论曰伤寒不应发汗而汗之，遂致亡阳，津液内竭，胃中燥实，则令谵语，此病或由津液
不和，内有燥屎，或三阳合病，或瘀热蓄血在里。或妇人热入血室，皆使谵语也。然谵语属
胃，胃者足阳明经也，阳明为病主身热，故谵言妄语，则身当有热，脉当洪大。而洪大亦阳
脉也，故其病为顺，若谵语而手足厥，脉反沉细而微者为逆也，然又有郑声者，取其郑重之
意，与谵语相类，盖古人以此分虚实，医者当以脉证参合别之。不可不慎，故谓虚则郑声，
实则谵语。
治伤寒阳明病，其人多汗，以津液外出，胃中燥，大便必硬，硬则谵语，宜小承气汤。
若一服谵语止，更莫服。小承气汤方
大黄（四两） 浓朴（去粗皮姜汁炙二两） 枳实（大者麸炒三枚）
上三味，锉如麻豆大，每服五钱匕，水一盏半，煎至七分，去滓温服。
治伤寒阳明病下血谵语者，此为热入血室，但头汗出者，刺期门随其实而写之， 然汗
出则愈，汗出谵语者，以有燥屎在胃中，此为风也，须下者，过经乃可下之，下之若早，语
言必乱，以表虚里实故也，下之愈，宜大承气汤方
大黄（酒洗四两） 浓朴（去粗皮生姜汁炙半斤） 枳实（麸炒五枚）
上三味，锉如麻豆，每服五钱匕，水一盏半，煎至七分，去滓入芒硝一钱匕，更上微火
一两沸，温服。
治伤寒三阳合病，腹满身重难以转侧，口不仁面垢，谵语遗尿，发汗则谵语，下之则额
上生汗，手足逆冷，若自汗出者。白虎汤主之方
知母（六两） 石膏（碎一斤） 甘草（炙二两） 粳米（六合）
上四味，粗捣筛，每服五钱匕，水一盏半，煎至七分，去滓温服。
治伤寒热实得汗不解，腹满胀痛，烦躁谵语。柴胡汤方
柴胡（去苗一两） 大黄（锉微炒） 黄芩（去黑心） 芍药 半夏（汤洗七遍焙干各
三分）
枳壳（去瓤麸炒半两）
上六味， 咀如麻豆，每服五钱匕，水一盏半，入生姜一分拍碎。煎至七分，去滓温服。
治伤寒邪热在胃，谵言妄语，身体壮热。犀角汤方
犀角（镑） 大青 人参（各三分） 远志（去心一分） 升麻（一两半） 柴胡（去
苗） 黄芩
（去黑心各一两） 甘草（炙锉半两）
上八味，粗捣筛，每服五钱匕，水一盏半，入生姜半分拍碎，芦根茅根各五寸，同煎至
半盏，去滓温服。
治伤寒脉沉在里，而反发汗，津液越出，大便难，表虚里实，遂发谵言，其人如狂。枳
实汤方
枳实（去瓤麸炒） 木香（各一分） 朴硝（三分） 大黄（锉微炒一两） 甘草（炙
半两）
上五味，粗捣筛，每服五钱匕，水一盏半，煎至七分，去滓温服。
治伤寒里实，谵语狂妄。芎 汤方
芎 （三分） 大黄（锉炒一两） 甘草（炙锉半两）
上三味，粗捣筛，每服五钱匕，水一盏半，煎至七分，去滓温服。
治伤寒热病谵言妄语，四肢烦热。犀角汤方
犀角（镑） 柴胡（去苗） 吴蓝 马牙硝（各一两） 升麻 葛根（锉各一两半） 甘
草（炙
半两）
上七味，粗捣筛，每服五钱匕，水一盏半，煎至七分，去滓食后温服，日再。
治伤寒热实，烦躁谵语。柴胡汤方
柴胡（去苗） 人参 黄芩（去黑心各一两） 犀角（镑） 朴硝 茯神（去木各三分）
甘草
（炙锉半两）
上七味，粗捣筛，每服五钱匕，水一盏半，煎至七分，去滓温服。
治伤寒经六七日不解，默默烦心，腹中干燥，大肠结涩，谵言妄语。人参柴胡汤方
人参（三分） 柴胡（去苗一两） 芍药 知母 黄芩（去黑心） 大黄（锉微炒） 葳
蕤半
夏（汤洗七遍焙） 甘草（炙各半两）
上九味，粗捣筛，每服五钱匕，水一盏半，入生姜一分拍碎，同煎至七分，去滓温服。
治伤寒烦热不解，谵言妄语，欲发狂走。黄芩散方
黄芩（去黑心） 甘遂（麸炒黄） 龙胆（去芦头各一两）
上三味，捣罗为散，每服一钱匕，冷水调下，更令病患饮水三两盏，腹满则吐，此方疗
积热甚效。
治伤寒发热烦躁，言语谵妄，目赤口干，心神恍惚。栝蒌散方
栝蒌根（二两） 郁金 甘草（生各一两）
上三味，捣罗为散，每服一钱，生姜蜜水调下，不拘时候。
治伤寒发汗多，亡阳谵语者，不可下，与柴胡桂枝汤，和其营卫，以通津液，后自愈。
方
柴胡（去苗四两） 桂（去粗皮） 黄芩（去黑心） 芍药 人参（各一两半） 半夏
（汤洗七
遍焙） 甘草（炙各一两）
上七味，锉如麻豆，每服五钱匕，水一盏半，入生姜半分拍碎，大枣两枚劈破，同煎至
七分，去滓温服，日三。
论述说：伤寒病本不应发汗，若误用发汗法，会导致亡阳（阳气耗散），津液在体内枯竭，胃中干燥结实，从而出现谵语（神志不清，胡言乱语）。这种病症有的因为津液不和，体内有燥屎；有的是三阳经合病；有的是瘀热蓄积于血分而在体内。或者是妇女热邪侵入血室，都会导致谵语。然而谵语归属于胃，胃属于足阳明经。阳明经受病主要表现为身体发热，所以出现胡言乱语时，身体应当有发热，脉象应当洪大。而洪大脉也属于阳脉，所以这种病情属于顺证。如果谵语的同时手足厥冷，脉象反而沉细微弱，这属于逆证。此外还有“郑声”（精神萎靡，语言重复，声音低微），取的是其郑重之意，与谵语相似。古人以此区分虚实，医生应当结合脉象和症状来辨别。不可不谨慎，所以说虚证表现为郑声，实证表现为谵语。
