经义
邪入于阳则狂。○阴不胜其阳，则脉流薄疾，并乃狂。○血并于阴，气并于阳，故为惊狂。○帝曰∶足阳
明之脉，病甚则弃衣而走，登高而歌；或至不食数日，窬垣上屋，所上之处，皆非其素所能也。病反能者，何
也？岐伯曰∶四肢者，诸阳之本也。阳盛则四肢实，实则能登高也。帝曰∶其弃衣而走者，何也？岐伯曰∶热
盛于身，故弃衣欲走也。帝曰∶其妄言骂詈不避亲疏而歌者，何也？曰∶阳盛则使人妄言骂詈不避亲疏而歌也。
○帝曰∶有病怒狂者，此病安生？岐伯曰∶生于阳也。阳气者，因暴折而难决，故善怒也。病名曰阳厥。○帝
曰∶人生而有病癫疾者，病名曰何？安所得之？岐伯曰∶名为胎病。此得之在母腹中时，其母有所大惊，气上
而不下，精气并居，故令子发为癫疾也。（《素问》）
重阳者狂，重阴者癫。○狂癫之病，何以别之？曰∶狂之始发，少卧不饥，自高贤也，自辨智也，自贵倨也，
妄笑，好歌乐，妄行不休是也。癫疾始发，意不乐，僵卧直视，其脉三部俱盛是也。（《难经》）
哲言
阴气衰者为癫，阳气衰者为狂。（《金匮》）
《素问》言癫狂而不及痫，《灵枢》乃有痫 、痫厥之名，诸书有言癫狂者，有言癫痫者，有言风痫者，
有言惊痫者，有分
癫痫为二门者，迄无定论。要之癫痫狂大相径庭，非名殊而实一之谓也。《灵枢》虽编癫狂为一门，而形证两
具，取治异途，较之于痫，又大不侔矣。徐嗣伯云∶大人曰癫，小儿曰痫。亦不然也。《素问》谓癫为母腹中
受惊所致，今乃曰小儿无癫可乎？痫病大人每每有之，妇人尤多。今据经文分辨于后∶癫者，或歌、或笑、或
悲、或泣，如醉如痴，言语有头无尾，秽洁不知，积年累月不愈，俗呼心风，此志愿高硕而不遂所欲者多有之。
狂者，病发猖狂刚暴，如伤寒阳明实，发狂骂詈，不避亲疏，甚则登高而歌，弃衣而走，窬垣上屋，或与人语
所未尝见之事，如有邪祟根据附者是也。痫病，发则昏不知人，眩仆倒地，甚则螈 抽掣，目睛上视，或口眼
斜，或口作六畜之声是也。（《证治准绳》）
癫、狂二证，皆由情志过度，则气伤而火壅，热甚而风生，风火相搏，痰涎胶固，粘着膻中，则昏迷而丧
其神守。故癫、狂皆属火炽痰壅，但有缓急之分耳。
癫、狂病本不同∶狂病之来，狂妄以渐，而经久难已；癫病之至，忽然僵仆，而时作时止。狂病常醒，多
怒而暴；癫病常昏，多倦而静。由此观之，则其阴阳寒热，自有冰炭之异。《难经》曰∶重阳者狂，重阴者癫。
义可知矣。后世诸家，有谓癫狂大概是热，此未必然，其间形气脉气自有可据，须辨察阴阳而分治之。（张景岳）
癫多喜笑，尚知畏惧，证属不足；狂多忿怒，人莫能制，证属有余。此病多因惊忧，痰血塞于心窍所致。（朱丹溪）
癫，有时人不之觉，是癫之轻也；狂有时人不及防，是狂之骤也。癫病，痰火一时忽动，阴阳相争，亦若
狂之状；狂病，痰火经久煎熬，神魂迷瞀，亦兼癫之状。（《见闻录》）
疑病为痴，口如木而不能言为呆，人事颠倒为癫，三病相似。痴，脾病；呆，肝病；癫，肾病。三者胥兼
心。○癫狂皆痰病也。癫因寒为虚，狂因火为实。癫病责心肾，狂病责肝胃。○有故而倒曰
惊，无故而倒曰痫，皆螈 也。痫虚而惊实。（《医参》）
痫疾者，风痰之故也。风者，阳气也。《经》曰∶阳之气，以天地之疾风名之，故其发也暴。所以令人仆
地者，厥气并于上，上实下虚，清浊倒置，故令人仆地，闷乱无知。浊邪干于心脏，而神明壅闭也。舌者心之
苗，而脾之经络连于舌本，阳明之经络入于上下齿缝中，故风邪实于心脾，则舌自挺，风邪实于阳明，则口自
噤，一挺一噤，故令嚼舌吐沫者，风热盛于内也。此风来潮汹之象，背反张目上视者，风在太阳经也。足太阳
之经，起于睛明，挟脊而下，风邪干之，则实而劲急，故目上视而背反张也。手足搐溺者，风属木，肝主筋，
风热盛于肝，则一身之筋挚，故令人手足搐溺也。搐者，四肢屈曲之名。搦者，十指开握之义也。或作六畜声
者，风痰鼓其气窍而声自变也，譬之弄笛，六孔闭塞不同，而宫商别异是也。（吴鹤皋）
病痫者，涎沫出于口，冷汗出于身，清涕出于鼻，皆阳跷、阴跷、督、冲四脉之邪上行为病也。此奇邪为
病，不系五行、阴阳、十二经所拘，当从督、冲、二跷四穴奇邪之法治之。（李东垣）
痫与痉，略同而实异。发时身软，时醒者，谓之痫；身体强直，反张如弓，不时醒者，谓之痉。痫病随其
痰之潮作，故有时而醒；痉比痫为甚而多挟虚，故常昏冒而亡者多矣。（刘宗浓）
论治
狂病多因于火，或谋为失志，或思虑郁结，屈无所伸，怒无所泄，以致肝胆气逆，木火合邪，是诚东方之
实证也。邪乘于心，则为神魂不守；邪乘于胃，则为暴横刚强。故当以治火为先，或痰或气，察其微甚而兼治
之。○癫病多由痰、气，凡气有所逆，痰有所滞，皆能壅闭经络，格塞心窍，故发则旋晕僵仆，口眼相引，目
睛上视，手足搐搦，腰脊强直，食顷乃苏。此其倏病倏已者，正由气之倏逆倏顺也。故当察痰察气，因其甚者
而先之。至若火之有无，当审脉证而兼治之。○痫证无火者多，且复有阴盛
阳衰，及气血暴脱，而绝无痰火气逆者。则凡四君、四物、八珍、十全等汤，或干姜、桂、附之类，皆所必用，
不得谓癫痫尽属实邪而概禁补剂也。若真阴大损，气不归根，而时发难愈者，必用河车丸，方可奏效。（张景岳）
天地一阴阳也，阴阳和则天清地凝，一有偏胜，遂有非常之变。人身亦一阴阳也，阴阳和则神清志定，一
有偏胜，则有不测之 。故《经》曰∶重阳者狂，重阴者癫。痫与癫其原则同也。古人集癫、痫、狂，辨以为
阳并于阴，阴并于阳。言乎见证∶狂则少卧不饥，妄言妄笑，甚则上屋窬垣，其候多躁而常醒；癫则或歌或哭，
如醉如痴，甚至不知秽洁，其候多静而常昏；痫则发作无时，卒然昏仆，筋脉螈 ，口中作声，其候经时必止。
推其病因∶狂由大惊大怒，病在肝、胆、胃经，三阳并而上升，故火炽则痰涌，心窍为之闭塞；癫由积忧积郁，
病在心、脾、包络，三阴蔽而不宣，故气郁则痰迷，神志为之混淆；痫病或由惊恐，或由饮食不节，或由母腹
中受惊，以致五内不平，经久失调，一触积痰，厥气内风，猝焉暴逆，莫能禁止，待其气反然后已。至于主治，
察形证，诊脉候，以辨虚实。狂之实者，以承气、白虎直折阳明之火，生铁落饮重制肝胆之邪；虚者，当壮水
以制火，二阴煎之类。癫之实者，以滚痰丸开痰壅闭，清心丸泄火郁勃；虚者，养神而通志，归脾、枕中之类。
痫之实者，用五痫丸以攻风，控涎丸以劫痰，龙荟丸以泻火；虚者，当补助气血，调摄阴阳，养营汤、河车丸
之类。三证治法，大旨不越乎此。他如肝风痰火者，则苦辛开泄；神虚火炎者，则清补并施；肝胆厥阳，化
风旋逆者，以极苦之药折之；神志两虚者，用交通心肾法；劳神太过者，宗静以生阴意，为敛补镇摄。医者惟
调理其阴阳，不使有所偏胜，则郁逆自消，而神气得反其常矣。（《临证指南》）
