张涣等方有中风方论，今见小儿绝无患者，而用药多犯香燥，恐血热生风、类
中风证，误用之，则为害不浅，故一切削而不载。薛氏云∶中风之证，西北方有之，
东南气温，腠理疏泄，人患之者皆类中风也。况小儿元气未充，皮毛不固，易虚易
实，外邪乘之，则壮热抽掣，气粗涎涌，甚至昏愦口噤，即似中风，误以续命等汤
投之，多至不救，大人且无真中，况小儿乎。凡有前证，当辨其因，若阳明经气虚，
风邪所乘，筋脉拘急者为外因。足厥阴肝火炽盛，筋脉偏急者为内因。脾肺虚弱，
腠理不密，外邪乘入，或惊风过服金石之剂，耗损肝血，或吐泻后内亡津液，不能
养肝，致口眼 斜者，皆肝血不足，肝火生风之类中风之类证也。
〔钱〕肝有风，甚则身反张强直，不搐，心不受热，当补肾治肝。补肾，地黄丸，
治肝，泻青丸。丹溪云∶痉比痫为虚，宜带补，多是气虚有火兼痰，用人参竹沥
治之，不用兼风药。此论实发前人所未发，汤氏虽云痉候十无一生，盖未尝有此法
施于人也。〔薛〕钱仲阳曰角弓反张者，由风邪客于太阳经也，经曰∶风从上受。
足太阳主周身之气，其脉起于目内 而行于背，肝属木主风，所以风邪易侵也。夫
小儿肌肤未密，外邪易伤，肝为相火，其怒易发，若身反张强直，发热不搐者，风
伤太阳也，宜用人参羌活散、小续命汤。若因暴怒而击动其肝火者，宜用泻青丸。
若饮前剂，其证益甚者，此邪气已去而脾气亏也，宜用异功散加芎、归补之。若
因肝经虚热，或因克伐真气，虚热生风者，宜用异功散、地黄丸补之。若因下而
脾气困惫，腹肚膨胀者，此中气损也，宜用白术散补之。若气血素弱，或服攻伐之
剂，而手寻衣领，切牙呵欠者，肝经虚甚也，急用地黄丸以补之，仍与肝脏参览。
一小儿忽腰背反张，目上视，面青赤。曰青属肝主风，赤属心主火，此风火相搏。用
柴胡栀子散倍加钓藤钩顿安，而痰如旧，又用抱龙丸而愈。一小儿忽腰背反张，
服治惊之药后不时举发，面色黄白，肢体甚倦。余用五味异功散十余剂而愈。后因
惊兼饮食不节，不时举发，随用前药即愈。遂日以参术末每服五七分，炮姜、大枣
煎汤调下，服至二两而不发。以上二证，元气虚而病气实也，若用攻邪之药，皆误
矣。一小儿素患前证痰盛，面色素白而兼青。余谓肺气不能平肝，肝气乘脾，脾
气虚而生痰耳。先用抱龙丸二服以平肝，随用六君子汤以补脾肺，月余而痊。半载
之后复发，谓非逐痰不能全愈，遂用下剂，痰涎甚多，而咽喉如锯声。余曰乃脾不
能摄涎也，咽间鸣，乃肺气虚甚也，遂用人参五钱、炮姜三分，水煎服而醒，至第
四剂后，加枣二枚，人参服数两而愈。后每发，非独参汤不应，若执常方，鲜有不
误者。
人参羌活散（方见惊搐） 小续命汤（方见杂病中风） 泻青丸（方见肝脏） 异功散（方
见吐泻） 柴胡栀子散（方见积热） 抱龙丸（方见惊搐） 六君子汤（方见吐泻）
张涣等人的医方中有关于中风治疗的论述，如今我发现小儿极少患此病，而当时用药多使用香燥之品，恐怕会导致血热生风、出现类似中风的证候，若误用这些药物，则危害极大，因此我将这些内容全部删去，不予收录。薛己说：真正的中风证，在西北方较为常见；东南地区气候温暖，人体腠理（皮肤毛孔）疏松易开泄，人们患的皆是类中风证。况且小儿元气尚未充盈，皮毛不坚固，病情容易由虚转实或由实转虚，外邪乘虚而入，就会出现高热、抽搐掣动、呼吸粗重、痰涎上涌，甚至昏迷、牙关紧闭，看起来像中风，如果误用续命汤等方剂治疗，大多导致死亡无法挽救，成年人尚且很少有真中风，何况小儿呢？凡是有上述症状，应当辨别病因。如果是阳明经气虚，风邪乘袭，导致筋脉拘急的，属于外因。如果是足厥阴肝火炽盛，导致筋脉一侧拘急的，属于内因。如果是脾肺虚弱，腠理不紧密，外邪乘入，或者惊风时过服金石类药物，耗损了肝血，或者吐泻后体内津液亡失，不能滋养肝脏，导致口眼歪斜的，都属于肝血不足、肝火生风之类的类中风证候。
钱乙说：肝有风邪，严重时身体反张强直，但不抽搐，心不受热，应当补肾兼治肝。补肾用六味地黄丸，治肝用泻青丸。朱丹溪说：痉证比痫证更偏虚证，治疗宜兼顾补益，多是气虚有火兼有痰湿，用人参和竹沥治疗，不使用祛风药。这一论断确实阐发了前人未曾发现的道理，虽然汤氏曾说痉证十人中有九人不能存活，大概是因为没有将此法应用于临床罢了。薛己按：钱仲阳（钱乙）说角弓反张，是由风邪客居于太阳经所致，《内经》说：风邪从上部受侵。足太阳膀胱经主管周身之气，其经脉起于目内眦而行于背部，肝属木主风，所以风邪容易侵袭。小儿肌肤不致密，外邪容易受伤，肝为相火，发怒容易引发肝火，如果出现身体反张强直、发热但不抽搐的，是风伤太阳经，适宜用人参羌活散或小续命汤。如果是因为暴怒触动肝火的，适宜用泻青丸。如果服用前两种方剂后，症状反而加重，这是邪气已去但脾气亏损，适宜用异功散加川芎、当归来补益。如果是因为肝经虚热，或者因为攻伐真气导致虚热生风的，适宜用异功散、地黄丸来补益。如果因为腹泻导致脾气困倦疲惫，腹部膨胀的，这是中气受损，适宜用白术散补益。如果气血素来虚弱，或者服用攻伐药剂后，出现手抓衣领、磨牙呵欠的，是肝经极度虚弱，急需用地黄丸来补益，仍需参考肝脏相关论述。
有一个小儿突然腰背反张，眼睛向上视，面色青赤。我说青色属肝主风，赤色属心主火，这是风火相搏。用柴胡栀子散倍加钩藤，一次服用即安定，但痰象依旧，又用抱龙丸而痊愈。另一个小儿突然腰背反张，服用治惊的药物后不时发作，面色黄白，肢体非常疲倦。我用五味异功散十余剂而痊愈。后来因为受惊兼饮食不节制，不时发作，随即用前面的药就痊愈了。于是每天让患儿服用人参、白术粉末五七分，用炮姜、大枣煎汤调下，服至二两后不再发作。以上两个病例，都是元气虚而病气实，如果用攻邪的药，都是错误的。
还有一个小儿平素患有前证且痰多，面色素白而兼青。我认为这是肺气不能制约肝木，肝气乘袭脾土，脾气虚弱而生痰。先用抱龙丸两服以平抑肝气，随后用六君子汤补益脾肺，一个多月后痊愈。半年后复发，认为非祛除痰涎不能全愈，于是用泻下剂，痰涎非常多，咽喉发出如拉锯的声音。我说这是脾不能摄纳涎液，咽喉鸣响，是肺气极度虚弱，于是用人参五钱、炮姜三分，水煎服后苏醒，到第四剂后，加红枣两枚，服用人参数两后痊愈。后来每次发作，单用独参汤无效，如果固执于常规方剂，很少有不犯错的。
