1. Manic & Depressive Psychosis TCM Diagnoses and Treatments Within TCM there are two main types of strong psychological disorders: Dian - yin type which is associated with withdrawal, passivity and anti- social behavior, generally considered more chronic. Kuang - yang type which is associated with aggressivity, movement and violence, generally consider more acute. Within modern medicine there are various mental disease, including organic & functional psychoses ( bipolar disorder, obsessive-compulsive, or paranoid schizophrenic) Etiology & Pathology: 1. Imbalance of Yin & Yang: 2. Seven emotional hyperactivity 3. Phlegm 4. Pathogenic fire 5. Blood & Qi stag.

2. Main Points for differentiation A) Location of the disease Liv. GB. Kid. Heart B) Depressive (Dian) & manic Syn. (kuang) DepressiveManic Syn. Sym. Mental depression, reticence, dementia, being slow moving Racketing, maltreatment, mania, unease & hyperactive behaviors Initial Mostly def.Excess Etiology Phlegm block Qi; Ht. & Sp Def. Phlegm & Fire Treatmen t Regulating Qi, Relieving stag., Nourishing Ht. & Sp., Enriching blood, Tranquilizing mind Eliminating pathogenic factors (Purging fire; Reducing phlegm; Nourishing Yin & reducing fire) Herbs Drastic herbs

3. Blood Provides the material foundation for the mind & spirit “ Blood is the mind of a person” “ When blood is harmonized, the mind has a residence” Ht. – Housing the mind, Governing Blood vessels Liv. – Housing the Ethereal soul, Storing the blood Any emotional stress --  Ht. or liv. -  Ht. blood or Liv. Blood -> mind or soul Blood was effected by emotional problems in 3 ways Def. Ht. blood def. : Feel depressed & tired; mind maybe confused & lack concentration liv. Blood def. : may lack a sense of direction in life & “vision” Stag. Ht. blood stag.: restless & prone to be easily startled Liv. Blood stag.: very anxious, restless and confused about his or her aims of life Heat Ht. heat: extremely anxious & agitated; impulsive & restless Liv. Heat: violent & hit people, feel angry & frustrated about his life, tend to be impulsive

4. Treatment Depressive Psychosis 1). Qi Stag. Combined with phlegm Signs & Symptoms: –Main Sym. : mental depression, apathetic depression, reticent, dull-witted (dementia), or suspicious & over-anxious, subjecting to changing mood, speaking incoherently –Concurrent sym.: muttering to oneself, subjecting to changing mood, loose of appetite –Tongue: light tongue proper, whitish & greasy fur –Pulse: wiry & slippery Treatment Protocol: –Soothing stag. liver Qi –Resolving phlegm

5. Formula: Modifications: Soothing Liver Qi -- Xiang Fu, Yu Jin Mental disorder -- Su He Xiang Wan Accumulation of phlegm in chest & diaphragm -- San Sheng San ( Gua Di, Fang Feng, Li Ru) Associated with sleeplessness & being subjecting to frightening, dysphoria & unconsciousness, yellow greasy fur -- Wen Dan Tang + Zhi Bao Wan Frequent belching & feeling of oppression in chest and abdomen -- Xuan Fu Hua, Dai Zhe Shi, Zi Su Geng Tao Tan Tang Ban XiaoDan Nan XingChen PiZhi ShiFu Ling Ren ShenShi Chang PuZu RuGan CaoShen Jiang Xiao Yao Powder

6. Treatment Depressive Psychosis 2). Qi Def. & phlegm accumulation Signs & Symptoms: –Main Sym. : Apathetic & indifferent expression, reticent even transfixed, staring like a fool, thinking aloud, lack of initiative, confused mind, presumption, reckless action, blame oneself. –Concurrent sym.: sallow complexion, loose stool, clear urine –Tongue: light & enlarged body, whitish & greasy fur –Pulse: slippery & weak Treatment Protocol: –Tonify Qi –Nourish Spleen –Eliminating phlegm –Calm down the mind

