（余躁热发狂附）
《活人书》论伤寒小儿、大人治，一般但小分剂，药差凉耳。问∶狂言者，何也？发狂有二证，阳毒发狂，蓄血如
狂，其外证与脉皆不同，病患烦躁，狂走妄言，面赤咽痛，脉实，潮热独语，如见鬼状，此阳毒也。治法药方在第四卷
第二十一问。第二十二问，（问病患潮热独语，如见鬼状，发则不识人，寻衣撮空，直视微喘，何也？仲景云∶伤寒若
吐若下后不解，不大便五、六日，上至十余日，日晡所发潮热，不恶寒，独语如见鬼状。若剧者，发则不识人，循衣摸
床，惕而不安，微喘直视但发热谵语者，大承气汤主之。若一服利则止后服。脉弦者生，涩者死。弦者，阳也；涩者，
阴也。阳证见阴脉者死。病患有阳证，而脉涩者，慎不可下。）病患无表证，不发寒热，唇燥但欲嗽水，不欲入咽，其
脉微而沉，小腹硬满，小便反利，大便必黑，身黄发狂，此血证谛也。（病患如热状，烦满口燥，其脉反无热，此为阴状，
其血证审矣。仲景云∶太阳病不解，热结膀胱，其人如狂，其血自下者愈。若外不解者，尚未可攻，当先解其表，宜桂
枝汤。外已解，但小腹急结者，乃可攻之，属桃仁承气汤主之。）大抵伤寒当汗不汗，热蓄在里，热化为血，其人喜忘
而如狂，血上逆则喜忘，血下蓄则内争，甚者抵当汤、抵当丸。轻者桃仁承气、犀角地黄汤。须取尽黑物为效。（失汗，
热蓄在膀胱经。若用抵当汤，更须仔细审其有无表证。若有蓄血证而外不解，亦未可便用抵当汤。先用桂枝汤已解其外，
缘热在膀胱太阳经故也。）又有火邪发惊狂者，医以火于卧床下，或周身用火迫劫汗出，或熨而成火邪。其人亡阳，烦
躁惊狂，卧起不安，桂枝去芍药加蜀漆牡蛎龙骨救逆汤、桂枝甘草龙骨牡蛎汤主之。（凡灸及烧针后证似大劫者，并用劫
法治之，金匮风引汤尤良，柴胡加龙骨牡蛎汤更捷。）
《圣惠》治小儿伤寒壅热，心狂谵语。铅霜散方
铅霜 马牙硝 人参（去芦头） 郁金 茯神（各一分） 甘草（半分，炙微赤，锉）
上件药捣，细罗为散。不计时候，煎麦门冬汤、放温，调下半钱。量儿大小，以意加减与服。
《活人书》仲景桂枝汤，方见伤寒自汗门中。
《活人书》仲景大承气汤，方见伤寒发喘门中。
《活人书》仲景桃仁承气汤
桃仁（去皮尖、双仁，五十枚，捶碎） 大黄（四两） 桂枝（去皮） 甘草（炙） 芒硝（各二两）
上锉如麻豆大。每服五钱匕，以水一大盏，煮取八分，去滓温服，以微利为度。未利，移时再服。
《活人书》仲景抵当汤
水蛭（十枚，熬，去子，杵碎，水蛭入腹再生化，为害尤甚，须锉断，用锻石炒，再熬） 大黄（一两，去皮，酒
洗） 虻虫（十枚，去翅足，熬） 桃仁（七枚，去皮尖，捶碎）
上锉如麻豆大。作二服，以水二盏，煮至七分，去滓温服。
《活人书》仲景抵当丸
水蛭（五枚，根据前法制） 桃仁（四枚） 大黄（三分，去皮） 虻虫（五枚，去翅足，熬）
上捣筛，只为一丸，以水一大白盏，煮至七分，顿服。 时当下血，不下便作之。
《活人书》犀角地黄汤，方见伤寒鼻衄门中。
《活人书》仲景桂枝去芍药加蜀漆牡蛎龙骨救逆汤
桂枝 蜀漆（洗去腥。各一两） 甘草（一两，炙） 牡蛎（二两半， ） 龙骨（二两）
上锉如麻豆大。每服抄五钱匕，生姜四片，枣子一枚，水一盏半，煮至八分，去滓温服。
《活人书》仲景桂枝甘草汤
桂枝（半两，去皮） 甘草（炙） 牡蛎（熬） 龙骨（各分两）
上锉如麻豆大。每服抄五钱匕，水一盏半，煮至八分，去滓温服。
《活人书》仲景金匮风引汤，方见惊痫门中。
《活人书》仲景柴胡加龙骨牡蛎汤
柴胡（二两） 黄芩（一两） 铅丹 人参 桂枝 茯苓 龙骨 牡蛎（ 。各三分） 半夏（六钱半，汤洗） 大
黄（半两）
上锉如麻豆大。每服抄五钱匕，生姜四片，枣子一枚，水一盏半，煮至八分，去滓温服。
《聚宝方》铅霜散 治大人、小儿伤寒三日后，心烦躁狂言。
铅白霜 马牙硝（各一分）
上二味研匀。每服大人半钱，小儿一字，生姜、蜜水调下。
长沙医者郑愈传治小儿躁热发狂。
甘草（炙） 郁金（火焙干） 牙硝 官桂
上四味等分为末。每服二钱，新汲水调下。如小儿发狂，一钱。
