【因】胃热蒸心。阳盛发狂。其主因也。伤寒少。温热病多。温热病夹 毒。夹痰
火者尤多。其先夹醉饱、夹惊、夹怒者亦多。此皆谓之阳狂。他如作汗发狂。蓄血发狂
。阴躁发狂。心风发狂。此皆谓之如狂。病源既异。病状自殊。
故治病必求其受病之源。
【证】伤寒化热传里。及温热病里热亢盛。症皆目赤唇焦。齿燥舌干。大渴饮水。
始得少卧。不安。妄语悲叹。继即弃衣狂奔。骂詈叫喊。不避亲疏。甚则逾垣上屋。登
高而歌。舌苔深黄浓腻。甚则老黄焦黄。或夹灰黑。多起芒刺。夹 毒者。胸闷心烦。
起卧无定。静躁不常。 点隐隐。壮热无汗。舌苔纯黄边黑。中见红点。夹痰火者。痰
壅气逆。胸闷呕吐。静则迷蒙昏厥。躁则狂妄舞蹈。舌苔黄浓而滑。或黄白相兼。或夹
灰腻。扪之湿润。夹醉饱者。或歌或骂。或笑或哭。嗳腐难闻。酒气喷人。舌色深紫而
黯。扪之滑润。或中见黄腻。或后根黄浓。夹受惊者。痰涎壅塞。牙关紧急。躁则狂言
多惊。卧起不安。静则短气心悸。神识如痴。舌苔多黄而滑。或夹红星。夹触怒
者。两
目斜视。势欲杀人。见人欲啮。切牙 齿。发则怒狂骂詈。醒则歌哭吁叹。舌多焦紫。
或鲜红起刺。此皆阳狂之本证夹证。有实无虚。若作汗发狂。其人欲食。大便自调。溺
反不利。骨节作痛。翕然发热。奄然发狂。 然汗出而解。舌苔薄白微黄。蓄血发狂。
太阳病不解。热在下焦。少腹硬满而痛。小便自利。大便反黑。瘀热在里。其人发狂。
舌色多紫而黯。扪之滑润。阴躁发狂。初起无头痛。不烦闷。但手足逆冷。阴极发躁。
欲坐卧于泥水井中。或欲阴凉处坐。或烦渴而不能饮水。躁乱不安。如发狂状。舌多灰
而淡白。或灰黑而嫩滑。心风发狂。发则牙关紧急。痰涎上塞。口吐白沫。迷闷恍惚。
醒则狂言多惊。喜怒不常。甚则或歌或哭。舌色纯绛鲜泽。略有垢浊薄苔。或红而上罩
粘腻。似苔非苔。此皆如狂之阴阳错杂证。虚实皆有。
【脉】荣斋按∶狂症脉多滑大（见王馥原医方简义），只有蓄血如狂则脉见沉弦，
或沉数而实；俞氏原文罗列了十一种脉症，头绪纷繁，徒乱人意。兹删之。
【治】发狂无汗者。新加白虎汤。加葱豉。凉泄郁热以出汗。汗仍不出。而热甚狂
乱者。三黄石膏汤。（川连、条芩、川柏各一钱、石膏八钱、知母四钱、生山栀、淡
香豉各三钱、麻黄六分、雪水煎药）加辰砂、连翘心（各一钱）、竹叶卷心（三钱）、
大发其汗以泄热。热泄汗出。其狂自止。发狂便结者。白虎承气汤。加芦笋、竹叶芯。
凉泻实火以通便。便仍不畅。而热闭狂昏者。牛黄泻心汤。（西牛黄、辰砂各五分、
生大黄三钱、梅冰一分、共研、先用生姜汁一滴、白蜜两小匙、和开水调服）、两清心
胃以泻火。火泄热清。其狂自愈。阳毒发狂。解毒承气汤。加紫雪丹（八分、药汤调下
）活水芦笋（二两）、大青叶（八钱、与方中绿豆煎汤代水）。峻逐毒火以泻阳。阳毒
虽解。而 发未透。神识昏迷者。犀地清络饮。加三黄泻心丸。（川连三钱、青子芩、
煨甘遂各二钱、西牛黄、广郁金各钱半、猪心血一枚为丸、重一钱、朱砂为衣、药
汤调下）。开窍透 以清神。神清 透。其病自痊。痰火发狂。轻则陷胸承气汤。重则
加味凉膈煎。调下安神滚痰丸。（ 礞石、风化硝、辰砂各一两、沉香、珠粉各五钱
、研细、竹沥姜汁皂荚膏为丸、如芡实大、每服三丸）。峻下痰火以除狂。狂除而神识
迷蒙者。玳瑁郁金汤去紫金片。调下《局方》妙香丸。清凉芳烈以开窃。整肃痰火以醒
神。神识清醒。其根自除。醉饱发狂。先以炒盐汤调下瓜蒂末（一钱）吐之。继以枳实
导滞汤。加槟榔（三钱）。枳 子（五钱）下之。终以葛花解酲汤加减。（生葛花一钱
、枳 子四钱、青皮八分、广皮钱半、生于术一钱、赤苓、猪苓、泽泻各钱半、六神
曲三钱、广木香、春砂仁各六分、鲜青果二枚）。解其酒毒。调其脾胃以善后。触惊发狂。先
与蒿芩清胆汤。调下许氏惊气丸。（铁粉、橘红、姜南星、南木香、白僵蚕、白
花蛇、麻黄、天麻各五钱、苏子一两、全蝎、辰砂各一钱、龙脑、麝香各一厘、
同研极匀、蜜丸如龙眼大、每服一丸）。镇肝清胆
以定狂。终与十味温胆汤。（潞党参、辰茯神、淡竹茹、熟地、枳实各钱半、姜半夏、
广皮各二钱、炒枣仁、远志肉各一钱、炙甘草五分、生姜一片、红枣一枚）。补虚壮胆
以善后。大怒发狂。便通而痰气上逆者。生铁落饮加减。（生石膏八钱、天竺黄、青龙
齿、辰茯神各三钱、制香附、元参心各二钱、淡竹沥两瓢、石菖蒲汁二匙、同冲、
先用生铁落一两、同生石膏煎汤代水）。坠痰镇肝以定狂。便闭而火势大盛者。白虎承
气汤去粳米。加川连（一钱）。铁粉（三钱、同石膏先煎清汤代水）。泻火解结以除狂
。欲汗发狂。只与葱豉荷米煎。和中解肌以助汗。或但饮沸水以发汗。汗出则狂自止。
蓄血如狂。轻则犀角地黄汤加味。（方载伤寒变证蓄血条）重则代抵当汤加减。（酒浸
生川军四钱、光桃仁十粒、风化硝、酒炒莪术、归尾各一钱、鲜生地一两炒、穿甲八
分、官桂三分、青糖一钱拌炒 虫五只）。搜逐瘀积以消之。瘀消血行。如狂自止。终与
四物绛覆汤。养血活络以善后。阴躁如狂。脉沉细而肢冷烦躁者。真武汤加辰砂（一钱
冲）、冷服。回阳摄阴以除之。脉数大而空。阴盛格阳而躁者。通脉四逆汤去葱白。加
别直参（三钱）冷服。破阴回阳以救之、若仍躁不得眠。脉伏不出者。回阳急救汤。生
脉回阳以固其脱。心风如狂。参珀茯神汤（西洋参、炒枣仁各钱半、茯神四钱、石菖蒲
、远志肉各一钱、乳香六分、琥珀、辰砂各五分、二味和匀同冲）。调下金箔镇心
