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‘Tan Re Mi Xin Qiao Hun Po’ – Phlegm and Fire disturb mind, Shen, Heart, ethereal & physical spirit.
For the purpose of general understanding of these disorders, they will be divided into 2 groups:
1. Mood episodes
2. Mood disorders (depressive, Bipolar, other)
Mood Episodes
Any period of time when a patient feels abnormally happy or sad. Mood episodes are the foundation, or
starting point from which many of the identifiable mood disorders are constructed. Most mood disorder
patients will have one or more of these 4 types of episode: major depressive, manic, mixed, and hypomanic.
Without additional information, none of these types of mood episodes is an identifiable diagnosis.
Major Depressive Episode: for at least 2 weeks the patient feels depressed or can’t enjoy life, and has
problems with eating and sleeping, feelings of guilt, fatigue, trouble concentrating, and thoughts about death.
Manic Episode: For at least 1 week the patient feels elated or sometimes irritable, and may be grandiose,
talkative, hyperactive, and distractible. Bad judgment leads to marked social or work impairment. Often these
patients must be hospitalized.
Mixed Episode: the patient has fulfilled the symptomatic criteria for both a manic and a major depressive, but
it has lasted as briefly as 1 week.
Hypomanic Episode: much like a manic episode but it is briefer and less severe.
Mood Disorders
A pattern of illness due to an abnormal mood. Nearly every patient who has a mood disorder experiences
depression at some time, but some also have ‘highs’ of mood. Many, but not all, mood disorders are
diagnosed on the basis of a mood episode. Most patients with mood disorders will fit into one of the
identifiable categories listed below. They are divided into 3 groups: depressive, bipolar, other.
Depressive
Major Depressive Disorder: these patients have never had manic or hypomanic episodes but have had one
or more major depressive episodes. Major Depressive Disorder will be either recurrent or single episode.
Dysthymic Disorder: not severe enough to be called a major depressive episode. This disorder lasts much
longer then major depressive disorder, and there are no ‘high’ phases.
Depressive Disorder not otherwise specified: when a patient has depressive symptoms that do not meet
the criteria for the depressive diagnoses above or for any other diagnosis in which depression is a feature.
Bipolar
Bipolar I Disorder: there must be at least 1 manic episode. Most Bipolar I patients have also had a major
depressive episode.
Bipolar II Disorder: at least 1 hypomanic episode plus at least 1 major depressive episode.
Cyclothymic Disorder: have had repeated mood swings, but none that are severe enough to be called major
depressive episodes or manic episodes.
Bipolar Disorder not otherwise specified: has bipolar symptoms that do not meet the criteria for the bipolar
diagnoses above.
Other
Mood Disorder due to a general medical condition: ‘highs’ and ‘lows’ can be caused by various types of
physical illness.
Substance-Induced Mood Disorder: Alcohol or other substances can cause ‘high’ or ‘low’ moods that may
not meet criteria for any of the above mentioned episodes or disorders.
Mood Disorder not otherwise specified: do not fit neatly into any of the mood disorder categories
mentioned above.
Schizoaffective Disorder: symptoms of Schizophrenia coexist with a major depressive or manic episode.
Cognitive Disorders with depressed mood: could show with dementia or Alzheimer’s. Delerium may also
start with depression, anxiety, or other expressions of dysphoria.
Adjustment Disorder with depressed mood: can only adjust to a life stress one way.
Personality Disorders: may be present in avoidant, dependant, histrionic, but most notably in borderline.
Bereavement: when symptoms last more than 2 months following the death of a loved one.
Misc: Schizophrenia, eating disorders, somatization, sexual and gender identity disorders, anxiety, panic
disorder, obsessive-compulsive, phobic disorder, and post traumatic stress disorder.
Personality traits: well ingrained ways in which people experience, interact with, and think about everything that
goes on around them.
Generally Personality patterns/disorders are present since early adult life. All people have components of
these patterns but are not considered disorders until they accentuate to the point of impairing one’s normal life
functioning, or cause distress.
There are 10 disorders divided into 3 clusters. 301.84 Passive-Aggressive pattern/disorder has been removed
since DSM III and put into an appendix to await further study.
301.00 Paranoid: suspicious and quick to take offense. They often have few confidants and may read hidden
meaning into innocent remarks.
301.20 Schizoid: care little for social relationships, have a restricted emotional range, and seem indifferent to
criticism or praise. Tending to be solitary, they avoid close (including sexual) relationships.
301.22 Schizotypal: interpersonal relationships are so difficult for these people that they appear peculiar or
strange to others. They lack close friends and are uncomfortable in social situations. They may show
suspiciousness, unusual perceptions or thinking, eccentric speech, and inappropriate affect.
