惊风之名，不见于古，迨至近世，其说始盛，后之附会者，益广增名目，巧立治法，于是今日之儿科，
惊风一证，遂占重要之位置矣。尝考惊风之立名，其初不过就其病状，信手拈取，既未探其病源，亦未明定
范围，故于惊啼作哭，名之曰惊，手足抽掣，亦名之曰惊，谵语闷乱，名之曰惊，角弓反张，亦名之曰
惊，痰涌喘急，名之曰惊，目痉斜视，亦名之曰惊，其证既非尽因惊得，亦非悉由风来，以其形之似惊
而状之如动风者，则概加以惊风二字，于是世俗之医，遂妄立七十二种之名，以炫世而欺
人，狂药乱治，误人不浅。其实即以所谓手足抽掣，角弓反张之惊风而论，亦只有虚实二种，实证即急惊风，
虚证即慢惊风是也。其他如惊之状，则凡小儿发热之甚者，或发热过久者，不论何证，皆每每见之，若果
悉以为惊风，则百病皆为惊风矣，此惊风二字之所以不可不辨也。本章所述，既以世人对于惊风之证，
确认已久，则为便利起见，姑仍沿其名，别为急惊风、慢惊风两证，分论其治法，其后则增入
类惊一证，以资与急慢惊风相比量而参看，若繁杂不当之名，概无取焉。
一、急惊起源
小儿脏腑薄弱，气血未充，内因饮食之所伤，外受时邪之所侵，正气偶衰，邪从虚袭，初由口鼻
以潜入，继由经络以传布，病势鸱张，热自内生，热甚侵肝，肝升风动，于是发为惊状，此
为惊风之起因。惊风之作，既由肝升风动，故其势剽疾，筋受熏灼，则骤见四肢螈 ，抽搐无定；风循脊背，
则骤见角弓反张，脊硬项强；风升巅顶，则骤见头痛如劈，目痉神昏；痰随风升，则骤见喘息不匀，喉中
鸣响。病势既疾，病状至急，此急惊风之所由名也。顾何以别于慢惊风乎？曰∶急惊风之证状，全由邪实
所致，邪势益实，正气益亟，不治其邪，病必不愈；慢惊则得之也渐，元气早亏，动见虚象。无实可攻，
无热可清，自与急惊风有天渊地隔之别矣。至近今有所谓流行性脑脊髓膜炎者，虽成人亦有感染，而患者
究以小儿为多，病之急者，不过一二日而亡，此盖急惊风之尤重者，岁时不正，时邪必盛，一经感染，不易施
治。此流行性脑脊髓膜炎证之所以多死亡累累也。虽然，惊风之起源既明，则触类旁通，活法在人，因势
利导，病非必不可痊者，是在司命者之审慎从事耳！
二、急惊病理
小儿为纯阳之体，诸邪感受，化热至速。小儿又多血气未充，肝虚易为邪乘。准是二因，故急惊之病理，
率为肝升太过，肺失清降，昔人所谓木旺无制，金气不伸也。因肝升之太过，故热势上炎，病多面红目赤，
下肢反冷；因肺失清降之权，故关窍不通，邪无泄路，郁久化火，上侵脑府，中烁肺胃，当其初起之
时，邪循太阳之经，故多恶寒项强，寒热无汗，继则由少阳而转属阳明，或径袭阳明之经，故或由发热恶
寒而渐见壮热，或骤见壮热不清之证，此时虽有汗出，邪已内传，故患是症者，恒多有汗而热不解者。邪既
内传，肝升风动，轻者痰升呕吐，肺胃受病，重者神志昏 ，心君为蒙，故患是症者，恒见发热而渴，有
痰，及神昏不语之状也。至于头痛项强，角弓反张，四肢抽掣，目窜或痉，则以太阳经脉所属，由目内 上
额交巅，从巅入络脑，还出别下项。循肩膊内，挟脊抵腰中，入络肾，下属膀胱，
循髀外，下至踝，终足小指，此诸证状之所以叠现也。剧者太阳
之本病未解，邪反愈趋愈深，热势不退，津液告竭，神气不续，终至虚脱。轻者邪从汗解，热从溲泄则霍
然以愈。此急惊风病理之大概也。
三、急惊症状
小儿初起，有恶寒微热之象，继则骤然四肢抽掣，牙关紧闭，项背强硬，渐至壮热无汗，面红目赤，
痰升气促，此急惊风也。甚者头痛如劈，起卧不安，角弓反张，手足厥冷，其间或兼
呕吐，或兼泄泻，或大便坚结，或小溲不利，则因人而互异，亦有仅见搐搦之状，而无口噤反张之象者，
则感寒、伤风、痧痘将发每多有之，非急惊风也。急惊风最重之证，状见目睛翻转，手足
挛急，头反至背，口噤不开者，多属不救。此急惊风症状之一斑也。
四、急惊治法
急惊风之原因及病理，既如上述，则急惊风之治法，固可推想而知，要不外解表祛邪，清热平肝
而已。昔贤有云∶小儿急惊，属肝木风痰有余之症，宜平肝镇心，驱风消痰，降火势，清
内热。寥寥数字，亦足以尽急惊风之治法也。惟病有浅深，治有先后，初起宜发表以祛邪，寒重则辛以兼
温，热重则辛以兼凉，继则热势内盛，宜内清外澈，表里并治。重证神昏痉厥，宜平肝镇心；危证邪深津耗，
宜解毒生津，此其纲也。至于自始至终，病变繁复，临机应变，则有下列诸法∶
（一）初起表邪颇重，形寒，热不壮，手足抽掣，项强或头痛，苔薄白者，宜葛根汤。
