‘Tan Re Mi
Xin Qiao Hun Po’ – Phlegm and Fire
disturb mind, Shen, Heart, ethereal & physical spirit.
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Bipolar (manic-depression)– Kuang Dian
Mood (affective) Patterns/Disorders (DSM IV)
For the purpose of
general understanding of these disorders, they will be divided into 2
1. Mood episodes
2. Mood disorders (depressive, Bipolar, other)
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.
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
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.
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.
Episode: much like a manic episode but it is
briefer and less severe.
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 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.
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’
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
Disorder: there must be at least 1 manic episode. Most Bipolar I patients have also had a
major depressive episode.
II Disorder: at least 1 hypomanic episode plus at
least 1 major depressive episode.
Disorder: have had repeated mood swings, but none
that are severe enough to be called major depressive episodes or manic
Disorder not otherwise specified: has bipolar symptoms that
do not meet the criteria for the bipolar diagnoses above.
Disorder due to a general medical condition: ‘highs’
and ‘lows’ can be caused by various types of physical illness.
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.
Disorder not otherwise specified: do not fit neatly into any
of the mood disorder categories mentioned above.
Disorder: symptoms of Schizophrenia coexist with a
major depressive or manic episode.
Disorders with depressed mood: could show with dementia or
Alzheimer’s. Delerium may also start
with depression, anxiety, or other expressions of dysphoria.
Disorder with depressed mood: can only adjust to a life stress one way.
Disorders: may be present in avoidant, dependant,
histrionic, but most notably in borderline.
symptoms last more than 2 months following the death of a loved one.
Schizophrenia, eating disorders, somatization, sexual and gender
identity disorders, anxiety, panic disorder, obsessive-compulsive, phobic
disorder, and post traumatic stress disorder.
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Personality Patterns/Disorders (DSM IV)
Personality traits: well ingrained ways in which people experience, interact
with, and think about everything that goes on around them.
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.
Cluster A (odd cluster)
People with cluster A
personality patterns/disorders can be described as withdrawn, cold,
suspicious, or irrational.
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.
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
Cluster B (dramatic cluster)
People with cluster B
patterns/disorders tend to be dramatic, emotional, and
attention-seeking. Their moods
change rapidly (mood swings) and are often shallow. They often have intense interpersonal
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.
Cluster C (anxious cluster)
People with cluster C patterns/disorders
tend to be anxious and tense, and are often over-controlled.
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.
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Schizophrenia (DSM IV)
Patient displays at least 2
of the following for 6 months or more…
delusions: think they are god or a famous person
(grandeur), think they have committed something terrible (guilt), think
they have disease, think that spouses or partners have been unfaithful
(jealous), think they are being controlled by outside powers i.e. aliens,
radio waves, etc. (passivity), think people blame them for things
(persecution), even though they may have a job and money in the bank they
feel they are poverty stricken or destined for destitution, feel that
people are talking behind their backs (reference), they may also believe
that others are putting thoughts into their heads (thought control).
hallucinations: false sensory perception that occurs in
the absence of a related sensory stimulus. These can affect all five senses
but most commonly affect visual and auditory senses.
disorganized behavior: physical actions that do not appear to be
goal oriented (i.e. taking off clothes in public, strange gestures or
postures, etc.), or otherwise bizarre physical activities.
disorganized speech: mental associations are governed not by
logic but by rhymes, puns, and other rules not apparent to the observer, or
by no clear rules at all. Generally
the speech is understandable but sometimes may be difficult to understand.
negative symptoms: reduced range of expression of emotion,
obvious reduced fluency of speech, loss of will to do things
(avolition). It seems that something
has been taken away from the patient, such as the textural richness of their
5 subtypes of Schizophrenia
Paranoid: these patients have persecutory delusions
and auditory hallucinations, but no negative symptoms, disorganized speech,
or catatonic behavior.
Disorganized: delusions and hallucinations are less
prominent than negative symptoms and disorganized speech and behavior.
Catatonic: excessively retarded or excessively
excited behavior that is very bizarre.
Undifferentiated: some of all the basic types of psychotic
symptoms, not one particularly dominates.
