〔《活》〕冬月阳明潮热，脉浮而紧者，发作有时，但脉涩者，心盗汗，黄芩汤主之。（方见下利。）
阳明为病，胃家实是也。胃实则谵语，故谵语宜入阳明门。阳明病，谵语，发潮热，脉滑而疾者，小承气
汤主之。因与承气汤一盏，腹中转矢气者，更服一盏。若不转矢气，勿更与之。明日不大便，脉反微涩者，里
虚也，为难治，不可更与承气汤。阳明病，谵语，有潮热，反不能食者，胃中必有燥屎五六枚，若能食者，但
硬，亦宜大承气汤下之。二阳并病，太阳病罢，但发热，手足 汗出，大便难而谵语者，下之则愈，宜大承
气汤。阳明病，其人多汗，以津液出，胃中燥，大便必硬，硬则谵语，小承气汤主之。若一服谵语止，勿更服。
汗出谵语者，必有燥粪在胃中，此为风也，须下之，必过经乃可下，下之若早，语言必乱，以表虚里实，
故下之则愈，宜大承气汤。夫实则谵语，虚则郑声。（谵语者，谓乱语无次第，数数更端也。郑声者，谓
郑重频烦也，只将一句旧言重叠频言之，终日殷勤不换他声也。盖神有余则能机变而乱语，数数更端。神不足
则无机变，而只守一声也。）伤寒四五日，脉沉而喘满，沉为在里，而反发其汗，津液越出，大便为难，
表虚里实，久则谵语。（成无己谓郑声为郑卫之声，非是，前辨已明。）
少阳病，发汗后，及小便数，脚挛急，误与桂枝攻表后，若胃不和谵语者，少与调胃承气汤。（方论见厥。）
三阳合病，腹满身重，难以转侧，口不仁而面垢，谵语遗尿，发汗则谵语，下之则额上生汗，手足逆冷，若
自汗出者，白虎汤主之。（论见身重。）汗发多，亡阳谵语者，不可下，与柴胡桂枝汤和其荣卫，以通津液，后自
愈。发汗多，又重发汗者，亡其阳，谵语脉短者死，脉自和者不死。诸逆发汗，病微者瘥，剧者言乱，目眩者死。
形作伤寒，其脉不弦紧而弱，弱者必渴，脉涩者必谵语，弱者发热，脉浮，解之当汗出愈。
太阳病，火劫汗后，身黄，小便难，身体枯燥，头汗腹满，微喘，或不大便，久则谵语。（论见头汗。）
太阳病，二日反躁，乃熨其背而大汗出，火热入胃，胃中水竭躁烦，必发谵语，十余日振栗自下利者，此
为欲解也。故其汗从腰以下不得汗，欲小便不得，反呕，欲失溲，足下恶风，大便硬，小盒饭数而反不数，及
多，大便已，头卓然而痛，其人足心必热，谷气下流故也。少阳病咳，咳而下利，谵语，小便难者，被火气
劫汗故也。吐、下、汗、温针后谵语，柴胡汤症罢者，此为坏病，知犯何逆，以法治之。（论见坏症。）
胸满谵语，若下后烦惊，小便不利，身重不可转侧者，柴胡加龙骨牡蛎汤主之。（方论见惊。）
阳明病，下血谵语者，此为热入血室，但头汗出者，刺期门，随其实泻之， 然汗出则愈。腹满谵语，脉
浮紧者，刺期门。（论见腹满。）太阳少阳并病，发汗则谵语，脉弦，五六日谵语不止者，宜刺期门。（论见
项强。）妇人发热，经水适来，谵语，为热入血室。若热除脉迟者，身凉，胸满如结胸状者，刺期门。若昼则
明了，暮则谵语者，无犯胃气及上二焦，必自愈。《活人》以小柴胡汤主之。（论见妇人伤寒。）
伤寒十三日不解，过经谵语者，以有热也，当以承气汤下之。若小便利者，大盒饭硬，而反下利，脉调和
