各种治法均有其相应的适应证候，是建立在辨证论治基础上的，但在现代中医临床上，有时辨证尚需与辨病相结合，才可更好地发挥中医治病的效果。如有关临床资料表明，益气补虚法适用于慢性胃炎的静止期，或萎缩期病变、肠化和不典型增生较明显者；疏肝和胃法适用于有幽门舒缩障碍和存在胆汁返流、引起明显的胃肠病状者；养阴清热法适用于炎症发作期，或第三卷２１４有胃粘膜充血水肿、糜烂出血者；活血化瘀法则可贯穿于治疗过程的始终。因为萎缩性胃炎患者胃粘膜的血流和微循环障碍是其发病的病理学基础，故在辨证用药的前提下，可加入较大剂量的丹参、赤芍、川芎等活血化瘀药，对于改善微循环障碍，消除炎症细胞浸润促进病灶恢复等均有良好的作用。
八、男性不育症治重肾脾男性不育症的主要病因，或先天不足，身体素弱，或幼时手淫斫伤过度，或接触异性过早，或大病后失于调养等。至于病理机制，根据中医基本理论，李氏认为，重点仍在于肾。因五脏藏精气而不泻，特别是肾主蛰，职司封藏。肾藏精，是为真阴，内附命火，是为真阳。真阳真阴寄寓其中，宜于固密而不宜妄泄。若先天不足，或后天失调，导致真阳虚衰，或真阴亏损，容易演变为男性不育之症。
（一）匡扶肾元１肾阳虚证候：阳痿，早泄，或精关不固，常自遗泄。并有头晕目眩，面色苍白，四肢发凉，腰酸腿软，精神不振，舌质淡白，脉沉无力或微细等。
肾中真阳，亦即命门之火，有鼓动肾气、强壮性功能的作用。肾气虚衰，故阳痿，或早泄，或常自遗精；腰为肾府，肾阳不足，所以腰酸腿软；阳气不能上荣，则见眩晕面白；阳气不能外充，则四肢发凉，其舌苔脉象都是阳气虚衰之象。宜温补下元，强壮肾气。
药方：常以右归丸（熟地、山药、山萸肉、熟附、杜仲、枸杞、当归、鹿角胶、菟丝子）或用附子汤（熟附片、人参、白术、白芍、茯苓）加肉苁蓉、淫羊藿、杜仲、巴戟肉、菟丝子、枸杞子等。
阳虚生寒，故男性不育症由于肾阳虚者，其舌脉证候都呈现寒象。治法以温补肾阳为主，因无阳则阴无以化，无阴而阳无以生，故又必兼用育阴滋液补精生髓之品，斯为善治。
治李姓，年逾２０，其父母为之完婚，而智力愚钝，性欲低下，如此数年，家属深以为忧，特来求诊。细询病因，始知幼年曾患慢惊风，遂致身体素亏，发育不良。审其证候，而脉象细弱，面色苍白，四肢不温，喜暖畏寒，绝不似青壮年活泼气氛，是男子不育症属于肾阳虚衰者。治当温补肾阳，益精充髓，促其性功能发育正常为善。遂用附子汤加淫羊藿、制仙茅、炒杜仲、桑椹子、鹿角胶、龟板胶、菟丝子、五味子、枸杞子、补骨脂、胡桃肉、桑螵蛸、肉苁蓉、熟地等出入为方，熬膏常服。越两年身体渐壮，阳事勃兴，其妇已受孕矣。
２肾阴虚证候：阳痿，或早泄，或常自遗精，并有头眩耳鸣，咽干口燥，心烦失眠，腰腿酸软，精神不振等症，舌红绛，脉细数。
肾藏精，为生生之本。肾阳偏虚，相火易于妄动，则阳痿早泄，或常自遗精，而为男性不育症的主要原因。阴虚液燥，虚热内生，故有头昏脑胀、目眩耳鸣、神识不安等症。肾主骨生髓，阴精不足，骨髓失养，故腰腿酸软，精神不振。其舌脉具有阴虚火旺之象。治宜滋阴清热，补肾生精。
方药：常用方如归肾丸（熟地、山药、萸肉、菟丝子、当归、茯苓、杜仲、枸杞子）加龟板胶、淫第三卷２１５羊藿、肉苁蓉、五味子、桑椹子等。
男性不育肾阴虚证的治法，以滋补真阴为主，所谓壮肾水以制阳光，如遇相火偏亢，又宜折火势以救阴液。故诊治此种类型证候，最须权衡于两者之间，是为必要之图。
曾治周某，男，年近３０，结婚数载，未有生育，审其证有颜面潮红，五心时热，心烦口干，夜寐不安，舌绛而苔黄，脉细数，自是阴虚内热证。细询其因，始知少年时迭患手淫遗泄，婚后房事无节，遂致阳事举而不坚，所泄精液稀薄。此时治法，当于育阴滋填中略兼苦寒折其火势。
庶几阳不过亢阴精得所藏宜。处方：知柏地黄汤加白薇、炙龟板、天冬、白芍、炒菟丝子。劝其节制房事，以心不妄动为善。此方连服２０余剂，越月余，再诊：前阴虚内热证象减轻，遂用集灵膏方（西洋参、二冬、二地、淫羊藿）加杜仲、桑椹子、菟丝子、五味子、金樱子、枸杞、山药、萸肉、龟板胶、广鱼鳔胶等药调理久服。后身体强壮，性生活正常，自服药至次年终，喜告已得一子。
上述男性不育症的重点是分肾阳虚、肾阴虚两种类型论治。但遇阴虚和阳虚交错出现的患者，则宜平补之法，以滋阴壮阳，补精益气而促进性功能的生化作用。李氏于临床中在运用古方的基础上，通常采用自制十子育麟汤（膏），方用：枸杞子、五味子、蛇床子、桑椹子、菟丝子、覆盆子、金樱子、益智仁、炒补骨脂、红参、肉苁蓉、鹿角胶、杜仲、淫羊藿、龟板胶、当归、熟地、橘红。水煎服，亦可为丸或膏，颇有良效。
（二）调理肝脾人体五脏六腑是一个有机的整体，相互依存，相互制约。设此平衡局面转为失调，即是病态。故男性不育症的病机重点虽侧重在肾，而肝郁失于调达或脾弱失于运化的患者，也能导致生育功能减弱而为不育症的发病原因。曾治丁某，男，３５岁。已婚数年，阳事不旺而无生育求诊。审其原因，知其性极抑郁，又有胁胀胸痞、嗳气、腰酸早泄、失眠、脉弦细等症状。认为肝郁失达，肾阳亦虚。治法拟滋肾水而不碍肝胃气机之滞，调肝气而有助于生育功能之复。予高鼓峰滋肾生肝散（地黄、山药、萸肉、茯苓、丹皮、泽泻、柴胡、当归、白术、五味子、炙草）加丹参、白芍、玫瑰花以柔肝和营，郁金、枳壳、合欢花以舒郁理气。上方守服出入加减约２０余剂，肝胃气滞减轻。再诊：仍用滋肾生肝散加枸杞、菟丝子、桑椹子、淫羊藿、杜仲、砂仁等以补益肾阴为主，并以胸怀开朗节制房事为劝。由冬至春，服药数月，身体渐壮，早泄已止，其妇已孕矣。
又治李某，男，２０岁。素质脾胃虚寒，每因稍受寒凉饮食失调即触发致病。因主证有纳食少、大便稀溏、舌白、脉弱，治法大抵以健脾温中为主。所用方药如香砂六君汤、理中汤之类。
兼胃寒而痛则加高良姜、制香附；兼嗳气不和则加代赭石、旋复花；兼腹膨不舒加厚朴、大腹皮；兼食物停滞加焦三仙、鸡内金；更有寒热夹杂而里急后重，利下赤白者，则加广木香、炒川连。
如此数年，服之甚适，后处一善后之方，用香砂理中丸兼参苓白术散加芡实、金樱子为丸，常服，不仅脾胃健旺，纳食增加，且其爱人已孕。
男性不育症之由于阳痿者，从来阳事不举，毫无性欲，所谓先天性的，治疗困难；开始无病态，以后因某种原因而出现阳痿，虽检查精子活动力小，如调治得当，而达到促进强化生育机能的作用，也可以徐图恢复。对于中药久服常服，必须树立信心，坚持数月，甚至年许，方能达到理想的效果。在服药期间，如有小效，性情不宜过于急躁，并对房事有所节制，以图巩固疗效。
男性不育症的肾阳虚证治法，虽重在扶阳气的一面，也要考虑阳根于阴的重要性。故在使用温补剂时，必须参入滋阴填精之品，否则久虚之体，又可向阳亢方面转化。又矿物石类的烈第三卷２１６性壮阳药如阳起石、钟乳石、硫磺等与酒类同服，或可取效于一时，稍经久服，多有耗损真阴戕伤真元之弊，需慎用。
