Guest guest Posted August 8, 2001 Report Share Posted August 8, 2001 Dear Group, The following concerns a discussion between Bob Flaws and Alon Marcus about "irritability." Dr. Flaws asserted that irritability "is the specific signature of liver depression." Alon Marcus countered that, "When I worked in the In-patient department irritability was often related by senior physicians as heat affecting spirit especially in septic patients and was clearly not related by them as a liver associated symptom. Shi Gao was a favorite for many patients showing irritability, clearly not a Liver herb." I believe this exchange was greatly hampered by using ambiguous terms. While I have no great love for the Wiseman-Ye terminology, I have had to use it in order to submit a manuscript to Blue Poppy. In reference to the above, I can certainly see its usefulness. Wiseman does not use the term "irritability" for yi nu ("proneness to anger"). Instead he translates this as "irascibility." Irritability has the following simple definitions (from Merriam-Webster): 1: the property of protoplasm and of living organisms that permits them to react to stimuli 2: the quality or state of being irritable: as a: quick excitability to annoyance, impatience, or anger: PETULANCE b: abnormal or excessive excitability of an organ or part of the body. Irascibility, on the other hand is the condition of being ":marked by hot temper and easily provoked anger." Irritability comes from a Latin root word meaning "to rise" while irascibility comes from a Latin root word meaning "anger." In other words, irascibility does not have a somatic component while irritability does, one that is almost close to "physiologically stimulated." On the other hand, in Wiseman and other sources, the word most associated with heat that has a connotation of irritability is "vexation." Vexation has the definitions: 1: the act of harassing or vexing: troubling 2: the quality of state of being vexed : irritation 3: a cause of trouble : affliction Wiseman says of fan zao (vexation and agitation): "[it is] A subjective feeling of heat and disquietude in the chest (vexation) and objective fidgetiness of the limbs (agitation). Both signs occur in vacuity, repletion, cold and heat patterns." Bensky tends to use "irritation" for what I infer is fan zao in his formula book when discussing yang ming syndromes, but I attended lectures with him and Dr. Ma where he indicated that this heat "irritation" had a strong somatic component. Disease mechanisms in the Shan Han Lun and Wen Bing Xue associated with vexation usually pertain to heat harassing the chest or heart, or spirit, disquieting the spirit, etc. The liver is not mentioned. Furthermore, I cannot find a "bow string" or "string-like" pulse associated with heat in the Shang Han Lun or Wen Bing except for heat in the shao yang and jue yin. In the jue yin Bensky says that a wiry pulse is a sign of a syndrome that involves liver heat descending into the large intestine. Based on the above, I believe that Dr. Flaws’ argument is that there is only one disease mechanism for "irascibility" (not "irritability") and that Alon Marcus might have been referring to "vexation" when he used "irritation" when senior physicians treated heat with shigao in septic patients. That is, they may have been talking about different things. The foregoing may or may not clear up the differences. I believe one must defer to clinical experience and I would like to know if it is Alon Marcus’ experience that septic patients do have a bow-string pulse without liver involvement and if these patients are irascible as well as vexed. If seems to me that patients that are constipated due to heat, for example, are irascible as well as vexed, and I am still not sure that this has to be due to liver qi. The argument that any blockage of qi affects the liver and thus whenever there is irascibility one must explain it by binding depression of liver qi (pain is a good example) seems overly simplistic and inelegant. Of course,this does not mean it is not true, and clinical experience must be the final judge. Get your FREE download of MSN Explorer at http://explorer.msn.com Quote Link to comment Share on other sites More sharing options...
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