Mania+(Kuang)

Withdrawal and Mania, //dian// and //kuang,// are a yin-yang pair of conditions which can either exist separately or alternate back and forth between the two. Mania refers to an agitated, excited affect accompanied by inappropriate anger and/or laughing, metal, physical, and emotional restlessness, etc.
 * Mania (Kuang)**

Relevant western diseases: Manic disorder, a manic episode in bipolar mood disorder, schizophrenia, delirium an psychoneurosis, psychogenic psychosis and personality disorder

Diagnosis: A.History of preliminary emotional or Shen injury B.Acute onset can create Shen confusion like irritability, delirium, hyperactivity, uncontrolled behavior, busy mind and improper emotional expression C.No history of febrile disease or summer heat attack D.X-ray, CT scan exams have negative results; peripheral blood and spinal cord fluid exams are normal Should have B and refer others to confirm the diagnosis

Prognosis: In the early stage, Kuang syndrome is almost always due to the fire or heat from the Liver, Heart or Stomach and the clinical symptoms are very pronounced. In the late stage, the Yin energy and Blood are becoming exhausted and causing a deficient Kuang situation. For [Kuang], the prognosis is much better than Dian syndrome and may have very good results. Some patients will be without Shen disturbance after finishing the treatment. Poor prognosis can occur in the recurrent type.

TCM Etiology and Pathogenesis: “primarily due to the heart spirit being harassed by some sort of evil heat or fire. This may be depressive heat, phlegm heat, yangming replete eat, or vacuity heat. However, some Chinese sources say that blood stasis may also cause mania. In this case, heat has damaged the blood and the blood has become static”1

“Fire and heat are the most common pathogens to cause Kuang syndrome; both can be produced by internal Zang Fu disharmony or direct external evil... Yang excess and evil attack can all cause Kuang syndrome. Zang Fu disharmony and dysfunction are commonly found in Liver, Heart and Stomach in early stage and Kidney Yin deficiency in the later stage, Brain Shen injury can occur at any time.” 2

TCM Pattern Differentiation: Liver Depression Transforming Fire Emotional tension, agitation, irritability, easy anger, bouts of explosive, possibly violent anger, chest, breast, rib-side, and abdominal distention and pain, menstrual irregularity and PMS, bitter taste in mouth, possible constipation, headache [Long Dan Cao (6-10g.), Chai Hu (6g.), Huang Qin (10g.), Huang Lian (3-4.5g.), Bai Shao (10g.), Zhi Zi (10g.), Dan Pi (10g.), Sheng Di (12g.), Dang Gui (10g.), Ze Xie (10g.), Che Qian Zi (10g.), Gan Cao (3g.)] Heart palpitations and insomnia: + Long Gu, Mu Li
 * Tongue:** Red, red or swollen tongue edges, thin yellow possibly slightly dry coat
 * Pulse:** Bowstring, rapid
 * Treatment Principles:** Course the liver and resolve depression, downbear fire and quiet the spirit
 * Acupuncture Treatment:** LR-2, GB-43, PC-8, PC-7, GV-14, PC-5
 * Herbal Treatment:** Long Dan Xie Gan Tang Jia Jian1
 * Modifications:**

Phlegm Fire Harassing Above Impetuosity, rashness and impatience, breaking things and injuring other people, cursing and foul speech, an angry look in the eyes, red facial complexion, red eyes, bound constipated stools [Da Huang (15g.), Huang Qin (15g.), Huang Lian (10g.), Zhi Mu (15g.), Zhi Zi (12g.), Yu Jin (12g.), Ban Xia (12g.), Dan Nan Xing (10g.), Tian Zhu Huang (10g.), Shi Chang Pu (10g.)]
 * Tongue:** Red, slippery yellow coat
 * Pulse:** Bowstring, large, slippery, rapid
 * Treatment Principles:** Settle the Heart and flush phlegm, clear the liver and drain fire
 * Acupuncture Treatment:** GV-14, GV-26, PC-6, PC-8, ST-40, LR-3. Draining technique
 * Herbal Treatment:** Da Huang Huang Lian Xie Xin Tang Jia Wei1

