Chapter Fifteen. Locked-up syndrome and formula composition
CHAPTER OUTLINE
This chapter introduces the principles, methods and strategies for the composition of formulas that aromatically regulate the Qi, transform phlegm and open the orifices. They are used to treat the locked-up syndrome (closed syndrome). All of the formulas shown in the examples are available in pill form for emergency use. At present, herbal injections or transfusions are administrated for even quicker effects.
Locked-up syndrome
Manifestations
Heat type
Main symptoms
Loss of consciousness, locked jaw, rigid limbs, clenched fists, no urination or bowel movement, high fever, irritability, red face, heavy breathing and warm limbs.
Tongue
Thick yellow coating.
Pulse
Rapid, slippery and forceful.
Cold type
Main symptoms
Loss of consciousness, locked jaw, rigid limbs, clenched fists, no urination or bowel movement, cold limbs, pale complexion.
Tongue
Thick white coating.
Pulse
Deep and wiry.
Associated disorders in western medicine
Cerebrovascular accident, epilepsy, sunstroke, hysteria, severe pain, fainting, hepatic coma and uremia.
Analysis of the syndrome
Locked-up syndrome is an acute, severe excess syndrome, which may occur alone or develop from some severe disease. The pathological change is a sudden blockage of the sensory orifices and blockage of the functions of associated internal organs by rebellious Qi, blood, phlegm or ascending Yang.
• The symptoms in this syndrome show obvious signs of blockage of the orifices and a locked-up body, such as loss of consciousness, locked jaw, rigid limbs, clenched fists, no urination or bowel movement.
• In locked-up syndrome caused by heat, there are symptoms and signs of heat, such as high fever, irritability, red face, heavy breathing, warm limbs, a thick yellow tongue coating and a rapid, slippery and forceful pulse.
• If locked-up syndrome is caused by cold, the Yang and Qi are blocked, and there are cold signs, such as cold limbs, pale complexion, a thick white tongue coating and a deep and wiry pulse.
Treatment principle: Aromatically open the orifices, regulate the Qi and blood, clear heat or transform turbidity, eliminate phlegm
Herb selection principles and formula composition strategies
• First, substances that are very pungent or substances that have a strong aromatic smell are selected as they move quickly and can open up blockage and revive the Shen.
• Second, herbs that eliminate phlegm and thereby open up the orifices are used.
• Third, herbs that eliminate heat-toxin or turbid-cold are often selected.
Note
A clear differentiation between collapsing syndrome and locked-up syndrome is important.
Locked-up syndrome is an acute excess syndrome. The orifices are locked up by disturbance of Qi and blood, which are complicated by phlegm, heat or cold, as well as ascending Yang. The symptoms are characterized by blockage of the orifices and a locked-up body, such as loss of consciousness, locked jaw, clenched fists, rigid limbs and a wiry, slippery and forceful pulse. Treatment should be given to open the orifices, expel phlegm, clear heat or warm the internal cold, and harmonize the Qi and blood.
Collapsing syndrome is a deficiency syndrome. It is caused by disharmony of Yin, Yang, Qi and blood when the Yang and Qi are too weak to hold the Yin and the blood and to carry on the functions of the internal organs. In this syndrome, patients lose consciousness gradually and have shallow respiration, shortness of breath, cold limbs, profuse sweating and incontinence of urine. The pulse is very deep and weak. This syndrome occurs in conditions where patients lose a large amount of blood, suffer from severe dehydration or myocardial infarction, or have severe infections. Treatment should be given to strongly strengthen the Qi and rescue the Yang. After the patient wakes up, treatment for tonifying the weakness and harmonizing the functions of the internal organs should start.
(See Figure 15.1 on page 333.)
CAUTIONS
1. Select the appropriate form of administration:
Since the aromatic ingredients that open the orifices can easily be destroyed by high temperature during cooking, the formulas are always prepared at low temperature. All of these formulas are available in pill form for emergency use. At present, herbal injections or transfusions are administrated for even quicker effects.
2. Use substitutes for banned products:
Although some substances such as She Xiang ( Moschus)** and Niu Huang ( Bovis calculus)** are banned, they can be substituted by synthetic versions. Xi Jiao ( Rhinoceri cornu)** and Ling Yang Jiao ( Antelopis cornu)** are also banned and should be replaced with other substances.
3. Choose a short treatment course:
Since these aromatic substances strongly stimulate the Yin, Yang, Qi and blood, they may scatter and weaken the Qi. Thus they should be applied only for a short period of time. After patients are revived from coma, treatment should be given according to the differentiation of the current syndrome.
