《千金》云∶小儿之痫有三，风痫，惊痫，食痫也。风痫，缘衣暖汗出，风因入
也，初时，先屈指如数物乃作。惊痫，起于惊怖大啼乃作。食痫，其先不哺乳，吐
而变热后发。然风痫、惊痫，时时有之，十儿之中未有一二，凡是先寒后发热者，
皆食痫也。惊痫皆按图灸之，风痫当以猪心汤，食痫当下乃愈，紫霜丸佳。
按∶此论三痫，盖有三因之分，风痫属外因，惊痫属内因，食痫属不内外
因也。
又按∶《全婴方》云。风痫因将养失度，血气不和，或浓衣汗出，腠理开舒，
风邪而入之，其病在肝，肝主风，验其证目青、面红、发搐，宜驱风膏、大青膏、
琥珀散、镇惊药，有热四顺饮，退后与利惊丸下其痰涎。惊痫因血气盛实，脏腑
生热，或惊怖大啼，精神伤动，外邪所入为之，其病在心，心主惊，验其证忽然
叫声发搐，宜琥珀散、红龙散、镇心丸，有热四顺饮、利惊丸下之，不生别病
也。食痫其病在脾，脾纳食，验其证嗳吐 气，即发搐，此病或大便酸臭，紫丸
子下之。以上三证，大同小异，并属阳也，各目睛鲜斜，手足潮搐，或作猪声，
发过即瘥，皆十生一死也。
《三因》云∶古方有五痫、五脏痫、六畜痫等，名证不同，难于备载。《别录》
有五痫之证，一曰马痫，作马嘶鸣，以马属在午，手少阴君火主之，故其病应于心。
二曰羊痫，作羊叫声，以羊属未，足太阴湿土主之，应乎脾。三曰鸡痫，作鸡叫声，
以鸡属酉，足阳明燥金主之，应乎胃。四曰猪痫，作猪叫声，以猪属亥，手厥阴心包
主之，应乎右肾。五曰牛痫，作牛吼声，以牛属丑，手太阴湿土主之，应乎肺。此
五痫应乎五畜，应乎五脏者也，发则旋晕颠倒，口眼相引，目睛上摇，手足搐搦，
背脊强直，食顷乃苏，各随所感，施以治法。〔钱〕凡治五痫，皆随脏治之，每脏
各一兽，犬痫反折上窜，犬叫，肝也。羊痫目瞪吐舌，羊叫，心也。牛痫目直视腹
满，牛叫，脾也。鸡痫惊跳反折手纵，鸡叫，肺也。猪痫如尸吐沫，猪叫，肾也。
五痫重者死，病后甚者亦死，轻者五色丸主之。〔薛〕面赤目瞪，吐舌啮舌，心烦
气短，其声如羊者，曰心痫。面青唇青，两眼上窜，手足挛掣反折，其声如犬者，
曰肝痫。面黑目振，吐涎沫，形体如尸，其声如猪者，曰肾痫。面如枯骨，目
白反视，惊跳反折，摇头吐沫，其声如鸡者，曰肺痫。面色痿黄，目直，腹
满自利，四肢不收，其声如牛者，曰脾痫。五痫，通用五色丸为主，仍参以各经之
药。心痫属血虚者用养心汤。发热饮冷为实热，用虎睛丸，发热饮汤为虚热，用
妙香散。肝痫者，虚证用地黄丸。抽搐有力为实邪，用柴胡清肝散。大便不通用
泻青丸。肾痫者，用地黄丸、紫河车丸之类，肾无泻法，故径从虚治之。肺
痫者，属气虚，用补肺散。面色痿黄者，土不能生也，用五味异功散。面色赤者，
阴火上冲于肺也，用地黄丸。脾痫者，用五味异功散。若面青泻利，饮食少思，
用六君子加木香、柴胡。
按∶《千金》叙六畜痫，无五脏之分属，钱氏始分之，而无马痫一证，曾氏谓
初发作羊犬声者，咽喉为风痰所梗，声自如此，其理甚明，言六畜者，特强名耳，故
丹溪谓于经既无所据，而治法亦未见有五者之分，所以不必分五也。
《千金方》说：小儿的痫病有三种，即风痫、惊痫和食痫。风痫，是因为穿衣过暖导致出汗，风邪乘虚而入所致，发作前通常先有手指屈伸如数物样的动作。惊痫，是由于受到惊吓恐惧后大声啼哭而引发。食痫，发病前先停止吃奶，呕吐并出现发热后才发作。然而风痫和惊痫虽然时有发生，但十个孩子中不到一两个；凡是先出现寒战随后发热的，都是食痫。惊痫应当参照图谱进行艾灸治疗，风痫应当用猪心汤治疗，食痫需要通过泻下才能痊愈，服用紫霜丸效果较好。
按语：这段论述关于三种痫病，大概分为三种病因：风痫属于外因，惊痫属于内因，食痫属于不内外因。
又按语：《全婴方》说：风痫是因为调养失当，气血不和，或者衣着厚重导致出汗，腠理（皮肤毛孔）开泄，风邪侵入所致，病变在肝，肝主风，验证其症状为目青、面红、抽搐，适宜使用驱风膏、大青膏、琥珀散、镇惊药，若有热症用四顺饮，退热后再用利惊丸泻下痰涎。惊痫是因为气血盛实，脏腑生热，或者因为惊吓恐惧大声啼哭，精神受损动摇，加上外邪入侵所致，病变在心，心主惊，验证其症状为突然叫声并发出抽搐，适宜使用琥珀散、红龙散、镇心丸，若有热症用四顺饮，再用利惊丸泻下，就不会再生其他疾病。食痫病变在脾，脾负责受纳食物，验证其症状为嗳气呕吐气息，随即发生抽搐，此病如果大便酸臭，可用紫丸子泻下。以上三种证候，大同小异，都属于阳证，各自表现为眼球偏斜或上视，手足阵发性抽搐，或者发出猪叫声，发作过后即缓解，都是十人中有九人存活一人死亡。
