观形察色辨因由，阴弱阳强发硬柔；若是伤寒双足冷，要知有热肚皮求。鼻冷便知是疮疹，耳冷应知
风热症；浑身皆热是伤寒，上热下冷伤热病。
五指梢头冷，惊来不可当；若逢中指热，必定是伤寒；中指独自冷，麻痘症相传；女右男分左，分明
仔细看。
面赤为风热，面青惊可详，心肝形此见，脉症辨温凉。脾怯黄疳积，虚寒 白光。若逢生黑气，肾败命须亡。
小儿三岁以下有病，须看男左女右手虎口三关。从第二指侧看，第一节名风关，第二节名气关，第三节名命关。
辨其纹色，紫者属热，红者属寒，青者惊风，白者疳病，黑者中恶，黄者脾之困也。若现于风关为轻，气关为重，过于
命关则难治矣。
紫黑红伤寒，青惊白是疳，黑时因中恶，黄即困脾端。
又∶青色大小曲，人惊并四足；赤色大小曲，水火飞禽扑；紫色大小曲，伤米面鱼肉；黑色大小曲，脾风微作搐。
（附∶慢脾）
总括 面红卒然浑身热，唇黑牙关气如绝；目翻搐搦喉有声，此是急惊容易决。
又∶阴虚阳盛病已深，吐余泻后睡扬睛；
神昏搐缓涎流甚，此症分明是慢惊。
脉法 浮数洪紧为急惊，沉迟散缓为慢惊。虎口纹青紫为惊风，情势弯入里者为顺，出外者为逆。
《医学纲目》云∶搐一也，而有晨夕之分，表里之异。身热力大者为急惊，身冷力小者为慢惊。仆地作声，醒时多
沫者为痫；头目仰视者为天吊；角弓反张为 ，而治各不同也。
看手法，风关青黑如悬针，主水惊，易治；气关赤色如悬针，主疳病，兼肺脏积热，犹可治；命关凡有此脉不问五
色，皆是危症。又三关通度如悬针，主慢惊，难治；风关青如鱼刺，易治，乃初惊之候，黑色难治；气关青如鱼刺，主
疳痨、身热，易治；命关青如鱼刺，主虚风邪传脾，难治。三关青是四足惊，赤是水惊，黑是人惊。
惊风有四症八候。四症者，惊、风、痰、热是已。八候者，搐、搦、掣、颤、反、引、窜、视是已。搐者两手伸缩；
搦者十指开合；掣者势若相扑；颤者头偏不正；反者两手仰向后；引者臂若开弓；窜者目直视怒视；视者睛露不活。四
症已具，八候生焉。四症既无，八候安有。
急惊风大叫三两声者心绝，难治。急惊四肢俱软者不治；急惊鼻中出血者为热将散，易治；口中出血，则难治。大
小便秘者易治，尿屎遗者难治；关黑纹直者死。
四肢厥冷，二便不禁，服 胃回阳以治之。治之不效，乃称不治。予曾治而效，不可因其有此症，便说不治也。
《内经》曰∶诸风掉眩，皆属肝木。盖小儿系纯阳之体，为其真水未旺，心火已炎，肺金受制而无以平木，故肝
木常有余，而脾土常不足也。为父母者，或失于保养，抱子当风，近于热地，或辛辣多食，衣衾过浓，邪热郁蒸，积于
心，传于肝，再受人物惊触。未发之时，夜卧不稳，睡中或笑或哭，啮齿咬乳，鼻额有汗，气促痰鸣，忽尔闷绝，目直
上视，口噤不开，手足搐掣，此热甚而然，沉兼面红脉数可辨。盖心有热而肝有风，风主乎动，火得风，则烟焰起，二
阳相鼓，风火相搏。肝藏魂，心藏神，因热则神魂易动，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，以宽气饮、三解散去参主之。如暴感此证，未别阴阳虚实，先用五苓散和宽气饮，少加宽热
饮，三药合用，姜汁沸汤调灌即解。大抵治搐之法，以宽气为妙，气顺则搐停，此自然之理。乎尝感慨诸人，每见惊风
搐作，不明标本，混为一症，遽用金石脑麝蜈蚕蛇蝎大寒搜风等剂，投之耗伤真气，其症益甚，多致勿救。殊不知惊生
于心，风生于肝，搐始于气，是为三症。其惊与风，首已详及。所谓搐始于气者，盖因风寒暑湿燥火之气，有一不顺，
便蓄于喉靥间，搏于心肺，传入肝经，其气上不能升，下不能降，使津液郁滞，不得流行，故痰涎壅蔽而作搐也，亦宜
宽气饮治之。
病有相似而实不同，此余素所经验。近有小儿先觉身热，少顷便僵仆不知人事，目睛上视，口唇牵动，状如惊风，
掣跳不止。一医以惊风治之，食顷间屡醒屡搐，故招予视之。予问曰∶两日热否？病家曰∶前日时发热，至傍晚方止，
昨日无恙，不意今午后热，遂成惊风。予曰∶此宿食顽痰胶固于中，荣卫不行，邪正相攻，乃疟疾也。以金石镇惊之药
投之，宁无助火为患乎。命渠且勿服药，恐药毒交攻，病势交剧，至下午少减，以二陈汤加楂麦青皮槟榔葛防服之，至
次日疟作而余症悉退，又服消痰散表之药，四剂而痊愈。
然当知所以受病。如病在惊，惊由痰热得，只可退热化痰，其惊自止；病在风，风由惊作，只可利惊化痰，其风自
