Library

Q: Why is delirium (Zhenyu) attributed to the Yangming Fu-organ syndrome?
A: The Heart is the mother of the Stomach, and the Lung is the child of the Stomach. The Heart governs the storage of the Spirit (Shen), which is the seat of mental clarity; the Lung governs vocalization and possesses a descending and purifying function. Currently, excessive heat in the Stomach ascends to invade the Heart and Lung, causing the Spirit to become confused and speech to become disordered. In mild cases, there is muttering and absurd talk; in severe cases, there is shouting, cursing, and abuse regardless of kinship or distance. Because the heat varies in severity, the delirium also varies in intensity.
Further question: The classics state that delirium can be either deficiency or excess. What does this mean?
Answer: Excess leads to delirium (Zhenyu), while deficiency leads to Zhengsheng. Delirium refers to chaotic speech without order, frequently changing topics; Zhengsheng refers to words spoken with solemnity, repeated frequently without shifting to other subjects. This is because when Qi is in excess, the mental mechanism changes rapidly leading to chaotic speech; when Qi is deficient, the mental mechanism lacks agility and only maintains a single tone.
Further question: When a woman suffers from Cold Damage (Shanghan), she is lucid during the day but experiences delirium at night. What is the cause?
Answer: This is the syndrome of Heat entering the Blood Chamber (Xueshi). When a woman's menstruation arrives, the Sea of Blood becomes empty, allowing pathogenic factors to take advantage of this void, resulting in this syndrome. The treatment method is to avoid damaging the Stomach Qi and not to attack the Upper and Middle Jiao; the disease will heal itself. It is appropriate to use Xiaochaihu Tang (Minor Bupleurum Decoction), removing Banxia (Pinelliae Rhizoma), and adding Honghua (Carthami Flos), Taoren (Persicae Semen), Shengdihuang (Rehmanniae Radix Recens), and Danpi (Moutan Cortex), among others.

Q: Why is mania (Kuangluan) attributed to Yangming Fu-disease?
A: Excessive Yin constitutes Dian (epilepsy/mental depression), while excessive Yang constitutes Kuang (mania). Mania arising from various meridians is always due to hyperactive Yang. In Cold Damage diseases, when Yang-heat reaches extreme excess, leading to mania, the condition is critical. The onset of mania involves little sleep, lack of hunger, nonsensical speech, and erratic behavior; some may climb high places to sing, discard clothes, and run, even jumping over walls or climbing onto roofs. All these are caused by extreme hyperactivity of Yang-heat, which cannot be resolved without purgation. Additionally, if Taiyang disease is not resolved, heat binds to the Bladder, and the person appears manic (Ru Kuang). This is blood stasis in the Lower Jiao, characterized by hardness and fullness in the lower abdomen, free urination, and black stool. Although appearing manic, it is initially not as severe as true mania. Furthermore, forcing sweat via fire therapy may lead to loss of Yang, causing Jingkuang (panic-stricken mania), presenting with panic and fear; this is essentially not true mania. Thus, it is known that Ru Kuang (appearing manic) is due to Bladder blood stasis; Jingkuang is due to loss of Yang from forced sweating; and Fa Kuang (developing mania) is due to excess heat in the Yangming Stomach-Fu organ.
Further question: Are there cases of mania arising from Cold syndromes? What is the reason?
Answer: This is the syndrome of Yin excess repelling Yang. The patient is restless and irritable, desiring to sit or lie in mud or water, known as Yin燥 (Yin dryness/restlessness). The pulse must be deep and slow, possibly accompanied by cold syndromes such as diarrhea with undigested food. Urgent warming and tonification are required; cold-cooling agents must not be mistakenly used.