癫出积忧积郁，病在心脾包络之阴，蔽而不宣，致气郁痰迷，神志为之混淆。狂由大惊
大恐，病在肝胆胃经，三阳并而上升，致火炽痰涌，心窍为之闭塞。不寐总由阳不交阴所
致，若因外邪而不寐者，当连去其邪，攘外即所以安内也。若因里症而不寐者，或焦劳过度
而离宫内热，或忧劳积郁而耗损心脾，或精不凝神而龙雷振荡，或肝血无藏而魂摇神漾。胃
病则阳跷穴满，胆热则口苦心烦，审病用方，法无一定。
狂症属阳主多怒，癫症属阴主多喜。心热为狂肝实癫，均为热症河间议。心经有损七情
伤，镇心安神最为利。天王补心用三参（人参、丹参、元参），酸枣地归二冬味。远志柏仁桔茯
神，灯草辰砂石菖配。怔忡健忘都可医，加减天王补心治。怔忡人呆将捕如，惕惕不宁神明
殊。心为人主血为主，神不守舍心血虚。健忘虽因气血隔，盛怒伤志亦成疾。静则神藏躁消
亡，心气不充神惫极。阳不变阴非外邪，此方亦可不寐吃（即天王补心丸）。
发狂木火动心神虚
人参 元参 枣仁 天冬 丹参 茯神 川连 麦冬 生地 远志 桔梗 伯仁 菖蒲
发癫，郁火，心肾不交（脉不鼓指）
生地 酒炒连 山栀 茯神 竹叶 川柏 炙坎版 菖蒲 远志
心火不寐
鲜生地 元参 竹叶心 净银花 麦冬 绿豆皮
胆火不寐
丹皮 半夏 钩藤 温胆汤 山栀 桑叶 橘红
脾营虚
用归脾汤为主
不寐胃病，阳跷脉虚
早服八味丸，晚服半夏秫米汤。
不寐怔忡，胆液亏，阳升虚烦
《金匮》酸枣仁汤 枣仁 甘草 知母 茯苓 川芎
不寐健忘，肝肾阴亏，阳浮（咸苦酸收甘缓法）
龟版胶 熟地 萸肉 五味子 宁淡菜 川柏 远志 白茯苓 鹿角胶 大熟地 淡苁蓉 羊肾子
何书田曰∶癫之实者，以滚痰丸开痰之壅塞，清心丸泄火之郁勃。虚者当养神而通志，
归脾丸、枕中丹。狂之实者，以承气汤、白虎汤直折阳明之火，生铁落饮重制肝胆之邪。虚者
当壮水以制火，二阴煎之类。
生地 枣仁 元参 茯苓 麦冬 甘草 黄芩 木通
思虑烦劳，身心过动，风阳内扰则营热。心悸惊怖，不寐，胁中动跃，治以酸枣仁汤。
枣仁 知母 川芎 甘草 茯苓 补心丹 枕中丹 清营之热佐以敛摄神志。
陈参曰∶《灵枢经》云∶阳气下交于阴，阳跷脉满，令人得寐。
Dian (Manic-Depressive Psychosis) arises from accumulated worry and depression, affecting the Yin aspect of the Heart, Spleen, and Pericardium. This blocks the Qi mechanism and confuses the Shen (Spirit) with phlegm turbidity. Kuang (Mania) results from great fright and terror, involving the Liver, Gallbladder, and Stomach meridians. The Yang Qi of the three Yang meridians rises together, causing blazing fire and surging phlegm, which obstructs the orifices of the Heart. Insomnia (Bu Mei) is generally caused by the failure of Yang to interact with Yin. If insomnia is due to external pathogens, one must first eliminate the pathogen; eliminating the exterior is equivalent to calming the interior. If insomnia is due to internal disorders, it may result from excessive labor causing heat in the Kidney (Li Gong), or from worry and labor depleting the Heart and Spleen, or from essence failing to anchor the spirit causing Dragon and Thunder fire to oscillate, or from Liver blood deficiency failing to store the Hun (Ethereal Soul). Stomach disease leads to fullness of the Yang Qiao Mai (Yang Heel Vessel); Gallbladder heat causes bitter taste and irritability. One must examine the disease to select the formula, as there is no fixed method.
Kuang syndrome belongs to Yang and is characterized by anger; Dian syndrome belongs to Yin and is characterized by excessive laughter. Heat in the Heart causes Kuang, excess in the Liver causes Dian; both are heat syndromes, as discussed by He Jian (Liu Wansu). Damage to the Heart Meridian from the Seven Emotions is best treated by calming the Heart and anchoring the Shen. Tian Wang Bu Xin Dan uses Ren Shen (Ginseng Radix), Dan Shen (Salvia Miltiorrhizae Radix et Rhizoma), and Xuan Shen (Scrophulariae Radix). It also includes Suan Zao Ren (Ziziphi Spinosae Semen), Di Huang (Rehmanniae Radix), Dang Gui (Angelicae Sinensis Radix), Tian Dong (Asparagi Radix), Mai Dong (Ophiopogonis Radix), and Wu Wei Zi (Schisandrae Chinensis Fructus). Added are Yuan Zhi (Polygalae Radix), Bai Ren (Platycladi Semen), Jie Geng (Platycodonis Radix), Fu Ling (Poria), Fu Shen (Poria with Hostwood), Deng Cao (Junci Medulla), Chen Sha (Cinnabar), and Shi Chang Pu (Acori Tatarinowii Rhizoma). It treats palpitations (Zheng Chong) and forgetfulness (Jian Wang) via modifications of Tian Wang Bu Xin Dan. Patients with Zheng Chong appear dull and terrified, uneasy, with disturbed Shen. The Heart is the master, Blood is the substance; when Shen does not reside in its house, it is due to Heart Blood deficiency. Forgetfulness can be caused by Qi and Blood obstruction, but also by anger injuring the Zhi (Will). Stillness allows the Shen to hide; restlessness causes the Shen to perish. If Heart Qi is insufficient, Shen becomes extremely fatigued. If Yang does not transform into Yin and it is not due to external pathogens, this formula (Tian Wang Bu Xin Wan) can also treat insomnia.