散；病在痰涎，急须退热化痰，若也有搐，须用截风散惊，此不治之症也。
东垣云∶小儿泻青有惊，当先补其土，后泻其木，其风木旺症，右关脉洪大，掌中热，腹皮热者是也。今立一方黄
益黄散主之。人参甘草黄 各等分，此三味皆温补脾土，益元气，甘能泻火。《内经》云∶热淫于内，以甘泻之，以酸
收之。白芍药酸寒，能泻火，酸能泻肝木而大补肺金。所补得金木之位，土旺则火虚矣。风木何由而来克土，然后泻邪，
火旺能实其木，木旺故来克土，当于心经中，以甘温补土之源；更于脾土中泻火以甘寒，补金以酸凉，故致脾土中金旺
火衰，则风木自虚也矣。
有伤风后发搐者，口中气出热，呵欠烦闷，手足动摇，此气血未实，不能胜任故也，治当先发散，大青膏主之。
有伤食后发搐者，身温多睡，或呕吐不思乳食，此食滞而气亦因之而滞，故发搐也，当先定搐，加羌活、防风、
兼下泻青丸，后用白饼子下其食，渐用异功散养其气。
有欲出麻痘而发搐者，身温多睡，或呕吐不欲饮食，此乃热乘于心，心火炎上，故目睛上窜。其症耳叶鼻尖手足梢
冷，喷嚏眼涩，睡中惊跳是也，但无痰涎为异耳。治法当平肝木，利小便。平肝木则风自去，利小便则心热除。风热既
退，则痘出而搐愈矣，宜导赤散加白芍、防风、荆芥之类。
有痘后发搐者，此气血虚弱，复感风寒热毒交滞，且不敢发散清利，不治者多矣。
有小儿闻声即掣跳者，乃肝肺不足，魂魄不安，故神有不稳，非谓惊也，可服犀角地黄丸。
又有小儿心气虚怯，神不安定，连并掣跳者，可服四君子汤加辰砂少许服之。
暑风一症，因夏日感冒风热太甚，致面垢唇红，脉沉细数，忽发惊搐，不省人事，治用消暑清心饮、辰砂五苓散及
抱龙丸。
慢惊属阴，阴主乎静而搐缓，故曰慢惊。或得于大病之余，或传误转之后，目慢神昏，手足偏动，口角流涎；或口
气冷缓；或囟门陷下，睡则扬睛；或半开半合，此真阳消耗而阴邪独盛，阴盛生寒，寒为水化，水生肝木，木为风化，
木克脾土，胃为脾之腑，故中有风，螈 渐生，两肩微耸，两手垂下，时复动摇不已也。此症有汗者必不治。故仲景曰∶
阴不得有汗。盖阴症无汗，有汗者亡阳耳。治法不可一概用药。如吐泻得之，则理中汤加木香以温其中，五苓散以导其
水；如脏寒泄泻得之，则先与术附汤；下积取转得之，则先与调气汤调和脾胃；如外感风寒，则可与桂枝汤、葛根汤，
其他可类推矣。然慢惊虽属阴，视其浅深如何，不可纯用温药及燥烈之剂。惟于平胃气中加截风定搐之剂，如全蝎、僵
蚕、白附、天麻、南星等剂为良方。若吐不止，可投定吐饮；泻不止，宜服六柱散、五苓散；若痰多唇白，四肢如冰，
不醒人事，方可回阳，用固真汤速灌之，以生胃气。胃气既回，投醒脾散，徐徐调理。
慢脾之候，面青额汗，舌卷低头，眼合不开，困睡中摇头吐舌，频呕腥臭，噤口切牙，手足微搐而不收，或身冷，
或身热，其脉沉细。盖由慢惊之后，吐泻损脾，病传已极，总归虚处，惟脾所受，故曰慢脾。若逐风则无风可逐，若疗
惊则无惊可疗，但脾间涎痰虚热往来，其眼合者，脾困气乏，神志昏迷，痰涎壅滞然耳，世所谓难疗者是也。大要生胃
回阳，金液丹、生附四君子汤酌而用之，胃气渐复，仍服醒脾散、异功散之类。诸药不效者，如有太冲脉，则取百会穴
灸之可也。
急惊不治症（口中出血，通关不嚏，间或亦有生者）∶眼睛反转，口中出血，两手摆挑，肚腹搐动，或神缓而摸体
寻衣，或症笃而神昏气促，喷药不下，通关不嚏，心中热痛，忽大叫者，不治。
慢惊不治症∶四肢厥冷，面黯神惨，鸦声鱼口，口生白疮，发直摇头，眼不转睛，头项软，二便不禁，手足一边
牵引者，不治。
慢脾不治同。
补遗
凡遇惊风发搐时，听其自动自止，不可抢紧，使其气得通畅。不然，定有惊瘫之症。
急惊用药，先与截风定搐，次与下热。热去则无风，风去则不搐。伤风伤寒之症，热极不能发搐，但牙关不紧，此
为似搐。
小儿惊风握拳者，此胸中有毒涎耳！须看男左女右。男子握大指于内为顺，叉指者恶症也。其吉凶虽不尽系此，然
亦有验。
〔附方〕
宽气饮 枳壳（炒） 枳实 人参 甘草
三解散 人参 防风 天麻 茯神 山栀 白附 大黄 赤芍 黄芩 僵蚕 全蝎 枳壳 甘草 实者加大
黄、藿香，虚者加人参。
五苓散 白术 猪苓 茯苓 泽泻 肉桂
宽热饮 玄明粉 枳壳 大黄 甘草
