Chapter 6
Xuedao Zheng, Baihe Bing, Meihe Qi
[blood course syndrome, lily disease, plum-pit qi]
Before embarking on a description of herbs used in treating shen-disorders, it may be helpful to examine some categories of illness that have been described particularly in relation to herb prescribing. Although these have their origins in ancient Chinese medicine, Japanese doctors have given more attention to them in recent decades than the Chinese, so Japanese sources are frequently relied upon for the descriptions. The disorders presented here are consistent with various neurotic syndromes.
Practitioners offering natural health care services often encounter patients who have, as part of their syndrome, a neurotic condition, characterized by worry, lack of clarity, and inability to control their emotions sufficiently to aid their health. They may present symptoms that are difficult to describe clearly, with some symptoms that vary or that appear to present conflicting characteristics (especially in terms of traditional Chinese categories such as hot/cold, dry/damp, etc.), and they may have unusual responses to therapies that have already been tried. Such patients are likely to have visited many practitioners in the past and felt unsatisfied with both the diagnosis given and the outcome of treatment. They usually display, upon further questioning, a close linkage between emotional, behavioral, and health problems.
Such patients have been given (or are able to find on their own) non-standard disease classifications, namely those that are not widely accepted in the practice of modern medicine. These diagnoses include candidiasis, multiple allergies, parasites, heavy metal or other toxicity, chronic fatigue syndrome, leaky gut, and others for which standard testing procedures do not confirm the disorder (though various alternative medicine methods may seem supportive). Finding a culprit to blame the condition on, something separate from the individual's emotions and behavior, is often deemed important. Thus, the diagnosis may include reference to a toxin or parasite or rare infection, or an impact from modern society, such as food additives, drugs, or environmental pollutants. Yet, these attributions can be very misleading because, whether or not they are present, they may have little to do with the symptoms.
A diagnosis for these patients such as "liver qi stagnation," "spleen weakness," or "heart fire," may be given by practitioners of Chinese medicine. These exotic terms do not carry the risk of labeling the condition with a term that merely stimulates the emotional reactions to it (e.g., neurosis, hysteria, or hypochondria). While the Chinese medical terms don't automatically convey such concepts as neurotic hypersensitivity or chronic anxiety, Chinese writers often translate the traditional terms in that way when producing translated text books. There is no question among medical doctors in the West-and those in the East-that physical problems exist in these patients; indeed, such patients may have one or more standard medical diagnoses along with the unexplained disorders. However, the patient also is recognized as having functional disorders associated with psychological problems and with behavior patterns that impair both physical and mental health. Doctors often find that sedative and anti-depressant drugs provide a certain degree of relief for the patients, though compliance with using the drugs is often poor because the patients worry about taking them or fear the side effects.
It is not always possible to separate organic diseases from others that might be termed psychosomatic, neurotic, or related to behavior and thought patterns. As an example, the condition known as chronic fatigue syndrome has been very difficult for medical researchers to study because there is such a diverse range of physical and mental conditions that are presented by those who claim to be suffering from it. Among them are persons who are simply depressed or living an erratic lifestyle that brings about fatigue, and there are others who have some kind of viral infection (or group of viruses) that may be identified as the culprit. The infectious agents can wreak havoc on the immune system and cause fatigue as a side effect, but so can emotional disturbances and the adverse effects of certain activities and difficult experiences.
Chinese physicians have dealt with complex patients and difficult to diagnose diseases, such as those depicted above, for many centuries. Examples of relevant disease categories to be presented here include xue dao zheng (blood course syndrome), baihe bing (lily disease), and meihe qi (plum pit qi). These syndromes have an interesting underlying unity, which is the accumulation of damp or phlegm-damp.
It is hoped that by presenting an overview of the way the Chinese have interpreted such patterns and treated them, practitioners who prescribe Chinese herbs as a part of their practice will be aided in both understanding and developing therapeutic plans for the unusual syndromes. Specifically, instead of veering off into a variety of alternative medicine explanations and techniques, practitioners will find that such problems are amenable to the traditional Chinese medical approach with a focus on herbs. Acupuncture therapies that address these patterns are also potentially helpful.
