הפרעות פניקה וחרדה

מהם הסינדרומים עפ"י הרפואה הסינית שגורמים להפרעות פאניקה וחרדה ? מהוא הטיפול המוממלץ עפ"י הרפואה הסינית , איזה נקודות ? איזה צמחים ?

היי שירה שני מאמרים שווים: THE TREATMENT OF PSYCH-EMOTIONAL DISTURBANCE BY ACUPUNCTURE WITH PARTICULAR REFERENCE TO THE DU MAI by Peter Deadman and Mazin Al-Khafaji Most acupuncturists will have had the experience of treating disorders such as insomnia, epilepsy, manic episodes, depression etc. using points such as Baihui DU-20, Renzhong DU-26, Wangu GB-12, Shenmai BL-62 etc. As the saying goes, however, "That's all very well in practice, but will it work in theory". This short article, therefore, is mainly concerned with the apparent paradox between the Heart-shen and brain-shen traditions in Chinese medicine. It came about as a result of attempting to understand the many psycho-emotional indications found in traditional texts for points of the Du Mai and Bladder channels. This curiosity, prompted me to write to various people whom I consider to have a greater depth of understanding and knowledge of Chinese classics and traditions than myself. Of these, Heiner Fruehauf (of the Institute for Traditional Medicine in Portland, Oregon) in particular, responded with a profound overview of the relationship between different traditions within Chinese medicine history and a number of translated quotations from Daoist classics and other historical sources. Unable to read Chinese myself, I am especially indebted to his contribution. Giovanni Maciocia also responded with many useful quotations and an emphasis on the inter-relationship between the Kidneys, jing, brain, Du Mai, Heart and shen. This article, which is intended mainly to draw attention to this subject and promote discussion, is principally therefore a combination of these contributions with the work carried out by Mazin Al-Khafaji and myself in preparing the forthcoming Manual of Acupuncture . A careful examination of the indications of the acupuncture points listed in various classical and modern texts reveals that a considerable number of them have been used for the treatment of psycho-emotional disorders. There are important points on every channel, but certain generalisations may be made that are helpful in the selection of suitable points for treatment. 1. Points from the Heart and Pericardium channels are of primary importance since they are directly able to treat the Heart and shen. For example: • Tongli HE-5: groaning and sadness, fear of people, restless zang disorder1, pain and agitation of the Heart, sadness and fright, depressive disorder2, frequent yawning, fright palpitation, pounding of the heart. • Shenmen HE-7: Palpitations, fright palpitations, pounding of the heart, insomnia, restless zang disorder, frequent talking during sleep, poor memory, mania-depression disorder3, epilepsy, dementia, desire to laugh, mad laughter, insulting people, sighing, sadness, fear and fright, disorientation, Heart agitation, loss of voice. • Shaofu HE-8: Sadness and worry with diminished qi, fearfulness, fear of people, excessive sighing, plumstone throat, epilepsy. • Shaochong HE-9: Palpitations, pounding of the heart, mania-depression disorder, epilepsy, fright epilepsy, excessive sighing, susceptibility to anger, fright and sadness with diminished qi, febrile disease with agitation and restlessness. • Ximen P-4: Agitated Heart, insomnia, melancholy, sadness and fear, fear of people, insufficiency of the shen qi, epilepsy. • Jianshi P-5: sudden palpitations, oppression of the chest, apprehensive, susceptibility to fright, sudden fright disorder in children4, epilepsy, mania, sudden mania, manic raving, agitation and restlessness, absent-mindedness, poor memory, loss of voice, ghost evil. • Neiguan P-6: insomnia, epilepsy, mania, poor memory, fear and fright, loss of wisdom, loss of will, loss of memory following windstroke. • Laogong P-8: epilepsy, mania-depression disorder, fright, sadness, apprehensiveness, susceptibility to anger, restless zang disorder, ceaseless laughter at other's misfortune. 2. Some points of the Small Intestine channel, for example Zhizheng SI-7 (mania-depression disorder, fear and fright, sadness and anxiety, restless zang disorder), also treat disorders of the shen due to the Small Intestine's paired relationship with the Heart. Zhizheng SI-7 is the luo-connecting point of the Small Intestine channel, joining with the Heart channel. This is reflected in its name 'Branch of the Upright', the 'upright' being the Heart channel. The Guide to the Classics of Acupuncture states "the luo-connecting points are located between two channels ... if they are punctured, symptoms of the exteriorly-interiorly related channels can be treated". Zhizheng SI-7 has a pronounced effect on regulating and calming the Shen. The Methods of Acupuncture and Moxibustion from the Golden Mirror of Medicine, more specifically recommends Zhizheng SI-7 for "depression and knotting of all the seven emotions". 3. Points from yangming channel are strongly indicated, especially in the treatment of shi-type disorders such as mania and mania-depression disorder. This may be explained by four factors: i. points of the Stomach channel, for example Fenglong ST-40, are important to resolve phlegm - an important aetiological factor in such disorders, ii. points of the Large Intestine channel are important to clear heat from the body, and it is the combination of phlegm and heat that underlies the most severe manifestations of psycho-emotional disorders; iii. the Stomach Divergent channel enters the Heart, iv. harmonious digestion is considered a precondition for a peaceful shen, and thus the Ling Shu*(Chapter 30) states "When the Stomach and Intestines are co-ordinated the five yin organs are peaceful, blood is harmonised and mental activity is stable. The Mind derives from the refined essence of water and food"5. These factors help to explain the following indications: • Yangxi L.I.-5: mania-depression disorder, febrile disease with agitated Heart, manic raving, propensity to laughter, sees ghosts, fright. • Taiyi ST-23: mania-depression disorder, agitation, tongue thrusting, manic walking. • Fenglong ST-40: mania-depression disorder, mad laughter, great happiness, desire to climb to high places and sing, desire to undress and run around, restlessness, sees ghosts, indolence, epilepsy. • Jiexi ST-41: epilepsy, spasm, mania, agitation, sadness and weeping, fright palpitations, Stomach heat with raving, sees ghosts. • Chongyang ST-42: mania-depression disorder, desire to ascend to high places and sing, desire to undress and run around. • Lidui ST-45: excessive dreaming, easily frightened with desire to sleep, insomnia, dizziness, mania-depression disorder, desire to ascend to high places and sing, desire to undress and run around. The Spleen channel connects with the Heart zang and its healthy yun hua function both provides the basis for proper nourishment of the Heart by blood, and ensures proper transportation and transformation of body fluids, thus preventing the formation of phlegm (an important aetiological factor in psycho-emotional disorders) and treating it once arisen. In the case of Gongsun SP-4, two additional factors are notable: i. it is the confluent point of the Chong Mai, which spreads in the chest, and ii. it is the luo-connecting point of the Spleen channel, and it is a unique characteristic of the luo-connecting points of the yin channels (Lieque LU-7, Tongli HE-5, Dazhong KID-4, Neiguan P-6 and Ligou LIV-5) that they have important effects on psycho-emotional disorders. • Yinbai SP-1: agitation, sighing, susceptibility to melancholy, mania-depression disorder, excessive dreaming, insomnia, chronic fright wind, corpse collapse. • Gongsun SP-4: mania-depression disorder, manic talking with much drinking, insomnia and restlessness, Heart pain, Gall Bladder deficiency, much sighing. • Shangqiu SP-5: mania-depression disorder, agitation with thirst, excessive thinking, propensity to laughter, nightmares, melancholy Heart, chronic, childhood fright wind, childhood fright