狂者。阳明邪热所发。有实无虚也。谵语。则虚实参半焉。郑声。则虚多而实
少矣。何以言之。阳明多气多血。邪又乘焉。则亢阳无制上乱神明。躁扰狂
越。不可名状。故为大实大热也。圣惠方。用大黄五两。醋炒微赤为散。以腊
雪水五升煎如膏。每服五匙。冷水下。盖取其骏快之性。定 乱以致太平。
非此不能。谵语者。亦属胃邪所致。然有热入血室。或蓄血停痰。郁结惊恐。
种种不一。则虚实参之。郑声者。止将一事一物。重复谆谆。乃因心有所寄。
情有所偏。兼以火邪。则虚多而实少矣。昔撄宁生治一人发狂。视人为鬼
其脉累累如薏苡子。且喘且抟。曰此得之阳明胃实。以三化汤三四下之
愈。此阳明发狂也。治一女患心疾。狂歌痛哭。裸裎詈骂。问之则瞪视默默。
脉沉坚而结。曰得之忧愤沉郁。食与痰交积胸中。涌之皆积痰裹血。复与
火剂清上膈。此兼郁痰而狂也。橘泉翁治吴检讨子。年十八。眩晕狂乱。医
以为中寒。已而四肢厥逆。欲自投火中。有欲用乌附回阳者。翁曰。此心脾
火盛。阳明内实。非热药可疗。以泻火解毒三剂得减。此兼火而狂也。汪石
山治一妇。三十余。忽病狂言。披发裸形。不知羞恶。其脉浮缓而濡。曰此必
忍饥或劳倦伤胃而然耳。经曰。二阳之病发心脾。二阳者胃与大肠也。忍
饥过劳。胃伤而火动矣。延及心脾。则心所藏之神。脾所藏之意。皆为扰乱。
失所根据归。安得不狂。此阳明虚也。法当补之。遂用独参汤加竹沥饮之痊。
此因内伤而狂也。壶仙翁治发狂谵语。歌笑不伦。手足厥逆。身冷而掌有
汗。两手脉沉滑有力。曰阳胜拒阴。火极而伏。反兼胜已之化。亢则害。承乃
制也。热胜血菀。故发狂谵语。火性炎上故歌笑不伦。阳极则反。故身冷厥
逆。泄其血则火除。抑其阳则神宁。乃用桃仁承气汤下血数升。益以黄连
竹沥石膏之剂。大汗而解。此兼血而狂也。要知狂为危候。医者到此。未便
措手。辄曰下之。岂知有如是变幻。吾故表而出之。丹溪治一少年。秋初热
病。口渴而妄语。两颧火赤。医作大热治。翁诊之。脉弱而迟。告曰此作劳后
病温。惟当服补剂自已。今六脉时见搏手。必凉药所致。竟以附子汤啜之。
应手而瘥。又治宪幕傅氏子。病妄语。时若有所见。翁切其脉。告曰。此病痰
也。然脉虚弦而沉数。盖得之当暑饮醉。又大惊。傅曰。然。尝夏因劳而甚渴。
恣饮梅水一二升。又连得惊数次。遂病。翁以治痰补虚之剂处之。浃旬愈。
此二症又谵妄之异者。并载附焉。
二化汤
浓朴（姜汁炒） 大黄 枳实（麸炒） 羌活（各三钱）
水煎服。
独参汤
人参（不拘多少分两随症）
拍破水煎服。
桃仁承气汤
桃仁 肉桂 甘草（各一钱） 大黄（二钱半） 芒硝（一钱半）
水煎服。
狂证，是由阳明经的邪热引发的。它属于实证，没有虚证的情况。谵语（神志不清，胡言乱语），则是虚实各占一半。郑声（神志昏沉，语言重复，声音低微），则是虚多实少。
为什么这样说呢？因为阳明经是多气多血的经脉，邪气又乘虚侵入，导致亢盛的阳气失去制约，向上扰乱心神，使人烦躁不安、狂乱越常，其状难以名状。所以这是大实大热的病证。《圣惠方》中，使用大黄五两，用醋炒至微红后研成散剂。用腊雪水五升煎煮成膏状。每次服用五匙，用冷水送服。大概是取其峻猛迅疾的药性，平定混乱以恢复平静。不用这种方法是不行的。
谵语，也属于胃中邪气所致。但是有热邪进入血室，或者有瘀血停滞、痰饮内停，以及因郁结、惊恐等原因引起的，情况种种不一，所以是虚实参半。郑声，只是将一件事或一个物体，反复啰嗦地说个不停。这是因为心神有所寄托，情感有所偏执，再加上火邪的影响，所以虚多实少。
从前，撄宁生治疗一个发狂的人，患者视人为鬼，脉象累累如薏苡子般坚硬且急促，并且气喘、脉搏搏动有力。他说：这是得自阳明胃腑的实证。用三化汤攻下三四次就好了。这是阳明经引发的狂证。
他治疗一个患心病的女子，狂歌痛哭，赤身裸体并辱骂他人。询问她，她就瞪眼沉默不语。脉象沉坚而结滞。他说：这是得自忧愤沉郁，食物与痰浊交结积滞在胸中。通过涌吐法，吐出的是积存的痰浊包裹着瘀血。随后再用清热药剂清泄上膈的热邪。这是兼有郁结痰浊而发的狂证。
橘泉翁治疗吴检讨的儿子，十八岁。出现眩晕、狂乱的症状。医生认为是中寒证。后来四肢厥冷逆乱，想要跳进火堆里。有人想用乌头、附子来回阳救逆。橘泉翁说：这是心脾火盛，阳明内部结实，不是热药可以治疗的。用泻火解毒的方剂，服用三剂后症状减轻。这是兼有火邪而发的狂证。
汪石山治疗一位三十多岁的妇人，忽然病发狂言，披头散发，赤身裸体，不知羞耻厌恶。她的脉象浮缓而濡软。他说：这一定是因为忍受饥饿或者劳倦损伤了胃气而导致的。《内经》说：二阳（指胃与大肠）的病会波及心脾。忍受饥饿过度劳累，胃受伤而火气妄动。延及心脾，那么心所藏的神、脾所藏的意，都被扰乱，失去了依托和归宿，怎么能不狂乱呢？这是阳明经的虚证。治法应当补益。于是用独参汤加竹沥饮用，痊愈了。这是因内伤而发的狂证。
壶仙翁治疗发狂谵语，歌笑不合常理，手足厥冷，身体冰冷但手掌有汗。两手脉象沉滑而有力。他说：阳胜拒阴，火极而伏，反而兼有胜过自身的变化（即真热假寒）。亢盛则有害，承制才能平衡。热胜导致血液郁滞，所以发狂谵语。火性炎上，所以歌笑不合常理。阳极则反，所以身体冰冷、四肢厥逆。泄去瘀血则火邪去除，抑制亢阳则神志安宁。于是用桃仁承气汤攻下瘀血数升，再辅以黄连、竹沥、石膏的药剂，大汗出而病解。这是兼有瘀血而发的狂证。
要知道，狂证是危重的候象。医生到了这种地步，往往不知如何下手，就说用攻下法。哪里知道病情有如此多的变幻。所以我特意列举出来加以说明。
