狂之为病有三,而阴症不与焉。经曰∶重阳则狂。又曰∶邪入于阳则狂。诸经之狂,总阳盛
也。
一曰发狂,盖阳明多气多血,阳邪入胃腑,热结不解,因而发狂。其症则妄起行,妄笑语,
登高而歌,弃衣而走,逾垣上屋,呼号骂詈,不避亲疏,数日不食,皆因阳明邪热上乘心肺,故
令神志昏乱,如此是为邪热已极,非峻逐火邪不能自已。故但察其面赤咽痛,潮热噎气,五心烦热,
唇肿口哕,发黄脉实,形如醉人,大便 结或腹满而坚。有可攻等症,则宜以大承气、六一顺气
等汤,凉膈散,消息出入下之。再甚则为阳毒,斟酌施治。如无胀、满、实、坚等症,而惟胃火
致然,则但以白虎汤、抽薪饮等,泄去火邪自愈。一曰如狂,或当汗不汗,
或覆盖不周而不汗。太阳之邪,无从而出,故随经入腑,小腹 满,小便自利,下焦蓄血,经所
谓热结膀胱,其人如狂。是特如狂而未至于狂耳,宜桃仁承气下之则愈。一曰火邪惊狂,其或薰
熨迫汗,灼艾烧针等治不如法,令人烦躁起卧不安是也。此伤寒中事,瘟疫门原无薰灼治法,故无
此变症。至于狂乱而兼小便自遗直视,汗出辄复热,不能食,舌卷囊缩,皆难治。
抽薪饮
黄芩 石斛 木通 炒栀 黄柏 枳壳(麸炒) 泽泻(盐水炒) 甘草
水煎冷服。热在经络者,加连翘、花粉;在血分、大小肠者,加槐花、黄连;在阳明头面,
或烦躁便实者,加石膏;在下焦,加胆草、车前;在阴分,津液少者,加二冬、生地、白芍;便
结,加硝、黄。
狂病有三种,其中不包括阴证。医经说:阳气过盛则发狂。又说:邪气侵入阳分则发狂。各经的狂病,总归都是阳气亢盛所致。
第一种叫“发狂”,这是因为阳明经多气多血,阳热邪气侵入胃腑,热结阻滞不能解除,因而引发狂病。其症状表现为无故起身行走,胡言乱语,登上高处唱歌,脱掉衣服奔跑,翻越墙垣屋顶,大声呼号辱骂,不分亲疏远近,几天不进食。这都是因为阳明邪热上攻心肺,导致神志昏乱。这种情况属于邪热已经极盛,非要用猛烈的手段驱逐火邪才能平息。因此,只要观察到患者面红、咽喉痛、潮热、噎气、五心烦热、嘴唇肿胀、呃逆、发黄、脉象实大、神态像喝醉的人、大便干结或腹部胀满坚硬等可攻下的症状,就适宜使用大承气汤、六一顺气汤等方剂,或者凉膈散,根据病情轻重缓急斟酌后使用泻下法。如果病情更重,发展为阳毒,需酌情施治。如果没有胀、满、实、坚等实证表现,仅仅是因为胃火导致,那么只需用白虎汤、抽薪饮等方剂,泄去火邪即可自愈。
第二种叫“如狂”(似狂非狂),可能是该用汗法却没有发汗,或者覆盖衣被不周全导致未能出汗。太阳经的邪气没有出路,于是顺着经络进入膀胱腑,出现小腹胀满,小便通畅自如。这是下焦蓄血,医经所说的“热结膀胱,其人如狂”。这仅仅是像狂而没有真正达到狂的程度,适宜用桃仁承气汤泻下治疗即可痊愈。
第三种叫“火邪惊狂”,可能是因为用熏蒸、熨烫强迫发汗,或者艾灸、烧针等治疗方法不当,导致患者烦躁不安,坐卧不宁。这是伤寒病中的变症,瘟疫病原本没有熏蒸灼热的治法,所以没有这种变症。至于狂乱同时伴有小便失禁、两眼直视、出汗后发热随即复发、不能进食、舌头卷缩、阴囊收缩等症状,都属于难治之症。
抽薪饮
黄芩、石斛、木通、炒栀子、黄柏、枳壳(麸炒)、泽泻(盐水炒)、甘草。
用水煎煮,冷服。如果热邪在经络,加连翘、天花粉;在血分、大小肠,加槐花、黄连;在阳明经头面部,或者烦躁、大便干实的,加石膏;在下焦,加龙胆草、车前子;在阴分、津液不足的,加天冬、麦冬、生地黄、白芍;大便干结的,加芒硝、大黄。
The disease of mania (Kuang) has three types, excluding Yin syndromes. The Classics state: "Excessive Yang leads to mania." It also states: "When pathogenic factors enter the Yang aspect, mania occurs." Mania from various meridians is generally due to hyperactivity of Yang Qi.
