温 癸亥二月二十九日 六十日之幼孩，痉已二十余日，现下脉不数，额上凉汗，并无
外感
可知，乃杂药乱投，致伤脾胃。故乳食有不化之形，恐成柔痉，俗所谓慢脾风。议护中焦，
乃实土制风法，又肝苦急，急食甘以缓之义也。
明天麻（三钱） 干姜（二钱） 茯苓（五钱） 广木香（五分） 炙甘草（三钱） 生苡仁（五
钱） 焦于术（钱半） 煨肉果（一钱） 煨姜（一片）
甘澜水五茶杯，煎成两茶杯，小儿服十之一二，乳母服十之八九。渣再煎一茶杯，服如
前。
三月初一日 赤子不赤而刮白兼青，脉迟凉汗，舌苔白滑而浓，食物不化，洞泄者必中
寒。
按∶痉必因于湿，古所谓柔痉是也。议从中治。经谓有者求之，无者求之。此症全无风火之
象，纯然虚寒，乳中之湿不化，土愈虚则肝中内风愈动，若不崇土而惟肝是求，恐日见穷蹴
矣。
人参（四分） 广皮炭（三分） 广木香（五分） 生于术（一钱） 焦白芍（一钱） 煨肉果（
五分） 炙甘草（钱） 明天麻（三钱） 生苡仁（一钱）
初二日 风湿相搏，有汗为柔痉。形若反弓者，病在太阳，俯视目珠向下者，病在阳明
，以
阳明为目下纲也。今久病为杂药困伤脾胃，大便泄，乳食不化，为湿多风少，痉时俯时多，
为病在阳明。故此症以脾胃为主，议补中益气法，渗湿下行，内用风药，领邪外出。
人参（三分） 桂枝（二分） 茯苓块（三钱） 白术（一钱） 葛根（二分） 山药（一钱） 炙
甘草（五分） 生苡仁（钱半） 焦白芍（一钱）
初三日 寒湿柔痉，昨用升阳益气法，从阳明提出太阳，兹精神倍昔，颜色生动，舌上
白浊化净，大便已实，甚为可喜，但痉家有炙疮者难治。
人参（三分） 茯苓块（一钱） 嫩桂枝（三分） 生于术（一钱） 焦杭白芍（一钱） 葛根（
二分） 广皮炭（二分） 莲子（三粒，去心不去皮，打碎） 生苡仁（一钱） 炙甘草（五分）
初四日 痉家自汗，有炙疮者难治。刻下且住脾胃，从脾胃中立以条连四肢，是久痉一
定之至理。若镂治其痉，是速之也。
人参（三分） 广皮（三分） 桂枝（二分） 茯苓块（一钱） 焦于术（八分） 煨肉果（三分）
生苡仁（一钱） 炙甘草（八分） 诃子肉（五分，煨） 茅术炭（六分）
初五日 痉家为苦寒所伤，脾阳下陷，又有炙疮，其痉万万不能即愈。议护中阳，勿致
虚脱为要，非深读钱仲阳、陈文仲、薛立斋、叶天士之书者，不知此恙。
人参（四分） 诃子肉（六分，煨） 白芍（二钱） 于术（一钱，炒） 桂枝（三分） 广木香
（四分） 茯苓（一钱） 煨肉果（六分） 广皮炭（三钱） 炙甘草（八分） 苡仁（钱半）
浓煎。
初七日 脉仍不数，大便犹溏，但舌苔微黄，神气渐复，不似前虚寒太甚之象，宜退刚
药，少进柔药。医经谓上守神，粗守形，兵法谓见可而进，知难而退，此之谓也。
人参（三分） 麦冬（一钱，米炒） 茯苓（一钱） 整莲子（一钱） 于术（一钱，炒） 白芍
（一钱，炒） 炙甘草（七分） 陈皮（四分，盐炒黑）
初九日 诸证渐退，神气亦佳，但舌上复起重浊之白苔，乳湿之过，暂停参药，且用疏
补法。
生苡仁（钱半） 整莲子（一钱） 麦冬（一钱，带心） 浓朴（五分） 茯苓（一钱） 焦神曲
（八分） 木香（四分） 广皮炭（五分）
张 十三岁 乙酉六月初三日 脉沉细而弱，舌苔白，滑幼童体，浓纯然湿邪致，痉一
年有余。
苍术炭（三钱） 云苓皮（五钱） 川椒炭（三分） 白蔻仁（一钱） 生苡仁（六钱） 广皮（
三钱） 桂枝（三钱）
四帖。
初八日 痉症发来渐稀，效不更方。
八帖。
十六日 脉至沉至细至缓，舌白滑甚，湿气太重，故效而不愈。于前方中加劫湿而通补
脾阳之草果，调和营卫之桂枝、白芍、甘草。
