癫狂，心脾肝胃病也。经曰∶重阴则癫，重阳则狂，阳并于阴则癫，阴并于阳则狂。癫多喜笑，症属心脾
不足。狂多忿怒，症属肝胃有余。癫则或笑或歌，或悲或泣，如醉如痴，语言颠倒，秽洁不知，经年不愈。
多由心脾郁结，志愿不遂，更或因惊恐，致神不守舍者有之。狂则自悲喜忘，善怒善恐，少卧不饥，自贤自贵。
此为心疾。或邪并阳明发狂，骂詈不避亲疏，登高而歌，弃衣而走，不食数日，逾垣上屋。此为胃火。或
阳气暴折而难决，为怒狂。此名阳厥。多由肝胆谋虑不决，屈无所伸，怒无所泄，木火合邪，乘心则神魂失守，
乘胃则暴横莫制。总之，癫狂皆心火自焚，痰迷窍络。故癫始发，其情志失常，状亦如狂，狂经久，其神魂
迷瞀，状乃类癫。治癫先逐其痰，控涎丹。次复其神，琥珀散。养其阴，滋阴安神汤。治狂先夺其食，食入
于阴，长气于阳。次下其痰，安神滚痰丸。降其火，生铁落饮。用生铁落者，金以制木，木平则火降也。二症
如因怒动肝火，风痰上涌而发。导痰汤加芩、连、菖、远，煎成入辰砂、沉香汁。如痰火久郁，神志恍惚，
牛黄清心丸。惊忧气结，痰血壅蔽，白金丸。心虚悸动，寤不稳寐，补心丹。心气不足，神不守舍，归神丹、
大剂独参汤。癫久不愈，必养神通志，归脾汤、枕中丹。狂久不愈，必壮水制火。二阴煎、生熟养心汤。此
治之大要，在参求脉症之虚实而分治之。
〔癫狂〕因惊忧而致，抱胆丸。因郁怒而致，安神导痰汤。痰火俱盛，甘遂散吐下之。痰火骤壅，发为怪
状，清心滚痰丸。气结为痰，闭其神识，四七汤。心热烦躁，芩连清心丸。阴亏晕仆，滋阴安神汤。痰迷心窍，
金箔镇心丸。思虑郁结，归脾汤加辰砂。心虑疑畏，定志丸。心脏气血不足，清心温胆汤。病后神
虚气怯，归神丹。久癫神魂不定，灵苑丹。癫已愈复发，断痫丹。妇人患癫，由血不调，加味逍遥散。别有
悲哭呻吟，为邪所凭，非狂也。一味蚕蜕纸烧灰，好酒调服二钱许。
〔狂症〕上焦实者，从高抑之，生铁落饮。阳明实者脉伏，大承气汤下之。痰火在上，因而越之，来苏
膏、三圣散涌吐之，立安。后用洗心散、凉膈散调之。形症脉气俱实，当涌吐兼利之，胜金丹。肝胆火旺，
木来乘心，降龙丹抑之。心火狂乱，黄连泻心汤。痰扰心包，郁金丸。风涎暴仆，通泄散。失魂若神灵所凭，
镇心丹。因劳神致伤心血，惊悸不安，辰砂安志丸。悲哀动中则伤魂，魂伤则狂妄不精，当以喜胜之，以温
药补魂之阳。龙齿清魂散。因喜乐无极则伤魄，魄伤则狂，当以恐胜之，以凉药补魄之阴。清神汤。肺虚喘乏，
加沙参。胃虚食少加人参。胆虚惊恐加羚羊角。热入血室发狂，小柴胡汤加犀角、生地黄。猝发狂言，针手
大指甲角一韭叶许，少商穴。肝盛怒狂，针足大趾甲角一韭叶许，大敦穴。
癫狂，是心、脾、肝、胃四脏发生病变的疾病。《内经》说：阴气过重则发为癫病，阳气过重则发为狂病；阳气并入阴分则发为癫病，阴气并入阳分则发为狂病。癫病患者多表现为喜笑，其证候属于心脾两虚。狂病患者多表现为忿怒，其证候属于肝胃实热。癫病的症状包括时而大笑时而歌唱，时而悲伤时而哭泣，如同醉酒或痴呆一般，言语错乱颠倒，不分秽洁，病程经年不愈。这多由心脾气机郁结，志愿未能实现所致，也有因遭受惊恐，导致神志不能安守于内而发病的。狂病的症状包括自悲自喜、健忘，容易愤怒和恐惧，睡眠少且不觉得饥饿，自视甚高且自以为尊贵。这属于心脏的神志疾病。也有因邪气并合于阳明经而发狂的，表现为辱骂他人而不避亲疏，登上高处唱歌，脱去衣服奔跑，几天不进食，翻越墙垣屋脊。这属于胃火炽盛。也有因阳气突然受挫而难以决断，表现为暴怒发狂的，这称为“阳厥”。多由肝胆谋虑不决，委屈无处伸展，愤怒无处发泄，导致木火合邪，侵犯心脏则神魂失守，侵犯胃腑则暴躁横行无法控制。总之，癫狂都是由于心火自焚，痰浊迷塞窍络所致。所以癫病初起时，情志失常，表现也类似狂病；狂病经久不愈，神魂迷乱昏蒙，表现乃类似癫病。治疗癫病，先要祛除痰浊，用控涎丹；其次恢复神志，用琥珀散；滋养阴液，用滋阴安神汤。治疗狂病，首先要剥夺饮食（因为食物入阴分，会助长阳热之气）；其次攻下痰浊，用安神滚痰丸；清降火势，用生铁落饮。使用生铁落的原因，是利用金克木的原理，使肝木平和则心火自降。这两种病症如果是因为愤怒引动肝火，风痰上涌而发作的，可用导痰汤加黄芩、黄连、石菖蒲、远志，煎好后加入辰砂汁、沉香汁。如果是痰火久郁，神志恍惚不清，用牛黄清心丸。如果是惊忧气结，痰血壅蔽心神，用白金丸。如果是心虚悸动，醒睡不安稳，用补心丹。如果是心气不足，神志不能安守，用归神丹、大剂量的独参汤。癫病日久不愈，必须调养神志，用归脾汤、枕中丹。狂病日久不愈，必须壮水制火，用二阴煎、生熟养心汤。这是治疗的纲要，关键在于参详脉象和症状的虚实来分别治疗。
〔癫狂〕因惊吓忧愁而致的，用抱胆丸。因抑郁愤怒而致的，用安神导痰汤。痰火俱盛的，用甘遂散通过吐法或下法治疗。痰火突然壅盛，出现怪异症状的，用清心滚痰丸。气结化为痰，闭塞神识的，用四七汤。心热烦躁的，用芩连清心丸。阴虚眩晕仆倒的，用滋阴安神汤。痰迷心窍的，用金箔镇心丸。思虑郁结的，用归脾汤加辰砂。心中疑虑畏惧的，用定志丸。心脏气血不足的，用清心温胆汤。病后神气虚弱怯懦的，用归神丹。久患癫病神魂不定的，用灵苑丹。癫病痊愈后又复发的，用断痫丹。妇女患癫病，因血液不调引起的，用加味逍遥散。另有悲伤哭泣呻吟，被邪气附体的，这不是狂病。单用一味蚕蜕纸烧成灰，用好酒调服约二钱。
