bubble_chart Concept

Dysphoria refers to the symptoms of restlessness and heat in the heart, with agitated and restless hands and feet.

This condition was first mentioned in Neijing. Suwen. Zhizhenyao Da Lun refers to it as "restlessness and agitation." It is also described in Jingui Yaolue and later medical texts such as "Qianjin Fang," "Hejian Liushu," Dongyuan Shishu, and Zhengzhi Zhunsheng. It can be seen in various diseases of internal damage and external contraction, often caused by heat and fire, and is mostly associated with excess pattern.

Restlessness and agitation are actually two different symptoms. For example, "vexing fullness," "heart vexation," "fire vexation," "sudden vexation," "deficiency vexation," and "mild vexation" all belong to the category of vexation, which are subjective symptoms. "Agitation," "restlessness," and "mania" belong to the category of agitation, which are objective symptoms. Leizheng Zhicai states: "Internal heat causes vexation, external heat causes agitation. Vexation originates from the lungs, agitation originates from the kidneys. When heat spreads to the lungs and kidneys, dysphoria occurs." It also says: "Vexation is yang," "agitation is yin." This section discusses cases where both vexation and agitation are present. For cases of only vexation without agitation, refer to entries such as "vexing heat in the chest, palms, and soles."

bubble_chart Pattern Analysis

1. Yangming Excess Heat︰High fever dysphoria, profuse sweating and coarse breathing, constipation or heat retention with watery discharge, abdominal distension and fullness, hard pain or periumbilical pain with tenderness, or delirious speech, yellow and dry tongue coating, or even scorched black with prickles, surging or deep and replete pulse. Mostly caused by dryness-heat flooding internally and externally, or heat binding with dry feces, leading to obstruction of bowel qi. The key points for pattern identification should focus on high fever, thirst, sweating, surging pulse, or constipation, epigastric and abdominal hardness and fullness, pain with tenderness, old yellow tongue coating or prickles, deep and replete pulse with strong force. The treatment should focus on clearing heat and promoting fluid production, clearing heat and purging the lower. Select White Tiger Decoction or Major Purgative Decoction according to the syndrome.
2. Heat Entering the Nutrient-Blood Level︰fever aggravated at night, dysphoria insomnia, or even mania, macula and papule eruption, hematemesis epistaxis, or hematuria bloody stool, tongue texture crimson, pulse thready and rapid. Mostly due to unresolved qi aspect pathogens, with pathogenic heat taking advantage of deficiency to invade the heart-nutrient level, hence manifestations such as heat penetrating the blood collaterals (rash and macules), reckless blood flow (hematemesis, epistaxis, hematuria, bloody stool), internal stirring of liver wind (limb twitching), and excessive heat damaging yin (dry mouth and throat). The key diagnostic points include dysphoric restlessness, eruption of macules and papules, blood loss, yin damage, and deep crimson tongue color. Treatment should focus on expelling nutrient-level heat through the qi aspect, clearing heat and cooling blood, using formulas such as Nutrient-Clearing Decoction or Rhinoceros Horn and Rehmannia Decoction.
3. Exterior Cold and Interior Heat︰aversion to cold with fever, without sweating dysphoria, headache and body pain, tongue coating thin blackend swallowwort root yellow, pulse floating and tight. It is caused by external wind-cold obstruction and internal yang-heat stagnation, hence presenting both exterior cold pattern with fever, aversion to cold, body pain, without sweating, floating and tight pulse, as well as signs of internal heat disturbance such as dysphoria and white tongue coating mixed with yellow. The treatment focuses on externally resolving wind-cold and internally clearing stagnant heat, using Major Blue Dragon Decoction.
4. Shaoyang Stagnation-heat︰chest and hypochondriac fullness and distress, dysphoria delirious speech, fright and vigilance restlessness, dysuria, general heaviness of the body, inability to turn over, thin yellow tongue coating, wiry and rapid pulse. The syndrome belongs to half-exterior half-interior, dysphoria accompanied by chest and hypochondriac fullness and distress, dysuria, fright and vigilance restlessness, heavy sensation in the limbs, inability to turn over. The treatment focuses on harmonizing shaoyang, clearing heat and calming fright, using Bupleurum Decoction Plus Dragon Bone and Oyster Shell.
5. Internal Disturbance of Phlegm-Fire︰Fever, flushed face, rapid breathing, restlessness, yellow and sticky phlegm, severe constipation, scanty dark urine, red tongue texture, yellow greasy coating, slippery and rapid pulse. Manifested as vexing heat in the heart, restlessness, yellow and sticky phlegm, rapid breathing and panting fullness, fever with flushed face, red tongue texture, yellow greasy coating, slippery and rapid pulse. Mostly caused by prolonged retention of phlegm, stagnation transforming into heat, or emotional frustration, {|###|}qi depression transforming into fire{|###|}, or {|###|}external contraction of seasonal pathogens{|###|}, transforming into heat and fire, scorching fluids and condensing them into turbid phlegm, with phlegm and fire binding together to disturb {|###|}mental activity{|###|}. Treatment focuses on {|###|}clearing and resolving heat-phlegm{|###|}, using the formula Gallbladder-Warming Decoction with additions such as {|###|}Coptis Rhizome{|###|} and {|###|}Skullcap Root{|###|}.
6. Static Blood Rushing to the Heart︰Heart dysphoria and restlessness, cyanotic lips and face, dark eye sockets, stabbing pain in the chest, or hardness and fullness with pain in the lower abdomen, normal urination, dark-colored stools that are easy to pass, purple-dark tongue texture with ecchymosis, deep and choppy or knotted and intermittent pulse. Accompanied by dull complexion, bluish lips, abdominal masses with hardness, fullness, and pain, cyanotic skin, or ecchymosis, purple-dark tongue texture, and other symptoms. Due to pathogenic heat lingering and penetrating deeply into the blood collaterals, blood being scorched by heat and flowing sluggishly, leading to stasis obstructing the heart orifices; or prolonged blood stasis stagnating and transforming into heat, with heat congesting blood stasis and disturbing the heart-mind. Treatment focuses on invigorating blood and resolving stasis, using Blood House Stasis-Expelling Decoction with modifications.
7. Yin Deficiency︰Restlessness and insomnia, agitation and unease, palpitation or severe palpitation, forgetfulness and dreamfulness, soreness and weakness in the lower back and knees, flushed cheeks and red lips, feverish sensation in the palms and soles, tidal fever and night sweats, dry throat and mouth, dark urine and dry stools, red tongue with scant coating, and thready rapid pulse. This is caused by prolonged illness damaging yin, or internal injury from the seven emotions, or aging and physical decline leading to insufficient kidney yin, resulting in water deficiency and floating fire that disturbs the heart-mind. During pattern identification, it is characterized by obvious symptoms of yin deficiency with internal heat, such as tidal fever or steaming bone fever, flushed cheeks and red lips, dry mouth and throat, red tongue with scant coating, and thready rapid pulse. The treatment should focus on nourishing yin and reducing fire, using the formula Anemarrhena, Phelloendron and Rehmannia Pill.