《活人书》论述伤寒在小儿和大人身上的治疗，方法基本相同，只是剂量稍小，药性稍微偏凉罢了。问：出现胡言乱语的症状，是什么原因呢？发狂有两种证候，一是阳毒发狂，二是蓄血如狂，它们的外在症状和脉象都不同。患者表现为烦躁不安，狂奔乱走，胡言乱语，面色红赤，咽喉疼痛，脉象实大，午后定时发热，独自说话，好像看见鬼怪一样，这是阳毒病。治疗方法及方剂见第四卷第二十一问。第二十二问中问道：“如果患者午后定时发热，独自说话，好像看见鬼怪；发作时不认识人，手抓衣角床沿，眼睛直视且呼吸微弱急促，这是什么原因？”张仲景说：“伤寒病经过吐法或下法治疗后病情未解，五六天甚至十多天不大便，每天下午申时左右定时发热，不怕冷，独自说话好像看见鬼怪。如果病情严重，发作时不认识人，手抓衣角床沿，惊恐不安，呼吸微弱且眼睛直视，只要发热并伴有胡言乱语，用大承气汤主治。如果服用一次后大便通畅，就停止后续服药。脉象弦长的预后良好，脉象涩滞的预后不良。弦脉属阳，涩脉属阴。阳证见到阴脉的会死亡。患者有阳证而脉象涩滞的，千万不可使用攻下法。”
如果患者没有表证，不发寒热，嘴唇干燥只想漱口但不想咽下，脉象微细而沉，小腹硬满，小便反而通利，大便必定色黑，身体发黄并出现发狂，这是蓄血证的确定表现。（患者看起来像有热的样子，心烦胸满，口燥，但脉象反而不数，这是阴证的表现，蓄血证就可以确定了。张仲景说：“太阳病未解，热邪结于膀胱，患者神志恍惚像要发狂，如果瘀血自行排出则病愈。如果表证仍未解除，还不可以攻里，应当先解表，宜用桂枝汤。表证已解，只有小腹急迫结聚的，才可以攻里，属于桃仁承气汤的主治范围。”）大体上，伤寒应当发汗而未发汗，热邪蓄积在体内，热极化为瘀血，患者容易健忘且神情恍惚像发狂。血气上逆则容易健忘，血液在下部蓄积则内部争斗，严重的用抵当汤、抵当丸。轻的用桃仁承气汤、犀角地黄汤。必须排出黑色的瘀血才算见效。（因失汗导致热邪蓄积在膀胱经。如果使用抵当汤，更须仔细审查是否有表证。如果有蓄血证而表证未解，也不可以立即使用抵当汤。应当先用桂枝汤解除表证，因为热邪在膀胱太阳经的缘故。）
又有因火邪导致惊狂的，医生在卧床下用火烘烤，或用火遍身逼迫出汗，或用熨法导致变成火邪。患者阳气亡失，烦躁惊狂，卧起不安，用桂枝去芍药加蜀漆牡蛎龙骨救逆汤、桂枝甘草龙骨牡蛎汤主治。（凡是艾灸及烧针后症状类似大劫病的，都用劫法治之，《金匮要略》中的风引汤尤其好，柴胡加龙骨牡蛎汤更快捷。）
《圣惠方》治疗小儿伤寒壅滞热盛，心狂谵语。铅霜散方：
铅霜、马牙硝、人参（去芦头）、郁金、茯神（各一分），甘草（半分，炙至微红，切碎）。
以上药物捣碎，过细筛成为散剂。不分时候，煎麦门冬汤，放温后，调服半钱。根据孩子的大小，酌情加减服用。
《活人书》引用张仲景的桃仁承气汤：
桃仁（去皮尖、双仁，五十枚，捣碎），大黄（四两），桂枝（去皮），甘草（炙），芒硝（各二两）。
以上切碎如麻豆大小。每次服用五钱匕，用水一大盏，煮取八分，去渣温服，以轻微腹泻为度。如果没有腹泻，过一段时间再服。
《活人书》引用张仲景的抵当汤：
水蛭（十枚，炒制，去掉卵粒，捣碎，水蛭进入腹部会再生化，危害尤其严重，必须剪断，用锻石炒，再炒），大黄（一两，去皮，酒洗），虻虫（十枚，去掉翅足，炒制），桃仁（七枚，去皮尖，捣碎）。
以上切碎如麻豆大小。分为两次服用，用水二盏，煮至七分，去渣温服。
《活人书》引用张仲景的抵当丸：
水蛭（五枚，根据前法制作），桃仁（四枚），大黄（三分，去皮），虻虫（五枚，去掉翅足，炒制）。
以上捣碎过筛，只做成一丸，用水一大白盏，煮至七分，一次性服用。此时应当下血，如果不下血就再做一丸服用。
《活人书》引用张仲景的桂枝去芍药加蜀漆牡蛎龙骨救逆汤：
桂枝、蜀漆（洗去腥味，各一两），甘草（一两，炙），牡蛎（二两半，煅），龙骨（二两）。
以上切碎如麻豆大小。每次取五钱匕，生姜四片，枣子一枚，水一盏半，煮至八分，去渣温服。
《活人书》引用张仲景的桂枝甘草龙骨牡蛎汤（原文误作桂枝甘草汤，据方义补全）：
桂枝（半两，去皮），甘草（炙），牡蛎（炒），龙骨（各等分）。
以上切碎如麻豆大小。每次取五钱匕，水一盏半，煮至八分，去渣温服。
《活人书》引用张仲景的柴胡加龙骨牡蛎汤：
柴胡（二两），黄芩（一两），铅丹，人参，桂枝，茯苓，龙骨，牡蛎（煅，各三分），半夏（六钱半，汤洗），大黄（半两）。
以上切碎如麻豆大小。每次取五钱匕，生姜四片，枣子一枚，水一盏半，煮至八分，去渣温服。
《聚宝方》铅霜散：治疗大人、小儿伤寒三日后，心中烦躁狂言。
铅白霜、马牙硝（各一分）。
以上两味研匀。每次服用大人半钱，小儿一字，用生姜、蜜水调下。
长沙医者郑愈传授治疗小儿躁热发狂的方法：
甘草（炙），郁金（火焙干），牙硝，官桂。
以上四味等分为末。每次服用二钱，用新汲水调下。如果是小儿发狂，服用一钱。
(Attached: Treatment of Mania Caused by Restlessness and Heat)