epilepsy. • Sanyinjiao SP-6: palpitations, insomnia, Gall Bladder deficiency. • Daheng SP-15: susceptibility to sadness, sighing. Certain points from the Lung channel are indicated, either because of their effect on the po/corporeal soul (e.g. Tianfu LU-3), or because their influence on the zong/gathering qi helps resolve blood stasis and consequent malnourishment of the Heart and shen (e.g. Taiyuan LU-9). • Tianfu LU-3: somnolence, insomnia, sadness, weeping, absent-minded and forgetful, floating corpse ghost-talk6, melancholy crying ghost talk. • Taiyuan LU-9: agitation with Heart pain accompanied by choppy pulse, manic raving. Points from the Kidney channel are indicated for their ability to nourish yin and harmonise and cool Heart fire (e.g. Taixi KID-3 and Zhaohai KID-6), to root upward rebellion of fire, yang and wind (e.g. Yongquan KID-1) or to treat the zhi/will power (e.g. Dazhong KID-4). For example: • Yongquan KID-1: agitation, insomnia, poor memory, inability to speak, susceptibility to fear, anger with desire to kill people, mania-depression disorder, loss of voice. • Taixi KID-3: insomnia, excessive dreaming, poor memory. • Dazhong KID-4: palpitations, agitation, mental idiocy, somnolence, tendency to anger, fear and fright, susceptibility to fear, desire to close the door and remain at home. • Zhaohai KID-6: insomnia, somnolence, night-time epilepsy, sadness, fright, nightmares. Points of the Gall Bladder and Liver channels are indicated for psycho-emotional disorders characterised by stagnation of qi and its subsequent transformation into heat which may rise to disturb the Heart, and for disorders of the hun/ethereal soul (e.g. insomnia and fear). It is interesting, however, to note that a point such as Taichong LIV-3 which is much used in modern practice for treating disorders such as depression, irritability, frustration etc. has surprisingly few indications of this sort in either traditional or modern texts. • Zhejin GB-23: sighing and tendency to sadness, insomnia, heat in the lower abdomen. • Riyue GB-24: sighing and tendency to sadness, heat in the lower abdomen. • Zuqiaoyin GB-44: nightmares, insomnia, agitation and restlessness, agitation and heat of the hands and feet. • Xingjian LIV-2: tendency to anger, sadness, susceptibility to fright, madness, insomnia, palpitations, epilepsy. • Ligou LIV-5: plumstone throat, depression, much belching, fright palpitations, fear and fright. • Zhangmen LIV-13: agitation and heat with a dry mouth, tendency to anger, susceptibility to fear, insomnia, manic walking, epilepsy, depression with inability to take a satisfactory breath. The back-shu7 and front-mu points, as well as certain points of the Du Mai, are indicated in the treatment of various psycho-emotional disorders, principally due to their action on their corresponding zang or fu, for example: • Xinshu BL-15: poor memory, anxiety, weeping with grief, insomnia, excessive dreaming, not speaking for years, heart xu frightened and watchful (cautious), delayed speech development, mania-depression disorder, epilepsy, dementia, mad walking, anxious and depressed sensation in the chest with inability to take a satisfactory breath. • Ganshu BL-18: much anger, mania-depression disorder, epilepsy. • Danshu BL-19: fright palpitations with unsound sleep, insomnia. • Gaohuangshu BL-43: poor memory, palpitations, insomnia, phlegm-fire mania. • Jinsuo DU-8: anger injures the Liver, mania, mad walking, much talking, epilepsy, fright epilepsy. • Shendao DU-11: sadness and anxiety with poor memory, fright palpitations, absent-mindedness, timidity with shortness of breath, apprehensiveness, epilepsy. • Shenzhu DU-12: mad walking, delirious raving, sees ghosts, rage with desire to kill people. • Juque REN-14: fright palpitations, poor memory, mania, mania-depression disorder, aversion to fire, tendency to curse and scold others, ranting and raving, anger, epilepsy with foamy vomiting. • Jiuwei REN-15: the five kinds of epilepsy, mania, mad walking, mad singing, dislikes hearing the sound of voices. In addition to the points listed above, whose indications can be explained by their action on qi, blood, phlegm, shen, hun, po and zhi, there is another group of points which demand a quite different explanation. These are points on (or affecting) channels which enter the brain i.e. points of the Du Mai and Bladder channels, and points located on the head and neck. For example: • Houxi SI-3: epilepsy, mania-depression disorder. • Tianzhu BL-10: mania, ceaseless talking, sees ghosts, epilepsy, childhood epilepsy. • Shenmai BL-62: mania-depression disorder, palpitations, insomnia. • Yuzhen BL-9: madness, manic walking, epilepsy. • Wangu GB-12: epilepsy, mania, mental agitation, insomnia. • Changqiang DU-1: mania, fright epilepsy, mad walking. • Fengfu DU-16: mania, ceaseless talking, mad walking and desire to commit suicide, sadness and fear with fright palpitations. • Baihui DU-20: fright palpitations, poor memory, lack of mental vigour, inability to choose words, absent-mindedness, much crying, sadness and crying with desire to die, wind epilepsy, mania. • Shenting DU-24: mania-depression disorder, ascends to high places and sings, discards clothing and runs around, mimics other people's speech, fright palpitations, insomnia, loss of consciousness, tongue thrusting8. • Renzhong DU-26: mania-depression disorder, epilepsy, inappropriate laughter, unexpected laughter and crying, speaking without awareness of a person's high or low status, ghost attack. There is indeed an apparent contradiction here within Chinese medicine theory. The concept that the shen is stored in the Heart is of course an axiom of Chinese medicine theory and is attested to in various classics, for example the Ling Shu : "The Heart controls the vessels; the vessels are the residence of the shen 9". "When the blood and qi are already in harmony, the ying and wei already communicating, the five zang already formed, the shen will reside in the Heart10. "The Heart is the great master of the five zang and six fu and the residence of the jing shen11", and the Su Wen "The Heart stores the shen12". At the same time, there are many classical references to the concept of the shen being stored in the head and brain, for example the Su Wen "the head is the residence of the intelligence13", the Xiuzhen Shishu "The brain is the ancestor of the body's form and the meeting place of the 100 shen14"; the Neijing (not Inner Canon but Daoist Internal Mirror)15 "The brain is the ancestral portal of the body, the capital where the 10,000 shen meet"; Sun Si Miao, in the 1000 Ducats "The head is the supreme leader, the place where man's shen concentrates"; Li Shi Zhen "The brain is the residence of the original shen"; the Ben Cao Bei Yao 16 "All of a person's memory resides in the brain". Three main factors may help to illuminate this theoretical difficulty, i. different traditions within Chinese medicine, ii. the influence of modern medicine, and iii. the inter-relationship of the Heart, blood, jing, brain and shen. Different traditions Both before and after the appearance of the Neijing, different traditions are apparent within the broad fields of Chinese medicine, spiritual practice and health preservation. In pre-Neijing times, a more structural perception of the human body placed the brain as the main organ in charge of mental activity17. From the Neijing onwards, when the study of medicine diverged and grew more independent of its Daoist roots, a more functional view of the body developed, based on the predominance of the five zang and six fu and their correspondences (especially five phase correspondences), the brain being 'relegated' to the status of an extra fu, and the Heart becoming the sovereign of the body and the residence of the shen. This divergence is reflected in the Neijing which says "I understand that there are some Daoists who have a completely different understanding of the nature of a zang and a fu. Some say the brain and the marrow are zang ... whereas others think of them as fu. If presented with a view other