Although there are many possible causes of complex disorders characterized by neurosis, two appear especially common from the Oriental view, as presented in the classical and modern literature:
The two causative factors-habits and emotions-often appear together, as poor dietary habits can lead one to be emotionally unstable (by failing to nourish the viscera, for example, therefore not allowing the inner "spirits" to rest), while emotional distress inhibits the functions of the spleen/stomach system (for example, excessive worry and anxiety impair the "transforming and transporting" functions).
Thus, in many situations a reasonable starting point for making improvements in a complex patient is by addressing the weakness of the stomach/spleen. Food therapy can have a big impact on healing, with its main effect being on the stomach/spleen. If a person cannot tolerate ingestion of healing foods and herbs, then it will be difficult to apply the desired kidney tonics, blood-vitalizing herbs, or other healing agents without getting adverse reactions. Certainly, the gentle damp-dispersing agents, such as hoelen (fuling) and atractylodes (baizhu) and the herbs that help moderate the severity of potentially irritating herbs on the stomach, such as jujube (dazao) and licorice (gancao), can usually be tolerated. Thus, the formula Si Junzi Tang is often suggested (which has these herbs plus ginseng or codonopsis) Acupuncture may be essential to reinvigorate the digestive system first, relying on points such as zusanli (ST-36) and sanyinjiao (SP-6). If a person does not change from an imbalanced diet towards a more balanced one (in relation to the disorder), it is difficult to heal the body even when the proper herbal therapies are administered and tolerated. Chinese dietary therapy for those with weak spleen and stomach often incorporates rice with a small amount of cooked vegetables and meat (it is only slightly more complex than that). A common error among Western practitioners of Chinese medicine is to focus on elimination diets (avoiding, for example, dairy, wheat, meat, etc.) rather than to focus on nutritious diets.
The other starting point for complex problems is the heart system, to be addressed by calming the spirit. This therapy is usually accomplished by sedating hyperactivity associated with both the liver and heart systems (liver disorders, particularly those involving liver fire, agitate the heart) and nourishing deficiencies. When the spirit is calm, the emotions are not so extreme, and the internal cause of disease, the unbalanced emotional responses, is removed or reduced in its influence. Acupuncture is one of the important therapies to address these concerns. Of special importance is neiguan (PC-6), which helps calm the emotions and settle the stomach qi. Mild sedative herbs, such as zizyphus (suanzaoren), biota (boziren), and albizzia (hehuanpi) can be given to most patients.
There are some herbal formulas that address both the distress of the digestive system and the lack of control of the emotions, which will be described in the following chapters. But, it should be mentioned here that the famous Licorice and Jujube Combination (Gancao Xiaomai Dazao Tang), comprised of the two named herbs plus a type of whole wheat (xiaomai), is a tonic for the stomach/spleen system and a sedative for the heart system. The use of wheat as a remedy in China may well reflect its natural content of B-vitamins that were lacking in some diets. In the book 100 Famous and Effective Prescription (1), the traditional indications for this simple formula are reported to include "frequent sad feelings, irritability, restless sleep, abnormal speech and behavior in severe cases....," while its modern applications (in which the formula is usually prepared with some added ingredients) include "neurasthenia, hysteria, schizophrenia, menopausal syndrome, etc." Here, as in many of the Chinese texts, menopausal syndrome refers mainly to the mental distress experienced during menopause, more so than hot flashes, dryness, or other physical symptoms. In the Shanghan Lun (2) and Jingui Yaolue (3) a combination of ginger, licorice, and jujube was included in many of the prescriptions to help enhance the effects of the key herbs of the formula. These three herbs benefit the stomach and spleen system; jujube and licorice, two of three herbs in the above-mentioned formula, also provide calming effects. Licorice has the traditional indications of calming the spirit and treating palpitation and melancholy (4).
