《素问》止言癫而不及痫。《灵枢》乃有痫 、痫厥之名。诸书有言癫狂者，有
言癫痫者，有言风痫者，有言惊痫者，有分癫痫为二门者，迄无定论。究其独言癫者，祖《素问》也。
言癫痫、言癫狂者，祖《灵枢》也。要之癫痫狂大相径庭，非名殊而实一之谓也。《灵枢》虽编颠狂
为一门，而形证两具，取治异途，较之于痫，又不侔矣。徐嗣伯云∶大人曰癫，小儿曰痫，亦不然也。
《素问》谓癫为母腹中受惊所致，今乃曰小儿无癫可乎？痫病，大人每每有之，妇人尤多。今据经文，
分辨于后。癫者，或狂或愚，或歌或笑，或悲或泣，如醉如 ，言语有头无尾，秽洁不知，积年累月
不愈，俗呼心风。此志愿高硕而不遂所欲者多有之。狂者，病之发时，猖狂刚暴，如伤寒阳明大实发
狂，骂詈不避亲疏，甚则登高而歌，弃衣而走，逾垣上屋，非力所能，或与人语所未尝见之事，如有
邪根据附者是也。痫病，发则昏不知人，眩仆倒地，不省高下，甚而螈 抽掣，目上视，或口眼 斜，
或口作六畜之声。赵以德曰∶考之《内经》有痫有癫，以痫而名者，曰心脉满大，痫 筋挛。注云∶
心脉满大，则肝气下流，热气内抟，筋干血枯，故痫 筋挛。曰肝脉小急，痫 筋挛。注云∶肝养筋
脏血，肝气受病，故痫 筋挛。曰二阴急为痫厥。注云∶少阴也。曰治痫惊脉。王注云∶阳陵泉也，
阳陵泉乃足少阳合穴也。曰厥狂颠疾，久逆之所生
也。《灵枢》以痫名者，曰足少阴筋病，主痫 及痉。曰暴挛痫眩，足不任身，取天柱。以癫名者，
肺脉急甚为癫疾。肾脉急甚为骨癫疾。癫狂篇则曰癫疾始生，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。治癫疾者，常与之居，察其所当取之处，病至，
视之有过者泻之，置其血于瓠壶中，至其发时，血独动矣，不动，灸穷骨二十壮，穷骨者， 骨也。
骨癫疾者， 齿诸 分肉皆满，而骨居，汗出烦 ，呕多沃沫，气下泄，不治。筋癫疾者，身倦挛急，
大刺项大经之大杼。呕多沃沫，气下泄，不治。脉癫疾者，暴仆，四肢之脉皆胀而纵。脉满，尽刺之
出血；不满，灸之挟项太阳，灸带脉于腰相去三寸，诸分肉本输。呕多沃沫，气下泄，不治。癫疾发
如狂者，死不治。气下泄不治者，癫本由邪入于阴，阴气满，风闭塞于下而逆上，今气下泄，则自肾
间正气虚脱于下故死。癫发如狂死不治者，由心之阳，不胜其阴气之逆，神明散乱，阳气暴绝故如狂，
犹灯将灭而明也。虽然未可以一概论也，盖必诊脉而后定。阴下脱者，尺脉不应。如狂者，寸脉不应。
若尺寸俱实，则是阴阳交错。既癫而又狂，则不可与此同
语矣。何以言之？《内经》复谓阳明之厥，则癫疾欲走，腹满不得卧而妄言者。盖足阳明者，胃脉也，
与足太阴脾为表里，脾为阴，胃为阳，阴脉从足而上行，阳脉从头而下行，二者有更虚更实之变，是
故阳明之厥者，由太阴之脉逆上，阳明之脉不得下行而返上故曰厥，厥则蓄积于中，蓄之未甚则癫，
甚则为热，热则狂而妄言也。不独阳明之厥有是证，凡足三阳之厥皆然。何则？如经所谓癫疾厥狂，
久逆之所生是也。《灵枢》经脉篇言∶足太阳脉所生病者，为狂癫之疾。凡经脉称是动者，为气病。
所生病，为血病。血者、阴也。足太阳内与肾少阴为表里，外与诸阳主气，故得为癫，亦得为狂也。
及考越人书于二十难曰，经言脉有阴阳，更有相乘，更相伏也。脉居阴部而反阳脉见者，为阳乘阴也；
虽时沉涩而短，此谓阳中伏阴也。脉居阳部而反阴脉见者，为阴乘阳也；脉虽时浮滑而长，为阴中伏
阳也。重阳者狂，重阴者癫。详《难经》之言，自阴阳相伏相乘，至于重阴重阳，皆为癫狂之病。以
此诸阴阳之交错，尽能致其病，非一因而已。夫如是，始与《内经》之意合。奈何诸家之注，止从重
阴重阳为癫狂，于前乘伏则勿论及。按王叔和《脉经》云，阴附阳则狂，阳附阴则癫者，则与《难经》
伏匿之意，即是舍己宫观而之他邦者。何以
言之？《脉经》论热病条谓，阳附阴者，腰以下至足热，腰以上寒。阴附阳者，腰以上至头热，腰以
下寒。盖阴虚气不能治于内，则附阳而上升，阳无承而不下降，故上热而下寒。阳虚气不能卫于外，
则下陷附于阴，故下热上寒。及用脉论癫狂，则谓心脉急甚为螈 ，肝脉微涩为螈 筋挛，脾脉急甚
为螈 ，脉气弦急病在肝，少食腹满，头眩筋挛癫疾，脉大、脉坚实者癫病，脉洪大长者风眩癫疾，
心气虚者精神离散，阴气衰则为癫疾，阳气衰则为狂。及定生死脉则云，诊癫病，虚则可治，实则死。
脉实坚者生，脉沉细小者死。脉搏大滑，久久自已，沉小急实不可治，小坚急亦不可治，脉实而紧急
癫痫可治。又有论奇经之癫痫者，前部左右弹者，阳跷也，动苦腰痛癫痫，恶风偏枯，僵仆羊鸣，身
强皮痹，取阳跷，在外踝上三寸直绝骨是。后部左右弹者，阴跷也，动苦癫痫寒热，皮肤强痹。从少
阳斜至太阳，是阳维也，动苦癫痫，僵仆羊鸣，手足相引，甚者失音不能言，癫疾，直取客主人，两
阳维脉，在外踝绝骨下二寸。从少阴斜至厥阴，是阴维也，动苦癫痫。尺寸俱浮，
直下直上，此为督脉，腰背强痛，不得俯仰，大人癫病，小儿痫疾。脉来中央浮，直上下痛者，督脉
