（《灵枢·癫狂篇》《素问·长刺节论》《通评虚实论》）
目 外决于面者为锐 ，在内近鼻者为内 ；上为外 ，下为内 。
（《灵枢·癫狂篇》。目 ，眼角也。目之外角曰锐 ，目之内角曰内 ，此以中外言也。若以上下言之，则目之上
网亦曰外 ，目之下网亦曰内 。按∶本篇所论， 癫狂厥逆之病，而此节所言目 若不相涉者何也？盖以癫狂等疾，
须察神气，欲察其神，当从目始。且内 外 、上网下网，各有分属，病在何经，于此可验，故首及之，示人以知所先
也。 音渍。）癫疾始生，先不乐，头重痛，视举目赤，甚作极已而烦心，候之于颜，取手太阳、阳明、太阴，血变而止。
（先不乐，神志将乱也。头重痛、视举目赤，厥气上行也。甚作极已而烦心，躁急不宁也。此皆癫疾将作之兆。颜，天
庭也。候之于颜，邪色必见于此也。当取手太阳支正、小海，手阳明偏历、温溜，手太阴太渊、列缺等穴，泻去邪血，
必待其血色变而后止针也。）癫疾始作而引口啼呼喘悸者，候之手阳明、太阳，左强者攻其右，右强者攻其左，血变而止。
（引口者，牵引歪斜也。或为啼呼，或为喘悸，当候于手阳明太阳二经，察病所在而刺之，穴如前。强，坚强也。左右
牵引，病多在络，故左强者当攻右，右强者当攻左，必候其血变而止，此缪刺之法也。悸音匮，心动也。）癫疾始作，先
反僵，因而脊痛，候之足太阳、阳明、太阴、手太阳，血变而止。（反僵，反张僵仆也。足太阳之委阳、飞阳、仆参、金
门，足阳明三里、解溪，足太阴隐白、公孙等穴皆主之。手阳明经穴同前。僵音姜。）治癫疾者，常与之居，察其所当取
之处。病至，视之有过者泻之，置其血于瓠壶之中，至其发时，血独动矣，不动，灸穷骨二十壮，穷骨者 骨也。（凡治
癫疾者，须常与之居，庶得察其病在何经，及当取之处，不致谬误也。故必于病至之时，视其有过之所，刺出其血以验
其可灸与否。瓠壶，瓠卢也。若前病发而瓠中之血不动者，乃可灸之。 骨，即督脉之长强穴。瓠音户。 音氐。）骨癫
疾者， 齿诸 分肉皆满，而骨居汗出烦 。呕多沃沫，气下泄，不治。（骨癫疾者，病深在骨也。其 齿诸穴分肉之间，
皆邪气壅闭，故为胀满。形则 羸，唯骨独居，汗出于外，烦闷于内，已为危证；若呕多沃沫，气泄于下者，尤为脾肾
俱败，必不可治。 音坎，又海敢切，义详经络类十三。 ，美本切，又音瞒。）筋癫疾者，身倦挛，急大，刺项大经之
大杼脉。呕多沃沫，气下泄，不治。（筋癫疾者，病在筋也。其身倦怠拘挛，其脉急大，当刺项下足太阳经之大杼穴。若
上而呕沫，下而泄气，亦不治之证。）脉癫疾者，暴仆，四肢之脉皆胀而纵。脉满，尽刺之出血；不满，灸之挟项太阳，
灸带脉于腰相去三寸，诸分肉本输。呕多沃沫，气下泄，不治。（脉癫疾者，病在血脉也。暴仆，猝倒也。纵，弛纵也。
治此者，如脉胀满，则尽刺之以出其血。如脉不满，则灸足太阳经挟项之天柱、大杼穴，又灸足少阳经之带脉穴，此穴
相去于腰计三寸许。诸分肉本输，谓诸经分肉之间及四肢之输，凡胀纵之所，皆当取也。若呕沫泄气者，亦不必治。）癫
疾者，疾发如狂者，死不治。（癫病发于阴，狂病发于阳。故二十难曰∶重阳者狂∶重阴者癫也。然阳多有余，故狂发无
时，其状疾而暴；阴多不足，故癫发有期，其状静而徐。此癫狂之辨也。今以癫疾而如狂者，阳邪盛极而阴之竭也，故
死不治。）
狂始生，先自悲也，喜忘苦怒善恐者，得之忧饥，治之取手太阴、阳明，血变而止，及取足太阴、阳明。（此下六节，
皆言狂病也。神不足则悲，魂伤则狂忘不精，志伤则善忘其前言，肝乘脾则苦怒，血不足则善恐，皆得之忧而且饥，致
伤脏气也。取手太阴之太渊、列缺，手阳明之偏历、温溜，足太阴之隐白、公孙，足阳明之三里、解溪等穴，并可治之，
