谵、多言也，妄、虚妄也，谵妄者，妄有闻见而语言无伦也，皆邪气炽盛，正气虚弱，神识不清之所致。
夫言为心声，心热则多言，睡中呢喃者，热之微也，寤而语言差谬，热则甚矣。亦有胃热而谵语者，大便必硬，
数日不更衣，方是。〔薛〕陈文宿先生云∶痘紫色顶陷，心烦狂躁，气喘妄语或如见鬼神，内热便秘者宜用龙
脑膏子、猪尾膏，如无内热，大便不实，不可轻服。窃谓前证多因初起热盛之时，失于解利所致，亦有因痘毒未尽，
有因胃经有热，有因肺胃有热，有因心脾有热，烦躁痘裂出血，便血衄血，屎黑痕赤，详见各证。大凡作渴发热，
手足指冷，或大便秘结者，内有热也，切不可禁其饮水，观张子和述水中儿事，良可验矣，盖热极，
故得水而生也。一小儿痘疹狂喘，热渴饮冷，痰涎不利。先君用十六味清膈饮、犀角地黄汤、而痊。一小儿出痘
发狂，作渴饮冷。此上焦热炽也。用黄连解毒汤、芹菜汁、而止，又用紫草快 汤，将靥，因间药饵三日，色黑倒
靥，用紫草散，渴止，又用人参白术散而痊。一小儿痘愈后，时发狂兼喘，发过面色黄白，手足并冷。此
脾胃虚弱也。余用补中、八珍、二汤各三十余剂，或云当先降火邪而后补元气，乃
服芩、连、朴硝之类，汗吐不止而殁。
初发热，便妄有所见闻，妄言如见鬼状，此为恶候。盖毒攻于里，心志昏惑，神识不清而然。况小儿神气怯弱，
鬼魅易侵，又厉鬼常乘疫气而行，乘人之虚而疰之，故凡痘疹妄见、妄闻、妄言、如见鬼者，不可治也。
须审发于何脏，如目直视，手寻衣领乱捻物，此发于肝，为亡魂。闷乱喘促，手掐眉目鼻面，此发于肺，为亡
魄。上窜切牙，多叫哭惊悸，或不能言，此发于心，为丧神。困睡，手足螈 ，不思饮食，此发于脾，为失意。目
无精光，畏明，欲坠下而缩身，此发于肾，为失志。故曰∶真藏见者不治。或发热时无此证，因大便秘结却有之，
此内热也，先以宣风散（发热）解利其热，后以导赤散（心）送下牛黄清心丸。（惊）或粉红丸（惊）以镇其神，病已
者可治，连作不已者，勿治。如胃中有燥屎，三五日未更衣者，宜涤肠解毒，宜四顺清凉饮、三黄丸（俱发热）主
之。如初发热狂乱，大便自调者，五苓散加辰砂主之，大便秘者，轻则三黄丸，甚则承气汤主之。
如起发、成浆、欲靥之时，忽然神昏谵语者，此由疮本稠密，精血外耗，不能
养神，宜养血泻火，安神丸主之。
安神丸
黄连 当归身 麦门冬 白茯神 甘草（各半两） 朱砂（一两） 龙脑（二分半）
上为末，汤浸蒸饼，和 猪心血捣匀，丸如黍米大。每服十丸，灯心汤下。
栀子仁汤 烦躁谵语，惊狂发 。
栀子仁 黄芩 石膏（各二钱） 知母 杏仁（各一钱半） 大青 柴胡 豆豉 赤芍药（各一
钱） 升麻（八分） 甘草（五分）
上，水煎服。
如昏不知人，语言无伦者死。经曰∶衣被不敛，言语不避亲疏者，神明之乱也。故不可治。如初发热便妄有
闻见，状如见鬼而恐怖者，不治。此证自始至终，皆不可有，乃神志俱丧，躯壳徒存，不过引日而已。
谵，指多言；妄，指虚妄。谵妄，是指患者产生虚幻的视听感觉，且言语杂乱无章。这通常是由于邪气炽盛、正气虚弱，导致神识不清所引起的。
说话是心声的外露，心热则多言。睡眠中喃喃自语，说明热势较轻；清醒时言语错谬，说明热势严重。也有因胃热而导致谵语的，这种情况大便必然干硬，数日不大便，才符合此证。[薛己]陈文宿先生曾说：痘疹颜色紫暗、顶陷，伴有心烦狂躁、气喘谵语或如见鬼神，内有热且便秘者，适宜使用龙脑膏子、猪尾膏；如果没有内热，大便稀溏，不可轻易服用。我认为上述病症多因初起热盛之时，未能及时解表透毒所致；也有因痘毒未尽、胃经有热、肺胃有热、心脾有热，导致烦躁、痘疮破裂出血、便血、鼻衄、大便黑、小便红赤等，详见各相关病证。