也，动苦腰背膝寒，大人癫，小儿痫也。灸顶上三丸。或曰奇经之癫痫，古今所无，《脉经》独言之
何也？曰，岂无所自者哉。按越人《难经》曰，奇经八脉者，不拘于十二经何也？盖经有十二，络有
十五，凡二十七气，相随上下，独八脉不拘于经也。比于圣人图设沟渠，沟渠满溢，流入深湖，故圣
人不能拘通也。而人脉隆盛，入于八脉，而不环周，故十二经亦不能拘之。其受邪气，蓄则肿热，砭
射之也。今于冲任带且勿论，独用五脉病癫痫者，言督脉者。注云∶其脉之流行，起自下极，循脊中，
上行至大椎，与手足三阳脉交会，上至喑门穴与阳维会，上至百会与太阳交会，下至于鼻柱，下水沟
穴与手阳明交会。据此推之，实为诸阳之海，阳脉之都纲也。病则脊强而厥。阳维、阴维者，维络一
身，阳维维于阳，阴维维于阴，为病心苦痛。阳跷脉者，起于跟中，循外踝上行入风池。阴跷脉者，
亦起跟中，循内踝上行至咽喉。注云∶跷、 疾也，言此脉是人行走之机要，动足之所由，故曰跷脉
焉。阴跷为病，阳缓而阴急。阳跷为病，阴缓而阳急。然而言二跷之所行，尚未及二脉皆上交会于目
内，阳脉交于阴则目闭，阴脉交于阳则目开。若《灵枢》
癫狂篇首叙目之外、内、上、下 者，正为癫则目闭，狂则目开之不同也。故大惑诸篇亦曰，卫气留
于阴，不得行于阳，留于阴则阴气盛，阴气盛则阴跷满，不得入于阳则阳气虚，故目闭也。卫气不得
入于阴，常留于阳，留于阳则阳气满，阳气满则阳跷盛，不得入于阴则阴气虚，故目不瞑矣。由是而
推，昼夜荣卫行五十度，而寤寐之机，岂不在二脉乎。二脉者，足少阴肾之别脉也。督与肾之大络，
同起于会阴，《脉经》谓阳维从少阳斜至太阳，阴维从少阴斜至厥阴，自其肾肝同在下焦，主地道资
生言之。可见五脉皆是辅相天机，动用于形体之要者也，故不随十二经之环周。嗟乎，巢氏方不达王
叔和之指，撰为《病源》，不复妆采，于是后失传焉，不独此也。至于圣人之旨，亦不皆及，辄立五
癫之说。一曰阳癫，发如死人，遗尿，食顷乃解。二曰阴癫，初生小儿，脐疮未愈，数洗浴因此得之。
三曰风癫，发时眼目相引，牵纵反僵，羊鸣，食顷乃解。由热作汗出当风，因房室过度，醉饮，令人
心意逼迫，短气脉悸得之。四曰湿癫，眉头痛，身重，坐热沐头，湿结脑沸
未止得之。五曰马癫，发时反目口噤，手足相引，身体皆然。诸癫发则仆地吐沫无知，若强 起如狂
及遗矢者难治。脉虚则可治，实则死。由是后代钱氏方论，遂增五兽所属为五脏之癫，各有其状。犬
癫者，反折上窜犬吠，肝也。鸡癫者，惊跳反折鸡叫，肺也。羊癫者，目瞪吐舌，摇头羊叫，心也。
牛痫者，目直视，腹满牛叫，脾也。猪痫者，如尸，吐沫猪叫，肾也。却无马癫。及《三因方》论，
则复有马痫者，作嘶鸣搐搦腾踊，多因挟热者，惊心动胆，摄郁涎入心之所致也。诸方皆以初因涎郁
闭塞脏气不动，因之倒仆口吐涎沫也。安知口吐涎沫，岂止素积于胸中者哉。大抵癫痫之发，厥乃成。
厥由肾中阴火上逆，而肝从之，故作搐搦，搐搦则遍身之脂液促迫而上，随逆气吐出于口也。盖诸方
不察其病源，故论如此。其源何如？大抵虽曰癫由邪入于阴，然如前所云，相乘相附，交错之变，于
所病经脉，一一当较量而治。更分其有从标而得者，有从本而得者。标者，止在经脉气不通，眩晕倒
仆；本者，深入两肾间动气中，当时肾受伤而虚。肾脏志，志不足则神躁扰。所以《灵枢》云其先不
乐也。所谓肾间者，以肾居两旁，各有肾俞一穴，离脊中三寸，又有志室二穴。杨上善谓七节之旁，
中有小心者，指此也。越人分之，左属肾，右为命
门。命门者，精神之所舍，原气之所系。及论右肾之气与左肾相通，则谓之两肾间动气，是人生命也，
系于生气之原，五脏六腑十二经脉之根本，呼吸之门也。夫如是者，即《内经》所谓肾治于里者是也。
所谓生气者，阳从阴极而生，即苍天之气，所自起之分也。故经曰∶苍天之气清净则志意治，顺之则
阳气固，虽有贼邪，弗能害也。或经脉引入外感，内伤深入于根本，伤其生气之原，邪正混乱，天枢
不发，卫气固留于阴而不行，不行则阴气蓄满，郁极乃发，发则命门之相火自下焦逆上，填塞其音声，
惟迫出其羊鸣者、一二声而已，遍身之脂液，脾之涎沫，皆迫而上胸臆流出于口，五脏六腑十二经脉
筋骨肉，皆不胜其冲逆，故卒倒而不知也。食顷，火气退散乃醒，醒后若邪气从病发而散，生气得复，
则颠不再作。或邪不散，仍与生气混乱，或邪虽退而生气之原尚虚，当时不治，则邪易入而复作也。
如此者，多成常证。故《内经》曰∶癫疾者，初病岁一发，不治，月四五发也。或曰子以癫痫之疾，
有由邪入两肾间而后作者，此言古今未尝闻，将有所自乎，曰方论未之考尔。《内经》既有二阴之癫，
《灵枢》又有足少阴筋病之痫。二阴，非肾之经乎。肾间动气，非肾之气乎。更以胎痫言之，便可推
之，肾间动气，本受父母精气，既为立命
之门，安得各经引邪深入者，不止于此乎。若夫以胎始论之，则七节之旁，命门穴在其后，脐在其前，
肾在两旁，胎在其中，是故子脐系以胞蒂，随母呼吸，母呼亦呼，母吸亦吸，通母之生气，食母谷气，
以化育内外百骸之形者，皆是肾间动气所致也。当母受惊之邪，子在母腹，随呼吸得之，与肾间动气
