Treating Auditory Hallucinations, Dissociation, Schizophrenia (“Hysteria”), and Depression Using Chinese Medicinals

Alvin Wong

Case History:

Patient: An unmarried woman, approximately 35 years of age, sought medical help from me on July 14th, 2023.

She had received psychiatric treatment outside of the United Kingdom for 10 years and had lived in the United Kingdom for 1 year. Her condition was monitored by the NHS psychiatric department. She was diagnosed with schizophrenia and melancholic depression by western medical practitioners outside of the United Kingdom and the NHS.

When she was treated outside of the United Kingdom, she was prescribed venlafaxine hydrochloride, with a dosage ranging from 37.5 mg at the beginning to 75 mg at the end of her 10th year of treatment. She has been living in the United Kingdom for more than 1 year. A NHS psychiatric specialist increased the dosage of venlafaxine hydrochloride from 75 mg to 150 mg and prescribed flupentixol 1.5 mg.

Her condition did not improve, so the NHS increased the dosage of venlafaxine hydrochloride from 150 mg to 225 mg and increased the dosage of flupentixol from 1.5 mg to 3 mg. However, her condition continued to deteriorate.

Even though she was taking high doses of psychiatric medication, she experienced the following health problems:

● Severe insomnia and lack of awareness of what she was doing

● Issues with “temporal perception”, difficulty in remembering times and dates

● Unable to comprehend short messages, emails, and articles in English, even if they were only 4-5 lines long

● Auditory hallucinations that lasted all day and increased in volume (including womens and childrens voices)

● Hallucinations and feelings that her soul had left her body and she could see her own body. She felt like she was floating in the air (commonly referred to as dissociation)

● When sleeping, she had many nightmares of bloody, violent scenes

● Terrible sleep quality

● Feeling depressed

● Sweating heavily all over her body during sleep, to the point that her clothes were wet

● No appetite

● Wet and watery feces

● Premenstrual pain so severe that she needed to take pain medication (paracetamol 2000 mg)

● Very tired with a strong desire to sleep; she could sleep for more than 13 hours at a time

When this patient sought assistance from me, she lived far from my clinic, so diagnosis and treatment were conducted via video consultation. This allowed me to observe, ask questions, and listen to her. One of the limitations of online consultation was that I could not conduct a pulse examination. To understand her condition, in addition to observing her facial expressions, I asked a lot of questions to cross-check her logic and word use in our conversation. Starting from details of her daily life, I proceeded to ask about her dreams. I also asked her to detail the locations in which her hallucinations took place.

Understanding Schizophrenia from the Western Medical Perspective

Schizophrenia is a serious mental disorder in which patients interpret reality abnormally, experiencing delusions. Schizophrenia may lead to some combination of hallucinations, delusions, and extremely disorganized or abnormal thinking, speech, and motor behaviors that impair daily functioning, and may even cause complete disability.

Causes of Schizophrenia from the Western Medical Perspective

Western pathology: Researchers believe that a combination of genetics, brain chemistry, and environment contributes to the development of the disorder.

Problems with chemicals that naturally occur in the brain, including neurotransmitters called dopamine and glutamate, may contribute to schizophrenia.

Understanding Schizophrenia from the TCM Perspective

TCM classifies schizophrenia as “hysteria” or a disorder of the spirit-mind, which is considered a kind of depressive disorder and may include the following:

1. Lily disease ［or hundred-union disease］ ［characterized by trance and mental incompetence］

2. Depression［of qi in viscera］

3. Visceral agitation

4. Plum pit qi

TCM categorizes hysteria as a type of depressive disorder. It is a disease caused by emotional disharmony and qi stagnation. Its main manifestations are depression, agitation, hypochondriac pain, irascibility, and crying, as well as pharyngeal obstruction, insomnia, and other symptoms. Clinically, it can be divided into liver qi binding depression, qi stagnation and phlegm obstruction, qi stagnation and fire obstruction, depression and devitalized essence-spirit, dual vacuity of the heart and spleen, and effulgent yin vacuity fire.

Causes of Schizophrenia from the TCM Perspective

TCM pathology: Depression is caused by 7 types of emotional discomfort and may present with a variety of symptoms. Depression may involve problems of the viscera, including the heart, spleen, liver, and gallbladder. Pathological mechanisms that cause depression can be divided into anxiety, depression, anger, and liver depression, as well as excessive worrying, spleen exhaustion, emotional overload, and heart exhaustion, among others.

