Herbs that open the orifices are aromatic substances that open the sense organs (orifices) and restore consciousness. They are used when heat attacks the pericardium or turbid phlegm mists the heart. The Manifestations include loss of consciousness, delirium, epilepsy and convulsions, or coma from wind-stroke.
Comas are ranked according to their severity into two types: tense syndrome (more severe) and flaccid syndrome (less severe). Tense syndrome is an excess syndrome manifested as the mouth being agape, clenched fists, and a forceful pulse. Flaccid syndrome is a deficiency syndrome manifested as cold sweating, cold limbs, and a fading pulse. Tense syndrome may be divided into cold-tense syndrome and heat-tense syndrome. Cold-tense syndrome is manifested with such symptoms as green complexion, a cold body, white tongue coating, and slow pulse; heat-tense syndrome, a red complexion, hot body, yellow tongue coating, and rapid pulse. To treat flaccid syndrome, use herbs that recapture Yang so as to prevent collapse, as well as those that tonify Qi. When one is treating flaccid syndrome, herbs that open the orifices are not allowed. Herbs that open the orifices can be added to other combinations in treating tense syndrome. In cold-tense syndrome, herbs that dispel cold and promote Qi are added. In heat-tense syndrome, herbs that clear heat and release toxins are added.
Aromatic herbs that open the orifices are used for first-aid treatment. Since they may consume primary Qi, they should be used only for short periods of time.
Prescriptions that are mainly composed of aromatic herbs with the action of inducing resuscitation and regaining consciousness in the treatment of coma are known as “Resuscitation Prescriptions.” Since coma may be the result of heat or cold pathogenic factors, the prescriptions can be divided into two categories:
(1)Resuscitation Prescriptions with composition of a cold nature: They clear heat, release toxins, subdue wind, promote resuscitation and the regaining of consciousness, and are used to treat unconsciousness and coma caused by heat blocking the mind.
(2)Resuscitation Prescriptions with composition of a warm nature: They promote Qi circulation, remove stagnation, promote resuscitation and the regaining of consciousness, and are used to treat unconsciousness or coma caused by cold blocking the mind, accompanied by stifling sensations and pains in the chest and abdomen.
These prescriptions are likely to impair one’s primordial Qi or the primordial Qi of a fetus if taken for extended periods of time, because their pungent flavor strongly disperses. Therefore, they are rarely given to patients except in emergency situations for first aid. They should be stopped immediately when the expected result is obtained, and used with great caution in pregnant women.
Herbs
Musk (She Xiang,麝香)
Pharmaceutical Name: Moschus
Part Used: Secretion of the male musk deer
Properties: Pungent and warm
Meridians: Heart and spleen
| Functions: | (a) | To open the orifices and clear the mind; |
| (b) | To invigorate the blood and disperse nodules; | |
| (c) | To stop pain; | |
| (d) | To expel retained placenta following birth. |
Applications:
(a)Unconsciousness due to high fever. Musk (She Xiang, 
) is used with Ox gallstone (Niu Huang, 
) and Rhinoceros horn (Xi Jiao, 
).
(b)Unconsciousness due to wind-stroke. Musk (She Xiang, 
) is used with Storax (Su He Xiang, 
) and Cloves (Ding Xiang, 
).
(c)Carbuncles, furuncles, and swellings. Musk (She Xiang, 
) is used with Frankincense (Ru Xiang, 
), Myrrh (Mo Yao, 
), and Realgar (Xiong Huang, 
).
(d)Sudden severe pain in the chest and abdominal region. Musk (She Xiang, 
) is used with Costus root (Mu Xiang, 
), Peach seed (Tao Ren, 
), and herbs that invigorate the blood.
(e)Swelling and pain caused by external injury. Musk (She Xiang, 
) is used with Sappan wood (Su Mu, 
), Myrrh (Mo Yao, 
), and Safflower (Hong Hua, 
).
(f)A dead fetus or a placenta failing to be expelled. Musk (She Xiang, 
) is used with Cinnamon bark (Rou Gui, 
).
(g)Dosage: 0.03–0.1 g.
Cautions and Contraindications: The substance must not be cooked. It is contraindicated during pregnancy.
Borneol (Bing Pian,槟榔)
Pharmaceutical Name: Borneolum Syntheticum
Part Used: The stems of Dryobalanops aromatica are steamed and then cooled into crystals.
Properties: Pungent, bitter, and slightly cold
Meridians: Heart, spleen, and lung
| Functions: | (a) | To open the orifices and clear the mind; |
| (b) | To clear heat and stop pain. |
Applications:
(a)Unconsciousness due to high fever. Borneol (Bing Pian, 
) is used with Musk (She Xiang, 
).
