the treatment of depression with chinese medicine

THE TREATMENT OF DEPRESSION WITH CHINESE MEDICINE

馬

萬

里 Copyright Giovanni Maciocia

WESTERN VIEW

A depressive illness is primarily characterized by a change in mood

consisting of a feeling of sadness which may vary from mild despondency to

the most abject despair.

The change in mood is relatively fixed and persists over a period of days,

weeks, months or years. Associated with the change in mood are

characteristic changes in behaviour, attitude, thinking, efficiency and

physiological functioning.

In distinguishing the normal reaction from pathological depression, a

quantitative judgement has to be made. If the precipitant seems inadequate,

the depression too severe and too long lasting, the condition is regarded as

abnormal.

In addition, the severity and incapacity in depressive illness differs

qualitatively as well as quantitatively from depressed feelings which are part

of normal experience.

Depression accounts for 35-40% of all psychiatric illnesses. It is twice as

common in women as in men. The onset of depression increases towards

middle age with a maximum onset in the 55-60 age group.

Depressive illness which is predominantly determined by genetic-

constitutional factors is referred to as endogenous depression. This is

characterized by being worse in the morning. Depressive illness which is

predominantly a reaction to environmental influences is referred to as

reactive depression.

NOTE

In my opinion, the distinction between endogenous and reactive

depression is not significant in Chinese medicine. We would view every

patient with depression as a combination of these two factors.

Types of depression:

Psychotic

Neurotic

Reactive

Endogenous

Involutional

Psychogenic

Pre-Senile

Acute

Chronic

Manic-depressive

Alcoholic

M. Seligman, Helplessness, W.H. Freeman and Co., San Francisco, 1975.

The most useful typology of depression (in Western medicine)

is that of endogenous and reactive.

Reactive depression is the most common. Roughly 75% of all

depressions are reactions to some external event, such as the

death of a family member.

Reactive depression does not cycle regularly in time, is not

usually responsive to drugs, is not genetically predisposed.

Endogenous depression is a response to some unknown internal

process. This depression is not triggered by any external event;

it just sweeps over the sufferer.


“Learned helplessness” suggests that one of the causes of depression

is the belief that action is futile.

Events that set off reactive depression include:

- Failure at work or school

- Death of a loved one

- Physical disease

- Financial difficulty

- Being faced with insoluble problems

- Old age.

What links these experiences and lies at the heart of depression is

unitary: the depressed patient believes or has learned that he cannot

control those elements of his/her life that relieve suffering, bring

gratification or provide nurture, in short, he/she believes that he/she is

helpless.

Endogenous depression, while not set off by an explicit helplessness-

inducing event, also may involve the belief in helplessness.


E. Bibring: What has been described as the basic mechanism

of depression, the ego’s shocking awareness of its helplessness

in regard to its aspirations, is assumed to represent the core of

depression.

F. Melges and J. Bowlby: Our thesis is that while a depressed

patient’s goals remain relatively unchanged his/her estimate of

the likelihood of achieving them is diminished…The depressed

person believes that his/her plans of action are no longer

effective in reaching his/her continuing and long-range goals.

From this state of mind is derived depression, indecisiveness,

inability to act, feeling of worthlessness and of guilt.

M. Seligman: Depression is both a cognitive and emotional

disorder. Cognition of helplessness lower mood and a lowered

mood increases the susceptibility to cognition of helplessness:

this is the most insidious vicious circle in depression. When

depression is observed close up, the exquisite interdependence

of feelings and thought is undeniable: one does not feel

depressed without depressing thoughts, nor does one have

depressing thoughts without feeling depressed.

Note

indecisiveness,

inability to act,

feeling of guilt.

Note combination

of cognitive and

emotional aspects.

In depression, there are many bodily changes:

• Increased aches and pains, which occur in about two out of

three people with depression

• Chronic fatigue

• Decreased interest in sex

• Decreased appetite

• Insomnia, lack of deep sleep, or oversleeping

• Gastrointestinal problems

In the primary care setting, a high percentage of patients with

depression present exclusively with physical symptoms. Simon et

al. analyzed a World Health Organization study of somatic

symptoms in the presentation of depression. Of the 1146 patients

in 14 countries included in the survey who met the criteria for

depression, 69% reported only somatic symptoms as the reason

for their visit.1

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC486942/

1. Simon GE, Von Korff M, and Piccinelli M. et al. An international study of the relation between

somatic symptoms and depression. N Engl J Med. 1999 341:658–659.

The main symptoms and signs of depression are:

- Painful thoughts

- Anxiety and agitation

- Loss of interest

- Loss of self-esteem

- Derealization and depersonalization (Shen Obstructed)

- Hypochondriasis

- Disorders of perception (Shen Obstructed)

- Insomnia

- Loss of appetite

- Diurnal variation (worse in the morning)

According to Bowlby depression is a mood that most people experience on

occasion, is an inevitable accompaniment of any state in which behaviour

becomes disorganized, as it is likely to do after a loss.1

1. Bowlby J 1980 Loss Sadness and Depression, The Hogarth Press, London, p. 246.

So long as there is active interchange between ourselves and the

external world, either in thought or in action, our subjective

experience is not one of depression: hope, fear, anger, satisfaction,

frustration, or any combination of these may be experienced.

It is when interchange has ceased that depression occurs until such

time as new patterns of interchange have become organized towards

a new object or goal.

It is characteristic of the mentally healthy person what they can bear

with this phase of depression and disorganization and emerge from it

after not too long a time with behaviour, thought and feeling

beginning to be reorganized for interactions of a new sort.

A person prone to depression will not be able to reorganize new

patterns of interaction between themselves and the external world.

SHEN 申伸 To extend, reach out, stretch, express

神

神

示

申

=

SHEN. Shen, spirit, mind, consciousness, vitality,

expression, soul, energy, god, God.

Shi “Influx from heaven; auspicious or inauspicious signs by

which the will of Heaven is known to mankind.” Altar (for

sacrifices). Spirit tablet.

Shen = to state, express, explain, to stretch, extend, the 9th Earthly

Branch 伸

According to Seligman depression is characterized by a feeling of

helplessness, principally the issue about which a person feels helpless is

his ability to make and to maintain affectional relationships. The feeling

of helplessness can be attributed to experiences in the family of origin

from childhood to adolescence:

1) He or she is likely to have had the bitter experience of never having

attained a stable and secure relationship with his parents despite having

made repeated efforts to do so. These childhood experiences result in

their developing a strong bias to interpret any loss they may later suffer as

yet another of his failures to make or maintain a stable affectional

relationship.

2) He or she may have been told repeatedly how unlovable, and/or

how inadequate, and/or how incompetent they are. Were they to have

had these experiences they would result in his developing a model of

himself as unlovable and unwanted, and a model of attachment

figures as likely to be unavailable, or rejecting, or punitive. Whenever

such a person suffers adversity, therefore, far from expecting others to

be helpful they expect them to be hostile and rejecting.

3) He or she is more likely than others to have experienced actual loss

of a parent during childhood.

4) Helplessness. According to Seligman, depression may be due

to learned helplessness, i.e. the conviction that one’s behaviour

will not affect the situation. They have little motivation in trying

to change a situation because they think that nothing will change

despite their efforts. (Zhi of the Kidneys).

Therefore the particular pattern of depressive illness that a person

develops will turn on the particular pattern of childhood

experiences they have had.

Exposure to such experiences in childhood also explains why in

depressive-prone individuals there is a strong tendency for the

sadness, yearning and perhaps anger aroused by a loss, to become

disconnected from the situation that aroused them.

Symptoms of depression according to Seligman:

Self dislike

Worthlessness

Guilt

Future looks black

Crying

Insomnia

Lack of sexual desire

Negative cognitive set

Lowered initiation of voluntary responses


- Painful thoughts

- Anxiety and agitation

- Loss of interest

- Loss of self-esteem

- Derealization and

depersonalization

- Hypochondriasis

- Disorders of perception

- Insomnia

- Loss of appetite

- Diurnal variation (worse in

the morning)

Isolated and withdrawn, prefers to remain by himself/herself,

stays in bed much of the time.

Gait and general behaviour slow and retarded. Volume of

voice decreased, sits alone very quietly.

Feels unable to act, feels unable to make decisions.

Gives the appearance of an empty person who has given up.

Paralysis of the will is a striking feature of severe depression:

In severe cases, there often is complete paralysis of the will.

The patient has no desire to do anything, even those things

which are essential to life. Consequently, he/she may be

relatively immobile unless prodded or pushed into activity by

others. It is sometimes necessary to pull the patient out of

bed, wash, dress and feed him/her. In extreme cases, even

communication may be blocked by the patient’s inertia.


志

MAJOR DEPRESSIVE SYNDROME

The main symptoms of major depressive syndrome are:

• Depressed mood most of the day nearly every day

• Markedly diminished interest or pleasure in all, or almost all, activities most of

the day, nearly every day

• Significant weight loss (or gain), decrease or increase in appetite

• Insomnia or sleepiness

• Psychomotor agitation or retardation every day

• Fatigue nearly every day

• Feelings of worthlessness or guilt (which may be delusional) nearly every day

(not merely self-reproach or guilt about being ill)

• Diminished ability to think or concentrate, indecisiveness nearly every day

• Recurrent thoughts of death, recurrent suicidal ideation without a specific

plan, or a suicide attempt or a specific plan for committing suicide.

MENTAL ILLNESS IN CHINESE MEDICINE

• BAI HE BING 百合病 Jin Gui Yao Lue 3-1

• YU ZHENG 郁证 “Depression”

• ZANG ZAO 脏躁 (Agitation) = Anxiety or hysteria

• MEI HE QI 梅核气 : Plum-Stone Syndrome

• XIN JI ZHENG CHONG 心悸怔忡 Palpitations and Anxiety

(modern)

• DIAN KUANG 癫狂 Bipolar Disease

• YI 癔 Hysteria

• CHI DAI 痴呆 mental retardation

• DIAN XIAN 癫痫 Epilepsy (wrongly included with mental illness)

Depression as defined in Western medicine has aspects of the first

five ancient disease categories mentioned above, i.e. Lilium

Syndrome (Bai He Bing), Depression (Yu Zheng), Agitation (Zang

Zao), Plum-Stone Syndrome (Mei He Qi), and Palpitations and

Anxiety (Xin Ji Zheng Chong).

CHINESE MEDICINE WESTERN MEDICINE

BAI HE BING

Lilium syndrome

YU ZHENG

Depression

MEI HE QI

Plum-stone Syndrome

ZANG ZAO

Agitation

XIN JI ZHENG CHONG

Palpitations and anxiety

DEPRESSION

YU ZHENG 郁证

Nanjing University of Chinese Medicine et al, Chinese Medicine Psychology (Zhong

Yi Xin Li Xue 中医心理学), People’s Health Publishing House, Beijing, 2007,

121.

The Chinese term for depression is yu 郁. "Yu" has the double meaning of

"depression" and "stagnation".

Yu Zheng is due to Qi stagnation (literally stagnation of the Qi Mechanism)

and disharmony of the Zangfu.

Clinical manifestations

Mental depression, emotional instability, feeling of oppression of the chest

(men 闷), hypochondrial distension and pain, prone to outbursts of anger, a

feeling of obstruction in the throat.

Yu Zheng term introduced in the Ming dynasty book “True Transmission

of Medicine” (Yi Xue Zheng Zhuan 医学正传). However, the term

yu was used earlier. The book goes on quoting passages from the Su

Wen and Ling Shu talking about the Qi derangement deriving from each

emotion (i.e. anger makes it rise, worry makes it stagnate, etc).

Chapter 71 of the Su Wen talks about the stagnation of the 5 Elements,

i.e. stagnations of Wood, Fire, Earth, Metal and Water.

The book then talks about the Mei He Qi and Zang Zao in the Jin Gui

Yao Lue as examples of Yu Zheng. The book Origin of Symptoms in

Diseases (Zhu Bing Yuan Hou Lun 诸病源候论) by Chao Yuan

Fang (AD 610) attributes Qi stagnation to worry and pensiveness and

calls Yu Zheng “Jie Qi” [结气] i.e. Stagnant Qi.

Zhu Dan Xi (Yuan dynasty) talked about the “6 Stagnation” (of Qi,

Blood, Heat, Dampness, Phlegm and Food) and used Yue Ju Wan for it.

Zhang Jing Yue gave a slightly different interpretation to Yu Zheng and

broadened its scope distinguishing between “stagnation” and “emotional

stagnation”. “In stagnation of the 5 Qi, stagnation is the cause of the

disease. In emotional stagnation, the disease is the cause of the stagnation”.

COMMENTS

• Qi stagnation is considered the only cause of Yu Zheng. Inexplicably, the

patterns presented later include other patterns, some Shi, some Xu, without

any explanation of how we get those patterns from Qi stagnation.

• Yu Zheng is identified with the Qi derangements deriving from the emotions

(anger makes it rise, worry makes it stagnate, etc.)

• There is no concept whatsoever of the autobiographical self, childhood

trauma, childhood experiences, nor of loss as a cause of depression.

PATHOLOGY

1) Liver-Qi stagnation from anger

2) Worry and pensiveness causing Xu, Spleen losing Yun Hua

3) “Excessive emotions”, the Heart loses nourishment

4) Zang-Qi stagnates, stagnation in the Interior

Zhou Chao Fan, Essential Chinese Medicine Treatment Principles in Successive

Dynasties (Li Dai Zhong Yi Zhi Ze Jing Hua 历代中医治则精华), Chinese

Medicine Publishing House, Beijing, 2000, p. 456.

