Visceral+Agitation+(Zang+Zao)

Visceral agitation is a paroxysmal mental disease most prevalent in women. The viscus implied by the name is the heart, and the agitation refers to agitation of the blood due to damaged Yin and to the rashness, impetuousity, and impatience that characterize this condition. The Chinese literature usually further says this condition is most common in adolescent females. However, it may also be used to describe severe premenstrual tension, and it is often seen in perimenopausal women. Visceral agitation often begins as melancholy, depression and emotional lability but then progresses to alternating laughing and crying for no reason, sighing for no apparent reason, and vexation and agitation. In severe cases such as postpartum when there has been a great loss of blood and body fluids, there may be convulsions with a white facial complexion and possible complete loss of consciousness.

Relevant Western Diseases: Psychoneurosis, depression, stress reactive types and hormonal psychosis

Differential Diagnosis: Medical Disorders: Effects of Substances: Psychiatric Disorders:
 * 1) CNS disorders, including mass lesions, seizure disorders, etc.
 * 2) History of head trauma
 * 1) Alcohol or illicit substance intoxication or withdrawal
 * 2) Side effects f medications
 * 1) Histrionic Personality Disorder
 * 2) Other Personality Disorders
 * 3) Major Depressive Disorder
 * 4) Bipolar Affective Disorder (BAD)
 * 5) Premenstrual Dysphoric Disorder (PMDD)

TCM Etiology & Pathogenesis: “Visceral agitation is primarily due to lack of construction and nourishment of the heart spirit and harassment of the spirit y some sort of evil heat. Lack of construction and nourishment of the heart is, in turn, mainly due to heart-spleen dual vacuity. Evil heat may be depressive heat, phlegm heat, or vacuity heat. In real-life clinical practice, liver depression is always operative in cases of visceral agitation. It is typically liver depression and spleen vacuity which are the root mechanisms for heart-spleen dual vacuity and for the engenderment of both depressive and phlegm heat. Likewise, it is typically enduring or severe depressive heat which damages and consumes Yin blood which then gives rise to Yin vacuity effulgent fire or Yin vacuity Yang hyperactivity. Because most cases of visceral agitation present with at least four simultaneous disease mechanisms (liver depression, depressive heat, spleen vacuity, and heart blood vacuity), the heat involved in visceral agitation is perhaps best described as a species of Yin fire”1

“In general this disease is caused by stress, overexertion, poor diet, pregnancy and postpartum difficulty, the pre heaven situation is also considered a fundamental factor in this disease. Most commonly Zang Zao is found in females, especially young middle and aged women with emotional disharmony”2

Prognosis: In general the symptoms will be relieved after treatment and almost all patients can recover quickly. However, some patients have relevant pre heaven situations which need Shen treatment; this psychological therapy requires longer2

Diagnosis: Should have A, then refer others
 * 1) Cry easily, depressed and moody
 * 2) Irritable, sensitive and Shen weakness
 * 3) Low energy and tiredness

