钱氏云∶痘疹痫搐，由内相胜也，惟心 、脾疹能作搐。盖
疹为脾所主，脾虚而不胜土，风热相搏，而动于心神。心喜热，神气不安，因搐成痫。 为心所生，心主热，热生风，
风属于肝，二藏相搏，风火相争，故发搐。当泻心肝。若凉惊用凉惊丸，温惊用粉红丸。海藏云∶诸痛痒疮疡，皆属心
火，无论虚实，皆属心火。上说脾虚则肝气乘之，与心火相合耳。若脾土实，心火旺而逆乘，以致痫者，此实邪也。便
结者泻青丸，便软者泻心汤。洁古云∶未出而发搐者，是外感风邪之寒，内发心火之热所作也，当用解毒丸、犀角地黄
丸主之。世传云∶疮疹欲出，身热烦躁，忽发惊搐，宜用驱风膏、小如圣饮。小便不通，八正散。痰涎壅盛，利惊丸、
抱龙丸。丹溪云∶欲发疮疹，先身热惊跳搐搦，此非惊风，宜用发散之药。窃谓前症痘疹未见而先发搐者，乃毒瓦斯自心
经出也，若病势轻缓，或形气虚弱者，不宜用峻厉之剂，恐元气内损，则毒瓦斯内陷，而疮不能起发也。或外感风寒之邪，
内因疮疹之热而相搏；或肝血虚火动而内生风，当补元气为主，佐以见症之剂。然前方多峻厉之剂，审有是症，方可用，
须察其色赤白，而以脾胃为主。虚则用温补，实则用解毒。若先发搐而后发疮，多有生意。疮已瘥而发搐，或吐泻者难
治。
一小儿痘痂脱尽，因其秽气，用葱椒煎汤浴之，发热痰喘，用八珍加白僵蚕、蝉蜕，一剂痰喘顿止；又用四君、芎、
归、钩藤钩而搐止。
一小儿痘疮色赤，四肢发搐，眉唇牵动，此心肝二经热甚，乘脾所致也，用四君、防风、钩藤钩而痊。
一小儿痘后，四肢发搐，眉棱尤动，小便频数，脸目青赤，此肝经风热，用四物、柴胡、山栀少愈，但四肢倦怠，
饮食少思，大便不实，此脾气受伤而未复也，用四君、升麻、
当归而痊。
一小儿痘后，寅卯申酉时热甚或兼搐，余谓寅卯时发热，此肝火本症，申酉时发搐，乃肝木侮金。先以四物、白
术、茯苓、钩藤钩，煎送柴胡二连丸而愈，夕用地黄丸，朝用四君、山栀、柴胡及四君子加当归而痊。
一小儿痘疮色赤，发搐痰盛，服抱龙丸而顿愈。又因母大怒，儿仍搐，母服柴胡栀子散、加味逍遥散，母子并愈。
一小儿痘愈后发搐，左额青赤，唇口牵动，余谓肝心二经风热所致，先用柴胡栀子散加钩藤钩，后用加味逍遥散，
而搐止，再用五味异功散而痘愈。
一小儿痘将愈，发搐痰涌，头目不清，脾虚气弱，肝木侮之，先用五味异功散加柴胡、钩藤钩，搐愈而靥。
柴胡二连丸 治肝经实火。
柴胡 宣黄连 胡黄连
各末糊丸，桐子大。每服二三十丸，白汤下。
补中益气汤（方见寒战切牙）
六君子汤（方见不靥闷乱）
四神丸（方见泄泻切牙）
十一味木香散（方见顶陷灰白）
Qian Yi stated: Convulsions and epilepsy caused by smallpox/rash result from the imbalance of mutual restraint among internal organs. Only pathological changes in the Heart and Spleen can induce convulsions. Since rashes are governed by the Spleen, when Spleen Qi is deficient and fails to control Liver Wood (note: "bu sheng tu" in the original text likely implies Spleen deficiency leading to relative Liver hyperactivity or internal wind-heat), Wind and Heat pathogens contend with each other, disturbing the Heart Spirit. The Heart favors heat; when the Spirit is unsettled, convulsions occur and develop into epilepsy. Pustules/rashes are generated by the Heart, which governs Heat. Excessive Heat generates Wind, and Wind belongs to the Liver. When the Heart and Liver pathogenic factors contend, Wind and Fire clash, causing convulsions. Treatment should involve purging the Heart and Liver. For Heat-induced惊 (Jing/convulsion), use Liang Jing Wan (Cooling Convulsion Pill); for Cold-induced Jing, use Fen Hong Wan (Pink Convulsion Pill).
Zhang Yuansu (Haizang) stated: All pain, itching, sores, and ulcers belong to Heart Fire, regardless of deficiency or excess. As mentioned above, when the Spleen is deficient, Liver Qi attacks it, combining with Heart Fire. If the Spleen Earth is in a state of excess, and Heart Fire is vigorous, counter-attacking Lung Metal (note: "ni cheng" usually refers to reverse restriction or侮), resulting in epilepsy, this is an excess pathogen condition. For those with constipation, use Xie Qing Wan (Purging Green Pill); for those with loose stools, use Xie Xin Tang (Purge Heart Decoction).
Li Dongyuan (Jiegu) stated: Convulsions occurring before the eruption of smallpox/rash are caused by external contraction of Wind-Cold pathogens contending with internally generated Heart Fire heat. One should primarily use Jie Du Wan (Detoxification Pill) and Xi Jiao Di Huang Wan (Rhinoceros Horn Rehmannia Decoction). Folk tradition states: When rash/pustules are about to erupt, if the body is hot and irritable, suddenly developing惊 convulsions, one should use Qu Feng Gao (Wind-Expelling Ointment) and Xiao Ru Sheng Yin (Little Like-Sage Drink). For urinary obstruction, use Ba Zheng San (Eight-Herb Rectifying Powder). For excessive phlegm-saliva obstruction, use Li Jing Wan (Relieve Convulsion Pill) and Bao Long Wan (Embrace Dragon Pill).
