癫脉搏大滑者生。沉小紧急不治。狂脉实大生。沉小死。癫脉虚可治。实则死。
内经曰。巨阳之厥。则肿首头重。脚不能行。发为 仆。（ 摇其目而暴仆也）是盖阳气
逆乱
故令人卒然暴仆而不知人。气复则苏。此痫之类也。又曰。阳明之厥。则癫疾欲走呼。腹
满不得卧。面热。妄见妄言。又曰。甚则弃衣而走。登高而歌。逾垣上屋。骂詈不避亲疏。
是盖得之于阳气太盛。胃与大肠实热。燥火郁结于中而为之耳。此则癫狂之候也。曰癫曰狂
分而言之。亦有异乎。难经谓重阴者癫。重阳者狂。素问注云。多喜为癫。多怒为狂。然
则喜伤于心。而怒伤于肝。乃二脏相火有余之症。难经阴阳之说。恐非理也。大抵狂为痰火
实盛。癫为心血不足。多为求望高远。不得志者有之。痫病独主乎痰。因火动之所作也。治
法。痫病宜吐。狂宜下。癫则宜安神养血。兼降痰火。虽然。此三症者。若神脱而目瞪
如愚痴者。纵有千金我酬。吾未如之何也已矣。癫者。喜笑不常。颠倒错乱之谓也。狂
者。
大开目。与人语所未尝见之事为狂也。又云狂者。狂乱而无主定也。谵语者。合目自言日用
常行之事为谵也。又蓄血症。则重复语矣。郑声者。声颤无力。不相接续。造字出于喉中。
为郑声也。阴附阳则狂。阳附阴则癫。脱阴者目盲。脱阳者妄见。
一论癫者。心血不足也。此方主癫狂喜笑不常。
养血清心汤
人参 白术（去芦） 白茯苓（去皮） 远志（去心） 酸枣仁（炒） 川芎（各一钱） 生地
黄（一钱） 石菖蒲（一钱） 当归（一钱五分） 甘草（五分） 麦门冬（去心一钱五分）
上锉一剂。水煎服。
一论狂者。痰火实盛也。宜后清心滚痰丸主之。若风热实盛者。宜防风通圣散。（方见
中风）根据本方加生地黄、桃仁、丹皮主之。治一切大风癫狂之疾。
一论喜笑不休者。心火之盛也。以海盐二两。火烧令红。研细。以河水一大碗。煎三五
沸。
待温。三次啜之。以钗探吐热痰。次服黄连解毒汤。（方见感冒）根据本方加半夏、竹叶、竹沥
、姜汁少许。
一论妇人癫疾。歌唱无时。逾垣上屋者。乃营血迷于心包所致也。
加味逍遥散
当归 白芍（炒） 白术（去芦） 白茯苓（去皮） 生地黄 柴胡 远志（去心） 桃仁（
去皮尖） 苏木 红花 甘草
上锉一剂。煨姜一片。水煎服。有热。加小柴胡汤、生地、辰砂。水煎服。
一论发狂无时。披头大叫欲杀人。不避水火。古人治狂。谓之失心。苦参主心腹结气。故
足以治时热狂言。
苦参丸
苦参为末。炼蜜为丸。如桐子大。每服二三十丸。薄荷汤送下。
一论一切癫痫疯狂。或因惊恐畏怖所致。及妇人产后。血虚惊气入心。并室女经脉通行
惊邪蕴结。须服此丸立效。
抱胆丸
水银（二两一钱） 朱砂（一两） 铅（一两半） 乳香（一两研）
上将铅入铫内。水银结成砂子。次下朱砂滴乳。乘热用柳木棍研匀。丸如芡实大。每
一丸。空心。井花水送下。
病者得睡。切莫惊动。觉来即安。再服一丸。除根。一方。薄荷汤送下亦可。
一论癫狂失心不寐。此方用朱砂能镇心安神。酸可使收引。故枣仁能敛神归心。香可使
利窍。故乳香能豁达心志。许学士加人参。亦谓人参能宁心耳。
宁志膏
辰砂（一两） 酸枣仁（炒五钱） 乳香（五钱） 人参（一两）
上为细末。炼蜜为丸。如弹子大。每服一丸。薄荷汤化下。
一论癫狂失心。此病因忧郁得之。痰涎包络心窍。此药能开郁痰。
白金丸
白矾（二两） 川郁金（七两）
上为末。米糊丸。每服五十丸。温水送下。
一论癫狂五痫惊悸。一切怪症。此皆痰火实盛也。
清心滚痰丸
大黄（酒蒸四两） 黄芩（四两） 青礞石（ 五钱） 沉香（二钱半） 牙皂（五钱） 犀角（
二钱） 麝香（五分） 朱砂（五钱为衣）
上为细末。水为丸。每服四五十丸。滚水送下。
一论心风者何。盖君火在心。因怒发之。相火助盛。痰动于中。胁气上攻。迷其心窍。则
