Library

[External Yang Internal Yin / Yang Mania]

The young son of General Wanyan Gong, titled "Pi Yin" (Spleen Seal), suffered from Shanghan (Cold Damage) for six or seven days. He experienced alternating chills and fever, had three to five spots on the posterior aspect of his wrists, and slight epistaxis (nosebleed). Physicians treated him with Baihu Tang (White Tiger Decoction) and Chai Hu (Bupleurum) preparations, but he did not recover. Upon my examination, his pulses in both hands were deep and choppy. There was no significant heat upon palpation of the chest, diaphragm, and limbs; this indicated internal cold. Inquiring into the cause, it was found that during the summer heat, he slept at the slanted corner of a palace hall. First, he contracted external cold, followed by extreme thirst, after which he drank a large bowl of iced cheese water. The external contraction was mild, while the internal injury from diet was severe. The external pathogen followed the internal pathological mechanism, resulting in a condition classified as Yin. Thus, epistaxis occurred first, followed by the manifestation of internal Yin syndrome, with alternating chills and fever. This may also involve the Spleen (Taiyin), rather than the alternating chills and fever characteristic of Shaoyang syndrome. He was treated with Tiao Zhong Tang (Regulate the Middle Decoction) for several doses and recovered.

Xu Shi, the wife of Zhang Yifu, son of Chancellor Zhang of Zhangde and daughter of Scholar Zhuangyuan Xu Xianzhi (sister of Shao Ming), suffered from Yang Jue Nu Kuang (Yang Reversal with Angry Mania). During attacks, her food intake increased four to five times normal; she cursed without distinguishing between relatives and strangers; she wore mourning attire to attend funerals; she alternated between crying and singing; and she sometimes injured people with blades. When silent, she appeared mute; when speaking, she acted like a madman. Although she normally could not read or write, she could recite texts from *Wen Xuan* (Selections of Refined Literature), leading people to believe she was possessed by ghosts or demons. Upon examining her when calm, all six pulses were imperceptible upon lifting and pressing. Her body surface felt cold as water and stone. During attacks, her cries became progressively louder. I once heard Elder Jiegu say: The *Shennong Bencao Jing* states that "taking away food cures it." This does not mean withholding food, but rather using treatment to make the patient unable to eat, which constitutes "taking away food." I used Dachengqi Tang (Major Order the Qi Decoction) to purge, expelling several sheng (a unit of volume) of foul matter. The mania subsided slightly, but relapsed after one or two days. I purged again, expelling several sheng of stool, and the illness calmed down again. After another day or two, it relapsed. A third purge stabilized the condition as before, but she could not eat. The disease lightened slightly but persisted. I continued purging, performing the procedure five to seven more times, totaling several dou (a unit of volume) of stool. The illness eased, her body warmed, and her pulse returned. By the fourteenth day, the illness was cured, and her pulse normalized. After lying drowsily for three or four days, she revived, began taking small amounts of food, and was fully restored after ten more days. At the onset of the illness, her speech and voice were extremely angry. All Yang qi of the body had sunk inward and hidden within the Stomach. Was it not appropriate to use a major purgative method? This reflects the meaning of "taking away food" as interpreted by Yi Lao (Zhang Yuansu).

The above case of Yang Mania should technically not be categorized under Yin syndromes. However, it is listed here alongside Yin Mania. While the manic behavior is identical, the nature of Cold and Heat differs. A difference of a hair's breadth leads to an error of a thousand miles. Readers should reflect deeply upon this passage.