目 外决于面者为锐 。在内近鼻者为内 。上为外 。下为内 。(经中凡叙癫狂皆关于目故特提唱之第嫌篇中少
连缀少发明耳)癫疾始生。先不乐。头重痛。视举。目赤甚作极。已而烦心。候之于颜。取手太阳阳明太阴。血变而止。
(作极盖言身之躁动不安非有所作为而令疲极也)癫疾始作。而引口。啼呼喘悸者。候之手阳明太阳。左强者攻其右。
右强者攻其左。血变而止。癫疾始作。先反僵。因而脊痛。候之足太阳阳明太阴手太阴。血变而止。治癫疾者。常与之
居。察其所当取之处。病至。视之。有过者。泻之。置其血于瓠壶之中。至其发时。血独动矣。不动。灸穷骨二十壮。
穷骨者 骨也。骨癫疾者。 齿诸 分肉皆满。而骨居。汗出。烦 。呕多沃沫。气下泄。不治。筋癫疾者。身倦挛急。
大刺项大经之大杼脉。呕多沃沫。气下泄。不治。脉癫疾者。暴仆。四肢之脉。皆胀而纵。脉满。尽刺之。出血。不满。
灸之。挟项太阳。灸带脉于腰。相去三寸。诸分肉本输。呕多沃沫。气下泄。不治。癫疾者疾发如狂者。死不治。狂始
生先自悲也。喜忘苦怒善恐者。得之忧饥。治之取手太阴阳明。血变而止。及取足太阴阳明。狂始发少卧。不饥自高贤
也。自辩智也。自尊贵也。善骂詈。日夜不休。治之。取手阳明太阳太阴舌下少阴。视之。盛者。皆取之。不盛。释之
也。狂言惊善笑。好歌乐妄行不休者得之。大恐治之。取手阳明太阳太阴。狂目妄见耳妄闻善呼者。少气之所生也。治
之取手太阳太阴阳明足太阴头两 。狂者。多食善见鬼神。善笑。而不发于外者。得之有所大喜。治之。取足太阴太阳
阳明。后取手太阴太阳阳明。狂而新发未应如此者。先取曲泉左右动脉及盛者。见血。有顷。巳不已。以法取之。灸骨
二十壮。风逆HT 。四肢肿。身漯漯。唏然时寒。饥则烦。饱则善变。取手太阴表里。足少阴阳明之经。肉清取荥骨清
取井经也。厥逆为病也。足HT 清。胸若将裂。肠若将以刀切之。烦而不能食。脉大小皆涩。暖取足少阴。清取足阳明。
清则补之。温则泻之。厥逆腹胀满。肠鸣。胸满不得息。取之下胸二肋咳而动手者。与背 以手按之立快者。是也。内
闭不得溲。刺足少阴太阳与 上。以长针。气逆。则取其太阴阳明厥阴。甚取少阴阳明动者之经也。少气。身漯漯也。
言吸吸也。骨 体重。懈惰不能动。补足少阴。短气。息短不属。动作气索。补足少阴。去血络也。
后半带叙厥逆。亦如前篇之带叙痈疽也。二篇乃纪事文中之极有声色有气焰者。
眼睛向外侧延伸至面颊的部分称为“外眦”(锐),在内部靠近鼻子的部分称为“内眦”()。上部为外侧,下部为内侧。(经文中凡是叙述癫狂病症都与眼睛有关,所以特别提出强调,只是遗憾篇章中缺少连贯性和进一步的阐发。)
癫疾刚开始发生时,患者首先感到心情不愉快,头部沉重疼痛,视物时眼球上翻,眼睛红赤严重甚至达到极点,随后心中烦闷。观察面色应在颜面部进行。治疗应选取手太阳、手阳明、手太阴经的穴位,直到血液颜色由暗变红即可停止针刺放血。
(“作极”大概是指身体躁动不安,并非指有所作为而导致极度疲劳。)
癫疾刚开始发作时,牵引口角歪斜,啼哭呼叫,气喘心悸的,应观察手阳明、手太阳经的表现。左侧强急的攻治右侧,右侧强急的攻治左侧,直到血液颜色由暗变红即可停止。
癫疾刚开始发作时,先出现身体向后反张僵硬,进而脊背疼痛。应观察足太阳、足阳明、足太阴及手太阴经,进行针刺放血,直到血液颜色由暗变红即可停止。
治疗癫疾的人,应当经常与患者相处,观察他们应当取穴的部位。当病发作时,观察患者,发现有邪气盛实的部位,就予以泻法。将放出的血置于葫芦壶中,等到病情发作时,壶中的血会独自跳动。如果不动,就在穷骨处艾灸二十壮。
穷骨就是骶骨。
患骨癫疾的,牙齿各个缝隙间的肌肉都饱满肿胀,骨骼突出,出汗,心烦,呕吐大量涎沫,气向下泄脱,属于难治之症。
患筋癫疾的,身体疲倦拘挛急迫。应用大针深刺项部大杼脉。若呕吐大量涎沫,气向下泄脱,属于难治之症。
患脉癫疾的,突然仆倒,四肢的脉络都胀满而弛纵。脉象满实,就全部刺之出血。脉象不满实,就用灸法。在挟持颈部的太阳经,以及腰部带脉处(距离旁开三寸)和各分肉的本输穴施灸。若呕吐大量涎沫,气向下泄脱,属于难治之症。
狂病刚开始发生时,患者首先自己感到悲伤,喜欢遗忘,苦于愤怒,容易恐惧,这是由于忧愁和饥饿引起的。治疗应选取手太阴、手阳明经,直到血液颜色由暗变红即可停止。并选取足太阴、足阳明经。
狂病刚开始发作时,睡眠少,不觉得饥饿,自认为高尚贤能,自认为聪明有辩才,自认为尊贵,喜欢骂人,日夜不停。治疗时,选取手阳明、手太阳、手太阴、舌下少阴经的穴位。观察这些穴位,如果气血盛实,就全部取用;如果不盛实,就放松不予处理。
狂言乱语,惊恐,喜欢笑,喜欢唱歌娱乐,行为妄乱不休的,是由于大惊引起的。治疗时,选取手阳明、手太阳、手太阴经。
狂病患者眼睛妄见,耳朵妄闻,喜欢呼喊的,是由于气少产生的。治疗时,选取手太阳、手太阴、手阳明及足太阴经,还有头部的两个特定部位。
