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Differential Diagnosis:: Heart - Spleen Dual Vacuity

This document discusses deranged speech in Chinese medicine. It provides definitions, differential diagnoses for medical and psychiatric disorders, and explanations of etiology and pathogenesis from a Traditional Chinese Medicine perspective. It then outlines seven patterns of deranged speech with their associated symptoms, tongue and pulse diagnoses, treatment principles, example acupuncture and herbal formulas. The patterns discussed are Heart-Spleen dual vacuity, Yin vacuity-blood dryness, Liver depression qi stagnation, phlegm dampness confounding the orifices, phlegm fire harassing above, and blood stasis obstructing internally.

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58 views2 pages

Differential Diagnosis:: Heart - Spleen Dual Vacuity

This document discusses deranged speech in Chinese medicine. It provides definitions, differential diagnoses for medical and psychiatric disorders, and explanations of etiology and pathogenesis from a Traditional Chinese Medicine perspective. It then outlines seven patterns of deranged speech with their associated symptoms, tongue and pulse diagnoses, treatment principles, example acupuncture and herbal formulas. The patterns discussed are Heart-Spleen dual vacuity, Yin vacuity-blood dryness, Liver depression qi stagnation, phlegm dampness confounding the orifices, phlegm fire harassing above, and blood stasis obstructing internally.

Uploaded by

peter911x2134
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We take content rights seriously. If you suspect this is your content, claim it here.
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Deranged Speech (Yan Yu Cuo Luan)

In Chinese medicine, deranged speech refers to incoherent, illogical, nonsensical speech.

Differential Diagnosis: 
Medical Disorders:
A. Delirium
B. Dementia
C. Cerebrovascular Accdent (CVA)
D. Tic Disorders
E. Traumatic Brain Injury
F. Seizure Disorders
G. CNS Tumors
Psychiatric Disorders:
A. Schizophrenia and other psychotic disorders
B. Acute Mania in Bipolar Disorders or Schizo-affective Disorder
C. Pervasive Development Disorders

TCM Etiology & Pathogenesis: 


“Speech is a function of the heart. When heart Qi and blood are replete and exuberant, and the heart spirit is
quiet, the speech is orderly and coherent. However, when the heart Qi and blood are insufficient to construct
and nourish the spirit and its functions, then the spirit may become disquieted, the functions of the heart may
lose their duty, and the speech may become deranged. Hence, deranged speech is primarily associated
with either lack of construction and nourishment of the heart spirit or harassment and blockage of the heart
spirit by the three evil Qi of phlegm, heat, and static blood”1

TCM Pattern Differentiation: 


Heart –Spleen Dual Vacuity1 
Deranged speech, disinclination to speak, insomnia, heart palpitations, fatigue, lassitude of the spirit, cold
hands and feet, a tendency to loose stools, poor appetite, a sallow yellow or pale white facial complexion,
pale lips and nails, lack of strength
Tongue: pale, fat tongue w/ teeth marks on edges
Pulse: fine, weak, possibly slow
Treatment Principles: Supplement the heart and nourish the blood, fortify the spleen and boost the Qi
Acupuncture Treatment: CV-23, HT-5, SP-6, ST-36, BL-15, BL-20. Even technique
Herbal Treatment: Gui Pi Tang Jia Wei1
[ Huang Qi (10-15g.), Dang Shen (10g.), Bai Zhu (10g.), Fu Shen (12g.), Gan Cao (6-12g.), Dang Gui (6-
10g.), Long Yan Rou (10g.), Yuan Zhi (6-10g.), Mu Xiang (6g.), Shi Chang Pu (6g.), Sheng Jiang (3g.) Da
Zao (3-5 pieces

Yin Vacuity-Blood Dryness1 


Deranged speech, emotional lability, alternating joy and crying without apparent reason, insomnia, heart
palpitations, fatigue, a dry throat, possible night sweats, agitation
Tongue: red, scanty dryish coat
Pulse: fine, possibly rapid, possibly bowstring
Treatment Principles: Enrich Yin and nourish the blood, clear heat and quiet the spirit
Acupuncture Treatment: SP-6, KI-3, HT-7, HT-5, CV-23, BL-15, BL-17. Even technique
Herbal Treatment: Gan Mai Da Zao Tang Jia Jian1
[Gan Cao(10-15g.),Huai Xiao Mai(15-30g.),Bai He(30g.),Suan Zao Ren (12g.),Zhi Mu (10g.),Bai Shao
(10g.),Da Zao (10 pieces)]

