Phlegm-Fire Harassing Heart

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This is one of the TCM imbalances which can result in severe mental

illness. The information is taken from The Foundations of Chinese

Medicine, Giovanni Maciocia, pp. 209-210.

 

" Clinical manifestations

 

" Mental restlessness, palpitations, bitter taste, insomnia, dream

disturbed sleep, propensity to be startled, incoherent speech, mental

confusion, rash behavior, tnedency to hit or scold people,

uncontrolled laughter or cry, agitation, shouting, muttering to

oneself, mental depression and dullness; in severe cases aphasia and

coma.

 

" Tongue: Red, yellow-sticky coating, midline crack with yellow

pricles in it. The tip may be redder and swollen with red points. "

 

(The condition of the Heart and Lungs frequently will be revealed in

the tip of the tongue. Red and yellow are associated with Heat. A

sticky tongue coating points to Damp and possibly to Phlegm. A

simplified explanation of Phlegm is that it is Dampness that has hung

around too long and congealed into Phlegm.)

 

" Pulse: Full-Rapid-Slippery or Rapid-Over-flowing-Slippery or Rapid-

Full-Wiry. "

 

(A rapid pulse usually is associated with Heat. A slippery pulse can

be associated with Phlegm, Dampness, food stagnation, or pregnancy

(p. 168). A wiry pulse can mean Liver imbalance, pain, and/or Phlegm

(p. 169). A full pulse indicates Excess. Excess conditions are

those caused by there being too much of something. Any Phlegm is too

much. A Deficiency condition is one in which problems are caused by

there not being enough of something. Actually, Phlegm-Fire Harassing

the Heart is a mixed Excess and Deficiency pattern, though the pulse

usually will reflect the Excess, the Phlegm. Spleen Qi is Deficient,

allowing fluids to " hang around too long " and get " cooked " into

Phlegm by Heat.)

 

" Key symptoms: all the various mental symptoms and the Red tongue

with sticky-yellow coating.

 

" Pathology

 

" This is an Excess pattern characterized by the presence of Fire and

Phlegm obstructing the Heart. All the mental symptoms are due to

Phlegm obstructing the Heart orifices and disturbing the Mind.

Although the main manifestations derive from dysfunction of the

Heart, this pattern is also characterized by deficient Spleen-Qi

being unable to transform and transport fluids which accumulate into

Phlegm. The interior Heat facilitates this process by condensing the

fluids into Phlegm. There are actually two separate aspects to this

pattern which may appear separately or alternately (as in manic-

depression):

 

" 1) Mental depression and dullness, muttering to oneself: this is

called DIAN in Chinese, meaning 'insanity'.

 

" 2) Uncontrolled laughter or cry, shouting, violent behaviour,

hitting or scolding people, incoherent speech: this is called KUANG

in Chinese, meaning 'violent behaviour'.

 

" Both these patterns are of the Excess type and are caused by Phlegm

and Fire obstructing the Heart and Mind. It is important not to be

misled by the Yin nature of the symptoms in the DIAN type and think

that it is a Deficiency pattern requiring tonification. "

 

(Even though the symptoms of the DIAN type suggest Deficiency, they

are coming from Excess, the Phlegm. The Phlegm will need to be

treated in both types. Don't confuse the DIAN manifestations with

Heart Yang Collapse (which is a Deficiency pattern).)

 

" The obstruction of the Heart orifices can, in extreme cases, blur

the Mind entirely and lead to aphasia and coma. In Chinese medical

terminology this is described as 'Phlegm obstructing the Heart

orifices'. This coma is of the Excess type (contrary to that from

Heart Yang Collapse) as is caused by obstruction by Phlegm.

 

" The yellow-sticky coating on the tongue reflects the presence of

Phlegm and the Red body colour reflects the presence of Heat. The

yellow prickles inside the midline crack also indicate the presence

of Phlegm in the Heart.

 

" The Slippery quality of the Pulse indicates Phlegm.

 

" Aetiology

 

" 1) Severe emotional problems and depression leading to stagnation of

Qi which, over a long period of time, turns into Fire. "

 

(More than likely, Liver Qi Stagnation eventually engendered Fire

after the Stagnation went on for some time without treatment.)

 

" 2) Excessive consumption of hot-greasy foods creates Heat and Phlegm.

 

" 3) This pattern can also appear during fevers from exterior Heat

invading the Pericardium. In this case there would not be all the

mental symptoms, but only mental confusion and unconsciousness.

Exterior Heat can also be a contribuing factor to the formation of

Interior Phlegm-Fire. "

 

(We're talking heat exhaustion and heat stroke in the latter.)

 

" Principle of treatment: clear Heart-Fire, resolve Phlegm, pacify the

Mind. "

 

(The weak Spleen Qi also will need to be addressed.)

 

Maciocia recommends the following points: Pericardium 5 to

resolve " Phlegm from the Heart and " clear orifices, Heart 7 ( " clears

Heat and pacifies Mind), Heart 8 and Heart 9 to " clear Heart-Fire and

restore consciousness " , Pericardium 7 ( " pacifies the Mind and clears

Heart-Fire " ), Ren 15 ( " pacifies the Mind " ), Bladder 15 to clear Heart-

Fire, Ren 12 to tonify " the Spleen to resolve Phlegm " , Stomach 40 to

resolve Phlegm, Spleen 6 ( " resolves Phlegm and pacifies the Mind " ),

Liver 3 qguxg " pacifies the Mind and subdues Fire (it brings Fire

down, away from the top part of the body) " , Liver 2 to subdue " Fire

(the same way as LIV-3) " , Du 20 which " restores consciousness in case

of coma " , GallBladder 13 and Du 24 to pacify Mind, and Gall Bladder

15 which " pacifies the Mind and balances the mental state (when it

oscillates between mania and depression).

 

(Phlegm disorders can take a long time to treat.)

 

Victoria