（二）初起发热恶寒，惊风烦闷，痰热作搐者，宜参苏饮。
（三）惊风一二日，寒微热甚者，宜葛根汤去麻黄、生姜之辛温，易豆豉、葱白之辛凉。肝胆热甚，
心肺受灼者加黄芩；热而作呕者，加竹茹、黄连；湿滞身重者加苍术、茯苓。
（四）惊风形寒壮热，便阻腹胀，抽掣口噤，表里俱实者，宜防风通圣散。寒热如疟者，宜达原饮；
疫疠之气，流行颇盛者，酌加玉枢丹。
（五）惊风数日，壮热欲狂，大便秘结者，宜用调胃承气汤。热盛口渴，灼筋成痉，不宜遽下者，
宜葛根汤、白虎汤合治之。
（六）惊风发表祛邪无效，其人血虚内寒者，手足冷，脉迟细，宜当归四逆汤。其人体实者，
汗出不解，内热仍蒸，宜葛根汤、白虎汤合治之。
（七）惊风角弓反张，神识似明似昧者，宜栀豉汤中加开郁发表之剂，热重者再加清热之剂。
（八）惊风昏厥者，宜辛凉解表，清凉退热，加羚羊角以平肝镇心。痰多者加鲜菖蒲、竹茹；便
坚者加天花粉、栝蒌；血热者加鲜生地、犀角；邪重势盛者，犀角宜磨服多用，庶能有效。
其他开泄之剂如至宝丹、紫雪丹之类，解毒之剂如玄参、板蓝、菊花之类，均可量症酌加。
（九）抽掣略减，神识略清者，宜天麻、钩藤以熄风镇痉，生地、丹皮以养血清热，羚羊、白芍以清热
舒筋，玄参、麦冬以养阴退火，他如石决明、西洋参、知母、石斛之类，皆可量症酌加。
（十）急惊搐搦之时，不可把持不令动，宜放卧地上，任其动作。
（十一）病后余邪不清，血中有热，朝凉夜热者，宜青蒿鳖甲汤清之。其有急惊重证，侥幸得愈，往
往筋络偏废或变成痴呆者，终身不治。至于用药大体，初起不可轻易即用走窜开泄之
剂，病之中期，不可过用消导攻下之剂，病后不可过用滋腻之剂，此其大端也。
附方
（一）通关散 治小儿惊风搐搦，关窍不通。
天南星（炮） 僵蚕（炮。各一钱） 麝香（少许） 猪牙皂角（一枚） 赤脚蜈蚣（炙，一条）
共研细末，以手点姜汁蘸药少许，擦牙。
（二）神效搐鼻散 治番痧臭毒，腹痛如绞，气闭神昏。
灯芯灰（一两） 羊踯躅（三钱） 北细辛 蟾酥 牙皂（各二钱） 牛黄 梅片 麝香（各一钱）
共研极细，瓷瓶紧装，毋令泄气，每用少许，吹入鼻中，得嚏则生。
（三）嚏惊散 打嚏，醒睡，急救卒死。
半夏（一钱） 猪牙皂角（五分）
研为末，每用如一豆许，以管子吹入鼻，立醒。
（四）葛根汤 治太阳与阳明合病，或利，或呕，或小便
少，或发热无汗，或喘满不食，或口噤不得语，欲作刚痉。
葛根 麻黄 桂枝 白芍 甘草 生姜 大枣
（五）参苏饮 治感冒风寒，头痛，发热憎寒，惊风烦闷，
脘闷呕恶，痰热作搐，咳嗽气逆，涕唾稠粘，脉弱无汗。
人参 紫苏梗叶 干葛 前胡 半夏 赤苓 枳壳 陈皮 桔梗 甘草 加生姜 大枣
（六）防风通圣散 治一切风湿暑湿，饥饱劳役，内外诸邪，气血怫郁，表里三焦俱实，憎寒
壮热，头目昏运，目赤睛痛，耳鸣鼻塞，口苦舌干，咽喉不利，唾涕稠粘，咳嗽上气，大
便秘结，小便赤涩，疮疡肿毒，折跌损伤，瘀血便血，肠风痔漏，手足螈 ，惊狂谵妄，丹斑瘾疹等证。
防风 川芎 当归 白芍（酒炒） 大黄（煨） 苏薄荷叶 麻黄
连翘 芒硝 石膏 黄芩 桔梗 滑石 生甘草 荆芥穗 白术 栀子 加葱白 生姜
（七）达原饮 治时疫邪气，初犯募原，及疫疟壮热，多汗而渴者。
黄芩（钱半） 甘草 白芍 浓朴 草果（各一钱） 知母 槟榔（各二钱） 加生姜 大枣
柴胡、桂枝、葛根、豆豉、菖蒲、葱白等，可量证酌加。
（八）玉枢丹 治一切喉毒，时痧时疫。
山慈菇 五倍子（各二两） 大戟 千金子（去油用净末，各一两） 蚤休 雄黄（各五钱） 麝香（三钱）
共为末，每服三五分。
（九）调胃承气汤 治太阳证汗后恶热，谵语心烦，中满脉浮者。
大黄 甘草 芒硝
（十）白虎汤 治阳明证汗出，渴欲饮水，脉洪大浮滑，不恶寒，反恶热，及中 烦热而渴。
石膏 知母 甘草 粳米
（十一）栀豉汤 开畅胸膈。治虚烦懊 。
栀子 豆豉
（十二）至宝丹 见第四章第一节。
（十三）紫雪丹 见第四章第一节。
（十四）青蒿鳖甲汤 治温病，夜热早凉，热退无汗，热自阴来者。
青蒿（二钱） 鳖甲（五钱） 细生地（四钱） 知母（二钱） 丹皮（三钱）
（十五）礞石滚痰丸 治实热老痰结核异证。小儿急惊热痰上潮，阻塞欲死。
青礞石（ 飞） 沉香 百药煎 川大黄 黄芩
共为细末，水泛丸如梧子大，每服一二钱。
（十六）已风丹 祛诸风，退惊。
天竺黄 防风 钩藤 白僵蚕 干全蝎 白附子（各五钱）
