The journal article originally appeared in the Pacific Journal of Oriental Medicine Spring 1995 No. 5 edition.
This paper concerns itself with the use of herbs to treat those psychological disorders which are rooted in the dysfunction of Heart Fire energies. While the emphasis here is on the Orifice (Cavity) Opening herbs, they cannot be considered in isolation from the attending disharmonies which inevitably occur and the herbs which are used to treat them. None of the following formulas are available at the present time as they are described in the literature due to restrictions based on a threat to endangered species or considerations of toxicity. Substitutes from among the substances listed below must be made depending on the diagnostic indications with regard to Qi, Yang, Yin and Blood deficiency, with regard to Phlegm and Heat, with regard to Blood stagnation and the need to Settle the Spirit.
These formulas include Bos and Musk, Bos and Curcuma, Rhinoceros and Succinum, Styrax Formula, Gleditsia and Asarum, Rhinoceros Horn and Antelope Horn, Yue Ju Wan or Pills to Relieve Stagnancy in the Chest, Guide out the Phlegm and Tan Qiao Huo Xue Tang or Unlock the Orifices and Invigorate the Blood Decoction.
Substitute herbs and a suggested substitute sample formula are listed below.
Clinical Considerations
In my practice I used these herb formulas to treat both mild, moderate and severe mental and emotional disturbances. The principle differences were in the greater or lesser weight given to specific herbs in the total picture and often increased dosages with the more severe disturbances.
In western medical terms these would include neurosis, depression, dipolar disorders and schizophrenia. In terms of
Chinese medicine the causes could be any combination of Zang- Fu disharmonies and Triple Burner pathology. The distinction between constitutional, congenital, childhood and adulthood aetiologies is also vital. Most important is an accurate diagnosis since the substances recommended for use in this discussion must be included in a matrix of treatment which accommodates the entire entity.
AWARENESS AND THE HEART
In my book Dragon Rises – Red Bird Flies I wrote that ‘Perhaps the most important consequence of the introduction of acupuncture into my practice was the flowering of awareness in my patients and my own appreciation of its significance to growth and development’. Awareness is the centerpiece of Zen Buddhism and is almost synonymous with the concept and experience of enlightenment.
The Heart Fire energies are deeply concerned with ‘creative awareness and expression’. With regard to awareness I wrote further that ‘Heart Yin inspires that substance (from Kidney Yin) into awareness and Heart Yang gives form to the creative idea. The dominance of consciousness and awareness, of creativity and love, by Fire energies places these energies in the center of all interpersonal considerations.
‘Also, in terms of consciousness and awareness, the Fire Element contacts the general energy (Heart), distributes it fairly (Triple Warmer and Pericardium), and purifies it (Small Intestine). On the level of feelings, and at their supreme maturation, these energies nourish and govern the awareness and the expression of unconditional love, both for self and for others.
‘The Earth Element bears the milk of human kindness and fulfils the basic ‘need’. This is the beginning of self-worth. The Heart Yin is the medium which enriches that ‘milk’ into the ‘cream’ of human congeniality and fulfils the basic ‘want’. Here is the source of all joy.
‘Heart energies are responsible for the higher, conscious, intellectual mental ‘investigation of life’ including: ‘awareness’, ‘symbol formation’, and the communication of ideas and feelings. The Heart ‘opens’ to the tongue and is embryologically close to the throat. There is a Hindu saying that ‘if one can close off the throat, one closes off the flow of thoughts’. The Heart controls the circulation of ideas within and between men.
‘Only through these Heart Yin energies do the Divine Spirit, Divine Love and Divine Will (discussed elsewhere in relation to Kidney Qi, Yin and Yang) come into conscious human awareness’.
Divine revelation is the gift of Heart Yin. A deficiency of Heart Yin will manifest as a ‘lack of awareness and consciousness of the inner self. An excess of Heart Yin energies involve ‘a greatly
enhanced awareness of both the inner chaotic world of the unconscious and the constantly impinging sensory’ and emotional stimuli from the outer world’. I Too much of a good thing is destructive.