混在其中，虽生出腹后一二岁始发，或八九岁后发，盖小儿初生之阳，如日方升，邪不易入，故痫未
发。必待复感之邪入深，与所感母腹之邪相搏而后作。夫如是，大人与小儿病此癫疾者，纵得禀质强
壮，终因邪害其生命之原，难得中寿。若发频而志愚者，仅至四十阴气衰半而已。小儿质弱目瞪者，
则不过岁月，远亦难出成人之年。盖肾间生命之气虚而不复，故不得寿也。诸方中所治，皆不及此何
哉。李东垣昼发灸阳跷，夜发灸阴跷，为二跷能行下焦之阴阳，阴阳行则动气中之邪，因而可散故也。
《素问》只论述了癫病，而没有提及痫病。《灵枢》中才有痫、痫厥的名称。各种医书中，有的论述癫狂，有的论述癫痫，有的论述风痫，有的论述惊痫，有的将癫痫分为两个门类，始终没有统一的定论。究其单独论述癫的原因，是遵循《素问》；论述癫痫或癫狂的原因，是遵循《灵枢》。总之，癫、痫、狂三者大相径庭，并不是名称不同而实质相同的意思。《灵枢》虽然将颠狂编为一门，但形态和证候都具备，治疗方法各异，与痫病相比，又不可同日而语。徐嗣伯说：成人叫癫，小儿叫痫，这也是不对的。《素问》认为癫是由于在母腹中受惊所致，现在却说小儿没有癫病，这可以吗？痫病，成人常常有，妇女尤其多。现在依据经文，分辨如下。
癫病，有时狂乱有时愚钝，有时唱歌有时笑，有时悲伤有时哭泣，像喝醉了一样，说话有头无尾，不知秽洁，长年累月不愈，俗称心风。这种病多见于志向高远宏大但不能实现愿望的人。狂病，发病时猖狂刚暴，像伤寒阳明腑实重症导致的发狂，骂人不管亲疏，严重时登上高处唱歌，扔掉衣服奔跑，翻越墙垣屋顶，这不是体力所能做到的，或者与人谈论从未见过的事情，好像有邪气依附在身上一样。痫病，发作时昏迷不省人事，眩晕跌倒在地，不知高低上下，严重时出现抽搐痉挛，眼睛上视，或者口眼歪斜，或者口中发出六畜的声音。
赵以德说：考察《内经》，有痫有癫，以“痫”命名的，如“心脉满大，痫瘛筋挛”。注解说：心脉满大，则肝气下流，热气内聚，筋干血枯，所以出现痫瘛筋挛。又说“肝脉小急，痫瘛筋挛”。注解说：肝滋养筋脏血，肝气受病，所以出现痫瘛筋挛。又说“二阴急为痫厥”。注解说：这是指少阴经。又说治疗痫惊的脉象。王冰注解说：这是阳陵泉穴，阳陵泉是足少阳胆经的合穴。又说“厥狂颠疾，久逆之所生也”。《灵枢》中以“痫”命名的，如“足少阴筋病，主痫瘛及痉”。又说“暴挛痫眩，足不任身，取天柱”。以“癫”命名的，如“肺脉急甚为癫疾”。肾脉急甚为骨癫疾。癫狂篇则说：癫疾刚开始产生时，先是不快乐，头重痛，看眼睛发红，严重发作极度疲劳后心烦，观察面色来诊断。取手太阳、手阳明、手太阴经的血络，见血色变化即止。治疗癫疾者，常与他在一起，观察应当针刺的部位，病发作时，看他有过盛的部位就泻之，将放出的血装入葫芦壶中，等到他再次发作时，血会独自跳动，如果不跳动，就在穷骨（骶骨）灸二十壮，穷骨就是骶骨。
骨癫疾，牙齿各个缝隙肌肉都胀满，骨头突出，出汗心烦，呕吐很多涎沫，气向下泄脱，无法治疗。筋癫疾，身体疲倦拘挛，用大针深刺项部大经的大杼穴。如果呕吐很多涎沫，气向下泄脱，无法治疗。脉癫疾，突然仆倒，四肢的脉络都胀大而弛纵。脉象满盛，全部刺之出血；脉不满盛，灸项部太阳经，以及腰部带脉旁三寸处，还有各分肉的本输穴。如果呕吐很多涎沫，气向下泄脱，无法治疗。癫疾发作像狂一样的，死症，无法治疗。所谓气下泄不治的，是因为癫本由邪气侵入阴分，阴气满盛，风气闭塞于下部而上逆，现在气向下泄脱，则是肾间正气虚脱于下，所以死亡。癫疾发作像狂一样的死症无法治疗的，是因为心的阳气不能胜过逆上的阴气，神明散乱，阳气暴绝所以像狂，就像灯将要熄灭时的光亮一样。虽然如此，也不能一概而论，必须诊脉后才能确定。阴气下脱的，尺脉不应指。像狂的，寸脉不应指。如果尺寸脉都实，这就是阴阳交错。既癫而又狂，就不能与此同语了。为什么这么说？《内经》又说阳明之厥，会导致癫疾想跑，腹部胀满不能卧而胡言乱语。足阳明是胃脉，与足太阴脾互为表里，脾为阴，胃为阳，阴脉从足向上行，阳脉从头向下行，二者有更虚更实的变易，所以阳明之厥，是由太阴之脉逆上，阳明之脉不得下行反而上行，所以叫厥，厥则蓄积于中，蓄积不严重时为癫，严重时化为热，热则狂而胡言乱语。不只是阳明之厥有这样的证候，凡是足三阳之厥都是这样。为什么呢？正如经文所说“癫疾厥狂，久逆之所生是也”。《灵枢》经脉篇说：足太阳脉所生的病，是狂癫之疾。凡是经脉称“是动”的，是气病；“所生病”，是血病。血属阴。足太阳内与肾少阴互为表里，外与诸阳主气，所以既能得癫，也能得狂。
