经曰。人生而病癫疾者。名为胎病。此得之在母腹中时。其母有所惊。气上而不下。精气并
居。故令子发为癫疾也。病初发。岁一发。不治。月一发。不治。月四五发。名曰癫。癫疾脉搏
大滑。久自已。脉小坚急。死不治。癫疾之脉。虚则可治。实则死。搏阴则为癫疾。
癫虽为阴。若得搏大滑脉。故自已。若得小坚急。为阴脉之极也。故不治。虚则邪气未盛。
故可治。实则纯乎邪矣。故死。
难经曰。重阴者癫。癫病始发。意不乐。直视僵仆。其脉三部阴阳俱盛是也。
脉经曰。阴附阳则狂。阳附阴则癫。阳附阴者。腰以下至足热。腰上寒也。阴附阳者。腰以
上至头热。腰下寒也。
癫之为证。多因郁抑不遂。 傺无聊所致。精神恍惚。语言错乱。或歌或笑。或悲或泣。如
醉如狂。言语有头无尾。秽洁
不知。经年不愈。皆由郁痰鼓塞心包。神不守舍。俗名痰迷心窍。安神豁痰为主。先以控涎丹涌
出痰涎。后用安神之剂。怒动肝火。风痰上盛而发癫狂。导痰汤加芩、连、菖、远。煎成入朱砂、
沉香磨汁调服。言语失伦。常常戏笑。不发狂者。心虚也。定志汤加姜汁、竹沥。膈间微痛者。
兼有瘀血。加琥珀、郁金。（如无郁金。蓬术代之。）因思虑而得者。先与稀涎散。后用归脾汤
加辰砂末调补之。心经蓄热。或时发躁。眼鼻觉热者。定志丸加芩、连、麦冬、牛黄。实者。凉
膈散加川连、麦冬、菖蒲。癫病语言错乱。神气昏惑者。千金防己地黄汤。因思虑妄想不遂。致
神不守舍而妄言妄见。若神祟所凭。初起用半夏茯神散。数服自愈。若日久为汤药所汨。神出舍
空。非大剂独参加姜汁、竹沥填补其神。不能克应。有病癫人。专服四七汤而愈。盖气结为痰。
痰饮郁闭其神识也。癫疾既久。动辙生疑。面色痿黄。或时吐沫。默默欲眠。此虫积为患。妙功
丸。若癫哭呻吟。为邪所凭。非狂也。烧蚕纸酒水下方寸匙。
李士材治张少椿女。以丧子悲伤。忽当雷雨交作。大恐。苦无所避。旦日或泣或笑。或自语。
或骂詈。如中鬼祟。诊其心脉浮滑。余皆沉细。此气血两亏。忧恐伤心。心伤则热。热积生风也。
以滚痰丸。用桔梗、延胡索、陈皮、杏仁煎汤送下。出痰积甚多而愈。
《黄帝内经》说：人一生下来就患有癫疾的，称为胎病。这是在母亲腹中时形成的，因为母亲受到惊吓，导致气机上逆而不能下行，精气并聚于上，所以使孩子发为癫疾。疾病初发时，一年发作一次；若不治疗，变为一个月发作一次；若再不治疗，一个月发作四五次，这就叫做癫。癫疾的脉象如果搏动大而滑利，时间久了会自行痊愈；如果脉象小、坚急，则是死证，无法治愈。癫疾的脉象，虚的可以治疗，实的则预后不良致死。阴经受邪搏结就会发为癫疾。
虽然癫属阴证，但如果出现搏大滑利的脉象，说明正气尚存，故能自行痊愈。如果出现小坚急的脉象，这是阴脉到了极点，所以无法治愈。脉虚说明邪气不盛，所以可治；脉实说明纯是邪气，所以致死。
《难经》说：重阴之证发为癫。癫病刚开始发作时，患者心情不愉快，两眼直视，突然僵倒。其脉象表现为寸关尺三部阴阳脉都盛大，就是这种情况。
《脉经》说：阴气依附阳气则发狂，阳气依附阴气则发癫。所谓阳气依附阴气，是指腰部以下至足部发热，腰部以上寒冷。所谓阴气依附阳气，是指腰部以上至头部发热，腰部以下寒冷。
癫这个病症，多因情志抑郁不得舒展，惆怅无聊所致。表现为精神恍惚，语言错乱，有时唱歌，有时大笑，有时悲伤哭泣，像喝醉了一样又像发狂一样，说话有头无尾，不分秽物与洁净。多年不愈，都是由郁结之痰阻塞心包，神志不能守舍所致，俗称“痰迷心窍”。治疗以安神豁痰为主。先用控涎丹涌吐痰涎，然后再用安神的药剂。如果是怒动肝火，风痰上盛而引发癫狂，可用导痰汤加黄芩、黄连、石菖蒲、远志，煎好药汁后调入朱砂粉和沉香磨成的汁服用。如果言语失去伦常，常常戏笑但不发狂，这是心气虚的表现，可用定志汤加姜汁、竹沥。如果膈间微痛，兼有瘀血，加入琥珀、郁金（如果没有郁金，可用蓬术代替）。因思虑过度而得病的，先给予稀涎散，然后用归脾汤加辰砂末调补。心经蓄积热邪，偶尔烦躁，感觉眼鼻发热，可用定志丸加黄芩、黄连、麦冬、牛黄。实证者，用凉膈散加川黄连、麦冬、石菖蒲。癫病患者言语错乱，神志昏惑不明的，用千金防己地黄汤。因思虑妄想不得遂意，导致神不守舍而胡言乱语、产生幻觉，好像被鬼神附体一样。初起时用半夏茯神散，服几剂即可自愈。如果日久被汤药扰乱，导致神气外越、神舍空虚，非要用大剂量的独参汤加姜汁、竹沥来填补神气，才能见效。有患癫病的人，专门服用四七汤而痊愈，这是因为气结形成痰饮，痰饮郁闭了神识。癫疾久了，动不动就产生疑心，面色萎黄，有时吐沫，沉默想睡，这是虫积为患，用妙功丸治疗。如果癫病患者哭泣呻吟，像是被邪气附体，但不是狂症，可将烧过的蚕纸用水酒送下方寸匙。