者，知医以丸药下之，非其治也。若自下利者，脉当微厥，今反和者，此为内实，调胃承气汤主之。若下利谵
语者，有燥屎也，宜小承气汤。（方见潮热。）
上下利谵语，其曰脉调和而手足和小便利者，阳也，故用承气下之。其脉当微厥。反少阴但欲寐，被
火气劫汗，谵语，小便难者，阴也。故当用补剂和之。（但欲寐、下利、谵语俱见下利少阴条。）
〔许〕有人病伤寒下利，身热神昏，多困谵语，不得眠，或者见下利，便以谵语为阴虚症。予曰∶此亦
小承气症。众骇曰∶下利而服小承气，仲景之法乎？予曰∶此仲景之法也。仲景云∶下利而谵语者，有燥粪也，
属小承气汤而得解。予尝读《素问》云∶微者逆之，甚者从之，逆者正治，从者反治，从多从少，视其事也。
帝曰∶何谓反治？岐伯曰∶塞因塞用，通因通用。王冰注云∶大热内结，注泻不止，热宜寒疗，
结复须除，以寒下之，结散利止，则通因通用也。正合于此，又何疑焉。
直视谵语喘满者死，下利者亦死。谵语妄言，身微热，脉浮大，手足温者生，逆冷脉沉细者，不
过一日死矣。
（《活人书》）冬季阳明病出现潮热，脉象浮而紧的，发作有定时；若脉象涩的，伴随心盗汗，用黄芩汤主治。（方剂见下利篇。）
阳明病，就是胃家实。胃实则会出现谵语，所以谵语应当归入阳明病门类。阳明病，出现谵语、发潮热，脉象滑而疾速的，用小承气汤主治。给予小承气汤一盏，服药后腹部有转矢气（放屁）现象的，再服一盏。若不转矢气，不要再次给予。第二天仍不大便，脉象反而微涩的，是里虚，属于难治之症，不可再给承气汤。阳明病，谵语，有潮热，反而不能食的，胃中必有燥屎五六枚，若能食的，只是大便硬，也宜用大承气汤攻下。二阳并病，太阳病证罢除，仅发热，手足出汗，大便困难且谵语的，攻下则愈，宜用大承气汤。阳明病，其人汗多，因津液外出，胃中干燥，大便必硬，硬则谵语，用小承气汤主治。若服一次药后谵语停止，不要再服。汗出谵语的，胃中必有燥粪，这是风邪所致，必须攻下，但必须经过表证阶段之后才可攻下，若攻下过早，语言必然错乱，因为表虚里实，所以攻下则愈，宜用大承气汤。实证则谵语，虚则郑声。（谵语，是指胡言乱语没有次序，屡次更换话题。郑声，是指郑重频烦，只将一句旧话重叠频繁地说，整天殷勤不换其他话语。大概神气有余则能机变而乱语，屡次更换话题。神气不足则无机变，而只守着一句话。）伤寒四五日，脉沉而喘满，沉主在里，却反用发汗法，导致津液外越，大便困难，表虚里实，日久则谵语。（成无己认为郑声是郑卫之声，不对，前文辨析已明。）
少阳病，发汗后，及小便频数，脚挛急，误用桂枝汤攻表后，若胃不和出现谵语的，少量给予调胃承气汤。（方论见厥阴篇。）三阳合病，腹满身重，难以转侧，口不仁而面色垢浊，谵语遗尿，发汗则谵语加重，攻下则额上生汗，手足逆冷，若自汗出的，用白虎汤主治。（论见身重篇。）汗出过多，亡阳谵语的，不可攻下，给予柴胡桂枝汤调和营卫，以通津液，之后自愈。发汗过多，又重复发汗的，亡其阳气，谵语且脉短的预后不良（死），脉象平和的不死。各种误治发汗，病轻者痊愈，病重者言语错乱，目眩者死。