等到考察《难经》第二十难说，经文说脉有阴阳，更有相乘，更相伏匿。脉居阴部而反见阳脉的，叫阳乘阴；虽然时而沉涩短，这叫阳中伏阴。脉居阳部而反见阴脉的，叫阴乘阳；脉虽然时而浮滑长，这叫阴中伏阳。重阳者为狂，重阴者为癫。详察《难经》的话，自阴阳相伏相乘，至于重阴重阳，都是癫狂的病。以此来看，各种阴阳的交错，都能导致这种病，不是单一原因造成的。这样才与《内经》的意思相合。奈何各家注解，只从重阴重阳来解释癫狂，对于前面的相乘伏匿却不予讨论。按王叔和《脉经》说，阴附阳则狂，阳附阴则癫，这与《难经》伏匿的意思，就像是舍弃自己的宫殿去别国居住一样。为什么这么说？《脉经》论热病条中说，阳附阴的，腰以下到脚热，腰以上寒。阴附阳的，腰以上到头热，腰以下寒。因为阴虚气不能治理内部，则依附于阳而上升，阳无承接而不能下降，所以上热下寒。阳虚气不能护卫外部，则下陷依附于阴，所以下热上寒。等到用脉论癫狂时，又说心脉急甚为抽搐，肝脉微涩为抽搐筋挛，脾脉急甚为抽搐，脉气弦急病在肝，少食腹满，头眩筋挛癫疾，脉大、脉坚实的是癫病，脉洪大长的是风眩癫疾，心气虚则精神离散，阴气衰则为癫疾，阳气衰则为狂。等到判定生死脉时说，诊癫病，虚则可治，实则死。脉实坚者生，脉沉细小者死。脉搏大滑，久久自愈，沉小急实不可治，小坚急也不可治，脉实而紧急的癫痫可治。又有论奇经的癫痫，前部左右弹动的，是阳跷脉，动则苦腰痛癫痫，恶风偏枯，僵仆羊鸣，身体强直皮肤麻木，取阳跷穴，在外踝上三寸直对绝骨处。后部左右弹动的，是阴跷脉，动则苦癫痫寒热，皮肤强直麻木。从少阳斜至太阳，是阳维脉，动则苦癫痫，僵仆羊鸣，手足牵引，严重的失音不能说话，癫疾，直接取客主人穴，两阳维脉，在外踝绝骨下二寸。从少阴斜至厥阴，是阴维脉，动则苦癫痫。尺寸俱浮，直下直上，这是督脉，腰背强痛，不能俯仰，成人癫病，小儿痫疾。脉来中央浮，直上下痛的，是督脉，动则苦腰背膝寒，成人癫，小儿痫。灸顶上三丸。有人说奇经的癫痫，古今都没有，《脉经》唯独提到它，为什么呢？回答说，难道没有来源吗？按越人《难经》说，奇经八脉，不拘束于十二经，为什么呢？因为经有十二条，络有十五条，共二十七气，相随上下，唯独八脉不拘束于经。好比圣人图设沟渠，沟渠满溢，流入深湖，所以圣人不能拘束通畅。而人脉隆盛，进入八脉，而不环周，所以十二经也不能拘束它。它们受到邪气，蓄积则肿热，可以用砭石射之。现在对于冲任带暂且不论，唯独使用五脉病癫痫的，说的是督脉。注解说：它的脉流行，起自下极，沿脊中，上行至大椎，与手足三阳脉交会，上至喑门穴与阳维会，上至百会与太阳交会，下至于鼻柱，下水沟穴与手阳明交会。据此推断，实为诸阳之海，阳脉的都纲。病则脊强而厥。阳维、阴维，维系联络一身，阳维维系阳，阴维维系阴，生病则心中痛苦。阳跷脉，起于脚跟中，沿外踝上行入风池。阴跷脉，也起于脚跟中，沿内踝上行至咽喉。注解说：跷，疾速也，说此脉是人行走的关键，动足的缘由，所以叫跷脉。阴跷为病，阳缓而阴急。阳跷为病，阴缓而阳急。然而说二跷的运行，还没有讲到这两脉都上交会于目内眦，阳脉交于阴则目闭，阴脉交于阳则目开。如果《灵枢》癫狂篇首先叙述目之外、内、上、下的情况，正是为了说明癫则目闭，狂则目开的不同。所以大惑诸篇也说，卫气留于阴，不得行于阳，留于阴则阴气盛，阴气盛则阴跷满，不得入于阳则阳气虚，所以目闭。卫气不得入于阴，常留于阳，留于阳则阳气满，阳气满则阳跷盛，不得入于阴则阴气虚，所以目不瞑。由此推断，昼夜营卫运行五十度，而醒睡的关键，难道不在二脉吗？二脉，是足少阴肾的别脉。督脉与肾的大络，同起于会阴，《脉经》谓阳维从少阳斜至太阳，阴维从少阴斜至厥阴，从肾肝同在下焦，主地道资生来说。可见这五脉都是辅助天机，动用于形体的关键，所以不随十二经的环周。唉，巢氏方不理解王叔和的旨意，撰写《病源》，不再采纳，于是后来失传了，不只是这一方面。至于圣人的旨意，也不全都涉及，随意设立五癫的说法。一曰阳癫，发作像死人，遗尿，过一会儿才清醒。二曰阴癫，初生婴儿，脐疮未愈，多次洗浴因此得之。三曰风癫，发作时眼睛互相牵引，牵拉纵伸反僵，羊鸣，过一会儿才清醒。因热作汗出当风，因房事过度，醉酒饮酒，让人心意逼迫，短气脉悸得之。四曰湿癫，眉头痛，身体沉重，坐热沐头，湿气结脑沸未止得之。五曰马癫，发作时反目口噤，手足牵引，身体都这样。诸癫发作则仆地吐沫无知，如果强行起身像狂以及遗屎的难治。脉虚则可治，实则死。
由此后代钱乙的方论，便增加五兽所属作为五脏之癫，各有其状。犬癫，反折上窜犬吠，属肝。鸡癫，惊跳反折鸡叫，属肺。羊癫，目瞪吐舌，摇头羊叫，属心。牛痫，目直视，腹满牛叫，属脾。猪痫，像尸体，吐沫猪叫，属肾。却没有马癫。及《三因方》论，则有马痫，发出嘶鸣搐搦腾踊，多因挟热，惊心动胆，摄郁涎入心所致。诸方都认为初因痰涎郁闭塞脏气不动，因此倒仆口吐涎沫。哪里知道口吐涎沫，岂止是素积于胸中的呢？大抵癫痫的发作，厥乃形成。厥由肾中阴火上逆，而肝随之，所以作抽搐，抽搐则遍身的脂液促迫而上，随逆气吐出于口。大概诸方不考察其病源，所以论述如此。其源如何？大抵虽说癫由邪入于阴，然而像前面所说的，相乘相附，交错的变易，在所病的经脉上，一一应当较量而治。更要区分有从标而得的，有从本而得的。标者，只在经脉气不通，眩晕倒仆；本者，深入两肾间动气中，当时肾受伤而虚。肾脏藏志，志不足则神躁扰。所以《灵枢》说其先不乐。所谓肾间者，以肾居两旁，各有肾俞一穴，离脊中三寸，又有志室二穴。杨上善说七节之旁，中有小心，指的就是这个。