经云∶邪入于阳则狂。又云∶重阳为狂。《伤寒书》以热毒入胃，并入于心，遂使狂言妄语，
大渴引饮，然此指热甚一条而言也。夫发狂症，内伤有痰热、挟食、惊气、蓄血、血虚、失
精、神不守舍七者之分，今外感以表邪壅闭，里热内结、血蓄、 毒、挟痰、食滞、阴躁七者
之别，未可概以火热治之，而犯误下寒凉抑遏之弊也。表邪壅闭者，其人素有积热，外冒表
邪，不得发泄，内扰神明，遂使志识昏迷，但见狂妄。即有表邪，因内有积热，不宜辛温发
散。无汗，脉浮数，先以羌活冲和汤散表，后以双解散和解表里。邪热内结者，六脉沉
数，唇焦口渴，手足多汗，狂乱谵语，二便闭涩，当以黄连解毒汤、凉膈散、导赤各半汤
清利里热。若大便不通，有下症者，承气汤下之。蓄血发狂者，如狂喜忘，漱水在口，不能
不咽，寸脉见芤者，血蓄上焦也，当归桃仁汤主之。小腹硬满，小便自利，尺脉见芤者，血
蓄下焦也，桃仁承气汤；甚者抵当汤。 毒发狂者，内伏 毒，外被风寒所束，或食生冷抑
遏，或因食滞中焦， 毒不得发越，内扰神明，左脉或浮或躁者，羌活败毒散。生冷抑遏，
食滞中焦，右脉滑大者，保和散、平胃散。时气发狂者，四时之疫气沿门患之，当察时令
所属，应发表者，羌活败毒散；应和解者，双解散；应清凉者，凉膈散、黄连解毒汤。另有
挟食发狂者，外感时令，内伤饮食，滞于中焦，则多谵语，症似阳狂，但脉大不数，口不消
水为异，亦宜平胃保和散等煎汤服之。又有挟痰发狂者，中脘有痰，胸膈痞满，迷塞包络，
口出无伦语，症似阳狂，但唇不焦，口不渴，舌有滑苔，痰在上焦，寸脉滑大，法先吐之，
盐豉汤探吐。痰在中焦，关脉洪滑，二陈汤加竹沥、胆星；有结痰痰积者，加海石、瓦棱
子。胁肋胀满作痛，有实候者，先以导痰汤服之。有下症者，以滚痰丸下之。阴躁发狂，另
具阴症门。
太阳病不解，热结膀胱，其人如狂，血自下者愈。其外不解者，尚未可下，当先解外。外已
解，但小腹急结者，乃可攻之，宜桃仁承气汤。
太阳病，六七日，表症仍在，脉微而沉，反不结胸，其人发狂者，以热在下焦，小腹当硬
满。小便自利者，下血乃愈。所以然者，以太阳经淤热在里故也。抵当汤主之。
太阳病，身黄脉沉结，小腹硬，小便不利者，为无血也。小便自利，其人如狂者，血症谛
也，抵当汤主之。
三条详注蓄血。
阳明病，初欲食，小便反不利，大便自调，其人骨节疼，翕翕如有热，庵然如狂， 然汗出而
解者，此水不胜谷气，与汗共并，脉紧则愈。
此条详注身痛。
羌活冲和汤 见发热。
发狂不用表药，今以表邪未解，故先散表邪，然后或清热，或消食，或消痰。
双解散
羌活 葛根 柴胡 防风 荆芥 石膏 黄芩 滑石 山栀 连翘 知母 甘草 桔梗
表邪发狂，止须解表；里热发狂，止须清里；若表里俱见之症，以此方双解表里。
黄连解毒汤
黄连 黄芩 黄柏 山栀 石膏
发狂之症，外无表邪，里无痰食，则以此方清里热。
凉膈散
桔梗 天花粉 连翘 薄荷 黄芩 大黄 芒硝 山栀
心藏神，肺藏魄，心肺为邪热所冒，则神识昏迷，狂言谵语，故以此方清上焦心肺之热。
承气汤 见大便结。
狂乱系热结在里，故大便不通而狂乱者，宜用此方。
导赤各半汤
木通 生地 甘草 黄连 知母 滑石 麦冬 山栀 黄芩 犀角
心为热冒，则发谵狂，故以导赤散合泻心汤；上清心经之火，加滑石，导心火；下通小便
而出，加知母、山栀、黄芩兼清上焦肺火。以利小便，莫如清肺，清肺热又莫如利二便也。
当归桃仁汤
当归 桃仁 红花 丹皮 山楂 泽兰叶
如狂喜忘之症，血结者多，故以此方治之。不应，再加枳壳、大黄，直达大肠。
桃仁承气汤 见蓄血。
血停上焦，用上方，兼化兼行；血蓄下焦，用此方。
抵蓄汤 见蓄血。
此方行血至重，然淤血沉结，非此不可。
羌活败毒散 见发热。
疫毒必从毛窍口鼻感入，故疫症发狂见表症者，宜先散疫毒。
保和丸
山楂 麦芽 莱菔子 熟半夏 连翘 香附 枳壳
热甚加栀、连；湿郁痞满，合平胃散、石菖蒲。
发狂症，皆以阳火主治。亦有食滞中焦，生冷抑遏，故特补此消导法门。
二陈竹沥胆星汤
熟半夏 白茯苓 陈皮 甘草 胆星 竹沥
寒凉凝结，加生姜；内有积热，加栀连；湿郁，合平胃散；气结，加枳壳、香附、石菖蒲。
滚痰丸
