Somatoform+Disorders

As a group somatoform disorders are characterized by physical symptoms that suggest but are not fully explained by a physical disorder and that cause significant distress or interfere with social, occupational or other functioning. Referred to in China by the outdated name "hysteria", most cases correspond to conversion disorders, a subset of somatoform disorders. Conversion disorders are characterized are characterized by physical symptoms caused by psychological conflict which is unconsciously converted to resemble those of a neurologic disorder. Such symptoms generally consist of impaired coordination or balance, weakness or paralysis of an arm or leg or loss of sensation in the body. Other symptoms include simulated convulsions; loss of one of the special senses such as vision or hearing; aphonia; difficulty swallowing; sensation of a lump in the throat; and urinary retention. Generally, onset of symptoms is linked to a socially or psychologically stressful event.

Relevant TCM Diseases: Visceral agitation (Zang Zao), Lily Disease (Bai He Bing), Depression Condition (Yu Zheng), Reversal Pattern (Jue Zheng), Plum Pit Qi (Mei He Qi), Running Piglet Qi (Ben Tun Qi)

Differential Diagnosis: Medical Disorders: A. Neurologic disorders, including multiple sclerosis (MS) B. Gastrointestinal disorders C. Chronic pain disorders D. Disorders causing sexual dysfunction E. Systemic Lupus Erythematosus F. Acute intermittent Porphyria Psychiatric Disorders: A. Major depressive episode with somatization B. Schizophrenia and other psychotic disorders C. Panic Disorder D. Generalized Anxiety Disorder (GAD) E. Malingering F. Factitious Disorder

TCM Etiology and Pathogenesis: “According to Chinese Medicine, hysteria is mainly caused by habitual bodily heart, liver & spleen weakness as well as stimuli by the seven affects and reactions to those stimuli. In those who tend toward repletion, the disease is located mainly in the heart, liver and spleen. This condition is mostly caused by loss of regulation of the seven affects, worry, thinking, vexation and annoyance, or extreme emotional tension.. Typically, either in the initial phase of the disease or during acute episodes, repletion is more important and vacuity is less. Initially we can also say the damage is to the qi division. If this disease endures for some time without cure or during remittent stages, than habitual bodily visceral weakness is more important, and pathological changes are more moderate in degree and tend to be due to vacuity.. In addition, vacuity and repletion may exist simultaneously. In that case the viscera and bowels lose their regulation, the qi and blood counterflow and become chaotic, and vacuity and repletion become mixed.”1

TCM Pattern Differentiation: Liver Qi Depression & Binding, Heart Spirit Delusion Pattern 1 Emotional depression, emotional anxiety, heart spirit restlessness, paranoia, easy fright, tendency to sorrow and crying, abnormal susceptibility to anger, frequent sighing, chest and rib-side distention & pain, epigastric oppression, torpid intake, irregular defecation, menstrual irregularity/PMS [Chai Hu (12g.), Zhi Ke (10g.), Bai Shao (12g.), Xiang Fu (10g.), Chuan Xiong (6g.), Gan Cao (10g.), Fu Xiao Mai (15-30g.), Da Zao (5-10g.)] Severe Liver depression: + Xuan Fu Hua, Yu Jin, Qing Pi, Fo Shou, Lu O Mei Qi depression -> fire w/ emotional tension, aggitation & easy anger, bitter taste: + Zhi Zi, Huang Lian, Mu Dan Pi Severe Heart Qi vacuity w/ blood not nourishing: +Suan Zao Ren, Long Yan Rou, Dang Gui, Bai Zi Ren, Fu Shen, etc. Burping & chest venter discomfort: + Ban Xia, Xuan Fu Hua, Dai Zhe Shi Liver-Spleen disharmony more pronounced: Use //Jie Yu Tang//
 * Tongue:** pale or slightly dark tongue, thin white coat
 * Pulse:** bowstring, fine
 * Treatment Principles:** Course the liver & resolve depression, rectify the qi, smooth the flow of the center
 * Acupuncture Treatment:** Liver depression & binding: PC-6, LI-4, SP-6, ST-36, LR-3, GB-20, CV-17. Draining technique; Heart spirit delusion: HT-7, SI-3, SP-6, PC-6. Tonifying technique.
 * Herbal Treatment:** //Chai Hu Shu Gan Tang He Gan Mai Da Zao Tang//1
 * Modifications:**

