Differentiation and Treatment of Hysteria in Jin Kui Yao Lun
By Prof Engin CAN (Enqin Zhang)
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The term "hysteria" was first used in Greece in the 5th century BC by Hippocratic doctors. They were trying to explain an illness whose main symptom was a sense of gas running from the lower abdomen to the chest and throat or suffocation in the throat, or breathing difficulties and emotional conditions. As most of the patients were seen chiefly to be recently bereaved widows, so they thought the symptoms were caused by a wandering womb putting pressure on other organs. In TCM the symptoms of “hysteria” are mostly termed “Bentun”, Meihe qi” and Zang zao” and others according to different clinical conditions. Especially in Jin Kui Yao Lun 金匱要略There are many clauses discussing about hysteria’s aetiology, pathology and manifestation as well as herbal formulae with detailed preparation and explanation. Clinical practices have proved that most of the recipes in Jin Kui Yao Lue are really effective and still widely used by TCM doctors in the world today.
The Jin Kui Yao Lue, often translated into “Synopsis of Prescriptions of the Golden Chamber” in English, or “Synopsis of the Golden Chamber” for short, is a part of Shanghan Zabing Lun 傷寒雜病論 mostly translated “Treatise on Febrile and Miscellaneous Diseases”, written by the outstanding physician Zhang Zhongjing (Zhang Ji) in the East Han Dynasty. Unfortunately, shortly after being published, the Shanghan Zabing Lun was lost due to war. It was collected by later generations, and re-arranged by Dr. Wang Shuhe in the Jin Dynasty and then re-published by the Bureau for Collation of Medical Books of the Song Dynasty (1065). As a result, the Shanghan Zabing Lun was divided form one book into 2 books, one titled Shanghan Lun / “Treatise on Febrile Diseases Caused by Cold” 傷寒論; the other, Jin Kui Yao Lue/ Synopsis of Prescriptions of the Golden Chamber” 金匱要略
In Jin Kui Yao Lun, the aetiology, manifestations and treatments of Bentun, Meiheqi and Zangzao were mostly described in Chapter 8 on Pulse, Symptoms and Treatments of Bentun Syndrome, and also seen in Chapter 22 on Pulse, Syndrome and Treatment of Miscellaneous Gynecological Diseases. Now we discuss them one by one as follows:
1. Bentun 奔豚, or called Bentunqi奔豚氣: In Chinese, “Ben奔” means running; “tun豚 means pig; “qi氣” here means gas. The Bentun is the syndrome characterized by a feeling of gas rushing up through the thorax to the throat from the lower abdomen. At the onset, pain may be also felt in the lower abdomen suggesting the presence of compressed gas. The patient then feels the gas ascending to the chest and finally to the throat. Some patient may experience great pain. The symptoms often resolve in between two minutes and two hours and occasionally longer. However, the syndrome diminishes and finally subsides. However it may reoccur again in future.
The first text of Chapter 8 is to explain the cause of Bentun syndrome: The master said, “There are four kinds of diseases, namely Bentun, Vomiting of pus, Panic, and Fire-pathogen syndrome, all of the above are caused by fright/ 師曰: 病有奔豚, 有吐膿, 有驚怖, 有火邪, 皆從驚發得之
The above text of Jin Kui Yao Lue says that Bentun is caused by fright. According to TCM theory, this is because the kidney is hurt mostly by fright恐傷腎. If Bentun originates from a kidney disorder, when the vital energy of the kidney is disturbed, it ascends to the thorax and throat, like a pig running within the body. Additionally, liver disorders can also cause Bentun. Since both the kidney and liver are located in the lower portion of the body cavity, when their vital energy is disturbed, it may tend to rush upward.