《经》云∶悲哀动中则伤魂，魂伤则狂妄不精，不精则不正。此悲哀伤魂而狂，当用温药补魂之伤，
《本事》惊气丸之类是也。
喜乐无极则伤魄，魄伤则狂，狂者意不存人。此喜乐伤魄而狂，当用凉药补魄之阴，辰砂、郁金、白矾之类是也。（娄全善）
五志之火，郁而成痰，为癫为狂，宜以人事制之。如喜伤心者，以怒解之，以恐胜之；忧伤肺者，以喜胜
之，以怒解之。（《证治准绳》）
狂病久而不愈，宜分治之。定志膏、一醉膏、辰砂散。盖狂病少卧，卫气行阳而不行阴，故阳盛阴虚，令
昏其神，使之得睡，则卫气得入于阴，阴得卫填则不虚，阳无卫助则不盛，故阴阳和而愈矣。（《医学六要》）
癫证等方，总不若用六君加减，以治痰之本；用六味丸不加减，以治肾水不足之源，为治癫之秘法。（方星岩）
《经》云∶癫疾呕多涎沫，气下泄者不治，发如狂者不治。气下泄不治者，癫本由邪入于阴，阴气闭塞
于下而奔逆于上，今气下泄，将见肾气虚脱故也。发如狂不治者，由心之阳不胜其阴气之逆，神明散乱，阳气
暴绝，犹灯将灭而复明也。（赵以德）
痫证往往生于郁闷之人，多缘病后本虚，或复感六淫，气虚痰积之故。盖以肾水本虚，不能制火，火气上
乘，痰壅脏腑，经脉闭遏，故卒然倒仆，手足搐搦，口目牵掣，乃热盛生风之候。虽分五痫，要以补肾为本，
豁痰为标，随经见证用药。（张石顽）
《千金方》云∶病先身热，掣 惊啼叫唤，而后发痫，脉浮者，为阳痫，病在六腑，犹易治也；病先身
冷，不惊掣，不啼呼，而病时发，脉沉者，为阴痫，病在五脏，为难治也。刘宗浓谓此论痫之阴阳，后世有认
为寒热者，误也。盖此疾皆以痰热所作而得，在表而浅为阳，故云易治；入里而深为阴，故曰难治。乃表里浅
深之谓，非寒热之谓也。（《赤水玄珠》）
痫证日久，宜以归脾汤扶其气血，六味丸治其龙雷之火。治痫之源，无出于此。（《伤寒百问》）
病笑不休，用盐 赤，研，入河水煎沸，啜之，探吐热痰数升即
愈。《素问》曰∶神有余则笑不休。神，心火也，火得风则焰，笑之象也。一妇病此半年，张子和用此方治愈。（《同寿录》）
脉候
帝曰∶癫疾何如？岐伯曰∶脉搏大滑，久自已；脉小坚急，死不治。帝曰∶癫疾之脉，虚实何如？岐伯曰∶
虚则可治，实则死。○心脉满大，痫螈筋挛。○肝脉小急，痫螈筋挛。○二阴急为痫厥。○搏阳为癫疾。（《素问》）
心脉缓甚为狂笑，微涩为癫疾。○肺脉急甚为癫疾。○肾脉急甚为骨癫疾。（《灵枢》）
《素问》通评虚实论∶癫疾，脉搏大滑，久自己，脉小坚急，死不治。按此癫疾之“癫”字，当是“狂”
字。脉搏大滑，阳病得阳脉，故自愈；脉小坚急，阳病得阴脉，故死。观下文即言癫疾之脉，虚则可治，实则
死。狂与癫证别阴阳，合勘益审。（《医参》）
选案
某姓少妇病狂四载，延余至，病者卧床上，甫就诊，突被反手相掣，口出妄言。出谓其夫曰∶脉虽未得，
而劫夺之际，已领料其病情。讯其目珠之赤，盖已三年。每发不必有因，唯自禁食，登高歌哭，厉声叫喊，昼
夜无眠，人莫能制，诸药罔效。其发一月、十日不一，已则如平人，惟食饮逾常，潮信愆期耳。为用大陷胸方，
大黄一两，芒硝、甘遂各三钱，加甘草钱许，服剂须臾，吐泻交作，次日犹能起居。然静而可诊，两脉皆坚锐
而数，按有胃气，因忆《内经》无过犯之旨，易以小剂，调胃承气继之。再泻十余行，口渴思饮，进稀粥碗余，
熟睡一昼夜，起坐不支，然后以开窍利痰兼安抚药调养月余，最后以补心丸、归脾丸间用，两月寻愈。询其前
事，如梦初觉。（曹恒占）
西园令弟陶士，狂证屡作，人莫能制，药不肯饮。予因其爱酒，用新葫芦一枚，去瓤，入浓酒盏许，封固，
外加面裹，水中煮
透，倒出露一宵，饮之大吐，病去如失。（程华仲）
一人得心病，状似癫狂，彻夜不寐，服药旬日，有用加味逍遥散者，有用补心丹者，有作痰治用胆星者，
有作火治用黄连者，皆不效。诊脉弦大，重按无力，唇红面赤。予曰∶脉大无力，非实火也。病由用心过度，
心火上浮，不能下交于肾，肾水下虚，不能上交于心。法当交通心肾，用八仙长寿丸，辰砂为衣，早晚各服三
钱，纳心火于肾水之中，以成既济之象。凡治心肾不交之病，每用六味加辰砂为衣，效者甚多。（许宣治）
相国寺僧患癫疾半年，医皆不效，召孙兆疗之。孙曰∶但有咸物，尽与食之，待渴可来取药，今夜睡着，
明日便愈。至夜，僧果渴，与酒一角，调药一服与之，再索，又与半角，遂睡两昼夜乃觉，人事如故。僧谢问
其治法，曰∶众人用药，能安神矣，而不能使其神昏得睡，此乃《灵苑方》中朱砂酸枣仁乳香散也，但人不识
用耳。（《证治准绳》）
一妇因心事拂郁，遂得心疾，半年服药不效。诊脉沉涩，左手更微，断为血虚之证。《经》曰∶心藏神，
肝藏魂，心血虚则神不得藏，肝血虚则魂无所归，是以神魂不定，语言无序，或啼或笑。然言语轻微，证属不
足，非若狂证之属有余也。且脉涩无力，血虚而气亦虚。夫有形之血，必藉无形之气以生，则补血尤须补气，
遂用归脾汤。初二剂加天竺黄分许，微化其痰之标。服后，前证不发，并制丸药调理而痊。（吴天士）
附方
熏鼻法 治癫狂最佳，亦治产后血晕。用炉贮炭火，时时沃醋，以熏其鼻。
又方 治痰迷心窍癫狂。用 树根皮焙干研末，每服二钱，鲜菖蒲煎水调下，吐泻痰涎即愈。
[Classical Discourses]
When pathogenic factors enter the Yang aspect, mania (Kuang) ensues. ○ When Yin cannot control Yang, the pulse flow becomes rapid and forceful, leading to mania. ○ When blood congregates in the Yin aspect and Qi congregates in the Yang aspect,惊狂 (Jing Kuang, startled mania) occurs. ○ The Yellow Emperor asked: In diseases of the Foot-Yangming Meridian, when severe, patients may discard their clothes and run, climb high and sing; or go several days without eating, leap over walls and roofs, going to places they could never reach before. Why can they perform these actions contrary