Liver Depression Transforming Fire w/ Qi Counterflowing Upward Pattern 1 Due to emotional stimulation, subjective sensation of qi surging upward from the lower abdomen to the throat accompanied by a desire to die, fright palpitations, restlessness, aversion to the sound of human voices, possible abdominal pain or vomiting, vexatious thirst, panting counterflow, first cold then heat, the qi returning incessantly. [Gan Cao (10g.), Chuan Xiong (10g.), Dang Gui (10g.), Ban Xia (12-15g.), Huang Qin (12g.), Ge Gen (18g.), Bai Shao (18g.), Sheng Jiang (3 slices), Gan Li Gen Bai Pi [peach tree bark] (6g.)]
 * Tongue:** whitish yellow coat
 * Pulse:** bowstring, rapid
 * Treatment Principles:** Level the liver, downbear counterflow, normalize the flow of qi
 * Acupuncture Treatment:** CV-12, PC-6, ST-36, SP-4, CV-13, CV-4, LI-4. Draining or even technique
 * Herbal Treatment:** //Ben Tun Tang//1

Liver Depression-Phlegm Obstruction Pattern 1 Emotional depression, low spirits, chest & abdominal fullness & oppression, torpid sitting, taciturnity, sound of phlegm in the throat, profuse phlegm, plum pit qi, torpid intake [Ban Xia (10g.), Fu Ling (12g.), Zi Su Ye (10g.), Hou Po (6g.), Sheng Jiang (10g.)] Qi depression predominant: + Chai Hu, Xiang Fu, Fo Shou, Zhi Ke Severe phlegm depression: + Hai Ge Ke, Zi Wan, Bei Mu, Chen Pi, Gua Lou
 * Tongue:** pale tongue, slimy white coat
 * Pulse:** bowstring, slippery
 * Treatment Principles:** Course the liver & rectify qi, transform phlegm, resolve phlegm
 * Acupuncture Treatment:** ST-36, SP-6, CV-12, ST-40, BL-18, CV-17. Draining technique.
 * Herbal Treatment:** //Ban Xia Hou Po Tang//1
 * Modifications:**

Phlegm Heat Harassing Above Pattern 1 Vexation, agitation, disquietude or restlessness, abnormal susceptibility to anger, chest vexation/oppression, insomnia, profuse dreams, bitter taste, oral thirst, possible spitting of yellow phlegm, yellow urine, constipation. [Huang Lian (3-6g.), Ban Xia (10g.), Zhu Ru (10g.), Chen Pi (10g.), Fu Ling (12g.), Zhi Shi (10g.), Gan Cao (3-6g.), Da Zao (3-5 pcs.)] Serious vexation & agitation, insomnia, profuse dreams: + Long Gu, Mu Li, Zhen Zhu Mu Heart fore effulgence: + Zhu Sha, Tie Lou Constipation: + Da Huang, Mang Xiao, Hou Po
 * Tongue:** red tongue, slimy yellow or glossy yellow coat
 * Pulse:** slippery, bowstring, rapid
 * Treatment Principles:** Transform phlegm & clear heat, resolve depression, quiet the spirit
 * Acupuncture Treatment:** HT-7, ST-40, PC-5, ST-36, BL-10, BL-18. Draining technique.
 * Herbal Treatment:** //Huang Lian Wen Dan Tang//1
 * Modifications:**

Qi Stagnation & Blood Stasis Pattern 1 Emotional lability, emotional depression & melancholy, sorrow and crying, emotional torpor and stagnation, chest and rib-side fullness & oppression, dark circle sunder the eyes, headache, insomnia, profuse dreams, easy fright if severe: lack of use of limbs, sleep-walking [Tao Ren (10g.), Hong Hua (10g.), Dang Gui (10g.), Chi Shao (30g.), Chuan Xiong (10g.), Sheng Di Huang (12g.), Chai Hu (10g.), Xiang Fu (12g.), Long Gu (30g.), Gan Cao (6g.), Hu Po (6g.)] Chest oppression, tension & agitation, bitter taste, yellow tongue: + Huang Lian, Zhi Zi Chest glomus w. sighing: + Fo Shou, Yu Jin Palpitations & insomnia: + Fu Shen, Suan Zao Ren
 * Tongue:** dark purplish tongue, possible static spots and macules
 * Pulse:** bowstring, choppy
 * Treatment Principles:** Quicken the blood & transform stasis, nourish the blood, moisten the viscera
 * Acupuncture Treatment:** SP-10, LR-3, LI-4, SP-6. Draining technique.
 * Herbal Treatment:** //Tao Hong Si Wu Tang Jia Wei//1
 * Modifications:**