7. Formula: Modifications: Soothing Liver Qi, & open mind -- Yuan Zhi, Yu Jin Severe perplexed and dull-witted state -- Su He Xiang Wan Tao Tan Tang Ban XiaoDan Nan XingChen PiZhi ShiFu Ling Ren ShenShi Chang PuZu RuGan CaoShen Jiang Si Jun Zi Tang

8. Treatment Depressive Psychosis 3) Heart & Spleen Def. Signs & Symptoms: –Main Sym. : protracted course of disease, the illness developed slowly, pale complexion, sluggish, too lazy to speak, listlessness, absentminded, palpitating, susceptible to fright and sorrow, presumption, disturbance of thought, talk in a confused manner, demoralized –Concurrent sym.: dreaminess, loss of appetite, loose stool. –Tongue: enlarged body with teeth marks –Pulse: weak Treatment Protocol: –Nourish Spleen & heart –Calming mind

9. Formula: Modifications: Kidney Yang Def. -- Ba Ji Tian, Rou Cong rong, Bu Gu Zhi Palpitation & fright -- Ci Shi, Long Chi Grief with susceptibility to weeping -- Zhi Gan Cao, Huai Xiao Mai Yang Xin Tang Ren ShenHuang QiGan CaoFu LingFu ShenDang Gui Chuan XiongBan XiaPo Zi RenSuan Zhao renYuan ZhiWu Wei Zi

10. Treatment Manic Psychosis 4) Phlegm-fire disturbing heart Signs & Symptoms: –Main Sym. : Onset suddenly, impetuousness, headache, sleeplessness, staring angrily, flushed face & ears, suddenly mad and violent rage, enthusiasm running high, speaking disorderly, climbing walls & roofs, abnormally powerful, making racket & shout in confusion, not caring about various relations, or destroying things & harming others persons, loving cold drinks, constipation, dark urine –Concurrent sym.: day & night without sleep and eating –Tongue: deep red body, yellow and greasy fur –Pulse: wiry slippery, rapid and forceful Treatment Protocol: –Purging fire –Eliminating phlegm –Calm down mind

11. Formula: Modifications: Nourish Yin & clear away fire -- Zhi Mu Calm down mind -- Iron Yang Ming Sym. + constipation -- Da Chen Qi Tang Restlessness & thirsty with desire to drink -- Mang Xiao 5g Restlessness & insomnia due to phlegm heat -- Huang lian, Zhu Ru, Zhi Shi Xie Xing Tang Da HuangHuang QinHuang Lian Meng Shi Gun Tan Wan

12. Treatment 5 ) Hyperactivity of fire due to yin Def. Signs & Symptoms: –Main Sym. : illness condition alleviated after protracted manic psychosis, be weary in mind, emotional instability, nervous, impatient, palpitating, be susceptible to fright, sometimes mad, restlessness, sleeplessness, feverish sensation in chest, palm & sole –Concurrent sym.: thin body shape, scanty dark urine, constipation –Tongue: red body, less or no fur –Pulse: thready rapid or wiry rapid Treatment Protocol: –Nourish Yin & removing fire –Tranquilizes the mind

13. Formula: Modifications: Nourish Yin: -- Er Yin Jian ( Shen di, Mai dong, Xuan shen) Clear the fire -- Bai Wei, Di Gu Pi Calm down mind -- Fu Shen, Suan Zhao Ren, Gan Cao Amnesia, sore lower back and weak knees, -- Gui Ban, Gou Qi Zi, E Jiao An Shen ding Zhi Wan Fu LingFu shenYuan zhiShi chang puRen shenLong Chi

14. Treatment Manic Psychosis 6) Blood & Qi Stag. Signs & Symptoms: –Main Sym. : dysphoria, fury, talk much, even singing, running & taking off clothing, or dumbstruck, talk less, being in a confused state of mind, often with darkish complexion, stabbing pain and fullness feeling in chest & hypochondrium, palpitating.. Or abdominal pain during the menstrual period in women, dark and clot in menstruation, or having injuries from falls, fractures, contusions and strains. –Concurrent sym.: headache or feeling fullness in the head –Tongue: dark purple body, thin whitish or thin yellow fur –Pulse: wiry thready or deep wiry Treatment Protocol: –Promoting blood circulation & removing blood stasis –Activating the flow of Qi