为癫为狂。所怒之事。胶固于心。辄自言谈。失其条序。谓之心风。与风无干也。若痰不盛
则有感亦轻。
一论久患心风。癫狂健忘。怔忡失志。及恍惚惊怖入心。神不守舍。多言不定。此药大
能安
神养血。宁心定志。以紫河车一具。长流水洗净。慢火焙干为末。炼蜜为丸。空心。酒送下
一人癫狂乱打。走叫上房。用瓜蒂散。吐出其痰数升。又以承气汤下之。即愈。
一人患心风。即痰迷心窍。发狂。用真花蕊石 。黄酒淬一次。为细末。每服一钱。黄
酒送下。
一论癫狂五痫眩晕。时作时止。痰涎壅盛。心神昏愦。此属气血虚。而挟风痰郁火也。
驱风化痰汤
人参 白术（去芦） 白茯苓（去皮） 半夏（姜炒） 陈皮 枳实（酒炒） 当归（酒洗）
川芎
白芍（酒炒） 桔梗（去芦） 南星 远志（甘草水泡去心） 栝蒌仁 白附子 僵蚕
天麻 黄连（酒炒） 黄芩（酒炒） 甘草 怀生地
上锉一剂。生姜五片。水煎。温服。
一癫狂健忘失志。及恍惚惊怖入心。神不守舍。多言不定。一切真气虚损。用紫河车入
补
药内服之。大能安神养血。宁志。治健忘惊悸。怔忡不寐。以六味丸加远志。石菖蒲、人参
、白茯苓、当归、酸枣仁炒。
一治心恙狂惑。用无灰酒一碗。真麻油四两。共和匀。杨枝二十条。逐一条搅一二下。
搅遍杨枝。直候油酒相和如膏。煎至八分。狂者强灌之。令熟睡。或吐或不吐。觉来即醒。
一治狂言乱语。用虾蟆一个。烧为末。酒调服。
一治癫狂诸病。
将军汤
大黄（四两酒浸一宿）
上用水三升煎之。分作三服。
癫狂病者。多怒为癫。多喜为狂。癫者。精神不守。言语错乱。妄见妄言。登高骂詈是
也。
狂之病始发。少卧少饥。自贤自贵。妄笑妄动。登高而歌。弃衣而走是也。癫病者。贼邪之
并于肝。狂病者。贼邪之并于心也。此皆实病。宜泻而不宜补。故用大黄以泻之。取其苦寒
无物不降。可以泻实。又必数日后方可与食。但得宁静。便为吉兆。不可见其瘦弱减食。
以温药补之。及以饮食饱之。病必再作。戒之戒之。缓与之食。方为得体。故曰。损其谷气
则病易愈。所以然者。食入于阴。长气于阳故也。又宜滚痰丸下之。
一治癫狂不止。得之惊忧。极者用甜瓜蒂半两为末。每服一钱。井水调一盏投之。即大
吐。
后熟睡。勿令惊起。神效。
一治邪狂癫痫。不欲眠。妄行不止。用白雄鸡二只。煮熟。五味
调和。作羹食。
一治因惊忧失心。或思过多。气结不散。积有痰涎。留灌心包。窒塞心窍。以致妄言妄
语。叫呼奔走。
雄朱丸
朱砂（颗块者二钱半研） 雄黄（明净者研一钱半） 白附子（一钱）
上和匀。以猪心血和为丸。如梧子大。另用朱砂为衣。每服三粒。以人参、菖蒲汤送下
常服一粒。能安魂定魄。补心益智。
一牧童小子。平日口中胡说。一片乱话。令人惊骇。予诊之脉洪大。是实热。以蚯蚓数
条研烂。井水调服。立愈。
The pulse of Dian (Manic-Depressive Disorder) presenting as large, slippery indicates a favorable prognosis; if the pulse is deep, small, and urgent, it is difficult to treat. The pulse of Kuang (Mania) presenting as full and large indicates a favorable prognosis; if deep and small, it indicates death. If the pulse of Dian is deficient, it is treatable; if excess, it is fatal.