Residual: after an acute psychosis the patient is
markedly improved, although they still seem somewhat unusual, odd, or
who display the proper signs and symptoms for diagnosis but have only been
affected for under 6 months.
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.
Psychotic disorder: at least one of the psychotic symptoms
for under one month.
Other Psychotic Disorders
Disorder due to a General Medical Condition: a
wide variety of medical and neurological conditions can produce psychotic
symptoms that may not meet criteria for the conditions above.
Psychotic Disorders: Alcohol or other substances (intoxication
or withdrawal) can cause psychotic symptoms that may not meet criteria fore
any of the conditions above.
Disorder not otherwise Specified: this is usually patients
with postpartum psychosis or other symptoms that do not seem to fit any of
the categories above.
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Bipolar Manic Depressive Psychosis – Kuang Dian
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.
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
Phlegm & Qi
onset, over thinking or worry injures the SP Qi → Phlegm builds up
causing stagnation → blocks the mind, extreme depression, listless,
do not speak for days or continuous speech, can’t make decisions, manic
happy/sad, no appetite, may be suicidal,
sl. purple w/ teeth-marks
Qi & dissolve Phlegm
Xiao Yao San
+ Di Tan Tang
Moxabustion is very
useful here. ST 40, Ren 4, 6, Bai
Hui, Du 4, 14, ST 36, Yintang.
These may be used for all Dian
Qi ↓ & Phlegm
Qi ↓, very quiet (wooden chicken), absence of or nonsensical
thought, puffy dull face, soft stool, fatigue, no appetite, T- pale swollen w/ teeth-marks P- weak slippery
SP Qi & dissolve Phlegm
Si Jun Zi Tang
+ Di Tan Tang
or Gui Pi Tang
Ban Xia Huo Po Tang
Qi & Blood ↓
chronic Qi & Blood ↓, long term
psychosis, lack of concentration, talk very little, talk to
themselves, very consumed,
palpitations, pale complexion, hard to get excited, no mental strength,
pale, white coat
Qi & Blood to strengthen HT SP (mind)
Yang Xin Tang
Depression: generally Lung or Liver patterns
Antidepressants - Injure Heart (hand Jue-yin)
-create blood stasis
-damage spleen yang
-cause general Qi deficiency
People experiencing depression have a severe case
when they wake earlier in the morning
(ie- more depressed if waking up
at 5 than if waking up at 7)
is often mixed with anxiety
Depression is usually 50% excess
and 50% deficiency
Anxiety is usually 90% deficiency
and 10% excess
Anxiety – Heart,Spleen,Kidney Suicide
– Kidney and Lung Deficiency
‘Tan Re Mi Xin Qiao Hun Po’ – Phlegm and Fire disturb mind, Shen,
Heart, ethereal & physical spirit.
Medicine: Manic Psychosis, Schizophrenia,
Hypomania, Postpartum disorders, Substance use disorders, Acute reactive
‘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.
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.
onset, very emotional, very irritable, very angry, may have insomnia
& headaches for a couple of days at start of attack, turn very
violent, Fire signs, thirst, red face eyes & tongue, constipation, do
not need to eat, have great amounts of energy, T- deep red w/ yellow coat
Fire & Phlegm
San Sheng San
Gun Tan Tang +
Xie Xin Tang (purge)
Phlegm from HT meridian)
Yin ↓ Fire
manic psychosis, attacks do not occur as acutely as before, Yin ↓
symptoms (gradually lose weight, anxiety, anger, irritable, night
sweat), T- red w/scanty
Yin, descend Fire, calm the mind
Er Yin Jian
+ Ding Zhi Wan
Dan Zhi Xiao Yao San
Zhi Bai Di Huang Wan
Qi & Blood stagnation
Kuang symptoms, PMS, large amounts of dark red menses w/ clots, chest
pain, pain in the heart or hypochondriac region, headache, dizziness,
abdominal pain, P- may be
deep if Blood Stasis
Blood circulation, remove Stasis & regulate Qi
Dian Kuang Meng Xin Tang
+ Da Huang Zhe Cong Wan
Xue Fu Zhu Yu Tang
Note: stop purging treatments
as soon as symptoms subside because they are damaging to the Spleen. Tonify Spleen afterwards.
