古人谓先发惊而后发痘者。是热在痘而不在心。为顺。先发痘而后发惊。是热在心而不在痘。
为逆。然有因风邪所激而发者。有因脾气虚弱而发者。不可不辨。若正当灌浆之时。忽手足摇动惊
搐者。肝热生风。风火相搏生痰也。治当平肝木利小便为要。泻肝则风去。利小便则热除。先与导
赤散、泻青丸。次以四圣散加人参、钩藤。若手足螈 。口眼 斜。涎盛语涩。腰项强急。口张
舌强者。此火盛耗金。木无所制而风生。消风散加蝎尾、钩藤。痰盛。加元明粉。若浑身冰冷。不
知人事者。不治。若发搐至口噤流涎。此脾胃受虚风。或误服凉惊之药所致。谓之痘风。急当清
火养血。卒多莫救。若痘初出时无惊搐。收靥时忽然发搐。如角弓反张。直视流涎者。此毒火传
心。移热于肝。木来乘土。气血但虚。最凶之兆。惟痘疹将出。先发惊搐者多吉。然发一二次即
止而见点者。其痘必稀。发十数次而报点者必密。报痘一二日而惊搐不止多重。虽曰痘前搐者吉。
若发之不止。为毒伏于里。未可以言吉也。 安世曰。大抵痘前发搐。责在热盛。痘后发搐。责
在正虚。昔余治一五岁儿。放标时忽发惊搐。痰涎壅盛。壮热不省。忝在同道。不忍坐视。先与
西黄厘许。点舌上。遂用硝、黄、芩、连。佐以荆、翘、大力之类下之。一服神清热缓。痘亦随
起。反掌收功。近于都门疗正黄旗四川道监察御史讳粹然李公之孙。年四岁。痂后忽发惊搐。诸
方皆谓莫救。亟邀予往。诊其六脉虚数无力。手足时发拘挛。口眼 僻。唇燥囊缩。溲便涩难。
证虽危殆。以举家恳救甚切。因思痘后发搐。多缘气血两亏。土衰木贼。虚风
内动所致。法当温养肝脾。峻补气血。使正气有权。虚风得以自息。若治其惊。是速其毙也。为
疏一方。以十全大补桂用枝。日进二服。搐遂稍定。又二服。二便自通。囊亦少纵。目睛转动。
诸证向安。但头发毒数处。其色亦不甚赤。于前方中去芍、地加白芷、忍冬、贝母。三日后毒亦
消散。声音清朗。饮食如常。惟左臂与左足不能举动。更于原方加牛膝倍当归。四剂便能步履。
独手腕无力。仍以牛膝易桂枝。先后不逾一方。调理而痊。孰谓证见危逆而悉委之不救哉。痘疹
盛行时。如见惊搐。切不可作惊治。一切朱砂、牛黄、脑、麝、轻粉等。皆痘所忌。不可不慎。
古人认为，先出现惊搐而后出痘的，是热邪在痘毒而不在心经，属于顺证。先出痘而后出现惊搐的，是热邪在心而不在痘毒，属于逆证。然而，惊搐也有因风邪刺激而引发的，也有因脾气虚弱而引发的，不可不加以辨别。如果在正当灌浆的时候，忽然手足摇动、惊搐，这是肝热生风，风火相搏而生痰。治疗应当以平抑肝木、通利小便为关键。泻肝则风邪自去，利小便则热邪自除。先用导赤散、泻青丸，接着用四圣散加入人参、钩藤。如果手足抽搐（螈），口眼歪斜，涎液多且言语不清，腰项强直紧急，口张舌硬，这是火盛耗伤肺金，肝木失去制约而风生。用消风散加蝎尾、钩藤。若痰盛，加元明粉。如果浑身冰冷，神志不清，无法救治。如果惊搐发展到牙关紧闭、流涎，这是脾胃受到虚风侵袭，或是误服凉惊药物所致，称为“痘风”。急当清火养血，若病情严重则难以挽救。如果在痘初出时没有惊搐，到收靥（结痂）时忽然发搐，像角弓反张，两眼直视、流涎，这是毒火传于心，移热于肝，肝木乘脾土，气血亏虚，是最凶险的征兆。只有痘疹将要发出时，先发惊搐的多为吉兆。然而，发一两次就停止并见痘点的，痘必稀疏；发十几次才报点（出痘）的，痘必密集。出痘后一两天惊搐不止的多为重证。虽然说痘前发搐是吉兆，但如果发作不止，说明毒邪伏于体内，不能说是吉兆。
安世说：大抵痘前发搐，责任在于热盛；痘后发搐，责任在于正气虚弱。过去我治疗一个五岁的孩子，在放标（指痘疮发展过程中的某个阶段或泛指发病初期）时忽然发生惊搐，痰涎壅盛，高热昏迷。身为同道中人，不忍坐视不管。先用少许西黄（牛黄）点涂舌上，随即用硝石、大黄、黄芩、黄连，佐以荆芥、连翘、牛大力之类攻下。服用一次后神志清醒、热势减退，痘疮也随之发出，很快痊愈。最近在京城治疗正黄旗四川道监察御史讳粹然李公的四岁孙子，结痂后忽然发搐，各方都说无法救治。急忙邀请我去诊治。诊得六脉虚数无力，手足时常拘挛，口眼歪斜，嘴唇干燥，阴囊收缩，大小便涩滞困难。虽然证候危殆，但鉴于全家恳切求救，我想到痘后发搐，多因气血两亏，脾土衰弱导致肝木贼犯，虚风内动所致。治法应当温养肝脾，峻补气血，使正气有权力，虚风得以自行平息。如果只治惊搐，是加速其死亡。于是开一方，用十全大补汤，将桂枝保留。每日进服两剂，惊搐稍定。又服两剂，大小便自然通畅，阴囊也稍微松弛，眼球转动，诸证趋向安定。只是头发处有几处毒疮，颜色也不太红，于是在前方中去掉白芍、地黄，加入白芷、忍冬、贝母。三天后毒疮消散，声音清朗，饮食如常。只是左臂和左脚不能活动，又在原方中加入牛膝，加倍当归。服用四剂便能行走，唯独手腕无力，仍以牛膝替换桂枝。前后未超过一方，经过调理而痊愈。谁说见到危重逆证就全都推脱说无法救治呢？在痘疹盛行时期，如见到惊搐，切不可当作普通惊风治疗。一切朱砂、牛黄、冰片、麝香、轻粉等药，都是痘证所禁忌的，不可不谨慎。
