HOW CHINESE MEDICINE VIEWS THE MIND
Thursday, December 13th, 2007 | Author: admin
By Efrem Korngold, LAc, OMD and Harriet Beinfield, LAc
Chinese medicine does not make absolute distinctions between what we in the West classify as the mind, the activity of the central nervous system, and the physiology of the visceral organs. Within traditional Chinese medical thinking, a person represents a field of Qi, a continuum of dynamic structures, functions, processes, sensory perceptions, and cognitive faculties that range from the gross, substantial, and visible (fluids, blood, flesh, muscles, vessels, sense organs, nerves, and bone) to the subtle, insubstantial, and invisible (sensations, perceptions, feelings, emotions, thoughts, images, and dreams). Although flux and transformation are the fundament of the field, there is a coherence and unity that exists within this continuum, known as Shen-Jing. Shen refers to the psyche or the intangible qualities of mind, and Jing refers to the soma or the tangible qualities of the material body. Shen-Jing implies the mutually arising, interpenetrating nature of Shen and Jing, a microcosmic
manifestation of the interdependence and interaction of Yang and Yin.
Both spheres are characterized by incessantly motile patterns of form and action. The structural parts of the organism have shape and move (with a distinct configuration and patterns of activity, fluids, blood, muscles, bones, and internal organs are in constant motion). Similarly, the contents of the mind emerge, assume form, and shift from place to place in recognizable patterns (images and ideas take shape, thoughts are shallow and deep, jump from one to another, move in circles, and habits of mind develop). Human development is construed to be a seamless, formative process, an expression of embodied intelligence in space and time that involves the intermingling of creative imagination and innate constitution initiated and sustained by the organizing power of Qi.
This enables a person to maintain life, cultivate an identity, and make a future”fulfilling destiny (Ming).
THE THREE LEVELS AND FIVE ASPECTS OF MIND
Mental activities and experiences occur at three levels, again proceeding
from the more tangible to the more intangible: sensations and perceptions, thoughts and ideas, feelings and emotions. Sensations and perceptions arise from specific parts of the soma: skin, muscle, viscera, ears, eyes, nose, mouth, and tongue. Thoughts and ideas arise from the psyche: imagination, dreams, memory, attention, and reflective contemplation. Feelings and emotions are the outcome of our responses to sensations and perceptions, those that arise inwardly, and those from the outside world that enter our field of awareness. Furthermore, whether we deem our experiences to be physical or mental, somatic or psychic, our capacity to recognize their influence is rooted in the physiological structure and functional processes that correspond to five organ systems referred to as the Five Organ Networks (Kidney, Liver, Heart, Spleen, Lung) that govern all internal events and outward expressions. That is to say, how the Qi moves in each of the Organ Networks and how they
interact from moment to moment is what determines the nature of
our life experience.
HOW THE FIVE ORGAN NETWORKS ORGANIZE OUR MOTILE, SENSORY, AND COGNITIVE LIFE
All activity is an expression of the movement of Qi occurring in various layers of the organism. At the level of sensations and perceptions, Qi manifests as the qualities of movement associated with muscles, nerves, and sense organs. At the level of thoughts, ideas, and images, Qi manifests as intellectual activity of the mind, or cognition. At the level of our response to sensations, perceptions, and thoughts, Qi assumes the form of feelings and emotions that are experienced simultaneously as physical and mental events, actions, or movements. Qi organizes that which moves, and all movement is a manifestation of Qi. Fundamentally, motility is Qi, and what is motile is alive.
When we consider the role of the central nervous system as it is defined in Western terms, we think of the organisms ability to regulate and coordinate a myriad of complex and interrelated functions including locomotion, perception, cognition, circulation, digestion, elimination, detoxification, reproduction, regeneration, growth, maturation, and even degeneration and dying. All of these processes involve patterned movement at the macroscopic level of organs, muscles, nerves, and vessels as well as at the microscopic level of cellular metabolism. In the Chinese view, it is the Organ Networks that modulate and coordinate all these processes.
HOW CHINESE MEDICINE VIEWS DISTURBANCES OF THE MIND AND NERVOUS SYSTEM
Since the sensory, neuromuscular, emotional, and cognitive aspects of the nervous system and mind are linked to the movement of Qi and the functional activities of the Five Organ Networks, disturbances of sensation, perception, mentation, and emotion are interpreted as being the consequence of disturbances of Qi, leading to Organ Network dysfunctions. In particular, the faculties and functions associated with the Liver and Heart Networks are considered to have a predominant influence over the tone, tempo, and clarity of behavior and consciousness.
