治癫狂失心，脉滑实者。
生赭石（二两，轧细） 大黄（一两） 朴硝（六钱） 清半夏（三钱） 郁金（三钱）
治前证，顽痰凝结之甚者，非其证大实不可轻投。其方，即前方加甘遂末二钱，将他药煎好，调药汤中服。
凡用甘遂，宜为末，水送服。或用其末，调药汤中服。若入汤剂煎服，必然吐出。又凡药中有甘遂，不
可连日服之，必隔两三日方可再服，不然亦多吐出。又其性与甘草相犯，用者须切记。
甘遂性猛烈走窜，后世本草，称其以攻决为用，为下水之圣药。痰亦水也，故其行痰之力，亦百倍于他
药。曾治一少年癫狂，医者投以大黄六两，连服两剂，大便不泻。后愚诊视，为
开此方，惟甘遂改用三钱。病家谓，从前服如许大黄，未见行动，今方中止用大黄两许，岂能效乎？愚曰∶但
服，无虑也。服后，大便连泻七八次，降下痰涎若干，癫狂顿愈。见者以为奇异，彼盖不知甘遂三钱之力，远
胜于大黄六两之力也。
痰脉多滑，然非顽痰也。愚治此证甚多。凡癫狂之剧者，脉多瘀塞，甚或六脉皆不见，用开痰药通之，
其脉方出，以是知顽痰之能闭脉也。
癫狂之证，乃痰火上泛，瘀塞其心与脑相连窍络，以致心脑不通，神明皆乱。故方中重用赭石，借其重
坠之力，摄引痰火下行，俾窍络之塞者皆通，则心与脑能相助为理，神明自复其旧也。是以愚治此证之剧者，
赭石恒有用至四两者，且又能镇甘遂使之专于下行，不至作呕吐也。
癫者，性情颠倒，失其是非之明。狂者，无所畏惧，妄为妄言，甚或见闻皆妄。大抵此证初起，先微露
癫意，继则发狂。狂久不愈，又渐成癫，甚或知觉全无。盖此证，由于忧思过度，心气结而不散，痰涎亦即随
之凝结。又加以思虑过则心血耗，而暗生内热。痰经热炼，而胶粘益甚，热为痰锢，而消解无从。于是痰火充
溢，将心与脑相通之窍络，尽皆瘀塞，是以其神明淆乱也。其初微露癫意者，痰火犹不甚剧也，迨痰火积而益
盛，则发狂矣。是以狂之甚者，用药下其痰，恒作红色，痰而至于红，其热可知。迨病久，则所瘀之痰，皆变
为顽痰。其神明淆乱之极，又渐至无所知觉，而变为癫证。且其知觉欲无，从前之忧思必减，其内热亦即渐消，
而无火以助其狂，此又所以变为癫也。然其初由癫而狂易治，其后由狂而癫难治。故此证，若延至三四年者，
治愈者甚少。
人之神明，原在心与脑两处。金正希曰∶“人见一物必留一影于脑中，小儿善忘者，脑髓未满也，老人
健忘者，脑髓渐空
也。”汪 庵释之曰∶“凡人追忆往事，恒闭目上瞪，凝神于脑，是影留于脑之明征。”由斯观之，是脑原主
追忆往事也。其人或有思慕不遂，而劳神想象，或因从前作事差误，而痛自懊 ，则可伤脑中之神。若因研究
理解工夫太过，或有将来难处之事，而思患预防，踌躇太过，苦心思索，则多伤心中之神。究之，心与脑，原
彻上彻下，共为神明之府。一处神明伤，则两处神俱伤。脑中之神明伤，可累及脑气筋。心中之神明伤，亦可
累及脑气筋。且脑气筋伤，可使神明颠倒狂乱，心有所伤，亦可使神明颠倒狂乱也。
曾治一少妇癫狂，强灌以药，不能下咽。遂俾以朴硝代盐，每饭食之，病患不知，月余而愈。诚以朴硝咸
寒属水，为心脏对宫之药，以水胜火，以寒胜热，能使心中之火热，消解无余，心中之神明，自得其养，非仅
取朴硝之能开痰也。
治疗癫狂、失心疯，且脉象滑而有力的病证。
生赭石（二两，碾碎） 大黄（一两） 朴硝（六钱） 清半夏（三钱） 郁金（三钱）
治疗上述病症，若是顽痰凝结特别严重的情况，除非病情确实是大实证，否则不可轻易使用此方。该方剂，即在前方基础上加入甘遂末二钱，将其他药物煎煮好后，把药粉调入药汤中服用。
凡是使用甘遂，应当制成粉末，用水送服。或者将其粉末调在药汤中服用。如果放入汤剂中一起煎煮服用，必然会引起呕吐。另外，凡药方中含有甘遂的，不可连续多日服用，必须间隔两三天才可以再次服用，否则也容易引起呕吐。还有，甘遂的药性与甘草相冲突，使用者必须牢记这一点。
甘遂药性猛烈，善于走窜通行，后世本草书籍称其以攻逐决破为功效，是通下水液的圣药。痰也是水液的一种，所以它化痰的力量，比其它药物强百倍。曾治疗过一个患癫狂的少年，医生投用大黄六两，连续服用两剂，大便没有泻下。后来我诊治，为他开了这个方子，只是将甘遂改为三钱。病人家属说，之前服用了那么多大黄，都没有见效，现在方子里只用了一两大黄，怎么能有效呢？我说：只管服用，不用担心。服药后，大便连续泻下七八次，降下了大量的痰涎，癫狂症状顿时痊愈。看到的人觉得很奇异，他们大概不知道甘遂三钱的力量，远远胜过大黄六两的力量。
痰证的脉象多表现为滑脉，但这并不是顽痰。我治疗这类病证很多。凡是癫狂严重的患者，脉象多有瘀塞阻滞，甚至六部脉都摸不到，使用开痰的药物疏通后，脉象才会出现，由此可知顽痰能够闭塞脉道。
