Vexation+and+Agitation+(Bu+An+Jing,+You)

In Chinese medicine, vexation means annoyance due to a hot, oppressive sensation in the chest. Agitation refers to a restless state of the limbs. The former is a subjective symptom, while the other is an objective sign. Although they are different, they are usually considered one term since, in most cases, they occur in combination and share the same disease mechanisms.

Differential Diagnosis:
 * Medical Disorders:**
 * 1) Parkinson’s Disease
 * 2) History of cerebrovascular accident (CVA)
 * 3) Brain Tumors
 * 4) Hyperthyroidism
 * Effects of Substances:**
 * 1) Alcohol or illicit substance intoxication or withdrawal
 * 2) Akathisia as a side effect of antipsychotic medications
 * 3) Side effects or discontinuation effects on mediation
 * Psychiatric Disorders:**
 * 1) Generalized Anxiety Disorder (GAD)
 * 2) Conversion Disorder
 * 3) Depression and other mood disorders
 * 4) Bipolar disorder, manic phase
 * 5) Schizophrenia, acute exacerbation, and other psychotic disorders
 * 6) Post-traumatic Stress Disorder (PTSD)
 * 7) Social phobia & Specific phobias
 * 8) Personality Disorders

TCM Pattern Differentiation: Exterior Cold-Depressed Heat Vexation and agitation, generalized body pain, fever (“emission of heat”), aversion to cold, no sweating, headache, slight thirst [Ma Huang (10g.), Gui Zhi (6g.), Gan Cao (6g.), Xing Ren (10g.), Shi Gao (25g.), Sheng Jiang (3g.), Da Zao(3 pieces), Dan Dou Chi (10g.)]
 * Tongue:** thin, yellowish white coat
 * Pulse:** Floating, tight, rapid
 * Treatment Principles:** Resolve the exterior and scatter cold, clear heat and eliminate vexation
 * Acupuncture Treatment:** HT-8, SI-7, BL-12, LI-4, LI-11. Draining technique
 * Herbal Treatment:** Da Qing Long Tang Jia Jian1

Yangming Replete Heat Vexation and agitation, high fever, sweating, course breathing, thirst, constipation w/ dry bound stools, abdominal fullness, pain in the abdomen exacerbated by pressure, in severe cases, delirium [Shi Gao (25g.), Zhi Mu (10g.), Gan Cao (6g.), Geng Mi (10g.), Dan Dou Chi (10g.), Zhi ZI (10g.)]
 * Tongue:** dry yellow or dry black coat
 * Pulse:** Surging, large or deep, replete
 * Treatment Principles:** Clear Heat, engender fluids, and greatly precipitate heat binding
 * Acupuncture Treatment:** LI-4, St-44, TW-6, ST-37, BL-21, KI-2. Draining technique
 * Herbal Treatment:** Bai Hu Tang Jia Wei1

Shaoyang Gallbladder Channel Depressed Fire Vexation and agitation, alternating cold and heat, chest and rib-side fullness and oppression, bitter taste in mouth, inhibited urination [Chai Hu (12g.), Huang Qin (10g.), Dang Shen (10g.), Ban Xia (10g.), Zhi Gan Cao (6g.), Qing Hao (10g.), Zhi Zi (10g.), Long Gu (12g.), Mu LI (12g.), Sheng Jiang (5g.)]
 * Tongue:** normal or red tongue, half yellow half white coat
 * Pulse:** Bowstring, rapid
 * Treatment Principles:** Harmonize the shaoyang, clear heat and eliminate vexation
 * Acupuncture Treatment:** LR-14, GV-14, PC-5, GB-41. Draining technique
 * Herbal Treatment:** Xiao Chai Hu Tang Jia Jian1

Heat Entering the Constructive & Blood Vexation and agitation, insomnia, fever which is worse at night, in severe cases, mania, macules or eruptions on the skin, blood ejection (i.e. hemetemesis, epistaxis, hematuria, hemafecia, etc.) [Shui Niu Jiao (25g.), Sheng Di (12g.), Xuan Shen (10-15g.) Zhu Ye (10g.), Mai Dong (12g.), Dan Pi (10g.), Dan Shen (10g.), Huang Lian (6g.), Jin Yin Hua (10-12g.) ,Lian Qiao (10-12g.)] Severe skin eruptions or blood ejection: -Jin Yin Hua ,Lian Qiao; + Zhi Zi, Chi Shao; increase Sheng Di to 20g. No Bleeding: + (bleed all) LI-11, LI-1, PC-9, TW-1, HT-9, SI-1
 * Tongue:** crimson
 * Pulse:** Fine, rapid
 * Treatment Principles:** Clear heat, cool the blood, and eliminate vexation
 * Acupuncture Treatment:** HT-8, PC-8, BL-40, LI-11, KI-1. Draining technique on all but BL-40 (bleed)
 * Herbal Treatment:** Qing Ying Tang Jia Jian1
 * Modifications:**

Diaphragm Heat Vacuity vexation, insomnia, burning sensation in the region of the heart, chest and diaphragm glomus and oppression with a desire to vomit [Zhi Zi (10g.), Dan Dou Chi (10g.), Bo He (6g.), Gan Cao (3g.)] Severe internal heat: + Shi Gao
 * Tongue:** thin yellow coat
 * Pulse:** rapid
 * Treatment Principles:** Clear the diaphragm and eliminate vexation
 * Acupuncture Treatment:** LI-5, ST-44, BL-17, HT-8, PC-3. Draining technique
 * Herbal Treatment:** Zhi Zi Dou Chi Tang Jia Wei1
 * Modifications:**

