脾印将军完颜公之子小将军病伤寒六七日，寒热间作，腕后有 三五点，鼻中微血出，医以
白虎汤、柴胡等药治之不愈。及余诊之，两手脉沉涩，胸膈间及四肢按执之殊无大热，此内
寒也。问其故，因暑热卧殿角之倾，先伤寒，次大渴，饮冰酪水一大碗，外感者轻，内伤者
重，外从内病，俱为阴也。故先 衄，后显内阴，寒热间作，脾亦有之，非往来少阳之寒热
也。与调中汤数服而愈。
彰德张相公子谊夫之妻许氏，乃状元许先之之女绍明之妹也，病阳厥怒狂，发时饮食四五倍
，骂詈不避亲疏，服饰临丧，或哭或歌，或以刃伤人，不言如哑，言即如狂，素不知书识字
便读文选，人皆以为鬼魔。待其静诊之，六脉举按皆无，身表如水石，其发也叫呼声声愈高
。余昔闻洁古老人云∶《本经》言夺食则已，非不与之食，而为夺食也。当以药大下之而使不能食，
为之夺食也。予用大承气汤下之得脏垢数
升，狂稍宁，待一二日复发，又下之，得便数升，其疾又宁，待一二日又发，三下之，宁如
旧，但不能食，疾稍轻而不已。下之，又五七次，计大便数斗，疾缓身温脉生，至十四日，
其疾愈，脉如旧，困卧三四日后起苏，饮食微进，又至十日后安得。始得病时，语言声怒非
常，一身诸阳尽伏于中隐于胃，非大下之可乎？此易老夺食之意也。
右阳狂一条，本不当例阴证中。今暨阴狂证并列，其狂则一，其为寒热二也。差之毫厘，缪
以千里。读者至此，其三复之。
【外阳内阴 / 阳狂】
脾印将军完颜公的儿子小将军患了伤寒六七天，寒热交替发作，手腕后有三五点皮疹，鼻子微微出血。医生用白虎汤、柴胡等药物治疗，但病情没有好转。等到我诊察时，发现他两手脉象沉涩，胸膈间及四肢按压下去并没有明显的大热感，这是内寒证。询问病因，是因为在暑热天气躺在殿角倾斜处睡觉，先受了风寒，接着感到极度口渴，喝了一大碗冰镇奶酪水。外感病邪较轻，内伤饮食较重，外邪随内伤之病机而发，都属于阴证。所以先出现鼻衄（鼻出血），随后显现出内阴证的特征，寒热交替发作，这也可能是太阴脾经的病变，而不是少阳经那种往来寒热的症状。给予调中汤服用几剂后痊愈。
彰德张相公的儿子张谊夫的妻子许氏，是状元许先之的女儿绍明的妹妹。她患有阳厥怒狂证，发病时饮食量增加四五倍，骂人不分亲疏，穿着丧服参加葬礼，有时哭有时歌，甚至用刀伤人；不说话时像哑巴，一说话就像发狂一样。她平时并不识字读书，却能阅读《文选》，人们都认为是鬼魔附体。待她安静下来时诊察，六脉举按皆无，身体表面冷如水石，发病时叫喊声越来越高。我以前听洁古老人说：《神农本草经》中提到“夺食则已”，并不是不给食物，而是通过治疗使其无法进食，这才是所谓的“夺食”。我用大承气汤攻下，排出脏垢数升，狂躁稍安，但过一两天又复发，再次攻下，排出粪便数升，病情再次安定，再过一两天又复发，第三次攻下后，病情如旧般安定，但不能进食，疾病稍轻但未停止。继续攻下，又进行了五七次，共计大便数斗，病情缓解，身体转温，脉象恢复，到第十四日，疾病痊愈，脉象恢复正常，困卧三四日后苏醒，饮食略微进补，又过了十天完全康复。刚得病时，语言声音愤怒异常，全身诸阳之气全部潜伏于中，隐匿于胃中，难道不是应该用大下法吗？这就是易老（张元素）“夺食”的意思。
上述阳狂这一条，本不应列入阴证之中。现在与阴狂证并列，其狂躁表现是一样的，但其寒热性质却不同。差之毫厘，谬以千里。读者读到此处，务必反复思考。
[External Yang Internal Yin / Yang Mania]
The young son of General Wanyan Gong, titled "Pi Yin" (Spleen Seal), suffered from Shanghan (Cold Damage) for six or seven days. He experienced alternating chills and fever, had three to five spots on the posterior aspect of his wrists, and slight epistaxis (nosebleed). Physicians treated him with Baihu Tang (White Tiger Decoction) and Chai Hu (Bupleurum) preparations, but he did not recover. Upon my examination, his pulses in both hands were deep and choppy. There was no significant heat upon palpation of the chest, diaphragm, and limbs; this indicated internal cold. Inquiring into the cause, it was found that during the summer heat, he slept at the slanted corner of a palace hall. First, he contracted external cold, followed by extreme thirst, after which he drank a large bowl of iced cheese water. The external contraction was mild, while the internal injury from diet was severe. The external pathogen followed the internal pathological mechanism, resulting in a condition classified as Yin. Thus, epistaxis occurred first, followed by the manifestation of internal Yin syndrome, with alternating chills and fever. This may also involve the Spleen (Taiyin), rather than the alternating chills and fever characteristic of Shaoyang syndrome. He was treated with Tiao Zhong Tang (Regulate the Middle Decoction) for several doses and recovered.
Xu Shi, the wife of Zhang Yifu, son of Chancellor Zhang of Zhangde and daughter of Scholar Zhuangyuan Xu Xianzhi (sister of Shao Ming), suffered from Yang Jue Nu Kuang (Yang Reversal with Angry Mania). During attacks, her food intake increased four to five times normal; she cursed without distinguishing between relatives and strangers; she wore mourning attire to attend funerals; she alternated between crying and singing; and she sometimes injured people with blades. When silent, she appeared mute; when speaking, she acted like a madman. Although she normally could not read or write, she could recite texts from *Wen Xuan* (Selections of Refined Literature), leading people to believe she was possessed by ghosts or demons. Upon examining her when calm, all six pulses were imperceptible upon lifting and pressing. Her body surface felt cold as water and stone. During attacks, her cries became progressively louder. I once heard Elder Jiegu say: The *Shennong Bencao Jing* states that "taking away food cures it." This does not mean withholding food, but rather using treatment to make the patient unable to eat, which constitutes "taking away food." I used Dachengqi Tang (Major Order the Qi Decoction) to purge, expelling several sheng (a unit of volume) of foul matter. The mania subsided slightly, but relapsed after one or two days. I purged again, expelling several sheng of stool, and the illness calmed down again. After another day or two, it relapsed. A third purge stabilized the condition as before, but she could not eat. The disease lightened slightly but persisted. I continued purging, performing the procedure five to seven more times, totaling several dou (a unit of volume) of stool. The illness eased, her body warmed, and her pulse returned. By the fourteenth day, the illness was cured, and her pulse normalized. After lying drowsily for three or four days, she revived, began taking small amounts of food, and was fully restored after ten more days. At the onset of the illness, her speech and voice were extremely angry. All Yang qi of the body had sunk inward and hidden within the Stomach. Was it not appropriate to use a major purgative method? This reflects the meaning of "taking away food" as interpreted by Yi Lao (Zhang Yuansu).
The above case of Yang Mania should technically not be categorized under Yin syndromes. However, it is listed here alongside Yin Mania. While the manic behavior is identical, the nature of Cold and Heat differs. A difference of a hair's breadth leads to an error of a thousand miles. Readers should reflect deeply upon this passage.