than their own, they insist that only their own interpretation is right18". Later esoteric Daoist texts strongly influenced certain great doctors of the Tang, Yuan and Ming dynasties such as Sun Simiao, Zhang Jingyue and Li Shizhen19, and their understanding of the role of the brain, and the principal acupuncture channel which influences it, the Du Mai, again entered the corpus of Chinese medicine theory. At the same time, none of these doctors challenged the theory of the Heart-shen as being essentially contradictory to the brain-shen theory. The influence of modern medicine During the Qing dynasty and the Republican era, knowledge of Western anatomy began to infiltrate China. One author who is considered to have been influenced by these developments was Wang Qingren20 who in the chapter 'On the Brain' (in Correcting the Errors of Medicine 1830) stated "intelligence and memory rely on the brain". Wang's book was published and distributed along with A New Treatise on Anatomy, a translation of basic Western medicine texts by an English medical missionary Benjamin Hobson and his assistant Chen Xiutang. The inter-relationship of the Heart, Kidneys, Jing, brain and Shen. All aspects of the human organism derive from the coming together of the jing of the parents. The Ling Shu says "Life comes about through the jing; when the two jing (of mother and father) unite, they form the shen21", and Zhang Jie Bin says "The two jing, one yin and one yang, unite ... to form life; the jing of mother and father unite to form the shen22". In other words the pre-natal jing, derived from the parents, is the origin of the existence of the human being and the original source of the shen. As far as zangfu theory is concerned, it is the Kidneys which store jing, and at the same time produce marrow and fill up the brain. Thus the Ling Shu states "The brain is the Sea of Marrow23". This is the meaning, therefore, of the statements by Li Shizhen "The brain is the residence of the original shen", and Yangxing Yanming Lu "Shen, that is jing. If we can preserve jing, then the shen will be bright; if shen is bright, there will be long life24". Other authors have stressed the relationship between the brain and the Heart, which is another reflection of the vital relationship between the Heart and Kidneys, fire and water. The Leizheng Zhizai25 says "The shen of the human being resides in the Heart, and the Heart's jing relies entirely on the Kidney. Thus, the brain is the store house of the original shen, the sea of jing marrow, and this is where memory comes from" , and the Daoist classic Ling Jian Zi26 stated "The Qi of the Heart is connected with the Niwan Palace above". 'Niwan' ('Sticky Pellet' or 'Mud Ball Palace'), is also known as 'Huangting' (The Yellow Palace). The Niwan in the Daoist tradition is the central one of the nine palaces of the brain where all the various shen meet, and is considered to be the location of the material basis of the shen. Niwan is discussed in various Daoist classics, for example "The origin of jing-shen in the brain is also called Niwan27"; "The entire shen that expresses in the face has its origin in Niwan"27, and "At the top of the human body, there is Tiangu Niwan, this is the where the shen is stored ... Tiangu, that is the Original Palace, the residence of the Original Shen, where mental and spiritual brightness exists, the most important aspect of Shen" 28. It is the extraordinary channel, the Du Mai, which serves as the link between the Kidneys, Heart and brain. Four pathways are described for this channel. Its first originates in the lower abdomen, emerges at the perineum, runs posteriorly along the midline of the sacrum and the interior of the spinal column to Fengfu DU-16 at the nape of the neck, enters the brain, ascends to the vertex descends along the midline of the head to the bridge of the nose and the philtrum and terminates at the junction of the upper lip and the gum. Its second pathway originates in the lower abdomen, descends to the perineum, winds around the anus, ascends the interior of the spinal column and enters the Kidneys. Its third pathway originates in the lower abdomen, ascends to the middle of the umbilicus, passes through the Heart, ascends to the throat, winds around the mouth and ascends to below the middle of the eye. Its fourth pathway emerges at Jingming BL-1, follows the Bladder channel bilaterally along the forehead, the bilateral branches converge at the vertex and enter the brain, the single channel emerges at Fengfu DU-16 and divides again, descending through Dazhu BL-11 and Fengmen BL-12 along either side of the spine to the Kidneys. This linkage of the Heart and brain was referred to by Cheng Xing Gan who said "When Marrow is full, thinking is clear. Too much thinking leads to Heart fire which burns the brain ... the Marrow is rooted in the jing and connects downwards with the Du Mai; when the ming men warms and nourishes, the marrow is full". In conclusion, therefore, the Du Mai is the channel that mediates between the brain and the Heart. Clinically many of its points may be used to treat a variety of psycho-emotional disorders, in much the same way that points of the twelve principal channels may be used, especially those of the Heart and Pericardium. If we try and be more precise about the use of the Du Mai points, we can suggest that a) their indications generally reflect shi patters of Shen disharmony such as mania-depression disorder, and b) they are especially indicated when psycho-emotional disorders are accompanied by fullness and discomfort of the head, dizziness, disturbance of consciousness and epilepsy. COMMONLY USED CHINESE HERB FORMULAS FOR THE TREATMENT OF MENTAL DISORDERS by Heiner Fruehauf The concept of an inseparable bodymind continuum is one of the main characteristics of Eastern thought. In classical Chinese medicine, therefore, mental activity has always been considered to be inseparable from bodily functions, and mental diseases were generally not treated differently from any other disorder. The Chinese term 'yuzheng' (depression), for instance, refers to stagnation on both a physical and mental plane, and is usually addressed with the same diagnostic and therapeutic means as diseases that would be considered to have entirely physical origins in the West. It is perhaps this absence of a body/mind dichotomy that is at the core of Chinese medical theory and practice. As described in the classic sources of Chinese scientific thought, such as the Yijing (Book of Change ), the Daodejing, or the Neijing (Inner Canon of the Yellow Emperor), ancient Chinese observers of life always postulated the existence of a primordial One. From this prenatal entity, they thought, emerged two polar aspects which interact in a process of constant flux. This concept that all differentiation originates from a single source is one of the main messages of the Daodejing, the Taoist text which first coined the classic statement: "The Dao produced the One, the One produced the Two, the Two produced the Three, and the Three produced the Myriad Things." Every thing and every phenomenon, according to Chinese medical theory, can be analysed with this one-two-three-many grid of categorisation. In the one space time continuum we live in, for instance, there are the two dominant celestial bodies sun and moon, surrounded by myriads of other stars; there is humankind as a whole, differentiated into male and female; and there is the individual human being, consisting of material form (body) and immaterial qi which in its highest form is called 'shen' - the conscious mind. Although most scholars and practitioners of Chinese Medicine agree that the body (xing) and the mind (shen) are interdependent entities, there has been much discussion about the concrete nature of this relationship. In the People's Republic of China, discussions of this nature are often influenced by political considerations. Most mainland scholars, acutely aware of the Marxist agenda of their superiors, usually draw a distinct line between religious 'idealists' and scientific 