Manic & Depressive PsychosisManic & Depressive Psychosis TCM Diagnoses and Treatments Within TCM there are two main types of strong psychological disorders:

Dian - yin type which is associated with withdrawal, passivity and anti-social behavior, generally considered more chronic.

Kuang - yang type which is associated with aggressivity, movement and violence, generally consider more acute.

Within modern medicine there are various mental disease, including organic & functional psychoses ( bipolar disorder, obsessive-compulsive, or paranoid schizophrenic)

Etiology & Pathology:1. Imbalance of Yin & Yang: 2. Seven emotional hyperactivity3. Phlegm4. Pathogenic fire 5. Blood & Qi stag.

Main Points for differentiationMain Points for differentiation

A) Location of the diseaseA) Location of the disease

Liv. GB. Kid. Liv. GB. Kid. HeartHeart

B) Depressive (Dian) & manic Syn. (kuang)B) Depressive (Dian) & manic Syn. (kuang)

Depressive Manic Syn.

Sym. Mental depression, reticence, dementia, being slow moving

Racketing, maltreatment, mania, unease & hyperactive behaviors

Initial Mostly def. Excess

Etiology Phlegm block Qi;

Ht. & Sp Def.

Phlegm & Fire

Treatment

Regulating Qi, Relieving stag., Nourishing Ht. & Sp. ,

Enriching blood, Tranquilizing mind

Eliminating pathogenic factors

(Purging fire; Reducing phlegm; Nourishing Yin & reducing fire)

Herbs Drastic herbs

Blood Provides the material foundation for the mind & spirit “ Blood is the mind of a person” “ When blood is harmonized, the mind has a residence” Ht. – Housing the mind, Governing Blood vessels Liv. – Housing the Ethereal soul , Storing the blood

Any emotional stress -- Ht. or liv. - Ht. blood or Liv. Blood -> mind or soul Blood was effected by emotional problems in 3 ways Def.Def. Ht. blood def. : Feel depressed & tired; mind maybe confused & lack

concentration liv. Blood def. : may lack a sense of direction in life & “vision” Stag.Stag. Ht. blood stag.: restless & prone to be easily startled

Liv. Blood stag.: very anxious, restless and confused about his or her aims of life

HeatHeatHt. heat: extremely anxious & agitated; impulsive & restlessLiv. Heat: violent & hit people, feel angry & frustrated about his life, tend to be impulsive

TreatmentTreatmentDepressive PsychosisDepressive Psychosis

1). Qi Stag. Combined with phlegm Signs & Symptoms:

– Main Sym. : mental depression, apathetic depression, reticent, dull-witted (dementia), or suspicious & over-anxious, subjecting to changing mood, speaking incoherently

– Concurrent sym.: muttering to oneself, subjecting to changing mood, loose of appetite

– Tongue: light tongue proper, whitish & greasy fur

– Pulse: wiry & slippery

• Treatment Protocol:

– Soothing stag. liver Qi– Resolving phlegm

Formula:

Modifications:

Soothing Liver Qi-- Xiang Fu, Yu Jin

Mental disorder-- Su He Xiang Wan

Accumulation of phlegm in chest & diaphragm-- San Sheng San ( Gua Di, Fang Feng, Li Ru)

Associated with sleeplessness & being subjecting to frightening, dysphoria & unconsciousness, yellow greasy fur

-- Wen Dan Tang + Zhi Bao WanFrequent belching & feeling of oppression in chest and abdomen

-- Xuan Fu Hua, Dai Zhe Shi, Zi Su Geng

Tao Tan Tang

Ban Xiao Dan Nan Xing Chen Pi Zhi Shi Fu Ling

Ren Shen Shi Chang Pu Zu Ru Gan Cao Shen Jiang

Xiao Yao Powder

TreatmentTreatmentDepressive PsychosisDepressive Psychosis

2). Qi Def. & phlegm accumulationSigns & Symptoms:

– Main Sym. : Apathetic & indifferent expression, reticent even transfixed, staring like a fool, thinking aloud, lack of initiative, confused mind, presumption, reckless action, blame oneself.

