惊风总论
阎孝忠曰∶小儿急慢惊风，古无之，惟曰阴阳滴而已。所谓急慢者，后世名之耳。正
如赤白痢疾之类是也。《直指方》云∶急者属阳，阳盛而阴亏；慢者属阴，阳亏而阴盛。阳
动而躁疾，阴静而迟缓。其始也，皆因脏腑虚而得之。虚能发热，热则生风，是以风生于肝，
痰生于脾，惊出于心，热出于肺，而心亦主热，惊风痰热合为四证，四证已具，八候生焉。
凡扎眼摇头，张口出舌，唇青脸赤，面青眼青泻青，太阳发际印堂青筋，三关虎口脉纹红紫或
青者皆惊风也。大抵热论虚实，证别逆顺，治有先后。盖实热为急惊，虚热为慢惊。慢惊本无
热，所以发热者，虚使然耳。急惊属阳，用药以凉；慢惊属阴，用药以温。其不可以阴阳无别，
故曰热论虚实者此也。男搐左视左，女搐右视右。男眼上窜，女眼下窜。男握拇指出外，
女握拇指入里。男引手挽，左直右曲，女引手挽，右直左曲，皆为之顺，反之则逆。亦有先搐
左，而双搐者。但搐顺则无声，搐逆则有声。其指纹情势挛入里者顺，出外者逆，出入相半
者难痊，故曰证别逆顺者此也。凡热盛生惊，惊盛生风，风盛发搐。治搐先于截风，治风先于
利惊，治惊先欲豁痰，治痰先于解热。其若四证俱有，又当兼施并理，一或有遗，必生他证，
故曰治有先后者，此也。纲领如此，若析急慢惊风而言之，则暴烈为急惊，沉重为慢惊，而慢
脾则又重而深矣。
急惊变为慢惊之因
急惊变为慢惊者，因壮热，精神恍惚发惊搐。医以吐下药太过，多以凉惊药不愈。《荏苒
经》曰∶脾虚不实，昏睡露睛，涎鸟气粗，肢冷时疼，时作螈 ，此急惊变成慢惊也。
慢惊变为急惊之因
慢惊变为急惊者，因伤乳食，或吐或泻，时作螈 。医以温热药太过，以慢惊药不愈。体
热涎盛，面红目赤，大便不通，小便赤沥，舌白唇红，急发惊搐。此慢惊变成急惊也。
惊有四证八候
四证者，惊风痰热是也。八候者，搐搦掣颤反引窜视是也。搐者，两手伸缩。搦者，
十指开合。掣者，势如相扑。颤者，头偏不正。反者，身仰向后。引者，臂若开弓。窜者，
目直似怒。视者，睛露不活。四证已备，
八候生焉。四证既无，八候安有？专是药者，可不究心及此？脉病证治，明有条类。大抵婴孩
得疾，贵乎早治，若初觉受惊，伤风发热，便与疏解，何患之有？传变之异，所谓闯门之盗，
不可以固留；逆流之水，不可以顺决。此有疾在谨其初之意也。
惊风总论
阎孝忠说：小儿的急惊风和慢惊风，古代是没有这个名称的，只称为“阴阳疳”（一种以消瘦、发热为主要表现的儿科疾病）。所谓急惊和慢惊，是后世才有的称呼。这就像赤痢和白痢的区别一样。《直指方》中说：急惊属于阳证，表现为阳气亢盛而阴液亏损；慢惊属于阴证，表现为阳气虚弱而阴气偏盛。阳主动且躁急，阴主静且迟缓。这两种病症起初都是因为脏腑虚弱而引发的。虚损会导致发热，发热则生风，因此风邪生于肝，痰浊生于脾，惊恐出于心，热邪出于肺，而心也主管热证。惊、风、痰、热四者结合形成四种主要证候，当这四种证候具备时，就会衍生出八种症状表现。凡是出现眼球上翻或斜视、摇头、张口伸舌、嘴唇发青面色潮红、面部青色眼睛青色腹泻排出青色粪便、太阳穴发际线及印堂部位出现青色筋脉、以及三关虎口处的指纹呈现红紫或青色等，都属于惊风范畴。大抵而言，需要辨别热证的虚实，区分病证的逆顺，治疗要有先后次序。一般来说，实热证导致的是急惊风，虚热证导致的是慢惊风。慢惊风本质上没有实热，之所以出现发热，是由于虚损所致。急惊风属阳，用药宜用凉性药物；慢惊风属阴，用药宜用温性药物。因为不能将阴阳混为一谈，所以强调要辨别热证的虚实，说的就是这个道理。男孩抽搐时眼球向左看，女孩向右看；男孩眼球向上窜动，女孩向下窜动；男孩拇指握拳向外侧伸出，女孩拇指握拳向内侧收拢；男孩手臂牵引时，左手伸直右手弯曲，女孩手臂牵引时，右手伸直左手弯曲，这些情况都称为“顺”，反之则为“逆”。也有先向左抽搐，随后双眼同时抽搐的情况。但抽搐动作顺畅则无声响，抽搐动作逆乱则有声响。其手指纹势向内挛缩为顺，向外伸展为逆，出入程度各半者难以痊愈，所以强调要区分病证的逆顺，说的就是这个道理。凡是热盛产生惊悸，惊悸盛产生风动，风动盛引发抽搐。治疗抽搐首先要截断风势，治疗风动首先要利惊安神，治疗惊悸首先要豁痰开窍，治疗痰浊首先要清热解表。如果四证俱全，又应当兼顾施治，若有所遗漏，必然引发其他变证，所以强调治疗要有先后次序，说的就是这个道理。纲领如此，若进一步分析急惊风和慢惊风，则发病暴烈者为急惊风，病情沉重者为慢惊风，而慢脾风则更为深重严重。
急惊风转变为慢惊风，是因为高热导致精神恍惚、发生惊厥抽搐。医生使用催吐和泻下的药物太过分，或者过多使用凉性惊风药却未能治愈。《荏苒经》中说：脾气虚弱且不充实，表现为昏睡且眼睛睁开露出眼珠，流口水气息粗重，四肢发冷时常疼痛，偶尔出现肢体抽搐，这是急惊风转变为慢惊风的表现。
慢惊风转变为急惊风，是因为乳食损伤，或者呕吐腹泻，偶尔出现肢体抽搐。医生使用温热药物太过分，或者单纯使用慢惊风药却未能治愈。表现为身体发热、涎液增多，面色发红眼睛充血，大便不通畅，小便短赤如淋，舌苔白嘴唇红，突然发生惊厥抽搐。这是慢惊风转变为急惊风的表现。
惊风有四种证候和八种症状
四种证候是指：惊、风、痰、热。八种症状是指：搐、搦、掣、颤、反、引、窜、视。搐，是指两手一伸一缩。搦，是指十指一张一合。掣，是指态势如同互相摔跤扑打。颤，是指头部偏向一侧不正。反，是指身体向后仰倒。引，是指手臂像拉开弓一样伸展。窜，是指眼睛直视似怒目圆睁。视，是指眼珠外露且转动不灵活。四种证候已经具备，八种症状就会产生。如果四种证候都不存在，八种症状又从何而来呢？专门从事药物治疗的人，怎能不深入研究这些内容呢？脉象、病机、证候和治疗，都有明确的条理分类。大抵婴幼儿患病，贵在早期治疗，如果刚察觉到受惊、伤风发热，就立即给予疏风解表的治疗，还有什么可担忧的呢？疾病传变的差异，就像闯入门户的盗贼，不能强行留住；又像逆流的水，不能顺着决堤疏导。这就是在疾病初期就要谨慎对待的意思。
General Discussion on Convulsive Disorders (Jing Feng)
