《素问·通评虚实论》帝曰∶癫疾何如？岐伯曰∶脉搏大滑，久自已；脉小坚急，死不治。帝曰∶癫疾之
脉，虚实何如？岐伯曰∶虚则可治，实则死。
此明癫疾之轻重死生也。由外邪痰浊胶结于血脉，血脉心所主，故蒙蔽心窍而神昏乱，其腑气流通，故食
便如常而不死。邪居阳分为狂，杀人放火；邪居阴分为癫，不省人事。以其邪实，故脉大搏指而有力，滑者，
气血尚活而流行，久久邪衰痰化，可以自愈；若脉小，则元气已戕，坚急，则邪气痼结，必死不能愈
矣。如不搏大而虚者，邪结不甚，尚可助正以解邪；如不滑利而但坚实，则邪结甚而无阳和之气，故死不可治。
诸厥篇中有怒狂一证，用铁落饮者，以阳邪亢极而名阳厥，宜与此合观之。
《灵枢·癫狂篇》曰∶癫疾始生，先不乐，头重痛，视举目赤甚，作极，已而烦心，候之于颜。取手太
阳、阳明、太阴，血变而止。
癫病在手经，邪结血脉，其始发也，郁热上冒，故先不乐而头重痛，目皆赤，发作极而心烦也。颜者，
阙庭，心肺之部位，故当候之于颜，观其色泽之浮沉明晦，以辨邪之轻重、正之虚实也。取手太阳小肠经、
阳明大肠经、太阴肺经以泄其邪，视其血变正色，则邪去而愈。此言针法，如用药亦当从三经治之矣。
癫疾始作，而引口啼呼，喘悸者，候之手阳明、太阳，左强者，攻其右，右强者，攻其左，血变乃止。
此痰闭风动，癫而兼痫者也，故口牵引啼呼而喘悸，其肢体或左或右而强急。候其大肠、小肠两经而针
治之，邪在左，则右强，故攻其左，邪在右，则左强，故攻其右，以邪闭经脉，而血气不得流注于无邪之处，
故筋脉燥急而强也。
癫疾始作，先反僵，因而脊痛，候之足太阳、阳明、太阴、手太阳，血变而止。
反僵者，如角弓反张，因而脊痛，以足太阳经行于背，邪闭其经，故反张而脊痛。兼治脾胃经者，以其统
一身之阴阳也。然仍不离于手经，故皆当取之，以小肠为心之腑，心病必泻其腑也。
治癫疾者，常与之居，察其所当取之处。病至视之，有过者泻之，置其血于瓠壶之中，至其发时，血独
动矣，不动，灸穷骨二十壮。穷骨者， 骨也。
癫邪结在血分，治之必刺出其血，置于瓠壶中，至病发时而血动，亦铜山西崩，洛钟东应之理。其能应
而动者，其人元气未败，可治；如不动，灸其 骨，助督脉之阳，以开其结邪也。按以上诸证，皆言时发时止，
即世俗所称羊癫风之类，非痴癫之病，而无心清之时也则伤肝、
肾、心三脏，其又呕沫，气下泄，是脾胃俱败，故死不可治也。
癫疾，疾发如狂者，死不治。
邪居阴分为癫，居阳分为狂。本居阴分而疾发如狂者，则邪遍阴阳而元气败矣，故死不可治。
《素问·通评虚实论》中，黄帝问道：癫疾（精神失常类疾病）的表现是怎样的？岐伯回答说：脉搏大而滑利，病程较长后可自行痊愈；脉搏细小、坚硬且急迫，属于死证，无法治疗。黄帝又问：癫疾的脉象，虚和实的情况如何？岐伯回答：脉虚可以治疗，脉实则预后不良，难以治愈。
这段文字阐明了癫疾病情的轻重及生死预后。由于外邪与痰浊胶结在血脉之中，而血脉由心所主，因此痰浊蒙蔽心窍导致神志昏迷混乱。如果腑气流通正常，饮食和二便如常，就不会死亡。邪气停留在阳分表现为狂证（躁动不安），会做出杀人放火等极端行为；邪气停留在阴分表现为癫证（沉默痴呆），患者不省人事。因为邪气盛实，所以脉搏搏指有力且大，滑利代表气血尚能流通，经过长时间后邪气衰退、痰浊化解，可以自愈；如果脉搏细小，说明元气已经受损，坚硬急迫说明邪气痼结难解，必然死亡无法治愈。如果不盛大搏指而是虚弱，说明邪结不深，还可以扶助正气以驱除邪气；如果不滑利而只是坚实，说明邪结严重且缺乏阳气调和之气，所以死亡且无法治疗。
在《诸厥篇》中有“怒狂”这一证候，使用铁落饮治疗，这是因为阳邪亢盛至极而命名为阳厥，应当与此处内容结合观看。
《灵枢·癫狂篇》说：癫疾刚开始发生时，患者首先感到心情不愉快，头痛沉重，眼睛发红甚至充血，发作极度痛苦，随后心中烦闷，观察部位在面部颜面区域。针刺取用手太阳经、手阳明经、手太阴经的穴位，直到血液颜色变化恢复正常为止。
癫病发生在手经，邪气结聚在血脉中，起初发病时，郁热上冲，所以先出现心情不悦、头痛沉重、眼睛发红，发作到极致时心烦意乱。颜面指的是阙庭（额头及鼻部区域），是心和肺的部位，所以应当在颜面观察，查看其色泽的浮沉明晦，以此辨别邪气的轻重和正气的虚实。取用手太阳小肠经、手阳明大肠经、手太阴肺经来泄除邪气，观察血液颜色变为正常血色，则邪气去除而病愈。这里讲的是针法，如果使用药物治疗也应当从这三条经脉所属脏腑进行调理。
癫疾刚开始发作时，口角牵引、啼哭呼叫，伴有气喘和心悸，观察手阳明经和手太阳经，左侧肢体强急的，针刺右侧；右侧肢体强急的，针刺左侧，直到血液颜色变化为止。
这是痰浊闭阻、风邪内动，癫证兼有痫证的表现，所以出现口角牵引、啼哭呼叫以及气喘心悸，肢体或左或右出现强直紧急。诊察其大肠经和小肠经进行针刺治疗，邪气在左侧，则右侧强急，所以针刺左侧；邪气在右侧，则左侧强急，所以针刺右侧。这是因为邪气闭阻经脉，气血不能流注到没有邪气的地方，所以筋脉干燥紧急而强直。
癫疾刚开始发作时，身体向后反折僵硬，随之脊柱疼痛，诊察足太阳经、足阳明经、足太阴经、手太阳经，直到血液颜色变化为止。
所谓反僵，就像角弓反张一样，随之脊柱疼痛，因为足太阳经行于背部，邪气闭阻该经，所以出现反张和脊柱疼痛。同时治疗脾胃经（足阳明、足太阴），是因为它们统摄一身之阴阳。然而治疗仍不离手经，所以都应当选取，因为小肠是心的腑，心病必须泻其腑。
治疗癫疾的人，经常陪伴在患者身边，观察并确定应当针刺的部位。病发时观察患者，发现有邪气盛实的部位就予以泻法，将刺出的血放在葫芦壶中，等到下次发作时，壶中的血会独自跳动；如果不跳动，就在穷骨（尾骶骨）处灸二十壮。穷骨就是尾骶骨。