The Liver is the abode of the Hun, and the Heart is the abode of the Shen: Hun represents the active, seeking, goal-directed, reactive, executive aspects of the mind and nervous system and Shen the receptive, globally aware, intuitive, insightful, and integrative aspects. There is a saying that the Heart receives and understands, whereas the Liver feels and acts. In other words, whereas the Liver perceives what the mind and body experience (sensation), the Heart gives it meaning in reference to a persons true nature or self (insight). The Liver acts in accord with the dictates of the self (producing feelings and reactions), and the Heart interprets the feelings and reactions in relation to their congruence with the self and its ideology and purposes (integration). In its role as feeler and actor, the Liver gives the tone and temperament to ones inner life, the effort and ease, confidence, and tenderness with which one responds to experience. In its role as receiver and integrator, the Heart gives breadth and depth, meaning and coherence to ones inner life. When the Heart is well, the Mind is tranquil, the senses are clear, and the body is comfortable. When the Liver is well, the Mind is flexible, the disposition cheerful, and the structure supple. The hallmarks of dysfunction are the unnatural distortions of healthy function. With disturbances of the Heart Network, the capacity to witness, understand, and integrate can transform into obliviousness, confusion, and incoherence. Because the Heart also governs the perfusion of blood throughout the body, disorders of the Heart may also manifest as flushing and chilling, labile hypertension or hypotension, and localized ischemia or insufficiency. With disturbances of the Liver Network, the capacity for good judgment and an even temper can transform into impulsivity and volatility. Because the Liver also governs the muscles and nerves as well as the volume of circulating blood, disorders of the Liver may manifest as cramps and spasms, numbness and pain, in-coordination, hyper-reactivity, and paradoxical conditions of heat and pressure: cold hands and feet coupled with heat in the chest and head; heat in the upper body and chill in the lower body; strength in the extremities and weakness in the torso or vice versa; fullness in the head and emptiness in the abdomen and vice versa.
Although the Heart and Liver Networks are paramount in maintaining the integrity of neuromuscular and neurocognitive functions, the other Organ Networks play significant roles in neurological, cognitive, and psychological health.
Thus, it can be seen that, whereas some predominate in the hierarchy of functions, all Five Organ Networks participate in the development and preservation of awareness, thinking, memory, perception, balance, orientation, discrimination, temperament, and judgment. Each contributes particular aptitudes and tonalities to the mix that, from a Western perspective, we understand as the neuropsychological basis of consciousness, integration, coordination, and adaptation. Disorganization of any or some of these Networks or functional terrains has a profound impact on the integrity of both cognitive faculties and neurological competencies.
HOW CHINESE MEDICINE VIEWS DEPRESSION
Websters dictionary defines depression as, a state. . . or disorder marked by sadness, inactivity, difficulty in thinking and concentration, increase or decrease in appetite and time sleeping, feelings of dejection and hopelessness, and sometimes suicidal tendencies; a lowering of vitality or functional activity. The last phrase, a lowering of vitality or functional activity, goes to the center of Chinese medicines understanding of the root causes of depression: that emotional and behavioral symptoms are manifestations of an underlying constraint, collapse, or dissolution of Qi that weakens and destabilizes the core identity or self (Shen-Jing).
All diagnoses in Chinese medicine conform to the Yin Yang” Five Phase paradigm regardless of whether the illness at hand primarily expresses itself somatically or psychologically. In the West, depression tends to be regarded as a psychological illness arising from a dysfunction or dysregulation of neurotransmitters in the brain, although this hypothesis is speculative, and the origin and nature of this pathology is poorly understood. In the view of Chinese medicine, because the unity of Shen-Jing is indissoluble throughout life, there is no illness” or for that matter,
health”that does not arise out of a synchrony of interpenetrating psychic and somatic processes. Even a purely mechanical injury such as a bone fracture is an insult to the organism as a whole that, potentially, may have a serious impact on the psyche, leaving the person feeling fearful and vulnerable long after the tissue damage has healed. Conversely, emotional trauma following the witnessing of a violent act can have a
profoundly destabilizing effect, resulting in chronic somatic complaints such as an irritable bowel or recurring headaches. Adaptation”the process of responding to stress, integrating experience, and organizing a coherent response that sustains individual and social life”is a product of the coordinated interaction of the Five Organ Networks and five body constituents (Mind, Qi, Moisture, Blood, Essence), which govern the body in accord with the laws of Yin and Yang and the formative power of Qi.
Nonhedonic states characterized by varying degrees of dysthymia or dissonance of mind and will. In fact, manic depression used to be called cyclothymia, unpredictable cycles of mood and behavior alternating between feelings of despondency, sluggish thinking, apathy and elation, grandiose thoughts, and gregariousness. In Chinese medical terms, the robust bond between the Mind (Shen) associated with the Heart Network and the Will (Zhi) associated with the Kidney Network has become too loose or, at worst, undone. This deep level of disorganization weakens a persons ability to maintain a realistic view of the world, compounding a sense of dissatisfaction, disappointment, and disconnection with a personal and social life.
