bubble_chart Concept

Delirious speech is a symptom characterized by confusion and incoherent babbling. It is commonly seen in excess pattern and is often caused by high fever.

Suwen. Re Lun refers to it as "delirious speech". Zhubing Yuanhou Lun calls it "nonsensical speech". Suwen. Qijiaobian Da Lun describes it as "delirium"; however, delirium, in addition to confusion and incoherent speech, often includes emotional fear, excitement, and agitation.

Delirious speech is different from "paraphasia", "manic speech", and "fading murmuring". Paraphasia is characterized by clear consciousness but disordered speech or self-awareness of speaking errors after the fact. Manic speech is caused by excessive pathogenic heat or internal disturbance by phlegm-fire, with patients exhibiting manic raving, incessant laughing, discarding clothes, and singing on high places. Fading murmuring is characterized by a dull consciousness, weak speech, faint low voice, and disjointed speech, often seen in the critical stage of internal damage to heart qi and mental dispersion. These symptoms are discussed in separate sections.

Heat entering the uterus and postpartum delirious speech are common gynecological conditions, which will not be discussed in this section.

bubble_chart Pattern Analysis

1. Exuberant Heat in Yangming︰Confused consciousness, delirious speech, high fever with a flushed face, thirst and sweating, coarse breathing resembling panting, scanty dark urine, red tongue with yellow coating, and a surging large pulse. Accompanied by fever, sweating, thirst with a desire to drink, and a surging large pulse. The {|###|}mechanism of disease{|###|} is: the pathogen of {|###|}taiyang{|###|} not resolving, {|###|}pathogenic heat{|###|} transmitting from the exterior to the interior, exuberant {|###|}heat at qi aspect{|###|} in yangming, diffusing throughout the body. Leizheng Zhicai states: "In the {|###|}cold-damage disease{|###|} yangming pattern,… the steaming of heat, thirst, and delirious speech indicate diffuse heat, with pathogens not yet conglomerated." The treatment focuses on {|###|}clearing heat and promoting fluid production{|###|}, using the formula White Tiger Decoction.
2. Yangming Fu-organ Excess︰late afternoon tidal fever，delirious speech dysphoria，chest tightness and panting fullness，abdominal distension and fullness hard，periumbilical pain，severe constipation，tongue coating yellow thick and dry，or gray-black dry，pulse deep solid and forceful。Must have severe constipation，epigastric and abdominal hardness and fullness，abdominal pain refusing pressure，coating yellow scorched，with prickles，pulse deep solid and forceful。Its mechanism of disease is：gastrointestinal dryness-heat forming solid，dryness-heat with turbidity qi rising to attack，dry feces obstructing，bowel qi stagnation。Treatment is to purge dryness accumulation，prescription useMajor Purgative Decoction。
3. Steaming of Heat Toxin︰高热谵语，烦躁不安，面赤口渴，痈肿疮疡，多发性脓肿流窜，或下痢脓血，或绞肠痛绝，舌质红绛，苔黄褐干燥，脉滑数。是由感受火毒时疫之邪，或火热之邪郁结成毒，热毒内扰，则谵语不安。是以毒壅上焦（头面红肿，咽喉肿烂），毒燔气血（高热心烦，吐衄发斑），多发性脓肿流窜（肌肤红肿、疼痛，破溃流脓），热毒伤阴（颧红潮热，唇舌红干，脉细数），为辨证要点。而治在清热解毒，凉血救阴，方用清瘟败毒饮。
4. Dampness-heat︰Hiding fever, or high fever, worsens in the afternoon, occasionally accompanied by delirious speech, abdominal distension and fullness, nausea, jaundice with bright yellow discoloration of the body and eyes, or bloody and mucoid dysentery, dark urine, a red tongue with yellow greasy coating, and a soggy rapid pulse. This condition arises from external invasion of dampness-heat that becomes stagnant and fails to disperse, or from spleen deficiency leading to impaired transportation, resulting in internal generation of dampness turbidity. The dampness stagnates and transforms into heat, leading to the accumulation of dampness-heat that clouds the heart orifices. The main manifestations include signs of dampness-heat affliction, such as hiding fever, dark urine, occasional delirious speech with intermittent lucidity; or jaundice with bright yellow discoloration of the body and eyes; or bloody and mucoid dysentery with tenesmus; a yellow, thick, greasy tongue coating, and a soggy rapid pulse. The treatment focuses on clearing and resolving dampness-heat, using Acorus Curcuma Root Decoction.
5. Heat Invading the Heart Nutritive Level︰Fever aggravated at night, delirious speech, dysphoria and restlessness, faint appearance of macula and papule, crimson tongue texture, thin and rapid pulse. It is caused by pathogenic heat invading the nutrient aspect, hence characterized by faint appearance of macula and papule and crimson tongue texture. As the condition progresses further, in addition to the manifestations of heat in the nutrient aspect, there may also be visible macula and papule, epistaxis, hematemesis with dark red blood, deep crimson tongue color, etc.; or symptoms of blood heat damaging yin such as feverish sensation in palms and soles, dry mouth and throat, red lips with scanty fluid; or signs of liver heat stirring wind like stiffness of the neck and back, intermittent convulsions. Heat entering the heart-nutrient aspect causes delirious speech, and the treatment focuses on clearing the nutrient aspect and discharging heat, using Nutrient-Clearing Decoction.