《三因极一病证方论》说：古方有五痫、五脏痫、六畜痫等名称，证候不同，难以全部记载。《别录》中有五痫的证候，一是马痫，发出马嘶鸣声，因为马对应地支午，手少阴君火主管它，所以病变应于心。二是羊痫，发出羊叫声，因为羊对应地支未，足太阴湿土主管它，应乎脾。三是鸡痫，发出鸡叫声，因为鸡对应地支酉，足阳明燥金主管它，应乎胃。四是猪痫，发出猪叫声，因为猪对应地支亥，手厥阴心包络主管它，应乎右肾。五是牛痫，发出牛吼声，因为牛对应地支丑，手太阴湿土主管它，应乎肺。这五痫对应五种牲畜，也对应五脏。发作时头晕颠倒，口眼牵引歪斜，眼球上摇，手足抽搐，背脊强直，约一顿饭时间才苏醒，各随所感应的脏腑，施以相应的治法。〔钱乙〕凡是治疗五痫，都随所属脏腑进行治疗，每脏对应一种兽类：犬痫表现为角弓反张向上窜动，叫如犬声，属肝。羊痫表现为瞪眼吐舌，叫如羊声，属心。牛痫表现为直视腹部胀满，叫如牛声，属脾。鸡痫表现为惊跳、角弓反张、手部松弛，叫如鸡声，属肺。猪痫表现为如尸体般僵硬、吐沫，叫如猪声，属肾。五痫重症者死，病后症状严重者也死，轻症者用五色丸主治。〔薛己〕面色红赤、眼睛瞪视、吐舌咬舌、心烦气短，声音像羊的，称为心痫。面色青、嘴唇青、两眼上视、手足挛缩反张，声音像狗的，称为肝痫。面色黑、眼睛震颤、吐涎沫、形体如尸、声音像猪的，称为肾痫。面色如枯骨、眼白反视、惊跳反张、摇头吐沫、声音像鸡的，称为肺痫。面色萎黄、眼睛直视、腹部胀满、自下利、四肢无力不收，声音像牛的，称为脾痫。五痫通用五色丸为主药，仍参酌各经的药物。心痫属于血虚的用养心汤。发热且想喝冷水的为实热，用虎睛丸；发热且想喝热水的为虚热，用妙香散。肝痫者，虚证用地黄丸。抽搐有力为实邪，用柴胡清肝散。大便不通的用泻青丸。肾痫者，用地黄丸、紫河车丸之类，肾没有泻法，所以直接从虚证治疗。肺痫者，属于气虚，用补肺散。面色萎黄的，是土不能生金，用五味异功散。面色红的，是阴火上冲于肺，用地黄丸。脾痫者，用五味异功散。如果面色青、腹泻、饮食减少思虑，用六君子汤加木香、柴胡。
按语：《千金方》叙述六畜痫，没有五脏的分属，钱乙开始进行分属，但没有马痫这一证候。曾世荣认为初发作时发出羊、犬叫声的，是因为咽喉被风痰阻塞，声音自然如此，道理很明白。所谓六畜，只是勉强命名罢了，所以朱丹溪说既然经典中没有依据，而且治疗方法也没有见到五种的区分，所以不必强行区分五种。
The *Qianjin Fang* (Prescriptions Worth a Thousand Gold) states: There are three types of epilepsy in children, namely Fengxian (Wind Epilepsy), Jingxian (Fright Epilepsy), and Shixian (Food Stagnation Epilepsy). Fengxian arises because excessive clothing causes sweating, allowing Wind Pathogen (external wind evil) to enter; initially, the fingers may flex and extend as if counting. Jingxian originates from fright and terror followed by loud crying. Shixian begins with refusal to nurse, vomiting, subsequent fever, and then the onset of seizures. However, although Fengxian and Jingxian occur occasionally, they account for less than one or two out of ten children; any case presenting with initial chills followed by fever is classified as Shixian. For Jingxian, moxibustion should be performed according to diagrams. Fengxian should be treated with Zhuxin Tang (Pig Heart Decoction). Shixian requires purgation to resolve, and Zishuang Wan (Purple Frost Pill) is effective.
