Submitted by admin on September 19, 2006 - 4:13pm.

Dr. Jin Shu Bai, Case #2-2, Pages 36-38

Yang Brightness Heat Binding and Phlegm Gathering

Lu XX XX, Male, age 25, worker.

Long Hua Hospital Outpatient Clinic, patient # 16838

Initial consultation date: 13 October 1974

Comments (from an accompanying family member):  The patient originally had a history of gastric ulcer.  When he suffered from an upper respiratory infection, he had high fever for 8 days that was treated in a local clinic.  One day he saw some people beside him quarrel and scuffle, and was frightened.  He suddenly developed mental irregularities that had already lasted for 15 days.  The local mental hospital administered chlorpromazine, but the symptoms did not seem to change.  Someone from his unit was sent to escort him to Shanghai. 

Diagnostic Observations: The patient had a confused spirit-orientation, raving speech, and a manic gate.  He was thirsty and drank a lot, did not sleep throughout the day or night, and was uncooperative.  He had no bowel movements in the last half month.  The tongue body was red or crimson, and the fur was peeling and ??flowery??. The pulse was slippery, large, string-like, and rapid.

Pattern Identification:  Yang brightness heat binding and phlegm gathering, and the spirit failing to keep to its abode.

Treatment Principle:  Settle the heart and flush phlegm, clear heat and quiet the spirit. 

Consultation #1:

Point Selection:  Ren Zhong (GV-26 connected to Yin Jiao (CV-7), Jian Shi (PC-5) connected to Zhi Gou(TB-6), He Gu (LI-4), and Feng Long (ST-40).

Hand Method:  The needle was inserted from Ren Zhong to inferior to the nasal septum, a distance of 1.5 cun or more.  The sensation made tears emerge. Lifting and thrusting heavy draining method was used.

Herbal Prescription: 

Sheng Tie Luo

30 grams

Crude Iron Flakes

Sheng Shi Gao

30 grams

Crude Gypsum

Lian Qiao (Dai Xin)

9 grams

Forsythia (with heart? seed?)

Ku Xing Ren

9 grams

Bitter Apricot Kernel

Gua Lou Ren

15 grams

Trichosanthes Seed

Yuan Zhi

4.5 grams

Polygala

Shi Chang Pu

9 grams

Acorus

Huang Qin

9 grams

Scutellaria

Sheng Gan Cao

3 grams

Raw Licorice

Xian Lu Gen

1 foot (remove
the nodes)

Fresh Phragmites

2 batches were given.

Consultation #2:  The constipation had been resolved, and the agitation was markedly reduced.  The treatment still kept to the prescription above, and two more batches of the same herbs were given.

Consultation #3:  The patient’s spirit-orientation was already clear.  The tongue body was still red — a result of residual heat.  The treatment was just as above, and three more batches of herbs were given.

Point Selection:  Same as above.

Consultation #4:  According to a statement from the family, after the patient’s mental irregularities had settled down, he went to some relative’s home for a meal. Upon returning to his own home there was a relapse of his mental symptoms.  Further questioning revealed that due to overeating an oily meat dish, an obstruction to movement and transportation lead to yang brightness heat binding and harassing the spirit light.  The patient’s pulse was slippery and rapid, the tongue was red with a dry fur.  The treatment method was to clear, settle, and abduct stagnation while transforming phlegm.  The acupuncture point selection was the same as for the previous consultations, while the original herbal prescription was bolstered with Medicated Leaven (9 grams (wrapped?)), Crataegus (9 grams), and Unripe Bitter Orange (9 grams).  Two batches were given.

Consultation #5: The patient’s spirit-orientation was clear and lucid.  He spoke and chatted normally, while his spirit and attitude were natural.  He explained that at night wind papules had erupted, and scratching them instigated heart vexation.  Pulse examination showed a string-like, fine pulse with rapidness.  The tongue was red and had changed to moist.  This was residual heat from the surplus yang brightness heat, and the construction aspect not clear.

