发搐之候。世俗所说者多矣。有言一证属一脏。一证属一腑。乔岳歌曰。小儿惊候有多般。不显根源见病
难。睡里切牙惊入肾。非时吊眼病归肝。夜啼到晓元因肺。唇白面青一般看。前后心烦四肢热。面红如火向心
间。干呕吃水脾惊患。脉微气喘一同言。汉东王氏言。非时吊眼惊入肝。睡后切牙惊入肾。夜啼到晓惊入小肠。
面青乍白惊入胆。气喘吃水惊入肺。面红脸赤惊入心。五心烦热惊入脾。喉中锯响惊入大肠。干呕无时惊入胃。
睡中啼哭惊入三焦。如此之类。言至百种。丛脞无据。何以为治。又有言惊发三次为痫者。第一次发，两太阳左右
青脉朝眼。第二次发。山根青脉见。第三次发。眼下睑
连金匮青脉见。又言发搐面赤。指内青纹见者为痫。又云耳后完骨上青脉如线者为痫。
此等之论。亦为臆说。大抵不发搐者为惊。发搐者为痫也。千金论痫证。大体只分三种。一曰风痫。因解脱衣
袂。触冒风邪而作。其证先屈指如数乃发。口中气热。呵欠顿闷。手足摇动。治当发散。二曰惊痫。猛闻大
声。或扑仆惊怖而作。其证先叫啼乃发。心神不宁。不可下之。下之内虚。则病益盛。治当安神去热。三曰
食痫。因乳哺失节。或有积而作癖。其证先不乳而吐。先寒后热乃发。其证身体或温或热。多睡喜唾。吐逆腹
胀。故小儿有癖积。脉大者必发痫。治当下之。此三种内。风惊二痫。时时有之。食痫者十中无一。下之便愈。
详此三种。虽诸病皆能变温。莫不缘于风惊食之所作也。又内经有云。五脏主五畜。其间发重者。各见其象。肝
为犬痫。目直视。身反折。手拳犬鸣。心为马痫。张口摇头。背强硬马叫。（一云。心为羊痫。目瞪吐舌羊叫）
脾为牛痫。目痴腹满牛叫。肺为鸡痫。摇头反折。手纵搐搦鸡叫。肾为猪痫。目横身直如尸。吐沫猪叫。以上论
痫发者。乃诸书精要也。然不若钱乙所论发搐者。乃心肝二脏为病也。其理有据而妙。肝主风。心主火。风火
相加。发而为搐。前论小儿诸病。新久皆能变痫发搐者。以人有病。则饮食退减。脾胃不旺。肝必凌之。引动肝
风。肝又主掣。若不得心火。则不能发搐。又人有病。则气血错乱。心神不宁。引动心火。心又主惊。若不得肝
风。亦不得发搐也。须肝心二脏相为子母。俱有实热。风火相搏。惊掣相持。乃能发搐。其状亦如风之荡火。焰
炽然也。故肝心二脏为病之源。余藏虽不正主。亦有相乘兼见之证。及所发亦有其时。假如钱论潮热变发搐。在
早晨寅卯辰时有。此肝用事之时也。身体壮热。目上视。手足摇动。口生热涎。项颈强急。此肝旺也。钱治补肾
泻肝。是谓补其母而泻其子也。发搐在日中巳午未时者。此心用事之时也。心惕目上。白睛赤色。牙关紧急。口
内涎生。手足摇动。此心旺也。钱治泻心。心热退则肝母亦不能旺。是谓子能令母虚也。发搐在日晚申酉戌时
者。此肺用事之时也。目微斜视。不甚搐而喘。身热睡露睛。手足冷。大便黄水。钱治泻其肝心。而补其脾。
发搐者心肝实为病之源。故泻之。手足冷。大便黄水者。脾虚候也。故补之。发搐在夜间亥子丑时者。此肾用事
之时也。不甚搐。眠卧不
稳，身体温壮。目睛紧斜。喉中有涎。大便银褐色。乳食不消。多昏不纳津液。钱治但泻其心而补其脾。且心肝
二脏为病之源。今独泻其心。而不泻其肝者。此本因潮热所作。发在肾用事之时。是肾虚心热极也。故但泻其
心。热退则肝亦平矣。若更泻肝。则肾转虚矣。其大便银褐色。乳食不消。不纳津液，皆脾衰之证。故补其脾
也。以上四脏。分主十二时。脾脏为兼见之证。此潮热发搐。治则惟泻心肝者。盖二脏俱实。为病之源故也。其
肺脏有虚实之证。见虚则补。见实则泻。况发搐是心火旺所作。而肺金实证亦罕。惟偏搐者有之外。肾脏
但主虚而无实。见其虚则补之。内经有云。虚则补其母。实则泻其子。先补其母。后泻其子。子能令母虚。母能
令子实。钱乙论此发搐原由。为治次第。乃谓得圣人之经旨深意也。可谓出群拔萃矣。今更以钱论三事参之。一
者发搐逆顺。二者发搐阴阳。三者发搐真假。及各于逐项之下。以钱治法为证。后学之士。将此三事。参推五
脏。审别形候。察其虚实。观以时刻。根据法为治。则小儿发搐之病。无以外也。
小儿出现抽搐的症状，世俗所说的情况非常多。有的说一种症状归属于一个脏，一种症状归属于一个腑。乔岳在《歌》中说：“小儿惊证有多种，不显根源见病难。睡中切牙惊入肾，非时吊眼病归肝。夜啼到晓元因肺，唇白面青一般看。前后心烦四肢热，面红如火向心间。干呕吃水脾惊患，脉微气喘一同言。”汉东王氏说：“非时吊眼惊入肝，睡后切牙惊入肾，夜啼到晓惊入小肠，面青乍白惊入胆，气喘吃水惊入肺，面红脸赤惊入心，五心烦热惊入脾，喉中锯响惊入大肠，干呕无时惊入胃，睡中啼哭惊入三焦。”像这样的说法，多达百种，杂乱无章且没有依据，怎么作为治疗的准则呢？
又有说惊证发作三次即为痫证（癫痫）的：第一次发作，两太阳穴左右有青色脉络朝向眼睛；第二次发作，山根（鼻根部）出现青色脉络；第三次发作，眼下眼睑连及金匮（眼眶周围）出现青色脉络。又说发作抽搐时面色发红，手指内侧出现青色纹路的是痫证。又说耳后完骨上方青色脉络如线状的是痫证。这些言论，也都是主观臆测之说。大体上，不发作抽搐的叫惊证，发作抽搐的叫痫证。
《千金方》论述痫证，大体只分为三种。一是风痫，因为解开衣被，触犯风邪而发作。其症状是先屈指像是在数数然后发作，口中气息热，打哈欠感到闷滞，手足摇动。治疗应当发散风邪。二是惊痫，猛听到大声，或跌倒受惊恐惧而发作。其症状是先叫喊啼哭然后发作，心神不宁。不可使用下法，如果下之导致内虚，则病情会更加严重。治疗应当安神清热。三是食痫，因为哺乳喂养失去节制，或有积滞形成癖块而发作。其症状是先不吃奶而呕吐，先寒后热然后发作。其症状身体有时温有时热，多睡喜唾，吐逆腹胀。所以小儿如果有癖积，脉象大的必定会发痫证。治疗应当用下法。这三种里面，风痫和惊痫时时都有，食痫十中无一，用下法就能痊愈。