治疗男性不育症的辅助单方，应重在日常服食之品，特别是血肉有情之品，所谓“精不足者，补之以味”，有很好的补精益气滋阴壮阳作用。如熟附块、羊肉慢火熬汤常服，对于治疗男性不育症的肾阳虚证，有一定效果。此外，如牛狗外肾、广鱼鳔胶、龟肉、鳖肉、墨鱼、海参、淡菜、紫河车等，皆可服食。又鹿茸、腽肭脐等，如条件许可，也可服用。
九、狂证论治分阳虚阳盛狂之症状，《内经》谓“狂始发，少卧不饥，自高贤也，自辨智也，自尊贵也，善骂詈，日夜不休”；或“狂言，惊，善笑，如歌乐，妄行不休”；或“狂，目妄视，耳妄闻”；或“多食，善见鬼神，善笑而不发于外”（《灵枢·癫狂篇》）。综此数条，实对狂病之具体状态，已描绘尽致，惟妙惟肖。至于狂病病机，《内经》病机十九条，概括为“诸躁狂热皆属于火”（《素问·至真要大论》）；或谓“阳盛”（《素问·阳明脉解篇》）；或云“阳微”（《素问·病能论》）。是狂之病机，实属阳，主动，主燥。
然狂有阳盛阳虚之分，兹结合临床症状为病例说明于次。
（一）阳虚为狂《内经》论狂较详，而侧重在阳盛火狂这一方面。惟仲景治狂，有桃核承气汤、抵当汤方，以治热盛血结者；若桂甘龙牡汤、救逆汤所治烦躁发狂，则是心阳不足，心神外越之阳虚发狂。
《金匮》谓“阳气衰者为狂”（《五脏风寒积聚病脉证并治第十一》），可谓已发其端。考后世医籍，如张石顽云：“妇科郑青山，因治病不顺，沉思辄夜，兼受他医讽言，心甚怀愤。天明病者霍然，愤喜交集。病家设酬之，因讽者已遁，愤无从泄，忽然大叫发狂，同道治之罔效。一日口科王道来往候，索已服未服等方观之，一并毁弃。曰此神不守舍之虚证。岂豁痰理气清火药所能克效哉，遂觅上好人参一两，一味煎汤，服之顿安，三啜而病如失，更与归脾汤调理而康”（《张氏医通》）。
又王孟英治“江某，年３０余，忽面目发赤，牙龈肿痛，渐至狂妄奔走。其父皇皇求孟英诊焉。脉大而数，重按虚散。与东洋参、熟地黄、辰砂、龙齿、磁石、菖蒲、枣仁、琥珀、肉桂、金箔、龙眼肉为剂，投匕而安”。张柳吟云：“昔余友彭香秋患此证，医虽知其虚而治不如法，竞以不起，今读此案，弥增惋叹”（《以上均见《王氏医案续编·卷一》）。
因忆抗战前，族人李某，住汉口观音阁，其妻三十许，患狂病，当时武汉诸前辈，选用牛黄清心丸、石滚痰丸、当归龙荟丸等方均无效，后经武昌杨寿丰药店一杨姓老中医与养心汤（黄芪、炙草、人参、茯苓、茯神、当归、川芎、柏子仁、远志、半夏、肉桂、五味子）重加龙骨、牡蛎，数剂而愈。此是用温补重镇法治狂而效者。
李氏于抗战期间，避难回乡应诊，曾治一朱姓少妇，因避难受惊发狂，杂治无效。诊时见其神情时作惊恐状，间作躁动发狂，面色时赤时白，脉虚细无力，舌淡白少华。断为阳虚而寒，心神浮越之证。急投养心汤重加龙牡，而病告愈。盖此方实具有桂甘龙牡汤、桂枝救逆汤之遗意也。
又治一李姓男子，年５０余，因精神迭受惊恐刺激，发而为狂，用泻火化痰安神治狂诸类药第三卷２１７无效。审其脉微细无力，舌淡白，神情疲惫，时而喃喃独语，时而惊作发狂，尿频汗多。作肾阴阳两虚神气外越之证治之。用芍药甘草附子汤加红参、五味子、磁石、龙牡、茯神数剂而安。是知狂病，有属于阳虚者。若一见狂病，即用治狂类方无效，更不从此多方探索，以为中医学术，不过尔尔，可为告叹。
（二）阳盛为狂针对阳盛发狂病证特点，李氏据其临床实践经验，总结为四种治法而分别论治。
１泻火降逆法泻火降逆法有二：（１）治阳明火热内盛上扰神明发狂者。曾治一李姓患者，因家境素丰，某年完婚前后，饮以参茸补酒，衣以新绵重裘，因受感发热后发狂。邀诊：视其面色通红，口臭唇焦，间见鼻衄，善怒喜躁，有时问答尚清，有时狂言谵语，大便数日未行，小便短赤，苔黄厚，脉滑数，证属阳明热盛显然。拟清泻阳热安定神明法。药用：炒大黄１０克，酒炒川连５克，酒炒黄芩１０克，以泻亢盛之火；生地１５克，白芍１５克，炙草６克，以护其真阴；用生铁落３０克（布包），以平其逆气。煎服。连服５剂，热始平，狂谵始止，继用养血清热安神以善后而愈。
（２）治肝胆气郁相火内发而狂者。曾治一王姓青年，病狂。家人偕来就诊，代诉：因生活问题与人争吵后，遂胸痞不舒，发而为狂。视其目赤善怒，时作太息，间有呃逆，神识有时比较安静，有时发狂奔走，苔黄，脉弦数。治拟平肝泻火，解郁降逆，安神定狂。与大柴胡汤加龙牡、代赭石、茯神等药。再诊：服药３剂后热势遂减，狂象渐轻，仍与前方５剂，并劝其家人设法解决其实际问题，后恢复如常。
阳明热盛而至悍热上冲于脑，引起神志失常而发狂者，有气分热盛而用白虎者，有胃实热结而用承气者，亦有石膏大黄并用之法。李氏认为，用苦寒直折法，能使热势顿挫，狂躁自平，故用途较辛甘寒药为广。仲景谓“若胃气不和谵语者，少与调胃承气汤”，似可为此说一证。肝胆气郁化火而发狂之证，有用龙胆泻肝汤加生大黄、生铁落而效者；有用龙胆泻肝汤间吞服当归龙荟丸；亦有用大柴胡汤加龙牡、赭石而愈者，如上例。用此方治狂较柴胡加龙牡汤为良。
因方中有枳实开泄行气，白芍缓肝和营，而无人参壅补滞气、桂枝辛温助火之弊也。
各种治法均有其相应的适应证候，是建立在辨证论治基础上的，但在现代中医临床上，有时辨证尚需与辨病相结合，才可更好地发挥中医治病的效果。如有关临床资料表明，益气补虚法适用于慢性胃炎的静止期，或萎缩期病变、肠化和不典型增生较明显者；疏肝和胃法适用于有幽门舒缩障碍和存在胆汁返流、引起明显的胃肠病状者；养阴清热法适用于炎症发作期，或第三卷２１４有胃粘膜充血水肿、糜烂出血者；活血化瘀法则可贯穿于治疗过程的始终。因为萎缩性胃炎患者胃粘膜的血流和微循环障碍是其发病的病理学基础，故在辨证用药的前提下，可加入较大剂量的丹参、赤芍、川芎等活血化瘀药，对于改善微循环障碍，消除炎症细胞浸润促进病灶恢复等均有良好的作用。
男性不育症的主要病因，或先天不足，身体素弱，或幼时手淫斫伤过度，或接触异性过早，或大病后失于调养等。至于病理机制，根据中医基本理论，李氏认为，重点仍在于肾。因五脏藏精气而不泻，特别是肾主蛰，职司封藏。肾藏精，是为真阴，内附命火，是为真阳。真阳真阴寄寓其中，宜于固密而不宜妄泄。若先天不足，或后天失调，导致真阳虚衰，或真阴亏损，容易演变为男性不育之症。
（一）匡扶肾元
１肾阳虚证候：阳痿，早泄，或精关不固，常自遗泄。并有头晕目眩，面色苍白，四肢发凉，腰酸腿软，精神不振，舌质淡白，脉沉无力或微细等。
肾中真阳，亦即命门之火，有鼓动肾气、强壮性功能的作用。肾气虚衰，故阳痿，或早泄，或常自遗精；腰为肾府，肾阳不足，所以腰酸腿软；阳气不能上荣，则见眩晕面白；阳气不能外充，则四肢发凉，其舌苔脉象都是阳气虚衰之象。宜温补下元，强壮肾气。