礞石 黄芩 大黄 黄柏 沉香
胃实食重，热结大肠，用承气汤下之。表邪下早，内陷心胸，用陷胸汤下之。今热痰胶固
肠胃，以此方下之。
古籍记载说：邪气侵入阳分就会发狂。又说：阳气过盛就会发狂。《伤寒书》认为热毒进入胃中，并波及心脏，从而导致胡言乱语、神志错乱，极度口渴想喝水，但这只是指热邪极盛这一种情况而言。
至于发狂的病症，内伤引起的有痰热、夹食、惊气、蓄血、血虚、失精、神不守舍这七种区别；外感引起的因表邪壅塞闭郁、里热内结、蓄血、毒邪、夹痰、食滞、阴躁这七种不同。不可以一概用火热病来治疗，从而犯下误用攻下法或寒凉药抑制遏伏的弊端。
如果是表邪壅塞闭郁的情况，患者平素体内就有积热，又外受表邪侵袭，导致邪气无法发泄，内扰神明，于是出现意识昏迷，只见狂妄之象。既然有表邪，但因内有积热，不宜使用辛温发散的方法。若无汗且脉浮数，先用羌活冲和汤疏散表邪，再用双解散调和表里。
如果是邪热内结的情况，六脉沉数，嘴唇焦裂口渴，手足多汗，狂乱谵语，大小便闭塞不通，应当用黄连解毒汤、凉膈散、导赤各半汤清利里热。如果大便不通，有可下之症者，用承气汤攻下。
蓄血导致的发狂，表现为似狂非狂、健忘，想漱口但不吞咽，寸脉见芤脉的，是血蓄在上焦，用当归桃仁汤主治。小腹硬满，小便自利，尺脉见芤脉的，是血蓄在下焦，用桃仁承气汤；病情严重的用抵当汤。
毒邪导致的发狂，体内潜伏毒邪，外部被风寒束缚，或因吃生冷食物抑制遏伏，或因食滞在中焦，导致毒邪不能发散，内扰神明，左脉或浮或躁动的，用羌活败毒散。若是因生冷抑制、食滞中焦，右脉滑大的，用保和散、平胃散。
时气（疫病）导致的发狂，是四季的疫气沿门传播患病，应当考察时令所属，该解表的用羌活败毒散；该和解的用双解散；该清凉的用凉膈散、黄连解毒汤。
另有夹食导致的发狂，外感时令邪气，内伤饮食，停滞在中焦，则多出现谵语，症状看似阳狂，但脉大而不数，口不渴水是不同之处，也适宜用平胃散、保和散等煎汤服用。
又有夹痰导致的发狂，中脘有痰，胸膈痞闷胀满，迷塞心包络，口中说出无条理的话，症状看似阳狂，但嘴唇不焦，口不渴，舌上有滑腻苔。痰在上焦，寸脉滑大，治法应先吐之，用盐豉汤探吐。痰在中焦，关脉洪滑，用二陈汤加竹沥、胆南星；若有结痰、痰积者，加海浮石、瓦楞子。胁肋胀满疼痛，有实证的，先用导痰汤服用。有可下之症的，用滚痰丸攻下。
太阳病不解，热邪结于膀胱，其人似狂，若瘀血自行排出则病愈。其表证未解的，尚不可攻下，应当先解表。表证已解，仅小腹急结的，才可以攻逐，宜用桃仁承气汤。
太阳病，经过六七天，表证仍在，脉微而沉，反而没有结胸，其人发狂的，是因为热邪在下焦，小腹应当硬满。小便自利的，下血后病愈。之所以这样，是因为太阳经瘀热在里的缘故。用抵当汤主治。
太阳病，身体发黄，脉沉结，小腹硬，小便不利的，是无瘀血。小便自利，其人似狂的，是瘀血的确证，用抵当汤主治。
以上三条详细注解了蓄血证。
阳明病，起初想吃饭，小便反而不利，大便正常，其人骨节疼痛，微微发热，恍惚如狂，濈然汗出而解的，这是水湿不胜谷气，与汗并出，脉紧则愈。
此条详细注解身痛。
羌活冲和汤 见发热章节。
发狂一般不用解表药，如今因为表邪未解，所以先散表邪，然后或清热，或消食，或消痰。
双解散
羌活、葛根、柴胡、防风、荆芥、石膏、黄芩、滑石、山栀、连翘、知母、甘草、桔梗。
表邪导致的发狂，只需解表；里热导致的发狂，只需清里；若表里同见的症状，用此方双解表里。
心藏神，肺藏魄，心肺被邪热所蒙蔽，则神识昏迷，胡言乱语，故用此方清上焦心肺之热。
承气汤 见大便结章节。
狂乱是由于热结在里，所以大便不通而狂乱的，宜用此方。
导赤各半汤
木通、生地、甘草、黄连、知母、滑石、麦冬、山栀、黄芩、犀角。
心被热邪蒙蔽，则发谵妄狂乱，故以导赤散合泻心汤；上清心经之火，加滑石，引导心火下行；下通小便而出，加知母、山栀、黄芩兼清上焦肺火。以利小便来说，莫过于清肺，清肺热又莫过于利二便。
似狂喜忘的症状，多是血结所致，故用此方治疗。若无效，再加枳壳、大黄，直达大肠。
血停在上焦，用上方，兼顾化瘀行血；血蓄在下焦，用此方。
