Phlegm clouding the heart spirit

Also:

• Phlegm confounding the orifices of the heart (痰迷心窍 tán mí xīn qiào)
• Phlegm turbidity clouding the pericardium (痰浊蒙蔽心包 tán zhuó méng bì xīn bāo)
• Phlegm obstructing the orifices of the heart (痰阻心窍 tán zǔ xīn qiào)
• phlegm clouding the pericardium (痰蒙心包 tán méng xīn bāo)

A disease pattern chiefly characterized by deranged spirit; depressed spirit-mind or clouded spirit; signs of phlegm turbidity.

Biomedical correspondence: schizophrenia; dementia; nervous system infections such as encephalitis B or epidemic encephalitis; epilepsy; cerebrovascular accident.

Description: Spirit-mind disturbances with oppression in the chest; vomiting and nausea; a slimy white tongue fur; and a slippery pulse. It occurs in three distinct diseases.

• Epilepsy : Sudden clouding collapse with drooling and foaming at the mouth, phlegm rale in the throat, squealing sounds, convulsions, and upward-staring eyes.
• Withdrawal : Depressed spirit-mind; indifferent expression; talking to self (soliloquy); and abnormal behavior.
• Externally contracted damp-turbidity: Oppression in the stomach duct and nausea; phlegm rale; unclear speech, and in severe cases, clouded spirit; dull stagnant complexion.

Pathogenesis: Three pathomechanisms are recognized, depending on the disease in which the pattern appears.

• Epilepsy: Phlegm carried up by internal wind to cloud the orifices of the heart.
• Withdrawal patterns: Depressed liver qì and congealing phlegm binding together when qì depression attributable to damage by the seven affects causes phlegm to accumulate or when phlegm causes qì stagnation.
• Externally contracted disease: External contraction of damp turbidity obstructing the qì dynamic and causing phlegm turbidity to block the orifices of the heart.

Analysis of signs

• Phlegm turbidity clouding the heart spirit: Unclear spirit-mind or loss of consciousness.
• Tongue: White and slimy fur, reflecting the presence of phlegm.
• Pulse: Slippery, reflecting the presence of phlegm.

Disease-specific signs

Epilepsy: Epileptic seizures are attributed to internal wind and congealing phlegm.

• Exuberant internal wind carrying phlegm upward: Sudden clouding collapse, loss of consciousness, drooling and foaming at the mouth, phlegm rale in the throat, and squealing sounds.
• Liver wind stirring internally: Convulsions and upward-staring eyes.

Withdrawal: Withdrawal patterns are mostly attributed to depressed liver qì and congealing phlegm giving rise to depressed spirit-mind, indifferent expression, talking to self (soliloquy), and abnormal behavior.

External contraction of damp turbidity: When externally contracted dampness evil lies depressed in the center, it disrupts the normal upbearing of spleen qì and downbearing of stomach qì and thickens to form phlegm.

• Impaired harmony and downbearing of the stomach: Oppression in the stomach duct and nausea.
• Phlegm lodged in the throat: Phlegm rale; phlegm ascending to cloud the orifices of the heart, causing unclear spirit, unclear speech, and in severe cases, loss of consciousness.
• Clear yáng failing to bear upward: Dull stagnant facial complexion.

Differentiation and Treatment

Withdrawal disease (癫疾 diān jí) is marked by mental depression with the gradual appearance of abnormal behavior, feeble-mindedness (dementia), and soliloquy that ceases when others notice.

