吐、如一时未吐、以硬鹅毛蘸桐油搅喉探吐、吐后人倦、安卧半日、欲食、少少进微温
米饮、切勿多、亦勿热、越日方进米粥、吐后每多口渴、不可饮茶、即取清童便饮之、
或服自己小便、名轮回酒、皆能洗涤余浊、兼解毒
药、（廉勘）此方较龙虎丸稍烈、比张天池红白断狂丸稍轻、方用生白砒、巴豆霜、朱
砂各一钱、面糊为丸、如芥菜子大、每服七八丸、新汲井花水送下。〕以吐顽痰浊涎。
如面色赤亮。或色青赤不常。日夜不寐。月余遂发狂言。逾垣上屋。经闭三月。脉搏长
大有力。多从心火炽盛。燔胃烧肝。而为狂惑哭詈。宜犀羚三黄汤。（犀角、川连各
一钱、羚角、铁粉、桃仁各二钱、鲜生地、丹参、石决明各五钱、琥珀、青黛各
五分、西牛黄二分调服、此方治男子多五六日而愈、治妇女必半月经至而定）。以清心
而泻肝。发狂虽有阴阳虚实。经络脏腑新久之异。要皆必经心肝两脏而发。以心藏神。
主知识。肝藏魂。主云为。未有神魂清醒。而昏狂迷妄至于此极者也。噫。胡君能立此
镇下吐清四大剂。可谓大手笔矣。即其补法两方。亦颇稳健。一参茯安神丸。（人参、
茯神、炒枣仁、当归、生地、酒炒川连、橘红、姜南星各一两、天竺黄五钱、雄黄、
西牛黄各二钱、为末蜜丸、梧子大、朱砂为衣、米饮下五十丸、忌动风辛热荤浊甜腻
之物。）治失志惊狂。经吐下后。大势已瘥。尚有目神昏钝。迷妄无定之状。以此镇心
安神。涤痰清火而痊。一柔肝息风煎。（制首乌、黄甘菊、辰茯神、归身、石斛、川断
、广郁金各三钱、白蒺藜、远志肉各钱半、川芎、明矾各八分。）治肝阴虚。内
风上冒神明。兼挟涎沫。而为失心癫狂。延久不愈。以此柔肝育阴。熄风除涎而愈。赵
晴老谓其善治狂证。洵不愧焉。总之外感发狂。一时之狂也。其死速。其愈亦速。内伤
发狂。终年之狂也。其死缓。其愈亦缓。俞氏分辨阳狂如狂。虽为狂病之正治。然药力
之峻。效验之速。尚不逮胡君在兹手笔之大。故节述之。
【荣斋按】伤寒阳明发狂，与癫狂不同。阳明之狂，因迷走神经起于延髓，终于肠
胃，胃热而迷走神经受炙，以致影响到大脑皮层，于是谵语、发狂出现了。所以阳明发
狂，是由于肠胃的实热壅闭；清其热，通其闭，则神经自安，谵狂便息 。然阳明之狂，
有潮热便闭等症状，而癫狂病则无∶癫狂病有发作性，时剧时已，而阳明病则不然。以
此为辨。至于“阳明发狂”的证治，根据文献记载及临床观察，经过初步的分析，得出
如
下几点∶
关于症状方面──（一）热度在四十度上下，最高是四十一度。（二）情绪及动作
的表现，是∶烦躁不安，神昏呓语，或欲登高而歌，弃衣而走，不能静卧，时或一跃而
起，且能奔走下楼；精神若明若糊，不能自制其行动。初时呼之则神志转清，渐则唤之
亦沉沉昏睡。（三）病重者两手时张时举，手指振颤，举措不全适意，或寻衣，摸床、
撮空。（四）两耳作聋，唇皮颤动，卧时吐气，鼻孔煽动，齿垢唇焦。（五）大小便
秘涩或失禁。（六）呓语约分三类∶一为日常生活或卖买之对答（平日劳心过度之故）
，一为奔走操作之演述（平日劳力过度之故），一为梦见神鬼之怪语（平日向畏鬼神因
高热而神经生幻觉状态）。
关于药治方面──（一）清热解毒安定神经，如犀角、黄连
、牛黄为主要药；佐以石膏、竹沥、金汁、大青叶、板蓝根。（二）镇静神经防止发厥
，如羚角、牛黄、龙胆草。（三）消炎退热，如知母、黄柏、丹皮、赤芍、青黛、花粉
、甘中黄、寒水石、黄芩。（四）清涤神经开窍醒脑，如朱砂、钩勾、冰片、西黄、广
郁金、麝香。（五）清肺化痰，如川贝、桑皮、鲜菖蒲、陈胆星。（六）养营，如生地
、元参、麦冬。其中也有应用下剂的，但须以腹诊及大便是否秘结为准。
又按∶俞氏所说“心风发狂”，体味他叙述的症状，相当于“癫痫”，不能说是发
狂。根据古人治法，应用吐剂以祛肺胃过多的分泌，以减少体内刺激（如张子和尝用瓜
蒂散以治癫痫，东人也屡用之。）安神镇逆以镇静神经；（茯神、远志、枣仁、龙牡等
。）铁剂（如《内经》生铁落饮）以除血结而益贫血；毒剂（如龙虎丸、妙功丸、龙马
自来丹。）以祛痰除毒，亢进血行；辛凉（羚羊、石膏之类）以除脑热；也有用大补气
血，以强壮脑神经。总之，法无一定，俞氏所谓“辨其阴阳虚实，对证发药。”这是要
诀。
