Dr. Jin Bai Shu, Case #3-2, pages 43-47

Hepatocystic Depressed Fire (Schizophrenia)

Ye XX XX, Female, age 19, Vocational student

Acupuncture Research Clinic, patient #18

Initial consultation date: 24 November 1970

Comments from an accompanying secretary: On October 17, 1970 the patient was travelling from Guang Dong to Shang Hai with 10 or so associates to study at a particular factory. While traveling she became fatigued, and felt exceedingly rash; after reaching Shang Hai the environment was unfamiliar, and she felt unaccustomed to the social ways and emotionally tense. She developed unquiet sleep at night, that developed into copious speech. At a mental hospital she was diagnosed as “schizophrenic,” and was hospitalized for observation.[?] She was given 200 gram internal doses of chlorpromazine and 4 tablets of trihexyphenidyl every day. After one week her condition had improved. She joined the class for one week, and then there was a relapse. She had copious speech, was disquieted whether sitting or standing, and was unable to get to sleep. Again she was admitted to a mental hospital for treatment. Daily dosages of chlorpromazine reached over 400 grams, but the symptoms were not controlled.

Diagnostic observations: Due to taking sedative drugs, the patient had a dull spirit-orientation. She required an assistant to walk, her clothes were in disarray, and she had increased speech and actions. She was uncooperative with personal contact. However, she did not have the explosive behavior of hitting people and cussing. Her throat was dry and red. She said that her chest and venter were uncomfortable, she wanted to spit but could not, and she was remorseful and agitated. The tongue fur was gray, yellow, thick, and slimy. The pulse reading was string-like and rapid. The patient had dry lips, thirst, and had been constipated for several days.

Pattern Identification: Hepatocystic depressed heat, and phlegm clouding the heart spirit (schizophrenia).

Treatment Principles: Abduct phlegm and drain the liver, quiet the spirit and course depression.

Consultation #1:

Point Selection: Ren Zhong (GV-26) connected to Jiao Yin (CV-7), and Nei Guan (PC-6).

Herbal Prescription:

1 batch.

Consultation #2: (Comments from an assistant) The evening before the patient took four 50 gram tablets of chlorpromazine, 1 tablet of trihexyphenidyl, and one batch of Chinese herbs. She slept from 7:30 p.m. to 11:30 p.m., was awake for about an hour, and then slept until 8 in the morning. Her mental condition had improved, and the uncomfortable, dry feeling in her throat had decreased. The patient herself reported that her menstrual period was delayed, and had still not started.

Diagnostic Observations: The patient’s memory, calculations, and planning were reasonably good. Her actions still tended toward excitation, and she had copious speech. The tongue fur was gray, thick, and had scant Jin-liquid??; the pulse was fine and rapid.

Point Selection: Same as before.

Herbal Prescription: The original prescription with the addition of 9 grams of Zhi Shi—Unripe Bitter Orange. 1 batch.

Consultation #3: The patient’s spirit-orientation was as if clear and as if dark. She was still uncooperative with personal contact. However, she was better than before, and her sleep was improving. The tongue tip was red, and the fur was gray and slimy, while the pulse was string-like, fine, and rapid.

Point Selection: Ren Zhong connected to Yin Jiao, Feng Long (St-40), and Tai Chong (LV-3).

Herbal Prescription: The current prescription with the addition of Ku Xing Ren—Bitter Apricot Kernel (9 grams). 1 batch.

Consultation #4: On this day the patient’s spirit-orientation was slightly clear, but she was still uncooperative with personal contact. The tongue fur was slimy and covered with gray; the pulse was deep and rapid. Such symptoms are ascribed to residual phlegm heat, which requires treatment that clears heat, sweeps phlegm, and quiets the spirit.

Point Selection: Ren Zhong, An Mian (N-HN-54), Shang Wan (CV-13), Zhong Wan (CV-12), and Jian Shi (PC-5).

Herbal Prescription:

1 batch.

Consultation #5: The previous night the patient slept well, her speech was reduced, and she was cooperative. She wanted to get an acupuncture treatment. Her bowels moved freely, but she still had dry lips and mouth. The tongue tip was red, and the fur was gray and slimy, while the pulse was deep and rapid.

Point Selection: Ren Zhong connected to Yin Jiao, An Mian, Shang Wan, Zhong Wan, and Jian Shi.

Herbal Prescription:

2 batches.

Consultation #6: Quiet nighttime sleep, gradually clearing spirit, and cooperative personal contact. The patient’s speech was almost normal, and her stools were alright. The tongue fur was gray, slimy, and becoming thin. The pulse was slippery ??? and small. With turbid phlegm and depressed fire gradually transforming, the primary treatment was to quiet the spirit and harmonize the stomach.

Point Selection: Ren Zhong, An Mian, Nei Guan, and Zu San Li.

Herbal Prescription: The same prescription was continued for two more batches.

Consultation #7: The patient’s spirit-orientation had already cleared, and she made clear responses to questions. Her stools were relatively stiff, and she also had headache.

