癫乃重阴，狂乃重阳。浮洪吉兆，沉急凶殃。
癫者颠也。谓发时颠倒，异于平日。语言错乱，喜怒无因，或笑或歌，或悲或
泣，神迷意惑，秽洁妄知。平日能言，发反沉默。平日沉默，发反多言。甚或行步
不休，或复僵仆不起。俗呼为失心风。狂者刚暴猖狂，叫号骂詈。甚则逾垣上屋，
蹈火赴汤，不避死生，不知饥饱，倍常勇力，若邪所凭。俗呼为发狂。二者证既不
同，因当各异。古人多以癫狂混称，亦疏略矣。盖人身气为阳，血为阴。腑为阳，
脏为阴。腑之手足六经为阳，脏之手足六经为阴。形质可见者为阳，神志不可见者
为阴。身半以上为阳，身半以下为阴。表为阳，里为阴。凡此阴阳，俱各两相根据倚，
互为交通。而后气血和平，腑脏安静，经脉调匀，形神合一。上下无厥逆之虞，表
里无盛虚之变。如是，则微 小疾，亦无自而生，况癫狂乎？今癫云重阴者，谓偏
重于阴也。邪入于阴而阴实也。五脏为阴，神志舍于五脏，亦为阴。设或抑郁不伸，
谋思不遂，悲哀不置， 傺无聊，久久藏神凝结，情识昏述，灵明何有，此癫之成
于神志者也。（宜灵苑辰砂散、归脾汤、人参琥珀丸之类。）一种因阳虚不能卫外，反下陷而附并于
阴。附并于阴则阴气实，下而不上，则升降紊而癫疾作矣，即《脉经》所谓阳附阴
则癫者是也。（宜升阳益气加补中益气汤、四逆散之类加减用之。）一种因三阳经从头下行，三阴经不
得从足上行而逆下。下则阴经实，亦似阳附阴之义。但此直指经脉之逆，经所谓癫
疾厥狂，久逆之所生者是也。（宜调其升降，正其逆顺，如交感丹加升麻、巴戟、木香、桂枝之类。）一种因
内有蓄血，令人如狂，或善忘，或如见鬼。如狂者，如狂而非狂，即癫状也。血者，
神明之府，血蓄不行，神机大碍，故见上证。血为阴，是亦重阴、阴实之义，谓之
邪入于阴亦可。（宜桃仁承气汤、代抵当丸之类。）狂则反是，乃重阳、阳实之证也。《素问》
宣明五气篇云∶邪入于阳则狂。邪入阳则阳实，阳实则热盛。阳性主动，以盛热而
加以动性，猖狂刚暴，不言可知。又生气通天论云∶阴不胜其阳，则脉流薄疾，并
乃狂。并则阳重、阳实之义。故《素问》病能论云∶狂生于阳也。又云∶阳明者常
动，巨阳、少阳不动。不动而动大疾，此其候也。盖言阳明之经脉常动，以阳明为
水谷之海，其气充盛，故常动。巨阳、少阳之脉不动，言二经之气不如阳明之盛，
故不动。不动者，非不动也，不如阳明之常动也。今无论常动者，即不动者，亦常
动而动且大疾，是为狂病之候。观此，则狂病之为重阳、阳实明矣。与上文脉流薄
疾，并乃狂，若出一义。又《灵枢》通天篇亦云∶阳重脱，易狂。脱非阳脱，
言重并于阳分，而若与阴脱离也。又《灵枢》本神篇云∶肝悲哀动中则伤魂，魂伤则狂
忘不精。肺喜乐无极则伤魄。魄伤则狂，狂者意不存人。夫肝属木，性上达而藏魂，
故魂主升，阳也。悲哀而至于动中，则神情消沮，恍成秋金而克木。木受克，则肝
气伤。肝气伤，则魂无所归。而欲其精明不忘，不可得矣。（宜升达，如逍遥散加郁金、香附、
远志、茯神、木香之类。）肺属金，性收降而藏魄，故魄主降，阴也。喜乐而至于无极，则
神情涣散，恍成夏火而克金。金受克，则肺气伤。肺气伤，则魄无所归。一派浮阳，
动成狂妄，又安能内照而意存人事哉。（宜收敛，如天王补心丹、朱雀丸加龙骨、牡蛎、枣仁、茯神之类。）
又《灵枢》经脉篇云∶阳明病至，则恶人与火。闻木声，则惕然而惊。心欲动。独
闭户塞牖而处，甚则欲上高而歌，弃衣而走。夫邪客阳明，则阳盛热甚。人则增烦，
火则助热，故恶也。闻木声而惊者，惊其相克，故惕然心动也。闭户塞牖，即恶人、
火之义。甚则欲上高而歌，弃衣而走者，以四肢为诸阳之本，热实四肢，健于登跃，
故能上高而歌。身表为诸阳之署，热盛于身，意求凉爽，故欲弃衣而走。（宜白虎汤、承
气汤、凉膈散、紫雪之类。）又《灵枢》大惑论云∶卫气不得入于阴，常留于阳。留于阳，则
阳气满。阳气满，则阳跷盛。不得入于阴，则阴气虚，故目不瞑。又曰∶卫气留于
阴，不得行于阳。留于阴，则阴气盛。阴气盛，则阴跷满。不得入于阳，则阳气虚，
故目闭也。其中言及二跷者。以二跷之脉皆上会于目内 。阳脉交于阴则阴跷盛，
故目闭。阴脉交于阳则阳跷盛，故目开。《灵枢》癫狂篇，首叙目之内外及上下 者，
亦以癫则目闭，狂则目开，而明阴阳之所以不同也。是皆不易之理。然而兼痰、兼
火、兼风者，常十之五。以三种兼证而较审之，则癫必多痰，而狂必多火、多风也。
痰则多滞九窍。九窍从阴从脏，九窍不利，故多癫。风火多淫四肢，四肢从腑从阳，