治疗伤寒阳明病，患者多汗，因为津液外泄，胃中干燥，大便必然坚硬，大便硬则导致谵语，适宜用小承气汤。如果服用一次后谵语停止，不要再服用。小承气汤方：大黄（四两）、浓朴（去除粗皮，用姜汁炙制二两）、枳实（大的，用麸炒三枚）。以上三味药，锉碎如麻豆大小，每次服用五钱匕，用水一盏半，煎至七分，去渣温服。
治疗伤寒阳明病下血且谵语的，这是热邪侵入血室，只有头部出汗的，针刺期门穴，根据其实证情况采用泻法，全身汗出则痊愈。如果是汗出且谵语，是因为胃中有燥屎，这是风邪所致，需要攻下的，必须经过表证阶段之后才可攻下。如果攻下过早，语言必定错乱，这是因为表虚里实的缘故，攻下后痊愈，适宜用大承气汤方：大黄（酒洗四两）、浓朴（去除粗皮，用生姜汁炙制半斤）、枳实（麸炒五枚）。以上三味药，锉碎如麻豆大小，每次服用五钱匕，用水一盏半，煎至七分，去渣后加入芒硝一钱匕，再放在微火上煮一两沸，温服。
治疗伤寒三阳合病，腹部胀满，身体沉重难以翻身，口舌麻木不知五味，面色垢浊，谵语，遗尿。发汗会导致谵语加重，攻下会导致额上出汗，手足逆冷。如果是自汗出的，用白虎汤主治。白虎汤方：知母（六两）、石膏（打碎一斤）、甘草（炙制二两）、粳米（六合）。以上四味药，粗捣筛过，每次服用五钱匕，用水一盏半，煎至七分，去渣温服。
治疗伤寒热实证，得汗后病不解，腹部胀满疼痛，烦躁谵语。用柴胡汤方：柴胡（去苗一两）、大黄（锉碎微炒）、黄芩（去黑心）、芍药、半夏（水烫七遍焙干，各三分）、枳壳（去瓤麸炒半两）。以上六味药，切碎如麻豆大小，每次服用五钱匕，用水一盏半，加入生姜一分拍碎。煎至七分，去渣温服。
治疗伤寒邪热在胃，胡言乱语，身体高热。用犀角汤方：犀角（镑片）、大青、人参（各三分）、远志（去心一分）、升麻（一两半）、柴胡（去苗）、黄芩（去黑心，各一两）、甘草（炙制锉碎半两）。以上八味药，粗捣筛过，每次服用五钱匕，用水一盏半，加入生姜半分拍碎，芦根、茅根各五寸，同煎至半盏，去渣温服。
治疗伤寒脉象沉在里，却反用发汗法，导致津液外越，大便困难，表虚里实，于是出现谵言，其人如狂。用枳实汤方：枳实（去瓤麸炒）、木香（各一分）、朴硝（三分）、大黄（锉碎微炒一两）、甘草（炙制半两）。以上五味药，粗捣筛过，每次服用五钱匕，用水一盏半，煎至七分，去渣温服。
治疗伤寒里实证，谵语狂妄。用芎䓖汤方：芎䓖（三分）、大黄（锉碎炒制一两）、甘草（炙制锉碎半两）。以上三味药，粗捣筛过，每次服用五钱匕，用水一盏半，煎至七分，去渣温服。
治疗伤寒热病，胡言乱语，四肢烦热。用犀角汤方：犀角（镑片）、柴胡（去苗）、吴蓝、马牙硝（各一两）、升麻、葛根（锉碎，各一两半）、甘草（炙制半两）。以上七味药，粗捣筛过，每次服用五钱匕，用水一盏半，煎至七分，去渣饭后温服，每日两次。
治疗伤寒热实证，烦躁谵语。用柴胡汤方：柴胡（去苗）、人参、黄芩（去黑心，各一两）、犀角（镑片）、朴硝、茯神（去木，各三分）、甘草（炙制锉碎半两）。以上七味药，粗捣筛过，每次服用五钱匕，用水一盏半，煎至七分，去渣温服。
治疗伤寒病程六七日未解，沉默寡言心中烦闷，腹中干燥，大肠结涩，胡言乱语。用人参柴胡汤方：人参（三分）、柴胡（去苗一两）、芍药、知母、黄芩（去黑心）、大黄（锉碎微炒）、葳蕤、半夏（水烫七遍焙）、甘草（炙制，各半两）。以上九味药，粗捣筛过，每次服用五钱匕，用水一盏半，加入生姜一分拍碎，同煎至七分，去渣温服。
治疗伤寒烦热不解，胡言乱语，想要发狂奔跑。用黄芩散方：黄芩（去黑心）、甘遂（麸炒至黄）、龙胆（去芦头，各一两）。以上三味药，捣罗为散剂，每次服用一钱匕，冷水调服，再让病人饮水三两盏，腹部胀满则会呕吐，此方治疗积热非常有效。
治疗伤寒发热烦躁，言语谵妄，眼睛红赤口干，心神恍惚。用栝蒌散方：栝蒌根（二两）、郁金、甘草（生用，各一两）。以上三味药，捣罗为散剂，每次服用一钱，用生姜蜜水调服，不限时候。
治疗伤寒发汗过多，亡阳导致谵语的，不可攻下，给予柴胡桂枝汤，调和营卫，以通利津液，之后自然痊愈。方：柴胡（去苗四两）、桂（去除粗皮）、黄芩（去黑心）、芍药、人参（各一两半）、半夏（水烫七遍焙）、甘草（炙制，各一两）。以上七味药，锉碎如麻豆大小，每次服用五钱匕，用水一盏半，加入生姜半分拍碎，大枣两枚劈破，同煎至七分，去渣温服，每日三次。