癫狂的病证，是由于痰火上泛，瘀塞了心脏与大脑相连的窍络，导致心脑之间气机不通，神明全部混乱。所以方中重用赭石，借助其沉重坠降的力量，摄引痰火下行，使得被堵塞的窍络得以通畅，那么心脏与大脑就能相互辅助协调，神明自然恢复常态。因此我治疗这种严重的病证时，赭石常常用到四两，而且它能镇住甘遂，使其专于下行，不至于引起呕吐。
癫证，是指性情颠倒，失去了判断是非的清明。狂证，是指无所畏惧，胡作非为，胡乱说话，甚至看到的听到的都是虚妄的。大抵这种病证初起时，先微微显露出癫证的迹象，随后则发展为狂证。狂证久了不愈，又逐渐演变成癫证，甚至知觉完全丧失。大概这种病证，是由于忧思过度，导致心气郁结而不能疏散，痰涎也随之凝结。再加上思虑过多耗伤心血，从而暗生内热。痰经过热邪煎熬，变得更为胶粘，热邪被痰邪束缚，无法消散。于是痰火充溢，将心脏与大脑相通的窍络全部瘀塞，因此神明混乱。起初微微显露癫意的时候，痰火还不算严重，等到痰火积聚而更加旺盛，就发为狂证了。所以狂证严重的，用药攻下痰浊时，痰常呈红色，痰变红，其热势可想而知。等到病程长久，所瘀积的痰，都变成了顽痰。神明混乱到了极点，又逐渐发展到没有知觉，而转变为癫证。并且由于知觉欲求消失，以前的忧思必然减少，体内的热邪也就逐渐消退，而没有火邪来助长狂躁，这又是转变为癫证的原因。然而，初期由癫转狂容易治疗，后期由狂转癫则难治。所以这种病证，如果拖延到三四年的，治愈者很少。
人的神明，原本存在于心脏和大脑两处。金正希说：“人看见一个物体，脑中必留下一个影像，小儿容易忘记事情，是因为脑髓尚未充盈；老人健忘，是因为脑髓逐渐空虚。”汪庵解释他说：“凡人追忆往事，常常闭目向上瞪视，精神凝聚于脑部，这是影像留在脑中的明显证据。”由此看来，脑原本主管追忆往事。这个人如果有思念爱慕未能如愿，因而劳神想象，或者因为以前做事有差错，而痛苦地自我懊悔，就可以损伤脑中的神明。如果因为研究理解的工夫太过，或者有将来难以处理的的事情，而提前担忧预防，犹豫不决太久，苦心思索，就会多损伤心中的神明。究其根本，心脏与大脑，原本上下贯通，共同作为神明的居所。一处神明受伤，则两处神明都会受损。脑中的神明受伤，可以累及脑气筋（神经）。心中的神明受伤，也可以累及脑气筋。而且脑气筋受伤，可以使神明颠倒狂乱，心中有所损伤，也可以使神明颠倒狂乱。
曾治疗过一个患癫狂的年轻妇女，强行灌药，不能咽下。于是让她用朴硝代替盐，每顿饭食用，病患自己不知道，一个多月后痊愈。确实是因为朴硝咸寒属水，是心脏对宫（对应脏腑）的药物，以水克火，以寒胜热，能使心中的火热消解无余，心中的神明自然得到滋养，不仅仅是取朴硝能开痰的功效。
Treating mania, insanity, and loss of mind (Dian Kuang Shi Xin), where the pulse is slippery and solid/excess.
Sheng Zhe Shi (Raw Ooidite, 2 liang, finely crushed) Da Huang (Rhubarb Root and Rhizome, 1 liang) Pu Xiao (Mirabilite, 6 qian) Qing Ban Xia (Processed Pinellia Tuber, 3 qian) Yu Jin (Curcuma Aromatica Rhizome, 3 qian).
To treat the aforementioned condition, if it is severe phlegm coagulation (Wan Tan Ning Jie), this formula should not be administered lightly unless the syndrome is a true excess pattern. This formula is the previous one with Gan Sui powder (Kansui Root) added in an amount of 2 qian; after decocting the other herbs, mix the powder into the herbal soup for administration.
