经云。狂始生。先自悲也。喜忘苦怒善恐者。得之忧饥。狂始发。少卧不饥。自高贤也。自
辩智也。自尊贵也。善骂詈。日夜不休。狂言。惊善笑。好歌乐。妄行不休者。得之大恐。狂。
目妄见。耳妄闻。善呼者。少气之所生也。狂者。多食善见鬼神。善
笑而不发于外者。得之有所大喜。足阳明之脉病。恶人与火。闻木音则惕然而惊。病甚则弃衣而
走。登高而歌。甚至不食数日。逾垣上屋。四肢者诸阳之本也。阳盛则四肢实。实则能登高也。
热盛于身。故弃衣欲走也。阳盛则妄言。骂詈不避亲疏。而不欲食。不欲食故妄走也。有怒狂者。
生于阳也。阳者因暴折而难决。故善怒也。病名阳厥。阳明者常动。巨阳少阳不动。不动而动大
疾。此其候也。夺其食则已。夫食入于阴。长气于阳。故夺其食则已。使之服以生铁洛为饮。夫
生铁洛者。下气疾也。
此阳气怫郁。不得疏越。少阳胆木挟三焦相火。太阳阴火上逆。故使人易怒如狂。夺其食者。
不使火助邪也。饮以生铁洛者。金以制木。木平则火降。故曰下气疾也。
狂之为病。皆由阻物过极。故猖狂刚暴。若有邪附。妄为不避水火。骂詈不避亲疏。或言未
尝见之事。非力所能。病反能也。上焦实者。从高抑之。生铁洛饮。阳明实则脉伏。大承气汤去
浓朴加当归、铁洛饮。以大利为度。在上者。因而越之。来苏膏。或戴人三圣散涌吐。其病立安。
后用洗心散、凉膈散调之。形证脉气俱实。当涌吐兼利。胜金丹一服神效。虽数年狂痴。无不克
应。但不可误施于癫痫之证。经云。悲哀动中。则伤魂。魂伤则狂妄不精。不精则不正。当以喜
胜之。以温药补魂之阳。龙齿清魂散。经云。喜乐无极则伤魄。魄伤则狂。狂者意不存。当以恐
胜之。以凉药补魄之阴。清神汤。肺虚喘乏。加沙参。胃虚少食。加人参。肝虚惊恐。加羚羊角。
热入血室。发狂不识人。小柴胡加犀角、生地黄。挟血如见祟状。当归活血汤加酒大黄微下之。
肝盛多怒狂妄者。针大敦。在足大指上。屡验。
一妇人狂言叫骂。歌笑非常。似祟凭根据。一边眼与口角吊起。或作痫治。或作心风治。皆不
效。乃是旧有头风之疾。
风痰作之使然。用芎辛汤加防风。数服顿愈。
妇科郑青山。因治病不顺。沉思辄夜。兼受他医讽言。心甚怀愤。天明病者霍然。愤喜交集。
病家设酌酬之。而讽者已遁。愤无从泄。忽然大叫发狂。同道诸名家治之罔效。一日。目科王道
来往候。索已服未服等方视之。一并毁弃。曰。此神不守舍之虚证。岂豁痰理气清火药所能克效
哉。遂令觅上好人参二两。一味煎汤服之顿安。三啜而病如失。更与归脾汤调理而康。
The *Classic of Difficult Issues* (Nan Jing) states: When mania (Kuang) first arises, the patient initially presents with sadness. If the patient suffers from forgetfulness, painful anger, and frequent fear, this is caused by worry and hunger.
When mania first erupts, the patient sleeps little and feels no hunger, considers themselves virtuous, claims to be eloquent and wise, and regards themselves as noble. They frequently curse others, day and night without rest. Presenting with delirious speech, easily startled, laughing excessively, enjoying singing and music, and engaging in aimless continuous movement, this is caused by great fright.
Mania manifests as visual hallucinations (seeing what is not there), auditory hallucinations (hearing what is not there), and frequent shouting; these are generated by deficiency of Qi. Manic patients eat large amounts, often see spirits or ghosts, laugh but do not express genuine joy externally; this is caused by excessive joy.
When the Foot-Yangming Stomach Meridian is diseased, the patient dislikes people and fire, and is startled upon hearing the sound of wood. In severe cases, they discard their clothes and run, climb high places and sing, and may even go several days without eating, jumping over walls and climbing onto roofs. The four limbs are the root of all Yang meridians. When Yang is excess, the four limbs become solid and strong, thus enabling climbing. Heat excess in the body causes the desire to discard clothes and run. Yang excess leads to delirious speech and cursing without regard for kinship or distance. The lack of desire to eat leads to aimless running.
