Zhengsheng (repetitive speech) in Shanghan (Cold Damage). It refers to an improper tone. Confucius said, "I detest Zheng music for disrupting the elegant music." He also said, "Discard Zheng music, stay away from flatterers. Zheng music is licentious; flatterers are dangerous." This is what is meant by Zhengsheng, referring to improper music. When Zhengsheng occurs in Shanghan, the voice resembles that of Zheng and Wei music, becoming improper. The classics state, "Deficiency manifests as Zhengsheng." Now, after sweating therapy or in prolonged illness, when a patient's voice changes (becoming low and repetitive), this is the case. From this, it can be known that this is a deficiency syndrome. Furthermore, "Zhengsheng" refers to "Chongyu" (repetitive speech). "Zheng" implies sound transformation (referring to disordered sounds). If the voice is heavy and transforms its original tone, it also falls into this category. Ignorant people do not understand this at all, mistakenly interpreting "Chong" as repetitive language, confusing it with Zhanyu (delirious speech) without being able to distinguish them. Thus, they merely use body heat, rapid pulse, irritability, thirst, difficulty in defecation, and excessive talking as criteria for Zhanyu; and use cool body temperature, small pulse, spontaneous diarrhea, lack of thirst, and excessive talking as criteria for Zhengsheng. Doing so loses the original intent of Zhang Zhongjing. Additionally, citing the phrase "Zheng music is licentious" to correct it, Zhengsheng is not merely repetitive language, but refers to improper sound. Moreover, in Zhang Zhongjing's work, over 390 syndromes are recorded, detailing various manifestations of Shanghan without omission. If Zhengsheng were simply excessive talking, there should also be entries in the Three Yin disease categories. Therefore, Zhengsheng has no separate syndrome treatment clauses because it is not classified with Zhanyu. Although it is called deficiency, it is only due to incomplete righteous Qi, causing the voice to transform and become improper. Wise people take this as a mirror and hope to investigate in detail.

How to clarify Zhanyu (delirious speech) in Shanghan? "Zhan" refers to muttering while speaking. It is also written as "Tan," referring to speaking falsely based on hallucinations. All these are caused by the confusion of true Qi and unclear consciousness. The Heart stores Shen (Spirit) and governs Fire; when diseased, heat qi gathers here. In Shanghan, excessive heat in the Stomach rises to invade the Heart. The Heart is covered by heat, leading to Shen confusion and increased speech. Consciousness becomes blurred, unaware of the cause, resulting in unstructured speech forming delirious words. Mild cases involve muttering during sleep; severe cases involve erroneous speech even when awake. There are those who speak deliriously, those who speak alone, those who speak wildly, those whose speech does not cease, and those whose speech is chaotic. These several conditions reflect the severity of heat. Zhanyu and Duyu (soliloquy), although occasionally containing absurd errors, if one can still converse with others in order, indicates that heat has not reached the extreme. The classics state, "Soliloquy appears as seeing ghosts." If the condition is severe, the patient does not recognize people upon onset, indicating that soliloquy is not yet the most critical stage. Kuangyu (wild speech) is a sign of extreme heat. Due to Shen confusion and lack of perception, it may escalate to shouting and speaking. Speech that does not cease is even more severe. Chaotic speech refers to nonsensical ranting and cursing, disregarding good and evil, and ignoring kinship and distance, because the Shen has already been severely disrupted. The classics state, "In various misdirected sweating therapies, mild cases are hard to cure; severe cases involve chaotic speech, which is difficult to treat again." The causes of Zhanyu differ and must be clearly distinguished. Some result from fire coercion, some from sweating, some from diarrhea, some from blood loss, some from dry stool in the Stomach, some from combined diseases of the Three Yang, some from passing the meridian cycle, and some from Yang collapse. The classics state, "Great heat entering the Stomach, drying up water and causing restlessness, inevitably leads to Zhanyu." Also, abdominal fullness, slight wheezing, dry mouth, rotten throat, or constipation, leading to Zhanyu over time, is Zhanyu caused by fire coercion. Sweating followed by Zhanyu is due to Wind pathogen; purgation is required, but only after the meridian cycle has passed. Purging too early will cause chaotic speech due to exterior deficiency and interior excess; this is the case of Zhanyu with sweating. Zhanyu with diarrhea is due to dry stool, treated with Xiao Chengqi Tang; this is Zhanyu with diarrhea. Zhanyu with blood loss is due to heat entering the Blood Chamber, requiring acupuncture at Qimen (LR14) to drain excess according to the pattern; this is Zhanyu with blood loss. Zhanyu accompanied by tidal fever but inability to eat indicates five or six pieces of dry stool in the Stomach; this is Zhanyu due to dry stool in the Stomach. Abdominal fullness, body heaviness, difficulty turning over, insensitivity of the mouth and face, Zhanyu, and urinary incontinence constitute Zhanyu from combined diseases of the Three Yang. Zhanyu after passing the meridian cycle is due to heat, requiring herbal decoction for purgation; this is Zhanyu after passing the meridian cycle. Zhanyu due to Yang collapse from excessive sweating cannot be treated with purgation; instead, Chaihu Guizhi Tang is given to harmonize Ying and Wei, allowing self-healing through the restoration of fluids; this is Zhanyu due to Yang collapse. In such cases, a short pulse indicates death, while a harmonious pulse indicates recovery. A slightly warm body with floating and large pulse indicates survival; cold limbs with deep and fine pulse indicate death within a day. Excess patterns manifest as Zhanyu, with Qi converging inward; excess is the primary disease. Alternatively, Qi rebelling upward causing wheezing and fullness, or Qi collapsing downward causing spontaneous diarrhea, are both adverse conditions. The classics state, "Fixed gaze, Zhanyu, and wheezing/fullness lead to death; diarrhea also leads to death," indicating the exhaustion of righteous Qi. Understanding the diagnosis of excess and deficiency, and recognizing the essentials of adverse and favorable trends, ensures that treating diseases will not result in error.