The ancients stated that if convulsions occur before the eruption of smallpox, the heat is in the smallpox toxin rather than in the Heart; this is a favorable condition (Shun). If smallpox erupts first and convulsions follow, the heat is in the Heart rather than in the smallpox toxin; this is an unfavorable condition (Ni). However, convulsions may also be triggered by wind pathogens or caused by spleen qi deficiency; these must not fail to be distinguished. If during the proper stage of pustule formation, sudden shaking of the limbs and convulsions occur, this is liver heat generating wind, where wind and fire interact to produce phlegm. Treatment should focus on soothing the Liver wood and promoting urination. Purging the Liver eliminates wind, while promoting urination removes heat. Initially administer Daochi San (Ledebouriella Decoction) and Xieqing Wan (Drain the Green Pill), followed by Sisheng San (Four Holy Powders) with added Renshen (Ginseng Radix et Rhizoma) and Gouteng (Uncariae Ramulus cum Uncis). If there are spasms of the limbs (yong), deviation of the mouth and eyes, excessive saliva, slurred speech, stiffness and tension of the waist and neck, open mouth, and stiff tongue, this indicates fire excess consuming Lung metal, leaving Liver wood uncontrolled and generating wind. Use Xiaofeng San (Eliminate Wind Powder) with added Scorpion tail (Quanxie) and Gouteng (Uncariae Ramulus cum Uncis). If phlegm is abundant, add Yuanmingfen (Mirabilite). If the whole body becomes cold and consciousness is lost, it is incurable. If convulsions progress to lockjaw and drooling, this is due to the Spleen and Stomach being affected by deficient wind, or caused by the mistaken administration of cooling anticonvulsant medicines; this is called "Smallpox Wind" (Dou Feng). Urgent treatment requires clearing fire and nourishing blood; if severe, it is untreatable. If there were no convulsions when the rash first appeared, but sudden convulsions occur during the crusting phase, resembling opisthotonos, with fixed gaze and drooling, this indicates toxic fire transmitting to the Heart and shifting heat to the Liver, where Liver wood overacts on Spleen earth, resulting in qi and blood deficiency; this is the most ominous sign. Only when convulsions precede the eruption of the rash is it generally auspicious. However, if convulsions cease after one or two episodes and spots appear, the smallpox will be sparse; if convulsions occur ten or more times before spots appear, the smallpox will be dense. If convulsions persist for one or two days after eruption, the case is likely heavy. Although it is said that convulsions preceding smallpox are auspicious, if they do not stop, it indicates toxins hidden internally, and thus cannot be considered auspicious.
