仲景先师所述方法具在，但须对证细加寻绎，如所云太阳证体强，KT KT 然，脉沉迟之类，有汗为
柔痉，为风多寒少，而用桂枝汤加法；无汗为刚痉，为寒痉，而用葛根汤，汤内有麻黄，乃不以桂枝立
名，亦不以麻黄立名者，以其病已至阳明也。诸如此类，须平时熟读其书，临时再加谨慎，手下自
有准的矣。
风寒咳嗽致痉者，用杏苏散辛温例，自当附入寒门。
（按此即螈证，少阳之气为之也，下温热、暑温、秋燥，皆同此例）
乃风之正令，阳气发泄之候，君火主气之时，宜用辛凉正法。轻者用辛凉轻剂，重者用辛凉重
剂，如本论上焦篇银翘散、白虎汤之类；伤津液者加甘凉，如银翘加生地、麦冬，玉女煎以白虎合冬、
地之类；神昏谵语，兼用芳香以开膻中，如清宫汤、牛黄丸、紫雪丹之类；愈后用六味、三才、复脉辈，
以复其丧失之津液。
风温咳嗽致痉者，用桑菊饮（方见上焦篇）、银翘散辛凉例，与风寒咳嗽迥别，断不可一概用杏苏辛温也。
（即六淫之火气，消烁真阴者也，《内经》谓先夏至为病温者是也）
即同上风温论治。但风温之病痉者轻而少，温热之致痉者多而重也。约之轻重浅深，视病之轻重浅深而已。
（暑兼湿热，后有湿痉一条，此则偏于热多湿少之病，去温热不远，经谓后夏至为病暑者是也）
按俗名小儿急惊风者，惟暑月最多，而兼证最杂，非心如澄潭，目如智珠，笔如分水犀者，未易辨
此。盖小儿肤薄神怯，经络脏腑嫩小，不奈三气发泄。邪之来也，势如奔马，其传变也，急如掣电，岂
粗疏者所能当此任哉！如夏月小儿身热头痛，项强无汗，此暑兼风寒者也，宜新加香薷饮；有汗则仍
用银翘散，重加桑叶；咳嗽则用桑菊饮；汗多则用白虎；脉芤而喘，则用人参白虎；身重汗少，则用苍
术白虎；脉芤面赤多言，喘喝欲脱者，即用生脉散；神识不清者，即用清营汤加钩藤、丹皮、羚羊角；神
昏者，兼用紫雪丹、牛黄丸等；病热轻微者，用清络饮之类，方法悉载上焦篇，学人当与前三焦篇暑门
中细心求之。但分量或用四之一，或用四之二，量
儿之壮弱大小加减之。痉因于暑，只治致痉之因，而痉自止，不必沾沾但于痉中求之。若执痉以求
痉，吾不知痉为何物。夫痉病名也，头痛亦病名也。善治头痛者必问致头痛之因，盖头痛有伤寒
头痛、伤风头痛、暑头痛、热头痛、湿头痛、燥头痛、痰厥头痛、阳虚头痛、阴虚头痛、跌扑头痛，心火欲
作痈脓之头痛、肝风内动上窜少阳胆络之偏头痛、朝发暮死之真头痛，若不问其致病之因，如时人但
见头痛，一以羌活、 本从事，何头痛之能愈哉！况痉病之难治者乎！
张仲景先师所记载的治疗方法都具备，但必须根据具体证候仔细推求分析。例如文中提到的太阳病证见身体强直、KT KT（形容拘急不舒之状）、脉象沉迟等情况，若有汗出，属于柔痉，是风邪偏多而寒邪偏少所致，治疗使用桂枝汤加减；若无汗出，属于刚痉，即寒痉，治疗使用葛根汤。葛根汤中含有麻黄，却不以桂枝命名方剂，也不以麻黄命名方剂，这是因为病邪已经传入阳明经的缘故。诸如此类的情况，需要平时熟读经典著作，临证时再加以谨慎，手下自然就有准确的把握了。
由风寒咳嗽引发痉挛的，采用杏苏散辛温解表的法则，自然应当归入寒门范畴。
（按：此即抽搐痉挛之证，是由少阳之气异常所致，下文的温热病、暑温病、秋燥病，都遵循同样的法则）
这是风的正常时令表现，也是阳气发泄的时节，正值君火主气的时候，适宜使用辛凉的正治法。病情轻者使用辛凉轻剂，病情重者使用辛凉重剂，如本书上焦篇中的银翘散、白虎汤之类；损伤津液者加用甘凉药物，如银翘散加生地黄、麦冬，玉女煎是将白虎汤与冬青子、生地黄合用之类；出现神志昏迷、胡言乱语者，兼用芳香药物以开通膻中窍闭，如清宫汤、牛黄丸、紫雪丹之类；痊愈后使用六味地黄丸、三才封髓丹、复脉汤等方剂，以恢复其丧失的津液。
由风温咳嗽引发痉挛的，采用桑菊饮（方剂见上焦篇）、银翘散辛凉解表的法则，这与风寒咳嗽截然不同，绝对不可一概使用杏苏散的辛温之法。
（这是六淫中的火气，会消烁人体真阴，《内经》所说的夏至前发病为温病就是指这种情况）
治疗方法同上述的风温论治。但是，风温导致痉挛的情况较轻且少见，温热病导致痉挛的情况较多且严重。概括来说，治疗的轻重深浅，取决于疾病的轻重深浅而已。
（暑邪兼夹湿热，后面有一条关于湿痉的论述，此处则是偏于热多湿少的病证，距离温热病不远，《内经》所说的夏至后发病为暑病就是指这种情况）
