曰误搐，即伤寒病痉也。盖头项强，背反张，目上视，属太阳；低头下视，口噤不语，手足牵引，肘膝相
构，属阳明；眼目或左或右而斜视，手足或左或右而搐搦，属少阳。此实三阳表证，岂得混称为惊风？痉由误
致，今故易名误搐，然痉有刚柔，治非一类，以柔痉列之于首，刚痉次之，更详其致痉之由，与治痉之方，总
归于误搐条下，证治井然有据，明者当不以予为妄也。
（伤风有汗为柔，风性软弱也）
经曰∶太阳病发热汗出，不恶寒者，名曰柔痉。其证初起，发热自汗，口中气热，呵欠顿闷，手足动摇，
甚则反张，由风邪伤卫，荣卫不和。小儿体弱者，最多此证，亦因腠理不密，自汗无时，所以风邪易入。幼科
见其多汗昏沉，辄以慢惊称之。
按∶此条风邪伤卫，本属轻证。若能早为解肌，调和荣卫，药到病起，误作慢惊，妄投补剂，其祸不可胜
言矣（此即前诸家所云，慢惊温补而不愈，变为急惊者，即此例也。）
（伤寒无汗为刚，寒性刚劲也）
经曰∶太阳中风，重感寒湿而变痉。盖伤风原有汗，愚人不知，重衣浓被，令其大汗。汗多衣褓必湿，湿
久寒生，渗注关节，故为重感寒湿。寒湿内闭，反令无汗，是名刚痉。其证初恶风寒，发热头痛，偎藏于母怀
者是也。小儿口不能言，父母一时不觉，但见其发热，不知其恶寒，但见其昏沉，不知其头痛。医者见其发热，
满口称为惊风，置伤寒表里于不问，惟事镇坠凉泻，抑遏其表邪，不能外出，必致延及于三阳（太阳传阳明，阳明
传少阳。）所以有身热足冷，颈项强急，头身俱热，面目红赤，独摇头，卒口噤，背反张，手足搐搦，眼目斜视。
此则三阳经之全痉，幼科所称四证八候者，即此也。斯时正宜循经用药，解去三阳之邪，其病霍然而起。倘舍此
不图，邪必自三阳而入于三阴，发热腹痛，四肢伛偻，能俯不能仰，已成阴痉凶危之候，犹以慢惊风称之，风
药乱投，死将旋踵。哀哉！（此即前诸家所云，急惊凉泻而不愈，或与吐下药太过，变为慢惊者，即此例也。）
按∶伤寒之来，岂初日便能变痉，由医者误治致之耳。盖邪自太阳而入，太阳之脉上起于头，中行于背，
下至于足，因其经脉受邪，荣卫涩滞，则头项背足，皆有痛楚牵
强之象。幼科见此，便诧为惊风，妄行镇坠，以致邪无所伸，而后乃变为痉。此际尚不知为误治所致，而反谓小
儿固有之证。此其所以为误中之误也。尝观夏初明治小儿作搐而死，以至三五日不醒者，悉用天保采微汤投之
而愈。其子禹铸广传其方，惜无一家发明之，致后人莫维其义。予不辞饶舌，聊为剖露∶夫天保采微汤乃败毒
散、不换金正气散、升麻葛根汤三方合凑者也。其中作用，以羌、独走太阳而祛寒发表，以苍、前、升、葛、
陈、朴、甘、苓走阳明而除湿解肌，以芎、柴入少阳而和解表里，以桔、半、枳、藿、芍药，入太阴而和荣逐
饮。或问既为三阳表药，何以辄及于太阴？曰∶小儿全藉脾肺为行药之主。此实扶中气以托邪，岂引邪入里之
谓耶？然其中一十七味，并非五金八石、三黄四神，而能于死中求活者，岂疏解之药可以起死回生乎？由从前
误以伤寒作惊治，未经发散，以致邪闭而死。今投疏解以生者，亦不过为从前补其阙失耳，岂有奇特深义哉！
第此等之治，犹为末着。若早循经治疗，又何至如是凶危，始效猎人之罗网四张，希庶几乎一遇。苟如鄙刻所
集，一见小儿发热昏沉，即为之分别有汗无汗，有汗者解散肌邪，无汗者开通荣卫，领邪外出，神志自清，又
何者闭塞昏迷之变耶？
所谓“误搐”，就是伤寒病引起的痉证。头项强直、背部反张、眼球上翻，属于太阳经；低头下视、牙关紧闭不能言语、手足牵引、肘膝相互拘挛，属于阳明经；眼睛向左或向右斜视、手足向左或向右抽搐，属于少阳经。这实际上是三阳经的表证，怎么能混淆称为惊风呢？痉证是由误治导致的，所以现在改名为误搐。然而痉证分为刚痉和柔痉，治疗方法并不相同。将柔痉列在首位，刚痉次之，详细阐述导致痉证的原因以及治疗痉证的方剂，总归都放在误搐这一条目下，证候与治疗井然有序且有据可依，明理的人应当不会认为我妄言吧。
（伤风有汗为柔痉，因为风性软弱）
《内经》说：太阳病发热出汗，不恶寒的，叫做柔痉。这种病症初起时，发热自汗，口中气息热，打哈欠且感到烦闷，手足动摇，严重时出现角弓反张，这是由于风邪伤害卫气，导致营卫不和。身体虚弱的小儿最容易患此证，也是因为腠理不致密，经常无定时地出汗，所以风邪容易侵入。儿科医生见到小儿多汗昏沉，就随意称之为慢惊风。
按语：这条所述的风邪伤卫，本来属于轻证。如果能早期解肌，调和营卫，药到病除，若误作慢惊风，胡乱投用补剂，其祸害不可胜言（这就是前代医家所说的，慢惊风用温补法治疗不愈，反而变成急惊风的例子）。
（伤寒无汗为刚痉，因为寒性刚劲）
《内经》说：太阳中风，再次感受寒湿而变为痉证。大概伤风原本就有汗，愚昧之人不知道这一点，给患儿穿厚衣盖厚被，使其大汗淋漓。汗多导致衣被必湿，湿气久留产生寒气，渗入关节，所以称为再次感受寒湿。寒湿内闭，反而导致无汗，这就叫刚痉。这种病症初起时恶风寒，发热头痛，喜欢依偎在母亲怀里。小儿不能说话，父母一时察觉不到，只看到他们发热，却不知道他们恶寒；只看到他们昏沉，却不知道他们头痛。医生见到他们发热，满口称为惊风，置伤寒的表里证于不问，只顾使用镇坠凉泻的药物，遏制了表邪，使其不能外出，必然导致病邪延及三阳经（太阳传阳明，阳明传少阳）。因此出现身热足冷、颈项强急、头身俱热、面目红赤、独自摇头、突然牙关紧闭、背部反张、手足抽搐、眼睛斜视等症状。这就是三阳经的全痉，也就是儿科所称的四证八候。此时正应该循经用药，解除三阳经的病邪，病就会霍然而愈。如果舍弃这种方法不去治疗，邪气必然从三阳传入三阴，出现发热腹痛、四肢弯曲、能俯不能仰的症状，已成阴痉这种凶险危重的证候，却还称之为慢惊风，胡乱投用风药，死亡很快就会到来。悲哀啊！（这就是前代医家所说的，急惊风用凉泻法治疗不愈，或者因吐下药太过，反而变成慢惊风的例子）。