'materialists' when it comes to body/mind related topics. Xunzi, the ancient philosopher who had said that "when there is a body, there can be a mind," has been hailed in contemporary books as a model of "materialist and thus scientific" thinking1. This increasing emphasis on the structural aspects of the body, however, goes back much further than the establishment of the People's Republic of China in 1949. If we take a look at Chinese medical history, it becomes evident that a gradual shift from the immaterial yang aspects to the structural yin aspects of diagnosis and treatment has been taking place throughout the last two millennia. In the original source texts of Chinese medicine, represented by the Book of Change, the Daodejing, and the Inner Canon, yin and yang are depicted as equal forces, yet the rising yang stands out as the conceptual landmark from which the various phases of the cyclical process of transformation are assessed. According to the Inner Canon, for instance, the energetic network that is referred to as the Heart governs the activities of all other organs: "The Heart is the ruler of all the other organ systems, and it is here that the power of the conscious mind is created. If the ruler is bright, there will be peace below ... If the ruler is dim, however, the twelve organ systems will enter a state of crisis, resulting in channel obstruction and severe injury to the physical body.2". Following the formative period of Chinese medicine, a gradual yet obvious shift of attention toward the structural (yin jing) aspects of the body occurred. Diagnostic procedure, for instance, changed from sensing the shen, i.e. the energetic glow of the face and eyes (Inner Canon, c. 200 B.C.) to the more hands-on yet still qi oriented method of pulse palpitation (Shanghan Lun, c. 200 A.D.), to a primarily structurally oriented system where tongue shape and colour (18-19th century) or X-ray pictures (PRC) are the main means of diagnosis. The same is true for the therapeutic realm where the ancient and entirely qi based modalities of qigong and acupuncture were gradually replaced by herbal medicine, a system that is based on the administration of material substances. Within the developing field of herbal medicine moreover, the early emphasis on yang herbs such as Rou Gui (Cortex Cinnamomi Cassiae) and Fu Zi (Radix Aconiti Carmichaeli Praeparatae) gave way to a growing preference for yin herbs such as Di Huang (Radix Rehmanniae Glutinosae), or dense jing tonics derived from animal materials. But no matter what school of thought they adhere to, scholars of Chinese medicine usually agree that the mental and physical aspects of the human body are engaged in a process of constant movement and transformation. Any physical process is believed to have mental implications and vice versa. The connecting entity is qi, which can be differentiated into physical and mental qi only academically. In general, mental energy (shen qi) is simply regarded as a more refined form of physical energy (jing qi). Traditional treatment principles for mental diseases, therefore, do not fall outside the realm of standard diagnostic and therapeutic procedure. Even in contemporary China, mental patients usually visit doctors who specialise in "internal medicine," that is the treatment of organ disorders with Chinese herbs, minerals, and animal materials. The therapeutic focus tends to be on the restoration of uninhibited qi flow, since unbalanced emotions first affect the qi before they influence the physical structure of the body. Since chronic qi stagnation eventually results in the formation of structural pathologies such as blood stasis or phlegm coagulation, the modalities of blood moving and phlegm purging are standard methods to treat the more chronic types of mental disorders. In addition, Chinese physicians often address various types of deficiencies. The following is a brief overview of traditional and contemporary approaches to the most common mental disorders. DEPRESSION In classic Chinese medical texts, depression is labelled yuzheng (depression syndrome) and refers to a wide array of symptoms which are usually attributed to stagnant qi. Unhappy emotions are generally believed to be the prime cause for stagnant qi. This psychosomatic aspect of qi has been emphasised in sources that go back at least as far as the Inner Canon, which pioneered the classic statement "In a patient full of grief and sadness, the qi becomes depressed and does not move"3. Later on, the 7th century medical compendium, Zhubing Yuanhou Lun (A Discussion of the Symptoms and Origins of Disease), devoted an entire subchapter to the pathogenesis and treatment of 'knotted qi', explaining that "the knotted qi disease is caused by grief and worry."4 The term 'yu' describes symptoms of mental depression and maybe the beginning stages of physical manifestation, such as discomfort in the sides of the body or the sensation of a lump in the throat. At a more advanced stage, it can incorporate severe symptoms of phlegm and blood stagnation such as tumours or other types of accumulations which have formed due to a chronic state of imbalance. Since the traditional Chinese concept of health is closely tied to the presence of an uninterrupted energy flow, depression - the manifestation of obstructed or 'depressed' qi flow - has always been taken very seriously by Chinese physicians. Several influential medical scholars even asserted that all disease has its origin in the depression of the mental and physical flow continuum. The Song dynasty physician Chen Yan, in his landmark work, Sanyin Ji Yi Bing Zheng Fang Lun (Discussion of Illnesses, Patterns, and Formulas Related to the Unification of the Three Aetiologies), first singled out the depression of the seven emotional affects (joy, anger, anxiety, worry, grief, apprehension, and fright) as a major aspect of clinical pathology. This theory culminated in the formation of an entire school of medical thought, represented by the six depression approach (depression of qi, blood, dampness, phlegm, fire, and food) authored by the 15th century physician Zhu Danxi. Zhu created the influential statement "If qi and blood exist in abundance and harmony, a person will not get sick. Once there is depression, all kinds of diseases will start to evolve. Therefore, all of the body's diseases are caused by depression."5 From this rich tapestry of medical thought and clinical experience evolved a prolific reservoir of herbal formulas that are frequently used in the treatment of depression. Not surprisingly, most of these formulas regulate various aspects of the Liver network. The Liver is in charge of the harmonious distribution of qi - the flow organ of the human body/mind complex; as the Chinese pictogram for Liver indicates (gan*character will be inserted: straight), it strives to spread upward and outward and resents being suppressed. The Liver channel, moreover, runs deep through the sexual organs, and another area associated with the realm of the subconscious - dream activity - is generally attributed to the Liver network. All of these factors indicate the close conceptual affinity of the Liver system to the hidden realm that Western culture accesses through psychotherapy. "All depression," the 18th century primer Zabing Yuanliu Xizhu (Wondrous Lantern Peering into the Origin and Development of Miscellaneous Diseases) thus declares, "can be classified as a Liver disease. The origin of this disorder is excessive worrying."6 'Yu' (depression), in other words, is a general term for diseases that have originally been caused by emotional problems. It is primarily a qi disorder, and is generally treated as such. After a long time, however, 'qi depression' may cause a) blood stasis, b) fire depression, c) damp depression, d) phlegm depression, or e) various levels of deficiency. Treatment strategies for chronic depression thus may have to take these components into account. Here are some of the most common traditional formulas which are still frequently used for the treatment of depression in contemporary