药方：常以右归丸（熟地、山药、山萸肉、熟附、杜仲、枸杞、当归、鹿角胶、菟丝子）或用附子汤（熟附片、人参、白术、白芍、茯苓）加肉苁蓉、淫羊藿、杜仲、巴戟肉、菟丝子、枸杞子等。
阳虚生寒，故男性不育症由于肾阳虚者，其舌脉证候都呈现寒象。治法以温补肾阳为主，因无阳则阴无以化，无阴而阳无以生，故又必兼用育阴滋液补精生髓之品，斯为善治。
治李姓，年逾２０，其父母为之完婚，而智力愚钝，性欲低下，如此数年，家属深以为忧，特来求诊。细询病因，始知幼年曾患慢惊风，遂致身体素亏，发育不良。审其证候，而脉象细弱，面色苍白，四肢不温，喜暖畏寒，绝不似青壮年活泼气氛，是男子不育症属于肾阳虚衰者。治当温补肾阳，益精充髓，促其性功能发育正常为善。遂用附子汤加淫羊藿、制仙茅、炒杜仲、桑椹子、鹿角胶、龟板胶、菟丝子、五味子、枸杞子、补骨脂、胡桃肉、桑螵蛸、肉苁蓉、熟地等出入为方，熬膏常服。越两年身体渐壮，阳事勃兴，其妇已受孕矣。
２肾阴虚证候：阳痿，或早泄，或常自遗精，并有头眩耳鸣，咽干口燥，心烦失眠，腰腿酸软，精神不振等症，舌红绛，脉细数。
肾藏精，为生生之本。肾阳偏虚，相火易于妄动，则阳痿早泄，或常自遗精，而为男性不育症的主要原因。阴虚液燥，虚热内生，故有头昏脑胀、目眩耳鸣、神识不安等症。肾主骨生髓，阴精不足，骨髓失养，故腰腿酸软，精神不振。其舌脉具有阴虚火旺之象。治宜滋阴清热，补肾生精。
方药：常用方如归肾丸（熟地、山药、萸肉、菟丝子、当归、茯苓、杜仲、枸杞子）加龟板胶、淫第三卷２１５羊藿、肉苁蓉、五味子、桑椹子等。
男性不育肾阴虚证的治法，以滋补真阴为主，所谓壮肾水以制阳光，如遇相火偏亢，又宜折火势以救阴液。故诊治此种类型证候，最须权衡于两者之间，是为必要之图。
曾治周某，男，年近３０，结婚数载，未有生育，审其证有颜面潮红，五心时热，心烦口干，夜寐不安，舌绛而苔黄，脉细数，自是阴虚内热证。细询其因，始知少年时迭患手淫遗泄，婚后房事无节，遂致阳事举而不坚，所泄精液稀薄。此时治法，当于育阴滋填中略兼苦寒折其火势。
庶几阳不过亢阴精得所藏宜。处方：知柏地黄汤加白薇、炙龟板、天冬、白芍、炒菟丝子。劝其节制房事，以心不妄动为善。此方连服２０余剂，越月余，再诊：前阴虚内热证象减轻，遂用集灵膏方（西洋参、二冬、二地、淫羊藿）加杜仲、桑椹子、菟丝子、五味子、金樱子、枸杞、山药、萸肉、龟板胶、广鱼鳔胶等药调理久服。后身体强壮，性生活正常，自服药至次年终，喜告已得一子。
上述男性不育症的重点是分肾阳虚、肾阴虚两种类型论治。但遇阴虚和阳虚交错出现的患者，则宜平补之法，以滋阴壮阳，补精益气而促进性功能的生化作用。李氏于临床中在运用古方的基础上，通常采用自制十子育麟汤（膏），方用：枸杞子、五味子、蛇床子、桑椹子、菟丝子、覆盆子、金樱子、益智仁、炒补骨脂、红参、肉苁蓉、鹿角胶、杜仲、淫羊藿、龟板胶、当归、熟地、橘红。水煎服，亦可为丸或膏，颇有良效。
（二）调理肝脾
人体五脏六腑是一个有机的整体，相互依存，相互制约。设此平衡局面转为失调，即是病态。故男性不育症的病机重点虽侧重在肾，而肝郁失于调达或脾弱失于运化的患者，也能导致生育功能减弱而为不育症的发病原因。曾治丁某，男，３５岁。已婚数年，阳事不旺而无生育求诊。审其原因，知其性极抑郁，又有胁胀胸痞、嗳气、腰酸早泄、失眠、脉弦细等症状。认为肝郁失达，肾阳亦虚。治法拟滋肾水而不碍肝胃气机之滞，调肝气而有助于生育功能之复。予高鼓峰滋肾生肝散（地黄、山药、萸肉、茯苓、丹皮、泽泻、柴胡、当归、白术、五味子、炙草）加丹参、白芍、玫瑰花以柔肝和营，郁金、枳壳、合欢花以舒郁理气。上方守服出入加减约２０余剂，肝胃气滞减轻。再诊：仍用滋肾生肝散加枸杞、菟丝子、桑椹子、淫羊藿、杜仲、砂仁等以补益肾阴为主，并以胸怀开朗节制房事为劝。由冬至春，服药数月，身体渐壮，早泄已止，其妇已孕矣。
又治李某，男，２０岁。素质脾胃虚寒，每因稍受寒凉饮食失调即触发致病。因主证有纳食少、大便稀溏、舌白、脉弱，治法大抵以健脾温中为主。所用方药如香砂六君汤、理中汤之类。
兼胃寒而痛则加高良姜、制香附；兼嗳气不和则加代赭石、旋复花；兼腹膨不舒加厚朴、大腹皮；兼食物停滞加焦三仙、鸡内金；更有寒热夹杂而里急后重，利下赤白者，则加广木香、炒川连。
如此数年，服之甚适，后处一善后之方，用香砂理中丸兼参苓白术散加芡实、金樱子为丸，常服，不仅脾胃健旺，纳食增加，且其爱人已孕。
男性不育症之由于阳痿者，从来阳事不举，毫无性欲，所谓先天性的，治疗困难；开始无病态，以后因某种原因而出现阳痿，虽检查精子活动力小，如调治得当，而达到促进强化生育机能的作用，也可以徐图恢复。对于中药久服常服，必须树立信心，坚持数月，甚至年许，方能达到理想的效果。在服药期间，如有小效，性情不宜过于急躁，并对房事有所节制，以图巩固疗效。
男性不育症的肾阳虚证治法，虽重在扶阳气的一面，也要考虑阳根于阴的重要性。故在使用温补剂时，必须参入滋阴填精之品，否则久虚之体，又可向阳亢方面转化。又矿物石类的烈第三卷２１６性壮阳药如阳起石、钟乳石、硫磺等与酒类同服，或可取效于一时，稍经久服，多有耗损真阴戕伤真元之弊，需慎用。
治疗男性不育症的辅助单方，应重在日常服食之品，特别是血肉有情之品，所谓“精不足者，补之以味”，有很好的补精益气滋阴壮阳作用。如熟附块、羊肉慢火熬汤常服，对于治疗男性不育症的肾阳虚证，有一定效果。此外，如牛狗外肾、广鱼鳔胶、龟肉、鳖肉、墨鱼、海参、淡菜、紫河车等，皆可服食。又鹿茸、腽肭脐等，如条件许可，也可服用。
九、狂证论治分阳虚阳盛
狂之症状，《内经》谓“狂始发，少卧不饥，自高贤也，自辨智也，自尊贵也，善骂詈，日夜不休”；或“狂言，惊，善笑，如歌乐，妄行不休”；或“狂，目妄视，耳妄闻”；或“多食，善见鬼神，善笑而不发于外”（《灵枢·癫狂篇》）。综此数条，实对狂病之具体状态，已描绘尽致，惟妙惟肖。至于狂病病机，《内经》病机十九条，概括为“诸躁狂热皆属于火”（《素问·至真要大论》）；或谓“阳盛”（《素问·阳明脉解篇》）；或云“阳微”（《素问·病能论》）。是狂之病机，实属阳，主动，主燥。
然狂有阳盛阳虚之分，兹结合临床症状为病例说明于次。
（一）阳虚为狂
《内经》论狂较详，而侧重在阳盛火狂这一方面。惟仲景治狂，有桃核承气汤、抵当汤方，以治热盛血结者；若桂甘龙牡汤、救逆汤所治烦躁发狂，则是心阳不足，心神外越之阳虚发狂。