All of the clinical issues mentioned below in the language and concept of Chinese medicine, Phlegm, Fire, Deficient Heat, Trapped Qi, Qi and Yang deficiency, closed Orifices, Blood stagnation all interfere with the ability of the Heart to fulfil its energetic function to maintain contact with, and sustain full awareness of the outer world of interpersonal affairs as well as the inner mental, emotional and spiritual world.
Depending on degree of interference, as well as other variables such as constitution, shock, trauma, nutrition, work, exercise and habits (drugs, sex etc.), there can be a wide variation in the severity and the nature of symptoms associated with the loss of awareness due to an impediment of the Heart and other Fire energies. Almost all psychological disorders can be understood as a function of awareness either in quantity, quality (perception
and distortion) and form. In fact the Greek word for insanity is alienation, which is in fact a loss of awareness of both the inner and/or the outer world.
The principle problems which attend human relationships fall mostly into the realm of communication. Fire energies are all about communication. Heart Yang and Pericardium Yang, Triple Warmer and Small Intestine energies, as discussed in my book, are all involved in the appropriate and effective expression of thoughts and feelings. Where the clarity of communication is involved, all of the distortions attending maladaptive discourse
are rooted in awareness. They are, therefore also ineluctably rooted in the integrity of the Heart and Fire phase.
Therefore, all human problems from marital and family conflicts to the most serious neurosis and psychosis are to some extent the manifestations of defects in Fire energy performance. The herbs which are listed below are critical to that performance in combinations dictated by an accurate Chinese diagnosis.
COMMENTS
Since the conventional herb formulas that clear Heat and open the orifices are no longer available due to the unavailability of substances from endangered species other combinations of substances are required at this point.
While orifice opening herbs were always a consideration in treating psychological disorders, phlegm removing herbs were included in my practice only if slipperiness was felt on the pulse, especially the Left Distal and/or Mitral Valve Positions. Slipperiness on other positions such as the Right Distal, and both Middle Positions also warranted consideration if the tongue and symptoms were appropriate. A vertical center line on the tongue with thick coating is a sign of phlegm in the Heart.
It is important to monitor the Heat removing herbs in these formulas since their continuation after the Heat is removed can weaken the Qi and Yang of the Heart. Likewise the Damp draining and Phlegm removing herbs will damage Heart Yin if not carefully monitored. Excessive use of formulas such as Niu Huang Qing Xin Wan can damage Heart Qi and Yin.
Classification of herbs affecting Heart
Function
In my practice there are several classes of herbs that function for this practice. One is simple Orifice opening, one is Phlegm removing, one is Heat astringing, one is Blood moving, one is Yin nourishing, one is Heat removing, one is Blood nourishing, one is Spirit settling and one is Qi nourishing. The Yin nourishing herbs are especially important where shock has been one aspect of aetiology, the representative formula is Sheng Mai San. The Blood tonifying and Spirit settling herbs are those most valuable for mild to moderate emotional instability or calming the mind.
