火劫汗后亡阳,心惊狂,起卧不安者,桂枝去芍药加蜀漆牡蛎龙骨救逆汤。(方论见惊。)汗家重发汗,
必恍惚心乱,小便已阴痛,与禹余粮丸。(方见痞。)
小腹满,发狂,或身黄者,宜抵当汤。(论见发热方见蓄血。)
遗尿狂言,目反直视者,此为肾绝。(论见大法。)
〔《活》〕病患烦躁,狂走妄言,面赤咽痛,脉实潮热,狂语如见鬼状,此阳毒也。(治阳毒法见阳毒门。
表者阳毒升麻汤、黑奴丸,里者大黄散。)
〔《本》〕治伤寒发狂,弃衣奔走,逾墙上屋,鹊石散。
黄连 寒水石(各等分)
上为细末,每服二钱,浓煎甘草汤,候冷调下。
〔云〕伤寒心风狂妄者,宜防风黄连汤。
黄连 大黄 防风 远志 茯神(各半两)
上为细末,每服一两,水煎服。
〔海〕黄 汤 治伤寒或歌或笑或悲哭,谵言妄语。(方见发热下。)
陈志仁伤寒狂妄,每欲狂走,四五人扶捉不定,脉虚数,用柴胡汤反剧,以参、 、归、术、甘草、
陈皮煎汤,一服狂定,再服安睡。
〔《集》〕伤寒发热,不识尊卑∶曲池、绝骨、百劳、涌泉。
〔《甲》〕热汗不出,狂互引癫疾,合谷主之。
伤寒若吐若下后,不解,不大便五六日至十余日,日晡所发潮热,不恶寒,狂语如见鬼状,若剧者,
发则不识人,循衣摸床,惕而不安,微喘直视,脉弦者生,涩者死。微者但发热谵语者,大承气汤主之。
若一服利,止后服。太阳病,以火劫发汗,阴阳枯竭,虚燥或不大便,久则谵语,甚者至哕,手足躁扰,
捻衣摸床,小便
利者可治。(论见头汗。)
〔许〕有人病伤寒,大便不利,日晡发潮热,手循衣缝,两手撮空,直视喘急,更数医矣,见之皆走,此
诚恶候,得之者十中九死。仲景虽有症而无法,但云脉弦者生,涩者死。已经吐下,难以下药,谩且救之。若
大便得通,而脉弦者,庶可治也,与小承气汤一服而大便利,诸疾渐退,脉且微弦,半月愈。或问曰∶
下之而脉弦者生,此何意也?予曰∶《金匮玉函》云∶循衣妄撮,怵惕不安,微喘直视,脉弦者生,涩者死,
微者但发热谵语者,承气汤主之。予尝观钱仲阳《小儿直诀》云∶手寻衣领及捻物者,肝热也。此症在《玉
函》列于阳明部,盖阳明者,胃也,肝有热,邪淫于胃经,故以承气泻之。且得弦脉,则肝平而胃不受克,此
所谓有生之理。读仲景论不能博通诸医书以发明其隐奥,吾未之见也。(海藏云∶许学士作寻衣撮空是肝热
风淫末疾,此论诚当然,莫若以为肺热之邪,其人必妄言乱语。《难经》云∶肺邪入心为谵语。)
After sweating induced by fire therapy leads to the loss of Yang Qi, resulting in a startled heart, mania (mania), and restlessness in bed or sitting up, Guizhi Qu Shaoyao Jia Shuqi Muli Longgu Jiuni Tang (Cinnamon Twig Decoction without Paeonia plus Coix Seed, Oyster Shell, and Dragon Bone to Rescue from Peril) is indicated. (The commentary on this formula can be found under "Palpitations".) For individuals who habitually sweat, if heavy sweating is induced again, it will inevitably lead to mental confusion and inner turmoil, along with pain in the genitalia after urination; Yuyuliang Wan (Hematitum Pill) should be administered. (The formula can be found under "Fullness"). If there is fullness in the lower abdomen, mania, or yellowing of the body, Didang Tang (Ephedra and Safflower Decoction) is appropriate. (The theory can be found under "Fever", and the formula under "Blood Stasis".) Urinary incontinence accompanied by delirious speech and eyes rolling upward with fixed gaze indicates the exhaustion of Kidney Qi. (The theory can be found under "General Principles".)
[From *Huoren Shu*] Patients suffer from irritability, running wildly and speaking nonsensically, with a red face and sore throat. The pulse is excess and associated with tidal fever. The delirious speech resembles seeing ghosts; this is Yang Du (Yang Toxin). (Methods for treating Yang Du can be found in the "Yang Du" section. For exterior patterns, Yangdu Shengma Tang and Heiniu Wan are used; for interior patterns, Dahuang San is used.)
[From *Bencao*] To treat mania caused by Shanghan (Cold Damage), where the patient discards clothes, runs about, and climbs over walls, Que Shi San (Magpie Stone Powder) is prescribed.