to their usual capabilities? Qibo replied: The four limbs are the root of all Yang meridians. When Yang is excessive, the four limbs become solid and strong, enabling one to climb high. The Yellow Emperor asked: What causes those who discard clothes and run? Qibo said: Excessive heat in the body causes them to discard clothes and wish to run. The Yellow Emperor asked: What causes those who speak nonsense, curse, and sing regardless of kinship or distance? The answer is: Excessive Yang causes people to speak nonsense, curse, and sing regardless of relationships. ○ The Yellow Emperor asked: Some suffer from anger-induced mania; how does this disease arise? Qibo said: It arises from the Yang aspect. Yang Qi, due to sudden frustration and inability to resolve, leads to frequent anger. This disease is named Yang Jue (Yang Reversal). ○ The Yellow Emperor asked: Some are born with epilepsy (Dian Ji); what is its name and origin? Qibo said: It is called Tai Bing (Fetal Disease). This originates when the mother suffers a great fright while in the womb; Qi rises but does not descend, and Jing Essence and Qi congregate, causing the child to develop epilepsy. (Su Wen)
Excess Yang leads to mania; excess Yin leads to epilepsy (Dian). ○ How to distinguish between mania and epilepsy? Answer: At the onset of mania, there is little sleep, no hunger, self-perception of being virtuous, wise, and noble, unprovoked laughter, love for singing and music, and continuous erratic behavior. At the onset of epilepsy, there is mental distress, rigid lying down, fixed staring, and a surging pulse in all three positions (Cun, Guan, Chi). (Nan Jing)
[Philosophical Remarks]
Deficiency of Yin leads to epilepsy; deficiency of Yang leads to mania. (Jin Gui Yao Lue)
Su Wen discusses Dian and Kuang but does not mention Xian (epileptic seizures). Ling Shu introduces terms like Xian and Xian Jue. Various texts discuss Dian-Kuang, Dian-Xian, Feng Xian (Wind Epilepsy), and Jing Xian (Startled Epilepsy), some dividing Dian and Xian into two categories, yet no consensus exists. Essentially, Dian, Xian, and Kuang are vastly different, not merely different names for the same reality. Although Ling Shu groups Dian and Kuang together, their symptoms and treatments differ significantly, and both differ greatly from Xian. Xu Sibai stated: Adults have Dian, children have Xian. This is incorrect. Su Wen states Dian results from fetal fright; can it be said children do not have Dian? Xian is common in adults, especially women. Based on classical texts, we distinguish as follows: Dian involves singing, laughing, crying, behaving drunk or foolish, speaking incompletely, lacking hygiene awareness, persisting for years, commonly called