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The *Neijing* states: "Excess patterns manifest as delirious speech (Shanyu), while deficiency patterns manifest as feeble, repetitive speech (Zhengsheng); this reflects the difference between excess and deficiency." Both delirious speech and feeble speech generally arise from the confusion of the spirit and mind leading to disordered language. How then can one distinguish between excess and deficiency? Delirious speech refers to arrogant and wild utterances; feeble speech refers to incoherent and fragmented vocalizations. Delirious speech belongs to excess, where "excess" implies an abundance of pathogenic factors. For instance, in Shaoyang disease, excessive heat in the Yangming channel ascends to disturb the Heart. When the Heart is obscured by heat, the spirit becomes confused, resulting in incessant delirium; this is caused by excess pathogens. Diseases caused by excess pathogens are characterized by a high-pitched voice, robust breath, strong pulse, and stern facial expression. Examples include shouting insults while climbing high, or manic agitation. Such conditions may arise from dry feces retained in the stomach, blood stasis within the viscera, extreme fire and heat, or abdominal distension with constipation accompanied by mouth ulcers and throat erosion. Upon confirming an excess pattern, one should treat it with formulas such as the Three Chengqi Decoctions (San Chengqi Tang), Baihu Decoction (Baihu Tang), or Liangge Powder (Liangge San).

Feeble speech belongs to deficiency, where "deficiency" implies a weakness of the spirit. For example, in Shaoyang disease, if the primordial spirit loses its residence and is invaded by pathogens, the mental state becomes dull and disordered; this is caused by deficient pathogens. Diseases caused by deficient pathogens are characterized by a low-pitched voice, shortness of breath, a forceless pulse, and a sallow, withered complexion. Examples include muttering to oneself incompletely, hallucinating ghosts, unceasing fear and panic, or failing to respond when asked and giving irrelevant answers. Such conditions may arise from yang collapse due to excessive sweating, yin exhaustion due to excessive purgation, internal injury from overexertion damaging the Spleen and Kidney, or gradual depletion of Middle Qi due to daily consumption. Although the patient may be able to rise and move, their condition stops when restrained, which is fundamentally different from the uncontrollable nature of excess pathogens; this constitutes a deficient pattern. Upon confirming a deficiency pattern, one must strictly avoid reckless use of attacking methods. Any slight error will inevitably lead to immediate death. In treating such cases, one must rapidly assess the essence and qi, differentiate yin and yang, disregard superficial symptoms, and rescue the root foundation. Delaying treatment risks being too late, let alone misdiagnosis. Conditions such as spontaneous diarrhea with cold limbs, grasping at empty air, or facing the wall while spitting are particularly ominous signs indicating reversal. Generally, delirium should not occur in patients with severe deficiency. Therefore, a prognosis is favorable if there is slight fever and a surging, slippery pulse; conversely, it is unfavorable (fatal) if there is mental irritability, a weak, fine, rapid pulse, and cold extremities. Thus, when delirium appears in the context of deficiency, it is a sign of critical danger and must be treated with utmost caution.