痉、厥、癫、痫四者，皆有猝倒无知之证，而病名各异者，其病机、病体有不同也。痉
之病
成于燥也，属于太阳，故项背必强，甚者角弓而反张矣。此筋病也。《内经》、仲景谓痉属
于湿者，推其原也。无论湿寒、湿热，必化燥而后痉，是津液凝结也。厥亦有寒热之分，而
身不强，是卫气逆乱之病也，病在脉外，皆属于实。其虚而厥者，直脱而已。虽曰有寒、有
热，究竟统归于热，但有外寒逼热而然者，总是荣气消耗，卫气无所系恋，而奔逸迫塞于心
包也。癫无寒热之分，而有久暴之别，是营气窒闭之病也，病在脉中 。经曰心营肺卫，又
心主知觉。心包络之脉，为痰血所阻塞，则心之机神停滞而无知矣。是营气壅实，而卫气力
不足以推荡之，蓄积以致此也。又心与小肠脉络相通，小肠脉中有凝痰瘀血，阻窒心气，亦
发为癫也。厥之病，气实而血虚；癫之病，血实而气虚。其邪皆实，其正皆虚。若夫痫者，
由于血热，发于肝风，手足抽掣，五兽同鸣。昔人以五兽分五脏，而总归于肝者，肝藏血，
热生风，风性动也。此脏病外连经络，盖气血俱实者也，而其本必由于寒。钱仲阳以小儿急
、慢惊风，为阴阳痫，乃别一证，名同而实异也。急惊由于肝热生风化燥，其证尚介痫 、
痉之间。其异乎痉者，手足拘挛，而不必反张；异乎痫者，手足抽掣，而绝无兽鸣也。慢惊
则全属脾脏阴阳两虚，故阴邪内拒，虚阳上迫，气机乍窒，卒然无知也。虚则易脱，故称难
治。方中行作《痉书》，以小儿惊风属之，亦只可指为痉之类，不可径指为此即是痉也。《
千金方》曰∶温病热入肾中，亦为痉；小儿病痫热甚，亦为痉。其意是以痫为惊风，而以痉
专属之拘挛缩急之证也。
《金匮》云∶奔豚病，从少腹起，上冲咽喉，发作欲死，复还止，此从惊恐得之。《素
问》
曰∶人有生而病癫者，此得之在母腹中时，有所大惊，气上而不下，精气并居，故令子发为
癫也。是奔豚与癫，皆生于惊。《金匮》遍论杂病，而无癫痫，窃疑奔豚即痫也。痫作猪声
者最多，豕水蓄，属肾，奔豚发于肾也。《千金方》第十四卷风眩门，小续命汤方前引徐嗣
伯曰∶痰热相感而动风，风心相乱则闷瞀，故谓之风眩。大人曰癫，小儿为痫，其实是一，
此方为治，万无不愈。而奔豚为患，发多气急，死不可救。故此一汤，是轻重之宜。观此，
是以奔豚为癫痫之重者。私尝论之，痉、厥，暴病也，其因皆津耗血干而气悍，脉管迫塞之
所致也。治之重以凉润生津，辛香泄气，而佐以行血豁痰之品，病可即愈矣。癫、痫、痼疾
也，有得寒即发者，有得怒、得劳即发者，其机不外《内经》气上不下之一语。其所以不下
之故，必由寒湿从下上犯，从胫足腰髀之经脉内侵弥漫，先使肾阳不得下通，邪气渐渐入于
脊膂，上逼心胃，阳气不得下降，故癫痫之人，即未发病，目多不能下视，两 足行动隐隐
不便，肾丸时或隐痛，如 疝之状，二便不能调畅。推此以求治法，必须用辛温，如细辛、
羌活、 本、威灵仙、生附子、吴茱萸、小茴香以通经脉之寒；而以牛膝抑之下行，更以破
血，如虻虫、 虫、蛴螬、延胡索、五灵脂、当归须、穿山甲、 砂、雄黄、枯矾温化之品
，以通小肠膂脊血脉之瘀，而以二丑导之下出。作为丸散，缓服久服，庶可渐瘳。又有寒湿
自肺胃扑灭心阳，使心气乍抑而熄，昏厥如死者，此寒湿伤于脑气，所谓阳中雾露之邪也。
与中寒相类，用辛温发散，使水气从上扬出，与寒湿从下上逆者不同。此多见于暴病，而痼
疾亦间有之。其人常俯视不抑，目胞下垂如睡，面色自额至颧深黑者是也。夫天下病，有热
而不可清，虚而不可补者，其惟癫痫乎!
