病由邪并于阳 狂病者，由风邪入并于阳所为也。风邪入血，使人阴阳二气，虚实不调。若一实一虚，
则令血气相并，气并于阳则为狂发，或欲走，或自高贤称神圣是也。（《病源论》）（按∶此本于《调经论》、
《阳明脉解篇》及《癫狂篇》等。）
病主于热 夫外清而内浊，动乱参差，火之体也。静顺清朗，准则信平，水之体也。由是肾水主志，而
水火相反，故心火旺则肾水衰，乃失志而狂越也。或云重阳者狂，重阴者癫，则素问之说不同也。经注曰∶多
喜为癫，多怒为狂。然喜为心志，故心热甚则多喜而为癫也。怒为肝志，火实制金，不能平木，故肝实则多怒
而为狂也。况五志所发皆为热，故狂者五志间发，但怒多尔。凡热于中，则多于阳明胃经也。经曰∶阳明之厥，
则癫疾欲走，腹满不得卧，面赤而热，妄言。又曰∶阳明病洒洒振寒，善伸数欠，或恶人与火，闻木音则惕然而
惊，心欲动，独闭户牖而处，欲上高而歌，弃衣而走，贲响腹胀，詈骂不避亲疏。又经曰∶热中消中，皆富贵人也。
今禁膏粱，是不合其心。禁芳草石药，是病不愈云云。盖服膏粱芳草石药，则热气坚劲疾利而为热中消中，发为
癫狂之疾，夫岂癫为重阴者欤。（《原病式》）（按∶芦和曰∶此《原病式》本《素问》之论，以谓癫狂俱是热病，
而重阴之说非也。）
狂之为病，经曰重阳者狂，其病属热。夫何热者阳也，阳者浮也，其病能弃衣登高。弃衣者，因热而不欲衣。
登高者，因浮而能轻举也。又能强辨是非，尊贵倨傲，妄笑好歌，妄行不休，不肯少卧者，何也？阳动而阴静，
故阳病欲见人，不欲闭户独处也。又能不饥者，何也？阳邪伏藏，胸膈饱满，所以不饥也。其病也有源，其发也
有候，世医不究其理，举以为痰，同声相应。噫！不知痰是何物，而狂是何病也。若以痰能为狂，则凡有痰者皆
狂，而予未之见。盍不观诸伤寒之发狂乎，伤寒大热则狂发也。又不观诸饮酒之发狂乎，夫酒者大辛之物，饮多则
热甚，热甚则发狂也。历历试之，则凡狂之为病，未有不属之于热也，但有轻重浅深之不同耳。（《儒医精要》）
病必属心有火有痰 心乃神明之舍，心既病，则神不守舍，言不择（按∶此似有脱），理之常也。（《澹寮》）
癫者全归于心，痫者归乎五脏。所谓颠者，神不守舍，狂言妄语，如有所见，动经年岁，不得即愈。若心经
有损，是为真病。如心经蓄热，则当清心除热。如痰逆心窍使然，又当下痰而宁其心志。（《大成》）
凡狂病多因于火，此或以谋为失志，或以思虑郁结，屈无所伸，怒无所泄，以致肝胆气逆，木火合邪，是诚东
方实证也。此其邪乘于心，则为神魂不守。邪乘于胃，则为暴横刚强。故治者，当以治火为先，而或痰或气，察其
甚而兼治之。（《景岳》）
颠狂二证必有所因，或因大怒动其肝风，或因大惊动其心火，或素有痰，卒为火升，升而不降，壅塞心窍，
神明不得出入，主宰失其号令，心反为痰所役，一时发越。若逾垣上屋，持刀杀人，裸体骂詈，不避亲疏，飞奔
疾走，涉水如陆
者，此肝气太旺，木来乘心，名之曰狂，又谓之大颠，法当抑肝镇心，降龙丹主之。若抚掌大笑，语言不伦，
左顾右盼，如见鬼神，片时正性复明，深为赧悔，少顷而状态如故者，此为上膈顽痰，泛滥洋溢，塞其道路，
心为之碍，痰少降则正性复明，痰复升则又发，名之曰颠，法当和肺安心安神，滚痰丸主之。（《订补指掌》）
（按∶此析颠狂本于《准绳》。）
脉候 颠痫之脉，浮洪大长（既见上），滑大坚疾，痰蓄心狂。（《崔氏脉诀》）
颠乃重阴，狂乃重阳，浮洪吉兆，沉急凶殃。（《濒糊脉学》）
其脉浮洪者，是为阳脉，阳狂得之，与证相宜；即阴癫得之，亦从阴转阳、自里达表之象，故均为吉兆。
若沉而急，沉则入阴迫里，急则强急不柔，是无胃气之脉也，不论狂癫，凶殃立至。（《续焰》）（按∶此所
谓癫，即狂一证。）
其脉何如？其脉三部俱盛，浮大滑数而长也。（《儒医精要》）
心风 心风者，精神恍惚，喜怒不常，言语时或错乱，有癫之意，不如癫之甚，亦痰气所为也，宜星香
散（南星、木香、生姜水煎）下寿星丸（用南星、朱砂、琥珀）。有心经蕴热，发作不常，或时烦躁，鼻眼各有
热气，不能自由，有类心风，稍定复作，清心汤加石菖蒲。（《要诀》）（按∶清心汤原作参苏饮，今从《统旨》
所改，清心汤方见后。）
春甫考心风病，诸书鲜有载之，而多附癫痫门候，混同论治。心风虽出于世俗之称，深中病情，诚为切当。
古人谓风善行而数变，风痹为不仁。此曰心风者，非若外风入中，甚言其变常无定，恍惚不仁，而心之病，诚若
风之魔也。此