– Concurrent sym.: sallow complexion, loose stool, clear urine – Tongue:

light & enlarged body, whitish & greasy fur– Pulse:

slippery & weak• Treatment Protocol:

– Tonify Qi– Nourish Spleen– Eliminating phlegm– Calm down the mind

Formula:

Modifications:Soothing Liver Qi, & open mind

-- Yuan Zhi, Yu Jin

Severe perplexed and dull-witted state

-- Su He Xiang Wan

Tao Tan Tang

Ban Xiao Dan Nan Xing Chen Pi Zhi Shi Fu Ling

Ren Shen Shi Chang Pu Zu Ru Gan Cao Shen Jiang

Si Jun Zi Tang

TreatmentTreatmentDepressive PsychosisDepressive Psychosis

3) Heart & Spleen Def.Signs & Symptoms:

– Main Sym. : protracted course of disease, the illness developed slowly, pale complexion, sluggish, too lazy to speak, listlessness, absentminded, palpitating, susceptible to fright and sorrow, presumption, disturbance of thought, talk in a confused manner, demoralized

– Concurrent sym.: dreaminess, loss of appetite, loose stool .– Tongue:

enlarged body with teeth marks– Pulse:

weak

• Treatment Protocol:

– Nourish Spleen & heart– Calming mind

Formula:

Modifications:Kidney Yang Def.

-- Ba Ji Tian, Rou Cong rong, Bu Gu Zhi

Palpitation & fright

-- Ci Shi, Long Chi

Grief with susceptibility to weeping

-- Zhi Gan Cao, Huai Xiao Mai

Yang Xin Tang

Ren Shen Huang Qi Gan Cao Fu Ling Fu Shen Dang Gui

Chuan Xiong Ban Xia Po Zi Ren Suan Zhao ren Yuan Zhi Wu Wei Zi

TreatmentTreatmentManic Psychosis 4) Phlegm-fire disturbing heartSigns & Symptoms:

– Main Sym. : Onset suddenly, impetuousness, headache, sleeplessness, staring angrily, flushed face & ears, suddenly mad and violent rage, enthusiasm running high, speaking disorderly, climbing walls & roofs, abnormally powerful, making racket & shout in confusion, not caring about various relations, or destroying things & harming others persons, loving cold drinks, constipation, dark urine

– Concurrent sym.: day & night without sleep and eating – Tongue:

deep red body, yellow and greasy fur– Pulse:

wiry slippery, rapid and forceful

• Treatment Protocol:

– Purging fire– Eliminating phlegm– Calm down mind

Formula:

Modifications:

Nourish Yin & clear away fire-- Zhi Mu

Calm down mind-- Iron

Yang Ming Sym. + constipation-- Da Chen Qi Tang

Restlessness & thirsty with desire to drink-- Mang Xiao 5g

Restlessness & insomnia due to phlegm heat-- Huang lian, Zhu Ru, Zhi Shi

Xie Xing Tang

Da Huang Huang Qin Huang Lian

Meng Shi Gun Tan Wan

TreatmentTreatment 5) Hyperactivity of fire due to yin Def.

Signs & Symptoms:

– Main Sym. : illness condition alleviated after protracted manic psychosis, be weary in mind, emotional instability, nervous, impatient, palpitating, be susceptible to fright, sometimes mad, restlessness, sleeplessness, feverish sensation in chest, palm & sole

– Concurrent sym.: thin body shape, scanty dark urine, constipation– Tongue:

red body, less or no fur– Pulse:

thready rapid or wiry rapid

• Treatment Protocol:

– Nourish Yin & removing fire– Tranquilizes the mind

Formula:

Modifications:Nourish Yin:

-- Er Yin Jian ( Shen di, Mai dong, Xuan shen)Clear the fire

-- Bai Wei, Di Gu PiCalm down mind

-- Fu Shen, Suan Zhao Ren, Gan CaoAmnesia, sore lower back and weak knees,

-- Gui Ban, Gou Qi Zi, E Jiao

An Shen ding Zhi Wan

Fu Ling Fu shen Yuan zhi Shi chang pu

Ren shen Long Chi

TreatmentTreatmentManic Psychosis 6) Blood & Qi Stag.Signs & Symptoms:

– Main Sym. : dysphoria, fury, talk much, even singing, running & taking off clothing, or dumbstruck, talk less, being in a confused state of mind, often with darkish complexion, stabbing pain and fullness feeling in chest & hypochondrium, palpitating.. Or abdominal pain during the menstrual period in women, dark and clot in menstruation, or having injuries from falls, fractures, contusions and strains.

