Coma


 * IBIS:**

Definition:
Unarousable unresponsiveness, even to energetic and repeated stimulation. It is always a medical emergency.

Etiology:
Most comas are metabolic, traumatic or toxic in origin. Normal consciousness is maintained by the proper functioning of the reticular activating system (RAS), both cerebral hemispheres, and the connections between them. If there is a lesion in one of those areas, a coma may result. The main reasons for malfunction are: » Bilateral hemisphere damage or suppression by toxins or drugs » A brainstem lesion or metabolic abnormality which damages or suppresses the RAS

Nutrition:
eating principles: IV feeding, nothing by mouth

Botanicals
• Acorus calamus (toxic): excitant (Felter and Lloyd, p. 391) • Arnica montana (toxic): coma as a result of a stroke (Mittman) • Atropa belladonna (toxic): coma, concussion (Felter and Lloyd, p. 339; Harper-Shove, p. 33)

Chinese Formulae
• Gleditsia and Asarum F. (Tong Guan San): First aid for sudden unconsciousness: "If the patient can be made to sneeze, he can be cured." After coming to, treatment is according to the symptomatic condition. (Hsu, 1980, p. 336; Bensky and Barolet, p. 425)

» "Obstruction" conformation: "the harmful toxin is thriving and the patient's chi is full": • Bos and Curcuma F. (An Gong Niu Huang Wan) (available as patent): Shi (Excess) Heat Type: Resulting from fever, uremic coma and hepatic coma, coma resulting from cerebral injury, epidemic encephalitis (Bos and Curcuma: Hsu, 1980, p. 330; Yeung, p. 31; Bensky and Barolet, p. 416; An Gong: Zhu, p. 129) • Styrax F. (Su He Xiang Wan): Cold Type: Coma due to apoplexy, abrupt coma, stroke, cholera,lockjaw, abdominal pain, face pale and white, oral and nasal breath cold, hands and feet cold, white slippery tongue coat, forceful pulse (Hsu, 1980, p. 335; Yeung, p. 222; Bensky and Barolet, p. 422)

» "Prostration" conformation: toneless hands, incontinence, feeble and minute respiration, spontaneous sweating: • Sheng Mai San; Di Huang Yin Zi: Yin Xu (Deficiency): Fatigue, shortness of breath, profuse sweating, feeble and weak pulse. (Sheng Mai San: Yeung, p. 207; Bensky and Barolet, p. 245; Di Huang Yin Zi: Yeung, p. 83; Bensky and Barolet, p. 408) • Shen Fu Tang: Yang Xu (Deficiency): Cold hands/feet, cold, loose stools, abdominal pain, weak breath. (Yeung, p. 199; Bensky and Barolet, p. 228)

Acupuncture
after assessing the person and palpating, consider these patterns: Heat invades, Phlegm and Fire obstruct the body cavities, and obscure the "light of the Shen";Extreme Heat Generating Liver Wind; Yin and/or Yang Xu (Deficiency)

» illustrative combinations: • GV-26, shi xuan (bleed), LI-4, Lv-3 for "obliterative type" (initial stage); also consider GV-14, PC-6, St-40 and Kd-1 (Lee and Cheung, p. 216) • GV-20, GV-6, CV-4, GV-25, Lu-9 and Kd-7 for "collapse type" (shock stage); also consider LI-4, PC-8 and St-36 (Lee and Cheung, p. 216) • GV-15, PC-8, Sp-6, Kd-1, Kd-3, CV-12, GB-30, St-36 and LI-4 are the Nine Needles for Returning the Yang (Li, p. 627-628; Ellis, et al, 1988, p. 66) • consider treatment for "Internal Dragons" or "External Dragons"; External Dragons: GV-20, UB-11, UB-23, UB-61; Internal Dragons: Master point 1/4" below CV-15, St-25, St-32, St-41; In both treatments, sedate first. If the person and the pulses change, fine. If no change with sedation, then tonify. (Worsley)

Homeopathy
• Belladonna: violent head congestion after cold; very red face, throbbing, injected eyes and mydriasis; beating of carotid arteries • Opium: heavy, stupid, sleep, complete loss of consciousness; perspiration; prostration, somnolence; face very red, covered with hot perspiration; contracted, insensitive pupils • Pilocarpus jaborandi: hot flushes, nausea, salivation, profuse perspiration

