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Also heart-spirit–quieting agents. Spirit-quieting medicinals are ones that treat disquieted heart spirit, that is, a condition characterized by heart palpitation, insomnia, profuse dreaming, and heart vexation arising when the heart’s function of storing the spirit is disturbed.

According to traditional theory, the heart governs the spirit, which means that the heart is the seat of consciousness in the body. When the body and heart are healthy, the spirit functions normally, enabling us to perceive the world and think clearly in the daytime, and sleep peacefully at night. When disharmonies of qì-blood and yīn-yáng or evils such as heat and phlegm affect the heart, the heart spirit becomes disquieted and fails to keep to its abode, i.e., it becomes overactive and manifests outwardly. Disquieted heart spirit takes the form of heart palpitation triggered by emotional stimulus (it may also manifest with the more severe condition known as fearful throbbing, which arises spontaneously). At night, it causes sleeplessness (insomnia) and profuse dreaming. In the daytime, it manifests in heart vexation, which is a feeling of disquietude and restlessness focused in the chest.

Disquieted heart spirit occurs in various patterns, including both vacuity and repletion, and in various diseases. Vacuity patterns occur when insufficiency of yīn-blood deprives the heart of nourishment, or when insufficiency of heart qì or heart yáng deprives the heart of nourishment and warmth. In such cases, disquieted heart spirit manifests in vacuity vexation, insomnia, heart palpitation or fearful throbbing (zhēng chōng), profuse dreaming, forgetfulness, and clouded head with dizzy vision, in addition to other vacuity signs associated with the presenting pattern. Repletion patterns of disquieted heart spirit occur as a result of hyperactivity of heart fire, phlegm confounding the orifices of the heart, phlegm-fire harassing the heart, or fulminant fear and fright. In such cases, we often see not merely heart vexation, but also agitation, a state characterized by increased physical movement, and in severe cases, manic agitation (which manifests in pronounced physical movement often described as flailing of the arms and legs). Other signs include fright palpitation, insomnia, profuse dreaming, and forgetfulness. In addition, there are repletion signs caused by the evil qì (heat and/or phlegm).

Spirit-quieting medicinals are used in specific diseases such as mania and withdrawal, epilepsy, and fright wind.

Subcategories

• Heavy settling spirit-quieting agents are minerals and shells that are heavy in weight and mostly used for repletion.
• Heart nourishing spirit-quieting agents are plant-products mostly used for vacuity patterns.

Properties

Nature: Largely balanced. Some are cold and have a heat-clearing action.

Flavor: Many are sweet and have a supplementing action.

Channel entry: Most enter the heart and liver channels. The heart stores the spirit; the liver stores the ethereal soul.

Bearing: Mostly downsinking (they calm the disquietude of the heart and return the spirit to its abode).

Toxicity: Zhū shā (Cinnabaris) is toxic.

Actions And Indications

Heavy settling spirit-quieting agents are minerals and shells that treat repletion patterns of disquieted heart spirit manifesting principally in fright palpitation. These medicinals are described as heavy settlers because they are physically heavy and have a calming action on the heart spirit.

Heart-nourishing spirit-quieting agents are vegetable products that not only quiet the spirit, but also nourish the heart. These treat vacuity patterns of disquieted heart spirit.

Below are five representative patterns that can be treated with spirit-quieting medicinals. It should be noted that spirit-quieting medicinals, particularly those that have no heart-nourishing action, mostly treat only the tip of the condition. Therefore they are usually combined with medicinals of other categories such as supplementing, heat-clearing, phlegm-transforming, or liver-yáng-calming medicinals.

Heart Qì Vacuity, Heart Yáng Vacuity

Pathomechanism: Both arise as a result of constitutional vacuity, mental taxation, enduring illness, inappropriate treatment, or the natural decline of health in advancing years.

Signs: Heart qì vacuity is characterized by heart palpitation or fearful throbbing, with a pale white or bright white facial complexion, a pale tongue with white fur, and a vacuous pulse.