丸。金箔五片、人参、茯神、犀角各一钱、西牛黄、天竺黄、青龙齿、龙胆草、生
地、远志、朱砂、铁粉各七分、为细末、蜜丸如桐子大、每服七丸、镇心宣窍以安神。
神安则如狂自止。总之发狂一证。虽有虚实寒热之不同。毕竟实证多。虚证少。治此者
。总以泻火为先。参以消痰、理气、凉血、通络。察其孰轻孰重而兼治之。此为治狂
之要诀。若夫似狂非狂。则求其病源而分治之。若误作阳狂实热。骤用凉泻。反速其死
。临证者务详
审而明辨之。当其狂势正盛之时。莫妙于病患处生火一盆。用醋一碗。倾于火上。使其
气冲入病患鼻内。再将冷姜水。喷于病患头面心胸。狂即暂安。方可审察病机。色脉合
参。以辨其阴阳虚实。对证发药。庶免草率误人之弊。一面嘱病家洞开窗户。揭起床帐
。放入清爽之气。使病患心气豁然开朗。亦为要务。
【秀按】热结在胃。胃热蒸心。窜入阳络则发狂。窜入阴络则发厥。多兼痰气郁结
。治以辛凉清胃。芳香开结为首要。予治狂证。每用内外兼施。外治以芒硝一斤。用开
水一盆烊化。将青布方圆一尺许三五块。浸于硝水中。俟冷。微搅半干。搭在病患胸膛
并后心上。频易冷者搭之。如得睡汗。狂势即轻。内治以陶氏解结汤。（即三汁宁络饮
、用竹沥姜汁调下。）开窍透络。两清心胃之热。以解其痰结气结。服后。作寒战汗出
。狂势即定。陶氏谓发狂得汗出者生。不得汗出者死。诚心得之言也。但此就伤寒失汗
。病转阳狂而言。若伏气温热。时行温疫。多因失清失下。以致阳盛发狂。失清者。以
白虎合黄连解毒汤清之。失下者。以白虎承气汤下之。痰盛者。佐以礞石滚痰丸。火盛
者。佐以当归龙荟丸。皆狂证应用之正方。惟热结胸口噤不能言。阳毒狂言不得汗。温
热病狂妄不得汗。热毒壅闭。精神将竭者。每以人参竹沥饮。（吉林参钱半、淡竹沥两
瓢、重汤炖好、去参渣、冲热童便一杯。）调下狂证夺命丹。（釜底墨、灶突墨、粱上
倒挂尘、青子芩、小麦奴、寒水石、麻黄各一两、川连一两五钱、雄精三钱、辰砂二
钱、西牛黄钱半、珍珠粉一钱各为细末、同研极匀、炼蜜为丸、每重一钱、晒干蜡匮
、每服一丸、寻常以新汲水一盏、研一丸放水中、令化尽服之、若病患渴欲饮水者与之
、多饮为妙。）须臾。当发寒战汗出。其狂即止。若服一时许不作汗。再服一丸。以汗
出狂定为止。此皆予从陶氏历治多验之方法。节录之。以备后学采用。
【廉勘】前哲皆谓胃热蒸心乃发狂。余独谓胃热蒸脑则发狂。胃热蒸心则发厥。盖
头为六阳之首。脑在其
间。而为元神之府。包络为手厥阴经。心居其中。而为藏神之脏。神明被逼而内乱。故
邪热入阳则狂。入阴则厥。狂证致病之由。外感多由于阳盛。《内经》曰。阳盛则四肢
实。实则能登高。热盛于身。则弃衣而走。《难经》所谓重阳者狂也。故通称为阳狂。
内伤多由于郁怒。石顽曰。阳厥暴怒发狂者。以阳气暴折。郁而多怒。则发狂。《内经》
所谓狂病善怒也。故通称为怒狂。治阳狂法。《李氏入门》。以大承气汤加黄连主之。
治怒狂法。张氏《绪论》。以大承气汤加铁落主之。此即龚商年所谓狂之实者。以承气
白虎等汤。直折阳明之火。生铁落饮。重制肝胆之邪是也。俞东扶曰。发狂实证十居八
九。故予治狂。多用吐下清镇四法。吐法以紫雪（九分）、品三物白散（一分）。通神明
以涌痰涎。下法。以尤氏泻狂汤。（生大黄、青龙齿、 牡蛎各三钱、炒蜀漆一钱、
小川连五分）。泻实火以劫惊痰。清法以羚熊清狂汤。（羚角片钱半、老竺黄三钱、寒
水石四钱、小川连八分、九制胆星五分、金汁一两、鲜石菖蒲汁两小匙同冲、熊胆一分
、药汤调下。）消痰热以熄风火。镇法以生铁落饮。平肝火以坠痰涎。吐下并治法。轻
则遂心丸。（煨甘遂二钱、猪心血一枚为丸、分作四粒、鲜石菖蒲叶一钱、鲜竹叶心五
十支、灯心三小帚、煎汤调下。）重则龙虎丸。（白石、辰砂各二分、西牛黄、巴霜
各三分、共研极匀、作二十丸、辰砂为衣、轻者一丸、重者二三丸、温开水送下、约
半时许、非吐即泻、武者即愈、文者较迟、如年远者、须服十余丸、方见效、愈后、忌
食猪肉二年。）吐尽胸膈之痰浊。攻下肠胃之宿垢。此治实狂之方法也。历治多验。然
虚狂亦不鲜。余每作神经衰弱。骤有感触。五志之火。上烁脑髓。神经顿失其常性。遂
发似狂非狂之证。东医所谓性情之狂。通称为精神病是也。与感证之阳盛发狂迥异。自
制牛马二宝散。（西牛黄、马宝各一钱、共研匀细、每服二分、一日二服。）用人参
竹沥饮调下。历治多验。此外以六味地黄汤加犀角汁（约磨六分至八分）清童便（一杯
同冲）治快乐狂（其人时发狂笑、手舞足蹈、倏而狂言、倏而狂跳）。以新加甘麦大枣
汤（生白芍、山萸肉各钱半、淮小麦、红枣肉、白石英各三钱、清
炙草一钱、此叶氏治验方。）治悲苦狂（其人数欠伸、喜悲伤欲哭、象如神灵所作、妇
女最多此病、金匮名曰脏燥、日医名曰脏躁。）以加减散花去癫汤。（生白芍一两、当
归、麦冬各五钱、焦栀、元参、辰茯神、杜牛膝各三钱、川柴胡二钱、生甘草、白
芥子、鲜石菖蒲各一钱、当门子五厘冲。）治情欲狂（妇女思慕男子不得、忽然发狂
、见男子抱住不放、以为情人、罔识羞耻、甚至裸体奔走、脉必弦出寸口、此名花癫、
俗称发花呆。）皆有特效。惟忧闷狂多由失望而来。必如其愿而病始痊。非无情之草木
所可疗。前哲谓药逍遥而人不逍遥。何益之有。诚哉是言。昔吾老友。赵晴初君。曾对
予言。耶溪胡在兹先生。善治狂证。其自述云。狂病或善食。或不食。若声音壮厉。面
