经曰。邪入于阳则狂。又曰。重阳则狂。狂为阳盛也。伤寒热毒在胃。并于心。至于发狂。邪热极矣。
邵评∶阳邪入于阳经。故曰重阳。阳盛则狂也。若邪热内伏胃中。火毒上熏。蒙扰
心包灵气。则神不自知而发狂。
狂之发。少卧。不饥。妄言笑。妄起止。弃衣而走。登高而歌。甚则逾垣上屋。皆独阳亢极使
然。非吐下不能已。
邵评∶此是阳明实火上升。神蒙不清。吐之下之。其热外泄。则狂自止。
凡胃中热极乘心。则神昏发狂。经云。重阳则狂者。谓热入于阳。则狂乱也。表实无
汗。三黄石膏汤。里实不便。大承气汤。无表里症。白虎合解毒汤。
邵评∶太阳表热不得外泄。郁而发狂。当清解表里热邪。阳明胃热不得下泄。燥屎内蒸而狂者。
治宜下之。阳明经热。胃火内燔而狂者。治以清解胃热。
病患烦躁狂走。妄言叫骂。面赤咽痛。鼻如烟煤。或身斑如锦。或下利赤黄。此阳毒
也。三黄汤、大黄散主之。
阳毒发狂。逾垣上屋者。霹雳汤。调下鹊石散二钱。或用人中黄三钱。开水下。或
水调瓜蒂末吐痰。（以上皆实症治法）
邵评∶火毒内燔。挟痰上灼。蒙蔽清灵。如醉如痴。宜大清其毒火。或吐其痰热。
以上皆实症治法。
取粪坑中青砖。用火中烧红取出。投入水中。水沸毕。取水饮之。治狂乱
有劳心过度。曲运神思。以致神昏狂乱。语言谬妄。外无表里实症见者。当治其心
与包络之火。如川连、辰砂、菖蒲、钩藤、茯神、小草、天竺黄、琥珀、金箔、半夏、竹茹之类酌用。
邵评∶劳伤心营。则心血耗散。神思不能收敛。心火亢甚。或挟痰浊上升。蔽其清灵之气。以致
昏妄似狂。此非外邪致病。无表里实症见象。由于内伤神明。当清心与心包之火。佐以涤痰安神
为治。与上之实热发狂不同也。
有阴虚挟感。微见躁烦。医误认为阳明。用犀角、葛根等升提药。以致虚火上冒。目赤颧红。唇燥
口渴。反发躁狂。有似阳症。但两足厥冷。舌形紫色。六脉洪大而空。或细而数。当以左归饮或六味参
麦之类主之。
邵评∶少阴水亏。感受温热。外邪入于阴经。乃水亏火盛之症。医者误用升散。提
之透之。阴愈伤而火愈盛。虚火上冒而无制。现此假热之象。而反躁狂。此是水
亏不能制火。虚火上浮。故脉沉细数。或见洪大。重按则空而似无。虚阳上扰。用
壮水制火之法治之。阴旺则浮火自平。
有少阴症。阴极似阳。发躁发狂。赤身裸体。扬手掷足。欲坐卧水中。此为阴狂。外症
与阳狂相似。当以脉为辨。其脉必洪大而空。或细数而躁。或手足厥冷。六脉沉微。
其舌必淡红而胖嫩。或微白而圆浓。当以人参八味饮冷服之。凡阴狂。外貌似热。扪之肌肉。则冷逼手。
邵评∶此与上条对勘。上条水亏火旺。此条阴盛阳微。少阴寒邪。阴多阳少。阳不恋阴而外浮
上越。阴寒格拒于中。见此躁扰虚狂之象。外假热而内真寒。故必以脉辨之。脉见洪大。按之则空。或
细数且躁。此是假热之征据。手足厥冷。脉微欲绝。此是阳脱之候。舌色淡红微白。舌本胖嫩圆浓。
症属阴寒格拒。虚阳浮越。顷刻欲散之兆。灯将绝而复明之义也。用六味以滋阴。桂附以回阳。其妙在冷
服。上焦之假热。以假冷之药制之。内伏之真寒。以真热之性除之。阳回寒化。其病自愈。此与上条
之水亏火旺。用纯阴壮水之品。两相合参。其阴阳虚实之不同。有如此者。
又有病发于少阴。不当正汗。医见恶寒发热。误以太阳法强汗之。汗遂漏不止。其
人亡阳。故狂。与阴极发狂相同。当兴建中汤。去饴糖、生姜加人参、黄 、熟附、龙骨
收之。（以上虚症治法）
邵评∶病在少阴。邪已入里。法不当汗。医者误用太阳发汗之药。汗漏不止。阳随
汗脱。而躁扰似狂。此虚阳外散。阳不恋阴而欲脱。故用建中汤。加参附以回阳。龙骨、黄 以敛摄之。
又评∶误发少阴之汗。阳随汗脱。而发躁狂。盖此数条。虚症发躁似狂。非狂之症也。
太阳蓄血发狂。则小腹硬痛。小便自利为辨。阳明蓄血发狂。则喜忘。大便黑为辨。（此如狂症）
邵评∶蓄血如狂之症。有太阳阳明两经之分。以见症辨之。此如狂症。蓄血如狂。分别太阳阳明。
狂言。目反。直视。肾绝也。不治。
The *Yellow Emperor's Inner Classic* states: When pathogenic factors enter the Yang aspect, mania ensues. It also states: When Yang is excessive, mania occurs. Mania is caused by an excess of Yang. In typhoid diseases, heat-toxin accumulates in the Stomach and ascends to disturb the Heart, leading to mania; this indicates that pathogenic heat has reached its extreme.
