谵语证本非一类。或因下利或胃实。三阳合病或瘀血。或者热入于血室。大抵发热
阳脉生。反见阴脉斯为逆。血室血瘀承气宜。柴胡白虎地黄合。
谵语者。数数更端。声高脉洪而数。盖由胃热乘心。神识昏冒。妄言不休。经曰。实则
谵语
是也。然谵语症非一端。有因胃有燥屎而谵语者。宜承气汤治之。有因过汗亡阳而谵语者。宜柴胡
加桂枝汤治之。以和荣卫而通津液也。有因三阳合病而谵语者。
宜白虎汤治之。有因热入血室而谵语者。宜桃仁承气汤及犀角地黄汤治之。大抵谵语属实。
故宜解清热。然亦有阳虚气脱而谵语者。宜用参术归 等剂。他如脉短则死。脉自和则愈。
又身微热。脉浮大者生。逆冷脉沉。或气上逆而喘满。或气下夺而自利。皆为逆。
郑声脉细是虚形。一语频言脉更沉。大小便稀手足冷。急煎附子理中汤。
郑声者。只将一事一语。郑重谆复。声低脉细而沉。经曰虚则郑声是也。其证大便稀。
小便
利。手足冷。此阳虚气脱之状也。宜急煎附子理中汤以救之。大抵郑声属虚。本非实证。他
如神昏气促。呃逆不止。不知人事者死。
胃家有热难停食。胃冷无和纳水浆。二证皆令人呕逆。呕家圣药是生姜。若是上行
为气逆。胃家由是不安康。
有物有声谓之呕。有物无声谓之吐。盖由表邪传里。里气上逆。则为呕吐水谷不下
是也
。然呕吐症本不同。有因气逆而呕者。宜小柴胡汤加生姜主之。有因水停心下而呕者。宜茯苓
甘草汤主之。有因胃热而吐者。宜竹叶石膏汤加生姜汁主之。有因胃寒而吐者。宜理中汤加
生姜主之。大抵呕吐清水。即为寒症。若胃中有热。必是涎液酸水。病机云。诸呕吐酸。及
水液混浊。皆属于热。诸病水液澄彻清冷。皆属于寒。此可见矣。
竹叶石膏汤用参。麦冬半夏更加临。甘草生姜加粳米。虚烦自利热能清。
The syndrome of *Zhanyu* (delirious speech) is not of a single category. It may be caused by diarrhea, or by excess in the Stomach. It may result from the simultaneous involvement of the three Yang channels, or from blood stasis. Or it may occur when heat enters the Blood Chamber (referring to the uterus or the blood aspect of the Liver channel). Generally speaking, fever accompanied by Yang pulses (floating, surging, rapid) indicates a favorable prognosis; conversely, the appearance of Yin pulses (deep, fine, slow) indicates an adverse prognosis. If caused by blood stasis in the Blood Chamber, Chengqi Decoction (Cathartic Decoction) is appropriate. It can also be combined with Xiaochaihu Decoction (Minor Bupleurum Decoction), Baihu Tang (White Tiger Decoction), or Dihuang Tang (Rehmannia Decoction).
*Zhanyu* is characterized by frequently changing topics, a loud voice, and a surging, rapid pulse. This is generally due to Stomach heat disturbing the Heart spirit, causing mental confusion and incessant delirious speech. The Classics state: "Excess manifests as *zhanyu*," which refers to this condition. However, there are various causes for *zhanyu*: those caused by dry feces retained in the Stomach should be treated with Chengqi Decoction; those caused by excessive sweating leading to Yang collapse should be treated with Chaihu Jia Guizhi Tang (Bupleurum plus Cinnamon Twig Decoction) to harmonize Ying and Wei (nutritive and defensive levels) and unblock body fluids; those caused by simultaneous involvement of the three Yang channels should be treated with Baihu Tang; those caused by heat entering the Blood Chamber should be treated with Tao Ren Chengqi Tang (Peach Kernel Cathartic Decoction) and Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction). Generally, *zhanyu* belongs to excess syndromes, so clearing heat and resolving depression is appropriate. However, there are cases where *zhanyu* results from Yang deficiency and Qi collapse, requiring tonifying formulas containing Renshen (Ginseng), Baizhu (Atractylodes Macrocephala Rhizome), Danggui (Angelica Sinensis Root), etc. Other indicators include: a short pulse indicates death; a harmonious pulse indicates recovery. Furthermore, slight fever with a floating and large pulse indicates survival; cold extremities with a deep pulse, or Qi rebelling upward causing wheezing and fullness, or Qi sinking downward causing spontaneous diarrhea, all indicate adverse prognoses.
The pulse of *Zhengsheng* (faint, repetitive speech) is fine, indicating a deficiency pattern. A single phrase is repeated frequently, and the pulse becomes even deeper and finer. Loose stools and urination, along with cold hands and feet, require immediate decoction of Fuzi Lizhong Tang (Aconite and Atractylodes Macrocephala Decoction).
*Zhengsheng* is characterized by focusing on one matter or phrase, repeating it earnestly and repeatedly, with a low voice and a fine, deep pulse. The Classics state: "Deficiency manifests as *zhengsheng*." Symptoms include loose stools, free urination, and cold hands and feet, which are signs of Yang deficiency and Qi collapse. Immediate treatment with Fuzi Lizhong Tang is required to rescue the patient. Generally, *zhengsheng* belongs to deficiency patterns and is not an excess syndrome. Other signs such as coma, shortness of breath, incessant hiccups, and loss of consciousness indicate death.
Heat in the Stomach makes it difficult to retain food; cold in the Stomach prevents the intake of liquids. Both conditions cause vomiting and regurgitation. Fresh Ginger (Shengjiang) is the holy medicine for treating vomiting. If Qi rebels upward causing vomiting, the Stomach becomes unhealthy.
Vomiting with sound and material is called "Ou" (vomiting); vomiting with material but no sound is called "Tu" (spitting up). This is usually due to exterior pathogens transmitting inward, causing rebellious Qi in the interior, leading to vomiting where food and fluids cannot descend. However, vomiting symptoms vary: vomiting due to rebellious Qi should be treated with Xiaochaihu Decoction plus Fresh Ginger; vomiting due to fluid retention under the Heart (epigastrium) should be treated with Fuling Gancao Tang (Poria and Licorice Decoction); vomiting due to Stomach heat should be treated with Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction) plus Fresh Ginger juice; vomiting due to Stomach cold should be treated with Lizhong Tang (Regulate the Middle Decoction) plus Fresh Ginger. Generally, vomiting clear water indicates a cold syndrome. If there is heat in the Stomach, there will be saliva and sour water. The *Jingyue Quanshu* states: "All vomiting of acid fluids and turbid liquids belong to heat; all pathological fluids that are clear, transparent, and cold belong to cold." This clarifies the distinction.
Zhuye Shigao Tang uses Renshen (Ginseng), Maidong (Ophiopogon Tuber), Banxia (Pinellia Tuber) are added further. Gancao (Licorice Root), Shengjiang (Fresh Ginger), and Jingmi (Glutinous Rice) are added; deficiency vexation and spontaneous diarrhea are cleared, and heat is resolved.