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Loss of Regulation in the Heart and Spleen

By admin
Created Sep 19 2006 - 4:22pm

JIN6.Doc

Dr. Jin Bai Shu, Case #6, pages 20-23

Loss of Regulation in the Heart and Spleen
Tang XX XX, Female, age 23, school graduate.
Acupuncture research clinic patient number 8
Initial consultation date: 27 April 1971

Comments (from an accompanying family member):  For unknown reasons in 1965 the patient had developed mental irregularities.  She was admitted to a mental hospital and diagnosed as having schizophrenia.  After 12 sessions of insulin shock treatments, over ten electric shock treatments, and internal doses of “Da Yin Wan” [*get translation] (the institute’s own formula), the patient made gradual improvement and was discharged from the hospital after four months.  In 1969 she was mobilized to go up the mountains and down to the countryside*, and she had a relapse. The state of her thoughts and thinking was more serious than before.  Again she was admitted to a mental hospital and was administered chlorpromazine, scopolamine, and other such medicines; after taking these she had trembling hands.

Investigative observations:  The patient had devitalized essence-spirit, copious thoughts and thinking, diminished speech and thoracic oppression, torpid stomach intake, heart vexation and disquiet, insomnia, and dream-filled sleep.  The pulse was fine and tongue fur was thin and slimy.  She was still taking 50 grams of chlorpromazine and 1 tablet of perphenazine every day.

Pattern Identification:  Depressed and blocked yang qi, inhibition of the heart and spleen, and stomach qi disharmony (schizophrenia).

Treatment Principle:  Course depression and quiet the spirit, regulate and disinhibit the heart and spleen.

Consultations #1-3

Point Selection:  Ya Men (GV-15), Ren Zhong (GV-26) (light stimulation), and Nei Guan (PC‑6).

Consultations #4-11

Point Selection:  Ren Zhong (light stimulation), Zhong Wan (CV-12), and Nei Guan.

Consultations #12-20

The patient’s sleep was not the best, and there was slight dizziness. 

Point selection:  Yin Tang (M-HN-3), Si Zu Kong (TB-23), and Nei Guan.  After needling in this way the spirit-orientation was clear and lucid, and the patient was motivated to perform household chores.

Consultation #22

The patient’s sleep was still not quiet, and the throat had the sensation of pressure.  Points An Mian (N-HN-22a) and Feng Long (ST-40) were added to the prescription above.

Herbal Prescription: [*9 herbs are listed]  Seven packets.

Consultations #23-26:

The patient was able to independently come to the clinic, and the comments she made had significant content.  Her spirit-affect had made a positive turn, and she joined conversation with the other patients.

Point Selection:  Yin Tang, An Mian, and Nei Guan

Consultations #27-30:

The menstruation was already 5 days late, so San Yin Jiao was added to the formula above. Menstruation had started by the 28th consultation.  By the 30th consultation the patient was able to join a ping-pong activity, and was emotionally happy.  Due to thoracic oppression and coughing of phlegm, additions were made of Lie Que (LU-7) and Feng Long (ST-40) to diffuse the lung and transform phlegm.

Consultations #30-34:

The patient’s sleep was still not quiet, and she still had excessive thinking.

Point Selection:  Ren Zhong (light stimulation), Yin Tang connected to Heart Region, An Mian, Nei Guan, Nei Guan, and San Yin Jiao.

Consultations #35-42:

The patient still had poor sleep, thoracic oppression, and spirit vexation. 

Point Selection:  Zhong Wan, Jian Li (CV-11), and Nei Guan to harmonize the middle and quiet the spirit.  At the 37th consultation point Da Zhui (meeting point of the  yang and the Governing Vessel) was also selected, as well as Shen Tang (BL-44--a dorsal shu point of the Bladder Channel, located one and a half cun lateral to Xin Shu(BL-15)).

Consultations #43-51:

After the previous treatments the patients sleep improved.

Point Selection:  Yin Tang, An Mian, and Nei Guan. After needling the patient’s spirit-affect was quiet and settled.

Consultation #52:

The tongue body was red, and the sides had dental impressions.  The coating was thin, greasy, and ?streaked? with gray.  The pulse shape was fine and rapid (108 beats/minute).  This is heart heat complicated with phlegm.  Point selection was the same as above with additions of Jian Shi (PC-5) and Feng Long.

Consultations #53-60:

The patient felt thoracic oppression, and her menstruation was delayed.

Point Selection:  Yin Tang, Jian Li, Nei Guan, An Mian, and San Yin Jiao to regulate the spirit, and course and disinhibit the heart and spleen.

Consultations #61-66:

Thoracic oppression had been resolved. The menstruation was delayed, and sleep was slight.

Point Selection: Yin Tang, Tai Yang(M-HN-9), An Mian, and San Yin Jiao.