15. Formula: Modifications: fever due to blood stasis -- Huang Qin Cold sym -- Gan Jiang, Fu Zi Calm down mind -- Fu Shen, Suan Zhao Ren, Gan Cao Dry & bitter mouth with yellow greasy coating -- Huang Qin Dark purplish tongue body -- Dan Shen, Hong Hua Dian Kuang Meng Xing Tang Tao RenCai HuXiang FuMu TongChi ShaoBan Xia Da Fu PiQin PiChen PiSang Bai PiSu ZhiGan cao Da Huang Zhe Chong Wan

16. Other treatments Dan Shen 60g, Ye Jiao Teng 30g, Ling Zhi 10g, Da Zao 10pcs ( Applicable to various types of schizophrenia) Gan Sui 10g, Da Ji 10g, Da Huang 10g, Bai Jie Zi 10g, Ai Ye 10g, Shi Chang Pu 10g ( Applicable to various types of schizophrenia )

17. Case History 1. Female 45 years Medical history: Usually narrow-minded, oversensitive, over anxious, feeling incompatibility between she and her husband. Her husband stayed at other places for a long period of time, and suspected that she has unfaithful intentions after back home and later beat her. Once after vigorous quarrel, she suddenly look steadily, reticent, refuse to take food and drink, then shouting at top of her voice, climbing walls and getting on roofs, being subject to changing mood, taking off her clothes in the presence of all, hitting others and destroying things; 3 or 4 young men could not check her. First visiting: Main complain: Manic Psychosis Most of the above symptoms had alleviated. Her symptoms manifested as flushed face and ears, constipation Tongue: red tongue with yellow fur Pulse: TCM diagnose: Phlegm-fire disturbing mental activities Treatment protocol: -- Eliminating phlegm --Clear the fire --Tranquilize the mind Formula: Meng Shi Gun Tan Wan + Dan Zhi Xiao Yao Wan

18. Case History 1. Male 31 years Medical history: First visiting: Main complain: Bipolar disorder for 3 years Patient was treated by western medicine for 3 years, however, symptoms were still unstable. 3 month ago, patient’s mental status started to be unstable again. Deliria. Thought himself should be a top leader of a big company. Be proud of his manage ability. Feel excited, irritability, insomnia, headache, distension feeling of head good appetite Tongue: dark red body with purple spot, yellow fur Pulse: wiry TCM diagnose: Blood stasis insulting mind Liver Qi stag. Treatment protocol: --Promoting blood circulation -- Smoothing Liver Qi --Tranquilize the mind Formula: Cai Hu 12, Xiang Fu 12, Qin Pi 10, Su Zi 15, Zheng Zhu Mu 30, Tao ren 15, Hong Hua 15, Chi Shao 20, Yu Jin 15, Da Huang 15, Long Gu 30, San Ling 15, E Zhu 15, Suan Zao Ren 15

19. Epilepsy TCM Diagnoses and Treatments Suddenly falling on the ground, unconsciousness, spitting saliva, staring upwards, clonic convulsion, or shouting as bleat or pig yell, and regaining consciousness some time later Etiology & Pathology: 1. Mental disorder 2. Congenital factors 3. Miscellaneous

20. Main Points for differentiation A) Def. or Excess Excess:Wind-phlegm Internal phlegm-fire Internal blockage of blood stasis Def. Heart & Kidney def. Liver & kid. Yin def. B) Attacking & Remission period Attacking: eliminating phlegm & regulating Qi Remission: Tonify the liver & kid. Yin C) Yang type & Yin Type Yang Type: Syndrome of excess heat Yin Type: Syndrome of deficient cold

21. Yang TypeYin type Good constitutionConstitution is not very good, Vital Qi is gradually exhausted Sudden attack, falling down & shout, clonic convulsion & spitting, lockjaw, looking upwards with taut, Suffered from frequent attack of epilepsy, pale complexion, dull- witted, unconsciousness, reticent, dumb-struck Rapid or wiry slipperyDeep, wiry or deep & slippery

22. Principles of the treatment Treatment must be according to the stage of the disease: Attacking or Intervals