皆七情五志久逆所生，而与癫痫则又不同矣。癫狂痫证，主于火炽风痰之盛，而寝延及于心，属实者多。心风则
由七情五志，久逆不遂。戴人所谓肝屡谋，胆屡不决，屈无所伸，怒无所泄。心之官则思，甚则心血且涸，脾液
不行，痰迷心窍，则成心风，属虚者多。治法须以七情相胜，五志遂心，养血豁痰，引神归舍，标本兼治，此
疾可愈矣。至若混同癫痫攻治，是谓虚虚而速其死也。（《医统》）
治心风，以五志诱之，然后药之，取效易。五志诱之者，如求利而遂病者，则诱之以金银，或诈以惠之，
或诡以遗之，而先定其心志，然后济之以药，是得治之要也。（同上）（按春甫立心风门，附有数方，然大抵与
他心疾诸方相通，今取正心汤一方，以列后补心方中。）
喜笑 戴人路经古亳，逢一妇病喜笑不止，已半年矣，众医治者皆无药术矣，求治于戴人。戴人曰∶此
易治也。以沧盐成块者二两，令用火烧令通赤，放冷研细，以河水一大碗，同煎至三、五沸，放温分三次啜之，
以钗探于咽中，吐去热痰五升，次服大剂黄连解毒汤，不数日而笑定矣。《内经》曰∶神有余则笑不休。此所谓
神者，心火是也。火得风而成焰，故有笑之象也。五行之中，惟火有笑矣。（《十形三疗》）
黄连解毒汤，加半夏、竹沥、姜汁服，能治喜笑不休，极效。（《医统》）
痴证 人病狂痴，手足厥，作狂病治不效。《名医录》曰∶此惊恐忧思所得。大惊伤心，大恐伤肾，
大忧思伤神志。神不足则狂痴，志不足则恐怖，恐怖则肾气留积，足不收，亦因积惊恐气伤肾也。（《资生》）
痴呆证，凡平素无痰，而或以郁结，或以不遂，或以思虑，或以疑贰，或以惊恐，而渐致痴呆。言辞颠倒，
举动不经，或多
汗，或善愁。其证则千奇万怪，无所不至。脉必或弦或数，或大或小，变易不常。此其逆气在心，或肝胆二经，
气有不清而然。但察其形体强壮，饮食不减，别无虚脱等证，则悉宜服蛮煎治之，最稳最妙（服蛮煎用生地、麦
冬、芍药、石菖、石斛、丹皮、茯神、陈皮、木通、知母）。然此证有可愈者，有不可愈者，亦在乎胃气元气
之强弱，待时而复，非可急也。（《景岳》）
人有终日不言不语，不饮不食，忽笑忽歌，忽愁忽哭，与之美馔则不受，与之粪秽则无辞，与之衣不服，
与之草木之叶则反喜。人以为此呆病，不必治也。然而呆病之成，必有其因。大约其始也起于肝气之郁，其终也
由于胃气之衰。肝郁则木克土而痰不能化，胃衰则木制土而痰不能消。于是痰积于胸中，盘据于心外，使神明不
清而成呆病矣。治法开郁逐痰，健胃通气，则心地光明，呆景尽散也。（《辨证录》）
妇人 妇人因血气迷心，或因产后恶露上冲，而语言错乱，神志不守者，又各当随其证治。（《大成》）
有妇人狂言叫骂，歌笑不常，似祟凭根据，一边眼与口角吊起。或作癫治，或作心风治，皆不效。乃是旧有头
风之疾，风痰之作使然。用芎辛汤（用附子、乌头、南星、干姜、细辛、川芎、甘草）加防风十分，数服顿愈。
（《要诀》）
治例 凡狂发则欲走，或自高贵称神圣，皆应备诸火灸，乃得永瘥耳。（《肘后》）
凡人患癫狂叫唤打人者，皆心经有热，当用镇心药兼大黄与之，服数日，然后服安神及风药，但得宁静，即
是安药。不可见其瘦弱减食，便以温药补之，病必再作，戒之戒之，缓缓调饮食可也，（《医说》引《御览》）
（按∶又引
《医余》论病有不可补者，狂疾居其一。）
狂病宜大吐下，则除之。治∶痰者吐之，三圣散。火者下之，承气汤。惊者平之，安神丸。（《丹溪》）
其治何如？损其六腑有余之阳，益其五脏不足之阴，务使阴阳相和，无所偏胜，如此而已矣，岂可以痰治
之哉。（《儒医精要》）
古方治法，风火颠狂皆谓有余，每以祛风泻火金石之剂从而治之，效者有之，因而绵延者亦有之。予者其
疾，未有不因脏神先虚，风邪得入。实者邪气实，虚者正气虚，不可偏执一见，但当审人虚实冷热，然后清痰
降火，安神养血，获效者多矣。（《诸证辩疑》）
涌吐方法 血气者，身之神也。神既衰乏，邪因而入。夫血气俱虚，痰客中焦，妨碍不得运用，以致十
二官各失其职，视听言动，皆有虚妄，宜吐之而愈。（《丹溪》）
有忧愤沉郁，痰食交结胸中，以致狂歌痛哭，裸裎妄骂，瞪视默默，脉得沉坚而结。须涌去积痰裹血，清
彻上膈，始愈。（《汇补》引汝言）
治心风吐药，瓜蒂散《全生指迷方》，张德明合中服之，吐涎甚多，遂安。又以医陈武功，亦效（按∶此
系仲景原方去香豉）。热米饮调一钱，羸人半钱，得吐即止。德明合中服三钱，方吐，数日后又服，遂全安。
（《是斋》）
经验治一切妇人心疾颠狂，因惊忧之极，痰犯心包所致。
