大意
重阴者癫。重阳者狂。（越人）多喜为癫。多怒为狂。（王太仆）然喜属心。怒属肝。二经皆火有余之地。
大都谋为不遂。郁抑不得志者恒多。（入门）且癫症在腑。痰流胞络。故时发时止。狂症在脏。痰伏心络。故
发而不止。（汇补）
内因
狂由痰火胶固心胸。阳邪充极。故猖狂刚暴。若有神灵所附。癫由心血不足。求望高远。抑郁不遂而成。虽
有轻重之分。然皆心神耗散。不能制其痰火而然也。
外候
狂病初发。少卧而不饥。自高贤也。自辨智也。自贵倨也。好笑好歌。妄行不休。甚则弃衣而走。登高而歌。逾
垣上屋。杀人。不畏水火。骂詈不避亲疏。癫病始发。意不乐。语言有头无尾。秽洁不知。如有所见。经年不逾。
俗呼心风。有狂之意。不如狂之甚。（衍义）
总治
二症之因。或大怒而动肝火。或大惊而动心火。或痰为火升。升而不降。壅塞心窍。神明不得出入。主宰失
其号令。心反为痰火所役。一时发越。逾垣上屋。持刀杀人。裸体骂詈。不避亲疏。飞奔疾走。涉水如陆。此肝
气太旺。木来乘心。名之曰狂。又谓之大癫。法当抑肝。镇心降龙丹主之。若抚掌大笑。言出不伦。左顾右盼。
如见神鬼。片时正性复明。深为赧悔。少顷态状如故者。此膈上顽痰。汛滥洋溢。塞其道路。心为之碍。痰少
降则正性复明。痰复升则又举发。名之曰癫。法当利肺安心。安神滚痰丸主之。（指掌）
五志相胜
五志之火。郁而成痰。为癫为狂。宜以人事制之。如喜伤心者。以怒解之。以恐胜之。忧伤肺者。以喜胜之。以
怒解之。（准绳）
醉饱致狂
有大醉过饱。膏粱浓味。填塞胸中发狂者。先用盐汤探吐。后随症施治。（节斋）
刚剂发狂
有服金石丹剂发癫狂者。此药性刚烈。热气 悍。治宜清热解毒。如三黄石膏汤。加黄连、甘草、青黛、板蓝
根。或紫金锭。（微义）
外感发狂
此阳明胃经邪热炽盛。燥火郁结于中。大便闭者下之。（金匮）
恚怒致狂
阳气最宜畅达。若暴怒所折。则志怫郁而不伸。或事有难决。则气抑逆而不疏。少阳胆木挟三焦相火而
上。故令人发怒如狂。治宜夺食自已。夫食入于阴。长气于阳。夺其食者。不使助火也。更服铁落饮者。取铁
性沉重。能坠热开结。平肝降火。乃金能制木也。（汇补）
痰食致狂
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。（汝言）
癫因心火
有心经蓄热。发作不常。或时烦躁。鼻眼觉有热气。不能自由。有类心风。稍定复作。宜清心汤。加菖蒲。或芩、
连、花粉、茯神、麦冬、丹参、远志、牛黄之类。
血迷似癫
有妇人月水崩漏过多。血气迷心。或产后恶露上冲。而言语错乱。神志不宁者。此血虚神耗也。宜宁神定
志。但不可纯服补心敛神药。宜清魂散。或举卿古拜散主之。（良方）
癫狂似祟
有视听言动俱妄。甚则能言平生未见闻事。及五色神鬼。此乃气血虚极。神光不足。或挟痰火。壅闭神明。
非真有祟也。宜随症治之。（汇补）
死症
癫发如狂者不治。气下泄者不治。如狂不治者。由心之阳。不胜其阴气之逆。神明散乱。阳气暴绝。故发如
狂。犹灯将绝而复明也。下泄不治者。癫本邪入于阴。阴气填塞于上。则气亦逆奔而上。今气下泄。将见肾
气虚脱故也。又神脱目瞪如愚者。不治。（汇补）
脉法
脉大坚实者癫狂。脉大滑实者自已。沉小急疾者死。又癫狂脉虚者可治。实则死。
用药
狂主二陈汤。加黄连、枳实、栝蒌、胆星、黄芩等。如便实火盛。加大黄下之。痰迷心窍。控涎丹吐之。癫亦主二
陈汤。加当归、生地、茯神、远志、枣仁、黄连、胆星、天麻等。风痰。加全蝎、白附子。心经蓄热。用牛黄清
心丸。因惊而得者。抱胆丸。思虑伤心者。归脾汤。兼用酒服天地膏。因七情郁痰为热者。用郁金七两、明矾三两为末。
薄荷汤泛丸。每服二钱。菖蒲姜汤下。
【附中邪】
血气者。心之神也。神既衰乏。邪因而袭。理或有之。若悲哭呻吟。为邪所凭者。主以定志丸。或烧蚕蜕故纸。
酒调下。或用秦承祖灸鬼法。（丹溪）
【附心风】
心风一症。精神恍惚。喜怒不常。言语或时错乱。有癫之意。不如癫之甚。亦痰气所谓也。宜星香散。加菖蒲、
人参、竹沥、姜汁。（微论）
癫狂选方
牛黄泻心汤 治心经邪实。狂言妄语。心神不安。
片脑（另研） 牛黄（另研） 朱砂（另研各一钱半） 生大黄（一两）
末之。每服三钱。生姜、蜜水调服。
灵苑方 治癫狂失神。宜助心气。
朱砂（一两） 枣仁（六钱炒研） 滴乳香（六钱另研）
上作一服。温酒下。以醉为度。勿令吐。服后便令熟睡。待其自醒。则神魂安矣。万一惊触。不可复治。
神应丹