〔狂症〕上焦实证的，采用“高者抑之”的方法，用生铁落饮。阳明腑实证的，脉象沉伏，用大承气汤攻下。痰火在上焦的，采用“其高者因而越之”的方法，用来自苏膏、三圣散涌吐，可立即安定。之后用洗心散、凉膈散调理。形体、症状、脉象、气机都实的，应当涌吐兼通利大便，用胜金丹。肝胆火旺，肝木乘袭心脏的，用降龙丹抑制。心火狂乱的，用黄连泻心汤。痰浊扰乱心包的，用郁金丸。风痰突然扑倒的，用通泄散。失魂仿佛神灵附体的，用镇心丹。因劳神过度损伤心血，惊悸不安的，用辰砂安志丸。悲哀触动内脏则伤魂，魂伤则狂妄不精明，应当用喜悦来克制它，用温药补益魂的阳气，用龙齿清魂散。因喜乐无度则伤魄，魄伤则发狂，应当用恐惧来克制它，用凉药补益魄的阴气，用清神汤。肺虚气喘乏力的，加沙参。胃虚食少的，加人参。胆虚易惊恐的，加羚羊角。热邪进入血室而发狂的，用小柴胡汤加犀角、生地黄。突然发出狂言的，针刺手大拇指指甲角旁一韭菜叶宽处，即少商穴。肝气盛怒发狂的，针刺足大趾指甲角旁一韭菜叶宽处，即大敦穴。
Mania and melancholia (Dian Kuang) are diseases involving the Heart, Spleen, Liver, and Stomach. The Classics state: "Excess Yin leads to melancholia (Dian), excess Yang leads to mania (Kuang); when Yang merges into Yin, it is melancholia; when Yin merges into Yang, it is mania." Melancholia is characterized by excessive laughter and belongs to deficiency of the Heart and Spleen. Mania is characterized by anger and belongs to excess in the Liver and Stomach. Symptoms of melancholia include laughing or singing at times, weeping or crying at other times, appearing intoxicated or foolish, speaking incoherently, lacking awareness of cleanliness or filth, and persisting for years without cure. This often arises from stagnation and knotting of Qi in the Heart and Spleen due to unfulfilled aspirations, or from fright and alarm causing the Spirit (Shen) to lose its residence. Symptoms of mania include alternating sadness and joy, forgetfulness, irritability, fear, little sleep, lack of appetite, self-aggrandizement, and arrogance. This is a disease of the Heart. Alternatively, mania may result from pathogenic factors merging with the Yangming channel, manifesting as cursing others regardless of kinship, climbing high places to sing, discarding clothes and running, fasting for several days, and climbing over walls and roofs. This is due to Stomach Fire. Another type is "Yang Jue" (Yang Reversal), caused by sudden frustration of Yang Qi leading to indecision and violent anger. This often stems from indecisiveness in the Liver and Gallbladder, where grievances cannot be expressed and anger has no outlet, causing Wood and Fire pathogens to combine. When attacking the Heart, the Soul and Spirit lose their control; when attacking the Stomach, violence