详细考察这三种，虽然各种病都能变为温病，但无不源于风、惊、食所引起。另外《内经》说：五脏主应五种畜类痫证，其中发作严重的，各自显现其象。肝为犬痫，目直视，身体反折，手握拳发出犬吠声。心为马痫，张口摇头，背强硬发出马叫声。（另一种说法：心为羊痫，目瞪吐舌发出羊叫声）。脾为牛痫，目光呆滞腹部胀满发出牛叫声。肺为鸡痫，摇头反折，手纵搐搦发出鸡叫声。肾为猪痫，目横身直像尸体一样，吐沫发出猪叫声。以上关于痫证发作的论述，是各书的精要所在。然而不如钱乙所论述的发搐，认为是心和肝二脏为病。其理论有据且精妙。肝主风，心主火，风火相加，发作而为抽搐。前文论述小儿各种病，无论新久都能变为痫证发搐，是因为人有了病，饮食就会减少，脾胃不旺盛，肝气必然乘侮它，引动肝风。肝又主掣（牵引），如果得不到心火的帮助，就不能发搐。另外人有了病，气血错乱，心神不宁，引动心火，心又主惊，如果得不到肝风的帮助，也不能发搐。必须肝心二脏互为子母关系，都具备实热，风火相搏，惊掣相持，才能发搐。其状态也像风荡火焰，火势炽盛的样子。所以肝心二脏是发病的根源，其余脏腑虽然不主要主管，也有相乘兼见的证候，以及发作也有其特定时间。
假如钱乙论述潮热变发搐，在早晨寅、卯、辰时有发作，这是肝当令的时间。身体壮热，目上视，手足摇动，口生热涎，项颈强急，这是肝旺的表现。钱乙治疗补肾泻肝，这叫补其母而泻其子。发搐在日中巳、午、未时的，这是心当令的时间。心中惕惕不安，目上视，白睛赤色，牙关紧急，口内涎生，手足摇动，这是心旺的表现。钱乙治疗泻心，心热退则肝母也不能旺，这叫子能令母虚。发搐在日晚申、酉、戌时的，这是肺当令的时间。目微斜视，不甚抽搐而喘，身热睡露睛，手足冷，大便黄水，钱乙治疗泻其肝心而补其脾。发搐者心肝实为病之源，所以泻之。手足冷，大便黄水者是脾虚候，所以补之。发搐在夜间亥、子、丑时的，这是肾当令的时间。不甚抽搐，眠卧不稳，身体温壮，目睛紧斜，喉中有涎，大便银褐色，乳食不消，多昏不纳津液，钱乙治疗只泻其心而补其脾。而且心肝二脏为病之源，现在只泻其心而不泻其肝的原因，是因为本因潮热所作，发在肾当令之时，是肾虚心热极也。所以只泻其心，热退则肝亦平矣。如果再泻肝，则肾转虚矣。其大便银褐色，乳食不消，不纳津液，都是脾衰的证候，所以补其脾。以上四脏，分主十二时辰，脾脏为兼见的证候。这种潮热发搐，治疗原则只有泻心肝的，因为二脏俱实，是病的根源。其肺脏有虚实之证，见虚则补，见实则泻。何况发搐是心火旺所作，而肺金实证也很少，只有偏搐者有之外。肾脏只主虚而无实，见其虚则补之。《内经》说：虚则补其母，实则泻其子。先补其母，后泻其子，子能令母虚，母能令子实。钱乙论述此发搐原由，为治次第，可谓深得圣人之经旨深意，出群拔萃了。
现在再结合钱乙论述的三件事参详：一者发搐逆顺，二者发搐阴阳，三者发搐真假，以及在各项目之下，以钱乙的治疗法则为证据。后学之士，将这三件事，参推五脏，审别形候，察其虚实，观以时刻，根据法则进行治疗，那么小儿发搐的病，就没有什么遗漏的了。
When a child experiences convulsions (spasms), there are many popular theories. Some claim that one symptom belongs to one Zang organ, and another to one Fu organ. Qiao Yue's song states: "Pediatric convulsive disorders manifest in various forms; without identifying the root cause, diagnosis is difficult. Grinding teeth during sleep indicates wind entering the Kidney; abnormal upward deviation of the eyes suggests pathology returning to the Liver. Crying from night until dawn originates from the Lung; pale lips and bluish complexion are viewed similarly. Restlessness in the chest and abdomen with heat in the four limbs, and a face red as fire, point towards the Heart. Dry retching and drinking water indicate spleen-related fright; a faint pulse with panting breath are discussed together." Wang Dongdong stated: "Abnormal eye deviation indicates liver wind; grinding teeth after sleep indicates kidney wind; crying until dawn indicates small intestine wind; alternating blue and white facial color