钱氏云。小儿慢惊。因病后。或吐泻。或药饵伤损脾胃。肢体逆冷。口鼻气微。手足螈 。
昏睡露睛。此脾虚生风无阳之证也。因吐泻脾肺俱虚。肝木所乘。或急惊屡用泻热。则脾损阴消。
遂变慢惊而致螈 微搐。楼全善所谓木虚则搐而无力。火虚则身寒。口中气冷。土虚则吐泻。睡
而露睛。治宜温补脾胃。六君子姜、桂、蝎尾。或兼夹热夹食夹痰。与外感证相似者。当审其因
而治之。大率吐泻痰鸣气喘。眼开神缓。昏睡露睛。惊跳搐搦。乍发乍静。或身热肢冷。面淡唇
青。其脉沉迟微缓者是也。当温补脾气为主。佐以安心制肝药。若禀赋不足。或久病脾虚。及常
服克伐之药者。多致此证。若因土虚不能生金。金不能平木。木来侮土。致成慢惊者。五味异功
散加当归、枣仁、钩藤以补土平木。若脾土虚寒者。六君子加乌头、蝎尾。泄泻。加炮姜、木香。
不应。急加附子以回阳气。凡元气亏损而致昏愦者。急灸百会穴。若
待下痰不愈而后灸之。则元气脱散而不救矣。此乃脏腑传变已极。总归虚处。惟脾受之。无风可
逐。无惊可疗。因脾虚不能摄涎。故津液妄泛而似痰者。当根据前法自效。若不审其因。泛用祛风
化痰之剂。反促其危也。每见小儿脾胃弱者。一病即成慢惊。不可泥为久病。误药而后始成也。
内经谓之慢脾风。意可见矣。慢惊而见目不转睛。痰鸣如拽锯声。项软身冷粘汗。手足一边牵引
者不治。喻嘉言曰。小儿初生。以及童幼。肌肉筋骨。脏腑血脉。俱未充长。阳则有余。阴则不
足。故易于生热。热甚则生痰生风生惊。亦所恒有。设当日直以四字立名。曰热痰风惊。则后人
不眩。因四字不便立名。乃节去二字。后人不解。遂以为奇特之病。且谓此病有八候。以其头摇
手劲也。而立抽掣之名。以其卒口噤脚挛急也。而立目邪心乱搐搦之名。以其脊强背反也。而立
角弓反张之名。相传既久。不知其妄造。遇此等证。无不以为奇特。而不知小儿之腠理未密。易
于感冒风寒。病则筋脉牵强。因筋脉牵强。生出抽掣搐搦角弓反张种种不通名目。而用金石药镇
坠。外邪深入脏腑。千中千死。间有体坚证轻得愈者。又诧为再造奇功。遂至各守专门。虽日杀
数儿。不自知其罪矣。如方书中有云。小儿八岁以前无伤寒。此等胡言。竟出自高明。偏足为惊
风之说树帜。曾不思小儿不耐伤寒。初传太阳一经。早已身强多汗。筋脉牵动。人事昏沉。势已
极于本经。汤药乱投。死亡接踵。何由见其传经解散耶。此所以误言小儿无伤寒也。不知小儿易
于外感。易于发热。伤寒为独多。世所妄称为惊风者。即此也。小儿伤寒。要在三日内即愈为贵。
若待经尽方解。必不能耐矣。又刚痉无汗。柔痉有汗。小儿肌腠不密。故刚痉少。柔痉多。世医
见其汗出不止。神昏不醒。往往以慢惊风证为名。而用参、 、术、附等药闭其腠理。热邪不得
外越。亦为大害。但比金石药为差减耳。所以凡治小儿之热。但撤其出表。不当固其入里也。仲
景原有桂枝汤法。若舍
而不用。从事东垣内伤为治。毫厘千里矣。
钱乙说，小儿慢惊风，是因为病后，或者呕吐腹泻，或者药物损伤了脾胃，导致四肢逆冷，口鼻气息微弱，手足抽搐，昏睡且眼睛半睁露出眼白。这是脾虚生风、阳气衰微的证候。因为吐泻导致脾肺两虚，肝木乘虚克制脾土；或者急惊风时屡次使用清热泻火药，导致脾损阴液消减，于是转变为慢惊风，出现轻微的抽搐。楼全善所说的“木虚则抽搐而无力，火虚则身体寒冷，口中气冷，土虚则呕吐腹泻，睡觉时眼睛半睁露睛”。治疗应当以温补脾胃为主，可用六君子汤加生姜、肉桂、蝎尾。如果兼夹有热、夹食积、夹痰，或与外感证相似的情况，应当审察病因进行治疗。大抵上，吐泻伴有痰鸣气喘，眼睛睁开神志倦怠，昏睡露睛，惊跳抽搐，发作有时停止，或者身体发热四肢冰冷，面色淡白嘴唇青紫，脉象沉迟微缓的，就是这种证候。应当以温补脾气为主，辅以安心制肝的药物。如果是先天禀赋不足，或者久病脾虚，以及经常服用攻伐药物的患者，多会导致这种证候。如果是因为脾土虚弱不能生肺金，肺金不能制约肝木，肝木反过来侮犯脾土，从而形成慢惊风的，用五味异功散加当归、酸枣仁、钩藤来补土平木。如果是脾土虚寒的，用六君子汤加川乌、蝎尾；如果有泄泻，加炮姜、木香；如果无效，紧急加入附子以回阳救逆。凡是元气亏损导致昏迷不省的，紧急灸百会穴。如果等到下痰症状不愈后再去灸治，那么元气就会脱散而无法挽救了。这是因为脏腑传变已经至极，总归归于虚处，只有脾脏受累，没有风可以驱逐，没有惊可以治疗。因为脾虚不能摄持涎液，所以津液妄行泛滥而看似痰饮。应当根据前面的方法治疗自然见效。如果不审察病因，滥用祛风化痰的药物，反而加速其危重。我常看见小儿脾胃弱的，一生病就变成慢惊风，不可固执地认为必须是久病或误药后才形成的。《内经》称之为慢脾风，意思就很明显了。慢惊风如果出现眼睛不转动，痰鸣声像拉锯一样，颈部软弱身体冰冷粘汗，手足一边牵引的，属于不治之症。喻嘉言说：小儿初生以及儿童时期，肌肉筋骨、脏腑血脉都尚未充盛长大，阳气相对有余，阴气不足，所以容易产生内热。热甚则生痰、生风、生惊，这也是常有的事。如果当初直接用这四个字立名，叫作“热、痰、风、惊”，那么后人就不会迷惑。因为这四个字不便作为病名，于是省略了两个字，后人不懂其中含义，遂以为这是一种奇特的疾病。并且说此病有八种候象，因为其头摇手劲，而立名为“抽掣”；因为其突然口噤脚挛急，而立名为“目邪心乱搐搦”；因为其脊背强直反折，而立名为“角弓反张”。相传既久，不知这是妄造的名目，遇到这些证候，无不以为是奇特之病，却不知道小儿腠理不密，容易感冒风寒，患病则筋脉牵强，因筋脉牵强，生出抽掣、搐搦、角弓反张种种不通的名目，而使用金石类药物镇坠安神，导致外邪深入脏腑，千中千死。间或有体质强健、证候较轻而痊愈的，又诧异地认为是再造奇功，遂至各守专门，虽然每天杀死几个孩子，自己也不知道是罪过。如方书中说：“小儿八岁以前无伤寒”，这种胡话，竟出自高明之士，偏偏足以为惊风之说树立旗帜。曾不思小儿不耐伤寒，初传太阳一经，早已身体强直多汗，筋脉牵动，人事昏沉，病势已极于本经，汤药乱投，死亡接踵而至，哪里还能看到其传经解散呢？这就是之所以误言小儿无伤寒的原因。不知道小儿易于外感，易于发热，患伤寒的特别多。世间妄称为惊风的，就是这种情况。小儿伤寒，要在三日内即愈才珍贵。如果等到经尽才解，必然不能耐受。另外，刚痉无汗，柔痉有汗，小儿肌腠不密，所以刚痉少，柔痉多。世医见到其汗出不止，神昏不醒，往往以慢惊风证为名，而用人参、白术、附子等药闭塞腠理，使热邪不得外越，也是大害。但这比金石类药物稍好一些。所以凡治疗小儿的热证，只要撤除其表邪，不应当固护使其入里。张仲景原有桂枝汤法，如果舍弃而不用，从事于李东垣的内伤理论来治疗，那就差之毫厘谬以千里了。
Qian Yi stated that slow convulsion (Man Jing) in children arises after an illness, or due to vomiting and diarrhea, or because medicinal errors have damaged the Spleen and Stomach. Symptoms include cold extremities, faint breath from the mouth and nose, twitching of the hands and feet, drowsiness with eyes half-open showing the whites. This is a syndrome of wind generated by Spleen deficiency and Yang collapse. Due to vomiting and diarrhea, both the Spleen and Lung are deficient, allowing Liver Wood to overact