Lei Jing ［The Classified Canon］proposed the medical concept of “unity of form and spirit”, as well as the academic concepts of “diseases arising as a result of depression” and “depression arising as a result of diseases”, highlighting the relationship between physiology and psychology. For example, “eye diseases can occur in people who have a bad temper This is because a bad temper reflects a tendency for the liver to be depressed. Heat is generated as a result of prolonged stagnation. Damp-heat brewing in the spleen injures the essence and qi, and covers the eyes.” This shows that extreme emotional changes can cause an imbalance of yin and yang, qi-blood disharmony, and functional disorders of the viscera and bowels.

Description of Treatment from July 14th 2023 to Present:

First, it is important to distinguish whether the patients condition of hallucinations and dissociation is a spiritual experience. If it is a spiritual experience, the patient should be referred to the relevant clergy.

Based on the results of my analysis, I was confident that she needed medical rather than spiritual assistance because depression is caused by 7 types of emotional discomfort and this patient had obvious signs of liver depression, one of which was menstrual pain. This fit the academic concept of “diseases arising as a result of depression” and “depression arising as a result of diseases”. My overall approach was to treat the imbalance of yin and yang, qi-blood disharmony, qi stagnation, phlegm-rheum, and functional disorders of the viscera and bowels. My first task was to course the liver and resolve depression.

Treatment Summary for the First Month (July 14th to Mid-August):

Clinical findings:

● Yin-yang imbalance

● Qi-blood disharmony

● Qi stagnation

● Severe liver depression

● Damp phlegm

Treatment approach:

● Course the liver and resolve depression, quiet the spirit and stabilize the mind, clear dampness

(All formulas in this clinic are pre-made concentrated powder.)

The primary formula was Free Wanderer Powder (xiāo yáo sǎn), combined with a variation of Bupleurum Decoction Plus Dragon Bone and Oyster Shell (chái hú lóng gǔ mǔ lì tāng).

Free Wanderer Powder (xiāo yáo sǎn), 5 g + Bupleurum Decoction Plus Dragon Bone and Oyster Shell (chái hú lóng gǔ mǔ lì tāng), 6 g

The evening prescription was Spiny Jujube Decoction (suān zǎo rén tāng) combined with a variation of Free Wanderer Powder (xiāo yáo sǎn).

Spiny Jujube Decoction (suān zǎo rén tāng), 5 g + Free Wanderer Powder (xiāo yáo sǎn), 5 g

The following variations were made as appropriate:

To resolve depression and calm the mind when the heart spirit is disquieted, add 1.5 g of silk tree flower (hé huān huā)

For severe insomnia, profuse dreaming, and profuse sweating with non-interaction of the heart and the kidney, add 1.5 g of flowery knotweed stem (yè jiāo téng)

For heart vacuity with fright palpitations, forgetfulness, and insomnia, add 1.5 g of root poria (fú shén)

For fright palpitations, forgetfulness, profuse dreaming, insomnia, and to calm and settle the spirit-mind, add 2 g of Siberian polygala root (yuǎn zhì)

Outcomes after the first month of treatment:

● Nightmares reduced by half

● Auditory hallucinations reduced by half

● Sleep quality improved

● Still had anxiety/panic attacks

● Still had to take pain medication (2000 mg) for menstrual pain

Treatment Summary for the Second Month (Mid-August to Mid -September):

Note: Because the patient could not use herbal granules in her work environment due to the smell, pills were prescribed to be taken at lunch in the office. The patient continued to take powdered herbs at home in the morning and evening.

Clinical findings:

● Qi-blood disharmony

● Severe liver depression and qi stagnation

● Damp-phlegm

● Severe vacuity of yin and yang

Treatment approach:

● Course the liver and resolve depression, nourish the heart and quiet the spirit, treat heart and kidney yin depletion, supplement qi and blood

Morning: Free Wanderer Powder (xiāo yáo sǎn), 5 g + Bupleurum Decoction Plus Dragon Bone and Oyster Shell (chái hú lóng gǔ mǔ lì tāng), 5 g

