有一二。非小儿所有痉病。皆因于惊吓也。证现发热。或有汗。或无汗。面时青时赤。梦中呓语。手足蠕动。
宜复脉汤。去参、桂、姜、枣。加丹参、丹皮、犀角。补心之体。以配心之用。大便结者加元参。溏者。加牡
蛎。汗多神不宁。有恐惧之象者。加龙骨、整琥珀、整朱砂块（取其气、而不取其质）。必细询病家确有所
见者。方用此例。若语涉支离。猜疑不定者。静心再诊。必得确情。而后用药。愚儿三岁。六月初九辰时。根据
门落空。少时发热。随热随痉。昏不知人。手足如冰。无脉。至戌时而痉止。身热神昏无汗。次日早。余方与
复脉汤。去参、桂、姜、枣。每日一帖。服至三四杯。不饮不食。至十四日巳时。得战汗而愈。若当痉厥神昏
之际。妄动乱治。岂有生理乎。盖痉厥则阴阳逆乱。少不合拍。则不可救。病家情急。因乱投药石。胡针乱
灸。而死者不可胜纪也。按朱遂生云。痉不待治而自止。此证不必责其痉也。发热无汗。纯是外感。自初九至
十四。凡六日。恰合经尽汗解之期。复脉汤非其治也。若以浮萍银翘汤治之。不过一药病愈矣。若包络热重。
唇舌干燥。目睛有赤缕者。牛黄清心丸。本论牛黄安宫丸。紫雪丹辈。亦可酌用之。汪瑟 云。世妄传惊风之
证。惟此一证。乃副其名。其因风因热等项之惊。神气昏愦。往往对面击鼓放铳。全然不知。客忤之证。则神
惊胆怯。畏见异言异服。极易分别也。朱遂生曰。客忤痉。轻者仅神惊胆怯。重者则神气昏愦。王氏子年十
七。夜出为疯狂人所逐。因而成痉。背反张。腿强直。气闭肢冷。呼唤不应。用通窍散。吹其鼻孔。复用水磨
紫金锭灌之立愈。
（九）本脏自病痉（此证则螈病也）此证由于小儿之父母恐儿受寒。覆被过多。着衣过浓。或冬月房屋
热炕过暖。以致小儿每日出汗。汗多亡血。与产妇亡血致痉一理。肝主血。血足则柔。血虚则强。故曰本脏自病。
此一痉也。又实为六淫致痉之根。盖汗多亡血者。本脏自病。汗多亡卫外之阳。则易感六淫之邪也。全赖明医
参透此理。于平日预先告谕小儿之父母。勿令过暖汗多亡血。暗中减少无穷之病矣。所谓治未病也。治本脏自
病法。一以育阴柔肝为主。与治产后亡血病痉同法。所谓血足风自灭也。复脉汤、三甲复脉三方。大小定风珠
二方。皆可选用。专翕膏。在痉止后。每日服四五钱。分两次。为填阴善后计也。六淫无汗致痉者。亦同此
例。救风温温热误汗者。先与存阴。不比伤寒误汗者。急于护阳也。盖寒病不足在阳。温病不足在阴也。
【炳章按】石氏《医原》。论痉病证治一则。颇有发明。录之以备参考。石芾南云。世俗未解六气致病
之理。不知六气最易化燥。及小儿尤易化燥之理。见儿发热。不问何邪。概曰风寒。辄与辛燥升散。杂以苦
温苦涩消导。津液耗伤。致成痉螈。乃见儿痉螈。便称惊风。乱投冰麝金石苦寒 悍毒药。以为开窍镇惊。
清热祛风。家藏丹丸。世传秘方。多系如此。误治甚多。又或将惊字误作筋字。挑筋刺血。强推强拿。其在
富贵之家。酿祸尤速。尝见荐医荐方。接踵而至。此医用热。彼医用寒。一日之间。七方十剂遍尝。刀针金
石全施。又或送鬼叩神。此摇彼唤。使儿无片刻之安。重棉浓絮。炉火壶汤。使儿在热 之内。假使延一
明理之医。对症施治。夫何至于此极。大抵痉病多由于燥热化风。虽名曰风。实是肝阳为病。筋失滋养。故
致强急。试举其大略言之。风寒初起。发热无汗。无论痉与不痉。治以辛润。如杏仁、牛蒡、桔梗之类。
寒重者。加温润。如葱白、生姜之类。风温温热。治以辛凉。于辛润法中。酌加微苦。如桑叶、姜皮、栀皮、
连翘、蔗皮、梨皮、沙参之类。热重者。酌加凉润轻品。如银花、菊花、知母、羚角、竹叶、芦根、梨汁、
蔗汁之类。湿痰。加半夏、蜜炙橘红之类。热痰。加川贝母、天竺黄、栝蒌霜、花粉、胆星之类。燥火甚者。
清燥救肺汤。在所必用。湿夹热者。加辛凉辛苦。如蔻仁、通草、茯苓、滑石、鲜竹叶、鲜荷叶、扁豆花、
姜炒川连之类。阴液亏极。色悴窍干。无涕无泪。口喑不能言。宜速救液。如鲜生地、麦冬、元参、鲜首乌、
阿胶、鸡子黄、鲜石斛、生玉竹、女贞子、牡蛎、龟版之类。液虚燥极。必多进方回。切勿中途易法。致令
不救。
又按王勋臣小儿抽风之论。实亦螈 之类。即吴鞠通所谓内伤饮食痉。世俗所谓慢脾风是也。王清任曰。夫
抽风一症。今人治之不效者。非今人错治。乃古方误人。此证多由于伤寒温疫。或痘疹吐泻等证。病久而抽。则
名曰慢惊风。慢惊风三字相连立名。不但文义不通。亦未细察病源。若真是风。风之中人。必有由皮肤入经
络。亦必有由表入里之证可查。既查无外感之表证。何得总言是风。其所以言风者。因见其病发作之时。项背
反张。两目天吊。口噤不开。口流涎沫。咽喉痰声。昏沉不省人事。以为中风无疑。殊不知项背反张。四肢抽
搐。手指固握。乃气虚不固肢体也。两目天吊。口噤不开。乃气虚不上升也。口流涎沫。乃气虚不归原也。元
气既虚。必不能达于血管。血管无气。必停留而痧。以一气虚血瘀之证。反用散风清火之方。服散风药。无风
则散气。服清火药。无火则凝血。再服攻伐克消之方。气败血亡。岂能望生。每见业小儿科阅历多者。绝不误
人。因抽风古方不效。见抽风则弃而不治。亦有看小儿现下之证。知必抽风。虽无方调治。亦必告知病家。此
病恐将来抽风。凡将欲抽风之前。必先见抽风之证。如见顶门下陷。昏睡露睛。口中摇舌。不能啼哭。哭无眼
泪。鼻孔煽动。咽喉痰声。头低不抬。口噤无声。四肢冰冷。口吐白沫。胸高如碗。喘息气促。面色青白。汗