木郁达之

火郁发之

土郁夺之

夺 duo = seize, capture, force one’s way

折 she = break, snap, twist, lose, bend

金郁泄之

水郁折之

The Su Wen in chapter 71 talks about 5

Stagnations of Wood, Fire, Earth, Metal

and Water. It says:

"When Wood stagnates it extends, when

Fire stagnates it rises, when Earth

stagnates it seizes, when Metal stagnates

it discharges, when Water stagnates it

pours".

When Wood stagnates, it “extends” causing hypochondrial pain, tinnitus,

dizziness, blurred vision. If there is stagnation of food in the Middle Burner, the

Liver and Gall-Bladder cannot ascend so that there is chest pain, vomiting. If

Wood stagnates “downwards”, there is coastal pain. If light use Chai Hu and

Chuan Xiong; if severe, use Dang Gui Long Hui Wan.

When Fire stagnates, the Heart stagnates and it “emits” (fa 发). Fire rises, rebels

upwards (ni 逆) and stagnates. Feeling of oppression of the chest (men 闷), red

eyes, shortness of breath, ulcers, thirst, vomiting sour fluids, mania (kuang 狂).

When Earth stagnates, the Spleen stagnates, it “seizes”. Feeling of fullness,

oedema, dysuria, constipation/diarrhoea, abdominal pain and distension

When Metal stagnates, the Lungs stagnate, it “disharges” (xie 泄). Cough,

throat pain, hoarse voice, chest fullness, breathlessness, nasal obstruction,

vomiting.

When Water stagnates, the Kidneys stagnate. Oedema, spitting, abdominal

distension, backache, knee ache, .

1980 Concise Dictionary of Chinese Medicine (Jian Ming Zhong Yi Ci

Dian 简明中医辞典 ). People’s Health Publishing House, Beijing.

As all other books do, this dictionary first talks about the 5

stagnations of the 5 Elements from chapter 71 of the Su Wen. It

then mentions the Six Stagnations by Zhu Dan Xi (Qi, Blood,

Dampness, Phlegm, Heat, Food). It then mentions Zhang Jing

Yue emotional stagnation, i.e. stagnation from anger,

pensiveness, worry, sadness, fright, fear. It then mentions

stagnation of Heart, Liver, Spleen, Lungs and Kidneys and says

that Liver-Qi stagnation is the most common one.

It then gives the most common patters as Liver-Qi stagnation,

stagnant Qi giving rise to Heat, Phlegm-Qi. Liver Qi stagnation

causes mental depression, feeling of oppression of the chest

(men), hypochondrial pain.

When Liver-Qi rebels horizontally, it invades the Stomach and

Spleen causing abdominal distension, belching, poor appetite,

use Si Ni San.

Stagnant Qi giving rise to Heat leads to Liver-Heat rebelling

upwards causing headache, dizziness, feeling of oppression of

the chest, hypochondrial distension, thirst, bitter taste, use Jia

Wei Xiao Yao San.

Stagnation of Qi-Phlegm causes a feeling of lump in the throat,

a feeling of foreign body that cannot be expelled, use Ban Xia

Hou Po Tang or Wen Dan Tang.

闷 MEN: Feeling of oppression of the chest

(“Heart squashed by a door”)

Liver-Qi stagnation: Chai Hu Shu Gan Tang

Stagnant Qi giving rise to Heat: Dan Zhi Xiao Yao San plus Zuo Jin Wan.

Qi stagnation with Phlegm: Ban Xia Hou Po Tang.

Worry injuring Shen: Gan Mai Da Zao Tang

Heart and Spleen Deficiency: Gui Pi Tang.

Yin Deficiency, “Fire Blazing”: Zi Shui Qing Gan Yin.

Wang Xin Hua, Selected Historical Medical Theories (Zhong Yi Li Dai Yi Lun

Xuan), Jiangsu Science Publishing House, Nanjing, 1980, p. 514.

There is anger stagnation, pensiveness stagnation and worry

stagnation.

In anger stagnation there is propensity to outburst of anger and

rebellious Qi (ni), it affects the Liver and causes Qi stagnation with

abdominal distension. If the stagnation affects the Spleen there is

tiredness and lack of appetite.

Pensiveness stagnation is common in widows (sic!). Pensiveness

causes Qi to stagnate, stagnation affects the Heart and weakens the

Spleen. It goes up affecting the Lungs and Stomach causing cough,

breathlessness, difficulty in swallowing, vomiting. It goes down

affecting the Kidneys and Liver causing vaginal discharge,

menorrhagia or amenorrhoea. One must subdue rebellious Qi and in

chronic cases tonify Qi.

Chong Xiang Yu, Chinese Medicine Psychology (Zhong Yi Xin Li Xue), People’s

Medical Publishing House, Bejing, 2007, p. 122.

Yu Zheng

Anger causing Liver-Qi stagnation

Worry, pensiveness and brooding (lü 虑) cause deficiency, anger causes

emotional “surge”, Liver loses its free flow, the Qi Mechanism is

obstructed, Liver-Qi stagnates, Stagnation is the main pathology. If it

persists, Liver-Qi stagnation may lead to Blood stasis, to Heat and to

Phlegm.

Worry and pensiveness affecting the Spleen

Worry, pensiveness and brooding cause stagnation of Spleen-Qi or

stagnation of Liver-Qi which rebels horizontally invading the Spleen: the

Spleen loses its yun-hua function so that Dampness is formed. Spleen

cannot transform food and this leads to Food Retention. Dampness

accumulates and this may lead to Phlegm. When the Spleen is injured

there is lack of appetite and therefore eating less which leads to deficiency

of Spleen and Heart.

“Excessive” emotions leading to loss of nourishment of the Heart

“Excessive” emotions affect the Mind (Jing-Shen), family life is not

harmonious, worry and pensiveness injure the Heart and Shen, the Heart

loses nourishment, Heart-Qi becomes deficient, it depletes Blood so that

there is Heart-Blood deficiency. Heart-Yin may be depleted which leads to

Fire (sic). The Shen is unsettled, Jing-Shen is chaotic. (Notice Confucian

influence here which makes this pattern more serious).

Zang-Qi easy to have stagnation

When stagnation develops the Heart stagnates (lit. “cannot extend”) which

affects the mind (jing-shen).

In summary, Yu Zheng has an external and internal cause. External cause is

the injury from emotions; internal cause is that Zang-Qi is prone to

stagnation. The pathology is stagnation of Qi Mechanism (Qi Ji 气机) and

disharmony (shi tiao 失调) of the Zangfu.

Qi stagnation is primary. After that, it gives rise to Blood stasis, Heat,

Phlegm, Food Retention, Dampness all Shi conditions. With time, Xu will

develop, affecting Heart, Liver, Spleen, Kidneys.

Wang Zhong Heng 1995 Collection of Patterns and Treatment of Difficult

Diseases in Internal Medicine (Nei Ke Za Bing Zheng Zhi Ji Jin 内科杂病证治集锦 ), Chinese Medicine Ancient Texts Publishing House,

Beijing.

Yu Zheng characterized by uncomfortable emotions, stagnation of the Qi

Mechanism [Qi Ji 气机], mental depression, crying, sadness.

Anger affecting the Liver: propensity to outbursts of anger, the Liver loses

its free flow, the Qi Mechanism stagnates, Qi stagnation; in the long term

it affects Blood and leads to Blood stasis. Stagnant Qi leads to Heat,

Liver-Fire blazes upwards, Fire injures Yin, Liver-Yin becomes deficient.

Pensiveness affecting the Spleen: due to long-standing worry and

pensiveness, Spleen-Qi stagnates, Liver-Qi rebels horizontally and it

invades the Spleen, the Spleen cannot transform and transport, Water

cannot be transformed and it leads to Phlegm, Phlegm stagnates, Heart

and Spleen lose nourishment, Qi and Blood become deficient.

“Excessive” emotions injure the Shen which loses nourishment: worry and

sadness, the Shen is injured, the Heart loses nourishment.

Therefore the three organs involved are Liver, Spleen and Heart.

There is Qi stagnation, Blood stasis, Fire, Phlegm, Food stagnation.

Liver-Qi stagnation: mental depression, sighing, restlessness, feeling

of oppression of the chest [men], hypochondrial distension and pain,

irregular periods, pre-menstrual breast distension.

Chai Hu Shu Gan Tang, or Yue Ju Wan.

Stagnant Liver-Qi turning into Heat: propensity to outbursts of anger,

headache, red eyes, hypochondrial distension, feeling of heat of the

head, acid reflux, bitter taste, dry mouth, constipation.

Dan Zhi Xiao Yao San, Hua Gan Jian.

Qi-Phlegm: feeling of lump in the throat, like a piece of roast meat that

does not go down or up, mental depression, feeling of oppression of

the chest [men], hypochondrial distension and pain. Ban Xia Hou Po

Tang, Xiao Yao San, Wen Dan Tang.

Heart and Spleen deficiency: palpitations, timidity, insomnia, poor

memory, worry, dizziness, tiredness, poor appetite, pale face, loose stools.

Gui Pi Tang, Ren Shen Yang Rong Tang.

Heart and Spleen loss of nourishment: anxiety, worry, propensity to

outbursts of anger, worry, crying, likes to stretch, cannot lie down, sits

down but is restless, palpitation.

Gan Mai Da Zao Tang, Ren Shen Hu Po Wan, An Shen Ding Zhi Wan.

The Su Wen in chapter 71 talks about 5 Stagnations of Wood, Fire, Earth,

Metal and Water. It says:

"When Wood stagnates it extends, when Fire stagnates it rises, when

Earth stagnates it seizes, when Metal stagnates it discharges, when Water

stagnates it pours".

The Jing Gui Yao Lue describes the pathology of Mei He Qi (Plum-Stone

Syndrome) and Zang Zao (Visceral Agitation) [but the book does not say

how that is related to Yu Zheng].

It then quotes Zhu Bing Yuan Hou Lun Discussion of the Origin of

Symptoms in Diseases, AD 610 that says: “Qi stagnation derives from

worry and pensiveness. When the Heart [Qi] accumulates, the Shen

stagnates, Qi accumulates and does not circulate, so there is stagnation

inside.”

Chinese Medicine Psychology (Zhong Yi Xin Li Xue), by Wang Lai Qu, People’s

Medical Publishing House, Beijing, 2007.

It then quotes Zhu Dan Xi’s 6 Stagnations of Qi, Blood, Food, Heat,

Dampness and Phlegm and his famous formula Yue Ju Wan.

It then quotes Zhang Jing Yue distinction between Qi stagnation and

emotional stagnation. “In stagnation of the 5 Qi, stagnation is the

cause of the disease. In emotional stagnation, the disease is the cause

of the stagnation”.

It then quotes Wang Qing Ren who attributes Yu Zheng to Blood

stasis [of course].

Aetiology

1) Anger leading to Liver-Qi stagnation

2) Worry and pensiveness leading to Spleen deficiency

3) “Excessive emotions” leading to Heart losing nourishment

4) Stagnation of Qi of the Zang

Patterns

1) Liver-Qi stagnation (Chai Hu Shu Gan Tang).

2) Qi Stagnant turning into Heat (Dan Zhi Xiao Yao San).

3) Blood stasis (Xue Fu Zhu Yu Tang).

4) Heart and Spleen deficiency (Gui Pi Tang).

5) Heart-Yin deficiency (Tian Wang Bu Xin Dan).

6) Liver-Yin deficiency (Qi Ju Di Huang Wan).

7) Phlegm and Qi stagnation (Ban Xia Hou Po Tang).

8) Heart and Spleen chaotic (Gan Mai Da Zao Tang). (Spirit “like

in a trance” [huang hu 精神恍惚], agitation [Xin Shen bu ding

心神不定], easily startled, sadness, crying, easily angered,

likes to stretch).

Thus, in Chinese medicine stagnation and depression are synonymous

implying that all depression is due to stagnation. However, this is not true

in practice, although mental depression does start initially with some

stagnation. In practice, there are many types of depression due to

Deficiency and especially Kidney deficiency.

However, it is true that all emotions, even those that initially deplete Qi,

lead to some Qi stagnation: thus, the first effect of emotional stress is some

Qi stagnation.

EMOTIONS

QI STAGNATION

QI DEFICIENCY

QI STAGNATION

(Anger, guilt, worry, shame,

pensiveness)

(Sadness, grief, shock, fear)

PATHOLOGY OF DEPRESSION

EMOTION

QI

STAGNATION

HEAT

PHLEGM

FIRE

BLOOD

STASIS

EMPTY HEAT

YIN

DEFICIENCY

QI

DEFICIENCY

When compressed, Qi

generates Heat Heat condenses

fluids

Phlegm and Blood

stasis aggravate

each other

Fire dries up Yin

Yin Xu leads to

Empty Heat

BLOOD XU

PATTERNS OF DEPRESSION

FULL EMPTY

QI STAGNATION

HEAT

QI-PHLEGM

HEART-QI DEFICIENCY

SPLEEN- AND HEART-BLOOD

DEFICIENCY

HEART- AND KIDNEY-YIN DEFICIENCY

KIDNEY-YANG DEFICIENCY

NOTE: Please note that in practice, there is usually a combination of Xu and Shi patterns,

e.g. Qi stagnation with Heart-Blood Xu, Qi-Phlegm with KI-Yang Xu, etc.