Because the core of individual life is the relationship between the Shen-Heart and Jing-Kidney, any serious or prolonged trauma, shock, illness, or deficiency can potentially damage this vital link, depending on the vulnerability of the individual. Vulnerability is not something that can be easily quantified, but it can be assessed by the classical Chinese methods of pulse, tongue, and physiognomic diagnosis. Any disharmony, ie, disruption of the interaction, between the Heart and Kidney Networks predisposes a person to destabilization from shock or injury. For example, stressful events as diverse as the loss of a loved one, injuries sustained in an auto accident, impairment following an illness, or exhaustion because of excessive physical or mental strain may not only deplete the body of Qi but may disrupt the coordinated interaction of the Organ Networks. What makes the organism adaptive, namely sensitivity
and responsiveness to the internal and external environment, also exposes it to the possibility of being overwhelmed. Many people come into the world with preexisting weaknesses, both inherited and congenital, that make it difficult for them to recover from insults, whether physiological or psychological. Their tolerance for stress is relatively reduced in comparison with those who have a hardier structure and a more resilient character.
A well-known instance of physiologically induced depression is that experienced by women following childbirth. The extreme effort required by body and mind during the process of labor can exhaust the Qi of the Kidney, especially its adaptive reserves (Essence or Jing)”what medical biologist Hans Selye termed adaptation energy. The immediate elation of accomplishment and fulfillment, the pleasure and joy facilitated by the Heart, cannot be sustained and is soon followed by feelings of fatigue, apathy, insecurity, melancholy, and emptiness because of the weakness of the Kidney. The desire for happiness and delight in motherhood remains, but the power to engage the self is diminished. This is one reason why, in Chinese society, the ideal support for a new mother is focused on insuring optimum rest, nutrition, and protection from physical and emotional strain so that her body is able to adequately replenish its
adaptive reserves of Qi, Blood, and Essence. If restoration of the Kidney Qi does not occur in a timely manner, depression may become chronic and potentially devolve into a much more serious and complex condition with additional features such as anxiety, panic, paranoia, uncontrolled weeping, dissociation, and paralysis of motivation or will.
Depression because of emotional trauma or shock is most often the result of an injury to the Qi of the Heart. Abandonment, betrayal, assault, humiliation, and divorce all offend the organisms sense of empathy, trust, safety, optimism, integrity, and, above all, connectedness. It is the job of the Heart Network to shelter the Mind (Shen) and enable us to experience the enjoyment of belonging, being part of an entity greater than ourselves. The sudden realization that we are alone, and at the mercy of people or events indifferent to our personal needs, desires, and destiny, can lead us
into a pervasive feeling of loneliness, sadness, pessimism, meaninglessness, and inertia. Without pleasure, security, conviviality, belief in the friendliness of the world, and meaning, life loses its purpose,
and anguish reigns. The physical energies for living may still be present, but the assurance that life promises fulfillment has become doubtful or even lost. This is depression due to a lack of spirit rather than a lack of will. Although the Kidney-Heart relationship is at the core of organismic
integrity, the Liver, Spleen, and Lung Networks play both minor and major roles in the etiology of depressive disorders. Next to Heart- and/or Kidney-related depression, disturbances of the Liver Network are a frequent cause of gloomy moods and negative attitudes toward life. The Liver likes to move freely and is the source of courage”of boldness and determination. Its Qi is easily perturbed by rage, frustration, alarm, or hurt feelings and blocked by excessive emotional restraint, particularly the suppression of anger and indignation. The Liver is weakened, its Qi dissipated, by persistent doubt, indecision, and apprehension. Disturbances of the Liver often manifest as irritability, volatility, and negative expectations. In particular, repeated experiences of frustration and failure undermine self-confidence. This leads to a kind of depression characterized by timidity, self-condemnation, scorn and blame of others,
irascibility, and a sense of futility.Onthe other hand, Liver-type depression can be relieved temporarily, or even permanently, by successfully responding to an emergency or opportunity involving personal risk and the urge to rescue others. Becoming aroused by anothers need dissipates the stagnant Qi, frees the body to act, restoring optimism and self-confidence. It is also the case that exhausting oneself in the pursuit of ones perceived goal or mission depletes the Qi of the body as a whole, but ultimately of the Kidney.
Because, in this situation, the Liver no longer has resources to draw on (the Kidney Jing/Essence), the person will begin to feel that the creative well has run dry, as if he/she is going through the motions of life out of habit, without enthusiasm or vigor. This is the typical burn out crisis of the successful workaholic, who, believing in his/her own unlimited power, finally runs out of steam and retreats into a bleak, colorless sanctuary of emotional and physical boredom and torpidity.
Other circumstances induce the Spleen and Lung Networks to display their own kind of misery. The Spleen and Lung are closely aligned as the second and third sources of Qi, following the Kidney as the first or original source. The Lung receives air through respiration and extracts Qi from it just as the Spleen receives food and extracts Qi from it. When the Spleen transforms solid and liquid into Nutritive Qi, this forms the constructive portion of the Blood and is combined with the Air Qi to form the Pure Qi of the body that circulates in vessels and channels. Because the Lung and Spleen are receptive, they are sensitive to deprivation and lack; inadequacy of food and air deprives them of their purpose and diminishes their power. Similarly, they are also vulnerable to that which is unfairly
withheld or unjustly taken from them: their cherished attachments,
whether to ideologies, values, expectations, or loved ones. To distinguish
between the two Organ Networks, the Spleen is wounded by disappointment and the Lung by loss. The Spleen worries about where the next reward is coming from, and the Lung pines for that which has come and gone.