研为细末，炼蜜和丸如芡实大，每服一二丸。
惊风这一病名，在古代医籍中并未出现，直到近代，这种说法才开始盛行。后世附会之人，进一步扩充了病名，巧妙设立各种治法，于是今天的儿科中，惊风一证便占据了重要的位置。我曾考证惊风立名的由来，起初不过是根据病症表现，随手拈来命名，既未探究其病因本源，也未明确界定其范围。因此，对于小儿惊啼哭闹，称之为“惊”；手足抽搐掣动，也称之为“惊”；胡言乱语、烦闷躁乱，称之为“惊”；身体反张如弓（角弓反张），也称之为“惊”；痰液涌盛、气喘急促，称之为“惊”；眼睛痉挛、视线偏斜，也称之为“惊”。这些症状并非全是因为受惊吓所致，也并非全部由风邪引起，只是因其形态类似受惊、状态如同动风，便一概冠以“惊风”二字。于是世俗的医生，便妄立七十二种名称，用来炫耀世人并欺骗患者，滥用药物、胡乱治疗，误人不浅。
其实，即便就所谓的手足抽搐、角弓反张的惊风而言，也只有虚证和实证两种：实证即急惊风，虚证即慢惊风。其他如“惊”的状态，凡是小儿发热严重的，或发热时间过长的，不论何种病证，常常都会见到。如果果真都认为是惊风，那么百病都成了惊风了，这就是“惊风”二字之所以必须加以辨析的原因。本章所述，既然世人对于惊风之证确认已久，为了便利起见，暂且沿用其名，分别论述急惊风和慢惊风两证的治法，其后则增加“类惊”一证，以便与急惊风、慢惊风进行比较参考，至于那些繁杂不当的名称，一概不予采纳。
一、急惊风的起源
小儿脏腑功能薄弱，气血尚未充盈，内因饮食损伤，外受时令邪气侵袭，正气偶尔衰弱，邪气乘虚而入，最初由口鼻潜入，随后通过经络传布全身，病势猖獗，热气自内生发。热势炽盛侵犯肝脏，导致肝气升发太过而引动肝风，于是出现惊厥的症状，这是惊风产生的起因。惊风发作，既然由于肝气升发太过、肝风内动，所以病势迅猛剽疾；筋脉受到火热熏灼，就会突然见到四肢抽搐、抽动无定势；风邪循行于脊背，就会突然见到角弓反张、脊柱僵硬、颈部强直；风邪上升直达头顶，就会突然见到头痛如刀劈、眼睛痉挛、神志昏迷；痰浊随风邪上逆，就会突然见到呼吸喘促不均、喉中有鸣响。病情发展迅速，症状危急，这就是急惊风得名的原因。
那么如何将其与慢惊风区别开来呢？答曰：急惊风的症状，完全由邪气实盛所致，邪气越实盛，正气越紧迫，如果不祛除邪气，疾病必然无法痊愈；而慢惊风则是逐渐形成的，元气早已亏损，经常表现出虚象。没有实邪可攻，没有实热可清，这与急惊风有着天壤之别。至于近代所谓的流行性脑脊髓膜炎，虽然成人也会感染，但患者终究以小儿居多，病情急重的，不过一两天就会死亡，这大概是急惊风中最为严重的类型。岁时不正，时邪必然强盛，一旦感染，不易治疗。这就是流行性脑脊髓膜炎导致大量死亡的原因。虽然如此，既然惊风的起源已经阐明，便能触类旁通，治疗方法灵活在于医者，顺应病势加以引导，疾病并非不可治愈，关键在于医生的审慎处理罢了！
二、急惊风的病理
小儿是纯阳之体，感受各种邪气后，化热速度极快。小儿又多气血未充，肝气虚弱容易遭受邪气乘袭。基于这两种原因，急惊风的病理，大率都是肝气升发太过，肺脏失去清肃下降的功能，正如古人所说“木旺无制，金气不伸”。因为肝气升发太过，所以热势向上炎蒸，病症多见面红目赤，下肢反而发冷；因为肺脏失去清肃下降的职权，所以关窍不通，邪气没有排泄出路，郁积久了化为火毒，向上侵犯脑部，向内灼烧肺胃。在疾病初起之时，邪气循行太阳经脉，所以多见恶寒、项强、寒热往来、无汗等症状；随后则由少阳经转属阳明经，或直接侵袭阳明经，所以或由发热恶寒逐渐转变为高热不退，或突然见到高热不清的症状。此时即使有汗出，邪气也已经内传，所以患此症的患者，常常多有汗出而热势不解的情况。邪气既然内传，肝气升发、肝风内动，轻者痰浊上逆引起呕吐，肺胃受病；重者神志昏蒙，心主神明被邪气蒙蔽，所以患此症的患者，常常见到发热口渴、有痰、以及神志昏迷不语的症状。至于头痛项强、角弓反张、四肢抽搐、眼球窜动或痉挛，这是因为太阳经脉所属路线，从目内眦上行至额部交会于头顶，从头顶入络于脑，复出下行别走项部，沿肩膊内侧，夹脊柱抵于腰中，入络肾脏，下属膀胱，循大腿外侧，下行至脚踝，终于足小趾。这些症状之所以接连出现，正是基于此经络走向。病情严重者，太阳经的本病未解，邪气反而愈趋愈深，热势不退，津液枯竭，神气断绝，最终导致虚脱。病情轻者，邪气随汗液排出而解除，热势从小便泄出则霍然痊愈。这就是急惊风病理的大概情况。
