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Delirious speech (Zhanyu, 谵语) is described in the classics: "When pathogenic factors are exuberant, it manifests as excess; when essential qi is depleted, it manifests as deficiency." Therefore, excess conditions lead to delirious speech, while deficiency conditions lead to feeble speech (Zhengsheng, 郑声). When excessive heat in the Stomach (Wei, 胃) ascends to disturb the Heart (Xin, 心), and the Heart is obscured by heat, consciousness becomes confused, leading to妄有所见而言 (hallucinations and inappropriate speech). Mild cases involve muttering in sleep, while severe cases involve speaking even when awake. Some patients exhibit delirious speech, some speak only to themselves (Duyu, 独语), some cannot stop talking, and some speak incoherently; these variations indicate the severity of the heat. Generally, when heat enters the Stomach, fluids are depleted and feces become dry, inevitably causing delirious speech, which is an excess condition. There are also cases of delirious speech caused by forced sweating via fire therapy, cases caused by Yang collapse (Wangyang, 亡阳), and cases involving purging of undigested food (Xialiqinggu, 下利清谷) without thirst, which are deficiency conditions. If the pulse is deep, solid, surging, rapid, and forceful, accompanied by constipation, dark urine, dryness and thirst, delirious and wild behavior, abdominal distension with hardness and pain, tidal fever with spontaneous sweating, or purging of pure clear water with epigastric and abdominal hardness and pain, these are all interior syndromes caused by pathogenic heat and dry fecal matter. All should be treated with Da Chengqi Tang (Great Order the Qi Decoction) to purge. If diarrhea persists after purging, or if there is wheezing and fullness with rebellious Qi rushing upward, or spontaneous purging with Qi collapse sinking downward, these are adverse signs (Ni, 逆). In combined syndromes of the three Yang channels, with a solid pulse, heavy body difficult to turn, insensitivity in the mouth, greasy facial complexion, and enuresis, Baihu Tang (White Tiger Decoction) is used. If there is dry stool, high fever, dry retching, incoherent speech, groaning, and insomnia, Xijiao Jiedu Tang (Rhinoceros Horn Detoxification Decoction) is used. If upon initial onset there is no fever but there is wild speech, restlessness, and spirit lacking vitality compared to normal, Wuling San (Five-Ingredient Powder with Poria) three qian can be administered, followed by induced vomiting using fresh well water; alternatively, Guiling Tang (Cinnamon Twig and Polyporus Decoction) may be used. Wild speech, desire to rinse the mouth with water but unwillingness to swallow, black stool, difficult urination, yellowing of the body, and abdominal distension indicate that delirious speech due to blood stasis occurred because purgation was indicated but not applied initially. Taoren Chengqi Tang (Peach Kernel Order the Qi Decoction) should be used; recovery occurs once black material is expelled. In women, if menstruation has just started or stopped, followed by alternating chills and fever, this is delirious speech due to heat entering the Blood Chamber (Xueshi, 血室), treated with Xiaochaihu Tang (Minor Bupleurum Decoction). In Yangming syndrome, forgetfulness and manic-like behavior indicate blood stasis; treat as previously described with Taoren Chengqi Tang until black material is expelled.

Feeble speech (Zhengsheng, 郑声) refers to improper sound, akin to the music of Zheng and Wei states. After sweating or purging, if the illness has been prolonged, the original voice loses control due to deficiency of righteous Qi, resulting in scattered speech lacking proper tone or volume. This is a sign of depletion of essence and Qi. The pulse is fine and minute, and urination and defecation are normal; treat with Xiaochaihu Tang (Minor Bupleurum Decoction).