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Grasping at clothes and bedrails (involuntary grasping movements) is a critical sign indicating a poor prognosis. There are two main syndromes: one arises from Wind-stroke of the Taiyang stage where fire therapy was mistakenly used to induce sweating, leading to a complicated disease with signs of picking at clothes and bedrails; if urination is free, there is hope for survival, but if difficult, death ensues. The other arises from extreme excess heat in the Yangming interior.

A wiry pulse indicates survival, while a choppy pulse indicates death.

In Wind-stroke of the Taiyang stage, if fire therapy is used to induce sweating, the pathogenic wind and fire combine to scorch the body, causing jaundice. Excess Yang leads to epistaxis; Yin deficiency leads to dysuria, sweating only on the head, dryness of the anus, throat ulceration, or constipation. Prolonged occurrence leads to delirium; severe cases may involve hiccups, restlessness of the hands and feet, and grasping at clothes and bedrails. If urination is free, it is treatable (see "Sweating on the Head").

In Cold Damage, if after emesis or purgation the condition remains unresolved, with constipation persisting for five to six days or even ten-plus days, tidal fever occurs during the Shen-You-Xu hours (3 PM - 7 PM), without aversion to cold, accompanied by muttering as if seeing ghosts. In severe cases, upon onset, the patient does not recognize people, picks at clothes and bedrails, feels terrified and uneasy, has slight panting, and stares fixedly. A wiry pulse indicates survival, while a choppy pulse indicates death. In milder cases, presenting only with fever and delirium, Da Cheng Qi Tang (Major Order the Qi Decoction) is the primary treatment. If bowel movement is achieved after one dose, subsequent doses should be stopped. (Cheng Wuji's commentary: Both emesis and purgation damage Stomach Qi. Constipation lasting from five to ten days results from fluid exhaustion, weak Stomach Qi, and internal binding of pathogenic heat. Yangming Qi prospers during the Shen-You-Xu hours, hence tidal fever occurs then, indicating severe Yangming heat. Absence of aversion to cold signifies the resolution of exterior syndrome. Muttering as if seeing ghosts indicates Yangming interior excess. While heat is considered surplus, severe cases imply excessive heat. Extreme internal heat confuses Zheng Qi, leading to disorientation. Grasping at clothes, terror, slight panting, and fixed staring represent Yang excess and Yin exhaustion (death), or Yin excess and Yang exhaustion (death). Severe heat belongs to Yang excess. A wiry pulse suggests Yin is still present; a choppy pulse suggests Yin deficiency. Although Yang heat is severe, a wiry pulse indicates Yin is not exhausted, allowing for potential recovery. A choppy pulse indicates Yin exhaustion, making treatment impossible. If pathogenic heat is mild and not severe, presenting only with fever and delirium, Da Cheng Qi Tang can be used to purge Stomach heat. The classic states: when using purgatives, stop once the disease is addressed; do not necessarily finish the full dose. Here, because heat is not extreme, it says if one dose achieves bowel movement, stop subsequent doses. [Zhao Sizhen] This passage should be divided into three parts. From "Cold Damage after emesis/purgation" to "muttering as if seeing ghosts" constitutes the first part, listing tidal fever, delirium, no aversion to cold, and constipation as current symptoms. The following text divides further to distinguish between severe and mild cases. The character "mild" is key: it refers to cases with only fever and delirium and no other symptoms. Using Cheng Qi Tang once daily, stopping after bowel movement, indicates light heat and caution against over-purging. For "severe" cases, characterized by disorientation, grasbing, terror, panting, and staring, the heat is extreme and the condition critical, requiring decisive judgment of life or death based on the pulse. Wiry pulse means survival, choppy means death. At this point of extreme Yang heat, a wiry pulse indicates Yin is not exhausted, allowing purgation to restore Yin; a choppy pulse indicates Yin exhaustion, making medication futile. *Ren Shu* omits "mild," conflating the two syndromes under Cheng Qi Tang, and places the prognostic pulse criteria for "severe" cases after the "mild" cases' treatment. Would mere fever and delirium suddenly lead to a choppy pulse and death? Zhang Zhongjing mentions another case of tidal fever, delirium, and choppy pulse being difficult to treat, which applies to patients who took Cheng Qi Tang but had no bowel movement, leading to toxin retention and a choppy pulse due to righteous Qi decline and pathogen excess. In the current discussion, mild cases resolve heat through purgation after taking the medicine, so there is no debate on life or death. It also states "Wiry is Yang, Choppy is Yin." Intestinal diseases showing Yin pulses survive, yet in Zhang's method, wiry/choppy belong to Yin, not Yang, raising doubts.)

Xu Shimiao recorded: A patient with Cold Damage suffered constipation, tidal fever at the Shen-You-Xu hours, picked at clothing seams, made empty-handed grasping movements, stared fixedly, and panted rapidly. Multiple physicians visited and fled, recognizing this as a dire sign with a 90% mortality rate. Zhang Zhongjing described the syndrome but provided no formula, stating only that a wiry pulse indicates survival and a choppy pulse indicates death. Since emesis and purgation had already been used, harsh purgatives were contraindicated. I attempted emergency rescue. If bowel movement occurred and the pulse became wiry, cure might be possible. I administered Xiao Cheng Qi Tang (Minor Order the Qi Decoction). After one dose, bowel movement was achieved, symptoms gradually subsided, and the pulse became slightly wiry. Recovery took half a month. When asked why a wiry pulse after purgation indicates survival, I replied: *Jin Gui Yu Han Jing* states: Grasping at clothes, terror, slight panting, fixed staring, wiry pulse indicates survival, choppy indicates death. Mild cases with only fever and delirium are treated with Cheng Qi Tang. I observed Qian Yi's *Xiao Er Zhi Jue* stating: Seeking shirt collars and picking at objects indicates Liver Heat. This syndrome is listed under Yangming in *Yu Han*, as Yangming corresponds to the Stomach. Liver heat invading the Stomach meridian is treated with purgation. Obtaining a wiry pulse indicates Liver equilibrium, preventing it from overacting on the Stomach, which is the rationale for survival. One cannot understand Zhang Zhongjing without consulting other medical texts to elucidate hidden depths. (Hai Zang noted: Xu Shimiao attributed "grasping at clothes" to Liver Wind and Heat. This is plausible. However, it may be Lung Heat causing delirium. *Nan Jing* states: Lung pathogen entering the Heart causes delirium.)

Appendix Case
Lou Quanshan treated several patients exhibiting grasping at clothes and bedrails using major Qi and Blood tonifying formulas. One patient additionally presented with tremors and a intermittent pulse (Dai Mai). Lou added a small amount of Guizhi (Cinnamon Twig) to the tonifying formula. The tremors ceased, the pulse harmonized, and the patient recovered.