Fever and Delirium, Talking Nonsense Like Bewitched?

Patient search terms: fever with delirium / raving and talking nonsense / like bewitched / fever and seeing things that are not there / sudden fever in autumn / large and forceful pulse

Medical terms: yang deficiency fever · qi deficiency fever · fatigue-induced internal injury · floating of deficient yang · delirium

The opening: a healthy young man suddenly “possessed”

In the Yuan dynasty, the county of Pujiang was home to a famous extended family. One day, a young man of the household suddenly fell ill — a high fever in autumn, thirst, and then he began to talk nonsense: the room was empty, yet he insisted he could see people and things that were not there. He raved as if possessed, as if he had seen a ghost. The whole family was terrified.

💬 Note from Doctor Luo: This kind of illness — “fever + talking nonsense + seeing ghosts” — let’s not rush to call it possession. In Chinese medicine there is a phrase: wang yan wang jian (妄言妄见) — “ravings and visions,” saying things that are not so and seeing things that are not there. In today’s case, Doctor Zhu Danxi will show you that one type of “talking nonsense” has its root not in fire, but in yang deficiency.

Doctor Zhu Danxi’s first move: look at the body and complexion, then take the pulse and ask

To understand this case, we first need to understand how Doctor Zhu Danxi practiced. Doctor Luo Dalun has noticed that Doctor Zhu Danxi’s case records share a trademark: he is especially fond of recording the patient’s personality, psychological state, build, and complexion. Why? Because he placed enormous weight on inspection (wang zhen).

Chinese medicine speaks of “look, listen, ask, feel” — “one who knows by looking is a spirit” (wang er zhi zhi wei zhi shen). At first glance: the spirit, the build, the complexion — that is the opening move of diagnosis.

💬 Note from Doctor Luo: Doctor Zhu Danxi held that to treat a disease you must first observe the body and complexion (guan xing se), then feel the pulse and question the symptoms. Inspection also includes tongue diagnosis. Doctor Zhu Danxi rarely wrote about the tongue in his cases, but in the history of tongue diagnosis there is a famous figure named Du Qingbi, who was a close friend of Doctor Zhu Danxi’s teacher Luo Zhiti and later had dealings with Doctor Zhu Danxi himself. Did Doctor Zhu Danxi understand tongue diagnosis? Of course he did — he just did not write it down.

How did Doctor Zhu Danxi “look” at a person? He had a set of rhyming maxims distilled from experience:

• The tall are not equal to the short (chang bu ji duan): a very tall person is not necessarily healthier than a short one — being tall means qi and blood must be delivered to that great height, and many tall people suffer from a sagging stomach and insufficient qi; short people are often “small but tough.”
• The large are not equal to the small; the fat are not equal to the thin (da bu ji xiao, fei bu ji shou): big, fat people tend to have more health problems. Have you ever met a tall, fat centenarian? Rarely. Centenarians are almost always thin and small — as the saying goes, “a thousand ounces of gold cannot buy an old person’s thinness.”
• The white are not equal to the dark; the delicate are not equal to the weather-worn (bai bu ji hei, nen bu ji cang): a person who spends every day in a study, pale and delicate from lack of exercise, is not as well off as one who works outdoors, tanned and weathered. Whiteness points to lung qi deficiency — the qi-deficient show a pale, sallow face; darkness points to sufficient kidney qi — the kidney-strong show a dark, healthy complexion, a normal state of qi and blood.
• The thin-hued are not equal to the deep-hued (bo bu ji hou): a faint, washed-out complexion is inferior to a deep, rich one — depth and richness mean qi and blood are full.

💬 Note from Doctor Luo: This art of inspection is now studied by very few people. The Huangdi Neijing (Yellow Emperor’s Classic of Internal Medicine) sets it out in great detail, yet it seems almost lost. I have told you before about the great master of inspection and complexion diagnosis, the late Wang Hongmo — one sweep of his eyes over a person and he knew roughly what was wrong with the body, because your colors are written all over your face. Master Wang’s skill ran in the family: as a child his father stood with him at the front door and pointed out people passing in the street, explaining what the color on this part of the face meant and what that part represented. After years of practice, faces to him looked “flowery” — different regions in different colors — and the body’s problems simply revealed themselves.

Who was the patient? The Zheng clan of Yimen, Pujiang — a “model family” praised by emperors

Back to the case. The patient was a young man of the Zheng clan of Yimen (义门郑氏) in Pujiang. What does “Yimen” mean? Doctor Luo Dalun has explained before — this family lived together for generations in remarkable harmony, and successive emperors issued commendations honoring them before the whole empire. It is said that even into the Qing dynasty, emperors still praised this family.

