In recent years, purging the pathogenic fire and removing phlegm and promoting blood circulation by removing blood stasis have been used in treating depressive and manic psychosis with more satisfactory results. Quite a few researchers made large amount of clinical and experimental studies on single medicinal herb such as loranthus mulberry mistletoe, yellow genkwa and datura flower and found that they have better therapeutic effect.
An Approach to the Regular Rule of Treatment with Syndrome Differentiation
Doctors of Beijing An Ding Hospital divide psychosis into two classes: excess syndrome and deficiency syndrome. The excess syndrome is subdivided into four types: accumulation of phlegm and heat, stagnation of the liver-qi and stagnation of qi, stagnation of the liver-qi and blood stasis, and domination of interior heat; the deficiency syndrome is also subdivided into four types: deficiency of qi and blood in the heart and spleen, insufficiency of both the spleen and the kidney, extreme heat due to deficiency of yin and phlegm stagnation due to hypofunction of the spleen. They hold that stagnation of the liver-qi and stagnation of qi, and stagnation of the liver-qi and blood stasis are more common in the excess syndrome and that deficiency of qi and blood in the heart and spleen and insufficiency of both the spleen and the kidney are more frequently observed

Author's unit name: Guangdong Gaoming Medical and Medicinal Institute of Encephalopathy 2 Heping Lane, Cangjiang Road, Hecheng District, Gaoming, Guangdong 528500
in the deficiency syndrome. Phlegm syndrome
is observed in both deficiency and excess syndrome.
Zhang et al divide schizophrenia into mental disturbance due to phlegm-fire, breakdown of the normal physiological coordination between the heart and the kidney, deficiency of qi and blood in the heart and spleen, insufficiency of the heart-qi and the gallbladder-qi, stagnaney of phlegm and qi and hypofunction of both the spleen and the kidney.
Doctors of Tianjin Mental Diseases Hospital divide the disease into manic-depressive psychosis and schizophrenia.
1. Manic-depressive psychosis is divided
into the following two types:
(1) Acute manic state It is caused by stagnated heat in the heart and the liver, mental confusion due to phlegm, and dryness-heat in Yangming Channel and treated by removing heat-phlegm and soothing the liver and tranquilizing the mind. The basic prescription consists of Sichuan coptis root, gentian root, capejasmine, scutellaria root, dried rehmannia root, rhubarb, mirabilite, clematis (hocquartia), fruit of citron, arisaema with bile, bamboo parasitic fungus, chlorite-schist, bupleurum root, and curcuma root, a dose of medicines for two decoctions daily. Red ochre, magnetite, dragon's bone, oyster shell, anemarrhena, polygala root, and cinnabar are to be decocted and taken every evening.
(2) Mild manic state It is caused (i) by stagnated heat in the heart and the liver and heart disturbed by phlegm-fire or accompanied by dryness-heat in Yangming Channel and treated by the basically same methods and with the basically same drugs as used above except the small doses of drugs bitter in taste and cold in nature or (ii) by stagnated heat in the heart and the liver and dysfunction of the spleen in transport and treated by regulating qi by alleviation of mental depression, reducing fever and strengthening the spleen and replenishing qi.
2. Schizophrenia
(1) Paranoid schizophrenia
(i) Breakdown of the normal physiological coordination between the heart and the kidney It is treated by nourishing the kidney-yin and restoring normal coordination between the heart and the kidney with such basic drugs as dried or prepared rehmannia root, dogwood fruit, Chinese yam, alisma, anemarrhena, phellodendron bark, glossy privet fruit, eclipta, loranthus mulberry mistletoe, tortoise plastron, coptis root, cinnamon bark, dragon's bone, and oyster shell.
(ii) Stagnation of the liver-qi and deficiency of the spleen It is treated by invigorating the spleen and relieving depression of the liver-qi and regulating qi and blood. The basic prescription includes bupleurum root, curcuma root, aucklandia root, pilose asiabell root, astragalus root, white atractylodes rhizome, poria, Chinese yam, Chinese angelica root, longan aril, pinellia tuber and tangerine peel.
(iii) Stagnation of the liver-qi and phlegm stagnancy It is treated by relieving the depressed liver and eliminating phlegm for resuscitation. The prescription is composed basically of bupleurum root, curcuma root, nutgrass flatsedge rhizome, Sichuan chinaberry, red sage root, tangerine peel, pinellia tuber, poria, bamboo endodermis, prepared arisaema with bile and grassleaf sweetflag.
(iv) Stagnancy of qi and blood stasis It is treated by soothing the liver and regulating the circulation of qi and promoting blood circulation by removing blood stasis. The prescription consists mainly of bupleurum root, curcuma root, nutgrass flatsedge rhizome, peach kernel, safflower, red sage root, Chinese angelica root, red peony root, and dried rehmannia root.
(v) Failure of descending of the stomach-qi It is treated by regulating the stomach and lowering the adverse flow of qi and eliminating undigested food by means of stomachics. The basic drugs include tangerine peel, perilla stem, aucklandia root, areca seed, forsythia fruit, hawthorn fruit, medicated leaven, parched germinated barley, inula flower, poria, pinellia tuber and red ochre.