痉、厥、癫、痫四种病证，都有突然昏倒、意识丧失的表现，但病名各不相同，这是因为它们的发病机制和病变部位有所不同。
痉病（以项背强直、角弓反张为特征的病证）是由于燥邪所致，归属于太阳经（足太阳膀胱经），所以必然出现项背部僵硬，严重的会出现角弓反张。这是筋脉的病变。《内经》和张仲景认为痉病属于湿邪，是追溯其本源而言的。无论是湿寒还是湿热，必须转化为燥邪后才会发生痉病，这是因为津液凝结所致。
厥病（以突然昏倒、不省人事为主要表现的病证）也有寒热之分，但身体不会僵硬，这是卫气逆乱引起的疾病，病变在脉外，都属于实证。如果是虚证导致的厥，则是正气直接脱失罢了。虽然说有寒有热，但最终统归于热，有的是外寒逼迫内热所致，总是因为营气消耗，卫气无所依附留恋，而奔逸迫塞于心包络（心之外围，代心行令）。
癫病（精神抑郁、沉默痴呆的精神失常病证）没有寒热之分，但有病程久暂的区别，这是营气窒闭的疾病，病变在脉中。经文说“心主营，肺主卫”，又说“心主知觉”。如果心包络的经脉被痰浊和瘀血阻塞，那么心的机神就会停滞而导致无知。这是营气壅滞实盛，而卫气力量不足以推动消散它，蓄积日久导致此病。另外，心与小肠的脉络相通，小肠脉中有凝滞的痰浊和瘀血，阻遏心气，也会引发癫病。
厥病的病机是气实而血虚；癫病的病机是血实而气虚。它们的邪气都是实的，正气都是虚的。至于痫病（以突然昏倒、四肢抽搐、口吐白沫、发出怪叫为特征的神志异常病证），是由于血热，发作于肝风，表现为手足抽搐，同时发出五种动物的叫声。古人将五种动物叫声对应五脏，但最终归结于肝，是因为肝藏血，热极生风，风性主动。这是脏腑病变外连经络，气血都实盛的病证，但其根本原因必定源于寒。钱乙（字仲阳）将小儿急惊风和慢惊风称为阴阳痫，那是另一种证候，名称相同但实质不同。急惊风是由于肝热生风化燥，其症状介于痫病和痉病之间。与痉病不同的是，手足拘挛但不一定角弓反张；与痫病不同的是，手足抽搐但完全没有动物叫声。慢惊风则完全属于脾脏阴阳两虚，所以阴邪在内抗拒，虚阳在上逼迫，气机突然窒塞，突然失去意识。虚证容易脱失，所以称为难治。方中行撰写了《痉书》，将小儿惊风归入其中，这也只能说是痉病的类似证，不能直接指认这就是痉病。《千金方》说：温病热邪深入肾中，也会引起痉病；小儿患痫病热势严重时，也会引起痉病。它的意思是将痫病视为惊风，而将痉病专门归属于拘挛缩急的病证。
《金匮要略》说：奔豚病（一种自觉气从少腹上冲胸咽的病症），从少腹发起，向上冲到咽喉，发作时痛苦欲死，过后又停止，这是从惊恐情绪中获得的。《素问》说：有人生来就患有癫病，这是因为在母腹中时，受到极大惊吓，气机上逆而不能下行，精气并聚，所以导致孩子出生后发为癫病。这样看来，奔豚和癫病，都是由惊恐引起的。《金匮要略》广泛论述杂病，却没有提到癫痫，我私下怀疑奔豚就是痫病。痫病发作时发出猪叫声的最多，豕（猪）与水蓄积有关，归属于肾，奔豚也是发于肾。《千金方》第十四卷风眩门，小续命汤方前引用徐嗣伯的话说：痰热相互感应而动风，风与心相乱则胸闷昏蒙，所以称为风眩。成人称为癫，小儿称为痫，其实是一样的，用这个方子治疗，没有不愈的。而奔豚为害，发作时多伴有气急，死亡不可挽救。所以这一个方子，体现了轻重适宜的治疗原则。由此看来，是将奔豚视为癫痫的重症。