Yangming Heat Binding Mania, agitation, improper emotional expression, non-stop laughing, excess self-esteem, boasting or talking big, deranged speech, singing aloud, climbing to high places, very creative at making songs or ideas, busy schedule and changing ideas frequently, may have illusions or hallucinations, red facial complexion, body feels very hot like fire burning, tendency to strip off one’s clothes, running around, more activity, no eating for days, thirsty and drinking cold water, recalcitrant constipation w/ dry bound stools, scanty reddish urine -LI-4, LI-11, ST-44, TW-6, GV-14, PC-8. Draining technique1 -LI-2, LI-4, LI-5, ST-40, ST-44, CV-12, SP-6 HT-5, HT-7, PC-7, PC-8; Bleed: LU-11, LI-1, ST-452 -Da Cheng Qi Tang Jia Wei – [Da Huang (15g.), Huang Qin (12g.), Mang Xiao (10g.), Huo Po (15g.) Zhi Shi (12g.), Zhi Zi (12g.), Lian Qiao (12g.), Bo He (6g.), Gan Cao (6g.)] 1 -[Da Huang, Huang Lian, Huang Qin, Huang Bai, Mang Xiao, Hou Po, Shi Gao, Zhi Mu, Shi Hu, Mai Men Dong, Lu Hui, Gan Cao]2 Thirst w/ desire to drink1: + Shi Gao, Zhi Mu
 * Tongue:** Red r purple tongue, thick dry yellow or grey coat
 * Pulse:** Deep, rapid, forceful
 * Treatment Principles:** Clear and drain the Yangming, calm the spirit and quiet agitation
 * Acupuncture Treatment:**
 * Herbal Treatment:**
 * Modifications:**

Yin Vacuity-Fire Effulgence (Heart and Kidney Not Communicating) Enduring, long-standing mania which is not too severe, laughing but less power than before, Shen irritability, hoarse voice, lack of strength for activity and talking but keeps going at the same pace, vexation and agitation, insomnia, excessive speech, susceptibility to fear, 5-palm heat, afternoon tidal heat, dry mouth, constipation, scanty and dark urination, possible malar flushing, possible night sweats -SP-6, KI-3, LR-3, KI-1, HT-7. Even technique1 -HT-7, PC-6, SP-6, KI-2, KI-3, KI-6, SP-6, LR-2, GV-24, An Mian, Tai Yang, Si Shen Cong2 -Er Yin Jian Jia Jian - [Sheng Di (12-15g.), Mai Dong (15g.), Xuan Shen (15g.), Suan Zao Ren (12g.), Fu Shen (12g.), Huang Lian (6-10g.), Mu Tong (10g.), Deng Xin Cao (10g.), Zhu Ye (10g.), Dang Shen (12g.), Shi Chag Pu (6g.)] 1 -[Sheng Di, Shu Di, Xuan Shen, Niu Zhen Zi, Huan Lian Cao, Huang Bai, Zhi Mu, Shi Jue Ming, Mu Li, Gui Ban, Bie Lia, Suan Zao Ren, Qing Hao, Yuan Zhi] 2 With Phlegm Heat1: Use Er Yin Jian modification1 Night Sweats1: + HT-6 Chronic dry sore throat, dry mouth and throat1: -KI-3; +LU-7, KI-6 Heart Palpitations1: + PC-6
 * Tongue:** Red, scanty possibly yellow coat (“may be like mirror”)
 * Pulse:** Fine, bowstring, rapid or deep, thready, rapid
 * Treatment Principles:** Supplement the kidneys and nourish the liver, downbear fire and quiet the spirit
 * Acupuncture Treatment:**
 * Herbal Treatment:**
 * Modifications:**

