第九章．治癫狂方

Chapter 9. Herbs for madness and crazy.

1．荡痰汤

1. Dangtan Tang (Dang here means cleansing with strong force; Tan: phlegm).

治癫狂失心，脉滑实者。
This formula is for madness and craziness. The pulse is slippery and strong.

生赭石（二两，轧细） 大黄（一两） 朴硝（六钱） 清半夏（三钱） 郁金（三钱）

Daizheshi 60 gram (grind into fine powder), Dahuang 30 gram, Poxiao 18 gram, Banxia 9 gram, Yujin 9 gram.

2．荡痰加甘遂汤

2. Dangtan jia Gansui Tang

治前证，顽痰凝结之甚者，非其证大实不可轻投。其方，即前方加甘遂末二钱，将他药煎好，调药汤中服。

To treat the same condition as above, but the phlegm is very hardly clotted and hard to dissolve with ordinary herbal therapy. Add herb Gansui powder 6 gram to the previous formula, but drink this herb with help of the herbal tea from above formula.

凡用甘遂，宜为末，水送服。或用其末，调药汤中服。若入汤剂煎服，必然吐出。又凡药中有甘遂，不可连日服之，必隔两三日方可再服，不然亦多吐出。又其性与甘草相犯，用者须切记。
Whenever use herb Gansui, it should be used in powder form and drink with help of water. Or, mix its powder into the herbal tea to drink. If add it into the other herbs to cook, the herbal tea would be vomited out. Again, the herb Gansui should not be used continuously for several days. It must be used once every other two to three days again. Other wise, it would also cause vomit. Its herbal nature conflicts with herb Gancao. This has to be reminded.

甘遂性猛烈走窜，后世本草，称其以攻决为用，为下水之圣药。痰亦水也，故其行痰之力，亦百倍于他药。曾治一少年癫狂，医者投以大黄六两，连服两剂，大便不泻。后愚诊视，为开此方，惟甘遂改用三钱。病家谓，从前服如许大黄，未见行动，今方中止用大黄两许，岂能效乎？愚曰：但服，无虑也。服后，大便连泻七八次，降下痰涎若干，癫狂顿愈。见者以为奇异，彼盖不知甘遂三钱之力，远胜于大黄六两之力也。
Gansui is aggressive, strong and penetrating. Later herb books call it a general in a war to break strong castle, so to cause water-depletion. The phlegm is the water, so its ability to remove phlegm is hundred times stronger than other herbs. There was a young boy with madness and craziness condition. Doctors have given him Dahuang 180 gram for two doses, there was no diarrhea. When I saw him, I used this formula here, but the Gansui was changed to 9 gram. The family said, previously when used Dahuang as that large amount, there was not bowel movement, now, the Dahuang was only 30 gram, how could the formula work? I said, let’s try and see. After take this formula, the boy had bowel movement seven to eight times, with phlegm material in the stool. The madness disappeared. The people who saw this healing course all felt surprising. They do not know that the Gansui 9 gram is much stronger than 180 gram of Dahuang.

痰脉多滑，然非顽痰也。愚治此证甚多。凡癫狂之剧者，脉多瘀塞，甚或六脉皆不见，用开痰药通之，其脉方出，以是知顽痰之能闭脉也。
The pulse for phlegm is slippery, but it does not the sign of a stubborn phlegm yet. I saw such cases a lot. If the madness condition is sever, the pulse is usually blocked, or even the pulse cannot be felt. After cleaning with phlegm-cleansing herbs, the pulse can then be felt again. This indicates that, stubborn phlegm can close the pulse.

癫狂之证，乃痰火上泛，瘀塞其心与脑相连窍络，以致心脑不通，神明皆乱。故方中重用赭石，借其重坠之力，摄引痰火下行，俾窍络之塞者皆通，则心与脑能相助为理，神明自复其旧也。是以愚治此证之剧者，赭石恒有用至四两者，且又能镇甘遂使之专于下行，不至作呕吐也。
The madness or craziness is caused by floating up of the Phlegm-Fire, which blocks the conduction between the Heart and the brain, so the heart-mind is not conducted and the spirit becomes chaotic. In this formula, the large amount of Daizheshi, for its heavy suppressing power, can bring the Phlegm-Fire down, to make the blocked vessels open,  and to re-conduct the Heart and the brain again, so that the Spirit can return its clear and calm status. For this reason, whenever I treated madness condition, the Daizheshi is usually used up to 120 gram, which can also prevent the up-rushing effect, e.g. the side effect of the vomit, caused by the herb Gansui.