三、急惊风的症状
小儿初起时，有恶寒微热的现象，继则突然四肢抽搐，牙关紧闭，项背部强硬，逐渐发展为高热无汗，面红目赤，痰浊上涌，气促喘息，这是急惊风。严重时头痛如刀劈，坐卧不安，角弓反张，手足冰冷，其间或兼有呕吐，或兼有泄泻，或大便干结，或小便不利，这些都因人而异有所不同。也有仅见抽搐症状，而没有牙关紧闭、角弓反张现象的，这多是感寒、伤风、痧痘即将发出时的常见现象，不属于急惊风。急惊风最严重的症状，表现为眼球翻转，手足拘挛紧急，头向后仰至背部，牙关紧闭无法张开，大多属于不治之症。这就是急惊风症状的一个概况。
四、急惊风的治疗法则
急惊风的病因及病理，既然如上所述，那么急惊风的治疗法则，自然可以推想而知，不外乎解表祛邪、清热平肝而已。古代贤人曾说：“小儿急惊，属于肝木风痰有余的病症，适宜平肝镇心，驱风消痰，降火势，清内热。”寥寥数语，也足以概括急惊风的治疗法则了。只是疾病有浅深之分，治疗有先后顺序，初起宜发表以祛除邪气，寒邪重则用辛温兼散，热邪重则用辛凉兼清，继则热势内盛，宜内清外透，表里同治。重症出现神志昏迷、痉厥，宜平肝镇心；危重证候邪气深入、津液耗损，宜解毒生津，这是治疗的纲领。至于从头到尾，病变繁复，临机应变，则有以下几种方法：
（一）初起表邪颇重，形寒怕冷，热势不壮，手足抽搐，项强或头痛，舌苔薄白者，适宜用葛根汤。
（二）初起发热恶寒，惊风烦闷，痰热引发抽搐者，适宜用参苏饮。
（三）惊风一二日，寒微热甚者，适宜用葛根汤去掉麻黄、生姜的辛温之性，改用豆豉、葱白的辛凉之性。若肝胆热甚，心肺受灼者加黄芩；热而作呕者，加竹茹、黄连；湿滞身重者加苍术、茯苓。
（四）惊风形寒壮热，大便阻塞腹胀，抽搐牙关紧闭，表里俱实者，适宜用防风通圣散。寒热往来如疟疾者，适宜用达原饮；疫疠之气流行颇盛者，酌情加入玉枢丹。
（五）惊风数日，高热欲狂，大便秘结者，适宜用调胃承气汤。热盛口渴，火热灼伤筋脉导致痉挛，不宜立即攻下者，适宜用葛根汤、白虎汤合方治疗。
（六）惊风经过发表祛邪无效，其人血虚内寒者，手足冷，脉迟细，适宜用当归四逆汤。其人身体壮实者，汗出后病不解，内热仍然蒸腾，适宜用葛根汤、白虎汤合方治疗。
（七）惊风角弓反张，神识似清似昧者，适宜在栀豉汤中加入开郁发表的药剂，热重者再加清热药剂。
（八）惊风昏厥者，适宜辛凉解表，清凉退热，加羚羊角以平肝镇心。痰多者加鲜石菖蒲、竹茹；大便干坚者加天花粉、瓜蒌；血热者加鲜生地、犀角；邪重势盛者，犀角宜磨服多用，才能有效。其他开泄药剂如至宝丹、紫雪丹之类，解毒药剂如玄参、板蓝根、菊花之类，均可根据症状酌情加入。
（九）抽搐略减，神识略清者，适宜用天麻、钩藤以熄风镇痉，生地、丹皮以养血清热，羚羊角、白芍以清热舒筋，玄参、麦冬以养阴退火，其他如石决明、西洋参、知母、石斛之类，皆可酌情加入。
（十）急惊抽搐之时，不可强行把持不让其活动，宜让其平卧在地上，任其动作。
（十一）病后余邪不清，血中有热，早晨凉晚上热者，适宜用青蒿鳖甲汤清解。那些患有急惊重证，侥幸痊愈的人，往往会出现筋络偏废或变成痴呆，终身难以治愈。至于用药大体原则，初起不可轻易即用走窜开泄之剂，病之中期，不可过用消导攻下之剂，病后不可过用滋腻之剂，这是大致原则。
附方
（一）通关散 治疗小儿惊风抽搐，关窍不通。
天南星（炮制） 僵蚕（炮制。各一钱） 麝香（少许） 猪牙皂角（一枚） 赤脚蜈蚣（炙，一条）
共研成细末，用手指蘸姜汁沾取少许药粉，擦牙。
（二）神效搐鼻散 治疗番痧臭毒，腹痛如绞，气闭神昏。
灯芯灰（一两） 羊踯躅（三钱） 北细辛 蟾酥 牙皂（各二钱） 牛黄 梅片（冰片） 麝香（各一钱）
共研成极细粉末，装入瓷瓶密封，勿使漏气，每次用少许，吹入鼻中，打喷嚏则生还。
（三）嚏惊散 inducing sneezing, 唤醒睡眠，急救猝死。
半夏（一钱） 猪牙皂角（五分）
研为末，每次用如豆粒大小，用管子吹入鼻中，立即苏醒。
（四）葛根汤 治疗太阳与阳明合病，或腹泻，或呕吐，或小便少，或发热无汗，或喘满不食，或牙关紧闭不能言语，欲作刚痉。
葛根 麻黄 桂枝 白芍 甘草 生姜 大枣
（五）参苏饮 治疗感冒风寒，头痛，发热憎寒，惊风烦闷，脘腹闷胀呕恶，痰热引发抽搐，咳嗽气逆，涕唾稠粘，脉弱无汗。
人参 紫苏梗叶 干葛 前胡 半夏 赤茯苓 枳壳 陈皮 桔梗 甘草 加生姜 大枣
