bubble_chart Concept

Fading murmuring is characterized by a state of mental confusion, repetitive speech, low and weak voice, and incoherent speech. It is a symptom that belongs to the advanced stage of a disease and represents a critical manifestation of scattered and disordered spirit.

The symptom of fading murmuring was first mentioned in the "Treatise on Cold Damage Diseases." Later medical texts such as the "Clarified Theory of Cold Damage Diseases," Dongyuan Shishu , "Complete Collection of Life," Puji Fang , and others also documented this condition. This symptom differs from "delirious speech," which is characterized by unclear consciousness, incoherent speech, and a loud, forceful voice, often associated with excess heat pattern. In contrast, fading murmuring occurs in the late stage of a disease, indicating a critical condition where the essential qi is internally depleted. As a result, the voice is necessarily low, the breath short, the complexion withered, and the spirit fatigued. The speech is mumbled, incomplete, and often self-directed, with the patient unresponsive to calls or questions. It falls within the category of spirit deficiency. As stated in the "Treatise on Cold Damage Diseases: Differentiation of Yangming Disease Pulse, Symptoms, and Treatment," "In excess conditions, there is delirious speech; in deficiency conditions, there is fading murmuring. Fading murmuring is a form of heavy speech."

bubble_chart Pattern Analysis

1. Yin Exhaustion︰Muttering speech, unclear consciousness, sunken eyes, dry and withered skin, slightly sticky sweating, rapid breathing, thirst with a preference for cold drinks, warm limbs, dry and red lips and tongue, and a weak, rapid, and large pulse. It is often caused by severe vomiting, severe diarrhea, excessive sweating, postpartum loss of blood, or traumatic bleeding, or prolonged retention of pathogenic heat, leading to exhaustion of yin essence and mental confusion. The key points of pattern identification are: warm skin, warm hands and feet, slightly sticky sweating, thirst with a preference for cold drinks, rapid breathing, dry and red lips and tongue, and a weak, large, and rapid pulse. Treatment should focus on rescuing yin and consolidating yang, using the modified Pulse-Reinforcing Powder.
2. Yang Exhaustion︰Muttering to oneself, repetitive speech, intermittent and incoherent, listlessness, unresponsiveness, pale complexion, reversal cold of limbs, shortness of breath and faint breathing, sticky and cold sweating, absence of thirst, preference for hot drinks, pale lips and tongue, or even bluish-purple in severe cases, faint and barely perceptible pulse or floating, rapid, and hollow pulse. It mostly develops from yin exhaustion, or from prolonged illness with decline of original qi, or severe leakage of cold qi leading to sudden collapse of primordial yang, or exhaustion of heart qi causing imminent depletion of true yang. The key diagnostic points are: great dripping sweating, reversal cold of limbs, pale complexion, shortness of breath and faint breathing, absence of thirst, preference for hot drinks, pale or bluish-purple lips and tongue, and faint, barely perceptible pulse. The treatment principle is restoring yang to save from collapse, using Ginseng and Aconite Decoction or modified Ginseng-Aconite-Dragon Bone-Oyster Shell Decoction.

The condition of fading murmuring, although differentiated by yin exhaustion and yang exhaustion, is interconnected through the mutual dependence of yin and yang. When yin is exhausted, yang has nothing to cling to and disperses; when yang is depleted, yin cannot be transformed and becomes exhausted. Therefore, yin exhaustion and yang exhaustion often occur sequentially, with yin exhaustion leading to yang exhaustion being particularly common. In treatment, while rescuing yin, one should also incorporate restoring yang, and in restoring yang, one must assist with astringing yin. Only by addressing both yin and yang can good therapeutic efficacy be achieved.

bubble_chart Documentation

1. Puji Fang．The "Cold-Damage Disease" section: Fading murmuring refers to repetitive speech. It is a transformation of the voice, where the original sound is altered. Those who are ignorant of this mistakenly interpret "repetition" as overlapping speech, confusing it with delirious speech. They then categorize those with fever, rapid pulse, frequent thirst, difficulty in bowel movements, and excessive talking as having delirious speech, while those with a cool body, small pulse, spontaneous diarrhea, no thirst, and excessive talking are considered to have fading murmuring. This interpretation deviates from Zhongjing's original intent. Moreover, Zhongjing's text covers over 390 symptoms, meticulously detailing the manifestations of cold-damage disease, without any omissions. If fading murmuring were simply excessive talking, it should be clearly listed among the three vaginal orifices. The fact that fading murmuring lacks specific treatments indicates that it is not classified with delirious speech. Although it is said to be a deficiency, it is only a deficiency of healthy qi. Being deficient but not entirely so causes the voice to transform and become abnormal. Those who understand this should carefully study it."
2. Jingyue Quanshu．The "Cold-Damage Disease" section below: "Fading murmuring is a deficiency, specifically a deficiency of the spirit. ... If it is indeed a deficiency, it is crucial to avoid reckless treatments. Even a slight mistake can lead to death. Those treating this condition should quickly assess the essential qi, distinguish the yin-yang, disregard the external symptoms, and address the root cause. Any delay could lead to further deficiency, let alone incorrect treatment. In severe cases, symptoms like spontaneous diarrhea, cold body, or actions such as searching for clothes, grasping at the air, or facing the wall while muttering are particularly ominous signs."