形体像伤寒，但其脉不弦紧而弱，脉弱者必口渴，脉涩者必谵语，脉弱者发热，脉浮的，解表当汗出而愈。
太阳病，火劫汗后，身黄，小便难，身体枯燥，头汗腹满，微喘，或不大便，日久则谵语。（论见头汗篇。）太阳病，二日反躁，乃熨其背而大汗出，火热入胃，胃中水竭躁烦，必发谵语，十余日后振栗自下利的，此为欲解。故其汗从腰以下不得汗，想小便不得，反呕，想失溲，足下恶风，大便硬，小便次数多但量反不多，以及量多，大便已下，头突然疼痛，其人足心必热，这是谷气下流的原因。少阳病咳，咳而下利，谵语，小便难的，是被火气劫汗所致。吐、下、汗、温针后谵语，柴胡汤证罢除的，此为坏病，需知犯了何种逆治，依法治疗。（论见坏病篇。）
胸满谵语，若下后烦惊，小便不利，身重不可转侧的，用柴胡加龙骨牡蛎汤主治。（方论见惊篇。）阳明病，下血谵语的，此为热入血室，仅头汗出的，刺期门穴，随其实证泻之，濈然汗出则愈。腹满谵语，脉浮紧的，刺期门。（论见腹满篇。）太阳少阳并病，发汗则谵语，脉弦，五六日谵语不止的，宜刺期门。（论见项强篇。）妇人发热，经水适来，谵语，为热入血室。若热除脉迟者，身凉，胸满如结胸状的，刺期门。若昼则明了，暮则谵语的，勿犯胃气及上二焦，必自愈。《活人书》以小柴胡汤主治。（论见妇人伤寒篇。）
伤寒十三日不解，过经谵语的，因为有热，应当用承气汤攻下。若小便利的，大便必硬，而反下利，脉调和的，知道医生用了丸药攻下，这不是正确的治法。若自下利的，脉当微厥，今反和的，此为内实，用调胃承气汤主治。若下利谵语的，有燥屎，宜用小承气汤。（方见潮热篇。）
上下利谵语，若脉调和而手足和小便利的，属阳证，故用承气汤攻下。其脉当微厥。反现少阴病但欲寐，被火气劫汗，谵语，小便难的，属阴证。故当用补剂和之。（但欲寐、下利、谵语俱见下利少阴条。）
（许叔微）有人患伤寒下利，身热神昏，多困谵语，不得眠，有人见下利，便以谵语为阴虚症。我说：这也是小承气汤证。众人惊讶说：下利而服小承气汤，是仲景的法度吗？我说：这是仲景的法度。仲景说：下利而谵语的，有燥粪，属小承气汤证可解。我曾读《素问》说：微者逆之，甚者从之，逆者正治，从者反治，从多从少，视其事也。帝曰：何谓反治？岐伯曰：塞因塞用，通因通用。王冰注云：大热内结，注泻不止，热宜寒疗，结复须除，以寒下之，结散利止，则通因通用也。正合于此，又何疑焉。
[From *Huoren Shu*] In winter, Yangming disease presents with tidal fever. If the pulse is floating and tight, the episodes occur at fixed times. If the pulse is choppy (Se), accompanied by heart spontaneous sweating, Huangqin Tang (Scutellaria Decoction) is the primary treatment. (Formula see under Diarrhea.)