Commentary: This discussion on the three epilepsies categorizes them into three etiologies: Fengxian belongs to external causes, Jingxian to internal causes, and Shixian to neither-internal-nor-external causes.
Further Commentary: The *Quanying Fang* (Formulas for Infant Care) states: Fengxian results from improper nursing leading to disharmony of Qi and Blood, or heavy clothing causing sweating and opening of Couli (pores/skin texture), allowing Wind Pathogen to invade. The pathology lies in the Liver, which governs Wind. Clinical signs include cyanosis of the eyes, redness of the face, and convulsions. Suitable treatments include Qufeng Gao (Wind-Expelling Paste), Daqing Gao (Great Cyan Paste), Hupo San (Amber Powder), and Zhenjing Yao (Calming Fright Medicines). If heat is present, Sishun Yin (Four-Obedient Decoction) is used; after the heat subsides, Lijing Wan (Relieve Fright Pill) is administered to purge phlegm-saliva. Jingxian arises from excess and fullness of Qi and Blood, generating heat in the Zang-Fu organs, or from fright/terror/crying damaging the Spirit, compounded by external pathogens. The pathology lies in the Heart, which governs Fright. Clinical signs include sudden cries accompanied by convulsions. Suitable treatments include Hupo San, Honglong San (Red Dragon Powder), and Zhenxin Wan (Calming Heart Pill). If heat is present, Sishun Yin is used, followed by Lijing Wan for purgation, preventing other diseases. Shixian pathology lies in the Spleen, which receives food. Clinical signs include belching/vomiting air followed by convulsions. If stools are sour and foul-smelling, Ziwanzi (Purple Pills) can be used for purgation. These three syndromes are largely similar but slightly different, all belonging to Yang syndromes. Each presents with strabismus or upward deviation of the eyes, tidal convulsions of hands and feet, or pig-like sounds. Recovery occurs immediately after the seizure ends. The prognosis is generally good, with nine survivors for every one death.