One of the most popular formulas for tonifying the stomach/spleen and calming the emotions is Ginseng and Longan Combination (Guipi Tang); it contains the ingredients of Si Junzi Tang. Guipi Tang will be discussed at some length in the following two chapters. A variety of other methods, aside from tonifying the stomach/spleen and calming the heart, have been applied in the treatment of these complex disorders. One can attempt, for example, to harmonize the circulation of qi and blood, get rid of obstructing accumulated fluids, or clear agitational heat. Several such methods are to be described here.
The term xue dao zheng means "blood course syndrome" (xue = blood; dao = way, movement; zheng = pattern, syndrome; xue zhi dao is the general term for blood course). The syndrome encompasses something different than what is now termed blood stasis, and might best be described as the combination of qi and blood stagnation combined with fluid accumulation.
The term xue dao first appears in the Chinese literature in chapter 75 of the Lingshu (5), compiled over 2,000 years ago. There, it is said:
When food and drink cannot be regulated, and joy and anger are not timely, this condition causes the ferrying of liquids to overflow to the insides. These liquids then descend and detain in the marshes [lower burner; affecting the reproductive organs] making the blood paths to be obstructed. Day by day this condition enlarges without rest.
When a person's dietary behavior is regular and the emotions stable, then the blood will naturally flow freely, otherwise, the blood paths will become obstructed. The condition can then continually worsen as the unhealthy daily patterns persist. The disorder begins with the overflow of liquids (from their normal path of movement through the triple burner system); as the description continues, it is noted that: "This disease prospers with the accumulation of water." Excess water is seen as a means of worsening obstruction (of qi and blood circulation). The excess water is sometimes called shuidu, or water toxin. Here, toxin implies a harmful condition (not necessarily something chemically toxic); most often, water toxin manifests as edema, but the water can also be hidden (lishui), obstructing without being seen.
Xue dao zheng mainly signifies obstructed or limited blood circulation that occurs in the "blood chamber" (liver, uterus, and chongmai channel). Chen Wuji stated that (6): "The blood chamber is called a chamber because, like a room in a house, it is a place to linger. The body's blood chamber is the place where the blood gathers and where all the channels and vessels convene, and that is why it is referred to as the sea of blood." The sea of blood (xuehai) is a term familiar to acupuncturists (the point xuehai, SP-10, is commonly used in the treatment of uterine blood flow disorders, such as menstrual bleeding or amenorrhea or postpartum blood stasis). It is also a designation for one of the eight extraordinary channels, which is alternatively called the chongmai (penetrating channel or thrusting channel). The sea of blood is part of the liver network, involved with the storing of blood, affecting menstruation and female sex hormones. The channel connects the lower abdomen with the head. When there is emptiness or fullness or stagnation in the lower warmer, the qi has a tendency to thrust upwards, or, as sometimes translated to English, to "flush up." The result is symptoms in the head, such as mental irritability, sweating of the forehead, tinnitus, or difficulty swallowing (with nausea). As explained by Wang Bing (6):
The chongmai is the sea of blood: that is the place where all of the channels convene. In males, the blood moves from here, whereas in females it stays here, and this is why this area is also called the blood chamber (xueshi).
The fact that the blood lingers in the blood chamber for women, but not men, is one of the reasons why xue dao zheng mainly affects women. The blood chamber can be afflicted by internal forces (the seven emotions) or by external forces (e.g., wind and cold), or other conditions (neither solely internal nor external, including infections, surgical interventions, and other damages, leading to alteration in the circulation of qi and blood). In turn, blood course syndrome can generate unfavorable mental symptoms that further complicate the physical condition of stagnation.
Xue dao zheng is a syndrome that is now mentioned mainly in the modern Japanese literature, rather than the Chinese literature. One of the primary commentators on xue dao zheng and its treatment is the famous Japanese herb doctor, Yakazu Domei. He first published an analysis of the syndrome in 1939. In 1982, he published a revised article on this subject (7). Selected aspects of that review will be discussed in this section, along with commentaries from other sources.
