Vexation and Agitation (Bu An Jing, You)

In Chinese medicine, vexation means annoyance due to a hot, oppressive sensation in the chest. Agitation refers to a restless state of the limbs. The
former is a subjective symptom, while the other is an objective sign. Although they are different, they are usually considered one term since, in most
cases, they occur in combination and share the same disease mechanisms.

Differential Diagnosis: 
Medical Disorders:
1. Parkinson’s Disease
2. History of cerebrovascular accident (CVA)
3. Brain Tumors
4. Hyperthyroidism

Effects of Substances:
1. Alcohol or illicit substance intoxication or withdrawal
2. Akathisia as a side effect of antipsychotic medications
3. Side effects or discontinuation effects on mediation

Psychiatric Disorders:
1. Generalized Anxiety Disorder (GAD)
2. Conversion Disorder
3. Depression and other mood disorders
4. Bipolar disorder, manic phase
5. Schizophrenia, acute exacerbation, and other psychotic disorders
6. Post-traumatic Stress Disorder (PTSD)
7. Social phobia & Specific phobias
8. Personality Disorders

TCM Pattern Differentiation: 

Exterior Cold-Depressed Heat 
Vexation and agitation, generalized body pain, fever (“emission of heat”), aversion to cold, no sweating, headache, slight thirst
Tongue: thin, yellowish white coat
Pulse: Floating, tight, rapid
Treatment Principles: Resolve the exterior and scatter cold, clear heat and eliminate vexation
Acupuncture Treatment: HT-8, SI-7, BL-12, LI-4, LI-11. Draining technique
Herbal Treatment: Da Qing Long Tang Jia Jian1
[Ma Huang (10g.), Gui Zhi (6g.), Gan Cao (6g.), Xing Ren (10g.), Shi Gao (25g.), Sheng Jiang (3g.), Da Zao(3 pieces), Dan Dou Chi (10g.)]

Yangming Replete Heat 

Vexation and agitation, high fever, sweating, course breathing, thirst, constipation w/ dry bound stools, abdominal fullness, pain in the abdomen
exacerbated by pressure, in severe cases, delirium
Tongue: dry yellow or dry black coat
Pulse: Surging, large or deep, replete
Treatment Principles: Clear Heat, engender fluids, and greatly precipitate heat binding
Acupuncture Treatment: LI-4, St-44, TW-6, ST-37, BL-21, KI-2. Draining technique
Herbal Treatment: Bai Hu Tang Jia Wei1
[Shi Gao (25g.), Zhi Mu (10g.), Gan Cao (6g.), Geng Mi (10g.), Dan Dou Chi (10g.), Zhi ZI (10g.)]

Shaoyang Gallbladder Channel Depressed Fire 

Vexation and agitation, alternating cold and heat, chest and rib-side fullness and oppression, bitter taste in mouth, inhibited urination
Tongue: normal or red tongue, half yellow half white coat
Pulse: Bowstring, rapid
Treatment Principles: Harmonize the shaoyang, clear heat and eliminate vexation
Acupuncture Treatment: LR-14, GV-14, PC-5, GB-41. Draining technique
Herbal Treatment: Xiao Chai Hu Tang Jia Jian1
[Chai Hu (12g.), Huang Qin (10g.), Dang Shen (10g.), Ban Xia (10g.), Zhi Gan Cao (6g.), Qing Hao (10g.), Zhi Zi (10g.), Long Gu (12g.), Mu LI (12g.),
Sheng Jiang (5g.)]

Heat Entering the Constructive & Blood 

Vexation and agitation, insomnia, fever which is worse at night, in severe cases, mania, macules or eruptions on the skin, blood ejection (i.e.
hemetemesis, epistaxis, hematuria, hemafecia, etc.)
Tongue: crimson
Pulse: Fine, rapid
Treatment Principles: Clear heat, cool the blood, and eliminate vexation
Acupuncture Treatment: HT-8, PC-8, BL-40, LI-11, KI-1. Draining technique on all but BL-40 (bleed)
Herbal Treatment: Qing Ying Tang Jia Jian1
[Shui Niu Jiao (25g.), Sheng Di (12g.), Xuan Shen (10-15g.) Zhu Ye (10g.), Mai Dong (12g.), Dan Pi (10g.), Dan Shen (10g.), Huang Lian (6g.), Jin
Yin Hua (10-12g.) ,Lian Qiao (10-12g.)]
Modifications: 
Severe skin eruptions or blood ejection: -Jin Yin Hua ,Lian Qiao; + Zhi Zi, Chi Shao; increase Sheng Di to 20g.
No Bleeding: + (bleed all) LI-11, LI-1, PC-9, TW-1, HT-9, SI-1 
Diaphragm Heat 
Vacuity vexation, insomnia, burning sensation in the region of the heart, chest and diaphragm glomus and oppression with a desire to vomit
Tongue: thin yellow coat
Pulse: rapid
Treatment Principles: Clear the diaphragm and eliminate vexation
Acupuncture Treatment: LI-5, ST-44, BL-17, HT-8, PC-3. Draining technique
Herbal Treatment: Zhi Zi Dou Chi Tang Jia Wei1
[Zhi Zi (10g.), Dan Dou Chi (10g.), Bo He (6g.), Gan Cao (3g.)]
Modifications: 
Severe internal heat: + Shi Gao

