Dr. Jin Shu Bai, Case #9, Pages 27-29.

Cardiorenal Insufficiency (Delusive type schizophrenia)

Sun XX XX, Female, age 35, worker

Acupuncture research clinic patient # 8

Initial consultation date: 24 December 1971.

From an accompanying family member: An incident at work (when changing shifts the patient had issues about where she had to sign her name) set off heartfelt unhappiness in the patient, and for one week she was unable to sleep. Later she suspected that others were planning things to do to her; if co-workers wore bright clothes she thought they were making fun of her. After changing work units, she suspected there were numerous intellectuals, and she did not get along well. In the worst times she had contradicting emotions; she often had excessive thinking, auditory hallucinations, palpitations and disquieted heart. She could not sit or stand quietly; if she saw tree leaves swaying she would squat down out of fear. A mental hospital had diagnosed her as delusive type of schizophrenia.

Diagnostic observations: The patient had a pale white facial complexion, and a dull expression. She had intellectual contradictions and at times had thoracic oppression. Her intellectual capacity and motivation were still good. She was taking tardan, 3 pills both in the morning and at noon, and 4 pills at night. The pulse was soggy and fine, while the tongue was pale.

Identification of Patterns: Cardio-renal insufficiency, and hepatocystic qi temerity (delusive type schizophrenia).

Treatment Principles: Support the correct and boost qi, simultaneously regulate the heart, liver and kidney.

Point Selection: Bai Hui (GV-20), Da Zhui (GV-14), Feng Fu (GV-16), Jing Ming (BL-1), Zhao Hai (KI-6), Xin Shu (BL-15), Gan Shu (BL-18) each with 3 cones of bright (i.e., indirect) moxibustion.

Herbal Prescription: Loadstone and Cinnabar Pill with additions.

After 10 consultations all of the complaints had improved. There was still thoracic oppression and gallbladder temerity, as well as auditory and visual delusions.

Point Selection: Da Zhui, Xin Shu, Gan Shu, Pi Shu (BL-20), and Shen Shu (BL-23).

Herbal Prescription:

1 package every day.

After the 20th consultation, symptoms of a disquieted heart spirit were much better than before. The patient had alternating auditory and visual delusions, and was also having copious night sweating.

Point selection: Same as above with the additions of Fu Liu (KI-7) and Zhao Hai.

After 30 consultations there was an obvious diminishment of sensory hallucinations, and dosages of Western drugs were reduced by one half. When she saw tree leaves swaying she only had the slightly disquieted state of trying to squat down; she still had gallbladder temerity.

Point selection: Heart Shu, Liver Shu, Ge Shu (BL-17), Pi Shu, and Shen Shu. On alternating days two pairs of points were selected and each was treated with three cones of bright moxibustion. The patient’s family was shown how to do the treatment at home.

A follow up examination after three months of the above treatment showed that all of the delusive thoughts, as well as the auditory and visual hallucinations, and signs of fear had been ameliorated.

Comments: Withdrawal pattern ascribes to yin and is usually vacuity. Normally this refers to heart, spleen, liver, and kidney viscera. When the heart loses nourishment, then there is disquieted insomnia, and dull expression. When there is hepatocystic qi temerity then there is doubtfulness, delusive visions, thoracic oppression, and propensity to fright. When spleen qi does not move then there are delusive thoughts, and drained white facial complexion. With insufficiency of kidney qi there are auditory hallucinations and fear. Soggy, fine pulse and pale tongue are all signs of qi insufficiency. “Vacuity is treated by supplementation.” Therefore, the treatment was primarily to support the correct, and simultaneously manage the symptoms. In this case some effectiveness was observed after a good deal of acupuncture, yet the symptoms still lingered on. The classics say “Where acupuncture does not manage, is where moxibustion is suitable.” Thus the dorsal shu points for the heart, liver, spleen, and diaphragm were selected with three cones of bright moxibustion, in order to warm and nourish qi of the viscera and bowels. It was accompanied with the herbal prescription Loadstone and Cinnabar Pills to enrich the kidneys and restrain yang, and enhance to cardio-renal interaction. [???????] then the heart is quiet, the spirit is stored, and the patient enters sleep. After ten consultations the prescription was changed to Peaceful Interaction Pill plus Gallbladder-Warming Decoction with modifications to free cardio-renal interaction, boost qi, nourish blood, transform phlegm, and quiet the heart; this formula assists the power of acupuncture and moxibustion treatments. For copious night sweats, point Fu Liu was chosen. The point Zhao Hai from the yin motility vessel was selected to moisten the eye essence and reduce hallucinatory perceptions because it arrives at the inner canthus of the eye. The heavy use of moxibustion in this case is worthy of broad application and advanced research.