凡烦躁而好啼哭。及闷乱不眠，谵语发狂发惊者，此痘家之常候。《经》曰∶诸痛
痒疮疡，皆属心火，盖热毒蕴于心舍而不得发越也，治宜大加发痘，痘出而兼解毒凉
血。如热盛而欲发惊搐者，更当利其小便以导之。如在成浆之后者，非因余毒，则是阴
虚也，治法不外解毒滋阴三者而已。
凡惊搐而在痘未出之时，则是毒火上逼，神魂为之不安，不能自主，而乃目睛上
窜，惊叫暴厥，有如惊风之状，此乃欲出之后，治宜表痘而兼泻肝，利水。泻肝则风
去，利水则热除，风热既退，则痘出而惊自愈矣。切不可妄投凉剂，盖心主一凉，气血
随敛，毒邪内蓄而反危矣。若痘既见而有此者，是热毒未解，尚宜疏通血脉，使毒尽泄
于外，而惊自平。若一失治，惊久不已，中虚毒伏，变为坏症，务审气虚血虚而调之。
血虚者，和其血，气虚者，壮其中，佐以姜桂鼓舞之药，则气血得力，自能逐毒出表。
若徒以毒药攻击，即药力无中气以运用，亦将行而复止，欲出外而缩入矣。更有胃弱而
致饮食不化，大便酸臭，秘泻不调，吐利腹痛，潮热往来，面黄发搐者，谓之食厥，泻
者消导之，秘者微下之，至如痘后惊搐者，恶症也。盖至靥后，则热毒当解，百病自
散。如反发惊者，则心气已绝，神无所根据，多不可治。
夫挟热吐泻，不可投燥药，伤寒身热，不可投凉药，痘疹发搐，不可投惊药，《经》
虽曰∶诸风掉眩，皆属肝木，然痘出之始，虽有四脏，心实主之，心火热甚，则肺金受
克，不能制伏肝木。是以热则生风，风火相搏，神气不安，故发惊搐。然何以别其痘疮
之发搐也？此必发搐而口无痰潮，不恶风而惟恶热，兼有腹痛眼涩，心悸烦燥呕吐，唇
红颊赤，发渴耳冷足冷，脉数舌白等症。凡遇此等症候，切不可投镇惊凉心之药，否
则，心主一凉，痘无自而出矣。故其治法当专以发痘为主，少佐平肝利水为要，肝平则
风息，水利则心清，风火既定而痘出，惊搐自愈矣。然痘先惊者多吉，以痘出惊止，无
余事也。痘后惊者多凶，以气血虚弱，神无所根据也。然其治法而又专理其脾土，何也？
以其脾土虚弱，不能当肝木所克，此非肝水之本病。譬如土薄而上有大木，不能乘载，
故无风而自动，栽培者当浓填其土，使根深本固而自无风邪之害也。然有脾土实火太旺
而逆乘者；有肝经血虚，是以火动生风者，并当养血而风自灭也。然书云惊痘为美者，
以痘从心经，自内达外，其候以惊耳，非谓外受惊触而痘者，自外伤内反为美也。
凡是出现烦躁、喜欢啼哭，以及心中烦闷扰乱、无法入睡、说胡话、发狂或受惊的人，这是痘疹患者常见的症状。《黄帝内经》说：“各种疼痛、瘙痒、疮疡，都属于心火”，这是因为热毒蕴结在心之宫舍而不能发散出去，治疗应当大力促使痘疹发出，在出痘的同时配合解毒凉血。如果热势旺盛且想要引发惊厥抽搐，更应当通利小便以引导热邪下行。如果在痘疹进入化脓阶段之后出现这种情况，如果不是因为余留的毒邪，那就是阴虚所致，治疗方法不外乎解毒和滋阴这两方面而已。
凡是惊厥抽搐发生在痘疹尚未发出的时候，这是由于毒火向上逼迫，导致神魂不安，不能自主控制，从而出现眼球上翻、惊叫甚至突然昏厥，看起来像惊风的症状。这属于痘疹欲出未出阶段的病症，治疗应当以透发痘疹为主，兼以清泻肝火、通利小便。清泻肝火则风邪自去，通利小便则热邪自除，风热既已消退，痘疹发出后惊厥自然痊愈。切不可胡乱投用寒凉药物，因为心主血脉，一旦使用寒凉药，气血就会随之收敛，导致毒邪内陷蓄积，反而造成危险。如果痘疹已经显现却仍有此症状，说明热毒尚未解除，仍宜疏通血脉，使毒邪完全从体表泄出，惊厥自然平息。如果一旦延误治疗，惊厥经久不愈，导致中气虚弱而毒邪潜伏，变成坏证，务必审察是气虚还是血虚来进行调理。血虚的，调和其血液；气虚的，补壮其中气，辅以生姜、肉桂等鼓舞阳气的药物，那么气血得力，自然能驱逐毒邪透出体表。如果仅仅用猛烈的毒药攻击，即使药力没有中气来运化，也会运行一段后又停止，想要向外发散却又退缩回去。更有因胃气虚弱导致饮食不消化，大便酸臭，便秘与腹泻交替，呕吐腹泻腹痛，潮热往来，面色发黄并发生抽搐的，称为“食厥”。对于腹泻的，用消食导滞的方法治疗；对于便秘的，用轻微攻下的方法治疗。至于痘疹痊愈后出现的惊厥抽搐，属于恶症。因为痘疹结痂后，热毒应当解除，百病自然消散。如果反而发生惊厥，说明心气已经衰竭，神无所依附，大多不可治愈。