李士材治疗张少椿的女儿，因为丧子悲伤，恰好遇到雷雨交加，极度惊恐，苦于无处躲避。第二天时而哭泣时而大笑，有时自言自语，有时骂人，像中了鬼祟一样。诊察其心脉浮滑，其余脉象沉细。这是气血两亏，忧恐伤心，心伤则生热，热积而生风。用滚痰丸，用桔梗、延胡索、陈皮、杏仁煎汤送服。吐出很多痰积后痊愈。
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: Those who suffer from dian disease (epilepsy/manic depression) from birth are said to have a congenital disease. This condition originates in the womb when the mother experiences fright, causing qi to ascend without descending, and essence and qi congregate above, thus causing the child to develop dian disease. At the initial onset of the illness, it occurs once a year; if untreated, it progresses to once a month; if still untreated, it occurs four or five times a month, which is termed dian. The pulse of dian disease, if large and slippery, will resolve spontaneously over time. If the pulse is small, firm, and rapid, it indicates a fatal prognosis that cannot be treated. For dian disease, a deficient pulse is treatable, whereas an excess pulse indicates death. Binding with yin meridians leads to dian disease.
Although dian is a yin syndrome, if the pulse is large and slippery, recovery is possible. If the pulse is small, firm, and rapid, it represents the extreme of yin pulses, indicating untreatability. A deficient pulse suggests that pathogenic factors are not yet vigorous, hence it is treatable; an excess pulse indicates pure pathogenic presence, hence fatal.
The *Nanjing* (Classic of Difficult Issues) states: Heavy yin conditions result in dian. When dian disease first begins, the patient feels unhappy, stares fixedly, and suddenly collapses stiffly. The pulse shows fullness in both yin and yang aspects across all three positions (cun, guan, chi).
The *Mai Jing* (Pulse Classic) states: Yin attaching to yang results in kuang (mania); yang attaching to yin results in dian. "Yang attaching to yin" refers to heat from the waist down to the feet, while cold above the waist. "Yin attaching to yang" refers to heat from the waist up to the head, while cold below the waist.