越人将其分开，左属肾，右为命门。命门，是精神所舍，原气所系。及论右肾之气与左肾相通，则叫两肾间动气，这是人的生命，系于生气之原，五脏六腑十二经脉的根本，呼吸之门。像这样，就是《内经》所谓肾治于里的意思。所谓生气，阳从阴极而生，即苍天之气，所自起的分界。所以经说：苍天之气清净则志意治，顺之则阳气固，虽有贼邪，弗能害也。或者经脉引入外感，内伤深入根本，伤其生气之原，邪正混乱，天枢不发，卫气固留于阴而不行，不行则阴气蓄满，郁极乃发，发则命门之相火自下焦逆上，填塞其音声，惟迫出其羊鸣的一二声而已，遍身的脂液，脾的涎沫，皆迫而上胸臆流出于口，五脏六腑十二经脉筋骨肉，皆不胜其冲逆，所以卒倒而不知。过一会儿，火气退散乃醒，醒后若邪气从病发而散，生气得复，则癫不再发作。或者邪不散，仍与生气混乱，或者邪虽退而生气之原尚虚，当时不治，则邪易入而复作。像这样，多成常证。所以《内经》说：癫疾者，初病岁一发，不治，月四五发也。或者说您认为癫痫之疾，有由邪入两肾间而后发的，这话古今未曾听闻，将有来源吗？回答说方论未考证罢了。《内经》既有二阴之癫，《灵枢》又有足少阴筋病之痫。二阴，不是肾的经吗？肾间动气，不是肾的气吗？再以胎痫来说，便可推知，肾间动气，本来受父母精气，既然为立命之门，怎么各经引邪深入者，不止于此呢？如果从胎始来论，则七节之旁，命门穴在其后，脐在其前，肾在两旁，胎在其中，所以子脐系以胞蒂，随母呼吸，母呼亦呼，母吸亦吸，通母之生气，食母谷气，以化育内外百骸之形者，皆是肾间动气所致。当母受惊之邪，子在母腹，随呼吸得之，与肾间动气混在其中，虽生出腹后一二岁始发，或八九岁后发，盖小儿初生之阳，如日方升，邪不易入，故痫未发。必待复感之邪入深，与所感母腹之邪相搏而后作。像这样，大人和小儿患此癫疾者，纵使禀质强壮，终因邪害其生命之原，难得中寿。如果发作频繁而志愚者，仅至四十阴气衰半而已。小儿质弱目瞪者，则不过岁月，远亦难出成人之年。盖肾间生命之气虚而不复，故不得寿也。诸方中所治，都不及此，为什么呢？李东垣昼发灸阳跷，夜发灸阴跷，因为二跷能行下焦之阴阳，阴阳行则动气中之邪，因而可散。
The *Suwen* (Basic Questions) only discusses dian (epilepsy/mental disorder) and does not mention xian (convulsive epilepsy). The *Lingxu* (Spiritual Pivot) contains the terms xian (convulsive epilepsy) and xian jue (convulsive syncope). Various medical texts discuss dian kuang (dian and kuang), dian xian (dian and xian), feng xian (wind xian), jing xian (startled xian), some dividing dian and xian into two categories, yet no definitive conclusion has been reached. Those who discuss only dian follow the *Suwen*. Those who discuss dian xian or dian kuang follow the *Lingxu*. In essence, dian, xian, and kuang are vastly different; they are not merely different in name but identical in substance. Although the *Lingxu* groups dian and kuang together, their manifestations and syndromes are complete, and their treatments differ, making them incomparable to xian. Xu Sibai stated: "Adults have dian, children have xian," which is incorrect. The *Suwen* states that dian results from fright suffered in the womb; how can one now say children do not suffer from dian? Xian occurs frequently in adults, especially women. Based on the classic texts, the differentiation follows below.
