《论》曰∶实则谵语，虚则郑声，此虚实之有不同也。夫谵语郑声，总由神魂昏乱而语言不正
，又何以分其虚实？但谵语者，狂妄之语也；郑声者，不正之声也。谵语为实，实者邪实也。如伤
寒阳明实热，上乘于心，心为热冒，则神魂昏乱而谵妄不休者，此实邪也。实邪为病，其声必高，
其气必壮，其脉必强，其色必厉，凡登高骂詈，狂呼躁扰之类皆是也。此之为病，有燥粪在胃而然
者，有瘀血在脏而然者，有火盛热极而然者，有腹胀便秘、口疮咽烂而然者。察其果实，即当以三
承气，或白虎汤、凉膈散之类治之。郑声为虚，虚者神虚也。如伤寒元神失守，为邪所乘，神志昏
沉而错乱不正者，此虚邪也。虚邪为病，其声必低，其气必短，其脉必无
力，其色必萎悴，凡其自言自语，喃喃不全，或见鬼怪，或惊恐不休，或问之不应、答之不知之类
皆是也。此之为病，有因汗亡阳，因下亡阴而然者；有焦思抑郁，竭尽心气而然者；有劳力内伤，
致损脾肾而然者；有日用消耗，暗残中气而然者。凡其或虽起倒，而遏之即止，终不若实邪之难制
者，即虚邪也。察其果虚，最忌妄行攻伐，少有差谬，无不即死。治此者，速宜察其精气，辨其阴
阳，舍其外证，救其根本，稍迟犹恐不及，而况于误治乎。甚至有自利身寒，或寻衣撮空，面壁啐
啐者，尤为逆候。盖谵妄一证，最于虚损者不宜有之，故凡身有微热，脉见洪滑者生，心多烦躁，
脉见微弱细急而逆冷者死。所以证逢虚损，而见有谵妄者，即大危之兆，不可不加之意也。
《内经》说：实证表现为谵语，虚证表现为郑声，这是虚实不同的表现。谵语和郑声，总归是由于神魂昏乱导致语言不正，又凭什么来区分虚实呢？但谵语，是指狂妄的言语；郑声，是指声音不端正（指语无伦次、重复啰嗦）。谵语属于实证，实是指邪气盛实。比如伤寒阳明经实热，上扰于心，心被热邪蒙蔽，导致神魂昏乱而谵妄不止，这就是实邪致病。实邪致病，其声音必定高亢，气息必定壮盛，脉象必定强劲，面色必定严厉，凡是登高骂人、狂呼躁动之类都属于此类。这种病，有的是因为胃中有燥屎所致，有的是因为脏腑内有瘀血所致，有的是因为火盛热极所致，有的是因为腹胀便秘、口舌生疮咽喉溃烂所致。观察确认是实证后，就应当用三承气汤，或者白虎汤、凉膈散之类的方剂来治疗。郑声属于虚证，虚是指神气虚弱。比如伤寒导致元神失守，被邪气乘虚而入，神志昏沉错乱而不端正，这就是虚邪致病。虚邪致病，其声音必定低微，气息必定短促，脉象必定无力，面色必定萎黄憔悴，凡是自言自语、喃喃自语不完整，或者看见鬼怪，或者惊恐不止，或者问他不回答、答非所问之类都属于此类。这种病，有的是因为发汗过多亡阳，因为泻下过度亡阴所致；有的是因为思虑过度抑郁，耗尽心气所致；有的是因为劳累内伤，损伤脾肾所致；有的是因为日常消耗，暗中残害中气所致。凡是虽然能起身活动，但制止后即停止，终究不像实邪那样难以控制，这就是虚邪。观察确认是虚证后，最忌讳胡乱使用攻伐之法，稍有差错，没有不立即死亡的。治疗这类疾病，必须迅速考察患者的精气，辨别阴阳，抛开外在症状，挽救根本元气，稍微迟缓恐怕都来不及，何况误治呢？甚至有自利（腹泻）身寒，或者伸手抓空、面向墙壁吐唾沫的，这更是逆证危候。大概谵妄这一证候，最不应该出现在虚损病人身上，所以凡是身体有轻微发热，脉象洪滑的预后良好；心中烦躁，脉象微弱细急且四肢逆冷的预后不良（死证）。因此，遇到虚损之证却出现谵妄的，就是大危重的征兆，不可不加以重视。
The *Neijing* states: "Excess patterns manifest as delirious speech (Shanyu), while deficiency patterns manifest as feeble, repetitive speech (Zhengsheng); this reflects the difference between excess and deficiency." Both delirious speech and feeble speech generally arise from the confusion of the spirit and mind leading to disordered language. How then can one distinguish between excess and deficiency? Delirious speech refers to arrogant and wild utterances; feeble speech refers to incoherent and fragmented vocalizations. Delirious speech belongs to excess, where "excess" implies an abundance of pathogenic factors. For instance, in Shaoyang disease, excessive heat in the Yangming channel ascends to disturb the Heart. When the Heart is obscured by heat, the spirit becomes confused, resulting in incessant delirium; this is caused by excess pathogens. Diseases caused by excess pathogens are characterized by a high-pitched voice, robust breath, strong pulse, and stern facial expression. Examples include shouting insults while climbing high, or manic agitation. Such conditions may arise from dry feces retained in the stomach, blood stasis within the viscera, extreme fire and heat, or abdominal distension with constipation accompanied by mouth ulcers and throat erosion. Upon confirming an excess pattern, one should treat it with formulas such as the Three Chengqi Decoctions (San Chengqi Tang), Baihu Decoction (Baihu Tang), or Liangge Powder (Liangge San).
Feeble speech belongs to deficiency, where "deficiency" implies a weakness of the spirit. For example, in Shaoyang disease, if the primordial spirit loses its residence and is invaded by pathogens, the mental state becomes dull and disordered; this is caused by deficient pathogens. Diseases caused by deficient pathogens are characterized by a low-pitched voice, shortness of breath, a forceless pulse, and a sallow, withered complexion. Examples include muttering to oneself incompletely, hallucinating ghosts, unceasing fear and panic, or failing to respond when asked and giving irrelevant answers. Such conditions may arise from yang collapse due to excessive sweating, yin exhaustion due to excessive purgation, internal injury from overexertion damaging the Spleen and Kidney, or gradual depletion of Middle Qi due to daily consumption. Although the patient may be able to rise and move, their condition stops when restrained, which is fundamentally different from the uncontrollable nature of excess pathogens; this constitutes a deficient pattern. Upon confirming a deficiency pattern, one must strictly avoid reckless use of attacking methods. Any slight error will inevitably lead to immediate death. In treating such cases, one must rapidly assess the essence and qi, differentiate yin and yang, disregard superficial symptoms, and rescue the root foundation. Delaying treatment risks being too late, let alone misdiagnosis. Conditions such as spontaneous diarrhea with cold limbs, grasping at empty air, or facing the wall while spitting are particularly ominous signs indicating reversal. Generally, delirium should not occur in patients with severe deficiency. Therefore, a prognosis is favorable if there is slight fever and a surging, slippery pulse; conversely, it is unfavorable (fatal) if there is mental irritability, a weak, fine, rapid pulse, and cold extremities. Thus, when delirium appears in the context of deficiency, it is a sign of critical danger and must be treated with utmost caution.