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[From *Huoren Shu*] In winter, Yangming disease presents with tidal fever. If the pulse is floating and tight, the episodes occur at fixed times. If the pulse is choppy (Se), accompanied by heart spontaneous sweating, Huangqin Tang (Scutellaria Decoction) is the primary treatment. (Formula see under Diarrhea.)

Yangming disease is characterized by "Stomach Fullness" (Wei Jia Shi). When the Stomach is full/excess, delirium occurs; therefore, delirium should be categorized under Yangming disease. In Yangming disease, if there is delirium, tidal fever, and a slippery and rapid pulse, Xiao Chengqi Tang (Minor Order the Yang Decoction) is indicated. Administer one cup of Chengqi Tang; if abdominal rotation of flatus (passing gas) occurs, administer another cup. If there is no rotation of flatus, do not administer more. If on the next day there is still no bowel movement, but the pulse becomes faint and choppy, this indicates interior deficiency; it is difficult to treat, and Chengqi Tang should not be administered again. In Yangming disease, if there is delirium and tidal fever, but the patient cannot eat, there must be dry fecal matter (dry stool) in the stomach/intestines. If the patient can eat, the stool is merely hard; Da Chengqi Tang (Major Order the Yang Decoction) should still be used to purge. In concurrent Taiyang and Yangming diseases, after Taiyang symptoms have resolved, if there is only fever, sweating of the hands and feet, difficulty in defecation, and delirium, purgation will cure it; Da Chengqi Tang is indicated. In Yangming disease, if the person sweats profusely, causing fluid loss, leading to dryness in the Stomach and hard stools resulting in delirium, Xiao Chengqi Tang is indicated. If delirium stops after one dose, do not administer further. If sweating accompanies delirium, there must be dry feces in the Stomach; this is due to Wind pathogen. Purging is necessary, but it must be done only after the exterior stage has passed. If purged too early, speech will become chaotic because the exterior is deficient and the interior is excess; thus, purging will cure it, and Da Chengqi Tang is indicated. Excess leads to delirium; deficiency leads to Zhengsheng (repetitive murmuring). (Delirium refers to incoherent speech without order, repeatedly changing topics. Zhengsheng refers to earnest and frequent repetition, repeating the same old phrase over and over all day without changing voice. Generally, when Shen [Spirit] is in excess, it can change mechanisms and speak randomly, changing topics frequently. When Shen is deficient, it lacks flexibility and only clings to one sound.) In Cold Damage after four or five days, if the pulse is deep and there is wheezing and fullness, deep indicates interior location. If sweating is incorrectly induced, fluids escape, making defecation difficult, leading to exterior deficiency and interior excess, which eventually causes delirium. (Cheng Wuji stated that Zhengsheng refers to Zheng-Wei sounds, which is incorrect; this was clarified earlier.)

In Shaoyang disease, after sweating, and with frequent urination and foot cramping, if Guizhi Tang was mistakenly used to attack the exterior, and subsequently the Stomach is disharmonious causing delirium, a small amount of Tiaowei Chengqi Tang (Regulate the Stomach Order the Yang Decoction) should be given. (Formula theory see under Jueyin.) In concurrent Three-Yang disease, with abdominal fullness, body heaviness, difficulty turning, mouth dysfunction, greasy facial complexion, delirium, and urinary incontinence: inducing sweating worsens delirium; purging causes sweating on the forehead and cold extremities. If there is spontaneous sweating, Baihu Tang (White Tiger Decoction) is indicated. (Theory see under Body Heaviness.) If sweating is excessive, leading to Yang collapse and delirium, purging is contraindicated. Instead, Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction) should be used to harmonize Ying and Wei and promote fluid circulation, after which self-recovery occurs. If sweating is excessive and repeated, leading to Yang collapse, delirium, and a short pulse indicates death; a harmonious pulse indicates survival. For various erroneous sweating treatments: mild cases recover; severe cases result in chaotic speech; those with dizziness die.

The appearance resembles Cold Damage, but the pulse is not wiry-tight but weak. A weak pulse implies thirst; a choppy pulse implies delirium. If there is fever with a weak pulse and floating pulse, resolving the exterior via sweating will lead to recovery.

