痘前渴者。宜清金利水。痘后渴者。当大补元气。若痘疮稠密而渴。为津液外泄。生脉散。
在藜藿。生津葛根汤。如烦躁 语身热者。白虎汤加麦冬、竹叶。若大便黑小便利。面黄小腹胀。
喘急而渴者。内有瘀血。犀角地黄汤加归尾、桃仁、红花、穿山甲。若夏暑窗牖闭塞烦渴。四苓
散加麦冬、黄连。薛氏云。若发热作渴。大便秘结。手足并热。善饮冷水。此阳盛也。四顺饮。
若烦渴泄泻。手足俱冷。饮沸汤而不知热。或陷伏黑 者。此属虚寒钱氏白术散。或陈氏异功散。
选用。若烦热作渴。面赤睛白。此为肾经虚热。生料六味丸。煎与恣饮。以救肾家将竭之水。燕
都小儿出痘作渴。恣与冷水饮之。如期而愈。亦无痘毒之患。盖北方人卧火炕。饮火酒。有热与
水相构而然也。按陈文宿云。痘疮发热。口渴烦躁。
切不可与冷水、蜂蜜、柿子、西瓜等物。恐内损脾胃。致腹胀喘满。寒颤切牙。则难治也。盖方
宜各有不同。不可一例而论。张涵高曰。痘出三四朝。便秘溺涩。烦渴壮热。痘色干红焦紫。必
用凉膈散下之。后用凉血解毒调理。如八九朝。元气虚弱而痘平塌。浆色清稀。保元汤补之。有
火证发渴。始终不可温补。但与凉血解毒。则浆行结 而愈。
凡痘未出而烦躁者。毒火内郁。或风寒壅遏不能即出。宜发散为主。痘未尽出而烦躁者。亦
毒火盛也。消毒饮加连翘、黑参。痘尽出而烦躁者。乃血热毒盛。犀角地黄汤解之。痘长养时烦
躁者。当辨虚实。若痘顶平。淡白少神。浆不易充者。此气血不足。保元汤加归、芍、门冬。虚
烦懊 者。栀子豉汤加解毒之药。若绽凸紫滞。便秘溺涩。乃正气实而毒盛不解。凉膈散、四顺
饮、三黄丸解利之。小便赤涩。益元散、导赤散分利之。若痘倒 喘胀而烦躁闷乱。乃气虚毒盛。
难治。
痘疹出现之前感到口渴的，适宜用清金利水的方药。痘疹消退之后感到口渴的，应当大补元气。如果痘疮分布稠密且伴有口渴，这是津液外泄所致，可用生脉散。对于贫寒体质者，可用生津葛根汤。如果出现烦躁、谵语、身体发热的症状，用白虎汤加麦冬、竹叶。如果大便颜色黑而小便通畅，面色黄，小腹胀满，气喘急促且口渴，这是体内有瘀血，用犀角地黄汤加当归尾、桃仁、红花、穿山甲。如果是夏季暑热因门窗紧闭导致烦渴，用四苓散加麦冬、黄连。薛氏说：如果发热作渴，大便秘结，手足都热，喜欢喝冷水，这是阳盛的表现，用四顺饮。如果烦渴并伴有泄泻，手足俱冷，喝滚烫的水却感觉不到烫，或者痘色陷伏变黑的，这属于虚寒证，选用钱乙的白术散或陈氏异功散。如果烦热作渴，面红但眼白睛无神，这是肾经虚热，用生料六味丸煎服，让患者随意饮用，以挽救肾中即将枯竭的阴水。燕京地区的小儿出痘疹作渴，大量给予冷水饮用，也能如期痊愈，也没有痘毒的后患。这是因为北方人睡火炕、喝烈性酒，体内有热，与水相互制约的缘故。按陈文宿所说：痘疹发热，口渴烦躁，切不可给冷水、蜂蜜、柿子、西瓜等食物，恐怕损伤脾胃，导致腹胀喘满、寒战咬牙，那就难以治疗了。因为方剂适宜各有不同，不可一概而论。张涵高说：痘疹发出三四天，大便秘结，小便涩滞，烦渴壮热，痘色干红焦紫，必须用凉膈散攻下，之后用凉血解毒的方法调理。如果是八九天，元气虚弱而痘形平塌，浆液清稀，用保元汤补益。如果有火证导致发渴，始终不可温补，只需用凉血解毒的方法，就能使浆液运行结痂而痊愈。
凡是痘疹未发出而烦躁的，是毒火内郁，或是风寒壅遏导致不能立即发出，宜以发散为主。痘疹尚未完全发出而烦躁的，也是毒火旺盛的表现，用消毒饮加连翘、黑参。痘疹全部发出后而烦躁的，乃是血热毒盛，用犀角地黄汤解之。痘疹生长灌浆期烦躁的，应当辨别虚实。如果痘顶平坦，颜色淡白少神，浆液不易充盈的，这是气血不足，用保元汤加当归、白芍、麦冬。如果是虚烦懊恼的，用栀子豉汤加解毒的药物。如果痘疹绽凸、颜色紫暗滞涩，大便秘结，小便涩滞，这是正气实而毒盛不解，用凉膈散、四顺饮、三黄丸通利解之。如果小便赤涩，用益元散、导赤散分利。如果痘疹倒靥，气喘胀满而烦躁闷乱，这是气虚毒盛，难治。
If thirst occurs before the eruption of smallpox, it is appropriate to use formulas that clear heat and promote diuresis. If thirst occurs after the resolution of smallpox, it is necessary to greatly tonify Yuan Qi (Original Qi). If the pustules are dense and accompanied by thirst, this indicates the leakage of Body Fluids; Shengmai San (Generate the Pulse Powder) should be used. For those with a poor constitution, Shengjin Gegen Tang (Gastrodia and Kudzu Decoction for Generating Fluids) is indicated. If symptoms include restlessness, delirious speech, and fever, Baihu Tang (White Tiger Decoction) added with Ophiopogonis Radix (Maidong) and Bambusae Folium (Zhuye) should be administered. If the stool is black while urination is free, the complexion is yellow, the lower abdomen is distended, and there is panting and thirst, this indicates intra-abdominal Blood Stasis; Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction) added with Angelicae Sinensis Radix Caudex (Guangui), Persicariae Semen (Taoren), Carthami Flos (Honghua), and Manis Squama (Chuanshanjia) is prescribed. In cases of summer-heat where windows and doors are closed leading to irritability and thirst, Siling San (Four-Ling Powder) added with Ophiopogonis Radix (Maidong) and Coptidis Rhizoma (Huanglian) is used. Mr. Xue stated: If fever with thirst, constipation, heat in both hands and feet, and a preference for drinking cold water occur, this is Excess Yang; Sishun Yin (Four-Obedient Drink) is indicated. If irritability and thirst are accompanied by diarrhea, coldness in both hands and feet, insensitivity to boiling hot water, or sunken blackened lesions, this belongs to Deficiency-Cold; Qian’s Baizhu San (Atractylodes Macrocephala Powder) or