癫者，性情颠倒，失其是非之明。狂者，无所畏惧，妄为妄言，甚或见闻皆妄。大抵此证初起，先微露癫意，继则发狂。狂久不愈，又渐成癫，甚或知觉全无。盖此证，由于忧思过度，心气结而不散，痰涎亦即随之凝结。又加以思虑过则心血耗，而暗生内热。痰经热炼，而胶粘益甚，热为痰锢，而消解无从。于是痰火充溢，将心与脑相通之窍络，尽皆瘀塞，是以其神明淆乱也。其初微露癫意者，痰火犹不甚剧也，迨痰火积而益盛，则发狂矣。是以狂之甚者，用药下其痰，恒作红色，痰而至于红，其热可知。迨病久，则所瘀之痰，皆变为顽痰。其神明淆乱之极，又渐至无所知觉，而变为癫证。且其知觉欲无，从前之忧思必减，其内热亦即渐消，而无火以助其狂，此又所以变为癫也。然其初由癫而狂易治，其后由狂而癫难治。故此证，若延至三四年者，治愈者甚少。
The person with the madness condition loses his/her normal personality, fails to identify the right or wrong. The person with craziness fears nothing, talks or speaks without any thinking or consideration. From beginning, the condition shows as mild madness, which gradually developing into the craziness. After a long time without cure, the craziness can become madness again, even without any consciousness. These conditions are due to over thinking, or missing something too much and too deep. The Heart Qi is interweaved together, so the phlegm. Again, the over work of the Heart exhausts Heart blood, so to cause inside Fire. The Phlegm is burned with the Fire, it becomes more stick. The Fire is fold and interweaved by the Phlegm, so becomes much more difficult to expel or to clear. The Phlegm-Fire is stronger and stronger, to block the conduction between the Heart and the mind, so cause the madness of the spirit. In the beginning when there is mild madness, the Phlegm-Fire is not so stronger yet, when the Phlegm-Fire is stronger, the craziness occurs. In the craziness condition, when cleansing by the herbs, the phlegm expelled shows red in color, suggesting the strong Fire in the phlegm. …When the condition is more severe to cause loss of consciousness, the previous over-work of mind reduces, so the inside Fire reduced too. Without the help by the Fire to the craziness, the condition turns to the madness again. However, it is easier when the madness becomes craziness; and it is hard to cure when the craziness turns back to the madness. For this reason, if the disease has been there for three to four year or more, the cure rate is low.  

人之神明，原在心与脑两处。金正希曰：“人见一物必留一影于脑中，小儿善忘者，脑髓未满也，老人健忘者，脑髓渐空也。”汪 庵释之曰：“凡人追忆往事，恒闭目上瞪，凝神于脑，是影留于脑之明征。”由斯观之，是脑原主追忆往事也。其人或有思慕不遂，而劳神想象，或因从前作事差误，而痛自懊 ，则可伤脑中之神。若因研究理解工夫太过，或有将来难处之事，而思患预防，踌躇太过，苦心思索，则多伤心中之神。究之，心与脑，原彻上彻下，共为神明之府。一处神明伤，则两处神俱伤。脑中之神明伤，可累及脑气筋。心中之神明伤，亦可累及脑气筋。且脑气筋伤，可使神明颠倒狂乱，心有所伤，亦可使神明颠倒狂乱也。
The Spirit originally locates in both the heart and the brain (mind). Mr. Jin Zhenxi said: “if person sees a stuff, there would be a memory of it in the brain. That a child is easy to forget, since his brain is not fully developed yet. That a old person is easy to forget, since his brain is to empty.” Mr. Wang An explained this way: “Whenever people try to remember something, he would close the eyes, and focuses on the brain, indicating that the memory is in the brain.” By this, it is the brain that dominates the recite. If a person has something that he cannot get or occupy or obtain, he would image hard. Or, if a person did something wrong before and he regrets too much, it would damage the spirit in the brain. If one works too hard in study, or in understanding something; or there is something that is hard to solve in future, which the person has to think how to solve it; such over-work of brain damages the spirit in the heart. See, the heart and the brain, one is in the upper and one is in the lower. Both are the staying place of the spirit. If the spirit in one place is damaged, that in another place is damaged too. …

曾治一少妇癫狂，强灌以药，不能下咽。遂俾以朴硝代盐，每饭食之，病患不知，月余而愈。诚以朴硝咸寒属水，为心脏对宫之药，以水胜火，以寒胜热，能使心中之火热，消解无余，心中之神明，自得其养，非仅取朴硝之能开痰也。

There was a lady with madness and craziness. She was forced to swallow herbs, but cannot swallow. So, Poxiao (mirabilite) is given to her as cooking salt, to eat every meal. The patient did not know this. The condition is solved after months. This is due to: the Poxiao is salty and cold in herbal nature. It belongs to the Water, which is the conflicting factor the Fire in the Heart. The Water conflicts against the Fire, and the Cold suppress the Hot, so it can clear the Heart Fire, so that the spirit in the Heart turns normal and calm. The healing effect by the Poxiao is not only due to it function to clear the phlegm.  