人参羌活散（方剂见惊搐章节） 小续命汤（方剂见杂病中风章节） 泻青丸（方剂见肝脏章节） 异功散（方剂见吐泻章节） 柴胡栀子散（方剂见积热章节） 抱龙丸（方剂见惊搐章节） 六君子汤（方剂见吐泻章节）
Zhang Huan and others included discussions on stroke in their medical formulas. However, I have observed that infants and children rarely suffer from this disease. The medications used at the time often involved aromatic and drying substances, which might generate wind from blood heat or present as symptoms resembling stroke. Misusing these remedies would cause significant harm; therefore, I have omitted all such content and do not record it here. Xue Ji stated: True stroke occurs mainly in the northwest regions. In the southeast, where the climate is warm, the cou li (skin pores) are loose and prone to sweating. People there suffer from conditions resembling stroke rather than true stroke. Moreover, children's primordial qi (Yuan Qi) is not yet fully developed, and their skin and hair are not solid. Their condition easily shifts from deficiency to excess or vice versa. When external pathogens invade, they may experience high fever, convulsive twitching, coarse breathing, and surging phlegm-saliva. In severe cases, they may become comatose with locked jaws, appearing similar to stroke. If mistakenly treated with decoctions like Xuming Tang (Minor Continue Life Decoction), death is often the result. Even adults rarely suffer from true stroke, let alone children. For any of the aforementioned symptoms, one must differentiate the etiology. If it is due to deficiency of qi in the Yangming channel, allowing wind pathogens to invade and causing stiffness and tension of the tendons and vessels, it is classified as an external cause. If it is due to blazing fire of the Foot Jueyin Liver channel, causing unilateral stiffness and tension of the tendons and vessels, it is classified as an internal cause. If it is due to weakness of the Spleen and Lung, with loose cou li allowing external pathogens to enter, or if excessive use of mineral medicines during convulsions damages Liver blood, or if vomiting and diarrhea lead to loss of body fluids that can no longer nourish the Liver, resulting in deviation of the mouth and eyes, all these belong to the category of conditions resembling stroke caused by insufficient Liver blood and wind generated by Liver fire.