以苦丁香（即甜瓜蒂）一味半两为末，每用一钱重，井华水调，满一盏投之，随得大吐，后熟睡勿惊之，
自是遂安。（《永类》）《得效》名独效苦丁香散，治忽患心疾，癫狂不止，得之因惊忧之极。（按∶《心法
附余》加轻粉，名涌泄散，其方原出《本草衍义》，既录在《痰涎》中，宜参。）
治心恙，一醉散（按∶《纲目》作一醉膏）。
无灰酒（二碗） 真香油（四两）
上和匀，用柳枝二十条，搅一二百下，换遍柳条，直候油酒相乳入如膏（《得效》无乳字），煎七分碗，狂
者强灌之，令熟睡，或吐或不吐，觉来即醒。（《永类》）
泻下方法 许氏病阳厥怒狂，骂詈不避亲疏，或哭或歌，六脉举按无力，身表如冰石，发即叫呼声高。
洁古云夺食则已，因不与之食。予用大承气汤下之，得脏腑（《纲目》此有渣秽二字）数升，狂稍宁，数日复发复
下，如此五七次，行大便数升，疾缓身温，脉生良愈，此易老夺食之法也。（《阴证略例》）
按癫狂之病，属痰热相结，多在肝胆胞络之间。余遇此证，辄投礞石滚痰丸二、三钱，下胶痰如桃胶蚬肉
者五升许，即愈。若痰少热多，阳明内实者，当如罗谦甫之治丑斯兀阑，发狂热渴，用大承气一两半，加黄连
二钱，以下其热，俾便通汗出乃愈。（《金匮翼》）
当归承气汤。
当归 大黄（各一两） 甘草（半两） 芒硝（九钱）
上锉如麻豆大，每服二两，水一大碗，入生姜五片，枣十枚，同煎至半碗，去滓热服。若阳狂奔走，骂詈
不避亲疏，此阳有余阴不足。大黄、芒硝去胃中实热。当归补血、益阴。甘草缓中。加生姜、枣，胃属土，此引
至于胃中也。经所谓微者逆之，甚者从之，此之谓也。以大利为度。微缓，以瓜蒂散加防风、藜芦吐之，其病
自愈。后调洗心散、凉膈散、解毒汤药调治之。（《保命集》）（按∶张子和有发狂用调胃承气汤大下血水与
瘀血治验。）
泻心汤，治心受积热，谵言发狂，逾墙上屋。（《得
效》）（按∶即三黄汤。）
三黄丸，辰砂为衣，新汲水下七、八十丸。一妇人伤寒后，每至午，弃衣奔走，妄言骂詈，不避亲疏，
服此而愈。（《医林集要》）
清心汤，即凉膈散加黄连。（同上）
牛黄泻心汤，治心经邪热，狂语，精神不爽。
脑子（二钱半） 牛黄（二钱半） 大黄末（生一两） 朱砂（二钱半）
上同研极细，每服三钱，生姜蜜水调下。（《御药院方》）
予治昆山清水湾一人发狂，先为刺百会、神庭、人中三穴，后以蜀漆（水拌炒熟一钱） 龙骨（ ）
牡蛎（ 各三钱） 黄连（五分） 生大黄（三钱）
水煎服，一剂即安。
按狂证，未有不从惊而得者，龙齿最能安魂者也。未有无痰者，惊则气逆，气逆则痰聚，蜀漆最善劫痰
者也。未有无火者，火性炎上，故登高而歌，弃衣而走，黄连能泻心火。病属阳明，故用大黄以泻之，釜底抽薪
法也。（鹤年）（《金匮翼》）
控涎丹（《三因方》），治痰迷窍，狂言如有所见。（《袖珍》）（三味即原方，今《三因》无所考。）
心风气热痰盛者，滚痰丸。（《丹溪》）
安神滚痰丸。
Mania (A disease characterized by mental disorder, restlessness, and agitation)
The onset of mania is caused by wind pathogen invading and merging into the Yang aspect. When the wind pathogen enters the blood level, it causes an imbalance of deficiency and excess in the body's Yin and Yang Qi. If there is one excess and one deficiency, it leads to the contention of Blood and Qi. When Qi merges excessively into the Yang, mania ensues, manifesting as a desire to run or self-aggrandizement, claiming to be virtuous or divine. (*Zhu Bing Yuan Hou Lun*) [Note: This view originates from *Su Wen: Tiao Jing Lun*, *Yangming Maijie Pian*, and *Diankuang Pian*, etc.]
