An Unimpeded State Of Mind
Wáng Xùgāo on Depression and Phlegm
I’ve been enjoying the presentations this month on the TCM Academy Spring Challenge (my own little contribution will post on Wednesday and be open for registrants through the end of the month). Since the series is focused on the Wood Element, there have been a lot of presentations on depression, in which the liver and gallbladder play a big part. So I thought I would post a short chapter on depression and phlegm by Wáng Xùgāo (王旭高, 1798-1862), from Yī Xué Chú Yán (醫學芻言, Medical Ruminations, 1862). This is my working version, and some commentary.
第五章 郁證、痰病
外感內傷，已言大略。又有郁證痰病，亦須講及。
郁證 郁證乃七情雜沓（沓：繁多。），難分經絡。如倦怠太息，或飢而不欲食，或食即飽脹，或心跳頭昏，或腰痠足軟，或火升內熱，即在一日之中，時覺暫快，時覺昏沉，懶於言動。婦人患此最多，每每經事不調，腹中時痛。古方治法雖詳，總以暢懷為要。治法如略有寒熱，尚未大虛者，逍遙散；倦怠少寐者，歸脾湯；心跳口乾內熱者，天王補心丹；兩足跟痛，腰膝痠痛，目花頭眩者，六味地黃湯；經不調而腹痛者，婦寶丹，即四物加阿膠、香附、艾葉等味也。
Chapter V Depression Patterns and Phlegm Diseases
We’ve already given a broad outline of external contraction and internal damage There is also depression patterns and phlegm diseases, which we should also speak about.
Depression Patterns: Depression patterns are a miscellaneous disarray of the seven affects (disarray: many and varied), difficult to differentiate into channels and network vessels. [There are manifestations] such as fatigue and sighing; perhaps hunger with no desire for food; or bloating after eating; or throbbing of the heart and dizziness; or aching lumbus and limp legs; or upbearing fire and internal heat; then within the space of one day, at times one feels temporarily keen, then temporarily disoriented, with sluggish speech and movement. Women suffer from this the most, and often have irregular menstruation at times with abdominal pain. Though the ancient formulas and treatment methods are elaborate, they generally emphasized an unimpeded state of mind.
The treatment methods are as such: in cases where there are a little chills and fever and not yet serious vacuity use Xiāo Yáo Sǎn [Free Wanderer Powder]; for those who are sluggish and lack sleep, use Guī Pí Tāng [Spleen-Returning Decoction]; for those with heart throbbing, dry mouth and internal heat, use Tiān Wáng Bǔ Xīn Dān [Celestial Emperor Heart-Supplementing Elixir]; for pain in both heels, aching pain of the low back and knees, flowery vision and dizziness, use Liù Wèi Dì Huáng Tāng [Six Ingredient Rehmannia Decoction]; for those with irregular menstruation and abdominal pain, use Fù Bǎo Dān [women’s precious elixir], meaning Sì Wù [Four Substance Decoction] plus ingredients such as Ē Jiāo [Colla Corii Asini], Xiāng Fù [Rz Cyperi], and Ài Yè [Fm Artemisii Vulgaris].
Mulch comments:
· Quite straightforward formula recommendations and wholly familiar to us in our practice environment today.
· Liù Wèi Dì Huáng Tāng isn’t generally thought of as a depression-lifting prescription today; if the depression is pronounced I would likely opt for Zī Shuǐ Qīng Gān Yǐn (Water-Enriching Liver-Clearing Beverage).
· We’ve discussed Guī Pí Tāng and Tiān Wáng Bǔ Xīn Dān in previous posts.
· Wang’s description of Fù Bǎo Dān is basically Jiāo Ài Sì Wù Tāng (Donkey Glue and Mugwort Four Substance Decoction) with added Xiāng Fù, a simple modification for a pattern of blood vacuity cold with some liver depression.
痰病 痰病多怪，周身無處不患，或喘咳多痰，舌苔厚膩，或舌紅口碎，頭目昏重，或經脈惕惕跳動，或如昧如狂，或嘔噦不眠，或頸項腿臂結核、痠疼。治痰方法總以二陳湯為主，老痰加南星、枳實，即導痰湯。頑痰不愈，礞石滾痰丸。如瓜蔞仁、海蛤粉、白芥子、風化硝、竹瀝、薑汁、蘿蔔汁，皆痰病可採之藥。至於夾火、夾寒、夾氣、夾郁、夾食、夾風、夾濕，即於寒、濕、風、火、氣鬱、傷食門中諸藥，採取一二味並用之可也。
Phlegm diseases: Phlegm diseases are numerous and strange, throughout the whole body there is nowhere that they cannot trouble; perhaps panting and coughing with copious phlegm, tongue coating thick and slimy; perhaps a red tongue with cracks in the mouth, heavy and clouded head and vision; perhaps fearful throbbing and thudding of the channels and vessels; perhaps as if one were stupid or insane; perhaps vomiting or lacking sleep; perhaps with nodules, tingling or soreness on the nape, legs, and arms.