(vi) Stagnated heat in the heart and the liver and heart disturbed by phlegm-fire It is treated by removing heat-phlegm and by soothing the liver and tranquilizing the mind.
(2) Hebephrenic schizophrenia
(i) Stagnated heat in the heart and the liver and heart disturbed by phlegm-fire It is treated by the basically same method as used in the manic state.
(ii) Stagnation of the liver-qi and deficiency of the spleen It is treated by invigorating the spleen and relieving depression of the liver-qi and by regulating qi and blood.
(3) Indeterminate type
(i) Stagnation of the liver-qi and stagnation of qi, stagnation of phlegm in the interior It is treated by soothing the liver and regulating the circulation of qi and by eliminating phlegm for resuscitation. The basic prescription includes bupleurum root, curcuma root, nutgrass flatsedge rhizome, grassleaf sweetflag, pinellia tuber, poria, tangerine peel and bamboo endodermis.
(ii) Deficiency of qi and blood in the heart and spleen It is treated mainly with Decoction for Invigorating the Spleen and Nourishing the Heart.
(iii) Stagnation of the liver-qi and deficiency of the spleen It is treated by invigorating the spleen and relieving depression of the liver-qi.
An Approach to the Principles and Methods of Treatment
Zhou classifies the principles of treatment into five categories: eliminating phlegm for resuscitation, clearing heat and purging fire, regulating the qi flowing in the channels and removing blood stasis with drastic drugs, restoring qi and nourishing vital-qi, and strengthening yang to induce excitation and holds that the usual treatment is not beyond the scope of the five aspects and that these principles should be used flexibly and symptomatologically in clinical application. (1) Eliminating phlegm for resuscitation In this method the commonly used drugs are bamboo juice, pinellia tuber, arisaema with bile, tabasheer, calcined chlorite-schist, ark shell, green tangerine orange peel, immature bitter orange, curcuma root, grassleaved sweetflag rhizome, rhubarb and Storax Pill. The author is of the opinion that the method of eliminating phlegm for resuscitation is effective only in treating some but not in treating all or most of psychotics. (2) Clearing heat and purging fire Drugs commonly used are coptis root, scutellaria root, phellodendron bark, Chinese angelica root, gentian root, aloes, bupleurum root, soft gypsum, anemarrhena, rhubarb and mirabilite. (3) Regulating the qi flowing in the channels and removing blood stasis with drastic drugs The newly prepared Decoction of Bupleurum, Decoction for Regulating Qi and Removing Blood Stasis, and Decoction for Tranquilizing Manic-depressive Psychosis are used for treatment. (4) Restoring qi and nourishing vital-qi The method is mainly used for treatment of depressive psychosis. (5) Strengthening yang to induce excitation In this method the Decoction for Strengthening Yang is used.
Having collected recent clinical data on treatment of schizophrenia with Chinese drugs, the author classifies the methods of treatment and prescriptions commonly used at the present into the following 11 categories: (1) Removing phlegm with heavy materials: The prescriptions used are Pig Iron Cinder Drink, Phlegm-Removing Decoction (composed of red ochre, pinellia tuber, curcuma root, rhubarb and mirabilite, see《Records of Traditional Chinese and Western Medicine in Combination》), Pill of Chlorite-schist for Expelling Phlegm (or combined with Controlling Phlegm-fluid Pill), Decoction of Bupleurum Plus Dragon's Bone and Oyster Shell, Magnetite and Cinnabar Pill, etc. (2) Removing heat-phlegm: The prescriptions used are Decoction for Clearing Away Gallbladder-heat, Alum and Curcuma Root, etc. (3) Resolving stubborn phlegm: The prescriptions used are Powder of Musk-melon Pedicel, Dragon-tiger Pill, etc. (4) Clearing heat and purging fire: The prescriptions used are Major Decoction for Activating Qi, Antidotal Decoction of Coptis, Decoction of Gentian for Purging the Liver-fire, etc. (5) Nourishing yin to reduce pathogenic fire: The prescription used is Fu Man Jian (composed of dried rehmannia root, ophiopogon root, dendrobium, anemarrhena, moutan bark, peony, grassleaf sweetflag, poria, tangerine peel and clematis (hocquartia), see《Complete Works of Zhang Jingyue》). (6) Removing blood stasis with potent drugs: The prescriptions used are Decoction of Peach Kernel for Activating Qi, etc. (7) Regulating the flow of qi to promote blood circulation: The prescriptions used are Decoction for Removing Blood Stasis in the Chest, Decoction for Relieving Manic-depressive Psychosis, etc. (8) Promoting flow of qi to alleviate mental depression: The prescriptions
used are Pill for Relieving Stagnancy, etc. (9) Nourishing the heart to calm the mind: The prescriptions used are Bolus for Tranquilization and Calming Mentality, Decoction of Licorice, Wheat and Date, etc. (10) Reinforcing the kidney and strengthening yang: The prescriptions used are Decoction for Strengthening Yang, Decoction of Two Immortals etc. (11) Restoring normal coordination between the heart fire and the kidney: Therapeutic effectiveness in varying degrees has been obtained with modification of above-mentioned prescriptions in all parts of the country.
