Symptom family: Cognitive Impairment

Did you mean? Confusion

What Is Delirium?

Delirium, also known as an acute confused state, is a serious cognitive disorder characterized by sudden changes in awareness, attention, and cognition. Individuals experiencing delirium often exhibit disorientation, difficulty in concentrating, and rapid mood swings, along with hallucinations or delusions. This condition can arise from various medical causes, such as infections, medication side effects, or metabolic imbalances, and is more common among the elderly or those with severe illness. Delirium requires immediate medical attention, as it can signal a life-threatening situation or lead to further cognitive decline if untreated.

How Does TCM View Delirium?

In Traditional Chinese Medicine (TCM), delirium is understood as a result of severe internal imbalances that disrupt the mind’s clarity and the smooth flow of Qi (vital energy). Unlike Western medicine, which focuses on underlying physical causes, TCM looks at the patterns of disharmony within the body that can lead to such an acute mental state. Identifying the correct pattern, whether it involves excessive Heat, Phlegm, or other factors, is crucial for effective treatment, as each pattern requires a different therapeutic approach.

Root Causes of Delirium in TCM

In Traditional Chinese Medicine, delirium is often linked to intense internal Heat, particularly within the Stomach, during the Bright Yang Stage of Zhang Zhong Jing's Six Stages Theory. This theory outlines the progression of disease, with Bright Yang being a phase where pathogenic Heat has deeply penetrated, causing severe disruptions in mental clarity. When this Heat accumulates in the Stomach, it can result in symptoms such as high fever, extreme thirst, restlessness, and the acute mental confusion associated with delirium. This pattern, known as Stomach Heat in the Bright Yang stage, is one of the critical ways in which TCM understands the onset of delirium.

Another potential cause of delirium in TCM is the accumulation of Phlegm, which can block the orifices of the Heart and disrupt mental clarity. Phlegm, often resulting from chronic Spleen deficiency or improper diet, congeals and causes symptoms such as dizziness, a stifling sensation in the chest, and mental cloudiness. When Phlegm combines with Heat, it can further exacerbate the symptoms of delirium, making the condition more severe. Recognizing these patterns helps TCM practitioners tailor treatment to the specific imbalances causing the delirium.

Explore below more details about what might cause Delirium according to TCM.

  • By Syndrome
  • By Organ
  • Stomach
  • Small Intestine
  • Pericardium
Detailed description of the cause

Heat

In TCM "Heat" signifies an excess of Yang energy, leading to an imbalance where heat predominates over the body's cool Yin aspects. This condition is metaphorically akin to an internal over-heating. Symptoms indicative of Heat can include feelings of warmth, fever, sweating, irritability, red face, thirst with a preference for cold drinks, and a rapid pulse. The tongue may appear red with a yellow coating. Unlike the common interpretation of heat in terms of temperature, in TCM, it represents a state of hyperactivity or inflammation in the body.... see more

Heat Patterns That Can Lead to Delirium

Common Symptoms: Irritability Thirst Flushed Face Feeling Of Heat Insomnia Incoherent Or Confused Speech Excessive Sweating Abdominal Pain

Pattern Name Relevant Symptoms Relevant Formulas
Bright Yang Fire in Stomach and Intestines Delirium, Afternoon fever, Excessive sweating, Sweating on limbs, Abdominal fullness, Abdominal pain, Constipation, Dry stools, Thirst, Dark urine, Anal burning, Irritability... see more Tiao Wei Cheng Qi Tang | Xiao Cheng Qi Tang
Bright Yang Stomach Heat Delirium, High fever, Excessive sweating, Excessive thirst, Flushed face, Feeling of heat, Irritability... see more Bai Hu Tang
Heat in Nutritive Qi level Delirium, Nighttime fever, Dry mouth without desire to drink, Restlessness, Insomnia, Incoherent or confused speech, Aphasia, Macules... see more Qing Ying Tang | Bai He Di Huang Tang
Heat in Pericardium Delirium, Nighttime fever, Confusion, Incoherent or confused speech, Cold extremities Qing Ying Tang | Zhi Bao Dan
Heat in the Blood Delirium, Feeling of heat, Red skin eruptions, Thirst, Frequent bleeding, Bloody sputum, Hematochezia, Hematuria, Vomiting blood, Cough of blood, Nosebleeds, Excessive menstruation... see more Qing Ying Tang | Bai He Di Huang Tang | Xi Jiao Di Huang Tang | Gu Jing Wan | Shi Hui San | Hua Ban Tang | Qing Re Gu Jing Tang
Wind Cold with Internal Heat Delirium, High fever, Severe chills, Lack of sweating, Headaches, Feeling of heaviness, General sensation of tightness, Flushed face, Eye hyperemia, Dry nose, Thirst, Irritability, Insomnia, Cough of blood, Mottled skin... see more Shi Gao Tang
Detailed description of the cause