Inadequacy of love, caring, and nurturance creates feelings of deprivation and inadequacy, which, in turn, may lead to a constant craving to be filled up and to prove competence, suspecting all the time that these demonstrations may be fraudulent. Not feeling able or deserving may prompt a person to seek satisfaction through enabling others, thereby deriving vicarious enjoyment from their achievements. The recognition that a person is habitually putting anothers life first may tumble her into a crevasse of self-pity and a panic of identitylessness. This individual is suffering because she does not recognize her own identity independently of others and thus feels lost without a compass to map her own destiny. Obsessions arise: with food, details, recognition, material security, and
enterprises that ensure becoming indispensable to others. The failure
to juggle many competing demands is what finally destabilizes the Spleen and leads to physical inertia and a pervasive feeling of
amorphousness.
Recurring loss, or separation from what one esteems or values, injures the Lung. Such insult feels as if there is no longer enough air to breathe or enough power to open the lungs so that the air can fill them. Extreme anguish over what has been lost may cause the chest to collapse or to become frozen in expansion. In either case, respiration is impeded along with the voicing of grief. On the other hand, unending travail and bemoaning of fate saps the Qi. Without the Qi of the air and the dynamic rhythm of breathing itself, the Kidney Qi erodes, sapping the Will and dulling the Mind. Depression of this type transforms a person into a husk of her/his former self, a kind of ghost, sentimental and nostalgic, without color, humor, or animation. This often happens to older people who survive
an adored spouse or child or lose a business or vocation that has been the central source of meaning and purpose.
The Chinese classics offered no specific term for depression as a separate and distinct pathology, although they did describe two forms of madness termed kuang (mania) and dian (withdrawal), the former a condition of unbridled Yang and the latter a condition of overflowing Yin. In contemporary language, kuang suggests mania and dian connotes catatonia. Sometimes these conditions were observed to occur in alternation like the modern manic-depressive psychoses. According to the fundamental laws of Yin and Yang, extreme Yin can transform into Yang”inertia and apathy can become agitation and panic”and vice versa. In severe cases, they might deteriorate into states of collapse, semiconsciousness, or even coma that might now be diagnosed as toxic brain disorders such as those that occur in alcoholism, Addisons disease, or HIV/AIDS.
Prior to the development of the distinct disciplines of clinical psychology and psychiatry in America in the 1950s, mental and emotional disturbances that were not identified as clear cases of madness (mania, catatonia, psychosis) were often subsumed within the broadly defined categories of neurasthenia, psycasthenia, hysteria, anxiety neurosis, and melancholia. In particular, neurasthenia was a diagnosis given to a syndrome of diverse symptoms that included both somatic and psychic complaints but for which no material cause could be found”what today would be called psychosomatic illness or a functional psycho-neuro-immunological disorder. The symptoms of neurasthenia included insomnia, disturbing dreams and nightmares, dyspepsia, nausea, vomiting, headache, sweating, tremors, vertigo, hyperventilation, fatigue, poor concentration, feelings of worthlessness and inadequacy, irritability, phobias, anxiety, spinal pain, diminished sense of taste, smell or hearing,
and temporary aphonia and aphasia. Yu or Yu Zheng, the Chinese term that is commonly translated as depression, refers to an abnormal condition of Qi in which it is confined or oppressed by the powerful suppression of emotion and self-expression. This obstructs the Qi in a manner that begins to generate a kind of friction (Heat) as a consequence both of the excessive effort required to inhibit it as well as the actual force of the Qi itself attempting to break through the constraint. If Heat becomes extreme, there may be sudden outbursts of rage, panic, sobbing, or laughter as well as eruptions in the form of boils, hives,
blisters, and nose bleeds. The condition of Heat engenders a feed forward
cycle in which surplus Yin substances (blood and fluids) are mobilized to cool down and pacify, but become progressively attenuated, leading to a secondary condition of depletion in which hyperactivity (agitation and emotionality) begins to alternate with periods of collapse (lethargy, apathy, loss of interest in food, sex, and social interaction). Ultimately, the strength of the organism begins to decline as the Qi becomes depleted. The Heat, however, remains and continues to produce irritability, nervousness, anxiety, and physical and emotional sensitivity, along with fatigue. Although tired, the person cannot sleep, which in turn produces more restlessness and more fatigue. As the condition progresses, Yang (animation and metabolism), unsupported by Yin, begins to fail, and a condition of Heat transforms into one of Cold. Now, the person is easily chilled, difficult to engage, sleeps an inordinate
number of hours without feeling rested, and has great difficulty rousing himself to respond to either external promptings or internal urges. The person appears dull and lifeless, feeling deadened, perhaps with the desire to die, feeling out of life.