Japanese doctors have speculated that, in modern terms, the hormonal changes that occur with menstruation, pregnancy, and menopause, as well as the effects of administered hormones and of induced abortion, can exacerbate autonomic nervous system disorders, leading to the syndrome. Yakazu Domei has suggested that there is a restored concern for the classically defined xue dao syndrome:
Due to changing social conditions, there has been a marked rise in disorders of this type. In fact, according to Dr. Kuhuto's statistics xue dao zheng places second among problems of out-patients. Its etiology is varied: genital [uterine] abnormalities caused by artificial abortion, fear of pregnancy, misuse of hormonal preparations, all of which cause an imbalance of the autonomic nervous system.
The concerns raised here can explain why there would be a new interest in this syndrome: modern circumstances have replaced earlier causes of the syndrome, which had previously been attributed to "wind" or "fever" or "cold" entering the uterus, or to complications associated with childbirth.
When consulting the body of reports on this syndrome, one can detect a certain level of annoyance that the physicians experience when trying to deal with the patients. The patients themselves appear chronically dissatisfied and, as in one description, are peevish (other characterizations: angry, jealous, anxious, nervous). Further, they may be unresponsive to the medical questioning or go on and on about their symptoms; even when they get better, they may not recognize it and admit it. No doubt, the physicians would consider that not only the disorder, but the patients themselves are "difficult" or "complex."
The modern description of xue dao zheng is often presented by the Japanese as "erratic complaints syndrome," based on its manifestation rather than its cause. Erratic complaints refers both to a multiplicity of problems and to the complaints coming and going, with the patient being very sensitive to environmental, dietary, and emotional influences.
In the article Clinical experience with women's erratic complaints syndrome (8), it is reported that "most patients with this syndrome have a nervous temperament...in some cases the symptoms go away, but the patient is unaware of the improvement." In a list of 49 symptoms characteristic of women's erratic complaints syndrome, the most common were: distention and pain in the diaphragm region and hypochondrial region; nausea; blurring eyesight; fatigue; itching; and late rising. In presenting three case histories of women treated for the syndrome, the authors point out that "all three patients in this study had had induced abortions....Many patients with this syndrome have had induced abortions and/or gynecological surgery." Gynecological surgeries affect abdominal blood flow and are performed frequently in modern times, including Cesarean section for childbirth and hysterectomy for several disorders (e.g., fibroids, unexplained uterine bleeding, and tumors). In a book by Mizuno Takusai (1841 A.D.) it was mentioned that xue dao zheng includes ailments preceding and following childbirth, as well as a variety of menstrual irregularities.
Shyoshi Kuhuto, a modern practitioner in Japan quoted by Yakazu Domei, has characterized the erratic complaints syndrome as follows (7):
This description appears to fit neurosis. In the book Clinic of Traditional Chinese Medicine (9), neurosis is described as follows: "The patients get excited or fatigued easily, and are frequently accompanied with various forms of somatic discomfort. It is more common in middle-aged females." Major clinical manifestations are "insomnia, waking up easily, distractibility, poor memory, emotion is easy to be changed, hypersensitivity, abdominal distention, frequent urination, constipation, and belching." Of importance, the lack of emotional control is evident; the person is hypersensitive and complains of what would otherwise be considered trivial things or ordinary discomforts, such as occur with weather changes or when consuming foods and meals that lead to some uneasiness. Men can also suffer these conditions, but the incidence is higher for women.
Neurosis associated with blood stagnation, as occurs with xue dao zheng is described this way by Yamada Terutane (10):
An experienced physician can easily detect neurotic or blood-stagnated women by virtue of their external signs, such as a worried look, anxiety, suspiciousness, and slurred speech. These patients generally do not feel like talking, but when asked, they either enumerate all their complaints (which may last for hours) or quietly submit their subjective symptoms in writing, often having prepared them in advance.
The reference to "slurred speech" is a poor translation. It means incoherent or illogical statements, rather than inability to control the muscles associated with speech; for example, the conclusion drawn by the patient seems unrelated to the prior description of events, so that it seems that the person is linking words together that don't connect. Terutane notes further that xue dao zheng especially affects middle-aged women with any of the following medical history, symptoms, and signs:
Several Japanese physicians link xue dao zheng to menopausal symptoms. According to Yakazu Domei (7), the way that xue dao syndrome became closely associated with menopause in the Japanese literature is as follows:
For years, when confronted with the term xue dao, many physicians trained in modern medicine just smiled. As a result, the term was replaced by the words climacteric disturbance or disturbance of the autonomic nervous system. However, these two terms describe only a part of the xue dao zheng.
