都××，年三旬，得癫狂失心证。
病因 心郁生热，因热生痰，遂至癫狂失心。
证候 言语错乱，精神昏瞀，时或忿怒，时或狂歌，其心中犹似烦躁，夜不能寐，恒以手自挠
其胸，盖自觉发闷也。问之亦不能答，观其身形似颇强壮，六脉滑实，两寸尤甚，一息五至。
诊断 人之元神在脑，识神在心，心脑息息相通，其神明自湛然长醒。生理学家谓心有四支血管通脑，
此即神明往来于心脑之路也。此证之脉其关前之滑实太过，系有热痰上壅将其心脑相通之路杜塞，遂至神
明有所隔碍，失其常性，此癫狂失心之所由来也。治之者当投以开通重坠之剂，引其痰火下行，其四支血
管为痰所瘀者，复其流通之旧，则神明之往来自无所隔碍，而复湛然长醒之旧矣。
处方 生赭石（两半轧细） 川大黄（八钱） 清半夏（五钱） 芒硝（四钱）
药共四味，先将赭石半夏煎十余沸，加入大黄煎两三沸，取汤一大盅，入芒硝融化温服。
方解 方中重用赭石者，其重坠之性能引血管中之瘀痰下行也。
复诊 三日服药一次（凡降下之药不可连服，须俟其正气稍缓再服），共服三次，每次服药
后通下大便两三次，似有痰涎随下，其精神较前稍明了，诊其脉仍有滑实之象，身体未见衰弱，拟
再投以较重之剂，盖凡癫狂之甚者，非重剂治之不能愈也。
处方 生赭石（二两轧细） 川大黄（一两） 芒硝（四钱） 甘遂（钱半细末）
药共四味，先煎赭石十余沸，入大黄煎两三沸，取汤一大盅，入芒硝融化，将服时再调入甘遂末。
三诊 将药如法煎服一剂，下大便五六次，带有痰涎若干，中隔两日又服药一次（药中有甘遂，必须三
日服一次，不然必作呕吐），又下大便五六次，中多兼痰块挑之不开，此所谓顽痰也。从此精神大见
明了，脉象亦不复滑实矣，拟改用平和之剂调治之。
处方 生怀山药（一两） 生杭芍（六钱） 清半夏（四钱） 石菖蒲（三钱）
生远志（二钱） 清竹沥（三钱） 镜面砂（三分研细）
药共七味，将前五味煎汤一大盅，调入竹沥送服朱砂细末。
效果 将药如法煎服数剂，病遂全愈。
都某某，三十岁左右，患上了癫狂失心证。
证候 言语错乱，精神昏沉迷糊，有时愤怒，有时狂歌，心中似乎烦躁不安，夜晚无法入睡，经常用手抓挠胸部，因为自觉胸闷。询问他也不能回答，看他的身形似乎颇为强壮，六脉滑实，两寸脉尤其明显，一息五至（呼吸一次脉搏跳动五次）。
诊断 人的元神在脑，识神在心，心与脑息息相通，神明自然清澈长久保持清醒。生理学家认为心脏有四支血管通向脑部，这就是神明在心脑之间往来的路径。此证的脉象关前部位滑实太过，是由于热痰上壅堵塞了心脑相通的路径，导致神明有所隔阂阻碍，失去常态，这就是癫狂失心的由来。治疗时应当投用具有开通和重坠作用的药剂，引导痰火下行，使被痰瘀阻的四支血管恢复原有的流通状态，那么神明的往来自然不再受阻，重新恢复清澈长久的清醒状态。
处方 生赭石（半两，轧细） 川大黄（八钱） 清半夏（五钱） 芒硝（四钱）
药共四味，先将赭石和半夏煎煮十余沸，加入大黄煎两三沸，取汤一大盅，放入芒硝融化后温服。
方解 方中重用赭石的原因，是因其重坠的性能能引导血管中的瘀痰下行。
复诊 三日服药一次（凡是降下性质的药物不可连续服用，必须等待正气稍缓后再服），共服三次，每次服药后通下大便两三次，似乎有痰涎随之下行，精神较之前稍微明了，诊其脉仍有滑实之象，身体未见衰弱，打算再投以较重的药剂，大概凡是癫狂严重的，不用重剂治疗不能痊愈。
处方 生赭石（二两，轧细） 川大黄（一两） 芒硝（四钱） 甘遂（钱半，研为细末）
药共四味，先煎赭石十余沸，加入大黄煎两三沸，取汤一大盅，放入芒硝融化，在服用时再调入甘遂细末。
三诊 将药按法煎服一剂，下大便五六次，带有若干痰涎，中间隔两天又服药一次（药中有甘遂，必须三日服一次，否则必然引起呕吐），又下大便五六次，其中多夹杂痰块挑之不开，这就是所谓的顽痰。从此精神大大变得明了，脉象也不再滑实了，打算改用平和的药剂调理治疗。
处方 生怀山药（一两） 生杭芍（六钱） 清半夏（四钱） 石菖蒲（三钱） 生远志（二钱） 清竹沥（三钱） 镜面砂（三分，研细）
药共七味，将前五味煎汤一大盅，调入竹沥送服朱砂细末。
效果 将药按法煎服数剂，病便完全痊愈。
Du [Name Redacted], aged about thirty, suffered from Dian Kuang Shi Xin syndrome (mania and insanity with loss of mental clarity).