The syndrome of dian is mostly caused by emotional depression and frustration, leading to despondency. Symptoms include mental vagueness, disordered speech, singing or laughing at inappropriate times, weeping or crying, appearing intoxicated or manic, speaking without coherence, and lacking awareness of cleanliness or filth. Chronic cases lasting years are due to stagnant phlegm obstructing the pericardium, causing the spirit (shen) to lose its residence, commonly known as "phlegm confusing the heart orifices." Treatment primarily focuses on calming the spirit and resolving phlegm. Initially, Kongxian Dan (Control Saliva Pill) is used to induce vomiting of phlegm, followed by formulas to calm the spirit. If anger stirs liver fire, causing wind-phlegm to surge upward and trigger mania/dian, Daotan Tang (Phlegm-Guiding Decoction) is modified with Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Shichangpu (Acori Tatarinowii Rhizoma), and Yuanzhi (Polygalae Radix). After decoction, Zhusha (Cinnabar) powder and Chenxiang (Aquilariae Lignum Resinatum) juice are added. If speech lacks propriety, frequent laughter occurs without mania, this indicates heart deficiency; Dingzhi Tang (Will-Firming Decoction) is modified with Jiangzhi (Zingiberis Rhizoma Recens Juice) and Zhuli (Bambusae Caulis in Taenia). If there is slight pain in the diaphragm, blood stasis is present; add Hupo (Succinum) and Yujin (Curcumae Longae Radix) (if Yujin is unavailable, Ezhu [Curcumae Rhizoma] may substitute). For cases caused by excessive thinking, Xixian San (Thin Saliva Powder) is given first, followed by Guipi Tang (Restore the Spleen Decoction) supplemented with Chen Sha (Cinnabar) for tonification. If heat accumulates in the heart meridian, causing occasional irritability and heat sensation in eyes and nose, Dingzhi Wan (Will-Firming Pill) is modified with Huangqin, Huanglian, Maidong (Ophiopogonis Radix), and Niuhuang (Bovis Calculus). In excess patterns, Liangge San (Cool the Diaphragm Powder) is modified with Chuanlian (Coptidis Rhizoma), Maidong, and Shichangpu. For dian patients with disordered speech and confused spirit, Qianjin Fangji Dihuang Tang (Thousand Gold Fangji Rehmannia Decoction) is used. Due to unfulfilled obsessive thoughts causing the spirit to leave its residence, resulting in妄言妄见 (delusions and hallucinations) as if possessed by spirits, Banxia Fushen San (Pinellia and Poria Powder) is used initially, curing after several doses. If chronic and disturbed by herbal medicines, causing the spirit to wander and the residence empty, large doses of Dushen Tang (Single Ginseng Decoction) with Jiangzhi and Zhuli are required to replenish the spirit. Some dian patients cured solely by Siquqi Tang (Four-Seven Decoction) because qi stagnation creates phlegm-fluids that close off consciousness. Long-standing dian often leads to suspicion, sallow complexion, occasional foaming at the mouth, silence, and desire to sleep, indicating parasitic accumulation; Miaogong Wan (Miraculous Merit Pill) is indicated. If dian patients cry and moan, seemingly possessed but not manic, burned mulberry paper powder mixed with water and wine (one cun chi spoonful) is administered.
Li Shicai treated the daughter of Zhang Shaochun. Grieving the loss of her child, she was terrified during a thunderstorm with no shelter. The next day, she alternated between crying and laughing, talking to herself, and cursing, as if possessed. Her heart pulse was floating and slippery, while others were deep and fine. This indicated dual deficiency of qi and blood, with worry and fear injuring the heart; heart injury generates heat, and heat accumulation generates wind. Gun Tan Wan (Rolling Phlegm Pill) was administered, taken with a decoction of Jiegeng (Platycodonis Radix), Yanhusuo (Corydalis Rhizoma), Chenpi (Citri Reticulatae Pericarpium), and Xingren (Armeniacae Semen Amarum). She recovered after expelling a large amount of phlegm accumulation.