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In Yangming disease, if delirium and tidal fever occur with a slippery and rapid pulse, Xiao Chengqi Tang (Minor Order the Qi Decoction) is the primary treatment. Therefore, administer one sheng of Chengqi Tang; if intestinal peristalsis occurs (passing gas), administer another sheng. If no peristalsis occurs, do not administer further. On the following day, if there is still no bowel movement but the pulse becomes faint and choppy, this indicates interior deficiency, which is difficult to treat, and Chengqi Tang should not be administered again.

A slippery and rapid pulse indicates blood heat and flourishing Yang. A faint and choppy pulse indicates blood cold and deficient Yang.

After vomiting or purging in Shaoyang disease, if the condition remains unresolved and there is no bowel movement for five to six days, or even up to ten or more days, tidal fever occurs at dusk (Shen hour), without aversion to cold, and the patient speaks alone as if seeing ghosts. In severe cases, the patient may become unrecognizable during episodes, grasp at clothing and bedrails, feel terrified and restless, have slight panting, and stare fixedly. If the pulse is wiry, survival is possible; if the pulse is choppy, death is likely due to exhaustion of Ying blood. In milder cases, only fever and delirium are present, treated with Da Chengqi Tang (Major Order the Qi Decoction). If the first dose results in relief (bowel movement), discontinue subsequent doses.

Extreme restlessness leads to grasping at clothing and bedrails; dryness of Liver Wood generating Wind causes terror and restlessness. Obstruction of Lung Qi with Lung Heat causes slight panting. Exhaustion of Blood leading to binding of sinews causes fixed staring. A wiry pulse indicates that Liver Wood Qi still exists, hence survival. A choppy pulse indicates that Ying blood has dried up, hence death.

In Shaoyang disease, after four or five days, if the pulse is deep and accompanied by panting and chest fullness, the deep pulse indicates the pathogen is in the interior. If sweating is incorrectly induced, fluids escape outward, making bowel movements difficult. This results in exterior deficiency and interior excess, eventually leading to delirium. Heat in the interior causes a deep pulse; stagnation of Stomach Qi obstructs Lung Qi causing panting; Qi stagnation causes fullness. Incorrect sweating depletes fluids, leaving exterior Yang deficient and interior heat excessive. Over time, mental agitation leads to delirium.

Sweating accompanied by delirium indicates dry feces retained in the Stomach, caused by Wind. Purging is required, but it should only be performed after the pathogen has passed through the meridians (entered the Yangming stage). If purging is done too early, speech will become chaotic due to exterior deficiency and interior excess. Purging will cure the condition; Da Chengqi Tang is appropriate. Excessive sweating consumes Stomach fluids, causing waste matter to lose lubrication and form dry feces. These block Stomach Qi, preventing the discharge of Stomach heat, which consumes Heart fluids, resulting in delirium. This is due to dryness of Liver Wood generating Wind. Stomach heat requires purging, but one must wait until after the sixth day, beyond the period of meridian transmission, before purging. If purged too early, when interior heat is not yet solidified, speech will become chaotic and turn into Zhengsheng (monotonous repetition of words). This is because excessive sweating depletes fluids, causing exterior deficiency and interior excess. The clear Qi in the meridians cannot withstand the flourishing evil fire in the fu organs. There is already a root for delirium; if purged hastily before interior excess is fully established, the delirium of an excess pattern transforms into the Zhengsheng of a deficiency pattern.

If Shaoyang disease persists for thirteen days without resolution and delirium occurs after passing through the meridians, it is due to internal heat, and decoctions should be used for purging. If urination is free, the stool should be hard, yet diarrhea occurs, and the Stomach pulse is harmonious. This indicates the physician incorrectly used pill-based purgatives, which is not the correct treatment. If the patient has spontaneous diarrhea, the pulse should be faint and cold (Jue). However, if the pulse is now harmonious, this indicates interior excess. Tiao Wei Chengqi Tang (Regulate the Stomach Order the Qi Decoction) is indicated.
Thirteen days have passed, exceeding the period of two meridian cycles, and delirium indicates internal heat requiring purging. If urination is free, the stool should be hard, yet diarrhea occurs, and the pulse is harmonious. This indicates the physician incorrectly used pill-based purgatives, failing to resolve internal heat, which is incorrect treatment. If there were internal deficiency with spontaneous diarrhea, the pulse would be faint and Jue (not harmonious). Since the pulse is now harmonious, this confirms interior excess. Interior excess requires decoctions, not pills; therefore, Tiao Wei Chengqi Tang should be administered.