(b)Red, swollen, and painful eyes. Borneol (Bing Pian, 
) can be used alone as eye drops.
(c)Sore throat or ulceration of the mouth. Borneol (Bing Pian, 
) is used with Sodium borate (Peng Sha, 
), and the compound of Licorice root (Gan Cao, 
) and Glauber’s salt (Mang Xiao, 
).
(d)Dosage: 3–9 g.
Cautions and Contraindications: This substance should be used with caution during pregnancy.
Storax (Su He Xiang, 苏合香)
Pharmaceutical Name: Styrax
Part Used: Resin
Properties: Pungent and warm
Meridians: Heart and spleen
| Functions: | (a) | To open the orifices and clear the mind; |
| (b) | To stop pain. |
Applications:
(a)Sudden coma caused by Qi stagnation or unconsciousness due to wind-stroke. Storax (Su He Xiang, 
) is used with Musk (She Xiang, 
), Cloves (Ding Xiang, 
), and Benzoin (An Xi Xiang, 
).
(b)Stifling sensation and pain in the chest. Storax (Su He Xiang, 
) is used with Borneol (Bing Pian, 
), Sandalwood (Tan Xiang, 
), and Cloves (Ding Xiang, 
).
(c)Dosage: 0.3–1 g.
(iv) Grass-leaved sweetflag (Shi Chang Pu, 
)
Pharmaceutical Name: Rhizome Acori graminei
Part Used: Rhizome
Properties: Pungent and warm
Meridians: Heart and stomach
| Functions: | (a) | To open the orifices; |
| (b) | To transform dampness and harmonize the stomach; | |
| (c) | To tranquilize the mind. |
Applications:
(a)Unconsciousness due to blockage of the pericardium by turbid phlegm or accumulation of dampness and heat. Grass-leaved sweetflag (Shi Chang Pu, 
) is used with fresh Bamboo juice (Zhu Li, 
) and Curcuma root (Yu Jin, 
).
(b)Dampness blocking the middle Jiao (spleen and stomach), manifested as a stifling sensation, distension, and pain in the chest and abdominal region. Grass-leaved sweetflag (Shi Chang Pu, 
) is used with Tangerine peel (Chen Pi, 
) and Magnolia bark (Hou Po, 
).
(c)Damp-heat blocking the middle Jiao, manifested as dysentery and vomiting after meals. Grass-leaved sweetflag (Shi Chang Pu, 
) is used with Coptis root (Huang Lian, 
).
(d)Insomnia, forgetfulness, tinnitus, and deafness. Grass-leaved sweetflag (Shi Chang Pu, 
) is used with Polygala root (Yuan Zhi, 
) and Poria (Fu Ling, 
).
(e)Dosage: 3–9 g.
Resuscitation Prescriptions
The following table is a comparison of functions among the four most important resuscitation Prescriptions:
(1)Angong Niu Huang Wan (Ox Gallstone Resurrection Pills, 
)
(2)Zhibao Dan (Most Precious Pellets, 
).
(3)Zixue Dan (Purple Snowy Powder, 
).
(4)Su He Xiang Wan (Styrax Pills, 
).
From the table, it can be concluded that all the Prescriptions except Su He Xiang Wan 
have the functions of clearing heat, releasing toxins, promoting resuscitation, and eliminating endogenous wind, but they vary in intensity. Angong Niu Huang Wan 
is most powerful for clearing heat and releasing toxins, and is used to treat febrile diseases caused by the invasion of exogenous pathogenic factors, such as high fever, loss of consciousness, coma, and convulsions. Zhibao Dan 
is strong in promoting resuscitation, but weaker in clearing heat and releasing toxins. It is well suited for relieving sudden coma. For the purpose of clearing heat and releasing toxins, Zixue Dan 
is not as good as Angong Niu Huang Wan 
, but is better than Zhibao Dan 
. In promoting resuscitation, Zixue Dan 
is not as good as Zhibao Dan 
, but has similar capabilities to Angong Niu Huang Wan 
. Zixue Dan 
is also the strongest of the four formulas in eliminating endogenous wind and stopping convulsions, regulating bowel movements, and dispelling heat. It is mostly used in febrile diseases manifested as high fever, loss of consciousness, coma, convulsions, and constipation. Su He Xiang Wan 
is the most powerful of the four in promoting resuscitation, promoting Qi and resolving stagnation. It is often used in extravasation of Qi and retention of turbid phlegm, which manifest as sudden coma, stifling sensations, and colic pains in the chest and abdomen.