The prescriptions and methods of treating phlegm generally use Èr Chén Tāng [Two Matured Ingredients Decoction] as the main formula; for old phlegm (lǎo tán) add Nán Xīng [Rz Arisaematis] and Zhǐ Shí [Fr Aurantii Immaturus], meaning Dǎo Tán Tāng [Phlegm-Flushing Decoction]. For obstinate phlegm that does not resolve, take Méng Shí Gǔn Tán Wán [Chlorite Phlegm-Rolling Pill].
For all phlegm diseases, one can select medicinals like Guā Lóu Rén [Sm Trichosanthis], Hǎi Gé Fěn [Concha Meretricis Pulverata], Bái Jiè Zǐ [Sm Sinapis Albae], Fēng Huà Xiāo [Efflorescentia Natrii Sulfatis], Zhú Lì [Succus Bambusae], Jiāng Zhī [Succus Zingiberis], Luó Bó Zhī [Succus Raphani]. As for [phlegm] mixed with fire, mixed with cold, mixed with qì, mixed with depression, mixed with food, mixed with wind, mixed with damp, go into the chapters on cold, damp, wind, fire, qì depression, and food damage and select one or two medicinals that you can use simultaneously [with the main prescription].
Mulch comments:
· Méng Shí Gǔn Tán Wán is Méng Shí (Lapis Chloriti), Dà Huáng (Rx et Rz Rhei), Huáng Qín (Rx Scutellariae Baicalensis), and Chén Xiāng (Lignum Aquilariae Resinatum).
· Jiāng Zhī and Luó Bó Zhī are ginger juice and daikon juice, respectively; in a pinch, ginger and daikon can be used as kitchen medicinals for treating phlegm.
· This chapter underscores the foundational role of Èr Chén Tāng in phlegm-transforming formulas.
As for the last line, Wáng writes in a later chapter, “For the prescriptions for various types of phlegm-rheum, I mainly rely on Èr Chén and add or subtract following the pattern (痰飲諸方，以二陳為主，余則隨證加減).” Among the types, he lists:
火痰加海蛤粉、瓜蔞霜、黃芩、浮石。
寒痰加乾薑、附子。
風痰加南星、天麻、竹瀝、薑汁。
燥痰加天冬、麥冬、玉竹、瓜蔞、連翹。
濕痰加蒼朮、白朮。
虛痰加人參、都氣丸、腎氣丸、金水六君煎。
食痰加枳實、萊菔子。
郁痰加川貝、川芎、香附、連翹。
· Fire-phlegm add Hǎi Gé Fěn, Guā Lóu Shuāng [Tricosanthis seed frost], Huáng Qín, Fú Shí [Pumice].
· Cold phlegm add Gān Jiāng [Rz Zingiberis], Fù Zǐ (Rx Aconiti Lateralis Praeparata)
· Wind phlegm add Nán Xīng, Tiān Má [Rz Gastrodiae], Zhú Lì, Jiāng Zhī.
· Dry phlegm, add Tiān Dōng [Rx Asparagi], Mài Dōng [Rx Ophiopogonis], Yù Zhú [Rz Polygonati Odorati], Guā Lóu, Lián Qiáo [Fr Forsythiae].
· Damp phlegm add Cāng Zhú [Rz Atractylodis], Bái Zhú [Rz Atractylodis Macrocephalae].
· Vacuity phlegm add Rén Shēn, Dū Qì Wán [Metropolis Qì Pill], Shèn Qì Wán [Kidney Qì Pill], or Jīn Shuǐ Liù Jūn Jiān [Metal and Water Six Gentlemen Brew]
· Food-phlegm add Zhǐ Shí, Lái Fú Zi [Sm Raphani].
· Depressed phlegm, add Chuān Bèi [Bulbus Fritillariae Cirrhosae], Chuān Xiōng [Rz Chuanxiong], Xiāng Fù, Lián Qiáo.
Conclusion
Depression and phlegm are pathomechanisms that present virtually every day in my clinic. As noted above, they can take many and varied forms, and a practical and flexible way to treat them is, from my point of view, a necessity. One of the things I love about Wáng Xùgāo is his pragmatic approach, of which this chapter is a prime example.
Students often ask about writing formulas, where does one start, it all seems overwhelming. One thing I recommend is to start with a small corpus of short formulas like Èr Chén Tāng, Sì Wù Tāng, and Sì Nì Sǎn (Counterflow Cold Powder), just add an assistant medicinal or two, and go from there.
That’s all for now. Thanks, as always, for reading.
Note: this publication is for information purposes only and is not intended as medical advice. Please seek the opinion of a health care professional for any specific medical issues you may have.
References
Wáng, X. (1862). Yī xué chú yán. https://jicheng.tw/tcm/book/%E9%86%AB%E5%AD%B8%E8%8A%BB%E8%A8%80/index.html
Wiseman, N., & Brand, E. (2020). Comprehensive Chinese materia medica. Paradigm Publications.