（六）防风通圣散 治疗一切风湿暑湿，饥饱劳役，内外诸邪，气血怫郁，表里三焦俱实，憎寒壮热，头目昏晕，目赤睛痛，耳鸣鼻塞，口苦舌干，咽喉不利，唾涕稠粘，咳嗽上气，大便秘结，小便赤涩，疮疡肿毒，折跌损伤，瘀血便血，肠风痔漏，手足抽搐，惊狂谵妄，丹斑瘾疹等证。
防风 川芎 当归 白芍（酒炒） 大黄（煨） 苏薄荷叶 麻黄
连翘 芒硝 石膏 黄芩 桔梗 滑石 生甘草 荆芥穗 白术 栀子 加葱白 生姜
（七）达原饮 治疗时疫邪气，初犯募原，及疫疟壮热，多汗而渴者。
黄芩（钱半） 甘草 白芍 浓朴 草果（各一钱） 知母 槟榔（各二钱） 加生姜 大枣
柴胡、桂枝、葛根、豆豉、菖蒲、葱白等，可量证酌加。
（八）玉枢丹 治疗一切喉毒，时痧时疫。
山慈菇 五倍子（各二两） 大戟 千金子（去油用净末，各一两） 蚤休 雄黄（各五钱） 麝香（三钱）
共为末，每服三五分。
（九）调胃承气汤 治疗太阳证汗后恶热，谵语心烦，中满脉浮者。
大黄 甘草 芒硝
（十）白虎汤 治疗阳明证汗出，渴欲饮水，脉洪大浮滑，不恶寒，反恶热，及心中烦热而渴。
石膏 知母 甘草 粳米
（十一）栀豉汤 开畅胸膈。治疗虚烦懊恼。
栀子 豆豉
（十二）至宝丹 见第四章第一节。
（十三）紫雪丹 见第四章第一节。
（十四）青蒿鳖甲汤 治疗温病，夜热早凉，热退无汗，热自阴来者。
青蒿（二钱） 鳖甲（五钱） 细生地（四钱） 知母（二钱） 丹皮（三钱）
（十五）礞石滚痰丸 治疗实热老痰结核异证。小儿急惊热痰上潮，阻塞欲死。
青礞石（飞研） 沉香 百药煎 川大黄 黄芩
共为细末，水泛丸如梧子大，每服一二钱。
（十六）已风丹 祛诸风，退惊。
天竺黄 防风 钩藤 白僵蚕 干全蝎 白附子（各五钱）
研为细末，炼蜜和丸如芡实大，每服一二丸。
The term "Jing Feng" (Convulsions with Wind) does not appear in ancient texts; it was only in recent times that this concept gained prominence. Later adherents further expanded the nomenclature and devised various treatment methods, thereby establishing "Jing Feng" as a significant category in modern pediatrics. Upon examining the origin of the term, it initially referred merely to specific symptoms: crying due to fright was called "Jing"; limb convulsions were also called "Jing"; delirium and restlessness were called "Jing; opisthotonos (body arching backward like a bow) was called "Jing"; phlegm surging with rapid breathing was called "Jing"; and eye spasms with strabismus were called "Jing". These conditions are not entirely caused by fright, nor exclusively by wind pathogen. Because their appearance resembles fright and their state mimics internal wind, they were collectively labeled "Jing Feng". Consequently, folk physicians arbitrarily invented seventy-two subtypes to dazzle and deceive the public, employing reckless medications and chaotic treatments, causing significant harm.