Dian (epilepsy/mental disorder): Sometimes manic, sometimes dull; sometimes singing, sometimes laughing; sometimes sorrowful, sometimes weeping; appearing intoxicated; speech starts but lacks a conclusion; unaware of cleanliness or filth; persisting for years without cure; commonly called Xin Feng (Heart Wind). This condition often affects those with high ambitions who fail to achieve their desires. Kuang (mania): Upon onset, the patient is reckless, violent, and aggressive, similar to the mania caused by severe Yangming excess heat syndrome; cursing regardless of kinship; at times climbing heights to sing, discarding clothes and running, scaling walls and roofs—actions beyond physical strength; conversing about things never seen, as if possessed by evil spirits. Xian (convulsive epilepsy): Upon onset, the patient loses consciousness, experiences vertigo and falls, unaware of surroundings; in severe cases, experiencing convulsions and spasms, eyes rolling upward, facial deviation, or emitting sounds resembling livestock.
Zhao Yi-de stated: Examining the *Neijing*, there are mentions of both xian and dian. Regarding "xian," it says: "When the Heart pulse is full and large, xian occurs with convulsions and tendon cramps." The commentary notes: A full and large Heart pulse indicates Liver Qi flowing downward and internal accumulation of heat, leading to dry tendons and depleted blood, thus causing xian with convulsions and tendon cramps. It also states: "When the Liver pulse is small and urgent, xian occurs with convulsions and tendon cramps." The commentary notes: The Liver nourishes tendons and stores blood; when Liver Qi is diseased, xian with convulsions and tendon cramps occurs. It further states: "Urgency in the Two Yin meridians causes xian jue." The commentary notes this refers to the Shaoyin meridian. It also mentions treating xian and startled conditions via specific pulses. Wang Bing's commentary identifies this as Yanglingquan (GB34), the He-Sea point of the Foot-Shaoyang Gallbladder Meridian. It also states: "Jue, kuang, dian diseases arise from long-standing rebellion [of Qi]." In the *Lingxu*, under "xian": "Diseases of the tendons of the Foot-Shaoyin Kidney Meridian govern xian convulsions and spasm." Also: "Sudden cramping, xian, and vertigo, inability of the feet to support the body, treat Tianzhu (BL10)." Under "dian": "Urgency in the Lung pulse leads to dian disease." Urgency in the Kidney pulse leads to bone dian disease. The Dian-Kuang chapter states: "At the onset of dian disease, the patient first feels unhappy, experiences heavy head pain, red eyes; upon severe exhaustion, they become vexed; diagnosis is made by observing the face." Treatment involves needling the blood vessels of the Hand-Taiyang, Hand-Yangming, and Hand-Taiyin meridians until the blood color changes. For treating dian disease, one should reside with the patient to observe where to needle; upon onset, identify excess areas and drain them, collecting the blood in a gourd vessel. At the next onset, the blood will move independently; if not, moxa twenty cones on Qionggu (sacrum/coccyx). Bone dian disease presents with distension of muscles around the teeth, protruding bones, sweating, vexation, excessive vomiting of saliva/phlegm, and downward leakage of Qi; this is untreatable. Tendon dian disease presents with body fatigue and cramping; treat with deep needling of Dazhu (BL11) in the neck region. If accompanied by excessive vomiting of saliva/phlegm and downward leakage of Qi, it is untreatable. Pulse dian disease presents with sudden collapse and distended, flaccid pulses in the four limbs. If pulses are full, bleed all affected areas; if not full, moxa the Taiyang meridians in the neck and the Dai Mai (Girdle Vessel) three cun lateral to the waist, along with Ben-Shu points in muscle spaces. If accompanied by excessive vomiting of saliva/phlegm and downward leakage of Qi, it is untreatable. Dian disease presenting like kuang is fatal and untreatable. The reason "downward leakage of Qi" is untreatable is that dian originates from evil invading Yin, causing Yin Qi excess and wind blocking the lower Jiao while rebelling upward; downward leakage indicates depletion of Zheng Qi (Upright Qi) from the Kidneys, leading to death. Dian presenting like kuang is fatal because Heart Yang cannot overcome rebellious Yin Qi, causing scattering of Shen (Spirit) and sudden extinction of Yang Qi, resembling a dying lamp. However, this cannot be generalized; pulse diagnosis is essential. Downward depletion of Yin manifests as non-responsive Chi (cun-guan-chi) pulse. Presenting like kuang manifests as non-responsive Cun pulse. If both Cun and Chi pulses are excess, it indicates intermingling of Yin and Yang. If both dian and kuang symptoms exist, it differs from the above. Why? The *Neijing* states: "Jue of Yangming leads to dian disease with desire to run, abdominal fullness, inability to lie down, and delirious speech." Foot-Yangming is the Stomach meridian, interior-exterior related to Foot-Taiyin Spleen. Spleen is Yin, Stomach is Yang. Yin meridians ascend from the foot; Yang meridians descend from the head. They undergo alternating deficiency and excess. Thus, Yangming Jue occurs when Taiyin Qi rebels upward, preventing Yangming Qi from descending, causing it to rebel upward (Jue). Accumulation ensues; mild accumulation causes dian, severe accumulation generates heat, leading to kuang and delirium. This applies not only to Yangming Jue but to all Three Yang meridians of the foot, as stated: "Dian, jue, kuang arise from long-standing rebellion." The *Lingxu* Meridian Chapter states: Diseases generated by the Foot-Taiyang meridian include kuang and dian diseases. "Shi Dong" (Movement) refers to Qi diseases; "Suo Sheng" (Generated) refers to Blood diseases. Blood is Yin. Foot-Taiyang is interior-exterior related to Foot-Shaoyin Kidney and exteriorly governs Qi with other Yang meridians; thus, it can cause both dian and kuang.
