发狂二证当别白。阳毒蓄血皆凭脉。（发狂有二证。有阳毒发狂。有蓄血发狂。）阳毒发狂多干呕。烦躁脉实并面赤。
（难经云。重阳者狂。重阴者癫。）蓄血如狂脉沉微。但欲嗽水不咽入。小腹硬满小便利。不发寒热大便黑。（仲景云。
阳明病七八日。表证仍在。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。以太阳随经。瘀热在里故也。抵当汤主之）大抵当汗而不汗。热化为血如何散。血上蓄兮喜忘多。血下蓄兮还闷
乱。（素问云。血在上则忘。血在下则狂。）更有火劫发狂时。桂枝救逆汤加减。（仲景云。伤寒之脉浮。而医以火迫劫之。
亡阳。惊狂。卧起不安。属桂枝。去芍药。加蜀漆。牡蛎。龙骨。救逆汤治）
温毒热病证两般。发斑隐疹满身间。（仲景云。风气相搏。则为隐疹。身体为痒。痒者为泄风）温毒冬月冒寒气。至
春始发在皮端。（此证谓冬月冒寒。至春阳气盛。发于表肤者。）热病表虚而里实。热毒不散锦纹斑。不可发汗重开泄。
升麻汤辈可求安。（巢氏云。热病在表。已发汗。未解。或吐下后。热毒瓦斯不散。烦躁。谵语。此为表虚里实。热气燥于
外。故身体发斑如锦纹。凡发斑不可用发汗药。令疮重开泄。更增斑烂也。宜升麻元参汤。热毒乘虚入胃。胃烂。故发
斑。其热微者。赤斑出。剧者黑斑出。赤斑出者五死一生。黑斑出者十死一生。）
发狂这一类病证需要仔细辨别。阳毒和蓄血导致的发狂都要依靠脉象来判断。（发狂有两种证型，一种是阳毒引起的发狂，另一种是蓄血引起的发狂。）阳毒引起的发狂多伴有干呕，症状表现为烦躁、脉象实大且面色发红。
（《难经》说：阳气重叠偏盛的人患狂病，阴气重叠偏盛的人患癫病。）蓄血引起的如狂状态，脉象沉而微弱，患者只想漱口喝水却不咽下，小腹坚硬胀满但小便通畅，没有寒热往来且大便颜色发黑。（张仲景说：阳明病经过七八天，表证依然存在，脉象微而沉，反而没有形成结胸证，病人出现发狂的症状，这是因为热邪在下焦，小腹部应当硬满，小便自利的，通过泻下瘀血才能痊愈。之所以这样，是因为太阳经的邪气随经入里，瘀热蕴结在体内所致。主治方剂为抵当汤。）大抵上，如果是应当发汗解表而没有发汗，导致热邪转化为瘀血，该如何消散呢？瘀血向上蓄积会导致健忘多梦，瘀血向下蓄积会导致烦闷混乱。（《素问》说：血在上部则健忘，血在下部则发狂。）更有因火疗劫迫导致的发狂，可用桂枝救逆汤加减治疗。（张仲景说：伤寒脉浮，医生用火法强迫发汗，导致亡阳，出现惊悸发狂，卧起不安，属于桂枝去芍药加蜀漆牡蛎龙骨救逆汤的治疗范围。）
温毒和热病引起的斑疹证候有所不同，发斑和隐疹遍布全身。（张仲景说：风邪与卫气相搏结，就会形成隐疹，身体瘙痒，瘙痒是由于泄风所致。）温毒是因冬季感受寒气，到了春季才发作，病位在皮肤表面。（这种证候是指冬季冒受寒气，到了春季阳气旺盛时，邪气发于体表肌肤。）热病若表虚而里实，热毒不散则出现如锦纹般的斑疹。此时不可再发汗以免再次开泄腠理，可用升麻汤之类的方剂寻求安宁。（巢元方说：热病在表，已经发汗但未解除，或者在吐下之后，热毒之气不散，出现烦躁、谵语，这称为表虚里实，热气燥烈于外，所以身体发出如锦纹般的斑疹。凡是发斑都不可用发汗药，以免疮口重新开泄，加重斑烂。适宜使用升麻元参汤。热毒乘虚侵入胃中，导致胃烂，所以发斑。热势轻微的，出赤斑；病情严重的，出黑斑。出赤斑的，十死一生；出黑斑的，十死一生。）
The two conditions of mania must be distinguished clearly. Yang toxicity and blood stasis both rely on pulse diagnosis for identification. (There are two types of mania: one caused by Yang toxicity, and the other by blood stasis.) Mania caused by Yang toxicity is often accompanied by dry retching, restlessness, a full pulse, and a red face.
