What is the basis for the diagnosis and treatment of mental illness in Chinese medicine?

Wang Kentang (1549-1613), a famous medical doctor in Ming Dynasty, was known as Yutai (宇泰), Lianan (损庵), and Nianxi Jushi (念西居士). He was a learned and versatile scholar, good at poetry and calligraphy, and was known in Ming history as “a good reader, especially good at medicine”. Written by the evidence of the treatment of quasi rope” and Li Shizhen’s “Compendium of Materia Medica” for the Ming Dynasty’s medical masterpieces. The author on the treatment of mental illnesses on the idea of organizing and summarizing, to explore the following: 1, pick up the sage of the Olympic purpose of the identification of epilepsy symptoms since the “Neijing”, “difficult to Jing” to the Ming Dynasty, many medical doctors, epilepsy and eclampsia, which is important to the mental illnesses of more than a fixed symptom standard. In the Neijing, there are epilepsy, epilepsy, epileptic disease, bungling disease, top disease, epileptic disease, madness epileptic disease, bone epileptic disease, tendon epileptic disease, pulse epileptic disease, etc. In the Lingshu? Epilepsy” in “epilepsy began to be born, the first not happy, headache …… epilepsy began to work and lead the mouth to cry …… epilepsy began to work and anti-stiffness, so the spine pain”, epilepsy and epilepsy is difficult to distinguish. The Difficult Classic highlights and summarizes the disease mechanism of epilepsy (in fact, epilepsy) and madness, “The heavy yang is mad, and the heavy yin is epileptic.” The Classic of Difficulties. Fifty-nine Difficulties” talks about, “How can one distinguish between the diseases of madness and epilepsy? Ran: the beginning of madness, less lying and not hungry, from the high and wise, from the defense of wisdom, from the noble and arrogant, delusional laughter, good song and music, delusional behavior is also unceasing. When epilepsy begins, the mind is not happy, and the stiff servant looks straight ahead.” The epilepsy discussed by the Qin and Yue people still followed the old Nei Jing, and there was no lack of epilepsy and epilepsy that could not be distinguished. Sui Chao Yuanfang, “The Origin of All Diseases. Ghosts and Evils”: “Or speech is wrong, or crying and frightening, or epilepsy and fainting, or joy, anger, sadness and crying, or great horror and fear as if people are coming to drive away, or singing and whistling, or refusing to speak.” It can be said that the clinical manifestations of epilepsy and mania are much more detailed and accurate than before, but the name of the disease does not correspond to the symptoms. The remainder of the treatise calls epilepsy mostly epilepsy, such as “epileptic, stroke, servant also, spitting saliva, thirst, eye anxious, hands and feet dazzle geng, unconscious, a long time to Su” (“epileptic waiting”). The characterization of epilepsy as an episodic disorder of the mind, its “five epileptic disease wait” “five epileptic” (Yang epileptic, Yin epileptic, wind epileptic, wet epileptic, horse epileptic) is also epileptic epileptic seizures combined with the etiology of the name, it can be seen that Nestle’s for epilepsy epileptic and other symptoms of disease is still in the stage of exploratory understanding. Tang Sun Simiao made a vivid and realistic description of epilepsy: “…… the end of epilepsy, and see its disease, or silent and silent, or again talk and ramble, or sing or cry, or chant or laugh, or sleep and sit in a ditch, sip and eat feces and filth, or naked, or day and night wandering, or anger, or gossamer insects elves, hand chaotic Eye anxious, such as the kind of epileptic people”. Although Sun’s observations are more detailed than those of previous generations, he still did not distinguish between epilepsy and madness. Under the influence of the theory of “Neijing”, Liu Wansu and Zhu Danxi in the Jin-Yuan era elaborated on the mechanism of epilepsy and epilepsy, such as “epilepsy is caused by fire” and “phlegm is knotted in the heart and chest”, which still belonged to the category of the theory of all diseases. Wang Kengtang, who lived during the Jiajing and Wanli reigns of the Ming Dynasty, deeply studied Manipulas and Huang Huang, read a wide range of books, and took advantage of the strengths of many schools of thought, and compiled the “Guidelines for the Treatment of Seizures,” which is a book of more than 2.7 million words, covering internal medicine, gynecology, pediatrics, and external medicine. He took the classics such as “Neijing” and “Lingshu” as a guideline, focused on evidence-based treatment, explored the root cause, and collected the great achievements of pre-Ming medicine, and made a