按照世俗的说法，小儿急惊风在夏季最多见，而且兼夹症状最为复杂，如果不是内心像清澈的潭水一样平静，目光像智慧的宝珠一样敏锐，笔法像分水犀一样精准的人，很难辨别清楚。大概是因为小儿皮肤薄、神气怯弱，经络脏腑稚嫩细小，不能耐受三种邪气的发泄。邪气来袭，势头如奔马般迅猛，其传变速度，快如闪电，这难道是粗疏大意的人所能胜任的吗！例如夏季小儿身体发热、头痛、项部强直无汗，这是暑邪兼夹风寒所致，适宜使用新加香薷饮；如果有汗出，则仍然使用银翘散，加重桑叶用量；有咳嗽则使用桑菊饮；汗多则使用白虎汤；脉象芤且气喘，则使用人参白虎汤；身体沉重、汗少，则使用苍术白虎汤；脉象芤、面色红赤、多言、气喘欲脱者，立即使用生脉散；神志不清者，立即使用清营汤加钩藤、牡丹皮、羚羊角；神志昏迷者，兼用紫雪丹、牛黄丸等；病情热势轻微者，使用清络饮之类，这些方法全部记载在上焦篇中，学习者应当与前三焦篇暑门中的内容一起细心探求。但是药量有的用四分之一，有的用二分之一，要根据小儿体质的强弱、年龄的大小进行增减调整。痉挛由于暑邪引起，只需治疗导致痉挛的原因，痉挛自然就会停止，不必仅仅局限于在“痉”这个症状本身去寻求治疗方法。如果执着于治疗痉挛这一表象来寻找对策，我不知道痉挛到底是什么东西。痉挛是一个病名，头痛也是一个病名。善于治疗头痛的人一定会询问导致头痛的原因，因为头痛有伤寒头痛、伤风头痛、暑邪头痛、热邪头痛、湿邪头痛、燥邪头痛、痰厥头痛、阳虚头痛、阴虚头痛、跌打损伤头痛、心火欲作痈脓引起的头痛、肝风内动向上窜扰少阳胆络引起的偏头痛、早晨发作晚上死亡的真头痛。如果不询问致病的原因，像当时的人只见头痛，就用羌活、藁本一味地从事治疗，怎么能治愈头痛呢！更何况是难治的痉挛病呢！
The methods described by our former master Zhang Zhongjing are all available, but one must carefully deduce them according to the specific syndrome. For instance, in cases where the Taiyang disease (disease of the Taiyang channel) presents with a stiff body, [KT KT] (describing a state of stiffness and discomfort), and a deep, slow pulse: if there is sweating, it is classified as Rou Jing (Soft Spasm), caused by wind predominating over cold, and treated with Guizhi Tang (Cinnamon Twig Decoction) modified; if there is no sweating, it is classified as Gang Jing (Hard Spasm) or Han Jing (Cold Spasm), and treated with Gegen Tang (Kudzu Root Decoction). Although Gegen Tang contains Ephedrae Herba (Mahuang, 麻黄), it is not named after Cinnamon Twig (Guizhi, 桂枝) nor after Ephedrae Herba, because the pathogen has already entered the Yangming channel. In such cases, one must be familiar with the classics through daily study and exercise caution during clinical practice, thereby ensuring accurate judgment.
When spasm is induced by Wind-Cold cough, the principle of Xing Su San (Apricot and Perilla Powder) using acrid-warm methods should naturally be included under the Cold category.
(Note: This refers to convulsions, caused by the abnormal Qi of the Shaoyang channel. The subsequent sections on Warm Heat, Summer-Heat Warmth, and Autumn Dryness follow this same principle.)