我私下议论：痉病、厥病，是急性暴发的疾病，其原因都是津液耗损、血液干枯而气机悍烈，导致脉管迫塞所致。治疗时用重剂凉润生津，辛香泄气，并辅以活血豁痰的药物，病就可以立即痊愈。癫病、痫病，是顽固性疾病，有的遇寒即发，有的遇怒或劳累即发，其机理不外乎《内经》所说的“气上不下”这一句话。之所以气不下行，必定是由寒湿从下向上侵犯，从胫足腰髀的经脉内部侵入弥漫，先使肾阳不能向下通达，邪气渐渐进入脊膂，向上逼迫心胃，阳气不能下降，所以癫痫患者，即使未发病，眼睛也多不能向下看，两脚行动隐隐不便，睾丸有时隐痛，像疝气的样子，大小便不能调畅。推究此理以求治疗方法，必须使用辛温药物，如细辛、羌活、藁本、威灵仙、生附子、吴茱萸、小茴香来通经脉之寒；并用牛膝引药下行，更用破血药物，如虻虫、水蛭、蛴螬、延胡索、五灵脂、当归须、穿山甲、砂仁、雄黄、枯矾等温化之品，来通小肠及脊膂血脉之瘀，并用牵牛子（二丑）引导瘀血从大便排出。制成丸散，缓慢服用、长期服用，才可以逐渐痊愈。又有寒湿从肺胃扑灭心阳，使心气突然抑制而熄灭，昏厥如同死人一样，这是寒湿损伤脑气，所谓阳中雾露之邪。这与中寒相似，用辛温发散的方法，使水气从上扬出，这与寒湿从下上逆的情况不同。这种情况多见于急性病，而顽固性疾病中也偶尔有之。这类病人常低头俯视而不仰视，眼睑下垂如同睡觉，面色从额头到颧骨深黑。天下的病，有热而不可清解，有虚而不可补益的，大概只有癫痫了吧！
Jing (Spasm), Jue (Syncope/Fainting), Dian (Manic-Depressive Psychosis/Depression-type Schizophrenia), and Xian (Epilepsy) are four conditions that all present with sudden collapse and loss of consciousness. However, their disease names differ because their pathogenesis and pathological locations vary.
Jing (Spasm: a condition characterized by stiffness of the neck and back, and opisthotonos) arises from dryness and belongs to the Taiyang (Taiyang Meridian: the Foot-Taiyang Bladder meridian). Therefore, there is inevitably stiffness in the neck and back; in severe cases, opisthotonos occurs. This is a disease of the sinews. The *Neijing* and Zhang Zhongjing attribute Jing to dampness when tracing its origin. Whether it is cold-damp or heat-damp, it must transform into dryness before Jing occurs; this is due to the coagulation of body fluids.