黄 益黄散 人参 黄 甘草 白芍 陈皮 黄连 白茯苓
大青膏 白附 青黛 天麻 全蝎 朱砂 乌蛇 麝香 天竺 大青叶
泻青丸 当归 胆草 川芎 山栀 羌活 防风 大黄
白饼子 滑石 轻粉 半夏 南星 巴豆（四十粒，去皮尖，水一升，煎水尽为度，研入药内为饼）
异功散 人参 甘草 白术 茯苓 陈皮 木香
导赤散 生地 木通 甘草 竹叶
犀角地黄丸 天冬 麦冬 茯苓 茯神 前胡 柴胡 人参 玄参 生地 川芎 天麻 羌活 防风 甘草
四君子汤 人参 白术 茯苓 甘草
消暑清心饮 藿香 泽泻 白术 茯苓 肉桂 辰砂
牛黄抱龙丸 西牛黄（二钱） 天竹黄（一两） 琥珀（七钱） 陈胆星（一两） 僵蚕（六十个） 川贝
（一两） 枳壳（一两） 茯神（六钱） 沉香（五钱） 制腰黄（五钱） 麝香（一钱） 飞辰砂（一两） 金箔
（三分） 竹沥丸 去西黄、南星、天虫，名琥珀抱龙丸；余
加制军五钱、蝉衣五十只，生甘草汤丸，名赤抱龙丸。
理中汤 人参 白术 干姜 炙甘草
术附汤 白术 附子 甘草
调气汤 木香 香附 人参 陈皮 藿香 甘草
桂枝汤 桂枝 芍药 生姜 甘草 大枣
葛根汤 干葛 麻黄 芍药 桂枝 甘草
定吐饮 半夏 生姜 薄桂
六柱散 人参 茯苓 木香 白术 肉果 熟附子
固真汤 人参 附子 白术 茯苓 山药 黄 肉桂 甘草
醒脾散 木香 全蝎 白附 天麻 石莲 菖蒲 茯苓 白术 人参 甘草
金液丹 舶上硫黄十两，研细入罐内， 过用。
生附四君子汤 人参 白术 茯苓 甘草 生附子（如前药四分中之一）
观察形体和面色以辨别病因：阴气虚弱、阳气强盛时，身体会出现僵硬或柔软的变化；如果是伤寒病，双脚会发冷，要判断是否有热邪，需查看腹部情况。鼻子发冷便知是疮疹，耳朵发冷应知是风热症；浑身发热是伤寒，上身热下身冷则是伤热病。
手指尖头发凉，惊风发作起来不可抵挡；如果中指发热，必定是伤寒；如果中指单独发凉，这是麻痘症的征兆；看手纹时要女看右手、男看左手，分明仔细查看。
面色发红属于风热，面色发青可详细判断为惊风，心肝的症状在此显现，通过脉象和症状辨别温病或寒证。脾气虚弱会有黄疸、疳积和虚寒导致的腹胀（白光指腹部胀大）。如果遇到黑色气色，说明肾气败坏，生命必将终结。
三岁以下的小儿患病，必须查看男左女右手虎口部位的三关纹路。从第二指侧面看，第一节叫风关，第二节名气关，第三节叫命关。辨别纹路的颜色：紫色属热，红色属寒，青色主惊风，白色主疳病，黑色主中恶，黄色主脾困。如果纹路出现在风关，病情较轻；出现在气关，病情较重；超过命关则难以治疗。
紫黑红主伤寒，青色主惊风，白色主疳病，黑色因中恶，黄色即脾困。
又说：青色呈大小弯曲状，是人惊并伴有四肢抽搐；赤色呈大小弯曲状，是水火飞禽扑击所致；紫色呈大小弯曲状，是伤食米面鱼肉所致；黑色呈大小弯曲状，是脾风轻微抽搐。
（附：慢脾风）
总括：面部突然发红，浑身发热，嘴唇发黑，牙关紧闭气息似绝；眼睛上翻，抽搐掣动，喉间有声音，这是急惊风，容易诊断。
又说：阴虚阳盛的病已深入，呕吐腹泻后睡眠时眼睛向上翻；神志昏迷，抽搐缓慢，流涎严重，这病症分明是慢惊风。
脉法：浮、数、洪、紧的脉象为急惊风，沉、迟、散、缓的脉象为慢惊风。虎口纹路青紫为惊风，纹路弯曲向里为顺证，向外为逆证。
《医学纲目》说：抽搐是一种症状，但有晨夕之分，表里之异。身体发热、力量大的是急惊风，身体发冷、力量小的是慢惊风。倒地发声，醒来时多泡沫的是痫病；头眼向上仰视的是天吊风；角弓反张的是痉病，治疗方法各不相同。
看手法（望指纹形态）：风关出现青黑色如悬针状，主水惊，容易治疗；气关出现赤色如悬针状，主疳病，兼肺脏积热，还可以治疗；命关凡是有这种脉象，不问五色，都是危重病症。另外三关贯通如悬针状，主慢惊风，难治；风关青色如鱼刺状，容易治疗，是初起惊风的征候，黑色则难治；气关青色如鱼刺状，主疳痨、身热，容易治疗；命关青色如鱼刺状，主虚风邪气传脾，难治。三关青色是四足惊，赤色是水惊，黑色是人惊。
惊风有四症八候。四症是：惊、风、痰、热。八候是：搐、搦、掣、颤、反、引、窜、视。搐是指两手伸缩；搦是指十指开合；掣是指势态像相扑；颤是指头偏不正；反是指两手向后仰；引是指手臂像拉开弓；窜是指眼睛直视怒视；视是指眼球露出而不灵活。四症具备，八候就会产生。四症如果没有，八候哪里会有。