DEPRESSION AND THE RELATIONSHIP BETWEEN THE SHEN AND

THE HUN

The relationship between Shen of the Heart and Hun of the Liver is essential

to understand depression. The Hun gives the Shen inspiration, creativity,

ideas, plans, life dreams, aspirations: this psychic energy is the result of the

“coming and going of the Hun” and it is the psychic manifestation of the free

flow of Liver-Qi (and, in particular, of the physiological ascending of Liver-

Qi).

On the other hand, the Shen needs to control the Hun somewhat and to

integrate the psychic material deriving from it. It is in the nature of the Hun to

“come and go”, i.e. it is always searching, it has ideas, inspiration, aims, etc. T

The Shen needs to integrate the material deriving from the Hun in the general

psyche: the Hun is the source of many ideas simultaneously; the Shen can

only deal with one at a time. Therefore “control” and “integration” are the key

words describing the function of the Shen in relation to the Hun.

The Shen “gathers” the Hun. Thus, on the one hand, the Hun brings

movement to the Shen, and on the other hand, the Shen provides some

control and integration. If the Shen is strong and the Hun properly

"gathered", there will be harmony between the two and the person has

calm vision, insight and wisdom.

SHEN-HUN RELATIONSHIP

SHEN

HUN

Controls,

integrates

Gives movement ideas,

inspiration intuition,

creativity

KEY WORDS: CONTROL AND INTEGRATION

When the “coming and going” of the Hun is deficient, there is a lack of

inspiration, creativity, ideas, plans, life dreams, aspirations: this is an

important feature of mental depression. It is important to note that the

psychic “coming and going” of the Hun may be deficient either because

itself is deficient, or because the Shen is over-controlling it.

The latter is common in individuals with strong, rigid beliefs

(“religious” in a broad sense) which lead the Shen to suppress the

psychic ideas coming from the Hun. This situation may also arise as a

consequence of guilt.

In severe depression, there is a disconnection between the Shen (Shen of

the Heart) and Hun: the Hun lacks its normal “movement” and the

person lacks creativity, ideas, imagination and, most of all, plans,

projects, life aims and inspiration so that depression results.

If the Shen overcontrols or if the Hun’s movement is lacking, the person lacks

vision, imagination, creativity and will be depressed.

Shen over-controls = depression

(Going of the Hun normal)

SHEN

HUN

SHEN

HUN

Hun coming and going not

enough = depression

(Control by Shen normal)

SHEN-HUN RELATIONSHIP

THE WILL-POWER (ZHI) OF THE KIDNEYS IN DEPRESSION

The Zhi of the Kidneys means “will-power” and it is in this context that

it plays an important role in depression. “Will-power” as a translation

of Zhi includes will-power itself, drive, determination, steadfastness,

enthusiasm, and physical and mental power.

In my experience, depression always involves a weakening of will-

power intended in the broad sense described above, i.e. including drive,

determination, steadfastness, enthusiasm, and physical and mental

power. These are all qualities that are missing in a depressed person

and, for this reason, I therefore always tonify the Kidneys in depression

even if there are no specific symptoms and signs of Kidney deficiency.

I do so because the mental-emotional lack of drive and will-power seen

in depression is indeed a Kidney-deficiency symptom by itself.

To tonify the will-power and drive deriving from the Kidneys I

generally use BL-23 Shenshu and BL-52 Zhishi.

志

Chapter 8 of the “Su Wen” says: “The Kidneys are the official in charge of

power 强: skill [qiao 巧] originates from them.”1 It is interesting that the

“Su Wen” mentions “power” in connection with the Kidneys.

This has two meanings. From a physical point of view, “power” refers to the

fact that the Kidneys are the root of Pre-Natal Qi and house the Jing: this

determines our innate energy, strength or “power”.

In fact, the symptoms of fullness of the Sea of Marrow (originating from the

Kidneys) are “full of vigour, great physical strength”). The Sea of Marrow is

mentioned in chapter 33 of the “Spiritual Axis”.2

1. Ibid., p. 58.

2. 1981 Spiritual Axis (Ling Shu Jing), People’s Health Publishing House, Beijing. First

published c. 100 BC, p. 77

From a mental point of view, “power” refers to the drive and

steadfastness stemming from the Kidneys. This corresponds to Zhi, i.e.

Will-Power.

The symptoms of fullness and emptiness of the Sea of Marrow have

mental-emotional significance. In fact, the symptoms of fullness of the

Sea of Marrow (originating from the Kidneys) are “full of vigour, great

physical strength”). The Sea of Marrow is mentioned in chapter 33 of

the “Spiritual Axis”

JING

SEA OF MARROW

The physical symptoms of deficiency of the Sea of Marrow are

dizziness, tinnitus, weak legs, blurred vision, and a desire to lie

down.

On a mental-emotional level, a person with a constitutional

deficiency of the Sea of Marrow will be more prone to emotional

stress: his or her Shen is more vulnerable and the person lacks

mental strength and resilience. Under these conditions, the person

is easily prone to depression when subject to emotional stress.

Sea of Marrow

Du Mai

The points given by chapter 33 of the “Spiritual Axis” for the Sea

of Marrow are Du-20 Baihui (described by the “Spiritual Axis” as

the “upper” point) and Du-16 (described as the “lower” point).

I particularly use Du-20 to strengthen the Sea of Marrow, nourish

the Shen and strengthen the Kidney’s Will-Power (Zhi). For these

reasons, Du-20 is a very important point for depression.

.

.

DISTINCTION BETWEEN DEPRESSION IN “YU” SYNDROME AND IN

“DIAN” SYNDROME

Many modern Chinese books often discuss Depression Syndrome (Yu Zheng) as

if it were identical to the depressive phase of manic-depression (Dian of Dian

Kuang) but they are different. From a Chinese perspective, the depressive and

manic phases of bipolar disorder (Dian Kuang) are two poles of a pathological

spectrum with the same pathology. Central to the pathology of Dian Kuang is

Phlegm obstructing the Shen: this accounts both for the depressive and manic

phases of the disease.

Phlegm obstructs the Shen but also the Hun so that it interferes with its coming

and going, resulting in depression when it does not come and go enough and

mania when it comes and goes too much.

By contrast, in Depression (Yu Zheng) Phlegm is not always present and the

“coming and going” of the Hun is impaired resulting in a depressed mood, a lack

of inspiration, lack of a sense of direction in life, lack of life dreams and plans.

Another important difference between the depression of Dian Kuang and that

of Yu Zheng is that, in the former, the Shen is Obstructed. This results in

mental confusion, derealization, and more serious mental symptoms such as

incoherent speech and laughter.

By contrast, in Yu Zheng, generally, there is no obstruction of the Shen. In

severe cases, there may be some obstruction of the Shen but this would result

more in derealization and perhaps obsessive thinking.

BAI HE BING

Chapter 3, Clause 1

In Bai He disease, the hundred vessels [channels] belong to one ancestor, and

all are acting together to cause this disease [or any of them can cause this

disease]. The patient wants to eat but cannot; wants to lie down but cannot;

wants to walk but cannot.

She occasionally enjoys eating tasty foods and sometimes has aversion to the

smell of food. Sometimes she feels cold, sometimes hot; has a bitter taste, the

urine is dark: all medicinals are ineffective, with severe vomiting and

diarrhea following treatment. The patient looks as if possessed by spirits

[shen ling 神灵], although the physical appearance is normal. The pulse is

slightly rapid.

Hu huo 狐惑

LILIUM SYNDROME (BAI HE BING)

The patient wants to eat, but is reluctant to

swallow food

Unwilling to speak

He or she wants to lie in bed but cannot

lie quietly as he or she is restless

although he or she

looks normal, he or

she is suffering.

Cannot tolerate the smell of food

He or she feels

cold or hot but

without fever or

chills

He or she wants to

walk but is soon

tired

After taking the medicine the

patient may vomit or have

diarrhoea

Modern symptoms: huang hu ( as if in a trance), mental restlessness,

bitter taste, dark urine, anxiety, depression, red tongue (which may be

without coating), rapid pulse.

Treatment principle: Moisten and nourish Heart and Lungs, tonify Qi,

nourish Yin, clear Heat (or Empty Heat), calm the Shen, settle the Zhi.

BAI HE TANG (BAI HE and ZHI MU)

Points suggested by Zhong Guo Zhen Jiu Liao Xue:

HE-7, KI-3, LU-9

BL-15, BL-13, BL-23

HE-5, LU-7, KI-4, SP-6

LU-7, KI-6, LIV-3.

HE-9, P-9, KI-7

COMMENTS

1) Bai He disease may have two different etiologies. It may be caused

by an external Heat disease injuring the Yin of Lungs and Heart; or, it

may be due to emotional stress which is a far more common case in the

patients we see. In particular, the Bai He disease is due to sadness, grief,

worry, or guilt.

2) The reference to the patient looking as if being possessed by spirits

is interesting because of the terms used. Normally when there are

references to spirits and possession in Chinese medicine books they

mention gui 鬼.

In this passage, however, the book mentions shen ling 神灵. This is

interesting because it is not a case of so called demonic medicine, i.e.

the patient being actually invaded by evil spirits. On the contrary, it is

a case of the patient being haunted by their own psychological

distress.

3) Considering the symptoms of the Bai He disease, (wants to eat but

cannot eat, wants to speak but cannot speak, wants to lie in bed but is

restless, looks haunted, etc.) we may simply say that this patient is

suffering from depression and anxiety. Modern Chinese books say that the

patient is “as if in a trance” (huang hu 恍惚).

AGITATION (ZANG ZAO)

Zang Zao, literally meaning “visceral restlessness” was first mentioned in the

chapter “Pulse, Syndromes and Treatment of Miscellaneous Gynaecological

Diseases” of the “Essential Prescriptions of the Golden Chest” (Jin Gui Yao

Lue, ca 220 AD).

This text says: “The patient suffers from Agitation [Zang Zao], feels sad and

tends to weep constantly as if she were haunted. She stretches frequently and

yawns repeatedly. The decoction of Fu Xiao Mai, Zhi Gan Cao and Da Zao

can calm the patient.”1

The formula for Agitation (Zang Zao) is therefore Gan Mai Da Zao Tang

Glycyrrhiza-Triticum-Jujuba Decoction. I personally use this formula not

only for Agitation but also for Depression arising against a background of Qi

and Blood deficiency.

1. Essential Prescriptions of the Golden Chest, p. 185.

AGITATION (ZANG ZAO) 脏躁

The patient suffers from

Agitation [Zang Zao]

feels sad and tends to weep constantly

as if she were haunted

She stretches

frequently and

yawns

repeatedly

CHAPTER 22 - CLAUSE 6

For women with agitation (Zang Zao 脏躁 ), suffering from sadness and

a desire to weep, appearing as though possessed by a spirit [Shen Ling 神灵] and frequently yawning and stretching, Gan Mai Da Zao Tang

(Glycyrrhiza-Triticum-Jujuba Decoction) is indicated. This formula also

tonifies Spleen-Qi.

COMMENTS

1) This is another very well known and important formula for mental-

emotional stress. Modern Chinese books frequently say that this formula

is for “hysteria” but this comes from a misunderstanding both about what

the formula is for and about hysteria itself. In modern terms, I would say

that this formula is simply for depression and anxiety. Of course,

“depression” is a Western-defined disease, which has little meaning in

Chinese medicine and I would say that this is for depression occurring

against a background of Qi and/or Yin deficiency.

2) There are some interesting observations to be made about the

symptoms as they are in the original text. First of all, there is the

question of zang zao which literally means “visceral restlessness”: I

simply translate zang zao as “agitation”. In my opinion, zang zao

suggests a certain intensity of the restlessness or agitation. This chapter is

actually the first mention of zang zao.

The second interesting observation is that the text actually does not say

that the patient is sad, but actually and literally that the patient likes to be

sad and also that the patient likes to weep.

I assume that is why modern Chinese books call this hysteria. For

example, the book Synopsis of Prescriptions of the Golden Chamber

translated by Luo Xiwen actually translates zang zao as “hysteria”. It

says: “The patient suffers from hysteria and tends to weep constantly”.

In my opinion this must be interpreted in the context of a book written in

the Han/Jin dynasty which was dominated by the Confucian philosophy

which had a very low opinion of women.

Confucius had a very low opinion of women and in one passage of the

Analects he says that women are like “petty people”—if you keep them

too close they become immodest if you keep them at a distance they

become resentful (Analects 17.25). The famous “accomplished person”

(Jun Zi) that is such an important Confucian ideal and that is often

translated as “gentleman” did refer to men, not women.

Therefore the picture that comes over in this clause is that of a

“hysterical” woman who “likes” to be sad and to weep.

3) Another interesting observation of the symptoms as they are in the text

is “appearing as if possessed by spirits”. Note that the word for spirits

here is not gui, but shen ling which indicates the spirits of dead people but

not the gui which can attack human beings causing disease. The reference

to shen ling here could be translated in a modern way in saying that the

patient appears haunted.

4) The reference to yawning is interesting and it usually refers to

stagnation of Qi of the Lungs and/or Heart.

5) Gan Mai Da Zao Tang is primarily a tonifying formula: it tonifies

primarily Heart and Spleen and Qi, Blood and Yin. Modern Chinese

books do say that this formula can be used for Qi and Yin deficiency,

but curiously they say that it is for Qi and Yin deficiency after major

surgery.

6) A particular and interesting feature of this formula is that it is based

on three very mild herbs which are actually foods as well as being

herbs. None of the ingredients has any particularly strong effect in

calming the Shen, and yet together these three ingredients, in my

experience, have a very powerful effect in depression and anxiety. As

the formula contains only three herbs, I often may add these three

herbs to another formula I am using when I suspect that the cause of

the problem is mental-emotional.