四肢盛实，故多狂。阴阳分属，二说觉更了然。（痰宜滚痰丸、寿星丸，火宜泻青丸之类。）其脉浮
洪者，是为阳脉。阳狂得之，与证相宜。即阴癫得之，亦从阴转阳，自里达表之象，
故均为吉兆。若沉而急，沉则入阴迫里，急则强急不柔，是无胃气之脉也。不论狂
癫，凶殃立至。又不独脉为然，而证亦不可忽者，故癫狂篇言呕多沃沫、气下泄者
不治，又言癫发如狂者不治。盖呕多沃沫，脾败；气下泄，肾败。脾、肾二脏，为
人之先后二天。二脏已败，自无生理。发如狂者，阴竭于内，阳散于外，脱根外越，
灯灭忽明之象，亦主死。如是，则脉与证，又不可不参看也。
癫证属于重阴，狂证属于重阳。脉象浮洪为吉兆，脉象沉急为凶兆。
癫，就是颠的意思。指发病时神志颠倒错乱，与平日不同。言语错乱，喜怒无常，有时笑有时歌，有时悲有时哭，神志迷乱，意识困惑，对秽物与洁净妄加分别。平时能说话的人，发病时反而沉默；平时沉默的人，发病时反而多言。甚至有的行走不停，或者突然僵倒不起。俗称“失心风”。狂证则是刚强暴烈、猖狂放肆，大声叫喊骂人。严重的甚至翻墙爬屋，踩火赴水，不顾生死，不知饥饱，力气倍增，好像被邪气附身。俗称“发狂”。这两种病症既然不同，病因也应当各异。古人大多将癫狂混为一谈，也是疏漏粗略了。
大概人身之气属阳，血属阴。腑属阳，脏属阴。手足六腑之经属阳，手足五脏之经属阴。有形可见的形体属阳，无形不可见的神志属阴。身体半以上属阳，身体半以下属阴。表属阳，里属阴。所有这些阴阳属性，都相互依存，互为交通。然后气血平和，脏腑安静，经脉调匀，形神合一。上下没有厥逆的忧患，表里没有盛虚的变化。像这样，即使是微小的疾病，也不会产生，何况是癫狂呢？现在说癫是重阴，是指偏重于阴。邪气侵入阴分而致阴实。五脏属阴，神志寄居于五脏，也属阴。假如抑郁不得舒展，谋思不能遂愿，悲哀不止，惆怅无聊，久而久之，藏神凝结，情识昏昧，灵明何存？这是癫证形成于神志方面的原因。（适宜使用灵苑辰砂散、归脾汤、人参琥珀丸之类。）
另一种情况是因为阳气虚弱不能卫护体表，反而下陷并依附于阴。依附于阴则阴气实，下行而不升，导致升降紊乱而癫疾发作，这就是《脉经》所说的“阳附阴则癫”的道理。（适宜用升阳益气法，加减使用补中益气汤、四逆散之类。）
还有一种情况是因为三阳经从头下行，三阴经不能从足上行而逆向下行。下行则阴经实，也类似阳附阴的含义。但这直接指向经脉的逆行，《内经》所谓“癫疾厥狂，久逆之所生”就是这个意思。（适宜调理升降，纠正逆顺，如交感丹加升麻、巴戟天、木香、桂枝之类。）
还有一种情况是因为体内有蓄血，使人出现如狂的症状，或者健忘，或者像见到鬼一样。所谓的“如狂”，是像狂而不是真狂，即表现为癫的状态。血是神明的居所，血液蓄积不行，神机受到严重阻碍，所以出现上述症状。血属阴，这也是重阴、阴实的含义，称之为邪入于阴也可以。（适宜使用桃仁承气汤、代抵当丸之类。）
狂证则相反，属于重阳、阳实的证候。《素问·宣明五气篇》说：邪气侵入阳分则发狂。邪入阳分则阳实，阳实则热盛。阳的性质主动，以盛热加上动的本性，猖狂刚暴，不言而喻。又《素问·生气通天论》说：阴不胜其阳，则血脉流动急迫，进而发狂。并合则意味着阳重、阳实。所以《素问·病能论》说：狂生于阳。又说：阳明经常动，巨阳（太阳）、少阳不动。不动而大动且急促，这是狂病的征候。大概意思是阳明经脉常动，因为阳明是水谷之海，其气充盛，所以常动。巨阳、少阳之脉不动，是说这两经的气不如阳明旺盛，所以不动。不动者，并非真的不动，而是不如阳明那样常动。现在不论常动的经脉，即使是不动的经脉，也常动而且动得很大很急，这就是狂病的征候。看这一点，则狂病属于重阳、阳实就很明白了。这与上文说的“脉流薄疾，并乃狂”，道理是一样的。又《灵枢·通天篇》也说：阳重脱，易狂。这里的“脱”不是阳气外脱，而是指重并于阳分，好像与阴脱离了一样。又《灵枢·本神篇》说：肝因悲哀触动内心则伤魂，魂伤则狂妄、健忘、不精明。肺因喜乐无极则伤魄。魄伤则狂，狂者心中无人。肝属木，性向上通达而藏魂，所以魂主升，属阳。悲哀以至于触动内心，则神情消沉沮丧，恍若秋金克木。木受克，则肝气受伤。肝气受伤，则魂无所归。想要它精明不忘，是不可能的。（适宜升达肝气，如逍遥散加郁金、香附、远志、茯神、木香之类。）肺属金，性收敛下降而藏魄，所以魄主降，属阴。喜乐至于无极，则神情涣散，恍若夏火克金。金受克，则肺气受伤。肺气受伤，则魄无所归。一派浮阳，动而成狂妄，又怎能内照而心意存于人事呢？（适宜收敛，如天王补心丹、朱雀丸加龙骨、牡蛎、酸枣仁、茯神之类。）