Lunch (2 days of herbal powder at home): Perfect Major Supplementation Decoction (shí quán dà bǔ tāng), 5 g + astragalus (huáng qí), 2 g + Bupleurum Decoction Plus Dragon Bone and Oyster Shell (chái hú lóng gǔ mǔ lì tāng), 3 g

Lunch (3 days of herbal pills in the office): Perfect Major Supplementation Decoction (shí quán dà bǔ tāng) Pills, 5 pills + Eight-Gem Decoction (bā zhēn tāng) Pills, 5 pills + Bupleurum Decoction Plus Dragon Bone and Oyster Shell (chái hú lóng gǔ mǔ lì tāng), 3 pills

Evening: Celestial Emperor Heart-Supplementing Elixir (tiān wáng bǔ xīn dān), 5 g + Free Wanderer Powder (xiāo yáo sǎn), 3 g + Spiny Jujube Decoction (suān zǎo rén tāng), 2 g

Modifications as needed:

To quiet the heart and spirit, tranquilize, and induce sleep, add 1 g of lily bulb (bǎi hé)

To resolve depression and quiet the spirit when the heart spirit is disquieted, add 1.5 g of silk tree flower (hé huān huā)

To dispel dampness, fortify the spleen, quiet the spirit, and disinhibit water without damaging the right qi, add 1.5 g of poria (yún líng)

To treat fright palpitations, forgetfulness, profuse dreaming, and insomnia, and quiet and settle the spirit mind, add 2 g of Siberian polygala root (yuǎn zhì)

To enter the heart and liver channels, quicken the blood and regulate menstruation, cool the blood and disperse welling-abscess, and quiet the spirit, add 1.5 g of salvia root (dān shēn)

Outcomes after the second month of treatment:

● Flupentixol was reduced from 3 mg to 1.5 mg

● Venlafaxine hydrochloride was reduced from 255 mg to 217.5 mg

● No nightmares; the content of dreams was daily life

● No hallucinations

● No auditory hallucinations

● No sweating

● No panic attacks

● Frequent feelings of anxiety

● Extreme fatigue

● Menstrual pain reduced by 50%

Treatment Summary for the Third Month (Mid-September to Mid-October):

Clinical findings:

● Moderate qi-blood disharmony

● Qi stagnation

● Moderate damp-phlegm

● Severe yang vacuity

● Moderate blood vacuity

Treatment approach:

● Course the liver and resolve depression first; nourish the heart and quiet the spirit, focus on greatly supplementing original qi, and supplement blood at the same time as supplementing qi

Morning: Bupleurum Decoction Plus Dragon Bone and Oyster Shell (chái hú lóng gǔ mǔ lì tāng), 5 g + Free Wanderer Powder (xiāo yáo sǎn), 4 g + Korean Red Ginseng (rén shēn) Powder Capsule, 1 pill

Lunch (herbal pills in the office for convenience and lack of odor): Perfect Major Supplementation Decoction (shí quán dà bǔ tāng) Pills, 4 pills + Bupleurum Decoction Plus Dragon Bone and Oyster Shell (chái hú lóng gǔ mǔ lì tāng) Pills, 4 pills + Korean Red Ginseng (rén shēn) Powder Capsule, 1 pill

Lunch (herbal powder at home, 4 days a week): Perfect Major Supplementation Decoction (shí quán dà bǔ tāng), 5 g + Eight-Gem Decoction (bā zhēn tāng), 4 g + Korean Red Ginseng (rén shēn) Powder Capsule

Evening: Celestial Emperor Heart-Supplementing Elixir (tiān wáng bǔ xīn dān), 5 g + Free Wanderer Powder (xiāo yáo sǎn), 3 g + Spiny Jujube Decoction (suān zǎo rén tāng), 3 g

Outcomes after the third month of treatment:

● Flupentixol has been stopped for half a month

● Venlafaxine hydrochloride dosage reduced from 255 mg to 150 mg

● No hallucinations

● No auditory hallucinations

● No nightmares; dreams are about everyday life

● No more heavy sweating

● No panic attacks, but there are still feelings of increased anxiety

● Still extremely fatigued

● 50% reduction in menstrual pain

● Able to talk and communicate with colleagues and young people for 2.5 hours before feeling exhausted and dissociating

● Reduced feelings of depression and anxiety

Treatment Summary for the Fourth Month (Mid-October to Mid-November)

Clinical findings:

● Moderate to mild qi stagnation

● Moderate yang vacuity

● Mild blood vacuity

● Moderate yin vacuity

● Insufficiency of kidney water

● Lung dryness

Treatment approach:

● Course the liver and resolve depression first; focus on greatly supplementing original qi, and supplement blood at the same time as supplementing qi; supplement yin.

