眩仆曰癫，失心曰狂，《灵枢》、《难经》其义判然矣。如《素问》云癫疾欲走呼之类，别是一义，而后世
或以癫为失心，殆非是也。癫与痫不过大人小儿之别，而痫字倘用之大人，则亦即癫已。盖癫狂二病，其状虽
异，而其因相近，治方亦相出入。故今析其证，而仍并为一门，学人宜互通酌耳。
癫狂辨异 阴附阳则狂，阳附阴则癫。（《脉经》）（按∶原文此上曰∶凡脉大为阳，浮为阳，数为阳云
云。又曰∶关前为阳，关后为阴。又《巢源》曰∶脉浮大附阴者癫疾。据此阴附阳，言关前见阴脉，阳附阴，言关
后见阳脉。以见阴犯阳者为狂、阳犯阴者为癫之理，与《金匮》阴气衰者为癫，阳气衰者为狂，其意相发，乃首
揭之。又《沙篆》、《续焰》并有释义，欠确，故不录。）
狂病之候，观其人初发之时，不欲眠卧，又不肯饮食，自言贤智尊贵，歌笑行走不休，皆阳气盛所为。故
经言重阳
者狂，此之谓也。今人以为癫疾，谬矣。癫，颠也，发则僵仆焉，故有颠蹶之言也，阴气太盛，故不得行立而
倒仆也。今人以为痫病，误矣。（杨玄操《难经注》）（按∶《资生经》载此说曰∶其剖析癫狂之病，晓然如
此，而人终不信，岂亦传习之误，难以改欤。先兄曰∶颜师古《急就篇注》曰∶颠疾，性理颠倒失常，亦谓之狂
也。是杨氏所非。又按∶《万全方》以癫为狂而《集成》从之，《准绳》就失心中分癫与狂，今并不取。又杨
氏辨以癫为痫之误，盖言癫与小儿惊风不同也。）
狂谓妄言妄走也，癫谓僵仆不省也，各自一证。然经有言狂癫疾者，有言狂互引颠者，又言颠疾为狂者，
此则又皆狂颠兼病。今病有妄言妄走顷时前后僵仆之类，有僵仆后妄见鬼神半日方已之类，是以颠狂兼病者也。
（《纲目》）
经云∶重阳者狂，重阴者癫。盖狂者狂言妄动，逾垣上屋，登高而歌，弃衣而走，骂詈不避亲疏，而自高
贤，好歌乐，此皆心火独盛，阳气有余，以致神不守舍，痰火壅盛而然。癫者沉默嗔忿，悒悒不乐，僵仆直视，
变易常情，此是阴虚血少，心火不宁以致此也。有怒气忿郁，一时不得舒越，以成狂癫者，须先开达肝火。
（《病源集》）
《难经》谓重阴者癫，重阳者狂。《素问注》云多喜为颠，多怒为狂。然则喜属于心而怒属于肝，乃二脏
相火有余之证。《难经》阴阳之说，恐非理也。大抵狂为痰火实盛，颠为心血不足，多为求望高达不得者有之。
（《正传》）
癫狂之病，病本不同。狂病之来，狂妄以渐，而经久难已。癫病之至，忽然僵仆，而时作时止。狂病常醒，
多怒而暴。癫病常昏，多倦而静。由此观之，则其阴阳寒热，自有冰炭之异。故《难经》曰∶重阳者狂，重阴者
癫。义可知也。
后世诸家，有谓癫狂之病，大概是热，此则未必然也。此其形气脉气，自亦有据，不可不辨察阴阳，分而治之。
（《景岳》）
因头部眩晕而突然跌倒称为癫，神志丧失、心智错乱称为狂，《灵枢》与《难经》中这两者的含义是截然不同的。例如《素问》中提到的癫疾想要奔跑呼喊等症状，属于另一种含义，而后世有人将癫等同于失心（神志不清），这大概是不正确的。癫与痫不过是大人与小儿发病的区别，如果“痫”字用于成人，那也就是癫了。大致上，癫和狂这两种病，虽然症状表现不同，但病因相近，治疗方法也大体相通。因此现在分析它们的证候，但仍将它们合并为一门，学习者应当互通参考斟酌。
癫与狂的鉴别：阴气依附于阳位则发狂，阳气依附于阴位则发癫。（出自《脉经》）（按语：原文在此之上说：凡是脉大属阳，脉浮属阳，脉数属阳等等。又说：关前为阳，关后为阴。另外《诸病源候论》说：脉象浮大且依附于阴位的，是癫疾。根据这些，所谓“阴附阳”，是指关前出现阴脉；“阳附阴”，是指关后出现阳脉。以此说明阴气侵犯阳位导致狂病、阳气侵犯阴位导致癫病的道理，这与《金匮要略》中说的“阴气衰者为癫，阳气衰者为狂”，其意相互印证，所以首先揭示这一观点。另外《沙篆》、《续焰》也有解释，不够确切，故不收录。）
狂病的征候，观察患者初发时，不想睡觉躺卧，也不肯吃东西，自称贤能智慧、尊贵，唱歌笑闹、行走不停，这都是阳气盛实所为。所以经文说“重阳者狂”，指的就是这种情况。现在的人把它当作癫疾，是错误的。癫，就是颠的意思，发作时身体僵硬仆倒，所以有“颠蹶”的说法，这是因为阴气太盛，所以不能站立行走而倒下。现在的人把它当作痫病，也是错误的。（杨玄操《难经注》）（按语：《资生经》记载此说法称：其对癫狂疾病的剖析如此清晰明白，但人们始终不信，难道也是传承习误，难以改变吗？先兄说：颜师古在《急就篇注》中说：颠疾，性情理路颠倒失常，也称为狂。这是杨氏所反对的观点。另外按：《万全方》将癫视为狂，而《医宗金鉴·集成》采纳此说，《医学准绳六要》就在失心中区分癫与狂，现在都不采用。另外杨氏辨析将癫误认为痫的错误，大概是说癫与小儿惊风不同。）