Xin Feng (Heart Wind), often seen in those with high aspirations unfulfilled. Kuang involves violent, reckless behavior, similar to Yangming excess in Cold Damage, cursing indiscriminately, climbing roofs, discarding clothes, discussing unseen events as if possessed by spirits. Xian involves sudden loss of consciousness, fainting, convulsions, upward gaze, facial deviation, or sounds resembling livestock. (Zheng Zhi Zhun Sheng)
Both Dian and Kuang result from emotional excess damaging Qi and obstructing Fire, leading to extreme heat generating Wind. Wind and Fire clash, phlegm-drool becomes sticky and adheres to Dan Zhong (Pericardium), causing coma and loss of spiritual guardianship. Thus, both belong to blazing Fire and obstructing Phlegm, differing only in severity.
The nature of Dian and Kuang differs: Kuang develops gradually and persists; Dian strikes suddenly with rigidity and comes and goes. Kuang patients are usually awake, angry, and violent; Dian patients are usually drowsy, tired, and quiet. Thus, their Yin/Yang and Cold/Heat natures are as distinct as ice and charcoal. Nan Jing states: Excess Yang is Kuang, excess Yin is Dian. This clarifies the principle. Later physicians claimed Dian/Kuang are mostly Heat, which is not always true; one must examine form, Qi, and pulse to differentiate Yin/Yang and treat accordingly. (Zhang Jingyue)
Dian often involves laughter and fear, indicating Deficiency; Kuang often involves anger and uncontrollability, indicating Excess. These diseases often stem from fright/worry causing Phlegm and Blood stasis blocking the Heart orifices. (Zhu Danxi)
Dian may go unnoticed by others, indicating mildness; Kuang may catch others off guard, indicating suddenness. Dian can resemble Kuang when Phlegm-Fire flares and Yin/Yang struggle; Kuang can resemble Dian when Phlegm-Fire lingers and confuses the Spirit. (Jian Wen Lu)
Obsessive doubt is Chi (Folly); mute rigidity is Dai (Stupor); chaotic behavior is Dian. These three are similar. Chi relates to Spleen; Dai to Liver; Dian to Kidney. All involve the Heart. ○ Dian and Kuang are Phlegm diseases. Dian is Cold/Deficiency; Kuang is Fire/Excess. Dian concerns Heart/Kidney; Kuang concerns Liver/Stomach. ○ Falling with cause is Jing (Startle); falling without cause is Xian (Epilepsy), both involving convulsions. Xian is Deficiency; Jing is Excess. (Yi Can)
