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。所谓谵妄，是指患者产生虚幻的视听感觉，且言语混乱无条理。这通常是由于邪气炽盛、正气虚弱，导致神识不清所引起。
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：痘疮颜色紫暗、顶陷，伴有心烦狂躁、气喘、胡言乱语或如见鬼神，且有内热便秘症状的，适宜使用龙脑膏子、猪尾膏；如果没有内热，大便稀溏，则不可轻易服用。我认为上述病症多因初起热盛之时，未能及时疏解透发所致；也有因痘毒未尽、胃经有热、肺胃有热、心脾有热，导致烦躁、痘疹破裂出血、便血、鼻衄、大便色黑、痘痕赤红等，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，说明体内有热，切不可禁止其饮水，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，得水方能生存。有一个小儿患痘疹，出现狂喘、热渴喜饮冷水、痰涎不利等症状。我的先父使用十六味清膈饮、犀角地黄汤治疗而痊愈。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、芹菜汁治疗使症状停止，又使用紫草快靛汤，在痘疹将收靥时，因间断服药三天，导致痘色变黑倒靥，使用紫草散治疗后口渴停止，又用人参白术散治疗而痊愈。还有一个小儿痘疹痊愈后，时常发作狂躁兼喘息，发作过后面色黄白，手足均冷，这是脾胃虚弱所致。我使用补中益气汤、八珍汤，两个方剂各服用三十余剂；有人声称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，此为恶候。这是因为毒邪攻里，心志昏惑，神识不清所致。况且小儿神气怯弱，鬼魅容易侵入，厉鬼常乘疫气而行，乘人之虚而传染，所以凡是痘疹出现妄见、妄闻、妄言、如见鬼状的，属于不可治之症。必须审察病变发自何脏：如目睛直视，手寻衣领乱捻物品，这是发自肝，为亡魂；闷乱喘促，手掐眉目鼻面，这是发自肺，为亡魄；上窜切牙，多叫哭惊悸，或不能言语，这是发自心，为丧神；困睡，手足抽搐，不思饮食，这是发自脾，为失意；目光无神，畏光，欲下坠缩身，这是发自肾，为失志。所以说：真脏脉现者不治。或者发热时没有这些症状，但因大便秘结而出现类似症状的，这是内热，先用宣风散（针对发热）疏解透发其热，后用导赤散（针对心）送服牛黄清心丸（针对惊厥），或用粉红丸（针对惊厥）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，三五日未排便的，适宜涤肠解毒，宜用四顺清凉饮、三黄丸（均针对发热）主治。如果初发热时狂乱，大便正常调匀的，用五苓散加辰砂主治，大便秘结的，轻症用三黄丸，重症用承气汤主治。
如果在起发、成浆、欲收靥的时候，忽然神昏谵语，这是由于疮毒本来稠密，精血外耗，不能养神所致，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，用米汤浸蒸饼，和入猪心血捣匀，制成如黍米大小的丸剂。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，言语混乱无条理者死。医经说：衣服被子不整理，言语不分亲疏远近的，是神明紊乱的表现，故不可治。如果初发热时就出现虚幻的见闻，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) implies that the patient perceives illusory sights and sounds and speaks incoherently. This is caused by flourishing pathogenic factors, deficiency of healthy qi, and unclear consciousness.
Speech is the expression of the heart's mind. Heat in the Heart leads to excessive talking. Murmuring during sleep indicates mild heat, whereas erroneous speech while awake indicates severe heat. There are also cases of delirious speech due to Stomach heat, where the stool must be hard and there has been no bowel movement for several days. [Xue Ji] Mr. Chen Wensu stated: For smallpox with purple color and depressed tops, accompanied by mental restlessness, mania, panting, delirious speech, or seeing ghosts, and with internal heat and constipation, Longnao Gaozi (Brain Ice 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 the aforementioned conditions are mostly caused by failing to resolve and vent the heat when it was initially intense; others are due to incomplete elimination of smallpox toxin, heat in the Stomach meridian, heat in the Lung and Stomach, or heat in the Heart and Spleen, leading to irritability, ruptured pox bleeding, hematochezia, epistaxis, black stool, and red scars, as detailed in respective sections. Generally, thirst, fever, coldness of the finger tips, or constipation indicate internal heat. One must not forbid drinking water. Referencing Zhang Zihe's account of reviving a child from water, this is verifiable, as extreme heat requires water for survival. A child with smallpox developed manic panting, thirst for cold drinks, and difficult expectoration. My father cured him using Shiliuwei Qingge Yin (Sixteen-Ingredient Diaphragm-Clearing Decoction) and Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction). Another child became manic after developing smallpox, with thirst for cold drinks, indicating blazing heat in the Upper Jiao. The symptoms ceased after using Huanglian Jiedu Tang (Coptis Decoction for Detoxification) and Celery Juice, followed by Zicao Kuaiye Tang (Arnebia Rapid-Eruption Decoction). Due to interrupting medication for three days during the eruption phase, the spots turned black and inverted. After using Zicao San (Arnebia Powder), thirst stopped, and the child recovered using Renshen Baizhu San (Ginseng and Atractylodes Macrocephala Powder). Another child, after recovering from smallpox, occasionally suffered from mania and panting, with yellowish-white complexion and cold limbs after episodes, indicating Spleen and Stomach deficiency. I treated him with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) and Bazhen Tang (Eight-Treasure Decoction), each administered for over thirty doses. Some claimed one should first clear fire pathogens and then tonify Yuan qi, so they administered Huangqin, Huanglian, and Poxiao (Mirabilite), leading to incessant sweating and vomiting until death.
