bubble_chart Concept

Syncope is characterized by sudden fainting, unconsciousness, cold limbs, and recovery after a period of time; upon waking, there are no sequelae such as aphasia, facial distortion, or

half-body paralysis. The "emotional syncope" mentioned in the Neijing, as well as later terms such as "depression and dizziness," "qi syncope," "blood syncope," "phlegm syncope," "crapulent syncope," "summerheat syncope," "alcoholic syncope," "syncope," "fainting," and "collapse," all fall within the category of syncope.

Syncope is different from "unconsciousness," which refers to a prolonged and difficult-to-recover state of mental confusion. Syncope is also distinct from "vertigo," which involves dizziness, spinning vision, and difficulty standing, but without loss of consciousness. The collapse seen in epilepsy, although the person gradually recovers after a period of time, is accompanied by limb spasms, facial twitching, clenched teeth, and foaming at the mouth, which differentiates it from syncope and should be distinguished accordingly.

bubble_chart Pattern Analysis

1. Qi Deficiency︰Sudden fainting, pale complexion, weak breath, sweating and cold limbs, pale tongue, deep and weak pulse. Often due to depletion of original qi, leading to exhaustion of yang qi, sinking of pectoral qi, and failure of spleen qi to ascend, resulting in sudden collapse; frequently triggered by overexertion leading to qi consumption, or during times of sorrow (causing qi consumption) and fear (causing qi sinking). Main manifestations: Blood belongs to yin, and insufficiency of yin-blood leads to failure of blood to ascend, resulting in a pale complexion and colorless lips. The pulse is deep and weak or irregular, and in severe cases, it may become faint and on the verge of ceasing. Treatment focuses on tonifying qi and restoring yang, using the formula Yang-Restoring Emergency Decoction.
2. Blood Deficiency︰Sudden syncope, pale complexion, colorless lips, slow breathing, sunken eyes without luster, pale tongue, thready and rapid weak pulse. It is caused by excessive bleeding from severe uterine bleeding, vomiting, postpartum, or trauma, leading to qi collapse following blood loss and impaired mental function. It is commonly seen after sudden standing or sitting up, or following blood loss. Qi belongs to yang; when yang qi is deficient, it fails to warm the body, resulting in cold limbs; when it fails to defend the exterior, spontaneous sweating occurs; when pectoral qi collapses, breathing becomes weak, with shortness of breath insufficient for inhalation, or the breath may nearly stop, and after waking, speech is low and timid; when qi fails to command blood, the blood vessels become sluggish, leading to cyanosis of the face and lips. Therefore, symptoms such as reversal cold of limbs, sticky cold sweating, shortness of breath, weak respiration, and cyanosis of the face and lips are the main manifestations. The tongue and pulse presentations also differ between the two conditions. The pulse is as fine as a thread or thready, rapid, and weak, or in severe cases, floating, large, and hollow in the middle. Treatment should focus on tonifying qi and astringing yin, as well as tonifying and nourishing qi and blood. The formulas used are Shengmai Powder or Ginseng Nutrient-Nourishing Decoction with modifications.
3. Blood Rising with Qi Counterflow︰Suddenly fainting, unconsciousness, clenched teeth, tightly clenched fists, coarse breathing, flushed face with purple lips, a red or dark purple tongue, and a deep, wiry pulse. This is often caused by anger damaging the liver, leading to rebellious qi movement, with blood surging upward along with qi, disturbing mental activity. Suwen. Shengqi Tongtian Lun: "Great anger causes the qi of the body to be cut off, and blood stagnates upward, leading to emotional syncope." This is due to excessive emotions causing qi counterflow and blood rising, belonging to an excess pattern. The patient has a robust constitution, with sudden onset and abrupt collapse. Symptoms include clenched teeth, chest fullness, labored breathing, cold limbs, flushed face with purple lips, etc. Upon regaining consciousness, the patient often exhibits abnormal crying or laughing, and episodes may recur during emotional changes. The tongue appears red or dark purple, and the pulse is deep and wiry. Treatment focuses on soothing the liver to direct qi downward, activating blood circulation, and resolving stasis, using Tongyu Jian combined with Peripatetic Powder.
4. Liver Hyperactivity Due to Yin Deficiency︰Dizziness, blurred vision, irritability, fainting with inability to speak, flushed face, red eyes, trembling limbs, red tongue with scant coating, wiry-thin-rapid pulse. Caused by excessive scheming, indecisive melancholy. Silent depletion of liver yin, or congenital deficiency of kidney yin. Unable to nourish the liver, liver yin insufficiency, yin failing to control yang, ascendant hyperactivity of liver yang, leading to syncope. This is yin deficiency with yang hyperactivity, belonging to root deficiency with branch excess. The patient is physically weak and emaciated, usually experiencing head distension, tinnitus, dry eyes, flushed cheeks, night sweats, seminal emission, and syncope triggered by emotional agitation. The tongue and pulse manifestations also differ between the two patterns. The tongue is glossy without coating, and the pulse is wiry-thin-rapid. Treatment should focus on nourishing yin and subduing yang, tonifying the liver and kidney. The recommended formula is Anemarrhena, Phellodendron, and Rehmannia Pill.
5. Phlegm-Turbidity Obscuring the Upper︰Suddenly fainting and collapsing, unconsciousness, throat with phlegm sounds, snoring like a saw, vomiting frothy saliva, cold limbs, white and greasy tongue coating, wiry and slippery pulse. It is caused by excessive phlegm-dampness, compounded by anger, qi counterflow leading to phlegm congestion, and the seven orifices being obstructed. Treatment should focus on moving qi and resolving phlegm, using Phlegm-Guiding Decoction.
6. Summer-heat Pathogen Attacking the Body︰Sudden fainting, panting without speaking, feverish body and cold limbs, cold sweating incessantly, complexion flushed or pale, clenched jaw or open mouth, red and dry tongue, pulse full and rapid or weak-rapid and large. Due to summerheat pathogen invading internally, heat stagnation qi counterflow, blocking the seven orifices, disturbing mental activity. Turbid stasis clouding upward causing syncope, often preceded by warning symptoms such as dizziness and blurred vision, feeling as if on a boat or carriage, vertigo worsening with movement, or nausea and vomiting, heaviness of the head as if wrapped, followed by sudden collapse, unconsciousness, phlegm rales in the throat, coarse breathing, drooling from the mouth, then gradual awakening. The syncope is generally not severe but prone to recurrence. Summerheat pathogen affecting a person causing syncope often occurs on extremely hot summer days or during high-temperature work, with sudden collapse. The patient has a clenched jaw, feverish body and flushed face, even delirium, with a full and rapid pulse. If there is internal block and external collapse, symptoms may also include pale complexion, incessant cold sweating, reversal cold of limbs, hands slack and mouth open, with a weak-rapid and large pulse. Treatment should focus on opening the orifices with pungent-cool medicinals. The formula used is Purple Snow Bolus. For cases of internal block and external collapse, treatment should address both collapse and blockage simultaneously. The formula used is Pulse-Reinforcing Powder combined with White Tiger Decoction with modifications.

