钱氏曰小儿急惊因闻大声或大惊而后发搐发过则如故此无阴也当下利惊丸主之此证本因
热生
于心身热面赤饮水口中气热大小便黄赤剧则发搐也盖热甚则风生风属肝此阳盛阴虚也故利惊
丸主之以除痰热不可用巴豆及温药太下之恐搐虚热不消也小儿热痰客于胃因闻声非常则动而
惊搐矣若热极虽不闻声亦自发搐阎氏云当其搐势渐减时与镇心治热之剂一二服候惊稍定须更
以药下其痰热心神安宁即愈洁古曰急惊阳证也俱腑受病耳小儿热痰客于心肺是少阳相火旺经
云热极生风因闻大声而作盖谓东方震卦得火气而发搐火本不动得风而动当用利惊丸导赤散泻
青丸地黄丸主之搐止服安神丸
阎孝忠曰慢惊得于大病之后吐泻之余或误取转致脾胃虚损风邪乘之似搐而不甚搐名曰螈
似
睡而精神慢四肢与口中气皆冷睡中露睛或胃痛而啼哭忽如鸦声此证已危盖脾胃虚损故也洁古
曰慢惊阴证也俱脏受病耳盖小儿吐泻病久脾胃虚损若不早治则成慢惊名曰螈 似搐而不甚搐
也因脾虚故大便不聚当去脾间风先以宣风散导之后用使君子丸益黄散则其痢自止既已失治则
脾肺俱虚致被肝木所乘是为慢惊也当用温补羌活膏主之
仁斋曰慢脾风之候面青额汗舌卷头低眼合不开困睡中摇头吐舌频呕腥臭禁口切牙手足微
搐而
不收或身冷或身热而四肢厥冷其脉沉微阴气极盛胃气极虚十救一二盖由慢惊之后吐泻损脾病
传已极总归虚处惟脾所受故曰慢脾若逐风则无风可逐若疗惊则无惊可疗但脾间涎痰虚热往来
其眼合者脾困气乏神志昏迷痰涎壅滞然耳世所谓难疗者是也然慢脾一名虚风凡小儿吐泻之后
面色虚黄大热虚损若因虚而发热继此随得慢惊脾风之疾方见摇头斜视以手摸人昏困喜睡额上
汗出身亦粘汗其声渐小而焦即是脾风之证不必皆由慢惊传次而至又当识之大要生胃回阳黑附
汤金液丹白丸子生附四君子汤可斟酌而用胃气渐复则异功散温平而调理之若其眼半开半闭手
足不冷证尚慢惊则勿用回阳或已入慢脾而阳气未甚脱者亦不可用硫黄附子凡服回阳汤剂手足
渐暖者仍服醒脾散等继其后以调之慢脾下痰轻者神保既济丹慢惊慢脾逆恶候诸药不效者如有太
冲脉则取百会穴灸之此治慢脾风之大要然也
按刘氏云以上诸家所论殆尽证治之要大抵惊风主风木甲木属阳腑病易治乙木属阴脏病难
治如
大人惊恐即后泄盖甲木克戊土也况小儿五脏之气未实神气未完而自病乎证非病后及吐泻脾胃
虚损得者中有夹火夹痰夹食病因不同风邪内陷有入腑入脏亦与外中风相似治此当本钱氏虚实
补泻之法则不致犯禁忌之误药有太过不及之失
钱乙说：小儿急惊是因为听到巨大的声响或受到极大惊吓后发作抽搐，抽搐过后则像正常人一样。这是因为体内无阴（阴虚）。应当使用利惊丸为主方治疗。此证原本是因为心火亢盛，表现为身体发热、面色红润、想喝水、口中呼出热气、大小便黄赤；病情严重时才会发生抽搐。大概是因为热极生风，风归属于肝，这是阳盛阴虚的表现，所以用利惊丸来清除痰热。不可使用巴豆及温热药物猛烈攻下，否则恐怕抽搐虽止但虚热不消。小儿的热痰停留在胃中，因为听到不寻常的声音而触动，导致惊厥抽搐。如果热势极盛，即使没有听到声音也会自发抽搐。阎孝忠说：当抽搐之势逐渐减弱时，给予镇心安神、清热的一两剂药，等惊厥稍微安定后，再用药物攻下其痰热，心神安宁即可痊愈。张元素说：急惊属于阳证，都是腑受病。小儿的热痰客居于心肺，是少阳相火旺盛。《内经》说“热极生风”，因听到巨大声响而发作。这好比东方震卦得火气而发搐，火本来不动，得风而动。应当用利惊丸、导赤散、泻青丸、地黄丸为主方。抽搐停止后服用安神丸。
阎孝忠说：慢惊是在大病之后，或吐泻之余，或因误治导致脾胃虚损，风邪乘虚而入。症状类似抽搐但不太剧烈，名叫螈疭（chōu zòng，手足抽搐）；似睡非睡且精神萎靡，四肢和口中气息皆冷，睡觉时眼睛睁开，或者胃痛而啼哭，声音忽然像乌鸦叫。此证已经危重，是因为脾胃虚损的缘故。张元素说：慢惊属于阴证，都是脏受病。大概小儿患吐泻病日久，脾胃虚损，如果不早治疗就会变成慢惊，名叫螈疭。症状类似抽搐但不太剧烈。因为脾虚，所以大便不成形。应当先去除脾间的风邪，先用宣风散疏导，然后用使君子丸、益黄散，痢疾自然停止。如果已经延误治疗，导致脾肺俱虚，被肝木所克制，这就是慢惊。应当用温补法，以羌活膏为主方。
杨士瀛（仁斋）说：慢脾风的候象是面色青暗、额头出汗、舌头卷缩、头低垂、眼睛闭合不睁、困倦嗜睡、摇头、吐舌、频繁呕吐带有腥臭味的东西、咬紧牙关、手足轻微抽搐而不能收拢，或者身体发冷，或者身体发热但四肢厥冷，脉象沉微，阴气极盛，胃气极虚，十个人中只能救活一两个。大概是由慢惊之后，吐泻损伤脾脏，病情传变已到极点，总归归于虚处，只有脾脏受累，所以叫慢脾。如果去逐风，则无风可逐；如果去疗惊，则无惊可疗。只是脾间的涎痰和虚热往来，眼睛闭合是因为脾困气乏，神志昏迷，痰涎壅滞所致。然而世人所谓难治的，就是这种情况。但是慢脾又称虚风。凡是小儿在吐泻之后，面色虚黄，大热虚损，如果因为虚而发热，随后又得了慢惊、脾风的疾病，出现摇头斜视、用手摸人、昏困喜睡、额头出汗、身体也粘汗、声音渐小而焦躁，这就是脾风的证候。不一定都是由慢惊传变而来，这一点也要认识清楚。治疗的大要是：生胃回阳，可用黑附汤、金液丹、白丸子、生附子、四君子汤，酌情使用。胃气逐渐恢复后，用异功散温和调理。如果眼睛半开半闭，手足不冷，证候尚属慢惊，则不要用回阳药；如果已经进入慢脾阶段，但阳气尚未完全脱失，也不可用硫黄、附子。凡是服用回阳汤剂后，手足逐渐变暖的，仍继续服用醒脾散等药来调治。慢脾风下痰，轻症用神保既济丹。对于慢惊、慢脾逆恶候，诸药无效的，如果有太冲脉，可以取百会穴进行艾灸。这就是治疗慢脾风的大要。
