Library

A man fell from a horse and subsequently went mad. Upon rising, his eyes were wide open, he spoke deliriously without recognizing relatives or strangers. He stripped off his clothes and ran about, cursing incessantly, with doubled strength, such that three or five people could not restrain him. Burning talismans and performing rituals were useless; Niuhuang (Calculus Bovis), Bingpian (Borneolum Syntheticum), and Shexiang (Moschus) were ineffective. He then sought treatment from Dairen (Zhang Hezi). Dairen buried a cart axle in the ground to a height of approximately two chi. A medium-sized wheel was placed on top. A hole was carved into the rim of the wheel, shaped like a basin. The mad patient was bound onto it, lying prone, cushioned with soft material. Another person sat below on a mechanism and stirred it with a rod, rotating the wheel thousands of times. The patient vomited one to two dou of greenish-yellow phlegm and saliva, which circulated around the wheel several times. The patient said, "I cannot endure this; please unbind me." They complied. He requested cool water, and after drinking several sheng of ice water, the madness ceased.

Hua Borén treated a monk who suffered from manic delirium, perceiving everyone as ghosts. His pulse was clustered like coix seeds, accompanied by wheezing and forceful pulsation. Hua stated, "This is caused by Yangming Stomach excess syndrome. As stated in *Suwen*: 'The Yangming governs the flesh; when blood and qi in its meridians are excessively abundant, it leads to discarding clothes, climbing high, scaling walls, and cursing recklessly.'" He prescribed Sanhua Tang (Three Transformations Decoction) for purgation three or four times, followed by Huoji (Fire Agent, likely a warming purgative), resulting in recovery.

Cangzhou treated a man whose fear caused "startle qi" to enter the Heart. He ran continuously throughout the day, disregarding fire and water. When speaking to others, he boasted of his own worth and nobility, alternating between crying and laughing. Palpation revealed wiry and slippery pulses in the upper positions, with the left side stronger than the right. This indicated overflow into Danzhong (Conception Vessel point CV17) and flooding into Xinbao (Pericardium), where wind pathogen invaded the five zang organs due to startle. He immediately administered an emetic, expelling a vessel of phlegm and saliva. Subsequently, he slowly administered Jingqi Wan (Startle Qi Pill). After completing one dose, the illness resolved.

[Appendix] Cangzhou also treated a man lodging in a monastery who suffered from mania. His pulses in all three positions were wiry, straight, and running up and down, with the left Cun position particularly floating and slippery. Cangzhou diagnosed this as wind-phlegm lingering in the Pericardium. Medication induced vomiting of four to five sheng of phlegm and saliva. The patient fell into a deep sleep overnight. Upon waking, the illness had completely vanished. He was regulated with Shen'an agents (Spirit-Calming Formulas) and fully recovered.

Wu Jiaoshan treated a woman who was thin, weak, and irritable. Due to excessive overthinking, she developed Dian disorder (depressive psychosis). She alternated between crying and laughing, sometimes running naked, other times talking excessively behind closed doors. Various treatments failed. Wu palpated her pulse as floating and choppy, diagnosing excessive injury from overthinking causing the Spirit (Shen) to lose its residence. He used two placenta (Ziheche, Human Placenta), washed properly, boiled until soft like pork stomach, sliced, and allowed her to eat freely. She recovered after two doses. Later, she took Dingzhi Wan (Stabilize Spirit Pill) for one course and Bu Xin Tang (Tonify Heart Decoction) daily. After one hundred days of regulation, she married. The following year, she gave birth to a healthy, robust child.