💬 Note from Doctor Luo: Doctor Zhu Danxi was especially close to this family: they asked him to set auspicious dates for weddings and other occasions; when anyone in the household fell ill, they called on him. He also loved to use the family as a teaching example, saying to others: look at the Zheng clan of Yimen — see how generations live together in harmony. Your family relationships are poor — go and learn from them. So when this young man of the Zheng family fell ill, of course Doctor Zhu Danxi hurried over.

How sick was he? Fever, thirst, and seeing things no one else could see

The patient was about twenty years old. In autumn he suddenly ran a high fever, was thirsty, and then began to show wang yan wang jian — raving as if he saw things that were not there, sick like one possessed, as if he had seen a ghost. At first everyone assumed it was demonic possession.

The illness dragged on for seven or eight days before the family sent for Doctor Zhu Danxi. Why so late? Pujiang was some distance from Yiwu, where Doctor Zhu Danxi lived, and he had to travel.

The moment he reached the patient, Doctor Zhu Danxi first took the pulse: both hands full and forceful (hong da er shi) — the pulse pounding “bang, bang,” large and strong. Then he looked — and here his inspection skill showed itself. He saw: the young man was plump and tall (xing fei chang); his face was red tinged with white (mian chi dai bai) — flushed, but the red was shot through with white. What does white indicate? Qi deficiency. And then: the veins stood out visibly beneath the skin (qing jin bao lu).

💬 Note from Doctor Luo: Normally, blood vessels should lie hidden beneath the flesh; they should not stand out. When veins bulge prominently on many people’s hands and legs, the meaning varies: most often it is seen in laboring people — those who do manual work, or very thin people with little fat, where the veins show clearly, especially in the elderly; another cause is stagnation of qi and blood — as in varicose veins, where the qi and blood cannot circulate and the vessels protrude. So “exposed veins” carried diagnostic meaning for Doctor Zhu Danxi — a sign of fatigue, deficiency, and stagnation.

Doctor Zhu Danxi’s reasoning: “The pulse is not truly solid — the cold medicines made it so”

And now came the puzzle: this young man of the Zheng family looked like a pale-faced scholar — white complexion, plump build. By all rights his pulse should not be this forceful. Yet here it was, large and solid. What was going on?

Doctor Zhu Danxi delivered his judgment — the stroke that shows his genius:

This man fell ill from fatigue — exhaustion and deficiency, with the bulging veins as further evidence; but on top of that, cold and cooling medicines had been used, and they wounded his yang. When yang is injured, the body tries to resist and readjust, making a last-ditch effort — and that is why the pulse beats so large.

💬 Note from Doctor Luo: Doctor Zhu Danxi put it with complete clarity — “the pulse is not truly solid; the cooling medicines made it so” (mai ben bu shi, liang yao suo zhi): this man’s pulse had no business being so solid; it became this way only after the cold medicines. What should be done? Use warming and tonifying herbs, and he will recover on his own.

What medicines had been used before? The family said: “These past days we treated him ourselves — we used a Bupleurum (chai hu) formula, seven or eight doses of it.”

💬 Note from Doctor Luo: Bupleurum-type formulas — Xiao Chai Hu Tang (Minor Bupleurum Decoction), for example — harmonize the lesser yang and can adjust disorders of the spirit where evil has entered the lesser yang. But this patient took seven or eight doses without effect. Doctor Zhu Danxi said: that is wrong; this should be warmed and tonified. Why? Because this is not heat — it is yang deficiency.

The prescription: Huangqi Fuzi Tang — and it had to be drunk cold

Doctor Zhu Danxi prescribed Huangqi Fuzi Tang (黄芪附子汤): huang qi (astragalus) to tonify qi, fu zi (aconite) to warm yang, with bai zhu (atractylodes), rou gui (cinnamon bark), gan jiang (dried ginger) and others — a yang-warming formula.

But one detail shows extraordinary care: after the decoction was finished, it was allowed to cool before he drank it.

💬 Note from Doctor Luo: Why drink it cool? To avoid ge ju (格拒) — “rejection.” This man’s yin cold was pronounced and his yang nearly exhausted; if a hot medicine is poured in, cold and heat clash, and the patient either cannot get it down or vomits it up. Cooled a little and sipped slowly, the medicine works from within. This is the classical technique of “warming medicine taken cool.”

After three doses, the young man began to sleep

After three days, a miracle: the young man who had been raving and frantic began to feel drowsy and slept deeply. When he woke from the sleep, he had sweated lightly — and the illness was dissolved. Doctor Zhu Danxi took the pulse again: it was soft, no longer huge and pounding.

Next, Doctor Zhu Danxi prescribed Huangqi Baizhu Tang (黄芪白术汤) and began to tonify qi and strengthen the spleen gently. After ten or so doses, the body gradually drew back together; after another half month of adjustment, the man was completely well.