Heart Spirit Deprived of Nourishment Pattern 1 Disquietude or restlessness of the heart spirit, an anxious worried affect, sorrow & desire to cry, mental instability, lots of stretching & yawning, heart vexation, inability to lie down, restlessness when sitting or lying down, palpitations [Gan Cao (10g.), Fu Xiao Mai (30g.), Da Zao (15 pcs.), Bai ZI Ren (10g.), Suan Zao Ren (15g.), Fu Shen (12g.), Long Chi (30g.), Mu Li (30g.)] Lusterless complexion, lassitude, fatigue, palpitations, insomnia + Dang Gui, Bai Shao, Huang Qi, etc. Heart qi insufficiency w/ restless heart spirit, anxious worried affect, restlessness when sitting/lying down: Use //Ren Shen Hu Po Wan// [Ren Shen, Hu Po, Fu Shen, Fu Ling, Shi Chang Pu, Yuan Zhi, Zhu Sha, Ru Xiang, Suan Zao Ren] Heart qi insufficiency w/ worry & depression damaging spirit w/ mental-emotional restlessness, palpitations, insomnia: Use //An Shen Ding Zhi Wan// [Ren Shen, Bai Zhu, Fu Shen, Fu Ling, Shi Chang Pu, Yuan Zhi, Zhu Sha, Mai Men Dong, Suan Zao Ren, Niu Huang, Long Yan Rou]
 * Tongue:** pale tongue, thin white coat
 * Pulse:** fine, weak
 * Treatment Principles:** Sweetly moisten & relax tension, nourish the heart, quiet the spirit
 * Acupuncture Treatment:** HT-7, PC-6, CV-17, Yintang. Tonifying technique.
 * Herbal Treatment:** //Gan Mai Da Zao Tang Jia Wei//1
 * Modifications:**

Heart-Liver Qi Counterflow w/ Malnourishment of the Network Vessels Pattern 1 One-sided or lower limb paralysis or wilting, weakness, and lack of strength after either sudden anger or sorrow, inability to stand or walk, palpitations, restlessness, chest oppresion, rib-side pain, dizziness, vertigo [Hysterical Paralysis] [Chai Hu (3-10g.), Dang Gui (10g.), Bai Shao (15-18g.), Bai Zhu (10g.), Fu Ling (10g.), Gan Cao (10-15g.), Fu Xiao Mai (15-30g.), Da Zao (10-15 pcs.), Sheng Jiang (2 slices)] If enduring & there is static blood obstructing the network vessels: + Chi Shao, Chuan Shan Jia, Niu Xi, Tao Ren
 * Tongue:** pale red or dark red tongue, thin white coat
 * Pulse:** bowstring, fine
 * Treatment Principles:** Course the Liver, Nourish the heart, calm the network vessels
 * Acupuncture Treatment:** HT-7, PC-6, CV-17. Upper extremities: LI-4, SI-3, LI-11, LI-15. Lower extremities: KI-1, LR-3, GB-34, GB-31, GB-30. Even technique [BL-62+SI-3]
 * Herbal Treatment:** //Gan Mai Da Zao Tang He Xiao Yao San Jia Jian//1
 * Modifications:**

Heart-Spleen Dual Vacuity, Qi & Blood Insufficiency Pattern 1 Essence spirit abstraction, palpitations, gallbladder timidity, excessive thinking, susceptibility to suspicions, insomnia, impaired memory, nighttime sleep not quiet, profuse dreams, easily awakened, dizziness, lassitude of the spirit, devitalized eating & drinking, lusterless complexion Severe insomnia: + He Huan Hua, Bai Zi Ren Qi depression not smoothly or easily flowing: + Yu Jin, He Huan Pi Yin Vacuity fire effulgence: + Sheng Di, Mai Men Dong, Huang Lian
 * Tongue:** pale tongue
 * Pulse:** fine, weak
 * Treatment Principles:** Supplement & boost the heart & spleen, nourish blood, quiet the spirit
 * Acupuncture Treatment:** SP-4, PC-6, ST-36, BL-15, CV-12, HT-7. Even technique.
 * Herbal Treatment:** //Gui Pi Tang//1
 * Modifications:**