（廉勘）这个方子比龙虎丸稍微猛烈一些，但比张天池的红白断狂丸要轻缓。方剂使用生白砒、巴豆霜、朱砂各一钱，用面糊制成药丸，大小如芥菜籽。每次服用七八丸，用新汲取的井水送服，以吐出顽固的痰浊涎沫。如果患者面色红亮，或者颜色青赤不定，日夜无法入睡，一个多月后开始说胡话，甚至翻墙爬屋，女性患者月经停止三个月，脉搏长而大且有力，这多是由于心火炽盛，燔灼胃和肝，从而导致狂乱、哭泣、骂詈等症状。适宜使用犀羚三黄汤。（犀角、川连各一钱，羚角、铁粉、桃仁各二钱，鲜生地、丹参、石决明各五钱，琥珀、青黛各五分，西牛黄二分调服。此方治疗男性患者多在五六日后痊愈，治疗女性患者则需半个月左右才能安定。）以此清心泻肝。发狂虽然分为阴阳虚实，经络脏腑的新久差异不同，但都要经过心、肝两脏而发病。因为心藏神，主宰知识和意识；肝藏魂，主宰行为和动作。没有神魂清醒却昏狂迷妄到这种极点的。唉！胡君能创立这四种镇下吐清的方剂，真可谓大手笔啊。即使是他的两个补益方剂，也相当稳健。一个是参茯安神丸。（人参、茯神、炒枣仁、当归、生地、酒炒川连、橘红、姜南星各一两，天竺黄五钱，雄黄、西牛黄各二钱，研为细末，蜜炼为丸，梧桐子大小，朱砂为衣，米饮送服五十丸，忌食动风、辛热、荤腥、浑浊、甜腻之物。）治疗因失志惊骇导致的发狂，在经历吐法、下法之后，大势已好转，但仍有眼神昏钝、迷妄不定的症状。以此方镇心安神，涤痰清火而痊愈。另一个是柔肝息风煎。（制首乌、黄甘菊、辰茯神、归身、石斛、川断、广郁金各三钱，白蒺藜、远志肉各钱半，川芎、明矾各八分。）治疗肝阴虚，内风上扰神明，兼夹痰涎，导致失心癫狂，拖延日久不愈。以此方柔肝育阴，熄风除涎而痊愈。赵晴老认为他善于治疗狂证，确实当之无愧。总之，外感引起的发狂，是一时的狂病，死亡迅速，痊愈也迅速；内伤引起的发狂，是终年的狂病，死亡缓慢，痊愈也缓慢。俞氏分辨阳狂与如狂，虽然是治疗狂病的正法，但药力的峻猛和疗效的快速，尚不及胡君的这些大手笔，所以节录叙述之。
【荣斋按】伤寒阳明经发狂，与癫狂病不同。阳明经的狂病，是因为迷走神经起于延髓，终于肠胃，胃热熏蒸使迷走神经受热，进而影响大脑皮层，于是出现谵语、发狂的症状。所以阳明发狂，是由于肠胃实热壅闭所致；清除其热，通开其闭，则神经自然安宁，谵语狂乱便会平息。然而阳明发狂，伴有潮热、便秘等症状，而癫狂病则没有这些症状；癫狂病具有发作性，时而剧烈时而缓解，而阳明病则不是这样。以此作为鉴别依据。至于“阳明发狂”的证治，根据文献记载及临床观察，经过初步分析，得出以下几点：
关于症状方面——（一）体温在四十度上下，最高可达四十一度。（二）情绪及动作表现为：烦躁不安，神志昏迷说胡话，或想要登高唱歌，脱衣奔跑，不能安静躺卧，有时一跃而起，还能奔走下楼；精神似清非清，无法控制自己的行为。起初呼唤时神志会暂时清醒，渐渐地即使呼唤也沉沉昏睡。（三）病情重者两手时而张开举起，手指震颤，举动不完全如意，或寻找衣物，抚摸床铺，向空中抓取东西。（四）双耳听力下降，嘴唇颤动，躺着时呼吸粗重，鼻孔煽动，牙齿有垢，嘴唇焦裂。（五）大小便秘涩不通或失禁。（六）胡话大约分为三类：一类是日常生活或买卖交易的对话（因为平日劳心过度），一类是奔走劳作的叙述（因为平日劳力过度），一类是梦见神鬼的怪诞言语（因为平日畏惧鬼神，因高热而产生神经幻觉状态）。
关于药物治疗方面——（一）清热解毒、安定神经，以犀角、黄连、牛黄为主要药物；辅以石膏、竹沥、金汁、大青叶、板蓝根。（二）镇静神经、防止厥逆，如羚角、牛黄、龙胆草。（三）消炎退热，如知母、黄柏、丹皮、赤芍、青黛、花粉、甘中黄、寒水石、黄芩。（四）清涤神经、开窍醒脑，如朱砂、钩藤、冰片、西黄、广郁金、麝香。（五）清肺化痰，如川贝、桑皮、鲜菖蒲、陈胆星。（六）滋养营血，如生地、元参、麦冬。其中也有应用泻下剂的，但必须以腹诊和大便是否秘结为准。
又按：俞氏所说的“心风发狂”，体味他所描述的症状，相当于“癫痫”，不能说是发狂。根据古人的治法，应用吐剂以祛除肺胃过多的分泌物，以减少体内刺激（如张子和曾用瓜蒂散治疗癫痫，东洋人也屡用此法。）；安神镇逆以镇静神经（如茯神、远志、枣仁、龙骨、牡蛎等）；铁剂（如《内经》中的生铁落饮）以消除血结并改善贫血；毒剂（如龙虎丸、妙功丸、龙马自来丹）以祛痰解毒，亢进血液循环；辛凉药物（如羚羊角、石膏之类）以清除脑部热邪；也有使用大补气血的方法，以强壮脑神经。总之，治疗方法没有定式，俞氏所谓“辨别其阴阳虚实，对症用药。”这是关键要领。