朱砂不拘多少。研细末飞过。猪心血和得所。蒸饼。裹蒸熟。取出。丸如桐子大。每服一丸。食后临卧。人参汤下。
苦参丸 治狂邪大叫。
苦参不拘多少。为末。蜜丸桐子大。薄荷汤下。每服五十丸。
大黄一物汤
大黄四两。酒浸一宿。煎分三服。必数日后。方可与食。但得宁静。方为吉兆。不可见其瘦弱减食。便以饮
食温药补之。犯必再发。
降龙丹 抑肝镇心。
黑铅（一两 开投水银一两不住手炒至成粉为度名曰银粉） 朱砂（五钱） 蛇含石（五钱火 ） 金箔 银箔（
各五十片） 研细。丸如芡实大。每服三丸。茯神汤磨化下。
安神滚痰丸
礞石（一两） 风化硝（一两） 朱砂（一两） 沉香（五钱） 珍珠（五钱）
末之。煎天麻膏为丸。如芡实大。每服三丸。姜汁、竹沥下。
抱胆丸
水银（二两） 朱砂（一两） 乳香（一两） 黑铅（一两半）
将铅入铫内。下水银结成砂子。次下乳香、朱砂。乘热研匀。丸如芡实大。每服一丸。空心。井花水下。
清魂散
泽兰叶 人参（各二钱半） 川芎（五钱） 荆芥穗（一两） 甘草（二钱）
上为细末。每服二钱。用温酒热汤各半盏。或入童便调。急灌之。下咽眼即开。气定即醒。
举卿古拜散 治妇人胎前产后中风。
荆芥穗焙燥为末。每服一钱。豆淋汤调服。
[General Principles]
Excess of Yin leads to Dian (Manic-Depressive Psychosis characterized by withdrawal). Excess of Yang leads to Kuang (Manic Disorder characterized by agitation). (From *Nan Jing*) Predominant laughter indicates Dian. Predominant anger indicates Kuang. (From Wang Bing's commentary on *Su Wen*) However, laughter is associated with the Heart, and anger with the Liver; both meridians are sites where Fire is in excess.
Most cases arise from individuals whose plans fail to materialize and who suffer from depression and unfulfilled ambitions. (From *Yi Zong Ru Men*) Furthermore, Dian pathology resides in the Fu organs, with phlegm flowing into the Bao Luo (uterine collaterals), causing intermittent attacks. Kuang pathology resides in the Zang organs, with phlegm latent in the Xin Luo (Heart collaterals), causing continuous attacks without cessation. (From *Zheng Zhi Hui Bu*)
[Etiology (Internal)]
Kuang arises from phlegm-fire consolidating in the chest and heart, with Yang pathogens reaching an extreme, resulting in reckless and violent behavior as if possessed by spirits. Dian arises from deficiency of Heart Blood, combined with unattainable high aspirations and depression. Although there are differences in severity, both result from the dissipation of Shen (Spirit) and the inability to control phlegm-fire.