Chen’s Yigong San (Extraordinary Merit Powder) should be selected. If irritability and heat with thirst, red face but white sclera, occur, this is Deficiency Heat of the Kidney Channel; Shengliao Liuwei Wan (Six-Ingredient Pill with Additions) decocted and allowed to be drunk freely is used to rescue the nearly exhausted Yin Water of the Kidneys. In Beijing, children with smallpox who drink cold water freely can recover on schedule without sequelae of toxin retention. This is because northerners sleep on heated kang beds and drink strong liquor, so internal heat interacts with water. According to Chen Wensu: When smallpox presents with fever, thirst, and irritability, one must absolutely avoid giving cold water, honey, persimmons, watermelon, etc., lest they damage the Spleen and Stomach, causing abdominal distension, panting, fullness, chills, and teeth grinding, which would be difficult to treat. Since the suitability of formulas varies, one cannot generalize. Zhang Hangao said: On the third or fourth day of eruption, if there is constipation, dysuria, irritability, intense thirst, and high fever, with dry, red, scorched-purple lesions, Liangge San (Cool the Diaphragm Powder) must be used to purge, followed by regulation with cooling-blood and detoxifying methods. If on the eighth or ninth day, Yuan Qi is weak and the lesions are flat with thin serum, Baoyuan Tang (Preserve the Origin Decoction) should be used to tonify. If fire syndromes cause thirst, warming and tonifying must never be used throughout; only cooling-blood and detoxifying methods will allow the serum to flow and scab over, leading to recovery.
For restlessness occurring before the eruption of smallpox, it is due to internal depression of toxin-fire or obstruction by wind-cold preventing immediate eruption; treatment should primarily focus on dispersing. For restlessness when smallpox has not fully erupted, it is also due to excess toxin-fire; Xiaodu Yin (Detoxify Toxin Drink) added with Forsythiae Fructum (Lianqiao) and Panax Notoginseng Root (Heishen) is indicated. For restlessness after all lesions have erupted, it is due to Blood Heat and excess toxin; Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction) is used to resolve it. For restlessness during the growth and suppuration phase, deficiency and excess must be differentiated. If the lesion tops are flat, pale, lacking spirit, and serum fails to fill, this is Deficiency of Qi and Blood; Baoyuan Tang (Preserve the Origin Decoction) added with Angelicae Sinensis Radix (Danggui), Paeoniae Radix Alba (Baishao), and Ophiopogonis Radix (Maidong) is prescribed. For empty irritability and mental restlessness, Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) added with detoxifying herbs is used. If lesions protrude, are purple and stagnant, with constipation and dysuria, this indicates excess Zheng Qi (Upright Qi) with unresolved excess toxin; Liangge San (Cool the Diaphragm Powder), Sishun Yin (Four-Obedient Drink), and Sanhuang Wan (Three-Yellow Pill) are used to purgatively resolve it. For red and scanty urine, Yiyuan San (Benefit Origin Powder) and Daochi San (Direct Out Redness Powder) are used to separate and drain. If lesions invert, with panting, distension, and severe irritability/confusion, this is Deficiency of Qi with excess toxin, which is difficult to treat.