经曰、重阳者狂,重阴者癫。又曰、邪入于阳则狂,邪入于阴则癫。又曰、阳邪并于阳则狂,阴邪并于阴
则癫。又曰、热毒在胃,并入于心,使神不宁,而志不定,遂发狂也。盖因阳症失汗,使阳热入深,又失下,
使阳气重盛,阴气暴绝,独阳而无阴者也。始则少卧频起,妄语妄笑,甚则登高而歌,弃衣而走,逾垣
上屋,热莫可遏,治宜寒凉之剂胜之。伤寒至于发狂,邪热至极,非大吐不能已也。若手足和暖,神气
清爽,脉息洪大,目睛光彩,此为可治。若反目直视,四肢厥冷,六脉沈微,狂言不食,此为必死。
凡发狂奔走,势不可遏,烦置火盆于病人处,用醋一碗倾于火炭上,令其气冲入病人鼻内,仍将姜汁喷其
头面身体手足即安,方可察其阳狂阴躁,而施治疗。
凡热病发狂,切不可掩闭床帐,须要揭开,候爽气良久,遂用铜镜按在心胸问,俟热势稍退即除。若热太盛,
燥渴不止,将硝一斤研细,以水一盆,用青布三五块浸于硝水中,微搅半干,搭在病人胸膛并心上,频频易
之,如得睡汗乃愈。
如狂者,势缓而尚能阻当,非若发狂势凶而不能抵御者也。惟起卧不安未至于狂耳。轻曰、热结膀
胱,其人如狂,此畜血症也,治以抵当汤或桃仁承气汤。
惊狂,乃亡阳惊惕之狂,非若重阳奔走之狂也。盖因阳邪在表,发汗再之而汗不行,以致津液内竭,
正气耗散,或置火□榻之下,或烧针灼艾,劫夺取汗,变为此症,所以焂然而起,惕然而动,精神耗乱,
肢体不宁。实者烦躁不已,虚者真阳脱亡。法当柴芩以却热,龙牡以收神又当视其虚实而酌治之。
《内经》说:阳气重叠亢盛则发狂,阴气重叠偏盛则发癫。又说:邪气侵入阳分则发狂,邪气侵入阴分则发癫。又说:阳邪与阳相并则发狂,阴邪与阴相并则发癫。又说:热毒在胃中,并入心经,使心神不宁,意志不定,于是发狂。这大概是因为阳证(表证)失于发汗,使阳热深入体内,又失于攻下,使阳气重盛,阴气突然衰竭,成为独阳而无阴的状态。起初表现为睡眠少、频繁起身、胡言乱语、无故嬉笑,严重时则登高唱歌、脱衣奔跑、翻墙越屋,热势无法遏制,治疗宜用寒凉药物以胜其热。伤寒病发展到发狂阶段,邪热至极,非用大吐法不能停止。如果手足温暖,神志清爽,脉象洪大,眼睛有神采,这是可治之症。如果反而两眼直视,四肢厥冷,六脉沉微,胡言乱语且不进食,这是必死之症。
凡是发狂奔走,势头不可遏制,可在病人处放置火盆,将一碗醋倒在火炭上,让蒸汽冲入病人鼻孔内,再将姜汁喷洒在其头面、身体、手足上,即可安定,然后才能辨别是阳狂还是阴躁,从而施以治疗。
凡是热病发狂,切不可掩闭床帐,必须揭开,等待凉爽空气进入良久,然后用铜镜按在心胸部位,等到热势稍退即取下。如果热势太盛,燥渴不止,将硝石一斤研细,用水一盆,用青布三五块浸在硝水中,微微搅动至半干,搭在病人胸膛和心上,频繁更换,如果得到睡后出汗,病就好了。
所谓“如狂”,是指势头较缓,尚能阻挡,不像发狂那样凶险而不能抵御。只是起卧不安,尚未达到真正发狂的程度。轻症说:热结膀胱,其人出现如狂症状,这是蓄血证,治疗用抵当汤或桃仁承气汤。
惊狂,是亡阳导致的惊惕之狂,不像重阳亢盛奔走的狂症。大概因为阳邪在表,发汗后再发汗而汗不出,导致津液内竭,正气耗散,或者在床榻下置火,或烧针灼艾,强行劫取汗液,变为此症,所以突然而起,惊恐而动,精神混乱,肢体不宁。实证者烦躁不已,虚证者真阳脱亡。治法应当用柴胡、黄芩以清热,龙骨、牡蛎以收敛神气,又应当视其虚实而斟酌治疗。
The *Neijing* states: When Yang qi is excessively redundant, mania (Kuang) occurs; when Yin qi is excessively redundant, melancholia (Dian) occurs. It also states: When pathogenic factors enter the Yang aspect, mania occurs; when they enter the Yin aspect, melancholia occurs. Furthermore: When Yang pathogens combine with Yang, mania occurs; when Yin pathogens combine with Yin, melancholia occurs. Additionally: Heat toxins in the Stomach merge into the Heart, disturbing the Shen (Spirit) and destabilizing the will, thereby inducing mania. This is generally due to the failure to induce sweating in Yang-patterns (Exterior syndromes), allowing Yang-heat to penetrate deeply, combined with the failure to purge, causing Yang qi to become excessive while Yin qi suddenly exhausts, resulting in a state of solitary Yang without Yin. Initially, there is little sleep, frequent rising, delirious speech, and inappropriate laughter. In severe cases, patients climb high places singing, discard clothing, run about, scale walls and roofs, with heat that cannot be restrained. Treatment should employ cold-natured agents to overcome the heat. In Taiyang disease progressing to mania, pathogenic heat reaches its extreme; only a major emetic can resolve it. If the hands and feet are warm, the spirit is clear, the pulse is surging (Hong), and the eyes have luster, this is treatable. Conversely, if the eyes stare fixedly, the four limbs are cold, the six pulses are deep and minute (Chen Wei), and the patient speaks deliriously without eating, this indicates inevitable death.