Some cases of rage-manial disorder arise from Yang excess. Yang, having been suddenly frustrated and unable to resolve smoothly, leads to irritability. This disease is named "Yang Jue" (Yang Reversal). The Yangming meridian normally has a palpable pulse, whereas the Taiyang and Shaoyang meridians do not typically show distinct pulsation. If the latter show vigorous pulsation where none should exist, this is the clinical sign. The treatment is to restrict food intake, which resolves the condition. Since food enters the Yin aspect and generates Qi in the Yang aspect, restricting food allows the Yang to subside. Administer a decoction containing Sheng Tie Luo (Ferrum Depuratum, Desiccated Iron). Sheng Tie Luo has the effect of rapidly descending rebellious Qi.
This occurs because Yang Qi is constrained and depressed, unable to diffuse freely. Shaoyang Gallbladder Wood carries Sanjiao Ministerial Fire upward, and Taiyin Yin Fire also rebels upward, causing irritability resembling mania. Restricting food prevents nourishment from aiding the pathogenic fire. Drinking Sheng Tie Luo utilizes Metal to control Wood; when Wood is balanced, Fire descends. Hence it is said to rapidly descend Qi.
Mania arises from extreme stimulation by external objects, resulting in reckless and violent behavior, as if possessed by evil spirits. Patients act recklessly without avoiding fire or water, curse without regard for relationships, or speak of things never seen. These actions exceed normal human capability but are performed by the patient.
If the Upper Jiao is full/excess, suppress it using Sheng Tie Luo Yin. If Yangming Fu-organ excess is present with a submerged pulse, use Da Cheng Qi Tang (Major Order the Qi Decoction) removing Hou Po (Magnolia Bark), adding Dang Gui (Angelica Sinensis) and Tie Luo Yin (Iron Decoction), aiming for significant purgation. For pathogens located superiorly, induce vomiting using Lai Su Gao or Dai Ren’s San Sheng San (Three Holy Powders); the illness will immediately improve. Subsequently regulate with Xi Xin San (Wash the Heart Powder) and Liang Ge San (Cool the Diaphragm Powder).
If physical form, symptoms, pulse, and Qi are all excess, employ both emesis and purgation. One dose of Sheng Jin Dan (Winning Gold Pill) yields miraculous results. Even chronic mania lasting years can be cured. However, do not mistakenly apply this to epilepsy.
The *Classic* states: Sadness moving internally injures Hun (Ethereal Soul). Injury to Hun leads to madness and lack of clarity; lack of clarity leads to improper conduct. Treat by overcoming sadness with joy, using warm medicines to tonify the Yang of Hun. Use Long Chi Qing Hun San (Dragon Tooth Clearing Hun Powder).
The *Classic* further states: Unrestrained joy injures Po (Corporeal Soul). Injury to Po leads to mania, where intent is lost. Treat by overcoming joy with fear, using cool medicines to tonify the Yin of Po. Use Qing Shen Tang (Clear Spirit Decoction).
For Lung deficiency with panting and fatigue, add Sha Shen (Glehnia Root). For Stomach deficiency with poor appetite, add Ren Shen (Ginseng Root). For Liver deficiency with fright and anxiety, add Ling Yang Jiao (Antelope Horn).
When heat enters the Blood Chamber (Xue Shi), causing mania and inability to recognize persons, use Xiao Chai Hu Tang (Minor Bupleurum Decoction) added with Xi Jiao (Rhinoceros Horn - note: substitute with Buffalo Horn in modern practice) and Sheng Di Huang (Rehmannia Root). If accompanied by blood stasis presenting as seeing malevolent spirits, use Dang Gui Huo Xue Tang (Angelica Invigorating Blood Decoction) added with Jiu Da Huang (Wine-processed Rhubarb) for mild purgation.
For Liver excess with much anger and mania, needle Da Dun (LR1, Great Surge), located on the dorsal side of the big toe. This has proven effective repeatedly.
A woman presented with delirious speech, cursing, and abnormal laughter, appearing possessed. One eye and the corner of her mouth were drawn upward. Treatment as epilepsy or Heart Wind was ineffective. This was actually an old headache disorder exacerbated by Wind-Phlegm. Using Xiong Xin Tang (Ligusticum and Asarum Decoction) added with Fang Feng (Saposhnikovia Root), she recovered after a few doses.
Zheng Qingshan, a gynecologist, became deeply contemplative due to unsuccessful treatments and suffered verbal abuse from other physicians. At dawn, his patient recovered abruptly. Zheng felt a mix of resentment and joy. While the family hosted a banquet to thank him, the abuser had fled. With no outlet for his resentment, he suddenly shouted and went mad. Renowned colleagues failed to treat him. Wang Dao, an ophthalmologist, visited, examined the prescribed and unprescribed formulas, destroyed them, and stated: "This is a deficiency syndrome where the Spirit does not reside in its house; how could phlegm-resolving, Qi-regulating, or fire-clearing herbs succeed?" He ordered two taels of high-quality Ren Shen (Ginseng Root), decocted alone and administered. The patient calmed immediately. After three doses, the illness vanished. He was then regulated with Gui Pi Tang (Restore the Spleen Decoction) until recovery.