Commentary by Shao: When Yang pathogenic factors enter Yang meridians, it is termed "redundant Yang." Excess Yang leads to mania. If pathogenic heat lies latent within the Stomach, fire-toxin steams upward, clouding and disturbing the spiritual energy of the Pericardium (Xinbao), consciousness loses autonomy, resulting in mania.
Symptoms of mania include: little sleep, lack of hunger, delirious speech and laughter, aimless rising and walking, discarding clothes and running, climbing high places and singing, and in severe cases, scaling walls or roofs. These are all caused by the extreme hyperactivity of solitary Yang. They cannot be cured without emesis or purgation.
Commentary by Shao: This is due to the ascent of excess fire in the Yangming channel, clouding the spirit. Using emesis or purgation allows the heat to vent outward, and the mania will cease spontaneously.
Whenever extreme heat in the Stomach overacts upon the Heart, it causes clouded consciousness and mania. The classic says "redundant Yang leads to mania," meaning heat entering the Yang aspect causes mental confusion and madness. If there is a exterior excess syndrome with no sweating, use Sanhuang Shigao Tang (Three Yellows and Gypsum Decoction). If there is an interior excess syndrome with constipation, use Dachengqi Tang (Major Order the Qi Decoction). If there are neither exterior nor interior syndromes, use Baihu Tang (White Tiger Decoction) combined with Jiedu Tang (Detoxification Decoction).
Commentary by Shao: When exterior heat of the Taiyang channel cannot vent outward, stagnation leads to mania; one should clear and resolve the heat in both the exterior and interior. When stomach heat of the Yangming channel cannot drain downward, and dry feces steam internally causing mania, treatment should employ purgation. When heat in the Yangming channel and blazing internal stomach fire cause mania, treatment should focus on clearing and resolving stomach heat.
If the patient is restless, runs wildly, speaks deliriously, shouts and curses, has a red face and sore throat, a nose black as soot, skin spots resembling brocade, or passes reddish-yellow diarrhea, this is Yang Du (Yang Toxin). Treat primarily with Sanhuang Tang (Three Yellows Decoction) or Dahuang San (Rhubarb Powder).