狂病患者,多吃东西,喜欢看见鬼神,喜欢笑,但情绪不外露的,是由于大喜引起的。治疗时,选取足太阴、足太阳、足阳明经,之后再选取手太阴、手太阳、手阳明经。
狂病新发,还没有发展到上述程度的,先选取曲泉穴左右动脉处,以及气血盛实的部位,见到出血为止。过一会儿,如果病还不愈,再按常规方法治疗。在骶骨处艾灸二十壮。
风逆证,四肢肿胀,身体湿冷,时不时发出叹息声且怕冷,饿了就烦躁,饱了就情绪多变。治疗应选取手太阴经及其表里经(手阳明),足少阴经及其表里经(足阳明)。肌肉清浅的取荥穴,骨骼清浅的取井穴,经脉深的取经穴。
厥逆病表现为:足部寒冷,胸部好像要裂开一样,肠道好像被刀切一样疼痛,心烦但不能进食,脉象大小都涩滞。温暖疗法取足少阴经,清凉疗法取足阳明经。寒证用补法,热证用泻法。
厥逆导致腹胀满,肠鸣,胸满呼吸困难,应选取下胸部第二肋骨咳嗽时手部动作明显的部位,以及背部用手按压后感觉舒适的部位,就是这些穴位。
体内闭塞导致小便不通,刺足少阴、足太阳经以及髀关穴附近,使用长针。气逆的,取手太阴、手阳明、足厥阴经,严重的取足少阴、足阳明经,即那些脉搏跳动的经脉。
气少,身体湿冷,呼吸微弱有声,骨骼沉重,懈怠懒惰不能活动,应补足少阴经。
短气,呼吸短促不连续,活动时气息衰竭,应补足少阴经,去除血络中的瘀血。
后半部分顺便叙述了厥逆证,也如同前篇顺便叙述痈疽证一样。这两篇是记事文章中极具声色气势的作品。
The part of the eye extending outward to the cheek is called the *lateral canthus* (Ruì). The part inside, near the nose, is called the *medial canthus*. The upper part is lateral, and the lower part is medial. (Since all descriptions of epilepsy and mania in the classics relate to the eyes, this is specifically highlighted; it is only regretted that the chapter lacks coherence and further elaboration.)
When epilepsy first begins, the patient initially feels unhappy, experiences heavy head pain, upward deviation of the eyes, severe redness of the eyes reaching an extreme, followed by mental restlessness. Observation should be conducted on the face. Treatment involves selecting points from the Hand Taiyang, Hand Yangming, and Hand Taiyin meridians. Bleeding should cease when the blood color changes [from dark to bright].
("Reaching an extreme" here likely refers to physical restlessness and agitation, not fatigue caused by excessive effort.)
When epilepsy first manifests with pulling of the mouth, crying out, panting, and palpitations, observe the Hand Yangming and Hand Taiyang meridians. If the left side is stiff, treat the right; if the right is stiff, treat the left. Bleeding should cease when the blood color changes.
When epilepsy first manifests with initial backward rigidity of the body followed by spinal pain, observe the Foot Taiyang, Foot Yangming, Foot Taiyin, and Hand Taiyin meridians. Perform bleeding therapy until the blood color changes.