Jue (Syncope/Fainting: a condition characterized by sudden loss of consciousness) can be divided into cold and heat types, but the body does not become stiff. It is a disease caused by the rebellion and disorder of Wei Qi (Defensive Qi), located outside the vessels, and all belong to excess patterns. If Jue is due to deficiency, it is simply a direct collapse of Zheng Qi (Upright Qi). Although there are cold and heat distinctions, ultimately they are unified under heat. Some cases result from external cold forcing internal heat; in all such cases, Ying Qi (Nutritive Qi) is consumed, and Wei Qi has nothing to cling to, leading it to rush and obstruct the Pericardium (the outer covering of the heart, acting on behalf of the heart's functions).
Dian (Manic-Depressive Psychosis/Depression-type Schizophrenia: a mental disorder characterized by depression, silence, and stupidity) has no distinction between cold and heat, but differs in duration (chronic vs. acute). It is a disease of blocked Ying Qi (Nutritive Qi), located within the vessels. The classics state that "the Heart governs Ying Qi, and the Lung governs Wei Qi," and further that "the Heart governs perception." If the meridians of the Pericardium are blocked by phlegm and blood stasis, the spirit and consciousness of the Heart stagnate, resulting in unconsciousness. This is caused by the accumulation and excess of Ying Qi, while the power of Wei Qi is insufficient to push it away, leading to this condition over time. Furthermore, the Heart and Small Intestine are connected by their meridians. If stagnant phlegm and blood stasis exist in the Small Intestine meridians, obstructing Heart Qi, Dian may also occur.
The pathology of Jue is excess Qi and deficient Blood; the pathology of Dian is excess Blood and deficient Qi. In both, the pathogenic factors are excess, and the healthy Qi is deficient. As for Xian (Epilepsy: a paroxysmal disorder characterized by sudden loss of consciousness, convulsions, foaming at the mouth, and abnormal sounds), it arises from blood heat and manifests as Liver Wind. Symptoms include twitching of the hands and feet and the emission of sounds resembling five animals. Ancients associated these five animal sounds with the Five Zang Organs but ultimately attributed them to the Liver, because the Liver stores Blood, heat generates wind, and wind is inherently moving. This is a disease of the Zang organs extending to the collaterals, where both Qi and Blood are excess, yet its root must lie in cold. Qian Zhongyang (Qian Yi) classified pediatric acute and chronic convulsive disorders as Yin and Yang Xian, which is a separate syndrome; although the name is the same, the substance is different. Acute convulsion arises from Liver heat generating wind and drying out fluids; its symptoms lie between Xian and Jing. It differs from Jing in that the limbs are cramped but do not necessarily exhibit opisthotonos; it differs from Xian in that the limbs twitch but absolutely lack the animal sounds. Chronic convulsion entirely belongs to the dual deficiency of Yin and Yang in the Spleen. Thus, Yin pathogens resist internally, and deficient Yang forces upward; Qi mechanisms suddenly obstruct, leading to sudden loss of consciousness. Deficiency makes collapse easy, hence it is called difficult to treat. Fang Zhongxing wrote *Jing Shu* (Book on Spasm), attributing pediatric convulsions to it; this can only be identified as similar to Jing, not directly equated with Jing. The *Qianjin Fang* states: "In warm diseases, if heat enters the Kidney, it also causes Jing; if children suffer from severe heat in Xian, it also causes Jing." Its intent is to regard Xian as convulsive disorder, while reserving Jing specifically for conditions of cramping and tightening.