*Huoren Shu* (Book of Vitality) discusses the treatment of Shanghan (Cold Damage) in both children and adults; the methods are generally the same, but the dosages are slightly smaller, and the medicinal properties are slightly cooler. Question: What is the cause of delirious speech? There are two types of mania: one is mania caused by Yang toxicity, and the other is mania-like state due to blood stasis. Their external symptoms and pulses are different. The patient presents with irritability, running wildly, delirious speech, red face, sore throat, a full pulse, tidal fever, speaking alone as if seeing ghosts; this is Yang toxicity. The treatment method and formula are found in Volume 4, Question 21. In Question 22, it asks: "If a patient has tidal fever, speaks alone as if seeing ghosts; during attacks, does not recognize people, grasps at clothes and bedrails, stares fixedly, and breathes slightly short, what is the cause?" Zhang Zhongjing said: "In Shanghan, if after emesis or purgation the condition remains unresolved, and there is no bowel movement for five or six days, up to ten or more days, with tidal fever occurring around the Shen hour (3-5 PM), without aversion to cold, speaking alone as if seeing ghosts. If severe, during attacks the patient does not recognize people, grasps at clothes and bedrails, feels terrified and uneasy, breathes slightly short, and stares fixedly; if there is only fever and delirium, Da Chengqi Tang (Major Order the Qi Decoction) is the primary treatment. If one dose results in relief, stop subsequent doses. A string-like pulse indicates survival; a choppy pulse indicates death. String-like is Yang; choppy is Yin. When Yang syndrome presents with Yin pulse, death occurs. If a patient has Yang syndrome but a choppy pulse, downward purging must be strictly avoided."