《金匮》谓“阳气衰者为狂”（《五脏风寒积聚病脉证并治第十一》），可谓已发其端。考后世医籍，如张石顽云：“妇科郑青山，因治病不顺，沉思辄夜，兼受他医讽言，心甚怀愤。天明病者霍然，愤喜交集。病家设酬之，因讽者已遁，愤无从泄，忽然大叫发狂，同道治之罔效。一日口科王道来往候，索已服未服等方观之，一并毁弃。曰此神不守舍之虚证。岂豁痰理气清火药所能克效哉，遂觅上好人参一两，一味煎汤，服之顿安，三啜而病如失，更与归脾汤调理而康”（《张氏医通》）。
又王孟英治“江某，年３０余，忽面目发赤，牙龈肿痛，渐至狂妄奔走。其父皇皇求孟英诊焉。脉大而数，重按虚散。与东洋参、熟地黄、辰砂、龙齿、磁石、菖蒲、枣仁、琥珀、肉桂、金箔、龙眼肉为剂，投匕而安”。张柳吟云：“昔余友彭香秋患此证，医虽知其虚而治不如法，竞以不起，今读此案，弥增惋叹”（《以上均见《王氏医案续编·卷一》）。
因忆抗战前，族人李某，住汉口观音阁，其妻三十许，患狂病，当时武汉诸前辈，选用牛黄清心丸、石滚痰丸、当归龙荟丸等方均无效，后经武昌杨寿丰药店一杨姓老中医与养心汤（黄芪、炙草、人参、茯苓、茯神、当归、川芎、柏子仁、远志、半夏、肉桂、五味子）重加龙骨、牡蛎，数剂而愈。此是用温补重镇法治狂而效者。
李氏于抗战期间，避难回乡应诊，曾治一朱姓少妇，因避难受惊发狂，杂治无效。诊时见其神情时作惊恐状，间作躁动发狂，面色时赤时白，脉虚细无力，舌淡白少华。断为阳虚而寒，心神浮越之证。急投养心汤重加龙牡，而病告愈。盖此方实具有桂甘龙牡汤、桂枝救逆汤之遗意也。
又治一李姓男子，年５０余，因精神迭受惊恐刺激，发而为狂，用泻火化痰安神治狂诸类药第三卷２１７无效。审其脉微细无力，舌淡白，神情疲惫，时而喃喃独语，时而惊作发狂，尿频汗多。作肾阴阳两虚神气外越之证治之。用芍药甘草附子汤加红参、五味子、磁石、龙牡、茯神数剂而安。是知狂病，有属于阳虚者。若一见狂病，即用治狂类方无效，更不从此多方探索，以为中医学术，不过尔尔，可为告叹。
（二）阳盛为狂
针对阳盛发狂病证特点，李氏据其临床实践经验，总结为四种治法而分别论治。
１泻火降逆法
泻火降逆法有二：（１）治阳明火热内盛上扰神明发狂者。曾治一李姓患者，因家境素丰，某年完婚前后，饮以参茸补酒，衣以新绵重裘，因受感发热后发狂。邀诊：视其面色通红，口臭唇焦，间见鼻衄，善怒喜躁，有时问答尚清，有时狂言谵语，大便数日未行，小便短赤，苔黄厚，脉滑数，证属阳明热盛显然。拟清泻阳热安定神明法。药用：炒大黄１０克，酒炒川连５克，酒炒黄芩１０克，以泻亢盛之火；生地１５克，白芍１５克，炙草６克，以护其真阴；用生铁落３０克（布包），以平其逆气。煎服。连服５剂，热始平，狂谵始止，继用养血清热安神以善后而愈。
（２）治肝胆气郁相火内发而狂者。曾治一王姓青年，病狂。家人偕来就诊，代诉：因生活问题与人争吵后，遂胸痞不舒，发而为狂。视其目赤善怒，时作太息，间有呃逆，神识有时比较安静，有时发狂奔走，苔黄，脉弦数。治拟平肝泻火，解郁降逆，安神定狂。与大柴胡汤加龙牡、代赭石、茯神等药。再诊：服药３剂后热势遂减，狂象渐轻，仍与前方５剂，并劝其家人设法解决其实际问题，后恢复如常。
阳明热盛而至悍热上冲于脑，引起神志失常而发狂者，有气分热盛而用白虎者，有胃实热结而用承气者，亦有石膏大黄并用之法。李氏认为，用苦寒直折法，能使热势顿挫，狂躁自平，故用途较辛甘寒药为广。仲景谓“若胃气不和谵语者，少与调胃承气汤”，似可为此说一证。肝胆气郁化火而发狂之证，有用龙胆泻肝汤加生大黄、生铁落而效者；有用龙胆泻肝汤间吞服当归龙荟丸；亦有用大柴胡汤加龙牡、赭石而愈者，如上例。用此方治狂较柴胡加龙牡汤为良。
Various therapeutic methods have their corresponding indications, which are based on the foundation of syndrome differentiation and treatment. However, in modern clinical practice of Traditional Chinese Medicine (TCM), it is sometimes necessary to combine syndrome differentiation with disease differentiation to better exert the curative effect of TCM. For instance, relevant clinical data indicate that the method of replenishing Qi and tonifying deficiency is suitable for the quiescent stage of chronic gastritis, or for lesions in the atrophic stage with obvious intestinal metaplasia and atypical hyperplasia; the method of soothing the Liver and harmonizing the Stomach is applicable to patients with pyloric sphincter dysfunction and bile reflux causing obvious gastrointestinal symptoms; the method of nourishing Yin and clearing heat is suitable for the inflammatory active stage, or for cases with gastric mucosal congestion, edema, erosion, and bleeding; while the method of invigorating blood and resolving stasis can be贯穿 throughout the entire treatment process. Since hemodynamic and microcirculatory disorders of the gastric mucosa constitute the pathological basis for the onset of atrophic gastritis, under the premise of syndrome-based medication, larger doses of blood-invigorating and stasis-resolving herbs such as Salviae Miltiorrhizae Radix et Rhizoma (Danshen, 丹参), Paeoniae Radix Rubra (Chishao, 赤芍), and Ligusticum Chuanxiong Rhizoma (Chuanxiong, 川芎) can be added. These have good effects on improving microcirculatory disorders, eliminating inflammatory cell infiltration, and promoting lesion recovery.