9) Modern Chinese books again attribute the pathology of this syndrome to

Liver-Qi stagnation, which I personally find quite absurd. For example, the

“Popular Guide to the Essential Prescriptions of the Golden Cabinet” by He

Ren says that the pathology of this syndrome is Blood deficiency (which

causes the agitation), Heart-Fire harassing the Shen, together with Liver-Qi

stagnation.1

10) Some modern Chinese books explain the action of this formula through

its sweet taste and they say that the sweet taste moderates the Liver, resolving

Qi stagnation (reverse Ke cycle of the 5 Elements from Earth to Wood).

Again, I do not agree with this view.

11) The emperor herb within the formula is actually Fu Xiao Mai which

nourishes the Heart and calms the Shen.

1. He Ren 1981 A New Explanation of the Synopsis of Prescriptions from the Golden Cabinet (Jin Gui

Yao Lue Xin Jie), Zhejiang Science Publishing House.

7) This formula may also be used for hyper-activity in children.

8) Modern Chinese books say that this formula has an oestrogen-like action, and

it can therefore be used for menopausal hot flashes and night sweating; however,

I do not see where this oestrogen-like action would come from.

PLUM-STONE SYNDROME (MEI HE QI)

Plum-Stone Syndrome was first described in the “Essential Prescriptions

of the Golden Chest” (Jin Gui Yao Lue, ca 220 AD). This text says: “The

patient has a suffocating feeling as if there was a piece of roast meat

stuck in the throat. Use Ban Xia Hou Po Tang.”

Therefore, originally the symptom of Plum-Stone Syndrome was

compared to the feeling of having a piece of meat (rather than a plum

stone) in the throat. The aetiology of this syndrome is emotional and is

due to depression.

Others attributed this syndrome to the combination of Qi stagnation and

Phlegm obstructing the throat. This type of Phlegm is called Qi-Phlegm

and it is the most non-substantial type of Phlegm.

Although all modern Chinese books attribute the Plum-Stone Syndrome

to stagnation of Liver-Qi, the formula Ban Xia Hou Po Tang Pinellia-

Magnolia Decoction actually acts on Lung- and Stomach-Qi. I therefore

use it primarily for stagnation of Qi of the Heart and Lungs in the chest

area deriving from sadness, grief and worry.

PLUM-STONE SYNDROME (MEI HE QI)

The patient has a

suffocating feeling as if

there was a piece of roast

meat stuck in the throat

CHAPTER 22 – CLAUSE 5

When a woman feels as if there was a piece of grilled meat in her throat, Ban

Xia Hou Po Tang [Pinellia-Magnolia Decoction] is indicated.

COMMENTS

1) This clause is the origin of the famous formula Ban Xia Hou Po Tang. The

clause is very succinct and it does not explain the pathology of the syndrome,

nor the action of the formula. Modern Chinese books always say that this

formula is for plum-pit Qi (Mei He Qi) syndrome due to Liver-Qi stagnation.

However, there is little evidence of this from the source. If we analyze the

ingredients of the formula none of the constituent herbs even enters the Liver.

Ban Xia Rhizoma Pinelliae preparatum

Hou Po Cortex Magnoliae

Zi Su Ye Folium Perillae

Fu Ling Poria

Sheng Jiang Rhizoma Zingiberis recens

In my opinion, this formula acts primarily on the Lungs, Stomach and

Heart: it makes their Qi descend and the primary focus of the formula is

the throat and chest.

The formula does treat Qi stagnation but it is primarily Qi stagnation of the

Lungs, Stomach and Heart; the formula also restores the descending of Qi

of these three organs.

Lung Heart

Besides Qi stagnation, there is also Phlegm but this is Qi-Phlegm, i.e.

the most non-substantial type of Phlegm. Ban Xia in the formula

makes Qi descend and resolves Phlegm. Hou Po also makes Qi

descend and opens the chest. Fu Ling helps Ban Xia to resolve

Phlegm. Zi Su Ye makes Lung-Qi descend and also acts on the throat.

2) The formula Ban Xia Hou Po Tang is also mentioned in Sun Si

Miao’s Qian Jin Yao Fang with slightly different symptoms: fullness

of the chest, a hardness below the heart, a feeling of obstruction of the

throat as if there was a piece of grilled meat that cannot be ejected nor

swallowed.

3) Although this syndrome and formula are in a chapter on

gynaecology, it does not mean it applies to women only: men can get

this syndrome too and the same formula is applicable.

In conclusion, the pathology of depression could be summarized as follows

with the acupuncture points suggested for each aspect and the main mental-

emotional aspect or organ involved:

1) Angst, anxiety, despair leads to sadness, feeling of helplessness

(Seligman), feeling of hopelessness: Du-24 Shenting, Ren-15 Jiuwei, HE-7

Shenmen. SHEN.

2) The Hun does not come and go enough, there is a lack of plans, ideas,

dreams, hope, inspiration, sense of direction: G.B.-40 Xiuxu, BL-47

Hunmen. HUN

3) The Zhi is impaired, there is lack of will-power, drive, initiative,

momentum to break out of depression: BL-23 Shenshu, BL-52 Zhishi. ZHI

TREATING THE FIVE SHENs

4) Morbid thoughts of death: BL-13 Feishu (“suicidal”), Du-12

Shenzhu (“desire to kill people”), BL-42 Pohu (“three corpses

flowing”). PO.

5) Obsessive thinking, pensiveness, brooding: G.B.-15 Toulinqi,

BL-49 Yishe. YI.

6) Problems in relationships: T.B.-5 Waiguan, P-7 Daling, P-6

Neiguan. PERICARDIUM and TRIPLE BURNER

7) Deficiency of the Gall-Bladder’s “courage” leads to

indecisiveness: G.B.-40 Qiuxu. GALL-BLADDER.

AETIOLOGY

a) EMOTIONAL STRESS

Emotional stress is the main aetiological factor in depression. The main

emotions that may give rise to depression are anger, sadness, grief, worry,

and guilt.

i. Anger

Anger (intended in a broad sense that includes frustration, resentment, hatred)

causes either Liver-Qi stagnation or Liver-Yang rising. When it is suppressed,

it is more likely to cause Liver-Qi stagnation and depression. Liver-Qi

stagnation is a frequent cause of mental depression, especially in its

beginning stages.

Liver-Qi stagnation causes depression by restraining the coming and going of

the Hun and therefore resulting in a lack of ideas, projects, aims, inspiration

and a general lack of sense of direction in life.

One of the most significant and important signs of Liver-Qi stagnation is

a Wiry pulse: if the pulse is generally Wiry in all positions, it is always a

definite sign that the mental depression is due to Liver-Qi stagnation.

Often the pulse picture contradicts the first appearance of the patient. In

fact, the patient may appear depressed, slow in movement, pale with a

weak voice, all signs pointing to a Deficiency as the cause of the problem,

but the pulse is Full and Wiry in every position: this is a sure sign that the

depression is due to Qi stagnation.

Indeed, in some cases (and in my experience, especially in men), the

person may seek treatment for tiredness as his or her main complaint, but

if the pulse is Full and Wiry in every position, it almost certainly

indicates that the person is depressed with Liver-Qi stagnation as the

main cause of it.

ANGER

LIVER-QI STAGNATION (Anger repressed)

LIVER-YANG RISING

LIVER-FIRE

Liver-Fire

Liver-Qi stagnation

(Anger expressed)

ii. Sadness and grief

Sadness and grief initially deplete Qi and therefore lead to Qi deficiency

of the Spleen, Heart and Lungs. However, after some time, the very

deficiency of Qi impairs its circulation and leads also to some Qi

stagnation: this is a Qi stagnation that affects not the Liver but the Heart

and Lungs.

The Heart- and/or Lung-Qi stagnation also affect the Hun and restrain its

coming and going resulting in a lack of life dreams, projects, aims,

inspiration and a general lack of sense of direction in life.

Sadness and grief are frequent causes of depression from loss of a

family member or partner from death or separation: this is called

reactive depression in Western psychiatry.

SADNESS

GRIEF QI DEFICIENCY

QI STAGNATION

(LU, HE)

WORRY QI STAGNATION

(SP, LU, HE)

Swollen sides chest area Purple and Swollen sides chest area

iii. Worry

Worry “knots” Qi which means it causes Qi stagnation. Worry causes

stagnation of Qi of the Spleen, Lungs and Heart; worry also affects the

Liver and may cause either Liver-Qi stagnation or Liver-Yang rising.

The Heart- and/or Lung-Qi stagnation also affect the Hun and restrain

its “coming and going” resulting in a lack of ideas, projects, aims,

inspiration and a general lack of sense of direction in life.

iv. Guilt

Guilt is a common cause of Qi stagnation: it affects primarily the Heart

and Kidneys. The Heart-Qi stagnation also affects the Hun and

restrains its coming and going resulting in a lack of ideas, projects,

aims, inspiration and a general lack of sense of direction in life.

As guilt also affects the Kidneys, it weakens the Zhi the weakness of

which is an important feature of depression.

CONSTITUTIONAL TRAITS

In my experience, constitutional traits play an important role in

the aetiology of depression. For example, a constitutional

deficiency of the Kidneys, with its resulting weakness of the Zhi

is a frequent underlying background for the development of

depression.

A constitutional tendency to Heart patterns is also an important

contributory factor to the development of depression. The most

important and reliable sign of a tendency to emotional problems

is a midline Heart crack on the tongue.

c) IRREGULAR DIET

Diet play a secondary role in the aetiology of depression; in my experience, it

contributes to the development of depression in the presence of emotional

stress.

Excessive consumption of dairy foods, sweets, sugar and bread may lead to

the formation of Phlegm. Phlegm may become a contributory pathological

element of depression as first of all, it impairs Qi and would therefore

aggravate any deficiency and stagnation of Qi. It is also obstructive and heavy

and therefore would cloud the Shen leading to mental confusion: this

condition would aggravate a condition of restraint of the Hun.

In my experience, a dietary contributory factor in the development of

depression is a diet lacking in nourishment. This occurs when patients follow

strict slimming diets or when they apply a vegetarian diet inappropriately.

This leads to deficiency of Qi and Blood which are the condition underlying

Deficiency types of depression.

PATTERNS IN DEPRESSION

LIVER-QI STAGNATION

HEART- AND LUNG-QI

STAGNATION

QI STAGNATION

TURNING INTO HEAT

BLOOD STASIS

QI STAGNATION AND

PHLEGM

WORRY INJURING SHEN

HEART AND SPLEEN

DEFICIENCY

HEART- AND KIDNEY-YIN

DEFICIENCY

KIDNEY-YANG

DEFICIENCY

FULL EMPTY

LIVER-QI STAGNATION

depression

moodiness

anxiety

frustration

uptight

tense hypochondriac pain and distension

abdominal distension

nausea

vomiting

irregular bowel movement

irregular periods pre-menstrual tension

Treatment principle: soothe Liver, move Qi, relieve stagnation.

wiry pulse

LIVER-QI STAGNATION

Depression moodiness worry

frustration

feeling uptight and

tense

hypochondrial pain and

distension

tension and ache of

the muscles of the

neck and top of the

shoulders

abdominal

distension

irregular

bowel

movement

irregular periods

pre-menstrual

tension

Pathology and mental-emotional pattern

Depression is characterized by the insufficient coming and going of

the Hun resulting in a lack of dreams, aspirations, plans, ideas,

inspiration. Liver-Qi stagnation may derive from anger including

frustration and resentment: anger is even more prone to cause Liver-Qi

stagnation when it is repressed. Liver-Qi stagnation may also derive

from worry and guilt.

The patient who is depressed against a background of Liver-Qi

stagnation will be not only depressed but also moody and prone to

outbursts of anger. He or she will also suffer from irritability, and an

intense feeling of frustration.

An important sign of Liver-Qi stagnation as the cause of depression is

a Wiry pulse.

Prescriptions

a) YUE JU WAN

Three Treasures: Release Constraint

b) CHAI HU SHU GAN TANG

Can add Yu Jin Tuber Curcumae and Qing Pi Pericarpium Citri

reticulatae viride.

c) XIAO YAO SAN (Freeing the Moon) d) WU GE KUAN ZHONG SAN Bai Dou Kou Fructus Cardamomi rotundi Hou Po Cortex Magnoliae officinalis Sha Ren Fructus Amomi Mu Xiang Radix Saussureae Xiang Fu Rhizoma Cyperi rotundi Qing Pi Pericarpium Citri reticulatae viridae Chen Pi Pericarpium Citri reticulatae Ding Xiang Flos Caryophylli Zhi Gan Cao Radix Glycyrrhizae preparata

YUE JU WAN

Xiang Fu Rhizoma Cyperi (Stagnation of Qi)

Chuan Xiong Rhizoma Chuanxiong (Stasis of Blood)

Cang Zhu Radix Atractylodis (Stagnation of Dampness/Phlegm)

Shan Zhi Zi Fructus Gardeniae (Stagnation of Heat)

Shen Qu Massa Medicata Fermentata (Stagnation of Food)

By Zhu Dan Xi 1280-1358

Formula for the 6 Stagnations (Qi, Blood, Dampness, Phlegm, Heat, Food)

YUE JU WAN XIAO YAO SAN

Patterns Liver-Qi stagnation Liver-Qi stagnation, Liver-Blood

deficiency

Pulse All Wiry Fine and slightly Wiry or Wiry on left,

Weak on right

2. HEART- AND LUNG-QI STAGNATION

Clinical manifestations

Tongue: slightly Red on the sides in

the chest areas.

