钱氏曰伤寒男体重面黄女面赤喘急憎寒口中气热呵欠顿闷项急也疮疹则腮赤躁多喷嚏悸
动昏
倦四肢冷伤寒当发散之治疹行温平有大热者解毒余见前说洁古曰凡伤风则皮涩拘急鼻塞 疹
则睡中发惊悸呵欠嚏喷是为易识矣
钱氏曰急惊因闻大声或大惊而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
热面赤引饮口中气热大小便黄赤剧则搐也盖热甚则风生风属肝此阳盛阴虚也故利惊丸主之以
除其痰热不可与巴豆及温药大下之恐搐虚热不消也小儿热痰容于心胃因闻声非常则动而惊搐
矣若热极虽不闻声及惊亦自发搐 慢惊因病后或吐泻脾胃虚损遍身冷口鼻气出亦冷手足时螈
昏睡露睛此无阳也栝蒌汤主之 凡急慢惊阴阳异证切宜辩而治之急惊合凉泻慢惊合温补如不
分别则误甚矣
阎孝忠曰急慢惊风古人无之惟曰阴阳痫阳动而速故阳病曰急惊阴静而缓故阴病曰慢惊此
阴阳
虚实寒热之别治之不可误也急惊犹有热热即生风又或因惊而发则目为连札涎潮搐搦身体口中
气
皆热及其发定或睡起即了了如故此急惊证也当其搐热渐减食与镇心退热药候定以药即下其痰
热心神安宁即愈慢惊得大病之余吐泻之后或误取转泄致脾胃虚损风邪乘之似搐而不甚搐似睡
而不似睡四肢与口中气皆冷睡露睛或胃痛而啼哭如鸦声此则危证脾胃虚损故也
洁古曰急惊阳证也俱腑受病尔小儿客痰热于心膈是少阳相火旺经云热则生风因闻大声而
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
慢惊阴证也俱脏受病尔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
因脾胃虚损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利自止既已失治
则脾肺俱虚致被肝木所乘是为慢惊也当用温补羌活膏
全婴方云惊证因风则目青面红发搐因惊其病在心忽然叫声发搐因食则其证嗳吐气即发搐
皆阳
痫也肺胃经虚则生粘痰痰者肺胃所出也痰则凝滞在于咽喉如牵锯之声时复螈 或因吐泻所致
脾虚则肺亦虚涎痰流溢其证亦然皆阴痫也 身热脉浮精神恍惚或吐或泻不思乳食发搐即是半
阴半阳合病 身凉脉沉精神倦怠不吐不泻又能乳食发搐者亦是半阴半阳合病正如伤寒半是表
半是里也亦有急惊凉泻而不愈或与吐下药太过发为慢惊慢惊温补而不愈变为急惊互相更变者
多矣
按以上诸家所论殆尽证治之要矣但钱云慢惊用栝蒌汤恐传写误耳大抵惊主风木甲木属阳
腑病
故急易治乙木属阴脏病故慢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热夹痰夹食病因不同至风邪内陷入腑
入脏亦与外中风相似故治此者当本钱氏虚实补泻法则不致犯禁之误药有太过不及之失
钱乙说：伤寒的症状是，男孩身体沉重、面色发黄，女孩面色发红、气喘急促、怕冷、口中气息发热、打哈欠、头昏脑胀、项部僵硬。疮疹（麻疹等出疹性疾病）则表现为腮部发红、烦躁不安、多打喷嚏、心悸、昏沉疲倦、四肢发冷。伤寒应当用发散法治疗；疮疹行发期宜用温和平和之法，若有大热者则需解毒。其余详见前文论述。
张元素（洁古）说：凡是伤风，则皮肤干燥拘急、鼻塞；若是疮疹，则在睡眠中发生惊悸、打哈欠、打喷嚏，这是容易识别的区别。
钱乙说：急惊风是因为听到巨大的声响或受到极大惊吓而引发抽搐，发作过后就像正常人一样。这是因为体内无阴（阴虚阳亢），应当以下利惊丸为主治方剂。此证本因心火内生，表现为身体发热、面色红润、想喝水、口中气息发热、大小便黄赤，严重时出现抽搐。大概因为热极生风，风归属于肝，这是阳气盛而阴气虚的表现，所以用利惊丸来清除痰热。不可使用巴豆及温热药物强力攻下，否则恐导致抽搐不止、虚热难消。小儿的热痰留滞于心胃，一旦听到不寻常的声音就会触动而引发惊搐。如果热势极盛，即使没有听到声音或受到惊吓，也会自发抽搐。
慢惊风是由于大病之后，或者呕吐腹泻导致脾胃虚损，表现为全身冰冷、口鼻呼出的气息也冷、手足时而抽搐、昏睡且眼睛半睁（露睛）。这是因为体内无阳（阳气衰微），应当以栝蒌汤为主治方剂。
凡是急惊风和慢惊风，属于阴阳不同的证候，务必辨别清楚再进行治疗。急惊风适合凉泻法，慢惊风适合温补法。如果不加区分，错误就大了。
阎孝忠说：古代并没有“急慢惊风”这一名称，只称为“阴阳痫”。阳气主动且迅速，所以阳病称为急惊；阴气主静且缓慢，所以阴病称为慢惊。这是阴阳、虚实、寒热的区别，治疗时不可搞错。急惊风尚有热象，热即生风，又或因惊吓而发作，表现为眼球转动频繁（连札）、唾液涌潮、抽搐强直，身体和口中气息皆热。等到发作停止或睡醒后，神志立刻清醒如常，这就是急惊风的证候。在抽搐时，待热势稍减，给予镇心退热的药物；待症状稳定后，再用药物祛除痰热，心神安宁即可痊愈。慢惊风是在大病之后、呕吐腹泻之后，或者误用催吐泻下药物导致脾胃虚损，风邪乘虚而入。表现为似有抽搐但不严重，似在睡觉但非熟睡，四肢和口中气息皆冷，睡觉时眼睛半睁，或者因胃痛而啼哭，哭声像乌鸦叫。这是危重证候，原因是脾胃虚损。
张元素（洁古）说：急惊风属于阳证，都是腑受病。小儿客痰热在心膈部位，这是少阳相火旺盛。《内经》说“热则生风”，因为听到巨大声响而发作。这好比东方震卦得火气而引发抽搐，火本来不动，得风才动。应当用利惊丸、导赤散、泻青丸、地黄丸为主治方剂。抽搐停止后服用安神丸。
慢惊风属于阴证，都是脏受病。小儿因呕吐腹泻病程长久，脾胃虚损，若不早期治疗则会形成慢惊风，名为“螈”（指肢体抽动），似有抽搐但不严重。因为脾胃虚损，所以大便不成形。应当先去除脾间的风邪，先用宣风散疏导，随后用使君子丸、益黄散，则腹泻自然停止。如果已经延误治疗，则脾肺俱虚，导致被肝木所克制，这就是慢惊风。应当用温补法，如羌活膏。