Point Selection:  [Using the same basic formula as before,] delete Ren Zhong, and add Tai Chong (LV-3) bilaterally.

Herbal Prescription:  From the current prescription delete Medicated Leaven, and Crataegus, and add Red Peony (9grams) and Dan Pi [Salvia?] (9 grams).  4 batches.

Follow-up investigation after two weeks showed that all of the symptoms were cured, and the patient had returned to his work unit.

Comment:  Mania pattern is frequently repletion, but naturally one can also see cases of vacuity within repletion.  In this patient’s example, he had a previous history of gastric ulcer.  The tongue was red or crimson and the fur was peeling and flowery[???].  These are signs of stomach yin insufficiency.  Due to the complicating factor of warm pathogen (evil), and high fever reduced by prescription, there was residual surplus toxin. The lung and large intestine stand in an interior-exterior relationship; as conveyance of the yang brightness was inhibited, heat knotted internally, qi and fire confined phlegm, and upward harassed the heart governor.  The spirit light lost it’s abode, and thus one could see confused spirit-orientation, raving and manic gate, no sleep throughout the day and night, no bowel movements for half a month, and other symptoms of yang brightness mania pattern.  This illness ascribes to vacuity within a repletion; therefore, since the patterns are different the treatment must be different.  For repletion pattern one uses Cheng Qi Tang that abducts downward; if it had been used on this patient it would have damaged stomach yin.  Therefore, Iron Flakes Beverage was selected; among the herbs, Iron Flakes outthrusts qi, fire, phlegm and phlegm-drool; Gypsum clears heat from the yang brightness. 

Ku Xing Ren

9 grams

Bitter Apricot Kernel

Gua Lou Ren

15 grams

Trichosanthes Seed

Yuan Zhi

4.5 grams

Polygala

Shi Chang Pu

9 grams

Acorus

Huang Qin

9 grams

Scutellaria

Sheng Gan Cao

3 grams

Raw Licorice

Xian Lu Gen

1 foot (remove
the ?nodes?)

Fresh Phragmites

[When these] two are combined with Acorus, Scutellaria, Apricot Kernel, Trichosanthes Seed, and Polygala, they transform phlegm, clear the heart, and moisten downward.  For needling, the “Three Thoracic Needles” were not selected, but the choice was to use Ren Zhong connected to Yin Jiao to clear heat and quiet the spirit, and free and communicate yin and yang; Jian Shi connected to Zhi Gou was selected to clear heat and free the stool, along with He Gu, the source point of the large intestine channel, to course and abduct the yang brightness. Feng Long, connecting point of the stomach channel, harmonizes the stomach and transforms phlegm.  The combination of acupuncture and herbal treatments reached the goal of clearing and settling, sweeping phlegm and resolving constipation, and quieting the spirit.  If the pattern identification had not been clear[ly discerned], and [if] seeing mania the always-applied heavy stimulation treatments were given to abduct downward, then the patient’s vacuity would have become more vacuous and the fire would have become very hyperactive, which would have been detrimental to yin; the force of the disease would have persisted, and the forecast would have been for slow recovery.  In this patient’s case, after the third consultation all of the symptoms were improving, yet due to a dietary mistake — excessive intake of heavy food —the fire of yang brightness resumed burning, and harassed the heart spirit above.  Thus, there was a relapse, and the primary method of treatment could not simply be continued.  The relevant formula had Medicated Leaven and Crataegus added to disperse food and assist movement.  The single herb Unripe Bitter Orange is very effective, and it was selected to abduct stagnation; two batches were effective.  At the 5th consultation residual heat in the construction aspect was seen again; the additions of Dan Pi (Salvia) and Red Peony were to clear heat and cool the blood.  In this way the prescriptions were changed to deal with the [presenting] pattern, and the medicinal ingredients followed the prescriptions to suitably treat the disease mechanism.  In the end this reaped complete success.