Dr. Jin Shu Bai, Case #2-3, pages 38-39
Liver Fire with Confined Phlegm
Huang XX XX, Male, age 51, worker
Long Hua Hospital Outpatient Clinic, patient #226317
Initial Consultation Date: 31 March 1972
The patient normally had the habits of smoking and drinking, and a rash, impatient nature. In 1968 he was in a domestic dispute where he went into the first degree of mental confusion. He banged his head against the wall, had raving speech and a manic gate, and was taken to a mental hospital for emergency treatment. With injections of chlorpromazine he was controlled, but afterwards was frequently seen to have unstable behavior. After the use of chlorpromazine and other heavy tranquilizing drugs, at times he was restrained, but at other times he still exhibited agitation. His family members were quite intimidated and disquieted, so they brought him in for examination.
Diagnostic observations: The patient reeked of alcohol so strongly it could choke person and he smoked uncountable cigarettes. His clothes were disheveled, his eyes fierce, and his speech coarse and explosive. He would maniacally strike at people. The patient felt thirsty and had dry lips, as well as dry, hard stools. The tongue was red with a yellow fur, while the pulse was string-like and slippery.
Pattern Identification: Liver fire with confined phlegm transversely harassing the heart and spirit; the spirit not keeping to its abode, and erupting as mania.
Treatment Principle: Settle the heart and abduct phlegm, drain the liver and clear fire.
Consultations #1-3:
Point Selection: Jiu Wei connected to Ju Jue(CV-15 & 14), Shang Wan (CV-23), and Zhong Wan (CV-12) with a straight, perpendicular insertion to the depth of 1 cun.
Hand Method: Lifting and thrusting for heavy draining. With this method, the mania was gradually seen to moderate; contact with the patient was more manageable, but he still had excessive speech and was easily angered.
Consultations #4-7:
Point Selection: (1) Jiu Wei connected to Ju Jue, Shang Wan, and Zhong Wan with a straight, perpendicular insertion to the depth of 1 cun.
Hand Method: Lifting and thrusting with heavy stimulation, draining method.
Herbal Prescription: Major Qi-Coordinating Decoction combined with Gentian Liver-Draining Decoction, with deletions. 3 packets.
Consultations #8-15: With this treatment, the stools were disinhibited, The tongue fur had transformed, and the pulse was moderate. The patient had a lucid spirit-orientation, and responded reasonably when he was spoken to. At times he still tended to be excitable.
Point Selection: Ren Zhong (CV-26) connected to Yin Jiao (CV-7), Jian Shi (PC-5), connected to Zhi Gou (TB-6), Feng Long (ST-40), and Tai Chong (LV-3). Herbal medication was discontinued. From the 8th thru the 10th treatments, a heavy stimulation, draining method was applied, and the patient’s spirit-orientation gradually and steadily became quiet and tranquil. For the 11th through the 15th treatments the hand method was changed to even supplementing, even draining, to clear the heart and quiet the spirit. After these treatments all of the patient’s symptoms were cured, and his life style returned to normal.
Comment: Su Wen “Zhi Zhen Yao Da Lun” says, “Excessive agitation and mania are ascribed to fire.” Jing Yue Quan Shu “Withdrawal-Mania and Feeblemindedness” also says:
In all mania cases the cause is frequently fire,…liver and gallbladder qi in counterflow, and wood-fire combines with a pathogen (evil). This is truly the eastern direction in repletion. In this case the pathogen (evil) exploits the heart, then is like the spirit with a ghost, not in keeping. The pathogen (evil) exploits the stomach and then has a transverse explosion that leads to rigidity.???
In this case example, the patient liked to smoke and drink without restraint, so the yang brightness fire was already severe; it was strengthened by rashness and impatience stirring the liver. Wood and fire combined with the pathogen, and the liver, stomach and heart all had repletion fire that was internally intense. With intense fire then phlegm gushes, it upbears and harasses the stirring of the heart-spirit, and manifests as mania. In this case the primary selection was “Three Thoracic Needles.” This combination sweeps phlegm, settles, and tranquilizes while clearing the heart and opening portals. Later Ren Zhong connected to Yin Jiao was used to communicate??? the conception and governing vessels, and thereby drain yang repletion. Jian Shi connected to Zhi Gou clears the heart and drains fire; Feng Long abducts phlegm while Tai Chong calms the liver. The herbal prescription of Major Qi-Coordinating Decoction combined with Gentian Liver-Draining Decoction was intended to clear, settle, and abduct below, to open and promote the triple burner, calm the liver, and drain fire. The simultaneous use of acupuncture and herbs brings out the best in both modalities. The stool was then free, and the fur was transformed, while the pulse became moderate, the spirit cleared, and all of the symptoms were cured.