bubble_chart Concept

Unconsciousness refers to a state of mental confusion and loss of consciousness, where the individual may even fail to respond to external stimuli.

This condition is referred to by various names in classical medical texts. Suwen calls it "sudden loss of awareness" or "inability to communicate with others"; the "Cold-Damage Disease Treatise" refers to it as "failure to recognize people"; Zhubing Yuanhou Lun , Zhangshi Yitong , and others describe it as "mental stupor"; Danxi Xinfa terms it "unconsciousness" or "unawareness"; Yizong Bidu , Zhengzhi Zhunsheng , Zhengyin Maizhi , and others also refer to it as "unconsciousness".

Unconsciousness is distinct from "drowsiness". Drowsiness is when the patient frequently feels the urge to sleep, can be awakened when called, but falls back asleep shortly after. Unconsciousness also differs from "syncope"; the former involves prolonged loss of consciousness and is not easily reversible, while the latter involves a sudden fainting spell with temporary unconsciousness, from which the patient gradually recovers after a short period. Conditions like "corpse syncope", "major syncope", and "scorching syncope" are characterized by sudden fainting, loss of consciousness, and a state resembling death, with prolonged inability to regain consciousness, thus also falling under the category of unconsciousness. The altered states of consciousness in "qi syncope", "blood syncope", "phlegm syncope", and "crapulent syncope" are often temporary and are discussed under the section on syncope. Unconsciousness is different from "depression and dizziness", which refers to a state of melancholy and vertigo, sometimes leading to temporary syncope, and can be caused by blood deficiency, damage to bodily fluids, liver qi depression, or obstruction by external pathogens. Jingui Yaolue states in the section on pulse diagnosis and treatment of women's pregnancy diseases: "Postpartum depression and dizziness... the reason for this is blood deficiency leading to syncope, and syncope inevitably causing dizziness."

Conditions such as "heat entering the uterus" in women, "eclampsia", and "infantile convulsion" leading to unconsciousness will be discussed in relevant sections and are not covered here.

