Withdrawal+(Dian)

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. Withdrawal refers to a torpid, flat, depressed affect with a tendency to taciturnity, uncommunicativeness, and solitariness. It may also include incoherent speech, a lowering of mental faculties, and even syncope and coma.

Relevant Western Diseases: Schizophrenia, psychoneurosis, depression, bipolar mood disorder, psychogenic psychosis, personality disorder, some hormonal and adolescent disorders

Diagnosis: A. Family History B. Introverted personality, resent for emotional occurrences C. Depressive emotion, flattening emotion, inactivity and decreased movement, mutism, or monologue, illogic speech. May be verbose, show anxiety and upset. Delusions and hallucinations D. No poison or epidemic disorder E. Brain imaging and laboratory exam are negative F. The disease duration over three months minimum Should have C, D and F and refer others to confirm the diagnosis

Prognosis: In the early stage, emotional disorder is the main clinical presentation; furthermore, Shen weakness or insufficiency and clouded mind can be found. The patient loses their ability to maintain normal daily lifestyle and power to work. In severe situations, patients lose social ability, stay home, missing meals or even Shen processing disturbances such as monologue (talking to oneself), illogical speech and laughing; these symptoms indicate the righteous Qi is very weak and Shen is deeply injured. This type of situation is very hard to cure.

TCM Etiology and Pathogenesis: “clear qi not being unborne and, therefore, the spirit brilliance not being constructed of evil causing lack of free flow of the qi and/or blockage of the heart orifice. ‘Mostly it is caused by phlegm binding within the heart and chest’ - Zhu Dan-Xi”1

“A person’s pre-heaven situation was mentioned as an etiological factor …The shen status is established by the pre-heaven condition so the shen can be injured or disharmonies can exist when the people are born. A patient’s post-heaven situation can be found in their emotional disharmony. Strong constant emotional movement or emotion stimulants can adversely affect the unprepared Shen. A child’s growth environment is a very important factor to Human Shen development later in life. Zang Fu disharmony and dysfunction is commonly found in the heart, liver, and spleen in early stage Dian and Heart, Liver and Kidney in the later stage; Brain Shen injury can occur at any stage. Qi, Blood, Phlegm, Fire and Stagnation are the common pathological situations responsible. Long-term disease causes Qi, Yang or Yin deficiency”2

TCM Pattern Differentiation:

Liver Qi Depression & Binding1
Emotional depression, a dull affect, taciturnity, illogical speech, irritability and easy anger, if sever, suicidal thoughts, no desire to live, or self-injury, chest an rib-side fullness and oppression, tendency to sigh, no thought for food or drink, menstrual irregularities in females [Chai Hu (12g.), Xiang Fu (10g.), Bai Shao (10g.), Zhi Ke (10g.), Chuan Xiong (6g.), Yuan Zhi (10g.), Su Geng (10g.), Chen Xiang (6g.), Gan Cao (3g.)] Extreme depression, transformed heat, bitter taste, extreme anger, red tongue, rapid pulse: + Huang Qin, Huang Lian With Spleen vacuity: Use Xiao Yao San w/ additions & subtractions Liver-Spleen disharmony w/ depressive heat: Use Dan Zi Xiao Yao San or Xiao Chai Hu Tang w/ additions and subtractions
 * Tongue:** Dark w/ thin white coat
 * Pulse:** Bowstring
 * Treatment Principles:** Course the Liver and rectify the Qi, resolve depression and arouse the spirit.
 * Acupuncture Treatment:** LR-3, PC-6, HT-7, LI-4, ST-36, CV-17. Use draining technique
 * Herbal Treatment:** Chai Hu Shu Gan San Jia Wei1
 * Modifications:**