4. Caution in pregnancy and bleeding conditions:
The aromatic substances should not be used for pregnant women and in conditions of heavy bleeding as they can easily and quickly activate the Qi and blood.
Structure of the formula and selection of herbs
Chief: Aromatically open the orifices
Synthetic Niu Huang ( Bovis calculus), She Xiang ( Moschus)** and Bing Pian ( Borneol)
These are aromatic substances. Niu Huang is cold and She Xiang is warm. They have a dispersing and penetrating ability, and as they move quickly, they can effectively open up blockage. They are often used in the formula to treat the heat type of locked-up syndrome.
Bing Pian is pungent, cold and aromatic. It has a dispersing and penetrating ability, can quickly promote Qi movement and open the obstruction of the orifice. It is often used in formulas to treat locked-up syndrome. Since Niu Huang and She Xiang are unavailable, this herb becomes more important in clinical practice.
Synthetic She Xiang ( Moschus), Su He Xiang ( Styrax) and An Xi Xiang ( Benzoinum)
These aromatic substances are warm in nature. They can penetrate the turbidity, regulate Qi and open up blockage. They are often used in the formula to treat the cold type of locked-up syndrome.
Deputy: Transform phlegm, clear heat-toxin, calm the mind and warm the interior
Yu Jin ( Curcumae radix), Tian Zhu Huang ( Bambusae concretio silicea) and Zhu Li ( Bambusae succus)
These cold herbs can effectively eliminate phlegm-heat and revive the Heart-spirit. They are used in the formula to treat the heat type of locked-up syndrome.
Shi Chang Pu ( Acori graminei rhizoma), Huo Xiang ( Agastachis herba) and Pei Lan ( Eupatorii herba)
These warm and aromatic herbs can penetrate turbidity, transform dampness and regulate Qi movement. They are used in the formula to treat the cold type of locked-up syndrome.
Xi Jiao ( Rhinoceri cornu)**, Ling Yang Jiao ( Antelopis cornu)**, Shi Gao ( Gypsum), Huang Lian ( Coptidis rhizoma), Huang Qin ( Scutellariae radix), Zhi Zi ( Gardeniae fructus) and Lian Qiao ( Forsythiae fructus)
These cold substances can clear heat and remove heat-toxin. They are used in the formula to treat the heat type of locked-up syndrome. Xi Jiao and Ling Yang Jiao should be replaced by other substances.
Jin Bo (Gold), Yin Bo (Silver), Zhu Sha ( Cinnabaris)*, Zhen Zhu ( Margarita usta) and Ci Shi ( Magnetitum)
These metals and mineral substances can calm the mind and relieve irritability. They are used in the formula to treat the heat type of locked-up syndrome. It should be mentioned that Zhu Sha is a poisonous substance that should be replaced with other substances.
Assistant: Regulate the Qi and expel wind
Mu Xiang ( Aucklandiae radix)**, Zhi Ke ( Aurantii fructus), Tan Xiang ( Santali albi lignum) and Chen Xiang ( Aquilariae lignum)
These aromatic herbs can particularly move the Qi and enhance the chief substances in the formula to open the orifices .
Jiang Can ( Bombyx batrycatus) and Quan Xie ( Scorpio)*
Jiang Can and Quan Xie can expel wind and eliminate phlegm from the collaterals. They are used in both the heat type and the cold type of locked-up syndrome.
Examples of classical formulas
As the following formulas are large in composition and are only used in patent form, only the differences between these formulas are discussed.
Comparison of the formulas An Gong Niu Huang Wan (Calm the Palace Pill with Cattle Gallstone) 
, Zhi Bao Dan (Greatest Treasure Special Pill) 
, Zi Xue Dan (Purple Snow Special Pill) 
and Su He Xiang Wan (Liquid Styrax Pill) 
The first three formulas contain substances that aromatically open the orifices, clear heat-toxin and transform phlegm-heat. They are used for the heat type of locked-up syndrome. Although they all have the functions of the three aspects, there are some differences in applications:
• for removing heat-toxin, An Gong Niu Huang Wan is the strongest and Zhi Bao Dan is the weakest
• for reducing heat, Zi Xue Dan is the strongest and Zhi Bao Dan is the weakest
• for transforming phlegm, Zhi Bao Dan is the strongest and Zi Xue Dan is the weakest.
Su He Xiang Wan contains substances that are warm in temperature, can regulate the Qi, transform phlegm, penetrate turbidity and open the orifices. It is used for the cold type of locked-up syndrome.
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| Figure 15.1 •. |
| Differentiation of collapsing syndrome and locked-up syndrome. |