Qian Yi stated: When the Liver has wind, in severe cases, the body becomes arched backward and rigid without convulsions. If the Heart is not affected by heat, one should tonify the Kidney and treat the Liver. Tonifying the Kidney uses Dihuang Wan (Rehmannia Pill); treating the Liver uses Xieqing Wan (Drain the Green Pill). Zhu Danxi stated: Spasm (Jing) is more deficient than epilepsy (Xian) and treatment should include tonification. It is mostly due to qi deficiency with fire and phlegm, treated with Ren Shen (Ginseng Root) and Zhuli (Bamboo Sap), avoiding wind-dispelling herbs. This theory truly elucidated insights previously unexplored by earlier scholars. Although Tang Shi claimed that ten out of ten cases of spasm were fatal, it was likely because this method had not been applied clinically. Xue Ji added: Qian Zhongyang (Qian Yi) stated that opisthotonos (arched back) is caused by wind pathogens lodging in the Taiyang channel. The Classic says: Wind enters from above. The Foot-Taiyang Bladder channel governs the qi of the whole body; its vessel originates from the inner canthus and runs along the back. Since the Liver belongs to Wood and governs wind, wind pathogens easily invade. Children's skin and flesh are not dense, making them susceptible to external pathogens. The Liver contains ministerial fire, and anger easily triggers Liver fire. If the body arches backward and becomes rigid with fever but no convulsions, it is wind injuring the Taiyang channel, suitable for treatment with Renshen Qianghuo San (Ginseng and Notopterygium Powder) or Xiao Xuming Tang (Minor Continue Life Decoction). If triggered by sudden rage stirring up Liver fire, Xieqing Wan (Drain the Green Pill) is suitable. If symptoms worsen after taking the former prescriptions, it indicates that the pathogen has departed but Spleen qi is deficient; Yigong San (Extraordinary Efficacy Powder) plus Chuanxiong (Szechwan Lovage Rhizome) and Danggui (Chinese Angelica Root) should be used to tonify. If due to deficiency-heat in the Liver channel, or if attacking true qi generates deficiency-heat and wind, Yigong San and Dihuang Wan should be used to tonify. If diarrhea leads to exhaustion of Spleen qi and abdominal distension, this is damage to Middle Qi, suitable for Baizhu San (Atractylodes Macrocephala Powder). If the person is constitutionally weak in qi and blood, or after taking attacking agents, exhibits grasping at clothing collars, grinding teeth, and yawning, it indicates extreme deficiency of the Liver channel; Dihuang Wan should be urgently administered to tonify, referring also to discussions on the Liver organ.