必俟其血色变而止针也。）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，治之取手阳明、太
阳、太阴、舌下、少阴，视之盛者皆取之，不盛释之也。（上节言始生，病生之初也。此节言始发，病成而发也。其为少
卧不饥等候，狂病之发，大概如此。手阳明、太阳、太阴经穴俱如前。舌下者，任脉之廉泉也。少阴者，心经之神门、
少冲也。于此诸经，必视其盛者皆取之，若其不盛则当释之无论也。诸治皆然。）狂言、惊、善笑、好歌乐、妄行不休者，
得之大恐，治之取手阳明、太阳、太阴。（恐伤志，故为惊为笑为歌乐妄行也。手阳明、太阳、太阴穴，俱见前第二节。）
狂，目妄见、耳妄闻、善呼者，少气之所生也，治之取手太阳、太阴、阳明、足太阴、头两 。（气衰则神怯，所以妄见
妄闻而惊呼也。手太阳、太阴、阳明、足太阴经穴，俱见前二节四节。头两 ，义亦如前。）狂者多食，善见鬼神，善笑
而不发于外者，得之有所大喜，治之取足太阴、太阳、阳明，后取手太阴、太阳、阳明。（多食见鬼善暗笑者，以大喜伤
神所致。《难经》曰∶脱阳者见鬼，脱阴者目盲也。足太阴、太阳、阳明穴，如前四节。手太阴、太阳、阳明穴，如前二
节。）狂而新发，未应如此者，先取曲泉左右动脉，及盛者见血，有顷已，不已以法取之，灸骨 二十壮。（未应如此者，
谓狂病新起，未有如上文五节之见证也。宜先取足厥阴肝经之曲泉穴，左右皆刺之，及诸经之脉有盛者皆出其血，有顷
病当自已，如不已则当照前五节求法以取之，仍灸督脉之长强穴二十壮。）
病在诸阳脉，且寒且热，诸分且寒且热，名曰狂
（《素问·长刺节论》。阳胜则为狂病，凡病在诸阳分，而经脉分肉之间且寒且热者，皆阳邪乱其血气，热极则生寒
也，故病为狂。）刺之虚脉，视分尽热病已止。（刺之虚脉，谓泻其盛者使之虚也。然必视针下诸分尽热，则气至邪退，
其病已而止针也。）病初发岁一发不治，月一发不治，月四五发名曰癫病。（阴胜则为癫病。岁一发、月一发者，气深道
远，有宿本也，故不易治。月四五发者，暴疾耳，其来速其去亦速，此为可治者也。）刺诸分诸脉，其无寒者，以针调之，
病已止。（诸分诸脉，刺法如前。若其无寒者，则癫疾亦有阳邪，或泻或补，当用针调之也。按∶《甲乙经》曰∶刺诸分
其脉尤寒者，以针补之。是仍言为阴证。）
刺痫惊脉五
（《素问·通评虚实论》。五脉如下文。痫音闲，癫病。）针手太阴各五刺经，（刺手太阴之经，经渠穴也。各五，以
左右手各五 也。下亦然。）太阳五，（亦以手太阳经穴言，当是阳谷穴。）刺手少阴经络旁者一，（手少阴之经穴，灵台
也，在络穴通里之旁，故曰络旁者一。）足阳明一，（亦言经穴解溪也。）上踝五寸刺三针。（足少阳胆经之络，光明穴也。
三针，即三 。）
(From *Ling Shu: Dian Kuang Pian*, *Su Wen: Chang Ci Jie Lun*, *Tong Ping Xu Shi Lun*)
The part of the eye extending outward to the face is called Rui (outer canthus); the part extending inward toward the nose is called Nei (inner canthus). From a superior-inferior perspective, the upper eyelid margin is referred to as "Outer," and the lower eyelid margin as "Inner."