Chinese hospitals and clinics: Xiao Chai Hu Tang (Minor Bupleurum Decoction): relieves shaoyang, harmonises the surface and the interior, realigns the Liver and Spleen. Typical symptoms include a bitter or metallic taste in the mouth, dry throat, blurred vision, restlessness, poor appetite, alternating hot and cold sensations, intercostal or subcostal distress, nausea, and a fine and wiry pulse. Da Chai Hu Tang (Major Bupleurum Decoction): harmonises shaoyang, purges internal heat accumulation. Typical symptoms include a sensation of alternating cold and heat, lateral chest pain, a bitter or metallic taste in the mouth, nausea, subcostal fullness and pain, constipation, restlessness, a greasy yellow tongue coating, and a deep and wiry pulse. Si Ni San (Frigid Extremities Powder): realigns the Liver and Spleen. Typical symptoms include distention, pain, or a stuck feeling in the Stomach, lower abdominal, or intercostal regions; a mild coldness of the hands and feet when getting nervous or stressed, constipation or a sensation of unsatisfactory bowel movement or diarrhoea accompanied by tenesmus, dry or swollen eyes, and a slippery Liver/Gallbladder pulse. Xiao Yao San (Rambling Powder): soothes the Liver and relieves stagnation, strengthens the Spleen and nourishes blood. Typical symptoms include poor or irregular appetite, intercostal distress, menstrual pain and/or pre-menstrual breast distention, sensation of fullness in the epigastric region, general fatigue, a flushed face, and a fine and wiry pulse. Ban Xia Hou Po Tang (Pinellia and Magnolia Bark Decoction): disperses stagnant qi and accumulation, dissolves phlegm, restores the downward movement of Stomach qi. Typical symptoms include plumpit syndrome (a subjective feeling of something being stuck in the throat) or a dry itching or piercing pain in the throat, a stuffy feeling in the chest and epigastric region, digestive symptoms (nausea, belching, poor appetite, gurgling sounds in the epigastric region); secondary symptoms may include localised swelling, insomnia, or coughing. Yue Ju Wan (Escape Restraint Pill): moves qi and resolves depression of qi, blood, phlegm, fire, damp, or food. Typical symptoms include stuffiness in the chest and diaphragm regions, intercostal distress, distention or pain in the epigastric or abdominal regions, acid belching, poor appetite, irregular bowel movements, a wiry and slippery pulse, and possibly nausea or vomiting. Gan Cao Xiao Mai Da Zao Tang (Licorice, Wheat, and Jujube Decoction): nourishes the Heart and quietens the spirit, relaxes tension and harmonises the Stomach. Typical symptoms include frequent crying, hysterical behaviour, loss of self-control, unfocused mind, overly self-conscious behaviour. Secondary symptoms may include tight abdominal muscles, insomnia or restless sleep, frequent yawning, and forgetfulness. Bai He Di Huang Tang (Lily and Rehmannia Decoction) or Bai He Zhi Mu Tang (Lily Combination): clears yin deficiency heat in the Heart and Lung, boosts qi, and quietens the spirit. Typical symptoms include an unusually wide variety of subjective symptoms, unstable emotions, poor focus, unclear goals, unclear sensation of temperature ("sometimes I am too hot, but then again, sometimes I really feel more cold"), dizziness, a metallic taste in the mouth, red tongue, yellow urine, and a rapid pulse. At the Institute for National Medicine and Pharmacology in Heilongjiang Province, Dr. Ma Longqi used a combination of the traditional shaoyang formulas Xiao Chai Hu Tang (Minor Bupleurum Decoction), Da Chai Hu Tang (Major Bupleurum Decoction) and Chai Hu Jia Long Gu Mu Li Tang (Bupleurum plus Dragon Bone and Oyster Shell Decoction), to treat 307 patients who had been officially diagnosed as suffering from 'neurasthenia', a term that is frequently used in China to describe depression. The formula he used, Ningshen Lingfang (Calm the Spirit Magic Formula) consisted of Chai Hu (Radix Bupleuri) 20g, Huang Qin (Radix Scutellariae Baicalensis) 15g, Ban Xia (Rhizoma Pinelliae Ternatae) 15g, Long Gu (Os Draconis) 20g, Mu Li (Concha Ostreae) 20g, Da Huang (Rhizoma Rhei) 7.5g, Gan Cao (Radix Glycyrrhizae Uralensis) 10g, and Gui Zhi (Ramulus Cinnamomi Cassiae) 15g. The formula was decocted, spray dried, and administered in granulated form. At the end of the study a general effectiveness rate of 96.7% was reported, with a markedly improved rate of 56%7. MENTAL DISEASE In Western clinical practice, the diagnosis and treatment of mental disease tends to be highly differentiated. Chinese physicians, however, have often discussed the various manifestations of mental disease under the same heading. Nonetheless, treatment strategies are complex, mostly consisting of the three aggressive methods of purging, flushing phlegm, and moving blood. Due to the obvious discrepancy between the modern and the traditional assessment of mental disease, contemporary Chinese researchers appear to be divided about the best way of conducting scientific clinical trials in this field. Some have opted to set up their trials according to Western diagnosis, accepting only cases that have been officially diagnosed as suffering from obsessional neurosis, or psychogenic psychosis, or schizophrenia. Others have opted to conduct their clinical studies according to their own clinical experience, using a single "mental formula" for all kinds of disorders, including depression or schizophrenia which are discussed elsewhere in this article. The following case studies all focus on the generic approach to mental disease. Wen Dan Tang (Warm the Gallbladder Decoction): rectifies qi flow and dissolves heat phlegm, clears the Gallbladder and harmonises the Stomach. Typical symptoms include stubborn insomnia, vivid dreaming, occasional palpitations, restlessness, stuffy feeling in the chest, bitter taste in the mouth, dizziness, a yellow and sticky tongue coating, and a slippery pulse. This is one of the representative formulas for heat phlegm. Since mental diseases are often diagnosed as phlegm obstructing the orifice of the Heart, it has evolved into one of the prime remedies for the treatment of mental and psycho neurotic diseases. In an early study, the formula was prescribed to 149 cases diagnosed with "mental disease;" 117 were reported cured, 2 markedly improved, 24 improved, and 6 showed no results8. In a more recent study, Wen Dan Tang was administered to 132 patients suffering from neurasthenia, menopausal syndrome, schizophrenia, or other mental disorders; at the end of the study, 41 were declared cured, 74 improved, while 17 showed no results. The overall effectiveness rate was assessed at 87%9. Chai Hu Jia Long Gu Mu Li Tang (Bupleurum plus Dragon Bone and Oyster Shell Decoction): courses the Liver and relieves depression, clears heat and purges fire. Typical symptoms include a stuffy feeling in the chest, a heavy and sinking feeling in the body, depression, insomnia, utterance of non-sensical gibberish, inhibited urination and digestive disturbances. This is a famous 'mental' formula which is particularly popular in Japan. In a relatively recent study, it was given to 35 cases with depression; 15 were reported cured, 10 markedly improved, 9 improved, and 1 showed no result10. In another study, the formula was prescribed to 54 cases with depression, and 36 cases with epilepsy; of the depressed patients, 32 were reported cured, 19 improved, and 3 showed no results; of the epileptic patients, 18 were declared cured, 11 improved, and 7 without results11. In a much earlier trial, the formula was combined with Diankuang Mengxing Tang (Awaken from the Dream of Mania Decoction) and administered to 40 schizophrenia patients; 10 were reported cured, 10 improved, and 20 showed no improvement12. Jieyu San (Relieve Depression Powder): This is a modern formula containing Chen Pi (Pericarpium Citri Reticulatae), Ban Xia (Rhizoma Pinelliae Ternatae), Zhi Qiao (Fructus Citri seu Ponciri), Zhu Ru (Caulis Bambusae in Taeniis), Zhi Zi (Fructus Gardeniae Jasminoidis), Hong Hua (Flos Carthami Tinctorii), Xiang Fu (Rhizoma Cyperi