The condition of dysphoria is essentially rooted in two aspects: deficiency and excess. In cases of excess, it is often caused by pathogenic heat, phlegm-fire, and static blood. In cases of deficiency, it is mostly due to yin deficiency with effulgent fire. However, regardless of whether the condition is one of deficiency or excess, it is frequently associated with fire in the Heart Meridian. The heart stores the spirit and governs mental activity. When mental activity is disturbed by heart fire, dysphoria and restlessness ensue. Zabing Yuanliu Xizhu states: "Dysphoria is a fire disease Rebing of the Heart Meridian." The treatment should primarily focus on clearing heat and purging fire. Once the fire is subdued, the heart spirit will be calm, and dysphoria will be cured.

bubble_chart Documentation

1. Suwen-Zhizhenyao Da Lun: "The predominance of Shaoyin causes heat below the heart, frequent hunger, reverse movement below the navel, qi wandering through the triple energizer, the arrival of intense heat, the wood producing fluid, the grass withering, vomiting, irritability, abdominal distension and fullness, pain, sloppy diarrhea, transforming into red dysentery."Jingui Yaolue．Water Qi Abnormal Pulse Syndrome and Treatment:
2. "Heart failure causes a heavy body and shortage of qi, inability to lie down, irritability and agitation, swelling of the vulva."
3. Zhangshi Yitong．Dysphoria: "The classic says: Qi disorder in the heart causes irritability, as heat residing in the lung causes irritability, entering the kidney causes agitation. Generally, when heart fire is strong, water is deficient and metal is scorched, only fire is blazing, thus the lung and kidney combine to cause dysphoria."
4. Zabing Yuanliu Xizhu．Dysphoria Forgetfulness Origin: "Internal heat and heart irritability are called irritability, thus irritability is only the depression and irritability in the heart. External heat and body agitation are called agitation, thus agitation is the external heat and agitation of the body. Internal heat belongs to rooted fire, its origin is heat. All cases of only irritability without agitation and first irritability then agitation are easy to treat, external heat belongs to rootless fire, its origin is cold, all cases of only agitation without irritability and first agitation then irritability are difficult to treat."
5. Leizheng Zhicai．Dysphoria: "There is also dysphoria from yang hidden in yin, headache, warm body, cold fingertips, chest fullness, nausea, deep and hidden pulse, pressing the bone feels forceful, must break up yin qi, guide and reach true fire. The original method uses Poyin Dan. For the syndrome of yang hidden in yin, using hot medicine to assist yang, it is blocked by yin, unable to conduct and exercise true yang. Using cold medicine, the hidden true fire immediately disappears; using Poyin Dan, makes water rise and fire descend, achieving sweat and recovery."