大凡出现口渴发热、手足指端发冷，或大便秘结的，属于内有热邪，切不可禁止饮水，参考张子和记载的从水中救活婴儿的案例，足以验证这一道理，因为热极之时，得水则能生存。有一个小儿患痘疹，狂喘、热渴喜饮冷水、痰涎不利。我的先父使用十六味清膈饮、犀角地黄汤，治愈了该病。另一个小儿出痘后发狂，口渴喜饮冷水，这是上焦热势炽盛。使用黄连解毒汤、芹菜汁，症状停止，又用紫草快靛汤，待痘疮将收靥时，因间断服药三天，痘色变黑倒靥，使用紫草散，口渴止住，又用人参白术散而痊愈。还有一个小儿痘疮痊愈后，时常发狂兼喘，发作过后面色黄白，手足均冷，这是脾胃虚弱。我使用补中益气汤、八珍汤，两个方剂各服用三十余剂；有人说是应当先降火邪而后补元气，于是服用黄芩、黄连、朴硝之类药物，导致汗吐不止而死亡。
初发热时，便出现虚幻的见闻，胡言乱语如见鬼状，这是恶候。这是因为毒邪攻入体内，心志昏惑，神识不清所致。况且小儿神气怯弱，鬼魅容易侵入，厉鬼常乘着疫气而行，趁着人体虚弱而传染，所以凡是痘疹出现妄见、妄闻、妄言、如见鬼状的，都是不可治之症。必须审察病发于何脏：如目睛直视，手寻衣领乱捻物品，这是病发于肝，为亡魂；闷乱喘促，手掐眉目鼻面，这是病发于肺，为亡魄；上窜切牙，多叫哭惊悸，或不能言语，这是病发于心，为丧神；困睡，手足抽搐，不思饮食，这是病发于脾，为失意；目光无神，畏光，欲低头缩身，这是病发于肾，为失志。所以说：真脏脉现者不治。或者发热时没有这些症状，但因大便秘结却出现了这些症状，这是内热，先用宣风散（针对发热）解利其热，后用导赤散（针对心）送服牛黄清心丸（针对惊）。或用粉红丸（针对惊）以镇摄心神，病已停止者可治，连续发作不止者，不可治。如果胃中有燥屎，三五日未排便者，适宜涤肠解毒，宜用四顺清凉饮、三黄丸（均针对发热）主治。如初发热即狂乱，大便正常者，用五苓散加辰砂主治，大便秘结者，轻症用三黄丸，重症用承气汤主治。
如在起发、成浆、欲收靥之时，忽然神昏谵语，这是由于疮毒本已稠密，精血外耗，不能养神，适宜养血泻火，用安神丸主治。
安神丸
黄连、当归身、麦门冬、白茯神、甘草（各半两）、朱砂（一两）、龙脑（二分半）
以上研为细末，用汤浸蒸饼，和猪心血捣匀，制成如黍米大小的丸药。每次服用十丸，灯心草汤送下。
栀子仁汤
主治烦躁谵语，惊狂抽搐。
栀子仁、黄芩、石膏（各二钱）、知母、杏仁（各一钱半）、大青、柴胡、豆豉、赤芍药（各一钱）、升麻（八分）、甘草（五分）
以上用水煎服。
如果昏迷不知人，言语杂乱无章的，预后不良致死。医经说：衣被不整，言语不分亲疏的，是神明混乱的表现。因此不可治。如初发热便出现虚幻的见闻，状如见鬼且恐惧的，不可治。此证自始至终都不应出现，一旦出现则是神志俱丧，躯壳徒存，不过是拖延时日而已。
Chan (delirious speech) refers to excessive talking; Wang (hallucination) refers to falsehood. Chanwang (delirium and hallucination) refers to the patient experiencing illusory auditory and visual perceptions, accompanied by incoherent speech. This is typically caused by exuberant pathogenic factors, deficiency of healthy qi, resulting in unclear consciousness.
