应下失下，真气亏微，及投承气，下咽少顷，额上汗出，发根燥痒，邪火上炎，
手足厥冷，甚则振战心烦，坐卧不安，如狂之状，此中气素亏，不能胜药，名为药烦。凡遇
此证，急投姜汤即已，药中多加生姜煎服，则无此状矣，更宜均两三次服，以防呕吐不纳。
服承气腹中不行，或次日方行，或半日仍吐原药，此因病久失下，中气大亏，不
能运药，名为停药，乃天元几绝，大凶之兆也。宜生姜以和药性，或加人参以助胃气，更有
邪实病重剂轻，亦令不行。
时疫坐卧不安，手足不定，卧未稳则起坐，才着坐即乱走，才抽身又欲卧，无有
宁刻。或循衣摸床，撮空捻指，师至才诊脉，将手缩去，六脉不甚显，尺脉不至，此平时斫
丧
，根源亏损，因不胜其邪，元气不能主持，故烦躁不宁，固非狂证，其危有甚于狂也，法当
大补。然有急下者，或下后厥回，尺脉至，烦躁少定，此因邪气少退，正气暂复，微阳少伸
也。不二时，邪气复聚，前证复起，勿以前下得效，今再下之，下之速死，急宜峻补，补不及者死
。此证表里无大热，下证不备者，庶几可生，譬如城郭空虚，虽残寇而能直入，战不可，守
不可，其危可知。
应下稽迟，血竭气耗，内热烦渴谵语，诸下证具，而数下之，渴热并减，下证悉
去，五六日后，谵语不止者，不可以为实，此邪气去，元神未复，宜清燥养荣汤，加辰砂一
钱。郑声谵语，态度无二，但有虚实之分，不应两立名色。
应当使用攻下法却延误了治疗，导致人体真气亏损微弱。此时投用承气汤，药液咽下不久，额头出汗，发根干燥发痒，邪火向上炎蒸，手足冰冷，甚至出现身体震颤、心烦意乱、坐卧不安、神志狂乱的症状。这是因为中焦脾胃之气素来亏虚，不能承受药力，这种情况称为“药烦”。凡是遇到这种证候，应立即服用姜汤即可缓解；在药物中多加生姜煎服，就不会出现这种症状；更适宜将药量分两三次服用，以防呕吐且无法受纳药物。
服用承气汤后腹部没有排便反应，或者到第二天才排便，或者半天后又吐出原本服下的药物，这是因为患病日久未能及时攻下，中气严重亏损，无法运化药力，这种情况称为“停药”，这是先天元气几乎断绝的征兆，属于大凶之象。应当用生姜来调和药性，或者加入人参以辅助胃气。也有因为邪气实盛而病情沉重，但用药剂量过轻，也会导致药效不显。
时行疫病期间，患者坐卧不安，手足躁动不定，躺下未稳就起身坐起，刚坐下就想四处乱跑，刚想抽身躺下又想坐起来，片刻不得安宁。有的患者抓摸衣被床沿，手在空中抓取捻弄手指，医生到来准备诊脉时，患者又将手缩回。六脉不明显，尺脉摸不到，这是因为平时过度耗损，根本元气亏损，因无法抵御邪气，元气不能主持机体，所以烦躁不宁。这固然不是狂证，但其危险程度比狂证更甚，治法应当大补元气。然而也有需要紧急攻下的情况，如果攻下后四肢厥冷消退，尺脉恢复，烦躁稍定，这是因为邪气稍微退去，正气暂时恢复，微弱的阳气得以伸展。若不超过两个时辰，邪气再次聚集，前面的症状再次出现，不要因为之前攻下有效，现在再次攻下，那样会导致迅速死亡，应当紧急进行峻补，如果补益不及就会死亡。此证表里没有大热，具备完整攻下指征的情况较少，这样或许还有生机。譬如城郭空虚，即使是残存的敌寇也能长驱直入，既不能战也不能守，其危险程度可想而知。
应当攻下却拖延迟缓，导致阴血枯竭、气机耗散，出现内热、烦躁、口渴、胡言乱语等症状，各种攻下指征都具备，但如果多次攻下，口渴和发热同时减轻，攻下指征全部消失，到了五六日后，胡言乱语仍不停止，就不能认为是实证。这是因为邪气已去，元神尚未恢复，适宜使用清燥养荣汤，加入辰砂一钱。郑声与谵语，表现态度没有区别，只是有虚证和实证的区分，不应将其列为两种截然不同的病名。
If purgation should have been used but was delayed, the true qi becomes deficient and weak. Upon administering Chengqi Tang (Cassia Seed Decoction), shortly after swallowing, sweat appears on the forehead, hair roots become dry and itchy, pathogenic fire flares upward, hands and feet become cold, and in severe cases, tremors, vexation, restlessness, and a manic state occur. This is because the middle jiao qi has always been deficient and cannot withstand the medication; this condition is named "medication annoyance" (Yao Fan). Whenever such a syndrome is encountered, one should urgently administer ginger soup to resolve it; adding more fresh ginger when decocting the medicine will prevent these symptoms. It is also advisable to divide the dose into two or three administrations to prevent vomiting and inability to retain the medicine.
After taking Chengqi Tang, if there is no bowel movement in the abdomen, or if it occurs only the next day, or if the original medicine is vomited up within half a day, this is due to prolonged illness without timely purgation, causing severe deficiency of middle qi which fails to transport the medicine. This condition is named "medicine suspension" (Ting Yao), indicating that heavenly yuan (innate vitality) is nearly extinct, a sign of great misfortune. One should use ginger to harmonize the medicinal properties, or add Ren Shen (Ginseng Root) to assist stomach qi. There are also cases where pathogenic factors are substantial and the disease is severe, but the dosage is too light, resulting in ineffective action.
