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When plague (Yiwen) progresses to the point of "seeking clothes and touching bed" (unconscious, repetitive grasping movements), the condition is critical; however, with appropriate treatment, survival is possible. There are two main causes: First, it results from extreme heat in the Yangming interior. The Yangming channel corresponds to the Stomach; when pathogenic heat from the Liver transfers to the Stomach, this symptom appears. The Stomach governs the four limbs, and Wind-Wood (Liver) exhibits a trembling nature; thus, these grasping movements are caused by pathogenic heat in the Liver and Stomach. A slippery pulse indicates survival, while a choppy pulse indicates death. If symptoms indicating the need for purgation are present, formulas such as Chengqi Tang (Gastrointestinal Releasing Decoction) should be used. Second, it results from improper use of fire therapy to force sweating. In this case, free urination indicates survival, while difficulty in urination indicates death. (Free urination implies that Lung Qi can still descend, Bladder Qi transformation remains functional, and Kidney Water has not been exhausted.) I once treated a patient with plague who exhibited intermittent grasping movements. Upon inquiry, he revealed that he had previously used cupping on his stomach area to induce sweating, which led to this symptom. I cured him using cooling and harmonizing herbs. Since there were no indications for purgation, and the cause was solely the coercive effect of fire therapy, clearing the heat resulted in recovery. There are also cases where this symptom occurs neither due to fire coercion nor after emesis or purgation; in all such instances, cooling and harmonizing methods are appropriate. Texts on Cold Damage sometimes attribute this grasping to extreme deficiency and recommend mild or severe tonification, but this approach has not been observed in plague.

Regarding "delirious speech" (Zhanyu) and "faltering speech" (Zhengsheng) in Cold Damage, interpretations vary. Etymologically, delirious speech refers to rambling and solitary talking regardless of whether the patient is awake or asleep, resembling seeing ghosts. This occurs because Stomach heat rises to overwhelm the Heart, causing mental confusion and erratic behavior, commonly known as speaking nonsense; this represents a milder form of heat. Severe cases involve incessant manic speech, cursing and shouting, unconsciousness, and failure to recognize people, indicating deep-seated heat. Faltering speech refers to murmuring with closed eyes, stopping upon waking; it is milder than delirious speech. This distinguishes the two terms. Delirious speech is traditionally categorized under Yangming disorders, but based on my experience, it can occur in all three Yang channels, though most frequently in Yangming. Some patients exhibit delirium immediately upon contracting the disease, accompanied by unconsciousness and inability to eat, indicating a severe condition. If these accompanying symptoms are absent, or if the patient murmurs only during sleep and is clear upon waking, or speaks erratically occasionally while awake with intervals of cessation, the condition is milder. The causes of delirium and faltering speech differ. Pathogens may be in the exterior, interior, half-exterior half-interior, or there may be exterior deficiency with interior excess. It may follow sweating therapy, purgative therapy, blood stasis, dry feces accumulation, pathogen invasion of the Heart channel, combined diseases, transmission beyond the usual sequence, or collapse of Yang. One must examine accompanying symptoms, pulse, complexion, voice, and the patient's deficiency or excess to ascertain the pathology. This section specifically addresses symptoms caused by pathogenic heat; occasionally, tonification is used after sweating or purgation, but Yin-cold patterns are excluded here. A harmonious pulse indicates ease of cure, while a short pulse indicates death. Slight body heat with a floating, large, and surging pulse indicates survival; cold extremities with a deep, weak, thin, and rapid pulse indicate death. Alternatively, rebellious Qi causing wheezing and fullness, or downward depletion causing spontaneous diarrhea, are both adverse signs.