Pulse: Empty but very slightly Overflowing on the left-Front

position and very slightly Tight on the right-Front position.

depression

sadness

slight anxiety

palpitations

a feeling of distension or oppression of the chest

slight shortness of breath

sighing

poor appetite

chest and upper epigastric distension

dislike of lying down

pale complexion

a slight feeling of lump

in the throat

HEART- AND LUNG-QI STAGNATION

depression sadness slight anxiety

palpitations

a feeling of distension or oppression

of the chest

a slight feeling of lump in the

throat

slight shortness of breath

poor appetite

sighing

chest and upper

epigastric distension

dislike of

lying down

weak and cold

limbs

pale complexion


Sadness, grief and worry affect the Heart and Lungs; whilst sadness and

grief initially deplete Qi while worry knots Qi, all three emotions, after

some time, lead to Qi stagnation in the chest area. The Lungs are

particularly affected by the sadness and grief deriving from separation

and loss: this is a frequent cause of depression.

The Qi stagnation deriving from the above emotions affect the

circulation of Heart-Qi and Lung-Qi in the chest and constrict the Po:

on a physical level, this causes a feeling of distension or tightness of the

chest and sighing. On a mental-emotional level, the person is sad,

depressed and tends to weep a lot.

The Qi stagnation deriving from the above emotions affect the

circulation of Qi in general and impairs the movement of the Hun.

Treatment principle

Move Heart- and Lung-Qi, calm the Shen, lift mood, settle the Po.

ii. Herbal therapy

Prescriptions

a) MU XIANG LIU QI YIN Aucklandia Flowing Qi Decoction.

Explanation

This formula moves Qi in the Heart and Lungs, subdues rebellious Qi in the

chest and tonifies Qi and Yin.

b) BAN XIA HOU PO TANG Pinellia-Magnolia Decoction

Three Treasures remedy

Open the Heart

MU XIANG LIU QI YIN

Mu Xiang Radix Aucklandiae


Chen Pi Pericarpium Citri reticulatae

Hou Po Cortex Magnoliae

Qing Pi Pericarpium Citri reticulatae viride

Gan Cao Radix Glycyrrihizae

Xiang Fu Rhizoma Cyperi

Zi Su Ye Folium Perillae

Ren Shen Radix Ginseng

Fu Ling Poria

Mu Gua Fructus Chaenoomelis

Chang Pu Rhizoma Acori

Bai Zhu Rhizoma Atractylodis macrocephalae

Bai Zhi Radix Angelicae dahuricae

Mai Men Dong Radix Ophiopogonis

Cao Guo Fructus Amomi

Rou Gui Cortex Cinnamomi

E Zhu Rhizoma Curcumae

Da Fu Pi Pericarpium Arecae

Ding Xiang Flos Caryophilli

Bing Lang Semen Arecae

Huo Xiang Herba Pogostemonis

Mu Tong Caulis Akebiae DO NOT USE

bitter taste

3. QI STAGNANT TURNING INTO HEAT

Tongue: Red sides

Depression

anxiety

agitation

short-temper

a feeling of oppression of

the chest

"noisy swallowing of sour liquid"

dry mouth

tinnitus

headache

red face-eyes

constipation

Pulse: Rapid-Wiry.

hypochondriac distension

STAGNANT LIVER-QI TURNING INTO HEAT

Depression moodiness worry frustration

feeling uptight and tense

anxiety

agitation

short-temper

dry mouth

bitter taste

constipation

headache red face-eyes

hypochondrial pain and

distension

tension and ache of the

muscles of the neck

and top of shoulders

abdominal

distension

irregular bowel

movement

irregular periods

pre-menstrual tension

Treatment principle: clear Liver, move Qi, clear Heat, move Qi, eliminate

stagnation, harmonize Stomach.


In Liver-Qi stagnation, the clinical manifestations are centered primarily in

the hypochondrium and abdomen while in Stagnant Liver-Qi turning into

Heat, there are also manifestations in the head such as headache, dry mouth,

red eyes and face and bitter taste. Liver-Qi stagnation impairs the coming and going of the Hun leading to depression in the same way as described above under the pattern of Liver-Qi stagnation. The Heat deriving from the long-term Qi stagnation, on the other hand, agitates the Shen and leads to anxiety.

Prescriptions:

XIAO YAO SAN with ZUO JIN WAN (Huang Lian and Wu Zhu

Yu).

DAN ZHI XIAO YAO SAN Moutan-Gardenia Free and Easy

Wanderer Powder

Three Treasures: Freeing the Sun

4. QI STAGNATION AND PHLEGM

Uncomfortable feeling in the throat like a foreign body, which cannot be coughed up

or swallowed

difficulty in swallowing

a feeling of oppression of the chest

moodiness

hypochondrial pain


Tongue: Swollen, sticky coating

Pulse: Wiry or Slippery.

QI STAGNATION WITH PHLEGM

depression moodiness

uncomfortable feeling in the throat like a

foreign body which cannot be coughed up or

swallowed

difficulty in swallowing

sighing

a feeling of oppression in the chest

hypochondrial pain


Treatment Principle: resolve Phlegm, move Qi, resolve stagnation.


The Hun provides this movement on a mental and psychic level to the Shen.

When the Hun does not come and go enough, the person lacks dreams, aims,

projects, inspiration and creativity, he or she lacks a sense of direction and

feels frustrated. These people are often at crossroads (which may have to do

with relationships or work) in life and lack a sense of direction: in short, the

person is depressed.

When Qi stagnates over a long period of time, the free flow of Qi in the

Triple Burner is impaired and this leads to impairment of the metabolism of

fluids: after time, this may result in the formation of Phlegm.

Phlegm obstructs the Shen and this may cause confused thinking, obsessive

thinking or slight manic behaviour.

The coming and going of the Hun may be restrained both by Qi stagnation and

by Phlegm, hence the patient is depressed and lacks a sense of direction in life.

When in addition to Qi stagnation, there is Phlegm, this clouds the Shen's

orifices and it leads to a certain loss of insight. The person feels confused,

bewildered.

Prescriptions

a) BAN XIA HOU PO TANG (Open the Heart)

b) SHI WEI WEN DAN TANG Variation (Clear the Soul)

c) SHUN QI DAO TAN TANG Rectifying Qi and Eliminating Phlegm

Decoction Variation. Original formula plus:

Shi Chang Pu Rhizoma Acori graminei

Yuan Zhi Radix Polygalae.

Three Treasures remedies

Open the Heart

Bright Spirit

Clear the Soul

SHUN QI DAO TAN TANG

Chen Pi Pericarpium Citri reticulatae

Fu Ling Poria


Gan Cao Radix Glycyrrhizae

Dan Nan Xing Rhizoma Arisaematis preparatum

Mu Xiang Radix Aucklandiae

Xiang Fu Rhizoma Cyperi

Zhi Shi Fructus Aurantii immaturus

5. BLOOD STASIS

Mental restlessness

depression

agitation at night

short temper

restless sleep

dreaming a lot

pain in chest

Tongue: Purple tongue

Pulse: Firm Pulse

BLOOD STASIS OBSTRUCTING THE MIND

Depression mental restlessness

agitation at night short temper

restless sleep

dreaming a lot

pain in the chest

Treatment Principle: move Blood, calm Shen, eliminate stasis.


Blood is the residence of the Shen and Hun and a deficiency of Blood affects

both the Shen and the Hun depriving them of their residence. However,

Blood stasis also affects the Shen and the Hun. In particular, Blood stasis tend

to obstruct the Shen in a similar way that Phlegm does and, in serious cases, it

can therefore also lead to a certain loss of insight.

The patient is depressed but also anxious and agitated and may dream a lot as

Blood stasis frequently causes an aggravation of symptoms at night.

Prescriptions

XUE FU ZHU YU TANG (or YUE JU WAN)

Three Treasures: Red Stirring

Bluish purple Reddish purple

XU

1) WORRY INJURING SHEN

Tongue: Pale, tongue coating sticky-white

Depression

feeling like in a trance

absent

anxiety no desire to do anything

sadness

worry crying

stretching and yawning

Pulse: Weak, Fine.

WORRY INJURING THE MIND

depression mental confusion

feeling absent

no desire to do

anything

insomnia

sadness

anxiety

crying

stretching and

yawning

worry

Treatment Principle: nourish Heart, calm Shen.


Empty pattern. It is caused by worry which knots Qi but also, in the long run,

leads to depletion of Qi and Blood. Heart-Blood is the residence of the Shen

and when it is deficient, the Shen is deprived of its residence resulting in

depression, anxiety and insomnia.

The patient presents with characteristic manifestations of Deficiency, i.e.

pallor, slow walking, slow speech, sad expression, Weak pulse, etc. The

Deficiency makes the patient lacking in drive so that he or she feels unwilling

or incapable of doing things.

Prescription

GAN MAI DA ZAO TANG

Three Treasures: Breaking Clouds, Searching Soul, Soothe the Shen

GAN MAI DA ZAO TANG Glycyrrhiza-Triticum-Jujuba Decoction

ZHI GAN CAO, DA ZAO, FU XIAO MAI

Modern Chinese books say that this formula is for Liver-Qi stagnation with the

syndrome of plum-stone in the throat. They say that the formula pacifies the

Liver with it sweet taste (reverse Ke cycle, i.e. sweet taste harmonizes Wood).

I personally use this formula for depression in Xu conditions (of Qi, Blood,

Yang or Qi and Yin). It is true that it pacifies the Liver with it sweet taste but it

also tonifies with its sweet taste. It therefore tonifies Qi and Blood and, by so

doing, it nourishes the Shen. It relieves depression occurring against a

background of Deficiency.

As it contains only three (mild) herbs, I frequently add this formula to other

formulae when I suspect that the root of the problem is emotional.

It is also good for hyperactive children.

Breaking

Clouds

SP-HE Lifts Qi Earth problems Sadness

Soothe the Shen HE Nourishes the

Heart

Fire problems Sadness, grief

Searching Soul LIV-HE Nourishes LIV

and HE

Problems of

Hun, life plans

and dreams

Sadness, guilt

dizziness

2) HEART AND SPLEEN DEFICIENCY

Tongue: Pale

brooding

depression

always thinking

palpitations

pale face

timidity

difficulty in falling asleep

poor appetite

Pulse: Weak or Choppy.

HEART AND SPLEEN DEFICIENCY

pale face

difficulty in falling

asleep

depression brooding always thinking

palpitations

timidity

dizziness

poor appetite

Treatment Principle: tonify Spleen-Qi, nourish Heart-Blood, calm the Shen.


Heart-Blood is the residence of the Shen and when it is deficient, the Shen is

deprived of its residence resulting in depression, anxiety and insomnia. This

pattern is characterized by Qi and Blood deficiency, the latter affecting three

organs, i.e. the Heart, Spleen and Liver. Heart-Blood houses the Shen and its

deficiency causes depression, anxiety and insomnia; Liver-Blood houses the

Hun and its deficiency causes insomnia and dream-disturbed sleep.

Prescription

a) GUI PI TANG

b) YANG XIN TANG

c) BU XIN TANG

Three Treasures: Calm the Shen

Pale, no coating, HE crack Pale, HE crack

Pale-dry

LIV-QI XU

LIV-BLOOD XU

DEPRESSION

ANXIETY

3) HEART- AND KIDNEY-YIN XU, EMPTY HEAT

Depression

anxiety in the evening

feeling hot

malar flush

dizziness palpitations

waking up at night

mental restlessness

nocturnal emissions with dreams

Tongue: Red

night sweating

Pulse: Wiry-Fine or Floating-Empty.

KIDNEY- AND HEART-YIN DEFICIENCY, EMPTY HEAT BLAZING

sore back

mental restlessness

depression

anxiety in the evening

feeling hot

malar flush

dizziness

palpitations

waking up at night

5-palm heat

night sweating

nocturnal emissions with dreams

Treatment principle: nourish Yin, subdue Empty-Heat, calm Shen.


Deficiency of Yin of the Kidneys and Heart and Empty Heat of the Heart.

Deficiency of Kidney-Yin leads to Empty Heat which blazes upwards to

affect the Heart. More common in the middle-aged or elderly. The Yin Xu

itself causes the patient to become depressed while the Empty Heat

harasses the Shen and the Hun causing the person to become anxious and

restless. An important sign for this combination of patterns is a Red tongue

without coating. Prescriptions a) TIAN WANG BU XIN DAN Heavenly Emperor Tonifying the Heart

Pill (Heavenly Empress) b) ZI SHUI QING GAN YIN (Nourish the Soul) c) JIE FAN YI XIN TANG Calming Mental Restlessness and Benefitting the Heart Decoction

b) ZI SHUI QING GAN YIN Nourish Water and Clearing the Liver Decoction

Sheng Di Huang Radix Rehmanniae 6 g

Shan Zhu Yu Fructus Corni 6 g

Shan Yao Rhizoma Dioscoreae 6 g

Fu Ling Poria 6 g

Mu Dan Pi Cortex Moutan 6 g

Ze Xie Rhizoma Alismatis 6 g

Dang Gui Radix Angelicae sinensis 6 g

Bai Shao Radix Paeoniae alba 6 g

Chai Hu Radix Bupleuri 6 g

Shan Zhi Zi Fructus Gardeniae 6 g

Suan Zao Ren Semen Ziziphi spinosae 6 g

c) JIE FAN YI XIN TANG Calming Mental Restlessness and Benefitting the Heart Decoction

Ren Shen Radix Ginseng 6 g

Huang Lian Rhizoma Coptidis 3 g

Suan Zao Ren Semen Ziziphi spinosae 9 g

Bai Zhu Rhizoma Atractylodis macrocephalae 3 g

Fu Shen Sclerotium Poriae pararadicis 6 g

Xuan Shen Radix Scrophulariae 15 g

Gan Cao Radix Glycyrrhizae uralensis 3 g

Zhi Ke Fructus Aurantii 0.5 g

Tian Hua Fen Radix Trichosanthis 6 g

4) KIDNEY- YANG DEFICIENCY

Tongue: very Pale

Pulse: Weak-Deep-Slow.

exhaustion

depression

does not want to do

anything or go out

no will power

no initiative

pale urine

frequent urination

chilliness

weariness

curling up sore back

KIDNEY- YANG DEFICIENCY

Depression

exhaustion

does not want to do anything or

go out

weariness

chilliness with desire to

curl up

sore back

frequent urination

pale urine

no will power no initiative

lack of drive and

determination

Treatment principle: tonify and warm Kidneys.