For Yang Du causing mania, where the patient scales walls and roofs, use Pili Tang (Thunderbolt Decoction) mixed with Que Shi San (Magpie Stone Powder), two qian. Alternatively, use Renzhong Huang (Human Waste Yellow), three qian, taken with boiled water, or induce vomiting of phlegm using Gua Di Mo (Melon Stem Powder) mixed with water. (These are all treatments for excess syndromes.)
Commentary by Shao: Fire-toxin blazes internally, carrying phlegm upward to scorch and cloud the clear spiritual essence, leaving the patient intoxicated and dazed. One must greatly clear the toxic fire or vomit the phlegm-heat.
All of the above are treatments for excess syndromes.
Take blue bricks from a cesspool, heat them red in fire, remove them, and throw them into water. After the water boils, take this water to drink. This treats mania and confusion.
In cases of excessive mental labor, where one strains the mind excessively, leading to clouded consciousness, mania, and erroneous speech, without any visible exterior or interior excess syndromes, one should treat the fire of the Heart and Pericardium (Xinbaoluo). Selectively use herbs such as Chuanlian (Coptidis Rhizoma), Chen Sha (Cinnabar), Changpu (Acori Tatarinowii Rhizoma), Gouteng (Uncariae Ramulus cum Uncis), Fushen (Poria with Hostwood), Xiaocao (Oldenlandiae Herba), Tianzhu Huang (Bambusae Caulis in Taenia), Hupo (Amber), Jinbo (Gold Leaf), Banxia (Pinelliae Rhizoma), and Zhuru (Bambusae Caulis in Taenia).
Commentary by Shao: Labor damages the Ying (Nutritive) level of the Heart, causing heart blood to dissipate and mental thoughts to fail to converge. Heart fire becomes hyperactive, possibly carrying turbid phlegm upward to obscure the clear spiritual qi, resulting in confusion and apparent madness. This is not caused by external pathogens, nor does it present with exterior-interior excess signs; it arises from internal injury to the Shen (Spirit). Treatment should clear the fire of the Heart and Pericardium, assisted by methods to wash away phlegm and calm the spirit. This differs from the aforementioned excess-heat mania.
In cases of Yin deficiency complicated by external contraction, slight restlessness may appear. If physicians mistakenly diagnose Yangming disease and use ascending and dispersing drugs like Xijiao (Rhinocerotis Cornu) and Gegen (Puerariae Radix), it causes deficient fire to surge upward. Symptoms include red eyes and malar flush, dry lips and mouth, followed by restlessness and mania, resembling a Yang syndrome. However, the feet are cold, the tongue is purple, and the six pulses are flooding yet empty, or fine and rapid. Treatment should primarily use Zuogui Yin (Left Restoring Decoction) or Liuwei Shenmai Tang (Six-Ingredient Decoction with Ginseng and Ophiopogon).
Commentary by Shao: Shaoyin kidney water is deficient, and warm-heat pathogens are contracted. External pathogens enter the Yin meridians, presenting as a syndrome of water deficiency and fire excess. Physicians mistakenly use ascending and dispersing agents, lifting and penetrating, which further injures Yin and intensifies fire. Unchecked deficient fire surges upward, creating false heat signs and causing restlessness and mania. This is because water deficiency fails to control fire, allowing deficient fire to float upward. Hence, the pulse is deep, fine, and rapid, or appears flooding but feels empty upon heavy pressure. With virtual Yang disturbing upward, treatment should employ strengthening water to control fire. When Yin flourishes, floating fire calms naturally.