Subtle Support
mental/emotional: • rhythmic folk songs • County Derry • songs of Steven Foster • Spanish tangos • Brahms' Hungarian dances • Sousa's marches • Strauss' waltzes • Gilbert and Sullivan • Indian Love Call • My Wild Irish Rose • Wishing • Estrellita (Heline, p.18)

Mind/Body
• Comatose persons are wakeful human beings going through one more meaningful step in their process of individuation. They resemble mythical heroes, figures who journey through the outermost gates of reality seeking information in the unknown reaches to return with a divine message. Many of these patients venture to the heights and depths to find some degree of ecstasy, prophetic insight, and self-knowledge. (Mindell, 1989, p. 5) • The kinds of feelings and thoughts we have about the comatose person strongly affect him. A medical attitude toward the person's experiences and the belief that they are due to pathologies can affect his reactions and even make him comatose again. To use certain terms (such as ill, psychotic, deranged, comatose, or drugged) can be considered an aggressive act which cuts people off from their experiences. A phenomenological approach accepts the comatose state and allows the signals descriptive of this state to unfold into a process. (Mindell, 1989, p. 69-70) • In a comatose state, people usually do not experience much pain because they do not identify with their normal bodies. Coming out of the coma, they feel pain again as they resume their old identities. Pain indicates a need to integrate the pain- maker. The pain creator is a part of our psychology we need, and if we do not pick it up consciously, it hurts us. (Mindell, 1989, p. 72) • When we come out of a coma, we retrieve our old personalities as well as our old bodies. Thus old symptoms may reoccur. The coma can be the solution to symptoms because during a coma, the individual is able to unconsciously identify with the process behind the dream or symptom. Yet a coma is not a complete solution because the process happens so unconsciously that integration is extremely difficult. People who come back from comas too early, without processing their experiences in depth, will seek a way to return to the comatose state. (Mindell, 1989, p. 75-6) • Fear; escaping something or someone. (Hay, 1984, p. 160) • NDE (near death experience): NDEers experience some or all of these events: a sense of being dead, peace and painlessness even during a "painful" experience, bodily separation, entering a dark region or tunnel, rising rapidly into the heavens, meeting deceased friends and relatives who are bathed in light, encountering a Supreme Being, reviewing one's life, and feeling a reluctance to return to the world of the living. (Moody, 1988, p. 2)

Chinese psychophysiology: • Heart ~ Xin houses the Shen (Spirit) and reveals itself through the brightness in the eyes; governs Fire; rules the Xue (Blood) and its vessels and directs the circulation; opens into the tongue and controls speech; and relates to the integration of the organs and the personality. » Healthy expressions are warmth, vitality, excitement, inner peace, love, and joy. » Heart Xu (Deficiency) signs include sadness; absence of laughter; depression; fear; anxiety; shortness of breath (Seem, p. 28); cold feeling in the chest and limbs; palpitations; cold sweat; inability to speak; memory failure; nocturnal emissions; and restless sleep. » The Heart is the Emperor of the bodily realm so that when the Heart is disturbed all the other organs will be disrupted.

• Pericardium ~ Xin Bao is the Minister who protects the Heart, the Emperor, and maintains the order of the Heart energy; and as such may be adversely affected by emotional stresses internally or invasion of Heat externally. The Pericardium is said to be the origin of joy and sadness. » Healthy expressions are joy, happiness, and healthy relationships. » Weakness, dysfunction, and illness are associated with confusion, delirium, nervousness, and psychosis. » Mental signs of Pericardium channel disorders include depression, sexual perversion, aversions, and phobias. (Seem, p. 28)

• Liver ~ Gan is the home of the Hun (Ethereal Soul); it relates to decisiveness, control, and the principle of emergence; maintains smooth flow of Qi and Xue (Blood); reflects emotional harmony and movement; opens into the eyes; and expresses itself in the nervous system. » Healthy expressions are kindness, spontaneity, and ease of movement. » Liver Xu (Deficiency) signs include impotence; frigidity; pain in thighs, pelvic region, and throat; ready tendency to "the blahs" (Seem, p. 28); timidity; depression; irritability; vertigo; pruritus; dry skin and/or tendons; asthma; aching at the waist; hernia; and difficulty raising head up and down. » Liver Wind derives from Liver Yin Xu (Deficiency) and/or Liver Xue Xu (Blood Deficiency) and their subsequent inability to embrace the Yang, and can manifest as joint stiffness, dizziness, tremor, paralysis, convulsions, and neurological problems.