indicates gallbladder wind; panting and drinking water indicate lung wind; red face indicates heart wind; five-center heat indicates spleen wind; sawing sounds in the throat indicate large intestine wind; intermittent dry retching indicates stomach wind; crying during sleep indicates Sanjiao wind." Such descriptions number in the hundreds, are cluttered and unfounded, and cannot serve as a basis for treatment.
Others claim that fright occurring three times becomes epilepsy (Xian syndrome). The first episode shows blue veins on both sides of the Taiyang acupoints facing the eyes. The second episode shows blue veins at the Shangen (root of the nose). The third episode shows blue veins connecting the lower eyelid to the orbital rim. It is also said that if the face is red during convulsions and blue streaks appear on the inner fingers, it is epilepsy. Furthermore, a blue line-like vein above the Wangu bone behind the ear indicates epilepsy. These discussions are merely speculative. Generally, conditions without convulsions are termed Fright (Jing), while those with convulsions are termed Epilepsy (Xian).
The *Qianjin Fang* discusses epilepsy, broadly categorizing it into three types. First is Wind Epilepsy (Feng Xian), caused by exposure to wind pathogens due to uncovering the body. Symptoms include flexing fingers as if counting before onset, hot breath, yawning with a sense of stuffiness, and shaking of hands and feet. Treatment requires dispersing wind. Second is Fright Epilepsy (Jing Xian), caused by sudden loud noises or fear from falling. Symptoms include screaming/crying before onset, restlessness of the mind and spirit. Purging methods should not be used; purging causes internal deficiency, worsening the disease. Treatment requires calming the spirit and clearing heat. Third is Food Epilepsy (Shi Xian), caused by irregular feeding or accumulation leading to masses. Symptoms include refusal to nurse followed by vomiting, initial chills then fever, variable body temperature, excessive sleeping and salivation, vomiting, abdominal distension. Children with such accumulations and a large pulse will inevitably develop epilepsy. Treatment requires purging. Among these three, Wind and Fright epilepsies occur frequently, while Food epilepsy is rare (one in ten); purging leads to recovery.