great leap in the understanding of epilepsy. For the first time, he made a clear differential diagnosis of epilepsy from the symptoms of epilepsy and madness: “To study the unique words of epilepsy, the ancestor of “Suwen”; the words of epilepsy and madness, the ancestor of “Ling Shu”. The epilepsy and madness are very different from each other, and they are not different in name but in reality.” “Epileptic or crazy or stupid, or singing or laughing, or sad or sobbing, such as drunkenness, speech has a head without a tail, dirty and clean do not know, for years and years do not heal, commonly known as the heart of the wind, which volunteers to high and do not try to desire more than one. The madness of the disease, rampant and violent, such as typhoid Yangming Da Shi madness, scolding and not avoiding affinity, or even climbed high and sing, abandon their clothes and go, over the wall on the house, not the force can be, or speak with people who have not yet seen things, such as the evil attached to the person is also. When epilepsy breaks out, the patient will not know who he is, will fall to the ground in a daze, and will not be able to realize the heights, or will even have a twitch, look upwards with the eyes, or make the sounds of the six animals in the mouth.” (Zi Zhi Qun Jiao. Epilepsy and Madness”) It was only at this point that epilepsy was recognized as a relatively independent disease. Mental illnesses often do not manifest themselves as individual, fragmented psychiatric symptoms, but rather as syndromes (symptom syndromes or symptom clusters) that have some internal connection or some sense of relatedness. Since the development of modern clinical psychiatry, due to the lack of sufficiently reliable and accurate objective examination means and methods, most of the clinical diagnosis of mental cases to a considerable extent still have to rely on the basic methods of questioning, conversation, observation, etc., to collect the relevant materials for judging the state of mind, make a symptomatic diagnosis, and then make a further diagnosis of the classification of the disease. Therefore, the symptoms of mental diseases are the basis for the diagnosis of mental diseases. The epilepsy and eclampsia discussed in Zhenzhi Zhiqian is a cluster or syndrome of mental disease symptoms that Wang cited the Neijing and other classics as the main points, and then referred to various schools of thought in the previous generations as the basis for exploring the origins, identifying differences and similarities, and making a clear distinction between the two. If we analyze the cognitive, emotional, and volitional aspects of modern psychological (mental) activities, it is not difficult to find that the symptoms and symptom clusters described by Wang Kentang can be corroborated with modern psychiatric terminology. For example, “if there is an evil attachment” (hallucination), “talking to people about things they have never seen” (delusion), “‘or foolishness’ ‘or foolish’ (delusion), “‘or stupid’ ‘like an idiot’ ‘speech with a beginning but no end'” (impoverished and ruptured thinking), and other symptoms are disorders of cognitive processes; “‘or madness, or singing or laughing, or sorrow or The symptoms such as “‘or madness, or singing or laughing, or sadness or weeping'” (the symptoms of ‘madness, cursing and insulting without avoiding affinity, or even climbing up high and singing, abandoning one’s clothes and walking away, and going up to the house over the wall, which is beyond one’s strength'” (the symptoms of high emotion, emotional vulnerability, and emotional outbursts) are affective disorders; while the symptoms of “not knowing the filth and cleanliness ” (lack of willfulness, inversion of intention), “‘like drunkenness’, ‘when the disease strikes, rampant and violent'” (psychomotor excitement) and so on are even more symptoms of volitional and behavioral disorders. (psychomotor excitement) are also symptoms of will-behavior disorders. As for the symptomatic description of “when epilepsy strikes, one faints and does not know who one is; one falls to the ground in a dizziness; one does not know what is high and what is low; and even one’s S is jerked, one’s eyes look upward, or one’s mouth makes the sounds of six animals”, the symptomatic description matches with that of the grand mal state of epilepsy in primary epilepsy of modern medical science. The recent Zheng’s will be depressed state, silent dementia, murmuring, expression of indifference, do not think of food, self-pity, etc. as epileptic symptoms; will be excited state, more words, incoherent, noisy scolding, manic restlessness, injuries and destruction of objects, do not avoid