急惊风大叫三两声的，是心气绝，难治。急惊风四肢都软的，不治；急惊风鼻中出血的，是热邪将要发散，容易治疗；口中出血的，则难治。大小便不通的容易治疗，遗尿失禁的难治；关纹黑直的死。
四肢厥冷，二便不禁，服用温胃回阳的药物来治疗。治疗无效，才称为不治。我曾经治疗有效，不能因为有这些症状就说是不治之症。
《内经》说：各种风病引起的摇动眩晕，都属于肝木。因为小儿是纯阳之体，由于真水未旺，心火已炎，肺金受制而无法平抑肝木，所以肝木常有余，而脾土常不足。作为父母，或者疏于保养，抱着孩子当风，靠近热地，或者辛辣多食，衣被过厚，邪热郁蒸，积聚于心，传给肝，再受人物惊吓触动。未发作时，夜间卧睡不稳，睡中有时笑有时哭，磨牙咬乳，鼻额有汗，气促痰鸣，忽然闷绝，眼睛直视上翻，牙关紧闭不开，手足抽搐掣动，这是热甚所致，结合面色红、脉数可以辨别。因为心有热而肝有风，风主乎动，火得风，则烟焰起，二阳相鼓动，风火相搏结。肝藏魂，心藏神，因热则神魂易动，所以发生惊风。心主乎神，独不受触，遇到惊吓则发热，热极生风，所以能成抽搐，名叫急惊风，用宽气饮、三解散去掉人参为主方治疗。如果暴感此证，未辨别阴阳虚实，先用五苓散配合宽气饮，少加宽热饮，三药合用，姜汁沸汤调灌即可解。大抵治疗抽搐的方法，以宽气为妙，气顺则抽搐停止，这是自然之理。我曾感慨众人，每见惊风抽搐发作，不明标本，混为一症，遽用金石脑麝蜈蚣蚕蛇蝎等大寒搜风等药剂，投之耗伤真气，其症状更加严重，多导致无法救治。殊不知惊生于心，风生于肝，搐始于气，这是三症。惊与风，前面已经详细说明。所谓搐始于气，是因为风寒暑湿燥火之气，有一不顺，便蓄积在喉靥之间，搏结于心肺，传入肝经，其气上不能升，下不能降，使津液郁滞，不得流行，所以痰涎壅蔽而作抽搐，也宜用宽气饮治疗。
病有相似而实际不同，这是我素来经验的。近来有个小儿先觉得身体发热，一会儿便僵仆不知人事，眼睛上视，口唇牵动，状如惊风，抽搐跳动不止。一个医生按惊风治疗，片刻间多次清醒多次抽搐，所以招我诊治。我问：这两天发热吗？病家说：前日时而发热，到傍晚才停，昨日无恙，不料今天下午发热，遂成惊风。我说：这是宿食顽痰胶固于中，营卫不行，邪正相攻，乃是疟疾。如果用金石镇惊的药投下，难道不会助火为患吗？命令他暂且不要服药，恐怕药毒交攻，病势加剧，到下午稍减，用二陈汤加山楂、麦芽、青皮、槟榔、葛根、防风服用，到第二天疟疾发作而其余症状全退，又服消痰散表的药，四剂而痊愈。
然而应当知道受病的原因。如病在惊，惊由痰热引起，只可退热化痰，惊自止；病在风，风由惊引起，只可利惊化痰，风自散；病在痰涎，急须退热化痰，如果有抽搐，须用截风散惊，这是不治之症。
东垣说：小儿泻青有惊，应当先补其土，后泻其木，其风木旺症，右关脉洪大，掌中热，腹皮热的是。现在立一方黄益黄散主治。人参、甘草、黄芪各等分，这三味皆温补脾土，益元气，甘能泻火。《内经》说：热淫于内，以甘泻之，以酸收之。白芍药酸寒，能泻火，酸能泻肝木而大补肺金。所补得金木之位，土旺则火虚矣。风木何由而来克土，然后泻邪，火旺能实其木，木旺故来克土，当于心经中，以甘温补土之源；更于脾土中泻火以甘寒，补金以酸凉，故致脾土中金旺火衰，则风木自虚也矣。
有伤风后发抽搐的，口中气出热，呵欠烦闷，手足动摇，这是气血未实，不能胜任的缘故，治疗应当先发散，大青膏主治。
有伤食后发抽搐的，身体温和多睡，或呕吐不思乳食，这是食滞而气也因之而滞，所以发抽搐，应当先定抽搐，加羌活、防风，兼下泻青丸，后用白饼子下其食，渐用异功散养其气。
有欲出麻痘而发抽搐的，身体温和多睡，或呕吐不欲饮食，这是热乘于心，心火炎上，所以眼睛上窜。其症状耳叶鼻尖手足梢冷，喷嚏眼涩，睡中惊跳是也，但无痰涎为异耳。治法当平肝木，利小便。平肝木则风自去，利小便则心热除。风热既退，则痘出而抽搐愈矣，宜导赤散加白芍、防风、荆芥之类。
有痘后发抽搐的，这是气血虚弱，复感风寒热毒交滞，且不敢发散清利，不治者多矣。
有小儿闻声即掣跳的，乃肝肺不足，魂魄不安，所以神有不稳，并非谓惊，可服犀角地黄丸。
又有小儿心气虚怯，神不安定，连并掣跳的，可服四君子汤加辰砂少许服用。