In other words, because the traditional Chinese medical term was not acceptable by the modern-trained physicians (who just smiled in embarrassment when the discussion turned to such an archaic concept), it was replaced with another that was considered acceptable: climacteric disturbance.
Hosono Shiro touched on the subject of blood stasis and menopause in the first of his ten lectures on Chinese herbal medicine presented in English by the Oriental Healing Arts Institute (11):
The stagnant blood conformation results from abnormalities in the central nervous, endocrine, and circulatory systems caused by changes in metabolism....The stagnant blood conformation also resembles menopausal disorders caused by hormonal and central nervous system abnormalities.
He also considered that post-partum illnesses and infertility were related to this type of problem. Poor memory, mental anomalies, and poor emotional control are among the symptoms he considers as primary indicators of the stagnated blood circulation.
The Kojien Encyclopedia quoted by Yakazu Domei (7) describes chi no michi, which is a common Japanese designation for xue dao zheng, as having the meaning of a syndrome of the path of blood circulation, and also referring to "uterus-related diseases." These latter problems are said to usually manifest in relation to the menstrual cycle, with symptoms such as headaches, nausea, hot flashes, sweating, etc., which might include premenstrual syndrome, menopausal distress, and post-partum disorders. Of course, some of these conditions are not uterine problems but, rather, ovarian problems; in the traditional Chinese literature, there is no division between the uterus and ovaries, so the translation is often haphazard.
In his book Aging and Blood Stasis (12), Yan Dexin describes three categories of menopausal syndrome, emphasizing the emotional factors:
Many of these symptoms are the same as those described above for the middle-aged women who suffer from xue dao zheng. It should be emphasized that some of the symptom reports are difficult to interpret directly; for example, a woman might sleep normally or even excessively, but complain about insomnia because she did not feel that the sleep gave her the sense of feeling rested; heart palpitations may be reported when the heart rate is normal but the sense that the heart is 'not right' is experienced.
The basic therapeutic approach to xue dao zheng is to both nourish blood and vitalize blood circulation, to strengthen the spleen and aid qi circulation, and to alleviate fluid accumulation associated with deficiency and stagnation. The herbs tang-kuei (danggui), peony (baishao), and hoelen (fuling) are frequently included in the prescriptions; all three benefit the spleen; tang-kuei and peony nourish and vitalize blood; hoelen dispels accumulated moisture and calms the spirit.
A complex and irregular disease described in the Jingui Yaolue (3) is "lily disease" (baihe bing). Lily disease is named after the main ingredient in formulas designed for its treatment, the herb lily-baihe. When used for treating this condition, lily is usually prescribed in small formulas with just one or two other herbs. According to this ancient text:
Baihe bing is a disease characterized by general malaise-a desire but inability to eat, talk, lie down, or walk. The patient often appears quiescent. Sometimes he has an appetite, sometimes not. He feels cold, but has no chills or else feels hot, but has no fever. A bitter taste invades his mouth and his urine flows red. No herbs can cure him because severe vomiting and diarrhea occur upon ingestion of herbs. It seems as though a certain spirit has possessed him though he appears to be normal except for a minute and quick pulse.
The conflicting and complicated pattern of symptoms gives the impression that there is a foreign influence (spirit; ghost) that has taken some control. The malaise characterized by "desire but inability" is typical of depression. The description of red urine in this context is consistent with the concept of heat centered in the heart that flows downward to the small intestine (the fu organ associated with the heart), and from there to the urinary bladder. This downward flow is due to the presence of damp (moisture accumulation) that carries the heat downward; the dampness also impairs the movement and expression of the individual. The vomiting and diarrhea mentioned here can come about because of damp accumulation affecting the spleen and from heat affecting the stomach, making it react to many herb remedies.