Xian disease is caused by Wind-Phlegm. Wind is Yang Qi. Classics state Yang Qi is named after swift wind, hence its sudden onset. Fainting occurs because Jue Qi gathers above, creating upper excess and lower deficiency, confusing clear/turbid energies, disturbing the Heart Mind. Tongue is the sprout of the Heart; Spleen meridians connect to the tongue base; Yangming meridians enter teeth gaps. Wind-Phlegm affecting Heart/Spleen causes tongue protrusion; affecting Yangming causes jaw clenching. Protrusion and clenching lead to biting tongue and foaming, indicating internal Wind-Heat. Back arching and upward gaze indicate Wind in the Taiyang Meridian. Foot-Taiyang starts at Jingming, runs along the spine; Wind invasion makes it tight, causing back arching. Hand-foot spasms occur because Wind belongs to Wood, Liver governs sinews; Wind-Heat in Liver causes whole-body spasm. "Chu" refers to limb flexion; "Nuo" refers to finger opening/closing. Livestock sounds arise from Wind-Phlegm altering air passages, like varying flute holes changing pitch. (Wu Hegao)
In Xian, saliva exits the mouth, cold sweat the body, clear mucus the nose, due to pathogenic factors in Yang Qiao, Yin Qiao, Du, and Chong meridians ascending. This odd-pathogen disease is not bound by Five Elements, Yin/Yang, or Twelve Meridians; treat via odd-pathogen methods of Du, Chong, and two Qiao points. (Li Dongyuan)
Xian and Jing (Spasm) are similar but distinct. Xian features soft body and intermittent consciousness; Jing features rigid body, opisthotonos, and persistent unconsciousness. Xian wakes as Phlegm subsides; Jing is more severe, often deficient, leading to frequent death. (Liu Zongnong)
[Treatment Principles]
Kuang is mostly due to Fire, arising from frustrated ambitions or depressed thoughts, causing Liver/Gallbladder Qi reversal and Wood-Fire combination (Eastern Excess). Pathogens attacking the Heart disturb Shen; attacking the Stomach cause violence. Treat Fire first, addressing Phlegm/Qi based on severity. ○ Dian is mostly due to Phlegm/Qi. Qi reversal and Phlegm stagnation block meridians and Heart orifices, causing dizziness, collapse, eye deviation, spasms, and stiffness, resolving quickly as Qi normalizes. Treat Phlegm/Qi primarily; assess Fire presence via pulse/symptoms. ○ Many Xian cases lack Fire, featuring Yin excess/Yang deficiency or sudden Qi/Blood depletion without Phlegm-Fire. Si Jun Zi Tang, Si Wu Tang, Ba Zhen Tang, Shi Quan Da Bu Tang, Gan Jiang, Gui Zhi, Fu Zi are essential. Do not forbid tonics assuming all Dian/Xian are Excess. For severe True Yin damage with floating Qi, He Che Wan is required. (Zhang Jingyue)
Heaven and Earth are Yin/Yang; harmony brings clarity, imbalance brings disaster. Humans are Yin/Yang; harmony brings calm spirit, imbalance brings unpredictable illness. Classics: Excess Yang is Kuang, excess Yin is Dian. Xian and Dian share principles. Ancient texts analyzed them as Yang merging into Yin, Yin into Yang. Symptoms: Kuang has little sleep, no hunger, nonsense, climbing, restlessness, wakefulness; Dian has