又《灵枢·经脉篇》说：阳明病发展到一定程度，则厌恶人和火。听到木声，则惊恐心动。只想独自关上门窗居住。严重时想登上高处唱歌，扔掉衣服奔跑。邪气客居阳明，则阳盛热甚。人则增加烦扰，火则助长热势，所以厌恶。听到木声而惊，是惊惧其相克，所以惕然心动。关门塞窗，就是厌恶人、火的含义。严重时想上高唱歌、弃衣而走，是因为四肢为诸阳之本，热实于四肢，善于登跃，所以能上高而歌。身体表面为诸阳之署，热盛于身，意求凉爽，所以想弃衣而走。（适宜使用白虎汤、承气汤、凉膈散、紫雪之类。）
又《灵枢·大惑论》说：卫气不能进入阴分，常停留于阳分。停留在阳分，则阳气满。阳气满，则阳跷脉盛。不能进入阴分，则阴气虚，所以眼睛睁着睡不着。又说：卫气停留于阴分，不能行于阳分。停留在阴分，则阴气盛。阴气盛，则阴跷脉满。不能进入阳分，则阳气虚，所以眼睛闭上想睡。其中提到二跷脉，是因为二跷脉都上行会合于目内眦。阳脉交于阴则阴跷盛，所以眼闭。阴脉交于阳则阳跷盛，所以眼开。《灵枢·癫狂篇》，首先叙述眼睛的内、外、上、下，也是因为癫证眼闭，狂证眼开，以此阐明阴阳的不同。这些都是不变的真理。
然而，兼夹痰、兼夹火、兼夹风的，常常占十分之五。仔细比较这三种兼证，则癫证多痰，而狂证多火、多风。痰则多阻滞九窍。九窍从阴从脏，九窍不利，所以多癫。风火多淫溢于四肢，四肢从腑从阳，四肢盛实，所以多狂。阴阳分属，这种说法觉得更加清楚。（痰证适宜滚痰丸、寿星丸，火证适宜泻青丸之类。）
脉象浮洪的，是为阳脉。阳狂得到这种脉，与证候相宜。即使是阴癫得到这种脉，也是从阴转阳，自里达表的征象，所以都是吉兆。如果脉沉而急，沉则入阴迫里，急则强急不柔，这是无胃气的脉象。不论是狂是癫，凶殃立刻到来。不仅脉象如此，证候也不可不重视，所以《癫狂篇》说呕吐多涎沫、气下泄的不治，又说癫发作像狂的不治。大概呕吐多涎沫，是脾败；气下泄，是肾败。脾、肾两脏，是人的先后二天。两脏已败，自然没有生机。发作像狂的，是阴竭于内，阳散于外，脱根外越，像灯灭忽明的景象，也主死。像这样，则脉与证，又不可以不参看啊。
Dian (Manic-Depressive Psychosis) belongs to Heavy Yin, while Kuang (Mania) belongs to Heavy Yang. A floating and surging pulse is an auspicious sign; a deep and rapid pulse is an inauspicious omen.
Dian refers to "toppling" or "disorder." It denotes a state during attacks where the mind is overturned and confused, differing from one's normal state. Speech is disordered, with joy and anger occurring without cause; sometimes laughing, sometimes singing, sometimes weeping or crying. The spirit is bewildered, consciousness is confused, and there is delusional perception of filth versus cleanliness. Those who can speak normally may become silent during attacks, while those who are usually silent may become talkative. In severe cases, patients may walk incessantly or suddenly collapse and remain motionless. This is commonly called "Shixin Feng" (Wind of Lost Heart). Kuang refers to being rigid, violent, reckless, and unruly, shouting and cursing. In extreme cases, patients may