Speech is the external expression of the heart's mind. Heat in the Heart leads to excessive talking. Murmuring during sleep indicates mild heat; erroneous speech while awake indicates severe heat. There are also cases of delirious speech caused by Stomach Heat, where the stool must be hard, and there has been no bowel movement for several days, which fits this syndrome. [Xue Ji] Mr. Chen Wensu stated: For varicella with purple color and depressed tops, accompanied by mental restlessness, mania, panting, delirious speech, or seeing ghosts, if there is internal heat and constipation, Longnao Gaozi (Brain Camphor Pills) and Zhuwei Gao (Pig Tail Paste) are suitable. If there is no internal heat and the stool is loose, they should not be taken lightly. I believe that the aforementioned conditions are mostly caused by failing to resolve and vent the pathogen when heat was intense at the beginning; some are due to incomplete resolution of varicella toxins, some due to Heat in the Stomach Meridian, some due to Heat in the Lung and Stomach, and some due to Heat in the Heart and Spleen, leading to irritability, rupture and bleeding of varicella sores, hematochezia, epistaxis, black stool, and red urine, as detailed in respective syndromes. Generally, thirst, fever, coldness of the fingertips, or constipation indicate internal heat. One must absolutely not prohibit drinking water. Referencing Zhang Zihe's account of saving a child from water, this can be verified: when heat reaches its extreme, water allows survival. A child suffered from varicella with mania, panting, thirst preferring cold drinks, and difficult expectoration of phlegm. My father treated this using Shiliuwei Qingge Yin (Sixteen-Ingredient Phlegm-Clearing Decoction) and Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction), achieving recovery. Another child developed mania after varicella eruption, with thirst preferring cold drinks; this indicated blazing heat in the Upper Jiao. Using Huanglian Jiedu Tang (Coptis Decoction for Resolving Toxins) and celery juice, the symptoms ceased. Then, Zicao Kuaiye Tang (Arnebia Rapid-Eruption Decoction) was used. When the sores were about to crust over, due to interrupting medication for three days, the sores turned black and inverted. Zicao San (Arnebia Powder) was used to stop thirst, followed by Renshen Baizhu San (Ginseng and Atractylodes Macrocephala Powder) for full recovery. Another child, after varicella recovery, occasionally experienced mania with panting. After episodes, the complexion was yellowish-white, and limbs were cold. This indicated Spleen and Stomach deficiency. I used Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) and Bazhen Tang (Eight-Treasure Decoction), administering each for more than thirty doses. Some suggested first clearing fire pathogens and then tonifying original qi, so they administered Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), and Poxiao (Natrii Sulfas). This led to incessant sweating and vomiting, resulting in death.
