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Also aromatic orifice-opening agents.

Orifice-opening medicinals open the orifices of the heart and arouse the spirit, i.e., restore consciousness in the treatment of clouded spirit in repletion patterns (block patterns).

In Chinese medicine, the spirit, also called heart spirit, is an entity that dwells in the heart; it is that part of us that experiences consciousness. The Nèi Jīng says: The heart holds the office of monarch, whence the bright spirit emanates. This metaphor invites us to see the body as a society and the heart as the imperial palace. The consciousness of the body is thus likened to an enlightened emperor who embodies the highest qualities of the society.

Disturbances of the heart spirit include disquieted heart spirit and clouded spirit. Clouded spirit refers to any form of impaired consciousness, such as stupor or coma.

Clouded spirit can occur in both vacuity and repletion patterns. Vacuity patterns in which clouded spirit occurs are referred to as desertion patterns. Repletion patterns in which clouded spirit occurs are called block patterns. The latter are so named because evil qì is understood to block the orifices of the heart and obscure consciousness. Block patterns occur in externally contracted febrile disease, tetany, fright wind, wind stroke, and epilepsy. Orifice-opening patterns are only used for block patterns. Desertion patterns are mostly treated using interior-warming agents and supplementing agents.

Clouded spirit occurring in block patterns is often described in terms of evil qì clouding or confounding the orifices of the heart. Orifices are openings in the body or points of contact with the outside world. The clear orifices are the eyes, nose, ears, mouth, and tongue. The turbid orifices are the anal and genital openings. According to traditional Chinese medical theory, each of the viscera opens at a particular orifice. The liver opens at the eyes, the spleen at the mouth, the lung at the nose, and the kidney at the ears. The heart opens at the tongue. Although the tongue cannot be considered as an orifice, it is traditionally said to be the orifice of the heart. However, in the term opening the orifices, the word orifice refers not to the tongue, but metaphorically to the interface between the spirit and the outside world understood as being the sum of all the clear orifices.

Block patterns can take the form of cold or heat; hence we distinguish between warm opening and cool opening. In the method of warm opening, orifice-opening medicinals are combined with interior-warming agents, while in cool opening, they are combined with heat-clearing agents. Orifice-opening medicinals are also combined with wind-extinguishing tetany-checking agents that extinguish wind and check tetany, phlegm-transforming agents, or spirit-quieting agents.

Orifice-opening medicinals are mostly warm in nature. They are acrid and aromatic in flavor, and are mobile and penetrating, thereby dispersing the block created by evil qì. Orifice-opening medicinals all enter the heart channel.

Properties

Nature: Mostly warm, although bīng piàn (Borneolum) is slightly cold.

Flavor: Acrid and aromatic.

Channel entry: All enter the heart channel. All also enter the spleen, except for shí chāng pú (Acori Tatarinowii Rhizoma), which enters the stomach channel. Bīng piàn (Borneolum) additionally enters the lung channel.

Actions

Orifice-opening medicinals are acrid and aromatic agents that are mobile and penetrating. They penetrate the cloud of unconsciousness and return the patient to his/her senses. This is traditionally called opening the orifices and rousing the spirit or reviving the spirit-mind. In Chinese medical theory, the sense organs are generically referred to as the clear orifices (清窍 qīng qiào), a reflection of their being understood as windows into the surrounding world. These are contrasted with the turbid orifices, 浊窍 zhuó qiào, which are the anus and urethra. The basis of consciousness is the spirit (shén), which is stored by the heart. Semiconsciousness or unconsciousness is referred to as clouded spirit. It is also metaphorically explained as blockage of the orifices of the heart. Here, orifices of the heart (心窍 xīn qiào) refers not to the tongue (the tongue is said to be the orifice or sprout of the heart), but the means by which the heart spirit perceives the outside world. Orifice-opening medicinals open the clear orifices and the orifices of the heart; in other words, they restore the senses.

Orifice-opening medicinals principally act on the heart. The heart governs the spirit. When evils cloud the clear orifices, the spirit is blocked and closed inside. The tongue is the sprout of the heart, and when the heart spirit is clouded, this often also manifests in delirious speech. Because they affect the heart spirit, orifice-opening medicinals enter the heart channel.