《全婴方》说：惊证如果是因风引起，则目色发青、面色发红、发生抽搐；如果是因惊引起，病位在心，忽然叫声大作并发生抽搐；如果是因食积引起，则表现为嗳气呕吐，气息上逆即发生抽搐。这些都属于阳痫。肺胃经虚弱则产生粘痰，痰是由肺胃产生的。痰液凝滞在于咽喉，发出像拉锯一样的声音，时常发生抽搐。或者是因呕吐腹泻所致，脾虚则肺亦虚，涎痰流溢，证候也是如此，这些都属于阴痫。
身体发热、脉浮、精神恍惚，或者呕吐或者腹泻、不思乳食、发生抽搐的，即是半阴半阳合病。身体凉爽、脉沉、精神倦怠、不吐不泻、能吃乳食、发生抽搐的，也是半阴半阳合病。正如伤寒病既有表证又有里证一样。也有急惊风用凉泻法治疗却不愈，或者因使用吐下药太过而转变为慢惊风；慢惊风用温补法治疗却不愈，反而变为急惊风。这种互相转换的情况很多。
按语：以上各家论述几乎涵盖了证治的要领。但钱乙说慢惊风用栝蒌汤，恐怕是传抄错误。大抵惊风主于风木，甲木属阳，为腑病，所以急惊易治；乙木属阴，为脏病，所以慢惊难治。如大人惊恐后即腹泻，是因为甲木克制戊土。何况小儿五脏之气未充实，神气未完备，容易自生病患。证候如果不是在大病后及呕吐腹泻导致脾胃虚损的情况下得的，其中有的夹杂火、热、痰、食，病因不同。至于风邪内陷入腑入脏，也与外感中风相似。所以治疗此病的人，应当遵循钱氏的虚实补泻法则，才不会犯禁忌的错误，避免药物太过或不及的失误。
Qian Yi said: The symptoms of Shanghan (Cold Damage) are, in boys, heavy body and yellowish complexion; in girls, red face, panting and urgency, aversion to cold, hot breath from the mouth, yawning, dizziness and stuffiness, and stiffness of the neck. For Chu Zhen (exanthematous diseases such as measles), the cheeks are red, there is irritability, frequent sneezing, palpitations, drowsiness and fatigue, and cold limbs. Shanghan should be treated with dispersing methods; during the eruption phase of Chu Zhen, mild and neutral methods should be used, and if there is high fever, detoxification is required. See previous discussions for details.
Zhang Yuansu (Jiegu) said: In cases of Wind Injury (Shang Feng), the skin is dry and tense with nasal congestion; whereas in Chu Zhen, there are palpitations, yawning, and sneezing during sleep, which makes it easy to distinguish.
Qian Yi said: Ji Jing (Acute Convulsion) is triggered by loud noises or severe fright, leading to convulsions. After the episode, the child returns to normal. This is due to Yin deficiency (with Yang hyperactivity). It should be primarily treated with Lijing Wan (Purgative Convulsion Pill). This condition originates from Heart Fire generating internally, manifesting as body heat, ruddy complexion, thirst, hot breath, yellow and reddish urine and stool, and convulsions when severe. Generally, extreme heat generates Wind, and Wind belongs to the Liver; this represents excess Yang and deficient Yin. Therefore, Lijing Wan is used to eliminate phlegm-heat. One must not use Euphorbiae Pekinensis Radix (Badou) or warm purgatives for strong evacuation, lest the convulsions persist and the deficiency-heat fail to dissipate. When pediatric phlegm-heat lodges in the Heart and Stomach, hearing unusual sounds can trigger fright and convulsions. If the heat is extreme, convulsions may occur spontaneously even without sound or fright.