The question, Does the depression cause the illness or the illness
cause the depression? is moot. From the Chinese medicine perspective,
obstruction of the natural movement of Qi through social or autoinhibition will lead just as readily to collapse of the vital power of the organism as will physical damage to the body through trauma, illness, or impoverishment. In either case, the Mind (Shen) and its faculties will lose their moorings, and the individuals fundamental sense of integrity, identity, and purpose will erode, leaving her/him disconnected from life and compromised in the capacity for joy and satisfaction. Yang depression is essentially a Qi congestion or constraint syndrome, whereas Yin depression is a Qi depletion or collapse syndrome.
Essentially, depression is viewed as one of the consequences of stress: environmental exposure, illness, overwork, inadequate nutrition, emotional trauma, mental strain, excessive sexual indulgence, physical trauma, or other cumulative influences. Those diagnosed with primary, essential, or idiopathic depression, from the Chinese medicine perspective, must have suffered early trauma or deficiencies during gestation, birth, or early development that were probably ignored or simply not recognized. Those who are constitutionally vulnerable will be more likely to suffer deeply from insults not only to the body but to the mind. Those who are constitutionally robust may or may not succumb to afflictions of the mind and spirit, but, if they do, they are more likely to recover given the right conditions and influences. The weaker individuals (poorly endowed or somehow drained of Qi, Blood, and Essence) may not recover even under optimal conditions. Then there is the issue of coherence: regardless of the endowment or current reserve of Qi/Blood/Essence, if the negative influence is powerful enough, it can permanently derange or disorganize
the continuum primum of Shen-Jing: all the kings horses and all the kings
men.. .. These individuals will need constant support from drugs and social milieu for a lifetime to hold themselves together; and as they age and the Qi declines, they will become more and more unstable, and vulnerable to future insults.
DIAGNOSIS
The impact of both physiological and psychological stress”whether
distress or eu-stress”is handled by all the Organ Networks, but especially the Liver and Heart. The initial burden of any insult or discomfort is born by the Liver, then interpreted and given its meaning by the Heart. Whether and how these experiences are integrated into an individuals life is then influenced by the Spleen, which digests them; the Lung, which evaluates them; and the Kidney, which ultimately archives and accepts them not only in memory but in identity. However, not all life experiences are easily or self-consciously incorporated into the self. Over time, ambivalence and lack of resolution may lead to underlying feelings of anxiety, uncertainty, lack of self-confidence, vulnerability, and insecurity. Anxiety will affect the Heart, vulnerability the Lung, doubt the
Liver, insecurity the Spleen, and lack of confidence the Kidney. For example, irritable bowel syndrome can be interpreted as entrenched ambivalence and indecision, a disharmony between the Liver and Spleen. Loss of physical power can be a metaphor for a loss of self-confidence and a posture of helplessness, a depletion of the Kidney. Asthma can be seen as an incomplete reconciliation with feelings of anger and sorrow because of loss, humiliation, or abandonment, a disharmony between the Liver and Lung.
Most contemporary manuals and textbooks of traditional Chinese
medicine (TCM) focus on disturbances of the Liver Network as the origin of depression. This is because it is the role of the Liver not only to assume the brunt of negative sensations and feelings but to detoxify them as they are absorbed into the Blood, softening their impact so as not to disturb the Heart, Spleen, Lung, and Kidney. In Chinese medical thought, the Blood is the medium of the mind, ubiquitous in its penetration of the organism as a whole, a concept paralleled in contemporary medical thinking by the peptide theory (neuropeptides are produced simultaneously by the gut, the cells of the immune system, and the brain). Because the Liver stores the Blood, negative or shocking experiences that are not adequately processed by the Liver (that is, detoxified and eliminated, or psychically neutralized and rejected) will
remain in the Blood, and therefore the Mind, as toxic residues or negative imprints and will eventually engender a disorganization of Qi that leads to various Organ Network dysfunctions. However, the Livers capacity for accommodating distressing feelings or toxic substances while also maintaining a smooth flow of Qi and Blood, and an even temperament, is limited. The strain of this effort causes the Liver to decompensate, manifesting as irritability, heightened emotional reactivity, and increasing physical sensitivity. As a backup strategy, the Liver may shunt these residues and imprints into the Kidney Network, which has a much greater capacity for storage and containment: The Kidney stores the Essence
(Jing). There are two problems that arise from this development: toxic agents and negative imprints that remain in the Blood are always available to consciousness and begin to undermine a persons ability to focus and maintain equanimity. Those that are stored with the Essence (Jing) by the Kidney become subconscious and, therefore, functionally speaking, forgotten”that is, suppressed. According to this model, the early stages of depression are characterized by patterns of Liver Qi Stagnation, Liver Heat, Liver Blood stagnation, deficient Liver Blood, and the adverse impact of these conditions on other Organ Networks.