癫邪结聚在血分，治疗时必须刺出其血液，置于葫芦壶中，等到病发时血液跳动，这也是“铜山西崩，洛钟东应”（比喻事物之间相互感应）的道理。能够感应跳动的，说明此人元气未败，可以治疗；如果不跳动，就灸治尾骶骨，以助督脉之阳气，从而开通结聚的邪气。按以上各证候所述，都是指时发时止的疾病，即世俗所称的羊癫风之类，而不是痴呆愚钝的病，也没有心智清醒的时候。这种情况下会损伤肝、肾、心三脏，如果再出现呕吐涎沫、气向下泄，说明脾胃功能都已败坏，所以死亡且无法治疗。
癫疾发作时像狂证一样的，属于死证，无法治疗。
邪气停留在阴分为癫，停留在阳分为狂。原本邪气居于阴分却突然发作得像狂证一样，说明邪气遍布阴阳两分且元气已败，所以属于死证，无法治疗。
In the *Suwen: Tongping Xushi Lun* (Plain Questions: Discussion on Excess and Deficiency), the Yellow Emperor asked: What are the manifestations of Dian disease (epilepsy/mental disorder)? Qibo replied: If the pulse is large and slippery, the disease may resolve spontaneously after a long period; if the pulse is small, firm, and rapid, it is a fatal condition that cannot be treated. The Yellow Emperor further asked: Regarding the pulse of Dian disease, what about excess and deficiency? Qibo answered: Deficiency can be treated, but excess indicates a poor prognosis and difficulty in cure.
This passage clarifies the severity and prognosis of Dian disease. It arises from external pathogens and turbid phlegm knotting within the blood vessels. Since the heart governs the blood vessels, the phlegm muddies the orifices of the heart, leading to confusion and loss of spirit. If the fu organs' qi flows smoothly, allowing normal eating and defecation, death will not occur. Pathogens residing in the Yang aspect manifest as Kuang syndrome (mania/excitement), characterized by extreme behaviors like killing or arson; pathogens residing in the Yin aspect manifest as Dian syndrome (depression/apathy), characterized by unconsciousness or lack of awareness. Because the pathogen is excess, the pulse is forceful and large against the finger. Slipperiness indicates that Qi and Blood are still circulating freely; over time, the pathogen declines and phlegm resolves, allowing self-healing. If the pulse is small, Yuan Qi (Original Qi) has been damaged; if firm and rapid, the pathogen is deeply entrenched, leading inevitably to death. If the pulse is not large and forceful but weak, the pathogenic knot is not severe, and supporting Zheng Qi (Upright Qi) to resolve the pathogen is possible. If the pulse is not slippery but merely firm, the pathogenic knot is severe and lacks the harmonizing Qi of Yang, resulting in death and untreatability.
