脉诀启蒙曰小儿脉促急为虚惊○直指云浮数洪紧为急惊○沉迟散缓为慢惊○虎口脉纹青
紫为
惊风○红者风热轻○赤者风热盛○紫者惊热○青者惊积○青紫相半惊积风热俱有主急惊风○
青而淡紫伸缩来去主慢惊风○紫丝青丝或黑丝隐隐相杂似出而不出主慢脾风○情势湾入里者
顺○出外者逆
阎孝忠曰小儿急慢惊风古无之惟曰阴阳痫而已所谓急慢者后世名之耳正如赤白痢之类是
也直
指方云急者属阳阳盛而阴亏慢者属阴阳亏而阴盛阳动而躁疾阴静而迟缓其始也皆因脏腑虚而
得之虚能发热热则生风是以风生于肝痰生于脾惊出于心热出于肺而心亦主热惊风痰热合为
四证四证已具八候生焉凡搭眼摇头张口出舌唇红脸赤面青眼青泻青太阳发际印堂青筋三关虎
口脉纹红紫或青者皆惊风也大抵热论虚实证别逆顺治有后先盖实热为急惊虚热为慢惊慢惊本
无热所以发热者虚使然耳急惊属阳用药以凉慢惊属阴用药以温其不可以阴阳无别故曰热论
虚实者此也男搐左视左女搐右视右男眼上窜女眼下窜男握拇指出外女握拇指入里男引手挽左
直右曲女挽手右直左曲皆为顺反之则逆亦有先搐左而后双搐者但搐顺则无声搐逆则有声其指
纹情势湾入里者顺出外者逆出入相半者难痊故曰证别逆顺者此也凡热盛生惊惊盛生风风盛发
搐治搐先于截风治风先于利惊治惊先欲豁痰治痰先于解热其若四证俱有又当兼施并理一或有
遗必生他证故曰治有先后者此也纲领如此若折急慢惊风而言之则暴烈为急惊沉重为慢惊而慢
脾则又重而深矣
按惊者虚惕怔忡气怯神散痰涎来去其泻必青渐生风而未至惊风也夫惊邪入心则面红脸赤
惕惕
夜啼惊邪入肝则面目俱青眼青窜视惊邪入肾则面黑恶叫啮乳切牙惊邪入肺则面白淡黄据脉视
之虚则散而濡实则数而驶治法镇惊化痰安神定志亦须究竟其脏受病之处而调治之然所谓温惊
有所谓利惊有所谓凉惊虚者和之热者凉之是为活法也
《脉诀启蒙》说：小儿脉搏急促是虚惊的表现。○《直指方》说：脉象浮、数、洪、紧属于急惊风；脉象沉、迟、散、缓属于慢惊风。○虎口脉络颜色青紫，主病为惊风；颜色红者，表示风热轻浅；颜色赤者，表示风热炽盛；颜色紫者，主惊热；颜色青者，主惊积（因惊恐导致饮食停滞）；青色与紫色各半，表示既有惊积又有风热，主治急惊风；青色而淡紫，且脉络伸缩往来，主慢惊风；紫色丝状、青色丝状或黑色丝状隐隐混杂，似出非出，主慢脾风；脉络形态弯曲向里者，为顺证；向外者，为逆证。
阎孝忠说：小儿急惊风和慢惊风在古代是没有的，只称为“阴阳痫”罢了。所谓急惊和慢惊，是后世才有的名称。这就像赤痢和白痢的区别一样。《直指方》中说：急惊属于阳证，表现为阳盛而阴亏；慢惊属于阴证，表现为阴亏而阴盛（此处原文逻辑可能有误，通常慢惊为脾肾阳虚，但依原文翻译）。阳气主动而躁疾，阴气主静而迟缓。这两种病的起始原因，都是因为脏腑虚弱所致。虚损会导致发热，发热则生风。因此，风生于肝，痰生于脾，惊出于心，热出于肺，而心也主热。惊、风、痰、热合为四证。四证具备后，八候（症状表现）随之产生。凡是出现眨眼、摇头、张口、吐舌、嘴唇红、脸红、面色青、眼睛青、泻青色大便、太阳穴发际处青筋显露、虎口三关脉络纹呈红、紫或青色等情况，都是惊风的表现。大抵来说，通过辨别热证的虚实来区分病情，辨别顺逆，治疗要有先后次序。实热证属于急惊风，虚热证属于慢惊风。慢惊风本来没有实热，之所以发热，是因为虚损的缘故。急惊风属阳，用药以清凉为主；慢惊风属阴，用药以温补为主。不能因为阴阳不同就区别对待，所以说要辨别热证的虚实，就是这个道理。男孩抽搐时眼球向左视，女孩向右视；男孩眼球上窜，女孩眼球下视；男孩拇指握拳伸出，女孩拇指握拳收进；男孩手臂挽拉时左边直右边曲，女孩右边直左边曲，这些都是顺证；反之则为逆证。也有先抽搐左侧而后双侧都抽搐的情况，只要抽搐方向顺则无声，逆则有声。其指纹形态弯曲向里的为顺，向外的为逆，出入相半的难治痊愈。所以说要辨别证的顺逆，就是这个道理。凡是热盛生惊，惊盛生风，风盛发搐（抽搐）。治疗抽搐要先截断风势，治疗风要先利惊，治疗惊要先豁痰，治疗痰要先解热。如果四证俱有，又应当兼施并理。一旦有所遗漏，必然产生其他病症。所以说治疗要有先后次序，就是这个道理。纲领如此。若折中论述急慢惊风，则暴烈者为急惊风，沉重者为慢惊风，而慢脾风则更加深重。
