〔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。
【万全论述】疮疹出现口渴，是因为体内有热。三焦是水谷运行的通道，津液是水谷化生的精华，它们变化流行，以灌溉滋养三焦。
疮疹之火从体内发起，消耗水谷，导致无法化生津液来灌溉脏腑，所以产生口渴。另外，如果疮疹形态稠密，津液外泄化为脓浆，不能滋养真气，也会引起口渴。
轻微的口渴是常见病症，不需要治疗；严重的口渴，要根据患者的虚实情况采用相应方法治疗。切不可给予冷水、红柿、梨、橘子、西瓜等食物，恐怕损伤脾胃，导致其他病变。
【薛己论述】上述症状中，如果大小便正常，饮食温和，口渴想喝热水，手脚不发热，这是虚热，不可吃生冷食物。如果大小便便秘不通，喜欢冷饮，口渴想喝水，手脚都发热，这是实热，可以给予冷水饮用。凡是痘疮发出后热势未止的，等到痘疮出齐，热势自然会停止。
如果在发热时大便大渴，说明热在里，用葛根解毒汤主治；如果服药后口渴不止，再加黄连以泻心火之有余，加黄柏、知母以滋肾水之不足。舌苔湿润则预后良好，舌面如芒刺则预后不良。因为舌是心的苗窍，少阴经脉的气血荣养于舌。
如果发热且自下利而口渴，是津液不足，用黄芩汤加人参、白术、麦门冬主治。朱丹溪说：初起发热烦躁、口渴引饮的，急用凉药解除其标证。钱乙说：身体发热烦渴，腹部胀满气喘，大小便涩滞色赤，烦闷混乱剧烈呕吐，这应当通利小便；如果不愈，用宣风散攻下。
葛根解毒汤
配方：葛粉、天花粉、麦门冬、生地黄、升麻（各等分），甘草（减半）。
制法：切碎细末。取糯米淘米水一盏，煎至七分，去渣，加入茅草根自然汁一合，服用。
黄芩汤（用于痘疮泄利）、五苓散（用于惊风）、宣风散（用于痘疮发热）
如果疮疹已经发出，或正在起发，或正在结痂收靥，但一直口渴不止，用人参麦门冬散主治。李东垣说：如果身体发热轻微口渴，用六味人参麦门冬散治疗。如果病不愈，或者身体发热严重口渴，用七味人参白术散治疗。如果仍不愈，用十一味木香散。
人参麦门冬散
配方：麦门冬、葛粉（各二钱），人参、甘草、升麻、白术（各一钱）。
制法：切碎细末。加粳米一合，淡竹叶七片，水一盏，煎至米熟，去渣温服。
六味人参麦门冬散
配方：麦门冬（去心，一两），人参（去芦头），甘草（炙），陈皮，白术，浓朴（姜制，各半两）。
制法：切碎。每次服用三钱，水一盏，煎至六分，去渣温服。体虚者减去浓朴。
【庞氏论述】地黄膏（见形期使用）
退火回生散：治疗痘疮血热、枯涩引起的口渴。
配方：滑石、辰砂（各一钱），冰片（三厘）。
制法：研为细末。用冷水调服一分，睡片刻后，痘疮必转红活。
如果能进食而口渴，是肺热。《内经》说：心将热邪移于肺，传变为膈消，由于心火上炎，乘袭肺金，熏蒸焦膈，耗伤津液，所以口渴。病位在上焦，用人参白虎汤加黄连主治。
人参白虎汤（又名化斑汤）
配方：人参、甘草（各一钱），知母（三钱），石膏（五钱），粳米（一合）。
制法：切碎细末。水二盏，煎至米熟，去渣温服，不限时间。
竹叶石膏汤：治疗痘疮表里俱虚，胸中烦闷，小便赤涩，多渴。若出现赤斑，又宜服用犀角散。
配方：石膏、知母（各二两），麦门冬、甘草（各一两）。
制法：切碎散剂。每次服用三钱，水一盏，淡竹叶一握，煎至半盏，温服，不限时间。
麦门冬汤：治疗麻疹烦渴吐泻，以及结痂后的余热。
配方：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）。
制法：用水煎服。
如果不能进食而口渴，是脾虚。王叔和说：口干，频繁饮水，多吃也易饥饿，这是因为脾素来虚弱，不能为胃传输津液，所以口渴。病位在中焦，用参苓白术散主治。
人参白术散（又名参苓白术散）
配方：人参、白术、藿香、木香、甘草、白茯苓（各一钱），干葛（二钱）。
制法：切碎细末。加生姜一片，水一盏，煎至七分，去渣，温服，不限时间。
【丹溪医案】陈十妹，二十岁，患痘疮，怀孕七个半月，严重口渴，痘疮不甚透发，寒热交替发作，属于血虚气虚。
处方：人参、白术、黄芪、陈皮、甘草（炙）、当归身（各一钱）。
加生姜三片，酒和水各半盏，煎服。
自下利而口渴，轻症用人参白术散，重症用陈氏木香散。自下利而口渴，是邪气传入肾脏。《正理论》说：自下利而口渴，属于少阴虚证，所以引水自救。因为肾主五液，其脉络联系于肺，系连舌本，邪气传入肾脏，则开阖功能失常，所以自下利；下利导致津液下走，肾水干枯，不能上润于舌，所以大渴。病位在下焦，适宜温补，用陈氏异攻散主治（适用于痘出不快者）。
面色苍白腹胀，自下利而口渴，用陈氏十一味木香散主治。文中说：腹胀而渴、腹泻而渴、脚趾冷而渴、惊悸而渴、身体温和而渴、身体发热面色青白而渴、寒战而渴不止、气急咬牙而渴、饮水后转为水泻不止者，以上九种证候，都不是热证，而是津液少，脾胃肌肉虚弱所致，宜用木香散治疗。如果病不愈，再加丁香、官桂。（此说法必须审慎使用，腹胀渴、泻渴、惊悸渴、寒战渴、切牙渴，也多属于热证，不可不仔细辨别。）
如果口渴且大便秘结，宜通利，用四顺清凉饮主治（属热证）。李东垣说：痘疮大肠闭涩，或伴有发热，用四君子汤加栝蒌根、桔梗主治。
痘疮稠密，津液少的，用十全大补汤（适用于汗出过多者）。
生脉散：止烦渴，病程始终通用。
配方：人参、五味子、麦门冬。
制法：水煎，当茶饮用。
[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.