Cold

In TCM "Cold" as a pattern of disharmony refers to a specific type of imbalance within the body's systems, often linked to a deficiency or weakness. It's not about feeling physically cold or having a common cold, but rather a metaphorical description of certain symptoms and underlying conditions. When a TCM practitioner says someone suffers from "Cold," it usually implies that the body's Yang energy, which is warm and active, is insufficient or overpowered by Yin energy, which is cool and passive. Symptoms of Cold in TCM can include a general feeling of coldness, cold limbs, pale complexion, low energy, slow metabolism, and a preference for warmth. ... see more

Cold Patterns That Can Lead to Delirium

Common Symptoms: Irritability Excessive Sweating Thirst High Fever Flushed Face Afternoon Fever Sweating On Limbs Abdominal Fullness

Pattern Name Relevant Symptoms Relevant Formulas
Bright Yang Fire in Stomach and Intestines Delirium, Afternoon fever, Excessive sweating, Sweating on limbs, Abdominal fullness, Abdominal pain, Constipation, Dry stools, Thirst, Dark urine, Anal burning, Irritability... see more Tiao Wei Cheng Qi Tang | Xiao Cheng Qi Tang
Bright Yang Stomach Heat Delirium, High fever, Excessive sweating, Excessive thirst, Flushed face, Feeling of heat, Irritability... see more Bai Hu Tang
Wind Cold with Internal Heat Delirium, High fever, Severe chills, Lack of sweating, Headaches, Feeling of heaviness, General sensation of tightness, Flushed face, Eye hyperemia, Dry nose, Thirst, Irritability, Insomnia, Cough of blood, Mottled skin... see more Shi Gao Tang
Detailed description of the cause

Wind

In TCM "Wind" is a concept that represents a pattern of disharmony, often characterized by its sudden and unpredictable nature, much like a gusty wind changing direction without warning. This pattern is associated with symptoms that come and go quickly or move around the body, such as itching, tremors, or even certain types of pain. Wind is considered to be a primary cause of illnesses that have these rapidly changing characteristics. In TCM, external Wind often refers to illnesses that start suddenly, like the common cold, believed to be caused by external pathogenic factors like climatic changes. On the other hand, internal Wind can be linked to internal imbalances and can manifest in conditions like dizziness or spasms. ... see more

Wind Patterns That Can Lead to Delirium

Common Symptoms: Irritability Excessive Sweating Thirst High Fever Flushed Face Afternoon Fever Sweating On Limbs Abdominal Fullness

Pattern Name Relevant Symptoms Relevant Formulas
Bright Yang Fire in Stomach and Intestines Delirium, Afternoon fever, Excessive sweating, Sweating on limbs, Abdominal fullness, Abdominal pain, Constipation, Dry stools, Thirst, Dark urine, Anal burning, Irritability... see more Tiao Wei Cheng Qi Tang | Xiao Cheng Qi Tang
Bright Yang Stomach Heat Delirium, High fever, Excessive sweating, Excessive thirst, Flushed face, Feeling of heat, Irritability... see more Bai Hu Tang
Wind Cold with Internal Heat Delirium, High fever, Severe chills, Lack of sweating, Headaches, Feeling of heaviness, General sensation of tightness, Flushed face, Eye hyperemia, Dry nose, Thirst, Irritability, Insomnia, Cough of blood, Mottled skin... see more Shi Gao Tang
Detailed description of the cause

Phlegm

In TCM "Phlegm" as a pattern of disharmony is a complex concept that extends beyond the physical manifestation of mucus. It represents a pathological factor that can disrupt the flow of Qi (vital energy) and blood, leading to various health issues. Phlegm in TCM is seen as a sticky, turbid substance arising from the body's inability to metabolize fluids properly, often due to a dysfunction of the spleen. It's not only associated with respiratory problems like cough and congestion but also with systemic issues. Symptoms can include a feeling of heaviness, mental cloudiness, dizziness, and in some cases, the formation of lumps or masses. Phlegm can even be "invisible," contributing to emotional disturbances like depression or stress. ... see more

Phlegm Patterns That Can Lead to Delirium

Pattern Name Relevant Symptoms Relevant Formulas
Phlegm Delirium, Stifling sensation in the chest, Head fog, Dizziness Er Chen Tang | Liu Jun Zi Tang | Ban Xia Bai Zhu Tian Ma Tang | Wen Dan Tang | Hao Qin Qing Dan Tang | Xing Su San
Detailed description of the cause