(The *Nanjing* states: "Excess of Yang leads to mania; excess of Yin leads to dementia.") Blood stasis causing a manic-like state presents with a deep and faint pulse. The patient desires to rinse their mouth with water but does not swallow it. The lower abdomen is hard and full, urination is free, there is no aversion to cold or fever, and the stool is black. (Zhang Zhongjing stated: "In Yangming disease, after seven or eight days, if exterior symptoms persist, the pulse is faint and deep, yet there is no Jie Xiong (chest binding) syndrome, and the person becomes manic, this is because heat is in the Lower Jiao, and the lower abdomen should be hard and full. If urination is normal, purging the blood will lead to recovery. This occurs because Taiyang pathogenic factors follow the meridians into the interior, where stasis and heat accumulate. The principal formula is Didang Tang.") Generally, if sweating should have been induced but was not, heat transforms into blood stasis; how can it be dispersed? When blood stasis accumulates upward, it causes forgetfulness; when it accumulates downward, it causes mental confusion. (*Suwen* states: "Blood stasis above leads to forgetfulness; blood stasis below leads to mania.") Furthermore, there is mania caused by fire therapy coercion, which can be treated with Guizhi Jiuni Decoction (Cinnamon Twig Rescue the Perdition Decoction) with modifications. (Zhang Zhongjing stated: "In Shaoyin disease, if the pulse is floating, and the physician uses fire methods to force sweating, leading to loss of Yang, resulting in fright, mania, and restlessness in bed and upon rising, this belongs to the treatment scope of Guizhi Decoction without Paeonia, plus Shuqi, Muli, and Longgu, known as Jiuni Decoction.")
Wendu (Warm Toxin) and Re Bing (Heat Disease) present differently regarding macules. Macules and hidden rashes appear all over the body. (Zhang Zhongjing stated: "When Wind Qi clashes with Wei Qi, Yin Zhen (hidden rashes) form, causing body itching; itching indicates Xie Feng (draining wind).") Wendu arises from contracting cold qi in winter, manifesting only in spring at the skin's surface. (This condition refers to contracting cold in winter, which manifests on the exterior skin when Yang Qi becomes abundant in spring.) In Heat Disease, if the exterior is deficient and the interior is excess, and heat toxin does not dissipate, brocade-patterned macules appear. Sweating should not be induced to avoid re-opening the pores; formulas such as Shengma Tang (Cimicifuga Decoction) may be sought for relief. (Chao Shi stated: "If Heat Disease is in the exterior and has been sweated out but not resolved, or after vomiting/purging, heat toxin qi does not dissipate, causing restlessness and delirium, this is termed Exterior Deficiency and Interior Excess. Heat qi dries the exterior, causing the body to develop macules like brocade patterns. For any macule eruption, diaphoretic herbs must not be used, lest sores reopen and worsen the macule rot. It is appropriate to use Shengma Yuanshen Tang. If heat toxin enters the Stomach via deficiency, causing Stomach corruption, macules erupt. Mild heat produces red macules; severe heat produces black macules. Red macules indicate five deaths to one survival; black macules indicate ten deaths to one survival.")