Rotundi), Shi Chang Pu (Rhizoma Acori Graminei), Shan Zha (Fructus Crataegi), Cang Zhu (Rhizoma Atractylodis), Sha Ren (Fructus seu Semen Amomi), Su He Xiang (Styrax), and Peng Sha (Borax). Ingredients are ground into a fine powder, and put into capsules containing 0.45g of herbal powder; patients are usually advised to take 4-8 capsules twice daily. This formula is primarily designed to treat the (excess) stasis aspect that is often present in mental disorders. It is said to be applicable for all kinds of mental diseases, including psycho neurosis, depression, schizophrenia, anxiety neurosis, psychogenic psychosis, obsessional neurosis, etc. In an experimental case study with 50 patients suffering from a variety of mental disorders, 16 were reported cured, 27 markedly improved, 6 improved, and 1 showed no result13 . Xiao Yao San (Rambling Powder) [see above]: This formula is one of the most frequently prescribed formulas for milder degrees of mental disorder, including depression. Like the two previous formulas, it addresses the stasis aspect, but it also considers the beginning stages of deficiency. In one clinical trial, the formula was prescribed to 26 cases with affective psychosis; 16 were reported markedly improved, 7 improved, and 3 without result14 . There are many reports on the successful use of Xiao Yao San (Rambling Powder) for the treatment of hysteria, including hysteric loss of voice15, hysteric blindness16 , and hysteric seizures17. Another study reported satisfying results for insomnia in neurasthenic patients18. Japanese physicians often use Jia Wei Xiao Yao San (Augmented Rambling Powder),the famous modification of the mother formula with Zhi Zi (Fructus Gardeniae Jasminoidis) and Mu Dan Pi (Cortex Moutan Radicis) added, to treat depression19. In Japan, it is also used as the standard formula for gastrointestinal neurosis, often in combination with Ban Xia Hou Po Tang (Pinellia and Magnolia Bark Decoction)20. A Chinese study reports that Jia Wei Xiao Yao San was prescribed successfully to patients with auditory hallucinations21. Gan Cao Xiao Mai Da Zao Tang (Licorice, Wheat, and Jujube Decoction), [see above]: Due to its safety and high effectiveness, this classic formula has remained a favourite for the treatment of less serious mental disturbances, particularly if a soothing and nourishing rather than a dispersing effect is desired. Prime symptoms are crying and signs of mental aggravation. A study conducted in 1960 reports that the original formula was administered to 25 patients with an acute outbreak of hysteria; all 25 were reportedly cured22 . Due to an avalanche of successful trials conducted between 1958-60, Gan Cao Xiao Mai Da Zao Tang has become the first choice for the treatment of hysteria in contemporary PRC clinics. Since the amount of Gan Cao (Radix Glycyrrhizae Uralensis) is usually high (15g/day), side effects of oedema have been observed after prolonged intake; one study suggested counteracting this undesired affect by adding Fu Ling (Sclerotium Poriae Cocos) and He Huan Pi (Cortex Albizziae Julibrissin)23. The broad symptom complex referred to as 'neurasthenia' is another common indication for this formula. One trial used the original three food herbs licorice, jujube, and wheat to treat 34 cases with neurasthenia, and reported good results in 30 patients, while 3 patients failed to improve24. In another study, Gan Cao Xiao Mai Da Zao Tang plus Bai He (Bulbus Lilii) and Zhi Mu (Radix Anemarrhenae Asphodeloidis) was prescribed to 100 cases with neurasthenia; 28 patients reported that their headache and insomnia were cured, and 64 reported improvement25. Another trial added Bai He (Bulbus Lilii), Sheng Di Huang (Radix Rehmanniae Glutinosae) and Shou Wu Teng (Caulis Polygoni Multiflori) to the base formula and administered it to 110 cases; 12 were reported cured, 32 markedly improved, and 60 improved. Best results were reported for the insomnia symptoms (74.2%), while the total effectiveness rate was assessed at 100%26. Other modifications of the formula include the addition of Bai He (Bulbus Lilii), Dang Shen (Radix Codonopsis Pilosulae), Long Chi (Dens Draconis), Hu Po (Succinum) and Wu Wei Zi (Fructus Schisandrae Chinensis), which was given to 94 cases with neurasthenic insomnia; 87 patients reported good results. The author of the study recommends that this modified version of the formula can be used for all kinds of deficiency related insomnia or other symptoms of yang flare-up, particularly if accompanied by symptoms of dizziness, palpitations, or memory loss27. Since 1959, there have been at least 8 reports in major Chinese medical journals concerning the use of Gan Cao Xiao Mai Da Zao Tang for schizophrenia28. In combination with Long Gu (Os Draconis) and Mu Li (Concha Ostreae), for instance, the formula was used to treat 79 cases with different types of schizophrenia who were not responding to any other medication. After taking the formula for 7-70 days, along with small amounts of chlorpromazine (maximum of 200 mg/day), 5 were reported cured, 23 markedly improved, 34 improved, and 17 without results. The markedly improved rate was assessed at 35.5%29. In another study, Dr. Cheng Menxue combined Gan Cao Xiao Mai Da Zao Tang with Bai He Gu Jin Tang (Lily Bulb Decoction to Preserve the Metal) to treat 146 schizophrenia patients who were not responding to Western psychopharmacopoeia (117 of the patients also took 200mg of chlorpromazine per day); after taking the formula for 7-98 days, with an average of 16.8 days, 11 were reportedly cured, 44 markedly improved, and 64 improved. The general effectiveness rate was assessed at 81.4%30. In two other recent trials, the formula was successfully used to treat 133 cases suffering from menopausal syndrome; hot flashes were reduced in 94.4% of patients, sweating in 84.1%, insomnia in 92.7%, headaches in 86.8%, dizziness in 67.8%, restlessness in 70.2%, and abdominal distention in 75%31. There have also been several reports about the use of this formula for the treatment of epilepsy in children32 . Other trials reported that the formulas was useful in the treatment of somnambulism and globus hystericus (plumpit syndrome). SCHIZOPHRENIA Schizophrenia has always been looked upon as a 'strange' disease by Chinese physicians. Over the last hundred years, many self-declared masters of difficult diseases have taken up the challenge. Among them were Wang Qingren, the 19th century renegade physician and representative of the clinically extremely important blood moving school, and Zhang Xichun, the eminent 1920's physician who was known for his phlegm oriented approach to difficult diseases. Wang designed yet another blood moving formula for the treatment of schizophrenia, namely Dian Kuang Meng Xing Tang (Awaken from the Dream of Madness Decoction), while Zhang created Dang Tan Tang (Flushing the Phlegm Decoction). By primarily addressing phlegm and blood stasis, both of these approaches are representative of the traditional treatment of schizophrenia and 'strange disorders' in general. In traditional texts, schizophrenia is usually referred to as 'madness syndrome' (dian kuang). This term is ambiguous, since it really includes two opposite conditions, namely dian (depression) and kuang (mania, wild and crazy behaviour). Kuang often refers to the violent eruption of a mental condition, which usually can be controlled rapidly by the application of purging methods33. The high status of purging methods among the therapeutic modalities of Chinese medicine reflects the ancient concept of an evil spirit possessing the patient, which needs to be aggressively expelled from the body. Schizophrenia, however, is a complex disorder which can have a multiplicity of causes. Prolonged purging, favoured in many contemporary Chinese case studies, is thus not necessarily the correct treatment for patients who have been diagnosed with schizophrenia by a Western physician. The contemporary manual, Xiandai Zhongyi Neike Xue (A Modern Handbook of TCM Internal Medicine), appropriately emphasises the necessity of broadly