The *Huangdi Neijing* states: When the Taiyang meridian experiences Jue (rebellious Qi), there will be swelling and heaviness in the head, inability to walk with the legs, and sudden collapse (Pu). ("Pu" refers to collapsing suddenly while the eyes tremble.) This is due to rebellious and chaotic Yang Qi causing sudden collapse and loss of consciousness. Upon recovery of Qi, the patient revives; this belongs to the category of Xian (Epilepsy). It also states: When the Yangming meridian experiences Jue, it leads to Dian disorder, desire to run and call out, abdominal fullness preventing sleep, facial heat, hallucinations, and delirious speech. Furthermore, in severe cases, the patient may discard clothes and run, climb high places and sing, scale walls and roofs, and curse without distinguishing kin from strangers. This results from excessive Yang Qi, excess-heat in the Stomach and Large Intestine, and dry-fire stagnating within. These are manifestations of Dian and Kuang. Speaking of Dian and Kuang separately, are they different? The *Nanjing* posits that heavy Yin constitutes Dian, and heavy Yang constitutes Kuang. The commentary on the *Suwen* states that excessive joy constitutes Dian, and excessive anger constitutes Kuang. Since joy injures the Heart and anger injures the Liver, these are symptoms of excess Fire in the Heart and Liver. The Yin-Yang theory in the *Nanjing* may not align with medical principles. Generally, Kuang is caused by excess Phlegm-Fire, while Dian is caused by deficiency of Heart Blood, often occurring in those who pursue lofty goals but fail to achieve them. Xian disease is primarily governed by Phlegm, triggered by Fire agitation. Therapeutic methods: Xian requires emesis; Kuang requires purgation; Dian requires calming the Spirit and nourishing Blood, combined with descending Phlegm-Fire. Nevertheless, for these three disorders, if the Spirit is scattered and the eyes are fixed like a fool, even with a thousand gold pieces, I would be helpless. Dian refers to abnormal laughter and joy, mental confusion and disorder. Kuang refers to wide-open eyes, conversing with others about things never seen. Another view states Kuang is madness without self-control. Chan Yu (Delirium) refers to speaking aloud with closed eyes about daily routine matters. Xu Xue syndrome (Blood Stasis) involves repetitive speech. Zheng Sheng (feeble voice) involves trembling, weak voice lacking continuity, words emerging from the throat. Yin attaching to Yang causes Kuang; Yang attaching to Yin causes Dian. Depletion of Yin causes blindness; depletion of Yang causes visual hallucinations.
Discussion on Dian: It is due to deficiency of Heart Blood. This formula treats Dian and Kuang with abnormal laughter and joy.
Yangxue Qingxin Tang (Nourish Blood and Clear Heart Decoction)
Renshen (Ginseng Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma, removed rhizome stump), Baifuling (Poria, removed bark), Yuanzhi (Polygalae Radix, removed heart), Suanzaoren (Ziziphi Spinosomi Semen, stir-fried), Chuanxiong (Ligustici Chuanxiong Rhizoma) (each 1 qian), Shengdihuang (Rehmanniae Radix Recens, 1 qian), Shichangpu (Acori Tatarinowii Rhizoma, 1 qian), Danggui (Angelicae Sinensis Radix, 1.5 qian), Gancao (Glycyrrhizae Radix et Rhizoma, 0.5 qian), Maimendong (Ophiopogonis Radix, removed heart, 1.5 qian).
Chop into one dose, decoct in water, and take orally.
Discussion on Kuang: It is due to excess Phlegm-Fire. The following Qingxin Guntan Wan (Clear Heart Rolling Phlegm Pill) should be used. If Wind-Heat is in excess, Fangfeng Tongsheng San (Siler and Saposhnikovia Powder to Unblock the Master) should be used (see Stroke chapter). Add Shengdihuang, Taoren, and Danpi to this formula. It treats all severe wind-induced Dian-Kuang disorders.
Discussion on incessant laughter: It is due to excess Heart Fire. Take 2 liang of sea salt, fire until red-hot, grind finely. Boil in one large bowl of river water for three to five boils. When warm, drink in three doses. Use a hairpin to induce vomiting of hot Phlegm. Then administer Huanglian Jiedu Tang (Coptis Decoction to Relieve Toxicity) (see Cold Damage chapter). Add Banxia, Zhuye, Zhuli, and a little Jiangzhi to this formula.
Discussion on women's Dian disorder: Singing at any time, scaling walls and roofs, is caused by Ying (Nutritive) Blood confusing the Pericardium.
Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder)
Danggui, Baishao (stir-fried), Baizhu (removed rhizome stump), Baifuling (removed bark), Shengdihuang, Chaihu, Yuanzhi (removed heart), Taoren (removed skin and tip), Sumu, Honghua, Gancao.