[Appendix] Mr. Zhu Huaiyin's brother from Jiashan suffered from Dian-Kuang (mania and depression). He was cured using Xiaotan Qinghuo (Resolve Phlegm and Clear Heat) herbs. Three years later, it relapsed; Xiaotan Qinghuo was ineffective. Tianwang Buxin Dan (Emperor of Heaven Special Formula for Tonifying the Heart) cured him. Two years later, it relapsed again; previous methods failed. Guipi Tang (Restore the Spleen Decoction) cured him. One year later, it relapsed. During attacks, he groaned and cried out, with limbs twitching and convulsing like a puppet on strings. When lying down, he would jump up like a leaping fish, sometimes presenting opisthotonos. His shouting could be heard outside the house, yet his mind remained clear. However, due to tremors, he bit his lips and tongue while trying to speak. These episodes lasted half a ke (approx. 7.5 minutes) before stopping. After stopping, his consciousness became dull and speech erratic. Half a ke later, the attack resumed. A famous doctor surnamed Wu used Renshen (Ginseng Radix et Rhizoma), Lurong (Antler Cervi Pantotrichum), Rougui (Cortex Cinnamomi), Shudi (Radix Rehmanniae Preparata), Longchi (Os Draconis), Qingqian (Magnetitum), Yuanzhi (Radix Polygalae), and Fuling (Poria) to great initial effect. However, there was no improvement after a month. He consulted Ye Tianshi. Ye laughed and said, "He uses expensive medicines, confident in his status as a famous doctor, but merely wastes the patient's wealth with no benefit to the disease; even a mediocre doctor does this. I will use light and bland medicines. Twenty doses should reduce symptoms by half; forty doses should cure it entirely." Asked about the cause of clarity during convulsions and confusion when they cease, Ye replied, "Excessive mental exertion and indecisive planning have depleted Liver Yin and Gallbladder Juice, leaving the Yang Qiao and Yin Qiao meridities empty, causing wind movement. This is not deficiency-cold." He prescribed Baishao (Radix Paeoniae Alba) and Yurou (Fructus Corni) 1.5 qian each, Baishiying (Quartzum Album), Huaixiaomai (Fructum Tritici Levis), and Nanzao Rou (Sarcocarpus Ziziphi Jujubae) 3 qian each, and Zhigancao (Radix Glycyrrhizae Preparata) 0.5 qian. The patient doubted the prescription, and bystanders, thinking the medicine too mild, combined two doses into one. After ten doses, symptoms halved; after twenty doses, full recovery occurred.

Ni Weide treated a woman who sang wildly, wept bitterly, and cursed while naked. When questioned, she stared silently. Her pulse was deep, firm, and knotted. Ni diagnosed忧愤沉郁 (depression from sorrow and anger) causing phlegm and blood to accumulate in the chest. Emesis expelled accumulated phlegm wrapped in blood. Subsequent treatment with large doses of Shangge Qingre (Clear Upper Jiao Heat) yielded no change after several days.

Another woman exhibited irregular laughter and crying, suspected of demonic possession. Ni palpated deep pulses in all positions and suspected gastric accumulation, which typically causes pain. He used Erchen Tang (Two-Cured Decoction) to guide out phlegm. Vomiting a significant amount of phlegm resulted in recovery. This illustrates "accumulated phlegm mimicking spirits."

Zhen notes: The above cases primarily utilize emesis, purgation, and clearing heat methods. Only the cases of Wu and Ye differ. Reading *Ben Shi Fang*, a soldier sentenced to death was pardoned, leading to spirit loss resembling dementia. One pill of Jingqi Wan (Startle Qi Pill) cured him upon waking. The wife of Commander Zhang in Jiangdong lost her mind fleeing bandits for years; this formula cured her. The wife of Patrol Officer Wo from Huangshan suffered mania and syncope for over a year without success; this formula (minus Fuzi, adding Tie Fen/Iron Powder) cured her quickly. Iron powder not only resolves phlegm and calms the spirit but specifically suppresses Liver Pathogen. For excessive anger causing strong Liver Pathogen, iron powder controls it. *Suwen* states Yang Jue (Yang Mania) is treated with Tiélà (Iron Filings), representing Metal controlling Wood. This discussion lies outside the emesis-purgation-clearing methods and is appended here.

Wang Zhongyang treated a woman suspicious of her husband's infidelity, leading to heart-mind disturbance and mania. She spoke incessantly day and night. The family struggled to restrain her. Wang administered Guntan Wan (Rolling Phlegm Pill), 80 pills. She slept silently. A second dose the next night expelled foul matter. Feeling ashamed, her diet and activity normalized. Within five to seven days, she could sew. However, her mood remained low. Fearful of relapse, Wang secretly instructed someone to say near her, "Poor woman, died suddenly from heatstroke." The patient was delighted and asked how he knew. The informant replied, "I just saw your husband preparing funeral arrangements." The patient showed joy and recovered. Wang asked if her menstruation had returned. Her mother-in-law said she hadn't eaten for over a month and was emaciated, implying amenorrhea. Wang said, "If blood appears slightly bright red, come for medicine." Soon, reddish blood appeared. Wang ordered Zixue Tang (Nourishing Blood Decoction) from Hunhe Men to stop bleeding, followed by Zengsun Siwu Tang (Modified Four Substance Decoction). Full recovery occurred within half a month with no recurrence.