丹溪治疗一个少年，秋初患热病，口渴且胡言乱语，两颧火红。医生当作大热证治疗。翁诊察他的脉象，弱而迟。告诉他说：这是在劳作后患温病，只应当服用补剂自然痊愈。现在六脉时常搏击手指，一定是凉药造成的伤害。最终用附子汤服用，应手而愈。
他又治疗宪幕傅氏的儿子，病发胡言乱语，时常好像看到了什么。翁切按其脉，告诉他说：这是痰病。然而脉象虚弦而沉数。大概是得自当暑天饮酒喝醉，又受大惊吓。傅某说：是的。曾经夏天因为劳累而极度口渴，恣意饮用梅子水一二升，又接连受到几次惊吓，于是生病。翁用治痰补虚的方剂处方，十天痊愈。这两个病症又是谵妄的不同类型，一并记载附上。
Mania (Kuang) is caused by pathogenic heat in the Yangming channel. It is an excess condition without deficiency. Delirium (Zhanyu), on the other hand, involves both excess and deficiency equally. Feeble speech (Zhengsheng) indicates that deficiency predominates over excess.
Why is this so? The Yangming channel is abundant in Qi and Blood. When pathogenic factors invade, they cause hyperactive Yang to lose restraint, disturbing the Spirit upwards, leading to restlessness, mania, and unruliness, which are indescribable. Thus, it represents a severe excess and heat condition. *Shenghui Fang* prescribes five liang of Dahuang (Rhubarb Root), stir-fried with vinegar until slightly red, then ground into powder. This is decocted with five sheng of snow water collected in the twelfth lunar month until it becomes a paste. Each dose consists of five spoons, taken with cold water. This utilizes its swift and potent nature to quell chaos and restore peace. Nothing else can achieve this effect.
Delirium also stems from stomach pathogenic factors. However, it may involve heat entering the Blood Chamber, or stagnation of blood and phlegm, as well as various causes such as depression, constraint, fright, and anxiety. These diverse scenarios result in a mix of excess and deficiency. Feeble speech merely involves repeating the same matter or object incessantly. This occurs because the Heart-Mind has a specific fixation and emotions are biased, compounded by fire pathogenic factors, resulting in predominant deficiency and slight excess.
In the past, Yingningsheng treated a patient suffering from mania who perceived people as ghosts. The pulse was continuous and hard like coix seeds, accompanied by asthma and forceful pulsation. He stated: "This originates from Yangming Stomach excess." It was cured after three or four administrations of Sanhua Tang (Three Transformations Decoction). This is mania arising from Yangming.