Stomach

In TCM the Stomach is regarded as the "sea of nourishment," pivotal for digesting food and transforming it into Qi and blood. It works closely with the Spleen to distribute these essential nutrients throughout the body. When the Stomach is out of balance or malfunctions in TCM, it often leads to digestive problems such as bloating, nausea, vomiting, poor appetite, or a feeling of fullness. There may also be issues like acid reflux or a sour taste in the mouth. Emotionally, an imbalanced Stomach can contribute to excessive worry and overthinking, reflecting the TCM belief that physical and emotional well-being are deeply interconnected.... see more

Stomach Patterns That Can Lead to Delirium

Common Symptoms: Excessive Sweating Irritability Afternoon Fever Sweating On Limbs Abdominal Fullness Abdominal Pain Constipation Dry Stools

Pattern Name Relevant Symptoms Relevant Formulas
Bright Yang Fire in Stomach and Intestines Delirium, Afternoon fever, Excessive sweating, Sweating on limbs, Abdominal fullness, Abdominal pain, Constipation, Dry stools, Thirst, Dark urine, Anal burning, Irritability... see more Tiao Wei Cheng Qi Tang | Xiao Cheng Qi Tang
Bright Yang Stomach Heat Delirium, High fever, Excessive sweating, Excessive thirst, Flushed face, Feeling of heat, Irritability... see more Bai Hu Tang
Detailed description of the cause

Small Intestine

In TCM the Small Intestine plays a critical role in receiving partially digested food from the Stomach and further separating the clear from the turbid, essentially distinguishing nutrients from waste. This process is vital for proper absorption and assimilation of food. The Small Intestine is also associated with clarity of judgment and decision-making. When it malfunctions or is imbalanced in TCM, it can lead to digestive issues such as abdominal pain, bloating, poor appetite, or irregular bowel movements. Additionally, a malfunctioning Small Intestine may manifest as mental confusion or difficulty in making decisions, reflecting its role in discernment and clarity in both physical and mental realms. ... see more

Small Intestine Patterns That Can Lead to Delirium

Pattern Name Relevant Symptoms Relevant Formulas
Bright Yang Fire in Stomach and Intestines Delirium, Afternoon fever, Excessive sweating, Sweating on limbs, Abdominal fullness, Abdominal pain, Constipation, Dry stools, Thirst, Dark urine, Anal burning, Irritability... see more Tiao Wei Cheng Qi Tang | Xiao Cheng Qi Tang
Detailed description of the cause

Pericardium

In TCM the Pericardium is more than a physical membrane protecting the heart; it's considered an organ system that acts as the "Heart's protector." It plays a crucial role in safeguarding the heart from external pathogenic factors and emotional disturbances. The Pericardium is also involved in regulating blood circulation and influencing emotional well-being, especially in terms of relationships and intimacy. When the Pericardium malfunctions or is imbalanced in TCM, it can lead to symptoms that mirror heart issues, such as chest pain or palpitations, but often with an emotional component like difficulty in forming emotional connections or excessive vulnerability to external stressors. Additionally, a disturbed Pericardium can result in sleep disturbances, anxiety, and in severe cases, mental confusion, reflecting its integral role in both physical heart protection and emotional balance.... see more

Pericardium Patterns That Can Lead to Delirium

Pattern Name Relevant Symptoms Relevant Formulas
Heat in Pericardium Delirium, Nighttime fever, Confusion, Incoherent or confused speech, Cold extremities Qing Ying Tang | Zhi Bao Dan

TCM Herbal Formulas for Delirium

To treat delirium, TCM focuses on clearing Heat and resolving Phlegm, depending on the underlying pattern identified. For delirium linked to Stomach Heat during the Bright Yang Stage, the formula Bai Hu Tang is often used. This formula, with Gypsum (Shi Gao) as its primary herb, effectively clears intense Heat at the Qi level, addressing symptoms such as high fever, excessive thirst, and mental agitation.

In cases where Phlegm is the dominant factor, Er Chen Tang is recommended. This formula is designed to dry Dampness and transform Phlegm, helping to clear the mind and improve cognitive function. The selection of herbs and formulas is highly individualized, based on the specific disharmony patterns present in the patient, emphasizing the importance of accurate diagnosis in TCM.

Explore below some TCM herbal formulas used to address delirium, organized by cause and by formula type.

