Using a case history, the author shows how the patient's psyche can be helped with TCM; that even though the patient's psyche may be in a complicated state, it is in the understanding of yin, yang, qi, xue, jin ye, i.e. 'substance', that TCM operates most effectively.
At the beginning of the 1980s when I left college and went into the world, the practice of effective Chinese medicine was a daunting task, especially in the realms of the psyche. I studied all I could in the areas of hun and shen etc. But it was a journey of constant frustration, as my patients were giving me precise and copious details as to their states of mind and emotions and I could not access precise information from TCM to give them the help I felt they needed. In desperation I began to turn my attention in the direction of homeopathy, which in comparison to TCM seemed rich and seething in detailed information on a plethora of mind states. I was prepared to be convinced that this was the way. So I enrolled at yet another college, The London College of Homeopathy. There I learnt much detail of the many types of personality and their different neuroses. After the first year of homeopathy exams, I came to a crucial point (it was clear that I could not practise TCM and homeopathy together); either I gave up Chinese medicine to pursue homeopathy, or I should accept the limitations of, as I saw it then, TCM in the realms of the psyche.
No contest! Chinese medicine was in my heart and in my blood, whilst homeopathy was just in my head. I realised that in time and with enough practice, I would perceive how TCM could help individuals with their specific individual psychological problems. In time it became obvious to me that I was still caught in the Western conditioning of the body/mind split. In every day practice it became clear to me that we work with 'energy' in its varying densities. To gather specific details as to the state of mind of your patient was not necessary. To understand the patients dynamics in terms of yin, yang, qi, xue and jin ye etc. was the point in TCM whatever their problems were. Thus my practice of TCM in the realms of the psyche gradually developed.
I give you a case history here to illustrate that even though the patient's psyche may be in a complicated state, it is in the understanding of yin, yang, qi, xue, jin ye, i.e. 'substance', that TCM operates most effectively.
CASE HISTORY A 26 year old woman presented to our London student clinic in the autumn of 1996. Ever since childhood she had been extremely anxious. She remembered, from the age of four years onwards, being constantly nervous and worried. For example she would be anxious if she had crossed the road when she knew she was not allowed to. She would feel guilty and worry for days ‘in case I was found out,’ she said. The symptoms of her anxiety presented as constantly being ‘on edge.’ She jumped with shock from loud noises. She felt confused, frightened, she could not think straight and, as she related this information to us in the clinic, she began to cry. She said she had got to the point of being constantly anxious about the emotional state she was in. She had a fear of being alone yet had an aversion to being alone with another person. This confused her and she could not understand it. She had little self confidence and felt paranoid a lot of the time.
She found it difficult to get to sleep at night and woke very early in the morning. She had recurring disturbing dreams. A typical theme was that, ‘everyone at work is giving me problems to try to get me out of the company.’ She got an average of 4-5 hours’ sleep at night. She described herself as hyperactive and worked long hours. She described her head as feeling muzzy and her brain being fuzzy and unclear, and said, ‘It's difficult to make out reality.’
Her mouth had a pasty taste and her sense of smell was weak. She did not drink fluids very much or often and neither did she pass much urine. She did not sweat easily, even with vigorous exercise. She constantly had phlegm obstruction in the nose, throat and lungs, with expectoration of green and sticky phlegm. She ate a rushed, junk food diet most of the time. Sometimes her bowels were difficult and dryish and other times they were loose.
She was prone to palpitations when she got panic type sensations in her chest with fright, feelings of heat flushing up and trembling. She had had many courses of antibiotics in her life to treat recurring throat infections and acne vulgaris. Her menstruation was regular, every 28 days. The bleeding used to be heavy, now it was dark and with clots but no pain. Pre-menstrual signs were weeping and increased anxiety before her menstrual flow. She had lumbar pains at times which were worse when her anxiety was bad.
She had received psychotherapy for a number of years and had had 20 sessions of hypnotherapy. Neither therapy, she claimed, had helped the way she constantly felt. Her insights gained from therapy were that she was outwardly aggressive to others in order to protect her inner vulnerability. She remembered that from an early age, ‘Mum was always pregnant but losing the babies.’ This caused increasing anxiety but she did not know why.
Her GP had prescribed Lorazepam, which she took for three months and it gave her some relief, but she had to stop because she felt drowsiness and found it even more difficult to concentrate than usual. She then had a course of acupuncture which brought some temporary relief, and the experience encouraged her to continue with Chinese medicine (and thus she was referred to the student Chinese Herb clinic).