💬 Note from Doctor Luo: Look at the whole course of treatment — Doctor Zhu Danxi used nothing but the warming yang approach, from start to finish, curing the illness entirely with warm, hot-natured medicines. In the past, mention Doctor Zhu Danxi and everyone calls him the founder of the “yin-nourishing school,” saying he only used cold medicines and injured yang — that is what happens when people do not read his books carefully. When warming yang is called for, Doctor Zhu Danxi does not hesitate in the least. He sees what pattern is present and treats with the corresponding method — he never locks himself into a single approach.

Note from Doctor Luo: when yang is deficient enough, a person “talks nonsense”

The most thought-provoking part of this case is the connection between “yang deficiency” and “talking nonsense.”

💬 Note from Doctor Luo: When yang deficiency and yin excess reach a certain depth, there can be changes in the emotional and mental state — anyone practicing clinical Chinese medicine must know this. Take the Wu Zhu Yu Tang (Evodia Decoction) pattern in the Shang Han Lun (Treatise on Cold Damage): many such patients, deep in yin cold, show raving, delirium, and confused speech — especially at night, when the mind is unsettled, the speech wild, the mood manic and restless. Would you assume that is a heat pattern? It is not! It is cold — yin cold overwhelming, yang nearly exhausted, the cold completely crushing the yang, and the heart-spirit falls into disorder. If you respond by settling the spirit and clearing fire, you are heading in the wrong direction.

This “suppression of yang” changes over the day, and also over the year — many people with depression fall ill from late autumn into winter, struggle through the whole winter, and gradually improve when spring arrives. Why? It has to do with sunlight: when the sun is warm and the daylight lengthens, yang rises and the mood improves; in winter, yin cold prevails and presses yang down, the spirits sink, and mental symptoms easily appear.

💬 Note from Doctor Luo: Our head is the “house of clarity” (qing ming zhi fu) — when the sun shines overhead, the house of clarity functions normally; when yin cold gathers within and turbid yin pools, mental problems arise. So remember: raving does not always mean fire — one type is caused by yang deficiency. Without clinical experience and this concept in mind, you would not recognize it even with the patient right in front of you. You walk into a home and see a patient raving, face flushed, pulse large — and recognize this as yang deficiency? That truly is not something just anyone can do.

Bonus: why did Doctor Zhu Danxi dare to lead with huang qi? “Sweet and warm can expel high fever”

There is one more layer of skill. Doctor Zhu Danxi looked at this man’s build — plump, and plump people are often qi-deficient; a red face shot through with white, that sallow-white complexion, is also qi deficiency; the protruding veins mean that after qi becomes deficient it cannot circulate smoothly, the blood vessels cannot flow, and stagnation settles in certain places. So both formulas, front to back, were led by huang qi.

💬 Note from Doctor Luo: Huang qi tonifies qi. And here is the beauty — once the qi was built up, the fever actually subsided. This is exactly what Doctor Li Dongyuan taught: “sweet and warm can expel high fever” (gan wen chu da re). There is a type of high fever whose root is qi deficiency and yang deficiency; build the qi, and the heat recedes of itself. Doctor Zhu Danxi built qi on one side and warmed yang on the other; as the upright qi returned, as yang returned, the body cured itself. Warming yang took only three doses — building the spleen and qi took more than twenty. What he was adjusting was this man’s constitution.

💬 Note from Doctor Luo: This case is a classic precisely because it is easy to overlook. It tests the ability not to be fooled by appearances: the face is a little red, there is fever, the pulse beats large — it looks like a heat pattern. Doctor Zhu Danxi looked and said: no — this is deficiency; the upright qi is insufficient, the yang is insufficient. He read the pattern accurately, used simple medicines, and the logic was crystal clear: three doses brought it under control, the sweat broke and the illness vanished, then twenty-odd doses slowly improved the constitution. What is a master? This is a master. So when someone dismisses Doctor Zhu Danxi as merely the “yin-nourishing school,” actually read his cases — you will find he practiced at a very high level, with every kind of approach in his repertoire, and read his patterns precisely. A master physician of the first rank (yi dai yi zong) — the title was not given lightly.

What to take away: fever with raving and hallucinations does not always mean fire. When the illness follows overwork, when the face is flushed yet shot through with white, when the veins stand out, when the pulse is large but the body plainly frail — think of yang deficiency and qi deficiency. Warm the yang and build the qi, and the “possessed” young man sleeps, sweats, and wakes himself cured. And when a patient’s true pattern is deficiency, do not be seduced by the surface signs of heat: sweet and warm can expel high fever — the three-dose cure and the twenty-dose constitution change are both part of the same art.

Retold from the case records of Doctor Zhu Danxi (Yuan dynasty, c. 1300s–1350s), specifically his treatise “To Treat Illness, First Observe the Body and Complexion, Then Feel the Pulse and Question the Symptoms” (from Ge Zhi Yu Lun, 《格致余论》), as narrated by Doctor Luo Dalun. Tomorrow Doctor Luo will tell a case where huang qi was used wrongly — stay tuned.