The pathology of mania primarily lies in Heat. Externally clear but internally turbid, chaotic and uneven, this is the nature of Fire. Quiet, compliant, clear, bright, standard, and peaceful, this is the nature of Water. Therefore, Kidney Water governs Will (Zhi), and since Water and Fire are opposite, when Heart Fire flares up, Kidney Water declines, leading to loss of will and manic transgression. Some say "Double Yang results in Mania, Double Yin results in Dian," which differs from the statement in *Su Wen*. The commentary on the classics states: Much joy indicates Dian, much anger indicates Mania. However, Joy is the emotion of the Heart; thus, excessive Heart Heat leads to much joy and Dian. Anger is the emotion of the Liver; when Fire is excessive and controls Metal (Lung), failing to subdue Wood (Liver), Liver Excess leads to much anger and Mania. Moreover, the emission of the Five Emotions (Joy, Anger, Worry, Thought, Fear) all generate Heat; therefore, Mania involves the interplay of the Five Emotions, with Anger being predominant. Generally, Heat within the body mostly involves the Yangming Stomach Meridian. The classics state: Reversal of Yangming Qi leads to Dian disease with a desire to run, abdominal fullness preventing lying down, red face, heat, and delirious speech. It also states: Yangming disease presents with aversion to cold, frequent stretching and yawning, aversion to people and fire, startle at the sound of wood, palpitations, staying alone behind closed doors, desire to climb high and sing, discarding clothes and running, borborygmus and abdominal distension, and cursing without distinction between kin and strangers. Furthermore, the classics state: Nei-Re (Internal Heat) and Xiao Zhong (Wasting and Thirsting) are diseases of the wealthy. Prohibiting rich and sweet foods goes against their desires; prohibiting aromatic herbs and mineral drugs means the disease will not heal. Essentially, consuming rich foods, aromatic herbs, and mineral drugs makes Heat firm, strong, rapid, and beneficial, forming Nei-Re or Xiao Zhong, which then develops into Dian or Mania. Could this be due to Double Yin? (*Yuan Bing Shi*) [Note: Lu He stated: This *Yuan Bing Shi* is based on the discussion in *Su Wen*, asserting that both Dian and Mania are Heat diseases, and the theory of Double Yin is incorrect.]