– Concurrent sym.: headache or feeling fullness in the head – Tongue:

dark purple body, thin whitish or thin yellow fur– Pulse:

wiry thready or deep wiry

• Treatment Protocol:

– Promoting blood circulation & removing blood stasis– Activating the flow of Qi

Formula:

Modifications:fever due to blood stasis

-- Huang QinCold sym

-- Gan Jiang, Fu ZiCalm down mind

-- Fu Shen, Suan Zhao Ren, Gan CaoDry & bitter mouth with yellow greasy coating

-- Huang QinDark purplish tongue body

-- Dan Shen, Hong Hua

Dian Kuang Meng Xing Tang

Tao Ren Cai Hu Xiang Fu Mu Tong Chi Shao Ban Xia

Da Fu Pi Qin Pi Chen Pi Sang Bai Pi Su Zhi Gan cao

Da Huang Zhe Chong Wan

• Other treatmentsDan Shen 60g, Ye Jiao Teng 30g, Ling Zhi

10g, Da Zao 10pcs

( Applicable to various types of schizophrenia)

Gan Sui 10g, Da Ji 10g, Da Huang 10g, Bai Jie Zi 10g, Ai Ye 10g, Shi Chang Pu 10g

( Applicable to various types of schizophrenia )

Case History

1. Female 45 years Medical history:Medical history: Usually narrow-minded, oversensitive, over anxious, feeling incompatibility between she and her husband. Her husband stayed at other places for a long period of time, and suspected that she has unfaithful intentions after back home and later beat her. Once after vigorous quarrel, she suddenly look steadily, reticent, refuse to take food and drink, then shouting at top of her voice, climbing walls and getting on roofs, being subject to changing mood, taking off her clothes in the presence of all, hitting others and destroying things; 3 or 4 young men could not check her. First visiting:First visiting:

Main complain: Manic Psychosis Most of the above symptoms had alleviated. Her symptoms manifested as flushed face

and ears,constipation

Tongue: red tongue with yellow furPulse:

TCM diagnose: Phlegm-fire disturbing mental activities

Treatment protocol:-- Eliminating phlegm--Clear the fire--Tranquilize the mind

Formula: Meng Shi Gun Tan Wan + Dan Zhi Xiao Yao Wan

Case History

1. Male 31 years Medical history:Medical history: First visiting:First visiting:

Main complain: Bipolar disorder for 3 years Patient was treated by western medicine for 3 years, however, symptoms

were still unstable. 3 month ago, patient’s mental status started to be unstable again. Deliria. Thought himself should be a top leader of a big company. Be proud of his manage ability. Feel excited, irritability, insomnia, headache, distension feeling of head good appetite

Tongue: dark red body with purple spot, yellow furPulse: wiry

TCM diagnose: Blood stasis insulting mind

Liver Qi stag. Treatment protocol:

--Promoting blood circulation-- Smoothing Liver Qi--Tranquilize the mind

Formula: Cai Hu 12, Xiang Fu 12, Qin Pi 10, Su Zi 15, Zheng Zhu Mu 30, Tao

ren 15, Hong Hua 15, Chi Shao 20, Yu Jin 15, Da Huang 15, Long Gu 30, San Ling 15, E Zhu 15, Suan Zao Ren 15

EpilepsyEpilepsy TCM Diagnoses and Treatments

Suddenly falling on the ground, unconsciousness, spitting saliva, staring upwards, clonic convulsion, or shouting as bleat or pig yell, and regaining consciousness some time later

Etiology & Pathology:1. Mental disorder1. Mental disorder2. Congenital factors2. Congenital factors3. Miscellaneous 3. Miscellaneous

Main Points for differentiationMain Points for differentiation A) Def. or ExcessA) Def. or ExcessExcess:Excess:

Wind-phlegmWind-phlegmInternal phlegm-fireInternal phlegm-fireInternal blockage of blood stasisInternal blockage of blood stasis

Def.Def.Heart & Kidney def.Heart & Kidney def.Liver & kid. Yin def.Liver & kid. Yin def.

B) Attacking & Remission periodB) Attacking & Remission periodAttacking: eliminating phlegm & regulating QiAttacking: eliminating phlegm & regulating QiRemission: Tonify the liver & kid. YinRemission: Tonify the liver & kid. Yin

C) Yang type & Yin TypeC) Yang type & Yin TypeYang Type: Syndrome of excess heatYang Type: Syndrome of excess heatYin Type: Syndrome of deficient coldYin Type: Syndrome of deficient cold

Yang Type Yin type

Good constitution Constitution is not very good, Vital Qi is gradually exhausted

Sudden attack, falling down & shout, clonic convulsion & spitting, lockjaw, looking upwards with taut,

Suffered from frequent attack of epilepsy, pale complexion, dull-witted, unconsciousness, reticent, dumb-struck

Rapid or wiry slippery Deep, wiry or deep & slippery

Principles of the treatmentPrinciples of the treatmentTreatment must be according to the stage of the disease:

Attacking or

Intervals