Yan Xiaozhong stated: The conditions of acute and chronic convulsive disorders in children did not exist in ancient times; they were only referred to as "Yin-Yang Ding" (a pediatric condition characterized by emaciation and fever). The terms "acute" and "chronic" are names coined in later generations. This is similar to the distinction between red and white dysentery. *Zhizhi Fang* states: Acute cases belong to Yang, characterized by excess Yang and deficiency of Yin; chronic cases belong to Yin, characterized by deficiency of Yang and excess of Yin. Yang is active and restless, while Yin is quiet and slow. Initially, both arise from the deficiency of the Zang-Fu organs. Deficiency generates heat, and heat generates wind. Therefore, wind arises from the Liver, phlegm from the Spleen, fright from the Heart, and heat from the Lung, with the Heart also governing heat. Fright, wind, phlegm, and heat combine to form four main syndromes. Once these four syndromes are established, eight postures emerge. Any manifestation such as upward deviation or lateral deviation of the eyes, head shaking, opening the mouth and protruding the tongue, cyanosis of the lips with a flushed face, greenish complexion of the face and eyes with greenish stool, blue veins appearing at the hairline of the Taiyang region and the Yintang point, or red-purple or blue discoloration of the fingerprint at the Three Passages and Tiger's Mouth all indicate convulsive disorders. Generally, one must distinguish between excess and deficiency in heat syndromes, differentiate between favorable and unfavorable prognoses, and prioritize treatment steps. Excess heat leads to acute convulsions, while deficiency heat leads to chronic convulsions. Chronic convulsions essentially lack excess heat; the fever present is due to deficiency. Acute convulsions belong to Yang, so cooling herbs should be used; chronic convulsions belong to Yin, so warming herbs should be used. Since Yin and Yang cannot be conflated, it is emphasized to distinguish the excess and deficiency of heat, which is what this refers to. In boys, convulsions involve looking left; in girls, looking right. Boys' eyes roll upward; girls' eyes roll downward. Boys' thumbs extend outward when clenched; girls' thumbs retract inward. When pulling the arms, boys have the left arm straight and the right curved; girls have the right arm straight and the left curved. These are considered "favorable" (Shun); the reverse is "unfavorable" (Ni). There are also cases where convulsions start on the left and then become bilateral. However, smooth convulsions are silent, while chaotic convulsions produce sound. If the fingerprint pattern contracts inward, it is favorable; if it extends outward, it is unfavorable; if it is balanced, recovery is difficult. Thus, distinguishing favorable and unfavorable prognoses is crucial. When heat is excessive, it generates fright; when fright is excessive, it generates wind; when wind is excessive, it triggers spasms. To treat spasms, one must first cut off the wind; to treat wind, one must first relieve fright; to treat fright, one must first resolve phlegm; to treat phlegm, one must first clear heat. If all four syndromes are present, they must be treated simultaneously. Neglecting any aspect will lead to other complications. Thus, prioritizing treatment steps is essential. The general principles are as above. Specifically, violent and sudden onset indicates acute convulsions, while heavy and sluggish presentation indicates chronic convulsions. Slow Spleen Wind (Man Pi Feng) is even more severe and deep-seated.
