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The classics state: "When pathogenic factors enter the Yang aspect, mania occurs." It also states: "Excessive Yang leads to mania." The *Shanghan Book* (Treatise on Cold Damage) posits that heat-toxin enters the stomach and spreads to the heart, causing delirious speech and madness, accompanied by extreme thirst and desire for drinking. However, this refers only to the case of extreme heat.

Regarding the syndrome of mania, internal injuries are categorized into seven types: phlegm-heat, food retention, fright qi, blood stasis, blood deficiency, essence loss, and spirit failing to reside in its abode. External contractions are distinguished by seven types: obstruction and closure of exterior pathogens, interior heat knotting, blood accumulation, toxin, phlegm retention, food stagnation, and yin restlessness. One cannot generally treat these as fire-heat syndromes, thereby committing the error of misusing purgatives or suppressing with cold-cooling herbs.

In cases of **obstruction and closure of exterior pathogens**, the patient typically has accumulated heat internally and is exposed to exterior pathogens. Unable to vent, the pathogen disturles the spirit, leading to confusion and apparent madness. Since there are exterior pathogens but also internal accumulated heat, acrid-warm dispersing methods are unsuitable. If there is no sweating and the pulse is floating and rapid, first use **Qianghuo Chonghe Tang** (Notopterygium Decoction for Harmony) to disperse the exterior, followed by **Shuangjie San** (Double Release Powder) to harmonize the interior and exterior.

In cases of **interior heat knotting**, the six pulses are deep and rapid, lips are scorched and dry, hands and feet sweat profusely, there is manic confusion and delirium, and bowel/bladder movements are obstructed. One should use **Huanglian Jiedu Tang** (Coptis Decoction for Resolving Toxins), **Liangge San** (Cooling the Diaphragm Powder), or **Daochi Banjie Tang** (Half-Half Decoction for Guiding Out Fire) to clear and drain interior heat. If the stool is unpassable and there are signs indicating purgation, use **Chengqi Tang** (Purgative Decoction).

For **mania due to blood stasis**, symptoms include being "like mad" with forgetfulness, wanting to rinse the mouth but not swallowing, and a cun (inch) pulse appearing hollow (Kou). This indicates blood accumulating in the Upper Jiao, treated with **Danggui Taoren Tang** (Angelica and Peach Kernel Decoction). If the lower abdomen is hard and full, urination is spontaneous, and the chi (cubit) pulse is hollow, this indicates blood accumulating in the Lower Jiao, treated with **Taoren Chengqi Tang** (Peach Kernel Purgative Decoction); in severe cases, use **Didang Tang**.

For **mania due to toxin**, latent toxins inside are constrained by external wind-cold, or suppressed by consuming raw/cold foods, or due to food stagnation in the Middle Jiao preventing toxin dispersion, disturbing the spirit. If the left pulse is floating or restless, use **Qianghuo Baidu San** (Notopterygium Decoction for Overcoming Toxins). If caused by raw/cold suppression or food stagnation in the Middle Jiao with a slippery and large right pulse, use **Baohe San** (Preserve Harmony Powder) or **Pingwei San** (Calm the Stomach Powder).

For **mania due to seasonal qi (epidemic)**, where epidemic qi spreads through the community, one must observe the season's characteristics. For exterior release, use Qianghuo Baidu San; for harmonizing, use Shuangjie San; for cooling, use Liangge San or Huanglian Jiedu Tang.

Additionally, **mania due to food retention** involves external seasonal contraction and internal dietary injury, stagnating in the Middle Jiao, causing much delirium. Symptoms resemble yang mania, but the pulse is large without rapidity, and there is no thirst for water. Use Pingwei San and Baohe San decocted together.

**Mania due to phlegm** involves phlegm in the Zhongwan area, chest/diaphragm oppression, blocking the pericardium, and incoherent speech. Symptoms resemble yang mania, but lips are not scorched, there is no thirst, and the tongue has a slippery coating. If phlegm is in the Upper Jiao with a slippery/large cun pulse, induce vomiting first using **Yanchi Tang** (Salt and Fermented Soybean Decoction). If phlegm is in the Middle Jiao with a surging/slippery guan (bar) pulse, use **Erchen Tang** (Two-Aged Decoction) plus **Zhuli** (Bamboo Sap) and **Danning** (Arisaema with Bear Bile). For condensed phlegm/phlegm masses, add **Haishi** (Flintstone) and **Walengzi** (Arca Shell). For distending pain in the hypochondrium with excess signs, first use **Daotan Tang** (Great Phlegm Decoction). If there are signs for purgation, use **Guntan Wan** (Rolling Phlegm Pill).

**Yin restlessness mania** is detailed in the Yin Syndrome chapter.

If **Taiyang Syndrome** remains unresolved, heat knots in the Bladder. The patient appears like they are mad. If blood passes spontaneously, the disease resolves. If exterior signs remain, purgation is not yet appropriate; resolve the exterior first. Once the exterior is resolved, if only the lower abdomen is urgent and knotted, attack it with **Taoren Chengqi Tang**.

