *Yang Xin Tang* (Nourish Heart Decoction), or *Liu Qi Jian* (Six Qi Decoction) added with *Zao Ren* (Semen Ziziphi Spinosae / Spinous Date Seed).
Master Zhang Zhongjing stated: "When the body is hot but the feet are cold, the head and neck are stiff and rigid, there is aversion to cold while the head feels hot, the face is red, the eye vessels are red, only the head shakes, sudden lockjaw occurs, and the back arches backward like a bow, this is Jing Disease (Spasm Disease)." Fever without sweating and aversion to cold is called Gang Jing (Stiff Spasm). Fever with sweating and no aversion to cold is called Rou Jing (Soft Spasm). It is also said: "In Taiyang Disease, excessive sweating leads to Jing Disease." Children have tender skin and thin flesh, loose interstices (*Cou Li*), and unfulfilled blood volume, making them prone to external infections. Often, when the pathogen initially transmits to the Taiyang Meridian, they experience body stiffness, profuse sweating, pulling sensations in the sinews and vessels, and mental confusion. This is precisely the transformation into Jing Syndrome. This is primarily due to severe heat injuring Yin, excessive sweating damaging fluids, internal deficiency of Qi and Blood, and sinews losing nourishment. Regarding treatment principles: If Jing occurs at the onset of illness, with unresolved exterior pathogens, Yin deficiency, no sweating, and fever, treat with *Ren Shen Qiang Huo San* (Ginseng and Notopterygium Powder), or *San Chai Hu Yin* (Three Bupleurum Decoction), or *Si Chai Hu Yin* (Four Bupleurum Decoction). If caused by excessive sweating or overuse of dispersing methods leading to severe Yang Qi deficiency, treat with *Shen Fu Tang* (Ginseng and Aconite Decoction), *Shen Gui Tang* (Ginseng and Angelica Decoction), or *Ren Shen Jian Zhong Tang* (Ginseng and Middle-Building Decoction). If sweating accompanies fire, with a surging and slippery pulse, irritability, or severe phlegm-heat, adopt Danxi's method using *Ren Shen Zhu Li* (Ginseng and Bamboo Sap). If the body has slight heat and the pulse is not tight or rapid, indicating the exterior pathogen has been resolved through sweating, do not use dispersing agents again; instead, focus solely on supporting Righteous Qi (*Zheng Qi*). Treat with *Wu Fu Yin* (Five Blessings Decoction). If there is severe deficiency with a deep, fine pulse indicating Yin excess, treat with *Da Ying Jian* (Great Camp Decoction), *Da Bu Yuan Jian* (Great Tonify Origin Decoction), or *Shi Quan Da Bu Tang* (Ten Complete Great Tonifying Decoction). Secondly, Jing can also be caused by various errors: misusing purgatives injuring Yin, excessive diarrhea, mistaking dampness for exterior syndrome and sweating, mistreating skin sores with sweating, excessive blood loss, postpartum conditions in women, summerheat injury, or wind-stroke. All these can lead to Jing. Why do worldly physicians fail to understand this? They mistakenly name the initial Taiyang transformation in children as Ji Jing Feng (Urgent Wind); they name cases of excessive sweating/purging with weak spirit, open mouth, and wide eyes as Man Jing Feng (Slow Wind); they name postpartum blood-deficiency spasms as Chan Hou Jing Feng (Postpartum Wind); they name trauma-induced blood-loss spasms as Po Shang Feng (Broken Injury Wind); they name summerheat damaging Zheng Qi with sweating and syncope as Shu Jing Feng (Summer Wind); and they categorize deficiency-type non-wind conditions under these names. Not realizing these are all extreme deficiency syndromes, they indiscriminately administer opening and sedating/astringent drugs. This further depletes True Qi, allows pathogens to sink inward, and leads to successive deaths. How unfortunate for the people! Practitioners of pediatrics must not see head shaking, lockjaw, opisthotonos, or convulsions and recklessly treat them as Jing Feng, thereby harming patients beyond recovery.