Syncope, although seen in various symptoms and signs, generally falls into two patterns: deficiency and excess. In the excess pattern, it is usually due to excessive qi, qi counterflow rushing upwards, blood rising with qi, or qi counterflow carrying phlegm, or summer-heat pathogen causing depression and dizziness, leading to the blockage of the seven orifices and resulting in syncope. In the deficiency pattern, it is often due to insufficient qi and blood, failure of clear yang to rise, blood not ascending, and the eyes not being nourished. The excess pattern is characterized by a robust physique, congested qi and coarse breathing, lockjaw and clenched fists, deep and solid or deep and hidden pulse. The deficiency pattern is characterized by a weak and emaciated body, sunken and dull eyes, pale face and faint breathing, sweating and cold limbs, pale tongue, and faint or thin and rapid pulse without strength. Zhengzhi Huibu．Syncope: "Syncope with lockjaw and clenched teeth is excess syncope. Syncope with open mouth and spontaneous sweating is deficiency syncope." For excess pattern syncope, treatment should focus on expelling pathogens and resuscitating the spirit; for deficiency pattern syncope, treatment should focus on tonifying and nourishing qi and blood to alleviate cold extremities.

bubble_chart Documentation

1. Yiguan．"Differentiation of Doubts on Dominant and Subordinate Qi": "Some people have no pain in their daily life, but suddenly become like dead people, their bodies do not move, they are silent and do not know people, their eyes are closed and cannot be opened, lockjaw cannot speak, or they know people slightly, hate to hear human voices, but are like dizziness, and wake up after a while. This is due to excessive sweating, blood shortage of qi and blood, yang alone goes up but not down, qi is blocked and cold and does not move, so the body is like death. When qi passes blood returns, yin-yang is restored and connected, so it takes a while to wake up, it is called depression and dizziness, also known as blood syncope, women often have it, it is suitable for Blackend Swallowwort Root soup, Canggong powder."
2. Jingyue Quanshu．"Cold Extremities": "The syndrome of alcoholic syncope is what the scripture calls the category of heat reversal. ... The light ones still know people, the heavy ones suddenly fall, suddenly become confused, or irritable, or silent, or phlegm and saliva like a surge, or panting fever, or cough, or hematemesis. But observe their dry stool, the pulse is solid and likes cold, this is the syndrome of dampness-heat upper blockage, it is suitable to use the Chouxin drink and the like, to quickly reduce the fire."
3. Zhengzhi Huibu．"Jue Syndrome": "The person with worm jue has worms in the stomach, and also suffers from cold injury to the stomach, or hunger without food, the worms seek food and attack upwards, or the external contraction syndrome should not sweat but rashly sweats, resulting in stomach qi deficiency cold, worms enter the diaphragm, dry tongue and mouth, rinse water without swallowing, dysphoria confusion, reversal cold of hands and feet, unconsciousness, even vomiting worms, it is suitable to use Lizhong Anhui soup."
4. Jingyue Quanshu．"Cold Extremities": "There are two types of color jue syndrome, one is sudden collapse, the other is moving blood. All those who have a sudden collapse of color jue must have a weak body, occasionally because of a strange encounter and try their best to do it, or because of long-term admiration and indulgence in lust, so after the event, the qi goes with the essence and suddenly collapses and does not return, it is suitable to pinch the philtrum quickly, ... then quickly use Duzhen soup to pour it, or moxibustion on Qihai for dozens of zhuang, to restore yang qi, it may be able to recover."
5. 《Shi Shi Mi Lu》: "When people urinate, they suddenly become dizzy and fall, it is also the qi desertion disease of yin-yang."