经曰∶邪气盛则实，精气夺则虚。故实则谵语，虚则郑声。伤寒，胃中热盛，上乘于心，心为
热冒，则神识昏迷，妄有所见而言也，轻者睡中呢喃，重者不睡
亦语。亦有谵语者，有独语者，有语言不休者，有言乱者，凡此见其热之轻重也。大抵热入于胃，
水涸屎燥，必发谵语。又有被火劫者，有亡阳者，名各不同。但气短者死，脉自和则愈。或喘满，
气逆而上奔，自利柔脱而夺下，皆为逆也。
谵语者，脉洪数，大便闭，小便赤，手足温，与调胃承气汤。胃实谵语，身热汗多，便难，或
潮热，诸承气汤选用之。
发汗多，亡阳谵语，身自和，不可下，柴胡桂枝汤。下利谵语，为有燥屎，脉不微细，小承气
汤；利不止者，不治。
三阳合病，谵语者，脉滑实，身重难以转侧，口中不仁，面垢遗尿，不可汗下，与白虎汤。
伤寒，大热干呕，呻吟错语，不得眠，犀角解毒汤。
得病无热，但狂言，烦躁不安，精采不与人相当，与五苓散二钱，以新汲水吐之则愈。一法用
猪苓汤。
瘀血狂言谵语，漱水，大便黑色，小便多，身黄腹满，此为当汗不汗，蓄热
在里，轻者犀角地黄汤，甚者桃仁承气汤、抵当丸。
妇人热入血室，昼静夜谵，如见鬼状，小柴胡汤。
阳明病，其人喜忘，必有瘀血，抵当丸。
郑声者，重语也。又为不正之音也。伤寒郑声，如郑卫之音，不正也。盖因汗后，若病患本音
失而正气虚，则郑重，语不知高下，乃精气夺之候也。其脉微细，二便利，用小柴胡汤。
《内经》说：邪气亢盛则表现为实证，精气耗损则表现为虚证。因此，实证会出现谵语（神志不清，胡言乱语），虚证会出现郑声（语言重复，声音低微）。伤寒病中，胃中热势炽盛，向上熏蒸于心，心被热邪蒙蔽，导致神识昏迷，出现幻觉并胡乱说话。轻者仅在睡眠中喃喃自语，重者即使清醒时也胡言乱语。也有出现谵语的，有独自自言自语的，有言语连绵不断的，有言语错乱无章的，凡此种种，都是用来判断热邪轻重的依据。大抵热邪入胃，津液枯竭，大便燥结，必然引发谵语。又有因误用火疗劫夺津液导致的，有因阳气亡失导致的，名称各不相同。但如果出现气短的症状则预后不良属死证，脉象平和自和的则会痊愈。如果出现气喘胸满，气逆上冲，或者下利滑脱不禁且伴有下焦虚寒，都属于逆证（难治之证）。
出现谵语，若脉象洪数，大便闭塞，小便色赤，手足温暖，给予调胃承气汤（调和胃气，缓下热结）。如果是胃实引起的谵语，身体发热汗出多，排便困难，或有潮热（定时发热），可选用各类承气汤治疗。
如果发汗过多，导致亡阳而出现的谵语，身体状态相对平和，不可使用攻下法，应给予柴胡桂枝汤（和解少阳，调和营卫）。如果下利同时出现谵语，说明体内有燥屎内结，脉象不微细，给予小承气汤（轻下热结）；如果下利不止，则属不治之证。
三阳合病（太阳、阳明、少阳三经同时受邪），出现谵语，脉象滑而有力，身体沉重难以翻身转动，口中感觉麻木不知味，面部污垢，遗尿，此时不可使用发汗或攻下法，应给予白虎汤（清热生津）。
伤寒病，出现大热、干呕、呻吟、言语错乱、无法入睡，给予犀角解毒汤（清热解毒凉血）。
患病后没有发热，只是狂言乱语，烦躁不安，精神神采与常人不同，给予五苓散二钱，用新汲水（刚打来的冷水）送服并催吐，即可痊愈。另一种方法是用猪苓汤（利水清热养阴）。
瘀血阻滞导致的狂言谵语，想漱口但不欲咽，大便黑色，小便量多，身体发黄，腹部胀满，这是因为应当发汗而未发汗，热邪蓄积在里所致。轻者给予犀角地黄汤（清热凉血散瘀），重者给予桃仁承气汤（破血下瘀）或抵当丸（逐瘀破积）。
妇女热邪侵入血室（指子宫及肝经相关部位），白天安静，夜间谵语，如同看见鬼怪一样，给予小柴胡汤（和解少阳）。
郑声，是指语言重复啰嗦。又指声音不正。伤寒病中的郑声，就像郑卫之音（古代被认为淫靡不正的音乐），是不正的表现。大概是因为发汗之后，如果病人原本的声音消失而正气虚弱，就会表现为郑重其词但言语无序，不知高低轻重，这是精气耗损的征候。其脉象微细，大小便正常，给予小柴胡汤。
The *Neijing* states: "When pathogenic factors are exuberant, it manifests as excess; when essential qi is depleted, it manifests as deficiency." Therefore, excess conditions lead to *danyu* (delirious speech), while deficiency conditions lead to *zhengsheng* (repetitive and low-pitched speech). In *Shanghan* (Cold Damage) diseases, excessive heat in the stomach steams upward to affect the Heart. When the Heart is obscured by heat, consciousness becomes confused, hallucinations occur, and the patient speaks irrationally. In mild cases, there is only muttering during sleep; in severe cases, the patient speaks irrationally even when awake. There are also cases of delirious speech, solitary talking, incessant speech, and disordered speech; all these serve to gauge the severity of the heat. Generally, when heat enters the stomach, fluids are exhausted, stool becomes dry and hard, and delirium inevitably ensues. There are also cases caused by coercive fire therapy or loss of Yang Qi, with different names. However, if shortness of breath occurs, it indicates a fatal prognosis; if the pulse is harmonious, recovery will occur. If wheezing and chest fullness occur, with Qi rebelling upward, or if there is spontaneous diarrhea with soft collapse and lower depletion, these are all adverse conditions (difficult-to-treat patterns).
