送下牛黄清心丸以镇其神。○如胃中有燥屎，三、五日未更衣，因而谵妄者，宜涤肠解毒，四顺清凉饮、三黄丸。
○如初热狂乱，大便自调者，五苓散加辰砂。○如起发成浆欲 之时，忽然神昏谵妄者，此由痘本稠密，精血
外耗，不能养神，宜养血泻火，安神丸主之。（《证治准绳》）
烦躁
烦者扰扰而烦，躁者愦愦而躁，合而言之，烦躁皆热也。析而分之，烦，阳也，热之轻；躁，阴也，热之
甚。《难知集》曰∶火入于肺则烦，火入于肾则躁。疮疹烦躁，须宜忌之。若吐利厥逆，腹胀喘促而烦躁者，
昏不知人；谵妄狂扰而烦躁者，谓之闷乱。皆不治之证。○凡痘疮盛作之时，必令心火有所导引。苟或毒出而
未尽，遂生烦躁，治以黑豆汤磨生犀汁饮之。若津液不足，虚烦不得卧者，宜酸枣仁汤。○如肺热而烦者，坐
卧不安，审于何时∶若初热便烦者，此毒火内郁也，用白虎汤加栀子；若疮见犹烦者，此毒伏于内未尽出也，用
消毒饮、夺命丹，合而服之；若疮出尽犹烦者，此内热也，用牛黄清心丸。（《证治准绳》）
二、三日间痘苗已长，日夜烦躁不止，防隐处发疔及斑疹等证。○标点虽见，热躁愈加，细参兼证∶或为
六气郁遏，则从时气治；或为内伤停滞，则从里证治。亦有表里两解者，亦有下夺者。但下法，寒凉之中必兼
活血理气，防其凝涩冰伏。（叶天士）
痘出烦闷不安，不问痘之轻重，先以清心安神为主，辰砂益元散最妙。神安则痘出，未有烦躁不安而毒得
解者。（许宣治）
失血
气为阳，血为阴。阳主动，阴主静。人身之血，不可妄动也。今疮疹之火，熏灼于里，迫血妄行，血随火
动，阳络伤则血从上出，或衄或呕；阴络伤则血从下出，或溺或便；阴阳俱伤，则血上下俱出也。诸失血惟从
鼻出者可治，余皆死证。有痘疮溃烂不能收 ，出血不止者，亦不可治。（万密斋）
所云血之妄行，悉皆不治，盖指出多而不止者言耳。若初出时，推其所因，善为清理，岂俱无生者耶？○
若痘疮赤痛，烦热作渴，便衄血者，先用犀角地黄汤，次用加减大紫草散，去黄 加木通。○治诸失血，始终以
犀角地黄汤加山栀、芩、连、白芍为主；亦有初出时衄血不止，用下药而得效者。（张兼善）
Administer Niuhuang Qingxin Wan (Calculus Bovis Clearing Heart Pill) to calm and anchor the Shen (Spirit). ○ If there are dry fecal masses in the Stomach, and no bowel movement for three to five days, leading to delirium, it is appropriate to purge the intestines and detoxify, using Sishun Qingliang Yin (Four-Compliant Cooling Decoction) or Sanhuang Wan (Three-Yellow Pill).