It is stated that in the disease of cold damage (Shanghan), sweating should not be induced; if mistakenly induced, it leads to Yang collapse (loss of Yang Qi) and internal exhaustion of body fluids. Dryness and excess in the Stomach then cause delirious speech (incoherent talking due to mental confusion). This condition may arise from disharmony of body fluids with dry feces retained inside, or from a combined disease of the three Yang channels, or from blood stasis with heat accumulating internally. In women, heat entering the Blood Chamber can also cause delirious speech. However, delirious speech belongs to the Stomach, which corresponds to the Foot-Yangming Channel. Diseases of the Yangming channel primarily manifest as fever of the body; therefore, when delirious speech occurs, the body should be hot, and the pulse should be surging and large. Since a surging and large pulse is also a Yang pulse, this indicates a favorable prognosis. Conversely, if delirious speech is accompanied by cold extremities and a pulse that is instead deep, fine, and faint, it indicates an unfavorable prognosis. Additionally, there is "Zhengsheng" (repetitive, low-voiced muttering indicating deficiency), which shares similarities with delirious speech but implies a sense of earnestness. The ancients used this distinction to differentiate between deficiency and excess patterns. Physicians must carefully differentiate by combining pulse diagnosis and symptom observation. It is said that deficiency manifests as Zhengsheng, while excess manifests as delirious speech.
For treating Yangming disease of cold damage, where the patient sweats profusely, leading to external loss of body fluids, dryness in the Stomach, and hard stools causing delirious speech, Xiao Chengqi Tang (Minor Order the Qi Decoction) is appropriate. If delirious speech ceases after one dose, do not administer further.
Xiao Chengqi Tang Formula: Dahuang (Rhubarb Root, 4 liang), Nongpo (Magnolia Bark, peeled and stir-fried with ginger juice, 2 liang), Zhishi (Immature Bitter Orange, bran-fried, 3 large pieces).