This represents the normal seasonal manifestation of Wind, a time when Yang Qi is venting, and when Jun Huo (Ministerial Fire) governs the Qi. It is appropriate to use the standard Acrid-Cool method. For mild cases, use a light Acrid-Cool formula; for severe cases, use a heavy Acrid-Cool formula, such as Yinqiao San (Honeysuckle and Forsythia Powder) and Baihu Tang (White Tiger Decoction) from the Upper Jiao chapter of this treatise. If Body Fluids are damaged, add Sweet-Cool herbs, such as adding Sheng Di Huang (Rehmanniae Radix Preparata) and Mai Dong (Ophiopogonis Tuber) to Yinqiao San, or Yu Nu Jian (Jade Woman Decoction), which combines Baihu Tang with Dong Qing Zi and Sheng Di Huang. If there is coma and delirium, combine with aromatic herbs to open the Danzhong (Chest Center), such as Qing Gong Tang (Palace Cleansing Decoction), Niu Huang Wan (Calculus Bovis Pill), or Zi Xue Dan (Purple Snow Elixir). After recovery, use Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill), San Cai Feng Sui Dan (Three-Talent Seal-Marrow Elixir), or Fumai Tang (Pulse-Replenishing Decoction) to restore lost Body Fluids.
When spasm is induced by Wind-Warmth cough, the Acrid-Cool principles of Sang Ju Yin (Mulberry Leaf and Chrysanthemum Drink) (formula seen in Upper Jiao chapter) and Yinqiao San apply. This is distinctly different from Wind-Cold cough, and one must absolutely not indiscriminately use the Acrid-Warm method of Xing Su San.
(This refers to the Fire Qi among the Six Evils, which consumes True Yin. As stated in the *Neijing*, diseases occurring before the Summer Solstice are termed Warm diseases.)
The treatment follows the same principles as Wind-Warmth discussed above. However, spasm caused by Wind-Warmth is mild and rare, whereas spasm caused by Warm Heat is frequent and severe. Generally, the severity and depth of treatment depend on the severity and depth of the disease.
(Summer-Heat combines with Damp-Heat. There is a separate section on Damp Spasm later; this case leans towards more Heat than Dampness, closely related to Warm Heat. As the *Jingshu* states, diseases occurring after the Summer Solstice are termed Summer-Heat diseases.)
According to common parlance, Infantile Acute Convulsive Wind (Xiao Er Ji Jing Feng) is most prevalent in summer and presents with the most complex accompanying symptoms. Only those whose minds are clear as a still pool, eyes sharp as wisdom pearls, and penmanship precise as a dividing-water rhino horn can easily distinguish this condition. Infants have thin skin and timid spirit, with delicate meridians and viscera that cannot withstand the venting of the Three Evils. When pathogens arrive, their momentum is like a galloping horse, and their transmission is as swift as lightning. How could a careless practitioner handle such responsibility? For example, in summer, if an infant has fever, headache, neck stiffness, and no sweat, this is Summer-Heat combined with Wind-Cold, and Xin Jia Xiang Ru Yin (Newly Added Elsholtzia Drink) is suitable. If there is sweat, continue using Yinqiao San with increased Sang Ye (Mulberry Leaf); if there is cough, use Sang Ju Yin; if there is excessive sweat, use Baihu Tang; if the pulse is Kou (Hollow) and there is wheezing, use Renshen Baihu Tang (Ginseng White Tiger Decoction); if the body feels heavy with little sweat, use Cang Zhu Baihu Tang (Atractylodes White Tiger Decoction); if the pulse is Kou, the face is red, there is excessive talking, and wheezing suggests impending collapse, immediately use Shengmai San (Generate Pulse Powder); if consciousness is unclear, immediately use Qingying Tang (Clear Nutrient Decoction) added with Gou Teng (Uncaria Ramulus), Mu Dan Pi (Moutan Cortex), and Ling Yang Jiao (Saiga Antelope Horn); if there is coma, combine with Zi Xue Dan or Niu Huang Wan. For mild heat conditions, use Qingluo Yin (Clear Collateral Drink). These methods are fully recorded in the Upper Jiao chapter; students should seek them out carefully alongside the Summer-Heat section of the first three Jiao chapters. However, dosages may be reduced to one-quarter or one-half, adjusted according to the infant's strength and size. If spasm is caused by Summer-Heat, one need only treat the cause of the spasm, and the spasm will cease naturally; one should not obsessively seek cures solely within the symptom of spasm itself. If one rigidly seeks to treat spasm merely as spasm, I do not know what spasm truly is. Spasm is a disease name, just as headache is a disease name. A skilled practitioner of headaches will always inquire about the cause of the headache, because headaches can be caused by Cold-Damage, Wind-Injury, Summer-Heat, Heat, Dampness, Dryness, Phlegm-Jue, Yang Deficiency, Yin Deficiency, trauma, Heart Fire intending to form abscesses, Liver Wind moving internally and ascending along the Shaoyang Gallbladder collateral causing lateral headache, or Zhen Tou Tong (True Headache) which causes death from morning to evening. If one does not ask for the cause of the disease, and simply treats all headaches with Qiang Huo (Notopterygii Rhizoma) and Gao Ben (Ligustici Rhizoma et Radix) as contemporary practitioners often do, how can the headache ever be cured! How much more difficult is it to treat spasm?