〔万〕疮疹渴者，里热也。盖三焦者，水谷之道路，津液者，水谷之精华，变化流行，以灌溉乎三焦也。
疮疹之火起之于内，销烁水谷，不得以变化津液，灌溉脏腑，故渴也。又疮本稠密，津液外泄，化为脓浆，
不能滋养真气，亦渴也。小渴者，
常病也，不须治之，大渴者，视其虚实以法治之，切不可以冷水、红柿、梨、橘、西瓜、等物与之，恐损脾胃，
致生灾异也。〔薛〕前证，若二便自调，饮食温和，口渴饮汤，手足不热，是为虚热，不可食生冷之物。若
二便秘结，饮食喜冷，口渴饮水，手足并热，是为实热，可与冷水饮之。凡痘出而热未止者，既出尽，则热自止。
如发热时便大渴者，热在里也，葛根解毒汤主之，不止，更加黄连以泻心火之有余，黄柏、知母、以滋肾
水之不足，舌润则生，舌如芒刺则死。盖舌乃心之苗，少阴之脉，荣于舌也，如发热自利而渴者，津液不足也，黄芩
汤加人参、白术、麦门冬主之。丹溪云∶初热烦躁渴引饮者，急以凉药解其标。钱氏云∶身热烦渴，
腹满而喘，大小便涩而赤，闷乱大吐，此当利小便，不瘥者，宣风散下之。
葛根解毒汤
葛粉 天花粉 麦门冬 生地黄 升麻（各等分） 甘草（减半）
上锉细。取糯米泔水一盏，煎七分，去滓，入茅根自然汁一合，服之。
黄芩汤（痘泄利） 五苓散（惊） 宣风散（痘发热）
如疮已出，或起发，或收靥，一向渴不止者，人参麦门冬散主之。海藏云∶若身热小渴者，六味人参麦门冬
散治之。如不愈，或身热大渴者，七味人参白术散治之。又不愈，十一味木香散。
人参麦门冬散
麦门冬 葛粉（各二钱） 人参 甘草 升麻 白术（各一钱）
上锉细。加粳米一合，淡竹叶七片，水一盏，煎米熟，去滓温服。
六味人参麦门冬散
麦门冬（去心，一两） 人参（去芦） 甘草（炙） 陈皮 白术 浓朴（姜制。各半两）
上 咀。每服三钱，水一盏，煎至六分，去滓温服。虚人减浓朴。
〔庞氏〕 地黄膏（见形）
退火回生散 治痘血热，枯涩发渴。
滑石 辰砂（各一钱） 冰片（三厘）
上为细末。冷水调服一分，睡片时，必转红活矣。
如能食而渴者，肺热也。经曰∶心移热于肺，传为膈消，由心火上炎，乘于肺
金，熏蒸焦膈，传耗津液，故渴也。治在上焦，人参白虎汤加黄连主之。
人参白虎汤（又名化 汤）
人参 甘草（各一钱） 知母（三钱） 石膏（五钱） 粳米（一合）
上锉细。水二盏，煎待米熟，去滓温服，无时。
竹叶石膏汤 治痘疮表里俱虚，胸中烦闷，小便赤涩，多渴。成赤 点者，又宜服犀角散。
石膏 知母（各二两） 麦门冬 甘草（各一两）
上锉散。每服三钱，水一盏，淡竹叶一握，煎半盏，温服，不拘时。
麦门冬汤 治 疹烦渴吐泻，及痂后余热。
麦门冬 人参 甘菊 赤芍药 赤茯苓 升麻（各一钱） 甘草（五分） 石膏（三钱）
上，用水煎服。
如不能食而渴者，脾虚也。叔和云∶口干，饶饮水，多食亦饥，虚由脾素弱，
不能为胃行其津液，故渴也。治在中焦，参苓白术散主之。
人参白术散（又名参苓白术散）
人参 白术 藿香 木香 甘草 白伏苓（各一钱） 干葛（二钱）
上锉细。加生姜一片，水一盏，煎七分，去滓，温服无时。
〔丹〕陈十妹、年二十岁，出痘，而有孕七个半月，大渴，不甚出透，寒热交作，血虚气虚。
人参 白术 黄 陈皮 甘草（炙） 当归身（各一钱）
姜三片，酒水各半盏，煎服。
自利而渴，轻则人参白术散，甚则陈氏木香散。自利而渴者邪传肾也，《正理论》云∶自利而渴者，属
少阴虚，故引水自救，盖肾主五液，其脉络于肺，系舌本，邪传于肾，则开阖不司，故自利，利则津液
下走，肾水干，不能上润于舌，故大渴也，治在下焦，宜温之，陈氏异攻散主之（出不快）。
面白腹胀，自利而渴者，陈氏十一味木香散主之。文中云∶腹胀渴者，泻渴者，足指冷渴者，惊悸渴者，
身温渴者，身热面 白色渴者，寒战渴不止者，气急切牙渴者，饮水转水泻不已者，以上九证，即非热也，
乃津液少，脾胃肌肉虚故也，宜木香散治之。如不愈，更加丁香、官桂。（此说，必加审用之，胀渴、泻渴、惊
悸渴、寒战渴、切牙
渴、亦多属热者，不可不察）如渴而大便秘者，宜利之，四顺清凉饮主之（热）。海藏云∶疮疹大
肠闭涩，或发热，四君子加栝蒌根、桔梗主之。
痘子稠密，津液少者，十全大补汤（汗）。
生脉散 止烦渴，首尾通用。
人参 五味子 麦门冬
水煎，当茶饮。
神功散 治痘作渴。
人参 黄 甘草 牛蒡子 红花 生地黄 前胡 紫草 白芍药
上，水煎服。
红花汤 治同上。
红花或子，随意煎汤饮，其渴即止，纵口中如烟，饮之即止。加牛蒡子尤妙。
[Wan Quan's Discussion] Thirst occurring during the eruption of sores and rashes is due to internal heat. The Sanjiao (Triple Burner) is the pathway for food and fluids; Jin Ye (Body Fluids) are the essence derived from food and fluids, which transform and circulate to irrigate the Sanjiao.
The fire of sores and rashes arises internally, consuming food and fluids, preventing the transformation of Jin Ye to irrigate the Zang-Fu organs, thus causing thirst. Furthermore, if the sores are dense, Jin Ye leaks externally and transforms into pus, failing to nourish the True Qi, which also causes thirst.
