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The *Classic of Internal Medicine* (*Huangdi Neijing*) states: If a person's stomach and intestines are large, the Wei Qi (Defensive Qi) entering the Yin (nighttime circulation within the zang-fu organs) stays for a long time. If the skin is damp and the muscle tissues are dense due to dampness (the interstices become tight because of dampness), then the movement of Wei Qi in the Yin is slow (it can be known that its return to the exterior is also slow). Because it stays long and moves slowly, the Qi becomes impure (the Qi is dull and lacks guiding force; this is different from the smooth and unobstructed transition between Yang and Yin). Therefore, there is excessive sleep. Generally speaking, people with clear spirit sleep less, while those with turbid spirit sleep more. Those who eat until full all day without mental exertion, remaining quiet and undisturbed, tend to sleep excessively. If caused by excessive dampness, there must be lethargy, flaccidity of the four limbs, or loose stools, with a slow pulse; treatment focuses on resolving dampness. There are also cases belonging to Heat. Fire has an active nature and should normally prevent sleep. However, if Fire is abundant, spreading and obstructing, obstruction leads to blockage, which paradoxically does not disturb, and since the Spirit is consumed by Heat causing confusion, one feels heavy, weary, and sleepy. However, sleep will be restless, and treatment focuses on clearing Heat. After recovery from a Heat disease, when Yin Qi is restored, there is peaceful sleep; upon waking, the mind is clear, which differs from the drowsiness after waking from Heat-induced stupor. Feeling sleepy and tired after eating indicates Spleen deficiency; the Spleen cannot transport immediately after eating, stagnation leads to stillness, and stillness induces sleep. Treatment uses Liu Jun Zi Tang (Six Gentlemen Decoction) plus Mai Ya (Sprouted Barley Fruit), Shan Zha (Hawthorn Fruit), Shen Qu (Medicated Leaven), etc.

Kuang syndrome (Mania) is characterized by reckless violence, nudity, cursing, disregard for relatives, and in severe cases, holding knives to kill, climbing walls and roofs, running wildly regardless of terrain, excessive anger, insomnia, staring straight ahead, shouting, sometimes singing loudly or laughing wildly, arrogant self-aggrandizement, and delusions of wisdom. Dian syndrome (Depressive Psychosis) presents as being like a drunkard or sleep-talking, alternating between sadness/crying and laughter/singing, speech lacking coherence, unaware of cleanliness or filth, looking around left and right as if seeing ghosts and spirits. Sometimes the true nature returns and consciousness clears, leading to deep shame and depression, but shortly after, the symptoms reappear. Xian syndrome (Epilepsy) involves sudden loss of consciousness and collapse, clenched jaws, expectoration of phlegm-saliva upon awakening, and in severe cases, convulsions of hands and feet, deviation of mouth and eyes, upward deviation of the eyeballs, and sounds resembling livestock. Upon waking, daily activities and diet return to normal, and the mind is clear. Some may have lingering mental dullness over time, but they do not remain perpetually confused like those with Dian or Kuang. (Sudden collapses from various wind-strokes are similar, but occur silently without sound, and awaken without phlegm.) The *Inner Canon* discusses Kuang as a Yang syndrome, indicating undoubtedly that Fire Evil is the cause. Observing that in Shang Han (Cold Damage) diseases where Heat enters the Stomach Fu, mania often occurs confirms this. However, Shang Han is an acute illness, involving only temporary Fire-Heat harassing the Heart Spirit, causing spiritual deviation; once the Heat is removed, the condition resolves. If mania persists for years without lucidity, it cannot be solely attributed to Fire. There must be Phlegm-Saliva confusing the orifices of the Heart, forming a chronic condition. When Fire-Qi harasses the Heart, Heart Blood must be deficient, and combined with the floating and overflowing of the Heart Spirit, failing to reside in its house, Phlegm-Saliva takes advantage of the deficiency to invade and occupy. Dian syndrome is similar but with less Phlegm-Fire, unlike the violent abundance of Fire in Kuang. Xian syndrome also belongs to Phlegm-Heat, but has