Morning: Bupleurum Decoction Plus Dragon Bone and Oyster Shell (chái hú lóng gǔ mǔ lì tāng), 4 g + Free Wanderer Powder (xiāo yáo sǎn), 4 g + acorus root (shí chāng pú), 1 g + magnolia flower (xīn yí huā), 1 g.

Lunch (herbal pills in the office for convenience and lack of odor): Six-Ingredient Rehmannia Decoction (liù wèi dì huáng tāng), 8 pills + Bupleurum Decoction Plus Dragon Bone and Oyster Shell (chái hú lóng gǔ mǔ lì tāng) Pills, 4 pills + Korean Red Ginseng (rén shēn) Powder Capsule, 1 pill.

Lunch (herbal powder at home, 4 days a week): Free Wanderer Powder (xiāo yáo sǎn), 4 g + Six-Ingredient Rehmannia Decoction (liù wèi dì huáng tāng), 4 g + Siberian polygala root (yuǎn zhì), 1 g + adenophora/glehnia root (shā shēn), 1 g + Solomon’s seal root (yù zhú), 1 g.

Evening: Celestial Emperor Heart-Supplementing Elixir (tiān wáng bǔ xīn dān), 3 g + Free Wanderer Powder (xiāo yáo sǎn), 3 g + Spiny Jujube Decoction (suān zǎo rén tāng), 3 g + Siberian polygala root (yuǎn zhì), 1 g + lily bulb (bǎi hé), 1 g + silk tree flower (hé huān huā), 1 g + ophiopogon root (mài mén dōng), 1 g.

治療成果(精神科藥物減少紀錄):

Outcomes (Decreases in Dosage of Psychiatric Medication):

After treatment for 4 months, the patient showed great improvement. The following is a summary of her condition:

The patient had completely stopped taking flupentixol. The dosage of venlafaxine hydrochloride was reduced from 255 mg to 37.5 mg

1. venlafaxine hydrochloride was reduced from 255 mg to 37.5 mg

2. No more auditory hallucinations

3. No more dissociative episodes

4. No nightmares, better sleep quality

5. No more heavy sweating

6. Good appetite

7. There is menstrual pain, but the dosage of pain medication was reduced

8. Comprehension ability has recovered; able to read emails and complete a 2000-word academic paper

9. Able to talk and communicate with colleagues for 6 hours; no more dissociative episodes in the office;

10. No more feelings of anxiety and depression

11. Able to chair online meetings

A word for practitioners:

This is not the first time that I treated this type of illness. Practitioners must keep in mind that stopping all western medication “cold turkey” is extremely dangerous. When Chinese medicinals are administered along with western medication, one must first treat what the body needs before attempting to decrease the western medication. One can only start to decrease the medication once the 5 phases of the patients body are in harmony.

Regarding my patient “X”, the following is a discussion of the pathology and a reflection on the treatment:

Since the patient was taking psychiatric medication, an east-meets-west approach to treatment was inevitable. The patient thought her condition had improved in the past 10 years, but in fact, depletion was building up in her body, and due to certain factors (a change in the environment, being extremely stressed), this condition of depletion was exposed. When her body was stressed, its serotonin secretion decreased, or it took in too much or too little dopamine in a chaotic situation. The medication prescribed to her by the psychiatrist, flupentixol, is a classic psychiatric drug that can suppress the action of dopamine receptors in the central nervous system to help alleviate the symptoms of schizophrenia.

When Chinese medicinals were used to treat the depletion and the body gradually recovered, it could start to reuptake dopamine receptors as it normally would, so an attempt could be made to decrease the flupentixol by ? of a dose at a time. At the same time, it is necessary to understand the half life elimination period of the medication. While tapering off the medication, it is essential to address the body’s depletion by greatly supplementing qi and blood. Simultaneously, one must promptly handle issues caused by the body’s depletion in a targeted manner. I used Korean red ginseng powder to greatly supplement qi and blood.