Phlegm Qi Depression & Binding 1 Emotional depression, a flat affect, paranoia, lots of worries, nonsensical speech, muttering to oneself, tendency to sigh, an rib-side fullness and oppression, no thought for food or drink, possible plum pit Qi, tendency to profuse phlegm, fibrocystic breasts in females [Ci Shi (12g.), Zhi Shi Ying (12g.), Tian Ma (10g.), Chen Pi (10g.), Ban Xia (12g.), Dan Nan Xing (10g.), Yuan Zhi (10g.), Bai Zhu (10g.), Fu Ling (12g.), Shi Chang Pu (15g.), Zhi Shi (10g.), Zhu Ru (10g.), Gan Cao (5g.), Deng Xin Cao (1.5-3g.)] With Spleen vacuity w/ fatigue, lassitude: + Dang Shen, increase Zhi Gan Cao Lack of heat disturbing heart: - Deng Xin Cao
 * Tongue:** Slippery Coat
 * Pulse:** Bowstring, Slippery
 * Treatment Principles:** Rectify the Qi & resolve depression, transform phlegm and open the orifices.
 * Acupuncture Treatment:** GV-26, HT-7, PC-6, CV-12, ST-36, LR-2, ST-40. Use even technique
 * Herbal Treatment:** Shi Si Wei Wen Dan Tang1
 * Modifications:**

Phlegm Dampness Obstructing Internally 1 Difficulty thinking, inattentiveness, a dull, flat affect, slow movements, fatigue, lack of strength, cowering, solitariness, possible visual and auditory hallucinations, torpid food intake, heart vexation, insomnia [Dang Shen (12g.), Bai Zhu (10g.), Fu Ling (20g.), Gan Cao (10g.), Mu Xiang (6g.), Sha Ren (6g.), Sheng Jiang (10g.), Gan Jiang (10g.), Chen Pi (10g.), Ban Xia (10g.), Cang Zhu (10g.), Yuan Zhi (6g.), Shi Chang Pu (10g.), Huo Xiang (10g.), Pei Lan (10g.)] Pronounced Spleen vacuity w/ fatigue, lack of strength: + Huang Qi, Sheng Ma Speen vacuity effecting Kidneys w/ low back pain, excessive, frequent (possibly turbid) urination and/or excessive white vaginal discharge: + Shan Yao, Bia Bian Dou
 * Tongue:** Swollen w/ teeth marks on edges, slippery white coat
 * Pulse:** Slippery or deep, slightly slow
 * Treatment Principles:** Warm Yang and fortify the Spleen, Transform phlegm and open the orifices
 * Acupuncture Treatment:** CV-17, Cv-12, PC-6, HT-7, St-36, ST-40, BL-20, BL-21
 * Herbal Treatment:** Xiang Sha Liu Jun Zi Tang + He Li Zhong Tang Jia Wei1
 * Modifications:**

Heart-Spleen Dual Vacuity 1,2 Excessive thinking, worry, and anxiety, easily embarrassed, dreaming a lot or of ghosts, insomnia, confusion, delusions and hallucinations, nonsensical speech, heart palpitation, easily frightened, a predilection to sorrow and a desire to cry, flattened emotion, prefers staying alone, impaired memory, difficulty thinking, sluggishness, fatigue, reduced intake of food, loose stool, poor digestion, sallow yellow or pale white complexion -BL-15, BL-20, PC-6, HT-7, St-36. Use Tonification. 1 -BL-15, BL-20, BL-43, HT-7, ST-36, SP-3, SP-6, SP-10, GV-17, GV-202 -Gui Pi Tang Jia Jian - [Huang Qi (30g.), Dang Shen (12g.), Dang Gui (12g.), Bai Zhu (12g.), Fu Shen (30g.), Long Ran Rou (12g.), Suan Zao Ren (15g.), Bai Zi Ren (15g.), Wu Wei Zi (10g.), Mu Xiang (10g.), Yuan Zhi (6g.), Gan Cao (6g.), Da Zao (5 pieces)] 1 -[Huang Qi, Dang Shen, Dang Gui, Bai Zhu, Fu Shen, Suan Zao Ren, Bai Zi Ren, Mu Xiang, Yuan Zhi, Da Zao, Ren Shen, Dan Shen, Shan Yu Rou] 2
 * Tongue:** Pale, often puffy
 * Pulse:** Fine and forceless or thready and weak
 * Treatment Principles:** Fortify the Spleen and nourish the Heart, boost the Qi and quiet the spirit
 * Acupuncture Treatment:**
 * Herbal Treatment:**