singing/crying, drunkenness, ignorance of hygiene, quietness, drowsiness; Xian has unpredictable onset, sudden collapse, spasms, sounds, temporary duration. Etiology: Kuang from shock/anger, affecting Liver/Gallbladder/Stomach (Three Yang rising), Fire blazing, Phlegm surging, blocking Heart orifices; Dian from chronic worry/depression, affecting Heart/Spleen/Pericardium (Three Yin blocked), Qi stagnating, Phlegm confusing, mixing Shen/Zhi; Xian from fright, diet irregularity, or fetal shock, causing internal imbalance, triggering accumulated Phlegm and internal Wind/Jue Qi. Treatment: Assess form/pulse for Deficiency/Excess. Kuang Excess: Cheng Qi Tang, Bai Hu Tang to drain Yangming Fire; Sheng Tie Luo Yin to suppress Liver/Gallbladder pathogens. Kuang Deficiency: Nourish Water to control Fire, e.g., Er Yin Jian. Dian Excess: Gun Tan Wan to open Phlegm obstruction; Qing Xin Wan to drain Fire. Dian Deficiency: Nourish Shen, e.g., Gui Pi Tang, Zhen Zhong Dan. Xian Excess: Wu Xian Wan to attack Wind; Kong Yan Wan to seize Phlegm; Long Hui Wan to drain Fire. Xian Deficiency: Tonify Qi/Blood, regulate Yin/Yang, e.g., Yang Ying Tang, He Che Wan. General principles apply. Other methods: Bitter/Pungent for Liver-Wind/Phlegm-Fire; Clear/Tonify for Shen-Deficiency/Fire-Flaring; Bitter drugs for Liver-Gallbladder Jue-Yang/Wind; Heart-Kidney intersection for Shen-Zhi Deficiency; Quietude for mental exhaustion. Regulate Yin/Yang to eliminate depression/reversal and restore normal Shen-Qi. (Lin Zheng Zhi Nan)
Classics: Grief damages Hun; Hun damage causes madness. Use warm herbs to tonify Hun, e.g., Jing Qi Wan. (Ben Shi Fang)
Unrestrained joy damages Po; Po damage causes madness (ignoring others). Use cool herbs to tonify Po-Yin, e.g., Chen Sha, Yu Jin, Bai Fan. (Lou Quanshan)
Fire from Five Emotions condenses into Phlegm, causing Dian/Kuang. Resolve via human interactions: Joy harms Heart, resolve with Anger/Fear; Worry harms Lung, resolve with Joy/Anger. (Zheng Zhi Zhun Sheng)
Chronic Kuang requires differentiation. Ding Zhi Gao, Yi Zui Gao, Chen Sha San. Kuang patients sleep little because Wei Qi moves in Yang but not Yin, causing Yang excess/Yin deficiency. Inducing sleep allows Wei Qi to enter Yin, balancing Yin/Yang. (Yi Xue Liu Yao)
For Dian, Liu Jun Zi Tang variations treat Phlegm root; Liu Wei Di Huang Wan treats Kidney Water deficiency source. This is a secret method for Dian. (Fang Xingyan)
Classics: Dian with vomiting/phlegm and downward Qi leakage is untreatable; Dian presenting as Kuang is untreatable. Downward leakage indicates Kidney Qi collapse from Yin obstruction reversing upward. Presenting as Kuang indicates Heart Yang failing against Yin reversal, Shen scattering, Yang abruptly perishing (like a flickering lamp). (Zhao Yi De)