3．调气养神汤

3. Tiaoqi Yangshen Tang (Tiao: to adjust or to balance; Yang: nourish; Shen: spirit)

治其人思虑过度，伤其神明。或更因思虑过度，暗生内热，其心肝之血，消耗日甚，以致心火肝气，上冲头部，扰乱神经，致神经失其所司，知觉错乱，以是为非，以非为是，而不至于疯狂过甚者。
This formula works for a condition, in which the person has too much mind work that damaged his spirit and consciousness. Due to over-work of the mind, there develops inside Fire in the body, which exhausts the blood in the Heart and Liver, so much so that the Heart Qi and the Liver Qi, both rush up to the brain, to disturb the mind, so that to cause disorder of the nerve system. The person regards the right thing as wrong, and wrong thing as the right, but the condition is not so severe yet.

龙眼肉（八钱） 柏子仁（五钱） 生龙骨（五钱，捣碎） 生牡蛎（五钱，捣碎） 远志（二钱，不炙）生地黄（六钱） 天门冬（四钱） 甘松（二钱） 生麦芽（三钱） 菖蒲（二钱） 甘草（钱半） 镜面朱砂（三分，研细用头次煎药汤两次送服） 磨取铁锈浓水煎药。
Longyanrou 24 gram, Boziren 15 gram, Longgu 15 gram, Muli 15 gram,Yuanzhi 6 gram, Shengdihuang 18 gram, Tianmendong 12 gram, Gansong 6 gram, Maiya 9 gram, Shichangpu 6 gram, Gancao 4.5 gram, Zhusha 1.2 gram (grind into powder,drink it with the herbal tea from other ingredients), Cook this formula with cutler water.

此乃养神明、滋心血、理肝气、清虚热之方也。龙眼肉色赤入心，且多津液，最能滋补血分，兼能保合心气之耗散，故以之为主药：柏子仁多含油质，故善养肝，兼能镇肝，又与龙骨、牡蛎之善于敛戢肝火肝气者同用，则肝火肝气自不挟心火上升，以扰乱神经也；用生地黄者，取其能泻上焦之虚热，更能助龙眼肉生血也；用天门冬者，取其凉润之性，能清心宁神，即以开燥痰也；用远志、菖蒲者，取其能开心窍、利痰涎，且能通神明也；用朱砂、铁锈水者，以其皆能镇安神经，又能定心平肝也；用生麦芽者，诚以肝为将军之官，中寄相火，若但知敛之镇之，或激动其响应之力，故又加生麦芽，以将顺其性，盖麦芽炒用能消食，生用则善舒肝气也。至于甘松，其性在中医用之以清热、开瘀、逐痹；在西医则推为安养神经之妙药，而兼能治霍乱转筋，盖神经不失其所司，则筋可不转，此亦足见安养神经之效也。

This formula works to nourish the spirit, nourish the heart blood, the liver Qi, and to cleansing the Xu Fire. The herb Longyanrou is red in color. It moves into the heart. For its rich in the liquid, it can nourish the heart blood, as wll as to protect the heart qi from disperse. So, it is the main herb in this formula. Boziren is rich in oily stuff, good to nourish the Liver and to suppress the Liver too. If it is used together with the Longgu and Muli, both of which are good to suppress the Liver Qi, they prevent the Liver Fire and Liver Qi from rushing up with the Heart Fire to the brain. Shengdihuang can cleanse the Xu Fire in the Upper Jiao, as well as to help Longyanrou to product more blood. Tianmendong is cooling and lubricating in herbal nature, can clear the Heart and calm down the spirit, e.g. to clear the dry Phlegm. The Yuanzhi and Shichangpo can wake up the heart, clear the phlegm, and conduct the heart to the brain. The Zhusha and cutler water work to calm down the spirit, can calm the Heart and balance the Liver. Maiya (malt), when used without any process, can release the Liver Qi; when used after process (to fry), can help digestion function. The Liver in the body works as a General with aggressive nature. It is the place where the Xiang Fire stays. If only to suppress it, it may rebound back to be more aggressive. So, the Maiya is used to calm it down by following its nature. Gansong works to clear Fire, to disperse stagnation, and to expel the Bi syndrome (block condition in the joints). In the western medicine, it is used as a good medication to calm nerve system, as well as to solve the muscle spasm in cholera, since the muscle would not be spasm if the nerve is not in disorder. Apparently, it is a herb to calm down the nerves.