If delirious perceptions and speech resembling seeing ghosts occur at the initial fever stage, it is an ominous sign. This is because toxins attack the interior, confusing the Heart spirit and clouding consciousness. Moreover, children have weak Shen qi, making them susceptible to demonic invasion; fierce ghosts often ride epidemic qi and infect the deficient. Therefore, any case of smallpox with hallucinations, false hearing, delirious speech, or seeing ghosts is considered incurable. One must examine which Zang organ is affected: If eyes stare straight and hands pick at clothes or fumble with objects, it originates from the Liver, representing loss of Hun (Ethereal Soul). If restless and panting, scratching eyebrows, eyes, nose, and face, it originates from the Lung, representing loss of Po (Corporeal Soul). If jumping up, grinding teeth, crying loudly, startled, or unable to speak, it originates from the Heart, representing loss of Shen (Spirit). If drowsy, with convulsions of limbs and loss of appetite, it originates from the Spleen, representing loss of Yi (Intellect). If eyes lack luster, fear light, and curl up, it originates from the Kidney, representing loss of Zhi (Will). Thus, it is said: Incurable if True Zang pulses appear. Or, if these symptoms do not appear during fever but appear due to constipation, it is internal heat. First use Xuanfeng San (Disperse Wind Powder) to vent the heat, then administer Niuhuang Qingxin Wan (Calves' Gall and Realgar Pill) via Daochi San (Guide Out Redness Powder) targeting the Heart, or Fenhong Wan (Pink Pill) to calm the Shen. If the condition stops, it is treatable; if continuous, it is incurable. If dry feces are in the Stomach and no bowel movement occurs for three to five days, purging the intestines and detoxifying is appropriate, using Sishun Qingliang Yin (Four-Obedience Cooling Decoction) or Sanhuang Wan (Three-Yellows Pill). If manic at initial fever with normal stools, use Wuling San (Five-Ingredient Powder with Licorice) plus Zhusha (Cinnabar); if constipated, mild cases use Sanhuang Wan, severe cases use Chengqi Tang (Chengqi Decoction).
If sudden confusion and delirium occur during the rising, blistering, or crusting stages, it is due to dense lesions consuming Jing blood, failing to nourish the Shen. It is appropriate to nourish blood and drain fire, using Anshen Wan (Calming Spirit Pill).
Anshen Wan (Calming Spirit Pill)
Huanglian (Coptidis Rhizoma), Danggui Shen (Angelicae Sinensis Radix), Maidong (Ophiopogonis Tuber), Baifushen (Poria Cocos with Hostwood), Gancao (Glycyrrhizae Radix et Rhizoma) (each half liang), Zhusha (Cinnabaris) (one liang), Longnao (Borneolum Syntheticum) (two fen and half).
Grind into powder, mix with steamed bread dough soaked in decoction, knead evenly with pig heart blood, and form pills the size of millet seeds. Take ten pills per dose, washed down with Dengxin Cao Tang (Juncus Effusus Decoction).
Zhizi Ren Tang (Gardenia Kernel Decoction)
Indications: Irritability, delirious speech, panic, and convulsions.
Zhizi Ren (Gardeniae Fructus), Huangqin (Scutellariae Radix), Shigao (Gypsum Fibrosum) (each two qian), Zhimu (Anemarrhenae Rhizoma), Xingren (Armeniacae Semen Amarum) (each one qian and half), Daqing (Isatidis Folium), Chaihu (Bupleuri Radix), Douchi (Sojae Semen Praeparatum), Chi Shaoyao (Paeoniae Radix Rubra) (each one qian), Shengma (Cimicifugae Rhizoma) (eight fen), Gancao (Glycyrrhizae Radix et Rhizoma) (five fen).
Decoct in water and take orally.
If unconscious and speaking incoherently, death ensues. The Classics state: Disarray in clothing and bedding, and speech disregarding kinship distinctions, indicate disorder of the Shen Ming (Spiritual Consciousness), thus incurable. If hallucinations and fear resembling seeing ghosts occur at the initial fever stage, it is incurable. This symptom should not appear throughout the disease course; its presence indicates total loss of Shen and Zhi, leaving only the physical shell, merely prolonging life.