Liver-Kidney Insufficiency w/ Malnourishment of the Sinews & Bones Pattern 1 A relatively long disease course, pre-heaven natural endowment insufficiency, or bodily emaciation, knee & lower leg wilting and weakness, inability to stand, if severe: atrophy of the large muscles of the legs, lower & upper back pain, dizziness, vertigo [Huang Bai (10g.), Zhi Mu (10g.), Shu Di Huang (12-15g.), Gui Ban (12-15g.), Bai Shao (10-15g.), Dang Gui, Niu Xi (10g.), Suo Yang (6g.), Chen Pi (6g.)] Concomitant yang vacuity: + Xian Ling Pi, Bai Ji Tian, Bu Gu Zhi Yin vacuity, yang hyperactivity w/ sorrow, tendency to cry, paranoia, easy fright, 5-palm heat, dry mouth, dizziness: Use //Zhi Bai Di Huang Tang Jia Bai He Zao Ren// [Bai He (12g.), Suan Zao Ren (12g.), Zhi Mu (10g.), Huang Bai (10g.) Shu Di Huang (12-15g.), Shan Yao (10g.), Shan Zhu Yu (10g.), Fu Ling (10g.), Mu Dan Pi (6-10g.), Ze Xie (6-10g.)]
 * Tongue:** thin, small, red tongue; scanty coat
 * Pulse:** fine, weak or fine, rapid
 * Treatment Principles:** Supplement & boost the liver & kidneys, nourish yin, clear heat
 * Acupuncture Treatment:** BL-18, BL-23, KI-3, SP-6, GV-20. tonifying technique
 * Herbal Treatment:** //Hu Qian Wan Jia Jian//1
 * Modifications:**

Yin Vacuity-Lung Heat Pattern 1 A feeling of something obstructing the throat, a red dry, sore throat, dry cough, vexatious heat, night sweats, 5-palm heat [Sheng Di Huang (15-20g.), Xuan Shen (10-15g.), Mai Men Dong (12g.), Bai Shao (10g.), Mu Dan Pi (10g.), Chuan Bei Mu (6-10g.), Bo He (3-6g.), Gan Cao (3g.)] Vexatious heat & night sweats: + Zhi Mu, Di Gu Pi Insomnia: + Suan Zao Ren, Ye Jiao Teng
 * Tongue:** red tongue; thin yellow coat
 * Pulse:** fine, rapid
 * Treatment Principles:** Nourish Yin, moisten the lungs, clear heat
 * Acupuncture Treatment:** BL-13, KI-3, LU-9, LU-10. tonifying technique
 * Herbal Treatment:** //Yang Yin Qing Fei Tang//1
 * Modifications:**

Cold Water Counterflowing Upward, Heart Yang Insufficiency Pattern 1 Due to stimulation by fright & fear there is a sensation of palpitations stirring below the umbilicus. This is followed by strong surging and counterflowing upward w/ heart fluste and restlessness, insomnia, profuse dreams, cold body & chilled limbs [Gui Zhi (15g.), Bai Shao (10g.), Sheng Jiang (6g.), Gan Cao (3-6g.), Da Zao (2 pcs.)]
 * Tongue:** pale tongue; slimy white coat
 * Pulse:** bowstring, tight pulse, possibly insufficient in the left cun position
 * Treatment Principles:** Warm yang, transform water, downbear counterflow
 * Acupuncture Treatment:** CV-12, CV-13, CV-4. tonifying technique and add moxibustion
 * Herbal Treatment:** //Gui Zhi Jia Gui Tang//1

Phlegm Turbidity Blocking the Orifices, Liver Wind Internally Stirring Pattern 1 Sudden Aphasia, sudden syncope, sound of phlegm in the throat, reversal chilling of the four extremities, possible arched back rigidity, both eyes staring upward, the two excretions normal [Ban Xia (12g.), Fu Ling (10g.), Chen Pi (6-10g.), Zhi Shi (6g.), Tian Nan Xing (6g.), Gan Cao (3-6g.), Bei Mu (10g.), Shi Chang Pu (6-10g.), Quan Xie (6g.), Long Gu (12g.), Mu Li (12g.)]
 * Tongue:** thin white coat
 * Pulse:** slippery, bowstring, rapid
 * Treatment Principles:** Flush phlegm & open the orifices, settle tetany, extinguish wind
 * Acupuncture Treatment:** GV-26, LI-4, LR-3, ST-40, CV-12, ST-36. draining technique
 * Herbal Treatment:** //Dao Tan Tang Jia Wei//1