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Orifice-opening formulas

开窍剂 〔開竅劑〕kāi qiào jì

Medicinal formulas that open the orifices treat clouded spirit and coma due to evil obstructing the orifices of the heart. Orifice-opening formulas are largely composed of orifice-opening medicinals.

Clouded spirit appears in both vacuity and repletion patterns. Orifice-opening formulas are only used for repletion patterns. Repletion patterns constitute block patterns, which normally result from congestion of evil qì clouding the orifices of the heart. Block patterns can be divided into cold and heat patterns. Heat block is caused by warm-heat evil falling into the heart, which is treated by clearing heat and opening the orifices, also called cool opening. Cold block is due to wind stroke or cold strike or to depressed qì and phlegm turbidity clouding the orifices of the heart and is treated by opening the orifices by warming and freeing, known as warm opening. Hence, formulas are divided into two categories.

Cautions

Of paramount importance is the need to differentiate vacuity and repletion patterns of clouded spirit. If the condition is one of exuberant evil and replete qì with clenched jaw, clenched hands, and a forceful pulse, this is a block pattern. If the patient presents with sweating, cold limbs, faint breath, limp hands, enuresis, and closed eyes, the pattern is one of desertion, for which orifice-opening formulas are prohibited.

Orifice-opening formulas contain aromatic substances that, being acrid, dispersing, and mobile, can easily damage original qì. Hence, once the patient has been revived, the treatment should be discontinued. Orifice-opening formulas should not be used for extended periods.

The orifice-opening agent musk (Moschus, 麝香 shè xiāng) should not be used in pregnancy since it can damage the fetus.

Orifice-opening formulas are prepared as powders, pills, or injection fluids. Powders are preferable to pills, and should be administered dissolved in warm water or by nasal feed. They should not be decocted since this can reduced their efficacy.

Subcategories

Cool Opening Formulas

Cool opening formulas treat block-pattern clouded spirit due to warm-heat evil entering the pericardium, manifesting in vigorous heat effusion (high fever), clouded spirit, delirious speech, and in some cases with tetanic reversal. They can also be used for sudden loss of consciousness when these signs are attributable to wind stroke, qì depression, phlegm reversal, or contraction of foul turbidity, provided there are heat signs.

Main agents

Added to the above are heat-clearing fire-draining agents or blood-cooling toxin-resolving medicinals. Furthermore, because heat entering the pericardium is marked by disquieted heart spirit, the following heavy settling heart-quieting agents are also often used:

Evil heat falling inward tends to scorch the fluids and produce phlegm, hence medicinals that clear heat and transform phlegm such as bile arisaema (Arisaema cum Bile, 胆星 dǎn xīng), Sichuan fritillaria (Fritillariae Cirrhosae Bulbus, 川贝母 chuān bèi mǔ), 天南星 (tiān nán xīng) arisaema (Arisaematis Rhizoma), and realgar (Realgar, 雄黄 xióng huáng) are often used.

Representative formulas

Warm Opening Formulas

Warm opening agents treat clouded spirit due to wind stroke, cold strike, qì depression or phlegm reversal, marked by sudden loss of consciousness, clenched jaw, clouded spirit, inability to speak, a white tongue fur, and a slow pulse. The main agents are aromatic orifice-opening agents.

Main agents

  • Musk (Moschus, 麝香 shè xiāng)
  • storax (Styrax, 苏合香 sū hé xiāng)
  • borneol (Borneolum, 冰片 bīng piàn)

    • These are often complemented with interior-warming and qì-moving medicinals.

    Representative formula Storax Pill (苏合香丸 sū hé xiāng wán).

    See opening the orifices.

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