For delirious speech, if the pulse is surging and rapid, stool is closed, urine is red, and hands and feet are warm, administer *Tiaowei Chengqi Tang* (Stomach-Regulating Major Order the Qi Decoction). For gastric excess causing delirious speech, accompanied by high fever, profuse sweating, difficulty in defecation, or tidal fever, various *Chengqi Tang* formulas should be selected for use.
If excessive sweating leads to loss of Yang Qi and subsequent delirious speech, and the body condition is relatively stable, purgatives must not be used; instead, administer *Chaihu Guizhi Tang* (Bupleurum and Cinnamon Twig Decoction). If diarrhea accompanies delirious speech, indicating the presence of dry feces, and the pulse is not faint and fine, administer *Xiao Chengqi Tang* (Minor Order the Qi Decoction); if diarrhea persists uncontrollably, it is incurable.
In combined disease of the Three Yangs (Taiyang, Yangming, Shaoyang), if delirious speech occurs, with a slippery and forceful pulse, heavy body difficult to turn, numbness in the mouth, facial greasiness, and enuresis, neither sweating nor purging methods should be used; instead, administer *Baitao Tang* (White Tiger Decoction).
In *Shanghan*, if high fever, dry retching, groaning, disordered speech, and insomnia occur, administer *Xijiao Jiedu Tang* (Rhinoceros Horn Detoxification Decoction).
If the disease presents without fever but with manic speech, restlessness, and spiritual demeanor inconsistent with normalcy, administer two qian of *Wuling San* (Five-Ingredient Powder with Poria), taken with fresh cold water to induce vomiting, which will lead to cure. Another method uses *Zhu Ling Tang* (Polyporus Decoction).
Manic and delirious speech caused by blood stasis, characterized by rinsing the mouth without swallowing, black stool, frequent urination, yellowish skin, and abdominal fullness, results from failure to sweat when indicated, leading to heat accumulation in the interior. In mild cases, administer *Xijiao Dihuang Tang* (Rhinoceros Horn and Rehmannia Decoction); in severe cases, administer *Taoren Chengqi Tang* (Peach Kernel Order the Qi Decoction) or *Didang Wan* (Dare-to-Attack Pill).
When heat enters the Blood Chamber (referring to the uterus and related Liver meridian aspects) in women, resulting in calmness during the day and delirium at night, resembling seeing ghosts, administer *Xiao Chaihu Tang* (Minor Bupleurum Decoction).
In Yangming disease, if the patient exhibits forgetfulness, it indicates the presence of blood stasis; administer *Didang Wan*.
*Zhengsheng* refers to repetitive and verbose speech. It also denotes an improper tone. In *Shanghan*, *zhengsheng* resembles the music of Zheng and Wei (ancient terms for licentious music), indicating impropriety. This generally occurs after sweating; if the patient's original voice is lost due to deficiency of righteous Qi, they speak with undue emphasis but lack coherence and pitch control. This is a sign of essential Qi depletion. If the pulse is faint and fine, and urination and defecation are normal, administer *Xiao Chaihu Tang*.