Spleen-Kidney Yang Vacuity 1,2 Advanced age, bodily weakness, difficulty thinking, poor memory, prefers staying alone, sluggishness, tiredness, inattentiveness, cowering, scanty speech, monologue, laughing by oneself, no thought for food and drink, diarrhea, bodily vacuity and lack of strength, lusterless facial complexion, fear of cold, chilled extremities -Bl-23, GV-4, BL-20, BL-21, CV-4, GV-201 -SP-3, SP-6, KI-3, KI-7, GV-20, CV-4, CV6, GB-15, Yintang2 -Bu Gu Zhi Wan Jia Jian - [Huang Qi (15g.), Dang Shen (12g.), Bu Gu Zhi (12g.), Rou Cong Rong (12g.), Ba Ji Tian (12g.), Gan Cao (6g.), Fu Ling (12g.), Yuan Zhi (10g.), Dang Gui (10g.), Chuan Xiong (10g.), Bai Zi Ren (12g.), Suan Zao Ren (12g.), Wu Wei Zi (10g.), Rou Gui (6g.)] 1 -[Huang Qi, Dang Shen, Bai Zhu, Fu Shen, Bai Shao, Dan Shen, Niu Zhen Zi, Du Zhong, Tu Si Zi, Gou Qi Zi]2 With Blood stasis (1): + Dan Pi, Yu Jin
 * Tongue:** Pale, thin white coat
 * Pulse:** Deep, fine, weak
 * Treatment Principles:** Warm and supplement the Spleen and Kidneys assisted by transforming phlegm and opening the orifices
 * Acupuncture Treatment:**
 * Herbal Treatment:**
 * Modifications:**

Blood Stasis Obstructing Internally 1,2 Emotional lability, irritability, suppressed anger, speaking to oneself, torpid spirit, paranoia, delusional thinking, auditory and visual hallucinations, no desire, poor motivation, menstrual pain w/ dark clots, dark stagnant facial complexion, piercing lancinating headache, possible painful areas of body [Tao Ren (10g.), Hong Hua (10g.), Dang Gui (10g.), Sheng Di (10g.), Chuan Xiong (6g.), Chi Shao (6g.), Jie Geng (5g.), Chuan Niu Xi (10g.), Chai Hu (3g.), Zhi Ke (6g.), Gan Cao (6g), Shui Zih (6g.)] Scanty speech and movement, lusterless complexion, fatigue & exhaustion: + Huang Qi, Dang Gui With Qi deficiency: Use [Tao Ren, Hong Hua, Dang Gui, Dan Shen, Chuan Xiong, Chi Shao, Huai Niu Xi, Huang Qi, Dang Shen, Fu Shen, Shan Yao, Ye Jiao Teng, Yuan Zhi] 2
 * Tongue:** Dark red w/ static macules or spots, possibly engorged tortuous sublingual veins
 * Pulse:** Bowstring, choppy
 * Treatment Principles:** Rectify the Qi and resolve depression, quicken the blood and transform stasis
 * Herbal Treatment:** Xue Fu Zu Yu Tang Jia Wei1
 * Modifications:**

Phlegm Fire Stagnating Within, Disturbing Brain Shen 2 Feels very depressed, clouded mind, irritable, easily stimulated and anxious, can have delusions and hallucinations, suspiciousness, busy mind, also red face and eyes, constipated, dark colored urine, chest and abdominal distention, snoring or phlegm sound [Huang Qin, Zhi Zi, Zhi Shi, Sheng Shi Gao, Meng Shi, Chen Pi, Zhu Ru, Pei Lan, Suan Zao Ren, Chuan Xiong, Da Huang] 2
 * Tongue:** red tongue, greasy thick yellow coat
 * Pulse:** wiry, slippery, rapid
 * Acupuncture Treatment:** GV-24, GB-20, LI-4, PC-7, ST-40, LR-3; Bleed: ST-45, LI-1
 * Herbal Treatment:**