8. Treatment of Male Infertility Emphasizes Kidney and Spleen
The main etiologies of male infertility include congenital insufficiency with generally weak constitution, excessive masturbation injury in childhood, premature contact with the opposite sex, or lack of proper recuperation after severe illness. Regarding the pathogenesis, according to basic TCM theory, Mr. Li believes that the focus remains on the Kidney. Because the five Zang organs store essence and Qi without draining, especially the Kidney which governs hibernation and is responsible for sealing and storing. The Kidney stores essence, which constitutes True Yin, and contains Mingmen Fire, which constitutes True Yang. True Yang and True Yin reside within, favoring consolidation and stability rather than reckless leakage. If there is congenital insufficiency or postnatal imbalance leading to decline of True Yang or depletion of True Yin, it easily evolves into male infertility.
(1) Supporting the Kidney Origin
1. Syndrome of Kidney Yang Deficiency: Impotence, premature ejaculation, or insecure sperm gate with frequent spontaneous emission. Accompanied by dizziness and vertigo, pale complexion, cold limbs, soreness and weakness of the lower back and legs, listlessness, pale tongue body, and deep, forceless or minute pulse.
True Yang in the Kidney, also known as the Fire of Mingmen, has the function of stimulating Kidney Qi and strengthening sexual function. Due to the decline of Kidney Qi, impotence, premature ejaculation, or frequent spontaneous seminal emission occur; the waist is the mansion of the Kidney, so insufficient Kidney Yang causes soreness and weakness of the lower back and legs; when Yang Qi cannot ascend to nourish, dizziness and pale face appear; when Yang Qi cannot fill the exterior, limbs become cold. The tongue coating and pulse are all signs of Yang Qi deficiency. The treatment should warm and tonify the lower origin and strengthen Kidney Qi.
Prescription: Often use Yougui Wan (Prepared Rehmanniae Radix, Dioscoreae Rhizoma, Corni Fructus, Prepared Aconiti Lateralis Radix, Eucommiae Cortex, Lycii Fructus, Angelicae Sinensis Radix, Cervi Cornu Colla, Cuscutae Semen) or Fuzi Tang (Prepared Aconiti Lateralis Radix Slice, Ginseng Radix, Atractylodis Macrocephalae Rhizoma, Paeoniae Radix Alba, Poria) plus Cynomorii Herba, Epimedii Herba, Eucommiae Cortex, Morinda Officinalis Radix, Cuscutae Semen, Lycii Fructus, etc.