My patient was treated using a combination of Chinese and western medicine. Ultimately, a radical cure requires the 5 phases of the body to be in balance, so that it will automatically release and reuptake serotonin, and medication to block the reuptake of serotonin will not be needed. Likewise, the body will finally reach a point where it can control the dopamine it receives and medications like dopamine receptor blockers will not be needed. The patient obtained good results from the first phase of treatment. In terms of cooperation between the patient and practitioner, one must incorporate psychological guidance when appropriate, as the patient must learn how to handle stress. When the body’s state of depletion improves to the point at which the 5 phases are balanced, serotonin will be naturally released when the body is in a balanced state. At the appropriate time, the practitioner can start to gradually reduce the dose of the western medication that inhibits the reuptake of serotonin. The overall duration of treatment is lengthy. As it stands now, the patient is delighted to enter the fourth month of treatment and is absolutely certain she can discontinue her western medication completely.

Update on the Patient’s Condition (January 19th, 2024):

The patient has successfully discontinued all psychiatric medication for 2 weeks, starting on January 5th, 2024.

She is continuing to take Chinese medicinals to regulate her body.

Perfect Major Supplementation Decoction (shí quán dà bǔ tāng) Pills, 4 pills + Bupleurum Decoction Plus Dragon Bone and Oyster Shell (chái hú lóng gǔ mǔ lì tāng) Pills, 4 pills + Korean Red Ginseng (rén shēn) Powder Capsule, 1 pill + Eight-Gem Decoction (bā zhēn tāng), 4 g

To share your thoughts on this article or engage in academic discussion, please email [email protected]

References

1.https://www.cacm.org.cn/wp-content/uploads/2021/07/%E7%A5%9E%E5%BF%97%E7%97%85%E4%B8%AD%E8%A5%BF%E5%8C%BB%E7%BB%93%E5%90%88%E4%B8%B4%E5%BA%8A%E8%AF%8A%E7%96%97%E6%8C%87%E5%8D%97-%E7%99%94%E7%97%85.pdf 神志病中西医结合临床诊疗指南 癔病。

2.https://www.mayoclinic.org/diseases-conditions/schizophrenia/symptoms-causes/syc20354443#:~:text=Overview,functioning%2C%20and%20can%20be%20disabling。

3.https://www.medicalteaching.org/posts/uAlaM3cBhgYN2SYvBcz4/,癔症中醫叫什麼

4.https://kknews.cc/zh-hk/health/6e4r45l.html 什麼是癔病？癔病的中醫外治和護理方法

5.https://www.softmind.com.tw/3g_news_content.php?id=26 解離乃是一種心理防衛機轉

6.https://www.nhs.uk/mental-health/conditions/dissociative-disorders/

7. https://kb.commonhealth.com.tw/library/431.html#data-3-collapse 什麼是解離症？



Author information:

Alvin Wong，TCM & Herbal Centre UACM，Registered Traditional Chinese Medicine Practitioner and Licensed Acupuncturist，Lok Yan Herbal Medicine and Acupuncture Clinic-Harpenden.

中藥治療幻聽, 離解,精神分裂症(“癔症”) ,

憂鬱症治療過程的成功個案

Alvin Wong

病案分享:

病人: 中年女士, 未婚, 35歲;在2023年7月14日聯絡本人求診。

在英國以外政府醫院接受精神科治療10年; 現居英1年, 由NHS 醫療精神科跟進其病況; 英國以外西醫及NHS診斷病人為精神分裂及憂鬱症。

英國以外醫院: 西醫處方 Venlafaxine Hydrochloride 37.5mg, 10年內由37.5mg 增至 75mg。現居英1年多, NHS 的精神科專科醫生處方 增加了 Venlafaxine Hydrochloride 由75mg 至150mg, Flupentixol 1.5mg。

其後情況沒有改善, NHS 再加Venlafaxine Hydrochloride 由150mg 增至225mg, Flupentixol 由1.5mg 增至3mg。 但病情持續變差。

雖然她接受高劑量的精神科藥物, 但仍有以下的問題:

● 嚴重失眠問題; 不懂自己在做什麼

● 有 “時間認知”問題,會錯記日期時間

● 不能理解閱讀英文簡短電郵及文章,而文章或電郵只有4-5行文字

● 有幻聽整天持續, 也越來越大聲, (包括有女士的聲音, 有小孩聲)

● 有幻覺, 有靈魂離體情況;自感覺可飄浮 (俗稱: 離解)

