Dian is a manifestation of abnormal mental state, with the initial onset characterized by emotional distress, soon followed by mental confusion and incoherent speech. Shoushi Baoyuan states: "Dian refers to abnormal laughter and chaotic behavior." It is commonly known as "literary madness."

This condition was first documented in Neijing. Suwen. Qibing Lun and Lingshu. The chapter on manic and depressive psychosis discusses it. In ancient times, epilepsy and dian were not clearly distinguished as two separate conditions. Zhubing Yuanhou Lun, Volume 45: "Those above ten years old are considered dian, while those below ten are considered xian (epilepsy)." Jingyue Quanshu. The chapter on manic and depressive psychosis and dementia states: "Dian is the same as xian. Observing Neijing, the description of dian is very detailed, while xian is not distinguished, which makes it clear." Later generations distinguished xian from dian by its symptoms: seizures occurring at any time, accompanied by spasms, fainting, foaming at the mouth, and normal consciousness after waking. This section only discusses dian.

bubble_chart Pattern Analysis

1. Phlegm and Qi Stagnation︰It manifests as mental depression, indifferent expression, vacant gaze, abnormal behavior, or inappropriate crying and laughing, incoherent speech, or muttering to oneself, hallucinations, frequent grimacing, silence, accompanied by irritability, restless sleep, sluggishness in daily life, poor appetite, thin and greasy tongue coating, and mostly wiry-slippery pulse. It is mostly caused by excessive contemplation and unfulfilled desires; or due to fright and terror, leading to counterflow of qi and blood, stagnation of qi and accumulation of fluids, which congeal into phlegm. The phlegm confuses the heart orifices, resulting in impaired mental activity, as mentioned in Jingyue Quanshu·Manic and Depressive Psychosis and Dementia: "Depressive psychosis is mostly caused by phlegm. Whenever qi rebels and phlegm stagnates, it can block the collaterals and obstruct the heart orifices." The key points of pattern identification include not only abnormal mental states and incessant talking and laughing but also poor appetite and a thin, greasy tongue coating due to phlegm-turbidity obstructing the middle. Phlegm and qi depression binding leads to a mostly wiry-slippery pulse. Treatment should focus on regulating qi and relieving depression, resolving phlegm for resuscitation. The recommended formula is Gallbladder-Warming Decoction with the addition of Acorus, Milkwort Root, and Curcuma Root. For severe cases, Three Sages Powder can be used to induce vomiting.
2. Deficiency of Both Heart and Spleen︰It manifests as being dumb as a wooden chicken, slow in response, absent-minded, palpitation and easily frightened, emotional decline, prone to sadness and crying, fatigue in limbs, unaware of cleanliness, complexion lacking luster, reduced appetite, tongue texture pale, and weak and thin pulse. It is often caused by prolonged illness, which depletes the heart and spleen. Spleen impairment leads to insufficient qi and blood supply, while heart impairment results in the failure of the mind to be nourished, leading to failure of the mind to keep to its abode, thus causing mania. The key points of pattern identification are absent-mindedness, dementia and sluggishness, complexion lacking luster, pale tongue, and thin pulse. The treatment should focus on nourishing the heart and tranquilizing the mind, strengthening the spleen, and replenishing blood. The recommended prescription is Heart-Nourishing Decoction.

bubble_chart Documentation

1. Linzheng Zhinan Yi'an．Epilepsy: "Epilepsy arises from accumulated worry and depression, affecting the heart, spleen, and pericardium. The three yin are obstructed and cannot disperse, hence qi depression leads to phlegm confusion, and the mind becomes muddled... For the substantial type of epilepsy, use the Rolling Phlegm Pill to open phlegm blockages, and the clearing heart pill to relieve fire stagnation. For the deficient type, nourish the spirit and clear the mind, with treatments like Guipi and Zhenzhong."
2. Zhengzhi Huibu．Manic and Depressive Psychosis: "There are cases where seeing, hearing, speaking, and moving are all delusional, even to the extent of speaking about things never seen or heard before, and seeing five-colored spirits and ghosts. This is due to extreme deficiency of qi and blood, insufficient spiritual light, or accompanied by phlegm-fire, blocking mental activity. It is not truly a haunting, and should be treated according to the symptoms."