Medicinal therapy: Flush phlegm and open the orifices. Use Phlegm-Abducting Decoction (导痰汤 dǎo tán tāng) with the judicious addition of acorus (Acori Tatarinowii Rhizoma, 石菖蒲 shí chāng pú), polygala (Polygalae Radix, 远志 yuǎn zhì), and cyperus (Cyperi Rhizoma, 香附子 xiāng fù zǐ). For patients suffering from insomnia, add stir-fried spiny jujube (Ziziphi Spinosi Semen, 酸枣仁 suān zǎo rén), arborvitae seed (Platycladi Semen, 柏子仁 bǎi zǐ rén), cinnabar root poria (Poria cum Pini Radice et Cinnabare, 朱茯神 zhū fú shén), dragon bone (Mastodi Ossis Fossilia, 龙骨 lóng gǔ), oyster shell (Ostreae Concha, 牡蛎 mǔ lì), and amber (Succinum, 琥珀 hǔ pò). For copious phlegm, add white mustard (Sinapis Alba Semen, 白芥子 bái jiè zǐ), gleditsia (Gleditsiae Fructus, 皂荚 zào jiá), and bamboo sap (Bambusae Succus, 竹沥 zhú lì). For depressed phlegm transforming into heat, use Phlegm-Abducting Decoction (导痰汤 dǎo tán tāng) plus bamboo shavings (Bambusae Caulis in Taenia, 竹茹 zhú rú), coptis (Coptidis Rhizoma, 黄连 huáng lián), and rhubarb (Rhei Radix et Rhizoma, 大黄 dà huáng), or combined with Alum and Curcuma Pill (白金丸 bái jīn wán).

Acumoxatherapy: The main points used to sweep phlegm and open the orifice are CV-12 (Center Stomach Duct, 中脘 zhōng wǎn), ST-36 (Leg Three Lǐ, 足三里 zú sān lǐ), ST-40 (Bountiful Bulge, 丰隆 fēng lóng), SP-6 (Three Yīn Intersection, 三阴交 sān yīn jiāo), GV-26 (Human Center, 人中 rén zhōng), and PC-5 (Intermediary Courier, 间使 jiān shǐ); needle with drainage. For withdrawal disease, add GV-20 (Hundred Convergences, 百会 bǎi huì), HT-7 (Spirit Gate, 神门 shén mén), PC-7 (Great Mound, 大陵 dà líng), and LR-3 (Supreme Surge, 太冲 tài chōng).

Damp warmth (湿温 shī wēn) is marked by indifferent expression and clouded spirit. The patient is sometimes conscious and sometimes unconscious, or seems both conscious and unconscious. Sometimes there is delirious speech. Generalized heat is present, but not high.

Medicinal therapy: Flush phlegm and open the orifices. Use Acorus and Curcuma Decoction (菖蒲郁金汤 chāng pú yù jīn tāng) with judicious addition of coix (Coicis Semen, 薏苡仁 yì yǐ rén), cardamom (Amomi Fructus Rotundus, 白豆蔻 bái dòu kòu), polyporus (Polyporus, 猪苓 zhū líng), poria (Poria, 茯苓 fú líng), alisma (Alismatis Rhizoma, 泽泻 zé xiè), rice-paper plant pith (Tetrapanacis Medulla, 通草 tōng cǎo), eupatorium (Eupatorii Herba, 佩兰 pèi lán), and coptis (Coptidis Rhizoma, 黄连 huáng lián).

Acumoxatherapy: To the main point listed above in the treatment for withdrawal disease add PC-6 (Inner Pass, 内关 nèi guān), LR-3 (Supreme Surge, 太冲 tài chōng), LI-11 (Pool at the Bend, 曲池 qū chí), LI-4 (Union Valley, 合谷 hé gǔ), and SP-9 (Yīn Mound Spring, 阴陵泉 yīn líng quán).

Epilepsy (痫 xián) is characterized by a sudden clouding collapse and unconsciousness convulsions of the limbs, phlegm rale in the throat, phlegm-drool foaming at the mouth, and in some cases the emission of a squeal like a goat’s or a pig’s. The patient soon regains consciousness.

Medicinal therapy: Treat with Fit-Settling Pill (定痫丸 dìng xián wán) with the judicious addition of curcuma (Curcumae Radix, 郁金 yù jīn), white mustard (Sinapis Alba Semen, 白芥子 bái jiè zǐ), centipede (Scolopendra, 蜈蚣 wú gōng), and mother-of-pearl (Concha Margaritifera, 珍珠母 zhēn zhū mǔ).

Acumoxatherapy: To the main points listed above, add GV-16 (Wind Mansion, 风府 fēng fǔ), CV-15 (Turtledove Tail, 鸠尾 jiū wěi), PC-6 (Inner Pass, 内关 nèi guān), LI-4 (Union Valley, 合谷 hé gǔ), and LR-3 (Supreme Surge, 太冲 tài chōng).