〔大〕夫妇人颠狂病者,由血气虚,受风邪所为也。人禀阴阳之气而生,而风邪入
并于阴则为颠,入并于阳则为狂。阴之与阳,有虚有实,随其虚时,为邪所并则发也。颠
者卒发,意不乐,直视仆地,吐涎沫,口 目急,手足撩戾,无所觉知,良久乃苏。狂
者少卧不饥,自高贤也,自辨智也,自贵倨也,妄笑好歌乐,妄行不休,故曰颠狂也。
《素问》云∶阳厥狂怒,饮以铁落。狂怒出于肝经,肝属木,铁落,金也,以金制木之意。
予尝治一女人眼见鬼物,言语失常,循衣直视。众医多用心药治之无效。予投养正丹二
帖,煎乳香汤送下,以三生饮佐之立愈。又一男子亦曾病此证,亦用此药收效。且养正
丹与《百一方》抱胆丸无异,抱胆丸内无硫黄,有乳香也。
〔薛〕刘宗浓先生云∶有在母腹中受惊者,或有闻大惊而得者。盖惊则神不守舍,舍
空则痰涎归之。或饮食失节,胃气有伤,痰停胸膈而作,当寻火、寻痰、固元气。若顽
痰胶固上膈,必先用吐法,若在肠胃,亦须下之。窃谓此证,若因元气虚弱,或痰盛发
热等,皆是虚象,如慢惊证,无风可祛,无痰可逐,但补脾胃,生气健旺,神智自清,痰
涎自化。若误用辛散祛逐脑麝之剂,必为败证。一妇人素清苦,因惊而颠,或用风痰
等药愈甚。余用参、 、归、术浓煎,佐以姜汁、竹沥,服三斤余方愈。
防风散 治妇人风邪颠狂,或啼泣不止,或歌笑无度,或心神恐惧,或言语失常。
防风 茯神(去木) 独活 人参 远志(去心) 龙齿(研) 菖蒲(去毛)
石膏 牡蛎(各一两) 秦艽 禹余粮 桂心(各半两) 甘草(七钱半) 蛇蜕(一尺,炙)
上为粗末,每服三钱,水一盏半,煎七分,去滓温服。
又方 羚羊角(屑) 人参 生干地黄(各七钱半) 独活 远志(去心) 菖蒲(去毛)
防风(各半两) 茯神(去木) 石膏 麦门冬(去心) 龙齿(别研) 白鲜皮(各一两)
上为粗末,每服三钱,水煎,温服无时。
牛黄清心丸亦可用。(方见杂病中风。)
余详杂病本门。
【戴元礼论述】妇女患颠狂病,是由于气血虚弱,感受风邪所致。人禀受阴阳二气而生,若风邪侵入并并入阴分,则发为颠证;若风邪侵入并并入阳分,则发为狂证。阴与阳,都有虚和实的不同,随着正气虚弱之时,被邪气所乘袭就会发病。
颠证是突然发作,患者心情不愉快,两眼直视倒地,口吐涎沫,口眼抽搐拘急,手足屈曲扭转,神志昏迷无知觉,过了很久才苏醒。狂证则是睡眠少、不知饥饿,自认为贤能,自认为聪慧,自认为尊贵傲慢,无故嬉笑、喜欢唱歌娱乐,行为妄动不停止,所以称为颠狂。
《素问》说:阳厥导致的狂怒,可以用铁落(Iron filings)制成的饮品治疗。狂怒源于肝经,肝属木,铁落属金,这是利用金来克制木的意思。
我曾经治疗一位妇女,看见鬼怪之物,言语失常,手循衣角且两眼直视。许多医生多用安神镇惊的药物(心药)治疗,但无效。我投用养正丹两帖,用乳香汤煎服送下,并配合三生饮辅助,立刻痊愈。又有一位男子也曾患此证,也使用此药而见效。况且养正丹与《百一方》中的抱胆丸没有区别,抱胆丸内不含硫黄,而是含有乳香。
【薛己论述】刘宗浓先生说:有的患者在母腹中受到惊吓,或者因听到巨大的惊恐而患病。大概是因为惊则神不守舍,心神之舍空虚则痰涎归聚于此。或者是饮食不节制,损伤了胃气,导致痰停聚在胸膈而发病,应当寻找火邪、寻找痰邪、固护元气。如果顽痰胶结固着在上膈,必须先用吐法;如果在肠胃,也必须用下法。
我个人认为此证,如果是由于元气虚弱,或者痰盛发热等,都属于虚象,就像慢惊风证一样,没有风可祛,没有痰可逐,只需补益脾胃,使生气健旺,神智自然清明,痰涎自然化解。如果误用辛散祛逐及脑麝类的药物,必然导致败证。有一位妇人平素清苦,因受惊而患颠证,有人用治风痰的药物,病情反而加重。我用人参、[此处原文缺字,据上下文推测可能为黄芪或白术等补气药,但依规则不增译,故略去或泛指]、当归、白术浓煎,佐以姜汁、竹沥,服用三斤多后才痊愈。
防风散:治疗妇人风邪引起的颠狂,或者啼哭不止,或者歌笑无度,或者心神恐惧,或者言语失常。
处方组成:防风、茯神(去除木质部分)、独活、人参、远志(去除心部)、龙齿(研碎)、菖蒲(去除毛刺)、石膏、牡蛎(各一两)、秦艽、禹余粮、桂心(各半两)、甘草(七钱半)、蛇蜕(一尺,炙烤)。
以上药材捣成粗末,每次服用三钱,加水一盏半,煎至七分,去渣滓温服。
另一个方子:羚羊角(屑)、人参、生干地黄(各七钱半)、独活、远志(去除心部)、菖蒲(去除毛刺)、防风(各半两)、茯神(去除木质部分)、石膏、麦门冬(去除心部)、龙齿(单独研碎)、白鲜皮(各一两)。
以上药材捣成粗末,每次服用三钱,水煎,随时温服。
牛黄清心丸也可以使用。(方剂见杂病中风门。)
其余详细内容参见杂病本门。
[Dai Yuanli's Discussion] Women suffering from Dian-Kuang (Dian and Kuang disorders) are afflicted due to deficiency of Qi and Blood, combined with invasion by Wind pathogen. Humans are born endowing Yin and Yang Qi; if Wind pathogen enters and merges into the Yin aspect, it manifests as Dian syndrome; if it enters and merges into the Yang aspect, it manifests as Kuang syndrome. Both Yin and Yang have states of deficiency and excess. When the healthy Qi is deficient, the pathogen takes advantage of this weakness, leading to the onset of disease.