bubble_chart Pattern Analysis

1. Heat Invading the Pericardium︰High fever, dysphoria, unconsciousness, delirious speech, red eyes, parched lips, stiff tongue with slurred speech, rash and macules, cold limbs, dark urine, constipation, red and crimson tongue texture, surging and rapid pulse. This syndrome is mainly caused by scorching of nutrient-blood by warm-heat pathogens, which internally invade the pericardium. The onset is sudden, fierce, and dangerous, with "reversed transmission to the pericardium" being particularly prominent. Depending on the location of the pathogen, unconsciousness can be differentiated as "heat in the nutrient aspect" or "heat in the blood aspect." The distinctions are as follows:
   1. When heat enters the nutrient aspect, it damages the nutrient yin, leading to symptoms such as fever aggravated at night, faint rashes, crimson tongue without coating, and thin, rapid pulse. The Wenre Lun states: "When the nutrient aspect is affected by heat, the blood is compromised, the spirit becomes restless, and sleep is disturbed at night"; "If heat transmits to the nutrient aspect, the tongue color will surely be crimson... If the lips are crimson and bright, it indicates disease of the pericardium." Unconsciousness due to heat invading the blood aspect, in addition to symptoms of pathogens in the nutrient aspect, also includes hematemesis, epistaxis, hematuria, blood accumulation, as well as rashes and macules, with purple macules appearing as dots.
   2. The tongue is the sprout of the heart. When heat invades the blood aspect, intense fire-heat scorches body fluids, generating turbid phlegm, which obstructs the heart orifices, causing a stiff tongue and slurred speech. Pathogenic heat trapped internally prevents yang qi from reaching the exterior, resulting in cold limbs. These manifestations are mostly absent when heat is in the nutrient aspect.
   3. The degree of unconsciousness also differs: in the nutrient aspect, it is merely due to nutrient-heat disturbing upwards, so unconsciousness is mild or consciousness may remain clear at times. In the blood aspect, unconsciousness is more severe.
   For heat in the nutrient aspect, treatment involves clearing the nutrient aspect and discharging heat, awakening the spirit and opening the orifices, using Nutrient-Clearing Decoction taken with Purple Snow Bolus and others. For heat in the blood aspect, treatment involves cooling blood to remove toxins, clearing the heart, and awakening the spirit, using Rhinoceros Horn and Rehmannia Decoction taken with Peaceful Palace Bovine Bezoar Pill or Supreme Treasured Pill .
2. Visceral Heat Steaming︰The mind is unclear, with delirious speech and floccillation, high fever or late afternoon tidal fever, red face and eyes, abdominal distension that feels hard upon palpation, constipation or heat retention with watery discharge, dark yellow urine, old yellow tongue coating that is dry and prickly, and a pulse that is surging or deep, hidden, and forceful. This is due to pathogenic heat penetrating deeply into the interior, combining with retention of food, resulting in yangming fu-organ excess. The qi of dryness-heat, mixed with turbidity, rises and surges upward, steaming and disturbing mental activity. It often occurs or worsens in the afternoon and is closely related to constipation. When constipation occurs, the stomach and intestines are obstructed by dryness and excess, leading to stagnation of fu-organ qi. The rising qi of turbid toxins steams upward, disturbing mental activity. Thus, the more severe the constipation, the worse the unconsciousness becomes. Treatment should involve bitter-cold purgation to drain heat and unblock the bowels, and options include Major or Minor Purgative Decoction. Once the fu-organ heat is cleared, intestinal dryness is resolved, and pathogenic factors no longer surge upward, the spirit will naturally calm.
3. Heat Toxin Attacking the Heart︰High fever with delirium, flushed and swollen face, swollen throat with ulceration, epistaxis and bloody stool, macules and papules appearing purplish-black, sores and ulcers or erysipelas spreading, multiple abscesses dispersing, crimson tongue with scorched coating or prickles, slippery and rapid pulse or six pulse conditions showing deep, thin, and rapid. This is due to the invasion of fire toxin seasonal epidemic pathogens, inward invasion causing running yellow, disturbing the nutrient aspect and damaging blood, transmitting to the pericardium, and impairing the movement of the spirit mechanism. The degree of unconsciousness is severe, accompanied by signs such as toxin congestion in the upper energizer, toxin scorching qi and blood, multiple abscesses in the limbs, and residual toxin damage to yin. This is commonly seen in swollen-head infection, suppurative parotitis, boils and sores, running yellow, and other diseases. Treatment focuses on clearing heat-toxin at the qi aspect and awakening the spirit by orifice-opening. Large doses of heat-clearing and toxin-removing herbs can be used, such as Rhinoceros Horn and Rehmannia Decoction or Plague-Clear Toxin-Vanquishing Decoction, taken with Peaceful Palace Bovine Bezoar Pill. For cases with residual toxin damage to yin, where kidney essence is depleted and the primordial spirit lacks nourishment, nourishing yin fluids is necessary, using Modified Pulse-Restoring Decoction tailored to the condition.
4. Summer-heat Invading Upward︰Sudden collapse, body heat and cold limbs, flushed complexion, or a dirty face, coarse breathing like panting, cold sweating incessantly, scanty dark urine, and a weak, rapid, and large pulse. This condition is only seen during the scorching summer months, caused by the invasion of summerheat pathogens, which consume qi and damage fluids, leading to a sudden collapse of qi and fluids, disrupting mental activity. Apart from unconsciousness, it is also accompanied by symptoms such as body heat, a dirty face, coarse breathing like panting, incessant cold sweating, reversal cold of limbs, and a weak, large, and rapid pulse. Treatment involves opening the orifices with pungent-cool medicinals, using formulas such as Purple Snow Bolus or Peaceful Palace Bovine Bezoar Pill.
5. Dampness-heat︰Hiding fever, bitter taste in mouth with stickiness, thirst without desire to drink, yellow complexion, heavy and fatigued limbs, chest and abdominal stuffiness and oppression, bloody or white dysentery, gradually leading to clouded spirit and consciousness, sometimes conscious, sometimes lethargic, or unconsciousness, red tongue with yellow greasy and foul coating, soggy and thin or slippery and rapid pulse. This condition arises when dampness-heat pathogens stagnate and obstruct the qi aspect without resolution, brewing and steaming phlegm-turbidity to cloud the heart orifices. It often manifests with intermittent clarity and confusion, presenting a hazy state, accompanied by hiding fever, heavy and sluggish limbs, dark urine, yellow eyes like the color of oranges, or bloody or white dysentery with tenesmus, yellow greasy tongue coating, and other signs of dampness-heat pattern. Treatment should focus on clearing heat and resolving dampness, as well as resolving phlegm for resuscitation. Prescriptions such as Acorus Curcuma Root Decoction or Styrax Pill may be selected.