Her physical body was slightly obese, with puffy flesh that looked slightly ‘turbid.’ She felt cold most of the time, although she had a reddish complexion and could flush up with heat at times.
Tongue inspection: Her tongue was a ‘Y’ shape, with a slightly swollen red tip which denoted shen disturbance, possibly of a long term nature. There were red spots on the tip and the sides of the tongue body. The main body of the tongue had a purple hue. The sides of the tongue were swollen in a thin strip. The lower jiao area of the tongue had an old medium thick white/yellow greasy fur. The tongue had no cracks. The tongue body was slightly swollen and covered in a thin, white, greasy fur. The sublingual veins were very large and distended, reaching up to the tip of the tongue. The veins were a red/purple, with dark red blood vessels fanning out from the upper third of the veins.
Her tongue reflected stagnation, especially blood stagnation of liver and heart of a long term nature. Her tongue showed liver qi stagnation leading to gan re (liver heat) agitating the heart and thus disturbing the shen. The slightly swollen tongue, covered in a thin white greasy fur, denoted that the transformation and transportation of the pi, i.e. spleen (transportation) and pancreas (transformation), was deficient, leading to the accumulation of damp and phlegm. The damp was draining downwards and stagnating in the lower jiao hindering the kidney qi in its transformation of fluids.
Pulse palpation: On the right side the pulse was located at the medium depth at a medium rate. It was knotted and rolling. The upper and middle jiao were rolling and the lower jiao was deep, soft and small. The left side pulse was of medium depth and rate. It was forceful, knotted , wiry and choppy.
Emotional analysis of some of the more important pulse qualities: The knotted pulse is related to some kind of emotional stagnation or repression. Her pulse was forceful, felt obstructed, and this related to obstruction of qi and xue due to chronic obstruction by phlegm and stagnant blood (especially when knotted was associated with rolling and choppy qualities). The knotted pulse could have been induced by some past shock/fright to the heart, shen, xue. From her pulse and from her past history we all felt that some trauma might have happened to her at an early age and that, if many sessions of psychotherapy and hypnotherapy had produced little results so far, it could be due to the stagnation and repression, obstructing the expression and therefore the realisation of certain events in her past.
The rolling pulse could (in my opinion) signify a determined avoidance of confrontation, again perhaps in her case relating to the past events in her life. In its physical manifestation, the rolling pulse denotes accumulation of phlegm-dampness; the more slippery the pulse, the more the damp has condensed into phlegm. The wiry pulse here signified chronic emotional and nervous tension caused by emotional repression, i.e. non-expression of emotions (leading to liver qi stagnation) possibly from past repressed anger or frustration.
The mixture of choppy and wiry pulse indicated obstruction of congealed blood and congestion of qi in the liver. This combination can be seen in people who keep erratic hours, have restless sleep and have a poor diet. The mixture of a choppy and rolling pulse may indicate, I believe, a person in an emotionally stuck state of non-confrontation and avoidance of the reality of the problems in the person's life. The patient may be aware of their stuck condition and even the causes of that state but they may perceive themselves as having no available options to change their situation.
Whether my opinion is correct or incorrect (as regards the psychological understanding of the pulses is concerned), it will have little relevance to the treatment principles that ensue, and that is the strength of TCM. As I related in the first paragraph of this article, it is through the understanding of yin, yang, qi and xue, i.e. ‘substance,’ that TCM operates most effectively. So why am I bothering to relate any personal details of this patient to you if we are just going to work with qi, xue and tan (phlegm) obstruction? It is clear that xue, tan and qi obstruction are manifesting at various depths of her being and at the most refined depth. Her psyche in this case is (in my opinion) the most vital area to direct our attention and care to at this point. There are a small group of herbs/minerals that will clear obstruction of xue, tan and qi, but they have also been shown through the centuries to focus on the family of spirits (shen, hun, zhi, yi and po) to promote integration and harmony within a being. Thus a herbal formula should have one action and many purposes (the Emperor and its ministers, assistants and messengers).
Diagnosis 1. Xue and tan obstruction. 2. Xue stagnation affecting heart and liver leading to shen and hun disturbance. 3. Damp phlegm obstruction. 4. Phlegm misting the mind. 5. Spleen qi xu - kidney yang xu leading to accumulation of damp, draining down into the lower jiao. 6. Liver qi stagnation leading to liver heat agitating the hun and heart shen.