抵当汤 见蓄血章节。（注：原文此处误写为“抵蓄汤”，根据上下文及中医常识修正为抵当汤，但在实体提取时保留原文或按标准名处理，此处翻译依原文逻辑理解为抵当汤）
此方活血力量极重，然而瘀血沉结，非此方不可。
羌活败毒散 见发热章节。
发狂症，多以阳火主治。也有因食滞中焦、生冷抑遏的，故特别补充此消导法门。
The classics state: "When pathogenic factors enter the Yang aspect, mania occurs." It also states: "Excessive Yang leads to mania." The *Shanghan Book* (Treatise on Cold Damage) posits that heat-toxin enters the stomach and spreads to the heart, causing delirious speech and madness, accompanied by extreme thirst and desire for drinking. However, this refers only to the case of extreme heat.
Regarding the syndrome of mania, internal injuries are categorized into seven types: phlegm-heat, food retention, fright qi, blood stasis, blood deficiency, essence loss, and spirit failing to reside in its abode. External contractions are distinguished by seven types: obstruction and closure of exterior pathogens, interior heat knotting, blood accumulation, toxin, phlegm retention, food stagnation, and yin restlessness. One cannot generally treat these as fire-heat syndromes, thereby committing the error of misusing purgatives or suppressing with cold-cooling herbs.
In cases of **obstruction and closure of exterior pathogens**, the patient typically has accumulated heat internally and is exposed to exterior pathogens. Unable to vent, the pathogen disturles the spirit, leading to confusion and apparent madness. Since there are exterior pathogens but also internal accumulated heat, acrid-warm dispersing methods are unsuitable. If there is no sweating and the pulse is floating and rapid, first use **Qianghuo Chonghe Tang** (Notopterygium Decoction for Harmony) to disperse the exterior, followed by **Shuangjie San** (Double Release Powder) to harmonize the interior and exterior.
