小儿惊搐之症必有痰，或因惊而痰聚，或因痰而
致惊。古人治惊方中，俱兼痰药，必须先治其痰，然后泻火清神。若痰壅塞胸膈不去，则泻火、清神之药，
无所施其功也，二陈汤加竹沥，入少姜汁，最稳；痰重者，滚痰丸、白饼子、利惊丸下之。滚痰丸下热痰，
白饼子、利惊丸下痰积。在上者宜吐之，重则用药吐，轻则探吐之。若不必吐下，以二陈为主，脾虚有热
痰，加白术、芩、连；风痰稠结，加南星、贝母、枳实；胃虚生痰，加白术、麦芽、竹沥。
愚按前症若因心肝二经风热炽盛，两目连札，四肢抽搐，宜治肝清心；若因心经蕴热，叫呼战栗，宜
清热安神；若因肺感风邪，气急喘促，宜治痰理肺；若因饮食停滞，嗳吐，困睡，宜消导健脾；若因脾肺
虚弱而风痰壅盛，以致前症，但宜补中益气为主。若执用祛风、治痰、理气之剂，则气散阴消，而促其危
矣。
大尹刘应昌子，患瘰 ，恪用化痰之剂，虚症悉至，殊类惊风。又服祛风至宝丹，小便频数，肢体抽
搐，或两目连札，切牙，呵欠，或作呕懒食，大便重坠，或泄泻，此土伤而木胜也。用补中益气汤、六味
地黄丸而痊。
冬官朱小溪子，项间结核，面色痿黄，肌体消瘦，切牙，抽搐，头摇，目札，此肝木克脾土也。用六君
子汤、九味芦荟丸而愈。
宪幕顾斐斋玄孙，二周，项结核，两臂反张，索败毒之药。余意其症属风热伤肝，血燥筋挛，未敢敷
药。翌早请治，果系前症，遂与六味丸一服，侵晨灌之，午后肢体如常。
儒者王文远子，患瘰 ，痰盛发搐，服金石香燥之剂，手足筋挛，此肝血复伤而致急惊风也。遂用加
味小柴胡加钩藤、山栀、芎、归一剂，又以六味丸料加五味、麦门煎服而安。
小儿忽然惊搐，目上视，摇头，切牙，症候怪异，世俗多作肝经有余之症，投以惊药，岂知饮食停滞，
痰涎壅积，亦多类惊者。便须审察有无伤积，腹痛，胸满，呕吐，恶食，轻则消滞化痰，重则探吐滞积，
而后调之。又有因感冒、吐泻而发热，气血虚为热所迫，虽见惊症，不可即服惊药，但调治吐泻、感冒，
则气自定、热自退，而惊自除矣。
愚按前症若因肝木侮脾土，用六君子加芍药、木香、柴胡；若因脾土虚而自病，用五味异功散。大凡
饮食停滞，痰积壅满，而见惊症，实因脾土虚弱，不能运化所致，但健脾胃，则食自消、痰自化。若轻用
惊药、风药，反所以成其风而重其病也。况脆嫩脏腑，安能受峻厉之剂耶？若专治其病则误矣。
姚仪部子，每停食身发赤晕，用清中解郁汤而愈，后患摇头，切牙，痰盛，发搐，吐出酸味。待其吐尽，
翌日少以七味白术散，后日以参苓白术散调理脾胃，遂不复患。大抵吐后儿安，不必更服药也。
一小儿，停食，服通利之剂作呕、腹胀，此脾胃复伤也。用补中益气汤而愈。
一小儿，两目动札，手足发搐，数服天麻防风丸之类，以祛风化痰，前症不愈，其痰益甚，得饮食诸
症稍愈，视其准头及左颊，色青黄。余曰∶脾主涎，此肝木制脾土，不能统摄其涎，非痰盛也。遂用六君
子汤加升麻、柴胡、钩藤，二剂，饮食渐进，诸症渐愈，又用补中益气而安。
小儿惊搐这一病症必然伴有痰证，可能是因为受惊导致痰液聚集，也可能是因为痰盛引发惊风。古人治疗惊风的方剂中，都兼用化痰药物，必须先治疗其痰，然后再泻火清心安神。如果痰浊壅塞胸膈不去除，那么泻火、清神的药物就无法发挥作用。此时可用二陈汤加入竹沥，再滴入少量姜汁，最为稳妥；痰重者，可用滚痰丸、白饼子或利惊丸攻下。滚痰丸用于攻下热痰，白饼子和利惊丸用于攻下痰积。病位在上焦的适宜采用催吐法，病情重的用药催吐，病情轻的用探喉法催吐。如果不需要吐下疗法，以二陈汤为主方：脾虚而有热痰的，加白术、黄芩、黄连；风痰稠厚凝结的，加天南星、贝母、枳实；胃虚生痰的，加白术、麦芽、竹沥。
我按语：前述病症若因心肝两经风热炽盛，出现两眼频繁眨动（连札），四肢抽搐，应当治肝清心；若因心经蕴藏热邪，出现呼叫、战栗，应当清热安神；若因肺感受风邪，出现气急喘促，应当治痰理肺；若因饮食停滞，出现嗳气呕吐、困倦嗜睡，应当消食导滞、健脾；若因脾肺虚弱而风痰壅盛，导致上述症状，只宜以补中益气为主。如果固执地使用祛风、治痰、理气的药剂，会导致气散阴消，从而加速危象的发生。
大尹刘应昌的儿子，患有瘰疬，严格使用化痰药剂，导致虚证全部显现，非常像惊风。又服用祛风至宝丹，出现小便频数，肢体抽搐，有时两眼频繁眨动，咬牙，打哈欠，有时作呕懒食，大便有重坠感，或者泄泻，这是脾土受伤而肝木亢盛的表现。使用补中益气汤、六味地黄丸后痊愈。
冬官朱小溪的儿子，颈部有结核，面色萎黄，身体消瘦，咬牙，抽搐，头摇，眨眼，这是肝木克制脾土的表现。使用六君子汤、九味芦荟丸后痊愈。
宪幕顾斐斋的玄孙，两周大，颈部结核，双臂反张，索要败毒的药物。我认为此症属于风热伤肝，血燥筋挛，不敢轻易敷药。第二天早上请诊，果然确实是前症，于是给予六味丸一服，清晨灌服，午后肢体恢复正常。
儒者王文远的儿子，患有瘰疬，痰盛引发惊搐，服用金石类香燥的药物，导致手足筋挛，这是肝血再次受损而导致的急惊风。于是使用加味小柴胡汤加钩藤、山栀、川芎、当归，一剂后，又以六味丸料加五味子、麦门冬煎服而安定。
小儿忽然惊搐，眼睛上视，摇头，咬牙，症状怪异，世俗多将其作为肝经有余之症，投用惊风药，哪里知道饮食停滞，痰涎壅积，也大多类似惊风。必须审察是否有伤食积滞，腹痛，胸满，呕吐，恶食，轻则消滞化痰，重则探吐滞积，然后进行调理。又有因感冒、吐泻而发热，气血虚弱被热邪逼迫，虽然见到惊症，不可立即服用惊风药，只需调治吐泻、感冒，那么气自定、热自退，惊风自然消除。