According to the Shennong Bencao Jing (13): "Lily is sweet and balanced. It mainly treats evil qi, abdominal distention, and heart pain. It disinhibits urination and defecation, supplements the center, and boosts the qi." One of the important actions is to "disinhibit" urination, which is a method for conducting out excess fluid and heat. Today, lily is often described simply as a yin nourishing herb, especially used for dry cough. The Chinese English Manual of Common-Used Herbs of Traditional Chinese Medicine (14) provides these indications for lily aside from moisturizing the lungs and relieving cough: "Clear away heart-fire and tranquilize the mind: for the convalescence of febrile diseases or yin deficiency with heat manifested as irritability, insomnia, dreaminess, palpitation, and absent-mindedness."
Lily disease has been associated in modern times with various psychological illnesses. In Chinese English Manual of Common-Used Prescriptions of Traditional Chinese Medicine (15), the indications for Lily and Talc Formula (Baihe Huashi San), includes this description:
Mainly for lily syndrome (depressive state of psychic disease), manifested as mental disorder, irritability, insomnia, anorexia....
Modern Clinical Necessities for Acupuncture and Moxibustion (16) mentions the syndrome:
Hysteria, mostly seen in the female, is a paroxysmal disease with complex and variable symptoms. In traditional Chinese medicine, it belongs to the category of Bai He Bing.
The main points recommended in this text are ximen (PC-4), which has an action similar to neiguan (PC-6), and yongquan (KI-1), which is used to drain the excess from above. More broadly, hysteria belongs to the larger class of disorders known as neurosis. In the companion text Modern Clinical Necessities for Traditional Chinese Medicine (17), it is said that:
Neurosis is a collective term for neurasthenia, hysteria, and obsession, which are diseases of disturbance of higher nervous functions commonly found in the clinic. They are classified in traditional Chinese medicine into yuzheng (depression), meihe qi (plum pit qi; globus hystericus), zangzao (hysteria), and baihe bing (lily disease).
According to the English-Chinese Encyclopedia of Practical Traditional Chinese Medicine (18), hysteria is the term used to refer to "a condition characterized by a series of mental symptoms and signs, such as emotional depression or unrest, abnormal crying or laughing. The causative factor of the condition is related to emotional disturbances such as depression, excessive joy, anger, or grief....Excessive anger can impair the function of liver in maintaining free flow of qi, causing derangement of qi mechanism and emotional unrest. Habitual depression with over-thinking and sorrow cause the liver to overact on the spleen...." The condition is listed in the section on gynecology.
Among the formulas recommended in this text for neurosis are Licorice and Jujube Combination (Gancao Xiaomai Dazao Tang), Lily and Rehmannia Combination (Baihe Dihuang Tang, a simple heat-clearing formula based on use of lily), and Bupleurum and Dragon Bone Combination (Chaihu Jia Longgu Muli Tang), which is an ancient remedy for mental agitation described in the Shanghan Lun (2). Formulas such as these are recommended in the treatment of chronic fatigue syndrome in China. In one medical journal article (19), the Chinese physician Yin Hengze designed a formula for chronic fatigue based on blending Four Major Herbs Combination (Si Junzi Tang), Lily and Rehmannia Combination (Baihe Dihuang Tang), and Tang-kuei and Bupleurum Formula (Xiao Yao San). The patients, suffering from a variety of symptoms including constant fatigue after any activity, difficulty concentrating, depression, sleep disorder, aches and pains, sore throats, etc., were treated with both the herb formula and psychotherapy. It was reported that two weeks of such treatment would produce some symptom resolution in about 2/3 of the patients.
The Western term globus hystericus implies a lump (actually, the sensation of a lump) that is the result of hysteria. The Chinese term for the condition, meihe qi (plum pit qi), indicates that the sensation is the result of qi stagnation and accumulation. There is no physical lump present; the feeling of its presence may come and go and it is highly irritating.