periods of onset and cessation, indicating the Phlegm has not entered the Heart but lies latent below the Heart. When Qi moves, it ascends and triggers an attack; when Qi calms, it descends and stops. This differs from Dian and Kuang where Phlegm constantly confuses the Heart orifices. These three syndromes are distinct but all belong to Heat. However, the *Nan Jing* classifies Xian under Dian, stating "Double Yang results in Kuang, Double Yin results in Dian." Consequently, later practitioners viewed Xian as a Cold-Damp syndrome, or divided it into Yin and Yang types, considering Yin Xian as Cold. In fact, while some Xian cases may turn into Deficiency-Cold due to mismanagement, none originate as Yin-Cold. Liu Zongnong stated: Yin and Yang Xian are like infantile acute and chronic convulsions. Yang Xian arises not from vomiting or purging, but from Phlegm-Heat lodging between the Heart and Stomach, triggered by fright. (Old theories suggest fetal epilepsy, where maternal fright transmits to the fetus, manifesting later after a major fright combines with the transmitted fright energy, emptying the spirit's residence and allowing Phlegm to enter the Heart. Liu's theory is based on this.) If Heat is abundant, attacks occur even without fright, treated with cold medicines. Yin Xian also originates from Phlegm-Heat but transforms into Yin due to excessive cold-purgative treatment; it requires warm, neutral, stomach-tonifying, and phlegm-drying medicines. If distinguishing Yin and Yang is not due to pathological transformation, it refers to the depth and location (exterior/interior) of the Phlegm-Heat. Can Xian originally be Cold? According to the *Nan Jing*: If the pulse is in the Yin position (Cun/Guan/Chi at Chi level, or deep position) but shows Yang pulses (floating, slippery, large, rapid), it is Yang invading Yin (Yin deficiency allows Yang to invade, indicating fever). If the pulse is occasionally floating, slippery, and long, it is Yang hidden within Yin (though Yang pulses appear temporarily, they are less common than Yang invading Yin; however, this indicates Yang hidden in Yin, likely to manifest in summer). If the pulse is in the Yang position but shows Yin pulses (deep, choppy, short), it is Yin invading Yang (indicating aversion to cold). If the pulse is occasionally deep, choppy, and short, it is Yin hidden within Yang (likely to manifest in winter. Original text order is corrected here). "Double Yang results in Kuang, Double Yin results in Dian" means seeing Yang pulses everywhere indicates Double Yang; seeing Yin pulses everywhere indicates Double Yin. However, the *Nan Jing* also says: Dian begins with unhappiness, staring straight, and stiff collapse. (Dian involves only dementia, not staring/collapse; these are signs of Xian. The *Nan Jing* conflates Xian with Dian, hence the description.) Its pulse shows both Yin and Yang positions are abundant. Since both Yin and Yang are abundant, the statement "Double Yin results in Dian" cannot be rigidly applied.

Treatment for Kuang: The *Classic* advises withholding food, as food enters Yin and generates Yang. Use Sheng Tie Luo Yin (Raw Iron Filings Drink) or Bao Dan Wan (Gallbladder-Calming Pill). For Yang Ming excess, purge using Dang Gui Cheng Qi Tang (Angelica Sinensis and Rhubarb Decoction), followed by Huang Lian Jie Du Tang (Coptis Decoction for Relieving Toxicity). To induce vomiting for phlegm, use Gua Di San (Melon Sepal Powder); to purge phlegm, use Qing Xin Gun Tan Wan (Heart-Clearing Rolling Phlegm Pill). For chronic deficiency, use Ning Zhi Gao (Spirit-Calming Paste), Yi Zui Gao (One Intoxication Paste), or Ling Yuan Chen Sha San (Lingyuan Cinnabar Powder). This disease involves little sleep because Wei Qi does not enter Yin, leading to Yang excess and Yin deficiency, confusing the spirit. Inducing sleep allows Wei Qi to enter Yin, balancing Yang and Yin. The *Classic* states: Sadness moving internally injures Hun (Ethereal Soul, associated with Liver, Yang, active, ascending). Sadness suppresses, contrary to its nature, causing injury. Thus, Kuang should be treated by overcoming it with Joy. It also states: Unrestrained joy injures Po (Corporeal Soul, associated with Lung, Yin, static, descending), as joy causes Qi to float and overflow. Thus, Kuang should be overcome by Fear. Note: This refers only to emotional causes of Kuang; there are many other causes.