按语：惊，是指虚怯、怔忡、气短、神志涣散，痰涎流动，其腹泻必为青色，逐渐生风但未至惊风程度。如果惊邪入心，则面红脸赤，夜间啼哭惊恐；惊邪入肝，则面目俱青，眼球青紫上视；惊邪入肾，则面色黑，恶叫，咬乳头，磨牙；惊邪入肺，则面色白或淡黄。根据脉象来看，虚证脉象散而濡软，实证脉象数而疾速。治疗方法包括镇惊、化痰、安神、定志，也必须彻底查究是哪个脏腑受病而进行调治。然而所谓的温惊、利惊、凉惊，虚证用调和法，热证用清凉法，这才是灵活变通的方法。
*Mai Jue Qi Meng* (Enlightenment on Pulse Diagnosis) states: A rapid and hurried pulse in children indicates deficiency-type fright (*Xu Jing*). ○ *Zhi Zhi Fang* (Direct Guidance Formulas) states: Floating, rapid, full, and tight pulses indicate acute convulsion syndrome (*Ji Jing Feng*); sinking, slow, scattered, and relaxed pulses indicate chronic convulsion syndrome (*Man Jing Feng*). ○ Blue-purple coloration of the Tiger's Mouth vein pattern indicates convulsion syndrome; red indicates mild wind-heat; crimson indicates severe wind-heat; purple indicates fright-heat; blue indicates fright-stagnation (food retention due to fright); equal parts of blue and purple indicate both fright-stagnation and wind-heat, primarily treated as acute convulsion syndrome; pale blue mixed with light purple, with extension and retraction, indicates chronic convulsion syndrome; faintly mixed purple, blue, or black thread-like patterns that seem to emerge but do not fully appear indicate slow spleen wind (*Man Pi Feng*); a vein pattern curving inward is a favorable sign (*Shun*); one curving outward is an unfavorable sign (*Ni*).