Xian often affects depressed individuals, stemming from post-illness deficiency or Six Evils invasion, causing Qi deficiency and Phlegm accumulation. Kidney Water deficiency fails to control Fire; Fire ascends, Phlegm obstructs organs/meridians, causing sudden collapse and spasms (Heat generating Wind). Though classified as Five Xian, tonifying Kidney is root, resolving Phlegm is branch, treating according to meridian/symptoms. (Zhang Shiwen)
Qian Jin Fang: Onset with fever, spasms, crying, floating pulse = Yang Xian (Six Fu, easier). Onset with cold body, no spasms/crying, sinking pulse = Yin Xian (Five Zang, harder). Liu Zongnong notes this refers to depth (superficial/internal), not Cold/Heat. Both stem from Phlegm-Heat; superficial is Yang/easy; deep is Yin/hard. (Chi Shui Xuan Zhu)
Chronic Xian: Gui Pi Tang to support Qi/Blood; Liu Wei Di Huang Wan to control Dragon/Fire. This addresses the root of Xian. (Shang Han Bai Wen)
Constant laughter: Roasted salt and red adzuki beans, powdered, boiled in river water, drunk, inducing vomiting of hot Phlegm cures. Su Wen: Excess Shen causes constant laughter. Shen is Heart Fire; Fire with wind flares, symbolizing laughter. Zhang Zihe cured a woman with this. (Tong Shou Lu)
[Pulse Diagnosis]
Yellow Emperor: How is Dian Ji diagnosed? Qibo: Large, slippery pulse resolves slowly; small, firm, rapid pulse indicates death/untreatable. Pulse Deficiency is treatable; Excess is fatal. ○ Full-large Heart pulse: Xian with spasms. ○ Small-rapid Liver pulse: Xian with spasms. ○ Rapid Two Yin pulses: Xian Jue. ○ Beating Yang: Dian Ji. (Su Wen)
Very slow Heart pulse: Manic laughter; slightly choppy: Dian Ji. ○ Very rapid Lung pulse: Dian Ji. ○ Very rapid Kidney pulse: Bone Dian Ji. (Ling Shu)
Su Wen Tong Ping Xu Shi Lun: Dian Ji, large-slippery pulse resolves; small-firm-rapid pulse indicates death. Note: "Dian" here likely means "Kuang". Large-slippery (Yang pulse for Yang disease) resolves; small-firm-rapid (Yin pulse for Yang disease) indicates death. Subsequent text confirms Dian pulse: Deficiency treatable, Excess fatal. Distinguishing Kuang/Dian by Yin/Yang clarifies this. (Yi Can)
[Selected Cases]
A young woman had Kuang for four years. Upon examination, she grabbed me violently and spoke nonsense. I told her husband: Though pulse was not taken, her violent action revealed the condition. Her eyes were red for three years. Attacks were spontaneous, involving fasting, climbing, singing/crying, shouting, insomnia, uncontrollable, resistant to meds. Attacks varied monthly/ten-day intervals; between attacks, she was normal except for increased appetite and delayed menstruation. Prescribed Da Xian