The following text describes the manifestations and prescription of Bentun due to stagnation of the liver-qi: The Bentun syndrome, manifests as a feeling of qi-rushing toward to the chest, abdominal pain, alternating chills and fever, and should be chiefly treated by Bentun Tang/ Decoction for Bentun syndrome/奔豚氣上沖胸, 腹痛, 往來寒熱, 奔豚湯主之
Recipe: Bentun Tang/Decoction for Bentun/奔豚湯方:
Gancao甘草Radix Glycyrrhizae 2 Liang/6 g
Xiongqiong/Chuangxiong /川芎Rhizoma Ligustici Chuangxiong 2 Liang/9g
Danggui 當歸Radix Angelicae Sinensis 2 Liang/9g
Banxia 半夏Rhizoma Pinelliae 4 Liang/12g
Huangqin 黃芩Radix Scutellariae 2 Liang/9g
Shengge葛根 Radix Puerariae 5 Liang/15g
Shaoyao芍藥Radix Paeoniae 2 Liang/ 9g
Shengjiang 生薑Rhizoma Zingiberis Recent 4 Liang/12g
Ganligenbaipi 甘李根白皮Cortex Prunus Armeniacae 1 Sheng/9g
Notes: Today’s dosages “g” following “Liang” in the recipes of this article are mostly according to the Converting the Dosage in the East Han Dynasty into Today’s Dosage (see the table in the appendix attached) as well as our own experience.
Administration: All the 9 herbs should be decocted in water about 2 Dou (4,000ml) in the pot, until reduced to 5 Sheng (1,000ml). Filter the decoction for oral use, drink 1 Sheng (200ml) each time, 3 times a day, and also drink once at night/上九味, 以水兩鬥, 煮取五升, 溫服一升, 日三服, 夜一服
Explanation: The above recipe is mostly effective for the Bentun syndrome caused by pathogenic fire with ascending-qi which originates with an abnormal accumulation of the liver-qi. In the recipe , Ganligenbaipi 甘李根白, another name “Ligenbaipi 李根白皮 Cortex Prunus Armeniacae is a special herb for treating Bentun syndrome. Other herbs, Gegen 葛根Radix Puerariae and Huangqin 黃芩 Radix Scutellariae can clear away fire and calm the liver; Shaoyao 芍藥Radix Paeoniae and Gancao 甘草Radix Glycyrrhizae can relieve pain and other symptoms of Bentun syndrome; Shengjiang 生薑Rhizoma Zingiberis Recens, Banxia 半夏 Rhizoma Pinelliae as well as Ganligenbaipi 甘李根白皮Cortex Prunus Armeniacae can regulate the stomach and reverse the abnormal ascending qi. Danggui 當歸Radix Angelicae Sinensis and Chuanxiong川芎 Rhizoma Ligustici Chuanxiong can nourish blood and regulate the liver-qi. All the above herbs work together to form a compound recipe for treating the Bentun syndrome due to stagnation of the liver-qi.
However, if Bentun syndrome is caused by the cold adverse ascent-qi due to wrong treatment or other reasons, its symptom and treatment are quite different in Jin Kui Yao Lue, for example:
After adopting a diaphoretic, warming needle was used for further perspiration. If locus of puncture hole is left unprotected and comes into contact with cold, it will turn red and swell. An impulsive feeling will rise from the lower abdomen to the chest resulting in a Bentun syndrome. The treatment of this condition should be to apply a moxibustion cone on each locus and Guizhi Plus Guizhi Tang/Decoction of Cinnamon Twig Plus Cinnamon Twig will be given/ 發汗後, 燒針令其汗, 針處 被寒, 核起而赤者, 必發奔豚, 氣從少腹上至心, 灸其核上各一壯, 與桂枝加桂枝湯主之
Recipe: Guizhi Plus Guizhi Tang/Decoction of Cinnamon Twig Plus Cinnamon Twig 桂枝加桂枝湯 方.
Guizhi桂枝 Ramulus Cinnamomi 5 Liang/15g
Shaoyao 芍藥Radix Paeoniae 3 Liang/9g
Zhigancao甘草Radix Glycyrrhizae Praeparatae 2 Liang/6g
Shengjiang 生薑Rhizoma Zingiberis Recens 3 Liang /9g
Dazao 大棗Fructus Ziziphi Jujubae 12 Pcs