按语：伤寒的到来，难道第一天就能变成痉证吗？这是由医生误治导致的。邪气从太阳经进入，太阳经脉上行于头，中行于背，下行至足，因为经脉受邪，营卫运行涩滞，所以头、项、背、足都有疼痛牵强的现象。儿科医生见此，便惊讶地称为惊风，胡乱进行镇坠治疗，以致邪气无法伸展，从而变成痉证。这个时候还不知道是误治所致，反而认为是小儿固有的证候。这就是所谓的误中之误。曾观察到夏初明代治疗小儿抽搐而死，甚至三五天不醒的病例，全部使用天保采微汤投服而痊愈。他的儿子禹铸广泛传播这个方子，可惜没有一家医家加以阐发，致使后人无法理解其中的义理。我不辞繁琐，姑且剖析显露：天保采微汤乃是败毒散、不换金正气散、升麻葛根汤三方合凑而成的。其中作用，以羌活、独活走太阳经而祛寒发表，以苍术、前胡、升麻、葛根、陈皮、厚朴、甘草、茯苓走阳明经而除湿解肌，以川芎、柴胡入少阳经而和解表里，以桔梗、半夏、枳壳、藿香、芍药入太阴经而调和营血驱逐饮邪。有人问：既然都是三阳经的解表药，为什么又涉及太阴经？回答说：小儿完全依赖脾肺作为运化药物的主体。这实际上是扶助中气以托举邪气，难道是引导邪气入里的说法吗？然而其中十七味药，并非五金八石、三黄四神等猛药，却能在死中求活，难道不是疏解类药物可以起死回生吗？这是因为从前误将伤寒当作惊风治疗，未经发散，以致邪气闭阻而死。现在投用疏解药物使其存活，也不过是弥补从前治疗的缺失罢了，哪里有什么奇特深奥的意义呢！只是这种治疗方法，还算是最末等的策略。如果早期循经治疗，又何至于如此凶险危重，就像猎人张开四面罗网，希望侥幸遇到一个猎物一样。如果按照我所编纂的方法，一见小儿发热昏沉，就分别为其辨别有汗无汗，有汗的用解散肌邪之法，无汗的用开通营卫之法，引领邪气外出，神志自然清醒，又有什么闭塞昏迷的变化呢？
The term "Wu Chu" (Misdiagnosed Convulsion) refers to the spasm syndrome caused by Shanghan disease. Stiffness of the head and neck, opisthotonos (back arching), and upward deviation of the eyes belong to the Taiyang channel; downward gaze, trismus (lockjaw) with inability to speak, traction of the limbs, and flexion of elbows and knees belong to the Yangming channel; oblique gaze to the left or right, and convulsions of the limbs to the left or right, belong to the Shaoyang channel. These are actually exterior syndromes of the Three Yang channels; how can they be confusedly termed Jing Feng (Wind Agitation/Convulsion)? The spasm is caused by mismanagement, hence it is now renamed Wu Chu. However, spasm is divided into Gang Jing (Stiff Spasm) and Rou Jing (Soft Spasm), and their treatments differ. Rou Jing is listed first, followed by Gang Jing. The causes leading to spasm and the formulas for treating spasm are detailed under the section on Wu Chu, making the syndromes and treatments orderly and well-founded. Those who understand should not consider my words as baseless.
(Exterior Wind with sweating constitutes Rou Jing, due to the soft nature of Wind.)
The Classics state: In a Taiyang disease with fever and sweating, if there is no aversion to cold, it is named Rou Jing. At the onset, symptoms include fever, spontaneous sweating, hot breath, yawning with a sense of stuffiness, trembling of the hands and feet, and in severe cases, opisthotonos. This is caused by Wind pathogen damaging the Wei Qi, leading to disharmony between Ying and Wei. Children with weak constitutions are most prone to this syndrome because their pores are not dense, leading to frequent and irregular sweating, which allows Wind pathogen to easily invade. Pediatric practitioners often see excessive sweating and lethargy in children and casually label it as Man Jing Feng (Slow Wind).
