Shanxi refers to the symptom of frequently laughing without reason, even when there is no joyful event or during times when one is not happy.

This condition, Lingshu. Jingmai chapter is referred to as "incessant laughter," Lingshu. Benshen chapter calls it "continuous laughter" and also "good laughter."

bubble_chart Pattern Analysis

1. Exuberance of Heart Fire︰Laughing frequently, or even manic raving and incoherent speech, dysphoria and restlessness, thirst with a preference for drinking, mouth and tongue sores, a red face and tongue, and a rapid pulse. This belongs to an excess pattern, as mentioned in the Lingshu．Benshen chapter: "The heart governs the vessels… in excess, there is incessant laughter"; and in Shoushi Baoyuan: "Incessant laughter is due to the blazing of heart fire." In the emotions, the heart corresponds to joy, and in sound, to laughter. If heart fire is excessive, the spirit has no abode, leading to abnormal laughter. Liu Hejian also said: "Those who laugh excessively all have exuberant heart fire. Among the Five Phases, only fire is associated with laughter. To treat incessant laughter with drooling, use Coptis Detoxification Decoction with Pinellia, ginger juice, and bamboo juice, and the laughter will cease." The key points for clinical diagnosis are: incessant laughter accompanied by mouth and tongue sores, thirst with a desire for cold drinks, a reddened tongue tip, and other symptoms and signs of exuberant heart fire. Treatment should aim to clear and drain heart fire, using Coptis Detoxification Decoction or Heart-Draining Decoction.
2. Non-interaction between Heart and Kidney︰He is prone to frequent laughter, accompanied by soreness and weakness in the waist and knees, insomnia with dreamfulness, vexing heat in the chest, palms, and soles, seminal emission, tinnitus, a red tongue with scant coating, and a thready, rapid pulse. This belongs to a deficiency pattern, often caused by the depletion of kidney water, which fails to nourish the heart, leading to the upward floating of heart fire and the loss of mental control, resulting in excessive laughter. The key clinical diagnostic points include persistent laughter combined with soreness and weakness in the waist and knees, tidal fever, night sweats, seminal emission, tinnitus, a red tongue with scant coating, and a thready, rapid, and weak pulse—all signs of kidney yin deficiency. The treatment should focus on tonifying the kidneys and strengthening water, nourishing yin and reducing fire. The recommended formula is the Six-Ingredient Rehmannia Decoction, embodying Wang Bing’s principle of "strengthening the source of water to control excessive yang."
3. Phlegm-fire Disturbing Heart︰Laughing uncontrollably, dysphoria with a bitter taste in the mouth, palpitations and forgetfulness, easily startled during sleep, yellow and greasy tongue coating, and rapid pulse. This condition is often caused by emotional distress, which leads to stagnation affecting the spleen and obstructing the stomach, accumulating dampness and producing phlegm. The phlegm stagnates and transforms into fire, which disturbs the heart orifice and clouds mental activity, resulting in uncontrolled laughter. The key clinical diagnostic points are: despite signs of heat such as irritability, restlessness, a red tongue, and rapid pulse, the laughter is accompanied by drooling, and the tongue coating is invariably yellow, thick, and greasy. Treatment should focus on clearing phlegm and reducing fire, as well as clearing the heart and tranquilizing the spirit. The recommended formula is Modified Gallbladder-Warming Decoction. Leizheng Zhicai records a case: "Ms. Wang, talking and laughing alone, with excessive phlegm and qi depression, was treated with Gallbladder-Warming Decoction, which reduced the phlegm disturbing the heart and stopped the drooling, showing effectiveness after several doses."
4. Liver Depression Transforming into Fire︰Mood swings, laughing without reason at times, distension and fullness in the chest and hypochondrium, irritability and暴躁, frequent nightmares, a red tongue, and a wiry, rapid pulse. Liver qi should flow smoothly and despises depression. If unfulfilled desires lead to anger damaging the liver, then the free flow and discharge functions become impaired, resulting in depression and stagnation of qi movement. Prolonged stagnation transforms into fire, and the wood-fire connects with the heart-fire, leading to blazing of heart-liver fire, which causes the spirit and soul to lose their anchorage, resulting in incessant laughter. Leizheng Zhicai records a medical case: "Mr. Wang developed mania due to depression, laughing, cursing, and prone to anger, with a red face and eyes, and a surging, large pulse. This is due to sudden暴析of yang qi, triggered by anger, leading to loss of control over wood-fire and hot phlegm ascending to the pericardium, known as heat reversal." The key points of clinical differentiation are: frequent laughter accompanied by distension or wandering pain in the chest and hypochondrium, irritability, red eyes, and a wiry, rapid, forceful pulse, which are signs of liver depression transforming into fire due to stagnation. Treatment should aim to soothe the liver and regulate qi, clear fire and drain heat. The recommended formulas are Green-Blue-Draining Pill or Gentian Liver-Draining Decoction.

bubble_chart Documentation

1. Suwen-Wuchangzheng Da Lun: "The era of Hexi,... its diseases include laughing malaria, sores and ulcers, wild blood flow, and red eyes."
2. Lingshu-Benshen chapter: "The lungs, when excessively joyful, will harm the soul."
3. Leizheng Zhicai medical case: "A young man's emotions are not fulfilled,... he speaks and laughs alone.... It is due to the liver and gallbladder malpractice of heat therapy, directly attacking, directly attacking the Danzhong...."