Coptidis Rhizoma (Huanglian) and Hanyanshi (Calcitum, 寒水石) in equal parts.
Grind into a fine powder. Take two qian each time, mixed with thickly boiled Glycyrrhizae Radix et Rhizoma (Gancao) decoction, cooled before administration.
[From Yun Qizi] For Shanghan causing Heart Wind and madness, Fangfeng Huanglian Tang (Saposhnikovia and Coptis Decoction) is suitable.
Coptidis Rhizoma (Huanglian), Rhei Radix et Rhizoma (Dahuang), Saposhnikoviae Radix (Fangfeng), Polygalae Radix (Yuanzhi), and Poria (Fushen) in equal parts of half liang.
Grind into a fine powder. Take one liang each time, decocted in water and taken orally.
[From Hai Zang] Huang Qin Tang (Scutellaria Decoction) treats Shanghan presenting with singing, laughing, or crying bitterly, along with delirious and nonsensical speech. (The formula can be found under "Fever".)
Chen Zhiren suffered from Shanghan-induced madness, frequently attempting to run wildly, requiring four or five people to restrain him. His pulse was deficient and rapid. Using Chaihu Tang (Bupleurum Decoction) worsened the condition. Instead, a decoction of Ginseng Radix et Rhizoma (Renshen), Atractylodis Macrocephalae Rhizoma (Baizhu), Angelicae Sinensis Radix (Danggui), Atractylodis Rhizoma (Baizhu - note: text repeats Baizhu, likely implying another Bai Zhu variant or error, kept as Baizhu), Glycyrrhizae Radix et Rhizoma (Gancao), and Tangerine Peel (Chenpi) was prepared. After one dose, the madness ceased; after a second dose, he slept peacefully.
[From *Jicheng*] For Shanghan fever with loss of recognition of social hierarchy: points Quchi (LI11), Juegu (GB39), Bailao (Extra point), and Yongquan (KI1) are selected.
[From *Jiayi Jing*] For heat with no sweating, mania leading to epilepsy, Hegu (LI4) is the primary point.
If Shanghan persists after emesis or purgation, and constipation lasts from five to ten days, accompanied by evening tidal fever, aversion to cold being absent, and delirious speech resembling seeing ghosts, the condition may progress. In severe cases, the patient becomes unrecognizable during episodes, engages in picking at clothes and bedsheets, feels terrified and restless, has slight panting and fixed staring. A string-like (Xian) pulse indicates survival, while a choppy (Se) pulse indicates death. For milder cases presenting only with fever and delirium, Dachengqi Tang (Major Order the Qi Decoction) is the main treatment. If bowel movement occurs after one dose, discontinue further doses.
In Taiyang disease, if fire therapy induces sweating, leading to the depletion of Yin and Yang, dryness, or constipation, prolonged delirium may occur. In severe cases, hiccups may appear, with restless hands and feet, and picking at clothes and bedsheets. If urination is free, the condition is treatable. (Theory can be found under "Head Sweat".)
[From Xu Shumi] A patient with Shanghan had difficulty defecating, evening tidal fever, hand movements picking at seams, grasping at empty air, fixed staring, and urgent panting. Several physicians had treated him but avoided him upon seeing these signs, as this is indeed a critical prognosis, with nine out of ten deaths. Zhang Zhongjing described the symptoms but offered no specific prescription, stating only that a Xian pulse implies survival and a Se pulse implies death. Since the patient had already undergone emesis and purgation, strong purgatives were difficult to administer, so a tentative rescue attempt was made. If the bowels opened and the pulse became Xian, recovery might be possible. A single dose of Xiaochengqi Tang (Minor Order the Qi Decoction) resulted in profuse bowel movement, gradual subsidence of other symptoms, and a slightly Xian pulse. Recovery occurred within half a month.
A question arose: Why does a Xian pulse after purgation indicate survival? I replied: *Jinkui Yufan Jing* states: Picking at clothes and grasping randomly, terror and restlessness, slight panting and fixed staring, with a Xian pulse indicates survival, and a Se pulse indicates death. Milder cases with only fever and delirium are treated with Chengqi Tang. I observed in Qian Zhongyang's *Xiao'er Zhijue* that seeking clothing collars and fiddling with objects indicates Liver Heat. This syndrome is listed in the Yangming section of *Yufan*. Yangming corresponds to the Stomach. When the Liver has heat, pathogenic factors invade the Stomach meridian, hence Chengqi Tang is used to purge. Obtaining a Xian pulse means the Liver is balanced and does not overact on the Stomach, which is the principle of survival. I have never seen anyone who reads Zhang Zhongjing’s discussions without extensively studying other medical texts to elucidate their hidden profundities. (Hai Zang stated: Scholar Xu considered picking at clothes and grasping at empty air as a terminal disease caused by Liver Wind and Pathogenic Fire invading the extremities. This argument is reasonable, but it is better regarded as Lung Heat, where the patient necessarily speaks nonsense. *Nanjing* states: Lung pathogen entering the Heart causes delirium.)