Dian syndrome occurs suddenly: the patient feels unhappy, stares straight ahead, falls to the ground, foams at the mouth, experiences spasms of the mouth and eyes, has twisted limbs, loses consciousness, and recovers after a long period. Kuang syndrome is characterized by little sleep, lack of hunger, arrogance regarding one's virtue, wisdom, and status, irrational laughter, fondness for singing and music, continuous erratic behavior, hence termed Dian-Kuang.
The *Su Wen* states: For mania arising from Yang Jue (Yang reversal), one should administer Iron Filings Decoction. Mania originates from the Liver Meridian; the Liver belongs to Wood, while Iron Filings belong to Metal, representing the principle of using Metal to control Wood.
I once treated a woman who saw ghosts, spoke abnormally, traced the edges of her clothes, and stared straight ahead. Many physicians used Shen-An (Spirit-Calming) medicines without effect. I prescribed Yang Zheng Dan (Nourish Righteousness Pill) twice, taken with Frankincense Decoction, assisted by San Sheng Yin (Three Lives Drink), resulting in immediate recovery. Another male patient suffered from the same condition and also recovered with this medication. Moreover, Yang Zheng Dan is identical to Bao Dan Wan (Protect Gallbladder Pill) from *Bai Yi Fang*; Bao Dan Wan contains no Realgar but includes Frankincense.
[Xue Ji's Discussion] Mr. Liu Zongnong stated: Some patients suffer fright in the womb, or contract the disease from hearing a sudden shock. Fright causes the Spirit (Shen) to lose its residence; when the residence is empty, Phlegm-Fluids gather there. Alternatively, irregular diet damages Stomach Qi, causing Phlegm to stagnate in the chest and diaphragm, triggering the disease. One must identify Fire pathogens, identify Phlegm, and consolidate Yuan Qi. If stubborn Phlegm is firmly lodged in the upper diaphragm, emesis must be induced first; if in the intestines and stomach, purgation is required.
In my opinion, if this syndrome arises from Yuan Qi deficiency or Phlegm-heat fever, these are all deficiency manifestations, similar to Slow Convulsion syndrome. There is no Wind to dispel nor Phlegm to purge; one should merely tonify the Spleen and Stomach. As vital Qi becomes robust, the Spirit will naturally clarify, and Phlegm-Fluids will resolve. Misusing acrid-dispersing agents containing Camphor and Musk will inevitably lead to a critical failure. A woman of ascetic disposition contracted Dian due to fright; treatment with Wind-Phlegm dispersing agents worsened her condition. I used dense decoctions of Ginseng, [Text missing], Angelica Sinensis, and Atractylodes Macrocephala, aided by Ginger Juice and Bamboo Sap. After consuming over three jin, she recovered.
Fang Feng San (Saposhnikovia Powder): Treats women’s Dian-Kuang caused by Wind pathogen, including incessant weeping, excessive singing/laughing, mental fear, or abnormal speech.
Ingredients: Fang Feng (Saposhnikovia Root), Fu Shen (Poria with Hostwood Removed), Du Huo (Angelica Pubescens Root), Ren Shen (Ginseng Root), Yuan Zhi (Polygala Root, Heart Removed), Long Chi (Dragon Teeth, Pulverized), Chang Pu (Acorus Rhizome, Hairs Removed), Shi Gao (Gypsum Fibrosum), Mu Li (Oyster Shell, each 1 liang); Qin Jiao (Gentiana Macrophylla Root), Yu Yu Liang (Halloysitum), Gui Xin (Cinnamon Twig Heart, each 0.5 liang); Gan Cao (Licorice Root, 7 qian 5 fen); She Tui (Snake Molt, 1 chi, roasted).
Grind into coarse powder. Take 3 qian per dose, boil in 1.5 cups of water until reduced to 0.7 cup, strain, and take warm.
Another Formula: Ling Yang Jiao (Antelope Horn, pulverized), Ren Shen (Ginseng Root), Sheng Gan Di Huang (Rehmannia Glutinosa Root, Raw and Dried, each 7 qian 5 fen); Du Huo (Angelica Pubescens Root), Yuan Zhi (Polygala Root, Heart Removed), Chang Pu (Acorus Rhizome, Hairs Removed), Fang Feng (Saposhnikovia Root, each 0.5 liang); Fu Shen (Poria with Hostwood Removed), Shi Gao (Gypsum Fibrosum), Mai Men Dong (Ophiopogon Tuber, Heart Removed), Long Chi (Dragon Teeth, separately pulverized), Bai Xian Pi (Dictamnus Root Bark, each 1 liang).
Grind into coarse powder. Take 3 qian per dose, boil in water, take warm at any time.
Niu Huang Qing Xin Wan (Calves' Calculus Clear Heart Pill) may also be used. (Formula see Miscellaneous Diseases, Stroke section.)
For further details, refer to the Miscellaneous Diseases section.