Yangming disease is characterized by "Stomach Fullness" (Wei Jia Shi). When the Stomach is full/excess, delirium occurs; therefore, delirium should be categorized under Yangming disease. In Yangming disease, if there is delirium, tidal fever, and a slippery and rapid pulse, Xiao Chengqi Tang (Minor Order the Yang Decoction) is indicated. Administer one cup of Chengqi Tang; if abdominal rotation of flatus (passing gas) occurs, administer another cup. If there is no rotation of flatus, do not administer more. If on the next day there is still no bowel movement, but the pulse becomes faint and choppy, this indicates interior deficiency; it is difficult to treat, and Chengqi Tang should not be administered again. In Yangming disease, if there is delirium and tidal fever, but the patient cannot eat, there must be dry fecal matter (dry stool) in the stomach/intestines. If the patient can eat, the stool is merely hard; Da Chengqi Tang (Major Order the Yang Decoction) should still be used to purge. In concurrent Taiyang and Yangming diseases, after Taiyang symptoms have resolved, if there is only fever, sweating of the hands and feet, difficulty in defecation, and delirium, purgation will cure it; Da Chengqi Tang is indicated. In Yangming disease, if the person sweats profusely, causing fluid loss, leading to dryness in the Stomach and hard stools resulting in delirium, Xiao Chengqi Tang is indicated. If delirium stops after one dose, do not administer further. If sweating accompanies delirium, there must be dry feces in the Stomach; this is due to Wind pathogen. Purging is necessary, but it must be done only after the exterior stage has passed. If purged too early, speech will become chaotic because the exterior is deficient and the interior is excess; thus, purging will cure it, and Da Chengqi Tang is indicated. Excess leads to delirium; deficiency leads to Zhengsheng (repetitive murmuring). (Delirium refers to incoherent speech without order, repeatedly changing topics. Zhengsheng refers to earnest and frequent repetition, repeating the same old phrase over and over all day without changing voice. Generally, when Shen [Spirit] is in excess, it can change mechanisms and speak randomly, changing topics frequently. When Shen is deficient, it lacks flexibility and only clings to one sound.) In Cold Damage after four or five days, if the pulse is deep and there is wheezing and fullness, deep indicates interior location. If sweating is incorrectly induced, fluids escape, making defecation difficult, leading to exterior deficiency and interior excess, which eventually causes delirium. (Cheng Wuji stated that Zhengsheng refers to Zheng-Wei sounds, which is incorrect; this was clarified earlier.)
In Shaoyang disease, after sweating, and with frequent urination and foot cramping, if Guizhi Tang was mistakenly used to attack the exterior, and subsequently the Stomach is disharmonious causing delirium, a small amount of Tiaowei Chengqi Tang (Regulate the Stomach Order the Yang Decoction) should be given. (Formula theory see under Jueyin.) In concurrent Three-Yang disease, with abdominal fullness, body heaviness, difficulty turning, mouth dysfunction, greasy facial complexion, delirium, and urinary incontinence: inducing sweating worsens delirium; purging causes sweating on the forehead and cold extremities. If there is spontaneous sweating, Baihu Tang (White Tiger Decoction) is indicated. (Theory see under Body Heaviness.) If sweating is excessive, leading to Yang collapse and delirium, purging is contraindicated. Instead, Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction) should be used to harmonize Ying and Wei and promote fluid circulation, after which self-recovery occurs. If sweating is excessive and repeated, leading to Yang collapse, delirium, and a short pulse indicates death; a harmonious pulse indicates survival. For various erroneous sweating treatments: mild cases recover; severe cases result in chaotic speech; those with dizziness die.
The appearance resembles Cold Damage, but the pulse is not wiry-tight but weak. A weak pulse implies thirst; a choppy pulse implies delirium. If there is fever with a weak pulse and floating pulse, resolving the exterior via sweating will lead to recovery.
After Fire therapy sweating in Taiyang disease, if there is yellow skin, difficult urination, dry body, head sweating, abdominal fullness, slight wheezing, or constipation, prolonged cases lead to delirium. (Theory see under Head Sweating.) In Taiyang disease, if irritability appears on the second day, and back moxibustion/ironing causes profuse sweating, fire heat enters the Stomach, exhausting fluids, causing agitation and delirium. After ten-plus days, if chills and spontaneous diarrhea occur, this indicates impending resolution. Thus, if sweating is absent below the waist, desire to urinate is blocked, vomiting occurs, desire for urinary incontinence, aversion to wind on soles, hard stool, frequent but scanty urination, or abundant urination, followed by sudden headache upon defecation, and warmth in the soles, this is due to Grain Qi flowing downward. In Shaoyang disease, if coughing is accompanied by diarrhea, delirium, and difficult urination, it is caused by Fire pathogen forcing sweat. After emesis, purging, sweating, or warm needle therapy, if delirium occurs and Chaihu syndrome resolves, this is a "Bad Disease" (Complication); determine the error and treat accordingly. (Theory see under Bad Diseases.)