The later and more serious stages of depression are characterized by patterns of Kidney Qi deficiency because of attrition of Jing (Essence): Kidney Yin and Yang. Why is the pattern of Kidney depression more serious? Because the Jing (Essence) is the somatic source and foundation of Shen (Mind), identity, and selfhood.
When the Essence is compromised, that is, when it is corrupted by images, thoughts, feelings, and memories that negate the true nature and potential of the being, the unity of Shen-Jing is weakened, and the capacity to discover, affirm, and follow ones life direction is derailed. Therefore, the symptoms and signs of Kidney depression are those that reflect a disengagement and disconnection with the process of living: apathy, lack of affect, lack of will, absence of desire, indifference to pain and pleasure, behavior, and thinking that lacks appropriateness and coherence vis a vis time, place, and persons.
When disturbances of the Liver and/or Kidney negatively affect other Organ Networks, the features of depression become more intricate because of the complexity of interacting functions. Although it may originate in disorders of the Liver and/or Kidney Network, depression has such a global impact on the whole organism, the characteristic symptoms and signs usually reflect Heart, Spleen, and Lung disturbances as well. For example, anorexia, dyspepsia, and discomfort below the diaphragm indicate interference with the natural movement of Stomach Qi; sighing, a weak voice, and shallow breathing indicate impairment of the Lung Qi; whereas insomnia, disturbing dreams, and restlessness represent agitation of the Mind (Shen) consistent with an instability of Heart Qi.
Similarly, disorders of Kidney Qi or Essence (Jing) will also undermine
the Qi of the Heart or Mind (Shen), resulting in feelings of dread and a pessimistic outlook. Indifference to the pleasures of food or social interaction mark a blocking of the Spleen Qi; anguished feelings of separateness and abandonment reveal the contraction of Lung Qi; whereas, the desolation that emerges from the poverty of passion and desire presages the dissolution of Heart Qi. Focusing on the constraint of Liver Qi, toxicity in the Blood, weakening of the Kidney, and erosion of Essence may be fundamental aims of therapy, but the distortions of Organ Network relationships will also need to be rectified to ensure a successful outcome.
TREATMENT
In actual practice, a Chinese medicine practitioner may employ any or all of the traditional modalities”acupuncture, herbal medicine, dietary therapy, physical therapy (tui na), physical exercise (calisthenics), life counseling, Qi cultivation (qi gong, tai chi, or dao yin)”in combination, alternation, or succession in the treatment of depression. For the purposes of modeling a straightforward methodology that can be easily implemented, the use of specific compound herbal formulas and acupuncture protocols can be designated that correspond to each diagnostic pattern or syndrome (combination of patterns). The diagnosis defines the therapeutic principles that are then matched in part or in total by the collective properties of the medicinal ingredients that compose an herbal formula or the selection, sequence, and stimulation of acupuncture points. For example, depression of the Liver type might include the
patterns of Qi stagnation (abdominal cramps, cold hands and feet, tension below the diaphragm), trapped Heat (inflamed eyes, moodiness,
and irritability), deficiency of Blood (dry eyes, brittle nails, and restless fatigue), agitation of the Mind (nervousness and insomnia), as well as Spleen Qi stagnation and deficiency (incessant food cravings, bloating and flatulence, loose stool, lethargy, continual worrying, easy distractibility). A famous classical formula that matches this picture is Xiao Yao San (Powder for Wandering Free) that disperses Liver Qi, tonifies Blood, dispels Heat, and strengthens Spleen. This formula is frequently used to ameliorate premenstrual melancholy, fatigue, and irritability, as well as depression and exhaustion associated with frustration, overwork, dissatisfaction, unacknowledged or unexpressed feelings of resentment, and an inability to resolve interpersonal conflicts. Because it tonifies the Blood and strengthens the Spleen, this formula relieves insomnia (an adequacy of Blood calms the Heart and quiets the Mind), alleviates fatigue, and improves digestion. If persistent insomnia, palpitations, and anxiety or panic are prominent and indigestion takes the form of difficult or infrequent bowel movements, then the formula Chai Hu Long Gu Mu Li Tang (bupleurum, oyster shell and dragon bone decoction) may be used. This combination is similar to Xiao Yao San but also contains tranquilizing herbs, strong Heat clearing and laxative herbs, and
additional ingredients to tonify the Qi and strengthen the Spleen.
The goal of this formula is to ease quickly the severe mental agitation
caused by an effulgence of Heat in the Liver Network that destabilizes the Heart and Mind to such a degree that a person completely loses his/her center (an important function of the Spleen Network).