Commentary: The condition described here, where Wind pathogen damages Wei Qi, is originally a mild syndrome. If treated early with methods to release the muscle layer and harmonize Ying and Wei, the medicine will take effect immediately. Mistaking it for Man Jing Feng and recklessly administering tonifying agents would lead to disastrous consequences (This is the example cited by previous physicians where Man Jing Feng fails to respond to warming and tonifying therapies, transforming into Ji Jing Feng [Fast Wind]).
(Shanghan without sweating constitutes Gang Jing, due to the stiff nature of Cold.)
The Classics state: Taiyang Wind strike, when compounded by Cold-Dampness, transforms into spasm. Generally, Wind strike involves sweating. Ignorant people fail to realize this and overdress the child, causing profuse sweating. The sweat wets the clothing and swaddling clothes; prolonged dampness generates Cold, which infiltrates the joints, thus termed "compounded Cold-Dampness." Internal closure by Cold-Dampness leads to an absence of sweating, which is named Gang Jing. Symptoms at onset include aversion to Wind and Cold, fever, headache, and a tendency to cuddle close to the mother's embrace. Since infants cannot speak, parents may not initially notice the aversion to Cold despite the fever, nor the headache despite the lethargy. Physicians seeing only fever often indiscriminately diagnose Jing Feng, ignoring the exterior-interior aspects of Shanghan. They rely solely on sedative, cooling, and purgative treatments, suppressing the exterior pathogen and preventing its expulsion. This inevitably leads to the pathogen spreading to the Three Yang channels (Taiyang transmitting to Yangming, Yangming to Shaoyang). Consequently, symptoms such as feverish body with cold feet, stiff neck, heat throughout the head and body, red face and eyes, solitary head shaking, sudden trismus, opisthotonos, limb convulsions, and oblique eye gaze appear. This represents the complete spasm of the Three Yang channels, corresponding to the "Four Syndromes and Eight Signs" known in pediatrics. At this stage, one should strictly follow the channel pathways to administer medication, resolving the pathogens of the Three Yang channels, and the illness will resolve rapidly. If this approach is abandoned, the pathogen will enter the Three Yin channels from the Three Yang, presenting with fever, abdominal pain, curled limbs, ability to bend but not extend, becoming a critical and dangerous Yin Spasm syndrome. Yet, it is still called Man Jing Feng, and reckless use of Wind-dispelling herbs will lead to imminent death. Alas! (This corresponds to the case cited by previous physicians where Ji Jing Feng fails to respond to cooling and purgative therapies, or results from excessive vomiting and purging, transforming into Man Jing Feng.)