climb walls and roofs, tread on fire or rush into water, disregarding life and death, unaware of hunger or fullness, possessing strength double that of usual, as if possessed by evil spirits. This is commonly called "Fa Kuang" (Onset of Mania). Since these two syndromes are distinct, their etiologies must also differ. Ancients often conflated Dian and Kuang, which was a negligence.
Generally, Qi in the human body is Yang, Blood is Yin. Fu organs are Yang, Zang organs are Yin. The six meridians of the hands and feet belonging to Fu organs are Yang, while those belonging to Zang organs are Yin. Tangible forms are Yang, intangible spirit and consciousness are Yin. The upper half of the body is Yang, the lower half is Yin. Exterior is Yang, Interior is Yin. All these Yin and Yang attributes rely upon each other and interact mutually. Only then can Qi and Blood be harmonious, Zang and Fu organs tranquil, meridians regular, and form and spirit unified. There would be no fear of Jue Ni (Rebellious Qi), nor changes of Excess and Deficiency between Exterior and Interior. Under such conditions, even minor illnesses would not arise, let alone Dian or Kuang.
Now, when it is said that Dian is "Heavy Yin," it means bias towards Yin. Evil Qi enters the Yin aspect, causing Yin Excess. The five Zang organs are Yin, and since Spirit resides within the five Zang organs, it is also Yin. If depression prevents expression, planning fails, sorrow persists, and one feels despondent and bored for a long time, the stored Spirit condenses, emotions and cognition become muddled, and spiritual clarity is lost. This describes the formation of Dian through disorders of spirit and consciousness. (Suitable formulas include Lingyuan Censha San [Lingyuan Cinnabar Powder], Guipi Tang [Restore the Spleen Decoction], and Renshen Hupo Wan [Ginseng and Amber Pill].)