Examining the *Nanjing* (Classic of Difficult Issues), Difficulty 20 states: Pulses have Yin and Yang, involving mutual overcoming (Cheng) and hiding (Fu). When a pulse resides in the Yin position but shows Yang characteristics, it is Yang overcoming Yin; even if occasionally deep, choppy, and short, this is Yang hiding Yin. When a pulse resides in the Yang position but shows Yin characteristics, it is Yin overcoming Yang; even if occasionally floating, slippery, and long, this is Yin hiding Yang. Excess Yang leads to kuang; Excess Yin leads to dian. Detailed analysis of the *Nanjing* shows that from Yin/Yang hiding and overcoming to Excess Yin/Yang, all constitute dian/kuang diseases. Thus, various Yin-Yang interminglings cause these diseases, not just a single factor. This aligns with the *Neijing*. However, later commentators focused only on Excess Yin/Yang, ignoring the concepts of Cheng and Fu. Wang Shuhe’s *Maijing* (Pulse Classic) states: "Yin attaching to Yang causes kuang; Yang attaching to Yin causes dian." This contradicts the *Nanjing*'s concept of hiding, akin to abandoning one's home for another land. Why? The *Maijing* on Heat Diseases states: "Yang attaching to Yin" presents with heat from waist to feet and cold above the waist. "Yin attaching to Yang" presents with heat from waist to head and cold below the waist. Yin deficiency fails to control internally, so Qi attaches to Yang and rises; Yang lacks reception and fails to descend, causing upper heat/lower cold. Yang deficiency fails to guard externally, so Qi sinks and attaches to Yin, causing lower heat/upper cold. Regarding pulse diagnosis for dian/kuang: Urgent Heart pulse causes convulsions; slightly choppy Liver pulse causes convulsions and tendon cramps; urgent Spleen pulse causes convulsions; string-taut pulse indicates Liver pathology, with reduced appetite, abdominal fullness, dizziness, tendon cramps, and dian disease; large or firm pulses indicate dian disease; large, long pulses indicate wind vertigo and dian disease; Heart Qi deficiency leads to scattered spirit; Yin deficiency causes dian; Yang deficiency causes kuang. Regarding vital vs. fatal pulses: Dian with deficient pulse is treatable; excess pulse is fatal. Firm/excess pulse indicates survival; deep/small pulse indicates death. Large/slipping pulse may resolve spontaneously; deep/small/urgent/excess is untreatable; small/firm/urgent is untreatable; excess/urgent pulse in epilepsy is treatable. Regarding Odd Meridians and epilepsy: Pulsation at the anterior left/right indicates Yang Qiao Mai; symptoms include lower back pain, epilepsy, aversion to wind, hemiplegia, sudden collapse, sheep-like bleating, body stiffness, and skin numbness. Treat Yang Qiao at San Yin Jiao (SP6), three cun above the medial malleolus. Pulsation at the posterior left/right indicates Yin Qiao Mai; symptoms include epilepsy, chills/fever, skin stiffness. Slanting from Shaoyang to Taiyang indicates Yang Wei Mai; symptoms include epilepsy, sudden collapse, sheep-like bleating, limb pulling, aphasia, dian disease. Treat Guest Master (ST7) bilaterally; Yang Wei Mai is two cun below the fibular head. Slanting from Shaoyin to Jueyin indicates Yin Wei Mai; symptoms include epilepsy. Floating pulses at Cun and Chi, moving straight up and down, indicate Du Mai; symptoms include stiff back, inability to bend/extend, adult dian, pediatric xian. Central floating pulse moving straight up/down indicates Du Mai; symptoms include cold in lower back/knees, adult dian, pediatric xian. Moxa three cones on the vertex. Some ask why the *Maijing* uniquely discusses odd meridians regarding epilepsy, claiming it is unknown in ancient/modern times. The answer lies in the *Nanjing*: The Eight Extraordinary Vessels are not confined to the Twelve Regular Meridians. There are twelve Jing and fifteen Luo, totaling twenty-seven Qi pathways; only the eight extraordinary vessels are unconstrained. Like ditches overflowing into lakes, these vessels handle excess Qi. When human Qi is abundant, it enters the eight vessels without circulating cyclically, escaping the constraint of the twelve meridians. When pathogenic factors invade, accumulation causes swelling and heat, treated with bian stone. Excluding Chong, Ren, and Dai, focusing on five vessels related to epilepsy, specifically Du Mai: Its flow starts at Changqiang (GV1), ascends along the spine to Dazhui (GV14), intersects with Hand/Foot Three Yang meridians, meets Yang Wei at Yamen (GV15), meets Taiyang at Baihui (GV20), descends to the nose tip, and intersects Hand-Yangming at Shuigou (GV26). Thus, it is the Sea of Yang and the chief guide of Yang meridians. Disease presents with stiff spine and jue. Yang Wei and Yin Wei connect the body; Yang Wei connects Yang, Yin Wei connects Yin; disease causes heart pain. Yang Qiao starts at the heel, ascends along the lateral malleolus to Fengchi (GB20). Yin Qiao starts at the heel, ascends along the medial malleolus to the throat. Commentary: "Qiao" means swift; these vessels are key to walking and movement. Yin Qiao disease causes slackness of Yang and tension of Yin; Yang Qiao disease causes slackness of Yin and tension of Yang. These vessels intersect at the inner canthus; Yang entering Yin closes the eyes; Yin entering Yang opens them. The *Lingxu* Dian-Kuang chapter describes