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
- Ghosts in dreams: SP 1, ST 45
Sun Si Miao’s 13 Ghost Points
originated from ‘Thousand Ducat
Formulas’ in the Tang dynasty (618-907 A.D., near the end of the middle
ages), which was when the first book was ever printed, and a push to make
Buddhism the state religion was attempted.
Quite possibly an idea of forced religion, and the beginnings of
information-overload provided by the invention of printing, both played a
role in the need for more empirical practice concerning mental disorders
(Kuang Dian), which we now refer to as mood, personality, and/or
Now, early in the new millennia, it seems to be of great importance
for Traditional Chinese Medicine and particularly Acupuncture with it’s
unique ability to regulate many aspects of our health and life, to step
forward into what seems to be another age with the need for mental health
The 13 Ghost Points:
- Guigong – Ghost Palace (Renzhong Du 26)
- Gui Zhen – Ghost Pillow (Fengfu Du 16)
- Guitang – ghost Hall (Shangxing Du 23)
- GuiShi – Ghost Market (Chengqiang Ren 24)
- Guixin – Ghost Faith (Shaoshang Lu 11)
- Guitui – Ghost Leg (Quchi LI 11)
- Guichuang – Ghost’s Bed (Jiache ST 6)
- Guilei – Ghost Fortress (Yinbai SP 1)
- Guixin – Ghost Heart (Daling PC 7)
- Guicu – Ghost Cave (Laogong PC 8)
- Guilu – Ghost Path (Shenmai BL 62)
- Guifeng – Ghost Seal (Haiquan extra point
- Guicang – Ghost Store (Huiyin Ren 1)
has been said that Guixin – Ghost Heart (Daling PC 7) is actually Taiyuan
Lu 9 (connecting these points may be of benefit). It is of popular belief that Guilu –
Ghost Path (Shenmai BL 62) is actually Jianshi
PC 5. Another text includes
Shenting Du 24, Ruzhong ST 17, Yanglingquan GB 34, and Xingjian LR 2, and
did not include Shenmai BL 62, Shangxing Du 23, Quchi
11, and Huiyin Ren 1.
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.
Yang Symptoms – loud, much action, extroverted
(use Ren Meridian)
Yin Symptoms – quiet, minimal action, introverted
(use Du Meridian)
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
2 -Blood nourish spirit – blood
3 –Qi – connects with - blood stasis
/ phlegm / fire
with phlegm – wants to kill self (moxa)
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 –
Lung not Descending – Da
Huang, Lu Hui + phlegm herbs
Top 13 Formulas
for Mental Disease:
Wen Dan Tang (cousin Rx – Dao Tan Tang, Di Tan Tang)
modifications: Huang Lian (king
fire) Huang Qin (minister Fire)
Fire Rising + Long Dan Xie Gan Tang, Mu Li
Fang Feng Tong Sheng Tang
(-mang xiao) + Qiang Huo/Du Huo (wind damp)
Gui Pi Tang - +
Huang Lian + Dan Shen (blood circ.) + Shu Di
Xue Fu Zhu Yu Tang
– Blood circulation
Tian Wang Bu Xin Tang
– Heart and Kidney Yin Deficiency
Meng Shi Guan Tan Wan
- Phlegm Fir
Su Hua Xiang Wan –
cold sticky phlegm
Bai Jing Wan –
(Bai Fan (Ming Fan), Yu Jin) Any Phlegm
Xiang Sha Liu Jun Zi Tang-
Long Dan Xie Gan Tang
– (Mu Tong? Toxic) + Lian Zi Xin, Dan Zhu Ye, Da Huang
Huang Lian Jie Du Tang
– excess fire, + Si Wu Tang (wen qin yin)
Chai Hu Jia Long Gu Mu Li
Chai Hu Shu Gan San
Phlegm Fire – Kuang Zheng - Yang
1. Main points: Ren 12,
2. Calm: Du
26-28 (strong stimulation), KI 1
Yangming: LI 4, 11, ST 36, 37, 39, SJ 6
BL 9, 10
6. yin tang
– downwards towards bridge of nose
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
Dian Zheng –
– PC 6, Du 20, 26,g12, 14,
16, GB 13, St 40, St 6, Sp 6
Moxa Ren 4, 6, and back shu
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