谵妄者，妄有闻见，语言无伦也。皆邪气炽盛，正气虚弱，神识不清所致。夫言为
心声，心热则多言，故睡中呢喃者，热之微也。寤而语言差谬者，热之甚也。有因胃热
使然者；有因痘毒未尽者；有因心脾有热，痘裂出血便血衄血者。然凡妄有所见闻，如
见鬼状者，最为恶候，盖毒攻于里，心志昏惑，神识不清，所谓神志俱丧，躯壳徒存
耳。又须审其发与何脏？如目直视，手寻衣领，及乱捻物，此发于肝，是为亡魂。如闷
乱喘促，手掐眉目鼻面，此发于肺，是为亡魄。如上视切牙，叫哭惊悸，或不能言，此
发于心，是为丧神。如困睡手足螈 ，不思饮食，此发于脾，是为失意。如目无精光，
身缩下坠，此发于肾，是为失志。《经》曰∶衣被不敛，言语不避亲疏者，神明之乱也，
故为不治。然有疮本稠密，是以起发成浆之后，精血外耗，不能养神，忽然神昏谵语
者，治宜养血安神为主。治之而即已者，吉。如连作不已者，死。
夫邪气炽盛，正气虚弱，则神识不清，而谵妄所由生也。然因心热者。则似睡非
睡，呢呢喃喃。若因胃热者，则大便坚闭，腹痛无伦。若因肝热，则忿怒不平，恍惚不
定。若因肾热则恐怖见鬼，而神志俱丧。昼夜谵妄者，阳虚也。夜多谵妄者，阴虚也
然在初热时则是火郁而然，必痘起则已。在行浆时是则痛极而然，必浆足则已，若止谵
妄而无他证者，则以治痘为主，倘兼别证者，又当随别证以审治之。
谵妄，是指患者出现幻觉和错觉，言语混乱无序。这通常是由于邪气炽盛、正气虚弱，导致神识（精神意识）不清所引起。言语是心声的外在表现，心经有热则多言，因此睡眠中喃喃自语的，说明热势较轻；清醒时言语错谬的，说明热势严重。有的因胃热所致；有的因痘毒未尽所致；有的因心脾有热，导致痘疮破裂出血、便血或鼻衄等。然而，凡是出现幻觉妄想，如见鬼状者，是最为凶险的证候，这是因为毒邪内攻，导致心志昏乱，神识不清，即所谓神与志都丧失，只剩躯壳存在罢了。此外，还必须辨别病变涉及哪个脏腑：如两眼直视，手抓衣领，以及胡乱捻弄物品，这是病发于肝，称为“亡魂”。如胸闷烦躁、气喘急促，手掐眉目鼻面，这是病发于肺，称为“亡魄”。如向上翻白眼、咬紧牙关、叫哭惊悸，或者不能说话，这是病发于心，称为“丧神”。如嗜睡、手足抽搐、不思饮食，这是病发于脾，称为“失意”。如目光无神、身体蜷缩下坠，这是病发于肾，称为“失志”。《内经》说：“衣服不整，言语不分亲疏远近的”，是神明紊乱的表现，所以属于不治之症。但是，如果疮本稠密，在起发成浆之后，精血外耗，不能滋养心神，忽然出现神昏谵语的，治疗应以养血安神为主。治疗后随即停止的，预后良好。如果连续发作不止的，预后不良（死）。
邪气炽盛，正气虚弱，就会导致神识不清，从而产生谵妄。如果是因心热引起的，则似睡非睡，喃喃自语。如果是因胃热引起的，则大便干结闭塞，腹痛剧烈。如果是因肝热引起的，则愤怒不平，神情恍惚不定。如果是因肾热引起的，则恐惧见鬼，神志俱丧。昼夜都谵妄的，属于阳虚。夜间多谵妄的，属于阴虚。然而在初热阶段则是火郁所致，必须等到痘疹发出才会停止。在行浆阶段则是疼痛至极所致，必须等到浆液充盈才会停止。如果只是谵妄而没有其他症状的，则以治疗痘病为主；倘若兼有其他症状的，又应当根据其他症状来辨证施治。
Delirium refers to the state where patients experience hallucinations and illusions, with disordered and incoherent speech. This is generally caused by excessive pathogenic factors and deficient healthy qi (vital energy), leading to unclear consciousness (spiritual awareness). Speech is the external manifestation of the heart's voice; when the Heart channel has heat, there is excessive talking. Therefore, muttering in sleep indicates mild heat, while erroneous speech while awake indicates severe heat. Some cases are due to Stomach heat; some are due to incomplete resolution of smallpox toxins; some are due to heat in the Heart and Spleen, causing ruptured smallpox sores with bleeding, hematochezia (blood in stool), or epistaxis (nosebleed). However, any case involving delusions and hallucinations, such as seeing ghosts, is a most ominous sign. This is because the toxin attacks internally, causing confusion of the mind and loss of clear consciousness, meaning both spirit and will are lost, leaving only the physical shell. Furthermore, one must determine which Zang organ is affected: if the eyes stare straight ahead, the hands grasp at clothing collars, and objects are fumbled with randomly, this originates from the Liver, termed "loss of Hun" (ethereal soul). If there is chest oppression, irritability, panting, and the hands pinch the eyebrows, eyes, nose, and face, this originates from the Lung, termed "loss of Po" (corporeal soul). If the eyes roll upward, teeth are clenched, crying and weeping occur with fright and palpitations, or speech is impossible, this originates from the Heart, termed "loss of Shen" (spirit). If there is lethargy, convulsions of the limbs, and lack of appetite, this originates from the Spleen, termed "loss of Yi" (intellect). If the eyes lack luster, and the body curls up and sinks, this originates from the Kidney, termed "loss of Zhi" (willpower). The Classic states: "Those who do not dress properly and speak without distinguishing between relatives and strangers" suffer from disorder of the divine light (Shenming), and thus are considered incurable. However, if the sores were originally dense, and after erupting and filling with pus, the essence and blood are externally depleted, failing to nourish the spirit, sudden coma and delirium may occur. Treatment should primarily focus on nourishing blood and calming the spirit. If it ceases immediately after treatment, the prognosis is auspicious. If it continues incessantly, death ensues.
When pathogenic factors are excessive and healthy qi is deficient, consciousness becomes unclear, giving rise to delirium. If caused by Heart heat, the patient appears half-asleep, muttering softly. If caused by Stomach heat, there is dry and obstructed stool and unbearable abdominal pain. If caused by Liver heat, there is anger and resentment, with an absent-minded and unstable demeanor. If caused by Kidney heat, there is fear and seeing ghosts, with loss of both spirit and will. Delirium occurring day and night indicates Yang deficiency. Delirium occurring mostly at night indicates Yin deficiency. However, during the initial fever stage, this is due to constrained fire and will cease once the rash erupts. During the pustule-filling stage, this is due to extreme pain and will cease once the pus is full. If delirium occurs without other symptoms, treatment should focus primarily on managing the smallpox. If accompanied by other symptoms, treatment should be adjusted according to those specific conditions.