In the *Zhu Jue Pian* (Chapter on Various Jue Syndromes), there is a syndrome called "Nulang" (Anger-induced Mania), treated with Tieluo Yin (Iron Filings Decoction). This occurs because Yang pathogens are extremely hyperactive, named Yang Jue (Yang Reversal), and should be viewed in conjunction with this text.
The *Lingnu: Dian Kuang Pian* (Spiritual Pivot: Chapter on Dian and Kuang) states: When Dian disease first begins, the patient initially feels unhappy, experiences heavy head pain, red eyes, extreme agitation, and subsequently mental restlessness. Observation should be focused on the Yan (face/forehead area). Acupuncture points from the Hand Taiyang, Hand Yangming, and Hand Taiyin meridians should be selected until the blood color changes [to normal].
Dian disease involves the hand meridians, where pathogens knot in the blood vessels. Initially, stagnant heat rises upward, causing initial unhappiness, heavy head pain, red eyes, and mental restlessness upon extreme发作 (paroxysm). The Yan refers to the Que Ting (glabella and forehead region), which corresponds to the Heart and Lung areas. Therefore, observation should focus on the face to assess the floating/sinking and brightness/darkness of the complexion, thereby distinguishing the severity of the pathogen and the strength of Zheng Qi. Selecting the Hand Taiyang Small Intestine Meridian, Hand Yangming Large Intestine Meridian, and Hand Taiyin Lung Meridian helps to drain the pathogen. When the blood color returns to its normal hue, the pathogen is expelled and recovery ensues. This describes acupuncture methods; if using herbal medicine, treatment should also target these three meridians and their associated zang-fu organs.
When Dian disease first starts, accompanied by mouth deviation, crying out, panting, and palpitations, observe the Hand Yangming and Hand Taiyang meridians. If stiffness is stronger on the left, treat the right side; if stronger on the right, treat the left side. Stop when the blood color changes.
This represents wind stirring due to phlegm obstruction, a combination of Dian and Xian (epileptic seizure) syndromes. Hence, there is mouth deviation, crying, panting, and palpitations, with limb stiffness on either the left or right side. By examining the Large Intestine and Small Intestine meridians for acupuncture, if the pathogen is on the left, the right side becomes stiff, so treat the left; if the pathogen is on the right, the left side becomes stiff, so treat the right. This is because pathogen obstruction in the meridians prevents Qi and Blood from flowing into areas without pathogens, causing tendons and vessels to become dry, urgent, and stiff.
When Dian disease first starts, the body arches backward rigidly, followed by spinal pain. Observe the Foot Taiyang, Foot Yangming, Foot Taiyin, and Hand Taiyang meridians. Stop when the blood color changes.
"Fan Jiang" (backward rigidity) resembles opisthotonos, followed by spinal pain, because the Foot Taiyang Meridian runs along the back, and pathogen obstruction causes backward arching and pain. Treating the Spleen and Stomach meridians (Foot Yangming and Foot Taiyin) is necessary because they govern the Yin and Yang of the whole body. However, treatment still involves the hand meridians, as the Small Intestine is the Fu organ of the Heart, and Heart diseases must drain their corresponding Fu organ.
Those treating Dian disease should reside frequently with the patient to observe and determine the appropriate acupuncture sites. When the disease strikes, observe the patient; if there is an area of excess, apply draining techniques. Place the extracted blood in a gourd vessel. At the time of the next paroxysm, the blood in the vessel will move independently. If it does not move, moxa twenty Zhu (moxa cones) at the Qionggu (coccyx). The Qionggu is the coccyx bone.
Dian pathogens knot in the Blood level, so treatment requires puncturing to extract blood, placed in a gourd vessel. The blood moving at the time of the paroxysm illustrates the principle of mutual resonance ("when copper mountains collapse, bells in Luoyang ring"). If the blood moves, it indicates that Yuan Qi is not yet exhausted, and the condition is treatable. If it does not move, moxa the coccyx to assist the Yang of the Du Mai (Governing Vessel) to open the knotted pathogens. According to the above syndromes, these refer to conditions that come and go intermittently, such as the secular term "Sheep Epilepsy," rather than dementia or idiocy, with no periods of mental clarity. Such conditions injure the Liver, Kidney, and Heart Zang organs. If accompanied by vomiting froth and downward leakage of Qi, it indicates failure of the Spleen and Stomach, resulting in death and untreatability.
If Dian disease manifests like Kuang (mania) during attacks, it is a fatal condition that cannot be treated.
Pathogens in the Yin aspect constitute Dian; those in the Yang aspect constitute Kuang. If the pathogen originally resides in the Yin aspect but suddenly manifests like Kuang, it means the pathogen has spread throughout both Yin and Yang, and Yuan Qi has failed. Thus, it is a fatal condition that cannot be treated.