upon Earth. Alternatively, if acute convulsion (Ji Jing) was treated repeatedly with heat-clearing methods, Spleen damage and Yin consumption occur, transforming into slow convulsion causing mild twitching. Lou Quanshan said: "When Wood is deficient, there is twitching but without strength; when Fire is deficient, the body is cold and breath from the mouth is cold; when Earth is deficient, there is vomiting and diarrhea, and sleep with eyes half-open." Treatment should focus on warming and tonifying the Spleen and Stomach, using Liu Jun Zi Tang (Six Gentlemen Decoction) added with Sheng Jiang (Fresh Ginger), Rou Gui (Cinnamon Bark), and Xie Wei (Scorpion Tail). If there are concurrent heat, food retention, or phlegm, resembling exterior syndromes, one must examine the cause and treat accordingly. Generally, cases involving vomiting and diarrhea with phlegm-rattling and wheezing, open eyes with sluggish spirit, drowsiness with exposed eyes, startle jumps and spasms, intermittent onset and cessation, or fever with cold limbs, pale face, and cyanotic lips, with a deep, slow, fine, and moderate pulse, belong to this category. The primary treatment should be warming and tonifying Spleen Qi, assisted by herbs that calm the Heart and restrain the Liver. If constitution is insufficient, or due to chronic Spleen deficiency from long-term illness, or frequent use of purgative drugs, this syndrome often results. If caused by weak Earth failing to generate Metal, and Metal failing to control Wood, leading to Wood insulting Earth and forming slow convulsion, use Wu Wei Yi Gong San (Five-Ingredient Powder for Extraordinary Efficacy) added with Dang Gui (Angelica Sinensis Root), Zao Ren (Ziziphus Seed), and Gou Teng (Uncaria Rhynchophylla Ramulus et Uncus) to tonify Earth and pacify Wood. If Spleen Earth is deficient and cold, use Liu Jun Zi Tang added with Wu Tou (Aconite Lateralis Radix Preparata) and Xie Wei; if accompanied by diarrhea, add Pao Jiang (Prepared Ginger Rhizome) and Mu Xiang (Aucklandiae Radix); if ineffective, urgently add Fu Zi (Aconiti Lateralis Radix Preparata) to restore Yang Qi. For cases where Yuan Qi depletion leads to coma, urgently moxa Bai Hui (GV20). If one waits until phlegm symptoms persist before applying moxibustion, Yuan Qi will scatter and become incurable. This is because organ transmission has reached its extreme, returning to deficiency, primarily affecting the Spleen. There is no wind to expel and no shock to treat. Because Spleen deficiency fails to control saliva, fluids overflow abnormally, appearing as phlegm. One should follow the previous methods for efficacy. If the cause is not examined and wind-expelling and phlegm-resolving agents are used indiscriminately, it will instead hasten danger. I often see that children with weak Spleen and Stomach develop slow convulsion immediately upon falling ill; one must not rigidly assume it only occurs after long-term illness or medication error. Nei Jing refers to this as Man Pi Feng (Slow Spleen Wind), which clarifies the meaning. If slow convulsion presents with fixed gaze, phlegm rattling like sawing wood, flaccid neck, cold body with sticky sweat, and unilateral traction of limbs, it is untreatable. Yu