（谵语者妄有所见呢喃而语不伦于理也多言稍有次第者独语如见鬼者睡中呢喃者
皆热之轻也音声高厉言之不休者热之重也狂言叫喊骂詈不辨亲疏神明昏乱热之最甚也皆因胃中热
盛上乘于心心为热冒故也脉短则死脉和则愈又身微热脉浮大者生逆冷脉沉者死或气逆喘满或
气下夺而自利皆为逆也）
阳明病。谵语。潮热。脉滑而疾。与小承气汤。转失气者更服。不转失气者。勿服。阳
明病
汤）脉浮自汗。微恶寒。挛急。误与桂枝攻表。胃不和而谵语。（调胃承气汤）三阳合病。腹
满。身重。口中不仁面垢遗尿。自汗。谵语。（白虎汤） 伤寒四五日。脉沉。喘满。沉为在
里。反发其汗。津液越出。大便为难。表虚里实。久则谵语。（大承气汤）脉弦头痛。发热。属
少阳。不可汗。汗则谵语。汗多亡阳。谵语。不可下。（柴胡桂枝汤和营卫以通津液自愈）
下后胸满烦惊。小便不利。谵语。一身尽痛。（柴胡加龙骨牡蛎汤）热入血室。在男子。阳明病
。下血谵语。（小柴胡汤加黄连栝蒌）妇人中风。发热恶寒。经水适来。昼则明了。暮则谵语
。（小柴胡汤加生地黄丹皮当归）十三日过经不解。谵语者热也。当以汤下之。小便利者。大
盒饭硬。而反下利。脉调和者。知以丸药下之。非其治也。若自利者。脉当微厥。今反和者
。内实也。（调胃承气汤）下利谵语。脉滑数。有燥屎也。此汤饮傍流。所利皆稀水。可下之
。（承气汤）气虚独言。脉无力者。（补中益气汤）虚则郑声。盖郑重频烦。语言谆复也。谓止
将一事。频烦谆复。不能如谵语之数数更端也。成注为郑卫之声误矣。四逆脉微。郑声。（
四君子汤甚者参附汤送黑锡丹）
按实则谵语。虚则郑声。二者本不难辨。但阳盛里实。与阴盛隔阳。皆致错语。须以他
症别之。如身热。烦渴。大便闭。小便赤。乃阳盛里实也。小便清白。大便洞泄。发躁。乃阴盛
隔阳也。
（谵语，是指患者神志不清，胡言乱语，言语没有条理；有的自言自语，好像看见了鬼魂；有的在睡梦中喃喃自语，这些都属于热邪较轻的情况。如果声音高亢洪亮，说话不停，属于热邪较重的情况；如果狂乱叫喊，骂人，不分亲疏，神志昏乱，这是热邪最严重的表现。这些都是因为胃中热盛，向上熏蒸于心，心被热邪蒙蔽的缘故。脉象短促的预后不良，脉象调和的则痊愈。另外，身体微热而脉象浮大的可生，四肢逆冷而脉象沉伏的死；或者气逆喘满，或者气虚下陷导致自发性腹泻，这些都是逆证。）
阳明病，出现谵语、潮热，脉象滑而疾速，给予小承气汤。服药后若转矢气（放屁），可再服；若不转矢气，则不要服用。
阳明病，脉浮、自汗出、轻微恶寒、肢体拘挛急迫，误用桂枝汤攻表，导致胃气不和而出现谵语。（治疗宜用调胃承气汤）
三阳合病，腹部胀满，身体沉重，口舌麻木不知味，面色垢浊，遗尿，自汗出，谵语。（治疗宜用白虎汤）
伤寒病程四五日，脉象沉，喘促胸满。沉脉主里证，反而发汗，导致津液外越，大便困难，表虚里实，时间久了会出现谵语。（治疗宜用大承气汤）
脉弦，头痛，发热，属于少阳病，不可发汗。发汗则会导致谵语，汗多亡失阳气，出现谵语，此时不可攻下。（可用柴胡桂枝汤调和营卫以通利津液，自愈）
攻下之后，胸中烦闷惊悸，小便不利，谵语，全身疼痛。（治疗宜用柴胡加龙骨牡蛎汤）
热邪陷入血室。在男子，表现为阳明病，便血并伴有谵语。（治疗宜用小柴胡汤加黄连、瓜蒌）。在妇人，中风发热恶寒，月经适来，白天神志清楚，傍晚则谵语。（治疗宜用小柴胡汤加生地黄、牡丹皮、当归）
病程十三日以上，过经不解，出现谵语，这是有热邪，应当用汤药攻下。如果小便通畅，大便应当硬结，但反而腹泻，脉象调和，可知是之前被丸药攻下所致，这不是正确的治法。如果是自发性腹泻，脉象应当微弱厥冷，现在反而调和，说明体内有实邪。（治疗宜用调胃承气汤）
腹泻且谵语，脉象滑数，说明有燥屎内结。这是“热结旁流”的现象，所下的都是稀水，可以攻下。（治疗宜用承气汤）
虚证表现为郑声。所谓郑声，是指郑重频繁，语言重复啰嗦。意思是只说一件事，反复啰嗦，不像谵语那样数数更端（话题多变）。成无己注解说郑声是“郑卫之声”是错误的。四逆汤证见脉微、郑声。（重症可用四君子汤，甚者用参附汤送服黑锡丹）
按：实证则谵语，虚证则郑声，这两者本来不难辨别。但是阳盛里实，与阴盛格阳，都会导致错语（言语错乱），必须通过其他症状来鉴别。如身体发热，烦躁口渴，大便闭塞，小便赤黄，这是阳盛里实。如果小便清长，大便洞泄，烦躁，这是阴盛格阳。