Examining these three types, although various diseases can transform into warm diseases, they all originate from Wind, Fright, or Food. Additionally, the *Neijing* states that the Five Zang organs correspond to five animal epilepsies. Severe cases manifest specific signs: Liver corresponds to Dog Epilepsy (staring eyes, opisthotonos, clenched fists, barking sounds); Heart corresponds to Horse Epilepsy (open mouth, head shaking, stiff back, neighing) [or Sheep Epilepsy (staring eyes, protruding tongue, bleating)]; Spleen corresponds to Ox Epilepsy (dull eyes, abdominal fullness, mooing); Lung corresponds to Chicken Epilepsy (head shaking, opisthotonos, flaccid spasms, clucking); Kidney corresponds to Pig Epilepsy (eyes rolling, body straight like a corpse, foaming, grunting). These descriptions of epilepsy are essential texts. However, Qian Yi’s discussion on convulsions is superior, attributing them to pathology in the Heart and Liver. His theory is well-founded and profound. The Liver governs Wind, and the Heart governs Fire. When wind and fire combine, convulsions occur. Previous texts note that new or old illnesses can transform into epilepsy/convulsions because illness reduces dietary intake, weakening the Spleen and Stomach, allowing Liver Qi to overact and stir Liver Wind. The Liver governs pulling/twitching; without Heart Fire, convulsions cannot occur. Conversely, illness disrupts Qi and Blood, disturbing the Heart Spirit and stirring Heart Fire. The Heart governs Fright; without Liver Wind, convulsions cannot occur. Thus, when the Heart and Liver (mother-son relationship) both possess excess heat, wind and fire clash, and fright and twitching persist, convulsions arise. This resembles wind fanning flames. Therefore, the Heart and Liver are the source of pathology; other organs may show secondary signs or have specific timing for attacks.
For instance, Qian Yi noted that tidal fever transforming into convulsions occurs during Yin, Mao, and Chen hours (morning), when the Liver is dominant. Symptoms include high fever, upward gaze, limb tremors, hot saliva, and neck stiffness, indicating Liver excess. Qian Yi treated this by tonifying the Kidney and draining the Liver, which is tonifying the mother and draining the son. Convulsions occurring during Si, Wu, and Wei hours (noon) correspond to the Heart being dominant. Symptoms include palpitations, upward gaze, red whites of the eyes, locked jaw, oral saliva, and limb tremors, indicating Heart excess. Qian Yi treated this by draining the Heart; as Heart heat subsides, the Liver (mother) also loses excess, known as 'the son making the mother deficient.' Convulsions occurring during Shen, You, and Xu hours (evening) correspond to the Lung being dominant. Symptoms include slight oblique gaze, mild convulsions with panting, fever with exposed eyes during sleep, cold limbs, and yellow watery stool. Qian Yi treated this by draining the Liver and Heart and tonifying the Spleen. Since the Heart and Liver are the source of convulsions, they are drained. Cold limbs and yellow stool indicate Spleen deficiency, so it is tonified. Convulsions occurring during Hai, Zi, and Chou hours (night) correspond to the Kidney being dominant. Symptoms include mild convulsions, unstable sleep, warm body, tight oblique eyes, phlegm in the throat, silver-brown stool, indigestion, lethargy, and inability to retain fluids. Qian Yi treated this by draining only the Heart and tonifying the Spleen. Although Heart and Liver are sources, only the Heart is drained here because the condition originated from tidal fever occurring during Kidney dominance, indicating Kidney deficiency and extreme Heart heat. Draining the Heart allows the Liver to calm; draining the Liver further would damage the Kidney. Silver-brown stool and indigestion indicate Spleen decline, hence it is tonified.
The four Zang organs govern the twelve two-hour periods, with the Spleen showing combined signs. For tidal fever convulsions, the treatment principle is draining Heart and Liver because both are excess and are the source. The Lung has both deficiency and excess patterns; tonify deficiency, drain excess. Since convulsions stem from Heart Fire excess, Lung excess is rare, except in unilateral convulsions. The Kidney governs only deficiency, never excess; tonify when deficient. The *Neijing* states: "Tonify the mother in deficiency, drain the son in excess." Tonify the mother first, then drain the son; the son makes the mother deficient, the mother makes the son excess. Qian Yi’s explanation of the origin and treatment sequence of convulsions deeply aligns with the sage’s principles, standing out remarkably.
Now, combining three aspects from Qian Yi’s discussion: 1. Prognosis (favorable/unfavorable) of convulsions; 2. Yin/Yang nature of convulsions; 3. True/false nature of convulsions. Below each item, Qian Yi’s treatment methods serve as evidence. Students should analyze these three aspects, correlate them with the Five Zang organs, examine symptoms, assess deficiency/excess, observe timing, and treat according to these principles. Then, pediatric convulsions will be fully understood.