Liver Fire Blazing Within Injuring Brain Shen 2 Irritable, easy to anger, delirium, incoherent speech, uncontrolled behavior, delusions and hallucinations, insomnia, more active and goes outside, prefers drinking cold, tinnitus, bitter taste, dry mouth, constipation, dark colored urine [Huang Qin, Zhi Zi, Long Dan Cao, Chuan Xiong, Zhi Ke, Che Qian Zi, Shi Gao, Shi Jue Ming, Long Chi, Mu Li, Da Huang] 2
 * Tongue:** red tongue, yellow coat
 * Pulse:** wiry, strong, rapid
 * Acupuncture Treatment:** PC-7, LI-4, GB-34, LR-3, LR-2; Bleed: LR-1
 * Herbal Treatment:**

Liver Qi and Phlegm Stagnation, Affecting Brain Shen 2 Flattened emotion, depression, decreased activity, stays alone, prefers quiet places, dislikes movement, has retardation and lassitude of lifestyle, delusions, hallucinations, chest and hypochondriac distention, low appetite [Chai Hu, Xiang Fu, Yu Jin, Bai Shao, Chi Shao, Chen Pi, Yuan Zhi, Fo Shou, Chuan Xiong] 2
 * Tongue:** pink tongue, thin white coat
 * Pulse:** wiry, slippery
 * Acupuncture Treatment:** PC-6, HT-7, LI-4, ST-40, LR-3, LR-14, GB-15
 * Herbal Treatment:**

Liver Qi and Phlegm Stagnation, Affecting Brain Shen 2 Flattened emotion, depression, decreased activity, stays alone, prefers quiet places, dislikes movement, has retardation and lassitude of lifestyle, delusions, hallucinations, chest and hypochondriac distention, low appetite [Chai Hu, Xiang Fu, Yu Jin, Bai Shao, Chi Shao, Chen Pi, Yuan Zhi, Fo Shou, Chuan Xiong] 2
 * Tongue:** pink tongue, thin white coat
 * Pulse:** wiry, slippery
 * Acupuncture Treatment:** PC-6, HT-7, LI-4, ST-40, LR-3, LR-14, GB-15
 * Herbal Treatment:**

Liver Qi Overacting Spleen, Brain Shen Losing Nourishment 2 Retardation of lifestyle, flattened emotional activities, timidity, suspiciousness, worries a lot, delusions and hallucinations, sallow complexion, weak body and extremities, low energy, looks exhausted, poor personal hygiene, insomnia, weight loss [Chai Hu, Xiang Fu, Huang Qi, Yu Jin, Bai Shao, Bai He, Dang Shen, Fu Ling, Bai Zhu, Shan Yu Rou, Chuan Xiong, Suan Zao Ren, Shen Qiu, Mai Ya] 2
 * Tongue:** pink tongue, thin white coat
 * Pulse:** wiry, thready, or weak
 * Acupuncture Treatment:** GV-20, Yintang, HT-7, ST-36, SP-3, SP-6, CV-3, CV-12, LR-3
 * Herbal Treatment:**

Liver Blood & Kidney Essence Deficiency Failing to Nourish Brain Shen 2 Poor memory, retardation, slow movement and reaction time, sensitive and suspicious, decreased talking and motivation, delusions and hallucinations, feels brain empty, dry mouth, weak body especially in lower body, numbness of limbs, 5-palm heat, night sweats, menstrual an menopausal problems [Niu Zhen Zi, Han Lian Cao, Tu Si Zi, Dang Gui, Dan Shen, He Shou Wu, Shan Yu Rou, Shu Di Huang, Mu Xiang, Mai Ya] 2
 * Tongue:** red tongue, thin white coat
 * Pulse:** wiry, thready
 * Acupuncture Treatment:** BL-18, BL-20, BL-23, BL-52, SP-6, KI-3, KI-6, GV-4, GV-17, GV-20
 * Herbal Treatment:**

Classical Treatments: 3 Diankuang caused by the one hundred pathologic factors: 13 Ghost Points – Sun Simiao In Dian (Specifically treats dementia of the heart): HT-7, GV-26, PC-5, HT-7 Perverse Dian: GV-26, PC-5 ‘HT-7 eliminates dementia from the heart’ ‘GV-26 Renzhong is the best point for treating dian, there is not even any need for the thirteen gui points’ ‘HT-7 Shenmen treats dian in particular, to better reach it, turn the bone of the hand’ ‘In dian disorders GV-12 Shenzu and GB-13 Benshen are indisensible’