(From *Ling Shu: Dian Kuang Pian*. The term "eye corner" refers to the canthi. The outer angle of the eye is termed Rui, and the inner angle Nei; this distinction is based on medial-lateral orientation. If described by superior-inferior position, the upper palpebral fissure is also called Outer, and the lower palpebral fissure Inner. Note: This chapter discusses diseases such as Dian (catatonic schizophrenia), Kuang (manic psychosis), and Jue Ni (reversal coldness), yet this section on ocular features seems unrelated. Why? Generally, for diseases like Dian and Kuang, one must observe the Shen (Spirit/Qi). To observe the Shen, one should start with the eyes. Furthermore, the Nei, Rui, upper lid, and lower lid each correspond to specific meridians; the affected meridian can be verified through these signs. Thus, they are mentioned first to indicate the priority of diagnosis.) When Dian disease begins, the patient first feels unhappy, experiences heavy head pain, upward deviation of the eyes with redness of the sclera, and after severe exhaustion, becomes irritable. Observation should focus on the Yan (forehead/Tian Ting area). Treatment involves selecting points from the Hand Taiyang, Hand Yangming, and Hand Taiyin meridians. Needling should continue until the blood color changes (from dark to bright red).
(Unhappiness indicates impending disorder of the Spirit. Heavy head pain, upward eye deviation, and red sclera result from the upward reversal of Jue Qi (counterflow qi). Severe exhaustion followed by irritability indicates restlessness and agitation. These are precursors to Dian. Yan refers to the Tian Ting (central forehead). Pathological colors manifest here. Points to select include Zhi Zheng (SI8) and Xiao Hai (SI81) of the Hand Taiyang; Pian Li (PC6) and Wen Liu (LI37) of the Hand Yangming; and Tai Yuan (LU9) and Lie Que (LU7) of the Hand Taiyin. Discharge pathogenic blood until the color changes, then stop needling.) When Dian disease begins with oral traction (corner of the mouth pulled), crying/calling out, panting, and palpitations, observe the Hand Yangming and Hand Taiyang meridians. If the left side is rigid, treat the right; if the right is rigid, treat the left. Stop when the blood color changes.
(Oral traction refers to deviation of the mouth. Crying or panting/palpitations require observation of the Hand Yangming and Hand Taiyang meridians to locate the pathology and needle accordingly. Rigid means stiff/spastic. Traction on left or right suggests pathology in the Luo (Collateral) vessels; thus, left rigidity requires treating the right, and vice versa. This is the Miao Ci (Miraculous Puncture) method. Ji refers to heart palpitations.) When Dian disease begins with opisthotonos (backward arching stiffness) followed by spinal pain, observe the Foot Taiyang, Foot Yangming, Foot Taiyin, and Hand Taiyang meridians. Stop when the blood color changes.