When using Gan Sui, it is appropriate to grind it into powder and take it with water. Alternatively, mix the powder into the herbal soup. If decocted together in a soup, it will inevitably cause vomiting. Furthermore, any prescription containing Gan Sui should not be taken on consecutive days; there must be an interval of two or three days before re-administration, otherwise vomiting is likely. Also, note that Gan Sui is incompatible with Gan Cao (Licorice Root); users must keep this in mind.
Gan Sui has a fierce nature and moves rapidly; later Materia Medica texts describe its function as attacking and resolving blockages, calling it the supreme medicine for draining water. Since phlegm is also a form of fluid, its power to resolve phlegm is a hundred times greater than other herbs. I once treated a young man with mania/insanity; a physician prescribed 6 liang of Da Huang, which he took for two doses without bowel movement. Later, I examined him and prescribed this formula, changing only the dosage of Gan Sui to 3 qian. The patient's family said, "Previously, taking such a large amount of Da Huang yielded no effect; now you use only about 1 liang of Da Huang in this formula, how can it be effective?" I replied, "Just take it, do not worry." After ingestion, the patient had seven or eight bowel movements, expelling a significant amount of phlegm-saliva, and the mania/insanity was instantly cured. Observers found this miraculous, as they did not know that the power of 3 qian of Gan Sui far exceeds that of 6 liang of Da Huang.
Phlegm syndromes often present with a slippery pulse, but this does not necessarily indicate stubborn phlegm (Wan Tan). I have treated many such cases. In severe cases of mania/insanity, the pulse is often obstructed by stasis, or even all six pulses are imperceptible. Upon administering phlegm-resolving medications to unblock the obstruction, the pulse becomes palpable, indicating that stubborn phlegm can close off the pulse channels.