6. Heat in the Blood Level︰High fever with delirium, worsening at night, restlessness and agitation, vomiting blood and epistaxis with macules; or tidal fever with flushed cheeks, evening fever and morning coolness, or wriggling of limbs, convulsions of the four limbs, or emaciated body, withered lips and contracted tongue, dry teeth with accumulated filth, sunken eyes and clouded vision, dry and crimson tongue with a bare appearance, pulse manifestation of thready and rapid, or faint, or weak. Mostly treated by clearing heat and cooling blood, using Rhinoceros Horn and Rehmannia Decoction.
7. Phlegm-Fire Harassing Upward︰Flushed face, vexing heat, delirious speech, reckless movement, rapid breathing, retching and nausea, phlegm-drool congestion, coughing up yellow phlegm, thick and sticky phlegm, short voidings of reddish urine, constipation, yellow and slimy tongue coating, slippery and rapid pulse. This is due to an inherently excessive phlegm constitution, with phlegm stagnation transforming into heat, or external contraction of seasonal pathogens, where intense heat internally scorches body fluids, forming turbid phlegm. Phlegm-heat steams upward, disturbing mental activity. The key diagnostic points are delirious speech, flushed face and vexing heat, phlegm-drool congestion, yellow and slimy tongue coating, and slippery and rapid pulse. For static blood harassing the heart causing delirious speech, the distinguishing features include cyanotic lips and nails, skin macules, hard fullness and pain in the lower abdomen, black-colored stool, uninhibited urination, purple-dark tongue texture with static macules. This aligns with the Gangmu in "Treatise on Cold Damage Diseases," which states: "Static blood internally manifests as black stool, uninhibited urination, lower abdominal pain, and the person appears manic with delirious speech." For phlegm-fire harassing upward causing delirious speech, treatment focuses on clearing and resolving heat-phlegm, using Qi-Clearing and Phlegm-Resolving Pill (combined with Supreme Treasured Pill).
8. Static Blood Rushing to the Heart︰Confused consciousness, delirious speech, skin eruptions, dark purple complexion, hematemesis, epistaxis, scorching heat in the body, hard fullness in the lower abdomen, pain with tenderness, normal urination, black-colored stool, dark purple tongue texture with ecchymosis, deep and rapid or deep and uneven pulse. This condition is caused by pathogenic heat entering the blood, scorching and congealing the blood, or exposure to toxic pathogens during childbirth, leading to conflict between pathogens and blood, resulting in impaired movement of the orifices. Treatment focuses on activating blood circulation and expelling stasis, with the prescription selection being Peach Kernel Purgative Decoction.
9. Exuberant Yin Repelling Yang︰Fear of cold, curled up lying, cold breath and faint breathing, delirious speech, restlessness, listlessness, cold limbs, abdominal pain with preference for warmth, clear and long urination, diarrhea with undigested food, feverish body but desire for clothing and blankets, flushed cheeks, thirst without desire to drink or preference for hot drinks, tongue texture pale and dull, gray-black and moist tongue coating, faint and thin pulse, or rapid pulse but weak upon pressure. This is due to excessive internal pudendal coldness, forcing yang outward. It is a syndrome of true cold with false heat; exhibiting both cold signs such as reversal cold of limbs, diarrhea with undigested food, fear of cold with curled up lying, cold breath and faint breathing, gray-black and moist tongue coating, and false heat symptoms such as feverish body but desire for blankets, flushed cheeks, thirst without desire to drink or preference for hot drinks. This is what is described in the Gangmu of the Cold-Damage Disease Treatise: "Normal urination, watery diarrhea, restlessness, or fever with delirious speech are signs of yin repelling yang." The treatment aims to break yin and restore yang, with the prescription of Vessel-Unblocking Cold-Extremities Decoction.
10. Yin Exhaustion and Yang Collapse︰Drowsy delirious speech, feverish body with flushed face, sweating and warm limbs, slightly rapid breathing, thirst with a preference for cold drinks, thready and rapid pulse with weakness, followed by shortness of breath and faint breathing, pale complexion, profuse dripping sweating, pale and moist lips and tongue, and a barely perceptible pulse. This is due to the depletion of yin fluids and the collapse of primordial yang. It represents the exhaustion of both yin and yang, initially manifesting as symptoms of yin exhaustion: sweating with warm limbs, thirst with a preference for cold drinks, a red and dry tongue, and a rapid but weak pulse; followed by symptoms of yang exhaustion: pale complexion, profuse dripping sweating, shortness of breath and faint breathing, cold limbs, and a barely perceptible pulse. This is what the Zhubing Yuanhou Lun refers to as "yang exhaustion delirious speech." The treatment focuses on restoring yang to rescue from collapse, and the recommended prescription is Ginseng and Aconite Decoction.