Yang deficiency generates cold, so in male infertility due to Kidney Yang deficiency, the tongue, pulse, and syndromes all present cold manifestations. The treatment focuses on warming and tonifying Kidney Yang. Because without Yang, Yin cannot transform, and without Yin, Yang cannot generate, it is necessary to simultaneously use substances that nourish Yin, moisten fluids, supplement essence, and generate marrow for optimal treatment.
Case: A patient surnamed Li, over 20 years old, whose parents arranged his marriage, exhibited dull intelligence and low libido for several years, causing great worry to his family who sought consultation. Upon detailed inquiry into the etiology, it was learned that he suffered from slow convulsions in childhood, leading to a generally deficient constitution and poor development. Examining his syndrome, the pulse was fine and weak, complexion pale, limbs not warm, preferring warmth and fearing cold, completely lacking the vitality of a young man. This indicates male infertility belonging to Kidney Yang deficiency and decline. The treatment should warm and tonify Kidney Yang, benefit essence and fill marrow, and promote normal sexual function development. Thus, Fuzi Tang was used with additions of Epimedii Herba, Processed Polygonati Odorati Rhizome, Stir-fried Eucommiae Cortex, Mori Fructus, Cervi Cornu Colla, Testudinis Carapax et Plastrum Colla, Cuscutae Semen, Schisandrae Fructus, Lycii Fructus, Psoraleae Fructus, Juglandis Semen, Mangosteen Shell, Cynomorii Herba, Prepared Rehmanniae Radix, etc., modified as needed, decocted into paste for regular consumption. After two years, his physique gradually strengthened, erectile function revived, and his wife became pregnant.
2. Syndrome of Kidney Yin Deficiency: Impotence, premature ejaculation, or frequent spontaneous seminal emission, accompanied by dizziness, tinnitus, dry throat and mouth, irritability, insomnia, soreness and weakness of lower back and legs, listlessness, red and crimson tongue, and fine and rapid pulse.
The Kidney stores essence and is the root of life. If Kidney Yang is relatively deficient, Ministerial Fire tends to move recklessly, causing impotence, premature ejaculation, or frequent spontaneous seminal emission, which are main causes of male infertility. Yin deficiency leads to fluid dryness and endogenous deficiency heat, resulting in dizziness, tinnitus, and mental unrest. The Kidney governs bones and generates marrow; insufficient Yin essence fails to nourish bone marrow, causing soreness and weakness of lower back and legs and listlessness. The tongue and pulse show signs of Yin deficiency with fire hyperactivity. The treatment should nourish Yin and clear heat, tonify Kidney and generate essence.
Formula: Commonly used formulas include Guishen Wan (Prepared Rehmanniae Radix, Dioscoreae Rhizoma, Corni Fructus, Cuscutae Semen, Angelicae Sinensis Radix, Poria, Eucommiae Cortex, Lycii Fructus) plus Testudinis Carapax et Plastrum Colla, Epimedii Herba, Cynomorii Herba, Schisandrae Fructus, Mori Fructus, etc.
For the treatment of Kidney Yin deficiency syndrome in male infertility, the method focuses on nourishing True Yin, i.e., strengthening Kidney Water to control Solar Fire. If Ministerial Fire is hyperactive, it is appropriate to reduce fire intensity to save Yin fluids. Therefore, in diagnosing and treating this type of syndrome, it is essential to weigh between these two aspects.
Case: Patient Zhou, male, nearly 30 years old, married for several years without offspring. Examination showed facial flushing, heat in the five centers, irritability, dry mouth, restless sleep, crimson tongue with yellow coating, and fine rapid pulse, indicating Yin deficiency with internal heat. Detailed inquiry revealed repeated episodes of masturbation-induced emission in youth and unregulated sexual activity after marriage, leading to inability to maintain erection and thin semen. At this time, the treatment should slightly incorporate bitter-cold herbs to reduce fire intensity among substances that nourish Yin and fill essence.
Thus, Yang will not be hyperactive and Yin essence will be stored appropriately. Prescription: Zhi Bai Dihuang Tang plus Anemarrhenae Rhizoma, Calcined Testudinis Carapax et Plastrum, Asparagi Radix, Paeoniae Radix Alba, Stir-fried Cuscutae Semen. Advised to regulate sexual activity and keep the mind calm. After taking this prescription for more than 20 doses, upon re-examination a month later, the signs of Yin deficiency with internal heat had subsided. Then Jiling Gao (American Ginseng, Asparagus Radix, Ophiopogon Radix, Prepared Rehmanniae Radix, Rehmanniae Radix) was used with additions of Eucommiae Cortex, Mori Fructus, Cuscutae Semen, Schisandrae Fructus, Rosa Laevigata Fruit, Lycii Fructus, Dioscoreae Rhizoma, Corni Fructus, Testudinis Carapax et Plastrum Colla, Fish Swim Bladder Colla, etc., for long-term regulation. Subsequently, his physique became strong, sexual life normalized, and by the end of the following year, he happily reported having obtained a son.
The above-mentioned treatment of male infertility focuses on differentiating and treating two types: Kidney Yang deficiency and Kidney Yin deficiency. However, for patients where Yin deficiency and Yang deficiency intermingle, a balanced tonification method should be used to nourish Yin and strengthen Yang, supplement essence and Qi, and promote the biochemical function of sexual capacity. In clinical practice, Mr. Li, based on ancient formulas, usually adopts his self-made Shizi Yulin Tang (Paste), composed of: Lycii Fructus, Schisandrae Fructus, Cnidii Fructus, Mori Fructus, Cuscutae Semen, Rubi Fructus, Rosa Laevigata Fruit, Alpiniae Oxyphyllae Fructus, Stir-fried Psoraleae Fructus, Red Ginseng, Cynomorii Herba, Cervi Cornu Colla, Eucommiae Cortex, Epimedii Herba, Testudinis Carapax et Plastrum Colla, Angelicae Sinensis Radix, Prepared Rehmanniae Radix, Citri Reticulatae Pericarpium Viride. Decocted in water, it can also be made into pills or paste, with good efficacy.
(2) Regulating Liver and Spleen
The five Zang and six Fu organs of the human body form an organic whole, mutually dependent and restraining. If this balance shifts to disharmony, it becomes pathology. Although the pathogenesis of male infertility focuses on the Kidney, patients with Liver Qi stagnation failing to flow freely or Spleen weakness failing to transport and transform can also lead to reduced fertility and cause infertility.