● 非常多血腥情境的惡夢

● 睡質極差

● 情緒低落

● 睡時有全身冒汗濕透衣服

● 胃口差

● 大便濕爛

● 有經前痛, 需要服止痛藥(Paracetamol 2000 mg)

● 十分疲倦, 十分渴睡; 可睡超過13小時

病人求診時並非居住近本人診所, 所以一直以視象診治, 望、聞、問可以, 但未有機會以“切診”,脈象改變未能監察比較, 只可以多發問題, 舌象, 面容, 神緒, 對話思想邏輯診治; 問症尤其十分重要; 由生活細節開始發問到夢境; 瞭解發生幻覺地點是非常重要。

從西醫角度認識精神分裂症

以西醫診斷角度診斷為Schizophrenia, 精神分裂症是一種嚴重的精神障礙，人們對現實的解釋不正常Delusions。精神分裂症可能會導致幻覺Hallucinations、妄想以及極度混亂的思維Disorganized thinking (speech)和行為Extremely disorganized or abnormal motor behavior，從而損害日常功能，並可能導致殘疾。

從西醫角度看精神分裂症原因

西醫病理: 遺傳學、腦化學和環境的結合導致了這種疾病的發展。

某些自然產生的大腦化學物質（包括稱為多巴胺(dopamine)和谷氨酸(glutamate）的神經傳導物質）的問題可能會導致精神分裂症。

從中醫角度認識精神分裂症

中醫以” 癔症” 神志病学(Hysteria),是一種抑鬱症,而範圍可以是:

1.百合病

2.鬱症

3.臟躁

4.核氣

中醫稱之為抑鬱症。它是一種由情緒失調和氣滯引起的疾病。其主要表現為抑鬱、情緒煩躁、疑病症疼痛、易怒和哭鬧，以及咽部異物阻塞和失眠等各種症狀。臨床上可分為肝氣鬱結、氣滯痰阻、氣滯火阻、抑鬱精神不振、心脾兩虛、陰虛火旺。

從中醫角度看精神分裂症原因

中醫病理: 抑鬱症的原因是七種情緒不舒服，而且症狀多種多樣。抑鬱症可能涉及心臟、脾臟、肝臟和膽囊。其發病機制可分為焦慮、抑鬱、憤怒和肝鬱、擔心、脾臟衰竭、情緒超載、心力衰竭等。

《類經》提出的“形神兼備”的醫學思想和“因抑鬱而生的疾病”、“因疾病而生的抑鬱”的學術思想，指出了生理學和心理學的關係。“眼病大多發生在脾氣暴躁的人身上。由於脾氣暴躁，肝臟容易抑鬱。熱量是由長時間的停滯產生的。溼熱蘊脾，損精損氣，遮目”。因此，劇烈的情緒變化會導致陰陽失衡、氣血不和、臟腑功能失調。

簡略由2023年7月14日至今治療過程:

首要分析病人的幻象幻聽,光環是否屬於靈界之事, 如屬靈界,則較交信仰人士合適處理。

基於分析結果, 認為非信仰靈界之事, 病人明顯是病理上抑鬱症的原因是七種情緒不舒服，肝鬱情況暝突顯, 從經痛可以為一個佐證。合乎“因抑鬱而生的疾病”、“因疾病而生的抑鬱”的學術思想，陰陽失衡、氣血不和、氣滯, 痰飲, 臟腑功能失調, 是治療的大方向, 疏肝解鬱為首要任務。

第1個月治療總結處方(7月14日-8月中左右):

病理:

● 陰陽失衡

● 氣血不和

● 氣滯

● 嚴重肝鬱

● 濕痰

治療方向:

疏肝解鬱; 安神定志, 清濕

（本診所使用濃縮藥粉）

主方以逍遙散為首, 配柴胡龍骨牡蠣湯加減。

逍遙散5克+柴胡龍骨牡蠣湯6克

晚用酸棗仁湯加逍遙散加減。

逍遙散5克, 酸棗仁湯5克

適合時使用加減

解鬱安神，心神不安用合歡花1.5克,

嚴重失眠，多夢,多汗,心腎不通用夜交籐1.5克;

心虚驚悸，健忘，失眠用茯神1.5克;

驚悸健忘、多夢失眠,安定神志用遠志2克

第1個月治療成果:

● 惡夢減少一半

● 幻聽減少一半

● 睡質改善

● 但有Anxiety/ Panic attack 情況

● 經期痛仍需要止痛藥(2000mg)

第2個月治療總結處方(8月中-9月中):

因病人在工作環境不能使用沖劑藥粉(因為氣味四散),所以在辦公室時間中午用藥丸(pills), 早晚仍使用濃縮藥粉

病理:

● 氣血不和

● 嚴重肝鬱氣滯

● 濕痰

● 嚴重陽陰皆虛

治療方向

● 疏肝解鬱，養心安神，治心腎陰虧; 補氣補血。

早上：處方主方以逍遙散5克為首，配柴胡龍骨牡蠣湯5克。

午用(在家工作時用,2天藥粉) : 十全大補湯 5克+黃芪2克+柴胡龍骨牡蠣湯3克。

午用(在辦公室,3天藥丸) : 十全大補湯藥丸5片+八珍湯5片+ 柴胡龍骨牡蠣湯3片。

晚用：主方天王補心丹5克+ 逍遙散3克 + 酸棗仁湯2克。

按需要時使用:

寧心安神,鎮靜催眠用百合1克，

解鬱安神，心神不安用合歡花1.5克，

袪濕，健脾安神，利水而不傷正氣用雲苓1.5克,

驚悸健忘、多夢失眠,安定神志用遠志2克;

歸心、肝經, 活血調經，涼血消癰，安神丹參1克。

第2個月治療成果:

● Flupentixol 3mg減至1.5mg

● Venlafaxine Hydrochloride 由 255mg 減至217.5mg

● 沒有惡夢，改發生活夢

● 沒有幻覺

● 沒有幻聽

● 沒有全身汗濕

● 沒有PANIC ATTACK

● 但有增加焦慮感覺

● 十分疲倦

● 經痛減少50%

第3個月治療總結處方(9月中至10月中):

病理:

● 中度氣血不和

● 氣滯

● 中度濕痰

● 嚴重陽虛

● 中度血虛

治療方向:

● 疏肝解鬱首; 養心安神; 著力大補元氣;補氣同時補血。

早上處方主方以柴胡龍骨牡蠣湯5克為首, 配逍遙散4克加韓國正官庄高麗人參粉藥丸1粒。

午用藥丸(在辦公室用口服藥丸,方便無味) : 十全大補湯丸4片+柴胡龍骨牡蠣湯丸4片+ 高麗人參粉1粒。

午用藥粉(在家工作時用,每星期4天) : 十全大補湯5克+八珍湯4克+高麗人參粉。

晚用主方天王補心丹5克配逍遙散3克+酸棗仁湯3克。

第3個月治療成果:

● Flupentixol 已經停用半個月了

● Venlafaxine Hydrochloride 由 255mg減至150mg

● 沒有幻覺

● 沒有幻聽

● 沒有惡夢，改發生活夢

● 沒有全身汗濕

● 沒有PANIC ATTACK, 但有增加焦慮感覺

● 仍十分疲倦

● 經痛減少50%

● 可以跟工作同事及年青人傾談2.5小時段, 才疲倦而出現離解

● 憂鬱/情緒低落感覺大減

第4個月治療總結處方(10月中至今): 〖HT〗

病理:

● 中度至輕度氣滯

● 中度陽虛

● 輕度血虛

● 中度陰虛

● 腎水不足

● 肺燥

治療方向:

● 疏肝解鬱首;著力大補元氣;補氣同時補血

早上:處方主方仍以柴胡龍骨牡蠣湯4克為首, 配逍遙散4克加 石菖蒲1g+辛夷花1g。

午用藥丸(在辦公室用口服藥丸,方便無味) : 六味地黃湯8粒+柴胡龍骨牡蠣湯丸4片+高麗人參粉1粒。

午用藥粉(在家工作時用,每星期4天) : 逍遙散4克+六味地黃湯4g+遠志1g+沙參1g+玉竹1g。

晚用:主方天王補心丹3克配逍遙散3克+酸棗仁湯3克+遠志1g+百合1g+合歡花1g+麥門冬1g。

治療成果(精神科藥物減少紀錄):

Outcomes (Decreases in Dosage of Psychiatric Medication):

經過差不多4個月之治療, 病人情況大有改善,總結病情如下:

1.西藥Flupentixol 已完全停了使用; Venlafaxine Hydrochloride 255mg成功減至37.5mg

2.幻聽已經沒有出現

3.靈魂離體情況(俗稱: 離解) 沒有出現

4.沒有惡夢, 睡質改善

5.沒有全身冒汗

6.胃口好

4.來經期痛, 可減少服止痛藥

8.理解能力恢復, 可看懂電郵,完成2000字學術文章

9.可以跟工作同事及年青人傾談6小時段, 沒有出現離解

10.憂鬱/情緒低落感覺沒有

11.可以主領網上會議

寫給醫師:

本人不是第一次治療這類疾病, 醫師切忌“一刀切”停用西藥, 此舉十分危險; 中西藥同時服用; 必須先治療身體需要後, 才開始試減西藥; 必須在病人身體五行和諧情況下才可開始進行減藥。

針對病人“X”,病理探討及治療心得:

因病人正服用精神科藥物，中西合壁治療是必然的方向, 病人過去10年本以為情況改善; 其實是累計身體虧虛, 當因為身體因某些原因(環境轉變, 大壓力下)，故虧虛情況顯露出來。當身體受壓致減少釋放血清素/在混亂情況下接收過多/少巴多胺Dopamine, 而精神科醫生處方Flupentixol是一種典型精神病藥物，能抑制中樞神經內多巴胺受體(Dopamine receptor blocker)所產生的作用，以幫助抒緩精神分裂症的症狀。

當有中藥治療虧虛之時,身體慢慢改善之時, 回收巴胺受體也開始正常工作之時, Flupentixol 則可試遞減, 以1/4 速度遞減藥量, 同時要瞭解藥物的消耗的時間(half life elimination), 遞減的同時必需要為身體虧虛大補氣血; 同時, 是需要及時處理及針對性處理身體虧虛問題. 本人採用了韓國正官庄高麗參粉作為大補元氣之用。

我的病人是中西綜合治療，最終根治是需要身體五行平衡, 自動釋放及回收血清素, 而不需用藥阻礙回收血清素;同樣, 身體達最終自我可探制接收多巴胺(Dopamine ), 而不需使用藥物Dopamine receptor blocker 。 病人已取得第1階段成果; 病人醫師合作, 合適時要引入心理輔導, 病人要學懂處理壓力, 當身體虧虛持續改善至五行平衡， 血清素會在身心平衡下自行釋放，醫師在合適時間才遞減阻礙回收血清素西藥。整體治療時間是漫長的。 以現在情況, 病人也喜悅接受進入第4個月治療，絕對相信可以完全減去西藥。

最新病況(2024年1月19日):

病人於2024年1月5日成功停了所有精神科藥物2星期。

繼續中藥調理身體，十全大補湯丸4片+柴胡龍骨牡蠣湯丸4片+高麗人參粉1粒+八珍湯4克。

對本文章有意見, 及學術討論, 歡迎來電 [email protected]

參考文獻

1.https://www.cacm.org.cn/wp-content/uploads/2021/07/%E7%A5%9E%E5%BF%97%E7%97%85%E4%B8%AD%E8%A5%BF%E5%8C%BB%E7%BB%93%E5%90%88%E4%B8%B4%E5%BA%8A%E8%AF%8A%E7%96%97%E6%8C%87%E5%8D%97-%E7%99%94%E7%97%85.pdf 神志病中西医结合临床诊疗指南 癔病。

2.https://www.mayoclinic.org/diseases-conditions/schizophrenia/symptoms-causes/syc20354443#:~:text=Overview,functioning%2C%20and%20can%20be%20disabling。

3. https://www.medicalteaching.org/posts/uAlaM3cBhgYN2SYvBcz4/,癔症中醫叫什麼

4. https://kknews.cc/zh-hk/health/6e4r45l.html 什麼是癔病？癔病的中醫外治和護理方法

5. https://www.softmind.com.tw/3g_news_content.php?id=26 解離乃是一種心理防衛機轉

6. https://www.nhs.uk/mental-health/conditions/dissociative-disorders/

7. https://kb.commonhealth.com.tw/library/431.html#data-3-collapse 什麼是解離症？

作者簡介:

Alvin Wong中醫師，英國中醫學院，註冊中醫師,註冊針灸師，英國樂仁中醫診所(Harpenden)