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In the *Suwen: Tongping Xushi Lun* (Plain Questions: Discussion on Excess and Deficiency), the Yellow Emperor asked: What are the manifestations of Dian disease (epilepsy/mental disorder)? Qibo replied: If the pulse is large and slippery, the disease may resolve spontaneously after a long period; if the pulse is small, firm, and rapid, it is a fatal condition that cannot be treated. The Yellow Emperor further asked: Regarding the pulse of Dian disease, what about excess and deficiency? Qibo answered: Deficiency can be treated, but excess indicates a poor prognosis and difficulty in cure.

This passage clarifies the severity and prognosis of Dian disease. It arises from external pathogens and turbid phlegm knotting within the blood vessels. Since the heart governs the blood vessels, the phlegm muddies the orifices of the heart, leading to confusion and loss of spirit. If the fu organs' qi flows smoothly, allowing normal eating and defecation, death will not occur. Pathogens residing in the Yang aspect manifest as Kuang syndrome (mania/excitement), characterized by extreme behaviors like killing or arson; pathogens residing in the Yin aspect manifest as Dian syndrome (depression/apathy), characterized by unconsciousness or lack of awareness. Because the pathogen is excess, the pulse is forceful and large against the finger. Slipperiness indicates that Qi and Blood are still circulating freely; over time, the pathogen declines and phlegm resolves, allowing self-healing. If the pulse is small, Yuan Qi (Original Qi) has been damaged; if firm and rapid, the pathogen is deeply entrenched, leading inevitably to death. If the pulse is not large and forceful but weak, the pathogenic knot is not severe, and supporting Zheng Qi (Upright Qi) to resolve the pathogen is possible. If the pulse is not slippery but merely firm, the pathogenic knot is severe and lacks the harmonizing Qi of Yang, resulting in death and untreatability.

In the *Zhu Jue Pian* (Chapter on Various Jue Syndromes), there is a syndrome called "Nulang" (Anger-induced Mania), treated with Tieluo Yin (Iron Filings Decoction). This occurs because Yang pathogens are extremely hyperactive, named Yang Jue (Yang Reversal), and should be viewed in conjunction with this text.

The *Lingnu: Dian Kuang Pian* (Spiritual Pivot: Chapter on Dian and Kuang) states: When Dian disease first begins, the patient initially feels unhappy, experiences heavy head pain, red eyes, extreme agitation, and subsequently mental restlessness. Observation should be focused on the Yan (face/forehead area). Acupuncture points from the Hand Taiyang, Hand Yangming, and Hand Taiyin meridians should be selected until the blood color changes [to normal].

Dian disease involves the hand meridians, where pathogens knot in the blood vessels. Initially, stagnant heat rises upward, causing initial unhappiness, heavy head pain, red eyes, and mental restlessness upon extreme发作 (paroxysm). The Yan refers to the Que Ting (glabella and forehead region), which corresponds to the Heart and Lung areas. Therefore, observation should focus on the face to assess the floating/sinking and brightness/darkness of the complexion, thereby distinguishing the severity of the pathogen and the strength of Zheng Qi. Selecting the Hand Taiyang Small Intestine Meridian, Hand Yangming Large Intestine Meridian, and Hand Taiyin Lung Meridian helps to drain the pathogen. When the blood color returns to its normal hue, the pathogen is expelled and recovery ensues. This describes acupuncture methods; if using herbal medicine, treatment should also target these three meridians and their associated zang-fu organs.

When Dian disease first starts, accompanied by mouth deviation, crying out, panting, and palpitations, observe the Hand Yangming and Hand Taiyang meridians. If stiffness is stronger on the left, treat the right side; if stronger on the right, treat the left side. Stop when the blood color changes.

This represents wind stirring due to phlegm obstruction, a combination of Dian and Xian (epileptic seizure) syndromes. Hence, there is mouth deviation, crying, panting, and palpitations, with limb stiffness on either the left or right side. By examining the Large Intestine and Small Intestine meridians for acupuncture, if the pathogen is on the left, the right side becomes stiff, so treat the left; if the pathogen is on the right, the left side becomes stiff, so treat the right. This is because pathogen obstruction in the meridians prevents Qi and Blood from flowing into areas without pathogens, causing tendons and vessels to become dry, urgent, and stiff.

When Dian disease first starts, the body arches backward rigidly, followed by spinal pain. Observe the Foot Taiyang, Foot Yangming, Foot Taiyin, and Hand Taiyang meridians. Stop when the blood color changes.

"Fan Jiang" (backward rigidity) resembles opisthotonos, followed by spinal pain, because the Foot Taiyang Meridian runs along the back, and pathogen obstruction causes backward arching and pain. Treating the Spleen and Stomach meridians (Foot Yangming and Foot Taiyin) is necessary because they govern the Yin and Yang of the whole body. However, treatment still involves the hand meridians, as the Small Intestine is the Fu organ of the Heart, and Heart diseases must drain their corresponding Fu organ.

Those treating Dian disease should reside frequently with the patient to observe and determine the appropriate acupuncture sites. When the disease strikes, observe the patient; if there is an area of excess, apply draining techniques. Place the extracted blood in a gourd vessel. At the time of the next paroxysm, the blood in the vessel will move independently. If it does not move, moxa twenty Zhu (moxa cones) at the Qionggu (coccyx). The Qionggu is the coccyx bone.

Dian pathogens knot in the Blood level, so treatment requires puncturing to extract blood, placed in a gourd vessel. The blood moving at the time of the paroxysm illustrates the principle of mutual resonance ("when copper mountains collapse, bells in Luoyang ring"). If the blood moves, it indicates that Yuan Qi is not yet exhausted, and the condition is treatable. If it does not move, moxa the coccyx to assist the Yang of the Du Mai (Governing Vessel) to open the knotted pathogens. According to the above syndromes, these refer to conditions that come and go intermittently, such as the secular term "Sheep Epilepsy," rather than dementia or idiocy, with no periods of mental clarity. Such conditions injure the Liver, Kidney, and Heart Zang organs. If accompanied by vomiting froth and downward leakage of Qi, it indicates failure of the Spleen and Stomach, resulting in death and untreatability.

If Dian disease manifests like Kuang (mania) during attacks, it is a fatal condition that cannot be treated.

Pathogens in the Yin aspect constitute Dian; those in the Yang aspect constitute Kuang. If the pathogen originally resides in the Yin aspect but suddenly manifests like Kuang, it means the pathogen has spread throughout both Yin and Yang, and Yuan Qi has failed. Thus, it is a fatal condition that cannot be treated.