Regarding Mania, the classics state "Double Yang results in Mania," and its pathology belongs to Heat. Why does Heat belong to Yang, and Yang floats, enabling patients to discard clothes and climb high? Discarding clothes is because of internal Heat and unwillingness to wear them; climbing high is because Yang floats, making the body light. Patients may also argue forcefully about right and wrong, act arrogantly, laugh and sing wildly, act erratically without stopping, and refuse to sleep. Why? Because Yang moves and Yin is still; thus, Yang disease patients wish to see others and do not wish to stay alone behind closed doors. They may also feel no hunger. Why? Because Yang pathogen hides, causing fullness in the chest and diaphragm, hence no hunger. This disease has a source, and its onset has signs. Physicians of the world do not investigate the principle, uniformly attributing it to Phlegm, echoing each other. Alas! Who knows what Phlegm is, and what Mania is? If Phlegm could cause Mania, then everyone with Phlegm would be manic, yet I have never seen such a case. Why not observe Mania caused by Shanghan (Cold Damage)? Severe Heat in Shanghan causes Mania. Why not observe Mania caused by drinking alcohol? Alcohol is a pungent substance; excessive drinking causes severe Heat, which triggers Mania. Testing this repeatedly, all cases of Mania belong to Heat, differing only in degree and depth. (*Ru Yi Jing Yao*)
Mania must belong to Heart Fire and Phlegm. The Heart is the residence of Spirit (Shen). Once the Heart is diseased, Spirit does not reside in its house, and speech lacks logic; this is the normal principle. (*Dan Liao Fang*)
Dian (Catatonia/Depressive Psychosis) is entirely attributed to the Heart, while Xian (Epilepsy) is attributed to the Five Zang Organs. Dian refers to Spirit not residing in its house, delirious speech, hallucinations, lasting for years without immediate cure. If the Heart Meridian is damaged, it is a true disease. If Heat accumulates in the Heart Meridian, one should clear Heart Heat. If Phlegm reverses and blocks the Heart orifices, one should purge Phlegm to calm the mind. (*Yi Xue Da Cheng*)
Generally, Mania is caused by Fire. This may result from frustrated ambitions or pent-up thoughts, where grievances cannot be expressed and anger cannot be vented, leading to counterflow of Liver and Gallbladder Qi, combining Wood and Fire. This is indeed an Excess syndrome of the East (Liver/Wood). This pathogen attacks the Heart, causing Shen and Hun (Ethereal Soul) to lose their residence; it attacks the Stomach, causing violent and rigid behavior. Therefore, treatment should prioritize clearing Fire, and simultaneously address Phlegm or Qi depending on severity. (*Jing Yue Quan Shu*)
Both Dian and Mania syndromes have specific causes. They may arise from great anger stirring Liver Wind, great fright stirring Heart Fire, or pre-existing Phlegm suddenly rising with Fire, ascending but not descending, blocking the Heart orifices. Spirit cannot enter or exit, the ruler loses command, and the Heart is enslaved by Phlegm, erupting suddenly. Behaviors like climbing walls, holding knives to kill, exposing oneself, cursing without discrimination, running fast, and wading through water as if on land indicate excessive Liver Qi, with Wood overacting on Heart, named Mania, also called Great Dian. Treatment should suppress Liver and calm Heart, mainly using Jiang Long Dan. Behaviors like clapping hands and laughing loudly, illogical speech, looking left and right as if seeing ghosts, followed by brief lucidity and shame, then returning to the previous state, indicate stubborn Phlegm in the upper Jiao overflowing and blocking pathways, hindering the Heart. When Phlegm descends slightly, lucidity returns; when it rises again, symptoms recur. This is named Dian. Treatment should harmonize Lung, calm Heart, and nourish Spirit, mainly using Gun Tan Wan. (*Ding Bu Zhi Zhang*) [Note: This analysis of Dian and Mania is based on *Zhun Sheng*.]
Pulse Diagnosis
The pulse for Dian and Xian is Floating, Surging, Large, Long (seen above), Slippery, Large, Firm, and Rapid, indicating Phlegm accumulation in the Heart causing Mania. (*Cui Shi Mai Jue*)
Dian is Double Yin, Mania is Double Yang. Floating and Surging pulses are auspicious omens; Deep and Rapid pulses are ominous disasters. (*Bin Hu Mai Xue*)
A Floating and Surging pulse is a Yang pulse. If obtained in Yang Mania, it suits the syndrome; even if obtained in Yin Dian, it indicates a shift from Yin to Yang, from interior to exterior, so both are auspicious. If Deep and Rapid, Deep implies entering Yin and pressing inward, Rapid implies rigidity and lack of flexibility, representing a pulse without Stomach Qi. Regardless of Mania or Dian, disaster strikes immediately. (*Xu Yan*) [Note: The Dian mentioned here refers to the Mania syndrome.]
What is its pulse? The pulses in all three positions are vigorous, Floating, Large, Slippery, Rapid, and Long. (*Ru Yi Jing Yao*)
Heart Wind
Heart Wind disease presents with spiritual vagueness, irregular joy and anger, and occasional disordered speech. It resembles Dian but is less severe, and is also caused by Phlegm and Qi. One should use Xing Xiang San (Tian Nan Xing, Mu Xiang, decocted with fresh ginger juice) administered with Shou Xing Wan (made of Tian Nan Xing, Cinnabar, Amber). For Heart Meridian latent Heat with irregular episodes, sometimes irritability, and heat sensation in nose and eyes that cannot be controlled, resembling Heart Wind, which subsides temporarily and recurs, use Qing Xin Tang plus Shi Chang Pu. (*Yao Jue*) [Note: Qing Xin Tang was originally Shen Su Yin, now modified according to *Tong Zhi*; the formula for Qing Xin Tang is listed later.]