出如水。不能裹乳。大便绿色。（大便色青、有寒有热。）腹内空鸣。下泻上嗽。肌肉跳动。俱是抽风先兆。
前二十证。不必全见。但见一二证。则知将来必抽。其中有可治者。有不可治者。若露睛天吊。不食不哭。痰
鸣气喘。病虽沉重。乃可治之证。若天庭灰黑。肾子收缩。或脉微细。或脉全无。外形虽轻。乃不治之证。可
治者。宜可保立苏汤主之。（生黄 一两五钱、党参三钱、白术二钱、甘草二钱、当归二钱、白芍二钱、炒枣
仁三钱、萸肉二钱、枸杞子二钱、破故纸一钱、桃核肉一枚、水煎服、此方专治小儿因伤寒瘟疫、或痘疹吐泻
等证、病久气虚、四肢抽搐、项背反张、两目天吊、口流涎沫、昏沉不省人事、至其分两、指四岁小儿而言、
若两岁者可减半、若一岁者可用三分之一、若二三月者、可用四分之一、不必拘于剂数、余治此证一日之间、
用至二三剂者、服至不抽、必告知病家、不可因不抽、遂不服药、必多服数剂、气足方妥。）
又按所述二十余证。皆虚寒之象。故尚可救药。若虚中挟热。则难治矣。余治马氏小儿。甫匝月患痉病。发表
攻里。汤丸杂投。针刺兼施。而痉不止。昼夜十数作。诊之左臂上伸。右臂下垂。手固握。目斜视。口流涎。
肢搐搦。身微热。用灯草、薄荷、白蜜、煎汤。少点姜汁。磨紫金锭灌之。痉减半。再服热退而痉未全止。改
用可保立苏汤两剂全愈。
【荣斋按】本节俞氏所讲的“病因”，引申渊博，为全书中最突出的一篇。但由于头绪繁复，因而失去了重
心，把“伤寒类症的痉”与“伤寒变症的痉”混在一起。本篇章节，既然是“伤寒坏证”中的“伤寒转痉”，
则所述者，应该是“伤寒变症的痉”，而不是“伤寒类症的痉”了。这一点，吴坤安《伤寒指掌》里分析得比
较清楚，他说∶“如太阳未曾表汗而发痉，明系风湿之邪，混扰于太阳，风湿相持而不解，则湿热交并，留滞经
络，营卫不和，津液不行，筋脉失所养而作也。此是伤寒类症，非伤寒变症也。其证背反张，头摇口噤，项强
拘急，转侧艰难，身热足冷。当审其风湿甚者，则有汗而为柔痉，风寒甚者，则无汗而为刚痉。若伤寒过表，
汗多而成痉，乃是伤寒变症；治分两途。盖汗多则血液干枯，筋无所养而痉作也。非湿非风，不得妄施前药。
故凡伤寒汗下后。痈疽溃脓后、妇人新产后，而见身体角弓反张，手足挛搐者；多是气血大亏、液不荣筋所
致。治法汇均以八珍汤加枸杞、川断、钩勾、桂枝主之，以养筋脉，不可纯作风治。”这样的论证处治，我意
认为很合理，不知俞氏何以下采取？廉臣先生勘语，也只引了吴鞠通的痉病九大纲，而不及吴坤安这条说法，
是必有故。现下、根据本节题意，我认为俞氏把伤寒类症的痉混入本节，是不够恰当的。这些直觉的体会，特
提请国内学人讨论。
12. 并非只有小儿才会患痉病，所有的痉病都是由惊吓引起的。症状表现为发热，有的有汗，有的无汗，面色时而发青时而发红，睡梦中说胡话，手足蠕动。
适宜使用复脉汤，去掉人参、桂枝、干姜、大枣，加入丹参、牡丹皮、犀角。以补益心脏的阴血（体），来制约心脏的功能（用）。大便干结的，加玄参；大便稀溏的，加牡蛎。如果出汗多且神志不宁，表现出恐惧神态的，加龙骨、整块琥珀、整块朱砂（取其气味，而不取其质地）。必须详细询问家属，确认确实有受惊见的情况，才可使用此法。如果言语杂乱无章，猜疑不定的，需静心再次诊察，务必弄清真实病情后，再用药。我的儿子三岁，六月初九辰时，从门上摔下落空，过了一会儿发热，随即出现痉挛，昏迷不省人事，手足冰冷，摸不到脉搏，到了戌时痉挛停止，身体发热、神志昏迷、无汗。第二天早上，我才给他服用复脉汤，去掉人参、桂枝、干姜、大枣，每日一剂。服到三四杯时，他不吃不喝。到了十四日巳时，通过战汗而痊愈。如果在痉挛厥逆、神志昏迷的时候，胡乱治疗，哪里还有生机呢？大概因为痉挛厥逆导致阴阳逆乱，稍微不合拍，就不可救治。家属情急之下，因此乱投药物，胡乱针灸，而死的人不可胜数。据朱遂生说，痉挛不需要治疗就能自行停止，这个病症不必苛责其痉挛。发热无汗，纯粹是外感病，从初九到十四日，共六天，恰好符合经气尽而通过汗解的周期。复脉汤并不是针对此症的正确治法。如果用浮萍银翘汤治疗，不过一服药病就好了。如果心包络热重，嘴唇舌头干燥，眼睛有红血丝的，可用牛黄清心丸。本论中的牛黄安宫丸、紫雪丹等，也可以酌情使用。汪瑟说，世间妄传的惊风证，只有一个证候才名副其实。那些因风、因热等原因导致的惊，神气昏沉，往往对面击鼓放炮，全然不知。客忤证，则是神惊胆怯，害怕见到奇怪的人和衣服，很容易区分。朱遂生说，客忤引起的痉挛，轻者仅神惊胆怯，重者则神气昏沉。王氏的儿子十七岁，晚上外出被疯子追赶，因而患上痉挛，背部反张，腿部强直，气闭肢冷，呼唤不应。用通窍散吹入鼻孔，又用水磨紫金锭灌服，立刻痊愈。
（九）本脏自病引起的痉挛（这种证候就是抽搐病）。这种证候是由于小儿的父母怕孩子受寒，盖被子过多，穿衣服过厚，或者冬天房屋火炕过暖，导致小儿每天出汗，汗多导致亡血，这与产妇亡血导致痉挛的道理一样。肝主血，血足则筋柔，血虚则筋强，所以叫本脏自病。这一类痉挛，实际上又是六淫致痉的根本原因。因为汗多亡血是本脏自病，汗多亡失卫外的阳气，就容易感受六淫邪气。全赖明医透彻理解这个道理，在平日预先告知小儿的父母，不要让小儿过热出汗导致亡血，暗中减少了无穷的病患。这就是所谓的“治未病”。治疗本脏自病的方法，以育阴柔肝为主，与治疗产后亡血致痉的方法相同。所谓血足则风自灭。复脉汤、三甲复脉汤三方、大小定风珠二方，都可以选用。专翕膏，在痉挛停止后，每日服用四五钱，分两次，作为填补阴精善后之计。六淫无汗致痉的，也同此例。救治温病温热误用发汗法的，先要保存阴液，不像伤寒误用发汗那样急于护阳。因为寒病不足在于阳，温病不足在于阴。
