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Mania and melancholia (Dian Kuang) are diseases involving the Heart, Spleen, Liver, and Stomach. The Classics state: "Excess Yin leads to melancholia (Dian), excess Yang leads to mania (Kuang); when Yang merges into Yin, it is melancholia; when Yin merges into Yang, it is mania." Melancholia is characterized by excessive laughter and belongs to deficiency of the Heart and Spleen. Mania is characterized by anger and belongs to excess in the Liver and Stomach. Symptoms of melancholia include laughing or singing at times, weeping or crying at other times, appearing intoxicated or foolish, speaking incoherently, lacking awareness of cleanliness or filth, and persisting for years without cure. This often arises from stagnation and knotting of Qi in the Heart and Spleen due to unfulfilled aspirations, or from fright and alarm causing the Spirit (Shen) to lose its residence. Symptoms of mania include alternating sadness and joy, forgetfulness, irritability, fear, little sleep, lack of appetite, self-aggrandizement, and arrogance. This is a disease of the Heart. Alternatively, mania may result from pathogenic factors merging with the Yangming channel, manifesting as cursing others regardless of kinship, climbing high places to sing, discarding clothes and running, fasting for several days, and climbing over walls and roofs. This is due to Stomach Fire. Another type is "Yang Jue" (Yang Reversal), caused by sudden frustration of Yang Qi leading to indecision and violent anger. This often stems from indecisiveness in the Liver and Gallbladder, where grievances cannot be expressed and anger has no outlet, causing Wood and Fire pathogens to combine. When attacking the Heart, the Soul and Spirit lose their control; when attacking the Stomach, violence becomes uncontrollable. In summary, both melancholia and mania are caused by Self-burning of Heart Fire and Phlegm confusing the orifices and collaterals. Thus, early-stage melancholia presents with emotional abnormality resembling mania; long-standing mania presents with confused Spirit and Soul resembling melancholia. To treat melancholia, first expel Phlegm using Kongxian Dan (Control Saliva Pill); then restore the Spirit using Hupo San (Amber Powder); nourish Yin using Ziyin Anshen Tang (Nourish Yin and Calm Spirit Decoction). To treat mania, first deprive food intake (as food enters Yin and generates Yang); then purge Phlegm using Anshen Guntan Wan (Calm Spirit and Roll Down Phlegm Pill); descend Fire using Shengtieluo Yin (Raw Iron Drop Drink). Raw Iron Drop is used because Metal controls Wood; when Wood is balanced, Fire descends. If these conditions arise from anger stirring Liver Fire and Wind-Phlegm surging upward, use Daotan Tang (Guide Phlegm Decoction) added with Huangqin (Scutellariae Radix), Lianzi (Coptidis Rhizoma), Shichangpu (Acori Tatarinowii Rhizoma), and Yuanzhi (Polygalae Radix), decocted and mixed with Chen Sha (Cinnabar) juice and Chenxiang (Aquilariae Lignum Resinatum) juice. If Phlegm-Fire has been stagnant for a long time causing vague consciousness, use Niuhuang Qingxin Wan (Calves' Bezoar Clearing Heart Pill). If fright and worry cause Qi knotting and Phlegm-Blood obstruction, use Baijin Wan (White Gold Pill). If Heart deficiency causes palpitations and restless sleep, use Buxin Dan (Tonify Heart Pill). If Heart Qi deficiency causes the Spirit to lose its residence, use Guishen Dan (Return Spirit Pill) or a large dose of Dushen Tang (Single Ginseng Decoction). For chronic melancholia that does not heal, one must nourish the Spirit and regulate emotions using Guipi Tang (Restore the Spleen Decoction) or Zhonggan Dan (Pillow Center Pill). For chronic mania that does not heal, one must strengthen Water to control Fire using Er Yin Jian (Two Yin Decoction) or Shengshu Yangxin Tang (Raw and Cooked Nourishing Heart Decoction). These are the general principles of treatment, which depend on analyzing the deficiency or excess of pulse and symptoms.