我按语：前述病症若因肝木侮犯脾土，用六君子汤加芍药、木香、柴胡；若因脾土虚弱而自病，用五味异功散。大凡饮食停滞，痰积壅满，而出现惊症，实因脾土虚弱，不能运化所致，只要健脾胃，则食物自消、痰自化。如果轻率使用惊药、风药，反而助长风邪而加重病情。何况脏腑脆嫩，怎么能承受峻烈猛烈的药剂呢？如果专门治疗惊风而误判病因，那就错了。
姚仪部的儿子，每次停食身体发出赤晕，用清中解郁汤而愈，后来患摇头，咬牙，痰盛，发搐，吐出酸味。等待其吐尽，第二天少量服用七味白术散，后天服用参苓白术散调理脾胃，于是不再患病。大体上吐完后婴儿安宁，不必再服药了。
一个小孩，停食，服用通利药剂后作呕、腹胀，这是脾胃再次受伤。用补中益气汤而愈。
一个小孩，两眼眨动，手足发搐，多次服用天麻防风丸之类，以祛风化痰，前症不愈，其痰更加严重，得到饮食后诸症稍好，观察其鼻准头及左颊，颜色青黄。我说：脾主涎，这是肝木克制脾土，不能统摄其涎，并非痰盛。于是用六君子汤加升麻、柴胡、钩藤，两剂后，饮食逐渐增加，诸症逐渐好转，又用补中益气汤而安定。
The syndrome of infantile convulsion and tremor (Jing Chu) is invariably associated with phlegm. It may be caused by phlegm accumulation due to fright, or by fright induced by excessive phlegm. In ancient formulas for treating fright, herbs resolving phlegm were always included; one must first treat the phlegm, then clear heat and calm the spirit. If phlegm turbidity obstructs the chest and diaphragm and is not removed, the efficacy of herbs that purge fire and clear the spirit will be nullified. For this, Er Chen Tang (Two-Cured Decoction) added with Bamboo Sap (Zhuli) and a small amount of Ginger Juice is most stable; for severe phlegm, Gun Tan Wan (Rolling Phlegm Pill), Bai Bing Zi (White Cake Pill), or Li Jing Wan (Relieving Fright Pill) are used to purge downward. Gun Tan Wan purges hot phlegm, while Bai Bing Zi and Li Jing Wan purge phlegm accumulations. When the pathogen is located in the upper jiao, emesis is indicated: for severe cases, medicinal emetics are used; for mild cases, throat-probing emesis is employed. If emesis and purgation are not necessary, Er Chen Tang serves as the main formula: for spleen deficiency with hot phlegm, add Atractylodis Macrocephalae Rhizoma (Baizhu), Scutellariae Radix (Huangqin), and Coptidis Rhizoma (Huanglian); for wind-phlegm that is thick and congealed, add Pinelliae Tuber (Nanxing), Fritillariae Bulbus (Beimu), and Aurantii Fructus Immaturus (Zhishi); for stomach deficiency generating phlegm, add Atractylodis Macrocephalae Rhizoma (Baizhu), Malto (Maiya), and Bamboo Sap (Zhuli).