五帖。
二十一日 痉症脉沉细，舌白滑，与湿淡法，发来渐稀，未得除根，于前方内去刚燥，
加化痰。
桂枝（四钱） 苡仁（五钱） 半夏（六钱） 白芍（三钱，炒） 益智子（二钱） 炙甘草（一
钱） 广皮（三钱） 云苓（五钱） 姜汁（三匙，冲）
二十五日 服前方四帖已效，舌苔仍然白滑，六脉阳微，照前方再服四帖。
二十九日 前方已服四帖，诸症皆安，惟痰尚多，再四帖。
七月初九日 前方又服九帖，痉症只发一次甚轻，已不呕吐，痰尚多，脉甚小，照前方
再服。
温氏患儿，癸亥年二月二十九日出生，现六十日大。患痉病已二十余日，目前脉象不数，额头出凉汗，并无外感症状，可知此乃因乱投杂药，损伤了脾胃。因此出现乳食不消化的现象，担心会演变为柔痉，即俗称为“慢脾风”的病症。议定采用保护中焦的方法，这是实土以制风的治法，同时也符合“肝苦急，急食甘以缓之”的理论。
明天麻（三钱） 干姜（二钱） 茯苓（五钱） 广木香（五分） 炙甘草（三钱） 生苡仁（五钱） 焦于术（一钱半） 煨肉果（一钱） 煨姜（一片）
用甘澜水五茶杯，煎至两茶杯，小儿服用十分之一到二，乳母服用十分之八九。药渣再煎一杯茶，服用方法同上。
三月初一日 婴儿面色不红润而发白兼青，脉迟且出凉汗，舌苔白滑而厚，食物不消化，腹泻如水者，必定是中寒证。
按语：痉病必然由湿邪引起，这就是古书所说的柔痉。议定从中焦治疗。《内经》说：“有者求之，无者求之。”此症完全没有风火的征象，纯属虚寒，乳汁中的湿气不能运化，脾土越虚，肝中的内风就越容易妄动，如果不培补脾土而只去平肝熄风，恐怕病情会越来越窘迫。
人参（四分） 广皮炭（三分） 广木香（五分） 生于术（一钱） 焦白芍（一钱） 煨肉果（五分） 炙甘草（一钱） 明天麻（三钱） 生苡仁（一钱）
初二日 风湿相互搏结，有汗出的称为柔痉。身体像反弓一样僵硬，病在太阳经；眼睛向下看，病在阳明经，因为阳明经是目下的纲领。如今久病被杂药困伤脾胃，大便泄泻，乳食不化，属于湿多风少，痉挛发作时头俯身多，说明病在阳明经。所以此症以脾胃为主，议定采用补中益气法，渗湿下行，内部使用风药，引领邪气外出。
人参（三分） 桂枝（二分） 茯苓块（三钱） 白术（一钱） 葛根（二分） 山药（一钱） 炙甘草（五分） 生苡仁（一钱半） 焦白芍（一钱）
初三日 寒湿引起的柔痉，昨天用了升阳益气的治法，从阳明经提升到太阳经，现在精神比之前好很多，面色生动，舌上的白浊苔已经化净，大便已经成形，非常可喜。但是患有痉病且有灸疮的患者难治。
人参（三分） 茯苓块（一钱） 嫩桂枝（三分） 生于术（一钱） 焦杭白芍（一钱） 葛根（二分） 广皮炭（二分） 莲子（三粒，去心不去皮，打碎） 生苡仁（一钱） 炙甘草（五分）
初四日 患痉病的患者自汗，如果有灸疮则难治。此刻暂且顾护脾胃，从脾胃入手来调理四肢，这是治疗久痉的一定道理。如果只针对痉挛本身治疗，那是加速其死亡。
人参（三分） 广皮（三分） 桂枝（二分） 茯苓块（一钱） 焦于术（八分） 煨肉果（三分） 生苡仁（一钱） 炙甘草（八分） 诃子肉（五分，煨） 茅术炭（六分）
初五日 患痉病的患者被苦寒药物所伤，脾阳下陷，又有灸疮，其痉挛万万不能立即痊愈。议定保护中阳，不要导致虚脱是关键，不是深读钱仲阳、陈文仲、薛立斋、叶天士著作的人，不知道这个病情的严重性。
人参（四分） 诃子肉（六分，煨） 白芍（二钱） 于术（一钱，炒） 桂枝（三分） 广木香（四分） 茯苓（一钱） 煨肉果（六分） 广皮炭（三钱） 炙甘草（八分） 苡仁（一钱半）
浓煎。