Chunfu examined Heart Wind disease. Few books record it separately, often attaching it to the Epilepsy section and treating it indiscriminately. Although "Heart Wind" is a secular term, it accurately describes the condition. Ancients said Wind moves swiftly and changes frequently; Feng Bi (Wind Bi) causes numbness. Here, "Heart Wind" does not refer to external Wind invading deeply, but rather the unpredictable changes, vagueness, and numbness of the Heart, truly like a wind demon. These arise from long-term reversal of Seven Emotions and Five Emotions, differing from Epilepsy. Dian, Mania, and Epilepsy syndromes are dominated by blazing Fire and abundant Wind-Phlegm, gradually affecting the Heart, mostly Excess. Heart Wind arises from long-term reversal and obstruction of Seven and Five Emotions. As Dairen said, Liver plans repeatedly, Gallbladder decides rarely, grievances unexpressed, anger unvented. The Heart's function is thought; excessive thinking depletes Heart Blood and stops Spleen fluids, causing Phlegm to confuse the Heart orifices, resulting in Heart Wind, mostly Deficiency. Treatment requires overcoming Seven Emotions with each other, satisfying Five Emotions, nourishing Blood and expelling Phlegm, guiding Spirit back to its residence, treating both root and branch, so this disease can be cured. Confusing it with Epilepsy and attacking it is called "making deficiency more deficient" and accelerating death. (*Yi Tong*)
To treat Heart Wind, induce emotions first, then medicate, for easier effect. Inducing emotions means, for example, for those ill due to greed, inducing them with gold and silver, or feigning gifts, to stabilize their mind before administering medicine. This is the key to treatment. (Ibid.) [Note: Chunfu established the Heart Wind section with several formulas, but they largely overlap with other Heart disease formulas. Now, Zheng Xin Tang is selected and listed in the subsequent Heart-Nourishing section.]
Excessive Laughter
Dairen passed through Gu Bo and met a woman suffering from incessant laughter for half a year. All physicians had exhausted their methods. She sought treatment from Dairen. Dairen said: This is easy to treat. Use two taels of block-shaped Cang Yan (Halite), heat it until red-hot, cool it, grind it fine. Decoct with one large bowl of river water until boiling three to five times. Drink warm in three doses. Stimulate the throat with a hairpin to induce vomiting, expelling five sheng of hot Phlegm. Then administer a large dose of Huang Lian Jie Du Tang. Within a few days, the laughter ceased. *Nei Jing* states: Excess Spirit causes incessant laughter. The Spirit mentioned here is Heart Fire. Fire becomes flame with Wind, hence the image of laughter. Among the Five Elements, only Fire relates to laughter. (*Shi Xing San Liao*)
Huang Lian Jie Du Tang, added with Ban Xia, Zhu Li (Bamboo Sap), and Jiang Zhi (Fresh Ginger Juice), effectively treats incessant laughter. (*Yi Tong*)
Folly Syndrome
Patients with Mania and Folly present with cold extremities. Treating as Mania is ineffective. *Ming Yi Lu* states: This results from Fright, Terror, Worry, and Overthinking. Great Fright injures Heart, Great Terror injures Kidney, Great Worry/Thinking injures Spirit and Will. Insufficient Spirit leads to Mania/Folly; insufficient Will leads to Terror. Terror causes Kidney Qi to stagnate, leading to inability to control legs, also due to accumulated Fright/Terror injuring Kidney. (*Zi Sheng Pian*)
Dementia Syndrome: Generally, those without pre-existing Phlegm develop dementia due to depression, frustration, overthinking, suspicion, or fright. Symptoms include inverted speech, erratic behavior, excessive sweating, or chronic sorrow. The manifestations are bizarre and varied. The pulse is invariably wiry or rapid, large or small, changing unpredictably. This is due to rebellious Qi in the Heart or Liver/Gallbladder meridians, causing turbid Qi. Provided the patient's physique is strong, appetite is normal, and there are no signs of collapse, they are suitable for Man Jian (most stable and effective). Ingredients: Sheng Di, Mai Dong, Shao Yao, Shi Chang Pu, Shi Hu, Dan Pi, Fu Shen, Chen Pi, Mu Tong, Zhi Mu. However, some cases are curable, others not, depending on the strength of Stomach Qi and Yuan Qi. Recovery takes time; do not rush. (*Jing Yue Quan Shu*)
Some individuals speak and eat nothing all day, suddenly laughing or singing, suddenly sorrowful or crying. They reject delicious food but accept filth, refuse clothes but prefer leaves. People consider this "Stupid Disease" and deem it untreatable. However, its formation has causes. Initially, it stems from Liver Qi stagnation; ultimately, from Stomach Qi decline. Liver stagnation causes Wood to overcome Earth, preventing Phlegm transformation; Stomach decline causes Wood to constrain Earth, preventing Phlegm resolution. Thus, Phlegm accumulates in the chest, surrounding the Heart, clouding Spirit and causing stupidity. Treatment: Resolve stagnation, purge Phlegm, strengthen Stomach, promote Qi circulation. Then the mind clears, and stupidity dissipates. (*Bian Zheng Lu*)
Women
Women whose language is disordered and Spirit unsettled due to Blood/Qi confusing the Heart, or due to postpartum lochia rushing upward, should be treated according to their specific syndromes. (*Yi Xue Da Cheng*)
A woman presented with manic shouting, irregular singing/laughing, seeming possessed, with one eye and corner of the mouth pulled up. Treatments for Dian or Heart Wind failed. This was actually an old Head Wind disease exacerbated by Wind-Phlegm. Use Xiong Xin Tang (Fu Zi, Wu Tou, Tian Nan Xing, Gan Jiang, Xi Xin, Chuan Xiong, Gan Cao) plus Fang Feng (10 parts). A few doses brought complete recovery. (*Yao Jue*)
Treatment Principles
Whenever Mania erupts with a desire to run or claims of nobility/divinity, moxibustion should be prepared to ensure permanent cure. (*Zhou Hou Bei Ji Fang*)
Anyone suffering from Dian/Mania, shouting, and hitting others has Heat in the Heart Meridian. Administer Heart-calming medicines combined with Da Huang. After a few days, administer Spirit-calming and Wind-dispersing medicines. Achieving tranquility indicates the calming medicine is working. Do not assume tonification with Warm medicines just because the patient is emaciated and eating less; the disease will relapse. Beware! Adjust diet slowly. (*Yi Shuo* citing *Yu Lan*) [Note: Also cites *Yi Yu* stating that some diseases should not be tonified, and Mania is one of them.]
