Neurosis is caused by long-term mental stress which results in imbalance of excito-inhibitory process of cerebral cortex. The patients get excited or fatigue easily, and are frequently accompanied with various forms of somatic discomfort. It is more common in middle-aged females. In TCM, this disease is categorized as "bu mei" (sleeplessness), "xin ji" (palpitation), "yu zheng" (melancholia), "yi jing" (emission), "ang wei" (impotence), "zang zao" (hysteria), "xu xun" (consumption), etc.

Main Points of Diagnosis

1. There is a history of mental conflict, or a long period of mental stress.

2. Major clinical manifestations

(1) Insomnia and reduced cerebral functions: such as insomnia, dreaminess, waking up easily, distractibility and bad memory.

(2) The emotion is easy to be changed, accompanied with restlessness, hypersensitivity, poor tolerance to the sound and light.

(3) Functional disorders of the viscera: The patients frequently complain of palpitation, abdominal distension, belching, anorexia, constipation, frequency of micturation, impotence, etc.

3. The organic diseases should be excluded after examinations of nervous and visceral functions.

Differentiation and Treatment of Common Syndromes     

1. Stagnation of the Liver-Qi

Main Symptoms and Signs: Emotional depression, doubting mania, anxiety, vertigo, blurred vision, fullness in the abdomen, eructation, anorexia, feeling of oppression in the chest, hypochondriac pain, irregular menstruation, reddish tongue with whitish fur, taut and thready pulse.

Therapeutic Principle: Dispersing depressed liver-qi to relieve emotional depression.

Recipe: Modified Bupleurum Powder for Relieving Liver-Qi

bupleurum root

nutgrass flatsedge

curcuma root

fruit of citron

white peony root

albizia flower

red sage root

All the above herbs are to be decocted in water for oral administration.

In addition, the recipe should include 10 grams of both medicated leaven and membrane of chicken's gizzard if the case is with indigestion; 12 grams of pinellia tuber, 10 grams of tangerine peel for the case with eructation and oppressed sensation in the chest; 10 grams of moutan bark and 10 grams of capejasmine when a disorder is ascribed to the fire-transmission due to stagnation of qi marked by bitter taste in the mouth, restlessness, headache, conjunctival congestion, red tongue with yellow fur, and taut rapid pulse; 10 grams of chrysanthemum and 15 grams of uncaria stem with hooks to treat such symptoms as dizziness and feeling of fullness in the head.

2. Hyperactivity of Fire due to Yin Deficiency

Main Symptoms and Signs: Anxiety, insomnia, dizziness, tinnitus, feverish sensation in the palms and soles, dry mouth with a few saliva, nocturnal emission, spermatorrhoea, premature ejaculation, palpitation, amnesia, soreness of waist, red tongue with yellowish fur, thready and rapid pulse.

Therapeutic Principle: Nourishing yin to clear away pathogenic fire.

Recipe: Modified Prescriptions of Decoction of Coptis and Donkey-Hide Gelatin and Heat-Tonifying Bolus.

dried rehmannia root

Chinese angelica

white peony root

ophiopogon root

coptis root

spiny jujube seed

fleece-flower stem

schisandra berry

poria with hostwood

red sage root

prepared licorice root

donkey-hide gelatin

All the above herbs are to be decocted in water for oral administration. In addition, donkey-hide gelatin is melted with the decoction for oral use.

If the patient is extremely disturbed by insomnia, 30 grams of raw fossil fragments and 30 grams of oyster shell ought to be administered. If deficiency of the liver-yin and kidney-yin is remarkable with symptoms of soreness and weakness of the loins and knees, 20 grams of prepared rehmannia root and 12 grams of wolfberry fruit be included. When a disorder is caused by insufficiency of the kidney-yang manifested as spermatorrhea, impotence, premature ejaculation, aversion to cold, cold limbs, listlessness, pale tongue, weak and deep pulse, the treatment should be aimed at tonifying the kidney-yang. The preferred recipe is modified Kidney-yang-reinforcing Bolus. The compositions are: prepared rehmannia root 20g, Chinese yam 12g, wolfberry fruit 12g, fruit of medicinal cornel 12g, dodder seed 12g, morinda root 12g antler glue 10g boiling water for oral administration with the decoction), red raspberry 10g, prepared aconite root 6g, epimedium 10g, curculigo rhizome 10g. All the herbs are to be decocted in water for oral administration.

3. Deficiency of the Heart and Spleen

Main Symptoms and signs: Dreaminess and being easy to wake, palpitation, amnesia, fatigue and weakness, anorexia, sallow complexion, pale tongue with thin whitish fur, thready and weak pulse.

Therapeutic principle: Invigorating the heart and spleen.

Recipe: Modified Decoction for Invigorating the Spleen and Nourishing the Heart.

astragalus root

codonopsis root

big-headed atractylodes rhizome

poria

Chinese angelica

spiny jujube seed

dried longan pulp

polygala root

aucklandia root

prepared licorice root

All the above herbs are to be decocted in water for oral administration.

If the patient ifs troubled by frequent insomnia, the recipe should include schisandra berry 10g, fleece flower stem 30g, or arborvitae seed 10g, raw fossil fragments 20g, oyster shell 20g, and if the patient complains of anorexia, 10 grams of membrane of chicken's gizzard. When a disorder is persistent depression resulting in impairment of the mind characterized by trance, dysphoria, sadness and melancholy and tending to cry, pale tongue with thin whitish fur, string-like and thready pulse, the treatment should be aimed at nourishing the heart to tranquilize the mind. Decoction of Licorice, Wheat and Chinese-Date with additional ingredients can be chosen for the case. It includes the following herbs:

prepared licorice root

light wheat

Chinese date

spiny jujube seed

arborvitae seed

albizia flower

dragon's teeth

curcuma root

All the above herbs are to be decocted in water for oral administration.  

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