bubble_chart Concept

Forgetfulness is a manifestation of memory decline, characterized by the ease of forgetting past events; in severe cases, individuals may not know the beginning or end of their conversations and forget things immediately after they occur.

Neijing and the "Treatise on Cold Damage Diseases" refer to it as "forgetfulness," but Suwen. Tiaojing Lun, Lingshu. Benshen mention the term "xi wang" (喜忘). Zhubing Yuanhou Lun calls it "duo wang" (多忘), and later medical practitioners commonly refer to it as "forgetfulness," also known as "hao wang" (好忘) or "yi wang" (易忘).

This condition is different from forgetfulness caused by low intelligence, which is due to inherent dullness, lack of natural talent, and low ability from a young age, sometimes even referred to as "idiocy." As for forgetfulness due to aging and physical decline, it is mostly a physiological phenomenon and differs from forgetfulness caused by disease, thus falling outside the scope of this discussion.

bubble_chart Pattern Analysis

1. Kidney Essence Deficiency︰Dazed forgetfulness, mental dullness, premature graying of hair, brittle and easily falling hair, loose and shaky teeth, weak and flaccid bones, difficulty in walking, pale tongue with white coating, and weak pulse. The kidney governs the storage of essence, dominates bones and generates marrow, and connects with the brain. Kidney essence insufficiency leads to emptiness of the sea of marrow, manifesting primarily as forgetfulness, mental dullness, loose teeth and hair loss, premature graying of hair, and weak and flaccid bones. Treatment should focus on replenishing essence and nourishing marrow, using the formula Great Life-Endowing Pill.
2. Non-interaction between Heart and Kidney︰Frequent forgetfulness, restlessness and insomnia, palpitation or severe palpitation, dizziness and tinnitus, soreness and weakness in the waist and legs, dreamfulness and seminal emission, tidal fever and night sweats, frequent urination at night, red tongue with scant coating, thready and rapid pulse. This syndrome is extremely common. Zhangshi Yitong said: "Forgetfulness is all attributed to the non-interaction between the heart and kidney." Its pathogenesis is often due to seminal emission, efflux diarrhea, prolonged illness, excessive sexual activity, or damage to kidney yin. When kidney yin is depleted and unable to ascend to nourish the heart, water fails to control fire, leading to hyperactivity of heart yang. Alternatively, excessive emotions may cause qi depression to transform into fire, or intense pathogenic heat may lead to internal blazing of heart fire, which in turn depletes kidney yin. Kidney deficiency impairs the will, resulting in forgetfulness. During diagnosis, the following two conditions should be distinguished:
   1. Heart and kidney yin deficiency with hyperactivity of heart yang (primarily heart and kidney yin deficiency, accompanied by relative hyperactivity of heart yang: forgetfulness, insomnia, palpitation, restlessness, soreness and weakness in the waist and knees, night sweats, seminal emission, red tongue without coating, thready and rapid pulse).
   2. Intense heart fire depleting kidney yin (upper heat and lower deficiency, excessive fire and depleted water, manifesting as restlessness, thirst, oral ulcers, flushed face, soreness and weakness in the waist and legs, yellow urine, and dry stools).
   The treatment principle for both is to restore coordination between the heart and kidney, but the specific approaches differ. For heart and kidney yin deficiency, the focus is on nourishing yin and reducing fire, as well as nourishing the heart and tranquilizing the mind. If the condition is more heart-related, Bu Xin Dan (Heart-Nourishing Pill) can be used; if more kidney-related, Six-Ingredient Rehmannia Pill is prescribed. For fire excess and water depletion, the treatment should clear the heart and reduce fire while nourishing kidney yin, using Coptis and Ass Hide Glue Decoction.
3. Deficiency of Both Heart and Spleen︰complexion pale, forgetfulness severe palpitation, dreamfulness insomnia, shortness of breath and timidity, poor appetite and fatigue, abdominal distension and fullness loose stool, women menstrual irregularities, white coating and pale tongue, thin and weak pulse. heart storing spirit, spleen governs thought, excessive contemplation, overstrain injures heart and spleen, spleen deficiency fails to transform and generate essence, blood deficiency is hard to recover, heart has nothing to govern; heart blood deficiency, spleen loses nourishment; insufficiency of heart fire fails to warm spleen for transformation; thus forming deficiency of both heart and spleen. heart spleen qi blood insufficiency, failure of mind to keep to its abode, then often forgetfulness. Jisheng Fang: "The spleen governs intention and thought, the heart also governs thought, excessive contemplation leads to unclear intention abode, spirit palace fails in its duty, causing forgetfulness." Besides manifestations of heart qi blood deficiency, this syndrome also includes symptoms of impaired transportation (reduced food intake, epigastric abdominal distension and fullness, loose stool diarrhea, fatigue and weakness). Treatment aims at tonifying and replenishing heart and spleen, using Returning to Spleen Decoction.
4. Phlegm-Turbidity Disturbing the Heart︰forgetfulness, lethargy, mental confusion, dizziness, dizzy vision, palpitation, insomnia, chest oppression, throat rattling with phlegm, white greasy tongue coating, wiry and slippery pulse. Phlegm-turbidity harassing the heart forgetfulness, often due to emotional distress, liver qi depression, spleen failing to transport, water-dampness failing to transform, turbid-phlegm internally generated, phlegm rising with qi counterflow, disturbing mental activity, leading to occasional forgetfulness. Danxi Xinfa: "Forgetfulness is mostly caused by insufficient spirit, but there are also cases due to phlegm. This condition often arises from excessive worry and contemplation, damaging the pericardium, resulting in unclear mental abode and frequent forgetfulness of events." It is a temporary illness, with manifestations of phlegm-turbidity harassing upward (dizziness, dizzy vision, like riding a boat or carriage), qi movement stagnation (chest oppression, nausea and vomiting), phlegm-drool congestion (coughing up phlegm-drool, throat rattling with phlegm), and even phlegm confusing the heart orifice (incoherent speech, abnormal crying and laughing). Treatment should focus on resolving phlegm to calm the heart, using Phlegm-Guiding Decoction or Poria Decoction.
5. Phlegm-Fire Harassing Upward︰forgetfulness dysphoria, vertigo headache, flushed face and dry throat, chest tightness and shortness of breath, coughing up yellow phlegm, yellow and greasy tongue coating, slippery and rapid pulse. Prolonged retention of phlegm leads to stagnation and transformation into heat, or emotional disturbances, five minds transforming into fire, phlegm-fire binding together, disrupting mental activity, resulting in forgetfulness. Treatment should focus on clearing and resolving heat-phlegm, using Coptis Rhizome Gallbladder-Warming Decoction.
6. Static Blood Attacking the Heart︰Sudden forgetfulness, stiff tongue and slurred speech, desire to rinse the mouth but not swallow water, abdominal distension and fullness with pain, tenderness and guarding, cyanosis of the face, lips, and nails, clear and copious urine, black-colored stools, and knotted or intermittent pulse. Forgetfulness due to static blood attacking the heart is mostly caused by static blood stagnation, obstruction of the collaterals, impeded flow of qi and blood, malnourishment of the heart spirit, or static blood obstructing and suppressing, disturbing the spirit, leading to forgetfulness. It often occurs suddenly and is difficult to cure, accompanied by other signs of static blood: palpable masses, pain, bleeding, desire to rinse the mouth but not swallow water, stools that are dry and hard yet easy to pass, and dark purple or black in color. *Treatise on Cold Damage Diseases: Differentiation of Yangming Disease Pulse Patterns and Treatment* states: "In Yangming disease, if the person is prone to forgetfulness, there must be blood accumulation. The reason for this is that there is long-standing static blood, which causes forgetfulness. Although the stool is hard, it is easy to pass, and its color must be black." The tongue is dark purple with ecchymotic spots, and the pulse is thin and choppy or knotted and intermittent. Treatment should focus on invigorating blood and resolving stasis, attacking and expelling blood accumulation. The formulas used are Blood House Stasis-Expelling Decoction or Resistant and Withstanding Decoction.