初七日 脉象仍然不数，大便仍然稀溏，但舌苔微黄，神气逐渐恢复，不像之前那样虚寒太甚，应当退去刚燥的药物，稍微进用柔和的药物。医经说：“上守神，粗守形”，兵法说：“见可而进，知难而退”，说的就是这个道理。
人参（三分） 麦冬（一钱，米炒） 茯苓（一钱） 整莲子（一钱） 于术（一钱，炒） 白芍（一钱，炒） 炙甘草（七分） 陈皮（四分，盐炒黑）
初九日 各种症状逐渐消退，神气也很好，但舌头上又出现厚重的白苔，这是乳湿过度的表现，暂停用人参药，暂且用疏补法。
生苡仁（一钱半） 整莲子（一钱） 麦冬（一钱，带心） 浓朴（五分） 茯苓（一钱） 焦神曲（八分） 木香（四分） 广皮炭（五分）
张姓患儿，十三岁，乙酉年六月初三日就诊。脉象沉细而弱，舌苔白，滑润，幼童体质，完全是湿邪所致，患痉病一年多了。
苍术炭（三钱） 云苓皮（五钱） 川椒炭（三分） 白蔻仁（一钱） 生苡仁（六钱） 广皮（三钱） 桂枝（三钱）
四帖。
初八日 痉症发作逐渐稀疏，有效就不换方子。
八帖。
十六日 脉象沉、细、缓，舌苔白滑严重，湿气太重，所以有效但未痊愈。在前方中加入劫湿并通补脾阳的草果，以及调和营卫的桂枝、白芍、甘草。
五帖。
二十一日 痉症脉象沉细，舌苔白滑，与淡渗利湿法，发作逐渐稀疏，未能除根，在前方中去掉刚燥药物，加入化痰药。
桂枝（四钱） 苡仁（五钱） 半夏（六钱） 白芍（三钱，炒） 益智子（二钱） 炙甘草（一钱） 广皮（三钱） 云苓（五钱） 姜汁（三匙，冲服）
二十五日 服用前方四帖已见效，舌苔仍然白滑，六脉阳气微弱，照前方再服四帖。
二十九日 前方已服四帖，所有症状都安定，只是痰还多，再服四帖。
Wen's infant, born in the Guihai year on February 29th, is now sixty days old. He has suffered from spasms (Jing) for over twenty days. Currently, his pulse is not rapid, there is cool sweat on the forehead, and there are no signs of external contraction, indicating that this condition resulted from the indiscriminate use of various medicines, which damaged the Spleen and Stomach. Consequently, milk and food are not digested properly. There is a fear that it may develop into Soft Spasm (Rou Jing), commonly known as "Slow Spleen Wind" (Man Pi Feng). The proposed treatment is to protect the Middle Jiao (Middle Burner), which is a method of strengthening Earth to control Wind, and also aligns with the principle that "when the Liver suffers from tension, sweet flavors should be eaten urgently to relieve it."