My commentary: Regarding the aforementioned syndromes, if they result from blazing wind-heat in the Heart and Liver meridians, manifesting as frequent blinking of both eyes and limb convulsions, treatment should focus on soothing the Liver and clearing the Heart. If caused by latent heat in the Heart meridian, manifesting as crying out and trembling, treatment should clear heat and calm the spirit. If caused by Wind pathogen affecting the Lung, manifesting as rapid breathing and panting, treatment should resolve phlegm and regulate the Lung. If caused by food stagnation, manifesting as belching, vomiting, drowsiness, and lethargy, treatment should promote digestion and strengthen the Spleen. If caused by Spleen and Lung deficiency leading to abundant wind-phlegm causing these symptoms, treatment should primarily tonify the Middle and boost Qi (Bu Zhong Yi Qi). Adhering rigidly to agents that dispel wind, resolve phlegm, or regulate Qi will scatter Qi and consume Yin, thereby hastening critical danger.
The son of Dayin Liu Yingchang suffered from scrofula (Luo Li). He strictly used phlegm-resolving agents, which led to the manifestation of all deficiency syndromes, closely resembling infantile convulsion. He then took Qu Feng Zhi Bao Dan (Wind-Dispelling Precious Pill), resulting in frequent urination, limb convulsions, occasional frequent blinking of both eyes, teeth grinding, yawning, occasional nausea and poor appetite, a sensation of heaviness in defecation, or diarrhea. This indicates injury to Earth (Spleen) allowing Wood (Liver) to flourish. He recovered after using Bu Zhong Yi Qi Tang (Tonify the Middle and Boost Qi Decoction) and Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia).
The son of Dongguan Zhu Xiaoxi had neck lymph node swellings, sallow complexion, emaciation, teeth grinding, convulsions, head shaking, and eye blinking. This represents Liver Wood overacting on Spleen Earth. He was cured using Liu Jun Zi Tang (Six-Gentleman Decoction) and Jiu Wei Lu Hui Wan (Nine-Ingredient Aloe Pill).
The great-grandson of Xianmu Gu Feizhai, aged two weeks, had neck lymph node swellings and opisthotonos (arms hyperextended backward). He requested detoxifying medicines. I reasoned that the syndrome belonged to wind-heat injuring the Liver, causing blood dryness and tendon spasms, so I dared not apply external medicine. The next morning, upon request for treatment, it proved to be the aforementioned syndrome. I administered one dose of Liu Wei Wan (Six-Ingredient Pill), given early in the morning; by afternoon, his limbs returned to normal.