伴有热象的呕吐腹泻，不可投用燥烈药物；伤寒身热，不可投用寒凉药物；痘疹发搐，不可投用镇惊药物。《黄帝内经》虽然说道：“各种风病引起的摇动眩晕，都归属于肝木”，然而痘疹初起之时，虽然涉及四脏，但主要由心所主。心火过旺，则会克制肺金，导致肺金不能制约肝木。因此热极生风，风火相搏，神气不安，所以发生惊厥抽搐。那么如何辨别这是痘疮引发的抽搐呢？这种抽搐必定伴随口中无痰鸣音，不恶风而只恶热，兼有腹痛、眼涩、心悸、烦躁、呕吐，嘴唇红、脸颊赤，口渴、耳朵冷、脚冷，脉数、舌苔白等症状。凡遇到这些症候，切不可投用镇惊清心的药物，否则，心主一遇寒凉，痘疹就无法自行发出了。所以其治疗方法应当专门以透发痘疹为主，少量辅以平肝利水的药物作为关键。肝气平和则风息止，水道通利则心火清，风火既定而痘疹发出，惊厥抽搐自然痊愈。然而，先出痘后惊厥的多为吉兆，因为痘出而惊止，没有其他问题了。痘后惊厥的多为凶兆，因为气血虚弱，神无所依附。但是其治疗方法又专门调理脾土，为什么呢？因为脾土虚弱，不能抵御肝木的克制，这并不是肝水本身的疾病。譬如土壤浅薄而上有大树，无法承载，所以没有风也自动摇晃，栽培者应当加厚填充土壤，使根深本固，自然就没有风邪的危害了。然而也有脾土实火太旺而逆克肝木的情况；也有肝经血虚，导致火动生风的情况，这些都应当养血，风邪自然熄灭。然而书上说“惊痘”是美症（好现象），是因为痘疹发自心经，由内达外，其征象表现为惊悸，并非指外受惊吓而导致长痘，如果是外伤内感反而认为是美症就不对了。
Whenever there is irritability, a preference for crying, mental restlessness, insomnia, delirium, mania, or fright, these are common manifestations in patients with smallpox (Xiaozhen). The *Classic* states: "All pain, itching, sores, and ulcers belong to Heart Fire." This is because heat-toxin accumulates in the Heart's residence and cannot be vented. Treatment should focus on vigorously promoting the eruption of the rash, accompanied by clearing heat-toxin and cooling the blood. If the heat is excessive and prone to induce convulsions, one must further promote urination to guide the pathogenic factors downward. If this occurs after the pustule stage, it is either due to residual toxins or Yin deficiency; the treatment methods do not go beyond resolving toxins and nourishing Yin.