In cases of **interior heat knotting**, the six pulses are deep and rapid, lips are scorched and dry, hands and feet sweat profusely, there is manic confusion and delirium, and bowel/bladder movements are obstructed. One should use **Huanglian Jiedu Tang** (Coptis Decoction for Resolving Toxins), **Liangge San** (Cooling the Diaphragm Powder), or **Daochi Banjie Tang** (Half-Half Decoction for Guiding Out Fire) to clear and drain interior heat. If the stool is unpassable and there are signs indicating purgation, use **Chengqi Tang** (Purgative Decoction).
For **mania due to blood stasis**, symptoms include being "like mad" with forgetfulness, wanting to rinse the mouth but not swallowing, and a cun (inch) pulse appearing hollow (Kou). This indicates blood accumulating in the Upper Jiao, treated with **Danggui Taoren Tang** (Angelica and Peach Kernel Decoction). If the lower abdomen is hard and full, urination is spontaneous, and the chi (cubit) pulse is hollow, this indicates blood accumulating in the Lower Jiao, treated with **Taoren Chengqi Tang** (Peach Kernel Purgative Decoction); in severe cases, use **Didang Tang**.
For **mania due to toxin**, latent toxins inside are constrained by external wind-cold, or suppressed by consuming raw/cold foods, or due to food stagnation in the Middle Jiao preventing toxin dispersion, disturbing the spirit. If the left pulse is floating or restless, use **Qianghuo Baidu San** (Notopterygium Decoction for Overcoming Toxins). If caused by raw/cold suppression or food stagnation in the Middle Jiao with a slippery and large right pulse, use **Baohe San** (Preserve Harmony Powder) or **Pingwei San** (Calm the Stomach Powder).
For **mania due to seasonal qi (epidemic)**, where epidemic qi spreads through the community, one must observe the season's characteristics. For exterior release, use Qianghuo Baidu San; for harmonizing, use Shuangjie San; for cooling, use Liangge San or Huanglian Jiedu Tang.
Additionally, **mania due to food retention** involves external seasonal contraction and internal dietary injury, stagnating in the Middle Jiao, causing much delirium. Symptoms resemble yang mania, but the pulse is large without rapidity, and there is no thirst for water. Use Pingwei San and Baohe San decocted together.
**Mania due to phlegm** involves phlegm in the Zhongwan area, chest/diaphragm oppression, blocking the pericardium, and incoherent speech. Symptoms resemble yang mania, but lips are not scorched, there is no thirst, and the tongue has a slippery coating. If phlegm is in the Upper Jiao with a slippery/large cun pulse, induce vomiting first using **Yanchi Tang** (Salt and Fermented Soybean Decoction). If phlegm is in the Middle Jiao with a surging/slippery guan (bar) pulse, use **Erchen Tang** (Two-Aged Decoction) plus **Zhuli** (Bamboo Sap) and **Danning** (Arisaema with Bear Bile). For condensed phlegm/phlegm masses, add **Haishi** (Flintstone) and **Walengzi** (Arca Shell). For distending pain in the hypochondrium with excess signs, first use **Daotan Tang** (Great Phlegm Decoction). If there are signs for purgation, use **Guntan Wan** (Rolling Phlegm Pill).
**Yin restlessness mania** is detailed in the Yin Syndrome chapter.
If **Taiyang Syndrome** remains unresolved, heat knots in the Bladder. The patient appears like they are mad. If blood passes spontaneously, the disease resolves. If exterior signs remain, purgation is not yet appropriate; resolve the exterior first. Once the exterior is resolved, if only the lower abdomen is urgent and knotted, attack it with **Taoren Chengqi Tang**.
In **Taiyang Syndrome**, after six or seven days, if exterior signs persist, the pulse is faint and deep, there is no Chest Bind, but the patient is manic, it is because heat is in the Lower Jiao and the lower abdomen should be hard/full. If urination is spontaneous, passing blood resolves the condition. This is due to Taiyang channel stasis-heat residing in the interior. Treat with **Didang Tang**.
In **Taiyang Syndrome**, if the body is yellow, pulse is deep and knotted, lower abdomen is hard, and urination is difficult, there is no blood stasis. If urination is spontaneous and the patient appears like they are mad, this is a definitive sign of blood stasis; treat with **Didang Tang**.
These three clauses detail Blood Stasis.
In **Yangming Syndrome**, initially desiring food, urination is unexpectedly difficult, stool is normal, bone joints ache, there is slight fever, and the patient is恍惚 (trance-like/like mad), resolving with sweating. This indicates water failing to overcome Grain Qi, merging with sweat; if the pulse is tight, it resolves.