Mania is best treated with drastic purgation and emesis to remove the pathogen. Treatment: For Phlegm, induce vomiting with San Sheng San. For Fire, purge with Cheng Qi Tang. For Fright, calm with An Shen Wan. (*Dan Xi Xin Fa*)
How to treat? Diminish the excess Yang of the Six Fu Organs, nourish the deficient Yin of the Five Zang Organs, ensuring Yin and Yang harmony without bias. That is all. How can it be treated merely as Phlegm? (*Ru Yi Jing Yao*)
Ancient treatments for Wind-Fire Dian/Mania considered them all Excess, often using Wind-dispersing and Fire-purging mineral agents. Some were effective, others prolonged the illness. I believe this disease always arises from prior deficiency of Zang Spirit, allowing Wind pathogen to enter. Excess refers to pathogenic excess, Deficiency refers to righteous Qi deficiency. One must not adhere to a single view. Instead, assess the patient's Excess/Deficiency and Cold/Heat, then clear Phlegm, descend Fire, calm Spirit, and nourish Blood. Many achieve success. (*Zhu Zheng Bian Yi*)
Emetic Methods
Blood and Qi are the Spirit of the body. When Spirit declines, pathogen enters. With both Blood and Qi deficient, Phlegm lodges in the Middle Jiao, obstructing function, causing the Twelve Officials to lose their duties, leading to false perceptions and actions in vision, hearing, speech, and movement. Emetic therapy is indicated for cure. (*Dan Xi Xin Fa*)
For those with suppressed grief and depression, where Phlegm and food knot in the chest, causing manic singing/crying, exposure, cursing, staring blankly, with a Deep, Firm, and Knotted pulse, one must induce vomiting to expel accumulated Phlegm and congealed Blood, clearing the Upper Jiao for cure. (*Hui Bu* citing Ru Yan)
For treating Heart Wind with emetics, Gua Di San (*Quan Sheng Zhi Mi Fang*). Zhang Deming took it mixed with other meds, vomited much saliva, and recovered. Physician Chen Wugong also found it effective (Note: This is Zhang Zhongjing's original formula minus Xiang Chi). Take 1 qian with hot rice water, 0.5 qian for frail persons. Stop once vomiting occurs. Deming took 3 qian mixed, vomited, took it again after a few days, and fully recovered. (*Shi Zhai Bai Yi Xuan Fang*)
Empirical treatment for all women's Heart diseases, Dian/Mania caused by extreme Fright/Worry and Phlegm invading the Pericardium.
Use Ku Ding Xiang (Sweet Melon Seed/Gua Di) 0.5 liang ground to powder. Take 1 qian, mix well with well-water, drink a full cup. Profuse vomiting follows. Let the patient sleep deeply without disturbance; they will recover naturally. (*Yong Lei Qian Fang*) *De Xiao Fang* calls this Du Xiao Ku Ding Xiang San, treating sudden Heart disease, incessant Dian/Mania caused by extreme Fright/Worry. (Note: *Xin Fa Fu Yu* adds Qing Fen, calling it Yong Xie San; the formula originates from *Ben Cao Yan Yi*, recorded in *Tan Xian*, consult there.)
Treating Heart ailments, Yi Zui San (Note: *Gang Mu* calls it Yi Zui Gao).