Zhen notes: This is "treating heart-mind disease with heart-mind medicine." Once, a man ill from poverty was cured when a doctor arranged for fake money to be given to him. These are temporary expedients. If the truth is revealed, the illness returns. It is better to guide with reason for enlightenment, avoiding relapse. Another case: a man with heart-mind disease saw objects as lions. Mr. Yifuchuan taught him to reach out and grab them; seeing nothing, he healed over time. Does this not break illusion? Illusion cannot disguise truth. This aligns with the Confucian study of rectifying the mind. However, if the patient is confused, this method is difficult. A physician who identifies the cause and resolves it practices the transmission of Xuanyuan and Qibo.

Wang Shishan treated a man over thirty, fat with white complexion. Humiliated while drunk, he developed heart-mind pathology. He held knives, climbed walls, and screamed with disheveled hair. Pulse was soggy, slow, and deficient, empty upon pressure. This indicates Yangming Deficiency. An atypical approach to tonify is necessary to avoid danger. A previous doctor had used Erchen Tang (Two-Cured Decoction) plus Zisu (Perilla Leaf) and Zhike (Aurantii Fructus) for two to three doses. Hearing Wang's diagnosis, the doctor angrily claimed his treatment was succeeding and challenged Wang's interference. Wang left. The doctor administered Niuhuang Qingxin Wan (Calculus Bovis Clearing Heart Pills), three pellets. Initial relief was felt, but subsequent doses caused severe dryness. By the third dose, mania doubled. He clutched his chest, crying, "How can I bear this heat?" Urgently calling for water to save his life. Family obeyed medical advice and withheld water. He found a basin of water before a deity statue, drank it all, still unsatisfied. He went to the kitchen, drank a bucket of water, reducing mania by half. Survival was fortunate. Wang was reconsulted. He used Renshen (Ginseng Radix et Rhizoma) and Gancao (Licorice Root) as sovereign sweet-warm herbs; Maidong (Ophiopogonis Radix) and Huangqin (Scutellariae Radix) as minister sweet-cool herbs; Qingpi (Tangerine Peel) as assistant to soothe Liver; Zhuli (Bambusa Textilis Sap) as envoy to clear phlegm; Shaoyao (Peony Root) and Fuling (Poria) adjusted for concurrent syndromes; Suanzaoren (Ziziphi Spinosae Semen) and Shanzhizi (Gardeniae Fructus) added/removed based on season. After over a month, symptoms lightened. Occasionally, eye tendons tightened, causing unconsciousness. After long recovery, Wang said it was fine, attributing it to incomplete restoration of Qi and Blood and chaotic Shen. He instructed strict adherence to the formula, taking Shen'an Wan (Spirit-Calming Pill) at night and Huqian Wan (Tiger-Hidden Pill) in the morning. After more than a year, stable sleep for a month ensured peace.

Zhen notes: Humiliation while drunk inevitably causes stagnant Liver Fire. Mania leading to climbing walls and excessive thirst confirms Phlegm-Fire Excess Syndrome. A bold doctor might use Dairen's emesis/purgation; a cautious one would use Huanglian (Coptidis Rhizoma), Shigao (Gypsum Fibrosum), Lingyangjiao (Saiga Antelope Horn), Dansheng (Arisaematis Cum Bile), Changpu (Acori Tatarinowii Rhizoma), and Zhuhuang (Bambusae Concretio Silicea) for standard treatment. The man's mania would worsen, deplete Yuan Qi, and lead to death while still manic, or cessation of mania upon death, with the doctor remaining unaware. Fortunately, Wang Shishan recognized the pulse pattern. Using Renshen [and Gancao], he recovered after a month. Can physicians speak lightly? The phrase "atypical approach to tonify" implies non-standard method, which deserves attention.