Phlegm Fire Harassing Above Vexatious heat in the heart and agitation, sound of phlegm in the throat, spitting sticky thick phlegm, dyspnea, heavy-headedness, vertigo, chest oppression, abdominal distention, nausea, vomiting [Ban Xia (10g.), Zhu Ru (10g.), Zhi Shi (6g.), Chen Pi (10g.), Gan Cao (3g.), Fu Ling (10g.), Sheng Jiang (3g.), Da Zao (3 pieces), Huang Lian (6g.), Huang Qin (10g.)]
 * Tongue:** slippery yellow coat
 * Pulse:** slippery, rapid
 * Treatment Principles:** Clear heat, transform phlegm, and eliminate vexation
 * Acupuncture Treatment:** PC-8, ST-44, LI-11, GV-14, St-40. Draining technique
 * Herbal Treatment:** Huang Lian Wen Dan Tang Jia Jian1

Liver Depression Transforming Heat Irritability, bitter taste in mouth, rib-side distention & pain, breast distention and pain, menstrual irregularity in females [Chai Hu (10g.), Bai Shao (10g.), Dang Gui (10g.), Bai Zhu (10g.), Fu Ling (10g.), Dan Pi (10g.), Zhi ZI (10g.), Gan Cao (6g.)]
 * Tongue:** red tongue, yellow coat
 * Pulse:** bowstring, rapid
 * Treatment Principles:** Course the liver and rectify the Qi, clear heat and resolve depression
 * Acupuncture Treatment:** LR-2, LR-3, LI-4, LI-11, St-36. Draining technique
 * Herbal Treatment:** Dan Zhi Xiao Yao San1

Heart Fire Effulgence Vexation and agitation, heart palpitations, insomnia, urgent choppy painful urination, sores in the mouth and tip of tongue [Sheng Di (12g.), Mu Tong (10g.), Deng Xin Cao (10g.), Huang Lian (6g.), Zhu Ye (6g.), Gan Cao (6g.), Hu Po (1g. powder)] Hematuria: + Huan Lian Cao, Xiao Ji Simultaneous Yin Vacuity: + Shi Hu, Zhi Mu
 * Tongue:** red or red-tipped tongue
 * Pulse:** bowstring, rapid
 * Treatment Principles:** Clear the heart and downbear fire, disinhibit urination and quiet the spirit
 * Acupuncture Treatment:** PC-8, HT-8, CV-4, ST-39, SI-2. Draining technique
 * Herbal Treatment:** Dao Chi San Jia Wei1
 * Modifications:**

Yin Vacuity Fire Effulgence Vacuity vexation and agitation, insomnia, heart palpitations, profuse dreams, low back and knee soreness and limpness, 5-palm heat, afternoon tidal heat, malar flushing, dry throat and mouth Predominant effulgent fire: Huang Lian E Jiao Tang Predominant Yin Vauity: Zhi Bai Di Huang Wan
 * Tongue:** red tongue, scanty coat
 * Pulse:** fine rapid, floating rapid, or surging rapid
 * Treatment Principles:** Nourish Yin, downbear fire, and eliminate vexation
 * Acupuncture Treatment:** HT-6, KI-7, KI-2, KI-3, ST-41. Even technique
 * Herbal Treatment:**

Heat & Stasis Mutually Binding Vexation and agitation, reddish purple lips and facial complexion, chest, breast, or abdominal pain which is severe, fixed in location, worse at night and associated with feelings of burning heat, spider nevi, hemagiomas, and varicosities, abnormal vaginal bleeding in females with clots mixed in with bright red blood [Huang Qin (10g.), Huang Lian (3-4.5g.), Tao Ren (10g.), Hong Hua (10g.), Dang Gui (10g.), Sheng Di (12g.), Chuan Xiong (6-0g.), Chi Shao (10g.), Chuan Niu Xi (10g.), Dan Shen (10g.), Chai Hu (6-10g.), Zhi Ke (6g.), Gan Cao (3g.)]
 * Tongue:** reddish purple tongue w/ static spots or macules, possible yellow coat
 * Pulse:** bowstring, rapid, possibly choppy
 * Treatment Principles:** Quicken the blood and transform stasis, clear heat and eliminate vexation
 * Acupuncture Treatment:** SP-10, SP-6, BL-17, HT-7, PC-6. Draining technique
 * Herbal Treatment:** Qin Lian Si Wu Tang Jia Wei1

Yin Exuberance-Repelling Yang Red facial complexion as if rouged, no aversion to cold, chilly breath, faint respiration, symptoms similar to mania, vexation and agitation, restlessness, desire to sit in water or in a Yin, cool place, reversal chilling of the four limbs, long clear urination, loose stools w/ undigested food, oral thirst but no desire to drink or possible liking for hot drinks [Fu Zi (10g.), Gan Jiang (4.5g.), Gan Cao (6g.)]
 * Tongue:** dark pale tongue, moist glossy coat
 * Pulse:** deep, fine
 * Treatment Principles:** Break Yin and rescue Yang, stem counterflow and scatter cold
 * Acupuncture Treatment:** ST-36, CV-8, CV-4. Moxa
 * Herbal Treatment:** Tong Mai Si Ni Tangi1