属阳明里症。阳明旺于申酉。故潮热发于午后。如潮信之按时。故名潮热。阳明病。潮热谵语。
大便硬者。可与承气。不硬不可与。若阳明病。潮热。大便溏。小便自利。
胸胁满不去者。小柴胡汤。
谵语谵语。皆胃中热甚。心为热冒。则神识昏乱。而语言谬妄也。诸症谵语。脉短者死。脉自和者愈。
邵评∶谵语为胃热。有虚热实热之不同须。分别治之。谵语气短为气虚。正虚不能胜邪。故死。
阳明胃实。则潮热谵语。汗出脉滑疾。胃中有燥屎也。宜下之。他如发汗后。下利后。下血后。俱有谵语。
悉属
虚。（参准绳）金鉴云。心气实热而神有余。则发为谵语。谵语为实。故声长而壮。乱言无次。数数更端
也。心气虚热而神不足。则发为郑声。郑声为虚。故音短而细。只将一言。重复呢喃也。凡谵语郑声。
与阳经同见者。均属热证。可以攻之。与阴经同见者。总为寒证。可以温之。若阳经无可攻之证。当清解之。阴
经无可温之证。当清补之。
经曰。邪入于阳则狂。伤寒热毒在胃。乘于心。则主发狂。邪热极矣。用甘草汤候冷。
调下鹊石散二钱。
邵评∶胃热乘心。可用大黄黄连泻心汤。煎成。冲童便莲心。最效。甚则锉入犀角末、金汁。
如狂症 太阳蓄血发狂。则少腹硬痛。小便自利。阳明蓄血如狂。则喜忘。大便黑。
均以桃仁承气汤主之。又有阳盛阴虚之人。作汗将解之时。奄然发狂。 然汗出而解者。当须识之。
不可与药也。（以上参准绳）
邵评∶如狂有蓄血狂汗之分。
凡胃热乘心。则神昏狂乱。表实无汗者。三黄石膏汤。里实不便者。承气汤。无表里症而热极者。
白虎、解毒等汤。（参金鉴）
属于阳明里证。阳明经气旺盛于申时和酉时（下午3点至7点）。所以潮热发作在午后，像月经按时来潮一样，因此称为潮热。阳明病出现潮热、说胡话，大便干硬的，可以给予承气汤类方剂；大便不硬则不可使用。如果是阳明病，表现为潮热，大便稀溏，小便通畅，胸胁部胀满感持续不消的，用小柴胡汤。
谵语（神志不清时的胡言乱语），都是由于胃中热势炽盛，热气上扰心神，导致神识昏乱，言语错谬妄诞。各种病症中出现谵语，如果脉象短促的预后不良（死证）；脉象平和的则会痊愈。
邵评：谵语属于胃热，有虚热和实热的不同，需要分别治疗。谵语伴气息短促的是气虚，正气虚弱不能抗御邪气，所以预后不良。
阳明胃腑实证，会出现潮热、谵语，出汗且脉象滑数疾速，这是胃中有燥屎积结，应当用攻下法。其他如发汗后、腹泻后、便血后，也都可能出现谵语，这些都属于虚证。（参考《医宗必读》）《医宗金鉴》说：心气实热而神气有余，就会发生谵语。谵语属于实证，所以声音长而壮烈，言语混乱没有次序，频繁更换话题。心气虚热而神气不足，就会发生郑声（精神萎靡时的重复低语）。郑声属于虚证，所以声音短小而细微，只将一句话反复喃喃自语。凡是谵语或郑声，与阳经症状同时出现的，都属于热证，可以用攻下法；与阴经症状同时出现的，总属寒证，可以用温补法。如果在阳经证候中没有可攻下的指征，应当清热解表；在阴经证候中没有可温补的指征，应当清热兼以补益。
经文说：邪气侵入阳分就会发狂。伤寒热毒蕴结在胃，上乘于心，就会导致发狂。这是邪热极盛的表现。可用甘草汤放凉后，调服鹊石散二钱。
邵评：胃热上乘于心，可用大黄黄连泻心汤，煎好后冲入童便和莲子心，效果最好。病情严重的，加入犀角末和金汁。
如狂症：太阳经蓄血证导致发狂，表现为少腹部硬痛，小便通畅。阳明经蓄血证导致如狂，表现为健忘，大便色黑。这两种情况都以桃仁承气汤为主治方剂。又有阳气偏盛、阴液亏虚的人，在将要通过出汗解除病邪的时候，突然发狂，随后出汗而病愈的，这种情况应当识别清楚，不要给药治疗。（以上参考《医宗必读》）
邵评：如狂症有蓄血致狂和战汗致狂的区别。
凡是胃热上乘于心，导致神志昏迷、狂乱躁动的，如果表实无汗，用三黄石膏汤；如果里实便秘，用承气汤；如果没有表里证候但热势极盛的，用白虎汤、解毒汤等方剂。（参考《医宗金鉴》）
It belongs to Yangming interior syndrome. The Qi of the Yangming channel is vigorous during Shen and You hours (3 PM to 7 PM). Therefore, tidal fever occurs in the afternoon, resembling the regular timing of menstruation, hence named "tidal fever." In Yangming disease, if there is tidal fever and delirium with hard stool, Chengqi Decoction may be administered; if the stool is not hard, it should not be used. If in Yangming disease there is tidal fever, loose stool, free urination, and persistent fullness in the chest and hypochondrium, Xiaochaihu Tang (Minor Bupleurum Decoction) is indicated.