【炳章按】石氏《医原》中关于痉病证治的一则论述，颇有发明，录之以供参考。石芾南说，世俗人不理解六气致病的道理，不知道六气最容易化燥，以及小儿尤其容易化燥的道理。见孩子发热，不问是什么邪气，一概说是风寒，就用辛燥升散的药，混杂苦温苦涩消导的药，导致津液耗伤，形成痉挛抽搐。等到看到孩子痉挛抽搐，便称为惊风，乱投冰片、麝香、金石等苦寒悍毒药，以为可以开窍镇惊、清热祛风。家藏的丹丸，世传的秘方，大多如此。误治很多。又有人将“惊”字误作“筋”字，挑筋刺血，强行推拿。在富贵人家，酿成的祸患尤其迅速。曾见推荐医生和方子的接踵而至，这个医生用热药，那个医生用寒药，一天之内，七方十剂遍尝，刀针金石全施。或者送鬼叩神，这里摇那里唤，使孩子没有片刻安宁。厚重的棉絮，炉火壶汤，使孩子在热气之中。假使延请一位明理之医，对症施治，何至于此极端境地？大抵痉病多由于燥热化风，虽然名为风，实际上是肝阳为病，筋失滋养，所以导致强急。试举其大致而言：风寒初起，发热无汗，无论是否痉挛，治疗用辛润法，如杏仁、牛蒡子、桔梗之类。寒重的，加温润药，如葱白、生姜之类。风温温热，治疗用辛凉法，在辛润法中酌加微苦药，如桑叶、姜皮、栀皮、连翘、蔗皮、梨皮、沙参之类。热重的，酌加凉润轻品，如金银花、菊花、知母、羚羊角、竹叶、芦根、梨汁、蔗汁之类。湿痰，加半夏、蜜炙橘红之类。热痰，加川贝母、天竺黄、栝蒌霜、花粉、胆星之类。燥火严重的，清燥救肺汤在所必用。湿夹热的，加辛凉辛苦药，如蔻仁、通草、茯苓、滑石、鲜竹叶、鲜荷叶、扁豆花、姜炒黄连之类。阴液亏极，面色憔悴，孔窍干燥，无涕无泪，口哑不能言，宜速救液，如鲜生地、麦冬、玄参、鲜首乌、阿胶、鸡子黄、鲜石斛、生玉竹、女贞子、牡蛎、龟版之类。液虚燥极，必须多进方回，切勿中途改变治法，导致不可救治。
又按王勋臣关于小儿抽风的论述，实际上也是抽搐之类，即吴鞠通所说的内伤饮食痉，世俗所谓慢脾风。王清任说，抽风一症，今人治疗无效的，不是今人错治，而是古方误人。此证多由于伤寒温疫，或痘疹吐泻等证，病久而出现抽搐，则名叫慢惊风。“慢惊风”三字相连立名，不但文义不通，也未细察病源。若真是风邪，风邪中人，必有由皮肤入经络的过程，也必有由表入里的证候可查。既然查无外感之表证，为何总说是风？之所以言风，是因为见其病发作之时，项背反张，两目上视，口噤不开，口流涎沫，咽喉有痰声，昏沉不省人事，以为中风无疑。殊不知项背反张，四肢抽搐，手指固握，是气虚不能固摄肢体；两目上视，口噤不开，是气虚不能上升；口流涎沫，是气虚不能归元。元气既虚，必不能达于血管，血管无气，必停留而成瘀。以一个气虚血瘀的证候，反而用散风清火的方子，服散风药，无风则散气；服清火药，无火则凝血。再服攻伐克消的方子，气败血亡，岂能望生？每见从事小儿科阅历多的人，绝不误人，因为抽风古方无效，见抽风则弃而不治。也有看小儿现下的证候，知道必将抽风，虽无方调治，也必告知病家，此病恐怕将来抽风。凡将要抽风之前，必先见抽风之证，如见顶门下陷，昏睡露睛，口中摇舌，不能啼哭，哭无眼泪，鼻孔煽动，咽喉痰声，头低不抬，口噤无声，四肢冰冷，口吐白沫，胸高如碗，喘息气促，面色青白，汗出如水，不能裹乳，大便绿色。（大便色青，有寒有热。）腹内空鸣，下泻上嗽，肌肉跳动，都是抽风先兆。前述二十个证候，不必全见，但见一二证，则知将来必抽。其中有可治的，有不可治的。若露睛天吊，不食不哭，痰鸣气喘，病虽沉重，乃是可治之证。若天庭灰黑，睾丸收缩，或脉微细，或脉全无，外形虽轻，乃是不治之证。可治者，宜用可保立苏汤主治。（生黄芪一两五钱、党参三钱、白术二钱、甘草二钱、当归二钱、白芍二钱、炒枣仁三钱、山茱萸二钱、枸杞子二钱、破故纸一钱、桃核肉一枚，水煎服。此方专治小儿因伤寒瘟疫、或痘疹吐泻等证、病久气虚、四肢抽搐、项背反张、两目上视、口流涎沫、昏沉不省人事。至其分量，指四岁小儿而言，若两岁者可减半，若一岁者可用三分之一，若二三月者，可用四分之一，不必拘泥于剂数。我治疗此证一日之间，用至二三剂者，服至不抽，必告知病家，不可因不抽，遂不服药，必多服数剂，气足方妥。）
又按所述二十余证，皆属虚寒之象，故尚可救药。若虚中挟热，则难治了。我治疗马氏小儿，刚满月患痉病，发表攻里，汤丸杂投，针刺兼施，而痉挛不止，昼夜发作十数次。诊之左臂上伸，右臂下垂，手握固，目斜视，口流涎，肢搐搦，身微热。用灯草、薄荷、白蜜煎汤，少点姜汁，磨紫金锭灌服，痉挛减半。再服热退而痉挛未全止。改用可保立苏汤两剂全愈。