(Lian Kan) This prescription is slightly more potent than Longhu Wan (Dragon-Tiger Pill) but milder than Zhang Tianchi's Hongbai Duan Kuang Wan (Red-White Crazy-Prescribing Pill). The formula uses raw white realgar (Bai Pi), castor bean frost (Badou Shuang), and cinnabar (Zhusha), each one qian. These are mixed with wheat paste to form pills the size of mustard seeds. Each dose consists of seven or eight pills, taken with newly drawn well water, to expel stubborn phlegm and turbid saliva. If the patient's complexion is bright red, or fluctuates between cyanotic and red, sleepless day and night, and after more than a month begins to speak nonsense, even climbing walls and roofs; if the female patient has amenorrhea for three months, and the pulse is long, large, and forceful, this is mostly due to blazing heart fire scorching the stomach and liver, leading to madness, crying, and cursing. It is suitable to use Xiling Sanhuang Tang (Rhinoceros Horn and Three Yellows Decoction). [Calculus Cornu Rhinocerotis, Coptidis Rhizoma each one qian; Calculus Cornu Caprae, Ferrum Preparatum, Persicariae Semen each two qian; fresh Rehmanniae Radix, Salviae Miltiorrhizae Radix, Halitostone each five qian; Succinum, Indigo Naturalis each five fen; Bovis Calculus two fen, mixed and taken.] This formula typically cures male patients within five to six days, and stabilizes female patients within half a month. It clears the heart and purges the liver. Although madness may be classified as yin or yang, excess or deficiency, and vary by newness or chronicity in meridians and zang-fu organs, it invariably involves the heart and liver. The heart houses the spirit (Shen) and governs cognition; the liver stores the soul (Hun) and governs motor activity. There is no case where the spirit and soul are clear yet the person falls into such extreme confusion and madness. Alas! Master Hu's establishment of these four major prescriptions for purging, vomiting, clearing, and descending is truly a masterstroke. Even his two tonifying formulas are quite steady. One is Shenfu Anshen Wan (Ginseng and Poria Spirit-Calming