Jiayan said: At birth and during childhood, muscles, bones, tendons, organs, and blood vessels are not yet fully developed. Yang is relatively abundant while Yin is insufficient, making them prone to generating heat. Excessive heat generates phlegm, wind, and shock, which is common. If originally named directly with four characters—"Heat, Phlegm, Wind, Shock"—later generations would not be confused. Since these four characters were inconvenient as a disease name, two were omitted. Later generations did not understand, considering it a peculiar disease. They claimed eight signs: because of head shaking and stiff hands, they named it "Twitching and Pulling"; because of sudden jaw clenching and leg cramping, they named it "Eye Deviation, Heart Chaos, Spasms"; because of stiff spine and opisthotonos, they named it "Opisthotonos". Long transmitted, unaware of these fabricated terms, encountering such syndromes, everyone considered them peculiar, not realizing children's cou li (pores/skin texture) are not dense, making them susceptible to wind-cold invasion. Illness causes tendon and vessel tension, leading to fabricated terms like twitching, spasms, and opisthotonos. Using mineral sedatives causes external pathogens to penetrate deeply into organs, resulting in death in nearly all cases. Occasionally, those with strong constitutions and mild symptoms recover, astonishing people who attribute it to miraculous healing. Thus, specialists guard their own schools; though killing children daily, they do not realize their fault. Formulas stating "Children under eight have no Taiyang syndrome" are nonsense from so-called experts, supporting the theory of wind-shock. Did they not consider that children cannot tolerate Taiyang syndrome well? Upon initial transmission to the Taiyang channel, they already exhibit stiff body, profuse sweating, tendon movement, and mental confusion. The pathology is already extreme within the primary channel. Random prescription leads to successive deaths; how can one observe transmission and resolution? This is why it is mistakenly said children have no Taiyang syndrome. In fact, children are prone to exterior invasions and fever, with Taiyang syndrome being very common. What the world wrongly calls wind-shock is precisely this. For pediatric Taiyang syndrome, recovery within three days is precious. If waiting until the meridian cycle completes for resolution, the child likely cannot endure. Furthermore, Gang Jing (Stiff Spasm) has no sweat, Rou Jing (Soft Spasm) has sweat. Due to children's loose cou li, Gang Jing is rare and Rou Jing is common. Physicians seeing continuous sweating and unconsciousness often diagnose it as slow convulsion, using Ren Shen (Ginseng Radix et Rhizoma), Bai Zhu (Atractylodis Macrocephalae Rhizoma), and Fu Zi to close the cou li, preventing heat pathogen from exiting outward, which is also harmful, though less so than mineral sedatives. Therefore, treating pediatric heat, one should release it to the exterior, not consolidate it inward. Zhang Zhongjing had the Gui Zhi Tang (Cinnamon Twig Decoction) method. Abandoning it to follow Li Dongyuan's internal injury theories is a deviation of a hair's breadth leading to a thousand miles of error.