【荣斋按】本节俞氏所讲的“病因”，引申渊博，为全书中最突出的一篇。但由于头绪繁复，因而失去了重心，把“伤寒类症的痉”与“伤寒变症的痉”混在一起。本篇章节，既然是“伤寒坏证”中的“伤寒转痉”，则所述者，应该是“伤寒变症的痉”，而不是“伤寒类症的痉”了。这一点，吴坤安《伤寒指掌》里分析得比较清楚，他说：“如太阳未曾表汗而发痉，明系风湿之邪，混扰于太阳，风湿相持而不解，则湿热交并，留滞经络，营卫不和，津液不行，筋脉失所养而作也。此是伤寒类症，非伤寒变症也。其证背反张，头摇口噤，项强拘急，转侧艰难，身热足冷。当审其风湿甚者，则有汗而为柔痉，风寒甚者，则无汗而为刚痉。若伤寒过表，汗多而成痉，乃是伤寒变症；治分两途。盖汗多则血液干枯，筋无所养而痉作也。非湿非风，不得妄施前药。故凡伤寒汗下后、痈疽溃脓后、妇人新产后，而见身体角弓反张，手足挛搐者；多是气血大亏、液不荣筋所致。治法汇均以八珍汤加枸杞、川断、钩藤、桂枝主之，以养筋脉，不可纯作风治。”这样的论证处治，我认为很合理，不知俞氏为何采取？廉臣先生勘语，也只引了吴鞠通的痉病九大纲，而不及吴坤安这条说法，是必有缘故。现在，根据本节题意，我认为俞氏把伤寒类症的痉混入本节，是不够恰当的。这些直觉的体会，特提请国内学人讨论。
12. It is not only children who suffer from spasm; all cases of spasm are caused by fright. The symptoms present as fever, with or without sweating, the complexion alternating between cyanosis and erythema, somniloquy in dreams, and writhing movements of the hands and feet.
The appropriate prescription is Fumai Tang (Recover Pulse Decoction), removing Ren Shen (Ginseng Root), Gui Zhi (Cinnamon Twig), Gan Jiang (Dried Ginger), and Da Zao (Jujube Fruit), and adding Dan Shen (Salvia Miltiorrhiza Root), Mu Dan Pi (Moutan Cortex), and Xi Jiao (Rhinoceros Horn). This nourishes the substance of the Heart to regulate its function. For constipation, add Xuan Shen (Scrophularia Root); for loose stools, add Mu Li (Oyster Shell). If there is excessive sweating and spiritual unrest manifesting fear, add Long Gu (Fossilized Bones), whole Hu Po (Amber), and whole Zhu Sha (Cinnabar) (utilizing their qi rather than their substance). One must carefully inquire with the family to confirm a definite history of fright before applying this method. If the speech is disjointed and suspicious, one should calmly re-examine the patient to ascertain the true condition before administering medication. My son was three years old. On the ninth day of the sixth lunar month at Chen hour, he fell from a doorway. Shortly after, he developed fever followed immediately by spasms, unconsciousness, ice-cold extremities, and an imperceptible pulse. By Xu hour, the spasms ceased, but he remained febrile, comatose, and anhidrotic. The next morning, I administered Fumai Tang, removing Ren Shen, Gui Zhi, Gan Jiang, and Da Zao, one dose daily. After consuming three to four cups, he refused food and drink. At Si hour on the fourteenth day, he recovered through a shivering sweat (Zhan Han). Had we acted rashly