Pill). [Ginseng Radix, Poria with Hostwood, fried Ziziphus Seed, Angelicae Sinensis Radix, Rehmanniae Radix, Coptidis Rhizoma wine-fried, Citrus Reticulata Pericarpium, Pinellia Ternata with Ginger each one liang; Hyacinth Bean Meal five qian, Realgar, Bovis Calculus each two qian. Pulverized, honey-pilled to the size of a wutong seed, coated with cinnabar, taken with rice drink, fifty pills per dose. Avoid wind-aggravating, pungent-warm, meaty, turbid, sweet, and greasy foods.] It treats madness caused by loss of will and fright, where after emesis and purgation, the major symptoms have subsided, but there remain dull eyes and indefinite delusions. It calms the heart, nourishes the spirit, eliminates phlegm, and clears fire to achieve recovery. The other is Rougan Xifeng Jian (Liver-Soothing Wind-Extinguishing Decoction). [Prepared Polygoni Multiflori Caulis, Chrysanthemi Flos, Poria with Hostwood, Angelicae Sinensis Radix, Dendrobii Caulis, Achyranthis Bidentatae Radix, Curcumae Aromatica Rhizome each three qian; Tribuli Fructus, Polygalae Radix each one and a half qian, Ligusticum Chuanxiong Rhizome, Alum each eight fen.] It treats liver yin deficiency with internal wind harassing the spirit, accompanied by phlegm-saliva, causing mental derangement and epilepsy that persists chronically. It soothes the liver, nourishes yin, extinguishes wind, and eliminates phlegm to achieve recovery. Zhao Qinglao stated that he excelled in treating mania, which is indeed fitting. In general, mania caused by external contraction is transient; death is rapid, and recovery is also rapid. Mania caused by internal injury is chronic; death is slow, and recovery is also slow. Yu's differentiation of yang mania and "ru kuang" (like-mania) is the orthodox treatment for mania. However, the potency of the drugs and the speed of efficacy do not surpass Master Hu's work here, so I excerpted it.
