未出烦躁消毒平，已出烦躁凉血宁，浆清发烦保元治，靥后虚烦四物灵。
【注】痘证始终以安静为吉，但有烦躁，必生他变。盖烦者，心愤也；躁者，身扰也。
皆由毒火太盛，神不能静也，痘未出而烦躁，是为表郁，以消毒饮主之；痘已出而烦躁，是
为血热，以凉血解毒汤主之；若养浆时顶平清稀而烦躁，是气虚也，以加味保元汤主之；
收靥后而烦躁，是血虚也，以加减四物汤主之。
加减消毒饮（方见杂证中发热）
凉血解毒汤（方见结痂落痂证治）
加味保元汤
人参 黄 （制） 甘草（炙） 当归（酒洗） 白芍药（炒） 麦冬（去心）
枣仁（炒、研）
水煎服。
【方歌】加味保元治虚烦，人参黄 甘草攒，酒洗当归白芍药，麦冬枣仁一同煎。
加减四物汤
人参 当归 麦门冬（去心） 生地 栀子（炒） 白芍药（炒）
水煎服。
【方歌】靥后血虚多烦躁，加减四物汤最妙，人参当归麦门冬，生地栀子白芍药。
毒热炽盛犯心经，错语妄言神不清，妄见妄闻志昏愦，黄连解毒服即宁。
【注】谵妄者，由毒热炽盛，上干心气，致使错语妄言，神气不清，妄见妄闻，志气
昏愦，以黄连解毒汤主之。
黄连解毒汤（方见结痂落痂证治）
初热大渴解毒汤，血热煎耗凉血良，成浆津泄麦冬散，靥后伤津生脉强。
【注】渴，由毒火燔灼，内伤津液而作也。如初发热即大渴者，里热盛也，宜葛根解毒
汤治之；痘出稠密，色艳作渴者，此血热毒盛也，凉血解毒汤主之；成浆津液外泄而作
渴者，人参麦冬散主之；靥后脾虚，内伤津液而作渴者，生脉六均汤主之。
葛根解毒汤
葛根 升麻 天花粉 甘草（生） 麦门冬（去心） 生地 茅根
引用灯心，水煎服。
【方歌】葛根解毒汤清热，津液上潮火自泄，升葛花粉生甘草，麦冬生地茅根列。
凉血解毒汤（方见结痂落痂证治）
人参麦冬散
人参 白术（土炒） 甘草（生） 葛根粉（煨） 麦冬（去心） 升麻
引用糯米，水煎服。
【方歌】人参麦冬效通仙，津液外泄治易痊，参术甘草煨葛粉，麦冬升麻糯米煎。
生脉六均汤
人参 五味子 麦门冬（去心） 陈皮 半夏（姜制） 茯苓 白术（土炒）
甘草（炙）
引用乌梅，水煎服。
【方歌】生脉六均医脾弱，泄泻伤津大渴作，人参五味麦门冬，陈半苓术甘草合。
Irritability and restlessness before the eruption of smallpox are pacified with Xiaodu Yin (Detoxification Decoction); irritability and restlessness after the eruption are calmed with Liangxue Tang (Cooling Blood Decoction). If irritability occurs during the fluid-filling stage with flat, clear, and thin pustules, Baoyuan Tang (Preserve the Origin Decoction) is used; if irritability due to deficiency occurs after the scabs fall off, Siwu Tang (Four Substances Decoction) is effective.
[Note] In smallpox cases, tranquility is always auspicious; the appearance of irritability and restlessness inevitably leads to other complications. "Fan" (irritability) refers to mental agitation; "Zao" (restlessness) refers to physical tossing and turning. These are caused by excessive toxic heat, preventing the spirit from remaining calm. Irritability and restlessness before the eruption indicates exterior constraint, treated primarily with Xiaodu Yin (Detoxification Decoction); irritability and restlessness after the eruption indicates blood heat, treated primarily with Liangxue Jiedu Tang (Cooling Blood and Detoxifying Decoction). If irritability occurs during the fluid-filling stage with flat pustules and clear, thin fluid, it indicates Qi deficiency, treated primarily with Jiawei Baoyuan Tang (Modified Preserve the Origin Decoction); irritability after the scabs fall off indicates Blood deficiency, treated primarily with Jiajian Siwu Tang (Modified Four Substances Decoction).
Ji Jian Xiaodu Yin (Formula see Miscellaneous Diseases: Fever chapter)
Liangxue Jiedu Tang (Formula see Scabbing and Falling Off chapter)
Jiawei Baoyuan Tang (Modified Preserve the Origin Decoction)
Renshen (Ginseng Radix), Huangqi (Astragali Radix, processed), Gancao (Licorice Root, honey-fried), Danggui (Angelicae Sinensis Radix, wine-washed), Baishao Yao (Paeoniae Radix Alba, stir-fried), Maidong (Ophiopogonis Tuber, heart removed), Zaoren (Ziziphi Spinosomi Semen, stir-fried and crushed).
Decoct in water and take orally.