An Shi stated: Generally, convulsions before smallpox are attributed to excess heat; convulsions after smallpox are attributed to deficiency of healthy qi. In the past, I treated a five-year-old child who suddenly developed convulsions during the early stage, with copious phlegm-saliva, high fever, and unconsciousness. As a fellow practitioner, I could not stand by idly. I first applied a tiny amount of Xihuang (Calculus Bovis, Niuhuang) to the tongue, then used Xiaoshi (Natrii Sulfas), Dahuang (Rhei Radix et Rhizoma), Huangqin (Scutellariae Radix), and Huanglian (Coptidis Rhizoma), assisted by Jingjie (Schizonepetae Herba), Lianqiao (Forsythiae Fructus), and Nidali (Nidali Caulis) to purge. After one dose, spirit cleared and heat subsided, and the rash erupted accordingly, leading to rapid recovery. Recently, in the capital, I treated the four-year-old grandson of Li Cuiran, Censor of Sichan Dao under the Plain Yellow Banner. After scabs formed, he suddenly developed convulsions. Various physicians deemed him incurable. I was urgently invited to examine him. His six pulses were deficient, rapid, and weak. His limbs frequently cramped, his mouth and eyes deviated, his lips were dry, his scrotum retracted, and urination and defecation were difficult. Although the condition was critical, given the family's desperate pleas for help, I reasoned that post-smallpox convulsions are often caused by dual deficiency of qi and blood, weakening of Spleen earth allowing Liver wood to invade, and internal movement of deficient wind. The method should be to warm and nourish the Liver and Spleen, vigorously tonify qi and blood, empowering healthy qi so that deficient wind subsides naturally. Treating only the convulsions would accelerate death. Therefore, I prescribed a formula based on Shiquan Dabu Tang (Ten Complete Tonifying Decoction), retaining Guizhi (Cinnamomi Ramulus). He took two doses daily. The convulsions stabilized slightly. After two more doses, urination and defecation normalized, the scrotum relaxed somewhat, eye movements returned, and symptoms improved. However, several boils appeared on the head, though not very red. I removed Shaoyao (Paeoniae Radix Alba) and Dihuang (Rehmanniae Radix Praeparata) from the previous formula and added Baizhi (Angelicae Dahuricae Radix), Rendong (Lonicerae Japonicae Flos), and Beimu (Fritillariae Thunbergii Bulbus). After three days, the boils dissipated, voice became clear, and appetite returned normally. However, the left arm and leg remained immobile. I added Niuxi (Achyranthis Bidentatae Radix) and doubled Danggui (Angelicae Sinensis Radix) in the original formula. After four doses, he could walk, though the wrist remained weak. I replaced Guizhi (Cinnamomi Ramulus) with Niuxi (Achyranthis Bidentatae Radix). Throughout, the prescription did not change significantly, and he recovered through regulation. Who says that critical and adverse conditions must all be abandoned as incurable? During epidemics of smallpox and chickenpox, if convulsions are seen, they must never be treated as ordinary convulsive disorders. All substances such as Zhusha (Cinnabar), Niuhuang (Calculus Bovis, Niuhuang), Bingpian (Borneolum Syntheticum), Shexiang (Moschus), and Qingfen (Calomelas) are contraindicated in smallpox; caution is essential.