This clause details Body Pain.
**Qianghuo Chonghe Tang**: See Fever section.
Mania usually does not use exterior-releasing herbs. Here, since the exterior pathogen is unresolved, we first disperse the exterior, then either clear heat, digest food, or resolve phlegm.
**Shuangjie San** (Double Release Powder):
Qianghuo, Gegen, Chaihu, Fangfeng, Jingjie, Shigao, Huangqin, Huashi, Shanzhi, Lianqiao, Zhimu, Gancao, Jiegeng.
For mania due to exterior pathogens, only release the exterior; for mania due to interior heat, only clear the interior; for simultaneous exterior-interior signs, use this formula to double-release both.
**Huanglian Jiedu Tang** (Coptis Decoction for Resolving Toxins):
Huanglian, Huangqin, Huangbai, Shanzhi, Shigao.
For mania with no exterior pathogen and no interior phlegm/food, use this to clear interior heat.
**Liangge San** (Cooling the Diaphragm Powder):
Jiegeng, Tianhuafen, Lianqiao, Bohe, Huangqin, Dahuang, Mangxiao, Shanzhi.
The Heart stores the Spirit, the Lung stores the Corporeal Soul. When Heat-Toxin covers the Heart and Lung, consciousness becomes confused, leading to delirium. This formula clears Heat from the Upper Jiao Heart and Lung.
**Chengqi Tang** (Purgative Decoction): See Constipation section.
Manic confusion stems from heat knotting in the interior. For mania with constipation, use this formula.
**Daochi Banjie Tang** (Half-Half Decoction for Guiding Out Fire):
Mutong, Shengdi, Gancao, Huanglian, Zhimu, Huashi, Maidong, Shanzhi, Huangqin, Xijiao.
When Heat covers the Heart, delirium and mania occur. We combine Daochi San and Xiexin Tang. To clear Heart Fire above, add Huashi to guide Heart Fire downward; to promote urination below, add Zhimu, Shanzhi, and Huangqin to clear Upper Jiao Lung Fire. Promoting urination is best achieved by clearing the Lung; clearing Lung Heat is best achieved by promoting bowel and bladder movement.
**Danggui Taoren Tang** (Angelica and Peach Kernel Decoction):
Danggui, Taoren, Honghua, Danpi, Shanzha, Zelan Ye.
"Like mad" and forgetfulness are mostly due to blood knotting; thus, use this formula. If ineffective, add Zhike and Dahuang to reach the Large Intestine directly.
**Taoren Chengqi Tang** (Peach Kernel Purgative Decoction): See Blood Stasis section.
For blood stagnating in the Upper Jiao, use the above formula to transform and move blood; for blood accumulating in the Lower Jiao, use this formula.
**Didang Tang**: See Blood Stasis section.
This formula strongly moves blood. For deep-seated stasis, this is indispensable.
**Qianghuo Baidu San** (Notopterygium Decoction for Overcoming Toxins): See Fever section.
Epidemic toxins enter via pores, nose, and mouth. For epidemic mania with exterior signs, first disperse the epidemic toxin.
**Baohe Wan** (Preserve Harmony Pill):
Shanzha, Maiya, Laifuzi, Shu Banxia, Lianqiao, Xiangfu, Zhike.
Add Shanzhi and Huanglian for severe heat; combine with Pingwei San and Shichangpu for dampness-induced oppression.
Mania is generally treated as Yang Fire. However, some cases involve food stagnation in the Middle Jiao or suppression by raw/cold foods; thus, this digestive method is specifically supplemented.
**Erchen Zhuli Danning Tang** (Two-Aged, Bamboo Sap, Arisaema with Bear Bile Decoction):
Shu Banxia, Baifuling, Chenpi, Gancao, Danning, Zhuli.
Add Shengjiang for cold-coagulation; add Shanzhi and Huanglian for internal accumulated heat; combine with Pingwei San for dampness; add Zhike, Xiangfu, and Shichangpu for Qi knotting.
**Guntan Wan** (Rolling Phlegm Pill):
Mengshi, Huangqin, Dahuang, Huangbai, Chenxiang.
For stomach excess and heavy food with heat knotting in the Large Intestine, use Chengqi Tang. If exterior pathogens were purged too early and sank into the Heart/Chest, use Xiantong Tang. Currently, with hot-phlegm congealing in the intestines/stomach, use this formula to purge.