(Admonitory speech (Zhanyu, 谵语), refers to the patient speaking nonsense in a delirious state without logical coherence. Some speak only to themselves as if seeing ghosts; some mutter in their sleep. These all indicate mild heat pathogen. If the voice is loud and harsh, and speech is incessant, it indicates severe heat. If the patient raves, shouts, curses, fails to distinguish relatives from strangers, and suffers from mental confusion, this represents the most severe heat. All these conditions arise because excessive heat in the Stomach ascends to harass the Heart, causing the Heart to be obscured by heat. A short pulse indicates death; a harmonious pulse indicates recovery. Additionally, slight body heat with a floating and large pulse suggests survival; cold extremities with a deep pulse suggest death. Alternatively, rebellious Qi causing wheezing and chest fullness, or Qi deficiency leading to spontaneous diarrhea, are all adverse conditions.)
In Yangming disease, presenting with admonitory speech (Zhanyu, 谵语) and tidal fever (Chaore, 潮热), with a slippery and rapid pulse, administer Xiao Chengqi Tang (Minor Order the Yellow Decoction). If flatus occurs after administration, give another dose; if no flatus occurs, do not administer.
In Yangming disease, with a floating pulse, spontaneous sweating, slight aversion to cold, and muscle cramping/spasms, mistakenly treating with Guizhi Tang (Cinnamon Twig Decoction) to attack the exterior leads to disharmony of the Stomach and results in admonitory speech (Zhanyu, 谵语). (Treatment should employ Tiaowei Chengqi Tang (Regulate the Stomach and Order the Yellow Decoction)).
In combined disease of the Three Yang, presenting with abdominal fullness, heaviness of the body, numbness/insensitivity of the mouth, greasy facial complexion, enuresis, spontaneous sweating, and admonitory speech (Zhanyu, 谵语). (Treatment should employ Baihu Tang (White Tiger Decoction)).