(Opisthotonos refers to backward arching and collapse. Points include Wei Yang (BL38), Fei Yang (BL58), Pu Can (BL60), Jin Men (BL53) of the Foot Taiyang; Zu San Li (ST36) and Jie Xi (ST41) of the Foot Yangming; Yin Bai (SP1) and Gong Sun (SP4) of the Foot Taiyin. Hand Yangming points are as previously stated.) Physicians treating Dian should reside near the patient to observe where to needle. Upon onset, identify areas of excess and drain them. Place the extracted blood in a Hu Hu (gourd vessel). At the next发作 (attack), the blood in the gourd will move independently. If it does not move, moxa Qiong Gu (sacrum/Coccyx, specifically Chang Qiang GV1) for 20 moxa cones.
(Gu Dian (Bone Dian) implies deep pathology in the bones. The muscles around the teeth and throughout the body are full/distended due to pathogenic obstruction. The form is emaciated, with bones protruding, sweating externally, and internal烦闷 (oppression/irritability), indicating a critical condition. If accompanied by vomiting copious saliva/phlegm and downward leakage of Qi, it signifies failure of Spleen and Kidney and is incurable.) In Jin Dian (Sinew Dian), the body is fatigued and spasmodic, and the pulse is rapid and large. Needle Da Zhu (BL11) in the neck (Foot Taiyang meridian). If accompanied by vomiting phlegm and downward Qi leakage, it is incurable.
(Jin Dian implies pathology in the sinews. Fatigue and spasms with a rapid/large pulse indicate the need to needle Da Zhu. Upper vomiting and lower Qi leakage indicate incurability.) In Mai Dian (Vessel Dian), the patient suddenly collapses, and the vessels of the four limbs are distended and flaccid. If the vessels are fully distended, needle all affected areas to bleed. If not fully distended, moxa the Taiyang vessels flanking the neck (Tian Zhu BL10, Da Zhu BL11), the Dai Mai (Belt Vessel) point three cun from the waist, and the Ben Shu (Source Points) in the muscle spaces. If accompanied by vomiting phlegm and Qi leakage, it is incurable.
(Mai Dian implies pathology in the blood vessels. Bao Pu means sudden collapse. Zong means flaccidity. If vessels are distended, bleed them. If not, moxa Tian Zhu and Da Zhu of the Foot Taiyang, and Dai Mai of the Foot Shaoyang (approx. 3 cun from waist). Ben Shu refers to source points in muscle spaces. Vomiting/Qi leakage indicates incurability.) If Dian attacks resemble Kuang (mania), it is a death sign and incurable.
(Dian originates from Yin; Kuang originates from Yang. As stated in *Nan Jing*: Excess Yang leads to Kuang; Excess Yin leads to Dian. Yang is often excessive, so Kuang has no fixed timing and presents acutely/violently. Yin is often deficient, so Dian has periodicity and presents quietly/slowly. This distinguishes Dian from Kuang. Dian presenting with Kuang symptoms indicates extreme Yang pathogen and exhaustion of Yin, hence fatal.)
When Kuang disease begins, the patient first feels sad, forgetful, prone to anger, and fearful. This results from worry and hunger. Treat by selecting Hand Taiyin and Hand Yangming points until blood color changes, and also select Foot Taiyin and Foot Yangming points.
(The following six sections discuss Kuang. Deficient Shen causes sadness; damaged Hun causes madness/amnesia; damaged Zhi causes forgetfulness; Liver overacting on Spleen causes anger; Blood deficiency causes fear. All result from worry and hunger damaging Zang Qi. Points include Tai Yuan (LU9), Lie Que (LU7), Pian Li (PC6), Wen Liu (LI37), Yin Bai (SP1), Gong Sun (SP4), Zu San Li (ST36), Jie Xi (ST41). Continue needling until blood color changes.) When Kuang first manifests, there is little sleep, lack of appetite, grandiosity (believing oneself wise/smart/noble), cursing, and ceaseless day-and-night activity. Treat by selecting Hand Yangming, Hand Taiyang, Hand Taiyin, sublingual (Ren Mai Lian Quan CV23), and Foot Shaoyin (Heart Meridian Shen Men HT7, Shao Chong HT9) points. Select those that are full/excess; release those that are not.