Choice of Acupuncture Formula with Treatment Principles and Points As this was a Chinese herbal student clinic we could not give her acupuncture treatment. In my private practice I would have used yin wei mai partly based on the pulse diagnosis, which showed the quality of a knotted pulse denoting blood and phlegm stagnation (possibly from past emotional trauma). The rolling and choppy pulse qualities, according to Wang Shu Hu who wrote the Mai Jing and Li Shi Zhen who wrote the Qi Jing Ba Mai Kao, denote obstruction in the yin wei mai of blood and phlegm. The Nan Jing states, ‘Yin we mai disease there is both physical and emotional suffering of heart pain symptoms.’ Other collected yin wei mai symptoms are insomnia, anxiety, mental restlessness, apprehension, depression, nightmares, paranoia, phobias, hysteria, lack of mental clarity, shock, palpitations, palpitations from fear etc. The acupuncture formula I would have used would consist of P 6 nei guan and Sp 4 gong sun assisted by P 5 jian shi on the left side and St 40 feng long on the right side.
Nei guan regulates yin wei mai to treat nervous shock which may affect the movement of the blood by heart qi. It invigorates the heart blood and regulates liver qi. It is assisted by jian shi which breaks chronic blood stagnation that can lead to unstable shen. It also clears phlegm that is misting the heart/shen (mind).
Gong sun assists nei guan in breaking up stagnation of blood. It especially concentrates on descending turbid damp and raising up clear qi. It also works with nei guan to generate heart blood to calm the shen. Gong sun is assisted by feng long which transforms dampness. Feng long also clears phlegm, especially when combined with jian shi, which together clear phlegm obstructing the shen (mind) with symptoms of anxiety, palpitations, confusion, mental and emotional hyperactivity, insomnia, and restlessness. Feng long also works with gong sun to clear turbid phlegm obstructing the head causing muzziness, and bring clarity to the mind.
Yin wei mai is especially used when the shen and the yi are not co-ordinated. In the words of Luo Mei Qing from the Qing dynasty 1675 AD, ‘Nourishing the heart blood to house the shen and reinforcing the spleen qi to support the yi helps the mind (shen) to focus and make sense of perceptions and thoughts (yi).’ This will lead to a person who can focus on trains of thought and make sense of them. If not, then the person will manifest obsessive thought patterns creating anxiety and preventing sleep, creating confusion, producing phobias, panic attacks, palpitations etc.
Choice of Herbal Formula The main treatment principles are focusing on breaking up xue and tan obstruction, bearing in mind their important role in the obstructed state of her psyche. Therefore, it seems preferablce to begin to look at some formulae that have an encompassing action of clearing and calming the psyche with clearing the obstruction of xue and tan.
Zhu Dan Xi (1281-1358 AD) suggested using Ding Zhi Wan (Settle Orientation Pill) with the addition of hu po and yu jin. If phlegm was obstructing the senses he suggested the addition of phlegm clearing herbs such as zhu li or tian zhu huang that specifically treats agitation, insomnia, mania, withdrawal, impaired memory, phlegm obstruction of head and consciousness etc. The main ingredients of Ding Zhi Wan are: shi chang pu, fu shen, fu ling, yuan zhi, bai zhu, etc. Another formula to look at is Bu Nao Wan which may be used in cases of uneasiness, palpitations, insomnia, mental agitation, neurosis, anxiety, nervous depression, panic attacks, phobias etc. It contains: rou cong rong, yuan zhi, long chi, hu po, suan zao ren, bai zi ren, etc.
Also we could look at Jian Nao Wan with similar symptoms to the last formula except with the depletion of the heart and kidneys. It contains: rou cong rong, hu po, long chi, tian zhu huang, shi chang pu, shan yao, yi zhi ren, etc. One could also look at modern Chinese research formulae that are based on classical formulae, e.g. Kang Yi Tang Jiang which contains: shi chang pu, yuan zhi, fu shen, yu jin, long chi, yi zhi ren, hu po. It is used when phlegm, blood and heat disturb the mind with similar symptoms to the last two formulae. I include a quote from the Institute of Traditional Medicine: ‘In modern Chinese treatments for insomnia and mental agitation, a primary ingredient is dan shen. It is found in Chinese patent medicines and research formulae. One type of substance often combined with dan shen for this purpose is calcium carbonate (e.g. long chi). Bamboo sap (tian zhu huang) is rich in silicon dioxide which calms heart palpitations and treats insomnia especially when due to fright, and is selected for its easy digestibility.’