Stasis and Heat Mutually Binding Emotional lability, agitation, speaking to oneself, delusional thinking, auditory and visual hallucinations, dark stagnant facial complexion, piercing lancinating headache [Tao Ren (12g.), Honh Hua (10g.), Dang Gui (10g.), Sheng Di (10g.), Chuan Xiong (6g.), Ci Shao (6g.), Jie Geng (5g.), Chuan Niu Xi (10g.), Huang Lian (3-6g.), Huang Qin (10-12g.), Chai Hu (3g.), Zhi Ke (6g.), Gan Cao (6g.), Shui Zhi (6g.)] With Constipation: + Da Huang, Mang Xiao Excitation and restlessness w/ agitated stirring: + Dan Pi, Sheng Di Restless sleep and depression, oppression, and discomfort: + He Huan Pi, Ye Jiao
 * Tongue:** Dark red w/ static macules or spots, possible engorged, tortuous sublingual veins and/or dryish, yellow coat
 * Pulse:** Bowstring, rapid, possibly skipping
 * Treatment Principles:** Quicken the blood and transform stasis
 * Acupuncture Treatment:** SP-10, SP-6, LI-4, LI-11, ST-25, GV-14. Draining technique
 * Herbal Treatment:** Qin Lian Si Wu Tang Jia Wei1
 * Modifications:**

Liver Qi and Phlegm Stagnation Transforming to be Fire, Affected Brain Shen 2 Depression, extreme irritability, easily stimulated, verbose, excited and anxious, has illusions and hallucinations, suspicious, uncontrolled behavior such as hitting people and destroying things, crying, breathing roughly, over eating and drinking, prefers cold, red face and eyes, constipated, dark colored urine [Qing Meng Shi, Shi Jue Ming, Shi Chang Pu, Yu Jin, Huang Lian, Huang Qin, Huang Bai, Da Huang]2
 * Tongue:** Red, greasy thick yellow coat
 * Pulse:** wiry, slippery, rapid
 * Acupuncture Treatment:** GV-24, GV-26, LI-4, HT-7, HT-8, PC-8, GB-34, GB-43, ST-40, ST-44, SP-6, LR-1, LR-2; Bleed: Ba Feng, Ba Xie, Er Jian
 * Herbal Treatment:**

Heart and Liver Fire Burning Up, Affected Brain Shen 2 Acute onset, irritability, verbose, talking loud, singing or reading loudly, improper emotional expression, laughing, ager, taking off of clothes, over eating or drinking, irregular eating without hunger or fullness, improperly helping others or volunteering, illogical talking, constipation, compulsive purchasing behavior, insomnia [Huang Lian, Huang Qin, Huang Bai, Shi Gao, Da Huang, Zhi Zi, Dan Shen, Long Dan Cao, Zhi Mu, Dan Zhu Ye, Suan Zao Ren, Xuan Shen]2
 * Tongue:** Red, yellow coat
 * Pulse:** wiry, rapid
 * Acupuncture Treatment:** GV-24, GV-26, Si Xuan, HT-3, HT-7, HT-8, PC-7, PC-8, LI-11, LR-2; Bleed: SI-1, HT-9, LR-1
 * Herbal Treatment:**

Classical Treatments: 3 Diankuang caused by the one hundred pathologic factors: 13 Ghost Points – Sun Simiao Kuang – one jumps and runs: CV-13, HT-7 Attack of kuang: HT-3, PC-5, LI-11, SI-3, GB-1, KI-7 Solie De Morant: Hyperexcitation: ST-45, St-42 Sudden hyperexcitation, hallucinations, violent sweats: PC-5 Attacks of hyperexcitation: HT-3, BL-43, CV-14, LR-8, CV-13, HT-7 Overexcitation from emotional agitation: GB-35, BL-18 Prolonged hyperexcitation, climbs up, sings, takes of clothes, runs: ST-45, ST-42, ST-40 Hyperexcitation becomes apoplexy (Stroke): GB-39

Relation to brain injury:
When the right orbital and/or right lateral convexity are damaged by injury, tumor, or seizures, behavior often becomes inappropriate, labile, and disinhibited.

Individuals may become -Hyperactive -Distractable, Flightiness of ideas -Hypersexual, disinhibited sexuality -Tangential -Delusional, usually of grandeur -Confabulatory -indiscriminant financial activity or irresponsibility -Decreased need for sleep -Pressured Speech -Emotional lability

Although laughing and joking one moment, these same patients can quickly become irritated, angered, enraged, destructive, or conversely tearful and depressed with slight provocation. That is, the patient may present with manic-depressive symptoms, with mania predominating. Hence, manic-depression (bipolar affective disturbances) may be due to waxing and waning abnormalities involving the right and left frontal lobes.