狂者。阳明邪热所发。有实无虚也。谵语。则虚实参半焉。郑声。则虚多而实
少矣。何以言之。阳明多气多血。邪又乘焉。则亢阳无制上乱神明。躁扰狂
越。不可名状。故为大实大热也。圣惠方。用大黄五两。醋炒微赤为散。以腊
雪水五升煎如膏。每服五匙。冷水下。盖取其骏快之性。定 乱以致太平。
非此不能。谵语者。亦属胃邪所致。然有热入血室。或蓄血停痰。郁结惊恐。
种种不一。则虚实参之。郑声者。止将一事一物。重复谆谆。乃因心有所寄。
情有所偏。兼以火邪。则虚多而实少矣。昔撄宁生治一人发狂。视人为鬼
其脉累累如薏苡子。且喘且抟。曰此得之阳明胃实。以三化汤三四下之
愈。此阳明发狂也。治一女患心疾。狂歌痛哭。裸裎詈骂。问之则瞪视默默。
脉沉坚而结。曰得之忧愤沉郁。食与痰交积胸中。涌之皆积痰裹血。复与
火剂清上膈。此兼郁痰而狂也。橘泉翁治吴检讨子。年十八。眩晕狂乱。医
以为中寒。已而四肢厥逆。欲自投火中。有欲用乌附回阳者。翁曰。此心脾
火盛。阳明内实。非热药可疗。以泻火解毒三剂得减。此兼火而狂也。汪石
山治一妇。三十余。忽病狂言。披发裸形。不知羞恶。其脉浮缓而濡。曰此必
忍饥或劳倦伤胃而然耳。经曰。二阳之病发心脾。二阳者胃与大肠也。忍
饥过劳。胃伤而火动矣。延及心脾。则心所藏之神。脾所藏之意。皆为扰乱。
失所根据归。安得不狂。此阳明虚也。法当补之。遂用独参汤加竹沥饮之痊。
此因内伤而狂也。壶仙翁治发狂谵语。歌笑不伦。手足厥逆。身冷而掌有
汗。两手脉沉滑有力。曰阳胜拒阴。火极而伏。反兼胜已之化。亢则害。承乃
制也。热胜血菀。故发狂谵语。火性炎上故歌笑不伦。阳极则反。故身冷厥
逆。泄其血则火除。抑其阳则神宁。乃用桃仁承气汤下血数升。益以黄连
竹沥石膏之剂。大汗而解。此兼血而狂也。要知狂为危候。医者到此。未便
措手。辄曰下之。岂知有如是变幻。吾故表而出之。丹溪治一少年。秋初热
病。口渴而妄语。两颧火赤。医作大热治。翁诊之。脉弱而迟。告曰此作劳后
病温。惟当服补剂自已。今六脉时见搏手。必凉药所致。竟以附子汤啜之。
应手而瘥。又治宪幕傅氏子。病妄语。时若有所见。翁切其脉。告曰。此病痰
也。然脉虚弦而沉数。盖得之当暑饮醉。又大惊。傅曰。然。尝夏因劳而甚渴。
恣饮梅水一二升。又连得惊数次。遂病。翁以治痰补虚之剂处之。浃旬愈。
此二症又谵妄之异者。并载附焉。
二化汤
浓朴（姜汁炒） 大黄 枳实（麸炒） 羌活（各三钱）
水煎服。
独参汤
人参（不拘多少分两随症）
拍破水煎服。
桃仁承气汤
桃仁 肉桂 甘草（各一钱） 大黄（二钱半） 芒硝（一钱半）
水煎服。
Mania (Kuang) is caused by pathogenic heat in the Yangming channel. It is an excess condition without deficiency. Delirium (Zhanyu), on the other hand, involves both excess and deficiency equally. Feeble speech (Zhengsheng) indicates that deficiency predominates over excess.
Why is this so? The Yangming channel is abundant in Qi and Blood. When pathogenic factors invade, they cause hyperactive Yang to lose restraint, disturbing the Spirit upwards, leading to restlessness, mania, and unruliness, which are indescribable. Thus, it represents a severe excess and heat condition. *Shenghui Fang* prescribes five liang of Dahuang (Rhubarb Root), stir-fried with vinegar until slightly red, then ground into powder. This is decocted with five sheng of snow water collected in the twelfth lunar month until it becomes a paste. Each dose consists of five spoons, taken with cold water. This utilizes its swift and potent nature to quell chaos and restore peace. Nothing else can achieve this effect.
Delirium also stems from stomach pathogenic factors. However, it may involve heat entering the Blood Chamber, or stagnation of blood and phlegm, as well as various causes such as depression, constraint, fright, and anxiety. These diverse scenarios result in a mix of excess and deficiency. Feeble speech merely involves repeating the same matter or object incessantly. This occurs because the Heart-Mind has a specific fixation and emotions are biased, compounded by fire pathogenic factors, resulting in predominant deficiency and slight excess.
In the past, Yingningsheng treated a patient suffering from mania who perceived people as ghosts. The pulse was continuous and hard like coix seeds, accompanied by asthma and forceful pulsation. He stated: "This originates from Yangming Stomach excess." It was cured after three or four administrations of Sanhua Tang (Three Transformations Decoction). This is mania arising from Yangming.