Liver Depression Qi Stagnation1 


Deranged speech, irritability, emotional depression, taciturnity, chest oppression, rib-side distention
Tongue: normal or slightly darkish tongue, thin white coat
Pulse: fine, bowstring
Treatment Principles: Course the Liver and resolve depression
Acupuncture Treatment: LR-3, LI-4, LR-14, CV-23, HT-5. Draining Technique
Herbal Treatment: Si Ni San Jia Wei1
[Chai Hu (6g.), Zhi Ke (10g.), Bai Shao (10g.), Gan Cao (6g.), Fo Shou (10g.), Xiang Yuan (10g.), Mei Gui
Hua (10g.), He Huan Hua (12g.), Shi Chang Pu (6-10g.)]
Modifications: Insomnia: + Yuan Zhi, Suan Zao Ren

Phlegm Dampness Cofounding the Orifices1 


Deranged speech, muttering to oneself, slow reactions, mental-emotional confusion or abstraction, dizziness
and vertigo, nausea and vomiting, chest and abdominal oppression and fullness, profuse phlegm
Tongue: swollen, fat tongue, slimy white coat
Pulse: slippery, bowstring
Treatment Principles: Transform phlegm and dry dampness, open the orifices and quiet the spirit
Acupuncture Treatment: ST-40, CV-12, ST-36, SP-9, CV-23, HT-5. Even Technique
Herbal Treatment: Dao Tan Tang1
[Ban Xia (10g.), Tian Nan Xing (10g.), Zhi Shi (6g.), Bai Zhu (10g.), Fu Ling (10g.), Chen Pi (6g.), Yuan Zhi
(6-10g.), Shi Chang Pu (6g.), Gan Cao (3-6g.), Sheng Jiag (3g.)]
Modifications:
With Spleen Qi vacuity: + Dang Shen, Huang Qi
Simultaneous heart vacuity with insomnia & palpitations: + Suan Zao Ren, Wu Wei Zi, Bai Zi Ren, Dang
Shen

Phlegm Fire Harassing Above1 


Deranged speech, muttering to oneself, slow reactions, mental-emotional confusion or abstraction, dizziness
and vertigo, nausea and vomiting, chest and abdominal oppression and fullness, profuse yellow phlegm,
irritability or even irascibility
Tongue: red tongue, slimy yellow coat
Pulse: slippery, bowstring, rapid
Treatment Principles: Transform phlegm and clear heat, open the orifices and quiet the spirit
Acupuncture Treatment: ST-40, ST-41, LR-2, CV-17, CV-12, CV-23, HT-5. Draining Technique
Herbal Treatment: Huang Lian Wen Dan Tang Jia Wei1
[Huang Lian (3-6g.), Huang Qin (10g.), Shi Chang Pu (6g.), Dan Nan Xing (3-6g.), Ban Xia (10g.), Chen Pi
(6-10g.), Fu Shen (12g.), Zhi Shi (6g.), Zhu Ru (6-10g.), Gan Cao (3-6g.), Da Zao (3-5 pieces)]

Blood Stasis Obstructing Internally1 


Deranged speech, especially premenstrually or postpartum in females with either dysmenorrheal or
abdominal pain and scanty lochia, possible menstrual irregularity, dark dusky facial complexion, spider nevi,
hemangiomas, or varicosities Tongue: purple red or possible static spots or macules; engorged, tortuous
sublingual veins
Pulse: bowstring, choppy or bound
Treatment Principles: Quicken the blood and transform stasis, open the orifices and quiet the spirit
Acupuncture Treatment: SP-10, SP-6, LI-4, CV-23, HT-5. Draining Technique
Herbal Treatment: Tao Hong Si Wu Tang Jia Wei1
[Tao Ren (10g.), Hong Hua (10g.), Shu Di (12g.), Dang Gui (10g.), Chi Shao (10g.), Chuan Xiong (10-15g.),
Yuan Zhi (6-10g.), Shi Chang Pu (6g.)
Modifications: Simultaneous Qi vacuity: + Huang Qi, Dang Shen

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