Case: Patient Ding, male, 35 years old. Married for several years, with weak sexual function and no offspring, sought consultation. Investigating the cause, it was found that he was extremely depressed, with distension in the hypochondrium and chest fullness, belching, lower back soreness, premature ejaculation, insomnia, and string-tight and fine pulse. It was considered that Liver Qi stagnation failed to flow, and Kidney Yang was also deficient. The treatment method aimed to nourish Kidney Water without hindering the stagnation of Liver and Stomach Qi mechanism, and regulate Liver Qi to assist the recovery of fertility function. Zishen Shenggan San by Gao Gufeng (Rehmanniae Radix, Dioscoreae Rhizoma, Corni Fructus, Poria, Moutan Cortex, Alisma Rhizoma, Bupleuri Radix, Angelicae Sinensis Radix, Atractylodis Macrocephalae Rhizoma, Schisandrae Fructus, Roasted Licorice Root) was given with additions of Salviae Miltiorrhizae Radix et Rhizoma, Paeoniae Radix Alba, Rosae Rugosae Flos to soften the Liver and harmonize Ying, Curcumae Radix, Aurantii Fructus, Albiziae Cortex to relieve depression and regulate Qi. After taking the above prescription with modifications for about 20 doses, Liver and Stomach Qi stagnation alleviated. Re-examination: Continued using Zishen Shenggan San with additions of Lycii Fructus, Cuscutae Semen, Mori Fructus, Epimedii Herba, Eucommiae Cortex, Amomi Fructus to mainly tonify Kidney Yin, and advised to keep a broad-minded attitude and regulate sexual activity. From winter to spring, after taking medicine for several months, his physique gradually strengthened, premature ejaculation stopped, and his wife became pregnant.
Another case: Patient Li, male, 20 years old. Constitutionally Spleen and Stomach deficient and cold, prone to triggering illness due to slight exposure to cold or dietary irregularities. Main symptoms included poor appetite, loose stools, white tongue coating, and weak pulse. The treatment largely focused on fortifying the Spleen and warming the Middle. Used formulas such as Xiangsha Liujun Tang and Lizhong Tang.
If accompanied by stomach cold and pain, add Galangal Rhizome and Processed Cyperi Rhizome; if accompanied by belching and disharmony, add Magnetitum and Inulae Flos; if accompanied by abdominal distension and discomfort, add Magnoliae Officinalis Cortex and Arecae Pericarpium; if accompanied by food stagnation, add Charred Three Immortals and Chicken Gizzard Membrane; if complicated with cold and heat with tenesmus and passage of red and white discharge, add Aucklandiae Radix and Stir-fried Coptidis Rhizome.
After taking this for several years with great comfort, a follow-up prescription was issued: Xiangsha Lizhong Wan combined with Shenling Baizhu San plus Euryales Semen and Rosa Laevigata Fruit made into pills, taken regularly. Not only did the Spleen and Stomach become robust and appetite increase, but his wife also became pregnant.
Male infertility due to impotence, where there is never erection and absolutely no libido, so-called congenital, is difficult to treat; initially asymptomatic, later developing impotence due to certain reasons, even if sperm motility is low, if treated properly to promote and strengthen reproductive function, gradual recovery is possible. For long-term and regular use of Chinese herbal medicine, one must establish confidence and persist for several months, even a year, to achieve ideal results. During medication, if there is minor efficacy, one should not be too impatient and should regulate sexual activity to consolidate curative effects.
For the treatment of Kidney Yang deficiency syndrome in male infertility, although emphasis is placed on supporting Yang Qi, the importance of Yang rooting in Yin must also be considered. Therefore, when using warming and tonifying agents, substances that nourish Yin and fill essence must be incorporated; otherwise, a chronically deficient body may transform towards Yang hyperactivity. Also, mineral and stone-type potent yang-tonifying drugs such as Crocidolite (Yangqishi), Speleothem (Zhonglushi), and Sulfur (Liuhuang) taken with alcohol may yield temporary results, but long-term use often damages True Yin and harms True Yuan, requiring caution.
Auxiliary single prescriptions for treating male infertility should emphasize daily dietary items, especially those of "flesh and blood" nature, as stated in "Where essence is insufficient, tonify with flavor," having good effects of supplementing essence, benefiting Qi, nourishing Yin, and strengthening Yang. For example, simmering prepared Aconite chunks and mutton slowly for soup and consuming it regularly has certain effects on treating Kidney Yang deficiency syndrome in male infertility. Additionally, bull and dog testes, fish swim bladder colla, turtle meat, softshell turtle meat, cuttlefish, sea cucumber, dried mussel, placenta (Ziheche), etc., can all be consumed. Also, Deer Antler Velvet (Lurong) and Otter Penis (Nayuqi), if conditions permit, can be taken.
9. Discussion on Treatment of Mania Divided into Yang Deficiency and Yang Excess
Symptoms of mania, according to *Neijing*, state: "Mania begins with little sleep and no hunger, considering oneself wise and virtuous, intelligent, noble, cursing constantly day and night"; or "mad speech, fright, laughing well, like singing music, walking wildly without rest"; or "mania, eyes seeing hallucinations, ears hearing hallucinations"; or "eating much, seeing ghosts and gods frequently, laughing but not expressing it externally" (*Ling Shu: Dian Kuang Pian*). Summarizing these points, the specific state of mania is depicted vividly. Regarding the pathogenesis of mania, the nineteen pathogenesis clauses in *Neijing* summarize it as "all restlessness, heat, and mania belong to Fire" (*Su Wen: Zhi Zhen Yao Da Lun*); or "Yang Excess" (*Su Wen: Yangming Maijie Pian*); or "Yang Micro" (*Su Wen: Bingneng Lun*). Thus, the pathogenesis of mania truly belongs to Yang, governing movement and dryness.
However, mania is divided into Yang Excess and Yang Deficiency. Here, combined with clinical symptoms, cases are explained below.
(1) Yang Deficiency Causing Mania
*Neijing* discusses mania in detail, focusing on Yang Excess and Fire Madness. However, Zhang Zhongjing's treatments for mania include Taohe Chengqi Tang and Didang Tang to treat heat excess with blood stasis; whereas Guigan Longmu Tang and Jiuni Tang treat irritability and mania caused by Heart Yang deficiency and floating of Shen Spirit, which is Yang deficiency causing mania.
*Jingui Yaolue* states "those with declining Yang Qi suffer from mania" (*Wuzang Fenghan Jiju Bing Maizheng Bingzhi Di Shiyi*), which can be said to have opened the beginning. Examining later medical records, Zhang Shiwan wrote: "Gynecology patient Zheng Qingshan, due to unsuccessful treatment, pondered deeply at night, and was influenced by other doctors' sarcastic remarks, harboring great resentment. At dawn, the patient suddenly recovered, mixed with anger and joy. The family prepared rewards, but since the mocker had fled, anger had no outlet. Suddenly shouting and going mad, colleagues' treatments were ineffective. One day, Dr. Wang Dao visited, asked to see prescribed and unprescribed formulas, destroyed them all, saying 'This is a deficiency syndrome where Shen does not dwell in its house. How can phlegm-resolving, Qi-regulating, and fire-clearing drugs be effective?' He then found high-quality Ginseng Radix, one liang, decocted alone, and after taking it, peace returned instantly. After three doses, the illness vanished, and Guipi Tang was given for regulation until recovery" (*Zhangshi Yitong*).