Wu Hui Jiu (Unfermented Wine, 2 bowls) Zhen Xiang You (True Sesame Oil, 4 liang)
Mix well. Stir with 20 willow branches 100-200 times, replacing branches until the oil and wine emulsify into a paste ( *De Xiao Fang* omits "emulsify"). Decoct to 0.7 bowl. Force-feed to manic patients to induce deep sleep. Whether they vomit or not, they wake up lucid. (*Yong Lei Qian Fang*)
Purgative Methods
Xu suffered from Yang Jue (Yang Reversal) with Angry Mania, cursing without discrimination, crying or singing, weak pulses upon lifting and pressing, body cold as ice stone, loud screaming upon attack. Jiegu said: Starve them, and it ends. So, no food was given. I used Da Cheng Qi Tang to purge, obtaining several sheng of fecal matter. Mania subsided slightly. Relapsed after a few days, purged again. Repeated 5-7 times, passing several sheng of stool. Disease eased, body warmed, pulse returned, good recovery. This is Elder Liu's method of starvation. (*Yin Zheng Lue Li*)
Note: Dian/Mania diseases involve Phlegm-Heat binding, mostly in the Liver/Gallbladder and Bao Luo (Collaterals). In my experience, administering Meng Shi Gun Tan Wan 2-3 qian expels sticky Phlegm like peach gum or clam meat (approx. 5 sheng), curing the patient. If Phlegm is scant and Heat is excessive, with Yangming Interior Excess, follow Luo Qianfu's treatment of Chusi Wulan (fever, mania, thirst): use Da Cheng Qi Tang 1.5 liang plus Huang Lian 2 qian to purge Heat, until bowel movement and sweating occur, then cure. (*Jin Kui Yi*)
Dang Gui Cheng Qi Tang.
Dang Gui, Da Huang (1 liang each), Gan Cao (0.5 liang), Mang Xiao (9 qian)
Grind to hemp-seed size. Take 2 liang per dose. Decoct with 1 large bowl of water, 5 slices of fresh ginger, 10 jujubes, until half a bowl remains. Strain and take hot. For Yang Mania with running and cursing, this indicates Yang Excess and Yin Deficiency. Da Huang and Mang Xiao purge Stomach Real Heat. Dang Gui nourishes Blood and benefits Yin. Gan Cao moderates the middle. Adding ginger and jujube guides the medicine to the Stomach (Earth). As the classics say: Treat mild cases oppositely, severe cases similarly. This is the meaning. Aim for profuse purgation. If mild/slow, use Gua Di San plus Fang Feng and Li Lu to induce vomiting; the disease heals itself. Afterwards, regulate with Xi Xin San, Liang Ge San, and Jie Du Tang. (*Bao Ming Ji*) [Note: Zhang Zihe has a case of Mania treated with Wei Cheng Qi Tang causing massive purgation of bloody water and stasis.]
Xie Xin Tang treats Heart receiving accumulated Heat, delirious speech, Mania, climbing walls and roofs. (*De Xiao Fang*) [Note: i.e., San Huang Tang.]
San Huang Wan, coated with Chen Sha, taken with fresh water, 70-80 pills. A woman, after Shanghan, discarded clothes and ran every noon, deliriously cursing without discrimination. She was cured by taking this. (*Yi Lin Ji Yao*)
Qing Xin Tang is Liang Ge San plus Huang Lian. (Ibid.)
Niu Huang Xie Xin Tang treats Heart Meridian Evil Heat, delirious speech, mental unrest.
Nao Zi (Camphor, 2.5 qian), Niu Huang (2.5 qian), Da Huang Mo (Raw, 1 liang), Zhu Sha (2.5 qian)
Grind extremely fine together. Take 3 qian per dose, mixed with fresh ginger and honey water. (*Yu Yao Yuan Fang*)
I treated a man from Qingshui Bay, Kunshan, who went mad. First, I needled Baihui, Shenting, and Renzhong points. Then, administered Shu Qi (stir-fried with water, 1 qian), Long Gu ( ), Mu Li (3 qian each), Huang Lian (5 fen), Raw Da Huang (3 qian). Decocted in water and taken orally. One dose brought peace.
Note: Mania syndromes always originate from Fright; Long Chi (Dragon Tooth) best calms the Hun (Ethereal Soul). There is no Mania without Phlegm; Fright causes Qi reversal, Qi reversal gathers Phlegm; Shu Qi best seizes Phlegm. There is no Mania without Fire; Fire flares upward, hence singing on heights and discarding clothes; Huang Lian purges Heart Fire. The disease belongs to Yangming, so Da Huang is used to purge it, the "drawing fire from under the pot" method. (He Nian) (*Jin Kui Yi*)
Kong Xian Dan (*San Yin Fang*) treats Phlegm confusing orifices, delirious speech with hallucinations. (*Xiu Zhen Fang*) (The three ingredients are the original formula; current *San Yin Fang* version is unverifiable.)
For Heart Wind with Heat and abundant Phlegm, use Gun Tan Wan. (*Dan Xi Xin Fa*)
An Shen Gun Tan Wan.