during the state of spasm, convulsion, and coma, there would have been no hope for life. Generally, spasm and convulsion cause a reversal and chaos of Yin and Yang; even a slight mismatch renders it incurable. In their anxiety, families often administer drugs indiscriminately and perform acupuncture and moxibustion recklessly, resulting in countless deaths. According to Zhu Suisheng, spasm may cease spontaneously without treatment; thus, one need not focus solely on the spasm itself. Fever without sweating indicates purely an external contraction. From the ninth to the fourteenth day spans six days, coinciding exactly with the period when the meridian qi exhausts and resolves through sweating. Fumai Tang is not the correct treatment for this case. If treated with Ping Ying Yin Qiao Tang (Floating Duckweed and Honeysuckle Decoction), the disease would have resolved with a single dose. If the heat in the Pericardium is severe, characterized by dry lips and tongue and red streaks in the eyes, Niu Huang Qing Xin Wan (Calculus Bovis Clearing Heart Pill) is indicated. Ben Lun's Niu Huang An Gong Wan (Calculus Bovis Calming Palace Pill) and Zi Xue Dan (Purple Snow Pellet) can also be used酌情 (discretionarily). Wang Se stated that among the various conditions falsely transmitted as "Fright Wind," only this specific condition truly fits the name. Other types of fright due to wind or heat involve mental confusion where the patient is unaware of loud noises like drumming or cannon fire nearby. In contrast, Ke Wu (Hostile Influence) presents with mental fright and timidity, fearing strange people or clothing, making it easy to distinguish. Zhu Suisheng said that for spasm caused by Ke Wu, mild cases show only mental fright and timidity, while severe cases involve mental confusion. The seventeen-year-old son of Mr. Wang contracted spasm after being chased by a madman at night. He exhibited opisthotonos, rigid legs, closed Qi, cold limbs, and unresponsiveness to calls. Using Tong Qiao San (Unblocking Orifices Powder) insufflated into the nostrils, followed by water-ground Zi Jin Ding (Purple Gold Tablet)灌服 (administered orally), he recovered immediately.