In **Taiyang Syndrome**, after six or seven days, if exterior signs persist, the pulse is faint and deep, there is no Chest Bind, but the patient is manic, it is because heat is in the Lower Jiao and the lower abdomen should be hard/full. If urination is spontaneous, passing blood resolves the condition. This is due to Taiyang channel stasis-heat residing in the interior. Treat with **Didang Tang**.

In **Taiyang Syndrome**, if the body is yellow, pulse is deep and knotted, lower abdomen is hard, and urination is difficult, there is no blood stasis. If urination is spontaneous and the patient appears like they are mad, this is a definitive sign of blood stasis; treat with **Didang Tang**.

These three clauses detail Blood Stasis.

In **Yangming Syndrome**, initially desiring food, urination is unexpectedly difficult, stool is normal, bone joints ache, there is slight fever, and the patient is恍惚 (trance-like/like mad), resolving with sweating. This indicates water failing to overcome Grain Qi, merging with sweat; if the pulse is tight, it resolves.

This clause details Body Pain.

**Qianghuo Chonghe Tang**: See Fever section.
Mania usually does not use exterior-releasing herbs. Here, since the exterior pathogen is unresolved, we first disperse the exterior, then either clear heat, digest food, or resolve phlegm.

**Shuangjie San** (Double Release Powder):
Qianghuo, Gegen, Chaihu, Fangfeng, Jingjie, Shigao, Huangqin, Huashi, Shanzhi, Lianqiao, Zhimu, Gancao, Jiegeng.
For mania due to exterior pathogens, only release the exterior; for mania due to interior heat, only clear the interior; for simultaneous exterior-interior signs, use this formula to double-release both.

**Huanglian Jiedu Tang** (Coptis Decoction for Resolving Toxins):
Huanglian, Huangqin, Huangbai, Shanzhi, Shigao.
For mania with no exterior pathogen and no interior phlegm/food, use this to clear interior heat.

**Liangge San** (Cooling the Diaphragm Powder):
Jiegeng, Tianhuafen, Lianqiao, Bohe, Huangqin, Dahuang, Mangxiao, Shanzhi.
The Heart stores the Spirit, the Lung stores the Corporeal Soul. When Heat-Toxin covers the Heart and Lung, consciousness becomes confused, leading to delirium. This formula clears Heat from the Upper Jiao Heart and Lung.

**Chengqi Tang** (Purgative Decoction): See Constipation section.
Manic confusion stems from heat knotting in the interior. For mania with constipation, use this formula.

**Daochi Banjie Tang** (Half-Half Decoction for Guiding Out Fire):
Mutong, Shengdi, Gancao, Huanglian, Zhimu, Huashi, Maidong, Shanzhi, Huangqin, Xijiao.
When Heat covers the Heart, delirium and mania occur. We combine Daochi San and Xiexin Tang. To clear Heart Fire above, add Huashi to guide Heart Fire downward; to promote urination below, add Zhimu, Shanzhi, and Huangqin to clear Upper Jiao Lung Fire. Promoting urination is best achieved by clearing the Lung; clearing Lung Heat is best achieved by promoting bowel and bladder movement.

**Danggui Taoren Tang** (Angelica and Peach Kernel Decoction):
Danggui, Taoren, Honghua, Danpi, Shanzha, Zelan Ye.
"Like mad" and forgetfulness are mostly due to blood knotting; thus, use this formula. If ineffective, add Zhike and Dahuang to reach the Large Intestine directly.

**Taoren Chengqi Tang** (Peach Kernel Purgative Decoction): See Blood Stasis section.
For blood stagnating in the Upper Jiao, use the above formula to transform and move blood; for blood accumulating in the Lower Jiao, use this formula.

**Didang Tang**: See Blood Stasis section.
This formula strongly moves blood. For deep-seated stasis, this is indispensable.

**Qianghuo Baidu San** (Notopterygium Decoction for Overcoming Toxins): See Fever section.
Epidemic toxins enter via pores, nose, and mouth. For epidemic mania with exterior signs, first disperse the epidemic toxin.

**Baohe Wan** (Preserve Harmony Pill):
Shanzha, Maiya, Laifuzi, Shu Banxia, Lianqiao, Xiangfu, Zhike.
Add Shanzhi and Huanglian for severe heat; combine with Pingwei San and Shichangpu for dampness-induced oppression.
Mania is generally treated as Yang Fire. However, some cases involve food stagnation in the Middle Jiao or suppression by raw/cold foods; thus, this digestive method is specifically supplemented.

**Erchen Zhuli Danning Tang** (Two-Aged, Bamboo Sap, Arisaema with Bear Bile Decoction):
Shu Banxia, Baifuling, Chenpi, Gancao, Danning, Zhuli.
Add Shengjiang for cold-coagulation; add Shanzhi and Huanglian for internal accumulated heat; combine with Pingwei San for dampness; add Zhike, Xiangfu, and Shichangpu for Qi knotting.

**Guntan Wan** (Rolling Phlegm Pill):
Mengshi, Huangqin, Dahuang, Huangbai, Chenxiang.
For stomach excess and heavy food with heat knotting in the Large Intestine, use Chengqi Tang. If exterior pathogens were purged too early and sank into the Heart/Chest, use Xiantong Tang. Currently, with hot-phlegm congealing in the intestines/stomach, use this formula to purge.