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The Pericardium Meridian of Hand-Jueyin. When heat pathogens stagnate and obstruct, delirious speech and madness arise. After the rash begins to recede, blood-cooling methods should be combined. When fever is present and the rash is erupting, dispersing and supporting methods should be used.

Delirious speech refers to incoherent talking. These symptoms are all caused by excessive heat pathogens, where fire toxins stagnate and obstruct in the pericardium (the protective sac surrounding the heart). If restlessness and manic speech occur at the initial stage of fever, or if the measles rash remains hidden and fails to erupt, Xuan Du Fa Biao Tang (Dispel Toxins and Release the Exterior Decoction) (see Item 5), with Shengma (Cimicifugae Rhizoma), Jiegeng (Platycodonis Radix), and Gancao (Glycyrrhizae Radix et Rhizoma) removed, should be decocted in water. The resulting liquid is mixed with Chen Sha (Cinnabar) and Huashi (Talcum Powder) for treatment. (Some use Jing Fang Bai Du San (Jingjie and Fangfeng Decoction to Overcome Toxicity) from Item 2, removing Chaihu (Bupleuri Radix), Chuanxiong (Chuanxiong Rhizoma), Qianghuo (Notopterygii Rhizoma et Radix), Renshen (Ginseng Radix et Rhizoma), and Gancao (Glycyrrhizae Radix et Rhizoma), and adding Mutong (Akebiae Caulis), Dougen (Stemona Root), and Gupi (Moutan Cortex) for treatment; this is recorded for reference.) If delirium occurs when fever has not yet erupted or is currently erupting, it is due to fire pathogens lying latent internally, unable to penetrate the exterior. Medication should employ dispersing and supporting methods, assisted by cooling agents that separate and treat the condition. Ge Gen Jie Ji Tang (Puerariae Radix to Relieve Muscle Tension Decoction) (see Item 5), with Chi Shao (Paeoniae Radix Rubra) and Gancao (Glycyrrhizae Radix et Rhizoma) removed, plus Maidong (Ophiopogonis Radix), Chi Fuling (Poria with Hostwood), Shigao (Gypsum Fibrosum), Zhimu (Anemarrhenae Rhizoma), and Zhike (Aurantii Fructus Immaturus), should be used. In severe cases, Mahuang (Ephedrae Herba) fried with honey and wine is added to disperse and vent the pathogen, allowing the measles to fully emerge on the skin surface, after which delirious speech will naturally cease. If manic and incoherent speech occurs after the measles have already erupted, Dan Zhu Ye (Lophatheri Herba) and Deng Xin Cao (Junci Medulla) are decocted in water, mixed with Chen Sha (Cinnabar) and Huashi (Talcum Powder) for treatment. For delirium occurring during the recession of the rash or after its complete recession, medication should focus on clearing heat and detoxifying, assisted by agents that promote diuresis and cool the blood. Bai Hu Jie Du Tang (White Tiger Detoxification Decoction) (see Item 26), with Tian Hua Fen (Trichosanthis Radix) removed, plus Niubangzi (Arctii Fructus), Lianqiao (Forsythiae Fructus), Mutong (Akebiae Caulis), and Chi Fuling (Poria with Hostwood), should be used to clear heat, cool the blood, and promote diuresis. (Some use Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction) with Renshen (Ginseng Radix et Rhizoma), Banxia (Pinelliae Rhizoma), Gancao Gao (tip of Glycyrrhizae Radix et Rhizoma), and Jingmi (Oryza Sativa Germen) removed, and Sheng Dihuang (Rehmanniae Radix Recens) added; however, this is practically ineffective.) Once the fire subsides and toxins are cleared, delirious speech will naturally stop. Do not delay, lest the condition become incurable. If the heat is mild but residual toxins remain, one must first observe various complexion changes and take preventive measures. Always use Xiao Du Yin (Detoxification Drink) (see Item 22) with Gancao (Glycyrrhizae Radix et Rhizoma) removed, plus Lianqiao (Forsythiae Fructus), Zhike (Aurantii Fructus Immaturus), Mutong (Akebiae Caulis), and Chi Fuling (Poria with Hostwood) to promote diuresis. (Some use Su Ge Tang (Perilla and Pueraria Decoction) or a modified ancient formula of Huang Lian Jie Du Tang (Coptis Decoction to Relieve Toxicity); these are recorded for reference.) If after the measles have receded, residual heat attacks internally, leading to picking at clothes and bedclothes (unconscious grasping movements), delirious speech, coma, and mental decline, it is a fatal sign.

Zhu stated: Delirious speech varies in severity. In Shanghan (Cold Damage) diseases, excessive heat in the stomach rises upward to affect the heart. The heart is obscured by heat, causing incessant delirium. This syndrome is extremely severe, so purgative methods must be used. The case described here is merely a mild form of manic speech, so it can be treated with clearing methods using Chen Sha (Cinnabar), Sheng Dihuang (Rehmanniae Radix Recens), Mutong (Akebiae Caulis), or formulas similar to Bai Hu Tang (White Tiger Decoction).