At the opposite extreme, depression might take the form of physical
inertia with restlessness and fatigue, lumbar soreness, mental dullness and forgetfulness, fearfulness and apprehension, aversion to being touched or comforted, chilliness, lack of hunger or interest in food, and diminished emotional responsiveness. Fits of ill temper, weeping, or anxiety might be the limit of this persons emotional intensity. This syndrome is a portrait of stagnant Liver Qi afflicting the Stomach, depletion of the Qi of the Liver and Kidney, and deficiency of Yang. A profound anergy, the inability to become emotionally aroused and to rouse the body or sustain any positive interest or activity, is the keynote of this type of depression: there is an absence of heat, motivation, and motility, the fundamental attributes of Qi. A formula that fits this syndrome might be a modified version of Shi Wei Wen Dan Tang (Warm the Gallbladder Decoction) in combination with a modification of Jin Gui Shen Qi Wan (Decoction for Restoring the Kidney). This new combination
of formulas would relieve anxiety and fear, enliven the emotions, restore the appetite, sharpen the senses, restore metabolic activity and body warmth, strengthen the back and limbs, and reawaken the instinct for survival and the desire for human contact.
Depression often follows in the wake of loss or separation: death of a loved one, dissolution of a friendship or marriage, failure of a business, loss of physical or mental competence because of illness or injury, disillusionment, and disappointment. Sorrow, regret, and anguish impair the Qi of the Lung. These feelings cause the Qi to become constricted in the chest. This not only hinders respiration but inhibits motility throughout the body, including the heart and vascular system. Peristalis, circulation, locomotion, and thinking all slow down, becoming dysrhythmic. Characteristic symptoms include tightness in the chest, feeling of a lump in the throat, a weak voice or fatigue from speaking, a tendency to weep and sigh, occasional palpitations, or changes in the heart rate at rest. A classical formula that fits this presentation is called Si Qi Tang (The Decoction of Four and Seven) that numerically symbolizes the four seasons and seven emotions (pleasure, concern, anguish, awe, ire, terror, shock). This combination of herbs relieves the stagnation and oppression of Qi in the chest, soothes the Heart and Mind, awakens the appetite (and the desire for living), frees the breath and circulation, restores the rhythm of the pulse, and elevates the spirits. The Spleen enables the Mind to consider and reformulate thoughts and feelings”to give them shape”like a lens bringing images into focus. A well-formulated idea gives birth to intention that transforms into motivation and, potentially, actualization.
Depression that engenders turmoil within the Spleen Network often displays ruminative and obsessive features. When the Qi of the Spleen
is oppressed or congested, the process of thinking may become
stuck. This manifests as incessant worry and circular thinking about
problems that seem to have no solution: a person feels trapped in mental quagmires and dilemmas from which there appear to be no exits. The unrelenting concern with intransigent thoughts leads to physical and mental fatigue. It becomes difficult if not impossible to act effectively, literally walking in circles. There may also be constant nail-biting and repetitive movements or sequences of movement”a kind of memory lapse because of the inability to pay attention to anything other than the Minds preoccupation. With the loss of a meaningful purpose (intentions) in life, obsessive behaviors become an alternative center around which daily life is organized, but, because the ritual thoughts and activities provide no real satisfaction, constant disappointment leads to futility that leads to paralysis and ennui. Because the Spleen Network is a pivotal source of Qi for the entire body, disturbances of other Organ Networks, especially the Heart and Lung, are part of the depressive syndrome. The pattern of Spleen Qi deficiency, Qi stagnation, and accumulation of Dampness is a common presentation. These symptoms include weakness and easy fatigability of the limbs; heavy feeling of the head and
body; thin, loose, or poorly formed stool; abdominal distension and flatulence; cravings for starches and sweets; inability to discern hunger or decide what to eat; water retention; tender muscles; easy bruising; hard to focus, easily distracted, and forgetful; worried and apprehensive about small matters; overwhelmed by details and complexity; excessively nostalgic and sentimental. If the Heart is also affected, there may be palpitations, insomnia, sleep easily interrupted and difficult to resume, tiredness in the morning and hard to get going, and rapid heart rate with slight exertion. If the Lung is involved, there may be shortness of breath, a feeling of weakness or emptiness in the chest, soreness and pain in the chest and upper back, sinus congestion, and cough with phlegm.
A traditional formula for Spleen-type depression with Heart involvement
is Gui Pi Tang (Decoction for Restoring the Spleen). This formula strengthens the Spleen and Heart by replenishing Qi and Blood, dispersing stagnant Qi, relieving Dampness, and quieting the Mind. For depression that displays a pattern of Spleen and Lung weakness, the
Decoction of Six Noble Ingredients combined with the Powder for
Generating the Pulse maybe used. Together, these two formulas restore
the Qi of the Spleen and Lung, relieve Dampness and dispel Phlegm,
disperse stagnant Qi, open the chest, and revive the spirits.