In Cold Damage (Shanghan, 伤寒) lasting four or five days, with a deep pulse, wheezing, and chest fullness. A deep pulse indicates interior involvement. Mistakenly inducing sweating causes fluids to leak out, leading to difficult defecation. Exterior deficiency with interior excess, persisting for a long time, results in admonitory speech (Zhanyu, 谵语). (Treatment should employ Da Chengqi Tang (Major Order the Yellow Decoction)).
With a wiry pulse, headache, and fever, the condition belongs to Shaoyang. Sweating is contraindicated. Inducing sweating leads to admonitory speech (Zhanyu, 谵语); excessive sweating depletes Yang Qi, resulting in admonitory speech (Zhanyu, 谵语), at which point purgation is contraindicated. (Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction) can be used to harmonize Ying and Wei to facilitate fluid circulation, leading to self-recovery).
After purgation, presenting with chest fullness, vexation, and fright, difficulty in urination, admonitory speech (Zhanyu, 谵语), and pain throughout the body. (Treatment should employ Chaihu Jia Longgu Muli Tang (Bupleurum plus Dragon Bone and Oyster Shell Decoction)).
Heat entering the Blood Chamber (Xueshi, 血室). In men, manifesting as Yangming disease with bloody stool and admonitory speech (Zhanyu, 谵语). (Treatment should employ Xiaochaihu Tang (Minor Bupleurum Decoction) added with Huanglian (Coptis Rhizome) and Gualou (Trichosanthes Fruit)). In women, Wind-Cold with fever and aversion to cold, where menstruation has just begun, clear consciousness during the day but admonitory speech (Zhanyu, 谵语) at night. (Treatment should employ Xiaochaihu Tang (Minor Bupleurum Decoction) added with Sheng Dihuang (Rehmannia Root), Mudanpi (Tree Peony Bark), and Danggui (Angelica Sinensis)).
Thirteen days have passed, the disease has crossed the meridians and remains unresolved, presenting with admonitory speech (Zhanyu, 谵语), indicating heat that should be treated with decoctions for purgation. If urination is free, the stool should be hard, yet diarrhea occurs instead. With a harmonious pulse, it is known that previous treatment involved pill-based purgatives, which was incorrect therapy. If there is spontaneous diarrhea, the pulse should be faint and cold; now that it is harmonious, it indicates interior excess. (Treatment should employ Tiaowei Chengqi Tang (Regulate the Stomach and Order the Yellow Decoction)).
Diarrhea accompanied by admonitory speech (Zhanyu, 谵语) and a slippery, rapid pulse indicates dry feces retained in the intestine. This is "heat binding with side-flow" (Rejie Pangliu, 热结旁流), where only watery stool is discharged. Purgation is indicated. (Treatment should employ Chengqi Tang (Order the Yellow Decoction)).
Speaking alone due to Qi deficiency, with a forceless pulse. (Treatment should employ Buzhong Yiqi Tang (Center-Supplementing and Qi-Boosting Decoction)).
Deficiency manifests as Zhengsheng (repetitive speech). Zhengsheng refers to speaking repeatedly and tediously about the same matter, unlike Zhanyu (admonitory speech) which changes topics frequently. Cheng Wuji's annotation describing Zhengsheng as "Zheng-Wei sounds" is erroneous. Sini Pulse (Sini Mai, 四逆脉) with faint pulse and Zhengsheng. (Severe cases: Sijunzi Tang (Four Gentlemen Decoction); even more severe: Shenfu Tang (Ginseng and Aconite Decoction) administered with Heixi Dan (Black Tin Pill)).
Analysis: Excess leads to Zhanyu (admonitory speech); deficiency leads to Zhengsheng (repetitive speech). These two are not difficult to differentiate. However, both Yang excess with interior excess and Yin excess repelling Yang can cause confused speech. One must distinguish them via other symptoms. For example, body heat, vexation, thirst, constipation, and dark urine indicate Yang excess with interior excess. Clear and copious urination, loose stools, and irritability indicate Yin excess repelling Yang.