色黄赤。目神郁忿。气力逾常。二便秘涩黄赤者。只须别其气机之清浊。而决治法。面
色清皎者。多从忿郁暴怒上逆。而为狂躁笑哭。若大便通调者。宜加味铁落饮。（生石
膏三两、青龙齿、辰茯神、青防风各一两五钱、元参、秦艽各一两、鲜生地四两、
先用铁落八两、长流水一斗、煮取五升、并以上七味、加竹沥半升、羚角五钱、入铁汁
中、煮取二升、去渣、和入竹沥、温分五服、一日服尽。）以泄肝阳。如面色浊闷。二
便结涩者。多从醇酒浓味。种热蒸痰。或乘天气极热。盛怒不释。而为狂妄骂詈歌笑。
甚则逾垣上屋。宜加减大承气汤（生川军、风化硝、枳实各五钱、 礞石、皂荚各
二钱、煎成、冲入猪胆汁、米醋各两小匙、调服西牛黄二分）。以下浊秽。若面色板
钝。目神滞顿。迷妄少语。喜阴恶阳。饮食起居若无病者。多从屈郁不伸。而为失志痴
呆。宜癫狂霹雳散。〔雄黄、雌黄、冰片、西牛黄各五分、生山栀二十枚、白急性子
一钱、生白砒四分、生绿豆百八十粒、将绿豆冷水浸少顷、去皮、同余各生晒为末、另
研入冰黄、大人可服一钱、十五六岁者、用四分、白汤下、再令食粉面糕饼等少许、当
[Pathogenesis] Stomach heat steaming the heart. Yang excess causing mania, this is the primary cause. It is rare in Shanghan (Cold Damage) diseases but common in Wenyue (Warm Diseases). Warm diseases often involve pathogenic toxins and phlegm-fire. Additionally, cases preceded by overindulgence in food and alcohol, fright, or anger are also frequent. These are all termed "Yang Mania" (Yang Kuang). Others, such as mania after sweating, mania due to blood stasis, Yin restlessness (Yin Zao), and Wind-Mania of the Heart (Xin Feng), are all termed "Like-Mania" (Ru Kuang - resembling mania but not true mania). Since the disease origins differ, the clinical manifestations naturally vary. Therefore, treating disease requires seeking the source of the pathology.
[Symptoms] When Shanghan transforms into heat and transmits inward, or when interior heat is hyperactive in warm diseases, symptoms include red eyes, cracked lips, dry teeth, dry tongue, extreme thirst with desire to drink water. Initially, there is little sleep, restlessness, delirious speech, and sighing/lamenting; subsequently, the patient discards clothes and runs wildly, cursing and shouting, ignoring kinship distinctions, even climbing walls and roofs, ascending heights and singing. The tongue coating is deep yellow and thick/greasy; severely, it is old yellow or scorched yellow, sometimes mixed with grey-black, often with prickles. If complicated by toxins: chest tightness, mental agitation, restless sitting/lying, alternating quiet/restless states, faint rashes on skin, high fever without sweat, tongue coating pure yellow with black edges and red dots in the center. If complicated by phlegm-fire: phlegm obstruction with qi rebellion, chest tightness, vomiting; quiet state