SPECIAL POPULATIONS
Children
On the one hand, infants and young children are perceived as particularly vulnerable. That is, they are rapidly changing, mentally and physically immature, and sensitive to outside influences. On the other hand, their sensitivity and malleability make them more responsive to modest, positive interventions than older children or adults. This vulnerability and impressionability is most prevalent in the first 7 to 8 months; it is somewhat less through the 7th and 8th years. Psychoneurological and developmental disorders that appear during this period are troubling on the one hand but highly responsive to treatment on the other. Pediatrics has been a specialty within Chinese traditional medicine for centuries. The administration of medicinal herbs, therapeutic diets, massage, and acupuncture are all appropriate when used in a gentle, cautious, watchful manner. Acupuncture, in particular, is often beneficial in the treatment of neurodevelopmental disorders. Infants and small children often respond
quickly and intensely to treatments, so careful and frequent monitoring by the practitioner is the prudent approach.
Pregnancy
Obstetrics and gynecology is another age-old specialty within Chinese traditional medicine. Although most if not all modern textbooks on herbal medicine and acupuncture caution against”though they do not expressly prohibit”treating women during pregnancy (especially in the first trimester), there is a long tradition of pregnancy management to enhance
the health of the mother and ensure the healthy development of the newborn child. Special attention is paid to maintaining the psychological equanimity of the mother to protect the fetus from the untoward effects of negative emotions and mental shocks. This is sought primarily through regulation of diet, living habits, and environment and, secondarily, through the administration of massage, acupuncture, and medicinal herbs should problems arise. There are specific herbal formulas and acupuncture protocols for conditions such as morning sickness, restless fetus, generalized weakness, vaginal bleeding, emotional disturbance, and prevention and treatment of eclampsia and preeclampsia, as well as for facilitating delivery and managing postpartum recovery. As with infants and young children, pregnant women are considered to be very vulnerable and are, therefore, treated with extreme care and caution. Conversely, pregnancy is also considered to be an opportunity for correcting preexisting deficiencies and disorders because the woman is in an unusually receptive condition.
The Elderly
Geriatrics is yet another well-recognized and respected traditional specialty that grew out of the ancient Chinese concern with promoting longevity. The old are somewhat like children in their vulnerability but unlike them in their inflexibility and slowness of response. Conditions of the elderly are generally considered to be the result of deficiencies”attritions of Qi, Moisture, Blood, and Essence”that have developed as
a consequence of the natural as well as the unfortunate stresses and strains of living. Because older people tend to be more frail as well as resistant to change, aggressive treatments are avoided. Gentle methods are employed that emphasize nurturance of substance and support of normal function while gradually ridding the body of toxins and accumulations. Mental and spiritual weariness are prevalent among the
aged, and respite from these is seen as equally if not more important than ameliorating physical weaknesses.
RESEARCH STUDIES ON ACUPUNCTURE AND DEPRESSION
Generally, in the minimal studies that have been done, acupuncture
has been found to improve symptoms of depression, reduce
the need for drugs, and attenuate or eliminate various side effects
of pharmaceuticals.
REFERENCES
1. Selye H. The Stress of Life. 2nd ed. New York, NY: McGraw-Hill;
1978.
2. Loewenberg S. Medical and Physical Diagnosis. Philadelphia, PA: FA
Davis; 1951.
3. Boericke W. Pocket Manual of Homeopathic Materia Medica. New
Delhi: Jain; 1978.
SUGGESTED READING
Beinfield H, Korngold E. Between Heaven and Earth. New York, NY:
Ballantine; 1991.
Chang J-H, Shen H, translators. Chinese Medical Treatment of Mental Disorders.
San Francisco, CA: self-published; 1987.
Hammer L. Dragon Rises, Red Bird Flies. Barrytown, NY: Station Hill
Press; 1990.
Huan ZY, Rose K. Who Can Ride The Dragon. Brookline, MA: Paradigm
Publications; 1999.
Kaptchuk T. The Web That Has No Weaver. Chicago, IL: Contemporary
Books; 2000.
Keleman S. Emotional Anatomy. Berkeley, CA: Center Press; 1985.
Keleman S. Embodying Experience. Berkeley, CA: Center Press; 1987.
Larre C, Schatz J, Rochat de la Vallee E. Survey of Traditional Chinese
Medicine. Columbia, MD: Institut Ricci (Paris) and Traditional Acupuncture
Foundation; 1986.
Larre C, Rochat de la Vallee E. The Seven Emotions. Cambridge, UK:
Monkey Press; 1996.
Maciocia G. The Foundations of Chinese Medicine. London, UK: Churchill
Livingstone; 1989.
Unschuld PU. Medicine in China: A History of Ideas. Berkeley, CA: University
of California Press; 1985.
Table 8. Continued
Study No. of Participants Findings
Han JS. Electro-acupuncture: an alternative to
antidepressants for treating affective diseases?
Intern J Neurosci. 1986;29(1-2):79-92.
Clinical data indicate that acupuncture is
effective in treating depressive patients, with
a higher therapeutic index than tricyclic
amitriptyline.
Poliakov SE. Acupuncture in the treatment of patients
with endogenous depression. Zh Nevropatol Psikhiatr
Im SS Korsakova. 1987;87:604-608.
167 Patients Response was most correlative with
antidepressants of the pyrasidol type.
Acupuncture was effective in some patients
resistant to antidepressants.
Chinese
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