At the initial stage of fever, if illusory perceptions occur, with delirious speech resembling seeing ghosts, this is an ominous sign. It is because toxins attack internally, confusing the mind and clouding consciousness. Moreover, children have weak Shen (Spirit), making them susceptible to invasion by malevolent entities. Malevolent ghosts often travel with epidemic qi, invading when human resistance is low. Therefore, any varicella case presenting with hallucinations, false hearing, delirious speech, or seeing ghosts is considered incurable. One must examine which Zang organ is affected: If eyes stare straight ahead and hands pick at clothes or fumble with objects, it originates from the Liver, indicating loss of Hun (Ethereal Soul). If there is chest oppression, panting, and hands scratching eyebrows, eyes, nose, and face, it originates from the Lungs, indicating loss of Po (Corporeal Soul). If there is upward staring, teeth grinding, frequent crying, fright, palpitations, or inability to speak, it originates from the Heart, indicating loss of Shen (Spirit). If there is lethargy, convulsions of limbs, and loss of appetite, it originates from the Spleen, indicating loss of Yi (Intellect). If eyes lack luster, fear light, and the body shrinks, it originates from the Kidneys, indicating loss of Zhi (Willpower). Thus it is said: Appearance of True Zang pulse indicates incurability. Or, if these symptoms do not appear during fever but appear due to constipation, this is internal heat. First use Xuanfeng San (Wind-Dispersing Powder) to clear heat, then administer Niuhuang Qingxin Wan (Calculus Bovis Clearing Heart Pill) via Daochi San (Guide Out Redness Powder) targeting the Heart. Or use Fenhong Wan (Pink Pill) to calm the Spirit. If the condition stops, it is treatable; if it continues incessantly, it is untreatable. If there are dry feces in the Stomach and no bowel movement for three to five days, purging the intestines and resolving toxins is appropriate, using Sishun Qingliang Yin (Four-Obedience Cooling and Refreshing Decoction) or Sanhuang Wan (Three-Yellow Pill) as the main treatment. If mania occurs at the initial fever stage with normal stools, Wuling San (Five-Agaric Powder) added with Zhensha (Cinnabar) is used. For constipation, mild cases use Sanhuang Wan, severe cases use Chengqi Tang (Chengqi Decoction).
If during the rising, pustule formation, or crusting stages, sudden confusion and delirium occur, it is because the sores were dense, causing exhaustion of essence and blood, failing to nourish the Spirit. Nourishing blood and purging fire is appropriate, using Anshen Wan (Spirit-Calming Pill).
Anshen Wan (Spirit-Calming Pill)
Huanglian (Coptidis Rhizoma), Danggui Shen (Angelicae Sinensis Radix Body), Maimendong (Ophiopogonis Tuber), Baifushen (Poria with Hostwood), Gancao (Licorice Root) (each 0.5 liang), Zhensha (Cinnabar) (1 liang), Longnao (Borneolum Syntheticum) (2.5 fen).
Grind into powder. Mix with steamed dough soaked in decoction, and knead evenly with pig heart blood. Form pills the size of millet seeds. Take ten pills each time, washed down with Dengxin Cao Tang (Juncus Effusus Decoction).
Zhiren Tang (Gardeniae Semen Decoction)
Indicated for irritability, delirious speech, fright, mania, and convulsions.
Zhiren (Gardeniae Semen), Huangqin (Scutellariae Radix), Shigao (Gypsum Fibrosum) (each 2 qian), Zhimu (Anemarrhenae Rhizoma), Xingren (Armeniacae Semen Amarum) (each 1.5 qian), Daqing (Isatidis Folium), Chaihu (Bupleuri Radix), Douchi (Sojae Semen Praeparatum), Chi Shaoyao (Paeoniae Radix Rubra) (each 1 qian), Shengma (Cimicifugae Rhizoma) (8 fen), Gancao (Licorice Root) (5 fen).
Decoct in water and take orally.
If the patient is comatose and incoherent, the prognosis is fatal. The Classics state: Disarray in clothing and speech without distinction between kin and strangers indicates chaos of the Shen (Spirit). Therefore, it is incurable. If at the initial fever stage, there are hallucinations resembling seeing ghosts with terror, it is incurable. This syndrome should not appear from start to finish. Its appearance indicates total loss of spirit and will, leaving only the physical shell, merely prolonging life.