(9) Spasm caused by self-disease of the Zang organs (this condition refers to twitching/convulsions). This condition arises because parents, fearing the child catches cold, cover them too heavily, dress them too warmly, or keep winter heated kang beds too warm, causing the child to sweat daily. Excessive sweating leads to blood loss, which shares the same principle as postpartum blood loss causing spasm. The Liver governs blood; sufficient blood ensures flexibility, while blood deficiency leads to rigidity. Hence, it is called self-disease of the Zang organ. This type of spasm is actually the root cause of spasm induced by the Six Evils. Since excessive sweating depletes blood (self-disease) and damages Wei Yang (defensive exterior yang), it predisposes one to contract the Six Evils. It relies entirely on enlightened physicians to thoroughly understand this principle and advise parents beforehand not to overheat children, thereby preventing endless illnesses unknowingly. This is what is meant by "treating disease before it arises." The treatment for self-disease of the Zang organs focuses on nourishing Yin and softening the Liver, identical to treating postpartum blood-loss-induced spasm. The principle is: when blood is sufficient, wind extinguishes itself. Fumai Tang, the three variants of San Jia Fumai Tang (Three Shells Recover Pulse Decoction), and the two formulas of Da Xiao Ding Feng Zhu (Great and Small Settling Wind Pearl) are all selectable. Zhuan Xi Gao (Special Gathering Paste) should be taken daily after spasms cease, divided into two doses of 4-5 qian, as a measure to replenish Yin for recovery. Cases of spasm due to Six Evils without sweating follow this example. For cases where Warm Disease or Heat Disease was mistakenly treated with sweating, one must first preserve Yin, unlike in Cold Damage where protecting Yang is urgent upon mistaken sweating. This is because Cold Damage deficiencies lie in Yang, whereas Warm Disease deficiencies lie in Yin.
[Bingzhang's Note] Shi's *Yi Yuan* contains a discussion on the syndrome differentiation and treatment of spasm, which offers significant insights. I record it for reference. Shi Feinan stated that laypeople do not understand the mechanism of the Six Qi causing disease, nor do they know that the Six Qi easily transform into Dryness, especially in children. Upon seeing a child with fever, regardless of the pathogen, they generally attribute it to Wind-Cold and prescribe acrid-warm ascending and dispersing herbs, mixed with bitter-warm and bitter-astringent digestive aids. This consumes body fluids, leading to spasm and twitching. Once spasm and twitching appear, it is labeled "Fright Wind," and doctors recklessly administer bitter-cold and harsh drugs like Bing Pian (Borneol), She Xiang (Musk), and minerals, claiming they open orifices, calm fright, clear heat, and dispel wind. Family pills and secret recipes are mostly like this, causing much mis-treatment. Others mistake "Jing" (Fright) for "Jin" (Sinew), performing sinew-piercing and blood-letting, or forcing massage. In wealthy families, the disaster accelerates. I have seen recommendations for doctors and prescriptions arriving continuously; one doctor uses hot herbs, another uses cold herbs. Within a day, seven prescriptions and ten doses are tried; knives, needles, and minerals are all applied. Or they summon ghosts and knock on gods, shaking and calling here and there, giving the child no peace. Heavy cotton and thick wadding, stove fires and hot pots, keep the child in heat. If a rational physician were summoned to treat according to the syndrome, how could it reach such an extreme? Generally, spasm is mostly due to Dryness-Heat transforming into Wind. Although named "Wind," it is actually a disorder of Liver Yang, where sinews lose nourishment, leading to rigidity. Briefly speaking: In early Wind-Cold, with fever and no sweating, whether spastic or not, treat with Acrid-Moistening methods, such as Xing Ren (Apricot Seed), Niu Bang Zi (Arctii Fructus), Jie Geng (Platycodon Root). If Cold is heavy, add Warm-Moistening agents like Cong Bai (Scallion White) and Sheng Jiang (Fresh Ginger). For Wind-Warmth and Warm-Heat, treat with Acrid-Cool methods, adding slightly bitter herbs to the Acrid-Moistening method, such as Sang Ye (Mulberry Leaf), Jiang Pi (Citrus Peel), Zhi Pi (Gardenia Bark), Lian Qiao (Forsythia Fruit), Zhe Pi (Sugarcane Peel), Li Pi (Pear Peel), and Sha Shen (Glehnia Root). If Heat is heavy, add cool-moistening light items like Yin Hua (Honeysuckle Flower), Ju Hua (Chrysanthemum Flower), Zhi Mu (Anemarrhena Rhizome), Ling Jiao (Antelope Horn), Zhu Ye (Bamboo Leaf), Lu Gen (Reed Rhizome), Li Zhi (Pear Juice), and Zhe Zhi (Sugarcane Juice). For Damp-Phlegm, add Ban Xia (Pinellia Tuber) and Mi Zhi Ju Hong (Honey-fried Tangerine Peel). For Heat-Phlegm, add Chuan Bei Mu (Fritillaria Bulb), Tian Zhu Huang (Calamus Bamboo Slurry), Gua Lou Shuang (Trichosanthes Powder), Hua Fen (Trichosanthes Root), and Dan Xing (Arisaema with Bile). For severe Dryness-Fire, Qing Zao Jiu Fei Tang (Clear Dryness Rescue Lung Decoction) is essential. For Dampness combined with Heat, add Acrid-Cool and Acrid-Bitter herbs like Kou Ren (Cardamom Seed), Tong Cao (Tetrapanax Pith), Fu Ling (Poria), Hua Shi (Talcum), Xian Zhu Ye (Fresh Bamboo Leaf), Xian He Ye (Fresh Lotus Leaf), Bian Dou Hua (Lablab Flower), and Jiang Chao Chuan Lian (Ginger-fried Coptis Rhizome). When Yin fluids are extremely depleted, with sallow complexion, dry orifices, no tears or nasal discharge, aphonia, quickly rescue the fluids using Xian Sheng Di (Fresh Rehmannia Root), Mai Dong (Ophiopogon Tuber), Xuan Shen (Scrophularia Root), Xian Shou Wu (Fresh Polygonum Multiflorum), E Jiao (Donkey-hide Gelatin), Ji Zi Huang (Egg Yolk), Xian Shi Hu (Fresh Dendrobium), Sheng Yu Zhu (Polygonatum Odoratum Rhizome), Nu Zhen Zi (Ligustrum Lucidum Fruit), Mu Li (Oyster Shell), and Gui Ban (Tartar Testudinis Carapax). When fluid deficiency and extreme dryness occur, one must continue the formula repeatedly; do not change the method midway, lest it become incurable.
Furthermore, Wang Xunchen's discussion on pediatric convulsions is essentially similar to twitching, i.e., Wu Jutong's concept of internal injury from diet causing spasm, commonly known as Slow Spleen Wind. Wang Qingren said, regarding convulsions: "When modern treatments fail, it is not because modern doctors are wrong, but because ancient formulas mislead. This condition often results from Cold Damage, Warm Epidemics, or prolonged diarrhea/vomiting from smallpox/rubella. Convulsions occurring late in the disease are named Slow Convulsive Wind. The name 'Slow Convulsive Wind' is linguistically awkward and fails to examine the disease source. If it were truly Wind, Wind entering the body must pass through skin and meridians, showing exterior-to-interior progression. Since there are no exterior signs of external contraction, why call it Wind? The term 'Wind' is used because during attacks, patients exhibit opisthotonos, upward-gazing eyes, locked jaw, drooling, phlegm rales in the throat, and coma, resembling Stroke. However, opisthotonos, limb convulsions, and clenched fingers indicate Qi deficiency failing to secure the limbs. Upward-gazing eyes and locked jaw indicate Qi deficiency failing to ascend. Drooling indicates Qi deficiency failing to return to its origin. Since Yuan Qi is deficient, it cannot reach the blood vessels; without Qi, blood stagnates and forms stasis. Treating a Qi-deficiency and Blood-stasis syndrome with Wind-dispersing and Fire-clearing formulas is erroneous. Wind-dispersing herbs scatter Qi when there is no Wind; Fire-clearing herbs coagulate Blood when there is no Fire. Follow-up attack/depletion formulas lead to Qi collapse and Blood exhaustion, making survival impossible. Experienced pediatricians rarely err because they see ancient formulas for convulsions are ineffective and abandon treatment upon seeing convulsions. Some recognize impending convulsions from current symptoms and warn families. Before convulsions occur, premonitory signs appear: sunken fontanelle, sleeping with eyes open, tongue trembling, inability to cry, crying without tears, flaring nostrils, phlegm rales, head drooping, silent locked jaw, cold limbs, foaming at the mouth, chest protruding like a bowl, rapid breathing, cyanotic-white complexion, profuse sweating, inability to suckle, green stool. (Green stool indicates Cold or Heat.) Empty rumbling in abdomen, lower diarrhea with upper cough, muscle twitching—all are precursors of convulsions. Among these twenty signs, not all need to be present; seeing one or two predicts future convulsions. Some are treatable, some are not. If eyes are open/upward, refusing food/cry, with phlegm-rales and panting, though