The condition of forgetfulness is closely related to the heart, spleen, and kidneys. Since the heart stores the spirit and governs mental activity, the kidneys store essence and connect to the brain, and the spleen governs intention and thought, deficiencies in heart and spleen qi and blood, as well as kidney essence deficiency, and the lack of interaction between the heart and kidneys can all lead to forgetfulness. Treatment primarily focuses on nourishing the heart and calming the mind, as well as tonifying and replenishing the spleen and kidneys.

bubble_chart Documentation

1. Suwen．Four Seasons Discussion on Contraindications and Compliance: "Winter acupuncture of the muscles leads to the exhaustion of yang qi, causing forgetfulness."
2. Zhubing Yuanhou Lun．On Forgetfulness: "If wind evil invades the blood and qi, causing disharmony between yin and yang, sometimes they conflict and separate, sometimes deficient and sometimes excessive, the blood and qi become chaotic, leading to a deficiency of the heart spirit and frequent forgetfulness."
3. Qianjin Yaofang．Heart: "People of the Yu tone sigh and are prone to anger; anger leads to forgetfulness, a dazed state with scattered thoughts. This is due to earth overcoming water, yang attacking yin, yin qi being suppressed and yang qi rising. When it rises, there is heat; when there is heat, there is excess; when there is excess, there is anger; when there is anger, there is forgetfulness."
4. Zhengzhi Zhunsheng．Miscellaneous Diseases．"Those with a clouded heart have a shortened spirit, so they cannot recall events without being distressed. ... If one's constitution is mixed with clarity and turbidity, they cannot endure the disturbance of affairs; disturbance leads to a loss of intelligence and forgetfulness."
5. Leizheng Zhicai．Forgetfulness: "Forgetfulness is suddenly forgetting something, and no matter how hard one tries, the thought does not come. The spirit of a person resides in the heart, the essence of the heart depends on the kidneys, and the brain is the house of the original spirit, the sea of essence and marrow, which is the basis of memory. Mr. Zheng Xijin often said that when people see something externally, an image is retained in the brain. Forgetfulness in children is due to the brain not being fully developed; forgetfulness in the elderly is due to the brain gradually becoming empty."