Delirious speech, although seen in deficiency, excess, cold, and heat pattern, is more common in excess pattern and heat pattern, and less common in deficiency pattern and cold pattern. Generally, those belonging to excess and heat are often seen at the peak of the disease, where the seasonal pathogen is exuberant and the healthy qi is not weakened, thus they are mostly easy to treat; deficiency pattern and cold pattern are commonly seen in the late stage [third stage] of the disease, a critical phase where the healthy qi is deficient and weak, and the ability to resist pathogens is diminished, thus they are mostly difficult to treat. Jingyue Quanshu．Under the section on cold-damage disease, it states: "Delirium is a condition that is most unsuitable for those with deficiency and damage, thus for those with mild fever and a pulse that is full and slippery, there is life; for those with much dysphoria and a pulse that is faint, thin, rapid, and with counterflow cold, there is death. Therefore, when encountering deficiency and damage and seeing delirium, it is a sign of great danger, and one must not be careless."

bubble_chart Documentation

1. Suwen-Qijiaobian Da Lun: "Excessive water in the year, cold qi prevails, harming the heart fire. People suffer from body heat, vexation, agitation, palpitations, cold reversal, cold in the middle, delirium, and heart pain."
2. Cold-damage disease theory．Differentiation of Taiyang disease pulse symptoms and treatment: "Cold-damage disease, abdominal distension and fullness, delirious speech, floating and tight wrist pulse, this is liver overacting on spleen, named longitudinal, puncture Qimen."
3. Zhubing Yuanhou Lun．Cold-damage disease various conditions: "Yangming disease, bleeding below and delirious speech, this is heat entering the uterus, only head sweating, should puncture Qimen point, drain according to the excess, profuse sweating then recovery."
4. Zhangshi Yitong．Mental disorders: "Delirium, excessive talking. Speech is the voice of the heart, caused by fire burning and sounding, so heart heat causes excessive talking.… If heat causes waking but unclear consciousness, then delirious speech." "Delirious speech often has blood stagnation, also blood deficiency, wind and phlegm stagnation, cannot be solely judged as phlegm, nor as blood counterflow, its onset of delirious speech, pulse must be large and forceful."
5. Cold-damage disease theory Gangmu．Yangming meridian symptoms: "Blood chamber is the liver. Liver is the organ storing blood, hence called blood chamber, women use blood for functions, hence most bleeding diseases. If men without injury, then no bleeding disease. Only Yangming governs blood related diseases, its meridian has much blood and qi, runs in front of the body, adjacent to Chong and Ren, Yangming heat severe, invades blood chamber, blood chamber not storing, overflows to external genitalia, hence both men and women have this condition.…Blood accumulation, purulent bloody stool, always heat entering the uterus."