[Formula Song] Jiawei Baoyuan treats deficiency-induced irritability, Renshen, Huangqi, and Gancao gather together; wine-washed Danggui and Baishao Yao, Maidong and Zaoren decocted together.
Jiajian Siwu Tang (Modified Four Substances Decoction)
Renshen (Ginseng Radix), Danggui (Angelicae Sinensis Radix), Maimendong (Ophiopogonis Tuber, heart removed), Shengdi (Rehmanniae Radix Preparata), Zhizi (Gardeniae Fructus, stir-fried), Baishao Yao (Paeoniae Radix Alba, stir-fried).
Decoct in water and take orally.
[Formula Song] After scabs fall off, Blood deficiency causes much irritability, Jiajian Siwu Tang is best; Renshen, Danggui, Maimendong, Shengdi, Zhizi, and Baishao Yao.
When toxic heat blazes and invades the Heart Meridian, it causes confused speech, delirious talking, and unclear spirit, along with hallucinations (seeing or hearing things that are not there) and mental confusion. Taking Huanglian Jiedu Tang (Coptis Decoction for Detoxification) brings immediate calm.
[Note] Delirium (Chanwang) is caused by blazing toxic heat disturbing the Qi of the Heart, resulting in confused speech, delirious talking, unclear spirit, hallucinations, and mental confusion. It is treated primarily with Huanglian Jiedu Tang (Coptis Decoction for Detoxification).
Huanglian Jiedu Tang (Formula see Scabbing and Falling Off chapter)
During the initial heat stage, severe thirst is treated with Jiedu Tang (Detoxification Decoction); when blood heat consumes fluids, Liangxue Tang (Cooling Blood Decoction) is effective. During the fluid-filling stage, thirst due to fluid leakage is treated with Maidong San (Ophiopogon Powder); after scabs fall off, thirst due to fluid injury is strengthened with Shengmai Liu Jun Tang (Generate Pulse Six-Equal Decoction).
[Note] Thirst arises from toxic fire blazing and injuring internal fluids internally. If severe thirst occurs immediately upon initial fever, it indicates interior heat excess, treated with Gegen Jiedu Tang (Kudzu Root Detoxification Decoction); if smallpox eruptions are dense, bright red, and accompanied by thirst, this indicates blood heat and toxin excess, treated with Liangxue Jiedu Tang (Cooling Blood and Detoxifying Decoction); if thirst occurs during the fluid-filling stage due to external leakage of fluids, Ren Shen Maidong San (Ginseng and Ophiopogon Powder) is used; if thirst occurs after scabs fall off due to Spleen deficiency and internal fluid injury, Shengmai Liu Jun Tang (Generate Pulse Six-Equal Decoction) is used.
Gegen Jiedu Tang (Kudzu Root Detoxification Decoction)
Gegen (Puerariae Lobatae Radix), Shengma (Cimicifugae Rhizoma), Tianhuafen (Trichosanthis Radix), Gancao (Licorice Root, raw), Maimendong (Ophiopogonis Tuber, heart removed), Shengdi (Rehmanniae Radix Preparata), Maogen (Imperatae Rhizoma).
Use Dengxincao (Junci Medulla) as a guide, decoct in water and take orally.
[Formula Song] Gegen Jiedu Tang clears heat, fluids rise and fire dissipates naturally; Shengma, Gegen, Tianhuafen, raw Gancao, Maidong, Shengdi, and Maogen are arranged.
Liangxue Jiedu Tang (Formula see Scabbing and Falling Off chapter)
Ren Shen Maidong San (Ginseng and Ophiopogon Powder)
Renshen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma, earth-fried), Gancao (Licorice Root, raw), Gegen Fen (Puerariae Lobatae Radix starch, roasted), Maidong (Ophiopogonis Tuber, heart removed), Shengma (Cimicifugae Rhizoma).
Use Nuomi (Oryza Sativa Glutinosa) as a guide, decoct in water and take orally.
[Formula Song] Ren Shen Maidong San has efficacy like an immortal, easily curing external fluid leakage; Ginseng, Atractylodes, Licorice, roasted Kudzu starch, Ophiopogon, Cimicifuga, and glutinous rice decocted.
Shengmai Liu Jun Tang (Generate Pulse Six-Equal Decoction)
Renshen (Ginseng Radix), Wuweizi (Schisandrae Chinensis Fructus), Maimendong (Ophiopogonis Tuber, heart removed), Chenpi (Citri Reticulatae Pericarpium), Banxia (Pinelliae Tuber, ginger-processed), Fuling (Poria), Baizhu (Atractylodis Macrocephalae Rhizoma, earth-fried), Gancao (Licorice Root, honey-fried).
Use Wumei (Mume Fructus) as a guide, decoct in water and take orally.
[Formula Song] Shengmai Liu Jun Tang treats Spleen weakness, diarrhea injuring fluids causing severe thirst; Ginseng, Schisandra, Ophiopogon, Citrus peel, Pinellia, Poria, Atractylodes, and Licorice combined.