ORIFICE OPENING HERBS
The following are herbs known to open the Heart orifices:
Acorus Shi cang pu
Antelope horn Ling yang jiao
Aquillaria Chen xiang
Benzoin An xi xiang
Borneol Bing pian
Calculus bovis Niu huang
Cinnebar Zhu sha
Clove Ding xiang
Curcumae Yu jin
Cortex albizzia He huan pi
Cypress Xiang fu
Eretmochelys Dai mao
Gleditisia fruit Zao jiao
Gold lin
Mastic Ru xiang
Musk She xiang
Persica Tao ren
Polygala Yuan zhi
Realgar Xiong huang
Rhinoceros horn Xi jiao
Styrax liquids Su he xiang
Succinum Hu pu
Venum Bufonis Chan su
Silver (Yin bo)
PHLEGM REDUCING HERBS
The following aromatic substances ‘vaporize’ phlegm as well as open orifices:
Acorus Shi cangpu
Calculus bovis Niu huang
Realgar Xiong huang
Polygala Yuan zhi
Other substances which assist in removing Damp and Phlegm
include:
Bamboo sap Zhu li
Bamboo shavings Zhu ru
Perilla fruit Zi su zi
Fritillaria Beimu
Trichosanthus fruit Gua lou
Concretio silicea bambusae Tian zhu huang
Concha cyclinnae sinesis Mai ge ke
Calculus rna ca cae mulattae Hou zao
Pinellia Ban xia
Arisma Tian nou xing
Platycodon jie gen
Gleditisae fruit Zao jiao
Agastache Huo xiang
Eupatorii fortunei Pei Ian
Magnolia bark Huo po
Polygala Yuan zhl
Atractylodes Bai zhu
Cardomon Sha ren
Aconite Fu zi
Many of the above assist by improving Spleen function and other by expelling Phlegm from the Upper Burner, especially the lungs.
HEAT ASTRINGING AND CALMING HERBS
Dragon bone long gu
Oyster shell mu li
Lotus seed lian zi
Wheat grain fu xiao mai
Cinnabar zhu sha
Pearl zhen zhu
Fluorite zi shi ying
Succinum hu po
BLOOD MOVING HERBS
Salvia Dan shen
Milletia li xue teng
Tumeric tuber Yu jin
Persica Tao ren
Carthamus Hong hua
Ramulus cinnamon Gui zhi
Red peony Chi shoo
Eupolphaga seu opisthoplatia Tu hie chong
Frankincense Ru xiang
Artemisia Anomalae Liu ji nu
Dragons blood Xue jie
Sappan Su Mu
Achyranthes Niu xi
Moutan Mu dan pi
Hirudo Shui zhi
Cnidium Chuan xiong
Yin Nourishing herbs
Ginseng Ren shen
American Ginseng Xi yang shen
Rehmannia Rehmannia sheng di
Asini a jiao
Lesser ginseng tai zi shen
Ophiopogon mai dong
Poria cocos paradicis fu shen
Schizandra wu wei zi
Lily bai he
BLOOD NOURISHING HERBS
Angelica sinesis dang gui
Euphorbia Longanae long yan rou
Zizyphus suan zao ren
Polygala yuan zhi
Polygoni multiflorurn he shou wu
Biota seed bai zi ren
Rehmannia shu di huang
Asini a jiao
Arboritae seed bai zi ren
Wild jujube suan zao ren
QI AND YANG NOURISHING HERBS
Ginseng ren shen
Poria cocos paradicis fu shen
Lesser ginseng root tai zi shen
Human placenta zhi he che
Ramulus cinnamoni gui zhi
Baked licorice zhi gan cao
Aconite fu zhi
HEAT REMOVING HERBS
Calcinitum han shui shi
Lotus plumule lian zi xin
Scute huang qin
Forsythia lian qiao
Yedeon’s violet zi hua di ding
Hb Andrographis Paniculate chuan xin lian
Dichroae febrifugae (poisonous) chang shan
Sophora subprostratae shan dou gen
TRAPPED QI AND HEAT
By trapped Qi (and heat) I am referring to conditions in which energy either cannot escape from an Organ (Inflated pulse quality) or cannot enter an Organ (Flat pulse quality). These conditions will be discussed in a forthcoming book on Chinese pulse diagnosis.’
Pinellia and Magnolia Formula Ban Xia Hou Po Tang
Clear the Plum Stone Throat Decoction Qing Mei Tang
The Formulas
A general formula for the Heart which I have recently developed in consultation with Miles Roberts is as follows.
Additions and subtractions can occur depending on the diagnosis, apart from Opening Heart Orifices and Removing
Phlegm Fire which is the subject of this article.