If the patient has no exterior syndrome, no chills or fever, dry lips desiring only to rinse the mouth without swallowing, a pulse that is faint and deep, hardness and fullness in the lower abdomen, urination that is surprisingly free, black stools, jaundice, and mania, this is a definitive blood stasis syndrome. (The patient appears to have heat signs, irritability, chest fullness, and dry mouth, but the pulse is unexpectedly not rapid; this indicates a Yin pattern, confirming blood stasis. Zhang Zhongjing said: "When Taiyang disease is unresolved, heat binds in the Bladder, and the person acts as if manic; if blood passes spontaneously, the disease heals. If the exterior is still unresolved, attack is not yet appropriate; first resolve the exterior, using Guizhi Tang (Cinnamon Twig Decoction). Once the exterior is resolved, and only the lower abdomen feels urgent and knotted, then attack is possible; this belongs to Taoren Chengqi Tang (Peach Kernel Order the Qi Decoction).") Generally, in Shanghan, if sweating should have been induced but was not, heat accumulates internally and transforms into blood stasis; the person becomes forgetful and acts as if manic. Blood rushing upward causes forgetfulness; blood accumulating downward causes internal conflict. Severe cases require Didang Tang (Eradicate Stasis Decoction) or Didang Wan (Eradicate Stasis Pill). Mild cases use Taoren Chengqi Tang or Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction). Efficacy is achieved only when black material is expelled. (Loss of sweat leads to heat accumulation in the Bladder Meridian. If using Didang Tang, one must carefully examine whether an exterior syndrome exists. If there is blood stasis syndrome but the exterior is unresolved, Didang Tang cannot be used immediately. First, use Guizhi Tang to resolve the exterior, because the heat is in the Bladder and Taiyang meridians.)
There is also mania caused by Fire Pathogen leading to fright and mania. This occurs when a doctor places fire under the sleeping mat, uses fire to force perspiration over the whole body, or applies moxibustion/ironing causing Fire Pathogen. The patient loses Yang qi, becoming irritable, frightened, and manic, unable to lie down or sit still calmly. Guizhi Qushaoyao Jia Shujimu Lulong Jiuni Tang (Cinnamon Twig Decoction without Peony plus Coix Seed, Oyster Shell, and Dragon Bone to Rescue from Emergency) or Guizhi Gancao Longgu Muli Tang (Cinnamon Twig and Licorice with Dragon Bone and Oyster Shell Decoction) are the primary treatments. (For conditions resembling major collapse after moxibustion or burning needles, treat with collapsing methods; Fengyin Tang (Wind-Driving Decoction) from *Jin Gui Yao Lue* is excellent, and Chaihu Jia Longgu Muli Tang (Bupleurum with Dragon Bone and Oyster Shell Decoction) is even more effective.)
*Shenghui Fang* (Holy Grace Formulary) treats pediatric Shanghan with obstructed heat, manic heart, and delirious speech. Qianshuang San (Lead Frost Powder):
Qianshuang (Lead Frost), Mayaxiao (Sodium Sulfate), Renshen (Ginseng Root, remove rhizome), Yujin (Curcuma Tuber), Fushen (Poria with Hostwood) (each 1 fen); Gancao (Licorice Root, 0.5 fen, honey-fried until slightly red, chopped).
Crush the above ingredients and sieve finely into powder. Administer at any time, mixing half a qian with warm Maidong Tang (Ophiopogon Decoction). Adjust dosage according to the child's size.
*Huoren Shu* cites Zhang Zhongjing's Guizhi Tang (Cinnamon Twig Decoction); see the section on Shanghan with spontaneous sweating.
*Huoren Shu* cites Zhang Zhongjing's Dachengqi Tang (Major Order the Qi Decoction); see the section on Shanghan with wheezing.
*Huoren Shu* cites Zhang Zhongjing's Taoren Chengqi Tang (Peach Kernel Order the Qi Decoction):
Taoren (Peach Kernel, remove skin and pointed ends, double-kernel ones excluded, 50 pieces, crushed), Dahuang (Rhubarb Root and Rhizome, 4 liang), Guizhi (Cinnamon Twig, remove bark), Gancao (Licorice Root, honey-fried), Mangxiao (Mirabilite) (each 2 liang).
Chop coarsely like hemp seeds. Take 5 qianbi per dose, boil in one large cup of water until reduced to 80%, strain, and take warm. Stop when slight diarrhea occurs. If no diarrhea, wait and administer again later.
*Huoren Shu* cites Zhang Zhongjing's Didang Tang (Eradicate Stasis Decoction):
Shuizhi (Leech, 10 pieces, stir-fried, remove eggs, crush; leeches regenerate in the abdomen causing severe harm, so cut them, stir-fry with calcined gypsum, then stir-fry again), Dahuang (Rhubarb Root and Rhizome, 1 liang, remove skin, wash with wine), Mengchong (Blue Bottle Fly Larva, 10 pieces, remove wings and feet, stir-fried), Taoren (Peach Kernel, 7 pieces, remove skin and pointed ends, crush).