Chop into one dose, add one slice of simmered ginger, decoct in water, and take orally. If heat signs are present, add Xiao Chaihu Tang, Shengdihuang, and Chen Sha, decoct in water, and take orally.
Discussion on unprovoked mania: Hair disheveled, screaming, wanting to kill, disregarding fire and water. Ancient practitioners treated Kuang as "Loss of Heart." Kushen (Sophorae Flavescentis Radix) treats Qi knotting in the Heart and Abdomen, thus treating febrile diseases with delirious speech.
Kushen Wan (Sophora Pill)
Grind Kushen into powder, make pills with refined honey, size of Sophora seeds. Take 20-30 pills per dose, washed down with Bohe Tang (Mint Decoction).
Discussion on all epilepsy, mania, and madness caused by fright or fear, or postpartum blood deficiency allowing Fright Qi to enter the Heart, or virgins experiencing menstrual flow with Fright Evil accumulation. This pill brings immediate effect.
Baodan Wan (Gallbladder Embracing Pill)
Shuiyin (Mercurius), Zhusha (Cinnabaris), Qian (Plumbum), Ruxiang (Boswelliae Resin, ground).
First place Qian in a crucible, add Shuiyin to form cinnabar-like grains. Then add Zhusha and drip Ruxiang. Grind evenly while hot with a willow stick. Make pills size of Euphorbia seeds. Take one pill on an empty stomach, washed down with Jinghua Shui (Well Water).
Ensure the patient sleeps; do not disturb. Upon waking, they will be calm. Take another pill to eradicate the root. Alternatively, wash down with Bohe Tang.
Discussion on Dian-Kuang with Loss of Heart and insomnia. Zhusha calms and anchors the Heart Spirit. Sour flavor promotes astringency, so Zaoren gathers the Spirit back to the Heart. Fragrant flavor opens orifices, so Ruxiang expands the Heart Will. Scholar Xu added Renshen, believing it calms the Heart.
Ningzhi Gao (Spirit-Calming Paste)
Chen Sha (Stibnite), Suanzaoren (stir-fried, 5 qian), Ruxiang (5 qian), Renshen (1 liang).
Grind into fine powder, make pills with refined honey, size of a bullet. Take one pill per dose, dissolve and wash down with Bohe Tang.
Discussion on Dian-Kuang with Loss of Heart. This condition arises from depression. Phlegm-Saliva envelops the Heart Orifice. This medicine opens Depressed Phlegm.
Baijin Wan (White Platinum Pill)
BaiFan (Alumen), Chuan Yujin (Curcumae Radix).
Grind into powder, make pills with rice paste. Take 50 pills per dose, washed down with warm water.
Discussion on Dian-Kuang, Five Xian, palpitations, and all strange syndromes. These are all due to excess Phlegm-Fire.
Qingxin Guntan Wan (Clear Heart Rolling Phlegm Pill)
Dahuang (steamed in wine, 4 liang), Huangqin (4 liang), Qingmengshi (5 qian), Chenxiang (2.5 qian), Yazao (5 qian), Xijiao (2 qian), Shexiang (0.5 fen), Zhusha (5 qian, for coating).
Grind into fine powder, make pills with water. Take 40-50 pills per dose, washed down with boiling water.
What is Xin Feng (Heart Wind)? The Ministerial Fire resides in the Heart. Triggered by anger, Assistant Fire assists its strength, Phlegm moves within, Qi from the flanks attacks upward, confusing the Heart Orifice, leading to Dian or Kuang. The object of anger remains stuck in the Heart, leading to spontaneous talking without order, called Xin Feng. It has nothing to do with external Wind. If Phlegm is not excessive, the sensation is mild.
Discussion on chronic Xin Feng, Dian-Kuang, amnesia, palpitations, loss of will,恍惚 (trance) with fright entering the Heart, Spirit not guarding the residence, excessive speech without stability. This medicine greatly calms the Spirit, nourishes Blood, stabilizes the Heart, and settles the Will. Take one Zijieche (Human Placenta), wash with long-flowing water, dry slowly over low fire, grind into powder. Make pills with refined honey. Take on an empty stomach, washed down with wine.
One patient with manic-disordered beating, running and shouting onto the roof. Used Gudi San (Melon Pedicle Powder) to vomit several sheng of Phlegm. Then administered Chengqi Tang (Chengqi Decoction) to purge. Immediately recovered.
One patient with Xin Feng, Phlegm confusing the Heart Orifice, manifesting as Kuang. Use genuine Huaruishi (Pyrite), quench once in Huangjiu (Yellow Wine), grind into fine powder. Take 1 qian per dose, washed down with Huangjiu.
