Glossary

A disorder that refers to any sort of severe madness. It is often translated as "mania-withdrawal" or "manic-depression" based on the meaning of the two characters:

癲 Dian can be broken down to the radical for disease next to a character that can mean "the top of the head; to jolt or upset; or to turn things upside down". Hence, it is a disease where one's head is turned upside down. The Nan Jing ch. 20 says that "Excess of Yin causes Dian" suggesting various Yin types of mental illness with symptoms like withdrawal, crying and catatonic states.

狂 Kuang uses the radical for a dog next to the character for a king suggesting acting like a wild dog alpha male. The Nan Jing ch. 20 says that "Excess of Yang causes Kuang" suggesting various Yang types of mental illness with excessive talking, shouting, or inappropriate, erratic behaviour. Su Wen ch. 74 simply says "Kuang Syndrome is due to Fire" and ch. 46 says that "Kuang is due to Yang ... and is treated with the formula Sheng Tie Luo Yin (Iron Filings Drink)" but without giving any specific recipe for this formula (the formula by Cheng Guo-Peng was devised over 1500 years later just using its namesake).

However, it can refer to almost any form of severe mental disturbance, the compound character being used to designate that it may refer to either form of illness and not exclusively disorders that involve a cycling between the two states. Besides these short etiologies given above, the most revealing chapters of the Nei Jing are Su Wen ch. 30 and Ling Shu ch. 22 which provide detailed descriptions of the symptoms, progression differential diagnosis and treatment strategies.

Su Wen ch. 30 gives a colourful description of Yangming Syndrome as a kind of mania disorder that involves "aversion to people and to fire" and is "frightened when he hears the sound of wood." He "throws off his clothes and runs around, he climbs on what is high and sings. In some cases he even fails to eat for several days and [yet] he leaps over walls, and he climbs on houses." He speaks "absurd words and voices insults, without sparing those near or distant to him." These are explained as being due to excessive Heat in the Yangming that gives the patient impressive energy and physical stamina, but causes him to feel hot and want to strip off to cool down and hates the heat. The fear of wood sounds comes from the fact that Wood controls Earth in the Five Phase cycle. However, when this Yangming Qi reverses, he "pants and is distressed" and experiences the "aversion to people" which can be fatal if it reaches the Zang, possibly referencing suicide during the depressive phases, but is survived if it only affects the Channels. However, it does not given any therapeutic advice.

Ling Shu ch. 22 gives detailed instructions on how to treat Dian-Kuang with acupuncture according to differentiation of symptoms.

• In the early stages of depression when the patient loses his cheer, his head is heavy and aches, and the heart is vexed, bleed the Hand Yangming, Taiyang and Taiyin Channels, stopping as soon as the colour of the blood changes.
• In the early stages of wailing, shouting and being perturbed, it shows in the Hand Yangming, Taiyang and the disease should be bled from the opposite side.
• In the early stages when the back is bent backward and stiffens, with pain in the spine, this shows in the Foot Taiyang, Yangming, Taiyin, and Hand Taiyang. If the Blood is not excited, 20 cones of moxa can be burnt on the tailbone (Changqiang Du-1).
• When Dian-Kuang involves the Sinews, the body is tired and cramps, then pierce Dazhu Bl-11.
• If it involves the Mai, and they suddenly fall to the ground, the Mai in the four extremities are all swollen and relax. If they are full, they must be bled. If they are not full, moxa is to be applied on the Taiyang Channel on both sides of the nape (Tianzhu Bl-10), on the Dai Mai at Zhishi Bl-52 and on all partings of the flesh at the root Shu points (本輸).
• In the early onset, when grieved about himself, forgetful, easily enraged, and fearful because they are sad and hungry, bleed Hand Taiyang Yangming Channels, stopping as soon as the blood changes. Foot Taiyin and Yangming can also be chosen.
• When they sleep little, are not hungry, use insulting words and do not rest at day or night, bleed any abundant Mai in the Hand Yangming, Taiyang and Taiyin Channels, as well as below the tongue (Jinjin & Yuye) and from the Shaoyin Channel.
• Those who speak madly, are startled, tend to laugh, love to sing and be happy, make absurd movements and find no rest, have become mad because of a massive fright. Blood must be removed from the Hand Yangming, Taiyang and Taiyin Channels.
• Madness with absurd visions, hearing absurd sounds, and a tendancy to shout caused by a dimunition of Qi can be treated by bleeding the Hand Taiyang, Taiyin and Yangming, and the Foot Taiyin on both cheeks (which is strange as neither Taiyin Channel goes up to the face).
• If they are mad and eat a lot, tend to see demon-spirits, laugh but cannot express outwardly, it is caused by a major delight and can be treated by removing blood from the Foot Taiyin, Taiyang and Yangming Channels, followed by the Hand Taiyin, Taiyang and Yangming Channels.
• When a madness has just started and not yet manifested into one of the patterns above, it can be stopped quickly by bleeding the moving vessels (where a pulse is felt) to the left and right of Ququan Liv-8. If it is not cured, differentiate according to the patterns above and burn 20 moxa cones on Changqiang Du-1
• If it is due to External Wind invasion and the extremities are suddenly swollen, they sweat profusely, moan, occasionally feel cold, and gets irritable when hungry, bleed from the outer and inner sections of the Hand Taiyin, Foot Shaoyin and Yangming. If the flesh is cool, remove through the Ying-Spring points; if the bones are cold, remove through the Jing-Well and Jing-River points.
• If Qi is receding and rebelling, the feet suddenly become cool, the chest feels as if it were about to burst, the intestines feel as if someone cut them with a knife, they are vexed and cannot eat, and the big and small pulses are rough. If the feet are warm, bleed the Foot Shaoyin Channel and drain them; if they are cool, bleed from the Foot Yangming and supplement them.
• If Qi is receding and rebelling, the abdomen swells, there are intestinal noises, with fullness in the chest and shortness of breath, bleed the two flanks below the chest. If they move their hands when they cough, the Back-Shu points can be pressed to bring immediate relief.
• If there is an internal blockage preventing urination, pierces the Foot Shaoyin and Taiyang Channels, as well as above the tailbone (Yaoshu Du-2) with a long needle.
• When the Qi rebels, it can be removed from the Taiyin and Yangming Channels. If the recession is extreme, choose the Shaoyin and Yangming where a movement occurs (i.e. a pulse, suggesting arterial bleeding).
• If Qi is diminished, they sweat profusely, they pant when they speak, the bones ache, the body feels heavy, they lack energy and cannot move. Supplement Foot Shaoyin. If breathing is short and disconnected, and any movement is like they are tied down, supplement the Foot Shaoyin and bleed the Luo.