Tian Tianma (Gastrodiae Rhizoma, 3 qian) Gan Jiang (Zingiberis Rhizoma Recens, 2 qian) Fu Ling (Poria, 5 qian) Guang Mu Xiang (Aucklandiae Radix, 0.5 qian) Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle, 3 qian) Sheng Yi Ren (Coicis Semen, 5 qian) Jiao Yu Zhu (Atractylodis Macrocephalae Rhizoma Fritum, 1.5 qian) Wei Rou Gu (Myristicae Semen, 1 qian) Wei Jiang (Zingiberis Rhizoma Recens, 1 slice)
Decoct five cups of Ganlan Water (water boiled and stirred vigorously) until two cups remain. The infant takes one-tenth to two-tenths; the nursing mother takes eight-tenths to nine-tenths. The dregs are decocted again for one cup, administered in the same manner.
March 1st The infant's complexion is not ruddy but pale white mixed with cyanosis. The pulse is slow with cool sweat. The tongue coating is white, slippery, and thick. Food is undigested, and diarrhea is watery; this indicates Cold invading the Middle (Zhong Han).
Note: Spasms must be caused by Dampness, which is what the ancients called Soft Spasm (Rou Jing). The proposal is to treat from the Middle Jiao. The Classic states: "Seek the cause where the pathogen exists; seek the cause where it does not exist." This case shows absolutely no signs of Wind or Fire, purely Deficiency-Cold. The dampness in the milk cannot be transformed. As the Earth (Spleen) becomes more deficient, the internal Wind in the Liver moves more vigorously. If one does not fortify the Earth but only seeks to calm the Liver, the condition will likely become increasingly desperate.
Ren Shen (Ginseng Radix, 0.4 qian) Guang Pi Tan (Citri Reticulatae Pericarpium Carbonisatum, 0.3 qian) Guang Mu Xiang (Aucklandiae Radix, 0.5 qian) Sheng Yu Zhu (Atractylodis Macrocephalae Rhizoma, 1 qian) Jiao Bai Shao (Paeoniae Radix Alba Fritum, 1 qian) Wei Rou Gu (Myristicae Semen, 0.5 qian) Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle, 1 qian) Tian Tianma (Gastrodiae Rhizoma, 3 qian) Sheng Yi Ren (Coicis Semen, 1 qian)
March 2nd Wind and Dampness struggle with each other; sweating characterizes Soft Spasm. A body arched backward like a bow indicates the disease is in the Taiyang (Greater Yang) channel. Eyes looking downward indicate the disease is in the Yangming (Yang Brightness) channel, as the Yangming channel governs the area below the eyes. Now, due to long-term illness and damage from miscellaneous medicines, the Spleen and Stomach are impaired. Diarrhea occurs, and milk/food is undigested, indicating much Dampness and little Wind. During spasms, the head bows and the body bends frequently, indicating the disease is in the Yangming channel. Therefore, this case focuses on the Spleen and Stomach. The proposal is to use Bu Zhong Yi Qi Fa (Tonifying the Middle and Augmenting Qi Method), leaching out Dampness downwards, and internally using Wind-dispelling herbs to lead pathogens out.