暑风一症，因夏日感冒风热太甚，致面垢唇红，脉沉细数，忽发惊搐，不省人事，治疗用消暑清心饮、辰砂五苓散及抱龙丸。
慢惊属阴，阴主乎静而抽搐缓慢，所以叫慢惊。或得于大病之余，或传误转之后，眼睛慢神昏，手足偏动，口角流涎；或口气冷缓；或囟门陷下，睡则扬睛；或半开半合，这是真阳消耗而阴邪独盛，阴盛生寒，寒为水化，水生肝木，木为风化，木克脾土，胃为脾之腑，所以中有风，抽搐渐生，两肩微耸，两手垂下，时复动摇不已也。此症有汗者必不治。所以仲景说：阴不得有汗。盖阴症无汗，有汗者亡阳耳。治法不可一概用药。如吐泻得之，则理中汤加木香以温其中，五苓散以导其水；如脏寒泄泻得之，则先与术附汤；下积取转得之，则先与调气汤调和脾胃；如外感风寒，则可与桂枝汤、葛根汤，其他可类推矣。然慢惊虽属阴，视其浅深如何，不可纯用温药及燥烈之剂。惟于平胃气中加截风定搐之剂，如全蝎、僵蚕、白附子、天麻、南星等剂为良方。若吐不止，可投定吐饮；泻不止，宜服六柱散、五苓散；若痰多唇白，四肢如冰，不醒人事，方可回阳，用固真汤速灌之，以生胃气。胃气既回，投醒脾散，徐徐调理。
慢脾的征候，面青额汗，舌卷低头，眼合不开，困睡中摇头吐舌，频呕腥臭，噤口切牙，手足微搐而不收，或身冷，或身热，其脉沉细。盖由慢惊之后，吐泻损脾，病传已极，总归虚处，惟脾所受，所以叫慢脾。若逐风则无风可逐，若疗惊则无惊可疗，但脾间涎痰虚热往来，其眼合者，脾困气乏，神志昏迷，痰涎壅滞然耳，世所谓难疗者是也。大要生胃回阳，金液丹、生附四君子汤酌而用之，胃气渐复，仍服醒脾散、异功散之类。诸药不效者，如有太冲脉，则取百会穴灸之可也。
急惊风不治症（口中出血，通关不嚏，间或亦有生者）：眼睛反转，口中出血，两手摆挑，肚腹搐动，或神缓而摸体寻衣，或症笃而神昏气促，喷药不下，通关不嚏，心中热痛，忽大叫者，不治。
慢惊风不治症：四肢厥冷，面黯神惨，鸦声鱼口，口生白疮，发直摇头，眼不转睛，头项软，二便不禁，手足一边牵引者，不治。
慢脾风不治同。
补遗
凡是遇到惊风发抽搐时，听其自动自止，不可抢紧，使其气得通畅。不然，定有惊瘫之症。
急惊用药，先与截风定搐，次与下热。热去则无风，风去则不搐。伤风伤寒之症，热极不能发搐，但牙关不紧，此为似搐。
小儿惊风握拳者，此胸中有毒涎耳！须看男左女右。男子握大指于内为顺，叉指者恶症也。其吉凶虽不尽系此，然亦有验。
Observe the physical form and facial complexion to distinguish the etiology: when Yin is weak and Yang is strong, the body may exhibit stiffness or flaccidity; if it is Taiyang disease (disease of the Taiyang channel), the feet will be cold, and to determine if there is heat, one must examine the abdomen. A cold nose indicates variola or smallpox eruptions; cold ears indicate wind-heat syndrome; general body heat indicates Taiyang disease; upper body heat with lower body coldness indicates heat injury.
Cold fingertips suggest convulsions that are difficult to control; warmth in the middle finger indicates Taiyang disease; coldness isolated to the middle finger suggests measles or smallpox; for females, observe the right hand, and for males, the left hand, examining clearly and carefully.