Mild thirst is a common condition and requires no treatment. Severe thirst should be treated according to deficiency or excess. One must absolutely avoid giving cold water, red persimmons, pears, oranges, watermelons, etc., as these may damage the Spleen and Stomach, leading to further complications.
[Xue Ji's Discussion] In the aforementioned symptoms, if urination and defecation are normal, diet is moderate, thirst is relieved by drinking hot water, and the hands and feet are not hot, this indicates Deficient Heat; raw and cold foods should be avoided. If urination and defecation are constipated, there is a preference for cold drinks, thirst is relieved by drinking water, and both hands and feet are hot, this indicates Excess Heat; cold water may be given. Generally, when fever persists after the eruption of smallpox, once the eruption is complete, the fever will cease naturally.
If severe thirst occurs during fever, the heat is in the interior; Gegen Jiedu Tang (Kudzu Root Detoxification Decoction) is the primary formula. If thirst persists, add Huanglian (Coptis Rhizome) to drain excess Heart Fire, and add Huangbai (Phellodendron Bark) and Zhimu (Anemarrhena Rhizome) to nourish deficient Kidney Water. A moist tongue indicates survival; a tongue with prickles like thorns indicates death. The tongue is the sprout of the Heart, and the Shaoyin meridian nourishes it.
If fever accompanies spontaneous diarrhea and thirst, it indicates insufficient Jin Ye; Huangqin Tang (Scutellaria Decoction) added with Renshen (Ginseng), Baizhu (Atractylodes Macrocephala Rhizome), and Maimendong (Ophiopogon Tuber) is indicated. Zhu Danxi stated: For initial fever, irritability, and intense thirst, urgently use cooling herbs to resolve the branch symptom. Qian Yi stated: For body heat, irritability, and thirst, abdominal fullness, panting, scanty and dark urine and stool, severe restlessness, and vomiting, one should promote urination. If ineffective, use Xuanfeng San (Wind-Releasing Powder) to purge.
Gegen Jiedu Tang (Kudzu Root Detoxification Decoction)
Ingredients: Gegen (Kudzu Root Powder), Huafen (Trichosanthes Root), Maimendong (Ophiopogon Tuber), Shengdihuang (Rehmannia Root), Shengma (Cimicifuga Rhizome) (equal parts); Gancao (Licorice Root) (half dose).
Preparation: Cut finely. Take one cup of rice washing water, decoct until reduced to 70%, strain, add one liang of fresh juice from Imperata cylindrica root, and administer.
Huangqin Tang (for smallpox diarrhea), Wuling San (for fright convulsion), Xuanfeng San (for smallpox fever).