The above three ingredients are cut into sizes similar to hemp seeds. Each dose consists of 5 qianbi, boiled in 1.5 sheng of water until reduced to 0.7 sheng. Strain and take warm.
For treating Yangming disease of cold damage characterized by bloody stool and delirious speech, this indicates heat entering the Blood Chamber. If only the head sweats, puncture Qimen (LR14) and apply the reducing method according to the excess pattern. Recovery occurs when general sweating ensues. If delirious speech occurs with sweating, it is due to dry feces in the Stomach caused by wind pathogen. Purging is required, but only after the exterior stage has passed. Premature purging will cause chaotic speech because the exterior is deficient and the interior is excess. After purging, recovery occurs; Da Chengqi Tang (Major Order the Qi Decoction) is indicated.
Da Chengqi Tang Formula: Dahuang (Rhubarb Root, wine-washed, 4 liang), Nongpo (Magnolia Bark, peeled and stir-fried with fresh ginger juice, 0.5 jin), Zhishi (Immature Bitter Orange, bran-fried, 5 pieces).
The above three ingredients are cut into sizes similar to hemp seeds. Each dose consists of 5 qianbi, boiled in 1.5 sheng of water until reduced to 0.7 sheng. Strain, add Mangxiao (Mirabilite, 1 qianbi), and boil gently for one or two boils. Take warm.
For treating combined disease of the three Yang channels in cold damage, presenting with abdominal fullness, heaviness of the body making turning difficult, numbness of the mouth and face, delirious speech, and urinary incontinence. Inducing sweating worsens delirium; purging causes sweating on the forehead and cold extremities. If spontaneous sweating is present, Baihu Tang (White Tiger Decoction) is the primary treatment.
Baihu Tang Formula: Zhimu (Anemarrhena Rhizome, 6 liang), Shigao (Gypsum Fibrosum, crushed, 1 jin), Gancao (Licorice Root, honey-fried, 2 liang), Jingsmi (Rice Grain, 6 he).