A red face indicates wind-heat; a green face allows for detailed diagnosis of convulsions; symptoms of the Heart and Liver manifest here, distinguished by pulse and symptom patterns as warm or cold syndromes. Spleen deficiency presents with jaundice, infantile malnutrition (Gan syndrome), and abdominal distension due to deficiency-cold. The appearance of black qi indicates Kidney failure and impending death.
For children under three years old with illness, inspect the Three Passages on the Tiger's Mouth of the male left or female right hand. Viewing from the side of the second finger, the first segment is the Wind Passage, the second is the Qi Passage, and the third is the Life Passage. Distinguish the color of the veins: purple indicates heat, red indicates cold, green indicates convulsions, white indicates Gan syndrome, black indicates evil invasion, and yellow indicates Spleen distress. Appearance at the Wind Passage signifies mild condition; at the Qi Passage, severe condition; extending beyond the Life Passage indicates a difficult-to-treat case.
Purple, black, and red indicate Taiyang disease; green indicates convulsions; white indicates Gan syndrome; black results from evil invasion; yellow indicates Spleen distress.
Furthermore: Green curves of varying sizes indicate human fright with four-limb convulsions; red curves indicate attacks by water/fire birds; purple curves indicate food injury from rice, flour, meat, or fish; black curves indicate slight spasms from Spleen wind.
(Attachment: Slow Spleen Wind)
Summary: Sudden facial redness, whole-body heat, black lips, jaw clenching with breath nearly ceased; eyes rolling up, convulsions with throat sounds; this is acute convulsion, easy to diagnose.
Furthermore: In deep diseases of Yin deficiency and Yang excess, after vomiting and diarrhea, sleep is accompanied by upward eye deviation; unconsciousness, slow convulsions, and profuse salivation clearly indicate slow convulsion.
Pulse Method: Floating, rapid, full, and tight pulses indicate acute convulsion; sinking, slow, scattered, and relaxed pulses indicate slow convulsion. Green-purple veins on the Tiger's Mouth indicate convulsion; veins curving inward are favorable (Shun), while those curving outward are unfavorable (Ni).
The *Medical Outline* states: Convulsion is one symptom, but differs by morning/evening and interior/exterior. Body heat with strong force indicates acute convulsion; body coldness with weak force indicates slow convulsion. Falling with sound and foaming upon waking indicates epilepsy; head and eyes looking upward indicates "Heavenly Hanging" (Tian Diao); opisthotonos indicates spasm, each treated differently.
Inspecting the vein morphology: Blue-black like a hanging needle at the Wind Passage indicates Water Fright, easy to treat; red like a hanging needle at the Qi Passage indicates Gan syndrome with Lung heat accumulation, still treatable; any such vein at the Life Passage, regardless of color, indicates a critical condition. If all three passages show a vein like a hanging needle, it indicates slow convulsion, difficult to treat; blue like a fish spine at the Wind Passage is easy to treat, indicating initial fright; black is difficult to treat; blue like a fish spine at the Qi Passage indicates Gan consumption with body heat, easy to treat; blue like a fish spine at the Life Passage indicates deficient wind transmitting to the Spleen, difficult to treat. Blue across all three passages indicates Four-Limb Fright; red indicates Water Fright; black indicates Human Fright.
Convulsion has four syndromes and eight signs. The four syndromes are: Fright, Wind, Phlegm, Heat. The eight signs are: Twitching (Chu), Grasping (Nuo), Jerking (Che), Trembling (Chan), Reversal (Fan), Drawing/Stretching (Yin), Staring (Cuan), and Gazing (Shi). Twitching refers to extension and flexion of hands; Grasping refers to opening and closing of fingers; Jerking resembles wrestling; Trembling refers to head tilting; Reversal refers to hands bending backward; Drawing refers to arms like a drawn bow; Staring refers to fixed, angry gaze; Gazing refers to exposed, unresponsive eyeballs. When the four syndromes exist, the eight signs arise. Without the four syndromes, how can the eight signs exist?
Acute convulsion with three or two loud cries indicates Heart Qi exhaustion, difficult to treat. Acute convulsion with flaccid limbs is untreatable; acute convulsion with nasal bleeding indicates dispersing heat, easy to treat; oral bleeding is difficult to treat. Constipation is easy to treat; enuresis/incontinence is difficult to treat; straight black lines at the junction indicate death.
Limb coldness and incontinence of urine/feces are treated with formulas to warm the Stomach and restore Yang. If treatment fails, it is deemed untreatable. I have treated such cases successfully; do not declare them untreatable solely based on these symptoms.