  • By Cause
  • By Formula Type
  • Formulas that purge heat accumulation
  • Formulas that clear nutritive-level heat
  • Formulas that clear heat from deficiency
  • Formulas that dry dampness and transform phlegm
  • Formulas that clear qi-level heat
  • Formulas that clear heat and open sensory orifices
  • Formulas that secure irregular uterine bleeding and stop vaginal discharge
  • Formulas that stop bleeding
  • Formulas that clear heat from qi and blood
  • Formulas that tonify qi
  • Formulas that transform phlegm and extinguish wind
  • Formulas that harmonize lesser yang-warp disorders
  • Formulas that disperse dryness and moisten
  • Formulas that release the exterior and clear the interior

All Formulas Recommended for Delirium Caused by Heat

Formula Patterns Suitable For
Qing Ying Tang Heat in Nutritive Qi level, Heat in Pericardium, Heat in the Blood
Bai He Di Huang Tang Heat in Nutritive Qi level, Heat in the Blood
Tiao Wei Cheng Qi Tang Bright Yang Fire in Stomach and Intestines
Xiao Cheng Qi Tang Bright Yang Fire in Stomach and Intestines
Bai Hu Tang Bright Yang Stomach Heat
Zhi Bao Dan Heat in Pericardium
Xi Jiao Di Huang Tang Heat in the Blood
Gu Jing Wan Heat in the Blood
Shi Hui San Heat in the Blood
Hua Ban Tang Heat in the Blood
Qing Re Gu Jing Tang Heat in the Blood
Shi Gao Tang Wind Cold with Internal Heat

All Formulas Recommended for Delirium Caused by Cold

Formula Patterns Suitable For
Tiao Wei Cheng Qi Tang Bright Yang Fire in Stomach and Intestines
Xiao Cheng Qi Tang Bright Yang Fire in Stomach and Intestines
Bai Hu Tang Bright Yang Stomach Heat
Shi Gao Tang Wind Cold with Internal Heat

All Formulas Recommended for Delirium Caused by Wind

Formula Patterns Suitable For
Tiao Wei Cheng Qi Tang Bright Yang Fire in Stomach and Intestines
Xiao Cheng Qi Tang Bright Yang Fire in Stomach and Intestines
Bai Hu Tang Bright Yang Stomach Heat
Shi Gao Tang Wind Cold with Internal Heat

All Formulas Recommended for Delirium Caused by Phlegm

Formula Patterns Suitable For
Er Chen Tang Phlegm
Liu Jun Zi Tang Phlegm
Ban Xia Bai Zhu Tian Ma Tang Phlegm
Wen Dan Tang Phlegm
Hao Qin Qing Dan Tang Phlegm
Xing Su San Phlegm

All "formulas that clear nutritive-level heat" recommended for delirium

Formula Patterns Suitable For (if applicable)
Qing Ying Tang Heat in Nutritive Qi level, Heat in Pericardium, Heat in the Blood
Xi Jiao Di Huang Tang Heat in the Blood

All "formulas that clear heat from deficiency" recommended for delirium

Formula Patterns Suitable For (if applicable)
Bai He Di Huang Tang Heat in Nutritive Qi level, Heat in the Blood
Qing Re Gu Jing Tang Heat in the Blood

All "formulas that purge heat accumulation" recommended for delirium

Formula Patterns Suitable For (if applicable)
Tiao Wei Cheng Qi Tang Bright Yang Fire in Stomach and Intestines
Xiao Cheng Qi Tang Bright Yang Fire in Stomach and Intestines

All "formulas that dry dampness and transform phlegm" recommended for delirium

Formula Patterns Suitable For (if applicable)
Er Chen Tang Phlegm
Wen Dan Tang Phlegm

Acupoints for Delirium

Acupuncture plays a crucial role in addressing the root causes of delirium by targeting specific acupoints that clear Heat, resolve Phlegm, and calm the mind. For cases of delirium associated with Stomach Heat in the Bright Yang stage, Laogong (P-8), located in the center of the palm, is often used to clear Heart Fire and restore consciousness, making it particularly effective in acute, severe cases.

When Phlegm is a contributing factor, Jianshi (P-5) is a key acupoint on the Pericardium channel that helps open the mind's orifices and remove Phlegm, thereby calming the mind and improving mental clarity. These acupoints, along with others like Weizhong (BL-40) on the Bladder channel, work together to address both the Heat and Phlegm patterns underlying delirium, providing a holistic approach to treatment in TCM.

Explore below some acupoints used to address delirium, organized by meridian.

  • By Meridian
  • Pericardium Channel
  • Bladder Channel
Quze P-3

Quze P-3

On the transverse cubital crease, at the ulnar side of the tendon of biceps brachii muscle.

Jianshi P-5

Jianshi P-5

3 cun above the transverse crease of the wrist, between the tendons of palmaris longus and flexor carpi radialis muscle.

Laogong P-8

Laogong P-8

In the center of the palm, between the 2nd and the 3rd metacarpal bones, proximal to the metacarpophalangeal joint.

Weizhong BL-40

Weizhong BL-40

At the midpoint of the popliteal crease, between the tendons of biceps femoris and semitendinosus muscle.

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