After Fire therapy sweating in Taiyang disease, if there is yellow skin, difficult urination, dry body, head sweating, abdominal fullness, slight wheezing, or constipation, prolonged cases lead to delirium. (Theory see under Head Sweating.) In Taiyang disease, if irritability appears on the second day, and back moxibustion/ironing causes profuse sweating, fire heat enters the Stomach, exhausting fluids, causing agitation and delirium. After ten-plus days, if chills and spontaneous diarrhea occur, this indicates impending resolution. Thus, if sweating is absent below the waist, desire to urinate is blocked, vomiting occurs, desire for urinary incontinence, aversion to wind on soles, hard stool, frequent but scanty urination, or abundant urination, followed by sudden headache upon defecation, and warmth in the soles, this is due to Grain Qi flowing downward. In Shaoyang disease, if coughing is accompanied by diarrhea, delirium, and difficult urination, it is caused by Fire pathogen forcing sweat. After emesis, purging, sweating, or warm needle therapy, if delirium occurs and Chaihu syndrome resolves, this is a "Bad Disease" (Complication); determine the error and treat accordingly. (Theory see under Bad Diseases.)

With chest fullness and delirium, if after purging there is vexation and fright, difficult urination, and body heaviness preventing turning, Chaihu Jia Longgu Muli Tang (Bupleurum plus Dragon Bone and Oyster Shell Decoction) is indicated. (Formula theory see under Fright.) In Yangming disease, if bleeding from the rectum accompanies delirium, this is Heat entering the Blood Chamber. If only the head sweats, puncture Qimen (LR14) to drain excess; copious sweating indicates recovery. With abdominal fullness and delirium, if the pulse is floating-tight, puncture Qimen. (Theory see under Abdominal Fullness.) In concurrent Taiyang-Shaoyang disease, if sweating causes delirium and the pulse is wiry, and delirium persists for five to six days, puncture Qimen. (Theory see under Neck Stiffness.) In women with fever, where menstruation just began, delirium indicates Heat entering the Blood Chamber. If heat clears and pulse is slow, body is cool, and chest fullness resembles Chest Binding, puncture Qimen. If clear during the day and delirious at night, do not harm Stomach Qi or the Upper/Middle Jiao; self-recovery will occur. *Huoren Shu* suggests Chaihu Tang (Bupleurum Decoction). (Theory see under Women's Cold Damage.)

In Cold Damage unresolved for thirteen days, passing the meridian cycle with delirium indicates internal heat; purging with Chengqi Tang is appropriate. If urination is free, stool should be hard, yet diarrhea occurs with a harmonious pulse, indicating the physician incorrectly used pill-based purgatives. If spontaneous diarrhea occurs with a normally harmonious pulse (instead of faint/cold), this indicates interior excess; Tiaowei Chengqi Tang is indicated. If diarrhea accompanies delirium, there is dry stool; Xiao Chengqi Tang is indicated. (Formula see under Tidal Fever.)

For upper and lower diarrhea with delirium: if the pulse is harmonious and hands/feet and urination are normal, it is a Yang pattern, so use Chengqi Tang to purge. The pulse should be faint/cold. Conversely, if Shaoyin pattern of lethargy occurs, combined with Fire-induced sweating, delirium, and difficult urination, it is a Yin pattern; thus, use tonifying/harmonizing formulas. (Lethargy, diarrhea, and delirium are also discussed under Shaoyin Diarrhea.)

[Xu Shuniwei] A patient suffered from Cold Damage with diarrhea, fever, mental confusion, fatigue, delirium, and insomnia. Some physicians, seeing diarrhea, diagnosed delirium as Yin deficiency. I said: This is also a Xiao Chengqi Tang pattern. Everyone was shocked: Using Xiao Chengqi Tang for diarrhea—is this Zhang Zhongjing’s method? I said: It is Zhang Zhongjing’s method. Zhongjing stated: Diarrhea with delirium indicates dry feces; it belongs to Xiao Chengqi Tang and can be resolved. I once read *Suwen*: "Treat mildly by opposing, severely by following; opposing is standard treatment, following is counter-treatment." The Emperor asked: What is counter-treatment? Qibo replied: "Use obstruction for obstruction, use unblocking for unblocking." Wang Bing commented: "Severe internal heat binding causes continuous diarrhea. Heat should be treated with cold; the binding must be removed. By using cold purgatives, the binding scatters and diarrhea stops; this is 'using unblocking for unblocking'." This perfectly fits the case, why doubt it?

Fixed gaze, delirium, wheezing, and fullness indicate death; diarrhea also indicates death. Delirious rambling, slight fever, floating-large pulse, and warm extremities indicate survival; cold extremities and deep-fine pulse indicate death within one day.