shows confusion/fainting, restless state shows wild dancing; tongue coating is yellow, thick, and slippery, or yellow-white mixed, or grey-greasy, moist to touch. If complicated by overindulgence in food/alcohol: singing, cursing, laughing, crying; foul belching, strong smell of alcohol; tongue color deep purple and dark, slippery to touch, or yellow-greasy in the middle, or thick yellow at the root. If complicated by fright: phlegm-saliva obstruction, locked jaw; restless state shows delirious speech with much fear, restless sleeping/waking; quiet state shows shortness of breath, palpitations, mind like a fool; tongue coating mostly yellow and slippery, or with red star-like spots. If complicated by anger: eyes deviated sideways, aggressive posture as if wanting to kill, biting people, grinding teeth; during attack, angry cursing; upon waking, singing/crying/sighing; tongue mostly scorched purple or fresh red with prickles. These are the principal and complicated syndromes of Yang Mania, characterized by excess without deficiency. Regarding mania after sweating: the patient desires food, stool is normal, urine is difficult, joints ache, mild fever, sudden onset of mania, resolving with slight sweating; tongue coating thin white slightly yellow. Mania due to blood stasis: Taiyang disease unresolved, heat in the lower jiao, lower abdomen hard/full/painful, urination normal, stool black, stasis-heat in interior, patient becomes manic; tongue color purple-dark, slippery to touch. Yin restlessness mania: no headache initially, no chest oppression, only cold extremities; extreme yin causing restlessness, desire to sit in mud/wells or cool places, or thirsty but unable to drink, restless like mania; tongue grey-pale white or grey-black tender/slippery. Wind-Mania of the Heart: attack involves locked jaw, phlegm-saliva blocking throat, foaming at mouth, coma/confusion; upon waking, delirious speech with fear, unpredictable emotions, sometimes singing/crying; tongue color pure crimson bright/shiny, slight greasy thin coating, or red covered with sticky substance, resembling coating but not; these are Yin-Yang mixed syndromes of Like-Mania, involving both excess and deficiency.