The above four ingredients are coarsely pounded and sifted. Each dose consists of 5 qianbi, boiled in 1.5 sheng of water until reduced to 0.7 sheng. Strain and take warm.
For treating excess heat syndrome in cold damage where sweating does not resolve the illness, presenting with abdominal fullness and pain, irritability, and delirious speech, use Chaihu Tang (Bupleurum Decoction).
Chaihu Tang Formula: Chaihu (Bupleurum Root, de-stemmed, 1 liang), Dahuang (Rhubarb Root, cut and lightly stir-fried), Huangqin (Scutellaria Root, remove black heart), Shaoyao (Peony Root), Banxia (Pinellia Tuber, washed in water seven times and dried, each 3 fen), Zhike (Aurantii Fructus Immaturus, pulp removed and bran-fried, 0.5 liang).
The above six ingredients are cut into sizes similar to hemp seeds. Each dose consists of 5 qianbi, boiled in 1.5 sheng of water with 1 fen of crushed fresh ginger. Reduce to 0.7 sheng, strain, and take warm.
For treating evil heat in the Stomach in cold damage, causing delirious speech and high fever, use Xijiao Tang (Rhinoceros Horn Decoction).
Xijiao Tang Formula: Xijiao (Rhinoceros Horn, sliced), Daqing (Isatidis Folium), Renshen (Ginseng Radix et Rhizoma, each 3 fen), Yuanzhi (Polygalae Radix, de-core, 1 fen), Shengma (Cimicifugae Rhizoma, 1.5 liang), Chaihu (Bupleurum Root, de-stemmed), Huangqin (Scutellaria Root, remove black heart, each 1 liang), Gancao (Licorice Root, honey-fried and cut, 0.5 liang).
The above eight ingredients are coarsely pounded and sifted. Each dose consists of 5 qianbi, boiled in 1.5 sheng of water with 0.5 fen of crushed fresh ginger, along with 5 cun of Wugen (Reed Rhizome) and Maogen (Imperata Rhizome). Reduce to half a sheng, strain, and take warm.
For treating cold damage where the pulse is deep indicating interior involvement, but sweating was mistakenly induced, causing body fluids to escape, difficulty in defecation, exterior deficiency and interior excess, leading to delirious speech and a manic-like state, use Zhishi Tang (Immature Bitter Orange Decoction).
Zhishi Tang Formula: Zhishi (Immature Bitter Orange, pulp removed and bran-fried), Muxiang (Aucklandiae Radix, each 1 fen), Puxiao (Natrii Sulfas, 3 fen), Dahuang (Rhubarb Root, cut and lightly stir-fried, 1 liang), Gancao (Licorice Root, honey-fried, 0.5 liang).
The above five ingredients are coarsely pounded and sifted. Each dose consists of 5 qianbi, boiled in 1.5 sheng of water until reduced to 0.7 sheng. Strain and take warm.
For treating interior excess in cold damage with delirious speech and madness, use Xiong Tang (Ligusticum Decoction).
Xiong Tang Formula: Xiongnu (Ligusticum Chuanxiong Rhizome, 3 fen), Dahuang (Rhubarb Root, cut and stir-fried, 1 liang), Gancao (Licorice Root, honey-fried and cut, 0.5 liang).
The above three ingredients are coarsely pounded and sifted. Each dose consists of 5 qianbi, boiled in 1.5 sheng of water until reduced to 0.7 sheng. Strain and take warm.
For treating febrile disease in cold damage with delirious speech and vexing heat in the four limbs, use Xijiao Tang (Rhinoceros Horn Decoction).
Xijiao Tang Formula: Xijiao (Rhinoceros Horn, sliced), Chaihu (Bupleurum Root, de-stemmed), Wu Lan (Baphicacanthis Cusia Herb), Mayaxiao (Mirabilite, each 1 liang), Shengma (Cimicifugae Rhizoma), Gegen (Puerariae Radix, cut, each 1.5 liang), Gancao (Licorice Root, honey-fried, 0.5 liang).