affinity, the two eyes look angrily, the red face for the manifestation of manic symptoms, the use of traditional Chinese medicine-based treatment with a small amount of Western medicine for the treatment of 125 cases, achieving 92% effective rate of the results. It can be said that Wang’s understanding of the symptoms of epilepsy has not only pointed out the direction of the ancient medical doctors’ diagnosis and treatment, but also has the role of starting and ending for the contemporary Chinese medicine practitioners in recognizing and treating mental diseases. He broke the narrowness of the “gateway” and took the lead in the “eclectic” approach. During the Jin Yuan period, Chinese medicine reached a full bloom stage, and many famous doctors actively explored the etiology and treatment of mental illnesses. Such as Liu Hetao in the “Suwen Xuanji original disease style? On epilepsy, Liu He-ma said, “Kidney water is the master of the will, and water and fire are opposite to each other. Therefore, if the fire of the heart is strong and the water of the kidney is weak, then it will lose its will and become mad. …… If the heart is very hot, then it will be more joyful and become mad. …… If the liver is real, then it will be more angry and become mad. The five will be issued, all for the heat, so the madness of the five will be issued between.” Its treatment of epilepsy, especially heavy spitting method, “spit out phlegm and saliva hostage, a sweep and healing”, the main to diarrhea fire gushing vomiting, “this Yang has more than the yin insufficient, three Chengqi soup with angelica, ginger and jujube, the name of angelica Chengqi soup to Lee several lines, waiting to do slow, to three saint San spit, after the use of cool septum san, wash the heart san, Huanglian detoxification soup transfer of the “. And Zhu Danxi on epilepsy, especially heavy phlegm knot. The “Danxi Xinfa? Epilepsy” puts forward the theory that the onset of epilepsy is related to “phlegm”, and that “the rate of phlegm is mostly due to the phlegm knot in the heart and chest”, and that phlegm is obsessed with the heart and orifices, and that the treatment should be to “calm the heart and mind, and to open the phlegm knot”. …… If heat is stored in the heart meridian, the heart should be cleared and heat removed, if phlegm is lost in the heart orifices, the phlegm should be removed and the heart should be tranquilized. But after the disciples, out of the need for controversy, many scholars are trapped in the abyss of the gateway, along the ancient rut, or stubbornly one’s own words to the exclusion of the other, or overkill, radical views, the formation of the pattern of the cold and warm water and fire strife. As the “Siku Quanshu synopsis” so-called: “(Xiyong) and jiebin at the same time, jiebin keep the law, and Xiyong quite able to change; jiebin still warm and tonic, and Xiyong quite with the cold, as well as if Yi Shui, Hetao each for the doorway.” “View Mu Xiyong of the remainder of the school, the virtual reality is different, but talk about the work of gypsum; Zhang Jiebin of the end of the stream, the diagnosis of the Hou did not apply, the first set of ginseng see. Wang Kengtang to rigorous and pragmatic attitude to realize that the portal of the bias of the medical development of the hazards brought about by the advocate of breaking the portal of the bias of narrow, wide collection of the long, with the eclectic first whip, to correct the bias, the exposition of their own theories, and is committed to clinical research. For example, his diagnosis and treatment of epilepsy and other mental illnesses are also good at summarizing the theories of former sages. In the book, “Epilepsy”, Xingxiang not only wrote about epilepsy, but also about the mental illnesses that he treated. Epilepsy” not only recorded a variety of experimental prescriptions such as Xingxiang San, Tianmendong Di Huang Paste, Qingxin Tang, Siqi Tang, etc., but also collected “Sun Zhaosheng treating a monk of Xiangguo Temple who suffered from epilepsy for half a year, and all the famous doctors were ineffective”, “Chen Liangfu treating a woman’s eyes to see ghosts, and the case of speech disorder”, “Slip Bo Ren treating a woman with epilepsy”, and “Slip Bo Ren treating a woman with epilepsy”. “Slip Bo Ren treats a monk with delirium and sees people as ghosts” and other doctors’ experiences, and includes the main acupuncture point formula and specific methods of applying needles and moxa in the treatment of epilepsy. The book also includes the main acupuncture point formulas and specific methods of applying acupuncture and moxa. Madness” also introduces the psychological treatment of Chinese medicine