Commentary: Does Shanghan transform into spasm on the very first day? No, this is caused by physician error. The pathogen enters via the Taiyang channel. The Taiyang meridian ascends to the head, runs down the back, and reaches the feet. When the meridian is affected by pathogen, Ying and Wei circulation becomes sluggish, causing pain and stiffness in the head, neck, back, and feet. Pediatricians, seeing this, erroneously diagnose it as Jing Feng and apply sedative treatments, trapping the pathogen and inducing spasm. Failing to recognize this as iatrogenic error, they attribute it to an inherent childhood condition. This is the "error within an error." I have observed cases in early summer during the Ming Dynasty where children died of convulsions or remained unconscious for three to five days, all cured by administering Tianbao Caiwei Tang. His son, Yu Zhu, widely disseminated this formula, yet no school elaborated on its principles, leaving later generations unable to grasp its meaning. I shall briefly elucidate: Tianbao Caiwei Tang is a combination of Baidu San (Decoction to Rescue from Toxins), Bu Huan Jin Zhengqi San (Decoction to Preserve Metal and Regulate Righteous Qi), and Shengma Gegen Tang (Kudzu Root and Ligusticum Decoction). Its actions are as follows: Qiang Huo (Notopterygii Rhizoma et Radix) and Du Huo (Angelicae Pubescentis Radix) target the Taiyang channel to dispel Cold and release the exterior; Cang Zhu (Atractylodis Rhizoma), Qian Hu (Peucedani Radix), Sheng Ma (Cimicifugae Rhizoma), Ge Gen (Puerariae Lobatae Radix), Chen Pi (Citri Reticulatae Pericarpium), Hou Po (Magnoliae Officinalis Cortex), Gan Cao (Glycyrrhizae Radix et Rhizoma), and Fu Ling (Poria) target the Yangming channel to resolve Dampness and release the muscle layer; Chuan Xiong (Ligustici Chuanxiong Rhizoma) and Chai Hu (Bupleuri Radix) enter the Shaoyang channel to harmonize the interior and exterior; Jie Geng (Platycodonis Radix), Ban Xia (Pinelliae Rhizoma), Zhi Ke (Aurantii Fructus Immaturus), Huo Xiang (Agastaches Herba), and Bai Shao (Paeoniae Radix Alba) enter the Taiyin channel to harmonize Ying and expel fluid retention. One might ask: Since these are primarily exterior-resolving herbs for the Three Yang channels, why do they involve the Taiyin channel? The answer is that children rely entirely on the Spleen and Lung to govern the distribution of medicinal properties. This formula actually supports the Middle Qi to push out the pathogen; it does not guide the pathogen inward. Although it contains seventeen ingredients, none are heavy minerals or harsh drugs like San Huang Si Shen, yet it achieves life from death. Is this not proof that dispersing and resolving herbs can revive the dying? The previous deaths were due to mistaking Shanghan for Jing Feng and failing to disperse the pathogen, leading to pathogen closure. The current survival is merely correcting the previous omission, not possessing any miraculous secret. However, this treatment is still considered a last resort. If treated early according to the channels, such critical danger would be avoided. It is like a hunter setting four nets, hoping to catch just one prey. But if one follows my compiled method: upon seeing fever and lethargy in a child, immediately distinguish between sweating and non-sweating. For those with sweating, resolve the muscle-layer pathogen; for those without sweating, open the Ying and Wei to guide the pathogen outward. The mental state will naturally clear, and what need is there for闭塞昏迷 (obstruction and coma) transformations?