He also treated a female patient with heart disease who sang wildly, wept bitterly, stripped naked, and cursed others. When questioned, she would stare blankly and remain silent. Her pulse was deep, firm, and knotted. He stated: "This resulted from deep-seated worry and indignation, where food and phlegm accumulated together in the chest." After inducing vomiting, copious amounts of phlegm mixed with blood were expelled. Subsequently, cooling agents were used to clear the upper Jiao. This is mania complicated by constrained phlegm.
Juquan Weng treated the son of Investigator Wu, aged eighteen, who suffered from vertigo and maniacal confusion. Physicians diagnosed it as Cold invasion. Later, his limbs became cold and inverted, and he desired to throw himself into fire. Someone suggested using Wutou (Aconite Lateralis Radix Preparata) and Fuzi (Aconiti Lateralis Radix Preparata) to restore Yang. Juquan Weng said: "This is excessive Fire in the Heart and Spleen, with internal excess in Yangming. It cannot be treated with hot herbs." He prescribed formulas to purge Fire and detoxify. After three doses, symptoms subsided. This is mania complicated by Fire.
Wang Shishan treated a woman in her thirties who suddenly spoke madly, disheveled her hair, went naked, and showed no sense of shame or disgust. Her pulse was floating, moderate, and soggy. He said: "This must be due to enduring hunger or fatigue damaging the Stomach." The Classics state: "Diseases of the Two Yang (Stomach and Large Intestine) affect the Heart and Spleen." Enduring hunger and overwork damages the Stomach, causing Fire to flare up. This extends to the Heart and Spleen; thus, the Shen (Spirit) housed in the Heart and the Yi (Intellect) housed in the Spleen are disturbed, losing their foundation and return. How could one not become manic? This is deficiency in the Yangming channel. The treatment method should be tonification. He therefore used Dushen Tang (Single Ginseng Decoction) added with Zhuli (Bamboo Juice), and the patient recovered. This is mania caused by internal injury.
Huxian Weng treated a case of mania and delirium, with inappropriate singing and laughing, cold hands and feet, a cold body but sweaty palms. The pulses in both wrists were deep, slippery, and forceful. He stated: "Yang prevails and rejects Yin; extreme Fire hides and mimics the transformation of the prevailing factor. Hyperactivity causes harm, while subordination brings control." Heat dominance leads to blood stasis, causing mania and delirium. Fire nature flares upward, causing inappropriate laughter. Extreme Yang reverses, causing cold body and limb inversion. Draining the blood removes the Fire; suppressing Yang calms the Spirit. He used Taoren Chengqi Tang (Peach Kernel Decoction to Order the Qi) to evacuate several sheng of blood, supplemented with Huanglian (Coptidis Rhizoma), Zhuli (Bamboo Juice), and Shigao (Gypsum Fibrosum). The patient sweated profusely and recovered. This is mania complicated by blood stasis.
One must know that mania is a critical condition. Physicians often find themselves at a loss and hastily resort to purgatives, unaware of such complexities. Therefore, I have recorded these cases for clarification.
Danxi treated a young man in early autumn with a febrile disease, thirst, and delirious speech, with fiery red malar regions. Physicians treated it as severe heat. Danxi palpated the pulse, finding it weak and slow. He told them: "This is Warmth disease contracted after exertion. Only tonifying agents will allow natural recovery. The current pounding pulse in all six positions is likely caused by cold medicines." He ultimately administered Fuzi Tang (Aconite Decoction), and the patient recovered promptly.
He also treated the son of Official Fu, who suffered from delirious speech and visual hallucinations. Upon palpating the pulse, Danxi said: "This is a Phlegm disease. However, the pulse is deficient, wiry, deep, and rapid." He deduced it resulted from drinking alcohol during summer heat followed by severe fright. Mr. Fu confirmed: "Yes, in summer, due to labor-induced extreme thirst, I drank one or two sheng of plum water excessively, and suffered several shocks subsequently, leading to illness." Danxi prescribed formulas to resolve Phlegm and tonify deficiency. The patient recovered within ten days. These two cases represent different types of delirium and hallucination, recorded here together.
Sanhua Tang (Three Transformations Decoction)
Houpo (Magnolia Bark, stir-fried with ginger juice) 3 qian
Dahuang (Rhubarb Root) 3 qian
Zhishi (Immature Bitter Orange, bran-fried) 3 qian
Qianghuo (Notopterygium Rhizome) 3 qian
Decoct in water and take orally.
Dushen Tang (Single Ginseng Decoction)
Renshen (Ginseng Root)
Quantity varies according to the syndrome.
Crush and decoct in water; take orally.
Taoren Chengqi Tang (Peach Kernel Decoction to Order the Qi)
Taoren (Peach Seed) 1 qian
Rougui (Cinnamon Bark) 1 qian
Gancao (Licorice Root) 1 qian
Dahuang (Rhubarb Root) 2.5 qian
Mangxiao (Mirabilite) 1.5 qian
Decoct in water and take orally.