[Pulse] Xu Rongzhai notes: Mania pulses are mostly slippery and large (see Wang Fuyuan's *Medical Formulas Simplified*). Only mania due to blood stasis presents with sunken-stringy, or sunken-rapid-solid pulses. Yu's original text lists eleven pulse-symptom combinations, which are confusing and disruptive. These have been deleted here.
[Treatment] For mania without sweat: New Modified Baihu Decoction, add Congchi (Scallion and Fermented Soybean), to cool-drain stagnant heat to induce sweat. If sweat does not come out and heat/manic behavior is severe: Sanhuang Shigao Tang (Coptis, Scutellaria, Phellodendron each 1 qian, Gypsum 8 qian, Anemarrhena 4 qian, Gardenia 3 qian, Fermented Soybean 3 qian, Ephedra 6 fen, decocted in Snow Water). Add Cinnabar, Forsythia Heart (each 1 qian), Bamboo Leaf Heart (3 qian), to vigorously induce sweat and drain heat. Once heat drains and sweat appears, mania stops. For mania with constipation: Baihu Chengqi Tang, add Reed Shoots, Bamboo Leaf Core, to cool-drain excess fire to unblock bowels. If bowels remain blocked and heat-closure causes coma: Niuhuang Xiexin Tang (Indian Rhinoceros Horn substitute/Coptis formula components: Buffalo Calculus, Cinnabar each 5 fen, Raw Rhubarb 3 qian, Borneol 1 fen, ground fine; mix with 1 drop Ginger Juice, 2 small spoons Honey, decocted in boiling water), to clear Heart/Stomach fire. Once fire drains and heat clears, mania heals. Yang Toxicity Mania: Jiedu Chengqi Tang, add Zixue Dan (8 fen, taken with medicine soup), Living Reed Shoots (2 liang), Isatis Leaf (8 qian, decocted with Mung Beans as water substitute), to fiercely purge toxin-fire to drain Yang toxicity. Although Yang toxicity resolves, if macules/rash do not fully emerge and consciousness is comatose: Xidi Qingluo Yin, add Sanhuang Xiexin Wan (Coptis 3 qian, Scutellaria, Calcined Kansui each 2 qian, Indian Rhinoceros Horn substitute, Curcuma Aromatica each 1.5 qian, made into pills with Pig Heart Blood, weighing 1 qian, coated with Cinnabar, taken with medicine soup), to open orifices and vent rash to clear spirit. Once spirit clears and rash vents, illness heals. Phlegm-Fire Mania: Mild cases use Xianxiong Chengqi Tang; severe cases use Jiawei Liangge Jian, taken with Anshen Guntan Wan (Qingmengshi, Efflorescent Niter, Cinnabar each 1 liang, Agarwood, Pearl Powder each 5 qian, ground fine, made into pills with Bamboo Sap, Ginger Juice, Gleditsia Paste, size of Cornelian Cherry, 3 pills per dose), to fiercely descend phlegm-fire to remove mania. After mania ceases but consciousness remains confused: Dai Mao Yujin Tang minus Zijian Pian, taken with Ju Fang Miaoxiang Wan, to use cooling-aromatic potency to open orifices and regulate phlegm-fire to awaken spirit. Once spirit is clear, root cause is removed. Food/Alcohol Mania: First use Fried Salt Soup to take Gou Ti Powder (1 qian) to induce vomiting. Then use Zhishi Daozhi Tang, add Areca Seed (3 qian), Ziziphus Spinosa Fruit (5 qian) to purge. Finally use Gegua Jieying Tang modified (Pueraria Flower 1 qian, Ziziphus Spinosa Fruit 4 qian, Tangerine Peel 8 fen, Broadleaf Citrus Peel 1.5 qian, Atractylodes Macrocephala 1 qian, Red Poria, Polyporus, Alisma each 1.5 qian, Medicated Leaven 3 qian, Aucklandia, Amomum Villosum each 6 fen, Fresh Olive 2 pieces), to resolve alcohol toxin and regulate Spleen/Stomach for recovery. Fright Mania: First give Haoqin Qingdan Tang, taken with Xu Shi Jingqi Wan (Iron Powder, Tangerine Peel, Ginger-processed Arisaema, Costus Root, White Silkworm, White Flower Snake, Ephedra, Gastrodia each 5 qian, Perilla Seed 1 liang, Full Scorpion, Cinnabar each 1 qian, Camphor, Musk each 1 li, ground uniform, honey pills size of Longan, 1 pill per dose), to calm Liver and clear Gallbladder to stabilize mania. Finally use Shiwei Wendan Tang (Codonopsis, Poria with Hostwood, Bamboo Shavings, Rehmannia, Immature Bitter Orange each 1.5 qian, Ginger-processed Pinellia, Broadleaf Citrus Peel each 2 qian, Fried Sour Jujube Seed, Polygala Root each 1 qian, Honey-fried