Heart yáng vacuity differs from heart qì vacuity chiefly by being more severe and by being characterized also by cold signs: fear of cold and cold limbs, heart pain, a bright white or dull facial complexion, a pale enlarged tongue with glossy white fur, and a faint fine pulse.

Treatment method: Heart qì vacuity is treated by supplementing heart qì with medicinals such as huáng qí (Astragali Radix), dǎng shēn (Codonopsis Radix) or rén shēn (Ginseng Radix), bǎi zǐ rén (Platycladi Semen), suān zǎo rén (Ziziphi Spinosi Semen), and mix-fried gān cǎo (Glycyrrhizae Radix), as in yǎng xīn tāng (Heart-Nourishing Decoction).

Heart yáng vacuity is treated by warming and freeing heart yáng using guì zhī (Cinnamomi Ramulus) and mix-fired gān cǎo (Glycyrrhizae Radix), as in guì zhī gān cǎo tāng (Cinnamon Twig and Licorice Decoction).

Heart Blood Vacuity, Heart Yīn Vacuity

Pathomechanism: Similar to that of heart qì vacuity and heart yáng vacuity above.

Signs: Heart blood vacuity and heart yīn vacuity: Heart blood vacuity is characterized by heart palpitation or fearful throbbing, forgetfulness, insomnia, profuse dreaming, and dizziness, with pale face, lips, and tongue, and a fine pulse.

Heart yīn vacuity differs essentially by being more severe and by being accompanied by heat signs like emaciation, tidal heat effusion, vexing heat in the five hearts, red cheeks, and dry throat and mouth.

Treatment method: Heart blood vacuity is treated by nourishing blood and quieting the spirit, using agents like dāng guī (Angelicae Sinensis Radix), shú dì huáng (Rehmanniae Radix Praeparata), chuān xiōng (Chuanxiong Rhizoma), and bái sháo (Paeoniae Radix Alba), as in sì wù tāng (Four Agents Decoction), with appropriate additions.

Heart yīn vacuity is treated by nourishing yīn and quieting the spirit with medicinals such as shú dì huáng (Rehmanniae Radix Praeparata), tiān dōng (Asparagi Radix), mài dōng (Ophiopogonis Radix), and xuán shēn (Scrophulariae Radix), as in tiān wáng bǔ xīn dān (Celestial Emperor Heart-Supplementing Elixir).

Hyperactive Heart Fire

Pathomechanism: This is a repletion heat pattern that arises when imbalance of the affects causes qì to become depressed and transform into fire, or when excessive consumption of rich, fatty, and hot spicy foods causes fire to arise internally. It may also arise when external fire invades the interior.

Signs: Heart vexation, insomnia, and in severe cases manic agitation and delirious speech, possibly with mouth and tongue sores or with vomiting of blood or nosebleed. Other signs include red facial complexion, thirst with desire for cold drinks, short voidings of reddish urine, and dry bound stool. The tongue is red at the tip, sometimes bearing prickles. The tongue fur is yellow. The pulse is rapid and forceful.

Treatment method: Clear and drain heart fire using dà huáng (Rhei Radix et Rhizoma), huáng lián (Coptidis Rhizoma), and huáng qín (Scutellariae Radix) as in sān huáng xiè xīn tāng (Three Yellows Heart-Draining Decoction).

Phlegm Confounding the Orifices of the Heart

Pathomechanism: This pattern, which is also called phlegm turbidity clouding the orifices of the heart, can arise when damage by the seven affects causes qì to bind with phlegm; it can also result from External contraction of damp turbidity, which hampers the qì dynamic, turns into phlegm, and obstructs the orifices of the heart.

Signs: Unclear spirit-mind, oppression in the stomach duct, vomiting, nausea, phlegm rale in the throat, and in severe cases loss of consciousness. The tongue fur is white and slimy; the pulse is slippery. Epilepsy as well as mania and withdrawal can take the form of phlegm confounding the orifices of the heart.