Chop coarsely like hemp seeds. Divide into two doses. Boil in two cups of water until reduced to 70%, strain, and take warm.
*Huoren Shu* cites Zhang Zhongjing's Didang Wan (Eradicate Stasis Pill):
Shuizhi (Leech, 5 pieces, prepared as above), Taoren (Peach Kernel, 4 pieces), Dahuang (Rhubarb Root and Rhizome, 3 fen, remove skin), Mengchong (Blue Bottle Fly Larva, 5 pieces, remove wings and feet, stir-fried).
Crush and sieve, form into one pill. Boil in one large white cup of water until reduced to 70%, take in one dose. Blood should pass stool at this time; if not, prepare another pill.
*Huoren Shu* cites Zhang Zhongjing's Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction); see the section on Shanghan with epistaxis.
*Huoren Shu* cites Zhang Zhongjing's Guizhi Qushaoyao Jia Shujimu Lulong Jiuni Tang (Cinnamon Twig Decoction without Peony plus Coix Seed, Oyster Shell, and Dragon Bone to Rescue from Emergency):
Guizhi (Cinnamon Twig), Shujun (Prepared Coix Seed, washed to remove fishy odor) (each 1 liang), Gancao (Licorice Root, 1 liang, honey-fried), Muli (Oyster Shell, 2.5 liang, calcined), Longgu (Dragon Bone, 2 liang).
Chop coarsely like hemp seeds. Take 5 qianbi per dose, add 4 slices of Shengjiang (Fresh Ginger) and one Zaozi (Jujube), boil in 1.5 cups of water until reduced to 80%, strain, and take warm.
*Huoren Shu* cites Zhang Zhongjing's Guizhi Gancao Longgu Muli Tang (Cinnamon Twig and Licorice with Dragon Bone and Oyster Shell Decoction)*:
Guizhi (Cinnamon Twig, 0.5 liang, remove bark), Gancao (Licorice Root, honey-fried), Muli (Oyster Shell, stir-fried), Longgu (Dragon Bone) (equal parts).
Chop coarsely like hemp seeds. Take 5 qianbi per dose, boil in 1.5 cups of water until reduced to 80%, strain, and take warm.
*(Note: The original text lists this as "Guizhi Gancao Tang" but includes Longgu and Muli in the ingredients and context, corresponding to Guizhi Gancao Longgu Muli Tang).*
*Huoren Shu* cites Zhang Zhongjing's Jin Gui Fengyin Tang (Wind-Driving Decoction from *Jin Gui Yao Lue*); see the section on fright and epilepsy.
*Huoren Shu* cites Zhang Zhongjing's Chaihu Jia Longgu Muli Tang (Bupleurum with Dragon Bone and Oyster Shell Decoction):
Chaihu (Bupleurum Root, 2 liang), Huangqin (Scutellaria Root, 1 liang), Qiandan (Lead Tetroxide), Renshen (Ginseng Root), Guizhi (Cinnamon Twig), Fuling (Poria), Longgu (Dragon Bone), Muli (Oyster Shell, calcined) (each 3 fen), Banxia (Pinellia Tuber, 6.5 qian, washed with hot water), Dahuang (Rhubarb Root and Rhizome, 0.5 liang).
Chop coarsely like hemp seeds. Take 5 qianbi per dose, add 4 slices of Shengjiang (Fresh Ginger) and one Zaozi (Jujube), boil in 1.5 cups of water until reduced to 80%, strain, and take warm.
*jubao Fang* (Treasure Collection Formulary) Qianshuang San (Lead Frost Powder): Treats adults and children with Shanghan after three days, presenting with mental restlessness, irritability, and delirious speech.
Qianbaishuang (White Lead Frost), Mayaxiao (Sodium Sulfate) (each 1 fen).
Grind these two ingredients evenly. Adults take half a qian, children take one zi (a very small measure), mixed with water containing Fresh Ginger and Honey.
Zheng Yu, a physician from Changsha, transmitted a treatment for pediatric restlessness, heat, and mania:
Gancao (Licorice Root, honey-fried), Yujin (Curcuma Tuber, baked over fire until dry), Yaxiao (Sodium Nitrate/Saltpeter), Guanguui (Official Cinnamon Bark).
Grind these four ingredients into equal parts powder. Take 2 qian per dose, mixed with fresh well water. For pediatric mania, take 1 qian.