Licorice 5 fen, Ginger slice 1 piece, Red Jujube 1 piece), to tonify deficiency and strengthen Gallbladder for recovery. Anger Mania: Bowels open but phlegm-qii rebels upward: Shengtie Luo Yin modified (Gypsum 8 qian, Hydrangea Anemarrhena, Green Dragon Teeth, Poria with Hostwood each 3 qian, Processed Cyperus, Metaplexis Root each 2 qian, Bamboo Sap 2 ladles, Acorus Juice 2 spoons, mixed together; first decoct Iron Filings 1 liang with Gypsum as water substitute), to descend phlegm and calm Liver to stabilize mania. Bowels closed and fire blazing: Baihu Chengqi Tang minus Rice, add Coptis (1 qian), Iron Powder (3 qian, decocted with Gypsum first as water substitute), to drain fire and resolve knots to remove mania. Mania desiring sweat: Only give Congchi Hemijian (Scallion, Fermented Soybean, Lotus Leaf), to harmonize middle and release muscle layer to assist sweat. Or simply drink boiling water to induce sweat; once sweat appears, mania stops. Blood Stasis Like-Mania: Mild cases use Xijiao Dihuang Tang modified (formula recorded under Shanghan Complications Blood Stasis section); severe cases use Daidang Tang modified (Wine-soaked Raw Rhubarb 4 qian, Peach Kernel 10 grains, Efflorescent Niter, Wine-fried Curcuma, Angelica Tail each 1 qian, Fresh Rehmannia 1 liang fried, Pangolin Scales 8 fen, Cinnamon Twig 3 fen, Brown Sugar 1 qian fried with Earthworms 5 pieces), to search-out and purge stasis accumulation to eliminate it. Once stasis clears and blood flows, like-mania stops. Finally use Siwu Jiangfu Tang, to nourish blood and activate collaterals for recovery. Yin Restlessness Like-Mania: Pulse sunken-thin with cold limbs and restlessness: Zhenwu Tang add Cinnabar (1 qian taken with liquid), taken cold, to return Yang and absorb Yin to remove it. Pulse rapid-large and empty, Yin excess repelling Yang causing restlessness: Tongmai Sini Tang minus Scallion, add American Ginseng (3 qian), taken cold, to break Yin and return Yang to rescue. If still restless unable to sleep, pulse hidden/unfelt: Huiyang Jijiu Tang, to generate pulse and return Yang to secure collapse. Wind-Mania of Heart Like-Mania: Shenpo Fushen Tang (American Ginseng, Fried Sour Jujube Seed each 1.5 qian, Poria with Hostwood 4 qian, Acorus, Polygala Root each 1 qian, Frankincense 6 fen, Amber, Cinnabar each 5 fen, two ingredients mixed and taken with liquid), taken with Jinbo Zhenxin Wan. Gold Foil 5 sheets, Ginseng, Poria with Hostwood, Rhinoceros Horn each 1 qian, Indian Rhinoceros Horn substitute, Hydrangea Anemarrhena, Green Dragon Teeth, Gentian Root, Rehmannia, Polygala Root, Cinnabar, Iron Powder each 7 fen, ground fine, honey pills size of Sesame, 7 pills per dose, to calm Heart and open orifices to soothe spirit. Once spirit is soothed, like-mania stops. In summary, regarding mania, although there are differences in excess/deficiency and cold/heat, excess patterns predominate, deficiency patterns are few. Treatment always prioritizes draining fire, supplemented by resolving phlegm, regulating qi, cooling blood, and activating collaterals, observing severity to treat concurrently. This is the key to treating mania. For cases resembling mania but not true mania, seek the disease origin and treat separately. Mistaking them for Yang Mania Excess Heat and suddenly using cooling purgatives will accelerate death. Clinicians must examine carefully and distinguish clearly. When mania is at its peak, nothing is better than placing a basin of fire near the patient, pouring a bowl of vinegar onto the fire so the vapor enters the patient's nose, then spraying cold ginger water on the patient's head, face, chest, and heart; mania will temporarily subside, allowing examination of pathology, combining inspection and pulse diagnosis to distinguish Yin/Yang and excess/deficiency, prescribing according to syndrome, avoiding careless errors. Meanwhile, instruct the family to open windows and lift bed curtains to let in fresh air, helping the patient's heart-mind open up, which is also crucial.