狂表现为胡言乱语、到处乱跑；癫表现为身体僵直仆倒、不省人事，这是各自独立的证候。然而经文中有说“狂癫疾”的，有说“狂互引颠”的，又有说“颠疾为狂”的，这又都是狂和颠兼有的疾病。现在的病症有胡言乱语、到处乱跑，片刻前后又出现僵直仆倒的情况；也有僵直仆倒后，妄见鬼神，半天才停止的情况，这就是颠狂兼病。（《本草纲目》）
经文说：重阳者狂，重阴者癫。大概狂症表现为胡言乱语、妄动，翻墙爬屋，登上高处唱歌，脱衣奔走，骂人不分亲疏，自视甚高，喜欢歌唱音乐，这些都是心火独盛，阳气有余，导致神志不守舍，痰火壅盛所致。癫症表现为沉默寡言、嗔怒愤恨，忧郁不乐，僵直仆倒、两眼直视，改变平常性情，这是阴虚血少，心火不宁导致的。还有因怒气忿郁，一时无法舒展发泄，从而形成狂癫的，必须先疏达肝火。（《病源集》）
《难经》说重阴者癫，重阳者狂。《素问注》说多喜为颠，多怒为狂。既然这样，喜归属于心，怒归属于肝，这是两脏相火有余的证候。《难经》关于阴阳的说法，恐怕不符合事理。大致上狂是痰火实盛，颠是心血不足，多为追求高位高名却得不到的人所患。（《丹溪心法·正传》）
癫和狂这两种病，病本不同。狂病发作，狂妄逐渐加重，而且经久难愈。癫病发作，突然僵直仆倒，时发时止。狂病通常清醒，易怒且暴躁。癫病通常昏沉，疲倦且安静。由此看来，它们的阴阳寒热，自有冰炭般的差异。所以《难经》说：重阳者狂，重阴者癫。其中的义理可以知晓了。
后世各家，有说癫狂之病，大抵都是热证，这则未必一定如此。这从患者的形体气质、脉象气息来看，自然也有依据，不可不辨别阴阳，分别治疗。（张景岳《景岳全书》）
Fainting due to dizziness is termed Dian (epilepsy/severe mental disorder), while loss of mind and mental confusion is termed Kuang (mania). The meanings of these two terms are clearly distinct in the *Ling Shu* and *Nan Jing*. For instance, the symptoms described in the *Su Wen*, such as a desire to run and shout in Dian Ji (epileptic disease), belong to a different meaning. Later generations equating Dian with Shi Xin (loss of mind/confusion) are likely incorrect. The difference between Dian and Xian (pediatric epilepsy) is merely that of adult versus pediatric onset; if the term "Xian" were applied to adults, it would essentially be Dian. Generally, although the manifestations of Dian and Kuang differ, their etiologies are similar, and their treatment methods overlap. Therefore, this text analyzes their respective syndromes but combines them into one category for study, urging learners to understand and apply them flexibly.
**Differentiation between Dian and Kuang**: When Yin attaches to Yang, Kuang occurs; when Yang attaches to Yin, Dian occurs (*Mai Jing*).