Causes of Acute Convulsions Transforming into Chronic Convulsions
Acute convulsions transform into chronic convulsions due to high fever causing mental confusion and convulsive episodes. Physicians may have overused emetic and purgative drugs, or excessively employed cooling anticonvulsant medications without success. *Renran Jing* states: Spleen Qi deficiency and insufficiency manifest as drowsiness with eyes open and staring, drooling, coarse breathing, cold limbs with intermittent pain, and occasional tremors. This represents the transformation from acute to chronic convulsions.
Causes of Chronic Convulsions Transforming into Acute Convulsions
Chronic convulsions transform into acute convulsions due to damage from milk or food, accompanied by vomiting or diarrhea, and occasional tremors. Physicians may have overused warming and tonifying drugs, or relied solely on treatments for chronic convulsions without success. Manifestations include body heat, excessive salivation, red face and bloodshot eyes, constipation, scanty dark urine, white tongue coating with red lips, and sudden onset of convulsions. This represents the transformation from chronic to acute convulsions.
Four Syndromes and Eight Postures of Convulsive Disorders
The four syndromes are: Fright, Wind, Phlegm, and Heat. The eight postures are: Spasm (Chu), Grasping (Nuo), Tugging (Che), Trembling (Chan), Reversal (Fan), Drawing (Yin), Gazing (Cuan), and Staring (Shi).
* **Spasm (Chu)**: Extension and flexion of the hands.
* **Grasping (Nuo)**: Opening and closing of the ten fingers.
* **Tugging (Che)**: Movements resembling wrestling or grappling.
* **Trembling (Chan)**: Tilting of the head to one side.
* **Reversal (Fan)**: Arching of the back backward.
* **Drawing (Yin)**: Extension of the arms like drawing a bow.
* **Gazing (Cuan)**: Straight staring of the eyes as if in anger.
* **Staring (Shi)**: Protrusion of the eyeballs with immobility.
Once the four syndromes are complete, the eight postures arise. If the four syndromes are absent, how can the eight postures exist? Practitioners relying solely on medication must investigate these aspects carefully. Pulse, disease pathology, symptoms, and treatments are clearly categorized. Generally, for infants falling ill, early treatment is paramount. If one detects initial fright, wind-cold invasion, or fever, immediate dispersing and resolving measures should be taken. What harm could there be? The variation in disease transmission is like a thief entering a gate—cannot be forcibly retained; or like water flowing against the current—cannot be allowed to breach the dike naturally. This emphasizes the importance of caution at the initial stage of illness.