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1.Differential Diagnosis of Syndromes
1. Hyperactivity of liver yang
Primary manifestations: Headache or dizziness aggravated by mental upset, irritability, flushed face, tinnitus, dry mouth with a bitter taste, dream-disturbed sleep, reddened tongue with yellow coating and tight, rapid pulse.
2. Deficiency of qi and blood
Primary manifestations: Headache or dizziness with lassitude, shortness of breath, palpitations, insomnia, spontaneous sweating, pink tongue with thin, white coating, and tight and thready pulse. (This morbid condition usually occurs in patients with hypertension complicated by cardiac dysfunction).
3. Deficiency in the kidneys
Primary manifestations: Headache or dizziness accompanied by an empty feeling of the head, tinnitus, weakness of the lower back and knees, impotence or nocturnal emission, dry mouth, reddened tongue with little coating and thready and weak pulse.
4. Interior retention of phlegm-damp
Primary manifestations: Headache or dizziness with a heavy and tight feeling in the head, a feeling of fullness and oppression over the chest and epigastrium, loss of appetite, somnolence, corpulent tongue with white, greasy coating, and soft and slippery pulse.
2. Treatment
1. Hyperactivity of liver yang
Principle of treatment: Calm the liver and suppress exuberant yang.
Formula of choice: Variant Gastrodia and Ucaria Beverage; in this recipe, gastrodia root, uncaria stem, abalone shell, and poria (prepared with cinnabar) calm the liver and suppress exuberant yang; gardenia fruit and scutellaria root clear away heat from the liver and strengthen the effect of calming the liver; and achyranthes root, eucommia bark and mistletoe nourish the kidneys to regulate the liver. In cases with flushed face, bloodshot eyes, bitter taste in the mouth, dry throat, yellow, greasy tongue coating and signs of a flaring-up of liver fire, use Gentian Liver-Draining Decoction.
2. Deficiency of qi and blood
Principle of treatment: Replenish qi and nourish blood.
Formula of choice: Middle-Tonifying Qi-Enriching Decoction plus asarum, vitex fruit, and ligusticum root for replenishing qi and expelling wind in patients suffering mainly from qi deficiency; Four Ingredients Decoction plus chrysanthemum flower and vitex fruit should be used with patients with headaches due predominantly to blood deficiency to nourish blood and eliminate wind.
3. Deficiency in the kidneys
Principle of treatment: Invigorate the kidneys
Formula of choice: Lycium Berry, Chrysanthemum, and Rehmannia Pill; this prescription is composed of Six Ingredient Rehmannia Pill, which nourishes kidney yin, and lycium berry and chrysanthemum flower, which nourish and calm the liver; for patients with deficiency of kidney yang, use Right-Restoring pill, while for patients with deficiency of kidney yin, use Left-Restoring Pill.
4. Interior retention of phlegm-damp
Principle of treatment: Eliminate damp and dissolve phlegm.
Formula of choice: Pinellia, White Atractylodes, and Gastrodia Decoction, in which tangerine peel, pinellia root, poria, and licorice root dissolve phlegm; gastrodia root and vitex fruit calm the liver and expel wind; ovate atractylodes root, and jujube regulate the middle-warmer and strengthen the spleen to enforce the effect of dissolving phlegm-damp.