The most notable pattern is no mention of Shaoyang or Jueyin Channels (one Liver point is mentioned by name, but only as a landmark). Instead treatment is almost always bled from the Yangming and Taiyang Channels, followed by Taiyin and Shaoyin. Usually the Hand Channels are preferred, except when the symptoms involve the back or lower body. This reflects the nature of the disorder as being one of Excess Heat and Yang that naturally rises to the upper Channels from where it needs to be released. The Hand Taiyang Channel can calm the Shen by having a Five Phase relationship with the Heart and an Earthly Branch relationship with the Liver, which Ling Shu ch. 8 suggests are the source of all emotions. The importance of Yangming and Taiyin suggests a connection with metabolism that creates this intense Heat followed by an equally intense collapse. This theory is currently being researched with ketogenic diets being trialled for bipolar disorders (Yu, Oz & Sethi, 2023). Meanwhile Taiyang also means "the sun" and Yangming as the "brilliance of Yang" suggests sunlight, highlighting another area of current scientific research, that bipolar disorders have a strong connection to circadian rhythm disruption (Gold & Kinrys, 2019). When this exhausts the system, the Yang must be strongly supplemented with 20 cones of moxa on the base of the Du Mai to prevent the disease penetrating to the Zang where it may cause death.

Other mentions in the classics include the Emergency Prescriptions worth 1000 Gold by Sun Simiao that describes a "Dian Kuang type of person on whom to use the 13 Ghost Points.

Folk traditions attributed it to demonic or ghostly possessions and external invasions of Wind in the Heart (心風) and was mostly treated with emetics and purgatives (Simonis, 2015). Later scholars used a theory of Phlegm accumulation that moved towards an internal pathomechanism, arguing that excess emotion could lead an upset of the Fire-Water balance, with excess Heart Fire suppressing the Kidney-Water and leading to fluid pathology that formed into Phlegm which could obstruct the chest, clouding the Heart and sensory orifices. Further scholars divided the etiologies into Excess and Deficient causes which could both result in insanity but which must be treated with purging and supplementing respectively.

The modern TCM theory that equates Dian Kuang with bipolar disorder describes it as a stagnation of Yang Qi which generates excessive Heat and sometimes Phlegm in the Yangming channels which agitate the Shen leading to restless and bizarre behaviours either as a result of overheating or trying cooling down (Jiang, 2003). It is impossible to sustain this indefinitely as the pathological Fire consumes the true Qi and when it is exhausted a crash into the Deficiency-Withdrawal phase occurs until the original obstruction starts generating Heat again.

For more information see:

Huang Di Nei Jing: Su Wen, ch. 30, Explanation of the Yang Brilliance Vessel
Huang Di Nei Jing: Su Wen, ch. 46, Discourse on Disease Manifestations
Huang Di Nei Jing: Su Wen, ch. 74, Comprehensive Discourse on the Most Reliable Essentials
Huang Di Nei Jing: Ling Shu, ch. 22, On Madness (Dian Kuang)
Nan Jing, ch. 20, The Twentieth Difficult Issue

Gold, A. K., & Kinrys, G. (2019). Treating Circadian Rhythm Disruption in Bipolar Disorder. Current psychiatry reports, 21(3), 14. https://doi.org/10.1007/s11920-019-1001-8
Jiang, Y.P. (2003). The TCM Diagnosis and Treatment of Bipolar Disorder, Part One. Acupuncture Today 4(9).
Simonis, F. (2015). Ghosts or Mucus? Medicine for Madness: New Doctrines, Therapies, and Rivalries. Modern Chinese Religion I (2 Vols.), 601-639.
Yu, B.J., Oz, R.S. & Sethi, S. (2023). Ketogenic diet as a metabolic therapy for bipolar disorder: Clinical developments. Journal of Affective Disorders Reports 11: 100457. Doi: https://doi.org/10.1016/j.jadr.2022.100457