Psychosis

Patient Information
Huang, a 20-year-old man from Tianjin, presented with psychosis.

Etiology
Chronic emotional depression led to mental disturbance.

Clinical Manifestations
Chest oppression with fever, loss of appetite, ascending qi from the lower abdomen and stomach triggering mental confusion, incoherent speech. Symptoms temporarily relieved after expectorating phlegm. Pulse: taut, hard, and wiry on the left; taut, long on the right. Both chi pulses weak on deep pressure. Rate: 5 beats per respiration.

Diagnosis
Rebellious liver fire driving Chong qi and stomach qi upward, compounded by phlegm obstructing the throat and brain, disrupting mental function.

​Left pulse (taut/hard): Liver blood deficiency with intense fire.

​Right pulse (taut/long): Rebellious Chong and stomach qi.

​Weak chi pulses: Deficient lower jiao qi, failing to anchor ascending qi.
Treatment: Subdue stomach and Chong qi, pacify liver fire, nourish liver blood, and clear heat.

Prescription

​Formula:
Raw Hematite (1 liang, powdered)
Magnetite (5 qian, powdered)
Dioscorea opposita (8 qian)
Raw Os Draconis (8 qian, crushed)
Paeonia lactiflora (6 qian)
Scrophularia ningpoensis (5 qian)
Platycladus orientalis seeds (5 qian)
Poria cocos slices (3 qian)
Pinellia ternata (3 qian)
Acorus tatarinowii (3 qian)
Polygala tenuifolia (2 qian)
Cinnabar (0.3 qian, powdered)
Decoct the first 11 herbs into a large bowl; take with cinnabar powder.

Follow-up
After 4 doses: Chest oppression and fever improved, appetite restored, ascending qi reduced without mental disruption. Pulses softened, but chi remained weak. Adjusted formula to fortify lower jiao:

​Revised Formula:
Raw Hematite (1 liang)
Cooked Rehmannia glutinosa (8 qian)
Dioscorea opposita (8 qian)
Lycium barbarum (6 qian)
Cornus officinalis (5 qian)
Paeonia lactiflora (4 qian)
Scrophularia ningpoensis (4 qian)
Poria cocos slices (2 qian)

Outcome
After 6 doses: Full recovery with normalized pulses.

Q&A
Q: Rehmannia is sticky and phlegm-inducing. Why was it used here without worsening symptoms?
A: Strategic herb pairing neutralizes drawbacks. For example, adding Hematite (8 qian) to Kidney Qi Pill (heavy in Rehmannia) resolved chest phlegm in a prior case. As Jin Gui Yao Lue states: “Shortness of breath with mild fluid retention should be treated by promoting urination—Ling Gui Zhu Gan Tang or Kidney Qi Pill.” This reflects Zhongjing’s wisdom in using Rehmannia despite its sticky nature, guided by formula synergy.

Key Notes

​Mechanism: Liver fire and Chong qi rebellion, compounded by phlegm, disrupted brain function.

​Strategy: Prioritized subduing rebellious qi and phlegm before tonifying lower jiao.

​Rehmannia’s Role: Despite its phlegm-inducing tendency, its synergy with Hematite and Kidney-nourishing herbs counteracted adverse effects, exemplifying formula balance.