The first type is called "true mania" (Fa Kuang). This is because the Yangming meridian is rich in both Qi and Blood; when Yang-heat pathogenic factors invade the Stomach fu organ, heat accumulation fails to resolve, thereby triggering mania. Symptoms include aimless walking, nonsensical speech and laughter, climbing high places to sing, discarding clothes and running, scaling walls and roofs, shouting and cursing regardless of kinship or distance, and abstaining from food for several days. These occur because Yangming pathogenic heat attacks upward to the Heart and Lungs, causing confusion of the spirit and mind. This indicates that pathogenic heat has reached an extreme level, requiring drastic measures to purge the fire pathogen to bring it under control. Therefore, if symptoms such as facial redness, sore throat, tidal fever, chest oppression, five-palm heat, swollen lips, hiccups, jaundice, a full and forceful pulse, a demeanor resembling drunkenness, dry stools, or abdominal fullness with hardness are present—indicating conditions suitable for purgation—one should use formulas such as Da Cheng Qi Tang (Major Order the Qi Decoction), Liu Yi Shun Qi Tang (Six-One Smooth Qi Decoction), or Liang Ge San (Cool the Diaphragm Powder), adjusting the dosage and method based on the severity to induce purgation. If the condition worsens into Yang Du (Yang Toxin), treatment must be adjusted accordingly. If there are no signs of fullness, distension, excess, or hardness, but the condition is solely caused by Stomach Fire, using Bai Hu Tang (White Tiger Decoction) or Chou Xin Yin (Draw Out the Firewood Drink) to drain the fire pathogen will lead to spontaneous recovery.
The second type is called "pseudo-mania" (Ru Kuang). This may result from a failure to induce sweating when diaphoresis was indicated, or from inadequate covering during treatment preventing sweat production. The Taiyang pathogenic factor has no outlet and thus follows the meridian into the Bladder fu organ, presenting with lower abdominal fullness and free urination. This represents blood stasis in the Lower Jiao, described in the Classics as "Heat binding in the Bladder, the person appears manic." This is merely appearing manic without reaching true mania. It should be treated with Tao Ren Cheng Qi Tang (Peach Kernel Order the Qi Decoction) via purgation to achieve cure.
The third type is called "Fire Pathogen Startling Mania" (Huo Xie Jing Kuang). This arises from improper treatments such as forced sweating through fumigation or hot compresses, or inappropriate application of moxibustion and burning needles, leading to irritability and restlessness. This is a complication specific to Shang Han (Cold Damage) diseases. Since plague diseases originally did not employ fumigation or burning methods, this specific complication does not occur in them. However, mania accompanied by urinary incontinence, fixed gaze, recurrent fever after sweating, inability to eat, tongue retraction, and testicular retraction are all considered difficult to treat.
Chou Xin Yin (Draw Out the Firewood Drink)
Scutellariae Radix (Huangqin), Dendrobii Caulis (Shihu), Akebiae Caulis (Mutong), Gardeniae Fructus (Chao Zhi), Phellodendri Cortex (Huangbai), Aurantii Fructus (Zhike, stir-baked with bran), Alismatis Rhizoma (Zexie, stir-fried with salt water), Glycyrrhizae Radix et Rhizoma (Gancao).
Decoct in water and take cold. If heat is in the meridians, add Forsythiae Fructum (Lianqiao) and Angelicae Dahuricae Radix (Huafen); if in the blood level or Large/Small Intestines, add Sophorae Flos (Huaihua) and Coptidis Rhizoma (Huanglian); if in the Yangming meridian affecting the head and face, or with irritability and solid stools, add Gypsum Fibrosum (Shigao); if in the Lower Jiao, add Gentianae Radix (Dancao) and Plantaginis Semen (Cheqian); if in the Yin level with deficient body fluids, add Asparagi Radix (Dongdong - Tianmai and Maidong) and Rehmanniae Radix Preparata (Shengdi), Paeoniae Radix Alba (Baishao); if with dry stools, add Mirabilite (Xiao) and Rheomi Radix et Rhizoma (Huang).