[External Manifestations]
In the initial stage of Kuang disease, the patient sleeps little, feels no hunger, considers themselves superior and wise, and acts arrogantly. They laugh and sing excessively, act wildly without stopping. In severe cases, they may strip naked and run, climb to heights to sing, jump over walls and roofs, kill people, fear neither fire nor water, and curse others regardless of kinship or distance.
In the initial stage of Dian disease, the patient feels unhappy, speaks incoherently (starting sentences but not finishing them), ignores hygiene, and hallucinates. The condition may persist for a year without resolution. It is commonly called "Xin Feng" (Wind affecting the Heart), resembling Kuang but less severe. (From *Ben Cao Yan Yi*)
[General Treatment]
The causes of these two conditions include: Liver Fire stirred by sudden rage, Heart Fire stirred by sudden fright, or Phlegm rising with Fire, ascending but not descending, blocking the Heart Orifices. This prevents Shen from entering and exiting, causing the ruler (Heart) to lose its command, and the Heart becomes enslaved by phlegm-fire. Sudden outbreaks involve jumping over walls, holding knives to kill, cursing nakedly, running wildly, wading through water as if on land. This is excessive Liver Qi, where Wood overacts on Heart (Fire), named Kuang, also called "Da Dian". The treatment method should suppress Liver Qi and calm/settle the Heart, primarily using Zhen Xin Jiang Long Dan (Dragon-Calming Pill to Settle the Heart).
If the patient claps hands laughing, speaks nonsensically, looks around left and right as if seeing gods or ghosts, then briefly regains sanity feeling ashamed, only to revert shortly after, this is stubborn phlegm above the diaphragm overflowing and blocking pathways, hindering the Heart. When phlegm descends slightly, sanity returns; when it rises again, the episode recurs. This is named Dian. The treatment method should benefit the Lung and calm the Heart, primarily using An Shen Gun Tan Wan (Spirit-Calming Rolling Phlegm Pill). (From *Xiao Er Yao Zheng Zhi Jue · Zhi Zhang Pian*)
[Five Emotions Mutual Overcoming]
Fire from the five emotions condenses into phlegm, causing Dian and Kuang. It is suitable to use human affairs to counteract them. For example, Joy damages the Heart; resolve it with Anger, overcome it with Fear. Sorrow damages the Lung; overcome it with Joy, resolve it with Anger. (From *Yi Xue Zhun Sheng Liu Yao*)
[Kuang Caused by Drunkenness and Overeating]
For Kuang caused by heavy drunkenness or overeating rich, greasy foods that block the chest, first induce vomiting with salt water, then treat according to symptoms. (From *Chi Shui Xuan Zhu · Jie Zhai*)
[Kuang Caused by Rigid Medicines]
For Dian/Kuang caused by taking mineral/cinnabar pills, the drug properties are rigid and fierce, generating intense heat. Treatment should clear heat and detoxify, such as using San Huang Shi Gao Tang (Three-Yellow and Gypsum Decoction) added with Huang Lian, Gan Cao, Qing Dai, Ban Lan Gen, or Zi Jin Ding. (From *Yi Xue Wei Yi*)
[Kuang Caused by External Pathogens]
This is due to blazing pathogenic heat in the Yangming Stomach Meridian, with dry-fire stagnating internally. If constipation is present, use purgation. (From *Jin Gui Yao Lue*)
[Kuang Caused by Resentment/Anger]
Yang Qi should be smooth and free-flowing. If snapped by sudden rage, will becomes depressed and cannot extend; if matters are hard to decide, Qi becomes suppressed and rebellious, unable to disperse. Shaoyang Gallbladder Wood carries Triple Warmer Ministerial Fire upward, causing rage-like Kuang. Treatment involves restricting food intake to let the condition resolve itself. Food generates Yin and nourishes Yang; restricting food prevents aiding the fire. Additionally, administer Tie Luo Yin (Iron-Falling Drink); iron is heavy, capable of sinking heat, opening knots, calming Liver, and descending fire, representing Metal controlling Wood. (From *Zheng Zhi Hui Bu*)
[Kuang Caused by Phlegm and Food]
For cases of deep depression and resentment where phlegm and food knot in the chest, causing wild singing, crying, nudity, cursing, staring blankly, with a deep, firm, and knotted pulse, one must use emesis to remove accumulated phlegm and trapped blood, clearing the upper diaphragm for recovery. (From *Zheng Zhi Zhun Sheng · Ru Yan*)
[Dian Due to Heart Fire]
With Heat stored in the Heart Meridian, attacks are irregular, sometimes involving irritability, sensation of heat in nose/eyes, loss of autonomy, resembling Xin Feng, subsiding slightly then recurring. Use Qing Xin Tang (Clear Heart Decoction) added with Shi Chang Pu, or Huang Qin, Huang Lian, Tian Hua Fen, Fu Shen, Mai Dong, Dan Shen, Yuan Zhi, Niu Huang.