With chest fullness and delirium, if after purging there is vexation and fright, difficult urination, and body heaviness preventing turning, Chaihu Jia Longgu Muli Tang (Bupleurum plus Dragon Bone and Oyster Shell Decoction) is indicated. (Formula theory see under Fright.) In Yangming disease, if bleeding from the rectum accompanies delirium, this is Heat entering the Blood Chamber. If only the head sweats, puncture Qimen (LR14) to drain excess; copious sweating indicates recovery. With abdominal fullness and delirium, if the pulse is floating-tight, puncture Qimen. (Theory see under Abdominal Fullness.) In concurrent Taiyang-Shaoyang disease, if sweating causes delirium and the pulse is wiry, and delirium persists for five to six days, puncture Qimen. (Theory see under Neck Stiffness.) In women with fever, where menstruation just began, delirium indicates Heat entering the Blood Chamber. If heat clears and pulse is slow, body is cool, and chest fullness resembles Chest Binding, puncture Qimen. If clear during the day and delirious at night, do not harm Stomach Qi or the Upper/Middle Jiao; self-recovery will occur. *Huoren Shu* suggests Chaihu Tang (Bupleurum Decoction). (Theory see under Women's Cold Damage.)
In Cold Damage unresolved for thirteen days, passing the meridian cycle with delirium indicates internal heat; purging with Chengqi Tang is appropriate. If urination is free, stool should be hard, yet diarrhea occurs with a harmonious pulse, indicating the physician incorrectly used pill-based purgatives. If spontaneous diarrhea occurs with a normally harmonious pulse (instead of faint/cold), this indicates interior excess; Tiaowei Chengqi Tang is indicated. If diarrhea accompanies delirium, there is dry stool; Xiao Chengqi Tang is indicated. (Formula see under Tidal Fever.)
For upper and lower diarrhea with delirium: if the pulse is harmonious and hands/feet and urination are normal, it is a Yang pattern, so use Chengqi Tang to purge. The pulse should be faint/cold. Conversely, if Shaoyin pattern of lethargy occurs, combined with Fire-induced sweating, delirium, and difficult urination, it is a Yin pattern; thus, use tonifying/harmonizing formulas. (Lethargy, diarrhea, and delirium are also discussed under Shaoyin Diarrhea.)
[Xu Shuniwei] A patient suffered from Cold Damage with diarrhea, fever, mental confusion, fatigue, delirium, and insomnia. Some physicians, seeing diarrhea, diagnosed delirium as Yin deficiency. I said: This is also a Xiao Chengqi Tang pattern. Everyone was shocked: Using Xiao Chengqi Tang for diarrhea—is this Zhang Zhongjing’s method? I said: It is Zhang Zhongjing’s method. Zhongjing stated: Diarrhea with delirium indicates dry feces; it belongs to Xiao Chengqi Tang and can be resolved. I once read *Suwen*: "Treat mildly by opposing, severely by following; opposing is standard treatment, following is counter-treatment." The Emperor asked: What is counter-treatment? Qibo replied: "Use obstruction for obstruction, use unblocking for unblocking." Wang Bing commented: "Severe internal heat binding causes continuous diarrhea. Heat should be treated with cold; the binding must be removed. By using cold purgatives, the binding scatters and diarrhea stops; this is 'using unblocking for unblocking'." This perfectly fits the case, why doubt it?
Fixed gaze, delirium, wheezing, and fullness indicate death; diarrhea also indicates death. Delirious rambling, slight fever, floating-large pulse, and warm extremities indicate survival; cold extremities and deep-fine pulse indicate death within one day.