Treatment for Dian: Use Xing Xiang San (Star Fragrance Powder) plus Shi Chang Pu (Acorus Rhizome), Ren Shen (Ginseng Root), Zhu Li (Bamboo Sap), and Jiang Zhi (Ginger Juice), administered with Shou Xing Wan (Longevity Star Pill). Or induce vomiting to remove phlegm-saliva, then administer spirit-calming agents. For cases caused by fright, use Bao Dan Wan. For cases caused by overthinking, use Tian Men Dong Di Huang Gao (Asparagus and Rehmannia Paste) mixed with wine, taken frequently for effect. Yu Jin (Curcuma Tuber) 7 liang, Ming Fan (Alum) 3 liang, powdered, formed into pills with Bo He Zhi (Mint Juice), size of paulownia seeds. Take 50-60 pills with water. This best removes stagnant phlegm from Heart orifices. Sun Zhao treated a monk by making him eat salty food to induce thirst, then administered medicine mixed with wine, curing him. Asked about the method, he said: "Doctors can calm the spirit, but cannot make the confused spirit sleep. This is Ling Yuan Chen Sha San, which people fail to use correctly." If the pulse is fluctuating (large/small, present/absent), suddenly normal, then like bird-pecking, roof-leaking, distant wandering, or fish-swimming, this is considered demonic influence. Use Qin Chengzu's Ghost-Moxibustion method or needle Guigong and 12 other acupoints.

Treatment for Xian: Zhao Yi-de stated: Superficial Xian affects meridians, Qi blockage causes dizziness and collapse. Deep Xian affects Kidney, evil lingers in Yin, stagnation fills Yin, extreme stagnation triggers eruption. Minfire rises counterflow from below, blocking voice, producing sheep-like bleats. Saliva rushes to chest/mouth. Meridians and sinews cannot withstand the counterflow, causing sudden collapse and unconsciousness. Awakening occurs when fire dissipates. Untreated, it becomes chronic. The *Classic* states: Dian with downward Qi leakage or appearing like Kuang during attack is fatal. When evil enters Yin, Yin fills, blocks below, and counterflows above. Downward Qi leakage indicates Kidney Qi sinking, leading to death. Heart Yang cannot withstand Yin counterflow, leading to sudden Yang exhaustion, thus appearing like Kuang is also fatal. However, this is not absolute. Yin collapse shows no response at Chi pulse; Kuang-like state shows no response at Cun pulse. If both Cun and Chi are abundant, it indicates Excess in both Yin and Yang, not necessarily fatal. Preceded by fever, convulsions, crying, and shouting, with floating pulse indicates disease in Fu organs, Yang Xian, easy to treat. Preceded by cold body, no convulsions/crying, sudden onset, with deep pulse indicates disease in Zang organs, Yin Xian, difficult to treat. Long-standing cases produce livestock sounds: Dog-like bark indicates Liver; Sheep-like bleat indicates Heart; Cow-like moo indicates Spleen; Chicken-like crow indicates Lung; Pig-like grunt indicates Kidney. Treatment principle remains the same: primarily resolve phlegm. Remove phlegm-fluids using Nan Xing (Arisaema Rhizome), Ban Xia (Pinellia Tuber), Zhu Li (Bamboo Sap), Jiang Zhi (Ginger Juice), Gua Lou (Trichosanthes Fruit), Jiang Can (Bombyx Batryticatus), Tian Ma (Gastrodia Rhizome), Long Chi (Dragon Tooth), Shi Chang Pu (Acorus Rhizome), Yuan Zhi (Polygala Root), with a small amount of Fu Zi (Aconite Lateral Root). Add Chai Hu (Bupleurum Root) for dog-type, Huang Lian (Coptis Rhizome) for sheep-type, Bai Shao (White Peony Root) for cow-type, Huang Qin (Scutellaria Root) for chicken-type, Zhi Mu (Anemarrhena Rhizome) for pig-type. Severe phlegm requires emesis. Fast for one meal, next morning decoct Cha Zi (Tea Seeds), bind lower abdomen, drink to induce vomiting. For deficiency, tonify first, then purge. Select Miao Gong Wan, Miao Xiang San, Niu Huang Wan (Calculus Bovis Pill), or Yang Shi Wu Xian Wan. For daytime attacks, moxa Yang Qiao Mai; for nighttime attacks, moxa Yin Qiao Mai, as these vessels govern lower Jiao Qi. Moxa 14 moxa cones each. Before moxa for Xian, purgation is mandatory; otherwise, Qi blockage can be fatal. Attacks at dawn relate to Foot Shaoyang; morning to Foot Jueyin; noon to Foot Taiyang; dusk to Foot Taiyin; nightfall to Foot Yangming; midnight to Foot Shaoyin. Add guiding herbs. After recovery, add blood-nourishing and spirit-calming herbs to phlegm-clearing formulas. Pulse deficient and wiry indicates Fright; deep and rapid indicates Excess-Heat. Deficient patients should have slow, weak pulses; if rapid, solid, deep, small, or deficient and wiry/tense, prognosis is poor.