Also, Wang Mengying treated "Patient Jiang, over 30 years old, suddenly developed red face and gums, swelling and pain, gradually becoming wild and running around. His father anxiously sought Wang Mengying's diagnosis. Pulse was large and rapid, void and scattered upon heavy pressure. Prescribed Japanese Ginseng, Prepared Rehmanniae Radix, Cinnabaris, Dragon Teeth, Magnetitum, Acori Tatarinowii Rhizome, Ziziphus Spinosa Seed, Succinum, Cinnamon Bark, Gold Leaf, Longan Aril as a dose, and after one spoonful, peace was achieved." Zhang Liuyin commented: "My friend Peng Xiangqiu suffered from this syndrome. Although doctors knew it was deficiency, the treatment was improper, and he eventually died. Reading this case now increases my sighs of regret" (All from *Wangshi Yi'an Xubian, Volume 1*).
Recalling before the Anti-Japanese War, a clansman named Li lived in Guanyin Ge, Hankou. His wife, around thirty, suffered from mania. Various senior doctors in Wuhan chose Niuhuang Qingxin Wan, Shi Dan Gun Tan Wan, Danggui Longhui Wan, etc., all ineffective. Later, an old TCM doctor surnamed Yang from Yang Shoufeng Pharmacy in Wuchang used Yangxin Tang (Astragali Radix, Roasted Licorice Root, Ginseng Radix, Poria, Poria Cum Radix Dendrobii, Angelicae Sinensis Radix, Ligusticum Chuanxiong Rhizome, Biota Orientalis Seed, Polygalae Radix, Pinelliae Rhizoma, Cinnamon Bark, Schisandrae Fructus) heavily supplemented with Dragon Bones and Oyster Shell, cured in a few doses. This is an example of using warming, tonifying, and heavy sedation to treat mania effectively.
During the Anti-Japanese War, Mr. Li took refuge in his hometown and consulted. He once treated a young woman surnamed Zhu who went mad from fright during evacuation, with miscellaneous treatments ineffective. On examination, her expression showed intermittent fear, occasional agitation and madness, complexion alternating between red and white, pulse void, fine, and forceless, tongue pale and lacking luster. Diagnosed as Yang deficiency with cold and floating Shen Spirit. Urgently administered Yangxin Tang heavily supplemented with Dragon Bones and Oyster Shell, and the illness was cured. This formula actually carries the intention of Guigan Longmu Tang and Guizhi Jiuni Tang.
He also treated a male patient surnamed Li, over 50 years old, who went mad after repeated mental fright stimuli. Treatments using fire-purging, phlegm-resolving, and spirit-calming drugs for mania were ineffective. Examining his pulse, it was minute, fine, and forceless; tongue pale; expression exhausted; occasionally muttering alone, occasionally frightened and going mad; frequent urination and sweating. Treated as Kidney Yin and Yang dual deficiency with Shen Qi floating outward. Using Shaoyao Gancao Fuzi Tang plus Red Ginseng, Schisandrae Fructus, Magnetitum, Dragon Bones, Oyster Shell, Poria Cum Radix Dendrobii for a few doses brought peace. Thus, we know that mania can belong to Yang deficiency. If one sees mania and immediately uses mania-treating formulas without effect, and does not explore further, thinking TCM academic knowledge is merely so-so, this is lamentable.
(2) Yang Excess Causing Mania
Targeting the characteristics of Yang Excess causing mania, Mr. Li summarized four treatment methods based on clinical experience for separate discussion.
1. Purging Fire and Descending Rebellious Qi
Purging Fire and Descending Rebellious Qi has two aspects:
(1) Treating Yangming Fire Heat internally abundant and disturbing the Shen Spirit causing mania. Case: A patient surnamed Li, from a wealthy family, around the time of his wedding, drank ginseng and deer antler tonic wine, wore new cotton and heavy furs, and after catching a cold and fever, went mad. Consultation: Face bright red, bad breath, scorched lips, occasional epistaxis, prone to anger and irritability, sometimes answering clearly, sometimes speaking madly and deliriously, bowel movements absent for several days, urine short and red, thick yellow tongue coating, slippery and rapid pulse. Clearly a syndrome of Yangming Heat Excess. Proposed method: Clear and purge Yang heat to stabilize Shen Spirit. Medicinals: Stir-fried Rheum Palmatum Rhizome 10g, Wine-fried Coptidis Rhizome 5g, Wine-fried Scutellariae Radix 10g to purge excessive fire; Prepared Rehmanniae Radix 15g, Paeoniae Radix Alba 15g, Roasted Licorice Root 6g to protect True Yin; Raw Iron Filings 30g (wrapped in cloth) to calm rebellious Qi. Decoct and take. Taken for 5 doses continuously, heat began to subside, madness and delirium stopped, followed by blood-nourishing, heat-clearing, and spirit-calming for aftermath and recovery.
(2) Treating Liver and Gallbladder Qi Stagnation with Ministerial Fire erupting internally causing mania. Case: A young man surnamed Wang, suffering from mania. Family accompanied him to consult, reporting: After arguing with others over life problems, chest fullness and discomfort ensued, leading to mania. Examination: Red eyes, prone to anger, occasional sighing, occasional hiccups, consciousness sometimes relatively quiet, sometimes running around wildly, yellow tongue coating, string-tight and rapid pulse. Treatment proposed: Calm Liver, purge fire, resolve depression, descend rebellious Qi, calm Shen and settle mania. Given Dachaihu Tang with additions of Dragon Bones, Oyster Shell, Magnetitum, Poria Cum Radix Dendrobii, etc. Re-examination: After 3 doses, heat trend decreased, mania signs gradually lightened, still given previous prescription for 5 doses, and advised family to solve practical problems, subsequently recovered normally.
When Yangming Heat Excess leads to fierce heat rushing up to the brain, causing mental disorder and mania, there are cases of Qi level heat excess using Baihu Tang, stomach excess heat binding using Chengqi Tang, or combined use of Gypsum and Rheum. Mr. Li believes that using bitter-cold direct suppression method can abruptly curb heat trend and calm mania, thus its application is broader than acrid-sweet-cold medicines. Zhongjing stated "If Stomach Qi is disharmonious with delirious speech, give small amounts of Tiaoweichengqi Tang," which seems to prove this point. For Liver and Gallbladder Qi stagnation transforming into fire causing mania, there are effective cases using Longdan Xiegan Tang plus raw Rheum and raw Iron Filings; using Longdan Xiegan Tang intermittently swallowing Danggui Longhui Wan; or using Dachaihu Tang with Dragon Bones, Oyster Shell, Magnetitum for cure, as in the above case. Using this formula to treat mania is superior to Chaihu Jiulongmu Tang.
Because the formula contains Zhi Shi to open and drain Qi movement, Bai Shao to soothe Liver and harmonize Ying, and lacks the drawbacks of Ren Shen clogging and stagnating Qi, and Gui Zhi being acrid-warm assisting fire.