6. Excessive Heat Generating Wind︰High fever convulsion, unconsciousness, scorching heat and cold limbs, opisthotonos, neck stiffness, upward staring of the eyes, red face and red eyes, scanty dark urine, constipation, red tongue texture, wiry and rapid pulse. The mechanism of disease is excessive pathogenic heat scorching the liver meridian and disturbing mental activity. Treatment involves clearing heat and extinguishing wind, awakening the spirit and opening the orifices. The prescription uses Antelope Horn and Uncaria Decoction combined with Purple Snow Bolus.
7. Stirring Wind Due to Yin Deficiency︰Occasional dizziness, blurred vision, numbness or trembling of limbs, followed by sudden fainting, slurred speech, {|###|}hemiplegia{|###|}, deviation of the mouth and eyes, a red tongue with scant coating, and a wiry, thin, and rapid pulse. The main symptoms are deviation of the mouth and eyes, {|###|}hemiplegia{|###|}, and slurred speech, primarily caused by chaotic {|###|}qi and blood counterflow{|###|} and obstruction of the meridians. The {|###|}mechanism of disease{|###|} is: {|###|}liver-kidney yin deficiency{|###|}, hyperactivity of deficient yang surging upward to the vertex, disturbing the spirit. Treatment should focus on {|###|}nourishing yin and subduing yang{|###|}, {|###|}pacifying the liver and extinguishing wind{|###|}. The recommended formulas are Major Wind-Stabilizing Pearl Decoction or Gastrodia and Uncaria Drink.
8. Wind Phlegm︰Sudden collapse, unconsciousness, tremor convulsion, drooling from the corners of the mouth, phlegm rales in the throat, deviation of the mouth and eyes, hemiplegia, white and greasy tongue coating, wiry and slippery pulse. The condition is caused by wind-phlegm, resulting from an inherently excessive phlegm constitution combined with exposure to wind pathogens, or hyperactivity of liver yang generating internal wind. Wind and yang carry phlegm to disturb the heart orifices, leading to unconsciousness, accompanied by symptoms of wind stirring internally such as limb tremor, convulsion, hemiplegia, and frothing at the mouth. Treatment should focus on pacifying the liver and extinguishing wind, resolving phlegm for resuscitation. Prescriptions include Phlegm-Cleansing Decoction, Gastrodia and Uncaria Drink, and others.
9. Static Blood Invading the Heart︰Confusion, delirious speech, restlessness, curled and shortened tongue, scorching body heat, hard and full lower abdomen, cyanotic lips and nails, black and easily passed stool, clear urine, dark purple tongue texture, deep and rough pulse. The key points of differentiation lie in the presence of symptoms of static blood besides unconsciousness, such as cyanotic lips and nails, hard and full lower abdomen, black stool, clear and profuse urine, dark purple tongue texture with purple spots. Wenre Lun states: "In summer, prolonged heat entering the blood often leads to blood accumulation, with symptoms of delirious speech and unconsciousness. The diagnosis should be confirmed by clear and profuse urine and black stool." In some cases, it may be difficult to determine whether unconsciousness is caused by static blood during the unconscious phase, but when black stool is passed and consciousness gradually returns afterward, it confirms that unconsciousness was due to blood stasis and obstruction. This syndrome is often caused by heat entering the nutrient-blood level, where blood and heat congeal and block the heart, or by exposure to pathogenic toxins during childbirth, leading to a struggle between pathogens and blood. If static blood remains unresolved, blood stasis and qi counterflow disturb mental activity, or dead blood lingers in the heart orifice, impairing the spirit mechanism. Unconsciousness due to瘀熱阻竅 (stagnant heat obstructing the orifices), heat entering the uterus, or real heart pain all fall into this category. When stagnant heat obstructs the orifices, delirious speech and scorching body heat appear; when heat enters the uterus, alternating chills and fever resembling malaria occur, with dark purple and clotted menstrual blood; in real heart pain, sudden heart pain, a blue complexion, and cold qi are observed. All these must be carefully differentiated in clinical practice. For treatment, the focus should be on removing stasis and opening the orifices, with appropriate selection of Collateral-Clearing Decoction or Blood House Stasis-Expelling Decoction. For postpartum static blood rushing to the heart, modified Peach Kernel Chengqi Decoction can be used.
10. Yin Exhaustion and Yang Collapse︰Drowsiness and unconsciousness, profuse sweating and warm limbs, shortness of breath, gradually turning to pale complexion, feeble breathing, cold and sticky sweating, reversal cold of limbs, involuntary discharge of urine and feces, pale tongue with white coating, faint and imperceptible pulse, or weak and rootless pulse. Mostly caused by excessive loss of blood, leading to qi collapse following blood loss; or frequent diarrhea, resulting in spleen qi exhaustion; or after profuse sweating, leading to internal fluid depletion. Initially, there is often yin exhaustion (warm hands and feet, hot and salty sweat, thirst with desire for cold drinks, coarse breathing, red and dry tongue, rapid and weak pulse), followed by yang exhaustion, manifesting as pale complexion, great dripping sweating, feeble breathing, and faint and imperceptible pulse. As for yang exhaustion leading to yin exhaustion, it is generally less common and should be treated by restoring yang to stop collapse, tonifying qi and astringing yin, with appropriate formulas selected based on the syndrome, such as Ginseng and Aconite Decoction, Cold-Extremities Decoction, Pulse-Reinforcing Powder.
11. Internal Block and External Collapse︰The mind is confused, the body is hot and steaming, breathing is rough, snoring is loud, eyes are closed and mouth is open, incontinence occurs, sweating with a pale face, cold limbs, a red or pale red tongue, a deep and hidden pulse, or a weak and rapid pulse. This is due to the excess of pathogenic qi, which internally blocks the seven orifices, while healthy qi is depleted, leading to the failure of the mind to stay in its abode. Both collapse and obstruction are present, with signs of pathogenic heat, turbid phlegm, and static blood (such as body heat, phlegm sounds, black stool, etc.), as well as signs of yin exhaustion and yang exhaustion, which can aid in differentiation. Treatment should address both collapse and obstruction. If the pattern of obstruction is predominant, focus first on opening the obstruction while also supporting healthy qi. If the pattern of collapse is severe, urgently stabilize the collapse while also paying attention to dispelling pathogenic factors. In clinical practice, it is essential to identify the primary and secondary aspects, and apply pattern identification and treatment accordingly.