One child suddenly presented with opisthotonos, upward gaze, and a cyanotic-red complexion. I said cyanosis belongs to the Liver and governs wind, while redness belongs to the Heart and governs fire; this is wind and fire clashing. Using Chaihu Zhizi San (Bupleurum and Gardenia Powder) with doubled Gouteng (Uncaria Ramulus), taken in one dose, brought immediate relief, but phlegm remained; subsequently, Baolong Wan (Embrace Dragon Pill) cured the condition. Another child suddenly presented with opisthotonos, recurring intermittently after taking anti-convulsant medicines, with a yellowish-white complexion and extreme limb fatigue. I used Wuyi Yigong San (Five-Agent Extraordinary Efficacy Powder) for over ten doses, resulting in recovery. Later, due to fright and irregular diet, symptoms recurred intermittently; using the previous prescription led to recovery. Thus, daily administration of powdered Renshen (Ginseng Root) and Baizhu (Atractylodes Macrocephala Rhizome), 5-7 fen per dose, mixed with decoction of Paojiang (Prepared Ginger) and Dazao (Jujube Fruit), resulted in cessation of symptoms after two liang were consumed. Both cases above involved deficiency of primordial qi and excess of pathogenic qi; using attacking herbs would have been erroneous.
Another child, suffering from the aforementioned condition with abundant phlegm, had a pale white complexion with a bluish tint. I reasoned that Lung qi failed to control Liver wood, Liver qi attacked Spleen earth, and Spleen deficiency generated phlegm. Initially, two doses of Baolong Wan (Embrace Dragon Pill) were used to calm the Liver, followed by Liujunzi Tang (Six Gentlemen Decoction) to tonify the Spleen and Lung, leading to recovery after more than a month. Six months later, it relapsed. I believed that only by purging phlegm could full recovery be achieved, so I used a purgative formula. Abundant phlegm-saliva was expelled, accompanied by a sawing sound in the throat. I stated this was due to the Spleen's inability to control saliva, and the throat noise indicated extreme Lung qi deficiency. I prescribed Renshen (Ginseng Root) 5 qian and Paojiang (Prepared Ginger) 3 fen, decocted in water. The child regained consciousness. After the fourth dose, two Zao (Jujube Fruit) were added. Consuming several liang of Renshen led to complete recovery. Subsequent episodes did not respond to Dushen Tang (Single Ginseng Decoction); adhering to standard formulas would rarely avoid error.
Renshen Qianghuo San (see Convulsions chapter); Xiao Xuming Tang (see Miscellaneous Diseases Stroke chapter); Xieqing Wan (see Liver chapter); Yigong San (see Vomiting and Diarrhea chapter); Chaihu Zhizi San (see Accumulated Heat chapter); Baolong Wan (see Convulsions chapter); Liujunzi Tang (see Vomiting and Diarrhea chapter).