A Study of Clinical Application of Simple Recipe and Proved Recipe
Several hundred reports on clinical observation of using simple and proved recipes have been published in this country, and part of these reports have data of experimental study, enriching the content of treating manic-depressive psychosis. For example, Zhang obtained better results using Decoction for Clearing Away Gallbladder-heat with increased ingredients, the prescription he used was Decoction for Clearing Away Gallbladder-heat plus parched wild jujuba seed, polygala root and tabasheer and had the effects of promoting circulation of qi to remove phlegm, removing heat-phlegm and tranquilizing mentality, being the uniform prescription for treating manic-depressive psychosis. For patients with severe and complicated disease, the following drugs must be added: (1) Those showing unconsciousness, anxiety, ravings, flushed face and conjunctival congestion, bright red tongue, yellowish fur, taut pulse or full and rapid pulse are of flaring heart-fire and disturbed mental activity and should be treated by clearing away the heart-fire with the previous prescription plus Wan's Bezoar Sedative Bolus. (2) Those showing high voice speaking and short breath, glaring eyes, pouring out a stream of abuse, savageness, irritability, fierce look, constipation, scanty dark urine, dry rough and yellowish fur or blackish prickled tongue, forceful pulse or slippery rapid pulse are of excessive fire with accumulation of phlegm and yangming heat of excess type and should be treated by purging the pathogenic fire to remove phlegm with the previous prescription plus Pill of Chlorite-schist for Expelling Phlegm. (3) Those showing insomnia and anorexia, dumbness, avoidance, dementia, saying no words, thin whitish or whitish greasy fur, deep taut or taut slippery pulse are of stagnation of qi and phlegm and blockage of channel and should be treated by alleviating mental depression and inducing resuscitation and by removing obstruction in the channels and removing phlegm with the previous prescription plus Storax Pill. For those with excessive fire and accumulation of phlegm and yangming heat of excess type, the use of drastic purgatives can produce rapid effect. For patients in initial stage of illness, such tonic drugs warm in nature as pilose asiabell root and astragalus root should not be used to avoid blockage of qi, support of fire and retention of phlegm. There are still reports on treatment of manic-depressive psychosis with Rhubarb Decoction, in which heavy rhubarb is used with compatible chlorite-schist, magnetite, gentian root and mirabilite. It is said that the Rhubarb Decoction is most suitable for those with heat of excess type who have taut, rapid and forceful pulse, bright red tongue, yellowish greasy fur, dry mouth with bitter taste, dark urine and constipation but is not suitable for those with severe dysfunction of the heart, liver, kidney, lung, etc. or those who are old and weak. Clinical observation made by many researchers from different institutions of this country has found that most of schizophreniacs have sign of blood stasis in varying degrees, such as purplish dark tongue or ecchymosis on the surface or tip and border of the tongue, or blue veins on the surface or sides of the tongue, and sublingual varicosity and that the use of Decoction for Removing Blood Stasis in the Chest to treat these patients has obtained better therapeutic effectiveness.
In the treatment with simple recipe, some therapeutic effectiveness has been obtained by using loranthus mulberry mistletoe, datura flower, nux-vomica seed, genkwa, knoxia root, buffalo horn and earthworm in treating psychosis by workers of many medical institutions. In addition, there are also reports on the use of acupuncture and moxibustion as well as cupping in treating psychosis with a certain curative effect.
The cause of manic-depressive psychosis is due mainly to internal injury of the seven emotions. The position of the illness is chiefly in the heart, spleen, liver and gallbladder, and the visceral dysfunction and imbalance of yin and yang caused by qi, blood, phlegm and stasis are the principal pathogenesis of the disease. Depressive psychosis belongs to yin and often manifests itself as depressive symptoms; mania belongs to yang and often manifests itself as manic symptoms. Clinically, depressive psychosis is generally classified into three syndromes: stagnation of phlegm-qi, deficiency of qi and phlegm stagnancy, and deficiency of both qi and blood and treated mostly by checking upward adverse flow of the lung or the stomach-qi and resolving phlegm and by relieving mental stress, those with deficiency syndrome due to chronic illness should be additionally treated by invigorating qi and nourishing the blood. Manic psychosis is generally classified into three syndromes: heart disturbed by phlegm-fire, hyperactivity of fire due to yin deficiency, and stagnation of blood and qi; patients with excessive fire and accumulation of phlegm and confused mental activity should be urgently treated by purging the pathogenic fire and removing phlegm; those with impairment of genuine yin in the advanced stage of the disease should be treated by nourishing yin and blood and clearing away fire of deficiency type; and those with blood stasis and stagnancy of qi should be treated by promoting blood circulation by removing blood stasis. In addition to pharmacotherapy, the prevention and nursing care of manic-depressive psychosis is also important and should not be neglected.
Ease Powder, Phlegm-Removing Decoction, Controlling Phlegm-fluid Pill and Decoction for Clearing Away Gallbladder-heat are the commonly used prescriptions.