The Kidneys house the Zhi. “Will-power” as a translation of Zhi includes

will-power itself, drive, determination, steadfastness and physical and

mental power. As Yang implies activity and movements towards the

outside, in this pattern of Kidney-Yang deficiency, there is a definite lack

of drive, determination and initiative. The person is deeply depressed, lack

enthusiasm and is unable to find the drive to do anything.

Prescriptions

a) YOU GUI WAN

b) JIN GUI SHEN QI WAN

Three Treasures: Strengthen the Root

The book Chinese Medicine Psychology (Zhong Yi Xin Li Xue) has two

other patterns for Yu Zheng.

1) LIVER-YIN DEFICIENCY

Irritability, prone to outbursts of anger, dizziness, tinnitus, dry eyes, floaters,

headache, red face, red eyes, Tongue: Red, dry, Pulse: Wiry-Fine.

Formula: Qi Ju Di Huang Wan.

2) HEART AND SPLEEN CHAOTIC

“Like in a trance” [huang hu], mental restlessness, easily startled, sadness,

worry, crying, getting angry, yawning, stretching.

Formula: Gan Mai Da Zao Tang.

Note: huang hu is a symptom of Bai He Bing in Jin Gui Yao Lue.

REMEDIES FOR DEPRESSION

- Release Constraint: Liver-Qi stagnation.

- Freeing the Moon: Liver-Qi stagnation, Liver-Blood Xu.

- Freeing the Sun: LIV-Qi stagnation, LIV-Heat.

- Open the Heart: Lung- and Heart-Qi stagnation.

- Bright Spirit: Lung- and Heart-Qi stagnation with Phlegm.

- Red Stirring: Heart-Blood stasis.

- Breaking Clouds: Qi deficiency

- Calm the Shen: Heart-Blood Xu.

- Nourish the Soul: Liver-Blood/Yin Xu.

- Heavenly Empress: HE- and KI-Yin Xu with HE Empty Heat.

- Strengthen the Root: KI-Yang Xu.

- Searching Soul: LIV-Qi Xu, Blood Xu.

- Soothe the Shen: HE- and LU-Qi Xu, Yin Xu.

BRAIN SHEN

SHEN

ZHI KIDNEY

HEART

DU MAI AND THE SPIRIT

DU POINTS FOR DEPRESSION

DU-11 SHENDAO: nourishes the Heart and the Shen, sadness,

depression, poor memory, palpitations, disorientation, timidity, weak

GB-Qi, Hun not coming and going enough. (Level with BL-15).

DU-12 SHENZHU: manic behaviour, Hun coming and going too much,

seeing ghosts, desire to kill people, settle the Po, morbid thoughts of

death. (See BL-13-42). (Not the same “Shen” 身 as in “Shendao 神 ).

DU-14 DAZHUI: strengthen the Heart, tonify Yang, strengthen Zhi,

tonify Heart- and Kidney-Yang, depression, lack of will-power and

drive, Hun not coming and going enough.

DU-16 FENGFU: Hun coming and going too much, manic behaviour,

desire to commit suicide, sadness, fear, subdue Liver-Yang.

DU-19 HOUDING: calms the Shen and nourishes the Heart, sadness,

depression. Good combined with Ren-15.

DU-20 BAIHUI: at the vertex, can make Qi descend in anxiety but also

rise in depression. Tonifies the clear Yang rising to the head (combined

with GB-40), stimulate the coming and going of the Hun, depression.

DU-24 SHENTING

Du-24 is a very important and powerful point to calm the Shen. It is frequently

combined with G.B.-13 Benshen for severe anxiety and fears.

An important feature of this point which makes it particularly useful is that it

can both calm and lift the Shen: therefore it is used not only for anxiety and

insomnia but also for depression and sadness. It is also used in psychiatric

practice for schizophrenia. Manic behaviour.

The name of this point refers to its strong influence on the Shen and Spirit.

The courtyard was traditionally considered to be a very important part of the

house as it was the one that gave the first impression to visitors; it is the

entrance. Thus, this point could be said to be the “entrance” to the Shen and

Spirit and its being a courtyard, highlights its importance. Being the

“entrance”, it controls our relationships with others.

Du-24 Du-20-19-16

DU POINTS AFFECTING SHEN

Du-14 Dazhui

Fever

Deficiency sweating, Xu-Lao

Epilepsy

Stiffness of spine and neck

Du-13 Taodao

Chills-fever, steaming bones

Stiffness of spine

Spasms

Agitation, depression, disorientation

. Du-14 Dazhui

Du-13 Taodao

Du-12 Shenzhu

Mania, seeing ghosts, desire to kill

Chest, breathlessness, cough

Headache

Epilepsy, spasms

Du-11 Shendao

Sadness, anxiety, palpitation, poor

memory, disorientation, timidity

Epilepsy, spasms

Fever with headache, chills-fever

Chest, breathlessness

Upper back pain and cold sensation

. Du-12 Shenzhu

Du-11 Shendao

Du-10 Lingtai

Breathlessness, cough

Stiffness and pain of back

Du-8 Jinsuo

Epilepsy, spasms

Mania

. Du-8 Jinsuo

Du-10 Lingtai

Note: “mania” is translation of kuang 狂

THE GALL-BLADDER AND THE SHEN

CONTROLS DECISIVENESS

While the Liver is said to control the ability of planning one’s life,

the Gall Bladder controls the capacity to make decisions. The two

functions have to be harmonized so that we can plan and act

accordingly. Chapter 8 of the “Simple Questions” says: “ The Gall

Bladder is like an impartial judge from whom decisiveness

emanates”.

Chapter 9 of the “Simple Questions” lists the functions of all the

organs (omitting the Pericardium) and, at the end, it says: “All the 11

organs depend on the decision-making of the Gall Bladder”.

This is an interesting statement because it implies not only that the

Gall Bladder controls our capacity to take decisions but also that all

the other internal organs depend on the Gall Bladder's “decision

making”: in other words, the Gall Bladder is the organ that

“motivates” all others and Gall Bladder points can be used for this

purpose, especially GB-40.

Simple Questions, p. 58.

Ibid., p. 69.

The Gall Bladder is responsible for decisiveness, for the capacity of

taking decisions.

Besides controlling decision-making, the Gall Bladder gives an

individual courage and initiative. Chinese expressions such as “big gall

bladder” meaning “courageous” and “small gall bladder” meaning

“timid or fearful”.

Important function of the Gall Bladder on a psychological level. It

controls the courage to take decisions and make changes. Although the

Kidneys control “drive” and initiative, the Gall Bladder gives us the

capacity to turn this drive and vitality into positive and decisive action.

Thus a deficient Gall Bladder will cause indecision, timidity and the

affected person will be easily discouraged at the slightest adversity.

The Gall Bladder provides the courage for the Shen, governed by the

Heart, to carry out decisions. This reflects the Mother-Child relationship

existing between Gall Bladder and Heart according to the 5 Elements

(Divergent GB channel goes through heart). In cases of weak Shen from

Heart deficiency, it is often necessary to tonify the Gall- Bladder to

support the Heart.

The Shen provides the clarity and most of all, the integration and

control necessary to “moderate” the decisiveness of the Gall Bladder:

without the control and integration of the Shen, the decisiveness of the

Gall Bladder may turn into recklessness.

The Gall Bladder influences the mental-emotional life in yet another

way. Gall Bladder-Qi helps the ascending of Liver-Qi. On a physical

level, Gall Bladder-Qi helps the ascending and free flow of Liver-Qi in

relation to the Stomach and Spleen.

On a psychological level, the ascending of Gall Bladder-Qi stimulates

the ascending and free flow of Liver Qi on a mental level. The Hun

which is housed in the Liver gives “movement” to the Shen of the

Heart providing it with inspiration, planning, ideas, initiative, creativity.

This “movement” of the Hun depends on the ascending of Liver-Qi

which, in turn, relies on Gall Bladder-Qi. If this “movement” of the

Hun is lacking, the person will tend to be depressed: in this case, Liver-

Qi is not ascending enough and Gall Bladder-Qi is weak.

As for the mental-emotional-spiritual aspect of the Shen (Heart), Hun

(Liver), Zhi (Kidneys), Gall-Bladder and Small Intestine, we can build a

picture of how these organs are involved and coordinated in decision-

making.

• The capacity of planning our life, to have “dreams” and plans that is

conferred by the Hun of the Liver

• The drive and will-power to want to make something of our lives that is

conferred by the Zhi of the Kidneys

• The capacity to discriminate between issues, to analyse issues with clarity,

to distinguish what is relevant and what is not that is conferred to us by the

Small Intestine

• The capacity to take a decision with resoluteness once all issues have been

analysed, the courage to act that is conferred by the Gall Bladder

• The integration and direction provided by the Shen of the Heart.

GALL-BLADDER HEART

SMALL-INTESTINE

Decision- making

Decisiveness

Mental clarity-integration

Discrimination and critical appraisal

ZHI OF THE

KIDNEYS

HEART

GALL-

BLADDER

Provides clarity and integration so

that decisiveness does not turn into

recklessness

Provides courage and decisiveness

to the Shen

GALL-

BLADDER

HUN

SHEN

Ascending of GB-Qi

Helps movement of Hun

Coming and going of Hun

Acupuncture points for Depression

LU-7 Taiyuan

LU-3 Tianfu

L.I.-4 Hegu

ST-36 Zusanli

ST-40 Fenglong

SP-6 Sanyinjiao

HE-5 Tongli

HE-7 Shenmen

BL-15 Xinshu

BL-42 Pohu

BL-44 Shentang

BL-47 Hunmen

KI-3 Taixi KI-9 Zhubin P-6 Neiguan T.B.-3 Zhongzhu

G.B.-13 Benshen LIV-3 Taichong Du-4 Mingmen

Du-11 Shendao Du-20 Baihui Du-24 Shenting

Ren-4 Guanyuan

Ren-15 Jiuwei

. .

.

.

. .

.

.

.

.

BL-52

BL-49

BL-47

BL-44

BL-42

Yishe Abode of Yi

Hunmen Door of Hun

Shentang Hall of Shen

Pohu Window of Po

Zhishi Room of Zhi

POINTS OF THE FIVE ZHI

OUTER BLADDER POINTS

BL-52 Zhishi Room of Zhi: strengthens will power, memory, drive, initiative, determination (Jing Xue Jie: nocturnal emissions with dreams) BL-49 Yishe Yi’s Shelter: For Spleen’s pensiveness, brooding, obsessive thoughts BL-47 Hunmen Door of Hun: strengthens Hun’s planning, intuition, inspiration, ideas, life’s dreams, sense of direction, projects, vision (Jing Xue Jie: it stores the 5 Zang but they can be seen from the outside, Hun goes in and out [through this point], lung diseases) BL-44 Shentang Hall of Shen: strengthens Shen, nourishes Heart, clear thinking, joy of life BL-42 Pohu Window of Po: strengthens Po, introspection, being comfortable with oneself, also sadness, grief, thoughts of death.

EFFECTS OF EMOTIONS (SAN YIN FANG 1174)

ANGER extends and “loosens” the Hun-Door (Hunmen BL-47). Pulse Wiry or Choppy.

FEAR makes Zhi-Room (Zhishi BL-52) not firm. Pulse Deep-Slow

WORRY makes Po-Window (Pohu BL-42) shut. Pulse Overflowing, Short

PENSIVENESS makes the Yi-Shelter (Yishe BL-49) restless. Pulse Wiry or Weak

JOY melts the Shen-Hall (Shentang BL-44). Pulse Deep, Scattered

LU-7 Lieque

LU-7 brings clear Qi up to

the head and promotes the

descending of turbid Qi

from the head.

On a physical level, this

means that LU-7 can treat

problems of the nose and

sinuses.

On a psychic level, it

clears the Shen and lifts

mood.

I use it for most types of

depression, whatever the

pattern involved.

FEELINGS-PO

.

.

Ascending of clear Qi to the Brain

Descending of turbid Qi from the Brain

LU-3 Tianfu (3 cun below axillary fold)

Window of Heaven point. These points is regulate the ascending and

descending of Qi from the body to and from the head: they do so in the

crucial neck area. Therefore, they can both subdue rebellious Qi and

promote the ascending of clear Qi to the head.

The “Explanation of the Acupuncture Points” says that LU-3 can make Qi

rise to treat forgetfulness, sadness and weeping due to Qi not rising to head.

Forgetfulness is an important indication for this point: this is forgetfulness

due to clear Qi not rising to the head. According to the “Explanation of the

Acupuncture Points”, this point treats forgetfulness by stimulating the

ascending of Qi of both Lungs and Heart.

