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

Dr. Jin Bai Shu
Case 4-2, pages 65-68
Dual Repletion of Qi and Yin, Heart and Spleen Depressed and Binding

Pan XX XX, Female, age 36, Worker.
Acupuncture Research Clinic patient #4
Initial consultation on 7 September 1970

Disease history:  In 1968 the patient had post-partum constitutional vacuity.  By chance she happened to meet someone with suicidal behavior, and was extremely frightened.  She had sweating throughout her body, and suddenly was stuperous.  She was taken to a hospital for emergency treatment, but there was no clear diagnosis.  In 1970 there were “reactionary slogans” in her work unit and public security units held a meeting for investigation.  The patient was told to attend, and thereafter she suspected others had views about her.  This made her unhappy and depressed; at night she could not sleep, she wailed and was anxious, and she had dizziness, brain distention, and poor memory.  She had no pleasure in eating, and weakness in the four limbs.  For treatment she was given 25 gram tablets of chlorpromazine, one tablet in the morning and at noon, and two in the evening.

The symptoms observed were facial complexion with no luster, lucid verbal responses, and unhappy emotions.  The patient was very suspicious and had copious thinking.  The patient herself explained that she had torpid intake and thoracic oppression, abdominal distention with susceptibility to sighing, scant sleep, and a tired sprit. The tongue body was pale red, the pulse shape was soggy and fine.

Pattern Identification: Dual repletion of qi and yin, heart and spleen depression and binding.

Treatment Principle:  Boost qi and nourish yin, quiet the spirit and course depression.

Consultations #1-11:

Point Selection: Ren Zhong (GV-26), Yin Tang (M-HN-3), Tai Yang (M-HN-9), Nei Guan (PC‑6), Zu San Li (ST-36),  and San Yin Jiao (SP-6). 

Hand Method:  Light stimulation on Ren Zhong, while the other points all had even supplementing and even draining.

Light stimulation on Ren Zhong was first done to treat the branch, and restrain the patient’s compulsive symptoms. By the tenth and eleventh consultations the patient was building faith in the treatment, and actively requested it on her own.  Her speech had comparatively more content, but her sleep was still unstable, she had thoracic oppression and weakness, and she wailed and was anxious.

Consultations #12-23:

Point Selection:  Yin Tang connected to Heart Region, Ren Zhong (light stimulation)(The two points were used in alternation), Nei Guan, and Zu San Li (ST-36).

With this treatment the patient’s sleep improved, and her nightly dosage of chlorpromazine was reduced to 25 grams.  Her facial expression was gradually getting more agile, the wailing and tears declined and then stopped, and the patient was able to steadily resume housework. However, at the 19th consultation she had been in an argument with a neighbor that resulted in unhappy emotions and disquieted sleep.  After the 21st consultation she returned to calm and tranquil, and was even able to supply a full history of her illness.

Consultations #24-35:

Point Selection: Ren Zhong, Yin Tang (The two points were used in alternation), An Mian, Nei Guan, and San Yin Jiao (SP-6).

After the 24th consultation the patient’s essence-spirit gradually was more vitalized, and at meetings she could make statements.  She could sleep for up to six hours.  After the 25th consultation she initiated requests for work.  After the 28th consultation she was sometimes unhappy and talked little.  This meant that her menstruation was about to start, and the cause was unregulated qi of the spleen and liver.  Ren Zhong was eliminated from the point selection, while Yin Tang was used with all of the other points.  A Chinese herbal pill, Free Wanderer Pill, was added to the treatment, with 10 grams taken every day.  After the menstruation was over the patient had no mental changes, and compared to before did not have so much abdominal distension, burping, or the other symptoms. After the menstruation needling was resumed on point Ren Zhong; the patient felt this point made her quite comfortable.  As she had aching lumbus and twitching sinews and flesh, selecting this point could free the lumbar governing vessel, and settle fright.  Additional Chinese herbal supplements:

Quan Dang Gui

9 grams

Whole Tangkuei

 

Sang Ji Sheng

12 grams

Mistletoe

   

Shan Yao

9 grams

Dioscorea

 

Yuan Zhi

4.5 grams

Polygala

 

Gou Teng

12 grams

Uncaria

(Add later)

Zao Ren

9 grams

Jujube Kernel

 

Fu Xiao Mai

30 grams

Light Wheat

 

Ye Jiao Teng

12 grams

Flowery Knotweed Stem

 

4 packets.

Consultations #36-48:

Point Selection:  Ju Jue (CV-14), Yin Tang, and Ren Zhong.