301.70 Antisocial: irresponsible, often criminal behavior of these people begins in childhood or early
adolescence with truancy, running away, cruelty, fighting, destructiveness, lying, and theft. In addition to
criminal behavior, as adults they may default on debts, or otherwise show irresponsibility, act recklessly or
impulsively, and show no remorse for their behavior.
301.83 Borderline: impulsive, make recurrent suicide threats or attempts. Affectively unstable, they often
show intense, inappropriate anger. They feel empty or bored and they frantically try to avoid abandonment.
They are uncertain about who they are, and lack the ability to maintain stable interpersonal relationships.
301.50 Histrionic: overly emotional, vague, and attention-seeking. Need constant reassurance about their
attractiveness. They may be self-centered and sexually seductive.
301.81 Narcissistic: self important and often preoccupied with envy, fantasies of success, or ruminations
about the uniqueness of their own problems. Their sense of entitlement and lack of empathy may cause them
to take advantage of others. They vigorously reject criticism, and need constant attention and admiration.
301.82 Avoidant: these timid people are so easily wounded by criticism that they hesitate to become involved
with others. They may fear the embarrassment of showing emotion or of saying things that seem foolish.
They may have no close friends, and they exaggerate the risks of undertaking pursuits outside their usual
routines.
301.60 Dependant: need the approval of others so much that they have trouble making independent
decisions or starting projects. They may even agree with others whom they know to be wrong. they fear
abandonment, feel helpless when they are alone, and are miserable when relationships end. They are easily
hurt by criticism and will even volunteer for unpleasant tasks to gain the favor of others.
301.40 Obsessive-Compulsive: perfectionism and rigidity. They are often workaholics and tend to be
indecisive, excessively scrupulous, and preoccupied with detail. They insist that others do things their way.
They have trouble expressing affection, tend to lack generosity, and may even resist throwing away worthless
objects they no longer need.
5 subtypes of Schizophrenia
1. Paranoid: these patients have persecutory delusions and auditory hallucinations, but no negative
symptoms, disorganized speech, or catatonic behavior.
2. Disorganized: delusions and hallucinations are less prominent than negative symptoms and disorganized
speech and behavior.
3. Catatonic: excessively retarded or excessively excited behavior that is very bizarre.
4. Undifferentiated: some of all the basic types of psychotic symptoms, not one particularly dominates.
5. Residual: after an acute psychosis the patient is markedly improved, although they still seem somewhat
unusual, odd, or peculiar.
Schizophrenia-like disorders
Schizophreniform: patients who display the proper signs and symptoms for diagnosis but have only been
affected for under 6 months.
Schizoaffective disorder: for at least one month the patient has had symptoms of schizophrenia, at the same
time they have prominent symptoms of mania and/or depression.
Brief Psychotic disorder: at least one of the psychotic symptoms for under one month.
Caution should be taken when treating: Kuang, must sedate and purge, but when moving towards Dian, must
change treatment principle as to not depress patient more. Clearing Phlegm can always be done.
Kuang – all three pulses & levels are big & flooding, people may strip in public, sing/scream/swear or
act out, become violent (have incredible force), lots of energy (don’t need to eat to maintain energy),
angry, very out of character, may be suicidal.
↑ Yang → purge & remove Phlegm-Fire or Blood Stasis.
Dian – all three pulses & levels are thin weak & deep, person is very quiet, no concentration, speaks
nonsense, lack of expression, eat unclean food from street/garbage, lie or laugh a lot for no reason, think
unreasonably, feel guilty, afraid that someone is after them, may think they are having a heart attack (but not
so), manic sadness & happiness.
↑ Yin → Phlegm & Qi stagnation.
Dian
Phlegm & Qi slow onset, over thinking
stagnation or worry injures the SP
Qi → Phlegm builds up
causing stagnation →
Xiao Yao San
blocks the mind,
+ Di Tan Tang
extreme depression,
listless, do not speak for
soothe LR Qi & dissolve Moxabustion is very
days or continuous
Phlegm useful here. ST 40, Ren
speech, can’t make
4, 6, Bai Hui, Du 4, 14,
decisions, manic
ST 36, Yintang. These
happy/sad, no appetite,
may be used for all Dian
may be suicidal,
T- sl. purple w/ teeth-
marks
P- slippery wiry
Qi ↓ & Phlegm chronic Qi ↓, very quiet
stagnation (wooden chicken),
absence of or Si Jun Zi Tang
nonsensical thought, nourish SP Qi & dissolve + Di Tan Tang
puffy dull face, soft stool, Phlegm or Gui Pi Tang
fatigue, no appetite, T- Ban Xia Huo Po Tang
pale swollen w/ teeth-
marks P- weak slippery
Qi & Blood ↓ chronic Qi & Blood ↓,
long term psychosis,
lack of concentration,
talk very little, talk to
themselves, very nourish Qi & Blood to
Yang Xin Tang
consumed, palpitations, strengthen HT SP (mind)
pale complexion, hard to
get excited, no mental
strength,
T- pale, white coat
Kuang Zheng
‘Tan Re Mi Xin Qiao Hun Po’ – Phlegm and Fire disturb mind, Shen, Heart, ethereal & physical spirit.