On a psychic level, LU-3 action in regulating the ascending and descending

of Qi to and from the head has a mental-emotional effect. For example,

insomnia is due to Qi ascending too much to the head (or not descending

from it) while somnolence and forgetfulness are due to clear Qi not

ascending to the head.

LU-3 Tianfu

Finally, “talking to ghosts” features heavily in this point's indications.

Generally speaking, when ancient books mention such symptoms as talking

or seeing ghosts among the indications of a point, it means that the point is

indicated for relatively serious mental-emotional problems and, in

particular, when the Shen is obstructed.

Obstruction of the Shen can potentially cause serious mental problems such

as manic-depression or psychosis. Again, this point can open the Shen's

orifices, i.e. de-obstruct the Shen by regulating the ascending and

descending of Qi to and from the head: it opens the Shen's orifices by

promoting the descending of turbid Qi from the head and the ascending of

clear Qi to the head. This is a general function of the Window of Heaven

points.

L.I.-4 Hegu

In my experience, L.I.-4 has a strong influence on the Shen and can

be used to soothe the Shen and allay anxiety, particularly if

combined with LIV-3 Taichong and with Du-24 Shenting and G.B.-

13 Benshen. I use this combination in depression accompanied by

anxiety.

ST-36 Zusanli

ST-36 has a powerful tonic action and, on the psychic level, it lifts

mood in patients who are depressed against a background of Qi and

Blood deficiency.

ST-40 Fenglong

ST-40 has a long history of use for mental-emotional conditions: it is

especially indicated to open the Shen’s orifices in persons tending to

manic behaviour.

This point has a profound calming the Shen action and I use it frequently

in patients who are depressed and anxious.

The Phlegm-resolving of this point should not be overemphasized

overlooking its other functions. Apart from its use to resolve Phlegm, ST-

40 can also be used to subdue rebellious Qi of the Stomach and Lungs

when the person is very anxious, and the anxiety reflects on the Stomach

function, with such symptoms as tightness of the epigastrium, a feeling of

knot in the Stomach or, as some people say, a feeling of “butterflies in the

stomach”.

Apart from the epigastrium, ST-40 also has an action on the chest: it

relaxes and “opens” the chest both from a physical point of view when it

is obstructed by Phlegm, and from a psychic point of view when Qi

stagnates in the chest from emotional problems.

ST-40 FENGLONG

The Phlegm-resolving effect of ST-40 should not be overemphasized. This point has many other actions: • It calms the Shen • It opens the Shen’s orifices • It treats all Full conditions of

the Stomach • It subdues rebellious Stomach-

Qi • It treats the epigastrium • It opens the chest and makes

Lung-Qi descend when the chest is obstructed by Phlegm

• It relaxes and opens the chest when Qi stagnates here from emotional problems.

.

SP-6 Sanyinjiao

From the emotional point of view, it helps to smooth Liver-Qi to calm the

Shen and allay irritability. It can therefore be used in depression

occurring against a background of Liver-Qi stagnation.

However, from the mental-emotional point of view, SP-6 has a wide range

of actions. It can calm the Shen, and is often used for insomnia,

particularly if from Blood or Yin deficiency.

In particular, it is used for Spleen- and Heart- Blood deficiency, when the

Spleen is not making enough Blood, the Heart is not supplied with enough

Blood and the Shen lacks residence and floats at night, so that insomnia

ensues.

SP-6 is the point to use in this case as it will simultaneously tonify the

Spleen, nourish Blood and calm the Shen. If such a comparison could be

made, this action is comparable to that of the formula Gui Pi Tang

Tonifying the Spleen Decoction. (Calm the Shen in the Three Treasures)

HE-5 Tongli

Main point to tonify Heart-Qi and Heart-Blood; my point of choice for

depression occurring against a background of Qi and Blood deficiency.

Its indications include sadness, mental restlessness, anger, fright,

depression, agitation, palpitations, and weak Heart-Qi.

Use of HE-5 in depression is also connected to this point’s nature of Luo

point. As a Luo point, it moves Qi and removes in the channel: on a

psychic level, this means that it can lift mood and stimulate the “coming

and going” of the Hun.

HE-7 Shenmen

Lift mood in depression and to calm the Shen in anxiety. Its indications include insomnia, poor memory, manic-depression, inappropriate laughter, shouting at people, sadness, fear, mental restlessness, agitation, palpitations. HE-7 nourishes Heart-Blood and is the point of choice for Heart-Blood deficiency causing the Shen to be deprived of its “residence” resulting in anxiety, insomnia, poor memory, palpitations and a Pale tongue.

BL-42 Pohu

Sadness, grief, feeling of oppression of the chest, depression, suicidal

thoughts, “three corpses flowing”.

On a psychological level, BL-42 is related to the Po which resides in the

Lungs. It strengthens and roots the Po in the Lungs. It frees breathing

when the Po is constricted by worry, sadness or grief.

For emotional problems related to the Lungs, sadness, grief and worry.

Soothing effect on the spirit and it nourishes Qi when this is dispersed by

a prolonged period of depression, sadness or grief.

The “Explanation of the Acupuncture Points” reports the indication “three

corpses flowing”. The association with corpses and death should be

interpreted in the way that this point is indicated for suicidal thought.

Because of the connection between the Po and death, points associated

with the Po (BL-13 Feishu and BL-42 Pohu) are indicated for suicidal

thoughts.

BL-44 Shentang

Indications: depression, insomnia, anxiety, mental restlessness, sadness,

grief, worry.

BL-44 is used for emotional and psychological problems related to the

Heart. With BL-15 Xinshu, for anxiety, insomnia and depression. BL-44

strengthens and calms the Shen. It stimulates the Shen's clarity and

intelligence.

BL-15 Xinshu

Anxiety, weeping, fright, insomnia, excessive dreaming, manic-depression,

disorientation, delayed speech development, poor memory, poor concentration,

mental confusion.

I use BL-15 to tonify Heart-Qi and Heart-Blood in depression occurring

against a background of Qi and Blood deficiency.

BL-47 Hunmen

Fear, depression, insomnia, excessive dreaming, lack of

sense of direction in life, “possession by corpse”.

BL-47 is used for emotional problems related to the Liver,

such as depression, frustration and resentment over a long

period of time. Settles and roots the Hun in the Liver;

strengthens the Hun's capacity of planning, sense of aim in

life, life-dreams, and projects.

It is a "door", so this point regulates the "coming and going"

of the Hun and Shen, i.e. relationships with other people and

the world in general. It has an outward movement which

could be contrasted with the inward movement of BL-42

Pohu.

The "Explanation of Acupuncture

Points" (1654) confirms that, due to this

point's nature of "window", “gate” or

“door”, the Hun goes in and out through

it. This confirms the dynamic nature of

this point in stimulating the movement of

the Hun and Shen; however, it can also

work the other way, i.e. to calm down the

excessive movement of the Hun.

In my experience, when used in

conjunction with BL-18 Ganshu, it has a

profound influence on a person’s

capacity of planning his or her life by

regulating the Hun. It can help a person

find a sense of direction and purpose in

life. This point will also help to lift

mental depression associated with such

difficulties.

. . HUN

BL-52 Zhishi

Indications for this point include depression, lack of motivation, lack of

drive, lack of will power.

This point strengthens will power and determination which are the mental-

spiritual phenomena pertaining to the Kidneys. It is a very useful point in

the treatment of certain types of depression, when the person lack

motivation and drive and lacks the will power and mental strength to make

an effort to get out of the spiral of depression. Needling this point with

reinforcing method, especially if combined with BL-23, will stimulate the

will power and lift the spirit.

BL-52 strengthens will-power, drive, determination, the capacity of

pursuing one's goals with single-mindedness, spirit of initiative and

steadfastness. I often use this point, if there is a Kidney deficiency, in

combination with one of the other four points affecting the Spirits of the

Yin organs, i.e. BL-42 Pohu, BL-44 Shentang, BL-47 Hunmen and BL-49

Yishe, as a solid mental-emotional foundation for the other aspects of the

psyche.

In particular, for depression I use the following combination:

-BL-23 Shenshu, BL-52 Zhishi and BL-47 Hunmen to strengthen will-

power and drive, and to instill a sense of direction and aim in one's life.

This combination is excellent to treat the mental exhaustion, lack of drive

and aimlessness and confusion which is typical of chronic depression.

KI-3 Taixi

KI-3 is the Source (Yuan) point of the Kidney channel and it is the best point

to tonify the Kidneys. I use this point in depression from a Kidney deficiency

to strengthen the will power, drive and initiative.

KI-9 Zhubin (Receiving Guest) (HE=guest; KI=host)

Indications for this point include anxiety, insomnia, palpitations, manic

behaviour. KI-9 is an excellent point to calm the Shen in cases of deep

anxiety and mental restlessness deriving from Kidney-Yin deficiency.

It also relaxes any tension or feeling of oppression felt in the chest, often with

palpitations. Because it tonifies Kidney-Yin, calms the Shen and treats

palpitations, this point is particularly indicated in the pattern of “Heart and

Kidneys not harmonized”.

It is the starting point of the Yin Wei Mai and it mental-emotional effect is

largely due to this. The Yin Wei Mai nourishes Heart-Blood and calms the

Shen.

It re-establishes the connection between Heart and Kidneys.

P-6 Neiguan

P-6 is an important point for depression. It is always used in modern China

for mental depression.

It treats especially depression deriving from Liver-Qi stagnation in two

ways. First, it moves Liver-Qi due to its connection with the Liver channel

within the Terminal Yin (Jue Yin) channels. Second, it treats the Shen due to

its close connection with the Heart.

Indications: insomnia, manic behaviour, poor memory, anxiety, fright,

sadness, depression.

T.B.-3 Zhongzhu

T.B.-3 moves Qi and eliminates stagnation. Due to its relationship with the

Gall-Bladder (within the Lesser Yang) and between this latter organ and the

Liver, T.B.-3 indirectly affects the Liver, so that it can be used to eliminate

stagnation of Liver-Qi manifesting with hypochondrial pain, depression and

mood swings.

On a psychological level, it moves Qi and lifts depression deriving from

stagnation of Liver-Qi, particularly in combination with Du-20 Baihui. It is

extremely effective in lifting the Shen when a person is depressed.

THE MENTAL-EMOTIONAL EFFECT OF P-6 NEIGUAN

P-6 Neiguan has a synergistic effect on acupuncture points

prescriptions. The addition of P-6 to any prescription increases the

therapeutic effect.

Just as P-6 has this effect on a physical level, it has one on a mental-

emotional level, i.e. it can bolster the effect of a point combination

for mental-emotional problems.

This effect of P-6 is due to various factors. Firstly, it affects the

Shen, but how does its effect on the Shen differ from that of the

Heart? The Heart is more Yin, it governs Blood which houses the

Shen. The Pericardium is more Yang, it is the external covering of

the Heart, it therefore controls movement of Qi on a mental-

emotional level. This effect on Qi is due also to its relationship with

the Liver within the Jue Yin.

The moving effect of P-6 is due also to other factors.

1) The first is its nature of Luo point of the Pericardium channel. As

Luo point, it affects the Triple Burner: it can therefore move Qi of

the Triple Burner in all three Burners and this also has a mental-

emotional effect.

2) Secondly, the Pericardium is the hinge of the Yin channels, and,

being the Luo point, P-6 is the “hinge” of the Hinge: in its capacity

as “hinge” it connects things. On a mental-emotional level, that

means that it regulates our capacity for relationships. Its function of

“hinge” is also related to its being the opening point of the Yin Wei

Mai which links all the Yin channels.

PERICARDIUM

Linked to

HEART

TRIPLE BURNER

Jue Yin

LIVER

Minister Fire

Xin Bao Luo

G.B.-13 Benshen

G.B.-13 is an important point for mental and emotional problems. It is used

in psychiatric practice for schizophrenia combined with HE-5 Tongli and

G.B.-38 Yangfu. It is also indicated when the person has persistent and

unreasonable feelings of jealousy and suspicion.

Apart from these mental traits, it has a powerful effect in calming the Shen

and relieving anxiety deriving from constant worry and fixed thoughts. Its

effect is enhanced if it is combined with Du-24 Shenting.

Apart from anxiety, G.B.-13 can also be used for depression. In fact, its

deep mental and emotional effect is also due to its action of “gathering”

Jing to the head. Kidney-Jing is the root of our Pre-Heaven Qi and is the

foundation for our mental and emotional life.

A strong Jing is the fundamental prerequisite for a clear Shen and a

balanced emotional life. This is the meaning of this point's name “Root of

the Shen”, i.e. this point gathers the Jing which is the root of the Shen .

Kidney-Jing is the source of Marrow which fills up the Brain: G.B.-13 is a

point where Jing and Marrow “gather”.

The “Great Dictionary of Acupuncture” says that this point “makes the Shen

return to its root”: the “root” of the Shen is the Jing, hence this point

“gathers” the Jing to the Brain and affects the Shen. As it connects the

Shen and the Jing , it also treats both the Heart and the Kidneys and

therefore the Shen and Zhi: for this reason, it is an important point in the

treatment of depression.

When combined with other points to nourish Jing (such as Ren-4

Guangyuan), G.B.-13 attracts Jing towards the head with the effect of

calming the Shen and strengthening clarity of Shen, memory and will

power. The connection between G.B.-13 and the Jing is confirmed by the

text “An Enquiry into Chinese Acupuncture” which has among the

indications of this point: “excessive menstrual bleeding, impotence and

seminal emissions.”