Delirium refers to incoherent speech due to loss of consciousness, caused by excessive heat in the Stomach disturbing the Heart, leading to confused spirit and erroneous speech. Among various conditions presenting with delirium, a short pulse indicates a fatal prognosis, while a harmonious pulse indicates recovery.
Shao's Commentary: Delirium stems from Stomach heat, which can be either deficiency-heat or excess-heat, requiring differentiated treatment. Delirium accompanied by shortness of breath indicates Qi deficiency; when Zheng Qi (Upright Qi) is too weak to overcome the pathogen, the prognosis is poor.
In Yangming Stomach excess syndrome, tidal fever and delirium occur with sweating and a slippery, rapid pulse, indicating dry feces in the Stomach; purgation is appropriate. Other causes of delirium include post-sweating, post-diarrhea, or post-hematochezia states, all of which belong to deficiency patterns (referencing *Yi Zong Bi Du*). *Yi Zong Jin Jian* states: When Heart Qi is excess-heat and Spirit is surplus, delirium occurs. Delirium is an excess pattern, characterized by loud, strong voice, chaotic speech without order, and frequent topic changes. When Heart Qi is deficiency-heat and Spirit is insufficient, Zheng Sheng (repetitive muttering) occurs. Zheng Sheng is a deficiency pattern, characterized by short, faint voice, repeating a single phrase murmuredly. Whenever delirium or Zheng Sheng appears alongside Yang meridian symptoms, it belongs to heat patterns and can be treated with purgation; when appearing alongside Yin meridian symptoms, it generally belongs to cold patterns and can be treated with warming methods. If Yang meridian patterns lack indications for purgation, clear and resolve; if Yin meridian patterns lack indications for warming, clear heat and tonify.
The Classic states: "When pathogenic factors enter the Yang, madness ensues." In typhoid, heat-toxin accumulates in the Stomach and ascends to the Heart, causing madness. This represents extreme pathogenic heat. Use Gancao Tang (Licorice Decoction), cooled, mixed with Que Shi San (Magpie Stone Powder), two qian.
Shao's Commentary: For Stomach heat ascending to disturb the Heart, Dahuang Huanglian Xiexin Tang (Rhubarb and Coptis Heart-Purging Decoction) can be used. After decocting, mix with child's urine and lotus plumule for best effect. In severe cases, add Rhinoceros Horn powder and Jin Zhi (Gold Juice).
Like-madness Syndrome: Sun Taiyang blood stasis causing madness presents with hardness and pain in the lower abdomen and free urination. Yangming blood stasis causing like-madness presents with forgetfulness and black stools. Both are primarily treated with Tao Ren Chengqi Tang (Peach Kernel Cathartic Decoction). Additionally, individuals with excess Yang and deficient Yin may suddenly become mad as they are about to resolve the pathogen through sweating, followed by sweating and recovery. This situation must be recognized, and no medication should be given (referencing *Yi Zong Bi Du*).
Shao's Commentary: Like-madness includes differentiation between blood-stasis-induced madness and battle-sweat-induced madness.
Whenever Stomach heat ascends to disturb the Heart, causing confusion and madness: if exterior excess with no sweating, use Sanyang Huangbo Gypsum Tang (Three-Yellow Gypsum Decoction); if interior excess with constipation, use Chengqi Tang; if there are no exterior/interior patterns but extreme heat, use Baihu Tang (White Tiger Decoction) or Jiedu Tang (Detoxification Decoction) (referencing *Yi Zong Jin Jian*).