TCM Pattern Differentiation: Qi and Blood Deficiency Failing to Nourish the Shen 2 Cries frequently and does not talk, or not clear why they feel such sadness, may be crying and laughing improperly, also sensitive and Shen is very weak, moody, upset, depressed, easily angered, low appetite an energy, insomnia [Gan Cao, Fu Xiao Mai, Da Zao] Heart Blood deficiency: + Shu Di Huang, Long Yan Rou Heart Yin deficiency: + Bai Zi Ren, Bai He Heart Qi deficiency: + Ren Shen, Dang Shen Heart Fire: + Sheng Di Huang, Gan Cao Shao Heart Shen sedating: + Zhen Zhu Mu, Ci Shi Heart Spirit Lack of Nourishment 1 Devitalized essence spirit, abstraction, sorrowfulness without apparent cause and abnormal laughing and crying, heart vexation, insomnia, profuse dreams, susceptibility to fright, heart palpitations, lassitude of the spirit During hysterical crisis: Use GV-26, PC-8, KI-1 Pronounced chest oppression: + CV-17 Plum pit Qi: + ST-40, CV-23, HT-5 Heart spirit lack of nourishment: + BL-15, BL-17, SP-6 Abnormal Laughing and weeping: + SI-3 Essence spirit abstraction: +BL-15, BL-47 //Symptoms of Yin & Blood vacuity more pronounced: Gan// Mai Da Zao Tang Jia Wei1 [Suan Zao Ren (12g.), Sheng Di (12g.), Bai He (12g.), Gan Cao (10-15g.), Huai Xiao Mai (15-30g.), Da Zao (5-15 pieces)] //Symptoms of liver depression more pronounced:// Xiao Yao San He Gan Mai Da Zao Tang Jia Wei1 [Chai Hu (6g.), Bo He (3-6g.), Bai Shao (10g.), Dang Gui (10g.), Bai Zhu (10g.), Fu Shen (12g.), Gan Cao (10g.), Huai Xiao Mai (15-30g.), Suan Zao Ren (12-15g.), Ye Jiao Teng (10-15g.), Da Zao (5 piece)] //If complicated by phlegm heat:// Wen Dan Tang He Gan Mai Da Zao Tang Jia Jian1 [Ban Xia (10g.), Fu Ling (10g.), Chen Pi (6g.), Zhi Ke (6g.), Zhu Ru (6-10g.), Gan Cao (6g.), Chai Hu (6-10g.), Bai Shao (10g.), Xiang Fu (10g.), Dan Pi (10g.), Zhi Zi (6g.), Huai Xiao Mai (15-30g.), Da Zao (5 pieces)] //Symptoms of Heart-Spleen dual vacuity more pronounced:// Gui Pi Tang He Gan Mai Da Zao Tang Jia Wei1 [Huang Qi (10-15g.), Dang Shen (10g.), Bai Zhu (10g.), Fu Shen (12g.), Dang Gui (6-10g.), Log Yan Rou (10g.), Mu Xiang (6g.), Yuan Zhi (6-10g.), Suan Zao Ren (12g.), Huai Xiao Mai (15-30g.),Da Zao (5 pieces),Shi Chang Pu (6g.),Gan Cao (10g.)] Plum pit Qi: + Ban Xia, Hou Po Even more pronounced Qi stagnation: + Fo Shou, He Huan Pi Liver depression transformed into heat: + Dan Pi, Zhi Zi, Huang Qin Heart-Liver Fire Effulgence 1 Heart vexation, easy anger, lack of tranquility when sitting or lying down, crying and laughing without constancy, profuse dreams, susceptibility to fright [Zhi Shi Ying (15g.), Long Gu (12g.), Mu Li (12g.), He Huan Pi (12g.), Chai Hu (9g.), Bai Zhu (9g.), Fu Ling (12g.), Dang Gui (9g.), Bai Shao (9g.), Dan Pi (9g.), Shan Zhi (9g.), Gan Cao (6g.)] Severe heart vexation and insomnia: + Ci Shi, Mia Dong, Wu Wei Zi Chest and rib-side distention & oppression w/ dry mouth & bitter taste: +Huang Qin, Sheng Di, Qing Pi Headaches and dizziness: + Shi Hue Ming, Ju Hua, Sang Ye
 * Tongue:** pale tongue, thin white coat
 * Pulse:** weak, thready
 * Acupuncture Treatment:** PC-6, HT-3, HT-7, GV-20, SP-6, KI-9, Yintang
 * Herbal Treatment:** Gan Mai Da Zao Tang Modification2
 * Modifications:**
 * Tongue:** tender and red
 * Pulse:** fine, bowstring
 * Treatment Principles:** Enrich the heart and supplement the spleen, nourish the blood and quiet the spirit
 * Acupuncture Treatment:** GV-26, GV-20, PC-6, HT-7. Even technique
 * Acupuncture Modifications:**
 * Herbal Treatment:**
 * Modifications:**
 * Tongue:** red tongue, thin yellow coat
 * Pulse:** fine, bowstring, rapid
 * Treatment Principles:** Clear the liver and resolve depression, tranquilize the heart and quiet the spirit
 * Acupuncture Treatment:** LR-3, SP-6, GV-16, HT-8. Draining technique
 * Herbal Treatment:** Dan Zhi Xiao Yao San Jia Wei1
 * Modifications:**

Liver-Kidney Insufficiency 1 Heart vexation, irritability, insomnia, heart palpitations, susceptibility to fright, dry mouth, dry stools, 5-palm heat, dizziness, tinnitus, low back and knee soreness and limpness //Yin Vacuity/Vacuity heat:// Bai He Di Tang He Zi Shui Qing Gan Yin1 [Bai He (10g.), Sheng Di (12g.) Shu Di (12g.), Shan Yao (10g.), Shan Zhu Yu (10g.), Dan Pi (6-10g.), Fu Ling (10g.), Zi Xie (6-10g.), Chai Hu (3-6g.), Bai Shao (10g.), Zhi Zi (6-10g.), Suan Zao Ren (12-15g.), Dang Gui (10g.)] //Yin Vacuity and Yang hyperactivity:// Tian Ma Gou Teng Yin He Gan Mai Da Zao Tang Jia Wei1 [Tian Ma (10g.), Gou Teng (10g.), Du Zhong (10g.), Niu Xi (10g.), Shi Jue Ming (12g.), Sheng Di (12g.), Zhi Zi (6-10g.), Huang Qin (10g.), Chai Hu (6-9g.), Fu Shen (12g.), Ye Jiao Teng (10-15g.), Huai Xiao Mai (10-15g.), Gan Cao (6-10g.), Da Za (5 pieces)] //Yin vacuity with phlegm fire:// Wen Dan Tang Jia Wei [Ban Xia (12g.), Fu Ling (9g.), Chen Pi (9g.), Zhi Shi (6g.), Zhu Ru (9g.), Dan Nan Xing (9g.), Ting Ling Zi (9g.), Zhi Mu (9g.), Mai Dong (12g.), Ye Jiao Teng (12g.), Gan Cao (6g.), Da Zao (5 pieces)] Severe agitation: + KI-1 Pronounced liver depression: + LR-3, TW-6 Liver depression transforming into fire: + LR-2, GB-43 Chest oppression: + CV-17 Accompanying phlegm or Plum pit Qi: +ST-40 Accompanying Blood stasis: + SP-10
 * Tongue:** red tongue, scanty possibly dry, possibly yellow coat
 * Pulse:** fine, bowstring, rapid or surging, rapid
 * Treatment Principles:** Enrich the kidneys and clear the liver, nourish the heart and quiet the spirit
 * Acupuncture Treatment:** GV-26, GV-20, HT-7, PC-6, KI-3, SP-6, CV-4. Even technique
 * Herbal Treatment:**
 * Modifications:**