The *Jingui Yaolue* states: "In Ben Tun (Rushing Pig Disease: a condition characterized by a sensation of gas rushing from the lower abdomen to the throat), qi rises from the lower abdomen, rushes up to the throat, the patient feels like dying during attacks, and then it subsides. This arises from fright and terror." The *Suwen* states: "Some people are born with Dian; this is acquired in the womb when the mother suffers a great fright. Qi moves upward and does not descend; essence and Qi gather together, causing the child to develop Dian." Thus, both Ben Tun and Dian originate from fright. The *Jingui Yaolue* extensively discusses miscellaneous diseases but omits Dian and Xian; I suspect that Ben Tun is actually Xian. Most Xian patients emit pig-like sounds. The pig is associated with water accumulation and belongs to the Kidney; Ben Tun also originates from the Kidney. Volume 14 of the *Qianjin Fang*, in the section on Wind and Vertigo, before the formula for Xiao Xuming Tang, quotes Xu Sibin: "Phlegm and heat interact to generate wind; wind and Heart confuse each other, causing oppression and dizziness, hence it is called Wind Vertigo. In adults, it is called Dian; in children, it is called Xian. In reality, they are one and the same. Using this formula for treatment yields universal cures." However, Ben Tun afflictions often involve急促 breathing during attacks and death is incurable. Therefore, this single formula illustrates the principle of treating severity appropriately. From this, it is inferred that Ben Tun is regarded as a severe form of Dian/Xian.
I have privately discussed this: Jing and Jue are acute, sudden diseases. Their cause is the consumption of fluids and drying of blood, leading to fierce Qi and obstruction of the vessel tubes. Treatment requires heavy doses of cooling and moistening agents to generate fluids, acrid and aromatic agents to dissipate Qi, assisted by blood-invigorating and phlegm-resolving substances, so the disease can be cured quickly. Dian and Xian are stubborn, chronic diseases. They may be triggered by cold, anger, or fatigue. Their mechanism does not exceed the phrase from the *Neijing*: "Qi moves upward and does not descend." The reason for Qi not descending must be due to cold-damp invading from below, penetrating diffusely through the meridians of the shins, feet, waist, and thighs. This first prevents Kidney Yang from descending, allowing pathogens to gradually enter the spine and back, pressing upward against the Heart and Stomach. Yang Qi cannot descend. Therefore, even when Dian/Xian patients are not having an attack, they often cannot look down, their legs move with difficulty, their testicles occasionally ache隐痛ly resembling hernia pain, and urination and defecation are not smooth. Deduced from this, the treatment method must use acrid-warm herbs, such as Xixin (Asari Radix et Rhizoma), Qianghuo (Notopterygii Rhizoma et Radix), Gaoben (Ligustici Rhizoma et Radix), Weilingxian (Syringae Ramulus et Folium), Sheng Fuzi (Aconiti Lateralis Radix Praeparata), Wuzhuyu (Evodiae Fructus), and Xiaohuixiang (Foeniculi Fructus) to unblock cold in the meridians; combined with Niuxi (Achyranthis Bidentatae Radix) to guide downward, and blood-breaking herbs such as Mengchong (Blattidae), Shéngzhéng (Hirudo), Qilao (Scytodidae), Yanhusuo (Corydalis Rhizoma), Wulingzhi (Trogopteri Dung), Dangguixu (Angelicae Sinensis Radix), Chanshanjia (Manis Squama), Sharen (Amomi Fructus Rotundus), Xionghuang (Realgar), and Kufan (Alumen) to warm-transform and unblock blood stasis in the Small Intestine and spinal meridians, assisted by Erchou (Semen Phasi) to guide expulsion downward. Prepared as pills or powders, taken slowly and long-term, gradual recovery may be achieved. There are also cases where cold-damp extinguishes Heart Yang from the Lung and Stomach, causing Heart Qi to suddenly suppress and extinguish, leading to coma resembling death. This is cold-damp injuring Brain Qi, known as "fog and dew pathogens among Yang." It resembles Cold Strike (Zhong Han). Treatment uses acrid-warm dispersants to raise water vapor from above, which differs from cold-damp reversing upward from below. This is mostly seen in acute diseases, but occasionally in chronic ones. Such patients often keep their heads bowed, eyelids droop as if sleeping, and the complexion is deep black from the forehead to the zygomatic arch. Among diseases in the world, there are those with heat that cannot be cleared, and deficiency that cannot be tonified; perhaps only Dian and Xian fit this description!