Yan Xiaozhong stated: Acute and chronic convulsion syndromes in children did not exist in ancient times; they were only referred to as Yin-Yang Epilepsy (*Yin Yang Xian*). The terms "acute" and "chronic" are names coined by later generations, similar to the distinction between red and white dysentery. *Zhi Zhi Fang* states: Acute cases belong to Yang, characterized by excess Yang and deficient Yin; chronic cases belong to Yin, characterized by deficient Yin and excess Yin (Note: Textual logic may vary, typically chronic implies Spleen-Kidney Yang Deficiency). Yang energy moves actively and restlessly, while Yin energy remains quiet and slow. Both conditions originate from deficiency of the Zang-Fu organs. Deficiency generates heat, and heat generates wind. Thus, wind arises from the Liver, phlegm from the Spleen, fright from the Heart, and heat from the Lung, though the Heart also governs heat. Fright, wind, phlegm, and heat combine into four pathogenic factors. Once these four factors are established, eight clinical manifestations (*Ba Hou*) arise. Any occurrence of blinking, head shaking, mouth opening, tongue protrusion, red lips, flushed face, cyanotic complexion, cyanotic eyes, green stools, visible bluish veins at the Taiyang hairline, and red, purple, or blue Tiger's Mouth vein patterns all indicate convulsion syndrome. Generally, heat syndromes are differentiated by excess and deficiency to determine prognosis and treatment sequence. Excess-heat constitutes acute convulsion syndrome, while deficiency-heat constitutes chronic convulsion syndrome. Chronic convulsion syndrome inherently lacks excess heat; any fever present is due to deficiency. Acute convulsion syndrome belongs to Yang, so treatment uses cooling methods; chronic convulsion syndrome belongs to Yin, so treatment uses warming methods. One cannot distinguish treatments solely based on Yin-Yang differences; hence, it is said that one must differentiate heat syndromes by excess and deficiency. For boys, if the eyes deviate to the left during convulsions, or look upward; if the thumb extends outward when clenched; if pulling the arm results in the left side being straight and the right curved—these are favorable signs. For girls, deviation to the right, downward gaze, thumb tucked inward, and right side straight/left curved are favorable. Conversely, these are unfavorable signs. If convulsions start on the left and then become bilateral, silence indicates a favorable course, while noise indicates an unfavorable one. Vein patterns curving inward are favorable, outward are unfavorable, and those showing equal inward/outward tendencies are difficult to cure. Hence, differentiating the favorability of symptoms is crucial. When heat is excessive, it generates fright; when fright is excessive, it generates wind; when wind is excessive, it causes spasms (*Chu*). To treat spasms, one must first cut off the wind; to treat wind, one must benefit the fright; to treat fright, one must resolve phlegm; to treat phlegm, one must clear heat. If all four factors are present, they must be addressed simultaneously. Neglecting any aspect will lead to other complications. Hence, treatment requires a specific sequence. These are the general principles. Regarding acute and chronic convulsions: violent and fierce presentations indicate acute convulsion syndrome; heavy and sluggish presentations indicate chronic convulsion syndrome; while slow spleen wind is even more severe and deep-seated.
Commentary: "Fright" refers to timidity, palpitations, shortness of breath, and scattered spirit, accompanied by moving phlegm-fluids and green diarrhea, gradually generating wind without reaching full convulsion syndrome. If fright pathogens enter the Heart, the face becomes red and flushed, with nocturnal crying and fear; if they enter the Liver, the face and eyes turn cyanotic with upward-gazing eyes; if they enter the Kidneys, the face turns black, with screaming, biting the nipple, and grinding teeth; if they enter the Lungs, the face appears pale or yellowish-white. According to the pulse: deficiency presents as scattered and soft, while excess presents as rapid and forceful. Treatment methods include calming fright, resolving phlegm, nourishing the spirit, and stabilizing the will. One must thoroughly investigate which Zang-Fu organ is diseased for targeted regulation. However, regarding warming fright, benefiting fright, and cooling fright: deficiency is treated with harmonization, and heat is treated with cooling. This represents flexible and adaptive methodology.