Point Selection: Same as before with the addition of bilateral Tai Yang (M-HN-9).

Consultations #8-9: The spirit was clear, the sleep was quiet, intake was alright, and the stools were disinhibited. There was still some headache. The tongue fur was gradually transforming, but the root was still coarse and slimy. The pulse was deep and string-like, as well as rapid. Menstruation had still not occurred; this was from residual surplus pathogen (evil), and again the treatment was to quiet the spirit, to clear and to course.

Point Selection: Yin Tang (M-HN-3) connected to Heart Region, Tai Yang, Nei Guan, Zu San Li, and San Yin Jiao.

Herbal Prescription:

3 batches.

Consultation #10: The patient had a clear spirit, cough, aching lumbus, dizziness, and constipation. This was from residual internal fire. The interior/exterior relationship of the lung and large intestine needed to be diffused.

Point Selection: Yin Tang connected to the Heart Region, Tai Yang, Lie Que (LU-7), Zu San Li, and Da Chang Shu (BL-25).

Herbal Prescription: Three more batches of the current formula.

Consultations #11-12: The patient had cough with sticky phlegm, constipation, dizziness as well as headache, and a bitter taste in the mouth. The tongue tip was red, and the pulse was slippery, small, as well as rapid. These are signs of residual phlegm-turbidity, hepatocystic dry depression, and undiffused yang brightness bowel qi. It was treated by coursing, abducting, and transforming phlegm.

Point Selection: Yin Tang, Feng Chi, Tai Yang, Nei Guan, He Gu, and Feng Long.

Herbal Prescription: The current formula with the addition of 9 grams of Bai2 Ji2 Li2.

Consultations #13-15: The headache and dizziness had already been eliminated, while the stools were disinhibited. Menstruation had passed and the patient had completely stable essence-spirit. She was able to come by herself to the clinic for treatment. The Western drug prescription of chlorpromazine was reduced to only the maintenance dosage level of two 25 gram tablets in the evening. The tongue fur had transformed while the pulse was slippery, small, and calm.

Point Selection: Yin Tang, Tai Yang, He Gu, Zu San Li, San Yin Jiao.

Herbal Prescription:

7 batches. After being cured the patient stayed in Shang Hai for the duration of her training. She later came to the clinic to bid us farewell. Her spirit and attitude appeared to be like a normal person.

Comment: In this patient’s case, the migration to a new environment and excessive thought and thinking lead to liver-gallbladder qi depression, and loss of coursing, discharge, and orderly reaching. The spleen lost fortification and movement, so phlegm turbidity was automatically engendered. With phlegm clouding the heart portals there emerged a hint of withdrawal; the symptoms seen were “unquiet sleep at night, that continued into copious speech.” with unresolved liver-gallbladder depression and binding, the desire to spit but unable to , and ??? agitation; as these symptoms endured there was transformation to fire that engendered heat, and phlegm was smelted by the heat such that it became sticky and difficult to resolve. When it harassed the heart it was seen that “she had increased speech and actions, in personal contact she lacked cooperation,” and “her throat was dry and red.” However, she still did not develop to the manic form of hitting people and cursing. With phlegm and heat obstructed in the middle, then the thoracic venter was uncomfortable, which resulted in gray, slimy, yellow tongue fur, and a pulse that was string-like, fine, and slightly rapid. This has some distinction from the large, slippery, and rapid pulse that is usual for mania. There were also dry lips and thirst, and several days of constipation, etc. These are all signs of depressed and binding phlegm heat. This pattern is like withdrawal, but it is not withdrawal; it is like mania, but it is not mania. Therefore, it is called “combined withdrawal and mania pattern.” The emphasis of treatment was to drain the liver and gallbladder while sweeping phlegm heat. When the liver and gallbladder are discharged, then agitated motion is automatically extinguished. When phlegm is flushed and heat is eliminated, then the spirit light is automatically cleared. The point selection of Ren Zhong connected to Yin Jiao controls agitated motion. Tai Chong courses the liver and downbears counterflow. Nei Guan courses depression and rectifies qi. Ying Tang connected to the Heart Region quiets sleep, the heart, and the spirit. Feng Long clears heat and sweeps phlegm, while Jian Shi clears the heart and eliminates vexation. Shang Wan and Zhong Wan harmonize the stomach. The herbal prescription selected for this patient at the early stage used ingredients to clear heat and flush phlegm, and drain the liver while freeing and abducting. These herbs are such as [5 herbs listed]. After 7 consultations the pulse had changed and the tongue fur was transformed, there was still residual surplus pathogen (evil), so variants on the ingredients were used to transform phlegm and clear the heart, harmonize the stomach, and quiet the spirit. For cough apricot kernel was added, for dizziness and headache Bai2 Ji2 Li2 was added. During the course of treatment the dosages of Western drugs were reduced from 400 grams per day to the maintenance dosages of only 50 grams in the evening while the cure was being consolidated.