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When epidemic febrile diseases present with excessive talking, it is a precursor to delirious speech (delirium), caused by epidemic heat steaming the Heart; the treatment is the same as for delirium.

Delirious speech refers to heat steaming the Heart. When an epidemic disease presents with delirium, one should immediately clear heat. However, there are cases where heat in the meridions steams the Heart causing delirium; the pathogen is in the Taiyang, Yangming, and Shaoyang meridians, often accompanied by exterior syndrome symptoms such as a floating and large pulse, headache, fever, and white tongue coating. In such cases, Wu’s Sanxiao Yin (Three-Drain Decoction) is most appropriate, while Liutong Shenxiao San (Six-Efficacy Universal Powder), Jiwei Qianghuo Tang (Nine-Ingredient Notopterygia Decoction), Fangfeng Tongsheng San (Saposhnikovia Releasing the Exterior Powder), Baihu Tang (White Tiger Decoction), and Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) may also be selected. There are cases where heat in the diaphragm steams the Heart causing delirium; characterized by a surging pulse, body heat, sweating, aversion to cold being absent but aversion to heat present, and no obstruction in the chest, Baihu Tang or Huangqin Tang (Scutellaria Decoction) may be selected. There are cases where phlegm-fluids bind with heat, accumulating in the Middle and Upper Jiao causing delirium; characterized by a string-taut and slippery pulse, chest pain, and epigastric pain that refuses pressure, Xiaoxianxiong Tang (Small Trap-in-the-Chest Decoction) or Daxiehu Tang (Major Bupleurum Decoction) may be selected. There are cases where stomach heat steams the Heart causing delirium; characterized by a slippery, solid, and large pulse, yellow, black, dry tongue coating, or prickles on the tongue, abdominal fullness refusing pressure, San Chengqi Tang (Three Bowel-Unblocking Decoctions) may be selected; for mild cases, Pingwei San (Stomach-Pacifying Powder) added with Hawthorn Fruit, Malt, and Radish Seed is effective. There are cases where heat enters the Blood level causing blood stasis, and blood heat steams the Heart causing delirium; characterized by a deep, knotted, or choppy pulse, tenderness refusing pressure from the epigastrium down to the lower abdomen with softness upon palpation, Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction), Tao Ren Chengqi Tang (Peach Kernel Bowel-Unblocking Decoction), or Didang Tang (Definitely-Invading Decoction) may be selected. There are cases where heat enters the Small Intestine and Bladder, and heat from water accumulation steams upward to the Heart causing delirium; characterized by a floating and rapid pulse, lower abdominal fullness, and difficult urination, Siling San (Four-Poria Powder), Zhuling Tang (Polyporus Decoction), or Yiyuan San (Supreme Origin Powder) may be selected. All of the above are excess-type delirium. As for those who have undergone repeated sweating, purging, and heat-clearing treatments, with clear and free urination and defecation, no obstruction in the chest and abdomen, yet presenting with delirium alongside a deficient, scattered, knotted, intermittent, or weak pulse, this indicates deficiency of both Yin and Yang, with the Spirit having no support. If deficiency is in the Upper Jiao, it must be accompanied by palpitations and mental fatigue; Shengmai San (Generate the Pulse Powder) added with Zao Ren (Semen Ziziphi Spinosae) or Tianwang Buxin Dan (Emperor of Heaven’s Heart-Nourishing Pill) may be used. If deficiency is in the Middle Jiao, it must be accompanied with sallow complexion and limb fatigue; Guipi Tang (Restore the Spleen Decoction) may be used. If deficiency is in the Lower Jiao, it must be accompanied by deafness and fixed staring eyes; Liuwei Dihuang Tang (Six-Ingredient Rehmannia Pill) added with Yuanzhi (Radix Polygalae), Wuweizi (Fructus Schisandrae), Longgu (Os Draconis et Ossis Mastodi), and Fushen (Poria cum Radix Pini) may be used.