In reality, even regarding the so-called limb convulsions and opisthotonos classified as "Jing Feng", there are only two types: deficiency and excess. The excess type is Ji Jing Feng (Acute Convulsions), and the deficiency type is Man Jing Feng (Chronic Convulsions). Other manifestations resembling "fright" occur frequently in children with severe or prolonged fever, regardless of the underlying disease. If all such cases were deemed "Jing Feng", then all diseases would become "Jing Feng". Thus, it is imperative to clarify the distinction. Since the public has long accepted the concept of "Jing Feng", for convenience, this chapter retains the name but distinguishes between Ji Jing Feng and Man Jing Feng, discussing their respective treatments separately. Additionally, a category of "Lei Jing" (Similar-to-Fright Conditions) is included for comparative reference, while繁杂 (complex/irrelevant) names are discarded.
1. Origin of Acute Convulsions (Ji Jing Feng)
Children have weak zang-fu organs and unfulfilled Qi and Blood. Internally, they are susceptible to dietary injury; externally, they are invaded by seasonal pathogens. When Zheng Qi (Upright Qi) temporarily declines, pathogens invade through deficiency. Initially entering via the mouth and nose, they spread through the meridians. The disease progresses rapidly, generating internal heat. Excessive heat invades the Liver, causing excessive Liver Qi ascent and stirring up Liver Wind, resulting in convulsive symptoms. This is the origin of Jing Feng. Since Jing Feng arises from excessive Liver Qi ascent and internal wind, its course is swift and violent. Heat scorching the sinews leads to sudden limb convulsions with variable movements; wind traveling along the spine causes sudden opisthotonos, spinal stiffness, and neck rigidity; wind rising to the vertex causes sudden splitting headaches, eye spasms, and coma; phlegm rising with wind causes uneven panting and throat rattling. Due to the rapid progression and acute symptoms, it is named Acute Convulsions.
How to distinguish it from Chronic Convulsions? The symptoms of Acute Convulsions are entirely caused by pathogenic excess. As pathogens intensify, Zheng Qi becomes critical; without eliminating pathogens, the disease will not resolve. Chronic Convulsions develop gradually, with early depletion of Yuan Qi (Primordial Qi) and frequent deficiency signs. There is no excess to attack and no real heat to clear, creating an abyssal difference from Acute Convulsions. Modern epidemic cerebrospinal meningitis, though affecting adults, predominantly affects children. Severe cases result in death within one to two days, representing the most critical form of Acute Convulsions. When seasonal pathogens are rampant, infection is difficult to treat, leading to high mortality. However, understanding the origin allows for flexible application of principles. By guiding the disease process appropriately, recovery is possible, depending on the physician's prudence.
2. Pathology of Acute Convulsions
Children are of a "Pure Yang" constitution, converting pathogens to heat rapidly. They also have unfulfilled Qi and Blood, making the Liver vulnerable to pathogenic invasion. Based on these factors, the pathology of Acute Convulsions generally involves excessive Liver Qi ascent and loss of Lung's descending function, described by ancients as "Wood hyperactivity without restraint, Metal Qi failing to extend." Due to excessive Liver ascent, heat flares upward, presenting with red face and eyes, while lower limbs remain cold. Due to loss of Lung's descending authority, orifices remain blocked, pathogens lack an exit, stagnation transforms into fire, invading the brain upwards and scorching the Lungs and Stomach internally. In the initial stage, pathogens follow the Taiyang Meridian, causing aversion to cold, neck stiffness, alternating chills and fever, and anhidrosis. Subsequently, pathogens transfer to the Shaoyang Meridian or directly invade the Yangming Meridian, progressing from chills/fever to persistent high fever, or suddenly presenting with high fever. Even with sweating, pathogens have already penetrated inward, so patients often exhibit sweating without fever resolution. Once pathogens penetrate inward, Liver ascent and wind stirring occur. Mild cases involve phlegm surging and vomiting, affecting Lungs and Stomach; severe cases involve mental confusion, where the Heart Spirit is obscured. Patients typically present with fever, thirst, phlegm, and mutism. Headache, neck stiffness, opisthotonos, limb convulsions, and eye deviation occur because the Taiyang Meridian runs from the inner canthus to the vertex, enters the brain, descends the neck, follows the shoulder blades, clamps the spine to the waist, connects to the Kidneys, governs the Bladder, runs down the lateral thigh to the ankle, and ends at the little toe. These symptoms manifest according to this meridian pathway. In severe cases, if the Taiyang root disease remains unresolved, pathogens deepen, heat persists, fluids deplete, and Shen (Spirit) fails, leading to collapse. In mild cases, pathogens resolve through sweat, and heat clears through urination, leading to recovery. This summarizes the pathology of Acute Convulsions.