[Blood Confusion Mimicking Dian]
In women with excessive uterine bleeding (Beng Lou), blood-Qi confuses the Heart Spirit, or postpartum lochia rushes upward, causing confused speech and restless spirit. This is Blood deficiency and Shen exhaustion. Calm the Spirit and stabilize will, but do not solely use tonifying/astringent Heart-Spirit herbs. Use Qing Hun San (Soul-Clearing Powder) or Ju Qing Gu Bai San. (From *Ji Sheng Fang · Liang Fang*)
[Dian/Kuang Resembling Possession]
When hearing, seeing, speaking, and acting are all delusional, even recounting unheard/unseen events or colored spirits, this is extreme deficiency of Qi and Blood, lack of Shen Light, or phlegm-fire blocking Shen. It is not true possession. Treat according to symptoms. (From *Zheng Zhi Hui Bu*)
[Terminal Symptoms (Prognosis)]
Dian presenting like Kuang is incurable. Leakage of Qi downward is incurable. Kuang that does not improve: Heart Yang cannot withstand rebellious Yin Qi, Shen scatters, Yang Qi abruptly perishes, hence appearing like Kuang, like a lamp flickering before extinction. Downward leakage: Dian involves evil entering Yin; Yin fills the upper body, causing Qi to rush up. Now Qi leaks down, indicating Kidney Qi collapse. Shen depletion with eyes fixed open like a fool is incurable. (From *Zheng Zhi Hui Bu*)
[Pulse Diagnosis]
Large and firm pulses indicate Dian/Kuang. Large, slippery, and solid pulses indicate spontaneous recovery. Deep, small, rapid, and urgent pulses indicate death. Generally, deficient pulses in Dian/Kuang are treatable; excess pulses indicate death.
[Medication]
Kuang primarily uses Er Chen Tang added with Huang Lian, Zhi Shi, Gua Lou, Dan Nan Xing, Huang Qin. If stool is solid and fire is strong, add Da Huang for purgation. For phlegm confusing Heart Orifices, use Kong Xian Dan for emesis.
Dian primarily uses Er Chen Tang added with Dang Gui, Sheng Di, Fu Shen, Yuan Zhi, Zao Ren, Huang Lian, Dan Nan Xing, Tian Ma. For Wind-Phlegm, add Quan Xie, Bai Fu Zi. For Heart Meridian Heat, use Niu Huang Qing Xin Wan. For cases due to fright, use Bao Dan Wan. For cases due to overthinking damaging Heart, use Gui Pi Tang, taken with wine alongside Tian Di Gao. For cases due to Seven Emotions stagnation transforming phlegm into heat, use Yu Jin (7 liang) and Ming Fan (3 liang) powdered, pillified with Bo He decoction, 2 qian per dose, taken with Shi Chang Pu Ginger Decoction.
[Appendix: Evil Invasion]
Qi and Blood are the manifestation of Heart Spirit. If Spirit is weak, evil invades, which is theoretically possible. For weeping/moaning due to evil possession, use Ding Zhi Wan, or burn silkworm molts, taken with wine. Or use Qin Cheng Zu’s Ghost-Moxibustion Method. (From *Ge Zhi Yu Lun · Dan Xi*)
[Appendix: Xin Feng]
Xin Feng presents with vague spirit, erratic joy/anger, occasional confused speech, resembling Dian but less severe, also related to Phlegm-Qi. Use Xing Xiang San added with Shi Chang Pu, Ren Shen, Zhu Li, Jiang Zhi. (From *Za Bing Yuan Liu Xi Zhu · Wei Lun*)
[Selected Formulas for Dian/Kuang]
**Niu Huang Xie Xin Tang**: Treats Heart Meridian excess evil, manic speech, unsettled Shen.
*Ingredients*: Pian Nao (Borneol, separately ground), Niu Huang (Calculus Bovis, separately ground), Zhu Sha (Cinnabaris, separately ground) each 1.5 qian; Sheng Da Huang (Rhei Radix et Rhizoma) 1 liang.