CALM HEART AND NOURISH SHEN (BLOOD AND QI)
Zizyphus – 10 gm Suan zao ren
Biotae seed – 5 gm Bai zi ren
Tarraradicis – 5 gm Fu shen
Polygala – 10 gm Yuan zhi
Longan – 5 gm Long yan rou
Dragon Bone – 5 gm Long gu
Cinnabar (when available) Zhu sha
Placenta – 10 gm Zhi he che
Cretegus – 5 gm Shan zha
MOVE HEART BLOOD
Persica – 5 gm Tao ren
Carthamus-IO gm Hong hua
Achryanthes – 10 gm Niu xi
Salvia – 10 gm Dan shen
Cnidium – 10 gm (circulation to the brain) Chuan xiong
MOVE CONSTRAINED LIVER QI AND LIVER WIND
Cyperus – 10 gm Xiang fu
Citrus Pongri Immaturus – 5 gm Chih shih
Gambir – 5 gm Gou teng
(Bupleururn – very drying especially in women) – 6 gm Chai hu
OPEN ORIFICES AND REMOVE PHLEGM
Acorus-5 gm shi chang pu
Calculus Bovis – 5 gm niu huang
Polygala – 3-6 gm yuan zhi
REMOVE EXCESS HEAT
Scute-5 gm huang qin
Forsythia – 5 gm lian qiao
YIN DEFICIENCY
Ophiopogon – 10 gm mai dong
Schizandra – 5 gm wu wei zi
Ginseng – 10 gm ren shen
Currently I use the base formula of Bamboo and Ginseng (Zhu Ru Wen Dan Tang) when I wish to remove Phlegm-Fire from the Heart if there is also Liver involvement and Bamboo and Hoelen (Wen Dan Tang) if there is no Liver involvement. In addition I add whatever herbs are available from the above list of Orifice Opening and Phlegm Fire removing herbs listed above.
Case history taken from Dragon Rises – Red Bird Flies
An example is a 63 year old woman who had been in and out of mental hospitals for about sixteen years. During this period of time, she had every type of diagnostic workup to no avail, and her treatment included many drugs and several courses of electric shock therapy which did not help. Her hospital diagnosis was ‘Chronic Schizophrenia’. When I first saw F., she walked around the room in circles at considerable speed, collapsing suddenly, and frequently breaking bones in the course of the fall. Her explanation for her behaviour was that someone was controlling her mind and forcing her to do this. The ‘someone’ was not clear at first. It was known that she has lived a life of service to her family and to her husband, who controlled her throughout her marriage.
At our first meeting, F. was running and falling as described above. I managed to feel her pulse briefly and noted clear-cut slipperiness on her Heart pulse and observed a thick coating on her tongue. I prescribed an herbal formula (Niu Huang Qing Xin Wan) to remove the mucous and heat from the Heart and open the Heart ‘orifices’.
Within three days she stopped the running and falling, and within a week she reported that she was no longer being
controlled. The slipperiness on the pulse disappeared and the tongue coating diminished. She was placed on a diet that minimised mucous-producing foods, and her gastrointestinal function was treated with herbs. Her improvement continued for one and a half years until she was convinced to stop her herbs by her sister who was a religious fanatic. While she did not revert to the running and falling she once again felt controlled and was violent towards her husband. Resumption of treatment was to no avail.
Conclusion
I have used the Orifice Opening and Phlegm removing herbs together with the other classes of herbs listed above to treat the entire spectrum of psychological misery from the least to the most disturbed.
Awareness is the critical attribute which ties all of these conditions together, whose presence is the single most important factor in health and whose deficit is the single most important factor in emotional, mental and spiritual disharmony.
I have attempted to explain the essential link between this critical awareness and the integrity of Heart and Fire energies which make these herbs so important to our well being.
References
- 1. Leon Hammer, MD, Dragon Rises – Red Bird Flies,
Station Hill Press, Barrytown, NY 1990, Pgs XVI, 19, 23, 32,
174,175,182,187. - Leon Hammer, MD, Contemporary Pulse Diagnosis,
Eastland Press, Seattle, WA, to be published in 1995.