becomes uncontrollable. In summary, both melancholia and mania are caused by Self-burning of Heart Fire and Phlegm confusing the orifices and collaterals. Thus, early-stage melancholia presents with emotional abnormality resembling mania; long-standing mania presents with confused Spirit and Soul resembling melancholia. To treat melancholia, first expel Phlegm using Kongxian Dan (Control Saliva Pill); then restore the Spirit using Hupo San (Amber Powder); nourish Yin using Ziyin Anshen Tang (Nourish Yin and Calm Spirit Decoction). To treat mania, first deprive food intake (as food enters Yin and generates Yang); then purge Phlegm using Anshen Guntan Wan (Calm Spirit and Roll Down Phlegm Pill); descend Fire using Shengtieluo Yin (Raw Iron Drop Drink). Raw Iron Drop is used because Metal controls Wood; when Wood is balanced, Fire descends. If these conditions arise from anger stirring Liver Fire and Wind-Phlegm surging upward, use Daotan Tang (Guide Phlegm Decoction) added with Huangqin (Scutellariae Radix), Lianzi (Coptidis Rhizoma), Shichangpu (Acori Tatarinowii Rhizoma), and Yuanzhi (Polygalae Radix), decocted and mixed with Chen Sha (Cinnabar) juice and Chenxiang (Aquilariae Lignum Resinatum) juice. If Phlegm-Fire has been stagnant for a long time causing vague consciousness, use Niuhuang Qingxin Wan (Calves' Bezoar Clearing Heart Pill). If fright and worry cause Qi knotting and Phlegm-Blood obstruction, use Baijin Wan (White Gold Pill). If Heart deficiency causes palpitations and restless sleep, use Buxin Dan (Tonify Heart Pill). If Heart Qi deficiency causes the Spirit to lose its residence, use Guishen Dan (Return Spirit Pill) or a large dose of Dushen Tang (Single Ginseng Decoction). For chronic melancholia that does not heal, one must nourish the Spirit and regulate emotions using Guipi Tang (Restore the Spleen Decoction) or Zhonggan Dan (Pillow Center Pill). For chronic mania that does not heal, one must strengthen Water to control Fire using Er Yin Jian (Two Yin Decoction) or Shengshu Yangxin Tang (Raw and Cooked Nourishing Heart Decoction). These are the general principles of treatment, which depend on analyzing the deficiency or excess of pulse and symptoms.
