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Typhoid Fever Manifesting as Mania. How should this be elucidated? "Mania" (Kuang, 狂) refers to reckless and unruly behavior, denoting a state of mental unrest. The *Nan Jing* (Classic of Difficult Issues) states: At the onset of mania, the patient sleeps little, lacks appetite, yet regards themselves as superior and virtuous; claims to be wise and intelligent; acts arrogantly and disdainfully; laughs inappropriately, enjoys singing and music; walks about aimlessly without cessation. The origin of all cases of mania is attributed to an excess of Yang. The *Nei Jing* (Inner Canon) states: When Yin cannot overcome Yang, the pulse becomes stagnant, thin, rapid, and combined, resulting in mania. It further states: When pathogenic factors enter the Yang aspect, mania occurs; when they enter the Yin aspect, aphonia occurs. The *Nan Jing* states: Excess Yang leads to mania; excess Yin leads to catatonia (Dian, 癫). The *Mai Jing* (Pulse Classic) states: When Yin attaches to Yang, mania occurs; when Yang attaches to Yin, catatonia occurs. The *Bing Yuan* (Source of Diseases) states: When Yang pathogens combine with Yang, mania occurs; when Yin pathogens combine with Yin, catatonia occurs. Thus, it is evident that mania in various meridians is due to Yang excess. Furthermore, in Yangming disease (Yangming Bing, 阳明病), the patient dislikes people and fire; hearing the sound of wood causes them to startle fearfully; their heart feels agitated; they prefer to stay alone behind closed doors and windows. In severe cases, they may wish to climb high places and sing, discard their clothes and run, jump over walls, or climb onto roofs. These actions are not capabilities they previously possessed. This is termed Yang pathogens combining with the Yangming meridian. In typhoid fever, heat toxins reside in the Stomach and combine with the Heart, disturbing the Shen (Spirit, 神) and destabilizing the Zhi (Will, 志), thereby inducing mania. When typhoid fever progresses to mania, it indicates that pathogenic heat has reached its extremity. Only drastic purgation (Da Tu Xia, 大吐下) can resolve it. There is also heat in the Lower Jiao (Xia Jiao, 下焦), where the patient appears manic (Ru Kuang, 如狂). The classics state: When heat enters the Bladder, the patient appears manic. Being described as "appearing manic" implies they have not yet reached full mania; they merely experience restlessness in lying down and rising. If there is incoherent speech (Kuang Yan, 狂言), eyes rolling back and staring straight ahead, this indicates the exhaustion of Kidney Qi. If sweating is followed by recurrent fever, incoherent speech, and inability to eat, this indicates the loss of Zhi (Will) and is a fatal sign. In such cases, medicinal therapy and acupuncture are likely ineffective; this represents a critical, true illness.

Typhoid Fever Manifesting as Huoluan (Colic with Vomiting and Diarrhea). How should this be elucidated? It is characterized by vomiting above and diarrhea below, with sudden and chaotic symptoms. When pathogens are in the Upper Jiao (Shang Jiao, 上焦), there is only vomiting without diarrhea. When pathogens are in the Lower Jiao (Xia Jiao, 下焦), there is only diarrhea without vomiting. However, if pathogens are in the Middle Jiao (Zhong Jiao, 中焦), the Stomach Qi fails to regulate properly, damaged by pathogens, causing a separation of Yin and Yang, leading to both vomiting and diarrhea. If vomiting stops but diarrhea continues, or vice versa, it is not necessarily Huoluan. True Huoluan requires simultaneous upper vomiting and lower diarrhea, accompanied by agitation, restlessness, and chaos. This differs from cases simply described as vomiting and diarrhea. Typhoid fever with vomiting and diarrhea is caused by pathogenic invasion; Huoluan with vomiting and diarrhea is caused by dietary injury. Some cases involve concurrent typhoid pathogens, leading to internal and external disharmony, accompanied by headache, fever, vomiting, and diarrhea. The classics ask: For a patient with fever, headache, body pain, aversion to cold, vomiting, and diarrhea, what disease is this? The answer is: This is named Huoluan. If after vomiting and diarrhea cease, fever recurs, this is Huoluan concurrent with typhoid fever. For Huoluan with headache and fever, if heat predominates and the patient desires water, Wuling San (Five-Ingredient Powder with Poria, 五苓散) is the primary treatment. If cold predominates and the patient does not desire water, Lizhong Wan (Regulate the Middle Pill, 理中丸) is the primary treatment. Because the Middle Jiao loses regulation and Yin-Yang separate, there must be a bias. Bias toward Yang results in more heat; bias toward Yin results in more cold. Xu Renze stated: There are two types of Huoluan: Gan Huoluan (Dry Huoluan, 干霍乱) and Shi Huoluan (Wet Huoluan, 湿霍乱). Dry Huoluan has a higher mortality rate; Wet Huoluan has a lower mortality rate. This is because in Wet Huoluan, the injured substances are expelled through vomiting and diarrhea. Although it is Huoluan, it stops once the food and water in the stomach are exhausted. Therefore, few die. In contrast, Dry Huoluan often leads to death because the patient cannot vomit upward nor defecate downward, so the injured substances cannot be expelled. This blocks the Zheng Qi (Righteous Qi, 正气), separates Yin and Yang, causing agitation, oppression, chaos, and restlessness without peace, along with panting and distension, leading to death from Dry Huoluan. Alas! Those who eat and drink in moderation and maintain regular daily routines, how could they contract Huoluan? "When food and drink exceed normal limits, the intestines and stomach are injured." The cause of death is truly self-inflicted.