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When epidemic febrile diseases manifest as mania (violent mental disorder), it is a severe form of delirium (incoherent speech due to disturbed spirit), caused by epidemic heat steaming the Heart. The treatment is the same as for delirium.

When epidemic febrile diseases manifest as forgetfulness (memory loss), it is caused by blood stasis (accumulation of stagnant blood). If blood stasis is in the Upper Jiao, the pulse is Kou (floating, large, and empty in the middle, like pressing a scallion stem); there must be pain in the chest and epigastrium, which is tender upon pressure and feels soft; Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction) should be administered. If blood stasis is in the Middle Jiao, the pulse may be Kou, Xian (wiry), or Se (choppy); there must be painful areas in the hypochondrium and above the umbilicus that are tender upon pressure and feel soft; Taoren Chengqi Tang (Peach Kernel and Magnolia Bark Decoction) should be administered. If blood stasis is in the Lower Jiao, the pulse is mostly Chenjie (deep and intermittent); there must be a painful area below the umbilicus that is tender upon pressure and feels soft; Didang Tang (Attack the Aorta Decoction) should be administered.

Although forgetfulness is a primary symptom of blood stasis, one must verify it through the urine and stool. Even if the feces are hard, if defecation is relatively easy and the color is invariably black, and urination is free and unobstructed, this constitutes the definitive evidence of blood stasis. Otherwise, treatment should still refer to methods for managing excessive talkativeness, delirium, and mania.

Coma (lethargy and unconsciousness) in epidemic febrile diseases is an extremely dangerous condition where heat has penetrated deeply. Initially, when heat begins to steam the Heart Meridian, the Heart Spirit becomes unsettled, leading to somniloquy (sleep-talking); upon waking, consciousness is clear. As heat steaming the Heart Meridian deepens, the Heart Spirit becomes increasingly irritable, with excessive talking about daily matters without confusion. When heat reaches the Pericardium, mental clarity occasionally lapses into drowsiness, and while talking excessively, some confused words appear, though clear speech predominates. As heat steaming the Pericardium deepens further, drowsiness predominates, speech involves hallucinations (seeing and hearing things that are not there), including suspicions of ghosts and gods, utterances beyond normal perception, yet some coherent language remains. Finally, when heat directly enters the Heart organ, complete coma occurs, with total loss of consciousness. This sequence illustrates the depth of heat penetration and helps distinguish the severity of symptoms. Therefore, for excessive talkativeness and delirium, indicating superficial heat, Zhi Zi (Gardeniae Fructus), Huang Qin (Scutellariae Radix), Zhi Mu (Anemarrhenae Rhizoma), and Shi Gao (Gypsum Fibrosum) can resolve it; for mania, indicating deep-seated heat binding, Mang Xiao (Natrii Sulfas) and Da Huang (Rhei Radix et Rhizoma) can resolve it; for coma, indicating extreme depth of heat, only Xi Jiao (Rhinocerotis Cornu), Huang Lian (Coptidis Rhizoma), Ling Yang Jiao (Caprae Hircus Cornu), and Niu Huang (Calculus Bovis) can resolve it. Although coma stems from deep heat, it may also involve concurrent phlegm-qi obstruction, stomach fu-organ accumulation, or blood stasis. Chest fullness and white tongue coating indicate concurrent phlegm-qi; add Chuan Bei Mu (Fritillariae Bulbus), Gua Lou (Trichosanthis Fructus), Ban Xia (Pinelliae Rhizoma), and Lai Fu Zi (Raphani Semen) to Xi Jiao and Huang Lian. Yellow, dry, or black tongue coating with abdominal fullness, hardness, and pain indicates stomach accumulation; add Xi Jiao and Huang Lian to San Chengqi Tang (Three Magnolia Bark Decoctions). Pain with abdominal softness indicates blood stasis; add Tao Ren (Persicae Semen), Mu Dan Pi (Moutan Cortex), and Chi Shao (Paeoniae Radix Rubra) to Xi Jiao and Huang Lian. The major principles for treating coma are thus established.

The above cases are all excess syndromes; deficiency syndromes must also be known. After repeated treatments with sweating, purging, clearing, and draining, if there is no heat in the exterior or interior, no obstruction in the chest and abdomen, and free urination and defecation, yet the spirit gradually declines from fatigue to lethargy, and from lethargy to deep coma, this is a critical deficiency syndrome. Even administering a large dose of Shengmai San (Generate the Pulse Powder) augmented with Gui Zhi (Cinnamomi Ramulus), Fu Zi (Aconiti Lateralis Radix Praeparata), Ren Shen (Ginseng Radix), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Fu Ling (Poria), and Bai Shao (Paeoniae Radix Alba) to urgently rescue Yin and Yang may prove insufficient.