[Melancholia and Mania] Caused by fright and worry, use Baodan Wan (Embrace Gallbladder Pill). Caused by depression and anger, use Anshen Daotan Tang (Calm Spirit and Guide Phlegm Decoction). With both Phlegm and Fire abundant, use Gansui San (Kansui Powder) to induce vomiting or purgation. With sudden congestion of Phlegm-Fire causing bizarre manifestations, use Qingxin Guntan Wan (Clear Heart and Roll Down Phlegm Pill). With Qi knotting transforming into Phlegm and blocking mental clarity, use Siqi Tang (Four Seven Decoction). With Heart heat and restlessness, use Qinlian Qingxin Wan (Scutellaria and Coptis Clearing Heart Pill). With Yin deficiency causing dizziness and collapse, use Ziyin Anshen Tang (Nourish Yin and Calm Spirit Decoction). With Phlegm confusing the Heart orifice, use Jinbo Zhenxin Wan (Gold Foil Settling Heart Pill). With overthinking and stagnation, use Guipi Tang (Restore the Spleen Decoction) added with Chen Sha (Cinnabar). With mental doubt and fear, use Dingzhi Wan (Stabilize Will Pill). With Heart Qi and Blood deficiency, use Qingxin Wendan Tang (Clear Heart and Warm Gallbladder Decoction). After illness, with weak Spirit and timid Qi, use Guishen Dan (Return Spirit Pill). For long-term melancholia with unsettled Spirit and Soul, use Lingyuan Dan (Spirit Garden Pill). For recurrence of cured melancholia, use Duanxian Dan (Stop Epilepsy/Mania Recurrence Pill). For women suffering from melancholia due to blood disharmony, use Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder). There is also a condition of sad weeping and moaning possessed by evil spirits, which is not mania. Burn single-layered silkworm pupal skin (Can Tuizhi) to ash, mix with good wine, and take approximately two qian.
[Mania Symptoms] For excess in the Upper Jiao, apply the method of "suppressing what is high," using Shengtieluo Yin (Raw Iron Drop Drink). For Yangming excess with deep pulse, use Dachengqi Tang (Major Order the Qi Decoction) to purge. For Phlegm-Fire in the upper part, apply the method of "evacuating what is high," using Laisu Gao (Laisu Ointment) and Sansheng San (Three Saints Powder) to induce vomiting for immediate relief. Afterwards, regulate with Xixin San (Wash Heart Powder) and Liangge San (Cool Diaphragm Powder). For cases where form, symptoms, pulse, and Qi are all excess, employ both vomiting and purgation using Shengjin Dan (Winning Gold Pill). For hyperactive Liver-Gallbladder Fire attacking the Heart with Wood, use Jianglong Dan (Subdue Dragon Pill) to suppress. For chaotic Heart Fire, use Huanglian Xiexin Tang (Coptis Draining Heart Decoction). For Phlegm disturbing the Pericardium, use Yujin Wan (Curcuma Pill). For sudden collapse due to Wind-Saliva, use Tongxie San (Unblocking and Purging Powder). For lost soul resembling spirit possession, use Zhenxin Dan (Settle Heart Pill). For damage to Heart Blood due to mental labor causing palpitations and unrest, use Chensha Anzhi Wan (Cinnabar Calming Will Pill). Sorrow moving internally damages the Hun (Ethereal Soul); damaged Hun leads to madness and lack of refinement; treat by using Joy to overcome it, and warm herbs to tonify the Yang of Hun, using Longchi Qinghun San (Dragon Tooth Clearing Hun Powder). Excessive joy damages the Po (Corporeal Soul); damaged Po leads to mania; treat by using Fear to overcome it, and cool herbs to tonify the Yin of Po, using Qingshen Tang (Clear Spirit Decoction). For Lung deficiency with panting and fatigue, add Shashen (Glehniae Radix). For Stomach deficiency with poor appetite, add Renshen (Ginseng Radix et Rhizoma). For Gallbladder deficiency with fright and terror, add Lingyangjiao (Saiga Tataricae Cornu). For mania caused by Heat entering the Blood Chamber, use Xiaochaihu Tang (Minor Bupleurum Decoction) added with Xijiao (Rhinocerotis Cornu) and Shengdihuang (Rehmanniae Radix). For sudden onset of manic speech, needle Shaoshang (LU11) at the corner of the thumbnail about one leek leaf width away. For Liver excess anger causing mania, needle Dadun (LR1) at the corner of the big toenail about one leek leaf width away.