bubble_chart Concept

Dementia refers to a state of mental dullness and low intelligence, which is a manifestation of severe impairment in intellectual activities.

In ancient times, dementia was categorized into "civil dementia" and "martial dementia." Dementia accompanied by mental depression, indifferent expression, sitting like a puppet, reticence, and a tendency to sadness and crying is referred to as "civil dementia"; dementia accompanied by wild and ignorant behavior, cursing and shouting, discarding clothes and exposing the body, not distinguishing between relatives and strangers, and climbing over walls and onto roofs is referred to as "martial dementia." This section discusses the former, while the latter belongs to the category of mania and is not within the scope of this discussion.

bubble_chart Pattern Analysis

1. Damp Phlegm︰Depressed spirit, dull expression, silent or muttering soliloquy, staying indoors alone, unwilling to see others, abdominal distension and fullness, excessive phlegm and saliva, white and greasy tongue coating, deep and slippery pulse. This is a deficiency-rooted excess pattern, with signs of damp-phlegm such as quietness and few words, or complete silence, heaviness of the head as if wrapped, fatigue and weakness, abdominal distension and fullness, regurgitation of phlegm and saliva, white and greasy tongue coating, deep and slippery pulse. Its clinical characteristics are: dementia that fluctuates in severity and is difficult to fully recover. Often caused by internal accumulation of water-dampness, which condenses into phlegm and ascends to cloud the seven orifices, resulting in mental dullness. Treatment should focus on resolving phlegm to restore consciousness, using prescriptions like Zhuandai Dan or Zhimi Tang.
2. Qi Stagnation and Blood Stasis︰Dull and foolish, mentally confused, frequent sighing, sorrowful and tearful, chest tightness and irritability, deficient restlessness and insomnia, tongue texture pale, wiry and thin pulse. It is a syndrome of deficiency and excess mixed together. Mainly due to liver qi depression and heart-spleen blood deficiency, hence dementia is accompanied by chest tightness and irritability, sighing, pale complexion, mental confusion, restlessness of the heart and spirit, and sorrowful weeping. Its characteristics are: sudden onset of dementia, often related to emotional stagnation or sudden mental stimulation. Generally, the condition is severe but lasts for a short duration and can recover relatively quickly with treatment. Mostly caused by emotional stagnation, liver depression overwhelming the spleen, or severe fright and sudden terror leading to qi and blood counterflow disorder, resulting in the heart losing its nourishment, manifesting as mental confusion and mute dementia. Treatment should focus on harmonizing qi and blood, using Peripatetic Powder combined with Licorice, Wheat and Jujube Decoction with modifications.
3. Liver and Kidney Deficiency︰Dim and dull eyes, sluggish speech, numbness in the limbs, clumsy movements, dizziness, blurred vision, tinnitus, deafness, feverish sensation in the palms and soles, flushed cheeks, night sweats, a red tongue without coating, and a thready, rapid pulse. This often occurs when pathogenic qi lingers for a long time, or when heat toxin penetrates deeply into the lower energizer, depleting the yin of the liver and kidneys; or due to advanced age and physical decline, insufficiency of the liver and kidneys, and the spirit losing its nourishment, leading to reticence and dullness akin to dementia. Manifestations include restricted joint flexion and extension, numbness in the limbs, sluggish speech, a haggard complexion, lifeless eyes, emaciation, and scaly skin. If there is yin deficiency with yang hyperactivity, reckless movement of deficient yang may stir internal wind, presenting symptoms such as stiff tongue and slurred speech, spasms, and convulsions—signs of internal wind. Treatment should focus on nourishing water to moisten wood, supplemented by extinguishing wind, using the Nacre Pill with modifications.
4. Insufficiency of the Sea of Marrow︰Low intelligence, dullness and stupidity, delayed development, soft and weak bones, delayed closure of the fontanel, difficulty in walking, sparse hair and few teeth, laziness and preference for lying down, pale tongue texture, and weak pulse. Mostly due to congenital deficiency, weak endowment, or consanguineous mating, or genetic defects, leading to poor development of the brain marrow, resulting in dementia. Symptoms include dull expression, delayed growth of teeth and hair, soft and weak bones, laziness and drowsiness, pale tongue and thin pulse. Additionally, deficiency of the liver and kidney is often seen in cases of severe or chronic illness, with intelligence gradually declining. In the initial stage [first stage], memory is poor, associations are slow, and speech is incoherent, which may later lead to severe intellectual disability or idiocy. Insufficiency of the sea of marrow is often seen in children, where intellectual impairment is not initially obvious but gradually becomes apparent as the child grows older. Treatment should focus on replenishing essence and nourishing the marrow. Prescriptions such as Left-Restoring Decoction or Great Life-Endowing Pill can be used.

In summary, although dementia has several causes, it fundamentally falls into two categories: deficiency and excess. Those of the excess type are due to phlegm-dampness, while those of the deficiency type stem from yin deficiency and marrow deficiency. Phlegm-dampness should be treated by resolving phlegm for resuscitation; yin deficiency requires nourishing and supplementing true yin, and marrow deficiency should be addressed with products rich in flesh and blood. However, since this condition often appears in the late stages of serious or chronic illnesses, or in mental disorders, and is stubborn and difficult to recover from, treatment should only be based on pattern identification and comprehensive therapeutic measures (such as herbal formulas, acupuncture, conduction exercises, etc.) to achieve certain therapeutic effects. For cases caused by qi depression, particular attention should be paid to psychological treatment, avoiding mental stimulation.

bubble_chart Documentation

1. Jingyue Quanshu．Manic and depressive psychosis dementia: "Dementia syndrome, in cases where there is usually no phlegm but due to depression, dissatisfaction, overthinking, suspicion, or fright, gradually leads to dementia, with incoherent speech and inappropriate actions, or profuse sweating, or excessive sorrow. The symptoms can be extremely varied and unpredictable, with the pulse being either wiry or rapid, or large or small, and constantly changing. This is due to rebellious qi in the heart, or unclear qi in the liver and gallbladder meridians. However, if the body is strong and appetite is normal, without any signs of deficiency, then it is best to treat with Fuman Jian, which is the most stable and effective. However, this condition can be cured or not, depending on the strength of stomach qi and original qi, and recovery takes time and cannot be rushed. For all these conditions, if sudden fright or shock damages the heart and gallbladder, leading to loss of vitality and confusion, the priority should be to quickly support healthy qi, using Qifu Yin or Major Original-Qi Tonifying Decoction."