The above seven ingredients are coarsely pounded and sifted. Each dose consists of 5 qianbi, boiled in 1.5 sheng of water until reduced to 0.7 sheng. Strain and take warm after meals, twice daily.
For treating excess heat in cold damage with irritability and delirious speech, use Chaihu Tang (Bupleurum Decoction).
Chaihu Tang Formula: Chaihu (Bupleurum Root, de-stemmed), Renshen (Ginseng Radix et Rhizoma), Huangqin (Scutellaria Root, remove black heart, each 1 liang), Xijiao (Rhinoceros Horn, sliced), Puxiao (Natrii Sulfas), Fushen (Poria with Wood, de-wood, each 3 fen), Gancao (Licorice Root, honey-fried and cut, 0.5 liang).
The above seven ingredients are coarsely pounded and sifted. Each dose consists of 5 qianbi, boiled in 1.5 sheng of water until reduced to 0.7 sheng. Strain and take warm.
For treating cold damage lasting six or seven days without resolution, presenting with silent irritability, dry abdomen, constipation of the Large Intestine, and delirious speech, use Renshen Chaihu Tang (Ginseng and Bupleurum Decoction).
Renshen Chaihu Tang Formula: Renshen (Ginseng Radix et Rhizoma, 3 fen), Chaihu (Bupleurum Root, de-stemmed, 1 liang), Shaoyao (Peony Root), Zhimu (Anemarrhena Rhizome), Huangqin (Scutellaria Root, remove black heart), Dahuang (Rhubarb Root, cut and lightly stir-fried), Weirui (Polygonatum Odoratum Rhizome), Banxia (Pinellia Tuber, washed in water seven times and dried), Gancao (Licorice Root, honey-fried, each 0.5 liang).
The above nine ingredients are coarsely pounded and sifted. Each dose consists of 5 qianbi, boiled in 1.5 sheng of water with 1 fen of crushed fresh ginger. Reduce to 0.7 sheng, strain, and take warm.
For treating unresolved vexing heat in cold damage with delirious speech and urge to run madly, use Huangqin San (Scutellaria Powder).
Huangqin San Formula: Huangqin (Scutellaria Root, remove black heart), Gansui (Euphorbia Lathyris Root, bran-fried until yellow), Longdan (Gentiana Root, de-rhizome, each 1 liang).
The above three ingredients are pounded and sieved into a powder. Each dose is 1 qianbi, taken with cold water. Have the patient drink 2-3 shengs of water afterwards; abdominal fullness will induce vomiting. This formula is highly effective for treating accumulated heat.
For treating cold damage with fever, irritability, delirious speech, red eyes, dry mouth, and mental恍惚 (fluctuation/uncertainty), use Gualou San (Trichosanthes Root Powder).
Gualou San Formula: Gualougen (Trichosanthes Radix, 2 liang), Yujin (Curcumae Radix), Gancao (Licorice Root, raw, each 1 liang).
The above three ingredients are pounded and sieved into a powder. Each dose is 1 qianbi, taken with water mixed with fresh ginger and honey, at any time.
For treating cold damage where excessive sweating led to Yang collapse and delirious speech, purging is contraindicated. Instead, administer Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction) to harmonize Ying and Wei (Nutritive and Defensive levels) and unblock body fluids, after which the condition will resolve spontaneously.
Chaihu Guizhi Tang Formula: Chaihu (Bupleurum Root, de-stemmed, 4 liang), Gui (Cinnamomi Ramulus, peeled), Huangqin (Scutellaria Root, remove black heart), Shaoyao (Peony Root), Renshen (Ginseng Radix et Rhizoma, each 1.5 liang), Banxia (Pinellia Tuber, washed in water seven times and dried), Gancao (Licorice Root, honey-fried, each 1 liang).
The above seven ingredients are cut into sizes similar to hemp seeds. Each dose consists of 5 qianbi, boiled in 1.5 sheng of water with 0.5 fen of crushed fresh ginger and 2 broken Jujubae Fructus (Chinese Date). Reduce to 0.7 sheng, strain, and take warm, three times daily.