*(Note: The original text states above: "Generally, a large pulse indicates Yang, a floating pulse indicates Yang, and a rapid pulse indicates Yang." It also states: "The area anterior to the Guan position is Yang, and the area posterior to the Guan position is Yin." Additionally, the *Zhu Bing Yuan Hou Lun* states: "A pulse that is floating, large, and attaching to the Yin position indicates Dian Ji." Based on this, 'Yin attaching to Yang' refers to observing Yin-type pulses at the anterior Guan position (Yang position); 'Yang attaching to Yin' refers to observing Yang-type pulses at the posterior Guan position (Yin position). This illustrates the principle that Yin invading Yang leads to Kuang, and Yang invading Yin leads to Dian. This aligns with the *Jin Gui Yao Lue*'s statement that "deficiency of Yin Qi leads to Dian, and deficiency of Yang Qi leads to Kuang," reinforcing the initial proposition. Other texts like *Sha Zhuan* and *Xu Yan* offer explanations that are deemed insufficiently accurate and are thus omitted.)*
The signs of Kuang disease, observed at its onset, include insomnia, refusal to eat, self-proclaimed wisdom and nobility, continuous singing, laughing, and walking. These are all caused by an excess of Yang Qi. Hence, the classics state that "Double Yang results in Kuang," which refers to this condition. Modern practitioners who classify this as Dian Ji are mistaken. Dian (also written as Dian/Dian) implies falling or overturning; upon attack, the body becomes stiff and falls, hence the term "Dian Jue" (falling/collapsing). This is caused by excessive Yin Qi, leading to an inability to stand or walk, resulting in collapse. Modern practitioners who classify this as Xian disease are also mistaken. (Yang Xuancao, *Commentary on Nan Jing*)
*(Note: The *Zi Sheng Jing* records this view, stating that the analysis of Dian and Kuang is so clear, yet people remain unconvinced. Is this due to entrenched errors in transmission? My elder brother remarked: Yan Shigu, in his commentary on the *Ji Jiu Pian*, stated that Dian Ji involves inverted and abnormal mental faculties, also called Kuang. This contradicts Yang's view. Furthermore, the *Wan Quan Fang* equates Dian with Kuang, a view adopted by the *Yi Zong Jin Jian*, while the *Zhun Sheng* distinguishes them within the context of Shi Xin. These views are not adopted here. Yang's distinction clarifies that Dian is not equivalent to Xian (pediatric convulsions).)*
Kuang is characterized by delirious speech and aimless wandering; Dian is characterized by stiffness, collapse, and unconsciousness. These are distinct syndromes. However, the classics mention "Kuang-Dian Ji," "Kuang intermingled with Dian," and "Dian Ji manifesting as Kuang," indicating cases where both conditions coexist. Current clinical presentations include patients who wander and speak deliriously, followed shortly by stiffness and collapse; or those who collapse, hallucinate spirits for half a day, and then recover. These represent combined Kuang and Dian diseases. (*Ben Cao Gang Mu*)
The classics state: "Double Yang results in Kuang; Double Yin results in Dian." Generally, Kuang manifests as delirious speech and hyperactivity, such as climbing walls and roofs, singing from heights, discarding clothes, running about, and cursing without regard for kinship or strangers, while holding oneself in high esteem and enjoying music. These are caused by solitary exuberance of Heart Fire and surplus of Yang Qi, leading to unsettled Shen (Spirit) and accumulation of Phlegm-Fire. Dian manifests as silence, irritability, depression, stiffness, collapse, fixed gaze, and alteration of normal temperament. These are caused by Yin deficiency and Blood insufficiency, leading to restless Heart Fire. Additionally, some cases arise from sudden anger and frustration that cannot be discharged, forming Kuang or Dian; in such cases, one must first soothe and unblock Liver Fire. (*Bing Yuan Ji*)
The *Nan Jing* states: "Double Yin results in Dian; Double Yang results in Kuang." The *Su Wen Zhu* states: "Excessive joy indicates Dian; excessive anger indicates Kuang." Since joy belongs to the Heart and anger belongs to the Liver, these are syndromes of excess Xiang Huo (Ministerial Fire) in these two organs. The Yin-Yang theory in the *Nan Jing* may not be entirely logical. Generally, Kuang is due to excess Phlegm-Fire, while Dian is due to insufficiency of Heart Blood, often occurring in individuals whose high aspirations go unfulfilled. (*Dan Xi Xin Fa: Zheng Zhuan*)
The root causes of Dian and Kuang are different. Kuang develops gradually with increasing madness and is difficult to cure over time. Dian strikes suddenly with stiffness and collapse, occurring intermittently. Patients with Kuang are usually awake, irritable, and violent. Patients with Dian are usually unconscious, fatigued, and quiet. Thus, their Yin-Yang and Cold-Heat natures are as opposite as ice and charcoal. Hence, the *Nan Jing* states: "Double Yang results in Kuang; Double Yin results in Dian," making the rationale clear.
Later scholars have suggested that Dian and Kuang are generally heat syndromes, which is not necessarily true. One must examine the patient's constitution and pulse qualities to distinguish Yin and Yang and treat them accordingly. (Zhang Jingyue, *Jing Yue Quan Shu*)