eye movements to distinguish dian (eyes closed) from kuang (eyes open). The Da Huo chapters state: If Wei Qi stays in Yin and cannot enter Yang, Yin becomes excess, Yin Qiao fills, Yang becomes deficient, causing eye closure. If Wei Qi cannot enter Yin and stays in Yang, Yang becomes excess, Yang Qiao fills, Yin becomes deficient, causing insomnia. Thus, the mechanism of waking/sleeping relies on these two vessels. They are branches of Foot-Shaoyin Kidney. Du Mai and the Great Luo of Kidney originate at Huiyin (CV1). The *Maijing* describes Yang Wei slanting from Shaoyang to Taiyang and Yin Wei from Shaoyin to Jueyin, reflecting the shared lower Jiao location of Kidney and Liver. These five vessels assist heavenly mechanisms and bodily functions, hence not cycling with the twelve meridians. Alas, Chao Yuanfang failed to understand Wang Shuhe’s intent in compiling the *Bingyuan Zhi Zhu*, leading to its loss. He arbitrarily proposed five types of dian: 1. Yang Dian: Appears dead, enuresis, recovers after a meal time. 2. Yin Dian: Occurs in newborns due to bathing umbilical wounds. 3. Feng Dian: Eyes pull inward, spasms, rigidity, sheep bleating, recovers after a meal time; caused by sweating in wind, excessive intercourse, drunkenness, leading to constrained mind, shortness of breath, palpitations. 4. Shi Dian: Brow headache, heaviness, caused by sitting in heat/washing head with hot water, dampness accumulating in the brain. 5. Ma Dian: Eyes rolled back, jaw clenched, limb pulling, whole body affected. All dian involve falling, foaming, unconsciousness; forcing rise like kuang or incontinence makes it difficult to treat. Deficient pulse is treatable; excess is fatal. Later, Qian Yi added five animal associations to Five Zang dian: Dog (Liver), Chicken (Lung), Sheep (Heart), Ox (Spleen), Pig (Kidney), omitting Horse. The *San Yin Fang* adds Ma Xian (Horse Epilepsy): neighing, spasms, jumping, often due to heat frightening the Heart/Gallbladder, drawing phlegm into the Heart. Most texts attribute initial causes to phlegm obstructing organ Qi, causing collapse and foaming. However, foaming is not just pre-existing phlegm in the chest. Generally, epilepsy arises from Jue (rebellion). Jue stems from Yin Fire rebelling from the Kidneys, followed by the Liver, causing spasms; spasms force body fluids upward, expelled as foam. Texts fail to investigate the root cause. The root: Although dian involves evil entering Yin, variations of Cheng/Fu/intermingling must be analyzed per meridian. Differentiate Biao (Branch) and Ben (Root). Biao: Meridian Qi blockage, dizziness, collapse. Ben: Deep invasion into the Moving Qi between the two Kidneys, injuring Kidney deficiency. Kidney stores Zhi (Will); insufficient Zhi causes restless Shen. Hence *Lingxu* says "first unhappy." "Between Kidneys" refers to Shenshu (BL23) and Zhishi (BL52), three cun from the spine. Yang Shangshan identified this as "Xiao Xin" near the seventh vertebral process. The *Nanjing* divides Left as Kidney, Right as Mingmen (Gate of Life). Mingmen houses Spirit and anchors Yuan Qi. Communication between right and left Kidneys is "Moving Qi between Kidneys," the root of life, origin of Sheng Qi, root of Zang-Fu and Twelve Meridians, gate of respiration. This matches *Neijing*: "Kidney governs the interior." Sheng Qi arises from Yang at extreme Yin, akin to Heaven's Qi. As stated: "Clear Heaven Qi regulates Will; following it secures Yang, protecting against pathogens." External pathogens or internal injuries damaging the root disrupt Sheng Qi, confusing Evil and Upright Qi. Tian Shu fails to activate; Wei Qi remains trapped in Yin, causing Yin excess and stagnation. Upon release, Minister Fire from Mingmen rebels from Lower Jiao, blocking voice (producing sheep bleats), forcing spleen phlegm and body fluids to the mouth. Organs and tissues cannot withstand this rebellion, causing sudden collapse. After fire dissipates, the patient wakes. If Evil disperses and Sheng Qi recovers, dian does not recur. If Evil persists or Sheng Qi remains deficient, recurrence is likely, becoming chronic. *Neijing* states: Untreated annual attacks increase to monthly. Some question the source of "evil entering between Kidneys." Sources include *Neijing*'s "Two Yin Dian" and *Lingxu*'s "Foot-Shaoyin Tendon Xian." Two Yin refers to Kidney meridians; Moving Qi is Kidney Qi. Considering fetal xian: Fetal Moving Qi receives parental Essence. Since it is the Gate of Life, how could pathogenic entry not reach here? From conception, the fetus connects via the umbilical cord, breathing with the mother, consuming maternal grain Qi, all driven by Moving Qi. Maternal fright enters the fetus via respiration, mixing with Moving Qi. Onset may occur 1-2 years or 8-9 years later. Children's Yang is like the rising sun, resisting evil initially. Recurrent evil combines with fetal evil to trigger disease. Adults/children with strong constitution still suffer damage to the Life Root, rarely reaching middle age. Frequent attacks with dullness lead to decline by forty. Weak infants with staring eyes die young. Depletion of Life Qi prevents longevity. Texts ignore this. Li Dongyuan advocated moxa Yang Qiao for daytime attacks and Yin Qiao for nighttime, as these vessels regulate Lower Jiao Yin/Yang; regulating them disperses Moving Qi evil.