Phlegm Fire Harassing Above 

Vexatious heat in the heart and agitation, sound of phlegm in the throat, spitting sticky thick phlegm, dyspnea, heavy-headedness, vertigo, chest
oppression, abdominal distention, nausea, vomiting
Tongue: slippery yellow coat
Pulse: slippery, rapid
Treatment Principles: Clear heat, transform phlegm, and eliminate vexation
Acupuncture Treatment: PC-8, ST-44, LI-11, GV-14, St-40. Draining technique
Herbal Treatment: Huang Lian Wen Dan Tang Jia Jian1
[Ban Xia (10g.), Zhu Ru (10g.), Zhi Shi (6g.), Chen Pi (10g.), Gan Cao (3g.), Fu Ling (10g.), Sheng Jiang (3g.), Da Zao (3 pieces), Huang Lian (6g.),
Huang Qin (10g.)]

Liver Depression Transforming Heat 

Irritability, bitter taste in mouth, rib-side distention & pain, breast distention and pain, menstrual irregularity in females
Tongue: red tongue, yellow coat
Pulse: bowstring, rapid
Treatment Principles: Course the liver and rectify the Qi, clear heat and resolve depression
Acupuncture Treatment: LR-2, LR-3, LI-4, LI-11, St-36. Draining technique
Herbal Treatment: Dan Zhi Xiao Yao San1
[Chai Hu (10g.), Bai Shao (10g.), Dang Gui (10g.), Bai Zhu (10g.), Fu Ling (10g.), Dan Pi (10g.), Zhi ZI (10g.), Gan Cao (6g.)]

Heart Fire Effulgence 

Vexation and agitation, heart palpitations, insomnia, urgent choppy painful urination, sores in the mouth and tip of tongue
Tongue: red or red-tipped tongue
Pulse: bowstring, rapid
Treatment Principles: Clear the heart and downbear fire, disinhibit urination and quiet the spirit
Acupuncture Treatment: PC-8, HT-8, CV-4, ST-39, SI-2. Draining technique
Herbal Treatment: Dao Chi San Jia Wei1
[Sheng Di (12g.), Mu Tong (10g.), Deng Xin Cao (10g.), Huang Lian (6g.), Zhu Ye (6g.), Gan Cao (6g.), Hu Po (1g. powder)]
Modifications: 
Hematuria: + Huan Lian Cao, Xiao Ji
Simultaneous Yin Vacuity: + Shi Hu, Zhi Mu

Yin Vacuity Fire Effulgence 

Vacuity vexation and agitation, insomnia, heart palpitations, profuse dreams, low back and knee soreness and limpness, 5-palm heat, afternoon tidal
heat, malar flushing, dry throat and mouth
Tongue: red tongue, scanty coat
Pulse: fine rapid, floating rapid, or surging rapid
Treatment Principles: Nourish Yin, downbear fire, and eliminate vexation
Acupuncture Treatment: HT-6, KI-7, KI-2, KI-3, ST-41. Even technique
Herbal Treatment: 
Predominant effulgent fire: Huang Lian E Jiao Tang
Predominant Yin Vauity: Zhi Bai Di Huang Wan

Heat & Stasis Mutually Binding 

Vexation and agitation, reddish purple lips and facial complexion, chest, breast, or abdominal pain which is severe, fixed in location, worse at night
and associated with feelings of burning heat, spider nevi, hemagiomas, and varicosities, abnormal vaginal bleeding in females with clots mixed in with
bright red blood
Tongue: reddish purple tongue w/ static spots or macules, possible yellow coat
Pulse: bowstring, rapid, possibly choppy
Treatment Principles: Quicken the blood and transform stasis, clear heat and eliminate vexation
Acupuncture Treatment: SP-10, SP-6, BL-17, HT-7, PC-6. Draining technique
Herbal Treatment: Qin Lian Si Wu Tang Jia Wei1
[Huang Qin (10g.), Huang Lian (3-4.5g.), Tao Ren (10g.), Hong Hua (10g.), Dang Gui (10g.), Sheng Di (12g.), Chuan Xiong (6-0g.), Chi Shao (10g.),
Chuan Niu Xi (10g.), Dan Shen (10g.), Chai Hu (6-10g.), Zhi Ke (6g.), Gan Cao (3g.)]

Yin Exuberance-Repelling Yang 

Red facial complexion as if rouged, no aversion to cold, chilly breath, faint respiration, symptoms similar to mania, vexation and agitation,
restlessness, desire to sit in water or in a Yin, cool place, reversal chilling of the four limbs, long clear urination, loose stools w/ undigested food, oral
thirst but no desire to drink or possible liking for hot drinks
Tongue: dark pale tongue, moist glossy coat
Pulse: deep, fine
Treatment Principles: Break Yin and rescue Yang, stem counterflow and scatter cold
Acupuncture Treatment: ST-36, CV-8, CV-4. Moxa
Herbal Treatment: Tong Mai Si Ni Tangi1
[Fu Zi (10g.), Gan Jiang (4.5g.), Gan Cao (6g.)]