3. Symptoms of Acute Convulsions
Initially, children show aversion to cold and slight fever, followed by sudden limb convulsions, locked jaw, and neck/back stiffness. Progressively, high fever with anhidrosis, red face and eyes, surging phlegm, and rapid breathing occur, characterizing Acute Convulsions. Severe cases include splitting headaches, restlessness, opisthotonos, and cold extremities. Accompanying symptoms may include vomiting, diarrhea, constipation, or dysuria, varying by individual. Some present only with convulsions without locked jaw or opisthotonos; these are often due to cold invasion, wind-cold, or impending rash/measles, not Acute Convulsions. The most critical sign of Acute Convulsions is eye rolling, limb spasm, head retracted to the back, and locked jaw, which are often fatal. This outlines the symptomatology of Acute Convulsions.
4. Treatment Methods for Acute Convulsions
Given the etiology and pathology described, treatment aims primarily at releasing the exterior, expelling pathogens, clearing heat, and pacifying the Liver. Ancients stated: "Pediatric Acute Convulsions belong to excess of Liver Wood, Wind, and Phlegm; treatment should pacify the Liver, calm the Heart, dispel wind, resolve phlegm, reduce fire, and clear internal heat." This succinctly covers the treatment principles. However, treatment depends on disease depth and sequence. Initial stages require releasing the exterior; if cold dominates, use acrid-warm; if heat dominates, use acrid-cool. Later, when internal heat prevails, treat both interior and exterior simultaneously. For severe cases with coma and spasms, pacify the Liver and calm the Heart; for critical cases with deep pathogens and fluid depletion, detoxify and generate fluids. These are the general guidelines. Specific methods include:
(1) Initial stage with heavy exterior pathogen, chills, mild fever, limb convulsions, neck stiffness/headache, thin white coating: Use Gegen Tang (Kudzu Decoction).
(2) Initial stage with fever, chills, irritability, phlegm-heat induced convulsions: Use Shensu Yin (Ginseng and Perilla Drink).
(3) One to two days of convulsions, mild chills, severe heat: Modify Gegen Tang by removing Mahuang (Ephedra) and Shengjiang (Fresh Ginger) for their acrid-warm nature, replacing them with Douchi (Fermented Soybean) and Congbai (Green Onion White) for acrid-cool nature. If Liver/Gallbladder heat scorches Heart/Lungs, add Huangqin (Scutellaria); if heat causes vomiting, add Zhuru (Bamboo Shavings) and Huanglian (Coptis); if dampness causes heaviness, add Cangzhu (Atractylodes) and Fuling (Poria).
(4) Chills with high fever, constipation, abdominal distension, convulsions with locked jaw, excess in both exterior and interior: Use Fangfeng Tongsheng San (Saposhnikovia Powder to Unblock the Nethermost). For chills and fever alternating like malaria, use Dayuan Yin (Reach the Source Drink). If epidemic qi is prevalent, add Yushu Dan (Jade Pill).
(5) Several days of convulsions, high fever approaching madness, constipation: Use Tiaowei Chengqi Tang (Regulate the Stomach and Purge the Bowels Decoction). If heat is severe with thirst and tendon cramping, avoid immediate purgation; instead, combine Gegen Tang and Baihu Tang (White Tiger Decoction).
(6) If exterior release fails and the patient shows blood deficiency and internal cold (cold extremities, slow/thready pulse): Use Danggui Sini Tang (Angelica Decoction for Frigid Extremities). If the patient is robust with unresolved sweating and lingering internal heat: Combine Gegen Tang and Baihu Tang.
(7) Opisthotonos with fluctuating consciousness: Add exterior-releasing and depression-resolving agents to Zhichi Tang (Gardenia and Fermented Soybean Decoction); add heat-clearing agents if heat is severe.
(8) Coma: Use acrid-cool exterior release and heat clearance; add Lingyangjiao (Antelope Horn) to pacify the Liver and calm the Heart. For excessive phlegm, add Xian Changpu (Fresh Acorus) and Zhuru; for hard stool, add Tianhuafen (Trichosanthes Root) and Gualou (Trichosanthes Fruit); for blood heat, add Xian Shengdi (Fresh Rehmannia) and Xijiao (Rhinoceros Horn - *Note: Substitute with Buffalo Horn in modern practice*). For severe pathogenic intensity, use more ground Xijiao for efficacy. Other opening agents like Zhibao Dan (Precious Treasure Pill) and Zixue Dan (Purple Snow Pill), and detoxifiers like Xuanshen (Scrophularia), Banlangen (Isatis Root), and Juhua (Chrysanthemum) can be added based on symptoms.
(9) As convulsions lessen and consciousness clears: Use Tianma (Gastrodia) and Gouteng (Uncaria) to extinguish wind and stop spasms; Shengdi (Rehmannia) and Danpi (Moutan) to nourish blood and clear heat; Lingyangjiao and Baishao (White Peony) to clear heat and relax tendons; Xuanshen and Maidong (Ophiopogon) to nourish Yin and reduce fire. Others like Shijueming (Haliotidis Shell), Xiyangshen (American Ginseng), Zhimu (Anemarrhena), and Shihu (Dendrobium) can be added.
(10) During acute convulsions, do not forcibly restrain movement; let the child lie flat on the ground and allow natural movement.
