bubble_chart Concept

Language confusion, also known as "language inversion," Danxi Xinfa abbreviated as "paraphasia," refers to a symptom where the mind is in a daze, and speech is incoherent and disordered, or the speaker realizes after speaking that they have made a mistake but cannot control it.

"Delirious speech" and "mania" also manifest as language confusion. However, delirious speech often occurs after high fever, with the patient in a confused state of mind; whereas language confusion occurs without fever, with the patient in a dazed or clear state of mind. Mania involves cursing without regard for close or distant relationships, and there are phenomena such as discarding clothes and climbing heights in a frenzy, which are still different from simple language confusion. This book intends to discuss "frenzy" and "delirious speech" in separate dedicated sections.

bubble_chart Pattern Analysis

1. Deficiency of Both Heart and Spleen︰Disordered speech, dull complexion, mental fatigue and limb weakness, poor appetite, palpitation and forgetfulness, insomnia and susceptibility to fright, low and timid voice, pale tongue and thin pulse. The syndrome arises from prolonged excessive contemplation and unfulfilled desires. The heart governs the spirit, and the spleen governs thought. Excessive contemplation over time leads to the hidden depletion of heart yin and damage to spleen qi, resulting in dual deficiency of heart and spleen qi and blood, and the misuse of mental activity, manifesting as disordered speech. Zabing Yuanliu Xizhu: "Some cases are due to overthinking injuring the heart and spleen, leading to forgetfulness and derangement, with speech as disordered as that of a fool." Key points of pattern identification: disordered speech, reticence and few words, accompanied by symptoms of dual deficiency of heart and spleen qi and blood, such as dull complexion, insomnia, palpitation due to fright, forgetfulness, and anorexia. Treatment should focus on regulating the heart and spleen, tonifying and replenishing qi and blood, with formulas such as Returning to Spleen Decoction.
2. Liver Qi Depression︰Disordered speech, emotional depression, few words, distension and oppression in the chest and hypochondrium, frequent sighing, occasional irritability, thin tongue coating, and a fine wiry pulse. This syndrome is often caused by mental trauma or emotional stimulation, leading to impaired dispersion of liver qi and unresolved stagnation. The liver governs anger in emotional states and speech in disease manifestations; thus, liver depression results in disordered speech. Clinical manifestations include disordered speech, emotional depression, chest oppression with sighing, disturbed sleep with dreams, and irritability. This syndrome shares similar disease causes with disordered speech due to deficiency of both the heart and spleen, but their disease mechanisms differ. In disordered speech due to deficiency of the heart and spleen, the disease location is in the heart and spleen, and the disease mechanism is primarily dual deficiency of qi and blood. In disordered speech due to liver depression and qi stagnation, the disease location is in the liver, and the disease mechanism is depression and stagnation of qi movement. The former belongs to a deficiency pattern, while the latter is an excess pattern—the two are fundamentally distinct.
3. Static Blood Disturbing the Heart︰Language confusion often occurs periodically with menstruation, accompanied by dysmenorrhea or menstrual disorders, or seen in postpartum lochia that lingers incessantly, with a dark and stagnant tongue texture or ecchymosis, and a choppy pulse. The mechanism of this disease, as Zhengzhi Huibu states: "Some women experience excessive menstruation, menorrhagia, and metrostaxis, leading to blood and qi confusing the heart, or postpartum lochia rushing upward, resulting in language confusion." Also, Shoushi Baoyuan mentions: "Menorrhagia and lochiorrhea, stabbing pain in the abdomen due to blood stagnation, edema from blood stasis, blood entering the heart meridian, causing incoherent speech..." This condition is mostly caused by internal accumulation of static blood, affecting blood circulation. The heart governs blood and mental activity; thus, blood stasis disturbs the heart-mind, leading to language confusion, which often occurs in women. Clinical features: Language confusion is often related to menstruation and postpartum conditions, with abdominal pain, a tongue with ecchymosis, and a choppy pulse as key diagnostic points. Treatment involves promoting blood circulation and resolving stasis, using formulas such as Peach Kernel, Carthamus and Four-Ingredient Decoction or Cinnamon Twig and Poria Pill.
4. Damp Phlegm︰Disordered speech, or muttering to oneself, dull expression, vertigo and nausea, poor appetite, chest tightness, abdominal distension and fullness, white and greasy tongue coating, swollen tongue body, soggy or slippery pulse. The individual's constitution tends to have excessive phlegm-dampness, or cold drinks and accumulated dampness transform into phlegm, or liver depression and spleen stagnation, leading to dampness accumulation and phlegm formation. When phlegm-dampness obstructs the seven orifices, mental activity becomes disturbed, resulting in disordered speech. Key points for pattern identification: In addition to disordered speech, symptoms of internal phlegm-dampness obstruction such as vertigo, nausea, anorexia, chest tightness, abdominal distension and fullness, and greasy tongue coating are present. Treatment should focus on drying dampness and resolving phlegm to dispel turbidity. The recommended prescription is the modified Ten-Ingredient Gallbladder-Warming Decoction.

The occurrence of language confusion is most closely related to the heart, liver, and spleen. Excess pattern is often caused by phlegm-dampness, static blood, and qi stagnation obstructing the heart orifice, leading to mental confusion and thus causing language confusion. Deficiency pattern results from excessive contemplation, leading to a deficiency of heart and spleen qi and blood. Based on the above disease mechanism characteristics and clinical manifestations, it is easy to distinguish.

bubble_chart Documentation

1. Zhangshi Yitong．Mental Disorders: "Madness is often caused by prolonged depression, frustration, and boredom, leading to mental confusion, incoherent speech, singing or laughing, sadness or crying, behaving like being drunk or insane, speaking incoherently, unaware of cleanliness, and not recovering for years. This is due to phlegm stagnation blocking the heart, failure of mind to keep to its abode, commonly known as 'phlegm confusing the heart.' The primary treatment is to calm the mind and resolve phlegm. First, use Drool-Controlling Pill to expel phlegm, followed by mind-calming formulas." "Incoherent speech, frequent laughing without mania, indicates heart deficiency. Use Calming the Mind Decoction with ginger juice and bamboo juice; if there is slight pain in the diaphragm, accompanied by static blood, add amber and Curcuma Root."
2. 《Essentials of Medicine》: "At the onset of madness, the patient feels unhappy, and in severe cases, becomes mentally dull, speaks incoherently, and sleeps as usual. This is due to evil merging with yin."