He also treated a female patient with heart disease who sang wildly, wept bitterly, stripped naked, and cursed others. When questioned, she would stare blankly and remain silent. Her pulse was deep, firm, and knotted. He stated: "This resulted from deep-seated worry and indignation, where food and phlegm accumulated together in the chest." After inducing vomiting, copious amounts of phlegm mixed with blood were expelled. Subsequently, cooling agents were used to clear the upper Jiao. This is mania complicated by constrained phlegm.
Juquan Weng treated the son of Investigator Wu, aged eighteen, who suffered from vertigo and maniacal confusion. Physicians diagnosed it as Cold invasion. Later, his limbs became cold and inverted, and he desired to throw himself into fire. Someone suggested using Wutou (Aconite Lateralis Radix Preparata) and Fuzi (Aconiti Lateralis Radix Preparata) to restore Yang. Juquan Weng said: "This is excessive Fire in the Heart and Spleen, with internal excess in Yangming. It cannot be treated with hot herbs." He prescribed formulas to purge Fire and detoxify. After three doses, symptoms subsided. This is mania complicated by Fire.
Wang Shishan treated a woman in her thirties who suddenly spoke madly, disheveled her hair, went naked, and showed no sense of shame or disgust. Her pulse was floating, moderate, and soggy. He said: "This must be due to enduring hunger or fatigue damaging the Stomach." The Classics state: "Diseases of the Two Yang (Stomach and Large Intestine) affect the Heart and Spleen." Enduring hunger and overwork damages the Stomach, causing Fire to flare up. This extends to the Heart and Spleen; thus, the Shen (Spirit) housed in the Heart and the Yi (Intellect) housed in the Spleen are disturbed, losing their foundation and return. How could one not become manic? This is deficiency in the Yangming channel. The treatment method should be tonification. He therefore used Dushen Tang (Single Ginseng Decoction) added with Zhuli (Bamboo Juice), and the patient recovered. This is mania caused by internal injury.
Huxian Weng treated a case of mania and delirium, with inappropriate singing and laughing, cold hands and feet, a cold body but sweaty palms. The pulses in both wrists were deep, slippery, and forceful. He stated: "Yang prevails and rejects Yin; extreme Fire hides and mimics the transformation of the prevailing factor. Hyperactivity causes harm, while subordination brings control." Heat dominance leads to blood stasis, causing mania and delirium. Fire nature flares upward, causing inappropriate laughter. Extreme Yang reverses, causing cold body and limb inversion. Draining the blood removes the Fire; suppressing Yang calms the Spirit. He used Taoren Chengqi Tang (Peach Kernel Decoction to Order the Qi) to evacuate several sheng of blood, supplemented with Huanglian (Coptidis Rhizoma), Zhuli (Bamboo Juice), and Shigao (Gypsum Fibrosum). The patient sweated profusely and recovered. This is mania complicated by blood stasis.
One must know that mania is a critical condition. Physicians often find themselves at a loss and hastily resort to purgatives, unaware of such complexities. Therefore, I have recorded these cases for clarification.
Danxi treated a young man in early autumn with a febrile disease, thirst, and delirious speech, with fiery red malar regions. Physicians treated it as severe heat. Danxi palpated the pulse, finding it weak and slow. He told them: "This is Warmth disease contracted after exertion. Only tonifying agents will allow natural recovery. The current pounding pulse in all six positions is likely caused by cold medicines." He ultimately administered Fuzi Tang (Aconite Decoction), and the patient recovered promptly.
He also treated the son of Official Fu, who suffered from delirious speech and visual hallucinations. Upon palpating the pulse, Danxi said: "This is a Phlegm disease. However, the pulse is deficient, wiry, deep, and rapid." He deduced it resulted from drinking alcohol during summer heat followed by severe fright. Mr. Fu confirmed: "Yes, in summer, due to labor-induced extreme thirst, I drank one or two sheng of plum water excessively, and suffered several shocks subsequently, leading to illness." Danxi prescribed formulas to resolve Phlegm and tonify deficiency. The patient recovered within ten days. These two cases represent different types of delirium and hallucination, recorded here together.
Sanhua Tang (Three Transformations Decoction)
Houpo (Magnolia Bark, stir-fried with ginger juice) 3 qian
Dahuang (Rhubarb Root) 3 qian
Zhishi (Immature Bitter Orange, bran-fried) 3 qian
Qianghuo (Notopterygium Rhizome) 3 qian
Decoct in water and take orally.
Dushen Tang (Single Ginseng Decoction)
Renshen (Ginseng Root)
Quantity varies according to the syndrome.
Crush and decoct in water; take orally.
Taoren Chengqi Tang (Peach Kernel Decoction to Order the Qi)
Taoren (Peach Seed) 1 qian
Rougui (Cinnamon Bark) 1 qian
Gancao (Licorice Root) 1 qian
Dahuang (Rhubarb Root) 2.5 qian
Mangxiao (Mirabilite) 1.5 qian
Decoct in water and take orally.