Another patent research formula contains: dan shen, which is the chief herb, hu po, long chi, zhu li or tian zhu huang, suan zao ren and ren shen. This formula is used principally to break blood stagnation and clear phlegm obstruction with symptoms of: insomnia, heart palpitation, nightmares, mental distress especially when due to fright or a traumatic experience. From the experience of using all these formulae, one formula is created, tailored to fit our patient.
Explanation of Treatment Principles within the Actions of the Herbal Formula:
Yu jin 10 Dan shen 10 San qi 4 Hu po 4 Yuan zhi 10 Fu shen 6 Fu Ling 6 Tian zhu huang 10 Shi chang pu 6 Long chi 12 Bai zhu 8 Rou cong rong 8 Deng xin cao6
Yu jin is the emperor herb in this formula. It enters yin wei mai, heart (xue), liver (qI), lungs (phlegm). Yu jin is a pungent, bitter and cold herb that enters the heart and liver at the xue level. Its bitter cold energy drains heart fire (here with the help of deng xin cao). Whilst cooling the heart blood (with dan shen) and breaking up xue stagnation (with san qi) and clearing phlegm (with tian zhu huang), it can also disperse knotted liver qi by moving liver qi at the blood level. Its pungent nature is light and lifting, reaching up to the vertex, clearing phlegm obstruction from the head and consciousness. Its cold, bitter nature is sinking, descending turbidity down to the lower jiao. It enters the yin wei mai, it clears obstruction of xue, qi, fire and tan (phlegm), as cited in the Ben Cao Hui Yan, Treasury of Words on the Materia Medica, by Ni Zhu Mo (1624). You may notice that most of the herbs in this formula enter the yin wei mai to perform similar treatment principles as related in the acupuncture formula mentioned earlier. Herbs that enter the eight extraordinary vessels were comprehensively written about by Li Shi Zhen in his Qi Jing Ba Mai Kao or The Examination of the Eight Extraordinary Vessels (1570). (Giovanni Maciocia and Professor Wu Bo Ping give excellent lectures on this subject.)
Yu jin is a psychic herb of a moderate nature. What makes it the emperor herb in this formula is its ability to regulate qi, move blood stagnation, clear heat agitation, and clear phlegm obstruction from the senses. Yu means 'obstruction' or 'constraint' of jin which means metal that is the phase (wu xing) that pertains to the physical organisation of a person/being. Thus we have a patient with a knotted, rolling and choppy pulse that denotes constraint of qi, xue and phlegm. Yu jin eases constraint and breaks up stagnation of blood and phlegm. Yu Jin also clears heat and cools the blood of the heart (caused by stagnation). It clears phlegm that obstructs the senses that can lead to anxiety, agitation, mental derangement and depression. It also moves liver qi depression to mobilise constrained emotions.
Then we address her chronic blood stagnation with three minister herbs: dan shen, san qi and hu po. Dan shen is the first minister that enters yin wei mai, chong mai, heart, liver and pericardium. Dan means cinnabar or the medicinal zhu sha (‘vermilion sand,’ mercuric sulphide, a strong shen-sedating medicinal that is not used today). The character for Dan represents a lump of the red mineral (mercury) inside a crucible. This was the process the Daoist alchemists used to turn mercury into gold to create the elixir of life or eternal life. This also relates to dan tian which means cinnabar field, the area around Ren 4, guan yuan ‘source gate,’ the place where the ‘moving qi between the kidneys (chong mai)’ manifests.
The Daoists related the herb dan shen to dan because of their similar colour (oxide red) and dan shen's special relationship to blood, just as ren shen (ginseng) has a special relationship with qi and yuan qi. Dan shen also has a special relationship with the element fire, xue and the heart. Traditionally, dan shen was likened to the chief blood formula Si Wu Tang, a balanced formula that nourishes and circulates heart and liver blood, which is a function of chong mai.