Both visceral heat steaming and heat invading the pericardium are excess pattern and heat pattern, hence they both exhibit general manifestations of excess heat pattern, such as body heat and flushed face, dysphoria and polylogia, parched lips and dry throat, scanty dark urine, and constipation. However, their disease causes and mechanisms differ.

Both dampness-heat clouding and wind-phlegm internal blockage are excess pattern, both resulting in unconsciousness due to excess pathogens blocking the orifices, but their disease causes are distinct.

Excessive heat generating wind unconsciousness and stirring wind due to yin deficiency unconsciousness: both belong to internal wind, but one is an excess heat pattern, while the other is a root deficiency with superficial excess pattern.

Yin exhaustion and yang collapse versus internal block and external collapse: one is a deficiency pattern, and the other is a pattern of deficiency and excess complex.

The symptom of unconsciousness, although its mechanism is complex and its manifestations varied, after unconsciousness occurs, it essentially boils down to distinguishing between "pattern of obstruction" and "pattern of collapse." The pattern of obstruction is characterized by clenched teeth, rigid limbs, clenched fists, flushed face, coarse breathing, and profuse phlegm during unconsciousness. Leizheng Zhicai said: "If the teeth are clenched and the hands are tightly gripped, it is the pattern of obstruction." The pattern of collapse is mainly manifested by closed eyes, open mouth, hands letting go, enuresis, faint snoring, cold sweating, and cold limbs. Zabing Yuanliu Xizhu : "What is collapse? The classics say: an open mouth indicates heart collapse, hands letting go indicate spleen collapse, closed eyes indicate liver collapse, enuresis indicates kidney collapse, and snoring sounds indicate lung collapse, all due to extreme deficiency leading to yang collapse." The pattern of obstruction must be treated by opening the block and clearing the passages; the pattern of collapse requires restoring yang to stop the collapse. The two are vastly different and should not be confused.

bubble_chart Documentation

1. Suwen-Mouci Lun: "Xieke is located in the collaterals of the hand and foot Shaoyin, Taiyin, and foot Yangming. These five collaterals all converge in the ear, connecting to the left corner above. If all five collaterals are exhausted, it causes the body's pulses to move while the form remains unconscious, resembling a corpse, hence termed 'corpse syncope.'"
2. Zhengzhi Yaojue．Shi Bian Zhong Shang: "Wind-cold, summerheat, and dampness can all affect people, but only dampness, when accumulated over time and lingering in the joints, can cause a stroke, unlike the sudden onset of wind-cold, summerheat, and dampness. The symptoms of dampness stroke include severe arthralgia, swelling, panting, abdominal distension and fullness, restlessness, and unconsciousness. White Atractylodes Rhizome wine is recommended. If there is a wound, and dampness enters through the wound during bathing, causing severe unconsciousness similar to dampness stroke, it is called 'wound injury,' and White Atractylodes Rhizome wine is also recommended."
3. Zhengyin Maizhi．miasmic malaria: "The symptoms of miasmic malaria include unconsciousness during the expulsion of pathogens, delirium, or hoarseness. This is the symptom of miasmic toxin malaria. The cause of miasmic malaria is the dampness toxin brewing in the mountain mists and stream valleys, where miasma enters the zang-fu organs, blood accumulates in the upper energizer, stagnant blood congests the heart orifice, and toxic saliva gathers in the liver and spleen, thus causing miasmic toxin malaria."
4. Zabing Yuanliu Xizhu．Cold Disease Origins: "Sudden death from cold reversal is also a disease of accumulated cold, different from cold in the middle. The cold in the middle does not necessarily accumulate over a long time; it can occur immediately upon exposure. In contrast, the cold in cold reversal is due to long-term latent cold evil within, triggered by new cold exposure, leading to sudden death. Therefore, although the symptoms include lockjaw, stiff limbs, and unconsciousness, the origins differ: one is an immediate expelling pathogen from exterior disease, and the other is a long-term triggered expelling pathogen from exterior disease."