distinguishing between the categories of yang type schizophrenia and yin type schizophrenia, that is between the 'wild' manic type and the depressed type. Yang type schizophrenia is characterised by symptoms of hallucinations (auditory, olfactory, or visual hallucinations; discussions with imaginary partners), delusions (paranoia, jealousy, hate, guilt, religious delusions etc.), bizarre behaviour (strange clothing, strange movements, tendency to attack others, repetitious speech or actions), and irregular thought patterns (answers do not match questions, sentences are not logically connected, constant change of topics, etc.). The base formula suggested in the manual is a modified version of Chai Hu Jia Long Gu Mu Li Tang (Bupleurum plus Dragon Bone and Oyster Shell Decoction) consisting of Chai Hu (Radix Bupleuri) 15g, Long Gu (Os Draconis) 60g, Mu Li (Concha Ostreae) 60g, Ban Xia (Rhizoma Pinelliae Ternatae) 15g, Tao Ren (Semen Persicae) 30g, Hong Hua (Flos Carthami Tinctorii) 15g, Chi Shao (Radix Paeoniae Rubrae) 30g and Da Huang (Rhizoma Rhei) 30g, to be taken daily for 60- 90 days. Yin type schizophrenia is characterised by symptoms of dull emotional expression (no change in facial expression, dull eyes, decrease in self-initiated movements, inability to love etc.), reduced intellectual activity (talks little, sentences have little content or are unfinished, slow response), and decrease of general awareness (lack of hygiene, loss of concentration, decreased sex drive, loner behaviour, low excitability, disregard of social codes). The suggested base formula is a modified version of Si Ni Jia Gui Tang (Frigid Extremities Decoction plus Cinnamon Twig), consisting of Fu Zi (Radix Aconiti Carmichaeli Praeparatae) 60g, Gan Jiang (Rhizoma Zingiberis Officinalis) 30g, Rou Gui (Cortex Cinnamomi Cassiae) 15g, and Gan Cao (Radix Glycyrrhizae Uralensis) 15g, to be taken for 60-90 days. Despite the high dose of Fu Zi (Radix Aconiti Carmichaeli Praeparatae), no side effects were observed in extended clinical trials34. Both of these approaches are characterised by their heavy usage of either Fu Zi (Radix Aconiti Carmichaeli Praeparatae) or Da Huang (Rhizoma Rhei), both of which, due to their pharmacological force, are otherwise rarely used in amounts exceeding 10g. Due to the traditional proverb that "special diseases should be addressed with special methods", this tendency of shocking both body and mind out of their highly disturbed state is quite common in contemporary clinical practice. One of China's leading schizophrenia specialists, Dr. Qiao Yuchuan, prescribed the following formula to 415 schizophrenia patients: Shi Gao (Gypsum) 155g, Da Huang (Rhizoma Rhei) 62g, Sheng Tie Luo (Frusta Ferri) 31g, Meng Shi (Lapis) 31g, Ye Jiao Teng (Caulis Polygoni Multiflori) 31g, Huang Qin (Radix Scutellariae Baicalensis) 24g, Huang Bai (Cortex Phellodendri) 24g. The herbs were boiled three times to yield a total of 2,000 ml of medicinal fluid which, divided into six portions, was imbibed at two hour intervals. The standard treatment time was two weeks, with an expected occurrence of diarrhoea that was not to be treated. After two weeks, the prescription of Gui Pi Tang (Restore the Spleen Decoction) or other harmonising formulas was advised. Of 415 participating patients, 330 were reported cured, 42 improved, 2 without result, and 41 stopped the treatment before completion. The overall effectiveness rate was 98.6%35. In a consecutive study conducted by the same research team employing three differentiations of this formula (Schizophrenia Formula No.1 for depressed Liver qi and fire flare-up, Schizophrenia Formula No.2 for blood deficiency and phlegm fire, and Schizophrenia Formula No.3 for excess heat in the yangming channels), similar results were achieved. Of 500 patients (229 males, 271 females, all ages, disease histories ranging from several months to 30 years), 401 were reported cured, 93 improved, and 6 without result36 . ANXIETY DISORDERS The modern term anxiety disorders encompasses a group of mental illnesses in which symptoms of anxiety prevail. Anxiety disorders are fairly common, affecting roughly four percent of the population in North America. Western medicine distinguishes between generalised anxiety disorder (anxiety neurosis), panic disorder, phobia, post-traumatic stress disorder, and obsessive-compulsive behaviour. All of these disorders involve the vegetative nervous system in an obvious manner. Patients tend to be extremely tense and nervous. During acute attacks involving fear and/or panic there may be breathing difficulties, palpitations, dizziness, nausea, abdominal distention, or a variety of other symptoms. Anxiety disorders are frequently accompanied by sleep disturbances such as insomnia or excessive sleeping. From a Chinese perspective, symptoms of anxiety always call for methods that 'quieten the spirit' (anshen, dingshen, ningshen). Almost all formulas designed for this disorder thus employ sedating materials, such as the downbearing minerals Ci Shi (Magnetitum) and Long Gu (Os Draconis). In addition, differentiated approaches are used to address the underlying cause for spirit unrest, such as blood deficiency or phlegm obstruction. Ning Shen Jie Lui Tang (Calm the Spirit and Resolve Anxiety Decoction), an experimental formula devised by Dr. Ding Fouting that was recently tried in a large scale study, illustrates the typical approach to anxiety neurosis in contemporary clinical practice. Note again the heavy dosages which are typical for the treatment of mental disorders. The base formula consists of Long Chi (Dens Draconis) 30g, Ci Shi (Magnetitum) 30g, Suan Zao Ren (Semen Ziziphi Spinosae) 15g, Yuan Zhi (Radix Polygalae Tenuifoliae) 15g, Shi Chang Pu (Rhizoma Acori Graminei) 15g, Yu Jin (Tuber Curcumae) 24g, Gan Song (Rhizoma Nardostachytis) 12g, He Huan Pi (Cortex Albizziae Julibrissin) 9g, Gan Cao (Radix Glycyrrhizae Uralensis) 9g, Hu Po (Succinum) 3g and Zhu Sha (Cinnabaris) 3g (the last two ingredients to be taken in powdered form). The base acupuncture point prescription accompanying the herbal treatment was Fengfu DU-16, Baihui DU-20, Tongli HE-5, Shenmen HE-7, and Neiguan P-6. Common differentiations addressing the underlying constitutional imbalance included the following: • Liver qi stagnation: plus Bai Shao (Radix Paeoniae Lactiflorae) 24g, Xiang Fu (Rhizoma Cyperi Rotundi) 24g, Chai Hu (Radix Bupleuri) 18g, Qing Pi (Pericarpium Citri Reticulatae Viride) 12g and Gan Cao (Radix Glycyrrhizae Uralensis) 9g. Acupuncture therapy: plus Ganshu BL-18 and Xingjian LIV-2. • Phlegm obstruction: plus Zhi Shi (Fructus Citri seu Ponciri Immaturus) 12g, Sheng Jiang (Rhizoma Zingiberis Officinalis Recens) 12g, Xiang Fu (Rhizoma Cyperi Rotundi) 12g, Dan Nan Xing (Rhizoma Arisaematis cum Felle Bovis) 9g, Fu Ling (Sclerotium Poriae Cocos) 15g, Ban Xia (Rhizoma Pinelliae Ternatae) 15g, Fu Hai Shi (Pumice) 30g, Meng Shi (Lapis) 30g, and Su Ye (Folium Perillae Frutescentis) 5g. Acupuncture therapy: plus Feishu BL-13, Hegu L.I.