The *Inner Canon* states: All wind-induced tremors and dizziness belong to Liver Wood. Children are pure Yang bodies; their True Water is not yet robust, while Heart Fire flares. Lung Metal is constrained and cannot pacify Liver Wood, so Liver Wood is often in excess, and Spleen Earth is often deficient. Parents may neglect care, exposing children to wind or heat, or allowing excessive spicy food and thick clothing, causing pathogenic heat to stagnate in the Heart, transmit to the Liver, and be triggered by external fright. Before onset, sleep is restless, with laughing/crying during sleep, teeth grinding, sweating on nose/forehead, rapid breathing, and phlegm rattle. Suddenly, they become unconscious, eyes roll up, jaws clamp shut, and limbs convulse. This is due to extreme heat, distinguishable by red face and rapid pulse. Heart heat and Liver wind interact; wind moves, fire spreads with wind, two Yangs stimulate each other, wind and fire collide. Liver stores Hun (Ethereal Soul), Heart stores Shen (Spirit); heat agitates Hun and Shen, causing fright. Heart governs Shen and is not easily disturbed, but fright causes heat, which generates wind, leading to convulsions, named Acute Convulsion. Treat primarily with Kuanqi Yin (Broad Qi Decoction) and Sandie San (Three-Dispersing Powder) removing Ren Shen. For sudden onset without distinguishing Yin/Yang or Deficiency/Excess, first use Wuling San combined with Kuanqi Yin and a little Kuanre Yin, mixed and administered with ginger juice and boiling water. Generally, treating convulsions by broading Qi is optimal; smooth Qi stops convulsions, a natural law. I lament that many physicians, seeing convulsions, fail to distinguish root and branch, mixing them into one syndrome, and hastily using large doses of cold herbs like minerals, borneol, musk, centipede, silkworm, snake, and scorpion to search out wind. This depletes true Qi and worsens symptoms, often leading to death. They do not know that Fright arises from Heart, Wind from Liver, and Convulsion begins with Qi. These are three distinct aspects. Fright and Wind were detailed earlier. Convulsion begins with Qi: when Wind, Cold, Summer-heat, Dampness, Dryness, or Fire becomes disordered, it accumulates in the throat/pharynx, clashes with Heart/Lung, transmits to Liver Meridian. Qi cannot ascend or descend, fluids stagnate, phlegm-saliva obstructs, causing convulsions. Treat with Kuanqi Yin.
Diseases may appear similar but differ essentially, as I have experienced. Recently, a child had body heat, then fell stiff and unconscious, eyes upturned, lips twitching, resembling convulsion with continuous jerking. A physician treated for convulsion, but the child woke and convulsed repeatedly. Upon examination, I asked about fever history. The family reported intermittent fever previously, resolved by evening, normal yesterday, but fever returned this afternoon leading to convulsion. I diagnosed this as Malaria caused by retained food and stubborn phlegm obstructing the center, blocking Ying and Wei, with Evil and Righteous Qi attacking each other. Using mineral-based calming drugs would only aid fire. I advised withholding medication to avoid drug toxicity exacerbating the condition. By afternoon, symptoms lessened. I prescribed Erchen Tang plus Hawthorn, Maidong, Qingpi, Areca Nut, Pueraria, and Saposhnikovia. By next day, malaria manifested and other symptoms receded. After taking phlegm-resolving and exterior-releasing medicines for four doses, the child recovered.
One must understand the cause of illness. If the issue is Fright caused by Phlegm-Heat, only clear heat and resolve phlegm, and Fright will cease. If the issue is Wind caused by Fright, only benefit Fright and resolve phlegm, and Wind will disperse. If the issue is Phlegm-Saliva, urgently clear heat and resolve phlegm; if convulsions occur, use wind-interrupting and fright-calming methods, though this is often untreatable.
Dongyuan stated: For children with diarrhea and fright, first tonify Earth, then drain Wood. Signs of hyperactive Wind-Wood include a large, flooding pulse at the Right Guan position, heat in palms, and heat in the abdominal wall. I now prescribe Huang Yi Huang San. Ren Shen, Gan Cao, and Huang Qi in equal parts warm and tonify Spleen Earth, boost Yuan Qi, and Sweet flavor drains fire. The *Inner Canon* says: For heat rampant within, use Sweet to drain and Sour to astringe. Bai Shao is Sour-Cold, draining fire and Liver Wood while tonifying Lung Metal. This balances Metal and Wood; when Earth is robust, Fire becomes deficient. How does Wind-Wood attack Earth? First drain the pathogen. Excessive Fire strengthens Wood, causing Wood to attack Earth. Tonify the source of Earth with Sweet-Warm in the Heart Meridian; drain Fire with Sweet-Cold in Spleen Earth; tonify Metal with Sour-Cool. Thus, Metal becomes robust and Fire declines in Spleen Earth, making Wind-Wood naturally deficient.
Convulsions following Wind-Cold injury, with hot breath, yawning, irritability, and limb trembling, result from insufficient Qi and Blood unable to cope. Treat by releasing the exterior first, using Da Qing Gao.
Convulsions following Food Injury, with warm body, lethargy, vomiting, and anorexia, result from food stagnation causing Qi stagnation. First stop convulsions, add Qiang Huo and Fang Feng, administer Xie Qing Wan, then use Bai Bing Zi to purge food, followed by Yigong San to nourish Qi gradually.
Convulsions preceding Measles/Smallpox eruption, with warm body, lethargy, vomiting, and aversion to food, result from Heat affecting Heart, with Heart Fire flaming upward, causing eyes to roll up. Symptoms include cold earlobes, nose tip, and fingertips, sneezing, gritty eyes, and startle during sleep, differing only by lack of phlegm. Treat by pacifying Liver Wood and promoting urination. Pacifying Liver removes Wind; urination clears Heart Heat. Once Wind-Heat subsides, eruptions appear and convulsions cease. Use Dao Chi San plus Bai Shao, Fang Feng, and Jing Jie.
