斑疹烦热神昏，舌黄尖绎，夜则谵妄，斑疹并
透，此热渐入营。宜用玉女煎加元参、连翘、人中
黄、鲜石斛、鲜菖蒲、青竹叶等味。清营转气也。
上条在气，此条入营，盖斑疹已透，而热犹未清，更兼
神昏夜谵，舌黄尖绛，入营之状昭然。故宜玉女煎两清气
血，合连翘、元参化斑，石斛养胃，人中黄解毒，菖蒲、竹
叶清营，使其从营转气，由气达表，不致入血为妙。
斑疹舌绎而黑，神昏谵语，烦燥妄笑，此热入心
包。宜用玉女煎加犀角、元参心、连翘心，鲜菖蒲、
牛黄丸等味，清营透斑也。
上条热入营络，此条热入心胞，渐延血分。夫营与心
胞，似为一症，实则营浅心深，却有层次之分。《温热论》
所谓卫之后方言气，营之后方言血。此为的辨。故心主血，
心热则血热，血热则神昏妄笑，舌绛而焦。非藉白虎清气，
生地凉血，犀角、元参、连翘化斑，菖蒲清窍，则热何由
解，斑何由化耶!
斑疹舌黑尖绎，神昏妄笑，扬手掷足，寻衣摸
床，此热入血分。宜用犀角地黄汤加元参，连翘、鲜
石斛、鲜菖蒲、青竹叶、牛黄丸、人中黄，人参等
味，凉血化斑也。
斑疹既透，烦热更甚，至舌黑尖绛，神昏妄笑，乃热已
入血，阴伤风动;扬手掷足，寻衣摸床，正虚不能胜邪，将
厥之兆也。急宜犀角地黄汤凉血，元参、连翘、石斛清热，
人参扶正，菖蒲、竹叶清心，人中黄化斑解毒，牛黄丸宜窍
逐秽，庶济危险于万一耳。
Maculae and papules appear accompanied by vexatious heat, clouding of spirit (clouding of consciousness), yellow tongue coating with a crimson tip, and delirium at night. The maculae and papules emerge simultaneously, indicating that the pathogenic heat is gradually entering the Ying (Nutrient) level. It is appropriate to use Yunu San (Jade Woman Decoction) added with Xuanshen (Radix Scrophulariae), Lianqiao (Forsythiae Fructus), Renzhonghuang (Calculus Bovis processed with human excrement), fresh Shihu (Dendrobii Caulis), fresh Shichangpu (Acori Tatarinowii Rhizoma), and Qingzhuyezi (Bambusae Folium). This method clears the Ying level and transforms the heat back to the Qi level.
The previous clause discussed pathology in the Qi level; this clause discusses pathology entering the Ying level. Generally, although the maculae and papules have emerged, the heat remains unclarified, compounded by clouding of spirit and delirium at night, along with a yellow tongue coating and crimson tip, making the signs of entering the Ying level evident. Therefore, it is appropriate to use Yunu San (Jade Woman Decoction) to clear both Qi and Blood levels simultaneously, combined with Lianqiao (Forsythiae Fructus) and Xuanshen (Radix Scrophulariae) to resolve the maculae, Shihu (Dendrobii Caulis) to nourish Stomach Yin, Renzhonghuang (Calculus Bovis processed with human excrement) to detoxify, and Shichangpu (Acori Tatarinowii Rhizoma) and Zhuyezi (Bambusae Folium) to clear the Ying level. This allows the heat to transform from Ying to Qi, and from Qi to reach the exterior, avoiding entry into the Xue (Blood) level, which is the essence of the treatment.
Maculae and papules appear with a crimson and black tongue body, clouding of spirit, delirious speech, restlessness, and inappropriate laughter. This indicates that heat has entered the Pericardium (Xinbao). It is appropriate to use Yunu San (Jade Woman Decoction) added with Xijiao (Rhinocerotis Cornu), Xuanshenxin (Medulla Sparganii), Lianqiaoxin (Core Forsythiae Fructus), fresh Shichangpu (Acori Tatarinowii Rhizoma), and Niuhuang Wan (Calculus Bovis Pill), to clear the Ying level and vent the maculae.
The previous clause described heat entering the Ying collaterals; this clause describes heat entering the Pericardium, gradually extending into the Xue (Blood) level. Although Ying level and Pericardium pathology seem similar, the Ying level is superficial while the Pericardium is deep, reflecting distinct hierarchical layers. As stated in *Wenre Lun* (Treatise on Warm Diseases): "After the Wei (Defensive) level, one speaks of the Qi level; after the Ying level, one speaks of the Xue level." This provides an accurate differentiation. Since the Heart governs the Blood, Heart heat leads to Blood heat; Blood heat causes clouding of spirit and inappropriate laughter, resulting in a crimson and scorched tongue body. Without relying on Baihu Tang (White Tiger Decoction) to clear Qi-level heat, Shengdi Huang (Rehmanniae Radix) to cool the Blood, Xijiao (Rhinocerotis Cornu), Xuanshen (Radix Scrophulariae), and Lianqiao (Forsythiae Fructus) to resolve maculae, and Shichangpu (Acori Tatarinowii Rhizoma) to open orifices, how could the heat be resolved and the maculae dissipated?
Maculae and papules appear with a black tongue body and crimson tip, clouding of spirit, inappropriate laughter, flinging hands and feet, and groping at clothes and bedsides. This indicates that heat has entered the Xue (Blood) level. It is appropriate to use Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction) added with Xuanshen (Radix Scrophulariae), Lianqiao (Forsythiae Fructus), fresh Shihu (Dendrobii Caulis), fresh Shichangpu (Acori Tatarinowii Rhizoma), Qingzhuyezi (Bambusae Folium), Niuhuang Wan (Calculus Bovis Pill), Renzhonghuang (Calculus Bovis processed with human excrement), and Renshen (Ginseng Radix et Rhizoma), to cool the Blood and resolve maculae.
Since the maculae and papules have emerged, the vexatious heat intensifies further. When the tongue becomes black with a crimson tip, accompanied by clouding of spirit and inappropriate laughter, it signifies that heat has entered the Xue (Blood) level, damaging Yin fluids and stirring internal wind. Flushing hands and feet, and groping at clothes and bedsides, indicate that righteous Qi is too weak to overcome the pathogenic factor, signaling an impending Jue syndrome (collapse). Urgently, Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction) should be used to cool the Blood, Xuanshen (Radix Scrophulariae), Lianqiao (Forsythiae Fructus), and Shihu (Dendrobii Caulis) to clear heat, Renshen (Ginseng Radix et Rhizoma) to support righteousness, Shichangpu (Acori Tatarinowii Rhizoma) and Zhuyezi (Bambusae Folium) to clear the Heart, Renzhonghuang (Calculus Bovis processed with human excrement) to resolve maculae and detoxify, and Niuhuang Wan (Calculus Bovis Pill) to open orifices and expel turbidity, thereby perhaps saving life from extreme danger.