[Xiu's Commentary] Heat knotting in the Stomach, Stomach heat steaming the Heart, entering Yang collaterals causes mania, entering Yin collaterals causes syncope/jue, often accompanied by phlegm-qii stagnation. Treatment prioritizes acrid-cool clearing of Stomach and aromatic resolution of knots. I treat mania using internal and external methods combined. External treatment: Use 1 jin of Mirabilite dissolved in a basin of hot water. Soak 3-5 pieces of blue cloth (approx. 1 chi square) in the nitre water. When cool, wring slightly until half-dry, apply to patient's chest and back-heart area. Frequently replace with cold ones. If sleep and sweat occur, mania subsides. Internal treatment: Tao's Jiejie Tang (i.e., Sanzhi Ningluo Yin, taken with Bamboo Sap and Ginger Juice), opening orifices and venting collaterals, clearing Heart/Stomach heat from both sides to resolve phlegm/qii knots. After ingestion, chills and sweat occur, mania stabilizes. Tao stated that mania patients who sweat survive, those who do not die; this is indeed insightful. However, this applies to Shanghan losing sweat turning into Yang Mania. For latent warmth-warm diseases or epidemic warm pathogens, mania due to Yang excess often results from failure to clear or purge. Failure to clear: use Baihu Tang combined with Huanglian Jiedu Tang to clear. Failure to purge: use Baihu Chengqi Tang to purge. Profuse phlegm: assist with Mengshi Guntan Wan. Blazing fire: assist with Danggui Longhui Wan. These are correct formulas for mania. Specifically for heat knotting in chest causing inability to speak, Yang toxicity mania without sweat, warm disease mania without sweat, heat-toxin blockage with impending exhaustion of spirit: frequently use Renshen Zhuli Yin (Jilin Ginseng 1.5 qian, Bamboo Sap 2 ladles, double-boiled well, remove ginseng residue, mix with 1 cup hot child's urine), taken with Kuangzheng Duoming Dan. (Kettle Bottom Ink, Chimney Top Ink, Dust from Ridge Beam, Scutellaria, Wheat Parasite, Halloysite, Ephedra each 1 liang, Coptis 1.5 liang, Realgar 3 qian, Cinnabar 2 qian, Indian Rhinoceros Horn substitute 1.5 qian, Pearl Powder 1 qian, all ground fine, mixed uniform, honey pills weighing 1 qian, dried and wax-sealed, 1 pill per dose; usually take 1 cup fresh drawn water, dissolve 1 pill in water, drink completely; if patient desires water, give more, drinking more is excellent). Shortly after, chills and sweat should occur, mania stops. If no sweat after one hour, take another pill, stopping when sweat occurs and mania settles. These are methods I verified many times from Tao, excerpted here for future students.
[Lian's Critique] Predecessors all stated Stomach heat steaming the Heart causes mania. I alone believe Stomach heat steaming the Brain causes mania, while Stomach heat steaming the Heart causes jue (syncope/extremity cold). The head is the summit of the Six Yang meridians, the Brain resides within, being the mansion of Primordial Spirit. Pericardium Meridian of Hand-Jueyin, Heart resides within, being the organ storing Spirit. When Spirit is forced into internal chaos, pathogenic heat entering Yang causes mania, entering Yin causes jue. Causes of mania: Exogenous factors mostly due to Yang excess. *Neijing* says: Yang excess makes limbs solid, solidity allows climbing high. Heat excessive in body leads to discarding clothes and running. *Nanjing* calls this "Double Yang is Mania." Hence generally called Yang Mania. Endogenous factors mostly due to depression/anger. Shiwang said: Yang jue violent anger mania occurs because Yang qi is abruptly fractured, stagnating causing much anger, leading to mania. *Neijing* says Mania disease loves anger. Hence generally called Anger Mania. Treating Yang Mania: *Li's Rumen* uses Dachengqi Tang add Coptis. Treating Anger Mania: Zhang's *Xulun* uses Dachengqi Tang add Iron Filings. This is what Gong Shangnian meant by "Excess Mania," using Dachengqi, Baihu etc. to directly cut Yangming fire, and Shengtie Luo Yin to heavily control Liver/Gallbladder evil. Yu Dongfu said: Excess mania accounts for 80-90%, so I treat mania using Vomiting, Purging, Clearing, Calming four methods. Vomiting method: Zixue (9 fen), Pin Sanwu Baisan (1 fen), to connect Spirit and surge phlegm-saliva. Purging method: You's Xiekang Tang (Raw Rhubarb, Green Dragon Teeth, Oyster Shell each 3 qian, Fried Shuku 1 qian, Small Coptis 5 fen), to drain excess fire and seize fright-phlegm. Clearing method: Lingxiong Qingkuang Tang (Antelope Horn 1.5 qian, Old Hydrangea Anemarrhena 3 qian, Halloysite 4 qian, Small Coptis 8 fen, Nine-processed Acanthopanax Star 5 fen, Golden Juice 1 liang, Fresh Acorus Juice 2 small spoons mixed together, Bear Bile 1 fen, taken with medicine soup), to resolve phlegm-heat and extinguish wind-fire. Calming method: Shengtie Luo Yin, to level Liver fire and descend phlegm-saliva. Vomiting-Purging