Convulsions after Smallpox result from Qi/Blood deficiency compounded by Wind-Cold-Heat-Toxin stagnation. Since exterior-releasing and clearing-draining methods are contraindicated, many are untreatable.
Children who jerk upon hearing sounds have insufficient Liver and Lung, with unsettled Hun and Po, leading to unstable Spirit, not necessarily Fright. Administer Xi Jiao Di Huang Wan.
Children with deficient Heart Qi and unsettled Spirit, accompanied by jerking, can take Si Jun Zi Tang with a little Chen Sha (Cinnabar).
Summer-Wind Syndrome, caused by severe Wind-Heat contraction in summer, presenting with dirty face, red lips, sinking-thin-rapid pulse, sudden convulsions, and unconsciousness, is treated with Xiao Shu Qing Xin Yin, Chen Sha Wuling San, and Bao Long Wan.
Slow Convulsion belongs to Yin; Yin governs stillness, hence slow convulsions. It may follow severe illness or mismanagement. Symptoms include slow eyes, unconsciousness, asymmetric limb movement, drooling, cold breath, sunken fontanelle, upward eye deviation during sleep, or half-open/half-closed eyes. This indicates depletion of True Yang and dominance of Yin-Evil. Yin excess generates Cold; Cold transforms to Water; Water generates Liver Wood; Wood transforms to Wind; Wind attacks Spleen Earth. Stomach is the腑 (Fu) of Spleen, so Wind arises internally, causing gradual spasms, shoulder shrugging, hanging arms, and constant trembling. Cases with sweating are untreatable. Zhongjing said: Yin conditions should not sweat. Yin conditions have no sweat; sweating indicates Yang collapse. Treatment varies. If caused by vomiting/diarrhea, use Lizhong Tang with Mu Xiang to warm the middle, and Wuling San to guide water. If caused by Cold-Fu diarrhea, first use Zhu Fu Tang. If caused by purging accumulated pathogens, first use Tiaoqi Tang to harmonize Spleen/Stomach. If caused by external Wind-Cold, use Guizhi Tang or Gegen Tang. Other cases can be inferred. Although Slow Convulsion is Yin, depending on depth, do not use purely warming or drying agents. Add wind-interrupting and convulsion-calming herbs like Quan Xie, Jiang Can, Bai Fu Zi, Tian Ma, and Nan Xing to formulas that stabilize Stomach Qi. For persistent vomiting, use Ding Tu Yin; for persistent diarrhea, use Liu Zhu San or Wuling San. If phlegm is abundant, lips are white, limbs are ice-cold, and consciousness is lost, restore Yang using Gu Zhen Tang quickly to generate Stomach Qi. Once Stomach Qi returns, use Xing Pi San for gradual regulation.
Signs of Slow Spleen Wind: Green face, forehead sweat, curled tongue, bowed head, closed eyes, shaking head and sticking out tongue during sleepy state, frequent vomiting of foul odor, locked jaw, grinding teeth, slight uncontrollable limb convulsions, cold or hot body, sinking-thin pulse. Following Slow Convulsion, vomiting/diarrhea damages Spleen; disease progresses to extremity, returning to deficiency, specifically affecting Spleen, hence called Slow Spleen. There is no Wind to expel, no Fright to calm; only phlegm-saliva and deficient heat circulate in Spleen. Closed eyes indicate Spleen distress, Qi exhaustion, coma, and phlegm obstruction, considered difficult to treat by the world. The key is generating Stomach Qi and restoring Yang, using Jin Ye Dan or Sheng Fu Si Jun Zi Tang酌情 (discretionarily). As Stomach Qi recovers, continue with Xing Pi San or Yigong San. If all medicines fail, if the Taichong pulse is present, moxa the Baihui acupoint.
Untreatable Acute Convulsion (oral bleeding, non-responsive to stimulation, occasionally some survive): Eyes rolling back, oral bleeding, hand waving, abdominal convulsions, or sluggish spirit touching body/searching clothes, or severe condition with unconsciousness and rapid breathing, inability to swallow medicine, non-responsive to stimulation, heart pain, sudden loud crying—untreatable.
Untreatable Slow Convulsion: Limb coldness, dark face, miserable spirit, crow-like voice, fish-mouth appearance, white ulcers in mouth, straight hair with head shaking, fixed eyes, soft neck/head, incontinence, unilateral limb traction—untreatable.
Untreatable Slow Spleen is the same.
Supplement:
When convulsions occur, allow them to subside naturally; do not restrain tightly, ensuring Qi flows smoothly. Otherwise, paralysis may result.
For Acute Convulsion, first interrupt wind and stop convulsions, then purge heat. Removing heat eliminates wind; removing wind stops convulsions. In Wind-Cold/Taiyang disease, extreme heat may not cause convulsions, only jaw clenching, resembling convulsion.
Children holding fists during convulsion have toxic phlegm in the chest. Observe male left, female right. For males, thumb inside is favorable; crossed fingers indicate bad prognosis. While not definitive, it is valid.