this is a closed disorder from phlegm-heat. it is usually associated with summerheat-stroke, wind-stroke, or the advanced stage of a warm-febrile disease when heat sinks into the pericardium and turbid phlegm veils the orifices of the heart.

when heat sinks into the pericardium, it causes disorientation by disturbing the spirit, and gives rise to fever, irritability and restlessness, delirious speech, or impaired consciousness. the vigorous, blazing heat scorches the fluids and causes them to congeal into phlegm.

heat and phlegm accentuate each other and completely veil the orifices of the heart, further disturbing the spirit and impairing the consciousness. as the phlegm increases, the impairment of consciousness becomes even more severe with such manifestations as loss of consciousness or coma. phlegm also obstructs the pathways of qi and gives rise to copious sputum and rough breathing accompanied by raspy sounds due to sputum in the throat.

extreme heat may generate internal wind which manifests as spasms or convulsions. the tongue is the `sprout’ of the heart; when heat enters the heart and the nutritive level, the tongue becomes red or deep red. the foul, greasy, yellow tongue coating and slippery, rapid pulse are indicative of phlegm-heat.