*Preparation*: Grind to powder. Take 3 qian per dose, mixed with fresh ginger and honey water.
**Ling Yuan Fang**: Treats Dian/Kuang with loss of Shen, benefits Heart Qi.
*Ingredients*: Zhu Sha (Cinnabaris) 1 liang; Zao Ren (Ziziphi Spinosae Semen) 6 qian (stir-fried and ground); Di Ru Xiang (Olibanum) 6 qian (separately ground).
*Preparation*: One dose. Take with warm wine until intoxicated. Do not induce vomiting. Let patient sleep deeply; upon waking, Shen is calmed. If startled afterwards, it is untreatable.
**Shen Ying Dan**:
*Ingredients*: Zhu Sha (Cinnabaris) appropriate amount, finely ground and washed; Pig Heart Blood.
*Preparation*: Mix appropriately, make steamed dough cakes, wrap and steam until cooked. Remove and form pills like wu-tzu seeds. Take one pill after meals and before bed, with Ren Shen (Ginseng Radix et Rhizoma) decoction.
**Ku Shen Wan**: Treats manic screaming.
*Ingredients*: Ku Shen (Sophorae Flavescentis Radix) appropriate amount.
*Preparation*: Grind to powder, honey-pill like wu-tzu seeds. Take 50 pills per dose with Bo He (Menthae Haplocalycis Herba) decoction.
**Da Huang Yi Wu Tang**:
*Ingredients*: Da Huang (Rhei Radix et Rhizoma) 4 liang, soaked in wine overnight.
*Preparation*: Decoct and divide into three doses. No food for several days. Only when calm is it auspicious. Do not tonify with warm foods/drugs just because the patient is thin/weak; relapse is certain if violated.
**Jiang Long Dan**: Suppresses Liver, Settles Heart.
*Ingredients*: Hei Qian (Plumbum) 1 liang (mixed with Shui Yin [Hydrargyrum] 1 liang, stir-fried constantly until powder forms, named Yin Fen); Zhu Sha (Cinnabaris) 5 qian; She Han Shi (Tubae Fungiformis Lapis) 5 qian (calcined); Jin Bo (Folium Aureum) and Yin Bo (Folium Argenteum) 50 pieces each.
*Preparation*: Grind fine, form pills like qu-real seeds. Take 3 pills per dose, ground and dissolved in Fu Shen (Poria) decoction.
**An Shen Gun Tan Wan**:
*Ingredients*: Meng Shi (Flavitatis Micae) 1 liang; Feng Hua Xiao (Natrii Sulfas Efflorescens) 1 liang; Zhu Sha (Cinnabaris) 1 liang; Chen Xiang (Aquilariae Lignum Resinatum) 5 qian; Zhen Zhu (Concha Margaritifera) 5 qian.
*Preparation*: Grind fine, form pills with Tian Ma (Gastrodiae Rhizoma) paste like qu-real seeds. Take 3 pills per dose with Jiang Zhi (Zingiberis Recens汁) and Zhu Li (Bambusae Succus).
**Bao Dan Wan**:
*Ingredients*: Shui Yin (Hydrargyrum) 2 liang; Zhu Sha (Cinnabaris) 1 liang; Ru Xiang (Olibanum) 1 liang; Hei Qian (Plumbum) 1.5 liang.
*Preparation*: Melt lead in a pot, add mercury to form cinnabar-like grains, then add Ru Xiang and Zhu Sha. Grind while hot, form pills like qu-real seeds. Take one pill on empty stomach with well water.
**Qing Hun San**:
*Ingredients*: Ze Lan Ye (Lycopus Japonici Herba) and Ren Shen (Ginseng Radix et Rhizoma) each 2.5 qian; Chuan Xiong (Chuanxiong Rhizoma) 5 qian; Jing Jie Sui (Schizonepetae Spica) 1 liang; Gan Cao (Glycyrrhizae Radix et Rhizoma) 2 qian.
*Preparation*: Fine powder. Take 2 qian per dose, mixed with half cup warm wine and half cup hot water, or mixed with Tong Bian (Infantis Urine). Administer urgently. Eyes open upon swallowing, breath stabilizes, patient awakens.
**Ju Qing Gu Bai San**: Treats wind-stroke in women during pregnancy or postpartum.
*Ingredients*: Jing Jie Sui (Schizonepetae Spica) roasted dry and powdered.
*Preparation*: Take 1 qian per dose, mixed with Dou Lin Tang (Black Soybean Decoction).