LIV-3 Taichong

LIV-3 is a major point for depression deriving from stagnation of Liver-

Qi. It moves Liver-Qi, stimulates the “coming and going” of the Hun in

depression and it also calms the Shen.

Du-4 Mingmen

Du-4 tonifies the Fire of the Ming Men and Kidney-Yang. As this is the

sea of Zhi, this point strongly tonifies the will power, drive and

determination in patients who suffer from depression. However, please

note that this point should be used only in the presence of Kidney-Yang

deficiency.

Du-11 Shendao

Indications for this point include sadness, anxiety, poor memory,

palpitations, disorientation, timidity.

Du-11 is on the same level as BL-15 Xinshu, the Back-Shu point of the

Heart, and its action mostly extends to the Heart. It nourishes the Heart

and calms the Shen, and therefore treats depression, sadness, anxiety.

Du-12 Shenzhu

Indications for this point include agitation, mad walking, delirious raving,

seeing ghosts, rage with desire to kill people.

This point is indicated for manic behaviour (kuang) and morbid thoughts

of death, for conditions in which the Hun comes and goes too much. It

settles the Po. This point should be seen in conjunction with BL-13

Feishu and BL-42 Pohu.

Please note that the “shen” in this point’s name means “body” and it is not

the “shen” that means “Shen” as in the previous point Shendao.

Du-14 Dazhui

This point strengthens the Heart, tonifies Yang, strengthens the Zhi,

tonifies Heart- and Kidney-Yang: it is very effective for depression, lack

of will-power and drive, with the Hun not coming and going enough.

Du-16 Fengfu

Indications: manic behaviour, incessant talking, mad walking, desire to commit

suicide, sadness and fear.

I use this point for depression and anxiety with morbid thoughts of death.

Du-19 Houding

Indications: mad walking and insomnia. This point calms the Shen and

nourishes the Heart and it is good for sadness and depression. Good combined

with Ren-15 Jiuwei.

Du-20 Baihui

I use Du-20 in practically every case of depression, whatever the pattern, to lift

Qi: on a psychic level, lifting Qi has the effect of lifting mood.

This point's lifting action on Yang has a mental effect in that it promotes the

rise of clear Yang to the Brain and the Shen. Du-20 has a powerful effect in

lifting depression and clearing of the Shen.

Du-24 Shenting

An important feature of this point which makes it particularly useful in

mental-emotional problems is that it can both calm and lift the Shen:

therefore it used not only for anxiety and insomnia but also for depression

and sadness. It is also used in psychiatric practice for schizophrenia and split

thoughts.

The name of this point refers to its strong influence on the Shen and Spirit.

The courtyard was traditionally considered to be a very important part of the

house as it was the one that gave the first impression to visitors; it is the

entrance. Thus, this point could be said to be the “entrance” to the Shen and

Spirit and its being a courtyard, highlights its importance.

Indications for this point include manic-depression, depression, anxiety, poor

memory, insomnia.

Ren-4 Guanyuan

I use Ren-4 frequently to tonify the Kidneys and the Zhi in patients

suffering from depression. In Kidney deficiency, I tend to use Ren-4

more than Du-4 as it has a more balanced effect. In fact, it can tonify

Kidney-Yang with direct moxa cones, but, with needle, it tonifies also

Blood and the Original (Yuan) Qi.

Ren-4 point can calm the Shen and settle the Hun by nourishing Blood

and Yin. It can strengthen the Lower Burner in persons who are very

anxious, especially if such anxiety derives from Yin deficiency. This

point tonifies the Qi of the Lower Burner, thus rooting Qi downwards

and subduing the rising of Qi to the head, which happens in severe

anxiety. In this way it has a powerful calming effect.

Ren-4 can root the Hun and can be used for a vague feeling of fear at

night which is said to be due to the floating of the Hun.

Ren-15 Jiuwei

I use Ren-15 very frequently to nourish the Heart, calm the Shen and lift

mood. I prefer this point to Ren-14 Juque. This point nourishes all Yin

organs and it calms the Shen particularly in Deficiency of Yin and/or

Blood. It has a very powerful calming action in severe anxiety, worry,

emotional upsets, fears or obsessions.

Although its indications show that it can be used to open the Shen's

orifices in serious mental conditions from a Full condition, I personally use

this point in mental-emotional states occurring against a background of

deficiency of Blood or Yin.

Indications for this point include manic-depression, palpitations, anxiety,

insomnia.

Herbs for Depression

a) Xiang Yuan

b) Fo Shou

c) Qing Pi

d) Mei Gui Hua

e) He Huan Hua

f) He Huan Pi

g) Yuan Zhi

h) Yu Jin

i) Shi Chang Pu

a) XIANG YUAN Fructus Citri medicae

Category: moving Qi

Channels entered: Liver, Spleen, Lungs

Taste and energy: pungent, slightly bitter,

sour, warm

Xiang Yuan moves Qi, eliminates stagnation,

relieves depression, resolves Phlegm and

benefits the diaphragm.

It is a very important herb for mental

depression deriving from Liver-Qi

stagnation as it eliminates stagnation and

specifically relieves depression. It is doubly

useful as it also resolves Phlegm that

frequently accompanies Qi stagnation. It

combines well with Fo Shou Fructus Citri

sarcodactylis.

b) FO SHOU Fructus Citri sarcodactylis

Category: moving Qi

Channels entered: Liver, Lungs, Stomach, Spleen

Taste and energy: pungent, bitter, warm.

Important herb for depression from Liver-Qi stagnation.

In fact, I frequently use one or two herbs to move Qi in a

prescription even in conditions not involving Liver-Qi

stagnation. I do so because the Qi-moving action of

these herbs stimulates the “coming and going” of the

Hun which is always deficient in depression.

Fo Shou moves Qi, harmonizes the Stomach and Spleen

and resolves Phlegm. This action is useful as Phlegm

often accompanies Qi stagnation (because stagnant Qi

fails to move correctly in the Triple Burner’s Water

passages resulting in the formation of Phlegm).

Finally, within the Qi-moving herbs, Fo Shou has a

particularly strong mental effect in relieving depression

and I frequently add it to a formula to stimulate the

“coming and going” of the Hun.

c) QING PI Pericarpium Citri reticulatae

viride

Category: moving Qi.

Channels entered: Gall-Bladder, Liver,

Stomach.

Taste and energy: pungent, bitter, warm.

Qing Pi has a strong Qi-moving action and it

enters primarily the Upper Burner. For this

reason, it goes to the chest and head and this

makes it particularly suitable to treat

depression. Qing Pi has a stronger action than

other Qi-moving herbs and this is another

reason why I often use it in formulae to treat

mental depression as it strongly stimulates the

“coming and going” of the Hun.

d) MEI GUI HUA Flos Rosae rugosae

Category: moving Qi.

Channels entered: Liver, Spleen.

Taste and energy: sweet, slightly bitter, warm.

Mei Gui Hua is frequently used for mental

depression occurring against a background of

Liver-Qi stagnation. I personally use this herb

frequently in depression from Qi stagnation.

Compared to the Qi-moving herbs mentioned

above and especially Qing Pi, it has a gentle Qi-

moving effect also due to its sweet rather than

pungent taste.

Another characteristic that makes it suitable to

treat mental depression is that it is a flower: as

such it is light and it therefore affects the upper

part of the body and the head. Although it is not

pungent, it is highly aromatic and that is another

feature that makes it suitable to treat mental

depression.

e) HE HUAN HUA Flos Albiziae

Category: calming the Shen.

Channels entered: Liver, Stomach.

Taste and energy: sweet, neutral.

Although He Huan Hua is placed in the category of herbs that calm

the Shen, it also moves Qi and eliminates stagnation. These two

actions make it very useful to treat mental depression accompanied

by anxiety and insomnia.

As for Mei Gui Hua, another characteristic that makes it suitable to

treat mental depression is that it is a flower: as such it is light and it

therefore affects the upper part of the body and the head. Although it

is not pungent, it is highly aromatic and that is another feature that

makes it suitable to treat mental depression.

f) HE HUAN PI Cortex Albiziae


Channels entered: Heart, Liver.

Taste and energy: sweet, neutral.

He Huan Pi is an important herb for the

treatment of mental depression. It combines

the two actions of moving Qi and eliminating

stagnation with that of calming the Shen (in

fact, it enters the Liver and Heart).

It has an ancient history of use for mental

depression and its indications include

depression, bad temper, insomnia and

irritability. The “Treasury of Words on the

Materia Medica” says: “He Huan Pi allows the

five spirits [Shen, Hun, Po, Yi and Zhi] to open

and reach outwards and eliminating extremes

of the five emotions.”

g) YUAN ZHI Radix Polygalae


Channels entered: Heart, Lungs.

Taste and energy: bitter, pungent, slightly warm.

Yuan Zhi calms the Shen, opens the Shen’s orifices

and resolves Phlegm.

Yuan Zhi pertains to the group of herbs that nourish the Heart and

is a very important herb to open the Shen’s orifices and to

stimulate the “coming and going” of the Hun with its pungent and

bitter taste. It is an extremely important herb for depression.

Yuan Zhi is often combined with Suan Zao Ren as these two

herbs complement each other very well: one pungent, the other

sour, they regulate the coming and going of the Hun (as the

pungent taste stimulates its coming and going and the sour taste

restrains it).

“Calming the Shen” in the category of herbs that calm the

Shen, should not be interpreted literally. The category of

herbs that “calm the Shen” include herbs that are pungent in

taste and “stimulate” the Shen and open the Shen’s orifices.

The category of herbs that “calm the Shen” comprises two

sub-categories of herbs: one sub-category of herbs that are

“heavy and therefore anchor, settle and calm the Shen (many

of these are minerals) and another sub-category of herbs that

nourish the Heart and calm the Shen.

Within this sub-category, there are two quite distinct group of

herbs: some sweet and sour that specifically calm the Shen

(such as Suan Zao Ren Semen Ziziphi spinosae and Bai Zi

Ren Semen Biotae) and others pungent that open the Shen’s

orifices such as Yuan Zhi or move Qi such as He Huan Pi.

Therefore “calming the Shen” should not be interpreted literally,

even less should be interpreted as being for anxiety like

benzodiazepines. Because of this misunderstanding some say

that “calming the Shen” herbs would potentiate benzodiazepines

which is not so in my opinion.

CALMING THE SHEN

ANCHOR, SETTLE AND

CALM THE SHEN

NOURISH THE HEART AND

CALM THE SHEN

Mostly sour, astringent, sinking Mostly sweet (some sour), but some

pungent

Long Gu

Mu Li

Ci Shi

Zhen Zhu Mu

Hu Po

Suan Zao Ren

Bai Zi Ren

Ye Jiao Teng

Ling Zhi

Yuan Zhi

He Huan Pi

He Huan Hua

pungent

h) YU JIN Tuber Curcumae

Category: invigorating Blood.

Channels entered: Heart, Lungs, Liver.

Taste and energy: pungent, bitter, cold.

Yu Jin moves Qi, invigorates Blood, cools Blood, opens the Shen’s

orifices and resolves Phlegm. It combines several functions that affect the

Shen and the Hun.

By moving Qi and invigorating Blood, it stimulates the “coming and

going” of the Hun when this is restrained by stagnation of Qi and/or

Blood.

By cooling Blood, it calms the Shen when this is affected by Heat. By

resolving Phlegm and opening the Shen’s orifices, it clears the Shen and

also stimulates the “coming and going” of the Hun when this is restrained

by Phlegm.

I use this herb very frequently in depression in combination with Yuan Zhi

Radix Polygalae.

i) SHI CHANG PU Rhizoma Acori tatarinowii

Category: opening the orifices.

Channels entered: Heart, Stomach.

Taste and energy: pungent, bitter, warm, aromatic.

Shi Chang Pu opens the orifices and the Shen’s orifices, it resolves

Phlegm and calms the Shen. I use this herb very frequently in

combination with Yuan Zhi Radix Polygalae to open the Shen’s orifices

and stimulate the “coming and going” of the Hun when this is

restrained by Phlegm. Shi Chang Pu enters the Heart and is pungent,

bitter and aromatic: it is these properties that make it so valuable to

open the Shen’s orifices and move Qi when the person is depressed.

Tricyclic antidepressants (TCAs)

Monoamine oxidase inhibitors (MAOIs)

Selective serotonin reuptake inhibitors (SSRIs) are a newer form of

antidepressant. These drugs work by altering the amount of serotonin.

Serotonin and norepinephrine reuptake inhibitors (SNRIs) are

another newer form of antidepressant. They treat depression by

increasing availability of serotonin and norepinephrine.

ANTI-DEPRESSANTS

SSRI

Celexa

Lexapro

Luvox

Paxil

Prozac

Zoloft

Wellbutrin

SNRI

Cymbalta

Effexor

Thank you for attending this webinar with Giovanni. Giovanni also

has several online CEU courses available, make sure you take this

opportunity to visit his websites after attending the webinar to see all

of the resources he has to offer.

www.maciociaonline.com

www.three-treasures.com

www.giovanni-maciocia.com

www.maciociaonline.blogspot.com

http://www.facebook.com/three.treasures

http://maciociaonlinespanish.blogspot.com (en Español)

http://www.facebook.com/pages/GIOVANNI-MACIOCIA-MEDICINA-

CHINA/136705379697654?v=wall (en Español)

http://twitter.com/#!/@gmaciocia

www.maciocia.com

the treatment of depression with chinese medicine

Documents