If the sores have erupted, or are rising, or are scabbing over, but thirst persists continuously, Ren Shen Maimendong San (Ginseng and Ophiopogon Powder) is indicated. Li Dongyuan stated: For mild body heat and slight thirst, Liuwei Renshen Maimendong San (Six-Ingredient Ginseng and Ophiopogon Powder) is used. If ineffective, or if there is severe body heat and intense thirst, Qiwei Renshen Baizhu San (Seven-Ingredient Ginseng and Atractylodes Powder) is used. If still ineffective, use Shi Yi Wei Muxiang San (Eleven-Ingredient Aucklandia Powder).
Ren Shen Maimendong San (Ginseng and Ophiopogon Powder)
Ingredients: Maimendong (Ophiopogon Tuber), Gegen (Kudzu Root Powder) (each 2 qian); Renshen (Ginseng), Gancao (Licorice Root), Shengma (Cimicifuga Rhizome), Baizhu (Atractylodes Macrocephala Rhizome) (each 1 qian).
Preparation: Cut finely. Add one heko of Jingmi (Japonica Rice), seven leaves of Danyezhu (Light Bamboo Leaf), one cup of water, decoct until the rice is cooked, strain, and take warm.
Liuwei Renshen Maimendong San (Six-Ingredient Ginseng and Ophiopogon Powder)
Ingredients: Maimendong (Ophiopogon Tuber, heart removed, 1 liang); Renshen (Ginseng, rhizome removed), Gancao (Licorice Root, honey-fried), Chenpi (Citrus Reticulata Peel), Baizhu (Atractylodes Macrocephala Rhizome), Houpo (Magnolia Bark, ginger-processed) (each half liang).
Preparation: Cut into pieces. Take 3 qian per dose, one cup of water, decoct until reduced to 60%, strain, and take warm. Reduce Houpo for deficient patients.
[Pang's Discussion] Dihuang Gao (Rehmannia Paste) (used during the manifestation stage).
Tuohuo Huisheng San (Fire-Reducing Life-Restoring Powder): Treats thirst caused by blood heat and dryness in smallpox.
Ingredients: Huashi (Talcum), Chensha (Cinnabar) (each 1 qian), Bingpian (Borneol) (3 li).
Preparation: Grind into fine powder. Mix with cold water, take 1 fen, sleep for a while; the sores will turn red and lively.
If the patient can eat but feels thirsty, it is Lung Heat. The Classics state: "Heart transfers heat to the Lung, transmitting as Ge Xiao (Diaphragmatic Consumption)." This is due to Heart Fire flaring upward, attacking Lung Metal, steaming the diaphragm, and consuming Jin Ye, thus causing thirst. The pathology is in the Upper Jiao; Ren Shen Baihu Tang (Ginseng White Tiger Decoction) added with Huanglian (Coptis Rhizome) is indicated.
Ren Shen Baihu Tang (Ginseng White Tiger Decoction) (also known as Hua Ban Tang)
Ingredients: Renshen (Ginseng), Gancao (Licorice Root) (each 1 qian); Zhimu (Anemarrhena Rhizome) (3 qian); Shigao (Gypsum Fibrosum) (5 qian); Jingmi (Japonica Rice) (one heko).
Preparation: Cut finely. Two cups of water, decoct until the rice is cooked, strain, and take warm at any time.
Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction): Treats smallpox with deficiency in both exterior and interior, chest irritability, dark and scanty urination, and excessive thirst. If red macules appear, Xijiao San (Rhinoceros Horn Powder) is suitable.
Ingredients: Shigao (Gypsum Fibrosum), Zhimu (Anemarrhena Rhizome) (each 2 liang); Maimendong (Ophiopogon Tuber), Gancao (Licorice Root) (each 1 liang).
Preparation: Cut into coarse powder. Take 3 qian per dose, one cup of water, a handful of Danyezhu (Light Bamboo Leaf), decoct until half a cup remains, take warm at any time.
Maimendong Tang (Ophiopogon Decoction): Treats irritability, thirst, vomiting, and diarrhea in measles, as well as residual heat after scabbing.
Ingredients: Maimendong (Ophiopogon Tuber), Renshen (Ginseng), Ganju (Chrysanthemum Morifolium Flower), Chishaoyao (Red Peony Root), Chifuling (Poria with Red Mycelium), Shengma (Cimicifuga Rhizome) (each 1 qian); Gancao (Licorice Root) (5 fen); Shigao (Gypsum Fibrosum) (3 qian).
Preparation: Decoct in water and take.
If the patient cannot eat but feels thirsty, it is Spleen Deficiency. Wang Shuhe stated: "Dry mouth, frequent desire to drink, hunger despite eating much" is due to inherent Spleen weakness, failing to transport Jin Ye for the Stomach, thus causing thirst. The pathology is in the Middle Jiao; Shen Ling Bai Zhu San (Ginseng, Poria, and Atractylodes Powder) is indicated.
