〔海〕伤寒传至五六日间，渐变神昏不语，或睡中独语一二句，目赤唇焦，舌干不饮水，稀粥与之则咽，
不与则不思，六脉细数而不洪大，心下无痞，腹中不满，大小便如常，或传至十日以来，形貌如醉。医见神昏
不已，多用大承气汤下之，则误矣。盖不知此热传手少阴心经也。然又未知自何经而来。答曰∶本太阳经伤风，
风为阳邪伤卫，阴血自燥，热蓄膀胱，壬病逆传于丙，丙丁兄妹，由是传心，心火自上迫熏肺，所以神昏也。
盖肺为清肃之脏，内有火邪，故令神昏，宜栀子黄芩黄连汤。若脉在丙者，导赤散；脉在丁者，泻心汤。若误
用凉膈散，此乃气中之血药也，如右手寸脉沉滑有力者，则可用之，或用犀角地黄汤，近于是已。本方所说，
若无犀角，以升麻代之，是阳明经药也，此解阳明经血中热药。若脉浮沉俱有力者，是丙丁俱有热，可以导赤
散、泻心汤各半服之则宜矣。此症膀胱传丙，足传手经者，下传上也。丙传丁者，表传里也。壬传丁者，艮之
离也。越经传者，又为腑传脏也。《活人》云∶伤寒只传足经，不传手经者，此言不尽意也。有从足经而传手经
者，何以知之？经云∶伤寒或止传一经，或间传三经，不可一途取之，但视其脉与外证治之，此活法也。与食
则咽者，邪不在胃也；不与则不思者，以其神昏故也；邪热既不在里，误用承气下之，其死也必矣。（脉在丙
者脉浮也，脉在丁者脉沉也，脉丙丁俱有热者浮沉俱有力也。）
[Hai Zang] When a cold damage (Shanghan) disease transmits to the fifth or sixth day, it gradually changes into a state of mental confusion and inability to speak, or the patient speaks alone for one or two sentences during sleep. The eyes are red, lips are scorched, the tongue is dry but there is no desire to drink water; if thin porridge is offered, the patient swallows it, but if not offered, there is no desire to eat. The six pulses are fine and rapid but not surging and large. There is no epigastric fullness/stuffiness (Pi), nor abdominal distension, and urination and defecation are normal. If the transmission continues to ten days or more, the patient's appearance resembles that of being drunk.
Physicians, seeing persistent mental confusion, often use Da Cheng Qi Tang (Major Order the Qi Decoction) to purge, which is an error. This is because they do not know that this heat has transmitted to the Hand-Shaoyin Heart Meridian. However, they also do not know from which meridian it originated. The answer is: Originally, the Taiyang Meridian was injured by wind. Wind is a yang pathogen that injures the Defensive Qi (Wei Qi), causing the Yin blood to naturally dry out. Heat accumulates in the Bladder. The disease of Ren (Water/Kidney-Bladder system) reversely transmits to Bing (Fire/Small Intestine-Large Intestine system). Bing and Ding (Small Intestine and Heart) are like siblings; thus, the heat transmits to the Heart. Heart Fire forces down and steams the Lung from above, resulting in mental confusion.
Since the Lung is a clear and descending organ, the presence of fire pathogen within causes mental confusion. It is appropriate to use Zhizi Huangqin Huanglian Tang (Gardenia, Scutellaria, and Coptis Decoction). If the pulse indicates the pathology is in Bing (Small Intestine/Yangming related), use Dao Chi San (Guide Out the Red Powder); if the pulse indicates the pathology is in Ding (Heart/Shao Yin related), use Xiexin Tang (Drain the Epigastrium Decoction). If Liang Ge San (Cool the Diaphragm Powder) is mistakenly used, this is a blood-resolving medication within the Qi level. It can only be used if the Cun position of the Right wrist pulse is deep, slippery, and forceful. Alternatively, Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) may be used, which is close to the correct treatment. The original text mentions that if Rhinoceros Horn (Xijiao) is unavailable, it can be replaced by Shengma (Cimicifugae Rhizoma), which is a Yangming Meridian herb; this resolves heat in the blood level of the Yangming Meridian. If both superficial and deep pulses are forceful, it indicates heat in both Bing and Ding. In this case, taking half doses of Dao Chi San and Xiexin Tang together would be appropriate.
This syndrome involves transmission from the Bladder to Bing (Small Intestine), from a Foot meridian to a Hand meridian, which is transmission from lower to upper. Transmission from Bing (Small Intestine) to Ding (Heart) is transmission from exterior to interior. Transmission from Ren (Kidney/Bladder) to Ding (Heart) corresponds to the transformation from Gen to Li (referencing specific I Ching/Five Elements dynamics). Transmissions skipping meridians involve transmission from Fu organs to Zang organs. *Huo Ren* states: "Cold damage only transmits through Foot meridians, not Hand meridians." This statement is incomplete. There are cases where transmission occurs from Foot meridians to Hand meridians. How do we know? The classics state: "Cold damage may transmit to only one meridian, or skip to transmit to three meridians; one cannot rely on a single pathway for diagnosis. One must treat based on observing the pulse and external symptoms; this is the flexible method."
If the patient swallows when food is offered, the pathogen is not in the Stomach; if they do not eat when not offered, it is due to mental confusion. Since the pathogenic heat is not in the interior, mistakenly using Cheng Qi Tang to purge will inevitably lead to death. (Pulse in Bing refers to a floating pulse; pulse in Ding refers to a deep pulse; pulse indicating heat in both Bing and Ding refers to forcefulness in both superficial and deep palpation.)