The *San Yin Ji Yi Bing Zheng Fang Lun* (Treatise on the Causes and Manifestations of Diseases Due to Three Categories) states: Ancient formulas mention Wu Xian (Five Epilepsies), Wuzang Xian (Five-Zang Epilepsies), and Liuchou Xian (Six Livestock Epilepsies), with varying names and manifestations difficult to fully record. The *Bie Lu* (Separate Records) describes five epilepsies: 1. Ma Xian (Horse Epilepsy), characterized by horse neighing. Horse corresponds to Wu (noon), governed by Hand Shaoyin Junhuo (Ministerial Fire), so the pathology corresponds to the Heart. 2. Yang Xian (Sheep Epilepsy), characterized by bleating. Sheep corresponds to Wei, governed by Foot Taiyin Shitu (Damp Earth), corresponding to the Spleen. 3. Ji Xian (Chicken Epilepsy), characterized by crowing. Chicken corresponds to You, governed by Foot Yangming Zaojin (Dry Metal), corresponding to the Stomach. 4. Zhu Xian (Pig Epilepsy), characterized by grunting. Pig corresponds to Hai, governed by Hand Jueyin Xinbao (Pericardium), corresponding to the Right Kidney. 5. Niu Xian (Ox Epilepsy), characterized by bellowing. Ox corresponds to Chou, governed by Hand Taiyin Shitu (Damp Earth), corresponding to the Lung. These five epilepsies correspond to the five livestock and five Zang organs. During attacks, patients experience dizziness and inversion, pulling of the mouth and eyes, upward rolling of the eyeballs, convulsions of hands and feet, and rigidity of the spine. They recover after about the time it takes to eat a meal. Treatments are applied according to the affected organ. [Qian Yi] All treatments for the five epilepsies follow the treatment of the respective Zang organ, each associated with an animal: Quan Xian (Dog Epilepsy) presents with opisthotonos and upward movement, dog-like barking, corresponding to the Liver. Yang Xian presents with staring eyes and protruding tongue, sheep-like bleating, corresponding to the Heart. Niu Xian presents with fixed gaze and abdominal distension, ox-like bellowing, corresponding to the Spleen. Ji Xian presents with jumping, opisthotonos, and relaxed hands, chicken-like crowing, corresponding to the Lung. Zhu Xian presents as if dead with foaming at the mouth, pig-like grunting, corresponding to the Kidney. Severe cases of the five epilepsies result in death; those with severe post-attack symptoms also die. Mild cases are primarily treated with Wuse Wan (Five-Color Pill). [Xue Ji] Red face, staring eyes, protruding/biting tongue, irritability, shortness of breath, and sheep-like voice indicate Xin Xian (Heart Epilepsy). Blue face/lips, upward eye deviation, limb spasms/opisthotonos, and dog-like voice indicate Gan Xian (Liver Epilepsy). Black face, trembling eyes, salivation, corpse-like posture, and pig-like voice indicate Shen Xian (Kidney Epilepsy). Face like dry bone, white sclera visible, jumping/opisthotonos, head shaking, foaming, and chicken-like voice indicate Fei Xian (Lung Epilepsy). Sallow/withered yellow face, fixed gaze, abdominal distension, spontaneous diarrhea, flaccid limbs, and ox-like voice indicate Pi Xian (Spleen Epilepsy). The five epilepsies generally use Wuse Wan as the main formula, supplemented by herbs specific to each meridian. For Xin Xian due to Blood Deficiency, Yangxin Tang (Nourish Heart Decoction) is used. Fever with desire for cold drinks indicates Excess Heat, treated with Huqing Wan (Tiger Eye Pill); fever with desire for warm drinks indicates Deficiency Heat, treated with Miaoxiang San (Wonderful Fragrance Powder). For Gan Xian, Deficiency patterns use Dihuang Wan (Rehmannia Pill); strong convulsions indicate Excess Evil, treated with Chaihu Qinggan San (Bupleurum Clear Liver Powder); constipation is treated with Xieqing Wan (Drain Green Pill). For Shen Xian, Dihuang Wan or Ziheche Wan (Placenta Pill) are used; since the Kidney has no purgative method, treatment addresses deficiency directly. For Fei Xian, Qi Deficiency is treated with Bufei San (Tonify Lung Powder). Sallow complexion indicates Earth failing to generate Metal, treated with Wuwei Yigong San (Five-Ingredient Extraordinary Merit Powder). Red face indicates Minster Fire rushing up to the Lung, treated with Dihuang Wan. For Pi Xian, Wuwei Yigong San is used. If blue face, diarrhea, and poor appetite are present, Liu Junzi Tang (Six Gentlemen Decoction) is modified with Muxiang and Chaihu.
Commentary: The *Qianjin Fang* describes Liuchou Xian without assigning them to the Five Zang organs; Qian Yi introduced this classification but omitted Ma Xian. Zeng Shirong argued that initial sounds resembling sheep or dogs are due to wind-phlegm obstructing the throat, making the "six livestock" designation merely a forced name. Therefore, Zhu Danxi stated that since there is no scriptural basis and no distinct therapeutic methods for the five types, differentiation into five is unnecessary.