Ren Shen (Ginseng Radix, 0.3 qian) Gui Zhi (Cinnamomi Ramulus, 0.2 qian) Fu Ling Kuai (Poria, 3 qian) Bai Zhu (Atractylodis Macrocephalae Rhizoma, 1 qian) Ge Gen (Puerariae Lobatae Radix, 0.2 qian) Shan Yao (Dioscoreae Rhizoma, 1 qian) Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle, 0.5 qian) Sheng Yi Ren (Coicis Semen, 1.5 qian) Jiao Bai Shao (Paeoniae Radix Alba Fritum, 1 qian)
March 3rd Cold-Damp Soft Spasm. Yesterday, the Sheng Yang Yi Qi Fa (Raising Yang and Augmenting Qi Method) was used to lift from Yangming to Taiyang. Now, spirit is significantly better, complexion is lively, the turbid white coating on the tongue has cleared completely, and stool has solidified. This is very gratifying. However, patients with Spasms who have moxibustion scars are difficult to treat.
Ren Shen (Ginseng Radix, 0.3 qian) Fu Ling Kuai (Poria, 1 qian) Nen Gui Zhi (Cinnamomi Ramulus Tender, 0.3 qian) Sheng Yu Zhu (Atractylodis Macrocephalae Rhizoma, 1 qian) Jiao Hang Bai Shao (Paeoniae Radix Alba Fritum, 1 qian) Ge Gen (Puerariae Lobatae Radix, 0.2 qian) Guang Pi Tan (Citri Reticulatae Pericarpium Carbonisatum, 0.2 qian) Lian Zi (Nelumbinis Semen, 3 grains, heart removed, skin retained, crushed) Sheng Yi Ren (Coicis Semen, 1 qian) Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle, 0.5 qian)
April 4th Patients with Spasms have spontaneous sweating; those with moxibustion scars are difficult to treat. At present, we must temporarily protect the Spleen and Stomach. Establishing regulation of the four limbs from the Spleen and Stomach is the definitive principle for treating chronic Spasms. If one treats only the spasms, it accelerates death.
Ren Shen (Ginseng Radix, 0.3 qian) Guang Pi (Citri Reticulatae Pericarpium, 0.3 qian) Gui Zhi (Cinnamomi Ramulus, 0.2 qian) Fu Ling Kuai (Poria, 1 qian) Jiao Yu Zhu (Atractylodis Macrocephalae Rhizoma Fritum, 0.8 qian) Wei Rou Gu (Myristicae Semen, 0.3 qian) Sheng Yi Ren (Coicis Semen, 1 qian) Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle, 0.8 qian) He Zi Rou (Terminalia Chebulae Fructus Carnis, 0.5 qian, roasted) Mao Zhu Tan (Atractylodis Rhizoma Carbonisatum, 0.6 qian)
May 5th Patients with Spasms injured by Bitter-Cold herbs suffer from sinking of Spleen-Yang. With moxibustion scars present, the spasms certainly cannot heal immediately. The proposal is to protect Middle-Yang, avoiding collapse, which is crucial. Only those who have deeply studied the works of Qian Zhongyang, Chen Wenzhong, Xue Lizhai, and Ye Tianshi understand this ailment.
Ren Shen (Ginseng Radix, 0.4 qian) He Zi Rou (Terminalia Chebulae Fructus Carnis, 0.6 qian, roasted) Bai Shao (Paeoniae Radix Alba, 2 qian) Yu Zhu (Atractylodis Macrocephalae Rhizoma, 1 qian, stir-fried) Gui Zhi (Cinnamomi Ramulus, 0.3 qian) Guang Mu Xiang (Aucklandiae Radix, 0.4 qian) Fu Ling (Poria, 1 qian) Wei Rou Gu (Myristicae Semen, 0.6 qian) Guang Pi Tan (Citri Reticulatae Pericarpium Carbonisatum, 3 qian) Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle, 0.8 qian) Yi Ren (Coicis Semen, 1.5 qian)
Decoct strongly.
July 7th The pulse is still not rapid, stool is still loose, but the tongue coating is slightly yellow. Spirit is gradually recovering, no longer showing extreme Deficiency-Cold as before. It is appropriate to withdraw rigid/dry herbs and slightly introduce soft/moistening herbs. The Medical Classic says: "The superior guard the Spirit, the crude guard the form." The Art of War says: "Advance when advantageous, retreat when difficult." This refers to such situations.