combined method: Mildly use Suixin Wan (Calcined Kansui 2 qian, Pig Heart Blood 1 pill divided into 4, Fresh Acorus Leaf 1 qian, Fresh Bamboo Leaf Heart 50 branches, Lampwick 3 small brooms, decocted soup to take); Severely use Longhu Wan (White Stone, Cinnabar each 2 fen, Indian Rhinoceros Horn substitute, Croton Seed each 3 fen, ground uniform, made into 20 pills, coated with Cinnabar, mild case 1 pill, severe case 2-3 pills, taken with warm water, approx. half an hour, vigorous types recover quickly, literary types slower, long-standing cases may need 10+ pills to see effect, after recovery, avoid pork for 2 years). Vomit out chest-diaphragm phlegm-turbidity, purge intestinal-stomach old filth, this is the method for treating excess mania. Verified many times. However, deficiency mania is also not rare. I often consider it Neurasthenia, sudden emotional trigger, Five Zang fires scorching Brain Marrow, nerves suddenly losing normal nature, thus developing like-mania-not-mania syndrome. Eastern Medicine calls this Temperament Mania, generally known as Mental Illness. It is vastly different from Exogenous Yang Excess Mania. Self-made Niuma Erbao San (Indian Rhinoceros Horn, Horse Treasure each 1 qian, ground uniform, 2 fen per dose, twice daily), taken with Renshen Zhuli Yin, verified many times. Additionally, Liuwei Dihuang Tang add Rhinoceros Horn Juice (grind approx. 6-8 fen) mixed with Child's Urine (1 cup mixed together) treats Happy Mania (patient occasionally laughs wildly, dances, speaks wildly, jumps wildly). Xinjia Ganmai Dazao Tang (Raw White Peony, Cornus Fruit each 1.5 qian, Chinese Wheat, Red Jujube Flesh, White Quartz each 3 qian, Honey-fried Licorice 1 qian, this Ye's verified formula) treats Sad Mania (patient frequently stretches/yawns, likes sadness/crying, like spirits acting, most common in women, *Jinkui* names it Zang Dryness, Japanese doctors name it Zang Irritation). Jiajian Sanhua Qudian Tang (Raw White Peony 1 liang, Angelica, Ophiopogon each 5 qian, Charred Gardenia, Scrophularia, Poria with Hostwood, Achyranthes Bidentata each 3 qian, Bupleurum 2 qian, Raw Licorice, White Mustard Seed, Fresh Acorus each 1 qian, Borneol 5 fen mixed) treats Desire Mania (women longing for men unable to obtain, suddenly go mad, hugging men tightly, thinking they are lovers, ignoring shame, even running naked, pulse definitely stringy emerging at Cun position, this name Hua Dian, commonly called Fa Hua Dai). All have special effects. Only Depressed Mania mostly comes from disappointment, must get wishes fulfilled for illness to heal, cannot be treated by emotionless herbs. Predecessors said "Medicine provides Xiaoyao but person does not, what benefit?" Truly said. My old friend Mr. Zhao Qingchu once told me, Mr. Hu Zaizi of Yexi was good at treating mania, his self-description: Mania disease may eat well or not eat, if voice is loud/strong, face color yellow-red, eye spirit depressed/angry, strength exceeds normal, two bowels/urine constipated yellow-red, only need to distinguish qi mechanism clarity/turbidity to decide treatment. Face color clear/bright: mostly from anger/depression/violent anger rebelling upward, becoming manic/restless laughing/crying, if bowels regular, use Jiawei Tie Luo Yin (Gypsum 3 liang, Green Dragon Teeth, Poria with Hostwood, Saposhnikovia each 1.5 liang, Scrophularia, Gentiana Macrophylla each 1 liang, Fresh Rehmannia 4 liang, first decoct Iron Filings 8 liang with flowing water 1 dou, boil to 5 sheng, add above seven herbs, Bamboo Sap 0.5 sheng, Antelope Horn 5 qian, enter iron juice, boil to 2 sheng, remove dregs, mix with Bamboo Sap, divide warm into 5 doses, finish in one day), to drain Liver Yang. If face color turbid/oppressed, two bowels/urine constipated: mostly from rich wine/heavy flavors generating heat-steaming-phlegm, or taking advantage of extreme hot weather, unreleased盛怒, becoming wild cursing/singing/laughing, even climbing walls/roofs, use Jiada Chenqi Tang (Raw Rhubarb, Efflorescent Niter, Immature Bitter Orange each 5 qian, Qingmengshi, Gleditsia Spine each 2 qian, decocted, mix in Pig Bile, Rice Vinegar each 2 small spoons, take Indian Rhinoceros Horn substitute 2 fen), to purge turbid filth. If face color dull/stiff, eye spirit sluggish/dull, delirious speaking little, preferring Yin fearing Yang, eating/living as if healthy: mostly from suppressed frustration not extending, becoming lost-wit dementia, use Diankuang Pili San [Realgar, Orpiment, Borneol, Indian Rhinoceros Horn substitute each 5 fen, Raw Gardenia 20 pods, White Acute Seed 1 qian, Raw White Arsenic 4 fen, Raw Mung Beans 180 grains, soak mung beans in cold water briefly, peel skin, dry-shade with remaining raw herbs to powder, separately grind in Ice/Yellow, adults can take 1 qian, 15-16 year olds take 4 fen, taken with white soup, then eat some flour/noodle cakes etc., should...]