Dr. Jin Bai Shu, Case #2-1, pages 35-36.

Yang Brightness Heat Pathogen (Evil) Invading the Heart (Manic-type of Mental Disease)

Ma XX XX, Male, age 16, Shanghai resident

The Clinic of Long Hua Hospital, patient #226634

Initial consultation date: 20 April 1972

Comments (from the head of the patient’s family): Two years before during a fight with a classmate, the patient had received a blow to the head, and later gradually developed mental irregularities with incoherent speech, manic raving, and manic gate. He was taken to a mental hospital and diagnosed as having manic type mental disease. With the use of chlorpromazine he gradually and steadily settled down. On April 15 of this year, due to the provoking cause of reading the novel Journey to the West, there was a relapse to the old disease, and acupuncture treatment was requested.

Diagnostic observations: The patient’s lips were dried, cracked, and bleeding, his clothes were in disarray, he had chaotic behavior and copious speech, and was uncooperative. The tongue was red, with a yellow fur; the pulse shape was slippery and rapid. The patient also had thirst, constipation for the last several days, and was unable to sleep at night.

Pattern Identification: Yang brightness heat pathogen (evil) invading the heart, and spirit light with loss of keeping ??? (Manic type of mental disease).

Treatment Principle: Clear, settle, and sweep phlegm.

Consultation #1:

Point Selection: Jiu Wei (CV-15) connected to Ju Jue (CV-14), Shang Wan (CV-13), and Zhong Wan (CV-12). The hand method chosen was lifting and thrusting for heavy sedation.

Herbal Prescription:

2 packets were given.

Consultation #2: The patient had a clear spirit and was cooperative. His stools were no longer inhibited, and his lips and tongue had become moist. The pulse reading was already moderate.

Point Selection: Same as above.

Herbal prescription: Same as before, with Iron Flakes and Gypsum reduced to 30 grams each. 2 packets.

Consultation #3: The patient was wearing neat and tidy clothing, and he had a natural demeanor. His essence-spirit was normal, and he had recovered to return to school.

Point Selection: Yin Tang (M-HN-3), and Jian Shi (PC-5), to clear the heart and quiet the spirit, for the patient’s future well being. The hand method used was rotation with light stimulation.

Herbal Prescription: Herbs were discontinued.

Comment: Nan Jing “The 20th Difficulty” states: “Patients with heavy yang have mania.” In patients with heavy yang, the yang pathogen (evil) enters the yang channels. The yang pathogens (evils) in mania syndrome are not beyond the pathogens (evils) of qi, fire, phlegm, and food. The yang channels are primarily the two channels of yang related to the stomach and to the gallbladder, with the stomach channel most important. Wang Ken Tang of the Ming Dynasty points out in Zheng Zhi Jun Bian: “In cases of mania, when the disease erupts there is a savage burst of fierceness, similar to the Shang Han (injurious cold) yang brightness in great repletion eruption of mania.” Thus, they have the same effect on the yang brightness, but one is an external contraction, and the other is an internal injury ???; they have the same name but different repletion.??? In injurious cold it is related to external pathogen (evil) that invades and develops to make the yang brightness hot to such an extreme that the spirit is clouded. In mania pattern with hegemony in the yang brightness there is cursing and cussing, and no recognition of family and friends; it is related to the pathogens phlegm, fire, qi, and food. Ling Shu: “Jing Mai Pian” in the section on the foot yang brightness and its role in disease ??? states: “…desire to ascend to a high place, remove clothes and run about , …” In this case the patient had disease in both the yang brightness channel and the bowel; it only had to enter and invade the heart channel for there to be manic behavior and copious speech, disheveled dress, yellow tongue fur, slippery, rapid pulse, and other signs. These are all caused by yang exuberance. The four limbs are the root of yang, and with yang exuberance the four limbs are in repletion; thus, with repletion there is manic, chaotic gate; with exuberant heat in the body there is disheveled clothes; due to heat harassing the heart spirit, there is incoherent speech and inability to sleep at night; the accompanying symptoms were thirst, dry, cracked, and bleeding lips, as well as constipation, etc. In treatment, Dr. Jin chose the “Three Thoracic Needles” to inspire yang from within yin, and to drain phlegm heat from the heart and stomach space. Simultaneously the cold and heavy herb Iron Flakes does heavy settling and downbears counterflow. The sweet, acrid, and cooling herb Gypsum clears heat and drains fire. Along with agents that flush phlegm, the combination clears, settles, and abducts phlegm, and succeeds in making the heart clear and spirit quiet.