Western Medicine: Manic Psychosis, Schizophrenia, Hypomania, Postpartum disorders, Substance use
disorders, Acute reactive disorders, hysteria.
‘Kuang Zheng’ is a Fire (Yang) pattern that is usually complicated with Phlegm covering the Heart, mind,
spirit, Hun (ethereal) and Po (physical) soul. This manifests as blockage accumulating until the point of
bursting causing Fire to surge upwards. It shows a relative excess of Yang and a deficiency of Yin
simultaneously.
Symptoms: sudden onset, irritability, flushed face, blood shot eyes, mania, restlessness, climbing to high
places, public singing, unusual strength, anorexia, insomnia, constipation, T- red with yellow coat, P- rapid
Treatment: Purge the Phlegm and Fire through the Large Intestine by inducing diarrhea, Tonify Yin, remove
stagnation.
***It is important to fully and completely eliminate the Phlegm in the treatment of Kuang, otherwise recurrence
is guaranteed.
Acupuncture
5 steps to follow…
1. Main points: Ren 12, 13, 15
2. Calm: Du 26-28 (strong stimulation), KI 1
3. Purge Yangming: LI 4, 11, ST 36, 37, 39, SJ 6
4. Shaoyang: GB 20
5. Taiyang: BL 9, 10
Empirical Acupuncture Combinations
Clear Minister Fire: connect PC 5 to SJ 6
Fire and Phlegm: PC 5, ST 40
Phlegm in Lung system: ST 40, LU 7
Sweating (night or daytime spontaneous): HT 6, KI 7
Fever: LI 11, Du 14, HT 3
Hearing voices in the head: SI 19, GB 2, PC 5
Ghosts in dreams: SP 1, ST 45
Dr. Liu Feng (20th century) expresses the need to balance and connect the triangle of ‘cognition/personality’,
‘will’, and ‘emotions’ to achieve results within treatment of all mental disease. He also stresses to watch
personality changes to understand severity of the patients disease. This helps to determine if the disorder is
simply a personality or neurotic disorder, or if it is more severe causing great distress and problems fitting in
with society which would lean more towards (affective) Mood disorders or Schizophrenia.
TCM Diagnosis:
Yang Symptoms – loud, much action, extroverted (use Ren Meridian)
Yin Symptoms – quiet, minimal action, introverted (use Du Meridian)
Organ Differentiation: heart/lung/liver/kidney/spleen
Heart Differentiation: Mental (hand shao-yin) Physical (hand jue-yin)
King fire more connects with stomach
Minister fire connects with spleen
Brain connects with TCM Heart and Kidney
Phlegm – root of all mental disease! covers heart
1- Invisible or Visible turbid phlegm
2 -Blood nourish spirit – blood stasis
3 –Qi – connects with - blood stasis / phlegm / fire
deficient fire with phlegm – wants to kill self (moxa)
King or Minister Fire?
excess fire with phlegm – wants to kill others (clear heat)
Yin Yang Fan Zhuo – yin and yang reversed
Tan Qi Jiao Jie – phlegm and qi stagnated and mixed into sticky condition
Liver Rising – Si Jue Ming, Dai Zhi Shi, Sang Tae Lou
Heart Kidney Disharmony – Ci Zhu
Lung not Descending – Da Huang, Lu Hui + phlegm herbs
Acupuncture:
Phlegm Fire – Kuang Zheng - Yang
1. Main points: Ren 12, 13, 15
2. Calm: Du 26-28 (strong stimulation), KI 1
3. Purge Yangming: LI 4, 11, ST 36, 37, 39, SJ 6
4. Shaoyang: GB 20
5. Taiyang: BL 9, 10
6. yin tang – downwards towards bridge of nose
experience points:
1.Clear Minister Fire: PC 5 to SJ 6
2.Fire and Phlegm: PC 5, ST 40
3.Phlegm in Lung system: ST 40, LU 7
4.Sweating (night or daytime spontaneous): HT 6, KI 7
5.Fever: LI 11, Du 14, HT 3
6.Hearing voices in the head: SI 19, GB 2, PC 5
7.Ghosts in dreams: SP 1, ST 45