based on medication with the psychological treatment of emotion: “Sorrow and sadness hurt the soul and madness, when the joy to win, with warm medicine to supplement the soul of the yang …… joy to hurt the soul and madness, when the fear to win, when the cool medicine to supplement the yin of the soul.” Because of the malfunction of the internal organs, the real evil stagnation caused by mental disorders, Wang Kendang follow the scripture from the purpose of the “real diarrhea”, and flexibly used. For example, the “spirit of the door? Madness”: “the upper solid from the high suppression of the, raw iron drop drink, holding gallbladder pills, Yangzheng Dan. In the upper and thus over the, Gua Ti San, Lai d cream”; all the real evil committed, turbid gas upward, aggravating the symptoms of mental illness, the lower method can make the phlegm, fire, blood and so on with the lower and out, “Yang Ming real is the pulse of the ambush, it is appropriate to the lower, large Cheng Qi Tang, Angelica Cheng Qi Tang. For mania caused by yin and yang imbalance, partial deficiency and partial exuberance, “the deficiency should be supplemented by Ning Zhi Cream, Yi Drunken Cream, and Cinnabar Scatter. The disease of madness is characterized by less lying down. Less lying is Wei alone, Yang not Yin, so Yang Sheng Yin deficiency. Now faint its God to sleep, then the Wei get into the Yin, and the Yin to fill the Wei is not weak, Yang no Wei help is not full, so the Yin and Yang are flat and healing,” (“Shen Zhi Men. Madness”) Wang boldly applied the Ning Zhi cream to the Yin, and a drunken cream. Wang boldly applied the complementary method of treatment, showing his high level of medical skills. Wang inherited the doctrines of the four great masters of the Jin-Yuan school and focused on clinical practice without prejudice. In the “Department of Spirit and Mind. Eclampsia” combines Liu Wansu’s theory of fire-heat, “Fire is cooled by Qing Shen Tang, and if it can be brought down, it can be brought down by Cheng Qi Tang”; Danxi’s theory of phlegm-enchanted heart and orifices, “If there is phlegm, it must be spat out, and after spitting, Dongguan Anshen Pill and medicines for calming the liver are used”; and Zhang Zihe’s theory of “Eclampsia does not come to an end. “If epilepsy does not come, and the eyes stare like a fool, use San Sheng San” to treat epilepsy by gushing and vomiting method into one furnace. The method of “pass through the internal organs and diarrhea” is a therapeutic way to reverse the obstruction of phlegm and turbidity in epilepsy. Scholar Wang Qingqi believed that this method of treating epilepsy could guide turbidity downward and clear the orifices, aiming to pass down turbid evils, so that the evils could have a way out to eliminate the source of the disease. Wang Kentang summarized the knowledge of medical doctors on epilepsy before the Ming Dynasty and made a clear differential diagnosis from the symptoms, which was an epoch-making contribution. He created Xingxiang San (Nanxing semixia, Chenpi, Xiangsuizi, Alum, Ginger), Qingxin Tang (Ginseng, Poria Cocos, Fenghuang, Chaihu, Psoriasis, Bamboo Leaching, Gold Foil), Ningzhi Cream (Ginseng, Jujubae Radix Sourdalis, Poria Cocos, Frankincense, Succinum, Cinnabar), as well as the prescriptions that he recommended, such as Sanxingshan, Dachengqitang, Sishichitang, and so on, which were all used in the treatment of psychiatric illnesses such as chronic schizophrenia, affective psychiatric disorders, alcoholic psychiatric disorders, epilepsy, sleep disorders and so on. The author, under the guidance of Zhong, has used these prescriptions to treat chronic schizophrenia, affective mental disorder, alcoholic mental disorder, epilepsy, sleep disorder and other psychiatric disorders, and has achieved good results. The essence of the “eclectic medical style” founded by Wang is to advocate an academic model that combines the knowledge of a hundred schools of thought in a coherent and harmonized manner, with no bias. Nowadays, the wide application of new and effective antipsychotic drugs and antidepressant drugs has effectively controlled the symptoms of many mental illnesses, but the adverse reactions and side effects associated with them have restricted the improvement of patients’ adherence to treatment, so in the process of using Chinese medicine to treat mental illnesses, there is a need to complement the East and the West, combining the old and the new, incorporating the strengths of all and communicating with each other for development. Therefore, Wang Kentang’s ideas on the treatment of mental diseases and the style of learning he established are still of great practical significance.