Epilepsy episodes occur when liver wind carries latent phlegm upward to cloud the orifices of the heart, giving rise to sudden collapse and loss of consciousness, phlegm rale in the throat, foaming at the mouth, upward staring eyes, and convulsions.

Mania and withdrawal arise when liver depression causes qì and phlegm to bind together, congeal, and cloud the orifices of the heart. It is characterized by mental depression, indifferent facial expression, mental torpor,talking to oneself (soliloquy), and abnormal behavior.

Treatment method: Flush phlegm and open the orifices with bàn xià (Pinelliae Rhizoma), jú hóng (Citri Reticulatae Pericarpium Rubrum), fú líng (Poria), gān cǎo (Glycyrrhizae Radix), zhǐ shí (Aurantii Fructus Immaturus), zhú rú (Bambusae Caulis in Taenia), tiān nán xīng (Arisaematis Rhizoma), and shí chāng pú (Acori Tatarinowii Rhizoma), as in dǎo tán tāng (Phlegm-Abducting Decoction).

Phlegm-Fire Harassing the Heart

Pathomechanism: This is a pattern that arises when phlegm and fire bind together and harass the heart spirit.

Signs: Heat effusion, rough breathing, red face and eyes, thick yellow phlegm, phlegm rale in the throat, manic agitation and delirious speech, a red tongue with slimy yellow tongue fur, and a slippery and rapid pulse. In some cases, heart vexation, insomnia, and oppression in the chest are observed. In some cases, the patient suffers from manic agitation, beats and curses people, throws off clothing, destroys things, weeps and laughs abnormally, and talks nonsense.

Treatment method: Sweep phlegm and clear the heart with niú huáng (Bovis Calculus), zhū shā (Cinnabaris), huáng lián (Coptidis Rhizoma), huáng qín (Scutellariae Radix), zhī zǐ (Gardeniae Fructus), and yù jīn (Curcumae Radix), as in niú huáng qīng xīn wán (Bovine Bezoar Heart-Clearing Pill).

Additional Uses

In addition to the above patterns, spirit-quieting medicinals are often used in the treatment of fright wind in children. fright wind is mostly caused by externally contracted heat engendering internal wind, and manifests in vigorous heat effusion (high fever), convulsions, and clouded spirit.

Combinations With Other Categories

Combinations for different causes of disquieted heart spirit

• Heart yīn vacuity: Select heart-nourishing spirit-quieting medicinals and combine them with agents that supplement yīn and blood.
• Heart-spleen qì vacuity: Combine with agents that supplement heart and spleen qì.
• Heart yáng vacuity: Combine with medicinals that warm and assist heart yáng.
• Hyperactivity of heart fire: Select medicinals that clear the heart and quiet the spirit, and combine them with medicinals that clear and drain heart fire.
• Phlegm confounding the orifices of the heart: Combine with phlegm-transforming medicinals.
• Hyperactivity of liver yáng: Combine with medicinals that calm the liver and subdue yáng.

Combinations for patterns concurrent with disquieted heart spirit

• Liver depression and qì stagnation: Combine with agents that course the liver and resolve depression.
• blood stasis: Combine with agents that quicken the blood and transform stasis.
• Epilepsy, mania and withdrawal, and fright wind: Combine with agents that extinguish wind and check tetany and/or ones that transform phlegm and open the orifices.

Method Of Use And Warnings

Minerals: Heavy settling spirit-quieting medicinals are largely minerals. They are used in the form of pills and powders. Because they easily damage the stomach, they should be combined with agents that fortify the stomach and spleen. In any event, they should not be used for too long. If they are used in decoctions, they should be crushed and wrapped before boiling.

Toxicity: Some of the spirit-quieting medicinals are toxic; hence their dosage should be controlled to prevent poisoning.

Spirit-quieting medicinals treat the tip: They should be combined with agents that treat the root.

Insomnia: When using spirit-quieting medicinals to treat insomnia, they should be given 30–60 minutes before going to bed.

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