Irritability+(Yi+Nu)

Irritability or //yi nu// is literally “easy anger.” This refers to an emotional disposition to easily becoming angry or irritated. In other words, irritability refers t a hot temper which is not under one’s volitional control. If easy anger is even more pronounced, it is then referred to as “great anger” or irascibility. However the disease mechanisms of irascibility are no different than irritability

Diagnosis: A. Moody, requent emotional changes B. Improper emotional expression C. Long-term emotional stimulant and stressor D. Acute emotional outburst Should have any one of the above

Prognosis: In almost all cases of this disorder will get better after the factors or stressors have been relieved. Exempting the emotional change as a preliminary sign for some severe Shen disturbance disease, in general this disease can be treated and cured in a scheduled treatment plan including Shen treatment techniques.

TCM Etiology and Pathogenesis: “Anger is the affect or emotion of the Liver. Therefore, all disease mechanisms producing easy anger or irritability are associated with the liver viscus. These include liver depression qi stagnation, liver-gallbladder fire heat, whether damp, depressive, or phlegm, and liver-kidney Yin vacuity. In every case there is an element of liver depression. The liver depression is nothing other than pent-up qi/unfulfilled desires. When these accumulate to a certain degree, any further stimulus causes this pent-up qi to rush out as a form of over-coursing and over-discharging. This over-coursing and over-discharging itself then damages the liver and inhibits its qi mechanism all the more.1”

TCM Pattern Differentiation: Liver Depression Qi Stagnation 1,2 Irritability, chest and rib-side distention and pain, depression, taciturnity, belching, low appetite, talkative, insomnia, worry and sensitive, suspiscious to small things, body aches and stiffness, frequent sighing, dymenorrhea or irregular menstruation -LR-3, PC-6, LI-4, HT-7. Draining technique 1 -LR-1, LR-3, LR-6, LR-14, LI-4, TW-6, T-7, CV-3, Yintang 2 -Chai Hu Shu Gan San Jia Jian1 – [Chai Hu (10g.), Zhi Ke (10g.), Bai Shao (10g.), Dang Gui (10g.), Chuan Xiong (6-10g.), Xiang Fu (10g.), Chuan Lian Zi (3-6g.), He Huan Pi (12g.)] 1 -[Chai Hu, Huang Qin, Yu Jin, Bai Shao, Chuan Xiong, Xiang Fu, Bai Zhu, Huang Qi, Dang Shen, Fu Ling, Shi Jue Ming] 2 Liver depression/ Spleen vacuity: Use Xiao Chai Hu Tang or Xiao Yao San as guiding formula Liver depression & Qi stagnation severe: + LR-14, BL-18 Irascibility is severe: + GV-24 Severe chest oppression: + CV-17
 * Tongue:** Dark or normal color, thin white coat
 * Pulse:** Bowstring, tense
 * Treatment Principles:** Course the liver and rectify the Qi
 * Acupuncture Treatment:**
 * Herbal Treatment:**
 * Modifications:**

Liver-Gallbladder Fire Effulgence 1 Irritability, vexation and agitation, red face and eyes, rib-side pain, bitter taste in mouth, dry mouth, possible headache or vertigo [Long Dan Cao (6g.), Zhi ZI (10g.), Huang Qin (10g.), Da Huang (3-6g.), Dang Gui (10g.), Chuan Xiong (6-10g.), Qiang Huo (10g.), Fang Feng (10g.), Gan Cao (3g.), Bo He (3-6g.), He Huan Pi (10g.)] Severe vexation & agitation: + Huang Lian Severe rib-side pain: + Chai Hu, Chuan Lian Zi, Yan Hu Suo Severe headache and vertigo: + Xia Ku Cao Severe red eyes: + Ju Hua
 * Tongue:** Red body, yellow tongue
 * Pulse:** Bowstring, rapid
 * Treatment Principles:** Clear the liver and drain gallbladder fire
 * Acupuncture Treatment:** LR-2, GB-41, ST-44, PC-5. Draining technique
 * Herbal Treatment:** Xie Qing Wan Jia Jian1
 * Modifications:**

Liver and Heart Excessive Fire, Shen Irritable 2 Anger easily, irritability, palpitations, insomnia, dream disturbed sleep, hypochondriac pain and burning sensation, red eyes and face, body feels hot, eating and drinking cold, constipation, scanty and yellow colored urination
 * Tongue:** Red tongue w/ reddish dots, possible pain and ulceration, yellow coat
 * Pulse:** dry, wiry, slippery
 * Acupuncture Treatment:** LR-1, LR-2, HT-8, HT-9, PC-7, GB-13, GB-43, CV-14, GV-14, GV-24
 * Herbal Treatment:** [Huang Qin, Huang Lian, Zhi Zi, Zhi Mu, Zhen Zhu Mu, Lu Hui, Huang Bai, Dan Shen, Yuan Zhi, Tian Dong]

Liver Blood-Kidney Yin Vacuity 1,2 Irritability, dizziness, depressed, feels like anger is held inside, low back and knee soreness and limpness, dry skin and throat, dry rough eyes, 5-palm heat, possible night sweats, malar flush, afternoon tidal heat, insomnia, profuse dreams -LR-3, SP-6, KI-3, KI-7. Even technique 1 - LR-3, LR-8, KI-2, KI-3, KI-6, KI-9, KI-27, SP-6, Yintang 2 -Qi Ju Di Huang Wan Jia Wei1 - [Shu Di (12g.), Shan Yao (10g.), Shan Zhu Yu (10g.), Ze Xie (6g.), Dan Pi (10g.), Gou Qi Zi (10-12g.), Ju Hua (10g.), Huang Bai (10g.), Long Gu (12g.)] 1 -[Shu Di, Shan Yao, Shan Zhu Yu, Ze Xie, Mu Dan Pi, Fu Shen, Ji Xue Teng, Dan Shen, Bai Shao, Chi Shao ] 2
 * Tongue:** Red or pale, red tip, scanty coat
 * Pulse:** Fine, rapid or floating, rapid
 * Treatment Principles:** Supplement the kidneys and enrich Yin, nourish the blood and emolliate the liver
 * Acupuncture Treatment:**
 * Herbal Treatment:**