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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.