-4, Lieque LU-7, Tiantu REN-22 and Fenglong ST-40. • Heart blood deficiency: Yuan Zhi (Radix Polygalae Tenuifoliae), Shi Chang Pu (Rhizoma Acori Graminei) and Yu Jin (Tuber Curcumae) were decreased to 9g each, Suan Zao Ren (Semen Ziziphi Spinosae) was increased to 30g plus Dang Shen (Radix Codonopsis Pilosulae) 30g, Dang Gui (Radix Angelicae Sinensis) 30g, Wu Wei Zi (Fructus Schisandrae Chinensis) 30g, Long Yan Rou (Arillus Euphoriae Longanae) 30g, Fu Shen (Poriae Cocos Pararadicis Sclerotium) 15g, Mai Men Dong (Tuber Ophiopogonis Japonici) 15g, and Da Zao (Fructus Zizyphi Jujubae) 15g. Acupuncture therapy: plus Xinshu BL-15 and Pishu BL-20. Pishu BL-20. • Blood stasis: plus Dan Shen (Radix Salviae Miltiorrhizae) 30g, Tao Ren (Semen Persicae) 15g, Hong Hua (Flos Carthami Tinctorii) 15g, Chi Shao (Radix Paeoniae Rubrae) 15g, and Shui Zhi (Hirudo seu Whitmaniae) 15g. Acupuncture therapy: plus Xuehai SP-10 and Geshu BL-17. Of the 266 cases participating in the study, all were reported cured. After one year, 211 remained without reoccurrence, 31 reported reoccurences and had to repeat the treatment, and 24 died of unrelated diseases37. NEUROTIC INSOMNIA Insomnia is probably the most frequent symptom accompanying neurotic disorders. In Chinese medicine, it is again the sedating aspect which plays a predominant role in clinical therapy. A modern formula with the programmatic name, Zhen Xin An Shen Tang (Sedate the Heart and Calm the Spirit Decoction), was used for 157 cases with sleeping disorders. All participating patients reported one of the following symptom complexes: extreme difficulty in falling asleep, less than three hours of sleep per night, loss of effectiveness of sleeping pills; or waking up early without being able to go back to sleep, sleeping only 2-3 hours a night, or inability to fall asleep at all during the night. The formula used was a combination of ingredients that are primarily known for their sedating affect: Long Gu (Os Draconis) 10-30g, Mu Li (Concha Ostreae) 30g, Fu Ling (Sclerotium Poriae Cocos) 12g, Ye Jiao Teng (Caulis Polygoni Multiflori) 30g, Dan Shen (Radix Salviae Miltiorrhizae) 30g, Chao Suan Zao Ren (Fried Semen Ziziphi Spinosae) 30g, He Huan Pi (Cortex Albizziae Julibrissin) 12g. Patients were instructed to boil the materials twice, take the weaker medicinal liquid obtained from the second boiling in the afternoon or in the evening, and drink the first boiling right before going to bed. If there was a tendency to wake up early, patients were advised to take the first boiling before going to bed, and the second boiling after waking up. After 3 days of treatment, progress in the 157 participants was evaluated in the following way: 98 markedly improved, 55 improved, and 4 without results38. A similar approach was employed by the designers of a herbal sleeping pill, which was formulated at the height of Chinese-Western combination therapy during the late 1970's. The experimental Anmian Wan (Sleeping Pills) contained equal amounts of Chuan Xiong (Radix Ligustici Wallichii), Suan Zao Ren (Semen Ziziphi Spinosae), Zhi Mu (Radix Anemarrhenae Asphodeloidis), Hu Po (Succinum), Bai Shao (Radix Paeoniae Lactiflorae), He Huan Hua (Flos Albizziae Julibrissin) , Mu Li (Concha Ostreae), Long Gu (Os Draconis), Bai He (Bulbus Lilii), and Zi Su Ye (Folium Perillae Frutescentis). Ingredients were ground into a fine powder and manufactured into honey pills weighing 3g each. Patients were advised to take 2-3 pills one hour before going to sleep. Of 453 cases, the treatment was considered effective (the patient could sleep within 30-60 minutes of taking the pills) in 361 patients, and not effective in 92 patients39 . Since Wang Qingren's contribution to Chinese medicine, there has been a heightened awareness of the role of blood stasis in chronic diseases. Contemporary Chinese clinicians thus put great emphasis on blood moving herbs such as Dan Shen (Radix Salviae Miltiorrhizae) and formulas such as Xue Fu Zhu Yu Tang (Drive Out Stasis in the Mansion of Blood Decoction) in the treatment of insomnia. In 1986, Dr. Xie Yong et. al. published his experience with the blood moving approach to insomnia in the article, 'A Report of Treating 240 Insomnia Cases With Blood Movers.' The base formula tested consisted of Dan Shen (Radix Salviae Miltiorrhizae) 20-45g, San Leng (Rhizoma Sparganii) 20-45g, Xiang Fu (Rhizoma Cyperi Rotundi) 10-25g, Mu Xiang (Radix Saussureae seu Vladimirae) 10-25g, Dang Gui (Radix Angelicae Sinensis) 10-25g, and Zhi Zi (Fructus Gardeniae Jasminoidis) 10-20g. Typical modifications were: for neurosis, plus He Huan Pi (Cortex Albizziae Julibrissin) 10-20g, Ye Jiao Teng (Caulis Polygoni Multiflori) 10-20g, and Zhen Zhu Mu (Concha Margaritaferae) 25-40g; for schizophrenia, plus Meng Shi (Lapis) 30-50g, Mu Li (Concha Ostreae) 30-50g, Long Gu (Os Draconis) 30-50g, and Hu Po (Succinum) 6-15g; for obvious headache, plus Chuan Xiong (Radix Ligustici Wallichii)10-20g and Chai Hu (Radix Bupleuri) 10-15g; for general deficiency, plus Dang Shen (Radix Codonopsis Pilosulae) and Huang Qi (Radix Astragali). Of 240 cases (115 males, 125 females; 120 neurosis patients, 120 schizophrenia patients; disease histories ranging from 3 months to 15 years, with an average of 3 years), 81 were reported markedly improved, 87 improved, and 72 without satisfying results. The treatment period was 20 days. The best effects were observed in neurasthenic patients40. Another example for this approach is the experimental research formula, Huo Xue Mian Tong Tang (Move the Blood and Bring About Sleep Formula). It contains San Leng (Rhizoma Sparganii) 10g, E Zhu (Rhizoma Curcumae Zedoariae) 10g, Chai Hu (Radix Bupleuri) 10g, Zhi Gan Cao (Radix Glycyrrhizae Praeparatae) 10g, Bai Shao (Radix Paeoniae Lactiflorae) 10g, Bai Zhu (Rhizoma Atractylodis Macrocephalae) 10g, Suan Zao Ren (Semen Ziziphi Spinosae) 12g, Dang Gui (Radix Angelicae Sinensis) 15g, Dan Shen (Radix Salviae Miltiorrhizae) 15g, Fu Ling (Sclerotium Poriae Cocos) 18g, Ye Jiao Teng (Caulis Polygoni Multiflori) 24g, and Zhen Zhu Mu (Concha Margaritaferae) 30g. The remedy was tried on 112 patients suffering from severe insomnia, which was defined as only 1-3 hours of sleep per night, accompanied by symptoms of dizziness/headache, memory loss, panicky emotional state, shortness of breath or fatigue. At the end of the study, 30 were reported cured, 45 markedly improved, 29 improved, and 8 without result. The general effectiveness rate was assessed at 93%. The shortest treatment time was 1 week, the longest 8 weeks, with an average of 3 weeks41 . APPENDIX The following is a more detailed discussion of many of the formulas discussed in the article above. The focus is on their application and modifications in the treatment of mental disorders, and their many other applications are not discussed. Chai Hu Jia Long Gu Mu Li Tang (Bupleurum plus Dragon Bone and Oyster Shell Decoction) Ingredients Chai Hu (Radix Bupleuri) 12g Huang Qin (Radix Scutellariae Baicalensis) 5g Da Huang (Rhizoma Rhei) 6g Ban Xia (Rhizoma Pinelliae Ternatae) 9g Sheng Jiang (Rhizoma Zingiberis Officinalis Recens) 5g Ren Shen (Radix Ginseng) 5g Da Zao (Fructus Zizyphi Jujubae) 5g Gui Zhi (Ramulus Cinnamomi Cassiae) 5g Fu Ling (Sclerotium Poriae Cocos) 5g Long Gu (Os Draconis) 5g Mu Li (Concha Ostreae) 5g Therapeutic principles: courses the Liver and relieves depression, clears heat and purges fire. Symptoms and signs: stuffy feeling in the chest, heavy and sinking feeling in the body; depression, easily startled, insomnia, utterance of non-sensical gibberish; inhibited urination; digestive disturbances (constipation, subcostal pressure and bloating, etc.). Pulse: wiry and rapid, possibly deep and forceful. Tongue: tends to be reddish, with no or yellow coating (especially towards the back). Indications: epilepsy, depression, schizophrenia, neurotic insomnia; cardiac neurosis; drug withdrawal syndrome (nicotine, caffeine, valium, etc.); baldness. Discussion of ingredients: Chai Hu disperses shaoyang pathogens (located between interior and surface); Huang Qin clears internal heat, particularly Gallbladder heat and upper burner heat; Da Huang purges internal fire and relieves constipation; Ren Shen and Da Zao strengthen and protect the Spleen; Ban Xia, Fu Ling and Sheng Jiang eliminate nausea by harmonising the Stomach and drying dampness and phlegm; Gui Zhi and Fu Ling stimulate water metabolism and disinhibit urination; Mu Li and Long Gu sedate the shen. Discussion: Chai Hu Jia Long Gu Mu Li Tang first appeared in the classic formula source book, Shanghan Lun. It is a famous modification of Xiao Chai Hu Tang (Minor Bupleurum Decoction), with a specific focus on mental disorders such as epilepsy, schizophrenia, or severe depression. Since the original formula includes lead, a potent yet toxic sedating agent, the formula is now rarely used in China. In Japan, however, where a no-lead version of Chai Hu Jia Long Gu Mu Li Tang has been approved by the Ministry of Health, the formula is prescribed very frequently. A variety of modern usages have been reported by Japanese doctors, including the stimulation of hair