Manic & 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 antisocial 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 hyperactivity
3. Phlegm
4. Pathogenic fire
5. Blood & Qi stag.
Main Points for differentiation
A) Location of the disease
Liv. GB. Kid. Heart
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
Treatmen
t
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.
Ht. blood def. : Feel depressed & tired; mind maybe confused & lack
concentration
liv. Blood def. : may lack a sense of direction in life & “vision”
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
Heat
Ht. heat: extremely anxious & agitated; impulsive & restless
Liv. Heat: violent & hit people, feel angry & frustrated about his life, tend to be
impulsive
Treatment
Depressive 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:
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
Modifications:
Xiao Yao Powder
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 Wan
Frequent belching & feeling of oppression in chest and abdomen
-- Xuan Fu Hua, Dai Zhe Shi, Zi Su Geng
Treatment
Depressive Psychosis
2). Qi Def. & phlegm accumulation
Signs & 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:
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
Modifications:
Soothing Liver Qi, & open mind
-- Yuan Zhi, Yu Jin
Severe perplexed and dull-witted state
-- Su He Xiang Wan
Treatment
Depressive 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:
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
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
Treatment
Manic Psychosis
4) Phlegm-fire disturbing heart
Signs & 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:
Xie Xing Tang
Da Huang
Huang Qin
Huang Lian
Meng Shi Gun Tan Wan
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
Treatment
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:
An Shen ding Zhi Wan
Fu Ling
Fu shen
Yuan zhi
Shi chang pu
Ren shen
Long Chi
Modifications:
Nourish Yin:
-- Er Yin Jian ( Shen di, Mai dong, Xuan shen)
Clear the fire
-- Bai Wei, Di Gu Pi
Calm down mind
-- Fu Shen, Suan Zhao Ren, Gan Cao
Amnesia, sore lower back and weak knees,
-- Gui Ban, Gou Qi Zi, E Jiao
Treatment
Manic 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:
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
Modifications:
fever due to blood stasis
-- Huang Qin
Cold sym
-- Gan Jiang, Fu Zi
Calm down mind
-- Fu Shen, Suan Zhao Ren, Gan Cao
Dry & bitter mouth with yellow greasy coating
-- Huang Qin
Dark purplish tongue body
-- Dan Shen, Hong Hua
• Other treatments
Dan 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: 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:
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 fur
Pulse:
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:
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 fur
Pulse: 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
Epilepsy
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 disorder
2. Congenital factors
3. Miscellaneous
Main Points for differentiation
A) Def. or Excess
Excess:
Wind-phlegm
Internal phlegm-fire
Internal blockage of blood stasis
Def.
Heart & Kidney def.
Liver & kid. Yin def.
B) Attacking & Remission period
Attacking: eliminating phlegm & regulating Qi
Remission: Tonify the liver & kid. Yin
C) Yang type & Yin Type
Yang Type: Syndrome of excess heat
Yin 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, dullwitted, unconsciousness, reticent,
dumb-struck
Rapid or wiry slippery
Deep, wiry or deep & slippery
Principles of the treatment
Treatment must be according to the stage
of the disease:
Attacking
or
Intervals