Ren Shen Baizhu San (Ginseng and Atractylodes Powder) (also known as Shen Ling Bai Zhu San)
Ingredients: Renshen (Ginseng), Baizhu (Atractylodes Macrocephala Rhizome), Huoxiang (Patchouli Herb), Muxiang (Aucklandia Root), Gancao (Licorice Root), Baifuling (Poria), Gange (Dried Kudzu Root) (each 1 qian).
Preparation: Cut finely. Add one slice of Shengjiang (Fresh Ginger), one cup of water, decoct until reduced to 70%, strain, and take warm at any time.
[Dan Xi's Case] Chen Shimei, aged twenty, suffered from smallpox while pregnant for seven and a half months. She had severe thirst, the eruption was not fully transparent, and alternating chills and fever occurred, indicating Blood and Qi deficiency.
Prescription: Renshen (Ginseng), Baizhu (Atractylodes Macrocephala Rhizome), Huangqi (Astragalus Root), Chenpi (Citrus Reticulata Peel), Gancao (Licorice Root, honey-fried), Dangguishen (Angelica Sinensis Root Body) (each 1 qian).
Add three slices of Shengjiang (Fresh Ginger), half a cup of wine and half a cup of water, decoct and take.
Spontaneous diarrhea with thirst: Mild cases use Ren Shen Baizhu San; severe cases use Chen Shi Muxiang San. Spontaneous diarrhea with thirst indicates pathogen transmission to the Kidney. The Zheng Li Lun states: "Spontaneous diarrhea with thirst belongs to Shaoyin deficiency," hence the desire to drink water to save oneself. The Kidney governs the five fluids, its meridians connect to the Lung, and it ties to the base of the tongue. Pathogen transmission to the Kidney disrupts opening and closing functions, causing spontaneous diarrhea; fluid loss leads to downward flow of Jin Ye, drying Kidney Water, which fails to moisten the tongue, causing severe thirst. The pathology is in the Lower Jiao, requiring warming; Chen Shi Yigong San (Chen's Differentiated Attack Powder) is indicated (for slow eruption).
Pale face, abdominal distension, spontaneous diarrhea with thirst: Chen Shi Shi Yi Wei Muxiang San (Chen's Eleven-Ingredient Aucklandia Powder) is indicated. The text states: Abdominal distension with thirst, diarrhea with thirst, cold toes with thirst, palpitations with fright with thirst, warm body with thirst, fever with pale/white face with thirst, shivering with persistent thirst, rapid breathing with teeth grinding with thirst, drinking water leading to continuous watery diarrhea—these nine syndromes are not heat patterns, but rather insufficient Jin Ye and deficiency of Spleen/Stomach muscles. Muxiang San is indicated. If ineffective, add Dingxiang (Caryophylli Flos) and Guirui (Cinnamon Twig). (Note: This view must be applied cautiously; abdominal distension-thirst, diarrhea-thirst, palpitation-thirst, shivering-thirst, and teeth-grinding-thirst often belong to heat patterns and must be carefully distinguished.)
Thirst with constipation: Promote purgation; Sishun Qingliang Yin (Four-Obedience Cooling Drink) is indicated (heat pattern). Li Dongyuan stated: For smallpox with large intestine obstruction or fever, Sijunzi Tang (Four Gentlemen Decoction) added with Gualougen (Trichosanthes Root) and Jiegeng (Platycodon Root) is indicated.
Dense smallpox with insufficient Jin Ye: Shiquan Dabu Tang (Complete Great Tonifying Decoction) (for excessive sweating).
Shengmai San (Generate Pulse Powder): Stops irritability and thirst; applicable throughout the course of the disease.
Ingredients: Renshen (Ginseng), Wuweizi (Schisandra Berry), Maimendong (Ophiopogon Tuber).
Preparation: Decoct in water, drink as tea.
Shengong San (Divine Merit Powder): Treats thirst in smallpox.
Ingredients: Renshen (Ginseng), Huangqi (Astragalus Root), Gancao (Licorice Root), Niubangzi (Arctii Fructus), Honghua (Carthamus Flower), Shengdihuang (Rehmannia Root), Qianhu (Peucedani Radix), Zicao (Leonuri Herba), Baishaoyao (White Peony Root).
Preparation: Decoct in water and take.
Honghua Tang (Carthamus Decoction): Treats the same as above.
Ingredients: Honghua (Carthamus Flower) or Honghuazi (Carthamus Seed), decoct in water as desired. Thirst will cease immediately; even if the mouth feels smoky, drinking will stop it. Adding Niubangzi (Arctii Fructus) is especially effective.