Consultations #67-79:

In these days the patient had common cold with bronchitis, dyspnea (panting), stuffy nose, sneezing, and dizziness. 

Point Selection:

Group 1:  Ding Chuan (M-BW-16), Da Zhui, He Gu, and Feng Long. 

Group 2:  Yin Tang, Zan Zhu (BL-2), Ying Xiang (LI-20), and He Gu. The two groups of points were used in alternation.

Herbal Prescription:  Variant of San Zi Yang Qin Tang. [*translate]

Consultations #80-83:

The patient’s spirit and emotions were happy, her sleep was fine, and the coughing of phlegm had been reduced.  There was still abdominal distension and delayed menstruation.

Point Selection: He Gu, Zu San Li, Feng Long, and San Yin Jiao.  Auricular points: Lung and Heart Point.

Herbal Prescription:  Xiao Yao Wan. [*translate]

During the next menstruation the patient’s essence-spirit was normal, and her sleep was tranquil.

Comment:  This patient had been ill for the length of six years with lingering mental abnormalities.  Although she was treated with “insulin shock, electric shock” and Western drugs, the patient still had sequela such as difficulty sleeping, copious thoughts and thinking, scant speech and thoracic oppression, poor stomach intake, scant and delayed menstruation, etc. Yi Jia Si Yao (Four Principles for Medical Experts([*translate]?)) discusses mania-withdrawal it explains:

“When the disease is withdrawal, it is frequently from not attaining what one has planned for.”

At the initial onset of withdrawal pattern, it is frequently repletion; prolonged cases are detrimental to the heart and spleen, consuming qi and blood.  When the heart does not engender blood, the spirit light loses nourishment, then it is difficult to get to sleep, and after sleeping there are copious dreams, the heart qi is inhibited, and thus there is scant speech and thoracic oppression, the spleen qi does not move, and the stomach qi is not harmonious, therefore the stomach intake is poor, qi is depressed and phlegm binds, blood does not nourish the spleen, the source of transformation is insufficient and then there is scant and delayed menstruation with copious thoughts and thinking, the pulse is fine, the tongue fur is thin and slimy, etc, all of which are signs of loss of regulation in the heart and spleen, and complications between vacuity repletion.**  The essence of Dr. Jin’s pattern identification was to consider that the chronic illness must be a vacuity, yet one could not simply supplement.  For mental patients with complications between vacuity and repletion, she frequently employs coursing, disinhibiting, and regulating the spirit as the primary aim, and the supplementary aim is treatment for the pattern.  This approach always gets good results.

The treatment principles for this patient were to course depression and quiet the spirit, and regulate and disinhibit the heart and spleen.  Using light stimulation on Ren Zhong is Dr. Jin’s unique personal hand method.  She also selects Ya Men, the meeting point of the governing vessel and the yang linking vessel, and Nei Guan, the meeting point of the reverting yin channel and yin linking vessel, to perfuse portals and course depression, and to regulate yin and yang. Zhong Wan disperses oppression and harmonizes the middle; the intention is that by enhancing stomach harmony then one lies down quietly.  When the patient had the sensation of pressure in the throat at the 22nd consultation, this was phlegm and turbid in upward counterflow; Feng Long was selected to transform phlegm and downbear turbid.  For scant and delayed menstruation, point San Yin Jiao was selected to regulate the menstruation and nourish blood.  In the later stages of treatment the patient had dyspnea (panting), coughing of phlegm, and other such symptoms. The points in groups 1 and 2 were chosen along with a variation of San Zi Yang Qin Tang [*translate] to downbear qi and disinhibit the diaphragm, transform phlegm and disperse food (accumulation).  At the very end He Gu (the hand yang brightness source point) with Zu San Li and Feng Long (the sea and connecting points of the foot yang brightness), as well as San Yin Jiao (the foot greater yin, reverting yin, and lesser yin meeting point), were used in combination.  This combination regulates and rectifies the yang brightness channel, which has copious qi and copious blood, and also regulates the greater yin [channel], to supplement the later heaven, and enrich the source of transformation.  When the heart and spleen have been boosted, the spirit has a place to govern, the thoughts have a place to reside, and what symptoms could possibly remain?  In the entire illness there were 83 sessions of acupuncture therapy, and the patient’s essence-spirit state made daily improvements.  After chronic illness for six years the patient was finally cured.

Translator’s Notes:

*The phrase “up the mountains and down to the countryside” was used in the Cultural Revolution; it meant that someone from an urban area (like Shanghai) was being sent to a non-urban area as part of a national policy that was intended to improve social values.  In some cases it meant the displaced people were subjected to very harsh labor and living conditions.

**Please let me explain about that run-on sentence.  Although it is not written in very good English, it literally translates what is in the original.  I could have edited it into several sentences, but perhaps left this way it will be more useful to all concerned.  Readers who would like to see it edited are free to email me with suggestions.


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