In Shaoyin syndromes, when Yin reaches its extreme and mimics Yang, restlessness and mania occur. The patient may be naked, waving hands and kicking feet, desiring to sit or lie in water. This is Yin Mania. The external symptoms resemble Yang Mania, so differentiation must rely on the pulse. The pulse will likely be flooding yet empty, or fine, rapid, and restless, or accompanied by cold extremities and deep, faint pulses throughout. The tongue will be pale red and swollen/tender, or slightly white and round/thick. Treat primarily with Renshen Bawei Yin (Ginseng Eight-Ingredient Decoction) taken cold. In all Yin Mania cases, although the exterior appears hot, touching the muscles reveals biting coldness.
Commentary by Shao: Compare this with the previous clause. The previous clause described water deficiency and fire hyperactivity; this clause describes Yin excess and Yang deficiency. In Shaoyin cold pathogens, Yin is abundant and Yang is scarce. Yang cannot cling to Yin and floats outward and upward; Yin-cold repels internally, producing these signs of restless, virtual mania. The exterior shows false heat while the interior presents true cold; thus, differentiation relies on the pulse. A flooding pulse that feels empty upon pressure, or a fine, rapid, and restless pulse, are signs of false heat. Cold extremities and a pulse faint to the point of disappearance indicate Yang collapse. A pale red, slightly white tongue that is swollen, tender, and round indicates Yin-cold repulsion and floating virtual Yang, signaling imminent dispersion of Yang, akin to a lamp flickering before extinction. Use Liuwang Dihuang Wan (Six-Ingredient Rehmannia Pill) to nourish Yin, and Rougui (Cinnamon Bark) and Fuzi (Aconiti Lateralis Radix Praeparata) to restore Yang. The subtlety lies in taking the medicine cold: the false heat in the upper Jiao is controlled by the seemingly cold nature of the drug, while the true cold lurking inside is eliminated by the truly hot properties. Once Yang returns and cold transforms, the illness heals spontaneously. Comparing this with the previous case of water deficiency and fire excess treated with purely Yin-nourishing substances highlights the differences between Yin-Yang and deficiency-excess conditions.
Furthermore, if a disease originates in Shaoyin, normal sweating is not indicated. If a physician sees aversion to cold and fever and mistakenly applies Taiyang methods to force sweating, sweat leaks incessantly. The patient suffers from Yang collapse, leading to mania, identical to mania caused by extreme Yin. Treat primarily with Jianzhong Tang (Establish the Middle Decoction), removing Yitang (Maltose) and Shengjiang (Zingiberis Rhizoma Recens), and adding Renshen (Ginseng Radix), Huangqi (Astragali Radix), Shufu (Prepared Aconite Root), and Longgu (Fossilia Ossis Mastodi) to consolidate and arrest leakage. (These are all treatments for deficiency syndromes.)
Commentary by Shao: The disease is in Shaoyin, and pathogens have entered the interior; sweating is contraindicated. Physicians mistakenly use Taiyang diaphoretic drugs, causing sweat to leak continuously. Yang escapes with the sweat, leading to restlessness and apparent mania. This is virtual Yang scattering outward; Yang cannot cling to Yin and is about to collapse. Therefore, Jianzhong Tang is used, supplemented with Renshen and Fuzi to restore Yang, and Longgu and Huangqi to consolidate and secure.
Additional Commentary: Mistakenly inducing sweating in Shaoyin causes Yang to escape with sweat, leading to restlessness and mania. Generally, the restlessness resembling mania described in these clauses represents deficiency syndromes, not true mania.
In Taiyang Blood Stasis causing mania, differentiation is based on hardness and pain in the lower abdomen and free urination. In Yangming Blood Stasis causing mania, differentiation is based on forgetfulness and black stools. (These are "like-man" syndromes.)
Commentary by Shao: Like-man syndromes caused by blood stasis differ between the Taiyang and Yangming channels. Differentiation is made based on presenting symptoms. Regarding like-man syndromes, blood stasis-induced like-man must be distinguished between Taiyang and Yangming channels.
Delirious speech, eyes rolling back, and fixed staring indicate Kidney exhaustion. This is untreatable.