按语：刘氏说：以上各家论述几乎涵盖了证治的大要。大致来说，惊风主风木。甲木属阳，为腑病，易治；乙木属阴，为脏病，难治。如大人惊恐会导致腹泻，这是因为甲木克戊土（胃土）。何况小儿五脏之气未充实，神气未完备，容易自病吗？证候如果不是病后及吐泻导致脾胃虚损而得的，其中有夹火、夹痰、夹食的，病因不同，风邪内陷，有入腑入脏的区别，也与外感中风相似。治疗此病应当遵循钱乙虚实补泻的原则，就不会犯禁忌的错误，避免药物太过或不及的失误。
Qian Yi stated: Pediatric acute convulsion (Ji Jing) occurs after the child hears a loud noise or suffers a great fright, followed by convulsions. After the convulsion subsides, the child returns to normal. This indicates Yin deficiency (Yin Xu). The primary treatment should be Lijing Wan (Detoxify Convulsion Pill). This condition originates from excessive heat in the Heart, manifesting as fever, flushed face, thirst, hot breath, and yellow-red urine and stool; severe cases develop convulsions. Generally, extreme heat generates wind, and wind is associated with the Liver; this represents Yang excess and Yin deficiency. Therefore, Lijing Wan is used to eliminate phlegm-heat. One must not use Crotonis Fructus (Badou) or warm purgatives for aggressive downward draining, lest the convulsions stop but the deficient heat remain unresolved. When pediatric phlegm-heat lodges in the Stomach, unusual sounds trigger agitation and convulsions. If heat is extreme, convulsions may occur spontaneously even without auditory stimuli. Yan Xiaozhong stated: When the intensity of convulsions begins to subside, administer one or two doses of formulas that calm the Heart and clear heat. Once the fright stabilizes slightly, use medications to purge phlegm-heat. When the Heart-Mind becomes tranquil, recovery ensues. Zhang Yuansu stated: Acute convulsion is a Yang syndrome involving the Fu organs. Phlegm-heat in children lodges in the Heart and Lung, indicating hyperactivity of Shaoyang Ministerial Fire. The Classic states "extreme heat generates wind," triggered by loud noises. This is likened to the Zhen trigram (East) receiving Fire energy to induce convulsions; fire does not move on its own but moves when stirred by wind. Treatments include Lijing Wan, Daochi San, Xieqing Wan, and Dihuang Wan. After convulsions cease, administer Anshen Wan.