In warm-heat disease, conditions characterized by clouded spirit are explained in terms of heat entering the pericardium or heat evil falling into the pericardium. Here, pericardium simply means the heart for most practical purposes.

Indications

Orifice-opening medicinals treat clouded spirit, which is observed in:

Externally contracted febrile disease patterns, such as heat entering the pericardium, phlegm confounding the orifices of the heart, or summerheat stroke.

Tetanic disease, i.e., diseases marked by clenched jaw and convulsions.

Child fright wind, i.e., conditions in children marked by convulsions and arched-back rigidity.

wind stroke, i.e., the condition commonly referred to as stroke, with hemiplegia, deviated eyes and mouth, and impeded speech that in many cases starts with sudden clouding collapse.

Epilepsy, a disease classically characterized by brief episodes of loss of consciousness, foaming at the mouth, and clenched jaw, after which the patient returns to normal.

It is crucial to understand that orifice-opening medicinals are only used to treat clouded spirit occurring in repletion patterns. When faced with a patient suffering from clouded spirit, the first task is to identify whether the condition is one of vacuity or repletion. Vacuity patterns are desertion patterns, which take the form of yáng desertion characterized by cold sweating, cold limbs, and a faint pulse on the verge of expiration or yīn desertion, marked by copious sweat, palpably hot skin, and warm limbs or reversal cold of the limbs with heat in the hearts of the soles and palms. Repletion patterns are block patterns, which are characterized by clenched jaw, clenched hands, and a forceful pulse. In clinical practice, it is imperative to be able to distinguish between block and desertion, because only block patterns are treated with orifice-opening medicinals. Desertion patterns are treated by returning yáng and stemming counterflow, boosting qì and stemming desertion. They are not treated with orifice-opening medicinals.

Once a block pattern has been identified, the next step is to determine whether it is cold block or heat block.

Cold Block

Pathomechanism: Phlegm-damp or static blood blocking the orifices of the heart, often observed in wind stroke.

Signs: Sudden clouding collapse with phlegm-drool welling upward, green-blue complexion, cold body, white tongue fur, and a slow pulse. (Phlegm-drool refers to relatively thin, clear mucus, vomited from the stomach or coughed up from the chest.)

Treatment method: Warm opening. In warm opening, orifice-opening medicinals are usually combined with cold-dispelling and qì-moving medicinals.

Heat Block

Pathomechanism: Mostly due to heat evil falling into the pericardium in warm-heat disease (including fright wind), summerheat strike, and tetanic disease.

Signs: Red face, generalized heat effusion, vexation and agitation, delirious speech, convulsions, rough breathing, yellow tongue fur, and a rapid pulse.

Treatment method: Cool opening. In cool opening, one usually combines orifice-opening medicinals with heat-clearing toxin-resolving medicinals.

Combinations With Other Categories

Cold block with clouded spirit due to cold phlegm or foul turbidity: Combine with interior-warming cold-dispersing medicinals (warm opening).

Heat block: Combine with heat-clearing fire-draining medicinals or blood-cooling toxin-resolving medicinals (cool opening).

Phlegm turbidity with phlegm rale in the throat: Combine with phlegm-transforming medicinals.

Wind stroke, epilepsy, or fright wind with hypertonicity of the sinews or convulsions: Combine with wind-extinguishing tetany-checking medicinals.

Clouded spirit with vexation and agitation: Combine with spirit-quieting medicinals.

Warnings

Emergency treatment only: Orifice-opening medicinals are used in emergency cases and constitute treatment of the tip (branch) rather than the root of the disease. They should never be administered over a long period because they cause wear on original qì.

Do not use for desertion patterns. Orifice-opening medicinals are used only for block patterns, not for desertion patterns.

Do not decoct. Because orifice-opening medicinals are acrid and aromatic, their effect is weakened by decoction; thus, they are usually administered in pill form. Shí chāng pú (Acori Tatarinowii Rhizoma) is an exception as it may be used by decoction and is more amenable to prolonged use, though it still may wear on right qì over time because of its acrid and warm nature. Additionally, shè xiāng (Moschus) and bīng piàn (Borneolum) are contraindicated in pregnancy because they can cause uterine contractions.

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