伤寒发狂。何以明之。狂者猖狂也。谓其不宁也。难经曰。狂之始发也。少卧不饥。而 自高贤也。自辨智也。自贵倨也。妄笑好歌乐也。妄行走不休也。狂家所起。皆阳盛 致然。内经曰。阴不胜其阳。脉留薄疾并。乃狂也。又曰。邪入于阳则狂。邪入于阴则喑。难经曰。重阳者狂。重阴者 癫。脉经曰。阴附阳则狂。阳附阴则癫。病源曰。阳邪并 于阳则狂。阴邪并于阴则癫。即诸经之狂为阳盛也。明矣。又阳明之病。恶人与火。 闻木音则惕然而惊。心欲动。独闭户牖而处。甚则欲上高而歌。弃衣而走。逾垣上 屋。其所上之处。皆非素能者。是谓阳邪并于阳明也。伤寒热毒在胃。并于心脏。使 神不宁。而志不定。遂发狂也。伤寒至于发狂。为邪热至极也。非大吐下则不能已。 又有热在下焦。其人如狂者。经曰。热入膀胱。其人如狂。谓之如狂。则未至于狂。但 卧起不安尔。其或狂言。目反直视。又为肾之绝。汗出辄复热。狂言不能食。又为失 志死。若此则殆非药石之所及。是为真病焉。

伤寒霍乱。何以明之。上吐而下利。挥霍而撩乱是也。邪 在上焦者。但吐而不利。邪 在下焦者。但利而不吐。而若邪在中焦。胃气不治。为邪所伤。使阴阳乖隔。遂上吐 而下利。若止呕吐。而利经止。得之吐利。必也上吐下利。躁扰烦乱。乃谓之霍乱。其 与但称吐利者。有以异也。伤寒吐利者。邪气所伤。霍乱吐利者。饮食所伤也。其有 兼伤寒之邪。内外不和者。加之头痛发热而吐利也。经曰。病发热头痛。身疼恶寒 吐利者。此属何病。答曰。此名霍乱。自吐下又利止。复更发热也。是霍乱兼伤寒者 也。霍乱头痛发热。热多欲饮水者。五苓散主之。寒多不用水者。理中丸主之。以其 中焦失治。阴阳乖隔。必有偏之者。偏阳则多热。偏阴则多寒。许仁则曰。病有干霍 乱。有湿霍乱。干霍乱死者多。湿霍乱死者少。盖吐利则所伤之物。得以出泄。虽霍 乱其则止于胃中水谷泄尽则止矣。所以死者少。及其干霍乱而死多者。以其上 不得吐。下不得利。则所伤之物。不得出泄。壅闭正气。关隔阴阳。烦扰闷乱。躁无所 安。喘胀干霍乱而死。呜呼。食饮有节。起居有常者。岂得致霍乱耶。饮食自倍。肠胃 乃伤。丧身之由。实自致尔。

Translation into Modern Chinese:

Typhoid fever manifesting as mania. How should this be understood? "Mania" refers to reckless and unruly behavior, meaning a state of inner unrest. The *Nan Jing* (Classic of Difficult Issues) states: When mania first begins, the patient sleeps little, has no appetite, yet considers themselves superior and virtuous; they claim to be wise and intelligent; they act arrogantly and disdainfully; they laugh inappropriately, enjoy singing and music; they walk around aimlessly without stopping. The onset of all cases of mania is caused by an excess of Yang. The *Nei Jing* (Inner Canon) states: When Yin cannot overcome Yang, the pulse becomes stagnant, thin, rapid, and combined, leading to mania. It also says: When pathogenic factors enter the Yang aspect, mania occurs; when they enter the Yin aspect, aphonia (loss of voice) occurs. The *Nan Jing* states: Excess Yang leads to mania; excess Yin leads to catatonia (dian). The *Mai Jing* (Pulse Classic) states: When Yin attaches to Yang, mania occurs; when Yang attaches to Yin, catatonia occurs. The *Bing Yuan* (Source of Diseases) states: When Yang pathogens combine with Yang, mania occurs; when Yin pathogens combine with Yin, catatonia occurs. Thus, it is clear that mania in various meridians is due to Yang excess. Furthermore, in Yangming disease, the patient dislikes people and fire; hearing the sound of wood causes them to startle fearfully; their heart feels agitated; they prefer to stay alone behind closed doors and windows. In severe cases, they may want to climb high places and sing, discard their clothes and run, jump over walls, or climb onto roofs. These actions are not things they were previously capable of doing. This is called Yang pathogens combining with the Yangming meridian. In typhoid fever, heat toxins reside in the Stomach and combine with the Heart, disturbing the Spirit (Shen) and destabilizing the Will (Zhi), thereby causing mania. When typhoid fever progresses to mania, it indicates that pathogenic heat has reached its extreme. Only drastic purgation (vomiting or purging) can resolve it. There is also heat in the Lower Jiao (Lower Burner), where the patient appears manic ("ru kuang"). The classics state: When heat enters the Bladder, the patient appears manic. Being described as "appearing manic" means they have not yet reached full mania; they merely experience restlessness in lying down and getting up. If there is incoherent speech, eyes rolling back and staring straight ahead, this indicates the exhaustion of Kidney Qi. If sweating is followed by recurrent fever, incoherent speech, and inability to eat, this indicates the loss of Zhi (Will) and is a fatal sign. In such cases, medicine and acupuncture are likely ineffective; this represents a true, critical illness.

Typhoid fever manifesting as Huoluan (Colic with Vomiting and Diarrhea). How should this be understood? It is characterized by vomiting above and diarrhea below, with sudden and chaotic symptoms. When pathogens are in the Upper Jiao (Upper Burner), there is only vomiting without diarrhea. When pathogens are in the Lower Jiao (Lower Burner), there is only diarrhea without vomiting. However, if pathogens are in the Middle Jiao (Middle Burner), the Stomach Qi fails to regulate properly, damaged by pathogens, causing a separation of Yin and Yang, leading to both vomiting and diarrhea. If vomiting stops but diarrhea continues, or vice versa, it is not necessarily Huoluan. True Huoluan requires simultaneous upper vomiting and lower diarrhea, accompanied by agitation, restlessness, and chaos. This differs from cases simply described as vomiting and diarrhea. Typhoid fever with vomiting and diarrhea is caused by pathogenic invasion; Huoluan with vomiting and diarrhea is caused by dietary injury. Some cases involve concurrent typhoid pathogens, leading to internal and external disharmony, accompanied by headache, fever, vomiting, and diarrhea. The classics ask: For a patient with fever, headache, body pain, aversion to cold, vomiting, and diarrhea, what disease is this? The answer is: This is named Huoluan. If after vomiting and diarrhea cease, fever recurs, this is Huoluan concurrent with typhoid fever. For Huoluan with headache and fever, if heat predominates and the patient desires water, Wuling San (Five-Ingredient Powder with Poria) is the primary treatment. If cold predominates and the patient does not desire water, Lizhong Wan (Regulate the Middle Pill) is the primary treatment. Because the Middle Jiao loses regulation and Yin-Yang separate, there must be a bias. Bias toward Yang results in more heat; bias toward Yin results in more cold. Xu Renze stated: There are two types of Huoluan: Gan Huoluan (Dry Huoluan) and Shi Huoluan (Wet Huoluan). Dry Huoluan has a higher mortality rate; Wet Huoluan has a lower mortality rate. This is because in Wet Huoluan, the injured substances are expelled through vomiting and diarrhea. Although it is Huoluan, it stops once the food and water in the stomach are exhausted. Therefore, few die. In contrast, Dry Huoluan often leads to death because the patient cannot vomit upward nor defecate downward, so the injured substances cannot be expelled. This blocks the Righteous Qi (Zheng Qi), separates Yin and Yang, causing agitation, oppression, chaos, and restlessness without peace, along with panting and distension, leading to death from Dry Huoluan. Alas! Those who eat and drink in moderation and maintain regular daily routines, how could they contract Huoluan? "When food and drink exceed normal limits, the intestines and stomach are injured." The cause of death is truly self-inflicted.