The Jingui Yaolue (3) presents a treatment for this disorder, namely Pinellia and Magnolia Combination (Banxia Houpu Tang), a formula that disperses stagnant qi, stagnant fluid, and accumulated phlegm-fluid. The text mentions that the condition happens in women, and prior to introducing the formula, it is mentioned that "sometimes a woman contracts evil wind with fever and chillphobia at the onset of menses...." The implication is that this disorder is in some way related to the uterus (or, more generally, the xuehai). The text continues with the introduction of Licorice and Jujube Combination (Gancao Xiaomai Dazao Tang) for "a woman with visceral irritation [hysteria] who tends to grieve and cry as though possessed by a spirit." In Commonly Used Chinese Herb Formulas with Illustrations (20), the indications for Pinellia and Magnolia Combination are:
Neurosis, nervous exhaustion, hysteria, nervousness, insomnia, fearfulness, neurotic esophageal constriction [globus hystericus], recurrent palpitations....
The formula is a simple one, comprised of magnolia bark, pinellia, fresh ginger, hoelen, and perilla leaf. In Chinese-English Manual of Common-Used Prescriptions in Traditional Chinese Medicine (15), it is said that the formula is "mainly for cases of globus hystericus due to the disorder of the seven emotions and the stagnation of phlegm." The sensation of a lump in the throat (rather than elsewhere) is attributed to "abnormal rising qi." One of the herbs used for such conditions is perilla leaf, which is a major component of Lindera and Cyperus Formula (Zhengqi Tianxiang San), indicated for "climacteric neurosis in females, diseases caused by occlusion and stagnation of qi, hysteria, neurasthenia, pre-partum and post-partum neuroses, amenorrhea, melena, neuroses of widows, nuns, and monks (20)." The last reference to widows, nuns, and monks suggests the psychological impact of being unmarried and not having a normal sexual and social life and does not necessarily mean that this syndrome was observed in such individuals.
Hong-yen Hsu provided a review of treatments for abnormal sensations in the throat (21). He considered that aside from local disturbances, such as inflammatory disease, the causes included mental factors, stating: "Fear and tension, as well as other strong emotions, often induce physiological problems in the autonomic nervous system." He reports that the condition is due to "mental depression, malfunction of the liver and spleen, accumulation of sputum, alternate flushing up of sputum and qi; it is caused by anger while eating and an imbalance between the liver and the stomach." Recommended formulas include Pinellia and Magnolia Combination (Banxia Houpu Tang) and several other prescriptions relying on pinellia (banxia) as a key component; this herb has long been used for its combined effect of resolving phlegm accumulation and lowering stomach qi. Hsu relayed the experience of physicians at the Tokyo University Medical School who treated plum pit qi syndromes. According to the report, 21 patients received Pinellia and Magnolia Combination (mostly for female patients with nervousness) and 13 patients received Bupleurum and Dragon Bone Combination (mostly for male patients with strong physique; see pages 74-75 for more details about this important formula).
The three syndromes described here involve different pathologies in the TCM system: stagnant blood in xue dao zheng, heart fire in baihe zheng, and stagnant qi in meihe qi. All three syndromes also tend to involve fluid accumulation; unfortunately, this aspect is not emphasized in the modern literature. As will be seen in the chapter on herb formulas, many of the treatments for these syndromes incorporate herbs for draining damp. Japanese physicians refer to shuidu (water toxin) and lishui (hidden water), the concept that accumulated fluids can have a corrupt nature when they accumulate, leading to production of bizarre symptoms. In the Chinese literature, there is reference to "turbidity" which implies corrupted fluids, and is especially applied to phlegm (phlegm-turbidity). Both moisture and phlegm can remain "hidden," particular concern is expressed for hidden phlegm, called "phlegm-mist."
Painting by Chen Hung-shou (1598-1652). For a time, he lived as a Buddhist monk at a monastery. He painted numerous nature scenes; in this one, a scholar is enjoying nature under a pine tree emerging from a towering rock. In his right hand he holds a brush, as he is inspired by the beauty of the scene to write poetry. From Eight Dynasties of Chinese Painting (1980 Cleveland Museum of Art).