(11) Post-illness with residual pathogens and blood heat (cool in morning, hot at night): Use Qinghao Biejia Tang (Artemisia and Turtle Shell Decoction). Children who survive severe Acute Convulsions may suffer permanent hemiplegia or dementia, which are incurable. General medication principles: Avoid aggressive opening/dispersing agents in the initial stage; avoid excessive purgatives in the middle stage; avoid cloying/nourishing agents in the recovery stage.
Attached Formulas
(1) Tongguan San (Pass Through Orifices Powder): Treats pediatric convulsions with blocked orifices. Prepared from Pao Tiannanxing (Prepared Arisaema), Pao Jiangcan (Prepared Silkworm), Moshe (Musk), Zhuya Zaojiao (Toothpick Soap Pod), and Chi Jiao Wugong (Red-footed Centipede). Grind to fine powder, dip finger in ginger juice, apply to teeth.
(2) Shenxiao Chubi San (Divine Effective Nasal Insufflation Powder): Treats toxic miasma, colic, Qi closure, and coma. Prepared from Dengxin Hui (Lampwick Ash), Yangzhizhu (Daphne), Beixixin (Asarum), Chansu (Toad Venom), Ya Zao (Soap Pod), Niuhuang (Calculus Bovis), Meipian (Borneol), and Moshe. Grind to ultra-fine powder, seal in porcelain, insufflate into nose to induce sneezing.
(3) Tijing San (Induce Sneezing Powder): Induces sneezing, awakens sleepers, emergency resuscitation. Prepared from Banxia (Pinellia) and Zhuya Zaojiao. Grind to powder, insufflate small amount into nose.
(4) Gegen Tang (Kudzu Decoction): Treats concurrent Taiyang and Yangming diseases, diarrhea, vomiting, oliguria, fever with anhidrosis, wheezing/fullness, locked jaw, impending rigid tetanus. Ingredients: Gegen, Mahuang, Guizhi, Baishao, Gancao, Shengjiang, Dazao.
(5) Shensu Yin (Ginseng and Perilla Drink): Treats wind-cold common cold, headache, fever with aversion to cold, irritability, epigastric fullness/vomiting, phlegm-heat convulsions, cough, sticky discharge, weak pulse without sweat. Ingredients: Renshen, Zisu Gengye, Qian Ge, Qianhu, Banxia, Chiling, Zhike, Chenpi, Jiegeng, Gancao, plus Shengjiang, Dazao.
(6) Fangfeng Tongsheng San: Treats wind-damp-summerheat, labor/dietary injury, internal/external pathogens, Qi/Blood stagnation, excess in exterior/interior/Sanjiao, chills/high fever, dizziness, red eyes, tinnitus, nasal congestion, bitter taste, dry tongue, sore throat, cough, constipation, dark urine, sores, trauma, bleeding, hemorrhoids, convulsions, mania, rashes. Ingredients: Fangfeng, Chuanxiong, Danggui, Baishao, Dahuang, Bohe, Mahuang, Lianqiao, Mangxiao, Shigao, Huangqin, Jiegeng, Huashi, Sheng Gancao, Jingjie, Baizhu, Zhizi, plus Congbai, Shengjiang.
(7) Dayuan Yin: Treats epidemic qi invading the Mu Yuan (Diaphragm), epidemic malaria with high fever, sweating, and thirst. Ingredients: Huangqin, Gancao, Baishao, Houpo, Caoguo, Zhimu, Binglang, plus Shengjiang, Dazao. Add Chaihu, Guizhi, Gegen, etc., as needed.
(8) Yushu Dan (Jade Pill): Treats throat toxins, epidemic rashes/miasma. Ingredients: Shancigu, Wubeizi, Daji, Qianjinzi, Zhexiu, Xionghuang, Moshe. Grind to powder, take 3-5 fen per dose.
(9) Tiaowei Chengqi Tang: Treats Taiyang syndrome post-sweating with aversion to heat, delirium, irritability, fullness, floating pulse. Ingredients: Dahuang, Gancao, Mangxiao.
(10) Baihu Tang (White Tiger Decoction): Treats Yangming syndrome with sweating, thirst, large/slippery pulse, aversion to heat, internal heat. Ingredients: Shigao, Zhimu, Gancao, Jingsmi.
(11) Zhichi Tang: Opens chest/diaphragm. Treats deficiency irritability. Ingredients: Zhizi, Douchi.
(12) Zhibao Dan: See Chapter 4, Section 1.
(13) Zixue Dan: See Chapter 4, Section 1.
(14) Qinghao Biejia Tang: Treats warm disease with night fever/morning coolness, no sweat upon fever reduction, heat arising from Yin. Ingredients: Qinghao, Biejia, Xi Shengdi, Zhimu, Danpi.
(15) Mengshi Gun Tan Wan (Black Rock Rolling Phlegm Pill): Treats solid heat and old phlegm nodules. Pediatric acute convulsions with surging hot phlegm. Ingredients: Qing Mengshi, Chenxiang, Baiyaojian, Dahuang, Huangqin. Water-pilled, take 1-2 qian.
(16) Yifeng Dan: Dispels wind, reduces fright. Ingredients: Tianzhuhuang, Fangfeng, Gouteng, Jiangcan, Quanxie, Baifu Zi. Honey-pilled, take 1-2 pills.