Manic

1

• 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 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 hyperactivity
• 3. Phlegm
• 4. Pathogenic fire
• 5. Blood Qi stag.

2

• 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
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
3

• 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 -gt 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

4

• 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

5

• 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 Wan
• Frequent belching feeling of oppression in
  chest and abdomen
• -- Xuan Fu Hua, Dai Zhe Shi, Zi Su Geng

Tao Tan Tang Tao Tan Tang Tao Tan Tang Tao Tan Tang Tao Tan Tang 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 Xiao Yao Powder Xiao Yao Powder Xiao Yao Powder Xiao Yao Powder Xiao Yao Powder
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• 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

7

• Formula
• Modifications
• Soothing Liver Qi, open mind
• -- Yuan Zhi, Yu Jin
• Severe perplexed and dull-witted state
• -- Su He Xiang Wan

Tao Tan Tang Tao Tan Tang Tao Tan Tang Tao Tan Tang Tao Tan Tang 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 Si Jun Zi Tang Si Jun Zi Tang Si Jun Zi Tang Si Jun Zi Tang Si Jun Zi Tang
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• 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

9

• 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 Yang Xin Tang Yang Xin Tang Yang Xin Tang Yang Xin Tang 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
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• 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

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• 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 Xie Xing Tang Xie Xing Tang Xie Xing Tang Xie Xing Tang Xie Xing Tang
Da Huang Huang Qin Huang Lian
Meng Shi Gun Tan Wan Meng Shi Gun Tan Wan Meng Shi Gun Tan Wan Meng Shi Gun Tan Wan Meng Shi Gun Tan Wan Meng Shi Gun Tan Wan
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• 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

13

• Formula
• 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

An Shen ding Zhi Wan An Shen ding Zhi Wan An Shen ding Zhi Wan An Shen ding Zhi Wan An Shen ding Zhi Wan An Shen ding Zhi Wan
Fu Ling Fu shen Yuan zhi Shi chang pu Ren shen Long Chi
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• 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

15

• Formula
• 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

Dian Kuang Meng Xing Tang Dian Kuang Meng Xing Tang Dian Kuang Meng Xing Tang Dian Kuang Meng Xing Tang Dian Kuang Meng Xing Tang 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 Da Huang Zhe Chong Wan Da Huang Zhe Chong Wan Da Huang Zhe Chong Wan Da Huang Zhe Chong Wan Da Huang Zhe Chong Wan
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• 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 )

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• 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

18

• 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, patients 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

19

• 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

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• 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

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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
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• Principles of the treatment
• Treatment must be according to the stage of the
  disease
• Attacking
• or
• Intervals