Man Jing (Chronic Convulsion) occurs after serious illness or following vomiting and diarrhea that damage the Spleen and Stomach. Symptoms include coldness of the entire body, cold breath from the mouth and nose, intermittent twitching of hands and feet, lethargy, and eyes half-open while sleeping (Lu Jing). This indicates Yang deficiency (deficiency of Yang Qi). It should be primarily treated with Gualou Tang (Trichosanthes Decoction).
One must carefully differentiate between Ji Jing and Man Jing, as they represent different Yin and Yang patterns, and treatment must follow this distinction. Ji Jing requires cooling and purging methods, while Man Jing requires warming and tonifying methods. Failure to distinguish them leads to significant errors.
Yan Xiaozhong said: Ancient texts did not use the terms "Acute/Chronic Convulsion" but referred to them as "Yin/Yang Epilepsy." Yang moves quickly, so Yang diseases are called Acute Convulsion; Yin is still and slow, so Yin diseases are called Chronic Convulsion. These reflect differences in Yin/Yang, Deficiency/Excess, and Cold/Heat. Treatment must not be mistaken. Acute Convulsion involves heat, which generates Wind, often triggered by fright. Symptoms include rapid eye movements, salivary flooding, convulsions and spasms, and heat in the body and breath. Once the attack subsides or upon waking, the child becomes lucid and normal, characterizing Acute Convulsion. During the convulsion, when heat slightly decreases, administer heart-calming and heat-reducing medicines. Once stabilized, use medicines to drain phlegm-heat; when the Spirit (Shen) is calm, recovery ensues. Chronic Convulsion follows serious illness, vomiting, diarrhea, or excessive use of emetics/purgatives causing Spleen-Stomach deficiency, allowing Wind pathogens to invade. Symptoms include mild twitching rather than severe convulsions, light sleep rather than deep slumber, cold limbs and breath, eyes half-open during sleep, or crying like a crow due to stomach pain. This is a critical condition caused by Spleen-Stomach deficiency.