Ren Shen (Ginseng Radix, 0.3 qian) Mai Dong (Ophiopogonis Radix, 1 qian, stir-fried with rice) Fu Ling (Poria, 1 qian) Zheng Lian Zi (Nelumbinis Semen, 1 qian) Yu Zhu (Atractylodis Macrocephalae Rhizoma, 1 qian, stir-fried) Bai Shao (Paeoniae Radix Alba, 1 qian, stir-fried) Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle, 0.7 qian) Chen Pi (Citri Reticulatae Pericarpium, 0.4 qian, salt-stir-fried until black)
July 9th Various symptoms are gradually receding, and spirit is good. However, a heavy, turbid white coating has reappeared on the tongue, indicating excessive milk-dampness. Temporarily stop using Ren Shen. Use a dispersing and tonifying method.
Sheng Yi Ren (Coicis Semen, 1.5 qian) Zheng Lian Zi (Nelumbinis Semen, 1 qian) Mai Dong (Ophiopogonis Radix, 1 qian, with heart) Hou Po (Magnoliae Officinalis Cortex, 0.5 qian) Fu Ling (Poria, 1 qian) Jiao Shen Qu (Massae Medicatae Fermentatae Fritum, 0.8 qian) Mu Xiang (Aucklandiae Radix, 0.4 qian) Guang Pi Tan (Citri Reticulatae Pericarpium Carbonisatum, 0.5 qian)
Patient Zhang, thirteen years old. Examined on June 3rd of the Yiyu year. Pulse is deep, fine, and weak. Tongue coating is white. The constitution is smooth and tender, typical of a child. The condition is purely caused by Dampness, with Spasms lasting for over a year.
Cang Zhu Tan (Atractylodis Rhizoma Carbonisatum, 3 qian) Yun Ling Pi (Poria Cum Pinellia Cortex, 5 qian) Chuan Jiao Tan (Zanthoxyli Pericarpium Carbonisatum, 0.3 qian) Bai Kou Ren (Amomi Fructus Rotundus, 1 qian) Sheng Yi Ren (Coicis Semen, 6 qian) Guang Pi (Citri Reticulatae Pericarpium, 3 qian) Gui Zhi (Cinnamomi Ramulus, 3 qian)
Four doses.
June 8th The frequency of Spasm attacks is gradually decreasing. Since effective, do not change the formula.
Eight doses.
June 16th The pulse is deep, fine, and slow. The tongue is very white and slippery. Dampness is too heavy, hence effectiveness without cure. Add Cao Guo (Tsaoko Fructus) to the previous formula to seize Dampness and unblock/tonify Spleen-Yang, along with Gui Zhi, Bai Shao, and Gan Cao to harmonize Ying and Wei.
Five doses.
June 21st For Spasms with deep, fine pulse and white slippery tongue, apply the Dan Lin Fa (Light Leaching Method). Attacks are gradually decreasing but not rooted out. Remove rigid/drying herbs from the previous formula and add Phlegm-resolving herbs.
Gui Zhi (Cinnamomi Ramulus, 4 qian) Yi Ren (Coicis Semen, 5 qian) Ban Xia (Pinelliae Rhizoma, 6 qian) Bai Shao (Paeoniae Radix Alba, 3 qian, stir-fried) Yi Zhi Zi (Alpiniae Oxyphyllae Fructus, 2 qian) Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle, 1 qian) Guang Pi (Citri Reticulatae Pericarpium, 3 qian) Yun Ling (Poria, 5 qian) Jiang Zhi (Zingiberis Juice, 3 spoons, added during decoction)
June 25th Four doses of the previous formula were taken with effect. Tongue coating remains white and slippery. Six pulses show slight Yang. Continue taking the previous formula for four more doses.
June 29th Four doses of the previous formula have been taken. All symptoms are stable, only Phlegm remains abundant. Take four more doses.
July 9th Nine more doses of the previous formula were taken. Spasms occurred only once and were very mild. Vomiting has ceased. Phlegm remains abundant. Pulse is very small. Continue taking the previous formula.