[Melancholia and Mania] Caused by fright and worry, use Baodan Wan (Embrace Gallbladder Pill). Caused by depression and anger, use Anshen Daotan Tang (Calm Spirit and Guide Phlegm Decoction). With both Phlegm and Fire abundant, use Gansui San (Kansui Powder) to induce vomiting or purgation. With sudden congestion of Phlegm-Fire causing bizarre manifestations, use Qingxin Guntan Wan (Clear Heart and Roll Down Phlegm Pill). With Qi knotting transforming into Phlegm and blocking mental clarity, use Siqi Tang (Four Seven Decoction). With Heart heat and restlessness, use Qinlian Qingxin Wan (Scutellaria and Coptis Clearing Heart Pill). With Yin deficiency causing dizziness and collapse, use Ziyin Anshen Tang (Nourish Yin and Calm Spirit Decoction). With Phlegm confusing the Heart orifice, use Jinbo Zhenxin Wan (Gold Foil Settling Heart Pill). With overthinking and stagnation, use Guipi Tang (Restore the Spleen Decoction) added with Chen Sha (Cinnabar). With mental doubt and fear, use Dingzhi Wan (Stabilize Will Pill). With Heart Qi and Blood deficiency, use Qingxin Wendan Tang (Clear Heart and Warm Gallbladder Decoction). After illness, with weak Spirit and timid Qi, use Guishen Dan (Return Spirit Pill). For long-term melancholia with unsettled Spirit and Soul, use Lingyuan Dan (Spirit Garden Pill). For recurrence of cured melancholia, use Duanxian Dan (Stop Epilepsy/Mania Recurrence Pill). For women suffering from melancholia due to blood disharmony, use Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder). There is also a condition of sad weeping and moaning possessed by evil spirits, which is not mania. Burn single-layered silkworm pupal skin (Can Tuizhi) to ash, mix with good wine, and take approximately two qian.

[Mania Symptoms] For excess in the Upper Jiao, apply the method of "suppressing what is high," using Shengtieluo Yin (Raw Iron Drop Drink). For Yangming excess with deep pulse, use Dachengqi Tang (Major Order the Qi Decoction) to purge. For Phlegm-Fire in the upper part, apply the method of "evacuating what is high," using Laisu Gao (Laisu Ointment) and Sansheng San (Three Saints Powder) to induce vomiting for immediate relief. Afterwards, regulate with Xixin San (Wash Heart Powder) and Liangge San (Cool Diaphragm Powder). For cases where form, symptoms, pulse, and Qi are all excess, employ both vomiting and purgation using Shengjin Dan (Winning Gold Pill). For hyperactive Liver-Gallbladder Fire attacking the Heart with Wood, use Jianglong Dan (Subdue Dragon Pill) to suppress. For chaotic Heart Fire, use Huanglian Xiexin Tang (Coptis Draining Heart Decoction). For Phlegm disturbing the Pericardium, use Yujin Wan (Curcuma Pill). For sudden collapse due to Wind-Saliva, use Tongxie San (Unblocking and Purging Powder). For lost soul resembling spirit possession, use Zhenxin Dan (Settle Heart Pill). For damage to Heart Blood due to mental labor causing palpitations and unrest, use Chensha Anzhi Wan (Cinnabar Calming Will Pill). Sorrow moving internally damages the Hun (Ethereal Soul); damaged Hun leads to madness and lack of refinement; treat by using Joy to overcome it, and warm herbs to tonify the Yang of Hun, using Longchi Qinghun San (Dragon Tooth Clearing Hun Powder). Excessive joy damages the Po (Corporeal Soul); damaged Po leads to mania; treat by using Fear to overcome it, and cool herbs to tonify the Yin of Po, using Qingshen Tang (Clear Spirit Decoction). For Lung deficiency with panting and fatigue, add Shashen (Glehniae Radix). For Stomach deficiency with poor appetite, add Renshen (Ginseng Radix et Rhizoma). For Gallbladder deficiency with fright and terror, add Lingyangjiao (Saiga Tataricae Cornu). For mania caused by Heat entering the Blood Chamber, use Xiaochaihu Tang (Minor Bupleurum Decoction) added with Xijiao (Rhinocerotis Cornu) and Shengdihuang (Rehmanniae Radix). For sudden onset of manic speech, needle Shaoshang (LU11) at the corner of the thumbnail about one leek leaf width away. For Liver excess anger causing mania, needle Dadun (LR1) at the corner of the big toenail about one leek leaf width away.