Dan shen breaks up congealed blood. The shen is housed in the heart/blood vessels and congealed blood indicates an obstruction of mind (shen = consciousness). Blood patency is regulated by the liver which houses the hun and emotions (hun = subconscious) and stagnant blood also results in obstructed emotions or vice-versa. Repressed qi (liver qi - emotions) leads to stagnation of blood, thus the consciousness is partially obstructed and its connection with the emotions (subconscious) is partially cut off. Thus dan shen will break up heart and liver blood stagnation and nourish the blood of the heart and liver. This harmonisation of blood or consciousness could re-establish connection between shen and hun (mind and emotions).
Dan shen is said to have a cooling/regulating function on the blood of the liver and heart and therefore relieve anguish, hyperactivity, mental and emotional unrest, premenstrual tension and spasmodic dysmenorrhoea with clots, insomnia, irritability, neurosis, palpitations, chest tightness, chest pains etc.
The next minister is san qi. It enters the liver and cardiovascular system. San qi is especially used for shock and trauma to the body tissues, blood vessels and to the blood and therefore consciousness. Dr John Shen often gives his patients san qi when he wishes to clear their ‘stuck’ mental/emotional trauma due to shock to the blood system. When the radial pulse drops a beat it can denote a past shock (that affects the stability of the shen = consciousness) to the blood and circulation (heart). San qi is a principle herb that will break the blood stagnation to release the trauma but at the same time its astringent nature will gather the blood and consciousness to focus the shen. Its sweet flavour gives it the traditional status as a ‘magic root for life preservation,’ i.e. it is a strong adaptogenic used for long term emotional/physical fatigue, chronic stress and low vitality. It has a rejuvenating effect on red blood cells and plasma. In this way it is a vital tonic and seen as closely related to ginseng. In fact it is called pseudoginseng. It also strongly assists yu jin and dan shen to clear blood stagnation.
Hu po is our third minister that also enters the yin wei mai as well as the heart, liver and bladder channels. Hu po is fossilised pine resin that has been under the ground for a long time so it has become hardened. It is also used to break up blood stasis caused by traumatic past experiences. The pine resin cools and calms the shen and hun. The fossilised aspect of hu po ‘earths’ (anchors) the shen (or conscious mind) and the hun (the subconscious and emotions). Hu po also harmonizes the shen and hun (to help integrate mind and emotions) which means that it could help the individual to be reconnected to the environment and other people. The disconnection will manifest as panic attacks, anxiety states, confusion, shock and fright, nightmares, vivid colourful dreams (hun not housed), an unstable consciousness with a hyperactive nervous condition. Thus hu po acts to focus the mind (shen) and collects the scattered emotions (hun). Hu po is used with yuan zhi and shi chang pu to treat emotional distress, palpitations with anxiety, forgetfulness and insomnia.
Next we address her phlegm damp obstruction with three minister herbs: yuan zhi, fu ling / fu shen and shi chang pu.
Yuan zhi also enters the yin wei mai as well as the heart, lung, liver and du mai channels. The second character in yuan zhi (zhi) is composed of two radicals. The top radical is the image of a small plant forcing its way up through the ground in a determined struggle to survive. This strong image denotes ‘will power.’ The character underneath is xin (heart – consciousness or mind) which denotes mind. Therefore yuan zhi is said to help one to focus on one's purpose in life. Yuan zhi clears phlegm obstruction of the heart and consciousness, and prevents the mind from getting obstructed or stuck, which could lead to pent up thoughts, brooding on past events. Yuan zhi is said to relieve high anxiety states and nervous stress, mental and emotional disorientation, apprehension, insomnia, nightmares, cerebral deficiency, mental fatigue, agitation, palpitations (it regulates heart qi).
Zhi can also be translated as memory. This type of memory is not the shorter term memorisation of facts that is conducted by the yi - spleen/pancreas. Zhi is the long term memory storage of events that gives us our place and identity in time. Zhi pertains to the kidney sphere, it connects with the du mai and thus to the sea of marrow, i.e. the brain. The brain is nourished by the jing and the jing relates to the past generations (our ancestors from who we inherit our jing), thus yuan zhi is combined here with rou cong rong which nourishes the jing. Yuan zhi harmonises shen (mind) with zhi (will-memory), supports memory and generates wisdom to help the mind focus on one’s place in this life and thus the will to live and propagate. Zhi can also be translated as the harmonisation of the 5 consciousnesses i.e. shen, hun, yi, po, with zhi (will) which directs the harmonisation in a similar way that yuan qi (arising from ming men - du mai) harmonises and directs the function of the zang organs. An ancient quotation highlights the directing function of zhi, ‘The will (zhi) doubtless, is that which the mind (shen) follows.’
