The symptom of "grasping at clothes and bedclothes" (Xun Yi Mo Chuang) is a critical sign indicating a poor prognosis. There are two main patterns:

First, it arises from Taiyang Wind Strike (Taiyang Zhong Feng, a syndrome caused by wind pathogen invading the Taiyang channel) where fire therapy was used to forcibly induce sweating, resulting in a complicated disease (Huai Bing). The patient exhibits grasping at clothes and bedclothes; if urination is free, there is hope for survival; if urination is difficult, death ensues. Second, it results from extreme excess heat in the Yangming interior.

If the pulse is wiry (Xian), survival is possible; if the pulse is choppy (Se), death ensues.

In Taiyang Wind Strike, when fire therapy is used to induce sweating, the external wind pathogen and the internal fire pathogen interact like two yangs fanning each other, causing jaundice. When yang is excessive, epistaxis may occur; when yin fluid is deficient, dysuria occurs. There may be sweat only on the head, dryness of the anus, ulceration of the throat, or constipation. Prolonged heat leads to delirium (Chan Yu); in severe cases, hiccups (Yue) occur, with restlessness of the hands and feet, and grasping at clothes and bedclothes. If urination is free, the condition is treatable (see Head Sweat entry).

In Cold Damage (Shang Han), if vomiting or purging therapies were used but the disease persists, with constipation lasting five to six days up to ten or more days, tidal fever (Chao Re) occurs in the late afternoon (Shen, You, Xu hours). There is aversion to cold absent, and the patient speaks alone as if seeing ghosts. In severe cases, the patient loses recognition of others, exhibits grasping at clothes and bedclothes, fearfulness and restlessness, slight asthma (Wei Chuan), and fixed gaze (Zhi Shi). If the pulse is wiry, the patient may survive; if the pulse is choppy, the patient will die. In milder cases, presenting only with fever and delirium, Da Cheng Qi Tang (Great Order the Qi Decoction) is indicated. If bowel movement is achieved after one dose, subsequent doses should be stopped.

(Cheng Wuji's commentary: Vomiting and purging both damage Stomach Qi. Constipation persisting for five to six days to over ten days indicates exhaustion of body fluids and deficiency of Stomach Qi, with evil heat knotting internally. Yangming qi prospers during Shen, You, and Xu hours; tidal fever indicates intense Yangming heat. Absence of aversion to cold signifies that the exterior syndrome has resolved. Speaking alone as if seeing ghosts indicates interior fullness of Yangming. This is attributed to excess heat. If the condition is severe, it is due to extreme heat disturbing the righteous qi, causing confusion and loss of recognition. Grasping at clothes, restlessness, slight asthma, and fixed gaze represent Yang excess leading to Yin exhaustion (death), or Yin excess leading to Yang exhaustion (death). Intense heat indicates Yang excess. A wiry pulse suggests residual Yin, implying potential for life; a choppy pulse indicates Yin exhaustion, making treatment futile. If the evil heat is mild and not yet severe, presenting only with fever and delirium, Da Cheng Qi Tang can be used to purge stomach heat. As the classics state: when using purgatives, stop once the disease is addressed; do not necessarily complete the full dose. Here, since the heat is not severe, it is stated that if one dose results in bowel movement, subsequent doses should be stopped.)

Zhao Sizhen's annotation: This passage should be divided into three parts. From "Cold Damage after vomiting/purging... speaking alone as if seeing ghosts" constitutes the first part, listing tidal fever, delirium, absence of aversion to cold, and constipation as current symptoms. The text then divides further to distinguish between severe and mild cases. The character "mild" (Wei) is key: it refers to cases with only fever and delirium and no other symptoms. Using Cheng Qi Tang once daily, stopping after bowel movement, indicates light heat, cautioning against excessive purging. For "severe" cases, characterized by loss of recognition, grasping at clothes, restlessness, slight asthma, and fixed gaze, the heat is extreme and the condition critical, requiring decisive judgment of life or death based on the pulse: wiry indicates life (Yin not exhausted, allowing purging to restore Yin), choppy indicates death (Yin exhausted, untreatable). *Ren Shu* mentions only "severe" cases, omitting "mild," conflating them under one protocol using Cheng Qi Tang, and placing the "wiry/life, choppy/death" prognosis after the mild case treatment. It is illogical to suggest that mere fever and delirium without other adverse signs would suddenly lead to a choppy pulse and death. Although Zhang Zhongjing mentions another case of tidal fever, delirium, and choppy pulse being difficult to treat, this refers to patients who have taken Cheng Qi Tang but still have no bowel movement, with toxins retained and pulse becoming faint/choppy due to righteous qi decline and evil excess. In the current context, "mild" cases recover after taking the decoction because evil heat is expelled. Furthermore, while some say "wiry is Yang, choppy is Yin," and intestinal diseases showing Yin pulses live, in Zhang Zhongjing's method, wiry and choppy belong to Yin, not Yang, raising doubts.

Xu Shimicro recorded: A patient with Cold Damage had constipation, tidal fever in the late afternoon, grasping at clothing seams, empty hand movements (Cuo Kong), fixed gaze, and rapid breathing. Multiple physicians fled upon seeing these dire signs. This is indeed a malignant sign, with nine out of ten deaths. Zhang Zhongjing described the signs but provided no specific formula, stating only that wiry pulse indicates life and choppy indicates death. Since the patient had already undergone vomiting and purging, harsh purgatives are contraindicated; emergency rescue is needed. If stool passes and the pulse becomes wiry, treatment may succeed. Xiao Cheng Qi Tang (Minor Order the Qi Decoction) was administered. After one dose, stool passed, symptoms subsided, and the pulse became slightly wiry. Recovery occurred in half a month. Question: Why does a wiry pulse after purging indicate life? Answer: *Jin Gui Yu Han Jing* states: Grasping at clothes, fearfulness, slight asthma, fixed gaze; wiry pulse indicates life, choppy indicates death. Mild cases with only fever and delirium are treated with Cheng Qi Tang. I observed Qian Yi's *Xiao Er Zhi Jue*: Hand seeking clothing collars and picking at objects indicates Liver Heat. This syndrome is listed in the Yangming section of *Yu Han*, as Yangming corresponds to the Stomach. Liver heat invading the Stomach channel requires purging via Cheng Qi Tang. A wiry pulse indicates the Liver is pacified and no longer overacting on the Stomach, which is the principle of survival. One cannot understand Zhang Zhongjing without consulting other medical texts to elucidate hidden meanings. (Hanghai noted: Xu Shimicro attributed grasping at clothes to Liver wind-heat affecting the extremities, which is reasonable. Alternatively, it could be Lung heat causing delirium, as *Nan Jing* states Lung pathogen entering Heart causes delirium.)

Appendix Case:
Lou Quanshan treated several patients with grasping at clothes and bedclothes using major tonifying formulas for Qi and Blood deficiency. One patient additionally exhibited tremors and an intermittent pulse (Dai Mai). Lou added a small amount of Guizhi (Cinnamon Twig) to the tonifying formula. The tremors ceased, the pulse became harmonious, and the patient recovered.