Those treating epilepsy should reside frequently with the patient to observe where points should be selected. When the disease strikes, observe the patient; for areas with excess pathogenic factors, apply draining methods. Place the extracted blood in a gourd vessel. At the time of recurrence, the blood in the vessel will move independently. If it does not move, moxa twenty doses at the Qionggu (sacral bone).
Qionggu refers to the sacrum.
In cases of Bone Epilepsy, the flesh around the teeth is full and swollen, bones are prominent, sweating occurs, mental restlessness ensues, vomiting of copious saliva happens, and Qi leaks downward. This is difficult to treat.
In cases of Tendon Epilepsy, the body is fatigued with spasms and cramps. Use large needles to deeply puncture the Dazhu (BL11) pulse in the neck. If there is vomiting of copious saliva and Qi leaking downward, this is difficult to treat.
In cases of Vessel Epilepsy, sudden collapse occurs, and the pulses of the four limbs are distended and flaccid. If the pulses are full, prick all of them to bleed. If not full, apply moxibustion. Moxa the Taiyang meridians flanking the neck, the Dai Mai (Girdle Vessel) on the waist (three cun apart), and the Ben Shu points of various muscle compartments. If there is vomiting of copious saliva and Qi leaking downward, this is difficult to treat.
If epilepsy manifests like mania during attacks, it is a death syndrome and difficult to treat.
When Mania first begins, the patient initially feels sad, prone to forgetfulness, bitter anger, and fear, caused by worry and hunger. Treatment involves selecting points from the Hand Taiyin and Hand Yangming meridians until the blood color changes. Also select points from the Foot Taiyin and Foot Yangming meridians.
When Mania first erupts, the patient sleeps little, feels no hunger, considers themselves noble and virtuous, claims wisdom and eloquence, considers themselves prestigious, curses constantly, day and night without rest. Treatment involves selecting points from the Hand Yangming, Hand Taiyang, Hand Taiyin, and the Shaoyin meridian under the tongue. Observe these points; if full, treat all; if not full, release them [do not treat aggressively].
Patients speaking wildly, frightened, laughing excessively, enjoying singing and music, and acting recklessly without stopping are caused by great fright. Treatment involves selecting the Hand Yangming, Hand Taiyang, and Hand Taiyin meridians.
Manic patients who see hallucinations, hear voices, and call out frequently suffer from deficiency of Qi. Treatment involves selecting the Hand Taiyang, Hand Taiyin, Hand Yangming, and Foot Taiyin meridians, as well as two specific locations on the head.
Manic patients who eat much, see spirits and ghosts, laugh, but do not express emotions externally are caused by great joy. Treatment involves selecting the Foot Taiyin, Foot Taiyang, and Foot Yangming meridians, followed by the Hand Taiyin, Hand Taiyang, and Hand Yangming meridians.
For newly onset mania that has not yet reached the aforementioned severity, first select the Ququan (KI35) artery on both sides and any full vessels until bleeding occurs. After a while, if the condition persists, treat according to standard methods. Apply moxibustion twenty doses at the sacral bone.
Wind-Ni syndrome presents with swelling of the four limbs, damp coldness of the body, occasional sighing and aversion to cold, irritability when hungry, and mood instability when full. Treatment involves selecting the Hand Taiyin meridian and its exterior-interior pair (Hand Yangming), and the Foot Shaoyin meridian and its exterior-interior pair (Foot Yangming). For superficial muscles, select Ying-Spring points; for superficial bones, select Jing-Well points; for deep meridians, select Jing-River points.
Jue-Ni (Reversal Cold/Heat) presents with cold feet, chest feeling as if splitting, intestines feeling as if cut by a knife, irritability without ability to eat, and pulses that are small or large yet choppy. For warm conditions, select the Foot Shaoyin meridian; for cold conditions, select the Foot Yangming meridian. Apply tonification for cold syndromes and sedation for heat syndromes.
Jue-Ni causing abdominal fullness, borborygmus, chest fullness, and dyspnea requires selecting points below the second rib on the chest where coughing induces hand movement, and points on the back that feel comfortable upon manual pressure.
Internal blockage preventing urination requires needling the Foot Shaoyin and Foot Taiyang meridians and the area above the thigh using long needles. For Qi rebellion, select the Hand Taiyin, Hand Yangming, and Foot Jueyin meridians; for severe cases, select the Foot Shaoyin and Foot Yangming meridians, specifically those with pulsating vessels.
Deficiency of Qi presents with damp coldness of the body, weak breathing sounds, heavy bones, lethargy, and inability to move. Tonify the Foot Shaoyin meridian.
Shortness of breath with discontinuous respiration and exhaustion upon movement requires tonifying the Foot Shaoyin meridian and removing blood from collateral vessels.
The latter half briefly discusses Jue-Ni, similar to how the previous chapter briefly discussed Carbuncles and Ulcers. These two chapters are among the most vivid and vigorous narrative texts in the records.