The son of Scholar Wang Wenyuan suffered from scrofula with abundant phlegm triggering convulsions. After taking metallic and aromatic-dry agents, he developed tendon spasms in hands and feet. This resulted from further injury to Liver Blood leading to acute infantile convulsion. I prescribed Jia Wei Xiao Chai Hu Tang (Modified Minor Bupleurum Decoction) added with Uncariae Ramulus cum Uncis (Gouteng), Gardeniae Fructus (Shanzhi), Ligustici Chuanxiong Rhizoma (Xiong), and Angelicae Sinensis Radix (Gui). One dose was given, followed by an infusion of Liu Wei Wan ingredients added with Schisandrae Fructus (Wuweizi) and Ophiopogonis Tuber (Maimen) to stabilize him.
When infants suddenly experience convulsion and tremor, upward gaze, head shaking, and teeth grinding, presenting bizarre symptoms, laypeople often diagnose it as excess in the Liver meridian and administer anticonvulsant drugs. They fail to realize that food stagnation and phlegm-saliva accumulation often mimic convulsion. One must carefully examine for signs of food retention, abdominal pain, chest fullness, vomiting, and food aversion. For mild cases, promote digestion and resolve phlegm; for severe cases, probe for emesis to expel retained food, then regulate. Additionally, fever caused by cold-attack or vomiting/diarrhea, where deficient Qi and Blood are forced by heat, may present with convulsive symptoms. Anticonvulsant drugs should not be taken immediately. Instead, regulating vomiting/diarrhea and cold-attack will naturally settle Qi, reduce heat, and eliminate convulsion.
My commentary: Regarding the aforementioned syndromes, if caused by Liver Wood insulting Spleen Earth, use Liu Jun Zi Tang added with Paeoniae Radix Alba (Shaoyao), Aucklandiae Radix (Muxiang), and Bupleuri Radix (Chaihu). If caused by Spleen Earth deficiency itself, use Wu Wei Yi Gong San (Five-Ingredient Formula for Benefiting Work). Generally, when food stagnation and phlegm accumulation cause convulsive symptoms, it is truly due to Spleen Earth deficiency failing to transform and transport. Strengthening the Spleen and Stomach will naturally digest food and resolve phlegm. Lightly using anticonvulsant or wind-dispelling drugs will instead generate wind and worsen the disease. Moreover, how can delicate organs withstand harsh and fierce agents? Treating only the apparent illness would be a mistake.
The son of Yibu Yao developed red halos on his body whenever food stagnated, cured by Qing Zhong Jie Yu Tang (Clear the Middle and Resolve Depression Decoction). Later, he suffered from head shaking, teeth grinding, abundant phlegm, and convulsions, vomiting sour fluid. After waiting for the vomitus to clear, he was given a small amount of Qi Wei Bai Zhu San (Seven-Ingredient Atractylodes Macrocephala Powder) the next day, followed by Shen Ling Bai Zhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) on subsequent days to regulate the Spleen and Stomach, after which he never suffered again. Generally, once vomiting ceases and the child is calm, no further medication is needed.
An infant with food stagnation developed nausea and abdominal distension after taking purgative/laxative agents, indicating secondary injury to the Spleen and Stomach. He recovered using Bu Zhong Yi Qi Tang.
An infant exhibited eye blinking and limb convulsions. Multiple doses of Tian Ma Fang Feng Wan (Gastrodia and Saposhnikovia Pill) were used to dispel wind and resolve phlegm, but the symptoms persisted and phlegm increased. Symptoms improved slightly after feeding. Observation of the nasal tip and left cheek revealed blue-yellow discoloration. I stated: The Spleen governs saliva/phlegm fluid. This is Liver Wood restraining Spleen Earth, failing to control the secretion of fluids, rather than excessive phlegm. I prescribed Liu Jun Zi Tang added with Cimicifugae Rhizoma (Shengma), Bupleuri Radix (Chaihu), and Uncariae Ramulus cum Uncis (Gouteng). After two doses, food intake gradually increased, and symptoms improved. Finally, Bu Zhong Yi Qi Tang was used to achieve stability.