Yan Xiaozhong stated: Chronic convulsion (Man Jing) arises after severe illness, following vomiting and diarrhea, or due to mismanagement causing Spleen-Stomach deficiency. Wind pathogens invade the deficiency, presenting symptoms resembling convulsions but less intense, termed Chongzong (wasting-and-binding syndrome with limb twitching); the child appears drowsy yet is not fully asleep, with lethargic spirit, cold limbs and breath, open eyes during sleep, stomach pain with crying, and sudden crow-like vocalizations. This condition is critical due to Spleen-Stomach deficiency. Zhang Yuansu stated: Chronic convulsion is a Yin syndrome involving the Zang organs. Prolonged vomiting and diarrhea in children damage the Spleen and Stomach; if untreated early, it develops into chronic convulsion, termed Chongzong. Symptoms resemble convulsions but are mild. Due to Spleen deficiency, stools are unformed. First, expel wind from the Spleen using Xuanfeng San (Disperse Wind Powder), followed by Shijunzi Wan and Yihuang San to stop dysentery. If treatment is delayed, Spleen and Lung become deficient, allowing Liver Wood to overact upon them, resulting in chronic convulsion. Treatment requires warming and tonification, primarily using Qianghuo Gao.
Yang Shima (Renzhai) described slow spleen wind (Man Pi Feng): The presentation includes cyanotic complexion, sweating on the forehead, curled tongue, drooping head, tightly closed eyes, drowsiness, head shaking, protruding tongue, frequent vomiting of foul-smelling matter, teeth grinding, slight involuntary movements of hands and feet, cold body or fever with cold extremities, deep and faint pulse, extreme Yin excess, and extreme Stomach Qi deficiency. Only one or two out of ten may survive. This typically follows chronic convulsion where vomiting and diarrhea damage the Spleen, progressing to extreme depletion centered on the Spleen. Since there is no actual wind to dispel nor fright to calm, the pathology involves saliva-phlegm and deficient heat circulating. Closed eyes indicate Spleen fatigue, Qi exhaustion, coma, and phlegm obstruction. This is considered difficult to treat. However, slow spleen is also called deficient wind. After vomiting and diarrhea, if the complexion is sallow, there is high fever and deficiency, and subsequent symptoms include head shaking, lateral gaze, touching others, lethargy, forehead sweating, sticky body sweat, fading voice, and irritability, these are signs of spleen wind. This does not always result from the progression of chronic convulsion. Key treatments to generate Stomach Qi and restore Yang include Heifu Tang, Jin Ye Dan, Bai Wan Zi, raw Fuzi, and Sizijunzi Tang, used judiciously. Once Stomach Qi recovers, Yigong San can be used for gentle regulation. If eyes are half-open/half-closed and limbs are not cold, suggesting residual chronic convulsion, avoid Yang-restoring herbs. If已进入 slow spleen stage but Yang has not completely collapsed, avoid Shihuang (Sulfur) and Fuzi. If extremities warm up after taking Yang-restoring decoctions, continue with Xingpi San to regulate. For mild phlegm in slow spleen, use Shenbao Jiji Dan. For refractory cases of chronic convulsion or slow spleen with adverse prognoses, if the Taichong pulse is present, moxa can be applied to Baihui point. This summarizes the major principles for treating slow spleen wind.
Commentary: Liu stated that the aforementioned discussions cover the essentials of diagnosis and treatment. Generally, convulsion disorders are governed by Wind-Wood. Jia Wood belongs to Yang and Fu organs, making it easier to treat; Yi Wood belongs to Yin and Zang organs, making it harder. For instance, fright in adults causes diarrhea because Jia Wood controls Wu Earth (Stomach). Children have immature Zang organ Qi and incomplete Spirit, making them prone to internal disease. Etiologies vary: post-illness or post-vomiting-diarrhea Spleen-Stomach deficiency; or patterns involving combined Fire, Phlegm, or Food retention. Internal invasion of Wind pathogens affects Fu or Zang organs, resembling external wind-stroke. Treatment must follow Qian’s principles of tonifying deficiency and draining excess to avoid contraindications and errors of excessive or insufficient medication.