At times the patient had excessive thought and thinking, thoracic oppression and unhappiness.  Therefore, Ju Jue was selected to open and sweep the heart and stomach qi; after needling the patient felt loose and disinhibited in the thorax.  In the patient’s period that month there was no disquieted anxiousness; there was only a slight feeling of fatigue, proclivity to fright when sleeping at night, and sweating.  This [pattern] is [due to] a breakdown of interaction between the kidney and heart, so the points Yin Xi (HT-6) and Fu Liu (KI-7) were selected to quiet the spirit and check sweating.  After menstruation these symptoms were all lessened and the patient requested full time work.

Consultations #49-60:

Point Selection:  Yin Tang, Si Zhu Kong (TB-23), Tian Tu (CV-22), Ju Jue, Nei Guan, San Yin Jiao, and Fu Liu with other additions and deletions. 

The patient’s night sweating was gradually diminishing; on waking in the morning she had swollen face, occasional head distension, thoracic oppression, and the sensation of obstruction in the throat.  Her menstruation was delayed but finally arrived.  This was from liver and spleen qi stagnation, and breakdown of interaction between the kidneys and heart.  After the 62nd consultation the following herbal prescriptions was given: 

Quan Dang Gui

9 grams

Whole Tangkuei

 

Zhu1 Yun2 Ling2

9 grams

??? Poria

   

Yuan Zhi

4.5 grams

Polygala

 

Ye Jiao Teng

15 grams

Flowery Knotweed Stem

 

Lü3 Dou4 Yi1

9 grams

???

 

Fu Xiao Mai

30 grams

Light Wheat

 

He Huan Pi

9 grams

Silk Tree Bark

   

Yu Jin

9 grams

Curcuma

 

Chen Pi

4.5 grams

Tangerine Peel

 

7 packets.

Consultations 69-96:

In both day and night the patient still easily discharged sweat, and she had slight facial swelling upon waking in the morning.  She had heart palpitations and spirit frustration???, scant and menstruation. While doing full time work, she still felt physically fatigued.  This is from insufficiency of qi and blood, and breakdown of interaction between the kidneys and the heart. Treatment was primarily to support the correct.

Point Selection:  Yin Tang, Qian Ding (GV-21), Ren Zhong, Yin Xi, Fu Liu, San Yin Jiao, and such points with modifications.

With this point combination all of the symptoms were gradually eliminated.  The patient’s essence-spirit and emotions were normal, and she completely stopped taking Western medications.  Acupuncture was discontinued for observation and the patient was quite fine.  She did normal full time work.

Comment:  When damage to the emotions results in depression, it is not formed in just one day and night.  Besides the physical circumstances of vacuity and repletion, repeated mental stimulants over a prolonged time are also involved.  Gu Jin Yi Tong, “Yu Zheng Men” says “Depression is when the 7 affects are not smooth, they gradually form depression and binding; when this depression endures, the developments of illness are multifaceted.”  In this case the patient had taken a fright and fear, and gradually manifested depression and unhappiness, disquieted sleep, copious wailing and anxiety, dizziness and brain distention, no pleasure in eating, weakness of the four limbs, and other symptoms of depressed and binding heart and spleen pattern.  Based on what Dr. Jin’s clinical observations, depression pattern patients most commonly have vacuity at root. Chi Shui Xuan Men “Yu Men—Yu” records: “[If a person] is constitutionally vacuous, when unfavorable events occur, they have dizziness, short and scant essence-spirit???, sinew atony and rapid breathing.  There are some similarities to vacuity patterns.  By first opening depression and normalizing qi, the disease will automatically be cured.”  This means that constitutional weakness is the preexisting internal cause of depression pattern becoming disease.  When doing treatment, one must separate the root and the tip, what is moderate and what is acute.  Light stimulation on Ren Zhong resolves and eliminates compulsive symptoms.  Yin Tang connected to Heart Region clears the heart and rouses the brain.  Nei Guan courses depression and rectifies qi, while quieting the heart and spirit.  In order to support the correct and treat the root, choose Zu San Li.  San Yin Jiao fortifies the spleen and harmonizes the stomach, courses the liver and boosts the kidney.  Then, there is a well-source for engendering and transforming qi and blood, the menstruation is regulated and disinhibited, the heart and spirit are nourished, and sleep automatically is quiet.  The accompanying symptom of thoracic oppression was treated by selecting the heart’s alarm-mu point, Ju Jue, which is capable of opening and sweeping the qi of the heart and stomach.  For sweating, select Fu Liu.  For head distention select Si Zhu Kong.  For sensation of an obstruction in the throat, select Tian Tu.  These points selection were all varied in accordance with the signs, and were agilely applied.  They were also accompanied by the herbs whole Tangkuei, ??? Poria, Light Wheat, Dioscorea, Polygala, Bai2 Ji2 Li, Uncaria, Flowery Knotweed Stem, etc., that open depression and rectify qi, nourish blood and quiet the spirit, calm the liver and settle fright.  After nearly 100 patiently applied treatments, all of the symptoms in the end were cured.