[Rongzhai's Note] Yangming mania in Shanghan differs from diankuang (epilepsy and mania). Yangming mania arises because the vagus nerve originates in the medulla oblongata and terminates in the gastrointestinal tract. Stomach heat scorches the vagus nerve, affecting the cerebral cortex, thus leading to delirium and mania. Therefore, Yangming mania is caused by excess heat and obstruction in the intestines and stomach; clearing the heat and unblocking the obstruction allows the nerves to settle, and delirium and mania cease. However, Yangming mania presents with tidal fever and constipation, whereas diankuang does not; diankuang is paroxysmal, alternating between severe and remission phases, while Yangming disease is not so. This serves as the basis for differentiation. Regarding the syndrome and treatment of "Yangming Mania," based on literature and clinical observation, preliminary analysis yields the following points:
Regarding symptoms—(1) Body temperature is around 40°C, reaching up to 41°C at its peak. (2) Emotional and behavioral manifestations include: restlessness, coma with muttering, or desire to climb high and sing, discarding clothes and running, inability to lie quietly, sometimes leaping up and running downstairs; consciousness is fluctuating, unable to control actions. Initially, calling them brings temporary clarity; gradually, even calling results in deep sleep. (3) In severe cases, hands open and raise intermittently, fingers tremble, movements are awkward, or they search for clothes, touch beds, or grasp at empty air. (4) Deafness in both ears, trembling lips, heavy breathing while lying, nasal flaring, dental crust, and cracked lips. (5) Constipation or incontinence of urine and feces. (6) Delirious speech is roughly divided into three types: one involves daily life or trade dialogues (due to excessive mental labor); another involves descriptions of physical labor (due to excessive physical labor); the third involves bizarre words about gods and ghosts (due to prior fear of spirits, resulting in neural hallucinations from high fever).
Regarding pharmacological treatment—(1) Clearing heat, detoxifying, and calming the nerves, using Calculus Cornu Rhinocerotis, Coptidis Rhizoma, and Bovis Calculus as main drugs; assisted by Gypsum Fibrosum, Phyllostachys Bambusae Sap, Jinzhi (Gold Juice), Isatidis Folium, and Isatidis Radix. (2) Sedating nerves and preventing jue (syncope/cold extremities), such as Calculus Cornu Caprae, Bovis Calculus, and Gentianae Radix. (3) Anti-inflammatory and antipyretic effects, such as Anemarrhenae Rhizoma, Phellodendri Cortex, Moutan Cortex, Paeoniae Radix Rubra, Indigo Naturalis, Trichosanthis Radix, Gan Zhong Huang, and Hypocoeruleum. (4) Cleansing nerves, opening orifices, and reviving the brain, such as Cinnabaris, Uncariae Ramulus cum Uncis, Borax, Bovis Calculus, Curcumae Aromatica Rhizome, and Moschus. (5) Clearing lungs and resolving phlegm, such as Fritillariae Thunbergii Bulbus, Morus Albae Cortex, fresh Acori Tatarinowii Rhizome, and aged Pinellia Ternata processed with bile. (6) Nourying Ying (nutritive qi), such as Rehmanniae Radix, Scrophulariae Radix, and Ophiopogonis Radix. Among these, purgatives are also used, but must be determined by abdominal diagnosis and whether stool is constipated.
Furthermore: What Yu described as "Xinfeng Fa Kuang" (Heart Wind Causing Mania), when examining his symptom description, corresponds to "Dianxian" (Epilepsy), and cannot be called mania. According to ancient treatments, emetics were applied to remove excessive secretions from the lungs and stomach, reducing internal stimulation (such as Zhang Zihe using Genti San to treat epilepsy, frequently used by Eastern practitioners). Spirit-calming and counter-flow-regulating agents were used to sedate nerves (such as Poria with Hostwood, Polygalae Radix, Ziziphus Seed, Dragon Bone, and Oyster Shell). Iron preparations (such as Shengtie Luo Yin from Neijing) were used to resolve blood stasis and benefit anemia. Toxic agents (such as Longhu Wan, Miaogong Wan, Longma Zilai Dan) were used to expel phlegm, detoxify, and stimulate blood circulation. Acrid-cool herbs (such as Calculus Cornu Caprae, Gypsum) were used to clear brain heat. There were also instances of using massive Qi and Blood tonics to strengthen brain nerves. In short, methods are not fixed. Yu's principle of "differentiating yin and yang, excess and deficiency, and prescribing according to the syndrome" is the key essence.