For Kuang caused by Wood-Fire disturbing the Heart and Heart Deficiency: Ren Shen, Xuan Shen, Zao Ren, Tian Dong, Dan Shen, Fu Shen, Chuan Lian (Coptidis Rhizoma), Mai Dong, Sheng Di, Yuan Zhi, Jie Geng, Bo Ren (Platycladi Semen), Chang Pu.
For Dian caused by Depressed Fire and Heart-Kidney Non-interaction (pulse not striking the finger): Sheng Di, Jiu Chao Lian (Alcohol-fried Coptidis Rhizoma), Shan Zhi (Gardeniae Fructus), Fu Shen, Zhu Ye (Bambusae Folium), Chuan Bai (Phellodendri Cortex), Zhi Kan Ban (Prepared Testudinis Carapax et Plastrum), Chang Pu, Yuan Zhi.
For Insomnia due to Heart Fire: Xian Sheng Di, Xuan Shen, Zhu Ye Xin (Heart of Bambusae Folium), Jing Yin Hua (Jasmine Flower), Mai Dong, Lu Dou Pi (Phaseoli Semen Integrum Cuticle).
For Insomnia due to Gallbladder Fire: Dan Pi (Moutan Cortex), Ban Xia (Pinelliae Rhizoma), Gou Teng (Uncariae Ramulus cum Uncis), Wen Dan Tang (Warm the Gallbladder Decoction), Shan Zhi, Sang Ye (Mori Folium), Ju Hong (Citri Reticulatae Pericarpium).
For Spleen Ying (Nutritive Level) Deficiency: Use Gui Pi Tang (Restore the Spleen Decoction) as the main formula.
For Insomnia due to Stomach Disease and Deficiency of Yang Qiao Mai: Take Ba Wei Wan (Eight-Ingredient Pill) in the morning, and Ban Xia Shu Mi Tang (Pinellia and Millet Decoction) at night.
For Insomnia with Palpitations due to Gallbladder Fluid Deficiency and Rising Yang causing Empty Irritability: Suan Zao Ren Tang (Sour Jujube Seed Decoction) from *Jin Gui Yao Lue*, containing Zao Ren, Gan Cao (Licorice Root), Zhi Mu (Anemarrhenae Rhizoma), Fu Ling, Chuan Xiong (Ligustici Chuanxiong Rhizoma).
For Insomnia with Forgetfulness due to Liver-Kidney Yin Deficiency and Floating Yang (using Salty, Bitter, Sour-astringent, and Sweet-moderating methods): Gui Ban Jiao (Testudinis Carapacis et Plastrum Colla), Shu Di (Prepared Rehmanniae Radix), Yu Rou (Corni Fructus), Wu Wei Zi, Ning Dan Cai (Nereis), Chuan Bai, Yuan Zhi, Bai Fu Ling, Lu Jiao Jiao (Cervi Cornus Colla), Da Shu Di, Dan Cong Rong (Cistanches Herba), Yang Shen Zi (Ovis Testis).
He Shutian stated: For Excess Dian, use Gun Tan Wan (Rolling Phlegm Pill) to open phlegm obstruction, and Qing Xin Wan (Clear the Heart Pill) to drain郁 fire. For Deficient Dian, nourish the Shen and unblock the Zhi using Gui Pi Wan and Zhen Zhong Dan. For Excess Kuang, use Cheng Qi Tang (Order the Qi Decoction) and Bai Hu Tang (White Tiger Decoction) to directly subdue Yangming fire, and Sheng Tie Luo Yin (Smelted Iron Drop Drink) to heavily restrain Liver-Gallbladder pathogens. For Deficient Kuang, strengthen Water to control Fire, using Er Yin Jian (Two Yin Decoction) and similar formulas.
Sheng Di, Zao Ren, Xuan Shen, Fu Ling, Mai Dong, Gan Cao, Huang Qin (Scutellariae Radix), Mu Tong (Akebiae Caulis).
Overthinking and fatigue cause excessive movement of body and mind, leading to internal disturbance of Wind-Yang and heat in the Ying level. Symptoms include palpitations, fear, insomnia, and jumping sensations in the hypochondrium. Treat with Suan Zao Ren Tang. Ingredients: Zao Ren, Zhi Mu, Chuan Xiong, Gan Cao, Fu Ling, Bu Xin Dan, Zhen Zhong Dan. Clear Ying-level heat and assist in astringing and anchoring the Shen.
Chen Can stated: The *Ling Shu* says: When Yang Qi descends to interact with Yin, and the Yang Qiao Mai is full, one obtains sleep.