For cases of mania with uncontrollable running, place a fire basin near the patient. Pour one bowl of vinegar onto hot charcoal, allowing the vapor to enter the patient's nose. Then spray ginger juice on the head, face, body, and extremities to calm the patient. Only then can one distinguish between Yang-manic and Yin-restless patterns to apply appropriate treatment.
In febrile diseases manifesting as mania, bed curtains must never be closed; they should be opened to allow fresh air to circulate for a considerable time. Then, press a copper mirror against the chest and heart area until the heat subsides slightly, then remove it. If the heat is excessive and dryness-thirst persists unceasingly, grind one jin (approx. 500g) of Natrii Sulfas (Xiaoshuo, 芒硝) finely. Mix with a basin of water, soak three to five pieces of blue cloth in the solution, wring them out until semi-dry, and apply to the patient's chest and heart. Change frequently. Recovery occurs when the patient sleeps and sweats.
"Ru Kuang" (Mania-like) refers to a milder condition where the patient can still be restrained, unlike true mania which is fierce and uncontrollable. The patient experiences restlessness in lying down and sitting but has not reached the stage of full mania. Mild presentations state: "Heat binding in the Bladder causes the person to appear manic; this is Blood Stasis syndrome." Treatment utilizes Didang Tang or Taoren Chengqi Tang.
Jing Kuang (Startled Mania) is mania arising from Yang collapse with fright and palpitations, distinct from the running mania of excessive Yang. It typically arises because an exterior Yang pathogen was subjected to repeated sweating attempts without success, leading to exhaustion of internal fluids and dispersion of righteous Qi. Alternatively, it may result from placing fire under the bed or using moxibustion/needling to forcibly extract sweat, transforming into this syndrome. Consequently, the patient rises suddenly, moves with fright, suffers mental confusion, and exhibits limb restlessness. In excess patterns, there is incessant irritability; in deficiency patterns, there is collapse of True Yang. The method involves using Chai Hu Huang Qin Tang (Bupleurum and Scutellaria Decoction) to clear heat, and Long Gu Mu Li (Dragon Bone and Oyster Shell) to anchor the Spirit. Treatment must be adjusted according to excess or deficiency.