头眩心悸，苔白多痰，常服苍术见效。近因神乱若痴，多从事于
痰火，清滋重镇，阴胜于阳，以致变幻。然欲开阴雾，法必通
阳，譬之离照当空，而后阴雾始散。议进仲景苓桂术甘汤加味。
苓桂术甘汤加远志。
渊按∶此从喻氏《寓意草》得来。昧者见神乱若痴，从事于
痰火，不思心主阳神，痰为阴物，以阴邪遏其阳气，灵明为之蒙
闭颠倒。《内经》云∶重阳则狂，重阴则癫。癫狂二证，未可混
治。世医一见神志昏乱，多从事于痰火，由不读《内经》耳。
仁渊曰∶肝风痰火，乃类中之渐也。故次于中风之后。原夫
肝之所以生风，由肾水不足灌溉，致木燥火生，火生风起；脾弱
不能运化饮食精微而生痰浊，痰浊为风阳煽动，上盛下虚。轻则
眩晕摇颤，气升呕逆，重则癫狂昏仆，与中风同类。案中治法，
大都上熄风阳，下滋肾水。痰多者，以化痰为主，虚多者以养阴
为主。虚而寒者宜温，虚而热者宜凉。亦有本虚标实，痰火上盛，
不得不先泻火开痰，俟标邪退而再图其本。见证虽属肝胆，而病
根全在脾肾。盖木之生也，栽培在土，滋灌赖水。苟土浓水润，
燥湿得宜，虽有大风，枝叶动而根干不摇；惟土薄水亏，始根
露干枯，无风且萎，有风宁不摇动乎！且脾土既虚，肺金失恃，
金虚不能制木，火升转欲焚金。将军之性，非可直制，惟咸苦甘
凉，佐微酸微辛，经所谓∶火淫于内，治以咸寒，佐以甘苦，
以酸收之，以苦发之。风淫于内，治以辛凉，佐以甘苦，以甘缓
之，以辛散之。夫咸苦酸甘，益阴泻火，以柔济刚。辛味虽阳，以能通散，助金而制木也。
头目眩晕、心悸，舌苔白且痰多，平时服用苍术能见效。近来因神志错乱如同痴呆，（前医）多从痰火论治，使用清热滋润和重镇安神的药物，导致阴气过盛而压制阳气，从而引发病情变化。然而想要驱散阴寒之雾，治法必须通阳，就像太阳高悬空中，阴雾才能消散。建议进服张仲景的苓桂术甘汤并加以加减。
苓桂术甘汤加远志。
渊按：此法源自喻嘉言《寓意草》。庸医见到神志错乱如痴，便从痰火论治，却不思考心主藏阳神，痰属于阴邪之物，阴邪遏制了阳气，致使灵明之心被蒙蔽颠倒。《黄帝内经》说：阳气过重则发狂，阴气过重则发癫。癫证和狂证两种病证，不可混淆治疗。世俗医生一见神志昏乱，多从痰火论治，这是因为不读《黄帝内经》的缘故。
仁渊曰：肝风夹痰火，是类中风的前兆。所以将其列在中风之后。原来肝之所以生风，是因为肾水不足无法灌溉，导致肝木干燥而生火，火盛则生风；脾虚不能运化饮食精微而产生痰浊，痰浊被风阳煽动，造成上实下虚。轻则出现眩晕摇颤、气逆呕吐，重则出现癫狂昏仆，与中风同类。案中的治疗方法，大多是上部熄风阳，下部滋肾水。痰多的，以化痰为主；虚损多的，以养阴为主。虚而偏寒的宜用温法，虚而偏热的宜用凉法。也有本虚标实，痰火上盛的，不得不先泻火开痰，等标邪退去后再图治其根本。见证虽属肝胆，但病根全在脾肾。盖树木的生长，栽培依靠土壤，滋润依赖水源。如果土壤肥沃、水源充足，燥湿适宜，即使有大风，枝叶动摇而根干不摇；只有土壤贫瘠、水源亏虚，才会根部裸露干枯，无风尚且萎蔫，有风岂能不摇动吗！况且脾土既已虚弱，肺金失去依托，肺金虚弱不能制约肝木，肝火上升反而焚烧肺金。肝（将军之官）的性情，不可直接强力压制，唯有用咸、苦、甘、凉药，佐以微酸、微辛的药，正如经书所说：火淫于内，用咸寒药治疗，佐以甘苦药，用酸味收敛它，用苦味发散它。风淫于内，用辛凉药治疗，佐以甘苦药，用甘味缓和它，用辛味疏散它。咸、苦、酸、甘诸味，能益阴泻火，以柔济刚。辛味虽属阳，但能通达疏散，助肺金以制约肝木。
Dizziness and palpitations, white tongue coating with abundant phlegm; taking Atractylodis Rhizoma (Cangzhu) regularly has been effective. Recently, due to mental confusion resembling dementia, previous treatments focused on Phlegm-Fire, using clearing and moistening agents along with heavy sedatives, resulting in Yin excess suppressing Yang, thereby causing pathological changes. However, to dispel the Yin fog, the method must involve unblocking Yang, akin to the sun shining brightly in the sky, after which the Yin fog dissipates. It is proposed to administer Linggui Zhugan Decoction (Poria, Cinnamon Twig, Atractodes Rhizome, and Licorice Decoction) modified by Zhang Zhongjing.