The next minister used is fu ling / fu shen and they enter heart, spleen and bladder. Fu ling / fu shen is a white fungus that grows around the roots of pine trees in the hills of northern China. Fu shen is the central part of the fungus that attaches to the pine tree root and it absorbs some of the pine essence which has a cooling and calming function on the shen (mind). Fu shen helps to co-ordinate the shen (mind) with the yi (perceptions). Yi is associated with the spleen/pancreas i.e. the transformation and transportation of ‘earthly’ nourishment. The character yi denotes 'upright consciousness' which is 'bright ' and has the ability to receive and then to perceive earthly (from the world] ideas. It sorts and separates the wholesome thoughts from the unwholesome thoughts. The wholesome thoughts are nourishing ideas to be stored. The unwholesome thoughts should be discharged because they may unsettle the shen (mind) if they are absorbed and stored.
Fu ling promotes the absorption (transformation) of the clear (thoughts) and the discharge of turbid (unwholesome and confusing thoughts) and fu shen promotes the ability of the shen (mind) to focus and make sense of thoughts and perceptions (yi). Fu shen is said to open the mind (clears turbidity) to benefit wisdom, and to discharge obsessive thoughts. It clears muddled thoughts, brightens the dim-witted and improves the memorisation process. Fu shen also cools and calms the shen (mind). Fu shen physically calms the heart that is manifesting palpitations with anxiety and rage. It will calm the mind and promote peaceful sleep.
The third minister is shi chang pu and it enters the heart, spleen, liver, lungs and du mai channels. Its strong yang expanding aromatic fragrance vaporises obstructed phlegm that clouds the senses and consciousness. It lifts mental depression, uplifts the shen and promotes optimism, as it is said to bring light into the consciousness. It eases agitation and nervous tension that causes restlessness and insomnia. As it enters the du mai, it clears the sea of marrow (the brain) of cloudiness (phlegm obstruction) that could lead to mental dullness and slowness producing states of confusion, mental disorientation, agitation, etc. Shi chang pu has a warm and fragrant nature that assists spleen yang in the transformation of gu qi (food and drink). Thus it assists fu ling and bai zhu in transformation and transportation in the middle jiao in order to stem the further production of damp and phlegm. It can also be used in intestinal qi restraint causing constipation and diarrhea.
The first assistant is tian zhu huang which enters the heart, san jiao, lung and liver channels. ‘Heaven bamboo yellow’ is cold and calming and clears phlegm heat that obscures, confuses and agitates the shen (mind). It assists shi chang pu and yuan zhi to clear confusion and agitation caused by obstruction of phlegm. In Zhu Dan XI’s Dan Xi Zhi Fa Yin Yao it states ‘palpitation, anxiety, easily startled, insomnia, mental disturbance etc. if it comes and goes, this is phlegm being moved by fire. In thin people lack of blood is usually the cause; in fat people it is always mostly from phlegm.’ The symptoms too can result from phlegm misting the heart. In her case we use yu jin, yuan zhi, shi chang pu, and fu shen with the assistance of tian zhu huang to clear the heat agitation from the heart and clear the phlegm misting the mind (heart – shen).
The next assistant is bai zhu which enters the spleen and stomach channels. Bai zhu is used here to co-ordinate with fu ling. Whilst bai zhu principally ascends clear qi, fu ling principally descends turbid qi, thus the two herbs produce a circular motion (up and down like the pedals of a bicycle) within the earth and thus produces a gentle movement of qi and fluids throughout the body. When this process is stagnant, the person will feel a general sense of congestion, with heaviness of the body and a dull pressure in the head. Bai zhu will assist fu ling to help the yi to absorb (transform) and memorise (transport) perceptions and thoughts. In the essay Dan Xi Xin Fa (1481) it cites bai zhu as one of the herbs for clearing phlegm damp. Bai zhu works with fu ling to reinforce spleen qi to treat loose bowels caused by poor transformation.