Xiong Fang: Da Huang 1 liang, Mang Xiao & Gan Sui 3 qian each, plus Gan Cao. Vomiting/diarrhea ensued; next day she could move. Pulse was firm/rapid/stomach Qi present. Switched to Xiao Ji (small dose) Tiao Wei Cheng Qi Tang. After 10+ purgations, thirst arose, consumed porridge, slept deeply. Recovered after month-long phlegm-resolving/calming therapy, followed by Bu Xin Wan and Gui Pi Wan alternating. Cured in two months. (Cao Hanzhan)
Brother of Xi Yuan magistrate, Tao Shi, recurrent Kuang, uncontrollable, refused meds. Knowing he loved wine, used fresh gourd, hollowed, filled with strong wine, sealed, dough-wrapped, boiled, exposed overnight. He drank it, vomited heavily, cured. (Cheng Huazhong)
Man with Heart disease, resembling Dian/Kuang, insomnia for 10 days. Tried Jia Wei Xiao Yao San, Bu Xin Dan, Dan Nan Xing (Phlegm), Huang Lian (Fire), all failed. Pulse string-large, weak on heavy press; red lips/cheeks. Said: Large-weak pulse is not Excess Fire. Cause: Overuse of mind, Heart Fire floats up, fails to descend to Kidney; Kidney Water deficients, fails to ascend to Heart. Treat Heart-Kidney non-interaction with Ba Xian Chang Shou Wan, Chen Sha coating, 3 qian morning/evening. Guides Heart Fire into Kidney Water, achieving Ji Ji (Intersection). Liu Wei Di Huang Wan + Chen Sha effective for this. (Xu Xuanzhi)
Monk at Xiang Guo Temple had Dian for half year, doctors failed. Sun Zhao treated: Eat salty foods until thirsty, then take medicine. Sleep tonight, cure tomorrow. Monk got thirsty, given wine cup + medicine, then another half cup, slept 2 days, recovered fully. Asked method: Others calm Shen but don't induce deep sleep. Used Zhu Sha, Suan Zao Ren, Ru Xiang powder from Ling Yuan Fang. (Zheng Zhi Zhun Sheng)
Woman with郁 (depression) developed Heart disease, half year meds failed. Pulse deep-choppy, left weaker. Diagnosed Blood Deficiency. Classics: Heart stores Shen, Liver stores Hun. Heart Blood deficiency loses Shen; Liver Blood deficiency loses Hun. Shen/Hun unsettled, speech disordered, crying/laughing. Speech gentle indicates Deficiency, unlike Kuang Excess. Choppy-weak pulse indicates Qi/Blood deficiency. Formative Blood needs Non-formative Qi to generate; tonify Qi to tonify Blood. Used Gui Pi Tang. First 2 doses + Tian Zhu Huang to resolve Phlegm branch. Symptoms ceased, cured with pills. (Wu Tianshi)
[Attached Formulas]
Nasal Fumigation Method: Best for Dian/Kuang, also for postpartum blood fainting. Charcoal in furnace, pour vinegar periodically, fumigate nose.
Another Method: For Phlegm confusing Heart orifices (Dian/Kuang). Dry and powder Chuan Pi (Bark of Toona sinensis), 2 qian per dose, mixed with fresh Shi Pu decoction. Vomiting/diarrhea of Phlegm cures.