Linggui Zhugan Decoction added with Polygalae Radix (Yuanzhi).
Yuanyuan notes: This approach originates from Yu Jia Yan's *Yuyi Cao*. Incompetent physicians, seeing mental confusion resembling dementia, treat it as Phlegm-Fire without considering that the Heart governs the Yang Spirit (Shen), while Phlegm is a Yin pathogen. The Yin pathogen suppresses Yang Qi, obscuring and reversing the clarity of the mind. The *Huangdi Neijing* states: "Excess Yang leads to mania; excess Yin leads to melancholia." The conditions of Mania (Kuang) and Melancholia (Dian) should not be treated indiscriminately. Modern physicians, upon seeing disordered consciousness, often attribute it to Phlegm-Fire, simply because they have not studied the *Huangdi Neijing*.
Ren Yuan says: Liver Wind with Phlegm-Fire is a precursor to stroke-like syndromes (Lei Zhong). Therefore, it is placed after Stroke. The reason Liver generates Wind is that insufficient Kidney Water fails to nourish, causing Liver Wood to become dry and generate Fire; when Fire is excessive, Wind arises. Spleen deficiency fails to transform dietary essence, generating turbid Phlegm. This Phlegm is stirred by Wind-Yang, leading to excess above and deficiency below. Mild cases present with dizziness, tremors, rising Qi, and vomiting; severe cases present with manic or melancholic states, fainting, and collapse, similar to Stroke. The treatment methods in this case mostly involve extinguishing Wind-Yang in the upper body and nourishing Kidney Water in the lower body. For abundant phlegm, resolving phlegm is primary; for significant deficiency, nourishing Yin is primary. Deficiency with cold warrants warming; deficiency with heat warrants cooling. There are also cases of root deficiency with branch excess, where Phlegm-Fire is excessive above; here, one must first purge fire and resolve phlegm, waiting for the branch pathogens to recede before addressing the root. Although the manifestations belong to the Liver and Gallbladder, the disease root lies entirely in the Spleen and Kidney. The growth of Wood depends on soil cultivation and water irrigation. If the soil is rich and water sufficient, with appropriate moisture balance, even strong winds may shake the branches but will not uproot the tree. Only when the soil is barren and water deficient does the root expose and dry out, wilting even without wind, let alone shaking in the wind! Moreover, if Spleen Earth is deficient, Lung Metal loses its support; deficient Lung Metal cannot control Liver Wood, and rising Fire burns Lung Metal. The nature of the General (Liver) cannot be directly suppressed; rather, one should use salty, bitter, sweet, and cool herbs, assisted by slightly sour and pungent herbs. As stated in the classics: "When Fire invades internally, treat with salty-cold, assist with sweet-bitter, astringe with sour, and disperse with bitter." "When Wind invades internally, treat with pungent-cool, assist with sweet-bitter, soothe with sweet, and disperse with pungent." Salty, bitter, sour, and sweet flavors nourish Yin and purge Fire, using softness to supplement hardness. Although Pungent flavor is Yang, it can unblock and disperse, assisting Lung Metal to control Liver Wood.