The third assistant is long chi that also enters the yin wei mai plus the heart, liver and kidney channels. ‘Dragon’s teeth’ is the foremost remedy for fear and fright. It is used for phobias, paranoia, nightmares, anxiety states, insomnia, dream disturbed sleep, emotional distress, irritability, restlessness, palpitations etc. Long chi is the fossilised remnants of large mammalian bones that have laid underground for at least a century or more. Thus the bones have an ‘earthing’ function on the shen and hun, and assist hu po. Long chi is heavy and sinking, with an anchoring action on the consciousness. Long chi has an astringent action so whilst it anchors the yang and calms shen (mind), it also astringes the liver yin and it is the liver yin that draws in and holds the hun. Insomnia with vivid dreams means there is excessive movement of the hun and shen. Long chi is said to earth the shen (mind] the hun (emotions) and stabilise the zhi (i.e. it strengthens clarity of purpose and the will).
The fourth assistant is rou cong rong that enters the dai mai, kidney, liver and colon channels. Its main function here is to assist long chi to stabilise the will (zhi). It is said to reinforce the zhi (will) against fear. Its other main function is to assist yuan zhi by producing jing to nourish the sea of marrow (brain) to reinforce zhi or long-term memory. As rou cong rong enters the dai mai, it promotes the function of the kidney qi to sort and separate the clear fluids from the turbid fluids and, being a warm kidney yang tonic, it will steam up the pure fluids to moisten and cool the upper jiao. In this case, damp and thin mucus are being produced because of spleen qi deficiency and kidney yang deficiency which is affecting the middle jiao primarily and draining down, causing some obstruction of the lower jiao. It can be treated by warm transformation herbs and here we are using rou cong rong with bai zhu, with the assistance of shi chang pu and fu ling. Rou cong rong also nourishes the blood to protect the blood from the vigorous blood moving herbs. Rou cong rong will also moisten the bowels in the case of dry difficult stools.
Deng xin cao, the last assistant, enters the lung, heart, small intestine and bladder channels. This herb gathers and guides heat and fire from the upper jiao (heart - shen – mind) down through the middle jiao (small intestine, heart's related organ in the fire phase), then draining down and out via the lower jiao (bladder, related to small intestine on the tai yang level) in the form of urine. Deng xin cao assists the draining damp herbs and the heat clearing herbs by its action of draining heat turbidity downwards. It can re-establish communication between the heart (excess fire) and kidneys (deficient water). So in this way it has a calming and cooling action on the shen and thus it can be used for irritability, hyperactivity, restlessness, insomnia, anxiety, weeping and crying fits.
Patient Response The patient came back to see us after taking the herbs for nearly a month. After her first week of herbs, she said that she was feeling mentally and emotionally worse. ‘I felt stirred up inside,’ she reported. She was asked to phone us if she had any problems or worries, but she did not think it was necessary. When she was into the second week she said that she began to feel more at ease, i.e. less anxiety and fear. She was now sleeping a full eight hours a night and since the second week she had had no more panic attacks. She said that her mind felt clearer. She noticed that when her phlegm had begun to clear from her nose and throat her anxiety also seemed to lessen at the same time. Her digestion and bowels were fine. She complained of a skin rash that appeared after the first week of herbs. Her skin became red, hot and itchy but this only lasted for five days before it disappeared.
On reflection, I think that the rash was a result of the fact that when we break up blood stasis we may release some heat into the blood which then floated out to the surface, i.e. the skin. All this heat should have been drained downwards by yu jin and deng xin cao. It seems I underestimated either the dosage levels of both these herbs, or I should have added an extra herb to clear heart fire, cool blood heat and drain heat downwards.
When inspecting her tongue, it was agreed that perhaps her sublingual vein distension was slightly less pronounced. Certainly the body of her tongue was less purple in colour. Her tongue fur had receded but there still remained a white/yellow greasy fur at the rear. Her pulse now had a regular beat but it still expressed a rolling and tense quality.
The same treatment principles still applied and she was given another month on a modified version of her first formula with instructions to phone at the end of the month to report in. She phoned a month later to say that everything was still fine. She was instructed to carry on without herbal treatment but to phone us if she ran into problems. As yet, we still haven't heard from her.
(A full Bibliography for this article is printed in the hard copy of The European Journal of Oriental Medicine Vol. 2 No. 5; Summer 1998.)
Ken Lloyd Ken Lloyd is currently a clinical Chinese Herbal Medicine teacher at the clinics of the London School of Acupuncture and Traditional Chinese Medicine, the University of Westminster, and the College of Integrated Chinese Medicine and Reading. He has been lecturing on acupuncture and Chinese herbal medicine at the above establishments since 1990.
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