When convulsions occur before the rash has erupted, it is due to toxic fire forcing upward, causing the Shen (Spirit) to be unsettled and unable to control itself, resulting in upward deviation of the eyes, screaming, sudden syncope, resembling wind-stroke. This belongs to the stage where the rash is about to erupt. Treatment should prioritize releasing the rash while simultaneously draining Liver fire and promoting urination. Draining Liver fire eliminates wind; promoting urination removes heat. Once wind-heat recedes, the rash erupts, and convulsions heal spontaneously. One must absolutely avoid recklessly administering cold/cooling agents. Since the Heart governs the vessels, if coldness is introduced, Qi and Blood will contract, causing toxin and evil to accumulate internally, leading to danger. If these symptoms persist after the rash has appeared, it indicates that heat-toxin has not yet resolved. One should still unblock the blood vessels to allow the toxin to be fully excreted externally, at which point convulsions will naturally subside. If treatment is delayed, prolonged convulsions lead to Spleen/Stomach deficiency with latent toxins, becoming a disastrous syndrome. One must carefully assess whether it is Qi deficiency or Blood deficiency and regulate accordingly. For Blood deficiency, harmonize the Blood; for Qi deficiency, strengthen the Middle Jiao. Assist with ginger and cinnamon to encourage Yang. When Qi and Blood are strengthened, they can naturally drive the toxin out to the exterior. If one merely uses harsh drugs to attack, without the transformation power of Zhong Qi (Middle Qi), the drug's action will stop midway, wanting to go out but retreating inward. Furthermore, if weak Stomach Qi leads to undigested food, sour-smelling stool, alternating constipation and diarrhea, vomiting, diarrhea, abdominal pain, tidal fever, yellow complexion, and convulsions, this is called Food Syncope (Shi Jue). For diarrhea, use digestion-promoting methods; for constipation, use mild purgation. As for convulsions occurring after the resolution of smallpox, this is an ominous sign. After the scabs fall off, heat-toxin should have resolved, and all diseases should dissipate. If convulsions recur, it means Heart Qi has exhausted, and the Shen has no foundation; such cases are mostly incurable.
For vomiting and diarrhea accompanied by heat, dry/hot drugs should not be administered. For body heat due to Cold Damage (Shanghan), cold/cool drugs should not be administered. For convulsions due to smallpox/rash, anti-convulsant drugs should not be administered. Although the *Classic* states: "All wind disorders involving tremors and dizziness belong to Liver Wood," at the beginning of smallpox eruption, although all four Zang organs are involved, the Heart is primarily responsible. Excessive Heart Fire overacts on Lung Metal, preventing Lung Metal from controlling Liver Wood. Thus, extreme heat generates wind; wind and fire struggle, unsettling the Shen and Qi, causing convulsions. How then to distinguish convulsions caused by smallpox? These convulsions must present without phlegm-rattling in the mouth, aversion to cold replaced by aversion to heat, accompanied by abdominal pain, dry eyes, palpitations, irritability, vomiting, red lips, flushed cheeks, thirst, cold ears, cold feet, rapid pulse, and white tongue coating. In such cases, one must absolutely avoid administering calming-the-Shen and cooling-the-Heart drugs. Otherwise, if the Heart encounters coldness, the rash will fail to erupt spontaneously. Therefore, the treatment method should focus primarily on releasing the rash, with minor assistance from soothing the Liver and promoting urination as key. Soothing the Liver stops wind; promoting urination clears the Heart. Once wind and fire are settled and the rash erupts, convulsions heal spontaneously. However, convulsions preceding the rash are generally auspicious, as the rash erupts and convulsions cease, leaving no other issues. Convulsions following the rash are generally inauspicious, due to weakness of Qi and Blood and lack of foundation for the Shen. Yet, the treatment method focuses specifically on regulating the Spleen Earth. Why? Because weak Spleen Earth cannot withstand the overacting Liver Wood; this is not the primary disease of Liver Water. It is like thin soil supporting a large tree; unable to bear the weight, it shakes even without wind. The cultivator must thicken the soil so that the roots become deep and the base solid, eliminating the harm of wind pathogens. However, there are cases of excessive Spleen Earth excess-fire overacting inversely; and cases of Liver Meridian Blood deficiency causing fire movement and wind generation. In both, nourishing Blood extinguishes wind. Books state that "convulsive smallpox" is a favorable condition because the rash originates from the Heart Meridian, moving from interior to exterior, manifesting as fright. This does not mean that external fright inducing smallpox is favorable; rather, internal origin manifesting externally is what is considered favorable.