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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.