Discussion on Dian-Kuang, Five Xian, vertigo, intermittent onset, excessive Phlegm-Saliva, confused Heart Spirit. This belongs to Qi-Blood deficiency complicated by Wind-Phlegm and Depressed Fire.
Qufeng Huatan Tang (Wind-Expelling and Phlegm-Resolving Decoction)
Renshen, Baizhu (removed rhizome stump), Baifuling (removed bark), Banxia (stir-fried with ginger), Chenpi, Zhishi (stir-fried with wine), Danggui (washed with wine), Chuanxiong, Baishao (stir-fried with wine), Jiegeng (removed rhizome stump), Nanxing, Yuanzhi (soaked in Licorice water, removed heart), Gualouren, Baifuzi, Jiangcan, Tianma, Huanglian (stir-fried with wine), Huangqin (stir-fried with wine), Gancao, Huaishengdi.
Chop into one dose, add five slices of fresh ginger, decoct in water, take warm.
Discussion on Dian-Kuang, amnesia, loss of will, trance with fright entering the Heart, Spirit not guarding the residence, excessive speech without stability. All true Qi deficiency and damage. Use Zijieche added to tonifying medicines. Greatly calms Spirit, nourishes Blood, settles Will. Treats amnesia, palpitations, restlessness, insomnia. Use Liuwei Wan (Six-Ingredient Pill) plus Yuanzhi, Shichangpu, Renshen, Baifuling, Danggui, and stir-fried Suanzaoren.
Treat Heart Malady with Mania and Confusion. Use one bowl of non-fermented wine, four liang of pure sesame oil. Mix well. Take twenty Yangzhi (Willow branches), stir each branch one or two times. Stir through all branches until oil and wine mix like paste. Boil until reduced to eight-tenths. Force-feed the manic patient. Let them sleep deeply. Whether they vomit or not, they will wake up alert.
Treat delirious and chaotic speech. Burn one toad into powder. Mix with wine and take orally.
Treat various Dian-Kuang disorders.
Jiangjun Tang (General Decoction)
Dahuang (four liang, soaked in wine overnight).
Decoct in three sheng of water. Divide into three doses.
Patients with Dian-Kuang: Excessive anger constitutes Dian; excessive joy constitutes Kuang. Dian is characterized by unsettled Spirit, confused speech, hallucinations, climbing high places, and cursing.
Kuang begins with little sleep, little hunger, feeling superior and noble, laughing and moving wildly, climbing high places and singing, discarding clothes and running. Dian is caused by pathogenic evil combining with the Liver; Kuang is caused by pathogenic evil combining with the Heart. These are all Excess conditions, suitable for purging rather than tonifying. Thus, use Dahuang to purge, leveraging its bitter-cold nature to descend everything, clearing excess. Food should only be given after several days. Calmness is an auspicious sign. Do not see their thinness and reduced appetite and tonify with warm medicines or force-feed. The disease will recur. Beware! Feed slowly, which is appropriate. Thus, reducing grain Qi makes the disease easier to cure. Why? Food enters Yin and generates Qi in Yang. Also suitable to purge with Guntan Wan.
Treat unremitting Dian-Kuang caused by fright and worry. In extreme cases, use half a liang of Tianguadi (Melon Pedicle) powder. Take 1 qian per dose, mixed with one bowl of well water to induce. Profuse vomiting occurs. Follow with deep sleep. Do not allow waking abruptly. Miraculous effect.
Treat Evil Kuang and Epilepsy, unwilling to sleep, walking aimlessly. Cook two white roosters. Season with five flavors, make into soup and eat.
Treat Loss of Heart due to fright and worry, or excessive thinking, Qi knotting without dispersing, accumulation of Phlegm-Saliva flooding the Pericardium, blocking the Heart Orifice, leading to delirious speech, shouting, and running.
Xiongzhu Wan (Male Cinnabar Pill)
Zhusha (chunky, 2.5 qian, ground), Xionghuang (pure, ground 1.5 qian), Baifuzi (1 qian).
Mix evenly, bind with Pig Heart Blood into pills size of Sophora seeds. Coat with Zhusha. Take three pills per dose, washed down with Renshen and Changpu Decoction. Regular intake of one pill calms Soul, stabilizes Essence, tonifies Heart, and benefits intelligence.
A shepherd boy usually spoke nonsense, shocking people. My diagnosis revealed a large, surging pulse, indicating Excess Heat. Grind several earthworms into pulp, mix with well water and take. Immediate recovery.