Zhu Danxi stated: Before the eruption of sores/rash, if there is initial body heat,惊 jumping, and convulsions, this is not惊风 (Wind-Disease); one should use dispersing medications. I believe that in the aforementioned conditions, where convulsions occur before the appearance of smallpox/rash, it is because the toxin/wa qi is emerging from the Heart Meridian. If the disease progression is mild or the patient's form and Qi are weak, one should not use harsh and drastic medicines, lest they damage the Yuan Qi internally, causing the toxin to sink inward and preventing the pustules from erupting. Alternatively, it may be due to external contraction of Wind-Cold pathogens contending with internal heat from the rash; or due to Liver Blood deficiency causing empty fire to move and generate internal Wind. Treatment should focus on tonifying Yuan Qi, assisted by medications addressing specific symptoms. However, the preceding formulas are mostly harsh and drastic; they should only be used after careful examination confirms the presence of these symptoms. One must observe the complexion (red or white) and prioritize regulating the Spleen and Stomach. For deficiency, use warming and tonifying methods; for excess, use detoxification methods. If convulsions occur first followed by the eruption of pustules, there is often hope for recovery. If convulsions recur after the pustules have healed, or if accompanied by vomiting and diarrhea, the condition is difficult to treat.
A child, after all scabs from smallpox had fallen off, bathed in a decoction of green onion and Sichuan pepper due to exposure to foul air, resulting in fever and phlegmic wheezing. After administering Ba Zhen Tang (Eight-Treasure Decoction) added with Bai Jiang Can (White Silkworm) and Chan Tui (Cicada Slough), the phlegmic wheezing stopped immediately after one dose. Subsequently, using Si Jun Zi Tang (Four Gentlemen Decoction) plus Chuan Xiong, Dang Gui, and Gou Teng Hook, the convulsions ceased.
A child with red-colored smallpox pustules experienced limb convulsions and twitching of the eyebrows and lips. This was caused by severe heat in the Heart and Liver meridians invading the Spleen. The child recovered after using Si Jun Zi Tang, Fang Feng, and Gou Teng Hook.
A child developed limb convulsions after smallpox, with particular twitching of the eyebrow ridge, frequent urination, and a bluish-red complexion. This was attributed to Wind-Heat in the Liver Meridian. Using Si Wu Tang (Four Substance Decoction), Chai Hu, and Shan Zhi, the symptoms improved slightly. However, the limbs remained fatigued, appetite was poor, and stools were unformed, indicating injury to Spleen Qi without full recovery. The child recovered after using Si Jun Zi Tang, Sheng Ma, and Dang Gui.
A child experienced severe fever or concurrent convulsions during Yin-Mao hours (3-7 AM) and Shen-You hours (3-7 PM) after smallpox. I reasoned that fever during Yin-Mao hours is a primary symptom of Liver Fire; convulsions during Shen-You hours indicate Liver Wood insulting Lung Metal. The child was cured after taking Si Wu Tang, Bai Zhu, Fu Ling, and Gou Teng Hook, administered with Chai Hu Lian Dan Wan (Bupleurum Coptis Pill). In the evening, Di Huang Wan (Rehmannia Pill) was used; in the morning, Si Jun Zi Tang, Shan Zhi, Chai Hu, and Si Jun Zi Tang added with Dang Gui were used.
A child with red smallpox pustules experienced convulsions and abundant phlegm. The condition resolved instantly after taking Bao Long Wan. Later, due to the mother's anger, the child continued to convulse. The mother took Chai Hu Zhi Zi San (Bupleurum Gardenia Powder) and Jia Wei Xiao Yao San (Modified Free Wanderer Powder), and both mother and child recovered.
A child developed convulsions after recovering from smallpox, with a blue-red left forehead and twitching of the lips and mouth. This was attributed to Wind-Heat in the Heart and Liver meridians. First, Chai Hu Zhi Zi San added with Gou Teng Hook was used; then Jia Wei Xiao Yao San was administered. The convulsions stopped, and finally, Wu Wei Yi Gong San (Five-Ingredient Extra-Effort Powder) was used to ensure complete recovery of the smallpox lesions.
A child experiencing impending resolution of smallpox developed convulsions and surging phlegm, with unclear head and eyes. This was due to Spleen deficiency and Qi weakness, allowing Liver Wood to invade. First, Wu Wei Yi Gong San added with Chai Hu and Gou Teng Hook was used. The convulsions ceased, and the scabs formed.
Chai Hu Lian Dan Wan: Treats excess fire in the Liver Meridian.
Ingredients: Chai Hu (Bupleuri Radix), Xuan Huang Lian (Coptidis Rhizoma), Hu Huang Lian (Picrorhizae Rhizoma).
Preparation: Grind each into powder, mix with paste to make pills the size of tung tree seeds. Take 20-30 pills per dose, washed down with warm water.
Bu Zhong Yi Qi Tang (Formula see entry for "Chills and Teeth Grinding")
Liu Jun Zi Tang (Formula see entry for "Failure of Scabbing and Restlessness")
Si Shen Wan (Formula see entry for "Diarrhea and Teeth Grinding")
Shi Yi Wei Mu Xiang San (Formula see entry for "Sunken Top and Ashen White")