Etiology Mental depression generated heat; due to the heat, phlegm was produced, leading to Dian Kuang Shi Xin.
Symptoms Disordered speech, dull and confused spirit, occasional anger, occasional manic singing, a sensation of inner restlessness and irritability, insomnia at night, frequently scratching the chest with hands due to subjective chest oppression. Unable to answer when questioned. The body appeared quite robust. The six pulses were slippery and solid, especially prominent in the Cun positions of both wrists, with five beats per respiration.
Diagnosis The Yuan Shen (Original Spirit) resides in the brain, and the Shi Shen (Acquired Spirit) resides in the heart. The heart and brain are continuously connected, allowing the Shen to remain clear and awake naturally. Physiologists state that four blood vessels connect the heart to the brain; this is the pathway for the Shen to travel between the heart and brain. In this case, the excessive slipperiness and solidity in the pulse before the Guan position indicate that hot phlegm has obstructed upward, blocking the pathway connecting the heart and brain. This causes an obstruction to the Shen, leading to a loss of normal temperament, which is the origin of Dian Kuang Shi Xin. Treatment should employ agents with opening and heavy-sinking properties to guide the phlegm and fire downward. Once the blood vessels blocked by phlegm stasis regain their original patency, the movement of the Shen will be unobstructed, restoring its original state of clear and sustained wakefulness.
Prescription Raw Hematitum (Sheng Zhe Shi, 1.5 liang, finely crushed) Rhubarb (Chuan Da Huang, 8 qian) Prepared Pinellia (Qing Ban Xia, 5 qian) Mirabilite (Mang Xiao, 4 qian)
There are four ingredients. First, decoct Hematitum and Pinellia for about ten boils. Add Rhubarb and decoct for two or three more boils. Strain to obtain one large cup of decoction. Dissolve Mirabilite in the warm decoction and administer orally.
Formula Analysis Heavy use of Hematitum in this formula is because its heavy-sinking property can guide phlegm stasis within the blood vessels downward.
Second Visit Take the medicine once every three days (Purgative medicines should not be taken consecutively; wait until the healthy qi recovers slightly before administering again). Taken three times in total. After each dose, there were two or three bowel movements, seemingly accompanied by the discharge of phlegm saliva. The spirit became slightly clearer than before. The pulse still showed slippery and solid characteristics, and the body had not weakened. It is proposed to administer a heavier dose next time, as severe cases of mania and insanity cannot be cured without heavy doses.
Prescription Raw Hematitum (Sheng Zhe Shi, 2 liang, finely crushed) Rhubarb (Chuan Da Huang, 1 liang) Mirabilite (Mang Xiao, 4 qian) Kansui Root (Gan Sui, 0.5 qian, fine powder)
There are four ingredients. First, decoct Hematitum for about ten boils. Add Rhubarb and decoct for two or three more boils. Strain to obtain one large cup of decoction. Dissolve Mirabilite in it. Just before administration, mix in the Kansui Root powder.
Third Visit Decoct and take one dose according to the method. There were five or six bowel movements, accompanied by some phlegm saliva. Two days later, another dose was taken (Kansui Root must be taken only once every three days; otherwise, vomiting will inevitably occur). Another five or six bowel movements occurred, containing many phlegm clumps that could not be broken apart by picking; this is referred to as stubborn phlegm. From then on, the spirit became significantly clearer, and the pulse no longer showed slippery and solid characteristics. It is proposed to switch to milder agents for regulation and treatment.
Prescription Raw Chinese Yam (Sheng Huai Shan Yao, 1 liang) Raw Paeonia Lactiflora (Sheng Hang Shao, 6 qian) Prepared Pinellia (Qing Ban Xia, 4 qian) Acorus Tatarinowii (Shi Chang Pu, 3 qian) Polygala Tenuifolia (Sheng Yuan Zhi, 2 qian) Bamboo Sap (Qing Zhu Li, 3 qian) Polished Cinnabar (Jing Mian Sha, 3 fen, finely ground)
There are seven ingredients. Decoct the first five ingredients to obtain one large cup of decoction. Mix in the Bamboo Sap and administer with the fine Cinnabar powder.
Outcome After taking several doses according to the method, the illness was completely cured.