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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.