○ If during the initial fever there is mania and restlessness, but the stool is normal, use Wuling San (Five-Ling Powder) with Zhensha (Cinnabar). ○ If during the stage when pustules are forming and about to rupture, sudden coma and delirium occur, this is due to the density of the pox causing exhaustion of essence and blood, which fails to nourish the Shen. It is appropriate to nourish blood and drain fire, treating primarily with Anshen Wan (Calming Spirit Pill). (from *Zhengzhi Zhunsheng*)
Restlessness and Irritability (Fan Zao)
"Fan" refers to inner mental agitation; "Zao" refers to physical restlessness and irritability. Generally speaking, both Fan and Zao belong to Heat syndromes. Analytically distinguishing them: Fan belongs to Yang and indicates milder Heat; Zao belongs to Yin and indicates severe Heat. The *Nan Zhi Ji* states: Fire entering the Lung causes Fan; Fire entering the Kidney causes Zao. Restlessness and irritability in sores and rashes require careful differentiation and contraindication assessment. If accompanied by vomiting, diarrhea, cold limbs, abdominal distension, panting, and irritability, leading to unconsciousness; or if accompanied by delirium, mania, and irritability, termed "Men Luan" (stifling chaos), these are all incurable conditions. ○ Whenever pox is erupting vigorously, one must ensure that Heart Fire has a proper outlet. If toxins have not been fully expelled and subsequently cause irritability, treat with Heidou Tang (Black Soybean Decoction) mixed with raw Xijiao juice (Rhinoceros Horn Juice). If fluid deficiency causes empty heat leading to insomnia, Suanzao Ren Tang (Sour Jujube Seed Decoction) is appropriate. ○ If irritability is caused by Lung Heat, manifesting as inability to sit or lie still, observe the timing: If irritability occurs at the initial fever stage, this is internal depression of toxic fire, use Baihu Tang (White Tiger Decoction) with Zhizi (Gardenia); if irritability persists after eruptions appear, this is residual toxin hidden internally, use Xiaodu Yin (Detoxifying Decoction) and Duoming Dan (Life-Snatching Pill) taken together; if irritability persists after eruptions are complete, this is internal heat, use Niuhuang Qingxin Wan. (from *Zhengzhi Zhunsheng*)
Between the second and third day, when pox seeds have grown, continuous day-and-night irritability warns against hidden Ding (carbuncles) or macules/rashes in concealed areas. ○ Although spots are visible, if heat and restlessness intensify, carefully examine concurrent symptoms: If caused by obstruction of the Six Qi, treat according to seasonal pathogens; if caused by internal injury and stagnation, treat according to interior syndromes. There are cases requiring simultaneous release of exterior and interior, and cases requiring purgation. However, when using purgative methods, blood-invigorating and qi-regulating herbs must be added to cold-natured drugs to prevent coagulation and freezing stagnation. (Ye Tianshi)
For irritability and distress following pox eruption, regardless of severity, prioritize clearing the Heart and calming the Shen; Chen Sha Yiyuan San (Cinnabar Benefiting Origin Powder) is most excellent. When the Shen is calm, pox will erupt smoothly; there is no case where irritability and unrest allow toxins to resolve. (Xu Xuanzhi)
Blood Loss (Shi Xue)
Qi belongs to Yang, Blood belongs to Yin. Yang governs movement, Yin governs stillness. Blood in the human body must not move recklessly. Now, the fire of sores and rashes scorches internally, forcing blood to move recklessly. Blood follows the fire: if Yang collaterals are injured, blood exits from above, either via epistaxis or hematemesis; if Yin collaterals are injured, blood exits from below, either via hematuria or melena/hematochezia; if both Yin and Yang collaterals are injured, blood exits from both above and below. Among various types of blood loss, only epistaxis is treatable; others are fatal signs. Cases where pox ulcers fail to heal and bleeding continues incessantly are also incurable. (Wan Mizhai)
The statement that reckless blood flow is invariably incurable refers specifically to profuse and unceasing bleeding. If, at the initial eruption stage, the cause is identified and managed properly, can it be said that no patients survive? ○ If pox is red and painful, accompanied by irritability, heat, thirst, and epistaxis, first use Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction), followed by Jiajian Dazicao San (Modified Great Cistanche Powder), removing Huangqin (Scutellaria) and adding Mutong (Akebia). ○ For treating various blood losses, always prioritize Xijiao Dihuang Tang with Shanzhi (Gardenia), Huangqin (Scutellaria), Huanglian (Coptis), and Baishao (White Peony Root); there are also cases of persistent epistaxis at the initial stage that respond to purgatives. (Zhang Jianshan)