Another type arises because Yang Qi is deficient and fails to protect the exterior, sinking instead and attaching to Yin. Attaching to Yin causes Yin Excess; descending without ascending leads to chaotic rising and falling, triggering Dian. This corresponds to what *Mai Jing* (Pulse Classic) states: "When Yang attaches to Yin, Dian occurs." (Treatment should involve raising Yang and benefiting Qi, modifying Buzhong Yiqi Tang [Tonify the Middle and Benefit Qi Decoction] or Sixni San [Four Reversal Powder].)
A third type occurs because the three Yang meridians descend from the head, while the three Yin meridians fail to ascend from the feet and instead reverse downward. Downward reversal causes Yin meridian excess, similar to the meaning of Yang attaching to Yin. However, this directly points to meridian reversal, as stated in the classics: "Dian, Jue, and Kuang are generated by prolonged reversal." (Treatment should regulate rising and falling, correct reversal and smooth flow, such as Jiaogan Dan [Heart-Mind Union Pill] modified with Shengma [Cimicifugae Rhizoma], Bajitian [Morindae Officinalis Radix], Muxiang [Aucklandiae Radix], and Guizhi [Cinnamomi Ramulus].)
A fourth type involves internal accumulation of Blood, causing symptoms like Kuang but not true Kuang, or forgetfulness, or hallucinations. "Like Kuang" resembles mania but is not true mania; it manifests as Dian. Blood is the residence of Shen (Spirit). When blood accumulates and stagnates, the mechanism of Shen is severely obstructed, leading to the aforementioned symptoms. Blood is Yin, so this also represents Heavy Yin and Yin Excess,亦可 described as evil entering Yin. (Suitable formulas include Taoren Chengqi Tang [Peach Kernel and Magnolia Bark Decoction] and Dai Didang Wan [Substitute Dangdang Pill].)
Kuang, conversely, is a syndrome of Heavy Yang and Yang Excess. *Suwen: Xuanming Wuqi Pian* states: "When evil enters Yang, Kuang results." Evil entering Yang causes Yang Excess, leading to intense heat. Yang nature is active; combined with excessive heat and its active nature, recklessness and violence are self-evident. *Suwen: Shengqi Tongtian Lun* states: "If Yin cannot overcome Yang, pulses flow rapidly and violently, leading to Kuang." "Merging" implies Heavy Yang and Yang Excess. Thus, *Suwen: Bingneng Lun* states: "Kuang originates from Yang." It further says: "The Yangming meridian is constantly active; Taiyang (Juyang) and Shaoyang are not active. Activity in what is normally inactive, especially if rapid, is the sign of Kuang." This means the Yangming meridian is constantly active because it is the Sea of Food and Fluids, with abundant Qi. Taiyang and Shaoyang are considered "not active" only relative to Yangming's abundance. Now, whether constantly active or relatively inactive, if they become highly active and rapid, this is the sign of Kuang. Thus, Kuang is clearly Heavy Yang and Yang Excess. This aligns with the previous statement: "Rapid pulse flow and merging lead to Kuang." *Lingshu: Tongtian Pian* also states: "Heavy Yang detachment leads easily to Kuang." Here, "detachment" does not mean Yang collapse, but rather heavy aggregation in Yang, appearing detached from Yin. *Lingshu: Benshen Pian* states: "If Liver is moved by sorrow internally, Hun (Ethereal Soul) is injured; Hun injury leads to Kuang, forgetfulness, and lack of clarity. If Lungs are injured by boundless joy, Po (Corporeal Soul) is injured; Po injury leads to Kuang, where the patient disregards others." Liver belongs to Wood, tends upward, and stores Hun; thus Hun ascends and is Yang. Sorrow moving internally causes spirit to decline, resembling Autumn Metal overcoming Wood. Wood overcomes leads to Liver Qi injury, Hun losing its home, making clarity impossible. (Treatment should lift and diffuse, e.g., Xiaoyao San [Free Wanderer Powder] added with Yujin [Curcumae Radix], Xiangfu [Cyperi Rhizoma], Yuanzhi [Polygalae Radix], Fushen [Poria with Hostwood], and Muxiang.) Lung belongs to Metal, tends downward, and stores Po; thus Po descends and is Yin. Boundless joy scatters spirit, resembling Summer Fire overcoming Metal. Metal overcomes leads to Lung Qi injury, Po losing its home. Floating Yang moves into recklessness, preventing inner reflection and social awareness. (Treatment should converge and anchor, e.g., Tianwang Buxin Dan [Heavenly Emperor's Heart-Nourishing Pill] or Zhuque Wan [Vermilion Bird Pill] added with Longgu [Fossilia Ossis Mastodi et Mammuti], Muli [Concha Ostreae], Suanzaoren [Ziziphi Spinosae Semen], and Fushen.)