(The previous section discussed onset (Sheng); this discusses manifestation (Fa). Little sleep and anorexia are typical of Kuang. Sublingual refers to Lian Quan. Shaoyin refers to Heart Meridian points. Select excess points; ignore non-excess ones. This applies generally.) With Kuang, characterized by delirious speech, fright, excessive laughter, singing/humming, and aimless walking, caused by great shock/fear, treat by selecting Hand Yangming, Hand Taiyang, and Hand Taiyin points.
(Fear damages Zhi, leading to fright, laughter, singing, and aimless walking. Points as cited in Section 2.) For Kuang with visual/auditory hallucinations and frequent calling, caused by Qi deficiency, treat by selecting Hand Taiyang, Hand Taiyin, Hand Yangming, Foot Taiyin, and bilateral Head points.
(Qi deficiency leads to weak Shen, causing hallucinations and calls. Points as cited in Sections 2 and 4. Head points refer to bilateral locations as previously defined.) For Kuang with polyphagia, seeing spirits/gods, and suppressed laughter, caused by excessive joy, treat by selecting Foot Taiyin, Foot Taiyang, and Foot Yangming, followed by Hand Taiyin, Hand Taiyang, and Hand Yangming.
(Polyphagia, hallucinations, and suppressed laughter result from Joy damaging Shen. *Nan Jing* states: Loss of Yang leads to seeing spirits; Loss of Yin leads to blindness. Points as cited in Sections 2 and 4.) For newly onset Kuang without the aforementioned five sets of symptoms, first select Qu Quan (LR8) arterial points on both sides, and bleed any full vessels. After a while, the disease should cease. If not, apply methods from the previous five sections, and moxa Qiong Gu (Chang Qiang GV1) for 20 cones.
("Not corresponding" means new onset without classic symptoms. First needle Qu Quan bilaterally and bleed excess vessels. If unresolved, follow previous protocols and moxa Chang Qiang.)
For pathology in the Yang meridians, alternating chills and fever in the meridians and muscle spaces is named Kuang.
(From *Su Wen: Chang Ci Jie Lun*. Yang excess causes Kuang. Alternating chills/fever in Yang divisions indicates Yang pathogen disturbing Blood and Qi; extreme heat generates cold. Hence, Kuang.) Deplete the vessels by needling. Observe the muscle spaces; stop when heat dissipates and the disease resolves.
(Depleting vessels means reducing excess. Stop when heat subsides, indicating Qi arrival and pathogen retreat.) If Kuang/Dian occurs once a year or once a month at onset, it is incurable. If it occurs 4-5 times a month, it is named Dian.
(Yang excess causes Kuang; Yin excess causes Dian. Annual/monthly occurrence implies deep pathology with root causes, making it hard to treat. Frequent monthly occurrence is acute/fast-resolving, hence treatable.) Needle the various muscle spaces and vessels. If there is no cold, regulate with needles until the disease resolves.
(If no cold, Dian may involve Yang pathogens; use tonification or sedation via needling. *Jia Yi Jing* notes: If vessels are very cold, use tonification, indicating a Yin syndrome.)
Five Methods for Needling Xian (Epileptic) Convulsions
(From *Su Wen: Tong Ping Xu Shi Lun*. Xian sounds like Jian, referring to Dian/Epilepsy.)
Needle Hand Taiyin five times (Jing Qu LU8). Five times refers to five needles per hand bilaterally. Similarly for others.
Hand Taiyang five times (Yang Gu SI5).
One needle beside the Hand Shaoyin Luo collateral (Ling Tai is likely a textual error for a Heart point near Tong Li PC4, or referring to a specific point adjacent to the Luo).
Foot Yangming one time (Jie Xi ST41).
Three needles five cun above the ankle malleolus (Guang Ming GB37, Foot Shaoyang Luo collateral). Three needles refers to three insertions/cones.