Zhang Yuansu (Jiegu) said: Acute Convulsion is a Yang pattern involving the Fu organs. Pediatric guest phlegm-heat lodges in the Chest and Diaphragm, indicating hyperactivity of Shaoyang Ministerial Fire. As the Classic states, "Heat generates Wind," triggered by loud noise. This is akin to the East (Zhen Trigram) receiving Fire energy to cause convulsions; Fire does not move on its own but moves with Wind. Treat with Lijing Wan, Daochi San, Xieqing Wan, and Dihuang Wan. After convulsions stop, administer Anshen Wan.
Chronic Convulsion is a Yin pattern involving the Zang organs. Prolonged vomiting and diarrhea in children damage the Spleen and Stomach. If not treated early, it becomes Chronic Convulsion, named "Yu" (twitching), characterized by mild convulsions. Due to Spleen-Stomach deficiency, stools are unformed. First, remove Wind from the Spleen using Xuanfeng San for guidance/drainage, followed by Shijunzi Wan and Yihuang San to stop diarrhea. If treatment is delayed, both Spleen and Lung become deficient, allowing Liver Wood to overact upon them, resulting in Chronic Convulsion. Treat with warming and tonifying methods, such as Qianghuo Gao.
The *Quan Ying Fang* states: Convulsions due to Wind present with blue-green eyes, red face, and convulsions; those due to Fright involve the Heart, sudden crying, and convulsions; those due to Food Stagnation present with belching and vomiting, with convulsions upon qi rebellion. These are all Yang Epilepsy. Deficiency of Lung and Stomach meridians generates sticky phlegm, which accumulates in the throat, producing a sawing sound and occasional twitching. Alternatively, caused by vomiting/diarrhea, Spleen deficiency leads to Lung deficiency, causing saliva and phlegm to overflow, presenting similarly. These are all Yin Epilepsy.
Body heat, floating pulse, absent-mindedness, vomiting or diarrhea, anorexia, and convulsions constitute a Half-Yin Half-Yang combined pattern. Cool body, deep pulse, lethargy, no vomiting/diarrhea, ability to feed, and convulsions also constitute a Half-Yin Half-Yang combined pattern, similar to Shanghan having both Exterior and Interior aspects. Acute Convulsion may fail to respond to cooling/purging and transform into Chronic Convulsion due to excessive emetic/purgative use; Chronic Convulsion may transform into Acute Convulsion if warming/tonifying fails. Such mutual transformations are common.
Note: The above discussions cover the essentials of syndrome differentiation and treatment. However, Qian's recommendation of Gualou Tang for Chronic Convulsion is likely a transcription error. Generally, Convulsion is governed by Wind-Wood. Jia Wood belongs to Yang and Fu diseases, making Acute Convulsion easier to treat; Yi Wood belongs to Yin and Zang diseases, making Chronic Convulsion difficult to treat. For instance, fright-induced diarrhea in adults occurs because Jia Wood controls Wu Earth. Moreover, children's Five Zang Qi are not yet solid, and their Shen Qi is incomplete, making them prone to self-generated disease. Unless the condition arises post-serious illness or post-vomiting/diarrhea with Spleen-Stomach deficiency, it may involve夹杂着 Fire, Heat, Phlegm, or Food. When Wind pathogens penetrate inward into Fu or Zang organs, it resembles external Wind-Stroke. Therefore, practitioners should follow Qian's principles of tonifying deficiency and purging excess to avoid contraindications and errors of excess or insufficiency in medication.