The syndrome of mania/insanity arises from phlegm-fire surging upward and obstructing the orifices and collaterals connecting the Heart and Brain, leading to a lack of communication between the Heart and Brain, causing total confusion of the Shen (Spirit/Mind). Therefore, the formula heavily utilizes Zhe Shi (Ooidite), borrowing its heavy and descending property to guide the phlegm-fire downward, thereby unblocking the obstructed orifices and collaterals. Consequently, the Heart and Brain can assist each other in regulation, and the Shen naturally returns to its normal state. Thus, when I treat severe cases of this syndrome, I often use up to 4 liang of Zhe Shi, which also calms Gan Sui to ensure it acts downwards, preventing vomiting.
"Dian" (Epilepsy-like insanity) refers to inverted temperament and loss of clarity in distinguishing right from wrong. "Kuang" (Mania) refers to fearlessness, reckless behavior, nonsensical speech, and even hallucinations. Generally, this syndrome begins with slight signs of Dian, followed by the onset of Kuang. If Kuang persists untreated, it gradually transforms into Dian, potentially leading to complete loss of consciousness. This syndrome typically stems from excessive worry and thought, causing Heart Qi to knot and fail to disperse, with phlegm-saliva condensing accordingly. Additionally, excessive thinking consumes Heart Blood, generating internal heat. Phlegm refined by heat becomes increasingly sticky; heat is trapped by phlegm, making resolution impossible. Thus, phlegm-fire overflows, completely obstructing the orifices and collaterals connecting the Heart and Brain, resulting in chaotic Shen. Initially, when slight signs of Dian appear, the phlegm-fire is not yet severe. When phlegm-fire accumulates and intensifies, Kuang develops. Therefore, in severe Kuang, when medication is used to purge phlegm, the expectorated phlegm is often red, indicating intense heat. As the disease progresses, the stagnant phlegm transforms into stubborn phlegm. Extreme chaos of Shen leads to a gradual loss of perception, transforming into Dian. Moreover, as the desire for perception vanishes, previous worries diminish, and internal heat gradually subsides. Without fire to fuel mania, it transforms into Dian. However, transformation from Dian to Kuang initially is easier to treat, while transformation from Kuang to Dian later is difficult. Thus, if this syndrome persists for three or four years, few patients recover.
Human Shen resides originally in both the Heart and the Brain. Zheng Jingxi stated: "When a person sees an object, an image remains in the brain. Children who forget easily have unfilled brain marrow; the elderly who forget easily have gradually emptying brain marrow." Wang En explained: "When people recall past events, they often close their eyes and look upward, concentrating spirit in the brain, which is clear evidence that images remain in the brain." From this, we see that the brain governs memory. If a person has unfulfilled longing, exhausting spirit through imagination, or regrets past mistakes painfully, they may damage the Shen in the brain. If one studies too intensely, worries excessively about future difficulties, hesitates too long, or thinks bitterly, they often damage the Shen in the heart. Ultimately, the Heart and Brain are connected throughout, jointly serving as the residence of Shen. Damage to Shen in one location affects both. Damage to Shen in the brain can affect the Nao Qi Jin (Brain Qi Tendons/Nerves). Damage to Shen in the heart can also affect the Nao Qi Jin. Injury to the Nao Qi Jin can cause inversion and chaos of Shen; injury to the heart can also cause inversion and chaos of Shen.
I once treated a young woman with mania/insanity who could not swallow forced medication. I instructed her to substitute salt with Pu Xiao (Mirabilite) in her meals, which she did unknowingly. She recovered after more than a month. Indeed, Pu Xiao is salty and cold, belonging to Water, and is the corresponding organ medicine for the Heart. Using Water to overcome Fire and Cold to overcome Heat allows the fire-heat in the Heart to dissipate completely, nourishing the Shen in the Heart. This is not merely relying on Pu Xiao's ability to resolve phlegm.