severe, it is treatable. If the forehead is gray-black, testicles retract, or pulse is faint/thready/non-existent, though exterior signs are mild, it is incurable. Treatable cases should use Ke Bao Li Su Tang (Preserve and Establish Recovery Decoction): Sheng Huang Qi (Raw Astragalus Root) 1.5 liang, Dang Shen (Codonopsis Root) 3 qian, Bai Zhu (Atractylodes Macrocephala Rhizome) 2 qian, Gan Cao (Licorice Root) 2 qian, Dang Gui (Angelica Sinensis Root) 2 qian, Bai Shao (White Peony Root) 2 qian, Chao Zao Ren (Fried Ziziphus Seed) 3 qian, Yu Rou (Cornus Fruit) 2 qian, Gou Qi Zi (Goji Berry) 2 qian, Po Gu Zhi (Cibotium Rhizome) 1 qian, Tao He Rou (Peach Kernel Flesh) 1 piece. Decoct in water. This formula treats pediatric Qi deficiency from prolonged Cold Damage, epidemics, or smallpox/diarrhea, presenting with limb convulsions, opisthotonos, upward gaze, drooling, and coma. Dosages refer to a four-year-old; halve for two years, use one-third for one year, one-quarter for two-three months. Do not be rigid about dosage. I have used up to 2-3 doses in a day until convulsions stopped. Inform the family not to stop medication just because convulsions cease; continue several more doses until Qi is sufficient.
As noted, the aforementioned twenty-plus signs are all images of Deficient-Cold, hence salvageable. If Deficiency is complicated by Heat, it is difficult to treat. I treated a Ma family infant who developed spasm at one month old. Despite exterior-releasing and interior-purging therapies, mixed decoctions/pills, and acupuncture, spasms persisted, occurring dozens of times day and night. Examination showed left arm extended, right arm hanging down, clenched hands, oblique gaze, drooling, limb cramping, and slight fever. I prepared a decoction of Deng Cao (Juncus Effusus Stem), Bo He (Mint Herb), and Bai Mi (White Honey), added a little Jiang Zhi (Ginger Juice), ground Zi Jin Ding, and administered it. Spasms reduced by half. After further administration, fever subsided but spasms did not fully cease. Switching to Ke Bao Li Su Tang for two doses resulted in complete recovery.
[Rongzhai's Note] The "etiology" discussed by Yu in this section is profound and extensive, standing out as the most prominent part of the book. However, due to complex threads, it loses focus, mixing "Spasm as a Similar Syndrome of Cold Damage" with "Spasm as a Transformation Syndrome of Cold Damage." Since this chapter belongs to "Bad Syndromes of Cold Damage" specifically "Cold Damage Transforming into Spasm," it should describe "Spasm as a Transformation Syndrome," not "Spasm as a Similar Syndrome." Wu Kun'an's *Shanghan Zhizhang* analyzes this clearly: "If spasm occurs in Taiyang without prior sweating, it is clearly Wind-Damp pathogens disturbing Taiyang. Wind and Damp contend unresolved, leading to Wet-Heat merging and stagnating in meridians. Ying and Wei are disharmonious, fluids do not circulate, and sinews lose nourishment, causing spasm. This is a Similar Syndrome of Cold Damage, not a Transformation Syndrome. Symptoms include opisthotonos, head shaking, locked jaw, neck stiffness/tension, difficulty turning, fever in upper body/cold feet. Assess if Wind-Damp is heavy: with sweating, it is Soft Spasm; without sweating, it is Hard Spasm. If Cold Damage is over-treated with sweating, leading to spasm from excessive sweat, this is a Transformation Syndrome; treatments diverge. Excessive sweating dries blood, sinews lack nourishment, causing spasm. It is neither Damp nor Wind, so previous medicines should not be used recklessly. Thus, after Cold Damage sweating/purging, after abscess rupture, or postpartum, if body opisthotonos and limb cramps occur, it is mostly due to severe Qi/Blood deficiency and fluids failing to nourish sinews. Treatment uniformly uses Ba Zhen Tang (Eight Treasure Decoction) plus Gou Qi (Goji Berry), Chuan Duan (Dipsacus Root), Gou Teng (Uncaria Ramulus), and Gui Zhi (Cinnamon Twig) to nourish sinews. Do not treat purely as Wind." I consider this argumentation and treatment very reasonable; I wonder why Yu adopted this approach? Lianchen's commentary only cited Wu Jutong's nine major outlines of spasm and omitted Wu Kun'an's point, which must have a reason. Based on the intent of this section, I believe Yu's inclusion of Similar Syndrome spasm is inappropriate. These intuitive observations are submitted for discussion by scholars domestically.