*Lingshu: Jingmai Pian* states: "When Yangming disease advances, the patient dislikes people and fire. Hearing wood sounds causes sudden fright and heart movement. They desire to close doors and windows and stay alone. In severe cases, they wish to climb high and sing, discard clothes, and run." When evil lodges in Yangming, Yang is excessive and heat is severe. People increase annoyance; fire aids heat, hence aversion. Fright at wood sounds stems from fear of Metal overcoming Wood. Closing doors/windows reflects aversion to people/fire. Climbing high/singing and discarding clothes/runing occur because limbs are the root of all Yang meridians; heat filling limbs enables vigorous jumping. Body surface is the station of all Yang meridians; heat overwhelming the body seeks coolness, hence discarding clothes. (Suitable formulas include Baihu Tang [White Tiger Decoction], Chengqi Tang [Order the Qi Decoctions], Liangge San [Cool the Chest Powder], and Zixue [Purple Snow].)
*Lingshu: Daguo Lun* states: "If Wei Qi (Defensive Qi) cannot enter Yin, it remains in Yang. Remaining in Yang fills Yang; filled Yang makes Yang Qiao Mai vigorous. Unable to enter Yin, Yin becomes deficient, resulting in inability to close eyes (insomnia)." Conversely, "If Wei Qi stays in Yin and cannot move to Yang, Yin becomes full. Full Yin makes Yin Qiao Mai full. Unable to enter Yang, Yang becomes deficient, resulting in closed eyes (sleepiness)." The mention of the two Qiao meridians is because both ascend to meet at the inner canthus. Yang meridians connecting to Yin make Yin Qiao full, closing eyes. Yin meridians connecting to Yang make Yang Qiao full, opening eyes. *Lingshu: Diankuang Pian* discusses eye positions first to illustrate that Dian involves closed eyes and Kuang involves open eyes, clarifying Yin-Yang differences. These are immutable principles.
However, cases complicated by Phlegm, Fire, or Wind account for 50%. Comparing these complications, Dian is mostly Phlegm-related, while Kuang is mostly Fire and Wind-related. Phlegm tends to obstruct the Nine Orifices. The Nine Orifices follow Yin and Zang organs; obstruction leads to Dian. Wind and Fire tend to affect the four limbs. Limbs follow Fu and Yang organs; excess in limbs leads to Kuang. This Yin-Yang distinction clarifies the matter. (Phlegm requires Tansu Wan [Phlegm-Rolling Pill] or Shouxing Wan [Star-Pillar Pill]; Fire requires Xieqing Wan [Drain Green Pill].)
A floating and surging pulse is a Yang pulse. For Yang-type Kuang, this matches the syndrome. Even for Yin-type Dian, it indicates transformation from Yin to Yang, moving from Interior to Exterior, hence auspicious. A deep and rapid pulse indicates invasion into Yin/Interior (deep) and rigidity/lack of flexibility (rapid), representing a pulse devoid of Stomach Qi. Regardless of Kuang or Dian, this portends immediate disaster. Not only pulses, but symptoms must also be noted. *Diankuang Pian* states that vomiting much saliva/phlegm and downward leakage of Qi are untreatable. Also, Dian presenting like Kuang is untreatable. Vomiting phlegm indicates Spleen failure; downward Qi leakage indicates Kidney failure. Spleen and Kidney are the Postnatal and Prenatal Foundations. Their failure means no hope. Dian presenting like Kuang indicates Yin exhaustion internally and Yang scattering externally, like a lamp flickering before dying, also fatal. Thus, pulse and symptoms must be consulted together.