During epidemic febrile diseases, patients may be restless in sitting and lying, with restless hands and feet. They rise from bed before settling down, pace around as soon as they sit, and attempt to lie down again immediately upon rising, having no moment of peace. Some may grasp at clothing, beds, or walls, or pick at empty air and fingers. When the physician arrives to take the pulse, the patient withdraws their hand. The six pulses are not distinct, and the chi pulse is absent. This is due to habitual depletion and loss of root essence; unable to overcome the pathogen, the primordial qi fails to govern, leading to irritability and restlessness. Although this is not mania, its danger exceeds that of mania. The method should be major tonification. However, there are cases requiring urgent purgation; if after purgation the cold limbs return to normal, the chi pulse reappears, and irritability subsides slightly, this indicates that pathogenic factors have receded somewhat and righteous qi has temporarily recovered, allowing slight yang to extend. If within two hours the pathogen gathers again and previous symptoms recur, do not purge again just because the previous purge was effective; doing so will lead to rapid death. Urgent vigorous tonification is required; if tonification is insufficient, death ensues. In this syndrome, if there is no significant heat in the interior and exterior, and the indications for purgation are incomplete, there is a chance of survival. It is like an empty city wall; even residual invaders can enter directly. Neither fighting nor defending is possible, and the danger is evident.
If purgation should have been performed but was delayed, blood is exhausted and qi is consumed, leading to internal heat, vexation, thirst, and delirious speech, with all indications for purgation present. However, if multiple purgations are administered, thirst and heat both decrease, and purgation indications disappear completely, but delirious speech persists after five or six days, this should not be considered excess. This is because the pathogen has left, but the primordial spirit has not yet recovered. Qing Zao Yang Rong Tang (Clear Dryness and Nourish Ying Decoction) should be used, with Chen Sha (Cinnabar) added, one qian. Zheng Sheng (feeble muttering) and Chan Yu (delirious speech) present similar attitudes and behaviors; they differ only in being deficiency or excess syndromes, and should not be classified as two separate diagnostic categories.